Sometimes I seem to waver between things feeling exciting and full of meaning and things feeling meaningless and fragmented. Or I oscillate between feeling highly confident and bold and feeling deeply anxious and uncertain, the complex reality of simultaneous contradictory feelings being too hard to hold. Sometimes I am buoyant and ambitious, and sometimes I struggle to just get by. (Paradoxically, it can be easier for me to exceed expectations than to merely meet them.)
To some degree, these are psychological patterns common to most people — the interplay of oppositions has a flavor of something archetypal, manifesting in each person in a unique way. Yet it was evident to me even as a kid that I had a sort of tendency towards “moderate extremes.” Around age 11, I remember thinking to myself that I had a pattern of “yin years” and “yang years”: years when I was markedly anxious, and years when I was markedly bold. I also at that age wrote a short story set in ancient China that depicted a young human girl with a lot of “yang energy” and a young dragon boy with a lot of “yin energy.” Yin and yang were complex concepts for me even then, signifying any or all of female and male, inward and outward, intuitive and rational, dark and light. In some way, I knew myself to be all of these, each pole deeply entwined with its opposite.
I was passionate about psychology in middle school, avidly reading Scientific American Mind. One issue of that magazine featured several articles about (binary) transgender kids. For a few months after reading them, I was obsessed with trying to understand how small children develop a gender identity. I once even interviewed a toddler at a playground, asking her questions like how she knew that her father was not a girl (her parents got annoyed at me for that). Another issue featured an article on the discovery of genetic relationships between autism, schizophrenia, and bipolar disorder. This intrigued me, for I observed in certain members of my family, including myself, traits that seemed potentially to be milder manifestations of these three conditions. I had previously wondered if I was autistic, partly due to the oft-repeated concerns expressed by my parents and teachers about my social skills, and now I wondered if my moody temperament had the seeds of bipolar disorder. Or perhaps I was just a “moody teenager”? But certainly, I seemed to get into more trouble with myself and others than did many other teenagers around me. Only time would tell, I surmised.
Indeed, I was given a diagnosis of bipolar disorder in the spring of 2021, when what initially was an obsessive rumination upon my gender identity (I worried, and then became convinced, that I had “lied” about being non-binary) first collapsed into the haziness of a depressive state and then developed into a confusing chaos of ups and downs. I actually was the one who first brought up the possibility of bipolar with my psychiatrist, similar to how when I first saw her, I mentioned that I had read about gender-focused OCD and believed that my anxiety often had an obsessive-compulsive character. But although she rejected the OCD idea, saying instead that I had generalized anxiety disorder that was just being temporarily concentrated on my gender, she appeared to take the bipolar possibility seriously, even changing my medication because of that. When in May I had an extreme breakdown that led to my being hospitalized, the psychiatrists who saw me in the emergency room and in the psych hospital seemed confident that I had experienced an episode of mania with psychosis, mixed with much anxiety and distress.
Even then I had some doubts about my diagnosis. I had certainly experienced an “extreme state” of a sort, and specific aspects of it did look a lot like mania and even a tad like psychosis, but it happened over only a few days, and it didn’t feel consistently like mania. But the “mixed” modifier seemed to account for that, maybe. I also about half a year prior experienced a somewhat less intense breakdown, in response to a stressful situation, that had an astounding number of similarities to this “manic episode,” so there was potential precedent for bipolar instability. Yet it was strange to me that the psychiatrist and others in the hospital mostly glossed over the crisis of gender identity that led to my breakdown, offering me no help for processing that and instead focusing on chemically controlling my moods. But I knew that I needed some sort of help, and the help that was being offered was according to this Western biomedical model, in the hyper-regimentation and sensory overload of a psych hospital. I was too disoriented and desperate to do anything but follow along.
When I was hospitalized for a second time that fall, in a different hospital, the psychiatrist there told me that she did not think that I was manic, despite the people in the emergency room having thought so. I was excitable and talked rapidly at the start of my appointment with her, but gradually calmed down as she spoke to me; manic people generally are difficult to calm. She suggested that there was something about my personality that inclined me towards intense moods. Immediately, I heard an implication of borderline personality disorder, though she never said that specifically, and this ended up angering me, to the extent of my acting out at one point in the hospital. I think I perceived a certain truth in what the psychiatrist said, but the idea of there being “something wrong” with my personality felt too painful (and ridiculous) to accept. After the first medication I was prescribed at that hospital for anxiety caused my mouth to be constantly uncomfortably dry, I told the psychiatrist something, I forget exactly what, but something indirectly meant to refute her suggestion that I had a “personality thing” rather than bipolar, that led her to prescribe me medications commonly used for bipolar disorder and intended to moderate moods from the top and bottom. Later I felt upset at myself for implicitly trying to sway the psychiatrist, but since the new meds were much more tolerable than the first one and might help even out my moods regardless of my diagnosis, I persisted with them.
After that hospital stay, I became more convinced that I had borderline personality disorder rather than bipolar and came to terms with that. I had not been diagnosed with it, but my hospital records noted me as having “Cluster B traits” as well as “unspecified” bipolar disorder, and borderline is a Cluster B personality disorder. It’s commonly confused with bipolar disorder and is a highly stigmatized condition, so I tried hard to be kind to myself about what I now perceived in myself. How surprised was I then that when I told my therapist at the time, a new one whom I began seeing a couple months prior, that I suspected that I had borderline personality disorder, she disputed the idea, saying that borderline tends to greatly affect people’s relationships in a way that I did not experience (“hallmark” traits include a fear of abandonment and a tendency to alternatingly idolize and then deeply hate a person). Yet she did not completely reject it, just as she still had not thrown out the possibility of my having bipolar. Labeling me with a diagnosis was neither urgent, nor really that important, to her.
My therapist’s approach of holding all the possibilities and not deciding on one too soon was, although initially frustrating, ultimately very helpful for me, especially regarding my complex and fluid gender identity. Regarding my mental health, it was also somewhat amusing, as my therapist told me to defer to my (also new) psychiatrist about diagnosis, and my psychiatrist, when I brought up the issue, then asked me what my therapist thought! My mind likes to categorize and to know things with certainty, so my care team’s disinclination to settle on a diagnosis irritated me, but eventually I found this approach liberating. It doesn’t matter how I label my “condition.” What’s more important is that I understand my personal needs and tendencies and develop my ability to respond to challenging circumstances, whether they arise internally or externally. Rather than a taxonomy of the mind, I need a physics of my psyche.
I’ve been fascinated with modern psychoanalytic theory as a way of more deeply understanding the idiosyncratic workings of my bodymind. I feel that its language of ego defenses, transference relations, and other psychological “forces” better clarifies for me the logic of my psychology than do the DSM’s myriad checklists of symptoms. Yet I also have many critiques of it, including its Eurocentrism and the fact that much psychoanalytic literature has deeply embedded in it a binaristic conception of gender. Thus I long for access to other alternatives to mainstream psychiatry as well, including the healing practices of my Chinese heritage, deeply rooted in a philosophy of yin and yang. I was actually initially hesitant to seek a psychiatrist, as I believed that I was experiencing a spiritual crisis that would lead to positive transformation. Why are such perspectives, which strive not just to get rid of distress but rather to make meaning from intense experiences, so often dismissed and neglected in conventional healthcare?
It’s not that the biomedical model has nothing to give people: many people have had their lives profoundly changed for the better by appropriate diagnoses, medications, and therapies, and I want people to have access to that sort of care if that is what they desire. But Western psychiatry (including psychoanalytic traditions) has done a lot of harm to people, especially when it is forced upon people as their “only” option. People’s experiences are wildly diverse, and only a diversity of options can do justice to our differing needs.
I’m hoping to get off my psych meds soon, having already largely tapered them down over several months, as I have become exasperated with the side effects and no longer think that the potential benefits outweigh the costs. (Also, I want to eat grapefruit again!) If later it seems that I would significantly benefit from medication, I would reconsider then. I’ve just started with a new therapist (since my previous one was affiliated with my college’s counseling services, and I just graduated), and I feel optimistic with them. They are non-binary and specialize in somatic experiencing therapy, which might help me to “get out of my head” as well as to process trauma that I carry in my body. I am working on creating a Madness map for myself in order to identify strategies to navigate distress, crisis, and extreme states. One goal I have is to avoid ever going to a psych hospital again by cataloging ahead of time other options for support and safety, including the long-term practice of mutual aid, that are less expensive and traumatizing and more conducive to healing for myself and for those I am connected to.
I’ve been on a waitlist for several months for an in-depth psychological evaluation that would include, among other things, assessments for ADHD and autism, and I expect to get off the waitlist in a month or two. But I’ve been questioning whether the assessments and potential diagnoses would be of enough benefit to me to justify the expense of the evaluation, especially as I already have a growing sense of what I want to work on in myself and what I need to survive in a world that is negligent of and dangerous for Mad and neurodivergent folks. I have embraced the identities “Mad” and “neurodivergent” for myself despite a lack of firm diagnoses, as it is empowering for me to name my experiences in a way that politically aligns me with Mad and Disability Justice movements. Similar to how my identifying myself as non-binary does not entitle anyone else to knowledge about the specifics of my gender experience, it is no one else’s right to assess whether my experiences adequately justify my identification as Mad and neurodivergent or to decide for me what being Mad and neurodivergent means for me. As I say in my experimental piano performance fluxing, quivering, transforming: I am, therefore I am.
I call myself yinyang ren, a person of yin and yang. The term is variously used in Mandarin to describe someone who is non-binary, trans, bigender, bisexual, or even intersex, but for me, a person of multifaceted, fluid polarities, it means so much more. I am yinyang ren: non-binary, Mad, neuroqueer, Han Chinese, an analytical and creative being, a deeply spiritual soul. I have always been, and I am always becoming.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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