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You Say "Co-Morbid" Like It Is a Bad Thing

By: Carissa Martos

When multiple diagnoses exist in the same person, and impact each other, they are known as co-morbid conditions. My bipolar diagnosis came when I was 19, but I'd struggled with the cycles of manic function and depressed inability since puberty.  My PTSD diagnosis wasn't made until I was in my 30s, and I’ve never been able to pin down whether the trauma started with the ocular migraines I thought came as a punishment from God, or the fact that my nine-year-old brother took up an iron fire poker and tried to cave my skull in. I think the worst part was that my parents disbelieved or discounted both, actually.

 All I knew was that sometimes I would be up all night and have all the energy in the world, and sometimes I couldn't open my eyes for anything. I also began to see that when situations became too overwhelming, I would get coldly detached, and then feel all of those repressed emotions at a later date. If I didn't vent the pressure and eventually feel all the scared, angry, fearful feelings, I would have utter breakdowns. Sometimes they presented as panic attacks that lasted for days until I wore myself out, while at other times I would be unable to move or speak until I'd finally cried or screamed my way through what had happened.

When I finally was old enough to move out, my bipolar diagnosis came quickly after I mentioned to a school class advisor that I was attending school full-time, working 60 hours a week, and planning a wedding. She was in awe of the fact that I was pulling a 3.8 GPA and planning on a transfer to UC Berkeley, but was concerned that my response to getting light-headed, turning blue, and spiking a fever was to crawl into my chemistry class so that I would get credit for being there, and attempt to take the test being given. This was, apparently, not what people did in such situations.

I graduated from Cal a few years later, with a nearly two-year-old daughter, pregnant with my son, and it had begun to dawn on me that I planned in a different manner than other people. I knew spring was the worst time for me, so I tried to take my harder classes in the fall, and to front-load all of my papers in my spring classes, sometimes completing all of the assignments that were listed in the syllabus less than a month into class. It mean nights with 4 hours of sleep, but I knew that if I wanted to be successful in school, I needed to take advantage of the hours gifted to me by winter's insomnia, because spring would leave me exhausted and barely able to climb on the bus. I didn't know it then but this was me managing my bipolar without meds or therapy because I didn't have access to either.  I knew how to do this because I'd been doing it my whole life.

I'd started fall term when my daughter was 2 weeks old, and she was a fussy and colicky baby. PPD was throwing off my bipolar cycle, and not being able to plan around it was making the depression feel worse. I knew that PPD and colicky infants was a mix that often resulted in shaken babies and I determined that I wouldn't allow myself to go down that mental path. Instead, I refused to raise my voice in the same room as my daughter knowing that yelling just makes me more upset about things that I can't change and that her screaming wasn't her fault. My fallback plan? Jump in front of a train if I yelled at her. I'm aware how unhealthy that sounds, but my brain was trying to set up lines of defense around my little girl.

 

In the next year, my PTSD symptoms, including pulling away from those I loved, lucid nightmares, and flashbacks, became worse. However, the skills I had utilized to manage my bipolar for decades allowed me to compartmentalize the terror, the helplessness, and the loss into what I've always described as boxes on a shelf. Once the event was over, I could open them and grieve or panic or rage in a space I made for that, the same way I made time for the depressive segment of Bipolar. I could finally let myself explore the what-if trail that proceeded from listening to the first ER doctor that misdiagnosed my daughter's necrotizing fasciitis/flesh-eating bacteria as a spider bite, and what we would have done had she died. That became useful when we discovered my son would need to have his skull removed at 6 weeks of age, because there was likelihood that he wouldn't make it through surgery. I didn't cry at doctor visits, and I wrote grad-school papers at my son's bedside, but once they were home, I could lay by their bed and weep.

My 22 year old brother, on medication and living with us when my son was born, was holding my daughter's hand when the 3rd story deck of rental collapsed, dropping them 30 feet to the pavement below. I had just come home and was on the other side of the house when it happened, and I heard the breaking of wood and the impact of their bodies. The shock of seeing my little girl come to our gate, covered in blood, to tell me that they'd fallen would have been too much for me had I not already learned to shut off the emotional aspect and do what needed doing. My brother shattered parts of his spine, was on a ventilator for a month and lives with incomplete quadriplegia now. My daughter had no physical injuries aside from a TBI because he pulled her to his chest to absorb the impact. I spent the next year answering phone calls, talking to lawyers, having major abdominal surgery, taking over as my brother's caregiver, and driving between my son's hospital and my brother's until he came home, and I didn't cry. I didn't feel safe opening up the boxes of sadness/despair/terror until we moved out of the state. I wouldn't have been able to talk to a surgeon about removing my brother from life support or left school when I was told my son would never talk and that we'd need to learn ASL. The feelings of it all would have crushed me.

Instead, I was able to sort through them slowly, in a safe place at a later date, because my brain and I had learned to co-exist and how to prioritize survival. That alone wouldn't have been enough, though, as I had also needed to negotiate space and time for me to feel the things that trigger the PTSD or a breakdown is inevitable. I have also learned to trust my instincts when I know there are some places I cannot voyage emotionally. Just as I knew it would be dangerous for me to raise my voice near my daughter, I cannot dwell on my son's future for too long, as the uncertainty drives my anxiety through the roof. I don't allow myself to focus on the loss of my planned career because that wound is still too tender. Without the Bipolar I wouldn't have known, so intricately, how my thinking and moods are intertwined, and I think the PTSD would have done me in. Without the PTSD, I wouldn't have seen how to negotiate between the rising anxiety of my manic moments and my need to be pragmatic. Discovering how to take the positives from each diagnosis has been one of the biggest steps forward in my life.

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