Being a Mother to a Bipolar Son

My son, Max,* was ten years old when his psychiatrist diagnosed him with Bipolar 1 disorder.

I’d called his doctor a few days before, physically exhausted and emotionally overwhelmed with Max’s confusing, escalating behavior. Yet, her advice to admit Max to the adolescent unit of the mental health center seemed extreme and unnecessary.

I said no. He was too little. He wouldn’t be safe in a unit with so many older kids.

His psychiatrist assured Max’s father and me that it was safe. Max’s dad, who didn’t spend as many hours with him as I did, believed I was exaggerating, that I was stressed out from work, and because I only grew up with sisters I didn’t know anything about raising boys.

The psychiatrist disagreed.

She said children as young as seven were admitted into the wing, often for longer periods of observation and treatment. Of course, Max wouldn’t like it but he’d be all right. He’d be safe.

She’d been treating Max for two years for ADHD and obsessive-compulsive disorder, and suspected a recent increase in his Ritalin dosage had triggered mania and what sounded like psychosis. Hospitalization would expedite a comprehensive diagnosis as well as allow close monitoring of his meds. “I truly believe this is the best course of action,” she said. “We would have a team to evaluate him.”

After Max’s therapist made an emergency house call to discuss the admission process — he agreed with the psychiatrist — we reluctantly agreed.

The hospital was over an hour away. We visited Max every day, suppressing tears as our son shuffled across the common room wearing the smallest sized hospital pajamas that still slipped down his hips to drag on the floor. We brought him hospital-approved gifts like apples, crayons, and drawing paper. We assured him he was coming home soon, and he wasn’t being punished; he was in the hospital so the doctors could make him better.

Despite being miserable and wanting to come home, Max was calming down. No one had hurt him, although he irately reported that a couple girls had been mean in the television room, teasing him that his shows were stupid and therefore they would not change the channel. He drew disturbing pictures of soldiers holding machetes and bad guys hanging from trees. Hospital school was dumb and boring and he hated group therapy. His arm hurt from daily blood draws. The food sucked but he appreciated the apples.

A few days after he’d been admitted, his psychiatrist called to arrange a conversation about his future treatment protocol.

She began slowly. “I won’t lie. This is the beginning of long and difficult journey.”

To this day, I despise the term “journey.”

“He’s young to be diagnosed with bipolar,” she said, “but given what we’ve observed while he’s been inpatient and how’s he’s responding to medication, that’s the likely condition.”

No more ADHD meds — they had to go. Instead of anti-depressants he’d be taking mood stabilizers, which had side effects like weight gain and disruptions to the thyroid.

With the medical aspect out of the way, she said, “You will go through a mourning process, so you need to be prepared.” Long pause. “Max’s life might not be what you’ve hoped and planned for him. You will grieve.”

You will grieve.

That day, I was thrown into a fiery sea and forced to navigate waves of love, worry, denial, fear, guilt, sadness, gratitude, hope, ignorance, devotion, insecurity, shame, cruelty, isolation, and yes, grief.

Zeus had condemned Sisyphus to an eternity of rolling a boulder up a hill. I was a mother floating in a life raft full of holes, paddling to save my son.

After Max’s diagnosis, I joined online communities focused on raising kids with emotional disabilities; I reached out to NAMI and attended a couple workshops. I read all the books: New Hope for Bipolar Disorder, The Difficult Child, The Sensitive Child, The Explosive Child, The Defiant Child, An Unquiet Mind, The Bipolar Child, Survival Strategies for Parenting Children with Bipolar Disorder…so many books that I can’t even name them all, but they still sit on a bookshelf in my office.

Nothing assuaged the overwhelming isolation.

Truthfully, I didn’t have time to participate in listserves and support organizations, and they didn’t help anyway. Between Max’s therapy sessions (individual and family), psychiatric visits, blood draws, pediatric checkups, endocrinologist consultations, meetings with school personnel (special education teacher, classroom teacher, speech therapist), trips to the pharmacy, and pickups from school, I read out loud to him for hours and hours every day (because doing so soothed him), cooked dinner, and cleaned the house. I also worked — I was a tenure-track Assistant Professor at the local university, which granted me enough flexibility to schedule all these appointments and tasks, but meant I graded papers and created lectures until midnight most evenings.

Of course, most working parents are exceptionally busy — no one expects raising children will be a leisurely stroll.

Suddenly, though, I became occupied with an expanding range of concerns: Did Max drink enough water today? How many times did the phlebotomist need to stick his stubborn veins? Will I get a phone call from the principal about something Max did or said? Did I remember to cut the scratchy tag out of his teeshirt this morning? Did he throw up after lunch?

Kids with bipolar disorder often experience confusing, frightening “rapid cycling,” where multiple, dramatic shifts in mood occur in a single day. When he was manic, Max said his head buzzed like a beehive. He talked incessantly and loudly, as if driven by an internal motor he couldn’t control. A depression crash, on the other hand, felt like a sad, angry wave surging into his brain. These emotional floods weren’t necessarily instigated by external causes like being teased at recess or struggling to memorize multiplication tables. They were chemical. If Max didn’t drink enough water during the day, the delicate balance of his medication was thrown off. He had to avoid being overheated for the same reason. Seasons mattered, too: November’s minimal daylight triggered depression and June’s bright, sunny days launched mania.

I learned to read the most subtle alterations in Max’s affect. Not just his face, but how he walked. Was his posture hunched and defensive? When I dropped him off at school, did he look suspiciously to the right and left as he stalked towards the entrance as if heading into battle? When he had his afternoon snack, was he jiggling his leg up and down under the table? Were his thoughts connected or jumbled? Could he modulate his voice, lowering it when I reminded him he didn’t need to shout?

In addition, I was obsessed with constructing a secure and impenetrable bubble around our home. He needed to know that his home was a safe environment, which meant the erection of disciplinary boundaries in addition to being loved.

At the hospital where Max was treated, parents met with a psychiatric social worker as part of the discharge protocol. Max had been in for nearly a week, and we wanted him home. The day before Max’s release, his father and I were ushered into John the Social Worker’s office to discuss Max’s treatment plan, receive an encouraging pep talk, and listen to John’s advice.

Knowledgeable and matter-of-fact, John was accustomed to using direct, blunt language when speaking with shell-shocked parents. “I want to discuss what to expect,” he said. “There’s a lot to take in, I know.”

Max would likely need inpatient treatment multiple times, he told us. “It’s common for these kiddos to need ‘tune-ups,’ especially during the teen years. They experiment with alcohol, smoke weed, try to self-medicate with drugs. I’ve seen in more times than I can count.”

Got it. He’ll be back, so get used to it. I nodded at John. Max’s father sat in his chair picking at the skin of his fingers and shaking his head in disbelief. His expression said it all — not my son.

“You must set behavioral boundaries,” John went on. “No walking on eggshells around him. You cannot be afraid to draw lines in the sand. He crosses the line, you enact swift consequences. Trust me, he’ll push it. They all do. Make him sign a contract, even. If he throws a chair, hits you, anything violent, you call the police. Or he goes back to the hospital. But you have to do it. You can’t threaten and not follow through. Otherwise you create a sociopath.”

My son was not going to be a sociopath.

“I’d strongly encourage you both not to discuss his diagnosis with anyone who doesn’t need to know,” John said. “And tell Max that he shouldn’t talk about it. Trust me, I know this from experience. The people you thought would understand won’t. They won’t act the way you hoped.”

How naive I was to be skeptical of that advice, thinking to myself at the time, “I’m not ashamed that Max has bipolar. It’s a health condition, not a moral failing. Why should we be afraid to talk about it?”

Social Worker John was right. It’s not about fearing disclosure or being embarrassed as much as whether I was willing to be an Ambassador for Bipolar Understanding. I did not have the energy to combat the misperceptions — of which there were far more than I’d imagined.

My mother, convinced the doctors were wrong, proclaimed that Max was so “intelligent and spirited that his teachers didn’t know what to do with an exceptional child.”

My father said Max needed a good spanking.

My sister-in-law said that if we’d adhered to stricter sleep discipline when Max was a baby, he’d know how to “self-soothe.”

An awkward friend to whom I thought it safe to confide warned that Max could become a child criminal. She asked if he’d ever tortured animals. (The opposite had happened: Max had been beaten up by a bunch junior high school boys he’d caught hurting a baby rabbit. The boys had abandoned their abuse of the rabbit and went after Max instead.)

A colleague (who enjoyed gossiping at the proverbial water cooler) saw me walking to my office building and shouted across the campus green, “Glad to see you are back! Sorry to hear about your kid’s Bipolar Disorder!”

All that within the first few months, in addition to the pitying looks, unsolicited advice, and sharp admonitions like, “Can’t you shut that kid up!” and “Why can’t he sit still?”

I’d never provided many specifics to friends or family about the behaviors leading to our decision to hospitalize him. Max was convinced Harry Potter dementors flew into his room to “rip off his face,” and said he wanted to “jump out the window and die.” He would follow me from room to room, even standing outside the bathroom door while I peed, in order to protect me from a shadowy, knife-wielding figure he saw stalking me.

Here are some of my journal entries from that year:

April 2nd: Max had another problem at school today. K. pushed him, which the teacher didn’t see, then Max went tearing after K. screaming, “I’m going to kill you!” I knew he’d lose his recesses, but he wound up in suspension.

May 15th: Max has not slept more than three hours a night in two weeks.

June 7th: For weeks now M. has been watching Chicken Little and singing “One Little Slip.” He has sung the Karaoke version, the instrumental version, and the animated dance version. His rule is he must sing all three versions in a row twice before he can stop.

October 6th: He’s had two or three episodes today, calling me a “Fucking Bitch Bastard!” Apparently his swearing is not bound by gender.

As you can see, it’s easier to be an isolated mother who confides only in her diary.

A couple of years ago, I met a mother who truly empathized, the first friend I made in twenty-five years who immediately grasped not only the few details I conveyed, but the trauma lurking in the spaces of those unsaid words.

One day I told her, “I’ve honestly not met anyone who understands how the grief never goes away. We don’t talk about it.”

“We don’t talk about it because no one would get it if we did,” she answered.

Initially I considered writing about that first inpatient hospitalization, still one of the most traumatic experiences of my life.

I texted Max, and he wrote back that the idea “sounded interesting.”

“I still think about it,” I wrote to him. “Worry about whether it was the right thing. Doubt myself. What the right choices were for you.”

His response: “It’s one of those things where we had no way to know what was best or what the right thing to do was.”

Yes. We will never know.