Mental Health

A bipolar take on body image and shame

Meegan Simpson-Cooke, BSW

Visions Journal, 2016, 12 (1), p. 21

As a child, a family friend once compared my size favourably to that of her daughter: How come you’re so thin? I felt bad for my friend, yet at the same time, I understood that being thin was something admirable.

I spent my early teen years pushing my body physically—with cross-country running, soccer and horseback-riding. When puberty hit, I was sideswiped—by weight gain, mood swings and menstrual cramps. For the first time, I felt betrayed by my body. And although I didn’t know it at the time, there would soon be another challenge: the onset of bipolar disorder. I had no idea then that my body image and my shame about my diagnosis would become key aspects of my journey towards a healthy body image.

I had my first episode at the age of 15. At the beginning of the school year, I started feeling anxious. I skipped meals and couldn’t sleep. I would reorganize and clean my room, over and over. I became very thin. One night, I was overcome with an all-consuming, inexplicable fright—and ran from the family home.

That night, my family had me admitted to the hospital. Although the possibility that I had bipolar disorder had been raised before, the attending psychiatrist preferred to wait before making a diagnosis. The possibility that I was mentally ill just increased my sense of anxiety. A close family member had struggled with bipolar disorder for more than 30 years of his life. I was afraid—and ashamed—to think I might be judged the way I felt he was—for his depression, his manic episodes and his coping mechanisms.

I did not return to school for another three weeks. Even then, I kept my experience to myself. I couldn’t face the shame of admitting what had happened. But I kept receiving compliments from peers about how much weight I had lost, and this made me feel good.

I spent the next few years denying my mental illness to myself and hiding it from others. I wanted to prove I was “normal”: I ignored my intuition, pushing my body to work harder. And I didn’t reach out for support. In hindsight, although I would never advocate diagnosing bipolar disorder prematurely, I do believe that the course of my illness was made more challenging simply because it took so long for me to recognise and accept what was going on and create a positive treatment plan.

When I was 19, I spent time travelling in the UK. Although I’d been on anti-depressants intermittently for several years, I wasn’t on medication at the time. After I returned to Canada, jet-lagged and overtired, I became fearful and anxious. I couldn’t sleep. I didn’t want to go out. My agitation increased steadily to the point that my mother and I realised I needed to be hospitalized again.

In the hospital, I was put on a new medication. Had I known what the side effects would be, I would have been better prepared for what happened next. Within just a few months, I ballooned from a size 6 to a size 16. With the sudden weight gain, I was mortified. I became depressed.

The new medication made me drowsy, and I craved sweets. I began to hate my body. My parents and my extended family are weight-conscious and wanted to protect me from the judgment of others. They meant well, but it never feels good when people make comments about your weight, even when they’re trying to be positive. Most people who cared about me recognized I had little control over the weight gain. But I think our society has been conditioned to view weight gain as something akin to personal failure; despite our best intentions, we internalize this view and look at others with that standard in mind, without realizing we are doing so.

I began to isolate myself from friends and family. I felt other people were frustrated with where I was at, sometimes even as if they were afraid of my mental illness, as if it were something they might catch. And I felt shame at what I perceived to be their judgment.

One day, after weighing myself yet again, I decided to do something. Without informing my physician, I stopped taking medication. I started exercising compulsively. I would go for a long run in the morning, then bike the 15 kilometres to work, then bike home at the end of the day. Because I wasn’t on medication, I stopped craving sweets and dropped clothes sizes quickly. I was obsessed with regaining control, getting my life back. I equated “being thin” with “being in control.” There was no balance. It was almost as if I was trying to compensate for the illness.

It should come as no surprise what happened next: I got ill again. This cycle repeated itself a number of times before I realized how much my desire to be thin was negatively affecting my mental illness: I would go on medication, gain weight, feel horrible, go off medication, get ill again and then restart medication.

In Western society, we are bombarded by images of an impossible ideal. We all want to feel attractive and healthy and fit. But the image presented in the media is an extreme version of this. It’s not enough to be healthy: we have to be impossibly beautiful, impossibly thin, eat impossibly healthy diets and exercise like athletes. It is difficult in this environment to maintain a balanced perspective.

It was only when I received a definitive diagnosis in my twenties that I started actively looking for mental health support and took on the responsibility for my well-being. I now accept that I must work every day on caring for both my body and my mind. I have had to compromise my desires for a thin body in order to maintain a balanced life. For me, it comes down to the fact that being ill is a lot worse than being overweight. The consequences of untreated bipolar disorder are too difficult for me—and for the people I care about—to deal with.

Today, exercise and eating well helps mitigate the negative side effects of the drugs. Some medications predictably cause weight gain, and some seem to cause weight gain even when I’ve been told weight gain isn’t likely. It’s about finding the right medications and combinations that work (and they seem to work differently for different people!). At the same time, I have realized that I may need to accept that some weight gain is inevitable if I wish to stay healthy.

I recommend finding a balance you can live with—in terms of both treatment and weight. Focus on health, and practise acceptance. Know what you value in yourself and strive to accentuate it. And don’t sacrifice your health to achieve an unattainable, untruthful ideal.

Above all, make peace with shame. There is no shame in striving to be healthy. There is no shame in failure. When we fail at something, we learn what we need to change. When we are able to let go of our shame and see that how we look on the outside is a small part of who we are, then—and only then—are we truly free. In an odd way, when we free ourselves from our shame, we use the very thing that hurts us to heal us.