"You know the worst place I find stigma? In my own mind."

A patient responds to my post on stigma and the mentally ill:

I was diagnosed bipolar during an enforced hospitalization in September 2003 due to an extreme mixed episode. I was trying to determine, because of thoughts sent to me from outside my brain, how much steady pressure it would take from a steak knife to sever my left hand. I never accomplished it: I had a small and ever-diminishing part of myself that screamed stop and well, ended up in hospital.

I realize there is legislation protecting my job.

I realize that we are a modern society and education is available.

I tell very few of my diagnosis. The few I've told now number people who begin almost every sentence with me: "Please don't take this the wrong way but..."

I haven't told my employers. Yes, the legislation protects me, but that's a hell of a lot of good when I'm fighting from a place of unemployment.

I haven't told a lot of my family and none of my husband's. Part of my particular version of BP gives me a strong tendency to be paranoid. The gossip would be debilitating.

But you know the worst place I find stigma? In my own mind.

I'm an intelligent woman, went to university on an academic scholarship for a history degree. I have an IQ that hovered around 140...I shrink from my diagnosis, a label of "mentally ill", the way I would from a bogey man in my closet. I know it's not what I think, but still I fear it. I try to remember that I'm still me, but then I struggle with the definition of what the real me is: the person I pretended to be in struggling to be "normal" for all those years, or the person who now struggles to be stable and can't remember what "normal" felt like.

I'm my own worst enemy. And all the public service announcements in the world won't change that.

The treatment of bipolar disorder is so much more than just giving lithium (or other mood stabilizers). Patients must learn how to live with the illness...a struggle that this patient describes so powerfully.