In 2010, Efren was 20, and he felt like there was nothing he couldn’t do. He was sailing through law school in his hometown of Mexico City, and had a job at a top law firm. Friends surrounded him at school; friends surrounded him at work. His professors liked him, and so did his bosses. Tall and athletic, he’d grown especially fit while training for mixed martial arts competitions, another realm in which everything, really, seemed to be going his way. He’d go to classes; then his job; stop by the gym on his way home and stay up late to study. His appetite was ravenous: He’d grab an order from the corner taco stand, or polish off huge steaks, then wash them down with whole cartons of orange juice and plenty of sugary Mexican drinks. 

Sleep? Unnecessary. For almost a year, he’d only close his eyes for a few hours every day-and-a-half or so. 

Energy, ideas, and strength all seemed pumped into his body from an invisible generator. So did limitless confidence: He enrolled himself in a tournament of professional MMA fighters even though he weighed five kilos less those in the heavyweight division in which he chose to compete. “I had the constant feeling I needed to be or do something ‘special,’” he says. That included sex, with lots of women: the sisters of friends, women in his office, women at school. They’d end up in parking lots, hidden spots in the courthouse where’d he go to file legal briefs; once on a rooftop, high above the capital. He hastens to point out that while he took precautions, he knew something wasn’t quite right. Still, he couldn’t stop himself. “I was over-performing in every way possible,” he says. “I felt like a superhero.”

He had big plans: “I was going to be a successful lawyer, rich and powerful. All the signs were pointing in that direction.”

But one morning nearly a year after this stretch of intensity began, Efren was tired. For the first time he could remember, he slept late. His crisply alert brain seemed replaced by one that was groggy and disoriented. Over the next few weeks, the guy who never needed more than two hours of sleep couldn’t seem to get out of bed. Horrifyingly, he lost his libido. “It was massively scarring for me,” he says. “I was a man in my early twenties who had been trying to keep all these separate relationships going and suddenly everything crashed.”  His prodigious life force had drained out of him. The repercussions of his personal life began to weigh on him, and he wasn’t even hungry anymore. His mood had switched from euphoria to sadness almost overnight.

He began to search his symptoms – fatigue, uneasiness -- on the Internet. He convinced himself he had diabetes. “It seemed like an easy fix,” he says. “I’d just get some insulin and I’d be fine.”

Efren’s parents had divorced when he was small, and his mother Gisela, an IT executive, had recently moved to Toronto. His father, also named Efren, had remained in Mexico City, and took Efren to a doctor, who, after hearing symptoms of Efren’s cycling moods, diagnosed him with bipolar disorder. Efren scoffed at the idea. “I thought he was full of it,” he says. The doctor prescribed a mood stabilizer and an antidepressant, which Efren resisted taking.

One afternoon, full of longing for his former capable self, Efren grew so despondent he believed his only alternative was to kill himself.

Hours later, Efren’s father found him, comatose and bleeding, on a busy street in Mexico City. He rushed him to the hospital, where Efren came to. There, a psychiatrist told him he needed to be admitted to the psychiatric unit, but Efren refused. Father and son left the hospital. A week later, Efren tried to overdose again, and an ambulance returned him to the hospital. This time, his father convinced Efren that he needed to transfer to a psychiatric hospital across the city. After two days, Efren decided he could not get well there. The other patients seemed far sicker than him: in the bed next to him, a man who had been diagnosed with schizophrenia spoke back to the voices he said he was hearing. Bandages from his recent suicide attempt covered scars the length of both forearms.   

While Efren struggled with his diagnosis, his mother Gisela soon accepted it. She recognized some of Efren’s recent behaviors as similar to those of her ex-husband, who himself was later diagnosed with the disorder. She encouraged Efren to come to Toronto to be with her and his two siblings, and began researching how to treat the illness. She joined a support group for family members of people who have the illness, and found Efren a psychiatrist who could treat him. He moved to Toronto in 2011, and began taking a number of medications that his new doctor said would prevent him from spiraling either into hypomania, or a suicidal depression, again. “It felt so grim,” he says. Sometimes, he stayed inside his room for days. Eventually, he enrolled in university but fought to maintain his footing. One cold winter night he was seized by the thought that he would never again live a normal life.  “I started feeling horrible and this idea popped into my head that there is a zero percent chance that I would ever get better,” he says. “I asked myself, ‘Why am I alive if all I’m only ever going to feel like this?’” Once again, he took handfuls of all the pills he had in his house. Gisela found him, and an ambulance raced with him to the hospital.

The next day, hospital staff and family members reassured him that everything would be all right, but due to the effects of the overdose, Efren felt the opposite: he couldn’t even manage basic tasks. Sentences he intended in English came out partially in Spanish, and he couldn’t recall any of his Internet passwords. He stayed a week. Although he felt miserable, he told the doctors he was well enough to be released. They let him go.

And he began feeling better. He realized that bipolar disorder was real, and that he had it. Ever affable, Efren freely shared his diagnosis with friends and extended family. Their responses were singularly unhelpful. Several commented: “Man, at least you don’t have cancer or HIV or some serious disease.” When he’d try to explain it, people offered advice: “Well, try to sleep better.” “Exercise more.” “Pray the rosary.” His favorite counsel was this: “Just try harder to be strong.”

He laughs when he says this, but his smile disappears as he considers his next words.

 “The reality of it is I have to take eight pills a day just to try and live normally.”

The intervening years have not always been stable. In 2012, Efren had just changed his medications. He remembers watching the opening ceremony of the London Olympics and thought everyone looked like they were having a great time. “People were waving and smiling and it just looked like so much fun,” he says. He found a cheap flight that left the next day, and arrived in London to join in. He checked into a hostel, met up with a friend, and went to a football game. “I had a great time,” he says, “but when I told my doctor about it, he told me I was heading into hypomania again.” He readjusted his drug prescriptions.

Three years later, he was feeling shaky again. With great effort, Efren had graduated from university with a degree in law. He was engaged to Kathryn, his girlfriend of two years, and who was intimately aware of his medical history. The couple were friends before they dated, and Efren told her about his illness when they first met. “I wasn’t thrown off by it,” says Kathryn. “Everyone has their issues.”

Efren had a job he loved and the couple was planning their wedding. But Efren began to despair that his life would never work out the way he’d once hoped. He puts it this way: “Brains get sick, just like any other organs. When your liver gets sick, your liver hurts,” he says. “When your heart gets sick, you have chest pain. Well, when your brain gets sick, you have emotional pain.” He shakes his shaved head. “And my brain got imbalanced again. I was convinced I was never going to feel joy again. I felt like a burden to others, especially to Kathryn.”

He grew hopeless once more, and while on the job he began browsing the dark web for ways to kill himself. “It just hits you,” he says, of his suicidal despair. “It’s all you can think about. It’s not a choice.” He confessed his desire to die to his best friend, who promised to help, but who insisted that he break up with Kathryn first. “Either break up with her, or get help,” he told him. “You can’t hurt her.” The thought of leaving Kathryn was too much bear, so this time, Efren agreed to go to the hospital before he needed an ambulance to take him there. His psychiatrist suggested that he get electroconvulsive therapy to help him gain equilibrium. Electroconvulsive therapy, or ECT, delivers small electric currents to the brain that intentionally cause brief seizures. It is believed to cause changes in brain chemistry that can help allay some symptoms of mental illness, particularly major depressions.  

Gisela and Kathryn gave their full support. “I knew how much pain he was in,” Kathryn says. “There was nothing I could do, or any other external help he could get, that was going to make him feel better. He was seeing a really good doctor who thought this was the best route. I thought, ‘This is extreme, but he needs something extreme.’”

Almost immediately, Efren felt better, and tolerated his six treatments well. Memory loss and disorientation are frequent side effects, and after his first session, the nurses in the recovery room asked questions to determine how he had fared. “Do you know where you are?” a nurse asked him, peering into his face. “At a beach in Mexico,” he responded sleepily. The staff looked on, concerned. “Just kidding, I know I’m in Toronto,” he says.

Gisela and Kathryn visited frequently, marveling at an Efren they hadn’t seen in months. “It was like a miracle,” Gisela recalls.

Still, Efren hated being in the psychiatric unit. One fellow patient occasionally barked, and another young woman laughed to herself for hours on end. Efren began needling his doctors to let him out. “I made a great case that people with mood disorders shouldn’t have to be with people who aren’t in touch with reality,” he says. “Nobody wants to be in the psych ward, but when you realize how bad things can be it just makes you feel worse.” This time, he and his doctors negotiated a compromise. Efren would stay for four weeks as an inpatient, but he could get out to go to his gym every few days. “It made it tolerable,” he says. “Less like a prison.”

A month after his release, the couple married in front of 130 guests on a Toronto island. Looking back, Efren sees this as one of the turning points of his life. “Not a lot women would even stay with a guy who had no job and had just been in the hospital for ECT,” he says, “but she went on to marry me.” Kathryn is a fundamentally optimistic person who believes that things will work out, and they have a way of balancing each other. Yet his sensitivity to his moods – and to hers – has made her more attuned to her own feelings.

“We hadn’t taken our vows yet but we were ready to. It’s not just saying ‘for better or worse, in sickness and in health’ that make a commitment. I knew he had bipolar disorder before we ever went on our first date. I knew before we got married that things wouldn’t always be great, but I loved him. It didn’t change anything. There was no way I was going to leave him when he most needed me.”

It rained as the Buddhist monk who officiated led them through the service they had written themselves. “Everyone cried,” Kathryn says.

Efren leans back on a stool at his kitchen counter in the bright, tidy apartment he and Kathryn share in Roncesvalles and drinks a glass of water. Then he pours another – his medications make him thirsty. It’s a sunny Sunday morning in late winter, and Gisela had prepared a brunch of eggs and chilaquiles, a Mexican dish with tortillas, peppers and cheese.

The ECT helped shake him out of a depression, but Efren is also disturbed that it has made much of his recent memory hazy.  “I have to rely on my mom and Kathryn for help with what happened when,” he says. Then he corrects himself. “I know I can rely on them both for a lot – they’ve supported me so much. My mom has dealt with more than any mother ever should have to. And she’s always like, ‘We’ve got this.’” 

Efren, who works as a manager of compliance in corporate finance, has different aspirations from the ones he once had in Mexico City. “I just want to be stable, have decent work, and take some nice trips,” he says. “Just normal.”

He doesn’t sugarcoat his condition. “I don’t see an upside to being bipolar,” he says. “I can miss being hypomanic, but I know the flip side of that is going to be a terrible depression. It’s a struggle. It’s been a thief, in a way, of my life. It’s a hindrance.”

He frowns. “You don’t walk around thinking, ‘Oh, thanks, what a great challenge life gave me.’”

He is grateful, he says, to live in Canada, where he says attitudes toward mental illness are progressive. “In Canada I’ve had the best care possible, the best doctors possible.”

Gisela also received counseling to learn how to communicate with Efren during his depressed moods. Instead of trying to talk him out of them, she now knows to empathize with how he feels. “I used to try to get him to take his dark glasses off, to see the bright side,” she says. “Now I know to speak him differently.”  

Efren participates in research so that others might learn more about the disorder, and he and Kathryn are honest with friends and colleagues when Efren is feeling unwell. “When people get migraines, nobody blames them,” Kathryn says. “It should be the same way with this. The only way to get there is by talking about it.”

Two years ago, Efren wrote a first-person piece about his experiences for a friend’s magazine in Mexico, and he was surprised by the overwhelmingly positive response it received. Increasingly he finds it easier to be open about his disease. And as the couple builds their lives together, he has been pushed to try new things. Efren doesn’t love to walk – he considers it an appropriate means of travel only for short distances – but Kathryn insists that they hike on weekends. “Me, hiking!” he says. “I hate it, but I do it.” Last spring, he planted seeds for a vegetable garden, and was delighted when his melons, spinach, lettuce, tomatoes and tomatillos actually grew. “I’m the least organically inclined person on the planet,” he says. “But I really enjoyed it.”  

Still, it’s a daily struggle. He ticks off the list of medications he’s tried, often with little success. “Sometimes it seems like it’s easier to give up, but I think of who I’d hurt. That’s why I keep going, keep trying, keep failing and trying again. I take my meds just like a diabetic takes insulin, and I keep working to stay stable. I have a good job, good friends, and the best marriage I could ever have hoped for.”   

They understand that theirs might take extra work as they cope with the ups and downs of Efren’s condition. But like every couple, they have behaviors that irk the other person – and Kathryn is annoyed by one that has nothing to do with her husband’s illness. He is exuberant in his enthusiasms, including for memes he spots online, and wants to share.

“We have a lot to be grateful for,” Kathryn says, turning to Efren. “But now we need to work on you barging into the bathroom to show me a funny video while I'm taking a bath!"

They both start to laugh. "Yeah,” Efren says, “but the one with puppy I showed you the other night was pretty good!"