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Cristina is laser-like when she identifies herself: she is 47, and the mother of three children. She has a demanding job as an insurance broker and has been married for almost two decades. The nuances, though, are a bit more complicated. During a long discussion at her Toronto home that is surrounded by rock and trees, visitors might be forgiven for thinking they were in a treehouse. There is the gleaming all-white kitchen and a modern light fixture that glitters above a harvest table, all overlooking an impeccably devised patio that serves as an outdoor living room. It is an instant reminder that someone planned every last tile, every last stone, every last surface.

“Do you like it?” she asks, her face breaking into a smile. She seems shy about taking credit at first, but then concedes to the truth: she was the mastermind of her townhouse’s recent three-year renovation. 

“The thing with bipolar is, you always need a project. Someplace to put your focus, your energy.”

Without that focus, Cristina starts to feel anxious. She was diagnosed in 2009, but still feels like she’s adjusting to the condition’s meaning for her identity, family and future. She’d had shaky years in her life – her parents’ painful divorce when she was little, and some brief bouts with anxiety and depression. But several months after she’d given birth to her youngest child, now 9, she felt more unsteady than ever.  

The pregnancy had been emotionally trying, even though it was a baby she had longed for. Cristina works with her father, and midway through her gestation he was diagnosed with cancer. Always a take-charge, commanding person, Cristina managed his business through her father’s illness and recovery. But after she delivered her son, things were so hectic at the office she brought him to work with her after only six days. She could do this: she’d recuperated quickly from the births of her older children, a boy, 5, and a girl, 2, and had a nanny to help look after them. Her husband, an insurance executive, was never quite the hands-on dad she’d hoped he’d become, but he helped in the mornings and evenings. And Cristina’s dad needed her. She was an experienced mum, and babies, when they are tiny and peaceful, are easy to manage. 

But soon, Cristina realized that she wasn’t bouncing back like she had before. She’d weep for no reason, and was so tired in the mornings she couldn’t drag herself out of bed. Disturbing thoughts began to plague her. She’d be holding her baby, looking down at his sweet perfect face as she carried him from her room to the nursery, and suddenly be paralyzed with the fear that she’d drop him – or worse, hurt him intentionally. And her body hurt everywhere, deep in her joints and limbs. Her doctor diagnosed her with postpartum depression and prescribed an antidepressant. Her doctor also suspected lupus and tested her for its biomarkers. Cristina carried the antibodies, and was referred to a rheumatologist who prescribed another seven medications. Her physical discomfort subsided, but things still weren’t quite right with her mind.

Cristina started talking -- quickly, loudly, and all the time. Her mouth seemed completely disconnected from her brain. She could hear her voice, droning, and would recoil at the sound of its rapidly firing words. “I’d be like, ‘Oh, just shut up!’ But I’d keep talking.” She’d laugh inappropriately, but was powerless to stop it. And then she’d shop uncontrollably, buying clothes and toys for the children that she knew they didn’t need. Having small children is by nature chaotic, but after the birth of her third baby it seemed as if a switch had flipped. Everything about her life felt speedy, turbocharged: her thoughts, her words, her actions. Her doctor had given her mindfulness exercises to try to quiet her brain, but when she closed her eyes to meditate, her mind raced so fast she wound up feeling anxious. But this burst of energy was new to her, and she kind of liked it. The pain hadn’t dissipated, but she was functioning well.

Her family doctor was concerned about her rapid speech, and referred her to a psychiatrist. Cristina went, reluctantly. 

“I thought I just had postpartum, which seemed fine to me. The baby blues, right? I just thought it would end soon.”

Her doctors said her depression was part of the lupus and once that was under control, the depression would be too. But when the psychiatrist told her she had bipolar disorder, Cristina balked. “I was in full blown denial,” she says. “I just couldn’t accept another diagnosis of that magnitude.”

Months went on, and her psychiatrist tweaked her medications. Soon, her doctors withdrew the lupus diagnosis and replaced it with fibromyalgia. Meanwhile, she had become increasingly hypomanic, speaking ever more quickly. 

Finally, what her doctor had told her began to sink in: she had bipolar disorder II, peripartum onset. Postpartum bipolar disorder is rare, and many mental health professionals are unaware that it even exists. (Bipolar disorder type I and II are uncommon, affecting less than 2% of the population; the prevalence of the more broad bipolar spectrum illness, which includes more mild variants of this fluctuating mood disorder, is no more than 4%.) 

“It’s one thing to have postpartum,” she says. “But it’s something else for someone to tell you, ‘No, you have bipolar.’”

A generation ago, there were few treatment options for those with clinical depression, which affects roughly 10% of the North American population. The stigma surrounding the illness was enormous, so sufferers were loath to admit they needed help. Often, people weren’t treated until their symptoms became so severe they attempted suicide and were recovering in psychiatric hospitals. But for many, the advent of Fluoxetine and other serotonin reuptake antidepressant medications together with education has reduced this stigma. As a result, millions of North Americans now seek treatment, and more openly disclose their condition.

Bipolar disorder, at least for Cristina, seemed different. “Crazier,” she says. Her friends and family couldn’t believe it either. “Bipolar is obviously not a popular thing to be,” she says. She smiles when she says it, but her eyes look anguished.

Since her diagnosis, she’s come to accept her illness and worked hard to keep it under control. She sees her psychiatrist once a month, and they continue to tweak her medications. Side effects, like weight gain, are a reality that Cristina reluctantly accepts.

To stay balanced, Cristina tries to stay active, get enough sleep and has eliminated caffeine. When she’s really feeling ragged after a long day, she smokes marijuana. (She initially had not shared this information with her psychiatrist.) At her doctor’s urging, she has tried to stop cursing to lower the temperature during difficult interactions. Mostly, she succeeds.

Small blips can derail her, triggering angry outbursts she regrets and then replays for months or years. Several winters ago, for example, she had planned an island getaway for her family. Cristina loves the sun, and looked forward to her time relaxing on the beach. At the airport, however, she discovered that the airline had lost her son’s luggage. She approached an airline official for help, but the woman gave a curt reply. This angered Cristina, who then began yelling at her. Her children looked on, mortified. Her husband tried to intervene, to no avail. “I was screaming and I couldn’t stop,” she says. “I was shaking, I was so upset.” The situation deteriorated so much that an airport authority approached Cristina’s husband and told him, “If you don’t get your wife to calm down, we’re going to have to handcuff her.”

Cristina’s eyes well up as she recalls the incident. “My kids had to stand there and see that,” she says. “On one hand, I’m the one who gets things done for my family. But then I snap and I don’t. I don’t even remember the trip. It just became, because of that one instant, that one thing that happened with the suitcase, it ruined everything. It’s just a blur.” 

Friendships are also difficult. She’s seen them come and go, and believes her transparency with her illness has turned a lot of people away. Cristina becomes anxious in social situations, fearful that she might talk too much, or get overly annoyed at something not meant to hurt her.

But she retains her sense of humour. When talking to a new neighbour in her condo, who was describing his former father-in-law, he said: “He’s so bipolar,” by way of explanation. Cristina didn’t miss a beat. “I’m bipolar, too,” she told him. He didn’t quite know what to say, but Cristina doesn’t regret it. “He’s probably already heard I’m volatile. Might as well know the truth.”

She worries about her children though, and what the illness might mean to them. Her oldest son is anxious. Does that mean he might one day develop the disorder, too? Her mother has a difficult time accepting her daughter’s diagnosis. “She talks about the ‘brutta figura,’” she says, using the expression that translates roughly to “create a bad impression.” “She thinks I can just get over it, that I’m overplaying it,” she says, and shrugs. “If only it were that simple.”

Nobody ever thinks, when they are growing up, that they will one day contend with a mental illness, she says. “It’s not where I want to be, but the only thing I can do is maintain the best life I can. I feel bad for my family because they didn’t ask for this,” she says. She raises her eyebrows. “Well, guess what? I didn’t, either. But I’m still here for them. I’m here for them no matter what.”

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