Trigger Warning: topic includes some discussion on self-harm, suicidal, and homicidal urges.
Lately I’ve been trying to do a better job of understanding the urges I feel and how they fit with my symptoms. Living with treatment resistant bipolar disorder has meant that even though I find myself having the sorts of urges everyone else seems to (though as human beings we all seem quite reluctant to talk about urges) I also experience urges brought on by my illness. On top of that, my ability to respond to these urges can be quite compromised based on what my symptoms are doing as well… but let’s back up for a second.
Urges are impulses. Strong desires. They are those feelings inside of us that scream out to “just do it” in certain situations. Sometimes my urges come only in the form of a feeling like gravity taking over and I act on them without thinking, sometimes they’re accompanied with thoughts that can encourage or discourage following an urge.
To break it down, here’s an example of a relatively healthy urge I have. A simple craving.
Urge: make eggs.
Thought: I do like to eat eggs.
Action: made eggs.
You can substitute chocolate in for eggs, chocolate is good. Or you could substitute tea, in which case the urge and actions become blurrier for me because I have dietary restrictions. In that situation having a chai tea latte, for example, becomes something I shouldn’t do. I will get sick if I have dairy, so the urge has a negative consequence –it becomes unhealthy.
Urge: drink a chai tea!
Thought: holy yum batman, but this will make me sick (Reminder: I can’t have milk or caffeine).
Action: urge denied, drank juice.
Even though drinking a chai tea is unhealthy for me, there are times when I am run down or worn out where the negative consequences of drinking one sort of fade out. In that kind of situation I find my thoughts work against me.
Urge: for pumpkin spice’s sake, drink a chai tea!
Thought: It is fall, I do like chai, and even if I get disgustingly bloaty and gassy and can’t leave my house for two days I don’t have any plans anyway.
Action: 20 minutes of sweet, sweet chai tea action, 48 hours of intestinal horror.
Finally, there are those situations where thinking doesn’t even come into play (I swear, I have a point here). If someone put the chai tea in my hand and told me to drink it, the impulse becomes much easier to carry out.
Urge: drink this chai tea in your hand!
Action: yes, thanks.
Alright, so this seems perfectly reasonable to understand when I am thinking about something mundane but delicious, like breakfast… but these same scenarios are true for most types of urges I encounter. As human beings, we come up against a lot of kinds of urges, but the ones I want to look at more specifically are the negative urges, the ones that we know will have (or are likely to have) negative consequences. Things like lying, cheating, stealing, violence, sexual attraction to inappropriate parties, overeating, overuse of drugs or alcohol, self-harm, and suicide (to name just a few).
Most of the things I’ve listed are not things people talk openly about despite how commonly we find ourselves feeling urges to do negative things. I’m sure there are people who excel at shooting down these urges, but I don’t think it is very clear cut. If my chai tea was now an act of violence (let’s say slapping someone in the face who had done something inappropriate), even a totally rational person might not deny the urge after several drinks.
Urge: that bitch just threw a drink in your face! Slap her!
Thought: I’m the bigger person here… she looks ridiculous, I can let it lie.
Action: deny urge, stand around dripping.
(But after several drinks, or a bad day, or after something particularly offensive like groping your partner…)
Urge: oh no she didn’t, slap her!
I’d say that, more than anything else, is why I don’t drink anymore. My mind, for whatever reason, seems fully capable of jumping from urge to action without being intoxicated.
Anyway, last example. Living with treatment resistant bipolar disorder has often meant living with suicidal urges on a regular basis, and this is one aspect of my illness that I think people understand least. You see, these urges are something I can typically rationalize away.
Urge: you should kill yourself.
Thought: I might not feel good right now but I’ll bounce back. Plus that sounds like a lot of work. Plus what about my dog? Plus I think people might get upset.
Action: still alive, despite lack of chai tea lattes.
But, as I mentioned with my chai example above, if I find myself in a position where extreme stress or a particularly long depressive episode has eroded my ability to think clearly, the urge becomes harder to contradict.
Urge: you really should kill yourself.
Thought: you’ve been pushing that nonstop for months, and I’m sure there is a reason I have resisted that urge in the past even if I can’t quite remember it now. I’d better call someone.
Action: call my therapist, she acts as a rational brain for me when mine isn’t working.
Then there are situations that I call “level 3” suicidality, and that is when hospitalization becomes required because the urge has consumed any ability to contradict with thought.
Urge: kill yourself.
Action: jaywalk, check into the ER.
I know it isn’t a pretty topic, I’m sure that is why it goes unmentioned most of the time. Just the fact that I spent so many years not knowing where the urges I felt were coming from or that they did not mean immediate suicide, or violence, or self-harm, that I still had a choice as to whether I would act on them or not, was exceptionally confusing and wildly detrimental to my sense of self-worth. On top of that, not knowing what kind of situations (alcohol, mania/mixed episodes, high stress) led me to jump from an urge to an action without thinking made it really hard for me to stop acting on the urges I felt.
Being unable to separate the urges I felt from the totality of who I thought I was meant years of trying to punish myself for urges I could not control in an effort to curb them because I assumed that “getting better” meant not having those horrible feelings anymore. Besides, urges that provide harmful consequences are not generally seen as normal in our communities despite how often people experience them because the topic is typically taboo. Needless to say, when I was sixteen and experiencing psychosis with homicidal urges I immediately assumed I was a terrible person who probably didn’t deserve to live, given the fact that I wanted so desperately to hurt other people. Even though I worked hard to deny those urges I still felt wildly ashamed for having those urges in the first place.
I still catch myself sometimes, telling myself that the urges I feel to self-harm or commit suicide mean I am something less that others, that it doesn’t matter how many worms on the sidewalk I frantically save from being walked on because overall I’m a terrible person.
But that simply isn’t true. (And I’m sure the worms do appreciate it in their own way.)
I can’t judge myself based on the urges I feel because doing so is like judging an entire library because one book doesn’t seem to get shelved properly on a regular basis. To discredit the entire system and collection because of one book seems absurd, especially once I’ve learned that there are many creative solutions for where to keep that book in the catalog.
As I’ve gotten older I’ve started to understand that everyone feels urges and that urges are outside of our control. We might not all feel the same ones, but I’m sure we’ve all felt an urge now and again we have felt ashamed of. Being able to take a step back from that shame has meant feeling better about myself and even though I don’t expect those urges to go away anymore, I just try to focus on the way I view the urge and how I choose to act when it comes up.
…and if I slip up and drink a chai tea now and again, I’m only human.