Lisa Zhakova recently published a photo project “We don’t think” about depression and bipolar disorder. In an interview with Psychologies.ru, she talked about how she lives with these diagnoses, why she does not want to associate her work with them, what is wrong with the #faceofdepression flash mob, and much more.
Psychologies: Lisa, you said you didn’t want your name to be associated with bipolar disorder. At the same time, you speak frankly on these topics in the press.
Liza Zhakova: Yes, I do not perceive it as a coming-out. Everyone I know has known this since I was 14. It’s just that my project is still a graphic product. I hope it may have therapeutic value, but I would like to separate work from illness.
I do a lot of things, and now I already want to do completely different things. As soon as I finished the project, this story stopped being interesting for me. I want to forget about it, as if it never existed, and do other projects that have nothing to do with bipolar disorder.
Were you scared by the resonance caused by your project?
No, it was pretty logical. If the thing I created works and it helps someone, that’s good. Of course, it had an effect on me personally as well.
It’s very brave of you to be so open about your diagnosis. Often people with bipolar disorder are embarrassed to talk about it.
Yes it is. Recently, a woman, a well-known journalist and photographer, wrote to me. She wanted to send her son to psychotherapy and complained that he did not listen to her at all – he agreed to take pills, but refused to work with a psychotherapist.
When I took the pills myself, the body could not cope with them: continuous side effects and no positive changes. I stopped drinking them, and I felt better, although at the same time it got worse. After giving up the pills, I lost 18 kg, and before that I gained more than 20 on the pills.
Do you think that in your situation you can just get by with psychotherapy?
Maybe yes. I’ve always been a rather asocial element. I myself decided that it would be better for me. And I think if I still took pills, then no psychotherapy would have worked.
How did you find out about the diagnosis? Was it hard to accept?
I was 18 years old. My grandmother sent me to a neurologist, they did an MRI, they took tests, and then they sent me to a psychiatrist at the Institute. V.M. Bekhterev. The psychiatrist prescribed antidepressants, but they did not work for me. A psychotherapist who worked there told me that depression is normal. And I was pounding so terribly, it seemed that I was about to vomit right there. I didn’t go to her again.
After that, I went to a psycho-neurological dispensary. There I was assigned to a day hospital, prescribed some kind of drug, and I felt better. I used to go there all the time.
But there is such a system: doctors do not announce the diagnosis to the patient if he is in serious condition and this diagnosis can scare him. The patient may refuse treatment or hospitalization, which is necessary in the opinion of doctors. And so I later learned the diagnosis.
I knew something was happening to me and I wanted to know what it was
At the next appointment with a psychiatrist, I was briefly left alone in his office. There was a laboratory assistant, quite young. We got to talking, and he told me what is written in my card. In fact, I learned the diagnosis fraudulently. They didn’t call me, they just said that in my condition I need to be treated and take pills that will be given out at the nurses’ post.
Nobody was going to tell you about the diagnosis?
Apparently yes. But I knew that something was happening to me, and I wanted to know what it was.
In our clinic, assistance to a person with bipolar affective disorder (BAD) is based on the following principles:
1. We explain the essence of what is happening, together we draw mood fluctuations throughout life, together we find patterns.
2. We discuss the goals of therapy: to make the phases more rare and less pronounced. Everyone has mood swings, but in the patient they are too pronounced, and this needs to be corrected. Separately, it should be noted that if the patient believes that this is not necessary, he simply will not come again.
3. We discuss ways of correction: medications, psychotherapy, lifestyle, solving other health problems.
4. The patient is managed by two specialists: a psychiatrist and a psychotherapist, who know methods of helping with bipolar disorder with proven effectiveness (cognitive-behavioral therapy, therapy of interpersonal and social rhythms).
These steps can be started only when the person has recovered from the acute condition. If he was taken to the acute department against his will, this is a completely different situation.
It is believed that in the stage of depression, people with bipolar disorder understand that they feel bad. And in the stage of mania, it is very difficult for them to realize that something is wrong. Have you noticed such an effect?
Yes, that is right. Rather, there is an understanding that something is wrong. But that doesn’t matter at all. You just don’t care. After one very unpleasant story, I went to a psycho-neurological dispensary and told everything about myself, as if in spirit. And the doctors shamed me and prescribed pills, which only made things worse.
You said that once you drank a smaller dose of medicine and you became ill. What then happened?
I then left for the summer to shoot. I bought pills with a margin, but I didn’t feel the need for them – they seemed to slow me down. And they stayed like that until I came back. I got worse, and I drank half the dosage of neuroleptic. I fell asleep for 16 hours, woke up, went to make tea and fell. I hit my head and my boyfriend took me to the injury. There they took an x-ray and said that everything was fine with the gray matter.
After this incident, I became very scared, because I never had suicidal tendencies.
Have you ever thought about suicide during your depression?
No, no matter how hard it is. I know for sure that even if I had such thoughts, I would never have done it.
A depressed person often needs the help of someone close to them to at least decide to see a doctor.
How do you feel about the flash mob #faceofdepression?
When I started shooting the project “We don’t think so”, I learned that there is a huge community dedicated to depression. Initially, I was going to shoot for the project not myself, but other people. I wrote a post, and it was published in one of the thematic channels.
Different people began to write to me, I began to meet with them. They told how communication in groups helps them, how much there is of everything useful and necessary. I became interested, and I went to read. To be honest, my hair started to move in horror, I didn’t agree with what people wrote there.
This flash mob is very logical. Previously, the topic was closed, but now a certain movement has begun around it. They write and talk a lot about depression, but there are very few really useful texts from which you can really learn and understand something – in all the time I have read only two of them, probably.
At the same time, there is nothing useful not only for healthy people, but also for people who are familiar with depression firsthand. Last year there was a flash mob #I’m not afraid to say. There was a wave, there was a hysteria about this on the Internet, and then it all went away, and few people remember it. It seems to me that the flash mob overly romanticizes this story. This is the wrong message, because it does not help fight depression. A depressed person often needs the help of someone close to them to at least decide to see a doctor about their problem.
What advice would you give to people whose loved ones suffer from such conditions?
Listen to what a loved one says, try to understand what worries him. Really hear it.
Did you have such people around when you were feeling bad?
Now I have a loved one who helps me a lot. Before that, no one really supported me. The ex-boyfriends were aware of my diagnosis, and it seems to me that they saw the disease in the first place and did not see me. This is terribly infuriating, because the personality is not determined by the diagnosis. I’m not a “bipolar girl”. Now, fortunately, everything is different in my relationship.
Do you think there is a prejudice in society regarding bipolar disorder?
It is. I see this a lot, but I don’t care what people say about it. I perfectly understand the difference between behavior when I feel bad, and behavior when I’m just sad. There is a huge difference between these two states. I think a depressed person is unbearable. There is something about him that makes people around him feel that way. Even people with depression irritate me. Despite the fact that I understand the reasons, it is very difficult to deal with this.
You just pull some things out of yourself, and they lose power over you.
How did you decide on therapy and how did you find a therapist?
At some point, I became very ill. I just lay in bed all day, sometimes I went to the dispensary. I had glazed eyes, I hardly spoke. My boyfriend supported me. One day his friend came from Moscow, who studied at the Institute of Psychoanalysis and became a psychoanalyst. He saw me in this state and after his departure advised my young man to talk to me about psychotherapy. He did not want me to know that he was aware of my condition, but he wanted to help in some way. I ended up going to psychotherapy.
What direction of psychotherapy did you choose?
Psychoanalysis. I don’t lie on the couch, I just sit and we talk. Mostly via skype. Previously, we practiced twice a week for 45 minutes, now less often. We met in person twice. The therapy has been going on for a year now.
Did you stop taking your pills when you went into therapy?
No, before. I haven’t taken a single pill since I fainted. On pills, I planted my stomach, I started having health problems. It seems to me that drugs, even painkillers, do not suit me.
There are psychotherapies specifically designed to help people with bipolar disorder (for example, interpersonal and social rhythm therapy). They allow the patient to learn to control their mood background in the same way that they control blood glucose levels in diabetes.
The set of tools is quite large: adjust the daily routine, maintain a normal sleep duration, do not allow a sharp increase in the amount of workload and commitments made in mild mania, regular exercise, phototherapy during seasonal fluctuations, etc. But still, psychotropic drugs are the fastest, most powerful and reliable means for stabilization. And often the most positive impact of psychotherapy is to show a person that it is reasonable for him to take drugs, and to support him in this intention.
I think it is wrong to blame a patient with bipolar disorder for not wanting to take drugs. If the phases are rare, shallow, and they can be “waited out” without compromising the quality of life, then this is a personal matter of a person. The doctor’s job is to help the person make an informed choice about treatment. Of course, it is better not to make such decisions during exacerbations.
If families break up due to illness, a person loses his job, undermines his health and risks his life, it is reasonable to endure discomfort for some time when choosing drugs in order to live stably later. True, a stable quiet life is not an unconditional value for some people, but that’s another matter.
In her autobiographical book, The Restless Mind, C. Jamison describes not only how bad she felt on the background of high doses of lithium, but also how her life improved when the dose was reduced to adequate. The problem is this: in order to find a treatment, you need to keep in touch with a psychiatrist, even when the treatment has made you feel bad. And you need to continue the treatment, even when it seems that everything is fine and the treatment does not seem to be needed.
These are very difficult tasks, and not everyone copes with them. In most cases, it is possible to find drugs that are well tolerated, but this can take time. For many people, the state of mania leaves such an indelible mark on the memory that they refuse to admit that this is not the norm. Manias are different: for someone this is an unpleasant state, and someone in it performs the most significant actions in their lives. No two cases are the same. Each one needs to be understood.
Complaints about “inhibition” should not be ignored – this is the same real suffering as a disease. Usually it is possible to find a balance between lethargy and exacerbation of the disease over time. But you need to be patient. Unfortunately, it may not be enough.
Did psychotherapy affect mood swings?
Yes, everything has become more “smooth”. And even this terrible depressive state, which I still do not know how to describe, I managed to stop. It ended before it even started.
If something seems to you, it doesn’t really seem to you
Won with the power of thought?
It works due to the fact that you begin to be more aware of everything. You just pull some things out of yourself, and they lose power over you. For example, I completely stopped communicating with my family.
Is it easier for you?
Yes. I have a very complicated family history, I was raised first by one grandmother, then another. From the age of 7 to 20, I lived with relatives in St. Petersburg. I didn’t live with my mother. Now I don’t even answer my parents’ phone calls, which is the smartest thing I’ve ever done. We communicate very rarely. I recently attended my great-grandmother’s birthday party and it was amazing. At half past eight in the evening, I said that I was late for the last minibus to the house, and left there not very elegantly.
Do you think it will get worse if you interact with them more?
Yes. It has a very bad effect on me.
It is believed that people with bipolar disorder tend to push away those closest to them. What do you think about it?
It depends on what the people close to you are. I don’t think it’s a matter of frustration in my case – our relationship has always been like that. If something seems to you, then it doesn’t really seem to you.
Did you say that it was a discovery for you that the emotions that you are experiencing actually exist?
Yes, and it’s very interesting. I came to therapy as a naive person, because all my ideas about psychotherapy were derived from American films. And rightly so, in this situation it is better to be an absolute “sucker”. Now I even think of entering the Institute of Psychoanalysis myself.
Do you want to study this topic further?
Yes, it turned out to be terribly exciting.
Would you like to help other people?
To begin with, I would just like to know and understand.
Depression is emptiness, boredom, something so sticky and disgusting that you can’t get out of. This state takes the soul out of you
What other projects do you have?
In addition to the project on depression, there is a project on the BDSM community, my favorite. In general, I shoot very different things. Last year we filmed a project in the Russian outback, now I am doing portrait photography, I want to make a book.
Why BDSM?
This is a funny story. We went to school to shoot at a sex exhibition. There, people danced to the music of the 90s, it looked very funny and somewhat ridiculous. I met a professional “mistress”, we became friends, and I photographed her for some time. But I myself have a very distant relation to this story, because in this sense I am as normal as possible.
What is normal?
In the classical sense, I have no deviations, except for a slight voyeurism.
And how do you feel about the point of view that there can be such a severe depression that the only way to help is with the help of euthanasia, as in the case that happened in the Netherlands?
I think you should never do this. Nothing is finite but death. When people say that they have depression and have to sit on pills for years, it’s terrible. Because years are long. It goes against everything and is completely unnatural. It’s hard for me to imagine a case where you can’t help.
What are you most afraid of?
Void. This feeling is difficult to describe, it is more at the level of the body. It’s very scary. Depression is emptiness, boredom, something so sticky and disgusting that you can’t get out of. This state takes the soul out of you.
How do you feel about the statement that “depression is a fracture of willpower”?
Depression has nothing to do with willpower. Willpower is needed to run a marathon. And to get out of depression, you need to feel very well what you need now. It has nothing to do with willpower. If I feel that this state is looming on the horizon, I say – ok, I have Shabbat. I turn off my phone and rest. And then I get up like new.
Does that mean you take care of yourself?
Yes, I began to love myself much more.
Haven’t loved before?
I used to hate it. Therapy is very difficult and painful. I described some of the emotions associated with therapy in my work, but there was actually a lot more. And it helped me. Friends say that even my face has changed. And I feel it myself.
Although drug therapy is the primary treatment for bipolar disorder, psychotherapy is essential. In the XNUMXth century, attempts were made to treat BD with psychoanalysis, but their effectiveness was extremely low, especially when the patient was in a state of mania and his ability to think critically was reduced.
Bipolar affective disorder is often accompanied by psychosocial problems. Many patients quit medications (or drink them irregularly, or reduce their dosage on their own), experience cognitive impairment. Interpersonal problems arise: depression often leads to divorce, and mania leads to betrayal, unreasonable spending, risky driving, participation in risky projects.
Modern psychotherapy, designed specifically for bipolar disorder, is aimed at solving these problems. It is more focused on specific symptoms. Much attention is paid to psychoeducation, involvement of family members, relapse prevention, the study of the relationship between mood and interpersonal relationships, the establishment of a regular sleep-wake cycle.
By and large, it does not matter what kind of psychotherapy a person chooses. The main thing is that it be developed specifically for BD: psychoeducation, cognitive behavioral therapy, interpersonal therapy and social rhythm therapy, family therapy and some others. But the effectiveness of all these types of psychotherapy has been studied only in combination with drug therapy.
I am aware of only one study on the treatment of bipolar disorder with psychotherapy and without the use of drugs – “A randomized pilot study of psychotherapy and quetiapine for the acute treatment of bipolar II depression” (Randomized controlled trial, Swartz HA, et al. Bipolar Disord. 2012). It compared interpersonal therapy and social rhythm therapy, developed specifically for bipolar disorder, with the drug Quetiapine for the treatment of depression in type XNUMX bipolar disorder (which is much milder than bipolar XNUMX disorder).
This was a small and very short study that showed that in the case of type XNUMX bipolar disorder, psychotherapy may have a marginal advantage over the use of Quetiapine, or that the difference between the two approaches is not significant. Unfortunately, there have been no large and sufficiently serious studies on this topic, so far-reaching conclusions cannot be drawn on the basis of this study alone.
I myself very rarely insist on medication. There are many more disorders that are quite well treated by psychotherapy than is traditionally considered in Russian psychiatric practice. But BAD is one of those rare instances where I strongly suggest discussing the pros and cons of drug therapy.
I have seen the consequences of refusing drugs more than once – people lost their business, families, health, made suicidal attempts. The BAR price is too high.
In any case, the decision on treatment is made by the patient. As specialists, we try to do everything possible to help a person within the limits that he has defined for himself.
Liza Zhakova – photographer, born and lives in St. Petersburg. Read more on her .