#like that psychosis is degenerative (it’s NOT) and that by going off my meds i was rotting my brain

[starblaster]

psychiatrists and pro-psychiatry ableists often label antipsychiatry as fearmongering, which is hilarious not only because it isn’t true but because psychiatry itself relies on fearmongering to continue existing. “accept this treatment or i will label you as noncompliant” is not care, it’s a threat.

[gardenerian]

in this post https://www.tumblr.com/gardenerian/706641891291217920/mel-i-am-wondering-when-you-think-ian-told-mickey?source=share you said you wanted a reminder to talk about how depressed ian was in s6 !!! I'd love to read it if you wanna sound off about it!!!!

hey there 💓 you sent this days ago and i have had a time with it - thanks for being patient.

i originally wrote this as an episode-by-episode breakdown like my s8 meta, but it stopped making sense and honestly kinda bummed me out asdkfh so instead, i'm gonna talk about a couple of things that are going on for ian in s6. if you wanna talk about any specific episodes or moments, lmk and we can definitely dive in.

i namely want to get into what mania can do to the brain, what recovery looks like, and how depression manifests in the process. i think these things are under-explored in shameless - and talking out some shameless misconceptions is something i've been thinking a lot about lately.

and so, onwards:

standard disclaimer that i am neither a doctor nor an expert, just a sick person who gets sick. i've done some reading and listening, but others can speak to this a lot better than i can. anyone else is welcome to chime in.

i guess we should begin by pointing out how soon s6 picks up after 5x12. it’s been what? weeks? debs is just confirming her pregnancy, so it hasn’t been too long - but long enough for carl to have spent some time in juvie.

so let’s recap on the last year or so of ian’s life:

manic episode -> depressive episode -> manic episode with psychosis -> hospitalization -> attempt at medication -> arrest -> implosion of personal life and break up -> now we’re at a kind of baseline depression

and that’s where we find him in s6. and i think it’s important to understand what ian’s been through in the lead up to this - not just situationally, but what his mind has literally just been through. 

what goes up must come down, yeah? ian spent much of the previous two seasons manic as all get out. his brain has really been through the wringer. studies show that bipolar disorder may cause physical changes to brain over time, and functional abnormalities during episodes. 

there are also studies that argue that bipolar can cause accelerated decrease of grey matter in the brain - which impacts physical coordination and motor skills, memory, and emotional regulation. there are degenerative health effects associated with illnesses like bipolar. untreated bipolar get worse with each each sequential episode.

this is not to say that ian is suffering from these longterm effects a year into his illness, but his brain has really gone through it. there is more to recover from than just the situational consequences. there’s a physical and neurological recovery as well. severe episodes like ian’s (untreated manic episodes can last 3-6 months) estimate about a 12-18 month recovery. 

and there’s a lot involved in this. it’s medication and vitamins, exercise, vitamin d. it’s financial recovery. rebuilding relationships. confidence. a sense of self and purpose. picking up the pieces of what the episode left in its wake. 

but it’s also cognitive recovery. working on memory, executive function, focus, sleep. i think a lot of people look at ian in s6 and think that the depression largely stems from the breakup and the diagnosis - i see a lot of fics that have ian realizing “what he’s done” with mickey after the meds kick in, and that’s what sends him off on this depressive mood we see. 

and of course that’s part of it. regret and shame are awful things to face. and there is a grief that accompanies recovery. you’re mourning your health, your plans, the future you thought you were building. 

and in a lot of ways, you end up mourning the mania itself - the ideas you had, the power you felt. it can feel like nothing will make you truly special or worthy again. and so you get depressed. it’s all over, and what’s left? what now?

the depression also comes from the ways we are all forced to define recovery. when do you get to declare yourself recovered, and what do you have to achieve first? what are the indicators of progress? for ian, i think the depression deepens when it comes to this aspect of the timeline. there’s no such thing as just bouncing back from an episode like that - and it’s so much more intricate than just rebuilding the social and practical aspects of his life. 

routine is good for us but it’s also boring sometimes. recovery is boring sometimes. when you’ve been going and moving and acting - the monotony of healing can be infuriating. i think ian definitely deals with this. when the progress is slow and largely internal, it can seem like we’re just stagnant. it feels awful. ian is lost, even as he heals. 

there are other studies that argue that existing scales and rating systems for bipolar depression can fail to capture the nuances of bp lows. this is because they are skewed towards unipolar depression (or MDD). so when we talk about bipolar depression, it’s important to really understand what we’re saying - we need to take into account the possible polarity changes within a single episode, we need to remember the greater mood variability. 

i think shameless skewed the fandom perception of what bipolar depression looks like. the first lows we see - monica in s2 and ian in s4 - show us catatonic characters completely unable to function. ian just seemingly wakes up that way. they don’t see it coming. 

and that happens. of course it does. other studies suggest that bipolar depressions might be shorter, but they are quicker to onset and have greater frequency than MDD. but that’s not the whole picture - and i think we do ian a disservice by glossing over the nuances of his experience and recovery. 

there are also cognitive troubles associated with depression that can only be compounded by those associated with mania and medication. it’s all of this that makes ian’s s6 story so remarkable. but it’s those s6 episodes that show us how deep it can settle in the bones, how tiring it is to exist, drifting from recovery milestone to recovery milestone - and then, before you know it, you’re blinking awake a little easier. thinking a little clearer. quicker, sharper. with something to fight for. a life to look forward to ❤️