Bipolar snakes and ladders – what’s your visual image?

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‘It’s a slippery slope, this bipolar stuff’. That’s how actor Michael Douglas recently described wife Catherine Zeta-Jones’ bipolar. Yup, definitely slippery. As someone who has struggled with bipolar disorder, I can vouch for that. But it’s something else, too. Waiting for the bell to ring in my son’s school playground recently, it struck me what that something else may be.

Imprinted on the pint-sized picnic table where we sat was a snakes and ladders board. That simple pattern, with its progressive squares, its strong, indefatigable ladders and its slippery, achievement-trashing snakes feels, for me, like a blueprint for how it feels to live with bipolar.

Now, I don’t remember playing snakes and ladders that much as a child, largely because it’s totally frustrating. There you are, doing so well, zipping your way up the board when, crash! You’re literally back to square one. Apart from helping you learn to count in those early days, snakes and ladders is, I feel, an energy-wasting and pointless pursuit.

The thing is, with most games, the more you play them the more you master them, like chess, and Scrabble. Learning from experience, you pick up tips and develop strategies. But anyone who has played snakes and ladders knows it’s not about strategy. No, this game is purely about luck, the throw of a dice, an exercise in randomness. This is why grown-ups don’t play it, except as a game with vodka shots where the unexpected adds to the hilarity. Up then down, up then down, up then down. It does your head in.

So imagine feeling that your life is like a never-ending game of snakes and ladders, a life where you’re seeking order but where randomness seems to prevail, no matter how hard you try. That’s life in a bipolar skin. Or, at least, that’s life in my bipolar skin.

The ladders (hypomania or mania) take you way, way above where you were before (and where any ‘normal’ person would be), giddy with the thrill of ascending too fast. Then, suddenly and without warning, a snake (depression) plunges you perilously down to the bottom, sending you from uber-competent to terrifyingly depressed, only to start the ascent all over again once wellness returns. And plead as you might, ‘I want to play something else!’, you’re stuck with it.

Another mental health blogger, bipolar II sufferer SlightlyManicMummy, talks about her ‘Snakes and Ladders life’ where her ‘delicious highs’ make her feel, amongst other things, ‘super-human’. Then there are her bipolar lows, her description of which hits this bipolar nail on the head:

F*ck you and your  d i s g u s t i n g ,  d i s g r a c e f u l  lows. When I am ugly. When I don’t wash for days. When I just don’t give a sh*t about myself. When I think I am the worst mother in the world. When I think I am the worst wife in the world. When I pity my family for having to put up with me. When I  l o n g   to be me before I got really ill. When I am cursed with crippling anxiety. When I peel the skin from my lips. When I can’t face anyone except my husband and son. When I just get so tired putting on a front.”

When I read this description of that depressive inertia that lies at the tip of the slippery snake’s tail, I can see how far away from the top of the board with its lofty ladders it seems, and I understand more fully why being bipolar is so exhausting and, quite frankly, the antithesis of fun.

OK, so I can see that for many people, even those who don’t have mental health issues, the snakes and ladders analogy may be apt. Life is largely random for all of us, despite our best efforts to frame and tame, and things can be going oh so well, only for life to intervene and dump us in the doldrums.

However, I think there are key differences for people with bipolar.

Firstly, for people with bipolar (especially for someone who is rapid cycling or has mixed affective disorder, like me, where highs and lows can happen simultaneously), the ladders or ‘highs’ aren’t necessarily peaks of happiness or achievement, as they may be for someone who is free of mental illness. Consultant psychiatrist and former vice-chairman of Bipolar UK Dr Nick Stafford, of Clinical Partners (, says: ‘If the ladders represent the highs, they don’t usually lead to an advancement in life, and the snakes are both episodes of highs and lows.’ Neither are particularly fun.

Secondly, if the course of ‘normal’ life is like snakes and ladders, then the speed at which this game is played is, by and large, comfortably and leisurely drawn out. For someone with bipolar, especially if it’s undiagnosed, untreated or responding poorly to treatment, it can be like playing rapid relay snakes and ladders, snakes and ladders against the clock, whizzing up and down and all over the board, tired and wired, locked into the highs and lows of a game that never seems to end. At the peak of my illness, especially before diagnosis, any given day for me felt like playing snakes and ladders scores or even hundreds of times. It’s at those times you feel like climbing out of your own skin and coming back later when it’s all calmed down.

Thirdly, if the the snakes and ladders analogy for ‘normal’ people is relevant, it exists alongside an ability to, at least for most of the time, cope with ups and downs by rationalising and intellectualising that this sadness, these hard times, aren’t going to be forever. The highs may also be pleasurable, marking true achievement or success, rather than being like a destructively fast car or an insane funfair ride. ‘Normal’ people are able to rationalise that the view from the ladders is capable of compensating for those times when life inevitably sends you down a snake.

But for someone with bipolar, rationale doesn’t really come into it, because it is an illness and not a frame of mind. No matter how straightforward the coping mechanism may seem to someone who is mentally well, the coping mechanism for someone with bipolar means they may be incapable of seeing the wood for the trees, even if it’s presented to them. This is why saying ‘chin up’ or ‘look at all the amazing things in your life!’ doesn’t work for someone with bipolar (and can, in the depths of illness, even make them feel worse).

Fourthly – and this is what can make bipolar such a lonely illness – it’s like playing a game that isn’t a game at all, a game that everyone knows in its harmless and benign form but not in this insidious and potentially deadly variety. ‘Voices of Glass‘ mental health blogger Kevin Deane says:

…whilst snakes and ladders or chutes and ladders is a game that friends and family can all get involved in and whilst friends and family can indeed get involved in the life of a Bipolar Disorder sufferer, the fact is that they can never truly know what those ladders or those snakes or chutes and the desperate opposing realities of difference between them are truly like unless they too also suffer from the illness.”

So this is bipolar as I see it (although I’m well aware that others may not view it in this way). If this is what it is, can you change it: can you choose a different game? Or is it a case of learning to live with it? I personally don’t think you can bow out of bipolar snakes and ladders (despite ‘remission’ this is a life-long game) but you can learn to manage it, tame it, reposition it, adapt it so that it somehow works for the different brain of a bipolar person.

Medication has helped me cope with the ‘game’, slowing down and elongating the pace of it so that it becomes more akin to the snakes and ladders game of life that I imagine ‘normal’ people play. It also, I think, helps to prevent the ladders being too lofty and the snakes feeling quite so deadly. It doesn’t prevent the undulations of life, the ups and downs, nor does it anaesthetise: it just stops things feeling crazily high or catastrophically low. The meds slow down the pace so there’s more time and space to think about how to handle the inevitable highs and lows of life to prevent relapse. They make me feel ‘normal’.

My visual image has been helpful because it enables me to understand how I function as someone with a condition. It has also enabled me to see where there may be gaps, places where drugs alone can’t reach, and how I might go about plugging them.

I’m thinking this may be where something ‘cognitive’ may be relevant, which is why I’ve been interested to read about social rhythm therapy (SRT), or Interpersonal and Social Rhythm Therapy (ISRT). This is a type of behavioural therapy devised by US Professor Ellen Frank, which – from what I can see – helps people with bipolar to take control of or work out how to stomach the highs and lows, the snakes and ladders. A combination of calming, coping and crap-clearing, tailor-made for bipolar ups and downs. Sounds enticing – I’m keen to give it a go.

In the meantime, I’m interested in other people’s visual images that they use to describe their mental illness. Fast cars and planes? Snakes and ladders? Or simply ‘a slippery slope’? Please let me know. Images like these can, I feel, lead to greater understanding, both for the person living with a condition and for those on the outside trying to help.

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Freelance journalist and mental health blogger, based in London UK

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