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I have a disability everyone can see. My bipolar friend who died by suicide did not.

At my last birthday in November, I received a cheery pink-and-white card from a close colleague who had died months before.

Startled, confused, I checked the handwriting and the return address. All legit. I immediately emailed a mutual friend. She had received one on her birthday, too.

No, this isn’t the prelude to a tawdry murder mystery. Our well-wisher had apparently hired a mailing service, which to my knowledge she had never done before. I had to wonder whether she was already planning her exit when she signed the cards.

Like Kate Spade and Anthony Bourdain, whose  suicides last June preceded my friend’s by only a matter of weeks, she struggled with her mental health. The day of my friend’s passing, I learned she was diagnosed with bipolar disorder, but I should’ve already known. As a longtime wheelchair-user and disability-rights advocate, I might have recognized the telltale signs.

Bipolar disorder is easy to hide, hard to ignore

A vibrant 50-year-old with her own business, a new boyfriend and no kids, she was prone to intermittent bursts of brilliant brainstorming energy followed by long, frustrating periods of solemn silence. She never told me why, and I never asked.

Not that my knowing would’ve made any difference. She had other friends who did know, as do many of the estimated 10 million American adults who experience bipolar disorder at some point in their lives, and at least a quarter of whom attempt suicide. It’s thought to be caused by a combination of biological and environmental factors. New treatments such as ketamine are said to help, but there is no cure.

I can’t pretend to understand this implacable, erratic psychiatric disability. The International Society for Bipolar Disorders, which is marking its sixth-annual World Bipolar Day this month, hopes that awareness and acceptance can lead to earlier, better diagnoses. Eliminating the stigma could help avert some suicides. I believe it, though it’s hard to be aware and accepting if we can’t see it.

The stigma surrounding disability is certainly real. For me, it can be as big a problem as steps or narrow doorways. Born with spinal muscular atrophy, a progressive neuromuscular weakness, I’m pencil thin and have a curved spine. Sometimes, even at age 56, I’m embarrassed by my appearance. I have to dig deep inside to bolster my self-esteem, especially when others stare at me or, worse, look right through me.

In a way, though, I have an advantage. My disabilities are obvious. Meet me and you know them instantly. This has forced me to develop coping mechanisms. It has forced me to accept what can’t be denied. I can’t pretend to pass.

My late friend, however, could pass. Whatever issues she faced were opaque, cryptic. Her mental illness was probably not easy to ignore, but easy to hide.

Social stigma and survivor’s guilt

I wish she had shared a little of her struggle with me, if only because I inevitably shared some of mine with her. We might have bonded over it, two kindred spirits. Then again, maybe our shared but unstated experience of otherness explains why our professional relationship evolved into a heartfelt friendship.

It might just be that I’m going through survivor’s guilt. I’m no stranger to grieving. You can’t live in the disability community long without losing a few friends. Every year my holiday mailing list grows shorter, though I can never delete the names of the no longer living from my Facebook or email contacts. Cyber immortality does no harm, I figure.

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