I have been HIV+ for twenty years. The usual: lost a lover, friends, was hospitalized, got protease inhibitors, kept going.

Two years ago I discovered I am also bipolar. I see the best psychpharmacologist and therapist in the city. I work, I have good friends and physically I am healthy. But I am alone, I am lost and I am worn out from a life of sadness. I am 45 and the thought of embarking on a new career (with all I have to deal with) is too much. I had a big life, but it's getting smaller and smaller. My suicide is the last thing I have any control over. Give me one reason (besides God) to continue to stick around.

Already Dead

Let me begin by saying that I am not a person nor a mental health professional categorically opposed to a person ending his or her own life when the quality of their life has so greatly diminshed, for instance, due to their being in such great chronic pain as to render further living unbearable. But from what you write you are far, far away from being anywhere that seems to make suicide a rational option. The fact that you are writing indicates that you really are not ready to die.

I am very concerned by the way you sign your e mail as already dead. You describe having a job, friends and yet you say you are alone. I don't know whether or not your descirption that your life is growing smaller is accurate. Having buried a partner and many close friends myself I empathize with your feeling sad, lost and overwhelmed. But from how you describe your life you are hardly alone. I am not minimizing the psychic sufferring that you are undergoing, I am just trying to give you a different perspective.

One of the best ways to expand your life is get out of yourself and away from focusing on your own problems. When was the last time that you did something for other people who are even less fortunate than yourself, like volunteering and donating your time and energy? This is a great way to begin to build meaning back into our life. The hopelessness, powerless and despair that you describe are all most probably symptoms of the depressive aspect of your bipolar illness, and I hope that you are talking about these issues with both your pharmacolgoist as well as therapist.

While there is indeed great sadness in your life, you just sound lost in feeling sorry for yourself. That is a self defeating path to stay on and one that can be changed by your taking responsibility for taking certain emotional and social risks that will have the potential to enrich your life and help you to creat meanng as well as even happiness.

Don't succumb to the despair. That is too easy and a total waste.

Michael Shernoff, MSW