Category Archives: bipolar disorder

After the Fall

One year ago, a bathtub full of blood. A fluttering of eyelids, a tightening of the gut after it hits you — that this is not nearly enough blood — that you have failed.

This is not about what led up to that moment. This is about what comes after.

***

Imagine, if you will, that you have been shot.

Imagine going to the emergency room after having been shot. Imagine having to detail the circumstances of the shooting to five different people, each of whom seem unable to understand why you got shot; none of whom believe you when you say the bullet is still inside you. Imagine being handed a photo of a Band-Aid and told that’s all they can do.

Imagine being told to “Have a nice day” as you leave, with the bullet still inside you.

***

You failed not because you suddenly decided life was worth living, but because your body simply didn’t allow you to succeed. You cannot die, and yet you cannot remember how to live.

So you spend hazy days searching for a new doctor to take you on, being referred to colleague after colleague, and each time you have to tell another person what you did — box cutter, Bayer, bath — a piece of your soul shakes itself loose and dissipates.

Now you are one more squirmy “Sorry, I’m not taking new patients” from another bathtub full of blood, and so you go, you finally go, to the place you said you’d never go.

At the psych ER you are taken in and patted down and escorted to a room that is more prison than hospital. The part of your brain still capable of reason understands why this is, but the rest is too busy wondering, “How did it come to this?” to care. You are in the place that has filled you with bowel-tying fear ever since you first thought about Doing That, was it 12 or 13, why can’t you remember. It feels important that you remember.

You try to explain to doctor after doctor what’s going on in your broken mind. They “mmhmm” at clinical intervals. You try not to cry while you are talking to them; you try to joke. This is a reflex — it is what you have always done.

You try to explain that this has happened before, and will happen again: You don’t know whether that’s in a couple days or a couple years, but you do know you need help, you need more than what you have been getting.

They discuss you behind bullet-proof panes. They tell you they do not think you need to be admitted.

A strange sense of rejection floods you. “What now?” you ask yourself after they leave the room, and you cry a little, because it is a scary thing, to be in this place and not know what to do.

They say they will give you the number for a “therapy center.” They fill out a “Personal Safety Plan” that is about as useful as a brick to the brainstem.

“I did all these things,” you tell one doctor, after he asks you where you can go to feel safe, and things you can do to feel less terrible. “They didn’t work. That was why I came here.”

He tells you you’ll be okay, that you just need someone to talk to.

You have been talking to people for nine years.

He hands you the number for a “New York Therapy Center” and a sheet of paper that says you are not a danger to yourself or others and leaves the room.

You step out hesitantly. “I can just go?”

The security guard buzzes the door open. “Have a nice day,” he says.

It is not until after you have found your way back out to the entrance that you realize you are, somehow, worse off than you were when you entered the building an hour and a half ago.

***

The New York Therapy Center is closed when you call.

You call again Monday morning. You explain what happened — the box cutter, the blood, the bathtub — to a receptionist who doesn’t seem to know how to respond. You ask to see a doctor as soon as possible. She takes your insurance information, ascertains that at this point you no longer care about having to go out-of-network, and tells you they’ll call back soon.

Tuesday morning passes. You call back Tuesday afternoon. “We’re still checking your benefits,” the receptionist explains. You reiterate your need to see someone as soon as possible.

Wednesday morning passes. You call a third time. “We’re sorry, but no doctors are taking new patients,” the receptionist says.

Your laughter comes out as a hoarse bark.

You find a random psychiatrist on ZocDoc who has an appointment available on Friday. When you show up, he deems you too “unstable” to treat — he specializes in medication management, not stabilization. “You need to talk to someone,” he says, even though you are sick unto death now of talking. He gives you the address of a walk-in clinic a couple miles from your apartment.

***

You do not go to the walk-in clinic. You think again about blood and bathtubs. You think about bridges and bullets. You wander aimlessly for a while, then start to laugh at nothing in particular.

You remember why you didn’t tell anyone the last time this happened. The medical establishment has failed you before, and they will fail you again.

There is no one in this world who can save you — save yourself.

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That Nameless Fear

The anxiety begins as a buzz nearly indistinguishable from the effects of a couple glasses of wine. Its source is somewhere inside your chest, possibly your heart, whose beat is currently cycling between the thrum of a hummingbird’s wings and the slow clop of a Clydesdale. The buzzing slowly fans out, up and through your clavicle and into your shoulders, down into your arms and finally into the fingers, moving restlessly, compulsively pressing the buttons on your phone. It snakes into your belly and wriggles like a living thing, your stomach churning with all the acid in the world. It crosses the blood-brain barrier and settles in your amygdala, activating the very worst of all the fears nested therein: You are unlovable, you are unwanted, now and forever. And all at once the buzzing turns to burning, a raging river of fire slicked with oil. The corrosive metallic taste in the back of your throat will not be relieved by any liquid, nature-made or not.

There is something wrong with you.

Two Poles, No Waiting

Everyone needs to read Jace Lacob’s amazing piece on Showtime’s stellar portrayal of bipolar disorder through two different lenses– self, and family. It’s bang-on, and has some really fascinating insights from the Homeland and Shameless writers.

I’ve yet to watch Shameless (it’s on my list), but there’s a reason everyone’s still raving about Claire Danes as Carrie Mathison in Homeland, and it’s because the character is written and portrayed as brutally, guttingly real. Carrie is a tragic figure, but there’s more to her than tragedy. For people like me to finally see ourselves on a screen, not as a murderer or degenerate or a collection of symptoms, but as a person, is truly remarkable.

“People like me,” yes. I’ve alluded to it in the past, but there’s no real point in being coy anymore: I’ve suffered from bipolar disorder for almost as long as I can remember. The toll it’s taken on my life is real, and every day brings with it another battle, but much like those poor souls still stuck in the closet, I’ve been unable to express any of these feelings, not to the people who matter. There’s an intrinsic fear of mental illness (a term I despise) in our society, an ironic nameless something in the back of our mind that whispers to us, “There but for the grace of God….” And so I kept this secret mostly locked inside, not wanting to unduly burden my loved ones. But coming up with excuses or thinly veiled falsehoods for friends (“Oh, I’ve got a bit of a cold, you go on without me”), or having to find a way to put feelings like “I am burning, with a thousand thousand hummingbirds flooding my veins” into normal, non-alarming parlance (“jittery”) wears on you, after a while. You begin to feel alienated, or alienating, even less capable of normalcy than usual. It’s easy to end up in a self-destructive tailspin, where all you can think is, But they can’t know.

So I smiled in sad recognition upon seeing the lengths Carrie goes to to hide her condition. And I felt the familiar clutch of panic in my gut as she descended into a hell where suddenly everything made sense but no one else could see. The strange, frightening joy of utter loneliness, drunk on the power of insight, with one small dark thought gnawing at you: It won’t last. The sudden crack as your mind crashes into the bedrock of reality, and you must once again find a way to gather the pieces. The Homeland writers genuinely understand that there is a certain strength that can come from this condition, and that the accompanying weaknesses are not to be trivialized. Carrie’s coping mechanisms aren’t so different from mine, either: She buries herself in work; I cocoon myself in my writing. We have specific music that must be listened to at certain times (for her it’s jazz; for me, Wilco’s very good at righting a listing ship). Sometimes, we don’t cope at all.

Of course, I doubt I’ll ever be able to share everything that goes on in this strange mass of misfiring neurons. It’s dark stuff, and scary, and that fear of abandonment or being a burden isn’t something that can truly be erased. For now, it is simply enough to say that this is who I am; that, like Carrie, I have my moments of brilliance and darkness, though seldom in equal measure; and that, most importantly, I am more than just a tragedy.

In which I tackle Something Serious

Well, this is terrifying.

I can’t imagine what it must be like to be a parent at 22, having just passed that agemarker myself. I would probably be a total wreck, and you certainly wouldn’t be reading this blog. But the above story of the woman and her child really is indicative of something very, very wrong with our medical system.

Everyone knows we’re living with a broken system, one that sees medical costs eating up 17 percent of our GDP and inflating at a rate three times that of the Consumer Price Index. The blame doesn’t just lie at the feet of insurance companies, though. (They’re certainly not helping, but they actually have a much slimmer profit margin than you might think.) Americans are starting to (starting to) fall into two categories: Those who don’t give a shit about their health or can’t afford to give a shit (which sucks so very badly), thus not receiving the treatment they need; and those who overreact and seek treatment for every little problem they encounter.

Don’t want to wait to see your general practitioner? Go to the ER. Feeling a bit under the weather? Better go to a doctor straightaway to get some antibiotics. (Not long ago, I was sick every couple weeks for a period of four months. Ear infection, cold, flu–you name it, I had it. My boss at the time harangued me, during each of these illnesses, to go to the doctor immediately, and was offended when I told him, other than the ear infection, that it really wasn’t necessary; I’m young, have a high-functioning immune system, and most of the time the doctor isn’t even sure what you have. They look at you for five minutes and send you on your way with a prescription for an antibiotic.)

Is your toddler acting up? Get thee to a child psychiatrist or neurologist, so he can be diagnosed with bipolar disorder, a condition that is incredibly difficult to diagnose in adults and encompasses a wide array of subconditions, and is really more of a spectrum than a discrete label. Finding the right medicine (hell, the right doctor) to treat the disorder is a long, grueling process that often doesn’t even have an endpoint. When you’re not the patient, you can’t possibly know what’s going on inside his head; you’re limited to interpreting external signals, which can be indicative of a huge number of mental states–even ones that fall within sociological norms. What makes this a hundred times more difficult is when the patient is just learning to speak and interact with other people in a meaningful way.

Now, again: I don’t have kids. But I was one once, and I helped my siblings grow into the surly teens they are today. (I’m 5 1/2 years older than my brother and 7 years older than my sister, so I have a pretty decent memory as far as their upbringing is concerned.) As my mother so helpfully reminds me every few weeks or so, I was an absolute monster from about the ages of six months to 3 years–in private. I yelled and screamed and beat my head with my fists and kicked the floor. But then I grew out of it (or was disciplined out of it, maybe). At gymnastics class at age 3, I was the kid who sat quietly while everyone else in the class gamboled about, driving the teacher nuts. I was the minority.

Kids are active, flighty little buggers; their brains are trying to figure out how to filter and process the overwhelming amount of information they receive every second, and they have an astonishing amount of energy. Sometimes that energy gets funneled into some pretty negative activities: My brother would frequently do something mean to me (either as retaliation against something I did to him–I’d be penalized too, in this case–or just because he felt like it, because he’s a boy, and that’s what little boys do), and would be sent to his room as punishment. Naturally, he did not approve of this punishment (purely, I suspect, because it was framed as a punishment; it’s not like his room was a broom closet or an iron maiden). How did he express his displeasure? Why, by lying on the floor in front of the door and just kicking the shit out of it. While screaming bloody murder, of course. He would do this for 20 minutes or more, sometimes kicking so hard, the locked-from-the-outside door would be jarred open. My parents did not medicate him into submission. They simply ignored his attention-seeking behavior when it was negative, and rewarded him when it was positive. When he did something bad, he was punished, and so learned that his actions have consequences. My brother is almost 18 now, and he’s just fine, aside from being obnoxiously arrogant; he is, after all, a 17-year-old boy.

My siblings and I were fortunate in that our parents were very intelligent people who knew the cognitive and behavioral milestones that children pass, and though their own were ahead of the curve, they understood that every child is different, and, just as some are a little faster, others develop at a slower pace. It’s when you have (metaphorically) poor young parents who are in way over their heads that you get problems. Of course there are fantastic young parents out there; they educate themselves and try to make as few mistakes as possible, like every other parent, and they tread carefully when it comes to medical treatment. But that can’t happen all the time. They’re busy, they’re stressed, they’re scraping by and/or going it alone, and when their kid starts acting like a total maniac or won’t talk even though the same-aged baby down the block is talking, they assume something is terribly wrong, when really it’s the kid being a kid. Maybe he’s acting out for more attention, maybe he’s just a little slower than the baby down the block or doesn’t feel the need to communicate. You can’t know this with any certainty, but what you can know is that drugs like Seroquel and Risperidal have a pretty serious side effect profile, and their impact on childhood development remains to be seen.

This is different from those horrible, awful people spreading the lie that vaccines cause autism. Vaccinations are necessary for disease control, and have a proven, demonstrable positive effect. Loading children up with antipsychotics (especially when they’re being prescribed off-label) brings us to the very fine line between “Better Living Through Chemistry” and “Just Being a Kid.”

Some children absolutely need medication. Obvious cases of ADD and ADHD, autism, etc. should be treated; it would be irresponsible not to. But cases like the one first mentioned are increasing at an unprecedented rate–shouldn’t we be exercising a little more caution here? Bringing down the number of overdiagnoses will bring down medical costs and save who knows how many kids from missing out on their childhood.

On Normalcy


Image ripped from Wikipedia

There are approximately nine definitions of the word “normal.” This rather large number of differing definitions stems from more than just variance from individual to individual; context is key.

In Mathematics:
Being at right angles, as a line; perpendicular.

But in Psychology:
a. Approximately average in any psychological trait, as intelligence, personality, or emotional adjustment.
b. Free from any mental disorder; sane.

(Funny how being different is normal in math, but abnormal in psych.)

I am not normal.

I lie somewhere along the bipolar spectrum. (“Where?” is not a question for which I really have an answer.) I’ve been this way most of my life; it was a relief to finally have a name–however vague–for what’s always gone on in my head.

And after seeing (half) the cast of Next to Normal perform at the Tonys (YouTube clip below), I decided that I definitely needed to see this show. Maybe it would teach me a valuable lesson in finding my way to–well, not complete normalcy, but something close enough.

That didn’t quite happen.

The show–about a manic depressive mom and the havoc she wreaks on her stalwart husband and angsty daughter–is magnificent. The cast is unparalleled. The music soars and roars and tugs at the heartstrings more than anything I’ve heard since The Last Five Years. But it terrified me. That is my future. Mental instability. Psychosis. Laying waste to the lives of everyone I love. Ruining a man whose sole purpose in life is to lift me up.

Of course, this is not something that is guaranteed to happen. (I’m not even sure men like Dan and Henry exist in real life, and you can’t ruin an imaginary person’s life, so I should be good on that front.) But even the possibility is enough to make you quarantine yourself.

Regardless of how much the show wrecked me, though, it occurred to me that this should be required viewing for anyone who knows a fellow bipolar bear. My hope is that Next to Normal will do for mentall illness (a term I really dislike, incidentally; beyond the stigma that surrounds it, it makes it sound like the flu or something) what RENT did for AIDS. While it’s ostensibly about Diana’s struggle with mental illness, the real protagonist of the piece is Dan, the long-suffering husband (played to perfection by J. Robert Spencer). It would be easy to write the character off as a codependent martyr (he can’t bear to face the world without her; he needs to save her), but there’s an earnestness, a sweetness, in him that is impossible to resist. His are the songs that rip your heart straight out of your chest, because you see he’s dedicated every fiber of his being to saving his wife. And why? Because forever is forever, for Dan. Because for him, love is stronger than darkness and death.

Like I said before, I don’t even know if that sort of dedication exists in the real world. I certainly haven’t seen anything like it. And it’s hard to imagine anyone who, after seeing the show, would be okay with becoming a Dan. But that’s exactly what some of us need, and what many never find.

And for those wondering about those manic/mixed episodes, the descriptions of the sensations are spot on: When a world that once had color fades to white and grey and black/ When tomorrow terrifies you, but you’ll die if you look back.

The sensation that you’re screaming, but you never make a sound/…Like a refugee, a fugitive, forever on the run. If it gets me it will kill me/ But I don’t know what I’ve done.

This is what it’s like for people like me. Every day. But I guess Dr. Madden (played by the super hot and amazing Louis Hobson) is right: “The one thing that’s sure is that there is no cure, but that doesn’t mean we don’t fight.”