RealMental

Hi Doctor, it’s (BipolarLawyerCook). Wanted to follow up with you about last week’s toxicity episode and the step back to a lower dose of lithium. I am feeling much physically better now– the headaches are essentially gone, as is the sensation of a waterlogged, heavy head. I am less dizzy, less sleepy, and less nauseous. That permanent lump in my throat is almost gone now.

But I’m really bummed out, because while we were waiting for my blood work to come back, my mood snapped into place, like a dislocated joint, or like that pop that your back makes when the massage therapist finally gets that one knot out. It’s since dislocated again, and I’m back to feeling a little too close to the surface. Before I slipped out of place again, the husband and I had a fabulous night, and he said “you haven’t laughed like that in a long time.” No, I haven’t.

I say “close to the surface” not in the sense of boiling over in irritation, of exploding with rage, of imploding at any minute into a sucking vortex of need. More like seeping through whatever dry, calm, surface I am trying to maintain. Cute puppies, a touching email from a friend, a favorite hymn? Teary-eyed. A sarcastic remark from the husband, a thoughtless interruption from some in-law? The eyes well, the hands and voice shake in anger and hurt. A question in an interview about some unresolved stuff from my last job? My face flushes, my voice and hands shake, I have to apologize for my “clearly still feeling angry.”

It never lasts too long, and I am learning to just be quiet through it, but I’m feeling I still need a tune-up, a popping back into place. Certainly, I could live close to the surface like this– because it’s still not the prickly cranky ouchy huffy angry enraged hurt self-conscious depressed worthless I don’t want to wake up, I’ve been holding this bottle of pills in my hand for too long spectrum. I could live like this– perhaps the inability to maintain a poker face is better for me, given my not-so-successful history of repressing my feelings. But I am getting tired of constantly blotting my now-slightly damp to outright-soggy surface– I really don’t own that many towels.

So, once we get me back down to my non-toxic dose, get my new level, and confirm the passage of the poison, I hope we can talk about some fine-tuning. I don’t know– half doses? Mega doses of B vitamins or Omega 3s? A gym membership? I feel the need to tinker, to tune, so I feel truly fine.

(Only slightly more detailed than the voice mail I left my poor psychiatrist.)

That you are more irritable, more angry, every day.

That I am not The Enemy.

That I am here because I choose to be.

That there are so many landmines around currently, I can’t take a step in any direction without setting one off.

That I have made, and continue to make, sacrifices of myself in order to be with you.

That I make these sacrifices because I love you.

That I do not feel like a martyr.

That  following a burst of anger just before bedtime, while you go to sleep with the aid of sedatives and sleeping pills, I am left awake, crying, hurt.

That I don’t have anyone to confide in–not really–partly because I want to protect the way you are perceived by others, and “this” is not “you.”

That I feel very, very alone.

That I temper every single decision I make, no matter how seemingly insignificant, with what possible effect it may have on you.

That I resent not only not being able to look forward to Springtime, but having to dread its coming.

That I feel like I’m being “used up” faster than I should be.

That when I am sick, like I am now, I try to somehow “schedule” my illness and treatments around what I think you can handle.

That I sometimes feel trapped, even though intellectually I know that I’m not.

That I have learned more than you’d believe about detachment.

That I refuse to be manipulated by The Bipolar Beast.

That a great deal of my strength in dealing with these bad times comes from knowing that I am only here by choice, and that the power to stay or leave is all mine.   I can say “I don’t have to take this,” and mean it.

That the fact that, so far, I have chosen to, and have been able to “take this,” does not mean that I always will be able to.

That you do keep getting better.  Even the worst times now are better than the best times “then.”

That I appreciate when you try.

That I understand that it is hard.

That I KNOW it’s not fair.

That I am your single most loyal ally on all of God’s earth.

That if I don’t figure out how to get some of myself back, there won’t be anything left to give to you.

That by the time you could read these words with understanding and empathy, they will no longer be relevant, because you’ll be “yourself” again.

That I’m not sure how long I can hold out waiting for that time to come this year.

Dear Mom:

Brother and I owe you an apology– we have been indulging in a months-long fantasy that you’ve been OK, ever since you left here in November. We should have known that two breaks in two months was too much, and come out to visit earlier. But we’ve been hoping and wishing that you’d be compliant, and take your meds, and go to your shrink, and behave like a rational adult. Why we engaged in this mutual delusion, when you never took responsibility before you were diagnosed, I don’t know. But I’m sorry we let you slide for so long.

Instead, when you stopped answering your phone this week and disconnected the answering machine “because God told you to,” I had a sense of dread that This Was It. And then I got the call from Shrink that you’d missed a second appointment in a row. When Aunt got over there to check on you at Brother’s request, it wasn’t pretty. You answered the door stark naked. The toilet had overflowed, and there was a more than dubious puddle out into the hallway and into your bedroom. The management company had to tear it up.

To be fair to us, even after we discovered that your mania had allowed you to lie about med compliance in a calm and even tone, there were long periods where you seemed really lucid. You had normal conversations, recalled things from past calls, had no trouble recalling words or nouns, and didn’t drift off, mid-sentence. Your intelligence masked how far off the deep end you were—it was only seeing you in person that would allow the observer to see all the things you’d thrown away, and read all the stacks of gibberish God had told you to write.

When Brother got there, he was able to observe those things. He was also able to see how suggestible you were. We’re both worried for what this means to your bank account. And you refused to go for inpatient treatment. Well, your shrink doesn’t want you back as a patient, so if Brother can’t find you a new one next week with the help of the county social services agency I’ll be calling, we may be committing you anyway.

You see, we need you stable enough so that you don’t act up on the plane ride home. Because you can’t stay out there anymore. You can’t be trusted to take your medications or attend your appointments, and we can’t fly out to the West Coast to frog march you into every appointment. Once we get you qualified for Disability, there’ll be a supplement to your income, too, and hopefully we can get you into a nice Assisted Living facility where you can take some of your stuff.

We’re not looking forward to the fight in getting you home. We’re hoping that physically watching you take your meds every day for two weeks will get you stabilized enough that you won’t fight about it. But if we have to have you declared incompetent over your objections, so be it. It might almost be better if you stayed as you are, docile and agreeable, while we pack your things, change all your financial papers, and deal with your current landlord.

If you do regain some lucidity, I know you’re going to think we’re just trying to take over your life, but that’s the furthest thing from the truth. See, I can’t speak for Brother, but I really want very little to do with you. I want you to be happy and safe—I don’t hate you—but I don’t want you in my life, really, except at the outskirts. Bringing you back means weekly visits and caretaking and tolerance of your narcissistic bullshit, when all the while I really want to slap you for being so selfish.

At the same time, Brother and I are happy for you, if not us, inasmuch as your separation from reality seems to have stabilized at a happy point. You’re not paranoid or angry or violent, and you know who and where you are. While a nice scary psychotic break would have at least landed you in the hospital, giving us some leeway in getting them to keep you longer to try out a better medication regimen, I don’t wish you the scary visions and voices that would have required.

We don’t know what’s going to happen—we’ve been worried you were undermedicated anyway, and on the wrong mood stabilizer to boot, so we’re hoping we can get you something back to normal. But it’s been a while now that you’ve been fluctuating in this narrow band of crazy, and that does real damage to your brain, even though you didn’t believe me when I tried to talk to you about the need to take your meds, back when this whole thing started. So, if you remain the precocious and delusional three year old that you are right now, well, it could be worse.

You may never read this letter. Even if you do, your bipolar and your narcissism may prevent you from appreciating the best intentions that Brother and I have in setting you up someplace where you can have some independence, and yet still be taken care of. Despite all your faults, despite all the damage you did, you did instill in us a sense of responsibility, of caring for those not capable. I’m sorry, too, that I can’t end this letter by saying that I forgive you. I don’t, and I may not be able to. But I won’t hold it against you, either, and that’s to your credit, no matter everything else.

It scares me that I, the crazy one, seem to understand best what’s going on in my mother’s head.  It also scares me that despite all the harm that she’s caused me over the course of my life, that I am also the most diligent at spanning the 3000 physical miles and 3 million mental and emotional miles in order to check in with her.  How scary that I, the one who hates and loathes her with much of my being, am the one who’s the most responsible.

My aunt, an older sister, has no insight into the mania/paranoia/delusions, and still takes it personally when my mother lashes out at her during an episode.  Almost a year from mom’s first diagnosis, she’s only now beginning to understand that distancing isn’t just necessary, it’s a lifesaver.  Granted, she’s got her own issues going on, and isn’t yet properly medicated and/or in a working therapeutic relationship, but you’d think that a lifetime of sisterhood would lend her better insight, better tolerance, than I.

My younger brother, the summa cum laude biochemistry graduate from an Ivy League school, perfect-scorer on his MCATs, decade-long pharmaceutical reasearcher who’s practically his own controlled experiment in SSRI’s, MAOI’s and tricyclics, tends to treat it all as pathological.  He doesn’t think, or doesn’t want to think, about the problems of underlying personality (narcissistic to the point of delusion) and the way they factor in to the difficulty to date in managing her disease.  He doesn’t yet get how the lack of a proper med combo to control her manic swings isn’t just the mania itself, but is further fed by her narcissistic insistence that she knows best when it comes to discontinuing her antipsychotics– she’s no longer feeling paranoid, and the voices aren’t so loud, so why shouldn’t she, she knows herself best– and so he thinks that it should be enough just to tinker with the meds until she’s on a better mood stabilizer and an antipsychotic that work.

And her psychiatrist, who seems to know what he’s doing, but he only sees her every two months and not usually during her worst manias, because she’s become a clever liar and because she cycles every six weeks?  Well, he just doesn’t see her when she’s bad, when she’s calling in the middle of the night, wanting me to do something from 3000 miles away, when she can’t even write down the phone numbers that I look up for her because she says she can’t find a pen or can’t make her hands form the numbers, or more usually, that “God says I can’t call them, you have to,” or that “God made the phone stop working, except for the speeddial.”  He doesn’t see that.  He also doesn’t see the narcissism at work, erasing the memories of those episodes in the aftermath, so that she says “oh, no” when I remind her what happened and tell her to update her speeddial.

Someone has to put the fear of God into her, and my attempts have failed.  I can’t make her stay on her antipsychotic.  I can’t jolt her from her narcissism, provoke the rock-bottoming that is sometimes necessary to break through that lying self-regard.  But if I can threaten her independence with the assistance of the county mental health social workers, and threaten to lock up her bank accounts against her spendthrift tendencies, make it so that someone out there is checking in on her every two weeks?  That might do it.  The concern of people who she ought to love enough to listen to isn’t doing it.  And frankly, if she never spoke to me again because of it?  I’d be happy, so long as she took her damned meds and went to therapy and did the stuff she’s supposed to do to manage her disease.

The problem is, she’s never acted like a grownup my entire life.  And I’ve been too much of a grownup since I was barely out of toddlerhood.  It doesn’t so much scare me that I, who still struggle with managing my own bipolar, know best what she’s going through.  It scares me that I will have to continue to mother a mother who never mothered her daughter, and that I will always know best, that no one else will step in to fill the gap.  It scares me that I will always be her mother.  I don’t want to be her daughter, or anyone’s daughter.  I don’t want to be her mother, her anything.  I want a chance to find a “just me” that doesn’t require those roles.  I want relief.

I’ve been battling this flu that has struck the Northeast like a tornado.  Knowing that half of my in-laws have it does nothing to alleviate my personal misery, however.  It’s bad.  After seven days of on-again, off-again fever, poor sleep and the inability to keep a thought in my head except what pestilent fever and congestion engender, all the negative thoughts I’ve been sifting through come crashing down all at once, making it harder to breathe than it already was, with that cough nesting in my chest.

I’m trying hard to heed the advice I would give a friend– to continue to take it easy.  To know that people who are even mildly depressed to begin with are more susceptible to illness.  To not try to rush my recovery, because I’m still depressed, and thus more prone to relapse.  To try to set aside the negative thoughts, the self-blame, the feelings of failure and the “sure knowledge” that I will never amount to anything– because I would tell my friend that the darkness of the sickroom is not the time or the place to meditate on such things.  Better to wait until I can examine them in the fresh air and sunshine, where I can get a better look at them, and not be overwhelmed by the stench of self-pity.

I’m going to try to take my own advice, since I know I’m someone to whom my friends turn.  Now if I can do the same…

Snow swirled, wind moaned, skies turned dark,
then lightened, sun shone, snow melted,
water steamed and cast little rainbows,
but moments later, all turned black again.
The cycle turned, three times snowing,
twice sunny, on and off throughout the day.

It was a relief when night fell–
to lose the sight of such extremes,
of sunny, black, sunny again,
exhausting to endure. Just as I’d
gotten used to one, the other’d come
rushing in to supplant it, turn and turn about.

At least in darkness the senses are less
overwhelmed, knowledge more certain.
The windows may rattle, or not–
but at least it’s one consistent view.
The the unlit pink sky, presaging snow,
is not far from simple black.

It’s not that I prefer nighttime, you must
try to understand. It’s that the change
from light to dark in the blink of an eye
is too much too soon to safely take in.
Were it sunny to overcast, or light to dusk—
I could bear it better, but not the extremes.

So when you’re perplexed why I’m
willing to abide an inner dusk,
shading to mental nighttime, please know
it’s not a preference for depression, but
rather the fear of the fall from a greater height.
The slow slide from a lower height is smoother.

Of course I’ve a preference for daylight.  But
I like it in measured doses, eight hours or ten,
a sustained release of happiness when I can
produce, relax, and predict better things to come.
Think about it like a roller coaster.
Once in a while, the speeding descent from

crest to trough is thrilling. But if you had
to ride the rollercoaster all day, you’d agree
the repetition makes you sick, that
you, too, had lost the sense of up from down.
You too would grip tight the safety bars,
close your eyes, and pray for the end, any end.

By JB

This week, I had a very hard decision to make. Faced with a meeting about my less-than-stellar academic performance, I had two choices. One, I could continue keeping my bipolar disorder a secret, continue pretending like I have no extra-ordinary challenges to medical school. Two, I could tell the truth I’ve been aching to tell all along. I’m bipolar. I’m treated. It presents unique challenges to my medical school education, and I am still figuring out all the intricate twists and turns of what it means to be a functioning bipolar person, a functioning bipolar medical student.

I’m only 10 months in, here. I am still figuring out who to tell, how to tell them, when to tell them. When is that magical moment? I told Joe in the line at Subway, I told Thomas while we were floating in kayaks on a river. I told Sahar while we were eating lunch; I told my lab group during one of our first lab meetings. All of these times, I felt, were the right times. These were people who needed–or deserved–to know. These were people I would feel fake around if I didn’t tell.

For all the grief it causes me in deciding, actually telling someone I am bipolar is truly a freeing event. Being bipolar is part of every moment of every day. It is inextricably tied up in my being. There is no point where I am not bipolar. I am medicated, which means I don’t act bipolar, but there is always the chance that my medicine will slip and become less effective, that I will need people in my life who know so that we can catch it early. So we can catch it before anything bad happens. So we can catch it before I ruin my life.

So I decided yes, which is something out of the norm. All materials I’ve read on the subject–and there are not many–by bipolar medical students reveal that they did not disclose. Above that, they refuse to disclose. They say it is the worst thing they could possibly do. Unfortunately, these medical students worry that the doctors who surround them, who decide about residencies, will discriminate against them. And I’m sure the concern is valid, which is a sad state in itself. How can we tell our patients that it is possible to be a whole functioning human being if we don’t believe it ourselves?

The truth is, I want to disclose my mental illness to everyone at my school. I want them to probe and pick my brain, to learn from my mistakes. This is something that my friends who know do sometimes. They get this look on their face, and it inevitably leads to a question. “Why did you seek treatment?”
“What was the worst part of being bipolar?” We talk about the symptoms and signs; we talk about what they should do if they suspect that something wrong is happening, which ranges from the practical [“Get me to a therapist.”] to the absurd [I’ll just run across the horseshoe and tackle you.”] We talk, which is good for me. It’s good for our friendships. It’s good for their future patients. It’s just good.

So, facing the dean of the graduate school, the director of my program, the words tumbled out like an avalanche. “In March, I was diagnosed with bipolar disorder. I am treated, and I have made a lot of lifestyle changes in the last year. The first semester of medical school was a difficult transition for me, because in college, I did a lot of manic studying. I’m still trying to figure out how normal people study.” He was very supportive and inquired about treatment. I assured him that I take my medication, but told him I was currently without a therapist or psychiatrist because of some insurance
problems. He was, thankfully, understanding, and referred me to the school psychologist. I have already made an appointment.

I hope that I–and my generation of doctors–can change minds, opinions, and attitudes about mental illness, especially as it pertains to medical school. People with mental illnesses can perform well in medical school, and they can [and deserve] to be doctors. Although I would gladly trade my mental illness for a clear bill of health, I can do good with it. I can advocate for other mentally ill people, and I will share a true empathetic bond with my patients. It is well-noted that doctors make poor patients, but I hope the opposite is true well. I hope that patients make good doctors.

So I disclosed. So I will continue to disclose, to trusted colleagues and administrators, to anyone who will hear and listen, to anyone who is interested and can offer support. I will continue to disclose, because I owe it to myself. I owe it to future generations of medical students, who I hope will have an easier time of disclosing. And I owe it to all of the patients of all the future doctors I know now, the ones who may have an easier diagnosis because of me.

Originally posted here.