Episode

Things That Are Meant To Make You Feel Safe And Comfortable In A Psych Ward That Just Make You Feel Crazier:

• Writing in crayons
• Eating meat with a spoon
• Measuring time in meals and snacks
• The conspicuous lack of plastic

I predicted this would happen. This is not impressive in the slightest, as this outcome was obvious given my history. Yet I was still left shaky and confused by just how accurate my precognition was, once I realized what was actually happening was a manic episode.

It goes like this: spring arrives and I’m exuberant. I get big ideas. I make plans. I make friends. I can’t stop writing. I crave fun. These are all fine, on the surface, but different from what a doctor would call my euthymic mood. This is hypomania. It is the great love of my life. I am not fully unconvinced most of my accomplishments in adulthood are not the result of this elevated state.

When it came this time, though, I felt a tiny bit of panic. I’d been unmedicated for months and months at this point. No pills, no doctor, no therapist—nothing tethering me to baseline should I start to slip too far upward. Things seemed to be going too well, and so I knew it would fall apart at some point.

I remember wondering in April if all my lists and laughs were kindling mania. I wrote the thought down: “I’m wondering if by June I’ll be a twitchy ball of nerves, bouncing from angry to ecstatic, wanting to do everything and thus incapable of completing anything. I’m a little afraid.”

I also remember thinking, as everything got more expansive, let’s just ride this out. This is, I think, having insight into the disorder while still lacking insight nearly entirely.

I’d bet nobody would want to give up sudden inspiration after a winter of writer’s block.

When I decided to go the the mental health crisis stabilization unit, I’d been drinking two bottles of wine a day for two weeks. I’d been further fucking my already fucked sleep cycle with iced coffee and terrible energy drinks. I couldn’t pick my thoughts apart, they stuck together too closely as they zipped through my head. And I was still having fun. Then I woke up sick and sweating, and I laughed at the black sludge I could hardly control sliding from my body. I searched ‘withdrawal from alcohol binge’ while opening a new bottle at noon, and cried as I read the results. I called my father. I demanded he not let me change my mind that I needed to go back on meds. He asked why, what was happening.

I’m sure I sounded insane on the phone. Maybe he’s just used to it.

“Do you have any thoughts about harming yourself?” the intake nurse asks. I am asked this approximately seven thousand more times during my stay.

“No,” I say. I want to ask, “You mean now? Or ever?”

Suicide has always seemed like an escape button for me. It goes back to high school, to my plan to kill myself upon graduating, back when college did not look like it’d be an option due to my poor performance. College had seemed inevitable until then, and the disappointment I knew I’d be to my family crushed me.

I had no idea then it was adolescent depression that made me go home and fall asleep to endless Law & Order marathons on TNT instead of doing my homework. I feel bad for the teachers who worried they weren’t challenging me enough. As if I’d ever avoid something because it was too easy.

I get along with the suicidal teenagers I meet while they’re waiting to be transferred to places that can house juveniles. They are all sad black girls like I was once. I look younger than I am, so they are surprised when they learn I am ten years older than the oldest of them. Maybe it’s my green hair. We watch Space Jam and I feel older than ever realizing they weren’t born when it came out. They are all there for suicidal ideation or actual attempts. It hurts my heart. I try to make them laugh and succeed. The third clinician to interview me is pleased by this, when she comes to collect me while I’m playing Bullshit with them. She says the place should hire me as a social chair.

I bond with the seventeen-year-old over Bukowski and Nirvana. I demand she watch the first Bring it On when she gets out. I give her my e-mail address. Later, she e-mails me the name of a song she was trying to remember while we were together. She sends updates on the “Christian therapeutic place” they end up sending her to. There is no Wi-Fi and it’s out in the country. She is so done, she says.

“I see you’re writing. Have you been doing a lot of that lately?”

“I’m always writing,” I tell the doctor. The resident with him nods. They both nod at me a lot. I wave around the hand holding the crayon as I explain. I’m writing a book, not like a novel, well I am writing a novel but that’s not what this is, it’s a chapbook, they’re like tiny books, anyway I got someone to agree to publish one but I felt blocked sometime in May and decided enough was enough finally and used the caffeine and the booze to help, to get back into that hypomanic Zen state when I had clearly already overshot the manic sweet spot. He says I’m talking fast. I tell him my Dad just told me to slow down on the phone, maybe an hour ago, who knows, it’s so weird there are no clocks in here, it makes you feel nuttier. I wonder, briefly, if he believes me about the book or if he thinks it’s a delusion. He explains degrees of mania to me and I nod, but I already know all this. I try to subtly mention I was diagnosed back when I was a graduate student studying pharmacology. I wonder if he thinks that’s delusion too. I wonder how smart I sound. I wonder how he understands mile a minute speaking crazies like me at all.

Once upon a time I wanted to be a psychiatrist. I realized I was too crazy to do it before the bipolar diagnosis came. When it was switched from dysthymia to major depression. When the Celexa made me hypomanic. When they added the Abilify to the Wellbutrin I was switched to because it helped with “treatment resistant” cases. I had to pick between taking the MCAT again and applying to medical school or going with the GRE and graduate school. I chose pharmacology because my mind told me I’d never make it through med school.

I didn’t make it through graduate school.

Perhaps having studied mood disorders and the like, having a lifelong interest in mental health really, has given me the insight that let me know I was manic and not okay this time. But it also makes me wonder, sometimes, if I am performing it all. If I’ve absorbed symptoms from books and research articles and anecdotes. This is how I talk myself into believing I don’t need medication, out of accepting the diagnosis. I can put together the puzzle pieces of clear depressive episodes where I spend months in bed barely eating, never showering, and the hypersexual, deeply creative, high flying mania that turns into me thinking I’m being watched, wanting to tear my skin off and die when the mood becomes mixed, and I will still say, “What’ll really happen if I don’t take these pills? I’ll be fine this time.”

I tell the unit’s weekend therapist this. She seems to enjoy talking to me, seems fascinated by my ability to rationalize away my diagnosis. I invite her into the room and joke it’s the cleanest place I’ll ever live. I tell her I cried when I arrived on the ward, after meeting two women clearly more ill with bipolar disorder than I am. I cried because I don’t belong here, I tell her. I cried because maybe I do.

A place like this is necessary, but poorly designed to control the group delusions that break out while I’m there. Throwing together all sorts of people in various states of crisis, this is bound to happen. One of the bipolar women there tells me about being overmedicated by the caretaker at her group home and I believe her until she talks about her sister wanting to kill her for some sort of inheritance. Her sister killed her mom, too, she says, back in the 70s and nobody is doing anything about it. She speaks with a medication induced stutter. She tells me I don’t belong there: I’m not crazy. Another manic woman spends her time drawing pictures of staff and patients and singing for us. She invites me to a party she’s having once she gets out and another patient moves in with her. There will be liquor and wine, she tells me. She draws two pictures of me. In one, she’s highlighted my nipples for some reason.

The girl who is supposedly going to move in with her has been there eight months. This seems beyond the time limit for crisis stabilization to me, and it confuses me. She alternates between tears and laughing the way an insane stock character would in a movie. When I arrive I bump into a man and she tells me not to touch her boyfriend. Later she is convinced I have said I will be her girlfriend and becomes upset when I correct her. She forgets she was mad at me fifteen minutes later and resumes planning an epic road trip. I tell her I don’t wanna go to Florida, I hate it. She says I can still go to California with her, then.

A nurse warns me to stop giving out my phone number. I am there to focus on myself, not everyone else’s problems. She tells me to keep to myself, get out, stay on meds, get back in school. I tell her I will. When I leave I add two friends on Facebook I met inside. We bonded over laughing at our collective misfortune of having to be there in the first place. We are crazy, but not that crazy.

Group therapy exercises on “mindfulness” aren’t possible when the group is comprised of several manic individuals. There’s one tranquil man, and he’s actually on a tranquilizer. The rest of us are talking over each other, getting distracted, blurting out non sequiturs. The clinician is patient, yet I perceive her frustration. I am frustrated too. I am mindful of this.

The “behavioral activation” group goes better, just two days later. We’ve had more time to let the meds cook up the neurochemical stew, maybe. I am leaving today. I am mindful that I am happy about this. I participate only to make the time until my father comes for me go by faster. We learn tips for changing our thoughts and how they affect our behavior. She gives us advice about taking on one big task for the day, not burdening ourselves with too much when things are rough.

I remember my quip about the cleanliness of my room back at home and I resolve to change. I activate my behavior. Serum level of aripiprazole rising, I wash all the clothes on my floor for the first time in months, since maybe around the time I first decided I didn’t need my anti-psychotic/mood stabilizer after all. It’s a small change. But it’s enough for today.

Tags: health, mental health, naadeyah haseeb, the butter