Saturday, November 26, 2011

Geodon Withdrawal

Well, I now know why I couldn't sleep.

I'd accidentally missed two days' worth of my Geodon and Cymbalta. And it was the Geodon withdrawal that was making me wired - among other things. What happened is this: I filled my weekly pill box, but ran out of Geodon and Cymbalta as I was filling it. No problem, I thought - I'll see my psychiatrist in a few days, he'll give me a prescription. Saw the psychiatrist, he gave me the prescription, but forgot to fill it Wednesday and obviously couldn't fill it on Thanksgiving. I thought I'd had enough in my pill box to get me through to Friday, but... no such luck. And because I take all my meds from my pill box during dinner, it's easy to forget which pills I've taken and which I haven't.

The upshot of missing my Geodon and Cymbalta was fifty-six hours of wakefulness, and at the forty-eighth hour additional symptoms: hot flashes and cold sweats, light-headedness, and worst of all these horrible electrical impulses that went from my brain to my feet. They were so bad I could barely walk. They were so bad that as my body, desperately tired, started to fall asleep, I'd be woken from my dreams by horrible, horrible brain zaps.

As my psychiatrist's office was closed for Thanksgiving, I ended up in the emergency room, where it was first suggested that I might have missed a dose of Geodon. In the emergency room with the on-call psychiatrist, I pieced together the last day I could be sure I'd taken all my meds, which made my symptoms make sense.

So now my family's out the cost of another ER visit, and I put everyone through a lot of stress and worry over an avoidable mistake. Everyone's being really nice about it, but I feel like /shit/. I could have avoided this if I'd been more careful and responsible.

Friday, November 25, 2011

Late Nights

It looks like I'm going to have been awake for forty-eight hours straight, and I'm terrified by this. I'm totally exhausted - physically ill - and I just can't get to sleep. In desperation I tripled the dose of the benzodiazepines I was prescribed, hoping I'd finally drop off, and... nothing. I'm woozy, I'm physically ill, and I still can't make myself fall asleep.

I think if I could finally conquer my sleep issues, I'd be able to live a relatively stable life, even with my diagnosis of bipolar disorder. Medications help, but sleep - really ironing out sleep - is so critical. It seems that sleep is the first thing to go wrong and the last thing to mend when I have an episode. Before I get depressed, for instance, my body starts to need more sleep than usual. A week or two after the hypersomnia begins, my mood starts to drop, and my sleep gets worse and worse. Meds can help fix the mood issues, but the sleep issues persist; it takes real sustained effort to get my sleep back on track.

I've been working hard - with help - to be able to sleep normally. Unfortunately, I haven't made much progress. For the past month, while my mood's been fairly stable, my body has been demanding ten to eleven hours of sleep per day. Worse, if I wake up after less than ten or eleven hours of sleep, I find it impossible to function - I can barely keep my eyes open, I'm not safe to drive, I stumble as I walk down the street, I fall asleep on the exercise bikes at the gym during my morning workouts. It's more than the usual morning grogginess, it's like being drugged.

And now, suddenly, I can't sleep. What precipitated all this was spending last night sleeping on the futon, since my brother was home for Thanksgiving and I gave him my bed to sleep on. I always have insomnia when I shift my sleeping arrangements - always. And I'd sort of forgotten this in my desire to make my brother more comfortable, and the upshot is that I couldn't fall asleep last night. And now I can't fall asleep tonight - I'm completely wired right now. And I took three Tylenol PM and three benzos, and by all rights I should be zonked out. And instead I'm increasingly clearheaded and feeling weirdly antsy and energetic, like I want to take a long walk or something crazy like that. It's two in the morning! I have to be up at six. I've been awake now for forty-two hours. And I'm not tired.

This is bad, obviously. Sleep deprivation is one of those things that brings about mania, after all, but more than that this is going to fuck up my circadian rhythm in a major way, and what progress I've made toward a regular sleep schedule is probably going down the drain.

I don't know how I'm going to get through tomorrow - there's a lot I have to get done - and I'm worried that I'm going to start hallucinating again, something that happens to me if I'm sleep-deprived. Out of the corner of my eye, things start to move that aren't supposed to move. The light switch on the wall starts to slide right and left, or to twist into shapes that are no longer rectangular. I see thousands of ants crawling out of pillows. I see the light fixture on the ceiling pulsing and twisting and throbbing. I know it's not real, but unless you've lived through it - lived through either psychiatric hallucinations or a really bad trip - it's hard to express how awful it is to have the world start to be untrustworthy. The best thing I can compare it to is being in an earthquake: the sudden panic that the rules you take for granted, ie that the earth is stable, are suddenly thrown out the window.

So yeah. I am not a happy camper.

Wednesday, November 23, 2011

Holidays and a few other things

Thanksgiving is almost here, and once again I'm bracing myself for the holidays with my family. Historically, my parents fight terribly over the holidays, particularly over Christmas; last Thanksgiving went well, however, but mostly because it was my father's first sober Thanksgiving in decades. My mother still drinks.

I hope she doesn't drink this Thanksgiving - it would be rotten if, in this small house, my mother got drunk and lost her temper the way she has in the past. She's having a rotten time right now at her job, which she hates, and she's pissed that her boss gave her neither the Wednesday before nor the Friday after Thanksgiving off; so of course the temptation to get really drunk and blow off some steam is there for her. I get it, I really do (as much as someone can who never drinks when she's angry) but I am afraid.

I hate being afraid every time a major holiday rolls 'round. It sucks that when people mention Christmas, my first thought is of domestic violence and drunken verbal abuse, but it's true. My parents have just been awful to each other and to some extent to their children for the past decade.

Why? For all the usual reasons. Holidays are stressful. My mother in particular feels it - she hates watching the money go out for what feels to her like manufactured cheeriness, a false happiness where everyone is expected to act delighted regardless of what they feel. And this pressure to look and act happy makes my mother miserable, and drives her to drink. My father's reasons for drinking I understand less well - in part it's a response to my mother's consumption, and the stress he feels being around an angry drunk. In part he had his own demons, I suppose.

But my mother drinks a lot less now than she used to. This family, which I'm so used to thinking of as a failed family, works a lot better now than it did three years ago, or five years ago, and god knows it works better than it did nine years ago, when things were really dark. I talk about a lot of private things on this blog, but some secrets aren't really mine to share, so I'll not say anything further in this vein.


There are a lot of street people in this town on the central coast of California where I now live. It shocks me, who for so many years lived on the east coast, to see on every street corner someone in a dirty jacket, maybe with a bike and a knapsack or saddlebags crammed to the gills with gear, or else with a cardboard sign that reads, "Hungry Please Help".

At first my reaction to being importuned for money or conversation was to ignore people - just to breeze on by and pretend I couldn't hear them. I am a shy and private person in many ways and being accosted on the street makes me nervous. But for a variety of reasons, I've gradually changed from ignoring street people to actively interacting with them. I had a conversation with a lady sitting on the street with a little dog the other night; I asked her if she'd like me to buy her dinner and she said "No, thanks, I've already eaten - it was a good night." So I gave her a little money for her dog, and talked with her a bit, and went home. Liked her more than the guy I met in a bar that night.

I made sandwiches and handed them out five days ago - sandwiches and cokes and apples. I don't like giving money, because I don't have much of that, but nobody in this family starves, thank god, so I feel okay taking food to give to the hungry. I'm getting to know some of the people, who usually frequents which part of town.

You ask why? Because I see myself in each one of them. Sometimes very strongly. Yesterday, driving to the supermarket to do the Thanksgiving shop, I saw a woman with her husband asking for money by the side of the road. I knew this woman. I'd been in the hospital with her. I won't betray the confidences of group therapy more than to say that when I met her she was actively delusional, and I very much doubt she's able to get her medications if she and her husband are homeless, as they appear to be.

I see myself in the homeless in part because - hokey as it sounds - I really truly believe that all men are brothers, all women sisters, in god if in no other sense, and that therefore we all owe it to each other to be kind and to give what we have to those who need it. It's not a terribly organized theory of charity, but it's the loving-kindness aspect of Christianity that I like so much, admire so much in that religion (and really, don't all religions advocate for helping the needy?). And in part I see myself in the homeless because I'm chronically mentally ill, currently unemployable, and if not for my family could very well have ended up in the streets, with all that that means.

So this Thanksgiving, I thank god that I am not homeless.

Sunday, November 13, 2011


One of the rougher parts of being mentally ill is always wondering what's the disease, what's you, and how much point there is in struggling against a particular symptom or side-effect.

I've been having bouts of hyper-somnolence lately where I wake up so tired I feel drugged, sleepwalk through the day until I can nap for a few hours, and for the rest of the day feel tired and low until I go to bed, usually quite early in the evening. These days are very hard on my family - it's rough for them to try to work around my exhaustion, which is pronounced and unusual, and it's also hard for them because they know, as I do, that irregular sleep is very bad for people who are bipolar and can cause or exacerbate episodes.

Dr. Dumas (who is going to work out, it looks like) thinks the Geodon may be the culprit. He's switched the time I take it from dinner time to right before bed, which is a pain because I have to eat substantially when I take this pill for it to be absorbed properly, and it's going to be hard for me to keep losing weight as rapidly as I have been if I'm eating a sandwich every night before bed. I found Dr. Dumas's explanation of why taking Geodon later should work better dubious, but I'm willing to try.

If it doesn't work, however, I'm tempted to ask him to stop the Geodon. This makes me nervous, for several reasons: first, because it was at least in part due to the Geodon that I snapped out of my most recent suicidal depression; second, because if I stop the Geodon I'll certainly have to up the Lithium, a drug I historically haven't tolerated well; and third because any major change in medication could destabilize me again.

So the calculus is difficult: is it worth having irregular, disruptive sleep habits (where three days out of the week I'm sleeping 12+ hours a day) but decent mood? Or is it worth risking my mood for the uncertain benefit of stable, regular sleep?

And added to all this is the question that maybe, if I tried extra hard, I'd be able to stay awake and fight through the tiredness despite the drugged feeling I get. Maybe if I were really, really tough and gritty and hard-working I could defeat the side-effects. It's hard to know. Hard to know.

Life is uncertainty.

Friday, November 11, 2011

Interviewing Shrinks

It's 5 am, and unfortunately for me, I've been awake since 3. I fell asleep at 7:30, and my body clock is all out of whack - as per usual, my bipolar brain is fighting my attempts to get a regular sleep schedule down. The plus side: more uninterrupted time for blogging!

Last week I had my first visit with the second of two psychiatrists I've seen in the region. The first is an eminent guy at a famous university. Let's call him Dr. Schmidt. He's a colleague of my grandfather's (my grandfather is a well-known Australian psychiatrist who's written a number of books on child psychiatry). Dr. Schmidt is a child psychiatrist, but he agreed to see me as a favor to my grandfather to give a second opinion and referrals to other docs. He's the guy who referred me to the psychiatrist I saw last week - let's call him Dr. Dumas.

I didn't like Dr. Dumas, but because I was so damn tired I was completely sedated through our first interview, and I didn't get a chance to interview him the way I wanted to. I'm at the point where I've seen enough different shrinks to know what I like and what I don't, and I don't want to see a guy I dislike, or with whom I disagree about important stuff. I'm hoping that, on a second visit, Dr. Dumas will improve. Here's what I didn't like about him:

1. His office was a total mess. Piled high with books, food, papers, all the way to the ceiling. Very uncomfortable to be in, very weird to be in. Bespeaks a disorganized mind - I'm frequently messy, too, especially when I'm doing poorly.

2. He swore, a lot, inexplicably. I think he works mostly with adolescents, and maybe it's an affectation he's picked up, trying to impress the kids with how "down" he is. Whatever his reason, there's no excuse for a shrink saying, of my side-effects, "That fucking sucks."

3. On a related note, he treated me weirdly as a child. For instance, he insisted on showing me magic tricks with a deck of cards. Why on earth should I care? What's the point? How does it relate to my treatment?

4. I just got a bad vibe. Harder to explain, but everything from his messy office to his ugly bowtie made me feel uncomfortable with him.

5. Finally, he prescribed me benzodiazepines for zleep. If I'd been more alert, I would have insisted- HELL NO! I'm not taking /anything/ with the possibility of drug dependence. HELL NO!

It might all be me, but I doubt it. During the meeting I have with him today I'll try to hash out what his treatment plan might look like, what his goals are, and what his methods might be. I'll ask him about his training and his affiliations.

And I expect him to get snippy about it. Doctors are used to being treated with unquestioning respect, and it's hard, as a patient, to convince your doctors to treat you with any respect at all as an educated consumer. Doctors don't like the consumer model of health care, and it has its problems, but I'd much rather be empowered through the consumer model than not at all.

I have no idea what the therapist I'm seeing this morning is going to be like. I was referred to this guy by Dr. Dumas, so I hope he's alright and not a weirdo, because it was hard enough getting an interview with him.

Tuesday, November 8, 2011


I've always been a terrible procrastinator, and that's what I'm doing right now - avoiding a chore I dread. What chore? Applying to a few California state schools for next fall. I need to apply for my brother's financial aid consideration, and I need to attend some school - any school - to keep my student loans deferred. But oh god, I don't want to go to a California school. I like California well enough, and I'm a good student when I'm sane, but I'd be a commuter student, and it's hard to make friends at a new school period, let alone when you're only there for classes. Of the three schools I'm applying to, I'd far and away prefer to go to UC Santa Cruz - it's the best of the three schools - but CSU Monterey Bay and Monterey Peninsula College are far cheaper and far closer. I'd be commuting more than an hour every day to go to Santa Cruz; the gas alone would be expensive, but the tuition is also more costly - twice what I'd pay at CSUMB, and much more than I'd pay at the local community college, MPC.

But it's hard to try to get excited about taking community college classes. My parents are friends with two professors in the area, one at CSUMB and one at MPC; both teach in subjects I care about - the professor at MPC is the head of their Great Books program, and the professor at CSUMB teaches biology - and I'm going to get to meet them this Saturday at my parents' dinner party. So I'll show up, be cheerful, look as normal as I possibly can in front of people who know about my mental breakdown because this party was cancelled a month ago so that my folks could fly me to California, and just grin and bear it.

But yes. Decreased expectations. And I do know I'll be happier and better off in any school rather than no school, but god damn it I want to be at St Johns, I want to be in Maryland, I don't want to be in California.

Sunday, November 6, 2011

Decreased Expectations

It's hard for me to believe it, but in August I was walking with my father at the Presidio, and we were talking about my plans for Medical School - how best to finish up my pre-medical requirements as a post-baccalaureate student. I was going to apply to Hopkins and Goucher, and my fallback was the excellent University of Maryland system. I'd be living near my friends even after I left my undergraduate life, and I'd be independent. I was so excited.

Now? I still don't have a degree, and may not have one for several years. My father's trying to convince me to get a paralegal certification, so that I'll have an employable skill that will enable me to live independently in "a few years, when you're more stable." My head knows that it's smart, that it's a way to get some job security (after all, even if I never got a job as a paralegal, I could get secretarial work). But my heart?

I can't believe this is what my life looks like. I'm scared of spending my twenties, the years which should be the freest and most independent of all, living in my parents' home, dependent on them for food, shelter, and the medical care I evidently need, with no friends in the area and of course no boyfriend or girlfriend, because how can you really date as an unemployed sometime student living with the 'rents in suburbia, with no car? It never happened last time, that's for sure.

Maybe this sounds entitled. Life never happens as planned, I know that rationally. But there's a big part of me that feels... cheated. When I was a kid, I was usually the smartest student in the room. Teachers would take me aside, tell me I was going to be so successful, that I could be anything I wanted. When I was teased at school my father would comfort me by telling me that one day I'd be the judge sentencing my bullies to jail time - a little over the top, I know, but you get the picture. What I'm trying to say is, I thought that part of the social contract was, if you work hard and you're smart, you'll have a good life and be rewarded for your efforts. But it isn't that simple if you get sick or for a whole lot of other reasons, like poverty or debt or bad family life.

I dream a lot about running away and escaping. I fantasize all the time about winning the lottery (though I don't buy tickets - I know they're a bad investment when you haven't got any money!) and using the money to move to Greece or travel the world. I think about money all the time, in a way that makes me feel low and mean. I feel a bit like Lydgate, from Middlemarch, shocked that such petty things could drown out my thoughts of philosophy! and science! I even fantasize sometimes that maybe I'm not really bipolar, I've actually got some bizarre parasitic infection that makes me seem crazy, but when a doctor figures it out, they'll cure me and I'll be sane for the rest of my life.

The last time I wrote, I was very fragile. I was trying to process a scene from the movie Margin Call, where a trader flirts with suicide on top of a skyscraper before deciding "not today". And I ended up triggering myself instead. In fact, I spent the night in bed with my mother - something I hadn't done since I was a very small child. The next day was my first appointment with a psychiatrist from the area, a peculiar man with a bow tie and a penchant for profanity. I didn't like him, but I'll try him a few more times - I was half asleep the first time I saw him, and that didn't help matters. He prescribed me benzodiazepines for sleep, which I am not going to take - insomnia isn't a huge problem for me right now, it's waking up in the morning that I have trouble with, and I'm scared of habit-forming substances. Petrified, actually.

I'm okay. I actually enjoy a lot of things about my days - I saw redwoods today! Huge beautiful trees that you could stand inside of, one that was forty-five feet around. I saw sea otters playing at Elkhorn Slough in Moss Landing. I saw a beautiful rainbow after the storm. But I also cry a lot, I think a lot about what I've lost, and I'm lonely a lot of the time. Things are good - for now - with my parents, and I hope it lasts, because if that goes I might get desperate again, and I make poor choices when I'm desperate. But for now I'm okay.

Thursday, November 3, 2011

Back when I lived in Rhode Island, there were places I avoided as much as I could. Some of them, I couldn't avoid. What they all had in common was being places where I'd contemplated suicide.

There was the sharp bend in the road that I'd thought about just driving into. There was the highway overpass I'd tried jumping off of before I lost the nerve. There was the McDonald's parking lot off of RI-24 where I'd sat for hours before walking to the side of the road and trying to work up the nerve to throw myself into traffic.

Since I'm sitting here today, clearly, I didn't go through with any of this. I often wonder why. I knew two young men who killed themselves. Both were friends, though neither very close. Here's what they had in common: both were bipolar, both were drug users and drinkers. Beyond that? I don't know. They were both very young, both quite bright. One was a college student, the other was a fellow employee at McDonald's, a talented musician, and an occasional marijuana dealer. One was white, the other was black.

I figure being female is part of what's protected me so far from suicide. The stats on suicide are pretty clear - women attempt more, but men complete more. That I don't use drugs or drink also probably makes a difference. My mother was drunk when she tried to kill herself, by overdose. She panicked and got my father to call 911, but she went farther in her attempt than I ever did. I guess the equivalent for me would've been if I'd actually jumped, but come out with a few broken limbs? I don't know.

I know that it's always been sheer physical terror that's kept me back. Just terror.

I'm going to stop writing now because this is triggering the fuck out of me and all I can think about is overdosing. I'm going to find someone to be with until this moment passes.

Wednesday, October 26, 2011


I was thinking yesterday about why I didn't try to kill myself the second night after I arrived in California, when my mother had been so angry with me.

I had formed a plan several days earlier; I had easy access to the pills I was planning on using. It would have been so simple: I'd take a hundred tylenol, and then I'd take a couple of my Saphris, which sedate me quickly.

So why didn't I? A couple of reasons. First, my father pleaded with me that night not to do anything to myself. He extracted a promise from me. That alone wouldn't have been sufficient. Second, a kind of sheer cussedness in me didn't want to die just because my mother was furious with me - "Don't give her the satisfaction." Almost directly contrary to that, but still complimentary, was a desire not to be seen as manipulative by my mother if my suicide attempt should fail - not to be seen as using suicide as a means of getting attention.

But the most important reason? I was too unhappy to kill myself.

Self-murder takes a certain moral clarity, a kind of courage. True, many people kill themselves because they are afraid to remain alive, but it takes courage to live with death for the days, weeks, months, hours leading up to a suicide attempt. When you are suicidal, the thought of suicide becomes a kind of talisman, a comfort, a reassurance that whenever you want to, you can just quit life, leave, abandon everything and everyone. Nobody can force you to live.

Even in hospitals it's possible to kill yourself. People leave windows open sometimes, or else you could hang yourself with your bedsheets, or just bang your head against the wall until you shattered your skull. You could save your plastic utensils, and splinter them into something sharp enough to cut yourself with. When you're suicidal, everything becomes a temptation for self-harm. While I was in the hospital this most recent time, before my meds were changed, I had been cajoled into arts and crafts, which they were calling "occupational therapy" for some reason. As I was sewing up a wallet I'd been given, I kept thinking about stabbing the needle into my eyes. Truly, everything becomes a means of self-harm in the depths of a suicidal depression.

But depression is not the same thing as unhappiness. I found the thought of suicide calming in the days leading up to my move to California. Every time my mind strayed to how much I was losing, how painful it was to be kicked out of school for a second time, to lose my friends and my apartment, I comforted myself with the thought of suicide. I was depressed, but the product of my depression - suicidality - actually made me calmer and happier.

It is very possible to be happy while depressed, and to be sad when your brain is functioning normally. This is what a few hours of happiness while depressed feels like, at least to me: there's a kind of hysterical giddiness to your temporary relief from pain. You know it's only temporary - that when you're alone again, away from the love and laughter of your friends or family, your depression will settle over you like a thick, viscous scum, tainting everything you touch, everything you try to do. At every moment, you feel the depression - like the specter of death - hovering over your shoulder, so close that you almost think you could catch sight of it if you turned around quickly enough. You feel extraordinarily visible, as if everyone can see you, can see that you're a fake, that your happiness isn't real. You laugh too loud, your eyes are a little too wide.

In contrast, I am now normal, and sometimes very sad. I cried two nights ago, silently and spontaneously, out of loneliness for my friends, for the people I left behind in Maryland. But I am alone for much of the day now, and this is no longer an object of terror for me: I go for walks by myself and am not afraid of my thoughts. I had a job interview today, and when I didn't get the job - the hours weren't right - I shrugged my shoulders, said "Oh, well," and enjoyed my day.

I don't know why I've been given this reprieve. I had fully expected the depression I felt this fall to last for months and months. It began lifting the day my meds were changed - and the day my mother reassured me that she loves me. Which was more important? I don't know. But as I said last time, each day now feels very precious to me, and I savor the sun on my shoulders as being especially sweet.

Saturday, October 22, 2011


A lot's happened since I last wrote.

I got kicked out of school.

I got put on suicide watch at school while my father flew to the east coast to pick me up.

I had a last meeting with my psychiatrist, "Dr. Blum".

I said goodbye to my dearest friends.

I flew to California, for the next two years at least, perhaps for the rest of my life.

My first night in California, driving down the highway from the airport, my father tried to prepare me for my mother's anger. I cried a lot, told him how suicidal I'd been for the past few days, and he backed off. I came into my parents' house scared and extraordinarily depressed.

Monday morning when I woke up my mother was already at work; I spent the day with my dog, who is a lovely dog, and I waited.

My mother didn't eat dinner with us. I knew it was bad - my mother's anger is slow, and it builds, and she lets it build, waiting until she's had enough to drink that it all comes pouring out of her. At maybe eight o'clock at night she knocked on the door of the room I'm sleeping in (my parents' guest room), and confronted me.

How could I have lied, and pretended everything was alright? How could I have missed appointments? What was wrong with me, that I'd fallen apart so completely? She'd always managed to work and make her appointments when she'd been so depressed. What did it mean that I was suicidal? Wasn't it just an act, an attention ploy? And above all, how could I have lied? Wasn't I just a terrible liar?

I quickly became incoherent, mute, in the face of her anger. I avoided her eyes, and this made my mother even angrier. It was a terrible evening, I wept inconsolably. I listened to my parents scream and fight about me outside my bedroom door.

The next day, my father drove me to the local hospital for an entrance interview for their partial day program - which, for those of you who aren't familiar with psychiatric care, is a 6 to 8 hour a day program of group therapy and individual meetings with a psychiatrist. During my interview with the program coordinator, I stated, after much prompting, that I was suicidal and couldn't swear that I wouldn't act impulsively and try to take my life. And so instead of entry into the partial program, I accidentally talked myself into another psych stay.

What can I say about the hospital? It was a large unit, and I was the youngest person there by about thirty years. Most of the patients on the floor were, like me, bipolar (I think because, compared to schizophrenia, bipolar is relatively common, and compared to depression, bipolar is relatively severe), and a few were delusional - none were acutely psychotic. As with all hospitals I've been in - and I've been in four - I slept as often as possible, because there was nothing to do and hospitals are frankly scary places to be trapped in. And you can't just walk out of a psych floor - once you've signed the papers, you're there until a psychiatrist releases you or you take legal action.

Within two days, I was feeling enormously better. I'd had my meds changed, by a doctor whose manner I disliked, but who I suppose knew what she was doing. I went from being on (deep breath) Saphris, Stratera, Lithium, Lamictal, Cymbalta and Latuda to being on Lithium, Lamictal, Cymbalta, and Geodon. Lithium is the classic bipolar mood stabilizer, Lamictal (generic lamotrigine) is an anti-seizure med which, like Depakote, was approved for use in bipolar in the early 90s, Cymbalta is an anti-depressant, and Geodon, like Saphris, Zyprexa, Abilify, Seroquel, and others, is an atypical antipsychotic.

Unfortunately, I've been experiencing a lot of unpleasant side-effects. Two I know are from the lithium: headaches and constant acid reflux. One I suspect is from the Geodon, since it started when I began taking the Geodon - dizziness and a kind of trembling weakness in my limbs, not so severe that I can't function normally, hold a pen, etc, but enough to be uncomfortable and disconcerting.

But like I say, I feel enormously better. The meds are probably a significant factor - but so was patching things up with my mother. I feel tremendously guilty about being hospitalized for a second time in two months, and I suspect my mother's current kindness to me is because of my hospitalization. I worry that she thinks I tried to get hospitalized to get back at her, that I was making suicidal threats as manipulation. Truly, I wonder whether perhaps that's unconsciously what I was trying to do. Consciously, no, but ... well... I don't know.

Today is a beautiful, sunny, gloriously warm California day. I walk my dog three times a day and get plenty of fresh air. I love the natural beauty of this town, on the water, with seals and sea lions and pelicans - pelicans! - along the piers. And I have felt happy now for two days in a row.

And that scares me. Scares me deeply. How can I be so happy, when I have lost so much? Lost my apartment in Maryland, lost the company of my friends, lost my chance at the best education in the world at a unique, impossible-to-duplicate school. I have no idea where I'll finish my college education, or when, or what degree I'll get, if any; what career I'll pursue, and in the short term, what job I'll manage to find in this down economy. I'm living on borrowed time and kindness, sheer kindness, in my parents' house. I live with two alcoholics, one eleven months in recovery and one who's still drinking. There's a lot of love in this house - in this family - but there's a lot of grief, anger, and resentment too, and sometimes that grief and anger and resentment is going to boil over and wound every one of us.

But today? I'm happy. God grant that many more days will follow. And I'll try to enjoy this feeling while I can.

Sunday, October 2, 2011

Consolations of Philosophy

I first began seeing my current psychiatrist - let's call him Dr. Blum - in January. During my first visit, Dr. Blum analogized mental illness to having a nail embedded in one's foot. In both cases, medical treatment is indicated; simply telling a person to cope with the pain would be inadequate, and also malpractice, because with medical treatment the root source of the pain could be eliminated (or at least managed, in the case of a chronic biologically-based mental illness like bipolar disorder).

That evening, I went home and started flipping through one of my two copies of the Everyman Epictetus, which contains the Discourses, Fragments, and Handbook. In the Handbook, I found this aphorism:

As, when walking about, you take care not to tread upon a nail or twist your foot, so likewise take care not to harm your ruling faculty. and, if we guard against this in every action, we shall set to work more securely.

Almost an identical analogy, but with such a different intended interpretation! Instead of mental anguish being thought of as an unforeseeable accident of life - but an accident whose effects could be ameliorated through medical care - Epictetus sees harm to one's mental faculties as a preventable accident which everyone has a duty to be on the watch for. As in so much of Epictetus's writing, one's mind is one's chief possession, the only one which any human being has any hope of holding on to and controlling, and the most valuable possession any human being has, as it is the one true path to happiness and freedom, as all earthly, bodily things can be stripped from a person.

Epictetus knew a lot about misery. He was born a slave in Phrygia; while his Roman master allowed him to study philosophy, according to one story that same master also deliberately crippled him by breaking one of his legs as punishment for some transgression or other. While Epictetus eventually gained his freedom, throughout his philosophy several key themes are repeated: one's life, freedom, health, and possessions are ultimately beyond one's control, as they can be taken away at any time by accidents of fate or deliberate human cruelty; and therefore one must seek happiness through self-control and internal virtue, as one's mind and one's choices are one's only true possessions.

Epictetus thrilled me when I first read him, several months before I descended into my first depression. I was seventeen, and in my second year of college. At sixteen, when I began my college education, I had read no philosophy; the Greek and Roman philosophers I read over the next two years made an extraordinary impression on me. Plato taught me to love the Good and Beauty, and to seek both ideals with all the passion and energy of eroticism. Aristotle showed me the possibility that through moderation human beings could achieve virtue, and that the goal of a philosophic life was to create the habits which would lead to virtue. And Epictetus taught me that philosophy would allow me to create my own happiness regardless of what happened in the world around me by teaching me self-control and the proper attitude with which to approach all of life's vicissitudes.


I was already predisposed to be skeptical of the psychiatric or psychological approach to misery before my first exposure to philosophy. I had witnessed my mother's terrible, terrifying depression for all of my adolescence, and had left home for college at sixteen in part to escape the tyranny of her moods. No amount of treatment seemed to make her any easier to live with. My father spoke dismissively of psychology as a soft science full of mumbo jumbo.

Ancient Philosophy taught me to think of the mind and soul as entities essentially separate from the body, and to blame myself for any unhappiness I felt, as clearly it meant I wasn't virtuous enough, or strong enough, or wise enough. If I were better, I wouldn't be miserable.

My first exposure to therapy only confirmed my preconception that my misery was "all in my head" - I did a course of cognitive-behavioral therapy with a Licensed Clinical Social Worker. By the time I saw her, I was already on the upswing, as I always am during the summer; I still retained a great deal of my native optimism and work ethic, and loved the idea that I could prevent negative feelings my recognizing irrational patterns of thought and stopping them in their tracks.

I went back to school for my junior year that fall unmedicated and with no treatment plan or follow-up scheduled, no idea what to do if my depression returned. And it returned. With a vengeance. I read Pascal for the first time that fall, identified intensely with his experience of wretchedness, mentally diagnosed him with Major Depressive Disorder, and wondered (not for the first time) whether I would find consolation in Christianity. Atheist that I am and was, I tried very hard to believe in God, but never had the experience of grace which Augustine describes. I was left to deal with my own wretchedness alone: no God, no family, no therapist, and certainly no psychiatrist.

I will not detail the years it took to finally get adequate treatment and an appropriate diagnosis. I will say that I fought medical treatment tooth and nail. I hated the idea that I would have to take mood-altering medications in order to be a functional human being. It felt like a betrayal of philosophy, an unvirtuous, weak-willed, materialist shortcut. But within three weeks of starting lithium and lamotrigine, I was a human being again, able to work, to laugh, to be a loving daughter.

Of course, my path has not been straightforward. I have continued to experience cycling moods despite improved (not perfect) compliance with medication. I am now resigned to the fact that my misery is biological, that no amount of strength of will can cure it, that neither grace from God nor the consolations of philosophy will be sufficient.

So what is the role of philosophy? What can stoicism, or Aristotelean ethics, offer to a psychiatric patient keenly aware that her brain - the seat of her mind, and perhaps her soul - is outside of her control?


A few things. I still use the CBT I was taught four years ago. I use it every day right now. I have the insight to recognize the illogical patterns of thought my depression creates, and CBT helps me to work through the pain. I am able to sit through class, to attend lecture, because I am able to challenge the thoughts which produce intense feelings of shame, guilt, anxiety, and self-loathing. Medication can help the depression lift, but until then I need CBT to endure the depression.

And philosophy helps me think about what kind of a person I want to be, what kind of a life I want to lead, what actions I think are ethical. Epictetus's stoicism has been of great comfort to me when dealing with miseries whose sources are external. Stoicism has been just as much use to me as therapy in dealing with turmoil in my family and cruelties inflicted by others. Stoicism is marvelous if you want to sort out what is or is not in your control, and helping you learn to base your own happiness only on the things that you can control.

Stoicism, like psychiatry, seeks to end human suffering. One works on the brain, the other on the soul; and we are still all wondering what the connection between the two is.

Thursday, September 29, 2011

Insight and Intelligence

In the past three days, I've been three times to the office of my new psychologist. He runs a large practice (I think at one point he said there are forty-odd people who spend some time in his offices each week), but I have primarily been interacting with the owner and director of the practice. Today I met with Barry (let's call him Barry) and my mother to interpret the results of the battery of tests I took yesterday. Aside from the obvious ("You're really depressed!"), there were a few things I've been thinking about since I left his office.

Barry commented that the tests showed I was both very intelligent and very insightful. I've heard this from multiple therapists and psychologists before, and where it once made me feel proud and hopeful, now it's mostly just annoying. I talked about it with my mother as I drove her to the airport: what good does it do to know that I'm bright and insightful, if I'm still miserable? What good is it to be bright and insightful?

Well, the insight I know rationally is a positive good: I don't, for instance, make the same kinds of mistakes that I made three or four years ago. Because I'm observant of my moods and behaviors, and report them fairly accurately to the professionals whom I see for treatment, I've been able to curtail some behaviors and thought patterns that caused me pain in the past. But insight has not been enough: there is no amount of insight-based or skills-based therapy that will cure me of bipolar disorder.

So I get tired and frustrated when I hear psychologists become excited over how intelligent! and insightful! I am. I'm sure I'm a more pleasant patient to see than one who is dull-witted, combative, and incapable of recognizing harmful patterns in behavior, but it's not much comfort to me in the moment when I'm experiencing a depression that I know, rationally, is chemically and biologically based but which still feels as though it's rooted in circumstances and in my character and personality.

Tuesday, September 27, 2011


I intend to use this blog both as a vehicle for self-exploration and as a platform for serious discussion of the intersection of psychology and philosophy as approaches to living with mental illness. I am twenty-one years old, a college student (by the skin of my teeth), and bipolar. I do not have a mild or particularly manageable case of bipolar - I have had many episodes, episodes of depression, of hypomania, and also mixed episodes with symptoms both of depression and of elevated mood. These episodes have frequently been disabling, and have interrupted my life in serious ways. I am not fond of this illness, and frequently wish that I did not have to live with it, but I am past the point of denial. Now it's just a matter of learning to live with this disorder - and oh, how easy that sounds when put into words, but how hard it is in practice!

I am currently three days out of a ten-day hospitalization for bipolar depression. To be blunt, I tried to jump off of a bridge. My depression has been somewhat alleviated by the medications I was prescribed while inpatient, but has not gone away; if my previous depressions are anything to judge by, my current episode may last for several months. Because of the severity of this episode, my graduation from college is going to be delayed by another year: by the time I graduate, I will have been an undergraduate for seven years, since I was sixteen years old. It is frustrating beyond words to see my friends graduate, get good jobs, even marry. But I have made myself a private promise: even if my disorder is sometimes limiting, I am determined not to let it become disabling.

I am bright and driven, and to my chagrin I have come to recognize that is not enough. For many years I was noncompliant with my medications, but the results of my unauthorized med holidays have been predictable, though not always rapid: a return of symptoms, symptoms which when untreated are disabling. I am now treatment compliant, but unfortunately that is not enough to ward off a return of symptoms, either - because my diagnosis is so new (a year and a half ago) I have not yet found, with my psychiatrist, the ideal combination of medications to keep me asymptomatic and free of onerous side effects. I have tried many, many medications, but I am blessed to live at a time of rapidly expanding treatment options for patients with mood disorders. Thirty years ago I might have been stuck with lithium, which gives me terrible, weeks-long headaches and awful nausea. Now, luckily, lithium is not my only option. But the plethora of choices poses difficulties all its own.

Much of my undergraduate education has involved a careful study of Western philosophy, not to mention literature. Many philosophers promise that their style of thinking, sometimes formulated as a system, sometimes expressed in aphorisms, can produce true happiness, can alleviate wretchedness, can provide real consolation. I love philosophy dearly, and it was very difficult for me to come to terms with the fact that there is a biologic - dare I say mechanical - underpinning to the grief and anguish which my disorder has often caused me. It is so tempting to say that if I only embraced Stoicism (or undertook Pascal's Wager) I would be able to conquer my bouts of depression through willpower alone. But I cannot. And I am left wondering what philosophy is for, if it is insufficient for human wretchedness?

These are the things I intend to write about: my own experience with mental illness; my own struggles with philosophy; the intersection of my disorder, my treatment, and my philosophy; and my attempts to live a life unafraid of stigma. I hope to reach out to others writing about similar topics, whether they be peers who also have psychiatric diagnoses, amateur philosophers, clinicians, or anyone else interested in the mind and its diseases.

Wish me luck!