“But I don’t want to go among mad people," Alice remarked.
"Oh, you can’t help that," said the Cat: "we’re all mad here. I’m mad. You’re mad."
"How do you know I’m mad?" said Alice.
"You must be," said the Cat, "or you wouldn’t have come here.”
― Lewis Carroll’s Alice in Wonderland
When it finally happens, it will happen quickly, too quickly perhaps, but quickly enough that it will make you wonder what took so long. There were so many incidents pointing to the moment, the realization, that there may be something wrong with you: Snippets of childhood when you felt isolated and lonely at family parties; the time as a teenager when you stole a bracelet from a friend’s bathroom because you were jealous she had so much and you had so little, and so you just took it as retribution for her privilege; days when you would scream and scream and scream at your sister the minute your mom left for the grocery story, just because you could, just because it felt so good to be heard; touching lips with boys you didn’t really like or touching skin with men you didn’t really know under the guise that you were a feminist and you could do what you wanted with whom you wanted; being the last to clock out at your fast food restaurant job because you could never get the dishes, the floor, the counters, clean enough. Maybe you had a wedding, but never really had a marriage because you felt relief, not grief, when your husband made out with a lesbian at your grad school commencement party. Maybe your divorce felt like an accomplishment when it should have been traumatizing, while actual celebratory events made getting out of bed and taking a shower an all-day struggle.
But you endured all those moments. You trudged through adolescence and into adulthood with minimal scarring. You now pursue your education so you can become an educator, to inspire the leaders of tomorrow, particularly those with an entrepreneurial spirit and a global view. You want to work toward something meaningful, toward something of validity.
In short: You want to give the impression that you have your shit together.
And so, the night before a big faculty presentation, you will find yourself imagining and examining every possible nuance of every possible situation, anticipating every problem, criticism, question, until your mind devours both itself and your chance for sleep. It shows in your dry and reddened eyes the next day as you take the floor, leaning against the long table at the front of the room, rather than standing behind it. You don’t need a shield. You’re not afraid of them.
Be brilliant. Be impressive. Be memorable. Be mindful that if your colleagues hate this program and the vote doesn’t go your way that it’s very likely you will lose your job.
Brevity is the secret to any presentation success, so keep it short. At the end, shift your eyes from the back wall to the faces seated in front of you, and stare down your colleagues for the first time since taking the floor. Brace yourself. “Any questions?”
They will stare. Some will have lowered their tense shoulders. Others will have empty faces, mouths agape, eyes that won’t make contact with yours. But they will have one thing in common: silence.
When a co-worker dressed as friend confronts you afterward, she will suggest you seek help. Your speedy, incomprehensible presentation, your shaking hands, your muttering and stuttering and lack of poise, all lead her to the only logical conclusion: Something isn’t right. “But I was just nervous,” you will argue because it’s your truth. “There’s nothing wrong with me.”
You’re not saying what you want to say: You’re not crazy. Are you?
She will shake her head. You can’t fake it on your own anymore. You cannot “pass” as one of the stable, one of the sane. The jig is up.
“Okay,” you will concede. “Okay.”
She will seem satisfied with your answer. “It will be. Okay, I mean. It will be okay.”
You will doubt her assurance, and you should. Because once you step over this threshold, you cannot go back.
THE WAITING ROOM
Every waiting room is different, but everyone knows how they work. Show up, sign in (first name and last initial only to protect your privacy), and wait to be buzzed in, let in, or invited back. The décor will vary. One therapist’s office may smell of essential oils, play the relaxing sounds of waterfalls and ocean waves, and invite you to take a free pen and journal from a basket resting on the side table. In another, you’ll settle into a winged-back chair in the receiving parlor of an 1890s colonial converted to a medical center, space shared by an ear/nose/throat doctor, a cardiologist, and a psychiatrist who believes in talk therapy. The house is old and will smell like it, the carpeting tired, and the windows sealed shut with lead paint. You will want to arrive early just to sit in that chair, to rest your head against the inside of it, and feel like a queen upon a throne.
In another, there will be a row of office chairs lined up against a wall. They will be uncomfortable and just a little too high to cross your legs and not wide enough to curl your legs underneath you. They are definitely not conducive to reading and they will squish your body into itself, making it difficult for you to breathe.
The best waiting room, though, the best is the one with the sunken red chairs covered in worn leather and lined with shiny brass tacks, the kind of chair you may come across in your grandma’s basement. They are the most comfortable, but also the noisiest, so try to sit still while you wait.
You will find magazines around you, of course, but more than magazines you’ll see pharmaceutical rep brochures, empowering you to ask your doctor about a new pill they’re pushing. There will be posters, flyers, no-postage-required information request cards. You’ll see a plastic box labeled “ADHD Support Center” sitting empty on the bottom shelf of a scratched bookcase. You’ll think that’s not very supportive, and you’ll be right. You’re clever like that, so go ahead and snicker, just do so quietly.
There are rules, you know, rules of etiquette to follow while waiting among other patients to see this kind of doctor. Make sure you follow them to the letter or risk being perceived as the most nuts person in the room.
Rule #1: Do not make eye contact.
Your eyes are to be shifty and remain focused on the floor, your cell phone, a book, magazine, or stray newspaper, at all times. You can fluctuate between focal points, as long as those eyes of yours never land on the eyes of another.
It’s not polite to stare, but you will anyway. The trick is to stare slyly, through brief peripheral glances, reaching up to smooth your eyebrow or brush your hair out of your face if the object of your glance happens to shift in your direction.
The others fascinate you, but you don’t want to invite them into your mind. You don’t want to acknowledge that you are all in the same room. You have nothing in common, yet you have everything in common because you’re all here for the same purpose. You are all—in your own way—crazy.
Rule #2: Do not socialize.
Scratching whispers will float between companions: a mother and her teenage son, a mother and her adult son, always a mother and someone else, it seems. Exception: When they are professionals on lunch breaks, crossing panty-hosed legs, a dangling stiletto balancing on their big toe. You will hear the rise and fall of their voices, pick up words, ideas, maybe more, that intrigue you. You may hear a joke or a line of sarcasm that makes you want to chuckle and respond.
Do not chuckle and respond. You are not part of their conversation, and you don’t want to appear desperate for socialization. Don’t be outgoing or even responsive. Don’t make small talk. If there is a window, stare out it until your name is called. You are not here to make friends. They are not your people.
Rule #3: Do not do anything that will make you appear crazy
Your space in that waiting room, the very seat you choose on your first visit, will say more about you than the amount of time you spend with the doctor, whether it be an hour-long diagnosis session or a fifteen-minute meds check. The staff and others in the waiting room will be poised and ready to slap you with a diagnosis the minute you step through the “crazies only” door. Be wary of the following:
Choose the same chair each time? OCD.
Choose a different chair each time? ADD.
Bring something to help pass the time? Social anxiety.
Bring nothing and slouch? Depression.
Fidget nonstop in your chair? ADHD.
Panic when something, anything, changes? Generalized Anxiety Disorder.
React emotionally to whatever you are reading? Bipolar.
Talk to yourself while compiling a grocery list? Schizophrenic.
Don’t be late for your appointment. Don’t be early, either. Most importantly, don’t show up on the wrong day, sign in, be ignored, then make a scene an hour later when the 17-year-old behind the desk—who is probably the shrink’s neighbor who needed a summer job—tells you that your appointment is actually next week, that your doctor isn’t even in today, that you’ll get a reminder phone call the day before, like always, remember?
There will be anti-role models all around you, so follow their lead on how not to behave. See the woman waiting in the corner? The one who is draped in a sweater, even at the onset of summer? Yes, her. See how her smirk doesn’t stop? Not with eye contact. Not after you’re taken to the back office and later return to her waiting quietly in that chair. All smiles, all the time, a grinning idiot.
Don’t be like her.
Don’t be the woman wearing dark sunglasses who wanders back to see the doctor when someone else’s name is called. When the doctor points to another patient and says, “She’s next,” don’t pretend, at first, that you didn’t hear him, until he grabs you by the elbow and steers you back toward the waiting room. “She’s next,” he will repeat, so that this time you understand him.
Don’t, seriously don’t, shake his hand and say, “It’s okay, doctor, I love you,” then saunter back into the waiting room to stare at the wall, or least look like you’re staring at the wall. With your sunglasses on, nobody will be able to know for sure.
You could be the teenage boy whose mom and dad both accompany you to appointments because their constant doting and hovering will assure the entire office staff that you take your ADD medication, but it will also assure that you will be incapable of growing into a responsible adult who can unload the dishwasher or fold laundry on your own without endless nagging from your impatient wife (best case scenario), or your mother when you’re still living at home in your thirties (more realistic scenario). Be grateful, at least, that you are the one advocating for your own mental health, that it is not a family affair.
You may be tempted to be that person who wanders back through the crazies only door, and while passing through the waiting room, remarks, “Today must be purple day,” then continue out into the hallway and leave it up to everyone else to figure out what exactly “purple day” means. Don’t be that person. Be the one who rolls your eyes at that person, instead.
Here’s what you should do: Show up wearing Burberry. Wear stylish rubber boots over black leggings on rainy days, huddle under a black puffy coat when it’s chilly and sit with your legs crossed tightly. When a new patient walks in, look up, smile thinly, make eye contact, but briefly, just briefly. Like that. That’s it. You, girl, are doing it right.
She will be called different things by different people. One doctor will call her by her first name (which you will never remember), another doctor will call her, “The girl at the front.” Secretary, assistant, medical something-or-other, does it really matter? You will call her the receptionist, even though you don’t feel very well-received when you arrive. Learn the difference between empathy, sympathy, and judgment. You will likely encounter all three in the same visit by the person sitting behind the counter. Nevertheless, when you arrive at a new office, be prepared to confront two kinds of receptionists.
There will be those who smile, are too friendly, too quick to highlight your name when you sign in. These are the “Have-a-nice-day” receptionists. They’re cheerful only because they’re grateful they’re not crazy. They go home each night, heat up their microwave dinners in their cookie-cutter apartments, and sit on their sane couches, watching their sane televisions. Their lives are simple, uncomplicated, and easy. They will return to work the next day, highlighter poised above the sign-in sheet, taking great joy in sliding the glass divider open then closed, open then closed, because it gives them a clear divider between the “us” and the “them.” You are now part of the “them” group. It’s time you accept it.
The other kind of receptionist is the one who is openly fearful of and disgusted by your classification as a mental health patient. The glass partition between you two isn’t nearly thick enough so she speaks to you with the window closed, and her voice will crawl further and further up her nose each time. She won’t even allow you to use her pen to sign the credit card slip.
“Use that one.” She will smile a sneering smile and point to a cup holding a single pen with a giant felt flower attached to the top of it.
Clearly, your illness is highly communicable, and lives on pens, door handles, and toilet seats, requiring delousing powder or bleach or latex gloves to prevent infection. She’s risking her own mental health by even working there. Clearly.
You may be crazy, but she is insane. Yours hurts only you, but hers is criminal, hurting everyone who walks through the door. She is inconvenienced by your questions, and cages herself off from the waiting room. She has even posted a sign on the partition, “Please be seated. Do not tap on the glass,” as if you were a patron visiting the zoo, and she an exotic novelty.
You won’t talk again until she has to schedule your next appointment, giving you an explanation for each day and time the doctor can’t be available to you. You’re stuck leaving work early, again, and hoping no one notices.
When you show up the following Tuesday, swipe the sign-in pen, so the receptionist has to share hers with the next patient. Twirl it in your fingers and stare her down from your uncomfortable chair, knowing she won’t make eye contact. Feel smug. Go ahead, you earned it. Nibble a little on the end, then rip the petals from the top with your teeth and spit them across the empty waiting room. You’ll be making a statement, except nobody will be listening. Leave the chewed pen on the side table when you’re called in for you appointment. Smile so widely that the doctor will say, “You’re feeling better today, I see.”
“Much better,” you will respond. “Much, much better.”
The following week, there will be a new pen in the cup. No flower with felted petals, though, just a blue ballpoint, generic and ordinary.
You will burn through doctors the way a middle school girl burns through crushes.
The first will be your best, even though she’s technically an over-educated nurse practitioner. She’s the only one who will combine therapy with pills, and always prescribe something established and affordable. But she’s forty minutes away and ongoing road construction plus a demanding job will make it impossible to keep your appointments. You’ll miss one because you’ll be having one of your paralysis days, those days that no matter what the commitment or how great the stakes, you will not be able to will yourself out of bed, it’s a by-product of your illness that will cost you $175 in no-show fees. You’ll attend fairly regularly after that, then cancel three sessions in a row, and finally stop booking appointments all together. It won’t be until after your meds run out and you start having trouble with flat-lining your rage or committing anything new to memory that you will decide to seek out a doctor who is more geographically convenient.
You may think that talking it out will empower you to fix your problems without the crutch of prescription drugs. If so, get a referral to see a therapist, and start meeting weekly. You will be uncomfortable at first. You won’t know how to start or what to say or what issues to focus on. Her office will be dark and smell of the cinnamon tea that she always drinks. You will like that your back is to a window and you can hear the rain hit the glass. Despite the cinnamon that makes your eyes water and the unnaturally dim lighting, you will find her office cozy. You’ll sink into her deep, heavy couch and hug a throw pillow as if to say, “Bring on the healing!”
She will convince you to try “energy work.” She will suggest you get a Vitamin D lamp to bright your mood. She’ll send you home with a device that you clip on your earlobes to sends shockwaves through your body. You won’t get more energy, though. You’ll get vertigo and nausea, instead. You’ll unclip the device, wrap it carefully and zip it back into its carrying case. You drop it off at her office before you next session, unwilling to give it a second try. Dizzy spells are not the solution to your problems.
“Don’t make any major life decisions until you get this sorted out.” This means your disorder, specifically the meds to treat the disorder, meds that are attempting to quiet the chorus of obsessive thoughts and premature emotions that run the gauntlet of your mind. You need a diagnosis; you need answers. You will decide it’s time to see a real doctor, not a therapist.
The doctor with the longest wait is the one with the most uncomfortable waiting room chairs and the snottiest receptionist. On average, you will wait at least two hours, no matter how early in the day you schedule your appointment. Others will wander in after you and see the doctor first, an injustice you will complain about to the secretary, but to no avail. The doctor will ignore the pileup of crazies in the waiting room, but make a special appearance from behind her office door when the pharmaceutical rep arrives with free coffee, gift cards, office supplies dressed in logos, and a suitcase full of samples.
When it’s your turn, the psychiatrist will smile a smug, unwelcoming smirk that seems to say, “Thank you for your money. Please don’t cry in front of me today.” You will last a month as her patient before you decide to find someone new.
Finally, the waiting room with the red leather chairs belongs to an 80-year-old man who wears his pleated pants high on his waist. His office will be filled high with papers, file folders, old textbooks. On a filing cabinet, he will have a wobbling stack of empty frames, and you will stare at it while you pick at the fabric in the chair. It will take every ounce of self-control you can muster to not march across the room and straighten the pile.
“How are you feeling?” They will always start these sessions with the most loaded of questions.
“Okay.” Translation: “I’m flat. But it’s better than being unhappy, isn’t it?”
The doctor will take your blood pressure at each session while talking about his worldwide travels and his adult grandkids. He, like your students, will hide behind his laptop while you answer his questions. He will nod as you speak, and at the end, say that you need to make time for yourself. “Part of being happy is living a happy life.”
You’ll cry at every visit. Your crying may not make sense to you. Your rational mind won’t be able to make sense of it.
Tears are for mourning. At least, that’s what you were raised to believe. It is reasonable to cry when someone is gone. People expect it. “Oh she’s so strong, he’s so brave,” they say of the stoic at funerals. They put themselves in the griever’s shoes and remark, “I would be a wreck,” or “I wouldn’t be able to hold it together,” or “I can’t imagine what he’s feeling,” or “I can’t imagine what she’s going through.”
You will hold this tenet as a personal truth. You can only cry at funerals. Openly cry, that is. Granted, you can dab your eyes at weddings and smile through tears at the end of a romantic comedy, but the broken voice, the swollen nose, the ugly, ugly transformation of your entire face? That can only happen when mourning the loss of a loved one.
The first time you remember your mother crying was at her grandmother’s funeral. She crumbled in front of the casket like tissue paper, remember? He thin shoulders sinking into her older sister? You remember that, right? How about twenty-five years later when your own grandmother dies and your younger sister falls into you the same way? Their crying, their mourning, will paralyze them. That’s okay, though. It’s supposed to. Funerals, remember, are made for that. But meeting with doctors, though? Certainly not.
You need to change your mindset. Think of it this way: You sneeze when you need to and nobody questions it. It’s a natural way of relieving irritation from the nose. It’s self-preservation, really. If you didn’t sneeze, then you wouldn’t clear your nasal passage of germs and obstructions, and illness would settle in quickly and unapologetically. Think of crying the same way, except the illness is in your mind. It burrows in there comfortably, an unwelcomed house guest, and leaves you burdened with extra work and exhausting responsibilities. You suppress the crying because there is no social equivalent to covering your nose when you sneeze.
Stop holding in the tears. Remember, growing up, when your best friend said, “If you hold your sneeze, your eyes will pop out”?
Imagine what could pop if you don’t cry. Just imagine.
THE ASSESSMENT AND DIAGNOSIS
Be prepared for a lot of questions, many personal questions that you will hate, coming from a stranger who is sitting behind a desk, behind a notebook, holding a pen, and looking hungry.
They will all zero in on different symptoms, choosing their favorites first, and then working down the list:
Racing thoughts? Panic? Sweating or stammering in nervous situations?
Lethargic? Unmotivated? Sleep too much? Not enough?
Thoughts of harming yourself or others?
Hearing voices or seeing things that aren’t there?
Consuming copious amounts of alcohol and collecting sex partners as though they were Beanie Babies?
Are you smoking? Doing drugs? Do you wear a seatbelt when you drive? Do you lock your front door?
How much do you work? How often do you leave your house?
The first doctor will diagnose you with generalized anxiety disorder and depression. Her explanation is colorful, albeit a little ridiculous: “You treat every stressor in your life like it’s a wooly mammoth that just appeared at the entrance of your cave.”
You’ll ask about the depression.
“Constant fear of the wooly mammoth is making it hard for you to live your life,” she’ll explain, as she rips a prescription from her pad and hands it to you.
The second doctor will give you a spiral-bound booklet (written and edited by the doctor herself) for you to read, annotate, and complete the questionnaire at the end. Think of it like a quiz in Cosmopolitan magazine, but instead of determining the best jeans for your body type, you’re discovering the best label for your mind.
You’ll answer how you feel at the moment, knowing that the moments change rapidly. Make sure you darken the circle exactly and use a #2 pencil, just like in elementary school. Otherwise, their scanning machine will spit out an inconclusive diagnosis. And the only thing worse than being crazy is being inconclusive.
At your next session, she will ask you, “Did you complete the assignment?”
Hand her the last page of the packet (conveniently, it will have perforated pages), and watch as she looks it over and nods. Wait for her to speak. And wait. And wait.
And finally ask her, “So what does this mean?”
She’ll remark about your promiscuity, your inability to sit through a session without crying, your daily cocktail hour. Finally, she will rustle the sheet of paper around a second and say, “You checked off twelve of the fifteen questions. Eight is the minimum for bipolar.” It’s textbook. Open, shut.
You’ll reread the questionnaire and want to ask, “But doesn’t everybody feel this way some of the time?” Don’t do that. You don’t get to ask those questions. You are there to confront your mental illness and treat it, not to question or deny it.
The only doctor who will answer your questions is Doctor Google. Your diagnoses—generalized anxiety disorder, depression, bipolar disorder, seasonal affective disorder—seem incomplete. They overlap too much to be an individual problem, but not enough to stand on their own. You find websites with soothing color palates and cross-check your symptoms with their bullet points. It’s this process that helps you conclude that what you have is, in fact, Bipolar II, hypomania with relapses of depression. You’re satisfied with this. For once, you have an answer.
When you move on to the third doctor, you’ll plop down in his chair and tell him you have bipolar disorder and you need a new medication.
The only question he asks you is, “How do you know you’re bipolar?” You rattle off your symptoms while staring down the pile of empty frames that are still (still!) stacked on the filing cabinet.
He doesn’t give you a quiz or ask you a series of questions. He’ll take your word for it, take the other doctor’s word for it, and update the notes in your file. Is that what you’ve become to them? A number in a database, reduced to a checklist of items?
After that, you will disappear for a while. You’re an introvert, so it’s easy for you to avoid making plans with others, intense social situations, and feeling lonely when you go three weekends in a row without any human interaction beyond the mailman and the clerk at the gas station. When you do need attention, you will seek it out in social media, responses and postings enough to sustain you.
Regardless, you will begin to teeter on the edge of losing your shit.
You will sleep more, feel exhausted, feel impatient with and annoyed by everyone, everything, even your pets. Even yourself.
This will be a darker bout of depression, the darkest in a while. Darker than you can ever remember. You will be buried so deep that when the mania finally does snatch you back to the surface and into the sky, you will soar along happily, surging with energy, knowing it won’t last, knowing it can’t last. Mania will look different each time she arrives at your door.
The goal will be balance and stabilization. Your treatment will either focus on behavior changes, prescription drugs, or a combination of the two.
Your therapist will tell you, “The first thing you need to do is get sober.”
Your resistance to this directive will be physical. Your foot will move to the floor as you brace yourself for the impact of change.
You’re not drinking yourself drunk all the time. She knows that. She does. Yes, she does because you told her. Twice. Say it again, and you will look like an addict.
“You’re self-medicating,” she will say, and continue with her explanation as you start to sweat. It’s just a beer after work. It’s just a glass of wine with friends. On the weekends your mantra is, “Sleep all day, party all night,” even if you do so by yourself. Isn’t that your liberty as a self-reliant adult?
“You can’t do any work until you get sober,” she will continue. “You need to stop drinking. At least for now.”
You will shake your head and look at your watch. Time is up, you will want to say, and that’s okay. Go ahead and say it. The truth is permissible, regardless of the weasel word it’s veiling.
There will be many prescriptions, even more prescriptions than doctors. There is no single drug designed to treat bipolar, so those that are most commonly prescribed fall into one of two primary classes: atypical antipsychotics that toy with your brain’s dopamine, and anticonvulsants, that are used to treat epilepsy, yet for some reason have been effective at balancing an imbalanced mind. It will be many trials and many errors before you find one that works for you, but when you do, feel grateful. Not everyone is so lucky.
The first doctor will prescribe you Celexa, then increase the dose and add Xanax, and finally go up on the dose again and add Ambien. Xanax and Ambien are to be taken as-needed (and never with alcohol), so those will hang out in your medicine cabinet while the Celexa continues to have no impact on you whatsoever. And just like that, she will switch you to Wellbutrin, starting the process all over again.
They will all tell you to get more exercise. Not easy advice to follow when you don’t even have enough energy to shower on the weekends, and—let’s face it—the occasional Wednesday.
Try meditation, they will say. It will help calm you, center you. You will sit cross-legged on your bedroom floor, close your eyes, and practice deep breathing. Your butt will go numb and you will wake up an hour later slumped against the dresser, rested, but with a crick in your neck.
For you, there is no such thing as a quiet mind.
The second doctor will start you on a multi-pill regimen that will cost nearly $150 a month to maintain: Depakote, Abilify, Latuda, all atypical antipsychotics, and no generics. You’ve never been a label person, but you will comply with her demands, even as the pharmacist balks while filling your prescription.
The doctor will warn you that weight gain is a possible side effect of Depakote. You gain forty pounds in three months, maxing out your body at a size you had never conceived of as possible.
“You just need to watch what you’re eating,” she will say when you mention it, then scold you for gaining too much, too fast.
You will leave her office in shame. It’s the most you will be able to feel, the best fight you could muster. You will have no energy, no metabolism, no will to do much more than to go through the motions of a day.
Your body has become a science experiment, and it’s starting to show on your face. A friend makes a recommendation: Go outside more. If possible, go near water. The theory is that when the sun shines onto fresh water, it will evaporate and release ions into the air. When you breathe in the ions, they’re supposed to make you feel better.
Well-meaning advice, you’re sure. But probably not the best idea to suggest that a depressed person stroll about a shoreline, lest she fill her pockets with rocks and wander into the river, never to be heard from again.
The Depakote won’t metabolize like it should, and it will begin to stress your liver. The doctor will lower the dose and start you on a Latuda, a sexy new drug specifically designed to treat bipolar. The first ever and quite a breakthrough. She will hand you a stack of samples freshly stocked by the pharmaceutical rep and send you on your way.
Within days you will have extreme bouts of paranoia, fear so debilitating that you will sit on your kitchen floor with your back against the stove, and be paralyzed with suspicion that someone is trying to break into your house. You won’t go outside after dark, not even to haul trash cans to the curb, and the bags pile up next to the house for two weeks after that. You will walk a loop to every window in your house three times, making sure each is double-locked. And still, you will sleep with mace in your bedside table, terrified of the moment that you’ll have to use it.
You will start to see flashes of color, of light, flashes of shapes that could be figures, but when you turn your head, nothing. There won’t be anyone there, even though you sensed it, you felt it on your skin that you were not alone in the room, that someone was hovering at your shoulder.
You tell the doctor, and she will increase your dose. Each time you go back, she will increase the dose.
Your prescription is giving you symptoms of schizophrenia, but you won’t figure that out until you ask Doctor Google. You will stop taking Latuda immediately, flushing the remaining pills down the toilet and shredding the boxes into the trashcan. You will quit the Depakote, too. You will quit everything, including the doctor. Cancel your next appointment and tell the receptionist it’s because the doctor is a quack and her two-hour minimum wait time is downright abusive. Wait for her to respond, listen to her smack her lips, then hang up the phone, triumphantly. You don’t need an antipsychotic. You need a doctor who doesn’t think you’re psychotic.
Despite his aloofness and disorganization, the third doctor will give you a prescription cocktail that makes you feel normal for the first time since puberty: Lamictal and Lexapro. His goal is to find the right combination of mood stabilizers. He suggests Lithium in passing and mentions one of his partners was involved in discovering Lithium as a treatment, but stops when he sees that you are shaking your head.
“I don’t want to be a zombie,” you tell him.
He will warn you to wean slowly off the Depakote. “Don’t stop cold-turkey. You’ll put yourself at risk for a seizure.”
Don’t tell him you already stopped. Even if he wrote a prescription to replace the pills you threw away, you won’t take them. There will be no greater risk than the one you have been taking with each old pill that you swallow.
Eventually, the nightmares and irrational fears will subside. Gradually your sleep will stabilize. Your weight will not.
Get a new job. You like teaching, right? So accept the offer for more classes, even if it means driving between colleges in rush hour traffic. Use that time to call your grandmother and talk in a way you never talked as a child with your parents around. After leukemia takes her from you, you will appreciate those long commutes.
Connect with your students. Laugh. Show them you’re a little vulnerable, too, that you don’t know everything. There will be opportune moments in which it is acceptable to say “fuck” in class. Yes, even if you’re the teacher. Seize those moments. Make your classes memorable. Make yourself memorable. Do this by inspiring them, not by sleeping with them. Sane people do not have sex with their students, even if they are your same age and more screwed in the head than you are. Can you assume you have students who are screwed in the head? Is that fair? Go ahead. People have been assuming you’re screwed in the head for years, and they were right. Being screwed in the head will make you more empathetic toward others, and that empathy will make you a good teacher. You’ll see.
Attend a writing conference. Surround yourself with people who are like-minded in a different way. Notice immediately a woman wearing an over-sized hat and dark sunglasses, even though you’re indoors and the auditorium lights are dim. Stare at her and wonder why you’re the only one staring. Her get-up will remind you of the Joyce Carol Oates story, “Three Girls,” in which Marilyn Monroe wanders around a bookstore in disguise. Does this woman have delusions that she is a celebrity not to be recognized? Look away, take a manuscript out of your bag and pretend to read. She’s odd; too odd for you to tolerate.
Maybe you’re normal and everyone around you is crazy. Or maybe, just maybe, we’re all mad here.
Meet a man who loves you, then lie there frigid when your naked body touches his, chemicals interfering with your sexual response. Stop taking the Lexapro, but be prepared for emotions that you had been masking. They will be angry and vengeful.
You will relapse into fits of rage and bouts of irritability. You shake, you struggle to wake up, but can never fall asleep. Your skin is sensitive to the touch of another, and you feel like you have spiders crawling around under your clothes. There will be no consoling you.
You will rebuke his affections until he finally asks, “Do you think you should go back on the anti-depressants?” He loves you, but you make him nervous.
Somehow, through the fog, he can still see you, still see a person, and not an illness. He will stand in front of you with his head down, giggling out nerves, tell you in chopped pieces how much you mean to him, his face buried in your neck. Then he will ask you to marry him, and you will cry, cry, cry as you cling to him. You’re unpredictable, but he’s willing to take the risk. Love isn’t reasonable, but it’s real.
Your doctor offers to invite him to a session to explain your treatment to him. You nod, slowly at first, then enthusiastically, because you realize it would be nice to have an explanation of your own.
Myth: Your illness isn’t real. At best, it’s a condition, but nothing life-threatening that requires round-the-clock care or consistent treatment. It’s inconvenient, like arthritis, interferes with functionality, like migraines. A day spent locked in dark room sipping water, and you will emerge the next feeling like a whole new person.
Fact: Everything you feel and everything you experience is real. There is no magic potion, no one-size-fits-all treatment, though. There is also no cure, so stop pining for one. Your illness requires constant monitoring like diabetes, it can fluctuate with factors of your environment like asthma, and it carries with it an unrelenting stigma like HPV.
It can stabilize. It can go into remission. You may eventually luck out and find the right dosage to keep you balanced and make the right life choices to avoid triggers and relapses. You may only have to see your doctor every three to six months for a Lamictal refill, where he will check your blood pressure and thank you for coming in. He always thanks you for coming in.
Leave his office and drag your fingertips along the mahogany bannister while you descend the stairs. Thank the stranger who holds the door for you, as you step outside and into the sun, and breathe. Feel healthy because you do and alive because you are.