From The Doctor's Side

I just finished reading Weekends at Bellevue by Julie Holland, M.D., It is her memoir about working the weekend overnight shift in the psych ER at New York's Bellevue Hospital. I really enjoyed reading about the psychiatrist's point of view. She tells countless stories of patients she saw come through the ER. in many shades of insanity. Toward the end of the book she has a short chapter in which she discusses the relative nature of mental illness.

She writes, "If any of us shared with a psychiatrist every intimate thought we had, our darkest secrets, is it possible we would still be judged safe and sane? There are plenty of times we feel murderous rage, or we think it would be easier if we didn't exist anymore. It's a common fantasy to see ourselves driving the car over the edge of the embankment or into oncoming traffic. Using the criteria of danger to self or others for involuntary commitment, any of these impulses and fantasies is enough to buy you a short stay in the hospital's inpatient psych ward. On the other hand as lon as you keep them to yourself, you can walk around the city freely."

She says shortly after this, "The reality is this: All of us, to some degree, are mentally ill." She lists off various manifestations of this including anxiety, depression, insomnia, compulsions, addictions great and small. Then she continues, "Every one of us has psychiatric symptoms, many of them serious enough to warrant attention, even if they are not incapacitating. But few of us are willing to let on that we are suffering. This secrecy and shame compounds our avoidance of those who have been officially diagnosed as mentally ill."

And later, "We avoid dealing with psychiatric patients because we hate to see things in others that we don't want to see in ourselves: weakness, need, despair, aggression. Our experiences with the psychiatrically ill often fill us with dread; they confront us with our own terror of reaching a catastrophically altered state from which there is no return, We should be compassionate to those who stumble out of our lockstep. Yet in our culture, the mentally ill are demonized and shunned They are ostracized and marginalized as a by-product of our primal fear of going cray ourselves."

She talks more about how we treat the mentally ill in this country and contrasts it with other countries, citing Vietnam as one example. Then she writes, "Instead of integrating them among us, we shutter our psychiatric patients away so that we will not have to be reminded of all that can go wrong with our own minds and brains."

I really liked this chapter. The tone is different than most of the book because she is making more of a commentary than recounting her experiences in story form, but because she doesn't preach much in the rest of the book, this sermon isn't off-putting.

I recommend this to anyone dealing with mental illness, either their own or someone else's It is a great perspective that most of us don't get to see.

From the inside

Where to start? The narrative of a manic episode from inside the head of the maniac is difficult to tell because of all the associations and leaps in logic, as well as the non-linear quality. I could start anywhere but everything seems to need some back story. I could start from the trip back from Florida. That is probably a place where normal thinking switches to manic thinking.

In the Denver airport I had some time to kill so I called a couple people. One was my friend P. who was living in Denver at that point. I hadn't spoken with him for a while and thought it would be nice to say hi while I was in town, even though it was unlikely he could meet me at the airport during my layover. I also talked to my ex-girlfriend. I think I thought of her after seeing a baby. The reasoning behind this is a side story not worth going into.

As I was talking on the phone I spotted a red-headed woman who appeared to be waiting for the same flight as me. The background on red-headed women is that I find them attractive, and in some of my obsessing over women I had keyed on redheads. Later when we lined up to get on the plane the redhead was in front of me. I decided I needed to talk to this woman or at least create the circumstance where we could interact on the flight, so I sat next to her. We didn't talk on the flight until the very end as we were approaching our destination, my hometown. Throughout the flight I was hoping to strike up some conversation but she was engrossed in her book, and I also didn't want to give the impression of being a creepy guy hitting on her. My mind was working overtime but I think I was able to act pretty mellow during the flight. When we did start talking at the end of the flight, she said she was visiting a friend and this was her first time visiting this city. I gave her some recommendations on what she might do while in town for the weekend. (Keep in mind this was Valentine's Weekend, this is relevant at a later point.) In particular I mentioned a Thai restaurant that I like.

After getting off the plane I was still hoping to talk to her and possibly give her my number. Even though she was from out of town, the possibilities between us were only bounded by my manic thinking's limits of imagination. I payed attention to which suitcase she grabbed from the baggage carousel and was not surprised when it was a wonderful shade of bright green, another sign to me of the necessary connection to her. I debated with myself about approaching her and giving her my number, which I didn't end up doing. When her friend arrived I was a man and then the thought occurred to me that it was the Wednesday before Valentine's Day and perhaps he wasn't merely a friend.

Mama D. picked me up from the airport and we went to get some food at the Thai restaurant that I had told the red-headed woman about. The whole time we were at the restaurant I was expecting her to walk in with her friend. It was meant to be. And like so many things that are "meant to be" when I'm manic, this was not.

I didn't get to bed until around 11pm that night which was 2 am according to my body's clock. This long day set the stage for the chaos that followed.

Florida

At the end of January/beginning of February last year I went to Florida to visit my grandparents. While I was in Florida I felt like my mood was pretty stable. I can see in retrospect that I was on the up side of things. My emotions were more acute. I was more intense about some things.

I remember having a very serious conversation with my grandfather while we were driving around about my mom and things I was just finding out about her, like the fact that she went to the hospital when she was 19 due to an overdose on drugs. I remember at the time suspecting that perhaps she intentionally overdosed, trying to commit suicide. This led to the idea that if that was true, perhaps her becoming pregnant with me saved her life. I haven't thought about these things since then. My grandfather wouldn't really tell me anything about what happened. He just said that I should talk to my mom about it, that she should be the one to tell me. I never brought it up to her. After I got back from Florida my mania kicked into high gear, and I became fixated on other things. Perhaps I should bring my questions about that time up to my mom. I have serious doubts about whether she would tell me anything. But if I don't ask, then I'll never know. I think I will talk to my psychiatrist about it first and see what he has to say.

What I think really put my mania over the edge was traveling home from Florida. I was up early East Coast time and I went to be about 11pm West Coast time. I calculated at the time that it was a 20 hour day. One thing I remember after getting off of the plane was about the time change. I did the math the wrong way and converted three hours in the wrong direction, leading me to think I had been up six hours less than I actually had been. This error is what partially led to staying up so late. Mama D. picked me up from the airport and I decided that I could get something to eat with her, when I should have gone straight home and to bed.

Fortunately, I didn't have to work the next day. The day after that, when I returned to work, was the day I realized that I was in love with J.

One Year Ago

One year ago I was on the brink of a very severe and life-(altering/shattering/disrupting) manic episode. Part of the purpose of this blog is to reflect on my past experiences with bipolar disorder. So I think I'll begin to write about my episode a year ago.

In January, and maybe in December I'm not totally sure, my mood began move into hypomanic/manic territory. I know this because other people in my life have told me this, and, in reflecting, I remember a few situations in which I can see the connection between my actions and an elevated mood.

For example, one night I went over to a friends house, to hang out and play an interesting strategy game. I had a good time and was feeling upbeat. I headed home on my bike. It was about 10:00 or 11:00 at night. While I was on my way home I passed a convenience store, in the parking lot of which there was a sizable group of young people on bikes. One member of the group had a trailer attached to his bike with a sound system set up on it. I call it a sound system because it wasn't a mere stereo, it was a serious set up attached to a car battery with some serious speakers. I passed the group, but felt pulled back to them. I went back to check out what was going on. This began the second part of my evening, which lasted until well after 1:00 in the morning and involved stopping at two different houses, one not too far from my house and the other in the inner NE part of town, maybe a few miles away. I didn't necessarily do anything particularly manic, but the simple fact that I joined in with a group of strangers, traveled around with them, stayed out late, and did all of this on a whim, makes this abnormal behavior which can be attributed to an elevated mood state.

Another thing I can look back at as evidence of an elevated mood are my pocket journals. I was writing all kinds of little notes and aphorisms. I was getting deeply involved in reading and thinking about Myers-Briggs personality types.

Another situation I remember from January last year was the big auction night at work. I know my mood was up that day. I was in action mode and feeling good, but I'm certain my mood was also elevated. I felt like a general with his troops. I was feeling self-confident, if not grandiose. My mind was running fast. I said some things I maybe shouldn't have or in a way I shouldn't have. Other things I remember from work that month are how I thought that my energy at work was affecting my co-workers. This was a bit of "magical thinking" or perceiving something that was on a different level. I think I was getting less work done, but I felt like I was doing important things like distributing events calenders and other tasks that I thought would part of my plan to get a promotion. I'm mainly relying on my memory right now, which is spotty, but even these scattered bits point to my elevated mood.

Of course, at the time I thought I was doing great. I couldn't see where things were headed. I didn't know that my enthusiasms and new interests would start to become obsessions and eventually I would fall into the most destructive obsession, the one focused on J. When I'm flirting with mania the line between possibility and certainty, between fantasy and reality, between hopes and facts becomes exceedingly thin. If I think it, it becomes real. If I want it, I try to make it happen. And I don't realize when I cross this line.

I took my feelings of friendship and closeness with J. and expanded them into a world of deep love and devotion. I took our working relationship and my perception of her role as my confidant and adviser and transformed them into a relationship outside of work that was mostly in my mind. The line between what I wanted and what existed disappeared. Because I wanted it, it must be so, and I must make it so.

This is how the month that shook me started.