Monday, May 14, 2012

Don’t Tell Me That I Am Sick

By Jennifer Ray

Coming to terms with my mental illness

I glanced at the clock on the opposite wall, taking a break from staring at a worn patch in the carpet near my feet. It was nearly 5 p.m.; the last time I looked up was about 1 p.m. My only motivation was to determine where we were in the rhythm of the day, to see how much longer I had to bear before I could retreat to my room. There, my eyes heavy from sleeping pills and emotional exhaustion, I could succumb to the only thing that brought relief from my depression: sleep.  It had not taken me long to discover that the most time-consuming activity on psychiatric units was doing nothing other that waiting for something to happen. Waiting to see your psychiatrist, your social worker, your nurse or waiting for a therapy group, for art therapy. pet therapy (if you’re lucky), waiting for a shower, to brush your teeth, waiting for morning meds, afternoon meds, evening meds, night meds, breakfast, lunch, dinner. How did I get here?

My depression during my sophomore year in college was not my first episode. I had gone through periods of depression twice during high school, received antidepressant treatment and counseling, and recovered. I took having a depressive disorder seriously and was diligent about seeking and getting help. I did not share my condition with other people, but I did not feel stigmatized. In an age of depressed Zoloft balls bouncing on the TV screen, depression seemed common in society; a little like having mild asthma or high blood pressure. I never though of myself as someone who was truly “sick”—I saved that term for people with schizophrenia or bipolar disorder, people I assumed spent most of their lives in secluded state institutions, receiving antipsychotics and getting “shock therapy.” If someone suggested I would someday know what it’s like to be in a hospital, to take a plethora of drugs, and to be considered severely and chronically disordered, I would have found the notion bizarre and comical, if not impossible. That was not me.

Near the end of my sophomore year, I noticed some familiar feelings that, in the past, heralded depression. Over the course of a few weeks, I lost my appetite. Things I normally found engaging—reading, being with friends, participating in groups on campus—had no allure. I lacked the concentration to read more than a page or two or even follow a conversation. As my mood sank, family and friends became concerned. I became increasingly depressed and despondent over a matter of weeks, and even though I recognized the symptoms and was educated about treatments, I did not want to admit that I was experiencing a relapse of the disorder I though had ended with my adolescence.

Ultimately, a close friend realized what was happening. Fearing for my safety, he made an urgent appointment with a local psychiatrist; I did not have the energy to protest. The psychiatrist spoke with me about my history, my current symptoms and thoughts of suicide, and determined that I needed to be hospitalized. My recollections of this decision, my admission, and the first few days in the hospital are foggy. My primary emotional response was shock and bewilderment, tempered only by the deadening apathy that engulfed my mood. I couldn’t quite get my head around how things had gotten “this far.”

I was on a locked unit with severely disordered men and women, many acutely psychotic. I was watched constantly by an aide, denied access to my shoelaces, and allowed to make phone calls only from a pay phone in the Day Room. But despite the indignities and trauma of this experience, I can now say it saved my life. I was discharged after a few weeks, not completely over my depression but on the way to feeling well again. I had started treatment and began to feel optimistic about my future. Within a month of getting back to school, I truly felt all this sadness and strife was behind me, and I never imagined that things could become even more challenging and complicated.

Right before my junior year I experienced symptoms that, unlike those during my depressions, I did not find troubling. I was always someone who needed a good nine hours of sleep to feel well rested, but I started getting by on dramatically less. Some nights I would not touch the bed (if I was even home), other nights I would fall asleep for 2-3 hours and then jolt awake, energized and ready to go. My waking hours became filled with frenzied activity—I never felt smarter, more able, or more confident. My thinking was swift and sharp and seemed to reach near superhuman perfection. These feelings continued, but the ecstasy soon devolved into agitation. Every annoyance seemed like a concerted, even conspiratorial, effort to thwart my plans. When my psychiatrist saw me in his office, he knew immediately what was wrong. I was experiencing a manic episode. I was enraged but eventually acquiesced to treatment. New medications—antipsychotics and mood stabilizers—were used to control my mood. Most of my symptoms abated within a few weeks, but the medications left me sedated and feeling somewhat dull. New medications for a new diagnosis: Bipolar I Disorder.

I came away from this traumatic experience dismayed and disheartened, my self-image shattered. I had already come to terms with being a “psychiatric patient.” But during my first manic episode, I was publicly sick in a way I hadn’t been before. I was embarrassed and humiliated. Being told I had a disorder only other people had—“other people” being unfortunates who lived their lives in drug-induced stupors in institutions or group homes compounded my feelings of defeat.

As I recovered, I reevaluated some of those feelings and saw things more realistically. I also met other young adults, through a support group, who struggled with the same disorder. It was enlightening and heartening to hear many of their stories, and they provided invaluable advice and support. My ideas as to what it meant to have a mental disorder shifted largely as a result of these conversations, allowing me to approach my own situation with more hope and strength. I began to see medications and therapy as my toolbox for maintaining a stable life in which I could achieve my goals. This involved tinkering to find the best combination of medicines and trade-offs in terms of putting up with some side effects if my overall health was good.

Coming to terms with having bipolar disorder, and learning how to effectively take care of myself, has been a process of peaks and valleys. After three years of feeling well, I relapsed and experienced episodes of mania and depression. Both required hospitalization and medication changes. Experiencing relapse after a few years of feeling great was a wake-up call. I secretly felt I was somehow past that sort of thing. Since then, I’ve tried to be optimistic while still recognizing that I have a chronic disorder, and the chance of having more episodes in the future is very high for me despite taking medication faithfully. Thankfully, when am stable I have no lingering symptoms. My goal is no longer to avoid getting sick again, but to keep myself stable and healthy for as long a stretch as possible. Despite my disorder, I’ve graduated college and graduate school. I’ve had lasting and meaningful relationships. I live on my own and have travelled widely. My disorder hasn’t defined my life, and despite the inevitable challenges ahead, I don’t believe it ever will.

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