Warning: this post contains discussion of mental illness, hospitalisation and pharmaceutical drugs.
I keep the discharge papers from my most recent hospitalisation next to me. I read them every hour or so, give or take, because it shakes me from the quicksand of denial; I need to be reminded, often, of what is real.
“Diagnosis (Principal): BIPOLAR 1 DISORDER”
I remember the words that the psychiatrist said to me in the hospital — I was in an Ativan-induced haze, unable to comprehend the gravity of my situation.
“Bipolar Type 1 with mood-congruent psychosis,” he told me. “Rapid-cycling.”
I walked to the nurse’s station right after and begged for more pills.
Because I didn’t want to think about what I had just been told. Because when he said those words to me, all I could hear was, “You’re fucked.”
Days later, the social worker sits down with me, explaining the doctor’s notes and my treatment plan. That was the first time I had seen the word “SEVERE” used to describe my illness — confirmed by a numbered scale which suggested that my prognosis was not good.
“Do you understand?” she asks me.
I don’t know how to tell her that I don’t. No, I don’t understand at all.
I’m Type 1? I was psychotic? It’s severe?
“Sam?” She tilts her head, looks at me. “Does this make sense?”
No. It’s never going to make sense.
Before I was hospitalised, you could say I was living out a very extended, very casual delusion.
I believed, sincerely, that if I got my shit together, had all my ducks in a row — great job, great apartment, great partners, great friends, great attitude — bipolar disorder couldn’t possibly touch me.
What could trigger an episode? My life was perfect now. I took my meds (most of the time, anyway).
I was a mental health advocate for a living, for crying out loud; I knew what I was doing. Besides, it had been so long since I’d experienced a real episode — I was practically cured. I couldn’t even remember what it felt like to hit rock bottom, and really, was it ever bad? So I stopped tracking my moods altogether.
And if I noticed them, I could always rationalise them. I’m despondent because I work too many hours. I may have an inflated sense of self, but it’s just because I’m confident. I may want to jump in front of this train, but who doesn’t feel defeated now and then? Yeah, I want to hook up with literally everyone, but it’s not hurting anyone! I think highly of myself — OK, really, really highly — but why does that have to be a problem?
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With me, nothing was ever a problem. I didn’t want to believe I might be getting sick again. So I shrugged off the red flags waving in my face, and I did what I could to hide the fact that I wasn’t as stable as everyone thought.
My life was good. I was good. I believed that nothing could go wrong.
And then something went wrong.
And then everything went wrong.
When I was first diagnosed as Type 2, I was told that people like me could go on to live “full and productive lives.” There were entire books, they told me, about people harnessing their hypomanic energy and doing extraordinary things.
But in the hospital, Type 1, no one promised me a full and productive life. No one told me I could be extraordinary, or much of anything, really. They told me about lithium and deep breathing and relapse and more lithium.
Every day they asked me if I still heard the voices, and every day I said, “Not yet.”
When I left the hospital, I picked up a memoir from the local bookstore. I hoped that it would help me process the new diagnosis.
Within the first 10 pages, it said that rapid-cycling Type 1 — my diagnosis — was “reputably the most severe form of the illness.” Angry, I threw the book at my wall. I vowed to read better books.
I returned to the store. I bought another book on bipolar disorder, something more scientific, thinking it would offer me practical advice to cope. Within the first ten pages, it said that 90 percent of people with Type 1 are hospitalised, and two thirds are hospitalised two or more times.
Defeated, I wondered how long it would be until I relapsed again. I must have read the word “severe” a hundred times, reading about “sufferers” who spent their entire lives going in and out of institutions.
People with my illness and my symptoms and my struggles, stumbling into the emergency room.
People like me, ankles tied to a stretcher, bound in the back of an ambulance, shrouded in the vivid, relentless stupor of psychosis.
Bipolar 1. Bipolar 1. Bipolar 1.
It’s become my mantra. I repeat it to myself again and again, so I won’t forget.
I spent one year of my life pretending that I wasn’t sick. One year with my eyes closed, insisting to everyone that I was reformed, that I was better now.
A year of illusions, a mental break, the emergency room. Locked in a facility, my door opened every 15 minutes to ensure I was still alive, wrapped in two hospital gowns in a cold room.
It will be the last year of my life that I ever pretend.
I can’t afford to anymore; I never could.