There Will Be Light

Next to Normal—a searing, brilliant, Pulitzer-winning rock opera examining the lives of a family whose mother is desperately struggling with bipolar depression—opened on Broadway 15 years ago today. The show beautifully captures the swings between the ridiculous highs and the soul-crushing lows the disease brings to those of us living in its fogs and terrors ... and to the selfless teams of people who care for us.

I’m fortunate enough to have seen the original production, very soon after I’d been diagnosed as bipolar and had found myself caught in a rather terrifying struggle to wrap my confused, exhausted brain around the fact that mental illness was no longer a mysterious entity in other people’s lives; it was MY life, and I had no idea how to manage it or what potential and very real horrors to expect from it.

The musical is rough to experience from any perspective, but seeing it for the first time tore me apart ... and then put me back together with its closing anthem, “Light,” which features an almost casually placed lyric that is at once devastating and hopeful and never fails to sneak up on me and emotionally gut me even though I know it’s coming: “The price of love is loss / but still we pay / we love anyway.”

Back when I saw the show on Broadway, selfies were new and weird and shameful—and for you young folks, it was the Middle Ages when our smartphones had cameras that faced only one way and didn’t let us see on our screens what our selfies would look like so we just had to hold our phones in the air and hope for the best—so I took this one-try selfie as quickly and discreetly as I could to ensure an entire city of complete strangers wouldn’t judge me. It turned out rather well, although I cut off the last letter of the sign. Which means as far as any of you know, I actually just saw a knockoff production called Next to Norma.

I've been invited to be the Bipolar Person in Residence and talk to the casts and audiences of Next to Normal productions at two local theaters over the last decade. And while I hope it was helpful for the actors as they rehearsed and found their characters' realities, it was extremely helpful for me to have an opportunity to articulate the swings and uncertainties and terrors of living with a mental illness—both so I could explain any weirdness I've personally exhibited and to help the actors help their audiences better understand these realities.

While every bipolar mind is different and therefore every moment of Next to Normal doesn't exactly mirror my experiences, every note and every word of the show is brilliant and hits brilliantly close to home. And that closing anthem—sung by the characters not to each other but to the audience and to the present and to the future—encapsulates the struggles and hopes I live with every day in astute prose and powerful, emotional, wall-of-sound vocals:

Day after day,

We'll find the will to find our way.

Knowing that the darkest skies

Will someday see the sun.

When our long night is done,

There will be light.

Timber!

Seven years ago today—three years after leaving the hospital and just hours after taking the very first dose of yet another new bipolar med added to my ever-evolving cocktail—I stood up from a chair, walked a couple steps, blacked completely the hell out, fell Timber! onto the tile floor (which I cracked with my face because GO BIG OR GO HOME), shredded myself eyebrow-to-chin on my shattered glasses, bit most of the way through my lip, loosened some teeth, got a concussion, and woke up in my sister's car holding a huge bloody rag to my face too confused to remember that Christmas had happened (or, for just a few glorious moments, that I was even bipolar) as she rushed me to the ER, where I looked so brutally horrifying that the nurses assumed I was the victim of a violent assault and three police officers were dispatched my room to question me well before the doctor showed up to assess the damage, declare me not dead and give me double-digit stitches.

I came home covered in swelling and bruises and scabs and stitches and glue—after telling the ER doctor in my foggy haze that my modeling days were over and I didn't care if he left scars all over my face but I vaguely remember him informing me that he still had a professional obligation to do his best—and filled eyeballs-to-spine with a deep, not-for-amateurs headache that brought crippling new levels to my understanding of pain ... and yet I still found a way to take time out of my busy schedule for a quick selfie to document the occasion for future biographers. (You're welcome, posterity!)
This Timber! event was directly linked to my new drug (called Fetzima, who sounds like a possibly immodest resident of the Anatevka demimonde in Fiddler on the Roof) that, as with all psychotropics, came with an alarming list of ramp-up side effects ... including abrupt blackouts. But I knew from a decade-plus of trial-and-error experience that I needed to tough out the first three or four weeks until the side effects subsided and the drug's level (or not level) of efficacy manifested (or didn't manifest) itself.

And despite its hyperdramatic entrance into the madcap musical of my life, Fetzima more-or-less quickly proved itself to be perhaps the drug that effectively balances my serotonin and norepinephrine and keeps me (more or less) stable and engaged and functional and capable and able to go to work and do shows and take care of my parents and run races and do handyman projects (quite well, if I can toot my own horn, which I shamelessly will) and practice the piano and buy shoes and buy more shoes and here I am seven years later, scar-free (thanks, conscientiously ethical ER doctor!) (though it took a good six months for the scars to heal and the scar tissue where I bit through my lip to subside to the point that I could drink out of a straw again) and concussion-free (pro tip: you DO. NOT. EVER. want a concussion), and clearly in possession of an added year's mouth wrinkles and silver foxiness.

[Super-fun side note: Aetna, in its infinite wisdom, abruptly stopped covering my Fetzima for two years and summarily rejected all three of my doctor’s allotted appeals. Because apparently risking sending me to the psych ward for another week was far more cost-effective than covering a proven psychotropic. So my doctor hoarded samples for me in the hope that Aetna would finally get its head out of its fetz (which it finally did this year) and/or Fetzima’s patent would expire, it went generic and it stopped costing $700/month out of pocket (which has yet to happen.]

Anyway, if you're inclined, raise a glass and yell Timber! in my scab-free, concussion-free, fog-free, not-functional-free honor today. I'm gonna go out and keep living. Timber!

Inpatient

After a year of unemployment in Chicago where I half-assedly looked for jobs and shuffled back and forth from Cedar Rapids, I more or less officially moved home nine years ago this month.

My bipolar disorder was escalating and I was seeing what I now understand was a hack psychiatrist (because how can you know what to look for and who’s competent when you’re new at finding mental health professionals and you’re crippled by a mental illness?) who kept prescribing medication after medication (including the anticonvulsant Depakote that I had NO business being on due to its highly problematic interactions with my Lamictal mood stabilizer) without following up or even letting me know what catastrophic side effects to look for. And my unmanaged Depakote cocktail was a living nightmare of day-long blackouts, terrifying hallucinations, and sleepwalking through what was thankfully benign but could have been fatal odd behavior.

Every psychotropic drug gives you temporary—sometimes awful—side effects as you ramp up on a new prescription and wean off of it when you find out it doesn’t work. And thanks to this doctor’s random changes of drugs and cocktails, I was in a constant state of up-and-down side effects that left me miserable and confused and unable to function in a multitude of ways.

On top of all that, I was newly single and living alone for the first time in seven years, which meant I didn’t have an extra brain in the house to remind me to take that litany of changing meds on their prescribed schedules.

So by the time I decided I was moving home, I was a mess. A catastrophic, dissociative, emotional-train-crash mess.

And as Christmas drew nearer and nearer, I found myself more and more overcome with panic and dread about holding myself together through our family activities, worrying that I’d ruin them for everyone and inevitably escalating even more.

I couldn’t breathe. I couldn’t think. I couldn’t comprehend.

I didn’t want to live.

So nine years ago today, my parents—my terrified, confused, helpless parents—and I together made the heart-wrenching decision that I needed to be hospitalized. Two days before Christmas.

The ensuing details are still hazy to me, but from what I can remember: I sobbed on our couch in Greek-tragedy emotional pain as I slowly wrapped my muddled brain around what I was about to do. Mom and Dad came with me to the emergency room. I was evaluated by a doctor. We were put in an empty holding room for four hours while they looked for an open bed, which they eventually—thankfully—found right there instead of in a hospital 200 miles away. We were taken to the mental ward where we first had to go through a room where Mom and Dad had to leave their coats and Mom had to leave her purse.

When we got in, I had to forfeit my coat and clothes and phone and basically everything but my glasses. I was given scrubs and hospital socks. I met privately with a doctor, who took me off every drug I was on and prescribed yet another new cocktail of drugs. Which meant more simultaneous ramping-up-and-down side effects.

And when I was finally done being triaged, I was given an opportunity to say goodbye to my parents and then I was escorted to my room.

I made one last look back as I was halfway down the hallway, and the looks on my parents’ faces—their anguish, fear and inconsolable sadness—will be forever seared in my memory.

And so will my feeling of complete, comforting relief from accepting the fact that all of this was bigger than I was, I could finally release the demons fighting inside me, and I was in the protective, hopefully healing care of people who could manage whatever it was that was tearing me apart.

Nine years ago today I launched into an unknown of what ended up being a full week in a locked mental ward in a hospital.

Nine years ago today I started yet another roller coaster of the disorienting, miserable side effects of changing medicines.

Nine years ago today I finally knew I was safe from myself, I was being cared for by experts, and for some reason what I found to be the most important: I wouldn’t ruin my family’s Christmas. I knew that not being there would be disruptive. But I also knew that being there would have been even worse.

Nine years ago today, I started what would still be a long, bumpy road to healing, but I knew I was at least on the road to healing. It was one of the worst things I’ve been through and one of the best things I’ve ever done.

If you’re struggling with the out-of-control pain and confusion of mental illness, please know there’s no shame in asking for help—even to the point of being hospitalized—and putting yourself in the focused care of others.

There most likely won’t be immediate healing. But there will be hope. For you, your family and your support network.

There will be calming, restorative, essential hope.

World Mental Health Day

Today is World Mental Health Day, an annual global event started in 1992 at the World Federation of Mental Health to promote awareness, education, understanding and advocacy for those of us suffering from mental disorders, the caregivers we sometimes desperately rely on, and the larger populations in which we live and often struggle to navigate every day of our lives.

In this spirit of awareness, education, understanding and advocacy, I'm offering here a view from inside the bipolar volcano hurricane that I wrote years ago as I was emerging from a distinctively catastrophic episode:

Sometimes being bipolar means waking up with your head covered in a gray wool blanket in the middle of a hot drenching rain and the weight of it is practically crippling but you know you're not depressed and you know you're not confused and you know you can breathe and you know you're invested in fighting your way out so you treat every blink and every word and every thought as fuel that sparks the next blink and the next word and the next thought and even though you're foggy and slow and maybe even late you're MOVING and no matter how long it takes and how hard you have to work just to achieve your minimum for now you know that it's just for now and you'll sooner than later find your way out of that hot wet scratchy gray wool blanket and you'll know from hard-fought experience that you may not have the power to make the rain go away but you have the tenacity and the fortitude to outlast it and find your clarity and focus again in the warm, restorative sunlight it was trying to hide from you and even though you're never entirely sure you know exactly what that unclouded sunlight feels like you'll always get close enough to know what you're fighting for and how to be stronger and smarter and even more certain of your indestructibility the next time.

Mental Health Awareness Month: NAMI

The National Alliance On Mental Illness (NAMI) is a nationwide organization that provides informational and emotional support for the caregivers who work to keep people with mental illnesses on track and stable—or at the very least it lets the caregivers know they're not alone.

The organization has 1,000 state and local affiliates across all 50 states, Washington, D.C., and Puerto Rico. To keep it accessible to everyone who needs it, NAMI is funded through pharmaceutical company donations, individual donors, sponsorships and grants.

My parents found a lifeline in NAMI when I was diagnosed as bipolar a decade ago. Now my mom—a retired teacher, so this is totally in her wheelhouse—has taught classes to help NAMI members better manage the situations they face and has undergone formal training to be a group meeting leader. I'm so thankful for everything my parents and my sister's family have done to support me in my bipolar adventures. NAMI has helped them help me manage my life with a considerable degree of success and relative normalcy.

If you’re interested in learning more or finding a NAMI group to attend, please visit nami.org.

Mental Health Awareness Month: An Unquiet Mind

An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison is a fearlessly, brutally honest 1995 memoir examining the exhilarating highs and soul-crushing lows of bipolar disorder (which was clinically called manic-depressive illness during the events of this book) from the perspective of a psychiatrist trapped in the disease. Her frank and intimately personal insights bring bipolar disorder’s cycles of terror, elation and crushing, abject despair into stark and sometimes heartbreaking clarity.

The book was recommended to me soon after I was diagnosed as bipolar in 2008, and it grabbed me on every level—from its smart writing to the recognizable, relatable, almost comforting details of its narrative—and I all but literally didn’t put the book down until I’d finished it.

I have an indelible memory of reading it on the Red Line EL train home from work one night in Chicago, and a man who’d clearly seen me reading it made sure we made eye contact as he stood up to leave and then he patted me reassuringly on the shoulder as he got off at the Sheridan stop. That encounter—a direct extension of this book—made me literally weep the rest of the way home as I was coming to grips with the label “mentally ill” and discovering the signs I’d never thought to notice until then that I wasn’t alone … and realizing that everywhere I go I’d never be alone.

If you are or love someone who is bipolar—or struggling with any mental illness—this book will make you weep, give you hope and quite possibly change your life.

Mental Health Awareness Month: Tardive Dyskenesia

As if mental illness itself weren’t embarrassing and exhausting enough—and as if the spectrum of side effects from psych meds weren’t even more embarrassing and exhausting—along comes tardive dyskenesia.

Aside from sounding like an antebellum flowering vine, tardive dyskenesia is also a range of involuntary, repetitive neuromuscular movements of the tongue, lips, face, torso and extremities that occur in people treated with long-term antipsychotics and other dopamine-receptor-blocking medications. If you’ve ever stood or sat near me for an extended period of time, you’ve no doubt seen the full compendium of symptoms: grimacing, lip chewing and pursing, heavy blinking, face touching (and I deserve seven gold medals for fighting back the compulsion to touch my face 75 times a minute in the Coronavirus Olympics), arm swinging, leg hitting, rocking, fidgeting, shaking, and—oddest of all—being on tiptoe whenever I’m sitting down. My foot also pulses on the gas pedal when I drive, and a number of people have told me it almost makes them carsick when they ride with me.

I’m rather lucky in that my flailing and wiggling are more embarrassing than physically problematic, but about 20% of the population living with the disorder literally can’t function; it can prevent them from walking, eating and even breathing.

And as a point of clarification, these symptoms are the opposite of those from Parkinson’s Disease. People with Parkinson's have difficulty moving, whereas people with tardive dyskinesia have difficulty not moving.

Tardive dyskenesia symptoms can lessen, change or even go away over time after a person stops taking neuroleptic medications, though more often than not they’re permanent. My symptoms have noticeably changed over the last decade, but I’ve traded making alarming sucking sounds on my lips for making an entire room tremble from my violently shaking legs.


There are many medications that can be used to manage the symptoms to varying degrees. After five-plus years of needless misery, I recently weaned myself off the anticonvulsant Gabapentin, which did or didn't work depending on the way the wind blew and the leg trembled. It also tended to make me drowsy and sometimes even confused, which makes me especially surprised that it’s used recreationally—under the totally lame street name Gabbies—for its supposed euphoric effects that I absolutely NEVER experienced.

One more thing: You may have seen the commercials for the prohibitively expensive tardive dyskenesia medications Ingrezza and Austedo … the commercials where they call tardive dyskenesia “TD” like it’s some cool brand of earphones or energy drink. Dear Ingrezza-makers Neurocrine Biosciences and Austedo-makers Teva Pharmaceuticals: I’ve had tardive dyskenesia for over a decade. I’ve been seeing psychiatrists and neurologists about it for over a decade. I’ve read everything I could read about it for over a decade. I’ve been on medications for it for over a decade. And NOBODY outside of medical publications and pharmacy websites calls it TD. STOP TRYING TO MAKE TD HAPPEN.

Mental Health Awareness Month: Depression

Everyone can feel occasionally sad, lonely or unmotivated as a result of anything from grief to just having an off day. But when these feelings become exponential and overwhelming and prevent you from functioning, you could be suffering from clinical depression.

And there isn’t a single kind of depression. It’s diagnosed when you present any long-term combination of symptoms including feelings of worthlessness and hopelessness, trouble concentrating, insomnia, fatigue, loss of interest in pleasurable things, restlessness, suicidal ideation—and even physical symptoms including body aches, digestive problems and appetite loss. Depression symptoms also vary widely based on age, gender and personal circumstances.

There isn’t a single kind of treatment either; depression can be managed with any combination of psychotherapy, antidepressants, exercise, certain supplements (vitamin D and fish oil have noticeably increased the efficacy of my meds) and in extreme cases electroconvulsive therapy (ECT)—with focused attention paid to people expressing suicidal thoughts and reckless behaviors.

Depression can also present itself along with other clinical disorders including psychosis, bipolar disorder and seasonal affective disorder. In my case, I have both bipolar II disorder and major depressive disorder—which means my shutdowns are almost always epic: I collapse into a deep, deep hole of despondency, exhaustion, physical pain, dull panic, slurred speech, a metallic taste on my tongue, and a fog that feels like a hot, wet, suffocating blanket I can’t find a way out of. All I can do is sleep in a drenching sweat, lose all track of time and frequently wake up with the pain of an oncoming migraine that thankfully never fully manifests itself.

Plus I’m totally no fun at parties. :-)

On a personal note, I have serious issues with the word “depression” in itself. I know it’s impossible to find a word that succinctly encompasses all these symptoms, but colloquial English has appropriated depression to mean feeling kinda blah, and people also associate the word with low spots in the ground, dips in the road and economic slumps, so they tend to think that clinical depression is just sadness. And if we depressed people had a nickel for every time someone told us to cheer up or decide to be happy, we just might be rich enough to actually BE happy. I know people who say these things are often coming from a place of not understanding and of just trying to be helpful, but the word “depression” is exactly the reason they’re confused and ultimately unhelpful.

And on that note, if you know someone who’s depressed or struggling through a depressive episode and you want to help, just ask what you can do. Some of us want to be left alone, but some people may want you to sit quietly with them so they don’t feel alone … or bring them some ice water … or call 911 … or some people may genuinely want you to try to cheer them up.

This is way off-topic and completely unhelpful given most of what I’ve just said, but if the latter request is the case, I recommend you start with my all-time favorite joke:

What’s brown and sticky?

A stick.

Mental Health Awareness Month: Bipolar Disorder

I’m starting my series of essays with something I know on a cellular level: I was diagnosed bipolar II over a decade ago, and I’ve spent a lot of time since then trying to learn everything about the illness, how the medical community’s understanding of it is evolving, and how we all can work to manage it both day-to-day and long-term.

Bipolar disorder in general involves one-to-two-week swings between two opposite poles of mood, energy, focus and function. The top pole is mania, which manifests itself with elation, irritability, energized behavior and lack of impulse control. People in manic episodes experience racing thoughts; an inability to focus or stay physically still; and delusions and hallucinations that can inspire irrational or risky behaviors including gambling, sexual activity and drug use without regard for what can be catastrophic consequences. The bottom pole is depression, which manifests itself with hopelessness, indifference and despondency. People in depressive episodes experience extreme sadness; suicidal ideation and attempts; and difficulty functioning, thinking or experiencing pleasure (which is called anhedonia).

There are three types of bipolar disorder. Bipolar I Disorder involves swings between both poles—sometimes both at once—that are so severe they can require hospitalization. Bipolar II Disorder—sometimes called bipolar depression—involves mild manic episodes (called hypomania) and often more profound depressive episodes. Cyclothymic Disorder, which isn’t as common, involves hypomanic and depressive episodes that last at least two years.

As I’ve said, I’m bipolar II, where my hypomanic episodes involve restlessness, fast (well, faster than normal) talking and thinking, and buying shoes online that I don’t need. I usually post these purchases on here to broadcast that 1) I bought awesome new shoes and 2) I’m currently hypomanic off my ass. My depressive episodes are soul-crushing in their extremity. I can’t think, I struggle to breathe, my vision is blurred, I feel like I’m wrapped in a wet wool blanket that I can’t kick my way out of, I sometimes have visual or aural hallucinations (including seeing people in black clothing lunging at me and hearing stupid, irritating circus music coming from another room), and I often contemplate suicide but I have no energy or initiative to carry it out … I generally feel like everything is completely hopeless and I just want to have never existed. And when I emerge from these episodes I’m exhausted to my core.

Bipolar disorders can be managed with psychotherapy (talking with a therapist), psychiatry (drug therapies) or a combination of both. I’ve never found much benefit from my visits with various psychologists, but I’m a HUGE believer in better living through chemistry. Psych meds (which are awesomely called psychotropics) affect me strongly, for better or worse. They involve a lot of trial and error, but I’ve been highly functional for the last four years after finally finding a magic cocktail of three psychotropics (there’s that cool word again).

I do want to stress, though, that what works for me is indicative only of what works for ME. If you’re living with a mental illness, don’t abandon a combination of therapies that might be working for you just because someone else is thriving on a different combination of therapies. And for God’s sake, ALWAYS TAKE YOUR MEDS.

Bipolar disorders were classified as manic depression through most of the 1900s. In 1980, the third edition of the Diagnostic and Statistical Manual of Mental Disorders (called DSM-III), officially changed the classification to bipolar disorder to reflect a wider range of nuance and understanding of the disease. This paragraph is a broad generalization of the naming history, but I wanted to explain that manic depression and bipolar disorder are essentially the same thing.

There is a lot more I could discuss here, but I want to keep these essays short(er than this one) and digestible for anyone who cares to read them. Feel free to share this with anyone you think might be interested, and I hope to have another short(er than this one) essay posted soon. Stay healthy!

Mental Health Awareness Month

May is Mental Health Awareness Month, and as your designated Bipolar Friend Who Can’t Seem To Shut Up About It, I’ll be spending the month posting short essays on a broad range of mental-illness topics and issues that I hope—if you want to read them—will provide helpful information and insight to give you a more nuanced understanding of the world occupied by people living with mental illnesses and the sainted people who take care of us.

I was diagnosed bipolar over a decade ago, when a friend’s suicide made me suddenly aware that—instead of mourning the loss of him like everyone else around me—I was jealous that he actually killed himself … and I’d been living in a state of just-under-the-radar suicidal ideation for as far back as I could remember. When fantasizing about when and how to kill yourself is your everyday normal, it doesn’t raise any interior red flags until something jolts you into the objectivity you need to stand outside your head and realize that you have a problem. A very serious problem. So going on nothing more than the foggy, horrifying, embarrassing realization that I had this problem, I wandered into what would prove to be a long, frustrating, flying-blind journey to erase—or learn how to manage—the crashing malfunctions in my poorly wired head.

As with most people living with mental illnesses, I’ve been to hell and back many times trying to figure out the magic cocktail of therapists and therapies and medications I need to achieve some sense of normalcy. And since there’s no basic training on what to look for or how to find a competent, ethical, moral mental-health doctor—especially when you’re yet-undiagnosed mentally ill—I stumbled into some even deeper horrors before I finally found a doctor who knew what she was doing and who had my overall health and best interests at heart.

So here I am with my fancy green-and-white Mental Health Awareness Month graphic and my list of topics to cover, and if you’re interested I hope I can give you something useful and meaningful to know this month whether you’re living with a mental illness, caring for someone with a mental illness, or just looking to understand more about the roller coasters lurching in and out of Mental Illness Land.

The natural progression of bipolar disorder:

depression > deep depression > despondency > recovery > fogginess > exhaustion > functionality > public panic attacks > Oreos

Cymbalta withdrawal is a bitch. Bitch Kitty is a bitch.

Cymbalta withdrawal gives me brain zaps, which are like blackouts with extra dizziness and lip tingles and confusion and disorientation but no actual blacking out. Bitch Kitty gives me the come-pet-my-soft-warm-exposed-tummy fakeout, which is like a real come-pet-my-soft-warm-exposed-tummy invitation but with growling and hissing and swatting and running away as fast as her waddly soft warm tummy will allow but with no actual soft warm tummy petting.

 
Cymbalta withdrawal brain zaps hit me then fade away then hit me then fade away until I'm exhausted. Bitch Kitty swats at me then runs away then swats at me then runs away until I'm tired of her bullshit.

 
Cymbalta withdrawal brain zaps will eventually go away and I will dance on their grave. Bitch Kitty will eventually go away and I'll actually kinda miss her.

Another crash

I was supposed to leave this morning for my annual summer vacation to visit friends in D.C. and stay at their best-porch-on-the-planet beach house in Rehoboth, DE, but I had to cancel a few weeks ago due to work issues. A lot of cool things have popped up on my calendar here in Cedar Rapids this weekend though, so I'm more or less OK with missing my trip.

But I still missed work this morning thanks to a rough descent into a bipolar depressive episode that started last night. I talk a lot about being bipolar on here, and every time I think I should stop someone messages me out of the blue to thank me for being so open and honest about it. Enough people have confided in me the stories of their struggles with mental illness that I sometimes worry I won't remember everyone in my mental checklist of kindred, struggling spirits. I've developed close, supportive friendships with a lot of these people though, and our check-ins and conversations and even drives across town just to give hugs are so dear and so valuable to me that I'll probably never stop talking about my own struggles.

So here's this morning's report: I woke up at 6:00 in a motivational black hole with a fiery headache and enough disorientation that I knew enough to skip the gym—which is huge because some days working out is the only thing that keeps me human—and to let my boss know that I'd come in after lunch, if at all today. Then I went back to the kind of non-sleep that feels like you're staying awake getting more and more exhausted compounded by the stress of feeling worried about getting more and more exhausted. But when I woke up around 11:00 my head was clear enough that I could look at the episode objectively and summon the coping and pushing-through skills I've learned over the last decade and I showered and ate and made it to work, where I've been surprisingly productive ... albeit profoundly exhausted.

So to all the people I know who are dealing with mental illness and to all the people I don't know who are dealing with mental illness and to all the rest of you curious enough about my struggles today to have read this far: You will fight this battle all your life. You will get meds that don't work, you will get meds that actually make things worse and you will find meds that you'll notice start to make improvements ... though you'll spend ages waiting cynically for them to fail you. In the mean time, learn what helps you stabilize yourself and what helps you push your way out of the wet wool blankets and the rolling fogs that trap you. As soon as I felt coherent this morning, I texted one friend who right now is in a bottomless depressive episode so we could both not feel alone in our struggles and I texted another friend who as far as I know is not having an episode just so I'd know that someone who deeply understands what I'm going through is at the very least thinking about me. And then I picked out a shirt that says carpe diem on it and I know that it's totally goofy bordering on stupid, but if I'm wearing a shirt that means something to me on a certain day or in a certain situation, I feel compelled to go out in the world and show it to everybody.

And after what my head put me through this morning, I need everyone to know—no, I need to SHOW everyone—that I'm seizing the hell out of the rest of my today.

Why is the waiting-room music at my psychiatrist’s office playing “Send in the Clowns”?

Addy Noma isn't just a mediocre drag name

FUN FACT: Bipolar disorder often comes as a set with a small benign pituitary tumor called an adenoma. And I've been lucky enough over all these years to have collected the whole set. My little adenoma—which would be a great title for a song by Poison—hasn't shown any significant growth in four years, so it's not causing much concern. But we still monitor it with an MRI every other year. And every other year happens in half an hour. Having an MRI on your brain is like being stuffed in a too-small casket that screams at you—like a song by Poison—for 45 minutes. Plus you can't obsessively play on Facebook while you're in your tiny, screamy casket. So it basically totally sucks. But at least it triggers any latent claustrophobia you may have hiding in you, so it totally gives you something to occupy your otherwise unproductive time. So there's that.

This is just a bucket of melty cheese encased in pointless single quotes ...

but I cannot overstate its inherent truth; I wouldn't be here today if it weren't for my family and friends. If you are a part of a mentally ill person's support team—even for a moment—you are a saint. And on behalf of everyone who ever needed a reminder to take his meds or a voice of reason before taking a wrong turn or just a random hug in person or via text, I thank you.

When you’re a total stupid dumbass

who absent-mindedly takes your Saturday PM meds when you wake up at 5:00 on a Monday and then a few hours later you take your Monday AM meds and quickly send yourself spiraling into a painful, disorienting, blinding, terrifying—but ultimately non-threatening—double-dose overdose situation last week so your mom devises a brilliant MomGyver fail-safe using nothing but rubber bands and a butter knife to save you from your stupid self in the future.

Also: While most of these pills are supplements to enhance the efficacy of my psych meds, the collective volume of psychotropic and supplemental pills has finally reached a critical mass that obligates me to take them in two shifts instead of in my usual badass single-fistful gulp.

The horrors of Depakote

Facebook is reminding me that seven years ago today was my first attempt at functioning in public (specifically at work) on the hardcore anticonvulsant Depakote:

Depakote either works wonders for you or it destroys you, and I was DEFINITELY on its no-fly list. The pharmacist who filled my first prescription actually pulled me into a consultation room, warned me about the horrible, terrifying things I might experience, and literally held onto my hand as she talked to me. I'll never forget the look in her eyes that was a mix of both kindness and visible concern.

[Don't get me started on the hack Chicago psychiatrist who'd prescribed it without saying any of this to me and who obviously made zero attempt to set up a line of communication should I have problems in my first terrifying, confusing days and weeks.]

Once I got home that night, I took my first dose with much trepidation, went to bed on the guestroom bed my parents slept in on their visits so I could maybe feel somehow close to them if I needed to ... and right on schedule I was immediately flooded with such graphic nightmares of being hunted and murdered over and over that they're seared in my brain and I can still replay them in my head with absolute clarity.

That was a Friday night, and all weekend I'd hallucinate intruders in black hiding in my apartment and wake up screaming when I tried to sleep. But psych drugs can have side effects like these as you ramp up, and I was at least self-aware enough to know (or be pretty sure I knew) that the hallucinations weren't real and the nightmares would eventually go away.

Which they never did. I was taking Depakote with the more established anticonvulsant Lamictal (which I'd been on for years) and at least one other drug (but probably two or three) that I can't remember, and in the weeks that followed it seemed to be the tipping point from barely managing my bipolar swings to living in terrifying hallucinations and falling into daylong blackouts where I'd come to riding the Red Line north to parts of Chicago I'd never been to or sitting on a bench in the Lincoln Park Zoo without my coat or my phone.

I seem to recall that seven years ago today I was able to hold myself together at work, but I do know that the abovementioned blackouts caused me to start missing entire days of work. I can't remember how long I gave Depakote to finally level out in my head and maybe start working, but I do remember it never did. And my hack psychiatrist eventually had me quit it cold-turkey as he threw some other random drug at me. And I was too meek and confused and overcome with self-doubt to challenge him on any of it.

And it was all awful. Just ... awful.

But it DID give me an opportunity to make a big-gay-musical pun (that wasn't half bad, imho) about it on Facebook seven years ago today. So there's that.

And it took another four years before I found my magic psych cocktail that's kept me stable and functioning and able to laugh at everything I went through. Especially that awesome big-gay-musical pun.

And if you're struggling through your own parade of trial-and-error psych meds (hopefully not with that hack psychiatrist at the helm), try to be be patient and diligent and even optimistic about your adventures. I made it. There's every chance you will too.

Not to make things alarmingly about me

but I accidentally took my meds twice this morning like a forgetful idiot and now I'm dizzy and unable to walk and really sensitive to light and barely able to see and slightly nauseated and talking a bit randomly so this post is taking forever to write.

My neurologist took forever to get back to us, but he said just to sleep it off—which is hard to do because I have to wedge my arms under my sides to hold myself in place because I have a weird sensation that I’m going to roll off the couch where I’m spending the day near my doting parents. 

If you’re on either of these meds, never take 600mg of Lamotrigine and/or 1,200mg of Gabapentin (we’re not sure which is/are making me fall into this bizarre hole). 

That’s enough typing.

Giving cigarettes the Axe

My seizure medication (Lamictal, which is being slowly titrated up from 400mg/day to an eventual 800mg/day) hasn’t killed my cigarette-smoke hallucinations, so I’ve resorted to attempting to mask the imaginary stink with one of these plug-in room-smell thingies (in the default—but debatable—Fresh Linen scent):

And even though it’s on the lowest setting and hidden halfway behind a huge piece of furniture, it makes my entire Basement Bachelor BunkerTM smell like a middle-school boys’ locker room the day after a massive sale on Axe Body Spray.

It does mask the cigarette-smoke hallucinations—which get especially strong (or at least acutely noticeable) as I work at my desk—but it’s giving me a low-grade headache.

Even worse, it’s giving me flashbacks to my boyish middle-school waistline, first fuzz of pubescent armpit hair and store-brand parachute pants. Can I borrow some hair mousse?

MRI/OLFACTORY HALLUCINATIONS UPDATE:

My MRI showed no evidence of seizures, but my cigarette-smoke hallucinations are so pervasive and choking that my neurologist had the levels of Lamotrigine—an anti-seizure medication I'm already on to control my bipolar disorder—tested, and since the numbers were so low he wants me to quadruple my dosage.

Quadruple. In one fell swoop. Which is crazy. And since I'm crazy, I KNOW crazy.

So I have a call in to my psychiatrist to get a second opinion. Because it took a decade to test and titrate the med cocktail I'm currently on that finally makes me (relatively—the jury is still out) functional. And I'd rather choke on imaginary cigarette smoke the rest of my life than spend another day in a psych ward with a roommate whose first words to me are that he just got out of prison. Because I've already crossed THAT off my bucket list.

BUTT UPDATE:
The super-handsome leather-clad supposed-to-be-for-a-dining-room chair I use for my work-at-home desk has started leaving crippling pain in my butt and tailbone—please keep your vulgar comments to yourselves—so I ordered an ergonomically designed butt pad to hopefully let me stand up after every hour of writing without shouting epithets at the no-butt-pain gods.

The pad I bought is literally called Everlasting Comfort(R)—which, I'm sorry, should have been snatched up by the funeral industry decades ago, so way to drop the ball, casket-makers—and it's velvety soft and everlasting-comforty cushy and it has a cavernous space for my poor beleaguered tailbone to hang in peace. I can't say the same for the little hill it expects me to rest my boys on, but if I can walk like a bipedal hominid after spending a day writing about pajamas and kitten hats, the boys and I will learn to adjust.

This is my first day riding the Everlasting Comfort Train, and I've been ergonomic-butting and tailbone-hanging and boys-resting on it for six hours of work now. So far it doesn't feel like anything's changed, but that could just be because my existing profound butt pain hasn't cleared itself up yet. So—like Nevada—the boys and I are still tallying votes and we'll announce the results sometime before the peaceful transfer of power.

Some people get MBAs. Or MSWs. Or Mrs.'s.

I just got an MRI. And I have the MRI hair to prove it.

My choking-cigarette-smoke olfactory hallucinations are now in their sixth straight sold-out week, so my neurologist ordered an MRI to see if I might be experiencing seizures. And since I was a bit overdue for my every-other-year MRI to monitor a benign adenoma tumor on my pituitary, my GP ordered one for that as well.

For those of you keeping score at home, that's two MRIs for the price of one Richter-scale bedhead.

And hoo-boy has the MRI spa experience improved in the last two years. Instead of being immobilized in a claustrophobic head cage and jammed full-body into the super-duper-claustrophobic MRI oven that clanks and screams at you like you're about to be devoured by robot ghosts, this time I was given noise-almost-canceling headphones with my choice of music (they cruelly didn't have a Broadway option, which is just rude) under my claustrophobic head cage and I was rolled into the oven only to my shoulders, which allowed a welcome sense of light and air circulation.

Side note: The top of the oven hole that I was rolled into was made of pale plastic molded with two ridged arcs that curved in from the sides and swooped down to meet in the middle and disappear at the bottom. And when you stare at them for over an hour as terrifying robot ghosts clank and scream in your ears, they start to look like ... well ... um ... a hoo-hoo. And once you see an abstract hoo-hoo arcing gracefully mere inches from your face, you totally can't UNsee it. So it's fair to say that I've had more than my fair share of molded abstract hoo-hoo for the day. Or the week. Or the decade.

When the guy who locked me in the claustrophobic head cage and rolled me into the MRI clanking-and-screaming-robot-ghost oven told me that Broadway wasn't an option for my musical distractions, I—in a pique of fluster—blurted out the obvious second choice for a Broadway lover: '70s rock. I have NO idea why I said that, other than the fact that I like The Eagles and "Little Willy" (the SONG, ya perverts), but the genre's stentorian guitar shredding and growled, node-guaranteeing singing ended up making an arguably better robot-ghost-clanking-and-screaming cover-up than "She Used to be Mine" or "Finishing the Hat."

Side note: When you're immobilized in a cage with a molded abstract hoo-hoo glaring in your face and an endless parade of '70s rock anthems you've never heard before blaring in your ears, you have to think of SOMETHING to pass the time. So you inevitably find yourself listening intently and trying to catalog the form and structure of each song.

Cliff's Notes: The '70s were clearly a period of unbridled musical creativity and innovation, because not a single song is written in AABA form. Not even "Old Time Rock and Roll," despite its UNAMBIGUOUSLY STATED allegiance to the AABA Golden Age. Thanks for nothing, Bob Deceiveger.

Medical-stuff conclusion: There is a measurably common—though not necessarily causal—relationship between mental illness and pituitary tumors. Which is one reason we monitor my adenoma every two years with an MRI to see if it's growing or in any way changing. There is also an objectively cruel relationship between my bipolar-meds-induced tardive dyskenesia—a permanent neurological disorder that causes LOTS of involuntary muscle movement—and my regular MRIs that require me to LIE THE FUCK STILL FOR OVER AN HOUR and hold all that twitching in. It's exhausting, which is why I always take a PTO day to recover when I have an MRI.

And to tame my damn bedhead.

Phantosmia isn't just the name of a potential Drag Race contestant

It's also the clinical term for olfactory hallucinations. And I've been choking in a cloud of hallucinatory cigarette smoke for almost a month now.

It gets so bad that I swear it's coating my throat and I almost start to gag. It feels so pervasive that I swear it's soaking deep into my skin like I've just emerged from spending the night in a smoky bar. (Remember when people used to smoke in bars? Remember when they suddenly couldn't anymore and bars slowly became more and more breathable as the stink dissipated and you didn't have to give yourself Silkwood showers every time you got home?)

And it's so everywhere that I've incorporated easily accessible cans of room spray almost permanently into our home décor. Which barely masks the odor, but it at least helps a little.

It may or may not be a side effect of my bipolar meds. It may or may not be a symptom of my bipolar disorder itself. It doesn't appear on any list of side effects I've seen for covid. And it may just be a stand-alone add-on to the pile of weird things about me.

And it doesn't at all appear to be concerning to my doctors, who have repeatedly shrugged it off.

Weirdly, while my mood stabilizers have left me EXTREMELY chill about covid, politics, the derecho and the state of the world in general, this inescapable cloud of cigarette smoke is really beating me down emotionally. I barely leave the house if I don't absolutely have to.

But I've read that people's phantosmia can manifest itself in clouds of feces, decaying meat and sour body odor. So choking on cigarette smoke 24/7 feels in comparison like I won the lottery.

I had these hallucinations for a month back in March and April and they eventually went away. So I'm counting on that happening again. In the mean time, if you're ever near me I'm going to look at you like you're a big stupid insane liar if you say you can't smell all the thick cigarette smoke around us that's so real it's making me gag.

Also: Don't smoke in real life. It's gross. And bad for you. Listen to your Uncle Jake on this.

So I've started writing this mental-health blog ...

Actually, so far I've just been retrofitting it with posts I've made on Facebook and my older blog over the last decade. And there are hundreds more posts buried away in my social-media attics and basements that I want to find and repost here to create a more robust picture of my personal experiences with and observations about bipolar depression.

Unless I have a massive episode or interesting experience to write about, I'll probably focus my efforts here on digging up and reposting older posts, essays, reviews and ruminations for a while. So if you decide to come back, poke around in the labels and archives scrolling down the column to your right to find new old stuff to read.

Getting this blog up and running and filled with (hopefully) meaningful mental-health content is very much a work in progress, and I hope every time you return you find something helpful or interesting or occasionally entertaining.

And I also hope you share the URL far and wide. We bipolar depressives need our validation. And I have dreams of getting a book deal. And eventually a sitcom and a line of action figures. So copy and paste this with wild abandon:

TMIpolar.blogspot.com

Stay healthy and be well!

The tenacity and the fortitude

Sometimes being bipolar means waking up with your head covered in a gray wool blanket in the middle of a hot drenching rain and the weight of it is practically crippling but you know you're not depressed and you know you're not confused and you know you can breathe and you know you're invested in fighting your way out so you treat every blink and every word and every thought as fuel that sparks the next blink and the next word and the next thought and even though you're foggy and slow and maybe even late you're MOVING and no matter how long it takes and how hard you have to work just to achieve your minimum for now you know that it's just for now and you'll sooner than later find your way out of that hot wet scratchy gray wool blanket and you'll know from hard-fought experience that you may not have the power to make the rain go away but you have the tenacity and the fortitude to outlast it and find your clarity and focus again in the warm, restorative sunlight it was trying to hide from you and even though you're never entirely sure you know exactly what that unclouded sunlight feels like you'll always get close enough to know what you're fighting for and how to be stronger and smarter and even more certain of your indestructibility the next time.