TW: hospitalization, medication, psychosis
The fourth time I was admitted to the hospital I was very lucky for two reasons. I could watch the Red Line from my window, and if I stretched I could see the Citgo sign in Kenmore Square in the distance.
And I was diagnosed with Bipolar.
For over a decade I had Depression after being diagnosed at 17. For the last half of my Junior year I suppressed my feelings and thought often about jumping out of a window or into the path of a train. I spiraled so quickly I spent school vacation in the hospital. We got my meds in line and I graduated on time.
I thought I knew my depression. It felt like the take my meds, go to therapy and be alright kind of Depression. It was just a nuisance but it behaved, because I stayed in line. Then 2016 came. My Crohn’s flared that summer and my GI put me on prednisone.
My flare was stubborn and came back as soon as I weaned off the prednisone. I haven’t flared often so I hadn’t taken a lot of steroids. And it wasn’t a very high dose. But those side effects — especially the mental ones like mood swings and insomnia — that everyone dreads caught up with me as 2016 turned into 2017. In January I ended up in the hospital because insomnia had triggered a psychotic break.
The first time it happened was the scariest. We didn’t know what was going on and could only grasp at straws for a reason. As it happened again and again it was frustrating, unpredictable and unnerving. When I was discharged my diagnosis read Major Depressive Disorder with Psychotic Features. Even the doctors didn’t know what was going on.
Every time it happens insomnia leads it. Then the disordered thinking and word salad set in. I can feel my mind race, ping-ponging from topic to topic before I can finish saying whatever mush came out of my mind. My heart races, pushing triple digits yet I’m standing still. My body drags, wading through molasses with effort. The more I retreat into my head the more out of it I am. I can’t break free, and I know enough to panic, even as I get tunnel vision.
I still remember most of my delusions. January 2017 I saw Trump on the newspaper and knew it was fake, because it was four years later and Clinton was starting her second term. I was born four years earlier, yet my ID had an error. The second time was in September 2017 when I was convinced my apartment was bugged and an online company was coming to take me out. By my third time in June 2018 I had found a job but was convinced I would be fired for some minor mistake. And finally in November 2018 I thought North Korea had bombed us and everyone was dead.
Four times in two years, with little progress. Until I woke up on the unit and asked during rounds for a sleep study. But instead the attending, surrounded by all the residents and students on my team, said I was Bipolar.
I was not expecting that.
At rounds you don’t have a lot of time with your team. There’s too many patients and not enough time. As I sat trying to absorb this out of left field diagnosis I was asked if I wanted to start lithium. Despite having Depression and being on various meds for that, no one had ever suggested Bipolar. At that moment I couldn’t think of an alternative so I said yes.
I am not a typical Bipolar 1 person. I’ve never been manic in the traditional euphoric sense that’s depicted in media. I’m not a fun crazy person. When insomnia settles in, and I can do nothing to reverse it, I’m dysphoric instead. The doctors use my triple digit heart rate in the ER as evidence of my manic state.
When they introduced lithium they would split the dose. I’d get one capsule at morning meds and then I’d get another capsule with an increased dose at night. There were lots of blood draws. Lithium is one of the oldest drugs used in psychiatry. But it’s a high maintenance treatment. There’s a risk of kidney damage and hypothyroidism. Every time I have a psychiatrist appointment I stop by the vampires. I’m lucky that I’m used to blood draws after dealing with Crohn’s for 20 years.
The doctor who finally diagnosed me was not my psychiatrist. Certain doctors work inpatient and others work outpatient. My therapist who has known me through all these hospitalizations doesn’t fully believe I’m bipolar. It could be that I have an indeterminate mental illness that just happens to respond to the mood stabilizers most commonly used for bipolar. I had already been on lamictal since the first admission in 2017. We also added some nighttime seroquel that helps me stay asleep.
If there was anything worse than spending time on the psychiatric unit, it’s spending your birthday in the hospital. I was admitted right before my 30th birthday, and because we were adding a brand new medication I stayed long enough for them to send up a 6 inch sugar frosted cake. I had been on this floor before, just over a year ago for my second admission. That helped in learning the rhythm and routine of the floor. It wasn’t entirely bad as we were allowed cellphones, as long as we left the charger with the nurse. And food services gave us daily menus so I felt more in control of what I ate.
Getting diagnosed with Crohn’s at 11 altered my view on life. It was a lot to have to handle a chronic illness before I hit puberty. By the time I was in high school I’d gotten over the self-stigma and thought myself as resilient. I had a great college essay topic. Fast forward to 2017 when having such a sustained and uncontrolled mental health flare was frightening and isolating. The rediagnosis at 30 stopped the recurrent hospitalizations but it came with more stigma. If I struggled to talk with my friends about my relatively mild Depression, how could I even mention my Bipolar?
I feel boxed in at times. During the decade plus that I lived with Depression I’d felt the stigma diminish. Now I’m back at square one. That’s why I’m writing here; I’m too scared to write anywhere else.
When November 2019 rolled around I wanted to celebrate a year being out of the hospital. It was the longest I’d gone so far between admissions. I’d been following Ace on twitter and commissioned them to paint my brain as I described how Bipolar nearly overwhelmed me.I wanted to show the “normal” brain side by side because even when I’m flaring the two states exist together.
In a sense I’m lucky that I was diagnosed with Crohn’s 20 years ago. Bipolar and Crohn’s are equally chronic and can flare at unpredictable times. But for both there are coping skills like keeping a regular bedtime or lifestyle adjustments like avoiding nuts, seeds and corn. My lithium is as vital as my Humira, just a lot cheaper. Without navigating Crohn’s since I was 11, I’d be more adrift with the Bipolar diagnosis. This is the third time I’ve been dealt something that has a lot of stigma attached to it. But now I feel like I can work through it.
I’m going to be living with Bipolar for a long time. I’m ready.
