The Search

compassion & care, mental health & illness


I realize that Part 3 of my three-part series didn’t go up as planned. That’s because I haven’t written it yet. If you’ve been waiting on pins and needles, I appreciate your patience. I’ve had a lot on my mind lately.

 

On Monday I saw my therapist, and she stated something that possibly changed everything  —  akin to my struggling for years to articulate something through a self-made pidgin sign language marked by confusion, and then a Helen Keller-esque understanding of what WATER is. Oh! It’s that simple! And yet not simple at all. It’s so new to me that I feel I must keep it private. I’m sort of embarrassed by it, even though it explains almost everything that I’ve done since I was barely a preteen. I apologize for being oblique.

 

And I saw my psychiatrist yesterday, whom I adore, and she is always very straightforward with me. We talked about my medications  —  mostly, how we can work to decrease the amount of medication that I take. (At least eight medications a day. I take 10 pills for one of those medications!) We also talked about how my diagnosis, which continues to fluctuate after 13 years of treatment, is most likely either Bipolar I Disorder with Cluster B features or Schizoaffective Disorder. The latter, she explained, has a poorer prognosis. She is concerned about my frequent “oscillations” in illness, and would like to get me to a place where I have at least six months of pure euthymia. I tried very hard to remember the last time I had six months of pure, symptom-less living, and found that I couldn’t. Every time you experience another episode of psychosis, she said, it damages your brain a little more  —  so we’d like to limit those episodes as much as possible. Either way, we treat the symptoms with the same medications, but I left her office feeling melancholy.

 

This week I also received some mail from a long-time friend who is not doing well. In the letter, she essentially asked what she should do. How do you do this with such grace? she asked. How do you keep going when drugs and therapy and time don’t work? How have you handled your trauma? What should I do?

I put the letter next to my bed, on my nightstand. I have no idea what to say. I just had a dream about my abusive rapist sex offender ex last night, even though I cut off contact with him in 2003. I had some “oscillations” less than a month ago. I go to work and I do my job and sometimes I have to take leaves of absence, because I am fortunate enough to work at a place where I can take short-term disability and not lose my job. When I am doing badly, I feel like I am handling life with anything but grace. I worry that there are giant holes or spiders in my brain, and that I will never be okay. I don’t feel this way all the time. It comes and it goes, like so many things do, including love. And, maybe, including grace.

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What I Talk About When I Talk About Psychosis, Pt. 2

mental health & illness


(This is Part 2 of a multi-part series. See Part 1 here.)

 

Although I had been living with bipolar disorder for approximately three years, with two hospitalizations during that timespan, I didn’t experience my first hallucination until I was a senior in college. I was in the shower, in the dorm bathroom. The bathroom was empty. Out of nowhere, and very clearly, as if someone were standing to the right of me and speaking directly into my ear, I heard a voice say, “I hate you.”

 

Bewildered, I finished my shower. That was the beginning of my hallucinatory phase.

 

Even though the first sign of something changing in my brain was auditory, the hallucinatory phase of my life manifested itself through both visual and auditory abnormalities. Sometimes, the things I saw were very clear, and only suspicious to me because of how ridiculous they seemed. My best example of this would be the time I saw a slumped and rotting corpse in the driver’s seat of a parked car, complete with eye sockets that would have been empty except for the crawling maggots. Even though that particular hallucination was certainly gruesome, I was far more disturbed by the impaired reality testing that I found myself spontaneously reacting to  —  the B-movie zombie being something that I could impassively ignore, therefore letting me “pass” as normal, and the latter being something that made me look like a lunatic. I would, for example, be walking across campus, and every few steps a birdlike shadow would dart at my head, which would cause me to duck for apparently no reason, or a nonexistent hole would open up in front of me, which would cause me to jump to the side. I hated these occurrences because I knew exactly what I looked like to anyone who happened to be watching: a crazy person. Which I was. And, try as I might to control my reactions to these things, I couldn’t control them any more than I would have been able to control my body’s natural reaction to an actual abyss opening up in front of me.

 

Such were the symptoms that I knew I had to do something about  —  symptoms that I honestly could not distinguish from reality. One night, I very clearly heard the sound of a woman being attacked and screaming outside my window. I even heard her feet running away from the attacker. So I did what pretty much anyone would do: I called 911, even though my roommate at the time insisted that she had heard nothing. Campus police showed up at my dorm. They looked around. After an hour or so, they came back to tell me that they had found nothing, including other witnesses. The next night, I heard the same thing: it was a woman being attacked and screaming outside my window. Instead of calling the police, I called my mother. “Go to sleep,” she said, even though I had mostly kept my burgeoning symptoms a secret; this was reminiscent of the time when I was 17 and drove home in hysterics, waking my parents up to tell them I had killed my co-worker, only to have my mother say, with bizarre maternal wisdom, “It’s okay. Don’t worry about it.” Now my mother added, “Don’t call 911 again.” The third night, I heard the screams again. I heard them through my ears as clearly as I heard my professors’ lectures on Gogol or my alarm clock in the morning, and yet I forced myself to analyze the situation: the odds of someone actually being attacked outside of my window three nights in a row, with the campus police already aware of a 911 call made on the first night, was very unlikely. I didn’t bother calling anyone that time.

 

When I did begin to talk to my psychiatrist about these symptoms, we both had a shared concern in addition to the obvious ones: I wasn’t having manic or depressive episodes during these episodes of what I called “impaired reality testing.” It is common, in severe cases of depression or bipolar disorder, for psychosis to occur during mood episodes, usually in the “tone” of the particular episode (for example, it would have made sense, although an unpleasant sort of sense, for me to hallucinate a corpse had I been depressed). As far as I was concerned, my mood was perfectly fine  —  it was these hallucinations that were impairing my life. She ordered a full neurological workup, which included everything from an MRI to an EEG to vision exams. Eventually, the neurologist assigned to my case called me. “Everything checked out,” she said. “Your problem is most likely psychiatric, not neurological.” (The difference between the two boils down to the way we currently understand brain versus mind; however, I’m nowhere near qualified enough to speak directly to how these lines are drawn. I took her results to mean that I didn’t have a brain tumor, which was enough for me.)

 

My diagnosis, which lay somewhere between Bipolar I and Bipolar II at that time, was “upgraded” to Bipolar I. I began taking levels of antipsychotics more targeted toward psychotic symptoms than mood stabilization. For a few years, I became mostly free of hallucinations. Sometimes, I would get stressed  —  usually about work  —  and the symptoms would recur. Sometimes my commute to the office filled with auditory hallucinations, which I ignored, and then I’d contact my doctor and we’d adjust the medication until I stabilized and stayed that way, and then, because less medication is usually better than more medication, we’d go back down on the dosage until the next trigger occurred. Because a part of me is fundamentally lazy, and because increasing dosages of an antipsychotic often come with side effects, including rapid weight gain and fatigue, I eventually wondered if it was worth going through all of the rigamarole with contacting Dr. C, explaining my symptoms, and so on, when all I was experiencing was, say, a few days of a repeating loop of the same annoying music in my ear (imagine when you get a song stuck in your head; now imagine that you are actually hearing the song, as if someone has attached earbuds to you without your permission); I would ignore it, and it would go away. Through all of this, I remained high-functioning.

 

In 2008, without any apparent explanation, my symptom profile of psychosis switched from mostly hallucinatory to mostly delusional. After seven years of being together, my boyfriend was considering formally proposing to me, while I unexpectedly launched into approximately ten days of confusion.

 

What I Talk About When I Talk About Psychosis, Pt. 3, which will focus on my experiences with delusions, will be up tomorrow.

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In the Sunday Stillness

a motley assortment


Chris has been visiting his family in New Orleans for the last week or so. Daphne and I spend most of our time together  —  she comes with me to work, comes home with me in the evenings, and we keep one another company all weekend long. Sometimes we go out back, and our upstairs neighbors will be in our shared backyard, where Daphne goads their new puppy, a downy, white clumsy charmer, into chasing her. She is infinitely more agile than he is. As Jillian says, to have a dog in the family is to be a member of a pack. Daphne and I are, in many ways, uncannily similar, and to have her at my side when I go jogging, or take a quick trip to the butcher down the street, is something simple and joyous.

 

I just finished the astonishing, 900+ paged book FAR FROM THE TREE by Andrew Solomon, in which years of research and interviews are distilled into the exploration of what happens when parents produce children they do not expect, and what kinds of identities result  —  from children who are deaf or have autism, to children who develop schizophrenia or turn out to be criminals, to children born from rape (a chapter I found most excruciating). The book is uplifting and depressing in turns, and sometimes both at the same time. With a little over a month of 2012 left, I’m certain that it will make my list of Top 3 Books of 2012.

 

Last night I sautéed chicken livers in butter, and ate them with roasted brussels sprouts and a glass of Muscato, which felt impossibly decadent because our refrigerator is pretty much empty except for condiments and one chocolate Easter egg from last spring, and I have been eating poorly out of laziness  —  so when I do make the effort to go out for groceries, and then to bring them home and prepare them, it is an exercise in slow knife moments and preparation and, ultimately, reward.

 

Tomorrow I will be posting Part 2 of my series about psychosis, focusing on my own experiences with hallucinations (Part 3 will focus on delusions). I hope that you will come back and see the fruits of my labor, for whatever reason  —  because you want to understand me better, because you want to understand the mind better, because you want to expand your knowledge base, because you want to feel less alone, and so forth.

 

And it’s not even noon yet. A whole day lies ahead.

 

Happy Sunday to you.

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What I Talk About When I Talk About Psychosis, Pt. 1

mental health & illness


Though I occasionally mention the looming role of psychosis in my life, only one friend has directly asked me what the term psychosis really means. To be psychotic, as stereotyped, conjures images of a screaming  homeless man on the bus, threatening and out of control; people who end up slaughtering and maiming while claiming they were ordered to by the Lord; maybe it means, A Beautiful Mind-style, that one is lost in a world of his or her own, with imaginary friends that appear and stay, constant enough to be believed as real people.

Let me begin with a disclaimer: I am not a psychiatrist or a psychologist. I received a BA in Psychology at Stanford University and, before that, studied psychology for two years at Yale; was a research assistant and then manager in a mood disorder and brain imaging laboratory for two years, where I was stringently trained to and routinely conducted three-hourlong structured clinical interviews (SCIDs) and co-managed a bicoastal longitudinal study about bipolar disorder; and also have been living with bipolar disorder since 2001, although I didn’t begin to have psychotic symptoms until a few years later. My approach to the concept of “psychosis” is therefore both highly medicalized and highly personal, as well as being informed by conducting hundreds of clinical interviews in which I heard personal stories of people who allegedly all had the same basic disorders, but experienced them in a multitude of complicated and nuanced ways.

Psychosis, in its most bare-bones clinical definition, can be categorized as either hallucinatory or delusional (or both). Hallucinations are experiences of sensory input, which do not exist in the outside world, but appear as genuine and indistinguishable from the reality of non-psychotic sensory input to the person experiencing it. Examples include auditory hallucinations (e.g. hearing voices), visual hallucinations (e.g. seeing things that aren’t there), and even tasting and experiencing tactile sensations. Delusions, on the other hand, are false beliefs that remain despite evidence to the contrary (e.g. I am Jesus, I can control the weather, I have caused genocide in Africa). Psychosis associated with different diagnoses can look different  —  schizophrenia is different from bipolar disorder, and so on. But I will primarily be talking about psychosis as I have experienced it, and do experience it. This will be, I anticipate, a series of posts, approaching the question from a variety of angles. I must also emphasize very, very strongly that my experience of psychosis is not universal to all individuals who experience psychosis. I am not speaking for anyone but myself. But I do hope that perhaps, in these inquiries and recollections, that I will bring clarity to those who know me, and even those who don’t.

 

What I Talk About When I Talk About Psychosis, Pt. 2, which will focus on my initial, hallucinatory symptoms, will be up on Monday.

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A Gentleness

compassion & care


This is my extended family on my mother’s side. With the exception of my brother, who’s the handsome fellow in the lower left corner of this photo, these people, although they comprise some of the most beloved people in the world to me, all live in Taiwan, including my mother, and my grandmother who just survived breast cancer, and my cousin Danya, who is one of the sweetest and smartest young women I know and loves IHOP, and my cousin Jackson, who used to play with me when I was still in the crib and is now a doctor and takes some of the most amazing, joyous, heartbreaking photographs that I know of, and my uncle who lived with us in America for five years, and so on. I love this image because of how ridiculously happy everyone looks. I feel sad when I see this image because I am always, on some level, fundamentally divorced from them, if only from the vantage point of distance. I go to see my Taiwanese relatives once every three to five years. But this will be one of those years, and every time, I see my faraway family and faraway country with different eyes.

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I am thankful for the restoration of my mental health (as much as such a thing exists), but the community I have that should allow this to happen, including my family, friends, doctors, hospitals, Daphne, blog readers, co-workers, etc. — all of you are what truly save me, year after year — and I do not exclude myself from this community; I am, in fact, fiercely proud to be a part of it.

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Whatever you do today, whoever you are, I hope you find a moment of rest.

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