(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.