Suspended Sentence

by Janice Morgan

  Still, both Mike and I felt we learned a lot from our experience. The directors never promised us a rainbow. They never said the program would “fix” our kids. Instead, the counselors always told us this: “When your son or daughter comes back home, that’s when the real work begins. Get ready.”

  CHAPTER 18: WHITE RABBIT

  Imagine it’s August 17, 1969 in Woodstock, New York. Jefferson Airplane is on stage. The musicians look out and see 500,000 young fans blanketing the fields around them. Soon, the electric guitars begin their hypnotic, Bolero-like rhythms, as Grace Slick steps up to take the mic. A cloud of long, curly hair surrounds her face; she’s dressed all in white with a long, fringed tunic and fluttery bell-bottom pants. Her unmistakable voice floats out over the crowd. They already know the words.

  One pill makes you larger

  And one pill makes you small

  And the ones that mother gives you

  Don’t do anything at all

  Go ask Alice

  When she’s ten feet tall

  Grace Slick’s lyrics from “White Rabbit” refer to her generation’s experimentation with psychedelic drugs to “expand consciousness.” According to legend, she was apparently tripping on LSD and listening obsessively to Miles Davis’s Sketches of Spain at the time she wrote it. Maybe more than a few in the crowd at Woodstock were sharing the same acid-induced trip that morning in 1969. By the time Grace built up to the song’s pulsing refrain, “Feed your head! Feed your head!” everyone in the crowd could chant it together and knew exactly what it meant. But today, these words could take on a whole different meaning.

  Of course, “Go ask Alice” in the song is a reference to the young heroine of Alice in Wonderland. I remember my dad reading this story to me when I was about six or seven years old, and I was way too young to understand all of Lewis Carroll’s puns and innuendos. I certainly didn’t make any connections to altered mental states. The problems Alice encountered once she chased the White Rabbit down the rabbit hole seemed related to the strange fact that she would change sizes, sometimes very dramatically, and not always when she wanted to. For example, early on, she finds a key on a glass table and is delighted to think that it must fit one of the closed doors she sees down a long hall. But by the time she finds the little door the key fits, she realizes that she is not the right size to go through it and into the lovely garden she glimpses beyond. Dismayed, she goes back to the glass table and finds, mysteriously, a small bottle on it that says “drink me.” After reassuring herself that the bottle doesn’t have any poison warnings marked on it, she decides to drink and soon finds herself shrinking down to just the right size to go through the little door.

  But then, she finds that she’s left the key on the table high above her, and she can’t reach it. Not to worry; she eventually finds a small cake nearby with the words “eat me” on it, which makes her grow taller, but—so true to human experience—this sudden change causes more disorientation, so by the time she finds a way to shrink enough to get through the little door, she finds she has once again left the key on the glass table. Many of her adventures subsequently have to do with her being an unusual size (either too big or too small), leading her to many strange sensations and a dream-like flow of encounters with various creatures.

  Though it may seem far-fetched to some, Alice’s adventures now seem like a close metaphor to describe untreated bipolar disorder. Because an unregulated brain chemistry puts the person experiencing this on a wild ride—“curiouser and curiouser,” as Alice says—it does ring true that she would always be trying to get herself to the “right size” in order to be able to do what she wants or needs to in that moment. And because of this, the person would—like Alice—be having some unusual perspectives on her surroundings, as well as some surprise encounters. She would also want a way to control all this crazy stuff.

  The rest of Alice’s adventures occur after she meets an imperious, if somewhat spaced-out caterpillar smoking a hookah atop a mushroom. By the time he crawls away, he gives her some advice to address her inappropriate sizing issues. He tells her to eat pieces of the mushroom: “One side will make you grow taller, and the other side will make you grow shorter.” Now, armed with a piece of the mushroom from opposite sides in each hand, Alice has the tools she needs for administering her own adjustment. She can self-medicate.

  With all the changes going on inside and all around them, it isn’t surprising that young persons with bipolar often become amateur pharmacologists. When your own mental thermostat isn’t working right, you rapidly start looking for compounds that can help adjust it—not to mention that you also have to be able to manage your social persona in various situations, ones that become increasingly demanding as you move beyond your family circle. You certainly don’t want to show to the rest of the world all the internal management problems you’re having! Cigarettes, alcohol, marijuana—at least, you’ll try those. After that, you can consider other possibilities. Yes, in no time, a person could become like Alice in Wonderland, looking around for that piece of mushroom, that little bottle that says “drink me” so she can get herself to the right size. After all, who knows when you might have to attend a Mad Hatter’s tea party, run on top of a chessboard, or play croquet with a deck of cards and a hedgehog? Life makes a lot of demands.

  These reflections relate to conversations I had with Dylan during his first winter in Drug Court. From time to time, Dylan commented on incidents that happened when he was a student at the University of Cincinnati, and I realized that I knew only a small part of what had actually occurred there. During my frequent “Mom Missions” after the robbery, for example, I didn’t realize that he was smoking pot regularly (still!) and that he was drinking. His doctors had always told him it wasn’t a good idea for someone in his medical situation to drink, but that apparently didn’t faze him. So when I once saw a whiskey bottle on his kitchen shelf, he assured me that was for his friend Neal who liked the stuff when he came over to socialize. He himself didn’t drink it, didn’t even like it.

  Now in Drug Court, though, Dylan was quite open about his past drinking and pot use. He matter-of-factly recounted how, for example, I would comment back during one of my weekend visits to Cincinnati how he seemed to be doing better and in good spirits. “You didn’t know, Mom, but I’d just been smoking a joint to mellow myself out right before you got there,” he told me. And probably the night before, he’d been with friends in a favorite neighborhood bar drinking the night away—all this when he knew he was supposed to be taking only his meds, nothing else. According to him, it was his right as a young adult to go out and socialize in bars. Danger? No, he didn’t see any danger in doing that. He felt he could handle his liquor better than most.

  After the robbery in 2008, I knew he was shaken; I didn’t even know if he could stay in school that semester. We talked about whether he should continue to live there. He wanted to, so I ended up going to Cincinnati almost every weekend. Mike was out of the country that fall teaching, so he wasn’t able to share the load of visits. It was seven hours on the road from Croftburg, one way. When I got there, Dylan and I had long conversations during those early weeks about how to deal with his moods, his anxiety, his lifestyle. Once, when he was feeling highly anxious, I insisted that he go to a clinician at the local primary care center for help. By this time, he’d managed to convince himself that he had ADHD, not bipolar. He was no longer taking a mood stabilizer. The clinician asked Dylan questions, and when he received the answers, was kind but direct with him.

  “You have a complex mental health situation,” he said. “And you need to have continuous care from a psychiatrist who can monitor how things are going.”

  “But my psychiatrist closed down his office,” Dylan protested. “He left town and since then, I’ve had trouble finding another one to give me an appointment.”

  “No matter,” the young doctor said. “You have to be patient. This is a major city. There are psychiatrists out there; you just have to
be persistent and find one and keep your appointments.”

  The doctor’s voice was calm, but the common-sense clarity of his words struck me like a thunderbolt. Of course! How in all this crazy tumult could we have lost track of the obvious? Well, unfortunately, it happens. To a person with a mood disorder—especially one in his early twenties, eager to try to fit in with his peers—there can be a long list of distractors. And we parents were often so busy just putting out brush fires in Dylan’s life that we could easily miss addressing the root cause: a complex brain disorder that needed steady, ongoing treatment. At that moment in the doctor’s office, I felt guilty that I hadn’t done enough to help my son find a psychiatrist to replace the one who had left his practice. I’d let Dylan take the lead. The path hadn’t been easy; he’d tried, but there had been obstacles. So instead, he took charge by self-medicating. Who knows? In his situation, I may well have done the same thing.

  Dylan’s White Rabbit Diary as a second-year college student in Cincinnati, 2008:

  8:30 am, Monday: Feeling anxious this morning. Again, no reason—just the way it is. Drink a shot of whiskey from the bottle Neal left behind on Saturday night. That will smooth me out enough to get dressed and ready for class.

  2:30 pm: Have to get to work on my assignments for tomorrow and my night class later this week. Feeling a little tuned out; it’ll be hard to concentrate. I’ll make some strong coffee and drink a few cups to sharpen up.

  5:00 pm: Too wired. Got my work done for tomorrow, but feeling anxious again. Time to come down. I’ll go out for a walk to the corner store and pick up some cigarettes—maybe find a guy there to sell me a joint. That’ll help even me out. No way I could eat anything in this state.

  8:00 pm: Time to work out at the gym. I need three protein bars and two cans of Red Bull to rev up.

  10:00 pm: Feeling mellow now after the workout. Time for dinner. This is great, but I won’t be able to do much on my assignment for Wednesday. Just hope I’ll be able to get some sleep tonight. Yeah, I think there’s a good chance of that. I’ll get up early tomorrow and finish my work then. But if by chance I have a rough night, it’s going to take a bomb-sized alarm clock to wake me up.

  9:00 am, Wednesday: Got a presentation coming up in my speech class. That professor can really be a hard-ass, too. She can really get in your face. To tell the truth, I think she’s entertaining in the way she does the class. But man, she can really put people on the spot: she can GRILL you! And today … well, gotta take a Klonopin or I’ll never make it through my speech. When I get uptight in front of the class, it’s all over. Ideas go straight out of my head; I start to sweat; I’m sure everyone can see I’m on pins and needles. I’ll need a Klonopin to keep myself calm.

  3:00 pm, same day: Well, I haven’t taken a mood stabilizer for a while now. No lithium, no Lamictal. I’m not so convinced I have a mood disorder—think it’s more like ADHD. I have trouble focusing and being able to concentrate. That’s why I can’t get my work done on time. Sometimes, I’m still half asleep and can’t get my mind awake. Other times, I get all these racing thoughts, sometimes going around in circles, too. If only Dr. Adivan hadn’t closed his practice and taken off for another state where he could make more money! Now, I can only go to the clinic and get the type of drugs any GP can prescribe, like Lexapro or Wellbutrin. Those help some, but maybe what I really need to focus my mind is Adderall.

  9:30 am, Thursday: When I look around at all these other students going to class, I wonder how they do it. They look so calm, so together. And then in class, they always have their assignments done. To me sometimes, it just seems they’re friggin’ robots! It’s like they’re pre-programmed to do everything just on time, just on cue, just the right way. Not me! No way I’ve ever been like that. Never will.

  9:30 am, Saturday: Mom’s coming for a visit. Better call Neal and have him stop by with a joint before she gets here. She means well and all that, but she can be really irritating, too. She just doesn’t get it, what all I have to deal with. No one else can really know what it’s like unless they have the same thing going on. Not to mention, now instead of having my own car, I have to rely on her driving me around. It’s crazy; I have to cue her on every turn, every move. She’s such a small-town driver! She doesn’t have a clue how to drive in a big city. All the more reason I’m going to need that joint—yeah, maybe two.

  The only problem with all these little hits and fixes is that the person starts to rely on them. Self-medication becomes the main way of trying to take control in a chaotic state. Often, what the person doesn’t see is that these are just yo-yo adjustments delivered by ingested chemicals, not a way of stabilizing the situation or learning to ride the waves. Instead, if the pattern continues, these “fixes” can start to alter an already off-kilter brain chemistry. If we go back to Alice, it’s as if she changed sizes so often for so long that she entirely lost any sense of her normal-sized self. So, instead of being able to modulate the highs and lows, the person with a mood disorder experiences peaks and valleys getting steeper and deeper. Far from gaining control, she drifts further out—often without realizing, or even caring. Addiction can set in. Soon, the person may have two monsters to deal with: bipolar and addiction. Today the usual term for this is “dual diagnosis.” I’ve learned, however, that not everyone living with bipolar veers toward drug addiction. Apparently, that tendency requires a special set of pre-disposition genes—yet another throw of the hereditary dice.

  Over the years, there had been several “off” periods before Dylan stayed on board with his diagnosis and his meds. Thank God, at present he seemed to be keeping his appointments with Dr. Peltay. When it came to meds, I couldn’t see why Dylan didn’t just stay on lithium, but he always wanted to try some new combination to see if it would work better. Usually, this meant taking a mood stabilizer and another pharmaceutical to calm his anxiety. Sooner or later, though, he wouldn’t like one of the side effects, like weight gain or interference with sleep. Other times, he said he didn’t like how a certain medication dulled his emotions, made him feel like a zombie. He said once it was as if before, he’d been watching the world through a high-definition, wide-screen color TV and then, after taking the medication, he’d have to get used to a standard 1950s-style TV model in black and white. It all seemed so fuzzy, so drab by comparison! Carrie Fisher, the late actress of Princess Leia fame, would confirm: “Being high on bipolar is way better than any drug—believe me,” she’s said in interviews. “And I’ve tried quite a few.”

  Dylan’s history of self-medication vs. medical treatment made me wonder about how my son viewed his mood disorder during his time in Drug Court, how he was either moving toward reconciliation with it or staying in resistance. Most people think of an illness as something to fight, something to vanquish. This is a fine strategy for hostile microbes, a virus, or cancer. But what if you have a disorder that affects your consciousness, your decision making? What if it is something so embedded in your concept of yourself—your personality and identity—that you can barely distinguish what part, exactly, is the disorder and what part is your essential self? As for mood swings, shifts from euphoric highs to listless lows, with bouts of extreme irritation and anxiety thrown in, racing thoughts, restless emotions (spaced out by periods of relative normalcy) —a person in Dylan’s situation often cannot remember a time when he didn’t have them. So then, when you try to even out, go on meds, try to have a “normal” life, impose limits on yourself, check out your own thinking—how do you get used to all that? Does “normal” feel like a strange glove you’re putting on, a buffer that separates you from the skin you’ve come to rely on as your sentient contact with the world?

  After I read Kay Redfield Jamison’s book An Unquiet Mind, the dilemma became clearer to me. Dr. Jamison is a professor of psychiatry and a clinician who not only studies mood disorders but also has bipolar herself (she calls it by its earlier term, manic-depressive disorder). Jamison courageously “came out” in the 1990s, writing an
astonishing memoir about how she struggled against—and eventually learned to live with—this serious illness. Frequently describing her personality as “mercurial,” she tells the harrowing story of how her passionate curiosity, hard work, and boundless energy degenerated into full-blown psychotic madness in her twenties, almost before she knew what was happening. After that, predictably, she fell into a deep depression. Even with expert medical care, this condition lasted a year and a half. When she finally recovered, she was glad to find her mind working again, but then began what she called an ongoing battle with lithium, the medication she needed to keep her moods under some semblance of control.

  The paradox is this: she didn’t like the control, and that’s what always surprises people. In her chapter “Missing Saturn,” she tells us what she missed the most: riding high on the wonderful waves of “white mania”—those sudden whirlwind enthusiasms, the transformational gusts of energy and inspiration that allowed her to sweep through the world without touching the ground. She calls this euphoric mood state “flying through the rings of Saturn.” For Jamison, a California girl with a test-pilot dad who flew fighter planes, Saturn was the wild blue yonder of your dreams and daring. Of course, she believed you could get there if you were special and flew high enough.

  Only gradually did she learn that these euphoric states were not infinitely repeatable. Her illness was progressing; the white manias were morphing into manic states of psychosis—often mingling with severe anxiety or irritation. Her illness, Bipolar I, was not going to stay within the bounds of a livable life without two things: medication and effort. She had to learn, however reluctantly, to accept softer waves, a new self. “In my case I had a horrible sense of loss for who I had been and where I had been. It was difficult to give up the high flights of mind and mood, even though the depressions that inevitably followed nearly cost me my life.” The way she tells it, she had to give up high flights through the rings of Saturn for a more practical life here on Earth.