by Mary Pilon
Kristina shrugged. She was glad her brother was safe, but resentful that her birthday weekend with her mother12 was a bust.
Some twenty-seven hundred miles separated her from Kevin, but in some peculiar way, nothing, really, had changed.
SUSANNE
By the time Susanne’s plane arrived in New England, Kevin was in the Human Resource Institute in Brookline, Massachusetts, heavily sedated, his face streaked with a well-worn drool path. Susanne’s brain volleyed back and forth between being a doctor and being Kevin’s mom as she tried to figure out what had gone wrong, and why, and what to do about it.
She learned that after being picked up in the park by the cops, Kevin had been taken to an emergency room and then transferred to the institute, one of the Boston area’s leading facilities for the compassionate treatment of mental illnesses. From the outside, its brick and beige building could easily have been mistaken for a school. Four stories tall, and half a block wide, it had symmetrical rectangular windows lined up in neat rows and an inviting staircase with a metal rail, as orderly as the description of what her son had been through wasn’t.
Years later, Susanne wouldn’t be able to recall who called her about Kevin or what the specifics of the conversation were. Maybe the shock blocked it all out. But she did remember flying from California to Boston, in a jarring transition from spending what she had hoped would be a relaxing time with one child to a frantic time with another. Whatever was wrong with Kevin felt completely beyond her scope as a parent, with even the best-case scenario seeming horrible. What had Kevin gotten himself into, and what, if anything, could she have done, or do, differently to avert what was already a disaster?
As Kevin lay in his hospital bed, Susanne tried to ask him questions, but his responses made no sense, just a slurred jumble of words and phrases as his mind roamed in the fog of delusion, the effects of medication mixed with reality’s thaw. Susanne knew that although tests and EEGs were being run, there was no promise that they would provide the black-and-white certainty of a diagnosis she so desperately craved.
It now felt miraculous that Kevin had managed to tell the doctors how to contact his family in California. Apparently, too, he had asked them to let him lie on the floor, a wish that they hadn’t granted. Now, he was going on and on about rivers being like wheels, with no beginning and no end.13
Amazingly, the police had brought no criminal charges against him, a privilege not often afforded to those exhibiting such erratic behavior. The irony was not lost on Kevin, whose delusion had itself focused on socio-economic concerns, but the reality of his being treated preferentially because he was white, young, male, and cleanly dressed would continue to baffle him, long after the drugs set in. Although the minds of those experiencing psychosis shared similarities, the societal framework of discrimination surrounding those brains, either based on skin color, gender, class, or some combination of all of those factors, yielded far different outcomes.
Susanne wondered if someone had slipped a drug of some kind into one of Kevin’s drinks, assuming that like any college student, Kevin indulged in partying from time to time. When his tests for drugs came back negative, she discarded that theory and wondered if his derangement could have been caused by the aftershocks of the case of shingles he’d had just a few weeks ago. Or Lyme disease? Encephalitis? For years, she had seen patients come in and out of her care, many of them children or young people, and she knew that it didn’t take much to throw the delicate balance of the human mind and body into chaos. It was one of the great marvels of life that it all worked as often and as well as it did.
Gordon arrived, and he and Susanne met with Kevin’s doctors, who told them that their son was suffering from manic depression—also known as bipolar disorder,14 the preferred term for the condition today. They told him that it wasn’t likely to go away anytime soon, if at all.
Unlike those with unipolar depression, people with bipolar disorder experience periods of mania alternating with, or mixed with, periods of depression. When they’re down, people with the disorder are lethargic, slow to react, and apathetic, and they may have difficulty concentrating. When they’re up, they may experience a state of frenzy marked by erratic, exuberant, grandiose, sometimes paranoid behavior. Psychologists’ understanding of it was still relatively nascent in the late 1980s, and at the time, the term “bipolar disorder” was only beginning to gain traction as a more scientific alternative to “manic depression,” which psychiatrists had used in decades prior.
Nor was Kevin alone. Estimates vary, but anywhere from 3 million to 6 million American adults, or between 1 percent and 2.6 percent15 of the American adult population, live with bipolar disorder. Its diagnosis often comes in the college years, as was the case for Kevin, and the average age of onset is eighteen. Unlike unipolar depression, which may make its symptoms known much earlier, it often hits young people whom society regards as adults, even though their brains and personalities will continue to develop dramatically until their midtwenties. Women and men are equally likely to develop it, and researchers have found that those of color are significantly more likely to be misdiagnosed,16 or not to receive proper treatment and services.
Kay Redfield Jamison, a physician who herself has been diagnosed with bipolar disorder and is one of the foremost authorities on the subject, writes in Touched with Fire that those with the disorder “usually have an inflated self-esteem, as well as a certainty of conviction about the correctness and importance of their ideas. This grandiosity can contribute to poor judgment, which, in turn, often results in chaotic patterns of personal and professional relationships.”17 It’s common for those who are manic, she says, to engage in impulse spending, reckless driving, impulsive sexual encounters, volatile outbursts, and other questionable behaviors. People with bipolar disorder may also be more prone to misuse drugs and alcohol and to become addicted to those substances.
In spite of the stigma that still hangs over discussing mental health diagnoses, many highly successful people through time have lived with bipolar disorder and can lead robust professional and personal lives: the actress Carrie Fisher, author Sherman Alexie, comedian Russell Brand, singer Demi Lovato, singer Rosemary Clooney, comedian Stephen Fry, novelist Graham Greene, politician Patrick Kennedy, artist Edvard Munch, journalist Jane Pauley, musician Lou Reed, businessman Ted Turner, and artist Vincent Van Gogh, among a long list of others.
Although it would be easy to romanticize the relationship between bipolar disorder and professional, particularly creative, success, the reality is that many have triumphed by overcoming their affliction, not because of it. They have fought to make that success happen every single day, the very act of creating being an act of resistance, with or without medication. For some, though, bipolar disorder played a role18 in the tragic ending of their lives: the authors Virginia Woolf and Ernest Hemingway, Nirvana lead singer Kurt Cobain, the activist Abbie Hoffman, to name a few. So, too, have some made the extremes of the disorder part of their work: the raw lyrics of Cobain, the violent swirls on Van Gogh’s canvases, the cerebral prose of Woolf’s novels and essays. Books, paintings, and songs are brains on paper, canvas, and in verse, and these individuals’ work continues to be a gift to those who suffer and seek community, as well as to those hoping to gain insight into their minds, peering in from a window outside. Bipolar disorder’s consequences, if untreated, can be catastrophic. Numbers vary, but the lifetime rate of attempted suicide19 for those with no history of a mental disorder is less than 1 percent; for those with a major depressive illness, it’s 18 percent; and for those suffering from manic depression, it’s 24 percent or greater.
Susanne and Gordon had both seen various psychiatric disorders in their careers, and they knew that their son’s condition couldn’t be treated with a few days of bed rest and antibiotics. Nor would it ever go away completely—it would follow him for the rest of his life. As they sat in the hospital trying to understand what was happening to Kevin, they were baffled. The predisposition for bipolar d
isorder is believed to be genetic, but there was no known history of it on either side of Kevin’s family.
Kevin’s parents also knew that the history of psychiatric care and incarceration are interwoven. For generations, those with mental illnesses have been ostracized and in some cases outright abused, locked in institutions far from the public eye. It would be impossible to count the number of jobs, intimate relationships, friendships, or other ties that have been severed after a disclosure of bipolar disorder, or any other mental illness, but the repercussions for talking about it were real. One 2006 survey found that a quarter of people thought depression was “a sign of personal weakness” and would not employ someone with it. Thirty percent said they would not vote for a politician if they knew he or she had depression, and 25 percent said that they considered people with schizophrenia to be dangerous.20 Yet a quarter of the first thirty-seven U.S. presidents had been afflicted by mental illness during their time in office. Though there is no shortage in pop culture of depictions of the mentally ill wielding axes, research consistently shows that those who have been diagnosed with a psychiatric disorder are far more likely to be victims of violent crime21 than perpetrators of it. Nor is it uncommon for psychologists to confuse manic depression with schizophrenia, a vastly different diagnosis and treatment protocol.
Kevin’s parents and doctors focused on medication, an approach in tune with the ideas of the period. At the time, it was widely thought that a pill could fix many mental woes, and Gordon especially latched onto that appealing possibility. A few months after Kevin’s Boston episode, Prozac appeared on the cover of Newsweek magazine as the “breakthrough drug for depression.”22 In a country of fast cars and fast food, fast cures for mental illness seemed just around the corner, the swallowing of a pill as simple as using the once newfangled oven known as a microwave. Maybe the time consuming practice of psychotherapy was not necessary, or less so, in a world of such magic pills.
Attitudes may have changed, but mood cycles have been documented for thousands of years, the English word “melancholia” deriving from the Greek words for “black” and “bile”; the ancient Greeks believed that mania was brought about by a rise of foul substance. Persian thinkers identified bipolar disorder as a separate disorder from mania and schizophrenia around A.D. 1000, and Chinese authors described bipolar disorder in the 1500s. In 1903, Carl Jung established modern diagnostic criteria for the disorder, laying a foundation that is still in use today. The term “manic depression” entered the Diagnostic and Statistical Manual, psychology’s bible, in 1952.
“The illness,” Jamison wrote of bipolar disorder, “encompasses the extremes of the human experience.”23
KEVIN
They said the words to him, bipolar disorder. But at first, they were just that—words.
There was some comfort in the clarity of a diagnosis, as now Kevin knew what he was suffering from and that it had a name. With that, too, came the overwhelming task of trying to understand the ailment and everything destined to come with it. For Kevin, it felt as though he had suddenly been thrust into a frightening mystery that was taking place in his head. He had to give himself a crash course in bipolar disorder, the same way he had to cram for a mathematics exam. Unlike math, though, this problem didn’t make any sense to him. He could also make the case that he had what felt like a spiritual emergency, or even a mystical awakening, and instead of trying to understand it, everyone was slapping some label on it. Whether intentional or not, everyone’s message to him seemed to be “You’re broken. Let’s fix it.”
Kevin’s parents had thought that by nurturing their son through childhood and adolescence, by ensuring that he was healthy and happy, they had more than cleared the way for him to become a successful young man. They simply didn’t understand how this could be happening to their son. Doctors gave Kevin heavy doses of lithium to bring him down from the high of The Show. A common treatment for bipolar disorder at the time, lithium had been reintroduced into popular use after World War II when an Australian psychiatrist began using it on patients and reporting some successful results, but also some patient deaths. It received FDA approval in the United States in the 1970s, and while many patients complained of side effects, including numbness, it saved lives; by some measures, it reduced the suicide attempt rate24 of those with bipolar disorder sevenfold.
As Kevin’s mania subsided into a new, heavier sadness and the tedium of everyday life, he assessed his situation and the people around him at the hospital in Brookline from a still-askew but dead-on-target point of view. “They gave me chemical suppressants,” Kevin wrote in his journal. “They gave me physical depressants like cigarette smoke and contradictions.”25 Kevin’s doctor was Russian, and Kevin wondered how the man could ever understand him unless the two of them first discussed George Orwell’s 1945 dystopian allegory Animal Farm. Kevin still couldn’t sleep. He jotted down a muddle of words and numbers. He visited the hospital’s music room.
Creative thinkers who suffer from bipolar disorder, unipolar depression, and other mental ailments are often granted some leeway by certain parts of society, the volatility of their moods almost expected as a tax to be paid for the flow of their ideas, but athletes are offered far less flexibility. Much less is known about the way in which bipolar disorder impacts athletes than is known about the way it impacts artists,26 who may suffer from it at a significantly higher rate than the general population. Not until years after Kevin was diagnosed would research find that in some cases, elite athletes are more prone27 to depression and anxiety than those in the general population. Being an athlete requires high levels of confidence and self-esteem, a belief that the seemingly impossible is in fact possible. It’s a narrative of the self that can push the bounds of human potential but also set dangerously high expectations.
Kevin’s jottings
“We are what we pretend to be,” Kurt Vonnegut wrote, “so we must be careful about what we pretend to be.” Kevin had not only pretended to be an elite athlete before his diagnosis, he had actually been one. Now that self-confidence was shaken, and he wondered if he would ever get it back. Athletes also learn not only to be fast and accurate, but to remain calm while doing so, and they have been shown to be able to predict the movements of their opponents by picking up on subliminal cues28 that others fail to notice. For years those skills had come naturally to Kevin, but now he wondered if he still had them. Or even if they had mattered in the first place.
As Kevin’s mania faded, the real-life consequences of his life on The Show became apparent. Doctors allowed him use of the phone and he called one of his French literature professors back in Providence. He explained, in French, that he had had a manic episode, that it had involved Duras, and that he might miss some classes because he was institutionalized.29
His French professor was surprised, as the story Kevin told her felt discordant with the bright, precocious sailor she had come to know in her class. This was certainly the first time that a student had called her from a psychiatric ward, and if she’d had to pick which of her students would have been most likely to do so, Kevin wouldn’t have made the list. And the coursework from her class had been part of his delusion? Had he been on drugs? For whatever it was worth, his French sounded great.
Kevin’s girlfriend, Meg, having been called by Kevin’s parents, arrived at the hospital to find him throwing his clothes around the room. Kevin told her that he was “pretending he was flexible” and proceeded to lie on the floor and giggle at his defiance of hospital conventions. She sat down beside him and held him as a kaleidoscope of thoughts about the king of England rushed through his head. Kevin wondered if they were clues.
Kevin leaned in toward Meg, indicating that he had something he wanted to say. She leant her ear.
It was all going to be okay, he assured her. He didn’t have to go to the Olympics and win a gold medal anymore. He had a much more important thing to do with his life.
Now he was the star of The Show.30
&nbs
p; GORDON
From the moment his phone rang in the middle of the night with the news that Kevin had experienced a psychotic break, Gordon felt as if he was living in a nightmare. The last few days had been a blur of getting on the plane, arriving in Boston, shuttling to a hospital, and sitting uncomfortably with his ex-wife as they tried to figure out what had happened and what on earth they were going to do about it.
Gordon could tell that Kevin being in the middle between his parents was making him tense. It was fraying Gordon’s nerves, too. Even though he and Susanne tried to be amicable after the divorce and maintain a sense of civility, there was no masking the awkwardness between them. Neither of them wanted to spend a lot of time with the other; it had been a long time since they had done so.
Tense or not, however, they all needed to agree on what had to be done to get him back to school, to the water, and to his life.
Since the divorce, Gordon had been living in Big Bear, a small, picturesque town in California’s San Bernardino Valley, a couple of hours’ drive from Los Angeles, with his new partner, Meimei. Like Gordon and Susanne, she was a doctor. Gordon reasoned that their home, in the resort destination and near a lake and skiing, could be a restful retreat for Kevin. He could stay with them over the upcoming Christmas holidays while he recuperated, Gordon said, and he would adjust his work schedule to tend to him.31
Gordon had hoped that the interlude would give him the opportunity to help his son, but now, as Kevin sulked around the house, clearly depressed about what had happened, feeling lonely and ostracized, it was hard not to feel like nothing more than a helpless observer. Even the most minor of Gordon’s suggestions—that Kevin join him and Meimei for a meal, go with him to the grocery store, accompany him for a drive—seemed to fall on deaf ears. The few times that Kevin did try to express himself, his words didn’t make any sense.
Gordon had arrived in Boston after Kevin’s mania had passed, finding just a sedated version of his son, so he didn’t fully understand what Kevin meant when he complained about his medication bringing him down. Wasn’t it making him feel better? Gordon wondered. Wasn’t it effective? This slug-like version of Kevin dragging himself around the house was like some strange inverse of the active sailor son he had always known. Gordon wondered how much of Kevin’s lethargy was due to depression and how much to the medication, a line that seemed impossible to draw.