by Terri Cheney
A review of the scientific literature by the Journal of Clinical Psychiatry found that rapid cycling affects at least a quarter of bipolar patients and is related to a longer course of illness, an earlier age at onset, and more illegal drug and alcohol use. Its cause remains unclear, although hypothyroidism may be implicated. Ironically, the use of antidepressants, which are frequently prescribed, can trigger or worsen cycling.
Understandably, doctors find rapid cycling very hard to manage because symptoms slip away before they can be properly treated, only to be replaced by new ones. Loved ones find it confusing and even infuriating because they don’t know which person will show up when, and this unpredictability may be construed as intentional or indulgent. I’ve been a rapid cycler all my life, and even I can’t keep up with my moods. But it has one advantage: although I don’t know how I’ll feel on any given occasion, I know I won’t feel that way forever.
THORNS TODAY, ROSES TOMORROW
Even I had to admit I was acting weird the week before my birthday: elated one minute, dejected the next, my emotions flitting too quickly through me to be properly felt and acknowledged. Since mood lability is the premier symptom of my bipolar disorder, I wondered, briefly, if I should call my doctor to adjust my meds. But I just chalked it up to birthday nerves. Everybody gets them, right?
I never like to admit that I’m symptomatic. It makes me feel weak and deficient. If only I were stronger, I think, I could just master my mind and be done with it. None of this up and down, hither and thither, all-over-the-place emoting. The fact that there’s a clinical name for such extreme volatility—rapid cycling—doesn’t make it any more palatable. My feelings can fluctuate more quickly than a twitchy stock market. It’s exhausting to be catapulted around this way.
But the morning of my birthday I woke up feeling just fine. Delicious, in fact. My cheeks were slightly flushed and my eyes extra bright. I was looking forward to the birthday lunch my girlfriends had scheduled at a lovely restaurant in Brentwood. I arrived extra early to pick out our table: a cozy nook under a canopy of flowering vines that would perfectly frame my face. When you’re bipolar and always trying to hide your symptoms, you think a lot about self-presentation.
The minute my friends arrived, I started to talk—about anything and everything and nothing, and why not? It was my birthday, and I had the floor. The topic soon turned to travel, and I offered up my adventures on safari in Kenya in considerable detail. I suspected I was talking way too much when my friends stopped asking questions and simply stared at me. Mania just loves to hear itself talk. But I wasn’t manic, I told myself. I was naturally exuberant because it was my birthday. And to prove it, I forced myself to speak more slowly and ask my friends about their own travels. It was incredibly hard, like wrestling a kite down out of the sky in a storm, but I did it. See? Not manic.
My friends countered with their own stories, of India and Kyoto and Cairo and Bali. And China. And Thailand. And Tibet. By the time the comparative merits of Himalayan spas had entered the conversation, I found I’d run out of things to contribute. I grew quieter and quieter, feeling ever more out of place and provincial. There’s nothing worse than being forlorn among friends.
By then the sun had shifted, and the foliage was casting a shadow across our table. I was suddenly tired, so tired I could barely say my good-byes. Driving home, I started crying so hard my tears blinded me and I nearly had an accident. I should never socialize, I thought. It always ends badly. Nobody really likes me, anyway—why force my company on them?
When I opened my gate, I stumbled over a long cardboard box. Yellow roses, two dozen of them. From the right guy. As I arranged them in my favorite vase, I started to hum. Softly at first, then what the hell—I belted it out like Liza: “Life is a cabaret, old chum! Come to the cabaret…”
A thorn pricked my finger, and I went into the bathroom to wash off the blood. My reflection made no sense to me: my eyes were luminous, lit up by my smile, but they were shrouded by long black streaks of mascara. It was a most undeniably bipolar face. For a moment, I thought again of calling my doctor. But I went back into the kitchen instead and inhaled my yellow roses. There was plenty of time, after all. I’d still be bipolar tomorrow, and who knew how I’d feel by then?
THE WORLD’S WORST PARTY GUEST
A while back, I had to go off some of my meds, and I found myself at the mercy of my moods—a very slippery place to be. I can go up and down and over and sideways with scarcely a heartbeat in between. This rapid cycling poses a genuine problem when I’m expected to act like a rational, ordinary human being: for example, a gracious guest. A recent overnight stay at a friend’s house got me thinking about all the possible do’s and don’ts in this situation. I may exaggerate a little—but alas, only a little.
DO’S AND DON’TS:
1. Accept the invitation with delight when you’re manic and volunteer to bring your famous chicken cacciatore as the main course for twelve people.
2. When the day of the party arrives, be wretchedly depressed and get greasy Chinese takeout instead.
3. Show up morose and forget everyone’s names, especially those people you’ve known forever.
4. Have a glass of wine at dinner even though your doctors forbid it because it destabilizes you. Have two. Get manic.
5. Deliver a scintillating monologue on politics and religion. Do not pause for breath to allow others to express their opinions.
6. Regale the table with a graphic account of your experience with electroshock therapy because it is, after all, your mission in life to educate the uninformed.
7. Refuse to listen to any questions because it is not, after all, your responsibility in life to mollycoddle the ignorant.
8. Contradict yourself frequently and when called on it, quote Walt Whitman: “Do I contradict myself? Very well then, I contradict myself.” Revel in the ensuing silence.
9. When guests start to leave, hug and kiss them inappropriately, especially those you barely know. Slip them your card and suggest you get together soon with a knowing wink.
10. When your host says it’s time to turn in, ask for a big glass of water and take a whopping handful of pills in front of him. This will undoubtedly reassure him that you’re not going to burn down the house while he sleeps.
11. Screw up and take your morning meds instead of your evening ones, so you’re wired to the gills.
12. Wander the house at night while everyone else is asleep. Tiptoe into the other bedrooms and sneak a peek at people while they’re sleeping and at their most vulnerable.
13. Open up the pantry and take out all the food so you can rearrange it in alphabetical order. Your host will thank you when he finds out.
14. Get bored halfway through and abandon the project at “Jasmine tea.”
15. Go into the bathroom and stare at yourself for twenty minutes. Feel intensely lonely because you’re the only one up, staring at herself in bad lighting. Get maudlin and start to cry.
16. Sit down on the toilet and cry until your eyes are swollen and you’ve used up all the toilet paper.
17. Decide to leave before anyone can see you looking so hideous. Pack up your things and sneak out the front door.
18. Set off the alarm. Do not, on any account, come back to explain.
19. Five days later, when you’re hypomanic, send your host a huge bouquet of dahlias and a witty thank-you note.
20. Do not expect a reply.
SUICIDALITY
“Death is defiance.”
—Virginia Woolf (1882–1941), Mrs. Dalloway
Our country is facing an unprecedented suicide epidemic. According to a shocking 2018 study by the Centers for Disease Control (CDC), the national suicide rate is the highest it has been in fifty years. It increased by more than 33 percent just since 1999. Every day, 121 more Americans will die by their own hands. What accounts for this tragedy?
It used to be a commonplace theory that over 90 percent of those who died by suicide suffere
d from a mental illness. But as the rate skyrockets, traditional thinking is changing. We are only beginning to realize the complexities of suicide—that it is a multidimensional issue, and that “mental illness” is a much broader concept than was previously thought. Substance abuse (particularly opioids), income inequality, the mechanization of the economy, relationship conflicts, the ready availability of guns, sexual trauma, marginalization—all of these social stressors and more potentially give rise to suicidal thoughts and attempts.
Now, the CDC reports that about half—54 percent—of people who died by suicide did not have a known mental illness. The American Psychiatric Association rightly asserts that many of these people may have been dealing with mental health challenges that had not yet been diagnosed or known to those around them. This is terrifying, and the challenge is clear: to prevent suicide, we must identify concerns earlier and more thoroughly.
A friend of mine, a suicide expert, calls this “upstreaming.” It’s particularly compelling since the rate of teenage suicide is through the roof, the highest it has been since the US government began collecting statistical data in 1960. This year, 16 percent of adolescents will consider killing themselves—and suicide is the second leading cause of death in the ten-to-twenty-four-year-old demographic.
The Harvard Medical School agrees that we need to adopt “a lifelong prevention approach of detecting psychological distress and trauma exposure at onset.” It believes this could provide America “with a resilience platform for averting [this] epidemic.” The utmost vigilance is clearly required—suicide is a harrowing ordeal that no one should ever be tempted near, lest, God forbid, they wind up another statistic.
THE END, AND THEN
Many years ago, on a cold winter’s trip, I tried to kill myself by overdosing on pills. It was a calm, deliberate, self-willed act. The original reason for my attempt—my beloved father’s painful death from cancer—had been eclipsed by a raging chemical depression from which I was sure I would never recover. So I figured I was free to end my life if I wanted to because there was no conceivable future left for me. But events beyond my control intervened and to my horror and shame, I continued to live.
Not long after I was discharged from the hospital, I walked out one night in the falling snow. It was dark and eerily quiet. I walked for thirty minutes or so, not caring where I was going. Exhausted, I stopped in a deserted park, unable to take another step. My father was gone, and all my best-laid plans to end my life had failed. So what was the point of going forward? And I didn’t just mean walking on in the snow.
I was too tired to wait for an answer, and too cold to listen for one. All I wanted to do was sleep and sleep and sleep. I lay down on the soft fluffy pillow of snow and closed my eyes. You’re going to freeze to death, I thought, but at least this was a pleasant way to go. It couldn’t hurt for very long… but it did. My arms and legs began to ache, and instinct took over. I furiously waved them up and down to get my circulation going. When the blood finally started to flow again, I got back on my feet and looked around for a clue to tell me where I was. But I didn’t see any landmarks or street signs. What I saw was that I’d made angel wings in the snow.
Since my botched overdose a few weeks before, I’d tried hard to stop my brain from thinking. But there, in the absolute quiet, I could hear it coming alive again; its constant refrain was, why? I’d plotted and planned; I’d acted with malice aforethought. I didn’t care if I was committing a crime against nature—so be it. We all have the right to do wrong. But in spite of my strenuous effort, I’d been syringed and pumped and shocked back to life. Why, a thousand times, why? Why this particular ending instead?
I didn’t want to believe it, but the evidence was pretty hard to ignore: Maybe the right to die wasn’t mine after all. Maybe there were things left to do, words left to speak, that were beyond my comprehension. Was it possible life wanted more from me, and I had more to give? There in the freezing cold, I took an honest inventory of myself. There was only one thing I knew I could do, but it was important: I could bear witness to the pain of depression.
Depression was real.
Depression was physical.
Depression wanted you dead.
I swore right then and there that I wouldn’t stop calling depression out. I wouldn’t let anyone forget what a monstrosity, a miscreant, an abomination it was—the antithesis of all that was clean and whole. And I wouldn’t stop exposing suicide as the great untruth, the lie masquerading as a promise.
My attempt had shocked me into sharper focus, and made me realize my own tensile strength. I knew then that I had the ability to fall from grace, and to get back up and keep on moving. Maybe I’d survived because this was where I needed to be: shivering but alive to tell the tale. Maybe it was as simple as that. I had to remember this moment, and I had to share it. I’d been as low as a person could possibly get, and yet—I’d made angel wings in the snow.
I DIDN’T PLAN TO GO TO THE ER THAT NIGHT…
I woke up in a sweat, confused and disoriented, as if I’d just emerged from a too-vivid dream. I went to the bathroom to run a cool washcloth over my face. At least, I think that’s what happened. All I really know for sure (and I’m not too clear about this) is that I fell and fell hard, hitting my head and my side on the edge of the bathtub. I know this from the contusions that are starting to erupt, and from the ongoing pain in my head. But that night, when I came to, all I thought was: This is it. I’m going to die.
I didn’t think this because I’d had a bad fall. I thought it because I was unable to move. I laid my head down on the bathroom rug and passed out. Again and again I tried to get up, only to lose consciousness. I realized in those few brief moments of wakefulness that I needed to call 911. But the phone was in my bedroom, which seemed a thousand feet away. My only possible hope was to drag myself over there in between swoons.
Time swirled—it felt like hours—but I finally made it across the room and dialed. The operator answered right away, and all I could say was “I fell” before I became unconscious again, dropping the phone on the floor. To my everlasting astonishment and gratitude, the 911 operator was able to trace my call, and shortly after that the ambulance arrived.
The siren woke me, and I heard voices shouting that they were going to have to break down the door. Dying or not, I knew my landlord would kill me, so I managed to crawl over and unlock it. When the paramedics entered, the first thing they must have seen were my drugs. There are bottles of them scattered all over the place, and an even greater cornucopia spilling out of my kitchen drawers.
“Did you try to commit suicide, ma’am?” one of the paramedics asked me. Then he slapped me awake and I shook my head no.
“What are all these drugs?” he said.
“Drugs,” I answered, as if that were obvious.
“What are you taking them for?”
“Bipolar—” I said, before I passed out. I don’t remember anything else, just waking up in a hospital bed at Cedars-Sinai and knowing I must have screwed up somehow. I don’t usually end up in the emergency room unless it’s at the other end of an overdose.
Something must have gone wrong with my drugs. Whenever really bad things happen to me, it always has something to do with my drugs. I must have inadvertently taken my night medications twice, was all I could think, because they are super-sedating and would explain my incoherence and inability to stay awake. This was a very likely possibility, but I couldn’t communicate it to anyone. Words were like butterflies flitting around my head, and I had no net to catch them.
I heard a voice above me say, “Probable suicide attempt.”
“No!” I wanted to shout, but my thick slab of tongue got in the way.
“Do an ethylene alcohol lab,” someone else said, and then I got angry because I’ve been sober for ages. But the butterflies swarmed and my head hit the pillow, and once again, I knew no more.
When I woke, I was consumed by regret. My splendid record of no suicide attemp
ts for at least ten years was going to be demolished, simply because I couldn’t speak. I kept trying to signal a nurse for something to write on, but just try getting ahold of an ER nurse. It’s like trying to tackle a Green Bay Packer. Now I was the one slapping my face, to keep awake so I could somehow explain my situation. That was more important to me than finding out what damage I’d done to my body.
I finally managed to croak a few words, and then I knew I was going to live; because as long as I have words at my disposal, I have a semblance of power over my fate. I snagged a passing white coat. “I didn’t try—” was all I could get out, before he shook off my hand and went on his way. But with the next white coat I got luckier. “I didn’t try to kill myself,” I said, halting between words for emphasis.
“Let’s have a look at your code,” he said, pulling a slim chart from the foot of my bed. “Hmm—a 99285.”
“Huh?”
“That means a significant threat to life or function, requiring advanced life support. It also says here that you’re bipolar and attempted suicide.”
I wanted to scream but I realized that was unlikely to help my case. “Absolutely not,” I whispered, pulling him down by his sleeve so he could hear me better. “I didn’t. I swear. You’ve got to change the chart.”
“Are you sure?” he asked. “Because it looks pretty bad, all those drugs lying around and you unresponsive.”
“I’m positive. Please,” I begged him, then I thought of the ultimate tactic, the clincher. “I’m a lawyer,” I said, as loudly as I could. As I knew it would, that worked. Saying I’m a lawyer almost always gets me out of trouble; I don’t know why. Perhaps the doctor was afraid of liability, or he was suddenly convinced of my credibility. Whatever. I was willing to don my dreaded J.D. again if it would clear my name.