Madness

by Marya Hornbacher

  Having freed the bedspread at last, I lug its considerable wet weight over to the dryer, where I spend five minutes trying to shove it in before I succeed and turn it on. As I head back up the stairs, I hear the dryer make a sound of great mechanical distress, nnnnnnneeeeeeeeeee, and I pause for only a moment before I decide that if I leave, I will no longer intimidate the machine, and it will then do its job very well without me.

  I go upstairs, let myself in with the spare key, and get into bed, after first raising the blinds to make sure I do not get depressed because I am sitting in bed in the dark on a gorgeous Saturday afternoon in fall, because I am a fucking wack job. I tuck myself in neatly and survey the situation. I get out of bed and go get an apple and get back in bed. I munch on my apple, chattering like Johnny Carson's dummy, A-yah yah yah yah yah. I put the apple core in the ashtray and light a cigarette. My sheets are covered with burn holes. "I really ought to stop smoking in bed," I note briskly, and open my 938-page clinical tome Manic-Depressive Illness, from which I am learning many interesting things about brain chemistry, and which surely, somewhere, somehow, will explain to me precisely why the fuck I am like this.

  I imagine what an outside observer would see if he stood at the foot of my bed: a woman with wild red hair and a pair of crooked glasses, an enormous book propped up on her lap titled, in gigantic letters, MANIC-DEPRESSIVE ILLNESS.

  "Well." I sigh. I pop an Ativan and turn a page. "So it goes."

  From the bowels of the building, the dryer screams in pain, makes a disturbing chunk sort of sound, and goes silent.

  Soon the hypomania morphs into something darker. The eating disorder has taken hold for real. It's no longer just a few symptoms I was using to try to control the moods. It's taken on a life of its own. I am eating next to nothing, spending hours every day at the gym, standing on the scale four, five times a day, consumed with the fear of gaining weight, with fear that the writing is going badly, with fear that Jeff and I aren't going to make it, with fear that I will always be alone, or go crazy again, or spend my life in an institution. So I channel all the vague, amorphous, all-encompassing fears that have come to rule my days and nights into a fierce desire to lose weight. And more weight. All bones, I clatter around my house, aimlessly, running this way and that, calling people and hanging up, starting projects and abandoning them, getting into bed in the middle of the day and then getting out. My brain is electric, no longer the beautiful network of perfectly connecting thoughts and ideas, but now the manic fritzing and spitting, so loud it feels like it's going to shatter my eardrums. I smoke three packs a day. Jeff and I get together and devolve into the same fight we've been having for months, and we walk away from each other, torn up a little more each time. I am intensely lonely, and the nights are endless.

  The fleeting feeling of confidence I got from moving into my own place and doing everything right has been replaced with the familiar, violent self-hatred I know. I had everything, and I lost it. Instead of hating the illness, I hate myself.

  Soon I am throwing up even the little I eat. I eat an apple, then throw it up. A few grapes, then throw them up. When I go out to lunch with Megan, I eat a salad, then disappear into the bathroom to throw it up. Megan is pleading with me to go to the hospital. She and all my friends and family are crazy with worry. I'm skeletal, jumpy, scared all the time. Jeff's petrified—he's never seen my eating disorder before, and he's not in any position to help me deal with it, so he just tries not to look at how ugly I've become. I see him less and less. I begin to hide out in my house. I begin abusing laxatives. I spend my days running from my kitchen to the bathroom. Some days I am brave enough to venture out of the house and spend hours at the gym; sometimes I am afraid I am being watched.

  And for the life of me, I can't figure out why my meds aren't working.

  Ruth gets me out of the house for coffee. I sit staring at the red Gerbera daisy in its little white vase on the table. It absorbs me completely. Ruth is talking. She sounds far away, as if my head is wrapped in cotton batting and the sound waves can't quite make it through. I watch her lips. I hear myself explain to her that my thoughts are getting weird, and while I know that, I can't seem to do anything to stop them.

  "It feels like I am physically trying to hold my head on. It feels like it's about to fly off. I don't want to go to the hospital. I don't want to hurt myself. I don't want to do any of it, but I feel like I have no way to keep myself together. What happens if I really can't?" I start to cry.

  Ruth puts her hands over mine on the table. I have twisted and shredded a number of napkins, and it looks as if the table is covered with snow. "Oh, honey," she says. "I'm sorry."

  I pick up a shred of napkin and blot at the mascara running down my cheeks. "It's okay," I say. "I hate crying. It's not a big deal, anyway. It's just a little bit harder than seems really necessary."

  "It is," she says. "Are you cutting yet?"

  I shake my head, pulling petals off the daisy. "I think about it all the time. I can't think other things for more than a few minutes before I think about it all over again."

  "You know that's crazy, right? You know cutting is not a realistic option?"

  I nod and heave a sigh. "It just seems like such a good idea. The obvious idea."

  "That's crazy."

  "It would be so calm. It would be so clean. Such nice clean lines, if you have a good razor. A few neat slices, and then I'd stop."

  "Marya, you don't stop after a few slices. You always mean to, but you never do."

  "I guess so," I say, lining the red petals up in a row.

  "So you can't start."

  I nod again. "The only thing that really worries me, though, is that I keep having this idea to try making a nice, neat slice in my neck, to see if I can hit the jugular."

  "Okay, you need to be in the hospital," Ruth says.

  I look at the bald stem sticking out of the little white vase. My eyes start leaking again, to my serious dismay. I tip my head forward over the table so I don't mess up my mascara more. I drip.

  "I'm okay," I say. "They're just thoughts. I don't have a plan." The doctors always ask if you're having suicidal ideation—thinking about death, fantasizing about killing yourself, even when you don't want to—which I am, and if so, whether or not you have a plan, which I don't. I know myself well enough to realize that if we went to the emergency room, I would miraculously get better. I would show no signs of madness. It's called plausible sanity. It's a product of what they call lack of insight: when you're very sick, you don't have any perspective. You truly believe you're well, so you report that you're well. You act cheerful, put-together, and completely sane. You're articulate and very persuasive, and you explain to them that there's been a terrible mistake—you're not really crazy, and this ridiculous trip to the hospital is just a friend overreacting, or your family trying to trap you, or your spouse trying to get back at you for something. Because you seem perfectly fine—plausibly sane—doctors are hard-pressed to believe that you are, in fact, crazy and in need of hospitalization, even in cases where you've wound up in their emergency room as the result of a suicide attempt.

  For this very reason, I often show up in the emergency room clutching a list of my symptoms. I make this list before I go, while I still have the insight to see that I'm crazy. I am aided in making this list by an objective observer—Megan, Jeff, Ruth, my mother, or my father—and when we get to the hospital and I immediately change my mind, feel fine, insist that I'm sane and want to go home, the objective observer can tear this list from my fat little fists and give it to the doctor as proof that I am not, in fact, plausibly sane, and need to be locked up. But when you don't have such a list, and you do seem plausibly sane, they send you home with alarming frequency. It's happened to me several times. And I've gone straight home and started doing all over again whatever it was that had gotten me to the hospital in the first place. It's not at all uncommon to find that a bipolar person had seen a doctor almost immediately before he or she
committed suicide. What happened? the baffled, grieving family and friends and colleagues ask. He seemed perfectly fine. She didn't even seem depressed. Why didn't the doctor stop him? Why didn't they keep her at the hospital?

  "What are you doing tonight?" Ruth asks me.

  I stare at her blankly, horror rising in my chest. I don't know. I have no idea how I will make it through the night. I can't bear the idea of going home and floating around, alone with my wretched, spinning thoughts. My eyes start to leak again.

  "All right," she says, standing up. "You're coming with me."

  We pick up Christi and go in search of dinner. Christi has been having a rough couple of days. I am wildly relieved to see her, both for my own sake and because I know that if she's with us, she'll be all right. For the rest of the evening, Ruth herds us around like a couple of giant children. We are crazy. Ruth is sane, at least today. So she gets to be in charge. She takes our hands and leads us into the restaurant. She orders for us. We stare at her as if she will explain everything any minute now. If Ruth is here, then there is hope. If Ruth is here, we are safe. Until the thoughts start up again.

  ***

  I don't know how long I've been in my house. It's dark. Last I checked it was day. I think I've thrown up seven times today. I'm so dehydrated I can barely walk, and I'm crawling down the hall. The eating disorder has gotten too bad. It's not working. I see it for what it is: an attempt to control a self that I felt was completely out of control, a life that was falling apart. And it has done nothing but make the bipolar worse, and ruin my body in the process. I have taken an entire box of laxatives. I am throwing up and peeing blood. But I didn't mean for it to get this bad—I only wanted to feel a little better—it seemed like a good idea at the time—I had forgotten how ugly this was. But I still have a loose grip left on reality, and I know that the bipolar will only keep getting worse if this keeps up. The eating disorder is only the beginning. I am half dead already, and if I don't stop I will wind up really dead.

  I call Ruth and tell her I need to go to the emergency room. She's at my door. Christi's with her. I'm dizzy, disoriented, sorry, scared. They drive me to the emergency room. Then it goes dark.

  I wake up on the eating disorders ward to find Megan standing over me, hands on her hips. She explains to me, none too cheerfully, that she has been trying to find me for three days.

  "Do you remember calling me?" she demands.

  "Vaguely." I do, very vaguely indeed; I remember laughing and whispering into the phone a really funny joke that I had just thought up, but I don't remember the joke.

  "You told me you were in an undisclosed location and were being restrained."

  "Aha! That's right." I start laughing all over again. "It was a good joke, wasn't it?"

  "I thought you were in jail."

  "Of course I wasn't in jail."

  "Then I thought you'd been kidnapped. Then I realized, wait, she disappears all the time, you freak, and I started calling all the hospitals in town." She leans forward, looking fierce. "Of course, none of them would tell me if you were there."

  "Why not?"

  "Because," she says, narrowing her eyes, "you're in here under a false name."

  "I am?" This is news.

  "Yes. You are. You're in here under Mary Miller."

  "Really?"

  "Yes. Why, exactly, are you in here under Mary Miller when your name is Marya Hornbacher?"

  "My name almost is Mary Miller."

  "No it's not! Your name is not almost Mary Miller!" she shouts.

  "It is! Marya is Russian for Mary, and—"

  "Forget it. Why are you in here under a false name in the first place?"

  I furrow my brow. "I guess I didn't want them to know who I am."

  "Marya, they know who you are!"

  I think, then remember. "That's right. I didn't want you to know I was here."

  "Why not?"

  "I didn't want you to worry."

  "You didn't want us to worry? Your mother's hysterical. Your father is ready to have the lakes dragged. And you didn't want us to worry?"

  "I hate it when you worry."

  She stares at me some more. She heaves a sigh and flops down next to me, shaking her head. Then she brightens up and says, "So, how's the food?"

  "How are you feeling?" asks the psychiatrist on the eating disorders ward.

  "A little zippy."

  "Not depressed?" As I've said before, the assumption when you've got an eating disorder is that you've also got depression.

  "No."

  "How is your depression?"

  "I don't have depression. I have bipolar."

  "Yes, but depression is part of that," she says, smiling tensely. She's getting irritated. She wants me to say I'm depressed. Right now I'm not, though, so we could be sitting here a long time.

  "I'm bipolar type one," I say. "Mostly I have mixed episodes."

  "So you're a little depressed."

  "No," I say patiently. "I'm not depressed at all right now. I don't get depressed until February. At the moment, in fact, I'm coming off a manic episode."

  "I think I'm going to increase your antidepressants." She turns to her desk and starts looking up meds in the pharmaceutical handbook. As far as I'm concerned, she might as well just page through it with her eyes closed and stab the page with her finger and say we're going to put me on ... let me see here ... lithium! Zoloft! Wellbutrin! Zyprexa! Why not!

  "I think that's a very bad idea," I say, becoming quite cross. "My psychiatrist will have a fit if you mess with my meds."

  "I'm sure he'll understand if I add a little Prozac. It should help with the anxiety. It's a good antidepressant."

  "Are you joking?" I ask, almost laughing. "You can't give me Prozac, or any SSRI! It will make me completely insane! Christ!" I throw my arms up in the air. "Haven't you people figured out yet that not everyone with an eating disorder has depression? And I can't believe you'd do something as stupid as put me on an SSRI. That shit sends me through the roof! Leave me on the antidepressants I'm on. They don't make me crazy."