He wanted me to be sick like him. Fucking seemed like something you would do only if you gave up on getting well, if you didn’t care how many days they tacked on for acting crazy, if you were trying to replicate life in here like life on the outside.
He sat next to me in every group for the rest of the day, sometimes touching his foot to mine, staring at me until I noticed. He wasn’t unattractive. His eyes were bright blue, and his teeth were all crooked but in a way that seemed cute. I didn’t know why he was in there; he hadn’t attempted suicide, which meant it was probably something worse. I didn’t need anyone’s crazy dick inside of me.
By free time that night, he’d given up. He was sitting next to this girl on the couch with stringy hair and sunken cheeks. I watched him put his hand under her shirt. She just sat there, no trace of emotion, no movement of accommodation or refusal, as though nothing was happening to her at all.
NOTES FROM ALTURA MENTAL HOSPITAL: MEDICINAL SERVICES
The medicine came in little paper cups on a tray, just before bedtime. There were other paper cups filled with water for us to swallow the pills. I had more pills in my cup than normal. When I asked about them, the nurse didn’t seem to care. She just checked back over my name on her clipboard and pushed the little cup toward me. “Doctor’s orders,” she said, like she was a robot, like she’d said that line hundreds of times before. Which she probably had.
She checked my mouth to make sure I swallowed everything, but really she just made me open my mouth and gave it a perfunctory glance. I could have hidden the pill under my tongue, or on the side of my tooth. If you think about it, there are so many places to hide a pill.
NOTES FROM ALTURA MENTAL HOSPITAL: ROOMIES
My roommate’s name was Sam. She said she’d been in here three times, the last time for a whole month, and if I had any questions I could just ask her. I didn’t know you could get stuck in here for a whole month. I wondered what you would have to do to be locked up that long. I asked her how long she was staying this time and she said she didn’t know. Maybe a week. She said she had new insurance and that’s when it ran out.
Her face was pretty, with these big brown cow eyes, but a pretty cow, soft and sad. Unfortunate legs though—tree trunk thighs pocked with cellulite. I saw this when we were changing into our pajamas. It was weird to get almost naked in front of someone you knew nothing about. She had big bandages on her arms, which I hadn’t seen before because she was wearing a sweater. Now she was wearing a sports bra and white Hanes underwear.
“Oh,” I said. “Did you try and kill yourself too?” I wasn’t sure if this was appropriate to ask. I didn’t know the etiquette of talking to someone you barely knew while standing together in your underwear in a mental hospital.
“No,” she said, like it was a normal question. She looked at the bandages, like they weren’t a part of her. “But no one believes me. I cut so deep I almost bled out. It was an accident. If I was trying to kill myself, I would have cut on the bottom, not the top. I’m not an idiot.”
I stepped closer to look, even though there was nothing to see because the bandages wrapped all around her arms. I could see the scars on her thighs, though, white and scaly and thick as ropes. Next to her scars, the ones on my own thighs seemed so tiny and normal.
“What did you do that with?” I asked her.
“A knife,” she said.
“What kind of knife? Like a pocket knife? I did that once.”
“No, a kitchen knife. One of those big ones.” She didn’t say it like she was bragging. She was saying it because it was true.
When I got in bed, which was more a cot than a bed, I couldn’t stop thinking about her scars. I couldn’t stop thinking about her taking a big kitchen knife and carving into herself like she was nothing more than food. I thought about doing it myself and I couldn’t. I couldn’t turn myself into food. I couldn’t stop being a body.
NOTES FROM ALTURA MENTAL HOSPITAL: WAKE-UP CALL
In the morning, someone flipped on the overhead lights. Sam groaned, and I didn’t move, thinking they would go away if they thought I was sleeping. But whoever it was started shaking me. I looked up and it was some guy, wearing scrubs, which was confusing because everyone I had seen so far wore regular clothes, even the nurse who passed out the medication. He told me to follow him, so I got up.
Whatever they’d given me the night before made me so dizzy it was hard to walk. He led me to the end of the hallway, where there was a nasty-ass chair. He stabbed a needle into my arm. The needle looked thicker than the ones in the regular hospital. He collected four tubes of blood, jiggling the needle a bunch each time he hooked up a new vial. Then he put a Band-Aid on it, told me to apply pressure for five minutes. I bled through the Band-Aid immediately.
Everyone else had been woken up. Sam said they did that to everyone the first three days—took blood. She didn’t know why, and neither did anyone else. My veins were already sore from the hospital, and by the time the three days were over, they were covered in thick scabs and bruises, yellow ones from the IVs in the hospital, fresh blues and purples from the morning blood tests.
NOTES FROM ALTURA MENTAL HOSPITAL: NUTRITION
The food was disgusting. Everything was either full of starch or grease or both—blobs that resembled scrambled eggs, biscuits and gravy, spaghetti with unidentifiable chunks of meat in a runny sauce. The milk came in bags and tasted like chemicals and glue. The juice was served warm, in these pitchers that sat out all day. There was no soda or coffee.
Nothing had a brand name—the ketchup came in packets that said KETCHUP on the side, the cereal in big industrial boxes labeled CORN FLAKES. We weren’t allowed knives, which made no sense because the utensils were plastic. How much damage can you possibly do with a plastic knife?
NOTES FROM ALTURA MENTAL HOSPITAL: HEALING TECHNIQUES
The days were broken up by different types of therapy. CBT involved worksheets and diagrams that explained how the way we acted and thought was wrong. Group therapy involved a counselor asking us all the same question on topics designed to make us cry, about mothers and fathers and abuse. It worked, sometimes, on the others. They had boxes of industrial-sized Kleenex (labeled FACIAL TISSUE) around the room, wherever they could fit them.
My favorite was art therapy. The art therapist was young, in her twenties, and unlike everyone else, seemed to actually enjoy her job. I couldn’t draw because my hands shook too much from the new medication, so she brought me paints. I figured out a way to do it so the shaking didn’t matter. All I had to do was limit myself to fat lines.
I tried to make the art therapist my friend. She looked more like me than everyone else did, her hair blond and straight and shaggy, pretty eyes, good bone structure. Her clothes were like mine too. I tried to talk to her, asked her about the job and what degrees she had. She had an engagement ring on her finger, so I asked about her fiancé. She told me they both liked to go hiking. I told her about a plan I had for when I got out, how I would go deep in the canyon and camp by myself and not eat anything. I thought she would think my idea was interesting, but instead she looked hard at my eyes like she was assessing me. My pupils had been dilated for weeks by then. I wasn’t sure if it was the psych drugs or the mania, but either way I always looked high, even when I wasn’t.
“I don’t think that’s a good idea,” she said. I think she noticed how upset I was so then she added, “Or at least you shouldn’t for a while.”
I was so stupid. There was no way she would be my friend. We had nothing in common.
NOTES FROM ALTURA MENTAL HOSPITAL: STEREOTYPES
On the afternoon of my first full day, I heard someone screaming like they were being killed. Sam said it was somebody in solitary. I asked what solitary was and she said it was the padded room down the hall. I thought she was joking, but later I saw a nurse go inside with a needle, and when the door opened I saw the white pads, like gym mats tacked all around the walls.
I walked by later, and peek
ed in the window real quick. The person who had been screaming was now asleep. I couldn’t tell if they were a boy or a girl. Their hair was too short and their body was too fat.
They showed up at group the next day. It was a girl. She’d tried to kill herself by stabbing a pencil into her neck. The stab hole was covered by just a Band-Aid, so it mustn’t have been very deep.
NOTES FROM ALTURA MENTAL HOSPITAL: THE OUTSIDE WORLD
Visiting hour came every day, after dinner in the recreation room, with the couches and the TV and the old board games and the terrible books, at a bunch of small tables there for that very purpose. My parents didn’t miss it once. It made me feel guilty because some people never had visitors. Sam’s grandfather, who raised her because she had no parents, only came once. Sam said he was mad at her because he was religious. She explained that she wasn’t trying to die, but that just made him angrier. It was a sin to treat a perfectly healthy body like that.
My parents still looked heartbroken and tired. You could tell it was an effort for them to come, that they felt responsible for cheering me up. They seemed to always have something saved for me, like they had lived the whole day waiting for something to report. Something that would give me a reason to live. My father told me about the dolphins he saw playing that morning when he was surfing, how they got in the waves to surf too. My mother told me about her six-year-old student who had started saying, “Oh hell!” during class. They told me about the sunsets, the brightness of Venus, and it did make me want to get out. The only bit of sky we got were slivers through the narrow shatterproof windows, so filthy that everything outside was just a smear.
The first three days were nice. I still had enough guilt to be remorseful. But I assumed I would get out on the fourth, after the involuntary hold was up. I was wrong. “It has been decided it is best to keep you longer,” a nurse told me that morning.
I was furious with my parents. The first three days were on me, but that day, and the ones that came after, were their fault. I sat down with them like normal, but they didn’t apologize or anything, so I got up to leave, angry, so fast that the chair sprang back and hit the table. I went back to my room and cried. I don’t know what happened to my parents.
On the fifth day, they brought Nicole. You could tell they didn’t want to, that they somehow blamed her. Two days before, they’d said I needed to get some new friends. They must have brought her as a peace offering.
She didn’t have much to say, just relayed the plot of some dumb show she watched. She told me about her diet. There was a lot of silence in between. She’d already lost seven pounds. She didn’t once look me in the eye.
Instead, she stared at the other people. I tried to see them through her eyes: pasty skin, bloated faces, dirty hair. Nobody wearing a belt or shoelaces. I pulled my baggy pants up. I touched the ends of my dirty hair. I was becoming less and less like her, more and more like them. A chasm.
NOTES FROM ALTURA MENTAL HOSPITAL: DREAMS
The new pill was Zyprexa. It was an antipsychotic, just temporary until I got better. “It’s like gently putting your feet on the brakes,” the psychiatrist said. He told me if I took it long term, I would get fat.
It made it so all I wanted to do was sleep. After breakfast we were supposed to get dressed and shower, but my eyes and feet felt so heavy that I just went back to sleep. We had ten free minutes in between each therapy, thirty for lunch, so for all of those I returned to bed. Head on the pillow and I was out, sucked into the shitty mattress. Sleep more than sleep; an overpowering force.
During the naps I had realistic dreams. Things like being at school and trying to avoid talking to people, oversleeping because I’d forgotten to set my alarm. Mom mad at me—why did I slam the door, why was my hair in the sink, could I please answer the phone. Each time I woke up it was so confusing to find myself on the too-thin mattress in the ugly room with the smeary windows and heavy door. Outside the world. Inside the world. Plucked from it.
A FACT SHEET FROM THE FUTURE
In 1990, a group of researchers at Harvard conducting studies on Prozac found that six of their subjects became suicidal after being placed on the drug. The patients previously showed little or no evidence of suicidality.1 This research was largely ignored, most likely due to the limited scope of the study.
Prozac became available to patients in the United States in 1987, the first of a new class of antidepressants called SSRIs (Selective Serotonin Reuptake Inhibitors). Other medications that fall under this category include Paxil, Celexa, and Zoloft. They work by, as the name suggests, limiting the reabsorption of serotonin in the brain.2
Wellbutrin, on the other hand, is an atypical antidepressant that works by limiting the reabsorption of dopamine. It also releases additional norepinephrine and dopamine.3
At the time of my diagnosis in 1998, Wellbutrin was considered the best, safest option for someone with a diagnosis of Bipolar I.4, 5
In 2003, Prozac became the first and only antidepressant that was FDA approved for treating depression in adolescents and children. Previously, any prescription of an antidepressant was done so “off-label.” As of 2013, Lexapro, Effexor, and Wellbutrin “may be considered” for adolescent use off-label.6
In 2012, a study showed that only 9.2% of antidepressant prescriptions given to juveniles were associated with FDA-approved indications.7
As of the time of this writing, there is no antidepressant that is FDA approved for the treatment of bipolar depression, for patients of any age. Moreover, studies have shown that there is no research backing up the efficacy of antidepressants in bipolar disorder.8
Although research has shown a correlation between antidepressants and increased suicidality since 1990 (particularly in children and adolescents), this evidence was continually dismissed by the FDA, saying it was “anecdotal.”9
However, after “a blue-ribbon scientific advisory panel” in September 2004, the FDA placed a black-box warning on antidepressants, due to the “increased risk of suicidal behaviour among pediatric users. Black-box warnings are typically reserved for lethal drugs.” They concluded that suicidality was nearly twice as likely when pediatric patients were placed on antidepressants versus a placebo.10
The black box warning states that it is especially important to monitor the patient for suicidality during “initial treatment (generally the first one to two months).”11
This suicide attempt occurred approximately three weeks after I was placed on Wellbutrin.
1 Teicher, Martin H., Carol Glod, and Jonathan O. Cole. “Emergence of Intense Suicidal Preoccupation During Fluoxetine Treatment.” American Journal of Psychiatry 147:2 (1990), 207–210. PDF.
2 “Selective Serotonin Reuptake Inhibitor.” Wikipedia, April 24, 2016.
3 “Buproprion.” Wikipedia, April 19, 2016.
4 Fogelson, D. L., A. Bystritsky, and R. Pasnau. “Bubroprion in the Treatment of Bipolar Disorders.” Journal of Clinical Psychiatry 53:12 (Dec. 1992), 443–446. NCBI.
5 Hartmann, P. M. “Strategies for Managing Depression Complicated by Bipolar Disorder.” Journal of American Board of Family Medicine 9:4 (July–Aug. 1996), 261–269. NCBI.
6 Rappaport, Nancy, Deborah Kulick, and LeAdelle Phelps. “Psychotropic Medications: An Update for School Psychologists.” Psychology in the Schools 50:6 (2013), 589–600. PDF.
7 Lee, E. et al. “Off-Label Prescribing Patterns of Antidepressants in Children and Adolescents.” Pharmacoepidemiology and Drug Safety 21:2 (Feb. 2012), 137–144. NCBI.
8 Goldberg, Joseph. “Antidepressants for Bipolar Disorder.” WebMD. WebMD, July 31, 2014.
9 Harris, Gardiner. “F.D.A. Links Drugs to Being Suicidal.” New York Times, Sept. 14, 2014.
10 Kondro, Wayne. “FDA Urges ‘Black Box’ Warning on Pediatric Antidepressants.” CMAJ: Canadian Medical Association Journal (Oct. 12, 2004), 837+. Academic OneFile.
11 U.S. Dept. of Health and Human Services. “Antidepressant Use in Children, Adolescents, and Adults.” Food
and Drug Administration, April 13, 2016.
* Diagnostic and Statistical Manual (DSM), fourth edition, ed. Thomas A. Widiger, Allen J. Frances, Harold Alan Pincus, Michael B. First, Ruth, Ross, and Wendy Davis (Washington, DC: American Psychiatric Association, 1994), 285.
BOOK TWO
WHY I STOPPED GOING TO SCHOOL
Nicole was waiting outside for me the first day I went back. The whole car ride over, I’d been imagining walking into those doors alone. I wasn’t sure I could do it. She stood next to me, escorted me to class, smiling in a way that seemed both brittle and genuine. Nicole seemed to feel guilty, willing to let me temporarily usurp Ariana, who wasn’t around anywhere. I might have felt ashamed or embarrassed by her obvious pity but I needed her too much to care. She met me at break, and, at lunch, got one of her friends in the grade above us with a driver’s license to take us off campus. She kept asking me over and over if I was doing OK. Still, it was nice. She was being so nice.
Besides that, the rest of the day was total shit.
Somebody had told everyone why I’d been absent, apparently. All the teachers wanted to talk to me after class. Ms. Novak called me to her desk as the other students were filing out and opened her gradebook. She smiled at me, or it was supposed to be a smile, except her lips were tight and thin. “We’ll do this here,” she said to me, erasing the F beside my name for the paper I had never turned in on The Odyssey. She blew away the eraser dust and wrote a big fat C.
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