Mental

by Jaime Lowe

  I tried to keep my head in the game by resisting meds, an obvious instrument of mind control. I would spit them out and run. I never made it far. Several nurses would tackle me in the hallway and pin me to the floor. They held my arms and my legs against the antiseptic linoleum. One nurse would peel back the waistband of my pants and stick a hypodermic needle into my left hip. In the needle was a cocktail of sedatives and antipsychotics. Nothing worked immediately. Those meds were appetizers to the medication that they would eventually give me in capsule form. Lithium.

  But before the lithium, I was still a savior, a messiah, a renegade. I would stand outside the rec room door, whispering to another patient (TeeVee Dude) about the evils of TV, like a ghost speaking in tongues: Back away, the rays, they are toxic, turn it off, it’s not worth it, the TV, the fiber optics they will suck you in and spit you out, zombie, commercial, an evil corporate plan for brain hijacking. Stop letting them hijack your brain. They will take your soul. They will turn you into a sitcom character. They will turn you into a watch, a bomb, a drone. Step away, step away. I am here to help you. Don’t be gassed, turn it off. Those rays, don’t you see them? They are colorful and there is a laugh track but they are still noxious, the fumes will poison you. You see them. Don’t breathe, don’t move, I will save you.

  I was a doomsday preacher, I believed in my telepathic and all-knowing predictions. I believed I could save TeeVee Dude and that I could save me. I needed to save the world and I needed to save him. That was made even more clear in the visitors’ lounge one afternoon when his stepmom sat in one folding chair and my aunt Carrie in another; they were old friends. The connection seemed uncanny to me, too coincidental. The boy was clearly sent to me as an ally, an inside support for revolution. Of course. I continued whispering in doorways about pipes and apocalypse. He continued not to hear. It was dark and crowded and chaotic. I was forced to go to group therapy, to appointments with people who grinned and said they could help.

  I explained to Dr. DeAntonio that those pipes, those pipes outside were actually a vessel for death. He nodded, curious, but replied calmly: “Jaime, they are the generator for the building.” Undeterred, a little exasperated, I repeated myself. There is a planned massacre in place, I explained, and it needs to be stopped. It would be the Holocaust all over again, teens and doctors gassed to death in the night. An asphalt volleyball court full of corpses. Gas seeping through Westwood village poisoning professors and tourists and crystal vendors alike. Could he not see it? Could he not feel it? It was imminent, it could be now! Those bodies would be on his hands. He had to let me go, I had to . . . stop it. Tuck and roll, escape, I explained. He could help me, I could sneak out through the volleyball courts. It was fate that my room faced north to the pipes; I could hear them breathing and sighing and steaming. I could stop it, I told Dr. DeAntonio confidently. It was up to me and I was up to the task. I left his office shouting loudly about the coming apocalypse, about the gas. If I was nuisance enough, maybe someone would let me go. That led to more tackling, more needles.

  “Don’t open the windows, don’t turn on the TV,” I told TeeVee Dude and the other patients and nurses, enacting my own emergency evacuation. When I talked to Dr. DeAntonio years later, he remembered me being aggravated and annoyed, on edge and obsessed with Nicaragua, that I was hysterical about the apocalypse. He said I was particularly interested in disrupting other patients’ routines, to tell them about the end of the world. But I was convinced I knew the truth; I was trying to save them. I refused medication. I would not take the Dixie cup full of pills that would sedate me—I needed to be sharp, aware, and ready. Once I raced away from some nurses. They followed. I thought it would be another hip check; I was ready to be tackled.

  Instead, they took me to a room. Dr. DeAntonio called it seclusion, I remember it as solitary confinement. The difference was nomenclature—it was a four-by-four-foot room with no door handles on the inside and brown marbled padded walls. The pattern was streaked—khaki, poop brown, orange brown, brown brown—all muddled together in stripes that looked more like a swirl. A kind of ikat, using J. Crew catalog terminology. There was a double-paneled glass square window in the handleless door; I could not make out anything that was happening in the hall. I panicked. I hyperventilated. I clawed at the walls and threw myself against the door. I exhausted myself with hysteria. There was nothing left to do, no one to see. I sat down in a corner. I touched the soft walls. I imagined them absorbing my screams, and screams before mine. But then I was quiet. I could hear my older brother, Matt, whose sitcom catchphrase with me was “Jaime, calm down.” His emphasis was slow and pointed. I hated when he said that. I collapsed on the floor. With no one to whisper to, no pipes to fear, no tunnels, no TV, no doctors, no teens, no hallucinations of Muppets, just me crumpled on the floor, tired in this variegated brown room, fetal and deflated.

  It felt safe in there, like space. I was floating, tethered to a toxic world but letting go. I felt far away and secluded and deserted. I could sense a shift, I was alone, I needed to be alone. It was quiet in the soft, brown room with no doorknobs, and then it was quiet in my brain and quiet in my body. I just sat still for the first time in a long time. I could feel the padded walls. I knew what padded walls meant—I was dangerous, to myself and to others. In solitary, there was nothing I could do but fold. I was curled up in a ball, alone but attached to support, forming and developing all over again—like the early moments of life. Recalibrating, adjusting my brain, adjusting my place in the world. I was in so much trouble, the world was in trouble, everything was trouble. Not too long ago, I was a small, normal teenager who made earrings, bought overdyed jeans from Jet Rag, gossiped about first kisses that were never mine, hoped for a first kiss of my own, and stressed about chemistry tests.

  My parents knew my behavior was not the norm. But adolescent psychosis raises the question: What is normal for a teenager? How do you distinguish between a kid encountering surging hormones and continuing physical and emotional development from one who is mentally ill? Adolescence has no logic, there is no norm. John Hughes’s canon of teenage angst and dystopia barely scratches the surface of adolescent issues that have cropped up in the decades since. A child’s brain was once thought to be structurally complete by age five or six, but more recent research shows that while 95 percent of the structure of the brain has been formed by then, the remaining 5 percent—including the prefrontal cortex, the area that controls mood, reason, and impulses—continues to develop. The teenage brain can “imprint” experiences. Certain triggers and experiences can change the way the brain works later in life. It’s a period of time when “nurture” can modify “nature.”

  The irony of mental illness in adolescence—when many mental illnesses first emerge—is that the brain, according to Frances E. Jensen and Amy Ellis Nutt’s The Teenage Brain, has to be mature enough to “do mental illness.” Jensen and Nutt ask, “How, for instance, can you have adult-like schizophrenia that stems at least in part from abnormal frontal lobe activity if your frontal lobes aren’t hooked up to the rest of your brain yet?”

  My mind and body were incubating in solitary confinement. I had very recently been close to Jesus and carrying on idle conversation with Michael Jackson. But a new version of me was emerging—I was floating through a black hole, I was a supernova, eating and exploding and forming and circulating. I sat in solitary for hours; it felt like days. My brain, simmering and cooking and settling and emerging. Eventually I sat with limited awareness of my actual surroundings. I could see that there was no Michael Jackson, no secret tunnels, I couldn’t hear voices anymore. I could just see the repeating pattern of the soft brown ikat walls.

  I melted into the corner, my knees splayed, my body taking on a languid state. I waited. Waiting I learned is a big part of mental illness recovery. So is a kind of breaking—like breaking a wild horse or a baby elephant. I had to be restrained and I had to learn to operate within certain societal structures
. I had to accept them. A day of seclusion broke me. One study that compared physical restraints to a seclusion room found that 82 percent of participants thought seclusion was less frightening than bed restraints, that they were able to reach a state of calm in a shorter period of time. I wasn’t really into either, but solitary was good for one thing: I decided that the end of the world could wait. I stopped clawing at the door. And they let me out.

  I was presented with a simple solution. Lithium, a mood stabilizer that can help stop and prevent manic cycles. It’s usually the first medication tried with bipolar patients. It’s effective for most of them. Including me. Dr. DeAntonio compared it to insulin, the hormone used to treat diabetes. Once it was explained that this was an element in everyone’s body and that I just needed more, the three pink pills in the Dixie cup didn’t seem so bad.

  CHAPTER 4

  FAT AND BLOOD AND CIRCULAR INSANITY

  MY DAD’S FRIEND LYNN, a Jungian analyst, told him when I was diagnosed, “She’s just going to have big feelings.” I knew about AIDS, everyone knew about AIDS in the early 1990s, but debilitating mental illness wasn’t part of the larger conversation. I didn’t know what I was or what was happening to my brain. I just knew that my judgment was horribly off, and that I believed things that were not real. It all hung on a delicate balance because it all felt real. Everything around me came into question: What was real, what was imaginary? What was genuine feeling and what was the disorder? Who was I in relationship to the disease? What was mental illness? How long had it been around?

  Bipolar disorder is now defined by the National Institute of Mental Health as “a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely ‘up,’ elated, and energized behavior (known as manic episodes) to very sad, ‘down,’ or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.” The generic definition doesn’t quite cover the extremes of the disease or its symptoms, which include inflated self-esteem, sleeplessness, loquaciousness, racing thoughts, and doing things that, according to the Mayo Clinic, have a high potential for painful consequences like unrestrained buying sprees, sexual indiscretions, or foolish business investments. The symptoms are weird and seemingly inexplicable, except that they all revolve around lowering inhibition. Hyperreligiosity is also a symptom—on the ward I insisted on some form of Shabbat celebration. I lit candles (which the nurses moved out of reach), I drank grape juice, and I said the Hamotzi over paper plates with bread. I was feeling Jesus and deeply Jewish simultaneously, and when my mania lifted, all that was gone, too.

  There is a spiritual appeal to lithium for me, though it is historically medicinal. The use of lithium as a therapy for mental illness goes back to Greek and Roman times, at least, when people soaked in alkali-rich mineral springs to soothe both “melancholia” and “mania.” Ancient writers are often credited with discovering the contemporary understanding that mental illness came from a biological perspective—the medical writers of the Hippocratic era considered the brain to be the root of the problem, denying explanations like demons or evil spirits. They viewed the brain as the seat of consciousness, emotion, intelligence, and wisdom and wrote that disorders involving these functions must be located in the brain and that they were not inflicted by the gods.

  Roughly 2,500 years ago, Hippocrates, the “father of medicine,” wrote what might be the first description of mania and melancholia: “The people ought to know that the brain is the sole origin of pleasures and joys, laughter and jests, sadness and worry as well as dysphoria and crying. Through the brain we can think, see, hear and differentiate between feeling ashamed, good, bad, happy. . . . Through the brain we become insane, enraged, we develop anxiety and fears, which can come in the night or during the day, we suffer from sleeplessness, we make mistakes and have unfounded worries, we lose the ability to recognize reality, we become apathetic and we cannot participate in social life. . . . We suffer all those mentioned above through the brain when it is ill.”

  That quote from Hippocrates is among the first pieces of medical writing describing any human disease—physical or mental. He was one of the first physicians to observe the human body in its entirety and to believe in rational explanations for illness. Through his research, Hippocrates formulated the first classifications of mental disorders—paranoia, melancholia, and mania. The physician Aretaeus of Cappadocia, a Roman doctor who was influenced by Hippocratic works, was the first physician to observe and describe the features of bipolar disorder in his two books On the Aetiology and Symptomatology of Chronic Diseases and The Treatment of Chronic Diseases. He wrote: “I think that melancholia is the beginning and a part of mania. . . . The development of a mania is really a worsening of the disease (melan-cholia) rather than a change into another disease,” an early observation that not only takes psychology into account, it also considers the possibility of mania and depression as one disease. (For me, the mania came first, but how was Aretaeus to know?) Aretaeus described manic patients he observed in his chapter “On Madness” from Chronic Diseases:

  And they with whose madness joy is associated, laugh, play, dance night and day, and sometimes go openly to the market crowned, as if victors in some contest of skill; . . . At the height of the disease they have impure dreams, and irresistible desire of venery, without any shame and restraint as to sexual intercourse; and if roused to anger by admonition or restraint, they become wholly mad. Wherefore they are affected with madness in various shapes; some run along unrestrainedly, and, not knowing how, return again to the same spot; some, after a long time, come back to their relatives; others roar aloud, bewailing themselves as if they had experienced robbery or violence. Some flee the haunts of men, and going to the wilderness, live by themselves.

  If they should attain any relaxation of the evil, they become torpid, dull, sorrowful; for having come to a knowledge of the disease they are saddened with their own calamity.

  His description could be a contemporary observation; parts of it were identical to my experience. Hippocratic physicians coined the term hysteria, which comes from the Greek word hysterika, meaning “uterus or womb.” The Greeks believed that various female maladies—including hysteria—stemmed from a wandering womb. Aretaeus even characterized the womb as “an animal within an animal,” an organ that “moved of itself hither and thither in the flanks.” The Greeks and Romans defined the difference between the female and male temperaments. They attributed female pain and emotional angst to a migratory womb that would theoretically bump into internal organs, wreaking havoc—both mentally and physically.

  It’s not so far from the truth as to be implausible—there I was, out of my mind, admitted to a psych ward one year after I started puberty, my adolescent brain still in the process of formation, frothing at the mouth, suffering from the same symptoms that ancient Greeks, Romans, Chinese, Israelis, Egyptians, frontiersmen, industrialists, paupers, and kings had been suffering from since forever. I had that mental illness. It was not a classification I appreciated at first. No manic person—in the throes of omnipotence, ecstasy, and strategic warfare—wants to hear that they are . . . just sick. I would have sooner connected with a diagnosis of a wandering animal womb.

  In the period between Greco-Roman innovation and the midnineteenth century, the understanding of mental illness and bipolar disorder progressed on a slow trajectory. Without listing everything that happened between then and 1854, here’s a snapshot: A hospital dedicated to the treatment of the mentally ill opened in Jerusalem in AD 490; the first dedicated psychiatric hospitals built by Arab Muslims opened in Baghdad in 790. Under Islam, the mentally ill were considered incapable yet deserving of humane treatment and protection; in 1591, the Chinese writer Gao Lian described bipolar disorder in his wor
k Eight Treatises on the Nurturing of Life; in the seventeenth century, Robert Burton wrote The Anatomy of Melancholy, which advocated for the use of music and dance as a form of treatment for melancholy (a condition he described as “nonspecific depression”); and later in the seventeenth century, Theophilus Bonet published Sepulchretum, a text about his experience performing three thousand autopsies. He linked mania and melancholy in a condition he called “manico-melancolicus.”

  The real progress was made starting in 1854 when French psychiatrist Jean-Pierre Falret recognized bipolar 1 disorder by calling it “folie circulaire” or “circular insanity,” describing it as “characterized by a continuous cycle of depression, mania and free intervals of varying length.” (People diagnosed with bipolar 2, introduced in 1994, suffer more intensely from depressive episodes.)

  Around the same time, lithium was thought to cure gout and sometimes “brain gout,” a lovely description for mania, extending the notion of swollen joints to a swollen brain. The element gets its name from lithos, the Greek word for “stone,” and lithium is indeed found in granite—and in seawater, mineral springs, meteorites, the sun and every other star, and all humans. It is classified as a metal on the periodic table of elements. It was first identified as a solid in the form of petalite ore on the Swedish island Utö in 1817. A year later, scientists found that lithium, when ground into powder, turned flames crimson red—the key ingredient in red fireworks. Lithium is also stripped from the inside of batteries to make methamphetamines. Fiery and unstable, lithium somehow calms emotional states often characterized in the same way.