Psych wards these days are a far cry from One Flew Over the Cuckoo's Nest. The staff has assured me that there will be no lobotomies. They don't seem to mind me; they explain everything, no matter how many times I ask, and forget, and ask again. They make every effort to treat people as if they are completely sane. You are sane until proven crazy. And when you are proven crazy, they know you'll come around again.
The outside world—"real" people—might treat me as if I'm a lost cause, hopeless, but the staff treats me as if I'm still human, still conscious, and that makes an enormous difference. I'm not completely removed from the world that you and I agree is real. My perspective is off, certainly, but I'm not totally gone. I'm not off the planet. I know what the world would think if they came onto the unit, what they would think if they saw me. The staff simply refuses to make those sorts of judgments.
Eventually I slow down to a frantic, cheerful agitation, in which state I spend several days—no sleep, extreme motor activity, rapid, continuous speech, but no hallucinations or delusions. I am no longer a millionaire, and I have no private jet; regrettable, but so it goes. Now, instead, I'm terrified, my chest churning with unspecified, wretched fears. Any thought that whips through my somewhat slowed but still speeding mind is cause for panic. I race up and down the hall trying to outrun the terrors, reciting under my breath, It will all be all right, I will be all right, it won't all fall apart—I pop out of my room twenty times a night, come padding down the hall in my hospital footies, hopping up and down with my latest question for the staff—What if my husband keeps me here? What if I stay in here so long I can't go on book tour? What if the doctor doesn't like me, what if he can't help me, what if morning never comes?
Marya, sit down. Well, all right. I'm going to give you something for the anxiety. It should help. No, it won't turn you into a zombie. It'll just take the edge off. It's called Klonopin.
The sunlight streams through the window in my room in a single ray. Dr. Lentz's face is half hidden by shadow, and periodically I forget who he is.
Marya, I need you to hold still and listen to me. He puts both laced-loafer-shod feet on the floor and leans forward. You need to start taking this seriously. From what you've told me, you're not doing the first thing to manage your mental illness. That's going to get you in trouble. Look around you. This is what you can expect to see, more and more often, if you don't work with me to treat it.
I leap out of my chair, irritated, agitated, dimly aware that what he's saying is important but not wanting to hear it. I fold my hands behind my back and start loping in circles around the room. Dr. Lentz is in the center and his head swings around to follow me as I go.
He clarifies my diagnosis—the manic break changed it from bipolar II to bipolar I, and he adds the term rapid cycle. The way you cycle up and down all day, and the way the moods come close together? That's what rapid cycle means.
He watches me lie face-down on the bed.
I honestly can't believe you weren't diagnosed sooner. That's one of the reasons your illness has gotten as bad as it is. But that's just the way it is. You're really going to have to work with me. You need to completely change the way you're living. You need to stay on your meds. It's going to take a while for us to get the right combination, and you need to do your part to control this.
Like what? Do what?
Don't drink, for starters. It will just neutralize the positive effects of the meds, and with the specific meds you're on, it can cause serious liver damage, seizures, and some other very unpleasant side effects. Sleep. Every night, seven to eight hours. Stay away from caffeine. Avoid situations that make you agitated. Marya, there's a lot you can do to make this better for yourself. You need to educate yourself about the illness and what you can do.
I leap off the bed and gallop around the room. I may be nuts, but I can take this in. Holy shit. If I go by his definition, if the symptoms he's talking about mean I'm having an episode, then how long have I been having them? I think of the suicide attempt three years ago. It must have been going on for at least that long. Does that mean that everything that's happened since then wasn't, somehow, real? Is my entire life going to be defined by being crazy?
No, no, Marya. Not at all. You're a writer, right? All the things you've written in that time, they're real. And the people in your life are real, and your memories are real. It's all real. It's just that it was all probably a little painful. Wasn't it? A little hard to get through the day?
I press my head with my fists, as it seems the thing to do if I am not going to cry. Far away, out in the hall, I can hear people shouting and talking, the calm voices of the staff saying, Maybe you could get dressed? How about you come into the day room and eat some breakfast? Come back here! Harry, you need to come with me. Sue, slow down, please. Stop shouting. It doesn't help the rest of the patients, and I hear the rapid chatter of some patients, and the slow, slurred speech of others. The voices come near my door, a body flashes or shuffles past, and then the voices fade away. I see the sound in waves, and put my hand out before me, tracing the waves in the air.
So the point is that now we can treat it, and make it a little less hard.
Always? Will it always be less hard, then? Will I stop acting crazy for good?
He smiles gently at me. No.
Then what?
Things will still be hard. You've had this a long time. It probably won't ever be easy. But we can make it livable.
Livable? I think. That's it?
But I have to admit, livable is better than nothing. Depending on what it entails.
Dr. Lentz tells me that once I've had a major manic break, I'm likely to have one again, and the more I have, the more I will have. He tells me the bipolar has already progressed quite a ways. No, it's not going to go away. No, there's no cure. Yes, you'll always have to take the meds. Yes, always. Yes.
Now I am crying. What will happen to me? I ask.
He raises his eyebrows and shrugs. That depends, he says. It's up to you. You can treat the illness, and you can arrest the progression, and your outcome will be better. It's possible, though unlikely, that you'll never have another complete break. You'll have fewer of them, though, if you are vigilant with your medication, and if you start living in a much healthier manner than you are right now—you've got to stop trying to do everything, you've got to learn how to rest. You've got to get some balance in your life.
I roll my eyes. Balance. They've been telling me that for years. It doesn't mean anything, and even if it did, I'm not capable of it.
That may be true.
I look sharply at him. Well, what if I'm not? What if I can't balance?
Then you'll get sicker. He closes my file and stands up. I think it could be more a matter of you don't want to balance, he says.
Wait—so what you're saying is that I could go crazy for good.
Not likely, with treatment.
Does the treatment always work?
Not always. Usually.
So you can't promise me I won't go crazy and wind up on the street. (This has always been my greatest fear, that I will become a muttering bag lady, talking to the voices in my head, people staring at the ground as they pass me, avoiding my eyes.)
I can't promise you anything. Although I think that's very unlikely. He looks at me. It really is up to you.
Okay! Okay okay okay, I yell. I flap my arms around and climb up on my bed. I stand here in my many gowns, mind spinning with information I can barely grasp but that makes me extremely afraid. Dr. Lentz smiles at me and tells me he'll be back tomorrow. I leap up and crash back on the hospital bed.
Upside down, I watch the clouds scud across a blue, blue sky. Lentz is gone. Well, never mind all that. It's not really so bad. I just take my meds, and I'm cured.
I lie on my back, still for a moment. I am at peace.
***
Now, this is the part of the book where I emerge from the hospital into the July sunshine, fresh-faced, rosy-cheeked, eyes a-twink
le, and gung ho to embark on my journey, the obvious journey, the recommended journey, the acceptable journey from sickness to health, from dark to light, from inside the locked door to outside it, freedom! How dear a price we pay! Here is me, mellowed and medicated, smiling mildly, like the Madonna, with that touch of knowing sorrow in my brow, but overridden now by the hope of new life.
Here I am, striding with newfound purpose into my house, collecting the bottles off the bar, out of the wine rack, out of the tank of the toilet, out from under the bed, behind the desk, in the washing machine, the garage, the spice cabinet, the bucket of cleaning supplies under the sink—shocked, just shocked to realize how much I'd been drinking, but full of strength, the strength of the totally sensible sane, strength enough to dramatically flush all the booze down the toilet, and here I am going to bed by ten and waking up at six every day, exactly right, and I'm taking my meds in the morning and taking them at night, and I begin yoga, and kick-boxing for good measure, and in the interest of balance, I become a Buddhist and meditate while perched on the silk pillow in my little temple, formerly my husband's office, and my husband is part of my support system and totally supports my hijacking of his office for the higher purpose of sanity and balance, and I decorate the room with all sorts of meaningful little knickknacks, Buddhas and the like, knickknacks not purchased, oh no, in any kind of manic spending spree.
Well, no. That's not exactly what happened. Just kidding. Really, it embarrasses and frankly baffles me to write this, but the next part of the book is where I'm at my house, knocking back my meds with a beer. I'm working twenty-four hours a day. I'm having parties, going to parties, staying up all night. I'm acting exactly as I did before.
You may be asking at this point, Why? Or more to the point, What the fuck is wrong with you? Are you completely dense? Are you—ha ha!—insane?
Ladies and gentlemen, yes I am.
Tour
January 1998
I'm standing in front of a crowd of people in New York the first time it happens: I'm on book tour, giving a reading from my book Wasted, and suddenly I come to, as if I've been away, and I don't know how I got here. I'm terrified, and I hear myself talking, and then people clap and praise my book, which I have apparently been reading from, and then they take me to a hotel and I stand in the middle of the hotel room, paralyzed and confused. Where am I? Where am I going tomorrow? What if I fuck up? What if I make a fool of myself? What if I just go crazy and start to scream? That's what scares me, because I feel as if I'm just about to do it, every minute of the day. I sit in television studios, in radio studios, the crazies welling up in my chest. I sit in coffee shops with reporters and recite the correct answers (What are the correct answers?), still feeling it. And then, at night, the switch trips and I am on, in front of a crowd, questions, more questions! Bring it on! I'm on top of the world! My speech comes out in rapid fire, I fling my hands around in sweeping gestures, my brain races along at the speed of light, and I love it, the heat, the crowds, the way I get so fucking high each night I think I'll never come down.
At first, it's just mania, which isn't so bad when you're on book tour. You're flying from one interview to the next, guzzling coffee, off to a reading, to a dinner, back to the hotel for a few hours of sleep, and up early to get on a plane to go do it again. I keep going as fast as I can. Day after day, I have endless energy. I'm always cheerful, never get tired, never need a break, will take any number of interviews; the publicists who drive me around are amazed. And, okay, I'm a little nuts, and they laugh at my constant stream of chatter, my loud laugh, my wildly gesturing arms. But no one mentions it because I'm a writer, and everybody knows writers are crazy (or maybe she's on cocaine?).
Might as well be. I hardly sleep. That in itself is enough. But I've forgotten everything Lentz told me about sleep, and everything else—the bipolar body clock is readily startled, he told me over and over, trying to get it through my head that I can't just go careening around all night. He warned me that the tenuous balance that exists in my brain is easily set off kilter, but like everything else he said, that has slipped my mind. I've thrown myself into the insane schedule of book tour, possessed with the need to do it perfectly, I have to do it right, what if I fail? I can't say no, I can't slow down, I have to keep going or they'll find out I'm a little kid in grownup's clothes and a fraud. The lack of sleep is one thing, and the airplane rides and time changes another, the erratic, unpredictable daily schedule, the back-to-back events and interviews, the poor nutrition, the continuous state of heightened awareness, the fact that I'm drunk almost around the clock—if Lentz were here, he'd tell me yet again: there's no way my system can maintain the homeostasis it requires to keep my chemistry on course. My brain becomes highly "brittle," thinks it's in a fight-or-flight situation. It's primed for collapse.
I fly back to Minneapolis for a weekend break from the tour. I get in around midnight and collapse into bed. I have forty-eight hours to get some sleep into my bone-tired body. But it's in these forty-eight hours, by some freak chance, that the worst that could happen does.
At five o'clock in the morning, the phone rings. It's just getting light. I pick it up.
My beloved cousin Brian is calling. I knew this phone call would come one day. His muscular dystrophy has been slowly killing him since the day he was born. The last two years in Minneapolis, I've been able to talk to him at all hours, see him nearly every day, have dinner, go to movies, spend time with all our friends as often as I wanted; and as close as we've been since we were little kids, now he's the most important thing in my life. I made myself forget he was sick. I knew, but I ignored it. I knew in the back of my mind I would lose him. I just didn't think I'd lose him so soon. Not yet. Not today.
We rush him to the hospital. His mother, father, and sister are there, and so are my mother and father. We race after the nurse who has cared for him when he's been hospitalized these past few months, who runs toward ICU, pushing Brian's gurney, Brian is howling in pain as his vital organs shut down, the nurse is crying and saying, I promised him this would never happen, and we finally reach the room and the nurse turns up the morphine and Brian's wails slow and then stop. He dies at 8:23 A.M.
His mother cries, My child, my child.
I turn into Julian's chest and slide down him to the floor.
I delay tour for a few more days to stay with my family and our friends for the memorial. We planned the service this winter while Brian was in the hospital. He made us swear they wouldn't play "On Eagle's Wings." He made his mother promise there would be no Jesus. There were to be two eulogies: he ordered our old friend Chris to make everyone laugh, and me to make everyone cry. He gave us his credit card and told us to go out after the wake and blow his entire credit line on a party at a bar, since he wasn't going to have to pay anyway. He made me promise to wear a red dress. Furious, I wear a red dress.
The night of his memorial, we drink ourselves half to death at Benchwarmer Bob's, laughing and crying and telling stories until last call. Julian drives and I stare out the window at the freeway lights and passing cars as we head for home, feeling like my guts have been ripped out.
I shut down. The next day I get on a plane bound for London to do what I'm supposed to, show up for the still-long list of radio, TV, and newspaper interviews, the panels and dinners and readings, another month on the road while it's taking everything I have not to scream. Shock. Grief. Jet lag. The booze I inhale on the plane. The pot of black tea I drink when I arrive. Enough to make anyone crazy. And more than enough for me.
I am triumphant. I have arrived. I am torn apart with grief. Brian is dead. BBC London loves me. The book critic loves me. I hold court at a publication party, pouring wine down my gullet like a pelican, the table littered with bottles, everyone laughs.
Then it hits me: they're laughing at me. They've found me out. They see what I actually am.
You can almost hear it: a little tiny snap. Here's my tiny scream as I go down.
I am
sitting at a table in a hotel bar in London, wrapped in a black wool thing. I am watching my hand, in fascination, as it lies on the table and trembles like a paper napkin in the breeze. My hand absorbs me completely. The bar is enormous, then tiny. I am sitting in a brass-tacked, leather-upholstered chair. I myself am enormous, like Alice, my legs and arms everywhere. But then I am minute, tucked back into the corner of the overstuffed, regal, genteel chair. They are watching me. Especially the barmaid—she hates me. She speaks to me only in French. My ashtray is the size of Montana. My cigarette burns in it slowly. The sound of the paper spitting as the red cherry creeps down the cigarette is deafening. I look around the room. The barmaid turns her head away in a haughty gesture. I note that things have taken on a particularly tactile, vivid, saturated look. The leather chairs are oxblood. They are very, very fine. There is a businessman in the bar, leaning back in his chair, smoking his cigar and reading the London Times. I panic. I remember there is an article about me in today's Times. I shrink in my chair. I know he will see it, see my picture, and he will swing his head in slow motion toward me and fix me with his beady, foxlike stare. "I don't care," says Pierre, I chant in my head. But I will let you fold the folding chair! "I don't care!" says Pierre. I will show that man I don't care. I am Pierre!
Madness: A Bipolar Life Page 8