Present Day, February 26th, 2017

The Big Three: Medications. Sleep. Therapy.

I have heard it time and time again. These are not the ONLY secrets to managing Bipolar or just about any other mental illness. However, they are three CRITICAL ones. In other words, do these three things right…and you are heading down a good path. Neglect them…and just about all other efforts will not likely make up the difference.

There is a catch tough. Probably more than one. But the one I am thinking of today is that they each carry a degree of humiliation to them.

Medications? I take a disgusting amount of pills every day, am practically a zombie by 10 p.m. at night, and live my life in the position of having to be held accountable to the periodical question “Have you taken your meds?”

Sleep? I take naps like a toddler. I wear a Fitbit to make sure I average out the necessary amount to keep my sanity somewhat in check. Like a teenager with an early curfew, I rarely get to “stay up late” and often pay a price if I do.

Even therapy has its humiliation. And I am not even talking about the phrases that exist in my life referring to having my own personal “therapist” or having to get to a “doctor appointment” every other week or sharing how “therapy went today.”

I am talking about the cold realities that therapy can put you through during the best of times. Because it is a reminder. Sometimes a slap in the face, that I am fucked up between the ears, as well as somewhere extending down into my heart (or soul, or wherever you ascribe as the seat of our feelings).

That was especially the case this past week. My wife joins me for therapy roughly once a quarter. It is a chance to make sure everyone is on the same page, and for my therapist (who…let me be clear, I greatly appreciate and enjoy meeting with) to see if there are any hidden issues that should be addressed. This time around I knew we would be addressing the management and handling of my next crisis experience. That’s right, no matter how good I was going to be feeling walking into those doors, we were going to address the when…not the if…of me losing my shit again. Because we all know I will.

As is often the case, following the session my wife and I grabbed an early dinner. A chance to debrief. To unwind from the tension the session can create.

By that point, I had entered a rather sober, somewhat discouraged place. We had just spent an hour talking about how my keys would be taken from me and locked in a safe that I didn’t have the combination to in order to ensure that I didn’t run away or park my truck in the garage with the door closed and a hose in the window. We had talked about whether I had the ability to load any of the antique guns in the house and blow my own brains out. We had talked about how I was allowed to sequester myself in the bedroom, but if I walked out the door my wife would have an acceptable authority to call the police and notify them that I was a danger to myself…and possibly others.

I’m pretty sure that you aren’t normal (and truly are insane) if that type of a conversation doesn’t sober you up a bit. Was it necessary? You bet. But so is sleep and medication. Doesn’t keep any of them from being at least somewhat humiliating.

Thursday, August 25th, 9 p.m.

I entered the room with no idea what to expect. I had been in a psychiatric ward before. Maybe 20 years earlier to visit someone. Scared the hell out of me. I had been in a hospital much more recently. Could never stand them. I had even held a job that required regular visits to a local detention center and watched plenty of movies or shows involving prisons.

In other words, my mind had plenty of memorized context for the sensory input it was about to receive. Which may or may not be helpful considering I was only barely able to hold myself up at this point due to the combination of my peaked physical exhaustion and complete emotional meltdown.

The nurse opened the door, reached inside, turned on a light and I shuffled in behind wearing my stunning ensemble of matching hospital gowns with tan slipper-socks trimmed those indiscriminate white rubber zig-zags to keep my feet from sliding out from under me.

To my right the wall stretched the entire length of the room. This was the wall that the headboard of the bed rested up against. A much simpler bed for a hospital. Lacking all the up and down incline gizmos and buttons. Just a simple headboard and footboard with a typical twin size, blue plastic lined box spring and mattress. It was unmade with two pillows, folded sheets and a blanket laying on top of it. On the wall was also a dry erase board. Not like a typical 2 x 2 one that I was used to seeing in a hospital declaring who my doctor and nurse for the day were. No, this one was large. Very large. Maybe more like 5 feet tall by 4 feet wide. While it did list the medical professionals on shift, the majority of it was designed to provide a morning to evening schedule for my day. Most of which was blank. Made sense for a new arrival at this time of day.

Straight across from the doorway was a wall that primarily consisted of three components. On the right side in the corner, joining up with the fairly plain wall I just described was a floor to ceiling wooden shelf unit. Sort of a closet with a door, but instead of a bar for hangers (or as I would later put together…for hanging myself) it simply had spaced shelves for folding my belongings and placing them in the closet. It was only 18″ or two feet wide, and then met a window that covered the entirety of the remainder of the wall. From desk height to ceiling. Looking out over the Chicago night. It was double-paned with the blind actually enclosed between the glasses. On the opposite wall was a switch that provided electronic control of the blinds. The panes looked extremely thick, which I am sure was also protective as in the days to come I would ponder throwing my desk chair through them and plunging myself to my death on the sidewalk below.

From the closet to the far wall was a single piece of marble or some stone. Interior design has never been my thing. It started about a foot lower than desk height and ran for about three feet as a sort of window seat. Over the next eight days, it would become one of my favorite places in the hospital. Then it rose to desk height and ran the remainder of the wall. There was a simple chair under the desk.

After a brief wall starting just to the left of the doorway was another doorway. This led to the bathroom. Similar to a handicap accessible bathroom at any other facility, this one was designed to provide everything in a single, undisturbed flow. As I discovered with the closet, this had to be very purposeful. No way to hang myself. No way to even harm myself. Even the toilet was of a very strange, almost indescribable form including a massive ring that would make it nearly impossible to even significantly harm myself with in any manner. If one wanted to hurt themselves in here, the primary choice would be bashing your head against the wall with whatever will you could muster. Otherwise, you were out of luck. No shower curtain. No hand rails. Even the place for soap or shampoo was a natural cut out of the material which the walls were made of.

The same held true for the sink, mirror, and beauty area outside the bathroom that consumed most of the rest of the remaining wall to the left of the door. Like the shower and toilet, no faucets or handles. Just small silver push buttons to provide the desired effect.

Strangely enough, there was an air of “nice” to it all at the same time. The subway tile in the bathroom, the small floor tiles, the marble (or psuedo-marble) material used for the desk, the electronic blinds with some amazing views of one of America’s largest cities. Yes, it was institutional…and clearly a hospital…but at the same time, I couldn’t help think a few days later that it was a few tweaks or modifications away from a reasonably impressive studio apartment. One not that much smaller than I had inhabited for 13 months of my life not that long ago. One that could probably fetch a pretty penny at this height in the sky and with these views in a city such as this.

All those thoughts would come at a later hour. At this hour the thoughts were simpler. More primal:

“I’m so tired.”

“How long will I be here?”

“What will tomorrow look like?”

…and the main one…

“No one here knows me. I don’t have to ‘be’ anyone in particular. Tomorrow morning, I get to define who I am and what I look like to these people. That seems very freeing.”

Thursday, August 25th, 10:26 p.m.

It is right there in the notes. The patient log. A direct physician’s order to provide me with 50 mg of Seroquel my first night in the psychiatric unit. Something to help me sleep, which I had basically not accomplished to a significant extent for more than 48 hours and to a healthy extent for weeks. Not to mention its assistance with depression and Bipolar Disorder.

However, it never came. In fact, I went to bed that night finding it extremely odd that after more than 12 hours in “protective custody”, emergency room care, and settling into the psych ward I had yet to place a single pill in my mouth. Not even a Tylenol PM.

Looking back, I fell asleep relatively quickly and slept relatively well. With significant emphasis being continually placed on “relatively.” Let’s face it, I was completely wiped out. Trashed. And I was resigned. For the moment. There would be future bouts and attempts to take back control of my situation, but not now. There was no way I was getting out of this room, in this ward, in this hospital, in this city on this night.

So I laid on the bed. The door was cracked with a stream of light coming in from the darkened halls. At the time, I assumed I was not allowed to close it completely. Subsequently I would learn otherwise, though leaving it open sure made the periodical nurse visits to check my vital signs and bed checks a bit more peaceful.

A mattress, sheet set, and pillow that would have on almost any other night of my life made sleep nearly impossible felt unusually comfortable compared to the lawns, benches, and train seats I had attempted to rest upon for the past two days on the run. The blinds had been left open to my right. A window that largely covered the entire spans of that wall in my room. The night lights of Chicago that could find their way to the 14th floor twinkled and flickered.

I do not remember all my thoughts of that evening, nor how long I remained awake. This one thing I do remember feeling deep down inside my heart…I was a mere shell of whoever I was born to be. The seven-year-old boy playing Little League. The 8th-grade member of the Junior High basketball team. The High School All-Northern California Honor Band trumpet player. The honor student. The Master’s Degree recipient. The husband. The father. The sole proprietor. They were all titles. All history. All accomplishments that seemed to belong to someone else.

Not a different person. The same physical body. But someone else. Someone other than this man lying on this bed in this room on this night. What was left of the mind of this man. What was left of the emotional stability and strength of this man. It had once again been fractured and broken in a more profound way than any of the times before.

And I had no idea if there would be found even enough left of “me” to truly constitute the person that was me.

Saturday, August 27th, 6 a.m.

I awoke fairly restless. Unlike the day of my capture (okay…”taken into protective custody”), the night before was the first I had been provided with medication. Not sure how that got missed on the day of my intake, but it did. I’ll let it slide, as that was literally about the only negative thing I could ever come up with for the mental health team at Northwestern Memorial Hospital.

However, last night I was medicated. Which means that for the first time in many days, to some extent weeks, I had a fairly quality night of sleep. Which also means that my mind was clearing, my emotions were coming into balance, and I was starting to feel normal. At least, as normal as a 47-year-old, married, father of five can feel in a psych ward multiple states and hundreds of miles from home. Which also means one more thing…I was doing what I have always done in the past…shifting my focus from the fact that I am significantly fucked up to all the other problems outside these walls that are in need of my attention. Like, now!

Here’s the thing (or at least one of them): if you are never willing to stop and look at what is broken on the inside, then you tend to get angry at anything getting in the way of your trying to fix what is broken on the outside. (I know I’m in no position to offer advice, but read that sentence again. Trust me on this one.)

Almost a week from now a psychologist will sit down with some test results and ask me to reflect on the following: “Tell me a time when you weren’t angry.” After a rather significant, long, and awkwardly silent pause I will end up saying, “Actually, I can’t remember a time when I wasn’t angry.”

Back to that early Saturday morning. This also was not such a time.

Now that I had survived my period of suicidal angst. Now that I felt ready to be trusted to return home (though it was probably a 50/50 toss-up as to whether I really would have). Now that my mind was clear and my emotions stabilized (as would only be perceived to be so by myself and no trained professional). Now that I had managed to fully immerse myself in the denial of my situation, it was time to move to anger and get down right pissed.

I have committed no crime. I have threatened no one. I’m not walking around screaming profanities to unseen ghosts in the halls of this psych ward. And forget the negatives. What about the positives? I own my own business (at least, I thought at that point that I still might). I have a masters degree. Property. Financial holdings.

What the hell am I doing sitting in this sterile room, on this plastic mattress, without so much as a shoestring or hoodie drawstring to even think about harming myself with? What am I doing in Chicago, Illinois on this late summer day?

My blood began to boil. My rage began to burn. And then it struck me, that will never work. No one will ever believe I am okay behaving like that.

Knowing that a nurse would be around at any moment to take my blood pressure and vitals, ask me how I slept and check in on my overall mood…I took a few deep breaths. It was time to do what I have always done in public throughout these many years of internal struggle and done quite well.

It was time to push that Bipolar self deep down where no one could see it. It was time to put on my game face. It was showtime…

Monday, November 28th, 2016

As I laid on my bed, it hit me. I have always been afraid. Battling fear. Paralyzing, debilitating, irrational fear. Some might even describe it as paranoia.

In the early years of my childhood, I would wake up after everyone else had gone to sleep. The house completely dark, but haunted by endless sounds that all homes make. And while not the most logical next step, I would slowly get out of bed, and begin to search the entire home. Slowly peering around each corner. Opening each closet. Ever so quietly making sure that we were all alone and it would be safe to at least attempt sleep once again.

The searches continued into my teen years, but the fear grew intensively worse. Many nights I could not pull myself from the bed to conduct the search. I would lie there frozen. Not moving for fear of creating a sound that would draw a would-be intruder’s attention. Convinced that someone had entered the home, and would soon be harming us. Eventually falling back asleep due to mental and emotional exhaustion.

It should be noted that in the midst of these years were the endless nightmares. I don’t know at what age they actually began, but they have continued to present day. Not as frequent as they once were, and varying in their appearance at different phases of my life. Nightmares that play out horrific deaths. Of me. Nightmares that provide very real images of pain. Torture. Abuse. Acts that should have killed me, but during which I miraculously remain alive to continue enduring the onslaught. I digress.

As I entered my adult years, another element was added to the fear. My mind would begin to play out dramatic, emotionally horrific scenarios. Now, while awake. With my eyes open. It was like a whole new phase. First, nightmares while I slept. Second, paranoia while paralyzed in bed. And now, third, excruciating mental images while wide awake. Maybe it would be thinking through a sequence of events where a loved one dies. As my mind races forward through the time loop, I would tighten up. My nerves would come alive. I might even begin crying.

As my kids grew older this could take on a level that easily should have been addressed with therapy and medication. Let’s say my son was going out with friends after a high school football game. Everyone else in the home may be sound asleep. I would be in the living room. Imagining a knock on the door. A police officer informing me there had been a horrific accident. Advising me my son was no more. And I would sob. Sitting there. On a Friday night just like any other. Weeping over the death of my son…which was totally fabricated by my severely broken mind.

As I drove north on the interstate three months ago and began facing a paranoia like I thought I had never before experienced it struck me as odd. I didn’t see myself as struggling with fear. As being a frightened person.

Now I see it. Because it has always been here. Another puzzle with many pieces I had never placed together. Another piece in the larger puzzle of my Bipolar mind.

Today I still struggle with occasional nightmares. I can still play out the dramatic, emotional, painfully weighted scenarios in my racing mind. I constantly battle trust issues which can tie directly to fears of being hurt. Pain. Sorrow. In my challenge to separate my rational from irrational thoughts, days in which I fail to do so can bring back so much of this past.

At FDR’s first inaugural address he is known to have said, “The only thing we have to fear is fear itself.” 

For me…that’s more than enough!

Saturday, August 27th (Hospitalization Day 3)

Typically I prefer to refrain from all-inclusive terminology: every, none, always, never, everyone, no one…you get the idea. I’ll stick to my leaning in that regard while suggesting that it might work in this particular instance.

When it comes to individuals with certain mental illnesses, such as Bipolar II in my case, most of us of a fairly reliable list of warning signs that things are about to go really bad. In fact, to take it a step further, the list is usually not even a short one.

Which means that as I entered my third day of hospitalization it was no surprise to begin reflecting on what went wrong, how it might have been avoided, and discover a rather lengthy list. It flowed easily, and for each item on the list…there were plenty of warnings!

warning-signs

I have been told the “Big Three” for Bipolar are Medications, Therapy, and Sleep. Well, since I was not on any medication, or in any therapy (yeah, I know) that only left sleep or it was three strikes and I’m out.

For me, seven hours a night will generally cut it. An average of seven and a half is better, and under seven…things are probably going to get a bit dicey. Quickly. Especially over any extended period of time.

I wear a FitBit to try and keep me honest and make sure I’m somewhere close to on track. And I wasn’t. Over the previous month just under seven hours had slid. First to six-and-a-half hours. Then to six, but that was largely due to five-hour nights getting supplemented with 60 to 90-minute naps. By the week before my hospitalization, I was pushing almost five days at right around four-and-a-half–hours a day…total.

One of the reasons sleep makes the Big 3 is due to the chain reactions created by a lack of it. For me, headaches ensue. My temper shortens. My hands start to shake. Under stress, I’ll experience chest pains and shortness of breath (fairly alarming for a man who survived a heart attack back in early 2015). Nothing in life seems to bring pleasure or fulfillment. And all while the mind is racing, thoughts are spiraling out of control, and hope of things feeling normal is plummeting.

Let’s face it, no one likes to be tired. I get that. People with mental illness are not special in that regard. Here seems to be the difference as I have experienced it. Without the illness, finding a way to catch up (sleeping in on the weekend, taking a nap, going to bed early, etc.) can get you back on track pretty quickly. With the illness, in a very short period of time, everything can start misfiring to where lack of sleep isn’t even recognized as the problem. Even if you do see it and find extra time in bed, lethargy sets in with its best friend depression. Life falls into a quicksand. Sleep wise you feel damned if you do and damned if you don’t.

All the while our world’s shift. Rationality disappears. Very smart people can begin to lose their grip on very rational, even simple solutions to what is taking place. And the ability to write…to process…to even come up with the list I sat down and wrote above seems so very far away.

Thursday, August 25th, 10:05 a.m.

As they opened the glass doors etched with the Amtrak police logo the thought passed through my mind in almost too fleeting of a way to even realize it had been there. Like a whisper…grab a gun. How quickly it all would have ended.

But I was almost catatonic. For the past 24 hours I had been living in a state of the deepest depression my emotions had ever delved into. I had not been asleep for well past that amount of time despite being on a regular diet of Tylenol PM every couple of hours. In fact, looking back, I had been operating on roughly six hours of sleep since 3 a.m. on Monday, August 22nd. Six hours in the past 75 with more diphenhydramine in my system than could be anywhere close to healthy.

So surrounded by three officers creating almost a bubble around me, I simply moved within that bubble until coming to the stereotypical hard, plastic, waiting room like chair next to a desk where they asked me to sit down. They put on latex gloves as they obtained my permission to search my bag. My person. I must have given it, though I have no recollection. Maybe I just shook my head. Maybe they simply took my lack of resistance as compliance. Maybe…

For those who have never been there, though I know many of the readers of this will have been, it is almost beyond reach to describe my state at that point. There was no awareness that my plan had been foiled. There was no understanding, or even curiosity of what they were going to do with me next. There was no plotting, calculating, or weighing the gravity of my situation. There. Was. Nothing. Were it not for the beating of my heart and the oxygen flowing in and out of my lungs…I had practically ceased to even exist.

Based on my limited experiences in life, I cannot imagine a person being alive while feeling more dead. To this day I can remember there being three officers. I can picture one. Vaguely a second. No idea what the third looked like. There was an office I was sitting in. No concept of the color of the walls or the placement of objects.

But I do remember this. Two of the officers could not stop talking to me. I believe the third had gone to call my wife. And all the two could say…over, and over, and over, and over, and over again was…“We have all been there.” “There is nothing to be embarrassed of.” “We all know how you feel.” “Everyone has experienced this.”

Really? This? How can you know how I feel when I don’t feel a fucking thing!

It is interesting now as I work through my therapy and recovery to look at some of the most profound underlying challenges in my emotional life. One of, if not the greatest, is a deep-seated, passionate, foundational feeling of anger. Hostility. Rage.

And it is interesting that at this moment of my life when I have never felt less alive, the one emotion that found a way to keep embers alive was that one.

“Shut up! YOU HAVE NO IDEA HOW I FEEL!!!