My Peers

Hello faithful blog readers,

I am not going to apologize for this lengthy absence because I have been having a wonderful and, in my opinion, well deserved vacation before starting medical school. However, I hope to write more in the upcoming months because I have a feeling that medical school will provide lots of fodder, both in terms of my own mental health management and exposure to mental health professionals and patients in the system.

Privacy

**Note: This is my first post using Blogsy, an iPad app -- hopefully everything works OK!!**

 

This morning, I had to go to the doctor's office for a simple blood test. I was fasting and hadn't had any coffee so was a little on edge. The lab tech didn't help when she looked over my file and loudly asked, when was the last time you took your lithium?

Three Years

For most of my adult life, I have been the least emotionally stable person in my interpersonal relationships. I have been the one struggling through physical and mental illness and undeniably, not always doing so in the most graceful and peaceable way. I have said unimaginably dramatic and cruel things to those I cared for and care for the most, I have complicated simple friendships, and I have raised the emotional stakes in almost every situation, no matter how benign. I shudder to remember my uncontrolled, raw emotions, my desperating coping mechanisms, and the despair and hopelessness I felt inside and unfortunately, transferred to my friends and family. This is not to say that no one ever mistreated me, or overreacted to something I did, or betrayed my trust, but simply that as part of my recovery, I started assuming that I was overreacting, emoting inappropriately, or creating drama for my own reasons. I did not start assuming this out of self loathing but out of pragmatism. I was usually correct, and approaching friends and family with humility, noting my weakness in this area, felt therapeutic, like admitting to a friend of mine who loves to ski that I am afraid of ski lifts. Over the past few years, my emotional health, distress tolerance, and quality of life have dramatically improved, and so have my relationships. As the former three have changed, my assumption feels less valid. Now, I am often the more emotionally healthy, balanced, or even reasonable person in a heated discussion, or perhaps most importantly, I am well trained and increasingly well practiced in using the appropriate skills to understand and manage my emotions. I am far from perfect, but I am closer to the middle of the pack then I have been for years.

I Came This Way

NB: The first three embedded links below are better than my post. Click on them.

Six days later, I completed the first season of Homeland. I am proud and disgusted by this feat. This television show has inspired me to return to this blog and more importantly, to challenge myself to articulate the challenges, joys, and small moments of living successfully and (dare I say it) happily with a mood disorder. These adverbs have been a long time coming, which perhaps is what makes watching Homeland so empowering and vindicating. The Internet is full of haters who claim not to relate with Carrie Mathison (or, for that matter, with Mindy Kaling in her new sitcom, and this is awesome), but I empathize so fully with her that watching Homeland feels self-congratulatory at times. As a teenager, I felt a similar relief/elation/joy/inspiration when I first read "The Namesake" - when Lahiri wrote about the protagonist's wife, I felt that she could have been writing about me. I am self-aggrandizing enough to believe that if I keep writing, someday I can create a Moushimi, or a Carrie, or a Mindy that some bipolar or Indian or smart or chubby or Portland-born or outdoor loving or stubborn or confused or empathic young woman will hold close to and be comforted and think wow, that author knows me. I came this way, and she came this way, too.

Homeland

Hello readers - sorry about the hiatus! I could apologize for it or make excuses, but I would rather move along and write about Homeland, the amazing Showtime drama that just won a couple Emmys and appears poised to help me ruin my GPA over the next nine weeks.

As I've previously discussed, mentally ill characters are often marginalized, ridiculed, grossly stereotyped or just plain mischaracterized in the name of entertainment (see: some, but not all, Law and Order characterizations, A Beautiful Mind, etc). I expected the main character to be overly moody, dramatic, and devastatingly broken and sexy and appealing because of her tragic flaws. I expected to feel weirdly guilty that my bipolar disorder isn't as beautiful, heartbreaking, and dependent as hers and also hugely defensive of the character and her ignored, omitted struggles. My expectations were wrong.

...Or Don't Come to Class

In high school, I had a teacher or two who'd kick you out of class if you hadn't done the reading. If you hadn't put the work in, they implied, you wouldn't get much out of the lesson anyway and could actually hold your fellow students back.

There's a lot of emphasis on the mentally ill to do our homework. We're supposed to understand our diagnosis, our variable body chemistry, our medications and their effects, and of course, the effects that we have on those we love. Some of us don't take care of these things. It's not just side effects that cause our life expectancies to be 20-30 years shorter than everyone else's. But some of us do. Some of us try super hard, and sometimes we're met with an unexpected result.

Like the teacher who goes back to graduate school and struggles to turn his own assignments in on time, it can be difficult for our loved ones to appreciate that they have homework too. There's a certain type of perceived heroism in supporting someone who is mentally ill, in holding their hands, in wiping your tears away bravely. Some people feel that they are special or caring because they do this, and they probably are. And (see those skills there) they  have homework too. 

Sabotage

Hello dear blog - it's been too long. To be honest, I've had moments when I've wanted to write, and incidents that I've wanted to discuss, but somehow the two haven't come together appropriately. This week, I couldn't stop thinking about two communications.

Si Te Vas

I've been phenomenally lucky over the past five (or, really, fifteen) years in that while I've struggled with my ups and downs, diagnoses and treatments and lack thereof, I've managed to hold things together professionally. In fact, I've excelled, or at least my achievement has remained in the upper echelons of what could be expected. Recently, I embarked upon a hugely new, highly risky endeavor, and there is a non-trivial chance that I will fail.

Part of the reason I'm so terrified of failure is that I'm not used to it. Another, and I think deeper, reason is that I'm afraid that if I fail, it will be because of my illness, because of an intractable truth of my biology or psychology. If I fail, it could mean that my illness is starting to take over my life. If I fail, it could mean that the illness has caused me to fail. If the illness causes me to fail once, it could cause me to fail over and over again. Maybe my illness is like a tsunami underwater, appearing tranquil until one day the waves reach a mile high and wreak chaos on the life I've fought so hard for.

I understand that I could fail at something because I don't try hard enough. I could fail because of a random event, or I could fail because I just don't have the capacity to achieve a certain goal. I recognize that, rationally, that failure could be a one time, non catastrophic event, but every time I start to slip, get a bad grade on an exam or have a suboptimal workout or a bad first date, I feel that tidal wave growing (again), rising inside of me and threatening to destroy everything that I've worked so hard for.

It's like there is a whole brood of adorable puppies inside of me, but one of them is rabid. I don't know which one, and every time I hear a dog bark I wonder if its the rabid one, and if he's escaped, and if he's going to attack me or someone I love. When I take the dogs for a walk I agonize over the length of the lease and maintain exhausting concentration, because the risk of failure is enormously high when you think that one failure could lead to a lifetime of failures, the end of the war, a crushing defeat.

So far, the obvious solution has been to keep all the dogs locked up all the time. That's neither a sustainable or humane (to me) option, but I haven't found a better one (a retractable leash? a safe dog pen to take risks in?) yet.

Signing Up

Writing is an exothermic exercise. It releases energy, and if you're lucky, real heat. Depression is an endothermic state. I feel myself sucking energy from those around me, from the environment, from the secret stores of energy that I keep guarded from the world for times like these. It's hard to write, to release energy, when everything in you is drawing inward. I've read some haunting descriptions of depression, but none of them capture the empty, raw, dull pain of watching yourself sabotage your own life, prospects, and friends. None of them capture the energy fluctuations, the tantalizing moments when you get up and walk across the room with purpose only to get to the other side and realize that you have no idea why you're there. It's hard to write about depression because it's endothermic.

If I can't write, I run. This week, running hasn't helped. I'm depressed when I started running,  I'm depressed as I run through the pain, and I'm depressed when I come home. However, I did find something that I can do: I've been signing up for races. A 10K and a half marathon, to be specific. Signing up for these races forces me to imagine myself as beautiful, vibrant, and smiling, crossing a finish line with a little bib on my front. It forces me to imagine weeks of training, some of which will be better than this one. It forces me to accept the fact that I will here, regardless of my mood and my medications and my loves and my losses, on this date in May and that date in October. And that knowlege, the knowledge that I'm not going to simply disappear, to be engulfed in this darkness, is worth a thousand entrance fees.

Jet Lag

I settled into an antiseptic, oddly smelling airplane seat in Portland at 10:20 am and landed in Mumbai at 12:20am the next next morning. Having spent most of the 25 transit hours sleeping, aided by the generous gin and tonics, I was dazed and confused as I navigated immigration and baggage claim. Date of my arrival? 12^th of December, or was it the 13^th now? Date of departure? Three weeks from now, or was it two? Destinations within India – I couldn’t seem to remember the itinerary. I knew I had something exciting, something life changing ahead of me, I just couldn’t quite remember what.

True Colors

I have lost so many things because of this illness. I lost a job I could have loved, I lost a man I thought I could have loved forever, I lost part of my health, I lost some of my dreams, and I lost my innocence. I gained things, as well, but the last two years of my life will be remembered as years of loss and growth. I hate that those two often go together.

Our Faults

I believe that we can be loved for, not in spite of, some of our deepest faults. One's flaws, the fundamental difficulties in one's personality that one grapples with all of his or her life, can actually be embraced by their loved ones (or maybe its just the struggle that is embraced). I love people for their tempers, their stubbornness, their loudness, their insistence, the pain they have endured.

When you're bipolar, your personality (or something) comes with a distinct set of faults. I am obsessive, angry, paranoid, high energy, hyper excited, furious, and delusional a few days about every month. For a few days each month I am sad, angry, have no noticeable sense of self worth, am clingy, and am sure that no one likes me. I can't blame this all on my illness. There are no doubt bipolar people more pleasant than I. But the consistent inconsistency, the cycles, are part of my disease, and they are confusing, scary, and difficult to those around me.

I live in constant fear of the people I love walking away. I live in constant fear that one day, that which was too much for me for several years will become too much for them. I live in constant fear that they will start to believe, as I sometimes do, that they can find someone to love who has all my good qualities and not this cyclic demon. And, I live in constant fear that these fears stem not from my illness, but from something core and dirty in my personality from which I can never escape. Not that that matters, as my illness in in fact something core and dirty that I cannot escape from.

I do not believe that people can love me for my illness, and that makes it exceedingly difficult to believe that anyone can love me at all. I believe that if someone is to love me, he will need to love me so much that he can somehow overlook this accident of biology, circumstance, and temperament. He will need to love me so much that I can express and share my volatile moods, my struggles with medication, my ambiguity about my past, present, and future. He will need to love me in spite of, and in spite of what: An elephant, a tiger, a poison.

Makes dating tough.

Disclosure

Recently, a colleague of mine decided to disclose her mental illness. Unlike me, she did so in an explosive and public fashion. I applaud the idea of disclosure in almost every context, and I understand intimately what a difficult decision and process it can be. However, her disclosure offends and deeply saddens me.

Which Like Two Spirits

In the past year, I've discovered two things that I think are passions in my life.

Just This

I thought long and hard about what to write about this, but there is very little that the video doesn't say. I wanted to quote a portion of it but I empathize and relate with almost every word. So don't read this. Read this.

Liar, Liar

Having bipolar disorder has made me a wonderful liar. There are so many little lies I tell every single day. What's that medicine? Oh, it's the end of a course of antibiotics. What doctor's appointment? This one's tricky - physical therapy is a great excuse. Why aren't you drinking tonight? Most recently, most poignantly: Why do you want to be a doctor?

$20 a Pill

Due to a variety of insurance adventures, I recently discovered that the cost of one of my mood stabilizing (and arguable life saving) medications without insurance is approximately $20/day. I'm not going to write a post about insurance companies or patent laws or Obama's health care plan because I don't think I have anything particularly new to say about them. I just want to say that $20/pill sucks.

Ironically, yet striking an all too familiar tone, the people who do have to pay these exorbitant prices are those who are especially unable to afford it. What if you don't have health insurance that covers name-brand drugs at an affordable price? What if you didn't realize you had a mental illness before a psychiatric emergency and don't have coverage at all? What if you're homeless, walked into an ER, and emerged with this prescription with no idea how to pay for it? What if you just made a bad decision about your insurance plan?

These are the what ifs that keep me up at night. They make me think about public health legislation and patent law. I don't have any answers and I don't even know if anyone is to blame here (I believe that free markets promote innovation and that we wouldn't have these drugs if someone couldn't charge $20 per pill, at least for awhile). I don't even know what the right questions are, but I hope people smarter than me are working on them because $20 a pill is too much. Especially when you depend on the pill keeps you alive, keeps you sane, and keeps you functional. Especially when you're already facing insurmountable challenges and this pill could help point you toward a halfway house, not prison, or a job, not poverty. Especially then.

Modern Love

Maybe this post is part 2 of 2 with my previous post, because it deals with similar subject. As I've thought about the pros and cons of sharing my stories, it's started to dawn upon me that they aren't my stories alone: they are our stories. I own my life and many things have happened exclusively to me, but many things have also happened, because of me, to other people.

Our Stories

Writing this blog has been a tremendous experience for me. I've found an outlet to process and express complex and evolving feelings and I've been touched beyond expression by the response from friends, colleagues, and strangers who emphathize and sympathize with the comments I post here.

As I've received positive feedback about my writing, I've started to think about other projects. There is a whole genre of topics that I can't write about in this forum, particularly related to relationships, that I could share in other formats: short stories, newspaper articles, maybe a book. Why not spend more time writing, both improving my craft and building something worth sharing more broadly? Last week, I remembered why not.

Meditation and Mania

Recently, I've been meditating on planes. The ~80 minute flight I've been taking is the perfect opportunity to enjoy a quiet, seated meditation and I've enjoyed having that time built into my day. Yesterday, I was experiencing some hypomanic symptoms while I tried to meditate and the results were quite interesting.