A TOUGH PILL TO SWALLOW

May is Mental Health Awareness Month. Part of shedding stigma involves talking and writing about our experiences. In this post, I discuss my ongoing resistance to medication as a means of treating my bipolar diagnosis.

I suppose it was foreboding that, during the summer after my first year of law school, I landed an internship with a non-profit called Mental Health Advocacy, just off skid row in downtown Los Angeles. On my first day, a client walked in and wanted to speak to an attorney about filing a lawsuit against whoever was misappropriating his image everywhere in public. He claimed to be the guy in the WALK signal at traffic lights. It would have been funny, but the guy wasn’t joking. He was agitated, incensed even. A coworker quietly leaned over to me and said, “Ronnie’s off his meds again.”

So funny was actually sad. During my stint with the agency, I heard many sad stories and a lot of them—but certainly not all—had a common theme. Things got messy whenever a client decided to go off medication.

I didn’t get it. I knew I wasn’t supposed to be judgmental but privately I did an awful lot of head shaking. Just take your meds! A pill a day, maybe a handful. Before or after a meal. Or after every meal. What was the big deal?

That was three decades ago—1990—when I was twenty-five and thought I knew everything. Okay, not quite. I didn’t have a cure for AIDS, I didn’t know how to serve and volley like Stefan Edberg and I didn’t have a clue why Jon Bon Jovi’s “Blaze of Glory” was a number one hit. (No, I’m not adding a link for the song. You’re on your own with that.)

As mental health has established permanent residence in my life, the medication issue has become far more complex. Muddled even. I frustrate healthcare professionals. I make their lives difficult. I’m one of the resistors. I hate meds.

Some of it may be rooted in childhood. While I reported daily tummy aches in kindergarten—we didn’t know much about anxiety a half century ago—I was an incredibly healthy child. Nothing to report other than a case of the chicken pox that I don’t remember and the occasional fever that would make me think the chair in my bedroom had mutated into a murderous monster. Piddly stuff. My mom was trained as a nurse and my dad was a doctor. I never ever went to a doctor’s office or a hospital. If I complained of an ache or a pain, my parents would pull out a thermometer and maybe let me lie down with a water bottle. But days marched on. I was the kid who got a perfect attendance certificate at the year-end school assembly. Every year.

In the ’70s, the main thing people talked about for staying healthy was Vitamin C. My parents went through phases when they’d make my brother, sister and me take a vitamin pill each morning. I always made it an ordeal. “Can’t I just have an orange? Isn’t that more natural?”

My parents held a united front. “Just. Take. Your. Vitamin.” I’d shrivel up my nose as I stared down at an approximation of a Flintstone character in the palm of my hand and then I’d put it in my mouth and swallow. No, not exactly. A bunch of water would go down the wrong way and I’d have a coughing fit, the vitamin still hanging out under my tongue. I’d try again. And again. I’d conjure up contorted facial expressions to convey the notion that I was being tortured but my mother would turn to the sink and my father would bury his head in the sports pages. Eventually, the chalky, half-dissolved mess would go down and I’d be left to face my now soggy, cheerless Cherrios.

“Tim Goodwin’s mom let’s him eat Froot Loops,” I’d say. Cue newspaper rattling and increased volume on AM radio station.

There was a period in my twenties when I could have veered into pill-popping territory. I was playing a lot of tennis and experiencing sidelining back pain. Hello, Advil. Hey, Motrin. Somewhere I’d heard something about long-term liver damage and I would give the handful of pills—usually twice the recommended dosage—the evil eye before swallowing them. Luckily my back pain went away and the lone bottle of pain relief currently under my bathroom sink has an expiration date from five years ago. Nasty habit averted.

Six years ago, I had my first ever hospital stay. Psych ward, involuntary admission. I’ve mentioned it in many previous posts. After twenty-four hours in lockup, I was ready to leave, but that wasn’t my decision. I learned to follow the rules—not a natural thing for me—and fake fine. A psychiatrist prescribed an antidepressant and I obligingly took it whenever a nurse showed up with two little paper cups: one with the pill, one with water.

On the night I got my freedom back, I drove to my local drugstore to fill the prescription and was mortified when the pharmacist on duty was the parent of a student who utterly adored me. She’d read my children’s novel and wanted to be a writer, too. He saw the hospital identification on the prescription pad, looked at the drug name and startled me by saying, “It must have been really difficult.” How much did he know? Was there some sort of code for “suicidal” scrawled on the paper? In my tiny community, I was a pillar; now I was damaged goods. I’d heard the compassion—no, pity—in his voice. I turned red, broke into a body shellacking sweat and hid in the toilet paper aisle for twenty minutes until my order was ready for pickup.

The medication interfered with any attempt to sleep and, at home, there weren’t nurses hanging out at three in the morning peddling blue tablets that offered a Fast Pass to dreamland. After a few days, I took myself off my meds. I was still emotionally frail, existing with zero sense of purpose, but rejecting pills felt like a teeny tiny victory. If I were going to carry on, I’d have to find the will and the resources on my own.

For the next two and a half years, I dutifully attended weekly therapy sessions, two different psychiatrists pushing pills to no avail. Even when I finally assented to give meds another try, the twice daily ritual met with a resistance not much more nuanced than my childhood vitamin protests. At best, I’d tell myself, “This is temporary.” Surely I’d pick up tangible, effective coping skills through psychotherapy, by attending peer-led mood disorder groups, while flipping through much buzzed about books on mindfulness and dialectical behavior therapy and from participating in a series of eating disorder interventions.

Dammit, nothing stuck. I’m mental health Teflon. Insert asterisk here.

Asterisk explanation: The meds kinda sorta sometimes worked. Things might have even been better if I remembered to take them every day. Maybe I’d be fine if I didn’t secretly go cold turkey off them a couple of times with disastrous results. Maybe I’d get to a point of happiness—instead of just being functional—if I didn’t keep demanding that psychiatrists change up the drugs and refusing to allow them to up the dosages. Maybe all that My Body empowerment is just self-destructive nonsense.

I can’t count how many times a medical professional has given me the diabetes speech. (They always unpack it like they wrote it from scratch while I do my best to appear curious and not roll my eyes.) “If you had diabetes and had to take insulin for the rest of your life, you’d take it wouldn’t you?”

I don’t have diabetes.

Diabetes is a not a mental health condition. Give me strategies, not dependency.

“What you’ve got is biochemical...” they’d say next. Whatever that is. “You can’t just rely on coping tools.”

Whenever the duel looks like it’ll end in a draw, I pull out my trump card. “I don’t like the side effects.” Sleep disturbances, grogginess, dizziness, flatness of affect. These concerns are real. With my current medication, I can’t skip a day. No pill means no sleep. Zippo. Midday naps are a thing of the past. I’m one hundred percent dependent on Seroquel if I want any shot at rest. The dreams are surreal and/or vividly annoying when they’re not wake-up-screaming nightmares. This supposedly beats the six months I “lived” as a walking zombie on my previous meds—I completely lost my laugh.

My Body...

If needed, I vaguely refer to possible long-term damage. There’s a page and a half of fine print that comes with each new medication. If I read it, I’d be so freaked out the entire contents of the bottle would instantly get flushed down the toilet. My Body...

When all this COVID-19 focus quiets down, I’m due to visit my family doctor. If I’m staying in this city and not moving, I need a referral for a new psychiatrist. (My last session with my current psychiatrist—the first in three months—was a phone call that lasted three minutes, sixteen seconds. Has he given up on anything but meds?) I need to try a different medication. It means another period of trial and error regarding the dosage and new side effects to navigate.

I now have much more empathy for Pedestrian-Walk-Symbol guy. I see my own likeness in him, if not the traffic sign. I get the appeal of going off medication. In my mental health social circles over the past six years, I’ve watch many stare down at their kneecaps as someone else in the room complains about a new med—what is does, what it doesn’t do. I’ve heard others speak with pride and determination about no longer taking medication. The struggles remain to some degree but I recognize the sense of control and autonomy that persons with mental health challenges desire. We all have our issues.

It’s four and a half hours until I’m due to pop my evening pill. I’ll do it. No scrunching up my nose, no gagging. Still, I’m holding out hope that one day antidepressants and mood stabilizers won’t be necessary and that healthy food, exercise, travel and an ability to ride out the lows will be enough.

BREAKING AWAY

May is Mental Health Awareness Month. Part of shedding stigma involves talking and writing about our experiences. In this post, I reach far, far back—well, to yesterday—to offer an illustration of how one aspect of my eating disorder and my struggles with depression play out.

More than once, my eating disorder has saved me. I know the psychiatrists, nurses, dietitians and occupational therapists who have worked with me don’t want me saying that. They’d shake their heads and mutter something about how I’m not ready for treatment. Yes, they’re right about me not being ready, but that doesn’t negate the fact my eating disorder has been a life saver.

It should come as no surprise that many people with eating disorders have concurrent mental health diagnoses, like anxiety, depression and obsessive-compulsive disorder. As someone who is bipolar II (basically that means my bouts of mania aren’t as extreme as a person who is bipolar I), my depression is a frequent visitor. (Alas, the mania doesn’t come as often. Things are GREAT when I’m manic. Until I come down from it, in one sudden crash.) I’ve come to know many people who experience depression, especially from attending a mood disorders group where people talked openly about their struggles. Through this, I’ve learned that the way I navigate through depression is atypical. And that’s because of the eating disorder.

Many people going through depression are lethargic. Hours, even days pass, shuffling from bed to sofa and back again. Sometimes there’s binge watching, but without any sense of pleasure. Letting Netflix roll into a next episode of a seven-season show is easier than lifting the clicker and pressing the power button off. Some people talk about being too tired to eat but more often what I hear is that they’re too tired to cook. A family size bag of Doritos becomes lunch, a tub of ice cream dinner. Weight gain becomes a byproduct of depression.

To be sure, I’ve had gone through prolonged periods of listlessness but they are rare. Part of my eating disorder is a compulsion to overexercise. This feeling is more urgent than anything I’m feeling—or not feeling—due to depression.

I only have to dig back to yesterday for an example. My day started off rather normal, but by afternoon, I sensed I was off. Before I knew it, I was seriously down. No reason. That’s the frustrating thing that can distinguish clinical depression from normal depression. If someone gets laid off or goes through a breakup, feeling depressed makes sense. It’s part of the process of dealing with loss: denial, anger, bargaining, depression, acceptance. I’m generally a taskmaster. Give me a problem and, after a fair bit of procrastination, I deal with it. It’s harder to snap out of depression when you can’t identify a reason for it.

By 4:30 in the afternoon, I was ready to surrender to the blues. I flopped on my bed, closed my eyes and thought, Good one, Depression. You surprised me again. You win. I became critical of my writing, my relationship, my decision-making—why the hell did I rent a place smack in the middle of a cacophony of construction booms and blasts? A nap would be nice, albeit impossible. Eyes still closed, I saw myself walking into traffic and jumping from the roof of a building. This I’ve termed “safe suicidal ideation.” I don’t have the guts to go through a violent death and I don’t want others to witness such a thing. Safe then, but dark.

And then I opened my eyes and sprang from the bed. I had to get changed and stretch before a three-hour bike ride. Eating disorder trumps depression. The mattress would still be here when I returned. And so I headed off. For the first twenty minutes of the ride, I was irritable. A side effect of COVID-19 has been that more people have sifted through their garages and hauled out bikes. My route was too crowded with too many curves that made me have to wait too long to make my passes. Everything was too much.

I pedaled on. I knew I’d soon break from the path and take the lesser-cycled roadway and eventually I’d be heading up the long climb to the University of British Columbia where many a casual rider would turn back. A guy on a fancy-schmancy road bike passed me and suddenly I had a new focus. Keep up with him. Don’t use your twenty-seven-year old squeaky eighteen-speed bike as an excuse for him to break away.

I did keep up. There were a couple of points where I could have passed him, but I didn’t. I knew he’d leave me in the dust when we reached the hill. Sure enough, my gears got fussy and I couldn’t get in the right groove on the ascent. I passed more riders but his jersey got away from me.

The good thing was that I’d shaken off depression and irritation. I felt content pushing my fitness level. I was appreciating the leafy coverage from century-old trees. I was in the moment, watching in case one of the cars parallel parked by the road might suddenly pull out, failing to see me in the side mirror (if they looked at all). By golly, a survival instinct had kicked in!

I passed a peloton of riders taking a break in a parking lot. Matching jerseys, more fancy bikes. I picked up my pace, but I knew they’d overtake me at some point up ahead. Bring it on!

Sure enough they passed me, but I implored my legs to work harder. I kept with the two “stragglers” and, in time, passed them as I had more power than them on the hills. At fifty-five, I was decades older. Cue imaginary fist pump.

Depressed people aren’t known to do a lot of fist bumps, imaginary or otherwise.

Seventy minutes into my ride, I dialed it back a bit, switching over to a shared pedestrian/cyclist greenway, deciding I didn’t want to be that guy who takes out a toddler on a tricycle. I explored new routes making my way east across the city. I stopped by the lovely blue heritage house built in 1904 that I used to own with an ex, before snapping pics in Mountain View Cemetery—research for one of my writing projects. I zigzagged along streets of a bike route I hadn’t taken in fifteen years, not since the ex and I sold that house. I dismounted and walked along a winding dirt path in a park that is but a sliver at the end of one block, a place I’d searched for to no avail last summer when I was putting together an article about Vancouver’s lesser known parks. I felt vindicated. I hadn’t imagined this spot after all! Once I reached the border for Burnaby, I turned back around, bumbling my way through detours due to pop-up construction zones. I cut through a path along Trout Lake and passed a few clusters of skateboarders in the slowly developing South Flats district before finding my way back to the seawall and reaching home.

If that’s a lot of detail about a single bike ride, it’s intentional. There was plenty to fill my mind along with a few adrenaline rushes. Sometimes the exercise is but a reprieve from depression. Nothing conquered, but a welcome distraction. Other times, like last night, it comes early enough in a depression cycle that the deeper malaise fails to take root. Last night, I felt satisfied and, yes, a little exhausted. It was a good kind of tiredness, body moving, mind in the moment, three hours away from my bed and the mindlessness of scrolling internet feeds with too much snarky political commentary and snippets of unsolicited porn.

This time I did it. I dodged depression. Hats off to exercise. Thank you, eating disorder. I’m still trying to learn effective strategies, still taking medications that I feel offer more side effects than solutions. For now I’m just grateful something works.

SHAKEN, NOT STIRRED

A cynical, somewhat crass ex of mine once said, “The first three months of dating are a bubble. You actually think his shit doesn’t stink.” I would have couched it in terms like “rose-colored glasses” and scored my inner thoughts to the tune “’S Wonderful,” but we were always a po-tay-to, po-tah-to couple. Enough about him. These days, it’s Daniel and me. Three months has passed; the bubble, if there ever was one, has burst. Best behavior gives way to reality. To be sure, I haven’t been my best self this week.

According to Wikipedia, May is National Bike Month, National Smile Month and National Guide Dog Month. (I always wonder what nation they’re referring to...Belarus? Botswana? Saint Vincent and the Grenadines?) As much as I like biking, smiling and any and all dogs, the most relevant designation for May is Mental Health Awareness Month. There’s a whole lot wrapped up in that for me.

I went through the first forty-nine years of life being “normal”. I worked—hard—and followed my parents’ playbook for whenever I felt “off”: Suck it up. I did everything I could to fit in. All those years of being a closeted gay and being “openly” gay with several asterisks proved good training ground. I became a master at hiding what society perceived as flaws. But maybe I wasn’t as much a master as I thought I was. Way back in law school, while at a social mixer at a Malibu bar, I recall a guy I was chatting with interrupting what I thought was a flowing conversation, a distinct air of annoyance in his voice as he said, “You know, you have a lot of quirks.”

Now the quirks have labels. They came in rapid succession shortly before my fiftieth birthday as a traumatic event triggered intense suicidal ideation and led to lock-up in a psych ward when I sought help. The act was intended to be protective, but it felt punitive. That’s what you get for sharing. The entire experience was scarring, but as a parting gift, I had my first label: major depressive disorder. That got tweaked to bipolar II while social anxiety and eating disorder, anorexia, filled out the portfolio. Last year, the insurance company overseeing my long-term leave of absence threw in its own term for good measure: totally disabled.

Surely all that would make my online dating profile stand out.

As I’ve mentioned before, Daniel knows all of this. True, it all came out during that shit-doesn’t-stink period, but that trimester is also known to be laden with mines, marked with red flags. Every week, it seemed, I was waving a new red flag. Daniel—poor, sweet Daniel—stayed.

Still, it’s one thing to stick around as the labels are shared; it’s quite another when the actual actions associated with the labels start to show.

Three months is a long time to be on one’s best behavior. The cracks started to show about a week ago. I could feel a flatness coming on, a state I was in for many months spanning 2018-2019. At the time, I attributed it to the cocktail of drugs I’d been prescribed to deal with me being bipolar: one to keep me from going too low, one to prevent me from going too high and an all-around “mood stabilizer” thrown in for good measure. Through persistent pleading, I got my daily pill popping down to two medications, then one, before I went off everything without telling doctors, leading to disastrous results. Sometimes we have to learn the hard way. I need meds, even if, as now, it’s just a single drug taken nightly at the lowest possible dosage.

Before this latest bout of flatness surfaced, I’d been having more dizziness when I got up from the sofa—little bouts of indoor surfing. My dreams also became increasingly vivid and surreal. Sometimes they were entertaining, but more often they were annoying and/or disturbing and/or exhausting. These are symptoms I’ve had in the past with certain medications but it seemed strange to have them arise anew with a pill I’d taken for six months without side effects.

As I ate dinner with Daniel and he excitedly shared the triumphs of his day, I struggled to sound supportive. I felt like I was following a response stream from a textbook. It didn’t seem genuine. I shared with him my flatness. He hadn’t noticed that I was off. Yes, all those years of masking things can make me almost pass as normal, particularly in the early going, but I needed Daniel to know what I was feeling...or not feeling. I also knew that, if the flatness stuck around, it would become more pronounced, and any attempt to mask would be futile.

After a bad sleep on the weekend—ahem, someone snores—I was even more off as we met some of his friends for a socially distanced gathering outside a coffee spot that’s stayed open for takeout throughout COVID-19. This morning social event is essential for Daniel while, even when I’m at my best, I find them painful. (Hello, social anxiety.) Once we parked, Daniel looked at me as I couldn’t get out of the vehicle. After several false starts, I stepped out and took my spot in line as Daniel joined the circle congregated outside and got a jump on his social fix. I prayed the line would move sloooowly. When I found my place in what had become an ever expanding human oval on the sidewalk, I did my best to laugh in the right places, to smile, to nod and to pepper the conversation with socially acceptable interjections (“Really?” “That’s amazing!” “Yeah...that Trump.”). Whenever it felt safe, I’d look pleadingly in Daniel’s eyes—Can we go? Please?! The longer we stayed, the more inept I felt. His friends would surely schedule an intervention. “Really, Daniel. What do you see in that guy?”

“They really like you,” Daniel has said many times. I think it helps that Daniel’s ex proved himself to be an epic schmuck as their twenty-five year relationship imploded.

Another bad night’s sleep followed, this time on my own. A nightmare had me bolt upright, shouting, tears flowing, at 4:30 in the morning. I moved to the sofa in the living room, afraid to fall back asleep while unsuccessfully trying to dismiss the traumas my dream had triggered—my first hospitalization, a deep unworthiness, a conviction that I didn’t deserve to still be alive six years on. It would have been a complete write-off of a day but for the fact I had a research deadline I needed to meet. A busy mind is a great distraction. Until it isn’t. I met my deadline and held on the next day with some writing tasks and a six-mile walk with a dear friend who has had her own struggles with an eating disorder and mood disorders. I felt relief. I called Daniel and asked to join him for coffee the next morning with his friends.

But then I forgot to take my medication, only remembering as I sat in bed at midnight, still wide awake. It bothers me greatly that I now require my medication if I’m to have any chance of sleep.

A late pill means a day of grogginess will follow. Sure enough, when my alarm sounded, I was in a fog...and a funk. I forced myself to shower, dress and pick up Daniel to head to the cafe. I could barely speak. Pulling up and seeing a cluster of somewhat familiar faces gathered on the sidewalk, I felt overly critical and cranky. Don’t they have anything else to do? I bet their wives kick them out every morning. Why are they all so old? I assumed my spot in the line and eyed a Rottweiler tied to a parking meter. After I paid, I figured I would be able to spend my time with the dog, a socially acceptable way not to be social. Alas, the dog barked at me and bared its teeth. The owner, two in front of me in line, turned and gave me a similar look. Where were all the golden labs and cockapoos?

I handed Daniel his coffee and then pretended to look at something important on my phone. Eventually, Daniel came back over to see what was going on. “I just need to sit in my car,” I said. “Take your time and chat. I’m good.” He gave me a quizzical look and I captioned it in my mind as, What is wrong with you? It wasn’t just the prospect of social conversation that seemed painful. Keeping my eyes open was painful. Thinking about writing was painful. Everything was.

I held things together enough to drop Daniel off at his personal training session in a local park—gyms remain closed—and then went home to crash. Straight to bed. Pillow over head. Go away, world (and all those booming construction sounds from buildings going up all around me). An hour later, still doing a bang-on zombie impression, I moved to the couch, draping a blanket over me, back to the window, scrolling Twitter where hot guys with perfect hair whined about needing a haircut—a ruse to get several hundred ego-boosting comments and thousands of likes—and people argued back and forth about whether it’s okay to say anything positive about Adele’s weight loss. Mindlessness can be soul-crushing.

Daniel texted to check in with me. “Can I call you?”

I responded, perhaps too honestly, “Not right now, thanks. It’s too difficult to think.”

He asked if he could call me after work at 8:30. I couldn’t respond. I just needed everything to go away—Twitter, the construction din, even Daniel. I paged through the novel I’m currently reading, with the cheery title They Both Die at the End, baked a pumpkin pie and then ran for an hour and a half. Exercise is a great aid for depression while feeding my eating disorder. I made it through an hour of a movie on Netflix, shut my phone off and turned in for the night.

This morning I looked at my phone—Do any of us look out our window to take in the day before reaching for that bloody device? No messages from Daniel. As I got up and made coffee, I felt normal. Ish. That happens. Sometimes when I can’t bat away depression, I give into it, hang on and ride it out. I texted a good morning message to Daniel, reassured him that I was feeling better and shifted the focus to him. Uncharacteristically, it took a while before he responded. Twenty minutes, maybe. In that time, I told myself he was gone. Finally, he could smell the shit. Time to shut the door.

He exchanged a few texts and then he wrote, “Can I see you tonight after work?”

A gentleman, I told myself. He’s breaking up in person. No one wants to be with someone as messed up as me...totally disabled, in fact.

Nice ride. Time to unfasten the seat belt and walk away.

I took his Facetime call at lunch. There he was smiling broadly, sharing about his day and the details from yesterday that he was bursting to tell me. I got giggly, finding amusement in some random comment he made and he patiently let me work through it, not really understanding my humor but maybe the old me was back. He floated some weekend ideas and then, three minutes after the call ended, sent a link for an animal refuge along with the message, “We should go here when it opens back up.”

Yes, poor, sweet Daniel. Thinking about tonight, this weekend and possibly weeks into our future. I’d given him a glimpse of my darker side and the silly fool wasn’t to be scared off. Not yet, at least.