296.41

Sitting in that uncomfortably squishy chair in September, I so desperately wanted to be told that whatever was happening to me was—although perhaps not normal—not unheard of. I wanted to be told that I had some kind of well-defined condition with a proper scientific name and a standard, highly successful clinical treatment.

“I get really excited about the ideas I have, and sometimes I feel so inspired by conversations with other people that I genuinely think whatever conclusions we’ve come to will somehow save the world. But those days—when I feel happy and motivated—are buffered by days when I'm fully convinced that nothing is worth anything, when 12 or 14 hours of sleep aren't enough to get me out of bed. And yea, I know everybody has mood swings, and fluctuations between feeling happy and sad are normal. But this feels really different, even from the kinds of mood swings I've had before. I sometimes hear strange things when I’m trying to fall asleep or even just when I’m really tired during the day, and I guess, to be completely honest, I'm afraid I'm going crazy."

He listened to what I had to say, and asked some follow-up questions about the relationship between alcohol and caffeine and my racing thoughts at night, whether I still liked my ideas after my mood had shifted back down, and whether anything still felt important when my depression made the rest seem worthless.

He looked down at his notebook and then back at his computer screen, which displayed a list of psychiatric disorders and their corresponding numerical codes.

"Okay, Alex. So I'm going to diagnose you with Bipolar I Disorder—296.41. The medication I have in mind is a standard mood-stabilizer that works quite well. It's called lithium. And if it’s fine with you, we're going to start you off with a low dose this afternoon."

I remember sitting on my porch one night with my laptop open, about a week after starting the medication, intending to write something about the junction at which I found myself: somewhere between four consecutive terms at Dartmouth and two upcoming months in an isolated Guatemalan village.

At that point, my grandfather had already been taking lithium for twenty years, and based on time spent with him and conversations we’d shared, I knew that it had the potential to change the way I thought, felt, and acted. While a genetic predisposition was comforting in many ways, knowledge of it gave me a sense of urgency. I was afraid that by taking the medication, I would be handing over the keys to my life to some chemical compound, and I wanted to leave myself a back door code by which I could, if necessary, reclaim autonomy. With my flight leaving in two days, I wanted to secure my thoughts in some permanent way.

But I couldn’t write. I couldn’t think. When a thought came to me as a candidate for typed words, any further reflection made it seem utterly stupid. I lost my ability to see big metaphors in small things, and  my journalistic endeavor was hopeless. I closed my laptop, walked inside, and fell asleep on the couch with my shoes on. Something ugly and invisible had beaten me. I was losing.

For the next few months, my mood—although “stabilized”—was fixed at a level of unpleasant but functional depression. I never felt as depressed as I had during the worst days that led me to get help in the first place, but I never really felt happy, either. I woke up almost every day feeling tired and unmotivated. Beyond that, I developed anxiety that I hadn't had since I was a small child.

The real anxiety began in early December. While visiting my girlfriend in Minnesota, we went to see a compilation of award-winning advertisements. I was enjoying myself until an anti-cyber bullying public service announcement played, which followed a young girl over time as her peers bullied her. Throughout the advertisement, a noose hung above the girl’s head, nearing her neck with each scene. The 60-second segment finally ended with the girl’s feet suspended several inches above the ground.

Normally, something like that would only unsettle me.  But from then on, I couldn’t get the girl out of my head. Loud noises during the following advertisements made me nervously look around the theater, and I began to furiously bite my lip. My legs were shaking. On the way home, I declined my girlfriend’s offer to drive. I sat in the passenger’s seat, fists clenched, staring out the windshield.

The parts about myself that I liked most began to change. I never felt inspired to write, became irritated by others for things that never would have bothered me before, and stopped caring about other people the way I used to. Over Christmas, my younger brother and sister—twins and seniors in high school—wanted me to help edit their college application essays. Because of the personal content in the essays, they wanted me, rather than my parents, to read them. While I normally enjoy helping them in any way I can, especially with writing, I couldn’t bring myself to do it. It’s not that I consciously didn’t care about them or thought their applications were unimportant, but I couldn’t make myself care enough to get out of bed.

The depression and mild psychotic symptoms that had brought to me see a psychiatrist in the first place only got worse with the lithium. Of course, many other factors were at play: the contrast between the constant social contact of sophomore summer and my subsequent four months away from almost all my friends; the shorter daylight hours of the winter, which had always taken their toll on me.

But the medication definitely didn't help.

I hoped that coming back to campus would snap me out of it, that taking classes and spending time with friends in a familiar place would somehow return me to my old self, but it didn't. I spent almost no time at my fraternity, and would often avoid eye contact with people I liked and knew well because I thought that smiling and exchanging How’s it going‘s would be disingenuous.

One afternoon, a few weeks into the term, my father and I spoke on the phone for almost an hour. I was feeling particularly down that day, and he could tell. Although I don’t specifically remember what I said to worry him so much, he called my psychiatrist later that night. The next morning, I received a voicemail from the doctor, who had decided to increase the dosages of the two medications I was on and to add two more to my daily regimen.

At that point, I felt myself falling into a deeper hole out of which I worried I’d never really pull myself, and decided that something else had to change before the pills did. I told him that I didn't want to take four medications to alter the way I felt, and he agreed to keep my original dosages and add only one new medication to be taken pro re nata.

A couple of weeks passed, and I still felt like someone else, someone whose moderate feelings and lack of ambitions ran completely counter to the person I'd always thought myself to be.

Nature had always been good to me, and I thought that if I could just muster the energy to walk through the woods for an hour or two, I’d leave mentally cleansed. So I took a long, slow walk through Pine Park to think and relax by myself. Since my freshman year, I’d run the same trail through those woods—from the medical school parking lot back around to Occom Pond—countless times, and returned to campus refreshed after each and every one of them. When all else had failed, standing beneath tall trees and breathing crisp air had given me a sense of grounding and protection.

But for the first time, I left the woods angry. Something about nature not making me feel better made me actively upset. I returned to my room feeling like I’d been cheated out of something to which I was entitled, adamantly concluding that nature’s psychological effect on me was more valuable than the medications. I was sick of listening to everyone else's advice on how to feel stable, how to feel “better,” sick of never getting excited about ideas or by the realization that I'm part of something really, really big — sick of feeling nothing.

Without telling my psychiatrist right away, I weaned myself off the lithium. Two days after cutting my dose down to a "non-therapeutic" level, I woke up to the sound of my alarm as usual, but the world had completely changed. There was no dark cloud above me, no numbness, no irritability, no penetrating feelings of nervousness. I woke up feeling like myself: the way I'd always been for the first 20 years of my life, and the way I'd always known how to be.

During each of the following days, several people went out of their ways to tell me that I seemed different. Seemed better. It wasn’t just some subtle change in the way I felt, but a drastic and obvious change in the way I interacted with the world. My girlfriend noticed, too, and although she never mentioned the opposite while I was still taking the lithium, she made it clear after the fact.

It honestly feels like you just came back to life. I see you like this and realize that’s how you always used to be. You seriously weren’t you until now.

I still feel depressed sometimes, and occasionally feel like I’m under the influence of some kind of weird, dissociative drug while completely sober. And although I don’t feel anxious without reason, I still worry: that I'm not smart enough to get into medical school, that bad things will happen to the people I care about, and that I'm fundamentally wasting my time on the path I've chosen so far in life.

But that’s all fine.

I think we often worry that the way we feel is somehow abnormal. We feel strange things at strange times and assume that something is wrong with us. But it now seems to me that we feel strange things at strange times simply because the world is a fantastically strange place. Of course we worry that our feelings are abnormal, because we've never been able to get inside someone else's head. But I think the more important reason is that "normal" isn't a feeling at all.

What's happened to me may not reflect the experiences of others in similar situations. If you feel like you really need psychiatric medication, get it. I'm glad I went through the process, even if only to realize that it was leading me somewhere I didn’t want to go.

But now I think back to that initial conversation in my psychiatrist's office with an almost entirely opposite perspective. Although I like the one medication I'm still taking, I know there's no magic pill, no one-size-fits-all solution, because there’s not even a one-size-fits-most problem. The narrow terms used to define many psychiatric conditions miss the point by failing to consider the wide, natural variety of human minds.

This isn’t some happy ending to the past six months of my life, and to be honest, I think part of the reason why I'm writing now is to give myself a sense of closure that I haven't yet earned. I still occasionally have to convince myself that feeling down is better than feeling like a different person. I’m still taking one medication. I’m still adjusting.

But even though I haven’t quite won yet, that ugly and invisible thing is no longer beating me.