BEFORE
Following diagnosis of bipolar I, subsequent medication management, and behavioral therapy, Patient has stopped using cocaine. She is paid to make coffee. She is paid to sell bad Italian food. She stops seeing the world vibrate.
Patient claims she has matured (is no longer a reckless, feral girl-child, bent on obliteration of the self) and suggests she might stop taking her sleeping medication. When she does not take her pill at the same time every night, she experiences a feeling similar to opiate withdrawal. We eliminate the medication.
Sleeping pill elimination successful. Average time Patient lies awake each night starting at the Absolut Vodka ads taped to her studio walls: 75 minutes.
Patient requests a decrease in her mood stabilizer. She is even less feral now and has enrolled in one community college course (Introduction to Mass Media Communications). She says, Maybe I am not, in fact, ill. The ends of all her sentences curve upward into questions. We reduce her medication with a warning: Bipolar I is a lifetime diagnosis, though we concede that perhaps Patient could do with a smaller dosage.
Second opinions are legitimate requests, but Patient feels guilt (like she is being unfaithful). We know anyway; we see everything. The appointment’s results are inconclusive. We provide no answers, but instead ask rhetorical questions and smile like a cat with a dish of milk. Our bookshelves are full of texts as thick as her palm is wide. Patient is uneasy and returns to us in our original form. She accepts the original diagnosis and subsequent course of treatment.
First dosage decrease is unremarkable. We asked Patient to disclose her medication changes to two people who will monitor her behavior (bipolar I patients cannot be trusted are notoriously resistant to taking medication), and both they and the Patient agree she has remained stable thus far. We are surprised. We decrease the dosage again.
Patient’s boyfriend, one of the checks she has put in place, suggests she stop fiddling with her medication and claims Patient is acting differently. He says Patient is irritable; she snaps where before she smiled. Privately, Patient knows her upturned mouth is directed elsewhere—she smiles too broadly at a tall coworker who is more convenient than handsome, whom she brushes past while carrying so many glasses on a small, circular tray. Dutiful, Patient tells us, and we tweak her dosage back up.
FIVE YEARS PASS
Patient moves out-of-state. Before leaving, she is discharged from our care and told she can now see a general practitioner for her monthly bottle of pills. We are all smiles. Patient is all smiles. Patient is now no longer a patient. Her illness is well-managed.
Living in a house on an acre of land with wild corn growing in the yard, Patient enrolls in graduate school. She becomes increasingly distressed, exhausted, and restless and despondent by turns. Distorted perceptions and erratic moods reoccur. Patient worries, quietly, that these are warning signs of a return to the psych ward. The worries build and culminate in what should be a minor, forgettable incident—a bicycle helmet clipped too tightly under her chin—that instead triggers what Patient's friends describe as a flashback (Patient herself denies this word choice). Wanting to preserve agency and autonomy, Patient makes an appointment at a local counseling center, not for medication management, but for talk therapy.
Patient turns twenty-five and her wonderful, previously omnipresent health insurance coughs a warning death-rattle. Patient feels—she doesn’t know what she feels. She wonders, as she did five years earlier, if she needs her medication. She asks her therapist, whom she likes very much, for a referral back to us, just to see. This is insincere; Patient knows what she wants but she also knows to stop cold turkey a medication she’s been taking for seven years is straight-up stupid. Patient is referred back into our care.
Patient does not like us in in our new form. Our office is obscenely large, the furniture made of studded leather that at this point Patient is certain comes standard-issue with every private practice. Even greater than Patient’s dislike of us is Patient’s dislike of her own medical history. She hates how it sounds coming out of her mouth: Yes, but—. Her defenses are weak against our volley of questions: Hospitalized for a psychiatric disturbance? History of drug abuse? Self-harm/suicidal ideation? Multiple sexual partners? Disordered eating? Are you sleeping? How are your moods? Your energy levels? Patient couches her answers in graduate school—everyone is tired, eats poorly, etc. We sit with one pantyhosed leg crossed over the over and ask Patient if she wants to decrease her bipolar medication, even though we both know it is the reason Patient came in. It is a rhetorical question, a lead in to our claim: It seems to us that Patient isn’t even stable now. Patient smiles. She is learning the value of her dimpled cheeks. Patient is polite. Patient speaks calmly, says, she’s curious and she’s in therapy and leans upon her therapist’s praises for us. Patient is patient. We write her a new prescription, eking down the dosage.
Patient tells us, when asked how the new dosage is working, that things are good. A thought intercedes: Individuals with bipolar mania sometimes stop taking their medication. So Patient hedges, is more truthful, mentions the disturbances at the initial decrease, calls it irritation rather than hatred. We are surprised by what she reports. We expected something more dramatic. Patient smiles. We write Patient another prescription.
In the middle of baking a loaf of lemon poppy seed bread—the speckled batter still in the bowl, not yet in the tin— Patient slumps to the floor. More despair.
Patient calls her friend in the middle of the night. He answers with a normal Hello? though this isn’t a normal phone call. Patient is kneeling on the floor of her living room. She sobs, keeps sobbing. Her friend asks what is wrong; he is concerned, maybe even frightened, because she moves through the daylight with bravado and swagger, all extroversion and arrogance, a new, hard rage keeps her upright like a concrete support beam. Patient says, I can’t, keeps repeating the phrase. She is hiccuping now. Can’t what? her friend asks. Patient is bent in half—her face is pressed into her knees so hard that afterward there will be marks on her cheeks and forehead, like pillow lines. Her sobs continue, the repetition continues. Eventually, Patient manages two more words, though no more information: I just fucking can’t. Her friend cannot fix what she is feeling, and she knows it, maybe even knew it before she called. Her brain is recalibrating.
Patient sleepwalks through the mornings and afternoons, until nighttime when she feels energized, an inverse morning-glory or sunflower.
Patient tells her therapist what is happening, and she tells her therapist she is going to lie to us about it. Patient doesn’t trust us. Patient looks at her therapist, earnest, seeking permission to lie. Patient is afraid. The withdrawal is hell but if she were to stop now then—what? With every passing day, despite her weeping, Patient suspects more and more she is not really sick in the way we’d told her she is.
During her third visit to us, Patient smiles and reiterates everything is fine. We say it’s as if Patient and this woman (we gesture to Patient’s file, a manila folder containing her medical history) are two completely different people. Patient nods, smiles some more. It’s as if, Patient reiterates. She is a small bird now, and she sees an open window. She takes the new script in her mouth, flies through it.
For Halloween, Patient dresses like Alex from Stanley Kubrik’s A Clockwork Orange, minus the codpiece. At a party, she worries she is drinking spiked punch and cannot shake the idea. It grows, sucks up into her lungs like vines, takes away her breath.
Patient splits her pills in half, as we instructed. She uses her fingers, breaks the chalky white along the scored line. It is a familiar motion.
A levee springs a slow leak. Maybe twice a week, Patient throws up her dinner. Maybe less. Maybe more.
Mood stabilizer is (successfully?) eliminated. Patient has split the last pill, taken the final half. She goes to bed for the first time in seven years without any amount of this medication in her system. It is the first time in ten years she has gone to bed without any amount of any medication. Patient feels like she is forgetting something. Patient asks her therapist if she was misdiagnosed. Her therapist doesn’t say misdiagnosed. Her therapist says instead she doesn’t think Patient has bipolar disorder.
AFTER
Patient remains wary.
What might Patient do now that she knows she is living without mental illness? Misdiagnosed. The word feels funny inside her mouth.
As Patient prepares to move across the country (again), her anxiety redoubles. It arrives in the form of obsessive thoughts. They are often related to her car. Patient drives down potholed Indiana highways convinced her tires are losing air, about to burst. Patient pulls over needlessly, sometimes multiple times in one trip, to check for leaks. She hears a story about a woman who was fucked up for years after stopping her antidepressants.
Patient’s therapist gives her a clean bill of health.
Self-pity is not a likable or admirable trait. Patient wants to say she does not feel sorry for herself and mean it. Patient spent so much time ashamed of a sickness that wasn’t real that now she swings in the opposite direction, showing everyone her insides tacked out like an animal on the dissection table. See here? This is the liver. The small intestines. The lungs.
The new phase of thinking is forced dichotomies: either Patient had bipolar disorder or Patient acted like such a selfish asshole that everyone (including us) believed she must have a mental illness.
Patient’s anxieties follow her to an ashram. Her car becomes a flammable trap made of metal, the other visitors are carriers of pathogens. She fears sudden, inexplicable death—freak accidents. Patient does not throw up, but wants to. She sneaks off the property late at night to smoke the cigarettes she swore off.
Lyme disease. Brain cancer. Blown Tire. HIV. Drunkenness. West Nile. Blown Tire. Lung cancer. MS. They are tiresome in their redundancies.
In her new city, Patient returns to us. For once, our office has no leather chairs. The windows are opaque with condensation and prickly caterpillars carpet the sidewalks. We ask about Patient’s medical history, and Patient says she was misdiagnosed bipolar, took the meds for seven years, stopped taking them eight months prior. We suck our teeth, look perturbed. The Patient cannot tell which of her anxiety is situational and which is pathological. She asks for medication—not the good stuff, not the benzos, but something she could take every day. We write a prescription.
The new pills make Patient nauseated. She is too sick and too tired to be anxious. She cannot orgasm. Her sleep schedule reverses: She naps during the day, falls asleep immediately at night, wakes every few hours until morning.
SSRI is ineffective eliminated. During her follow-up appointment, Patient says I don’t think this is supposed to happen. Patient describes her side effects. We ask why she didn’t stop taking the pills sooner. Patient shrugs, says she thought it would get better. When we ask if Patient wants to try a different medication, Patient refuses, though not unkindly. She offers us a gummy cherry from a bag in her lap. We demur, saying we cannot take food from patients. Patient smiles because she is no longer our patient, and says so. We take the candy.
Patient has moved from dichotomy to plurality—each actor (Patient, all our manifestations, Patient’s family and friends) affected by their own ideas from books, from television, from science, from music, from who-knows-where, of what mental illness is and does and how nice girls from good families are supposed to behave. Factored thusly, it’s incalculable, the equation.
At a conference in Portugal, Patient is just now comfortable enough to breathe the word misdiagnosis in the open Atlantic air. She reads an essay aloud that features her trip to the psych ward. A woman she knows, but not well, comes up to her afterward, while they are freezing on a cobblestoned plaza overlooking a beautiful skyline, and says that the same thing happened to her brother. He was so much better off the meds. Patient doesn’t smile yet, but she nods and nods and nods.
"Withdrawal" is an excerpt from Alysia Sawchyn's debut essay collection, A Fish Growing Lungs, forthcoming in June 2020. Preorder now from Burrow Press.