Misdiagnosed

“Fucking, fucking, fucking, fucking.”

With each swear, the scissor blade hit my arms, but the pain never surfaced. I was already in too much pain for it to matter.

“Fucking, fucking, fucking, fucking.”

I cursed myself, cursed my family, cursed the world, and cursed the scissors for not hurting enough. But I decided not to die.

“Thaaaat’s e…e…e…enough.”

I ran back to the freezer for another swig of vodka, left over from a party we’d had at our suite weeks earlier. I wanted a respite, to dwell in those lively college times with my close friends, but by now I was a prisoner of each brain cell, fragments of painful reality holding the innumerable keys. And I was bleeding steadily from both arms.

My friends would be back at any moment, and they couldn’t see this. I quickly threw on a sweatshirt and sat in my room, tremors running through me intermittently like a broken metronome.

A few minutes later, I heard the front door open and they walked in. Then there was a knock at my door.

“Hey Ad, you in there?”

I could barely talk, but I let them in anyway. They could tell right away there was something horribly wrong, especially since I couldn’t speak. Every time they spoke, I began to repeat what they were saying back to them. It was a reflex, an involuntary response. I couldn’t initiate, only mimic. They took me to the hospital right away.

At the hospital, my friends did what they could to explain the situation. They still had no idea my arms had been sliced into like bar lemons, the juices still absorbing into the sleeves of my thick hoody and drying up. The attending nurse said the hospital would probably keep me overnight, and she proceeded to do a patient intake. She gave me a sedative and had me sleep through the night on a bed resembling an operating table. I didn’t dream that night. As for nightmares, well, I was used to having those awake.

By the winter of 2004, my parents’ tumultuous divorce had been raging on for over four years. Despite initial promises that everything would be amicable, the opposite reigned true. We’d had to leave our house, and the lawsuits were constant. Throughout my life, my father had always been verbally and emotionally abusive. As the oldest of four, it became my job to protect everyone.

Not long after my sisters and I spoke with a law guardian (appointed in custody situations to protect the interests of minor children), my father was allowed to have supervised visitations. At fourteen, I had already decided not to see him anymore, following a tirade that culminated in him insulting me, my other family members, and telling me about a cocaine addiction he had battled for nearly a year when my then four-year-old sister was an infant.

He was furious about the court decision and he decided to procure a new lawyer, an older woman known for her mordant tongue and ruthless legal tactics. He initiated another lawsuit, during which time my sisters and I were required to visit a forensic psychologist he hired as an expert for upcoming legal proceedings. Dr. Pepper was an abrasive older man who spent the long group session trying to impress upon us that our feelings about our father were unsubstantiated and wrong, probably the result of confusion and our mother’s influence.

At fifteen I tried to reconcile with my father, and while he did apologize for some of his actions, he continued to argue “his side of the story.” But the reconciliation did not last. The night I came out to him, I was seventeen and looking for a father’s understanding. Instead, I got the next shock of my life when he, in turn, came out to me. At what I thought was my coming out to him, my father confessed to me that he too experienced desire for men and that he had engaged in several experiences with other married men during his marriage to my mother. These were well-kept secrets during their divorce, when any admission of adultery (or drugs) might have threatened his legal combat. He asked me not to say anything to my mother, as there were still legal proceedings to come, and he would prefer if I didn’t rock the boat. In my hopes to protect my mother and sisters from further pain and keep any semblance of a relationship with my father, I kept the secret for over a year. But following yet another painful episode when I overheard him insulting me and other family members, I decided to call it quits again.

Despite the events of the previous night, the hospital was ready to release me the next day. No therapy, no delving, nothing but an emergency sedative. My mother’s fiancé at the time was an LCSW and, considering what had happened, he feared that I was not ready to leave. I agreed, fearing another possibly dangerous episode. With my permission, he convinced them to admit me for a longer stay. At least this way, we figured, I would have time to recover in a safe environment where I could be monitored and, more importantly, discuss the issues that had led to the situation at hand with professionals.

But, as I quickly learned, no one was interested in talking to me. No one felt the need to understand my situation or me. As a hospital, their interest was in diagnosis. If I weren’t ill, why would I be there? If the hospital didn’t diagnose me, there would be no proof for the insurance company that I was, in fact, in need of medical assistance. There was no such diagnosis as “Circumstantial Depression” or “Family-related Trauma,” and for very good reason. Such diagnoses would most likely carry burdens of uncertainty and extensive behavioral therapy. Most importantly, this type of diagnosis would not necessarily lead to the essential, moneymaking ruse of American psychological culture: Medication.

According to the DSM, any person who suffers an episode of “mania” should be given the diagnosis of Bipolar Disorder. The previous night, I had lost my ability to speak coherently, had several shots of Vodka, and turned my arms into cutting boards. Apparently, that qualified as a “Manic Episode.” And now that I could be properly diagnosed as Bipolar, I could be properly cured by pills. Lithium pills.

I am lucky to have been born in 1985, only twelve years after the American Psychiatric Association finally decided to take Homosexuality off its list of treatable mental illnesses. I had only come out as homosexual a year and a half earlier. Had this been twenty years earlier, I would have been given an even stronger set of pills to swallow.

I sat with one of the psychiatrists in a small back room lit by fluorescent office lights. I was desperate for a way to get it all out, to somehow explain the pain of the past few years and receive validation that, at nineteen-years-old, I had been through a kind of hell that would drive any person to at least one manic episode.

He lifted up a bright green pamphlet with a rudimentary drawing of a person in two positions: smiling and high as a kite, then dull and low as death. Weaving around the two moods was a roller coaster track. For the sake of integrity, I can only recall the gist of our discussion, not the actual words. After all, I didn’t realize I would have to revisit this story so often later on.

“You see this, Adam,” he said. “Most people can keep their emotions to a normal set of peaks and valleys, a roller coaster that would be a thrill ride to the average person. But as a person with Bipolar Disorder, you experience the roller coaster much more strongly than the average rider.”

Where was the high? I wondered. If I have to feel so damn sad all the time, can I at least get some tips on how to get myself to my manic state more often? I sure could have used it.

So I asked, “But I don’t really get those highs. I mean, I’m really depressed, but there’s so much going on right now with my family.”

“That makes sense. There are many contributing factors. Most people get diagnosed as Bipolar around college-age. But you had a manic episode last night, and you will again if you stop taking your medication.”

I was not truly convinced, but I wanted to believe him. I said, “Well what if I don’t need to be on the medication? How do I know for sure?”

“You’ll continue to discuss all that with whatever psychiatrist you go to back home. But whatever you do, do not stop taking your medication. I say this from experience. My wife is Bipolar, and she has thought she could stop taking her medication too. And I’m telling you, if you don’t stay on your medication, you’ll end up right back in the hospital again. Or worse.”

What did I know about being mentally ill? Here was a doctor trying to help me; who was I to disobey? I merely listened to the doctor tell me who I was after about a half-hour of speaking to me. It was a relief, too. Now that I knew I was mentally ill and could take pills to cure it, my life would be much improved, I thought. How wonderful.

The adult psychiatric unit of the hospital did not turn out to be a place I felt safe. Like most patients, I was given a roommate during my stay. Mine was Harold, a bald man nearing sixty who wore heavy glasses. His soft, intense demeanor made me recall those childhood warnings about strangers offering you candy to get into their cars. But since all I wanted was a break, I made sure to be very friendly and willing to talk. A part of me appreciated the distraction of talking to Harold, whose personal problems could keep my focus away from my own.

Within a day or two, Harold revealed that he was in the hospital after overdosing on sleeping pills to commit suicide. He seemed glad to be alive after all, but the pain in his eyes was unmistakable. Our conversations were pleasant, and I shared with him my own reasons for ending up in this “loony bin.” Harold appreciated the distraction of my stories as much as I did his, until I realized I was having a much deeper effect on him than I thought.

Around the third day of our friendship, I felt conflicted about how to approach Harold’s confessions to me. I enjoyed playing therapist because it meant staving away my own pain and gratifying myself for helping such a troubled man. Then came the clincher.

Harold had grown up in a rural part of Pennsylvania with his conservative parents and an older brother. When Harold was still a child of seven or eight, his brother was experiencing the pains of puberty. But instead of seeking help for his sexual confusion, Harold’s brother began acting sexually towards him. It was not gentle or loving, nor was it mutual; it was aggressive. Before long, when Harold tried to ward off his brother’s advances, his brother became violent and raped him. Harold became a prisoner of his own childhood home and was systematically raped by his brother for several years, up until the time his brother finally left home as a teenager.

As uncomfortable as it was for me to hear the traumatic memories of his childhood, Harold had yet another important detail to confess. Throughout his entire adult life and marriage, he told me, he had never confided this secret to anyone — not his wife, not his parents, not his doctors. His brother was now married to a woman and had his own children, and he and Harold were still in touch. Harold had his own wife, children, and now grandchildren, but the horrific secret plagued him like an emotional cancer for which he felt there could be no treatment but death.

Here I was, in the psychiatric wing of a hospital recovering from my own traumas, and I was facing indirect trauma through my roommate’s confidence in me. I knew it was not my place to share his secrets with anyone at the hospital. I also felt I had no right to force Harold to confide in anyone else if he didn’t feel ready.

That evening after dinner, I lay in bed struggling to fall asleep as usual. But as I finally began to drift toward sleep, I was awoken by a figure walking past my bed: Harold. I kept still, thinking he had gotten up to use the bathroom. He did go into the bathroom, but I felt uneasy and decided to keep myself awake until I knew he was back in bed.

After a while in the bathroom, I heard Harold come out and walk towards his own bed, which was on the far side of the room. But before he got to his own bed, he stopped in the middle of the room between my bed and his. I was still pretending to be asleep, my eyelids allowing only enough space for me to see his figure now standing above my bed. For several minutes he stood watching me, as if trapped by some raging inner conflict. I felt my pulse quicken, but I didn’t believe Harold wanted to hurt me. Finally, he moved closer to my bed and stood directly over me.

I decided to prepare myself in case he tried something drastic. He was not a muscular man, but he could easily jump on top of me or suffocate me. But rather than make a swift move, I noticed Harold’s hand begin to reach out at me. I wondered if maybe he was projecting himself on me, looking to caress my face as if it were his own, comforting the inner child that had suffered so deeply. His hand was not, however, heading toward my face. I could tell his thoughts were irrational as his hand drew close to the lower half of my body. Methodically, before his hand reached my comforter, I quickly threw myself over to my other side, making a noise I hoped would sound like disturbed sleep. Once over, I subtly peered over and saw Harold recoil and get into bed.

Did I really belong in this hospital amidst people like Harold? Like Risa, a girl who often spent the night screaming out the spelling of her name for hours on end: “ARRRRRR-AHYYYYYY-ESSSSSSS-AAAAAY! ARRRRRR-AHYYYYYY-ESSSSSSS-AAAAAY!” Like Kathy, a middle-aged woman with several missing teeth who begged everyone around to watch her practice handstands down the corridors all day? Or was I merely a male case of “Girl, Interrupted?”

I decided to leave my room quietly and made my way to the central area of the floor, the Nurse’s Station. The attending nurse looked at me confused. I was not the type of patient the staff expected to be awake at all hours.

“What do you need?” she asked.

“To sleep somewhere else. Maybe just tonight, but definitely for tonight.”

“Well, we don’t have another room available right now. What’s the problem?”

“I’m Harold’s roommate, and we’ve gotten close as far as talking about our problems and all. But he’s gotten a bit too close to me I think. And he kind of, well, he kind of tried to molest me.”

The nurse listened, but seemed unfazed.

“Well did he actually touch you or do anything physical?”

“No, he thought I was asleep and when I saw his hand reach out to touch me, I turned over to throw him off. Then he went to bed.”

“Well that’s good,” she reassured, then paused. “If you’re okay not having a bed for the rest of the night, I can have you stay in the Rec Room on the couch. I can’t promise you’ll be able to stay there every night, but it’s fine for tonight,” she explained.

“Yes, that’s great!” I exclaimed in a whisper. “Thank you.”

The Recreation Room was pleasant enough, and aside from a couch it offered the most important element: solitude. The relief of being alone was potent enough to grant me sleep within minutes. But it was short-lived, as I was awoken at 6am to a nurse tapping at my shoulder.

“Gotta take your vitals,” she said, wrapping a blood pressure monitor around my arm. Moments later, she stuck a needle into my arm to draw blood. I had forgotten that I began my Lithium the day before.

At breakfast a couple of hours later, I was surprised not to see Harold. He was usually a fixture there by the time it started. I decided to visit my room and check on Harold. Despite the night’s events, I still did not feel he was malicious or dangerous, just a troubled man in tremendous pain. I noticed he was still in bed as I entered, his comforter engulfing his entire body. Then I looked over at my bed and saw a white sheet of paper.

ADAM, I’M SO SORRY ABOUT LAST NIGHT.
YOU ARE SUCH A WONDERFUL PERSON
AND NOW I’VE DESTROYED YOUR TRUST IN ME.
I HOPE YOU CAN FIND IT IN YOUR HEART
TO FORGIVE ME. I NEVER WANTED TO HURT
YOU. I HOPE YOU CAN UNDERSTAND AND WE
CAN STILL BE FRIENDS.
– HAROLD

I took the letter and placed it back on my bed, unsure if I wanted Harold to know I’d read it. By lunchtime, Harold still had not come out of bed. I overheard a couple staff members discussing it, confused at the withdrawn behavior atypical of this gentle bald man. I was conflicted about how to handle the situation, but I knew I had to make a choice for my own conscience to remain clear.

I finished my lunch and re-entered our room to find Harold still in the same position on his bed, covered by his white comforter like a polar bear in the snow. It was time to get Harold out of emotional hibernation as best as I could.

I tapped on him through the comforter. He stirred awake quickly and put on his glasses, but when he realized who it was, his eyes widened and he threw his face back into the comforter. I could tell he was still playing out the scene as would an eight-year-old. But, knowing the greater part of him was a fifty-eight-year-old, I knew I could get through to him.

“Harold,” I asserted, “it’s okay. Really, I’m okay and everything’s fine. Thanks for the letter. I don’t hate you or anything like that. It’s okay.”

His face came away from his pillow just enough to mouth, “I’m sorry.” He was so ashamed he could barely speak.

“I forgive you,” I reassured. “It’s okay. But, I do need you to promise me something.”

“What?” he replied unsteadily.

“I need you to promise that you’re finally going to tell somebody about everything. Somebody who can help you in a way I can’t.”

“Thank you, Adam,” he answered. “You’re right.”

Two days later I left the hospital and never saw Harold again. I hope he found a path back toward peace.

My psych ward days behind me, I still had an indeterminate road ahead. I had to return to my college and take a formal leave of absence for the semester. For now, my life would be about healing, accepting my diagnosis, and accepting myself as mentally ill.

Once we got back to my family’s house in New York, the next step was to decide which course of therapy to take. There were only a few psychiatrists in our area who also practiced therapy and we made an appointment with one for the following week. It seemed ironic to me that medication always seemed to take precedence over therapy, as if the “cure” were more important than the “symptoms.” But despite not feeling any better or worse on the Lithium pills I’d now been taking for several weeks, the hospital made me understand the essential truths I was facing: I am Bipolar. I need medication.

My mother’s friend recommended a psychiatrist who was known for an integrative approach, utilizing both therapy and medication equally. Upon meeting with Dr. Cott, I was comfortable with his easygoing approach to my treatment. He suggested that unless I was experiencing negative side effects, it would be better to stay on the medication I was already taking as we talked more about my issues in therapy. He did also mention, however, that Lithium was not always a beneficial option long-term because of its potential to damage the kidneys and liver.

Over the next few weeks, this thought reverberated constantly in my medicated mind. Either these pills are necessary and I’ll go right back to the hospital if I stop using them, or I’m potentially damaging my internal organs for nothing. It was a catch-22, and I needed to do something about it. I decided it was an absolute imperative for me to try living without the pills. Around this time, I also learned that I had the opportunity to study abroad in London during my next semester at college. All it would take was a clean bill of health and a short application process, along with my mother’s blessing.

Over the next couple of weeks I completely stopped taking my pills, and not one family member or friend even noticed. If anything about my medication came up in general, I went along as though I were still under their influence. About two months later, with the deadline for my study-abroad program approaching, I dropped the bomb on my mother that I had in fact, dropped the balm entirely.

She was taken aback at first, but as I fully explained my reasoning, that nothing was any different, and that no one could even tell, she understood. She admitted to noticing nothing different about me at all. We scheduled an appointment with Dr. Cott right away.

A few days later, I sat in Dr. Cott’s office with mom, who hadn’t told him the current circumstances. I started by telling him that I was looking to study in London during my next semester, which would begin in less than two months. He said it wasn’t out of the question and that we would see how I was progressing. Then I said, “Well, I’ve decided that if I get in, I’m going no matter what.” He seemed okay with that, but cautious. Then I went on.

“I also wanted to let you know… I stopped taking the Lithium. Two months ago. And no one noticed.”

He seemed perplexed.

“Well, that’s not a very good idea, Adam. You don’t know how that might affect you later on.”

“It’s been two months,” I explained. “I felt no different on them, and now I feel no different off them. None of my family members noticed anything. My mom didn’t know at all.”

Mom chimed in, “That’s true. If he feels okay without them, maybe we can just continue to see how he does?”

Dr. Cott looked worried. Over the past few months, he had made some effort to understand me during therapy. He even downgraded my condition to “Mixed Bipolar in Partial Remission,” a diagnosis that still made no sense to me at all despite his explanations. It sounded as if I were going through some robotic, biochemical cancer that had arbitrarily fled once I felt less stressed. But not taking pills? That was as good as disregarding my illness entirely.

“Even if Adam weren’t thinking of going across the ocean for an entire semester, I would say it would be safer to continue the pills. We could always switch him to something else that would make more sense. But since he’s planning to go London in only a short time, something that would be tough even for a kid not going through all of this, I would definitely not recommend stopping the medication.”

And then my mother interjected the kind of wisdom for which a child can be forever grateful.

“How about you prescribe him a round of the Lithium, and when he gets to London, if he feels like he needs them, he’ll start taking them again. I really feel that Adam knows himself well, and I think it’s important to trust him. I trust that if he needs them, he’ll take them.”

Despite Dr. Cott’s continued warnings, he followed my mother’s request.

I went on to have the most exciting, positive time of my life, studying theatre and enjoying all that London had to offer. I finished my semester there with a grade point average of 4.0, something my advisor back at my college said was rare for any student. The pills stayed shut away, as did any further symptoms of Bipolar Disorder I may have expressed.

To this day, nearly ten years later, neither has resurfaced. I have done my best to reconcile with my father, who continues to have difficulty in showing remorse for the poor choices that wreaked havoc on our family and my mind. He remains trapped in blaming others, including me, for his choices, and has never sought true forgiveness because he believes his actions were somehow justifiable. It continues to be a case of, “I’m sorry you feel that way.”

While I have continued to work on my personal and family issues from the past, I now recognize that there is an important distinction to be made between circumstantial stressors and mental illness. Despite how blurry the line may seem, it is understanding that brings ultimate healing, not simply medication. Medication is a piece of understanding, in capsule form.