When folks ask me how I spent my summer, I respond straight up: "I was a mental patient." If they are not completely unnerved by my frank reply, I consider their nonchalance a challenge; after all, what's the fun of being crazy if you can't use it to get a rise out of people? I proceed to explain that, in keeping with the expected overachieving character of a William & Mary student, I could not content myself with an average loony bin. I had to have the best. While my peers held prestigious internships and traveled the globe, I served as a research subject on the biological psychiatry unit for affective disorders at the National Institutes of Health. Essentially, I was a guinea pig.
Like my friends' pursuits, my position required considerable experience and qualifications. Unfortunately, my psychiatric credentials are impeccable. I am among the estimated 20 million plus Americans with a mood disorder.1 Following a tumultuous first semester of my freshman year, I was diagnosed with unipolar disorder, a condition more commonly known as depression. I found every single day to be a taxing ordeal, since virtually every aspect of my life was marred by a struggle for sanity. Getting out of bed in the morning required an enormous amount of effort, and even though I clocked from nine to twelve hours a night, no matter how much I slept I was constantly exhausted. Besides being completely apathetic about my classes and the newness of college life, I was inexplicably sad. I recall spending hours at a time crying silently, letting the tears roll down my face. Occasionally I felt suicidal. When my friends would ask what was wrong, why I wanted to stop living, I had no answer. Perhaps worst of all, I could not will myself out of this state. Things I would typically enjoy, like an ice cream cone or a long walk with a friend, would only heighten my frustration, because I felt that I should be enjoying myself. I thought that if I tried hard enough, I could snap out of it.'
Individuals experience unipolar disorder differently, but the symptoms I have described (disrupted sleep patterns, fatigue, apathy, and a persistent sadness) are among those typical of a depressive episode. Although the disease is incredibly painful, it is mercifully treatable. I began seeing a psychiatrist over semester break. He prescribed an antidepressant, and within two weeks, I was feeling better than I had in more than a year. For the next eight months or so I was fortunate enough to be included among the 80 percent of patients who respond to medication and "achieve substantial relief"2 from it. Initially, the idea of using drugs to control my mood made me feel like a failure, but after experiencing such a dramatic change in my mental state, I slowly came to accept its necessity.
The medication worked so well, in fact, that it propelled me to a state of hypomania, thereby altering my initial diagnosis from unipolar disorder to bipolar disorder. Mania and its less extreme form, hypomania, are the absolute opposites of depression. Whereas a depressed person has a dearth of energy, a manic individual has excessive energy. During the second semester of my freshman year, I spoke quickly and constantly, and my thoughts were often random and jumbled. Thoughts came so rapidly that I felt pressured to get them out. I was unfailingly happy, exuberant, and energetic. Depression is when you can't stand yourself. Mania is when others can't stand you.
Unfortunately, this state did not last long enough. Just prior to the beginning of my sophomore year, my depressive symptoms began to recur. I slept more. I found myself crying for no reason. Nothing interested me. Thus began the trend in my disease that I have been dealing with ever since. My psychiatrist attempted to jump-start my mood by increasing my dosage of medication, but by two months into the semester my concentration had become so poor that I could no longer read more than a page or two at a time. I had already withdrawn from one class in an attempt to preserve my sanity. Even though I love to write, I was so depressed that drafting simple two or three page papers rendered me hysterical.
Being at school had become too much for me. The weekend of the Tercentenary
Homecoming Celebration, I awoke to the joyful sounds of the parade on Duke of
Gloucester Street. From my room in Brown I looked out into a sea of green and gold, of
smiling faces. Tears began to roll down my face as I desperately sought to understand
how these people could be so happy. I spent the day isolated from the merriment outside
my windows, sobbing uncontrollably. While my friends made plans to travel to Busch
Gardens for a day of frolic, I made plans to leave school indefinitely.
I spent three weeks at home trying to collect myself while changing my medication.
I returned to Williamsburg feeling a little better, but a few days later my mood
deteriorated. I found myself in a dark room explaining to two R.A.s that life wasn't worth
living. They subsequently enacted the suicide protocol, and by the next day, I had
medically withdrawn. I returned for the spring semester, although I had not greatly
improved. The series of med trials that began in 1993 continues through today. At last
count I had been on more than eight different drugs within a two year period, each
combination being only partially effective, if at all. It is because of this unusual resistance
to traditional treatment that I ended up at the National Institutes of Health this past
summer.
Last December my regular psychiatrist arranged a screening, an intensive interview. Few things are as odd as trying to convince a panel of health care professionals that you are ill enough for them to want you in their program. I never thought I'd be competing to persuade doctors that I was a really fascinating sick person. Obviously I did a decent job of it, because they called me a few days later to invite me for an all-expense paid, five day, four night stay in beautiful Bethesda, Maryland. I rounded out my break with a few days at the loony bin.
Those few days in January were kid's stuff compared to my summer; I spent six weeks as an inpatient, subjecting myself to a variety of painful and difficult procedures. Some mornings I woke up at 6 a.m. to the sound of the phlebotomist's voice telling me that he was about to stick a needle in my arm and collect 10 or so vials of blood from my impossible-to-find veins. Every day I took part in data collection so that they could keep records of my weight, temperature, pulse, and blood pressure. Twice a day I filled out a three page long survey designed to assess my physical and psychological symptoms. The questions are rather amusing the first fifteen to twenty times you answer them, as they inquire about the extent to which you are hearing voices that others don't hear and ask whether you are experiencing "unusual thoughts." That question was my special favorite, since I don't think a day in my life has passed when I have not experienced a multitude of unusual thoughts. Four times a day nurses administered cups full of identical pink mystery capsules. Since I was taking blinded medication, neither the nurses nor my immediate doctor knew the contents of these pills. I participated in a 72 hour urine collection. Every time I left the unit during those three days, I was carrying a container of piss on ice in a bowling bag.
Sometimes the experiments were a bit more glamorous than that. I had a spinal tap, or should I say, an attempted spinal tap. For some reason my spine was unwilling to cooperate. Imagine that: it objected to having a three foot long needle suck 1/3 of my cerebrospinal fluid out. The body is a strange thing.
Twice I had PET scans, a process of photographing the metabolic activity in the brain. This involved having my artery punctured, something I found rather entertaining considering they had been trying to keep me from slitting my own wrists for years. I then lay on a table for an hour with a tube in my arm and radioactive material in my brain while wearing a mask that would make Freddy Krueger look like the Easter Bunny. For a half an hour of that time I listened to three tones of varying volume, pressing a button whenever I heard the quietest one. It was like some sort of game show from hell.
These medical procedures may sound uncomfortable, but by far the hardest part of my summer was living in the hospital, being constantly reminded how sick I really am. I spent my time exploring D.C., visiting friends in Nova, reading to kids on the pediatric units at the hospital, and learning from the researchers at N.I.H. My days were often full, but I could not have survived without my peers. I was fortunate to be living in a community of amazing people, regular folks like me from all across the country and all different backgrounds who happen to be cursed with a wretched brain disease. They helped me adjust to the hospital and to approach acceptance of my illness. My fellow patients were some of the strongest people I have ever met, and I admire them for surviving, for resisting the obvious temptation to end their suffering. They are an inspiration to me.
Although my summer did not yield an immediate cure, I continue to work with the National Institutes of Health, and I try to remain hopeful that they will eventually find the exact chemical combination that my brain needs to function normally. Even if their research does not directly benefit me, it will undoubtedly help to relieve the suffering of another victim of this horrible disease.
This summer I came to R.A. training by way of N.I.H. That's right; ironically enough, I
am a second-year R.A. As such, I have actually participated in both sides of the suicide
protocol, and my experiences as a mental patient have equipped me to serve my
residents. Staying in college remains a daily challenge. Although my academics may have
suffered over the past few years, my education has flourished.