Why I Went to the Psychiatrist in the First Place

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25 July 1999

You can fool yourself on a lot of things. Even unintentionally.

For all the years since I was seventeen, I had mood swings that were damaging to me in every part of my life and it never occurred to me that there was a problem. Never. But that sort of luck does not last forever.

In October 1996, I lost the capability to cope. Or rather, I was doing so much that I couldn’t cope with it all. At the time I was the manager of the major downtown park in my city – a high maintenance, long hour, high stress job.

I was also the secretary of the Planning Society in my country; was instigator for setting up a web site for my old high school; was laying the groundwork to open my own company offering City Planning services; was helping rewrite the payroll software for the family business; and together with a close friend had just finished coordinating one of the largest celebrations ever held in my country of the Hindu festival of Divali.

I can do all this when I’m in my hyperactive (hypomanic, mildly manic) state. But my mood swings are fairly rapid. So for one week I would be hypomanic and really capable and efficient. Then the next week I would be depressed and accomplish very little. And then the mood swing cycle would start over.

For a while the amount of work I accomplished in the hypomanic parts of my mood cycle was able to compensate for the periods of depression in which I did very little. However, by October 1996 my depression episodes had become severe enough that I stopped going to work during them. So work and undone tasks started to pile up.

And then my depression episodes got really bad.

Sometime in November 1996 I disappeared for two weeks. No one could find me, not the people at work, not my friends, not my parents or my brother. No one. My parents thought I had been killed by car-thieves. When I eventually resurfaced, in apparently good order, my family was too happy to see me to ask many questions – none of which I could answer sensibly anyway. I was the prodigal son returned.

I took back up life as normal. The vast majority of the people either didn’t notice I was missing or thought I was just working so hard that I didn’t have time to go out with them. I was the manager at my workplace so no one questioned my disappearance. And incredibly, I didn’t think anything was wrong. It was as if there was this blind spot over my memory that prevented me from seeing what had happened and realising I needed help (I still have trouble remembering such episodes).

My parents persuaded me to see a psychiatrist, an old skinny man a generation or two before my time who asked me a few questions, explained in a perfunctory manner that depression could be alleviated by medication, and prescribed Paxil, an antidepressant. By the end of the session, I had decided that I did not like him, that I clearly could not be suffering from depression, and that this was a waste of my time. But I got the medicine anyway, took it for a week, and then stopped it when it seemed to have no effect.

Christmas 1996 was a miserable time. Everything limped along at work. Nothing went badly but none of the plans I had for making Christmas special took place. I knew things were not right in my life but I was unable to do anything about it. My life felt broken, as if pieces of my dreams and plans and work and social life just lay scattered on the floor with nothing holding them together and no connection between one piece and the others. All I felt I was doing was dealing with what seemed to be crisis after crisis.

I also felt as I if I was an observer of my own life, standing behind a piece of glass and watching myself stagger through daily life. I knew exactly what was wrong but I was unable to reach through the glass to get the me who was living to change habits or actions.

I remember Christmas being lustreless. I dutifully purchased Christmas presents, at the last moment, gave them out and received my presents in return. There was no joy, no fun in seeing my niece and nephew get their presents – indeed it was almost unbearable to be in the noisy house with my parents and brother’s family and I escaped as soon as it was polite.

In keeping with my fluctuating moods, between Christmas morning and the following afternoon I somehow arranged with my cousins to have an Old Year’s party at my house. I remember it as special because my grandmother attended and surprised all her grandchildren by dancing through the midnight hour and keeping up with the best of us until the party finished around 3:30 in the morning.

Within the first week in January my grandmother became gravely ill and about one month later she died peacefully and I think happily in her bed surrounded by her sons and daughters and clouds of her grandchildren and angels.

When you are bipolar, you are often asked what stressful events in your life might have triggered your mood swings. I suppose that it could be said that Christmas 1996 and January 1997 had quite enough happenings that could cause my mood swings. But while I certainly grieved for my grandmother, it never felt as if any of these circumstances were causing my mood swings. And I was already having a pretty difficult time before my grandmother died.

During January and February 1997, nothing changed to improve my overall situation. My alternating periods of depression and hypomania were causing my work and my life to get more and more out of control in spite of the best I could do. I was sane in the conventional sense in that if you had spoken to me you would have seen me (more often than not) as an intelligent person with a good grasp of the problems and conflicts in my life and with an excellent grasp on how I should be solving them.

The problem was that I just wasn’t solving my problems at all.

I did not see my problems as anything other than overwork and procrastination on my part. What was actually happening was that I made the standard mistake of seeing each symptom of being manic depressive as a separate problem and not seeing the larger picture in which all the symptoms were connected. I was applying patch after patch to each problem / symptom as it happened without realising that I needed to fix a much larger problem.

And because I was blind to the larger problem, I did not realise that the very nature of being manic depressive would inevitably cause my method of patching up each crisis to fail.

By the end of February 1997 I had reached a position where I was not being at all successful in clearing up my problems. I would gain some ground during my hypomanic week but then fall even further behind during my depression week.

I know what failing is like because I’ve often been there. But back in 1997 it had reached an extreme stage. All my projects at work or outside of work were failing. Not most. All.

In a way that was mostly ok. Problems can be fixed. What was intolerable was that I couldn’t fix them. My projects weren’t failing, I was. During my depression episodes I felt that I would never be of value to myself or anyone else ever again. In my hypomanic periods I would scramble feverishly and in vain to do something, anything, to shore up the things I was doing. And while I was doing this I was also standing on the sidelines watching in horror as everything that gave my life meaning lost familiarity, faded, failed, and became meaningless.

By March 1997 the depression episodes had become ascendant and began to last more than one week. I began go out with my friends less, and do everything less. My house began to look like a student’s apartment as dirty clothes and dishes piled up and books sprung up everywhere all covered with dust. My garden transformed itself into a small forest. I began to live on fast food and I put on quite a bit of weight. I began to think of my house as a haven, a cave to which I could retreat at the end of work and where I stayed until I was forced to go to work. On weekends I did not emerge until Monday morning, and then only very reluctantly.

And eventually I stopped going to work. It didn’t happen all at once, but rather I would reach to work later and later until finally a day would arrive when I didn’t make it in at all. And on the days I didn’t make it in I would disappear. Basically, I would roam around the country in my car without telling anyone where I was – anxious because I was doing something I considered wrong, but not being able to stop what I was doing or even think coherently about it.

It turns out this anxiety is an inherent symptom of my depression, but I did not know that at the time and just chalked up my disappearing as yet another personal failure. Cowardice was added to my list of character flaws.

This disappearing or not wanting to see or meet with people got stronger the worse in each successive depression episode. In a way this felt like a reasonable response – my disappearing was something very stupid, I had no answer for it, and I really did not know how to explain it to anyone. The same anxiety that made me it impossible for me to go to work and caused me to disappear made it difficult to return home on afternoons to face the answering machine, my parents, a concerned friend, anybody. Eventually I started leaving home at seven in the morning and returning after midnight just to avoid having to talk with anyone.

And finally, one day in May I just did not return for two weeks. I almost did not return at all.

I usually tell people I don’t know what I do when I disappear and then reassure them that I did not do anything stupid. The fact is that I can remember everything I do when I disappear, but it is an odd sort of memory. Even immediately after it happens, it feels as if it happened a long time ago. I remember it as if it was an old home movie faded with time and with tears and other imperfections in the scenes. It takes quite a bit of effort to pull what has happened to the forefront and answer any questions about the times when I disappear.

Also, I remember these memories suffused with anxiety or terror to a level that has to be experienced to be believed. My mental state was close to how we think about an animal’s awareness, without true conscious thought, just an instinct for food and comfort and sleep. During the periods I disappeared, I don’t think I really ever thought about anything at all, and my intelligence was just used to solve immediate instinctive problems of finding food, etc..

I don’t try to remember or explain any of these times to anyone. One does not describe the antechamber of the court of madness to anyone.

I reentered the real world two weeks after I disappeared, when I crashed my car at about four o’clock one morning. I had managed to skid off the road, jump clear over a ditch, miss a piece of iron that would have ripped out the underside of my car (and probably me), run over four saplings and stick the front of the car about four feet off the ground on a fifth. I came away completely unhurt.

Even then I was at the stage of walking away from the wreck and continuing my disappearance. Fortunately, or unfortunately, a good Samaritan had been driving behind me. To my great annoyance at that time, he insisted on helping me disentangle my car and then calling someone to help me. He may have saved my life because I have never been sure what would have happened if I had walked away from the wreck.

My father came to collect me.

In all the favours that my parents have ever given to me, I don’t think any have ever matched the one they bestowed in not questioning me about what had happened over the two weeks I had been missing. I suppose they had their ideas or their worries but they never tried to verify any. They just accepted me back and wrapped their wings around me to protect me from the next few weeks.

I tried to continue my work. But my depression was too profound. About ten days after my return and trying to do basic work in office, and not really succeeding, I handed in my resignation. And then I did nothing for many months.

Actually, shortly afterwards I started to see a therapist who had been recommended by a close friend. I was jobless and I knew that something was wrong that needed to be fixed. But I still didn’t feel anything important had happened. Like all previous memories, this last episode had very quickly faded into relative insignificance. So once the anxiety wore off and I felt less stressed, I started questioning the need to be in therapy.

I was not in denial. I simply did not see that there was a problem.

Nevertheless I enjoyed therapy very much. My therapist and I met twice a week and after the usual first sessions in which nothing productive happened (I was defensive and uncomfortable), I started to admit that perhaps I was having problems. Over the course of a few months I began to feel that I was getting somewhere. The therapy did make it easier to handle the changes in mood. However, the mood swings did not stop, and as I started back to take on additional projects in my hypomanic periods the stress started to build again.

I suspect that I would have given myself another breakdown and scared everyone again if I had not gone on vacation in November 1997.

My vacations are my relief valves. I go on them, visit friends and come back refreshed to take on the world. Only this time it did not work out. Instead of my usual energised self, I found myself unable to enjoy spending time with my friends or indeed unable to coordinate my sightseeing schedule. When my friends weren’t with me I was very close to being a zombie, unable to decide what to do or go visit. I was in Toronto, but I don’t think I saw or enjoyed much of it at all.

I had promised very close friends in Miami I would visit them after Toronto on the way home, but I was so apathetic and full of anxiety about talking with people that I was unable to make the simple call to tell them when I would be arriving. Needless to say they were both annoyed by my basic discourtesy and when I did arrive in Miami was told off by them both for it.

You can always say you gave up a job because it was too stressful. Or that your memory loss is “just one of those things.” Or that you and your lover broke up for real or stupid reasons. Or that things are sliding because you are overworked or tired. But I had a difficult time explaining to myself why I was treating friends I valued so much so cavalierly.

Changing one’s life doesn’t happen all at once; it happens piece by piece. Nevertheless, if there was a single point I would point to and say – “There, that was when I admitted I was ill” – it was at the realisation that I could lose real friends if I didn’t fix myself.

When I returned to Trinidad, I asked my therapist to recommend a psychiatrist so I could be prescribed antidepressants. Four months before I would never had considered this, but the time spent in therapy had acclimated me to the concept. I still didn’t think I suffered from depression or manic depression, but I did think I needed something to tide me through.

The psychiatrist spent far less time in diagnosis than I expected. I was asked questions about myself, which I could readily answer since I had discussed most of them in therapy already. I was given a list of questions about mania and depression to answer, which showed clearly I was both, but not to any severe degree. What was also abundantly clear was that I moved from one state to the other quite rapidly. And in what I thought was an extraordinarily short period of time I was diagnosed as Bipolar II, possibly Cyclothymic.

I have never been satisfied with that initial diagnosis, even though it has been borne out as true. I have always felt that if I was going to be told that I was going to be crazy for the rest of my life it should certainly take more than one hour. And it should certainly be a more, well, technical process than chatting pleasantly with a very nice guy. I don’t think I have ever forgiven him for my diagnosis, and it probably was the major factor in eventually changing to another psychiatrist. Bearers of bad news often do get executed.

And so I started taking medication. The next pages are the experiences with those.

Next: Chapter 2: Taking Medication for the First Time
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