Note: This is a serial blog. To start at the beginning, click on Chapter 1 – The Meltdown under “Categories” and start at the bottom.
Reflecting back on the Meltdown year is always difficult for me. Most of the time I don’t let myself think about it. After all, it has been twelve years. However, writing this book has forced me to transport myself back to that time. As a result I’ve had to re-experience the grief that I felt. Prior to working on this book, I had managed to tuck away my feelings about everything that happened that year, except for a small grieving period every year around the anniversary of the Meltdown. Aside from this, I haven’t let myself dwell on that period of my life (or I would be in a perpetual state of depression). Since we began working on the book, though, I’ve had to consider the overwhelming losses I suffered in 2003 and the utter hopelessness I felt at that time. The crisis during that year led to emotional, occupational, financial, and social devastation for me. I was suddenly facing a new reality, one which I had never imagined myself living.
I had to attempt to integrate the fact that I had a serious and chronic mental illness, not simply the depression I had suffered at times. In my mind there was a huge difference between depression and chronic mental illness. Depression had become more socially acceptable by 2003. I had several friends who had experienced depression and were taking antidepressants as a result. We could talk openly about seeing therapists, and even joked about it with each other. Being chronically mentally ill was a whole different story, though.
At that time my experience with people who had serious mental illnesses resulted mainly from my work as a group facilitator for adults at a community mental health center. The clients were predominantly diagnosed with schizophrenia and bipolar disorder. Most of them lived in group homes and did not have jobs, instead collecting Social Security Disability benefits due to an inability to sustain employment. I observed the attitude of people in the community toward these clients first hand, when the group met at the library. People stared and moved away from them, as many of the clients had poor hygiene or were overtly responding to auditory hallucinations. Although I was sympathetic to my clients and their experiences, I did not identify myself as one of them. Not in any way. They were the people that others either made fun of or felt sorry for. I was one of the people who helped them. In 2003 my vision of what it meant to be seriously mentally ill was forever changed, as I tried to grasp what it meant to be “one of them.”
I also had to accept taking an antipsychotic medication for the first time. This was an issue because I didn’t want any association with anything that had the word “psychotic” attached to it. In my experience with the clients in group therapy, those who had been prescribed antipsychotic medications for a long time sometimes had side effects such as tardive dyskinesia, which causes involuntary muscle movements. They often gained weight or had other side effects, and I was afraid I would experience these things too. But mostly, taking antipsychotic medication put me too close to that category where I didn’t want to be. That category where people were laughed at or pitied, or both.
Being a patient in a psychiatric hospital, which I never considered as a possibility prior to my Meltdown, and having ECTs with the enormous stigma attached to them, were further blows to my identity as I had known it. It was very difficult to acknowledge these events as part of “me.” I was familiar with being on the other side of the mental illness divide, as a helper and a professional. I wasn’t even remotely ready to accept being on the side of the stigmatized patient. It terrified me.
I had to face the possibility that I might be unable to return to my job as a case manager at the facility where I had worked successfully for over four years. This completely impacted my social network, as much of my social life revolved around my job. There was uncertainty as to whether I could return to work as a case manager at any facility. Although I stayed focused on returning to my previous life, deep down I didn’t know if I would ever again be able to work in mental health in any capacity. Losing my job and being uncertain about my ability to return to work in the mental health field crushed my identity, which centered around my life as a respected mental health professional. My self-esteem and confidence were shot.
Filing for bankruptcy and applying for long-term disability were further blows to my self-image. More importantly, though, my independence was threatened. I had to face the possibility that I would no longer be able to afford to live on my own. I was in my mid-thirties and I certainly did not want to return to living with my parents. I had moved home ten years earlier after quitting a job (soon after the meltdown that led to my first appointment with Sharon). After that, I had lived with roommates or alone in my own apartment. It would have felt like an enormous step backward if I was forced to go back home to live, assuming my parents would have allowed me to move in. I also, obviously, had Epiphany to consider as my parents had a dog. I was still depressed, and having to try to grasp all of the ramifications of my newly diagnosed bipolar illness was completely overwhelming.
When I finally got stabilized and back to “feeling like myself” again, this meant my thoughts weren’t going a million miles a minute, I wasn’t obsessing about suicide, and my depression and anxiety symptoms felt manageable. I wasn’t cured, but I finally felt like I was back to my baseline of stability. However, I was still completely uncertain about my future ability to work, to support myself, and to live independently. That year, 2003, ended with my reality being completely different compared to when it started. I was less depressed and felt more stable, but my life was in ruins.
Aside from grieving the losses that resulted from my Meltdown, as I reflect on that year I’m very surprised I did not actually kill myself. My surprise is due to the fact that I was so focused on suicide most of the time. I was completely obsessed with taking my life and spent hours on the internet, painstakingly researching methods that would allow me to do so successfully. Also, despite Sharon’s efforts to get me to abstain, I drank alcohol frequently during that year. I drank in order to numb myself and get some form of relief from the painful depression I felt. But the combination of obsessive suicidal thoughts and drinking alcohol, when my impulse control was also being affected by my bipolar symptoms, was a potent recipe for disaster. I have no idea why I did not, in a weak moment, just do it. In my more coherent moments I knew I didn’t want to hurt people or put Epiphany in a bad situation. But I had plenty of moments where I wasn’t coherent and wanted very badly to be dead. I guess I was lucky, or something bigger than me was operating. I have no idea why I survived.
When I reflect back I feel enormous gratitude for my treatment team, especially Sharon. Her extraordinary efforts, going way above what is expected of a therapist, are a large part of the reason I am alive. I was very lucky to have treatment providers who worked well together to provide my care. Sharon and Dr. Greene were a cohesive team. If I went into the hospital, Sharon was able work with me and Dr. Greene remained my treating physician. There were no gaps in communication. This is not the case in many communities, especially not now after many changes have taken place in the funding of health care over the past decade.
I have not been hospitalized since 2008. But if I had to be hospitalized today in my community, I would not have anything close to the level of continuity of care I had back in 2003. The large community mental health center where Sharon and Dr. Greene worked, ended up closing in 2011, largely due to financial issues. My current therapist and psychiatrist now work for a different agency than the new local psychiatric hospital. If I had to be hospitalized today, they would not be involved in my care in any way. I would be treated by a psychiatrist and therapist who don’t know me, and who may or may not request information from my treating providers. This reality terrifies me, because there is no guarantee I’ll never be hospitalized again. I’m still on most of the same medications that stabilized me in 2003, and have no idea what would happen if a doctor I don’t know chose to change them. My fear about this possibility helps keep me motivated to do everything I can to keep my bipolar symptoms under control.
When reflecting on my Meltdown and the subsequent nightmare year I also have to consider the changes that happened in my close relationships, namely with my family and with Sharon. The change with my family was very slow and gradual, especially with my parents. I was slightly open with my brother, Bob, at the time of my Meltdown. I was able to tell him about my hospitalization after a few days. However, I wasn’t open with my parents. They had no idea how emotionally unstable I was when I had the Meltdown, and I didn’t inform them that I was in the hospital for quite a while. I was used to faking it with everyone so I wouldn’t have to talk about how depressed or suicidal I was feeling. As the year progressed I was able to be more open with my family, although at the end of this year I still wasn’t comfortable telling them when I was suicidal. I knew that the thought of me killing myself was hard for them to consider, and I didn’t want to freak them out anymore than I already had.
In terms of my relationship with Sharon, the change was more noticeable. I had been faking it with her to an extent for years in therapy. I let her know when I was depressed, but didn’t reveal how suicidal or out of control I felt. It was important to me that she respect me, and I didn’t want to be just another “crazy” client on her case load. I was very rigid in terms of boundaries, which I knew was important in therapy because of my own work in the mental health field. These issues all changed, however, when I had the Meltdown. Suddenly, my filter was gone and I said things I would never have previously said. I began to express my feelings more openly with her, like telling her when I was feeling like drinking or killing myself.
As Sharon stretched the boundaries of our relationship and encouraged me to continue to open up, I was initially very anxious because it was such a change from how I had always been in all of my relationships. I had never told anyone how I really felt. I actually didn’t even know how to articulate it. Gradually, it got easier with Sharon’s encouragement, although I worried about becoming too dependent on her because of the frequent contact. I knew it could not continue to be that way forever, and was afraid to be too open. I was afraid it would be too hard when things had to change back to a more normal pattern of contact. But, I think it was me knowing Sharon was willing to work so hard to help me that made me feel more able to be open with her. It made me anxious to talk about my feelings and thoughts, for many reasons, but Sharon motivated me to try harder and it eventually got easier.
There are obvious lessons to be learned from my experiences during the Meltdown year. For instance, it is crucial to take medications as prescribed and not self-medicate with alcohol or non-prescribed drugs. Also, it is important to become as educated as possible about your mental illness. But, I think the most important take away from my experiences is the need to be open with treatment providers and develop a support system of family and/or friends. Had I been more open about my real issues with Sharon sooner, I could’ve been diagnosed correctly sooner and received the proper treatment earlier in the process. I was lucky to have Sharon as a therapist for as long as I did, and that she put in the extraordinary time and effort that she did to help and support me. However, this is not typical in therapy, and shouldn’t be expected. It’s crucial to have other sources of support. It took time, but I eventually became open with my family and some friends so that they could support me as Sharon gradually decreased her contact with me over the years.
If I could change anything, obviously I would never choose to have bipolar disorder, or obsessive-compulsive disorder, or any of the other symptoms I experience. However, some good came out of that nightmare year. It was not an easy process rebuilding my life, but I am now more connected to other people and feel much more stable than I ever did prior to being correctly diagnosed and treated. In 2003, I could have never imagined myself saying this.