Questions and Answers and What's Next in This Space

Happy new year.

The replies to my last post have been strange. They have been kinder than I deserve, which I am on the ambivalent side of grateful for. Some have been angry, of course, which is more what I expected. There have been a lot of questions. I suppose that makes sense—I did say that anyone could reach out with questions and I meant it—and I thought about doing a kind of FAQ round-up, but that felt crass. Instead I'll just talk for a bit. For the most part there have been two main asks: First, what exactly am I diagnosed with? Second, in so many words, do you believe that you’re responsible for your actions? 

The first question is easy to answer, and I’m sorry for not being more specific before. All I can say is that one of my greatest desires in life was to never talk openly about my mental health, to confine it to my clinicians and family and partner and a few friends. So I am not very practiced in discussing it and so of course failed to ever actually say what the diagnosis was (or, maybe failed in a half-conscious way). Also, if you learn anything about mental health it’s that these labels are imprecise and constantly in flux, but that being said my current diagnosis is somewhere between "schizoaffective disorder, bipolar type" and bipolar disorder type 1 with dysphoric/mixed episodes and psychotic features. I won’t go on endlessly about what that means, but the short version is that prior to being medication, I oscillated between deep depressions and a joyless mania—a kind that made me paranoid, impulsive, aggressive, and irrational. Sometimes that came with full psychotic episodes. Sometimes it came with auditory hallucinations. For years, it entailed a persistent delusion about my relationship with the Holy Spirit that I still find too embarrassing to talk about too much. Another way to put it: I had cycles of sadness and cycles of madness, like schizophrenia in bursts. The good news, again, is that I am heavily medicated now and have been for years and while the medication is always being adjusted and isn’t perfect, it does control the most extreme ends of things. As far as outlook goes, I am a fairly successful treatment case. (Basically, with this condition, not being dead or in prison are a good baseline for success; having a job is excellent). There are people even with meds who never stop having delusions, or who can never stay on meds because of the side effects. I feel a little cloudy most days--one med I have always believed makes me dumber--and I have spent the last few years taking notes on almost everything because my memory does not work like it used to. I feel nauseous and sore when a dose gets adjusted; if one med amount goes high enough, I've discovered, I have nightmares that sometimes involve shouting in my sleep. But basically I’m fine. Meds have varied over the years, but for what it’s worth, I currently take both a mood stabilizer and an antipsychotic, with sedatives added in as-needed if an episode nonetheless threatens to get bad. I’m OK.

The second question is more complicated. How responsible am I for my actions before I was treated? The truth is that I don’t know. In terms of ethics, in terms of consequences, I am absolutely responsible. Harm done is harm done regardless of cause. If I stole your money, or punched you in the face, or ignored your boundaries, or disappeared when you needed me or went off meds and tweeted something so embarrassing to my employer that it became a minor national news scandal, and my doing one of those things hurt you, then it doesn’t hurt less just because I did it in the bout of indiscriminate manic impulsiveness or psychosis and not in some cold, targeted, and premeditated malice. I really have never properly wanted to hurt anyone in my life, but it doesn't matter. The damage is still done, every bit as much as if I were sane. Beyond that—I don’t know. I am certainly responsible now. The most important thing I can do, ethically, is stay on my meds forever no matter what. If I don’t and I lose it and I hurt someone, then that’s my fault.

 Before my meds? Before the diagnosis? I don’t know. I wish it were easy and I could just plead insanity and have that be that, but it isn’t that simple, and when I think after it too long, I wind up in mental loops. While there is a well-established link between people with my condition (especially the ones who self-medicate with drugs) and all kinds of shittiness and violence and criminality, it’s also true that a lot of mentally ill people—most mentally ill people—are harmless to everyone but, often, themselves. At any rate we aren't meant to talk about that link: it invariably stigmatizes everyone else with one of these conditions. But then, the psychiatric wards are full of people who have stolen and beaten and murdered because of their illnesses. So I don't know. What I mean is that I can’t tell anyone how to think of the ethics of the situation. I’ve hurt a lot of people in a lot of ways. It would be strange to look at that fact and look at the fact that I was (and am) severely mentally ill and pretend those facts have nothing to do with each other. But it would be too easy, I think, to make that fact really exculpatory. I don’t know. What I do know is that with medication, with my psychiatrist, with my psychotherapist, with the lifestyle changes and habits and routines I’ve been developing over the past few years, with all of those things, I am safe to be around. I can even be agreeable sometimes. I get the sense that some people believe that's a great external metric to have--my decency can be guaranteed with pills!-- but then, many people who have done shitty things to people can just learn to be better and that’s that. Without the pharmaceutical industry, I will slow boil back down into psychosis. That will always be true. I don’t know that that’s better or more reassuring than the sincere self-reflection of a mentally typical person. Even a psychopath can make a rational calculation to maximize their outlook through behavioral changes. My brain just wants to feel too much, to lose touch with reality, to act out. I suppose the answer is that I cannot control my own mind, but ethically, these days, I can control whether or not I take the pills in the morning and the pills at night that can control my mind for me. It's more complicated than that, of course, but that's where I'm at.

At any rate, I am accepting the need to talk about this all openly, and I'm realizing that I want to, too. In the sort of classic way, once you start talking about something you’ve avoided talking about, it’s very hard to stop. I’ve started working on a project about all of this, although I don’t quite know the shape of it yet. But I’ve been writing in short bursts, and I think I’m going to publish little bits here as I generate them. They won’t even properly be essays—too first draft, too short, too scattered and incomplete for that—but maybe they’ll help answer some of these questions better than I can answer them right now. Who knows, maybe they’ll be enjoyable to read for some people. Largely it’ll just be for me, on my largely private blog, to have a way to talk to myself.