Madness (31 page)

I shake my head, pulling petals off the daisy. "I think about it all the time. I can't think other things for more than a few minutes before I think about it all over again."

"You know that's crazy, right? You know cutting is not a realistic option?"

I nod and heave a sigh. "It just seems like such a good idea. The obvious idea."

"That's crazy."

"It would be so calm. It would be so clean. Such nice clean lines, if you have a good razor. A few neat slices, and then I'd stop."

"Marya, you don't stop after a few slices. You always mean to, but you never do."

"I guess so," I say, lining the red petals up in a row.

"So you can't start."

I nod again. "The only thing that really worries me, though, is that I keep having this idea to try making a nice, neat slice in my neck, to see if I can hit the jugular."

"Okay, you need to be in the hospital," Ruth says.

I look at the bald stem sticking out of the little white vase. My eyes start leaking again, to my serious dismay. I tip my head forward over the table so I don't mess up my mascara more. I drip.

"I'm okay," I say. "They're just thoughts. I don't have a plan." The doctors always ask if you're having suicidal ideation—thinking about death, fantasizing about killing yourself, even when you don't want to—which I am, and if so, whether or not you have a plan, which I don't. I know myself well enough to realize that if we went to the emergency room, I would miraculously get better. I would show no signs of madness. It's called plausible sanity. It's a product of what they call lack of insight: when you're very sick, you don't have any perspective. You truly believe you're well, so you report that you're well. You act cheerful, put-together, and completely sane. You're articulate and very persuasive, and you explain to them that there's been a terrible mistake—you're not really crazy, and this ridiculous trip to the hospital is just a friend overreacting, or your family trying to trap you, or your spouse trying to get back at you for something. Because you seem perfectly fine—plausibly sane—doctors are hard-pressed to believe that you are, in fact, crazy and in need of hospitalization, even in cases where you've wound up in their emergency room as the result of a suicide attempt.

For this very reason, I often show up in the emergency room
clutching a list of my symptoms. I make this list before I go, while I still have the insight to see that I'm crazy. I am aided in making this list by an objective observer—Megan, Jeff, Ruth, my mother, or my father—and when we get to the hospital and I immediately change my mind, feel fine, insist that I'm sane and want to go home, the objective observer can tear this list from my fat little fists and give it to the doctor as proof that I am not, in fact,
plausibly sane,
and need to be locked up. But when you don't have such a list, and you do seem plausibly sane, they send you home with alarming frequency. It's happened to me several times. And I've gone straight home and started doing all over again whatever it was that had gotten me to the hospital in the first place. It's not at all uncommon to find that a bipolar person had seen a doctor almost immediately before he or she committed suicide. What happened? the baffled, grieving family and friends and colleagues ask. He seemed perfectly fine. She didn't even seem depressed. Why didn't the doctor stop him? Why didn't they keep her at the hospital?

"What are you doing tonight?" Ruth asks me.

I stare at her blankly, horror rising in my chest. I don't know. I have no idea how I will make it through the night. I can't bear the idea of going home and floating around, alone with my wretched, spinning thoughts. My eyes start to leak again.

"All right," she says, standing up. "You're coming with me."

We pick up Christi and go in search of dinner. Christi has been having a rough couple of days. I am wildly relieved to see her, both for my own sake and because I know that if she's with us, she'll be all right. For the rest of the evening, Ruth herds us around like a couple of giant children. We are crazy. Ruth is sane, at least today. So she gets to be in charge. She takes our hands and leads us into the restaurant. She orders for us. We stare at her as if she will explain everything any minute now. If Ruth is here, then there is hope. If Ruth is here, we are safe. Until the thoughts start up again.

***

I don't know how long I've been in my house. It's dark. Last I checked it was day. I think I've thrown up seven times today. I'm so dehydrated I can barely walk, and I'm crawling down the hall. The eating disorder has gotten too bad. It's not working. I see it for what it is: an attempt to control a self that I felt was completely out of control, a life that was falling apart. And it has done nothing but make the bipolar worse, and ruin my body in the process. I have taken an entire box of laxatives. I am throwing up and peeing blood. But I didn't mean for it to get this bad—I only wanted to feel a little better—it seemed like a good idea at the time—I had forgotten how ugly this was. But I still have a loose grip left on reality, and I know that the bipolar will only keep getting worse if this keeps up. The eating disorder is only the beginning. I am half dead already, and if I don't stop I will wind up really dead.

I call Ruth and tell her I need to go to the emergency room. She's at my door. Christi's with her. I'm dizzy, disoriented, sorry, scared. They drive me to the emergency room. Then it goes dark.

I wake up on the eating disorders ward to find Megan standing over me, hands on her hips. She explains to me, none too cheerfully, that she has been trying to find me for three days.

"Do you remember calling me?" she demands.

"Vaguely." I do, very vaguely indeed; I remember laughing and whispering into the phone a really funny joke that I had just thought up, but I don't remember the joke.

"You told me you were in an undisclosed location and were being restrained."

"Aha! That's right." I start laughing all over again. "It was a good joke, wasn't it?"

"I thought you were in jail."

"Of course I wasn't in jail."

"Then I thought you'd been kidnapped. Then I realized, wait,
she disappears
all the time,
you
freak,
and I started calling all the hospitals in town." She leans forward, looking fierce. "Of course, none of them would tell me if you were
there."

"Why not?"

"Because," she says, narrowing her eyes, "you're in here under a
false name."

"I am?" This is news.

"Yes. You are. You're in here under Mary Miller."

"Really?"

"Yes. Why, exactly, are you in here under Mary Miller when your name is
Marya Hornbacher?"

"My name almost
is
Mary Miller."

"No it's not! Your name is not almost Mary Miller!" she shouts.

"It is! Marya is Russian for Mary, and—"

"Forget it. Why are you in here under a false name in the first place?"

I furrow my brow. "I guess I didn't want them to know who I am."

"Marya, they
know
who you are!"

I think, then remember. "That's right. I didn't want
you
to know I was here."

"Why not?"

"I didn't want you to worry."

"You didn't want us to
worry?
Your mother's hysterical. Your father is ready to have the lakes dragged. And you didn't want us to
worry?"

"I hate it when you worry."

She stares at me some more. She heaves a sigh and flops down next to me, shaking her head. Then she brightens up and says, "So, how's the food?"

"How are you feeling?" asks the psychiatrist on the eating disorders ward.

"A little zippy."

"Not depressed?" As I've said before, the assumption when you've got an eating disorder is that you've also got depression.

"No."

"How is your depression?"

"I don't have depression. I have bipolar."

"Yes, but depression is part of that," she says, smiling tensely. She's getting irritated. She wants me to say I'm depressed. Right now I'm not, though, so we could be sitting here a long time.

"I'm bipolar type one," I say. "Mostly I have mixed episodes."

"So you're a little depressed."

"No," I say patiently. "I'm not depressed at all right now. I don't get depressed until February. At the moment, in fact, I'm coming off a
manic
episode."

"I think I'm going to increase your antidepressants." She turns to her desk and starts looking up meds in the pharmaceutical handbook. As far as I'm concerned, she might as well just page through it with her eyes closed and stab the page with her finger and say we're going to put me on ... let me see here ... lithium! Zoloft! Wellbutrin! Zyprexa! Why not!

"I think that's a very bad idea," I say, becoming quite cross. "My psychiatrist will have a fit if you mess with my meds."

"I'm sure he'll understand if I add a little Prozac. It should help with the anxiety. It's a good antidepressant."

"Are you joking?" I ask, almost laughing. "You can't give me Prozac, or any SSRI! It will make me completely insane! Christ!" I throw my arms up in the air. "Haven't you people figured out yet that not everyone with an eating disorder has depression? And I can't
believe
you'd do something as stupid as put me on an SSRI. That shit sends me through the roof! Leave me on the antidepressants I'm on. They don't make me crazy."

She sighs, writing the order in my chart. "I think you'll find the Prozac will help your depression a great deal. It has almost no side effects."

"Except the one where it makes a lot of bipolar people
psy
chotic!"
I tie myself into a tighter knot in my chair and chew my knee in frustration.

"You know," she says, glancing up, shaking her head and looking concerned, "I read your first book. I am just
really
sorry that you had such bad experiences with therapy and psychiatry. That's really uncommon." She looks totally baffled.

I stare at her. "Right-o," I say.

"I see here you've been having trouble sleeping. Do you want something to sleep?"

"I take trazodone. It works okay."

"Why don't I put you on Ambien?"

"Because I'm an addict and I'll start abusing it. Doesn't it say that in my chart?"

"Yes. I'm sure you won't start abusing it." She writes an order for Ambien in my chart. Now I'll have everyone staring at me tonight while I argue with the nurse about whether or not I'm going to take my meds. I feel like throwing the
DSM-IV
at her and telling her to look up
Axis I: bipolar disorder; Axis II: substance abuse.

"I won't take it."

"So you're saying you're going to resist treatment." She sighs dramatically.

"No. I'm saying I'm going to continue the treatment my doctor has laid out for me."

"What about your depression? I don't think he's really looking at your depression. Untreated depression is a terrible thing. In fact, I suspect your eating disorder may have reemerged because you are very depressed."

"I'm done now," I say. I untie my legs and shuffle out of the office and down the hall to
Snack.
I hate the world.

I get discharged in December. I've broken the cycle of the eating disorder and remember how to go back to living without one. The mania, too, has broken. I feel like I'm broken myself.

But I do my best. I go home to my empty condo, buy some real food, and eat like a normal person. I pay the bills that have piled up, return the phone calls, get back to work. I write the lectures that I'm scheduled to give at a couple of universities in February and March.

It's winter. Winter brings the blues. I'm afraid of them coming, and I know they will. My only hope is that I can get through the winter without going back to the hospital. If I can do this, then maybe I can stop hating myself. I think, if I just keep going, keep doing what they say, take the meds, go to sleep, use the light box, get out of the house, get
some
exercise (as opposed to working out four hours a day), eat enough, try to avoid stress, then maybe I can do it.

They don't tell you how to manage grief. And I miss Jeff so much it's killing me.

But there's nothing I can do about that now. All I can do is keep going forward. Maybe this way I can make it to April. Just this once.

Seven
A
.
M
.
I wake up in the dark. There are so few hours of daylight—the sun will start to fall at about three o'clock in the afternoon, and it will be fully dark by four. It is hard to want to leave the house, or work, or live, in Minnesota during the winter months. The suicide rate goes sky high. All over this snow-blanketed city, there are people who lie in bed well into the flat gray afternoon, turning this way and that, slogging in and out of sleep. They may drag themselves up around dinner, when a spouse or partner comes home; they may attempt to dress, or they may
not. February is the worst for me, but it's not February yet, and today I am hoping to spend the hours of light at my desk, trying to pretend the lack of sun isn't pressing in at me, pushing me into catatonia, a failure of the will to live. And so:

Eight
A
.
M
.
I go into my kitchen. Take my handfuls of meds. Take the supplements they tell me will help. Take anything they tell me to take. I eat the food they tell me to eat; a little protein, they say, takes the edge off the anxiety, the ever-present morning fears. I go into my office and turn on the light box, which blasts a blinding fluorescent light into the room. I stare at it, drinking my coffee, for the allotted half-hour—enough to block the depression, with luck, but not so much that it will trigger mania. The balance in winter is hard to strike. All these years, every winter I've slipped into a mixed episode, a devastating depression coupled with the frenzied, chaotic energy of mania. This is what we are trying to avoid. I am not certain I can. I doubt it. But I have a little hope. And so:

Nine
A
.
M
.
I sit down at my desk to work. I'm not writing well, but I'm only writing for myself. This is to make me feel functional, a feeling I lost during those years of total disability, so that at the end of the day I can feel good about the fact that the day did not pass me by. They want me to be functional. My doctors' goal, ultimately, is for me to return to a normal life—well, not return, for I've never had such a life, but to build the skills that will help me function at a level acceptable to me. They know that my functioning may have been damaged by the severity of the episodes over the past few years. I'm still holding out hope that I will return to those two good years when Jeff and I were first married—the constant parties, the spotless house, the boundless energy, the endless, unstoppable work. They have tried to tell me that I might not have that, and even that it might not be desirable; they are trying to explain to me that such a life may be exactly what triggers the episodes. But I don't want to believe it. I believe
that
life is normal.
That, to me, is functioning. I don't listen when they say I might have to adjust my expectations for myself. To me, this sounds like
You will have to accept failure. You will never be good enough again.