Chicken or egg
by Natasha S. Archer
I guess maybe everyone has these chicken or egg type questions, right? I’m sitting in the room with my psychiatrist, whom I’ve trusted for roughly a year now, after he passed some crucial tests. My psychiatrist is maybe in his late 60s and I don’t know for sure, because it’s rude to ask; he’s hard of hearing and I have a soft voice and he always forgets this when we meet and every single time I sit down and begin speaking, his eyes light up, he smiles, and then he fiddles with the hearing aid in his ear, saying, “You would think I would write something about this in your chart by this point, huh?” And we both laugh. Every time. This is our game.
The truth is, I don’t have a soft voice. I just hate talking about myself, and I particularly hate talking about my faults. And I think any rational person might think that if I really learned anything over the last seven years of training in the mental health field, then I’d probably stop referring to mental health symptoms as faults, but I reserve that compassion for everyone else; me, I was built for pain and suffering and should have the constant, unrelenting strength of a Greek fucking god. So, these symptoms are faults, chinks in my armor, cracks in my façade, and they are certainly nothing to go speaking boldly about.
I’m built for pain and suffering because I was born into it, borne of it, raised in it, baptized in it, bathed in it as a child. Objectively speaking, if I am ever able to speak objectively of myself, I would read my case history, as it were, and think I make sense. Why be present when you can dissociate? Why stay in your body when you’ve figured out how to leave it and people are using it for horrific things? Why believe the world is consistently a real place when it’s a fucking waking nightmare your entire childhood? And the drugs, my god, the drugs. When I was a kid, there was this advert on TV wherein this smug-sounding dude says in a voiceover, “No one wants to be a junkie when they grow up.”. I didn’t exactly know what it meant, but I did know I loved huffing rubber cement fumes in the washroom of my elementary school while everyone was at recess and that I couldn’t wait to find a way to live in that cloud. And so I figured that out.
I turn 25, booze doesn’t work anymore, pills and weed don’t work anymore, just opiates…heroin if I could get it, but I would steal Darvocet from my own grandmother’s medicine cabinet if she weren’t already dead by that point and none of the good stuff was there anymore. So, it was either OD, stay on this fucked up sick-and-well cycle, or get sober. So, here I am, sitting across from my psychiatrist, who knows I’ve been clean for 14 years, except for the benzos he prescribes for my PTSD / GAD / Panic Disorder / whatever. And I tell him I don’t think I’ve ever been depressed before, but I’m pretty sure I am now. And he asks me to tell him about it.
“I don’t eat. I don’t sleep. I used to cry; I don’t cry anymore. I am afraid of everything and everyone. I get nothing done. I can’t focus. I’m doing all the fucking things I’m supposed to do and nothing is working. And I need you to help me.”
“What else?”
“What do you mean?”
“How much weight have you lost since I saw you last?”
“I don’t know. Do you think 20 pounds? My clothes don’t fit, which is why I’m wearing this…” I gesture to my shitty active wear, in which I’ve been inactive for three days now.
“I think that’s probably close. I saw you three months ago. What else?”
“What do you want me to say? I’m not suicidal. I think about self-harm a lot. That hasn’t been a problem for years. I don’t want to see my friends. I hate my friends, most of them. I don’t trust them. Some of them have given me reasons to not trust them, some of them, not. That makes me feel crazy.”
“Okay. What else?” And the way he is just sitting there nodding his head is irritating me.
“What else? I don’t know. Risky sex? Maybe. I mean, I never got therapy for the rape.”
“What?”
“I never got therapy for the rape. I was busy with work. I was doing therapy with other survivors or victims or whatever.”
“Oh. Do you think that was a good choice?”
“I finished my dissertation on time. I finished my internship before anyone else. I did everything before anyone else in my cohort. Do you think a better choice would have been to let him take that, too?” I have never felt this aggressive towards him before.
“That’s excellent work. Can I ask you, how many days did you take to write the paper?”
“It’s a two-year process. You know that.” My psychiatrist is also a psychologist.
“How many days?”
“I mean…three days for my literature review. One day for the first chapter, two days for the third chapter…”
“That’s what I thought.”
“Oh. Okay…”
“So, you’re ready to hear this now. I’ve been thinking about it for a while, but I wanted to observe you.”
“Okay.”
“I think you have bipolar disorder…” He kept talking but I don’t remember a lot of it because I fully checked out.
“Wait. What? No.”
“Why not?”
“I would know. I don’t get manic. I don’t get hypomanic even. I…I would know. Wouldn’t I know?”
“Well, you would know it if you knew what I’m talking about when I say ‘hypomanic,’ but you’re thinking of the ‘fun kind.’ I’m thinking of a darker kind.”
“There isn’t a darker kind. It’s always fun. Life of the party. All kinds of games. Excitement. Lots of sex. Getting shit done…”
“Risky sex? Writing your literature review in three days?” He eyes me, question marks dancing around.
“That’s not the same thing. I’m telling you that happens when I’m depressed, the sex bit. And it’s to do with the rape, I’m sure.”
“Fine. And you hate your friends and some of them gave you no reason to do and this makes you feel ‘crazy’ and you stay at home because…”
“Because I’m worried something will happen.” “Do you think it’s fine to do that?”
“I think it’s fine if you were sexually assaulted less than a year ago.”
“I knew you before the rape. This is a pattern for you.” “Okay.”
“Okay? You don’t believe me.” He starts citing instances, multiple instances, and I finally ask him to stop. “This isn’t the kind of stuff they teach you about hypomania. You aren’t manic. This isn’t psychosis, this isn’t mania, but in my experience, it’s hypomania. And I don’t think it’s happening at this moment, but I do think it’s happening sometimes.” He pauses again. “And as to you saying you’ve never been depressed? You live there.”
“I what?”
“You live there. That’s your baseline. You react poorly to SSRIs, SSNIs, tricylics, all of them. So you live there. And you think it’s just the way it is.” I let it sink in and I think of arguments, but none of them will hold up. So, I just sit there. “You explained what happens to you when you take usual antidepressants; that’s another sign.” And there I am, pushing 40, finding out I might have a disorder I should have known about forever ago.
“But what about the PTSD? The anxiety? Do I not have those?” And my psychiatrist chuckles.
“One doesn’t rule out the others.” I sit there in silence, thinking of everything that happened in my life up to this point
“So, what? I’ve always been this way? Are my experiences my fault? Like, am I acting out in an ‘episode’ or some shit?”
“I don’t think so. Maybe you’re acting out, but this isn’t a ‘fault’ thing. This is a chicken or egg scenario. I’m not saying what your parents did, your foster parents, those people who hurt you, any of them should have done it? Am I saying it helped your situation? No. Am I saying you would have had this disorder if none of this happened? To that, I’m saying, I don’t know. What I’m asking is if you will try to let me help you with this and see if maybe, just maybe, I might be right.”
And so I agree to try. And the medicine works. Like, really works. Like, realizing I lived life at Level Four mood and thought there was nothing better and I now live life at Level Six, works. This may not seem like much to you, but I taste food now, see actual objects more clearly, I talk about myself in full sentences unabashedly. I am more confident, I feel stronger. I am a mental health professional, a fucking doctor of psychology, and I was diagnosed with Bipolar Disorder, Type II at age 39. And it fits and explains so many things, and for that, I am grateful.