A Worthy Cause by Ellen Forney

It's a common syndrome of Psych 101 students to self-diagnose with all sorts of mental disorders. Need to keep your dorm room tidy? OCD, for sure. Nervous at parties? Social Anxiety Disorder. Moody? Bipolar disorder. We were all crazy, with at least one disorder, if not two or three. Later in the semester, sitting in a circle and passing the T.A.'s bong, we realized that normal personality and behavioral characteristics were pathologized in the field—all in the interest of big pharmaceutical companies, or the Patriarchy—and, with relief and some disappointment, we decided that none of us were crazy after all.

I graduated from Wesleyan University in 1989 with a degree in psychology. I chose psychology because by junior year, when I had to choose a major, that's where I had the most credits, plus I wouldn't have to do a thesis. I'm a good listener, I worked on the student crisis phone line, and people seem to naturally open up to me, so it seemed to make sense that I become a therapist.

I decided to get my feet wet before committing to grad school, and found a job at Evergreen Evaluation and Treatment Center, a private, short-term, involuntary psychiatric unit in Seattle. Training entailed learning where everything was on the one-floor unit—the cafeteria, the dark TV room, the brightly lit activity room and the two tiny seclusion rooms. My job was to have a short sit-down with each of my five clients sometime during my eight-and-a-half hour shift, taking note of what they said, how they behaved and what they did.

Training was about a week. Then I was a “mental health specialist.”

A short-term involuntary unit is a holding tank, kind of a M.A.S.H. unit, for the dangerously crazy. These people had been forcibly removed from the public, for at least 72 hours and up to two months, while they waited for more appropriate treatment to be arranged for them off the unit. They'd go to Cedar Hills Drug Treatment Center, maybe a halfway house in Capitol Hill, maybe Western State. Evergreen was a virtual bouquet of crazy people with vastly differing diagnoses, aged from late teens to senior citizens.

Staff always wore shoes we could run in. During my first summer at Evergreen, we had Code 5s at least once a week. “Code 5 to the activity room!” A Code 5 is when all staff except one person behind the desk sprints to the dining room, or the TV room, or whichever room had been specified over the loudspeaker. It meant there was a crisis, maybe a dangerous crisis. It was time for our expert mental health specialist intervention. We were psych unit warriors.

Who knew what we'd find, as we jostled each other in the doorway? The 22-year-old man with antisocial personality disorder hurling chairs across the activity room; the 40-year-old, six-foot, two-inch paranoid schizophrenic man out of nowhere punching a seated pregnant staff member in the abdomen; the 32-year-old developmentally disabled man yelling incomprehensible threats at the 20-year-old borderline personality disorder woman, waving his plastic spork in front of him like a switchblade.

If the situation wasn't too bad, the leader of the “show of force” would call “uppers.” Two staff members would lock our arms in the client's arms and walk them to a seclusion room, the rest of the staff trailing like a parade. “Uppers and lowers” was for more serious situations—four staff members would flank the client and each would grab a limb at the same time, and carry the client horizontally, face down, to a seclusion room. Worst case, the supervisor would say “take 'im down!” and we'd basically tackle the person and someone would run for the bag of extra restraints. The client, probably still struggling, would be shackled and carried like a log into the seclusion room.

A Code 5 could also be for a suicide. That never happened during my year and a half there, but my supervisor had been there for two.

A few of my clients had bipolar disorder. One of them seemed really together when you first saw her, really normal looking, like a suburban mom. She was a starry, charismatic burst of charm. She promised to find jobs for everyone on the unit, when they got out. She was going to cure the paranoid schizophrenic. She made out with him in the TV room. She could see inside people. She had a direct channel to god. Nevertheless, she was released after 72 hours. She presented really well.

Another client was a teenager with intense green eyes. When we sat down for our meeting, he'd started out making sense, talking excitedly about his new volunteer job canvassing for the Rainforest Action Network. But his monologue soon crescendoed and his speech became jumbled, his train of thought branching off in all directions. He leaned forward and traced shapes in the air with his hands to illustrate his points. He was a part of some cosmic meaning but couldn't quite figure it out and he just needed to write it all down. By the next day, he was totally gorked out on some medication the psychiatrist had prescribed for him. “Watched TV all shift,” I wrote in his chart. “Flat affect.”

The Mental Health Specialists kept the clients' charts. At the end of every shift—harried, and ready to go home—we'd sit with our piles of three-ring binders, and write our “SOAP” notes, assessing our clients' behavior. SOAP is an acronym. “S” is for “subjective,” and would be a choice quote from the client, like, “Leave me alone.” “O” is “objective,” and described the client's behavior, like, “Didn't eat all shift. Mumbling to self.” “A” is “assessment,” our interpretation of the client's behavior: “Internally preoccupied.” “P” is “plan,” which was almost always “Continue observation and treatment.”

These charts would be used when the clients went to court. The court system was involved, of course, because these people were essentially in jail. We were compiling the evidence that they were crazy. We weren't supposed to diagnose the clients ourselves—the psychiatrists who saw them once in a blue moon were supposed to do that—but of course we pored over the DSM, the “Diagnostic and Statistical Manual of Mental Disorders.” The thick blue book behind the front desk was our bible of sorts, and we came to our own conclusions. We had the most contact with the clients. We knew.


January 1998: Topless, in my leather miniskirt, fishnet stockings, and knee-high motorcycle boots, I straddled Owen's chair backwards, facing away from him. He carefully placed the carbon transfer for what would be a very large tattoo on my back. I had anticipated this visit to his parlor for a full year, while my friend and fellow cartoonist Kaz drew the design. I had been a professional cartoonist for six years, no longer aiming to be a therapist. One of the many reasons I was getting this particular tattoo, full of Kaz's cartoon characters, was to proclaim definitively my commitment to the thankless field of comics.

I had intended to wait until my 30th birthday in March, but when I got the original artwork in the mail, it was urgent that I get it on my body immediately. Destiny was here, now. I had to wait an interminable four days before Owen could fit me into his schedule.

The evening would be a rite of passage. I'd made preparations for the event: I brought a whole buffet: rosemary bread, goat cheese, a variety of olives, a huge bunch of red grapes, a smaller bunch of champagne grapes because I thought they looked pretty hilarious next to the bigger grapes, and expensive chocolates. I brought an enormous, overpriced bunch of pink Gerbera daisies. I brought a bottle of expensive Scotch. Owen warned me that the alcohol would thin my blood, but I didn't care. Let the ritual be bloody.

It was painful but in a very intense, controlled way. Every time Owen traced a new line with his needle, the sensation felt like a brilliant white light, up and to the right. It was beaming down at me and emanating back up from my forehead. It was a bolt of lightning, and the electricity pinned me in Owen's chair.

“I have a high pain tolerance,” I said proudly. I was being transformed. I was walking over red hot coals. I was the virgin at the edge of the volcano.

I sat under Owen's needle for five and a half hours. At the end of the session I was exhilarated. I asked Owen if I could kiss him and I lunged at him and kissed him with my tongue. He pulled back. “Whoa. You're an interesting woman.”

It snowed in Seattle that night, big fluffy flakes that glittered under the streetlights, and muffled sound, and crunched underfoot as I walked home. It never snows in Seattle. This was an elegant nod of approval from the universe. My back felt warm under my coat, like a sunburn, and the heat created a yin-yang balance with the cold air and the snow. It was perfect. More than perfect: exponentially perfect. Everything was magical and intense and bursting with universal truth.


A few weeks later, I sat in a green leather swivel chair in front of a psychiatrist. Her office was in a small building right on Lake Union, and it swayed with the tide. Her head was tilted a little and her hands were in her lap. She had just told me that I'm bipolar. I rolled my eyes and nodded dismissively. “My mother and I both have manic-depressive tendencies”—I had said that for years, that I had manic-depressive tendencies—“but I'm not like, bipolar-bipolar.”

I had seen bipolar people on the psych unit. I had written in their charts. I might be weird, but I wasn't crazy.

“Let's take a look at the DSM,” Carol said.

The DSM. She stood up and took the familiar blue book off her bookshelf. How many times had I paged through that book on the psych unit? It's actually a pretty good read. Methodical descriptions of borderline personality disorder, kleptomania, exhibitionism, fetishism. The edition with case studies was even better.

Carol waved me to come next to her and opened the book on her lap. She read the criteria out loud, one by one.

Inflated self-esteem or grandiosity.

I had to admit to that one. I'd only just recently had the sudden realization that if I were at a cocktail party, and Madonna was there, I wouldn't be starstruck at all. As a matter of fact, it was just as likely that she would be humbled by me and my remarkable charisma.

Decreased need for sleep.

For the past two months, I'd been getting about four hours of sleep per night, instead of my usual eight. I hadn't really seen this as a problem.

More talkative than usual or pressure to keep talking.

Flight of ideas or subjective experience that thoughts are racing.

Distractability.

Sexual indiscretions.

Those were a very strange couple of minutes. I knew I'd been amped for a while, “jazzed” was how my previous therapist had put it, but I felt like I was intensely me, exponentially me. The real me. My unique personality was described right there, in the book in Carol's lap.


When I tell someone that I'm bipolar, the first thing they want to know is if I take meds. That's the qualifier that would make me certifiably crazy.

I was clear with Carol right away that I absolutely did NOT want to take meds. You know the ideal of the crazy artist? It's actually a credential of sorts, right? Van Gogh, Michelangelo, Virginia Woolf, Beethoven. They'd stay up for weeks, working feverishly on grand oeuvres, and writing brilliant letters back and forth with their other crazy famous artist friends. Later, exhausted after their prolific whirlwind, they'd lock themselves in their rooms, their letters now about darkness and suicide, to be quoted years later in dissertations by reverent grad students.

These famous bipolar artists were UNMEDICATED.

So there was no way I was going to take meds. Carol convinced me I should seriously consider getting more than four hours of sleep a night, so she started me on Klonopin, a benzodiazapine, like Valium. I took it at night, I took it all day long. I also smoked a lot of pot, smoked a lot of cigarettes and drank plenty of Wild Turkey. I started getting maybe six or seven hours of sleep.

At the end of March, I went to the Capitol Hill library to do some research on the mating habits of dogs. I was doing a comic about the disastrous deflowering of my childhood dog, Sparkle. I had come down from my soaring four-month manic high, and surprisingly, it felt pretty good to be on solid ground. I flipped through the big children's reference book, “It's a Dog's Life!”

I was getting a cold. I had that tickle in the back of my throat and there was pressure in my nasal passages. I'd forgotten about this part. During a manic episode, depression seems just entirely impossible. At the end of a high, though, I'd get sick.

I sat on a tiny chair in the library's children's section, at the long wooden table with the contact paper-covered can of oversized pencils. I had a sinking, sick feeling like I was about to get fired, or dumped, or that I was about to slide down into the deep, familiar muck that had faded from my memory.

Two nights later, I called my psychiatrist's emergency phone line in a panic. My head was a cage of frantic, scrabbling rats. I was slipping down and there was nothing I could grab onto. It was a very vivid mental image.

Carol, I changed my mind, I'll take meds, anything, experimental brain surgery, please, just throw me a rope. I'm terrified.

Carol started me on Lithium. LITHIUM. I was now officially blue-ribbon Bipolar 1 crazy. But, Lithium is a mood stabilizer and doesn't actually lift a depression that's already begun, so I fell into the hole anyway.

Here are some of the criteria in the DSM for a major depressive episode: depressed mood most or all of the day; hypersomnia or insomnia, or both; feelings of worthlessness; diminished ability to think or concentrate; markedly diminished pleasure in all, or almost all, activities, including activities that had previously been experienced as pleasurable. I learned a new word: “anhedonia,” noun—inability to experience pleasure. Kind of the opposite of hedonism.

For the following months, I found some relief drawing miserable self-portraits. The act of drawing calmed me down—sometimes it was the only thing that calmed me down. I was never far from my sketchbook:

It usually helped to pin the images down on paper, instead of their whirling around my head. Sometimes my drawings would scare me, though. I'd have to skip those pages for a while.

Seeking company, I found an online chat room for people with bipolar disorder, HarborOfHope.com. It was just as bad as any other chat room: inane banter, strings of exclamation points, obscure emoticons. The pages of bipolar art were even more alienating. My dark, joyless sketches contrasted sharply with the colored-pencil unicorns with flowing manes, shedding a single, big tear.

By the end of 1999, I was still waiting for the light at the end of the tunnel that my psychiatrist swore would eventually emerge. It was exhausting. I did feel a little better—I at least had enough energy to feel completely exasperated.

One of my drawings around New Year's depicted a collapsed, dying old-year me, bound by my “1999” banner, surrounded by pills and vomit. A miserable, ghostly new-year me rose from the old-year me's abdomen. I wrote, “Phoenixlike, Ellen 1999 rises from the ashes of Ellen 1998.” I'd really been expecting to turn the corner by New Year's. No such luck.

Getting manic again, in the spring, wasn't nearly as fun as it had been before I'd been diagnosed:

Now I was all too aware that I was interrupting my friends, buying things I couldn't quite afford, and asking overly intimate questions to new colleagues, like “What's the deal with you straight guys and anal penetration, anyway?” Euphoric, restless, all familiar feelings, but now I recognized them as symptoms. Symptoms of my mental disorder.

Trying to rein myself in was something new. It was very difficult to shut up, and very difficult to concentrate. My thoughts were swirling, or popping like popcorn. My memory was bad, so I made lots of lists. I had to keep track of my meds, my sleep, my appetite, my behavior… everything.

The meds helped, but only so much. My friend Kristen came up with a nickname for me: “Benzo Girl!” I bought an antique pillbox for my Klonopin and carried it with me always, popping tiny blue pills throughout the day. The pillbox became my blankie, rattling at the bottom of my handbag. I had become deeply thankful to the patriarchal pharmaceutical companies for benzodiazepines.

I learned another new word: “euthymia,” noun, which means “at peace.” Not manic, not depressed. My goal.


Here's the full answer about my meds: I've been on a number of them. It took a long time to figure out the right meds, or the right combination of meds, and the right dosages. At one point I was on side effect meds for my side effect meds.