Posted: Thursday, February 7, 2013 7:00 am | Updated: 9:39 pm, Wed Feb 20, 2013.
On the Mind: My battle with myself (and bipolar disorder) Robbie Ottley RedAndBlack.com | 4 comments
Posted on February 7, 2013
by ROBBIE OTTLEY
I can't think of anything more comfortable in my life than watching the Atlanta Braves.
I've been a fan of the Braves my entire life, so it wasn't out of the ordinary that I was watching them in early August 2011. Second baseman Dan Uggla was on a hitting streak already the best in team history, and he hit a home run early in the game to score the great Chipper Jones and put the Braves up 3-1 over the Chicago Cubs.
I walked out of the room and returned later, only to see that the score was tied 1-1. Was there a mistake? Had the broadcast's producers screwed up? Or was something more serious wrong — the "2-run home run" graphic couldn't be explained away.
Except it could, because Uggla didn't hit a two-run homer, and the baseball game hadn't happened the way I'd seen it. Jones batted after Uggla, the Braves never led.
That night, Aug. 13, 2011, was my first full night in an inpatient treatment facility in a Smyrna mental hospital. I underwent a period of hyperactivity known as a manic episode for which I was hospitalized and would eventually be diagnosed with bipolar disorder. I had a series of departures from reality combining into what's called a psychotic break. During the manic episode, I ran the gamut of emotions, from elation to skepticism, from wonderment to terror.
It took me a long time to get better, but I'm still not fully healed. Depending on the evolution of medicine, I may never be.
In the movie “A Beautiful Mind,” the schizophrenic John Nash, played by Russell Crowe, sees people who aren't there and believes in things that never occur. While I don't think I imagined people from thin air, several themes ran through my head which proved to not be based in reality, a recurring refrain of my episode.
Psychologists commonly refer to these themes as "delusions of grandeur" — exaggerated feelings of self-esteem, a belief in omnipotence, or similarly, relation to famous people or the divine. These delusions expressed themselves through a sense of self-righteousness, which led to belligerence when contradicted, a sense that I had everything figured out, and, eventually, a belief media figures were sending hidden messages meant only for me. I also slept little and focused intensely on certain tasks while ignoring more mundane ones.
Had my episode not progressed to erratic behavior — and had it not been characterized by thinking disconnected from reality — it might have gone undiagnosed, dismissed as a period of exceptionally high functioning. I now recognize these symptoms of my manic episode began at least several weeks before my hospitalization.
Illness rears its head:
I spent my summer in Washington, D.C., interning in two congressional offices and having a blast, in a job I was pretty good at. But by the time my service was drawing to a close, my behavior was becoming unusual, my thinking especially so. I began to wander the marble halls of the Capitol complex, pondering the events of the summer, the impending start of the semester, the world and my role in it.
I recall surmising I had a genius-level intellect in my understanding of the way people relate to one another, and that I might have prescient abilities — able to predict the future based on an understanding of surrounding events combined with patterns in the past. I would spend periods as long as half an hour walking the perimeter of buildings, passing the same people in the hallways over and over.
When I'd return from my meandering, my fellow interns would ask where I was, and my answer — that I had been walking — was met with skeptical faces. I'd see those looks often during the ensuing days and weeks — from friends I was living with, from sports information directors down in Butts-Mehre Heritage Hall, from my co-workers at The Red & Black.
I returned from Washington to my home in Marietta one night in early August. That night would be the last time my family would be together for months since I was due in Athens the next day. But it was a devastating evening. That night, my father and mother informed me and my siblings they would divorce.
Divorce was a thing that happened to other families, not mine. This couldn't be happening to us; I wouldn't let it. With my growing belief in my own omnipotence, I would singlehandedly fix my parents' marriage.
Although I would have experienced a manic episode regardless, the news was the spark that set off my erratic actions. I couldn't sleep that night, so I embarked on a quest of editing Wikipedia lasting several days. At first I contributed positively — I'd seen firsthand the summer’s debt ceiling crisis in Washington, so I could add valuable perspective to the articles about it. But I quickly became emboldened by my success, and moved from assertive editing to a belief I was the flaming sword of righteousness on the website — not an opinion shared by the other users. After a few days — and many an angry message received — I was blocked from editing.
When I returned to Athens, I introduced then-Student Government Association president Mallory Davis and Rachel G. Bowers, the editor of The Red & Black at the time. I attempted to explain some of my divergent thoughts while meeting with the two women in the conference room of The Red & Black building one night. There, I put together one of the most classic, "A Beautiful Mind"-esque symptoms of disconnection from reality — a chart attempting to explain how everything I was saying fit together.
Of course, nothing fit together outside my mind. But as with many a person suffering from paranoid delusions, my biggest departure from reality before my hospitalization had to do with the federal government.
On the plane back from D.C., I had written an op-ed proposing changes to Congress in order to end Washington’s dysfunction. Since my ego was the size of a planet at the time, I submitted the piece to The New York Times, and after they told me it wouldn't run, to the Washington Post. Upon correspondence with a reporter, I came to believe the piece would run, its proposals would be immediately adopted, and it would basically solve all the nation's problems. Grandiose though it was, this delusion wouldn't even be the most misguided of my thoughts during the episode. But it did lead me to believe I would become one of the most important people in the nation in short order. As a result, I believed reporters would seek after me, and, in another classic delusional symptom, that the media was sending messages meant only for me. I went on an epic Twitter rant trying to connect the pieces as I watched CNN and scanned the Internet.
Read Robbie's Twitter rant here.
When I called my mom saying reporters would be coming to our house, she was concerned enough that she came to Athens to take me back home. When she arrived, I refused to go with her; I was an adult and she couldn't take me against my will. I yelled at her, I tried to get witnesses on the phone to prove I wasn't crazy, and eventually I called the police.
The officer who arrived spoke with my mom first, then spoke with me. When I said I planned for the night to end without anyone getting shot, he asked why I would say that and moved his hand to his gun.
I briefly feared for my life.
He moved his hand away, and satisfied I wasn't a danger to myself or others, allowed me to go home with my mom provided I wouldn't cause trouble on the way home. I wasn't exactly civil on the ride back to Marietta — more yelling occurred. But I did move along without resisting, and went to sleep without further incident. The next morning, Aug. 12, my mom drove me by my high school en route to the hospital, where one of my former teachers finally convinced me I wasn't making sense and that I needed further help. In short order, we arrived at Atlanta's Piedmont Hospital.
The breaking point:
I went through a brief intake interview in the emergency room, then was moved to a bed a short walk away from the waiting room. By this point I was little more than a babbling mess, and even though I don't recall having a desire to commit suicide, the records show I made suicidal statements. In short order, the door to the room was locked, and the equivalent of a garage door was lowered, separating me from the usual utilities necessary for a room in the ER. I developed the belief the hospital staff was taking actions for my benefit. Someone was sitting at a bank of televisions watching me through cameras in the ceiling of the room; the hospital wanted me to remove the piece of paper over the mirror to test whether I could look at myself; the psychiatrist who came in to talk to me faked a cell phone call as another test.
Also growing inside me was a concern that began earlier in the week that the people around me were in danger of a mental breakdown, while I wasn’t. I thought back to the morning after Thanksgiving break my senior year of high school, when the entire student body gathered in the assembly hall to hear my principal announce that one of my classmates had killed herself. I announced at the front desk of the ER I was checking in my mom and sister for mental health issues; my mom laughed nervously and sat me down. Later, when my dad came in, I quickly asked him to leave — I told him what I wanted him to hear the week before. Eventually it wasn't helping for my mom and dad to be in the room with me, so they waited outside, and the medical staff wasn't coming in because they had to attend to other patients.
In that locked, windowless room, I hearkened back to C.S. Lewis’ conclusion to his Narnia series. The characters arrive in the afterlife together, not immediately aware they had died on Earth in a train crash. Was this death, I pondered, and was I simply unaware I had passed? Was the afterlife a white room with a locked door, beyond which lies the world of the living, to which you can never return? And if I was to be left here by myself for eternity, was I in hell?
To a degree there are existential questions we face as people cannot be answered. Usually, instead of always questioning, we simply live our lives as best we can. But being in such an unstable mental state, I was gripped by a terror I never knew before.
I called for the nurse, fearing my heart would break down, and he calmed me down. With me broken and crying on the floor, my mom joined me, hugging me and telling me everything would be OK. My day at Piedmont got easier, although I was still a long way from sanity, much less recovery.
When I woke up from a much-needed nap, the medical staff and my family turned to the issue of my treatment going forward. I would clearly go from Piedmont to an inpatient hospitalization facility.
Ridgeview Institute, close to home in Smyrna, became the first choice, though initially we were told there weren’t beds available at Ridgeview. In my fearful state, I told my mom I didn’t want to spend the night in that locked, windowless room. Eventually, a bed opened up, and I rode in an ambulance up to Ridgeview.
I was involuntarily committed to Ridgeview under authority of Georgia law, Title 37, which provides for transport to an emergency facility upon the directive of a licensed mental health professional. Ridgeview staff and patients call this action a “1013,” because the mental health professional fills out a Form 1013 from the Georgia Department of Behavioral Health and Developmental Disabilities to authorize the transport. Upon arrival at Ridgeview, I went through another intake interview, then entered the adult inpatient facility, also known as Cottage C.
No one wants to end up in Cottage C.
While I received an exceptional level of care, it’s also the kind of place people tell horror stories about, mostly because while patients are there, they’re in a state of mind they cannot understand, surrounded by patients also in a state of mind they can’t understand. At least the surroundings don’t look like any mental facility you’ve seen on TV or in movies; I’d liken the look to one of lodges in Georgia’s state parks. Of course, in Cottage C, you’re not on vacation.
I can't exactly say why, but by the time I reached Cottage C, my episode progressed from delusion closer to the point of the psychotic break. The record of my intake interview shows I still believed I was the focus of the national media, and reports I said, "I am the story." As an extension of these delusions, I believed the fellow patients in Cottage C were public figures or celebrities, lying about who they were.
For several days, my belief the medical staff was acting for my benefit progressed into my thinking I thought every action around me was previously scripted, and I was surrounded by actors, given roles and motivations and ad-libbing conversations with me. I didn't quite think I was in a "The Truman Show" style situation — didn't believe my actions were being broadcast to a television audience, but I did go about that first day feeling I was on the cusp of exiting a Plato's Cave set up for me by a national conspiracy. If I just could get to the real-life equivalent of the end of the episode, or the last level of the video game, I would walk out freely into a brave new world. I spent most of the next day shunting about the facility, considering every interaction to be a new plot point.
One of the first things I did, as soon as I could find a pen, was to write the numbers from "Lost" on the back of the green wristband that denoted my name, date of birth and assigned psychiatrist, as a way of establishing I could at least remember 2+2=4. Of course, I took the wristband off as soon as I thought it was holding me back from reaching the end of my journey.
The first psychiatrist's report, taken that afternoon, reports I was disoriented, in and out of the room and suffering from hallucinations and delusions of an unspecified nature. I recall thinking he wasn't a physician but just an actor in a beard and a white shirt and therefore couldn't help me. In a class about Cottage C and its purposes, I couldn't sit still, running between the meeting focused on addiction patients and the one focused on psychiatric patients.
Once I gained some sense of my surroundings, I ascertained family visitation was to take place at its regularly scheduled time, 5 p.m. on Saturdays. This, I thought, would be the moment I would exit the hospital, newly empowered to go forth to greater purposes. However, when I walked through the door to the room where my family awaited, I didn't see a sunlit crowd of prominent figures applauding me and my entry into a brave new world, but rather a simple, carpet-floored gym with family members visiting their loved ones, and my mom, dad, brother, and sister sitting in folding chairs.
I asked if they were there to take me out of the hospital; they responded they were not. I told them about the revelations I thought I'd had and the public figures I thought I'd met. But when I said a certain celebrity was in the hospital with me, my mom responded gently, "No, he's not." Upset my family didn't believe me, I stormed out of the gym.
Returning to the main part of the facility, I settled in, still striving to reach the next level. Then I saw the night staff I'd met upon my entry returning to their jobs, and it once again became clear the world I knew was on the outside and I could not return to it, at least for the time being. With the fresh memory of the locked, windowless room, I again feared I was trapped forever.
Choking up and nearing tears, I rushed back to the gym, where my family waited. As they circled around me, we prayed together. It’s one of my last memories of the five of us as a family.
After that first day, my memory gets pretty hazy. I started losing the date as I slept through entire days. One of the first things a staff member said to me was, "You're not going to remember everything," and though I didn't believe him, it proved true. I have to rely on the scribblings I wrote on borrowed journal pages and the backs of crossword puzzles, as well as my psychiatrist's notes.
The record of my initial interview reports I had tangential speech and grandiose ideas, was hyperactive and lacked sleep and was generally paranoid. The interviewer checked every box recommending inpatient treatment except detoxification. My psychiatrist reported I presented as either "extremely agitated or psychotic," and made suicidal statements at various points. At one point, still in the grips of that psychosis, I shouted to my psychiatrist, "I don't need to see you! I don't believe you!"
The doctors initially put me on a high dose of Geodon, an atypical antipsychotic, to treat my psychosis, and I had significant adverse physical reactions — I remember my tongue getting stuck outside my mouth, and being unable to speak. My delusions continued, and while the idea all my interactions were scripted began to pass away, I remained convinced I was surrounded by celebrities. My ravings about how my experiences in D.C. related to my manic episode made sense to me but were outside rational thinking of any observer, including my psychiatrist. And I slept, a lot, wandered the halls a lot, and wondered if I had lost track of the date and my memory.
One particular incident, about a week into my time at Cottage C, was a turning point in my treatment. In one group therapy session, a fellow groupmate struggling with schizophrenia said cameras in Cottage C were watching us, and we were all in danger there. At the same time, a group of new patients arrived, and since most of the patients I met in my first days in Cottage C had left, I hadn't formed relationships with the new people.
Rather than simply reaching out to them, I associated them with the danger my groupmate was talking about and feared they were trying to kill or take hostage everyone in Cottage C. According to the records, I pressed a panic button, and remember huddling in a corner, causing a disturbance, and eventually losing consciousness. My mother saw me during visitation that afternoon and said I was in a wheelchair barely cognizant of my surroundings.
I have no memory of the next few days, but after that day, I began to improve, although I remain unsure why. I assume medication and therapy helped me to become more aware of my condition and connected to reality. But I can't pinpoint a moment when I consciously decided to change my way of thinking, just like I didn't consciously decide to become delusional, just like I don't have a conscious knowledge of whether tomorrow will see another departure from reality.
But in Cottage C, I stopped pacing the hallway, would sit in one place during lectures and group time, and actively participated alongside my parents in the determination of my treatment going forward.
After 11 days in Cottage C, well over the average stay of three to seven days, I entered the Partial Hospitalization Program. I stayed on the Ridgeview campus, but slept in the Recovery Residence, a halfway house where we were allowed a degree of freedom. During the days, I went to two classes and two groups, focusing on the reality of my condition and stressors in my life, chief among them the impending divorce. I still had a way to go with my delusional thinking — although I recognized most of my fellow patients as regular people, I still thought the staff was taking certain actions for my benefit, and certain people were lying about who they were, until a therapist starkly told me, "When people check in here, we use their real names." I had to accept the reality I had a psychotic break and had to learn coping skills to help me avoid another one.
As I accepted my departure from reality, I feared a lifetime characterized by a constant inability to ascertain what is real and what is not. But my illness doesn't align with John Nash's schizophrenia or with the hallucinations that constantly follow him. Symptoms of a manic episode lasting a week are necessary for a diagnosis of bipolar type I. Including my grandiosity, delusions, paranoia and hallucinations, I also experienced other symptoms of a manic episode, including decreased sleep, talking more than usual, distractibility and racing thoughts.
Schizophrenia, on the other hand, is classified as a psychotic disorder, not a mood disorder like bipolar. While symptoms of schizophrenia like hallucinations and delusions may be present in a manic episode with characteristics of psychosis, as they were in my case, those symptoms don't go away for schizophrenics. I feel fortunate I don't have as severe a mental illness as schizophrenia, as I cannot imagine the demons with which schizophrenics must contend every hour of every day.
Eventually, I returned to live at home, and entered the Intensive Outpatient Program, which required I be at Ridgeview for half the day. My medications became stabilized, and I set up appointments with my psychiatrist in his private practice, and with a therapist outside Ridgeview. By October, I was released from the hospital, and in the spring, I returned to school.
The way forward:
The story doesn't have a happy ending. Sure, I haven't had a manic episode since leaving the hospital, but I've had significant struggles with the other side of bipolar disorder, depression. With no commitment lined up and weeks to kill after leaving the hospital before returning to school, I spun my wheels for a couple months, generally unable to do anything productive. I had a good spring last year, albeit one with a few bumps here and there.
But just when I thought my troubles were ending, I went through a major depressive episode, stopped going to class, withdrew from school and went back to Ridgeview. I'm back in school now, but I still struggle with depression, isolation and motivation, and worry whether I'll be able to complete college, because eventually, you have to get the credit hours.
Even if I graduate, get a job, start a family and generally live out my hopes and dreams, I'll still have to contend with my illness, and the lingering fear another psychotic break could happen at any moment. I will be in a different place psychologically than most people I encounter for the rest of my life.
And the stigma surrounding mental illness means many people will misunderstand my condition, seeing it as intentional laziness or anti-social behavior, or even thinking I'm dangerous. The stigma even seeps insidiously into my self-image — even though intellectually I know my depression is out of my control, it's hard to maintain the belief that a period of low functioning isn't just weakness.
Despite all these challenges, I still have hope, and I like to think my story will have a happy ending.