There is a sound that plays in the back of my skull every morning before I open my eyes, and it is not a ringing, not a voice, not a hum — it is the sound of knowing that before I can become a person today, I must first become a chemistry experiment, and that who I am is bracketed on both sides by a small white tablet and a glass of water on the nightstand, and that until those two things meet inside my body, I am not safe to be around, not safe to think, not safe to exist in the world as a functioning human being, and so I lie there sometimes for minutes, sometimes for an hour, listening to the ceiling fan turn and feeling the weight of what it means to be someone whose mind is not trustworthy on its own, whose thoughts will unravel without pharmaceutical intervention, whose perception of reality is contingent upon a chemical compound manufactured in a facility I will never see, tested in trials I will never understand, prescribed by a doctor who sees me for forty-five minutes every three months, and yet this compound, this tiny disc of molecules, is the thin membrane between me and a world that would otherwise collapse into hallucination, paranoia, anxiety, dread, and the particular kind of darkness that does not merely sad — it disassembles.
I was not always this way, or maybe I was and did not know it, which is perhaps the cruelest part — the not-knowing — because there was a version of me, younger, thinner, louder, who believed that the strange feelings were just sensitivity, that the whispers in the hallway at night were just the house settling, that the certainty that everyone in the room was thinking something terrible about me was just social awkwardness magnified by a brain that had always run a little too fast and a little too hot, and I told myself stories about what I was creative, intense, a deep feeler, a person who experienced things more vividly than others and for a while those stories held, the way a cracked dam holds, the way a leaning fence holds in a wind that has not yet reached its full force, and then one day the wind came, and it did not stop, and the dam broke, and I found myself standing in a psychiatrist's office at the age of twenty-something trying to explain that I had heard a radio playing in an empty apartment, that I had been followed by a man who did not exist, that my thoughts were being broadcast on frequencies I could not tune out, and the doctor did not look surprised, which was both a relief and a devastation, because his calm told me that what I was experiencing had a name, and the name was schizophrenia, and the name came with a prescription pad, and the prescription pad came with a new life, one I had not chosen, one I did not want, one that would require me to swallow obedience every single day for the rest of my natural life in order to remain a person the world recognized as a person.
The medication works — I want to say that plainly and honestly because it matters — it works the way a tourniquet works, the way insulin works, the way a wheelchair ramp works, which is to say it does not cure, it enables, and enabling is not nothing, enabling is the difference between lying on a floor staring at patterns in the ceiling while your mind tells you that the walls are breathing and sitting in a chair having a conversation with your mother about what to cook for dinner, but enabling also means dependence, and dependence means that the boundary between the medicine and the self becomes so blurred that you no longer know which emotions are yours and which are the drug's, whether the flatness you feel at a birthday party is the illness or the side effect, whether the tiredness that settles into your bones by two o'clock every afternoon is the depression or the antipsychotic, whether the shaking in your hands is anxiety or akathisia, and you begin to live inside a Venn diagram where you are the overlapping space, neither fully sick nor fully well, neither fully medicated nor fully yourself, just a body navigating the narrow channel between too much dopamine and too little, between psychosis and numbness, between the voices and the silence, and you learn that neither side of that channel is pleasant, that both shores are hostile, and that the middle of the river is the only place you can exist, and even there the current is strong and the water is cold and you are always, always swimming.
Depression lives in the same house, and it is not the glamorous sadness of films and novels — it is the inability to initiate movement, the way your limbs become filled with something heavier than fatigue, something geological, something that feels like the earth itself is pulling you downward through the mattress and into the floor and into the dirt, and you lie there knowing you should get up, knowing the dishes are piling up, knowing the rent is due, knowing your mother called twice yesterday and you let it ring, and the guilt of not doing these things piles higher than the dishes and heavier than the earth-pull and compounds the paralysis until you are trapped under a mountain made of your own unmet obligations and the only thing that makes it possible to move is the other medication, the antidepressant, which adds another column to the daily architecture of chemicals that holds up the roof of your mind, and you take it and you wait four to six weeks for it to reach therapeutic levels and during those four to six weeks you are still depressed but now you are depressed with hope, which is arguably worse, because hope means you are measuring time again, and measuring time means you are aware of each day that passes without improvement, and each day is a small disappointment stacked on the last, and the stack grows and grows until either the drug kicks in or it does not, and if it does not you begin the process again with a different molecule and another four to six weeks, and this is your life, this is the rhythm, trial and error conducted on your own brain with your own consciousness as the only measurement tool, and you are both the laboratory and the experiment and the researcher scribbling notes about whether today felt slightly more bearable than yesterday, and the data is unreliable because you are compromised, you are the instrument that is being calibrated by the instrument itself, and there is something absurd about that, something almost funny if you could feel humor, which you cannot, because the depression has taken that too, the way it takes everything, not all at once but slowly, the way rust takes a car, until one day you look at the thing you used to be and do not recognize it.
Anxiety sits on top of everything like a lid on a boiling pot, pressing down, holding in, vibrating with the pressure of all the things you cannot express — the fear that the medication will stop working, the fear that the diagnosis will change, the fear that the doctor will retire and the new doctor will not understand your case, the fear that the pharmacy will be out of stock and you will miss a dose and the withdrawal will begin, and withdrawal from psychiatric medication is not like withdrawal from other things, it is not dramatic and cinematic, it is slow and internal, a gradual return of the symptoms the drug was holding at bay, the whispers growing louder, the shadows growing faces, the paranoia creeping in like fog under a door, and you know it is coming and you cannot stop it and the anxiety of that knowledge sits in your chest like a stone, and the anxiety medication is supposed to dissolve the stone but instead it makes you feel like you are watching your own life through glass, muted, detached, present but not participating, and you wonder if this is what normal feels like for other people — this muted, glass-walled distance — and if so, how do they stand it, how do they walk through the world like this, and the answer is that they do not feel this way, that the glass is the drug and not the default, and the realization makes you jealous in a way that you are ashamed of, because jealousy implies that you believe other people have something you do not, and you do believe that, you believe it every day, you believe it when you see someone laugh without effort, when you see someone make plans without first consulting their pill organizer, when you see someone cry and mean it, because your tears — when they come — are suspect, they could be the illness or the drug or the withdrawal or the side effect or some combination of all four, and you no longer trust your own tears, and that is a loneliness that is difficult to describe to someone who has never had their emotions medically mediated, the loneliness of not trusting the authenticity of your own feelings, of running every emotional experience through a diagnostic filter before allowing yourself to feel it, of thinking "is this real or is this the schizophrenia" every time you have a strange thought, "is this joy or is this mania" every time you feel good, "is this sadness or is this the depression breaking through" every time you feel bad, until the act of feeling becomes an act of surveillance, and you are both the prisoner and the guard, watching yourself from inside yourself, never resting, never off duty, always monitoring your own mind for signs of slippage, and the monitoring itself is exhausting, more exhausting than the symptoms it watches for, and you wonder sometimes if the watching is the real illness and the schizophrenia is just what happens when you stop watching, and then you wonder if that thought is itself a symptom, and the spiral continues, inward and downward, and the only way out is the pill, always the pill, always the small white assurance that for today, for this hour, for this moment, you are held together by something stronger than your own will, and that without it you would come apart like a book with a broken spine, pages scattering, narrative lost, story incoherent.
There are people who say things like "have you tried meditation" or "my cousin took supplements and felt much better" or "have you considered that the medication might be making it worse," and I understand that these people mean well, I understand that they are reaching toward me with the only tools they have, which are the tools of the well, the tools of the unmedicated, the tools of people whose minds do not threaten to dissolve without chemical reinforcement, and I try to receive these offerings graciously the way one receives a casserole from a neighbor when your house has burned down — it is kind, it is warm, it is not the thing you need, which is a house, which is a mind that works, which is a morning that does not begin with a pill and a prayer that the pill will be enough — and I smile and I say thank you and I do not say what I am really thinking, which is that you cannot meditate away a hallucination, that no supplement has ever silenced the radio that plays in empty rooms, that the medication is not making it worse, the medication is the only reason I am able to sit here in this coffee shop having this conversation with you instead of standing in the parking lot convinced that the cars are communicating with each other in a language I almost understand like the Autobot, and I do not say this because it would frighten you, because the reality of schizophrenia is frightening in a way that the wellness culture cannot accommodate, because wellness culture is built on the premise that the mind is a garden that can be tended into bloom, and my mind is not a garden, my mind is a fortress under permanent siege, and the medication is not fertilizer, it is the wall, and without the wall there is no garden, there is no bloom, there is only the siege and the falling and the screaming silence of a mind that has turned against itself.
And yet — and this is the part I am most afraid to write, the part that feels like betrayal — there are days when I am grateful, not for the illness, never for the illness, but for the clarity it has forced upon me, the way it has stripped away every illusion of control, every comfortable about the sovereignty of God that make me sane and keep functioning biblically. All of us stood on the edge of our own dissolution and been pulled back by a molecule, we understand something about human fragility that I do not think you can learn any other way, you understand that we are all one chemical imbalance away from a completely different life, that the border between sanity and madness is not a wall but a membrane, permeable and thin, and that the people on the other side are not monsters or mysteries but people like you who woke up one morning and found that the membrane had ruptured, and you carry this knowledge with you like a scar, visible or not, and it changes how you see the woman talking to herself on the bus, the man rocking in the emergency room, the teenager who has stopped coming to school, because they are not "other" to me, they are mirrors, they are the versions of myself that exist in parallel universes where the prescription was never written or was written too late or was written for the wrong thing, and I feel a kinship with them that I cannot explain to my therapist without her raising an eyebrow and adjusting her notes, a kinship that is not romanticized suffering but simple recognition, the way one refugee recognizes another, the way one survivor looks at another and knows without speaking what it cost to be sitting in this in this room, in this moment, intact enough to be mistaken for someone who is fine.
But I am not fine. I want to say that clearly because the world keeps asking me to say that I am fine, and I am tired of the performance. I am functional. There is a difference. Functional means I take my medication and I go to work and I pay my bills and I nod when people ask how I am doing and I say "good, thanks" and I mean "I have not been hospitalized in years and the voices are quiet today and the depression is a low hum instead of a scream and the anxiety is manageable although it much worse now, which means it is present but not paralyzing, which is the best I can hope for, which is not the same as fine, not the same as well, not the same as the thing you mean when you say 'how are you' and expect a one-word answer to fit inside a hallway greeting." Fine is for people who do not arrange their entire lives around pill schedules, who do not set three alarms to remember their evening dose because missing it by more than a few hours means the beginning of the slide, who do not carry a backup supply in every bag and jacket and car compartment like a diabetic carries glucose, who do not have a psychiatrist's number saved under "Emergency" in their phone, who do not know the names of antipsychotics the way other people know the names of football players, who have never had to sit in a waiting room filling out a questionnaire that asks "Have you felt that people are reading your thoughts?" and check the box that says "Sometimes" and wonder whether checking "Sometimes" is honest or strategic, whether honesty will lead to a higher dose and strategy will lead to freedom that is actually just a slower relapse, who have never had to explain to a new partner that there are nights when they should not be alone, that there are mornings when getting out of bed is not laziness but a neurological negotiation, that there are moments when the world will look different to them than it looks to anyone else and not in a poetic way but in a terrifying way and the only thing that keeps the terror at bay is a daily act of chemical submission that will never end, that will never taper, that will be the first thing I do every morning and the last thing I do every night until the day I die, and that even on the day I die someone will need to account for the pills, will need to dispose of them properly, will need to close the bottle and throw it away, and even in death the medication will be there, a ghost in the medicine cabinet, a reminder that this life was managed, not lived freely but managed carefully, like a city under constant threat of flood, the levees always maintained, the pumps always running, the watchmen always posted, and the river always, always rising.
What I want — what I think many of us want, those of us who live in this particular intersection of schizophrenia and depression and anxiety and the daily pharmacology that keeps us upright — is not to be cured, because we have made a kind of peace with the permanence of our condition, a peace that is more truce than treaty, more exhaustion than acceptance, but a peace nonetheless, and what we want instead is to be understood, to be seen as whole people rather than diagnostic categories, to be allowed to talk about our medication the way a diabetic talks about insulin — matter-of-factly, without shame, without the implicit suggestion that we are somehow weaker for needing it, without the subtle cultural messaging that says if we just tried harder, ate cleaner, meditated longer, walked more, journaled better, we might not need the pills at all, and we could be free, and the freedom they imagine is a freedom none of them would actually want, a freedom indistinguishable from chaos, a freedom that sounds like radios in empty rooms and looks like shadows with faces and feels like the earth pulling you down through the floor and into the dark, and I have been to that country, and I am not going back, and if the cost of staying here, in the land of the functional, in the province of the managed, in the narrow strip of livable ground between the river and the wall, is a pill every morning and a pill every night and a pill in the afternoon when the anxiety presses too hard, then I will pay it, I pay it every day, I will pay it tomorrow, and the day after, and the day after that, not because I am brave — I am not brave, bravery implies a choice and I do not have a choice — but because the alternative is not survival, the alternative is the flood, and I have seen the flood, and I choose the wall, and I choose the pill that builds the wall, and I choose the life that the pill makes possible, diminished though it may be, muted though it may feel, half-lived though it sometimes seems, because it is mine, it is the only one I have, and it is built on the thinnest of foundations, a foundation of molecules and minutes and the stubborn refusal to let the mind win when the mind has turned against itself, and that refusal — quiet, daily, unremarkable, invisible to everyone but me — is the bravest thing I have ever done, and I do it every single day, and nobody knows, and nobody will ever know, nor nobody really care and that is the loneliest part of all.
Written from the inside. For those who live there too.
Tags
Mental Health