When it comes to mental illness, which reality is real?
This story originally aired on April 27, 2019.
I’ve been on and off drugs for decades — the pharmaceutical kind, for my brain. When I was 13 or 14 years old, and before my doctors looked too closely, the diagnosis was garden-variety depression and generalized anxiety disorder, aka “you have a lot of panic attacks and we’re not entirely sure why.”
And it was really hard to prove any different. I was terrible at keeping both mood logs and therapists. I was taking SSRIs, one of the most common families of antidepressants that can trigger mania — which shows up as an animated, elevated mood.
In retrospect, this was the case for me, and I took it as a sign that the pills were working. When I would crash later it would just seem like a bad fit.
Bipolar disorder is more likely to be misdiagnosed as major depression in women — maybe because of hormonal cycles, or because of everyday sexism. And bipolar disorder often comes with a side of ADHD, which is even more likely to be missed in girls. So, in my very early teens — when I went from being a voracious reader to just skimming my way through every school assignment — I thought it was personal failure.
That’s how it took until my 30s to end up on my current medication cocktail: Escitalopram, an antidepressant, wards off my panic attacks, helped along by an as-needed emergency panic pill. Lamotrigine, an anticonvulsant that also treats bipolar, stabilizes my mood. And then there’s the newest addition to my pill case — levoamphetamine and dextroamphetamine, commonly known as Adderall, because a doctor finally saw my inability to focus as something that maybe couldn’t be solved with cognitive behavioral therapy.
I’ve gotten to know myself pretty well over the last three decades without these mood stabilizers and pharmaceutical speed. But the person I’ve known for those three decades is frequently out of touch with reality.
A couple of moments from my late teens stand out to me pretty vividly. The first was when I was about 17, waiting alone for a bus in West Seattle, and I looked up at the sky and suddenly my whole world was this big, empty vastness, like the eerie silence of an atom bomb in a movie. Nothing was empirically wrong — my feet were on the ground, I was physically healthy, I had everything I needed for the day. But I was overwhelmed and I was detached, floating above reality looking down, and it felt insurmountable.
A couple years later, I stumbled from my dorm room to the student health center with a sharp, aching coldness in my chest. I was given a clean bill of health and a psychiatrist’s business card. It was the biggest panic attack I’d had so far by a long shot.
So, I white-knuckled it for a few years with miniature versions of that major panic episode, sometimes daily. I was constantly taking my pulse, getting dizzy spells, trying to shake off a seemingly permanent feeling of impending doom.
This fight-or-flight feeling, this tightness in my chest, this being absolutely sure I am dying when I’m not — it’s so detached from reality. So is racking up credit card debt like it’s Monopoly money during a high, or getting so low I can barely make a frozen pizza, much less leave the house or my bed.
But the thing I grapple with — looking back over, again, three decades of untreated and undertreated mental illness — is that this is my reality.
I’ve taken drugs that I’ll just say were not prescribed by a doctor to help me cope with my sometimes overwhelming world. Then, I was on drugs, in the Reefer Madness sense.
But what am I doing now? I’m still on drugs, drugs that affect my mind, even though I had to do a lot of work on myself to get there. It helps that I have the luxury of not self-medicating: I have insurance and experience navigating the medical system; not everyone does.
So, which version of me is the altered state? Is the me with undiagnosed mental illness the original or the remix? What about the me that’s functional — but with a little chemistry added to bring me back to earth?
Yeah, I know we’re always growing as human beings. I was never going to be the same person I was at 17 or in college, mentally ill or no. But it’s still the question of my wiring that I can’t shake. I could still get that same feeling I had at that bus stop — where I’m floating above my own reality with an unshakable feeling of dread — from a medium to bad acid trip. Is my rescue Xanax, which some people take recreationally, actually my anti-drug?
And it’s the attention deficit thing that maybe gets to me the most. If I weren’t too terrified by my daily panic attacks to take Adderall in college to study, I would’ve been considered… altered, but it turns out that I actually, really, clinically needed it to study — who knew? I’d been trying to claw my way toward normalcy, but it turns out there’s just been something in the way the whole time.
I realized the amphetamines were actually fixing some of my wiring when I managed to read for pleasure again. Not just read for pleasure, but read two books, cover to cover, in four days. Reading had been one of my lifelong loves, but it’s embarrassing to admit: I hadn’t read multiple books that quickly in 20 years.
But, as we all know, your best self isn’t typically your true self. Things aren’t perfect. My cocktail probably isn’t even perfect — I’ll probably be adjusting that my whole life. I’m still adjusting the amphetamines because, hey, it turns out they have some pretty potent effects.
And so I’ve started to think that there’s no part of us that isn’t altered in one way or another. Like, maybe I’m just as augmented when I’m sober in the middle of the day as when I wind down with some pot or a glass of wine in the evening — and that I’m just capable of different things and have access to different parts of my brain.
Or maybe that’s just the speed talking.