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An Unquiet Mind

I went directly from Touched With Fire to Dr. Lay Redfield Jamison’s An Unquiet Mind: A Memoir of Moods and Madness, her chronicle of her own battle with manic-depressive disorder and how it informed her career in mental health. Her candor about the extremities of her illness, and the criticality of maintaining medication upon diagnosis has given me much to think about.

My subject is how my own creative thought and action has been impacted by the illness and the medications I have taken. I am on an extremely low does of Risperidone (0.25 mg), and I question whether that is in part the cause of the collapse of my creative life. I am not Bipolar I, the extreme form. For all my excess and outlandish behaviors, I have never had a psychotic break. I believe I experienced a form of paredoila, seeing an old man’s face and a boar in the folds as the base of oak trees during my longs walks after precipitously quitting my job in 2015. When I walk the same paths I can’t see them clearly anymore. But there was nothing approaching hallucination.

My depressions were not the paralysis of despair. I was floating in a boat on still and windless gray sea at times, but never tempted to jump overboard. Some of my depression may have equally had roots in life experiences. I used to tell a prior pill doctor and the psychiatrist who helped me off Klonopin (and who first diagnosed me correctly) that given some of my life experiences in the past decade and more, I’d be a psychopath not to be depressed.. I currently take 20mg of generic Prozac. In the past I was given citalopram and buproprion. After reading about Dr. Jamison’s experience with discontinuing Lithium, I am increasingly inclined to continue my small dose of Risperidone, and consider whether I truly need to still be taking an SSRI after five years of remission, and ten years total taking them.

Something shut off the creative part of my brain, and I’m not entirely convinced it was solely remission of bipolar disorder. I always prided myself on my vocabulary, and yet I frequently find myself looking up words that I know I know. I noted above how my ability read, enjoy and analyze poetry evaporated with my remission, and how I turned to easier genre fiction. I just read Beloved because of the recent controversy, and it was a difficult slog. And I always enjoyed Faulker and Joyce re-reading Ulysses every other June or so. I feel like my concentration is strained in my sometimes complex work life in which I test computer software. My prior psychiatrist thought perhaps ADHD was keeping my associative though from organizing itself, and I was on guanfacine for a long while, and don’t recall precisely why I discontinued it. My general recollection is I went off that about the time of my bipolar diagnosis, and began transitioning away from Klonopin and toward the anti-seizure sort of medication.

It is possible what i am experiencing is just a factor of my age (64), but I desperately want to know if I’m drifting toward some form of dementia, or whether I am bringing it on myself through medication. To extend a person without advance statistical and methodological training can decode medical journal articles, a few things jump out at me:

  • There is evidence that long-term use of SSRIs for anxiety disorder may impact cognitive function..
  • There is evidence that Bipolar Disorder is associated with cognitive impairment, but the studies have been on mostly BP1 and/or inpatients, i.e., people with extremely acute conditions.
  • Long term studies starting in childhood indicate that people with subsequent BP disorder often have higher cognitive function earlier in life.

What I cannot find is any study that looks like the difference between treated and untreated individuals, probably because if you’re an inpatient you are having severe, schizophrenic symptoms. I don’t see anything that looks specifically at the treatments such as anti-psychotics as possible actors in decline in cognitive function separate from the disease.

At this point, my dosage of Risperidone is very low — 0.25 mg a day — so for now my inclination is to continue that medication to avoid some of my past, unhealthy behaviors. As extended use of SSRIs might affect cognition, I’m going to start by titrating off of Prozax.

I’m not exactly excited about discontinuing the Prozac. I’ve experienced a brain zap and it’s a startling and unpleasant experience. But SSRIs are also associated with some decline of cognitive function, and I think that is where I will take the conversation with my psychologist. If I have to worry about dementia in my old age as an unavoidable process, I’d rather start addressing that now. And I believe reducing my intake of psychotropic drugs is an important first step on eliminating those as a cause.

Well Bottom Blues

—Hand me back my crawl, condign Heaven. Tighten into a ball elongate & valved Henry. Tuck him peace. Render him sightless, or ruin at high rate his crampon focus, wipe out his need. Reduce him to the rest of us

John Berryman, Dream Song No. 25

In August 2005, not only the levees of New Orleans broke. A damn that had contained a wild side of my nature also burst and inundated my life. The two most obvious examples of the change were the precipitous decision to move my family to a disaster zone, and the place I chronicled that journey: a blog titled Wet Bank Guide. The name was a play on the newspaper where I once worked on the West Bank of New Orleans and an apt description of its purpose. It was at first a journalistic exercise in collecting information for the Katrina diaspora, but quickly morphed into a very person journal of my own experience of loss and disruption, the survivor guilt that led to our move to New Orleans, and a chronicle of the city’s woes and moments of triumph.

This sudden outburst of writing and action was itself one long moment of constant cycling triumph and woe, easily recognized from outside or in retrospect as a long period of cyclothymic if not outright manic-depressive behavior. At first it was manageable cyclothymic behavior, a tremendous outburst of creativity and activity. The group of fellow bloggers about Katrina organized an annual conference called Rising Tide on the future of New Orleans. I was elected housing chair of the Mid-City Neighborhood Recovery Group, an ad hoc assembly of a few score people that came together to participate in the city’s recovery planning process when the formal neighborhood organization declined to participate. I started keeping a list of every person murdered in New Orleans for several years.

And I wrote: constantly. In the early months of the blog I spent countless hours after work scouring the news for information to share and comment on, frequently forgoing more than a few hours sleep. I started for the first time in decades to write poetry, and was regarded good at it when I immersed myself in the local poetry scene. I sat in a audience of half a hundred people mostly poets and the state poet laurate pointed out the New Orleans poets in attendance, myself and another well-established and published writer. And I started a second blog: Toulouse Street, Odd Bits of Life in New Orleans, a more personal and eccentric view of the city where one blog reviewer said I let my freak flag fly. When the local newspaper shut down its book page and laid off its editor, I started Odd Words, collecting all the literary activity in the city in a weekly column. I also covered and wrote about events such as the Tennessee Williams Literary Festival. I started to review plays for a local on-line newspaper during the annual In—– Festival. I co-founded a publishing company to collect and publish the Katrina bloggers.

I was the whirlwind.

There were other symptoms. An ill-advised, mostly platonic affair with another blogger that broke my already floundering marriage. Later a period of excessive late nights (and some dawns) of drinking and random, one night stands even while I was in the early stages of a post-marriage relationship that has lasted these eleven years. Less destructive but instructive was spending on random things, like a small conga drum I never learned to play. At one point I was adding didgeridoos to my Amazon Wish List. When my job laid me off in 2010 (contemporaneous with my separation and divorce) with healthy severance package, I went back to school to finish the degree I abandoned in the late 1970s. And when I graduated in 2014 I took a memorable but ill-advised trip to a summer semester in Italy, from which I came back after forty days and nights exhausted and broke.

I was a mess.

It wasn’t the first time in my life. My twenties married to an alcoholic as a joyful enabler were probably symptoms of the same disorder in my life. I can think of examples going back to my teens when I discovered that alcohol and drugs could unlock the person inside my frighteningly shy shell. The worst of it came and went in cycles. I don’t remember periods of deep depression, but I remember the cycle of high-flying feeling and the behavior it engendered. That sort of behavior was finally quieted by my marriage and children, for fifteen mostly peaceful American-dream years of raising the kids, buying houses and increasingly practical cars. It all came undone in 2015, and I became the whirlwind once again.

I had sought psychiatric help and was prescribed a varying and colorful list of anti-depressants, and an anti-psychotic for mood disorder. I was taking 2 mg of Klonopin a day to control what was initially diagnosed as anxiety disorder. I had suffered from something like that for as long as I can remember. And I began to undergo another transformation. I began to withdraw from life and all of my activities. I was becoming reclusive and loosing what had come to be important parts of my life, particularly writing. I stopped publishing Odd Words, a third book for our press was abandoned after the initial printing and my circle of friends shrank. I kept up the Toulouse Street blog, and at one point wrote Confessions of a Pill Eater:

I can’t write. I am amazed I made it to 600 words without a syllabus and a deadline. The first draft of this was created at the end of June (2012). Two months to manage 3,800 words. I try write, to do the Work, just as I can get up and make my daily 7:30 a.m. conference call for Moloch. You set a time, you sit down and do it because writing is The Work, but now I find myself staring at my reflection in the blank page. It just doesn’t come. I started a long poem a while back and that is The Work, sitting down and filling in the plan, adjusting as you go along, finding the lines and fitting all the pieces together, but I can’t focus enough to make progress… Perhaps my writing was an ephemeral phenomenon, a temporary imbalance in the brain waiting to be set right… The blank page stares back at me, and I turn away.

This seemed as consequential as my earlier bouts of maniacal behavior. I felt neutered as a human being as my muse or whatever withdrew into pharmacology. I left the care person I called The Pill Doctor and sought out an M.D. Psychiatrist who happens to have a shelf of Poetry magazine in his waiting room. He helped me to kick Klonpin but also diagnosed me (correctly I believe) as Bipolar II, and started me an another anti-psychotic, Risperidone, and continued my on an anti-depressant. Over a period of time my life settled down, although I was employed only as an Uber Lyft driver, and moved in with my partner to make the finances of that work. My life stabilized. The late nights drinking and carousing went away. I found another professional job after a long search, and settled once again into a reasonably quiet life. I had my enthusiasms as I had my entire life, and my bouts of morose introspection, which some people casually attributed to being born a Gemini, but were in reality the expression of a psyche that had always been cyclothemic and had in the past erupted into bi-polar disorder .

My life as a person of action and writer had, however, come to an end. I had stopped publishing the literary listings a few years earlier, and abandoned the Toulouse Street blog to posterity. It no longer outranks the Doobie Brothers on Google. I gradually stopped writing poetry because it was too difficult to get into the headspace that requires. I gradually stopped reading poetry, as I found difficult works I had once treasured like the Dream Songs quoted at the top to be an alien language I could no longer decode. I took refuge in reading genre stuff, science fiction and fantasy, and became a devotee of Terry Pratchett.

Recently I stumbled into the Bipolar Creativity and Illness Group on Facebook, and promptly read Kay Redfield Jamison’s Touched With Fire: Manic-Depressive Illness and the Artistic Temperament. I think I was always drawn toward the manic ones, the Confessional poets, people who reflected back my own inner turmoil in works of great beauty and power. It is no accident this blog starts with a quote from John Berryman, or that my self-medicating self was intrigued by Charles Bukowski. The morose side of my personality deeply identified with the Bukowski who wrote “The Consummation of Grief.

I don’t doubt my diagnosis; only my treatment. It is obvious that psychopharmacology has changed who I am in more ways that those intended by medicine. It crushed someone with clear creative potential as collateral damage. After reading Jamison’s book, I am determined to re-evaluate who I am and how I behave, to try to recover some of that without going off the rails. And in the course of this, to adjust or even forgo my current medication. A dose of 0.25 milligrams of Risperidone is apparently not enough to crush this resolve. This is more than I have written in years. I intend, however, to venture into the dark territory of discontinuing medication, as I kicked the Klonopin years ago, and venture to discover if I can recapture the creative impulse and — more importantly — the pathways in my mind that understood, could

decode and recreate the intricacies of creative writing.