Defying the Verdict: My Bipolar Life

IN THE COURTROOM, my parents and my Baltimore pastor, Bishop B., stood with my lawyer and me as the judge heard my case. The judge’s ruling included something about my need to be evaluated. That night, I woke up in a medication-induced fog at Springfield Hospital Center, the upgraded version of the Maryland State mental institution where my grandmother resided years earlier.

Her memory, intelligence, orientation and abstraction capacity cannot be assessed. She has no insight, totally impaired judgement and excited and agitated mood and unpredictable behavior. She is quite angry and hostile.

The following day, March 16, 1982, Dr. I. Turek provided the following Mental Status Examination, which is used to determine a patient’s readiness for discharge.

In this interview Charita is observed to be tall, physically healthy, appearing her chronological age, female who was dressed properly. She, however, carried a posture which was markedly bizarre and facial expression which was quite grimacing, silly and inappropriate. Her motor behavior is observed to be moderately impared. She is pacing, restless, fidgety. Her general attitude was markedly uncooperative, moderately inappropriate. She had impaired functioning goal-directed activities. She was dramatic, sexually seductive. Her mood was markedly euphoric and hypomanic. Her affect was inappropriate in a moderate degree. Her speech was quite dramatic with an average rate and productivity. However, she was incoherent, irrelevant, evasive, with loosening associations. She was muttering at times in an unintelligent way. The content of thought could not be ascertained from her because she was so uncooperative. However, when she was left to spontaneous conversation, she stated the following: “Kelvin, stop those voices.” She kept on screaming about Kelvin and Kelvin, she stated, was her brother. Then she continued on saying, “Do you know where Kelvin was born? Where is Kelvin? Are you Kelvin? I talked to him yesterday. Pluto is Elva’s sister. Earth to Pluto, Earth to Pluto, Come in Elva, come in Elva. You don’t have to do that that way. This is a new City.” She then stood up and walked to the window and looked outside and said, “Beautiful, this is really Sykesville. I want to be in Brooklandville. Blue is for hope, for Penny. My name is Gloria Penny. Penny is my best friend. Gloria is my best friend. I need Bill.” All my efforts to get her to talk rationally were fruitless. She tried to seduce me; tried to sit next to me. He wanted to read what I was writing. She was laughing and having a good time. She did not respond to the questions of delusions or hallucinatory experiences.

Her orientation could not be tested. Her cognitive functions seems to be disturbed. She had marked degree of destructibility and marked degree of attention disturbances. Her judgement was poor. Insight nil.

PROVISIONAL DIAGNOSES:

Axis I:

296.44

Bipolar disorder, manic, with psychotic features

Axis II:

V71.09

No diagnosis on Axis II

Axis III:

Her previous laboratory reports indicated Cushing’s Syndrome. Needs to be clarified further.

NOTE FOR HEARING OFFICER:

This patient is mentally in need of impatient hospitalization. She will be a danger to her own safety if she is discharged into her own custody.

This time, the doctors refused to let me come home if I did not agree to be medicated with lithium. It took weeks for me to benefit from it. I was also prescribed thorazine, a potent antipsychotic that is now administered to patients in much smaller doses than that prescribed to me. Internally, the combination of drugs flattened my affect, making me feel like a zombie and bringing back unwelcome memories of my childhood visit to see Granny in Springfield.

As the psychotherapist predicted, each successive manic-depressive episode I experienced brought a higher high and a lower low than its predecessors.

With prolonged use, lithium’s most dangerous side effect is kidney damage. When I discussed not wanting to take the risk with Valerie, she assured me, with chief sibling assurance, “You’ll be all right.” Adding humor, she continued, “If your kidneys fail, you have six siblings. One of us is sure to be a match.”

Karen visited daily. Since she is not a talkative person, she encouraged me by showing up. Anytime I was ill, she dropped whatever she was doing to do, what I labeled, asylum duty. Her presence felt like she was sitting shivah for me, as is the Jewish custom after someone dies. I was still in my body, but the life I had embraced had ended. Most evenings, she brought my mother with her.

Besides the first night of my commitment, my contact with my father was solely by phone. I believe his experience in Connecticut in 1980 when he could not prevent my CVH commitment had traumatized both of us. For the second time, he could not protect me from myself. His command that I rest my nerves was no longer enough to keep my mood balanced.

My mother brought a gentleman who had entertained a romantic interest in me to the institution in an attempt to cheer me up. As you might guess, the visit extinguished that spark. My dad had warned my mother that bringing him to visit me at a psych ward was a bad idea. I had no romantic interest in this suitor, but my mother saw his potential as a son-in-law. Yet I wondered, Is this a bad omen? If I was indeed broken, as in no longer smart—would anyone ever want to marry me?

Members of my church visited along with their children. A few years ago, I told my friend Jo Ann, “I was horrified when you brought your children to visit me at Springfield.” I related the fear awakened in me when I visited my grandmother in an institution.

She laughed a little, then challenged, “Charita, name one child who was traumatized by those visits. We brought them because they loved you and asked to see you.” At least this Springfield upgrade smelled clean, I concluded internally, after admitting the children suffered no harm.

At one point in my commitment, I was assigned a roommate who punched me in the jaw in a fit of rage that had nothing to do with me. A tech arrived in response to my shrieking and removed her from the room. She was assigned to another room where the staff could watch her more closely. This is the incident I remember most vividly from this nightmarish experience.

My Springfield Hospital Center Release Summary was submitted by M. Malayeri, M.D.

APRIL 16, 1982

22-year-old, black, single, female admitted to Springfield Hospital Center March 15, 1982 with two doctors certificates from Sinai hospital because she was excited, manicky, hallucinating auditorily, hearing voices from God, paranoid, grandiose, delusional, unpredictable, and exhibited some violent behavior.

When she was seen for Mental Status Examination on March 17, 1982, she was found to be grossly psychotic. She was angry, hostile, demanding and abusive. She presented psychomotor agitation and she was unable to give proper account for her admission. Most of the background information was obtained from her mother [who] reported that she had a previous psychiatric hospitalization from December, 1980 until January, 1981. She was hospitalized at Connecticut Valley State hospital in Middletown, Connecticut for two weeks. She was diagnosed as hypomanic. Apparently, since then she had no outpatient therapy, except for the few times she was seen at Sinai Outpatient Clinic and was not given any medication. There was no history of using drugs or alcohol in the past. On mental status examination she was observed to be tall, physically healthy, appearing her chronological age. She was dressed properly. However, she carried a posture, which was markedly bizarre and facial expression, which was quite grimacing, silly, and inappropriate. She presented psychomotor agitation. She was pacing, restless. Her general attitude was markedly uncooperative. She was grossly incoherent and irrelevant. Affect was inappropriate and she was mumbling at times in an unintelligent way. She had grandiose delusions with persecutory thoughts. Her impulse control was poor. Her behavior indicated having auditory hallucinations. She denies suicidal and homicidal thoughts. She was alert and oriented. Her insight and judgment were poor. Impression was Bipolar disorder, manic, with psychotic features. During this term of hospitalization, she received chemotherapy, milieu therapy and supportive therapy. She also participated in activity therapy. She was treated with the anti-psychotic drug; Thorazine. She gradually and slowly showed improvement. Psychomotor agitation, delusional thoughts, auditory hallucinations subsided. Since March 24, 1982, Lithium Carbonate was added to her treatment. She started home visit on 4-2-82, which was reported successful, and on 4-16-82 she was discharged to her family from home visit.

FINAL DIAGNOSIS:

Axis I:

296.44

Bipolar disorder, manic with psychotic features

CONDITION ON DISCHARGE: She was quiet and cooperative and she was free from psychotic symptomatology. She was considered to be in full remission.

PROGNOSIS: Short term prognosis is favorable. Long term prognosis considered to be guarded.

MEDICATION:

Thorazine 100mg. a.m. and 200 mg. at bedtime Lithium Carbonate 300 mg. three times a day

AFTERCARE PLAN: Arrangement was made by social worker to be followed at Sinai Outpatient Clinic. (Psychiatric and Medical)

RESIDENCE:

4536 Finney Avenue, Baltimore, Maryland, 21215

When I got home in April, my body felt heavy, like wet rags needing to be wrung out. Mentally, I felt like I was slogging through molasses, blindfolded. Meanwhile, I tried to forget the therapist’s diagnosis of eventual custodial care, but it recurred in my thoughts, awakening a feeling of dread. My family did their best to cheer me. No longer on a manic high, I concluded, I must be a real embarrassment to my family. I certainly embarrass myself.

In May, I resumed my temp job in the accounts payable department at Johns Hopkins. Determined to avoid custodial care, I made my life as small as necessary, minimizing my innate theatricality whenever possible. In alignment with my erroneous assumption, I rehearsed, my dramatic flair must be triggering these improvisational manias. I cannot serve both God and theater.

I went to counseling sessions with Elder Hickey at The Abundant Life Counseling Center for a year. Mutually, we decided my therapeutic process had run its course. I placed myself squarely in an imaginary box with just enough space to sit, stand, lie down, and walk. Though breathing stagnant air, I was neither ready nor willing to explore the circumstances that controlled my thoughts. I would continue to pray and study my Bible, following the rules for living as taught in my Baltimore congregation.

I supposed, nobody could have an episode living in this medicated stupor. Perhaps my present existence is as abundant as it will ever be.

Still, I mourned my former life.

Axis I:	296.40	Bipolar disorder, manic type
	295.70	Schizoaffective Disorder, excited type
	295.20	Schizophrenia, catatonic, excited