A Chapter from Learning Through Literature:

Transition

Lynne Connell moved to Chicago because she needed a second chance.

Back in her hometown, her six-year-long effort to find a paying job and a good psychiatrist — she was bipolar — had failed. Here she would be near her mother and her boyfriend, John, at least once John arrived with their things.

She first felt the left flank pain as she drove through the Chicago streets, looking for an apartment. A doctor in the emergency room of the Loyola Medical Center told her that the lithium she had been taking for thirteen years had damaged her kidneys, stones had formed, and she was starting to pass them down her left ureter. That was the good news.

The bad news was that she needed to find a psychiatrist to prescribe another med to control her disorder, or the lithium she was on would destroy her kidneys completely. Since she didn’t know Chicago, she located a therapist through the phone book, a man named Dr. Baumgartner.

"Paxil, or any other medicine, is not likely to cause stone formation," Baumgartner said. "Lithium's the one that damages the kidneys." He gave her some Paxil samples and told her to feel free to keep coming back until she found a pill she liked.

The word "like" bothered Lynne, but she didn't say anything. She just started taking the Paxil.

Finally, Lynne’s boyfriend, who drove for the moving company, arrived. He unloaded the truck, then headed off for another job, promising to be home by nine. But he didn't show up until3 a.m.

"I was about to call the police," Lynne said.

John asked,"You waited up all night for me?"

"No. This Paxil gives me insomnia. The psychiatrist says it'll go away."

But the insomnia didn’t go away. Baumgartner's secretary set up an emergency appointment for Lynne to switch to a better drug.

"Give me something that doesn't cause insomnia, please," Lynne said to the psychiatrist.

"It doesn't work that way," Baumgartner said. "The same drug can cause insomnia in one person and be fine for somebody else. Finding the right med is just trial and error."

Lynne had thought that psychiatrists had some kind of magic formula for determining which pill was best for which patient.

"I can't tell by looking at you which pill you need," Baumgartner said, "just that you need either an antidepressant or a mood stabilizer. There are a lot of pills in each group. We'll just have to keep trying them until we find one you like."

"Like?" Lynne said. "You think I take these meds because I like to?" She took the doctor's prescription for Remeron, drove to the pharmacy, and filled it before she went home.

"Hey, John," she yelled. "I saw Dr. B today and he gave me another form of torture."

No answer.

"John, are you here?" Lynne's throat tightened. Maybe he was —

John came out of the bathroom, yelling, "Would you mind keeping your voice down?"

"You have a headache?"

"Do I have to have a headache for you to refrain from screaming at me?"

"John, I was calling for you, not screaming at you."

He stormed out of the apartment. Now Lynne's head ached. Was it the Remeron doing it, or was it John's foul mood? She had no idea.

What she hated most about being bipolar was that she could never tell which part of her was Lynne Connell and which part was the disorder. When she lay awake at night, did she have important issues to resolve, or was the problem a chemical imbalance affecting her limbic system or a side effect of her meds? When she felt happy, was it because she had finally managed to get her life going smoothly, or was it just another fake-out, another manic precursor to a depressive letdown?

When she felt proud of being in control of a situation, had she made a good choice, a wise decision, or was she just sick with delusions of grandeur? She could never be sure what was real and what was not. Any choice she made, no matter how right it felt, could prove foolish, even base, a few days later. She couldn't trust her own heart, her own judgment, her own self.

No longer willing or able to handle the stress of living with a man who was seldom home and who yelled at her when he was, Lynne packed her things and moved in with her mother.

Since Lynne had switched to Remeron, she had been groggy most of the morning and tense the rest of the day. She had to get things done, to be productive, or what good was she? She called Baumgartner's secretary for another emergency appointment. But this time the psychiatrist was too busy to fit her in.

"Not even if it's an emergency?" Lynne asked the secretary, feeling close to desperate. The Torquemada of her tension was tightening the screws.

"If it's an emergency, then you need to go to a psychiatric hospital," the secretary said. [Note: If you want to scare the average consumer half to death, just mention psychiatric hospitals.]

"That's out of the question," Lynne said, her voice firm. "A psychiatrist's purpose is to keep people out of mental hospitals, not send their overflow straight to them."

But the secretary pushed it. "If it's not an emergency, then you can perfectly well wait until Dr. B's med clinic on Wednesday. If you have to see a psychiatrist right now, go to Loyola Med Center's psychiatric wing — "

Lynne ran to her medicine cabinet, got a Lorazepam, threw the tiny pill down her throat, and did relaxation exercises until the pill took effect. She had no choice but to wait until Wednesday and attend Baumgartner's med clinic.

Although she showed up early, there were seven people ahead of her. For three and one half hours she sat, her gut knotted with psychic pain, trying not to fidget too noticeably or break out screaming. She remembered that some psychiatric inpatients rock back and forth, and she tried it herself a couple of times. It did make her feel a little better, but she stopped anyway. She was in a crowded room, after all.

Finally the doctor called her into his office. She told him that she needed to switch pills again.

"When did you take your last Remeron?" Baumgartner asked.

"Last night. Why?"

"Once you decide you don't like a pill, you don't have to keep taking it — "

"Like? If you think these pills are so likable then, here, you try them." She got up and shoved her pill bottle into the psychiatrist's face.

"I'm sorry," Baumgartner said. His expression didn’t change; not one muscle in his body flinched. Lynne wondered if it was his psychiatric training that kept him in control or if it was her much smaller, hardly threatening, size. She sat back down.

"If you find the side effects of a pill intolerable, just go off meds until the next time you see me."

"You're telling me to go completely without meds for several days?"

"Yes. I'd like to see what you're like when you're not taking anything."

Lynne asked, "How long have you been a psychiatrist?"

"Forty years. Why?"

"Because you must have forgotten something somewhere along the way," she said. "This is not a picnic. I'm going through hell without decent meds. Go off meds til the next time I see you? You have to be kidding."

Baumgartner was silent.

"Listen, you fat, smug, jerk! I live in fear of what each new pill is going to do to me. How's it going to make me feel? How's it going to make me behave? How do I know there's any pill that's going to work on me? How do I know I won't regress to the way I used to act? Or worse? How do I know I won't kill somebody?" She got up, sat back down, glared at the maddeningly silent shrink.

"You sit there, you probably never had a dysfunctional moment in your life, and smugly tell me to — oh, just go off meds altogether for a while, la de da — so you can satisfy your intellectual curiosity. I'll tell you what you can do with your intellectual curiosity."

He was still silent. Lynne started to calm down.

"You said yourself that looking at me doesn't tell you which pill I need to take. So you're asking me to endure several days of incredible psychic torture, even risk suicide, just to satisfy your intellectual curiosity."

Finally Baumgartner spoke. But he didn't apologize this time. He just switched her from the antidepressant to a mood stabilizer, Trileptal.

All Lynne could do was wait and see what it would do to her.

She waited. Each day, the old depression seemed closer, more ominous. Hell was descending on her all over again, like a cloud of nuclear fallout on Hiroshima. She became so bitchy that she was actually glad that she no longer lived with John.

Her mother she could just avoid, and she did avoid her, for days on end. She had no alternative; without effective meds, she couldn't trust herself around anybody.

It had been three months since she had taken a psychotropic drug that could protect her the way lithium used to, establish a floor beneath which her fear could not sink, prevent the uncontrollable whirl of depressive thought from leading her all the way to suicide. She stocked her apartment with food, locked the door, closed the curtains, and waited. Her mother knocked on her door.

"Lynne?"

No answer.

"Lynne, honey! Are you OK?"

Lynne shrank into a little ball on her sofa, tears streaming from her eyes, afraid to say one word to her mother, afraid of what she might say, of what interacting with other people might make her do. She was ashamed to let anybody see her like this. All the work she had done trying to recover was going down the tubes. She subsisted, terrified of re-becoming the old Lynne, caught in that futile cycle of mania and depression, everybody calling her "dangerous" and, worst of all, everybody laughing at her behind her back because she acted so "crazy".

Her mother went away. Lynne still waited.

Then, thank God, the mood stabilizer started to work. It drained four months of stress from her body and made her back into her real self. After apologizing to her mother for scaring her, Lynne went to visit John in his motel room.

Since the door was open, she walked in. He was watching TV, an "Out For Lunch" look on his face.

"Want me back?" she said.

"Yes," John said.

Transition

I.Lesson Objective

Participants will have a basic understanding of, and empathy for, what psychiatric patients go through when they change meds.

II. Definitions

Mood stabilizers: The primary medications used in the treatment of bipolar disorder. The mood stabilizers include lithium, Trileptal, and many other anticonvulsants.

III. Study Questions

A. If determining which medication is best for which patient is primarily a matter of trial and error, why do we need psychiatrists?

B. Why couldn't Lynne ever be sure what was real and what was not?

C. Do you agree with Lynne that, "A psychiatrist's purpose is to keep people out of mental hospitals, not send their overflow straight to them"?

1. Would a medication-compliant person who can live independently and take care of him or herself need to live in a psychiatric hospital?

2. What is the purpose of psychiatric hospitalization?

D. Lynne shuts herself up in her room because she is afraid.

1. What is she afraid of?

2. How does the prejudice against consumers aggravate her fear?

E. What did you, personally, learn from this story?

IV. Exactly What We Consumers Need and Want

1. We can be sensitive about the misuse of words, e.g., “a pill you like” rather than “a pill you can stand to take”. Please humor us.

2. We often consider even a hint that we might check into a psychiatric hospital to be either a threat or an insult, even if we have done so previously. Broach this topic gently.

3. If we rock back and forth, we do it to feel better. Please do not look at us funny.

4. We probably won’t tell you this outright, but Dr. Baumgartner’s unflappable calm is to be emulated.

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