Anatomy of an Epidemic (30 page)

He has been on SSDI ever since. The good news is that he hasn’t been hospitalized since 2000, and, as he rightly points out, in spite of his constant battle with bipolar symptoms, he leads a productive life. Remarried now, he volunteers as a “reader” for people who are physically disabled, gives talks about bipolar illness to community groups, and is one of the leaders of DBSA Boston. He also has published essays and poetry in various small publications. But when I last spoke to him, in the spring of 2009, he was cycling through multiple mood swings every day, his symptoms apparently continuing to worsen.

“I would say in the main, I have been worse when taking medication. The medication I am taking now is neutral at best. I wish I could clone myself. I could be my own control group in a trial. I’d like to know if I’d be better, the same, or worse without it.”

Brandon Banks can identify the precise moment he became “bipolar,” and while it did involve an antidepressant, there was a series of life events that led up to it. He grew up poor in Elizabethtown, Kentucky, without a father at home, and he has painful memories of sexual abuse, physical abuse, and of a horrible car wreck that killed his aunt, uncle, and another relative. At school, other kids regularly taunted him about a facial birthmark, which so traumatized him that he began wearing a hat pulled low on his head to cover it up. After graduating from high school in 2000, he moved to Louisville, where he went to college part-time and worked nights at United Parcel Service. Soon he noticed that he “wasn’t feeling right,” and when he went back home, his family doctor diagnosed him with “moderate depression” and prescribed an antidepressant. “I went manic in three days,” Brandon says. “It was fast.”

His doctor explained that since he’d had that reaction to the drug, he must be bipolar, rather than just depressed. The drug had “unmasked” the illness, which Brandon took as a positive thing. “I’m thinking, This isn’t so bad, I could have stayed in the system a long time without getting immediate confirmation that I’m bipolar like that.” He was put on a cocktail composed of a mood stabilizer, an antidepressant, and an antipsychotic, and then it hit him. “This was a serious shove into seriousness.”

Over the next four years, his psychiatrists constantly changed his prescriptions. “It was like musical chairs with the cocktails,” he says. “They would tell me, ‘Let’s take this drug out and put this one in.’” He took Depakote, Neurontin, Risperdal, Zyprexa, Seroquel, Haldol, Thorazine, lithium, and an endless succession of antidepressants, and as time went on he became a rapid cycler who suffered from mixed states. His medical records also document the development of new psychiatric symptoms: worsening anxiety, panic attacks, obsessive-compulsive behaviors, voices, hallucinations. He was hospitalized several times, and at one point he climbed up on top of a parking garage and threatened to jump off. His ability to concentrate declined so severely that Kentucky took away his driver’s license. “What my life became was staying at home all day, getting
up in the morning and laying my pills out on the counter, taking them, and then going back to sleep because I couldn’t stay awake if I tried. Then I would get up, play some video games, and hang out with my family.”

Twenty-four years old, he felt like a total failure, and one day, after a fight with his mother, he moved out and stopped taking his meds. “I deteriorated badly,” he recalls. “I wasn’t bathing and I wasn’t eating.” However, as the weeks turned into months, his bipolar symptoms lessened, and “I began to think that it’s more like I’m just fucked up,” he says. This was a thought that gave him hope, because now there was the possibility of change, and he took off traveling around the South. “I might as well be homeless,” he told himself, and that journey ultimately turned into a transformative experience. By the time he returned home, he had sworn off eating meat and drinking alcohol, on his way to becoming a “health freak” who practices yoga. “I came back from that trip, and man, I was on top of it. I felt like a million dollars, and everyone in my family—cousins, relatives, aunts and uncles—said that they hadn’t seen me glow like this since I was a kid.”

Since then, Brandon has stayed off psychiatric medications. But it hasn’t been easy, and the up-and-down nature of his life came into sharp relief during his 2008–2009 year at Elizabethtown Community and Technical College. He enrolled there in January of 2008 with dreams of becoming a journalist and a writer, and in the fall, he became managing editor of the school’s newspaper. Under his leadership, the newspaper won twenty-four awards from the Kentucky Intercollegiate Press Association during the 2008–2009 year, and Bran don personally garnered ten such honors for the articles he’d written, including first place in a deadline-writing competition. Incredibly, during those nine months, Brandon racked up other successes too. One of his short stories won second place in a competition and was published in a Louisville weekly; one of his photos was picked as cover art for a literary journal; a short film he shot was nominated for a best documentary award in a local film festival. In May of 2009, his school honored him with its “outstanding sophomore” award. Yet, even during this season of remarkable accomplishment, Brandon suffered several hypomanic and depressive
episodes that left him feeling deeply suicidal. “I spent several weekends reading depressive authors with a gun in my hand,” he says. “My accomplishments at these moments just seem to make everything worse. It never seems like enough.”

That is where matters stood in his life in the summer of 2009. He was thriving and struggling at the same time, and his struggles were such that if psychiatric medications had worked for him the first time, he would gladly have turned to them for relief. “I’m still pretty isolated from other people,” he explains. “I stick out because of the birthmark. I’m different. I can’t blend in. It becomes an issue with people. But I’m trying to integrate myself more into life. I have more people in my life now than I have had in a long time. I’m starting to make more contacts. I had lunch with a friend the other day. Doing this is hard for me, and that’s because it’s just not easy for me to deal with people and deal with my emotions. I am trying to get better at it.”

A math and science whiz, Greg, who asked that I not use his last name, was the sort of child who, when he was in junior high, built a Van de Graaff generator from scrounged parts (which included a vacuum cleaner and a salad bowl, to be precise). However, he had a troubled relationship with his parents, and at the start of his senior year, he began to slide into a mad state (and without having used illegal drugs). “I was delusional, very paranoid, and full of anxiety,” he says. “I was convinced that my parents were trying to kill me.”

Hospitalized for six weeks, Greg was told he was schizoaffective with bipolar tendencies (a “manic-depressive” type diagnosis), and he was discharged on a cocktail composed of two antipsychotics and an antidepressant. But the drugs didn’t chase away his paranoid thoughts, and after he was hospitalized a second time, his psychiatrists added a mood stabilizer and a benzodiazepine to the cocktail and told him he needed to give up his scholastic dreams. “They told me I would be on medication for the rest of my life, and that I would probably be a ward of the state, and that maybe, by the time I was twenty-five or thirty, I could think about getting a part-time
job. And I believed it, and so I began trying to figure out how to live with the crushing hopelessness that they are telling you is going to be your life.”

The next five years passed pretty much as his psychiatrists had predicted. Although Greg entered Worcester Polytechnic Institute (WPI) in Massachusetts, he was so heavily medicated that, he says, “I was living in a haze most of the time. Your mind is just a bag of sand. And so I did really poorly in school. I rarely even left my room, and I was kind of out of touch with reality.” He petered along in school for a couple of years, not really making much progress, and then, from 2004 to 2006, he dropped out and mostly stayed in his apartment, smoking marijuana constantly, as “it helped me accept the condition I was forced into.” Six feet, five inches tall, Greg’s weight went from 255 pounds to nearly 500 pounds. “Finally, I said to myself, this is ridiculous. I’d rather be crazy and have a life than not be crazy and not have a life.”

He went for a medical checkup, thinking this would be a first step toward reducing his medications, only to be informed that he needed to stop taking Depakote and Geodon right away, as his liver was shutting down. The abrupt withdrawal induced such physical pain—“sweats, joint and muscle pain, nausea, dizziness,” he says—that he didn’t even pay attention to whether his paranoia was coming back. But in very short order, he was off all of his psychiatric drugs, except for occasional use of a stimulant, and he had also stopped smoking marijuana. “Honestly, it felt like I was waking up for the first time in five years,” he says. “It felt like I had been turned off all those years and had just been rolling through life and I was being pushed around in a wheelchair and finally I had woken up and had gotten back to being myself again. I felt like the drugs took away everything that was me, and then when I went off the drugs, my brain woke up and started working again.”

In late 2007, Greg went back to school. We met in the spring of 2009, and after he had told me the story of his bout with mental illness, he showed me around his research laboratory at WPI, where he now spent eighty hours a week, designing and constructing a robot capable of conducting brain surgery inside an MRI. In a few weeks, he would receive an undergraduate degree in mechanical engineering,
and since he’d entered a master’s program while still doing undergraduate work, later that summer he would receive a master’s degree in mechatronics, which is a fusion of mechanical and electrical engineering. The day before my visit, his robotics research had won second prize in a competition that featured 187 entries by graduate students at WPI. Already he had published three papers in academic journals on his project, and in a few weeks he was scheduled to fly to Japan to give a talk about it. He was doing this project under the guidance of a WPI professor, and they expected to conduct animal and cadaver trials with the robot in the fall of 2009. If all went well, clinical trials with humans would begin in two years.

While in his laboratory, Greg showed me the robot and the computer drawings of its circuit boards, which seemed impossibly complex. Naturally, I thought of John Nash, the Princeton mathematician whose inspiring story of recovering from schizophrenia, and doing so while off medication, was told in the book
A Beautiful Mind
. “I still feel that I have some bad habits to get out of and some better habits to get into before I get into the professional life, but I really do feel that I have left that [mentally ill] part of my life behind,” says Greg, who has lost more than one hundred pounds. “Honestly, I almost never think of it. I now think of myself as a person who is susceptible to building anxiety, but when I start feeling this anxiety, or start feeling negative about things, I stop and say to myself, ‘Are these really reasonable feelings to feel, or is it just insecurity?’ I just have to take the time to check myself.” He is, he concluded, “pretty optimistic about my future now.”

There is a famous optical illusion called the young lady and the old hag, and depending on how you look at it, you see either a beautiful young woman or an old witch. The drawing illustrates how one’s perception of an object can suddenly flip, and in a sense, the dueling histories that we have fleshed out in this book have that same curious quality. There is the “young woman” picture of the psychopharmacology era that most of American society believes in, which tells of a revolutionary advance in the treatment of mental disorders, and then there is the “old hag” picture that we have sketched out in this book, which tells of a form of care that has led to an epidemic of disabling mental illness.

The young-lady picture of the psychopharmacology era arises from a powerful combination of history, language, science, and clinical experience. Prior to 1955, history tells us, the state mental hospitals were bulging with raving lunatics. But then researchers discovered an
antipsychotic
medication, Thorazine, and that drug made it possible for the states to close their decrepit hospitals and to treat schizophrenics in the community. Next, psychiatric researchers discovered
anti-anxiety
agents,
antidepressants
, and a magic bullet—lithium—for bipolar disorder. Science then proved that the drugs worked: In clinical trials, the drugs were found to ameliorate a target symptom over the short term better than placebo. Finally, psychiatrists regularly saw that their drugs were effective. They gave them to their distressed patients, and their symptoms often abated. If their patients stopped taking the drugs, their symptoms frequently returned. This clinical course—initial symptom reduction and relapse upon drug withdrawal—also gave patients reason to say: “I need my medication. I can’t do well without it.”