Just Like Someone Without Mental Illness Only More So

Flowers and Fish
, 2005

(Painting by Mark Vonnegut)

The other day I found the final version—along with several drafts—of the note below:

Living with a seven-year-old who asks Santa for a 470-piece Civil War battle replica play set is a great joy and privilege. Yesterday he asked me, “So what happened to the slaves after the Emancipation Proclamation?”

This book is dedicated to all seven-year-olds … and
their
seven-year-olds and
their
seven-year-olds and so forth and so on.

When I talk to the National Alliance on Mental Illness (NAMI) and other patient support groups, I take questions at the end. At one talk I was asked, “What’s the difference between yourself and someone without mental illness?”

At another talk I was asked, “How do you make the voices be not so mean?”

I wish I knew.

I’ve gotten used to it, but very little about my life has been likely. In my early twenties I stopped being able to eat or sleep. I heard voices, went up against locked doors, was given a lot of medication, and lost my confidence that going crazy was something that happened to other people. It would have made perfectly good sense for me not to have done well and maybe have ended up killing myself after
x
number of relapses. Everyone would have adjusted. But I recovered enough to be able to think about what I would have wanted to become if it wasn’t for the sixties and mental illness. I wanted to be a doctor and applied to twenty medical schools. It was a round number.

It would have been utterly unremarkable for all twenty to have said no. That the one that said yes was Harvard is either a miracle or a very funny joke.

Luck and circumstances make us as different from who we might have been as cats are from dogs and birds are from bugs. There must be a point in paying attention to what goes on. My father’s fame falls into the one-in-a-zillion category. Had I told someone after my first series of breaks that I might go to Harvard Medical School, they would have upped my meds and canceled my dayroom privileges.

I’ve had the bad luck to get sick four times and the remarkable good luck to get better again each time. None of us are entirely well, and none of us are irrecoverably sick. At my best I have islands of being sick. At my worst I had islands of being well. Except for a reluctance to give up on myself there isn’t anything I can claim credit for that helped me recover from my breaks. Even that doesn’t count. You either have or don’t have a reluctance to give up on yourself. It helps a lot if others don’t give up on you. Had I been a little sicker a little longer or taken a little longer to get better, I never could have applied to, let alone gotten into, medical school. I managed to get well in the nick of time, by the skin of my teeth, needing every ounce of every resource I had.

And if you’re lucky enough to survive going crazy and get back to the point where you can pass for normal, it builds a question into the rest of your life. You have to forgive people for wondering, “How all right can he be?”

After my fourth break, fourteen years after the first three, when everything was supposed to be okay because I had graduated from medical school and was a respected physician in the so-called real world but I fell apart anyway, my task was, once again, to get my sorry, sick, humiliated self back together as quickly as possible. Because if I didn’t stand up and do a credible job of walking and talking, my license and job would have been up for grabs, and then how would I be able to tell if I was okay?

——

My psychotic episodes start out great. As a reward for diligence, patience, and the refusal to accept lesser gods, I am set free. We’re all one, really and truly one, free at last, blissfully overwhelmed by God’s boundless love. There’s peace and universal brotherhood. There’s no need to wait for the other shoe to drop.

And then, a few weeks later, ten or twenty pounds lighter, I’m foggily embarrassed in a cold world with things that need doing, like figuring out if I can still be a doctor and how to explain mental illness to my young children.

There were crazy people in my family, but I had figured out good and sound reasons why I wouldn’t go that way. I was stronger than that. But then there were three breaks in quick succession in 1971. I was diagnosed as suffering from schizophrenia. With the publication of the third edition of the
Diagnostic and Statistical Manual of Mental Disorder (DSM III
) in 1980, the diagnosis of schizophrenia was made more standard and required continual symptoms for at least five years. What I had and have is more consistent with what is now called bipolar disorder, which used to be called manic depression. The name change was an effort to get away from the stigma around the diagnosis of manic depression. Good luck.

Until we come up with an unequivocal blood test or the equivalent, we’re all blowing smoke and don’t know if what we call schizophrenia and bipolar disorder are one disorder or a dozen.

Break number four, in 1985, came as a complete surprise and taught me once and for all that what I think is and isn’t going to happen doesn’t count for much. My friends and family and psychiatrist all think I’m doing well and won’t go crazy again, and I appreciate their optimism.

In the middle of break number one, I made a lot of promises. When I promised to try to remember to tell the truth, it seemed to help.

It’s now been almost twenty-five years since my last break. It was a matter of faith that I could go to medical school and do a pediatric internship and residency and that it would turn out okay. I’ve had a good run as a pediatrician. I’m happily married and have three healthy sons, but I’ll never fully shake the feeling that I’m being tracked by the voices and a parallel psychotic life.