Mental Health Pt 2 (read Pt 1 here)
“The house is burning Molly; you need to tell Dr. B that you’re in a crisis…
It’s time to come home, honey.”
Ah, yes, what every woman in her thirties hopes to hear from her mom while the country, or the world rather, is seemingly falling apart. Though, she was right. Whether it was seeing the akathisia (involuntary movements caused by medication) clear as day on video or seeing my dishes pile up in the sink, I needed the support of my family.
Given that this conversation occurred in the first few days of June 2020, during COVID, it was unsafe to fly. This left a 31-hour drive as my best option. Quite frankly, it seemed like my only option. There were plenty of instances where I loved making that drive and made it without hesitation. After all, I had a few years of nomadic living under my belt! This was not one of those times.
Another hesitation in leaving was that I would no longer be able to afford my one-bedroom apartment in San Diego with the financial dive I was experiencing. I was self-employed, and pandemic unemployment for independent contractors was not in existence. Only standard unemployment was available, which I didn’t qualify for as a sole proprietor. Could I go home to Wisconsin without first moving out of my apartment? What would I do with my belongings? Was it possible to go home while continuing to pay for the apartment with my dwindling funds? I was looking at $1,500 a month in rent alone and had no idea how long I’d be gone, nor how or when I’d obtain any income. I would also have to pay to get out of my lease early if I went that route. I had applied for the PPP (the Paycheck Protection Program for sole proprietors and business owners), but I hadn’t heard back yet. Overall, when it came to a trip home, there were a few roadblocks.
Not ignoring these stark factors or my current disposition, my mom asked about logistics and whether I was capable of driving home. I didn’t see another option, and in truth, neither did she. So, I let her know I’d talk to Adam (my partner) and be in touch about when I thought the trek would commence. Given the urgency in the matter, I decided to keep my apartment, at least for the time being. Within an hour, Adam was over, and I told him the news. I’m not one to wait on important matters, and since I wear my heart so heavily on my sleeve, I don’t think I could have if I tried.
“I think I need to go home to Wisconsin.”
Not a millisecond later, he replied:
“I think that’s a great idea.”
Once again, what every woman wants to hear. It was the right response, and that is one of the many wonderful things about Adam—he wants what is best for Molly. He knows that whatever is best for me is also best for us as an entity. I would even say that he wants what is best for me regardless of what that means for the entity of Molly and Adam. He offered to take care of anything necessary with my apartment, even if that meant packing up all of its contents, finding storage, and cleaning the entire place. No matter what happens, he said, he would be there when I returned… to whatever capacity I wanted or needed him to be.
He sure is darling.
Meanwhile, I was grateful that the Latuda was working its way out of my system. And I had gotten to know Dr. B., or more appropriately, he had gotten to know me.
He was a young man filled with optimism and candor. His move was to put me on another antipsychotic, one that he said was known for minimal side effects and that worked like a swiss army knife. Dr. B likes analogies; this one is about Abilify working as, you guessed it, a multitool. The mental imagery that came to mind was ranging from splinter removal to bottle opening to rope splicing. Maybe translating to major depressive disorder, bipolar disorder, and schizophrenia. He also referred to the analogy about a house burning down and said that it’s difficult to know what caused the fire when it’s all in flames. I was impressed; he expanded on my analogy to support his argument—this guy could keep up. Though he did also point out that, even though Abilify was likely to produce the least amount of side effects for that class of drugs (ehemm, antipsychotics), it could also just be a starting point:
“…a swiss army knife is great unless you need an allen wrench.”
Oh, the wit! I caught what he was throwin’ down and agreed to try it. The day before I hit the road, I started 2.5mg of Abilify.
I left on Friday morning, and it was absolute shit. I felt pretty melancholy about leaving and started journaling about the anticipated three days of travel. I just couldn’t bring myself to handwrite all of my reservations as they were overwhelming. Hence the moment I found myself with a pretty burnt out keyboard that’s seen a lot of life between cigarette ashes, tequila spills, international van life, and most recently, maple syrup.
I encountered an accident within the first hour of hitting the road. I literally stumbled upon it about the same time the authorities did. No one was seriously hurt, thankfully, just my timeframe. I swear I break my own heart through expectation. Las Vegas is a five hour drive. I landed at hour seven, so I didn’t exactly hit the ground running. At least I was able to have my virtual therapy appointment along the way to account for some of that lost time, right? Not the case. I started out less than hopeful, which looked something like me inside my car on an 102 degree day in a small town outside of Vegas while my connection was complete shit and my phone needed to restart for reasons unbeknownst to me (there has never been a time I didn’t have to restart my phone in Vegas in order to get service). Lastly, where my phone was mounted on my dashboard in the smoldering sun caused it to overheat, deeming my therapy appointment the most relentlessly impossible, incomplete task of the day. But it had competition. There was the anticipated oil change which looked like me at a dealership (still in Vegas) where I was told it’d take much longer than expected—an hour and a half. That would put me leaving Vegas at 5 pm on a weekday. No, thanks. They, instead, turned off my nuisance of a tire pressure gauge that wouldn’t stop beeping (even after I filled up along the way which took me two stops… Let’s call the second stop setback number seventy-two). As far as luck’s concerned, my dad tends to say that if shit can happen, it will happen to Molly. It may feel as though he’s been proven right on this time and time again, but I, instead, try to take this perspective:
“Whether you think you can, or think you can’t, you’re right.” Henry Ford
After a few tumbleweeds to my grill, two dust storms in Utah, both a fire and a rainstorm in Colorado, then two anxiety-inducing, anti-mask gas stations in podunk Nebraska and Iowa… I was home. Oh, and I finally got my oil changed along the way, and the dealership had a couch for me to nap on.
Come late June, I had steadily been on 5mg of Abilify for nearly a month. Dr. B and I had continued regular, virtual appointments while I was in Wisconsin. I had informed him of my increasing anxiety, and he offered to up the Abilify to 7.5 if I’d like or said we could add Zoloft, if I’d like.
“I don’t know what I’d like. I don’t know what I want because I don’t know what’s best for me. I feel like I don’t have enough information to make that call.”
What devastated me in that moment is that I knew he didn’t know what to do either. As much as I needed autonomy with my mental health, I felt I needed more guidance. He paused for a moment, made eye contact with me through each of our computer screens, and said:
“I have been very honest with you in sharing that I just don’t know.”
He then went on to say that, as we discussed, diagnoses are made up by humans. They’re just “boxes.” I referred to a comment he made in an earlier session about how even though diagnoses are made up, symptoms are not.
“Molly, you just don’t fit into a box.”
I could have lost it right there. It was an overwhelming feeling of hopelessness. I so terribly wanted to fit into a box, something I never thought I’d say, but it was for the benefit of medication intervention.
“What do you have me diagnosed as?”
“What I have you diagnosed as, and what I believe your diagnosis to be, are two different things.”
Well, that sounds slightly troublesome.
He explained that in order to be able to play around with medications, he has to select certain diagnoses.
Is my pseudo diagnosis on record?
“What do you believe I have then…?”
“I believe you have generalized anxiety disorder, and as you know, PMDD.”
A real treat.
PMDD is treated with antidepressants and birth control. I got off birth control in 2016.
Dr. B’s diagnosis would change again in 2021, but in either case, as it turned out, I didn’t fit into the bipolar box. Though, as Dr. P had presumed, I’d like to think I’m still a riot at parties (though I wasn’t sure if I could ever attend a party again…ehemm, COVID).
We upped the Abilify to 7.5mg. It wasn’t long after this increase that I started having issues with word retrieval, which was scary, and about the same time I found myself chomping at the bit to get out of bed each day. Despite this energy, my anxiety made me feel as though I couldn’t leave the house (the pandemic certainly compounded this). As the anxiety grew, so did my restlessness; I was battling an inability to sit still while simultaneously satiating my creativity through writing and drawing. Writing is a must for my well-being, and I was chock full of material at the time. I had also just started drawing Mandalas and was determined to use what I had compiled thus far to print a coloring book for my grandma.
I sat in bed, striving for symmetry in putting pencil to paper, and for a fleeting moment, the lines on the page doubled while a straining pain crept in from behind my eyes. The most successfully I can articulate this is that I was involuntarily crossing my eyes. I instinctively closed them immediately, then looked up and outward to the other side of the room. I looked back again at the page and was delighted to see the lines greet me singularly with a painless ease.
Weird. I need to remember to tell Dr. B about that… just in case.
My creative releases occurred in between debilitating bouts of anxiety and significant distractibility. I certainly noted the unnaturalness of the energy and drive, a feeling my intuition can only articulate as meddy. It’s sort of like taking a drag of an electronic cigarette after only ever having had the real thing. Like alright, this seems unnatural, and it worries me a bit that I don’t quite understand the chemicals in it or how the fuck it works, but hey, I don’t smell like shit, and it’s supposedly better for me, right?!
I knew what it was like to wake up every morning as Molly. Now, that feeling was drastically different. Of course, change was the whole point of the medication, but the shift felt so inauthentic. Not because of the elevation it gave me but rather its level of intensity. To open my eyes in the morning, unable to continue lying for even a millisecond longer? Well, it was just unsettling. My restlessness grew and manifested in the form of what my doctor once again classified as akathisia (reminder: an involuntary movement disorder). As discouraged as I felt, I’ll admit I wasn’t all that surprised. Latuda had afterall caused akathisia in the form of mouth and jaw clenching, and now on Abilify, I was involuntarily clicking my tongue on the roof of my mouth while incapable of sitting still. Nearly a laughable level of frustration at this point. We immediately lowered my dosage back to 5mg.
If that had been the end of it, it’d be one thing. Turns out, akathisia part two was barely a blip on my shitstorm radar.
On July 8th, 2020 I was standing in the lake at the end of my parents’ pier with my journal lying open on the pier in front of me. I watched in dismay as the blank lines completely crossed… without going back to normal. I was trying with everything I had in me to see the lines as I knew them to be; I squinted, I moved the journal both closer and farther from me… to no avail. I felt a panic coming over me. Imagine that uncomfortable sensation when crossing your eyes; it was like that, but I couldn’t get it to go away unless I looked at something from a distance.
Something was very, very wrong.
I rushed into the house and called my optometrist back in San Diego. I told him that it felt as though my eyes “weren’t seeing eye to eye.” They couldn’t focus, and they seemed to be crossing whenever I tried; then I would see double. Again, a difficult sensation to articulate, but he seemed to know exactly what I was saying. His understanding was both relieving and disconcerting.
Did the medication give me an eye condition? What happens if this continues to progress? Am I at risk of going cross eyed? Is that permanent?
The ruminations had begun, and my old nemesis, neurosis, had crashed the party too.
I told him about Abilify, and it was clear he had seen issues like this before:
“Medications in that class can affect the eyes; actually they can affect all of your senses.”
Fuck.
After I elaborated on the condition of my eyes throughout that day, the doctor said that it seemed to be progressing rapidly, and that I needed to schedule an appointment right away. If it persisted before I was able to get in to see someone, he told me that I needed to go to urgent care. It was 5 pm in Wisconsin, and I couldn’t get a local doctor to pick up the phone, much less see me. In thirty minutes, I had four friends coming over for a little social distancing on my parent’s patio. It was to be my first social encounter with more than one person (outside of family members) since the pandemic took fruition. I was mortified I wouldn’t be able to switch my mindset to be good company for them. There was also that slight but present (once again neurotic) fear that I’d go cross-eyed at any moment. On the flip, it could make for one hell of a dinner party.
I never brought it up.
The next day marked about four months after starting Latuda and five weeks of being on Abilify, and I found myself sitting at the optometrist’s office, unable to focus my eyes on any object within ten feet of me.
I was in a bit of a crisis (shocker) as I waited for the doctor. I reflected on the fact that over the past four months I had either been in a symptom-induced or side effect-induced predicament, often a challenge to distinguish the two. Abilify had seemed pretty promising, or at least I had been optimistic, and then I started clicking my tongue to the roof of my mouth and experienced an internal restlessness that had me feeling like a fly in a jar. Not my finest moments, also not my fault. Though it was tough not to internally place blame; it was afterall my choice to seek out a psychiatrist and start psychotropic drugs, veering off course from my usual SSRIs.
In the midst of this reflection the doctor came in. I focused my attention on the task at hand. Unfortunately, my eyes couldn’t do the same. After an hour-long appointment and several straining eye tests, she sighed, put her hands on her lap, and said:
“Okay…”
There was a pause. “Okay” what, lady?! I could tell she was struggling to tell me what was wrong.
“What did those tests tell you?”
“You have convergence insufficiency.”
Oh, come on! Also, what the fuck does that mean?!
I’m sure I was wearing that familiar look of defeat and concern. She said convergence insufficiency usually happens with patients with concussions or head trauma and also in children whose eyes haven’t fully developed. She continued to say that eyes need to look inward at -20 to focus close up, and that mine couldn’t get past 6.
“They’re just not strong enough.”
How do we fix it? Is it permanent? If I get off the medication, will it go away? But my eyes have been strong enough my entire life!
“Medications like this affect the eyes. There isn’t a surgery to remedy it, and there aren’t glasses that can fix it, but if you decide to stay on the medication, you can do regular therapy to strengthen your eyes in hopes they return to normal.”
STAY on the medication? No way. No-fucking-way, lady.
She continued to include that I can discuss getting off the medication with my doctor if that’s what I’d like to do and come back at a later date for another exam. I already knew I would be getting off the medication. Immediately.
“These are my eyes; it’s one of my senses—I have to get off Abilify.”
She nodded her head in agreement. I could tell she didn’t blame me for feeling the way I did. I hadn’t taken Abilify the night before, having already feared the medication was to blame and that I needed more information before continuing on with it. So, I was already on my way to it exiting my system.
I walked out of the doctor’s office feeling that familiar burden of starting over, once again, with medication. The weight I had been ditching and carrying time and again. Before the breakdown earlier in 2020, there had been other medication trials the year before. This consisted of Wellbutrin (SSIR) and Buspirone (Anxiolytic aka anti-anxiety), unsuccessfully due to side effects. Both Dr. B and Dr. P did say that I’m a “slow metabolizer,” which I had to chuckle at because though I know nothing of the matter, I grew up so often being told I must have a fast metabolism!
Back to exiting the doctor’s office…
I was confident that my eyes would go back to normal and find the strength they always had before. I couldn’t view it any other way. But how long?
I’d be able to read and write again in no time! Right?
It wouldn’t be helpful to believe anything else, but I couldn’t help but wonder. For some reason, I thought that Latuda had been the worst of it, and that things would look up from there, but I had no rational reason for this. It was merely the notion that bad reactions just couldn’t keep happening. It wouldn’t be fair! Or maybe that it was just unlikely? We all know that life doesn’t work like that… in fairness, that is. Honestly, one unfavorable reaction could actually deem it more plausible to have another, and another! All of this isn’t meant to be melancholy; it’s meant to be true. There have been plenty of times where my life seemed to be composed of one positive experience after another. Maybe just like those fortunate events, the unfortunate can unfold in the same fashion… as I had experienced over the last several months. I remember a conversation with Dr. B which I journaled about:
“I’m trying to be positive and exercise gratitude, but it just honestly feels like shitty things keep happening in my life that are outside of my control.”
“It feels that way, Molly, because it is that way.”
Touche, doc, touche.
My genuine, authentic reaction and response to everything that had unfolded by July 10th of 2020 was, in the infamous words of Ron Burgundy in Anchorman:
“…please tell me this is some kind of sick, tasteless joke!”
I digress.
I had an appointment with Dr. B and told him about the convergence insufficiency.
“I’m tempted to ixnay antipsychotics for you, at least for a while.”
I nodded, eyes widening:
“Umm, I’m going to ixnay them forever!”
He nodded back in agreement, and we discussed my options.
Dr. B thought that the Abilify would be out of my eyes in about two weeks, taking an average of maybe three weeks to exit my system entirely. I had a brief moment thinking about what two weeks without reading, writing, or drawing looked like, then realized I should shift my focus to all of the Audible books and Podcasts I’d get to listen to instead of focusing on the negative. Plus, there have been countless times in my life when I felt overwhelmed with responsibilities and obligations that required me to, well, use my eyes! Not just emails either—I’d often take breaks from my phone for a full day and avoided all correspondence (though in doing this, it was easy to feel overwhelmed and even guilty on returning to the reality most of us have created for ourselves in this day and age of constant contact with others via text). Now, with what I was experiencing with my eyes, I had a concrete reason to be aloof… and it happened to be at a time when I was really struggling to set boundaries. I wasn’t my usual self, I was both insecure and unsure.
The two to three week countdown began.
Thank you for reading. Coming in Pt 3:
Convergence insufficiency soon became the least of my eye issues. After another emergency eye appointment, I witnessed my grandpa pass away, and then I had to make a frantic drive back to California for a brain MRI.
Turns out, I was just getting warmed up, as you can see…
Molly, as someone who has struggled with eyesight problems their whole life, I can understand what hell this must have been for you. My situation is much different from yours obviously, but sometimes in life we’re just dealt a bad hand. But from what I’ve seen with these stories of yours, you’ve made the best out of your hand. I admire you for all you’ve been through. And I’m sure we’ve only scratch the surface here.