the only catch was Catch-22

I’ve written about this before, so maybe this is just part of the greatest hits. I don’t know.

We are living in an era in which we have ostensibly seen improvements in the visibility of people living with mental illness and in public understanding and support for them. From my limited vantage the average American seems more aware of specific disorders and the symptoms associated with them than they were in my youth. We are, at least, less likely to be confronted with overt stigmas against having a mental illness and more inclined to understand that many millions of Americans suffer from one.

It has not all been progress. There is a weird sense in which the effort to destigmatize mental illness has led some people to sort of sunnily ignore the myriad negative aspects of having one. I have been frequently confused by people who, having learned of my mental illness, react by essentially expressing the attitude that my illness must not impact my behavior or otherwise threaten my grip on life. This is well-meaning, I guess, to think that mental illness is so normal as to be unworthy of mention. But it is the opposite of what those with mental illnesses need, which is precisely an understanding that mental illness alters behavior – that the mentally ill are not the camera-ready crazy dreamers the movies have sold to you, but regular human beings who are flawed in all the normal ways and have the added problem of reduced impulse control, delusions about the current reality, and compromised cognitive functioning.

At an extreme you have the new and bizarre ritual of people insisting after a mass shooting that a shooter could not possibly be mentally ill, as mental illness never compels people to violence. (To say otherwise would be to promote stigma.) But some mentally ill people, a minority but some, most certainly are inclined to violence when symptomatic, and it only hurts their interests to pretend otherwise.

(This question is not the same as the question about whether people who suffer from mental illness are responsible for their behaviors while symptomatic. I am, personally, but that’s a far different conversation than I want to have.)

I suspect that in fact recent woke norms about mental illness have contributed to one of the most casually destructive attitudes one can have: the sense that the only real expression of mental illness is in psychosis. Mental illness is normal, so it becomes relevant only in those cases where someone is so far gone that the facade of normalcy crumbles. But mental health symptoms are spectral, not binary, and in fact most people become symptomatic gradually, with no clear break between a lucid reality and a delusional mindset. And in these stages, these grey pre-psychotic areas, help can potentially be most effective: it can save people a great deal of problems by intervening before they hit someone, before they spend all their money, before they make paranoid threats, before they commit the behaviors that they then have to account for when they are in recovery and thus in their most vulnerable state.

The problem is that the system seems set up to make getting help in these stages impossible.

My experience in 2017 seems typical. My bipolar cycle is exceptionally slow, depression and mania building in turn over the course of months. I certainly don’t envy people with rapid cycling bipolar disorder, but the alternative offers its own challenges. For me it is a perfect example of the classic trope of the boiling frog: my cycles descend on me so slowly and gradually that I don’t notice them until they are at such an acute stage that they become unmistakable. In a depressive phase this is tricky because depression makes things like getting to see a psychiatrist for meds and securing a therapist seem like an impossible mountain to climb. In a manic phase the condition is worse, as the paranoia makes me view treatment with suspicion and thus anyone who suggests it as a potential enemy who is working towards nefarious ends.

Events and my own bad behavior made treatment impossible to avoid, though I was able to stave it off long enough to inflict permanent injury to my own life and to treat others inexcusably. I was forced into care. Most importantly, my brother got involved and came up to New York to get me into treatment, without which I think it would have required arrest before I would have entered into any kind of program.

We first went to a facility that has a dedicated psychiatric emergency room, which seemed like the place where my problems were most likely to be taken seriously. And yet when I got worked up there the doctor did not take me seriously. I was ambulatory, I was communicative, I was unrestrained, and these facts alone seemed to signal to him that I was not a candidate for emergency psychiatric care. This despite my loudly stated and deeply sincere belief that there was a conspiracy working against me and that they would soon turn to violent means to hurt me. He asked me about my first break when I was younger, an event which certainly qualifies as full-blown psychosis and ended with me shot up with Haldol. He seemed unimpressed.

Eventually it became clear that we were doing a dance that, I have to believe, happens all the time: the admitting psychiatrist would only entertain admission if I indicated I was a danger to myself and to others – that is, if I was willing to say the magic words that can trigger involuntary commitment. But giving up control over my life and being forced to placate shadowy authority figures to get it back was utterly against the desires of my paranoid mind. I was facing a far-too typical dilemma: how I could get admitted without being committed. How could I prove the severity of my problem without triggering the potentially devastating consequences of involuntary commitment?

This is the terrible bind people with mental illness sometimes find themselves in: the sense among loved ones and even medical professionals that people lucid enough to know they need help are therefore too lucid to need help. That is the Catch-22, the bind. And experience suggest to me that it represents a clear impediment to care. How many people with a deep need for care have declined to seek professional help for fear of ending up in involuntary commitment, giving up their personal autonomy in the most basic sense?

I’m sure some would question whether someone who was lucid enough to attempt to avoid involuntary commitment was really experiencing a psychotic episode. Well, first, for me specifically, it makes sense: my manic states are characterized by extreme paranoia more than anything else. I see enemies everywhere. Knowing that the intervention of medical personnel invites risk of catching an involuntary commitment changes my paranoid behavior and gives me a very convenient excuse to avoid treatment. More to the point, it seems to me that progress will come precisely when we stop seeing manic states in binary terms of psychotic and minor. Too many people in the mental health community seem not able to understand that for many, there are periods in which the need for help becomes obvious to the conscious mind even while the perceptions of that mind become more and more distorted.

Leaving that hospital in Staten Island was one of the most brutal “what the fuck do I do now?” moments of my life. Ultimately sheer pragmatism pushed me in the direction of outpatient care: while there were surely private facilities that would have taken me on as an admitted patient, navigating the thicket of America’s health insurance system made inpatient care seem impossible. It took days more, and some deeply unpleasant medical misadventures while in a manic state, but I was able to connect with a doctor who got me on a short-term antipsychotic that made possible my adherence to a full treatment regimen, including long-term oral antipsychotics. I got lucky. I had the right friends and the support of family and enough money on hand to pay out of pocket. Many people don’t have those things.

I recognize that inpatient care is not appropriate for all patients or in all cases. I understand that in New York at least there is a city-wide effort to steer more patients away from costly hospital stays and towards outpatient care. I even broadly agree with that effort. And some would say that my experience demonstrates the system working, that outpatient care has worked and that pursuing it was more appropriate than being admitted for days or weeks. I don’t know, maybe they’re right.

I do know, though, that the conversation with me and that ER psychiatrist was a deeply unhealthy, disordered thing, both of us stalking around a legal definition that would compel him to act in a way that I found untenable. I am certain that this dynamic plays out all the time. I recognize that the life of an ER psychiatrist is likely difficult and that, given how often they experience psychosis, anything less than a full-blown case might seem like a waste of time. But there has to be a space between involuntary commitment on one hand and sedatives and the street on the other. One of the most basic needs of someone seeking psychiatric care is to have their problems reaffirmed as real problems, and yet bureaucratic and legal entanglements push doctors to see patients first as potential vectors for liability. It’s just not healthy for either side of the equation.

Triage is a fact of life in medicine. But the triage nurse should not be a formidable barrier to care, and too often, I have reason to believe, they are. If I fall out of a tree and tell my doctor that I think I broke my leg, that belief does not somehow complicate his or her diagnosis of whether I in fact did. And if I, now 17 years removed from my first diagnosis, am capable of acknowledging to medical personnel that I have descended again into manic hell, that should not confuse anyone into thinking that my condition is therefore not dire. If we are to dismantle stigma, let’s dismantle this one while we’re at it: the pernicious and false notion that people who can perceive their own illness aren’t really ill.

some personal news

So things are a bit of a mess for me, which I suppose is disappointing given all of the doctors, drugs, therapists, meetings, and more. But whose life isn’t a mess?

The news is that I’m losing my job. Brooklyn College will not be renewing my contract after it expires at the end of June. (The fact that I have a few months to figure things out is yet another blessing I owe to my union.) It’s obviously a big setback for me. Money’s already tight, as I wasn’t allowed to teach this semester, and I don’t have much of a cushion. My bigger fear is about losing my health insurance, particularly my prescription coverage. It’s just really expensive to receive consistent treatment for a chronic mental health condition. I don’t know how people without good insurance (or any insurance at all) do it. At least most of my prescriptions are generics. And there’s what I’ve put into the pension, which hasn’t vested yet, and the transit benefit, etc etc.

As far as the why, I won’t say much, other than that new leadership came in that doesn’t think I’m right for the position. And perhaps they’re right. Maybe it was never a great fit. Part of the essential issue is that I was trained as an academic, not an administrator, and those instincts and ways of thinking are hard to change. I do think I’d make a good administrator in the right position but management has made it clear this is not the right position. Anyway, regardless of the reasons I’ll be moving on.

(Coming in to work every day when everyone knows you’ve been slow-motion fired is as awkward as you’d think.)

I am applying for jobs but it’s slim pickings. I’m in kind of a tough spot. I’d love to stay in New York but I know I don’t have the luxury of refusing to move so I’m looking all over. I am mostly looking in academia, in both teaching positions and admin, although I’d cast my nets wider if I knew where or how. The job market appears not to have improved since I was on it in 2015-2016. Having a book in the bag helps some, though my academic research essentially stopped in 2016 when I started at Brooklyn College. I always intended to continue submitting articles for review but I underestimated just how tired I would be when I got home in the evenings. Hopefully people hiring will understand the difficulty of balancing a 40 hour a week admin job with the need to publish. Sadly the best lead I had has evaporated as the job was pulled due to a lack of funding, a not-uncommon turn of events in academia.

The elephant in the room is that a Google search will reveal that I had a very public meltdown in 2017, and that (among a lot of other stuff) in the course of it I made an inexcusable and deeply hurtful false accusation. And I’m sure I’ll get filtered out of a lot of jobs simply on that basis. Though I will once again say that I take and have always taken full responsibility for everything I did, I would hope people would take into account that I was having a manic episode, and that I’ve now been properly medicated and in treatment for two and a half years. I have genuinely experienced several years of stability and effective management of my disorder for the first time in my adult life, and I am in such a better place to be holding down professional commitments than I once was. But, well, if describing yourself as having been clinically psychotic is your defense… Many or most employers just wouldn’t want to get involved on sight, and I guess I can’t blame them.

Compounding matters is the fact that the other half of my resume, the more impressive side, is the journalism/writing side – and there I’m in both self-imposed and externally-imposed exile. I do have an impressive list of credits. Some people still ask me to pitch, every once in awhile. I haven’t taken them up on it because I have felt that I need to stay away, that removing myself from the takes industry is part of my penance and the least I can do. That’s not to say I’d never write a freelance piece again; there are a couple ideas that I still want to explore, and in the right venue and right situation I would definitely do a one-off. But in any event – it’s not like I’m making some bold sacrifice, as I have to assume that most places would not publish me now. Thanks to my own actions my name is toxic in much of the professional opinion writing world. I can’t see a freelance career is in the works. Perhaps some publication would take me on in a behind-the-scenes capacity like editor, which would be cool, and which I’d be good at. But it would take a particularly open-minded place, given my history.

(Ghost writing. I’d be really good at ghost writing. In some sense it’s ideal; I could use my craft without my name, my writing with none of my baggage.)

There is the book. And I’m happy and grateful for it. It helps to make me feel like there’s some positive momentum in my future. I truly believe it will sell, and St. Martins/MacMillan have given every indication of supporting it strongly, but I’m not nearly naive enough to believe that those sales can replace a full time job. The timing could be a lot better…. It might have helped with a buffer zone between losing and getting a job if it was being published this spring. And if I were already actively promoting it there might have been some opportunities arising from that, a chance to introduce myself to new people in a new context.

Emotionally, I cannot believe I still have to wait five months. It’s truly killing me and seems so senseless. I of course understand that big publishing works the way it works, and they have catalogs and media campaigns to consider. I get it. I just want it to be out there, so that people can read it, think about its arguments, and either get inspired or get mad. I’m even looking forward to the inevitable ruthless reviews. Maybe most of all. Anyway, August 5th is the big day.

Besides, I want the book out there so that people can read it and understand what it actually argues and what it doesn’t. A year or more ago there was apparently a Twitter meltdown accusing the book of supporting race science – it explicitly and unambiguously does not – and there could be no accountability because the book was not there in print for people to see for themselves. Of course, that will never stop people from lying about its contents, but at least then the deception would be plain.

Without social media I will not be exposed to much of the bad faith and misinformation, but neither will I have the means to defend myself in those forums. Even without Twitter I am sure I will have much cause to insist that the book says what it says and not what people says it says, in the year ahead. All I can do is put my faith in the text on the page, to trust that the book itself will always be its own evidence for what I believe.

I have also written a novel but I can’t even get my agent interested in it lol.

The thing is that despite my uncertain job prospects, I know that I can be useful and valuable in the right situation. I can write, in many different modes and genres. I can research and edit. And I can teach, and I have evidence that demonstrates that fact. I am passionate about teaching, love students, and have 10 years of collegiate experience. I could potentially cobble together a living with adjuncting and grading, maybe do some more editing and content development of textbooks. The problem with those cobbled together jobs is that they do nothing to solve the health insurance angle. But who knows, maybe one of these career jobs I’ve applied to recently will give me a call and this will all settle itself out. I would make a great professor; I have evidence of strong teaching and I’m going to be publishing books in my life, whether I’m in academia or not.

One of my great regrets in life is never having worked as a bartender. If only I had any knowledge or training or skills in that whatsoever!

I maintain a vague sense that the future will be doing something I’ve never done before, something out of left field. I think that was easier in olden days; if you browse Wikipedia you’ll often find people moving between fields that have no earthly connection to each other and without any apparent training. (Prior to designing Central Park Olmsted had no gardening experience.) I am always impressed with people who are able to make these kind of bold leaps; I’m just not sure if the 21st century labor market, with its incredibly exacting job requirements and demands for experience, is conducive to doing it. But I get excited when I realize that, in a sense, I could do anything.

I write this aware that to many it will sound as if I am feeling sorry for myself. I am not. I recognize the luck and privileges that I have enjoyed. I continue to live what is in many ways a charmed life. I am definitely in a real pickle. But I’ve been in pickles before. I have been through a lot in my life and I can survive. In general in life I am convinced that we are all doomed and that everything good is gone and that the only hope for the future is that a rain comes and washes everything that exists away, but I am cheerful about it. I have hope for my own future if not the world’s. Having a few more months to figure stuff out is a rare privilege. I just wish the path was a little clearer right now.

God help me, I even made a LinkedIn.

Elizabeth Wurtzel, 1967-2020

Mandatory Credit: Photo by Dan Callister/Shutterstock (4871343h) Elizabeth Wurtzel, New York – 10 Jun 2015

I had one little run in with Elizabeth Wurtzel, some five or so years ago. We were both on a panel on some sort of web talk show, streamed in via Google Hangouts or whatever. There were maybe four of us and a host. I could not tell you the topic of that conversation if my life depended on it, much less the name of the show. But I do remember her. Before the show began, we were all sitting there, waiting, and it was awkward, or it would have been, had she not started talking. She talked quickly and confidently. She asked me about “my deal,” and before I knew it we were talking about my cat. She was forward and endearingly nosy. She seemed completely at home with herself. And then the show started, and I said some stupid pablum when my time to talk came and it was over.

I read Prozac Nation when I was a young man, in my early twenties. I devoured every page, finishing it in a week, and hating her the entire time, which if nothing else proves once again that there is only one hatred: the hatred of recognition. I’m told that “reading,” in the drag world, refers to the act of sizing someone up so completely that you gain power over them. If I have that right, then she read me while I was reading her. For if the past decade of my illness has been defined by mania, my young adulthood was defined by the depression. I think back to my first little studio apartment and I can’t imagine a worse house of horrors, the endless hours spent curled up in the fetal position on the carpet. And I think about her book – it’s been, I think, 17 years since I read it – and I can’t quite grasp why I was so repelled by the familiar. I suppose the only honest answer is that I was not looking for honest answers. Not then. Back then I was running.

What I didn’t know at the time was that she understood things I couldn’t see. What Wurtzel grasped was that there was no percentage in trying to soft pedal a disease that would give no quarter if she did. She understood that behind depression there’s just more depression. And so why not try to do the impossible and put into words that which comes to be the defining facet of your life? Depression is a negotiation, made against someone who has all the leverage. You can, perhaps, improve your negotiating position with drugs and therapy. But the actual experience of depression will remain visceral no matter how hard you try to render it banal. There simply was no value, to her, in trying to make others feel more comfortable about the spiraling instability that was her early adulthood. This might sound selfish but in reality it’s the kind of internal bargaining that could only be made by someone who thoroughly knew herself.

Was her work pretentious and self-absorbed? Sure. But she never claimed to be otherwise. Depression makes you myopic; hurt develops its own kind of gravity, and over time everything falls in, except those people with foresight enough to see that they are approaching the event horizon who step away in time. You will not be saved by trying to maintain the requisite ironic distance from your own life, to act like some 21st century Twitter power user who deadens their experience of life with jokes and memes and cleverness. She chose to do the opposite, and being a writer, she did it with words: she wrote down what it means to be depressed, and what it mean to be a brilliant beautiful Gen X degenerate, and she did it as good as any and better than most.

Besides, I’ve been an advocate for pretension for a long time. What you gain from refusing to be pretentious is, I guess, becoming a harder target to hit when people inevitably come to dress you down. That’s the only upside I can see. And the downside? You become a stranger to yourself. You are so consumed with not being pretentious that you leave beside anything deep, penetrating, and true. You doubt your own reaction to beautiful people and perfect art. You are scared to bare your undershirt, let alone your soul. You know that there is always a built-in limit to the ecstasy of any experience. You become a slave to your own self defenses. You are neutral in all the places where neutrality makes you boring. You are afraid. Me, personally? I’m a cancer orphan who got his first shot of Haldol at 21. How could I have ended up any other way than pretentious? And for those of us in that position, there is Wurtzel to say, fuck them, say it anyway. Say it anyway.

I have only just thumbed through the text again the last few days, but if I remember correctly Wurtzel mentions cancer often in Prozac Nation. This too is a preoccupation of the depressive. I suspect it’s because cancer is the realest illness, the most visceral and the hardest to deny. Surely that has great appeal to those who, like the depressive, have been told in voices both loud and soft that their illness is not real and that their concerns are those of the coddled. Breast or brain, cancer can kill you; I suppose it was only fitting that a person held captive by her own mind would become convinced that it was her mind that would kill her. Now it makes me think of Trumbull Stickney, who wrote

Sir, say no more.
Within me ’t is as if
The green and climbing eyesight of a cat
Crawled near my mind’s poor birds.

There is a period of time, when you are on-boarding meds, where you are altered and know you are altered. It turns out that this is something of a blessing. Because what comes afterwords is the persistent question inspired by no longer feeling altered: have I acclimated to the meds, and am now back to my old self? Or did I just get so used to being altered, I’ve forgotten how I used to be? And at this point, do I even care about the difference?

I look back now at my earlier self, the one who was so hard on Elizabeth Wurtzel for articulating everything I felt and could not bear to say, and I can only think of one thing: my certainty, at one time, that my resolve mattered, that what drugs and doctors couldn’t do, my will could. If I am being honest, that is the biggest change in my life from those days when I would count the grains of sand in the paint on my ceiling: I have surrendered. I have learned that I am not strong enough, and that even if I could summon the strength, there was not much worth saving. Elizabeth Wurtzel knew intrinsically what took me decades to learn. She knew that depression, like cancer, was no tame animal, that it took who it chose when it felt like taking them. And so she made up her mind to describe it as fully and forcefully as she could, undeterred by the inevitable criticism, determined to try and express feelings that undermine the foundations of the language in which you express them. She did not deny her illness, nor try and sand off the edges that came along with it. She understood that she had no power over her illnesses but the power of description, and so she described. Her descriptions were true, as true to depression as has ever been written, and they will endure. She knew things, like the price of telling that truth. And that for her, and for me, and for you, the bargain with cancer and with depression remains the same: the fates will decide, and you will survive, or be consumed.

statement

On August 18th 2017 I lied and accused Malcolm Harris of rape and sexual harassment of women, particularly of women he works with.  These allegations were completely untrue, Malcolm in no way deserved them, and if anyone held a shred of doubt, let him be fully exonerated. Crucially, despite my mental state at the time, I knew when I sent those tweets that they were untrue. I am responsible for having made those false allegations, and that makes me a liar, it makes me guilty of slander, and it makes me someone who undermined the profound seriousness of rape allegations.

I have bipolar disorder. I have been dealing with it since I was 21. For most of that time I have hidden my condition and resisted treatment, only telling my siblings more than a decade after my first manic episode.

When I first moved to New York I arranged to see a psychiatrist and was medicated for a few months. However my relationship with her was not good and getting to appointments was difficult and so, as has happened many times, I let my treatment lapse. In early 2017 I descended gradually into mania. My cycles are quite slow which can make it difficult to realize when my condition is falling out of my control. By late summer I was a danger to myself and others because of the extreme paranoid delusions that are common to my episodes. It was in that context that I made these accusations, but I again stress that I was responsible for my actions and that I have to be accountable for them.

I am ashamed of myself and have been ever since. I think about it every day.

I would like to be able to say that the incident with Malcolm – my accusations, my digging in on those accusations despite their obvious lack of credibility, my subsequent deletion of my Twitter account – inspired me to get help, but that wouldn’t be true. I only went to the hospital under threat of legal trouble – from someone other than Malcolm, who has been to his considerable credit explicit and adamant that he would not be pursuing a legal option. (Let me additionally say that I am not publishing this apology because of Malcolm pressuring me or in any other way putting me up to this.) That weekend I accused someone who was once quite close to me of conspiring against me, and threatened to harm them in revenge. They told me that either I went to get help the next day or they would have me arrested. I called my brother for help and sought treatment the next day at Richmond University Medical Center.

In terms of making amends, I can point to major changes that I have made and stuck with since I went to the hospital. I have now been on meds consistently for the longest period of my life. I have finally relented and accepted the fact that I must be on antipsychotic medication long-term, resistance to which has long proven a serious barrier to care. I have abandoned all social media permanently. I have stopped freelance writing. I have in general tried to permanently remove myself from online life and from the world of political writing in which Malcolm resides and I once resided. These changes are not attempts to make up for what I’ve done, really; they are just matters of self-preservation as I try to build a life where I do not cause harm to people anymore. I have fully committed to constant treatment, and I have fully committed to going away. I am so profoundly sorry.

That’s all.

the involuntary admission barrier to care

I am very far away from the news cycle, these days, but even I have not missed the horror of another terrible school shooting. As it should, the topic of America’s mental health system appears to have again come up. I want to very briefly note a serious practical barrier to appropriate care, which is the involuntary admission system.

When I reached the end of my ability to cope with my illness last August, I had a dilemma. I went to the hospital because of a long string of erratic and self-destructive behaviors. But the final event that drove me to seek emergency care was that I had accused a friend of hacking into my bank account and threatened to harm them in revenge. That they didn’t have me arrested was an act of mercy. When I got to the hospital, I knew that if I revealed that I had threatened physical harm to someone, I would be at risk of a 9.13(b), New York’s involuntary admissions policy. Most other states, I believe, have similar laws. I could not risk the disruption to my life, and the total loss of control, a 72 hour stay would entail. And since I was not willing to divulge that detail, which would have made my crisis clear, the psychiatrist who treated me would not allow me a voluntary admission and I was left to pursue outpatient care. This is the lacuna into which you may find yourself when you have a psychiatric crisis: how to receive appropriately urgent care without losing control of your life. This problem was particularly acute in years past because I was hiding my condition from family and friends and was terrified of them finding out.

This dynamic, I’m sure, would not have impacted the Florida shooting. And I recognize the need for some form of involuntary admissions. But I am convinced that many people avoid seeking care entirely out of fear of involuntary admission, and something has to change.