Approximately four months ago, my psychiatrist placed my Bipolar 1 Disorder in partial remission.  Since, I have struggled, grappled, with the word “partial.”  How is it possible that I am only partially towards remission?  Where is the line drawn in the division of these categories, where does the curtain fall – symptomatic, partially symptomatic, fully asymptomatic?  The application of “partial” poses discomfort for me on several levels, the very first being my perceived lack of control.  As the entity experiencing the disorder, how can an outsider peer in and see the inner clock working, ticking, turning of my mind and know, with a certainty, I have progressed up the ladder?  I feel quite wary of such a distinction.  I see mental illnesses as fluid disorders, not remaining in exact, crystallized forms for extended periods of time.  Thus, as I continue to have episodes of mania and depression, I squirm with angst and frustration that such emotions should have been annihilated by now, as I am in partial remission, correct?  I am constantly flowing in and out of states, and these two words attempt to hit a fragment of my existence like a dart to a bullseye and obliterate all outlying symptoms.  At least this is how my mind perceives it to be.  Rather, as I have discovered in the medical world, labels are just an issue of semantics, present only for clear and consistent communication among medical professionals and for the direction of effective treatment.

If I can entertain the notion of casting all labels aside and truly examine my progress, there rests marked improvement.  One year ago, I was still receiving electroconvulsive therapy treatments, and much of my episodes surrounded suicidal thoughts and intrusive thoughts of self-harm.  Episodes lasted weeks, even months, despite aggressive treatment.  If asked what my greatest worry for the future was, I most likely would have answered suicide.

I had my final official meeting with my psychiatric nurse case manager yesterday.  We were discussing my progress and impending ability, due to vast improvements, to be discharged from the intensive care program.  She posed the question, what are you most worried about in the coming year?  My immediate, knee jerk response was “not getting into grad school programs.”  What a departure from a year ago, twelve months ago, three-hundred sixty-five days ago.  It was in this moment that I could see how significantly my perspectives have changed, have shifted.  Instead of contemplating the unsure existence of life in the near future, I imagine a place in which I live, I am successful, and I humanly exist.

To battle words is a futile battle.  One must recognize that words only hold the power that you allow or wish for them to hold.  And why can words not be fluid as well?  In consideration, can the word partial possibly be considered fluid and dynamic, for does it not imply a sort of limbo?  How more advantageous it would be to see it as a realm of existence where I can experience a spectrum of differing symptoms, yet still exist in a space of reduced symptomatic expression.  I do not have to imagine lines and curtains, theatrical representations of the process of remission.  The underlying, driving emotion in this wrestling match is fear, in two parts.  As I progress into partial remission, does there lie an impending regression into severe illness once again?  Or alternately, as I move from partial remission to a possible full remission in the future, will I lose the mind I have and hold so dearly, or my depth of experience, as well?

I can take a shower and perform morning ablutions without washing my hands repeatedly to avoid contamination.  When things do not occur within increments of four, I no longer freak out.  It only takes me a few minutes to leave my apartment, checking all faucets and appliances and the door only a few times.  These rituals, but a small part of my cornucopia of symptoms, were all-consuming.  The other day I realized I did not massage my scalp to the count of four as I was shampooing, and that was okay.  Anxiety had abated, and I could wash my hair without the abacus clicking within my head.  Instead of focusing on semantics, I vow to focus on my improvements, my victories in the face of crises.  Why get hung up on words when I can drink the sweet wine of life?

Loosen the Barbed Wire, Please

Carrying obsessions is one of the most painful things I endure.  I do not speak of a penchant for designer shoes and purses, but rather a demon so powerful, so insidious, one that wraps barbed wire around my soul and refuses to let go.  My focuses of attention shift with time.  The patterns of the responses surrounding my obsessions may likened unto an EKG monitor recording a heart rhythm.  There exists the baseline, and then there are spikes and plummets that dance around the baseline, neither staying for very long.  There are times when the obsessions/compulsions flare up severely, like a firecracker shooting into the sky, and I burn and burn until all that is left are ashes indicative of a fight I have lost.  The performance of each compulsion is never enough, never satisfactory, and never will be.  The demon demands more and more, with each request tightening the hold on the ever-constricting barbed wire.  I ask my mother repeatedly, please look and see if I have degenerative gum disease, please look, and with each answer of “no” I receive, there grows a greater impetus to ask again, because no matter how many times I receive the answer I am seeking, my brain refuses to believe it as truth and deems it to be a lie.  There is but a fraction of a second where my mind considers the validity of the answer before the impulse to ask again ensues.

During the summer a little over a year ago, I lived in a special place of hell.  I was in the throes of two obsessions that worked to destroy what little existed of the life I was attempting to live.  I had just moved back to Portland to return to school after living at home for a few months following one of many psychiatric hospitalizations.  The building was old – historic, they call it – and it terrified the living daylights out of me from the get-go.  I was dipping into psychosis as well, and from the minute I began to move into the building I became thoroughly convinced that it and my apartment were infested with bedbugs.

The unpacking process never really happened, as I became obsessed with the infestation and spreading of bedbugs in the apartment.  I had places designated in the apartment for contaminated and uncontaminated items in order to slow the infestation.  Upon arriving in the apartment, my shoes were placed in a specific spot that prevented bedbugs living in the hallways from entering my apartment any further than the door.  I then had to place a special pair of socks on my feet that allowed me to walk through the apartment.  As clothes became contaminated, I collected them in a plastic bin, and when it came time to wash the clothing, I could not allow the bin nor the clothes to come into contact with the building in any way between my apartment and the laundry room, and then between the laundry room and my apartment in order to prevent contamination.

My cat was living with my at the time, and I became very afraid of her.  I began to see her as another vessel in the apartment that was capable spreading bedbugs.  I attempted to eschew all contact with her, because she was “contaminated” as well.  Then I started seeing the bedbugs everywhere (which is probably where some psychosis comes in).  My special socks started to be covered in them.  I could find them all over the floor, my bed.  I would tear my bed apart repeatedly looking for evidence of bedbugs.  I forbid my cat from coming into contact with my bed, and each time she did, it initiated a storm.  It came to the point where no place remained uncontaminated.

It was also during this time that I became obsessed with having a degenerative gum disease.  I spent literally hours in front of the bathroom mirror, with a second hand-held mirror to maximize the angles, studying and dissecting what I saw before me.  I thought the periodontal tissue was deteriorating and with such rapidity that I would soon lose all of my teeth.  Even after seeing doctors and being told otherwise, my fears could not be assuaged.

The barbed wire gripped my soul so tightly and strengthened its grip with each attempt I made to break free through performing a compulsion.  I bled and bled and bled that summer.  I came home one weekend during this time and had an especially distressing flareup with my degenerative gum disease obsession and ended up cutting my arm very badly in attempts to escape the hellish world in which I was trapped.  What I call “the nightmare” ended with a hospitalization and a strong dose of lithium.

In Brain Lock, Dr. Jeffrey Schwartz discusses the neuroscience behind obsessive-compulsive disorder.  The parts of the brain in the orbital cortex fail in their ability to initiate change from one thought or behavior to the next with fluidity.  Thus thoughts and behaviors get “caught in gear.”  Hence why compulsions are performed repeatedly to no avail, and thoughts perseverate uncontrollably.  I have found that, personally, the most successful way for me to detach from the obsessions and compulsions and free myself from the tightening grip is to defuse.  I recognize the thoughts for what they are – information coming from my brain that cannot be held as undeniable truth – and let them go.  One by one, over and over again.  Only when I can recognize the thoughts as pathological and not veritable can I detach from the vicious cycle.

I am still struggling with obsessions daily, but I have made some strides in being able to defuse and let go of troubling obsessions that may arise.  I strongly recommend the work of Dr. Jeffrey Schwartz, and specifically his book Brain Lockin better understanding obsessive-compulsive thoughts and behaviors.  Perhaps the most painful aspect is that a compulsion is never enough.  What little fleeting relief one may feel is immediately replaced with the flood of fear, anxiety, foreboding, and it truly will never, ever be enough.