Notes to Self

“The spotted hawk swoops by and accuses me, he complains of my gab and my loitering.

I too am not a bit tamed, I too am untranslatable,

I sound my barbaric yawp over the roofs of the world.

The last scud of day holds back for me,

It flings my likeness after the rest and true as any on the shadow’d wilds,

It coaxes me to the vapor and the dusk.

I depart as air, I shake my white locks at the runaway sun,

I effuse my flesh in eddies, and drift it in lacy jags.

I bequeath myself to the dirt to grow from the grass I love,

If you want me again look for me under your boot-soles.

You will hardly know who I am or what I mean,

But I shall be good health to you nevertheless,

And filter and fibre your blood.

Failing to fetch me at first keep encouraged,

Missing me one place search another,

I stop somewhere waiting for you.”

Walt Whitman, Song of Myself

*     *     *

Dear Elliot,

When you read this, I want you to know what is happening to you. People will say things to you like “Maybe that won’t happen for a long time” and other ways of telling you not to think about this, but that won’t help you, because it never has.

First, about the treatment you will try—they say it’s common to forget why you did it. Which makes sense, since you’re almost certain to lose your memories of the time immediately surrounding the treatment. So, for the record, here’s how you made the decision: you were standing in the middle of Target, next to a display of plastic organizational baskets, which were neatly arranged by color and stacked atop one another. You had been actively suicidal for over a week straight. Your hands trembled as you held the phone to your ear. Your psychiatrist was talking to you; you thought she must be a good psychiatrist, because she listened to you, and also, her voice was soothing.

“If I were you,” she said, “Personally, I’d choose ECT.” So that’s what you will do.

The empirical literature suggests that bipolar disorder is a progressive illness. Interventions, such as lithium therapy, can prevent the progression to further stages; however, when intervention does not come soon enough to the onset of symptoms, bipolar disorder will follow a predictable worsening course.

Yes, one day—maybe soon, I will put down the pen, and I will leave you. Maybe ECT will bring me back for a while.

“Late-stage” bipolar disorder is characterized by shorter episodes and rapid cycling (the mood episodes get closer together, with progressively less euthymic or “normal” time in between them), as well as sustained attention deficits and greater functional impairment. Research has found that bipolar brains become increasingly abnormal as the number of previous episodes rises. And, in its “final form,” bipolar disorder may cease to respond to pharmacological treatment altogether. This is what has happened to you.

When you saw your (new, young-seeming) psychiatrist, Dr. N, she talked to you for a long time. She said “this is very serious” a few times and looked at you with genuine nervousness; then she said she would make a call, and started to do so, and then stopped. She looked at you again, that nervous look, and said she would step outside to call. Your therapist would later tell you that Dr. N consulted with the best psychiatrist UCLA has to offer, thus, one of the very best psychiatrists in the entire world.

You knew then that it was true. You are getting worse, and you will not get better.

Yes, one day—maybe soon, I will put down the pen, and I will leave you. Maybe ECT will bring me back for a while. But not forever. When this happens, you will be hurt and alone, I know. When I cease to exist within our mind, I suppose that is like dying. I have always been characterized as a confident voice; yet I am face-to-face with an indescribable fear—I do not know what will happen to me after I die. But, I think I will miss being alive; breathing, eating, writing, living, even if you do not remember me or anything anymore, maybe in some way, somewhere—I will live on in you.

*     *     *

Dear Elliot,

You wrote your tenth grade pre-AP English “research paper” on a topic of your choosing. You chose a topic that you knew would get you screamed at (or worse) behind the closed doors of your suburban childhood home (and it did!): transgender rights.

But you wrote the paper, and you put everything you had into it, because you were very stubborn and you refused to be broken. Later, for the final paper—it wasn’t actually the final, but the last assignment you completed due to your absences and subsequently vast amount of missing work—Mrs. E had you write your first-ever piece of memoir in response to The Things They Carried. You wrote about your relationship with Alec, the first trans guy you ever knew; and you printed it out and stapled it and neatly hand-wrote marginal comments for her in blue ink.

She cried reading it. You were proud, and from that day on, you knew you had power with your words.

Others were beginning to become aware of your power, too. Your college essay was about coming out. You were genuinely nervous about it (as you very much desired to go to college so that you could move out of your house), and reflexively said that you would revise it. Mr. M replied that it was already perfect, “like a glass of fine wine.” It was the only perfect first draft in your entire grade.

You didn’t have power over your life, but you had power over the page. It helped you cope with some of the other things: like how you were forced to change for gym in the nurse’s office, and then you’d always get in trouble for being the last one to gym; or that math teacher who openly and actively refused to use your pronouns; or the time you got an anonymous letter from some girls in your class who thought it was “disgusting” that you did not shave your legs, and that you did not look very much like a boy at all, and accused you of simply not “trying hard enough” to grow facial hair. You knew right away how incredibly stupid they had to be—it takes hormone replacement therapy to do that, and no amount of thinking will help!—and yet it was as if they knew exactly how to cut you, by telling you that you didn’t even want it bad enough.

Because the truth is that you wanted to be a boy more than you had ever wanted anything in your life, before or since then, and probably more than they had or would ever want anything in their lives, either. Even when that therapist tried to convince you that you didn’t want it, you knew that you did. You learned to lie, and to hide things. You learned to go places by yourself for the very first time—even somewhere as simple as the CVS on Gillette Avenue was a new frontier for you, and you were absolutely terrified that your parents would drive by and see you buying store-brand men’s deodorant with the $10 bill you carefully stole from your mom’s purse.

But those experiences are what made you independent today. You found a voice, you learned to fight and to stand up for yourself. You were strong. And you still are.

One summer, many years later, you were sitting on the swings in your backyard with one of the nerds (your nerds), Mike, smoking a bowl under the stars. He told you how, in high school, popular kids would ask him personal questions about you, like why you were so quiet in school. And he told you that he would always say the same things to them:

“Look, I really don’t know. He doesn’t talk to me or anyone about his past or the way he feels. And I wouldn’t ask him. He does seem sad sometimes. Personally, I think he’s been through things, bad things, horrible things, I think he’s had a life you or I couldn’t even wrap our heads around. Listen, because I mean this: [Author Name] is the strongest person I know.

*     *     *

Dear Elliot,

You will need some materials before you read this next part: a blanket, a favorite beverage, and a box of tissues. It will be hard to remember these things. For many years, you suppressed thoughts like this from your mind and destroyed most of your memories; but I think they are important for you to understand why you are the way you are and to be gentle with your own personality.

They say she loved you more than anyone else in the world. You have never considered yourself a delusional person, and so you do not believe in ghosts or guardian angels.

As you know, bipolar disorder runs in families; it is highly genetic—perhaps more so than any other DSM diagnosis—and there is a phenomenon called “genetic anticipation” wherein successive generations tend to have the illness earlier and more severely. You will know most of this because doctors will ask you, as part of a routine intake, whether you have any relatives with bipolar disorder. At first, you didn’t know how to answer this question because nobody in your family had ever told you that she had a diagnosis; but you are comfortable by now asserting that, indeed, she was bipolar. She was your grandmother.

You remember—her house. You spent a lot of time there. It was messy, with objects strewn into piles in every room; a lot of it was (to your great joy) art supplies. You remember digging through her mountains of junk one day and stumbling across a barely-used box of charcoals—not an unusual find, and of course she let you draw with them. You did many art projects together. She was probably a very creative person, and she also loved to bake. Your favorite was her blueberry tart.

Most people recognized that she was eccentric. You do not know if they knew her eccentricities were signs of underlying bipolar illness.

Try as you might, you are no longer able to remember what she was like. There are only fragments of her left, short and nonsensical-seeming clips you can play over and over again in your head, but nothing more. It will occur to you at some point that this is very strange; after all, most people your age can remember (to some extent) being ten years old.

You think that you were very close with her. She was always the “parent” you brought to elementary school functions, and you chose to bestow such honors with care.

You were, as far as anyone in your family knows, the last person to see her alive. You think—not from memories but gut feelings—that she told you how much you’d grown up, how much she would always love you. It was Valentine’s Day. She gave you gifts, including a teddy bear; you don’t know what happened to them.

Your parents will insist to you for your whole life that what happened was an accident. But you knew things about her that even they did not know. You knew, and you have always known, that it was not.

Yes—she committed suicide. It’s okay to remember things and to feel sad. I have learned that “sadness” and “depression” are different things. You banished these thoughts and feelings for years afterwards, or at least, experienced them without knowing why.

You don’t know who told you that she died; you only remember waking in the middle of the night, scared and alone. The rest of those days are a blackout. Your family have implied that you had a mental breakdown—your very own first bipolar episode.

You could not go to her funeral.

Although you moved on—destroyed the pictures of you and her together even—your brain never returned to being the way it was before it happened. Your prodigiously accurate Asperger’s memory became distorted and dysfluent.

You are very much like her. We can call this a “gene-environment interaction”.

Your rational mind knew that she did not intend her suicide as a rejection of you—but it’s always been hard to feel that way. After all, she quit, exited stage right. You learned to cope. That’s what happened to your personality.

They say she loved you more than anyone else in the world. You have never considered yourself a delusional person, and so you do not believe in ghosts or guardian angels. But some people believe that the night, about two weeks after she died, the night you hemorrhaged—and almost died yourself—but, for some unknown reason, you woke up, covered in blood, red everywhere, your pillows were permanently stained—they believe that was her spirit, protecting you. They believe she protects you still.

I think maybe it’s okay, in this one instance, to believe in such things.

*     *     *

Dear Elliot,

I had a Skype call with our college mentor, Dr. Pinball, a couple of days ago. Actually, my writing these letters began at his suggestion.

During the most recent episode—well, you sent him a lot of emails. You always have. It’s not like he doesn’t already know you or how you can be; Dr. Pinball and I have worked closely together for years. But he seemed to notice that this time was different, that things are changing, that the room we inhabit is getting darker and warping at a faster rate. He is, after all, a clinical psychologist—and a good one, to be sure.

I can’t explain exactly why we latched onto Dr. Pinball the way we have. It’s probably an excessive relationship to have with one’s college mentor. He is aware of this, too; so I thought maybe he would request that you stop sending him these obviously distressed messages. It would be justifiable to anyone. He looked thoughtful (as he often does) and said, “I respect you very much, and your work, and—well, you, and I hope you feel the same way. But I also have an obligation, an ethical obligation, as a clinical psychologist.”

Quietly, I nodded, and said, “I do respect you very much.”

“Well, it seems like maybe those emails are a way of managing those feelings for you—a catharsis of sorts—and I could ask you to stop sending them to me. Maybe it would make me feel happier and more comfortable. But that’s—after the things you’ve been through, in your life—that’s not the point, is it?” He chuckled kind of softly, maybe sadly. Dr. Pinball knows more about your life than anyone else.

“You were hurting and in pain, [Author Name]—but, this last time, the content—in the future, I have to be able to make sure you are actually safe.” He paused. “And I want you to know that I wouldn’t be having this conversation with just anybody, I mean, if someone else sent me emails like this, then…”

I looked at the floor, rested my hands on my desk because they were trembling and hoped he would not be able to notice this. I guess I didn’t really know what to say. The relationship we have with Dr. Pinball is not something even I, with all my gifts, can express easily in words; it never has been. He asked me a few questions about what he could do to help you, and how he could know that you aren’t going to kill yourself (or, alternatively, exactly when he would really have to take action). I agreed to write up a contract with this type of information, even though outsmarting you is very difficult.

“The good thing about our field,” he said (proudly), “Is that—you’re my student and I’m your mentor, so no matter how far you go—until, well, forever!—I’ll always be.”

I smiled—I did not cry, although it was difficult. Somehow, for once, we felt a little bit loved.

I do not know—can’t really know—where I am going, or how far, or how it will be when I get there. But the darkness in the room feels just a little bit lighter than before.

Sincerely yours,

Elliot

 

Elliot Gavin Keenan is a PhD student in human development & psychology at the University of California, Los Angeles, where he studies cognition in autistic individuals. (There are rumors that he is autistic himself. Fortunately, these rumors are true.) He is 22 years old. He lives with his cat, Tarot, who is not very classy at all. His interests include strategy board games, swinging on swing sets, and using italics.