Matt Maday
I’m in fourth grade, and I have a special token about the size of a quarter: a round thing that looks like it’s a punched-out piece of scrap metal. I know the token is monetarily worthless, but I’m obsessed with it. I lose it at school one afternoon and beg my mom to help me find it. Because the token has an overwhelming personal value that isn’t communicable to outsiders, I’m wary to ask my teachers about it, but I feel compelled to ask. My computer teacher finds the token, bringing a surge of relief. I lose the token again, this time permanently, but gradually, I don’t care; the token’s mental value depreciates. The obsession evaporates.
The obsession changes to involve the radio. Instead of focusing on my homework after school, I turn on the radio and anxiously wait to hear my favorite songs. Then I want to hear the songs again. I wonder if I’m addicted to the radio. At a parent-teacher conference, my teacher expresses concerns about my low grades, instilling a sense of anxiety so extreme that I fear my teacher will hold me back a year. Her stern visage frightens me at the beginning of the conference, but by the end, she smiles reassuringly and I promise to improve my grades. I’m able to complete elementary school.
By the time I reach middle school, I realize that my concern about failing fourth grade was an exaggeration, but I wonder if I’m prone to exaggeration. I’m so worried about germs that I wash my hands countless times, locking myself in the bathroom to keep anyone from stopping me. I wash my hands until they bleed. I hate how my skin looks, but I can’t stop washing. I can’t sleep. I’m continually distracted. It feels like I’m having a constant panic attack.
At fourteen, I start to consider my options if I run out of hope completely. One day, I go on a hike with my parents: a family event I see as a parental ploy to get me to share my thoughts and feelings. Instead of talking to my parents, I have suicidal ideations. I worry about the emotional pain my suicide will cause people who love me, so I consider options that involve making my death look like an accident. As part of a religious obsession, I worry that, if I commit suicide, Satan will claim me as one of his followers. My anxiety about the consequences of suicide deters me from making a suicide attempt, but I’m terrified by the prospect of living an anxious life.
I can’t bring myself to completely reveal my thoughts to my parents, but I tell them enough that they make me an appointment with a psychiatrist. The appointment seems like a twisted game show. I assume a psychiatrist will ask me questions, and I’m afraid if I answer incorrectly, I’ll exit the stage never knowing what the correct answers are, huddled inside a suffering that can’t be labeled and treated. It’s hard to imagine walking away a winner.
The counseling session results in victory, however. A psychiatrist diagnoses me with Obsessive Compulsive Disorder (OCD). When I wander onto the psychiatric stage, I’m wearing my diagnosis as a costume: the narrative I tell matches with the diagnostic script, pill bottle props are waiting to be handed to me from backstage by a pharmacist. My psychiatrist notices the scabs on my hands and asks if I pick them. Yes. The repetitive handwashing, obsessions with symmetry. Yes. Ritualistic superstitious behavior not clearly tied to an established religion? Yep. The psychiatrist prescribes Selective Serotonin Reuptake Inhibitors (SSRI’s). I win a prize in a plastic bottle.
Once I get a stable level of medication in my bloodstream, the hand-washing decreases and I begin to accept the dirtiness of the physical world. I start to feel like I’ve left OCD behind, until the symptoms switch to focus on a different domain: I fear that I will unwittingly cause evil spirits to spiritually harm me and those I love if I don’t maintain control over the accidental writing of evil words, numbers, or phrases. I’m apprehensive about physical touch because I fear transferring evil and unintentionally behaving in morally corrupt ways. My schoolwork vastly improves because the medication makes it easier to avoid repetitive behaviors such as erasing and re-writing, re-reading, and cleansing, but I can’t clean my mind. I’m left with internal obsessions that lack the corresponding behaviors of classic OCD, a situation psychiatrically referred to as Pure-O (the name sounds like a new energy drink destined to hit the shelves any minute). Although I’m taking SSRI’s, the common first-wave treatment for OCD, the symptoms never reach zero like my psychiatrist wants; they hover around. After consultation with my psychiatrist, I move on to the second wave: antipsychotics.
As I start my antipsychotic treatment, I begin to feel shaky and irritable (like I’ve had way too much caffeine) while simultaneously sedated to the point where my counselor remarks that she’s worried if I’ll be able to make it up the stairs to her office. I have head rushes with an accompanying sense of euphoria, which I find to be the most enjoyable side effect until, one time when I’m at work, I stand up quickly and find myself in a state of complete blindness. I quickly regain my vision, but not before losing my balance, trying to catch myself on a shelf, and falling dizzily to the floor. I get up and make my way to a chair. I clear my head and return to work.
Yet, due to the side effects, I never feel that my head is really clear. I feel like someone working through an injury, but the injury isn’t the result of something like an occupational accident. My side effects are somewhat consistent with the warnings on the medication bottle, but reading the label won’t make someone aware of the effects in the way I’m made experientially aware. When I try to describe the side effects to my psychiatrist, his confused expression leads me to believe they are ineffable. Yet, monitored by my psychiatrist, I go off the antipsychotics.
While I’m away at college studying psychology, my family counselor dies. I keep my last appointment with him: his funeral. I hate how close I was to feeling better; how much I relied on him, how much I emulated him, how much I thought, one day, we would be colleagues: true equals. I take myself off the last of the meds, the SSRI’s, without telling my psychiatrist: not exactly the commonsense approach, but I’m done with the way their drugs make me feel. I aspire to be a mad genius who treats his own madness using a loose collection of advice from counselors, independent research, brainstorming, and a post-secondary education in psychology. I don’t refill my prescription when it runs out. I think about whether I’ll be able to call myself a “psychiatric survivor,” but I don’t have a vendetta against the psychiatric industry. Because medication helped me make it through a time when I was worried I wouldn’t survive OCD, I owe my psychiatrist at least one last visit. I also owe the visit to myself and those around me to ensure my medication transition goes smoothly.
Instead of making one last visit, I clear my calendar of psychiatric appointments. I drop out of counseling. I obsess over my own diagnosis, spending extracurricular time reading the Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision (DSM-IV-TR). The DSM-IV-TR contains criteria for diagnoses officially recognized by the American Psychological Association, but gives me little in the way of proposed causes for disorders. The diagnostic criteria form a smug blanket of inductive reasoning. The complex reasons (i.e. psychological causes) for disorders are speculative apparitions that hide behind a diagnostic veneer composed of observable behavior and expressed thoughts: a manifest evidentiary curtain hiding the psychological event. The psychological event is a group of actors backstage asking the stage manager not what their lines are, but why their lines are written the way they are. And also, how many characters do I play in this one? Are we in the one called Dissociative Identity or Dual Diagnosis? How much can one character trait affect your identity?
One summer, I peruse Ralph Waldo Emerson’s essay “Self-Reliance,” an essay I’m familiar with but find myself rereading every now and then. This time, I halt when I read the line “imitation is suicide.” The thoughts and behaviors of OCD are attempts at establishing order and conformity, at imitating an almost mechanistic ideal, but they become fractured, anxious imitations of humanity that appear as helplessly tangled, human, and vulnerable paths to altruistic suicide in the face of impossible individualism. It would be nice to pick up a loose collection of precut electronic parts and meld them into my organic-electronic brain, “fix” myself in an obsessive fantasy about cyborgs, but really, I know my fellow humans aren’t robots, and that’s what scares me. I have to ask myself, “Should I stay caught in my moments of deepest disjuncture, living as an assortment of arbitrarily categorized variables disconnected from a community I can’t relate to or predict, but at the same time I’m locked into my wildly individualistic identity?”
Sometimes I’d rather take conformity because it’s cleaner than individualism.
Matt Maday 