It starts as moments of feeling deep despair. Tears threaten to fall at any moment. I turn off my camera in these days of personal interactions over Zoom, leaving my interlocutor unsure and troubled about my behavior. I lie, say that I need to blow my nose or do something else no one really wants to see me doing. After hanging up, the tears make good on the promise, an assault that lasts for the rest of the day.
I cancel professional appointments because I can’t trust myself to not cry when crying would be unprofessional. I apologize to my husband for the mood swings, especially the crying that leaves him feeling helpless. I hide my face from my children, especially my littlest one, who has an emotional intelligence beyond his nine years, a knack for knowing when I am sad.
I soldier through the best I can. I’ve done this countless times before, projecting an image of confidence and stability, when I feel nothing but insecurity and dizziness. I do my first television interview, makeup perfect, skin radiant, a confident smile on my face and sure of the knowledge in my words. I know I can reschedule the appointments. I know that this depression is not my fault. I smile so as not to alert my children. And when I can’t hold it together, I retreat to my room, lock the door, get into my bed, and let go.
I’m in the In-Between.
The in-between is mental health’s “horrible middle,” the place where you are too sick to carry on as usual but not sick enough for an intensive mode of treatment. It’s the place where weekly therapy is not enough, but inpatient treatment is too much. It’s the place where the mental health system fails those who are suffering, waiting for us to reach the bottom of the depths of our illness before real help comes along.
“Why do we make it so hard to find a place for those who are mid-fall, who need more than once a week with a therapist, less than an intervention on the street? Why do we wait for them to hit rock bottom?”
There is no mental health “system” in this country, “a regularly interacting or interdependent group of items forming a unified whole.” Things do not work together. Medication and therapy are siloed, and one side rarely talks to the other, requiring the patient to do the coordination at a time when it’s hard to get out of the bed, let alone coordinate. Even in a unified health care apparatus, one side only “talks” to the other through electronic charts with specialized language that cannot hope to capture the experience of what it feels like to be in the in-between.
My in-between episode was somewhat inevitable. Mentally, I was doing well. But two days ago, I was prescribed medication by an urgent care doctor who should have known better. He saw that I had bipolar disorder, even mentioned it to me, but prescribed steroids anyway without apprising me of the side-effects that were specific to my condition. Steroids were likely the best course of action; I was experiencing what could have been a tragic bout of tongue swelling that could progress to block my airways, and I was having difficulty swallowing and breathing.
Of course, the medication insert and directions reads that the doctor has prescribed this medication believing that the benefits outweigh the costs. It’s obviously true; I needed an epi-pen in the case of an emergency, and the chances of blocking the airway and death must trump the chances of having a depressive episode. But I wish he would have talked to me about that, telling me about the side effects and what to expect instead of letting me run into this wall blind. I wish he could have called my therapist or my psychiatrist to get an accurate prediction of what might happen to me as me, not just a generic bipolar patient. I wish he would have told me what to do if I was in the in-between. But he didn’t.
My internet doctoring suggests that when I end this medication, I may or may not get out of the in-between. I may or may not stop crying for no reason at all. I may or may not stop feeling like I’m standing on a cliff. Well enough to not want to step off, but sick enough to fear looking over the edge for the possibility of losing my balance.