genesis 2018 final digital.pdf What Could Have Been Cleveland Dietz II prehistoric humans and complaining about my computer class. Then, the panic attacks started. In the driver’s seat of a rusted shell of a car parked at Ivy Tech Community College, unfettered terror developed in my chest and gut, growing until it spilled out of my rocking body in a torrent of tingling skin, chattering teeth, moaning, crying, shaking and shallow breathing. My eyes narrowed, and the path of my life diminished into a straight line, a tunnel into the dark earth. hoped its repetition would act as a kind of mantra. I thought it could dissolve into nonsense sounds and focus my mind. It couldn’t. Indiana. I tried to focus on the grindstone, getting things ready for the next general manager, but the noise found me there, too. I heard it as I scheduled promos for air, discussed changes to the station’s bylaws and and hours passed, it got louder until it couldn’t be contained anymore when I pulled into my driveway in the evening. Then, face down in the pillow, I repeated with increasing force, “stop, stop, please stop,” until exhaustion pulled me into sleep. I stopped taking the medicine. * * * Kelsey’s gentle hands rubbed my shoulders from the bed as I cried ten years, attempted suicide twice, thought of doing it many other times, “I think so,” she answered. “That’s not important. If you think you should go, you need to go.” “I don’t know. It’s too much.” I wasn’t suicidal, but I didn’t know if I would become so. I didn’t everything. It was a minor comfort that there were no guns in our rural home, though their absence had long been a source of tension between 1 It felt like death was going to come soon. It would be delivered as a heart attack or an aneurysm or some shapeless end in my sleep. If not that, the cancer surely building in my mouth would claim me, suddenly, as leukemia did my papaw. The thought of it had always been in the back rate feelings of anxiety and depression I may be having on a scale of one a prescription for quetiapine XR—an antipsychotic primarily used to treat 2 with bipolar disorder while attending college in 2006. I remembered referring to them as coma pills then. I slept for twelve, thirteen, fourteen hours at a time after taking the medication. If I managed to stay awake, everything that touched my skin, even the air, hurt. I didn’t have health that he was trying to kill me. I stopped taking the medicine. What Could Have Been The prescription this time was for two weeks. I was to double the could cause manic episodes or suicidal behavior in some people. I would’ve done anything to stop the feeling. * * * from me. “Why are you here?” she asked, and I told the stories I always told. I’d told them so many times, it was as if they weren’t mine anymore. I smiled and laughed at the right moments, as though I was recounting the comic foibles of a character in a movie. * * * It began with a shopping cart. I was seventeen years old, ambling through a Walmart parking lot, hard as I could into a ditch. It was an innocuous enough event—one most likely shared by teenagers around the world—but it was out of character for me. For several months after the incident, I was inundated with hallucinations. badger suit emerged from a gravel alleyway between a church and a squat, beige house. He or she started across the street, stopped in the middle toward the town square. No one else saw it. No one else was there—no parties, no children, no parked vehicles. The church door was locked, and the houses were hushed. It was unreal, and a sign of things to come. Indianapolis, I saw it rain spiders. I saw them fall through the air, all cascading down the glass and into the dirt below. They appeared, then they were gone, replaced with more impossibilities. On the drive home, impotently kicking up dust. One night in Indianapolis—the night Kelsey and I started us on the other side of the street. We were walking along the wall of a parking garage, talking about ditching Indiana as soon as we could, when Cleveland Dietz II the shine in their eyes became apparent. I threw myself between Kelsey and the dogs. If they came, we’d be trapped between them and the wall. “What’s going on? What’s over there?” she asked. and still.” any sign at all that there were dogs nearby. “Cleveland,” she said. Finally. We waited until I understood. There was nothing. “What do you want to do now?” she asked, and we stood by the wall talking for a long time. It was as though I slammed the shopping cart through the tissue linking the prefrontal cortex and the basal ganglia regions of my brain. psychosis—episodic breaks from reality—and depression.3 The neurologist who saw me in 2005, after the cart and the spiders, couldn’t have known that when he said there were no signs of brain dysfunction in my episodes of mania and depression occur.4 * * * I tried to hold myself accountable. There was always something I could do to eliminate my neuroses. It wasn’t out of my control; I just wasn’t doing enough or the right things. For example, the nurse practitioner who prescribed the antipsychotics discovered that I was 12 vitamin to symptoms of depression and psychosis—symptoms that could look like bipolar disorder.5 I told a new psychiatrist about it when I saw him in early 2016. I he made his diagnosis. He suggested I think about taking lithium. It had the highest success rate for treating people with bipolar disorder6, but there were caveats. Its use required regular bloodwork, because it could become toxic 7 He asked me to read An Unquiet What Could Have Been Cleveland Dietz II Mind Worse, she no longer comprehended what she read and couldn’t write. It took her years to regain those skills. That was an unacceptable risk. The psychiatrist suggested lamotrigine as an alternative. * * * years8 9 That approval was for epilepsy treatment.10 lamotrigine for bipolar disorder.11 The two drugs impact the disorder in 12 by enormous energy, euphoric and racing thoughts, and irresponsible behavior13—while lamotrigine is best at reducing depression.14 15 fatal rash could develop after starting the medication.16 learned that increasing the dosage to the desired level over time could help prevent the rash.17 I was to increase the dosage from 25 to 100 milligrams over four 12 shots totaling six months. If the would be impossible to tell which. * * * From 2005 to 2007, I didn’t sleep more than two hours a night, if I slept at all. I wandered and wrote and read and watched movies and become an archaeologist, play Chopin, build furniture, throw myself into open a bar, run a battle of the bands, hitchhike, hop rails, code, move to Mania is boundless. It’s everything; it’s impossible. It’s looking outside a hotel window in the big city at the most crushing moment of this moment is one of billions happening at once. It’s doing anything, honest and wrecking friendships. It’s not caring if people’s feelings are hurt. It’s not respecting others’ privacy. It’s spending money recklessly, yours and theirs. It’s sleeping on broken futons after dropping out of after notebook with hurried scrawls. manic episodes drove your achievements, then drove them straight into the * * * The Diagnostic and Statistical Manual of Mental Disorders requires a criteria have been met. It’s a life sentence. * * * psychiatrist I had been seeing announced the clinic was closing. medication,” he said. “Make an appointment as soon as you can. It might He wasn’t alone in making the move. The whole outpatient clinic was consolidated into another IU Health hospital. The day he made the announcement was his wife’s birthday. They were getting old. “I got her a pile of dirt as a sort of joke, you know?” he said from 12 shot, I told the nurse practitioner promise me you’ll follow up with a psychiatrist. I want to know when you get an appointment. That’s the deal.” * * * the department estimated there would be between 6,080 and 15,400 fewer nationwide.18 It also noted that providers were unevenly distributed across What Could Have Been Cleveland Dietz II the states and shortfalls may have been present in some places, even when surpluses were expected.19Indiana had just one psychiatrist per 16,543 residents in 2016.20, 21 laden process to receive treatment. intake—an initial assessment of the severity of my illness—and see a therapist before the psychiatrist could see me. The timeline was long: Two months before the intake, another month to see the therapist, and another to see the psychiatrist. Had it not been for the nurse’s willingness to in treatment and, perhaps, never gone back at all—a common story that I was lucky not to fall into myself. “I’m sick of having to prove this,” I told Kelsey. “They have medical records. They know the history. If I had a broken leg, I wouldn’t have to demonstrate over and over that it was broken.” “I’ve spent most of my life thinking I would one day kill myself,” I told her. The Bell Jar after again?” "What Could Have Been" Endnotes with bipolar disorders follow for up to 2 years.” Bipolar Disorders 2006, vol. 8, Oct. 2006, pp. Antipsychotics: History, Science, and Issues. Greenwood, 2017, pp. disorder.” Dialogues in Clinical Neuroscience U.S. National Library of Medicine National Institutes of Health, 2008, https://www.ncbi.nlm.nih.gov/pmc/arti 4 Ibid. Nutrition Journal, vol. 7, no. 2, 2008. U.S. National Library of Medicine National Institutes of Health, 2008, ics.” Journal of Molecular Psychiatry U.S. National Library of Medicine National Institutes of Health, 2016 November, https://www.ncbi.nlm.nih.gov/pmc/ International Journal of Bipolar Disorders, vol. 3, no. 13, 2015. U.S. National Library of Medicine National Institutes of Health, 2015, https://www.ncbi.nlm. nih.gov/pmc/articles/PMC4456600/ ics.” Journal of Molecular Psychiatry U.S. National Library of Medicine National Institutes of Health, 2016 November, https://www.ncbi.nlm.nih.gov/pmc/ U.S. Food and Drug Administration 10 Ibid. lithium’; drug helps prevent depressive episodes.” Clinical Psychiatry News genetics.” Journal of Molecular Psychiatry U.S. National Library of Medicine National Institutes of Health, 2016 November, https://www.ncbi.nlm.nih.gov/ Diagnostic and Statistical Manual of Mental Disorders, 5th ed. 14 Ng, Felicity, et al. “The role of lamotrigine in the management of bipolar disorder.” Neuropsychiat- ric Disease and Treatment U.S. National Library of Medicine National Institutes of Health U.S. Food and Drug Cleveland Dietz II Administration 16 Ibid. 17 Ibid. U.S. Department of Health and Human Services, November 2016. https://bhw. U.S. Census Bureau, 2017. https://www.census.gov/