I Believe in God but Then Again I Dont
The Mental Wellness Upshot
'I Don't Believe in God, but I Believe in Lithium'
My 20-year struggle with bipolar disorder.
The common salt flats of the vast Salar de Uyuni, in Bolivia, beneath which lies roughly l percent of the world'south supply of lithium. Credit... Olaf Otto Becker
The manila folder is full of faded faxes. The summit sheet contains a brief description of my beginning medically confirmed manic episode, more than xx years agone, when I was admitted as a teenager to U.C.L.A.'s Neuropsychiatric Institute: "Increased psychomotor rate, decreased need for sleep (about 2 to three hours a nighttime), racing thoughts and paranoid ideation regarding her parents post-obit her and watching her, every bit well every bit taping the phone calls that she was making."
I believed I had special powers, the study noted; I knew ''when the finish of the globe was coming due to toxic substances'' and felt that I was the only one who could finish information technology. There was also an account of my elaborate academic sponsorship plan and then I could afford to attend Yale — some corporation would pay for a twelvemonth of teaching in commutation for labor or repayment down the line. (Another thou delusion. I was a B-plus student, at best.)
After I was admitted to the constitute'due south adolescent ward, I thought the nurses and doctors and therapists were trying to poison me. Then was the Television set in the rec room. I warned my one friend in the ward that its rays were trying to kill him. The generator exterior my window was pumping in gas. The place, I was sure, was a expiry camp.
I refused meds because they were obviously agents of annihilation. It took 4 orderlies to medicate me: They pinned me to the floor while a nurse plunged a syringe into my left hip. Over time, I became too tired to refuse medication. Or perhaps the cocktail of antipsychotics started working. The Dixie loving cup total of pills included lithium, which slowly took agree of my mania. Subsequently a few weeks, I stopped whispering to the other patients that we were all about to be killed. Eventually, I stopped believing it myself.
Marking DeAntonio, the U.C.L.A. psychiatrist who was treating me, said I had bipolar disorder. Here's the phrasing from the National Institute of Mental Health: ''unusually intense emotional states that occur in singled-out periods called 'mood episodes.' Each mood episode represents a drastic change from a person's usual mood and beliefs. An overly joyful or overexcited country is called a manic episode, and an extremely sad or hopeless land is called a depressive episode.'' The generic definition doesn't quite cover the extremes of the disease or its symptoms, which include inflated cocky-esteem, sleeplessness, loquaciousness, racing thoughts and doing things that, according to the Mayo Dispensary, ''have a high potential for painful consequences — for example, unrestrained buying sprees, sexual indiscretions or foolish business concern investments.''
I was but 17, immature at that time to receive a bipolar diagnosis. Nearly of the teenagers on the ward were there for eating disorders or low. I had to eat my meals lone because my food intake wasn't restricted or monitored, equally it was for everyone else. I made moccasins in occupational therapy and played volleyball with the eating-disorder girls in recreational therapy. I went from being locked in lonely solitude, clawing at the soft dark-brown walls, to being granted TV privileges. I was even immune to hold the remote and choose the channel. Visitors came and left presents and balloons and a big get-well annotation on poster lath signed in puffy paint and Sharpies past all my high-schoolhouse friends.
Lithium, a mood stabilizer that can help stop and prevent manic cycles, is usually the start medication tried with bipolar patients; information technology's effective for most of them. Including me. I was discharged and sent dorsum to loftier schoolhouse with an apple-size trample on my hip. For two decades since then, I have been taking lithium almost continuously. It has curbed my mania, my depression and, nearly meaning, the wild delusional cycles that have taken me from obsessing over the value of zip to creating a hippie cult (my compatible: bell-bottoms, psychedelic sports bra and torso glitter, head to toe). As long equally I take those three pink lithium-carbonate capsules every solar day, I can function. If I don't, I will be riding on tiptop of subway cars measuring speed and looking for calorie-free in elevated realms.
The use of lithium as a therapy for mental illness goes dorsum to at least Greek and Roman times, when people soaked in alkali-rich mineral springs to soothe both ''melancholia'' and ''mania.'' In the mid-1800s, lithium was thought to cure gout and sometimes ''brain gout,'' a lovely description for mania, extending the notion of swollen joints to a swollen brain. The chemical element gets its name from lithos, the Greek word for stone, and lithium is indeed institute in granite — and in seawater, mineral springs, meteorites, the sun and every other star and all humans. It is classified as a metal on the periodic table of elements. It was first identified equally a solid in the grade of petalite ore on the Swedish island Utö in 1817. A year later, scientists found that lithium, when ground into powder, turned flames ruby red — it's the key ingredient in red fireworks. Peppery and unstable, lithium somehow calms emotional states often characterized in the same manner.
Despite the fact that people have benefited from its employ for millenniums, how lithium works upon brains is largely unknown. ''It has so-called trophic or fertilizing activity on the brain — that is, it stabilizes membranes,'' says James Kocsis, a professor of psychiatry at Weill Cornell Medical College in New York and an expert on lithium. But the bodily mechanics are a mystery. One way to call up most its effect, though, is suggested by a 2007 U.C.L.A. study that institute that bipolar patients taking lithium had significantly more than grayness matter than their counterparts, especially in the region associated with a person's capacity to maintain attending and emotional control.
Ane of the first references to lithium in a neurological context appears in 1870, past a neurologist in Philadelphia named Silas Weir Mitchell, who recommended the compound lithium bromide as an anticonvulsant and a hypnotic for epileptic patients. But by the turn of the century, medical lithium had largely been supplanted by other treatments. And then, in 1947, John Cade, a psychiatrist working in a infirmary exterior Melbourne, Australia, rediscovered its medicinal potential. Cade was among the first to conclude that mental illness included bodily manifestations and thus should exist treated with medication, not just talk therapy. ''It required a change in how people sympathize mental affliction,'' says Robert Beech, an assistant professor of psychiatry at Yale University who conducts studies of medical lithium. He describes this insight as a shift from ''more psychological, Freudian explanations to a biological explanation.''
Cade, whose begetter was as well a psychiatrist, was at beginning just trying to isolate the cause of mania. Having noticed that the urine of manic patients was unlike that of his stable subjects, he figured the distinguishing component, uric acid, was responsible for the mania. Seeking to produce that mania in his animal subjects, guinea pigs, he needed a solution in which to supply the uric acid to them, and he chanced to use lithium urate (and later, lithium carbonate). Merely his republic of guinea pigs became lethargic; instead of inducing mania, he had accidentally discovered a treatment. Cade became convinced lithium could cure many of his patients experiencing symptoms we now associate with schizophrenia, bipolar disorder, mail-traumatic stress disorder and dementia. To exam its prophylactic, he ingested lithium himself; afterward, he began a trial with 19 patients. The 10 manic subjects experienced a meaning shift in mood and function, but Cade's timing was unfortunate. One of his subjects died, probably from a high dose. And toward the end of the '40s, lithium's utilise equally a table-common salt substitute for congestive eye patients in the United States proved lethal in at least two instances.
Simply fifty-fifty as these outcomes hindered the widespread awarding of lithium, studies continued in a number of countries. Gradually, after dosages approached uniformity and careful monitoring became routine, lithium in diverse compounds was recognized every bit an acceptable treatment. Lithium gluconate was canonical in France in 1961, lithium carbonate in Great britain in 1966, lithium acetate in Germany in 1967 and lithium glutamate in Italy in 1970. Amid the drug's champions was an American medical resident named Ronald Fieve, who began experimenting with lithium in 1958, afterwards his adviser at Columbia University returned from Australia with tales of Cade'southward experiment. ''It was and then effective,'' Fieve told me, that he was ''treating the well-nigh severe bipolar i patients, and this lithium brought them back to normalcy in 10 to 15 days.''
It was not until 1970 that Fieve, at present a doc, and four other psychiatrists successfully lobbied the Nutrient and Drug Assistants to approve lithium every bit a psychiatric medication. ''The F.D.A. was reluctant,'' he says, ''simply nosotros brought enough data that this was a new superb drug for bipolar and that if it was monitored properly, it would be safety.''
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Fieve says that lithium hasn't been extensively tested as a treatment for other conditions in role because it's a natural substance: Elements on the periodic table can't be patented. Pharmaceutical companies therefore take piffling incentive to promote lithium or develop other uses for information technology, despite its potential. It has shown promise as a therapy for Alzheimer'southward, for instance. A written report in Japan has shown a sample population to be less likely to commit suicide later drinking tap h2o containing lithium. In the '30s and '40s, vii-Up included lithium citrate as a mood-booster. There were ''lithia beers'' and a lithium version of Coca-Cola. As recently as last fall, a psychiatrist posed the question on the Op-Ed folio of The New York Times: ''Should nosotros all have a bit of lithium?''
Despite its widespread use every bit a mood stabilizer, only 5 percent of all lithium product is devoted to medication. The rest goes into things similar ceramics, glass and batteries. The tech and electronics industries especially are becoming dependent on the element. A new highway shortly to be built volition connect the only American lithium mine in operation, Rockwood Lithium, in Silver Peak, Nev., to the northern part of the state, where Elon Musk is currently constructing a billion-dollar ''gigafactory'' to manufacture lithium-ion batteries for his Tesla automobiles.
Rockwood is probably where my pink pills come from. In May, I visited Silver Peak, where David Klawitter, a mechanic at the mine, showed me his swollen reddish hands. ''The lithium burns sometimes,'' he said. ''It eats sockets, though, rusts them up solid. You can see what information technology does to the trucks.'' In the mid-'60s, Rockwood's predecessor company, Foote Mineral, located its found in this mineral-rich wasteland after establishing a method to extract lithium from underground brine. ''We make medical-grade lithium here,'' Klawitter said. ''We're processing a pure class of lithium, the purest.''
Forth a dusty route not far from Silver Peak is Alkali Hot Jump, once the bathing grounds for tent-city miners and frontiersmen like the Earp brothers who prospected for gold at the turn of the final century. Hoses now bring lithium h2o, at about 100 degrees Fahrenheit, from the springs to 2 tubs where the locals still take the waters.
An fifty-fifty larger deposit of lithium, an estimated 50 percentage of the globe'south supply, lies beneath the Salar de Uyuni in southern Bolivia. The increasing global demand for lithium has prompted many proclamations, including claims by Bolivians that the landlocked socialist country will get the ''Saudi Arabia of lithium.'' Economists have been forecasting a lithium economy for decades, and information technology may well be that anytime every car, reckoner and clothing electronic device — non to mention our energy storehouses — volition depend on lithium batteries the way I've relied on medicinal lithium for the final 20 years.
By 2000, I had gone seven years without a manic episode. I graduated from the University of California, Davis, with degrees in English and fine art. I moved to New York and was leading what seemed like a regular life, writing about music for The Village Voice and painting. I went to work every twenty-four hours and paid my hire. If y'all had met me on the street, I'll bet you would accept thought: This person is normal, has normal problems, approaches the globe in a normal way. I decided, along with my psychiatrist of a couple years, Henry Schwartz, to taper off the lithium. Perhaps I had been given the wrong diagnosis equally an adolescent. Maybe I was past the bespeak of having manic episodes.
After a few months off lithium, I felt energetic, engaged, fifty-fifty electric. It's hard to know if that feeling was only a ramping up toward mania again or if it was the lifting of a lithium fog. But this is what ended up happening: I turned downwards jobs and burned all professional person bridges with abrupt and illogical emails, many of them referring to Eminem; I kept a stash of homemade granola in my pocket to hand out to anyone who would have a stranger'due south muddy pocket granola; I developed an alter ego, a rapper named Jamya; I painted my face with spectacular dark-green-and-gold eye shadow; I was kicked out of a bar without fifty-fifty drinking; I stood on my caput every morning time; my flat burned down; I served equally the sole witness to a stranger's wedding on meridian of the World Trade Middle; I wore 800 necklaces and spoke in a ho-hum growl or sometimes a high-pitched bleat; I saved a corgi from being hit by a cab on Central Park Westward (on which occasion Ben Vereen stopped to telephone call a dog ambulance); I spoke to strangers with the intensity of a automobile salesman stuck in a Mamet monologue; I preached most Jesus wherever I went, which for a Jew is unusual; I spent well-nigh $700 on butternut squash and assorted seasonal gourds. My wearing apparel smelled of burn down, from the burned-out apartment. I scared the scary people on the subway. All that took identify over two weeks, perchance iii, as I fabricated my way back and forth between Los Angeles and New York.
Paradigm
It was kumquat flavor and I wanted to exist dorsum in New York with Mike, a crush I met a calendar month earlier. He worked in a start-up on the floor below my apartment. In the weeks after the fire, he followed me around with a video camera, more often than not considering I told him to. A few years ago, he sent me a few scenes on a VHS tape he had stashed away in his parents' lake house. I watched it recently. I looked pretty and young and magnetic and so crazy. My face was less creased with worry and my pilus was coiffed in a deep cherry Afro, framing perfectly shaped eyebrows. I was sporting my trademark manic style — almost 100 sparkling necklaces, 14 layers of clothing in every clashing design possible, thick makeup and a pack of Fantasia cigarettes. My voice was hoarse and slow, like a '40s-era lounge singer.
The video starts with the states sitting on Mike's stoop on Sixth Artery and Garfield Place in Park Slope, talking with a group of moon-faced teenagers. I guess I already had the ''marry Mike'' campaign going because I got each of those kids to say, ''Yous should marry Jaime.'' In my hip-hop drawl, I started reciting lines from ''Romeo and Juliet.'' Then the kids chanted with me: ''roses smelling sweet!'' Yous tin can see they're mesmerized and confused by this pseudo-adult, crazed, clad in a tutu. At the end of the exchange I said, ''You babies are all right!'' Then I jumped into some Eminem lyrics.
The adjacent scene on the tape is me showing the camera unlike anthology covers and singing songs from each album. I'm wearing a cowboy hat, gold pants, a fluorescent flower brim and all the necklaces in the earth. I pause at ''Sweeney Todd'' and say, ''Oh, this one's virtually eating people, so, that'southward cool.'' Mike, off-photographic camera, peppers me with questions, asking me to hold the albums college or lower or to the side.
The next morning I set up up the camera then the lens's signal of view shows what I've made — kumquat-and-avocado salad, cubed PowerBars and a glass of vino. I videotape Mike waking upwards. He negotiates for more than sleeping fourth dimension. I conspicuously hadn't slept at all and was now wearing a silvery-flecked red bra and a gold brim. He finally acknowledges me by eating a PowerBar. I say Baruch atah Adonai over the cup of wine, borrowing from the Hebrew prayer. I whisper it as if my vocalization is a direct line to God. Mike asks me what I'm going to do today.
''Today, I'm going to contact MTV to fence Gore, Bush-league or Tipper Gore. I hope information technology's Tipper. I have a lot of piece of work to do today.'' Pause. ''I take to change the world.''
Mike asks me why I'm holding an avocado pit in my hand. ''I saved the pit and then we could plant it wherever we decide to land,'' I say. Then I kickoff talking about a singing toilet bowl, a scene from the musical I had written.
The last fragment of the record captures that aforementioned day at sunset. The camera is pointed toward the floor, and I am dragging Mike up to the roof. You can hear the fatigue in his voice and the growing irritation. He's resisting, while I'm guiding him upstairs. ''Why are we going on the roof?'' he asks.
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We have to, I insist. He threatens to turn off the camcorder. I ask him to signal information technology at me. Then, on bended knee, I ask him to marry me. ''It's all set up,'' I say. The picture turns to snowfall.
Afterward I watched the record final year, I chatted with Mike, who is still a close friend. ''I was always a lilliputian jealous of what you went through,'' he told me. ''Y'all've had an experience that so few people have had. You lot've lost your mind entirely. It's virtually like you've been someone else.''
What I saw was someone who resembled me, looked related to me, whom I remembered being. Information technology was me without lithium.
After that episode, I went back on lithium and stayed on information technology, despite the health risks, which include increased thirst, weight gain and memory loss and, more rarely, thyroid deterioration, kidney dysfunction and the same dullness and lethargy experienced by Cade's guinea pigs. I was scared by what happened when I went off it. Some people who take lithium feel robbed of their natural personality. But for me, at a certain indicate the mania takes over, and my actions become unbearable, to me and to others. Toward the end of my terminal episode, I was such a menace that my female parent hired a minder to lookout man me, a Caribbean woman named Alma who would braid my hair into cornrows and take me to 99-cent stores.
I wanted a calmer life. Then for the next 13 years, I took my three pink capsules and all was well. I wrote a book, I learned how to cook in an Italian-restaurant kitchen, I had a few relationships that lasted longer than a month, I wrote, I boxed, I traveled, I painted, I took my pills. I was fine.
Then, last fall, I saw my primary doctor — and he sent me to the nearest emergency room. He was alarmed at my combination of high creatinine levels, damaged kidneys and heart-attack-level blood force per unit area (185/130). At Mount Sinai Hospital, my md's fears were confirmed in a matter of days: My kidneys were irreparably damaged, an ''uncommon but non rare'' side effect of long-term lithium utilise. I was told I could phase out lithium and start another medication, or face dialysis and a kidney transplant in 10 years.
It doesn't really feel similar an obvious choice; it just feels like two bad options. Switching meds might hateful the return of cornrowed, Eminem-obsessed Jamya and many seasonal gourds. Yet tubing up and cleansing my blood until I go a stranger's kidney quilted into the residue of my insides is hardly more appealing. Test results bespeak that my kidneys are working about one-half likewise every bit they should; Maria DeVita, a nephrologist at Lenox Hill Hospital, told me that if I am to switch to preserve the kidney part I have left, ''the time to strike is now.''
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When I start tapering off lithium a month or two from now, Schwartz will prescribe Depakote, a medicine used to care for bipolar disorder too as seizures and migraines. The only way to know whether it works is if I don't have a manic episode. And the thought of waiting for that terrifies me. My boyfriend of iii and a half years doesn't know what I'one thousand similar when I'm manic. In that location'southward nothing that I tin can say that will prepare him. If information technology happens again, I'k worried I'll run off and ride the rail or that I'll be accidentally unfaithful or that I'll insist on wearing metallic unitards and Mexican wrestling masks or that, worst of all, I simply won't exist me, and he won't exist able to retrieve who I am or that I'm in there somewhere. I worry that without lithium I will lose my job, my partner, my domicile, my mind … because I've been through all this. I don't believe in God, but I believe in lithium.
Before leaping into the worrisome unknown, I decided to travel to 1 of the grandest, most delusional places of all, the globe's largest reserve of lithium, in Bolivia. I would brand a symbolic pilgrimage to the wellspring of my sanity.
The vastness of Salar de Uyuni is intensified by its mind-bending, flesh-burning, breathtaking altitude. The salt flats spread out 12,000 feet above bounding main level and bring to mind the biggest, most perfect ice-skating swimming imaginable. This part of southern Republic of bolivia consists of four,000 square miles of what were once prehistoric lakes, at present dried up into crust and brine. Scientists say information technology took three minutes following the Big Bang, 13.7 billion years ago, for the starting time three elements to emerge — helium, hydrogen and so trace amounts of lithium, atomic number 3. Gazing out at the horizon here in Salar de Uyuni feels like looking dorsum into those earliest moments of the universe. Nearby you tin see natural hot springs and the Sol de Mañana, a geothermal spot pockmarked with steamy craters burping humid mud. The identify feels like a hallucination; in that location'due south an island populated by century-old cactuses, a blood-ruddy lagoon, flocks of hot pink wild flamingos and piles of a blindingly white crystalline substance.
In that location were tire tracks in the salt from iv-past-fours. Off in the distance lay an isolated processing plant, christened in 2013 by the Bolivian president, Evo Morales. Evaporation ponds checkered the endless white expanse with shades of aqua.
I walked the crusted, jigsaw surface. I wanted to feel and taste its granularity and saltiness. The far-off Andean peaks floated dreamily, with no visible foundation. As I ran between the common salt mounds, cracks accompanied each step. My hiking-boot footprints flooded with milky saltwater. I was so breathless, so thirsty, and so thrilled. If ever there has been a perfect properties for a grandiose delusion, information technology is the Salar de Uyuni.
The lithium we have on World now — office stardust, part primordial dust and part earth grit — is a elective function of our planet, one that sometimes shapes personalities. The thought occurred to me that possibly my taking lithium prophesied a lithium-dependent future, connecting it to a by when our globe was birthed in fiery lithium explosions. Maybe that capsule filled with a salt, the one that allowed me to part, tethered by, present and future together. Only so, extravagant prophecies built on the miraculous powers of a prehistoric element reek of mania.
After a few days of trekking, I stopped at a camp and slept in a building made of salt bricks — a lithium igloo. I saturday in the nearby hot springs, in water naturally laden with loftier concentrations of lithium, and watched the steam ascent on the moonshine horizon. If I soaked in this warm bath long enough, I thought, maybe it wouldn't feel so bad to allow go of my medicine.
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Source: https://www.nytimes.com/2015/06/28/magazine/i-dont-believe-in-god-but-i-believe-in-lithium.html
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