Each day begins and ends with the pill tray. In the morning, it’s the antipsychotic Abilify, anti-anxiety Buspar, and antidepressant Prozac. In the evening, Buspar returns with the famed mood stabilizer, lithium. Within the first four hours of waking, I’ll know if I haven’t taken my medications by a sudden tightness in my chest or a nervous tingling across my skin. When this happens, I rush to choke down a cracker or two before taking them.

Each has its job. Abilify keeps out the belief that the neighbors want to hurt me, or that they’re talking about me. It quiets the obsessive thinking, such as movie clips playing over and over in my head with no discernible purpose until I can’t sleep. Buspar and Prozac take anxiety’s edge off, though the controlled Ativan sometimes steps in to finish the job. Lithium keeps mania and depression in check, allowing me to label myself “stable.”

Stability has a price. Every day after lunch, I take the diabetes medication, Metformin, to combat the ravenous appetite I obtained from a regular dosage of Abilify. No amount of exercise and dieting saved me from gaining over fifty pounds on the medication. Many months I’ve tried on clothing or stepped onto a scale and wondered if silencing the demons in my mind was truly worth the drastic, negative change in my appearance and health. 

The price is steeper with lithium. At a high enough level, my blood becomes toxic. Hydration is key to prevent this, as well as regular bloodwork. I no longer flinch when I see a needle enter my arm. I am tested for kidney function, thyroid function, and the amount of lithium in my blood. One extra pill in the evening means I will be in toxic territory. I know from experience that symptoms of toxicity mimic the stomach flu and last for days. The need to stay hydrated means I can’t enjoy one of my favorite hobbies, hiking, without making sure I have plenty of water. And I can’t have more than one alcoholic drink on an outing. 

The commercials on mood stabilizers and antipsychotics breeze by the side-effects in a matter-of-fact way that minimizes them for mentally ill people and their families. Latuda, for instance, made my legs so restless I couldn’t sleep. Geodon nearly caused me to fall asleep at the wheel and crash into another car on the highway. Seroquel left me in a state of sedation where every movement was like moving through syrup. Lamictal made me lose my appetite until my weight loss became so severe people tossed around the word “anorexic.”

Depakote simply stopped working. A lot of them have stopped working for me. 

I first took medication in the safety of the Parkridge Valley Child & Adolescents campus when I was twelve years old. I’d taken Zoloft since I was eight, but those memories are fuzzy at best. I arrived at Parkridge in a police car after a suicidal threat during a manic episode. The staff at Parkridge stuck my arm with a needle upon arrival, ignoring my insistence that they would miss the vein in the arm they chose—which they did. I was placed in a room with a line from Poe’s “The Raven” carved into the desk. I wasn’t familiar with “The Raven” at the time, so the words kept me awake for many nights. The medication they gave me was Effexor XR. Each day, I took it and wiggled my tongue for the nurse so he or she could see I’d swallowed it.

Within the next year, as my hormones raged, Effexor XR would become useless in the face of developing bipolar and obsessive-compulsive disorders.  

In a time critical to the development of a self, I struggled between four selves. My manic self was excited by throwing chairs across rooms and kicking holes in doors during fits of rage. Or blowing all of her high school graduation money on a random trip to North Carolina with two friends she barely spoke to afterwards. Her thoughts raced until she burst into tears and manic laughter that often left her mother staring, completely lost. She’d hit the dog just a bit too hard when it misbehaved, spit poison at whoever said the wrong thing. She’d stay up late for an entire month watching reruns of Buffy the Vampire Slayer. When her mind became too loud and quick, she’d run a blade over her skin to silence it and ignite the obsessive need to care for a bleeding wound. She’d pace restlessly, babbling on while others attempted to make sense of the nonsense.

My depressed self preferred to spend hours alone. She would forget to feed her pets, losing sight of the routine another self carefully placed for her. She’d cancel plans, crawl into bed, and take a Xanax or Ambien to knock her out regardless of the time or risk. She’d mull over thoughts of suicide with a palm full of lithium, trying to determine the level of pain she would be in before she died. Everything remained half-finished—novels, short stories, assignments, craft projects. Well, everything except the food she devoured.

My obsessive-compulsive self ran deeper than checking each exit to make sure the doors were locked, organizing movies in alphabetical order, or rearranging objects until they were aesthetically appealing. She lost an entire month to an episode triggered by cutting her biological father out of her life. She remembered a scene from a horror movie she’d seen years before involving a rotting body, and the scene played in her head on loop for over thirty days. She couldn’t sleep. She couldn’t attend college or work, slave to this short movie clip playing in her mind. 

My stable self rarely made appearances. It required a list of medications—Lamictal, lithium, Abilify, Seroquel, Geodon, Buspar, Prozac, Wellbutrin, Xanax, Ativan, Ambien, Klonopin, Depakote, Latuda. I could breathe again. At those moments, I was simply “me.” I was developing who I would become, banishing the possible selves that existed without the safety net of medication. I monitored my sleep schedule and caffeine intake to keep mania and depression at bay while avoiding any video I wouldn’t want stuck in my head on loop. At the same time, I feared who I was off of the medication, frustrated with the fact that it was quite possibly the only thing keeping me alive.  

My husband struggles with depression. He once said, “I’m worried I won’t like who I am on the meds.”

As he spoke, a blur of memories filled me. I remembered the way my manic brain reacted to my dog’s barking years before I ever met my husband. I’d kicked a hole in the door just for a moment of silence, to give my racing mind peace that couldn’t possibly be reached. I remembered the way I’d crumpled when my mother threatened to have me taken to Parkridge Valley due to the damage I’d caused. I’d instantly sobered and begged to not be sent away to the place that broke my bodily autonomy. I remember the way I’d spitefully told my parents I hated them, or the way I’d knocked my sister down with as much force as I could muster. I remembered the way I’d cut my hip in my desperation for a moment’s peace. I remembered all of the days spent in bed, wrapped in a comforter with no intention of showering or brushing my teeth.

I remembered these things, and I couldn’t sympathize. I have been medicated since the age of eight and don’t know of a time I’ve gone unmedicated for more than a week. It’s impossible to reject the manic, depressive, and obsessive-compulsive sides of me, as doing so takes away from the responsibility of my actions during these episodes. I can, however, acknowledge the me I want to be. The stable, medicated me is the one I choose to acknowledge as the “real” me, the “main” me. 

I remember the girl at Parkridge Valley, the twelve-year-old forced to down a medication that would stop working in less than a year. I think of her frustration, embarrassment, and despair at having control wrested from her. I think of her tongue wiggling around so the indifferent nurses could check for hidden pills. 

I think of the little girl on Zoloft taking a little green pill day after day without truly being aware of the consequences. I think of what could have happened if there had never been any expectations, if I had first been offered a mood stabilizer as a rebellious teenager, if I had ever had the chance to say “no.” 

I wonder if there would have been a “self” if I had refused. 

-Keily Blair

Keily Blair is a creative writing student at UT Chattanooga, where her nonfiction won the Creative Writing Nonfiction Award. Her speculative fiction has appeared in Nth Degree, Five on the Fifth, The Dread Machine, and is upcoming in Night to Dawn, Breath and Shadow, and Trembling With Fear. Her creative nonfiction has appeared in the Sequoya Review and Breath and Shadow. She is currently at work on a fantasy novel and a collection of essays about being a person with bipolar disorder.