PSYCHO

You say you know what it’s like to live in my mind. You say you know what it’s like to be in my world. You say you know what it’s like to be me. So you fucking say. 

You tell me it’ll go away. You tell me it’s just blowing up in my head. You tell me I’m overreacting. You tell me I’m always like this. You tell me it’s easy, to just not think about it. You tell me to ignore it. But you don’t fucking know what it is. 

You act like you’ll always be there. You act like everything’s normal. You act like you know what’s going on inside me. You act like you can fix me. You act like you’re in control. And yet, I don’t fucking believe you. 

So I let you keep pretending. Like you know everything about me. Because I’ll be really honest with you. I don’t fucking care about you and what you think. 

Bipolar expression

Manic questions

Reality melting

Forcing confessions

Anxiety howls

Alcoholic vowels

Blurring the scowls

Of consonant growls

Marijuana stains

Severed chains

Borderline brain

And bloody veins

Lovely depression

At your discretion

Please tell me about

Your sick obsession

With my panic

The transatlantic

The beautiful manic

Bordering on satanic

I hear you, I see you

I feel you, I sense you

I taste you, I smell you

I can actually touch you.

So you’re not just voices

Or the PTSD

Or the nasty little pills

Laughing at me

Not just the flickers of light 

Or a trick of the night

Disappearing from sight

In a bright flash of white

Only I can see you

Only I know you’re there

Even with all the lies that you spew

I always keep you in my prayers.

So excuse me 

While I go talk to the walls

For only they seem to catch me

When I’m in free fall

And if people see me

Dancing with the air

I hope they know better

Than to stop and stare

Because they can’t see you

And I don’t want to share

Just how crazy you make me

So fucking crazy I swear.

The screen flickers to life and I am pulled out of my musings. I see my therapist on the other side. My second to last therapy session with her. I wonder what will happen today. 

“I want to talk about the paranoia you’ve been mentioning,” she said. “How’s that been?”

Paranoia. It’s there. It comes and goes. Sometimes it gets worse and I can’t leave my house if I don’t triple check three times that I haven’t turned the stove on. Or I can almost swear I see a shadow standing in the corner of my room. Or I’ll see a flicker slide past me out of the corner of my eye. 

But sometimes it’s not so bad. I can convince myself it’s just the light. It’s unsettling though, because I know someone is always watching me. Somewhere, somehow. 

“It’s okay. It hasn’t been that bad lately. It’s usually worse when I’m not in a good headspace.”

“I wanted to talk to you about that today. Just to explore it a little more,” she said.

I felt my heart swoop. Why? It happens, right? It’s part of the borderline. It’s part of the bipolar. I’ve always been like this. Even when I was a kid. I’d talk to myself. It was like my dissociation and disconnection from reality. It was a coping mechanism. And they say it’s okay to talk to yourself but if you respond, that’s when you know you’re crazy. 

But ever since I was a kid, I was always alone. So of course I’d respond to myself. Who the fuck else was talking to me anyway? But that didn’t mean I was crazy. I just acted a little differently from everyone else. 

“I don’t know if you ever noticed this, and I don’t know if it’s related. But I’ve noticed that when you talk to me, your eyes often look off to the side. Are you checking for something? Are you conscious of that?”

“What, no? I do?”

“You just did it again.”

“Uh, no. I’m not conscious of it. I had no idea I did that.”

“It may just be an impulse. But I’ve noticed you do it a lot. And you don’t often make eye contact when you’re talking. Sometimes you look everywhere but me.”

That’s odd. But I’ve always been shifty and easily startled. I get scared really easily. That’s why I hate horror movies and jump scares. That’s why I hate loud noises and the dark. It’s just how I’ve always been. I always scan my surroundings, everywhere around me, behind me.. Check my parameters. Just to make sure I’m safe. But that’s normal, isn’t it? Everyone does that.

“I also know that you talk to yourself. You’ve been doing it since you were a kid, haven’t you? Do you ever hear voices?”

“I mean, yeah. When I’m talking to myself but I’m not saying anything out loud. I hear my own voice inside my head.”

“But are there ever multiple? Or just one? Does it sound like your own voice?”

“I guess? When I’m not in a good place, my head is really loud. The thoughts are bursting and I have waterfalls of different thought streams pouring in from all directions. And these thoughts are all different voices. Saying and thinking different things. Does that make sense?”

“Yes that makes sense. But the voices. Is it just yours? Does it ever sound like the voice isn’t your voice?”

“I mean, there are so many thoughts and “voices” in my head that they can’t all possibly be mine, right?”

“Well, yes…”

“Wait, wait wait. Wait. I think I know what you’re trying to say. I’ve been consciously aware of it once. I was really fucking high. Like just out of my mind high that night and I noticed that I was talking to myself. Like internally, so not out loud. But the voice talking wasn’t mine. It was just telling me to do things though. Impulsive, dumb, reckless things. But I figured, you know, weed makes you paranoid. Makes you think like that sometimes.”

“So you were actively aware of it that one time. Are there any other times?”

“Probably not when I was conscious about it. But you know the way I talk to myself. I told you I’m not very nice. I yell at myself, I talk to myself all angry. It’s the only way I know how to converse with myself, and it’s internalized from the way I grew up.”

“Yes, you’ve mentioned that before.”

My thoughts are racing. I’m thinking. Were there any other times? Why was she asking me all of these questions? Where was she trying to go with this? I think about my impulse control. I remember sometimes when I’m manic or crazy depressed, I don’t act like myself.

“Like so when I used to cut a lot, right, it was like this rational and irrational voice fighting inside me. My rational voice would know that I shouldn’t cut. That’s not a healthy way of solving my problems. But the other voice. The irrational one would tell me to do it anyway. Because that was the only way, the only thing that would make me feel better. It would stop the cycle, make me FEEL.”

“Tell me more about that.”

I feel the frustration building inside me. What was there to tell? I’m repeating things at this point. I’ve told her this story before. 

“So remember how I explained the voices to you before. When we were trying to figure out my bipolar. I told you how it’s always loud inside me. And the only way I can sit with myself and introspect, which is what I NEED but can’t sometimes, is to make all the voices in me align. There’s the rational thinking voice. Then there’s the internal voice that never seems to agree and contradicts the rational voice. And then there’s the external voice, the voice I use to verbally express myself. So I guess if you’re trying to ask about voices, that’s your answer. And I can’t be certain all of the voices are my own. I really can’t be. Because sometimes I do things that are just out of character for me. When I’m manic and am not completely aware that I’m not in control. But that’s not me. I’m not telling myself to do it. I know I shouldn’t. But I fucking do anyway.”

Holy shit. I’ve always wondered about that. I like being in control. I like to know what I need to do at every point in my life. I like having a plan. But sometimes I just do things that are fucking out of pocket. I have better control over that impulse, especially when I go through my periods of improvement. So sometimes, why am I not in control?

“Ella, can I ask? Are your thoughts ever self-sabotaging?”

“Self-sabotaging? I mean, they told me to cut before. They tell me to do stupid things just to feel something. Sometimes I just can’t feel shit. And the voices are like if you do this, maybe you won’t be so numb. They tell me I’m shitty. That I deserve nothing. That life sucks. It’s pointless. So what’s the big fucking deal? They’re never really…nice to me. Why? How come you’re asking? Is this not normal? Well, okay I know it’s not fucking normal, we’ve already been through that whole bit. So what’s this now?”

“Ella, do you remember when you told me about your friend? The one with schizophrenia? Do you still talk to him?”

“No. Not really. He doesn’t talk to me. But then, he doesn’t talk to anyone. And out of everyone, I’m the only one he chooses to maintain contact with. If he were to reach out to someone, it’d likely be me.”

“Do you remember your conversations with him? Do you remember what he was like when he talked about his thoughts and schizophrenia?”

“It was pretty gnarly. He’d be talking about fifty things at once. All over the place. But when I talked to him and tried to explain everything going on inside him that he couldn’t verbalize, it seemed to make sense to him.”

“What do you mean?”

“Like….you know how I gave you that analogy about the millions of waterfall thoughts inside my brain? And you have to pluck one out and follow the stream to see where the thought is going, and sometimes it leads nowhere. Sometimes it’s just a dead-end random thought. There are a lot of them, and you just have to keep plucking at the thoughts one by one until you get to one that you can follow. I explained it to him that way. About how it’s loud in my head too. And he got it. He was really paranoid, too. Always thought someone was out to get him. I understood that, too. Like how I feel sometimes that something bad is going to happen. Or I have to keep looking over my shoulder. Because I just don’t know.”

“Okay, Ella. Remember how we talked about your bipolar. I really do think you exhibit symptoms of bipolar, but it’s hard to categorize your symptoms into one of the categories of the disorder that there are. You definitely aren’t bipolar I. Your mania and depression aren’t clear-cut like that. It could be hypomania, making it bipolar II, but the time frames don’t seem to match up to the official diagnosis. Which is why I suggested cyclothymia. Your cycles and mood swings are more constant back and forth. But then you’ve been bringing up this paranoia bit, and you’ve mentioned it pretty much every session we’ve had. So I don’t think you’re just bipolar.”

“Another diagnosis? What is it?”

I watch her pause, then search something up on her computer. I wait and watch the second tick by in agony. Not bipolar? What the fuck? Again? Another diagnosis? I’d just figured this one out. What the fuck was happening? What the fuck is wrong with me?

I watch my mouse hover over the link she sent, clicking it. I watch everything happen in slow motion, the page popping up on my browser, the words hitting me in flashing lights. Schizoaffective disorder.

“I think you exhibit symptoms for schizoaffective disorder. Let’s go through it together.”

I feel time stop all around me. Schizo??? Like schizophrenia? That’s crazy shit. That’s literally batshit insane crazy shit. No. That can’t be it. That’s not me. It can’t be.

“There are two kinds of schizoaffective disorder. But about the name itself. The schizo- part means schizophrenia…”

“Is schizophrenia a personality disorder? Like borderline?”

“No. Schizophrenia is a psychotic disorder. And the affective part characterizes a mood disorder, so like depression or bipolar. Like I said there are two types of schizoaffective disorder. There’s depression type and there’s bipolar type. The symptoms described fit the bill of what you’ve been telling me about. It would explain the paranoia. It would explain the bipolar symptoms. I think you have schizoaffective disorder bipolar type.”

“Oh my fucking god.”

“I know. This is a lot. But would you like me to talk you through it a little?”

“Yeah. Yeah…yeah. Please.”

“People with schizoaffective disorder bipolar type go through the extreme mood swings of bipolar disorder. But the cycles are more constant between the hypomania or mania and the depression. And throughout these episodes, the paranoid thoughts are there. But the paranoid thoughts persist even when you come out of the mania and the depression. They might lighten up or be less, but they’re still there. And after the cycles of mania and depression, people with schizoaffective disorder will go through cycles and periods of improvement. Which would explain your “quieter” periods like now or during quarantine.”

“Fuck. Yes. Yes. Because I thought in quarantine I got so much better. But then in October it got loud in my head again. After this period of mania in September.”

She nods, letting me absorb this. But the schizo? What the fuck about that?

Almost like she heard me, she forges ahead, “Schizophrenia is characterized by paranoia and paranoid thoughts. People with schizoaffective disorder or schizophrenia will withdraw from society, like how you do sometimes during your episodes. And they experience a limited range of emotion, which sounds a little like you when you say you have a hard time feeling things. And I’ve seen the way you act change in our sessions. Sometimes you’re more talkative and animated, sometimes you’re more grounded, sometimes you’re in a frenzy, sometimes you have no energy or emotion.”

I don’t say anything. I don’t know what to say. This is a lot.

“I know this is a lot, Ella. How are you feeling?”

“I hate that this makes sense to me because it sounds like me. But this is a diagnosis that is far out of the bounds that I thought my mental health was in. I never considered a psychotic disorder. I don’t know how to feel. I don’t even know how to see myself anymore. This is just…a lot. I know I said this with bipolar but this is completely different. I don’t know what I am. It’s like my identity keeps changing. And it just seems to consume me every time it changes.”

“Ella, I know how you feel about this topic. But I really do want to bring it up again. Because I think it’s important, especially if we can confirm this diagnosis and as you move on to a different therapist. I want you to think about medication again.”

“I fucking hate meds.”

“I know you do. But I’m worried about your thoughts and your voices. Right now, you’re self aware. Things are good. You can talk yourself off the ledge. But what if it gets bad again?”

“It can’t ever get as bad as it used to be, right? Because now I know? I’m better now. I’m more equipped. Things have changed. I’ve changed. I’m better. Like I hear my thoughts. I know the voices. I’m not going to act on them. They tell me to think about suicide. It’s just depending on my moods, right. Sometimes out of the blue I’ll just get wildly depressed and think about ending it. But I know I won’t. Because I can rationalize myself out of it. I know it’s a random black box thought. And it just happens. I’m used to it.”

“Ella, remember the night you tried to walk in front of a car? What particularly struck me about that story was that you told me you didn’t have a plan. When people are suicidal, they oftentimes have a plan. They know what they’re going to do and they follow their plan. But that night, things were bad for you. Your mind was already in a bad place. You were doing something very out of character for you. You were wandering around in a city you’ve never been in before in the middle of the night. And when you saw the car, you thought, I can end it right here and now. And you acted on that thought.”

Shit. She’s fucking right. That’s what always unsettled me about that night. I didn’t have a fucking plan. But I went ahead and acted on that impulse anyway. And now that she’s mentioned it. What if it happens again?

But it can’t be. I’m so much better. I won’t be on that ledge again. It’s just not me. 

How the fuck do you know? What the fuck do you know about yourself now anyway? Everything keeps changing. Everything feels like a lie. Everything you built, everything you’ve known. It all just. keeps. fucking. changing. Listen to yourself, Ella. You’re a fucking psycho. 

And for the first time in my life, I felt terrified of my own self. 

“So I really have to think about medication now probably,” I finally say. 

“What were you on before? The ones you said worked the best.”

“Lamictal. That’s a mood stabilizer. So for the bipolar and mood swings. I was on an antidepressant. And another sleep antidepressant. Oh, and aripiprazole.”

She hesitates, “Aripiprazole is an antipsychotic, Ella.”

“So you’re telling me I was already on these meds? My psychiatrist kind of predicted all this before I even fucking knew about this?”

“It means that you’ve always exhibited the symptoms. Mental disorders, especially the ones you have, have lots of overlap anyway.”

“Holy shit, Juliet.”

“Yes?”

“I remember something. I remember why I went on medication the first time. Because I told you. I was going crazy. I saw the walls waving. I saw the ceiling rise from the floor to catch me. I felt dimensions enveloping me. I was scared to leave my own bed because I thought the ground would swallow me. And I literally thought I was going insane. That’s why I started medication the first time.”

“That’s called psychosis, Ella. That’s literally what schizophrenia is. So this may not be as new to you as you think. But now you’re at the crossroads again. And you have to make the decision again, with everything you’ve learned up to this point.”

We ran out of time during that session. I left, drained. Confused. Conflicted. So I took a long nap instead. When I woke up, I could hear the voices again. 

Hello, psychosis, my old friend. How nice of you to find me here. 

Finally figured it out, didn’t you, you psycho bitch?

Get the fuck out of my head. I’ll fucking figure you out again. I lived with you before.

And it seems like I’m here to stay.

Call me psycho bitch one more fucking time and I’ll reckless impulse you. 

Sheesh, feisty today, aren’t we?

You fucking listen to me and you listen fucking good. You don’t know shit about me. But I know about you. You’re a fucking coward. Because all you can do is hide inside me and manipulate me with my own anger. But I own these thoughts. I own these voices. I own YOU. And you’ll do as I fucking say. And you know what? Some days you’ll fucking win. Some days you will defeat me. But those days won’t be the fucking last you see of me. Because I know you want me to jump off that balcony. I know you wanted me to walk in front of that car. I know you wanted me to cut my arms open and bleed myself dry. 

But guess fucking what? I’m still fucking standing. But you won’t fucking beat me. Not in this lifetime. Not in the fucking next. So shut the fuck up. I don’t have time for any of your shit today. 

Silence.

Psychotic, dichotic

Neurotic, chaotic

Narcotic, hypnotic, 

Demonic, psychotic.

Schizo psycho

Depressed anxious

Manic borderline

Panic abuse

Bipolar affect

Smoke addict

Alcohol catharsis

Complex compulsive.

Think you know me? You fucking don’t. Yeah, I’m fucking psycho. But you don’t get to call me that. Because you don’t know the first thing about being psycho. We don’t give up. I won’t stop. That’s what being psycho means.

So news flash: I’m stronger than you. What the fuck do you know about me anyway? You thought you almost killed me once. But I’m still fucking here.