Medicine and Madness: Stories of a Bipolar Physician

By Cynthia Clinkingbeard MD MHS

This collection of personal essays provides a candid and in depth look at mental illness from the perspective of a bipolar physician.

This book chronicles Dr. Cynthia Clinkingbeard's journey through medicine and into madness and beyond. It is at ti

• Language: English
• Publisher: Cynthia Clinkingbeard MD MHS
• Release date: Apr 23, 2024
• ISBN: 9798869336576

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Cynthia Clinkingbeard, MD, MHS

Copyright © 2023 Cynthia Clinkingbeard

All rights reserved.No part of this publication may be reproduced,distributed, or transmitted in any form or by any means without theauthor’s prior written permission.

ISBN:

979-8-9894828-0-1

979-8-9894828-1-8

Contents

Prologue

Glossary

Dedication

Acknowledgments

My Blue Dress

Nowhere to Hide

Birth of an Eating Disorder

Born Again

The Scholarship

Door Number Two

The Swallower

Abdominal Aortic Aneurysm

It’s Contagious

A New Plague

San Francisco General Hospital

Magical Thinking

At Work in a Medical Warehouse

Reverse PMS

Arrogance

Fridays with Elsie

The Bigot

Can Things Get Worse?

Depression

Ship High in Transit

My Last Morning with Shakira

Koolio

A Winter Swim

Guarded and Conserved

Redemption

The Last Fishing Trip

Staples

Imprisonment

Probation

Electroconvulsive Therapy

Morbid Obesity

Ketamine Therapy

About the Author, Cynthia Clinkingbeard

Prologue

The stories of severe mental illness are seldom told and certainly not often told by the mentally ill ourselves. Our lives are usually too chaotic for us to chronicle. We are depressed, we get scared, we are manic, we are psychotic, we are disorganized, and we are mortified by what we have done while we are sick. We aren’t writers. The drugs make us stupid, unmotivated, and fat. We don’t want our stories told. We don’t want to embarrass our families. We commit suicide, we smoke more, our hair falls out, we die 9 years earlier than those without mental illness, we are more likely to get dementia, and our bones are thinner.

The severe psychiatric illnesses (bipolar, schizophrenia, major depression, and anxiety) are quixotic, persistent, wily, and hard to treat and live with. Patients are frequently unstable. They can require minute-to-minute monitoring. The drugs have tremendous and intolerable side effects. In addition to those listed above, they cause diabetes (largely through weight gain), heart disease, movement disorders such as dyskinesia, and the much more serious, disfiguring, and irreversible tardive dyskinesia (one drug to treat the symptoms of this malady is over $14,000 per year out of pocket), constant dry mouth, blurred vision and slowed mentation. The newer antipsychotics disrupt metabolism and cause excess mortality in elderly demented patients. It’s not hard to see why medication compliance is such an important issue in psychiatry.

The World Health Organization reports that depression is the most common mental disorder and is a leading cause of disability worldwide. About 8 million deaths are attributed to mental disorders each year worldwide. The National Institutes of Health states that more than 1 in 5 U.S. adults have a mental illness. (57.8 million in 2021) The suicide rate increased by 5% in 2021 and 2.6% in 2022. Bipolar disorder is the most lethal mental illness, with a 10.26% suicide rate yearly. Depressive disorder is 5.69%.

Mental illness is about loss. Loss of autonomy, loss of agency, loss of income, loss of jobs, loss of financial stability, loss of friends and family members, loss of homes, and, far too often, loss of life. Mental illness predicts homelessness, and homelessness exacerbates mental illness. Two-thirds of homeless adults surveyed reported a mental illness or substance abuse disorder. (National Health Care for the Homeless Council) We are losing the battle with mental illness.

Glossary

Bipolar Disorder 1

A severe mood disorder with recurrent episodes of depression and psychotic mania. May also have episodes of hypomania, anxiety with panic attacks, and PTSD (Post Traumatic Stress Disorder). It has the highest rate of suicide of all the psychiatric disorders at 10%.

Mania

An affective state characterized by elevated mood, hyperactivity, irritability, hypersexuality, excessive talking, excessive spending, impaired judgment, and psychotic symptoms, such as delusions of grandeur, e.g., believing one is the second coming of Christ.

Hypomania

Mania like state but not as severe and without psychotic or dissociative features.

Depression

A condition of loss of a sense of well-being, general emotional dejection, hypoactivity, withdrawal, and prominent anhedonia, often accompanied by extreme negativity, suicidal thoughts or actions. The suicide rate for major depression is 6%.

Schizophrenia

A thought disorder marked by delusions, hallucinations, flat affect, disorganized speech, behavior, and intellectual functioning. Not to be confused with multiple personality (dissociative identity disorder).

Anxiety

An uneasy feeling of discomfort or dread accompanied by an autonomic response; the source is often nonspecific or unknown to the individual; a feeling of apprehension caused by anticipation of danger.

A1C

An average measure of the last 3 months of blood glucose. Normal is 4 to 5.7, prediabetes is 5.7 to 6.4, and over 6.4 denotes diabetes.

Dedication

This book is dedicated to Susan, who has stayed with me to infinity and beyond, and to my tribe: Taylor, Aliyah, Mackenzie, Mason, Tess, Markus, and Eleanor.

Acknowledgments

Susan Barkis designed this book's cover and held my hand throughevery technical aspect of creating this book.Without her, this bookwould not have been published.Thank you is not enough for all she contributed.She is my inspiration.

Thanks to Bruce Ballenger, Ph.D., who guided my first stories in his Creative Nonfiction Class at Boise State University in 2007.

Thanks to Kathleen Reading Haws, who provided the first round of editing this book and encouraged me to finish it.

Thanks to Julie Hoefnagles, Kathy Young, Collette Jackson, Carol, Renee, and Lynn Coad for supporting and encouraging me and thisproject.

Thanks to the many people who have read stories and given positive feedback.

Thanks to Carolyn Corbett, PMHNP, for keeping me alive as mypsychiatric provider for ten years.Her retirement was devastating.

Thanks to Joniruth Digaum, NP, for bravely taking the reins of my complicated psychiatric care.

Thanks to Cathy Gwin, Psy.D., for always being my cheerleader and believing in me every step of the way.

Thanks to Sandra Clapp, my lawyer, who saved me from the evil guardian and conservator and has remained a good friend ever since.

Thanks to Bret Shoufler, my lawyer, who guided me through the criminal justice system.

Thanks to my family for living through these stories with me and never giving up on me.

Thanks to Nancy Oliver Harvey, who bought a copy of an earlierdraft of this book and has been encouraging me to get it published ever since.

Medicine and Madness contain true stories, but some names and details have changed.

My Blue Dress

Two days ago, I escaped from the locked psychiatric ward. They left me alone in the courtyard after our exercise. Usually, this exercise was a smoke break for the smokers, with the rest of us waiting to return to the mind-numbing tedium inside. I don’t know how I came to be left behind outside. I don’t know why there was a loose board in the fence. I just know that, at that moment, I had to get out. I squeezed through the hole, jumped to my feet, and ran. I passed stealthily around the front of the building. About the time the exhilaration of freedom hit, so did the realization that I had nowhere to go. I had no money to hail a cab or catch a bus. I had no credit card. I had no one I could call to come pick me up. I was just as trapped outside as I had been inside. I went back to the front door of the psychiatry building and buzzed to be let back in.

You would have thought I had committed a serious felony. The staff went berserk. I thought, How mad can you get at someone who escapes only to come right back inside to be locked back up? They saw no humor in the situation. Where the hell did you think you were going? said Jane, my primary nurse. I remained silent. Don’t you realize how serious this is? she said. She received more silence from me. My outside privileges were removed, and I was demoted from an A to a C. This was a disaster for one on the inside. This demotion represented a serious restriction of privileges—no smoking, no outside time, and, worst of all, no sitting on the ward without supervision. I think they were mostly furious at being fallible. How locked is a locked ward where patients can walk away? Maybe they thought I would give the other prisoners ideas. Perhaps someone else’s escape might have proved more ominous. Maybe someone else could have gotten away.

I’ve put on a pretty blue dress for court. The policeman asks for my hands and slips the handcuffs around my wrists. My crime? Mental illness. Specifically, my crime is a manic relapse of bipolar disorder that has landed me involuntarily in the hospital. The policeman will handcuff me and put me in a squad car to drive me to the courtroom. He doesn’t speak to me other than to order me around. He puts the cuffs on tighter than they need to be. He acts like he would like to wash his hands after touching me. I have become a psychiatric chattel. Some patients may be a danger to themselves or others; therefore, all are treated as if dangerous. Take no chances on the one in the blue floral dress.

The drive to the courtroom is only a few blocks away. I am taken to a holding room to wait for my lawyer. This is a tiny cement cell with a cement bench and a heavy locking door. It is not a room for claustrophobics. The cement bench is cold, and I shiver as I wait. Finally, my lawyer showed up and told me the court had decided to send me to the State Mental Hospital in Orofino on the hospital's recommendation. This is 6 hours away, up north, in the middle of nowhere, next to a state prison. He promises to visit. He convinces me it is not worth fighting this edict.

I have held it together so far, but I cry as I enter the courtroom and see my father and cousins sitting in the back. I am bereft and completely mortified for them to see me like this. The tears stream down my face, unchecked by my handcuffed hands. The judge comes in. The prosecutor enumerates my unspeakable sins. I have been unable to stay well for the 30 days required by my last order. I must be put away. I will go to one of the state’s two mental hospitals for an undetermined time. One is usually put on a waiting list for a bed in the state hospital, but as soon as I was out of my handcuffs and back at the locked unit, there was a hurry to get me ready to go. A bed had opened, and getting rid of me was a high priority. My estranged partner was there to collect my belongings—I won’t need my pretty blue dress or much besides the clothes on my back. No belts allowed. There was more crying as I was once again cuffed and put unceremoniously into the backseat of a squad car.

I have always been a nervous airplane passenger. Takeoffs, turbulence, and landings make my palms sweat and my heart race. The plane to Orofino had exactly four seats: two for patients and two for pilots. The other patient had a nasty, off-putting scowl on her face and wasn’t speaking. To my utter disbelief, the other patient heading north and I were to remain handcuffed for the ride. The copilot had a gun if the circumstances were not already disturbing enough. I don’t really remember getting on the plane. In some moments of pure terror, the brain dissociates. It just locks down and blocks out whatever is going on. It is thought to be a protective mechanism to keep the psyche intact.

Having survived the takeoff, I tried to soothe myself by conversing with the other patient. I was met with further stony silence. It wasn’t long till we hit significant turbulence, and I was convinced that the plane was falling to the ground. I screamed and grabbed the leg of the silent one next to me. The scowl turned into a glare, and I apologized to her for my outburst and breach of her boundaries. Sure that I was not going to survive this plane flight, I was further terrified by the knowledge that I would be handcuffed when it crashed and burst into flame. If we landed in the water, I would have no escape and would surely drown.

I was too worn out when we landed to feel further fear. We were met by a benign-looking, middle-aged couple who were to drive us to the hospital. They were mystifyingly pleasant. They could have been proprietors of a bed and breakfast. It was only a few minutes up the hill to learn that they were part of the keepers, and we were definitely part of the kept. State mental hospitals are for the sickest of the sick and the poorest of the poor. Only the toughest cases end up in these thick cement walls in a faraway place. State hospital is for those with treatment-resistant mental illness, severe noncompliance, or who run afoul of the law. Most patients had chronic schizophrenia. I have none of those things. I have been sent to this isolated freak show of incarceration to be punished.

I had the means to go to a private hospital, but my doctor decided to teach me a lesson. His arrogantly misinformed assumption was that I wasn’t trying to get well. What a serious misunderstanding of mania. Mania takes away the capacity for insight and judgment. One becomes one’s worst enemy and makes one poor decision after another. I had been hospitalized earlier in the summer and released too soon with inadequate follow-up. Quite predictably, I relapsed, and the State Hospital it was. I was too sick to fight it. My lawyer could have helped, but he was interested in one thing—his fee. He didn’t want me spending all my money on a private hospital. And he never did visit.

Being in the patient role was made all that much harder because I am a physician. I was used to being in control, the one with the key to the locked ward. Not only being in the patient role but also being forcibly locked up rattled my armor. I was very caught up in my physician identity. Having to check my white coat at the door was like leaving myself behind. This psychological disruption added to the confusion of mania. It left me bewildered and unprepared to negotiate the treacherous halls of a State mental institution.

I walked onto the ward and was relieved to find one of the