Red Orbs and Blankets
Sirens wail while a man kneels before me asking if I remember who he is—I don’t. A friend, who I do recognize, cries, and clings to my right arm. Cool brick presses against my back, and hard tiles support my weight. Heavy boots stomp up the stairs, and one pair stops right in front of me—displacing the unrecognizable man. The antipsychotic I swallowed twenty minutes ago begins to take effect. A firefighter looks me in the eyes. At his gentle order, my classmate releases me and shuffles aside:
“What’s your name?”
“Do you know where you are?”
“USC, uh, yeah.”
“How are you feeling?”
“A…a Blanket, it, uh, feels, it covers my head. It feels like it’s, uh, it’s inside my brain. It, it’s hard to think.”
Cold alcohol evaporates off my chest as cold metal leads glue to my skin: a firefighter to my right starts an ECG.
As with many articles, I’m going to link my disclaimer and emphasize that I am not a medical professional. All information in this article comes from personal research and experiences, and should not be taken as medical advise.
Proper medication plans can greatly benefit OCD treatment, but there’s no one medication plan for everyone. The FDA only approves a few medications, primarily Selective-Serotonin Reuptake Inhibitors (SSRI), for OCD treatment, but many “off-label” medications work in treating the disorder. We’ve all heard long disclaimers of a drug’s every side effect during commercials, but the reality of those lists seem distant and abstract. Psychiatric drugs directly affect your brain, by definition, and thus can have unique and peculiar side effects including some very rare issues with dangerous aftereffects. SSRIs can increase suicidal thoughts and risk, contribute to severe sleeping issues, and cause potentially fatal serotonin syndrome. Luckily, severe side effects tend to be rare, and constant communication with a psychiatrist can catch issues early on. However, some unfortunate individuals have severe, rapid-onset symptoms; I am one of those unfortunate people.
The cold gleam of winter sun greeted my arrival to Los Angeles. My father and sister carried heavy boxes—nabbed from a hospital recycling bin—to my new apartment down the street from the University of Southern California. In 2018, USC offered a faculty position to my then Ph.D. adviser who brought along his entire laboratory. Leaving the painful humidity of Louisiana, we headed to our new home and graduate school in the City of Flowers and Sunshine—dangerous sunshine that I know all too well. In only 12 months, I’d moved from Utah to San Francisco to Louisiana and then to Los Angeles for internships and school. I saw a therapist for a few short sessions before leaving Utah as I struggled with depression. Then the depression seemingly disappeared for a month after moving to San Francisco before returning tenfold. This pattern repeated in Louisiana, and I figured it’d return in LA.
Moving and Cycling
I spend a lot of time reflecting on my various behaviors to contextualize them within my disorders and specific circumstance. Moving triggers many new sensations including manual effort, a different climate, and numerous little challenges that manifest throughout the process. ADHD loves new sensations, as long as they’re not overwhelming, unique challenges, and hands-on labor. However, both OCD and ADHD don’t adjust well to large life changes. Following a “grace month” due to ADHD, all the fears, intrusive thoughts, and depression take over. They even feel more forceful than before the move due to the complacency between storms.
A few weeks after classes started, I called USC’s therapists and explained my concerns and history of depression. The man answering my calls keenly noted my problems were beyond the scope of university therapy for students. He referred me to a nearby therapist and psychiatrist (well, the psychiatrist was in West Hollywood, and I didn’t own a car, so “nearby” is a deceiving term here). After several sessions, my kind and knowledgeable therapist recognized that I might have OCD and encouraged me to see the psychiatrist finally. The psychiatrist corroborated the diagnosis and prescribed me an SSRI; he then quit the clinic. A nurse practitioner met with me for a session before assigning me a new psychiatrist a week or so later. Effectively, no one monitored me for the first month while I took a new medication. SSRIs, and the majority of psychiatric drugs, concentrates in your brain for weeks before becoming effective. As such, the build-up period needs close monitoring for side effects. Fortunately, I experienced no notable side effects during this poorly handled month.
My newly assigned psychiatrist sat stoically behind his desk and asked me numerous blunt questions about my experience with the current SSRI. I had good news: the depression and OCD symptoms had decreased! Excitingly, this particular drug’s standard antidepressant dosage can be doubled and even quadrupled to treat OCD. Taking a long, bumpy bus ride back to campus, I stopped by CVS and got my first fill of the double dosage, and accompanying hope. The drug concentrated in my brain increased over two unassuming and relatively peaceful weeks, but ocean swells can break without warning.
A short, blond classmate gave a fantastic talk detailing her latest research on a stereotypically sunny southern Californian day. Well, I imagine her talk was fantastic. She normally gave great presentations, but a red orb burned a hole through my memory. She did give a talk, right? That orb. Oh god, that orb. Sitting in the front of the classroom, I experienced my first episode of delirium. I sent the following verbatim letter to my therapist and psychiatrist shortly after that fateful day:
On the 9th of April, 2019, I had an incident occurred that I do not know how to describe, but I will do me best to detail it here.
During a student presentation in one of my classes, something attacked my mind. But that’s not quite right, it was my mind, isn’t my mind, was not me, but thought it was. I truly don’t believe that I am capable of explaining what this sensation, this thing, this episode is. The words and feelings to explain it just do not exist and I will never be able to fully describe it to someone. For the purposes of this writing, I will call it “It”, because nothing more specific will do. It was a grinding, painful, invading, controlling, identifying thing. The moment It happened, I stopped forming memories. I could not remember the rest of the talk I was listening to and, when I came to and people were discussing one of the slides, it was wholly unfamiliar to me. I didn’t just “zone out”, those ten minutes ceased to exist and all there was, was It.
It was a grinding sensation, as if an angle grinder disk was taken to the inside of my upper right skull from the inside. This is perhaps the best description I have of the sensation as it made a halo on the inside of my skull that felt like it was spinning thousands of times per second. Physically, I could feel it but there was no pain—it ground as a pressure, if you will. But I could physically feel it. Mentally, it was a searing pain and unbearable. From this halo, It came. It was red and emanated from the halo as a fiery storm of red tendrils of light. In many ways, it was like the computer generated images of what a block hole should look like but with the flares of a star. There was a black sphere connecting the halo that was throwing off red and tendrils of red. The red was angry and consuming. All of my brain power was spent by It, me analyzing It, and me fighting It.
It thought it was me and It wanted “myself” to die. I say “myself” because It used “myself”. It didn’t speak, but I knew It’s every thought and vice versa. It wanted myself to die. Alex Hyer didn’t want to die, Alex Hyer wasn’t and isn’t suicidal, but It wanted myself to die. It was nefariously suicidal. It wanted myself to die because It was evil and angry and would be satisfied if myself died. It wanted myself to die for spite against myself and for evil and anger’s sake alone.
It showed me images of myself disappearing and everyone moving on with their life. The images, scenes, were more impressions than a movie. I did see things, It’s black core would be replaced with images and impressions. I would be in them and simply vanish and everyone else would continue doing what their doing. It wanted me to feel like no one would care so I should just end it. But It was in my head, literally, and it didn’t and/or couldn’t directly seem to make me feel worthless as it wanted me to feel. It had to convince me with haunting thoughts and images, but it couldn’t directly make me feel like it wanted to.
After the initial ordeal, It started to subside very slowly over the course of several hours. About ten real-world minutes (it felt much, much longer) later, I could remember things again. I remember the discussion after the talk and I reached out to two friends in that class for help. We have a safety word that I’ve never used before and I messaged it to them. I went home with one of them for the evening. We took the train, walked their dogs, and sat on their rooftop by the pool for an hour. During that hour, it finally disappeared and we met up with another friend and got dinner. I went to my own home to sleep, though my friends offered me to stay the night if it ever came back. I was wringing my hands the whole evening though, which I never do. I almost always am playing with something in my hand, but never wringing them, that was new.
I can still feel the outline of the halo if I think about it. Though that’s likely because I’m focusing on it, so I might be generating those sensations, but I feel it both physically and mentally when I do. I don’t know what It was. It thought it was me, It believed it was me, but I didn’t believe It was me. It wasn’t a demon, a possession, a spirit. I’m not remotely superstitious, but I want to explain what it isn’t via feel as I can’t describe what It is. It pulsed, It thought, It consumed, It took up a semi-defined space, but It wasn’t physical. It was It.
The idea of It coming back terrifies me and thinking two days back fills me with a sense of dread. I am afraid.
The following morning, I woke up exhausted and realized I couldn’t remember the last week, or her talk and began to spiral: How could I have missed her presentation? What’s wrong with me? I’ve hurt her. She knows I didn’t listen. Why did I do that? Worse still, a cigarette burn smothered that entire register from my brain. My therapist and psychiatrist both made immediate room in their schedules, and I booked quasi-emergency appointments. The psychiatrist prescribed an antipsychotic in the event of another incident: an unfortunately apt preparation. USC helped schedule an appointment with a neurologist to address my amnesia and prescribe an MRI. The day before that MRI, I got called to the ring for round two:
On the 1st of May, 2019, I experienced another concerning mental health episode unlike anything I’ve experienced before. While not as bad as my previous episode, or at least less concerning from my point of view, it was much more public and still terrifying. I am labeling this incident The Blanket.
The day started off poorly as I had to rush to an exam I was proctoring and didn’t eat breakfast. My intrusive thoughts were particularly strong and were mocking my performance as a TA. The exam finished and I was doing better when I attended a PhD defense of someone in the department. Following the defense, I went to go eat lunch at Panda Express. On the way, I passed an employee of the department at 1230 who told me hello and asked how my day was. I responded “well” which was true at the time. I arrived at Panda Express shortly afterwards; that is when my episode began. I almost immediately became disoriented and every time the worker dishing my food asked me another question—such as what sides I wanted—I felt like I was snapped back to reality from being completely empty and disassociated. I would then look around, remember I was in Panda and why I was there, and then respond. This happened three or so times while waiting for food.
I brought my lunch back to my lab and had to really focus on how to use chopsticks to eat, an activity I perform regularly. My lab mate called me at about 1240 asking where I was since our final exam for one of my classes started shortly. While while she called, I stabilized myself on a concrete wall because I felt uncomfortable standing. On my way to the exam, Keck Medical Center called asking for payment information for my MRI scheduled the next day. While getting out my credit cards, I couldn’t remember what credit card I should use or which cards I had on me. It felt like I was fishing for something that didn’t exist and the segmentation faults of my brain were scaring me. Eventually, I managed to read off my credit card information and attended the exam.
Upon being given the exam, I read the questions and drew a blank. I attempted to answer a single question but couldn’t finish it or focus. Starting prior to the exam, a Blanket-like sensation weighted over my head and began to penetrate into my brain. Unlike It, this Blanket had no thoughts or will nor did it try to convince me of anything. Instead, it suppressed my brain and thoughts and made me incapable of all but the simplest, most repetitive thoughts. This Blanket also hurt a bit, somewhat like a dull headache, but not quite. The pain was fairly minor overall. I began to contemplate leaving the test and calling the University of Southern California’s (USC) Department of Pubic Safety (DPS). However, I was worried about disrupting the test and stayed.
Eventually, I began writing a note on my exam to my professor requesting that they escort me outside and call DPS. Once I began writing though, I could not stop. Going beyond my note, I began to write whatever came to my head. My arms felt sore as I wrote and scribbled at a furious pace. I remember writing the number 30 dozens of time and discussing the A/C system. The A/C system had kicked and it was loud and all my thoughts were channeled against it. I wrote about how I hated the A/C and how it rattled, then wrote “and rattled” a dozen or so times. The final thing I remember writing is that I loved the two people in my lab who have been so helpful caring (which I do, they are amazing people), and repeatedly wrote about how they’re amazing and I don’t ever want anyone to ever hurt them. When I finally ran out of room on my exam, I wrote “READ THIS NOW” in and circled it in blue ink, handed it to my professor, and sat out in the hallway.
He every quickly came out side and asked if I was okay and I just said “no” because I didn’t know if I could say anything else. While he got someone to call DPS, I took my prescribed olanzapine ODT (5 mg). On a side note, that shit is bitter and chalky and the taste lingered on my tongue for a long time, but it’s 110% worth it as I’ll soon describe. Several USC biology staff members came up and sat with me including the person whom I had spoken to briefly before everything started. I couldn’t remember who one of them was and they the staff member I saw earlier began to walk me through events, which I began to remember, and I started trying to describe what was happening and was slowly able to reconstruct the story above. My exam was given to a higher up in the department.
A DPS police officer arrived began to take my information and kindly ask me questions including what medication I took. Shortly afterwards, the Los Angeles Fire Department (LAFD) showed up with and had brought a transport team (ambulance). They took my blood pressure, blood oxygen levels, and hooked me up to a portable EKG (I believe it was an EKG). They said everything looked fine except my blood pressure was high but that could be due to being in a small room with a bunch of firefighters. They said all they could do at this point was transport me to the ER if I felt it was necessary but that, since my medication appeared to be working quickly, I should probably just take it easy today. I opted out of an ER visit, especially since I have an MRI scheduled on May 2nd.
Now to discuss the olanzapine before telling you what happened after the firefighters left. Within a few minutes of taking the medication, I noticed the Blanket got lighter and began to leave my brain. Everything still felt slow, but I was starting to return to my normal self. At the beginning of my conversation with the fireman, I was still hazy but the Blanket was out of my brain. By the end of the conversation (which ended approximately 30 minutes after taking olanzapine), I felt like everything clear and I was in control again. Everything still felt slow, but I felt like I was me again. Importantly, I felt composed and I didn’t notice any intrusive thoughts. It also made me very tired. Between the Blanket and the meds, I was exhausted.
After the firefighters left, I made small-talk with some of my classmates and attended a meeting with the medical leave coordinator for USC which was coincidentally on the same day. Afterwards I spoke with a lab mate and my PhD advisor about emergency plans for the night (aka having DPS on speed dial and informing my roommate of what was going on). I got home at about 1730 and immediately went to bed for 13 hours. I woke up feeling well rested and starving, had a great meal, attended a meeting, and am now at the Keck medical center waiting for my MRI (I arrived several hours early, oops).
I definitely am still having intrusive thoughts today, but they’re at a normal background level for me and aren’t nearly as strong as they were yesterday. Since the Blanket peaked during the exam, I imagine most people will assume I had a nervous breakdown due to the exam. However, I think the timing was largely coincidental. The final exam is actually worth half of that class’ previous exams and I had come to terms that I would not perform well on the final several days ago due to the amount of class I’ve been missing. I legitimately have not been worried about this exam including on the day of the final. I recognize that perhaps I could have been stressing about the exam but not recognizing it as such or directing it elsewhere; however, as far as my pathos is concerned, the exam did not play into the Blanket.
I feel it important to note that the Blanket was far less scary, though still scary, than It as the Blanket did not try to manipulate me or harm me and had no will. However, it scared a lot of people around me as it was far more public and visible than It.
Finally, I feel it important to note that both It and the Blanket, which are my only two such events, occurred only after being raised to 40 mg/day of fluoxetine from 20 mg/day. I am strongly aware that correlation does not equal causation and that there are numerous confounding variables to any such connection in my current life such as end-of-semester stressors such as committee meetings. However, I feel it is important to mention.
PS It may somehow be relevant to mention an episode of paranoia I had on the 30th of April (the day before the Blanket). While many of my intrusive thoughts are paranoid, I am not myself paranoid nor do these thoughts drive me to paranoia. This was not true of April 30th, a Tuesday. I’ve been eating a lot of food ordered from Uber Eats to avoid leaving my apartment and the empty food boxes have been piling up in my room and I only take them to the trash every few days to avoid leaving my apartment as much as I can. They embarrass me, to be frank. However, on Tuesday, I began to believe that my roommate had been in my room and seen the trash and been disgusted by it. He had a friend over that evening to study for the upcoming finals and I believed that if I left the apartment, he would take his roommate into my room and laugh about me. The true paranoia came from my belief that they were conspiring against me. If they entered my room and laughed, I believed that they would attempt to prevent me from signing a new lease, effectively kicking me out, and that his friend would take my place. This prevented me from leaving my apartment at all for the whole day. My room is near our living room, so I could literally hear them talking about their exam and not about me. In fact, my logical mind knew they weren’t conspiring against me and was not paranoid. However, my emotional self felt it so strongly that overruled everything and dictated my behavior. This feeling did not alleviate until my roommate’s friend left. I have never felt anything like this before.
The MRI revealed nothing abnormal, my roommate didn’t lock me out of the apartment, and I actually remembered the week before The Blanket. However, multiple delirium episodes caused USC and I to agree on immediate medical leave to attend an Intensive Outpatient Program for OCD, and solve medication issues. Since these episodes occurred only after doubling my SSRI dosage, my psychiatrist logically decided to drop the dose. Well, except he dropped the dosage to 0 mg/day: an immediate and complete cessation of antidepressant medication. My roommate may not have locked me out of my home, but I locked myself in.
Have a great day and always practice self-compassion!A Fantastic Friend of Mine