A bright white notification on my phone contrasts the dark greens and browns on the monitor above it. The light squeak of brakes floats above the sounds of combat emanating from my headphones: a delivery person has arrived. “Food, brb” sounds from the speakers of half-a-dozen people across the United States. The character on screen retreats to its base as brisk footsteps clap throughout the apartment. Two doors open in succession with four locks in total—they’ll get checked twice each tonight—and concrete stairs shudder with heavy footfalls. Dressed in pajamas, and un-showered, I find the driver quickly, state my name, grab my food, and run back into the dwelling. Locks click shut seconds before the light crunch of Styrofoam contacts the floor a bit too quickly. “Alright, I’m back.”
After my fluoxetine-induced delirium episodes, the University of Southern California and I agreed on a medical leave for the summer of 2019. I immediately and completely stopped taking my medication under the instruction of my psychiatrist, but that induced a second hell. Since SSRIs increase the level of serotonin—a key neurochemical—in the brain, they must be gradually introduced into your system. Similarly, getting off of an SSRI requires a wind down period. Furthermore, due to the risk of serotonin syndrome, a potentially fatal condition caused by excess serotonin, switching between drugs requires great care and a lot of time. I received a prescription for a different SSRI—that I’m still on—but needed to wait ten drug-less days before taking it. Immediately ceasing a medication controlling serotonin levels causes Antidepressant Discontinuation Syndrome (ADS), which develops in less than three days. Depression hit me with the force of an entire ocean. All energy drained from my mind and body: that hollow body boiled with loss. What little effort remained in reserve became subject to OCD. Thoughts formed, fled, frayed, splayed, and returned. Each day became a tangle of metaphysical screams and starvation.
Having a replacement prescription doesn’t mean much when you can’t physically acquire the medication. A CVS less than a half-mile from my house filled my prescriptions, but just leaving the door was virtually impossible. Day after day, the sun shone upon that pharmacy; day after day, I remained in a fetal position. After missing a therapy appointment, my therapist called to find out what was wrong. She immediately realized the severity of the situation, and talked me through every step of leaving my apartment. An hour after hanging up, she called again to ensure I did get and take my SSRI. ADS dissipated rather quickly thereafter, and I returned to a more standard state of dysfunction. However, another Goliath dammed further progress.
The aforementioned therapist is the very same person that first recognized my OCD, and suggested I speak to a psychiatrist. She is truly an amazing person.
Mental health costs enormous sums of money, not only because of the literal cost of treatment, but also the costs incurred through impulsive and unhealthy decisions stemming from a given disorder. Shortly after my medical leave started, I researched the costs of Intensive Outpatient Programs (IOP) and Partial Hospitalization Programs (PHP) specializing in the treatment of Obsessive-Compulsive Disorder. The cheapest location charged around $15,000 per month, and one clinic even charged north of $33,000! That’s more than I make in a year! Worse still, very few insurance companies cover IOPs beyond ten days—a bit over a week must be sufficient to treat a legally disabling chronic disorder, right? People with low mental health also tend to make poor decisions and have fewer means overall. Anything from purchasing unnecessary goods, participating in unsafe sex, and binge eating can contribute to the ultimate financial burden of mental disorders without improving the underlying condition. Finally, people with mental disorders may already have trouble holding a job, and likely don’t know the legal protections available to them. Combining low income, uncovered and expensive treatment, and ineffective purchasing leaves many individuals with mental disorders financially destitute and deprived of proper medical care.
Fun fact: becoming an Uber Platinum member requires $2,500 in purchases. A not-so-fun fact: I’m an Uber Platinum member. After realizing the financial impossibility of care, I disappeared into a shell of compulsive coping behaviors. The inability to afford care became a seed for obsessions. Intrusive thoughts berated my current financial state, negatively evaluated previous monetary success, and triggered substantial self-loathing:
You’re a failure.
Remember when you could actually buy things?
When you paid for your study abroad, and built your own PC?
You’re not like that now. You’re not that. You can’t be that.
No one will care for you.
Why can’t you afford care?
Because you’re a failure.
Call someone. No!
Then they’ll know I’m a failure.
They must already know.
They can’t know.
It’s too late.
You’re a failure.
My roommate, the same one I feared would eject me from my apartment, moved back to his parents for the summer but kept paying his contractual half of the rent. This physical isolation contributed to emotional and social isolation walls growing around me. My coworkers knew why I wasn’t in the lab anymore, so engaging them meant facing my situation—a circumstance that I refused to acknowledge. Reaching out to family felt similarly unfeasible. With no healthy outlet or severity-appropriate treatment, extreme distraction became necessary to avoid intrusive thoughts. Watching YouTube until the late afternoon, I’d completely neglect eating and drinking. Only the restroom motivated me to leave the bed, but then I’d immediately return to my phone without sustenance. Eventually, hunger would overtake me, and I’d attack myself for “being so stupid.” After an hour or so of self-hatred, a quick swipe summoned Uber Eats with an accompanying $40+ of food. My distended stomach hurt as I shoved over 5,000 calories into my mouth in a single sitting, but I couldn’t stop. I paid for it all, couldn’t let it go to waste, right? 10, 20, 50 lbs. in four months. Stretch marks strained under the growing mass of fat, and associated credit card debt. Yet binge eating could only occupy so much time; I needed something more.
There are wounds that never show on the body that are deeper and more hurtful than anything that bleeds.Laurell K. Hamilton
Videos game became another critical means of avoiding intrusive thoughts. YouTube eventually grew stale, and I had watched all my shows on Netflix twice. Previously, interactive entertainment required too much energy, but I needed to hide from my brain. As video games require effort beyond sitting on a couch and hitting play, I contorted this shift in media as a positive sign for my mental health. Many of my friends game online, and I found solace in their unwitting participation in my compulsive behavior. Whether getting off a B shift or C shift, my friends would find me online with someone somewhere. No one’s around? Time to grind lengthy, single-player games until the sun rises. Sunrise marked my bedtime, and afternoons became my mornings, but my sleep was worse than just a reversed circadian rhythm. Those 30 minutes in bed before most peoples’ eyes fall became a breeding ground for all the obsessions suppressed throughout the day. A waterfall of intrusive thoughts assaulted me every night and I feared those 30 minutes every day. Avoiding this period required dragging gaming sessions to the point of collapse. Most afternoons found me lying face down on the bed snoring, fully clothed, lights on, and a game still consuming energy on the desktop. Ironically, the drive to prevent those cursed 30 minutes caused me to power through prescription sleep medication meant to make me fall asleep quickly. An average day consisted of two massive meals, 14 hours of gaming, a few hours of TV, and maybe six hours of sleep. I related to Bill Murray in “Groundhog Day” a tad too much.
Repetition and ritual coexisted with aforementioned compulsory activities. Every night, the intrusive thoughts claimed I hadn’t locked the doors:
The door is unlocked.
No it’s not.
But what if it is?
But I locked it.
But if you didn’t, someone might steal everything.
Go check it.
The conversation would continue until I unlocked my doors, looked around outside, and locked all the doors. I literally could not think or do anything until I checked the doors. A similar performance followed every trip to the restroom: I must not have wiped well enough, and am thus unclean. For 20 minutes, I’d fight the urge to return to the restroom, but I always lost. Hundreds of tiny, faint scars adorn my forearms and chest, where I picked my skin between matches of a game or bites of food. Compulsive rituals consumed every waking moment of my life.
The gaming-TV-food binge continued for nearly three months before coming to a head. My parents called weekly during the entirety of my medical leave, and they received the same answer every week: “I’m fine, everything’s okay.” I’d constantly reassure them that I was going to therapy and researching treatment centers. I did go to weekly therapy, but an hour a week isn’t enough to treat OCD. Furthermore, I skipped every intake appointment I booked with an IOP—couldn’t afford them anyway. But one credit card maxed as the summer dragged on, then a second card ran out of credit. A line of credit and a third credit card followed their predecessors. All my savings disappeared into the coffers of my landlord, delivery food services, and video games. On a fateful Saturday, Uber Eats declined my final card. I had nothing left. Sans money and with only one last meal crafted to exactly fit into my remaining credit, I expected to atrophy in my room. As per ritual, my parents called on Sunday and asked: “How are you doing?” My lips tried to say, “I’m fine,” but my throat cried out. Sobbing, I released more emotion than I thought my body contained. The reality of my life finally manifested before my eyes.
Golden beams glinted off the wings of the plane as Los Angeles’ vast suburbs shrank behind me. Within two hours, the erect spines of the Wasatch Front towered above the horizon. Utah rose to the meet the screech of wheels, and a soft jolt propagated through the passengers. For the first time that year, a soft ray of hope opened.
Have a great day and always practice self-compassion!A Fantastic Friend of Mine