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My Brother's Journey Stuck Between Two Poles

“I am alive on Lithium, aren’t I?”

I was watching a highly recommended show with concentration, in bed.

My brother was in the same room and was taking his medications.

“What?” I said, distractedly.

“Lithium. It keeps me alive. Right?”

“That would be an overstatement. It is, however, vital for maintaining your sanity.”

“But my sanity keeps me alive. And I have gotten my answer,” he said, swallowing his morning pills. A plethora of antipsychotics, mood stabilizers and neuromuscular modulators.

My brother, N, was diagnosed with bipolar affective disorder in 2015. In these last five years, he has had three acute attacks of mania, requiring hospitalization. The somber diagnosis was hard for me to accept. But being the only person in my family in the medical field, the doctor-sister, it was my obvious duty to understand the problem, comprehend the management and explain it to my family members as well as provide emotional support. My mother’s incredulity never helped. During his first hospitalization, I was a medical student who was an adept member of the dramatics club. I used those skills to keep this façade of a calm and collected person. I trusted his doctor more than I should have. She would explain everything to me in the most empathetic manner ever, I never felt the need to doubt her skills or look into the in-patient psychiatric care she provided.

His third hospitalization occurred last year. The events leading up to it have etched into my memory until the end of times. We had changed doctors. N was exhibiting classical symptoms of grandiosity and decreased need for sleep. After an hour-long session, and I still do not understand why, and how, but he diagnosed N as being on the other pole of his condition. N was depressed according to the doctor. He was prescribed anti-depressants willy-nilly. The anti-depressants worsened N’s mania and led to eventual psychosis.

The exact time was 5:50 p.m. when he went into psychosis. He and I were alone at the house. I was talking to him calmly, trying to make him go to sleep. After spewing out some gibberish, he lifted his arm to smack me across the face. Thank God for my quick reflexes and I ducked. He was violent, I realized that and I could not talk him out of it of course. I needed to act. I called my mother to come home immediately. We, somehow, took him to the nearby emergency. My actions there still haunt me. I failed my brother. I was frozen. My brain had chosen dissociation as a coping mechanism. I did not know what I was supposed to do. I had spent the entire previous years taking vitals, as a reflex, of patients presenting with life-threatening emergencies. Here, when it was my brother restrained with ropes, lying in the ER bed in front of my eyes, I forgot all the learned skills. I merely wept.

With the help of a friend, we landed in yet another private in-patient psychiatric facility. My mother and I decided to not leave his side during the two weeks he spent there. And these two weeks forced me to look at the world through his eyes for the first time in my life.

From belonging to a broken home to never being able to focus on his studies, he would mumble about all the wounds and scars tugging at his heart. I would listen. I would weep. He was disoriented. He does not remember now the things he said. But I do. And I am angry. And hurt. Not because of him. But because of everything that stigmatizes psychiatric disorders and mental illnesses. And because of the psychiatrists and psychologists in South-Asian societies that fail their patients.

I write this today because the world is under a shared burden of a rampant pandemic. The lockdown that we are under and the constant fear for the lives of my loved ones have forced me to be more reflective. When the first news came of lockdown in my country, back in March, my first reaction was to call my mother and stock up N’s necessary medications.

COVID-19 has slammed rambunctious anxiety onto this world. Every happy-go-lucky Tom, Dick and Harry is stressed out. These stressors are worse for people with underlying psychiatric conditions. Back in April, when N said he felt paranoid and delusional, I went into panic mode. I immediately contacted his psychiatrist and psychologist to arrange a telehealth consultation. One agreed, for the other, I had to take him down to the clinic, livery in personal protective equipment. I started having flashbacks and nightmares. I was scared. What if N is triggered into mania again? With a deadly virus looming on our heads, how will we manage a hospitalization?

Ours is a society that has reluctantly started to talk about depression. Depression is still considered a myth amongst our elderly, or a lack of spirituality and character. We are far from accepting and destigmatizing other psychiatric disorders. But I fear that if we do not start talking now, millions of lives will be lost. We need better psychiatric trainees. We need trainees that consider this field their passion, not just a relatively relaxed specialty. I know that sounds silly to the readers, but it is a harsh reality of trainees in my country.

We need psychiatrists who are not only empathetic towards the patients but also their families. We require doctors who understand the struggles of living in a South-Asian culture, who take transcultural psychiatry seriously. That means doctors who prescribe medicine as a means of helping the patient instead of just numbing their minds. We are in dire need of awareness of psychiatric conditions amongst the public. We have to help them understand that they are not alone; they are not crazy! They have a medically legit condition that is hard to comprehend but as real as life. We need a support system for our psychiatric patients.

N’s most recent doctor has been a life-saver. He has made my brother’s life functional and manageable. But the bitter truth of it all often makes me twist and turn in bed. We found this new doctor by a hit and trial method. I, being a graduate of a prestigious university, was still unaware of how to manage N’s and my mental well-being. I often feel guilty. I sometimes dissociate. I will not label it as post-traumatic stress disorder just yet, because I am still trying to process it. But I do know one thing. My depression, anxiety and fibromyalgia are enough to keep my brain running like a rat on a wheel. To support my brother and his condition with two poles, especially during a global pandemic, I need an extra set of neurons. I worry about his medication regimens; he must not miss his Lithium at any cost. I worry about the side effects of these medications; every twitch he exhibits makes me think of extrapyramidal effects. I worry about keeping him away from stressors. I worry. All the time. I imagine what would have happened if, under his psychosis, he would have succeeded in physically hurting me or worse, himself. And it is chewing me up inside.

I wishfully fantasize sometimes, how different things could have been if we would have gotten our hands to good psychiatric care during the first attack. Ah! The “If” and the “Could Have Been…”

But you know that is worse than that fantasy? The actual existence of these two bodies, good and bad psychiatric care!

Acknowledgements: I am extremely grateful to my brother who let me share his story from my point of view. I kept his name under covers, but the people who know me, know him. We love you, N!

Getty image via Svetlana Ivanova