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Columns   |    
Personal Accounts: Scaling Mount Rushmore: Cartography of a Manic Episode
Brian Daniel Harvey
Psychiatric Services 2006; doi: 10.1176/appi.ps.57.2.177
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Winter 2002. My life then. As I was exiting Keystone, South Dakota, on foot, heading to the next state on the map, I was stopped by a Mount Rushmore park ranger. A very courteous and coiffed blonde, she wanted to know whether the materials I had deposited in the slot at the local post office were laced with anthrax. I don't remember how I answered, but I managed to make her laugh. I probably burbled bipolarly about "fraud, falsification, misrepresentation, and omission"—concepts I had become obsessed with during my homeless journey in search of a "civil state."

Even though I was fully manic, I was conscious of being homeless. I had arrived in South Dakota courtesy of a truck driver who picked me up along a highway in Wyoming. Wherever I touched down, I filed a change-of-address form—actually, a change in "general delivery" from the last main post office I breezed through. At the Keystone post office, I had put the completed form in the slot inside, including notations to Prince William and scraps of photographs—we were somehow related, according to one of many conspiracies I had cooked up about royal and Hollywood mechanical androids.

I had arrived at Mount Rushmore National Park at the crack of dawn, just before the rangers showed up. Undisturbed, in a euphoric manic state, I had the solitude to contemplate Mount Rushmore. But a more important question, in retrospect, was, How had I arrived at this homeless state in the middle of nowhere, undergoing a massive manic episode yet again? There had been the horrific episode in Moscow a decade earlier. To this day, I have been hospitalized some seven times for bipolar affective mood disorder, better known as manic depression. This was the third time I had ended up homeless. A graduate of Berkeley in Soviet studies and Slavic languages and literature and a former postgraduate research student at Oxford. A former research assistant at the Hoover Institution on War, Revolution, and Peace at Stanford. A former summer replacement reporter-researcher at Time magazine.

My first homeless adventure, in December 1996, took me from a 72-hour observation at the insistence of my parents in the psychiatric ward at Stanford Medical Center to a motel in Palo Alto paid for by the brother of a bipolar bud, and then to the steps of the Lincoln Memorial in the dead of night in frigid weather with a streetwise African American named Alex, who was also homeless, and, finally, to St. Elizabeths Hospital in Southeast Washington, D.C.

August 2001. Washington, D.C. I had been fired from my job as a publications production coordinator at a nonprofit research library association. I had been to the U.S. Equal Employment Opportunities Commission at the suggestion of the police (after I had called 911) to issue a complaint that I had not been granted "reasonable accommodation" under the Americans With Disabilities Act. I became so bipolar, with the symptom of severe and persistent mania, that I jumped on a bus from Washington, D.C., to Athens, Georgia—the first destination in a nonstop tour of more than a dozen states … on foot … homeless … fully inflated mania. And now, there was Mount Rushmore.

Election 2000. New York City. Having quit my job as a correspondence control specialist at the Ford Foundation, I quickly spiraled out of manic control, had a "breakthrough," and stopped taking my quetiapine and lithium. The person from whom I had been renting a postage-stamp-sized room in Astoria, Queens, put a bolt on the door so I could not reenter, which led me to call 911, with the result that two police officers showed up and told this individual that he was acting against the law, in that I had been a tenant for more than a year, even if I wasn't on the lease. To no avail. The policemen's walkie-talkies sounded off, and they were off to their next emergency, my landlord kicking me out on to the streets. No longer taking my medication, I took to walking to every emergency department in Manhattan to get a blood test for a blood-borne malady that was coursing through my veins; I wanted a cure, a panacea. I sought intervention about this most important phenomenon.

However, before walking to all these hospitals I walked less than a block away to the United Nations. I felt just like Cary Grant in Alfred Hitchcock's North by Northwest. I passed all the checkpoints and used the desk phone in the lobby to report to the human rights offices possible violations I had been subjected to when in Moscow some nine years earlier. My voice was galloping at full speed, telling the receptionist all about a conspiracy at a diplomatic reception I had organized for the U.S. ambassador, his wife, and a visiting delegation in June 1991, attended by then-Governor Bill Clinton. Once I allowed myself to breathe, she concluded, "It sounds personal."

After my visit to the United Nations, I found myself in the East Village, a particular quarter of which in my technicolor hypervisual mind had been transformed into Monaco. Somehow the Concorde had transported me there. I had a small carrying case with some clothing. At one point, a woman in a leopard-skin outfit overtook me on the sidewalk, which led me promptly to deposit my own leopard-print silk underpants in the nearest trash receptacle, draped on the top of the waste bin like a commemorative flag.

One day, while a homeless tourist in Manhattan, I drifted on to a ferry with a group of mystical, silent "royals" who were headed to Ellis Island and Liberty Island. While on the boat I caught sight of the Grimaldis sailing, all in matching yellow rain jacket. Was it them? Someone from the boat yelled out an obscenity—which I naturally took to be directed at me—signaling me not to disembark at Liberty Island. Once back in Manhattan, I found myself approaching the authorities at Bellevue's emergency department about the panacea for my blood-borne illness. I was grabbed by a group of emergency department staff, who were chanting "Give us the blood, Brian!" And my next adventure under four-point restraint on olanzapine started. Yet another new antipsychotic! So much for the panacea for my royal blood disease.

It's funny how doctors forget to give you the full diagnosis. In January 1995 I received my first diagnosis from a Polish intern in the emergency department at St. Luke's Hospital up near Columbia University, who simply said "bipolar"—not bipolar I or bipolar 2, just "bipolar." It took going to support groups for me to learn that I had bipolar I disorder, the delusional and psychotic type, rather than bipolar II, the hypomanic milder variety—rather like ultra-light cigarettes. Seven hospitalizations and seven years later, a social worker let it slip that I had "severe and persistent bipolar illness." Severe and persistent—it sounded like something from the Weather Channel: "We're expecting a severe and persistent hailstorm with hailstones the size of bipolar boulders throughout most of California today!"

During the spring of 2002, after nine months "on the road," homeless and going in a grand circle around the interior of the United States, I made my way back to New York. Just outside Washington, D.C., I caught a ride all the way to Brooklyn. I was a fright. I didn't have my glasses any longer, having been assaulted in Fort Wayne, Indiana. I was assaulted again in Washington, which left a gash on my forehead, which was stitched at Howard University Hospital. I visited the remains of the World Trade Center and became very emotional, thinking somehow I had caused the destruction. I would go into Barnes & Noble bookstores and see photographs of the events of September 11 and could barely hold back my tears. Without a cell phone, I took to visiting former acquaintances and friends at their homes or at their places of employment.

I was picked up by the police for ringing the doorbell of another person with a mood disorder and taken to St. Luke's Hospital emergency department near the campus of Columbia University and then transferred to Roosevelt Hospital. I was assigned to the unit chief of 7G at Roosevelt, who arranged for me to take haloperidol by court order because I was essentially incapable of caring for myself. Once my mind began to clear of the psychotic and delusional haze that had been hanging over it for so long, I sat down and spoke with my doctor about which antipsychotic might be best. I told her that I had had severe side effects from risperidone, olanzapine, and quetiapine. Was there a new drug? In fact, there was, one called ziprasidone.

Most people are in a hurry to get out of a psychiatric ward. This time around, however, I was pleased to be there for four months. The controlled environment of the ward allowed the medication to take effect and stabilize me. It had been more than a decade since I had felt so well. Moreover, I was not being shoveled out of the hospital into another potentially homeless state. A bed in a "supportive shelter" for people with mental illness who have formerly been homeless was secured for me. My experience in the hospital this time around reinforced my commitment to maintaining my mental health.

For the first time since my first psychotic break in Moscow in 1991, I feel stable. And the key is compliance with my medication regimen—and a sound and trusting relationship with my therapist and psychopharmacologist. I am currently receiving Social Security Disability from the Social Security Administration, and I realize the task at hand is staying stable and remaining outside the hospital. My life now.

Mr. Harvey lives in Mountain View, California. Send correspondence to him at 490 Chiquita Avenue, Apartment 12, Mountain View, California 94041-1797 (e-mail, kinoved@hotmail.com). Jeffrey L. Geller, M.D., M.P.H., is editor of this column.

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