"Here's the choice: you can have your mental health or your physical health. But not both." The doctor didn't actually say that, but that was the subtext. When you're bipolar, faced with the complexities of today's medications, it's a conundrum you face all too often.

Last Thursday night, completely out of the blue, my body decided to revolt. It wouldn't obey my stern command to lie in bed quietly and fall asleep. Instead, I started twitching all over. My knees jerked, my back spasmed, my muscles wouldn’t stop fidgeting. I kept trying to find a comfortable position, but the minute I thought I'd found one, some part of me complained. So I got up, stretched and walked around. The discomfort let up for a second, then returned. I had to keep moving in search of relief. 

You know that special torture when you're strapped into a tiny airline seat, miles above an endless ocean, and all you want to do is move? That's how it felt – like I was on a fourteen-hour flight somewhere, consigned to the purgatory of coach, desperately trying not to panic. Except there was no airplane: I was trapped inside my own body.

This lasted all night, and when it showed no signs of dissipating I left an urgent message for my psychopharmacologist at daybreak. I knew it had to be my drugs. Whenever something truly bizarre goes wrong, it's always the fault of the drugs. Like the time I started lactating in the middle of a jury trial, milk flowing copiously out of my breasts. I wasn't pregnant, I hadn't given birth, but I was on a psychotropic drug for which lactation was a rare side effect. I specialize in rare side effects, it seems:  odd rashes and extreme photosensitivity and eyelash loss. I'm not a stranger to the garden-variety problems, either: fatigue, weight gain, acne, tremors, insomnia, blurred vision – you name it, I’ve been there and done that. 

Why, you might wonder, do I persist in taking drugs that have such harmful consequences for my body? Because my mind needs the leash: when it’s left to run free, it’s capable of horrible things. If I’m depressed, I’m acutely suicidal. If I’m manic, I don’t give a damn for convention, the law, or the subtleties of friendship: I ruin whatever I touch.

I don’t take medication lightly or blindly. I work very hard in therapy, and I've tried lots of alternative healing techniques: meditation, mindfulness, yoga, hypnosis, etc. But nothing has ever helped me like the drugs. When they work, they truly are magic. Sometimes, it seems, black magic.

By the time my doctor called me back, I’d worked myself up into a tizzy and had difficulty understanding what he was trying to say.

“It sounds like akathisia,” he said.

“Aka what?”

“Akathisia. It’s a painful, sometimes excruciating inner restlessness, usually caused by the atypical anti-psychotics. I can give you something now for the symptoms, but we may have to cut your dose way down or wean you off them altogether.”

That frightened me more than the pain itself. Atypical anti-psychotics – the latest generation of psychotropic drugs – are the mainstay of my medication cocktail. They’ve made all the difference to my recovery, and I couldn’t imagine life without them. I told my doctor just that.

“Sometimes you have to make a choice,” he said, and there it was: that awful subtext. Which would I choose, my mind or my body? 

Suddenly I felt furious. I knew I had to hang up the phone or my fury would shoot straight through the line and spew out all over my doctor. After all, it wasn’t his fault (although that didn’t stop me from being irrationally angry with him). But whose fault was it – God’s? Fate’s? What loathsome, gruesome act had I ever committed, to be placed in such an untenable position? 

It wasn’t fair, and unfairness is a dangerous emotional trigger for me. The more I contemplate the injustice of the world, the closer depression edges to me, until it seeps into my psyche and the sunlight completely disappears.

So I decided, ultimately, to stay on the drugs. I knew I would. Physical discomfort may be terrible, but mental torment is unendurable. The body at least has its boundaries; but psychic suffering knows no limits. I chose my mind, but in truth, I really had no choice. 

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