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Key points
- Bipolar illness often involves impulsive journeys.
- At this point in the escalation there may be psychotic delusions.
My intention in writing these posts is to share the experiences that I went through with my son, starting with the first manifestation of his illness and our journey through numerous subsequent episodes. It's also to provide commentary as a parent and psychiatrist on issues that these experiences bring up, such as how the diagnostic process works in mental health, and how to work with treatment providers and medication issues. My hope is that reading this may be helpful for people with mental health issues and also their families and friends.
In one manic episode, my son Bill was convinced that demonic forces had arrived in our city to maraud and murder, that he was the leader of a revolutionary force that had to fight off the invaders, and that he was being monitored by helicopters flying overhead.
In response, he set off in our old Volvo station wagon, throwing the things in back he would need as he moved away to start a new life. The journey ended abruptly, several hundred miles away, when police detained him for behaving erratically. When they approached him, he was parked under a bridge, throwing things out of the back of the car and rambling about the marauding invaders—the demons that he and his forces needed to fend off. The police took him to their station, and after they called me, I drove up with my brother and one of my sons to bring Bill home.
Sudden Journey to Illinois
This frightening episode of psychosis began about two years after Bill was first diagnosed with mental illness. It occurred after he had already manifested psychotic symptoms and been hospitalized and discharged into outpatient care, but it happened at a time when he appeared to be stable. He had just returned after his second year in college at Washington University to live at home, which was located right across the street from the university. He was enrolled in summer school, taking two courses and also working with his friends at the MUNY (the municipal theater association in St Louis), and he decided not to join a trip to Florida with his brothers and me for a long weekend while I attended a work conference. In Bill’s situation, the psychosis came on so quickly that at the point we left town he still seemed perfectly rational.
We had just spent a weekend at the conference hotel by the ocean. With teenagers it’s never entirely smooth sailing, but Bill's brothers had a good time. They played tennis, swam in the pool, or stayed in the room playing video games while I attended the conference. In the evening we went to dinner. They had fun ordering virgin Daquiris and picking out exotic food. We took walks on the beach, feet sinking into the soft sand, our footsteps partially washed away by the time we returned. Driving back to the house from the airport I was in good spirits, anticipating being back home—and was jolted out of them when I saw the smashed flowerpots in our driveway.
We dragged our suitcases into the kitchen and surveyed the damage: things pulled out of cupboards, rice and cat food strewn on the floor, chairs overturned. Within five minutes of our arrival the Illinois state troopers called. “Is this Yvette Sheline?” a woman asked. "We have your son Bill here at the station.” She politely described how they had spotted a car under a highway overpass with a young man throwing things out of the back, in no particular order and for no apparent reason. They had assumed that the behavior was due to drug abuse, but when they approached him, they found no evidence of drugs nor behavior associated with drug use. They took him back to the station, where he readily gave them his home phone number. Waiting on hold, I suddenly noticed a note next to the phone: “’Bye Mom I have gone to seek housing. Back East. I will be in touch when I find a new place to live. Love Bill.”
My dismay spiked as I realized he had gone off the deep end again. Taking off on a sudden trip is highly characteristic of mania. The combination of restlessness and delusions often leads patients to embark on a mission involving sudden travel. My brother Charles agreed to come with me to get Bill, to drive the car back and keep me company. My son Mike agreed to stay behind to watch my brother’s two young children, and my son Tom came along. We set off without time to grab dinner, just hurrying to get Bill before the troopers changed their minds and decided to jail him. They actually had no duty to keep him at the station, where they had to watch him; it would have been easier for them to just let him go.
We talked about Bill on the drive up. Charles had seen him the day before at the zoo, together with Charles’ kids, and said he seemed fine, if very quiet. I speculated that he had already started to get psychotic and was staying mum to not spill out what was roiling inside his head. By now I had learned that he deliberately clammed up when the symptoms of his bipolar illness were returning.
“I’m really worried that Bill isn’t taking his medicine,” I told Charles. “Sometimes when patients go off their medicine and get psychotic, it gets harder to get them stable. Tom, can I count on you to help me talk Bill into taking the medicine?”
When I turned to the backseat I saw that Tom had tears in his eyes. I squeezed his arm, saying, “I know you love Bill. I’m sure we’ll find a way to help him.”
The State Troopers
We arrived at the station after sunset, the sky rapidly darkening. There were nine or ten troopers clustered near the main entrance when we arrived. I talked to the officer who had been at the scene. He described the possessions Bill had thrown out of the car in all directions. They took me inside and brought Bill into the room. He was glaring and assumed a martial arts stance with his feet apart, knees bent and hands in karate chop style. I greeted and hugged him. He passively accepted the embrace, arms by his side, but didn’t return it. I told him that for me to take him back home in the car he would first have to take medicine so I could count on his being calm. I showed him the pills in my hand and said that I had consulted with his doctor about which medicine to take. He shouted that he was not taking any “f---ing pills.” The nearest officer stepped up to him and said, “That’s enough, you heard what she said. You need to take the medicine.” I was so grateful that he understood the situation and was supporting me. With 10 officers surrounding him and 20 eyes watching him, he put the pills in his mouth and the officer handed him a cup of water. I told him that I was going to look under his tongue to make sure that he had swallowed, and that I would be doing that from now on.
Getting Him Home
We still had another 45-minute drive farther north, to where his car was located. Bill was hostile and belligerent, cursing constantly. He was sure that there was a helicopter flying overhead monitoring his movements. I reassured him. “We’re going to keep you safe here in the car—you don’t need to be afraid.” It was a technique I had often used with acutely psychotic patients to help them calm down. Later, he explained that he had been on an important mission, which was the reason the helicopters were monitoring him.
When we got to the car we saw some of his things strewn in the ditch, but the car was filled with more of his belongings. In the ditch were an air purifier, a fan, clothes (including a ski parka), and miscellaneous food items. Bill couldn’t explain—then or later—why he’d discarded these particular items. He later explained that he needed to move away so he could take command of revolutionary forces resisting the invasion, and that he had smashed the flowerpots in our driveway to warn us of the impending disaster.
In the darkness, we gathered up the items we could see. Then Bill, Tom, and I drove in one car and Charles drove Bill’s old car. Bill became increasingly sleepy as the medicine delivered its desired effect—a sufficiently high dose that he was not only calmer, but also sedated. By the time we arrived home three hours later he was asleep so soundly that he was hard to awaken. I pulled on his arm and supported his weight to get him on his feet. Fortunately, he started walking, but he was confused, thinking I had taken him to the hospital. I reassured him that we’d get some sleep and think about that in the morning.
This was my perspective on what happened that evening. His account, which he didn’t write until years later, gave me new insight into how profoundly the psychosis had altered his thinking and perceptions—and his version shows how frightening psychosis is because it is so alien to day-to-day reality.
