“Lithium carbonate is a white, light, alkaline powder that was first used to dissolve urate crystals in the bloodstreams of rats…You are being prescribed lithium because you have experienced a manic or hypomanic episode.”
— “Lithium: A Patient Information Leaflet”
Not that long ago, I was in the backseat of an autorickshaw in Jaipur, India, hurtling towards a psychiatric practice in the distant neighborhood of Malviya Nagar. I had slept roughly eight hours in five nights and was in a state that’s probably best described as “the perfect stillness resulting from zombified excitement.” Next to me was the avuncular Shyam Ji1 , who was intently focused on a printout he was holding. The printout was badly waterlogged from a flash downpour earlier that morning and contained, among other things, my TSH and creatine levels. Written at the bottom of the printout was: Blood work indicates patient well enough to take lithium. The entire thing was in English for some reason. Shyam Ji knew almost no English. I knew marginally more Hindi. Between the two of us, we were typically able to scrape together conversations in Hindi about the weather and our respective families. Shyam Ji would ask politely detailed questions like “Do your mother and father enjoy living in Chicago, or would they rather move elsewhere?” and I’d respond: “They like it — Chicago. It is a nice and big city.”
The fact that he was pretending to understand what must’ve looked like Runic symbols to him demonstrated his extreme concern for me, and I appreciated it. I wanted to return the gesture but I couldn’t think of how. Any socially intelligible behavior was beyond me. The thing I could do really well was flatten myself against my seat and let my eyes go wide and think some really obtuse thoughts, thirty to sixty per minute. The autorickshaw driver was cutting off motorcycles, trucks, and other rickshaws, puffing up his chest and yelling Kya!?2 when anyone objected. I thought: OK, yes, now here’s someone who’s keeping pace with my mental state.
It was desert-hot, somewhere around 117 degrees. Shyam Ji flipped the printout over and began to stare at the very neat handwriting on the back side. He scratched his forehead with his thumb and I could see that he’d begun sweating off his tilak.3 He’d clearly never seen anything like this: he was the administrative assistant at the Hindi school where I studied, typically deployed to officiate final exams or take students to the Foreigner Regional Registration Office. This was the first time in the history of his job that he was looking at someone’s blood work. The owner of the very neat handwriting had been a Cambridge-educated Specialist in Mental Disease who’d looked barely older than me. When I told her I did not under any circumstances want to leave the country, she smiled, readjusted her glasses, and said: “Come on, of course you don’t. You love India -– it is very good for you to be here, better than home.” Then she’d taken a vial of my blood and referred me to the psychiatrist in Malviya Nagar.
I began to read her handwriting myself — Rebekah Frumkin 24/F History of Disorder; First diagnosis: November 28th, 2013, Patient’s self-reportage of drug use: — then looked away promptly, not because I didn’t want to continue reading, but because I’d seen out of the corner of my eye a peacock sitting on the Rajasthan University gate. “Peacock” was one of the few English words Shyam Ji could generate without help, for reasons that probably had to do with his interest in the goddess Lakshmi4 . Seeing a peacock in India is more fun than seeing a peacock stateside because you get to watch everyone be really nonchalant about a phosphorescent bird that’s just another part of their daily commute. I pointed out the peacock to Shyam Ji and he regarded it with glancing half-interest, saying “peacock” and nodding the encouraging nod adults use for children who are beginning to grasp basic concepts. Then he leaned forward so he was basically speaking in the driver’s ear: “Zyada jaldi5! ” He checked his cell phone, which displayed two missed calls from D.C. We were in trouble with the U.S. Department of State. Or really only I was.
To backtrack, here were the mistakes I’d made so far:
1. Failed to disclose to the DoS, which was paying for me to learn Hindi in India, the fact that I’d received the diagnosis of Bipolar II multiple times and in multiple settings, one of which was in the psychiatric ward of Iowa City’s Mercy Hospital. This information hadn’t seemed relevant at the time.
2. Traveled to India without the lithium prescribed to me for Bipolar II. In fact I’d flushed most of the pills down the toilet a month before I left. I’d done this because lithium made me feel like a thirsty caveperson sprayed with formaldehyde and trapped behind glass. Also I was really committed to not having a problem that needed lithium.
3. Gone out for beers with my friend T and stayed awake until two in the morning on a rooftop bar chain-smoking bidis and making a tenuous pact to stay in India after our course of study. T wanted to do this because she was a scientist and athletically gifted and interested in somehow running across India to study its water supply. I wanted to do this because the person I was in India — or at least the person I was regarded as — was better and saner than the person I was stateside. Our conversation was the tipping point: I’d gotten so worked up about the possibility of expatriation that I stopped sleeping for almost a week afterward, rendering myself unfit to represent the United States on foreign soil.
I had come to India on the following whim: I would like to learn Hindi. When this whim first occurred to me, I was at grad school in Iowa meeting with a fiction student of mine named Miles. We were going to discuss a short story he had written. I was a few months out of the psych ward and starting to sleep two hours a night again. Even though Miles was a nineteen-year-old male, he and I were dressed as each other’s mirror image: beanies, silk-screened sweatshirts (his featured a burrito, mine a Great Pyrenees), black jeans. Miles had written a story from the point of view of the various animals slaughtered in the manufacture of the semi-meat Spam. One of the animals—the one who finally defeats the slaughtering farmer, spoiler alert — was called Jagannath. I asked him how he’d thought of the name.
“Oh, Jagannath?” he asked, trying to play it off. “That’s a Hindi word. It means the Lord of the Universe. It’s where we get the English word ‘juggernaut’ from.”
“OK, OK,” I said, nodding, realizing I knew nothing about what he was saying. “That’s amazing, Miles.”
And it really was amazing. But to be fair, a lot of things were amazing at that point in time.
In a few minutes I was home at my desk, the surface of which was glutted with the following: my laptop (dried peanut butter in the keys), an act of Faust I had to annotate in German by the next morning, a jar of peanut butter (my only food for the past two days), a book claiming to make the reader an expert ESL teacher overnight, a thrice-edited story, a postcard from an Alabamian pen pal I’d forgotten I had, an overdue ER bill, a film of whitish powder that could’ve been one of three types of amphetamine, a bendable Gumby doll, and a plastic traffic cone with the words I HATE MONDAYS printed on the surface. I looked up Jagannath, Lord of the Universe (a Hindu god classically depicted as a giant-eyed wooden stump), then I redoubled my efforts and researched Hindu mythology, which led to a quick-and-dirty introduction to the Hindi writing system (Devanagari). By dawn I’d found out that the DoS ran a program that paid for American graduate students to study “critical languages” abroad: “critical” here meaning something like “the United States will derive economic or intelligence-related benefits from Americans knowing how to speak this language.” Hindi happened to be one such language. By sundown the next day, I’d drafted an application. It goes without saying that I failed the Faust assignment.
This method of living is something I call “dust to the wind,” after the scene in The Big Lebowski where Walter and the Dude try to scatter Donny’s ashes in the Pacific only to suffer some blowback in the facial area. At that point, I was throwing some twenty projects to the wind and doing whatever blew back. India blew back, incredibly. And because of my zealot’s faith in dust to the wind, I became obsessed with going to India. I brushed up on Partition-era history, got some nosebleeds, and took Benadryl to induce sleep. I was the shining model of productivity. Still, there was a toothless hissing at the edge of my psyche that something was really very wrong with this behavior, promising me I’d crash (as I often did) and be exposed as an individual unable to function normally.
I was in India for less than a week when I realized this wasn’t going to happen. In Jaipur there was no context for my weird behavior. I hung out with university students, language professors, and the Sonis, a family of tailors whose vacant rooftop apartment I was renting. I would bring up mental idiosyncrasies on the sly, careful not to mention my personal experience. For almost everyone I spoke to, psychiatric medication was an unheard-of thing. As was the concept of being “unable to function normally.” Changes in mood, no matter how paralyzing, were not regarded as symptoms of a disease that prevented someone from maximizing their utility — instead they were frequent and reparable side effects of being human. In fact, the maximization of one’s utility didn’t seem to be the Big Social Goal at all. My good friend Mumal,6 a psychology student and my lifestyle foil (engaged to my very-much-not-engaged, perennially substance-free to my “I’ve snorted horse tranquilizer,” lover of sherbet), told me point-blank that the psychotherapeutic model was a purely Western importation, as were categories of mental illness like depression, bipolar, and PTSD and the prescription medications used to treat them. I objected that while there were definitely distinct cultural differences at play, mental unease had to be a cross-cultural absolute. To say otherwise would be to risk erasing the experiences of the mentally ill.
She clucked her tongue and gave me her you’re-acting-so-stupid-wow look. “No, no! It’s not what I’m saying here. I mean you people7 think of it differently. Of course you feel a certain awful way sometimes. But you make it into a disease where there is none.”
This was a thrilling prospect. I was in love with it. The kind of head-over-heels love that makes you immune to the effects of Benadryl or Trazodone8 .
You’re right, Mumal, I thought, pacing the Sonis’ roof one night at 4:00am. This is conclusive proof that I’m definitely not brain-sick. All I have to do is stay in India with T forever and I’ll not be bipolar.
That’s almost certainly right, rejoined Chili, the dangerously fat family dog who basically lived on the roof and spoke perfect British English.
Here was the catch-22 as I very dimly saw it: realizing that bipolar may be a social construct was causing me to act like a bipolar person. Acting like a bipolar person at the rate I was acting like a bipolar person would get me sent home from the place that had birthed this tremendous realization. So in order to not get sent home, I would need to head the situation off at the pass and take lithium like a bipolar person. That way I could finish out my study, get a visa, and continue living in India as a non-bipolar person.
Out of what I told myself was my loyalty to India, I fell on my sword and admitted my non-lithiation to school officials. Emails were sent, government bureaucrats were incensed, and a deadline was established: get lithium in my system within thirty-six hours or be returned to U.S. soil. I had recklessly endangered myself in a foreign country. And now it was Shyam Ji’s problem. As the autorickshaw flew over potholes on J.L.N. Marg, I turned to him and surprised myself by being able to speak:
“Mor bahut sundor hain.”
(Peacocks are very beautiful.)
He nodded and looked worried.
“Maaf kijiye,” I said lamely.
(I’m so incredibly sorry.)
“Koi baat nahi.”
(Don’t worry about it.)
The doctor’s office was humid and tightly packed. Most of the occupants wore the cheap saris and kurtas that marked them as dalit, or sub-caste “untouchables.”9 There were two waiting rooms: an ante-waiting room and a main waiting room where patients had formed a line in front of the doctor’s office that was roughly ten people deep. In the ante-waiting room, a skeletal woman sweated and shook in the arms of a man who looked like he could be her father. The man and I made accidental eye contact. I looked away, guessing she was in opium withdrawal. Shyam Ji kept standing up to speak rapid-fire Hindi with a henna-haired clerk in the main waiting room. Their exchanges usually resulted in Shyam Ji returning to his seat dejectedly while the clerk re-shuffled some papers he’d already shuffled. It took a while for me to get it through my shriveled brain that Shyam Ji was trying to make an exception for me. The skeletal woman eventually passed out from exhaustion. By the time we were standing in the doctor’s doorway, the ante-waiting room’s main player was a teenaged autistic boy who screeched and slapped himself in pained response to his mother’s constant questioning.
The doctor’s office was as crowded as both waiting rooms. Shyam Ji and I sat on a urine-smelling couch with four other patients until we were called to approach the desk for a consultation. The doctor greeted me in English; the other patients looked on inquisitively. He read my printout.
“According to this you have bipolar disorder type two,” he said. “You need lithium.”
I said nothing. Shyam Ji smiled at me encouragingly.
“So tell me what’s going on.”
I told him what I’d told the Specialist in Mental Disease: that I couldn’t go home because I realized home made me sick.
“But you are sick here.”
“Right, I know,” I said. “But the — it’s just the thought of going home is what’s gotten me into this situation. I don’t think I’m really bipolar at all, really.”
“You are bipolar no matter where you are,” he said. “Why do you want to stay here? It’s worse for you here.”
“I don’t think so.”
He squinted at me in disbelief. The autistic boy shrieked in the background. A man on the couch behind us began to cry. Shyam Ji said something to the doctor in Hindi that began with “Woh samajti… ”10 The doctor listened, looking at me in silent judgment. Then he sighed, shook his head, and pulled out his prescription pad.
“Delusions,” he muttered, writing out my dosage. “You’ll take this lithium and I think then you’ll see how much you really want to go home.”
I took the prescription from him. Game on, doctor.
1 Honorific used in Hindi and other Indian languages to denote age, level of accomplishment, and authority. Can also be used ironically: viz. “Rebekah Ji.”
3 A mark typically painted on the forehead to represent sectarian affiliation in the Hindu religion.
4 Hindu goddess of love, prosperity, and beauty; wife of Vishnu; often associated with peacocks. Bringer of centeredness and joy to the life of Shyam Ji.
6 The only one of my interlocutors who’d actually heard the clinical term “bipolar” before and knew what it meant.
7 One of my favorite Hindi-to-English malapropisms. In Hindi the second person plural is “aap log,” which literally translates to “you people” – there’s no “you” or “you all.” English speakers are always getting so up in arms about this verbal tic, but I love it.
8 Tranquilizing SSRI for treatment of major depressive disorder; used when Benadryl isn’t cutting it but you don’t want to mess with barbiturates. Sometimes referred to as “traz” or “trazosaurus rex” (the second is my own).
9 Although discrimination based on caste was abolished by the 1955 Protection of Civil Rights Act and plenty of affirmative action programs have since been put into play, dalits remain an oppressed lower class.
10 “She understands…”