The Cost of a Bipolar 1 Diagnosis

I have mental illness(es). I knew this from the age of 15 but back then I assumed it was probably only one, and not a really bad one at that. Now I’m 23 and have recently been diagnosed with bipolar 1. I also have depression and generalized anxiety but I kind of forget about those ones.

You might have some degree of familiarity with bipolar 1 or someone who has it. Maybe you have it yourself, or someone in your family does, or maybe you studied psychology. My only experience with bipolar before my mental shit hit the fan that tries to destroy your life was through Lady Dynamite on Netflix starring Maria Bamford. I’m thankful that I was exposed to this wonderful television program before “the incident” (more on that later).

Since this is a story about how bipolar has affected my finances, I’ll mention that I still use the Netflix account my parents pay for.

There are several types of bipolar. You may have heard of bipolar types 1 and 2. The difference is that in bipolar 1 a person experiences more extreme mania that can even tip over into a florid psychosis. I’ll tell you the end at the beginning and note that what you think is going to happen here is eventually going to happen.

I was a teen on Tumblr when one of the prized discourse topics was whether or not self-diagnosing oneself with a mental illness was bad or not. I was also pretty sure I had depression. I read a lot of personal accounts from people with depression and many of them rang true. However, it wasn’t like I was going to ask my parents for therapy or antidepressants and I don’t think I wanted either of those things.

My college career started off well. Things trended downhill halfway through; slowly at first, then alarmingly fast. Yes, I failed courses and had to repeat them. Yes, that added to my student loan debt. The idea that I should be doing better in school was a huge impetus for me to seek out a psychiatric diagnosis and attendant psychiatric drugs for the first time. It was also an easy way to get some help because I could go to my school’s counseling center and see a therapist and a psychiatrist for free.

Teen-self had been correct and I was diagnosed with depression and generalized anxiety disorder. I was prescribed a few different antidepressants but I didn’t like them. Not because they had awful side effects, but because as far as I could tell, they didn’t do anything. I was lucky that with my parent’s insurance I never paid more than $10 for a bottle of pills.

Also, my college grades weren’t getting any better. I was working while in school, but that proved to be too stressful to keep up consistently. I quit one job because I was failing classes and thought that lightening my responsibility load would turn that around, though I ended up failing for real anyway. I would not work for one semester to try to get a handle on things, then decide to get a job again because I wanted the money (and also needed it). I went to college in a big city and the dorms were sitting on some prime real estate; the boarding costs were a joke. I lived off campus in a reasonable neighborhood and paid my rent with student loans.

This is where the fun begins. I was steered by the college’s counselors towards an outside practicing therapist who also had some type of nurse practitioner license to prescribe medication. I wish I could understand the details of this more but it’s like a really long acronym in their title. (Okay, so I looked through the paperwork, the title is APRN).  I was prescribed a new medication called Venlafaxine, and I remember being told that it was likely to be especially helpful with social anxiety, so I was excited. As with the previous antidepressant experiments, nothing was happening. I would go in for my appointments, report nothing new, and my dosage was increased, eventually to 75mg. Weeks of nothing, nothing, nothing… and then, decidedly, something.

Yes, we’ve arrived at “the incident.” It was during Thanksgiving break of what was supposed to be my final semester of college. Things were really low already but I felt in control in the sense that it was I who was ruining my own life. There was One Day when it flew off the rails. I woke up that morning feeling awful both mentally and physically. I had been sick with some kind of stomach-achey virus and had already used my available sick time so I was going to have to go in to work. I steeled myself for the hour-long commute by train to my job as an in-store grocery shopper for Instacart (yes, the gig economy). I thought the pay was awesome, almost always averaging out to around $15/hr. I could usually use the one hour on the train to psych myself up and be fine with work by the time I got there. This time the feeling I woke up with didn’t go away.

Instacart shoppers use an app to work. I was so frazzled that I couldn’t fully operate my phone’s touch screen. I would press too hard or not hard enough. I knew something was wrong. I had to go hide in the bathroom for 20 minutes. My coworkers asked me if I was ok when they saw my orders weren’t finished on time, but I couldn’t even respond with a full sentence. At this point I legitimately could barely read the words on my screen. We didn’t have anything like a break room, so I crouched down behind our cash register podium before I had enough sense to realize I had to leave and just stood up and walked out of the store and back to the train station. Once I got there I was sobbing uncontrollably. I’m enough of a scary-crier as it is but this was truly next level, and I felt like I had entered the Crying on Public Transportation Hall of Fame.

My emotions were heightened to what felt like 1,000x stronger than anything I had ever felt. I knew I needed to do something to soothe myself, and thankfully it never entered my mind that I should try to hurt myself. I took a notebook out of my bag and started grinding a marker down onto the page in circles as hard as I possibly could over and over. The woman across from me gave me a very concerned but sympathetic look. I got off a few stops early. I was outside a major hospital in the major city I lived in. I considered walking into the emergency room. I decided not to because I didn’t want to go inpatient and I knew that’s what they were going to tell me to do.

I get myself home without incident. I sleep, I breathe, things lighten up a little. It wouldn’t last long. Over the next two or three days, these wildly outsized emotions came over me again and again as I hid out in my bedroom. I can’t remember many of my thoughts, but I remember a physical sensation like all of my skin was on fire. I would stare at letters without being able to comprehend them as words. I knew I had to go to the hospital now for sure. I thought I’d book an Uber but couldn’t get my brain to cooperate in carrying that action out.

I know ambulances are expensive but at this point I don’t know how to get out of my apartment without one. I’ve packed clothes, my toothbrush, and my Venlafaxine in a duffel, and I walk down the apartment building’s steps. It was all I could do to pound 9, 1, and 1 into my phone. When the ambulance pulled up I was so goddamn terrified I crumpled to the ground. It was très dramatique and at the time I thought I must have something like a bleed in my brain.

Finally at an emergency room, I truly lose it, as if I wasn’t lost enough already. I can’t stop pacing in circles. I’m able to call my sister and tell her I’m in the hospital. She asks me if I need my dad to drive 7 hours to come be with me now or if he can leave in the morning. I tell her that he needs to leave right then. They gave me an EKG and an MRI. They made me talk to psychologists who wanted me to go inpatient. I told them I didn’t want to and they didn’t have any reasons to hold me involuntarily. I was discharged. My parents tried to keep most of the financial worry away from my eyes, but I found an explanation of benefits and the total before insurance for that hospital stay was $7,818.

Unfortunately the story’s hardly begun. My dad takes me back to my apartment and I think my dad can watch over me for a few days and surely my brain has to stop racing at some point. We go to the Target nearby to get groceries. I’m still manic and I throw the biggest, fluffiest robe I’ve ever seen into the cart because I’ve Been Traumatized and I Need It. Every joint in my body feels like it’s imploding and my brain thinks my teeth hurt so I put an extra soft bristle toothbrush in the cart too. My dad pays for this stuff.  

I have my dad help me call my school so I can explain I was in the hospital and officially withdraw for the semester. We realize I need to be at home instead of seven hours away in a different city. As soon as I get there things ratchet up again and I sinkingly realize I need to return to the emergency room. I finally got it through my thick skull and this time I let them take me to an inpatient psychiatric hospital. This entails another ambulance ride, and the psych facility is an hour and a half away. I could not possibly be more embarrassed at this point so while I’m on a gurney in the back of the ambulance I sing folk songs to myself to muster some positive spirit, and the EMT drivers say I have a pleasant voice which was sweet but unnecessary because I don’t.

Does the healing begin here in the psych hospital? Not really. This is where I am given a diagnosis of bipolar 1. Shit got weird. I remember being asked to identify a photo of John Mayer and having an abdominal X-ray after being asked by a nurse if it was “possible that I had swallowed a ring.” I suppose I must have claimed to have swallowed jewelry (I did not in fact swallow any jewelry). I could write endlessly about the irrational thoughts I thought, but of course I’m saving it all for my memoirs. My dad would visit me every other day and had to drive three hours round trip from our home to the hospital; his siblings lent him some money. He missed fifteen days of work. Grand total for gas around $250. The final medical bills were around $2,600 when all was said and done. I’m including the two ER visits, two ambulance rides, and inpatient in that total. I was inpatient for 30 days. My dad’s employer health insurance means our family hardly ever has to worry about it. In many ways I won the lottery with a garden variety psychosis and solid SES. In group therapy, other patients talked about homelessness and disability assisted housing.

I can barely believe that it was so cheap to have a brush with a life-shattering event. I abandoned religion long ago, but: there for but the grace of God go I. Right out of the hospital, I felt weird for a month but was soon back to just regular old depressive thoughts. I returned to school immediately. I had tuition insurance that cost something like $250 a semester and I was fully reimbursed for the cost of the previous semester I hadn’t completed. I hated college so I wanted to finish it as soon as possible. I concurrently went back to that same old job at Instacart. I could set my schedule in the Instacart app so it was easy enough to start applying for shifts again. (I promise this post isn’t sponsored by Instacart, and I also don’t work for them anymore.)

I was able to graduate from college in just one semester to make up for the one I didn’t complete. I was eager to get it taken care of because once I didn’t have to worry about college anymore I could let things relax a little. I’m currently working part time but underemployed and being very bad about trying to find the best job I can. My parents are paying my $500/month rent for a year. Before any of this I would’ve hated myself a lot more for this arrangement but having my parents pay my rent is certainly not any more embarrassing than the delusions and completely erratic behavior I had in the hospital. My student loans are now in repayment and I owe a lot. So much that I truly don’t want to say because it doesn’t help my case that I’m still somewhat sound of mind, and because this story isn’t about the quotidian mountains of debt that run underneath the lives of almost everyone in my age cohort. I wrote this heavy on the parts before and during and less on the after because financially things are a mess right now.

It’s been just over a year since I was discharged from inpatient. I now know that wild and scary things are going to pop up in life and they are going to potentially cost a lot of money. It’s really a gift that this happened to me at 22. I was old enough to have a stable sense of self and come out the other side, but young enough that I could rely on my parent’s help and their insurance. I’m a very bad psychiatric patient. I’m not even in therapy or on any meds right now even though it wouldn’t be prohibitively expensive (please do not yell at me, but also please do not be like me). There’s evidence that my psychosis was caused by taking Venlafaxine, but I don’t want to be fooled into thinking it was the only factor. I know I need to have that financial safety net there and a plan in place for recurrence, but I believe in my soul that I’m never going to have a psychotic episode again (famous last words?).

There is no beneficial financial moral to take from this, just that this is a thing that happens to people. I implore you to have empathy for people dealing with mental illness and navigating a healthcare system that comes with monstrous costs. The size of my wound was $2,600 but that’s really just a papercut. A papercut with a $2,600 band-aid.

Anonymous thinks John Mayer is overrated and thanks their former roommates for being kind and not asking too many questions.

Photo by rawpixel on Unsplash.

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