Alex and the Adjustment Age

Alex is a mild-mannered, middle-aged man with hobbies like taking a walk, making responsible plans, and maintaining a complex, evolving relationship with reality.

He has schizoaffective disorder; imagine schizophrenia and bipolar disorder being best friends. Alex also has a psychiatrist, which matters because otherwise this would sound like he’s free-handing his brain chemistry the way some guys freehand home wiring: confidently, incorrectly, and right before something starts smoking.

With his doctor’s blessing, Alex is constantly tinkering with his psych meds routine. Adjusting timing. Tweaking dosage. Tracking side effects. Watching patterns. Waiting. Repeating. It’s not chaotic—though it can look that way from the outside. It’s more like home maintenance, except the house is your nervous system and the pipes are thoughts.

People who don’t take psychiatric meds tend to imagine the process as dignified and linear. You go in, you describe what’s happening, the doctor nods, you leave with a prescription, and suddenly you’re jogging through a sunlit park wearing clean athleisure and the ability to enjoy a salad.

For Alex, it’s more like tuning an old furnace in a basement where the light switch controls an outlet in an entirely different room. You make a careful adjustment and then you wait to see if the clanging stops—or if it starts clanging in a new and more inventive way.

Because schizoaffective disorder, like schizophrenia, isn’t a single problem you “fix.” It’s a set of experiences you learn to manage, and management is rarely cinematic. It’s mostly scheduling. Sleep. Stress reduction. Not skipping meals. Not overinterpreting coincidences. It’s the grown-up version of putting a hand on the radiator and going, “Is it supposed to do that?”

Sometimes Alex’s brain will offer him a thought with the confidence of a man in a reflective vest holding a clipboard.

The thought will be wrong.

But it will be delivered like it’s urgent, official information from the city.

Alex has gotten good at responding the way you respond to any confident nonsense: politely, with boundaries.

“Thanks,” he tells the clipboard man. “We’re not making major changes based on one anonymous tip. Please submit your concerns during regular business hours.”

That’s one of the gifts of medication when it works: not silence, not perfection, but distance. The volume gets turned down. The “emergency broadcasts” come less often. Reality becomes less… drafty. The doors in his mind close more cleanly instead of swinging open every time the wind changes.

And of course, like any repair that actually helps, there are trade-offs.

There are side effects. There is fatigue. There is the occasional emotional flattening, like someone installed new carpet over your feelings and now everything is quieter but also slightly harder to vacuum. And then there’s the one Alex jokes about because if he doesn’t joke about it, he’ll just stand in the kitchen staring into the fridge like it’s a philosophical problem.

Weight gain.

Alex used to be thin.

Not “movie montage thin.” Just “people assume you jog” thin. The kind of thin strangers describe as “lucky,” as if your body is a raffle prize you win for being morally pure and never owning a comfortable chair.

Then he found a medication routine that helped him stay stable.

And now he is no longer thin.

Now he is… structurally sound.

He is “well-insulated.”

He is “built to code.”

He is “sponsored by appetite.”

He looks in the mirror sometimes and thinks: I appear to be a man who plans to be alive next month.

It’s a dark joke, but it’s also an honest one. The grief of schizoaffective isn’t just the scary moments. It’s the constant negotiation with your own mind, and the strange nostalgia for earlier versions of yourself—even the versions that weren’t doing well.

Alex misses being thin the way you miss anything that belonged to a past chapter. It’s not that the past was better. It’s that the past was familiar. The past had fewer pill bottles.

Now he carries all of his medications in original bottles when traveling. He has alarms. He has an “in case I forgot” system that sits beside the main system like a spare key hidden in the fake rock of adulthood.

He’s developed the solemn little rituals of maintenance. Check the day. Confirm the dose. Confirm that time is, in fact, moving forward in a straight line and not doing that weird thing where it feels like it’s looping for symbolic reasons.

When you’re doing well, this routine can feel ridiculous. When you’re not doing well, it feels sacred.

The adjusting never really stops because life never really stops. Stress changes. Sleep changes. Work changes. The world changes. Someone sends an email with the subject line “Quick Question,” and Alex’s nervous system reacts like it just heard a floorboard creak at 2:00 a.m.

So he goes back to his psychiatrist. He reports what he’s noticing. Together they make a plan. They adjust. They wait. They track.

Waiting is the fun part, in the way waiting for a leak to reveal itself is fun. Because with psych meds, you don’t always know right away what a change means. Sometimes you feel better and assume the adjustment worked, when actually you just had a good week because you slept eight hours and nobody made you talk on speakerphone.

Sometimes you feel worse and assume you’ve ruined everything, when actually you’re just experiencing a perfectly normal human phenomenon called Tuesday.

So Alex learns to aim for functional instead of perfect. “Normal” is vague. Functional is measurable.

Functional is:

• going to the grocery store without his brain narrating the trip like a thriller,
• having a conversation without doing secret calculations about whether the other person is real or metaphorical,
• falling asleep without his thoughts turning into an emergency city council meeting.

Functional is also, frankly, remembering to eat something that isn’t a handful of cereal eaten over the sink at midnight because the meds made him hungry in a very specific, unromantic way.

The least glamorous part is how boring it all is. People like their mental illness stories dramatic and mystical. Alex’s version is mostly practical. It’s refill requests. It’s making sure he doesn’t run out because he assumed the pharmacy would “just handle it,” like the pharmacy is his mother and not a place staffed by exhausted humans with a fax machine from 1997.

It’s noticing early warning signs and treating them like weather: not moral, just information.

If his thoughts start getting sticky—if coincidences feel meaningful in that ominous, electrically charged way—he doesn’t scold himself. He doesn’t panic. He doesn’t try to power through on vibes. He says, “Noted.”, and talks it over with his wife.

Then he does the boring things: tighten routine, reduce stress, talk to his doctor, tell a trusted person, protect sleep. The mental equivalent of turning off the water at the main before you start ripping out drywall.

And on good days—on the days when his mind is quiet enough to hear himself think—Alex almost forgets how much work it takes to keep the place running.

Then he’ll be standing there, flipping open the mental organizer, choosing stability one compartment at a time, and he’ll remember: this is maintenance. This is what he does instead of pretending he doesn’t need upkeep.

He’d love it if staying well didn’t come with weight gain. He’d love it if he could be stable and effortlessly thin, like a man in a tasteful commercial laughing in a sunlit kitchen while eating a single almond and feeling emotionally fulfilled by it.

But if the choice is “thin” or “here,” Alex will take “here.”

Even if “here” comes with a little extra Alex.

Because in the end, he’s not trying to be flawless.

He’s trying to be inhabitable.