What follows is drawn from a journal I wrote in early February 2020, shortly after my first psychiatric hospitalization.
The wave had been building for eighteen months. Not cresting, not breaking — just climbing, the way waves do in open water where there is no shore to measure against. An episode of mania that smoldered so lightly at first he did not realize there was a fire starting. The sun got sunnier. He got more talkative. He told his mother he was the happiest he had ever been. These are the kinds of statements that, in retrospect, function as evidence rather than updates.
Six months in, the paranoia arrived. Twelve months in, the behavior became risky and uncharacteristic — the particular recklessness of a mind that has convinced itself it is finally operating at capacity. He slept less. Seven hours, then six, then five, eventually four. The energy did not diminish with the sleep; it compounded, interest on a debt no one had agreed to take on. He burned it at the gym. He burned it in conversations that lasted too long and went too far. He burned it in every direction except the one that might have helped, which was to mention to literally anyone that something was wrong.
He did not know something was wrong. This is the particular cruelty of mania — it does not feel like illness. It feels like arrival.
And then, eighteen months after the smolder began, the wave crested and broke, and Alex found himself in an emergency room in St. Paul with his mind in pieces on the floor.
He remembers the overnight stay in snippets. The smell of lavender — aromatherapy, he thinks, placed on his hospital clothing, though the scent lingered long after the source should have faded. Two different rooms. Racing thoughts. The screams of other patients. Getting up at various times to use the restroom, the particular aimlessness of a body that does not know what to do with itself while the mind is coming apart.
The social worker arrived in the early morning. She slid the glass door open, walked in, and began the structured questions that Alex would later recognize as a clinical assessment tool — each one stepping up from the last, a staircase built toward the question that mattered. How are you, Alex? More questions. Are you having thoughts of suicide? Yes. Do you have a plan?
He started to cry. His mind was racing, pulling him back out into the dark water of the break. Between bursts of crying, staring directly into her eyes, not looking away, he told her. Of course he had a plan. He is an engineer, after all. Two electrical cords behind the television. A hospital light apparatus on the ceiling that he believed would hold his weight. He motioned to both while maintaining eye contact, describing the load-bearing capacity of institutional fixtures with the specificity of someone presenting project specifications.
In a blink, or a skip of his memory, he was in a different room. More secure. No cords, no ceiling fixtures. Recessed lights that never turned off. A camera pointed at the bed.
They gave him Haldol. As the antipsychotic flooded his brain and slowed the machinery to a crawl, all he saw was blackness. He did not know if he was asleep or awake, or if perhaps he had succeeded. Out of the murky dark, the word appeared: Haldol. Three-dimensional, rotating on an imaginary axis, the letters pivoting in the void like a logo in a 1990’s screensaver no one had designed. Someone was saying the word to him, or he was saying the word to himself and hearing it echo back. Haldol. It dipped into the blackness and reappeared. Haldol. It twisted and rotated. Haldol. A single word, fully formed, spinning in the dark — the mind narrating its own sedation, labeling the thing that was shutting it down. Then the void won, and everything faded.
The ambulance was bumpy. Alex dozed off and on while the driver listened to the radio. In the moments he was awake, he watched the highway roll out behind through the rear windows — treeless expanses, twists in the road, exits and on-ramps stitching one highway to the next. Grey, overcast, with small wisps of snow swirling in the ambulance’s wake. The distance between St. Paul and New Ulm is roughly a hundred miles, most of it the flat, stubborn geography of southern Minnesota doing its best impression of itself.
The paramedic who rode beside him was a young woman, full-figured, with a small piercing in her nose. He does not remember a single word of their conversation, which means either they did not speak or the Haldol had rendered his memory selective. The driver, in a voice loud enough to carry through the entire vehicle, announced their arrival.
It was cold outside, and the ambulance would not fit in the garage, so they wheeled him in from the open air. He stepped off the gurney. He was patted down. A metal detector was waved over his body — the same deliberate sweep as an airport, but with a more specific list of contraband. He is a cutter, after all.
How he got to the fourth floor is one of the details the day had already eaten. Elevator on the gurney, or on foot? Gone. He was walked back into the mental health unit, and shown to his room.
Room 428. Bed 2.
This is where Alex becomes I. Because what happens inside the ward belongs to a different kind of telling, and the distance of a name is no longer enough to hold it.
In bed 1 of room 428, a short, red-haired man was sound asleep. His daily goals sheet, taped to the wall, said his name was Gary. He was snoring with the full commitment of someone who had made peace with the noise he produced, and he punctuated the snoring with flatulence at intervals of roughly two minutes, a metronome of bodily function that would become the soundtrack of my nights. My heart was racing. I swallowed the lump in my throat each time I swallowed. The antipsychotic from earlier in the day had worn off, and I was vibrating with an anxiety that had no edges, no boundaries — just a generalized hum of wrongness that saturated everything it touched.
I do not remember the intake coordinator. I must have met with someone — the days that followed made that clear — but the meeting itself is gone, filed in whatever cabinet my brain had designated for things that happened while it was on fire.
Melissa arrived when dinner was arriving. We talked. I do not recall what we talked about. I ate a turkey sandwich, which was notable because it was the first bit of meat I had consumed in months as I had decided that I was a vegan. I knew, as I ate it, that it was going to do a number on my stomach. I ate it anyway. There are hierarchies of concern, and gastrointestinal distress does not rank when you have been ambulanced to a psychiatric ward in a town you have never lived in.
Walking up and down the hallway — I would later learn his name was Marcus. Marcus was a large young man, well over three hundred pounds, nearly twenty-one years old, with a southern twang in his voice that seemed geographically improbable for southern Minnesota. He kept getting excited about tacos. “Is it taco Tuesday?” he yelled to no one in particular. “I know it ain’t Tuesday, but I sure as fuck got me some tacos for dinner.” He took his tray from the meal cart and settled into the group room, where hae continued to expound upon his love of tacos with the fervor of a man who had finally found a subject worthy of his passion.
Another patient, Tyler, took his tray and sheepishly followed Marcus. Tyler was still in high school. He was a rosy-faced kid with big ears and a flat backside to his head, and he had a slight speech impediment. He followed Marcus the way smaller objects orbit larger ones — not out of friendship, exactly, but out of gravitational pull, the quiet math of mass and proximity.
Gary got up to collect his dinner. Standing, he looked like an anthropomorphic troll doll — the red hair, the stout frame, a face that seemed designed for a different scale. He wore a ring on his left hand, a tattoo visible on his upper arm. Except for the long hair, he struck me as the kind of drifter who would have been at home with Steinbeck characters during the Dust Bowl, the kind of man interested primarily in locating a hot meal and a bed for the night. He had found both in the mental health unit.
I talked a bit more with Melissa. Visiting hours were closing, and she and her sister, who had been waiting in the lobby, had over a two-hour drive back to St. Paul. I said good night and cried until there was nothing left. I was scared. The particular fear of a psychiatric ward is not the fear of the place itself — it is the fear of being a person who belongs there. Of having crossed a line you did not know existed until you were on the other side of it, watching your wife walk away toward a parking lot and a life you are no longer certain is yours.
Later in the evening, I met with an intake doctor to discuss my medications. He was an affable fellow in his late fifties, wearing scrubs, balding on top, clean-shaven. There was a pattern of questions emerging — every person I spoke with asked the same ones, and everyone was obviously comparing notes, assembling a portrait of me from overlapping sketches. I had mentioned to a nurse at some point that I worked in renewable energy. The intake doctor made a joke about wind turbines producing huge amounts of radiation — a clear jab at a certain president’s claims about wind energy. I appreciated the effort. Humor from medical staff in psychiatric units occupies a particular register: careful, calibrated, designed to make you feel like a person having a conversation rather than a patient being processed.
With medications settled, I wandered back to my room. I had not cleaned up since early the prior morning. My skin was greasy and my teeth were scaly. I asked about taking a shower and was walked down to one of two shower rooms. I picked the smaller one, which also contained a toilet and a sink. I made a mental note: maybe there is only one toilet. I peed, and there was what appeared to be blood in my urine. Or I was imagining it. The line between observation and hallucination had become unreliable, and I did not have the energy to determine which side of it I was standing on.
I showered. I brushed my teeth. I put on clean scrubs and went to bed. Gary was snoring. I did not sleep well.
Early in the morning, Nate and Chris were walking up and down the hallway, loudly chatting about music. “Dude, you gotta hear Sublime,” Chris was saying. “Brad Nowell, man, he’s got some great stuff.” He then proceeded to sing lines from “Save a Horse, Ride a Cowboy,” which is not a Sublime song. Nate nodded in agreement. They seemed to be having entirely separate conversations while existing in a state of total consensus. I noticed that each of them had single rooms, no roommates. I wondered if this was intentional.
The morning brought oatmeal and decaffeinated coffee. My head was a bit clearer — not clear, but clearer, the difference between a whiteout and a heavy fog. A nurse mentioned there would be a group activity. I decided to join.
Large windows looked out over the hospital’s helipad. It was grey outside, a light snow falling, flakes flicking in the wind. I took a seat at the table in a corner, facing the door with my back to the windows — the particular seating choice of someone whose brain was monitoring all entry points. Gary sat at the opposite corner. Marcus sat next to him. Tyler sat to Marcus’s right. Sandra, whom I had not met yet, sat next to Tyler. Sandra was a woman in her mid-thirties with a sorrowful expression and eyes bloodshot from crying. I recognized the look of depression on her face the way you recognize a dialect — not the specific words, but the shape of the mouth forming them. Others took seats around the table. Eight of us in total.
The group activity, led by a social worker, was to randomly draw a slip of paper from a cup, read it aloud, and respond. The questions were innocuous — designed to get people talking without asking them to talk about anything that mattered. I drew: “Talk about the first time you went to a circus, amusement park, or carnival.”
I talked about the Shriners’ Circus, which came to my hometown every couple of years when I was a kid. Northern Minnesota, in the 1980s. This was my first circus experience. Around the table, others mentioned county fairs, or the amusement park Valley Fair. When it came to Marcus, he said the Shriners’ Circus — because his grandfather had been a clown. He described the clown car, how he got to ride through Clown Alley, his voice animated with the particular wonder of a story told many times, each telling adding a layer of polish.
I could not decide if Marcus was riffing off my description — hearing “Shriners’ Circus” and constructing a grandfather to populate it — or if he truly had ridden in a clown car down Clown Alley. It did not matter. The exercise was designed to get us out of our shells, even slightly, and in that regard a fictional grandfather in greasepaint served the same purpose as a real one.
Lunch arrived and was uneventful, except for Marcus, who talked about this and that with the volume and confidence of a man unburdened by self-consciousness. He mentioned he had been married at the age of fifteen. “It’s the law of the gypsies,” he said, by way of explanation. Tyler nodded along. Nate and Chris walked the hallway, still in apparent agreement about everything, still seemingly discussing different subjects.
After the group, Sandra cornered me in the doorway. “What are you here for?” she asked. She studied me for a moment. “You’re a cutter, aren’t you.” It was not a question. I nodded and pulled my left sleeve up on my New Ulm Medical Center sweatshirt to show her the latest work. She showed me a scar on the back of her hand. “I’m a cutter, too.” There is a look that cutters recognize in each other — the particular way the eyes check the wrists and forearms of a new acquaintance, the scan that happens before the conversation does. She had scanned me, and I had not even noticed.
I walked back to my room to meditate. I had not found a clock yet, but we had not had lunch when I left for the group, and now we had, so some amount of time was passing. It looked grey and cold outside. This was the rhythm of the ward: meals arriving, hallway walking, group sessions, the grey view of the helipad through large windows. And between all of it, long stretches of nothing — time spent sitting with the particular silence of a place designed to hold people whose minds had turned against them. Somewhere, the single toilet was not flushing properly. Someone was always struggling with it, the handle pressed and released without result, the particular frustration of a bodily need meeting mechanical resistance.
In the evening, a nurse stopped at my room. “The psychiatrist will see you now.”
I walked to her office. I had spoken with her earlier in the day, briefly, over the phone — she had been home with a sick child, calling in to the social worker who held the receiver near my ear. The call had been short. Now she was here, and the conversation would not be.
We talked about the suicidal ideation. The cutting. I teared up. It is a specific kind of difficulty, handing the worst parts of yourself to a stranger who is taking notes. She mentioned she had read my intake file and the notes the staff had been comparing all day, the composite portrait they had assembled from their overlapping questions.
Then she asked the question that would reorganize the architecture of my entire life.
“Has anyone ever told you that you are bipolar?”
No one had. But over the years, I had had inklings and hunches — the kind of quiet suspicions that live in the back of your mind and never quite manage to become action. They surfaced now, all of them, all at once. The last eighteen months rearranged themselves in my head like puzzle pieces snapping into a frame I had not known existed. The climbing energy. The paranoia. The sleeplessness. The risky behavior. The conviction that everything was finally going well. These were not personality traits or character flaws or the natural consequences of a stressful life. They were symptoms. They had a name.
It explained more than the recent episode. It reached backward through years — the mood spikes and drops, the tendencies I had during my undergraduate years in Duluth, the periods of inexplicable energy followed by periods of inexplicable flatness. An entire history, suddenly legible, like a document translated from a language I had been reading in the wrong direction.
We talked more. She recommended an antidepressant to start with; I would take my first dose in the morning. It turned out she was originally from the Iron Range, too — that stretch of northern Minnesota that produces iron ore and a certain kind of person, and that holds onto both long after the mines have closed. We talked about how the Range is a strange place to return to once you have been gone for a while, the particular dissonance of being from a place that shaped you entirely and that you no longer entirely recognize. It was a small connection, but in a psychiatrist’s office on a locked ward, small connections carry weight disproportionate to their size.
I walked back to my room and kept rolling the word around in my head. Bipolar. I turned it over the way you turn a stone found on a beach — examining its weight, its texture, its implications. It was a triage diagnosis — the first pass, the best fit for what she could see from an intake file and a single conversation on a locked ward. It would later be refined and clarified to schizoaffective disorder, a diagnosis that better matched the full constellation of symptoms, but that distinction was years away. What mattered that evening was the word itself, and the way it made the chaos comprehensible. Not fixed. Not resolved. Just named.
My immediate task was getting well enough to leave. I set my goal: home by Friday. Even in crisis, the engineer needed a timeline, a deliverable, a definition of done. I am bipolar. I did not know what exactly that meant. But I knew what Friday was, and I knew where home was, and for the moment, two fixed points were enough to navigate by.
Night in the ward. Gary snoring in bed 1, the flatulence continuing on schedule. Clean scrubs. Teeth brushed. The recessed lights in the hallway casting their permanent glow under the door, because the lights in a psychiatric ward never fully go out — someone is always watching, which is both the comfort and the confinement of a place like this.
The word sat in my mind the way knowledge arrives in certain dreams — fully formed, without origin, as true as gravity. Bipolar. It was not a resolution. It was not an ending, or a beginning in the way that stories use beginnings — bright, promising, angled toward the future. It was a beginning the way maintenance is a beginning: the first day of a long negotiation with a thing that will not be cured, only managed. The first day of understanding that the mind you have been living in has a name for what it does, and that the name does not fix it, but it makes the work of carrying it slightly less like stumbling in the dark.
The ward held its silence. The helipad sat empty outside the windows. Somewhere down the hallway, someone was struggling with the toilet again. Somewhere on a highway between New Ulm and St. Paul, Melissa was driving through the Minnesota night, back toward a home I had set a goal to return to by Friday.
I waited.
Quiet Mind, Loud Brain 
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