I noticed it on Saturday. A small thing, a comment someone had made to me in a parking lot a week earlier, the kind of remark a person forgets the same day it happens, had been replaying in my head four or five times that morning. And probably four or five times the morning before. I had not, until Saturday, noticed myself doing it.
This is the state I have learned to call squirrelly. The thoughts are not depressed. They are not manic. They are not the planning thoughts that precede self-harm, which have a different shape and a different smell. They are squirrelly. Faster than they should be. Jumping from one thing to another without invitation. Lingering on a particular thing, a conversation or a face or a piece of news, for too long, then lurching to the next without the orderly transitions that an unaffected mind uses to move between subjects.
I call the state squirrelly because of the grey squirrels in the yard. I have watched them long enough to have a sense of how they move. The grey squirrel does not move in a line. It moves in jumps. It commits fully to one place, then commits fully to another, then commits fully to a third. The branches it lands on are not chosen with any visible deliberation. The motion is propulsive and discontinuous and there is no transition between the destinations. The squirrel is on the porch railing and then the squirrel is on the maple and then the squirrel is on the ground and then the squirrel is on the maple again, and the path between these positions is not really a path. It is a sequence of arrivals.
My thoughts, when I am squirrelly, do the same thing. There is a thought and then there is another thought and then there is a third thought and the third thought is connected to the first by no mechanism I can name. I am not following anything. I am arriving at things, in sequence, propulsively. The state has the energy of a thing in motion, but the motion is not directed. The motion is the point. The squirrel does not need to be anywhere. It needs to be moving.
Sometimes the squirrelly state runs the other way, into an unnatural focus on a single thing or person. The same squirrel that jumps from branch to branch in spring is the squirrel that caches nuts in autumn, returning obsessively to the same patch of ground, planning and strategizing and burying, single-minded in a way that looks nothing like the spring jumping. The squirrel does not know it is hoarding; it only knows the nut and the ground and the next nut and the next patch of ground.
Either way, the state is squirrelly. Flicking or caching, it is the same brain in different postures, and I have learned, over time, to read both as the same kind of signal: a tell that something has shifted and that the day will need watching.
The clinical literature has a name for it. They call it the *relapse signature*: a pattern of subtle, idiosyncratic shifts that precede an exacerbation of a psychotic-spectrum condition. Max Birchwood and colleagues at Birmingham first published on it in 1989, in a paper that set up a monitoring system asking patients and their families to track small changes in mood and sleep and perception in the weeks before a relapse.1 The paper’s core finding has held up in the decades since: exacerbations are rarely sudden. They are preceded by small, person-specific changes that the person can learn, over time, to read. Not everyone learns. The reading is a skill, and the skill takes practice.
What the literature does not say, because the literature is written by professionals who have to use professional words, is that the signature is also a thing you can name yourself. The research found me later. It told me, in formal language, that what I had been doing privately for years had a name and a literature and a place in a body of professional knowledge. The research did not invent the practice. The research described what the practice looks like from the outside.
Here is the part of this essay I want to land carefully, because it cuts against the way most people understand mental health.
A schizoaffective brain that is being managed well is not a schizoaffective brain in which nothing is happening. It is a schizoaffective brain in which the things that are happening are getting noticed, named, and responded to before they grow into the thing the medication is trying to prevent. The squirrelly state is not evidence that the management is failing. The squirrelly state is evidence that the management is working. The alarm is firing. The detector is doing what the detector was installed to do.
The smoke detector going off in the kitchen does not mean the house is on fire. It usually means someone was cooking, and the detector did the job a smoke detector is supposed to do, which is to draw attention to a thing that might or might not turn out to be serious. A house in which the smoke detector never goes off is not a house that has been protected from fire. It is a house in which either nothing is ever cooked or the detector has been removed. Neither of those is a healthier state than a house in which the detector goes off, gets silenced, and is reset.
I had this understanding wrong for a long time. I believed, without ever articulating the belief to myself, that being well-managed meant feeling nothing unusual. That stability meant the absence of any blip. That if I had a squirrelly day, the management had broken. The truth, which arrived slowly and against my preferences, is the opposite. The blips are the system functioning. The squirrelly days are the smoke detector earning its keep. Stability is not stillness. Stability is the working loop of detect and respond.
When I am squirrelly the protocol is short. I take an extra Seroquel. Seroquel is, in the toolkit of an antipsychotic, something between a watchmaker’s screwdriver and a sledgehammer, and what I use it for in the squirrelly state is closer to the sledgehammer. I do not need a fine adjustment. I need the noise turned down a notch or two so that the jumping settles into something more like a walk. The drug does this reliably. It is not gentle. It is effective. The trade-off is that I am foggier the next morning than I would otherwise be. The fogginess is a fair price.
The other half of the protocol, the half that is easier to forget and that I have come to think is at least as important as the medication, is to tell someone. Melissa, usually. The therapist on the day I see her. The psychiatrist if it has gone on long enough to mention. The point of telling is not that anyone needs to do anything about it. The point of telling is that the state, named out loud, becomes a thing other people in my life can see. They can adjust the rhythm of the evening. They can ask, in the morning, how I slept. They can notice if the squirrelly hours stretch into a squirrelly day and the squirrelly day stretches into a squirrelly week, which is the point at which the system is no longer self-correcting and the people around me are the next layer of defense.
I do not feel virtuous when I report the state. I do not feel that I am taking responsibility for anything. I am just doing the thing the protocol calls for. The protocol is the management. The reporting is the protocol. The state, named out loud to a person who knows how to hear it, is half of what makes the management work.
The squirrelly state surfaces a few times a month. It lasts a few hours to a few days. Spring is slightly more active than other seasons, but the correlation is loose. I cannot predict the days. I cannot read the antecedents. I have tried to map the triggers and the mapping has not been useful, which is part of the lesson. The state is not caused by anything I can control. The state is a property of the brain I have. The brain produces the state on its own schedule and according to its own logic, and I do not get to know in advance when it will produce it.
This used to bother me. I wanted a model. I wanted to know which night out, which week of poor sleep, which season change would produce the next episode. I wanted the predictability that a person trying to manage a condition wants, the predictability that would let me preempt the episode and prevent the alarm from firing in the first place.
I do not have that predictability and I am not going to. The alarm fires when it fires. My job is not to prevent the firing. My job is to hear it. My job is to recognize the squirrelly state when it begins, name it, take the extra pill, tell my wife, and ride out the few hours or few days the state usually lasts. The job is not to be the kind of person whose alarm never fires. The job is to be the kind of person who hears the alarm, every time, and responds.
There is a grey squirrel on the walnut tree in our yard right now. It does not know it is a metaphor. It jumps to the pin cherry tree. It jumps from the pin cherry tree to the cedar tree and back to the walnut tree. It moves the way it moves. The day will end. The squirrel will go wherever squirrels go.
I will take an extra Seroquel if I need to. I will tell Melissa if the state is still in me at dinner. The alarm will quiet. The thoughts will settle back into something more like walking and less like jumping. The detector will reset. The house will be a house again. Nothing will have broken. Something will have worked.
- Birchwood et al., “Predicting relapse in schizophrenia: the development and implementation of an early signs monitoring system using patients and families as observers,” *Psychological Medicine* 19(3), 1989. https://doi.org/10.1017/S0033291700024247 ↩︎
Quiet Mind, Loud Brain 
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