On my chest, over my right pectoral, I have a tattoo. It isn’t a ribbon for recovery. It isn’t a semicolon, though I have a few of those in other places. It’s the pagan symbol of Mephistopheles: the seal of the party on the other side of Faust’s deal. Faust signed in his own blood. The sigil belonged to the one who collected.
I have other tattoos from the schizoaffective years, the dates when I was discharged from the hospital, a night sky covering my shoulder. Over the left pectoral, the heart side, there is a second seal: Caim, a president of hell who appears first as a blackbird and who grants, among his offices, the understanding of voices that do not come in words, the speech of birds and cattle and running water and dogs. I have lived with dogs my entire life. You can guess which office I was buying. But it is the seal on the right that tells the truth of what happened. I didn’t beat anything. I signed something.
The act of signing doesn’t feel like signing, at the time. It sounds like a prescribing conversation. They explain what the condition is like using dry, clinical language. They say that the medications will cap the high episodes and establish a floor to protect you from the lows. They say that the medications might lead to weight gain and increased blood pressure. They don’t tell you, mostly because they cannot, what it all means.
The deal with the devil, as I learned through experience, included fifty pounds of more me and a blood pressure medication. Those losses are the ones that show up on a chart. The others are harder to name.
There had been a way the colors looked. A way the sun felt on my face. A sense, underneath everything, that I was living the life I was supposed to be living. Mania and hypomania were intoxicating. Ideas came faster than I could hold them. Sleep was optional. The volume on everything was turned up at once. There was a feeling of rightness about it all.
Here is the honest part of the bargain. For me, the medications did cap the ceilings on mania and hypomania, and they provided a floor under my low moods. The lows had been the kind where you do the math on whether the people who love you would be better off without you. That math does not happen anymore. The floor was real, but it was also not the whole story.
I have been in this deal long enough now to give a field report. Medication is only one part of the bargain. The rest is labor, and the labor is yours.
To get through it, you’ll need a therapist who specializes in schizophrenia and/or schizoaffective disorder. Someone who will not flinch or change the experience into something less disturbing, someone who will not reach for a worksheet designed for generalized anxiety. The assignments you’ll receive involve working with your own life. Tracking your sleep cycle, which is a canary. Knowing the first signs of changes in mood, the indicators that your brain is about to go into a state you cannot follow. Practicing what you should do when ideas start appearing faster than you are able to formulate them. Calling your pharmacist sister, then your psychiatrist, and letting someone you trust know that tonight is not a night to be alone. Stability does not just arrive, it is assembled, piece by piece, by you, in the hours when no clinician is in the room.
I was diagnosed with this disorder in my late thirties. The label was refined over time until it fit. It started as bipolar disorder, which was the closest approximation based on my mood symptoms. At the time, I was in a locked psychiatric ward in southern Minnesota. Then the condition became schizoaffective disorder based on evidence collected during my hospital stay. This change did not affect what was happening inside my head, it just modified how the room perceived it and what they were allowed to do about it. Diagnosis is a key, one that unlocks cabinets with medications, establishes a coding system to pay a therapist, gives access to the waiting room, and modifies how a person should be expected to behave forever. As soon as the word is pronounced, you can feel the door to the cabinet being opened.
The conversation about weight gain happened on the psychiatric unit, in a small room with two chairs and a non-functioning window. The psychiatrist was kind. She and I both hailed from northeastern Minnesota, a coincidence we discovered in the first five minutes, and the recognition softened everything that came after. She explained what a mood disorder was. What bipolar disorder entailed. She named several celebrities known to be diagnosed with such conditions, apparently to help me cope with it. Somewhere in the middle of all of that explanation, in the same tone, she said the medications could cause some weight gain. This was said the way you would mention that a restaurant is a little loud. I nodded. I was busy being grateful that the person in the other chair knew where I was from.
Fifty pounds is not “some weight gain.” Fifty pounds is a different relationship with every mirror, every doorway, every photograph, every pair of pants you owned before. It is a body you did not agree to in the conversation you thought you were having about your mind.
The other losses didn’t announce themselves in the same way. I was diagnosed in the winter, which is not a season with much color in Minnesota. The sky was gray, snow covered the ground, and there was no light left to feel after three o’clock. Spring, however, was the first indicator. Spring in Minnesota is usually an event: the snow disappears, the light returns, the first green leaves are almost aggressive. For most of my life, it had been one of the reliable joys of living in that part of the country, the annual proof that the winter had not, in fact, been permanent. The spring after I got diagnosed was quieter. Green appeared as usual, I saw it, yet I did not feel it.
It took me weeks to understand what was missing, partly because nothing was missing in a way you could point to. The colors were the same, the sun shone in the usual way, but I was somehow different. I had been tuned to a different frequency; the instrument had been adjusted.
That is the kind of loss a prescribing conversation does not describe, because there is no clinical language for it. You cannot chart the brightness of a spring you used to be able to feel. You cannot measure the absence of a conviction that you are fulfilling your purpose. While the medications did not steal it from me, they became a tool of the thief. The thief was the arrangement, which I signed when I agreed on the medication.
The hardest part of the arrangement is that the euphoria is not lost once. It is lost twice.
The first loss comes from the diagnosis itself. Prior to that, I could enjoy these heightened states. Ideas arrived faster than I could hold them because that was what my brain did on its best days. The volume was louder because the world had increased in intensity. After getting diagnosed, this sensation became a “symptom,” and even if I could reach that state again, it wouldn’t be as enjoyable as it used to be; it would be contaminated by what the diagnosis taught me. You cannot unknow that the thing you were calling joy has a clinical label and a treatment protocol and a billing code. The innocence of the experience is the first thing the cabinet takes, and it takes it on the day the name is spoken, before any pill has been swallowed.
The second loss is from the medications. They raise the floor and lower the ceiling, recalibrating the instrument to a range that does not include those higher frequencies. You can still see the door to euphoria but you can’t reach the handle anymore. The first loss you can, in theory, argue with. The second loss is built into the mechanism of the treatment, which requires the presence of a barrier. You do not get one without the other.
Such is the shape of the bargain no one prepares you for: the instrument that saves you is the same instrument that takes away your joy.
The deal was a real deal. It cost what it cost. I am still here, which means the arrangement held up its side. On my chest, over my right pectoral, is the sigil I gave the bargain so I would not forget what it was. The left side, the heart side, belongs to Caim, who understands the dogs. The bargain never touched that one. Nothing has.
This essay first appeared, in slightly different form, in Mad in America in May 2026.
Quiet Mind, Loud Brain 
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