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I brought my hands together. “Bipolar is a mood disorder that causes alternating periods of mania and depression. In the manic phase, Paige barely eats or sleeps and runs on nervous energy. Then, after the mania passes, depression sets in, and that’s just what it sounds like. There’s a lot of crying and a lot of sleeping, and dark, dark thoughts intrude. Sometimes she becomes suicidal.”
“And that’s what happened?”
“Kind of,” I said. “With Paige, there’s more. She has bipolar 1, which is an even more severe form of the illness. Every now and then she experiences a psychotic break, complete with delusions and hallucinations. That’s why she thought I was still in high school. It’s also the reason her psychiatrist recommended that I not visit her again until she’s stabilized.”
“But you’re her brother….”
“She’s in restraints, Morgan. If this episode is anything like the last one, she imagines she’s new in town and on the run from her husband. The last time it happened, she was also convinced her son, Tommie, had been abducted. But none of that is true.” I rubbed my eyes, infinitely weary. “She’s even calling herself Beverly again.”
“Beverly?”
I sighed, hating the biology and genetics my sister inherited, hating that I hadn’t been at the farm when she needed me most.
“It’s her first name, but after my mom died, she started using her middle name, Paige. That’s how everyone knows her. The only time I ever hear the name Beverly is during times like these.”
“Isn’t there any medication that can help her?”
“She’s on medication. Or she’s supposed to be, anyway. I’m not sure whether the medication stopped working or whether she forgot to take it in the midst of the crisis with my aunt, but…” I turned to her, spreading my hands out before me. “I know what you’re thinking, and trust me when I say I understand how scary the words psychotic break sound. But please keep in mind that in those periods—like now—Paige isn’t really dangerous to anyone but herself. Do you know anything about bipolar psychosis? Or delusions and hallucinations?”
When she shook her head, I went on.
“A delusion is a faulty but unshakable belief system. For example, like I said, in her last episode she truly believed she was on the run from her husband, Gary, who was trying to take Tommie away from her and eventually did. As far as hallucinations go, hers are both visual and auditory. In other words, she also believed that Tommie was with her. She saw and spoke to him just the way you and I are interacting now. It felt that real to her.”
I could see Morgan struggling to absorb this information. “That almost sounds like schizophrenia.”
“The conditions are different, but sometimes they share the same symptoms. Delusions and hallucinations are rarer for those with bipolar, but they can be triggered by a bunch of different things—acute stress, sleep deprivation, lack of medication, sometimes marijuana. Anyway, once the mania begins to wane, it becomes more and more difficult for Paige to maintain the delusion, and the depressive phase sets in. Sometimes it’s just too much for her mind to handle, which, in her case, spirals down into suicide attempts. There’s a lot more to all this, but that’s a general overview.”
She was silent for a while, digesting, before she realized the obvious.
“You never told me that she had a son.”
“Tommie,” I said, nodding.
“Where’s he now? Does Gary have custody?”
I expelled a breath. “Gary and Tommie died over six years ago in a car accident.”
Morgan covered her mouth in shock. “Oh my God…”
“Tommie was only a toddler at the time,” I said, my voice soft. “It was one of those stupid things, another car running a red light. The guy wasn’t drinking; he was just distracted by his phone. Not long after their funerals, Paige had her first psychotic break. We found her in Arkansas, after we got a call from the sheriff. She’d been arrested for vagrancy. I guess my aunt had sent her a letter with a return address and Paige had it in her bag, which was good, because she had no other identification with her. The sheriff made it clear that she needed medical help, so my aunt and I drove out to get her. Her psychiatrist—the same one I met with this morning—was the one who eventually diagnosed her and got her on the appropriate medicines. Once she was stabilized, she agreed to move back to the farm, and I set her up with a workshop in the barn.”
“Where does the delusion come from? I mean, if there’s an answer to that.”
I shrugged, knowing I barely understood it myself. “As far as I can tell, she mixes up bits and pieces of her past into her delusions; she fits everything she sees into the story she’s currently telling herself, and there are usually grains of truth in all of it. For instance, I know that she and Gary were having serious troubles in their marriage, to the point that they’d separated. I’m sure her illness had something to do with it, since it wasn’t being treated at the time, but anyway, Gary was temporarily awarded full custody, and he wanted to make it permanent. He also worked for the Department of Homeland Security, though in his case it was for FEMA, not any security or anti-terrorism branch. As for the specifics of this particular episode, I really can’t tell you. Some of the things she was ranting about in the hospital this morning echoed delusions from her last episode, but others didn’t. Like…she swore that Gary must have gone to John Small Elementary School, which is where both of us, not Gary, went to school when we were little, so that part didn’t make sense. Until she fully stabilizes, I won’t know for sure.”
“And you said she’s attempted suicide before?”
I nodded, feeling a wave of hopelessness wash over me. “On our way back from Arkansas, she tried to jump out of the car while we were on the highway. In the end, we had to use duct tape to keep her from trying again. Her second attempt happened a couple of years after she’d moved back to the farm. In that instance, her medication had stopped working, and we didn’t realize that she had begun self-medicating with weed. I woke one morning to discover that she’d run off in the middle of the night. She took buses and hitchhiked halfway across the country, but fortunately, in that case, she had her phone and I was able to track her with Find My Friends. I eventually found her in a diner near a bus station. She had a cup of hot water and was using packets of ketchup to make tomato soup. She was still in her manic phase and didn’t recognize me, but when I offered her a ride, she accepted. For whatever reason, she thought I sold carpets for a living. In the truck on the way back, she began sleeping more and crying more, and when we finally stopped at a hotel for the night, she tried to jump from the balcony. I should have known it was coming, but I’d gone to use the bathroom for just a minute. I caught her when she was halfway over the railing. Had I not found her when I did, had she been alone that night, I don’t…”
After trailing off, I could see her trying to grasp it all. “It’s a good thing she had Find My Friends turned on so you could find her,” she said.
“Believe me, I make sure she keeps it on, and I checked it while I was driving home. Not that it did me much good this time.”
“Is she going to recover?”
“Physically, yes, once she’s stabilized. But it’ll be really hard for her emotionally for a while, because she’ll remember most of what she did and everything she was thinking, and a lot of it won’t make sense even to her. She feels a ton of shame and guilt about that, and it’s going to take her a while to forgive herself. I sort of get it,” I admitted, running a hand through my hair. “When I was walking you through the house, it felt like I was wandering into her mind and seeing how broken it was….” I could hear my voice dwindling. “I know how awful that sounds.”
Morgan shook her head in sympathy. “It sounds like she’s sick and she can’t help it.”
