I went to Ontario today to see my psychiatrist. I had a rather frightening episode the other night, so it was good to get reassurance from him.

I'd had some trouble sleeping the night before, so I figured screw it; I'll just stay up all night and try to get in a better sleep schedule.

Big mistake. Huge.

By the time I got to bed the next night (around 10 pm), I'd been awake for something like 36 hours. I haven't had much of an appetite since I got back from Hawaii, so aside from some coffee and a lot of cigarettes I hadn't had any real nourishment. I turned off the computer and headed in to brush and floss for bedtime.

While I was brushing I kept hearing this strange noise. At first I thought my parents had left the TV on or that the radio in my room was on. But when I turned off the water, the noise didn't get louder or change substantially.

I did a circuit of the house, even looked outside to see if the itinerant Mexican fieldhands were having a party at their camp upriver. Nope. Nothing.

I took my evening dose of medication (Lamictal and Seroquel), turned off the light, and put my head down on my pillow.

Immediately the noises got louder and more insistent. It was like white noise between radio channels - some words seemed to get through, but it was mostly just a cacaphony of indistinct, garbled voices. I tried to concentrate on the sound of the ceiling fan, but I couldn't get the noise to stop. Children's voices. Womens' voices. Deeper, more threatening voices.

If I listened to the noise closely, I could hear my name. To make matters worse, it sounded as though whatever was calling my name was angry.

Spooked as hell, I got back up and practically ran to the kitchen. I was already groggy from my regular (smallish) evening dose of Quetiapine, so it was more like stumbling to the kitchen, but I knew I needed something to make this shit stop, right NOW.

A little medical background here. Lamictal is used in bipolar patients as a primary mood stabilizer. What's fascinating is that it was first used, and continues to be used, for epileptic patients. It appears to inhibit uncontrolled electical activity in the brain.

A seizure is essentially a normal action of the brain - an act of sensing the environment - that goes awry. The epileptic brain seizes when normal brain activity spirals out of control. It's been compared to a nuclear reaction. Normal electrical brain activity begins (for example, smelling, tasting, hearing, or especially seeing bright or flashing lights), and for reasons still unknown the brain is unable to put the brakes on. It's sensory overload to the nth degree. Electrical activity is supposed to cease when a particular act of sensing has been completed. In a seizure-prone brain, however, the brain just can't stop the activity, and a seizure results. Grand mal and petit mal seizures are pretty much the same experience, but on vastly different scales.

A few short years ago, psychiatrists noticed that in bipolar patients who are also epileptic, anti-seizure meds appeared to inhibit severe manic or depressive episodes. Clinical trials revealed that the anti-seizure class of drugs did indeed act as mood stabilizers, much as lithium does, but with fewer side effects.

It's clear from magnetic resonance imaging and CAT scans that the same part of the brain where epileptic seizures tend to originate is also the part of the brain that experiences abnormally high levels of electrical activity in bipolar patients. No one yet knows why this happens or why drugs like valprioc acid, gabapentin, and lamotrigine work so well for controlling and inhibiting both epileptic seizures and severe mood swings, but they do. So severe manic (and possibly, severe depressive) episodes are essentially the same thing as normal seizures, only much, much longer-lasting and spread out over a much, much longer time.

Seroquel has a soporific effect, but taken in small dosages it doesn't cause carryover spaciness or tiredness. It does, however, have mild antipsychotic properties, which is what I need for the next several months to keep the electrical activity in my brain under control. My own manic episodes tend to snowball rather dramatically into severe psychosis with alarming speed. Seroquel is supposed to prevent that from happening.

When I had the last string of severe episodes at the beginning of 2005, my doctor presribed clonazepam and risperidone, two rather strong (and in the case of Klonopin potentially addictive) antipsychotic medications. These are drugs that are, like Seroquel, ordinarily used to treat schizophrenia. I was mercifully able to stop taking those drugs by late February; they are soporific to the point of making me feel like the walking dead. In small doses, Seroquel alone has worked to keep my brain activity under control.

So when I started having mild auditory hallucinations the other night, I was scared as hell. I thought I was having a breakthrough episode, an episode where the illness slips the leash of all medication and runs its course as a regular episode. Such episodes must be treated aggressively, usually with injectable antipsychotics. Not a lot of fun, but highly effective for stopping a manic episode in its tracks.

I'd been experiencing several hypomanic symptoms since I'd come home from Hawaii. Travel, jet lag, and stress can all contribute to a sleep deficit, and sleep deficit is a significant triggering factors for manic episodes.

I'd been sleeping sporadically and uneasily. I'd experienced hypergraphia and pressured speech. I was having trouble concentrating on words when I was spoken to. I'd been smoking far more than I usually do. All these symptoms should have tipped me off that Bad News was on the way, but I tried to ignore them rather than treat them with the respect they deserve.

So here I was at 11 pm hearing voices. Shit shit shit.

I rooted around the medicine drawer in a frantic search for Klonopin or Risperdal. I managed to scrounge up a solitary 1 milligram tablet of Klonopin, so I frantically gulped it down with a swig of milk from the carton along with an extra Seroquel, for good measure.

I went back to bed and tried to read, but my eyes wouldn't focus. I didn't want to turn out the light (the voices seemed louder and more distinct in the darkness), so I closed my eyes with the light on. Slowly, so slowly, the voices began to dissipate, grow fainter, and finally disappear.

Thank GOD for medication.

I slept for almost 18 hours, and when I woke up I was shaky but creepy-hallucinated-voices-free, which is always a plus. I immediately got on the phone and made an emergency appointment with my blue-eyed shrink (he's a hottie, what can I say) to figure out what the hell just happened to me.

He was funny. He was actually kind of amused. Ashley, he said wonderingly, what the hell did you expect after allowing yourself to get sleep deprived?

Dammit, the man had a point.

He told me that I'd absolutely done the right thing in treating the auditory hallucinations as aggressively as I could. He also said that this is definitely not a breakthrough episode but was likely a normal, organic reaction to extreme sleep dep. He cautioned me about smoking - he smokes himself, but warned me that not only will smoking kill me, but that nicotine is a powerful stimulant that profoundly disturbs sleep. Coffee, obviously, is right out after about 11 am, which will put a giant damper on my after-dinner cup. He told me hot herbal tea or nothing.

This is a guy who deals primarily with meth addicts, and he reminded me that my brain is almost identical to the brain of an addict. My brain's been allowed to roam free for too long without the necessary constraints, without any normal boundaries. It's prone to wandering off in any direction it pleases, and it hasn't been disciplined to do things like sleep regularly, eat on schedule, or be quiet when it needs to be. Lucky me, I get to tweak naturally. My brain - the one and only brain I'll ever get - has been bathed far too regularly in chemicals both organic and also-kinda-organic-but-introduced-by-me, due primarily to a lack of discipline.

My new job - the only job I have right now, and the most important job I will ever master - is to re-train my brain, housebreak it, teach it some fucking manners.

Doctor Cutiepie also said that this was a great first step. The bottom line is this: I have an illness that can either control me or be controlled by me. As long as I take my meds, pay close attention to my sleep patterns, get the requisite amount of rest and exercise, and watch my diet and alcohol intake, this fucking disease will not own me. But it's up to me to learn my own rhythms and take care of my own body and mind. If I start to spiral out toward hypomania, I have to treat it the way that I did the other night - aggressively, with stronger antipsychotic meds.

If I don't, well - it's back to a series of hospitalizations, back to a lifestyle of hitting brick walls over and over and over again with escalating force as I grow older. If I don't get a hold on this thing, it will doubtless eventually kill me.

Bipolar disorder carries with it an incredibly high mortality rate - mostly from suicide, but also from the body and brain simply being ground to powder. Our brains are not designed to be continually buffeted by wave after wave of adrenaline, dopamine, and serotonin, our hearts are unable to bear such a massive strain, and eventually they both give out. Untreated or not taken seriously, bipolar disorder is more lethal than most forms of cancer.

Mister Blue Eyes gave me a script for Klonopin to keep on hand for emergencies, patted me on the back, and said to get my ass in bed by no later than 11 pm every night. I'm supposed to force myself into a normal sleep routine of bed at 11 and rising in the morning between 7 and 9 am. I'm supposed to walk a couple of miles first thing every morning, avoid alcohol entirely, lay off the cigarettes, and eat three well-balanced meals every single day, hungry or not.

Makes sense to me, but this entails a massive amount of self-discipline on my part. Not only do I have to cut down on smoking, particularly in the evenings, but I also have to fight my natural tendency to stay up until all hours tapping away at this keyboard or reading book after book. I have to force myself to eat, as hypomania and mania proper are possibly the best appetite suppressants ever in the history of the world.

But I look at the alternative, and holy crap the alternative sucks.

So it was a scare, but the good news is that I weathered a potential storm.

I'm learning, slowly but surely, how to tame this beast.