TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

RESPONDENT: [00:00:34] Hello. I want to [inaudible at 00:00:35] There we go. I had my bag one day [ph] going to the work center. To work, to work it up!

INTERVIEWER: Yeah.

RESPONDENT: So, man – so you want messages today, I’m sure.

INTERVIEWER: I did, yeah.

RESPONDENT: So I immediately cut back my lithium to 300 a day. I’m not taking two pills a day. [00:01:00]

I went back to – I looked at my mood chart…

INTERVIEWER: Yeah.

RESPONDENT: I studied the past couple of months of it, and – Darcy was over last night. I was like, “Ah, I’m having all these side effects, like my hands are trembling and I’m feeling nauseous, and my kidneys hurt.” And I know what it is like when your kidneys hurt. I just took a shot to the kidneys in college, and they were bleeding for a little while, so I’m familiar with kidney pain and how that works.

INTERVIEWER: Mm-hmm.

RESPONDENT: I had my blood drawn on Tuesday, I guess.

INTERVIEWER: You just had it done Tuesday?

RESPONDENT: Yep, so I await the results in a few days. But the fax is to Carla, and I won’t be surprised if my blood toxicity is above the 1.0 level. So…

INTERVIEWER: Mm. What were you on – what are you…?

RESPONDENT: Six hundred. I was on 600, twice a day.

INTERVIEWER: And when did you go up to six?

RESPONDENT: What is that? About a month, total – a month, total.

INTERVIEWER: Oh, OK.

RESPONDENT: And so, looking at the mood chart – and Darcy was even over. She was like, “Yeah, but it seems like there was a good period where you were doing really well.” [00:02:04]

And I’m like, “Yeah, I was on 300 milligrams of lithium, and I was 400 of Lamictal, and I was taking one to 1.5 Klonopin a day.”

INTERVIEWER: Yeah.

RESPONDENT: I was like. “Yeah, that was a really good spot. I was really pleased with that.” And then I went up to the 600, and it was like an increasing – an increasingly disturbing amount of my decision-making, running into, “Well, I should just kill myself” for the slightest of things, the slightest of anticipations and so forth. “Man, money is going to be getting tight. Well, I should probably just kill myself.”

INTERVIEWER: Mm-hmm.

RESPONDENT: But not like, “Oh, I’m so sad. I should kill myself,” but just sitting there, going, “The logical thing would be just to kill myself.” And when all my thought processes were ending with, “I should probably just kill myself,” I was like, “Something is clearly wrong.” [00:03:00]

And this past week, especially just – I know I drank a lot on Sunday, but even through Tuesday, I was feeling awful and, on Wednesday, I was feeling a little bit better; that was yesterday. And today, I’m feeling fine, like I don’t feel my hand trembling as much.

INTERVIEWER: Mm-hmm.

RESPONDENT: And the thing is – here is what is pissing me off, Carl. Right? Psychiatrists are fucking idiots, just like doctors. They’ve got all these fucking books in front of them and all these stats and whatever, and [pauses] – and the other [ph] is learned. You go and do your own research, and you’re like, “Oh, here is what my fucking doctor forgot to tell me.” For instance, Carla never mentioned, if you’re on lithium, do not drink alcohol; don’t do it. It is – because it can mask your body’s ability to recognize that it has been poisoned.

INTERVIEWER: Mm.

RESPONDENT: She never mentioned that. [00:04:00]

INTERVIEWER: And she never…?

RESPONDENT: No, that never came up, because it has probably never come up in her practice. [Pauses] As well as other things – yeah, other signs of toxicity are hand tremor and drowsiness, and – I’m like, “Yes, these are all signs of toxicity that I own, that I’m researching.

INTERVIEWER: Mm-hmm.

RESPONDENT: And Carla, of course, would be like, “Oh, your research on the Web and you see things that scare you.” I’m like, “Well, no, I see things that are happening.”

INTERVIEWER: Yeah.

RESPONDENT: And I’m just like, “This is a pain in the ass. I don’t want to keep switching psychiatrists until I find one who is going to prescribe me things that work.” Right? So I meet with her a week from Monday.

INTERVIEWER: Yeah.

RESPONDENT: I’m just going to be like, “Well, I dropped down to 300, and that seemed to be working fine.” And if that is just placebo then fine. I’ll ditch it and I know that I’m fine with Klonopin and Lamictal. So… [00:05:00]

INTERVIEWER: Yeah, but there is kind of a sense that she is not going to really…

RESPONDENT: Well, it is the same thing like Darcy and I were talking about, where she had Dr. Vaughn back when I did, and she switched.

INTERVIEWER: She did?

RESPONDENT: Yep, and then she switched again. And it is the same thing my sister runs into, as well. It is like psychiatrists want to fiddle with you.

INTERVIEWER: Yeah.

RESPONDENT: They’re like, there is this perfect state they can get you to, and I’m like, “No, you can’t, because bullshit.” It is like maybe you, with your normal brain chemistry, think that you can fix everybody else, but…

INTERVIEWER: Well, I think you’re also right to be observant of what – especially at this period, when you’re changing things up very – very…

RESPONDENT: Pretty rapidly.

INTERVIEWER: Very rapidly and very, very importantly. These are hard – these are major medications. You know?

RESPONDENT: Yeah. [00:06:00]

INTERVIEWER: And you’ve got to be really observant about what is going on with you. And I think you should definitely be – and I’ll certainly reiterate to her – I’ll probably send her an e-mail, telling her what you’ve been telling me, and noting that…

RESPONDENT: Sure, go ahead. That it is not…

INTERVIEWER: …That there has been an increase in how…

RESPONDENT: …In suicidal ideation, which, of course, “Did you [ph]?” And I was like, “No, that is impossible. Lithium…”

INTERVIEWER: Well, lithium doesn’t…

RESPONDENT: What the – yeah, they don’t have it.

INTERVIEWER: Everybody is different.

RESPONDENT: Exactly! Everybody is different. Brains are – it is an incredibly complex machine. Neuroscientists are still trying to figure out how it works.

INTERVIEWER: And they do have to adjust and be sensitive to what is going on with the individual.

RESPONDENT: Right. And it gets to the point where, “Listen, writing me these prescriptions, can you do that? If not, can you recommend a better psychiatrist, one that will listen to what I am saying?” Because it is absolutely ridiculous. [00:07:01]

I mean, it is like, “You’re a patient.” No, no, no, you work for me, Carla. You work for me. And I will fire you.

INTERVIEWER: Yeah. Well, and I’ll say the other thing – it is not uncommon for this stuff to go – to – in fact, most people I’ve run into, that are trying to change medications and adding new things, it never is the first go; it just never is. [Chuckles]

RESPONDENT: Yeah.

INTERVIEWER: It is never – usually not even the second go in terms of what is the right dosage. It really…

RESPONDENT: Well, and then, she is like, “Well, 300 milligrams shouldn’t actually have any effect, like shouldn’t get you into the clinical – we call it clinical efficacy in terms of blood toxicity.” Something between 0.6 and 1.0 is where you want to be.

INTERVIEWER: Did you already do a blood test?

RESPONDENT: I just – that is what I’ve been doing.

INTERVIEWER: That was just the one test for…?

RESPONDENT: Yeah. And it is one of the messiest-looking blood test results, in terms of on my arm. She was new, and she was so sweet, though, because she was really worried about hurting me. [00:08:06]

And I’m meditative through the process. That made it a little easier. But there was a three or four year-old in the other room, who was having his blood taken for the first time, and he was screaming and crying because there is traumatic effect. Someone is sticking a needle in you, and that hurts real bad if you’re a little kid, as you have no context of pain of that kind. And that was the day when my Spanish came in really useful. It was when we were actually in the blood lab, with the nurses asking him what to do. She is speaking Spanish to the blood lab technician, the one who runs it. And she is like, “Oh, yeah, just go and take him over there, sit him down, get him ready,” but she said it in Spanish, so I was able to start moving. I was like, “OK, I know where I’m supposed to go.” Not that I could have said that in Spanish – I spent long enough to hear – I’m like, “OK, yeah, she wants me to –” she instructed her to go and sit me down somewhere else, so I’ll go and do that. [00:09:06]

And she is a very sweet woman. She’s taking my blood, and I heard that kid cry, and I’m like, “Oh, poor little kid.” She is like, “You feel them?” I’m like, “I do.” Which is the English version of, “Lo siento,” which is like, “You experience this pain?” Like, “You feel as if you were him?” It is such a better way to say, “I’m sorry.” There are two in Spanish – “Disculpeme/Perdoneme,” which is just like, “Oh, my bad. Sorry” versus “Lo siento,” which is, “I feel what you are feeling.”

INTERVIEWER: Mm-hmm, hm.

RESPONDENT: Yeah, very different.

INTERVIEWER: Very different, I guess.

RESPONDENT: Yeah, but she said it in English. This is one of those benefits [ph] of taking other languages – when someone is speaking English, no their first language, and they are speaking it strangely, I’m like, “Ah, I know why you’re saying what you’re saying. What you would say in Spanish is this, and so that is what you’re trying to convey.” [00:10:09]

So it makes it easier to communicate.

INTERVIEWER: Well, yeah. What is important in all of this seems to be the idea of somebody understand – of saying, “I feel what you’re feeling” as opposed to something different.

RESPONDENT: Yeah. In Spanish, it is also funny that “Se hizo tarde” – “it got late on me.” In Spanish, you can’t actually be late. Time has its [ph] own volition. It is not your fault. It is a funny thing. This was true in May. They were throwing parties and were like, “Yeah, the party starts at six.” I’m like, “OK, cool.” At six o’clock, we left to go and get party supplies. I’m like, “The party starts at six.” They were like, “Yeah, but no one needs to be here ‘til eight.” And it wasn’t even like an, “Oh, it’ll be at eight.” It was just common sense, like, “The party starts at six but no one is going to be here ‘til eight. What? Are you crazy?” [00:11:07]

INTERVIEWER: [Chuckles]

RESPONDENT: “Who shows up at six?” [Chuckles] So vamos chiflada [ph].

INTERVIEWER: Yeah, but I – the other thing I was thinking about that kind of relates to what you’ve just been talking about, with the nurse saying it that way – I’ve been thinking about – we’ve been talking about Ginny and her coming in for a meeting, and [pauses] – and kind of what I had in mind is more how the interactions around when you’re feeling really, really lousy, what can be useful for you. [00:12:00]

RESPONDENT: [Chuckles]

INTERVIEWER: And part of it is helping her.

RESPONDENT: Well, yeah. I just don’t want her to cry all the time.

INTERVIEWER: Yeah. And what I think is so – really, really complicated for you is that – the way you describe it is that, I think – and sometimes you really want her to know what you’re feeling and then, others, at the same time, don’t want her to know what you’re feeling.

RESPONDENT: Mm.

INTERVIEWER: You know, like in a way, don’t want her to feel? You know?

RESPONDENT: Protect her from what I’m feeling so she doesn’t have to go through experiencing whatever it is she experiences.

INTERVIEWER: Yeah. But, also, that there is some way that you don’t want her to see it [sighs] as something that is crazy?

RESPONDENT: Yeah.

INTERVIEWER: And while it is so complicated the way you describe it, and it is true, I think, that sometimes you feel that, “There is something about my bipolar that is active here, but I don’t want to – that doesn’t mean it is crazy.” There is something that… [00:13:00]

RESPONDENT: Well, but, at the same time, I’d be describing myself as insane fairly often.

INTERVIEWER: [Whispers] Yeah, yeah!

RESPONDENT: And that is irritating to me.

INTERVIEWER: [Whispers] Yes.

RESPONDENT: And it is irritating to me because I have to go and deal with people like Carla, who are going to keep trying to fiddle and make me perfect. I don’t think there is a perfect.

INTERVIEWER: Oh.

RESPONDENT: I don’t think there is a – I am at a point where I am like, “I think that, maybe, this is as good as it gets.” You know?

INTERVIEWER: Yeah, tell me about this, though. This is important. [Chuckles]

RESPONDENT: OK, OK.

INTERVIEWER: It is.

RESPONDENT: OK. The [exhales] – I don’t want to take so many pills – right? – that I lose control of my hands. That – first off, that is a deal breaker. These are some of the most important things in my life.

INTERVIEWER: Yeah. And you noticed that this week.

RESPONDENT: Especially. But I’ve been noticing it and – because I paint. And I’m trying to paint these little dudes, and I’m just like…

INTERVIEWER: Yeah, OK.

RESPONDENT: I’m like – I can’t fucking control the detail, and I’m like, “What is the fucking point of taking something like this, that makes me feel [pauses] trembly?” [00:14:07]

What is the trade-off? It is like, well, you can do this and you could feel like a normal person, or you can give up the things you love doing. It even fucks up my typing.

INTERVIEWER: [Sighs] Yeah.

RESPONDENT: I’m like – I can’t have that. I absolutely cannot have that. When I’m not doing stuff, I can look at you and type a different sentence while I’m talking to you.

INTERVIEWER: Mm-hmm.

RESPONDENT: You know?

INTERVIEWER: Divide your attention really easily.

RESPONDENT: Yeah, which is weird, because what I’m really doing is switching back and forth very quickly, because you can’t actually multitask. So [pauses] – but, yeah, divide it and switch back and forth, quickly.

INTERVIEWER: Yeah.

RESPONDENT: That is more difficult now because I need to look at the keyboard more often, to make sure I know where I know where my hands are going. And I find that I’m missing – I’m writing, the wrong words on Facebook. [00:15:00]

But I look back afterward and go, “Fuck! I wrote ‘two’ instead of ‘four’!”

INTERVIEWER: OK, yeah.

RESPONDENT: You know?

INTERVIEWER: And it is kind of just maddening that…

RESPONDENT: Yeah!

INTERVIEWER: That it is – yeah, it is not really you. [Chuckles]

RESPONDENT: I’m really good at typing and suddenly not good at typing.

INTERVIEWER: It changes your typing.

RESPONDENT: Yeah, and I’m not willing to give that up. And I liked Klonopin. Things were better. And [pauses] things were better [pauses] to a great degree. [Pauses] And, no, I refuse – I refuse to make those trade-offs.

INTERVIEWER: Mm.

RESPONDENT: It is like your brain feels better but you lose control of your body. And the extended periods on lithium will kill your kidneys. Every time I look up, it is like, “No, there is long-term kidney damage.” I’m also not willing to go through that. So… [00:16:09]

INTERVIEWER: It changes your body.

RESPONDENT: Yeah, I refuse. I absolutely refuse. So [pauses] I would be willing to continue trying 300 a day, to see what – take another blood test and see what that has to say. And if it is not in clinical efficacy, then I’ll be like, “OK, then the lithium was a placebo, so we ditch it.” [Pauses] “There it is. I’ll take Lamictal and Klonopin. And I’m not perfect but I can use my hands.”

INTERVIEWER: Yeah, what – tell – you were saying something, too, about it. It is like Carla – or psychiatry wants to maybe fiddle into perfect…

RESPONDENT: They want to fiddle. Yeah, there is like a perfect euthymic state.

INTERVIEWER: Mm. [00:16:59]

RESPONDENT: I’m like OK, maybe that exists. You can tell me it exists. And you can say that, over years of experience, it exists. But maybe I’m not looking to get there. Maybe the trade-off isn’t worth it to me. It is like, oh, yeah, my mind feels better but I’ve lost control of my hands, and I’m getting kidney damage. No, thank you. That is – I would rather take [pauses] – I would rather take the experience where, some days, I call into work and am like, “I’m not coming in today. I will be available on IM and e-mail, but I will not be coming in.”

INTERVIEWER: Mm-hmm.

RESPONDENT: “And if you really, really need me immediately then give me a call, and I can fix whatever problem you’re having over the phone.” Why? Because I’m that fucking good. [00:17:59]

Speaking of which, I have a job interview on Tuesday.

INTERVIEWER: Oh, uh-huh.

RESPONDENT: I checked in. I’m like, “Hey, man, so working on progress reports.” Like, “Oh, yeah, can you come in on Tuesday, for a couple of hours?” I’m like, “Yeah, definitely.”

INTERVIEWER: Mm-hmm.

RESPONDENT: Definitely. [Pauses] [Sighs] So…

INTERVIEWER: Yeah, yeah. Well, it makes me think – again, what you’ve been describing as the search for the – the “chemical solution,” sometimes as you describe it – like what would be the right blend. But one thing is that, when you lose – something about – you’re describing when the hands go or you notice certain things associated.

RESPONDENT: Yeah.

INTERVIEWER: It can be – it could be stuff you’re prescribing yourself, like, for instance, the marijuana. You’ll be like, “I am pissed, because, OK, I’m feeling better in some ways but I’m slower in other ways.”

RESPONDENT: Yeah, right.

INTERVIEWER: And it is kind of…

RESPONDENT: Exactly. And there is – it is just like, for once in my life, that trade-off isn’t useful. [00:19:02]

You know? Like [pauses] – and that is no good.

INTERVIEWER: What do you – what is it like for you to find things like your hands are trembling?

RESPONDENT: It is fucking infuriating is what it is.

INTERVIEWER: Uh-huh.

RESPONDENT: It is just like, “Why am I doing this? Nothing is worth this.” Ten million dollars is not worth trembling hands. I’ve been thinking about stuff like that, like what sort of – how much money would someone have to give me to live with a hand tremor? And I can’t think of a number. I can’t think of a number.

INTERVIEWER: OK.

RESPONDENT: Except in my most desperate times; maybe then I’d make a foolish choice like that.

INTERVIEWER: [Pauses] Because your hands are…

RESPONDENT: I use – my hands and my eyes for everything. [00:20:00]

That is how we interact with the world. I mean, [pauses]…

INTERVIEWER: Yep.

RESPONDENT: I can’t [pauses] – and the fact that Carla didn’t tell me that drinking alcohol with lithium is a really bad idea irritates the fuck out of me. [Pauses] It seems like that should be the very first thing, is like, “OK, now you’re on lithium. Here are a number of things you cannot do.” [Shifts in seat] And also…

INTERVIEWER: Yeah.

RESPONDENT: …I don’t drink alcohol that often, but I like to sometimes, usually like once a week or once every two weeks. It is not common but it happens, and I do it for specific reasons. I’m like, “This is the chemical effect I’m going to get. I’m going to get a little drunk. And it is going to be fun. I’ll feel a little loser. I’ll be funnier.” [00:21:07]

INTERVIEWER: Yeah, you wanted [ph] to get more sick of…

RESPONDENT: Yeah, so totally. Totally. Well, yeah, lithium can mask your body’s signal to say, “Oh, you’re poisoned right now.”

INTERVIEWER: Yeah, yeah, it would have made it worse.

RESPONDENT: Yeah. But, again, not worth it. Absolutely not worth it, especially since, all month, my solution to every problem was, “Well, I should probably just kill myself.”

INTERVIEWER: Well, yeah.

RESPONDENT: You know? [Pauses] And I’ve been kind of on and off weed, like weed once a day – sorry once a week.

INTERVIEWER: Uh-huh?

RESPONDENT: And I can almost see that drop-off. Like, “Oh, you had weed,” then, “You can stay on it,” then, “OK, now you’re down today.” [00:22:01]

But [pauses] I really didn’t like the way I felt all week. I was like, “This is not good, what I am feeling. This is bad. My kidneys should not hurt. My hands should not be trembling the way it is.” And I was wondering this past month, “Why am I falling asleep so early? I am getting really tired.” Drowsiness is a sign of blood toxicity with lithium; this is what the Internet tells me after research.

INTERVIEWER: It is – yeah, you’re putting some serious stuff in your body.

RESPONDENT: And then there is a huge list of side effects.

INTERVIEWER: Yeah.

RESPONDENT: There is an enormous list of side effects, none of which Carla brought up, not a single one of which. She just said, “Make sure you drink more water, because it is salt.” [00:23:00]

I go, “Thank you.” That is one of a list of ten issues with lithium.

INTERVIEWER: Yeah. The other thing – do you know – they’re going to give it directly to Carla, but I’m assuming, too, that if it was – there was a toxic level, they’d call you.

RESPONDENT: Yeah. I expect them to mail me the results.

INTERVIEWER: It is just generally standard operating procedure.

RESPONDENT: Yeah, I would think so. And, if not, I’ll call them and be like, “Hey, what were my blood test results?” because it is my blood, after all, and I should know what my blood said.

INTERVIEWER: Yeah.

RESPONDENT: Um…

INTERVIEWER: Yeah, that is pretty standard for them to call if there is something that is high, and they’ll want you to…

RESPONDENT: Yeah. They’re like, “So you know, yeah, you’re way above “ [Pauses] I mean, still, I’m like OK, now given the list of side effects and long-term damage, I expect to live past 47, and ten years of lithium is what it takes to start doing actual kidney damage. [00:24:02]

That is when you can expect to have kidney damage, so that is, again, a no-go right there.

INTERVIEWER: Hm.

RESPONDENT: Uh, [pauses for seven seconds] and it is like, what is this is as good as it gets? What if, sometimes, I spend more money than I’m supposed to? What if – I don’t know – what if, sometimes, I get really sad? But it only lasts hours. It only lasts hours on 300 milligrams of lithium. [Pauses]

INTERVIEWER: Yeah, it is super complicated business to figure out what it right for you, what you want.

RESPONDENT: Right. Yeah, and she says, “A 300 shouldn’t have an effect.” I’m like, “Well, it seems to. I feel better.” [00:25:01]

INTERVIEWER: Certainly, yes.

RESPONDENT: “And, at 600, I feel worse.” So [slaps surface]….

INTERVIEWER: My guess is that she won’t be surprised that something might be wrong, might be more off.

RESPONDENT: She fucking better not be.

INTERVIEWER: Yeah.

RESPONDENT: I mean, I don’t really want to [inaudible at 00:25:22]…

INTERVIEWER: It is so common that people have, that people will feel lousy but if there is too much…

RESPONDENT: Yeah. Well, that is good. That is good to know, because I felt fucking lousy, especially this last week.

INTERVIEWER: Well, yeah.

RESPONDENT: It was like [pauses] it was one less pill to swallow at night.

INTERVIEWER: Absolutely. You don’t have to take that stuff if it is…

RESPONDENT: Yeah, and you don’t – and if she is insistent, I’ll take the prescription and just take half of it.

INTERVIEWER: You’re right. That is not her job to be insistent.

RESPONDENT: Yeah. And that is why Darcy left Doc Vaughn. He was insistent. He was like, “No, this is the right dosage for you.” She was like, “I don’t feel well.” He was like, “No, this is the right dosage.” So she left and she got someone else. [00:26:02]

And they’re like, “You actually shouldn’t be on Lamictal at all. You’re just depressed. Here is some Prozac.” And she was like, “Oh, this works really well.” It turns out like, no, do you know what else is a side effect of Lamictal, that no one has ever mentioned to me?

INTERVIEWER: What is that?

RESPONDENT: It can lower your ability to absorb vitamin B. And, with Darcy, it really affected her. It made her stupid. She was like, “I feel really, really slow.” And she went to a doctor, who was like, “Yeah, you should – you’re really low on vitamin B. Here are some vitamin B12 shots.” She was like, “Oh, wow! I’m me again.” And I’m on to that, about myself.

INTERVIEWER: Yeah. When you go to a primary care doctor, do they do blood draws?

RESPONDENT: Yeah, usually. Usually.

INTERVIEWER: They test for that. I mean, they will test for all those levels.

RESPONDENT: Yeah?

INTERVIEWER: Yeah. And they should give you – a lot of docs now will give you the total results back on what is out of range. There is a print-out that they just have from the blood work. [00:27:00]

RESPONDENT: I should just call? I know there is some way I can log in and see my medical records now, which is part of the Georgetown Health Alliance, I believe.

INTERVIEWER: OK.

RESPONDENT: So I can just – I’ve got my yearly coming up in fucking March.

INTERVIEWER: Yeah.

RESPONDENT: But I don’t want to wait ‘til March. If I’m low on B12, I want to be getting regular B12 injections. And – which would make sense. Blair [ph] was like, “Man, I guess I smoked a lot of weed. Maybe I’m stupid now.” And maybe I’m not; maybe I’m just not getting enough B12. [Pauses]

INTERVIEWER: Yeah, the last time I heard about pot and the cognitive effects is that they’re short-term…

RESPONDENT: Yeah.

INTERVIEWER: …That once you’re off for a certain amount of time, then…

RESPONDENT: Yeah, after about six weeks. Yeah, six weeks is the longest it stays in your system. And I’ve heard that it can vary, but the longest I’ve ever heard was six weeks.

INTERVIEWER: Yeah.

RESPONDENT: You know? I haven’t heard of anything about the long-term – well, there haven’t been a lot of clinical trials in it. [00:28:02]

But just from experience of people I know who’ve smoked weed every day for their entire lives, I wouldn’t say anything noticeable.

INTERVIEWER: Yeah.

RESPONDENT: You know? In any significant way. My fucking father [ph] made his own LSD for – Christ’s sakes – he was 50 years old and smoking weed since he was a kid. Was he an odd man? Yes, but he’d probably always been a little odd. Was he distracted and useless in any way? No.

INTERVIEWER: Yeah, it is mostly memory stuff, the common…

RESPONDENT: Yeah. And I don’t drink when I’m smoking a lot. I don’t remember my dreams. I know I’ve been off weed for a few days because I’m breathing [ph] again. Like [pauses]…

INTERVIEWER: Yeah. It also seems to me like some of the – some of what you’ve been describing is like – that has been particularly maddening has been all the changes you’ve been noticing in yourself, like there is something about… [00:29:12]

RESPONDENT: Well, yeah. I mean, I was really happy for what I learned [ph]. I was like, “Oh, yeah. This is nice. This feels better.”

INTERVIEWER: Yeah.

RESPONDENT: And if you’re in mode rims [ph], and every six months a blood draw is – like keeps me in that state, that is fine. It is like, “All right. Not a problem.”

INTERVIEWER: Yeah. [Pauses] But – and you were also – I know you mentioned in the message that you were concerned that what I might say to Carla. I want to make sure that you…

RESPONDENT: Oh, yeah. Yeah.

INTERVIEWER: What were you…?

RESPONDENT: I don’t know. You’d be like, “All right, Fred’s thinking of killing himself,” and then she’d be like, “Well, let’s up his dosage.” And then, “Let’s do 900,” is where she wants me to eventually be – at 900.

INTERVIEWER: Yeah.

RESPONDENT: That does not… [00:29:58]

INTERVIEWER: I’m not a psychopharmacologist, but that doesn’t sound like it makes sense.

RESPONDENT: Yeah, make sense – especially considering the way I’m feeling.

INTERVIEWER: No, I – more than that, I just want to kind of back – make sure that she does know that I’m seeing it, too.

RESPONDENT: Yeah, it is not just my insanity being…

INTERVIEWER: Well, that is the thing. It is…

RESPONDENT: “Nabetty-floo [ph]!”

INTERVIEWER: That is somehow the something that is at play here, is some way that the doctor can kind of think – like a Vaughn can kind of go, “Well, you’re seeing it wrong,” it something like that.

RESPONDENT: Right. Yeah, you’re…

INTERVIEWER: “Your mental illness is making you not…”

[Crosstalk]

RESPONDENT: “Your experience is incorrect.” Exactly – “Your mental illness is confusing you as to what you’re experiencing.” I’m like, “Well, consciousness is the most subjective experience we have, so who the fuck are you to tell me what I’m experiencing?”

INTERVIEWER: Yeah. [Chuckles]

RESPONDENT: I’ve been doing this long enough that I recognize more easily now, “Ah! This is a manic state I’m in.” [00:30:56]

Someone online on one of these research forums, someone was like, “Yeah, I had to give up lithium, and so I still get some amount of mania.” And then she is like, “But I have instituted” – she is like, “My mania expresses itself by buying things.” And she said, “So I’ve instituted a rule of three, which is where I ask three other people what they think about the purchase, and then I wait three days. And if I still want it, then…”

INTERVIEWER: Oh, yeah.

RESPONDENT: “…And these people are like, ‘Yeah, that seems like a logical choice,’ then I buy it.” And I’ve been very good, very good in terms of not pre-celebrating. In the past, I’ve had a promising interview for a high-paying job, and I’m like, “Sweet!” and go out and spend like 100 bucks on stuff I want, because I’m going to have a really high-paying job soon. And when I don’t get it, I’m like, “What the fuck? What was that all about?” And [pauses]… [00:32:00]

So I didn’t do that this time. There is this war wagon that I really want that costs 90 bucks, and I really, really want it. And this is what I’ve told myself I’m going to buy when I get the job. If I get the job, I can go and spend 90 bucks and get it. And Alana [ph] has been like, “Well, yeah, you should just go and get it.” I’m like, “No, I don’t – I shouldn’t do that because I don’t have the job yet. I don’t have 90 bucks to throw at a hunk of resin and metal.” You know?

INTERVIEWER: Mm-hmm.

RESPONDENT: So…

INTERVIEWER: Yeah, how do you understand that feeling of wanting to celebrate? Do you sort of feel it – does it fall in the category of mania to you? Are you sort of feeling it is kind of like this is what a lot of people ? What are your…?

RESPONDENT: I think – well, I don’t know. It feels like something that I am likely to do.

INTERVIEWER: [Chuckles] Yeah.

RESPONDENT: Like, I recognize that. It is like I start to feel happy and now I want to buy things when I feel happy to make me feel happier. [00:33:04]

INTERVIEWER: Yeah.

RESPONDENT: You know? And I also want to buy things when I feel sad, because that will make me feel happier. And this – it probably is also linked to the fact that I spent most of my childhood in a mall.

INTERVIEWER: [Whispers] Yeah.

RESPONDENT: Like, this was every day. Every day, we would go on errands, which is where she would take us to the mall and she would buy things she didn’t need. And we would also get things we didn’t even need.

INTERVIEWER: Yeah.

RESPONDENT: You know? Unless there wasn’t enough money for her to buy stuff she wanted, in which case she would buy what she wanted regardless of what we needed. The fucking juice extractor versus pants for me…

INTERVIEWER: She’d go with the…?

RESPONDENT: …Juice extractor, because God told her to get the juice extractor. And she would just laugh at me, how angry I was.

INTERVIEWER: Oh, boy.

RESPONDENT: Yeah. So – but crazy bitch. [00:34:00]

“Crazy, fucking cunt,” as my father would call her. You know? Completely dehumanizing language to what he would use normally. But, yeah…

INTERVIEWER: Well, it is hard to see the humanity in somebody buying a juice extractor…

RESPONDENT: …Over pants that I’d need. Yeah, exactly.

INTERVIEWER: …Needs for her son.

RESPONDENT: I had two pairs of pants; they were the same pair in different colors. And I was outgrowing them, and people at school had noticed how I had only two pants.

INTERVIEWER: Yeah.

RESPONDENT: And they’d mock me for it. Well...

INTERVIEWER: Yeah.

RESPONDENT: Yeah, so…

INTERVIEWER: Well, she wasn’t a mother.

RESPONDENT: No, she wasn’t! She wasn’t and she never will be. Never will be no matter how much she begs. But [pauses] – but I am hopeful for this job. If I don’t get this job, it is the coffee shop. And it is like, “Go get a job at a coffee shop.” [00:35:05]

INTERVIEWER: But what about that?

RESPONDENT: Well, that’d be a little depressing, wouldn’t it?

INTERVIEWER: Yeah.

RESPONDENT: Would I be managing that coffee shop within a few months? Absolutely. But, like, still [pauses] – or some other coffee shop. [Pauses for ten seconds] Yeah. So, [pauses] again, I just don’t want to be fiddled with. It is like, when I feel that I’m OK, that is when you stop prescribing me anything else. It is simple.

INTERVIEWER: Yeah.

RESPONDENT: I may be prescribing 400 milligrams of Lamictal, and you give me 1.5 milligrams of Klonopin, and maybe 300 milligrams of lithium. [00:36:02]

Unless it is just placebo, in which case fuck it. Who needs this kind of metric [ph] $1.05 at the pharmacy? At least not a prescription. Kilo Ks [ph] are really small, so [pauses] yeah – it is amazing how bad her healthcare was when she worked at a hospice agency. You know? Like [pauses]…

INTERVIEWER: [inaudible at 00:36:31] Yeah. It looks like.

RESPONDENT: It is ridiculous. Like you said – “shady.” And it was shady.

INTERVIEWER: Yeah, [inaudible at 00:36:43]

RESPONDENT: Yeah, but [exhales] yeah. But this job interview on Tuesday – because, yesterday, I reached out to Viggo, and I was like, “Hey, man, I just wondered if there had been any progress on your end.” He was like, “Oh, yeah, could you come in for a couple of hours?” “Absolutely.” And I’ve been rehearsing this interview for over a month now. [00:37:02]

So I’m feeling pretty good about it. And I’ll continue to rehearse.

INTERVIEWER: Yeah.

RESPONDENT: And [pauses] eventually I’ll learn. [Sighs] Really, the only problem is – there are two potential problems, the second of which is unlikely to be the problems that they’re having me coming in. That problem would be, “Oh, we’re not really ready to – we’re not really sure. We’re not really comfortable with the idea the QA plan leaves no need for [ph] one,” which would be a stupid thing for them to turn me down for. [Pauses] The other possibility is like, “Oh, am I the oldest guy in the company? Is that a problem for you?” It is like, “Hello, Mr. CEO. I’m a good seven years older than you are.” [00:38:05]

But I think that is the thing to that I try to put forward, is like, “I’m not looking to run a company. I’ve no desire to run a company.” I’m like, “I want to build stuff. I want to help you make your shit better. That is all I’m here to do.”

INTERVIEWER: That must be reassuring.

RESPONDENT: Well, I hope so. It is like, “I’m here to help you.”

INTERVIEWER: Yeah.

RESPONDENT: And there is really…

INTERVIEWER: Did you see this real often [ph]?

RESPONDENT: Yeah, exactly. “Yeah, I’ve got more experience than you guys, in the industry,” so…

INTERVIEWER: Yeah.

RESPONDENT: Yeah.

INTERVIEWER: That was like – what? back in the ‘80s?

RESPONDENT: Yeah, yeah. Like, “Kill troll with ax.” [Chuckles] “Kill troll.” “Kill troll with what?” “Kill troll with ax.” Oh, OK. You kill the troll with the ax. [Pauses] [00:39:00]

So it is very dark. You’re likely to be eaten by a grue. So [pauses]…

INTERVIEWER: But he had been there – yeah, I remember you talking about him. He had been there for years.

RESPONDENT: Mm-hmm. Yeah, for a long time. Yeah, he was at Melody, and he had lots of great sage advice, and…

INTERVIEWER: He’d been around for years, yeah.

RESPONDENT: …After a while, they started telling him to shut the fuck up every time he was like, “We’re hemorrhaging millions of dollars a years, and here are some ways to stop hemorrhaging millions of dollars a year.” They’d just shut him down. So he actually left the company on the same day that I did.

INTERVIEWER: Oh.

RESPONDENT: We both were like, “Lay us off, because we’re out.”

INTERVIEWER: Hmph.

RESPONDENT: All the people in finance, all the people who are like, “You’re hemorrhaging millions of dollars a year – tens of millions of dollars a year. Here are our suggestions for how we could slow that lead.” [00:40:03]

But they just didn’t want to hear it. They wanted to believe their own fairytale. “No, no, no, we’re rock stars. We’re just going to keep doing what we’re doing until it works again.”

INTERVIEWER: Mm-hmm.

RESPONDENT: I have to explain, “It didn’t work the first time. You got bought, and they gave you an unlimited budget for two years.” So that was amazing, and once it became an actual budget, they started hemorrhaging millions of dollars a year. [Pauses] They called me to task for having a $6-million budget. I’m like, “OK, fine. I never had a budget. This was never brought to my attention that I actually had any money to spend. And now you’ve actually made us responsible for budgets, and you’re surprised that you’ve been spending $6 million a year. And you’ve been paying that money TBA [ph] without my knowledge or input.” So whatever. I cut that down to $1 million. [00:41:00]

INTERVIEWER: Mm.

RESPONDENT: Like, basically, immediately. I was like, “Oh, we’re paying $6 million?” They’re like, “You need to spend with your money!” “Fine. Done. Let me rearrange all our clients $1 million a year. How do you like that? I cut $5 million out of the budget right there.” Just as efficient, just as good. They were throwing money away.

INTERVIEWER: Yeah. No, I – as you would think about doing another – working with a new company, you know that there are all these kind of maneuvers that people do.

RESPONDENT: Oh, yeah.

INTERVIEWER: And things that put people – and it is psychologically [chuckles] demanding to figure out how you negotiate all that stuff.

RESPONDENT: Well, you know what my job is, ultimately? It is to make them feel safe.

INTERVIEWER: Yeah.

RESPONDENT: You know? And – to make them feel safe. And they’ve got one guy right now, I think, I’ve worked with before. He is a guy whom I hired years and years and years ago. [00:42:06]

He is a good tester – solid tester, not like the gifted tester but a solid tester. You know? Smart guy who knows how to do the job completely reliable, standard numbers. [Pauses] [Sighs]…

INTERVIEWER: But they were indicating to you that they need a – they need something…?

RESPONDENT: They don’t have a plan.

INTERVIEWER: They don’t have a plan?

RESPONDENT: They don’t what they’re going to do yet.

INTERVIEWER: Mm.

RESPONDENT: I said – I told them, “I’ll build it.” It is like I’ve done this a number of times.

INTERVIEWER: Yeah, that is great.

RESPONDENT: Yeah. I was like, “I’ll do it as a consultant. I’ll give you a team and walk away. But you’ll get more value out of me if you just keep me around and give me access to higher-level decision-making.” [00:42:59]

INTERVIEWER: Well, being older, being the oldest guy could be really beneficial for you.

RESPONDENT: It could be, especially if I’m like, “Guys, I’m just here to listen. That is what I’m going to do.”

INTERVIEWER: You see good [ph] companies working with smaller and smaller…

RESPONDENT: Yeah, I’ve seen good companies, I’ve seen small companies fail. I’m like…

INTERVIEWER: Yeah.

RESPONDENT: Yeah. My last two places had extremely high turnover because people didn’t know what they were doing.

INTERVIEWER: Yeah.

RESPONDENT: And I – I realized – I realized a couple of years ago now that I don’t lose staring contests anymore. It is just like CEOs try to intimidate me, and I’m like I’m actually not intimidated. I grew up with a psychotic. There is very little that I actually – you could say to me that is going to make me afraid. [Pauses] And Ginny remembered it. She is like when – that day that Josh came in and threatened to shut down the whole company because maybe we were getting near [ph] dates, and Ginny was like, “That was really stupid of them.” [00:44:06]

She was like, “When people make idle threats, you shut down.”

INTERVIEWER: Huh.

RESPONDENT: I’m like, “That is true.” I bet you can lose all respect for living in that moment. It is like, “Oh, you just tried to use fear to motivate me.”

INTERVIEWER: Huh-huh – I see. That is…

RESPONDENT: That means you are terrified.

INTERVIEWER: Huh.

RESPONDENT: I remember telling him that part of the problem was his management style. He just flips his gaze to me and this glare, which he has seen everyone else in the company wilt under. I didn’t have a response. I’m not – there is no response. My face remains as it was when I told him what the problem was. He was glaring at me, waiting for me to look away, and I’m just like – I’m not glaring back; I’m just [pauses] not impressed. [Chuckles] You know? [00:44:59]

INTERVIEWER: It is familiar [ph].

RESPONDENT: It is. And it is weaker than real hatred. With real hatred the psychosis can give you – I mean, that is a deep, visceral, burning hatred they have out of nowhere. Yeah.

INTERVIEWER: Powerful? More powerful than that?

RESPONDENT: Yeah. And I was like – this is why I could work so easily with [] at Melody. He terrified people, because his temper was out of control sometimes: the things he would say to people, the vitriol he can spit, and just the anger and rage he could summon. And I was unaffected by it. I go, “So what is the actual problem?” Like, [imitates emotional yelling] “You said anything, and this couldn’t be anything. I had to switch [ph] everything.” I’m like, “That is an excellent point. I’ll be sure to name all my variables in the future.” “All right! “OK, cool. In the meantime, the variable you want to us is this.” [00:46:00]

At his five-year – because he was hired a couple of months before I was, and at his five-year, some people got up to say stuff about him. And I’m like, “He can difficult to work with. He works incredibly hard,” blah-blah-blah. And an artist, goes up there and is like – he has written a poem. [Chuckles] [Pauses] He opens it up and unfolds it, and cruises through it in front of the whole company, and he is like, “Roses are red. Violets are blue. One time, [] told me I was a fucking idiot.”

That was the end of the poem? [Chuckles] We’re all like, “Yeah, that sounds [chuckles] about right.” He calmed down so much over the years as people were like, “James, you cannot interact with other human beings this way.”

INTERVIEWER: Hm, hm.

RESPONDENT: But I told him I got it. I was like, “Listen, I tell my testers who are afraid of you – I tell them, ‘You don’t need to be afraid of him. He’s is a teddy bear. But he is still a fucking bear, so watch your step’.” [00:47:07]

But I...

INTERVIEWER: [Chuckles]

RESPONDENT: I’d love him. I loved him so much, because his anger came from [pauses] the purest of places, which is that he worked his ass off every day to be perfect – right? – to make no mistakes.

INTERVIEWER: Huh.

RESPONDENT: And the second he suspected that you weren’t doing the same thing, he would explode. He was like…

INTERVIEWER: He expected the same out of other people?

RESPONDENT: Yeah, exactly. He expected that of everybody else. He was like, “I’m working my ass off here. Why aren’t you working your ass off?” I’d be like, “He, not everyone else is a genius. It is like we’re in the tech industry, so, basically, everyone is above average at the minimum…”

INTERVIEWER: Well, I think what also – what seems to me sets you apart even more [chuckles] than that is like a real strong ethic around working as hard and as well as you can. [00:48:05]

RESPONDENT: Yeah, certainly.

INTERVIEWER: That is not – that is not a given.

RESPONDENT: [Chuckles] It is not. It is not. But, at the same time, I am also…

INTERVIEWER: It is not a given.

RESPONDENT: The think I need to be very clear with bosses about is, “You will be really sad if you make me sit in a chair for eight hours a day. It is like you’re getting the least out of me, because I’ll become bored for three of those hours that I’m just sitting in a chair, because I don’t anticipate…”

INTERVIEWER: It is, “Because I’m supposed to sit in a chair for eight hours?”

RESPONDENT: Yeah, exactly. And I’ve done everything. Like, I’ve solved the problems for today but I’ve also solved for the week. Right? If something else comes up – “Awesome. I’m here.” You know?

INTERVIEWER: Yeah! Listen, you’re of an age now where it is not your – you’re not 20-something. You know that you get the job done.

RESPONDENT: Right, and I know I get it done faster and better than those people in that generation are capable of.

INTERVIEWER: So it doesn’t make sense for you to sit around and…

RESPONDENT: Welcome to the one percent. Yeah, exactly.

INTERVIEWER: …Do nothing, and twiddle your thumbs. It is going to be [chuckles] frustrating to maddening to do that. [00:49:01]

RESPONDENT: Right, exactly. And then, what happens is that I get bored, and I grow to resent being here and resent turns to contempt…

INTERVIEWER: That is a – it is a good point to raise, though, like wanting kind of a schedule that…

RESPONDENT: …Is flexible. You know?

INTERVIEWER: Yeah, that you do the job and you get it done, and…

RESPONDENT: Yeah. I think that is the thing I’ve always got to point out, is, “Listen, I have always gotten the job done. I’ve never missed a deadline. I’ve never…”

INTERVIEWER: No one is going to need to make sure it is…

RESPONDENT: Yeah, I’ve never – I’ve never failed to get everything done, [pauses] even when that meant skipping the holiday party to get the job done, because everyone else went to the holiday party. It is like, “OK, guys, the job is not done. I guess I will sit here and do it despite the fact that this is not in my job description. Seeing as how no one else is really worried, I’ll just – don’t worry guys. I’ll make the deadline. No problem.” [00:50:00]

INTERVIEWER: Mm-hmm. [Pauses] So, listen, I will – I’ll shoot out Carla an e-mail just to kind of – telling her that I have been noticing, and you’ve been telling me that, since – for the last month and a half – how long would you characterize it?

RESPONDENT: Yeah, roughly, about a month, or since I started the – shortly after I started the double-dose.

INTERVIEWER: That you’ve been noticing more suicidal ideation.

RESPONDENT: …Suicidal ideation. It seems like the most logical choice to every problem. You know?

INTERVIEWER: And described more in the way of tremors and…

RESPONDENT: Yeah, and feeling the – my fucking kidneys hurt.

INTERVIEWER: And feeling like your kidneys hurt, yeah.

RESPONDENT: Yeah, and falling asleep much earlier than I used to. And [pauses]…

INTERVIEWER: Yeah.

RESPONDENT: Like, in a really weird way, “It is 9:30. Why am I tired? Normally, I wouldn’t be tired until like 2 o’clock in the morning. Why am I tired now?” [Pauses] [00:50:57]

INTERVIEWER: I also do expect her to take that seriously and not be…

RESPONDENT: Well, as do I.

INTERVIEWER: Yeah. And I know you’re not there right now with this, but if there was a time that you felt like it wasn’t working for you – between you and Carla – and you wanted to stop, that is not going to – I know, I realize I’m the one that referred you…

RESPONDENT: Oh, yeah. No, I get it. You’re not going to be affected by that.

INTERVIEWER: I mean, I – if you do, [chuckles] I can understand if you didn’t want me to, but I’d be happy to try to find you someone else.

RESPONDENT: No, I’d love to hear another suggestion. The goal is to continue to have the prescription. You know?

INTERVIEWER: Yeah, yeah. Well, I know that is a step by step [ph]. It is not like your [inaudible at 00:51:43].

RESPONDENT: Yeah, not yet. [Sighs] Not yet. I’m assuming we’re basically out of time…

INTERVIEWER: Oh, yeah, yeah.

RESPONDENT: …Which is why I’m getting all this other shit ready.

INTERVIEWER: And when do you meet with her? Tues…?

RESPONDENT: A week from Monday, a week from Monday.

INTERVIEWER: OK, a week from Monday.

RESPONDENT: Yeah so… [00:52:01]

INTERVIEWER: And [pauses] it is – let me ask you this about – in terms of a Monday meeting with Ginny…

RESPONDENT: …Ginny.

INTERVIEWER: …Would there be a chance that she could meet at 10:30 as opposed to – and that the two of you could meet at 10:30 on a Monday as opposed to…?

RESPONDENT: Yeah, definitely. She works it either way. It is flexible.

INTERVIEWER: OK, OK. I’m still in the process of working on that.

RESPONDENT: No, I appreciate that. I appreciate it.

INTERVIEWER: That is better. [Pauses]

RESPONDENT: All right, that is mine, as well. Yeah, don’t forget this. Well, I could forget this but I shouldn’t.

INTERVIEWER: Off to – that is for the Lab [ph]? Are you going there now?

RESPONDENT: Yeah, it is the book and the practice test, and the answer keys to the practice test, and the sheet of all possible formulas I will ever need.

INTERVIEWER: Uh-huh.

RESPONDENT: So, again, I’ll try to learn despite the fact he just wants me to pass. [00:53:03]

INTERVIEWER: All right. Is that good [ph]?

RESPONDENT: Monday [ph].

INTERVIEWER: OK.

END TRANSCRIPT