“You will probably be somebody who has to take this for the rest of their life,” said my psychiatrist, turning to her computer to put in the order for my next script.

She said the rest of my life could be measured in script renewals, bottled emptied and filled in 30, 60, 90-day intervals, first multiply by months in a year, then by the years I will live – that number of round, pale and pink and powerful pills flooding my bedside, sink, in my purse, desk; maybe I could also be measured in lonely walks to the pharmacy, collecting the same orange bottles and twisting off the same white lids as my hands that do the twisting, followed by my whole body, ages and morphs.

My life could be measured in pills, each one a painful swallow, literally, of something I beg to forget: the sobbing. The weeks in bed. The flat, dimmed, uncaring and ugly universe of my life, a place where surviving each day felt like a Herculean task. Then, the speed. The high. The unprompted euphoria that flipped me from wanting to jump in front of traffic to drafting my acceptance speech for a Nobel Prize. My parents had been thrilled when I suddenly started laughing and talking a lot, but I remember how their faces grew confused, then grave, when they realized I wasn’t actually making sense. I knew what they were thinking: my grandma.

As for everyone else – the friends that used to love my company, the professors I used to dazzle with my work, even the doctors that were supposed to be helping me – I knew what they were thinking: What is wrong with this kid? She used to be so… so….

Smart? Nice? Normal?

My grandma died in near obscurity, at age 82. People tried to remember her fondly, but they didn’t really know what to remember. She was either being quiet or being difficult. She needed help with everything. She couldn’t look after her own kids. Ten years before she ultimately died, she was finally brought to a psychiatrist because my parents were “about to lose it.” In her seventies she was prescribed the same pill, an antipsychotic, that was urged down my throat when I was twenty, one of three pills that my psychiatrist now wanted to refill, and refill, and refill, forever. Each pill, a reminder that I was this close to the edge. A reminder that even while I had managed to shakily resume some semblance of my previous life as an appreciated friend, student, and daughter, I was anything but normal. No matter what milestone or accomplishment I tried to present as proof of my normalcy, every appointment with the psychiatrist, every single pill, reminded me that I couldn’t hide, that I better be careful, or my whole mental health train wreck could commence again, because my bipolarity was here to stay.

Maybe even beyond the confines of my individual life.

My grandma’s life, her blood and her story, had seeped into mine. I had some, but not all of my grandmother in me. I had the swinging and the sadness. Occassional stares. The loneliness, the existential crises. I also had way more money than her, an education, and medicine. But I was desperate to not experience my illness the way she had, as an outcast, a mystery, a problem that never went away. I was desperate to not scare people. To not make them silence and shun me or lament my existence, reduce me to how I acted when my illness was in control of me. I was ashamed.

I had inherited not only my grandma’s literal blood – the genetic perpetuation of my bipolar disorder – but also the shame that was stuck thick and inseparable from it. I inherited the sticking weight of being othered, of being suffocated, from the person who gave it to her, and the person before them, and back, and back – it runs in families – I believe, just like a chronic illness, the trauma of stigma doesn’t dissipate. It needs somewhere to go. Inheriting bipolar disorder meant inheriting shame.

I have inherited this illness, this trauma. Now I am being handed these pills.

Maybe I can’t undo the genetic fervor of bipolar disorder, but the shame –

Mental illness, especially bipolar disorder, flourishes from stress, especially the stress of exclusion. Dark skin was never designed to be stressful. Female body parts were never designed to be stressful. As a result of both, my grandma was barred from school and work and independence and representation and agency, practically before she was born; married my grandfather, had her children, and stayed quiet until she started acting “crazy”. I wonder what she knew and what she experienced that she couldn’t share with anybody. We’ll never know.

As a result of both, I was set up for stress. I was set up for sticking out, being subjugated by default, and having to prove myself. From a young age, I was like so many girls who heard in school, on TV, from their families, from people they admired, from people with power, from people who even thought they were helping, “You are not – you are not – you are not –” – and then – “you should – you should – you should –”.

There was always something to cover up, change, or fix, usually to please someone else. Because in our society, everyone looks at something else – a diagnosis, a physical feature, a difference – before they look at you. There was always something we had to be quiet about.

They like to talk about weird women who don’t act or think the right way. But maybe how we act is the correct representation of everything incorrect. The inability to make choices in your community, in your family. The loss of protection from your community, from your family. Maybe how some of us feel the state of the world ends up as bipolar disorder.

The psychiatrist says there are genetic and environmental factors.

Epigenetically, a trauma or environmental factor can set off our genetic predisposition. For many of us, the environment is a trauma. Of course, our susceptibilities will find some way
to ignite. The volatility of one bipolar person is a microcosm of the volatility in the universe. But it’s easier to focus on the individuals, instead of what made them that way. It’s easier to forget the centuries of discrimination and neglect and assault and silence that the women in my family faced, even for my own family to overlook tragic events in my childhood and instead ask, “What is wrong with you?”

We don’t look out and around, because that would be too hard. Instead, we augment trauma-bred illness with the additional trauma of stigma. We turn on each other. We are afraid of the swinging and the outbursts that afflict people like me, because we don’t want to think about what these symptoms really mean. We’re afraid of the bipolar label. But I was even afraid of the cure. I didn’t want to relinquish my normalcy and dignity and self-control to the “crazy pills” that I considered at odds with who I really was and the life I wanted to live.

Smart, nice, and normal.

In reality, I am genetically susceptible to bipolar disorder, dark-skinned with female body parts, still poised for difference and othering to aggravate what has already been done to so many before me and make me that many times more traumatized, add that much more weight to my blood. To aggravate my genetic susceptibility and make me sick. I am supposed to be ashamed of bipolar disorder. I am supposed to think it’s my fault. But I don’t anymore. I didn’t create the traumatic environment that taunts my genes.

Because now each pill I take is a wish for the peace of everyone before me, everyone who was simply labeled crazy, everyone dismissed for their illness, their difference. I may have inherited our collective, expanding, ballooning stress, our abuse, but that is why I am okay with my medicine. It is helping. It helps me live to my full identity. By taking it, I represent that I am not only my difference. I can tend to it and there’s more of me to look at. I would even argue, my difference is good.

Because with each pill, I make a promise to my future children, whose ancestral trauma will slowly lighten and soften through my commitment to care for myself. Each pill, each visit to the pharmacy, to the psychiatrist, each workout, meditation, healthy meal, phone call to ask for support, each breath, sunrise I live to see, may not heal my bipolar disorder, but heals the shame that is thicker and harder than the diagnosis itself, thicker than the cells and bloods in my genes that may always get passed down. But the shame doesn’t have to. With each pill, I say a prayer for everyone who was obscured before they were helped.

A side to my grandmother that I wish more of us remembered, was how she loved storytelling. She may have contributed to my bipolar susceptibility, but she also contributed to my love of writing. She made the Indian myths and creation legends from millennia ago come alive with fantastic color and sharp relevance and immediacy, even though they were older than mankind. She brought the myths alive, and they brought her alive; she often had a flat affect, except when she got into her storytelling mode, you could see the life and vitality and person come back into her eyes. I think you could see the person she really was, if people had cared to look beyond the fact that she was, well, different. She told me about texts like the Advaita Vedanta. The Vedanta talks about the relationship between the Self and God, and ultimately suggests that there is none; because God has innumerable identities, and is impossible to describe, a manifestation of God must be in every living being. There’s no separation between God and Self, or between God and everyone else you encounter.

What if everyone valued themselves, and each other, like God? What if that was the perspective with which we approached the never-ending, intergenerational fight against illness, exclusion, and trauma – that God is in everyone? Beneath the diagnosis we shudder at, there is a Self that is God, owed the same time and care and awe and prayer and power we bestow in the latter. I can adhere to a pill regimen to celebrate myself, the same way I would worship God. I can simultaneously aid and delight in the healing of others, no different than God would.

Bipolar disorder could be chronic in our genes, at least for the foreseeable future, maybe until the end of time. But with each pill, I challenge an environment of shame, I advocate for an environment of access where people get what they deserve and can be who they want.

I am a chronic patient and a forever healer. I heal myself.

I heal my past loved ones, my future loved ones. I have enough love to love myself and everyone else like God.

I heal this society that has told us we are born with a reason to feel bad.

I don’t skip any psychiatry appointments. I tell the psychiatrist that I am somebody who “gets” to take this for the rest of my life. I get to feel healthy and secure, get closer to reaching my full potential, to living out the parts of me that can’t be suffocated by a diagnosis. I get to pass on good things. I get to work in service that others can do the same. The formula to do so is complex and ever-changing, but this prescription is a happily welcomed component. It’s not simply medicine that starts and ends with me. It is cycle breaking.

Mallika Iyer is a special educator, writer and recovery advocate in Boston. Her essays have been featured in Tiny Buddha and Tricycle: The Buddhist Review, with an additional piece forthcoming in Spirituality+Health. An alumna of the Fulbright Fellowship, she is passionate about making learning and healing accessible for youth of all abilities.