The Psychiatry Machine

Bipolar Treatment vs. Bureaucracy

The Psychiatry Machine

Author’s Note

This reflects my treatment, told with some exaggeration. I’m genuinely grateful for my team. The system has kept me alive and stable. I’m sharing this because the absurdities of psychiatric care need honest discussion.

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You don't enter the psychiatry machine.

You get absorbed by it.

It starts with a phone call to your family doctor, using the approved phrases:

"Struggling lately"

"Things feel unmanageable"

"My medication isn't working"

You get a referral to psychiatry.

The clinic receptionist is kind in the way people are kind when they have no real power. She taps at her keyboard, feeding your name into the schedule.

Next available intake: four to six months.

You repeat the number like you’ve misheard. (Surely she means four to six weeks?)

You clarify you're not doing well now. Showering is a mission. Joy doesn’t register. Even texts feel like work.

She suggests emergency if things get "really bad," the way someone might suggest a different restaurant if this one is full.

Months later, you're across from Psychiatrist #1, who has twenty-seven minutes to solve you.

You've condensed your life into bullet points:

• long depression

• brief "high" spells

• no sleep

• racing thoughts

• family history that is… not encouraging.

  
  

They nod, frown at lab results, and arrive at a verdict with calm finality: Major Depressive Disorder, recurrent, severe.

SSRIs.

Follow-up in three months.

Try exercise.

Maybe yoga?

(Yoga will not fix this. But sure, yoga).

You leave with new pills and the sense that if you just cooperate enough, the system will reward you with stability.

Instead, the pills quickly wreck you.

Sleep becomes optional.

Impulse control quits.

Ideas stack six high.

You report this through reception.

Weeks later, someone calls back to say the doctor recommends you "give it more time."

(Exactly how much time is not specified).

Then comes the collapse large enough that no one can pretend it's fine.

You arrive in emergency, eyes wide, thoughts on 3x speed, half-convinced of things that don't exist. Form 1, then Form 3 — the alphabet of involuntary status.

You can feel the machine sliding you from one setting to the next.

Psychiatrist #2 sees you on Day 1: “Classic bipolar I. Antidepressants flipped you into mania. We’ll stop them and add an antipsychotic.”

Case closed.

(For now).

You stabilize just enough to be discharged — shaky, stunned, already counting the days until the next crash.

Two months later the police deliver you for Hospitalization #2. Same fluorescent hell, louder brain.

Psychiatrist #3 shows up on Day 3, skims the wreckage, and shrugs: “Psychosis congruent with mood, some dissociation — could be trauma. Time will tell.”

(Time tells nothing).

Discharge.

Crash.

Hospitalization #3.

(Carbon copy of the others. Worse food. Same despair).

By Hospitalization #4, Psychiatrist #4 declares it “Bipolar II with rapid cycling, rule out schizoaffective disorder, assess for ADHD, monitor for emerging personality features.”

(He says this while scrolling UpToDate).

In the end, no one agrees.

Everyone is certain.

They all say things with conviction, as though anyone could infer your baseline at this point.

As diagnoses accumulate, so does the sense of being written rather than listened to, like the machine is drafting you and you’re just there to sign your name.

Somewhere along the way, you acquire the Community Treatment Order.

It sounds gentle, like a neighbourhood picnic.

(It isn't).

It’s the machine following you home: a legal leash — you will attend appointments, you will take your meds, and if you don't, the hospital will send someone to bring you back.

You are technically free, functionally on parole.

You don't get to sign the CTO. You just get presented with it, the way someone might present you with a bill after a meal you didn't order.

The alternative, of course, is staying in hospital indefinitely or being dragged back the next time you breakdown in public.

The CTO has an expiry date and a line that says "may be renewed." No one can tell you exactly what will trigger renewal. It lives in the realm of vibes and risk assessments.

(Which is to say: astrology with clipboards).

The CTO also comes with a monthly ritual: the injection.

Once every four weeks, a nurse calls your name, confirms your birthdate, checks the order. There’s small talk while they draw up the drug that will live under your skin longer than most relationships.

(At least this one shows up every four weeks).

"Left or right arm today?"

You pick the right.

Sleeve up.

Cold wipe.

Sharp sting.

The first time, the pain is shocking. Not the needle — the medication itself, thick and viscous, spreading under your skin like liquid concrete. Your arm throbs for hours. That night, you can’t sleep. You can’t find a position that doesn’t press on the injection site. So you lie there, wondering if this is what the rest of your life looks like: choosing which arm hurts less, trading one kind of pain for another.

(Then morning comes and you take your other pills anyway, because what else are you going to do).

But the physical pain is just the opening act.

Something else happens in the weeks that follow. The world goes muted. Colors drain; music loses texture. You can still think, but it’s like thinking through fog. Your sex drive doesn’t leave, it gets erased, like someone pressure-washed your brain to clean away the sin. Motivation doesn’t disappear; it just stops mattering.

You try to explain this at your next appointment. The nurse nods sympathetically. The doctor says, "Side effects take time to adjust to. Let's see how you do at the next dose."

(Spoiler: not great).

If you ever stop showing up for your injections, the CTO machine whirs into action: calls, letters, wellness checks, police at your door.

You exist at the crossroads of health care and law enforcement.

There's also a peculiar whiplash in how you're treated.

At your worst, your "insight is impaired." You cannot refuse medication, leave the ward, or sign forms without a substitute decision-maker. Strangers override your judgment because, officially, you lack it.

Then you get discharged, and the same system that decided you couldn’t be trusted with shoelaces expects you to navigate referrals, refills, bloodwork, and follow-ups with near-perfect executive function.

Meanwhile, your employer needs a form filled out for your return to work.

(A simple form. One page. Double-sided).

Your psychiatrist needs to confirm you're stable enough to go back.

You submit the request in June. It isn’t filled in July. Or August.

You email; reception says they’ll pass it along. You call; the doctor will review it “when they have time.” You explain you’re about to lose your job. They understand, but the doctor is very busy.

By September, still nothing.

Your employer’s patience runs out. You’re on unpaid leave, then almost terminated. Your savings evaporate. Rent becomes a crisis. You’re eating pasta and canned beans because that’s what’s left.

Four months. Four months of your life suspended, your income gone, your stability collapsing, all waiting for someone to fill out one double-sided page.

The form finally get signed.

"Patient is stable, can return to work. Part-time. 2 days a week."

(Progress, apparently).

Your disability claim isn’t better; it sits in bureaucratic purgatory.

You applied in July. It's now December.

The insurance company wants more documentation.

Your psychiatrist's office says they sent it. The insurer says they never received it. Somewhere there must be a fax machine that has seen more of your medical records than any human ever will.

The disability adjuster emails to ask if your condition is "permanent or temporary."

(You type "yes" and hit send).

You adjust to this world like a foreign country. You answer questions less honestly, more strategically. Underreport on good days so no one discharges you. Overreport on bad days so no one classifies you “low risk.”

You become, against your will, an expert in navigating the machine that insists you are not to be trusted with your own care.

You get good at things you never wanted to master:

Waiting.

Taking pills.

Being grateful for two hours.

And yet, despite it all, you keep showing up. Because somewhere under the fluorescent lights and contradictory paperwork, things do, sometimes, help.

The absurdity is real.

So is the nurse who remembers your kids’ names. So is waking up and not wanting to disappear.

So is being less dead.

So you live with the contradictions. You hold four diagnoses at once and still show up for the monthly injection, because the alternative is worse.

You show up for the needle.

You show up even when you don’t want to.

You rail against the CTO and also recognize that, without it, there is a tired version of you who might quietly stop everything and drift back toward Hospitalization #5.

You are not meant to make sense of it.

You are meant to endure it.

You don't get the neat narrative where one brilliant doctor finally figures it out.

What you get is this: a stumbling, contradicting, exhaustingly bureaucratic truce with your mind, mediated by systems built for a much simpler species.

You keep going anyway — not because the machine makes sense, but because, despite itself, it sometimes keeps you stable to make a little sense of your own.

You go to your injection.

Left arm this time.

(You've learned not to use your right arm two months in a row).

You plan your life in four-week intervals around a needle that keeps you stable and also destroys half of what makes you want to stay alive in the first place.

The nurse asks how you're doing. You say fine. She knows you're lying. You know she knows.

You both pretend this is good enough.

You roll your sleeve down over the fresh lump of concrete and wonder if the machine awards frequent-pain points.

It doesn't.

It just schedules your next appointment.

(The machine hums, satisfied).

Same time next month.