• Feature Story • 75th anniversary
This story is part of a special one 75th anniversary series featuring the experiences of people living with mental illness. The views of respondents are their own and do not reflect the views of NIMH, NIH, HHS, or the federal government. This content may not be reused without permission. please see NIMH Copyright Policy For more information.
Note: This feature article contains references to suicide and self-harm, which may be disturbing to some. If you or someone you know has a mental illness, is experiencing emotional difficulties or is worried about their mental health, there are ways to get help. If you are in crisis, call or text 988 to connect to 988 Suicide & Crisis Lifeline . To learn more about bipolar disorder and ADHD, visit NIMH’s bipolar disorder and ADHD health information pages.
Somewhere between Boston and the White Mountains of New Hampshire, Josh Santana lost touch with reality.
The change marked a stark departure for the young student, as the previous weeks had ranked among the best he could remember. He no longer needed an alarm clock to wake up. He ran his fastest mile. He walked for hours at night, thinking about how to improve the world. But the best part, she said, was that years of mental illness disappeared overnight. His pain, his depression, his anxiety—all of it—ceased.
“It was such a rush of euphoria that at first I was like, ‘I’m finally out of this.’ I am no longer mentally ill,” Santana said.
The milestone was short-lived. Two weeks later, still euphoric, Santana’s seizure began to subside.
Talk to strangers about the future. He invented ways to shift the planets. He lost trust in his friends. His strongest advocate, his mother, became concerned. Then, on a whim, he dropped out of a teaching gig. And somewhere on a dark mountain road, he thought of driving over a bridge.
“At that point, people around me had seen such a stark difference in my behavior that when I walked into my house, I was surrounded by three police cars,” Santana said. “Someone had mentioned they were worried about me.”
What Santana, then 21, had experienced was a major manic episode—a serious and dangerous symptom of bipolar disorder.
“People with bipolar disorder experience periods of ‘high’, with rage and euphoria or irritability. These periods alternate with episodes of depression or “lows,” with loss of interest, motivation, concentration, and energy,” said Matt Rudorfer, MD, director of the Adult Psychopharmacology, Physical and Integrative Medicine Research Program at the National Institute of Mental Health (NIMH).
But it’s more than just mood swings. The changes can be extreme and episodes can last from days to months. In addition, bipolar disorder is associated with suicide risk, said Dr. Rudorfer.
“The life disruptions caused by bipolar disorder are poorly controlled, making it difficult to focus, think clearly and, in extreme cases, tell what’s real and what’s not,” he said. “This can make it difficult or impossible to function at work, school or home.”
For Santana, the episode was a low point in his life and the culmination of a long history of mental illness.
When life revolves around mental illness
Now 27, a successful real estate agent and musician, Santana is nothing like the manic college student he once was. He is articulate, organized and driven to excel.
Recently, it was included in the book, You are not alone, by Ken Duckworth, MD, Chief Medical Officer of the National Alliance on Mental Illness. Reflecting on the lessons he learned from his challenges with mental illness, Santana told Dr. Duckworth that his difficulties began at a very young age.
“I was removed from regular kindergarten because I attacked a teacher during a behavioral outburst,” she told Dr. Duckworth. “I was 4 years old and wasn’t allowed to go back to regular preschool unless my mom agreed to psych me up and stay with me paraprofessionally throughout my preschool as well. From the age of 5 onwards, I was heavily medicated and a lot of those early years were a blur.”
It was a rough start for the toddler, and Santana later learned that his difficulties stemmed from attention-deficit/hyperactivity disorder (ADHD). The disorder is characterized by a persistent pattern of inattention and/or hyperactivity and impulsivity that interferes with functioning or development.
Although academically gifted — learning the basics of algebra by age 8 — Santana said he felt ADHD hindered his cognitive development. While his work was excellent and he passed all the tests, the teachers failed him because of behavior.
Those failures led to feelings of shame and guilt, she said.
“The hardest part was managing the physical energy on my end because there were so many situations where I would have to hold back and have to internalize some of that stress,” Santana said. “I think the behavior problems and too much energy prevented me from focusing and nurturing it [gifted] part of me from an early age.”
Although he has never met Santana, Dr. Rudorfer said the pattern of behavioral outbursts is common with ADHD.
“Typically, boys with this disorder will be physically hyperactive, having difficulty sitting still, in some cases running around the classroom, leading to frequent trips to the principal’s office,” said Dr. Rudorfer, adding that ADHD can persist into adulthood.
For Santana, ADHD was just the beginning. Bouts of anxiety and depression followed around sixth grade, creating layers of mental illness within him. This led to more medication until, at one point, he was cycling through an “endless menu” of prescriptions. During this time, Santana experienced lulls and “windows of stability,” where one wave of mental illness would subside, only to be replaced by another.
By the time he turned 15, Santana was beginning to experience the symptoms of bipolar disorder. His doctor prescribed more medication, this time antipsychotics.
“My life completely revolved around my mental illness: If I was depressed, I didn’t do my homework. If I was hyper, I didn’t do my homework,” Santana said. “Throughout high school, I had a lot of ups and downs because of it. I also had a lot of high moods where I spent a lot of time doing dangerous things.”
My life is messed up
By college, Santana was able to manage his symptoms, but the series of drugs numbed him. He slept 13 hours a day and slept in class and while driving.
When the psychiatrist he had seen since he was 5 abruptly retired, Santana stopped taking his medication. A manic episode soon followed. While everyone around him could see the changes in his behavior, Santana couldn’t see the changes himself.
“In my mind, I was like, ‘Finally, … I’m ready to make a difference,'” he said. “For the most part, I felt fine, until the end, right before I went to the ER.”
Police who arrived at his home after driving up the mountain described Santana realizing he was not well. He entered a form of outpatient care called partial hospitalization.
As the fury faded, reality set in. In the past two weeks, Santana had destroyed relationships, some with longtime friends.
“Sometimes, the emotional symptoms of bipolar illness don’t reflect the intentions behind the real person,” he said. “And it’s one of the reasons why the guilt comes so strong afterwards, because you’re like, ‘Who the hell was that?'”
Immediately, he fell into another depressive episode.
“I was watching my whole life fade away,” she said.
The road to recovery
During the partial hospitalization, doctors adjusted Santana’s treatment plan and he slowly began to stabilize. As he continued treatment, Santana reduced his medications to just two – low doses. He also found a regimen that worked and stuck with it.
He credits this combined effort – therapy, coping mechanisms, perfecting his eating and sleeping routines, and mindfulness practice – as playing a major role in his recovery.
“It was a mix of everything,” he said. “It seems like people’s situations can be so unique and we often want a quick fix … but it was a lot of trial and error.”
Dr. Rudorfer acknowledged that treatment is not always easy.
“Finding the right drug—even the right dose of a particular drug—can be difficult. Everyone is different and it takes time to see how the brain will respond to treatment while trying to keep side effects to a minimum. “Many people have other conditions that coexist with bipolar disorder, which compounds these challenges and often requires a combination of medications for best results,” said Dr. Rudorfer.
The important thing is to maintain good communication with your health care provider and give the medication time to work while following all parts of the treatment plan, including treatment and attention to the sleep-wake cycle, explained Dr. Rudorfer.
“While the process can be difficult, people can get better with the right treatment. Today’s treatment regimens aim not just to reduce symptoms — but to achieve true remission and life-changing, life-saving recovery,” he said.
In time, Santana returned to school. He made a concerted effort to make amends for his past behavior and improve himself. He adopted a dog, Konta, completed his master’s degree in music, earned his real estate license, and joined a nonprofit orchestra for people with mental illness.
Now recovered, Santana’s life no longer revolves around mental illness. He is healthy, thriving and happy. It was a long journey, but he said it was worth it.
“I’m at a point where mental illness hasn’t played such a big role in my life — and I feel good,” she said.
