Insulin induced hypoglycemia and suicidal ideation

How does one ask this question of a psychiatrist who’s so prepared to put a patient into the hospital: How do I manage suicidal ideation, that accompanies bouts of hypoglycemia, while mildly depressed?

The question is obviously one outside of the experience of most psychiatrists, since very few patients with bipolar disorder also have type 1 diabetes, for which injecting insulin is absolutely necessary, and can lead to occasional episodes of serious hypoglycemia. I’ve discovered that this is murky territory psychiatrists don’t want to visit.

In fact, in my experience, it’s a forbidden question because asking will almost certainly place me in danger of being incarcerated on a psych ward. I know because the last time I asked, the police were called and waiting for me when I arrived home from the appointment. All because I mentioned the suicide word, while asking what I thought was a perfectly reasonable question.

The point is that there are times when I have low levels of depression made worse by seriously low blood glucose levels. During these episodes, when my brain lacks the fuel required to function properly, any irrational thoughts I have safely stored away, may be let loose and run free.

FYI: The day the cops scooped me my glucose levels got lower and lower as the events unfolded, because the cops didn’t believe I was diabetic and wouldn’t let me eat. They justified this by pointing out that I wasn’t wearing my bracelet—my choice, my mistake. So, by the time I arrived at the hospital in the back of a police car, my sugars were so low that even the emergency ward nurse raised an eyebrow. When my glucose level was normalised, however, I was actually able to talk my way out of being admitted to the psych ward, a testament to my ability to think and communicate rationally when all is well.

The result is that now I don’t ask the question.

Am I capable of following through with an attempt at suicide, as a result of thoughts that come during a bout of hypoglycemia? So far I haven’t, obviously. All I need is a few seconds of clarity to know that I need some quick sugar. The problem is that the clarity doesn’t always arrive.

Is it smugness on the part of a psychiatrist, or a need to inspire confidence by presenting him or herself as all-knowing, that leads to an inability to calmly discuss this challenge? I’ve experienced both of these attitudes in doctors, much to my disappointment. So, what’s the strategy? Time will tell.





take your meds

FYI, telling a person who you know has a mental disability to ‘take your meds’ when you disagree with her or him, is bigotry. It’s also a cheap and lazy way to make your point in a conversation. It’s the same as calling them a psycho, a mental case, a retard or any other prejudicial term.

I was made acutely aware of how common this use of language is once more today, when a person in my neighbourhood, who knows I live with a mental disability, disagreed with me on the topic of personal boundaries.

“Oh, take your meds,” he said, like that cemented his side of the conversation.

“What a bigoted thing to say,” I said. “Do you know how hateful and stigmatising a term that is?”

Apparently not. He looked shocked for a moment, then incredulous. Then he told me to fuck off, and walked away.

This is a person who would never use the N word, or any other horrible slur against a racial minority, and rightly so. But he felt within his rights to slap me with this stigmatising term. Perhaps he didn’t expect a person with bipolar disorder, who endures episodic bouts of psychosis, to logically assert himself in a conversation.

But I wonder, how many times do I have to be certified under the Mental Health Act, and held against my will, without being charged with or convicted of any crime? How many times do I have to attempt suicide because the voices and my inner narrative say it’s the only way? How many times do I have to be beaten and restrained by the police for eccentric, but harmless behaviours? How long do I have to subsist living in legislated poverty? And, how many times do I have to encounter mocking and infantilizing dismissal, whenever I raise these questions?

Finally, how long do I have to survive in spite of these things, and more, and mostly prosper, before I gain the right to respect?

the loneliest hotel room in the world

…is on the twelfth floor of east Hastings street
where the evangelists come
seeking the incomplete where
psychosis compels rebelling
against painted shut windows where
I have gone brown like a leaf the

hand outstretched
complete you hear as I
devise devising knowing the
voices are wrong always
wrong like a lover
ruinous in the world
genius in her use of zero
laughter applause
knocking at the door
saturate in the hall
haunted as I’m
sure they do as I’m
sure they are as I
have twice paid my rent there are
faults & folds I am
mountain ranges surfacing
fingers straights, breaking
no one has asked

consent is fantasy



the Amazing Rubeni

His suspicions regarding the overall poverty of height had transformed from an abstract concern and into a genuine source of anxiety faster than he could ever have imagined. Would such a short fall adequately fill his needs? After all, he’d chosen the rooms on the fifth floor, from which he’d just jumped, for their gentle north eastern exposure and faux Rococo styling, not for their hands-down utility in the event of some desperate suicidal leap. He was also, in that instant, perplexed by the disturbing elasticity of time. Falling such a short distance seemed to be taking a very long while.

It was irrelevant now, but he knew from casual inquiry that the weight equation defined weight, or W, to be equal to the mass, or m, of an object times gravitational acceleration, represented by g, or W = m * g. The value of g was 9.8 meters per squared second on the surface of the planet, and gravitational acceleration decreases with the squared distance from the center of the earth. For most practical problems related to atmosphere, he knew he could take it for granted that this factor was constant.

The drag equation told him that drag, D, is equal to a drag coefficient, Cd, times one half the air density, r, multiplied by the squared velocity, V, times a reference area, A, on which the drag coefficient is based. In other words, he was being opposed by aerodynamic drag – that was the point; he was always being opposed by something, and he resented it.

Another thought he had, as the wind whistled quietly in his ears, was one he’d had several times before: Why was success considered the only logical outcome of perseverance? This was an unsolvable mystery. He had practised perseverance throughout his life, without success. He was diligent in his perseverance, painstaking. One could even say assiduous. Wasn’t that how his psychiatrist described Rubeni’s bipolar personality? Mania was perseverance and depression was empathy. The psychiatrist had said this as though it was the firmest, most fundamental of universal truths. Why wouldn’t have Rubeni believed it?

But now that he thought of it, the psychiatrist had never said that to persevere was to succeed. It was everyone else who’d said that. His psychiatrist had just written Rubeni a new prescription and told him that the appointment was over. That was no way to have ended what was supposed to be a therapeutic appointment, of course. But he’d always been unlucky with psychiatrists, their profession so undervalued by everyone but themselves. Who could blame them for being bastards?

As he continued to fall, Rubeni rolled round in space and looked up at the balcony from which he’d just leapt, and saw three faces looking down at him. It was the two plane clothes cops and the priest, his small personal choir that had, up until a moment ago, been singing a hymn called Don’t Jump. Why had they brought in a priest? Another mystery. Rubeni was Jewish.

“All things come to pass,” the priest had said when it was time for his choir solo, after the cops had recited their scripted homily of reassurance and acceptance. “These feelings you’re having, they will pass.”

“And I’ll feel better?” said Rubeni, his back to the priest as he pondered the pavement below.

“Yes, that’s the idea,” the priest said.

“And I’ll be able to cope again?”

“Yes, yes.” The priest was pleased with the idea.

“All things come to pass, then.”

“Yes,” said the priest.

“Then these bad feelings will pass and be replaced by good feelings.”

“That’s right.”

“But then,” Rubeni said, “if all things come to pass, the good feelings you promise will also pass, and I’ll feel like shit again, or even worse, and want to kill myself all over again, maybe even more than I do right now. It seems very iffy, this theory of yours.”

“Our moods and emotions can be a burden at times, I agree,” said the priest. “Some of us are prone to dark thought. You must pray always, but even more strenuously and sincerely when you are struck by these extreme feelings.”

“Have you ever felt like ending it all?” Rubeni asked the priest.

“That is a weight God has spared me.”

“So,” said Rubeni, noticing his undone shoelace, “you’re really talking outta yer hat, aren’t you? I mean, this is something they taught you back at priest school, isn’t it? Not the all things come to pass thing. I mean your presumption that I will without doubt be delivered from this distressful circumstance to some peaceful equilibrium. It’s not anything that comes out of your own lived experience, is it?”

“Would my presumption be a more valid proposal if it did?”


“Then I am sincerely sorry for never having been in a suicidal state, so that now my words would reflect that personal experience.”

“Thank you for saying so. I believe that’s the first honest thing you or 5-O has said this morning.”

“Consider me your student, Mr Rubeni.”

“Don’t ruin it, mister priest.”

“I’ll try no to.”


“Is there any material thing I can get for you?”

“No. Just back off for a while. I need to think.”

“Very well.”

It was nice when the priest finally backed off and Rubeni could breathe. He wasn’t a religious man, certainly not a Catholic. Who could be Catholic, anyway? A religion ruled over on Earth by a man they considered infallible. A man, therefore, who didn’t have the word oops in his vocabulary. A man who couldn’t, by definition, be implicated in any mishap or, apparently, even trip on a curb. Had they built Vatican City without curbs, he wondered. That would certainly decrease the chances of the Pope tripping and unintentionally saying oops.

And it wasn’t that he didn’t believe in God. Rubeni knew God wasn’t dead; God was alive and well, and fucking with the world constantly. It was just that he couldn’t connect the God of Exodus and Leviticus with the God of iPhones and Gangnam Style. Where was Rubeni’s burning bush? Where was God’s code whispered in the leaves and deciphered in Rubeni’s dreams? Absent, he deduced, as he fell, seeing Mrs Wilshire, the tenant who lived below him on the fourth floor looking out her window.

Their eyes met, and Rubeni felt slightly ashamed. There was good-bye in Mrs Wilshire’s moist, elderly eyes. He’d carried her groceries and had looked after her three cats when she’d gone to Saskatoon. Now she was witnessing him fall from above toward the merciless pavement below. There were nightmares in her future, all of them his fault. Perhaps he should have chosen another high spot from which to jump, but that was silly.

As he once more marvelled at the slow passage of seconds, Maria came to mind. Maria, the tall dark idol he’d worshipped and nearly married. There she was, vividly driving her Smart Car through the city with her yoga mat in the back seat and her bag of organic grapes riding shotgun. What could be the point of this new torture? He had adored her. It was Maria who’d called him amazing. The Amazing Rubeni, she’d said, as though he were a circus act. He didn’t know at first if he should resent it. Had she been laughing at him?

But she’d meant his poetry, his confidence and intensity in a world too frightened to correctly name its trepidation. She’d said she loved him, that she wanted to marry him. That was until she witnessed his mania, how it had manifested out of his artful sub-sanity into shambolic inner rage that tore him to pieces. Had she known about his bipolar disorder? Of course. There were no secrets. And she’d had the greatest of empathy, until he showed symptoms. Then it was no longer a conceptual thing defined in textbooks and hidden behind a curtain of medication. Then it was too much and she’d run away to her Buddhist retreat to count her breaths.

Hadn’t it always been this way? Wasn’t this the reason for him, in this moment, arcing out through space, compelled by the downward tug of the planet’s molten core? — the world always impressed by him in the beginning, then equally appalled as he imploded into confused, teary eyed calamity, again and again, as he wrote each suicide note in rich, cataclysmic pentameter? His irredeemable couplets tattooing the red brick back alleys walls that mapped out is volatile mind. There was no pill for this shame, no prayer. No nanosecond short enough or equation comforting enough. It was an episodic landscape of jagged slopes throughout adolescence and into adulthood, mountain ranges of mood with valleys deeper than the darkest imaginable stanza.

Wasn’t it all a comedy? If so, then surely there’d be good-hearted laughter any moment, no?

His mind returned to a second before, and saw the priest approach him once more.

“Have you had time to reconsider, Mr Rubeni,” the priest asked.

Rubeni looked down at his untied shoelace. “Tell me one hopeful thing, mister priest,” he said.

“If you choose not to jump,” said the priest, “this will turn into a story of personal strength and redemption.”

“Is that it?” said Rubeni.

“Where there is life, there is hope, my son. Your escape from this will bring hope to others.”

“That ain’t much, but fuck it,” Rubeni said, and commenced turning away from the empty space below. “Maybe that was the one right thing to say, mister priest.”

The priest smiled. If Rubeni came in off the balcony now, there still might be time for racquetball at the seminary, and a previously scheduled lunch appointment.

But turning round on that small ledge, on the wrong side of the balcony railing, was more difficult than it appeared, and Rubeni stepped on his loose shoelace. It happened just in time for him to make eye contact with the priest, and they both knew then that he’d lost his balance. The priest lunged forward and Rubeni reached out, never having wanted to live so badly. But the priests hands failed to grasp his, and the Amazing Rubeni fell.

W = m * g


how to take antipsychotic medication

to sleep like a seed
& dream of a garden
the stem I will be
bent under late snow

voices on oils
their lips their
stilled tongues & rapid eyes
they think of me as family
from a tragic buttoned distance
the Christmas poet
still as a century
on a Seroquel street corner
in my shoplifted coat

take at bedtime
the label says or
when the angels gather &
hum your name or
do not take them at all &
fall in with the angels &
walk with them their
whispered mile

bedlam boy

dark condenses finely upon
each object in the room the
psychiatrist’s stare is his

am a true bedlam boy a
waste of his DSM mysticism
administered & urging my brain on
toward cheerful banality some
pedestrian evenness where
razorblades offer their blue innocence
like a child’s simple grin

meanwhile I
am thinking of a
garden wet & dark with
unreliable night
wrapping round pointless paths &
kept by a great wooden gate

spider waits all
eight-eyed upon
her coiled labour for the
food chain to draw taut round
a buzz of blind protein the
near disaster of broken silk the
tickle & panic the

psychiatrist scribbles on
creating more artefact with my
name upon it he
looks up at me then
scribbles more while

somewhere there’s a
highway a
cigarette commercial a
convertible with a well vetted woman riding
shotgun he’d
rather be with than
me in this room but
there are profession & possession & the
dewy garden at dawn he
hasn’t considered