Do I write because I’m mentally ill? Or am I mentally ill because I write?

“Am I in hell?” I ask the ER psychiatrist at Johns Hopkins. My face is a stinging, salty mask. The young doctor, who introduces himself only as “Ed,” wears green scrubs and sneakers.

“How strong is that delusion, Alaina? How long have you had it?” he answers.

“Maybe I’ve already committed suicide,” I shoot back, pacing in wobbly circles, “and hell is this hospital. I can’t seem to get out of it.”

“I think you’re messing with me, Alaina,” he says flatly. The slight, terse menace in the words is like a stick snapping in the night forest. A tiny, stone-cold voice rears up through the last several hours of pain and despair.

Be careful.

Diagnosis: Out of choices

I’ve been in and out of many doctors’ offices and hospitals over the last several years, with poorly understood diagnoses like interstitial cystitis and fibromyalgia. They bring equal measures of grief and relief. We can’t cure the agony, but we can help. Here’s the reason you’re hurting.

Is this different?

Ed folds his arms. His stillness, the deliberate distance he keeps, and the way his eyes track my body, make me take my first real look at the room I’m trapped in. It’s probably about 8 x 12 feet. There’s fluorescent lighting. No light switch. Cabinets, locked. A stainless-steel sink and counter, a hospital bed made up with a rough white blanket, and a rolling bedside table. Even the soap dispenser has been taken away, leaving its plastic fossil on the wall. A heavy wooden door. A thick glass window. On the other side, an atoll of computers, nurses, and uniformed guards. Other patients huddled on beds, wailing, shouting, or slumped as if dead.

After disappearing for perhaps an hour, Ed returns with a fistful of paper. He explains something about 72 hours. I can still choose to sign the papers “voluntarily,” or, well, the rest isn’t clear. But somehow, it is.

I force my hot, blurry eyes to read the words on the form.

“So, in your opinion, what mental disorder do I exhibit?” I ask Ed.

He shrugs.

“Could be adjustment disorder,” he replies. He asks a few pointed questions about my appetite, and leaves me alone behind the door, drenched in my own pain and panic, for 12 hours.

“S.I.,” the letters I heard the ER nurses murmuring, must stand for “suicidal ideation.”

After five months of being mostly bedridden with excruciating pain, is it strange that death would become a fantasy instead of a fear?

What’s in a name?

There’s no blood test or X-ray or MRI for psychiatric problems, but that doesn’t mean doctors don’t rush to define and categorize them.

“Adjustment disorder” is just one diagnosis I get.

Ruling out the really bad stuff

I conduct several interviews a week for my work with NewsWorks and other outlets, but at Hopkins, where I’m trapped for four days, the tables are turned. I’m summoned many times to an office crammed with several people: up to three psychiatrists, a nurse, a social worker, and an earnest med student in glasses with thick black frames. Some introduce themselves to me, some do not.

As if to test gaps in a shady alibi, the same questions pelt me again and again; in the office and in my bedroom on the ward, where any doctor or nurse, man or woman, can enter at any time. Do I hear voices or see things that aren’t really there? Do I believe that other people can steal my thoughts or control my mind? Have I attempted to hurt myself? Do I want to hurt others? Do I just feel very sad, or do I have times when I’m very active and have trouble controlling what I do? How many drinks do I have per week? Do I take any drugs? How much do I eat, and when?

With a long history of clinical depression, I know the gamut. The first thing any M.D.’s gotta do is rule out addiction, schizophrenia, eating disorders, bipolar disorder, and maybe a few others before they can type plain old “depression” into the diagnosis field on their screens and explain to me that pain is a physical and psychological issue.

I know what’s wrong with me. I think. Yeah, medicine is tricky: I went to multiple orthopedists for my debilitating back pain, had three MRIs, and got what sounded like three different diagnoses: dark disc disease, spondylosis, and degenerative discs. But it turned out my doctors all agree: I lost the genetic lottery and the discs between my lumbar vertebrae are deteriorating, fissured and dry, even though I’m barely 31. Physical therapy may help.

Psychiatry is harder.

Hear those questions enough times, especially with locked doors, guards in the hall, mirrors that are polished metal plates bolted to the wall, bins of plastic utensils with no picnic in sight, and you start to feel scrambled in a way you never do at the orthopedist.

I make a friend on the psych ward — another wary, weary woman incarcerated for having depression. After we’re released, we become pen pals.

“It has been suggested by some that I am bipolar,” she writes to me a few months later. “I have resisted the idea, because I’ve never been manic. But like many things on review, I can begin to doubt even that certainty.”

This is because she had a few days when she suddenly roused from her usual deep apathy to bake for people who are helping her family. Was she in the mood to bake? To say thank you? Or was this outburst of cookies, at long last, the “mania” that psychiatrists have been grilling us about for years?

My own discharge papers announce recurrent major depressive disorder, but my new outpatient psychiatrist has his own ideas.

I’m not crazy, I’m just a writer

I take a lot of notes during our session, like I do in any meeting.

“What are you writing?” the new psychiatrist asks. He sounds uncomfortable. I explain that taking notes keeps me focused, grounded, and helps me remember important details.

Since I was a child, I’ve needed to write almost as much as I need to eat and sleep. Writing is as consuming and illuminating as it is soothing. I tell the doctor that writing is often the only thing that quiets the black storm inside my head.

He says I’m obviously “highly functional,” and declares my disorder treatable through psychotherapy.

What disorder is that?

“Has anyone ever talked to you about a borderline personality disorder?” he asks, stretching back in his chair.

No, not like dissociative identity disorder, he clarifies. Instead, I have coping mechanisms that aren’t constructive.

Specifically, he adds, my history points to obsessive compulsive personality disorder (OCPD).

“What obsessive compulsive behaviors do I exhibit?”

“Well, there’s the writing,” he says.

Crap.

I tell my psychologist about my latest diagnosis. She pulls her DSM off the shelf and reads the list of OCPD symptoms aloud, as if we’re sitting down to a freshly opened puzzle.

Workaholic habits, a hyper-intellectual orientation, aversion to emotional displays, perfectionism? Well, yeah.

But a rigidly controlling attitude, a refusal to adjust to others’ working styles, and getting so bogged down in the details that I can’t complete tasks? That’s the antithesis of my life as a successful freelance writer and editor.

Do I have a personality disorder? Do I write because that’s the only way I can keep the painful paralysis of my depression at bay? Or do I just love my craft?

One more down, a billion to go

After my latest diagnosis, a few things happen.

A psychologist pal warns me that a possible personality disorder might be too stigmatizing to write about. I write and publish a few dozen articles on a few dozen topics since my release from Hopkins in May. When I’m not working, the depression looms as heavily as it ever did.

And I don’t trust psychiatrists anymore.

I know myself. I know a lot of writers. And part of me thinks that psychiatrists, with their lucrative jobs, relatively normal working hours, and plush offices, would put us ragtag writers in the DSM one way or another.

Or is that my illness speaking? We’ll never know. This article, at least, is finished.

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A version of this essay first appeared in Broad Street Review.