Monica Fahmy, PharmD; Alyssa M. Peckham, PharmD, BCPP
Zack McDermott’s Gorilla and the Bird takes readers on a whirlwind of emotions while discovering the ins and outs of McDermott’s bipolar disorder based on his true life events. McDermott worked for the Legal Aid Society of New York as a public defender and is now the co-founder of the GorillaBird Foundation with his mother. In this memoir, McDermott beautifully articulates his life leading up to, and throughout, psychosis prior to his diagnosis of bipolar disorder. He writes about his experience with manic episodes but also describes the process of re-integrating into society after these psychotic breaks and inpatient hospitalizations. McDermott also emphasizes his experience with depression which followed manic episodes. Through his stories, he can begin to predict that the greater the manic episode, the worse the depression.
Being a recent pharmacy graduate, I have learned about bipolar disorder and its risks, signs, symptoms and treatment. However, learning about a mental illness and hearing it from the viewpoint of someone with lived experience is incredibly different. McDermott invites readers into his mind during his psychotic breaks – he describes exactly what he was thinking during these episodes which allows readers to develop a deeper, more emotional understanding of the illness. We understand that what these patients may be hearing or seeing during manic episodes, namely hallucinations, becomes their reality. This becomes more evident through Zack’s description of events and checking off the list of clinical diagnostic criteria for Bipolar Disorder I becomes apparent.
DSM-5 diagnostic criteria: A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day:
Right from the beginning, we are taken on McDermott’s journey of a manic episode where he is has an explosive personality, stopping to talk to and interact with everyone he meets, that is paired with high energy and rapid shifts between activities.
DSM-5 diagnostic criteria: During the period of mood disturbance and increased energy or activity, three or more symptoms are present to a significant degree and represent a noticeable change from usual behavior:
McDermott quickly begins to believe his entire life is being filmed to star in a movie, to thinking he is going to be the next greatest comedian (grandiosity). He stays up most nights preparing his comedy (decreased need for sleep) or organizing his thoughts by writing them all over his apartment walls with red sharpie (flight of ideas), and he starts many projects and endeavors within a short period of time (increased goal-directed activity).
DSM-5 diagnostic criteria: The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
McDermott soon loses his ability to perform at work, show-up on time, and appropriately represent his clients which causes his colleagues to question his health and ultimately results in a medical leave of absence.
DSM-5 diagnostic criteria: The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or to another medical condition.
Initially, the onset of McDermott’s manic episodes that rapidly shift to psychosis seem to be related to smoked marijuana, but it later turns out that this is not the only driving factor.
With the discovery of his mental illness, McDermott was hospitalized and stabilized on divalproex sodium and risperidone, medications that are known to cause significant side effects, such as alopecia, increased sedation, drooling, weight gain, and impaired sexual dysfunction. He provides a patient’s insight of experiencing these side effects and how they impact his daily living. McDermott sums up the effects of his medications in the memoir when talking to his doctor as he says, “my hair is falling out. I’m drooling. I’m impotent. I can’t ejaculate. I go minutes without realizing I’m awake. And I’ve gained ten pounds in a week” (p.100). Despite learning about the side effect profile of these medications in school, it was troubling to read that on top of McDermott’s other life challenges (i.e. guilty feelings toward mother, shame/stigma amongst roommates and co-workers, embarrassment among friends), he now has significant side effects that he must manage or cope with as a tradeoff for euthymia.
A key element in this memoir is the tight-knit relationship of McDermott and his mother, who he refers to as the Bird. McDermott describes the hardships his mother has had to face her entire life, from having an abusive father, to having a brother with bipolar disorder who was beaten by police and admitted to a psychiatric ward, to dropping out of school after marrying a man who acted as though he were a drill sergeant. Throughout her life, the Bird only grew stronger and learned how to persevere. Throughout each of McDermott’s psychotic breaks, the Bird traveled from near or far to care for her son and played a large role in his acceptance of his illness as well as his access to proper treatment. Whenever McDermott was hospitalized, his mother was there to advocate for him and find him the best care possible. Because of her devotion to her son, McDermott was able to cope with his bipolar disorder and find ways to live a fulfilling life. Without the Bird, it is unclear what McDermott’s future would have looked like, which is a testament to how confusing it can be to navigate the mental health system without support or advocacy.
Overall, McDermott is unapologetically candid with readers about his experiences, his deep-rooted fear of the mental health system, and how he came to accept his mental illness. Because of this, this memoir is sure to enhance pharmacy student understanding of bipolar disorder, how it may impact patients and their families, and may instill a deeper sense of empathy for patients with bipolar disorder.