In today’s New York Times, a novelist describes his mental breakdown: Manic-depression (bipolar disorder)? Multiple personality? Both?

In a personal essay—“A (Manic Depressive) Man’s Best Friend”—published in the Sunday Review section of today’s New York Times, novelist Karim Dimechkie describes his mental breakdown:

“…I graduated, sold my book, and left Austin…for Manhattan…where I would have an inexplicable meltdown. Inexplicable may be the wrong word. There are always explanations. Manic depression for one…But surely the mental downfall had something to do with the void I’d dropped into upon finishing my novel, the end of grad school and that safe identity of ‘student’ it had offered, and the supremacy of New York City over my senses and bank account and of course, the strangers who have always lived inside me, humming threats of destruction, finally making good on their promise to bring the house down. Some combination of these wrapped me in fear, neediness, confusion and anger…

“…I cracked up in the middle of Essex Street, unable to stand, sensory distortions clanging around my head…I barged into a behavioral health clinic…and shrieked for immediate professional supervision, which later led to intensive therapy and medication…I spent the afternoon imploring my brain to switch itself off. Wanting badly to die but unable to kill myself…my delusions made me see my loving partner as a merciless deceiver…four months later…I surfaced from whatever absurd agony I’d been drowning in. Finally able to sleep again. Finally able to trust again…”

Now, he may very well have manic-depression (bipolar disorder), and he may be describing a mixed episode of paranoid mania and suicidal depression. But, inconsistent with that diagnosis, is this: “the strangers who have always lived inside me, humming threats of destruction, finally making good on their promise to bring the house down.” This seems to describe alternate personalities, who have “always lived inside me.”

Manic-depression cannot account for a longstanding, continuous sense of having strangers living inside you. Multiple personality could account for that, but it was never considered.