What It Means When Catherine Zeta-Jones Says She’s Getting “Bipolar Maintenance”

Catherine Zeta-Jones, who has bipolar disorder, has checked herself into the hospital for treatment. Her publicist has explained this a proactive visit, and a source told TMZ the hospital stay is “maintenance.” As a result, the National Alliance on Mental Illness’ medical director has commended Zeta-Jones: “It’s great that she is getting help for herself and serving as a role model.”

And indeed she is, though I’m sure many people have no idea what they’re all talking about when they say the hospital stay is for “maintenance”—as though she’s a car in for a tuneup. Thing is, it’s not too different from an automotive tuneup. A twist of the wrench here, a ribbon of oil there, and things run a lot more smoothly. Only the twists and ribbons are medical interventions.

In psychiatric parlance, the word “maintenance” is most often associated with electroconvulsive therapy (ECT)—what’s colloquially known as shock treatments. Carrie Fisher gets maintenance ECT, as she’s written, and who knows? Maybe Zeta-Jones does ECT too. But it’s just as likely that her tuneup is pharmacological—a few weeks or so to deal with those pesky medications.

The saying “the cure is worse than the disease” must have been coined in relation to pharmacology, because taking medication long-term is a bitch. That’s true for any medication for chronic illness, of course, but psych meds deserve a special place in hell when it comes to potential long-term impact. First-generation antipsychotics cause cardiovascular disease. Atypical antipsychotics increase the risk of diabetes. Lithium can wreak havoc on the kidneys. Benzodiazepines take a toll on memory and cognition. The list goes on.

When one of these long-term effects rears its ugly head, a medication has to be adjusted—either discontinued altogether, or its dosage changed, or combined with another med that has an ameliorating effect. It may not sound that complicated, but it’s a huge project—the kind that conjures the same dread you feel when your mechanic says, “It’s the transmission.”

I’ve gone through many med changes, but my transmission breakdown came when my so-called magic bullet, Seroquel, started to make my legs and arms feel creepy-crawly, like there were tiny worms under my skin, and I couldn’t sit down. That side effect is called akathisia, and in the 10-plus years the medication kept my brain on track, I’d never had to deal with it. So where did it come from all of sudden? My doctor didn’t know. Satan, probably. After a careful evaluation of all the options, we decided the safest thing to do would be to discontinue the medication entirely. You don’t want to mess around with neuromuscular side effects—that’s how people end up twitchy.

But the reasons for med changes aren’t always so dramatic. Maybe you’ve got a new exercise regimen or a new diet; maybe you’re pregnant or trying to conceive; maybe you’ve decided to quit drinking or start smoking pot. A new job, a breakup, moving to a new apartment—life changes big and small can have an impact on how medication works. It’s a delicate balance that needs constant reassessment. Unlike Catherine Zeta-Jones, however, most people don’t have money to go to a fancy looney palace where they’ll be monitored as they come off one medication and then try numerous replacements.

Instead, they taper the meds s-l-o-w-l-y, and at home. It’s frightening and exhausting to be ping-ponging between one side effect and another, to have your mood shift unpredictably, to exercise hypervigilance on your own behalf because there’s no at-home medical supervision. And it’s virtually impossible to explain to an employer what’s going on—and why it’s going on and on for weeks. Frankly, I’d rather not bother. At the moment, I’m taking 60 milligrams of something I only need 30 milligrams of, but who has the time for the withdrawal? Catherine Zeta-Jones, that’s who.

Zeta-Jones has Bipolar II, which means when things go awry, she likely descends into a deep, dark well of physical paralysis and mental anguish. Preventive care—maintenance, a tuneup, proactive hospitalization, whatever a publicist calls it—is essential. What’s better, she’s making a point of being forthright about her treatment, with no apologies. I appreciate her honesty. But most of all, I’m terribly envious. I’ll bet wherever she’s getting her tuneup, the thread count of the sheets is really high.