by Jane Green
‘What did he tell you?’
An empathic expression as Frank looks at her, pools of understanding and compassion in his eyes. ‘He said he’s very worried about you. That you haven’t seemed like yourself. I was hoping we could talk more about that.’
Grace takes a deep breath, thinking she has nothing to say. All morning she has walked around the house wondering what it is she should be talking about in the psychiatrist’s office, constantly coming up blank. They would sit in awkward silence, she thought. She would perhaps tell him a little about her life, but not much, for how could she reveal her self, her true self, to a stranger? How could she allow herself that vulnerability with someone she doesn’t know?
And here she is. Talking, suddenly. Her words tripping over themselves in relief at finally having someone to talk to.
‘I feel like I’m going crazy,’ she says. ‘I’ve always been so calm, so happy, and right now the tiniest thing sets me off in tears. I’ve always loved my life, but all I want to do is go to bed and crawl under the covers. And I know I’ve been flying off the handle at the slightest provocation. I know how horrible I’m being, but even when I’m in it, I just don’t know how to stop myself and I can’t stand feeling this way.’
Each time she finishes, or thinks she’d finished, Frank looks at her, nodding, as if he understands exactly, but exactly, what she is going through, as if he has felt the precise pain she feels. As if, were professional boundaries not in place, he would gather her in his arms and cradle her like a baby, rocking her to safety and warmth. As if the only thing he cares about, the only thing he wants in the world, is to make Grace better.
She talks, and cries, and laughs. She cries, and laughs, and talks. He has set aside two hours for this first session, and it flies by, Grace barely stopping for breath, aware only that she is in the presence of a warmth and compassion so strong, it feels as if she has come home.
‘I’m sorry,’ Frank says when the two hours are up. ‘We have to bring it to a close. How do you feel now?’
‘Oh God!’ Grace sits back with an embarrassed laugh, running her hands through her hair. ‘I feel . . . stunned. I can’t believe how much I had to say. I had no idea. How do I feel? I feel good. Really good! Talking to someone who understands! I never realized how powerful that could be. And I feel . . .’ Tears spring into her eyes. ‘Relieved. I feel relieved. I guess I never realized how alone I’ve been. Just being here and talking to you makes me feel I don’t have to do it all alone.’
‘That’s right. You don’t. Would you like to make another appointment, or perhaps think about it?’
‘Definitely another appointment. Tomorrow?’ Grace says, only partly joking, before they agree to a twice-weekly schedule.
Outside, it is as if she is noticing the sky for the first time. There is a chill in the air and the leaves are starting to turn. She stands in the car park for a while, her head thrown back, seeing, really seeing, the trees, and the sky, and the beauty of where they live.
She climbs in the car to go home, smiling all the way.
Nineteen
‘Grace really does seem much better.’ Ted puts down the pages he is editing and looks over at Beth, who has just walked in with a box of books she has collected from the post office.
‘I just saw her,’ Beth says. ‘She seems . . . exhilarated.’
Ted looks at her. ‘Exhilarated in a good way, though, yes? Considering how down in the dumps she’s been, ever since she has started seeing that Frank Ellery, she has seemed like a different person. She has had six sessions, and already she seems . . . better.’
‘You’re right.’ Beth puts down the boxes, then comes to sit in the chair by Frank’s desk. ‘She definitely seems happier. I guess I’m just worried it’s a little too happy.’
‘Is there such a thing as too happy?’
‘I don’t know. I just worry. I always think the goal in life is to be peaceful, rather than any of the extremes, in either direction.’
‘Hmm. Peaceful. I don’t even know whether that’s attainable for the average person, although it’s certainly an admirable goal. If peaceful is the goal, then no, Grace definitely doesn’t seem peaceful. Do you think I ought to have another chat with her doctor?’
‘I don’t know. Why do you think that?’
‘I suppose because I always see the fatal flaw in any kind of therapy is that you are presenting yourself to the therapist not as the world sees you, but as you see yourself. We build very careful constructs, creating who we wish to be. Asking us to strip those constructs away and present who we really are, when most of the time we rarely have any idea who we really are, seems impossible. How is a therapist supposed to decipher what is real and what is not, when they only have evidence coming from you? Frank did say to keep him advised of any concerns, or any behaviour I might find odd. “Exhilaration.” Interesting.’ He is now staring into space, talking to himself. ‘Not peaceful. I’ll have to give him a call.’
‘My mother was . . . difficult.’ Grace has been reluctant to talk about her mother. She has spent hours and hours talking about herself, her marriage, her husband. Anything to avoid the great big elephant in the room.
‘You have mentioned that before,’ says Frank. ‘A number of times, but you haven’t elaborated. Are you able to tell me a little more?’
Grace takes a deep breath, not knowing how to start. ‘Someone was talking recently about not having had a childhood because of their parents’ alcoholism, and I related. My mother was an alcoholic, which I think I’ve told you, but . . .’ She closes her eyes briefly, not having said the words out loud for years. The last time she talked about it was with Patrick, when her mother died. When she made a pact never to talk about it again.
‘She also had manic depression.’ Grace winces as she looks at Frank, expecting a look of sympathy, concern, but his expression is blank. ‘She had long periods of depression, when she was in bed and basically completely absent, and then suddenly one day she’d be up and out, and come home having spent thousands of dollars. Or she’d put me in the car for an adventure and take me to a casino. She would have these explosive rages that were completely and utterly terrifying to me. I spent much of my childhood trying to hide from her. And,’ Grace almost chokes out these next words, ‘I have spent my entire life terrified that I would turn into her.’ She exhales, stunned at the relief she feels, finally saying those words out loud.
Frank nods, watching Grace, waiting for her to say more, but she is done.
‘Thank you for telling me that. I can see that it was hard for you to put into words. Is this the first time you have ever admitted that to someone?’
‘That I’m frightened I’ll turn into her? Yes.’
‘I’m proud of you for doing that. Secrets are sickness, and once we voice our worst fears, it diffuses the power, the hold those secrets have had on you. I imagine you already feel better for having said it out loud.’
‘I do!’ Grace almost laughs.
‘I’m glad you told me. I won’t lie. From the little you had said about your childhood, I had already suspected that that was your mother’s diagnosis. I don’t, generally, like labels,’ he says. ‘I find them mostly unhelpful and often irrelevant. We tend to put someone in a box and treat the label rather than the person, and there is so much we miss when that happens.’
‘Yes!’ says Grace, who is aghast at how she is suddenly surrounded by people whose children have any variety of mental disorder she had never heard of ten years ago. ADHD at every turn, personality disorders – oppositional, defiant, disruptive disorders.
‘But sometimes,’ he says, ‘it is very obvious to me what is going on, and in these instances a label can actually be more of a help than a hindrance, can help the sufferer really understand why they are behaving the way they are, and what they can do to make it better. Particularly when there is a genetic component.’
‘Yes?’ Grace is cautious, unsure of what she is about to hear, wishing she hadn�
�t voiced her fears, wishing she could just stand up and leave.
‘We have spent several sessions talking about what you have been going through, particularly the mood swings and the anger. We have also talked a lot about the lack of sleeping and the bursts of energy you get. You’ve talked about your mother and I know how difficult it has been for you to admit your own fear of turning out to be like her. The first thing I want to say is that today, bipolar disorder is entirely manageable. If your mother were alive now, the chances are she would be on medications that would make her very normal. Unfortunately, these illnesses do have a genetic component. Even though you clearly do not have the illness to the extent of your mother, I am pretty clear that everything you’ve been going through is indicative that you are on the spectrum.’
‘What?’ Grace’s voice is a shocked whisper. ‘You’re telling me I’m crazy like my mother?’
‘No. That’s not what I’m saying. I think your mother had a very severe form of what we call bipolar one, periods of depression interspersed with classic mania. I’m pretty certain that yours is far less severe, what we call bipolar two, which is a far less dramatic version, but can still, nevertheless, be very difficult if it isn’t managed properly.’
‘I don’t think that’s a correct diagnosis.’ Grace shakes her head. ‘If bipolar is the modern name for manic depression, where’s the depression? And more to the point, where’s the mania?’
‘Grace,’ he says. ‘You’re sleeping your days away. What is that if not depression?’
‘It’s being up all night, that’s what that is. It isn’t depression. I don’t feel depressed. And the being up all night isn’t mania, it’s just . . . a phase. It’s more likely to be perimenopause than mania, for God’s sake.’
‘Being up all night is very common. Mania usually isn’t what people think, nor depression. This illness, it can manifest itself in a myriad ways, sleeping being one of the most common. As for being up all night, that is a typical example of hypomania, and what we call rapid cycling . . .’
He continues talking, Grace continues looking at him, pretending to listen, while everything in her mind is fighting what he is saying. There’s no way she has bipolar disorder, one or two. Is there? There’s no way her worst fears have come true.
She has always dreaded confessing her worst fears, saying them out loud for fear of them coming true, but now that she has, she realizes Frank’s proclamation that she does, in fact, have her mother’s disease, doesn’t feel right. There is no Aha! moment, no moment when she feels intense relief at someone having finally diagnosed what is wrong with her, someone finally seeing away to help.
There is nothing other than confusion and disbelief as she tunes back in to Frank.
‘I’m sorry,’ she says when he has finished explaining why he is so sure. ‘But I disagree with you. It just doesn’t resonate with me.’
‘Why would it?’ he says gently. ‘It doesn’t resonate with anyone. This, unfortunately, is something we see in almost all patients who have bipolar disorder – and, by the way, it’s important to point out the difference between being bipolar, and having bipolar – this is not who you are, it is something you have. But this initial resistance? It can take people months to come to terms with something so huge, and most struggle with acceptance until they realize the difference medication can make in their lives.’
Grace sits up. ‘Medication?’
His eyes liquid pools, Frank nods. ‘Grace, you have been struggling to deal with this very difficult disorder by yourself. Medication will make your life so much easier. Medication,’ he pauses, ‘will give you back your life. It will give you back yourself.’
‘But . . . but . . . are you sure? Are you absolutely sure?’
‘Grace.’ He smiles an indulgent smile. ‘I’ve been doing this a very long time and I’m very good at what I do. I’m not saying I’ve never been wrong, but in this instance there is no hesitation in my mind whatsoever. What I’d like to do is start you on a medication called Depakote. We’ll start at a low dose and gradually increase to the therapeutic level, and I think you’ll see very quickly how much better you feel, how much calmer you are.’
‘Depakote?’ Grace is numb.
‘Yes. It’s often used as an antiseizure medication, but has proved to be remarkably effective as a treatment for bipolar two. But Grace, this is important. I don’t want you to go online and read about it. Don’t read up about the side effects, because there is so much false information online. I advise all my patients to come to me if they have side effects, and we can deal with them together. In honesty, I think you will be fine on this drug. The only thing you might notice is a little more tiredness, but that should wear off after a week or two.’
‘I’m really . . . not comfortable with this.’ Grace feels as if she is about to cry.
‘I know. But I want you to think of it another way. Now you have an explanation for the way you’ve been feeling. The lack of sleep, the sleeping during the day, the anger, the flare-ups. You not only know that it isn’t your fault, but that it’s treatable. That’s the beauty of these medications, and in fact of having this kind of disorder. It’s entirely manageable, and very soon you will feel exactly like your old self.’
Grace, unfamiliar with doctors at every level, finds herself regressing back to a child, where doctors were akin to God, where when they told you they knew better than you, you believed them. Who is she, wife, mother, friend, who is she to tell the psychiatrist he might be wrong?
He does, after all, do this for a living.
If he says this is so, then what else can she do but let it be so?
It doesn’t feel right when Grace climbs into the car and heads to the pharmacy, prescription tucked into her bag. It doesn’t feel right when she goes in, forcing a chat with the pharmacist she has known for years, handing over the small green and white slip of paper, watching his facial expression carefully as he reads the prescription, waiting for him to look at her with surprise, but his face is blank.
It takes fifteen minutes. Fifteen minutes, during which time Grace walks around the pharmacy, weighed down with shame.
Bipolar disorder. How can this be? How can she have spent all these years being perfectly normal, only to have suddenly developed a mental illness at this age.
Her session, the conversation with Frank, plays over and over in her mind. Her resistance, her arguments, his persistence, his explanations. And above all, his overriding, omniscient and absolute declaration that in this instance he was right, and there was no doubt whatsoever in his mind.
The exhilaration she had been feeling at having found someone to talk to, at no longer feeling she had to shoulder this burden of life on her own, dissipated earlier today in his office, and there is little sign of it returning.
Back home, about to make fish cakes for dinner, Grace pulls the mayonnaise and mustard out of the fridge, then pauses, pulled by the pharmacy bag sitting in the middle of the kitchen counter.
Depakote. Grace Chapman. She examines the bottle, turning it over and over, preparing herself to set foot on a journey she does not want to start.
But think, she tells herself, of what you have been feeling of late. Think of the anger, the tears, the way you sometimes feel as if your head will explode with all the chaos it contains. What if he is right, and my resistance, my lack of willingness to believe in the diagnosis, is part of the disease?
What if these pills do indeed turn out to be magic, and I am restored to my old self?
Then it would be worth it. She doesn’t have to stay on them for long. Right now she doesn’t have much fight left in her. The easiest thing to do is to take them to make everyone happy. And if they don’t work, she’ll simply stop.
FISH CAKES WITH TOMATO SAUCE
(Serves 4)
INGREDIENTS
For the cakes
450g cod, or similar white fish, poached
1 egg
4 tablespoons mayonnaise
1
tablespoon Dijon mustard
1 tablespoon dill
Zest of 1 lemon
Approximately 25g panko breadcrumbs
65g all-purpose flour
Salt and pepper for seasoning
For the sauce
½ white onion, chopped
1 clove garlic, minced
1 medium can chopped tomatoes
1 tablespoon olive oil
Cayenne pepper
Salt
Flake the fish and mix together the first six ingredients. Season. Add breadcrumbs until mixture is firm enough to form into patties. Shape into patties and refrigerate for at least 1 hour.
For sauce, soften onions in olive oil for around five minutes. Add garlic, then cook for a further 5 minutes. Add canned tomatoes, and heat on low heat for around 15 minutes. Season well, then puree into smooth sauce.
When ready to cook the fish cakes, dip in flour, then saute in butter and olive oil until golden brown.
Twenty
Never in her life has Grace slept as much as she has been sleeping these past three months since starting the bipolar medication, and never in her life has she felt so utterly, completely depleted.
I feel as if I have been drugged, she keeps thinking, remembering with irony that she has been. Frank has assured her this exhaustion is temporary, that it will wear off, but she can barely crawl out of bed. He has prescribed more pills to try and help – something to try and reduce the tiredness, try and keep her awake, and Metformin, which has, she vaguely recalls, something to do with blood sugar. It isn’t used as a diet pill exactly, said Frank, but it would stop her cravings.
For Grace has been hungrier than she ever would have dreamed possible while taking these pills. Starving. Her stomach a bottomless pit, never full, thinking only about what she can eat next, even before she has finished eating whatever it is she is currently eating.