Modern Madness

by Terri Cheney

  I once tried to explain this to a new boyfriend who was chiding me for, as he put it, “actively resisting pleasure.” I told him I was concerned that I was feeling so marvelous because I didn’t know why that should be the case.

  “Sounds like a champagne problem to me,” he said. “Just go with the flow, like I do.” (Yes, he spoke like a ’70s greeting card and no, we didn’t last long.)

  “But what if you can’t stop laughing, for no good reason?” I persisted. “It doesn’t disturb you in the least that you don’t know why?”

  “I don’t care what the cause is,” he said, drawing me closer. “I just enjoy the effect.”

  How I envied his careless insouciance. For me, happiness always needs a hook, a place to hang my emotions on—and I was sure he wasn’t it.

  So on that plain old Tuesday morning, I looked around me: same stack of laundry on the chair, still not folded; same pile of bills on the table, still unpaid. I glanced out the window: It wasn’t a particularly nice day. In fact, it looked rather gloomy, dark gray nimbus clouds threatening rain. And yet, and yet—I couldn’t help it. I felt all sunny inside. I buttered my muffin and savored each bite. Then I emailed my therapist: “Feeling awfully good today.”

  “Careful,” he replied.

  THE HAPPINESS HUSTLE

  Sometimes I feel like life is run by a snooty maître d’. The joy section seems strictly reserved for other people—people who don’t have to struggle with their sanity every day. Lucky people. But do they make their own luck, and thus their own joy? It’s a question I wrestle with every day: do I work hard enough at being happy?

  I have a dear friend, Arnold, who’s eighty-six years old and keeps getting battered by cancer. In spite of his hardships, he has the joie de vivre of a child. His grin reaches from ear to ear, it comes sparkling out of his eyes. He cultivates culture like no one I’ve ever met before: always at this or that premiere, the hottest plays, the coolest restaurants. He’s like a burst of jazz that revs you up, that you can’t help tapping your feet to. For me, he is quintessential joy.

  A few summers ago, Arnold asked me to join him and some of his friends at the Hollywood Bowl (where he has a center box, naturally), to hear the celebrated pianist Lang Lang play with the L.A. Philharmonic, under the direction of the great Gustavo Dudamel. Despite the glittering program, I hesitated before saying yes. I was fighting a severe depression at the time, so bad I had to write down reasons to live. I wasn’t sure I could commit to tomorrow, let alone an excursion a whole week away.

  Arnold knew I was depressed, and he knew the depth of my depressions. He didn’t try to argue me out of my feelings, but he urged me to go with him anyway. “You’re a fighter,” he said, a huge compliment coming from him. “And besides,” he added with a sneaky smile, “it might be material.” He understood me all too well—writers can’t resist a possible story. With misgivings, I agreed to go.

  But when the day of the performance came, my funk was worse than ever. It didn’t occur to me that I might feel better if I got out for an evening: that’s not how I think in depression. It always feels dangerous to raise my hopes because when they’re dashed, I fall even lower than before. It’s much safer not to hope at all. At least, that’s what I told myself as I sat down at my computer, composing my regrets. I tried out various excuses and lies, but none of them sounded convincing and all of them sounded ungrateful. I finally got so frustrated I just said to hell with it, and threw on some clothes.

  Three hot, sweaty, honking hours later I arrived at the Bowl and found the box. Arnold greeted me with a great big hug that I wanted to feel but couldn’t. I dutifully smiled my way through introductions and conversation. Although I was hardly in a picnic mood, I filled my plate, chewed and swallowed appropriately. In short, I performed on my own little stage. It’s incredibly hard to withstand the beauty of the Bowl—the huge trees framing the Art Deco clamshell, the cobalt twilight, the star-pocked sky—but I tried. I did my best to uphold my stalwart code of depression.

  Then the orchestra played “The Star-Spangled Banner,” and fifteen thousand people stood up to sing along. As if on cue, a breeze lifted the flag and it waved in allegiance with the music. My eyes began to sting—I blamed the breeze—but before I knew it a tear had rolled down my cheek. A chunk of the ice that was my soul was slowly beginning to thaw.

  Lang Lang came out and made love to the piano, while Dudamel seduced the orchestra. It was all very erotic: the light wind on my sweaty neck, the clustered nearness of so many strangers, Tchaikovsky stroking my senses. I tried to resist being touched, being moved—but then I saw out of the corner of my eye that Arnold was so rapt in the music, he was waving his arms like Dudamel, leading us on. The sight was too charming: I couldn’t help but smile.

  It’s scary to let down my defenses when it feels like they’re all that’s holding me together. But I forced myself to surrender, and let it all flood me: the glorious music and the treasured friendship and the magnificence of the setting. I worked hard at being happy, like Arnold does, and the rewards came tumbling in. I completely forgot that I was depressed, and didn’t remember until I got home. But by then it was too late to do anything about it, so I washed my face, conducted a bit of Tchaikovsky in the mirror, and slept until morning.

  SECTION VI

  Maintenance

  MEDICATIONS

  “Canst thou not minister to a mind diseased, pluck from the memory a rooted sorrow, raze out the written troubles of the brain…?”

  —William Shakespeare (1564–1616), Macbeth, act 5, scene 3

  Antidepressants are the second-most commonly prescribed drugs in the United States, just after cholesterol-lowering drugs. According to the American Psychological Association, most antidepressants are prescribed by primary care doctors “who may have limited training in treating mental health disorders.” In the United States, almost four out of five prescriptions for psychiatric drugs are written by physicians who aren’t psychiatrists.

  And yet, experts believe that psychotropic drugs are both overprescribed and underprescribed. Many adults who could greatly benefit from the drugs—those with psychotic disorders, for example, or major depression—do not receive treatment. Stigma (“pill shaming”), financial constraints, a lack of insight into their illness, side effects, and other concerns prevent them from seeking or obtaining help. At the same time, many people with mild or situational depression are prescribed antidepressants even though other treatment modalities, like cognitive behavioral therapy, have proven more effective (https://www.apa.org/monitor/2012/06/prescribing).

  Despite the controversy, there is no question that medication plays an essential role in controlling mental illness. As the Mayo Clinic observed, while psychiatric drugs don’t provide a cure, they can significantly improve symptoms. They can also help make other treatments, such as psychotherapy, more effective by giving the patient the stability needed to address their problems (https://www.mayoclinic.org/diseases-conditions/mental-illness/diagnosis-treatment/drc-20374974).

  Medication compliance isn’t easy—it’s rather heroic, when you consider how difficult it can be. But it’s critical for those of us who need these drugs to live productive, healthy lives. Pill shaming doesn’t occur with insulin; there is no reason it should occur with medications used to treat a brain dysfunction.

  MIXOLOGY: THE MEDICATION COCKTAIL

  At one of my recent speaking engagements, an angry young woman brought up the subject of medication compliance. “Why don’t people just stay on their meds?” she asked me. “It seems like every time something really bad happens, you hear that the person went off their meds. It’s become such a cliché.”

  There were murmurs of assent in the crowd. Another woman spoke up. “All of you”—all of who, I wondered—“keep telling me that mental illness needs to be treated just like physical illness. Fine, then people should take their medication, just as if they were really sick.”

  That “really sick” got under my skin
, but I understood the woman’s frustration. Medication compliance is a hotly emotional topic, and I rant about it, too. It makes me furious when people get into trouble because they’ve stopped taking their prescribed medication. It tars me with the same stigmatic brush—I must be violent, or dangerous, or a ticking time bomb—even though I steadfastly take my pills every day.

  But, and how bipolar is this, I can see both sides of the argument.

  Taking meds is really hard. In fact, I doubt most people realize how difficult it is to coordinate all the drugs that are necessary to keep a person with bipolar disorder stable. Many of us—perhaps most—must take a “medication cocktail:” drugs to avoid mood swings; drugs to counteract the side effects of those drugs; drugs to ameliorate the side effects of the side effects drugs, etc., etc. I mean, come on. I have a J.D. and it takes all my mental acuity just to figure it out: which meds need to be refilled when; which should be taken in the morning and which at night; which must be taken with food or on an empty stomach; and annoying little details like whether grapefruit juice is safe. It’s mind-boggling, and you need an advanced mixology degree to prepare the perfect cocktail—which is only arrived at by months, sometimes years, of trial and error and constant, ongoing tweaking.

  So why do it? People often ask me this (medical doctors, especially): You seem stable enough. Why do you take all these drugs? As if it’s a whim, or a joyride, or something that I choose to do because it makes me high. The truth is, without the drugs I’m a mess. Or as my psychiatrist once put it bluntly: “a menace to society.” That was back when I was still drinking and didn’t take the myriad of warnings on the medication labels seriously. Back when I considered the “Don’t mix with alcohol” proscription to be a suggestion, not a mandate.

  Doctors don’t tell you the secret life of meds when they rip off that scrip and send you toddling off to the pharmacy. Pharmacists don’t, either. It’s up to you to read the Patient Information Leaflet that sometimes comes with the pills, sometimes not. It’s written in teeny-tiny, frequently unintelligible clinical-ese, with a list of potential side effects that quite often includes cancer and death. It takes blind faith in your doctor and the health care system to swallow that innocent-looking capsule and pray that your nose doesn’t fall off.

  In the end, faith and hope are the key ingredients in any medication cocktail. Faith in your doctors and hope that this last little pill will finally, please God, take the pain away and make you feel normal—or at least like everyone else. If you have bipolar disorder and you believe in Western medicine, you are conscripted into the religion of psychopharmacology, whether you want to believe in it or not.

  But hey, I know I’m lucky to be able to afford treatment at all, although it’s obscenely expensive. I’m lucky to have found drugs that work for me, much of the time. So many people never experience relief, and so many refuse to avail themselves of the opportunity. Perhaps, like me, they don’t like to feel dependent on anything other than their self-control. But I’ve seen the results of my self-control, and I’m far better off taking drugs. Hence my medication compliance: it’s not because I possess better morals, it’s just that I have sufficient evidence of who I was before.

  THERE BUT FOR THE GRACE OF MEDS…

  I was not happy. I was waiting in line at the pharmacy to pick up a prescription; it was one of my more expensive medications, and I didn’t look forward to forking over hundreds of hard-earned dollars. As I waited, I wondered: Why was I taking this drug, anyway? It’s an atypical antipsychotic, and I’ve never been psychotic. Maybe that’s where the atypical comes in. Who knows? Nobody really understands the mechanisms of these psychotropic medications because nobody really knows what causes bipolar disorder in the first place. It’s a frantic rub on a genie’s lamp.

  But I waited in line, and I got out my credit card because that’s what you do when you’re medication-compliant: you comply.

  The outside door opened, or rather the door was flung open by a middle-aged woman. She was crying, and in a voice loud enough to reach every corner of the pharmacy, she yelled, “I’m not going to f***king jail!” This was followed by a string of curses, which were so profane I’m not even going to try to reproduce them here. I took a quick look at her and backed away, as did the other two people in line with me.

  Her clothing was disheveled, her face deeply weathered, and a powerful stench of sweat and urine enveloped her. She didn’t look at me or at anyone, for that matter. She just continued to curse in a voice so harsh and guttural it actually hurt my ears. I wanted to leave but she was blocking the exit.

  “Call my goddamn doctor!” she shouted. “Do it! Call him! I’m not going to f***king jail!”

  I felt dizzy, not because of the smell or my fear, but because I was suddenly plunged deep into déjà vu. It was maybe fifteen years ago, and I was walking along in a shopping mall. Well, “walking” may not be the right word. I was stumbling. Listing. Aspiring to step in a straight line, and failing. I was taking a new drug called a monoamine oxidase inhibitor, or MAOI for short. It was a last-ditch medication for treatment-resistant depression, and if I hadn’t been so desperate I never would have taken it.

  The side effects were truly debilitating: if you ate pizza or soy sauce or any other food containing a substance called tyramine, you could suffer a fatal stroke. Same if you took it with other antidepressants, or allergy medications. Or alcohol. Niggling little issues like that. But what really concerned me were the unpredictable and severe spells of dizziness I kept experiencing. I was okay so long as I was sitting down, but once I was standing or walking I never knew if I’d find myself fainting in a stranger’s arms. There was nothing romantic about these swoons. More often than not, I fell and hit my head or incurred a nasty bruise on my increasingly black-and-blue body.

  That particular afternoon I was feeling my usual woozy—so much so that I’d actually taken a cab to the mall, an expensive precaution but I didn’t want to risk driving. I took a few shaky steps, and a blinding whiteness engulfed me. I heard a loud buzzing, as if I were suddenly swarmed by bees, but before I could wave them off my knees buckled and I fell to the ground. A sharp searing pain stung my cheekbone. After that, I heard nothing until I was shaken awake by a strange man in a familiar uniform: a cop. Not a mall cop, either. A bona fide pistol-toting, stern-faced policeman.

  “What’s your name?” he asked. I shook my head free of its fog and told him.

  “Let me see some I.D.” My hands were shaking—cops make me nervous—but I rummaged through my purse and produced my driver’s license.

  “But I didn’t drive here,” I said. “I took a cab because—”

  “Ms. Cheney, have you been drinking today?”

  I vehemently shook my head no.

  “Because you appear intoxicated to me.”

  “I’m not intoxicated; I just got dizzy, is all.” I stood up and damn it, got dizzy again. I clutched the cop’s arm for support, and sat back down on the curb.

  “Something’s not right here,” he said. “I’m taking you to the station.”

  “No, look, it’s just this new medication I’m on. I’m fine as long as I’m sitting down, but—”

  “The city has strict rules against public intoxication,” he said.

  “But I’m not intoxicated,” I insisted. “It’s perfectly legal medication. Here, you can call my doctor and he’ll tell you.” I fished out my psychiatrist’s card from my purse. I carried it everywhere, no matter the occasion, because I felt like he was my proof of sanity and I never knew when I might need that.

  “No, I’d better take you in,” he said. “For your safety as well as the public’s.”

  That did it. What did he think I was going to do, go on a wobbly-kneed robbing spree? I thrust the card in his hand and heard my voice go shrill, but I couldn’t help it. “I’m not going to jail!” I said. “Call my goddamn doctor!”

  I was so upset, I started to cry. The cop must have been one of that breed of men who can’
t bear to see a woman’s tears because he paged my doctor, who called him back immediately and confirmed that I was merely experiencing transient side effects from a prescribed medication. I suppose he reassured him that I wasn’t a menace to myself or others because the cop finally let me go.

  “You know,” he said as a parting shot, “just because it’s legal doesn’t make it okay. You can still be intoxicated even if it’s prescribed.”

  I was too eager to be rid of him to acknowledge the importance of his warning. All I wanted was to get the hell away from there, back to the safety of my own home. I was so rattled I didn’t even try to get up. I just sat on the curb and waited for the cab to deliver me from danger.

  Fifteen years later, as the homeless woman in my pharmacy grew increasingly agitated, my past echoed as loudly as her screams. “I’m not going to jail! Call my goddam doctor!” was not a cry you heard from every person on the street. We were clearly sisters under the skin, separated only by some inexplicable flick of destiny.

  I had been gifted with resources the homeless woman had plainly been denied. My middle-class appearance must have given me a credibility that she unfortunately lacked—people wanted to help me. Plus my illness responded to medication; not always smoothly, but in the end. Perhaps I had a spark of conscience or fear that the woman didn’t possess, that kept me med-compliant. But who’s to say what her story was?

  Someone must have called the police because two cops arrived to take the woman away. Her tears had no apparent impact on them because they were none too gentle as they escorted her out. The pharmacist shook his head as he gave me my pills. “We see her a lot,” he said. “You’d think someone would get her some help.” I looked at my bottle of atypical antipsychotics, and I looked at the police car just pulling away from the curb. And no, I didn’t rush out to save the day. I didn’t try to fix fate. But I closed my eyes and said a prayer for her; then I blessed each and every one of the little pink pills I held in my hand.