by Terri Cheney
But miracles are magic, and recovery takes hard work. Even when ECT is successful, further treatment is required to sustain the progress. This means, in most cases, a good old-fashioned combination of medication and talk therapy. Of course, there are many alternative therapies as well, and I’ve had the dubious luxury of trying dozens of them. Here is a sampling of what’s worked for me, and what hasn’t:
COGNITIVE BEHAVIORAL THERAPY
This is a type of talk therapy in which you identify distorted perceptions and how they impact your emotions and behavior. For example, black-and-white thinking, in which no shades of subtlety are allowed to exist. Or globalization, in which everything is wrong and everybody hates you. There are many such distortions, which you can find online just by googling “cognitive distortions.” I’m guilty of almost all of them, and it helps tremendously when I realize it and can reorder my thinking to reflect reality. Having a therapist trained in this technique to guide you is a bonus, but you have to do the homework yourself. CBT has been heavily researched, and no other form of psychotherapy has been shown to be systematically superior.
EMDR
I hesitate to tell you what this stands for because it’s so absurdly technical: eye movement desensitization and reprocessing. Trust me—the technique itself is a whole lot simpler than the name. EMDR is essentially a trauma processing technique that helps the patient confront, and work through, painful memories. When it was first developed, patients would watch their therapist move his finger back and forth as they recalled a traumatic event. Both of you felt pretty silly—until it started to work.
Now there are flashing light boards, or pulsing devices you hold in each hand, which feel a little more scientific. But the method doesn’t seem to matter: The point is to provide bilateral stimulation. Some say this darting back-and-forth movement resembles REM sleep; others say it connects the right and left hemispheres of the brain. Whatever the mechanism, it’s benefited me tremendously, and I’d love to see it more commonly used.
AA AND OTHER TWELVE-STEP RECOVERY PROGRAMS
The rooms are dingy. People smoke and there’s too much hugging. The canned wisdom can make you gag. All so true, and so beside the point. Jargon alert: AA works if you work it. You have to find the right room, the right people, the words that speak directly to you and cut through all the smoke. They’re out there, and I have over two decades’ worth of sobriety to prove it.
A word of caution, though: I’ve come across a shocking amount of prejudice in some meetings against taking prescribed medication for mental illness. This runs directly contrary to the founding principles of AA and its progeny, but nonetheless, the ignorance exists and it’s dangerous. I suggest downloading a copy of the pamphlet, “The A.A. Member—Medications and Other Drugs,” an official A.A. publication that clearly supports the use of psychiatric medication in sobriety (if taken, of course, as prescribed).
WRITING AND NARRATIVE THERAPY
Writing has been a godsend for me. I’ve been in the same writing group for over fifteen years and have taken as many classes and courses as I can, all with the same ultimate goal: bearing witness. I firmly believe that Socrates was right, that the unexamined life is not worth living. On a more practical level, journaling helps me track my moods so I can fine-tune my medication; research even shows that creative writing may help improve the immune system’s functioning. What I know beyond a doubt is that writing has kept me alive—I want to see how the story ends.
MINDFULNESS AND MEDITATION
These are highly in vogue in the medical field right now, and rightly so. One of the most destructive aspects of mental illness is harmful and excessive rumination—about the miseries of the past and the projected woes of the future. Mindfulness encourages you to be in the present, and meditation helps you to achieve that state of awareness. It takes practice, but I know it’s a more enlightened way of being so I’m willing to keep working at it, although I have a nagging feeling that it shouldn’t be so hard.
ART THERAPY
When I was hospitalized, I balked when I heard that “art therapy” was going to be one of my required sessions. Balked is putting it mildly; I flat out refused to go. I pictured crocheted belts and beaded bracelets and lopsided ashtrays. I seriously doubted whether my insurance would cover such nonsense. And besides, I was a grown-up and a professional—I made deals, not découpage. While I may have been sick, I still had my pride.
But crafts turned out to be only a small, and optional, part of the therapy. The rest of the program was much more varied: role-playing, painting, singing, telling stories, and the like. And to my amazement, the best results I saw in the hospital were not achieved through medication or process groups but through art therapy. Patients who refused to speak up during the other groups somehow found their voices through their unleashed creativity, and let others—including their doctors—know their secret suffering. It was a joy and a wonder to watch.
EXERCISE THERAPY
When you live in Southern California, it’s practically a statutory requirement that you try yoga. I have, and it’s wonderful—if I’m not really depressed. Exercise of any kind, even walking, is impossible then because of the extreme psychomotor retardation and physical paralysis that overcome me. But that’s just me. I know that numerous studies have shown the great efficacy of exercise for moderate depression, and people are always telling me in glowing terms about their endorphin rushes. I envy them, and I kind of wish they’d shut up.
BIOFEEDBACK
This is a noninvasive procedure in which electrodes are attached to your body, and you watch a screen that reflects your brain activity via functional magnetic resonance imaging (fMRI). The goal is to enable patients to voluntarily control the activity of certain regions of the brain. I spent months hooked up to a machine, watching my alpha and beta waves rise and fall. It made me severely anxious, to the point where the doctor—who said he’d never seen this technique fail before—gave up on me and quit.
HYPNOTHERAPY
Once, in a show where members of the audience were hypnotized, I got up on stage and ate a raw onion, which I’d been told was a delicious Fuji apple. I’m highly suggestible. Years later, I tried hypnotherapy for chronic insomnia, without success. But I liked the feeling of relaxation and deep focus I experienced, so I’m not crossing this off my list.
There are many, many other therapies that I haven’t yet tried, but would like to: for example, dialectical behavior therapy (DBT), which helps with emotion regulation and is particularly effective with suicidality; and the psychedelics, like ketamine and LSD. I’ve seen some amazing results from both these treatments, and I’m sure I’ll get around to them in time. After all these years of experimenting with my brain, I still believe an answer is out there. I just have to keep reformulating the question.
Therapy of any kind is inherently mysterious, since we don’t really know why mental illness occurs in the first place. But one thing is certain: The way a therapy is administered makes a big difference. If it’s pitched with enough kindness and confidence, anything can work. The placebo effect is well documented; it’s more than just “fake medicine.” In clinical trials, people with schizophrenia and depression have exhibited a particularly strong placebo response, and researchers at Harvard Medical School believe they are well on their way to corralling its biochemical basis. It’s a thrilling idea—let the mind heal the mind, and Big Pharma, beware.
Ultimately, treatment is a tricky balancing act. There’s a lot of good help out there, along with some bad. Take your hope with a good dose of common sense, but do take it.
SECTION VII
Warranties
ACCEPTANCE
“Be yourself. Everyone else is already taken.”
—Oscar Wilde (1854–1900)
In recovery terms, acceptance of one’s mental health situation means not only acceptance of the diagnosis but of the need for treatment, and even associated limitations and consequences. Acceptance of stigma is a thorni
er question: should one ever accept what is morally and intrinsically wrong?
The National Alliance on Mental Illness promotes “radical acceptance,” a term popularized by Marsha Linehan, founder of the dialectical behavior therapy (DBT) technique. This means “completely and totally accepting something from the depths of your soul, with your heart and your mind,” she says. If you truly accept your mental health condition, you don’t waste valuable energy trying to pretend that it doesn’t exist. Rather, you turn your resistant ruminating into forward movement, by taking the necessary steps to care for yourself instead (https://www.nami.org/Blogs/NAMI-Blog/January-2019/Self-Help-Techniques-for-Coping-with-Mental-Illness).
This doesn’t happen overnight. It’s a coping skill that requires practice because it doesn’t come easily and it doesn’t mean that you are then magically immune to the sorrows, fear, and sadness that naturally inhabit all our lives. But the wonderful thing is, you don’t have to worsen the situation by adding the pain and struggle of nonacceptance to it. You accept that being human encompasses both good and bad, darkness and light. As J. R. R. Tolkien so poignantly noted, “not all tears are an evil.”
DIAGNOSIS: THE GOOD NEWS?
When you live in L.A., you have to expect that people are going to try to explain bad things by telling you that “Mercury is in retrograde.” If you’re like me and you don’t know what the hell that means, you just nod and say, “Thanks, that makes sense.” Like everyone else, I cling to any explanation that might pierce the daily murk. It’s bedrock human nature—lost as we are, we’ll follow any path to enlightenment.
I think this is one of the reasons I’ve come to accept my diagnosis of bipolar disorder to the surprising extent that I do. The very idea that my amorphous, inexplicable emotions have clustered together into a syndrome that I can describe in two words excites me and gives me hope. But believe me, I wasn’t always like this. For the first half of my life, I knew something was wrong but I refused to investigate the possibilities. The fact that there was a raging monster inside me was obvious, but I didn’t want to find out what kind of monster it was. I just wanted it to go away.
Even when I reluctantly started to examine my emotions in psychotherapy, it wasn’t an easy task to find the correct diagnosis. It was like looking for the perfect pair of jeans, or worse yet, the perfect bathing suit. I had to face the mirror naked for an uncomfortable period of time and endure an endless amount of trial and error.
Dysthymia was my first diagnosis: a low-grade general misery that was just noxious enough to be recognized (if not reimbursed) by my insurance. I admire the doctor who gave me that wrong diagnosis, and I don’t think it was her fault. I hid my howling so well that all she heard was a mournful peep. Eventually, she upgraded me to major depression, which was still the wrong diagnosis but much closer to the core of my condition. By then, I had learned to trust her more and invite her into my mind; so she could see that the monster was much, much bigger than she had originally guessed.
As is the case with so many people who have bipolar disorder, it took years—almost a decade—before I was properly diagnosed. And that only happened by a fluke. I was in the middle of a course of electroshock therapy for an excruciating episode of depression. Without warning, I got zapped into mania. For the first time ever, my doctors saw the amped-up, jazzy side of me that I’d always kept hidden from them. I didn’t hide it intentionally. I just felt so good when I was manic that I didn’t bother to keep my appointments.
With my new diagnosis came new medications, and to my surprise, some of them actually helped—along with getting sober, which allowed the meds to work without outside interference. Even stranger, I felt less shame about being bipolar than “just” being depressed. Bipolar has a tinge of the exotic to it, like a rare plant that needs special handling. Whereas everybody claims they’ve been depressed, and I had trouble making people understand the difference between chemical depression and the everyday blues.
My bipolar diagnosis explains so many things about me that used to be a mystery: the wild volatility, the odd combination of ferocity and fragility, the sudden spurts of creativity. It’s no wonder that I cling to the clinical label. It lifts me up from denial, to glide on the wings of science. Let Mercury be in retrograde—my own world is so much clearer to me now.
SHADES OF TRUE LIGHT
I’ve been feeling good lately, which is always hard for me to admit. I’ve noticed this is true of a lot of people with bipolar disorder: We’re afraid we’ll jinx the normalcy. Or maybe we’re afraid we won’t be believed when the bad days strike again. Whatever the reason, I’m scared to say it, but it’s true: I feel surprisingly good.
When I’m doing well, I always take advantage of my newfound energy to seek out “a dose of beauty,” as my therapist calls it. It’s the best nonprescription medicine I know. And the greatest beauty I can imagine comes from Johannes Vermeer, the seventeenth-century Dutch painter and my all-time favorite artist. Most people know him for his Girl with a Pearl Earring, but he’s so much more than that. He’s a rare jewel: exquisite, multifaceted, and extremely hard to find. I once maxed out my last remaining credit card to travel to a Vermeer exhibit at the National Gallery, only to be surrounded by so many other admirers I could barely see a thing. I left in disgust. You have to have moments alone with great beauty, so it can work its way inside.
On a quick jaunt to New York a few months ago, I went on a pilgrimage again. I found him: three Vermeers at the Frick Collection, and another four at the Met. At the Frick, I waited until everyone else had cleared the gallery before I allowed myself to look. I stepped up to An Officer and a Laughing Girl, my head bowed as if I were in church. Then slowly, inch by inch, I raised my chin and let the painting in.
There, at last: the light.
Everyone who loves Vermeer remarks, of course, on his use of light—how it falls oh-so-naturally through the ubiquitous windows on the left to flood the scene with warmth. I saw the wondrous light; I sighed in recognition, but this time I also saw something else. For the first time in my life, I saw the shadows. Now of course they had to be there all along, right? Truly depicted light must cast a shadow, and no one is truer to nature than Vermeer. But why had I never seen them before? And why was I seeing them now?
I thought about this all the way back to L.A., and even after that. The answer finally came to me: I simply didn’t want there to be shadows before. I wanted to believe there was one place on earth I could go where there was never any gloom, just a splendiferous glow. But perhaps I’m growing strong enough to accept that life demands a balance. How will we recognize rapture if we haven’t first felt sorrow? We can’t. Pleasure is indebted to pain.
I know this duality in my bones—I live it because I’m bipolar. Which doesn’t mean I haven’t railed against it for many years. But I feel a tender acceptance growing inside me, and I don’t want to disturb it. I’m not wearing blinders: today I may celebrate my strength; tomorrow I may lose myself in my struggle. But when I can’t believe in anything else, I can always believe in Vermeer. He’s tangible, irrefutable proof that my soul was once calm and still enough to accept true beauty—light and shadow, intermixed. And to my surprise, I welcome those shadows. I think I’m ready for them now.
HOPE
“You must think that something is happening within you, and remember that life has not forgotten you; it holds you in its hand and will not let you fall.”
—Rainer Maria Rilke (1875–1926), Letters to a Young Poet
A recent Cambridge University study examined “the importance of hope against other factors in the recovery of mental illness.” It concluded that “the central tenet in recovery is hope—it is the catalyst for change, and the enabler of the other factors involved in recovery to take charge” (https://www.ncbi.nlm.nih.gov/pubmed/28953841).
Important as it is, hope can be maddeningly elusive. As trauma therapist Jonathan Foiles observes, “Hope can seem like a radical, even foolish, act. In times of despa
ir, it can seem naive or dangerous to think that things may get better.” This fundamentally misunderstands the nature of hope, he says. “To be hopeful is to acknowledge that the future remains unwritten and that we have the ability to play a part in its making” (https://slate.com/technology/2018/06/a-trauma-therapist-explains-how-to-cope-with-existential-despair.html).
Many of us caught in the web of mental illness doubt our capacity to make the changes in ourselves and the world that seem necessary for personal, and societal, recovery. But giving up hope altogether just doesn’t work when you’re human. Hope is bred into our bone marrow; it’s what keeps our blood pulsing, day after day, no matter what. Instinct knows what we sometimes don’t: just keep moving. Hope is an active verb.
But what about when you’re paralyzed by depression, or immobilized by anxiety, or rendered inert by suffering? How then do you move? You have to redefine movement—it isn’t necessarily physical action. Sometimes it isn’t even conscious thought. It’s desire, which is always simmering somewhere deep inside us. Desire to change, to have a fuller, richer, more dream-worthy life. As the Cambridge University study found, “Recovery depends on the notion that a patient desires to get better.”
So many of us are told to readjust our goals because we’re mentally ill, which is fine so long as it doesn’t lower our opinions of our intrinsic worth. We deserve more than mere survival. We deserve hope. That hope may be tempered; so is steel.
NEW LOVE: HANDLE WITH CARE
“You’re so fragile.” I used to love hearing that. I thought it made me sound delicate, like an early Renaissance madonna. And very, very costly, like the best bone china or the finest platinum filigree. All the really good pieces in any museum are fragile, I’d proudly tell myself each time the word materialized in a friend’s conversation. What I didn’t say, because I didn’t want to hear it, was that the most fragile pieces are also the ones roped off from the public and labeled DO NOT TOUCH in forbidding capital letters.