Death Grip

by Matt Samet

  Two weeks in, I meet another climber. We’re standing in the elevator together and slowly come to recognize each other. He is a photographer, and in a better year we collaborated on a shoot down in New Mexico: muscle ripping up limestone, the camera shutter clicking, warm June air pregnant with flowering cholla cactus and chamisa. I had just returned from six months in Europe, where I’d spent the final month in Corfu, then climbing in Provence. I was skinny, tan, psyched, had weathered that first benzo withdrawal and felt well again. The photographer resided in Santa Fe, making a good living playing. Now, however, he lives back East, consumed by rage, breaking computers, throwing things out his windows, thinking of ending it. He asks me why I’m here, and I say it’s to quit benzos. “Oh, yeah, like Klonopin,” he says. “I was on that and then stopped pretty quickly. What a nasty one that was…” How long ago? I ask. Oh, a year, he says, maybe less. I tell him I’ve read about the pills on the Web, and that they can cause problems well after you stop. He nods his head, as if recognizing some truth.

  It’s an illuminating conversation, one I will repeat with half the patients on the ward, all having been at this time or in the recent past withdrawn from benzodiazepine tranquilizers. It’s somehow fitting to have these chats at Hopkins, the hospital in part responsible for William Styron’s bestselling memoir of depression, Darkness Visible. (It was at a Hopkins-sponsored symposium that a talk given by Styron turned into a Vanity Fair article, later expanded into his seminal book.1) I’ve read Darkness Visible three times—it’s a page-turner—the first while still on benzos. I stopped on pages seventy and seventy-one in particular to reread two paragraphs. Here Styron describes telling a hospital doctor, upon admission for his suicidal depression, that he had been taking 0.75 milligrams of Halcion every night. Halcion is an infamous pill, the shortest half-life benzodiazepine (two hours) and one banned in certain countries for negative effects including amnesia, depression, anxiety, and psychosis. The doctor, duly appalled, tells Styron that this is triple the standard dose for someone his age and switches him to the slower-acting hypnotic Dalmane, after which the author’s “suicidal notions dwindled and then disappeared.” Even as he accepts responsibility for carelessly taking so much Halcion, Styron implicates it in supercharging his depression—not as the sole culprit (he also points to his abrupt withdrawal from alcohol, among other factors), but a pill without which he “might not have been brought so low.” Styron also calls out benzos in general, writing that his own cavalier attitude toward them had formed a few years earlier “when I began to take Ativan at the behest of the breezy doctor who told me that I could, without harm, take as many of the pills as I wished.”2 Styron also bemoans the “promiscuous prescribing of these potentially dangerous tranquilizers.”

  Unfortunately, little has changed since the book’s first printing, in 1990. They hand out these pills like candy, and then yank you off way too quickly if they bother to do so at all.

  I soon learn that all my fellow patients who were on benzos have in fact stopped abruptly, some upon doctor’s orders, some self-directed, and some on this very ward. One gentleman a year earlier had a Hopkins doctor taper his three milligrams of Klonopin in less than a week; he paced laps around the halls, not sleeping, feeling like he “was on crack.” He’d been bouncing in and out of hospitals ever since, playing med roulette. Another, a young woman, very smart with bright, intense eyes and of Middle Eastern heritage, is a hospital veteran—her family hospitalizes her every time she becomes manic. She tells me she takes three or four milligrams of Klonopin out in the world, but stops cold turkey before each hospitalization because she knows that the doctors will take the pills away once she’s inside. At Hopkins, she paces and paces and paces, day and night until ordered to her room. Another woman, middle-aged and divorced, tried to commit suicide a year earlier via a Klonopin overdose, after which she was no longer given the drug. Now she is lower than low, trying ECT for her depression. Another patient, a fellow in his early twenties, cold-turkeyed Klonopin but used marijuana to temper the withdrawal. He ended up holed up with a sniper rifle in a motel across the street from a park before they brought him in. Another, a retired farmer who sustained a head injury falling off a ladder, is being tapered rapidly from his “sleeping pills”—Ativan, it turns out. He lines up at the med station an hour early, pleading for his meds, saying he feels “funny.” A woman whom I’ve remained friends with, a vibrant, talented woman who held a high-powered university job, has been yanked off two milligrams of Xanax in only a week after her admission two weeks earlier. This, I tell her, is likely too fast, and a blush of realization blooms across her face. “Oh, my God,” she says. “That explains so much—I’ve been so angry, so mean to my husband and short with him when he visits. And I can’t sleep, and all these heart palpitations and panic attacks I’ve been having…” Whenever she can, she uses her day pass to run laps around the outside of the Hopkins complex, even on days bitter with wind and snow.

  You could say I’m conducting my own one-man study. When the nurses come into my room, I grill them about what they’ve seen, as it’s really them and not the doctors down in the trenches. The closest I get to an answer is one nurse saying that, as far as he knows, there have been no benzo-related “sequellae” and that I shouldn’t pay attention to anything I read on the Internet. He parrots the doctors’ spiel that apart from a week or two of flu-like symptoms and a slight elevation in anxiety, I will soon feel like myself again. Of course, what happens to patients once they’re off the ward is anyone’s guess, hence the lack of “sequellae.” Psychiatric hospitals do not follow up to see if their treatment has worked. Out in the world, patients can easily go back on benzos, continue to mask withdrawal symptoms with other medications, or re-intake with issues possibly related to cessation of the pills but that go undiagnosed as such. Even “the best hospital in America” can’t acknowledge the existence of a benzodiazepine withdrawal syndrome nor their potential role in causing it. To them, these pills are like baby aspirin, to be stopped or started rapidly with impunity. Even when half their patients are experiencing issues that might be linked to benzos, they do not stop to connect the dots; they do not ask questions. The paradigm seems to be: “Benzos are bad, really, really bad, so we’re going to get you off them.” But then, paradoxically, “Anything you feel beyond our official, drug-study-sanctioned, med-school-taught view of brief symptomology is due strictly to your own flawed biochemistry.”

  If you continue down this road, you’ll end up a lifer. In spring 2005, just as I began to taper, I met the Ghost of Christmas Future. A onetime climber who’d come to Carbondale to visit a coworker, he used a fishing-tackle box as a travel kit for his psychiatric meds. I will later learn, from a friend who interned at a VA hospital, about veterans with PTSD on thirty or more medications a day, including benzos. The chemicals accrue over the years, he tells me. Even once one med stops working, the doctors are reluctant to taper a patient off and hence keep piling on pills. I’m not sure how these vets’ livers function or how the men get through the day. I cannot imagine. I will also, through a support group on Yahoo, read countless tales of people like me, dependent on or trying to stop benzos but placed instead on five, eight, ten meds a day: antidepressants, mood stabilizers, antipsychotics, barbiturates. I feel for these people even as I praise the Fates that I escaped before this too became my final chapter. You see, I left the hospital and have not looked back. Within a month, I found my solution: that number for a benzo-support group I should have called months if not years earlier.

  This was not going to be my life.

  CHAPTER 11

  The first thing to realize about acute benzo withdrawal is that it’s not “anxiety” as you know it. If anxiety is a yippy little Chihuahua in a handbag, then this is a Rottweiler mauling your face off—for months. A clinician listening to you describe your symptoms might diagnose anxiety, but deep inside, in your subjective experience where it truly matters, you will feel a primal and monolithic terror that
cannot, as with garden-variety anxiety, be reasoned with: Your calming GABA “light switch” is busted or even frozen in the off position, and you will not experience reality as it was until your receptors renormalize. The merest trifle—a barking dog, a near fender-bender, an angry word from a friend, an upsetting movie—will push you off the panic cliff. This much I learned by studying my own reactions to stress: If anger or fear entered my system, or if I overexerted myself physically, I’d have panic attacks and remain flooded with adrenaline for hours and sometimes days. The parasympathetic nervous system would not bring me back down reliably, as it had in the past, and sometimes it would not bring me back down at all.

  I return alone on a four-hour nonstop flight home from Baltimore to Denver, raw around the edges, away from the hospital and my father’s house. After a final two weeks as an outpatient at Hopkins, after countless panic attacks and night terrors at my father’s, after the night he came to my bedroom and stroked my brow as he had when I was a child and woke up distressed, I need to let him resume his life. And I need to try to get on with my own. I swallow a Neurontin before boarding, take my seat, and pretend to read a potboiler novel. It’s difficult, but I’m doing it, which is no small thing. Then the plane aborts its takeoff. The nose is up, the engines are firing, and then they suddenly cut to nil and the pilot is slamming on the brakes. He comes over the intercom to let us know that the tower mistakenly gave us clearance, and that we need to wait ten minutes to try again. My heart hiccups, it slams, my hands shake, I sweat. I wait for the panic to pass, as it has in the past, but it doesn’t. I will stay in this heightened, hyperalert state for the next four hours, avoiding eye contact with other passengers, gripping my closed paperback like it’s the Holy Bible, my gaze flitting about the cabin like a moth in a bell jar. As we descend into Denver, dropping through white, arctic-front storm clouds, the pilot comes on again to tell us that the runways are too icy to land. He eases the plane back up and we start circling, the ground invisible, the moist air turning pink with molecules of frozen sunset. The plane jostles in the mist, its engines firing intermittently to keep us at elevation while snowplows clear the runways.

  Ice starts to crust on the wings, plastering over the landing lights—this is how jetliners crash. I think I might puke. I would rather open an exit door and jump out than feel this fear for one more second. When we finally land, I feel no relief being back on the ground. I should, but I don’t. Kasey is waiting outside the airport. It’s night. We drive home through lashing snows. The gentle prairie swells along Peña Boulevard heading south from Denver International overhead, poised to break like massive waves. I cringe in my seat, trying to disappear into the upholstery. Kasey talks about her infant nephew who’s having seizures, and I can’t stand to listen. This is too dark, too intense and scary, this poor, ailing baby boy. I become him, feeling that I might have a seizure myself, my gut as empty and stale as a mummy’s core.

  At Hopkins, they warned me that the transition back home would be hard, but this is something else entirely—this is sinister.

  That night, I do not sleep. I do not even approximate sleep. The adrenaline keeps me awake, firing and firing until morning, until a thin meniscus of orange forms in the east and pale dishwater light seeps over Boulder. I thought I would feel stronger back in Colorado, but I’m weaker than ever, a textbook agoraphobe. I rarely leave the house. I pace and fret and writhe and sweat as the walls close in. I have nothing to do, but neither am I able to do anything because I’m so distracted and distractable. I was supposed to go to Hawaii with my father, his girlfriend, and her children for my dad’s sixtieth birthday, but I demur. My father and I get into a shouting match on the phone—he wants me there and keeps saying, “You have to come. You have to,” partially for selfish reasons but also, I’m sure, because he wants the hospital to have fixed me. Kasey heads home to Oregon, and I’m alone over Christmas. I drive her a half mile to the bus depot from where she’ll leave for the airport. Tiny Boulder seems immense—downtown, with its fifty-foot buildings, looks towering and frenetic as if I’ve been picked up by a tornado in Nebraska and deposited in Times Square. But also distant, like the surface of a glacier glimpsed through a telescope. I begin to taper the lithium and Neurontin; I don’t care what might happen. One of these meds has brought a rash over my belly, and they need to go. I have a med check-in with Dr. Porridge. He urges me not to quit the pills, but I tell him that I’m doing it anyway. He reiterates that I have anxiety and depression, which must be medicated, and that I’m undoing all the “great treatment” I received at Hopkins. Fine, whatever. During those first two weeks back home, I’ll e-mail my friend Jim: “I’m in complete and utter hell … the withdrawal and panic attacks are awful, and the fucking shithead docs at Hopkins and my doctor here are trying to tell me it’s my ‘natural anxiety.’ I feel pretty overwhelmed [and] can’t leave the house much.…”

  It’s a La Niña year so great fronts back up along the Continental Divide, sending Chinook winds howling over Mount Sanitas, flexing the windows, tearing the screen doors from their hinges. I fear that our duplex might, like me, blow away into the darkness, streaming off atom by atom. Clyde has figured out a way to escape under the backyard fence and launches rogue missions down the alley, upsetting trashcans to scrounge for food scraps. He’s quick—if I don’t stand watch atop the stairs, if I turn away for so much as ten seconds, he’s gone, and I must spend an hour, maybe two, hunting him out in frigid winds under the sterile moonlight, beneath dead leaves rattling on threadbare trees reaching skeleton hands skyward. I can hardly breathe amidst a thick, molasses-like fatigue, lurching like some creep along the alleys, calling for the hound in a high, reedy wheeze. If Clyde heads uphill, toward Fourth and Third streets, it takes even longer to find him because then I can only shuffle, pausing every few steps for breath like a Himalayan mountaineer in the Death Zone. I’m always out looking for Clyde. He thinks it’s the greatest game.

  Mornings are bad because I wake up spitting blood, my throat and sinuses inflamed from chronic hyperventilation. I hack up the corrupt red blossoms, spit them into the toilet, and flush them away, wiping bloody sputum from my lips. This will go on for a year. I will start to sleep with nasal strips on and duct tape over my mouth in the hopes of promoting slow, diaphragmatic breathing.

  Daytime is bad because I have nothing to do, am constantly in a state of fear, and my focus is shattered, a trifecta of idleness, terror, and distraction. I can no longer read books or even long-format magazine articles. It will remain this way for months. I will start back with Maxim, work my way up to Esquire, and finally The New Yorker before I can engage with a novel again. Also, I can’t stand to let anything end, even a simple task like washing the dishes, because I’ll immediately have to face the empty minutes again. But conversely, I hate to begin anything because I’m not sure I’ll be able to finish. So I flit from meaningless chore to meaningless chore, breezing in and out of Web sites, cleaning the house in stages, pacing, going out to the front patio to sit in the sun for two minutes, picking up Clyde’s poop, turning on the television, turning it off, trying to do breathing exercises, repeating it all over again. It’s a simple pleasure, really, to sit still and be at peace—the healthy take it for granted—but it’s one that will ever elude the benzo sufferer.

  Nights are bad because I cannot sleep. At best I get two hours, and often wake up screaming, seeing phantoms levitate above me to wash against the ceiling and dissolve into squidlings of ectoplasm. I ask the neighbors, sheepishly, if they can hear me bellowing, but they cannot. It will be nine months before I take my first daytime nap—a one-minute nap; an incredible victory—and two years before I get more than five hours of continuous sleep at night. Some nights, scratching noises come from inside the bedroom closet, like someone is raking his fingernails along the doors. But when I turn on the lights and slide the doors back, no one is there and the noises stop. My brain is incredibly suggestible: If I watch an upsetting movie, it seeps into me until I i
nhabit whatever bad event has occurred on-screen. Before she left, Kasey and I watched the Russell Crowe boxing film Cinderella Man, and I almost had to leave the room. When rough punches landed and heads snapped back during the fight scenes, I could feel my own gray matter sloshing around in sympathy. With horror movies, it’s even worse.

  Who is this scared, pathetic man?

  I continue to see the therapist. To her credit, she gets me out the door when no one else can. I help at the food bank where she volunteers, go to her house with Clyde, take walks around Mapleton Hill with its brick Victorians and silent, tree-lined sidewalks. She is not an unkind person, but again, she does not understand benzo withdrawal and neither does she try to. She does not listen when I say that I don’t think that this is my natural state. This woman reiterates that I have the worst anxiety of anyone she’s seen, that I need to stop focusing on symptoms and feeling sorry for myself, and that I need to stop letting myself have panic attacks because it will only reinforce the neurological channel along which they travel. The therapist tells me that I have what the Buddhists call “wild mind,” and that I need to harness my racing thoughts through meditation. She advises me not to stop my current meds, saying that the doctors must have had “a good reason” for prescribing. And she diagnoses that I’m “OCD about my breathing,” as the inability to draw a full breath has become my strongest symptom and hence an obsession.