David's Inferno

by David Blistein

  On reflection, I want to shake myself by the shoulders and yell, “Look out!” If nothing else, it would have shown solidarity with those in the process of being devastated by Hurricane Katrina. During August, I did notice some familiar suspicious shadows building up the area behind my eyes and cheekbones—although, like floaters, you can’t see them unless you really look close, and even then they stay just on the edge of your field of vision.

  Two appointments, however, catch my eye: August 17th and September 12th. They were with a bodyworker who combines a Zen master’s unrelenting insistence on being in the “now”—a place I’ve always enjoyed visiting, but don’t necessarily want to live—with the equally relentless work of an experienced Rolfer: 1½ hours of deep massage that can be so intense you see flashes of light.

  At the end of both sessions—and for hours afterwards—my mind was quiet, my heart was open, and my body was completely relaxed. It felt like a whole lot of thought patterns had been shattered and visceral memories unleashed … ancient prison doors of the psyche swung wide open … the inmates, free at last, running every which way.

  I’ve often wondered whether those two rolfing treatments helped trigger the inevitable series of synaptic disconnects that culminated in what I call my “breakdown.” The idea of seeing the guy again still makes my psoas tremble. But at least that pain was fleeting.

  I also had a couple of appointments with my acupuncturist. I recorded the first session on August 28th. It suggests that my condition was already a little more fragile than I remember:

  D: The shadows are right there … it’s physical.

  A: Are you sleeping?

  D: Yes. It’s not manic.

  A: So right now it’s depression about to cascade down on you. How long have you been off your meds?

  D: Since late spring.

  A: We’ll check your pubes …

  D: I feel like I don’t have any. [As she begins putting in needles I jump.] Guess I do.

  D: So what is the Chinese medicine take on depression? They don’t call it depression, right?

  A: No, the blood storing that part of the spirit holds its consistency and intention.

  D: Of the depression?

  A: No, just of your engagement with life. There’s so much in the blood that needs to be nourished to keep moving. So people use the depression as a buffer sometimes.

  D: Because they can’t get enough nourishment?

  A: Yes, because they can’t get enough nourishment so their blood gets congealed … this whole plexus of energy around your wrist is really opening up [from the needles] and the energy will flow better because by treating here we’re actually treating your heart meridian.

  D: What do you find with people on antidepressants … does the energy have to go around the meds? Or does it work with them? Does that make sense?

  A: Hopefully, people get more use out of their antidepressants. As the stagnation and congealed blood heal up, they can take less and less of the meds. The point is to get the maximum use of the smallest amount of the chemical.

  Everyone has totems and talismans. Seashells, pieces of jewelry, ancient carved figures. Autographed baseballs, tickets to rock concerts, and mementos of all kinds. My totems not only speak to me, they tend to speak for me; as if representing perspectives I don’t have time to represent myself—or, if you want to get neurotic about it, that I’m not quite willing to fully “own.”

  In mid-September I lost one of my long-term traveling companions, a small stuffed cat named Ferguson, on a trip to Washington, DC. Probably on a bench outside the National Museum of African Art. Ferguson was blessed with far more wisdom than those tiresome “bobble-heads,” and as much compassion as the ubiquitous statues of the Buddha (my generation’s version of plastic lawn ornaments). He was intensely curious about everything and assumed, with an uncommon degree of wisdom and guilelessness, that people were always well-intentioned … although perhaps occasionally a bit misguided.

  Lest you think this too childish a subject for such a serious book, you should know that Ferguson’s presence and insights were held in high esteem not just by me, but by all who knew him—and his fans were legion.

  In the clutches of hypomania, being two minutes late for a meeting simply causes heart palpitations. Hearing a strange sound from the back of your car triggers thought patterns resembling those of a squirrel in a blizzard trying to remember where the hell he put that last acorn. Losing something irreplaceable adds an obsession that blocks out everything, everything else.

  When I realized Ferguson was gone, I wrote to the Washington Convention Center, Smithsonian, Southwest Airlines, Manchester airport, and anyplace else I could think of. In these emails, I implied that this “toy” had belonged to a small child—to their credit, most people took my request very seriously.

  In retrospect, the fact that, at the age of 53, I was sending emails complete with pictures to the Smithsonian Museum (your tax dollars at work) seems bizarre even to me.

  They say that psychosis is losing your mind. When I lost Ferguson I lost a small, innocent, and stable part of mine.

  On Sunday, October 2nd, 2005, I managed to get up and speak briefly at a memorial service for my aunt … even though doing so felt like trying to single-handedly pull back a 20 foot–high curtain on the stage of a one-man show. There was no longer any question I needed to start taking Celexa again. But, the next day I was flying out west for a writing workshop, and didn’t think it would be a good idea to wrestle with potential side effects while 2,000 miles from home—several hours of which would be at 35,000 feet.

  On Sunday, October 9th, 2005, John Lennon would have been 65. (Imagine that.) I was 53 years, four months, and one day. I woke up early in the morning and got on a plane in Montana for the trip home, arriving in Vermont just before dinner—early enough to take a walk up the road, and dose myself with a little reassuring fall foliage.

  The week that followed would prove to be one of the most devastating and transformative weeks of my life. But, at the time, I just wanted to have dinner, catch up with Wendy, go to bed early, get up early, start taking my meds, and get back to my writing.

  On Monday morning, October 10th, I cut that half of a 40 mg tablet, swallowed, and went to work.

  I did the same the next morning and went to the dentist. One cavity. I made another appointment for two weeks later to have it filled.

  By Wednesday, October 12th, I was already getting a little edgy from the meds. That’s a common side effect when starting up. Fortunately, I had already made an appointment with my acupuncturist, and figured a treatment and some Chinese herbs would help me stay calm as the Celexa kicked in. After the session, she warned me to be careful.

  On Thursday, October 13th, I decided to up my dose of Celexa a little. This isn’t as reckless as it sounds. Finding the right dosage is a matter of trial and error and often, as long as those side effects aren’t too bad, increasing the dose can help get you past them and reach a therapeutic level. Since I wasn’t feeling much except minor edginess from the 20 mg, I decided to ramp it up a bit. Fortunately, in spite of my increasing urgency to feel better (and legendary addictive personality), I simply took another 10 mg instead of a fistful, bringing my total daily dosage to 30 mg—just half of what I had been taking the previous spring.

  By Friday, October 14th, I was beginning to suspect that things were not quite right. I knew that Selective Serotonin Reuptake Inhibitors (SSRIs) like Celexa can cause some weird flutters in your stomach, but I didn’t realize it could feel like the string section of the New York Philharmonic was tuning up in your gut. So I went back down to 20 mg and double-checked the insert to make sure that my side effects were common, if a bit extreme. Unfortunately, I didn’t have a lot of time to get past these “minor” symptoms because I was about to get on another plane—a business trip with my partner to California. And the idea of taking off while jumping out of my skin was somewhat troubling.

  Figuring I probably couldn’t reach m
y psychiatrist on a Friday afternoon, I called my regular doctor and, in my most matter-of-fact voice, asked if I might have some Valium to get me through the plane trips. He was kind enough to give me a prescription for a few 5 mg tablets.

  On Saturday, October 15th, I called my partner and said I might not be able to join him on the trip to California.

  By Sunday, October 16th, things had gotten totally out of hand. Even armed with my precautionary stash of Valium—most of which I’d already taken—I knew I couldn’t go. It wasn’t fear of flying. It was fear of being. On the way to the airport, my partner and his wife—two of my oldest friends—stopped by to see how I was doing.

  A few years later, I asked her what she saw that day:

  … You were in sweats and you looked like you had just pulled three all-nighters in a row, hair a mess, needing a shave, disheveled. That was just the outside. The inside felt even worse. You were having a hard time relating, a furtive look in the eye, like where is the closest rock I can hide under, and not a lot of eye contact. The sense I got was there was an amazing number of strings or cords of energy all around you and they were all tangled up in knots, so much so that I couldn’t clearly see you—both see you psychically and actually see you in the physical, like there was fog all around you.

  Did you lie down on the floor, near the dining room table? Perhaps. Were we unsure what was really happening? Yes. Did we deep, deep down feel huge concern? Even fear? Yes.

  I turned to Wendy to get a read and she was circumspect, protective. Perhaps she didn’t really know either, and perhaps she was afraid and freaked. I remember her in the background that morning. I was unsure what was really happening, and remember feeling kind of fuzzy. It took me some time to really see the gravity of this situation. Some of it I dismissed because I didn’t want to or couldn’t process what was happening … we don’t have any structures for when someone comes unhinged … I think it took months before I really understood (from the outside, of course) what was happening to my dear, dear friend.

  Make Up Your Mind

  He felt like somebody had taken the lid off life and let him see the works.

  —DASHIELL HAMMETT

  ON MONDAY, OCTOBER 17, 2005, I got up off the floor, called my psychiatrist, told him I’d gone back on Celexa and, in a masterpiece of understatement, reported that things weren’t going very well. He asked if I was taking anything that might be causing an interaction. I told him about the Chinese herbs. He told me about serotonin overload.

  “Serotonin overload?” a good friend asked disbelievingly a few days later—this being a guy who had done some serious self-medicating in his day … a day that continues up to the present. “Shouldn’t that be a good thing?”

  Perhaps … if all we were dealing with were the hippocampus and a few of the other animals running around in our brains. But there are a whole lot of other physical processes that involve serotonin, including little things like blood pressure and breathing. Plus 90% of all serotonin receptors are in your stomach where they play a major role in digestion and trigger things like “gut feelings.” Thoughts really do affect our digestion, which can affect our moods, which can affect our thoughts again. In fact, scientists now consider your stomach to be like a “second brain.”

  So if you jack your serotonin system up too much too fast, both your first and second brains can start behaving the way that, well, mine were behaving.

  This official diagnosis is “Serotonin Syndrome,” and it can be fatal.

  While my case was nowhere near that severe, it obviously triggered a significant imbalance. In fact, my behavior was remarkably similar to that of someone who “flips out” on LSD.

  No knock on Chinese herbs, my psychiatrist explained, but there was a chance they were working synergistically with the Celexa in the serotonergic system (say it three times fast). He suggested I go off them, at least until I had stabilized on the SSRI. He encouraged me to continue taking the Valium if I needed to calm down and sleep. No encouragement needed.

  So there we were. Me and Wendy. She wasn’t working that day. I wasn’t functional that day. Both of us were stuck in the house with someone who wasn’t a whole lot of fun to be around. Someone who took up a huge amount of psychological space.

  She suggested we drive to Northampton. Just to get out of the house. Go somewhere. Change of scene.

  I sat in the passenger seat the whole way, hands folded, head down, monosyllabic responses—like grandpa being taken out of the home for a Sunday afternoon drive, physically incapable of dragging my awareness from the lump in my throat, darkness behind my eyes, and a tenacious agitation that could attach itself nettle-like to the most trivial sensation or thought.

  I followed her into various stores. Did my best impersonation of someone who was interested in something … anything. Survived the terrifying decision of whether to have a cappuccino or a latte. And, in general, tried not to make Wendy’s life any more distressing than I’d already made it.

  Most masters of meditation would undoubtedly disagree, but being aware every moment isn’t always all it’s cracked up to be. One of the “blessed curses” of being in a state like this is that wherever you go, there it is. No special technique required.

  A week later, I called my psychiatrist back and told him that, even though I’d stopped taking the Chinese herbs and remained at a very low dose of Celexa, I was still extremely anxious, had frequent crying jags and, most important was running out of Valium. He said to stop taking the Celexa and come see him the next day. I arrived in his office, agitated, emotional, tearful. With that wired feeling in the pit of my stomach. Five pounds lighter than I’d been the week before.

  There’s a particular sensation when you’re about to get something you crave. The mouth-watering anticipation of being mere inches from that first bite of your favorite dessert. The equally moisturizing sensation of being on the verge of some serious—or not-so-serious—sex. The gentle relief in the back of your throat when you pour yourself a beer after work and begin to lift it to your lips. The more intense urgency of being on the verge of taking that first drag of a cigarette or line of cocaine. (Those days may be well behind me, but just saying the words evokes the sensation.)

  When you’re that bent out of shape, watching your psychiatrist write a prescription is just as intense. You believe with all your heart that you’re one trip to the pharmacy and a dose or two away from relief. Realizing he isn’t going to write that prescription is heart-breaking. But my doctor, undoubtedly wisely, said I’d better stay off the Celexa until “I felt myself again.” Valium was a consolation prize. It meant we couldn’t even get to square one until we had a chance to sort out the pieces.

  To my surprise, things got better immediately. In email after email I announced my return to the free world:

  October 26: “I stopped taking the Celexa yesterday and actually got a real night’s sleep.”

  October 27: “I am starting to feel ‘normal’ and am even considering joining you guys this weekend for that bike ride.”

  October 29: “While I hesitate to ever describe myself as ‘normal,’ I’m pleased to report that I am once again functional and, occasionally, even have a sense of humor.”

  October 30: “I’ve gone from the most excruciating mental state I’ve ever experienced to one of the calmest, most productive, optimistic. Jeez, the mind …”

  On Halloween evening, I sat in the same chair as I had the week before, in front of the same fireplace, drinking what might as well have been the same glass of wine, and waiting with childlike (i.e., immature) anticipation for the first trick-or-treaters. We never get trick-or-treaters. We live too far out in the country. But it’s an excuse to buy a bag of serotonin-boosting chocolate. After eating my fair share and asking Wendy to hide the rest, I reflected on how my every thought was a mirror image of the week before:

  Last Week: Oh, God, how am I ever going to face another human being?

  This Week: Maybe I’ll go downtown and see who
I run into.

  Last Week: How can I possibly call to make an appointment to get snow tires?

  This Week: How could I possibly have been too frazzled to make a simple appointment?

  Last Week: I can’t sleep. I can’t sit still. The wind is howling. A tree might fall on the house.

  This Week: What a great night’s sleep. Wind whipping around … I could lie here forever.

  Last Week: It’s like every thought brings up a wave of emotional nausea.

  This Week: What a relief just to be able to think straight again.

  Last Week: How can I possibly live another 1, 2, 20 years with this inside me?

  This Week: I will never, never, never, think that anyone with any kind of mental illness should ever “snap out of it.”

  In retrospect, my “Last Weeks” sound a bit melodramatic. And my “This Weeks” too simplistic. Regardless, when you’re walking that razor-sharp line between the two, you can’t help but be aware that behind each thought of opportunity, interest, or humor, lies a shadow of hopelessness, apathy, or sorrow. And, more happily, vice versa.

  When you bounce back from a major mind-altering experience, you get a “double shot” of pleasure from the most ordinary activity. You not only enjoy what you’re doing, you enjoy the fact that you’re enjoying it.

  I was particularly thrilled that I was able to have interesting conversations with strangers in crowded rooms—a high-wire act of such courage and creativity that I received standing ovations from other parts of my brain: He walks! He talks! He makes sense! He doesn’t have to rush off and go to the bathroom to pee or throw up! Chatting up the car repair guy? Piece of cake. Having lunch with friends who thought you were about to be committed? No problem. Contentious meeting? Bring it on!