David's Inferno

by David Blistein

  • Peter Kramer writes about depression and creativity in his book Against Depression (2005).

  • Storming Heaven: LSD and the American Dream, by Jay Stevens, was published by Grove Press in 1998.

  • Before he died, William Blake (1757-1827) actually started doing illustrations of The Divine Comedy, see http://www.blakearchive.org/exist/blake/archive/work.xq?workid=but812&java=no, a project of the Library of Congress in conjunction with the University of Rochester, University of North Carolina at Chapel Hill, and National Endowment of the Humanities.

  • Bob Dylan’s homage to Dante is in the song “Tangled up in Blue” from the album Blood on the Tracks (1975).

  • I’m very poorly read (if at all) in the philosophy of deconstructionism. But I’ve always liked the concept. I found the Jacques Derrida quote in Rubin’s book.

  Depression and Spirituality

  • The Epigraph: A prophetic remark from a conversation with one of my favorite psychics in the summer of 2006.

  • St. John of the Cross’s Dark Night of the Soul is one of the classics of Christian spirituality … a poem that describes how a human can be detached from the things of this world and thereby merge with the light of God in much the same way as described by Dante.

  • Eckhart Tolle’s The Power of Now: A Guide to Spiritual Enlightenment was published by New World Library in 1999.

  • While on the subject of koans and kundalini: the great Hindu guru Sri Ramana Maharshi (1879–1950) said that all you really needed to do to raise your kundalini energy was to hammer on that “Who am I?” koan until you broke wide open. Maharshi was a teacher of several of the most important figures who brought Eastern spirituality to the West … including Paul Brunton and Paul Reps.

  • The Mary Oliver (b. 1935) poem with the refrain “What blazes the trail is not necessarily pretty,” is called “Skunk Cabbage.” It’s in her collection American Primitive (1983). She won the Pulitzer Prize for that book.

  • “Abraham” is a spirit who’s been channeled by a woman named Esther Hicks for more than three decades. As with all such things, it’s probably most productive to focus on the message and not worry about the medium.

  THE DIVINE COMEDY

  Beholding the Stars

  The Epigraph: From Arch of Triumph (1945) by Erich Maria Remarque … one of the great existential love and war stories of all time.

  Glossary

  HAVING SPENT 40 YEARS traveling the highways and bi-ways of traditional and alternative medicine, I tend to casually throw words around, forgetting that they aren’t familiar to a lot of people. Hope I caught most of them because I wouldn’t want to be accused of being a sesquipedalian …

  5-HTP: A natural amino acid that regulates serotonin levels.

  Acetylcholine: A neurotransmitter involved in memory, learning, and voluntary muscular control … including orgasm! A lack may be associated with Alzheimer’s disease.

  Acupuncture: An ancient Chinese medical treatment based on stimulating certain points in the body with tiny needles. Often combined with Chinese herbal medicine.

  Agitated Depression: Just what it like sounds … depression combined with uncontrolled restlessness.

  Amino Acids: The molecules your body uses to make proteins.

  Axons: An umbilical-cord-like thing-a-ma-jig that extends out from the body of the cell and has a whole lot of filaments that shoot out neurotransmitting molecules to other cells.

  Ayurvedic: A traditional Hindu approach to medicine involving massage, hygiene, and herbal remedies.

  Bach Flower Remedies: A collection of plant extracts developed in the 1930s by a British doctor that are commonly used in alternative medicine to treat emotional and mental imbalances. The most famous one is called Rescue Remedy. Don’t knock it ’til you’ve tried it … many people find it a much milder and equally effective relaxant as prescription benzodiazepines.

  Benzodiazepine: The most common type of sedative and anti-anxiety medication. Including Valium, Lorazepam, and Klonopin. They vary mainly in terms of the therapeutic dosage, half-life, and tendency to lead to addiction.

  Bipolar: Psychiatric condition in which periods of manic behavior alternate with deep depression. Bipolar II is the milder form.

  Craniosacral: A special kind of bodywork in which the practitioner makes subtle adjustments to how the “cranial fluid” is moving. The technique is used by osteopaths and chiropractors as well as massage therapists.

  Dendrites: Tiny receptors on neurons that receive the neurotransmitters from axons on other neurons, thereby transmitting “information” (in the form of electric charges or molecular changes).

  Dopamine: Raises alertness and confidence; lowers aggression, compulsivity, and paranoia. Also helps you get a good night’s sleep. Parkinson’s disease seems to be linked to dopamine deficit. Excessive amounts are a factor in schizophrenia. Speaking of which, cocaine and amphetamines crank the levels up really high.

  Dysphoria: The opposite of euphoria. That is, manic behavior marked by deep anxiety/depression.

  Enzyme: Molecules that increase or decrease the speed of change in cells. The enzymes in the brain break down used neurotransmitters in a way that corresponds to how stomach enzymes break down (digest) food.

  Full Spectrum Lights: Bright lights that mimic the spectrum of the light of the sun in order to help people with Seasonal Affective Disorder.

  GABA: Keeping those GABA levels up can make you feel more relaxed and less anxious. Sedatives often help GABA receptors meet their quotas. It’s also the target of several drugs for psychosis. By the way: GABA stands for gamma-aminobutyric acid. Might come in handy next time you do a crossword puzzle.

  Glutamate: Glutamate is the other side of the GABA coin. It gets the target neurons more excited. In fact, some drugs that are used for bipolar and schizophrenia may work by somehow balancing the GABA and glutamate receptors.

  Hippocampus: A part of the brain that’s particularly involved in memory and orienting yourself in space.

  Hypnagogic: The dream-like images that you see just before falling asleep.

  Kundalini: In Tantric and Kundalini Yoga, concentrated energy in the base of the spine that changes consciousness when it spirals up into the brain. In Sanskrit, “kund” means “to burn.”

  Macrobiotic: A therapeutic diet—and lifestyle—that focuses on eating whole grains and locally-grown vegetables, but little if any meat or processed foods.

  Neurons: Brain cells. Neurons look kind of like giant squids with a whole lot of tentacles and a real whole lot of filaments coming out of each one.

  Neurotransmitters: Molecules made in neurons that transmit signals from one neuron to another. The way a person feels “off” usually depends on which neurotransmitters aren’t getting the job done. Even though each type has its general area of expertise, there’s a lot of cross over and they tend to be willing to cover for each other when one wants to go out for a cup of coffee or take a millisecond or two off.

  Norepinephrine: Gets your body up and at ’em by increasing your heart rate and blood pressure. So you feel more energized, alert, and able to focus. It’s also used in heart medications. (Norepinephrine is another word for adrenaline.)

  Petroglyphs: Pre-historic glyph-like images carved in rocks. There are tens of thousands of them in the Southwest alone.

  PTSD: Post Traumatic Stress Disorder. While best known, and most prevalent, among soldiers returning from war, the diagnosis is also occasionally given to people with similar symptoms that have been caused by a wide range of other traumas.

  Receptors: You’re not going to believe this, but each of the tiny dendrites on a neuron has really, tiny, tiny doors. The doors are different shapes so they’ll only let in certain kinds of neurotransmitters and thereby pass along certain kinds of messages. Usually people describe it as a lock and key kind of thing.

  Rolfing: A special form of deep-tissue massage developed by a woman named Ida Rolf in 1971. Among other things, it can have a majo
r impact on your posture.

  Serotonin: The most famous mood-related neurotransmitter. Serotonin can decrease anxiety and aggression while calming and lifting the emotions. There are cells making serotonin through your entire nervous system and, as pointed out in the text, 90% of the serotonin in your body is in your tummy. Think about that next time you have a gut feeling!

  Shamanism: A “magical” religion that, in some cultures, includes ceremonial use of hallucinogenic plants.

  Synapse: The space between cells that neurotransmitters leap across to pass signals from one to another, eventually leading to a part of the brain that knows how to do things like “Crank it up!” or “Chill out!’ Or one of a million different variations on those two messages. That is, it’s all about getting the brain cells to move and shake in a way Goldilocks would approve of—that is, not too fast, not too slow … just right.

  Tyrosine: An amino acid that neurons use to make neurotransmitters.

  MEDICATIONS (Trade/Generic)

  Every time I read about prescription meds I wish I had one complete list of the trade/generic names of the most common ones. So I finally put my own list together based on a variety of sources. Many of these medications are not mentioned in the book. But a similar one may be, in which case this may help you figure out what type of drug it is and what it’s usually prescribed for.

  As I mentioned in the book, there’s a lot of mixing apples and oranges here. For example, there’s a wide class of drugs usually referred to as “atypicals.” Which are typically prescribed for psychosis, mood stabilizing, bipolar, and/or schizophrenia—although some tend to be prescribed more often for one condition: e.g., bipolar (Depakote) or schizophrenia (Haldol) or mood stabilizing (Lamictal).

  TRADE NAME GENERIC NAME INDICATION - CLASS

  Abilify aripiprazole Antipsychotic/Mood Stabilizer/Bipolar

  Adderall amphetamine Attention Deficit Disorder

  Ambien zolpidem Sleeping Aid

  Anafranil clomipramine Antidepressant - Tricyclic

  Aventyl nortriptyline Antidepressant - Tricyclic

  BuSpar busprione Anti-anxiety - Azapirone

  Celexa citalopram Antidepressant - SSRI

  Concerta methylphenidate Attention Deficit Disorder

  Cymbalta duloxetine Antidepressant - SNRI

  Depakote valproic acid Antipsychotic/Mood Stabilizer/Bipolar

  Desyrel trazodone Antipsychotic/Mood Stabilizer/Bipolar

  Dexedrine dextroamphetamine Stimulant - ADHD

  Effexor venlafaxine Antidepressant - SNRI

  Elavil amitriptyline Antidepressant - Tricyclic

  Emsam selegiline Antidepressant - MAO Inhibitor

  Eskalith lithium Antipsychotic/Mood Stabilizer/Bipolar

  Focalin dexmethylphenidate Stimulant

  Geodon ziprasidone Antipsychotic/Mood Stabilizer/Bipolar

  Halcion triazolam Anti-Anxiety - Benzodiazepine

  Haldol haloperidol Antipsychotic/Mood Stabilizer/Bipolar

  Klonopin clonazepam Anti-Anxiety - Benzodiazepine

  Lamictal lamotrigine Antipsychotic/Mood Stabilizer/Bipolar

  Lexapro escitalopram Antidepressant - SSRI

  Librium chlordiazepoxide Anti-Anxiety - Benzodiazepine

  Limbitrol amitriptyline Antidepressant - Tricyclic

  Lithobid lithium Antipsychotic/Mood Stabilizer/Bipolar

  Lorazepam Ativan Anti-Anxiety - Benzodiazepine

  Lunesta eszopiclone Sleeping Aid

  Marplan isocarboxazid Antidepressant - MAO Inhibitor

  Nardil phenelzine Antidepressant - MAO Inhibitor

  Norpramin desipramine Antidepressant - Tricyclic

  Parnate tranylsypromine Antidepressant - MAO Inhibitor

  Paxil paroxetine Antidepressant - SSRI

  Pristiq desvenlafaxine Antidepressant - SNRI

  Prozac fluoxetine Antidepressant - SSRI

  Remeron mirtazapine Antidepressant - Tricyclic

  Risperdal risperidone Antipsychotic/Mood Stabilizer/Bipolar

  Ritalin methylphenidate Attention Deficit Disorder

  Seroquel quetiapine Antipsychotic/Mood Stabilizer/Bipolar

  Sinequan doxipin Antidepressant - Tricyclic

  Strattera atomoxetine Attention Deficit Disorder

  Thorazine chlopromazine Antipsychotic/Mood Stabilizer/Bipolar

  Tofranil imiprimine Antidepressant - Tricyclic

  Valium diazepam Anti-Anxiety - Benzodiazepine

  Vyvanse lisdexamfetamine Attention Deficit Disorder

  Wellbutrin bupropion Antidepressant - NDRI

  Xanax alprazolam Anti-Anxiety - Benzodiazepine

  Zoloft sertraline Antidepressant - SSRI

  Zyban bupropion Smoking Cessation

  Zyprexa olanzepine Antipsychotic/Mood Stabilizer/Bipolar

  Antidepressant Classes

  MAOI (Monoamineoxidase Inhibitor): Blocks the enzyme that breaks down neurotransmitters so they stay in the synapse longer.

  SSRI: Selective Serotonin Reuptake Inhibitor. It keeps neurotransmitters, primarily serotonin, from skedaddling out of the synapse before they’ve done their job.

  SNRI: Ditto, except it works on serotonin and norepinephrine.

  NDRI: Ditto, except it works on norepinephrine and dopamine.

  Tricyclic: Blocks reuptake of serotonin, norepinephrine, and/or dopamine.

  *All of the above have varying degrees of effect on the “receiving side,” making receptors more receptive (agonists) or less (antagonist).

  Acknowledgments

  Thank you …

  Ambrose Bierce called love, “a temporary insanity curable by marriage.” Wendy and my marriage has been more like a long-term insanity curable by love. Of all our 35 years together, this book describes two of the hardest. And yet here we are. Still together. Something for which we are both very grateful, and maybe a little amazed. (By the way, the prophetic dedication is from Bruce Springsteen’s song “Born to Run” which was released just a few months before we met in January, 1976.)

  I’m similarly thankful to and for our daughter Emily who, while deeply troubled by what I was going through, always managed to say or write the right words at the right time. Thanks also to her husband Drew and the boys: Owen, Lucas, and little Julian—whose smile, from Day 1, has been an inspiration to us all.

  I’m also eternally indebted to my late parents Elmer and Sophie Blistein who taught me to think, feel, read, and write; and believe it or not, had a set of Dante and Beatrice bookends in their ample library.

  Keeping it in the family a bit longer, I want to thank my brother Adam, in particular for our annual Thanksgiving walks and talks, as well as his family—Maralin, Jonathan, and Lenna—for, among other things, helping to keep holidays relatively sane and mom relatively relieved. Also, my late cousin Rob Cutler who showed us all how to keep laughing in the face of adversity, as well as the whole extended family of Cutlers, Kerns, and Schaffers, particularly Dora Schaffer, Ronni Kern (on the West Coast) and David and Robin Kern (on the East Coast), who helped me understand—and be amused by—the curiosities of our particular gene pool.

  There are so many others:

  Ken Burns, for the Foreword, the Depressive’s Mantra (“It will pass. Be kind to yourself. Ask for help …”), 40 years of friendship, and “24/7.”

  Joe Marks & Maggie Cahoon whose support, friendship, and ability to lift my spirits never wavered, day after heartbreaking day.

  All my “special correspondents:” particularly Deb Delisi, Gigi Kast, and Camilla Rockwell. Our back-and-forth emails are the basis for some of the more insightful parts of this book; as are the words of Betsy Alden, Brenda Biddle, Caroline Carr, John Cadley, Noah Elbers, Norman Lerchen, Mark Semon, and Deb Shumlin.

  Then there are all the people who did their professional best to help me stay within screaming range of sanity. From traditional psychiatrists to untraditional psychics, I’m indebted to them all in equal measure: Ray Abney, Ann Acheson, Laurie Crosby, Marcus Daniels, Lucinda Dee, Bruce Dow,
Deb Feiner, Richard Fletcher, Jacqueline Jimoi, Julian Jonas, Spero Latchis, Carl McNeely, Marilyn Morgan, Janet Isabel Murphy, Kassie Nelson, and Susan Taylor.

  A special thanks to Joe Kohout who stopped by to share his unique insights into strange states on many a Tuesday evening; Nancy Guzik who so generously let me share her space on many a Wednesday; Ann Fielder who—I think it was a Thursday—did her own no-nonsense intervention; and the late Al and Martha Morgan who let me wander into their house down the road any day of the week, pour myself a drink, share stories, watch baseball, and forget about everything else for a while.

  While some of the following people may not even know why I include them, rest assured that, in some way, you helped me make it from breakdown to book—for reasons that range from well-timed bike rides and squash games to one-time conversations and long-term friendships: Charlie Conquest, Wendy Conquest, Leo Dunn, Phil Feidelseit, Sam Gearhart, Rebecca Jones, Arnie Katz, Suzanne Kingsbury, Ruth Klein, Anna Kuo, Mark Lachman, Eric Leo, Kathy Leo, Lynn Levine, Jill Lillie, Sally Mattson, Nanci McCrackin, the Miller Family, Joey Morgan, Stephan Morse, Cynthia Nims, John Nopper, Julie Peterson, Kathy Pontz, Jeff Potter, Cynthia Reeves, Andy Rome, John Scherer, Richard Senft, Michele Slatnik, Larry Spitz, Amy Stechler, Susanna Steisel, John Stephans, Robert Stone, Jack Wesley, Tim Wick, Keith Wilson, and Tom Yahn. If I’ve left you out, please let me know!

  I’m grateful to Hotel Pharmacy in Brattleboro, VT for understanding the intricacies of co-pays even better than the insurance companies. Thanks to Brooks Memorial Library in Brattleboro, for having the books I needed when I needed them—including three copies of the DSM-IV! And let’s not forget the Windham Wheelmen (and women) and all my friends at Some Like It Hot in Putney, VT and Brattleboro Racquetsports, who kept my core strong and endorphins pumping when I needed it most.