And then I found that the air was getting so hard and brittle that the words were coming through in stacatto noises that I couldn’t quite string together. Perhaps you have had the experience of attending a lecture and realizing that in order to follow the main points you need to keep paying attention; but your mind wanders a bit and then you can’t quite make sense of what is being said when you return to it. The logic is missing. So it was for me, but on a sentence-by-sentence basis. I felt the logic disappearing right out from under me. Someone had said something about China, but I wasn’t sure what. I thought someone else had mentioned ivory, but I didn’t know whether it was the same person who’d been talking about China, though I did remember that the Chinese had made ivory things. Someone was asking me something about a fish, perhaps my fish? Whether I’d ordered fish? Whether I liked fishing? Was there something about Chinese fish? I heard someone repeat a question (I recognized the sentence pattern from the time before), and then I felt my eyes close and I thought quietly, it is not polite to fall asleep when someone asks you a question for the second time. I must wake up. So I pulled my head up from my chest and smiled in what was meant to be an I-didn’t-quite-catch-that way. I saw puzzled faces looking at me. “Are you okay?” someone asked again, and I said, “Possibly not,” and some friends who were there took me by the arms and led me outside.
“So sorry,” I kept saying, dimly aware that I had left everyone at the table thinking I was probably strung out on drugs, and wishing that I had simply said that I was depressed, hypermedicated, and unsure of how well I’d get through the evening. “So sorry,” and everyone kept saying that there was nothing to be sorry about. And the friends who had saved me got me home and up to my bed. I took out my contact lenses and then tried to chat for a few minutes, to reassure myself. “So how are you?” I said, but when my friend started to answer me, he became rather faint, like the Cheshire cat, and then I passed out again and went into a cavernous sleep for seventeen hours and dreamed of a great war. My God, I had forgotten the intensity of depression. It cuts so deep, so far! We are determined by sets of norms that are quite beyond us. The norms to which I was brought up and which I established for myself are quite high by world standards; if I do not feel able to write books, I feel something is wrong with me. Some people’s norms are much lower; those of other people are much higher. If George W. Bush wakes up one day feeling that he can’t be the leader of the free world, something’s wrong with him. But some people feel that they’re okay as long as they can feed themselves and keep on living. Collapsing at dinner is well outside of the range I count okay.
I woke up feeling slightly less horrible than I had felt the day before, though I was also upset by my wander out of control. The idea of going outside still seemed shockingly difficult, but I knew that I could go downstairs (though I wasn’t sure I wanted to do such a thing). I could send some E-mail. I made a bleary call to my psychopharmacologist, and he suggested that I cut back to half of a Zyprexa and lower the consumption of Xanax. I was frankly incredulous when my symptoms started to lift that afternoon. By the evening, I was nearly fine, like a hermit crab who had outgrown one shell and given it up, crawled vulnerable across the beach, and then found another shell elsewhere. Though I still had a ways to go, I was joyous at the knowledge that I was recovering.
So that was the third breakdown. It was a revelation. While the first and second breakdowns had been acute for periods of about six weeks each and had lasted in all about eight months each, the third breakdown, which I call the mini-breakdown, was acute for six days and lasted about two months. I was lucky to have a very good response to the Zyprexa, but I also found that the research I had been doing for this book, whether it was to be of value to anyone else or not, was terrifically useful to me. I had been sad for a few months for a variety of reasons and was under considerable stress, coping with everything, but not easily. Because I had learned so much about depression, I recognized the crossover point immediately for what it was. I had found a psychopharmacologist who was capable of subtlety in modulating a drug cocktail. I believe that if I had gone on medication before my first breakdown had swept me all the way into the abyss, I would have been able to bring my first depression to heel before it got out of control, and that I might have avoided real breakdowns altogether. If I had not gone off the medication that helped me through that breakdown, I might never have had a second one. By the time I started heading for a third one, I was determined not to make a stupid mistake again.
Remission from mental illness requires maintenance: all of us periodically encounter physical and psychological trauma, and chances are pretty good that those of us with a significant vulnerability will all have moments of relapse in the face of problems. A lifetime of relative freedom can unfold best with careful and responsible attention to medication, balanced with steadying, insight-producing talk. Most people with severe depression require a combination of drugs, sometimes at unorthodox doses. They also require an understanding of their shifting selves, one that a professional can facilitate. Among the people whose stories I have found achingly tragic are the many who have had depression, have sought help, and have been thrown some product that they have taken, often at the wrong dose, to half-help symptoms that could have been cured. Perhaps the most tragic among these are the ones who know they are getting poor treatment but whose health maintenance organizations (HMOs) and insurance make it impossible for them to do better.
There is an old fable that used to be told in my family about a poor family, a sage, and a goat. The poor family lived in misery and squalor, nine of them sharing one room, and no one had enough to eat and everyone’s clothes were in rags and their life was one of utter, unrelenting misery. Finally one day the man of the house set off to visit the sage and said to him, “Great sage, we are so miserable that we can barely stay alive. The noise is terrible, and the filth is awful, and the lack of privacy could kill a person, and we never have enough to eat, and we are all beginning to hate one another, and it is just horrendous. What should we do?” To which the sage replied simply, “You must get a goat and have the goat live inside the house with you for one month. Then your problems will be solved.” The man looked at the sage in astonishment. “A goat? To live with a goat?” But the sage insisted, and since he was a very wise sage, the man did as he had been told. For the next month, the hellish life of this man’s family was beyond intolerable. The noise was worse; the filth was worse; there was nothing remotely resembling privacy; there was nothing to eat since the goat kept eating everything; and there were no clothes because the goat ate everyone’s clothes as well. The rancor in the house became explosive. At the end of the month, the man returned to the sage in a fury. “We have lived for one month with a goat in our hut,” he said. “It has been horrendous. How could you have given us such ludicrous advice?” The sage nodded sagely and said, “Now get rid of the goat and you will see how peaceful and sublime your lives are.”
It’s that way with depression. If you can knock out your depression, you can live in wonderful peace with the real-world problems you may have to confront, which always seem minimal by comparison. I called one of the people I was interviewing for this book and politely began the conversation by asking how he was. “Well,” he said, “my back hurts; I’ve sprained an ankle; the children are mad at me; it’s pouring rain; the cat died; and I’m facing bankruptcy. On the other hand, I’m psychologically asymptomatic at present, so I’d say all in all that things are fabulous.” My third breakdown was a real goat of a breakdown; it came at a time when I was feeling discontent about a variety of things in my life that I knew, rationally, were ultimately fixable. When I pulled through it, I felt like throwing a small festival to celebrate the joyfulness of my messy life. And I felt surprisingly ready, indeed curiously happy, to return to this book, which I had pushed aside for the two months preceding. All of that being said, it was a breakdown and it had taken place while I was on medication, and I have never since then felt fully secu
re. During the late stages of writing this book I would get struck by paroxysms of fear and loneliness. They were not breakdown stuff, but sometimes I would type a page and then I’d have to go lie down for half an hour to recover from my own words. Sometimes I got weepy; sometimes I got anxious and spent a day or two in bed. I think those experiences accurately reflected the difficulty of this writing and a certain petrifying uncertainty about the rest of my life, but I do not feel free; I am not free.
I have done pretty well for side effects. My current psychopharmacologist is expert in side-effect management. I have had some sexual side effects from my medications—a slightly decreased libido and the universal problem of much-delayed orgasm. A few years ago, I added Wellbutrin to my regimen; it seemed to get my libido running again, though things have never come up to old standards. My psychopharmacologist has also given me Viagra, just in case I get that side effect, and has since added dexamphetamine, which is supposed to increase sexual drive. I think it does but it also make me twitchy. My body seems to go through shifts beyond my ability to discern, and what works just splendidly one night may be a bit tricky the next. Zyprexa is sedating and I mostly sleep too much, about ten hours a night, but I have Xanax around for the occasional night when I am assaulted by sensation and cannot get my eyes closed.
There is a curious intimacy that comes of swapping breakdown stories. Laura Anderson and I have communicated with each other almost daily for more than three years, and during my third breakdown, she was extraordinarily attentive. She came from nowhere into my life and we developed a friendship of strange and sudden intimacy: within a few months of her first letter to me, I felt as though I had known her forever, and though our contact—mostly by E-mail but sometimes by letter or postcard, very occasionally by phone, and once in person—remained separate from the rest of my life, it was nonetheless so habitual as to become, very soon, addictive. It took on the shape of a love story, running through discovery, ecstasy, tiredness, rebirth, habit, and profundity. At times Laura was too much too soon, and in the early stages of our contact I sometimes rebelled against her or tried to contain the contact between us—but soon I came to feel on the rare days when I didn’t hear from Laura as though I’d missed a meal or a night’s sleep. Though Laura Anderson is bipolar, her manic episodes are much less pronounced than her depressive ones, and they are more easily controlled—a condition that is with increasing frequency called bipolar two. She’s one of the many people for whom, no matter how carefully medications and treatments and behaviors are regulated, depression always lies waiting—some days she’s free of it and other days she’s not, and there’s nothing she can do to keep it at bay.
She sent me the first letter in January of 1998. It was a letter full of hope. She had read my magazine story about depression, and she felt that we knew each other. She gave me her home number and told me to call anytime at any hour whenever I wished, and she enclosed a list of albums that had helped her to get through bad times and one of the books she thought I would like that were on my wavelength. She was in Austin, Texas, because that was where her boyfriend lived, but she was somewhat isolated and bored there. She had been too depressed to work, though she was interested in government service and hoped to get a job in the Texas statehouse. She told me that she had taken Prozac, Paxil, Zoloft, Wellbutrin, Klonopin, BuSpar, Valium, Librium, Ativan, and “of course Xanax” and was now on several of these as well as Depakote and Ambien. She was having trouble with her supervising psychiatrist, “so—guess what—off to doctor number forty-nine.” There was something in her letter that attracted me, and I wrote back as warmly as I could.
I next heard from her in February. “The Depakote is not proving itself,” she wrote. “I am frustrated by memory loss and shaky hands and stuttering and forgetting the lighter when it’s taken forty minutes to compile the cigarettes and the ashtray anyway. I am frustrated because these diseases seem to me so blatantly multipolar in many instances—it makes me wish Lévi-Strauss had never brought our attention to binary opposition. Bicycle is about as far as I’ll go with the prefix. I am convinced there are forty different shades of black, and I don’t like looking at this on a linear scale—I see it more as a circle and a cycle where the wheel is spinning too quickly and a desire for death can enter through any spoke. I thought of checking myself into the hospital this week, but I have been in there enough to know that I would not be allowed a stereo even with headphones, or scissors to make Valentine’s Day cards, and that I would miss my dogs, and that I would be terrified without and would miss terribly Peter, my boyfriend, who loves me through all the vomit and anger and unrest and no sex and that I would have to sleep in the hall by the nurses’ station or be locked in a room on suicide watch and so on—well, no thank you. I’m fairly confident that with the meds keeping me equatorial—between the two poles—I’ll be okay.”
As spring came her spirits lifted. In May, she became pregnant and was excited about having a baby. She learned, however, that Depakote has been associated with spina bifida and improper brain development; tried to go off it; worried that she had not gone off soon enough; began to destabilize; and soon wrote to me, “Here I sit in a postabortion blue stupor. I guess going back on the medication is my silver lining. I try not to get angry or resentful about all this, but sometimes it seems so unfair. It’s a breezy, big blue-sky day here in Austin and I’m wondering why I feel so depleted. See? Anything—even a normal reaction to a crummy ordeal—sends me into a fit of worry over a possible imminent depression. I’m in a sort of lackluster, grumpy Valium haze, though: headachy and stressed from crying.”
Ten days later, she wrote, “I have stabilized—perhaps going down a bit further than I’d like, but not into a worrisome range. I have changed doctors and medicine—from Depakote to Tegretol, with some Zyprexa thrown in to expedite the effects of the Tegretol. Zyprexa really slows me down. Physical side effects for mental illness seem such an insult! I think with all the stuff I’ve taken I now qualify for Advanced Depression. Still—I get this strange amnesia—it becomes impossible to remember, when an hour is an honest hour, just how dreadful depression is—eking one’s way through endless minutes. I am so tired, so exhausted of trying to figure out who I am when I’m ‘fine’—what is normal or acceptable for me.”
A few days later she wrote, “The self-consciousness gets in the way of offering much depth of personality to people—as a result, most friends I’ve made in the past eight or nine years are fairly casual. This grows lonely, and leaves me feeling idiotic. I just called, for example, a very dear (and demanding) friend in West Virginia, who wants an explanation for my not coming to visit her and her new baby. What to say? That I would have loved to make the trip but was busy staying out of the mental hospital? It’s so humiliating—so degrading. If I knew I wouldn’t get caught, I’d love to lie about it—invent an acceptable cancer, that recurs and vanishes, that people could understand—that wouldn’t make them frightened and uncomfortable.”
Laura is constantly hindered; every part of her life is defined around her illness. “As for dating: I need people I date to be a little able to take care of themselves, because me taking care of me takes a lot of energy, and I can’t be responsible for every little hurt feeling someone has. Isn’t that a terrible way to feel about love? It’s hard to manage professionally too—the short-lived jobs, the gaps in between them. Who wants to hear about your hopes for your new medication? How can you ask that anyone understand? Before I’d ever had this illness myself, I had a dear friend who was depressive. I listened to everything he said as if we understood the same language, when what I’ve realized since is that depression speaks, or teaches you, an entirely different one.”
In the months that followed she seemed to be struggling against something she could feel in the wings. In the meanwhile, she and I set about the business of getting to know each other. I learned that she had been molested as a teenager and raped in her early twenties, and that each of these experiences had left de
ep marks. She had married at twenty-six and had had her first depression the following year. Her husband had seemed unable to cope with it, and she had coped by drinking too much. In the autumn, she had become slightly manic and gone to the doctor; he had told her that she was just tense and put her on Valium. “The mania was enveloping my mind but my body was gruesomely slowed down,” she later told me. At the Christmas party she and her husband had held the next month, she had become furious and thrown a trout mousse at him. Then she had gone upstairs and swallowed the rest of the Valium. He had taken her to the emergency room and told the attending staff that he couldn’t cope with her; she had been put in a mental health facility and had stayed there through Christmas. When she came home, heavily medicated, “the marriage was over. We sort of limped through the next year, but that following Christmas we went to Paris, and I looked at him over dinner and thought, ‘I am no happier now than I was a year ago in the hospital.’ ” She moved out; met a new boyfriend fairly soon; and moved to Austin to be with him. The depression was fairly regular thereafter, at least once a year.
The Noonday Demon Page 13