Mental
Page 22
I walked to KissSalis the next day with a bathing suit, a change of clothes, and a book. It looked like a glorious mall—modern and made of glass, boasting eight indoor and two outdoor pools and more than ten thousand square feet of relaxation. There was less protocol to follow than I thought. All the common areas were clothes on, the saunas were super naked and coed. Easy to navigate that.
I jumped in and went to the outdoor current pool first. I moved with the water and an elderly woman moved at her own pace in front of me, jogging in a circle with the happiest old face on earth. She wore dark round steampunk glasses and a big black bathing cap whose shape resembled the Coneheads. She had the biggest no-tooth smile as she babbled and waltzed with the water. Indoors, in the main pool, a column lit from within with otherworldly presence dominated the center of the open building. Underwater aluminum stretchers lined the edges so that bathers could watch the almost imperceptible rainbow transition. The column changed colors slowly—one minute pale blue, the next pale green. I felt like the pillar had power; it could stretch to the moon and lord over its earthly tenants. Maybe the column could reach to the galaxies far away, drawing lithium down? There was a fire hose–strength waterfall that I sat under for minutes, hours, days? Who knew. Time was not relevant to this place. I went to the saltiest indoor pool, a nearly pitch-black room with holes poked into a ceiling blanket to mimic a night sky. I hitched my heels to the edge and floated effortlessly. Classical music played underwater. And I basically took a nap on the surface of the water. I felt liquid.
CHAPTER 22
WHEN IN ROME AND THE LITHIUM RECKONING
THE CONFERENCE IN ROME was a lark, mostly an effort to track down the mysterious Dr. Jules Angst (real name). In July 2015, I’d received a manila envelope in the mail from a scientist who had read the article I wrote about my kidneys in the New York Times Magazine. Dr. Ed Ilgren sent me a bio of himself and his work researching how lithium exposure through natural water sources in Chile affected indigenous populations. Over dinner, he made it clear that he was worried for my safety, and insisted that I find Dr. Jules Angst. Dr. Ilgren introduced us over e-mail, but because of a language gap, Angst and I could never quite connect. So I found myself searching for his next lecture, and if I had to go to Rome, I would suffer that fate. It was sort of a kill-two-birds-with-one-stone kind of trip: I could find the mythical Angst and I could pick the brains of leading international psychiatrists about my kidney/lithium predicament. At this point, I was asking cabdrivers, inanimate objects, anyone who would listen what they thought. Most people didn’t have an answer—no one could.
When I got to Rome, I had business. I had to find the ruins of Caracalla, one of the largest bathhouses of Rome commissioned by Septimus Severus and completed by AD 235. These baths, the second-oldest in Italy, had been in use until AD 537—1,600 people at one time could use the cold baths, tepid baths, hot baths, steam baths, and the open-air bath, which was the size of a modern Olympic-sized swimming pool. Part of the bathing experience that I liked best was its simplicity and ability to transcend millennia.
RUINS OF CARACALLA IN ROME.
I had already been a spa convert—I’d spent evenings pouring ice-cold water on my head while schvitzing in the East Village and gone to Korean spas for soaks and scrubs in LA and New Jersey and Queens, feeling more at ease with the world upon exit than I ever had with a Xanax. One winter night at the Russian and Turkish bathhouse in the East Village, Hana and I had taken to the soaks and the heat, sweating out the city. We steamed, we saunaed, we went to the back room where Russian men slap other Russian men with platka leaves for vitality. The sensation of going hot and cold, the extremity of the temperature shift in body and air, felt so alive, like an external heartbeat. In the back room, when we were at the brink of heat, skin crisping, we would dump buckets of ice water over our heads and bodies. Hot and cold and hot and hotter, then coldest. Finally when our bodies had an internal temperature of warmer than normal, we made our way to the roof deck. We lay steaming on the sun chairs, looking at the rooftops, the fire escapes, the back alleys of the East Village we had once traipsed through—and we watched the first of winter’s snowflakes fall delicately, kissing the roof and our skin. Our breath escaped; each flake that touched our bodies melted.
After Bad Kissingen, I was a total convert to healing waters. The lineage of treatment only added to the allure. So it was a formal, almost ceremonial homage to the ruins of Caracalla, to the Romans, the O.G. bathers! It seemed like they did everything in the baths—Romans would conduct business, read, buy perfumes, get massages, watch athletic performances, socialize, and soak in these facilities modeled after Greek baths. The main buildings were constructed in such a way that the visitors could easily walk from one facility to another, with a main corridor between the two entrance halls. The ruins now stand nearly one hundred feet tall and are an extension of a southern area of Rome surrounded by parks populated by tall, top-heavy stone pines. The Roman use of baths was more social than medicinal, but the complex was impressive. I’m not sure what I thought I could absorb from sitting there on yellowed grass and in minimal shade—a return to a Roman time when melancholia and mania was first thought of and considered? Or just a sense of the reliance and importance that this society once placed on relaxation? It used to be a sign of empirical strength to be able to build such an enormous and architecturally complicated complex devoted to leisure, to calming the mind. Now, I sat under the trees mostly, to take it in and to think. This was my spirit quest, my way into a decision and a plan.
That night I ate pasta at trattoria Lilli, a no-frills family place that felt like a Noodle Pudding; there were more Romans than tourists, all laughing through goblets of red wine. Again, I was reminded that Italians know how to relax and take in life, without much effort. For a nervous Jew with a damaged kidney on a lithium quest, this space was a welcome respite. The unassuming white tablecloths and simple pasta dishes reminded me of my favorite form of therapy—slurping noodles until olive oil dripped down my chin. Eating bread soaked in olive oil, olives soaked in olive oil. I ordered a big bowl of caci e pepe, cracked a Moretti, and settled into some easy reading about lithium. I thought of the epitaph of an ex-slave, Tiberius Claudius Secundus, at the baths. It read “Balnea, vina, Venus corrumpunt corpora nostra; sed vitam faciunt balnea, vina, Venus,” which translates to, “Baths, wine, and sex spoil our bodies; but baths, wine, and sex make up life.” It’s as good an epitaph as any, and in Italy it seemed like lithium and kidneys and health mattered less. I did not want my epitaph to read, “Lithium and obsessive thinking spoils your body; but lithium and obsessive thinking make up life.” That is a shitty epitaph. There was fresh produce and tomatoes that tasted like hummingbird nectar, gelato that dripped from thumb to elbow, and people who yelled affectionately. A woman in a stall near the conference made me pasta and took offense at my not eating enough. Everyone seemed to stroll through life at pace with the sun and the moon and the cycle of storms. I thought maybe it was New York or my life, or that stress was just too stressful for me, that I need to remember that cosmic space of soaking in KissSalis. Or if I could combine both and soak in waters while slurping pasta, well, that would be a good life, too.
I woke up the next day and walked to the conference, completely uncertain if Angst would be there and what a room full of psychiatrists would be like. The eighteenth International Review of Psychosis and Bipolarity was a three-day affair organized by the group’s director, Russ Pendleton. There were papers that seemed relevant, like “Nothing New Under the Sun? An Update on Current Treatments for Bipolar Disorder and Beyond,” chaired by Dr. Dina Popovic, or “The Issue of Tolerability in the Long-Term Treatment of Bipolar Disorders,” chaired by Dr. Andrea Murru, and the last day’s presentation was especially interesting to me: “Past and Future of Lithium Therapy,” chaired by Dr. Paolo Giraldi and Dr. Leonardo Tondo. The conference was the all-stars of international psychiatry—with
doctors traveling from Israel, Serbia, Tunisia, Austria, Canada, and the United Kingdom to try to penetrate the impenetrable: mental illness, its treatment, and its study. The chair and president of the group was the elusive Dr. Angst. To get to the Hotel Nazionale where the conference was located, I walked through alleys and cobbled streets, making wrong turns only twice. I had practiced the day before so that I could spot landmarks, a clear sign of the anxiety I felt that I might never find the conference or Angst or satisfy the reason I came all this way in the first place. The upside was that, either way, I’d experience Angst. The conference room was yellowed and taupe and windowless and could have been anywhere—Cleveland, Vegas, the Frankfurt airport. The main presentation room had the feeling like it was a vessel for PowerPoints. But there was Dr. Angst, eighty-nine years old, sitting on a bench with his wife, who it turned out had actually been the one responding to my e-mails. I introduced myself.
DIRECTIONS TO THE IRPB CONFERENCE IN ROME.
“Ah, I thought you were a Portuguese man based on your name.”
He shook my hand and we sat to talk about the history of psychiatry, medication, and why anyone would study brains and emotion in the first place. His father was a technical draftsman and his mother managed a bake shop and he was an only child. When he was young, Angst picked up his father’s entomology hobby, and noticed that butterflies that came from different altitudes had different wing patterns. He experimented by taking low-altitude butterfly larvae and birthing them in freezing temperatures in the refrigerators of the city slaughterhouse. The result: a high-altitude wing pattern. That was the beginning of his belief that health—including mental health—was a holistic issue, affected by environmental factors that shifted the expression of genes. He explained that he started his studies, alone in a library in Zürich, poring through the pages of Jung and Freud. He became disenchanted by his own practice of analysis. It was then that he decided to become a psychiatrist. He thought taking time with patients was essential and more important than the theories and methods of different schools of analysis.
Angst said he had schizophrenic patients who didn’t change long term with analysis, so he shifted his focus in the early 1960s to study psychopharmacology. “In order to diagnose and treat patients, one has to examine their physical condition as well as their psychopathology. I didn’t feel a connection to analysis. Devoting enough time to patients is essential. More than fifty percent of the time now is documenting what you are doing at the computer. It hasn’t become very ameliorating in terms of human relationships,” Angst said. We talked about how we have ways of measuring the heart, blood pressure, ways to map the body with numbers and guidelines—I explained that from my experience it seemed like tracking mood was impossible. Dr. Angst countered that he and others had developed a series of questions—the Hypomania Checklist, a thirty-two-question self-assessment survey. I thought back to my adolescent self-assessment and was wary. If you are manic, you are likely to answer delusionally. And what could a survey really show? And that seemed to be the crux of why treatment is so hard—there’s no way for a doctor, especially a doctor just meeting a patient for the first time, to be able to identify what is manic for one person versus manic for another. For all Dr. Angst knew, I was not a writer, not working on a book at all, and that I was in the throes of an episode, interviewing experts as part of a manic episode. And maybe I was? I was eating barrels full of pasta, talking to random strangers, and I was here for a slightly bizarre and complicated purpose, almost grandiose.
I could see how my questions, repeated to all the psychiatrists there, might come off as crazy—I didn’t have papers to prove that my kidneys were busted, or that I was taking my lithium. Even though Dr. Angst had developed this survey, he knew that the reality was that “even if you could measure mental illness, you couldn’t define normal based on statistics. An individual is much more complex.” Angst and I talked about times when he was depressed—once when he was depressed over a love affair, and once when he was briefly suicidal after unsuccessful back surgery for disc hernia with paralysis. He had felt a range of emotions in his lifetime but he was not predisposed to manic depressive disorder, though it seemed like he had a window into it through his patients and through his own experience. He wouldn’t go into more detail because he said it felt too personal, but he was open to sharing how his professional life was shaped by lithium, if not by taking it, by believing in it as much as I did. He was among the first advocates for lithium in Europe by showing with Paul Grof that bipolar disorder could be improved by lithium. At the time, the UK psychiatric community believed that manic depression was unaffected by lithium treatment. He had even traveled to Australia to meet Dr. Cade in the 1970s.
Angst brought up two things that I hadn’t really thought about. He mentioned the concept of trust and that with “compliance and trust, a lot of what you have is the placebo effect. The effect the patient has that he believes in you, whether you are giving a placebo or an active drug.” More than half of the positive treatment responses in mood disorders are due to placebo effects. In one study, when patients were treated with clonazepam or an SSRI (a type of medication commonly used to treat depression), 60 to 70 percent of those with panic disorder become panic-free during a ten-week treatment period. During the same period, half or more of patients with panic disorder who were treated with placebo become panic-free. Angst believes that there’s the potential of a placebo effect in all psychopharmacology—that the patient’s trust in medicine is built through her trust in care. “It is essential to look at human beings in their whole development; we should study humans from intrauterine development to the end of life. Such a long-term perspective is also important brain research. You have to follow changes over time, without which you lose this continuity,” Angst said. It’s not a new approach. Hippocrates urged physicians to make frequent visits with their patients and directly inquire about their situations without intermediaries, laypersons, or nurses interfering. This effort was to inspire confidence among patients so that they would feel comfortable trusting their doctors. Because once again, how do you know if medication is working in mental illness? You don’t, you only know when it’s not working.
Angst spoke with a slight Austrian accent and had a hard time hearing my questions over the din of the conference and the tittering psychiatrists who filtered in and out of the lobby to get coffee. Nevertheless, we talked about the artists he’s treated, and he mentioned that van Gogh had a manic spurt of production before his death in July 1890. I thought back to my days of unstretching my canvases in the backyard of my dad’s house—hovering over old paintings, painting layer upon layer over a finished piece, each slap of paint more genius than the next. In college I painted an homage to my NPI stay in high school; it was a huge canvas, maybe eight feet tall. There was a section devoted to me in a hospital nightie, my butt exposed and the back of my red hair flowing, running from nurses and needles. Another section was an elaborate ink drawing of the pipes I thought would poison me. This was a painting I made when I was sane, thinking of crazy times. When I was manic the second time in 2001, I unrolled this mammoth canvas and painted over every inch. My dad and Marilyn were just glad I was occupied with something even if it was guttural manic painting. The most striking new image was a serpentine black figure with hot-pink hair streaked out this way and that, a demon really—I wrote ERASE HER! across the breast of the figure. You can see my footprints winding around in paint showing the path of concentration, where I was focused. I flung red paint. I bathed in it. I was dripping in paint and walked across the painting leaving a trail; I put stickers on it that said SPECIAL HANDLING, STAT; I wrote smoking peace pipes next to nuclear-looking storage tanks. I tagged most of my college paintings with silver spray paint and splattered fire-engine red across surfaces. I took carvings I made in printmaking workshops and made other new quick-fire paintings, all demon faces, some with glitter, some without.
DETAIL OF MY PAINTING OVER MY COLLEGE PAINTING, WITH THE WORDS ERASE HER SCRAWLED ON THE CHEST OF THE FIGURE.
The comedian Chris Gethard and so many other comedians/artists say and I would agree: the myth that medication stunts creativity is bullshit. (He spoke more eloquently and emphatically about it in his one-man show Career Suicide, in which he explains that you can’t be creative, you can’t write a joke, if you can’t get out of bed.) Medication allows for function, which is the first step toward doing anything—creative or otherwise. My creative spurt wasn’t really a creative spurt at all, it was the opposite: destruction. After my medication kicked in and I was coming to, I looked at that canvas and thought of it as ruined. I rolled it up and pushed it out of sight—a piece I had worked on for months in college was all of a sudden slashed, taken hostage. But now I see it as this relic, a canvas in which I was exorcising a part of me. The paint articulating what I couldn’t.
In his final weeks, van Gogh painted a number of landscapes of the wheat fields. During van Gogh’s time in Auvers, where he died, he made even more paintings and drawings—he completed seventy works including sketches during his stay from May 1890 until his death on July 29, 1890. On July 10, 1890, van Gogh wrote to his brother, Theo, about two of the canvases, saying, “They are vast stretches of wheat under troubled skies, and I did not have to go out of my way very much in order to try to express sadness and extreme loneliness. . . . I’m fairly sure that these canvases will tell you what I cannot say in words, that is, how healthy and invigorating I find the countryside.” In a letter two days later, he wrote to his parents, “I myself am quite absorbed in that immense plain with wheat fields up as far as the hills, boundless as the ocean, delicate yellow, delicate soft green, the delicate purple of a tilled and weeded piece of ground, with the regular speckle of the green of flowering potato plants, everything under a sky of delicate tones of blue, white, pink and violet. I am in a mood of almost too much calm, just the mood needed for painting this.” He speaks of mood just weeks before his suicide—an alternate mood, one of calm and near elation, but certainly not depression. Depressed people don’t paint; depressed people don’t see glory in wheat. There are other theories about van Gogh’s death—that he did not commit suicide—but his letters certainly speak to the self-awareness of his disease and the fluctuations of his mood. Some of his greatest works were completed before his death. “The positive aspects are important,” Dr. Angst then said. “What I have seen on lithium was that it didn’t change creativity, lithium made it more consistent. There are so many creative people who are mentally ill. I have treated so many artists who were bipolar and addicted and they are very inventive during manic episodes, but taking lithium doesn’t stop that.”