by Anna Berry
Mom is at the training center too early the next day, and every weekday thereafter for four months. I don’t see her much for the first month or so because I’m busy with exams and my job as a resident advisor in my dorm, but I promise to visit her for a few days during my next school vacation.
I finish my last final exam early on a Friday afternoon. I pack a knapsack and hop a cab over to Mom’s building. I wait for her on the front steps until she arrives home from classes herself around three-thirty.
She gives me a big hug and leads me upstairs. I notice that she’s lost some weight since I’ve last seen her, and she’s dyed her graying hair back to the deep auburn I remember from my childhood. Her clothes are neat and pressed, her makeup perfect. “I’ve got so much to tell you,” Mom says while she pours both of us glasses of sweet iced tea from a pitcher. “Here, let me show you some of my school papers. You’ll be proud of me—I’m getting straight As, Anna. Just like you do.”
She takes a manila folder out of her satchel and opens it proudly. I flip through several mimeographed tests on medical terminology, office administration, and typing skills and see that Mom has achieved perfect or near-perfect scores on all of them. They’re emblazoned with gold stars and red smiley faces and “GREAT JOB!” is written in red ink everywhere. “This is fantastic, Mom,” I say, and hug her. “I knew you’d do well.”
“We do a lot more than just job training at the center,” Mom says. She beams as she rummages around in her satchel. “We do group counseling too. Every week one of the students gets to do a presentation on how she copes with her illness and stays focused on work. Our teacher asked me to give an extra-special presentation next week on what I do. I’ve come up with a whole plan based on some things I’ve learned from Dr. Friedman and some stuff I’ve come up with on my own. It’s called ‘Living in the Moment.’”
This piques my interest. I’m deep into my infatuation with Todd Naismith and all things Beat Generation and Zen at the time, and I can’t help but see the connection. “‘Living in the Moment,’ huh? You mean Zen.”
Mom looks bewildered. “What’s Zen?”
“Never mind. Just show me what you’ve put together.”
Mom presents me with a handwritten draft of a detailed study guide she plans to pass out to her classmates when she gives her presentation. I glance over it and find that Mom has essentially recreated all the basic tenets of Zen Buddhism—moment-by-moment awareness, humility, finding peace in the mindful enjoyment of simple daily tasks and service to others—without ever having been exposed to these ideas.
I’m first filled with awe, and then rage. There I am, spending inordinate amounts of time reading books and taking college classes on Eastern philosophy and zazen meditation, hanging out in Todd Naismith’s dorm room pining over both my affection for him and my envy of his easygoing brand of devil-may-care Buddhism while I strive with every fiber of my being to achieve some modicum of enlightenment—and my mother has managed to find it completely by accident. If my mother is any example, all one needs to do to become enlightened is pop a hundred milligrams of antidepressants a day and then take some free typing classes designed especially for lunatics. It’s ironic—my mother, who has been mentally ill for as long as I can remember, is doing so well when I’m an emotional wreck. It doesn’t seem fair, and I hate myself for that. It’s so hard to be happy for her when I’m so miserable, but I try my best—and still come up short.
I hate to admit it, but I’m jealous. All at once I feel like chucking into the trash the paperback copies of Kerouac’s The Dharma Bums and Suzuki’s Zen Mind, Beginner’s Mind I always carry in my knapsack.
Mom picks up on this right away. “Hon, is something wrong?”
I shake my head, cheeks smarting. “Go ahead and show me the rest of your presentation.”
She does. The whole thing takes about forty-five minutes. She explains how to “live in the moment” and what it means, how doing so can relieve anxiety and fear, how it can make even the dullest of office tasks meaningful and enjoyable. She’s included inspirational quotes from Mahatma Gandhi and Norman Vincent Peale, and she displays posters on which she’s pasted up drawings and watercolors she’s done of flowers and seascapes to help relieve anxiety. She even demonstrates a deep-cleansing, monitored breathing technique that I recognize as identical to that used in Zen meditation. Mom concludes the presentation with a guided imagery exercise that leads her participants to an island of serenity in a calm blue ocean, and she finishes with the Serenity Prayer. It’s a truly beautiful thing to behold, and yet I can’t bring myself to feel anything about it but jealousy.
“Well?” Mom asks as she put the papers and posters she’s prepared back into a cardboard box. “What do you think?”
“I think it’s very nice, Mom,” I say through gritted teeth. “I’m sure you’ll get a good grade for it.”
“I didn’t do this for a grade, hon.”
I have difficulty understanding this. It just doesn’t fit into my black-and-white thinking patterns at the time. “Then why do it at all?”
Mom just smiles. “Sometimes we just do things for the sake of doing them, hon. And that’s reason enough.”
My jealousy of Mom’s sudden mental and spiritual awakening soon subsides. It’s simply impossible not to be awed by her rapid transformation. She’s gone from zombielike pill-junkie to productive citizen in a matter of a few months. She graduates with flying colors from the job-training program a month earlier than the rest of her class and soon lands a full-time job as a medical-records coordinator at QCB, the social-services agency where her caseworker and Dr. Friedman both work. QCB has hired Mom in part based on the success of her Living in the Moment seminar, which has been so well-received at the job-training center that several local social-service agencies have asked her to present it to their clients. She is earning a real middle-class salary for the first time in her adult life, and she’s a celebrity among the local clinical-depressive set to boot.
By the end of the summer, Mom has moved out of her two-room, shared-bathroom apartment (in our family’s long tradition of psychiatric irony, Mom sublets it to Mark, who’s recently dropped out of his third junior college in as many years due to his inability to cope with school and schizophrenia simultaneously) and into the much larger attic apartment Bob has leased upstairs. They rekindle their marriage. They start saving for a down payment on a house. They are happy.
And they stay happy, for many years. Mom and Bob buy their first house together in the spring of 1996, a two-bedroom 1920s brick bungalow on Evansville’s northwest side. I’m able to spend a couple weekends helping her strip ancient wallpaper from the kitchen and hall before I move to Chicago for graduate school, and I track the progress of her and Bob’s loving, room-by-room restoration on holiday visits. Mom calls me in Chicago at least three times a week, monitoring my exciting big-city life (and my not-so-exciting emotional ups and downs) with a healthy, doting mother’s perfect combination of concern and detachment. Just like when I was back in college, she’s doing so well when I’m barely scraping by, and that can be hard for me to take. She sends me care packages, and she takes Greyhound buses to Chicago at least once a year for mother-daughter visits. She wires me grocery money when I’m out of work, even when her own money is tight. I worry sometimes when I’m at my lowest points if I’ll end up like she used to be, driving a jalopy around town searching for dead bodies in my bathrobe and curlers. But Mom doesn’t dwell on her sick, dysfunctional past. She lives in the present, and she does very well.
But it doesn’t last.
Mom remains the picture of good mental health until the winter of 2004, when everything my mother has built for the past nine years begins to fall apart.
Mom’s been working at QCB and thriving under Dr. Friedman’s care for almost nine years when a major change in management occurs. QCB changes from a non-profit social-services agency to a for-profit entity when it merges with PRI,[5] a rival agency with which it has often
competed for government contracts. PRI’s policy prohibits any employee from seeing any psychiatrist or psychologist who is also a PRI employee; that policy forces Dr. Friedman to sever his patient relationship with Mom—unless she quits her job.
Mom is heartbroken. Dr. Friedman is far and away the best psychiatrist she’s ever had, and now the job that he helped her get is taking him away from her. She can’t quit, either—with the consolidation of the region’s two largest mental health agencies into one, there isn’t anywhere else she can go in town now to receive both a good salary and on-the-job counseling.
PRI’s new executive director tells Mom she’ll have to find a new psychiatrist and gives her a list of names to choose from. Mom scans the list until she sees a name she recognizes—Rumanna J. Agarwal, MD.[6] Dr. Agarwal is a middle-aged Indian Sikh woman whom Mom encountered some years ago during her 1986–1987 hospitalization stint. Mom wasn’t under Dr. Agarwal’s care at the time; without any private insurance, Mom had to see whichever psychiatrist the Medicaid program assigned her. But back in 1987, Dr. Agarwal had stopped Mom in the hallway toward the end of her hospital stay and offered her free private counseling if she wanted it after her discharge. “You pay a few dollars if you can, otherwise free,” Dr. Agarwal had said in her thick Bengali accent. Dr. Agarwal’s office wasn’t on any bus line and Mom didn’t have a car in 1987, so she hadn’t taken up Dr. Agarwal’s generous offer. But Mom hasn’t forgotten Dr. Agarwal’s kindness, so she chooses Dr. Agarwal as her new agency-approved psychiatrist.
Dr. Agarwal’s office is in a converted Victorian mansion in an upscale Evansville neighborhood. Mom describes Dr. Agarwal’s office and waiting room as “super-duper ritzy,” with Spanish leather-on-mahogany furniture and Ralph Lauren wallpaper with matching curtains. Mom and I have since speculated as to why it’s so lavish, though based on the experience Mom has during the six months she is Dr. Agarwal’s patient, I think it’s likely that Dr. Agarwal gets a significant proportion of her practice income from under-the-table pharmaceutical kickbacks, otherwise known as “consulting fees,” which Big Pharma pays physicians in exchange for giving public lectures and writing journal articles promoting the use of certain drugs over others and also for favoring certain drugs with their patients.
Mom has to wait almost a month before she can get an intake appointment with Dr. Agarwal. In the interim, Mom is under heavy pressure at work. PRI has laid off all of QCB’s Medical Records Division management and replaced them with its own people, and my mother’s new direct supervisor—I’ll call her Louise—is not satisfied with Mom’s work. Mom has received stellar performance reviews ever since starting at QCB, and she has even helped design a more efficient system for archiving and pulling patient files. On busy days, Mom often stays after hours, without pay, to make sure the records remain in perfect order; she frequently takes work home with her too. She rarely calls in sick and never takes more than two or three days of vacation at a time. My mother is, by all accounts, a model employee.
None of this matters to Louise, however. As a product of PRI’s institutional aversion to hiring former mental health “consumers” as employees, Louise dislikes Mom from the start.
“I don’t like no crazies on my staff,” Louise tells Mom every morning. Then Louise follows Mom around wherever she goes, admonishing her for not pulling files fast enough or not refiling them in a way that Louise likes. Louise complains that the entire Records Division is put together “by crazies like you.” Mom tries to explain that the records filing system was approved by the agency senior management and done according to precise specifications. Louise tells Mom to shut up and work faster, belittling her every step of the way.
Mom calls me almost every evening during this period, giving me detailed play-by-play descriptions of what’s going on, asking for support and guidance. I am newly married and therefore preoccupied with other things, so I’m not much help. But I encourage her to report Louise’s behavior to the senior management. “What she’s doing is probably illegal, Mom. After all the years of hard work you’ve put in, I’m sure the agency will back you up.”
How naive of me to think so.
When Mom complains to PRI senior management about the way she’s being treated, they tell her “to find a way to get along with Louise, or else.” Mom then seeks Dr. Friedman’s help, but he tells her they both risk reprimand—perhaps even termination—if he does anything on her behalf now that the PRI policy is expressly against employee/staff-psychiatrist relationships of any kind. Meanwhile, Louise has stepped up her on-the-job belittling until it has become all-out harassment.
Under the increasing pressure, Mom’s anxiety levels increase for the first time in almost nine years. She starts having trouble sleeping, and the familiar black cloud of clinical depression looms. Mom knows that she needs an adjustment in her medication, but until she can get an appointment with Dr. Agarwal, she self-medicates with alcohol instead.
By the time Mom finally gets her intake appointment with Dr. Agarwal over a month later, she’s a mess.
Mom asks Dr. Agarwal if she can readjust the dosage in Dr. Friedman’s “little cocktail,” which has worked so well for her for so many years, to help her cope with her job stress. Dr. Agarwal refuses. Not only does she refuse, she takes Mom off Dr. Friedman’s “little cocktail” entirely, and puts her on a heavy mix of addictive benzodiazepine antianxiety meds and sleeping pills—the same drugs Dr. Friedman detoxed her from. The side effects of these heavy meds are many—including uncontrolled trembling, weight gain, blurred vision, and mouth problems, along with walking around zombie-like in a deep, drug-induced haze. Unlike Dr. Friedman, Dr. Agarwal gives my mother no cognitive therapy or counseling of any kind; her sessions with Mom consist of asking a few rudimentary questions, scribbling on a prescription pad, and walking out the door to see her next patient, as if she’s on a psychotropic assembly line. Pens, notepads, posters, and brochures advertising the latest psychoactive drugs litter Dr. Agarwal’s office at every turn, even in the bathrooms.
For the next six months, Mom sees Dr. Agarwal at least once a week. And every week, Dr. Agarwal changes Mom’s medication.
“She never gave anything a chance to work,” Mom says now. “I don’t even remember all the stuff Dr. Agarwal had me on.” Mom only remembers the drugs she took for more than two weeks at a time—there weren’t many—under Dr. Agarwal’s care. Sometimes Dr. Agarwal puts Mom on an antidepressant-benzodiazepine cocktail one week, then switches to an antipsychotic-sleeping-pill cocktail the next, then switches back. With all the random switching and replacing of meds, Mom’s brain soon becomes a chemically-induced firestorm.
Almost all the drugs Dr. Agarwal prescribes are known to cause drug-seeking behavior even in small doses, especially in persons with a history of substance abuse. Soon Mom is mentally and physically hooked on all these drugs, and whenever Dr. Agarwal switches a prescription or takes away a bottle of leftover pills—only to re-prescribe them again two or three weeks later—Mom finds ways to “seek” the meds her brain and body now desperately need to survive. Mom learns how to “clue” Dr. Agarwal into reissuing a past prescription by using her personal copy of Physicians’ Desk Reference to research which symptoms to rattle off in her weekly checkups. Since it’s evident that Dr. Agarwal gets financial incentives from the drug companies to push their meds as much as possible anyway, this strategy usually works just fine.
On the rare occasions that it doesn’t work, or when Mom can’t get the dosage that her mind and body increasingly need to prevent withdrawal symptoms, Mom finds other sources to feed her addictions. She does research on the Internet and discovers that over-the-counter antihistamines produce a sedative effect (and sometimes even pleasant hallucinations) when taken in large doses or combined with alcohol. Indeed, Mom finds that all the drugs she’s on seem more potent when mixed with large doses of antihistamines and cheap beer. She buys so many allergy meds from the CVS pharmacy down the street from her house that the pharmacist be
comes suspicious, takes it off the regular store shelves, and places it behind the pharmacy counter, refusing to sell her any more of it. (I learn this months later, when I visit Mom in Indiana and she makes up a story about having an allergic skin rash that requires oral antihistamines and sends me down to the corner CVS to buy her three boxes of the stuff.)
As Mom becomes more and more medicated, she has more and more difficulty performing her job. She shakes so much that she can’t hang onto medical files, and she spills their contents all over the place. Her vision gets so blurry she can’t read the charts correctly and she starts pulling the wrong ones. She starts calling in sick at least one day a week, and soon she finds herself unable to work for days at a time.
Her supervisor Louise loves every minute of it. She sees Mom’s deteriorating job performance as her chance to get Mom fired. However, taking Mom’s many years of loyal service under consideration, the executive director allows Mom to go on short-term disability instead, as long as she keeps seeing Dr. Agarwal and comes back to work within three months.
That condition, however, dooms Mom to failure. The longer Mom is under Dr. Agarwal’s care, the sicker she gets.
In February 2004, I get a call one night from my brother Mark. Mark and I have never been close as adults, and he never calls me at home, outside of Christmas and birthdays, unless (1) he wants money, or (2) Mom is sick.
The phone rings during dinner. At thirty-one, Mark is back in college for the umpteenth time, though this time it looks like he might actually graduate. He calls from his campus apartment. “Hi Anna, it’s your brother,” he says in his usual singsong baritone, slurred as always by the cocktail of heavy antipsychotics he takes for his schizophrenia. “Wanted to let you know Mom is in the hospital.”