River of Time

by Naomi Judd

  The advice I would give Carly was to take off her shoes, which kind of fit with her act anyway, and spread her toes wide. “Remember that you are connected with the great Mother Earth, Carly. Then rock your hips around to get more flexible and feel your energy flowing up and down. When you go onstage, make eye contact with your favorite band member, and go back to stand by him if you feel anxiety coming on. Let him know beforehand, so he can make eye contact.”

  Carly told me that she never wanted to be a performer, only a songwriter. It seems clear that our bodies react negatively to thoughts and experiences that are outside of our true wants and desires. Her desire was to stay off the stage, but she was under pressure from her record labels to do live shows. In contrast, my desire was to stay onstage, and my whole biological being seemed to be in turmoil because I had no alternative plan for when my career came to an abrupt end.

  After the next six ECT treatments, I didn’t notice any improvement in my depression, although I did think much less about putting a gun to my head or jumping off the bridge. Dr. Rosenbaum advised that I complete the course of ECT treatments, twelve more, as my depression had proven to be severely treatment resistant. For the next two months my life revolved around going to the ECT clinic once every three days and then needing a full day of recovery the day after, when I felt “zapped” of my energy. The following day I would feel better, but then would have to return for another treatment the next morning and repeat the three-day cycle. Larry continued to stay by my side, driving me back and forth for treatments. My heart went out to any of the other patients who lived alone or had to figure out how to manage without such support.

  After one of my ECT treatments at Vanderbilt, the chair of the department of psychiatry came to check on me. I had been having a rough morning, and was in need of a strong dose of encouragement. When I asked this ultimate expert, “Am I going to make it?” He answered coldly, without pause, “I don’t think so.” That was it. I was flattened by a cruel and crushing proclamation of defeat. Following that day, I no longer believed in the ability of the ECT therapy to help heal my mind and I never went back.

  * * *

  Though the ECT treatments didn’t affect my short-term memory, which is a side effect for some people, it did make my mind feel much more foggy and unfocused. This concerned me greatly because I still had a string of scheduled speeches on my calendar that I had committed to more than a year earlier. As tough as the speaking engagements had been for me prior to the ECT treatments, it was now even more frightening. I couldn’t keep track of where I was in the delivery. In many ways, I was feeling like a novice in unfamiliar territory, though I’ve been a keynote speaker for years. Before my depression treatments, I was able to talk for forty-five minutes with only a brief outline on one piece of paper. Now it became a laborious process for me. My assistant would have to organize and set up PowerPoint slides so that I could remember the direction the speech needed to go. Without them, I might find myself meandering off topic. For many of the groups in the health care profession, my keynote speech served as part of their mandatory continuing education units. This piled on the pressure since I had been brought in to expand the foundation of knowledge for the attending professionals and keep them up-to-date on new developments. Somehow I pulled it off.

  My taste buds were still missing in action three months after that fourth ECT treatment. I could no longer enjoy any food at all. One evening, Larry and I went to a popular Mexican restaurant in town. I thought that perhaps the more spicy flavors would override the bad taste, but it made it worse. The food tasted like chemicals to me. I couldn’t take more than two bites. The salsa had looked delicious, but it tasted as though it was laced with Windex, and the chip tasted like burnt plastic.

  I wanted to leave as soon as possible. I became even more wary of eating anything in public after this unsuccessful outing. I know most of the restaurant owners and chefs in our small town and didn’t want them to feel it was their fault that I couldn’t eat what I had ordered. They’d often come over to our table to ask what was wrong with my barely touched plate of food.

  I found myself left with only a very few choices for nutrition. I could manage to swallow a tablespoon of peanut butter for protein, and drink smoothies for fruits and veggies, and that was my limit. Other foods would make me feel like gagging. I started to lose weight rapidly, about two pounds each week. Not a diet I would recommend to anyone! Taste buds are something we all take for granted and having them misfire, making everything taste horrible, added to my anxious feelings that I would never have a normal life again.

  About a month after the ECT treatments ended, I could tell that I was slowly falling back into thoughts of suicide. After three major hospitalizations, an outpatient program, a cavalcade of prescription medicines, one right after another, and twenty-four ECT treatments, I didn’t see that I had gained much ground at all. In fact, I seemed to be adding more unnerving symptoms. Besides my distorted sense of taste making it impossible to eat, I was having a visible symptom that made me never want to leave the safety of my kitchen couch. My hair began shedding by the handful. Every time I brushed my hair, more fell out.

  I had always had thick, wavy, auburn hair, which was the physical feature I liked most about myself. Losing most of my once-glorious head of hair increased my feelings of hopelessness. The only place I could be without wearing a hat or a full wig was my own house. When I visited my doctor and had to remove my hat, the people in the office questioned what type of cancer treatment I was undergoing.

  My fervent hopes of patching up my relationship with Wynonna seemed more faint than ever. Since I still didn’t want her to see me in my current condition, I didn’t reach out to her, either. One of the brightest lights in my relentless sorrow was my grandson, Elijah, who would come over at night with a stack of funny videos or movies that we would watch together. He could tell that I was in a hole once again. His steady and caring nature gave me reason to hang in there day by day, though I could no longer imagine any future that would hold hope. Even the spring and summer days with their longer hours of daylight didn’t help much to boost my increasing sense of taking a one-way street to an early end.

  Dr. Rosenbaum checked in with me by phone at least twice a week. After listening to my voice, he strongly urged me to travel back to Boston for an appointment. He wanted to see me, in person, to note how I appear physically. He told me that direct observation reassures him more than just hearing my voice on the phone, so observing me was paramount to his decision making.

  During electroconvulsive therapy, the protocol is for the patient to abstain from taking certain types of psychiatric-based medications. It was now clear that the ECT had not provided consistent improvement for me. Dr. Rosenbaum decided to take a totally different approach with my medications, since no antidepressants had previously worked. He started me on high daily dosages of Parnate, an MAOI (monoamine oxidase inhibitor). He explained that it’s an old-school second-line treatment that works best for people with major depressive disorders combined with extreme anxiety. The MAOIs have been around since the mid-1950s and are not often used for depression anymore because of the dangers of fatal interactions with foods or other medications. I was sternly warned that I couldn’t eat or drink anything containing high levels of tyramine, which is derived from the amino acid tyrosine. I was given an entire list of foods that the drug could react with and possibly kill me. This includes anything fermented or aged: wine, cheese, smoked meats, soy products, and others. Sadly, included on this list was chocolate.

  He also decided to prescribe lithium, an element found in traces in granite, other types of rock, seawater, and mineral hot springs. Lithium carbonate is the form used for psychiatric drugs. It is mainly indicated as a mood stabilizer for mood swings but is thought by some to potentiate or add to the efficacy of antidepressants. It has many properties that affect brain activity and neuronal signaling but why it can work is still mainly unknown. Like Parnate, it comes with certain
dietary cautions like too much or too little salt and excessive caffeine intake. The Lithium levels also have to be monitored through having blood tests, as too high of levels are toxic to our biology.

  About seven days after beginning both prescriptions, I could feel a slight change, a peek at a new dawn on the horizon. It wasn’t a dramatic difference. It was more like a spark of stability that was within my sight. For the first time in two and a half years, I could sense the possibility of ascending from, instead of descending deeper into, a dark and lifeless hole. I was also prescribed many other medications.

  While I was in Boston, Dr. Rosenbaum was very direct with me about facing and accepting where I was in my life. Without an ounce of cruelty in his voice, he asked very direct questions about my unwillingness to face some of the new realities of life as time had passed, since I had done the work to face my long suppressed traumas. He wanted to bring me into the present.

  “How did you imagine life would be as you got older? Did you think about a new normal with respect to beauty and fame as you aged? Did you not consider that Wynonna would want to sing solo going forward? Do you understand that it is too late to be a failure because you have already acquired such a lifetime of success? Can you hold in your thoughts the awareness of all you have done, where you have been, and the joys still ahead? You have insatiable curiosity. Aren’t you getting tired of only grieving what is passed?”

  It was like having a bucket of cold water dumped over my head, shocking me out of my evaporating daydream. I was angry as hell because he struck a nerve of truth. He was right. I was clinging, desperately, to a past that I wanted to continue into the present. It wasn’t going to be and I had no other choice than to face it. After many tests, observations, interviews, and meetings with Larry, Dr. Rosenbaum, and Dr. Mona Lisa, I was diagnosed with severe treatment-resistant depression. Meaning they had tried everything they could think of and nothing was working.

  Dr. Rosenbaum firmly suggested that in conjunction with the prescription medicines, I start working with a therapist trained in dialectical behavior therapy. He assured me that it didn’t need to be in a hospital setting and that there were qualified people in the Nashville area and across the United States.

  I had participated in cognitive behavior therapy while doing outpatient therapy at PCS in Arizona. It’s a method of treatment that focuses on altering your current thought process for the better and changing behaviors that are causing you to suffer emotionally. I wasn’t aware of dialectical behavior therapy.

  The word dialectical refers to the way the mind understands a concept by recognizing its polar opposite. As a simple example, we wouldn’t understand the concept of daylight if we didn’t experience the darkness of nighttime.

  Psychologist Marsha Linehan developed dialectical behavior therapy in response to people who weren’t being helped by cognitive behavioral therapy. It’s a tried-and-true evidence-based therapy, particularly created for people with suicidal ideation, people who chronically have thoughts of ending their emotional anguish with death.

  DBT starts with actively accepting and validating the patient no matter what the current state of mind is, even if the patient is suicidal. First the therapist works on acceptance and then begins to incorporate change, especially for clients with low distress tolerance. Instead of teaching clients how to change, the goal for dialectical behavior therapy is to help clients learn to “radically accept” where they are and learn to tolerate stress and distress. The therapist works as an ally, keeping the patient participating in her own therapy by learning problem-solving skills, and then validating the client’s efforts.

  The therapy is a comprehensive treatment that has worked for many emotional problems and mental health issues. It has proven highly successful for people with traumatic childhoods like mine. One of the concepts of DBT that isn’t part of most therapies is traumatic invalidation.

  Traumatic invalidation happens when you feel invalidated or ignored for the person you are, what you do, and what you think, by people who matter greatly to you. When someone important to you invalidates you, parents specifically, you can still be traumatized by shame, anger, and deep hurt decades later and it continues to influence how you react to current life experiences.

  This was my entire childhood, living in an extended family, both maternal and paternal, of people with no relationship skills or ability to express their true feelings in a healthy way. And it was also my current life.

  I could no longer feel validated as a performer. Wynonna was no longer into the Judds as her career direction. She was busy creating Wynonna and the Big Noise. Many of the fans moved over to follow her new direction. I believed I was thought of only as a nostalgic memory and it hurt badly. Also, Wy and I were out of tune with each other personally, and I missed her desperately.

  I went back to the farm, knowing that I would have to figure out how to find peace in the present and create a new future; otherwise I would never heal my depression and anxiety. I saw a couple of DBT therapists both privately and in a group setting, but didn’t feel comfortable in either situation. In a group setting, I fell into the trap of wanting to “help” others too much, because it’s my nature. This was detrimental for my therapeutic purpose, as I needed to deal with my own issues and not distract myself with the problems of others. I began to get discouraged, my self-esteem dipped lower, and I questioned if I would ever find the right therapist.

  Dr. Rosenbaum encouraged me to keep searching, trying out different therapists. He stressed that a therapist you can trust is crucial to the process. If you’re working with someone who makes you feel uneasy, you will find yourself holding back. The right balance is to find a therapist who makes you feel safe, but who will also challenge you to move beyond the thoughts that are keeping you stuck in your depression or anxiety.

  After a few months of mismatches, I found my wonderful DBT therapist, Diana Partington. She recognized right away that I was in a vulnerable and defeated state of mind, so we began our session there. She is a great combination of gentle, caring warmth and dedicated and persuasive coach, who absolutely expects me to rise to my potential.

  The creator of DBT, Marsha Linehan, published a workbook with valuable information and actual homework to do between sessions with your therapist. It’s a toolkit of skills to use to both self-validate and in reaction to other people and emotional circumstances. Instead of digging deep into the unconscious and analyzing how you came to be where you are, DBT helps you get through your present day and the near future, reducing your vulnerability to your emotions, by teaching skills to increase certain behaviors, some of which are listed in the workbook as “ABC PLEASE.”

  A: ACCUMULATE POSITIVE EMOTIONS: I began to incorporate such emotion into my life by choosing to do things that are pleasant and possible today. Also, Diana encouraged me to make changes so that more positive events would happen in my future.

  B: BUILD MASTERY: Find something that you feel strongly or passionate about. Choose something that makes you feel effective and competent. The purpose of this is to move you away from a feeling of hopelessness.

  C: COPE AHEAD OF TIME WITH EMOTIONAL SITUATIONS: Have a plan in mind if you are heading into a situation that makes you emotional. This skill helps you feel less helpless.

  PLEASE: TAKE CARE OF YOUR MIND BY TAKING CARE OF YOUR BODY. Balance nutritious eating, plenty of sleep, and daily exercise with having any physical illnesses treated.

  Diana met with me weekly, as I slowly began to apply the methods of emotional regulation suggested by DBT. I still had long weeks of immobility, as new side effects of taking Parnate, lithium, and the other medications began to appear. Though Parnate was the first medication that proved to have an effect on my depression, it was not without a price. The Parnate continued to cause my hair loss. By the end of summer, I was left with a ponytail about as thick as you might see on a fourteen-month-old baby, and Parnate made my cheeks puffy. In addition, the lithium gave my hands a tremor that was wor
se in the morning and a bit better later in the day. If I had to meet with anyone, I would hide my hands under the table or behind me.

  I could no longer write with a pen in a legible way. My penmanship looked wavy and wobbled off in random directions, the result of my hand shaking uncontrollably. Beginning in grade school, people had always complimented me on my nice handwriting. Like my hair, it was always a source of pride and one of my attributes I appreciated the most. (A Nashville radio DJ once told Wynonna, “I want to show you something.” From his desk drawer he pulled out a handwritten thank-you note I had sent to him early in our career, after he took a chance and played our newly released first song on his station. He told Wy that he had held on to it all these years because he rarely gets thank-you notes from artists and my handwriting was beautiful.)

  Losing both my handwriting ability and my hair made me feel that God Himself was testing me like Job. What else would vanish from my life? My career had evaporated. Sleeping for more than a couple of hours a night was next to impossible. My oldest daughter was out of touch with me. Mother appeared to be oblivious to anything I was going through. I had lost millions of dollars to a swindler business partner. And now my hair and my ability even to sign my name were vanishing, leaving me to feel I was dispossessed of many things that had defined me for most of my life.

  As a dialectical behavior therapist Diane didn’t deny my feelings. She wanted to know “why I wanted to end it.” I answered, “I want God to end this pain.” She explained to me that when things are really, really bad, it’s easy to romanticize suicide as an escape hatch. You begin to think that everything will be better once it’s all over. Then she asked me, bluntly, “So, what do you think happens after you die? Is it going to be better? The Bible and most religions don’t look favorably upon suicide. Do you have any guarantees that it’s going to be better?” I didn’t have an answer for her.