Dr. Cameron began by talking to me about bipolar illness—the modern term for manic depression—explaining how there was now general agreement that it resulted from a chemical imbalance in the brain. I had barely heard of serotonin or dopamine, but Dr. Cameron gave me lessons in both. Lack of serotonin is believed to depress the brain by failing to conduct positive signals to our emotional cortex, thereby causing depression. Serotonin is a jelly-like chemical in the brain; it’s a conductor between neuron transmitters that allows you to feel delight from everyday living. Dopamine is a neurotransmitter and it accounts for the huge surges that come with mania.
Depression starts slowly, and the first victim of diminished serotonin is sleep patterns. You have trouble sleeping—because your thoughts are racing and you have no time for sleep—or you sleep far too much. You stop eating properly and you start loading up on carbohydrates and chocolate and sugar to try to make yourself better because you find yourself slipping. You think these comfort foods will make you feel better, and you start putting on weight. You get sloppy in your appearance and you stop accepting invitations because you’re not feeling great and your clothes don’t fit. Isolation takes hold, and so does the depression. You’ve stopped going to the gym or going for that great walk. You’re not eating, sleeping or playing well, and those are the things that help you have healthy serotonin levels. That’s how we get serotonin—by being alive. With no positive reinforcement, no reminders that anything in life is any good, you start sinking. People around you try to help you out by telling you to get a hobby, and then you start pushing them away, and before you know it you’re in the dark. They haven’t shunned you; you’ve just stopped answering their calls and you become more and more alone. Maybe you self-medicate, with alcohol or drugs from the medicine cabinet or the street.
Finally, you do get help. Your doctor sees you and understands by your overwhelming sadness that you’re depressed and prescribes a drug to lift your serotonin levels, and you see your doctor once a month to get the drug level adjusted, and people think that’s where treatment stops. No, that just got you up on terra firma, where you have the ability, once more, to feel delight, to feel joy. But if you’re stuck in a meaningless life, wearing masks and pretending to be someone you’re not and not fulfilling your own personal dreams, then nothing has really changed.
My family doctor, who is nearing retirement now, tells me that at least half the patients he sees every day in his office are presenting with problems, often physiological ones, but the root cause is emotional. The lower back, the neck are often places where this referred pain expresses itself, but the pain really starts in the brain.
I remember my family doctor, a very compassionate man, asking me, “Margaret, what’s really pinching you?” He knew that my pain had a source. And I wept to realize that he knew. By 2000, science had made considerable breakthroughs in understanding the brain. Though there was still some confusion over the term bipolar (some people found the term offensive because they believed it belittled the illness), Dr. Cameron told me he preferred that word to manic depression since sufferers must endure both mania and depression. Bipolar, on the other hand, seemed to suggest two neat categories at either end of a spectrum. I well knew that the illness was not tidy at all, but had wildly fluctuating highs and lows. Today, however, bipolar is the more widely accepted term.
Dr. Cameron seemed to know precisely what I had endured and how much I had suffered. Let no one, he said, make the mistake of thinking that bipolar disorder is not a crippling and destructive illness, with complicated and difficult emotions, with ominous, dark and terrifying lows, with week after week of despair and dread alternating with passionate highs filled with bubbling and brilliant moments of sheer exuberance, and in between every kind of mortifying and embarrassing behaviour, violent outbursts and self-destructive longings. I knew only too well just how seductive my unbridled and manic moods had been, with their explosions of smells and sounds and colours, and how welcome I had found them when faced with Pierre’s caution and reason.
Lithium would have been the obvious drug to start me off with, but lithium, as I knew from my earlier hospitalization, did not suit me. There was something in it that I could not tolerate, however small the dose. But Dr. Cameron explained that a whole new generation of mood-stabilizing drugs was now on the market. He began by putting me on something called olanzapine, which had widely been heralded as a miracle drug in schizophrenia and the mood disorders of bipolar illness.
Olanzapine did indeed perform miracles for me. The drug stopped the mania, but the list of potential side effects was long: they included the inability to sit still, dizziness, insomnia, tremor and shaking—of the mouth, tongue, eyelids, arms and legs—which could be irreversible. I was spared all that.
What I got, though, was weight gain. I had lost a great deal of weight in the preceding months, but what happened now took me by surprise. I put on pound after pound after pound. There was also the little matter of cost. When I went to pay for my prescription, I thought the pharmacist had added a zero to the bill—$480. I showed him his mistake: Surely he meant $48? No, he said, the number was right, but there was a program that I could join to help me pay. It made me think again how tough it is for people to afford medicine they desperately need.
The other problem with olanzapine was that, in my case, the drug imposed a ceiling on my feelings, making it very hard to feel despair or elation, or to delight in creativity. After several months of trial and error, Dr. Cameron put me on risperidone, an antipsychotic drug that controlled dopamine in the brain. I easily tolerated the drug and the ceiling lifted.
Risperidone seemed to lessen my oversensitivity to events and situations, and yet left me free to be more proactive, to think of doing something about my situations without collapsing or running away. I had cried my way through the Vietnam War, Biafra and the plight of our aboriginal people in the North; perhaps I would now be able to stop crying and actually do something about them. Dr. Cameron took great pains to talk to me about the drugs he was prescribing, urging me to ask him any questions and giving me material to read about the possible side effects.
On the first day, I had been terrified to see the words “antipsychotic” and asked him in some panic whether he thought that I might be a sociopath. He reassured me that though risperidone was not a drug commonly used for bipolar illness, he had found it extremely helpful in cases like mine; the drug had the great advantage of calming mania while not imposing too heavy a ceiling on thought and creativity.
I was soon feeling immensely better. I settled down to a regime of antidepressants to raise the serotonin, and risperidone to balance my moods. Even so, the precise doses of each remained a matter of endless adjustment, and many months would pass before the combination was exactly right. What Dr. Cameron impressed on me was compliance, the need to trust him and follow his orders carefully.
Dr. Cameron was a psychiatrist in the fullest and best sense, a doctor who believed that there was no simple, magic cure for mental illness, no pill or combination of pills that alone could effect a cure. Real recovery, he said, again and again, was a long journey in which I would have to play my part. I would have to take baby steps, one at a time, and I would have to face the fact that after the mania, after the events of the recent past, there would certainly be a depression, probably a very deep one.
This could not be avoided. I was going to have to learn to face reality, the reality that I had a bipolar illness and must live with certain facts: that I would have this illness my entire life, that Michel was dead and that I must find a way to exist with that knowledge.
I had a choice to make. I could either accept that I would stay on a roller coaster for the rest of my life, ricocheting from high to low, or I would have to engage in the long, slow and painful work that would eventually lead to stability.
Because I had gone without sustained treatment for long periods, the journey to recovery was going to be extremely hard, Dr. Cameron told me, al
most impossibly so. The patterns of bipolar illness, the cycles, were by now deeply ingrained in me. I had been diagnosed as manic depressive as a young woman, but even had I understood and acted on that diagnosis, the treatment and drugs were not yet available. So much time had passed, and my behaviours were so entrenched. The good news was that drug and other therapies were available to help me. The bad news? I had to shed many old ways, and learn new ones.
Like a small child, I had to learn new responses to life: not to overreact in the face of criticism, not to wallow in shame and loathing, not to protect myself with delusion, not to blame others for my own inappropriate responses. I listened, I thought, and, at last, I accepted: the fifth stage, acceptance, had begun.
At heart, I knew perfectly well that everything Dr. Cameron said was right; I had known for many years that there was something very wrong with me, but I had stopped believing that I would ever find a cure. I had, quite simply, given up: I believed that I was condemned to a life of unhappiness. I now had to believe that, on the contrary, I could not only accept the hand of life that had been dealt to me but find areas of new happiness.
One of the first steps Dr. Cameron insisted on was that I see a nutritionist. I liked her immediately. I knew that I was in terrible shape and that I had been starving myself for many months, and that whenever moods of depression or mania assailed me the first thing to go had been eating. What I didn’t know was the part that malnutrition had played in my eventual collapse.
As the nutritionist explained it, the fuel you put into your body must be like that which goes into supersonic jets—pure and strong. Months of eating beans out of cans, the occasional piece of cheese, with never any fruit or vegetables, had done terrible things to my gastrointestinal system.
Some time in the autumn I had found that I had difficulty swallowing. I would chew interminably but be unable to get the food down and eventually I would spit it out. I remembered how, during the worst times of my life, I had always felt unable either to breathe or to swallow. I now realized that what I had been experiencing was a form of passive suicide. There had been no conscious decision, merely an instinct not to nourish myself.
My stomach had shrunk so much, the nutritionist told me, that I was going to have to start eating properly—but only very slowly or I would not tolerate the food. I told her that I had always liked oatmeal, that it was one of my comfort foods. My mother, heeding an old Scottish tradition, served us this hot cereal from early fall to the end of winter. Every morning, and several times during the day, the nutritionist now appeared at my bedside with small bowls of oatmeal, with salt and sugar and milk.
Though at first I found the oatmeal almost impossible to swallow, and was often sick, I began to look forward to her appearance and realized that I was even quite pleased to eat. The nutritionist put me on a careful diet, with many small meals a day. Though the hospital cafeteria was perfectly adequate, a long time passed before the smell of cooked food stopped making me feel nauseated.
The next doctor I was sent to within the hospital was Dr. Paul Grof, who was born in the former Czechoslovakia, and European doctors have long been interested in vitamins and minerals as supplements. Dr. Grof was also one of the leading psychopharmacologists in the field. He explained in considerable detail what drugs were available, how they worked and what choices were available to me. Dr. Grof underlined that I should think of drugs as a supplement for the brain, where chemicals that for one reason or another were lacking needed replacing in order to restore balance. In much the same way, he told me, I was going to need nutritional supplements, such as the omega-3 fatty acid of fish oil, folic acid, vitamin B. Particularly large doses of that vitamin would not only repair but fine-tune the workings of my neural transmitters.
As important, and more surprising to me, was Dr. Cameron’s insistence that I see the hospital’s drug addiction specialist—Dr. Allan Wilson. My first reaction was one of irritation and disbelief. What was the point? I wasn’t a drug addict, after all; all I had done was to smoke a bit of marijuana over the years.
Or so I told myself at the time. I look back on that thought and I think of what Willie Nelson once told Jay Leno on The Tonight Show. Leno noted that Nelson had been picked up by police in Texas and found to be in possession of a little marijuana. “That’s a lie!” Nelson countered. “I would never have been in possession of a little marijuana.”
I very much liked Dr. Wilson. He was in his early forties, athletic and full of life, with sparkling eyes. He was, and I mean this as a compliment, not too earnest—as some psychiatrists are. Earnest is a mean word for me. I have, apparently, freely used sarcasm as a weapon in my life, and for me to call someone “earnest” is one of my unkinder cuts. Earnest people take themselves far too seriously.
Dr. Wilson was no less kind and patient than Dr. Cameron, but he was equally clear. He explained, in great detail, how marijuana had become my own form of self-medication, and how I had used it to fill what was missing in my life. This sense of neediness, of there always being something unfulfilled, was probably caused by my bipolar condition. The need for the drug had been a symptom; I had to learn to feel better without it. I hadn’t taken marijuana constantly or even regularly, but when I did use it to try to tame my brain, I binged on it. Marijuana had been an artificial prop, based on delusions, false perceptions, and fuelled by fear. What I now needed to do was find another way to enjoy life without these unreal highs.
More than that, the marijuana had probably been the trigger for many of my bouts of extreme mania. New research was increasingly showing a strong and lasting relationship between the two. Addiction in all its forms—whether to drugs, drink, sex, porn, gambling or food—was beginning to be seen as a form of escape and a symptom of an underlying mental illness.
For so many years, addiction and mental illness were thought to be separate issues; no longer. I listened and took it all in but found it very hard to accept. Marijuana had been a friend that got me through many lonely days. But somewhere inside me I had always suspected that the “friend” had done me harm. Countless times I had reported to doctors that I feared that part of my trouble was taking so much marijuana, only to be told that drugs were unrelated to mental health.
At one point, Dr. Wilson considered whether I might benefit from attending Narcotics Anonymous meetings, but he came to the conclusion that NA might be more than I could take. NA tends to draw the bad boys, men on cool drugs with their motorcycles, and I’ve always liked the bad boys. On the one hand, Alcoholics Anonymous was an odd choice for I can’t drink much before I become ill. On the other hand, I was an addict. All my life, I had self-medicated with marijuana.
So it was decided that AA was a better bet, with fewer bad boys. I gave it a try. Friends in my circle had become addicted to alcohol, had benefited from the AA process and were very committed to it. I was given the location of the closest venue, and it was close, all right, but in another way it was a world apart. I lived in the tony part of town; this AA gathering place was located in one of the poorest parts of Ottawa.
When British rocker Ozzy Osbourne and his band Black Sabbath came to Ottawa in the 1990s, he asked for the AA location in the down-and-out part of the city—I presume where he would feel most at home while he continued to battle his drinking demons. Had our dates coincided, we might have met. In any case, I rubbed shoulders with the poor and the homeless and eventually I found another AA location that had a clientele better suited to my background.
So I went to the meetings, where I chanted and memorized, confessed and held hands. Some knew who I was, some didn’t. When my turn came to speak, I talked about the death of my son and the pain of that loss—this was grief work. The famous Big Blue Book embraced by AA didn’t really work for me. Most of these men and women repeated their wounds over and over again. The meetings were like theatre, with people reliving the darkest moments of their lives. It was clear to me that they were self-medicating with alcohol, but I also understood that their real ai
lment was mental illness, something far deeper than dependence on booze. And there was no one there with training in psychiatry. Did a blue book first published in 1939 offer the truth, the secret to beating addiction? All I heard were tired clichés.
But there was this reassuring community, warm company over coffee and an intimacy that came from revealing deep secrets. And while I don’t necessarily believe in the AA process, I do believe that I was helped by going to those meetings.
As important as the antipsychotic drugs and antidepressants, however, was the next step Dr. Cameron proposed to me. None of my treatment was likely to have a lasting effect, he explained, without some regular psychotherapy. There was a great deal that I needed to understand about my past behaviour, and many responses that I had to unlearn. The muddled cobweb of my unquiet mind had to be spun anew. As Dr. Cameron put it, psychotherapy would be extremely serious and hard work, no fun at all, and bound to come up were issues that I would prefer not to face. But face them I must. Foremost was my lifelong and exceptional sensitivity to pain, guilt and other people’s suffering. I had always cried too readily, been too easily obsessed with images of grief and destruction.
Growing up in a world in which I felt I had to please everyone, I had lost my sense of balance—an imbalance only intensified by marriage to an older, very rational man with whom I had little in common beyond our shared love for the children. The huge differences in our ages and characters doomed the marriage in any case. Bipolar disorder was not the straw that broke the camel’s back, but more like a huge round bale of straw weighing many hundreds of pounds.
And because I had lived behind a mask, trying to behave in ways that didn’t come naturally to me, there were times when I had reacted with self-destructive behaviour and by taking absurd risks. This, in turn, had led to guilt and shame and self-loathing, and to escape them I had turned to anything that made me feel better, namely and most often, marijuana. And that, in turn, had led to hypomania, followed by depression, after which the whole cycle would begin again.
Changing My Mind Page 23