All the Things We Never Knew

by Sheila Hamilton

  Copyright 2015 Sheila Hamilton

  Seal Press

  A Member of the Perseus Books Group

  1700 Fourth Street

  Berkeley, California

  sealpress.com

  All rights reserved. No part of this book may be reproduced or transmitted in any form without written permission from the publisher, except by reviewers who may quote brief excerpts in connection with a review. Some names and identifying details have changed to protect the privacy of individuals.

  Library of Congress Cataloging-in-Publication Data is available.

  ISBN: 978-1-58005-585-7

  10 9 8 7 6 5 4 3 2 1

  Cover design by Faceout Studio, Derek Thornton

  Interior design by Tabitha Lahr

  Printed in the United States of America

  Distributed by Publishers Group West

  To Sophie—your willingness to lovingly embrace things just as they are allowed us all to move forward

  Contents

  Introduction

  Chapter One

  Chapter Two

  Chapter Three

  Chapter Four

  Chapter Five

  Chapter Six

  Chapter Seven

  Chapter Eight

  Chapter Nine

  Chapter Ten

  Chapter Eleven

  Chapter Twelve

  Chapter Thirteen

  Chapter Fourteen

  Chapter Fifteen

  Chapter Sixteen

  Chapter Seventeen

  Chapter Eighteen

  Chapter Nineteen

  Chapter Twenty

  Chapter Twenty-One

  Chapter Twenty-Two

  Chapter Twenty-Three

  Chapter Twenty-Four

  Chapter Twenty-Five

  Chapter Twenty-Six

  Chapter Twenty-Seven

  Chapter Twenty-Eight

  Epilogue

  Notes

  Acknowledgments

  About the Author

  Introduction

  I missed much of the unfolding of my husband’s mental illness. By the time I’d pieced together the puzzle of who David actually was, he was falling apart. My once brilliant, intense, and passionate partner was dead within six weeks of a formal diagnosis of bipolar disorder, leaving my nine-year-old daughter and me without so much as a note to understand his decision. He’d left us hundreds of thousands of dollars in debt and with no plan for helping us recover from the profound grief of his suicide.

  David’s employees never called to tell me he wasn’t showing up at the job sites where his company was remodeling high-end residences and commercial businesses. By the time David experienced his first full-blown manic episode, we’d already been keeping separate bank accounts and separate lives. He isolated himself from me with lies and infidelity. I returned the salvo, alienating myself from him by pretending I didn’t hurt.

  David’s parents may have known about his struggle with mental illness, but they never let on.

  Mental illness, unlike breast cancer, isn’t celebrated with big marches or pink ribbons. The stigma is stifling, and it prevents most people from seeking help. David refused to accept the label of bipolar disorder. He could not imagine a life of medications and therapy, which had helped him so little. David’s path is not unique. Suicide is now the tenth most common cause of death for men and women. Every thirteen minutes, another American dies from suicide. What could we have done differently? What should we have known? According to a 2008 report by the National Institute of Mental Health, research shows that risk factors for suicide include depression and other mental disorders and substance abuse disorders (often in combination with other mental disorders). More than 90 percent of the people who die by suicide have those risk factors.

  It is my belief that many people could benefit from hearing more about how psychiatric conditions unfold. In the years, months, and days leading up to David’s death, I didn’t classify him as mentally ill. I missed many signs. I ignored others, believing it could get better. And I scrambled, as the world came crashing down around us, just to maintain my own sanity and the health of my daughter.

  Our daughter celebrates her birthday each June. I can’t help but measure her birthdays with an equal sense of apprehension and elation. She’s a teenager now, and still no signs of the brooding, the polarity, the darkness that descended on David like Portland’s thick gray clouds in January, refusing to budge. Yes, she has his intellect, but she also has my relatively sunny nature. She is physically stunning with long, muscular legs and a waist that defies her voracious appetite. She has David’s European cheekbones. The color of her skin is his. Her ears have the same shape. There are times I find myself staring at one of her features for too long. She bats me away: “Mom, enough.”

  But David’s genetics also carry a downside. “There’s a 50 percent chance your daughter will present with the same disorder,” a well-meaning psychologist once advised. “It is most common between the ages of sixteen and twenty-one.”

  I knew the statistical odds by heart. After David’s death, I’d read every book I could get my hands on about bipolar disorder. I’d measured the likelihood of a gene mutation against the things I could influence—what she ate, how much sleep and exercise she got, the unconditional love that I gave her.

  But the genetic risk of mental illness is such that my daughter is keenly aware of what she can’t do. She understands heavy drinking would kill brain cells that she may need to rely on for higher functioning. She’ll never be able to safely experiment with drugs. It’s a burden a teenager shouldn’t have to take on, but more than half of people with bipolar disorder commit suicide. The numbers are intractable, unchangeable. Read fifteen studies and the numbers come up consistently grim.

  And yet, there is much to celebrate.

  There have been tremendous breakthroughs in brain science from 2005 to 2015. The ability of scientists to study aberrations in MRI imaging has led to new thinking about the treatment for brain disorders. The work of Dr. Bruce Perry at the Child Trauma Academy in Houston, Texas, is focused on brain disorders in children, but the applications may also be relevant to adult populations.

  When children are subjected to abuse, neglect, absent parenting, or drug and alcohol exposure, brain development can be severely stunted. Perry’s ability to define treatment based on the child’s current brain functioning is of particular interest to me, since I watched my husband’s behavior regress to that of a child during his hospitalization. I had no context at the time for understanding exactly what was happening to him, or to me.

  If I were faced with the same predicament today, I would forcefully advocate for the type of care Perry has successfully practiced: the neurosequential model of therapeutics (NMT), which is a sensitive, neurobiologically informed approach to clinical work. NMT helps match the nature and timing of specific therapeutic techniques to the development of the patient. This research was not available ten years ago and is only now starting to be practiced in some mental health facilities.

  NMT’s reliance on somatosensory activities like music, movement, yoga, and therapeutic massage allows healing at the most elementary level. A traumatized brain is incapable of processing the subtleties of group therapy. It is impossible to ask people who have just suffered a manic episode to start sorting out their bills. It is crucial that we understand the limitations of the people we are attempting to help.

  I strongly believe that the litany of medications David was prescribed did very little to help. In fact, his first suicidal thought came just days after being prescribed an antidepressant by a well-meaning physician-friend. Medication has helped millions of people, but it fails tens of thousa
nds of families every year. We have relied for too long on an approach to mental illness that relies on pharmaceuticals and fails to take into consideration the whole person—mind, body, spirit.

  The collaborative problem-solving method developed by Dr. Ross Greene, of Harvard, is an important milestone in communicating with people suffering from brain disorders. Though the technique was developed for children, it offers an important template for caregivers. David’s early behavior of withdrawal and isolation in our marriage made it impossible for us to solve disagreements or disputes in a collaborative and mutually satisfactory manner. The collaborative problem-solving model employs empathy, consideration of real-life consequences, and collaborative brainstorming to arrive at a place of solution that is both realistic and mutually satisfactory. It may have offered a creative form of communication that I simply did not have at my disposal.

  If we knew then all the things we understand now, I might have been more equipped to do more than watch my beloved husband’s decline in a state of denial, grief, and fear. I would have had more resources and wouldn’t have felt so woefully unprepared for marriage to a person with a mental illness. Instead, I compartmentalized our problems in order to deal with the needs of my child and a demanding job. And in my ignorance and fear, I too allowed our lives to spiral out of control.

  In the aftermath of David’s death, it took years to stabilize my family’s financial future and the emotional current of our lives. Once I came to terms with what killed David, I did an enormous amount of research to learn more about mental illness and what we can all do to be more compassionate to the people in our lives who are touched with brain disorders.

  I have learned so much from my involvement in the Flawless Foundation, a nonprofit advocating for people with brain disorders. My interest is in preventing another loss of life as exquisite as David’s. If we begin modification at the earliest ages, we might improve the chances of mitigating the onset of mental illness.

  Dr. Elisabeth Kübler-Ross has described the five stages of grief as denial, anger, bargaining, depression, and acceptance. When a loved one commits suicide, that list is incomplete. We are haunted by the questions “Why would he?” or “What could I have done differently?”

  Suicide is an unnatural choice and leaves carnage for the living. I’d propose one more stage of grief to Kübler-Ross’s list in the case of suicide: forgiveness. It was not until I reached this stage of forgiveness that I was able to sort out my own failings from those of my husband. In accepting responsibility for my part in David’s death, I was able to understand his sense of futility and his unwillingness to face his illness. I forgave him. And in doing so, I’ve been better able to understand his decision.

  My hope is that our story—told from the other side of this sixth stage—will be a catalyst for positive change in the ways we approach, regard, and respond to the social fallout of mental illness.

  Chapter One

  The doorman scanned two pages of names before he found ours—Colin MacLean “plus one.” That was me: the plus one. It was strange to be known that way and even stranger to be wearing a dress. For the last three months, I’d worn nothing in the evening but sweatpants, the uniform of crisis. I tugged at the hem of my black silk dress to pull it down farther.

  The young doorman nodded and opened the door, “Enjoy your evening.”

  The knot in my stomach tightened along with my smile. The tension was highest just below my rib cage.

  The restaurant was one of Portland’s trendiest, with a long marble bar and two stories of dining. The art was modern, and the place thumped with electronic dance music. Dozens of young men and women were moving on the dance floor. The bass bounced off the acoustic ceilings and the glass windows, amplifying the beat. The party took up both floors of the restaurant. Upstairs, dining tables had been pushed aside so guests could hang over the banister to watch the dance floor.

  One of them, a young man with sticky, gelled hair, yelled down at my date, “Hey, MacLean, you’re late!”

  Colin waved and then gently folded his long fingers around mine. A true gentleman, I smiled to myself. He opened car doors for me. He was the first to stand whenever a woman left or rejoined a group at the dinner table. He thanked waiters and waitresses for their service and did it all sincerely. It was a type of chivalry I hadn’t seen in a long, long time, certainly not from my soon-to-be ex. The marriage was over, except for the formalities, except for David’s signature on the papers. I caught myself nervously biting the inside of my lip and forced myself to stop and be in the moment.

  The focus of this party, the birthday boy, was a local real estate agent, a hugely successful, balding, middle-aged guy who liked his newly single life and women under thirty. He was jammed between several women in the middle of the dance floor, oblivious to his newly arriving guests.

  I’d been dating Colin for only about a month, but he already seemed like the guy I’d been searching for back in my twenties, when my list of must-haves seemed important. He called when he said he was going to call. He was, as a mutual friend described him, “one of the last remaining good guys.” But I was like a detective trying to uncover Colin’s dark side. I’d even paid a background check company to make sure he didn’t have a record, a history of violence, or a history of pretending he was someone he wasn’t. Men aren’t always as they appear, but they are what they hide.

  I watched his profile as he summed up the party: a wonderful nose, perfect in its lines except for a slight bump at the top. It would have been too perfect in its geometry without the break. I liked a man with a few scars, stories to tell about his various broken bones. He was the most stylish man there, taller than the rest, in a black jacket, white tuxedo shirt, and jeans. He smiled easily and shook hands with nearly everyone he passed. The owner of the restaurant made it a point to wind his way through the crowd. “Well, now the party begins,” he said, shaking Colin’s hand and then kissing me expertly on the side of the cheek. I wanted to relax into Colin’s breeze. Instead, I felt like a hurricane was looming.

  An oversized mirrored ball hung from the ceiling, spinning slowly, throwing bursts of light onto people’s faces. Like so much in my life, it seemed precarious. Would it drop and smash into pieces? The exits were guarded to keep the party private. I felt my underarms begin to sweat. Part of me felt trapped. Before, I loved parties, the thrill of too much everything: music, people, alcohol. Now in my early forties, my world had been reduced to worrying about my estranged husband, a man I no longer loved. He was in trouble, I knew, suffering from a sudden and acute mental breakdown; tonight he was safe, though. Tonight he was at our home with his mother to watch him. I reminded myself of this and tried to ease the knot below my breastbone, but it had become a part of my physical landscape, like worry lines. A young woman with blonde hair extensions teetered toward us. Colin squeezed my hand and started weaving us through the couples.

  I wriggled loose of his grip. “That’s okay; I’ll get a drink first,” I said, smiling, finally breaking free. It was all too much, too fast. I shouldn’t have come. I had convinced myself I was ready to rejoin the social scene. But I was wrong.

  The bar was pure chaos. The bartender held two bottles in his hands, pouring, shaking, then pushing drinks toward a line of loud customers. I waved in the bartender’s direction. Nothing.

  “I’ll have a vodka martini, double,” I said. Still nothing.

  “Vodka martini!” I yelled, and he finally looked my way, nodding.

  The light from my phone distracted me from the bartender. “Unknown number,” the phone read.

  I took in a breath. Sophie. It must be my nine-year-old calling from her sleepover. I pressed the talk button and held the phone against my ear.

  “Ms. Hamilton? Sheila Hamilton?” I could barely make out the man’s voice. The music thumped louder than ever.

  “Hold on, hold on. I can’t hear you.” I walked through the middle of the crowd with the phone to my head. Colin saw me striding towar
d the bathroom and mouthed, Everything okay? I nodded, trying to keep the panic from my face. I pushed past sweaty bodies to the small unisex bathroom.

  Inside, I yelled loudly into the tiny speaker of my cell phone. “Sorry. I’m at a birthday party. Who is this?”

  “It’s Officer Todd Rodale from the Clackamas County Sheriff’s Office.”

  My body suddenly felt heavy, too heavy to stand. Bang, bang, bang! The door shook like someone was kicking it from the outside.

  “Hey!” a drunk yelled. “I’ve got to piss.”

  Unisex bathrooms, I thought. What a stupid invention. The guy would have to wait. “Sorry, Officer, go on,” I said into the telephone. I plugged my other ear to drown out the drunk, and the music, and the absurdity of the place.

  “Ms. Hamilton, we got a report that your husband broke into a woman’s home in the Columbia Gorge and stole her gun.”

  I pushed the phone closer to my head. “What? I’m sorry, did I hear you correctly—he has a what?” My soon-to-be ex was supposed to be at the home we’d shared. His mother was supposed to be watching him. This must be a mistake. The dim light of the bathroom made the scene feel like a bad dream.

  The cop repeated the words gun and husband and woman. He said they were looking for David, that my husband knew the “victim,” and that they considered this man I was not yet divorced from “armed and dangerous.”

  My husband was on Larch Mountain, the officer said. I repeated the information, scrambling to make sense of the bizarre story. I stopped cold at “shots fired.”

  “We didn’t know how to reach you,” said the cop, “so I called the radio station. I’m a big fan of yours.”

  I drew in a breath. I’d tried so hard to keep the drama of my personal life from most of my coworkers at KINK-FM—and I’d never mentioned on air how serious the problems were.

  “I hope you don’t mind that they gave me your cell phone number,” said this cop, this fan.

  Shame, humiliation, nausea—the storm moved through my body. I stood up to interrupt the bile rising in my stomach and caught a reflection of my face in the mirror. Red blotches covered my neck and ears. My foundation had disappeared from the sweat. My eyes, which Colin described as a deep emerald color, were bloodshot and pinched. I was pressing the cell phone so hard against my head that my blonde hair was mushed against one ear. The face in the mirror was a mug shot.