All the Things We Never Knew

by Sheila Hamilton

  One class of psychotropic drugs, known as selective serotonin reuptake inhibitors (SSRIs), are prescribed for a variety of symptoms, including depression, bipolar disorder, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and schizophrenia. In addition, SSRIs are used to correct low levels of serotonin in the brain.

  Although SSRIs have been used to successfully treat many patients, they can be disastrous when prescribed to people with bipolar disorder. In a study of thirty-eight bipolar patients treated with an antidepressant, 55 percent developed mania and 23 percent turned into rapid cyclers. The group prescribed antidepressants also spent “significantly more time depressed” than bipolar patients not given the drug.

  It may seem paradoxical that a treatment that is therapeutic for depression can worsen the course of bipolar disorder, but there are numerous studies to back up this claim. Researchers find that “there are significant risks of mania and long-term worsening with antidepressants” among bipolar patients. Use of antidepressants may “destabilize the illness, leading to an increase in the number of both manic and depressive episodes” and “increase the likelihood of a mixed state,” in which feelings of depression and mania occur simultaneously.

  Once antidepressants induce rapid cycling, it abates in only one-third of patients over the long term, even after the offending antidepressant is withdrawn. Forty percent of patients who have worsened in this way continue to “cycle rapidly with unmodified severity” for years on end. Antidepressants can induce a “chronic, dysphoric, irritable state” in bipolar patients.

  In a large study by the National Institute of Mental Health, “the major predictor of worse outcome was antidepressant use.” These patients were nearly four times more likely than the unexposed patients to develop rapid cycling, and twice as likely to have multiple manic or depressive episodes.

  SSRIs carry mandatory warning labels about potential increased suicide risks for children, usually those being treated for ADD or ADHD. Increased suicide risk in adults is also a factor with SSRIs, but warnings are not as widespread, which has led to many unnecessary, avoidable deaths. It is important to understand the risk to people who may appear to be depressed, but, in fact, suffer from bipolar I or II.

  Chapter Fifteen

  I hadn’t seen Colin since the birthday party. Part of me believed that I should cut it off. The other part longed for a partner again, a person to laugh with and to share the interior of my life. Balancing a new relationship was a ridiculous feat given what I was going through, but I had a powerful intuition about why Colin had entered my life when he had. I was not meant to live ridden with anxiety. I was as worthy of love as any other human being.

  I think back on those early days of knowing Colin and wonder how I knew—knew that he was kind and compassionate and that he would be there for me not just in crisis but in the daily ups and downs of life. With all the betrayal, and the unmasking of David as a man I barely knew, how did I dare even trust a man I’d known only a few weeks?

  Despite the sickening feeling that David had become a completely different person than the one I fell in love with, I felt intuitively that his isolation and dishonesty had contributed to his breakdown. If he’d loved openly and honestly, and shared with me his private horrors early on, our life together could have been saved. In David’s mental breakdown, I saw what becomes of one who keeps his heart on a short lead. Yet I wasn’t ready to give up on love. In fact, as my marriage crumbled, I felt more open and vulnerable than I had in years. I was humbled by Colin’s courage in dealing with what was an untenable beginning to a relationship. He was sturdy and reliable at the time I felt the most unsure. The least I could do was see if my hunch about him was correct.

  I punched in his number.

  “Hey,” he said, “I’ve been worried about you. Can you meet us for a quick bite?”

  “Us?” I asked tentatively.

  “My beautiful, lovely daughters,” Colin said. “Meet us at Twenty-third and Lovejoy. Santa Fe—the taco joint. See you there in half an hour.”

  I hesitated and then whispered the mantra that helped me through so many of the decisions I made during the first few months with Colin. “Stay open.” The phrase struck me then as it does now—oddly simple and profoundly powerful. I replaced my T-shirt with a long-sleeved sweater and ran a brush through my hair.

  Colin introduced me as a friend. His girls were largely oblivious to me as they doted on their dad. One tied pigtails in the top of his hair. The other sat on his lap. The oldest, Charlotte, was eight. She had her dad’s beautiful blue eyes and dark brown curly hair.

  The youngest, Olivia, was a tiny, lithe, blonde five-year-old, smiling sheepishly from her dad’s lap while she took bites of a bean and cheese burrito. He was patient, cutting Olivia’s food into tiny bites for her and filling the guacamole cup three times.

  I mostly listened to them talk about school and their teachers. I looked for any clues they might be irreversibly scarred from divorce. Nothing out of the ordinary. They had big appetites, reminding me to pick up more groceries for Sophie and all the relatives staying at my house.

  Colin held the girls’ hands as we crossed the street for gelato. The girls sat at the ice cream bar while we talked at a table nearby.

  “It’s really good to see you,” he said. “How are you holding up?”

  I wanted to bury myself in his shoulder and surrender all my worries to him. Instead, I faked a smile.

  “It’s good to see you, too,” I said, telling the truth. It was good to see him. Just being here with him made me calmer, more centered. “I’m doing okay, I think. The bureaucracy is unbelievable. We don’t know when David will get into a treatment facility, and we can’t really move forward until the county tells us where to go.” I bit the inside of my mouth. I didn’t want to worry him, but I also didn’t want to hide something so important. “They never found the gun.”

  Colin interrupted, “They don’t know where the gun is? You mean, he could go back up there and get it?” His eyes were concerned, his brows narrowed. Colin, I knew by now, was not a man prone to dramatics. “Do they think he hid it, or dropped it, or what?”

  I knew what he was thinking—that David could escape and hurt me, or Sophie. Even Colin or his daughters.

  “I don’t know, but we’re doing everything we can to find out,” I said, underscoring the need for concern. “His girlfriend is looking for the gun. But she’s on twenty-five acres up there; it’s not like carefully manicured trails or anything. It is deep brush and trees. It could be anywhere.”

  “Wow,” he sighed. “This is unreal, isn’t it? I don’t know how you’re doing it, Sheila.” He held my hand across the table. I suppressed the anxiety and fear and put on a brave smile.

  “Would you consider staying with me?” he asked. “Just until we know you’re safe.”

  “No, thanks,” I said. “I’ll be fine. Really, we’ll be okay.”

  The girls turned from the bar with gelato mustaches and smiles on their faces. “We’re done, Daddy,” Olivia said. “Can we go?”

  Colin threw me a conflicted glance, his fingers lingering around my hand. I squeezed his hand back, careful not to show how frightened I’d really become. Colin cleared the gelato cups from the bar, tipped the waitress generously, and then carefully folded a paper napkin before he dabbed the gelato mustaches from his daughters’ lips. “There you go,” he said gently. Seeing that familiar gesture of affection and caring, one I’d seen so many times when David dabbed Sophie’s upper lip, made me shudder.

  “I really want you to stay in touch with me,” Colin said. “Okay?” I nodded, grateful, but wondered whether I was complicating my life rather than straightening it out. I watched out the window as they headed to the sidewalk. Colin instinctively reached down to grab his girls’ hands before reaching the intersection.

  David was transferred to a psychiatric care facility two days after his suicide attempt. Robert Stellar, the caseworker, had o
bviously pulled strings to get David to a facility so quickly, and one that was so close to my work. He called me whenever there was a new piece of information, anything for me to hang on to. David would be transferred while I was at work. His sister could stay with him during the transition. I could visit when I got off. I signed off wondering if listeners had any idea how much stress I was under, whether my voice sounded broken and scared, or whether the years of training really could mask my anxiety.

  I parked in a space in front of the hospital. Outside, three young skateboarders dressed in baggy shorts and T-shirts loitered around the entrance, skating, stopping, starting over. There were good stairs, handrails, and smooth cement here: A skater’s paradise, I thought to myself. The worlds outside and inside a hospital could not be more different.

  The receptionist gave me directions to the psychiatric center. It took up one wing of Good Samaritan hospital. Robert had prepared me on the phone for what I’d encounter once I got to the psychiatric center: A small box on the wall with a button. You push it, and the people inside look at you through a camera to determine if you are safe. Two sets of heavily locked doors open. Then you surrender your purse, your shoes, and your belt. Only then can you see the patient.

  The communal room was bare of windows, no pictures, no art anywhere. (Glass is considered dangerous.) Four tables were set up on one side of the room leading to a kitchen. There were small seating areas for families to visit, the kind of furniture you see in group homes that haven’t been updated in a decade. The room was full of the stink of Brussels sprouts just cooked, the clank of people cleaning up from dinner.

  The muted, bland colors on the couches would make anyone depressed. A couple of families sat with patients—you could tell which ones were the patients because they were dressed in cotton scrubs. One man shuffled past, disoriented and mumbling. He took tiny steps, a couple of inches at a time, as if he were recovering from a stroke.

  My throat tightened. I couldn’t swallow. What kind of place was this? How could someone possibly get better here? The lighting was horrible, artificial, dim. The staffers sat behind heavy shatterproof glass laced with wire. They were completely walled off from the patients. After they’d taken my purse, no one had even attempted to show me where to go, or let me see David’s bedroom, or even tell him I was here. My palms were sweating.

  Breathe, breathe, and breathe, I told myself.

  A young woman, who looked like she weighed about eighty-five pounds, eyed me from the corner. She was curled in a fetal position, her mouth slack-jawed when she looked my way. The scrubs hung on her emaciated body, and her feet showed bones covered by thin, dry skin. She growled as I walked past.

  I looked to the other side of the room: there was David rounding the bend. He was completely shaven again and clean, cleaner than I’d seen him in months. His wrists were bandaged, but his arms were still tan from gardening. He stood across from me awkwardly, as if we were strangers meeting in an airport. He swallowed. His mouth sounded dry.

  He wore blue scrubs with black slippers and a plastic tie around his waist that replaced his leather belt. “Yeah, I’ve always wanted to be an MD,” he said with his hands turned up, showing off the outfit.

  I laughed, confused. I hadn’t expected this. Could David be better already? His eyes were clear again. He wasn’t shaking. It was as if he’d come up from a long slumber and looked and felt better. His hair was combed back, and even though he was thin, he looked like he might survive.

  He led me to a furniture grouping, four chairs divided by a low table. He sat, clasped his hands between his knees, and hung his head.

  “How are you feeling?” I asked.

  “I don’t know anymore.”

  “Have you seen a doctor here?”

  “Not yet.” He shook his head. “Sometime tomorrow afternoon.”

  I wondered what he would do until then, in this bare and dismal place. He hated to sit still; it made him antsy and nervous. He was used to handling a dozen jobs, flying around in his truck, juggling two cell phones and the demands of clients. Hospitals are always boring, but this was even more so. There were no books or magazines and no recreation room. There appeared to be nothing for him to do here. This place looked like One Flew Over the Cuckoo’s Nest, only smaller.

  “Is that for the kids?” I asked, noticing a table in the corner set up with crayons and coloring books.

  “That’s for us.” He raised his eyebrows. “They invited me to color this afternoon.”

  Tears filled my eyes. I remembered my friend Claudine telling me once how she’d never asked a question David didn’t know the answer to. Whether it was politics or religion or history or mathematical theory, David was a walking encyclopedia. Full of stories. Full of life.

  “This won’t work,” I said, unable to control my tears. “This place is horrible, David. You are not as sick as these people, David. We have got to get you out of here.” I was protecting myself again. Denial.

  He grabbed my arm across the table and looked me straight in the eye. “I am these people,” he said. “This is where I belong.”

  “No, no, you aren’t!” I objected. “David, you are not doing a shuffle and talking to the sky. You are not so emaciated you can’t think. Well, you are skinny, but you are not . . .” I broke down crying. “You are not as sick as they are.”

  David had always been different—and I’d finally accepted that he was mentally ill, but the full impact of what that meant was now making its way into my consciousness blow by blow.

  David kept his voice measured and low. “Yes, I am,” he said. “I am, Sheila.”

  I rambled, desperate to reframe his story: “You do not know that, David! You just lost your dad; we’re going through a really terrible time, you and me. But that doesn’t mean you can’t get over this. With medication and rest, you can repair yourself, David. But not here, not here.”

  He sighed, suddenly looking tired again. It was as if I’d caught him at his best for a few moments, and now that person was gone, replaced by someone who needed to go back to bed. I tried to reach him the one way I knew I always could.

  “Sophie misses you, David,” I said. “She misses you so much.”

  “Ah, the Sophster,” he said, as if he were being reminded of an old friend. “How is she?”

  “She doesn’t understand, of course. But she needs you, David; she needs you home.”

  “Yes.” Suddenly he stood, even though I was nowhere near finished talking. He clearly was. “Please give her my love.”

  Then he shook my hand. We might have been complete strangers.

  “Thanks for coming,” he said politely, and then he turned and walked into a bedroom several feet away.

  I followed him. I couldn’t just walk away without reaching him, without telling him that I’d help him to get better, that Sophie would, too. That we’d find a way to make him healthy and whole again. But could we?

  The room was bare—there were no windows. It was the size of a prison cell. There was a bed and a chest of drawers. He lay down facing the wall.

  “I’m really tired,” he said, without turning over. “Maybe you could come back another time.”

  I sighed, tension building in my throat. I was the imposter in a world he’d already accepted as his own. Did he know something about the interior of his mind that I didn’t? Had he really left the world—my world, Sophie’s world—so far behind?

  “Okay, David,” I said, patting his arm. “Okay, I’ll see you tomorrow.”

  I wandered through the room back to the security area and knocked on the window. A couple of people behind the desk talked to one another. I knocked again. The dark-haired woman looked up, annoyed, and then continued her conversation with another nurse.

  I knocked a third time, annoyed. Being a nurse in a psych ward had to be tough, but these two nurses were taking complacency to a whole new level.

  “Are you leaving now?” she asked, looking up from her conversation.

 
“I’d like to talk to David’s doctor first, if that’s okay.”

  She looked at a book below her. “David? What’s his full name?” she said.

  “David, David Krol.”

  “How do you spell that?”

  I sighed. Of course they don’t know who their patients are. Of course they don’t know who the patients’ doctors are. This was a high-priced holding cell for people hell-bent on killing themselves. My blood pressure rose. My chest rose and fell quickly.

  “How many clients do you have here tonight?” I said.

  “Twelve,” she replied.

  “Then would it be possible to learn their names?” I asked. “They have names, you know. They are hurting out there. And here you all are locked behind your glass cages. David has been here since nine o’clock this morning and hasn’t seen a doctor? What am I paying for, anyway? Imagine him in the emergency room for nine hours without seeing a doctor!” They were underpaid and overworked, I knew. But they had stopped caring, letting the system turn them into cogs, to the point at which they were hurting, not helping, their patients.

  The woman straightened her back. “The doctor will be on tomorrow,” she snapped. “If you want to come back during business hours, you are welcome to talk to her then.”

  She clicked the glass door closed. The other nurse came around with my purse.

  “Visiting hours are over,” she said, coldly. I suddenly realized the fatal error I’d made. In showing how angry I was over what I realized was inept and callous care, I made the staff my enemies when I needed them most. But I was too tired to try to fix my mistake, and I walked quietly out the door, hearing it shut with a firm swing behind me.

  INVOLUNTARY HOSPITALIZATION

  When a loved one needs immediate psychiatric intervention or help, but they don’t agree with that decision, caregivers may come up against the issue of involuntary commitment, also known as civil commitment. Involuntary commitment occurs when a judge decides that a person is mentally ill and mandates treatment, which can include psychiatric hospitalization. If a loved one resists outpatient care and cannot agree upon a plan for his or her safety, sometimes involuntary commitment may be necessary; David’s second suicide attempt triggered an involuntary commitment.