It was only in the reading of David’s medical records that I later learned how far he had fallen: “It is imperative that this man be kept in a safe situation until he gets enough relief from the psychotic depression. He has annihilistic delusions, believing that his mind is gone, cannot be recovered, and that things will only get worse for him. He feels an overwhelming unilateral guilt in the loss of his marriage and business. In my interview with him, it became clear that he is so convinced of this that from his perspective it would not make any sense to go on living much longer. He cannot even decide whether his daughter would be better off with him or without him.”
Jim knew I was the person who would be responsible for David’s personal debts. He outlined the process. “This will be a temporary measure, David. We’ll give Sheila the authority to make decisions for you and look after your financial affairs for a period of three months. That should give us a better idea of what we need to do next. Are you sure you are okay with this?”
David nodded yes. He didn’t look at me before he signed the document. His signature looked exactly as it had a decade or so earlier when he’d signed our marriage contract—all loopy and slanted heavily to the right. The nurses from behind the glass wall shot me their customary dirty looks. David handed me the papers and said, “I’m so sorry for doing this to you. To you and Sophie.”
I swallowed before I spoke. He was so vulnerable here. “We’ll work it out, David. We’ll take care of everything.”
Jim sensed his intrusion and excused himself briefly to the table nearby. Alice excused herself to the restroom. “David,” I asked, “why couldn’t you tell me your company was in trouble?”
“I thought you’d think I was stupid.” He lowered his gaze to the floor.
“But what about your accountant, your taxes?”
“There are a lot of people who owe me money. I just couldn’t ask. I couldn’t ask for payment.”
“What? What do you mean? There are people who owe you money? For how many jobs?”
“I don’t know, six or seven.” He motioned for a pen and the pad of paper I held. “These are the names. Some of the jobs are nearly finished. Others have been done for a long time but the clients want some minor changes. I just lost track of it all, Sheila. I’m sorry. I feel like a fool.”
I was beginning to understand the depth of his illness in terms that now tied David’s past to the present. I thought of the story his mother had told me in the kitchen when we first met, how his paper route had turned sour when he became too paralyzed to collect money from his clients. I put my fingers over my mouth, pressing against the sadness welling up inside me. David squirmed on the couch, looking like a kid forced to stay after school. His left leg bounced up and down.
“Do you think I’ll ever get out of here?” he asked.
“Of course you will, David. You’ll stay for a couple of weeks, maybe. Then we’ll move you back home, and you can rebuild your life.”
“I just can’t see it, you know?” He searched my eyes to make sure I understood. “I just can’t see being the guy who picks up Sophie from another person’s house. I don’t want to do it. I can’t.”
Jim must have sensed David’s agitation. “Everything okay over there?” he asked. David nodded yes.
“You know what’s weird?” he said, turning back to me. “They have this manual, this huge physician’s manual that talks about all these different psychiatric illnesses. One of the aides here let me read it when I finished the books everyone has brought me.”
He leaned forward in his chair as if he were sharing a secret. His eyes widened, and he spoke in low tones. “I’m bipolar. It’s true. It’s like, check, check, check. Even the strange things I think I’m smelling.” He made a sign with his hand as if he was counting off the warning signs that applied to him.
It was the first time I had heard anyone mention a diagnosis. My spine stiffened, and I felt my jaw drop.
“Is that what they say, David? Is that the diagnosis?”
He nodded.
No wonder David felt so paralyzed he couldn’t bill the clients who owed him money. No wonder he couldn’t sleep, couldn’t eat. No wonder he had huge variations in his weight and his energy. People with bipolar II disorder are often highly prone to lying. They experience irritability and anxiety instead of the joyous, manic high associated with bipolar I. They also suffer from maddening swings in energy and focus. They are highly sexualized, and infidelity is common. All the signs were there.
My temples began to throb. A wave of pity and longing for the man he used to be washed over me. I stroked the top of his head and kissed him on the cheek.
“David,” I said, “we’ll all be here for you, no matter what happens.” It was as if a small lens I’d used to view him had suddenly opened wide, and finally, the big picture was in view.
David stood up and shook my hand, as he had the last time. “Goodbye for now,” he said, walking toward his mother.
I swallowed hard and tried to compose myself. Jim sat down next to me.
“You’re going to need to be tougher than all of us put together.” He patted my hand.
“I don’t know, Jim,” I said, “I don’t know if I have it in me.”
Later that day, I took the legal papers to David’s bank and asked for a printout of all the deposits he’d made in the last six months, all the checks he’d written, and the balance left in his business account. The woman behind the counter looked at the power of attorney document, her eyebrows penciled in and pinched.
She made several long phone calls before she finally pushed a slip of paper under the glass and reported the account balances. Ten thousand dollars remaining—not enough to make a ding in any of his debt.
I remembered attorney Jody Stahancyk’s admonition: “Your ignorance may have saved you, but, on the other hand, if he’s rung up personal debt, you’re on the hook.” I raced to the car and called David’s accountant.
“Did you know anything about this?” I asked him.
“I had a feeling things were way out of control,” he said, Hendrix music blasting in the background.
“Why?”
“Because he hasn’t paid me either.”
David’s mother, his sister, and a friend of theirs were sitting in my living room when I got home. I poked my head in on Sophie. She was listening to her iPod in her room. “Hi, love, how are you?” I asked.
She threw her arms around me, and I could hear the music too loud from the earbuds. Things had settled between us since the scene in the car. “I’m okay, Mama,” she smiled. “How are you?”
My heart melted when she called me “Mama.” There’s something so profoundly personal about that term of endearment. “I’m good, too, sweetheart. Just fine—better now that I see you.”
I smothered her head with kisses. “Hey, turn the tunes down a notch, would you?” She rolled her eyes, smiling. If she worried about David every day, every moment as I did, it did not show.
I settled in the living room with Alice and Adele. “I’m in real trouble,” I said. “It looks like a large portion of David’s debt, his taxes, his county debts, will fall to me and Sophie. I know you want David to be able to stay in the house, but I don’t know whether he can afford it. And I don’t know where Sophie and I would go, either.”
I loved this house, this kitchen, the place we had finally settled into as home. The thought of leaving it now, unsettling Sophie when things were so chaotic, packing her clothes and stuffed animals and moving to a tiny apartment, all seemed incomprehensible. The last few weeks had taken my spirit. I bit my lip to stop it from trembling.
Alice avoided the topic. There was a chicken in the oven, which she must have cooked. The aroma wafted through the air, a mix of rich olive oil, herbs, and sea salt. “What do you say we eat something? You must be starved.”
Her denial never waned.
I stayed up reading with Sophie and then tucked her in. “Is he going to be okay?” Sophie asked. I knew
from her tone she was not talking about Harry Potter.
“I hope so, baby. We’re doing everything we can for him.” I kissed her on the forehead, and she turned over, as she did every night, so that I could scratch her back. Her tiny waist and long torso looked so much like David’s sisters, all beautiful women.
Their emotional struggles hadn’t meant much to me before David’s illness; every woman suffers from a bout of sadness and anxiety now and then. But now, I obsessed over his family’s propensity for depression and mental illness.
I had more of the story than Alice knew. Adele had given me the complete history. David had been sent away to boarding school in England at the age of ten, a year in which he was brutalized by the other students. He returned home to attend school at a Boston prep school as his father studied at Harvard Business School. The transitions were hard on him; he’d made few friends since the kids at both schools had been together for an extern long time, and David was an outsider.
Although David always did well academically, and his test scores were off the charts, he was kicked out of school because he quit going to class. Next came another boarding school, another difficult transition. David was finally kicked out of the house at sixteen. Michael’s sister Adele says her father suffered from erratic mood swings and David was often the target of his anger.
But Alice never let on about any of this, not to me. She never shared the details of David’s upbringing that I would later realize were central to his feelings of abandonment. There was so much unsaid about their family’s pain—no mention of Lew’s erratic behavior or his affair with a family friend, no mention of both parents kicking David out of the house at sixteen. They were a family good at keeping secrets.
His father, prone to shutting himself off in his bedroom during our visits, had given up a lucrative career and a Harvard education at the age of forty-three. He never worked for another person again, instead buying, remodeling, and then selling houses to keep his family afloat between sporadic moves around the world. Adele would later tell David’s psychiatrists she was convinced Lew was bipolar, and that her mother suffered from depressive episodes. Adele’s mother, however, would never accept the designation of a psychiatric disorder. She was deeply skeptical of the profession and refused to categorize her loved ones’ suffering as mental illness.
Watching Sophie sleep, I knew I needed to understand everything I could about the genetic nature of bipolar disorder and the genetic risk of depression, one from his side, another from my own mother. A double whammy from two gene pools. Sophie deserved my vigilance. I kissed her on the cheek and wished her peaceful dreams. When her breath was even and deep, I went to my bedroom and opened my laptop.
Dr. Kay Redfield Jamison appeared in the search as one of the leading experts on bipolar disorder, a condition she has survived since college. She writes intimately about her condition: “About 5.7 million American adults or about 2.6 percent of the population age 18 and older in any given year have bipolar disorder. The disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life.” I drew in a breath and forced myself to continue reading. The house seemed to go completely still, and every keystroke I made sounded abnormally loud, underlying the gravity of what I was learning.
“Manic depression is far more lethal than the nomenclature suggests. Cycles of fluctuating moods and energy levels serve as a background to constantly changing thoughts, behaviors, and feelings.” This is what I saw in the final weeks before David was finally admitted to the hospital: the extremes of the human experience, the breaking of every boundary I’d ever thought existed in David’s personality. He had swung from psychosis to a condition that resembled retardation. It was all there in the literature.
I put my hands to my forehead and felt overwhelmed, stupid. How had I missed it? The early years with David were confusing and erratic. I chalked his behavior up to a million different things—moving, too much stress at work, too little exercise. David refused to talk with me about how he was really doing and instead blamed demanding clients, the cold, the rain, me. But in the last three years, it was all there to see. Every question about David’s behavior was answered in clinical terms—his seductiveness, his reclusiveness, his frenzies, his abnormal intellect, and his creative side.
I pulled my robe tighter around me and read what I should have been told the first time David attempted to cut his wrists, the first cry for help. “Patients with depressive and manic depressive illness are far more likely to commit suicide than individuals in any other psychiatric or medical risk group. The mortality rate is higher than it is for most types of heart disease and cancer. Yet the lethality is underemphasized, a tendency traceable to the widespread belief that suicide is volitional.”
The computer burbled out the time. “It’s 1:00 a.m.” I dug further.
One study, reported in The New York Times, called into question whether nature, not nurture, was the single factor making a person prone to mental illness. “The new report, by several of the prominent researchers in the field, does not imply that interactions between genes and life experiences are trivial; they are almost certainly fundamental, experts agree. But it does suggest that nailing down those factors in a precise way is far more difficult than scientists believed even a few years ago, and that the original finding could have been due to chance.”
The article concluded, “The findings are likely to inflame a debate over the direction of the field itself, which has found that the genetics of illnesses like schizophrenia and bipolar disorder remain elusive.”
Even if David had a genetic predisposition toward mental illness, he’d functioned, albeit with mixed results, until the strain of our divorce and the death of his father. Dr. Jamison cites the risk factors for suicide: “losing a spouse, living alone, not being married, the death of a loved one.”
The stress of our divorce, the lack of sleep, and the side effects of antidepressants that should never have been prescribed created a lethal trifecta in David’s body.
I propped another pillow behind my back while reading about the psychiatric topics that I would now need to thoroughly understand: depression, bipolar disorder, suicide. Suicide is now the third leading cause of death in young people in the United States, and the second for college students. The 1995 National College Health Risk Behavior Survey, conducted by the Centers for Disease Control and Prevention, found that one in ten college students had seriously considered suicide during the year prior to the survey; most of those had gone so far as to draw up a plan.
In the next room, Sophie slept. Even though I was no longer in love with David, I adored him for what he gave our daughter. I would always care for him, if allowed.
The house was quiet, except for the low hum of the furnace. Sophie dreamed, but of what? How would I ever really know her mind if I couldn’t understand David’s? How might his life have turned out differently if he’d allowed true intimacy, a deep connection with someone he trusted? What should I have done differently? I vowed then to teach Sophie everything I had learned and would learn about the nature of mental illness, however confusing and contrary the information seemed. She needed to understand her risk. She would not be able to do recreational drugs, or work in overly stressful jobs, without learning how to cope first. She would need my help, help I would have gladly given my husband if he’d been willing to take it.
The information gave me a sense of confidence. Now that I finally understood what I was up against, I thought I could help David in a way I hadn’t been able to previously. I thought it would all work out.
WORKING ON MENTAL HEALTH CHALLENGES TOGETHER
Organizations around the country are stepping up to support families and instigate changes to the way research is conducted on mental health. However, most data is funded and provided by pharmaceutical industries, and while this is enormously helpful, there are inevitable concerns that big pharma’s top prio
rity when conducting research and sharing data isn’t necessarily the wellbeing of the consumer.
However, there is one community foundation that focuses solely on supporting research that has no commercial interest or benefit. Dr. Gina Nikkel is the CEO and president of the Foundation for Excellence in Mental Health Care, a nonprofit organization with the ambitious goal of bringing new and effective recovery practices to every community in the country. By joining the efforts of private philanthropists, public policy analysts, and top medical researchers, the organization strives to provide support and tools not just for those experiencing mental illness but also to those who treat them—psychiatrists, psychologists, and other mental-health clinicians.
Nikkel says, “The strategy is threefold: research, recovery, and program development and education. It’s clear that we must pay attention to what research actually says, support a wide variety of bio-psycho-social research that is not paid for by a commercial interest group, and join together to fund programs that are trauma informed and promote recovery.“
In addition to allowing donors to create their own funds, the organization engages with investment advisors to carefully choose the existing funds it supports. As many charitable organizations do, it invests widely, and seeks improvement through innovative and creative solutions from all over the world. One fund it supports is the Hearing Voices Research & Development Fund, a UK-based nonprofit that brings peer-group support to communities in the United States. Another is the Bill Anthony General Research Fund, an educational grant focused on research into early treatment methods, better standards for evaluating children, and long-term use of antipsychotics in the treatment of schizophrenia.
For more information about these organizations and others, contact the Foundation for Excellence in Mental Health Care at www.mentalhealthexcellence.org.
All the Things We Never Knew Page 17