Woman Who Could Not Forget

by Richard Rhodes

  She told Dr. B that she did not think her mental state was that bad and that she didn’t need to go to a recovery facility. Actually, I saw that Dr. B was fully aware of Iris’s sensitivity. He was very careful and had already avoided using the word “hospital” or “institution.” He pointed out that the facility was like a resort or a residential facility, except that there were supervisors overseeing the residents.

  I was interested in finding some specialists in the psychiatric field who he could recommend to help Iris in her situation. Dr. B mentioned two psychiatrists at a local medical clinic.

  The discussion in Dr. B’s office lasted nearly an hour and did not really get anywhere. When we all left the office, I saw that Iris was very alert and displeased. After we reached home, Iris told me that on the way home, she and Brett had already decided that Dr. B was too old and that they did not believe what he said. She was going to discontinue seeing him.

  I was astounded to learn that she had made this decision just because he mentioned that she should check into a recovery facility. In spite of that, I told her that I thought Dr. B was quite kind to arrange a special meeting immediately on a Saturday afternoon and to voice his concern. However, Brett said he had lost confidence in Dr. B when Dr. B said “To be honest, I’ve never treated a patient like you before.”

  I got busy looking into the background of two psychiatry specialists that Dr. B had recommended. It was a surprise to find that these two doctors specialized in electroconvulsive therapy (ECT), which was commonly known as electroshock treatment. My God, I said to myself, if I told this to Iris, it would further confirm her decision that she would never go to Dr. B again. Iris had told me a long time ago about how cruel it had been to use electroshock therapy to treat mental patients in the past.

  Indeed, when I told her about what I had found out about the doctors, she was very upset and said, “Do you know this is a very old method for treating mental patients? There is tons of scientific evidence that has proved it’s ineffective. I could not imagine he would suggest that I go to see doctors using this kind of method. . . .”

  Dr. B’s recommendation was only making her feel worse.

  Dr. B was going to take a week-long vacation and, before he left, he asked Iris to see him after he came back from the trip. This gave Iris an excuse to avoid making a followup appointment with him, and she switched to another doctor.

  In the September 18 meeting, to help Iris’s condition, Dr. B had prescribed the antidepressant drug Celexa (citalopram, from Forest Pharmaceuticals). He prescribed 5 mg of Celexa for Iris to take for four days, then increasing the dosage to 10 mg. This was in addition to the 10 mg of Abilify.

  At this time, Iris was already experiencing the strong side effects of Abilify. Most obvious were her lack of energy and the fact that she was drowsy all the time. In addition, when she woke up from her daily nap, she complained that her shoulder and leg joints were sore, which were new symptoms that she thought likely to have been caused by the drug. I was quite worried about the side effects of Abilify and voiced my concern to Dr. B. He said the dosage was the lowest possible and that the side effects would gradually disappear. In retrospect, it appears to us that Abilify had a big impact on Iris’s mental state; it was a turning point in that her condition became worse after she started taking Abilify, and then later worsened even more with Celexa.

  After Iris decided she was not going to see Dr. B anymore, Dr. A came back from his month-long vacation. Brett made an appointment for Iris to see him because we had not found another doctor yet. The appointment was on the evening of September 20. Since Brett would be out of town on that day, he asked us to take Iris to the appointment, which was at 8:15 P.M. It was probably Dr. A’s last appointment for the day.

  Dr. A let us all into his office, and he looked very tired. Perhaps that was why we felt that he was not very interested in hearing about Iris’s condition. Iris told him that she had seen Dr. B, but was not going to see him anymore and wanted to continue with him, Dr. A. Dr. A did not like the drug Abilify that Dr. B had prescribed, and said he would change Iris back to Risperdal, but he did not insist on changing back right away.

  When the session was about to end after only ten or fifteen minutes, he reminded Iris to make the co-payment right there, just as before. This distressed us all, and we could not help getting the impression that he was more interested in the co-payment than anything else. When we walked out the office, we felt very disappointed because he had not been helpful at all.

  After this meeting, I told Brett, who agreed with me, that we needed to find a board-certified, better, more concerned psychiatrist immediately.

  Tuesday, September 21, was a day I would never forget. In the morning, after Luann and I took Christopher to the preschool, I went home; by this time Iris had gotten up, and she said she wanted to go to the post office and then the library. I wanted to go with her as usual, but she refused. I did not like her to drive by herself. The sedating side effect of the drugs was quite serious, making driving dangerous. However, she was upset because I was accompanying her everywhere and she felt I was following her too closely. She insisted on driving by herself to the library. I acquiesced and told her she needed to get home before 6 P.M. She agreed.

  I was uneasy all afternoon. Near 6 P.M., I called Luann and learned that Iris had not returned home. Brett was in Ohio. I was so worried, I went to the entrance of our housing complex and stood at the side of the street and waited. I watched every passing car, hoping to see Iris’s car. I waited and waited and the day became dark, and I still had not seen Iris’s white Oldsmobile. I was almost going crazy with not knowing where she was.

  At this point, I also called Brett in Ohio and told him what had happened and asked him what was the license number of Iris’s car. About 7 P.M., we called the police and reported that Iris was missing and told them the car model and license number. Then at 7:30 P.M., Iris called me. She sounded a little confused. She said that she had gone shopping and become tired, so she’d checked into a hotel to sleep. She said she had just woken up and realized that it was already evening. Her voice was soft and sounded a little guilty.

  I comforted her and said it was all right. I asked whether she needed me to pick her up. She said she was in the nearby shopping square and would drive back home right away. We waited another half hour before she showed up. She was all right, but she looked very confused. Several minutes later, two police officers arrived at her home. We explained to them that Iris had just returned and we were so sorry to have bothered them. The police did ask Iris a number of questions before they left.

  During the police questioning, Iris told them that she was fine without giving any details. After they left, Iris told us that she had checked into a hotel, and she thought she had swallowed some sleeping pills, and she wanted to go to the hospital for a checkup. We were very confused and wondered whether what she was saying was true or not. Shau-Jin and I asked her many questions, and she said she had indeed taken sleeping pills in the hotel.

  By this time, Michael had arrived; we had told him about Iris being missing. We decided that what Iris had told us was true, so Michael drove us all to a local hospital’s emergency room. On the way, Iris told us that she was really not sure whether she had taken the sleeping pills or not. From her appearance, she seemed normal and sober and not under any influence of any drugs. At the ER, while waiting in the doctor’s office, she told me again that she could not remember whether she had taken the sleeping pills or not. When the doctor finally came, he examined her and asked a few questions. The doctor concluded that she had not taken any sleeping pills and said that if she had, she would not have been as sober as she was. I was puzzled as to what had really happened while she was in the hotel.

  Several days later, we found a big unopened bottle of vodka in her kitchen cabinet. Later, we realized that she had indeed made her first suicide attempt in the hotel. She’d bought the vodka and sleeping pills and checked into a hotel, but then she must
have fallen asleep in the hotel, perhaps due to her prescription medications. In the end, she did not take the sleeping pills nor the vodka. When she woke up, she was not sure herself whether she had taken the pills. At the time, we still had not realized the strong side effects psychiatric drugs could have on a person’s mental function, nor the possibility that they could cause or amplify thoughts of suicide. We now know that the Abilify Web site warns that the drug “can affect your judgment, thinking, or motor skills,” as well as the side effects of increasing the risk of suicide, drowsiness, anxiety, and muscle stiffness, and the Celexa Web site warns about suicide, anxiety, and akathesia (a dangerous agitation associated with self-destructive or aggressive impulses).

  It is my firm opinion that the side effects of the medication had altered Iris in a big way. In all the years we have known each other, as mother and daughter, Iris has always been strong, resilient, and undaunted and had never considered suicide as a way out. She often expressed that she could not understand how people would commit suicide. Her first attempted suicide occurred when she was on 10 mg of an antipsychotic drug, Abilify, for nine days, and on 5 mg of an antidepressant, Celexa, for two days.

  I have since learned from all the sources (see Epilogue) that antidepressant drugs like Celexa belong in the class of medications called SSRIs (Selective Serotonin Reuptake Inhibitors) which includes Prozac, Paxil, and Zoloft. These medications can paradoxically have the side effects of making a depressed patient even more anxious and suicidal. It could make people confused and alter their personalities. In some patients, SSRIs can induce suicide ideation and behavior; these serious side effects of SSRIs have been well documented in recent years, but we were not aware of it at the time. And perhaps even more importantly, research has revealed that the first few days on an antidepressant SSRI, and any time that a dose was changed, were the times of greatest risk.

  What happened on September 21 was very scary for all of us. The incident indicated that Iris was considering committing suicide, and now my deepest fear became a reality and I knew I had to watch her even more closely.

  The next day, she got up early and seemed alert. She told me she was going to her home office to clean up and work. I went to see her in the afternoon; she was working hard in her office sorting out her papers. This was the first time since she’d come back from Louisville that I saw her as the old Iris—hard at work.

  “You look good today,” I said to her.

  She said, sounding like her old self, “Because I don’t want to die.”

  I was overjoyed to hear her say that and stayed in her office for a while. I helped her a little before I went to pick up Christopher from preschool. Once Christopher got home, Iris played with him, and she also tried to help Luann with the household chores. But after several days, Iris became depressed again.

  On Friday, September 24, Brett told us that Luann had suggested that she would like to take Christopher with her to Illinois in light of the current situation. After we heard the news, both Shau-Jin and I felt uneasy about the suggestion; but when we told Iris about it, to our surprise, she agreed. She expressed that she felt it was best for Christopher to move to Illinois. Her reason was that she believed someone was going to hurt her immediate family members, and Christopher would be safer if he lived away from her.

  Once Iris and Brett agreed, it was no use for us to show our disapproval. The date for the move was October 9. Ken would come to California on October 1; then Ken and Luann and Brett would travel together to take Christopher to Illinois.

  On Wednesday, September 29, Brett accompanied Iris to see Dr. A because we still had not yet found another psychiatrist for her. She complained to Dr. A that she was too sleepy with the Abilify, so Dr. A asked her to discontinue Abilify and go back to Risperdal.

  On Saturday, October 2, there was only one week left for Christopher in California. It was sad for us to think that he would separate from his mother soon. Iris was very sad too, but I could see that she truly believed someone might want to harm him. Now that Christopher was going to live with Luann and Ken, she seemed calmer, even though it was such a sad situation. Needless to say, Shau-Jin and I were heartbroken that we would not be able to see our grandson every day like we had for the past two years.

  At this time, we tried to cheer Iris up by encouraging her to call her close friends, such as Barbara Masin. Barbara drove up from Santa Barbara and visited Iris for a weekend. They went out hiking and saw a movie together. It seemed that Iris’s spirits were lifted somewhat when Barbara was with her. But as soon as she left, Iris was depressed again.

  Iris switched back to Risperdal 1 mg and Celexa 10 mg each day after she saw Dr. A on September 29. We had been very concerned about whether the medication was right for her. It seemed like it did not help her much with her depression but just made her sleepy and agitated. We were desperate and felt that she needed a good doctor to follow her progress. Shau-Jin and I went to the San Jose State University library to do a background search on each doctor on the list provided by Brett’s health plan. It turned out that most of the doctors were either child psychiatrists, or their office location was too far away, or the specialty was not listed.

  Shau-Jin and I wanted desperately to lift Iris’s spirits. We were alone in this struggle, because Iris did not want us to disclose her condition to anyone outside of her very closest family members: Brett, his parents, her parents, and her brother. We respected Iris’s wishes. We did not dare to ask other friends of ours or hers for help or advice, for fear that she would think we’d betrayed her, which would mean we would lose her trust in us.

  Almost every day, we asked Iris to take a walk with us on the levee in the back of our housing complex. We knew that the exercise was good for her, and we hoped the walking outside in the sunshine would dispel her depressive thoughts.

  On Tuesday, October 5, it was partly cloudy, a typical northern California autumn day. I could not sleep the night before. Christopher was going back to Illinois with Luann and Ken that coming Saturday, only four days away. The thought haunted me. We went to Iris’s house that afternoon and asked her to take a walk with us. For a change, instead of walking on the levee near our house, Shau-Jin suggested that we go to Hakone Garden, a Japanese garden, located in the Saratoga Mountains, a twenty-minute drive from our home.

  When we arrived at Hakone Garden, which was up on a hill, there was not a single person in the garden, and the surrounding area was very tranquil and peaceful. We passed a small arched wooden bridge and walked up the path leading to a bamboo garden. The silence gave me an unspoken anxiety. Finally, we reached a small resting place where we could sit down. It was a wisteria vine-covered shelter surrounded by oaks and pines. It was unbelievably quiet; I could only hear the wind as it blew through the woods and the rustling sound of leaves. Suddenly, Iris said to us, “They tried to recruit me.”

  “Who?” Shau-Jin asked, surprised.

  Iris sat down on the wooden bench, her body against a vine-covered post.

  “During the book tour. There was a person who came up and talked to me in a threatening tone, ‘You will be safer to join us.’”

  “What did you say to this person?” Shau-Jin asked.

  “I was scared and did not know what to do, so I just ran away and did not say a word,” Iris replied. “Dad, do you think it’s safer to join an organization or not to join? I’m worried about the safety of our family.”

  “Iris, you are fine.” Shau-Jin tried to calm her down. “In my opinion, not to join any organization was the safest way. You see, if you want to maintain the freedom of speech, stay where you are now, an independent writer and author. That is the best.”

  Shau-Jin continued, “You may join an organization if you want to, but not because someone is threatening you to do so.”

  Then I also told Iris that that was why Shau-Jin and I liked to work in an academic institution. We could have the freedom to voice our opinions at any time. We also assured her that she had done nothing wron
g, and that everything would be all right. She was safe with us.

  We spent about an hour discussing the issue. It seemed Iris did not feel she’d handled the situation well; said she should not have just run away from that person. I could see she was not convinced about what we told her. This was the second time she had mentioned this incident to us. The first time was right after she’d come back from the extended five-week-long book tour in April and May. She wanted us to keep it confidential.

  In that garden on that day, she reiterated her fear that someone was trying to harm her and her immediate family. Now the sun peeked out of the clouds and the autumn colors of trees were so bright that it hurt my eyes. The seeming tranquility of the garden could not give me any peace. My heart was heavier than before we’d come.

  It seemed that the drugs Iris was taking were not helping her at all. I started wondering about the side effects of the drugs. I had read the warnings of those medicines in fine print, stating that SSRIs such as Celexa could have a suicidal risk in children and adolescents, but Iris was thirty-six years old. At the time, I did not realize that SSRIs could induce suicide ideation and behavior in adults too. Nevertheless, the warning about suicide gave me an eerie feeling.