Safe, Wanted, and Loved: A Family Memoir of Mental Illness, Heartbreak, and Hope

by Patrick Dylan

  Unfortunately, the medication caused her sullen disposition to reappear, and she once again isolated herself from the family. Her short-term memory went to hell and her diet fell apart. It was familiar to us now, but it didn’t make things easier. In his conservative style, Dr. Rojas wanted to be sure that the episode was fully under control, so he kept Mia on high doses of olanzapine for several weeks. We suffered a second Christmas under the gloom of her grumpy moodiness.

  As the new year started, we began another drawn-out titration of medication. The usual pattern returned, with Mia’s attitude becoming unpredictable in the days following a change in dose. At her worst, she was mean; at her best, she was detached. In every case, she was far from the person with whom I had fallen in love.

  At least, like Will had said, we knew she would recover. That knowledge made her behavior more tolerable, but it also made it easier for us to ignore. Wait until she comes back seemed to be the unspoken approach among the three of us. Our family, which had been mending deep wounds so effectively during the fall, was ripped apart again.

  I felt an overwhelming sense of sympathy for Mia. Before having kids, we had talked with so much excitement about watching them grow. But she had basically missed the past year and a half of their development. Will was midway through middle school, and Jamie was almost finished with elementary. The old Mia would have been crushed at having missed it, even though the medicated Mia didn’t seem to care.

  As for our relationship, I avoided considering it. Thankfully, my defenses remained strong during the relapse, and I didn’t suffer nearly the sense of personal grief as the first time around. Rather than think of Mia as my wife, I found myself viewing her more as my friend. I couldn’t abandon a friend to a life of periodic mental crises, where months and months of strong medications left her unrecognizable, but I didn’t know what to do.

  Dr. Rojas thought Mia had suffered from a onetime event, but it didn’t take a degree in psychiatry to question that diagnosis. As for solutions, we were stuck. We could handle the illness, that much was certain. But could we figure out what was causing it?

  Could we find a way to prevent Mia from facing a never-ending battle with psychosis?

  18.

  Desperation

  Dire Straits

  “Romeo and Juliet”

  2:57–3:23

  After my experience at Sam’s software company, I returned to Harvard to finish my last semester of business school. Since leaving three years prior, Mia and I had become parents twice over. Our little startup had gone public, suffered the ups and downs of the internet, and finally merged with another public company.

  Remembering my promise, I suggested to Mia that we try living in Florida after graduation. I knew little about the Sunshine State, but it was important to both of us to be near family.

  I talked my way into a role at a small investment firm in Sarasota. The city was close enough to family for visits but far enough that we would have independence. I didn’t do any homework when considering the job. I met the owner, interviewed with a few employees, and accepted an offer. Mia and I needed a catalyst to jump-start our move, and the position seemed good enough.

  In late July, a moving truck came and hauled away our furniture and carefully packed boxes. Prior to our departure, Mia and I signed a contract to purchase a home in Sarasota. We had enough for a down payment and were committed to spending at least two years in the area. We figured a house would be good for the kids and a decent investment if we wound up staying.

  We pulled into our new town in early August, and I had my first day of work the following Monday. The tiny business advised wealthy clients in an emerging area of finance. Within twenty minutes, I had met everyone at the company. They were friendly enough, but I soon discovered that poor decisions were being made by the senior executives. They weren’t doing things that were blatantly illegal, but their actions made me extremely uncomfortable.

  The discovery startled me. At first, I was upset for not having done more research before taking the job, but then I started thinking about the money we were spending on the house. The more I thought about it, the sillier and more reckless our decision seemed. Boston was filled with friends and opportunities. Apart from family, Florida offered nothing, except a questionable role with strangers that I didn’t trust.

  At noon, I left the office on the pretext of going to lunch. Instead, I nervously huddled in my car and dialed Mia’s cell phone.

  “We can’t stay here,” I said when she answered. “We need to call the moving truck and tell them to turn around. We have to get out of buying that house. Let’s put the kids in the car and drive back to Boston.”

  “What?” she asked, caught completely by surprise.

  “I won’t go into it, but I can’t work with these people,” I pleaded. “You wouldn’t believe what’s going on at this place.”

  Mia didn’t ask clarifying questions; she didn’t argue. Instead, she let a few moments pass. Then she said, slowly and steadily, “Listen to me, Pat. You promised me two years.” She took another pause. “Figure it out.”

  It was like a physical slap to the face, and I stared blankly at the parking lot around me. She was right. We didn’t move to Florida because of this particular job; we moved for more important reasons. I couldn’t let one poor decision sour the rest of our plans.

  I learned something vital that day. The struggle is okay; it drives you forward, forces you to find solutions. But you can’t give up.

  You can never give up.

  ***

  It took over four months to wean Mia off the medications the second time around, and the experience was just as unpleasant as before. We were painfully reminded of the remarkable and demoralizing differences between the healthy Mia and the medicated Mia. In her presence, everyone remained subdued and serious. Even Jamie was learning the routine; she kept her imagination reined in.

  We restarted our weekly meetings with Dr. Rojas, having swiftly abandoned the goal of never seeing him again. In March, he broached the subject of Mia’s revised prognosis. “I didn’t expect this setback,” he admitted, “but it doesn’t change my initial diagnosis. I still believe this was a onetime event.”

  I didn’t understand it. “Dr. Rojas,” I said, with as much decorum as possible, “it wasn’t a onetime event. It happened twice.”

  “Yes, but the second time wouldn’t have occurred if the first time hadn’t been so damaging.” He looked at Mia. “That experience was so traumatic that your brain became more susceptible to it happening again. Something in December must have caused you to become more anxious than normal, and that progressed into a degradation of your sleeping patterns. As you lost sleep, the chemical balance in your brain was interrupted, and that led you back to paranoid delusions.”

  Mia didn’t respond.

  “Okay,” I said, “but even if that did happen, why did the thought disorder start so quickly? The first time around, she was worried about work for weeks before the psychosis suddenly appeared.”

  “I don’t believe it all broke at once back then. This time around, you were attuned to the signals. You were watching closely, Pat, and Mia wasn’t hiding anything. Working together, you were able to catch it quickly. The first time around, you weren’t.

  “We know that the brain can withstand a lot of pressure before breaking,” he continued, “but once that happens, it can take a long time to heal. Mia’s brain was still recovering and was vulnerable.”

  “You’re saying that these two episodes were somehow related, that one led to the other?” I asked. “You’re looking at this as one drawn-out and connected event?”

  “Yes. What I’m saying is that the problem came a year and a half ago. What happened in December was an aftershock.”

  I was starting to understand his perspective. “Alright, but how do we fend off another aftershock?”

 
“That is the key question,” Dr. Rojas responded. “I’m confident that the longer we can push out any potential future episodes, the less severe they will be and the shorter they will last, if at all.”

  “So, you don’t think this is schizophrenia?” Mia asked, nervously joining the conversation.

  “No, I do not think you have schizophrenia,” he stressed. “It doesn’t fit at all.” I could see the tension draining from her body at his answer.

  “Okay, how do we push out future episodes?” I asked.

  “First, I’d suggest you stop working,” he said to Mia. “I know that isn’t what you want to hear, but your new job played a role in this. You must have been worried about something, even if you didn’t realize it.”

  “Okay,” Mia replied, unable to hide her disappointment.

  “It isn’t forever, just until we put some time behind us. Second, we should do what we can to minimize your overall anxiety. We can’t let it affect your sleep. That’s where the trouble starts.”

  “How do we do that?” I asked.

  “Mia needs to find activities that will remove stress from her life. We might also try a small dose of antianxiety medication. We could use it as a prophylactic for a short period of time.”

  “Fine,” Mia said, “whatever we need to do. I don’t want this to happen again.” Her eyes welled up. “It can’t happen again. It’s so hard on the kids and on Pat.” I put my arm around her, but that only invited more tears.

  “It’s okay, babe,” I said. “We just want you to stay healthy.”

  Dr. Rojas offered her a box of Kleenex. She pulled a few tissues and began dabbing her eyes. “It’s not okay, Pat,” she whispered. “I’m losing the kids. I’m losing you. I’m missing out . . .”

  I didn’t know what to do but pull her closer.

  “Mia,” Dr. Rojas said, giving her a comforting smile, “you are fortunate to have a supportive family. Your brain will heal itself with time.”

  By April, the second titration had come to an end. Dr. Rojas gave Mia a few weeks without medication before putting her on a small dose of fluoxetine. It was more commonly known by its brand name, Prozac, an antidepression drug that also had antianxiety properties. Mia wasn’t excited about taking more pills, but she was determined to avoid another setback.

  We reverted to our previous interactions, with Mia coming to me frequently for thought confirmation. I didn’t mind, and as Dr. Rojas had pointed out, the transparency helped us gauge her mental clarity. She was still having issues with paranoia and taking people too literally, but once again she was able to override her initial reactions.

  We knew the fluoxetine would take a few weeks to work, and we were both hopeful that it would add another layer of defense. But later that month, it became obvious that this new strategy wasn’t viable.

  I was pulling into my office parking lot after lunch when I received a distressing text from Mia:

  Something isn’t right

  I’ve never felt so depressed

  Her words glowed on the screen before me.

  Did something happen this morning?

  I waited impatiently for her reply.

  No, but this isn’t normal

  I feel really down

  I feel suicidal

  I stopped texting and immediately called. She answered quickly. Her day had been okay until a few hours prior, when she had started to feel depressed. It steadily worsened until she felt compelled to alert me. I kept her on the phone until I arrived home.

  For two years, we had been fighting mania, but depression had never surfaced. It was the main reason that a diagnosis of bipolar disorder was inappropriate. After discussing it with Dr. Rojas, he firmly believed that the fluoxetine was to blame; suicidal thought was a rare but well-documented side effect. Mia immediately stopped taking it.

  Thankfully, once she quit the medication, the depression rapidly subsided, and all thoughts of suicide vanished. I was astonished that a chemical could have such a focused and frightening effect on her brain. Anyone who thinks that mental illness is “all in someone’s head” has had no experience with these drugs.

  After that scare, we abandoned the part of the plan that involved more medication. Instead, Mia concentrated on finding natural ways to remove anxiety from her life. She started therapy again, and she experimented with biofeedback techniques and meditation.

  As the spring moved into summer, it felt like a repeat of the previous year. The old Mia gradually reappeared. Her diet returned to normal, and the additional weight melted off her frame. She gained energy and enthusiasm, rejoining the family and restoring her broken bonds with the kids. Will and Jamie accepted her overtures more readily this time around, the benefit of time and experience giving them a more mature view of the illness.

  But for Mia and me, something was different. Before, we thought that the worst was behind us and that she wouldn’t suffer again. Now, we knew that the illness remained, lurking in the darkness, and the only way to keep it at bay was sufficient sleep. For that reason, we became hyperaware of Mia’s nightly patterns. Our conversations revolved around how many hours she had slept or if she had woken up during the night. I didn’t know how she fell asleep at all with the pressure. She became well versed in valerian teas, melatonin, and other natural sleep aids.

  By late August, our house had returned to normal yet again, or as normal as possible given our constant vigilance around sleep. The kids were doing well in school, now in eighth and sixth grades, and Mia’s personality was fully restored. Our relationship hadn’t yet been mended, the intimacy still lacking. It was my fault. My defenses remained high. I wasn’t a husband but a clinician, watching my patient with concerned eyes.

  Then, in September, Mia woke me in the middle of the night; she couldn’t fall back to sleep. As we had planned, she roused me after lying awake for thirty minutes.

  “Okay, let’s do twenty-five milligrams of Benadryl,” I said. “That’s what Dr. Rojas would say.” She took the pill, and I waited quietly next to her in the dark, until she began twitching. It took over an hour, but at least it worked. We contacted Dr. Rojas in the morning.

  Forget the Benadryl

  Go right to Restoril tonight

  15 mg and then 15 mg if needed upon waking

  Keep me updated

  The pattern was familiar, the results devastating. We fought hard to keep Mia asleep, fought with medication and herbs, meditation and relaxation. Nothing worked. The Restoril kept her asleep for three hours at a time, if we were lucky. She and I both knew what was coming next; it was like watching someone drown in slow motion, but being helpless to throw a lifeline.

  Some weeks prior, we had arranged a dinner with my cousin Phil and his wife, Caroline. They visited three days into the new ordeal. Until then, Mia hadn’t shown any signs of paranoia or thought disorder, only a desperate and growing concern to sleep through the night. It all changed while they were with us.

  Phil, funny and entertaining, was telling a childhood story about breaking down in his old car with a high school friend. He was using phrases like, “We couldn’t get that car running to save our lives” and “We tried to jump it but that wasn’t working.” Caroline and I were following along and laughing, but my focus was on Mia. She was unable to find any humor in what he was saying. She didn’t mention anything at the time; she only sat and observed like someone trying to understand a foreign movie.

  When they left, and the kids were getting ready for bed, I confronted her. “What did you think of Phil’s story?”

  “Pat, I didn’t understand it,” she conceded, looking more confused than worried. “The car was broken down, why would that threaten their lives? And why would he and his friend want to jump over their car? It didn’t make any sense.”

  Dr. Rojas, already on high alert, didn’t wait any longer. We started the olanzapine and Ativan immedi
ately, and poor Mia started down the same dreadful path. Handing her the pills that night was heart-wrenching, like not only watching that drowning victim but throwing the anchor that drags her under.

  Mia was lost again to the overmedicated paranoia that had become her alter ego. I knew it would be weeks before we started to titrate the medication, and then we would head into months of living with the unhappy stranger. After that, we would witness a period of reemergence, the butterfly crawling out of its blackened chrysalis. Finally, the wonderful person that was my wife would reappear, and we would relish her presence for a few months. But then, like a monster slithering through the night, the illness would steal her away again.

  She was stabilized by mid-October, turned once more into an emotionally blunted zombie. Back at work, I arranged a call with Dr. Rojas. I wanted to speak to him without Mia overhearing.

  After providing a quick update on her condition, I launched into a necessary but unpleasant conversation. “Dr. Rojas,” I said, probably more forcefully than intended, “can you and I agree that this is not a onetime event?”

  Silence. I continued, “Look, I want to start this conversation by telling you how much I respect your expertise and value your partnership. You have been the greatest support to Mia and me over the past two years. And so please know that I am not passing judgment on you as a psychiatrist.”

  “I know you aren’t, Pat,” he responded softly.

  “Good, because we need you now more than ever. But this approach is not working.”

  “I agree. The pattern is becoming clear.”

  “Right.” I was thankful that he wasn’t clinging to his prior prognosis. “We need to figure this out for Mia and for the kids. She’s missing life. I can’t bear to watch it. And the whiplash is impossible for us.” My voice was breaking, tears beginning to form.