Saturday, January 16, 2010
On Doctors (Very Briefly)
I would think that for someone with your experience, it would be a very short leap to an anti-doctor position?
Agreed. And it’s a short leap I’ve taken often. But the trouble with short leaps is that they often lead off cliffs, or into swamps, or other places you don’t want to be. As sure as I am that the battery of phenothiazines and electroshocks I received did me substantial harm, I’m equally sure that the decades I spent shunning professional help, fearing the mental health system but also unable to help myself adequately, also harmed me significantly. For twenty or twenty-five years, I got by, barely...but I didn’t thrive.
That’s a long time not to thrive.
Often, when I read statements by anti-doctor, specifically anti-psychiatry groups, I find my reactions following a Yes...Yes...Huh? progression.
Yes to the horror stories (I’ve seen and lived them). Yes to the dismay at, the doubt and criticism of what psychiatry too often is. The Huh? comes when I get to the end of the article or website and there is no mention of an alternative person or organization I should contact when I am about to cut or kill myself, or am disabled by depression or hallucinations...or when someone I know is in these dire straits.
That is one thing that complicates the doctor picture.
Here is another: I have a wonderful psychiatrist at the moment. I trust her completely. Strange, yes, and sad, that it took me thirty-five years and perhaps a dozen psychiatrists before I could say that. But I’m saying it now. Better late than never.
Here’s another complication: Most of the people who harm you don’t mean to. May mean, in fact, to help you. But harm you nonetheless, because they make mistakes, don’t know enough...or because nobody, currently, knows enough. It’s hard to be robbed of a villain. It leaves you with no one to blame outright for your suffering. A doctor performed an unnecessary surgery on my knee when I was eighteen, removing a part of the joint that I needed. With each limping, progressively arthritic step since then, I’ve wondered: Did he know? Though at times it’s simplified things to think so, I don’t really believe it. He was doing his best as he saw it...and I happened to be there.
That is one of the hardest kinds of accidents to accept. And one of the most common.
Only the platooning system of medicine interests me now. Meaning: myself as my chief doctor, consulting other doctors as need be.
The more you learn about yourself, a subject that is endless because it is always changing, the better able you will be to become your own doctor. Not a replacement for the doctor you have, but a colleague, a partner for her or him. After all, you are the world’s foremost expert on your condition. What treatment could possibly succeed without your input? Assuming, of course, your doctor will welcome a colleague. And assuming, equally, that you are willing to shoulder some of the responsibility for your own treatment.
Become–and keep becoming–your own doctor. Since no one has all the answers, look carefully and critically for the best colleagues you can find. Consider what they have to say, and decide each case–all cases being your case–as best you can. Evaluate the results, and learn from your mistakes. Even the best doctors make them. So will you.
...It Exacts a Full Look at the Worst
“Where's the hope?” That question again. And I have to go to my lifeline, Thomas Hardy: “...if way to the Better there be, it exacts a full look at the Worst.”
All right, then, here is a little two-item inventory of the Worst.
1) As I’ve realized, this past year especially, there isn’t a corner of my life that hasn’t been affected, and to some degree disabled, by mental illness. Romantic relationships, friendships, family ties. Ability to work productively and consistently, even to hold a job. Ability to learn (it was mental illness, I now realize, that caused me to take 13 years to get my B.A., not, as I often told myself, boredom or stupidity or the need to focus on creative writing). And the most fundamentally disabling aspect of losing self-definition, self-identity, because the narrative of life keeps getting blown apart. Today is October 27. Will I be able to read and understand these thoughts on November 27? I hope so. I am on a new combination of drugs that shows promise; I really hope to avoid hitting those depths. I want so badly to keep working and living more consistently. I want to stop living part-time, and try it full-time. I’m ready.
2) I’ve been told that I am an unusually high-functioning example of someone with a severe bipolar condition. Despite the crippling depressions, the equally dangerous manias, the suicidal spells; despite all this and more, I’ve managed to keep my self-employment as a tutor for the past fourteen years, I’ve published seven books, I’m happily married, I’m blessed with rich friendships. “You’re a success story,” my doctor tells me...and I believe her.
But...what is wrong with this picture?
If I am the success story, the fortunate exception, what about the rule? What about all the others? You hear people say, “He or she has a mental illness, but it is well-controlled.” Or: “They’re all right as long as they take their medication.” But: What does well-controlled mean? What is all right? What is functioning? Functioning how? By whose standards?
It is only a personal sample, but listen to this: In my year and a half living on a psychiatric ward, I met many seriously ill patients: schizophrenics, manic-depressives, suicide survivors. Over the years, I’ve run into many of these people–perhaps two dozen of them. Not one of them–not one–has ever returned fully to the life they were living before they became so drastically ill. I don’t pretend that’s a scientific, or exhaustive, study. But doesn’t it give you pause? Doesn’t it make you think?
While I was writing The Lily Pond, I met two people I went to high school with. James and Callie, I’ll call them. Both wrote poetry, were bright and vivacious–magnetic people with a risky lustre in their eyes. Both were carried, literally kicking and screaming, into Emergency wards in their twenties, and from there admitted to psychiatric wards. This happened many times, throughout their twenties and thirties. Our paths crossed on wards and in outpatient services. Once I was the one who wrestled Callie to the floor and frog-marched her to ER–one of the most horrible things I’ve ever had to do, and one of the most necessary. I lost touch with them. When I met them again, two years ago, at a conference our doctors had pressed us to attend, they both told me they were doing well on their drug regimens. They hadn’t been hospitalized in years. That was the good news. The bad news, from my persepective, was: glassy-eyed, slow-moving people, whose lined faces and missing teeth made them look ten years older than they were; their poverty, working at subsidized part-time jobs and living in group homes; their obvious cognitive impairment, speaking in simple, gappy sentences and utterly disengaged from their previous passion for literature and art.
Which is higher functioning? A fast–too fast–living poet, whose dangerous mental states put her or him as well as others at risk, and lead to hospitalization..or the “walking shadow” of that person, who is never hospitalized, but lives within vastly truncated horizons? I don’t have an answer to that terribly complicated question. But I hope you’ll agree with me that it’s a question worth asking.
One more note on this very thorny subject. Health care workers, and others close to the patient, will often call mental fogging or memory loss “an acceptable cost.” But acceptable to whom? Let’s reverse the roles. A doctor comes to me in severe psychological crisis. I say: here’s a pill that will alleviate your distress, at the acceptable cost of memory and thinking difficulties, attention deficit, sexual dysfunction, and a certain numbness and disengagement emotionally. Still acceptable? Let’s say the doctor tries the drug, and finding herself unable to practice as a doctor on it, unable to tolerate the disconnect with others, elects to stop taking the drug and accept the risk of further disabling episodes. Is she irrational? Is she “non-compliant”?
This is why I’ve chosen–to the frustration of some who know me–to err on the side of risk, opting for a mild regimen that stabilizes a little while risking bad episodes...if I can still be me. I have to keep pushing the envelope, because a life in which I cannot write, cannot think clearly or deeply, cannot feel passionately, cannot connect with others emotionally or physically...this is not my life as I ever want to define or live it.
People say: What if you have to accept it? Well, if I have to, I’ll try to. Like anyone backed into an ultimate corner, I’ll try my damndest to make my peace with it. But I’ll fight to the last second before it comes to that.
If Way to the Better There Be...
“...if way to the Better there be, it exacts a full look at the Worst.” Thomas Hardy wrote that, in 1895. If you want to build a foundation for anything, including hope, you need first to take rock and soil samples from the place where you plan to dig. You need to know the ground.
In the service of trying to build such a foundation–a platform for hope–I’m going to share some soil samples with you tonight.
I felt apprehensive as the publication of The Lily Pond approached, in ways I never had with a book before. After writing and reflecting on the matters in the book for a couple of years, I felt I had made my peace with them; but I worried about what others would think and feel, especially others close to me. The anxiety became very bad; I had terrible nightmares. My fears were well-founded, but I had their direction backwards. Most of the people around me were supportive; I felt that some of my relationships took on new meaning and solidity by having this intimate subject now more in the open. What staggered me, however–I’m still reeling from it–was the realization of the extent to which manic-depressive illness has deranged, and continues to derange, my life. It was as if the book, along with talking about it afterwards, showed me the true dimensions of an adversary that, for my own protection, I’d only been able to see partially, in glimpses. I thought that, after decades, I knew all about it...but I didn’t. I know much more now. What I’ve learned has frightened and dispirited me...but also, through those blocks of black asphalt, sent a few new shoots of hope.
Here is an entry I wrote in my journal before the book was published: Bad dreams nightly. In the day without warning, smacked feelings of airlessness, of choking or being strangled. Hands to neck, chest. Dr. George [she’s my psychiatrist] says: “What you wrote may have unearthed a box. It may have been sealed for a reason...so you could keep functioning. Now it may be time to open it, or at least peek into it. Cautiously.” I still feel, often, that I’m strangling, or sinking and drowning. But I’m still peeking into that unsealed box. Staring at its contents. Looking, looking, looking.
Where’s the hope? A woman asked me that after one talk. I’d been discussing the ongoing process of recovery, how it involved successes but also fall-backs, downturns, slides; and she said: You say you’re better, but you also say you still go through terrible periods. Where’s the hope?
I answered her as best I could, but she still wasn’t satisfied. Where’s the hope? is a good question, and one that I’m trying to answer more fully tonight. It’s in the background of everything I say.
My first answer to her was: I’m here. I’m talking to you. You’re talking to me. Considering that it could have been otherwise, many times, for me–and maybe for you–that is no small thing. In fact, it’s everything.
But an answer like that won’t begin to equate with hope, or even the beginnings of it, if what you’re looking for is a cure, a final end to troubles. To some people, only that means hope. But I can’t conceive of any part of life being finally resolved; I don’t think I even want to. I can only think of hope in terms of continuous, evolving process: an ongoing experiment, struggle, dance...in which success is measured not by once-and-for-all victory but by incremental gains in understanding, strength, courage, grace.
I’m trying to learn to be a better dancer. My partner is the black bear of chronic, recurring illness. Its steps are savage and crude; it leads thoughtlessly. I really wish I’d drawn a better partner–but when the music started, there we were. My wife Heather has a similar partner, which makes for a crowded dance floor, the four of us waltzing awkwardly in our apartment. Thankfully, sometimes the the ugly and ungainly others take a break, and Heather and I have a slow dance by ourselves.
Where’s the hope? (She is insistent. And why shouldn’t she be?)
I’ve written a book, a memoir of mental illness. Starting four years ago, I sat down every day, before and after my paying job of tutoring, and tried to sort out my thoughts about a part of my life I’d never written down before. Not directly, though I’d touched on it in my six previous books of poetry, short stories, novels. All books are fundamentally hopeful, whatever their subject matter; without hope, no one would try to wrestle raw, chaotic experience into the coherent patterns of art.
Where’s the hope? Again I hear her question.
And again: I’m here. No one would grapple for nearly 40 years with an illness pulling him down, pulling him apart, unless he had equally strong allies (internal and external) pulling him up, pulling him together. Those allies include love, joy in life, and a strong and resilient spirit. They are not unique to me. Any survivor has them. And they are rightly to be cherished, as wellsprings of pride and constant renewal.
Where’s the hope, where’s the hope, where’s the hope?
All right, then. It’s in the process, hidden behind catastrophe. In going out...and coming back in. In falling down..and getting up. It’s in disaster’s classroom...if you’re able to attend.
It’s in yourself. And in other people. When you’re ready and able to meet them.
It’s nowhere if you’re looking for a cure.
It’s everywhere if you’re searching for a way.
When and where is it?
When it goes, nowhere. When it returns, everywhere.
But surely there must be some way to court it, encourage it?
There is. Stop looking for hopeful signs, and do one hopeful thing.
Thursday, January 14, 2010
Through the Lens of a Mood
People have asked me what role spirituality, what role God, has in living with mental illness? It is a fair question. If the mosaic of mental management has room for a SAD light, omega-3 pills, almonds, “the truth of and”...and umpteen other interventions... might not a Supreme Being be slotted in?
It might well. For a believer, I don’t see how it couldn’t be. But I don’t believe in a God. Not as “God” has ever been defined for me, and perhaps not at all, by any name.
(Perhaps “belief” is the problem. I’ve never believed in anything. I know things or I don’t know them. Take Santa Claus. I knew he existed, and then I knew he didn’t. Knowledge doesn’t require a leap of faith. I suspect the problem comes from knowing something that is difficult to put into words, or knowing something you expect others to doubt or disparage. Trusting that kind of knowledge may well require a leap of faith, or at least a credo that includes good manners: I believe my knowledge is valid, though I can’t prove it and can’t convince you of it.)
Still, I am no “just this-just here” dogmatist (that faith has never snared me either). I have my spiritual yearnings and intuitions, my cosmic or oceanic glimpses that will not fit under the rubric of the everyday explainable. And it is curious how they dovetail with the question “Now what?” as if to answer that imponderable with a commensurate vastness–or vagueness, some will say. Fair enough. Except that there is nothing vague about the comfort I have found in contemplating those vistas–like the inviting fogs in a Turner painting–where hard lines blend into permitting light and space.
And if this is mysticism, why would I deny myself the solace of the mystical (a solace tested true for decades) when I am willing to submit myself to a molecule turned on a chemist’s lathe? What the science of help must exclude–inscrutable aid; remediation by agents not yet, and perhaps not ever to be, explained–the art of help can welcome with a fine carelessness.
Squinting through the lens of that mood–
Now what? can't be less that the sum total of moments in a life, beautiful and hideous, extraordinary and humdrum...all that vast array of small, glittering tiles that make up the mosaic of a life. Amor fati, counselled Jung. And so did Nietzsche, who defined the Latin phrase this way: amor fati: that one wants nothing to be different, not forward, not backward, not in all eternity. Not merely bear what is necessary, still less conceal it—...but love it. Love your fate. Embrace it, however awkwardly or reluctantly. Clasp the actual, the torrent of lived particulars you swim in and that swim in you. That sounds like clutching at water–but what other choice is there for the omni-amphibian that is a human being? Sometimes it will mean grabbing mere air, other times it will mean contact with the earth: mud, sand, clean stone, fertile ground. And if we’re using the four elements of antiquity, including fire, sometimes it will mean being burned alive. And...hopping out again. As I have seen toads do from campfires built unthinkingly over the stone they were sheltering under.
Only this kind of openness–the curiosity and courage that lets you live in, and learn from, all the times of your life–permits you, as the late Kurt Vonnegut, Jr., advised, to “Bargain in good faith with destiny.”
What does that mean? I don’t know exactly. But I like the sound of it. I like the hope, and the sense (even if it is illusory) of cosmic comradery, parleying and wrangling with the unfathomable forces of the universe. It’s not something I can think about too long without my head swimming. But, of course, as you realize by now, I like to let my head swim. Even still...even after everything. It’s a proclivity that has led me into deep waters...and will again. Still, I can’t help marvelling at those little threads of destiny, pattern if not purpose you can tease out and examine sometimes, the only fractions of a great unseen tapestry we are permitted to glimpse.
Like the thread that connects me sitting down at a table three and a half years ago to try and write a story I’d never written before...which somehow, in some deeply mysterious way, led me to this room, to talking with you for the past 45 minutes. Writing brought me here, writing about mental illness. Which must mean, in some way, that that disturbed and bleeding young man in the emergency ward in 1977...brought me here.
I call that a miracle. Without overt religious connotation, but also without embarrassment, since I don’t know what else to call it.
And when I try to imagine, which is all I can do, the multiple branching paths that led each of you through the mazes, gardens and forests of your own lives to arrive here in this room–
Well, I know that also is uncanny. A strange and wonderful set of convergences lies behind every meeting. And though I can’t call it an end without contradicting everything I’ve said here today, I am happy to accept as a point of pause that genuine miracle.
“Now what?” is a question you hear often in discussions of mental illness. (You hear it in discussions of any difficult problem.) Now what?, or its inversion, What now? I understand the impulse to ask it. A life has come unglued, fallen apart–your own life or that of someone close to you–and emerging from the hospital ward or the doctor’s office, you would very much like to have all the helpless looming uncertainties resolved into definite causes and cures.
I understand where the question comes from, but as a question, it either makes perfect sense or no sense to me.
As a question about what to do now, i.e. of the best next step, it makes perfect sense. In that form it is the necessary question the car mechanic or cook or surgeon asks many times every day. I’ve done steps 1, 2, and 3...Now what? This is one of the best mental health questions to ask, since no matter how bad a crisis is, there is always something–an action to take, a circumstance to adjust–that will make the situation better or worse. Often, the patient knows exactly what this is (turn on/turn off a light, eat a favourite food, take a walk, take a nap, talk with someone, talk with no one and lock the door...). Curiously, though, this first form of Now what? gets asked too seldom. In the frantic search for Cure, we bypass help. Peering into the distance for Help, we overlook the many small helps at hand.
Now what? in its second form is partly to blame. Like all ultimate questions, it refuses to divide the Grail of the big answer into smaller, more local quests. Now what? in the large sense means: How do we solve this problem once and for all? (i.e. Make it go away.) This is understandable. A trunk of horrors has appeared in the living room, troubles spilling out from its gaping lid. Now what?! Now what?! Yes. But the least effective way to unpack a trunk, or close its lid (even temporarily), is to wish the trunk would vanish.
Second form Now what?–ultimate Now what?–makes no sense to me. Which doesn’t mean I don’t waste time on it. But I give it less time than I used to. In fact I have been helped precisely to the extent I have been able to take What now? angst (Where is all this leading to? What will become of me? What does it all mean?) and break it down to What now? approachables (What might I change? What helped the last time this happened?). It is transferring the dread of fog to the search for road signs, landmarks, and places to pull over.
The Lily Pond supplies many details about both kinds of Now what?–details horrible at times, hopeful at others–but it can’t supply a beginning and an end that are not in sight. (Beginnings and ends are typical second form imponderables.) In “Hunters in the Snow,” the second section of the book, I track back from my fiftieth birthday party through childhood memories, finding evidence that things were going awry for me psychologically–“sliding out of focus” as I said in one interview–many years before I officially began my psychiatric career at age seventeen. But no matter how much attention I train on it, eventually the trail peters out, becomes invisible in the forest. As I write at one point: These things begin with such branching subtlety, twining tendrils of the new around old roots and branches, that there is no way to pinpoint their origins–not at the time, and not even in retrospect. Not until the process is sufficiently underway do you spot an outgrowth, a flower–a symptom. And deepening the confusion is the fact that what is new seems like a thing–not me, not my life–and yet it is a thing that can only grow and express itself through a life, mingling inextricably with it. You may feel that something is subverting your will, betraying it–and something may in fact be doing so, if what you mean by your self is your self-in-health–but if so, the invader can only work by annexing your will, working through your will. It is a stealth attack, to which most of the incestuous terminology of modern warfare applies: diplomatic maneuverings, pressure points, secret cells, covert agents, sleeper agents, terror tactics, propaganda, appeasement; most importantly, resistance and collaboration.
Causes are hard, at this point impossible, to pinpoint.
Is it in the genes? It must be, partly. Which puts the beginning where? Some day or night in November, 1954, when I was conceived? The day William Barnes and Mary Green first set eyes on each other? A mutation long ago, on the savannahs, that allowed for too much mobility of mood, too much permeability of perception–the proverbial “loose wires...loose screws”–but which somehow compensated its possessor for these perils with...with what? With a survival advantage of some kind, however slight? Or with a disadvantage that, while trying, wasn’t fatal? As I said, the trail, though fascinating, grows fainter and fainter, and peters out.
So, in true bipolar fashion, I’ll switch abruptly to the end, which I’m afraid isn't definitive either. In fact the first comment my publisher Dan Wells made after reading the manuscript was, “It doesn’t end.” His tone of voice told me he wasn’t voicing a criticism, but rather an essential truth about the story. An ailing mind is not something like a broken car, which can be either fixed or scrapped decisively. Or even a physical problem like a toothache, which again can, and will, be resolved one way or the other. Mental illness, like life itself, is a whole complex of intertwined challenges, which can only be met and managed, grappled with, more or less successfully, with success being measured not by absolute or even continuous victory, but by small, incremental gains in understanding, workable strategies, and a certain grace, hard to define but certainly including humour, about dancing awkwardly with the black bear of chronic and recurring illness. That is not everyone's idea of hope. But to me it is hope real and tangible. Light visible, to invert John Milton’s and then William Styron’s phrase.
Writing The Lily Pond, I felt frightened as I neared the end. Frightened because I was writing, in the last section, of my wife Heather’s mental illness as well as my own. Now we were, officically, two mentally ill people struggling together, which at its best feels like two old pros who know how to prop each other up, and at its worst like two drowning swimmers flailing towards the bottom. All of these things were in my mind, forty years of illness as I wrote, and who knows how many more to come, and I thought, fearfully: How will this end? Because I knew I would write down honestly what I felt, not fudging. So I was greatly relieved to find my way to a moment of hope, which I recorded as the book’s last sentence. I was glad, though not, on reflection, surprised. No one could go to the bottom as often as I have, and return, without a strong and resilient love of life. No swimmer would kick that hard against the tide unless he loved the land and wanted, desperately, to stand on it again.
But to hope, in flood times, to stand on land perpetually? Isn’t it much–isn’t it enough–to say: I swim much better than I used to. I find my way to shore more often.
Tuesday, January 12, 2010
Zero and Back
Which brings me back to my United States of Self, the Continuity Clause I started with...and to why the frog, that symbol of a resilient traveller between elements, is such an important image in The Lily Pond’s last section. Multiple and often conflicting selves are a reality for anyone, not just someone with a diagnosed mental illness. For anybody, on any path, it is true: Parts of you are leaping ahead, parts are lagging behind, parts are stuck in the mud, parts are fleeing in the opposite direction. Ignorance of all these different momentums or, worse, denial that they are occurring, will only hinder your ability to find the direction you need and are capable of taking now.
Only by granting legitimacy to the very different states, purposes and abilities that are known collectively as “I,” can a united self–a republic, if you will, of recognized selves, each with its rights and limitations–be made possible...and a pace be found, variable and humane, permitting that manifold self to move and act in the world.
The smoothness of that phrase may make it sound easy. That is the peril of rhetoric. It is not smooth or easy. It is the hardest, most necessary, thing I know.
I’d like to close by reading two passages from The Lily Pond that illustrate what I’ve been saying here today. The first is short and is quoted on the back cover. I have been there and come back. Come back partly, at least. Return is possible; the door swings both ways. This gets at a paradox I’m learning more about each day. If your view of yourself is elastic enough to allow for downtimes, backslides, failures, even breakdowns–not only are you more likely to get back on your feet after these setbacks, but–and this is the truly magical part of the paradox–you are even less likely to get knocked down in the first place. “The door swings both ways.” You can more easily go out a swinging door, but also more easily come back in. Knowing there is such a door may even mean you don’t need to use it.
Another, longer passage from near the end of the book uses the example of the wood frog to explore this tolerant truth of out...and in. Down...and back up again. The passage is from the book’s last section, called “The Lily Pond,” where the main focus shifts to Heather, as she survives a mental health crisis and is diagnosed herself with bipolar disorder. After a siege of several months, exhausted, we took a cautious week’s vacation in a rented cabin on Lake Temagami.
The television, which we spurned at first, comes in handy after all. Scrolling through its channels, which number into the hundreds, is a good antidote when Heather becomes jittery and tired in the evening, a pattern from home that now resumes despite our lengthy sleeps. There is a lot of channel-scrolling to find a few interesting, and a couple of absorbing, programs. The most absorbing is a documentary on the wood frog’s hibernation. Heather calls me from making dinner to watch it with her. We know, from our book at home, of the astonishing ability these northern frogs have to manufacture glycogen in their livers, turning their blood to a kind of sugary antifreeze that allows their bodies to freeze solid through the winter and then unfreeze safely in the spring. It is one thing to know this; it is another to watch it happen. A scientist in a white coat puts several wood frogs on a tray and places the tray in a freezer. [I recoil from this a little,] but despite his clinical procedures the scientist seems a true and kindly enthusiast about the frogs. There is a video camera in the freezer. As we watch, the frogs’ breathing slows, and slows, then finally stops. Frost crystals cluster, coating them all over, including their eyes, which stay open. The scientist brings them out of the freezer, picks one up and flicks it (again that aversive prickle), then bobbles it in his hand: hard as rock. But in the tray left out on the table, the process has begun to reverse itself; in time-lapse photography, compressing several hours into minutes, we see the ice crystals melt and slide off; the skin soften in appearance, becoming less brittle and more rubbery-looking; one frog, the fastest thawer, draws a breath, a twitch in his small side; after long moments, another breath; then other frogs are breathing, small sides lifting and falling; finally, one makes a small hop. Alive.
Down to zero–close to it–and back again. Neither of us says a word. There is nothing to be said; we saw it.
On our last day, we take the last sections of our watermelon in a plastic bag and paddle to a quiet bay we visited before. Heather turns around in her seat to face me and we drift in the deep green shadows of the pines and cedars, eating pink watermelon and dropping the gnawed rinds into the bag. It is a moment of perfect restfulness, and it ends with a perfect, miraculous discovery. We have seen only one frog up here, a large leopard frog that hopped away once as we landed the canoe. The nights have been cold for late August, a few aspens already tinged with yellow. But today, when we stop on shore to stretch our legs, I see movement in the pine needles at my feet. I am a few moments spotting the small frog, his browns are blended so perfectly with the needles and rock and lichen. I put down my hand and trap him easily; he barely squirms inside my fingers. When I show him to Heather, parting my fingers to let his upper half pop out, then pinning him gently by the legs, we are amazed to see that it is the wood frog from the TV documentary. His black, robber-mask eye markings cinch it. It seems providential somehow, a sign, and standing on the rock admiring then releasing him–he hops away unhurriedly–we are both too moved to speak.
Heather, who has paddled in the bow all week, suggests that she try paddling us home herself. She stays facing me and begins moving us homeward, awkwardly at first, unsure of her steering, having to switch from side to side, but then strongly and more steadily, smiling with shy disbelief as her J-stroke returns to her. It is wonderful to watch; and hard in a way, too. Mental illness–meaning, here, the diagnosis and treatment of it, especially–is working against her confidence, implanting radical doubts in her about her basic capability. It is one of the reasons I feel so strongly that hospitalization should be avoided except as a last resort. If diagnosis means that one is being considered seriously for a position, then hospitalization is confirmation that one has got the job. And it can be a hard position to leave; it can easily become a career leading to retirement, and beyond.
Heather, after a break of many years, has gone back to school this year. This school: U of T. She is picking her own way along the learning curve, as everyone must. She doesn’t need to be reminded of what I’m saying here today as much as I do. In fact, though I said before I had no wish to advise my younger self, it’s not really true. I do in fact sometimes travel back in time to counsel him. He isn’t very inclined to listen–that hasn’t changed–but that no longer deters me from sharing with him what I’ve learned. What I tell him is a sort of footnote to Polonius, that off-and-on pedagogue ironically prone to forgetting himself. His admonition to Laertes as he returns to school, runs, in my amended version, like this: To thine own selves be true. Honour the people you were and will be, not just the person you are today.
Know Thy Selves
“Know thyself.” Everyone has heard the ancient Greek injunction, inscribed in the forecourt of the Temple of Apollo at Delphi. For all its wisdom, though, I still think it could be improved. It presumes, in its singular pronoun, a stable and consistent identity, when in fact identity is malleable and multiple, a condition of flux which must be constantly updated, even renegotiated. “Know thy selves,” I humbly suggest, would be a more humane and practical credo.
Something I remained ignorant about for a long time, for example, was the fact that my periodic inability to read–words, these things I loved, going dead and blank, their sequences fuzzy and meaningless–is a common symptom of depression, and doesn’t at all betoken apathy or lack of intelligence. Or at least not permanent forms of those things. What it may mean, though, is a temporary impairment of interest and cognitive ability. And there are far better ways to deal with that than simply dropping out of the life one wants.
Like what? you may be thinking. What are you supposed to do if you find yourself bottoming out just when you need yourself most? Unable to read–but an exam coming up? Unable to write–but an essay due? I can think of some practical approaches to these problems, but outlining them would take us too far astray in a short talk. And I would be the last person to say that these are not serious problems, serious threats. Fluctations in mental health still threaten my job and my personal life; they’re a minefield I am always trying to pick my way through. I have no wish to travel back in time to advise my younger self: he did the best he could, what he had to do, then. But I know a couple of things he didn’t. One is that hiding a problem–from yourself and from others–usually takes more energy than trying to manage it. Coming out is almost always a good idea. What I hope I would do now, when I felt myself slipping, is to approach someone I trust with the facts: I want to do this (finish my course, write my exam, hang on till tomorrow), but for some reason I’m unable to. I need help, something to get me through this. That would be a start. Not a solution yet, but the only sure step I know towards finding one. I don’t say it is an easy step to take.
It seems strange that my eighteen months on a psychiatric ward in my early twenties had not begun my education in these matters. That tumultuous passage had schooled me in many miseries, fears and self-doubts of every kind, but it had not taken me very far at all in developing a practical awareness of myself, how I had changed, and how I might get on with my life, given the fluctuating and rather fragile (though at the same time newly toughened and robust) creature I now seemed to be.
Strange...or not so strange. Many medical mishaps–including a misdiagnosis of schizophrenia, zombiefying tranquilizers, many electroshock treatments and a near-fatal overdose–had given me good reasons to drop out of the standard curriculum of mental health. Again, though, I was an extremist: I shunned the mental health system completely for the next decade, which included some of the lowest and most pointless wandering in my life. Some kinds of learning occur only slowly, in tiny increments. No matter how successfully it is managed, trauma takes time. Time to occur (since it occurs in waves, even if one event precipitates it)...and a long time to come back from. Long, slow time is usually not on offer in an age that idolizes speed and a narrowly defined functioning. These idols of quick-time get stamped out crudely and worshipped thoughtlessly. And is it perhaps yourself–your image and expectations of yourself–that have helped to mold this unforgiving deity? Just because what you need isn’t on offer–or doesn’t appear to be–doesn’t mean you can’t ask for it, claim it. A system may function badly–many do–but it can’t function better than we ask it to. Demand it to. And: permit it to. “Time heals,” we say, but do we act as if we believe it? It takes courage to trust time–the courage to wait and see.
After that, of course, comes the challenge of admitting what you see, and finding room to accept it. Several times each year I still experience what I call my “shut-downs.” These are the periods that have taught me how far beyond sadness depression really goes. In these dead zones my brain and body and spirit–my whole self, really–become, in stages, unable to comprehend or respond to the world. It is a lot like that famous scene in 2001, when Dave Bowman unplugs HAL, and the computer disappears circuit by circuit–busted right down to his programmed origins of “Dai-sy...Dai-sy”–though by that time I have long since lost the urge to sing. At such times I’ve learned to apply what I call the small-circle cure. This means reducing activity and stimulation to a bare minimum. Dimming the lights, unplugging the phone, cancelling social engagements. And, as I feel my ability to think in sequence ebbing away, scaling my reading down from the love life of Anna Karenina to the love life of Britney Spears...and then further down, to just flipping through books of pictures or watching reruns of The Sopranos. To return to the idea of functioning: Someone seeing me lying on my side for hours beside a single lamp, flipping pages of Rolling Stone or People, might see a very low order of functioning...and it is, in a way...but it is a much higher order of functioning than I showed in the years when I tried to keep reading and writing through these spells, which can last six weeks or more, and added terrible frustration to depression when I could understand nothing, produce nothing. Self-acceptance, I’ve come to see, involves a better understanding of one of the simplest words: and. I am a person who reads, and writes, challenging books...and I am a person who, at times, cannot read or write the simplest sentence. The two facts are not mutually exclusive; they mustn’t be, since I’m living both of them.
But that little word and can be a terribly hard word to remember. A major part of my ongoing recovery, including the therapy I do with the excellent psychiatrist I have now, involves trying to remember the truth of and. As I said earlier, there is a degree of amnesia to my condition, so that every time I lurch upward into mania or downward into depression, it feels like the first time, and I lose all memory that I have been here before and gotten through it. Retaining a thin thread of memory, enough that I can say, “I know this place; I was here before, and I left again,” is one of the most important gains I’ve made in recent years. It’s a lifeline to cling to, a thread to guide me out of the labyrinth.
I learned all this again just last fall. Ironically, after my book launch in October, and at the talks I gave subsequently, some listeners said to me, “You seem well now,” as if all the troubles I was describing were safely behind me. “I do feel well,” I said, “...now.” But I could tell they didn’t believe me when I said I knew bad times would return, times they, and even I, could scarcely imagine. Sure enough, within a month, I was floundering, slipping into a netherworld of sleeplessness and incoherent thoughts and depression and even hallucinations. I could barely understand the book I myself had written or the talks I had given about it. But while I felt myself slipping, while I still had time, I did a useful, practical thing. Using what few verbal resources I had left, I wrote myself a letter, a sort of “message in a bottle” from my still-hanging-on self to the unwell self I felt gaining on him. I taped the letter to the wall beside my desk, it is still there, and read it often in the next two months, feeling disbelief but also comfort at its assurances that I had gone to this black place before and had returned from it. I wanted to read it as part of this talk, but it is a little too long. “Letter to Thursday” is a frank and simple statement from one self to another, saying in essence: I know you, even if you don’t remember me. We are in this together.
“In this together” is a sentiment alien to the depressed person, since a feeling of utter desertion is at the core of the predicament. One is abandoned by joy, by purpose, by energy...by others, by the world, by life...by oneself. The last is the harshest turning in the lock. Losing this first advisor, ally, friend–this best angel, truly–confirms that the ship has indeed been abandoned and must inevitably go down. Without this “other” there is no self–only a cave where someone used to live. Heaing no word is having no word. Getting a letter, a postcard, a murmur, on the other hand, is evidence that desertion may not be absolute, or at least not final, since somewhere your self-in-health is still speaking.
The Continuity Clause
(This passage and the two that follow it are taken from “On and Off the Learning Curve: Notes by a Bipolar Student,” a talk originally given at the University of Toronto on March 11, 2009. To preserve a closely woven argument, it has been necessary in places to repeat material from previous talks. I have shortened or reworked these sections where possible.)
Seven weeks ago, I, along with millions of others suffering a long-term malaise, was given a strong antidepressant. The treatment included watching chopper blades lift George Bush out of sight, and watching and hearing Barack Obama sworn in as the U.S. president. Many of you will remember this vividly, I’m sure, especially if you were a fellow sufferer. Like all treatments, though, this one had its unwanted side effects, one of which was exposure to potentially toxic levels of rhetoric. That same day, I heard a commentator gush: “It’s a brand new country!” Immediately, this was contradicted by a colleague’s more sour view: “It’s the same old place.” Which was true? I wondered. And I decided they both could be. It’s the same old, brand new place.
And within a few days, influenced no doubt by the ceremony to the south, I wrote the following, applied to a person instead of a country. I call it “The Continuity Clause: Amendment to the Constitution of the United States of Self”:
“I” shall still be considered “I” in spite of lapses or contradictions in the behaviour of myself or the partial or complete disappearance of myself for whatever duration and for whatever reason.
So help me...anyone.
What does this have to do with a book on mental illness called The Lily Pond: A Memoir of Madness, Memory, Myth and Metamorphosis? Everything, really. A core theme in the book–addressed both explicitly and implicitly–is the existential conundrum of how to maintain a self and a life, when that self and life are subject to regular and radical disruption. How does chaos become continuity? The answers to that very big question, which I can only begin to suggest, have, I think, a special relevance to education.
The Lily Pond has four sections, which are like concentric rings. I imagine them sometimes as the ripples set up by a frog jumping into a still pond. They might also be seen as a series of lenses, with each lens offering a wider view of the subject. The first view is a close-up of a patient in crisis, me; the second, of the patient’s family, companions and fellow sufferers; then, moving further outward, a view of living in the wider community as a writer and a participant in psychotherapy; and finally, to caring–trying to care–for my wife Heather as she survives her own mental health crisis. The last view, though it involves many close-ups of each of us and of our marriage, is the widest view because its focus is on trying to make use of illness, trying to turn its hard lessons to some positive and outward-facing account.
The book’s four rings, then, move gradually outward from isolation and passivity–lying motionless on a hospital bed–to a life shared with others, including shared illness. They chronicle the journey (as the back cover says) “from the darkness of unconscious suffering to the daylight of mindful recovery.” What I mean by mindful recovery is not a cure–nothing so final or triumphant-sounding. It is more like tugging recurrent problems into better light so they can be worked on, coped with, managed. This is a long, indeed endless process. Ongoing active awareness is what I mean.
I also think of these concentric rings in another way: as my own story of mental illness, inside the larger story of mental health, which in turn fits inside the much larger story of existence and its challenges, for some of which we use the shorthand “mental health.” The story in The Lily Pond spans four decades. There are mentions in it of my stop-and-start university career, but that’s not described in detail. I’d like to look at it a little more closely now.
I got my Honours B.A. on the 13-year plan. I started in 1973 and graduated in 1986. While I have nothing against gradualism, it’s not a schedule I would recommend to anyone. You see, I was never a part-time student, but rather a full-time student who kept being forced to drop out. Interruptions to my course of study included those eighteen months on a psychiatric ward, working (after my discharge) as a dishwasher for two years, stints of unemployment and short-term jobs, all of this in a series of rented rooms–a “tumbleweed life,” I called it once–before I decided, at age 30, to complete the last year of my degree which had stalled at the three-year mark.
Why did it take me so long? And what, since I call the interruptions “forced,” was forcing me?
There’s more than one answer to that question. But the main reason, I think, is one that eluded me for many years; in fact, it was not until fairly recently that I fully acknowledged it.
Mental illness. Plunges into listless or agitated depressions, followed by equally destabilizing flights into rushing manias. And–far more damaging than these swings themselves–my bewilderment about what was happening to me, which led me to ascribe my swings to other, misleading causes.
Here is what kept happening. I’d start a school year with energy and enthusiasm–attending lectures, doing the readings, getting good marks...learning–and then at some point–usually in the late fall or spring, though it was not strictly seasonal–I would simply bottom out. Lose interest in the classes and the readings, start falling asleep over books, have trouble following a line of argument or even a sentence...and I would think: Why am I here? I’m not interested in this stuff. Or: I’m not smart enough, I can’t do this. (Forgetting–for depression has its characteristic amnesia as well as other forms of inattention–that only weeks or days before I had been smart enough, interested enough.) My reading and attendance became spotty, my work and marks trailed off...I dropped out. Usually vowing never to return.
Looking back, I see that what I was mainly lacking, to pursue my education, was not intelligence or desire or diligence, but self-knowledge. I was not well enough acquainted with myself, and not forgiving or understanding enough of those parts with which I was acquainted, to succeed in school. I needed to educate myself about myself before I could educate myself about anything else. Or at least–since the processes should occur in tandem–I needed to be learning about myself while I was trying to learn about Geoffrey Chaucer and John Milton.
Like generations of bad students before me, I aspired to speak passably well about lives and minds and relations in worlds remote from my own, and to do so I turned exclusively to textbooks and experts, disdaining the materials nearest to hand: my life, mind, and relations in this world, now.
Monday, January 11, 2010
My Medic-Alert Bracelet
Dear Mental Health Professional:
If you are reading this, I assume it is because I am not in my right mind and someone has directed you to this page. Unless you believe that my long history of mental illness renders my advice useless, I hope you will take a minute or two to read these instructions which I have set down while of sound mind. They are too long to put on a bracelet, but brief nonetheless. They could save us both a lot of time, and grief.
Sedation is likely a good idea. I am sure that before I landed in your emergency ward, my sleep had been dwindling to three, two, one, zero hours a night–possibly for a long time–so that my most pressing health problem is extreme exhaustion. It might even be the principal cause of many of the symptoms confronting you. Let me sleep as much as possible for two or three days. Make no attempt, or as little as possible, to hurry me back into a “normal” routine. I don’t need normalization as much as I need sleep.
When my brain and body have rested a little, ease off on all drugs to take a look at my baseline condition. I have come back spontaneously many times from where you see me; try to get a read on my ability to do so now. If my frame of mind is even halfway reasonable, give me some time–a few days perhaps–to see if I can restabilize on my own. Allow me to spend the time quietly, doing little or nothing, with as little contact with others as your facility will permit. Resist the urge to intervene. It is tough, I know, to feel that “standing by” is legitimate treatment, but it is sometimes the only legitimate treatment.
If you feel you need to begin a course of drugs, do so extremely cautiously. I am a slow metabolizer of drugs, so it is best to start me at a half, a quarter, an eighth of what you are used to thinking of as the normal therapeutic range. Trust me: if the drug you prescribe can benefit me, it will do so at a far lower level than its manufacturer recommends; and if it can harm me, it will do so rapidly even at low doses. I have thirty-five years of drug disasters to attest to this. Start small, and advance in minuscule increments. Continue mild sedation so that my sleep schedule is maintained.
As soon as I am even halfway stabilized, ask me what further course I would recommend. I realize this may be difficult in front of your colleagues; do it in private if it helps. I have been through this many times, and have a wealth of suggestions about what could help and what will definitely not. Seek my advice, and I will be more likely to seek yours. Each of us has information the other needs.
Do not panic. Try especially to avoid the type of panic that calls itself “aggressive treatment.” Remember that the patient in your interview room (or on your examining table if I have hurt myself physically) is the same person who wrote these notes. The note-writer will return faster if you follow the steps above, and the faster he returns, the better the chance that he will remain. He is the best colleague you can hope for.
Trust yourself. Try to trust me. And good luck, for both our sakes.
Friday, January 8, 2010
The Truth (and Trouble) of and
Again and again I come back to it: the truth of and. It is such an important truth that sometimes I think I will be well precisely to the extent that I understand it. Meaning know and live it...down to my bones.
I once won a literary prize, and part of the judges’ citation stuck with me: “acceptance of puzzlement as a natural state of mind.” With a couple of adjustments it could stand as the truth of and: “acceptance of contradiction as a natural state of life.”
Substituting and for but, though, either...or, or any of the binary exclusions that occlude our daily language, works wonders. Try it. I am a hopeful, happy person and (not but) I am often sad and listless. I am energetic and ambitious, and (not though) quite lazy. I am loyal and disloyal (not either/or).
Why force a great, wandering river into canals?
But that little word and can be a terribly hard word to remember. I learn it and forget, practice and neglect. Over and over, I slide from inclusion and acknowledgement (not blanket acceptance: I can acknowledge a part of my nature and work actively to change it) to exclusion and denial. I try and convict myself in the Court of Either-Or, and hear Judge One-Way (me again) pronounce sentence: You must be one thing or the other; you cannot be both.
I learned all this again just last fall. Ironically, after my book launch in October, and at the talks I gave subsequently, some listeners said to me, “You seem well now,” as if all the troubles I was describing were safely behind me. “I do feel well,” I said, “...now.” But I could tell they didn’t believe me when I said I knew bad times would return, times they, and even I, could scarcely imagine. Sure enough, within a month, I was floundering, slipping into a netherworld of sleeplessness and incoherent thoughts and depression and even hallucinations. I could barely understand the book I myself had written or the talks I had given about it. But while I felt myself slipping, while I still had time, I did a useful, practical thing. Using what few verbal resources I had left, I wrote myself a letter, a sort of “message in a bottle” from my still-hanging-on self to the unwell self I felt gaining on him. I taped the letter to the wall beside my desk, and read it often in the next two months, feeling disbelief but also comfort at its assurances that I had gone to this black place before, and had returned from it. I wanted to read it as part of this talk, but it is a little too long. “Letter to Thursday” is still taped to my wall, waiting for when I need it again. It is a frank and simple statement from one self to another, saying in essence: I know you, even if you don’t remember me. We are in this together.
Still, a real and practical difficulty posed by “the truth of and” is planning. Planning requires a committment based on some assurance about who you will be in the future, so it relates to that difficulty of maintaining a reliable storyline of self and life. I think all of you will know what I mean. When I was asked to come here today, I was just emerging from a bad depression. I had to perform a familiar calculation, a kind of guesswork, i.e. if I’m a little better now, will I be better enough by then? What if I’m not? Future planning is really tough with a mood disorder. How do I plan for an event 2 weeks, 2 months, 2 years from now–when I don’t know who, what version of myself, will be present then? In practice, this is not an easy problem to solve, but in theory at least I have developed a simple approach: Say yes to whatever seems reasonable now, but allow yourself the option of backing out if necessary when the day arrives. When and if that happens, telling the truth is preferable–overall, I’ve been greatly helped by being more open about my condition–but don’t be too hard on yourself if, in an imperfect world, where intolerance and misunderstanding and stigma are all alive and well, circumstances force you to lie, and instead of “I can't make it; I’m in bad shape mentally,” you say “I’ve got the flu,” or “I have to work,” or “My car broke down.” Metaphorically, they’re all true, after all: you are sick, you do have to work (on yourself), and your vehicle (you) needs maintenance in the shop.
I tell the truth when I can, and lie when I must. (Unless it is it the other way around...)
Needles and Haystacks
About drugs I only have one thing to say. It is a very recent insight, but it offers a glimpse into a wealth of possibilities. It’s not about drugs per se, but about dosage. Over the years, I’ve tried a huge spectrum of drugs–from phenothiazine tranquilizers to antidepressants to various mood stabilizers–but all of them, even the ones that seemed to help, had side effects I couldn’t tolerate. So I’ve become very wary of drugs. My psychiatrist doesn’t push them–“I’m here to advise; the decisions are yours,” she says, which is one of the reasons I trust her–but she does sometimes suggest, especially when I get backed into a particularly bad corner, that there might be a drug that could help. Last fall, I got backed into such a corner and she suggested quetiapine (or Seroquel, its brand name). But when I tried it, at the lowest standard dose of 25 mg, it zonked me out so thoroughly and for so long–the familiar “zombie” effect–that I realized I could not possibly function in any normal way on it. An hour after taking it, I was drooling (literally) in front of the computer screen. I lurched down the hall and collapsed into bed, coming to hours later with a brain like wet burlap.
I cut the pills in half, then into quarters; though better, it still knocked me too far under. So I dropped the trial. But Dr. George happened to mention that she knew a couple of people who were helped by extremely small doses of this drug. And then Heather’s doctor said the same thing, that she’d heard of people who were aided by a mere “whiff,” as she put it, of quetiapine. So Dr. George wrote me a prescription for 1 mg–we would start from that baseline. The trouble came when I tried to fill the prescription at Shopper’s, only to be told by the pharmacist, very insistently, that the lowest dose sold was the 25 mg tablet and it was unobtainable in 1mg strength. “But that's the prescription my doctor wrote,” I said, pointing at the slip. “You might try a compounding pharmacy,” he muttered, then looked past me and said, “Next?” To make a long story short, in all of Toronto I found only two old-fashioned compounding pharmacies who could make up the prescription in the lower strength. I have been trying it for a few weeks now...it shows promise. But my point is (or rather, my two points are): 1) Cui bono? Who stands to gain if drugs are only sold in higher-strength amounts? You don’t have to be a conspiracy theorist to see that drug companies would not want it widely advertised that minute portions of their brands might help some people. Would any drug seller want it known that some buyers got by on a “whiff” of his product? Would he want to pay for the tests to discover such a possibility? 2) Which of my many failed drug trials over the years might have stood a chance of success at a dosage of one half, one quarter...one sixteenth...of the normal range? A “tincture of this, a tincture of that,” as the old saying went.
A bit of this...a bit of that. Even tiny pieces can have an important place in the mosaic.
Dr. George tells me that one thing that has changed for the better about psychiatry–at least with good psychiatrists–is the understanding of how variable the optimal drug dosage is for different people, and how some patients may be helped by very small doses. Naturally this is not something the drug companies are eager to admit, and you often have to dig out the information yourself and insist on it. Also, more is now known about the very different rates at which people metabolize drugs. It is clear now that I am what is known as a slow metabolizer. Despite my large size, I absorb the psychiatric drugs very, very slowly, so that a little goes a long way with me. For instance, Heather is only two thirds of my weight, yet she easily tolerates, and needs, more than twice the dose of one drug that we are both on. This helps to explain some of the drug disasters I experienced on and off wards, when the “normal therapeutic range” was administered to me and it knocked me flat or sent me reeling. And it is why I combine very small doses of things–pieces of “the shifting mosaic”–to try to find the right overall treatment program.
Now it is a year and half later, and that 1 mg of quetiapine has inched in tiny stages up to 5 mg, which seems to be the dose that helps without hampering me. Still one-fifth of the recommended starting dose. For the moment, that piece of the mosaic is in place. But another that showed promise has fallen out. Last July I started on 5 mg of celexa–one quarter of the standard therapeutic dose–to address the intractable depressions which have become ever more frequent and severe. We proceeded cautiously because of the danger that any antidepressant will kick a bipolar patient up into mania. The 5 mg gave me a helpful nudge, but soon I needed more. Upwards...slowly. 7.5 mg, 10, 12.5, 15, 17.5...all this over a three-month period...and finally to 20 mg. Good. For a few stable, productive weeks. Along the way there were side effects, but these were manageable and lessened with time. But then the serious side effect of akathisia developed, and worsened rapidly. Akathisia tormented me so relentlessly on the psychiatric ward that the very word is horrid to me. Its agony is indescribable except by metaphors: imagine a brush fire along your nerves and muscles, which can’t be relieved by scratching, clenching, kneading, pulling, tearing, squeezing, or pummelling (all of which you’ll try; along, perhaps, with throwing yourself at walls or floors; I was one of many on the ward stitched and bandaged for that); only vigorous activity lessens the inner burning, for a few seconds; then it catches again. Sufferers go vacuum-eyed fighting it day and night.
Tapering off celexa...quickly. Still feeling the burning-tingling-needling-itching. Fear that celexa is not the cause, or it has started something which now cannot be stopped. I have a new prescription for escitalopram. A cousin of celexa (citalopram), but one with slightly less potential for akathisia. It frightens me...but so do the depressions.
If I can get clear of the akathisia, I will probably give it a try.
Like looking for a needle in a haystack. Yes, but what else can you do if you need the needle?
Tuesday, January 5, 2010
Last October, in Hamilton, I was walking up the street with Holly, a woman who was helping me organize the book launch for The Lily Pond. I remember it was a cool but sunny day.
“Can I ask you something?” Holly said out of the blue.
“Sure,” I said.
“Is your book hopeful?” she asked. “Because I found hope in it.”
She sounded a bit perplexed, even a bit apologetic, as if she might have found something in the book the author hadn’t intended to put there.
“Yes!” I said. “Of course!” All books are fundamentally hopeful, whatever their subject matter; without hope, no one would try to wrestle raw, chaotic experience into the coherent patterns of art. But also: I’m here. No one would grapple for nearly 40 years with an illness pulling him down, pulling him apart, unless he had equally strong allies (internal and external) pulling him up, pulling him together. Those allies include love, joy in life, and a strong and resilient spirit. They are not unique to me. Any survivor has them. And they are rightly to be cherished, as wellsprings of pride and constant renewal.
To underline the reality of hope, and to remind myself of it, I’d like to read a passage from the book. A paradox of autobiographical writing is that, as it becomes more vivid and convincing, it tends to obscure–make dubious, even–the real life it purports to record. To suggest totality it must extract, and to convey immediacy must freeze the past, sculpting in ice what was once flowing water. Picture supplants pictor. This is especially true of descriptions of low points: if they live at all, they make ghostly the survivor who has won, at the least, the leisure and the will to recollect.
In May of 1979, the water level of French River reached its highest point in living memory. On a vertical rock just east of Dry Pine Bay, someone chalked and dated a line marking the water’s furthest climb. Just as someone doubtless will note–on paper this time, for a rock would be submerged–the record low water mark attained in the summer of 2005. In 1979, I came north with my parents to open the cottage; I remember loading the boat as it floated beside the gas pumps at the marina, three or more feet above the usual docks even at high water. I remember little else about that springtime trip; probably there was little of me left to remember with. I had only recently been discharged from a psychiatric ward after a year-and-a-half siege. It was really a siege of seven years, beginning with my first serious depression and psychiatric treatment at age seventeen, which cut short my last year of high school and inaugurated a long, chaotic slide away from active and communal life, culminating in the self-mutilation that earned me a diagnosis of schizophrenia and embarked me on the hospitalized ordeal of neuroleptic drugs, electroshock treatments and hydra-headed symptoms that came close to killing me, and, in the sense of obliterating all vestiges of my former life, in a way did kill me. My amnesia of that springtime trip north with my parents seems fitting; I could not have accompanied them except as a dazed and depleted survivor, a convalescent with tremors and scars and a battered brain, a broken and wide-eyed child though nominally a man of twenty-four, gaping at the debris left by the flood.
That is where I was almost exactly thirty years ago. And today I’m standing here in this room. In some ways still the same, in some ways greatly altered.