Thursday, January 14, 2010

Talking the Walk (22)

Now What?

“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.

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