Monday, December 28, 2009
Crusoe and the Swinging Door
Another figure that recurs in my book is not a shadowy stalker but an amazed, and dazed, wanderer on a beach. Robinson Crusoe. At one point I talk about the frequent sense I have of “stepping out from [a mist] to stare, alert and surprised, at the present I find myself in. Crusoe mode, as Heather and I call this islanding in the present, has its positive aspect. Washed up on a new beach, you focus intently on the things about you: grains of sand, a shell, the leaves of a new tree, a footprint. You are alive to the life about you in a way you scarcely could have been during the routine and tedium of the voyage.” This sense of witnessing an ongoing miracle–and a newborn baby, if we knew how it thought, must also live in Crusoe mode–was one of the most striking results after I finally got out of the hospital. I hitchhiked across Canada with my friend that summer. It must have been a somewhat harrowing trip for him–I would only sleep an hour or two at night, and often saw strange things, such as the giant, 2-metre-long crow that swooped repeatedly at one ride’s window–but luckily, my friend was a good sport, and even more luckily, a sound sleeper. I remember one day we were in a diner, I think it was in Kamloops, having breakfast, and I was sitting there after my scrambled eggs, watching my spoon glitter in a pool of sunlight, and my friend said, sounding surprised, “You feel good now, don’t you?” Yes, I told him. And more than good: wealthy. He asked me about that and I tried to explain. I was warm and comfortable, I’d been fed, I was free to sit on a vinyl chair and look about, listening to my friend, gazing at a spoon, watching other people...what more than these riches did I need?
To a large extent I’ve never lost that perspective. It’s a permanent gift I received.(1) A legacy of madness. Or, perhaps, a grateful ebullience that was always there, but that madness, or just hitting bottom, heightened. I’m aware of it standing here now. Inside–out of the November elements–invited to talk to people...pretty confident I’ll get a good lunch somewhere. I don’t really need anything more. Except–I need to say something... or else you’ll begin shifting uncomfortably in your seats. And then we’ll all feel bad.
And there’s the rub. How to live in the moment, but move to the next moment. A practical problem for all of us: how to live now, but still be living tomorrow. Which I must have solved somehow, or I would be a skeleton grinning at a dusty spoon in a boarded-over diner in Kamloops.
How did I solve it? I wonder. How do I? I think perhaps, at my best, I solve it by becoming, by living as, a moving now, a moving readiness. A newborn on the move...as newborns always are (even when they're sleeping). A Crusoe with a plan...as Crusoe soon developed.
Continued life does involve forward-thinking. Future-thinking. But...I have trouble with future-thought. For a good and healthful reason–my tendency to marvel at the miracle of the present–but also for a more destructive one, which is a simple inability to believe I can have a future. That it won’t be swept away by another trip through the swinging door of madness.
My current psychiatrist, an excellent doctor, has given me much counsel on this problem, but a lot of it boils down to two of those simple words that call out for attention: “as if.” Live for today, but also “as if” tomorrow will come. Prepare “as if” you will be granted a future as well as a present. A tall order, but a sensible and necessary one.
Doors are another metaphor that run through my book. I think of the altered states of madness as a door that, for someone of good mental health, should properly be a little sticky and resistant. But if it bangs open once, it will open more easily again. It it swings open many times, as it has with me, it starts to resemble one of those screen doors with worn-out hinges that flap at the slightest breeze. You have to learn to live with a door with loose hinges, which means the possibility of something coming in...or something, maybe you, going out. You have to learn to live with a door that is ajar.
There are worse things. Permanently locked doors, for example. Being sealed out...or in.
(1) A blessing and a curse, actually. “Live for the moment,” runs the advice we are always getting–and often, most of us, giving. But it is a counsel of ruin for so many of the important moments we find ourselves in. Moments during a job interview, a consultation about health or finances, a pledge of romance or friendship–when success, when fulfillment, depends precisely on the degree to which we can offer ourselves as a person capable of deferment, someone who can be reliably counted on to bank a portion of every moment’s potential for future spending. Someone prudent enough to have opened, long ago, an RRSP of vital energies and to be committed to making regular, incremental contributions.
Sunday, December 27, 2009
It’s true. It’s true.
Soon after my first admission to hospital, I entered a state of complete catatonia, either as a result of psychosis or the powerful tranquilizers I was put on, or most likely a combination of both. But before that, I have fragmented but clear memories of an exchange that kept recurring during my first intake interviews. It involved the doctors telling me, with regard to the wound I had given myself–what I called my “self-Caesarean”–and my beliefs about it, that it was a delusion, a hallucination, part of the psychosis. And I kept saying, with the monosyllabic stubbornness of a trapped person, “No...it’s true.” I think I kept repeating this until it was just a whisper, and then it became an internal voice: It’s true. It’s true. You see, I had been guided by a vision that a rebirth was coming. That the person I had been was dying, and had to die, so that a new person might be born. “You’re sick,” they kept saying. “No, it’s true,” I kept saying. We were speaking from different vantage points–they from sickness, symptoms, and treatment; and I from existence, metaphor and what I saw as salvation–so we couldn’t understand one another. What I might say to them now, if I could travel back in time, is, “I’m sick...and it’s true.” What I’d done was violent and horrible and terribly distorted–with more violence and distortion to come–but it was also true. Twistedly true. Or, if you prefer, truly twisted. And true in the most literal way. A straight-A high school student, a good and likeable boy whose future seemed promising–now lay bandaged and mute, drugged and shocked, on a psychiatric ward, with, after a while, very little hope held out, even by the doctors, for his recovery. Clearly, someone had died. And then, two years later, working as a part-time dishwasher and living in a rented room, tramping about the city all day and night scribbling poems on scraps of paper, restaurant napkins and placemats, even the margins of dollar bills...hand-stitching little books, making collages out of curb-found objects...and feeling exultant, jubilant that at last I’d found the life in art I was meant for. Just as clearly, someone had been born.
It is terrible, of course, to be un-made as a person. And exhilarating. And terrible to be exhilarated by your own un-making. As I thought about this the other day, what flew into my mind, like a flaming arrow, was the famous war cry attributed to Crazy Horse: “It is a good day to die.” Which means, as I understand it, that it is also a good day to live. (Especially if you couple it with the first sentence Crazy Horse is supposed to have said: “It is a good day to fight. It is a good day to die.”) If it is a good day to die, it is a good day to live. And...if it is not a good day to die, then probably it has not been a very good day to live. This, by the way, is not related by any neat corollary to suicide, which stalks through my book like a shadowy hunter. I won’t generalize about suicide, which I think is talked about too glibly, when in fact it must be as various and complex as the people and moods that turn to it. I only want to say that I have known the impulse to exit life not as a good day to die, but rather as a day so bad to live that dying seemed the only way to end it. That is very different.
Wednesday, December 23, 2009
Catching Up to Yourself (Part 2)
How did your wife’s diagnosis effect you?
Well, the long answer to that is the fourth section of the book: “The Lily Pond,” which became the title for the whole. The manuscript was originally just the first three sections. But after Heather got sick, was diagnosed...and came through a very rough time...after that, we agreed that I should try to write about it. Heather encouraged me to do so. In fact, earlier she had said she felt there was “something missing...another piece” from the story. That may have been partly her own premonition of illness. Which usually gives an advance aura of itself, and seldom, if ever, comes truly out of the blue. The short answer is that I was affected much as I imagine anyone else would be. I felt sadness, worry, fear, exhaustion. Bewilderment. Helplessness. My own history of mental illness gave me a general purchase on what was happening, but still...it takes different forms, poses new perils, in each person...even someone you know very well. No amount of preparation can make it predictable or fully understandable. You can’t tame it. You can learn a bit to manage the terror and bafflement, but you can’t erase them.
Was writing this book a catharsis?
I don’t know. I started writing it three years ago, and it was published three months ago, yet I still feel I’m coming to grips with it. Catching up to it, maybe. I think that might be true for a long time to come. Publishing froze the text at a certain point, but the processes it describes are still unfolding. One thing I’ve noticed, a mixed blessing: writing down the past gave more of it back to me, recalling things I’d thought were lost, making connections I hadn’t seen before...but that strengthened past now seems to crowd into the present more, bullying it at times. There have been moments of catharsis. It still feels like early days.
What is your advice to writers with bipolar disorder?
I don’t know that I have any general advice that would be helpful. Every writer is up against the same challenge (though the challenge may be more extreme in the bipolar writer): how to find the rhythms and processes that work for you. We're handed so many fantasy templates of what it means to be an artist–and we hand ourselves so many–that it’s an arduous task to keep recalibrating back to the basics: Yes, but what works for me? What tools and procedures actuate my talent, my vision? Experiments can be useful. I talk about one in the “Leavetaking” section. My psychiatrist noted that over the years I’d become resigned to my own productivity being geared to the cycles of illness: sleepless non-stop writing in the energized phases, wordless inactivity in the lows. And she encouraged me to question both assumptions: that quality work came only from the highs, and that nothing worthwhile could be accomplished in the lows. And numerically, empirically, she and I proved that the poles weren’t so clear-cut. That there was middle ground where much could be done...and done more surely, clear-headedly, than during a lurching, veering high. Still, I doubt I could ever be a steady, year-round producer. Mild depression is a workable state for a writer–even a favourable one for some parts of the writing process–but serious depression, which still lays claim to me regularly, is a destructive state to attempt work in. Depletion falls to even lower ebb if it’s not acknowledged. It’s a time to minimize, conserve...convalesce. In a fight where you’re being pummelled, there’s a time for the defensive crouch, to protect the vitals.
Was there anything you couldn't put in the book that you wanted to for various reasons?
No, I can’t think of anything. I felt free to say what I had to say.
You wrote “this is the first time for me as a writer that the period after writing has proved far more difficult than the writing itself.” Can you expand on this?
Full expansion might need a therapist and lots of hours, but here are a couple of ways I’ve found it difficult. Unlike other books, which have receded after being written, this one has remained “right here.” Because I’m “still living it,” as I’ve been reminded. But also, I think on some level, not consciously, I expected some resolution–maybe the catharsis you spoke of–from writing. Yet mentally I’ve taken some frightening tumbles this fall...episodes so bad, I’ve felt that no time has passed and I’m right back where I began. Despair, mental anarchy: these are timeless states; in a sense, they occur outside biography. All that I’ve learned gives me more means to manage psychological upheaval, but doesn’t prevent it. That’s sobering to realize. “There’s no cure” is an easy thing to say, to understand intellectually...but tougher to come to grips with as a lived reality. And there’s another difficulty. Giving talks this fall, reading from and reflecting on the book–I realize as never before how much of my life has been spent on the rat’s wheel of mental illness. Along with a strengthening sense of my own resilience, for hitting bottom so often and reinventing myself, there’s a corresponding sense of waste, of sheer destruction. So much time and energy–and how much else?–have been chewed up by that wheel. Time and energy that might have gone toward other things. These are autumnal thoughts, wintry thoughts. But it snowed last night, and it’s near the end of the year.
How do the poles affect productivity? You said they are not always so clear-cut.
Well, the simple fact I’m finally getting straight is that the mood in which you work is no accurate measure of the work’s quality. Euphoria colours things brightly; depression colours them darkly. But some of the glittering things lose their lustre if you wait a while, and some of the drab things gain. Of course, waiting doesn’t come easily if you’re on fire...and if you’re ashes, there’s nothing but waiting. Realizing there’s more middle ground than you thought is not the same as knowing how to utilize it. Rather than the two poles, here, very crudely, is the 5-zone range that I think I operate in: low...heading down/up...baseline...heading up/down...high. Good work is done in the stable middle and the transitional zones on either side. At the highest extreme, vast quantities are produced, little of it worthwhile; at the lowest, nothing can occur, it’s a dead zone. It helps to have things lying around at different stages of development, since the different zones have their characteristic energies. For example, the energized loose associations of the upper end are ideal for generating ideas and possibilities...but not so good for evaluating them. Mild depression, as I said before, may be sluggish at generating new stuff, but good at evaluating and revising. A degree of disillusionment and irritability could amount to sober second thought. Of course, there’s a world of subtlety and discrimination in that “degree.” That’s what makes this a living issue, which is to say endless, and not a science project. (Though rational experiment has its place. I describe an experiment my doctor prescribed for me in the book. In a manic burst one January, I’d written several dozen poems in several weeks. When that sputtered down, my psychiatrist suggested I try writing some more. I didn’t see any point to it, but gave it a go. And did manage to write a few more poems, though they seemed rather dull and workmanlike. Yet when it came time to finalize the contents of my collection A Thaw Foretold, the editor and I picked 6 from the frenzied burst and 5 from the assigned work. Considering the size of the starting pools, “a better hit rate” from “mild depression” than from “wild euphoria.” The conclusion seemed obvious: my perception of my ability swings more wildly than my actual ability. There’s a real oscillation of faculties, to be sure, but the pendulum swing of self-assessment is even wider and more erratic.)
Tuesday, December 22, 2009
Catching Up to Yourself (Part 1)
I sometimes wonder whether interviews wouldn’t be a good therapeutic tool. The several I have done, whether in person or in writing, have proved almost disorientingly informative (to me, at least); I left them with a wildly buzzing brain, as if I had been hooked up to one of those sci-fi learning machines, which transferred information into my head that I must have known before, but hadn’t known I knew.
For days afterward, I wandered around remembering some of my answers, thinking: Do I really believe that? Think that? Feel that? Yes. For how long?
You have a sense of catching up to yourself. Becoming aware of things you already think and feel, but have never clearly articulated before.
How do you know you’re not spinning a line–putting across the image you want the other, or yourself, to believe?
Same way you always do. Revisit the statements, examine them from different angles. (You’ll need to keep a transcript to do this.) Give it time. If they still sit right, and keep sitting right, they probably are.
What are the conditions necessary for a good interview?
Two people who want to find out something.
After The Lily Pond had been out for about three months, I did an e-mail interview with the Danforth Review which helped to clarify for me some aspects of what I’d learned, and hadn’t learned, about mental illness.
When did you begin outlining this book?
I plunged into writing it, without an outline, in November 2005. I describe the initial impulse in the third section of the book, “Leavetaking.” The first words of the first section, “Two Rooms,” came into my head, then joined to other sentences. The writing came steadily and quickly...but calmly, too. That last part surprised me, given the often harrowing nature of what I was describing. I was already well into the writing when I saw how the different sections might fit together. In some ways, it seemed to come pre-formatted...which might mean it had been taking shape in my mind a long time before I was aware of it. I find that’s often true. What you focus on at any point is what’s in front of you on the work bench, but all around the shop are pieces at various stages, from half-finished to mere raw materials...and you sometimes catch glimpses of these, too.
When did you first notice a cohesive (if that was the case) pattern to your mood swings?
It was only about 5 years ago (I’m 53 now) that I fully accepted the diagnosis of bipolar affective disorder, or manic-depression in the old terminology. And that’s after psychiatric treatment starting at age 17, eighteen months in hospital at age 22, multiple “breaks” and breakdowns...throughout all this turbulence, I still resisted a label, fearing it was somehow destructive, reductive. I’m still wary of it; I think of it mainly as a working hypothesis. But finally it seemed even more destructive to keep turning over rocks in my own life, looking for “exogenous” factors, problems in my life or relationships ... when it was obvious, and had been for a long time, that I roared up or crashed down regardless of what was happening in my life. When did it start? By my late teens I knew that something was awry internally. I had no language to use about it then, so I just thought of it as something “off,” “wrong,” “alien.” At that stage, the worst periods were notably seasonal: speed-ups in early fall and spring, followed by depressive crashes. But the pattern still wasn’t clear to me, I think partly because my states are so often what they call “mixed,” e.g. high, driven energy combined with very black mood. Is that high? Low? It’s elements of both. That’s why “mood” is such a crude term. Energy, both psychic and physical, and in terms of both quantity and quality, would be more accurate. And although I’m wary of the current eagerness to identify “the bipolar child,” I do see signs that my own swings began early in my life, certainly by the time of adolescence. I talk about that in the book’s second section, “Hunters in the Snow.” But it takes–or it took me at least–a long time to see any coherent pattern in something that seems so chaotic. For instance, it’s clear to me now that the main reason I kept bombing out of school–it took me 13 years to complete my B.A.–was the neatly horrible overlap between my worst times and the crunch-times of the university year: late fall, spring. My mind would be failing on me–the words I was reading going dead and senseless–and I kept assuming that I simply had no interest in what I was studying...and then quitting, or just scraping by on past performance. Yet the words I couldn’t understand in late November were the same words I was excited by, charged up by, in September. This is something I’ve learned to accept, but with difficulty: going through “spells” of six weeks or more where not only do I have no desire to read my favourite books, but on the most basic level, I can’t even understand them. Can’t track a sentence to its end and know what it said. With all the multiple strategies I’ve learned, the awareness I’ve developed...I’m able to manage these periods better, perhaps level them off slightly...but not change them fundamentally. Could there be a better proof of a biochemical disorder than that? Unfortunately, in some ways the cycles are becoming more random and faster, something I’m told is typical with aging. I’m sorry, I thought this was going to be a very short answer. It’s complicated. It’s taken decades to sort out even these basics.
Did you ever feel while writing this that the simple barebones “non-fiction” element was too close to home. Did you fear it would trigger a negative outcome?
Actually, it felt more like relief to concentrate on just my own story, understanding and telling it as well as I could, without the need to create characters and invent things for them to say and do. At the same time, it felt, if anything, more deeply imagined (as opposed to invented) than fiction: there was a need to find the underlying patterns and structures that could link true events. But I guess you’re asking more about personal risk. That was something I was not so aware of at the time–when I felt mostly exhilarated to be recovering the past–but have become very aware of since. More aware every day. I think there have been, and will be, many negative outcomes for me from writing this book. They’re hard to name and harder to quantify, but I feel them, certainly. Writing names things, which can sound like taming them; but in another sense it gives them new substance and power: it bodies them forth. It’s daunting as well as strengthening to take the true dimensions of an enemy you’ve been battling...especially when there's no sign of an end to the battle. At one point, when we were discussing the manuscript, my psychiatrist advised me to be cautious in dealing with what I had recalled. I quoted her for a piece I wrote about dealing with what I had written: “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.” This is the first time for me as a writer that the period after writing has proved far more difficult than the writing itself.
Saturday, December 19, 2009
I was fortunate to find Dan Wells, the publisher of my last three books. In Dan I found a true bibliophile (who are not so common, even in the literary world); a publisher whose almost alarming energies are fast building, in Biblioasis, the best small press in the country; and a friend. Dan and I are both slaves to our love of books and our love of conversation, and the mood swings of those masters colour our exchanges, often by email at hours when more temperate passions would be sleeping.
One day Dan sent me a list of questions for an interview that he later posted on the Biblioasis blog.
The title of your memoir is The Lily Pond: A Memoir of Madness, Memory, Myth and Metamorphosis. I wonder if you could start by explaining this a bit, with perhaps particular emphasis paid to your rather interesting subtitle?
For a few months the manuscript had another title, and only three sections instead of four. I thought it was finished. When I was surprised by the events, and then the writing, of the last section, I realized that its title, “The Lily Pond,” had to be the title of the whole book, since it encapsulates so many of the themes and images explored throughout. But a book just called The Lily Pond could be mistaken for a manual on aquatic gardening or a study of Monet—hence the subtitle. It came from me asking myself a simple question: What is the book about? What are its main and recurrent elements? It’s about madness, an oldfashioned term which I prefer to the more modern “bipolar disorder.” Madness covers a huge range of extreme states: from craziness to fiery creative passion to overmastering love and obsession. I think this scope makes it a more humane term, but also a more accurate one. The book is also about memory. This might be considered redundant: isn’t a memoir by definition about memory? No. All memoirs draw on memory, but this one actively explores how memory may be lost or damaged (through illness and its treatments), how and to what extent it may be recovered, and how a coherent life story may be maintained even in the absence of reliable memory. The book is also about myth. It draws on world mythologies to make some of its points, but in a broader sense, it questions the daily myths of illness and wellness by which we know ourselves and others. How do these myths damage, limit, nourish, reveal? Can they be changed? Lastly, it is a story of metamorphosis: of altered states wrought by illness and confusion, but also by recovery and understanding. It is about the paradox of accepting radical ongoing transformation as the foundation of life and sanity.
Plus, I like the alliteration of all those M’s. They sound like murmuring.
It seems to me that this is a book you have been working toward for quite a while. Your other books–some of your stories, your poetry, perhaps most especially your first novel, The Syllabus–have grappled with the subjects of madness, of memory (and forgetting), of metamorphosis. Especially M., the hero of The Syllabus. You describe memory in The Lily Pond as a Turner fogscape. Can you briefly explain?
Well, that comparison comes specifically from “Two Rooms,” the first section of the book, where the period I am trying to remember is the eighteen months I spent on and off (mostly on) a psychiatric ward...when accurate recall was swamped by a perfect storm of memory disruptors: dozens of electroshock treatments, phenothiazines and other powerful drugs, and the confusions and distortions of psychosis itself. So the snippets that come back to me are often like those tantalizing gleams in Turner’s veils of fog. Sometimes, if I concentrate, more details will come and the object or face, a scene, will solidify and make more sense. And this also happens looking at Turner’s paintings. This doesn’t mean, though, that the glimpses of things could be anything, are random. I have a sense—a memory trace, I assume—of what is really there, and it has weight, a “rightness” on those occasions when I find it. For example, a year ago, my sister told me of visiting me in the hospital at a time when I was catatonic, just lying on my bed unmoving day after day. And fleeting images of her then came back to me, bits of her face, hands, the hospital wall behind her...and I trusted these. Partly because they had that weight I’m speaking of...pieces actually dredged up from something sunken...but also because they stayed as bits, fleeting fragments. I think a wish-fulfillment fantasy would have bloomed more completely. This was one of the worst times, memory-wise. Nearly obliterative of those years, but also of much of my life up till then, as if a retroactive fog had swallowed much of the past. And the memory troubles continued forward too, with fog and “gap-outs,” as I call them, especially during times of illness. In recent years I have felt more able to retrieve the past. Relatively speaking–when I compare notes with other people, they express surprise at how much of my life has simply vanished. But I’ve learned a lot of tricks that help: checks and double-checks, ways of reinforcement, and also habits of concentration and reflection to lay down and maintain a stronger memory track. And I’ve learned to live with the holes. Turner’s fog can be unsettling...but it also has its gentle and allusive aspect, a richness of suggestion. Easy-to-see can also mean easy-to-dismiss, which is another kind of forgetting. I’m sorry: you asked for “briefly” and this hasn’t been. Memory is a raw nerve.
Can you say a few words about the writing of the book?
The story of the book’s genesis is told in the book’s third section,“Leavetaking.” There, with the help of my psychiatrist, I follow, in an almost detective-like fashion, a number of mysterious clues and events that lead me to an answer which is also a course of action: telling my own story, this memoir, for the first time. One of the precipitating events was being asked to speak about my life as a writer for a university group. In preparing that talk, I realized that I had never really told, even to myself, my own story—or not this important aspect of it. In my poems and fiction I had alluded to it often and tried to illuminate it from various angles. But I had never consciously explored at length, in writing, the meaning for me of my decades of mental illness. This preliminary thinking led me into areas that were unusable for a talk to strangers but which proved to be the beginnings of this manuscript. After writing the first three-quarters of it, I sent it to four friends, less to get their judgement on its literary merits than to see if it spoke to them as a human story. Their encouraging responses led me to continue the project, eventually writing the last section about Heather’s recently-diagnosed illness, and, in slow steps, to consider and finally say yes to your offer to publish the book.
Friday, December 18, 2009
Title and Total These questions about the book’s title are related to the questions I have been asked by readers and interviewers about the book’s reflections, at points, about such things as great paintings, star constellations, ancient myths, and common animals like frogs. The questioners have sometimes seemed to regard these as poetic digressions, depatures from the book’s core of mental breakdowns, psychiatric treatment, poverty and other turmoil, and slow recovery. I have two things to say in answer, answers that haven’t always come readily on the telephone or in a radio studio, in response to questions that have sometimes sounded sympathetically curious, but sometimes impatient or hostile: 1) I wrote this book, first, long before I thought of publishing it, to better understand events that had been dogging me for most of my life. The stakes, for me, couldn’t have been higher. So I had no time, no room, for any line that didn’t help to illuminate for me some corner of the subject. 2) Second, why is it that people think you’re talking straight when you talk of shock treatments or tears in a psychiatrist’s office–as I also do in the book–but raise their eyebrows when you speak of how you perceive the world, how your mind, in illness and in health, processes it? It demeans the mentally ill, as it demeans anyone, to say: Tell us about your heart, but not about your mind. It not only dumbs down the person, and the problem, but it makes plain a paradox that still bedevils our understanding of mental illness. We will allow in the heart–How do you feel? is heard routinely; but we still prefer to leave the mind out of mental illness–How do you think? is a rare question. And that is strange. Because if you go crazy with your whole self–mind, heart, body, all of you–then arriving at any sort of understanding of that going crazy must involve your whole self also. You go mad with who and what you are, and aren’t; you recover, if you do and to the extent that you do, with the same totality.
The Lily Pond has a lengthy subtitle: A Memoir of Madness, Memory, Myth and Metamorphosis. Back in the summer, Chapters-Indigo told my publisher, Dan Wells, that it would place the book on one of its coveted “power tables”–a coup for a small press–if we changed the subtitle to feature “bipolar disorder” prominently. I was loath to cost Dan possible sales, but I argued strenuously against this, outlining many reasons in a marathon email, which I’ll shorten drastically here. Besides liking the alliteration of all those murmuring “M’s,” I had reasons for each word. Madness, for example. While “bipolar disorder” may be a workable shorthand for a medical condition, or conditions, in general I prefer the old-fashioned word “madness,” which can mean craziness, illness, but also wildness, fiery creative passion, overmastering love or obsession. It has more scope, more texture...more humanity. In its wider allusiveness it is more accurate. Memory, myth, metamorphosis–I have my own rationale for each of them. And I convinced Dan. But not Chapters-Indigo. I doubt if you win many battles with a large chain. At best, you state your case and then the line goes dead. They still ordered a small number of copies. These can be found, thin spines out, in Health and Wellness, under Mood Disorders or Depression.
These questions about the book’s title are related to the questions I have been asked by readers and interviewers about the book’s reflections, at points, about such things as great paintings, star constellations, ancient myths, and common animals like frogs. The questioners have sometimes seemed to regard these as poetic digressions, depatures from the book’s core of mental breakdowns, psychiatric treatment, poverty and other turmoil, and slow recovery. I have two things to say in answer, answers that haven’t always come readily on the telephone or in a radio studio, in response to questions that have sometimes sounded sympathetically curious, but sometimes impatient or hostile: 1) I wrote this book, first, long before I thought of publishing it, to better understand events that had been dogging me for most of my life. The stakes, for me, couldn’t have been higher. So I had no time, no room, for any line that didn’t help to illuminate for me some corner of the subject. 2) Second, why is it that people think you’re talking straight when you talk of shock treatments or tears in a psychiatrist’s office–as I also do in the book–but raise their eyebrows when you speak of how you perceive the world, how your mind, in illness and in health, processes it? It demeans the mentally ill, as it demeans anyone, to say: Tell us about your heart, but not about your mind. It not only dumbs down the person, and the problem, but it makes plain a paradox that still bedevils our understanding of mental illness. We will allow in the heart–How do you feel? is heard routinely; but we still prefer to leave the mind out of mental illness–How do you think? is a rare question. And that is strange. Because if you go crazy with your whole self–mind, heart, body, all of you–then arriving at any sort of understanding of that going crazy must involve your whole self also. You go mad with who and what you are, and aren’t; you recover, if you do and to the extent that you do, with the same totality.
Saturday, December 12, 2009
A Pair of Us
“There's a pair of us,” Heather says to me, a bit breathlessly, after we have left the psychiatrist’s office and are sitting in our car. It is early June. She has turned in her seat to face me, and her eyes are wide and lambent, glittering with that desperate euphoria, or euphoric desperation, that has lit them–except when they have gone overcast, shrouded in cancelling gloom–for these last few burning, tumultuous weeks.
She seems relieved for the moment. To have a diagnosis, an illness with a name? (She had feared having a name, but then feared more being something unnamable.) To be sharing, as we have shared so much, a diagnosis with me? “It always amazes me how often you people find each other,” the psychiatrist remarked, when I had joined them in the office for the last ten minutes of Heather's interview. He spoke of the number of “bipolar couples” he had met, who had been drawn irresistibly together (often despite existing marriages or other serious obstacles) and who had established unusual but sustaining ways of coping with their cycles of illness, often long before either of them had been diagnosed. Heather and I exchange a look. His bemused, somewhat clinical reflections make it sound as if he is describing a species of exotic animals, creatures that emit a special mating call, inaudible or registered as noise outside their kind, and then embark on bizarre and esoteric mating rites. Yet the gist of his remarks rings true. From the start, Heather and I have been able to speak in shorthand, with intuitive understanding, of steeply swinging moods and strange mental states, and we quickly developed ways of gearing together discordant swings and of warily surviving the most dangerous times, when the swings coincide and amplify each other. We have even joked of a day like today, when Heather’s distrust of doctors would relent (gently, in our fantasy, not under the duress of crisis) and we would “make it official.”
But the day foreseen is not the day that arrives. I look through the windshield up the street, which is lined with parked cars and empty of people. The leaves of the overhanging shade trees are a bright, incongruous green; we have been keeping such wildly irregular hours lately that it has been a long time since I have paid attention to such basics as the weather or the changing season.
It is Sunday morning, early, before church even. It seems a strange time to be meeting with a psychiatrist outside of an emergency ward, but this psychiatrist has a quirky schedule and neither of Heather's other two doctors felt that it was safe to wait another day. The appointment was scheduled by telephone late last night. This recognition of the need for haste, of the peril Heather is in despite her equable demeanor, inclines me to trust these doctors, despite my own long history of damage by medical misadventure. Already they understand Heather well enough to know that she, like me, will understate rather than exaggerate a crisis, and understate with a more savage discretion as the crisis nears its climax.
Is it time yet? The question, sceptical but insistent–shadowing the mind at dawn, at , at –has altered to a more drastic shape: Is there still time? Out of the myriad confusions of the last few harrowing weeks, Heather and I have arrived at one certainty: medical intervention is required. To wait, to hope for change, is no longer permissible; it is not safe. In this, at least, the doctors and we are in accord.
As we drive off toward the pharmacy where we will fill Heather's first prescription of lithium, she murmurs again, softly, as if to herself, “a pair of us.” Thinking of the Emily Dickinson poem she is quoting from, in which one frog discourses to another, I wonder if I am hearing, besides a mixed and quizzical expression of relief, a first sign of the controlling image of Heather’s sickness–or, could it be, the hopeful image of her health? For if you find yourself floundering between elemental extremes, might not the image of an amphibian be a comfort, a guide? As precarious as a frog’s survival may be, as it undoubtedly is, it has to afford more hope than the dominant image shaped by, and then shaping, my own first psychosis. Through the summer and fall of 1977, I kept seeing, faintly and intermittently at first, and then constantly and with bullying vividness, a seam of red glowing from within a brownish crust–like molten lava glowing under soil or rock, presaging volcanic eruption. The image was pregnant with violence, a fiery birth that I saw approaching and desired as a consummation, and it ended with blood spilling down my abdomen from the “self-Caesarean” I had performed on myself.
Twenty-nine years later, my thoughts are focused, as they have been for weeks, on how Heather might be spared such a moment, along with its lifelong ramifications, its endlessly rippling aftermath. Surely, I think, my own huge kit bag of mental illness must contain a few instruments to help another. Diet, daily habits, even lighting and room layouts–what might be changed? What might be tinkered with? The smallest adjustment could make a difference, tip the balance. And to that end, everything–even the grotesque, arguments our sleepless, cross-wired selves inveigle us into–must be examined (in retrospect in those cases) for a possible clue.
As I drive down the surreally bright, surreally empty streets, I try to remember the exact wording of the
I’m Nobody! Who are you?
Then there’s a pair of us?
Don’t tell! They’d advertise–you know!
The poet’s frog is all questions, exclamations, and commands. There’s not a single croak of reasoned calm amid the flurry of agitated queries and exhortations. It sounds familiar, which means it is not what I am looking for.
On the other hand: Who better?
So far I’ve talked about the stages of crisis, aftermath, and recovery. I’d like to touch now on the question of what happens when recovery is completed. That one’s easy. Nothing happens. It’s never completed. That may sound dire, but only if you’re the kind of person who thinks people “get over” tough things that happen to them. I don’t think anybody gets over anything...and thank God. Getting over a part of life makes it sound like a fence rail in a horse race. A more human goal, I think, is to try to weave the experience into the fabric of one’s ongoing life, making the past part of the texture of the present and the future.
“Unfinalizable” is a word that Dr. George likes, and I’ve grown fond of it too. Recovery is unfinalizable because you’re still living it. Can a life be resolved? Would you even want it to be? In my case, there isn’t any cure for the difficulties I’ve had and continue to have. They’re chronic. I manage them...sometimes well, sometimes not so well.
This, by the way, is why we didn’t want to use a conventional image of a water lily bloom on the cover. The kind of image you might see on a meditation book or a collection of Zen sayings. Beautiful–the lotus blossom of enlightenment. But too perfect. Too finished. Too pristine and complete. So we bought our big plastic bucket from Hamilton Kitchen Supplies and tried, from June to September, to grow our own lily plant on the apartment balcony. And got leaves, lots of leaves...but no bloom. Not enough sun, said my gardening advisor; they need long, pure hours of it. Which, in the end, we decided was better after all. We rinsed off the plant when it looked like it was starting to wane and photographed the whole length of it, from root mass, with a new shoot poking out, to long stems, to leaves. Complete...in itself. But not perfect.
It should be clear by now that I don’t believe any of these processes are unique to mental illness and its treatment. In fact, I’m often struck, when thinking of these subjects, how when the phrase “mental illness” is left out, the issues are existential ones common to everyone. Perhaps many mental health problems, even the severest crises, and however they may be caused, are intensifications of everyday human concerns and challenges. These existential concerns–of encounter, of crisis, of recovery, of living with the unfinalizable–are only more obvious in episodes of trauma, which shines a harsh light on questions of existence that are always operative, always urgent.
Unfinalizable. It ain’t over till it’s over. And even then, there’s probably no conclusion to any story, but only the sense of a new chapter beginning, in which the events of the previous chapter are incorporated and enlarged...and the question becomes: have you learned anything from what came before, anything you can apply in your life, now?
Writing this book gave me an object lesson in the meaning of unfinalizable. In many ways...but in one way I would never have wished, but which couldn’t have been a more powerful demonstration. After I’d written what is now the third section of the book, I thought the manuscript was done. I showed it to a few people...cautiously, tentatively. Their reactions were encouraging, but I had a nagging sense that the matters I’d been writing about were still hanging overhead, left undone, developing. Why? I kept asking. What’s next? What’s coming? Part of what was coming, as Dr. George pointed out, was simply more life, living with it. Something doesn’t end because you write about it. But what also turned out to be developing–and I tell this with her permission, as she generously and courageously gave me her permission to write about it–was my wife, Heather’s, deepening mental health crisis, which spiralled into an acute episode and her own diagnosis of bipolar disorder. Along with all the emotions anyone would feel–worry, fear, sadness, exhaustion–I wondered: Had I learned anything from my own experience that could help her? Or, even more simply, could we find a way to be sick together...to perform the often awkward, but sometimes strangely graceful, dance of helping and being helped?
The answers, I’m afraid, are the usual trinity: Yes. No. Maybe.
Monday, November 23, 2009
Are you anti-psychiatry? I have been asked that many times since publishing The Lily Pond. The answer is a clear No. I don't think I would be standing here, and possibly not standing anywhere, if not for the excellent psychiatric care I have received for the past five years. The third section of The Lily Pond gives a view of that care, which includes managing a crisis as well as embarking on the writing of this book.
Lest this be mistaken for a ringing endorsement of the mental health system, let me add that those five years are the only time–in a psychiatric career stretching back more than thirty-five years–that I have felt myself to be in good hands. My previous shrinks ranged from passable (possibly) to lacklustre to frighteningly bad. To put good health care into perspective, I’d like to read a portrait of the kind of care I’d come to settle for. If you find it funny, be sure to listen for the punchline at the end, which comes at my expense.
Heather and I called my Toronto shrink The Idiot. I had been seeing him once a month for several years, whenever I needed my prescription refilled. He wouldn't phone it in to the pharmacy or write for more than one month: he wanted to bill for the office visit. The appointment lasted for half an hour. He spent at least half of that time, every time, finding my file folder, fixing his coffee and stirring it by the machine. Sometimes more time was wasted because he couldn’t remember my name. He would come back with a file for Barrens, or Burnez, or Marks, or Michaels. He never did learn my name in the several years I saw him, and he mispronounced it each time I told it to him again. When I showed up for one appointment and the nurses said, with nasty looks, that he had moved–only one had any idea where his new office might be–I guessed that his privileges at that hospital had been suspended. He worked now in a little brick building over a pharmacy; he seemed to have cut a deal with the pharmacist, since he urged me to fill my prescriptions downstairs and sulked and made difficulties if I wanted to go elsewhere. He had the insufferable bombast of the dullard still vested with authority. After the 9/11 attacks, he treated me to a thirty minute harangue on Egyptian politics; that was the price of pills that day. He raised the dosage as I requested–as I increasingly needed–but asserted his authority by lecturing me on my condition, making inane speculations, sometimes rationalizing his own laxness by flattering himself for having the sagacity to know when a patient was capable of self-monitoring. But eventually, if you have been seeing for years a doctor you call The Idiot, you have to ask yourself: Who is? Seeing a doctor you find contemptible is a position of the utmost precariousness. He broke most of the ethical rules of psychiatry, but that wasn’t what scared me most about him. What frightened me was that I could wind up in hospital under his care, and then he would have the power to do as he saw fit with me. I knew more than a little about what that could mean.
Yes, that’s how bad it can get. But the joke is really on me. I am the other fool and incompetent in the passage, someone whose sense of self-worth and personal horizons had shrunk to the dangerous point where he would accept that level of care and not look, not feel he could or should or must, look for better.
I think that good psychotherapy is necessary for every person suffering from mental illness. People tell me that resources are strained and this is not possible. Really? It might save on excuses if we agreed on this premise at the outset: There is enough money to do whatever we decide is worth doing. And its corollary: if we’re not doing something, it’s because we haven’t felt collectively that it’s worth doing.
Even the most effective drug treatment–and I know people whose lives have been literally saved by mood stabilizers and antidepressants, to name just two classes of drugs–still leaves unaddressed many issues of self-understanding, self-acceptance, self-forgiving that cannot be left out of mental health. In addition to being enormously helpful, psychotherapy is extremely interesting, mysterious and unpredictable. When it is fruitful, it is not only challenging but also suprising and even exciting.
Go to a physiotherapy clinic, a gym, a chiropractor’s office, a massage therapist, a medical supply store, a mattress shop or a furniture store, and you’ll meet people–all of us, sooner or later–willing to invest time and energy and dollars on ways to help weak and ailing body parts. Is the psyche worth caring for even half as well as we care for our ankles, knees, necks, and backs?
Tuesday, November 17, 2009
Along with the personal Do’s I’ve discovered, there are also lots of Don’t’s. Here are a few.
Don’t panic...try not to. 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 most important results of my recent years of therapy. It’s a lifeline to cling to, a thread to guide me out of the labyrinth.
Don’t forget the past. And its flipside: Don’t enshrine the past as law.
Don’t overgeneralize, i.e. don’t throw the baby out with the bathwater. I meet patients who are virulently anti-psychiatry, and I meet others who are passively acquiescent in their treatment. I have been both and I know both to be self-destructive. I feel sympathy with the anger, fear, sadness and distrust of people who have had bad experiences, but recovery means not ruling out any possible resource, while judging each one’s benefits and costs rigorously. Ruling out a whole class of experiences on the basis of a few adverse encounters could cost you valuable allies. It cost me dearly, and I regard the fifteen years when I shunned the mental health system, drifting through a series of rented rooms, short-term jobs and very bad times, as some of the worst and most pointless years of my life...years when I despaired of finding any external help whatsoever and had to be pushed back into it.
People have wondered how I can talk about electroshock in the same breath as drinking too much in rented rooms. But noting certain similarities between experiences is not the same as equating them. Jolt and juice are both ways of battering the brain, though the juice usually happens in slower motion. And when staring at a ceiling lowered to about two inches above your face, it’s never a bad idea to ask what role you might have played in disappearing the horizon.
Don’t forget what they did to you.
Don’t forget what you did to yourself.
Sunday, November 15, 2009
The phase after the aftermath is usually called recovery. It’s a word you hear a lot these days, often in connection with a specific trauma: in recovery from addiction, from abuse, from mental illness. But I think recovery, properly understood, is universal–something each person is, or should be, engaged in. If you think of recovery as learning how to make your wounds and losses part of your life–fully acknowledging them without allowing them to overwhelm or completely determine you–then I would ask: Who is not in recovery? Who has not suffered wounds and losses? Who is not trying to live with them? Who is not facing serious challenges in the present? Who is not trying to build, out of a heap of cracked and broken, along with beautifully solid, pieces, a whole life?
Clearly, recovery understood in these terms can never refer to a final or finished state. It can can only gesture toward a process, a continual set of reorientations that come from the willingness to tinker, like an amazed and persevering chemist, with the basic elements of your experience.
This means that every recovery is personal. Individual and changing, an ongoing negotiation. What works? It is intensely, even ruthlessly, practical: the person who wants to actively recover has to be as wily as a fox in sniffing out potential help, discarding harm, and bold enough to experiment to discover which is which. This is the search for what Pat Deegan calls “personal medicine”: the procedures and prescriptions that work for you.
My own personal medicine cabinet is stuffed, by now. Here are a few items from it, to give some idea of the range of idiosyncratic possibilities.
Diet. I'll spare you the details, but I eat a lot better now than I did in my twenties, and overall, I’m a little less crazy. I know there’s a connection.
Sleep. This remains one of my biggest problems. Especially since I know that accumulated insomnia is one of the surest triggers for my worst episodes. I’ve tried most of the mood stabilizers, but they’ve had side effects I couldn’t tolerate. I take clonazepam and lorazepam which help with sleep. I take another over-the-counter relaxant: alcohol. Naturally I worry about addiction, especially as I see my dosage climb with the years. But I’ve also wondered which would harm my liver faster: too much alcohol, or long stretches of 1-3 hours of sleep a night, which I suffer frequently. This isn’t an excuse or an apologia for booze. It’s a weighing. A balancing.
Light therapy during the winter, since there is still a seasonal component to my swings.
My biggest discovery of the last few years has been the benefit of large (very large) doses of the omega-3’s, along with other vitamins. I began this regimen four years ago and have no doubt that it’s given me more stability.
Hydrotherapy. The eternal solace of water. I seek it out wherever I can. Bathtubs. Showers. The overcrowded YMCA pool. Puddles, streams, rivers. Lake Ontario. I crave the ocean, but I am a two-day drive from the nearest one.
Longo’s supermarket. It almost never fails to pick me up. I like the bright lights, I like the vivid colours, I like the silver-haired produce manager who dispenses helpful advice (often with me lurking nearby to listen) on when a mango is ripe or why the asparagus lasted longer this year. No matter how dismal my day has been, I leave Longo’s with bagfuls of that most useful thing: food. In a hungry world this is no small achievement.
What I call the small-circle cure, which I take in small doses regularly, but in large doses a couple of times each year. 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, 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 beside a single lamp, flipping pages of Rolling Stone or People, might see a 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’m coming to see, involves a better understanding of one of the simplest words: and. I am a person who reads, and writes, challenging texts...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.
Understanding and. If I’ve learned anything, it’s that the effort to include, and re-include, is central to both the word and the process of recovery.
Friday, November 13, 2009
Before Came After was the title a poet I once knew gave to her first, self-published collection. It stayed with me as a truth about (at least) the psychic order of things: you have to be on the far side of something to catch more than a glimmer of its approach. Saying that, though, casts doubt on all the conventions of sequence and finality embedded in our language. The far side? The far side? Or just...another side? They are conventions we need, of course. The narrative of beginning-middle-end is one of the most profoundly practical of human inventions: the equivalent of fire or the wheel, in terms of helping us shape and use experience. Saying A led to B led to C–though we know better; know, as the best stories always imply, it could not be quite so simple–allows us to mingle timeless truths with the timed necessities of tigers and ticket-takers. But it never hurts, as a refinement of that fire-wheel, to remind ourselves of the inescapable circularity of all processes. Before comes after. After comes before. There is no such thing as a conclusion, but if there were, it would double as the ideal introduction.
I want to pick up my story on the other side of crisis, that first episode as it’s sometimes called, which in my case was very protracted. Whatever treatment is used, even if it’s old-fashioned time, the easing of crisis is not a return to health, but only the first step in such a return. It is that dazed mixture of relief, exhaustion and bewilderment commonly called the aftermath–a fragile condition, a thin soil in which hope may try to put down roots. A passage in the second section of The Lily Pond describes this state of aftermath. I’m not alone in the passage, appropriately, since the emotions of aftermath, like the emotions of crisis, ripple out to affect everyone close to the patient, especially family and friends. A feature of aftermath that I don’t think is talked about often enough is the intellectual challenge it poses. Most people can imagine the emotional blow that trauma inflicts, and that is what most accounts focus on. But what has also been damaged, perhaps even shattered, is the personal narrative of self and life we are all telling ourselves, which must now resume with drastically altered prospects and circumstances. Simply put, serious mental illness poses a constant question that is very hard to answer, but which must be answered in some fashion: Who am I now in the light of that? What can I now expect? What can I do?
In May of 1979, the water level of French River reached its highest point in living memory. ...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.
Floodscapes present ambiguous vistas–at least to those Noahs lucky enough to survive them.
There is destruction, obviously.
But, also, new shorelines.
Deep (fertile?) mud.
Tuesday, November 10, 2009
In Praise of Puzzlement
It’s time to sing of puzzlement as a desired, and desirable, state of mind. It’s time to paint in lush, layered grays. Living grays.
A friend wrote me the other day of G.E. Moore saying, of the young Wittgenstein, “I have a very good opinion of him. He is the only student who looks puzzled in my lectures.”
In brutish schools of thought (often among the most powerful and influential schools of thought), puzzlement is typically derided as a sign of the infirm or timid mind. It can be. Just as it can be sign of the strongest and bravest. Do you have what it takes to live with–live in–“maybe...maybe not”?
I see you’re critical of the mental health system. Yes...to a point.
You think you know a better way. Yes...to a point.
I don’t have a one-treatment-fits-all program to suggest. I’m left with–left in–puzzlement, but out of puzzlement I do have a couple of questions to pose.
1) Why has one of the oldest and most low-tech approaches to mental illness fallen so out of favour? I’m talking here of the “rest cure” as it used to be called, making use of the healing power of time and quiet as the wounded psyche sorts itself out. I think of this sometimes as I walk around the now-disused grounds of the old Ontario Hospital, a place I was almost sent to for the long-term care that we patients called “bagging.” I find those lawns and chestnut trees restful and restorative now...I suspect I would find them even more so in a time of acute illness. Not, certainly, as a “bagged” person, a warehoused shell of myself–but as a broken soul in need of sanctuary, of asylum, in need of the long, slow time necessary to reknit brokenness. 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.
2) Now, I know that part of the answer to my first question is that we have other treatments now. More focused ones, usually pharmacological but also psychotherapeutic. The “rest cure” was partly because the ones prescribing it had nothing else to prescribe. But that’s only part of the answer. Another part has to do with our haste these days to restore a patient to functioning. “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. And I have absolutely nothing against functioning. At my best, I juggle a full-time job with serious reading and writing, seeing family and friends, other hobbies and interests–I like being active and productive, as only someone who has spent months and even years out of commission, can. But I think we all fall into the trap of defining functioning too narrowly. And of making it a kind of idol. Functioning can’t really be understood in abstract or absolute or general terms, but only in individual terms, as part of a larger concept of overall mental health. It’s likely that, after the onset of illness, a person’s means of functioning will change, temporarily or permanently; it may also fluctuate, which is certainly true for me. I’ve had to develop–and this is something I’m still doing–a new model of functioning...one that fits the person I am now.
Can there be any person for whom this is not true? That is, anyone who, to answer the question What can I do today? must not first ask the question Who am I today?
“Who decides what functioning is?” I asked Dr. George in one of our first sessions.
She looked puzzled. At last! I’d seen psychiatrists furrow their brows in anger, in disbelief, in impatience...in any one of the rainbow hues of pique. When had I last seen a brow furrowed in honest perplexity?
“You do,” she said. “Who else?”
Sunday, November 8, 2009
Recently I came across a quotation that I’ve been turning over in my mind. It’s by the philosopher Ludwig Wittgenstein, who said: “You must always be puzzled by mental illness.” What did he mean? I wondered. I decided it was not a statement for confusion or against certainty, but rather for curiosity and respect for the mystery of others, and against a too-easy certainty. And I would broaden it; I would say: You must always be puzzled by other people. Not because puzzlement is a good in itself, but because if you aren’t puzzled, you aren’t paying attention, and if you aren’t paying attention...what can you discover that you don’t already know?
Every psychiatric history, no matter how long (and mine is over 35 years long now), begins with something very simple: an encounter. Typically, this encounter occurs between a doctor and a patient, maybe late at night, maybe in an emergency room. In one sense this is a unique situation, but it shares features with any other encounter between strangers: curiosity, fluctuating levels of trust and suspicion, needs (on both sides), hope...and fear, assumptions, and expectations. What it always contains is a large portion of the unknown. Whatever knowledge and experience both persons bring to the encounter–whatever inner stars they have learned to steer by–these can’t change the fundamental fact that the person facing you is unique, unlike anyone you have met before.
A passage early on in The Lily Pond describes such an encounter:
The emergency staff of North York General Hospital could not have had much more than questions on the morning of November 11, 1977, when a twenty-two-year-old white male, agreeably calm and strangely articulate, presented with a deep transverse incision in his belly and shorter slashes across his abdomen and above his left knee. The main wound was of the size and in the place that a later examiner would ask about the patient’s appendectomy, and the patient himself spoke wryly of his “self-Caesarean,” adding that he guessed it was “in the wrong direction.” He also produced a thick hardbound book with a pebbly red cover, which contained some two hundred pages of close-packed writing alternating with drawings and collages, the artwork garishly colored and badly smeared in places from the artist’s taste for thickly applied oil pastels. An interviewer, glancing from time to time up at the patient, riffled through the massed output, too quickly to take in more than an impression of frantic copiousness; the crucially telling point that the book had been new and empty a week before probably did not emerge. I sometimes wonder about those first examiners, whose faces I cannot remember. Where are they now? What are they doing? If still alive, the oldest would be long retired, in advanced old age; the very youngest, residents then, would be in the latter third of a career in medicine. It was twenty-eight years ago, longer than the life of Keats. But whoever they were, and whatever little they had to go on, one thing was certain: they had to do something. The stitching up must have been in some sense soothing to both patient and practitioner: here, at least, was an unquestioned good. An obvious need fitly addressed. Now what?
“Now what?” sets the stage for a new encounter.
Saturday, November 7, 2009
One of the most rewarding aspects of publishing a memoir on mental illness has been the opportunity to speak to different groups of people about the many matters that fall under the umbrella term “mental health.” Doing this–in venues that have included a hospital (the one where I once spent a year and a half), a bookstore, an art gallery, a church, and various meeting centres and community halls–I’ve been struck by the sheer need of so many people to talk about these issues. A need, it’s very clear, that is mostly unmet. At times, the urge of unburdening that fills the room has felt almost overwhelming.
The talks have been an evolving process. Each time I’ve written something new for the occasion, while incorporating pieces of previous talks. So each talk represents a further stage in climbing a rock face–or descending into a rock pit, since the same muscles and equipment are needed to explore upward as downward–...reaching out from a line of pitons already secured, in order to hammer in one or two more.
Three of these talks–one audio-visual, one audio-only, and one text–are posted in their entirety online, and are accessible from the links on the upper righthand side of this blog.
Some listeners have asked me, however, for printouts of particular points made in the talks. To supply these, and to review the points myself, I will be entering portions here over the next few weeks. Where necessary, I will make slight adjustments so the passage stands better alone. I hope, too, that in the process new thoughts will occur to me, which I can include as additional entries.
Whenever, over the years, I heard the question: “Do you talk the talk, or walk the walk?”–I always had an unsatisfied sense of only two doors? I get to talk, or walk...that’s it? I would rather talk the walk and walk the talk...if I can.
Talking the Walk, Walking the Talk.
Or, since people tell me that in these Twitter Times no title should exceed three words: Talking the Walk.
Tuesday, October 27, 2009
of her unruly hair
descends to the floor, where they drift
into corners and clot around doors.
I tell her, I warn her,
‘You don’t keep the house.
Tidying’s my job, but fair is fair:
Think of me when you’re cutting or combing
Your hair.’ And she will
for a time, but slovenly ways
trump a kind heart; so year after year,
to immaculate floors,
Fall brown hairs, then gray hairs,
then glimmering white–these pepper-salt
mouse nests on shelves and on stairs.”
It was all long ago. Now my room is scrubbed bare.
(Note: This poem is supposed to be centered all the way down, the lines breathing around a central spine. But I haven't been able to figure out how to do anything with poem formats other than the straight align left. If anyone who reads this knows, could you let me know...either email me directly if you have my address, or ask my publisher–Dan Wells at Biblioasis–to forward the message? Once in a while, I might like to take a pinstep away from the Good Left Rock.)
Monday, October 26, 2009
Monday, October 19, 2009
who didn’t like to swim? Expats from the womb,
unless held back by fear or mother's arms,
they gambol again in grace-giving fluid,
spin fast bubbling somersaults.
On chairs apart, safe from splashing’s range,
the amnio-amnesiac rest their spotted limbs,
watch heavy-liddedly, with fond thin smiles.
The middle is a slippery, stuff-strewn zone
of psychic halflings: beached uncertainly,
sun-struck, cold, lithe-torpid and fat-spry,
they take quick lurching plunges to cool off,
chase a better body, bob up goggle-eyed,
then kick once and glide down to weed-columned halls.
Friday, October 16, 2009
(A Big-Pharm boardroom, lattes. Arnie, celebrated celibate Chem-wiz, speaking)
“You have, er, very sad persons. Chronically low, lonely...people. We pick them up a bit, but fix it so they can’t get it on. Affect without effect. Heh heh. These, er, clients must catch the nearest bus to self-loathing. Recriminations...endless. Next stop is a higher dosage. They'll never get off the juice.”
(2 weeks later. Impromptu song at the company picnic, crooned falsetto by a kick line of naked and aroused revellers, high on Arnie's punch)
“If they can't get it on, get it on, get it on,
They'll never get off, get off, get off the...JUICE!”
Sunday, October 11, 2009
Thursday, October 1, 2009
Saturday, September 19, 2009
2. Chronic skepticism, like chronic credulity, takes root in a lack of experience. Inquiry into everything–or nothing–shows a lack of sophistication, a shrinking from the amplitude of the partial.
3. If writing brings me face to face with the mediocrity of my mind and the frequent coldness of my heart, it also reminds me of the agility of my spirit and the robustness of my appetites.
4. The landscaper makes his living, as do I, from people's disinclination to turn their own soil.
Monday, September 14, 2009
Thanks for your email. You say that down in Florida you're hearing horror stories about Canada's socialized medicine, which have got you more worried than ever about Obama's proposed health care reforms. You ask if I can shed any light on the matter.
I'll try. We hear the horror stories up here, too. In fact, most of us have told a few. Stories about long waits, bad doctors, wrong treatments, no treatment–all the ways a system can let you down just where you feel it the most: your health. They're like stories of bad car crashes or miscarriages of justice, with this difference: no one claims that privatized roads or courtrooms would eliminate those ills.
Come to think of it, I can't remember the last time I heard a Canadian suggest we abandon our public health care system in favour of a private one. Even those with a financial incentive usually advocate privatizing parts of the system; they want to tinker up their returns, not tear down the house. Everyone wants the system to work better, but they want it to work better, not be scrapped for another one that does not guarantee universal coverage.
Complaining is natural; everyone does it. When it comes to putting a bad spin on a good thing, Canadians take a back seat to nobody. Still, we need to balance the horror stories with other kinds of stories, just as true and happening every day. Call them anti-horror stories.
Here is one.
I used to go years without seeing a doctor–not smart. I still put it off too long sometimes. But this past month, a perfect storm of health problems caused me to seek medical attention from eight different doctors and at least a dozen nurses, in half a dozen clinics, offices, and hospitals. It was a very thorough, if involuntary, sampling of socialized medicine. What were the results?
Across the board I received competent, courteous, compassionate care. And surprisingly promptly, too, given that wait times are Monster A in horror stories on both sides of the border. But “across the board” is not a story; only details are. Here are a few of those. I've had several skin cancers. At this month's checkup, my dermatologist gave me some free ointment for a spot she didn't like the looks of. She asked about my latest book and gave me good advice on a public speaking possibility. A few days later, I developed an infection in my face that spread rapidly. It was Friday afternoon. My G.P. was gone till Monday, so his secretary located the walk-in clinic closest to me. I went there, was examined by a nurse and doctor, and within two hours was back home with my prescription for antibiotics filled. The next morning the infection was much worse. I called Tele-Health, and after a rapid but detailed phone interview, was advised to return to the clinic, where I would likely be referred to a hospital emergency room. I was.
On each of the next four days, I returned to Sunnybrook Hospital's ER to get IV antibiotics. I saw three different doctors; each had my thickening file to consult, and each examined me anew, listened and asked questions, and discussed the treatment. Staff remembered me and greeted me with a smile, despite the constant stream of patients they were dealing with. From triage nurse to treatment to parking lot cashier, I was through in about three hours each visit, which seems to me a very acceptable turnaround time in a busy urban hospital. A few days later, the infection coming around, I met my psychiatrist for our regular appointment; she helped me as sensibly and conscientiously as ever, asking me to update her by email every two days about the new drug we are trying. Finally, today I see my G.P. to follow up on the infection and to ask about new ear pain which may be related. He is a careful doctor, so I wouldn't be surprised if he sends me to an ear, nose and throat specialist.
Sorry for the litany, Jenny. But I had to show you how thoroughly I'd tested the system here. None of it cost me a cent; I simply showed my health card on each visit. If I'd had to pay for it all–well, that would have given you your horror story. And so, I fear, would my trying to find an insurer, assuming I could pay for one, that would accept me given my serious pre-existing conditions and my age (54).
It's just one person's story. But so is each horror story.
What is “socialized medicine” anyway? Public schools are run by governments, and so are public roads, but I don't hear people worrying about socialized education or socialized transportation. Comparing my Webster's and Canadian Oxford, I find that the bogeyman of socialism is third on the list of meanings of “socialize.” Before it come the senses of making social or sociable. Which means, my dictionaries tell me: fitting to organized society; concerned with the mutual relations of human beings; ready and willing to talk and act with others. That doesn't sound scary. It sounds more like the antidote to scary, as if the secret meaning of “social” might be “un-scary.”
What's the alternative? Health care that is, by design, un-social? Anti-social?
Against that possibility, we all need all the anti-horror stories we can tell.