Feeling Yourself Disintegrate

"Zoloft saved my life." 
Greg Dulli, Rolling Stone Interview

"Much madness is divinest sense/To a Discerning Eye."

Emily Dickinson, from Life

"Your delusion is total, and all the more dangerous and incurable in that you speak just like a person who is fully in possession of her reason." 

From the memoirs of Hersilie Rouy

"I strive against low spirits all I can, but it is a very hard thing to get the better of."

Mary Lamb to Dorothy Wordsworth, July 9, 1803

The Emperor's New Psychopharmacologist
As a woman in her thirties -- with an M.A. in English and Creative Writing, a well-paid job in higher education, a supportive wonder-husband, no kids unless you count the chihuahua -- my life is relatively wonderful and uncomplicated. As a woman with the brain, mind, and body God gave me, my life is pretty much fucked.
Somewhere between birth and early adulthood, things went from "pretty great" to "wait--what?" When this took place exactly I cannot say. I know it didn't happen in childhood, it didn't happen in high school, and it didn't even happen during the first years of college (though by the summer of sophomore year, I felt signs that something was amiss). It was during my junior year, however, that things became somewhat dire. Life itself felt murky, turbid, in a word: shitty. At this time in my life, I was somewhat unmoored--I was in the middle of a year-long study abroad program at the Universitya' di Bologna in Italy. I was going through a minor break-up of what felt like a major romance. A few of my fellows were dealing with depression and a roommate of mine would sometimes lock herself in the bathroom to wail. 

I'd always been an imaginative, highly sensitive, somewhat suggestible person. I recall wondering if it wasn't my imagination making it so, or the general landscape, or these modern times, but I knew something wasn't quite right with my head. 

In fact, I can recall the first time I experienced something acute. I vividly remember the first major flash of anxiety/depression: it happened during that year, in Italy, when I was 20 years old. I was sitting in a computer lab, typing a paper on Lyric poets, when thwap!--something changed. I looked around. What in the world just happened? Suddenly my stomach and veins filled with something poisonous and my brain said, almost calmly: bbbllllaaagggrrrhhgggffffuuuucccccckk. What? I got up and tried to shake it off, this feeling. I thought, I just need to physically shake my head around (shake my brain), do a handstand, maybe get a good night sleep. Then I'll be fine. For the rest of the day that feeling swelled up then died down. Every time it swelled up, I felt nothing short of terror. And every time it rolled back out to sea, I felt relieved, almost giddy, as if I'd survived something harrowing. 

The next day the feeling didn't happen--or maybe it did. I don't remember because I started drinking pretty early that afternoon with a friend who was studying in England and who'd come to town. He and I walked through the serpentine streets of Bologna, brushing our hands along the stucco walls and talking about friends back home, until we found a liquor store. We bought wine and whiskey and cigarettes from a machine, and then went to my apartment and worked on obliterating consciousness. I didn't tell him what had happened in the computer lab, but I did admit to having cut out booze for a few weeks prior to his arrival due to my concerns that I was drinking too much -- that I was drinking too much in order to deal with stress, and that I was now experiencing sleep problems -- worse than usual. He said the sleep difficulty was probably due to my quitting drinking. "That's all it is," he said. 

"You'll be all right," he said as he poured me another big glass of red wine. I touched my glass to his and nodded in agreement. Everything would be all right.

Between that year (2000) and this year (2012) my battle with anxiety and depression played a game of hide and seek. This is what I'd like to discuss -- the push and pull of mental illness. But how to discuss this exactly? How to portray my experience in a way that does justice not only to me, but to the reader -- the reader who has her own experience with her own mind -- and particularly the reader who knows exactly what I'm talking about when I talk about the Janus face of mental illness. When it goes away, you're sure--almost sure--it's gone. You've beaten it, conquered it. But it shows up again. Sometimes you see it right away and greet it by screaming (while driving in your car, looking out the windshield): fuck! Sometimes you say, nah, that's just the shadow of a worry or an unhappy memory--that's not the thing itself. Sometimes you insist it's not the thing itself for days, weeks, months on end, well into a full blown hole. Or you concede it is there, but insist that doing something about it through the assistance of the mental health community, would be tantamount to conspiring with the very patriarchy and state systems that are trying to control you and keep you docile. 

See, there's a well-founded opinion out there that chasing mental wellness is submitting to mind control. That seeking a life of coherence, semi-stability, and decreased suffering is seeking a life of numbed-out, zoned-out, semi-zonked bliss.

During graduate school, I dated a man who felt strongly about this. We'd go to Barnes and Noble in Rittenhouse Park or a used bookstore in South Philly and he'd find an edition of Michel Foucault he hadn't read. I'd buy it for him (this man, for all his self-declared brilliance, was, as Richard Powers has noted, an invalid of High Modernism). While I waited for him to come home from an evening out with his students, I would thumb through these volumes, reading the text and looking at his notes in the margin, gagging at his little models of the state vis-à-vis the masses. For the great Michel Foucault, state powers in collusion with the courts and psychiatric profession, created not mentally healthy individuals, but catalogued, categorizable and confined individuals. 

"For Friedan, Millett, Greer, the great feminists of the second wave, mind doctors constituted the enemy, agents of patriarchy who trapped women in a psychology they attributed to her, stupefied her with pills or therapy, and confined her either to the 'madhouse' or the restricted life of conventional roles."
Lisa Appingnanesi
For me -- just me -- when I'm in the midst of an episodic depression/anxiety, I don't have the luxury of reading ideas about madness through classical paradigms, or religious conceptions, through Lockean forms of insanity or neurochemistry breakthroughs or psychodynamic models of recovery. I'm just trying to stay functional, and aware that 'this too shall pass'... 

An episode is characterized by a day like this: Somewhere between putting shampoo in my hand and raising this hand to my head to lather my hair, I'm depressed. The bottom drops out. I'm fucked. My life is fucked. The future is a cruel joke, the past a cruel reminder of long gone salad days. Thoughts of death -- eternal absence -- pour down on me. I become obsessed with the drive to get out of the shower -- it's the shower that's the problem! I just need to avoid being in the shower too long! Then I'm out, drying my hair, dressing. I see the dog, resting on his blanket. The poor thing will die one day, I think. (How soon?) He will die, become food for the fishes, ashes to ashes, dust to dust, and I'll miss him. I'll feel sick about his missing, I'll -- oh shit, here comes the tidal wave, my face is sweating, my pulse picks up and I focus on belly breathing. Somehow I'm dressed and walking through the house looking for my shoes, taking deep breaths. The bed is unmade, I notice, and I make it, fearing if I come home to an unmade bed my already delicately constructed sanity will get the last push over the edge and that will be it. 

I recognize this is pathetic -- pathetic -- but, again, I don't have the convenience of casually evaluating my neurotic behavior or having a light-hearted (or dark-hearted) laugh at my own expense. My world, by 9 a.m., has taken on such a bleak pallor that I wonder if I should call in sick. But then what? Stay here, in this house, alone? I sit on the edge of the bed. I feel like my brain must be shortcircuiting. I feel my head start to ache in random places. My brain is leaking something! Something that's pooling and causing a dull, yet sharp, headache. And then, somewhere, the meta-me says: nothing whatsoever is happening and you are perfectly healthy and mentally sound and this is all an overactive imagination. But by now I'm hardly willing to believe that ME. That ME is gone and I am off, far away, down memory lane, remembering her -- the ME who never dealt with this shit, who never went through such panic just getting ready for work, who didn't dread every little fucking thing, the ME who entertained thoughts of death and despair and destruction, sure, but didn't host them interminably or drill into them demanding final answers. That ME could snap out of it and smile with warm assurance that at least I was only flirting with those ideas, I had control over them after all. I was one of the lucky ones, the sane ones. I could listen to wrist-slitting music and take it all in, grist for the mill, ideas for stories, moods to try on like hats at Macy's.

The ME that played the role of the depressive or the monomaniac, but didn't actually endure the legitimate symptoms, I lived with that ME for a long time. Long enough that I feel she's there, still -- older and wiser now, but still there. These days I've become a bit of a different ME. This ME is unfamiliar. This ME is un-calm, un-secure, un-cool, and un-happy. Somewhere, somehow, slowly then quickly, I crossed that porous line from regular crazy or pretend crazy, to real crazy. 

The worst part of being legit mentally ill is I have to live day in, day out with this involuntary terror and accompanying darkness. The next worst part is, I have to put these hideous feelings into words. In order for me to get better, I need to try to make myself understandable, to make myself understood. And the next worst part is, for one reason or another, there are people out there that are skeptical that anything is happening, at all. 

Cultural Construct, Genetic Disease
LIfe is nuts, the people say. Times are tough. Who wouldn't be mad in this environment? You are becoming increasingly aware of life's difficulties, that's all. (Honey, I've been aware for a long time. This isn't awareness, this is clinical depression.) As a psychiatrist recently said in an article on CNN, depression is a problem of perception. Life IS fucking brutal, and cruel, often wantonly -- but that's not the problem. The problem is I can't sit with myself for more than a few minutes without wanting to move. The problem is I can't remember the last time I was "in the moment" or the last time I looked forward to the future or the last time I didn't feel that washing up of despair over nothing at all. 

"I can feel my mind disintegrating again."

Sylvia Plath, Letter to Doctor Ruth Beuscher (AKA Doctor Nolan in the novel The Bell Jar) 
When I am in this state, all I can handle are crossword puzzles, Word Mole (Blackberry game), classic Tom Hanks movies, and young adult sci-fi horror novels. I want plot -- straight plot, with a dose of the super natural. I want to use the parts of my brain that handle task-oriented... tasks. I do not want to isolate and stew and fret -- as I know that makes my condition worse -- but that's what I feel driven to do. And, believe me, if you are reading this and thinking: um, that's called the human condition, jackass, I agree with you. I think this is normal. I think this is stock human condition stuff. But what about when this goes on, and on, and on, and on, and now you're avoiding making contact with mirrors because the sight of your reflection is too much to bear. What about when it causes you to sit up or turn over into child's pose while in bed because you're suddenly overcome with fear... of what? Of some half-formed dream that started and then shook you awake, or some disruption in your body's rhythm, or some primal fear of the unknown? What about when it causes you to wonder if being alive is tolerable? If this is what the rest of it is going to be like, is this tolerable? And then a thought creeps in. A thought that says, well, you just need to live the rest of the days of your life. That's all you need to do. As you walk from one building to another, you look at people -- do they feel it? You see someone laugh and toss her hair. You see a little boy who wants to be noticed. You see a small group conferring over weekend plans. You remember when you were like that, not just in college, but after... You wanted to experience life -- and you did. You still want to experience life -- but now you can't. For some fucked up reason, somehow now you can't.

"The attack subsided, but never completely, and I had the nearly constant feeling during the next few months that something terrible was going to happen, a visceral sense that even the ground I was walking on wasn't to be trusted as stable. At times the panic would begin to rise and I'd have to leave wherever I was and run outside to breathe."

Shawn Colvin, Diamond in the Rough
The paradox is exactly this. There's a popular working wisdom that says: people who take mental health drugs are doing so in order to protect themselves from experiencing life. Indeed, one of the oft repeated refrains I've heard is: I would never take meds -- never, or, I want to feel it all. Ah, yes! Me, too! I want to say, so do I! But my interlocutor doesn't seem to understand; they've decided I'm shirking my due, or trying to. They've positioned themselves on that side of the line, and to be fair, I've positioned myself on the other side of the line, the one that says: taking meds is not avoiding life and is not the coward's move and is not a cheat on the soldier's path. I flash back to 1999. I'm sitting on a couch in my apartment in Bologna, Italy. My boyfriend from the U.S. has asserted he's not my boyfriend, and I'm crying bitter tears of rejection, bruised ego, sadness, etc. It hurts, frankly. I'd like the pain to go away. My roommate, Giovanna, proffers marijuana. I say, no, grazie. I say "Voglio sentire tutto." And I mean it. I want to feel everything. At nineteen, I know that is part of the deal. You can't skip steps. You can't sidestep the hurting, or the missing, or the grieving, the wounded pride and battered vanity -- you need to endure all of this to get your hard won experience of relief. You need to go through the mountain, not around it, as they say in addiction/recovery circles. Or even better, as Alanis Morissette says:

You live you learn
You love you learn
You cry you learn
You lose you learn
You bleed you learn
You scream you learn
A mistake that thinking people make about those who battle depression/anxiety is that we are trying to erase discomfort, trying to to flatten experience. They think we are like the girl on the couch who's just been broken up with (except this time she wants to blunt the pain) or the woman who spends too much time in front of the computer doing work that doesn't engage her socially or on the community-level, or perhaps it doesn't validate what she learned in grad school (so she's trying to wash it all away with a pill that mysteriously makes it all OK--or at least tolerable. For the record the only pill I know that does this comes in a wine glass and is made of fermented grapes). These women and I, we apparently are trying to skip the stages of adulthood and avoid uncomfortable realities (e.g., life/work are sometimes meaningless, we're all going to die; friends, even good ones, let us down.) Yes, I cry! Bring me the pills! The ones marked Effexor/Lexapro/Prozac/Paxil/Zoloft/Celexa/Wellbutrin/Pristiq/Seroquel/Lamictal/Cymbalta/ETC! Bring those pills forth, the ones that work nothing like red wine and benzos (for the record I've never taken a benzodiazapine in my life, but apparently they're wonderful at muting distress.) 

Depression and anxiety are tricky for the taker to understand and tricky for the non-taking public to understand. A Pill? (Yes.) To make you happy? (Not exactly.) But aren't you just trying to find a synthetic solution to environmental/social problems? Avoid the big questions? Find the easy way out? Don't you owe it to yourself to experience these things? YES! In fact, I do! And by taking my meds, I'm able to experience these things: life, in all its fucked up splendor, emotions, good and bad, big questions, even the toughest and least fruit-bearing. 

"It's like there's some hook in your head. You're still fueling your fears by intellectualizing them, thinking this way and that." 

Mary Karr

Depression/Anxiety keep me from living my life. They keep me firmly pressed between NADA and OMFG and "I wonder if the wine store is still open..." 
As a culture, I think most of us are fascinated by mental illness, specifically, by its (il)logical conclusion: suicide. It is such an act against nature. Often so dramatic in its means, perversely glamorous, and so very final. But to the people who are left behind, there's nothing about it that even hints at glamour, or valor, or any of it. And to those of us who've had the unfortunate reality of this thought whispering in our ear, we can't help but think about that person who gave in. We can't not think of that person's state of mind and heart in the moments just before their death. Greg Dulli of the Afghan Whigs and The Twilight Singers had a few things to say on the subject of his friend, Elliott Smith’s death: "I told somebody that the thing I felt the worst about it was not that he did it or not that I wasn't going to get to talk to him anymore, but that I had thought about the five minutes before the act, and I think that's probably the absolute pit of loneliness and despair."

A Day in 2008

"He is alive to the way in which extreme circustances -- abusive relationships, the fatal power of suggestion by the strong over the weak, incarceration itself -- can derail sanity." 

Lisa Appignanesi.

I was driving home from work. It was 2008. I was 28. I worked in an office and lived in a one bedroom apartment in the Art Museum neighborhood of Philadelphia. I'd been depressed for months, maybe even a year at this point. I'd been hoping (with increasing desperation) that it would just go away. I thought: "This is an unfortunate phase. I've just left an abusive relationship. I've just completed a somewhat hellish graduate program. I work in a job that doesn't fulfill my desires. I am thousands of miles from family and long-term friends. Plus, I'm smart. And smart people suffer. That's all there is to it. I'm not mad, or insane, or crazy. I'll find a way out. More philosophy. More writing and journaling. More long runs and yoga. More self-help books. I am not actually depressed. I am NOT crazy. It's just time to revisit SARK."

"The history of my stupidity would fill many volumes."

Czeslaw Milosz
I'd been seeing a very good therapist for about a month and though that hadn't fixed my symptoms, it had given me a glimpse through the clouds. The sun had broken through enough to give me hope that things could be different, things could be better. This therapist had helped me sort out my feelings and come to terms with several salient issues affecting my life. However, the dull terror was still there, as was the sinking breathless feeling that seemed to descend upon me from nowhere -- at predictable and unpredictable turns. (I remember driving along the turnpike and having to pull off because I'd begun to feel unsafe. My eyes didn't feel like they were working, my hands started tingling. I started praying out loud that I'd make it to the exit. Another time, I was typing a mundane email, sitting at my computer, and I felt like the rug was pulled out from my universe -- I pushed my chair back from my desk and put my hands to my neck: was I still breathing? Nothing made sense, including me for a couple minutes, and I truly thought life -- as I had known it -- was over.) That's the thing: for anxiety and depression sufferers, while you're in the throes of it, life feels, more or less, over. 

One of the distressing aspects of mental distress is what I said before: trying to explain what's going on to someone, and hoping they hear you, hoping they don't challenge you about what is a baffling and devastating illness, hoping they don't undermine your experience. To be fair, it's hard for anyone to know how to respond. But, in my experience, all you or I or anyone needs to do is show compassion and trust that the person reaching out to you is looking for support, not a critical appraisal or a corrected copy of their views -- not even on the otherwise objective categories of depression, psychotherapy, and the complex world of medication. It is incredibly difficult when you try to tell someone what's been happening and they deny you're experiencing anything unusual or anything that needs assistance, or treatment. Sometimes they make it about them. You try to say, I am sorry you've gone through that and I hear you, however I wasn't trying to deny you your pain. But what's the difference? they say. I'm talking about clinical depression and panic disorder. (Oh, they say, those are just names Big Pharma invented, they'll say). OK, you say, I'm talking about feeling like I'm dying while parking my car. I'm talking about crawling out of my skin at a random moment. Sure, they nod -- I'm talking about the same thing, just with different terms. No. No, you think. You haven't heard me.
How do I know this? It's a look. A response. Anyone who has been through the very real hell of mental illness will not placate you or swat away your symptoms and feelings as so much quotidian melodrama. They'll get it, often right away. Their eyes will tell you immediately: I am so fucking sorry. And amid all the bullshit responses you've received, after sharing your most private (and, tragically, embarrassing) pain -- after so much historicity of mental illness thrust on you alongside anecdotal nods to the preponderance of evidence from clinical trials -- you will receive a look of compassion and empathy, a look that says, dang, I'm so sorry. 

And this, will mean everything.
But to close I'd like to return to that memorable day in 2008... I was driving along Girard Avenue, heading to my apartment on a Friday, the end of the work week, and I stopped at a traffic light. I looked out my window and noticed the door frames of the row homes and tenements that lined the street. They were brightly colored and ornate and looked Moroccan. I thought: those are beautiful. It wasn't like a psychedelic trip. It was like, I'd been in a fog of near despair and suddenly that cloud lifted. I'd been on an SNRI medication for almost two weeks when this moment occurred. Tears stung my eyes at the realization that I was feeling something -- I was feeling someone -- that I hadn't felt in a very long time. This person, was ME.

"When I'm crying, when tears are actually coming out of my eyes, I know the medicine is working." 


Post Script: 

I ultimately went off that medication after two years of happy use. I wanted to see if I was one of those people who only needed to be on medication temporarily. I was optimistic and I made plans to make up the difference (extra exercise, social engagements, talk therapy).

Things didn't get bad right away, but when I realized they'd gotten bad, it was beyond regular miserable. In that place, I wouldn't have been able to write this. I'd have been too busy focusing on breathing, surviving the next ten minutes, and wondering why the fuck I had to enter this world. While the critics debate meds, I will be taking mine and seeing a therapist who assured me a while ago that my goal shouldn't be not to take meds, but to be healthy -- happy needs more qualification, but I can admit to pursuing health. I can admit to saying yes to health. Beautiful, complicated, glorious, phenomenal health. 

Normal, Happy, Crazy
-- Abbi Mireille Dion
   August 27, 2012

For Further Reading: 

from "On Depression and Getting Help"
"The sole reason I've written this is so that someone who is depressed or knows someone who is depressed might see it. ... But after having been through depression and having had the wonderful good fortune to help a couple of people who've been through it, I will say that as hard as it is, IT CAN BE SURVIVED. And after the stabilization process, which can be and often is f**king terrifying, a HAPPY PRODUCTIVE LIFE is possible and statistically likely. Get help. Don't think. Get help."
Rob Delaney, from "On Depression and Getting Help"

"In 1987, less than one person in 100 was being treated for depression. That had doubled in 1997, and by 2007, the number had increased to slightly less than three.My friend Dave was part of that tally. We met in our freshman year of college, and he was one of the loudest, funniest, most exuberant humans I'd ever met -- and the most deeply depressed. Not that anyone outside our intimate circle knew; like many of us who live with the condition, he wore a brighter self in public to distract from the darkness that settled over him behind closed doors. Most people don't see depression in others, and that's by design. We depressives simply spirit ourselves away when we've dimmed so as not to stain those who live in the sun. Dave saw it in me, though, and I in him [...] Dave never made it that far. A year after graduation, in the late summer of 1995, I was un-surprised but thoroughly gutted when I got the call -- Dave had tidied his apartment, neatly laid out a note, his accounts and bills, next to checks from his balanced checkbook, and stepped into a closet with a belt. [...] Dave was the first person I ever knew with Internet access. Among a million other things I wish he'd lived to see is the community of souls online, generously baring and sharing their depression struggles with strangers. There's no substitute for quality therapy (in whatever flavor you take it) or medication (if that's your cup of homeopathic tea), but by God, it's hard to get there."

from "Acknowledging Depression"
"In Europe, Lord Stevenson of Coddenham, one of the most powerful men in Britain, has spoken openly about his depression and the necessity to change the attitude that depression is "self-imposed" and something to be "snapped out of." Alastair Campbell, Prime Minister Tony Blair's former director of communications and strategy, has said that he never tried to conceal his manic break from the public and felt that he was treated well by people and by the press. He also believes that he is a better and stronger person as a result of his breakdown and his openness about it. Former prime minister of Norway, Kjell Magne Bondevik, took sick leave when he became depressed; polls taken at the time indicated that his countrymen overwhelmingly supported his honesty."


·     "Mood stabilizers changed my life.  I ran the gauntlet of anti-depressants (failing at each one). Then I convinced myself for years that a magical combination of exercise (maybe yoga! maybe spin class!), sleep, vitamins, creative pursuits (art class! no, trumpet lessons!) meditation, and self-tolerance would be the key to cutting back the highs and lows. It was after visits to therapists, doctors, every gym in the county, classes, the dentist (maybe it's gum disease - it wasn't and that's ridiculous) and even the optometrist (maybe bad eyesight was giving me headaches that made me depressed - it wasn't) that I made an appointment with a psychiatrist that changed my life. It's not that you aren't normal, she said, it's that your combination of things that make you awesome is individual. And then she prescribed a mood stabilizer and then I really was awesome. Just like she said."

N.B. This is not meant to be polemic, but to be a resource or simply an account of one woman's experience with anxiety and depression. Please feel more than free to handle your mental health as you feel best. XO

I am welcomed on a boat—it’s a canoe hollowed from a dark tree.
The canoe is incredibly wobbly, even when you sit on your heels.
A balancing act. If you have the heart on the left side you have to lean
A bit to the right, nothing in the pockets, no big arm movements, please,
All rhetoric has to be left behind. Precisely: rhetoric is impossible here.
The canoe glides out over the water.

--Tomas Transtromer, “Standing Up”


RGZ said...

i've just read this for probably the 15th time. i've sent it to a client -- and this is not the first time i've done that, either. as far as i am concerned this is the seminal piece on depression. ;). really though. no competition.

Unknown said...

Wow. Just wow. Thank you for sharing this, you are my hero.