Modern Madness

by Terri Cheney

  Maybe you have to be a survivor of multiple suicide attempts to understand how urgent this felt. I was so proud of my “clean and sane” time—the many, many occasions when I’d wanted to kill myself but had resisted the temptation. It had been so hard when I was suffering to put all the pills back into their bottles, to log off the creepy instructional websites, undo the nooses I’d so carefully tied, and commit to yet another day. Sometimes it had taken every last ounce of my will and every last vestige of prayer, but somehow I had done it for ten whole years and no one—no one!—was going to snatch that accomplishment away from me.

  I’m beginning now to receive what I’m sure will be dozens of exorbitant medical bills. But they can’t overshadow the joy of the final verdict, which is printed proof on those bills: “Overdose, accidental/unintentional.” In all my years of practicing law, it’s my sweetest victory. It’s proof that I’ve chosen to live.

  NEVER BE FOOLED BY A SMILE

  It was just another day. I was driving to the car wash when I got an email from a friend back east. The subject line was oddly worded, and for a few moments its true meaning didn’t sink in. “My Wife Rebecca Taking Her Own Life,” it said. It sounded like it was describing a picture or a video, and I couldn’t even begin to imagine what that would look like. But the body of the email went on to explain that my friend’s wife, Rebecca, had died by suicide. The message didn’t offer any explanations, only details of a memorial service to be held in a few days.

  I pulled over to the side of the road and waited for a reaction to flood me. But all I could feel was surprise. Surely there was a mistake, the message wasn’t meant for me, it was some other Rebecca, somebody else’s tragedy. The Rebecca I knew would never have taken her own life. Sure, she had a mental illness and suffered greatly from it at times. But she would never have given up the fight.

  I’d met Rebecca and her then-boyfriend Frank at a mental health support group in L.A. Frank was bipolar, and I believe Rebecca’s last diagnosis was schizoaffective. I wasn’t all that fond of the group, but I was very fond of Rebecca and Frank. They made such a charming couple—both struggling but very supportive of each other. And they were so knowledgeable about their conditions. They read everything, attended every local lecture on the subject, and could pass for doctors if one didn’t know better.

  It’s true that Rebecca was sometimes slightly “off”—I could tell her medications weren’t working quite right at those times. She would stare into space or answer a question a few beats too slowly. But that was just a small blip on the screen; the big picture was so impressive. Rebecca had graduated UCLA with a psychology major and attained her master’s degree in another field. She knew where she was going: she wanted to teach, and I always thought her future students would be lucky to have her.

  I ran into Frank a few years later, and he told me that he and Rebecca were going to be married. They were planning to live in Iowa, and attend school there so Rebecca could get yet another degree. I was sorry to see them go, but so proud of them for achieving the American dream, in spite of the significant odds against them. They were a true success story—proof to many of us with mental illness that love and marriage were not impossible goals.

  She did everything right. What could have possibly gone so wrong?

  Recently Frank got back in touch with me. He sent me a picture of Rebecca, taken shortly before she killed herself. You can’t imagine a sweeter scene: Rebecca curled up on a couch with her beloved cat, a beatific smile on her face. If angels ever deign to live on earth, that’s what Rebecca looked like. What in God’s name had happened?

  Frank told me he blamed himself for Rebecca’s suicide, which troubled me because he always took such good care of her. He had been called out of town, he said, and she was lonely and anxious without him. He felt like he hadn’t been paying close enough attention, and didn’t take her expressions of pain seriously enough. As he so poignantly put it, “I didn’t understand her intent until I learned she was dead.”

  I tried to reassure him that suicide often has very little to do with the people around you. It’s an intensely personal act; the emotional pain blots out any thoughts you might have about how your actions could affect others. Too often, there’s no obvious warning. And afterward no good answer to the endless “why.” Then I emailed the picture of Rebecca to people who were close to me. “Just so you know,” I wrote. “You have to watch for suicide, like you’d watch a smoldering fire.”

  I wonder how many people really understood what I meant. I got responses like, “What a pretty girl” and “What a beautiful picture.” They wanted to know if the cat was all right. But no one responded directly to my warning about suicide. I guess the world is too willing to be fooled by a smile.

  Take it from someone who’s been there and back: If you love a person who’s suicidal, you have to see beyond that smile. It’s all too easy to look fine and feel desperate. In my own life, the closer I’ve come to killing myself, the finer I’ve appeared. I don’t want to be foiled at the last minute, so I pretend I’m getting better. Maybe I even look like Rebecca on that couch.

  But you have to ask, and keep on asking those people in pain: Do you have a plan, are you stockpiling pills, is there a gun in the house? Sure, they may get annoyed with you, but annoyed is better than dead. Do I wish my loved ones had nagged me like this, and seen past my facade? Yes. Do I blame them? No. As I told Frank, suicide is nobody else’s fault—it’s your life to live, and yours to end.

  And yet… For all my cool, dispassionate take on the subject, the truth is I’m still terrified by how close I’ve come to dying. A child’s voice inside me says, why weren’t they watching more closely? Why did they leave me alone? Of course, as a grown-up, I realize how utterly unrealistic this is. No one has X-ray vision; Superman’s just a cartoon. But you get very small when you’re suicidal. You want to be looked after, coddled, taken by the hand to cross the street. Part of you really wants to be watched, even as you push people away.

  Rebecca, if you’re listening, I promise you: my eyes are wide open now.

  THE MIND-BODY CONNECTION

  “A sick thought can devour the body’s flesh more than fever or consumption.”

  —Guy de Maupassant (1850–1893), Le Horla et Autres Contes Fantastiques

  Whoever came up with the term “mental illness”? I’d like to meet him and smack him around. He did us a grave disservice because what we deem mental illness isn’t just limited to the brain. According to the National Institutes of Health, “there is no real division between mind and body because of networks of communication that exist between the brain and neurological, endocrine and immune systems.” An increasing number of medical schools, including Harvard, UCLA, and Columbia, now have departments devoted to mind-body research and treatment.

  This relatively new interdisciplinary field, often called psychoneuroimmunology, has witnessed an explosion of empirical findings. Among the most promising theories being tested is that mental illness may have its root in inflammation, the by-product of an overactive immune system (https://www.health.harvard.edu/newsletter_article/infection-inflammation-and-mental-illness). The discovery of objective “proof” of mental illness—that elusive biomarker that would verify a diagnosis—could have profound results on treatment. Just as importantly, it could greatly diminish both societal and self-imposed stigma by facilitating “a shift toward parity of esteem between physical and mental health” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436791/).

  The science may sound complicated, but the conclusion is simple: Mind and body aren’t strangers who haven’t been introduced. What affects one is very likely to affect the other. Maybe we find that frightening because it dissolves our artificial limits. It shows that mental illness is systemic and consumes far more territory than we had previously believed. In short, the mind leaks.

  WHEN YOUR MIND WON’T LET YOUR BODY MOVE

  One of the hardest things to explain to other people about bipola
r depression is that it robs you of control—not just over your emotions, but over your body as well. There’s a phenomenon called “psychomotor retardation” that occurs in many episodes: It can begin as a general slowing of your mental and physical processes and worsen into a near-paralysis. Of all the things I hate about depression, I think this tops the list.

  I don’t just mean that it’s hard to move; I mean it’s practically impossible. Let’s say there’s a bowl of frozen yogurt sitting in front of me, waiting to be eaten. I love frozen yogurt; I believe it makes the world a better place. But when I’m severely depressed, I can’t summon up the energy or willpower necessary to grasp the spoon. The yogurt just sits in front of me, taunting me while it melts: “Who’s frozen now?”

  If I can’t surmount the paralysis long enough to do something that gives me pleasure, imagine what it’s like to face the unpleasant chores of daily living. Just the thought of getting out of bed plunges me into despair. Then there’s the ungodly rigors of brushing my teeth. The torture of fluffing the pillows. The agony of buttoning my sweater. It’s all beyond me, yet it has to be done and I swear to you, I’ve lain in bed for hours just trying to toss off the duvet so I can tackle life.

  I’ve tried over and over to explain the horrors of psychomotor retardation to my doctors, friends, and anyone who will listen. I want them to see past my inert body and into my torpid brain. Maybe then they could truly understand that my failure to respond to messages, inability to socialize, lassitude, and lethargy are in no way voluntary. But no matter how much I plead for understanding, I always feel like I come up short. Like I’m whining about something ephemeral that’s within my control—something I could master if I really tried.

  I’ve really tried.

  That’s one of the reasons I get so upset when well-meaning people try to cheer me up by telling me about all the studies saying exercise can cure depression, or that it’s at least as effective in treating it as antidepressants are. Invariably, these people forget an essential modifier that’s used in all those studies: “moderate” depression. Believe me, if I were only moderately depressed I’d be the first one to jump up out of bed and go grab myself some sunshine. But when I’m depressed to the point of paralysis, I just hear that advice and blink with incredulity. They’re kidding me, right? If I could move, would I be lying here helplessly enshrouded by my duvet? If I could move, why the hell wouldn’t I?

  Once when I was in the psychiatric hospital, I met a woman who was so depressed she was almost catatonic. She could barely blink, let alone groom herself or interact. Then her doctors tried a new drug on her, and I’ll never forget what happened next. One morning before a therapy session, I watched her pull her comb from her purse and start to brush her hair. Long, fluid strokes in a smooth, even rhythm—so beautiful no ballet I’ve ever seen could possibly compete. With that movement, I knew that her depression had ceded control and she was in charge of her life again.

  I often think of that moment when I’m bound by paralysis. I dream of the day when I, too, will simply get up and brush my hair.

  THE BOTOX CURE

  A study suggesting Botox may be a treatment for depression raised eyebrows, so to speak, at a recent American Psychiatric Association meeting. The study, conducted in Germany, showed a positive effect on the mood of patients who’d been injected with the toxin in certain facial muscles involved in emotion—particularly frown lines between the eyebrows.

  As I understand it, the theory is that these muscles send feedback to the brain, reinforcing negative emotions by a frown or a furrow. But Botox prevents the muscles from moving, thereby stopping the signals from reaching the brain. The result: you look and actually feel less depressed. And significant results may be achieved with a single treatment.

  Anthem Blue Cross, are you listening?

  I didn’t need a study to tell me that depression and appearance are closely aligned. After years spent in hospitals and mental health support groups, I can spot a depressed person from across the room. The sagging face always gives it away. I’ve often wondered: Does gravity affect depressed people more than others? Because that’s what it looks like to me—like the weight of the world is pressing on the flesh, deepening the nasolabial folds and dragging the eyes and the mouth down, down, down.

  I’m not immune to this phenomenon. I used to think I hid my depressions pretty well, behind a relatively composed and neutral countenance. But all the publicity I did for my books gave me a unique opportunity to see myself as others see me. In photo after photo, reel after reel, I saw what I looked like when I wasn’t “on”—before the cameras started to click and my public face took over. It was a revelation that I’m still trying to process.

  There was only one word for it: grim. And this was after a makeup artist got through with me, airbrushing out the wrinkles, simulating a healthy flush on my cheeks, making my eyes and skin glow. Sure, as soon as the red light blinked or the interviewer spoke to me, I instantly became animated and life and light poured back into my face. I flashed an eager smile. But until I knew I was being watched, I looked like my dog had just died.

  What I wouldn’t give to un-see those pictures, to forget that I ever looked like that. It shook me to my core because up until then I had truly believed that I passed for normal most of the time—that you’d never know, just to look at me, the sorrow that’s burned through my soul. But there it was, for all the world to see and to judge.

  It’s taken me a while to develop some compassion for the sadness that’s been etched into my face after so many years of struggling with depression. I suppose I could take the approach that these are my battle scars, honorably won and therefore something to be proud of. I suppose. For the time being, I’m just trying to remember to smile: not simply for publicity, but for the sake of my face. If there’s such a thing as neuroplasticity for the brain, maybe my countenance can be retrained, too.

  Botox may sound a bit Beverly Hills, and I doubt my insurance would go for it. But you know what? I think that study is right. Smiling doesn’t just lift my eyes, it lifts my heart, as well. It’s hard to feel truly miserable when my face refuses to participate in the gloom. Of course, sometimes it’s simply impossible to smile, no matter how hard I try—it feels like a betrayal of my true emotions. But if stopping a frown can deceive depression, I’m all for cheating on myself. As Thích Nhâ´t Ha·hn put it, “Sometimes your joy is the source of your smile, but sometimes your smile can be the source of your joy.”

  HOORAY! I’M REALLY SICK!

  For several months in a row a while back, I’d been flat-out exhausted. Not just tired—running on fumes. Worse yet, my mood was oscillating. After a long period of being relatively stable, I was ping-ponging between bouts of intense irritability and depression. Therapy once a week didn’t help. Twice a week made me feel even crankier, mired in inertia and self-pity. It was time to call in the cavalry: my psychopharmacologist, the doctor who prescribes my medications and has the power to send me skyrocketing or plummeting, depending on the dose. I simultaneously admire and fear him.

  With some trepidation, I left him a message, telling him I was cycling again. Just saying this to his answering machine made me feel like a bad patient, like I must have failed him somehow. A better patient would simply swallow her pills and be magically cured, to validate the magician. But he called me back immediately, and we pored over my list of meds, trying to find something to fiddle with.

  My doctor’s very cautious, and before he would adjust my dosage or try a new drug, he insisted I get some blood work done, to make sure I wasn’t damaging my kidneys or doing other nefarious things to my body in my ongoing quest for sanity. I reluctantly complied, although needles scare me, the tests sounded expensive, and I was certain they would reveal one of those gruesome possibilities I’d read about online.

  My doctor called me a few days later. “I got your labs back,” he said.

  Kidneys for sure, I thought, or maybe my liver. Or cancer. Google had said so. I
sat down and gripped the arm of my chair. “What is it?”

  “Your thyroid’s completely out of whack,” he said. “It’s way below what it ought to be. That’s probably what’s causing your fatigue and low spirits.”

  Hypothyroidism! I wanted to kiss him. Only someone with a mental illness will understand my ecstatic reaction: This time it wasn’t all in my head. What was happening to me was quantifiable—I could check it and chart it and predict its response. Whereas with bipolar disorder, you have to rely on assumption and faith because no one has discovered a definitive biomarker yet. If only there were a blood test, an X-ray, a saliva sample—something concrete a doctor could point to and say, “Yes, you’re bipolar”—then no one could deny its existence. Until then, it’s a cluster of symptoms dangling from a theory.

  Treatment for my hypothyroidism was a breeze compared to the systematized torture I’ve come to expect from voodoo psychopharmacology, even at the hands of a brilliant physician. At one point, I was intimate with practically every antidepressant on the market because I’d slept with them all. Some of them twice. I know it’s good that we have more options now, but it takes forever to comb through them—and when you’re suicidally depressed, it’s beyond cruel to have to wait six to eight weeks to know if a medication will give you relief. Then to start a new one, and wait again. And again, and again, until you hit the drug lottery. Or not.

  There is at least reason to hope: I know that studies are in progress to determine whether a patient will respond to a particular drug, and how long it might take. Narrowing the field this way could revolutionize treatment, saving millions of dollars as well as millions of lives. But however well-intentioned, studies make promises that take too long to fulfill when patients are in extremis. It shouldn’t have to be so hard.