Modern Madness

by Terri Cheney

  When I do manage to send it though, the responsibility shifts—and somehow this is the point where it all gets screwed up. For the first few days, I get inundated by calls and texts and emails that I can’t return, containing insistent, intrusive offers to visit, bring me movies, take me out to dinner. I know people sincerely want to help, but if I could go out to dinner, for Christ’s sake, I wouldn’t have had to send that message in the first place. I also get tons of well-meaning advice, and there’s nothing more demeaning and distancing than hearing “you should” when you can’t.

  Or else, most mystifying of all, I get silence, the very last thing I want to hear. Nothing. Not a word, not an inquiry, not a whisper of hope—from people who supposedly adore me. It breaks my frayed and aching heart, and is a complete enigma to me. How can anyone know that a loved one is going through hell and not reach out to comfort them? I don’t get it; I never will. I’ve talked to my therapist about this, and he told me, “People are afraid of complicated emotions. They’re afraid they’ll be caught up in the depression.” I think the more likely explanation is what I always hear when I come back to life: “I thought you wanted your space.” Yes, but not a vast, empty void.

  I realize that helping someone who’s depressed is a very complex scenario, but there are some simple answers. If you who worry that you may not be doing enough, let me tell you what has really worked for me:

  1. Leave a quick check-in message on my voicemail: “I love you. This will pass.” Or,

  2. Send me a short email or text: “I love you. This will pass.”

  3. Repeat as necessary.

  Anything along those lines would mean the world to me. You’re not asking me to do what I can’t. You’re not arguing with me about how I feel. You’re just reminding me that I’m alive, and that it matters to you. Even if it doesn’t to me.

  IT ISN’T “JUST” ANXIETY

  Very often a mental illness diagnosis doesn’t travel alone. It’s accompanied by other diagnoses: anxiety, in my case, or substance abuse, or eating disorders, etc. This is such a common occurrence there’s a special word for it: “co-morbidity.” A scary-sounding word and a troubling situation, which makes everything more difficult: diagnosis, treatment, recovery, and especially relationships. It’s hard enough to learn how to deal with one disorder, without the extra curve.

  Last week I’d made plans to go to lunch with a friend, but that was before I was besieged by intense anxiety. What was I feeling so anxious about? Everything, nothing, I didn’t know. Vague, restless spirits were blackening the sky, and calamity was coming, that was all I was sure of. I called my friend and told him how I felt so he could back out of the lunch if he wanted to—because my anxiety, if not handled properly, can devour everything in its presence. He took me up on my offer. He’s seen me anxious before.

  I was hurt, but I wasn’t surprised. Despite its harrowing nature, anxiety seems to be the least respected of the mental illnesses. Depression is now recognized as having a physical component. Schizophrenia and bipolar disorder have achieved a certain gravitas. But anxiety? Please. Get over it.

  Everybody gets anxious, or so they think. And they deal with it. So why the fuss? Obviously, we need a different word to describe the nightmare that is clinical anxiety. It bears little resemblance to the garden-variety jitters everyone is familiar with. When I’m anxious, it’s almost worse than being depressed. It’s like a metronome is lodged in my brain, ticking off potential disasters. That endless litany of “what if, what if” crowds out any thoughts that might be useful or soothing.

  Most people get anxious about specific things, and when those things get better, the disquiet disappears. But with generalized anxiety disorder—which affects at least 6.8 million adults in the United States—there’s no apparent cause for the apprehension that haunts one night and day. It’s just free-floating fear, a sense of great and imminent doom that can’t be reasoned away. Feeling anxious over a bill, or a relationship, or a work issue now and then doesn’t begin to approximate the pervasive distress of chronic anxiety. An occasional shadow crossing the sun is not a raging storm.

  Clinical anxiety isn’t just a figment of an overactive imagination. Cold hard science proves its existence. For example, it’s clearly genetic: A child is six times more likely to have it if one of his parents does. Yet despite the evidence to the contrary, we still consider anxiety to be a character defect, a moral failing that could be cured if a person just showed a little more grit.

  Take my friend who doesn’t like being around my anxiety. He says it disturbs him to listen to me talk about it. I can hear our canceled lunch conversation now:

  “You’re acting funny,” he’d say. “What’s going on?”

  “I’m terrified I’m going to end up alone,” I’d say.

  “You’re not alone at the moment, you’re with me,” he’d say. “Stop worrying about the future.”

  “But what if I’m right?”

  “But what if you’re wrong?”

  “But what if I’m right?”

  I’d feel his patience unraveling. “Why are you obsessing about this?” he’d say. “Order something, already.”

  “But isn’t it better to worry now than to be blindsided later?”

  “You could be hit by a meteorite later. Why don’t you worry about that?”

  “Why? Do you know something?” I’d ask, scanning the sky.

  He’d sigh. “You’re wearing me out.”

  Now this may be strictly a personal take, but as with depression, I don’t want to be talked out of my feelings. I want to enumerate, out loud, all the reasons why I know something wicked is coming my way and is about to feast on my bones. It helps to get those thoughts out of my head—even I can sometimes hear how absurd they sound when they’re exposed to the open air.

  But the way we treat anxiety these days, you’re not allowed to dwell on those “dangerous” thoughts. You have to medicate them away, disprove them via cognitive therapy, or otherwise pretend that they don’t exist; which makes for a very lonely, very guilty mind when they refuse to leave. So maybe it’s best that my friend said no to our lunch—I’d feel so isolated in his company. Trust in science and logic, he’d tell me. Two and two will always make four, and prime numbers will go on forever. If I could just believe this strongly enough, there’d be no reason to worry. To him, life is that explicable.

  But reason and logic are generally useless and frankly, potentially harmful tools when it comes to handling my anxiety. They dismiss and belittle and can make things worse. That’s why I’d feel much calmer and happier if my physics-spouting friend would just sit there and let me tell him I’m scared. I wouldn’t feel so completely alone, and maybe he wouldn’t feel so puzzled and impatient. He’d know why I seem irrational and on edge, and we could both investigate the underpinnings of my concern. Maybe, who knows, it would dissipate—maybe even in laughter. At the very least, I would feel heard; nothing soothes the frenzy of anxiety like being heard, and being loved and accepted anyway.

  THE RULES OF SUICIDE

  Camus said it best: “There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy.”

  Fundamental philosophy aside, I’ve learned a lot about suicide over the years. Some of the knowledge comes from straight research, but mostly I know way too much about suicide because of my own attempts. I’ve met that enemy face-to-face; I’ve studied his features up close. Unfortunately, my reluctant insight also comes from having lost people I love to suicide. Every time it happens, I think I’ve steeled myself against the grief. But I haven’t, and I doubt I ever will. That’s why I want to share what I’ve learned, however ruthless the lessons may seem. It’s essential knowledge, cruelly acquired.

  First, a note of reassurance: in my opinion, assigning blame after a suicide is pointless. There are always echoes of guilt: Could I have said something, done something, se
en it coming? If only I’d been there at that last moment. If only we hadn’t had that stupid fight. If only I’d seen the signs. The “if onlys” ring in your head so loudly, they drown out everything else. This may be small comfort to offer, but I think it’s best to let go of the guilt. I know from my own experience that sometimes, at my lowest, nothing anyone can say or do will deter me.

  But there are a few proactive things to try with those who are still alive and willing (however reluctantly) to listen. As is always the case with mental illness, preemptive education is key. Learning the nasty truths about suicide, and imparting those truths to someone in distress, can be an extremely powerful intervention. It may seem harsh, and it may not be what that person wants to hear at that moment, but you might just shock him into wanting to live. Here are three hard facts about suicide that have made a huge difference to me:

  1. PEOPLE WILL BE VERY ANGRY AT YOU IF YOU MAKE AN ATTEMPT

  It doesn’t matter that you’re suffering so much you feel you have to resort to a step this drastic. Suicide is and always has been the ultimate social taboo. People are terrified of it and therefore terrified of you for not having honored the rules. At a time when you need tremendous love and support, you will be yelled at, cursed, accused of cowardice and selfishness, abandoned, and generally made to feel like a pariah. This is a guarantee.

  Rather than celebrating your survival, people will think you weren’t serious. They will underestimate your pain. How many times have I heard those terrible words: “It must have just been a cry for help.” Now when you tell people you feel suicidal, they will think you’re crying wolf. You will lose all credibility with your loved ones and your doctors, just when you need it the most.

  2. YOUR DOCTORS MAY REFUSE TO TREAT YOU

  Many of us, when we enter therapy, make a contract promising we will not attempt suicide for the duration of treatment. Believe me, doctors will enforce that promise. I once had a caring, committed psychiatrist call me in the hospital after I’d made a serious attempt. I ran to the phone, eager for his help. He terminated our relationship, not without empathy but with no wiggle room, either. Even if you’ve never entered such a contract, you’re likely to experience problems with your current and future treatment. Doctors are very concerned about their liability, which means it might also be difficult for you to find another health care professional who’s willing to take you on. You’re now officially labeled a risk.

  3. YOU RUN A HUGE RISK OF MAIMING YOURSELF

  The body revolts. It clings to life, no matter how ardently you try to break that bond. But just because you don’t manage to die doesn’t mean that you escape suffering. Time and again, I’ve inflicted horrible injuries on myself while spiraling into unconsciousness. I once fell so badly after an overdose, I couldn’t walk for six months without the use of crutches. Another time, I sustained such terrible bruises all over my body that when I was taken to the emergency room, the police assumed I was a victim of domestic assault and hauled my boyfriend in for questioning. That was the end of that relationship. However you may feel about life right now, it’s a mighty and tenacious force that we apparently are not supposed to tamper with.

  I’d tattoo these grim but inescapable facts on your loved one’s brain—or better yet, write them down and post them on his refrigerator because the brain isn’t always accessible when someone’s suicidal. And you need to remind him of some softer truths, too: (1) You love him, no matter what; and (2) Life is constantly changing. Not so very long ago, I was practicing knots for a noose. Today I’m sitting in a charming outdoor café at a museum, eating asparagus purée soup with a grilled-cheese sandwich. What changed in my life? Nothing—except my brain chemistry. Today, the grilled cheese tastes delicious.

  RANDOM ACTS OF KINDNESS

  Several summers ago, I was struggling financially, and as a result of the stress, I developed an ulcer. Then I found out I had cancer on my nose and needed reconstructive surgery. But the worst was yet to come: the man I loved left me—without a word, without any warning. This combination of events proved too much for me, and I dive-bombed into a vicious, suicidal depression. All I’d ever known boiled down to this: if the world could be so heartless and cruel, I didn’t want to be a part of it anymore.

  My support team did what they could—my therapist phoned me every day, my psychopharmacologist prescribed drug after endless drug. But I was so shocked by the savagery of the universe, I couldn’t understand why anyone who loved me wouldn’t just let me die. I didn’t know then that life doesn’t care if you’re suicidal. The gas bill needs to be paid regardless; the body still needs to be fed.

  That summer, in my writing group, I casually wrote about a situation I was facing: I could afford either groceries or medication, but not both. I didn’t write this seeking help, I was just cataloging a realistic, if gruesome, fact of my life. A couple of days later I received a card in the mail from my group, with a check large enough to get me past my dilemma. I didn’t have the slightest idea what to do—I was stunned and perplexed and deeply touched. I wasn’t sure what the proper protocol was for taking money from friends. But desperation trumps protocol every time, and I quickly cashed the check.

  A few weeks later there was a knock at my door. I opened it to a delivery man bearing a glorious bunch of white lilies. They were from a person who knew I was severely depressed because I kept canceling our lunch plans. Getting flowers is always great, but these were extraordinary because there was no special occasion, and they were a custom bouquet. The sender knew from reading Manic that white lilies mean the world to me. Every day I inhaled that heavenly fragrance, I felt a little farther from death.

  Shortly after that I ran into a man I hadn’t seen in years. He asked me how I was, and I didn’t have the energy to edit.

  “I feel awful,” I said. “Life sucks.”

  “I know,” he said. “Me, too.”

  With that we cut clean through the viscera and got down to the heart of things. I told him about my faithless lover. It turned out his wife had left him, too.

  “I don’t see any point in going on,” I said. “I’ll never love again.”

  “You may love, but it will never be the same,” he responded.

  All this on the street corner. You’d think it would have increased my despondency to have my worst suspicions about life confirmed, but it didn’t. It made me feel human again to be privy to another person’s wounds. They were different from mine, but close enough to make me realize that I didn’t have a monopoly on pain. The music was sad, but it struck a universal chord.

  By unspoken consensus we walked to a nearby park and spent the next two hours commiserating. I got to say everything I wanted and someone listened and gave a damn. And I listened back with an intensity of empathy that surprised me—I’d thought that part of me was dead. As the day slipped tranquilly into night, I could feel something ripped and shredded inside me slowly begin to knit together.

  Money, flowers, and an open ear: random acts of kindness performed not for gain or advantage, but simply because someone cared enough to make the effort. It made me realize an essential truth. The world may be brutal at times, but it’s also capable of great compassion, and that’s a world I want to live in. I’ll never again underestimate the boundless power of a small benevolence. I know now what that transaction’s worth—you not only get to reap the karma, you may just rewrite a life.

  I’M NOT SICK AND YOU CAN’T MAKE ME

  When I was a litigation attorney, I had to learn to think fast on my feet. Courts are no place to dither; judges have zero tolerance for hesitation. As a result, I can usually improvise my way through question-and-answer sessions at readings and lectures. It helps that growing older has made me humbler than I used to be. I can now say, “I’m sorry, I don’t know the answer to that” without dissolving into a puddle of shame. But there’s one question that I consider my nemesis, the one I most dread to hear, and that always—always!—gets asked: “How do you help someone who do
esn’t want help?”

  The question is inevitably preceded by a very sad story about a loved one’s continuing fall from grace; the devastating impact it’s having on all those around him; and his inexplicable refusal to take medication, go to therapy, or even acknowledge that anything is wrong. I can tell who’s going to ask the question almost before they speak: Frustration is written across their faces. They are maxed out: they’ve tried everything—and yet they’re hoping against hope that I’ll have an answer.

  I wish to God I did. I wish I could provide the magic words that would instantly deliver a happy ending. Instead, I’ve learned to come clean. “You know what?” I say. “That’s the hardest question I’m ever asked, and it breaks my heart every time I hear it. I don’t have an answer, but I have some suggestions.”

  Then I tell them about the National Alliance on Mental Illness (nami.org) and the International Bipolar Foundation (ibpf.org), both terrific organizations for families and friends of loved ones with mental illness. When that response feels too clinical, I share my personal thoughts about this problem:

  1. First and most obvious (clichés exist for a reason), always remember the airplane scenario. When the oxygen mask drops, you have to put on your own before assisting anyone else. It makes total sense: When you can’t breathe, you can’t help. But so many of us forget this in crisis, when others are screaming loud in our ears. We let our own needs dangle, unattended, while we try to solve other people’s lives. The result: nobody survives. The harsh reality is, dealing with someone in denial can be exhausting. You’ve got to take care of yourself first, or you’re no good to anyone else.