by Terri Cheney
2. Recognize the tremendous fear that lies beneath a refusal to seek help. In most cases I can almost guarantee that the person knows, at some repressed level, that something is wrong with him. His life is becoming unmanageable, to borrow twelve-step wisdom. But he doesn’t dare lift his head above ground for fear of what he might see—and the even greater fear that there will be no way out.
3. Know about “anosognosia.” It’s a big word, with a big meaning. People who suffer from anosognosia aren’t simply in denial about their illness; they don’t even realize they’re ill. Anosognosia means lack of insight or awareness, and it’s most common in individuals with schizophrenia and schizoaffective disorder, although it’s not limited to them. Doctors have determined that in many cases, actual changes to the brain structure may be the cause. I bring it to your attention—and to the attention of as many law enforcement personnel as I can—because I think it might engender a better understanding of why some mentally ill people just don’t seem to get it. Maybe they can’t.
4. Acknowledge what you share with the person in denial, however disparate your situations may seem on the surface. After all, we all use denial as a defense mechanism from time to time. How else could we face the great unsolvable mystery that is life? Realizing you have some common ground may lessen the agonizing bewilderment you feel when you look at the other person.
This last point, subtle as it may sound, has made all the difference in the world to me. For years, I was one of those intransigent people who refused to admit to myself or others that I needed help. When I finally acknowledged that I was in trouble, I didn’t suddenly become more lovable or easier to fix—I was just easier to understand. I wasn’t an enigma anymore, a problem that couldn’t and wouldn’t be solved. I was human, fallible, and therefore just like the people who were trying to help me. Bridges slowly began to be built; the great divide grew narrower at last. It taught me an essential lesson, which is all I can pass on to others now: empathy reaches where sympathy can’t.
SECTION V
Troubleshooting
BAD COPING SKILLS
“I have not failed. I’ve just found 10,000 ways that won’t work.”
—Thomas A. Edison (1847–1931)
Virginia Satir, a prominent clinical therapist, nailed the dilemma: “Problems are not the problem,” she said. “Coping is the problem.” People respond to stressful experiences in both adaptive (helpful) and maladaptive (harmful) ways. Unfortunately, maladaptive coping methods—such as denial, avoidance, substance abuse, self-harm, rumination, social withdrawal, to name just a few—can actually be effective in reducing immediate symptoms of anxiety and distress. But their end result is only to increase dysfunction because the core problem is never dealt with, only whisked away for a short while. Ultimately, they simply perpetuate the pain, creating new and sometimes even more intractable problems on top of the old.
Researchers agree that it’s very common for a person to use more than one maladaptive coping method. Where they differ, however, is on how these harmful strategies develop. Some believe they arise instinctually, from our subconscious. But child development experts believe they are a result of toxic early environments—invalidating interactions with caregivers, as well as a lack of healthy alternatives and exposure to uncontrollable stress (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442090/).
How they begin seems less important than how to end them. Naturally, being introduced to healthier coping alternatives is essential, and this is one of the ways that therapy can transform a life. But it’s also critical to recognize the purpose the maladaptive behavior is serving—what exactly is the seminal problem that’s being avoided? Otherwise we risk simply replacing it with another, perhaps even more harmful, avoidant behavior. Again, it’s hard work that can be achieved in a therapeutic setting.
The good news is that brain plasticity isn’t just a theory—it’s proven science. Learning new and more effective ways to cope with stress will actually lay new neural pathways that can prevent further damage and even reclaim a life.
GOING UNDERGROUND: ISOLATING
I heard it before I felt it: a long screech of brakes, protesting their inability to stop, helpless against the inevitable. Then that horrible sound, unlike any other, of metal crunching metal. I went blank as I realized it was my car under assault, that it was me being catapulted against the unyielding seat belt. Fortunately, I walked away from the accident, but my poor car could only limp its way onto a tow truck. What might have seemed like a lucky break turned into a nightmare, as intransigent insurance companies and scheming body shops and words like “totaled” were thrown into the mix.
I was distraught and distressed and all kinds of upset. But I’m relatively good at facing situational depressions like this—the kind that arrive in response to some external calamity. They can be extremely anxiety-provoking at the moment, but they usually yield to time and good therapy. And clearly, this was a rotten situation, which would have upset anyone. So I turned to my friends for sympathy and advice, and they were forthcoming. Everyone’s had a car accident. They all understood what I was going through.
A week passed, and the initial shock began to dissipate. But inexplicably, I felt worse. I sought out my friends again, and once again they came through. “It’s perfectly normal,” one of them said. “Reality is starting to set in now.”
Well, reality kept on setting in, deeper and deeper with each passing day. I felt like I had when those brakes started squealing—I knew something really bad was about to happen, but I couldn’t get out of the way. I wondered if I was getting the flu. My body was achy and sluggish, my head so heavy it was hard to lift it even to watch TV. I felt pathetic, unlovable, a total wreck—as damaged as my mangled car and just as unworthy of repair.
I reached out to my friends yet again. The responses were much slower this time around. The general gist of them was, “Sorry you still feel so bad.” That “still” stood out; it could have been in all caps. I was trying people’s patience now.
It happens sometimes—situational depressions turn into major chemical depressions. Then I’m no longer fighting external events, I’m waging war with my own mind. What was once sympathetic to the outside world seems neurotic and obsessive. Friends are no longer a resource, they’re the enemy because they don’t or can’t understand my pain. It’s happened to me time and again: in spite of all my years in therapy, my rigorous compliance with medication, the advice I’ve given and taken to heart, I succumb. I forget all my carefully honed coping skills and fall back on the same old habit that has served me, badly, for as far back as I can remember.
I go underground.
I don’t want help from anyone then, from doctors or friends or any other well-meaning persons. I simply want to be alone. With a vehemence I can hardly describe, I can’t stand the thought of anyone trying to soothe me. The prospect of a hug is anathema—I can’t bear to be touched, not for even a second. The stimulation would short-circuit my already overloaded nerves. So I erect a prickly, thorn-strewn wall between me and any possible resources.
Alone feels safe; it asks nothing of me. It’s a haven of silence, into which I can pour all the wretched thoughts and feelings I can’t expose to the rest of the world without risking rejection. Alone is that rare space without stigma, where I can be my true self. I don’t have to smile, or talk, or pretend to be interested in anything else. My tears can fall freely, and no one is around to try to stop them. I can wipe them away with my old flannel pj’s, and not feel ashamed of those, either.
The problem with isolating is that being alone with my thoughts only makes me think harder. Why, when I most need the comfort of others, do I adamantly refuse to be held? Why do I shrink from the extended hand, which might be just what I need at the moment? Obviously, the best thing I can do for myself during a chemical depression is to engage, to seek help, to take that one small step outside my comfort zone. But the urge to be alone is just too strong to resist.
I
’m not sure why I feel so guilty about this; after all, I didn’t invent isolation. No doubt there was a suffering caveman somewhere, who likewise sought shelter away from his tribe. It may be human nature to bond, but it’s also natural to want to slip away to lick your wounds in private. In fact, it’s extremely common for depressed individuals to isolate as a coping mechanism, despite the health risks clearly associated with it. (One study claims lack of social connection is comparable to smoking fifteen cigarettes a day.) That doesn’t help me change my behavior, but it does reduce the shame somewhat. I feel childishly justified: if so many other people can do it, then so can I. I’m shut off in my own little world, but in truth I’m never really alone. I’m in the company of thousands of strangers, all doing what we shouldn’t.
BAD BEDTIME STORIES: SELF-BLAME
Years ago I was hospitalized at Cedars-Sinai after a suicide attempt. I wasn’t very happy about it at the time—I didn’t like the people, didn’t like the program, and especially didn’t like the doctor who’d been assigned to me. “You don’t handle stress very well,” she told me in our first session, as if that could somehow sum up everything that was wrong with me and shock me into new behavior. It didn’t. I felt aggrieved and insulted and went into hiding in the open air. I withdrew from any help she might have given me. Her statement still rankles, after all this time.
Years later, I sat in another doctor’s office, clutching an emesis bowl the nurse had given me. I’d been violently sick for several months, and this was my third attempt to find a doctor who could tell me why it wouldn’t stop, and what was going on with my body.
“Sounds like an ulcer,” the doctor said. “You must not handle stress very well.”
I was catapulted back to Cedars-Sinai and the anger and guilt I’d felt at that time. I thought I’d evolved past it, that I was an old hand at dealing with stigmatic illness. After all, I’d been diagnosed with bipolar disorder over twenty years before. As time passed and the illness didn’t succeed in killing me, I thought it only made me stronger, better able to handle the rigors of life. I thought I held my head up just a little higher than most because I had sunk as low as suicide and yet, somehow, survived.
So when my doctor said “ulcer,” I visibly cringed. Ulcers happen to dissolute advertising execs like those East Coast guys on Mad Men, who drink too much and attack life too vigorously. But I’ve been sober for over twenty years, and I’m not a typical Type-A anymore. I chose to leave the practice of law to pursue a cleaner, quieter existence: to write, to reflect, to observe.
But apparently, I still “didn’t handle stress very well.” The shame of that phrase spun around and around in my head until I finally realized that the greatest stressor of all wasn’t my ulcer, or even my bipolar disorder. It was the story I told myself about myself, the words I elected to use, the truths I chose to believe. My relationship with stress was mine to define, and I wasn’t defining it very well.
Self-stigma is every bit as pernicious as the stigma one encounters in the outside world; maybe even worse because we know ourselves so well we know exactly which buttons to push. It’s too easy to believe in my own bedtime stories—those terrible things I tell myself when I can’t get to sleep: you’re hopeless, you’re weak, you can’t handle stress. Old words, familiar but worn to shreds. Was it possible, I wondered, to tell myself a different tale—one with a happier ending?
Well, yes and no. It’s hard to let go of your most cherished beliefs, even the ones that are torturing you. But one bleak night when my thoughts kept betraying me, I took a deep breath and tried out a new beginning: “You’re telling me I can’t handle stress? Are you kidding? I’ve battled mental illness all my life. I’ve been subjected to more medication trials than a lab rat. And I’m still here as Exhibit A.” The words were not just plausible; they went down like warm milk.
Balm, you would think, to any ulcer; that night I did sleep better. But then came the harsh light of a new morning and damn it, the dawn of more doubts. I couldn’t help but think that the doctors knew something about me that I didn’t know—that their exams and their instruments verified a fault that somehow proved their theory, that I was sick because I simply couldn’t handle stress.
I knew in my heart that this wasn’t true, and that I’d work through its fallacy yet again. But this is what self-blame does: It eats through your faith in yourself like a poison. It burns until it’s all you can feel and all you can believe. It’s arsenic, laced with a little truth.
THE WEB: OBSESSION
I don’t like to admit that I’m obsessive, despite how often I hear it from others. I prefer to think that I’m highly focused. Driven. Single-minded. But every now and then, even I have to acknowledge that I’ve gone over to the dark side, where reason doesn’t shine.
Like with spiders. I loathe spiders. Nasty, creepy, primeval things, with the emphasis on “evil.” They’re out to get me, I just know it. So when I was driving my car the other day and saw an enormous spider climbing on my side view mirror, I swerved all the way into the other lane, narrowly missing a FedEx truck.
My window was closed; I was in no immediate danger of being attacked. The only real danger I faced was that I couldn’t stop staring at the spider as he clung to the mirror, all eight legs spread-eagled across the glass. Several horns honked at me as I lurched from side to side, trying to knock him off. No luck. Revulsion gradually gave way to wonder: how was he holding on?
I knew of a street nearby where there was never any traffic, and cops would be unlikely to lurk. It was me against the spider now, and battle needs a clear playing field. I headed there and floored it: forty, forty-five, fifty. I spun a U-turn in the middle of the road and came screeching to a halt. I looked at the mirror, and hooray! No spider.
Feeling triumphant and clever, I resumed my trip at a more leisurely speed. Approaching Sunset Boulevard, I flicked on my left turn signal, dutifully glanced at my side view mirror—and there it was, a single crooked leg pawing at the glass, followed by another, then another, then another, and so forth, until the damned thing had crawled its way back home.
I shuddered, but I had to admire its tenacity. It was obsessed with this particular mirror and refused to be evicted. Maybe obsession wasn’t as bad a character trait as I had always thought. Maybe if I gave my own obsessions freer reign, I could accomplish marvelous things, like this spider had in the face of great odds.
Okay, what the hell—I decided I would give myself an entire day to be as obsessive as I liked. I wouldn’t try to fight it, I’d just give in. I’d take my psyche off its interminable leash and let it cling or not cling, attach or detach, whatever mind games it wanted to play. For once, I wouldn’t worry about how much I was worrying.
So I flitted through the myriad of possible things to obsess about, and quickly settled on the least productive one: men. One man in particular, who had called me yesterday and vaguely mentioned something about dinner tonight. It was three-thirty and I still hadn’t heard from him. Should I go ahead and eat something? Should I make other plans? And what about getting dressed? Dressing for dinner—especially a dinner date—at the very least meant curling my eyelashes and finding the right lingerie and picking out killer shoes. That took time; how much time did I have?
Before long, annoyance turned into angst. Why couldn’t I find a man who cared enough about me to commit to a single evening? I was an afterthought, a maybe if, a rung below essential. I seized the pain and wrung it dry. What was wrong with me anyway, that I still had to fret about dinner dates? Was it because I was bipolar? Was that always going to get in my way? Would there never be a cure?
I turned onto my street, my eyes obscured by tears. I parked my car and stepped out. The spider was still sitting there, obviously in love with its reflection in the mirror. I whacked it hard with my purse. Obsession can be a dangerous thing, I thought. Best not to indulge it.
BLAME IT ON BASIC INSTINCT: IMPULSIVITY
Like most attorneys, I know how to bend the
law, but I’m essentially a law-abiding citizen. I’m the least likely person to be profiled as a problem: I’m middle-class, white, well kempt and well behaved. That is, when I’m not manic.
One Saturday night in the early ’90s, I went to catch a movie at the Third Street Promenade, an upscale outdoor shopping mecca in Santa Monica. The breeze from the ocean was chilly, and even though I was trying to stop drinking—alcohol did strange things to me—I figured an Irish coffee would warm me up just fine. Which it did, and the second and third one chased the chill away even further.
When I sauntered out of the pub, I surveyed the world and thought it was good. I had a promising career, a budding romance, and a full life spread out before me, just mine for the taking. I bought the movie ticket, pocketed it, and decided to stroll for the remaining twenty minutes. Well, stroll might not be the right word. The Promenade’s always chaotic, but on a Saturday night it’s positively frenetic, with jugglers and acrobats and rappers and the like, all hustling the tightly packed crowd.
I shuffled along with the rest of them, elbowing for space. As more and more people bumped into me, or I into them, the fine haze from my buzz began to disappear. I could feel that sharp nip in the air again, although the back of my neck was clammy with sweat. My heart thudded; I stopped and tried to take my pulse, but I kept getting jostled. Was I sick? No, but I felt dizzy and feverish, like I was sprinting even though I was standing still at the stoplight. I knew I ought to just leave and seek solace, away from the hubbub and clamor. But the whiskey said no, the party’s not over. I wasn’t conversant enough with my symptoms back then to realize what my body was trying to tell me: that my mood was rocketing straight up to mania, and the whiskey was just the chaser.
