David's Inferno

by David Blistein

  Gobbledy-gook, you say? Well, in March 2007 I indeed went through my final major crisis. And, by June 2007, the storm was, indeed, well on its way out to sea. Power of suggestion? Mental placebo? Fine. Bring it on.

  Maybe the only reliable diagnosis is the treatment. Maybe we should give up trying to label all the different flavors of mental weirdness. Doesn’t the fact that there are so many diagnoses suggest that it’s an effort in futility? Especially since a whole lot of them are NOS (Not Otherwise Specified). C’mon. That’s clearly a cop-out.

  Why not, instead, diagnose people based on whatever ever-changing formulation of prescription drugs, alternative remedies and therapies, random symptoms, psychological/spiritual practices, everyday functioning, and self-medication that’s getting them through the day? (Or failing to do so.)

  There are as many variations on depression, obsession, agitation, mania, attention deficit and combinations thereof as there are patients. But I’m currently the only guy I know who’s a fairly highly functioning, Lamictal-Cymbalta-Klonopin taking, alternative-medicine-trusting, wood-splitting, road-biking, single-malt drinking, melancholic, hypomanic writer in remission.

  … Who, during the 1980s and 1990s was an extremely unpredictable, cigarette-smoking, whiskey-drinking, racquetball playing, business-owning, vitamin-taking, garden-variety (and vegetable-gardening), self-medicating depressive with hypomanic spells.

  … Who, after surviving his first big-time breakdown in 1999, became a fairly high-functioning Celexa, Wellbutrin, acupuncture-ing, freelance writing, squash-playing, moderate major (or major moderate) depressive in remission.

  … Who, one fateful day in 2005 became, for the next two years, a barely functioning, try-just-about-anything, desperately self-medicating, exercising-like-crazy, anxiety-ridden and occasionally screaming major depressive with a touch of hypomania.

  To provide a “precise” diagnosis of anyone, you’d have to add details about their gender, weight, genetics, hours of sleep, diet, the number of close friends … the list is endless.

  The disease is that personal.

  The treatment is that elusive.

  When I told a friend I’d had a nervous breakdown, he suggested, with a slightly maniacal if transcendent grin, that maybe I’d actually had a breakup. With a single preposition, he changed the entire way I understood my experience.

  Things break down—bicycles, laptops, nuclear power plants, etc. You want them to work the way they did before. Even if it means buying a few new, identical parts.

  Relationships break up—teenage romances, marriages, negotiations, etc. In those cases you usually don’t want things to work the way they did before. You want to use the opportunity to try something new.

  Mental illness rides the line between them.

  During what I called my breakdown, I thought I wanted my mind to work the way it did before. During remissions, I’d say: “I think I’m back.”

  At the same time, my relationship with and perspective on myself and the world had completely broken up and there was no going back—any more than there had been after I got stoned for the first time, lost my virginity, got married, watched our daughter being born, or buried my father.

  Our brains are things. Physical objects in which cells divide, cerebral spinal fluid flows, and neurons exchange molecules. When those parts break down, we want to get them working physically the way they did before. Or, better yet, like they did when we were younger!

  But each of us—the whole package—is an ever-changing, seemingly limitless, network of complex relationships between the physical and the distinctly (albeit mysteriously) ineffable.

  And so, while in many ways I yearned desperately for a brain that I could relate to as I did before—a brain that didn’t keep sending fight-flight signals to my adrenals; that had internal circuitry which tickled some pleasure points once in a while; a brain where millions of tiny synaptic electrical signals created the occasional wave of calm; a brain that could convince itself that this too would pass—I also sincerely hoped and believed the experience would be transformative … one way or another.

  Perhaps even a breakthrough.

  BACK IN HELL, DANTE ACTED LIKE A TOURIST. HEY, IT wasn’t his fault he was down there. It was part of a research project. Beatrice wanted him to learn as much as he could about the structure of the universe. And, as part of his final presentation, he was able to make sure all his enemies got what they deserved. Talk about poetic justice!

  But now Dante’s entering Purgatory. Which is an entirely different scene. He’s been on the road—circling round and round Florence—long enough to begin realizing that those damn clerics and politicians don’t have a monopoly on sin … he’s no angel either (yet).

  As he walks through the Gates of Purgatory, a real angel carves seven Ps on his forehead—representing the seven deadly sins. Every time he successfully works his way around and up another terrace of Purgatory Mountain, one of those Ps is brushed away.

  But it takes work. He walks along the First Terrace bent over with the prideful (as well he should), all of whom carry massive weights on their back. On the Third Terrace, he walks with the wrathful through black smoke.

  The key scene takes place when it’s time for Dante to cleanse himself of the final deadly sin: lust. To do so, he has to walk through flames. He hesitates. Virgil pushes and prods. Dante resists. Virgil tells him not to worry … nobody dies here, so to speak. It’s only when Virgil promises Dante that Beatrice is on the other side, does he manage to screw up the courage to do it.

  Isn’t it kind of ironic that he needs lust to transform lust?

  By now, even Dante must be thinking that the whole sin thing is getting kind of old. Throughout history, it’s been such a moving and often self-serving target. In order to make sure they’re in the right, people’s definitions have ranged from outer rules so strict that there’s little margin for error to inner disciplines that are supposed to cultivate qualities of wisdom and judgment in and of themselves. Doesn’t make much difference: regardless of beliefs or philosophy, people find ways to justify the most outrageous behaviors.

  While the seven deadly sins can definitely get you into a lot of trouble, they aren’t really deadly. Even more heretically, they’re not even sins per se. They’re the other side of the story. Pride is part and parcel of courage. Envy, aspiration. Wrath, energy. Sloth, contemplativeness. Greed, hunger. Gluttony, completion. And lust? Lust? Lust is passion.

  There’s a famous Zen story about some monks going to their Master to complain about one of their fellow monks—a real screw-up. The guy coughs, sneezes, and makes even less-pleasant bodily sounds during meditation. When it’s his turn to serve dinner, he trips and spills hot soup on the Master’s lap.

  One day they’re all out working in the woods and this guy fells a tree so close to the group that a branch whacks the Master on the side of his head and knocks him out. That’s the last straw.

  “We gotta get rid of this guy,” the monks say to the Master, who’s finally come back to (enlightened) consciousness. He’s lying in a hospital bed, sipping chai tea through a bendable straw, his head held rigidly in place by one of those contraptions that holds your head rigidly in place.

  The Master hears them out and thinks (or no-thinks) about it deeply for a while. So deeply and for so long that they think he’s fallen asleep, is resting in satori, or both. Finally the Master speaks: “Okay. We’ll send him away.”

  The monks are surprised, but very relieved. At last, they can get back to the serious business of stillness—without worrying about what that crazy monk is going to do next. But, as they begin to file out, the Master calls them back into the hospital room. Even with bandages covering half his head, the monks can tell the Master is still pondering the issue. They wait expectantly. The Master sighs. They wait expectantly. The Master looks up at them quizzically—as if he’s been working on a koan of his very own:

  “But who will we replace him with?” he asks.

/>   Without lust—okay, passion—how would we get anywhere?

  Of course, without love, how would we survive the flames?

  Hard Turns and False Tops

  Nobody realizes that some people expend tremendous energy merely to be normal.

  —ALBERT CAMUS

  THERE’S A LEGEND among road bikers in Vermont that back in the 1700s when they first cut roads in the Green Mountains, they’d eyeball the height and start working their way up—at, say, a 6%–8% incline. But, they inevitably miscalculated a little, so toward the top, rather than bother with another full switchback, they’d take one more hard turn and head straight up at a 12%+ pitch.

  More than one good biker has rounded that last corner only to realize he’s got no more gears on his bike or strength in his quads.

  The other bane of a climber’s existence is the false top. Glimpses of treetops on surrounding hills make you think you can tell how much elevation remains, only to find out that, thanks to some unseen dips, you still have several steep climbs to go. (Or, as they say, the problem with downhills in Vermont is that they’re mostly up.)

  My most vivid memories of returning home from my trip out west in spring 2006 are of the calmingly familiar smells, sounds, and textures of early spring in Vermont. While I certainly wasn’t out of the woods, the comforts of home did keep the vibrations in my chest and throat down to a dull roar.

  Spring came particularly early for me that year, because I’d followed it all the way from Missouri, daring the dogwood to keep up with me on my mad dash north.

  By the time I arrived at our home, the forsythia were in full bloom, the maple buds were swelling, and the sweet smell of manure (it’s an acquired taste) was in the air. I did my best to join in this riotous celebration of renewal. Instead of relying on divine intervention, I found a down-to-earth mechanic to replace my VW’s starter. I successfully poured some of my restless energy into regular squash games and bike rides. I transformed the stories of my hellish weeks on the road into a collection of humorous shticks. I acted relatively normal during a three-day visit from mom. I even had a crown made—the tooth kind—and, while I may have gagged on that clay stuff they use to make the cast, I refrained from bolting out of the chair, uttering unearthly screams, ripping the dental bib off, and running out the door.

  Most impressively, one day I had a flat tire a few miles from home and fixed it calmly, actually smiling as I imagined all the far worse places (mostly in Kansas) where it could have happened.

  Throughout the spring of 2006, I told myself and anyone who asked that the hard periods weren’t quite so hard, and the okay periods were a bit more okay. But, in reality, I didn’t really feel all that different from when I’d left. Occasionally, in the privacy of my own solitude, I dropped the thin veneer of optimism. One day, I made these notes “for future reference.”

  Wake most mornings 4:30 with what feels like a vibration or “racing” in my heart or throat chakra, or occasionally solar plexus. Can’t go back to sleep, but feel exhausted and can’t focus enough to get up and write. Wish I could sleep for a million years and wake up refreshed. No real suicidal thoughts, but I appreciate how people do it. Appreciate? Weird word.

  Occasional bursts of sunshine, optimism, and normalcy. Sometimes focusing on a project helps. Sometimes doing anything seems like a burden. Total debilitating breakdown every week or so. Utter hopelessness; crying jags; how can I spend another 20–30 years like this? When that happens, Valium is the only relief.

  Stopped virtually all caffeine. Just a little to clear my head once in a while. Clear my head? Yeah, right, Dave, just have a cup of coffee and clear your head.

  Speaking of Valium, among my more vivid memories is the look on my doctor’s face when I confessed that once or twice I’d taken up to 30 mg of Valium between about 4 A.M. and 8 A.M. as I desperately tried to avoid facing the day.

  He managed to retain his calm, clinical tone while explaining that he didn’t mind prescribing that much for someone who arrived at the ER just one un-restrain-able thrash short of a straitjacket. In that case, they usually gave an injection. Fortunately, the idea of self-injection never appealed to me, or else he would have been giving the wrong person the wrong idea at the wrong time. I mean it’s not like I was overdosing per se: 30 mg–40 mg is, as far as I can tell, the maximum daily prescribed dose. It was probably the 4-hour time period that troubled him. And the fact I was down to 125 pounds. And the fact that I wasn’t eating much. The shot of Jameson’s the evening before may have also helped visions of rehab dance in his head. It wasn’t like I was taking that much every night, either, I reassured him. Often I took as little as 5 mg–10 mg.

  I’d been hoping my trip, some spring sunshine, and warm weather would cook the madness out of my system. Instead, I continued negotiating hard turns and false tops on a daily, weekly, and monthly basis. Trying to catch my breath on the occasional downhill.

  Just act normal. Those three words are the legendary mantra of all who’ve ever been drunk, stoned, or more seriously inebriated in public. They are also the moment-by-moment mantra of the mentally incapacitated.

  As the spring of 2006 went on, I got a lot of practice.

  There was the trip to Burlington with a close friend to see our daughters who both happened to be living there. A calming drive through the familiar Vermont hills. A fascinating conversation that ranged from farming to writing to politics to education to God. Followed by a wonderful brunch with all four of us, before each of us wandered off to catch up on the life and times of our respective daughters. Yet, what I remember most is trying to act normal; trying to act normal; trying to act normal. My friend and my daughter were both as aware as they could be of what was going on inside me, but I wanted to do whatever I could to make it normal for them, too. Regardless, when that perfect day was over I heaved a sigh of relief.

  There was the trip to New York to do some presentations, during which I frantically dug around in my deep store of small talk so I wouldn’t suddenly burst into tears and freak out the young, enthusiastic PR person who was guiding me through the day.

  There were all those lunches and dinners and midday coffees with friends and acquaintances, during which I managed to provide reasonably good color commentary about what I going through, while trying to mask the fact that I was actually doing play-by-play. My friends weren’t totally oblivious, but they had little choice but to play along.

  All these experiences reflect the endless internal tug-of-war of agitated depression or mixed states. You want to be alone—away from the pressure to “act normal.” You want to be with people—away from the prison of your own experience. You want to sit still and relax. You have to keep moving or you’ll explode. You desperately want to do something. You desperately want to rest.

  Like an actor struggling to remember his lines, you present a slightly frazzled, but usually reasonable facsimile of who you were before, while trying to restrain the crazed director from dragging you off the stage. And so you walk through life—the two of you—side by side.

  The Wit and Wisdom of Neurotransmitters

  A thing is mysterious if you don’t know what or how to feel about it and wish you did. Mystery is a lack not of information but of meaning. Indeed, greater knowledge of certain subjects can intensify rather than soothe emotional itchiness about them.

  —PETER SCHJEDAHL

  I’VE NEVER TAKEN A CHEMISTRY CLASS. So, when I was prescribed 40 mg of C20H22BrFN2O (a.k.a. Celexa) back in 1999, I just rolled my eyes, rolled the dice, and swallowed.

  But, the more I’ve explored the deep dark recesses of libraries and the Internet, the more curious I’ve become about what’s going on in that twisted bundle of ganglia on top of my neck.

  I certainly don’t want to belittle the efforts of anyone who’s spent countless years and dollars trying to master the jargon and formulae of modern biochemistry. But, neither do I want to belittle the intelligence of any of us who take the drugs they prescribe.

&n
bsp; I figure if doctors insist that the best patient is a well-informed patient, we might as well give them a run for their money.

  Admittedly, the fact that I spent a couple of hours trying to figure out how many molecules are in a 100 mg tablet of Lamictal may be more a reflection of my OCD than my thirst for knowledge. Fortunately, I gave up and asked my favorite Physics Ph.D., who told me 100 mg of Lamictal has 24.5 hundred billion tera molecules. A tera being a thousand billion. That’s a lot of zeroes. (See the Chapter Notes for his entire email. Good luck!)

  With the caveat that professionals might quarrel with some of the following, or even the fact that a guy who’s never taken a chemistry class is trying to explain it in the first place, I’ll try to describe the neurotransmitter theory of depression in terms we ordinary mortals can understand.

  This explanation is based on many hours staring at illustrations in a lot of books and on a lot of websites. So, if you really want to follow along, you might want to look up one of those pictures for reference. If, however, this explanation is already giving you headaches, dizziness, palpitations, or, God forbid, sexual dysfunction, I encourage you to move right along to the next chapter.

  In other words, “Abandon all hope, ye who enter here.”

  It’s all in your mind. Sure, but what exactly “it” is, what causes “it,” how to fix “it,” what “fix” even means under the circumstances, and whether it really is “all” … well, there are a whole lot of angels dancing on the heads of those pins and, if you’re going to write about the science of depression, you’re going to have to dance with quite a few of them.

  About fifteen years ago, I came across an article in Scientific American (June 1998) entitled, “The Neurobiology of Depression.” After reading it, I convinced myself and many unsuspecting friends that I understood how antidepressants worked. My spiel went something like this: