Will's Choice

by Gail Griffith

  Unfortunately, by shifting the burden of oversight out of the house and beyond paternal control, we have made the problem more difficult by erecting legal impediments preventing parents from taking quick action to come to the aid of a child who is dangerously dysfunctional. Civil rights and liberties intended to protect our children’s privacy allow that once a child turns eighteen, he or she becomes an adult in the eyes of the law and parents have a hell of a time trying to impose medical intervention—even if the school, medical personnel, or the authorities deem it appropriate.

  Dr. Ebinger suggests that if parents know their child is depressed, they should get a support network started by visiting an academic dean, visiting the psychiatric counseling center at the school, and giving permission for the two to interact. Even though a student is over eighteen, he or she can give permission to school authorities to talk to parents and, perhaps even more important, to school authorities to talk to each other. Dr. Ebinger also recommends that school officials urge a student’s friends and roommates to alert them when they suspect a classmate is suffering from depression—even at the expense of alienating the student. “Students often came to me worried about a friend and I would get moving on that knowledge,” she offered.

  Ultimately, whose responsibility is it to ensure a young person’s health and well-being once he or she has left home? Society’s institutions, including universities, are loath to get in the middle of the debate over how and when our children reach maturity. But once a student lands on school turf, it is presumed that colleges and universities offer certain guarantees regarding health and safety.

  The debate over institutional responsibilities to students versus the family’s responsibility for their child’s health and well-being will doubtless continue over the next decade, and I surmise it will require that the two communities come together to hammer out precise guidelines weighing privacy against security and health. Meanwhile, if you suspect your college-age son or daughter is suffering from depression or another affective disorder, do not expect the campus environment to offer a salutary benefit; be prepared for the opposite.

  I wrote my mother a letter fall semester of my sophomore year, in a struggle to describe my misery: “I feel so alone, so confused and hopeless,” I confided.

  I do not know if my confession alarmed her or not. I think she may have put it down to a spate of overly dramatic melancholy, because she wrote back, “Gail, we are all alone. We come in that way and we go out that way. It’s how you cope with the aloneness that measures your personal worth.”

  Right. Good advice for an existentialist, but I thought, “Jeez, I’m out on a limb being eaten by snakes. Does it have to hurt so badly?” I didn’t broach the subject with anyone again until much later.

  Was I aware that major depression can usually be traced back to genetic makeup? No way. No one in my immediate family was ever diagnosed with a mental illness. I was only told about a great-aunt’s suicide after my diagnosis at age forty. If I knew now…But three of my four grandparents were alcoholics, or “heavy drinkers”—the term “alcoholic” was verboten in our household; it never applied to us, just “others” who couldn’t control their liquor. There was much too much alcohol consumed in my family, and even as a young kid, I was able to discern a certain “mood shift” after the adults were a couple of hours into “Cocktail Hour.”

  No one in the field of medicine now disputes the link between alcohol (or drug) abuse and depression. Clearly, some people “self-medicate” with pills or liquor as a means of coping with depression. Who succumbs to addiction and who does not, however, remains a great mystery, but one that I think we will unravel in the next decade as genetic research untangles the web of brain and behavior.

  Reflecting back on it, I consider my childhood a happy one, although there were some major hurdles. I was hospitalized with polio when I was four and suffered paralysis on my left side, but, with physical therapy, I was lucky enough to regain complete mobility after a year or two. And then there were the constant moves required by my father’s career as an engineering executive. I attended ten different schools over the course of twelve years; it was hard when I was young but was traumatic when I was a teenager. And we didn’t do the kinds of things many families do—have sit-down meals together every evening (my father never arrived home early enough in the evening), attend church regularly (my parents eschewed organized religion), engage in sports or large family reunions. But my parents, my younger sister, and I traveled and lived in interesting, colorful places, and I believed that an exotic childhood was somehow more spectacular than a “normal” one.

  In a 1992 profile in USA Today,5 the hugely successful mystery writer Sue Grafton suggested that “no one with a happy childhood ever amounts to much in this world. They’re so well-adjusted, they never are driven to achieve anything.” She credits her upbringing by “alcoholic, genteel, college-educated” parents as a blessing. She explains, “I had this great freedom because there was all this benign neglect going on.” At one time I would have endorsed Grafton’s supposition. I don’t anymore.

  When I was growing up, I held the reputation in the family as “the difficult kid.” In many ways, behaviors my mother ascribed to me as a young child carried the same vexing traits I saw in my son Max: fearfulness, anxiety, caution, an outsized temper, and a desire to please persons beyond the family.

  As an infant I rocked my crib so violently during the night that the crib would scoot across the wooden floor; in the morning my mother would discover the crib and me clear across the room. When I was three years old, my parents shaved my head because I had pulled out tufts of my own hair by the fistful until my scalp looked like a Wiffle ball; at four, I habitually smacked my head against the concrete sidewalk in front of our house whenever I was in a fury and able to break free of my mother’s grasp. I am sure the constant purple lump on my forehead must have looked suspicious to neighbors and family, but was no doubt explained away by the “difficult child” label.

  Today, such behavior would be cause for a thorough work-up with a child psychiatrist; psychiatrists and pediatricians would probably posit a deficit in serotonin production—and rightly so—if a child showed up at a clinic nowadays with these same self-mutilating tendencies. But not back then; not in the 1950s.

  Finally, my struggle with depression came to a head in the summer of my fortieth year. I was deeply confused by a marriage that no longer worked and trapped in a job that had spun out of control both personally and professionally. I confided in a colleague: “You know, I don’t know what’s wrong with me. I am no longer at home in my body.”

  As the summer of 1991 ground down, my mood continued its vertiginous slide. My boys were my sole anchor. In early August I escorted them to California to be with their cousins, aunts, and uncles in the north and their grandparents in the south for a month, a sojourn they relished and repeated every summer since infancy.

  I flew back to the East Coast without the kids in mid-August and returned to a fragile marriage and a job that had taken an unpleasant downturn. I nosedived into a deep depression. I was lost without my children.

  I had struggled with these “moods” before, but this one had no bottom. I had often fantasized about suicide. This time, however, I found myself contemplating not just how but when I would end my life. For the first time, I imagined both the method and manner and ran the details over and over again in my mind, sucking on a mental lozenge that offered the fantasy of relief.

  Bob came home from work one evening to find me sitting, rocking and mute, in the dining room. I had not been to the office in two or three days; nor had I bathed or dressed or eaten or ventured out of the house. Bob had never suffered from depression, but mental illness ran in his immediate family: after a long and debilitating battle, his sister was diagnosed with bipolar illness when she was in her early thirties. As I sat curled up on the floor in the corner of the room, he, thankfully, discerned the seriousness of the situation and insisted that I call
a suicide hotline.

  I had never consulted a doctor or therapist before about depression. My only prior experience with the mental health profession was when Bob and I sought out marriage counseling as our marriage began to skid. The process threw us together with an incompetent, self-absorbed psychotherapist who at the end of our fourth session burst into tears and exclaimed, “You two are such a nice couple, I don’t think I can handle this.”

  “Well, this is not really working for us either,” I retorted sarcastically. I later learned that the therapist herself was in the throes of a marital crisis and instead of putting her practice on hold, she carried her personal baggage in her briefcase and brought it into her sessions with patients. I had little confidence in therapy’s ability to help me. Death, on the other hand, sounded like just the ticket; it was seductive and as palpable as an elixir just out of reach.

  I made the call to the suicide hotline.

  “Yes, I am thinking of harming myself.”

  “Do you have a method in mind and can you talk about it?”

  “Yes, I have a thought as to how to go about it and no I don’t want to talk about it.”

  “Have you consulted a doctor?”

  “No.”

  “Are you willing to talk to a doctor?”

  “Perhaps.”

  “We’ll have someone contact you to set up an appointment right away.”

  “Okay.”

  “Are you safe where you are for the moment?”

  “Yes, I think so.”

  “Is there someone who can stay with you?”

  “Yes, my husband.”

  “Okay, we’ll have a therapist contact you right away.”

  A therapist saw me that evening and sized up the situation immediately. He dispatched me to a psychiatrist (no mean feat given it was mid-August in Washington, when most professionals have fled the city).

  The morning of Friday, August 23, 1991, found me in Dr. Salerian’s office for the first time. I refused his offer to sit down and instead began rearranging the books on his bookshelf. I was disheveled, agitated, and unable to control a steady drizzle of tears. He asked me, “Are you suicidal?”

  “Isn’t everybody?” I replied earnestly.

  I was hospitalized at the Psychiatric Institute of Washington that same day. I was given a berth in a dormitory-style room, reminiscent of college lodging, which I shared with three other women. The view from our fourth-story window looked down onto Johnson’s Nursery and Garden Center where symmetrical rows of flats pulsing with golden marigolds, bloodred salvia, and autumn-colored chrysanthemums blanketed the hot asphalt.

  “Sharps,” any personal item that could be used for self-harm—such as a compact with a mirror, a hair dryer, or a nail file—were stored upon arrival on the Mood Disorders Unit at the nurses’ station. Personal effects such as clothes, books, and photos were put away in an assigned upright wooden bureau. The windows of the building didn’t open. I perched myself on the ledge above the air-conditioning unit and stared out the window at the nursery below for hours.

  Gradually, I fell in with the routine on the unit. “Community wake-up” was announced over the loudspeaker at 6:30 AM, reminding you of the day of the week, the month, and the day’s agenda. Patients saw their doctors for half an hour each AM and lined up for meds before being escorted down to the cafeteria for breakfast.

  I was a novice and not inclined to be participatory, but I was also too polite, too accustomed to wanting to please others to buck the routine. I did not want to leave my bed in the morning—or at any point in the day—those first few days, but I was coaxed matter-of-factly by Dr. Salerian himself, who appeared at my bedside at 7:00 AM like an apparition from an army training film.

  “Gail, I want to see you in my office in ten minutes.” My God, the principal had spoken. I reluctantly put some clothes on and lumbered down the hospital corridor to meet with him.

  My first Monday morning on the unit, several of us (all patients of Dr. Salerian) sat in a circle for the 10:00 AM group session. Dr. Salerian introduced me and asked me to “share” with the group my reasons for being there. I recoiled in horror and stammered something about “being depressed” before I clammed up and stared at my lap. I secretly hoped a meteor would crash into the building and incinerate the lot of us, Salerian included.

  A reluctance to “share,” however, didn’t stop Dr. Salerian from telling my cohorts why I was there, exposing all the ugly details: failing marriage, sinking career, disastrous entanglements…Oh, my God, why was he doing this? It was mortifying. I sought anonymity for my problems, not exposure. I had no intention of sharing anything at “Group”—or in any setting—with these people, people I didn’t know and with whom I had nothing in common. What would it accomplish? Why had I submitted myself to this?

  Conformity has its virtues. Eventually, I melded with the rest of the “patient population,” swimming with a tide of therapeutic sessions: Group, Art Therapy, Psychodrama, Occupational Therapy, Movement Therapy, and, for the advanced members of our group, a once-a-week physical activity that entailed tightrope walking and “trusting others” called Challenge (the one therapeutic offering I managed to escape during my tenure at PIW). Who knew so much time could be devoted and so many methods employed to heal sick minds?

  From time to time I felt as though I had wandered onto the set of a sitcom. One Friday afternoon we were treated to a session of “humor therapy,” which consisted of back-to-back Three Stooges movies. (They were not funny.) During an hour devoted to “relaxation therapy,” we were urged to imagine ourselves “in our own special peaceful space,” to the background noise of pseudo–beat poet Rod McKuen’s “Listen to the Warm.” (Now, that was funny.) We modeled clay into hideous shapes (Art Therapy) and exchanged roles with one another, acting out “alternative solutions” to life’s complex problems (Psychodrama). And every Saturday night, the community voted on a movie (nothing with an R rating) to watch over pizza and juice. Arnold Schwarzenegger’s 1990 classic science-fiction thriller Total Recall, in which the bad guys insert fully developed memory chips into the minds of unsuspecting victims, somehow managed to evade our staff censor. It was a hands-down favorite.

  I also learned that illness is The Great Equalizer, and came to a reckoning in the first few days and weeks as I began to appreciate the leveling effects of depression and institutionalization.

  Members of the “community” were as diverse as vacationers at Disney World on an ordinary day. Every walk of life, ethnic group, and economic stratum was represented. The Mood Disorders Unit boasted a television reporter; a China scholar from the Library of Congress; a CIA analyst who specialized in strategic minerals; a drug-addicted contractor who tried to run his floundering house-painting business from the single pay phone in the common room; an elegant, older African-American doctor who, at one point, had been a successful psychotherapist; an abused young Hispanic mother; a sweet-natured drug dealer with a sixth-grade education; and a thirty-year-old telecommunications manager responsible for outfitting the federal government with its voice mail system—thirty or forty men and women all totaled.

  When you are severely depressed, you land on the bottom and you grope in the dark for a while until you see a flicker of light somewhere above—a fast-acting drug, a sympathetic insight, a resolute guide to help you out of your trap. By then, you are stripped of all your tightly held precepts about who you are and your role in the cosmos; you are just a tiny broken thing and your pain and suffering is indistinguishable from the pain depression inflicts on the house painter, the abused mother, or the CIA analyst.

  And pain is relative; my particulars may be “better” or “worse” than the patient next to me, but individually our biological framework limits our ability to tolerate suffering; that is what brings us to our knees, flips the switch of our depression, and forces us to retreat from the rest of the world. That is what we have in common.

  Maybe it comes with the territory: shared experiences in gr
oups organized around a common goal—or shared adversity—are often powerful and life-changing. You see this phenomenon in programs for addiction recovery and in gatherings of the fervently religious or fanatically political. My hospital stay with fellow depression sufferers was humbling and instructive. I was outraged to see so many people, good people, wounded people, laid low by this disease. No one “deserved” to be depressed; no one had “earned” it. The experience taught me never to judge too quickly or too harshly. Depression is an equal-opportunity illness.

  Late one night three or four weeks into my stay, a small fire erupted two floors above my unit. I was roused out of drugged sleep well past midnight by the sound of an alarm that bored through a dream of zoo animals. Unhurriedly, resentfully, we pulled ourselves out of our beds as the nursing staff marched through the corridors, bellowing orders and taking head counts, trying, with mounting urgency, to herd the mass of us, in various stages of dress, down four flights of stairs to street level and the Exxon station parking lot adjacent to the hospital.

  The hospital staff faced an uphill slog from the get-go.

  “Let’s move, everybody! No, leave that stuff behind, you don’t have time.” “Everybody out?” “Anyone seen so-and-so?”