by Andy Behrman
April 7, 1996. New York.
I don’t think I’ve left my apartment more than three times this week—twice to see Dr. Fried and once to pick up my prescriptions. I don’t have enough energy to go food shopping, so I order in almost every night. The combination of ECT and adjustments that Dr. Fried has made to my medication has really exhausted me. All I want to do is lie in bed in complete isolation—no television, no music, no telephone, just silence. I crave it. I think this is what best heals me. The thought of putting my face into my pillow is the most pleasant one I can imagine. I am so on edge that the sound of a car horn outside, a noise near my front door, even the ringing of the telephone sends me flying. I can’t handle any kind of stimulation. I don’t take showers, clean up, cook. I lie around and hope that miraculously I’ll feel better the next morning.
April 15, 1996.
I want to start from scratch with a brand-new therapist, while keeping Dr. Fried as my psychiatrist. I don’t feel like I’m making any progress with Dr. Marks and I’m motivated to get well, and so I want someone aggressive. Dr. Wallenstein recommends Dr. Carol Sternfeld, a colleague in whom he has a lot of faith. “She’s tough and she knows what she’s doing,” he says, and he tells me I will like her very much.
When I first meet Dr. Sternfeld at her Upper East Side office, I’m greeted by her two dogs, both mutts, who sit in on our session. Immediately I’m drawn to them—Guinness, a mostly black dog who craves attention, and Patch, whose white coat is covered with brown patches. Patch lunges for my hand when I get too close to Dr. Sternfeld. She warns me that he is very protective of her, so I learn to keep my distance from him. I’m quickly struck by Dr. Sternfeld’s intense bright blue eyes, which seem to drink in my words. Within five minutes I’ve decided I want to be her patient. “It’s because we both have blue eyes,” I tell her. I feel a very strong connection to her. I’m ready to get down to business, and begin talking about my recent experience with ECT and manic depression. “The last year of ECT has sucked every bit of life from me,” I tell her. “I feel like my memory’s a bit shot and I might be a bit too sedated for this, so I’m not going to be able to give you too much to work with today.” “Well, we’ll just start slowly from the beginning,” she says. Oddly, the past ten years start to unravel effortlessly in the forty-five-minute session with this stranger and the two dogs by her side. It’s the first time I ever talk with anyone about my illness with such clarity, which probably comes from the ECT and the medication. Dr. Sternfeld sees me three times a week, and I begin to gain perspective on where I was and where I am now. I still suffer from the manic depression and have problems with medication. I slip into manic episodes for weeks and still find myself in deep depressions that last days. My use of drugs and alcohol isn’t helping; it just continues to blur the picture of my mental health. I’m coming to understand the impact the manic depression has had on me over the last ten years, informing nearly every poor choice I made, leading me to risk, danger, and trouble. And I’m coming to understand the reality that my manic depression is a chronic condition. Just last week I was out at 2:00 A.M. on the Upper West Side, searching for a pint of Hershey’s chocolate milk at more than five delicatessens. None of them had it. I had to have that brand. I was irritated. How could nobody have Hershey’s chocolate milk in the biggest city in the world? I hailed a cab and went thirty blocks to midtown until I found a supermarket that had it. I bought just one and drank it in the cab on the way home. It was so satisfying. But these episodes are less frequent than they’ve ever been; they’re like little blips on the screen, and I’ve adjusted myself to living with the inconvenience that they cause me.
April 18, 1996.
I call Dr. Wallenstein a few days before a scheduled ECT treatment, which will be my twentieth, an unusually high number. (Most patients are treated in the hospital with four or five rounds over a period of seven to ten days.) I’m feeling particularly lucid. “Dr. Wallenstein, I think I’m done with ECT for now,” I tell him. I believe I’m balanced enough that I can work with Dr. Sternfeld, and quite honestly, I know that I’m addicted to the ECT and the premedication. He seems to trust my judgment but tells me to call him if I feel like I’m slipping and want to come back in for maintenance. This strikes me as odd because although I’m rational and capable of making decisions for myself at this stage, if I do slip again I don’t think undergoing ECT is a decision I’ll actually be able to make by myself.
April 26, 1996.
It frustrates me that I can’t just grab the manic depression in my hands and smash it into pieces or burn it or bury it. I’ve been paralyzed for years, recovering from an intangible illness that cripples my head and now only allows me to function minimally within the confines of my apartment. I’m still more comfortable staying at home, and I hesitate to venture outside a five-block radius in case I have some type of breakdown. I feel only steps away from my mind crumbling and sending me back to the hospital. A year after house arrest, I’m free to come and go as I please now, yet I’m still a prisoner of my apartment. All the trips I take—to my doctors, to the grocery store, to the bank—are scary. They have to be well planned, or else I’m setting myself up for disaster. I’m paranoid about being arrested by cops on the street, attacked by pedestrians, approached by an old acquaintance whom I may not recognize or who may notice changes in my appearance, or being hit by a bus. I want to go outside and see what other people are doing on the street and what they’re buying in the stores, but life is much safer for me inside my apartment.
May 3, 1996.
With the exception of my psychotherapy and psychiatric appointments, I go out only to see friends a few times a week. There are still entire days I don’t leave my apartment at all and just go downstairs to check my mailbox. My body—mainly my neck and my limbs—and facial muscles are stiff, I walk with a shuffle, and there’s a permanent blank gaze in my eyes, which makes me look like I can stare right through you. I’m like a patient sitting in the lounge of a psychiatric ward watching the doctors and nurses walk by.
May 9, 1996.
I have no idea where the medication regimen is going. Nothing seems to be working again, and the side effects are awful: weight gain, hand tremors, muscle stiffness, dry mouth, diarrhea, and of course the memory loss. These medications are probably going to destroy me. Dr. Fried has me pieced together with thirty-two pills and capsules a day: Wellbutrin, Effexor, Lamictal, Luvox, Neurontin, Zyprexa, and Trazodone. Every week there is something new to mix into the cocktail. I’m utterly hopeless. It’s all making me sick. Today I shit in my pants waiting on line for my prescriptions to be filled at the pharmacy. The cashier wouldn’t let me use the employee bathroom.
June 8, 1996.
I’m feeling more and more guilty that I can’t get myself better. I’m wondering what the ECT actually accomplished and if the medication is really doing anything. Doctors try to treat me through crisis after crisis; my parents watch me stare at them like I’ll forever be in this state. I’m their helpless child, only I’m thirty-four years old. We’re all confused. When my mania disappears I expect the initial calm of ECT to return, but instead I’m fooled again and thrown into wild depression, an agitated state of melancholy marked with fits of rage. My temper is short, and I argue with everyone who steps in my path. I have an ongoing battle with my landlord over a huge list of problems in my apartment and in the building, and I often become threatening—withholding my rent, calling all of the city housing agencies, starting buildingwide petitions. I beg for the mania to come back because it feels better than this depressive rage. Constantly craving the mania becomes a horrible, frustrating addiction because the price of the euphoria is a bout of depression. This rapid cycling has been going on for years, so I’m accustomed to the frequent mood changes without notice. When I’m in the darkness of the depression I fantasize about my manic memories—getting myself heavily into debt buying clothing, furniture, and paintings, counterfeiting artwork around the world, having sex with anonymous
partners, drinking and doing drugs, and even the experience of being a defendant in a criminal case. I am high through all of that and enjoy my crazy lifestyle and put on a show for my friends. Look at me. What would you like to see me do next? Mania isn’t nearly as painful as depression, which feels like an awful storm inside my head and leaves me hopeless and despairing.
The Sleeping Dragon
I tell my parents about the lecture I hear by Dr. Frederick Goodwin at Beth Israel Hospital in Manhattan. He’s one of the world’s foremost authorities on depression and manic-depressive illness, and former director of the National Institute of Mental Health in Washington. Dr. Goodwin talks about manic depression as a chronic illness, but he has a warriorlike approach to treating it that I like. My parents ask me if I want to make an appointment to see him, and I agree to give it a chance. There is a bit of a wait, but in the meantime I complete a case history and take some preliminary psychological tests by mail with one of his social workers. About a month later we head to Washington, in search of the magic cure. Dr. Goodwin is a pensive middle-aged man who meets with me first by myself and later with my parents. He carefully asks me about my psychiatric history and my manic episodes and lows, and I tell him about the current flat, bored, and disconnected feelings inflicted by the medication. “I don’t feel like the same person anymore,” I complain. “I can’t be as funny.” I tell him that I don’t have the ability to entertain anymore; my jokes don’t work. “I’m no longer the life of the party or the center of attention,” I say. He scribbles some notes. “Are you drinking alcohol or using drugs now?” he asks me. “Yes, to both,” I say. I tell him I’m drinking daily, snorting cocaine and smoking pot on occasion, using inhalants like amyl nitrate, and stepping up my dose of sleeping pills. He tells me that this kind of activity, which is symptomatic of manic depression, is going to get in the way of my recovery. Finally, he calls in my parents and I fear that he’ll tell them about the drinking and the drugs. But after the two-hour-long session, he comes to the unsurprising conclusion that I am, in fact, just another statistic—one more manic depressive. He recommends some minor medication changes to Dr. Fried and emphasizes the drug and alcohol issue, which has been ignored for so long because I chose not to make a big deal about it with her, always believing I would just give it up. Now Dr. Fried knows the whole story. I feel like Dr. Goodwin is the last doctor I’ll ever need to see, and I’m relieved that he is in general agreement with how Dr. Fried is treating me and that the two have spoken about my future treatment. I leave Washington feeling like I’ve been given the final diagnosis. There is no reason to search out a fortune-teller, a yogi, a spiritual healer, or a witch doctor. I have manic depression. And the chief expert says so.
With Dr. Sternfeld I start re-creating structure in my life, a life that formerly had no rules, no day, no night. We start by setting a slow and stress-free pace with a schedule that I can follow: a time to go to bed, a time to wake up, a time to shower. During one visit she suggests that perhaps it’s time I consider working. I start screaming when she suggests clerking at Barnes & Noble or doing volunteer work. How could she think I’m ready to go back to work? “I’m still sick!” I scream. “You’ve got to be kidding if you think I’m ready to work!” I have accepted the fact that I’m comfortable doing nothing, that this manic depression has taken control of my mind and body and has every intention of parking itself here for the rest of my life.
A few months later, though, I find myself going through my Rolodex, making some phone calls. I reconnect with former PR contacts and set up appointments with them or people they’ve referred me to. Soon I’m working on a couple of different PR projects again, even traveling cross-country to meet with clients. It’s an entirely different kind of energy this time—rational, sane, healthy. I don’t come on like gangbusters—it’s a low-key approach to doing PR, but I can still get clients excited. I appear composed, knowledgeable, and determined to get the job done, and, despite my brush with the law in 1993, I still have a good reputation in the business. And I’m helped by the fact that, after trying every possible combination of medications, Dr. Fried has found a cocktail that seems to work well for me for the time being. It consists of 1½ milligrams of Risperdal, an antipsychotic; 750 milligrams of Depakote, a mood stabilizer; 1,200 milligrams of Neurontin, an anticonvulsant; 300 milligrams of Symmetrel, for Parkinsonian syndrome; 30 milligrams of Propranolol, for tremors; 50 milligrams of Benadryl, for muscle stiffness; 2 milligrams of Klonopin, for anxiety; 60 milligrams of BuSpar, also for anxiety; and 10 milligrams of Ambien, a sleeping aid. That’s down to a little more than twenty-two pills a day. I can count them out into my hands with my eyes blindfolded. There’s an area on my kitchen counter that my friends refer to as my own little pharmacy. The cocktail needs to be tweaked every so often, and I spend a lot of time with Dr. Fried on the phone adjusting dosages, but my moods are starting to stay pretty even.
Throughout this recovery period, I despise manic depression but pretend to be its friend, so as not to set it off. I work with it. I take all the pills at all the right times. I monitor my mood and behavior. I go to sleep on time. I eat well. I avoid stress. I play the good patient. And I don’t like any of it. I miss the planes, the trips, the money, the dinners, the alcohol, the drugs, and the sex. My recovery represents a tremendous loss.
When I start feeling like I’m winning the battle and I’m balanced, I get these colossal surges of strength and power, often lasting a day or two. I often confuse them with mania. Am I having an episode, or am I conquering this illness?
The Dragon Awakes
November 27, 1997.
Thanksgiving Day. My parents pick me up at my apartment to drive to my aunt and uncle’s in Connecticut. Dr. Fried has taken me off Risperdal, the antipsychotic, as an experiment, because of the severe muscle stiffness, shuffling, and nonblinking. I’ve gone four days without it. Before I get into the car I warn my parents that I’m not feeling well and that my mood isn’t going to improve too much. I don’t talk at all during the ride. When we arrive in Connecticut, I sit by myself in the living room staring at the football game on television. I eat very little. My family is concerned about me but knows not to make a fuss over my condition, since that will only upset me. Everybody figures I’m having a bad day, I’ll go home, get some sleep, and be fine in the morning. By the end of the evening, I’ve taken so much Klonopin because of my anxiety (much more than the recommended dose) that I can barely get into the car. I sleep the entire way back to New York. That night I’m lying in bed watching television and I look down and see that my torso, my arms, and my legs are covered with graffiti—script handwriting, numbers, drawings, nothing I can quite make out. I realize that as I process thoughts, they get written on my skin, by an invisible hand, until finally there’s no room left. I jump into the shower and start scrubbing my body with a sponge and Clorox, trying to rub off the hundreds of words, sentences, and drawings covering every inch of my skin. They start blinking like Christmas lights. After about an hour of scrubbing, I rinse off my burning skin and I get back into bed, but I’m frightened it’s going to return. I don’t know what to do next. I call my friend Bobbie, who lives ten blocks away, and tell her about my panic. She rushes over at 4:30 A.M. and assures me that there’s no graffiti on my body. She sits with me to try to calm me down, then calls Dr. Fried’s pager number, which I know like my Social Security number. While we wait for Dr. Fried to call back, Bobbie stands me in front of the mirror, but I see the intricate designs on my skin. Dr. Fried instructs me to go back on the Risperdal right away. It takes about two days for the medication to take full effect, but I do recover, and Dr. Fried tells me I must stay on it. Plainly, I will never be able to stop taking these medications. Am I more myself on them or less? There’s no sense in trying to determine which me is the real me—in the end, I need the medications if I’m to lead a balanced life. I have a chronic illness, and I can’t survive without them.
Happy Birthday
Janu
ary 27, 1998. New York.
It’s my thirty-sixth birthday. I meet my friend Jen Copaken for breakfast at the French Roast on Broadway, and over eggs and toast she tells me about a great idea for a screenplay. It’s a love story that takes place in Shanghai during World War II; a population of twenty-five thousand European Jews flees the Nazis and resettles there with the help of a courageous Japanese consul in Lithuania. It’s 9:30 A.M. and for the first time in years I’m fired up by a creative idea. I’m finding Jen’s telling of the story fascinating and her enthusiasm infectious. She’s given me something to grab on to. We decide to start researching right away and we work on the screenplay every day for a year. I see Dr. Fried at noon for my monthly appointment, which I had purposely planned for my birthday as a thirty-six-year checkup. It’s a playful session; the tone is light. How’s your energy? Good. Your sleep? Six to seven hours. Appetite? Normal. She asks me to rate my mood on a scale of one to ten. I tell her eight point five. “Not bad,” she says. She checks me for muscle stiffness from the Risperdal. Not great. She examines me for tardive dyskinesia, which can be a side effect of some of the antipsychotics. It usually starts out with a wormlike movement of the tongue, and later it can develop into involuntary movements of the head, neck, trunk, and extremities. Once it takes hold, it’s permanent, even if you stop taking the medication. But I’m fine. I passed the test. Maybe I should increase the Benadryl because of the muscular stiffness from the Risperdal, she thinks. “Yes, take another at bedtime,” she tells me. I ask her about dropping the Depakote, the mood stabilizer, to see what happens. The less I’m on the better; it blows me up like a balloon. “Not now,” she advises me. She wishes me a happy birthday and reminds me it’s been four years since she started seeing me. I’m amazed it’s been so long and impressed she’s been able to handle me this whole time. So many appointments, crises, and daily phone calls. She sits down and writes me prescriptions and warns me not to stay out too late or do anything crazy. I leave feeling I’ve had the 25,000-mile tune-up. After making an appointment to see her in February, I spend the rest of the afternoon having a massage and getting a haircut. At home I answer phone calls from family and friends wishing me a happy birthday. I feel like it’s a happy birthday for the first time in many years, maybe since I turned thirteen and had my bar mitzvah celebration. My friends Brian and Joe take me to Vong for dinner, and I’m glad to be out. Brian, who enjoys good wine, orders a Pomerol Guillot and a St.-Estèphe Château Haut-Marbuzet; I’m hardly drinking, but I taste both, and they have more richness than any glass of wine I can remember. I remind myself that I’m sober. I leave the restaurant feeling satisfied, get into a cab, and am under the covers by 12:30 A.M., thinking about the twenty-five thousand Jewish refugees in Shanghai.
