One Friday in April

by One Friday in April (retail) (epub)

  But I left the hospital unwell. The compression in my chest had lessened, and my anxiety no longer felt as if it originated in my muscles and bones. Just the same, I was anxious, and back on lithium and nortriptyline. It was spring 2011, and then summer, five years since the first hospitalization. I was afraid that I wouldn’t make it, wouldn’t be able to live and sustain myself. But I also remembered feeling healthy. That summer, I began a relationship with Cynthia, who worked for a city agency and carried a badge. Cynthia and I had mutual friends. She had a Bernese mountain dog named Rose. We called her the Bear, and invented an imaginary world in which the Bear was a great scientist, hard at work, whenever Cynthia and I were out of the house, on absurd solutions to the world’s problems. Cynthia told me that the Bear would help me, and she was right. I walked the Bear, and we had petting sessions. I scratched her ears. Cynthia said, “Where’s your belly?” and the Bear rolled onto her back with her paws in the air. At night, the Bear watched over us. She slept by the door, and then, later in the night, in the hall; and in the morning we found her beside the bed. She died in 2015. She’d lived a good, long life. She had cancer and dysplasia; she couldn’t easily move her hind legs, or balance herself. She spent the days lying on the floor. On the last morning of her life, though, before the vet came to euthanize her, she got up. She stood by herself, and walked to the bathroom. Cynthia and I bathed her. We toweled her dry, and later our friends who knew the Bear came to say goodbye. It was a Friday. The day was cold, and the light outside the windows was fading. Cynthia, the doctor, and I sat in a circle on the floor. The Bear rested her head in Cynthia’s lap, and I put my hand on the Bear’s side. The vet pushed in the needle, and I felt the Bear’s breathing stop.

  My family is gone now, all but Terry, her husband, John, and their two children, Tim and Liz. They live across the country. My sister and I don’t talk much these days, not since we lost our parents, not since I got so sick. In the year after the Bear died, Cynthia and I parted.

  What is suicide? Why do we have it? We talk about the brain and the mind. One is an organ, and the other seems a mystery. Deprived of touch, our bodies and our brains might suffer, as does our capacity for social life. We may seem “mindless” or “crazy” or “mad,” or we might appear sullen, or rebellious; or we cry and cry, or never cry, or overeat, or starve ourselves; we tremble, and yell at our partners and siblings, and carry out our own violence. Some victims of trauma learn to seek and perpetrate abuse. Abuse at a young age affects development. The effects last through life. Trauma can cause changes in our brains and our bodies. Must we distinguish between brain and body? Can we say whether our brains control our bodies, or whether our bodies inform our brains? Does my heart pound in anxiety, or am I anxious because my heart is pounding? Am I out of breath because I’m scared, or am I feeling scared because I am in cardiac and pulmonary distress? Am I better off dead, or do I feel the urgent need to warn you about a crisis that can kill you? Does my psychosis originate in areas of my brain, or is psychotic rumination an expectable expression of a more global sickness? Am I untouchable because I am sick, or am I sick because I am not touched?

  My hands got stiff. I was cold. My joints hurt. Tingling pain spread up my legs. My voice was flat. The light hurt my eyes. Sounds were irritants. My breathing became shallow and effortful. My skin broke out. I could not get an erection. I had hypertension and tachycardia. I couldn’t smile, laugh, or stand straight. I lost my appetite and weight, and hid in my apartment, and crossed my arms over my chest. I lost all feeling of safety and security. I curled in a ball. I saw myself broken on the patio beneath the fire escape. I had the feeling sometimes that people, even my close friends, were poking at me, poking and retreating, as if checking to see whether I was dead enough to leave behind. My illness was not confined to my brain or my body. Even after I’d got out of the hospital, it troubled everyone around me. Stigma is not merely a social imposition of hatred. It is not unilateral. I accommodated my own shunning. I stopped answering the phone. I stopped seeing people. I turned the lock. It was shame. Up on the roof, that Friday in 2006, I imagined my life reduced, compromised, evacuated of people, but I’d not imagined my own hand in achieving this. I’d not seen, then, how I would retreat, never feeling welcome or wanted. Are you ashamed of your life? Are you afraid that people will know something about you? What will they know? Will you be picked for the interview, for the promotion, for your hand in marriage?

  The term “mind” need not refer to a concept. I understand mind as empathy, which we wrongly equate with compassion and kindness. I think of empathy as an awareness of others, not as a category of feeling or gestures. The seventeenth-century philosopher René Descartes writes, “I think, therefore I am,” giving rise to our belief that each of us lives independently from other people. The prisoner in isolation is not independent, but in anguish. The person whose sexuality must be hidden or denied lives in isolation, not independence. Bullied children who don’t leave their rooms are not seeking solitude. The homeless, many expelled from our depleted hospital system, are our Bedlam. The asylums of the nineteenth and early twentieth centuries, designed as working communities, institutional homes for people who need them, are largely gone. We walk and drive past our homeless sick and dying, and our neglect is murder. “We are born alone and we die alone,” people say, as if we don’t have mothers and fathers, sisters and brothers, good or bad homes, losses that we suffer. We say that we lose our minds, but what we lose may be our bonds with others. I understand mind as brain, body, and environment—your body, my body, the body politic, the body electric. Were it up to me, I might give this illness a whole new name, not depression or even suicide or psychosis. I might call suicide death in place. The name speaks to the body in sickness and in society, to a death that seems to exist everywhere and nowhere. Death in place presents with compression in the chest and the clumsiness and exhaustion that come with movement of any kind. It presents as agitation and anxiety. Can we imagine a dying process writ large, our bodies saturated with stress hormones, insufficiently oxygenated, deprived of sleep, our muscles and joints aching, our neuronal signaling and organ and gastrointestinal functioning gone awry, our faces expressionless, our hands clenched? Do we recede from others and the world in sadness, in anger, in grief? Do we have a so-called chemical imbalance, or some genetic predisposition to suicide? Do we have disorders and comorbidities? Can the problem be found in our serotonin levels, our norepinephrine, or a deficiency of dopamine? Are we short on oxytocin, the chemical associated with bonding between mother and child? Oxytocin produces feelings of warmth and attachment. In sickness, we feel neither of those things. We become rigid. We take shallow breaths. Our hearts beat and beat. We are like babies needing to be held. If we are not held, then we will not thrive. We say that our heads are heavy, and that we carry the weight of the world. The statement, “My burden is my death and your life,” understood literally, could help us better cope with this disease. And Descartes, amended, might read, “I feel, therefore we are.” But who would think such a thing in a society like ours, where individualism is praised and social support agencies go underfunded? Suicide seems simply to happen, for reasons that we believe cannot be known. And yet we blame ourselves when we lose people. Do we fail the suicide, or do we condemn the suicide?

  We have the hospital. I was there. I wanted to live and not die. The hospital’s floors and white walls, and the bedrooms and bathrooms, were clean. The patients were not beaten, humiliated, or shoved aside. Medication was never forced. Solitude was possible, but no one was kept in isolation. A nurse was always close. I had my black canvas bag, with nothing in it that could harm me. There was soap on the bathroom sink ledge, and coffee with breakfast, and the comfort of other patients. We need our hospitals. We aren’t madmen or impulsive, wild-eyed types. We are your neighbors, your friends. We are students and singers, grandmothers and addicts. Maybe we’re you. What story can you tell? How does it begin? What can you see? What can you touch and f
eel? You will need to describe the chair in the corner, and the cup on the table, and the window that looks out on the swing set in the backyard. Is there a path through the trees? Who lives in your part of the world? What language do they speak?

  As long as we see suicide as a rational act taken after rational deliberation, it will remain incomprehensible. Stigma, society’s unacknowledged violence toward the sick, will remain strong. But if we accept that the suicide is trying to survive, then we can begin to describe an illness. I believe that we must make this leap in our thinking. We must rule out myth and speculation. This letter, this report, this book, seeks a paradigm shift in our understanding of suicide in society. It finds neither will nor agency in suicide, only dying, and calls for a great commitment to the hospital, to our community and our health. What is the hospital, if not all of us? What is medicine, if not touch? Suicide must not be imagined as enigmatic; it isn’t poetry or philosophy. I have come to think of suicide as a natural history that may begin in trauma and abjection, or the withdrawal of touch, and that ends in death by one’s own hand. The purpose of suicide is death, not what we may think of as rage, revenge, or atonement for sin. To the extent that the suicide acts, it is but a falling away.

  I am married now. My wife’s name is Marija. She is a classical pianist. She is an only child. Our friends Sasha and Vlada introduced us in late 2016. She was born in Belgrade, Serbia, and came to New York in the early nineties for conservatory. Back in Belgrade, she has her aunt Zora, her mother’s sister; and her cousins, Milos and Milan; and Milos’s mother, Marija’s father’s stepsister, Olga. Milan is married to Tijana; and Milos and his wife, also named Marija, have two grown daughters, Tara and Una. Three years before she and I met, Marija lost her mother, and her father died shortly after we met. Her mother’s name was Dušanka, and her father’s was Dragoslav; his friends called him Spika. Spika was a civil engineer. I remember the morning in Brooklyn when Marija got the phone call telling her that her father had had a stroke. It was winter, 2017. Marija and I had been together two months. She screamed and fell to the floor.

  She found him in intensive care at Belgrade’s main neurology hospital, in the middle of the city. She was allowed an hour each day with him. He couldn’t speak or move. He’d lain on the floor for six hours before one of his employees found him. She thought that he seemed to see her. She held his hand and told him that she was beside him. Could he hear her? None of the other patients seemed to be doing well. Marija went to the hospital every day. She and I talked on the phone. She was not sleeping. We made plans to live in Serbia while her father recovered. Would it help him to be in the countryside? Should he be in a private hospital? Should he at least have his own room? He was seventy-five. She stayed with him a month, and then he died. I bought a ticket, packed my suitcase, called a car, and rode to the airport.

  The plane landed in Belgrade early on a Thursday. Marija’s father’s funeral was the next day, Friday. The funeral was held at an old Orthodox cemetery on a hillside, with stone crypts rising above the ground, and walking paths that descended steeply and then wound around the hill. Marija’s father’s grave was next to her mother’s. Her mother’s was sealed; her father’s was open. Avala Mountain was visible in the distance. Marija, her cousins and nieces, her aunt Zora, and I stood in a line in a small chapel, a shed, really, with stone floors and walls, and a low ceiling. The priest swung his censer, and people passed through, a procession, everyone holding candles. They passed before the family, and then, one after another, stood their candles in a metal box with a sand bottom. Here were the old friends and fellow builders and engineers, and the children of friends already dead, and classmates from school, and people who’d owed Spika money, or from whom he’d borrowed, aging businessmen and a few mafiosi from the Yugoslav years. An hour passed; the candle box seemed ablaze; its fire lit the room. And then the candles began to melt. By the time the service was over, there was only liquid wax, filling the box.

  After the funeral, Marija’s friends and family members clutched my hand and told me that they didn’t know what would become of Marija without me. We were all meeting for the first time. I was glad that I was there. Marija and I have been together since. We married in late 2017, at city hall in Brooklyn. Couples waited in line to stand before the justice of the peace and say their vows. The people waiting seemed to come from every part of the world, and to belong to every nationality and race. It was a hectic scene.

  Marija said, “I do.”

  “I do,” I said.

  Now we spend Christmas and part of the summer in Belgrade. We sometimes think of moving there. Mainly, though, and for now, we live in the apartment in Brooklyn, the apartment from which, a decade and a half ago, I ran to the roof and hung from the fire escape. I still suffer anxiety, some days, and remain vigilant over my moods, and always will. I don’t always sleep well. I am sometimes fearful, though not of the hospital, which for me was medicine and asylum.

  I am home with Marija. She sits at the piano, and I sit on the living room sofa, writing to you. The piano’s sound is rich and full, and I can feel the vibrations through the floor and in the air. The vibrations are Chopin, or Janácˇek, or Bach. I vibrate too; the sensation is of hearing and feeling; electricity, therapy, harmony. At night in bed, Marija and I can see the fire escape. We see it outside the bedroom window, its dark outline against the city sky, the metal steps going up or down. I remember that Friday in April, that day on the roof, that time, that life, those friends, the months and years, that eternity. What will you remember? What will you write in your letter to a friend you can trust? And were you to write and send that letter, do you think that it could change the world?

  Acknowledgments

  I wish to thank the people who believed in this book before it was a book; my editor at Norton, Jill Bialosky, and her assistant, Drew Elizabeth Weitman; Rebecca Nagel, Tracy Bohan, and Andrew Wylie, my agents; and Dorothy Janick and Liping Wang; my former teachers John Reimers and Allan Gurganus; and Deborah Treisman, my editor at The New Yorker, who listened to me talk about this book for countless hours, and who read scores of early pages. Dawn Skorczewski, Lewis Allen Kirshner, and Anna Ornstein introduced me to a circle of doctors in Boston, with whom I met several times. Andrea Benzacar’s suggestions brought clarity and sense. My friends Jane Shapiro and Mark Singer were invaluable company along the way. My greatest debt is to my wife, Marija, who read the manuscript and was always enthusiastic and reassuring. Writing began at the MacDowell Colony and continued at the Corporation of Yaddo. This book would not be here at all were it not for a generous fellowship grant from the John D. and Catherine T. MacArthur Foundation.

  Works Consulted

  Alcoholics Anonymous, The Big Book.

  Bliss, Michael. William Osler: A Life in Medicine.

  Bowlby, John. Attachment.

  _____. Loss: Sadness and Depression.

  _____. A Secure Base: Parent-Child Attachment and Healthy Human Development.

  _____. Separation: Anxiety and Anger.

  Cregan, Mary. The Scar: A Personal History of Depression and Recovery.

  de Waal, Frans. Primates and Philosophers: How Morality Evolved.

  Dunbar, Robin. Grooming, Gossip, and the Evolution of Language.

  Durkheim, Émile. Suicide.

  Erikson, Erik H. Childhood and Society.

  Freud, Sigmund. The Standard Edition of the Complete Psychological Works.

  Goffman, Erving. Asylums: Essays on the Social Stimulation of Mental Patients and Other Inmates

  Grevens, Phillip. Spare the Child: The Religious Roots of Punishment and the Psychological Impact of Physical Abuse.

  Grob, Gerald N. The Mad Among Us: A History of the Care of America’s Mentally Ill.

  Herman, Judith, MD. Trauma and Recovery: The Aftermath of Violence—From Domestic Abuse to Political Terror.

  Hyde, Lewis. Imagination and the Erotic Life of Poetry.

  Jamison, Kay Redfield. Night Falls Fast: Understanding S
uicide.

  Lieberman, Mathew D. Social: Why Our Brains Are Wired to Connect.

  Lloyd, G. E.R., ed. Hippocratic Writings.

  Masson, Jeffrey Moussaieff. The Assault on Truth: Freud’s Suppression of the Seduction Theory.

  Miller, Alice. Breaking Down the Wall of Silence: The Liberating Experience of Facing Personal Truth.

  _____. The Drama of the Gifted Child: The Search for the True Self.

  _____. For Your Own Good: Hidden Cruelty in Childhood and the Roots of Violence.

  _____. Thou Shalt Not Be Aware: Society’s Betrayal of the Child.

  Mitchell, Stephen A., and Margaret J. Black. Freud and Beyond: A History of Modern Psychoanalytic Thought.

  Porges, Stephen W. The Pocket Guide to Polyvagal Theory: The Transformative Power of Feeling Safe.

  Porter, Roy. Madness: A Short History.

  _____, ed. The Cambridge Illustrated History of Medicine.

  Schafer, Roy. A New Language for Psychoanalysis.

  Shay, Jonathan, MD, PhD. Odysseus in America: Combat Trauma and the Trials of Homecoming.

  Shengold, Leonard, MD. Soul Murder: The Effects of Childhood Abuse and Deprivation.

  Shorter, Edward, and David Healy. Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness.

  Sigerist, Henry, ed. Paracelsus: Four Treatises.

  Solomon, Andrew. The Noonday Demon: An Atlas of Depression.

  Styron, William. Darkness Visible: A Memoir of Madness.

  van der Kolk, Bessel, MD. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.

  Winnicott, D. W. The Child and the Family.

  _____. The Child, the Family, and the Outside World

  _____. Playing and Reality.

  _____. Thinking About Children.

  ALSO BY DONALD ANTRIM

  The Emerald Light in the Air: Stories