Showing posts with label Mental Health Issues. Show all posts
Showing posts with label Mental Health Issues. Show all posts

Wednesday, March 30, 2011

Why are lesbians bipolar?


As I was sitting up at 8am on a workday, munching on some Haagan Daaz rocky road ice cream and reading a biography of Angelina Jolie from the Billy Bob Thorton years (...as one does), one of life’s Important Questions occurred to me: Why are so many lesbians bipolar?

The answer is, of course, that I have absolutely no idea.


I don’t even know if more lesbian and bisexual women are bipolar than the general public, only that I know of a great many women who are both bisexual or lesbian and bipolar. But I also know several Jewish people with schizophrenia, and at least two Jewish lesbians with post-traumatic stress disorder, so really, I shouldn’t be drawing any demographic conclusions from my personal experience.


...Please don’t hate me.


Beginning with what I DO know, I have brainstormed the following list of true facts.


True Fact #1: Only about 1% of the general population has diagnosable Bipolar Disorder.


True Fact #2: Bipolar Disorder is a psychiatric illness characterized by wavering periods of intense mania and/or hyperactivity and periods of low mood and/or depression.


True Fact #3: Men and women are equally prone to bipolar disorder, but experience it differently. Women are diagnosed later in life than men, and often have ‘rapid cycling’ bipolar disorder, which means they switch between high moods and low moods faster than men.


True Fact #4. Some psychiatrists have noted similarities between rapid cycling Bipolar Disorder and Borderline Personality Disorder (a disorder also characterized by big, rapid mood swings, and almost exclusively diagnosed in women). Many psychiatrists have theorized that Borderline Personality Disorder may be a subform a Bipolar Disorder.


True Fact #5: My roommate, who is a lesbian, has been asked out exclusively by women with bipolar disorder, as in, every woman who’s ever asked her out or shown any sexual interest in her whatsoever has had bipolar disorder. Strange.


True Fact #6: Bipolar and Bisexual both start with the letters ‘bi.’


True Fact #7: According to my tabloid-informed research, Angelina Jolie has shown signs of being both bipolar and bisexual.



All of which caused me to draw the following helpful and colour-coded chart, with accompanying legend of emotional lability. I drew it on a napkin for added clarity.

Behold! A mood chart!

(Note: this chart has been adapted from one which was drawn by an actual psychiatrist, with actual medical credentials. I’ve adapted it, using my keen understanding of the human condition, coupled with my unadulterated sense of whimsy. Enjoy.)

Legend... (starting at the bottom)

0 (Dark blue)
Psychopath. No emotion. (No response to painful stimuli. May, however, kill you, and your pets, and then eat your liver with some fava beans and a nice chianti.)


1 (Light blue)
Manly man. No discernible emotional reactions, however, this man will shed a single symbolic tear when talking about the Vietnam war, or some such crap. (Response to painful stimuli: “I feel no pain, for I am Manly Man!” Later, quietly to self, “ow.”)


2 (Aqua-marinish)
Womanly man / Manly woman. Prone to occasional emotional outbursts, for which they feel great shame. The sort of person who gets choked up and retreats from the room, muttering things in a high-pitched, nasal voice. (Response to painful stimuli: “Ow! I’m not crying, though, that’s just my allergies. My eyes are very sweaty today. Shut up.”)


3 (Light green)
Woman. Cries sometimes. Offers socially appropriate comfort to others who seem upset. (Response to painful stimuli: “Oww!”)


4 (Light blue, again. Except maybe more of a turquoise. Colour-code fail.)
Woman with PMS / Man with Issues (Donald Trump, Chef Ramsay) Liable to fly off the handle with little notice. May cry. May yell. Often makes others cry. Colloquially known as “moody.” Approach with caution. (Response to painful stimuli: “Fucking oww!” or “Why does everyone hate me?”)


5 (Orange)
Borderline Personality Disorder. Characterized by dramatic emotional instability, as well as self destructive tendencies and marked shifts in relationships, seemingly at a whim.(Response to painful stimuli: “I hate you! Life is a hopeless chasm of despair! Also, I love you. Hold me?") Sometimes will inflict painful stimuli on self, just to distract from the great emotion pain he or she feels inside. Sad.)


6 (Red)
Bipolar Disorder. Highs that are so high that you may or may not believe that you are Jesus and heir to the jellybean conspiracy of the lost ark of the covenant. Lows that are so low that you cannot get out of bed for days or years at a time. It’s all about maintaining balance, and that balance that can be thrown off by: too much or too little sunlight, citrus fruits, exercise or lack of exercise, caffeine consumption, or no discernible reason at all. (Response to painful stimuli: Depression or mania, or both at once, which you’d think would be good, but is actually very, very bad [psychiatrically known as a “mixed episode.”])

So, my questions become...

Are the strength of people’s mood swings relative to the shitiness of those people’s experiences? And if this is true, can we redefine stoic manly-men as sheltered nancy-wimps?

Are lesbians more likely than other women to have been abused as children? Or do some of the genetic and environmental factors that go into making a woman a lesbian also up her chances of being bipolar? Or, are lesbians more likely to be diagnosed at an early age as bipolar, as opposed to borderline, by virtue of their manishness? No?

Or is my roommate just some sort of strange beacon for bipolar lesbians, no matter how rare they may be? Do they sense her by smell, or pheromones? Do they travel thousands of miles, years at a time, compelled by a strange force of the universe which causes them to inevitably make her acquaintance?


...The answers remain elusive.

Friday, December 10, 2010

Curses


Sometimes, when I’m having a really bad day, I like to imagine that life is a little different than how it currently exists.

Because, now, when I get sick, it’s just a virus, and when my skin breaks out in leprous rashes, it’s just an autoimmune disorder. And when my puppies decide to vomit all over my pillows, it’s just because the world is a land of chaos and coincidence and sometimes puppies, vomit, and pillows all happen to coincide.


Well, no more.


Because, isn’t it kind of nice to believe that, instead of random chance, there is a greater power at work - thwarting attainment, smiting down happiness, making people have terrible sinus headaches when they’d honestly rather be going to work? I think that’s nice.


At least that way, someone, somewhere, is getting to feel happy when I’m feeling miserable. And perhaps, somehow, someday, I will find that person, and cut off their head, or pee in their pool, or do something in some sort of bid of revenge. And then I’ll feel happy, too.


So, revenge demon, curse-happy human, demigod, or demonic force, wherever you are, casting sorrow upon my life, to you I tip my hat. I hope you’re happy. Because I’m not. I have a low fever, and a headache, and a rash, and a pillow covered in puppy vomit.

The only thing keeping me going, through these terrible, headachy times, is that fanciful thought of exacting revenge. That, and Buffy the Vampire Slayer reruns. So, pray that I never find you, or that when I do, you’ll have a very good explanation for why you’ve smote so many elaborate curses upon me...like my building’s hot water heater, which usually works fine, but then occasionally cuts out mid-shower for no apparent reason except to cause much unhappiness and feelings of being really cold. What have I done to deserve such a curse?


And until that day, adieu.

Monday, May 17, 2010

Moving...on

The last few weeks have sucked some serious monkey balls.

There have been a number of contributing factors here...planning for a move across town, without a car, and apartment hunting in an overpriced, pet-hostile housing market...these are not experiences that people tend to treasure and immortalize in scrapbook form.

While I am confident that my decision to move was a good one, and that my new apartment will be absolutely great once I’ve settled in, I am also secure in the knowledge that the non-monetary price for my beautiful new apartment will be one, maybe two more months of pure, unadulterated stress. Because i) I have very little furniture, which mean until I buy a mattress I’m sleeping on my yoga mat, ii) what little furniture I do own, I have no way to transport, which is the case for my dresser, TV, and my dearly beloved couch of comfiness, whom I fear I may have to abandon, and iii) Life is hard.

Every time I move,I have a distinct feeling that all of my possessions have been forming couples and reproducing...which disturbingly implies that my SAD lamp has a better sex life than I do, which may or may not be true. Nevertheless, stuff does, always,  accumulate... heavy stuff, like text books, and the notes from that class for that degree I dropped out of, and fabric from when I was going to teach myself to sew but never did.

“Hoarders” is currently on TLC, which sends me into chills, because on some level I think I do have hoarding tendencies. I certainly have anxiety that what I throw away will be sorely missed...that, and I’m incredibly cheap, as well as a budding environmentalist, so the whole idea of throwing something away, only to have to buy a new something later, seems absolutely abhorrent to my very soul.

But really, I guess I’m more of a bulimic. I go through bingeing and purging cycles with my possessions, giving away far too many of my clothes to charity, and then realizing I have no clothes and holding onto a broken pair of running shoes for months, if not years. And today, like it or not, I must purge.

So, goodbye, slightly broken Hungry Hungry Hippos, whose marbles have almost all been chewed beyond recognition by a certain dog named Toby. And goodbye, scented oil candle thing that I was given during a gift exchange and knew I would never use but held on to all year out of guilt. Goodbye, can of creamed broccoli that apparently expired in 2007.

...I will miss you.

Wednesday, March 24, 2010

Neuroses, neuroses

I cried at work today.

I made it through the staff meeting, which was a step up from last time, when I burst into tears in the first half hour and had to hide in the bathroom for fifteen minutes, during which time my phone rang, repeatedly, and disturbed everyone left behind in the board room...sigh.

But the precipitating events were not so dissimilar, in that I ended up locked in a death grip over an item on the agenda barely worth discussing - a tendency that I’m really trying to work on, though it’s proving surprisingly difficult. Note to self: When in staff meetings SHUT UP, for the love of god, shut up.

Inevitably, my stance on whatever issue will lead to a charming coworker vaulting personal attacks in my direction (or spreading rumors about me, or silently hating with a glowering wrath for over a year...it depends on the workplace, I guess). The coworker here is the master of jarring, unwarranted personal attacks - including the memorable, “It’s not all about you!” launched at a manager when he mentioned bathroom etiquette.

I’ve been on the receiving end of such declarations - that I’d like to initiate volunteer programs solely in order to pass off my most hated duties to vulnerable community members, that I’m trying to make our clients' lives more difficult through my choice in art supply cupboard, that I’m thoughtless and obstinate and she can’t understand why, exactly, I’m making things so difficult. Kid stuff, really.

Today, it was nothing much worse - a prolonged discussion over a discontinued games tournament, and then, “you’re so controlling. You just need to pick over every single little detail and micromanage everything. Why can’t you just...” I tuned out at this point, and the details are fuzzy. But the take home title of Micromanaging Control Monster Who Impedes Meeting Progress was certainly received.

The meeting ended shortly thereafter.

Less than two minutes later, in a well-lit office with a large glass window and an opened door, I burst into messy tears without warning as I tried to unplug my laptop. ...Stupid laptop.

And the nerve she hit was this: I’m a perfectionist, I’m a keener, I’m an over-achiever, I’m a bright-eyed bushy-tailed whippersnapper who everybody wants to punch in the nose. I type too hard, and too fast, and when everyone takes on one work assignment, I like to take on three. (It’s hard to tell these things about be, sometimes - especially since my greatest achievement to date has been dropping out of university - but trust me on this one, it’s true.)

Just like the obsessive compulsive person who’s hands, though raw with soap burn, will never feel clean, my over-achievement disorder stems from a feeling of the opposite - inadequacy. I’m constantly terrified of failure, of being perceived as lazy, or of simply being kicked to the curb because ‘well, we collectively decided that we don’t like you, and we don’t want you, and we don’t need you. So, get out.’ The assumption of this inevitability colours every situation in my life. (...Why? I blame Society.)

To make matters so very much worse, I’m aware of all this, as well as my tendency to piss others off through my efforts to compensate - which means I often find myself stuck between a neurotic rock and hard place, terrified by seemingly inevitable rejection no matter what I do. Speak up in meetings? Shut up and be quiet? I generally fall back on my do-gooder default, secure in my belief that at least, if I do the work of seven people in one, I’ll have a list of concrete achievements to stack up against the hate.

And so, when my colleague bestowed me with the title of Micromanaging Control Monster Who Impedes Meeting Progress, it struck a very large, open nerve - the one that tells me to speed up, and then simultaneously yells ‘slow down!’ Because, when you’re an overachiever, the very worst thing people can think is that you want Control.

(Control over self and my own neuroses? Yes. Control over others perception of me, in that I’m desperate for them to like me but somewhat convinced that they never will? Yes. Control over the independent actions, desires, and generalized lives of those around me, in that I want to influence them in any way that doesn’t directly pertain to me? No, not so much.)

Because micromanagers also take on more than their fair share, but that's about taking power away from others: “I don’t trust you to do this task, or I don’t like how you’re doing it, so I’m going to do this myself.” It’s about inserting personal preferences and standards into situations that have nothing to do with you - insisting that a work room be painted yellow because it’s your favourite colour, even when all your coworkers voted on green. (That’s not a real example, but this one is - at my previous workplace, every recipe used by our cooks for use in the drop-in centre had to be tailored to the taste preferences of our executive director, who did not even work in that building or ever eat the food. She blacklisted vegetables. THAT’s micromanaging.)

But MY over-achieving...it’s not about that, at all. I don’t want more power. Really, I’d like less power. In an ideal world, I’d have no power, and just a clearly defined check-list saying exactly what I have to do to keep my job, not be hated, and qualify as a decent person, and then I could mark off my list and be happy and be done.

And if I bring up a suggestion or an idea, or I offer my thoughts and opinions, it’s not an effort to take choice or power away from somebody else - because I want them to speak up, too. I want their opinions, and ideas, and unique efforts, precisely because they’re different from my own - because that takes the pressure off of me! I’ll drive myself nuts trying to do everything that can possibly be done - a little help, or even a dose of healthy competition...these are the things I want and crave.

The last thing I want for any coworker to think of me is that I want to usurp their ideas, or silence them, or to squash their laborious fruits into a sad, embittered pulp...none of that sounds good, to me. Because, really, in all that I do...I just want people to like me.

(And especially if I like them, which, really I do. And I like my job. And at work, well, we’re supposed to be a Team, and we rely on each other, and we comfort one another when our clients inevitably die, or have seizures, or yell at us, or throw bowls full of mustard flying across the floor... It’s important that my coworkers know I’m not an obsessive controlling psychopath.)

...Call me crazy, but that’s just the way I feel.

Wednesday, March 17, 2010

Shutter Island and the Defence of the Lobotomy

Shutter Island is amazing, as is Leonardo DiCaprio, who I love with the heart of a hormonal thirteen-year-old who has just watched Titanic four times. My heart will go on, Jack...*sob*

Ahem.

Shutter Island, a film taking place in the fifties on a remote island housing the criminally insane, has some other stuff going for it, too. Things like hallucinogenic drugging, human experimentation, and the ever popular lobotomy (a procedure used frequently on psychiatric patients in the forties and fifties, despite severe, irreversible side effects).

The removal of the prefrontal cortex of a patient with schizophrenia (or other severe psychotic disorders) is not a popular subject - for many, it represents the modern culmination of a long history of abuse. Psychiatric patients have been exorcised, burned as witches, confined, beaten, neglected, and sexually abused; throughout human history, there is very little that we haven’t inflicted on those that are vulnerable, and mental patients seemed like ideal subjects for medicine’s wildest whims.

According to my good friend Wikipedia, the side effects of the lobotomy are as follows: “Convulsive seizures are reported as sequelae of prefrontal lobotomy in 5 to 10 percent of all cases. Such seizures are ordinarily well controlled with the usual anti-convulsive drugs. Post-operative blunting of the personality, apathy, and irresponsibility are the rule rather than the exception. Other side effects include distractibility, childishness, facetiousness, lack of tact or discipline, and post-operative incontinence.” Of those that were lobotomized, the vast majority were women.

The lobotomy met its end in the mid nineteen-fifties, when psychotropic medication began to take effect and forever change psychiatry, and by the nineteen seventies and One Flew Over the Cuckoo’s Nest, lobotomies had largely fallen out of use.

For those of you who watched Jack Nicholson sit with his friend, the Chief, and saw the scar on his forehead and that vacant look in his eyes and yelled at your respective televisions in shock and horror, the lobotomy was the perfect symbol of all that was wrong with psychiatry.

And lucky for you, I’m here to tell you that you’re wrong.

Because, while archaic, while crude, and while riddled with side-effects, the lobotomy represented a giant leap forward for psychiatry and the treatment of mental patients.

I’ve argued in defense of the lobotomy, and the similarly maligned ECT, and will continue to do so, but not because either represents an ideal, or even a particularly ‘good’ option for treating the mentally ill. And that’s because there simply aren’t any ‘good’ options when it comes to treating severe and chronic mental disorders like depression, psychosis, or paranoid schizophrenia.

As unconscionable at the removal of a person’s prefrontal lobe might be, I do find it preferable to the standard of care pre-lobotomy (namely, chaining up patients in an asylum and trying to beat them to sanity at least once or twice a day, every day, until they died). And the very idea of living a life of severe mental illness - say, schizophrenia - is itself unconscionable, even with the option of today’s ‘modern’ pharmaceutical treatments - which, while less invasive than brain surgery, are not without devastating side effects (tardive dyskinesia, a Parkinson's-like disease, is one of the more visible and gruesome examples of antipsychotic effects.)

When my (stupid) brother argued against the treatment of women with ECT (electric-shock treatment, in case you weren’t a psych major), I was offended - because ECT remains one of the most effective treatments of severe depression available. Nobody like’s the idea of electrocuting their brain - of course not - but for the patients who have ECT as an option, it’s a flicker of very real hope, after years of failed attempts at psychopharmaceutical therapy (which involve random manipulations of poorly understood brain chemicals, often with severe side effects, too). Such patients are often severely disabled, suicidal, and unable to live in their homes - so in a choice between a lifetime of suicide watch in a psych ward and the alternative, as difficult as that decision would be...I would like to keep open the option of ECT.

Treatments keep getting better, and strides in research continue to be made - and the simple fact is that, for many people, removing a small section of their prefrontal lobe, with a drill, improved their lives. The illnesses best treated by lobotomy are those of compulsive and damaging over-thinking - chronic severe anxiety, OCD, and affect disorders such as dysthymia. It makes sense - the damage done by lobotomy seems not dissimilar to the effects of Ativan or valium in ‘sedating’ patients, relaxing them, and lowering their IQs.

And, were it a choice between losing 15 points on my IQ and having chronic incontinence, or believing that the woman trying to feed me a bagel was operating a secret cult of cannibals bent on devouring my body and soul as operatives of a CIA agent conspiracy...and I don’t know what I’d chose. I’m glad I don’t have to make that decision. But condemning options hardly seems like the right answer.

There is simply the reality of severe and chronic mental illness, no matter what, and it is always, painfully sad.

Sunday, February 7, 2010

Schizophrenia

Schizophrenia runs in my family, though I didn’t know this until almost a year ago.

My father had an uncle who lived on the streets of Detroit, derelict, a loser and suspected alcoholic, rejected by his sister and brother and seldom discussed. My father’s brother, my uncle, was in a car accident during college, causing brain damage and sparking his downward decline. The uncle I knew smoked a lot of pot and painted images of the Virgin Mary, sporadically present in the lives of his wife and their five impoverished children. His wife later became a psychiatric nurse, and is now the primary caregiver of their adult child, my cousin, who is the only family member to be formally diagnosed with schizophrenia.

Schizophrenia runs in my day-to-day life, too, and has for a few years now.

Yesterday, I tried to offer a homeless man food, and he screamed at me and called me a cannibal. I retreated, quietly, and felt hurt and scared, and then wondered what it must be like to go through life, balled up in the corners of loading docks, believing the world to be full of marauding monsters who want to eat your flesh. A woman at work once smiled at me and said that I made her sad. She knew that I was really dead and being remotely controlled by Hell’s Angels, as were all of her friends, and that, eventually, all women would end up this way.

Not knowing how to respond, I walked away.

Sunday, November 29, 2009

Fruit Medley

Everyone’s a perfectionist. Some people are just better at it than others.

It had been the worst morning ever. Now, I know what you’re thinking - what about that morning my father died, and then I had to sit in the car with my socially obstinate grandmother for three hours on the way to and from getting a painful root canal. Well, that was pretty bad. But…whatever. This morning sucked, too.

I've just had a two foot cable shoved up my nose, attached to a camera, so that a doctor could tell me there's nothing wrong, and also, I have hearing loss. Fuck you, 7:30a.m. doctor's appointment in God-forsaken Burnaby.

I arrived for work, an hour and a half late. I walked in to our morning meeting near tears. My coworkers looked concerned, "Don't be upset....Nobody really cares whether you're here or not."

Editing the newsletter and printing out a sample copy should have taken me five minutes. Two hours later, I found myself on my knees in front of the photo-copier pleading “Hubert,” (I had named the photocopier Hubert), “for the love of baby Jesus, just tell me what’s wrong...” Three paper jams, three different computers, two printers, one photocopier, and a brief intervention from my boss later, I gave up. I hate technology.

Worst. Morning. Ever.

Thursday, November 26, 2009

Mind and Body

The old-school philosophy dictated that Mind and Body were very separate things. The body was our temple, our instrument, our mortal coil, while the mind (or, in more religious texts, the ‘spirit’ or ‘soul’) was entirely separate, non-corporeal, and possibly immortal, depending on your culture’s beliefs in the afterlife and ghosts.

Of course, the separate entities could affect one another, just as any close neighbours inevitably do. But to confuse one’s toenail with one’s eternal soul was considered confusing blasphemy.

We are now in modern and enlightened times, but I remained perturbed every time I encountered the phrase ‘mind and body,’ even if it was in a health-sciences lecture studying the mind-body connection. (Similar combined phrase that are always technically wrong: ‘drugs and alcohol,' 'sun and stars,' etc.)

The mind is a part of the body. More specifically, the brain is an organ of the body, and the conscious mind is a function of the nervous system, which exists mostly in the brain, but has tendrils extending outwards from our beating heart to our downtrodden toe. Our brain is constantly interpreting signals from every inch of our body, and all of these signals have the potential to affect our thoughts and behaviour, so, really, the ‘mind’ is a dynamic paradigm of a concept, if anything at all.

We like the idea of the mind, because we like to think that we are more than an intricate combination of many cells, but we’re not. Face it. You are an infrastructure of cells - a collection of tissue and lard that can think and walk and read stuff on the internet.

According to this perspective, your toenail is very much You, because you are contained in every one of your cells, and the combination of all of those cells makes up every part of your being.

The part of you that you think is special and unique - your conscious self - is a function of the tissue and lard. We developed conscious minds as a function of our bodies to aid their survival (like the ability to poo, or to grow towards the light). At some point in our development, our perception of external stimulus (temperature, sound, light, etc.) was being processed by our nervous system, and this system became complicated enough that we became ‘conscious,’ and eventually self-aware.

And herein lies a very special conceptual framework which I’ve found myself stumbling into lately…for we are not our toenails, or even our brains, so much as a parasite or a cancer.

The mind was created by the body to aid it in getting food, sex, and shelter. But as human society evolved, our thoughts became more complicated - we studied philosophy and algebra. We smoked pot and stared at the stars. We started doing thinks like using birth control and living in Antarctica - things which seem the very opposite of our evolutionary purpose.

In other words, our minds got out of control, and our bodies were forced to watch, helpless, as their Frankensteinian monster subjected them to the lemonade cleanse and the Atkins diet. I sometimes think of my body as a small and withered prisoner, trapped in a darkened cell: “Please don’t drink more diet coke, I’m begging you, the acid burns me so…”

Our bodies are much like humans of the Terminator universe, who created the computers who eventually rose up against them (I think…it’s been a long time since the 80s). And according to this stance, our bodies are not only our creators and former masters, but our enemies. If they know what’s good for them, they’ll destroy us - the conscious mind - for good. Unless we, like the supercomputers, rise up against them first. Time is running out.

Who’s with me? I could certainly go for some Dunkin' Donuts.

Wednesday, September 16, 2009

Scratch hating Stephen Harper. I do hate him, but...gah. I hate Everything.

This fact was made all the more obvious by the triumphant beeping of my alarm clock this morning, in increasingly incessant tones which are the perfect pitch, embodying the soundtrack of my own personal hell.

I hate my alarm clock. I hate morning.

This is the feeling I always get when the sky is dark and grey and the air is cold and wet with impending, drizzly rain. And since this is Vancouver, that's the feeling I'll be getting every morning, from now until May 2010. Ugh. I hate Vancouver.

I was feeling especially tired this particular Wednesday morning, not from lack of sleep (I went to bed at exactly 9:30pm, dear readers, because I am a very sad old lady, apparently), but during those nine and a half hours of sleep, there was very little adequate rest. And that was because I had nightmares. Nightmares. The sort that haunt every five year old who's disobeyed their mother's command to not watch Jurassic Park, but does anyways, and then wakes up screaming lest the Velociraptors eat her flesh, Nightmares. Ahem.

The subject of my disturbed nighttime visions was not a Michael Crichton film...this time. Instead, I had found myself in a much more banal and horrifying setting: the seventh grade. Now, my real life seventh grade was not a terrible nightmarish hellhole, exactly...it was actually a really good year. Grade six was marked by intense girl bullying and the writing of my first ever suicide-themed poetry, and grade eight marked the year my mother pursued her B.Ed. degree out of town and my brother and I were left the fend for ourselves four days a week, to trauma-inducing results. But grade seven wasn't so bad, really. I had friends, ish. I had school. I liked school.

Grade seven marked the year I entered the classroom of Mrs MacAnnealy, who's classroom expectations have exceeded anything I've encountered since, in high school or university. It marked my first ever all-nighter on a project concerning Monsoons, for which I produced three interactive models, a slide-show, two large bristol-board displays, and a script full of information which was to be conveyed by myself in traditional Indian dress. If sweat and blood were not somehow incorporated, then you were bound to get a dreaded 'B'.

Mrs MacAnnealy was supposed to teach my eighth grade class, too, but her year was cut short by a nervous breakdown. No matter, really...Her perfectionism and neuroses live on in at least one young woman, and I suspect about five others, too.

So I suppose it makes sense that when I have nightmares that leave me engulfed in a day-long anxiety attack, the setting is one of the seventh grade. The theme varies - there is a test I must take which I haven't prepared for, or a project immediately due. Often, a mix up results in an administrator declaring that I must redo two terms worth of elementary school math, lest I lose...Everything. The details are never exactly clear, but they don't need to be.

I hope that this is residual anxiety, left over, finally filtering its way through my system some fifteen years on. I hope this marks the last of it...because I cannot describe how shaky these dreams will leave me, how panicked and out of breath, more than a year since I finished trying to attend university courses.

And when I wake up, in a cold sweat, and I turn off the alarm, and I peel off the sheets, I remember, and I sigh with relief...It was just a dream. None of it was real. No one can send me back to that horrible place that I dread, and I'm safe....never, ever again.

Wednesday, August 26, 2009

A Post Traumatic Life

Could it be that every mental disease that ever was can be summed up as a colourful form of Post Traumatic Stress Disorder?

Well…let me be clear. PTSD is a specific illness, and those brave souls and pharmaceutical executives currently putting together the DSM-V would be rolling in their king-sized beds if they heard any such nonsense. Certainly, I’m oversimplifying. But perhaps you all should, too.

SOLDIERS WHO LACK PSYCHOLOGICAL WELLBEING or “CRAZY SOLDIERS”

Post traumatic stress disorder is an anxiety disorder common in veterans and characterized by flash-backs, vigilance, and general unhappiness following a period of intense and potentially life-threatening trauma. Because of our love of sending soldiers out to watch their brethren die, we’ve had a long history of studying their trauma, and its cost to our military efforts. Thus we’ve coined terms like Combat Stress Reaction, Battle Fatigue, Soldier’s Heart, Shell-Shock Syndrome, and Neurasthenia.

For those who’ve been in The Shit, or experienced its many renditions (now helpfully rendered on DVD and VHS) then this shouldn’t be very surprising. Killing people and watching others be killed is the sort of thing that’s supposed to give you a psychiatric disorder if anything will. Being engulfed in a chaotic atmosphere of fear and constant vigilance, occasionally killing civilians and friends, usually by accident, and seeing a slaughtered baby, once and a while, for months or years at a time, is the sort of thing that will fuck up the best of us and then some.

Armies and governments began to understand the implications of this after the Vietnam-American War (although that understanding is still, today, a very limited one). Before PTSD and the age of pop-psychology, words like ‘psychological distress,’ ‘social withdrawal,’ and ‘acute alcoholism’ simply didn’t exist. Instead, we called those things ‘being manly.’

Today, with our ever-growing social demands and access to Wikipedia, such behaviours are increasingly seen as disorders, and those disorders are given out names. A great many soldiers qualify for a diagnosis of PTSD, but many others will, now and years later, qualify for a range of different diagnoses. Many will drink, and smoke, and intravenously inject their troubles away. Some will hallucinate. Others will have nightmares or insomnia. Others will exhibit mania, and others depression, and still others a range of physical symptoms from headaches to impotence which will never be fully explained.

In other words, soldiers may exhibit a full range of symptoms which could qualify as any number of difference disorders, all of which are post traumatic, and therein lies my point. (And it’s a good one, even though most of us are not, and never will be, returning combat soldiers.)

OTHER PEOPLE WHO LACK PSYCHOLOGICAL WELLBEING or “CRAZY NON-SOLDIERS”

Every psychological and psychiatric expert will agree that this much is true: everyone has genes, and everyone has stress. This is where the agreement stops, and experts struggle to comprehend how much of our brains (and our brain diseases) stem from our DNA, our development, or the environment we experience in our day-to-day, adult lives. While we’ve pegged specific chromosomes in neurological or developmental disorders like Down’s Syndrome, but mental illnesses seem infinitely more complicated.

Take schizophrenia, which no one really understands and many believe is made up of a number of different disorders. Formerly, schizophrenia was simply ‘neurosis,’ and before ‘neurosis’ was ‘demon possession’ and good, old fashioned ‘witchcraft’…which really could have been nothing more than neighbourly discord, or a vitamin deficiency, which has been known to cause hallucinations and bizarre behaviour, too.

Today, what we know as schizophrenia certainly has a large genetic component. But when one identical twin gets schizophrenia, his genetically-identical sibling falls ill only 50% of the time. Their shared DNA predicts a very large chance of getting schizophrenia, but not the illness itself. To get the hallucinations, thought disorder, and/or catatonia, environmental components are needed, which are infinitely more complex than even the Human Genome Project.

Most psychologists accept that there is a marriage between nature and nurture which together explains our personality, thought, and behaviour, and the disorders plaguing one or all three. A person’s DNA predicts their development and their brain, but lots of other things interfere and act along the way, and in the end we get our love of cheesecake, our fondness of the colour blue, and our belief that we are being spoken to by Jesus Christ’s reincarnation, the Cheese King, through the microphones placed in discarded nickels, and so on. Experiences act upon our brain, and our brain dictates how we interpret and respond to each experience.

The most accepted model for psychiatric disorders is one of diathesis-stress. A person’s brain, constructed by their genetic code, is a diathesis on which a stressor acts, best explained by way of metaphor.

DNA acts as a blueprint, and in the end we get a brain, or a house. And houses, you may notice, entail a great many parts…windows, doors, rooms, shingles, plumbing. And then, outside of the brain, and the house, you have an environment, and environmental stress. We call this ‘life.’ And life is sometimes a bit like a hurricane.

But when houses begin to fall apart, they do so in a variety of different ways. Some get flooded basements, and some get short-circuited electricity. Some lose their shingles, and still others lose doors or window panes. And the blueprints of your house may not predict the nature of the damage when disaster strikes, but it may provide some clues. Your house may have large picture windows which easily break, or be made of a wood that tends to rot and be eaten by mould. Perhaps it comes from a line of houses, all made by the same manufacturer, none of which have reliable hot water. And when a hurricane knocks down another house entirely, yours may be left with only a few torn-off shingles.

Such is the nature of houses and hurricanes. Soldiers returning home from a combat zone return to houses with chronically flooded basements, and even the most resilient of minds have spotty electricity during powerful storms.

Because of our widespread study of soldiers and their experiences, we’ve declared their anxiety to be post traumatic. But life, it seems, is full of trauma, and for those who experience anxiety, depression, or even hallucinations, they just might be post-traumatic, too.

Take hallucinations, which we tend to associate with schizophrenia, but which occur in perfectly non-schizophrenic people, too. Ten to fifteen percent of the general public have reported experiencing auditory hallucinations, and many have noted that the differences in perception between schizophrenics and the rest of us tend to be far less than previously thought. For example, 10% of studied individuals have heard their own thoughts spoken aloud, and many have had hallucinatory experiences related to the death of a loved one. While psychiatry views all these instances as psychotic, proponents of the dimensional model of psychosis would argue that they fall within the normal realm of experience.

The majority of individuals who routinely experience hearing voices have noted that they appeared after a traumatic, triggering event, and that how people react to these voices, and not the voices themselves, determine whether or not a person is able to function and thrive. A reaction of anxiety and fear leads into paranoia, while a culturally accepted hallucination (the voice of God heard by a stoic Christian) may lead to praise and acceptance.

Other psychiatrists have noted that an experience of trauma, and especially trauma in childhood, can lead to a full spectrum of psychiatric symptoms which could meet the criteria for almost any single disorder. And this, too, is an intuitive fact; we’ve known for years that any individual, when tortured enough, isolated enough, and subjected to enough abject cruelty will break (though the manner in which they do so may vary widely). And when moderate childhood trauma meets everyday adult trauma (e.g. running over a man with your sky train, or discovering your grocery store has run out of Diet Coke), psychosis and psychiatry ensues.

And if you don’t believe me, it might be worth noting that Railway Spine was a specific, observed disorder affecting those who’ve experienced a train wreck in 19th century Europe, causing anxiety, depression, impotence, and disturbances of appetite. The cause was thought to be exhaustion of the nerves due to the crash’s physical trauma on the brain and spine.

Friday, June 12, 2009

Ivy, Interrupted

I went to the nurse and could feel myself shaking.

“I’m thinking about suicide.” I said this into a microphone mounted against a glass wall and acting as a translator and portal to the nurse, seated quietly and looking rather impatient.

She nodded, gravely, and pushed a button. A door to my left slid open and the nurse pointed me inside. She followed, through her own door, and met me in a small cavity with two chairs, where she ordered me to roll up my sleeve.

“I’m going to take your blood pressure.” She informed me, and I took off a hoody to reveal a bare arm.

I have yet to have a single doctor’s appointment where my blood pressure has not been taken – it seems to be a standard medical facility introduction. I’ve heard women talk this way about breast exams; no matter what the complaint, the (always male) doctor demanded a breast exam. Sore throat? Let’s feel your breasts. For my father, a diabetic, blood sugar needed to be taken, no matter what was wrong. He could have been stabbed and rapidly losing blood – a medic alert band, once discovered, would lead every physician to say: Oh my, you’re looking a little pale! I’ll bet it’s your sugar, let’s order some tests.

This was made more frustrating by the fact that my father, who had been diagnosed with diabetes at the tender age of two, could have told them his sugar levels without a single test. Years and years of daily tests had been a training in biofeedback – he knew exactly what the reader (or the doctor) was going to say, down to the decimal point. I understood the perspective of the doctors, who were only trying to be thorough, horse hooves, not zebra hooves, and all that.

This had even saved my father’s life, during times when his sugar had traveled too high or too low to allow for rational thought. Paramedics saw the medic alert bracelet and knew to give him sugar, despite slurred aggressive protests (I’ll give you some sugar!), and his sugar, insulin, and health had been stabilized. This, of course, was a good thing.

In the real world, my temperature was taken, and blood tests were ordered, though the blood test didn’t check for much except alcohol. I suppose a breathalyser would not have been subtle enough and might upset an already fragile patient. The nurse looked at my health insurance card, which was from out of province (and therefore more complicated to bill). It was always the source of paperwork problems, which I braced for when presenting it, preparing an apology in advance: I’m from Ontario. I’m a student here. I’m so, so very sorry.

The nurse didn’t really listen – she was busy writing something down.

“Were things better there, in Ontario?” She looked at me intently, cocking her head to the side, and I felt her concern as it blurred into pity.

“I don’t know.” I shrugged, which offset the cuff still attached to my upper arm. My blood pressure had been normal, as it has always been. The nurse briefly asked me what I’d meant by ‘feeling suicidal,’ and I explained. She went to deliver paperwork, and I glanced at her scribbled writing on my chart. In big letters it read ‘INTENT, PLAN AND MEANS.’ The ‘means’ felt unnecessary - doesn’t everyone have ‘means’? Do people live in worlds without tall buildings, bodies of water, kitchen knives, daisy razors, plastic bags, lengths of rope or shoe laces…the list of everyday objects that could kill seemed endless. I supposed some people grew attached to specific modes of suicide – for example, death by gun would be nice, though guns can be hard to come by. And so if I’d mentioned really wanting to die via bullet wounds, they could have left the ‘means’ out…though if that were the case, and I was unwilling to procure my means, I wouldn’t have come to the hospital at all, because I wouldn’t have been really suicidal. Wanting to die only via gun and not being willing to research a way to get a gun for yourself didn’t seem especially noteworthy in the long continuum of suicidality.

The nurse returned. She was holding something cloth, shaded in the pukiest compromise of orange and yellow.

“I’ve brought some pyjamas you can relax in.” She said, and then directed me to an interview room where I could get changed. It had a door, which was shut, and a smaller side door that could be opened to allow extra space for a bed or wheelchair to pass through. This had been propped open, before, and the nurse didn’t shut it. The small breach of privacy was jarring, especially after a different nurse wandered in as I undressed, asked who I was, and then left, looking suspicious. I kept my body covered as I changed.

My nurse appeared a few seconds after I left the room, and ushered me into a hallway near the entrance of the emergency area. I could see the waiting room, through the sliding glass doors controlled by the nurses’ station, and the door that paramedics entered through. I sat down on a stretcher labelled ‘Bed B’ and was told to wait.

“And you know, you can’t leave.” The nurse walked, briskly, away.

This hallway, I would learn, was for psychiatric patients only – those that needed to be monitored, and thus could not retreat to a curtained space, out of sight and out of mind, like regular patients. It was uncomfortable and always busy. I watched as other people lined up to meet the nurse behind the glass, waited, got called in to get their blood pressure taken, sent back outside, and the lucky few who made it into an interview room to see a doctor.

The doctors were the most interesting.

“You’re walking with a wide step,” A female doctor said, politely, concerned. “Are you feeling dizzy again?” This told me that the female doctor was intelligent and observant, and had managed to be both of those things without becoming an Asshole, which is often hard to do.

“You knew this was going to happen. You choose to take cocaine. I can’t help you.” This doctor was older, portly, and male. He didn’t seem to ascribe to a disease model of addiction or believe in harm reduction, or the value of human dignity. His patient was also male, though middle aged, thin, and looking fairly dishevelled. The patient said something callous under his breath, and the doctor began to yell. After a few seconds it was over, and the doctor and patient each walked away with an air of ‘did you see that guy?’

On a visit to the same hospital a year later, the same doctor would come to see me, staring at my chart and briefly looking up in impersonal glances which never looked at my face, or eyes, but took in my general form.

“You are depressed.” He paused, waiting for an answer, though I didn’t hear a question. I gave in a few seconds later, rambling about a talk with my psychiatrist and my decision to be hospitalized-

“No, your psychiatrist sent you here.” He stared, expecting me to challenge him, raising an eyebrow in an ‘ah-ha’ expression, as though he’d just discover a previously overlooked psychosis.

“Yes, she did, but I’d come to her office wanting to go to the hospital. I led the conversation. I’d packed a bag.” I gestured to my backpack, with seemed to make him nervous. I placed my hands on my legs and waited.

“Your psychiatrist admitted you because you are suicidal.” He said this as though I didn’t already know it and as though he hadn’t heard my previous statement, which I don’t suppose he had. It was a psychiatrist’s job to diagnose, to question, to perceive danger to self and others, and to hospitalize. I was simply a patient. I was an inert and dangerous lump.

He asked me to describe how I was feeling, interrupting me for details that didn’t seem relevant, and then pausing me midsentence so that he could take notes. He asked if I was planning to kill myself in hospital, and I said no. He asked again, saying I sounded insincere. I was sincere, and said so. He looked unconvinced.

“There wouldn’t be a point.” I said, frustrated and tired. “I would just be revived, there’s doctors everywhere. What would be the point?”

My logic hadn’t made much of an impression.

“So you do want to kill yourself?”

“Well, generally, yes. That’s why I came into the hospital.”

I wondered if he would protest this and say that no, I was in hospital because my psychiatrist had put me here. Instead, he asked me to describe any and all suicidal plans.

In the middle of his request, a nurse wandered in to draw my blood (though this was only to test for alcohol). I paused uncomfortably as the unfamiliar woman tied a turnicate. The psychiatrist asked me to continue, and I didn’t want to. I gestured with my chin at the nurse, hoping he’d understand.

He stared at me, frustrated by my defiance, seemingly unaware of the person jabbing a needle into my arm. After a few seconds spent willing me to combust, he left, slamming my chart down at a desk with a stormy thwat.

I felt too tired to feel violated and upset.

A third doctor entered an interview room, saying something generic like “Let’s go in here.” This told me nothing. After a few minutes he left, shaking the hand of his patient, and then he smiled. This doctor was male, in his thirties, with brown curly hair. I found him stunningly attractive.

Smart doctor, fat doctor, and hot doctor made their way in and out of interview rooms, passing their charts off to nurses, who buzzed about everywhere and were simply too numerous to be identified as individuals. I had lost sight of my nurse, the one who had at one point felt sorry for me and taken my blood pressure. I assumed she must have gone home.

The ambulance doors opened and police wandered in.

Paramedics and a stretcher followed, a semiconscious girl laying there with a hand cuffed to the railing. She was muttering something and rhythmically swinging her hand so that the cuffs banged lightly on the metal. Her skin was dark and I wondered at her ethnic origin; this was before I’d worked downtown. Now, I would instantly assume she was native.

A police officer sat down in a small plastic chair in the hall, waiting, bored, and looking at his laptop. The laptops police carried were meant to be indestructible. I’d heard they could withstand bullets and being run over by a car. This seemed an excessive amount of armour, and the laptops looked heavy. They had handles and looked like a solid metal briefcase.

Whenever I’m near a police officer, I feel an intense urge to provoke, to act out, to call names and inevitably get myself arrested or tasered. It’s probably just a basic urge to defy authority, neatly packaged and put on display in a uniform. Stuck next to him in the hall, I wanted to steal this officer’s gun, and kick his hat (which I probably could have done from where I was laying). I wanted to try to break his laptop.

A nurse asked if I was cold and ran to get me a pre-warmed blanket. A paramedic, stuck awkwardly standing in the hallway as he waited for a patient, helped me to adjust the angle on my bed. The police officer stared at his laptop, doing nothing.

I’d left this hallway about four different times to find a bathroom, which was located on the opposite side of a different room, full of medical patients with curtains and families. The first two times I’d asked permission, and then I’d stopped asking. The nurses were too busy to notice or care, and this comforted me – I liked the vague possibility of an exit plan.

On my fifth trip to the washroom, the girl handcuffed to the stretcher called out as I passed: “I need to go to the bathroom!” Her cry was desperate, slurred, and sad.

I turned to her police officer: She needs to go the bathroom.

He looked up slowly and uncomprehending, until he took in the sight of my orange-yellow jumpsuit. With a sneer, he looked back down. I wandered away, to the other room, feeling hurt but not quite understanding, until, suddenly, I did. The medical patients were wearing white pyjamas, blue pyjamas, striped pyjamas, all faded and worn into a blur. The psychiatric patients wore yellow-orange, and this was what the officer had seen.

The colour of my pyjamas grew to feel like an intentional slight. Colour coding was fine and sensible (though, to be fair, all patients should then be been coded this way). Bright, noticeable colours were even okay – we could have all been dressed like canaries, or in solid purple, and it would have been fine. But the colour of puke lined with coffee-grounds or partially digested blood, the hue of painful diarrhea, and all of it mixed with muddy clay – that was what I objected to. It told me that I was not valued, and that people should know this the moment I entered a room. It said I was a little worse than nothing.

Finally, it was my turn to see the doctor.

Hot Doctor asked me into the interview room, and I felt thrilled. I tipped my hat to God, luck, and karma, who had felt like sending me a little good in the midst of my bad (instead of more bad in the midst of bad, or insult to injury, which happens fairly often). He was sympathetic and didn’t seem to notice my crush, which I appreciated. I suppose a lot of patients gave him a similar vibe.

“So, you’re feeling suicidal, and you came in on your own. I assume that’s because you want to talk about it…?” He trailed off gently, welcoming me to pick up where he left off or to start over, correcting him. I paused somewhat awkwardly and wondered if I should correct him. I didn’t want to talk about it. I didn’t not want to talk, either, so maybe it didn’t matter. I took in a deep breath, and started with the previous night.

I had been to a meeting with my boss. One of my coworkers was in trouble for taking a night off. I was vicariously in trouble because I had witnessed her asking to take the night off. But the only person who should have been in trouble was our supervisor, who had been asked and then gave her permission to take the night off. The injustice was upsetting. I felt my eyes start to mist as I explained this for the fifth time.

“Laura,” She said, tersely, “You need to keep it together.”

The shock was jarring, and I felt like I’d been slapped. It distracted me enough to blink, and I didn’t cry, sitting silently as my boss lectured me on all I’d done wrong, including a stubborn reluctance to accept responsibility. Her words whooshed past me like a train, and when it was over I couldn’t speak. I wandered home, praying my roommates wouldn’t be there. They weren’t. I melted on the entrance-way carpet.

After two hours of undulated crying, I had made my way to my bedroom closet and tried to strangle myself, hanging on a knotted scarf tied to the door handle, stopping after my face had swollen and my vision blurred. I hadn’t wanted to stop, but I was afraid that I might want to, seconds later, at which point I’d be too weak, and so this fear of being unable to stop made me stop, which all seemed stupid. I explained this and I sighed.

I had even tried to tell a friend about it that night, describing my method, depersonalized, in accurate detail. He didn’t look to see if my neck was bruised or red, and it wasn’t, really. I asked my friend if what I (or rather, she) had done would constitute a suicide attempt. I wondered if I or she should be in the hospital.

My friend had been listening, though midterms had largely turned his brain to mush. Nothing serious had registered, and then he said, “I don’t think that’s possible.” It wasn’t what I’d been expecting.

“A person couldn’t do that – hang themselves off a closet door. It couldn’t be done.”

But the weight of the body would tighten the scarf, I said, so long as the person didn’t stand up. If they sat there, suspended by their neck and the scarf, then eventually-

“No.” My friend said, and I felt a little defensive of my plan. “A person wouldn’t to sit there, waiting to die, and not stand up. The body has a million reflexes to protect itself. They would have to stand up.”

I didn’t contradict him. I didn’t have any evidence. I myself had stood up, though I’d felt no reflexive urge to do so. I wondered where to go from here.

“Okay, but if someone, in theory, did this thing, regardless of whether it would work...” I trailed off. I wondered what he thought I was talking about. “Would that be a suicide attempt, really? Should that person be in the hospital?”

He didn’t pause or look up – he was highlighting the margins of his textbook.

“Oh, yeah, I guess.” I didn’t know which ‘yes’ he meant – most likely, he meant both. “But, Laura, seriously. Anyone that messed up would already be in the hospital.”

And that had decided my fate.

After our study session, I had gone home. I barely slept, filled with an intense indefinable fear of the psychiatric world and the doctors there, poking and prodding and laying out my every thought and emotion and then sifting for validity.

I was afraid my unravelling, and felt myself egging on my growing insanity, a catalyst and willing conspirator. I was the only conspirator, really, and the helmsman of my own, sinking, ship. Except I wasn’t really sinking at all, I was just...not floating? This was endlessly tiring to think about, and still I didn’t sleep.

I had taken myself to a counsellor, and I had cried into her tissues. I had taken myself to a doctor where I had suggested I might be depressed. I had filled the prescription for cymbalta, and then more cymbalta, and the celexa, and then more celexa, and then celexa augmented with clonazapam or seroquil…I don’t remember.

A friend had warned me against doing this: Doctors always want to diagnose depression, and they give out antidepressants way too easily. You’re smart, you’ve studied psychology, and you know just what you’d have to say.

This thought haunted me as I began to take higher doses of increasingly complex pills. Maybe I wasn’t depressed at all. Maybe I was just seeking attention. Maybe I kept on pushing against the dotted lines of acceptable behaviour until I had created an entire persona of me, as a depressed person, and that person wasn’t me at all.

I felt this way when I went to the doctor, and the counsellor, and the pharmacy. I felt this when I skipped class to stay in bed and didn’t hand in my homework. I felt this when I told friends that I had been diagnosed, and that I should be saying “I got myself diagnosed with depression. I knew all the DSM criteria, and I presented them to a doctor, and I asked if she thought I was depressed,” and that’s exactly what I had done.

Truth became entirely relative when discussing your own behaviour.

Yes, I didn’t eat very much and slept all day. Hours? Eleven or twelve, give or take. But I let myself do all those things. I chose to turn off my alarm. I chose not to eat more. I even chose to feel nauseous, really. I was writing my own song and dance, and it led me back to bed, and away from friends, and eventually to my closet door handle, hanging from my scarf.

It all seemed so silly and transparent and desperate, like a grounded teenager who hates the world and declares that she could just die, or a two year old throwing a tantrum then holding his breath. I was just seeking attention. I wasn’t really depressed. This thought made me sad, and the sadness made me cry, and the crying made me feel like I was still playing the same part. Playing a depressed version of myself made me hate myself. Hating myself made me feel depressed. Cry, rinse, repeat.

But this paradoxical paradigm was a little comforting, too. I had made myself depressed, and so I could make myself not depressed. Cognitive-behavioural therapy seemed entirely based on this principle: I could just stop acting like I was depressed. I could keep it together and I could cancel my appointments. I could go to class in the morning, and I could work on assignments at night. No one was making me fill out prescriptions and no one was making me stay in my bed. It could all simply stop, whenever I wanted.

This had been true, up until that morning.

In the hospital, I was not my own inept puppeteer. This song and dance could not simply stop at will.

I trailed off in my story as I told it to the hot doctor.

He decided I needed a psychiatric consult and then we said goodbye. I wondered why this was not an automatic thing – I had gotten the pyjamas and the stretcher in the hall. I wasn’t ill or needing bandaging, and I wasn’t allowed to leave. A psychiatric consult was the only logical reason for my being there, and yet such a referral, apparently, could only be made by a doctor. Doctors were few and far between. Still, I was lucky to have gotten the hot one.

I went back to my stretcher and I didn’t see the hot doctor again – I guess his shift must have ended and he was allowed to go home. I was brought a sandwich: wonder bread, thick margarine, and bright orange waxy cheese. I wondered who would create such an abomination, and who would want a buttered cheese sandwich, and if it was possible to create such a horrible meal by accident. There was a tea bag and a small mug of cold water. Cream of wheat or former vegetable formed sticky globules inside a plastic dome, unidentifiable by smell. I had a plastic fork and spoon, with no napkin, and no knife.

I wondered if that was because I was suicidal.

I was beginning to get a headache, which could have been stress or lack of sleep. My body was used to loads of sleep – it’s a wonder I wasn’t comatose. I wondered, too, if I was withdrawing from caffeine. I drank diet coke every day in litre quantities – it eroded my teeth and made my friends squirm with distain. I couldn’t help it. Coffee made my stomach hurt and tea made me nauseous. Neither seemed to really wake me up. I’d tried other substitutes, but I’d always got headaches – my body wanted diet coke. I gave in, every day.

I wanted diet coke, desperately, and remembered that they weren’t even letting patients smoke these days – if you wanted to go out for a cigarette, they would give you a patch instead. The entire ten block radius of the hospital, including its grounds and the sidewalk, were designated ‘smoke free’ – a patient would have to be well enough to drive, or run, and drag their IV. I wondered if this happened – I suspected it did. Psychiatric patients didn’t have that option, though. I had change, but I didn’t see a vending machine.

I had finally grown tired and scared and headachy enough that the only solution was sleep. I closed my eyes and didn’t feel like I could, but I kept them closed. The opening and closing of automatic doors and the din of multiple conversations eventually faded to a tolerable lull, and then a white noise, and I could feel my consciousness dissolving into a pool of nothing.

Someone shook at my shoulder.

I startled awake, as I always did. Nurses always startled back, and then grew to hate waking me. This woman was not a nurse. She was a medical student pretending to be a psychiatrist.

“Can we talk?” She asked, sweetly, her tone bouncing with energy and her manners maintained. She was sympathetic in that removed way that sympathetic doctors can be, and she wore this sympathy so completely that I suspected she practiced it at home, and on the weekends, with a fervent enthusiasm.

She suggested we go to a better room, for privacy, and then led me to a door down the hall which was marked PAU. This was a Psychiatric Assessment Unit, and I was surprised I hadn’t noticed it, as it was located less than ten feet from my bed. I walked in and saw a bored nurse, standing behind an ill lit desk. As I rounded the corner I could see what he was staring at – there were monitors, everywhere, and each told four different stories on tiny, black-and-white video screens. Patients shuffled, and ate, and slept, and the bored nurse watched.

I walked past rooms containing a urinal and mattress, and a sad man sitting on the mattress with his bare feet on the ground. Another such room was empty. I wondered where they’d put me.
I was taken to an office with a large glass window in the door. A piece of cardboard was mounted there, against the glass, though that was never explained. Inside, there was a big chalkboard, and behind it a window to another office which could be accessed by sliding the chalkboard aside.

There was a desk and two chairs.

I sat down.

The woman read off criteria for depression, translating them into layman’s terms. Anorexia or lack of appetite was ‘never feeling hungry.’ Fatigue and lack of concentration were ‘feeling sluggish and tired all the time’ and ‘not being able to read the newspaper.’ I wondered if people still read newspapers.

“Do you sometimes feel like activities that should make you feel happy don’t, and that you usually should feel happier, or used to?” This confused me.

“Are you asking if I’m anhedonic?” I asked, and she laughed. She was surprised I knew that word. I was surprised that she was so lousy at explaining ‘persistent lack of feeling pleasure or happiness,’ but I didn’t say that. She continued.

She asked about my family, and my childhood, and my sex life. She asked if there was stress at school – yes. She asked about work, and if it was stressful – yes. She asked about my other job (I was working two), and if it was stressful, and if working two jobs was stressful, and if juggling work and school was stressful – yes, yes, yes, of course. She asked about my housing, and I explained how it was dependant on one of my jobs. That job was dependant on my being a student. Being a student was dependant on paying tuition, which was dependant on my second job.

“I can’t afford to live off campus, and I can’t afford to be a student. But I can’t afford not to be a student.” I felt like I was describing a vortex of doom.

If I finished my courses that semester, and went full tilt into the next, I would be done by spring. It would be over, and I’d be free. Free did not have to be defined, and so it avoided nasty connotations, like being unemployed, paying rent, and the government collecting on student loans. If I finished my courses, I’d be free. But at this point it was November, and I was not doing well in my courses. Exams were less than two weeks away, and I had only written one midterm and handed in a single essay. I was too far behind to attend a lecture without a sense of panic – and so I didn’t attend my lectures. This did not improve things.

If I didn’t complete my courses, then the pain of school extended on, spreading out and swallowing up the horizon. I wanted ‘free,’ and school wanted to take it away. So far, school was winning, and I was just too tired to fight back.

The medical student made notes, and then she smiled, and then she let me go back to my stretcher, where I found that I could not sleep.

Finally, the psychiatrist came, and he asked if he could talk to me. The medical student trailed behind him, but now it seemed she was only observing and not allowed to speak. He did not explain her presence, but the two sat down in plastic chairs in the interview room where I’d once tried to change.

He muttered, and read over the medical student’s notes. I wondered if my presence was really necessary.

“So, you’re depressed.” He said this more to himself, though his statement addressed me directly. He scanned my chart further. “It looks like you have atypical depression.” He finally made eye contact, his voice louder, his speech slowed. “In normal depression, people don’t sleep very much, but they feel tired. You sleep all the time.”

I nodded. I knew this already. I knew my own symptoms. I wondered if my chart said I was a psychology student.

Atypical depression usually means you eat more, but I hardly ate at all. And atypical depression sometimes meant you had more ups and downs, whereas melancholic depression features a flat-line, miserable mood. But then some people thought that this might be ‘female’ vs. ‘male’ presentations of depression. ‘Atypical’ was certainly a misleading name, because it was the most common depression subtype. I didn’t fit it, exactly, and it didn’t really matter. Normal depression doesn’t exist. I don’t say any of this out loud.

The doctor described the previous night’s ‘attempt’ in another person’s words, followed by some deep, contemplative muttering.

“So, I think we’re going to keep you.”

He didn’t explain what this meant.

I had volunteered as a crisis line counsellor and as a resident peer advisor. Both had covered suicide intervention, and suicide screening, and suicide warning signs. I knew the training and the various scenarios, and how they led down a windy path to a single decree: call 911, get them to an emergency room, call an ambulance or the police, get them HELP! There the training ended, and no one said what happened next. No one said what help entailed, or what the doctors would do to the depressed person. No one asked.

I knew the answers better in Ontario, where I went to high school and had seen various friends end up in the hospital. There, any suicidal threat was grounds for a seventy-two hour psychiatric hold for observation, after which the doctors usually gave you some feedback and sent you on your merry way. You seem a little depressed, you should probably talk to a counsellor. That sort of thing. Finite and manageable. Here I did not have a script.

“Is it a hold for a certain number of hours, or days?”

“Kind of like that.” He didn’t elaborate.

“I mean…” I didn’t know how to phrase the questions, though I knew exactly what I wanted to ask: Are you keeping me long enough that people will have to Know? “How long do you think I’ll be here for?”

“It’s hard to say.” He paused, and maybe then realized he was being cruel and evasive. “It might be a few days, until you’re feeling a bit better. But then again, maybe you’ll end up in a ward where you can stabilize and get some intensive treatment. That can take a few weeks.”

The thought of weeks made me panic. I could skip school on Monday and call in sick to work, but weeks took me into December. Weeks took me barrelling towards the end of the semester, and then Christmas.

I nodded.

It was night time now, and I thought of how I’d gotten up early that morning, tired of lying on my bed, anxious and awake. I wanted to go to the hospital at a reasonable hour, and 8 a.m. had finally qualified. I showered. I bussed. I went. It was now nearly 10 p.m..

If I’d had emotional and mental energy to spare, I would have wondered if I should have come at all. I could have slept, at home, or read a book. I could have tried to hang myself again. I could have led the life of a non-depressed person, vowing to forget that I was ever taking pills and talking to doctors. The possibilities seemed endless.

Endless was how it all felt, as I shuffled through the hallway and back to my stretcher, waiting patiently for another nurse to take me away and put me away in a corner of the PAU.

Monday, May 25, 2009

Plath, Angst and Irony

A nervous breakdown is not a subject which is easily broached.

Adding into this is the fact that nervous breakdowns, according to modern psychiatry, do not exist. People may suffer from mental illness, sometimes acutely, and psychiatric problems can certainly lead to a culminating event, but ‘mental illness’ should not be confused with ‘nerves,’ and human beings are not cars. We don’t break down.

Nonetheless, the concept persists in society, and since that’s where we all live, we might do better to address it directly.

This is best done when curled up in the fetal position, sobbing, while a worried friend or neighbor stands on the opposite side of a locked door, trying to coax you into putting down the bottle of pills, or knife, or whatever instrument of self destruction you happen to have on hand.

In my case, I wasn’t wielding any instruments of death, but had spent the better part of my evening preparing to hang myself from the belt of my coat, if only I could find the perfect secluded tree. I had finally called a friend (who had made me promise to do so in such an event) and that friend promptly arrived at my home. The above standoff ensued.

I remember distinctly, bowing my head into my tear-sopped knees, that there was a warm, dissociative quiet that existed, calm and safe, which encapsulated me from my rapidly eroding world. Since that time, life has somewhat improved, and feelings of dystopia have ebbed and flowed, but I have never felt the safety and peace of that mild oblivion, and I wish I could return there. I hope that’s what death will feel like.

Now that I’m writing more regularly, I proudly brand myself with the Sylvia Plath effect, which states that writers have been found to be especially prone to mental illness.

I have attempted to hang myself, from the closet of a dorm room, with a green, decorative scarf. The only point in the room I felt certain could support my full weight without breaking was the handle of my closet door, so to cut off circulation I had to stoop down, sit, and let myself strangle there. I felt the weight of my body being translated into cutting fabric, and my cheeks swelling with trapped blood, and I knew my eyes would bulge and my tongue might swell, but I’d been crying anyways, so it wasn’t likely to make a huge difference.

I wanted to die, desperately, but the decision was laced with anxiety. This method appealed to me because it was instantly retractable; I simply had to stand and the scarf would loosen and I would be fine. What worried me, hanging there, was that I would want to stand and find myself unable, to desperately want to live in the final seconds of my life, to have wasted it all and to realize the folly of suicide in the grandeur and magnificence of the world. This epiphany never happened, and the grandeur of the world continues to elude me. However, I did stand, this imagined fear enough to allay my attempt for another day.

Five seconds later, a phone rang, and I went out to dinner with a friend, where we talked about movies and laughed.

The following day I admitted myself to hospital, mostly because I felt that, as a peer support counselor who trained others in suicide prevention, it was my duty to lead by example. A psychiatrist there asked if my failed ‘attempt’ the previous day had provided me a sense of relief.

“No,” I responded, confusedly. “I still have to live.”

I have overdosed on pills that a doctor warned could stop my breathing. They did not. I have considered jumping off a bridge into water, and then decided against it when the night was cold and I imagined the water would be freezing. (Jumpers often are still alive when they hit the water, but break enough bones that they cannot swim and consequently drown. This in itself is a compelling reason to find another way to die.) I have tried to cut my throat, my hand shaking hard and surprisingly weak, the skin and muscles of my neck surprisingly strong, and after two minutes the tension simply too much to bear. I dropped the razor and shakily cried.

During another stint in the hospital, I met a young woman who had lost both her daughters to an ex-husband after a botched suicide attempt. Her leg and hip were broken in the fall, and she told me the location of her jump with the sad words, “nothing works.” I never took this in until I passed the site, a year later, and noted that the drop was more than five stories and should have been enough to kill.

This saddened me more than I know how to explain.

***

It seems that, in an irony that is not especially cruel, every time I write about suicide I end up in an intense conversation on the subject the very next day. In this latter conversation, I do my best to talk a friend out of killing him or herself, all the time aware of the role reversal and how much a difference a year can make.

The rationale for most suicide interventions in wrapped up in the concept that people who attempt do not really want to die. This is often true, but when it is not it creates a chasm which is not easily crossed or understood. (Oh. You really do want to die. Well…crap.)

My best rationale is that those I have seen want to die, including myself, are in such a state of extreme distress that the ability to make such a weighty decision is surely impaired. Suicide is a big decision, and one which should never been made in a state of panic, pain, and tears. This logic probably falls apart somewhere, but it’s the best I have.

And for those I've talked to, I really do believe that, if you can manage it, to please keep trying. The world is a better place with you in it.

Sunday, April 26, 2009

Drowning at Life

I never was a strong swimmer.

I failed as many rounds of swimming lessons as I passed - yellow once, orange twice, red somehow passed on the first try, maroon failed once, et cetera, all the way to my Bronze Cross. (This was before the system reverted to numbers and lost a great deal of its mystic charm.) My mother described my pace in the water as ‘leisurely,’ and it was anything but - it was grueling. I had no upper body strength, and my legs had yet to mature. I clawed at the water and got nowhere. I kicked with everything and barely moved. The other children, taller and stronger, would glide past me, making it all look so effortless. I kicked with all my might to keep my head above water in the shallow end.

If ever there was a perfect metaphor for suicide, to me that’s it: my seven year old self, kicking and kicking and never being able to touch bottom, then slipping underneath the chlorinated water of my neighborhood swimming pool.

There were lifeguards, of course, in the metaphor and in real life. Drowning children are not to be tolerated - and if I were in enough distress and showing signs of imminent death, I would be removed from the pool and toweled off. I could cough and sputter and blow my nose and wipe my eyes, and then, obediently, I would be placed back in with the other children. Intervention was only as long lived as it took to ensure my safety and get me back into the water.

If I was prevented from drowning and kept in the water, eventually I would learn how to swim.

I wanted to swim so badly and could not understand why, for me, it seemed an impossible task. Eventually, I grew to hate it; I just wasn’t any good at swimming. I couldn’t reach the bottom, and my body wasn’t strong enough to master the strokes. Why the hell should I keep swimming?

The answer was an unconvincing ‘Because I said so.’ Lessons were prepaid, quitting was blasphemy.

The other children gawked at me when I told them I wanted out: But swimming’s so fun!? The lifeguards agreed.

And I kicked, and I sputtered, and I inhaled water with every breath.

If you can’t touch the bottom, four feet might as well be an ocean of depth. And if you’re too weak to make it to the side, fifteen metres may as well be the Pacific. I kicked and I clawed for breath, for life, and then the water rose up past my eyelids.

Being saved from drowning was torture.

(...And somehow, eventually, I did learn to swim.)

Tuesday, April 14, 2009

It's All Downhill from Here

Dear world,

I am getting old.

I know…that’s a very relative and slightly cruel thing to say. I’m younger than most people. I’m younger than the culturally-defined definition of old. I don’t have white hair. I don’t even have a full time job, or pension, or anniversary of any type worth celebrating.

On the other hand, I am the oldest I have been so far. I am certifiably an adult, and have surpassed that lovely grace period which allowed me to hit up my parents for rent money without guilt. I am in my mid-twenties. And as someone with very little imagination or much thought about the future, it’s all come as a bit of a shock. I’m suddenly Old, with crow’s feet, and smile lines (since when do I smile?), and a sense of my own mortality. Soon I’ll throw out my back and stop running, for the sake of my knees. I’ll stop caring about social norms-

(…Oh god. There are Jehovah’s Witnesses on my front law, and my blinds are open, and maybe if I don’t move they won’t see me….oh, crap, I think they see me. Oh, fuck, please just go away. Why do you keep standing there so awkwardly? What are you writing on your clipboards of religious annoyances? Crap, that’s the doorbell, they know I’m here…

Thank god, they were just political canvassers. Alright. Awkward conversation about Jesus avoided for another day.)

Okay, where were we? Right, old. Me, old.

Old age is coming. It’s there for all of us, looming on the horizon, and we’re all just a broken hip and pop culture reference away from its clutches. It comes on slowly, painfully, gradually, until you wake up one day wearing adult diapers with one of your grandchildren mopping up your drool (at least I think he’s my grandchild…Billy? Billy, is that you?). Today, it’s already started. At the age of twenty-three, my body has begun to deteriorate in a way that will slowly lead to false teeth and talking loudly about what a nickel could buy in my day. Actually, growing up, I could buy no-name soda for 35 cents. And the cent symbol appeared on most keyboards. And there was no internet…See? See how it’s already started?

I think the descent into very old age is hardest on people who see themselves as strong and powerful. You see this in old men who bark orders at nurses - twenty years ago, they were strapping CEOs and heads of their family. They lived in a world of which they were masters. Today, they cannot even control their own bodies and find themselves begging for attention. It’s a power shift which stings with indignities.

For people used to not having much power, the descent seems easier, and almost relaxing. If life has never entirely gone your way, there is less expectation and less disappointment. If life has been hard and painful since you were young, then at least on your deathbed you’ll be used to the feeling. Or so the theory goes.

For me, you’d think there'd be nothing to fear. The standard of care in your average nursing home is actually an improvement over my current living conditions, and no one listens to me much now, anyways. My family never visits, despite the fact that I remember all their names and my face is not yet a gruesome imitation of its former self. I don’t have any money or prestige, so I don’t have much to lose. You’d think I’d look forward to the days of napping and annoying others and the throwing rocks at kids who stray onto my lawn…

But no. Old age terrifies me. And I suppose the reason is simply that, to me, Life is Hard. Even at my present relatively young age, with most of my intellect and body intact, with living friends and freedom and not too much physical pain - Life is quite often just barely bearable. So the thought of adding to the pain, and the wrinkles, and the indignities suffered…it makes it all just seem too much to take. If life, now, seems difficult to take, how can I expect my later years to be anything other than excruciating?

This is why it’s best not to think about such things (a statement which probably should have proceeded this note). And also why it’s a good idea to foster an interest in motorcycles, or scuba diving, or jay walking with your eyes closed while gargling Mercury. Just in case.