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There was a moment when I was reading last night when I felt inextricably linked to the author.  These are moments I live for: that moment during reading when you know for sure it is the author coming through, and not a fictional voice.

I was reading an essay titled “The View from Mrs. Thompson’s” in David Foster Wallace’s collection of essays Consider the Lobster.  Though he skirts around it at first, the essay is about 9/11 and the reaction of his particular town at the time, Bloomington Indiana.  The event is referred to as the Horror, maybe in an attempt to give it an alternate or different meaning.

As DFW has no TV to watch the Horror, as soon as he hears what’s going on via radio, he jumps straight from the shower and heads to a fellow churchgoer’s home to watch. (I never thought of him as a church-going person, another revelation from this essay.)  But before this, before Tuesday, we learn what happened on Wednesday, the dreadful day after.

Wednesday was the day of the flags; American flags everywhere, planted in lawns “as if they’d somehow all just sprouted overnight.”   Showing your flag was somehow supportive not having a flag was, well,  bad.  DFW doesn’t have a flag and goes off in search of one, ending up in a convenience market, having a small breakdown.

DFW’s struggle with depression is well known at this point, though I’m not sure how well known it was at this time.  But there’s this moment in the essay, this one striking moment, when he is completely vulnerable, in a public place, in front of others:

“All those dead people, and I’m sent to the edge by a plastic flag.” 

His panic worsens as others ask if he is alright, and he ends up in the store’s storage area trying to calm himself.

This is so dead-on what it’s like to have depression, to feel panic, to be overwhelmed by something so small and so damn inconsequential.  It’s completely maddening.  And to be in public during an episode is the worst.

This single moment was a gut-punch to me.  I felt simultaneously tender towards the author, and as if I were looking in a mirror.  It feels so stupid to get worked up over something that seems so small, and yet… This is what emotional problems look like.  This is what they are.  Thousands of these kinds of moments make up what we know as depression.

I first tried to read Sylvia Plath’s novel The Bell Jar twenty years ago, while I was in college.  But I got about fifty pages in, just to the mass food poisoning scene, and I quit.  And I didn’t pick up the novel again until this past weekend.

I wish I’d finished the book twenty years ago;  I also wish that I hadn’t had a serious case of OCD and depression, both of which are what stopped me from finishing the book.  I had such fear of food poisoning that I couldn’t even read about it. How’s that for neurosis?

Esther’s descent into depression is one I’m well familiar with, and Plath is able to nail it with poetic language and startling imagery.  Esther seemingly has it all:  she’s smart, driven, focused.  She wins a scholarship and travels to NYC.  But during this trip, as in everywhere else in her life, she fails to connect to others.  As she grows more and more depressed and realizes that she can’t envision her future, she starts planning her suicide.

Esther becomes very paranoid about others; as her own confidence fails, as her disinterest in her life grows, she begins to distance herself from others, and from her life.  This is classic depression:  losing interest and beating a quick retreat from everything.  If life is too painful, just quit.

After Esther makes a good attempt at suicide (modeled after the author’s own first attempt), she is sent from hospital to hospital, eventually ending up in a private country club sort of facility, the 60’s version of a psychiatric hospital.  She has shock treatments, first at one hospital, then the private hospital.  There aren’t many details about the treatment itself, but it was common at the time.  ECT is still in use today, but not as common as chemical treatments.

The other treatment Esther is given is Insulin Shock treatment, which makes her gain weight, but seems to have little other effect.  Talk therapy is ineffective as well, so what is it that changes so that she is freed from the hospital?  Is it time that makes her better? Is she really better?  Is she back to her ‘normal’ self?

In the throes of depression, this is a thought that often surfaces for me:  why can’t I just be myself again?  The problem with this line of thinking is that, most likely, I wasn’t really feeling like myself before the sudden onslaught of depression, and most likely was already feeling unlike myself.  Romanticizing the past (and thinking of what you’ve lost or given up) is detrimental to you, but it’s a self indulgence few can resist.  Esther is no exception:  she looks back at her life and wonders why she couldn’t enjoy her achievements.

Again, is she cured?  Has she improved?  In the last few pages of The Bell Jar, Esther’s thoughts:

“I took a deep breath and listened to the old brag of my heart. 

I am, I am, I am.” 

Bragging over still beating, or bragging because she failed at her suicide attempts?  The ending can be seen as positive, with Esther returning to school and leaving the hospital.  But what has changed?  Is she cured, or will she return to a similar state in the future?

The answer depends on your view of mental health and psychiatry.  There are no known cures for depression or anxiety or bi-polar disorder; there are only ways to control the symptoms.  Every generation has its panacea for these ills:  electroshock therapy, lobotomy, life commitment.  Our generation has seen Prozac and other SSRI’s claim to battle our ills with little white pills.  Even further in our past, there were holes drilled in heads (trephining), blood let from our veins.

Mental illness doesn’t happen in a vacuum; it’s more of a spectrum.  It can also be episodic, with remissions lasting years, decades.  I don’t know what happens to Esther after she is discharged from the hospital, but i do know what happened to the author.

The first book I picked up this year is Green Girl, by Kate Zambreno.  This has never happened to me before, but as I read it, it began to seem very familiar to me.  Familiar in the style, mostly, not as much in story.  And then it hit me:  this novel reminds me strongly of my own non-fiction work.

The protagonist of Green Girl, Ruth, is a lost soul.  She is having an identity crisis, sparked by a break-up and a death.  It’s the intensity of this crisis, the harsh internal gaze, the inability to keep up even the most basic of hygienic rituals, the masking of the internal turmoil, that grabbed me.  Maybe this looks so familiar because I know that state so intimately myself:  this is depression at it’s worst.  You get so steeped in it, you can’t see anything else.

Another similarity that struck me:  the use of repetition.  This is a device I use often in my own writing and appreciate when it’s done well.  Here, I think use of repetition serves the novel and the character very well.  Repetition can show how mired a person can become, how stuck in destructive thoughts and habits.  Thoughts can become symbols of illness, foggy, unclear, the brain trying to work out the crisis.  Rumination is said to be the brain’s way of problem solving, trying to work things out.

We see Ruth through her own foggy gaze, speaking about herself in the third person, evaluating herself through the gaze of her lost lover, who is still in the States.  Ruth has run away, literally, from her problems, run to the gray streets of London.  We don’t know much about Ruth, really, aside from her status as ‘green girl’ and her habit of making bad choices.  She seems almost apathetic about her life, another sign of her depressive crisis.  She is ‘dead inside’ or makes the appearance of it, pretends that she is dead, numb.

Then, a life-saving transformation:  a haircut.  It seems trite, trivial, but if you are at the bottom of a crisis, even a simple act such as cutting off all of your hair and changing at least your outward appearance can be a life-saver.  This is temporary, though, and the effects of it wear thin, soon.

There is a sense that Ruth needs ‘saving,’ that all of the green girls need saving.  Ruth is impressionable, a trait which shows strongly in the end.   And as much as I usually hate the endings of novels (this one being no exception), I had to wonder in the end what did I expect to happen to Ruth?  What other ending could there be?

The crisis of identity is a familiar theme, but I like the way Zambreno really lets her character wallow in it, because that’s really the only way to get through it.

My very own little GNA strands have finally proven what I’ve known all along: SSRI’s will not work for me.

About a month ago, I saw my psychiatrist, who asked me if I’d yet taken my pill.  No, I said, not surprisingly.  I want to, but no.  She then suggested a new test:  a DNA saliva test that would tell me what liver enzymes I had, and what genetic markers I might have, which would in turn tell the doctor what medications would work for me, and which would not.  Something about metabolism and how fast my body would metabolize certain drugs.  I did the test there in the office and was told I’d need to come back to discuss the results with the doctor.

Today, I finally got my results.

Let me refresh your memory on how I feel about prescription drugs and the pharmaceutical industry in general:  I hate them.  I loathe them.  I think pills in general (SSRI’s in specific) are evil and I am reluctant, to put it mildly, to take them.  When I took the GNA test, I hoped that it would show some reason for my aversion.  And I was not disappointed.

In regards to serotonin transmitters, I have a gene that causes ultra-rapid metabolism.  In plain terms, this means that any SSRI’s I take will go straight through my system, not staying long enough to produce positive effects, but long enough to cause nasty side effects.  Basically, all these years, doctors have been throwing SSRI’s at me (the new and improved treatment for depression/anxiety!) promising me that they would work, they would help.  Wrong.

Second, there is an indication that I have impaired folic acid metabolism.  Folic acid is turned into methylfolate in the body; methylfolate is a precursor to neurotransmitter synthesis (serotonin, dopamine, norepinephrine).  I was given a prescription for a ‘prescription food’ pill (more like a supplement).  I was given some pamphlets to peruse.

So what does all of this mean?  That for years– nay, decades– doctors have been winging it.  They’ve thrown pills at every problem and hoped for the best.  They’ve gambled to see what pill would work for each person, not having the slightest indication if that particular version or brand would work, what side effects might be, what other complications would arise.  It’s been a complete and total guessing game.  Trial and error performed on humans.  But with this new testing, the age of ‘personalized medicine’ has been born.

Another important implication from all of this is that what was recommended for me isn’t an actual drug.  It’s more like a supplement, which isn’t a far cry from an actual supplement… or from food.  The next step for me may well just be upping my nutritional game and investing in good organic foods that can be used medicinally.

Personalized medicine will be huge, I think.  But with results such as mine, will doctors start leaning more towards natural and nutritional based remedies over chemical ones?  Let’s hope so.

It’s my constant battle with myself:  to stay and face the danger, or flee from it. 

Except, there is no real danger.  My brain is playing games with me.  

Except, it doesn’t feel like a game.  It feels real.  It feels like actual danger.

The past twelve months have been book-ended by two truly unhappy events.  Last August, I was at Nashville airport ready to board a plane to San Diego, what would have been my first trip to California.  It’s a long story, but in the end, I didn’t make it to San Diego.  I sat in the airport and cried, and popped Xanax.  I even got another flight for the next day but never made it.  I haven’t written about it because it was too painful.  Too embarrassing.  

It was like something you’d see in a movie, or see happen to someone else.  It’s something you never imagine would happen to you:  this is what would happen to someone else. This would never happen to you because you are in control, you can control your anxiety, you are strong.  This is the narrative in your head.  This is what you tell yourself in crowds, in movie theaters, on planes.  You are strong.  You’ve been through worse.  You have anxiety but it’s under control.  You would never let it get out of control.

This narrative has worked for you for years.  You don’t need medication because it’s under control.  

And then, you find yourself screaming in the last seat of a plane, a plane that is taxiing away from the airport, a plane already heading towards the runway.  You scream until they turn the plane back, go back to the gate.  You have to get off of the plane.  The entire cabin full of people knows it’s you because the captain has announced that there is an ‘anxious passenger’ that has to get off.  You are in the last seat and so you must walk past each and every passenger on the way to the door. You are embarrassed, humiliated.  

Two nights ago, Tori Amos played at the historic Ryman Auditorium.  I had a ticket and was looking forward to seeing her again at the Ryman.  I live less than five miles from the Ryman.  I took a xanax and got ready for the show.  

Well, you can guess how this turned out:  I never made it to the show.  Just being in the car caused me to panic.  Agoraphobia?  Probably.  But it’s been a year– a year in which I had ups and downs, went back and forth to work, traveled.  It’s tiresome, dealing with anxiety.  It wears me out.  It tears me down. 

In our culture, people don’t take anxiety (or depression) seriously.  Everyone has felt anxious about something in their lives: speaking in public, or flying overseas.  There are a thousand reasons to feel anxious, to feel nervous.  But having an anxiety disorder is so much different than nervous butterflies.  It’s so much more threatening.  Constant anxiety isn’t healthy and it’s not productive.  I myself have not taken it as seriously as I should have.  It’s already caused tremendous changes in my life: I’m unable to work, I’m unable to function like normal. I can’t bear to be away from my apartment.  I feel stuck, unable to make necessary changes.  

My body and mind are in constant fight or flight mode.  The question I’m asking myself is this:  will I run away or stay and fight?  

A depressed man uses a puppet (found in the garbage) as a way to deal with the “negative aspects” of his personality.  As a way to deal with the fact that he tried to commit suicide.  As a way to deal with his failed suicide attempts, failed marriage, failed business, failed fatherhood.

I’m all for alternative forms of therapy; I think Americans, in general, are way too over-medicated.  Got an ill, here’s a pill.  A pill for every  ill.  So I guess it’s refreshing to see someone talking about other therapies besides chemical ones.

The Beaver puppet is startling at first;  Mr. Black’s family is taken aback, understandably.  As is the audience.  It’s awkward, it’s uncomfortable.  And just when you think you’re getting used to it, the film dives into some even weirder shit.  This movie gets really really weird.

Just like most psychiatric drugs, there are side effects to using the puppet.  The Beaver becomes a crutch;  Mr. Black becomes dependent on it. He can’t talk with out it;  hell, he can’t even have sex without the Beaver  (plushophilia, anyone??).  Mr. Black seems to be on the right track:  gets his business going again, gets his wife and one kid back.  But he’s dependent on that puppet, just as he would be on a prescribed drug.  The puppet is a symbol of modern drug therapy:  once you get on it, you can’t get off.  Eventually this happens to Mr. Black:  he can’t take the puppet off.

Several things caught my attention in this film.  First, the family’s reaction to his therapy:  skepticism at first, acceptance, then total rejection.  Work colleagues were different:  they saw the puppet as an eccentricity, until it became too horrific, and they then rejected Mr. Black altogether (how many times have we seen this in the media?).  The public loved him and his puppet until they found out just how really crazy and mental he was.  Again, sound familiar?

Mr. Black’s oldest son rejects him completely, sick or no, until the very end of the film.  Interesting that the son, too, shows signs of depression and keeps post-it notes all over his room with traits he sees in his father that he wants to avoid.  We’ve all done this, right?  But the question remains:  how will the son avoid the same pitfalls as the father?  We know that depression and other mental illnesses are genetic; we can see this in the film, but the mom (Jodie Foster) doesn’t seem quite aware of that.  She gets angry at the son for sleeping all day.  This is very familiar to me:  as a person who suffers emotionally, I’ve often felt the anger of a parent directed at me simply because I was sick.  No other reason necessary.

What is this film trying to say about depression and mental illness and our treatment of it?  The film culminates in a scene set in an institution, father and son hugging, finding common ground at last.  Is this the message?  That we can only find solutions in institutions?  That we must be taken out of society and locked up?  That no other therapies will work?

I think if the puppet is metaphor for chemical treatment of depression, then it works.  Chemicals are destructive to our minds and bodies, our relationships with others.  This still doesn’t answer the question of why he ends up in an institution, or where he goes from there.  Which leaves me wondering:  where does the field of psychiatry go from here, once we realize drugs are not the only answer?

 

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