Wednesday, October 26, 2011


I was thinking yesterday about why I didn't try to kill myself the second night after I arrived in California, when my mother had been so angry with me.

I had formed a plan several days earlier; I had easy access to the pills I was planning on using. It would have been so simple: I'd take a hundred tylenol, and then I'd take a couple of my Saphris, which sedate me quickly.

So why didn't I? A couple of reasons. First, my father pleaded with me that night not to do anything to myself. He extracted a promise from me. That alone wouldn't have been sufficient. Second, a kind of sheer cussedness in me didn't want to die just because my mother was furious with me - "Don't give her the satisfaction." Almost directly contrary to that, but still complimentary, was a desire not to be seen as manipulative by my mother if my suicide attempt should fail - not to be seen as using suicide as a means of getting attention.

But the most important reason? I was too unhappy to kill myself.

Self-murder takes a certain moral clarity, a kind of courage. True, many people kill themselves because they are afraid to remain alive, but it takes courage to live with death for the days, weeks, months, hours leading up to a suicide attempt. When you are suicidal, the thought of suicide becomes a kind of talisman, a comfort, a reassurance that whenever you want to, you can just quit life, leave, abandon everything and everyone. Nobody can force you to live.

Even in hospitals it's possible to kill yourself. People leave windows open sometimes, or else you could hang yourself with your bedsheets, or just bang your head against the wall until you shattered your skull. You could save your plastic utensils, and splinter them into something sharp enough to cut yourself with. When you're suicidal, everything becomes a temptation for self-harm. While I was in the hospital this most recent time, before my meds were changed, I had been cajoled into arts and crafts, which they were calling "occupational therapy" for some reason. As I was sewing up a wallet I'd been given, I kept thinking about stabbing the needle into my eyes. Truly, everything becomes a means of self-harm in the depths of a suicidal depression.

But depression is not the same thing as unhappiness. I found the thought of suicide calming in the days leading up to my move to California. Every time my mind strayed to how much I was losing, how painful it was to be kicked out of school for a second time, to lose my friends and my apartment, I comforted myself with the thought of suicide. I was depressed, but the product of my depression - suicidality - actually made me calmer and happier.

It is very possible to be happy while depressed, and to be sad when your brain is functioning normally. This is what a few hours of happiness while depressed feels like, at least to me: there's a kind of hysterical giddiness to your temporary relief from pain. You know it's only temporary - that when you're alone again, away from the love and laughter of your friends or family, your depression will settle over you like a thick, viscous scum, tainting everything you touch, everything you try to do. At every moment, you feel the depression - like the specter of death - hovering over your shoulder, so close that you almost think you could catch sight of it if you turned around quickly enough. You feel extraordinarily visible, as if everyone can see you, can see that you're a fake, that your happiness isn't real. You laugh too loud, your eyes are a little too wide.

In contrast, I am now normal, and sometimes very sad. I cried two nights ago, silently and spontaneously, out of loneliness for my friends, for the people I left behind in Maryland. But I am alone for much of the day now, and this is no longer an object of terror for me: I go for walks by myself and am not afraid of my thoughts. I had a job interview today, and when I didn't get the job - the hours weren't right - I shrugged my shoulders, said "Oh, well," and enjoyed my day.

I don't know why I've been given this reprieve. I had fully expected the depression I felt this fall to last for months and months. It began lifting the day my meds were changed - and the day my mother reassured me that she loves me. Which was more important? I don't know. But as I said last time, each day now feels very precious to me, and I savor the sun on my shoulders as being especially sweet.

Saturday, October 22, 2011


A lot's happened since I last wrote.

I got kicked out of school.

I got put on suicide watch at school while my father flew to the east coast to pick me up.

I had a last meeting with my psychiatrist, "Dr. Blum".

I said goodbye to my dearest friends.

I flew to California, for the next two years at least, perhaps for the rest of my life.

My first night in California, driving down the highway from the airport, my father tried to prepare me for my mother's anger. I cried a lot, told him how suicidal I'd been for the past few days, and he backed off. I came into my parents' house scared and extraordinarily depressed.

Monday morning when I woke up my mother was already at work; I spent the day with my dog, who is a lovely dog, and I waited.

My mother didn't eat dinner with us. I knew it was bad - my mother's anger is slow, and it builds, and she lets it build, waiting until she's had enough to drink that it all comes pouring out of her. At maybe eight o'clock at night she knocked on the door of the room I'm sleeping in (my parents' guest room), and confronted me.

How could I have lied, and pretended everything was alright? How could I have missed appointments? What was wrong with me, that I'd fallen apart so completely? She'd always managed to work and make her appointments when she'd been so depressed. What did it mean that I was suicidal? Wasn't it just an act, an attention ploy? And above all, how could I have lied? Wasn't I just a terrible liar?

I quickly became incoherent, mute, in the face of her anger. I avoided her eyes, and this made my mother even angrier. It was a terrible evening, I wept inconsolably. I listened to my parents scream and fight about me outside my bedroom door.

The next day, my father drove me to the local hospital for an entrance interview for their partial day program - which, for those of you who aren't familiar with psychiatric care, is a 6 to 8 hour a day program of group therapy and individual meetings with a psychiatrist. During my interview with the program coordinator, I stated, after much prompting, that I was suicidal and couldn't swear that I wouldn't act impulsively and try to take my life. And so instead of entry into the partial program, I accidentally talked myself into another psych stay.

What can I say about the hospital? It was a large unit, and I was the youngest person there by about thirty years. Most of the patients on the floor were, like me, bipolar (I think because, compared to schizophrenia, bipolar is relatively common, and compared to depression, bipolar is relatively severe), and a few were delusional - none were acutely psychotic. As with all hospitals I've been in - and I've been in four - I slept as often as possible, because there was nothing to do and hospitals are frankly scary places to be trapped in. And you can't just walk out of a psych floor - once you've signed the papers, you're there until a psychiatrist releases you or you take legal action.

Within two days, I was feeling enormously better. I'd had my meds changed, by a doctor whose manner I disliked, but who I suppose knew what she was doing. I went from being on (deep breath) Saphris, Stratera, Lithium, Lamictal, Cymbalta and Latuda to being on Lithium, Lamictal, Cymbalta, and Geodon. Lithium is the classic bipolar mood stabilizer, Lamictal (generic lamotrigine) is an anti-seizure med which, like Depakote, was approved for use in bipolar in the early 90s, Cymbalta is an anti-depressant, and Geodon, like Saphris, Zyprexa, Abilify, Seroquel, and others, is an atypical antipsychotic.

Unfortunately, I've been experiencing a lot of unpleasant side-effects. Two I know are from the lithium: headaches and constant acid reflux. One I suspect is from the Geodon, since it started when I began taking the Geodon - dizziness and a kind of trembling weakness in my limbs, not so severe that I can't function normally, hold a pen, etc, but enough to be uncomfortable and disconcerting.

But like I say, I feel enormously better. The meds are probably a significant factor - but so was patching things up with my mother. I feel tremendously guilty about being hospitalized for a second time in two months, and I suspect my mother's current kindness to me is because of my hospitalization. I worry that she thinks I tried to get hospitalized to get back at her, that I was making suicidal threats as manipulation. Truly, I wonder whether perhaps that's unconsciously what I was trying to do. Consciously, no, but ... well... I don't know.

Today is a beautiful, sunny, gloriously warm California day. I walk my dog three times a day and get plenty of fresh air. I love the natural beauty of this town, on the water, with seals and sea lions and pelicans - pelicans! - along the piers. And I have felt happy now for two days in a row.

And that scares me. Scares me deeply. How can I be so happy, when I have lost so much? Lost my apartment in Maryland, lost the company of my friends, lost my chance at the best education in the world at a unique, impossible-to-duplicate school. I have no idea where I'll finish my college education, or when, or what degree I'll get, if any; what career I'll pursue, and in the short term, what job I'll manage to find in this down economy. I'm living on borrowed time and kindness, sheer kindness, in my parents' house. I live with two alcoholics, one eleven months in recovery and one who's still drinking. There's a lot of love in this house - in this family - but there's a lot of grief, anger, and resentment too, and sometimes that grief and anger and resentment is going to boil over and wound every one of us.

But today? I'm happy. God grant that many more days will follow. And I'll try to enjoy this feeling while I can.

Sunday, October 2, 2011

Consolations of Philosophy

I first began seeing my current psychiatrist - let's call him Dr. Blum - in January. During my first visit, Dr. Blum analogized mental illness to having a nail embedded in one's foot. In both cases, medical treatment is indicated; simply telling a person to cope with the pain would be inadequate, and also malpractice, because with medical treatment the root source of the pain could be eliminated (or at least managed, in the case of a chronic biologically-based mental illness like bipolar disorder).

That evening, I went home and started flipping through one of my two copies of the Everyman Epictetus, which contains the Discourses, Fragments, and Handbook. In the Handbook, I found this aphorism:

As, when walking about, you take care not to tread upon a nail or twist your foot, so likewise take care not to harm your ruling faculty. and, if we guard against this in every action, we shall set to work more securely.

Almost an identical analogy, but with such a different intended interpretation! Instead of mental anguish being thought of as an unforeseeable accident of life - but an accident whose effects could be ameliorated through medical care - Epictetus sees harm to one's mental faculties as a preventable accident which everyone has a duty to be on the watch for. As in so much of Epictetus's writing, one's mind is one's chief possession, the only one which any human being has any hope of holding on to and controlling, and the most valuable possession any human being has, as it is the one true path to happiness and freedom, as all earthly, bodily things can be stripped from a person.

Epictetus knew a lot about misery. He was born a slave in Phrygia; while his Roman master allowed him to study philosophy, according to one story that same master also deliberately crippled him by breaking one of his legs as punishment for some transgression or other. While Epictetus eventually gained his freedom, throughout his philosophy several key themes are repeated: one's life, freedom, health, and possessions are ultimately beyond one's control, as they can be taken away at any time by accidents of fate or deliberate human cruelty; and therefore one must seek happiness through self-control and internal virtue, as one's mind and one's choices are one's only true possessions.

Epictetus thrilled me when I first read him, several months before I descended into my first depression. I was seventeen, and in my second year of college. At sixteen, when I began my college education, I had read no philosophy; the Greek and Roman philosophers I read over the next two years made an extraordinary impression on me. Plato taught me to love the Good and Beauty, and to seek both ideals with all the passion and energy of eroticism. Aristotle showed me the possibility that through moderation human beings could achieve virtue, and that the goal of a philosophic life was to create the habits which would lead to virtue. And Epictetus taught me that philosophy would allow me to create my own happiness regardless of what happened in the world around me by teaching me self-control and the proper attitude with which to approach all of life's vicissitudes.


I was already predisposed to be skeptical of the psychiatric or psychological approach to misery before my first exposure to philosophy. I had witnessed my mother's terrible, terrifying depression for all of my adolescence, and had left home for college at sixteen in part to escape the tyranny of her moods. No amount of treatment seemed to make her any easier to live with. My father spoke dismissively of psychology as a soft science full of mumbo jumbo.

Ancient Philosophy taught me to think of the mind and soul as entities essentially separate from the body, and to blame myself for any unhappiness I felt, as clearly it meant I wasn't virtuous enough, or strong enough, or wise enough. If I were better, I wouldn't be miserable.

My first exposure to therapy only confirmed my preconception that my misery was "all in my head" - I did a course of cognitive-behavioral therapy with a Licensed Clinical Social Worker. By the time I saw her, I was already on the upswing, as I always am during the summer; I still retained a great deal of my native optimism and work ethic, and loved the idea that I could prevent negative feelings my recognizing irrational patterns of thought and stopping them in their tracks.

I went back to school for my junior year that fall unmedicated and with no treatment plan or follow-up scheduled, no idea what to do if my depression returned. And it returned. With a vengeance. I read Pascal for the first time that fall, identified intensely with his experience of wretchedness, mentally diagnosed him with Major Depressive Disorder, and wondered (not for the first time) whether I would find consolation in Christianity. Atheist that I am and was, I tried very hard to believe in God, but never had the experience of grace which Augustine describes. I was left to deal with my own wretchedness alone: no God, no family, no therapist, and certainly no psychiatrist.

I will not detail the years it took to finally get adequate treatment and an appropriate diagnosis. I will say that I fought medical treatment tooth and nail. I hated the idea that I would have to take mood-altering medications in order to be a functional human being. It felt like a betrayal of philosophy, an unvirtuous, weak-willed, materialist shortcut. But within three weeks of starting lithium and lamotrigine, I was a human being again, able to work, to laugh, to be a loving daughter.

Of course, my path has not been straightforward. I have continued to experience cycling moods despite improved (not perfect) compliance with medication. I am now resigned to the fact that my misery is biological, that no amount of strength of will can cure it, that neither grace from God nor the consolations of philosophy will be sufficient.

So what is the role of philosophy? What can stoicism, or Aristotelean ethics, offer to a psychiatric patient keenly aware that her brain - the seat of her mind, and perhaps her soul - is outside of her control?


A few things. I still use the CBT I was taught four years ago. I use it every day right now. I have the insight to recognize the illogical patterns of thought my depression creates, and CBT helps me to work through the pain. I am able to sit through class, to attend lecture, because I am able to challenge the thoughts which produce intense feelings of shame, guilt, anxiety, and self-loathing. Medication can help the depression lift, but until then I need CBT to endure the depression.

And philosophy helps me think about what kind of a person I want to be, what kind of a life I want to lead, what actions I think are ethical. Epictetus's stoicism has been of great comfort to me when dealing with miseries whose sources are external. Stoicism has been just as much use to me as therapy in dealing with turmoil in my family and cruelties inflicted by others. Stoicism is marvelous if you want to sort out what is or is not in your control, and helping you learn to base your own happiness only on the things that you can control.

Stoicism, like psychiatry, seeks to end human suffering. One works on the brain, the other on the soul; and we are still all wondering what the connection between the two is.