New Help for Depression, Anxiety and Addiction
By Colette Dowling
"I Wish There Were a Pill"
In the late sixties, my husband, Ed, and I and our three small children were living on the Upper West Side of Manhattan. The neighborhood we lived in attracted writers, actors, and musicians. As a community, we prided ourselves on political consciousness, on caring about those less privileged than ourselves. We worried that our own lives were in some way overly indulgent, even though none of us had an extra dime. I worked as a free-lance writer, taking care of our children during the day and writing at night. Ed was a staff writer on a magazine. We had been married seven years when he made what I would think of, ever after, as "that fateful trip to Puerto Rico."
It was only for a week, to visit friends, his first vacation in several years. I had urged him to go without us, since we hadn't the money for a family trip. When he returned, it was clear immediately that something was wrong. Ed was cheerful, very cheerful. But he was also restless and agitated. The first night home, Ed didn't sleep well. The second night, he slept hardly at all. I'd get up from time to time to find him pacing in the living room, lights on all over and his electric typewriter whirring. He was feverishly creative, bursting with ideas, wordplay, puns, chuckling with self-delight.
On his second day back at the office, his managing editor called to say he was worried. Ed had torn up the galleys intended for the printer, saying they were "graven images." Even though I was terrified for him, I smiled as I heard of his rebellion against the magazine whose editorial policies he had always thought to be tainted by advertising interests. "We tried to get him to go to a doctor, but he became insulted and stalked out," the managing editor said. What he was telling me confirmed devastatingly my suspicion that something was terribly wrong. But what?
Late that afternoon, Ed telephoned to announce that he was at Big Wilt Chamberlain's, a popular bar in Harlem. He wanted me to know he'd be walking home soon, "by way of Grant's Tomb," he added grandly, as if mere proximity to the general's resting place would confirm his princely state. I begged him to come immediately. He arrived home a short while later, sweating from the exertion of his long, fast walk and smiling fiercely. I had worried that he'd be drunk. He wasn't drunk, but he was high, very high, elated beyond all reason. Yet he seemed completely unaware that he was not his normal self. His behavior was baffling. It was also frightening.
That evening, I consulted the psychiatrist who had run the therapy group Ed and I had attended earlier. Although the doctor knew Ed fairly well, his response, after hearing of the events of the previous forty-eight hours, was "Anyone can wig out on lack of sleep." Those were his exact words. He never questioned what might have caused the lack of sleep, but wrote up a prescription for Thorazine, a powerful antipsychotic. The drug apparently did its work, putting Ed to sleep for over twenty-four hours. When he awoke, he was himself again, although fragile and shaken.
We were relieved, but confused and anxious about what had happened. Another two years were to pass before we learned that what Ed had suffered was a manic episode, the upward swing of a form of mood illness called bipolar disorder. Related to the more common unipolar type of depression, it is marked by volatile shifts between grandiose elation and utter despair.
It was strange and terrifying to see the man I had known and loved for seven years slip from one week to the next into a kind of hell. What was going on here, I yearned to know. What was this? Only recently he had been healthy and in his prime. What did this illness mean for the remainder of Ed's life, and what did it mean for our children? These were the questions that haunted me. I'm sure they haunted Ed as well. He had left a normal, if troubled, existence and, for reasons that were beyond us, had entered the fathomless stretch of a wildly altered state.
There were drugs, of course, though at the time they seemed primitive. Lithium brought the mania under control. In addition to lithium, Ed was given Thorazine to make him less agitated while waiting for the lithium to take effect. The Thorazine made his face stiff and masklike; the lithium caused his hands to shake. At night, these images of Ed, and of his innocence in the face of what was happening to him, would come into my mind, and I would cry.
By 1971, Ed and I had separated. During the periods when his mood was stable, he continued to visit the children, and he and I kept in touch, sometimes meeting for coffee in a neighborhood luncheonette. As time went by, I began to wonder if it had been our separation that had worsened his illness. In those days, the psychological interpretation of manic depression held sway, and I knew that loss was considered a significant factor. Had the end of our marriage caused the feelings connected with some earlier loss to resurface, destroying Ed's peace of mind?
Eventually, I would learn that though stress can trigger the onset of a manic episode, it doesn't cause it. Nevertheless, for a long time I felt implicated. It's easy to feel responsible. If only I had done things differently, been more sensitive, been more alert to his needs! We assume responsibility in part because it's less frightening than the alternative, which is recognizing that no one makes such illnesses happen. No one is in control.
As is characteristic of those with bipolar disorder, Ed was not able to recognize the early signs of his mood problem. Mostly he was very up, very optimistic, very keenly energized. Today this mood state would be called "hypomanic." While apparently feeling better than the rest of us, someone who is hypomanic is actually anxious and agitated and often has difficulty in relationships. The hypomanic gets worked up over every little thing and is overly sensitive to rejection. Physicians and therapists often miss the signs of this particular form of depressive illness.
Scientists have learned in the past decade or so that there are many different types of depression, each with its own cluster of symptoms, each with its own type of treatment. The types lie across a spectrum of severity. Of them all, bipolar disorder, or "manic depression," is the most severe.
In the Family
When someone in a family is very sick, it is natural enough to hope that the illness will come to rest with that person. Rarely does this turn out to be the case. More likely the illness will ripple out, touching the lives of everyone. The effects of their father's bipolar disorder reverberate in the lives of my children to this day. Growing up, they knew that he was ill. Eventually, because he couldn't work anymore, he had to accept welfare benefits. Still, he remained the children's doting father, visiting them frequently, taking them on excursions around the city, buying small presents for them on birthdays and holidays. Although they didn't speak of it until they were older, they worried about this illness in the family and what it might mean for them.
I worried, too. Research had begun to show that people are genetically predisposed to what then was called manic-depressive disease. When my children reached adolescence, the time the illness often makes its first appearance, I began looking at them for signs of mania - the inability to sleep, the jumble of brilliant thoughts, the grandiose plans. But while my kids were bright and intellectually expansive, their thoughts were not jumbled. They seemed, for the most part, happy, well organized, optimistic.
Yet as they grew out of adolescence and entered their early twenties, it began to be apparent that my oldest child was not as happy as she once had been. At first, the signs in Gabrielle were slight: a certain gravity, or somberness, which can be seen today in snapshots taken in her late teens and early twenties; a subtle diminution in her intellectual curiosity. In fact, she had returned home from college in her freshman year.
I had always thought that being seventeen and leaving our little farm town to enter the competitive whirl of Harvard had been too much for her. When she was older, she'd go back, I thought; if not to Harvard, then somewhere else. But returning to school was not to be a part of Gabrielle's agenda. She worked at a few part-time restaurant jobs and went out with her friends at night. The friends, the going out, seemed at that point the only part of life that really interested her.
When I took an apartment in New York, Gabrielle came to the city too, got a job, and moved into her own apartment. Somehow, though, her life seemed flatter. After work, she'd come home and watch television. On weekends, she spent time with friends, but she often complained of being tired. When visiting with me at my house in the country, she'd sleep until noon. At family gatherings, she never seemed, really, well. . . happy. When I look now at snapshots from those holiday occasions, it's clear from Gabrielle's face that something was wrong. But then I would think, How happy was / at that age? And, measuring her youthful mood against my own, I deduced not that my own unhappiness as a young woman had been unnatural but that my daughter's unhappiness was natural because it was like mine!
It's remarkable, actually, how difficult it can be to admit that we're not content - that though we might get by, our experience lacks pleasure, or zest. We begin to rationalize depression almost as soon as the symptoms appear. "This will pass," we say; or, "Who do I know that's really happy, anyway?" As my daughter grew darker and less animated, I actually began thinking, Soon she'll get married. She'll have babies. Then everything will even out. I thought that because it had been that way for me. Having babies made me happier for a while, and certainly it made me less self-involved.
It can happen, though, in a woman's life, that in responding to others' needs, she ignores a sense of emptiness that lies at the core of everything.
Discovering That a Daughter Is Ill
By the time Gabrielle was twenty-five, it was clear that something was happening to her that having babies wouldn't help. Her reliable behavior had slowly become less so. One day she missed a lunch date with me in the city. "Forgot," she said. Several times I called her office in late morning to find that she was not expected until even later. When, on these occasions, I asked her what had happened, she always reported some cold or flu or stomachache. Increasingly, she complained of fatigue.
Gabrielle had been bulimic for several years in her teens, and I wondered now if her gastrointestinal system had been affected by the binging and purging. I'd suggest she have a physical, but after a while the malaise would disappear, and the doctor would be forgotten. Then the aches and pains would reappear. Everything one might imagine came to mind. I thought of drugs, I thought of alcohol, I thought perhaps she was still bulimic. Sometimes I'd comment that she seemed depressed. "Maybe I have been depressed and just haven't been aware of it," she mused, once. Our discussions never progressed beyond that. Somehow I thought it was up to her to figure out what was wrong. That's the way we've been taught to think about problems we assume are psychological.
Nevertheless, I was worried. It seemed to me that my daughter's face had lost some of its mobility. She didn't smile very often. Increasingly, her responses were brief, perfunctory. Unbeknownst to all of us, Gabrielle was on the huge parabola of a mood shift that was taking months to accomplish.
Confusing, too, was her apparent ability to function in the world. She had a demanding job as assistant to the president of a small public relations firm. Since moving out on her own, she had never asked for financial help. Now I thought she needed help of another kind, but I wavered on what sort and whether or not I could provide it.