David's Inferno: Crazy Wisdom from the Dark Woods.

From: The Introduction

On October 14^th, 2005, I had a nervous breakdown. The phrase is both inadequate and inaccurate. 

       The experience is way beyond “nervous.” It’’s a rampant agitation that careens from constant low-level anxiety to gut-wrenching, dry-heaving despair. After the worst attacks, I’d feel like I’d just been spit up, Jonah-like, on the shore, wondering if next time the whale would be a shark.  

       Breakdown is way too static a word. Every day is spent on roiling waves. Occasionally—for an hour or two, maybe even a day—those waves buoy you up high enough for a gasp of blessed air, only to sweep you back down into such fierce undertow that drowning, while terrifying, at least holds out the promise of peace.

       For the next two years, only my own desperately flailing will and the determined surround of family, friends, and guides kept me from being institutionalized or far worse. 

       As I wrestled with this relentless onslaught, a procession of compassionate and insightful healers: doctors, psychiatrists, acupuncturists, astrologers, tarot readers, homeopaths, cranial sacral specialists, medical intuitives, wise-ones-who-cannot-be-labeled, and a dear friend who guided me through soul rendering and blood curling wails in the Southwest desert, did everything they could to help me stay on the treacherous path that I’’d chosen——yes chosen, whether subconsciously or karmically—without wandering so far into the wilderness that I’’d never find my way back.

       Depending on their backgrounds and perspectives, they described my experience in many ways: “major depressive disorder/moderate; ditto…severe; Pluto directly opposed my sun and rising signs; raging kundalini;” “congealed ch’’i along the heart meridian,” and, of course, “a midlife crisis of the most virulent sort.” But they were all gracious enough to know that no name could describe this pain. And no therapy, western or eastern, could provide more than temporary relief. 

       My daughter, quoting Mary Oliver, provided the simplest and most profound description of the process: “What blazes the trail is not necessarily pretty.”” 

From: Diagnosis

You know what’s the hardest thing about writing this book? It’s certainly not sitting in a cabin in Vermont watching the snow come down, drinking my version of a café mocha, and listening to rock & roll. That’s not hard at all.

       It’s not trying to transform years worth of erratic journaling, essays, emails, and my medical records into one more-or-less coherent whole, without sucking all the juice out. That’s kind of hard, but I enjoy it.  

       Occasionally, it is hard to maximize the creative waves that ebb and flow during the day. But by juggling food, research, working out, paperwork, conversations, and coffee, I can usually put in a good day’s work. 

       It’s hard for all of us to avoid getting distracted and procrastinated by e-mail and the Internet. But, to me, that’s now just part of the process. In the old days, I’d light another cigarette or pace the floor.

       No. The hardest thing about writing this book is, to Dylan-ize it, “My best friend, the doctor [couldn’t] even say what it is I got.” 

       My ±2 year walk on this particular wild side was not technically bipolar—although there have been shorter periods in my life when that diagnosis might have been appropriate. My manic phases just didn’t last long enough to qualify and, besides, they were dysphoric; i.e., the opposite of, and not as much fun as euphoric. 

       My doctor's current official description, Major Depressive Disorder, Recurrent, in Partial Remission, sounds kind of tame. Although, at one point, I earned the word “Severe,” which is a little more impressive. He also threw around the phrase Major Cyclothymic Depression at one point. That’s a little technical for my taste, although its definition as a "persistent instability of mood" is something that people who know me would identify with—going back to the days when my parents and brother found those moods alternately amusing and annoying. 

       I do think Overlapping Cyclothymia or Double Depression are appropriately descriptive. As is Dysphoric Mania which sounds noble, in an early-20th century kind of way. Plus, the Merck Manual describes it as "prominent depressive symptoms superimposed on manic psychosis.” I also like Agitated Depression, "a state of clinical depression in which the person exhibits irritability or restlessness." Fortunately, I don't have an advanced degree in psychiatry, so I feel no obligation to explain the difference. Although, I'd say that my better days were closer to the latter and worse days were more like the former. 

       By the way, I think I deserve a little credit for surviving Anhedonia—the loss of capacity to experience pleasure. The few times my doctor asked me if I was able to have any fun, I looked at him like he was out of his mind. 
       I really like Melancholia Agitata. It makes me picture myself, hand on forehead, swooning onto a Victorian fainting couch, and then twitching uncontrollably until I collapse ignominiously onto the floor. 

       But if I had to choose my favorite, I’d have to say Melancholic Depression-Severe with Hypomanic Episodes. Just seems like a nice blend of literary and technical.  

       Regardless, while browsing in a library yesterday, I read that people "blessed" with dysphoric symptoms have a higher rate of suicide than people with "plain old" major depression.

       Which makes me grateful that, thanks to my doctors, family, friends, some little yellow pills, blue-tan capsules, and substances and circumstances beyond our collective control, I am living proof that we are neither labels nor statistics. 

From: Treatments: Pharmaceutical and Psychological

Among my more vivid memories is the look on a psychiatrist’s face when I told him that, on my worst mornings, I was taking up to 30mg of Valium—mostly between ±4 a.m. and 8 a.m.—as I desperately tried to avoid facing the day.

       He managed to retain his calm, clinical tone as he explained that he didn’t mind prescribing that much for someone who arrived at the hospital just one un-restrainable thrash short of a straitjacket. In that case, they usually gave an injection. Fortunately, the idea of self-injection never appealed to me, or else he would have been giving the wrong person the wrong idea at the wrong time.

       I mean it’s not like I was overdosing per se: 30mg - 40mg is, as far as I can tell, the maximum daily-prescribed dose. It was probably the 4-hour dosage period of time that troubled him…and the fact that I wasn’t eating much. The Jameson or two the evening before may have also helped visions of rehab dance in his head.

       It wasn’t even like I was doing the max every night, I reassured him. Often it was as little as 5mg - 10mg. Isn’t it interesting how we closely we read the look on our doctors’ faces when we’re trying to convince them to give us more or less of the drug he/she wants to prescribe and we do or don't want to take? 

       Nevertheless, while reviewing my records—ask your pharmacist to see yours…they’re fascinating—I see that I was first prescribed 30 (5mg) Valium which would last several months. 

       Over the next four months, however, I would be prescribed 30, 90, 90 again, and finally 120. In other words, I was averaging 20mg/day. It was as if my former doctor was just throwing the stuff at me in a wild attempt to stop the madness.

From: Treatments: Alternative

In the midst of my personal chazerai, a homeopath was trying to determine the right "constitutional" for me: a kind of magic bullet that I hoped would heal all my ills.
      Homeopathic constitutionals are not the same as the symptom-specific remedies in little bottles and tubes that we buy to deal with aching muscles, insect bites, and this year’s version of the plague, a.k.a. flu.

       The right constitutional gets so deep into the fundamental energetic causes of what ails you, that it can bring about a pretty radical transformation in your physical, mental, and/or emotional well-being. 

       This isn’t as strange as it seems. In spite of all the relatively modern focus on observable and/or measurable phenomena—such as germs, cellular aberrations, heredity, and environmental factors—there’s a certain indefinable something that seems to determine how, why, and when each of us gets sick in our own individual way. An indefinable something that underlies not only those germs, etc., but even our positive or negative thoughts, our ability to love and be loved, or what we eat.

       Homeopaths look for that certain something. 

       A lot of people walk into their offices saying that have a chronic headache, back problem, a cough that won’t stop, or manic-depression so bad they don’t know if they’re coming, going, or both. But from the homeopath’s perspective, each of these symptoms is just one of a myriad of ways that you are “presenting” what really ails you. 

       He wants to know what time you wake up in the morning; if you have a history of knee problems; where you itch; if, how, and when your private parts have been working lately; and way more than you’d like to tell anybody about your sweat, snot, and bathroom habits. In fact, during the first appointment—which can last a couple of hours—you may wonder whether the guy is more OCD than you are. 

       Again, however, this isn’t as strange as it sounds. After all, a psychiatrist evaluates each individual’s symptoms to try to intuit which anti-depressive, psychotic, or anxiety medication will work. Often it takes several tries. A homeopath is, essentially, trying to do the same thing. It’s just that he's looking at a way wider set of conditions, and trying to intuit a remedy whose effect, if any, is more all-pervasive and can’t be explained by any current scientific model. 

       In any event, based on one or more of these in-depth examinations, a homeopath gives you a few tiny sugar-based pills that contain an essence of some animal, vegetable, or mineral substance that’s been diluted so much that scientists often can’t find a single trace of it left in the remedy.

       And that’s when the fun begins. Or not.

From: Not-So-Everyday Life

What did I actually do all day? Looking back, I wonder the same thing. Because, even when you feel almost human, you can’t walk away from a “major episode” of agitated depression. Wherever you go, there it is. 

       Still, even though I lost 25 pounds, I did eat. Even though I feared waking up in the morning, I did sleep. Even though I lost most of my interest in TV, I did watch some. Even though I wasn't all that functional, I did work a couple of days a week. And, even though they were primarily monosyllabic, words did come out of my mouth. 

       I even did some writing. Some of which wasn’t all that bad, although clearly lacking in life, like a plant that only thrives in full sun. 

       I also started projects I was unable to finish: washing every window in sight; cleaning up the basement; going through boxes of memorabilia. All remained half done. (Most still are!)
       There were, however, a few projects that I did finish—a path, a bridge, a labyrinth—that were so rife with symbolism that they bordered on the banal. But every time I retrace those steps, I’m reminded, in an oddly fond way, of what it was like in the midst. 

From: Support Systems

There are three main things that depressives want to attract or avoid. I was more of the avoidance type. So just switch the following around when talking with someone who wants this kind of attention. (Not that it will be all that easy for you to tell…)

       Scrutiny: The very question: "How are you doing today?" made me claustrophobic. I preferred it when someone just nodded his/her head and said, with or without words, "I’m here if you need me."

       Suggestions: The question: "Have you tried…?” usually made me feel more hopeless. If you have a good idea, it might be better to just do it than ask it: I.e., "I’m making an appointment for you to have (a complete checkup, cranial sacral treatment, frontal lobotomy, etc.) and I’m driving you there." Or, "I’ll drop off a couple of truckloads of B-Vitamins tomorrow and make you take a dozen every day until you snap out of this."

       Sympathy: I was horrified by the notion that people would pray for me. It felt like an invasion of privacy. That’s just me. Many people find prayer very helpful. In fact, I’m happy to pray for them. I just believe that if you feel someone’s pain, that’s twice as much pain.

       I know people appreciate how hard it is for depressives to talk about what they’re going through.

       I just wanted you to know that we appreciate how hard it is for you to talk back.

From: Creativity and Spirituality

If you’re a writer with a mental illness, there’s a real good chance that, at some point, you’ll want to write about it. 

       At times, that might mean frantic scribbles—or a keyboard slick with tears—as your fingers race after thoughts which scramble just out of reach or lie buried a little deeper than you can dig.

       You write about the experience with the same unmanageably frantic energy or pervasive lethargy that you might do anything in that moment—go for a walk, start some chore you’ll probably never finish, try to maintain some semblance of a persona who can participate in small talk, or even bring a trembling glass of whiskey to your lips. 

       But, you’re a writer. So sometimes, in the midst of it all, you just start writing. With the vague hope that it might distract you for a while from the discomfort; or, if you can imagine a life beyond that painful now, provide faint breadcrumbs back to the memories—in case you ever "need them for reference."

       After or between episodes, it’s different but no easier. Because, when you’re not in the midst of the experience, writing about it seems disingenuous. You want to turn to yourself and say, impatiently, “What do you know about it?"

       I suppose all human experiences are like that—or at least all those moments in which the emotional component is so intense, it evades the most agile intellect. But somehow, when you share most experiences with someone else who has had them: whether smelling a particular flower, riding your bike up a particular hill, or sitting with a parent who’s dying, you feel like you’re making a truly shared connection—emotional as well as physical. 

       But those who have experienced depression know all-too-well that the others’ experience is, and will always remain, just over the horizon.