Chapter Three
TREADING FIRE
“When a man finds that it is his destiny to suffer, he will have to accept his suffering as his single and unique task. No one can relieve him of his suffering or suffer in his place. His unique opportunity lies in the way in which he bears his burden.”
–Victor Frankl
“War is hell. So is mental illness.”
–Binford W. Gilbert
The towering door closed behind me with a grave finality. “Are you sure you have to keep it locked?” I asked the orderly. “I voluntarily checked myself in here, so I don't think I'm going to try to escape.”
“It's not you we are worried about,” he replied. “With all of the addicts on this ward, we can't risk having any more drugs smuggled into the unit. That's why no one is allowed to go outside.”
This was not the private facility at Springbrook with its manicured walking paths. With all of my other options exhausted, I had entered Pacific Gateway Hospital, a dual diagnosis psychiatric facility in the Portland area. Unlike Springbrook (and other drug and alcohol treatment centers), Gateway accepted patients who suffered solely from mental disorders. While Springbrook's clientele consisted of doctors, lawyers and other professionals, Gateway ministered to the common folk. Like pilgrims converging on Mecca, they streamed in from all parts of the Pacific Northwest, seeking salvation from the “three D's”—drinking, drugging and depression.
At Gateway, instead of having 72 hours to get better, my managed care provider had granted me seven to ten days (an inadequate time to heal from depression, let alone get clean and sober). It was the best I could muster.
Words of Hope
Only two hours remained before I was to be admitted to the psychiatric ward of Pacific Gateway Hospital. As my partner Joan packed my suitcase, I became increasingly anxious about being taken to an unknown and threatening environment. My friend Kathleen shared with me the following words of hope and encouragement:
1. You are falling apart in order to be put together in a new way. You will come through this because you are loved.
2. As a result of this breakdown, you will emerge a better person.
3. You are strong; you made a decision not to give up in the past, and you will not give up now.
4. All of the good you have done will help you to a better future.
My days at Gateway were spent attending groups, playing backgammon, and being beaten at speed chess by a mercurial manic-depressive who supported his drug habit by hustling chess games on the street. During my stay, my condition declined, not because of the environment (Gateway had an excellent reputation), but because the depressive illness had taken on a life of its own and was metastasizing through me like a psychic cancer. The downward trajectory of my disease was evidenced by the increasing frequency and duration of my anxiety attacks. Without the option of outdoor exercise, I was reduced to pacing the hallways, wearing out both the carpet and my welcome. My sorry plight earned me the sympathy of the hard-core heroin users who housed the ward (“We thought we had problems,” they said to themselves, “but this dude is really messed up.”)
As the day grew closer to my release, I began to panic. Joan was now working full time, and if I could not create an alternative support system, I would be shipped off to the state hospital at Salem.
Admission Summary: Pacific Gateway Hospital
PATIENT: Bloch, Douglas. This is the first Pacific Gateway hospitalization for this 47-year-old white male.
REASON FOR ADMISSION: The patient is depressed, anxious, and increasingly out of control.
MENTAL STATUS EXAMINATION: Patient is a well-developed, well-nourished adult male appearing stated age. Patient's speech was variable in flow from slow to pressured. Thought content was that he was overwhelmed, hopeless, helpless and out of control, and that he needed help. His mood was markedly anxious with an undercurrent of depression. His affect was mildly labile. Recent memory based on object recall is good. Remote memory based on historical reconstruction is good. Intelligence, based on vocabulary, fund of knowledge and educational achievement is above average to superior. His insight is fair. His judgment is poor. He presents as extremely dependent and hopeless. He denies suicidal or homicidal ideation at this time.
STRENGTHS AND ASSETS: (1) The patient is very intelligent. (2) The patient tends to form a good therapeutic alliance.
ATTENDING DIAGNOSIS: (1) Major depression; (2) Recurrent, severe panic attacks with agoraphobia (patient reports episodes in which he is so anxious he cannot leave the house); (3) Generalized anxiety disorder.
INITIAL TREATMENT PLAN:
PROBLEM LIST (1) Depression; (2) Anxiety.
MEDICATION: I will probably increase the Zoloft. He took 50 mgs. the first time today. May increase the Elavil and may increase the Klonopin.
PLAN OF TREATMENT: Admit the patient to the adult unit. Work with the patient on the issues of stress management and anxiety reduction. Get the patient stabilized on medication. Work with him on issues of self esteem. Get him transitioned to day program.
ESTIMATED LENGTH OF STAY: 5 days.
GOALS, DISCHARGE CRITERIA: (1) The patient will be stable on medications; (2) The patient will be able to manage his affairs outside the hospital.
Signed Dr. 10-23-1996
One day, shortly before my release, I noticed a new person in the lunchroom who wasn't from our unit.
“Hi.” I reached out my hand. “My name is Douglas.”
“My name is Tom Peters,” came the reply.
“Are you a patient on the ward?”
“I attend day treatment next door.”
“What's that?”
“It's where people go after they leave the hospital. It's pretty good, actually. We attend groups most of the day and come here for a free lunch.”
The lunch I couldn't have cared less about. The full-time structure was another matter.
“What are the hours?”
“Nine-thirty till three-thirty, kind of like going to school.”
Later that day I approached my psychiatrist, who confirmed that the program was for real.
“How soon can I get in?” I inquired.
‘The program is crowded right now, but they may have space for you. I'll introduce you to the director, Mike Terry, tomorrow at lunch.”
Two days later, on November 1, 1996, I was discharged from Gateway. I left the hospital's main entrance, made a right turn, walked one block, and found myself at the doorstep of the Sellwood Day Treatment Center.1
Day treatment was a highly structured outpatient program consisting of group and individual therapy that was available to recently hospitalized patients. The center was housed within a historic landmark—the home of Dr. Sellwood, after whom the Sellwood district of Portland is named. The two-story dwelling was constructed in 1906 and expressed the Victorian charm and elegance of the homes built during that era. The cheerful, well-lit rooms and tasteful furnishings conveyed a sense of home and family. Day treatment was more than a psychiatric clinic; it was a true therapeutic community. Its healing milieu supplied three ingredients that were crucial for my stabilization:
1) Containment: Being in a structured environment with defined limits and daily tasks decreased my anxiety.
2) Contact: Nurturing connection and support from staff and patients helped me to focus outward and to escape my inner nightmare.
3) Routine: A regular, daily rhythm with predictable activities calmed and soothed my nervous system.
The heart of the program was group therapy, which ran from 9:30 A.M. to 3:30 P.M. and was facilitated by members of the treatment team—a psychiatrist, three psychologists, two social workers, a nurse, an art therapist, a movement therapist, and two drug and alcohol counselors. Day treatment provided me with a complete, uninterrupted support system which far surpassed the assistance that any single therapist could offer. For the next nine months, this program would play a pivotal role in my survival.
Day Treatment Schedule
It was not the content but the context of day treatment that I found so healing. The psychological information presented in the groups was fairly elementary—I had learned most of it in my first year of undergraduate studies. It didn't matter. I was not attending the program to add to my intellectual knowledge; I was there because I needed the structure and support. I decided to humble myself and to accept the help that was so generously offered.
Asking the Right Question
Shortly after my arrival at day treatment, I was assigned my individual therapist, Pat Ritter. Pat was a registered nurse and a recovering alcoholic who, having been clinically depressed herself, understood mental illness from both sides of the hospital door.
“This is your life,” Pat stated matter-of-factly at our first meeting. “For reasons we may not understand, the universe has given you the challenge of major depression right now. You do not get to choose whether you have this mental illness. Your choice lies in how you are going to deal with it.”2
“But what about those self-help books that say you can create anything you want if you just apply the right technique?” I asked. I was thinking about all the “can do” motivational self-help tracts I had read (and written) in my quest for self-improvement.
“They may work in other contexts,” she replied, “but not in this one. This time you are dealing with a force that is more powerful than your ego.”
As Pat spoke, I imagined myself as a sailor who had survived a terrible shipwreck and was lost at sea. I shared my image with Pat.
“What is the task of that sailor?” she asked.
“To try to stay afloat until help comes.”
“Precisely! Your job is to create an ‘emotional life raft’ that will keep you afloat, until the pattern of your illness shifts.”
“And how do I do this?”
“In AA we have something called the ‘24-hour plan.’ Instead of promising never to drink again, we focus on keeping sober for the current twenty-four hours. I suggest you adopt a similar strategy.”
Pat was right. Whenever I contemplated the prospect of dealing with my pain over the long term, I became overwhelmed. But if I could reduce my life to a single 24-hour segment of time—that was something I could handle. If I could tread water (or, being in hell, tread fire) each day, then perhaps I could survive my ordeal.
A Survival Plan for Living in Hell
“My definition of a man is this: a being who can get used to anything.”
Working together, Pat and I created what I called “my daily survival plan.” The central idea was simple—to develop coping strategies that would get me through the day, hour by hour, minute by minute. Because I was fighting a war on two fronts, I had to devise and employ techniques that would deal with both the depression and the anxiety. I used my coping strategies to create four categories of support, which I have summarized on the following pages. These categories are: physical support, mental/emotional support, spiritual support, and most importantly, people support.
Putting together a survival plan did more than help me cope. In designing and carrying out this program, I became “the captain of my ship,” an empowering move for someone who felt powerless. As Pat later reflected, “When you made the decision to do more, I saw a glimmer of hope in your eyes.”
Here, then, is the plan we created.
A Daily Survival Plan for Responding to Depression/Anxiety
What follows is a brief outline of my daily survival plan. I have rewritten it in the second person so that you can adapt it to your individual needs. Remember, the goal is to identify coping strategies that will keep you safe and get you through each day until the pattern of the depression shifts.
A. People Support
Find a way to structure your daily routine so that you will be around people much of the time. If there is a day treatment program in your area, some form of group therapy, or depression support groups at your local hospital, attend them. Don't be embarrassed about asking for help from family members or friends. You are suffering from an illness, not a personal weakness or defect in character.
B. Physical Support
1. Exercise is one of the best ways to elevate and stabilize mood as well as improve overall physical health. Pick an activity that you might enjoy, even if it is as simple as walking around the block, and engage in it as often as you can (three to four times a week is ideal).
2. Eat a diet that is high in complex carbohydrates and protein, avoiding foods such as simple sugars that can cause emotional ups and downs.
3. Adopt a regular sleep schedule to get your body into a routine.
4. Take your medication as prescribed. Check with your health care professional before making any changes in dosage. Be patient and give the medicine enough time to work.
C. Mental Support
Monitoring self-talk is an important strategy in helping to stabilize one's mood. Although you may not be able to control the depression and anxiety, you may be able to modify the way you think about your symptoms. You may wish to work with a therapist who specializes in cognitive therapy.3 He or she can help you to replace thoughts of catastrophe and doom with affirmations that encourage you to apply present-moment coping strategies. Perhaps the most powerful thought you can hold is “This too, will pass.”
D. Spiritual Support
If you believe in God, a Higher Power, or any benevolent spiritual presence, now is the time to make use of your faith. Attending a form of worship with other people can bring both spiritual and social support. If you have a spiritual advisor (rabbi, priest, minister, etc.), talk with that person as often as possible. Put your name on any prayer support list(s) you know of; don't be bashful about asking others to pray for you. The universe longs to help you in your time of need.
Because of the disabling nature of depression, you may not be able to implement all of these strategies. That is okay. Just do the best you can. Do not underestimate the power of intention. Your earnest desire to get well is a powerful force that can draw unexpected help and support to you—even when you are severely limited by a depressive illness.
People Support
The centerpiece of my survival strategy involved being around people. Interacting with other human beings drew me out of my tormented inner world and gave me something external to focus on. Talking with others was often the only intervention that would calm me down in the midst of a major anxiety attack. Like a screaming infant who is held by his mother, I found human contact tranquilizing and soothing.
My sense of connection with people also gave me a reason not to harm myself. I did not want to afflict my friends and family with the anguish that would result from my self-imposed departure. Kim, a lifeguard at the pool where I swam, agreed with my thinking. “Other people are a good reason to stay alive,” she affirmed.
Knowing the curative effect of human caring and connection, I committed myself to attending day treatment. Unfortunately, getting to the clinic was not so simple. Like many people who suffer from depression, my symptoms were most severe in the morning. Oftentimes I would wake at 6:00 A.M., paralyzed by fear and overwhelmed by anxiety. To deal with my immobility, I asked five of my friends if they would each pick a day of the week to call me and roust me out of bed (hearing a caring person's voice on the other end of the telephone line served as a natural tranquilizer). The plan worked beautifully, and on those days when I was totally incapacitated, my friend Christine would drive me to day treatment. Instead of being home pacing the floors and hitting myself, I had a place to go where being around others ensured that I was safe.
In addition to group therapy, the other cornerstone of day treatment was my individual therapy, which took place on Tuesdays and Thursdays. These sessions did not consist of the usual insight-oriented psychotherapy. Being in survival mode, my goal was to focus on present-moment coping strategies. For example, I often entered Pat's office in the middle of a full-blown anxiety attack and spent the session pacing the floor while Pat gently coaxed me into taking a Klonopin. In this way, Pat functioned as a cheerleader, encouraging me from the sidelines, even though she could not directly influence the outcome of the game.
Attending day treatment was like going to a regular job—except here the task was to get well. My “co-workers” suffered from a wide range of mental disorders—depression, anxiety, manic-depression, schizophrenia, multiple-personality disorder and PTSD (post-traumatic stress disorder). The patients at day treatment did not fit the stereotype of “crazy people” that I had been taught as a child. These were brave souls who struggled against powerful and deadly brain disorders. They were my comrades in healing, and together, we formed a “brotherhood of pain.”
Many of my fellow group members lived on SSI (supplemental security income) or SSD (social security disability) while Medicare paid for their therapy.4 (I frequently wondered where the wealthy depressives went for help.) My friends commuted to the clinic on the bus, often traveling many hours over long distances. Some were homeless and were forced to live in whatever transition shelters would accept them. (I, who owned my own home, felt like Bill Gates in comparison.) Suddenly I realized that our celebrity-obsessed culture had it all backwards—that these nameless souls, stigmatized by their poverty and mental illness, were our true heroes—for they possessed what Woody Allen, in the opening lines of the film “Manhattan,” rightly called the most important human attribute—courage.
Day treatment was a true life raft that kept me afloat during the most critical period of my illness. The program's only limitation was that it did not provide 24-hour care. Groups ended at 3:30 P.M. on Monday through Thursday, and 2:30 P.M. on Friday. Since Joan and my friends were all working, I needed to find additional support for the rest of the afternoon. The solution came in the form of Terry, a home health aide whom I located through an agency in the Yellow Pages.5 Terry was a guardian angel who stayed with me on weekday afternoons and guided me through various mundane tasks that kept me focused—i.e., cleaning the house, balancing my checkbook, mailing books to my readers, buying vegetable starters for the garden, taking a leisurely hike in Forest Park, and so on.
Weekends were also a challenge because they lacked the structure that day treatment provided. I organized my time as best as I could, asking Joan and my friends to take “shifts” as my caretaker (the task was too big for any one person). Walks in nature alternated with car drives along the Columbia River Highway, games of Scrabble, piecing together jigsaw puzzles and watching movies (when I could focus). Since it is extremely demanding to be around someone who is emotionally and physically agitated, I will always be grateful to those people who displayed saint-like patience and understanding in the midst of my ordeal.
Support is critical in helping people to cope with all kinds of extreme circumstances. Survivor researcher Julius Siegal emphasizes that communication among prisoners of war provides a lifeline for their survival. And for those who are prisoners of their inner wars, support is equally crucial. In chronicling his own depressive episode, novelist Andrew Solomon wrote:
Recovery depends enormously on support. The depressives I've met who have done the best were cushioned with love. Nothing taught me more about the love of my father and my friends than my own depression.6
Physical Support
The second aspect of my daily survival plan consisted of finding ways to nurture my physical body.
1) Exercise. Research has shown that regular exercise can improve mood in cases of mild to moderate depression. In the midst of my clinical depression, exercise provided a decided, if only temporary reprieve from my emotional torment. For years my favorite physical activity had been swimming; now it became a cornerstone of my survival strategy. My 9:00 A.M. swim helped calm my morning anxiety and prepared me for day treatment. The evening swim elevated my mood and alleviated whatever residual anxiety was still present. When the attacks were particularly bad, I would swim 30 to 40 laps until I collapsed in exhaustion.
On weekends I exercised by taking hikes in the Columbia Gorge, around Mt. Hood, or in Portland's beautiful Forest Park. Although walking in the woods did not eliminate the depression or anxiety, it provided a safe structure in which I could physically burn off a portion of my distress.
2) Eating and sleeping. To stabilize my emotions, I ate a diet high in complex carbohydrates and protein (fish, chicken, vegetables, whole grains, pasta, whole wheat breads, potatoes, yogurt, etc.) and avoided foods, such as simple sugars, that produce mood swings. Fortunately, loss of appetite was not one of my symptoms, and so I ate regularly.
Although my prior depressive episodes had been marked by severe insomnia (few things are as debilitating as waking up at 3:00 A.M. and not being able to get back to sleep), this time I was able to rest, thanks to small doses of the antidepressant Elavil as well as the antianxiety drugs Klonopin and Ativan. This allowed me to keep a regular sleep schedule, which helped my body get into a rhythm.
On those nights when I experienced “early morning awakenings” (a classic symptom of depression), I reminded myself that no one ever died of insomnia. If I couldn't fall asleep with 20 minutes, I would get up and read (if I could focus), walk around the block, watch some television, or do some simple housework. Within an hour I was usually back to sleep.
3) Medication. While antidepressants did little to alleviate my depression, I learned to use the drug Klonopin to manage my anxiety. Klonopin is an antianxiety medication which is a member of the benzodiazepine family that includes Xanax, Ativan, Valium, Librium, etc. Despite my fears of getting hooked on the drug, I soon realized that the benefits of taking Klonopin (i.e., containing my anxiety) outweighed the risks—depression combined with anxiety is more likely to result in suicide. Thus, when my anxiety began to escalate, I ingested a half milligram of Klonopin and was guaranteed two to three hours of temporary relief. Although I sometimes felt a bit groggy, being sedated was preferable to jumping off a bridge.
Mental/Emotional Support
Although I could not always control the painful symptoms of depression and anxiety, I could influence the way I thought and felt about those symptoms.
1) Monitoring self-talk. Monitoring one's self-talk is an integral strategy of cognitive-behavioral therapy, a talk therapy widely used in treating depression. The Catch 22, of course, was that the part of me that was supposed to do the monitoring—my thinking self—was itself diseased. I felt like a legless man who is told that the only way to save his life is to get up and walk.
Fortunately, before the onset of my illness I had spent eight years writing books and articles on the subject of positive self-talk. With Pat's help, I used a process from my book Words That Heal to create specific affirmations that would counter the all-too-frequent thoughts of gloom and doom that dominated my brain. For example, the statement “My depression will never get better” was replaced by the affirmation “Nothing stays the same forever” or “This, too, will pass.” (I'll say more about this process in Chapter Five.)
Switching from negative to positive self-talk was a process that occurred once, twice, sometimes ten times a day. Since the depressed brain tends to see life through dark-colored glasses, monitoring my inner dialogue proved to be a constant and unending challenge.
2) Keeping a mood diary. One of the survival techniques I used to stay alive in my hell was to keep track of my anxiety and depression on a day-to-day basis. To this end, I created a daily mood scale (see facing page).
Somehow, the simple act of observing and recording moods gave me a sense of control over them. I also used the mood diary to track my reactions to pharmaceutical drugs and to record daily thoughts and feelings. This ongoing log served as an important progress report, both for myself and for my healthcare providers. It also provided an operational definition of recovery—my psychiatrist defined my getting well as seeing both the depression and anxiety ratings decrease to a score of “2” or below for six consecutive weeks. As my mood scale for the month of January 1997 indicates, however, I was light years from that goal (see opposite page).
Daily Rating Scale for Anxiety and Depression
| 1-10 Depression Scale | 1-10 Anxiety Scale |
| 8-10 despair, suicidal feelings | 8-10 out-of-control behavior, hitting, rhyming voices |
| 6-7 feeling really bad, at the edge | 6-7 strong agitation, pacing |
| 5 definite malaise, insomnia | 5 moderate worry, physical agitation |
| 3-4 depression slightly stronger | 3-4 mild fear and worry |
| 1-2 minorly depressed mood | 1-2 slight fear and worry |
| 0 absence of symptoms | 0 absence of symptoms |
January Mood Diary
3) Venting when I need to. Part of surviving meant being able to express my feelings—especially anger and grief about my plight. With Pat's encouragement, I vented my rage and fury through yelling, pounding a pillow, or painting my feelings in art therapy.
Later I learned that the body's immune system is actually strengthened by expressing feelings—and that both positive (joyful) and so-called negative (sad/angry) feelings are equally therapeutic. There is something about catharsis—giving full expression to one's deepest feelings of anguish—that is good for us.7 Perhaps that is why the Book of Psalms contains as many lamentations as songs of praise.
4) Being compassionate with myself. As part of my emotional self-care, it was important to release the toxic feelings of blame, guilt or shame that are so often felt by a person who is depressed. As Pat reassured me, “Depression is an illness, like diabetes or heart disease. It is not caused by a personal weakness or a defect in character. It is not your fault that you have this disorder.”
Once again I turned to the affirmation process. Whenever I started to judge myself for being depressed I would repeat, “It's not my fault that I am unwell. I am actually a powerful person residing inside a very sick body. I am taking good care of myself and will continue to do so until I get well.”
5) Focusing on the little things: One day I asked Pat, “If all I am doing is trying to survive from day to day, how do I find any quality to my life?”
“The quality is in the little things,” she replied.
How true! Shortly after Pat's comment, Portland was unexpectedly blessed with a sunny day. As I beheld with awe and wonder the magnificent pinks and red hues of the sunset, I recalled the words of poet Robert Browning—“God's in his heaven; all's right with the world!” The experience was made all the more poignant by its transitory nature; I knew that in a matter of hours my depression would return, and I would be cast back into outer darkness.
In another instance, a friend and I spent an evening listening to the celestial chants of the Taize monks, founders of an intentional spiritual community located in the south of France. I was particularly moved by one refrain: “Within our darkest night, you kindle the fire that never dies away, that never dies away…” As my voice merged with the voices of the audience, I was momentarily catapulted into ecstasy. Like a trapeze artist balanced on the high wire, I stood suspended above the abyss of my suicidal thoughts, safe from harm.
Having moments like this was akin to making deposits into an “emotional bank account.” When I sank back into my depression I would draw upon my stored memories and affirm that life could still be beautiful, if only for an instant.8
6) Adapting to the cyclical nature of the illness. Another adjustment I had to make was understanding the up and down nature of my depressive illness. There were two levels at which this occurred. First, I observed that days of intense anxiety would alternate with those of immobilizing depression.
Second, like the person with a chronic physical disease such as cancer, I came to learn that periods of progress and recovery were often followed by unwanted setbacks. Such relapses were particularly dangerous, for my accompanying disillusionment led to despair and suicidal thinking. To counteract these thoughts I trained myself to say, “One day, the respites will last. One day, they will turn into a genuine recovery.” I also reminded myself of Dougal Robertson's famous counsel from his manual describing how he and his family survived thirty-eight days lost at sea. Robertson wrote, “Rescue will come as a welcome interruption of the survival voyage.”
Spiritual Support
The spiritual aspect of my struggle centered around a single word—FAITH. I wanted desperately to believe that my suffering had meaning and purpose, and that one day it would end. The irony was that I had authored a number of spiritual self-help books which provided readers with healing affirmations and spiritual encouragement in the face of fear, doubt and despair. Over the past decade, I had received hundreds of letters and phone calls from people who testified that my words had helped them to overcome a variety of physical and emotional challenges. “Read your own books!” my friends would tell me. I did so from time to time, but whatever comfort I derived from the passages was drowned out by my pain which gave evidence to the conviction that God had truly abandoned me.
Despite my absence of faith, I began to attend church again. My place of worship was the Living Enrichment Center (LEC), a large, nondenominational church located in Wilsonville, Oregon. It taught many principles of the Unity School of Practical Christianity, whose philosophy I had studied for twenty-five years.9 Like day treatment, attending LEC gave structure to my day and provided me with a community of like-minded people where I could hear messages of hope and inspiration that I had once believed.
To help bolster my waning faith, one of the ministers at LEC suggested that I take up an old hobby—gardening. On the day I planted my garden, I was so agitated that three people had to steady me while I sowed the seeds in the fertile soil. Nonetheless, the message I gave the universe was clear: “I expect to be alive in the fall to reap the harvest.”
These, then, were the main components of my “daily survival plan.” Like a soldier on the battlefield, my primary job was to keep myself alive until the end of the day. Here is an example of how this strategy worked during a typically hellish twenty-four hours.
A Day in the Inferno
“I have developed a new philosophy…I only dread one day at a time.”
The phone rings once, twice, three times. I reach to pick it up. “Rise and shine!” sings the cheery voice. “It's your friend Christine with your daily wake-up call.”
As I emerge from my oblivion, I quickly scan my body for signs of agitation. I feel my left leg starting to twitch, the first sign of an oncoming anxiety attack. I take a few deep breaths and attempt to relax, but it's like trying to maintain my ground in the face of a charging bull.
“I think I'm going to need some help. Could you drive me to day treatment?” I ask feebly.
“Sure,” my friend replies. “I'll be right over.”
As Christine hangs up, the agitation becomes so strong that I can no longer lie in bed. I hurriedly get up and begin to pace the floor. It is the start of another day in hell.
Knowing that Christine is on her way helps to calm me a little. Still, my body is shaking as I struggle to dress, so I take half a milligram of Klonopin with some orange juice. Soon, Christine arrives and drives me to the community pool, where she waits in the lobby while I take my morning swim. Because my anxiety is high, I thrash about in the lap lane, barely avoiding a collision with oncoming swimmers. After ten minutes of frenetic activity, I jump into the hot tub. The warm, relaxing waters add to the sedating effects of the Klonopin. I'm glad that Christine is driving.
Depression Life-Raft Card
At Pat's suggestion, I wrote down some of my main survival strategies on a three-by-five card and carried it around in my pocket. Reading the card helped me to stay on task and keep me focused in the present, instead of catastrophizing about the future. Today, I still refer to the crumpled card when I feel myself losing my center.
I am surviving one day at a time.
I do this by practicing these self-care and self-nurturing strategies:
|
|
I arrive at day treatment in time for the 10:30 A.M. goals group. I sit through the meeting in a daze. Sedation is better than agitation. Then in the 11:30 A.M. medication group, the Klonopin wears off, and I start to feel the initial sensations of an anxiety attack. In a few minutes my body becomes so agitated that I start rocking to and fro like an autistic child.
“Christ!” I think to myself. “I was starting to calm down, and now this has to happen. It's futile. I'll never get better.” With each new catastrophic thought, I feel myself being dragged into the mire of hopelessness and despair.
Suddenly a voice in my head cries out, “CANCEL! CANCEL!” I realize what my mind is doing and switch gears to repeat my affirmations.
“This attack will not last forever.”
“I've been here before and have survived.”
“I can get through this.”
“I have options. I can take a Klonopin, talk to a staff person, or walk around the block.”
Fortunately, we are about to go to lunch, which is served at the hospital next door. Our group marches rank-and-file to the hospital lounge, where I engage in my daily ritual of doing the newspaper crossword puzzle to distract myself from my pain. At 12:30 P.M. the receptionist asks me to stop, and our group files into the lunchroom. Along the way, we pass the barbed-wire courtyard of the psychiatric ward where I once resided. I wave at the patients, some of whom I recognize, knowing that I could rejoin them at any time.
At lunch, the hospital food is atrocious, but the fellowship is healing. I enjoy the one-on-one interactions with a counselor and a fellow patient. At a quarter past the hour we are asked to leave the lunchroom. The next group starts at 1:30 P.M., but with a new anxiety attack coming on, fifteen minutes seems like an eternity. How will I contain myself without losing control? I grab a patient, saying “I can't be alone right now. Please walk with me.” And he agrees.
After I ingest a second Klonopin, the afternoon sessions go a bit smoother, and at 3:30 P.M. Christine picks me up and drives me to my weekly massage. My massage therapist lives and works in a houseboat on the shores of the Willamette River. During the session, I am soothed by the gently lapping waves and the singing of the birds. For the next forty-five minutes, I experience a respite from the pain.
All too soon I am awakened from my reverie by the sound of Raeanne's voice, telling me it is time to leave. “No!” I protest. “I want to lie here forever.” Moments later, a gentle nudge tells me that I must make room for the next client. I quickly dress and walk along the moorage back to the shore. The colors of the sky are a thousand shades of indigo blue, and the clouds look like elephants; I feel as if I am on a drug—which I am. I don't like the side effects of these antidepressants.
Christine drives me home. After thanking her, I go inside to check my schedule. At 6:00 P.M., I will take my evening lap swim and then have dinner with my friend Ann. What will I do for the next hour? Unstructured time is the enemy; I can't be alone with the anxiety right now. I call the Metro Crisis Line and explain my predicament. Talking to someone gives me a focus and decreases my agitation. Human contact is my salvation.
By 6:00 I am calm enough to drive myself to the community center's swimming pool. As I begin my second lap swim of the day, I feel the Klonopin wearing off. To cope with the anxiety, I synchronize the rhythm of my strokes and my breathing to a 4-4 beat, using my affirmation to fend off despairing thoughts:
| “I am peace-ful, | I am peace-ful, | I am calm.” |
| 1 2 3 4, | 1 2 3 4, | 1 2 3 4. |
| “I am peace-ful, | I am peace-ful, | I am calm.” |
| 1 2 3 4, | 1 2 3 4, | 1 2 3 4. |
It takes two repetitions of my affirmation to swim one length of the pool; four repetitions equals one lap. As the laps unfold, my nervous system unwinds. My brain releases a few endorphins. I am swimming not for my health, but for my life.
After my swim, I eat dinner with my friend Ann and watch an intriguing episode of “Mystery!” on PBS. Like many people who suffer from depression, I am most anxious and depressed in the morning and feel calmer as the day progresses. On this particular evening, the black cloud lifts and I actually feel normal again. Later, as I drift off to sleep, I pray that my newfound peace will carry over into the morning. “Maybe this is the turning point,” I think. “Maybe tomorrow will bring my salvation.”
But like Bill Murray's character in the movie Groundhog Day, I awake at dawn to find myself in the all-too-familiar anxious and depressed state. It's time to tread fire all over again.
As I have shared in this account, my battle to survive was waged not just day by day, but hour to hour and minute to minute. Like a volatile stock market, my psyche was subject to unpredictable episodes of anxiety and depression which rained down upon me like showers blowing in from the Oregon coast. As each downpour subsided, I was granted momentary relief—until the next front came in. Because I never knew when an anxiety attack would strike, I had to be ready at a moment's notice to readjust my plans (quite a lesson in learning to be flexible!).
Living this way was quite draining. I felt as if I were at the mercy of a strong undertow dragging me out to sea. I would struggle with all my might to swim a few strokes toward shore, only to be pulled back toward the ocean by the overpowering current. By the end of the day I was run down and exhausted, which at least helped me fall asleep. But as the constant battle against the unrelenting black tide began to wear me down, I wondered whether the struggle was really worth it. Soon, my rhyming voices had composed a new verse: “Madness or suicide, it's yours to decide.”
1 Not all cities have such a comprehensive program. If a day treatment center does not exist in your area, you can seek out 12-step groups, depression support groups, or any combination of structures that work. (Mental health support groups can be located by calling your local hospital or by contacting the organizations listed in Appendix C.)
2 In his classic book, Man's Search for Meaning, Victor Frankl says that while imprisoned in a Nazi concentration camp, he discovered that “everything can be taken from a man but one thing—the ability to choose one's attitude in any given set of circumstances.”
3 Please see page 213—Week 5 of the Better Mood Recovery Program—for information on cognitive and other forms of therapy used to treat depression. A sidebar on cognitive distortions also appears on page 218.
4 More information about financially surviving a mental illness can be found in chapter 12.
5 The cost of hiring a home health aide can be reasonable, about $10 to $12 an hour.
6 Andrew Solomon, “Anatomy of Melancholy,” New Yorker, January 12, 1998. Volume 73, Number 42, pg. 51.
7 Moyers, Bill, Healing and the Mind, Doubleday, New York, 1993, pp. 197-99.
8 Although I have described the pain of depression as “seemingly unrelenting,” there were tiny moments of respite. Every now and then a day or two of relief from the intense pain would offer me a time to relax, recoup, and feel a tiny bit of hope. If the pain were 100 percent continuous, no one would survive a clinical depression.
9 The Unity School of Practical Christianity was founded by Charles and Myrtle Fillmore in 1889. It was formed to teach how the principles of the Old and New Testaments can be practically applied to helping people live fuller, more abundant and joyful lives.