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Authors: Sheila Hamilton

All the Things We Never Knew

BOOK: All the Things We Never Knew
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Copyright 2015 Sheila Hamilton

Seal Press

A Member of the Perseus Books Group

1700 Fourth Street

Berkeley, California

sealpress.com

All rights reserved. No part of this book may be reproduced or transmitted in any form without written permission from the publisher, except by reviewers who may quote brief excerpts in connection with a review. Some names and identifying details have changed to protect the privacy of individuals.

Library of Congress Cataloging-in-Publication Data is available.

ISBN: 978-1-58005-585-7

10 9 8 7 6 5 4 3 2 1

Cover design by Faceout Studio, Derek Thornton

Interior design by Tabitha Lahr

Printed in the United States of America

Distributed by Publishers Group West

To Sophie—your willingness to lovingly embrace things just as they are allowed us all to move forward

Contents

Introduction

Chapter One

Chapter Two

Chapter Three

Chapter Four

Chapter Five

Chapter Six

Chapter Seven

Chapter Eight

Chapter Nine

Chapter Ten

Chapter Eleven

Chapter Twelve

Chapter Thirteen

Chapter Fourteen

Chapter Fifteen

Chapter Sixteen

Chapter Seventeen

Chapter Eighteen

Chapter Nineteen

Chapter Twenty

Chapter Twenty-One

Chapter Twenty-Two

Chapter Twenty-Three

Chapter Twenty-Four

Chapter Twenty-Five

Chapter Twenty-Six

Chapter Twenty-Seven

Chapter Twenty-Eight

Epilogue

Notes

Acknowledgments

About the Author

Introduction

I missed much of the unfolding of my husband's mental illness. By the time I'd pieced together the puzzle of who David actually was, he was falling apart. My once brilliant, intense, and passionate partner was dead within six weeks of a formal diagnosis of bipolar disorder, leaving my nine-year-old daughter and me without so much as a note to understand his decision. He'd left us hundreds of thousands of dollars in debt and with no plan for helping us recover from the profound grief of his suicide.

David's employees never called to tell me he wasn't showing up at the job sites where his company was remodeling high-end residences and commercial businesses. By the time David experienced his first full-blown manic episode, we'd already been keeping separate bank accounts and separate lives. He isolated himself from me with lies and infidelity. I returned the salvo, alienating myself from him by pretending I didn't hurt.

David's parents may have known about his struggle with mental illness, but they never let on.

Mental illness, unlike breast cancer, isn't celebrated with big marches or pink ribbons. The stigma is stifling, and it prevents most people from seeking help. David refused to accept the label of bipolar disorder. He could not imagine a life of medications and therapy,
which had helped him so little. David's path is not unique. Suicide is now the tenth most common cause of death for men and women. Every thirteen minutes, another American dies from suicide. What could we have done differently? What should we have known?
According to a 2008 report by the National Institute of Mental Health, research shows that risk factors for suicide include depression and other mental disorders and substance abuse disorders (often in combination with other mental disorders). More than 90 percent of the people who die by suicide have those risk factors.

It is my belief that many people could benefit from hearing more about how psychiatric conditions unfold. In the years, months, and days leading up to David's death, I didn't classify him as mentally ill. I missed many signs. I ignored others, believing it could get better. And I scrambled, as the world came crashing down around us, just to maintain my own sanity and the health of my daughter.

Our daughter celebrates her birthday each June. I can't help but measure her birthdays with an equal sense of apprehension and elation. She's a teenager now, and still no signs of the brooding, the polarity, the darkness that descended on David like Portland's thick gray clouds in January, refusing to budge. Yes, she has his intellect, but she also has my relatively sunny nature. She is physically stunning with long, muscular legs and a waist that defies her voracious appetite. She has David's European cheekbones. The color of her skin is his. Her ears have the same shape. There are times I find myself staring at one of her features for too long. She bats me away: “Mom, enough.”

But David's genetics also carry a downside. “There's a 50 percent chance your daughter will present with the same disorder,” a well-meaning psychologist once advised. “It is most common between the ages of sixteen and twenty-one.”

I knew the statistical odds by heart. After David's death, I'd read every book I could get my hands on about bipolar disorder. I'd measured the likelihood of a gene mutation against the things I could influence—what she ate, how much sleep and exercise she got, the unconditional love that I gave her.

But the genetic risk of mental illness is such that my daughter is keenly aware of what she can't do. She understands heavy drinking would kill brain cells that she may need to rely on for higher functioning. She'll never be able to safely experiment with drugs. It's a burden a teenager shouldn't have to take on, but more than half of people with bipolar disorder commit suicide. The numbers are intractable, unchangeable. Read fifteen studies and the numbers come up consistently grim.

And yet, there is much to celebrate.

There have been tremendous breakthroughs in brain science from 2005 to 2015. The ability of scientists to study aberrations in MRI imaging has led to new thinking about the treatment for brain disorders. The work of
Dr. Bruce Perry at the Child Trauma Academy in Houston, Texas, is focused on brain disorders in children, but the applications may also be relevant to adult populations.

When children are subjected to abuse, neglect, absent parenting, or drug and alcohol exposure, brain development can be severely stunted. Perry's ability to define treatment based on the child's current brain functioning is of particular interest to me, since I watched my husband's behavior regress to that of a child during his hospitalization. I had no context at the time for understanding exactly what was happening to him, or to me.

If I were faced with the same predicament today, I would forcefully advocate for the type of care Perry has successfully practiced: the
neurosequential model of therapeutics (NMT), which is a sensitive, neurobiologically informed approach to clinical work. NMT helps match the nature and timing of specific therapeutic techniques to the development of the patient. This research was not available ten years ago and is only now starting to be practiced in some mental health facilities.

NMT's reliance on somatosensory activities like music, movement, yoga, and therapeutic massage allows healing at the most elementary level. A traumatized brain is incapable of processing the subtleties of group therapy. It is impossible to ask people who have
just suffered a manic episode to start sorting out their bills. It is crucial that we understand the limitations of the people we are attempting to help.

I strongly believe that the litany of medications David was prescribed did very little to help. In fact, his first suicidal thought came just days after being prescribed an antidepressant by a well-meaning physician-friend. Medication has helped millions of people, but it fails tens of thousands of families every year. We have relied for too long on an approach to mental illness that relies on pharmaceuticals and fails to take into consideration the whole person—mind, body, spirit.

The
collaborative problem-solving method developed by Dr. Ross Greene, of Harvard, is an important milestone in communicating with people suffering from brain disorders. Though the technique was developed for children, it offers an important template for caregivers. David's early behavior of withdrawal and isolation in our marriage made it impossible for us to solve disagreements or disputes in a collaborative and mutually satisfactory manner. The collaborative problem-solving model employs empathy, consideration of real-life consequences, and collaborative brainstorming to arrive at a place of solution that is both realistic and mutually satisfactory. It may have offered a creative form of communication that I simply did not have at my disposal.

If we knew then all the things we understand now, I might have been more equipped to do more than watch my beloved husband's decline in a state of denial, grief, and fear. I would have had more resources and wouldn't have felt so woefully unprepared for marriage to a person with a mental illness. Instead, I compartmentalized our problems in order to deal with the needs of my child and a demanding job. And in my ignorance and fear, I too allowed our lives to spiral out of control.

In the aftermath of David's death, it took years to stabilize my family's financial future and the emotional current of our lives. Once I came to terms with what killed David, I did an enormous amount
of research to learn more about mental illness and what we can all do to be more compassionate to the people in our lives who are touched with brain disorders.

I have learned so much from my involvement in
the Flawless Foundation, a nonprofit advocating for people with brain disorders. My interest is in preventing another loss of life as exquisite as David's. If we begin modification at the earliest ages, we might improve the chances of mitigating the onset of mental illness.

Dr. Elisabeth Kübler-Ross has described the five stages of grief as denial, anger, bargaining, depression, and acceptance. When a loved one commits suicide, that list is incomplete. We are haunted by the questions “Why would he?” or “What could I have done differently?”

Suicide is an unnatural choice and leaves carnage for the living. I'd propose one more stage of grief to Kübler-Ross's list in the case of suicide: forgiveness. It was not until I reached this stage of forgiveness that I was able to sort out my own failings from those of my husband. In accepting responsibility for my part in David's death, I was able to understand his sense of futility and his unwillingness to face his illness. I forgave him. And in doing so, I've been better able to understand his decision.

BOOK: All the Things We Never Knew
8.58Mb size Format: txt, pdf, ePub
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