David's Inferno (12 page)

I've been called all kinds of things over the years. My official diagnosis is currently Major Depressive Disorder, Recurrent, in Partial Remission. That sounds kind of tame, although during one particularly difficult phase, I earned the term “Severe,” which is a little more impressive. I've also been “accused” of having a severe Cyclothymic Disorder. That's a little technical for my taste, although its definition as a “persistent instability of mood” is something to which many people would testify—going back to my childhood when my parents and brother found those unstable moods alternately amusing and annoying.

Agitated Depression, “a state of clinical depression in which the person exhibits irritability or restlessness,” is a pretty accurate descriptive term, as are Overlapping Cyclothymia or Double Depression.

As a writer, I'm partial to Dysphoric Mania. It sounds noble, in an early-twentieth century kind of way. The Merck Manual describes it as “prominent depressive symptoms superimposed on manic psychosis.” Even better is Melancholia Agitata, which makes
me picture myself, hand on forehead, swooning onto a Victorian fainting couch, and twitching uncontrollably until I collapse ignominiously onto the floor.

In Dante's day, I would have been labeled as having
acedia
. That word is unfortunately usually translated as sloth. This may be how it seems from the outside, but it's a far cry—actually many far cries—from how it feels.

I definitely think I deserve a little credit for surviving
akathisia—
the inability to sit still—and
anhedonia
—the loss of capacity to experience pleasure. One time my doctor asked me if I was having any fun. I looked at him as if he were from another planet. Fun? Fun? To me, that was like asking a homeless person if they'd eaten at any good restaurants lately.

This was not fun.

There seems to be some disagreement as to whether I was or am bipolar or not. I know from my reading that in cases of extreme Bipolar I, the highs are way out-of-control higher than anything I've experienced … except perhaps many years ago on hallucinogens … bordering on and occasionally crossing the line into delusion. And the lows are virtually catatonic. While there were times I displayed symptoms of Bipolar II (the lesser of the two evils), my manic phases usually weren't sufficiently psychotic and didn't last long enough to qualify. Besides, my mania was dysphoric; that is, the opposite of, and not as much fun as euphoric. Instead of swinging wildly from low to high, my moods would swing from depressed to intensely, agitatedly depressed.

But if I had to choose my favorite diagnosis, I'd say Melancholic Depression–Severe with Hypomanic Episodes. Just seems like a nice blend of literary and technical, with intense visual undertones—a dark brooding figure in a medieval Doré woodcut next to some shrieking Ruben-esque figure on a nonstop train to Hell.

Big-time depression is way more than extreme sadness. Every psychiatrist, textbook, and pharmaceutical company may draw the
line in a slightly different place. But for us case studies, there's no question when you've crossed it.

To use a biking analogy, sadness is like finding yourself at the bottom of a steep hill that you know well. You may be discouraged when you realize you have to climb this hill again, but you just had your bike tuned up, the road's in good condition, you know which gears to use, and are confident you
will
eventually reach the top.

Depression, however, is like finding yourself at the bottom of a real steep hill you've never climbed before. You don't know the road or how steep it gets. Turns out it's not even paved. You have your road bike instead of your mountain bike. The shifting's screwed up so you can't get into the lowest gears. The tires are worn smooth and you don't have any replacement tubes. Or a pump. Oh yeah, I forgot: a bunch of drunk kids drove up the road the night before and threw empty beer bottles out the window, shattering glass all over the place. You have serious doubts you'll ever get to the top.

For me, the line between sadness and major depression can't be drawn based on the quality or quantity of sad
thoughts
. In both cases, they ooze around all the time—appearing in a wide range of inner conversations about things that worry, frustrate, and upset me. In both cases, outer circumstances can fuel or calm these thoughts. Still, specific thoughts aren't the hallmark of the experience.

Nor do I experience the distinction between sadness and depression based on the quality or quantity of my sad
feelings
. In both cases, I can feel hopeless, despairing, and overwhelmed. In both cases, outer circumstances can make these feelings better or worse. Still, specific feelings aren't the hallmark of the experience.

For me, the hallmarks of big-time depression are
physical … visceral
. More than the classic heaviness of sadness, it's a scrim that coats my insides—a swath of sensation that runs from behind my eyes, through my tear ducts, down into the deep base of my throat, through my chest cavity, and into the formless abyss of my gut.

Big-time agitation is way more than a bad case of the nerves. More than a little vibration caused by something that triggers your garden-variety adrenaline rush. It's a high-frequency wave that radiates out from the base of your throat and throughout your whole body, pulsing a new charge every few seconds, with little relevance to or concern for what's going on at the time. (“Oh my God, I don't know whether to get a burrito or taco and the waitress is waiting!!!”)

Everybody has phobias. There are certainly enough to go around: ±600 of them—most of which, I'm happy to report, I've never had. For example, I've never been afraid of paper (
papryophobia
), progress (
prosophobia
), or puppets (
pupaphobia
)—although, as a child, Pinocchio was pretty frightening. I'd also prefer not to be in the presence of certain popes (
papaphobia
) or politicians (
politicophobia
), but neither would make me break out in a cold sweat. Remarkably, no one lists a writer's worst phobia (
typophobia
), which rears its frenetic head anytime you realize there's a typo in an email you already sent or a book that's already been publised. (See what I mean?)

I don't think the dosage of my inner adrenaline shots were any stronger than the kind anyone with a serious phobia experiences. The real difference is that, when you're in the throes of agitated depression, you can have paralyzing phobic reactions to just about
anything
—or even the thought of anything … especially anything that can't be remedied
immediately
. And, underlying all those phobias is the fear that someone around you might realize how dysfunctional you really are.

At their worst, the attacks feel like your whole body is under siege, the ramparts constantly assaulted by forces that cannot be denied. When it's over, whether for a moment or an hour, you're in a kind of shock, gasping for breath, relieved, but wary of what the next moment might bring.

True “mixed-states” are more than mood swings. When I'm manic, it's like my brain is weightless. Ideas rise and soar out of it virtually untethered—zipping around my consciousness (and often out my mouth) as if they're tripping across a high-wire. Ideas that roll over each other in exhilarating succession, multiple connections elaborating themselves in waves, often faster than words can identify them.

The subsequent crash, which can come a few hours, sometimes a day later, is a depression like that described above, only cranked up, or actually down, a few notches. When people talk about mood swings, it sounds like a kind of emotional pendulum. To get the full picture you'd also have to knock that pendulum's base around once in a while so those swings remained unpredictable in frequency, duration, and intensity.

I wasn't delusional—well, depends who you ask. And I was rarely catatonic. I couldn't sit still long enough. Rather, I was somewhere in between … and not anywhere for long.

The first step in getting an official diagnosis is to fill out the dreaded “Patient Questionnaire.” Instead of pacing the waiting room floor … instead of gazing longingly at the drug company salesperson with his briefcase full of free samples … instead of just slumping in that metal chair with your head in your hands, so disassociated you can't even get interested in
People Magazine
(what
did
happen to Lindsay Lohan?), you have to answer 132 personal questions on a scale from
0
(Not True) to
5
(Very True). Looking back, I seem to have seamlessly careened from painful honesty to shameless denial:

Question #10: Do you ever feel life isn't worth living—that you have a hopeless outlook?

My answer? 5. (Very True.) Fair enough.

Questions #48/#53: Are you a worrier? Have you ever been bothered by persistent, unwelcome thoughts or images such as … that you would be responsible for things going wrong?

My answer? 1. Not true? Are you kidding me? C'mon, David, you've spent your whole life worried that you would be responsible for things going wrong. From the car not starting to the universe coming to a screeching halt.

Question #126: Do you tend to drive yourself pretty hard, like you need to do just a little more?

My answer? 5. That's more like it.

Question #91 (Everyone's favorite): In the past 12 months, have you had 3 or more drinks of alcohol within a 3-hour period on 3 or more occasions?

My answer? 1. 1??? This isn't a job application, Dave. You're trying to get help. I know it usually takes you four hours … even five, instead of three. But have you seen the sizes of those drinks?

Fortunately, my doctor based his diagnosis on a lot more than this highly suspect information. Here are some choice nuggets from one of my Psychiatric Evaluations: