Nothing Was the Same (4 page)

For every coldness or drawing back by my colleagues, however, there have been far more acts of kindness and drawing in. At meetings in Dublin, my Irish colleagues were fabulous. The dean of St. Bartholomew’s Hospital toasted me with a glass of champagne to congratulate me on my “personal courage,” and colleagues from Trinity and University College Dublin were kind beyond reckoning. One of the consulting psychiatrists gave me a book of poems by Yeats, with a note that said simply, “Thank you.” Another sent a breathtaking bouquet of tangerine poppies and wild cornflowers to my room. After dinner and an easy flow of wine, two other colleagues, professors of psychiatry in Dublin, took me to the General Post Office, heart of the
1916
Easter Uprising, and pointed to the statue of the dying Cúchulainn. We thought you might like to see this, they said, laughing.
He
had it really hard.

My private life was now exposed to all and sundry, and I found it hard to live with the new reality. As a child I had been quiet and invisible when troubled; as an adult, I had hidden my mental illness behind an elaborate construction of laughter and work and dissembling. Now, my mind and heart and their respective pathologies were brightly lit on a page, behind a lectern, on a television screen. Yet, despite this, it felt good to be honest, to be a part of the community I until recently had kept to the edges of. I was no longer just a re-searcher and a clinician answering questions about diagnosis and treatment; I could talk of my own madness and fears, feel not so distant, not so hypocritical.

I was overwhelmed by the many thousands of letters I received in response to the publication of
An Unquiet Mind
. Most were generous; many were disturbing. Religious diatribes were common. I received hundreds of letters from fundamentalist Christians berating me for turning my back on God and abandoning my Christian faith, which I had not been aware I had or had not done. Others thought my illness just deserts for not having truly accepted the Lord Jesus Christ into my heart, or for not having prayed often or sincerely enough. I had left my mind open to Satan, and he had entered in. Madness and despair were precisely what I deserved and would have in this world and in the next. I should expect to burn throughout eternity. I got more than a taste of the intolerance and hatred religious extremity harbors toward those with mental illness; it was unpleasant and frightening.

I was taken aback by the medieval quality of some of the beliefs held, modern incarnations of demons and possession, and by the viciousness of the attacks. One woman, who included a prayer card with excerpts from the Bible, wrote that it was a good thing I hadn’t had children as I had at least “spared the world of one more crazy manic-depressive.” There were several variations on this theme. “You are clearly unaware of the pain and suffering you and other manic-depressives cause,” wrote one person. “How could you have even
considered
having children, bringing another psychotic into existence?”

There is a large and politically powerful contingent that is virulently opposed to the use of any kind of medication to treat psychiatric illnesses; they weighed in often and with frightening vehemence. Individuals who enjoyed their manias or regarded their ecstatic psychoses as a gift castigated me for colluding with the medical establishment by recommending medication. Others, a smaller group, felt I had written with too much affection about my manias.

Some people questioned whether my psychotic experiences were not in fact perfectly sane, simply visionary states or another, more enlightened form of consciousness. A trip I had taken to Saturn during one of my manic episodes and that I had described in my book seemed to me, when
compos mentis
, quite clearly psychotic. I soon found I was a piker when it came to inter-galactic
travel
. Scores described their trips to Mars and Saturn and star clusters far beyond. Some regarded their planetary voyaging as a manifestation of illness, others as a useful extension of their usual mental lives. One person’s madness is another’s perceived gift.

Many wish to believe that the odd is not so odd, the bizarre not so bizarre, and there is little changing of minds once they are set. There are only so many ways to understand the strange and disordered. The Greeks imagined gods to explain what they themselves could not. It is human nature to invent reasons for why the mind shatters, hope plummets, or the will to live dies. Scientific explanations are complicated and, for many, less humanly satisfying than visionary or religious ones. They are also less interesting than explanations based on planetary misalignment, toxins, or childhoods gone awry. There is a disturbing gap between what scientists and doctors know about mental illness and what most people believe.

Some expressed resentment that I had had the advantage of financial security and supportive friends, colleagues, and family: What right did I have to complain? I could not possibly understand the real pain of mental illness. One colleague, hard-edged and drunk, in front of several of our junior colleagues, snapped that she thought because I had had a “privileged” upbringing, I had “no right” to write about the pain of bipolar illness; it was presumptuous. I found this outrageous. It seemed beyond the pale to have to explain to a professor of psychiatry that the pain of bipolar illness, like the pain of cancer, does not discriminate on the basis of “privilege.”

At the end of the day, only Richard could make me feel less awful about the vitriol that came my way. Put the letters aside, he would say. Ignore the ugliness. If you
must
reread them, put them away for a week or so. He believed, from his own experience of having received stinging critiques on scientific papers, that criticism never seemed as bad on subsequent reading. Often he would call friends of ours and suggest that a group of us go out to dinner, knowing that warmth and laughter and shared tales of scathing reviews or wicked comments would lessen the hurt.

After a particularly difficult time, Richard planned a long weekend for us on the Eastern Shore, thinking that the Chesapeake Bay, which I had loved since childhood, might pull me out of my discouragement and gloom. He insisted that we do nothing but eat, sleep, walk, and make love. No talk of work or illness, no obsessing over the rightness or wrongness of decisions made. No dwelling on hostile letters.

I fell in love with Richard all over again that weekend and, as he knew I would, fell back in love with life. One afternoon, he went out for a drive and came back with a large cottonwood swan under each arm. Decoys, a male and a female, they had been carved by craftsmen on the Eastern Shore; they were beautiful. And, as Richard pointed out, swans mate for life.

Despite the occasional criticism and second-guessing, most people were kind in ways I could not have imagined. Acts of cruelty or criticism have been far outweighed by innumerable acts of warmth and generosity. For every discomfort about the loss of privacy or fear of personal or professional reprisal, there has been a countervailing relief in the honesty.

More than anything, I have been impressed by what people survive: the pain, the injustices of a health-care system that makes no pretense of fairness toward those with mental illness, financial ruin, violence, and most devastating, the suicide of a child, husband or wife, or parent. Everywhere I have gone, I have seen the wreckage left by mental illness and the resilience, inventiveness, and generosity of those who contend with it.

This mixture of devastation and bounty is most obvious in students who struggle with mental illness. I had been particularly eager to reach out to young people with my book, in part because the student years represent the age of greatest risk—the average age of onset of bipolar illness is eighteen or so—and in part because I, at that age, felt so alone with the uncertainty and terror of my own manic-depressive illness. For students who are depressed or who have other mental illnesses, the contrast between how they feel and the energy and high spirits they observe in their fellow students is razor-sharp.

Colleges and universities are incapable of handling the number of students with psychiatric disorders. Usually, administrative awareness of the problem is short-lived and ineffectual, stirred only by campus violence or the suicide of a student. Once the immediate crisis is past, there is little of a constructive nature put into place. On every campus at which I have spoken, students described to me not only the pain and the hopelessness they felt from their psychiatric illnesses, but also the lack of understanding they felt from their professors and college administrators; the lack of adequate health insurance; their fears about being asked to go on medical leave and not being allowed to return to campus; and how aware they are that their behavior is frightening and disruptive to their roommates (and the guilt they feel and are made to feel as a result of this). Always, I am struck by how far-reaching depression’s presence is: a secretary or a department chairman; a football player; the university president or a trustee; a music student, a premed; a business student in suit and tie—anyone might be affected.

When I talk to students, so many of whom have tried to kill themselves, I usually ask them, Did you talk with your parents about this? Few say they have. They invariably ask me, Do you worry about getting sick again? How have you stayed well?, and I tell them, Yes, of course I worry. I worry every day. But it is good to worry. I tell them that it is hard to get well and that it is hard to stay well, but that it can be done. I find myself using Richard’s words: Take your medication. Learn about your illness. Question your doctor. Watch your sleep. Use common sense about recreational drugs and alcohol. Reach out to others. I tell them that bipolar illness is a bad illness to get, but that now is a great time to get it. Science is moving fast, and public understanding is better than it has ever been; they are lucky to have been diagnosed and treated early.

I have been deeply touched by the courage of these students, struggling as they do to study and to compete, to love, and to stay alive. I admire how they have played the hard, unpredictable cards they have been dealt. They take less for granted and appreciate life more than do so many others of their age. I have enjoyed and learned from my time talking with these students over meals, in seminars, after lectures and before. There is a magic in being trusted with the stories of their lives, and if I had nothing but those days and evenings in their company, I would rest content and have little qualm about having made public my private nightmares and weaknesses.

Students have reached out to me and to their fellow students with generosity and ideas. Medical students at the University of California, San Francisco, for instance, who themselves suffer from depression or bipolar illness, set up a support group for other medical students and house staff with similar problems. To my great pleasure they named their group the Redfield Club and asked me to give a lecture in memory of a popular professor of anatomy who had taken his own life. After my talk, they presented me with a first-edition copy of Robert Lowell’s
Life Studies
. It was a profoundly thoughtful gift and, by no coincidence, contained several poems I had used in teaching over the years. “My mind’s not right,” Lowell had written in one of them. “I hear my ill-spirit sob in each blood cell, / as if my hand were at its throat… / I myself am hell.” I keep the book from the medical students on my desk, reminded of Lowell’s hell and theirs. I am reminded even more of the good that some can seize from pain.

Most of my discussions have been with undergraduate, graduate, or medical students, but, because mood disorders often hit those much younger, I have spoken as well to hundreds of children and young adolescents with depression or bipolar illness. They experience the same pain and have the same fears as those who are older, but, because the illness is usually more severe in the very young, and because they cannot understand as much about their illness as those who are older, they have a particularly hard time of it.

One afternoon, I went to a high school in Northern Virginia to give the commencement address. The school, which specializes in teaching students with severe mental illness, had a graduating class of nine. The auditorium was ratty—a far cry from those in the elite private schools that hold such sway in the Washington area—and it was decorated with a decidedly non-traditional triumphal arc of black balloons. Each child had been to hell in his or her own way, and each had stayed in hell far longer than anyone should have to. Theirs was not a world of math tutors, lacrosse practice, and cello lessons. It was, instead, a world of pain, hospitals, psychosis, suicide attempts, and medication. It was also a world of grit, gallows humor, and little taken for granted. They were gutsy and admirable. The small band of graduating students marched to the stage to receive their diplomas, crosswise and out of step, to a scratchy tape recording of “Pomp and Circumstance.” I can count on one hand the number of times I have had to fight hard to keep from crying in a public setting. This was one of them. Mental illness is pernicious in the young. Courage in the face of it is remarkable.

I was keenly aware of this when I talked with a group of children and adolescents in Colorado several years ago. They ranged in age from seven to seventeen and all suffered from bipolar illness. We talked about what it was like to struggle with depression and mania and to have to take medications with unpleasant side effects, how hard it was to concentrate and to study, and how it was nearly impossible to make friends and family understand. These were things they knew too well, too young. But we talked of hope, as well, and how one could live a good life with the illness. It was hard, but it could be done. I answered their questions as best I could. Then, as I was leaving, a young boy, perhaps seven or eight years old, came up to me and put his hand in mine. He looked up at me and asked, “Are you
really
okay?”

I put my arms around him and felt him sobbing against me. “Yes, I am,” I said to him. “I really am. You will be, too.” He looked doubtful. I reached into my handbag, pulled out my key chain, and removed the plastic Bugs Bunny charm I had carried for years. I told him it was my extra-lucky charm because it had not just one rabbit’s foot, but four. A small smile appeared. I gave him the key fob and assured him that Bugs Bunny would bring him the same good luck he had brought me.