All posts for the month November, 2013
Posted by Laura P. Schulman, MD, MA on November 26, 2013
Read this first thing in my morning (not what most people think of as morning, but it’s mine). Made me feel grateful. And she’s a fine writer. I can’t bear to say “enjoy”- too close to the bone for many of us. If anything, I’d have to post a Trigger Warning for those of us who have spent any significant length of time in a psych hospital. But here’s a view from the other side of the… experience, I guess you could call it.
Posted by Laura P. Schulman, MD, MA on November 26, 2013
I got so excited writing my last post that I forgot to mention the “family tradition” part! So here it is, in all its sad gory. Yes, that’s what I wrote: sad gory.
Let’s start with the unfortunate fact that the first time I heard anything whatsoever about my family’s mental health history was when my mother came to visit me during my first psychiatric hospitalization. That’s when she chose to open up about the fact that her own mother had been hospitalized countless times for depression, and had hundreds of ECT (Electro-Convulsive Therapy) treatments, many of them AT HOME, where my mother and her sister had to hold their mother down on the bed while the doctor administered the treatments. Apparently at that time they did not anesthetize the patient, but just let ‘er rip with the voltage.
Then poor Nana got hooked on Miltown, and after that, various barbiturates, which the doctors later switched over to benzodiazepines. When she was put in a nursing home, her dose of Librium was limited to doctor’s orders, far less than the dose she was used to. “They didn’t want her to become addicted.” She already was addicted, the fools. She used to get other people to sneak her a stash, which she always put in the drawer of her bedside table, and the nurses’ aides always confiscated. Then she would call me (I was a med student at the time) and beg me to prescribe her some more. I always had to say the same thing: “I’m sorry, Nana, I can’t do that. I would if I could.”
I felt bad for her, since she was really an addict, and why should they deprive a 90 year old woman of her comfort? Benzodiazepine withdrawal is a terrible thing. Luckily Tricyclic Antidepressants came along and saved her some suffering.
And now for my father’s side of the family. The first to come up was my Great-Uncle Benny, who was my paternal grandmother’s brother. He was a doctor, and the two siblings had escaped from the Ukraine just before the Bolshevik Revolution, when terrible pogroms were decimating Jewish communities. Their parents sent them to America to escape the atrocities. Unfortunately, Benny “had a breakdown” sometime after reaching New York, was put into Rockland State Hospital, and was never heard from again. The family just shut the door on him and assumed that he had lived there till he died. That’s what my mother told me, anyway.
But. On a hunch, I looked him up in Ancestry.com and by using all the data that I had about Uncle Benny found a living son, in California. So it seems that the man the family threw away DID get out of the hospital, and went on to have a life and a family. But to MY family, Uncle Benny went into the black hole of the hospital and never came out. And I don’t blame him for not getting back in touch with them!
And then there was my Grandpa on my father’s side, who married Benny’s sister. Grandpa became overwhelmingly depressed at the age of thirty or so, and never recovered. His doctor, who was a cousin of my grandmother’s, (and actually a urologist, if the truth be known), advised that he spend winters in Florida instead of upstate New York (where they lived), and knowing what we now know about light and its effects on depression, that was good advice. But Grandpa was never able to work, never able to do much at all. He had no treatment whatsoever for his depression. He lived a miserable life until the age of 91. I have great pity for him, having to live so long in that hell, even though he was very unpleasant to be around.
Speaking of the doctor who was a cousin of my grandmother, who would have been Uncle Benny’s, um, second cousin once removed, or something like that–anyway, one of his sons committed suicide.
So here I was, in the hospital, having felt terrible literally my entire life, and I do not exaggerate here–I cannot remember a time when I did not feel terrible, as a baseline, with episodes of euphoria that unfailingly got me into some kind of trouble–and only then was I told that the genetic cards had been stacked against me. And I was forty-five years old.
I felt as if a closet had been opened and a whole family’s worth of skeletons came tumbling out with a crash and a shattering of bones, some of them mine.
Why had I not been told? The impact on my life was so profound. If I had known, then I could have sought help as a young adult, after I left home, at least–since my parents believed in psychiatry only for other people, not any of us: that was for crazy people, and they drugged you up and you were a zombie. Well, that may have been true, for some people, because the medicines they had back then were crude. But they certainly did have psychotherapists back then, and I sure could have used one. At the very least I would have had some insight into why I felt terrible all the time, and not have to feel like I was some kind of freak.
But our family history was seen as an embarrassment to be hushed up and stuffed into the closet, skeleton by skeleton, and the door wallpapered over and that part of history as good as erased. Until I came along and broke up the party.
I will never forget the shock I felt, after I had lost my medical practice and had a serious breakdown as a result, and my first hospitalization–I ran into a bevy of my mother’s friends in a parking lot, and they all started cooing about how my mother had said my practice was flourishing and how well I was doing. I had a moment of mental white-out and then said, “Well, actually, no. I’ve lost my practice, and just got out of the mental hospital.” Then I turned on my heel and walked off, noting with satisfaction their jaws resting on their shoe-tops while flies flew in and out of their big mouths. But it really wasn’t their fault. They were just told a pack of lies.
Posted by Laura P. Schulman, MD, MA on November 24, 2013
I think this “SAD light” is helping. Whereas before I had it, all I could think of was classier and more refined ways of offing myself, now I find myself thinking about ways to get back on the ol’ horse and ride.
Sadly, a return to medical practice is not an option. Too much time has elapsed since I did my last official doctoring (I say “official” because I take care of the odd mild emergency here and there, without charge). The face of medicine has completely changed, and to tell you the truth, I want no truck with it. Doctors now are nothing but machines. I’m an old-fashioned country doc, and I know it’s a waste but I’m stuck with what I’ve been dealt.
But wait: I have other talents yet to be tapped! I have a Master’s Degree in Medical Anthropology. I have spent the past eight years studying Hebrew cosmology, in Jerusalem! I think that gives me a set of credentials unique enough to shop myself as a visiting professor in some humanities department at some university. I love to teach. And what fun!
Good heavens, there’s a university practically next door to me, University of North Carolina at Asheville. And another one in Johnson City, Tennessee, only an hour away. It’s worth a try, anyway. Hell’s bells, they’re still teaching the Bhagavad Gita over there, and the Epic of Gilgamesh, and no doubt Beowulf, and certainly Plato’s Republic, Sophocles, and the rest of the cast of thousands representing contrasting world views.
But I have never, ever seen Hebrew cosmology taught in any curriculum save programs in Jewish Studies, and even there, it’s not presented from an Anthropological point of view, but as pure theology.
And people, the Cosmology I’m talking about is not your Jewish Grandma’s matzo ball soup. It’s Hebrew physics: a sophisticated body of theoretical systems that explain how the world was created as “some-thing” out of “no-thing,” and continues in its trajectory of creation even now. In essence, it runs exactly parallel to modern wave/particle theory, and other theories in modern physics and astronomy.
So I had this chiddush (“ch” as in “Bach”), which means “brand new light-bulb-type idea,” while sipping Turkish coffee flavored with cardamom this morning. I got addicted to the stuff in Israel, and it is one of the things I stuff a suitcase with whenever I come back to America.
So yes, I had this chiddush. Why don’t I make an appointment with someone important in the Humanities department in Asheville, and pitch my idea to them? I could even wear my normal everyday Israeli clothes, which do look a bit odd compared to American clothes, but they are authentic and might add a flavor of genuineness to my demeanor.
Since I always call my mother at 11 am to check on how their night was, I did so this morning. And since I was rather hyped up by my chiddush, I told her about it (minus the Israeli clothes, since she thinks they are bizarre and wants nothing to do with them).
She oohed and aahed over the whole idea, since the fact that I have been on disability is awkward for her; when people ask what I am doing and she has to make up some lie because she doesn’t want to tell the truth. She is embarrassed by the reason for my disability: mental illness. She wouldn’t mind so much if it were cancer or MS, but mental illness–disgraceful.
And so it was that right in the midst of her ecstasy at the thought of my doing something “productive” again, she stopped dead and hissed, “Don’t you tell them why you haven’t been working. You’ll shoot yourself in the foot.”
“What! Are you telling me that you think an educated person would not hire me because I’m bipolar?” I fairly screamed.
“Yes, that’s exactly what I’m talking about!” Quoth she.
“Let’s look at this thing,” I said more calmly. “Twenty years ago a gay person wouldn’t dare come out and say they were gay. That’s because they were IN THE CLOSET, afraid to come out because they were afraid of losing their jobs, among other things. And now being gay is just part of who someone is. You’re telling me now that you think that I should stay in the closet because I’m bipolar? Bipolar is a part of who I am. It’s me, and I’m not going to deny who I am. Of course I’m not going to shake hands with the program director and say “Hi, I’m Laura and I’m bipolar, anymore than I would say “Hi, I’m Laura and I’m bisexual (only my mother chooses to “forget” that I’m bisexual, so she doesn’t get that part).”
But, if the interview goes well and we get down to nuts and bolts, and the director wants me to teach an 8 o’clock class, then I’ll certainly come out and tell her that I have a health issue that limits the times that I can work; and if the vibes are appropriate, I’ll tell her what it is.
If the truth be known, there’s a huge LGBT population, both in the student body and in the faculty, at UNCA, and I’m sure that like anywhere else there must be a significant percentage of people at the University with various mental illnesses. I’m hoping that since sexual preference diversity is so much out in the open, that neurodiversity might be well accepted too. I’m hoping.
Oh, look! I’ve already made the assumption that they’re going to get all excited about my syllabus and hire me straight away!
“Damn the torpedoes, full steam ahead!”–Admiral David Farragut
Posted by Laura P. Schulman, MD, MA on November 24, 2013
Marci posted this great Ted Talk about coming out of the closet. It’s specifically the story of one gay woman’s journey, and she frames it beautifully. But it’s hitting me where I live right now. I find myself slinking around thinking, uhhh, what if SHE knew, what if HE knew, would they discount everything I said because I’M BIPOLAR and everybody knows that bipolar people are, like, unreliable and have imaginations the size of Texas and might even hallucinate, so how can anyone take me seriously? And then I saw this film and thought, dang, this is ME talking only I haven’t got the cojones to come out and SAY it yet. I wonder if Ted Talks has anything on coming out of the “mentally ill” closet. Come to think of it, even though it has caused me a lot of distress and illness, I am thinking more of my condition as a neurodiversity and not rubber-stamp illness, because I’m not ill with it all the time, but it’s there all the time. It’s just when it gets out of balance that I’m ill. Be that what it may, what are your thoughts on “coming out of the mental illness closet”?
Posted by Laura P. Schulman, MD, MA on November 22, 2013
I knew him when I was a child, mostly. I’ve spent many giggly times on his knee. He was one of those funny people who didn’t put any effort into being funny. He had a heart that spanned the whole world, and would instantly give you anything he had, if you wanted it. He was open-hearted, open-souled, completely without the egotistical layers that most artists cultivate.
He was soft-spoken, but could be boisterous in his own way–which was balanced by his wife, a former nurse, who retained her identity and function as the family and community nurse until this day, I am sure. I remember well being chased down with the intention of giving me an enema, which I didn’t at all want, by our gentle yet strict family nurse…and locking my three-year-old self in the bathroom. They had to take the hinges off. I got the enema anyway!
His son and I were in love. We were three and four. We grew up and married other people, but at the time it was taken as a known fact that we should certainly marry. I often wonder what would have happened–and then, with my bipolar disease, I cringe to think what might have happened, what beautiful things broken, what bridges burned–and I’m happy to remain with the family fantasy, and the family intact.
For our two families have really been one as long as I can remember. Although we have all gone our own ways over the years, there is still the sense of wholeness and familiarity, the heart-bond that will never be broken.
And so, when I heard of his passing, I felt struck in the heart as if by a fist. I have cried on and off all day. It will be hard to imagine the place where they live without him, as he was a legendary icon in his area of art.
Fare well, Val Cushing, wherever you fare.
Posted by Laura P. Schulman, MD, MA on November 20, 2013
My astrologer is in sort of a crisis mode these days, so I don’t really want to bother her with the question: Why is it that I am feeling bombarded by people who feel that bipolar disorder is something to celebrate? It’s true that if I weren’t bipolar, I couldn’t possibly have accomplished the feat of living several concurrent lives.
I’ve got a lot done. I’ve created little empires, and lost them. I’ve made a lot of money, and lost it. I’ve had bosom friends, and intense relationships, and wonderful marriages–all gone.
I hated being a child. Children were so…stupid. Like cattle, running in herds, living their happy little lives, sniveling at trifles, reading Dick and Jane. Innocent, docile, boring little things. I refused to associate with them.
I had one friend, and one friend only: Terry Martin, whose father was a carpenter and let Terry use all his hand tools. There was a creek in the woods behind my house, and Terry and I built bridges over the creek using scrap two-by-fours salvaged from Terry’s father’s scrap pile. We would design a bridge, build it, tear it down, design another one and build it, ad infinitum. I imagine Terry must have grown up to be a famous architect. We were seven, eight, nine, in our bridge-building years.
The rest of my childhood was consumed with books. Grown-up books, not kid books; although I did love Charlotte’s Web and anything else by E. B. White, who is still my literary hero. And of course animals–horses in particular, and any other non-human creature. I used to take in injured animals, wild bunnies who had been half mangled by the cat, a mouse rescued from the trap, and nurse them back to health. It was my introduction to healing.
But I suffered terribly from depression–of course it was not known, in the 1950’s and 60’s, that children could be depressed. But I had frequent bouts of overwhelming sadness and a sense of confusion, not knowing where I was in space or time, dissociation I would call it now. I would cry for hours over seemingly nothing. I hated my existence and wanted to be gone.
And then there were episodes of ecstatic heroic fantasy. Like the time I tied the sleeves of my coat around my neck for a cape, and ran full throttle around the schoolyard shouting that I was going to save the world (it was the Cold War then, and the world needed saving). And the time I lost Terry Martin, by planning out and executing my fantasy of winning his nine-year-old heart to be my forever lover, by singing him a love song I had learned from the radio. That heralded the end of our bridge-building days, and plunged me into a deep river of remorse.
High school. Oh dear. I suppose most high school girls spend their after-school hours writing poetry and drawing diagrams of what would later be called “wave-particle theory.” It was the 60’s, it was Flower Power, it was Viet Nam, it was smoking pot, it was losing my virginity to a vicious rape and running away from home, all the way from Massachusetts to California. It was wandering, purposeless, homeless, sometimes adventure and sometimes just doing what was necessary to keep alive.
Young adulthood–three different art colleges, no degree, frequent bouts of dissociation, PTSD from the now many rapes and close shaves with abduction and what was then called “White Slavery,” now known as Sex Trafficking. Paralyzing depressions, then marathon painting sessions, up all night listening to WGBH Boston and working on three or four canvasses at once–hanging them on the otherwise bare walls of my bedroom and moving from one to the other until 3 am when the fishermen’s coffee shop (Mike’s) opened and I could go down the hill for espresso and listen to the hushed conversation of the Gloucester fishermen, getting their coffees and Italian pastries to warm their bellies before heading out on their boats for the day.
And then it was back up the hill for me, to get ready to hitchhike to art school, take my chances with whatever creep pulled over to pick me up–would he be manageable or would I have a fight on my hands first thing in the morning–who knew? Left art school one quarter shy of graduating–I had to go play in my boyfriend’s band. Granted, it was a good Irish band but couldn’t I have just stuck it out three more months and graduated? No.
Everything was a blur. I could not concentrate. They told me I was good, if I could only get it together–but I couldn’t get it together, because I didn’t know what together was. So I quit to join the band. We had a good roll with the band, and I was painfully in love. He told me flat out he wished he could tell me that he loved me, but he didn’t. I kept on hoping…and lapsing into states where I would go far, far away and no one could reach me, so they just went on and left me to my own devices, and I would wake up crying, feeling lost and abandoned.
Decided I’d better be a doctor, because that’s where my heart was–and is. Talked my way into University of Chicago without a high school diploma–how did I do that? I was on a high and nothing could stop me. I blazed through the interview, charmed the interviewers, and got in.
My parents had had enough of paying for schools, so they refused to help with this one. So I worked three jobs–from 6 am to 8 am blood rounds as a phlebotomist at the hospital. Ten to three, classes. Three to eight, nap and homework. Nine pm to 2 am, cocktail waitress at a downtown disco. 3 am to 6 am, lab tech. On nights I didn’t work the disco, I went out Latin dancing with the South American grad student crowd. And at 9 am I ran three miles with Sunny, the girl I was in love with and didn’t find out she was also bi until after college. Sure I got depressed. I just thought that was normal, since I’d always felt that way.
Let’s fast forward, because this is a blog post and not a book. This is the interesting part anyway. After a dual degree in medicine and Medical Anthropology, I went on to a residency in Pediatrics and Adolescent Medicine. I was a very poor resident, partly because I had begun to have episodes of deep depression triggered by sleep deprivation. Instead of recognizing that I was having a health problem, the administration punished me for my lethargy and crying spells by assigning me to more and more rigorous rotations–extra stints in the Neonatal Intensive Care Unit, which I loathed, and extra time in the Pediatric Emergency Department in the Gulag, which is what we called the hospital in the northern reaches of Rochester, NY, also fondly known as the Knife-and-Gun Club, since it was situated in the heart of Gang War Territory.
I loved the Gulag, for some reason. It was rough and tough and you never knew when there was going to be a lockdown because some gangs got in and were shooting it out in the stairwell. It was my kind of place. I ended up working nights there and becoming the Acting Director when the previous one quit. I took the place from being a skunk works with one intern to a fully-staffed professional department.
Then the boss hired an old girlfriend over me. She had no emergency medicine experience, was a developmental pediatrician. I put on my cape and went into Superhero mode and wrote letters to every bigwig in the medical school. I got fired.
I got a better job, developing a brand new pediatric emergency department in another part of the country. I used what was turning into boundless energy to create a top-notch state-of-the-art facility. But that wasn’t all. I got married, bought a 32 horse boarding stable with 40 acres of land, 20 acres of prime alfalfa that we baled 5 times a year, and an asphalt hauling business. We had one employee, a stable girl. Otherwise, we did it all ourselves: my husband, my son, and his son. And I worked 60 hours a week at the hospital. Not unpredictably, I got irritable and contentious. I didn’t get partnership.
I quit and got another job. I quit and got another job. I quit and went into practice for myself, which was heaven on a stick, except that now I was having to go into my private office between patients to cry. Disaster hit. A church-based organization bought out my hospital, which owned my building, and I was suddenly practice-less. The blow was too much. It sent me to the hospital, the first time out of twice. I have never been the same since.
Yes, I did create mini-empires with my bipolar. I could never have done all that stuff, and I haven’t even told you the rest. But the price was too high. I’m totally disabled now. At sixty, I have little to look forward to. I think now, in these days, when there is so much more consciousness about mental health in general and bipolar in particular, there might be hope for consciously channeling that super-hero energy while somehow mitigating the crushing depressions. I certainly hope so.
For me, it’s a day late and a dollar short.
Posted by Laura P. Schulman, MD, MA on November 19, 2013
I haven’t been writing much lately. I haven’t been doing anything at all much, lately.
In fact, I’m not sure I’ve even been much aware of the passage of time.
There are markers of time that I follow, like scratches on prison walls.
Yesterday I went to Asheville, to the women writers’ workshop. I heard some good writing from other members, and I read a couple of chapters from my new-old novel. It scares me.
Saturday was Shabbat, so I know what happened then: I read the Torah portion in Hebrew, and slept.
I know today is Monday, because I was eagerly anticipating putting my new gym membership into action.
However, the channa dal tikka masala biryani whatever, that I ate from the hot bar at Whole Foods, sent me packing to the outhouse most of the day. That was terrifying as well as uncomfortable, because it was windy. Some of you may recall what happened to my outhouse last time it got really windy, but for those of you who don’t remember, it looked like this:
This is what my poor outhouse looked like when the wind blew it over the edge of the cliff that it sits on. The only way the honey-dipper (that’s what the people who clean out outhouses are called, no lie) could get to it was to haul it with ropes down to the bottom of the cliff and get it onto his truck from there.
So when it’s really windy I just don’t like to go in there.
That was the highlight of today.
There was a tedious form for the insurance company regarding the theft of my car back in August, that had to be filled out again even though I already filled it out, because the first time I filled it out I was in Israel, and the American insurance company insisted that it be notarized, but there is no such thing as a “Notary Public” in Israel. That is difficult for American insurance people to understand, that things could be different in another country, that something that we take for granted in America, like cheeseburgers for instance, do not even exist in some other countries, like Israel.
So they are making me fill out this minutely descriptive form about where and when and how much and what time and with whom my car was stolen and wrecked by this criminal with a blood alcohol level of 0.5 that’s oh-point-five, ladies and gentlemen. That is technically incompatible with life. This man was clearly a career drinker.
Thank god he did not kill or seriously injure anyone. He was too drunk. He allegedly passed out in the passing lane on the highway, and when a passing ambulance driver saw him slumped over the steering wheel and tapped on the window to see if there was anybody home, the guy stomped on the gas and caromed off of four other vehicles, the last being a rear-ender, which stopped him. He was taken to hospital, and from there to jail, where he remains.
But I was not there for any of this. I was in Israel, supposedly for the High Holy Days, but in fact I was struggling just to stay alive.
(Oh, my car, if anyone was wondering, was parked in my cousin’s apartment complex parking lot, where I have left it several times before while I’ve been in Israel. This is the first time it has ever been stolen from there.)
Just after my car was stolen and all of that madness of faxes and PDFs and arguments about whether there was or was not a notary public to be found in all of Israel, and during which time I had the horrible discovery that I had bed bugs in my new-old apartment, I happened to trip on my way into a hardware store, and knocked myself out cold. I got what has proven to be a rather bad concussion out of that.
The High Holidays came and went, and I am sure that I came and went with them, but I do not remember any of it. All I remember was an abiding sense of loss that I just could not get spiritually “plugged in” to the incredible high that has always filled me with awe during the High Holy Days. My body was there, but my soul felt locked out.
Much of the time my head felt too scrambled to manage going to services. This grieved me even worse, because my congregation in Israel is as ecstatic as any tent revival. And I was on the outside looking in, scratching off the days on the outside walls.
I think this concussion is still not quite gone. At least, I am sure that I am not quite right. I notice things about my memory that really do make it look like Swiss cheese. Holes.
And then there is my psychiatrist.
At our last visit he took an hour to examine the mechanisms that turn the cogs of my brain, something with springs and gears and levers, all run by a mouse with a spiral tail that provides the energy for the whole thing to work. Or not. More not than yes.
He (psychiatrist, not mouse) is certain that I have ADD. This makes the third time he has send me away with yet another dosage form of Dexadrine. I do not like speed. I have tried it. I have had it put into my LSD without my knowledge or consent. I do not like it, Sam I Am.
But he prescribed it so I did try it. It made me irritable.
So much so, that when my dear sweet Noga peed on the rug even though she knows very well where she is meant to, and must, pee when indoors (on her special “potty pad” from Walmart, is where)–I was so irritable that instead of merely blotting up the pee spot with paper toweling while grumbling my displeasure, instead I blotted up the pee by jumping up and down on the paper towels and screaming.
Although this was extreme, I do think that Noga got the point, and I hope it will be some time or perhaps not at all, that she thinks of peeing in the wrong place. She is a very intelligent Apso, and she knows the difference.
I think that part of my general state of disorientation has to do with my utter lack of vocation, and therefore complete lack of any sense of purpose. I am in a state of suspended animation.
If I could have one wish, aside from the wish that my child should live a healthy, long, productive, happy life, if I could have one wish beside that one, it would be: to have a healthy brain, and to be happily back at work again, up to my elbows in pediatric secretions, contentedly fixing Nursemaid’s Elbows, consulting my crystal ball and waving my magic wand.
If only. One. Wish.
Posted by Laura P. Schulman, MD, MA on November 18, 2013