| | |  Health & Beauty | May 2009 
A Journey Through Darkness - Part 2
 Daphne Merkin - New York Times
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| | (Lettering by James Victore; Photograph From Daphne Merkin) | |
What if ECT would just leave me a stranger to myself, with chopped-up memories of my life before and immediately after? I may have hated my life, but I valued my memories — even the unhappy ones, paradoxical as that may seem. I lived for the details, and the writer I once was made vivid use of them. The cartoonish image of my head being fried, tiny shocks and whiffs of smoke coming off it as the electric current went through, haunted me even though I knew that ECT no longer was administered with convulsive force, jolting patients in their straps.
But in the end, no matter how much I wanted to stay put, I ran out of resistance. I spent the weekend before going into the hospital in my oldest sister’s apartment, lost in the Gothic kingdom of depression: I was unable to move from the bed, trapped in interior debates about jumping off a roof versus throwing myself in front of a car. Yet somewhere in the background were other voices — my sister’s, my doctors’ — arguing on behalf of my sticking around; I could half-hear them. I wanted to die, but at the same time I didn’t want to, not completely. Suicide could wait, my sister said. Why didn’t I give the hospital a chance? She relayed messages from each of my doctors that they would look out for me on the unit. No one would force me to do anything, including ECT. I felt too tired to argue.
THAT MONDAY MORNING, I returned home and packed up two small bags. I threw in a disproportionate number of books (especially given the fact that I couldn’t read), a couple of pairs of linen pants and cotton T-shirts, my favorite night cream (although I hadn’t touched it in weeks) and a photo of my daughter, the last with the thought of anchoring myself. In return for agreeing to undergo one of several available protocols — either switching my medication or availing myself of ECT — I would get to stay at 4 Center as long as I needed at no cost. My sister picked me up in a cab, and as I recall, I cried the whole ride up there, watching the passing view with an elegaic sense of leave-taking.
As soon as my sister gave my name to the nurse whose head appeared in the window of the locked door to the unit and we were both let in, I knew immediately that this wasn’t where I wanted to be. Everything seemed empty and silent under the fluorescent lighting except for one 40-ish man pacing up and down the hallway in a T-shirt and sweat pants, seemingly oblivious to what was going on around him. Underneath the kind of baldfaced clock you see in train stations were two run-down pay phones; there was something sad about the glaring outdatedness of them, especially since I associated them almost exclusively with hospitals and certain barren corners of Third Avenue. And then, in what seemed like an instant, my sister was saying goodbye, promising that all would turn out for the better, and I was left to fend for myself.
My bags were taken behind the glassed-in nurse’s station and checked for potential weapons of self-destruction referred to as “sharps” — razors, scissors, mirrors — which were taken away until your departure. Cellphones were also forbidden for reasons that seemed unclear even to the staff but had something to do with their photo-taking ability. In my intake interview, I alternated between breaking down in tears and repeating that I wanted to go home, like a woeful 7-year-old left behind at sleep-away camp. The admitting nurse, who was pleasant enough in a down-to-earth way, was hardly swept away by gusts of empathy with my bereft state. And yet I wanted to stay in the room and keep talking to her forever, if only to avoid going back out on to the unit, with its pathetically slim collection of out-of-date magazines, ugly groupings of wooden furniture cushioned with teal and plum vinyl and airless TV rooms — one overrun, the other desolate. Anything to avoid being me, feeling numb and desperate, thrust into a place that felt like the worst combination of exposure and anonymity.
I emerged in time for dinner, which was served at the premature hour of 5:30, as if the night ahead were so chockablock with activities that we had to get this necessary ritual out of the way. Since in reality dinner led to nothing more strenuous than another bout of “fresh air” and lots of free time until the lights went out at 11, I would have thought that it would be a good occasion to dally. But as it turned out, the other patients were finished eating within 10 or 15 minutes, and I found myself alone at the table, not yet having realized that the point was to get in and out as quickly as possible.
It didn’t help that the room we ate in was beyond dismal, featuring an out-of-tune piano and a Ping-Pong table that was never used. Or that, despite its being summer, there was barely any fresh fruit in sight except for autumnal apples and the occasional banana. There would be culinary bright moments — cream puffs were served on Father’s Day, and one Tuesday the staff set up a barbecue lunch in the patients’ park, where I munched on hot dogs and joined in a charadeslike game called Guesstures — but the general standard was determinedly low. After a while, I began requesting bottles of Ensure Plus, the liquid nutrition supplement that came in chocolate and vanilla and was a staple of the anorexics’ meal plans; if you closed your eyes it could pass for a milkshake.
It wasn’t only the anorexics’ Ensure that I coveted. From the very first night, when sounds of conversation and laughter floated over from their group to the gloomy, near-silent table of depressives I had joined, I yearned to be one of them. Unlike our group, they were required to remain at lunch and dinner for a full half-hour, which of necessity created a more congenial atmosphere. No matter that one or two had been brought on to the floor on stretchers, as I was later informed, or that they were victims of a cruel, hard-to-treat disease with sometimes fatal implications; they still struck me as enviable. However heartbreakingly scrawny, they were all young (in their mid-20s or early 30s) and expectant; they talked about boyfriends and concerned parents, worked tirelessly on their “journaling” or on art projects when they weren’t participating in activities designed exclusively for them, including “self-esteem” and “body image.” They were clearly and poignantly victims of a culture that said you were too fat if you weren’t too thin and had taken this message to heart. No one could blame them for their condition or view it as a moral failure, which was what I suspected even the nurses of doing about us depressed patients. In the eyes of the world, they were suffering from a disease, and we were suffering from being intractably and disconsolately — and some might say self-indulgently — ourselves.
I SHARED A SMALL ROOM right across from the nurse’s station with a pretty, middle-aged woman who introduced herself before dinner — the only one to do so — with a remarkable amount of good cheer, as if we were meeting at a cocktail party. For a minute I felt that things couldn’t be so terrible, that the unit couldn’t be as abject a destination as I conceived it to be if this woman had deigned to throw her lot in with the rest of us. She wore “Frownies” — little patented patches that were supposed to minimize wrinkles — to bed, which only furthered the impression she conveyed of an ordinary adjustment to what I saw as extraordinary circumstances. Clearly, she had a future in mind, even if I didn’t — one that required her to retain a fetching youthfulness. I hadn’t so much as washed my face for the past few months, but here was someone who understood the importance of keeping up appearances, even on a psychiatric unit.
The room itself, on the other hand, couldn’t have been less welcoming. Like the rest of the unit, it was lighted by overhead fluorescent bulbs that didn’t so much illuminate as bring things glaringly into view. There were two beds, two night tables and two chests of drawers. In keeping with the Noah’s-ark design ethos, the room was also furnished with a pair of enormous plastic trash cans; one stood near the door, casting a bleak plastic pall over things, and the other took up too much space in the tiny shared bathroom. The shower water came out of a flat fixture on the wall — the presence of a conventional shower head, I soon learned, was seen as a potential inducement to hanging yourself — and the weak flow was tepid at best.
I got into bed that first night, under the ratty white blanket, and tried to calm myself. The lack of a reading lamp added to my panic; even if my depression prevented me from losing myself in a book, the absence of a light source by which to read after dark represented the end of civilization as I had known it. (It turned out that you could bring in a battery-powered reading lamp of your own, albeit with the Kafkaesque restriction that it didn’t make use of glass light bulbs.) My mind went round and round the same barrage of questions, like a persistent police inspector. How did I get here? How did I allow myself to get here? Why didn’t I have the resolve to stay out? Why hadn’t anything changed with the passage of years? It was one thing to be depressed in your 20s or 30s, when the aspect of youth gave it an undeniable poignancy, a certain tattered charm; it was another thing entirely to be depressed in middle age, when you were supposed to have come to terms with life’s failings, as well as your own. Now that my mother was gone — I always thought she’d outlive me, but her lung cancer took precedence over my suicidal impulses — there was no one to blame for my depressions, no one to whom I could turn for some magical, longed-for compensation. But the truly intolerable part was that I had acquiesced in this godforsaken plan; there was ultimately no one to blame for my banishment to this remote-seeming outpost but myself.
I plumped the barracks-thin pillow, pulled up the sheet and blanket around me — the entire hospital was air-conditioned to a fine chill — and curled up, inviting sleep. There was nothing to feel so desperate about, I tried soothing myself. You’re not a prisoner. You can ask to leave tomorrow. I listened to my roommate’s calm, even breathing and wished I were her, wished I were anyone but myself. Mostly, I wished I were a person who wasn’t consumingly depressed. All over the city, less depressed or entirely undepressed people were leading their ordinary lives, watching TV or blogging or having a late dinner. Why wasn’t I among them? After staring into the darkness for what seemed like hours, I finally got up and put on my robe, having decided that I’d overcome my sense of being a specimen on display — here comes Mental Patient No. 12 — and approach the nurses’ station about getting more sleeping meds.
Outside the room the light was blinding. Two of the aides were at the desk, playing some sort of word game on the computer screen. They looked up at me impassively and waited for me to state my case. I explained that I couldn’t sleep, my voice sounding furry with anxiety. My hands were clammy and my mouth was dry. One of them got up and went into the back to check whether the resident in psychiatry who was assigned to me had approved the request. She handed me a pill in a little cup, and I mumbled something about how nervous I was feeling. “You’ll feel better after you get some sleep,” she said. I nodded and said, “Good night,” feeling dismissed. “Night,” she said, casual as could be. I was no one to her, no one to myself.
I SUPPOSE IT WOULD MAKE for some kind of symmetry — a glimpse of an upward trajectory, at least — if I said that the first night was the hardest, but the truth is that it never got any easier. My frantic sense of dislocation and abandonment persisted for the entire three weeks I spent on 4 Center, yielding only at rare moments to a slightly less anxious state of hibernation. I would eventually discover several friendlier nurses or nurses’ aides with whom it was possible to talk about the bizarre reality of being on a psychiatric unit with a locked door and fiercely regulated visiting hours (5:30 to 8 on weekday evenings and 2 to 8 on weekends) without feeling like an official mental patient. By the end of the second week, when I was no longer chained to the unit, one of the male nurses would invite me for coffee breaks to the little eatery on the sixth floor where the hospital staff repaired for their meals.
These outings were always kept short — we never lingered for more than 15 minutes — and they always brought home to me how artificial the dividing line between 4 Center and the outside world really was. It could cause vertigo if you weren’t careful. One minute you were in the shuttered-down universe of the verifiably unwell, of people who talked about their precarious inner states as if that were all that mattered, and the next you were admitted back into ordinary reality, where people were free to roam as they pleased and seemed filled with a sense of larger purpose. As I cradled my coffee, I looked on at the medical students who flitted in and out, holding their clipboards and notebooks, with a feeling verging on awe. How had they figured out a way to live without getting bogged down in the shadows? From what source did they draw all their energy? I couldn’t imagine ever joining this world again, given how my time had become so aimlessly filled, waiting for calls to come in on the pay phone or sitting in “community meetings,” in which people made forlorn and implausible requests for light-dimmers and hole-punchers and exiting patients tearfully thanked everyone on the unit for their help.
It wasn’t as if there weren’t attempts made to organize the days as they went sluggishly by. A weekly schedule was posted that gave the impression that we patients were quite the busy bees, what with therapy sessions, yoga, walks and creative-writing groups. Friday mornings featured my favorite group, “Coffee Klatch.” This was run by the same amiable gym-coach-like woman who oversaw exercise, and it was devoted to board games of the Trivial Pursuit variety. The real draw was the promise of baked goods and freshly brewed coffee.
But in truth there was more uncharted time than not, especially for the depressives — great swaths of white space that wrapped themselves around the day, creating an undertow of lassitude. Forging friendships on the unit, which would have passed the time, was touch-and-go because patients came and went and the only real link was one of duress. The other restriction came with the territory: people were either comfortably settled into being on the unit, which was off-putting in one kind of way, or raring to get out, which was off-putting in another. I had become attached to my roommate, who was funny and somehow seemed above the fray, and I felt inordinately sad when she left, in possession of a new diagnosis and new medication, halfway into my stay.
Still, the consuming issue as far as I was concerned — the question that colored my entire stay — was whether I would undergo ECT. It was on my mind from the very beginning, if only because the first patient I encountered when I entered the unit, pacing up and down the halls, was in the midst of getting a series of ECT treatments and insisted loudly to anyone who would listen that they were destroying his brain. And indeed, the patients I saw returning from ECT acted dazed, as if an essential piece of themselves had been misplaced.
During the first week or so the subject lay mostly in abeyance as I was weaned off the medications I came in on and tried to acclimatize to life on 4 Center. I met daily with Dr. R., the young resident I saw the first evening, mostly to discuss why I shouldn’t leave right away and what other avenues might be explored medicationwise. She sported a diamond engagement ring and a diamond wedding band that my eye always went to first thing; I took them as painful reminders that not everyone was as full of holes as I was, that she had made sparkling choices and might indeed turn out to be one of those put-together young women who had it all — the career, the husband, the children. During our half-hour sessions I tried to borrow from Dr. R.’s outlook, to see myself through her charitable eyes. I reminded myself that people found me interesting even if I had ceased to interest myself, and that the way I felt wasn’t all my fault. But the reprieve was always short-lived, and within an hour of her departure I was back to staving off despair, doing battle with the usual furies.
One day early into my second week, I was called out of a therapy session to meet with a psychiatrist from the ECT unit. I still wonder whether this brief encounter was the defining one, scaring me off forever. She might as well have been a prison warden for all her interpersonal skills; we had barely said two words before she announced I was showing clear signs of being in a “neurovegetative” condition. She pointed out that I spoke slurringly and that my mind seemed to be crawling along as well, adding grimly that I would never be able to write again if I remained in this state. Her scrutiny seemed merciless: I felt attacked, as if there were nothing left of me but my illness. Obviously ECT was in order, she briskly concluded. I nodded, afraid to say much lest I sound imbecilic, but in my head the alarms were going off. No, it wasn’t, I thought. Not yet. I’m not quite the pushover you take me to be. It was the first stirring of positive will on my own behalf, a delicate green bud that could easily be crushed, but I felt its force.
The strongest and most benign advocate for ECT was a psychiatrist at the institute who saw me three decades earlier and was instrumental in convincing me to come into 4 Center. In his formal but well-meaning way he pointed out that I lived with a level of depression that was unnecessary to live with and that my best shot for real relief was ECT. He came in to make his case once again as I was sitting at dinner on a Friday evening, pretending to nibble at a rubbery piece of chicken. The other patients had gone and my sister was visiting. I turned to her as he waxed almost passionate on my account, going on about the horror of my kind of treatment-resistant depression and the glorious benefits of ECT that would surely outweigh any downside. I didn’t trust him, much as I wished to. Help me, I implored my sister without saying a word. I don’t want this. Tears trickled down my cheeks as if I were a mute, wordless but still able to feel anguish. My sister spoke for me as if she were an interpreter of silence. It looked like I didn’t want it, she said to the doctor, and my wishes had to be respected.
I COULD SEE MYSELF LINGERING on in the hospital, not because I had grown any more fond of the atmosphere but because after a certain amount of time it became easier to stay than to leave. The picayune details of my life — bills, appointments, deadlines — had been suspended during my last few months at home, then left outside the hospital confines altogether, and it began to seem inconceivable that I’d ever have the wherewithal to take them on again. Instead of growing stronger on the unit, I felt a kind of further weakening of my psychological muscle. The new medication I was on left me exhausted, and I took to going back to sleep after breakfast. I was tired even of being visited, of sitting in the hideous little lounge and making conversation, of expressing gratitude for the chocolates, smoked salmon and change for the pay phones that people brought. I felt as if I were being wished bon voyage over and over again, perennially about to leave on a trip that never happened.
I went out on several day passes in the week leading to my departure, as a kind of preparation for re-entry, but none of them were particularly successful. On one, I went out on a broiling Saturday afternoon with my daughter for a walk to the nearby Starbucks on 168th and Broadway. I felt thick-headed with the new sedating medication I was on and far away from her. When she left me for a minute to make a phone call on her cell, I started crying, as if something tragic had happened. I wondered uneasily what effect seeing me in this state was having on my daughter, what she made of my being in the hospital — did she view me as a burden that she would need to shoulder for the rest of her life? Would my depression rub off on her? — but in between we laughed at small, odd things as we always did, and it occurred to me that I wasn’t as much a stranger to her as I was to myself.
With the staff’s tentative agreement — they didn’t think I was ready to go home but had no real reason to prevent me from doing so — I left 4 Center three weeks to the day I arrived, my belongings piled up on a trolley for greater mobility through the annex to the exit. It was a hot June day similar to the one I checked in on, the heat pouring off the windows of parked cars. Everything felt noisy and magnified. It felt shocking to be outside, knowing I was on a permanent pass this time, that I wouldn’t be returning to the unit.
I was sent home on Klonopin, an anti-anxiety drug I’d been on forever, as well as a duet of pills — Remeron and Effexor — that were referred to as California rocket fuel for its presumed igniting effect. As it turned out, the combo wasn’t destined to work on me. At home, I was gripped again by thoughts of suicide and clung to my bed, afraid to go out even on a walk around the block with my daughter. When I wasn’t asleep, I stared into space, lost in the terrors of the far-off past, which had become the terrors of the present. It was decided that I shouldn’t be left alone, so my sister and my good friend took turns staying with me. But it was clear this arrangement was short term, and by the end of the weekend, after phone calls to various doctors, it was agreed that I would go back into the hospital to try ECT.
And then, the Sunday afternoon before I planned to return to 4 Center, something shifted ever so slightly in my mind. I had gone off the Remeron and started a new drug, Abilify. I was feeling a bit calmer, and my bedroom didn’t seem like such an alien place anymore. Maybe it was the fear of ECT, or perhaps the tweaked medication had kicked in, or maybe the depression had finally taken its course and was beginning to lift. I had — and still have — no real idea what did it. For a brief interval, no one was home, and I decided to get up and go outside. I stopped at Food Emporium and studied the cereal section, as amazed at the array as if I had just emerged from the gulag. I bought some paper towels and strawberries, and then I walked home and got back into bed. It wasn’t a trip to the Yucatan, but it was a start. I didn’t check into the hospital the next day and instead passed the rest of the summer slowly reinhabiting my life, coaxing myself along. I spent time with people I trusted, with whom I didn’t have to pretend.
Toward the end of August I went out for a few days to the rented Southampton house of my friend Elizabeth. It was just her, me and her three annoying dogs. I had brought a novel along, “The Gathering,” by Anne Enright, the sort of book about incomplete people and unhappy families that has always spoken to me. It was the first book to absorb me — the first I could read at all — since before I went into the hospital. I came to the last page on the third afternoon of my visit. It was about 4:30, the time of day that, by mid-August, brings with it a whiff of summer’s end. I looked up into the startlingly blue sky; one of the dogs was sitting at my side, her warm body against my leg, drying me off after the swim I had recently taken. I could begin to see the curve of fall up ahead. There would be new books to read, new films to see and new restaurants to try. I envisioned myself writing again, and it didn’t seem like a totally preposterous idea. I had things I wanted to say.
Everything felt fragile and freshly come upon, but for now, at least, my depression had stepped back, giving me room to move forward. I had forgotten what it was like to be without it, and for a moment I floundered, wondering how I would recognize myself. I knew for certain it would return, sneaking up on me when I wasn’t looking, but meanwhile there were bound to be glimpses of light if only I stayed around and held fast to the long perspective. It was a chance that seemed worth taking.
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Daphne Merkin is a contributing writer for the magazine. Her last article was about the Kabbalah Center. |
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