Wednesday, January 28, 2009

Best of: At Six Kilorats

From 12/29/07

It's hard to write. Since discontinuing the expensive wonder drugs, Lamictal and Abilify (they had stopped working despite increased doses), I've gotten worse. If I wake up at night I start crying. I can hardly speak to my visiting daughter without the necessity of strangling sobs. I feel so inestimably sad, it's as if all the sorrow of the universe could be poured in me and I would not overflow. I don't know what sadness and crying are for anymore. To me they are just an incapacitating signal I cannot turn off. Sure, I experience the feeling—a feeling like being left in the dark hungry with a dirty diaper by your mother when you're nine months old, something like that—but the feeling has no cause.

Sadness should be provoked by loss; free-floating sadness seeks an object for its own justification. So if I weep while thinking about my recently deceased daughter, Rachel, some dark part of me agrees, “Well, you're not just weeping for nothing.” But that's a lie. I am weeping for nothing and no one and everything and everyone; I'm just stuck, I'm a skipping record, the proverbial tape loop, the Mobius strip always condemned to be on one side of the equation: “I have seen the universe and it is dark. Abandon hope all ye who enter here.”

Do I feel guilty about my illness? You bet. How about helpless? Worthless? Selfish? Self-centered? Of course. Then there are inner accusations that I'm faking it, I'm not trying hard enough, I'm trying to get out of life, I'm a coward--but willfulness has nothing to with it.

I think back to similar times in my illness and how I tried to cope. Once while taking a full load at UCLA I took on three jobs so that not a minute could be devoted to my thinking about myself. Later, after I graduated, I took a job in a fabric warehouse for the mindlessness of it. Even there they tried to promote me but I refused. I can't seem to do a job badly except the job of being myself, but that has gone way beyond being a job into some supernatural burden.

I can't be myself. Yet here I am with myself. My whole life seems a travesty. For the last ten years I have had the privilege of being able to write what I wanted, but I have nothing to show for it except hundreds of publications, mainly in obscure and non-paying journals. My new ambition to write only for money has been sincere, but even if I were to receive a six-figure advance for a book I would feel no better. I am a laughingstock to myself.

It's true in the last year and a half that I've had two brief remissions from my underlying condition, one with Cymbalta and one with Abilify plus the other meds. But in both cases the meds quit working, even when they were increased. It felt so good to be normal--I had begun to make plans, to look forward to the future—normal meaning the usual checkered existence of light and dark, not one or the other, which to me feels like heaven—and then cruelly, for reasons I don't understand, it was taken from me. The entire episode has now lasted 19 mos; if I subtract the three months of normal mood, it leaves me with a depression of 16 mos, which matches the worst spell in my life, at age 29, when I had to drop out of the last year of psychiatric residency. Don't worry, the irony is free.

There are new treatments available I'd like to try, but unfortunately my insurance won't kick in for another several months and locally there is no mechanism for me to pursue intravenous ketamine or Diprivan (the latter snapped me out of a minor depression some seven years ago during an endoscopy; there is great promise in these short-acting anesthetics). I've heard of a street drug called DMTT, a powder that you smoke, that has a similar effect as Diprivan but am afraid to try it, naturally. But I'm close to it. If I had more gumption I might go looking for it.

It is a joy to have my baby, Sarah (18), visiting. It is also a strain since I don't want to load her down with my leaden affect. “Suck it up, Craig. You gotta suck it up, at least until she leaves.” So I tell myself.

I am sick with a physical illness. I do not want people telling me how a model of “learned helplessness” or Freudian “anger turned inward” have anything to do with my condition. I've been through this many times before. One day the chemicals straighten out and I am fine. Then it turns out there was nothing psychologically wrong with me besides an artist's dose of too much narcissism, I suppose, but nothing requiring therapy. I just get well. EOS.

As for suicide, I won't do it. My father did it at 62; as I like to say, “Why let him win?” Maybe when I'm 63 I'll re-evaluate the idea. My main fantasy for a method of suicide is to plunge a butcher knife directly under my sternum into my heart and have a little consciousness before I go. In driving to pick Sarah up at the airport Thursday, I did have visions of driving off of the road into the river, but the drop was not precipitous enough to guarantee my demise. These are fantasies and tempting ones at that, but no one should assume I'm at risk for them. I'm tougher than that.

I wonder if incurable depression will ever be a justification for euthanasia?

I have always gotten better in the past, eventually, even miraculously, but how much damage is done to me and my loved ones and this organ called the brain in the meanwhile cannot be calculated.

If there's anything you can do for me today, cheer up a friend, lighten the day up a little for someone who is able to receive it. You will be happy you did and so will they--provided the brain chemistry is normal.

6 Kilorats,


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