The Black Dog worsens

I"ve been in a fragiile state what with resuming some medications.  They don't seem to be helping.  For the last four days I've been stuck in a horrible mood.  I wake up crying; I can't stop all day.  Only at night do I get a little relief.  And I stay up, afraid of the feelings the next moring will bring.  I see my psychiatrist tomorrow but after six months have little faith we shall be able to put this beast back in its cage.  I swear when I'm normal I'm normal.   But these long bouts of depression are killing me one neuron at a time, one ambition at a clip, yes, I am disabled.  I couldn't work like this.  I couldn't practice medicine like this.  I'm sick, really sick.  Kathleen says I'm as bad as she's seen.  And just two weeks ago it seemed I was getting better, with the addition of one new medication and some traveling that kept me from thinking about myself.  That's the main thing--trying to distract yourself from dwelling on the black hole within, that abyss that sucks all you were into an infinite descent.  Here's another dark sonnet I just penned, no great shakes poetically but honest.


Dark Sonnet XV


You wake up weeping but you don’t know why,
Stream after stream without why or what for.
You never have attempted suicide.
You think of it as the coward’s last chore.
Trashy novels hold you for a while,
Detective gore and science fiction fare
But all less real than the painful smile
You engineer to dodge the stranger’s stare.
You want to spare the ones you love, your friends,
Your children, brothers, sister, beloved wife.
A gift of guilt’s no way to make amends.
The best course is to hold on to this life
And trust and suffer and lean on your God
Though you’d no doubt prefer six feet of sod.

7 Kilorats,

Craig

Achievement and Being

I suppose if I just start writing it will turn into some kind of a post I  can eventually title, but such faith in one's blathering may be misplaced, if one only prattles to blather and blathers to bloviate.  Then these are wind-up sentences, just as the opening of a poem is rarely worth preserving, it is a warm-up for what follows, and the poet must have the wherewithal to recognize where the poem actually starts and practice has ceased.  Perhaps the same applies to prose.

In my human self-centeredness I ask, "Where am I today?"  I really have no idea.  I feel somewhat calmer since the doctor added an antidepressant over the weekend, but today, when I reached for the bottle, I broke into tears.  The tears said something like: "Why should I have to take this medicine?  Why should there be something wrong with me?"  As if I were the only human with this feeling!  It extends to the cancer victim, to the amputee, to the least and greatest of us.  But is such a feeling merely self-pity or a form of compassion?  I don't know.  The best reply I ever heard to a confession of being bipolar was a man who said, "Oh.  Bad luck!"  That's really what it boils down to.  Statistics are inutile unless you become one.  About 1% of the population is bipolar I.  Who am I to gainsay the odds?  Bad luck indeed.

Yet I am lucky in much more, in being loved by a good woman I don't deserve, and by my children and siblings and friends.  I sometimes wonder if these people love me unconditionally--for who I am, whatever that means--or if my achievements matter to them at all.  I like to think they don't.  Nevertheless I have never been able to separate my self-worth from achievement; I was programmed to achieve at a young age else I fear I would feel no worth at all. 

It is not wrong to sorrow for ourselves or our deficits.  It is hard to imagine us being who we are without our deficits, in fact.  As my wife says, "My deafness made me."  In a similar way I can opine, "My manic-depression made me."  And how?

Without it I could not have driven myself, I think, to have been a doctor by age 25, already married with two children.  This is inconceivable to my present mind, but this ambition and adjustment occurred before I was ever diagnosed.  Since being diagnosed I have had good years, ambitious ones where much was accomplished, and bad ones, where my chief value was survival.  That is what severe depression reduces one to: survival.  Asking more is asking too much.  Not to commit suicide seems the height of heroism in such a state.  I may flatter myself and the disease, but I think not. 

Right now I am somewhat suspended between pole and tropic, action and inaction.  I have an ambition to have my medical license restored, but do not know how much work I could tolerate, and if so, whether part-time work would provide enough for us to live, as any return to medicine would end the support of disability.  The first thing is to get the license restored, for which I need 50 current continuing medical education units, something I could attain online or through conferences (though I prefer the learning method of conferences--with real speakers and real interaction--though I know some of this is possible on the web).  And what subjects should I undertake?  Obviously a full review of primary care practices, perhaps with some geriatrics and hospice care courses thrown in, as through my volunteering as a hospice worker I have developed quite an interest in it.

I had no ambition today to do anything concrete; usually I have, at least, some small goal, as yesterday I accomplished something (though I've already forgotten it--perhaps it was finishing my page-turner novel, "Likeness"?). 

For a non-sequitir, here's a new poem whose origins escape me, something about grief:

Inhabit the Wind


The dying face the furnace in hospital hallways,
in the faces of family through flames of annihilating truth.
Oneself, once faced, ceases to be the monster feared

but the living cannot see this; new loss is too present
to be overcome by psychology; no amount of angels
can comfort the freshly bereaved as they mourn

the being lost to themselves, how they were cheapened,
as if a nanogram of spirit had been siphoned
from their own, and that particular emptiness

in the shape of a lover or daughter or beloved uncle
can never be replaced. “O dark dark dark.
They all go into to the dark” while we remain,

fisting strings to the ether where the kites fled,
amazed at how grief alone holds up the lines
to lost faces never again to inhabit the wind.

Don't know where that poem came from, but the loss of my daughter Rachel in 2007 is never far from me.  In fact, death seems always near, perhaps heightened by hospice work.  And "memento mori" is a sobering background mantra in the face of daily tasks, though if one concentrates too much upon it it can rob the present of importance.  It can take the color right out of your Polaroid.  Better to think of it as the frame around the picture, not the content or meaning of the scene.  That we all must die is no reason to despair.  What we do between our beginning and end is what matters--whom we loved, how we contributed, our attachments, our art.   Will my art outlast me?  On paper and on the web, surely, but as a living testimony--likely not.  I do not live with the illusion that my death will bring my poetry or music to any greater notice.  But I'm proud of what I've done, I've worked hard and said much.  Best are the poems that resulted in personal letters, as one from a grandfather who appreciated my take on fame in the case of young girls idolizing Barbies and pop icons.  Despite all the warnings, however, all studies agree on this: the greatest influences in one's life are parents, or those who function as parents.  That should give all parents and grandparents hope.  The television and Net are not all; they will be seen through the lattice of values we inculcate in our offspring independent of media.

I have practiced medicine before while in the grips of depression, and it was barely endurable, but I never endangered any patients, indeed in my short career of fifteen years was never directly sued while seeing 30 patients/day.  Luck or?  I like to think some skill is involved.

Likewise I know if I were to attempt to return to medicine, I could not predict when or for how long I might suffer depression, the soul-killer, which is not a good state in which to practice, as one loses hope of cure for others since one feels incurable.  To say the condition is temporary is true, but temporary in my case has lasted up to two years.  I can't imagine practicing medicine under such conditions, though I have in the past because I knew no way out.  No combination of medications has rendered me ultimately stable.  I have no guarantees.  It would be one big crap shoot where, if I lost my disability and felt I again required it, I might not be able to get it back. 

There is also my back to consider.  The pain is distracting, even as I write this.  How much could I endure as a family doctor, which requires a lot of sitting and standing and walking in hospitals?  At home, unless writing, I usually am recumbent to rest my disks unless I go walking.  I don't know how a full day of doctoring would affect me; obviously my pain would increase, and would that necessitate an increase in medications, and would that increase still permit me to function?  All of these questions gnaw at me.  And I know some are premature.  The main thing is to restore my license and then look at some volunteer possibilities, perhaps, that do not require too much work or time.  After that, if my disability insurance cooperated, I might be able to segue to paid part-time and receive disability for half-time. 

When I last tried that, before opting for full disability, it proved quite difficult.  Am I just fooling myself with these medical ambitions?  Am I scratching for self-esteem among the relics of my past?  I don't know.  I want to be a useful engine, as Thomas the Tank likes to say.   Milton said, "They also serve who only stand and wait."  But it takes a great deal of inner convincing to believe that.  Standing and waiting do not feel like achievements.

I will say that hospice training has encouraged my sense of being and being with others, as opposed to doing and doing for others.  I realize now how important it is just to be with people, no agenda, simply present and open.  This is the kind of support relatives often can't provide, being too caught up with the person in question.  Too often I assume the responsibility for my existence when it might be wiser just to wait and see what life brings.  On the other hand, if you only wait you tempt a sort of pointlessness that satisfies no one and requires great faith on the part of the inactive.

What I need is balance, balance between science and art, work and play.  At this age all work is play and all play, work.  But this human machine is so designed that it needs to see progress, i.e. some effect upon its physical circumstances to feel good about itself.  This can happen with gardening, with writing a new song or poem, with discharging some responsibility regarding car or bicycle repair, etc., etc.--anything that changes the face of reality vis a vis the individual in need of accomplishment. 
.
When I think of my greatest accomplishments, not committing suicide has to be near the top.  I've never attempted it.  This may not sound like heroism to most, but to those who have suffered clinical depression for over a year at a time, I think it qualifies.  Providing for my family and caring for my daughters over the years would have to rank second.  Third would be the pursuit and capture of my one true love, Kathleen; I was willing to risk everything to attain her, and I've never regretted my actions.   As any who have glanced at the love poems in my book know, she is of inestimable importance to my heart and mind and soul.

Funny, none of the above have anything to do with medicine, music or poetry, the endeavors in which I've excelled.  People come first; they must else all religion is deceit. 

Enough rambling for a day.  My back hurts too much to continue.

Au revoir.3 Kilorats,

CE

Medications and Mozart

I have essentially ceased updating my blog for two reasons: 1) I fear I have nothing more to say on manic-depression; and 2) I'm not so sure I want to go on exposing my guts to virtual strangers.

My reluctance may also have something to do with my current emotional lability.  After nearly five months of depression from January through May, I've made a start in recovery but still feel fragile.  My shrink and I agreed on a washout of all medications as none were working; now we have slowly resumed two, and I'm better, but the ground still feels treacherous beneath my feet.  Consequently on Friday I finallly persuaded him to add an antidepressant to my regimen.  Thus I am now on a mood stabilizer, a mild stimulant, and an antidepressant.  Given the time it takes an antidepressant to work, I should know within two or three weeks if its addition is going to help.

Meanwhile what do I do?  Write about it?  What more is there to tell?  Here are the best books I know on the subject: "Darkness Visible" by William Styron; "An Unquiet Mind" by Kay Jamison; and "Noonday Demon" whose author escapes me.  The last one is the most meandering of the three and goes to great lengths to try various treatments, including witchdoctor rituals in Africa.  In the end the author ends up taking medications.  I could have told him that, but then his journey would not have been nearly as interesting.

As for art, I posted a couple of new songs at my Soundclick site, "Angel" and "To the West."  The link is on this page.  I wrote the latter for a solstice ceremony we held last night at my friend's lodge called Spirit House.  I used the song to call in the direction of the west on the medicine wheel.  The lyrics are available on the Soundclick page if you click on "song info" before (or after) listening.  (All the songs on my page are available for free downloading.) 

My friend told me that the west, in Indian lore, was associated with introspection, looking inside.  Another friend told me that the gatekeeper of the west is the bear, another symbol for going inside, given the pattern of hibernation.  Yet introspection I find dangerous for a depressive; one is too easily stuck on one's shortcomings if chemically impaired; best not to go there, better to keep it light.  A sense of humor is indispensible in surviving the black dog.

I'm especially proud of "Angel," a simple Elizabethan love song,  somewhat out of character for me as my songs usually have a more complex structure than three chords.  But three chords often sufficed for Mozart, so who am I to gainsay simplicity?  In a recent post I included one of the better poems I've written in recent memory, "Foxgloves," in which I make some observations on Mozart.  I find his music supportive of mental health; the recurrent structure and resolutions tie up reality into a neat digestible package, or appear to do so in my mind.  It avoids the early Romantic power of Beethoven and the late Romantic questioning of Brahms, in its Classical power of conundrums resolved from  The Age of Enlightenment, the age of proportion and balance.  Listening can prove therapeutic.  I don't have houseplants but in experiments it is said that Mozart aids their growth whereas heavy metal does not.  Heavy metal poisoning--you gotta love that.  Of course everyone ought to know where the term "heavy metal" comes from; it's from Steppenwolf's "Born to Be Wild" and references the "heavy metal thunder" of a motorcycle.  I am, however, over motorcycles, especially since my accident of July 2008.  I'm extremely grateful that I can still play the guitar in light of the permanent nerve injuries to my left hand, which include numbness and weakness I have been able to compensate for the impediment for the most part so that it cannot be easily observed by others, save in my inability (though improving) to really sustain a clean bar chord.

And how about those Lakers!  What a gritty win in game 7.  We outhustled and outlasted Boston.  They led in every shooting category: from the field, from three-point land and from the free throw line, but by sheer determination we outrebounded them by 15 and had a number of second chance points.  Kobe got 15 rebounds himself on a night when in Chick Hearn's words, "He couldn't throw a pea in the ocean."  Nor could anyone else on the team; team shooting from the field was a pitiful 32%.  Boston's percentage was nearly ten points higher.  But we wanted it more, else fatigue had done them in.   Even Kobe said, after the game, that he "had been drained" from the outset, that his fuel gage was on empty before the game started.  I was proud of the whole team, and especially Ron Artest, who not only won his first ring but was instrumental in the two clinching victories.  In game 7 he had 20 pts., five rebounds and five steals.  The steals meant much.  He had more steals than the rest of the team.  His post-game interview was predictably bizarre, but he did directly credit his psychiatrist with helping him calm down for the game.  I hope this starts a trend and that more crazy athletes will give credit where credit is due.

For a Father's Day gift my middle daughter, Keturah, offered to fly me down for the Lakers' parade tomorrow, but by the time we found out it was tomorrow, I had less than twenty-four hours to get down to LA and of course the price of the flight increased because of short notice, so I declined, also because in my present state travel can accentuate my vulnerability to a depressive relapse, the very thing I'm trying to prevent.  Before everything else I must get well and stay well.  Besides, I wanted Kathleen to come.  I can only hope we have another one next year.  You never know.  Most of the team will come back intact, and if Andrew Bynum can have an injury-free season we could be hard to beat.

 An acquaintance recently purchased a copy of "Unexpected Light" then came back two days later to purchase another for his aunt's birthday.  And this is a guy who doesn't read poetry.  If I can just get my book, "Unexpected Light," into a person's hands they will usually buy it. At readings, too, when people hear the work, there's a much better chance that they will purchase it.  It's hard to market a book of poetry without a personal connection, unless you are a "major" poet with a dedicated following. 

I haven't been posting much at poetry boards of late, not only because of the paucity of my output but because of its deficient quality.  And that's not just because I've been seeing my work through the lens of depression; it is a dispassionate analysis of my current state of inspiration.  The recent poem, "Foxgloves," was a welcome exception.

Today I visited the local Catholic church and was pleasantly surprised to find it low key and accessible, not quite high church though the liturgy was naturally used in the mass.  I don't know exactly when they reformed the practice, but now in communion parishioners are also allowed to drink the wine.  Long ago (or not so long ago?) only the priest was allowed.  That simple ritual of wine and bread grounds me like no other.  It proclaims that Christ is real, that the incarnation really happened, as real as the bread in your mouth.  Interesting that a religion's chief ceremony should involve food and drink.  I think that's pretty smart marketing.  We need something to hold onto what with an abstract, invisible God and all the things competing for our attention in the material world.  Good to have a solid ritual of material ingestion.

I'm enjoying this prattling.  It's been a while since I wrote an extended letter to anyone.  Perhaps I will return to blogging for its therapeutic benefit; it has helped me to hang on before.  Whether anyone reads it or not is secondary; the act itself helps the brain into a semblance of order, along with medications and Mozart.

2 Kilorats and fragile,

Dr. Chaffin

Temporary Setback...

I do not mean to make it a practice again to blog about my long manic-depressive cycles, I only alluded to some recent hope in my last post from resuming medication in the face of another depression. 

Alas, after two weeks of improvement I felt the swill and suck of demon melancholy pulling at me Monday; by today I was weeping in my psychiatrist's office--where he made me laugh, referring to me as a third-generation "blueblood bipolar."  I laughed in the midst of my tears.  Great guy.

Anyway, he added meds today and I hope they work, but I am prepared to endure what I must to endure.  My best times are with my hospice client, who has metastatic cancer, for when I am with her I am simply being with her, only sometimes doing for her.  The being with is what counts.  And in that I can forget myself, a major blessing.

But God how I hate "being" depressed, and no amount of doing can bring me out of it--just time and medications.  What I most wish for is a stretch of stable years like I had from 1997 to 2006 on Lamictal.  Why in the last four years I lost that stability I can't say.  "Bad luck" is the extent of my understanding. 

I'm hoping for good luck.  I hope to take Craig with me this weekend to visit my grandson and daughters and friends, and not be stuck 24/7 with his weeping doppelganger.  That melancholy man can be such a bore, and living in his body gives me the willies!  As if everything were a test he was about to fail, from tying his shoes to wiping his mouth after a sandwich, with his constant self-judgment and accompanying terror without object or relief, the vacuum inside, the loss of self, self being replaced by a golem of anti-matter, not even a dark self, more a non-self, as if a ghost were speaking words through my mouth.

Should this depression continue I may have to return to my blog for therapy, though slightly embarrassed by the need.  But why should I be embarrassed?  I've laid it all out before.

Let this depression pass through me
like a radioactive cloud borne on the wind.
Let it touch me but not become me.
Though it hurt me more deeply than my daughter's death,
though its burning fangs sink into the gray cushion of my mind,
let the poison pass.  However long it may linger,
I cling to the grace that it is temporary.
Let the blessed winds blow!

Thine,

Craig

A Note on Bipolar Disease; New Poem, "Foxgloves"

There is much to tell, yet little again.  I have ascended out of my 4 1/2-month depression after a washout of all psychiatric medications and the re-introduction of Lamictal which previously kept me stable for nine years.  I did not blog about this except through my "Dark Sonnets," essentially, because I had little more to say about the black dog, and after having been underwater more than above the last four years, I am hopeful for another long stretch of relative sanity.  No need to repeat the experience in detail as I did from 2006-2008 (when, not unexpectedly, my readership was highest).

What people most need to understand about my disease:

1) External circumstances, though sometimes involved in a "trigger," in general bear little relationship to one's prevailing mood.  The two proceed in separate arcs, and any intersection is largely coincidental.  The mood disorder goes on; it is "endogenous," or self-generated.  One question I used to ask patients to distinguish depression from the blues was their reaction to winning the lottery.  If no reaction they more likely depressed.  No external happenstance can cheer one when in a state of severe clinical depression.

2)  The horror and self-despite of clinical depression cannot be adequately communicated to one who has not suffered it.  Think of the worst day of your life and the associated feelings; multiply that exponentially and extend it for months, even years.  Suicide begins to appear as heaven, and resisting it takes much fortitude. 

3)  If truly afflicted by manic-depression, only one thing helps in treatment: medications.  ECT ought to be included except that it failed me in my last attempt and I will not try it again--combined with the heavy psychiatric drugs they gave me at the hospital (Invega), I actually became worse.

There. 

Now for a new poem:

Foxgloves


Mozart does it so neatly,
answering every question posed.
I swear his concerto billowing out the porch
attracts birdsong.

                                              Their song
is not so neatly balanced as the master’s.
Their melodies can end in queries
or falter in mid-arc without resolution
while no matter how far Mozart’s questing strays
it always folds back on itself to the origin
not just by counterpoint but reaffirmation
as if the world made sense.

Beyond the porch the shaggy foxgloves
droop their furiously maculate lilac bells,
broad leaves uneven, some prematurely yellowed
and these are nothing like Mozart,
more like life, shedding and beautiful,
its messy menstrual necessities
even in crescendo trumpeting decay.
In fact when earlier I tried to straighten
the foxgloves’ winding stalks
they would have none of it.
See how they curl like snakes?

Thine in Truth and Art,

C. E. Chaffin