That Time (16)

How Could One Little Letter Make Such a Difference?

Depression runs in my family but I don’t know if that’s true. I’ve been in therapy sporadically since I was a teenager. I have been depressed since I was a child. I don’t know if that’s true. I have been told many times that depression is in my brain and that I need to take drugs to “manage” it. My father was depressed. My mother was depressed. Ergo, I was depressed. I am depressed. I will always be depressed. No, I’m not. No, I won’t be. Oh, yes, I am.

It has been suggested, and accepted by many people, that mental illnesses may be caused by chemical imbalances in the brain. I used to believe this about my family and myself. Both of my parents were depressed. Some of my siblings were depressed. One of them committed suicide. It was therefore logical to think that my chronic mental distress was depression. I had all the symptoms from a young age.

During high school, I had a friend who was manic-depressive. We had a lot of fun together but he was often challenging to be around. He had mood swings. He was often depressed (angry) and just as often he was manic (fun). From my time with him I learned that the human mind is unfathomably complex. I also learned a bit about bipolar disorder.

My first therapist, when I was 15, told me I should get a job. This was after I told him the trees were calling to me. I had to find out why. I told him I was consumed with sadness, that I felt no joy or hope in my life. All I wanted to do was get high and sleep. He said my melancholia was because I had no sense of purpose. He did not inquire about my family life or my relationship with my parents. I took his advice despite the fact that he believed in aliens. Working did not bring me joy or hope but it enabled me to buy drugs and alcohol so partial success.

My next therapist was one of my high school teachers. Her name was Marilyn and I was in love with her. The class she taught was called Values Clarification. My high school had some progressive ideas and programs and the existence of this class was one result. It was the only class that I attended on a regular basis during 10th grade. I don't remember the curriculum but I remember being interested and feeling engaged. The classes weren't lectures, there were no quizzes or tests, and the text books were paperback self-help manuals. "I'm OK, You're OK," was one of them.

I became so enamored with Marilyn that I would seek her out while skipping my other classes. She allowed me to hang out in her cubicle as often as I wanted with no questions asked. At first she was a mentor to me but our relationship evolved into a therapeutic one when we both found ourselves volunteering at the town's crisis intervention and drop-in center. We had weekly sessions where I poured my heart out about the things teenagers obsess with and she taught me the value of self inquiry and sharing my feelings. I guess we can say she's largely responsible for turning me into a process whore. No self-deprecation or offense intended. I yam what I yam, as these words testify.

At age 20, I was told that I had mood swings by a woman I was in a relationship with. (Hi Cathy.) She thought I might be manic-depressive. Prior to her observation I didn’t realize I had mood swings. But she was right. I was always either up or down and rarely in between. My downs were always more intense than my ups and they lasted longer so I began to think of myself as suffering from chronic depression.

In my 30's, Pam and I entered into "couples" therapy. After a couple years that, with some good results, we determined that I had some long neglected underlying issues that I needed to explore.

It took from about 2000 through 2012 to zero in on and identity my sexual assault as the key factor behind most of my mental illness symptoms. That might seem like an inordinate amount of time but remember, I had been hiding from the attack, from myself, for 30 years. That’s a lot of unpacking to do.

The whole point of a Level 1 Weekend of Recovery is to enable male survivors of sexual assault to tell their story. My work with Paul, one day before I arrived at my First W.O.R in October, 2012, was what enabled me to finally have a complete story to tell. Prior to that my story was non-specific. Something happened. Something bad happened. But it was vague, unspecific. I knew it was a sexual assault but I couldn’t say, “I was orally raped.”

Unlike my memories of my assault, I remember that first W.O.R. vividly. Without exagerration, I can say it was the most important weekend of my life. I was terrified. In a way, it feltlike I was about to mee myself for the first. time. I was nervous with equal parts excitement and dread.

Growing up, I never felt like I belonged. Not to my family, not to my schools, and apart from a few close friends, not to society at large. I have always felt like an outsider. For much of my adult life I assumed this to be the result of not having been raised within the boundaries of any culture. The illusion of a cohesive American culture had been vaporized by beatniks, the civil rights movement, hippies, and the Viet Nam war protests* but I was born too late (1959) to identify with any of those movements. My mother was English, my father Irish, but apart from a few drunken singing uncles, that signified nothing to me. As a kid who got in trouble at school foro refusing to recite the pledge of alleigance I was a prime candidate for the punk scene but there wasn’t anything like that in the cow town I grew up in, nor on Cape Cod, where I spent my teen years.

I arrived at the W.O.R. on a Thursday evening and met some of my fellow survivors at dinner. Aside from some brief small talk, I barely interacted with any of them. Having never been socially adept I had no skills with which to break ice with them. I was also afraid. Of them. None of them looked like me. By that I mean, with the exception of one unusually dressed man, most of them looked like ‘citizens.‘ You know what I mean. They were uniformly unremarkable. Some in sports coats, some in sports wear, a few knitted sweaters, a rare one or two in casual suits. Don’t get me wrong, we were all white and seemingly middle class, so very much alike in that sense. But I still felt like an outsider. I saw no visible tattoos, piercings, not even a goatee.

When it hit me was upon entering the first group session the following morning. As is typical for me, I waited until the last minute to enter the large conference room. Inside was a large circle of chairs with about 30 people already seated. I was one of the final stragglers to enter. What hit me was recognition. As I surveyed the circle, and as many of them looked back at me, I thought, ‘this is them. This is my tribe. I am not alone.’

The weekend was transformative, to say the least. I’ve already told you about the exhileration I felt after the final session on Sunday. I literally returned home a change man. I got back just in time for a Thanksgiving gathering with the Pamily (that word should tell you something about Pam, who is my wife, partner, and best friend). Everybody remarked on my demeanor, dispoition, mood, attitude, whatever it was. They all saw that something in me had shifted. It was a wonderful time for me, and for those around me.

Of course, it didn’t last, too good ot be true, etc. By the same time next year I was back in my depression. My symptoms, unfortunately, expanded to include intense anxiety, insomnia, and a rekindled paranoia. The simple fact of being back in my darkness made it even worse. Because now I had something to contrast it with. For most of my life, my metal distress was so familiar I took it for normal. I now knew, had experienced, that things could be different, better. So why wasn’t it?

I continued my therapy but I also reverted to thjinking that my condition was genetic. I had been using anti-depressants for several years but I turned to psychiatry. Maybe there really was somethign wrong mith my chemistry? I spent the next few years exploring this idea. If anti-dpressants alone weren’t enough, maybe some other medications might help. During this time I was diagnosed as having, in addition to generalized depressive disorder, generalized anxiety disorder, cyclothymia, and bipolar type ii. (I’m not including paranoia because by itself it isn’t a disorder. It’s a symptom of various other conditions) All of these diagnoses came with prescriptions and I tried all of them. I kept getting worse.

At some point during this time I also remembered that my younger brother was once diagnosed as having PTSD. From his childhood. We weren't close so I only know the gist of it. His childhood was traumatic enough that he had PTSD symptoms as an adult. Could that be what was wrong with me? Could that be what was wrong with my parents? Were we all struggling as a result of trauma?

Post Traumatic Stress Disorder. It happens to combat soldiers. Victims of violent crimes or accidents. Torture and rape survivors. Hostages. And children.

Mental Disorder. Generalized Depression Disorder. Generalized Anxiety Disorder. Bipolar Disorder.

dis·or·der | ˌdisˈôrdər |

noun

1. a state of confusion (check)

2. the disruption of peaceful and law-abiding behavior (check)

3. an illness or condition that disrupts normal physical or mental functions (check)

Which came first? The mood swings or the chemical imbalance? The trauma or the disorder?

Thinking about my condition as PTSD was helpful but this framing alone wasn’t enough. It wasn’t complete. I continued my therapy with Joanne, while also continuing to explore different medications under the advice of a psychiatrist. My insomnia, as well as the constant stopping and starting of new medications make the years 2016 and 2017 difficult to remember in detail. I was functioning but I was also a wreck. I stopped practicing yoga and I began spending less time at my studio. I kept up appearances but I was in a downward spiral. After an absence of many years, an old friend came back to visit me. His name? Suicidal Ideation.

I have always contemplated suicide but i have never attempted it. Thinking is what I do, what all of us do, so thinking about suicide is not only common but healthy. How can we choose not to do something if we haven’t fully considered it as a possibility? But no matter how much I may have thought about it I never came as close to attempting it as I did in the Fall of 2017. I began rehearsing it in my head.

Pam and I had been together 30 years at the time. She knew me well enough that, no matter how much I tried to shield it from her, she knew. She called a suicide hotline. I love how life is full of coincidences. I used to volunteer at a crisis intervention center and was trained as a suicide counselor at the age of 16 and, whaddaya know, 42 years later I’m the subject of an intervention. Pam was instructed to take me to a hospital emergency room, which is how I ended up spending 7 days in a psychiatric hospital.

I’m happy to report that The New Yorker saved me. Not from suicide, that was Pam, by convincing me to check in. The food was horrible. The company was… interesting. The fact that I was there at all pushed me deeper into my depression. They gave me ambien to help with the insomnia but then they woke me up every hour to make sure I hadn’t been playing with the bedsheets. The group therapy was like being in a Eugene Ionesco play. While it wasn’t quite as bad as a Cuckoo’s Next, it was unsurprisingly miserable and demoralizing. The New Yorker saved me from trying to kill myself with ennui. I read every word of about 30 issues, including the antidepressant advertisements. Have you seen how tiny and dense the type is on those? Every word.

I was actually at a very good hospital, one that was connected to Emory University and Hospital. They offered state of the art therapies including shock treatment and ketamine injections. Of course, I asked if I could try the ketamine. No such luck, but they didn’t zap me, either, so there’s that. I met daily with a panel of doctors, professors, nurses, medical students, and a few unidentified men in black suits with dark shades (I think they were from the cafeteria.) Oddly, they barely spoke to me, apart from asking a few routine questions about my childhood abuse. They encouraged me talk freely and I took them up on it. Have you heard the expression, ‘diarrhea of the mouth?‘’ Yeah, that was me. I was only allowed 20 minutes per sessions so I talked fast. I literally spewed my words at them non-stop for 19 minutes and 58 seconds, ending each time with, ‘can I go home now?‘ I was astounded when, on day six, they said, ‘yes, you may go home tomorrow.’

I was relieved but dumbfounded. What happened? I asked for an explanation and they gave me one by adding a single letter to one of my diagnoses. It was the letter, ‘c.’

“We don’t believe you are bipolar. There’s strong evidence that you have mild forms of general depressive and anxiety disorders but we think the root of your problem is C-PTSD.”

Complex-PTSD. Here are some brief descriptions from a few different sources:

“…a psychological disorder that can develop in response to exposure to an extremely traumatic event or series of events in a context in which the individual perceives little or no chance of escape, and particularly where the exposure is prolonged or repetitive.”

“Complex PTSD comes in response to chronic traumatization over the course of months or, more often, years… because the [child’s] brain is still developing and they're just beginning to learn who they are as an individual… severe trauma interrupts the entire course of their psychologic and neurologic development.“

“The psychological implications are enormous leaving the child with a complex mess of their core beliefs about who they are what they are. This tangled mess becomes even more complicated by flashbacks, nightmares and other symptoms that are worse in adulthood.”

Remember this from a few paragraphs ago:

“In a way, it felt like I was about to meet myself for the first time.”

Self, meet self. Big Eric, meet little Eric. I thought I was hiding from my painful memories but I was really hiding from myself.

Post-hospitalization I still had a lot to work on. I didn’t feel better right away. I had a lot of questions. One of them was, ‘how could a single assault, no matter how vile, be responsible for such a long lasting and complex mental illness?’ I found a couple of answers.

One is that the longer a trauma remains untreated, the more difficult it becomes to treat. The more entrenched it becomes. The intensity and depth of my struggles owe as much to the fact that I was silent for so long as it does to the initial attack.

The other answer took another year of therapy with Joanna to fully realize. My early family life was rife with trauma. My siblings and I were all subjected to severe emotional abuse and neglect that endured for the duration of our childhood. I came to understand that this kind of abuse can be even more insidious than physical abuse.

But I also remembered something else…