M O O D S

By Nell Casey

 "I'm happiest in the hospital," Maud told my mother and me in the visitors' room. "This is the only place where I can really be myself." We were sitting on orange plastic chairs, inches away from the other patients and their families, all of us in our tight huddles of concern.

My own sanity, I realized later, must've seemed like magic to Maud in those moments. "You're so strong," she said then, eyeing me with suspicion and awe. The truth is, though, I am like Maud. We are both an erratic mix of fragility and strength. We are both worried. But I am a different breed-all wiry energy and dizzying panic attacks. Once, at the height of my distress over Maud's second hospitalization, I couldn't read the menu at a restaurant. The words just stopped being reasonable. I wasn't convinced I'd officially learned the English language in the first place. How do you live with a mind that can't hold on? 

In the beginning of Maud's second breakdown, however, I felt pure, heroic strength. I pictured those women you hear about who suddenly take on otherworldly powers in an emergency and lift trucks off their children. In mobilizing around Maud's roiling emotion, I was able to give my own a purpose. I dealt with doctors and medical paperwork, waited patiently on the phone while Blue Cross had me on hold, made the seventy-minute subway ride to the hospital in Queens almost every day after work and arranged for others to go when I couldn't make it. I informed friends and relatives about the situation-saying too much with a kind of dire rapture. (Maud burned her arm with a cigarette! They put her in restraints last night!) Sometimes, I found myself consoling the person I'd just made cry with the grisly details.

And, through therapy, medication, and a month and a half in a hideous psychiatric hospital, Maud did become grounded again. That is, grounded in the sense that she no longer believed there was a bomb in the bed, but not in the sense that she was, once again, Maud. After she reined it in and focused on life as we're asked to experience it on a daily level, she hurtled in another direction. 

I want so much to explain the absence of my sister during her depression. The hidden, shadowy terror of devouring misery. The hollow lifelessness of her pupils, cartoonishly exaggerated into large, black pools from medication. The listless physicality. I have watched Maud shuffle down hospital corridors-dirty sweatsocks, toes knocking into the backs of her ankles as she saunters up and down to nowhere. Oh, for chrissakes, pick up your feet!

Maud came to see me-with those hungry, medicated pupils-right away when she came back to Manhattan in September. I cried in my bed all night afterward. It was impossible to decipher a real person in her. She seemed so tiny. She's not tall to begin with-maybe five-three-and she'd lost a lot of weight, but, most alarmingly, her spirit had vanished. She came over that night with all the trappings of a new lease on life, armed with a Gap bag full of clothes. She tried on a pair of army-green pants she'd bought and slowly twirled in front of the mirror. The too-tight pants pulled awkwardly against her body as if everything now was conspiring to show how difficult it would be for her to reenter this world.

She was walking, talking, making sense, and somehow this was worse. There was enough of her there to imitate a functioning, viable person in the world (able to shop at the Gap), but the sum of these parts only added up to a ghostly version of the person she used to be. She crawled into my bed. She was like a strange infant of sadness in my arms. Her tenderness-able to reign over such intense misery-struck me hard. That and my own first flash of bottomless doubt. Maybe this is it. Maybe this is as well as she gets.

When it did find a voice, Maud's depression opened up new worlds of insecurity: Should I live in New York? Do I know enough about history? Have I said the right thing? In the right language? We had these conversations on the phone at night, sitting on the sidewalk (when she was too seized with anxiety to continue walking down the street), in our cramped New York apartments. I mostly gave practical, soothing answers, but I was frighteningly close to asking myself the same questions Maud kept firing away. One moment, I had total compassion--this, this is what it's like to be Maud. The next, the feelings were eating me alive, threatening to hurl me downward as well. I had the taste of this thing on the tip of my tongue.

This is adapted from an essay in Unholy Ghost: Writers on Depression edited by Nell Casey and recently published in paperback by Harper Perennial.  

Nell Casey edited Unholy Ghost: Writers on Depression, a compilation of various writers detailing their personal struggles with depression. The book also includes some essays by their spouses and siblings about what it was like to live with a person suffering from depression. Some writers are William Styron, Larry McMurtry, A.Alvarez, Lesley Dormen, David Karp, Darcey Steinke,  Nancy Mairs and Lauren Slater.   You can purchase and read more about Unholy Ghost: Writers on Depression from Amazon.com by clicking on the following links. Purchases made this way result in a referral fee being paid by Amazon to MDSG at no cost to you. The hardcover edition of the book sells for $16.10 as of May 2002 (the price can change at any time). The paperback edition sells for $11.16 (also as of May 2002).   Nell Casey was interviewed by Salon.com in June 2001.

Ask the Doctor        with Dr. Ivan Goldberg

Q. My son 27 has been hospitalized numerous times, since first diagnosed with bipolar/schizoaffective disorder at age 17. He is doing great currently, but keeps stopping his Zyprexa and Depakote because of a 60 pound weight gain. What can be done about this?

A. Zyprexa and Depakote both tend to cause weight gain, and when they are used together the weight gain can be massive and cause such complications as diabetes and increased blood pressure. When one of my patients has gained unacceptable amounts of weight from combinations of medications such as Depakote plus Zyprexa, I make every effort to switch their medications to Geodon and Topamax, as that combination usually does a good job of controlling both mood and psychotic symptoms and often leads to weight loss.

Q. I am bipolar and currently taking Tegretol and Seroquel and an oral contraceptive (Minovral). I would like to stop taking the Minovral, and begin Depo-Provera. Would switching to Depo-Provera be a mistake? 

A. Taking Depo-Provera as a contraceptive is a mistake for women with mood disorders. Despite adequate amounts of mood stabilizers, there is a significant likelihood that Depo-Provera will destabilize moods and cause severe depression.

Q. Are there any dangers in taking Paxil while you are pregnant?

A. Not that much is known about the safety of Paxil during pregnancy. The antidepressant that has been studied the most is Prozac, and it appears to be relatively safe to the developing fetus. The developing fetus is most vulnerable to drugs taken by the mother during the first three months of a pregnancy. Many pregnant women have taken antidepressants, including Paxil, during the final two-thirds of a pregnancy without damaging the developing fetus..

We Get By with a Little Help from Our Friends . . . 

MDSG provides award-winning services to New York’s entire mental health community---over 800 individual support groups a year, the distinguished lecture series, our telephone information service, this newsletter. And all at the lowest possible cost, through volunteers.  The $4 contribution for meetings doesn’t cover all our expenses. We need your help to pay the phone bill, print the newsletter, promote MDSG in the media, and meet other needs.

Annual membership is $35 for individuals, $50 for families. Your membership card is a free ticket to support groups and most lectures. Contributions are tax deductible. So be a friend of MDSG--support us as we support you!

Memberships and contributions to MDSG are tax-deductible to the extent allowed by law. MDSG is an IRS-recognized 501(c)(3) organization..

About MDSG

MDSG/NY sponsors a series of  lectures on various aspects of mood disorders. Anyone can attend our lectures. More information is available on our lectures page. Our next lecture is:

Meet Judge Sol Wachtler
Monday,  June 3, 2002  
Chronic and manic depression affects millions of Americans each year, trapping them in a seemingly inescapable downward spiral. One such individual was Sol Wachtler. Former Chief Justice of New York’s Court of Appeals and one of the nation’s finest legal minds, Wachtler made headlines across the country for a reason few would have expected. He was arrested. His fall from grace, which was instigated by an undiagnosed case of bipolar disorder, left him in solitary confinement in a federal prison. Now, after emerging from his dark odyssey with a new sense of hope and focus, Judge Wachtler breaks the silence and stigmas surrounding mental illness that prevent people from seeking necessary treatment. He has turned his own painful story of mania and depression into an inspirational lesson for others. The lecture will discuss the recovery from his fall from grace after undiagnosed bipolar disorder wrecked havoc in his life. 
Note: This is a special fundraiser lecture. Admission is $6 for members, $10 for non-members.