This may be my favorite chapter of the book, and I think it stands strong alone as a short story.
Memory is contextual, held in relation to who we are now and all that has come since the event remembered, not entirely accurate or agreed upon by others who were there with us. My story to this point is told how I best remember it, but my memory changed with my time in Phoenix. In fact, I remember little of what happened there, as if I was jolted from sleep and by the time the coffee was brewed the dream I wished to hold on to was gone.
Theresa and I lived in at least two apartments while we were in Arizona, but if you took me there today I’d have no idea where they were or how to get to them. I do remember where I worked and a few friends. I do remember the heat and the monsoon, when the sky darkened and the wind howled but the rain evaporated before it hit the ground. A few things are crystal clear, like the morning routine in the pre-op room on the days I underwent electro-convulsive therapy. For the rest, Theresa kept detailed notes and left them for me when she left with everything else she had.
When we first moved to Phoenix Theresa worked her internship at the VA Hospital and I joined Merrill Lynch, smiling and dialing, trying to talk retirees in Sun City into giving up a bit of their retirement savings for a fund called The Dogs of the Dow. I passed my licensing exams but failed at cold calling, so I soon went to work at Charles Schwab placing trades for customers with large accounts. At Schwab I began to spark ideas again. Economics and investing were my most lasting passions, and I always came back to them. Here, I was in the excitement of a trading floor, working with clients on option strategies and limits. Actually I was tied to a computer placing trades, more of a glorified order taker. But I thrived there, made few errors, and wrote and presented training programs on economics and earnings analysis for the other brokers. The fire of business burned inside of me again, and my career was back on track. I was well into studying for my CFP when a sort of malaise kicked in and I stopped attending classes.
At the job I made a circle of friends easily, and Theresa and I travelled with a bunch of them to Rocky Point in Mexico. Each of us “Schwabies” invested our own money and congratulated ourselves on success that was simply a given in the market of the late 90s. I found a few guys to practice kendo with, and a moment of focus sliced through this period of remission. Then I began drinking a lot and Theresa became close with an older doctor at the hospital, but I was too numb to notice, let alone be jealous. She finished her internship and spent a few months unemployed before becoming doctor at a prison. I read Jeanette Winterson and Cormac McCarthy and began to write, sure I could match the music of their prose. I think we had a cat. At some point things began to turn and little inconsistencies stabbed holes in my comeback. I soon missed work so often that it was noted on my reviews. Then came more strange rumblings from within. I honestly don’t remember if I was taking medicine at this time, but if I was it surely wasn’t regularly, as I didn’t have a psychiatrist, and I relied on my wife and her colleagues for my care. Still, I had a sense that I’d recovered, and was living like mental illness was not a part of my life. While the previous two years had seen their ups and downs, there had been no swings like the ones that decimated my friendships, life, and career in Richmond. I thought all that was gone.
String a few months without symptoms together and it’s easy to believe that the fight with the disease is over. I almost forgot it. But I hadn’t yet learned to manage it, was doing nothing special to manage it, and it began to creep back into my life. Only I didn’t notice it yet. While a full-blown episode is fraught with terror, hypomania is quite nice and easy to get caught up in with little thought of anything being amiss. When hypomanic I’m full of charisma, seductive, and electrified with grandiose ideas I’m sure that I can pull-off. And others believe me, are attracted to me, and want to be around me. I was married to a beautiful and intelligent woman whose uncompromising attitude I took as a positive comment on me. I was doing well again in my career, and I was making trusted and dependable friends. Definitely on the upswing, I gave no thought to mental illness and how my behavior might influence it.
But it always came back, and when I did notice it, it was too late.
Slowly, inconsistencies in character and action became exaggerated and the same relationships made so easy by hypomania’s charismatic energy began to strain. The positive flow of budding mania combined with a darkening of mood and outlook and a mixed-episode gained control by obliterating all that opposed it. Pleasures lined up like ducks in a shooting gallery. Things once enjoyed were picked-off one-by-one. Picked-off by ammunition such as panic attacks, disorientation, physical pain, side-effects, and sleep. A feeling not felt since I was a teenager and lost my first love took hold. A sense of rejection, neglect, and total negation overwhelmed me and a pain settled in somewhere between my sternum and my gut. It couldn’t be shaken, and my heart ached. But the energy still blazed and agitation boiled within.
Things got so bad that I was sure they couldn’t get any worse, as if I’d hit bottom. But the bounce never came, symptoms worsened, and psychosis began. So I wasn’t done with the horror and hallucinations after all. Whatever it was in me, I had to cut it out.
In 1998 there’s a hole in Theresa’s notes and a chasm in my mind as I deeply decompensated. Why I came apart, if there was any reason other than brain chemistry, I don’t know. I do remember Theresa yelling that she didn’t want to be married to a man who wrote poetry, drank coffee, and never worked, so I threw the notebooks in the dumpster but still failed at my job. I left the trading desk and curled up on the couch. A side-effect of a medicine I was taking and a period of inactivity collided and I gained thirty pounds. At some point I applied for and was given a job at a Starbucks I could walk to, but I never showed up for my first shift or any shift after that. But still, Theresa pushed for more. I didn’t know what she was expecting. Maybe she saw some great potential in me based on my career before I got sick, before we even met. I did seem, for a while at least, to be on the way back. But she’d married a barista, for Christ’s sake, and was now looking for someone to support her while she pondered leaving medicine to enter law school. I was an unlikely candidate.
Perhaps it’s the fate of a partner of someone with severe mental illness to be let down. Good days are inevitably followed by very bad days, and along with the inconsistencies and haplessness of each successive episode comes snowballing disappointment. I should have taken it as a compliment that her expectations of me were so high, but my own were a bit lower. She sought status and independence, and I sought a level day and a good night’s sleep. There was a short span on short-term disability. My money ran out paying a portion of Theresa’s student debt and for her thigh-slimming plastic surgery that her body dysmorphic disorder demanded. There were medication changes that didn’t work as my moods darkened and my thoughts grew more expansive, and whenever it hurt too much I self-treated by cutting myself.
The cutting was new. In the depths of psychosis the emotional pain was so great that changing it into physical pain made it more bearable. The endless ache and heartbreak of emotions could be alleviated by a sudden stab, a piercing pain, and the endorphin rush that followed. The first time I cut myself was a sensation of such release it was almost sexual. It was as if I could ball up all of the emotional pain I suffered and squeeze it into my forearm, full of tension and despair. To take a razor and pierce the skin was to make such psychic pain physical and feel it leave my body as the blood ran into my palm. The physical pain was so much easier to deal with than the emotional haunting. It was almost pleasant, even, and to experience it instead of the mixed despair of the onslaught of dark mania was a revelation.
I began to cut a lot, and the scars ran down my arm like railroad ties. At first I wore long sleeves in the desert heat to hide the marks, but that began to feel as if I was still holding in the pain. So I rolled up my sleeves to give air to my suffering. No one ever asked about the scars, if anyone even noticed, but if they had I was prepared to say I had fallen through a glass door and tried to catch myself as I went down.
One time I cut so deep that when Theresa came home she had to stich me up, and it was a moment of intimacy unlike any we had shared in a long time. A touching and an entering so lovingly physical that we held each other and didn’t speak afterward. She rose from the sofa and, in a way, walked off for good as I began to emote that she and my family would be better off without me.
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On January 28, 1999 I was admitted to Thunderbird Samaritan hospital and, apparently, early interventions did not help. So on February 2 a long series of electro-convulsive therapy (ECT), or shock treatments, began. It may have been the ECT that robbed me of the memories that should have laid in my mind at this time. It remains a controversial treatment, and groups from dissenting psychiatrists to Scientology believe it is akin to mind control and erases what the mind holds dearest and what is most significant in a person’s recollection. Events, people, and relationships from this point on are seen as if through a hazy, humid mist that shrouds the city in the distance; all heavy, slow, stuck in one place too exhausted to move, if they are to be remembered at all. So the story here becomes more difficult to tell. But memory is not as simple as placing events in chronological order. One can forget an entire year but still remember how to drive a car or conjugate a verb in Spanish. Now my memory is inconsistent, and maybe untrustworthy, and my mind has tucked away like clothes seldom worn in the back of a drawer that which was most painful or most confusing, not to be burdened with again. So perhaps the ECT erasing so many memories is a form of protection.
Or maybe it wasn’t the ECT at all. Maybe it was the medicine. I have taken, and continue to take, some very powerful psychotropics. These could be blocking the entry into my deepest mind, making it impossible for the mundane, maybe even the significant, to settle in. Or, possibly, the disease itself is the culprit. Science reveals that it is very difficult for the brain to lay down new memories during manic episodes, and I was entering a period of my life where the episodes would crush upon my peace like invading armies. We as individuals are the result of our experiences. Could I be less for not recalling so many of them? They’re in there, in the depths of my mind, like ships sunk too far from shore in water too deep, never to be heard from again. All I know is that I’m not entirely sure about patches of time that passed, or what those patches cover.
But I do remember the morning of each shock treatment.
One of the nurses was named Karen and the other Nancy. One of them wore a jacket with three-quarter sleeves and the other wore regular scrubs. It was early and cold in the pre-op room, as one prepared the IV. No one else was there. The nurses laid me down and wheeled me into a tiny room, a closet, really, with the machine with the dials on it. Dr. H came in. He had a handlebar mustache and wore his pants pulled up high, with his knit shirt tucked in over his big belly. He told me he had a Porsche that he liked to race on the track, and once joked that my treatment paid for it. He fiddled with the dials and set something cold in my mouth and rubbed gel into my temples as a nurse placed a blood pressure cuff around my right ankle. The cuff tightened as the other nurse injected anesthesia into the IV. In my next lucid moment I’m sitting with my wife in a coffee shop eating a chocolate croissant. This happened 24 times over a four-month period.
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The first few treatments, 2/2, 2/4, 2/8, 2/10, and 2/12 were in-patient. Theresa wrote that she took time off of work to be with me each day until my parents arrived from New Jersey. But she didn’t want me released and brought in another doctor to consult on my case to lobby for further in-patient treatment. Professional courtesy is common and commendable, and Dr W made a strong case on Theresa’s behalf. His consult, dated 2/10/99, reads:
Reason for consult: Wife has been attempting to talk with Dr H who is administering to her husband a series of ECT treatments and as of early yesterday had not received a response. This magnified her fears that Husband might be discharged to outpatient status in a (temporarily) incompetent mental state with post-ECT memory and judgment impairment. Because she is a physician in a crucial and very sensitive (State of AZ) job and is the only breadwinner as well as being $140,000 in debt, she feels desperate to have her husband cared for in the hospital during ECT lest she lose her job, income, and ability to pay for rent and food while she dutifully takes care of him at home. In the meanwhile, as of 2 hours ago, Husband received his 4th ECT. I spoke with his nurse manager and social worker who – along with Dr S (they report) all concluded that the treatment is, (or will be) continued during in-pt status. I have assisted the Social Worker in providing direct, “real-time” genuine info to the patient’s insurance carrier (ie – that the security of this patient will be immediately and dangerously jeopardized if he is released to out pt in the midst of a course of intensive ECT). Mental Status (+interview of pt). Given his prior level of mixed manic depression, the ECT so far appears to have had a genuine and remarkably positive effect. George also has a brilliant mind (IQ 140-150) and a powerful memory. He is completely oriented in all spheres this AM but both he and examiner note that his reaction time is significantly slower and he feels unprepared to care for himself. Altho (sic) on the surface he is fearful about finances (wife planning to go to law school along with MD degree) he obviously loves and respects her (as she does him) and they are in complete concurrence with an in hospital treatment plan. Dx Bipolar 1 (going into remission with indicated successful course of ECT). Pt’s mood is level at this moment. Recommendations: 1. Continue in hospital status (pt’s care here is excellent and the results so far are proof). 2. As has been Dr H’s treatment, I support the need to observe at least 48 hours after last planned ECT to see if it is really enough – if any sign of discord or discomfort for whatever reason occurs on pt’s part, give another ECT.
The insurance company was inconsiderate of Theresa’s inconvenience, and I was discharged on February 12th. But the treatments were only beginning.
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Outpatient, bilateral ECTs continued: 2/19, 2/24, 2/26, 3/1, 3/5, 3/15, 3/26. We’d get up at 4:30 for a treatment at 6:00, then I’d get my croissant and Theresa would leave for work. My parents stayed for a while and I saw a few spring training games with my Dad. Troy and Stacey visited for a few days and took me horseback riding. I have no idea what my state was like, and I have no memory at all of anything but the morning routine in the pre-op room and the coffee shop afterwards.
On April 9th Dr H changed my course to unilateral treatments, and I actually managed to spend a few days in Vegas with Theresa’s parents. Late in April the ECT continued, with unilateral treatments given on 4/30, 5/3, 5/5, 5/12, and 5/26. On May 28th I took a break and had a vasectomy.
Affective disorders like bipolar disorder and depression show definite heritability, and with Theresa and I both having suffered from severe mood disorders the chance of having a child who suffered from the same was better than 75%, so we had decided to never have children. I guess Theresa wanted to be very sure of this because in the middle of the course of my 24 ECT treatments she took me to have a vasectomy. It’s certain that I knew, sitting in that doctor’s office, that Theresa and I would split up. It’s just as certain that I was irrational, unthinking even, and incapable of making such a big decision at that time. I have seen people undergo a course of ECT treatments, and the blank affect and slow thinking are unmistakable. But some doctors will do anything, especially for other doctors, and Theresa found one who would sterilize a mental patient in the midst of the worst episode and harshest treatment of his life. It hadn’t been that long ago in history that this was normal in psychiatry, so this urologist may not have felt his acting to stop my genes and my craziness from passing to a poor, innocent child to be unusual. I’m sure he thought he was doing Theresa and I a favor, or perhaps he was just happy to get paid.
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Dr H wasn’t finished and the treatments persisted: 6/1, 6/4, 6/9. I’m passive as I write this, and I was surely passive then. I come from an upbringing where you do what the doctor tells you and inevitably you get better. But I didn’t get better, so I needed more. The average course of treatment is 6 - 11 ECTs, and at this point I was well over that and given a break. My friend Brian from Schwab had moved to Colorado, and I went to visit him. We hiked with his dog through the mountains and I’m sure the awe of nature provided a better cure than the gurney and pulsing in Phoenix. I don’t remember the trip at all, but I have a picture. And I look happy.
I returned to the stifling heat and found an email open on the computer. While I was in Colorado Theresa had been in San Diego with her old friend from undergrad. It was clear from the tone and the longing that she was in love. Just not with me. My reaction must have been bad, for by June 18th I was back in the hospital. Three more ECT treatments, 6/18, 6/21, 6/23, were to follow until my discharge on the 25th. Then it was over. The insurance may have run out or the doctors may have thrown in the towel. I don’t believe I ever saw Dr H again, and when my memories begin again I was no better. Theresa was to return east to go to law school, and I had no choice but to go, trailing along like an unwanted puppy.
I do remember a trip to Jackson Hole in early July, and whatever rapid cycling of panic and despair I was feeling was not enough to ruin my settling into the one place that could calm me. As the light crept behind the Tetons and a gentle wind rippled Jenny Lake I considered staying there, settling in Moose and making my life so small that I’d be lost for good, never to be found, in the majesty of the west. The Tetons have no foothills. They just upend the plain and split the sky and strike an awe that pulls insignificance from the most expansive mind, and to just fade into the landscape, maybe fish a little, could have been the cure. But we had return tickets and a place to move to, break up, and settle apart. I had no courage, so I went back to Arizona. Years later, Theresa’s Mom would tell my Mom that the only time Theresa was truly happy was the few years she spent with me. That may have been the case. Or maybe we were all faking it, committed to a cause that was floundering: Both of us in it too soon, yet too far along to admit a mistake. Then the sun set over the mountains and all was gone. The summer was smoldering, but the coming winter was to be the coldest in years. Mere geography, as much as our icing relationship, would make it so.
To pay for the move out of Phoenix we sold my car. I was sensible enough, at this point, to not raid my IRA for marital whims and sunk costs, but the sale of the Acura and the emptying of my liquid savings left me with nothing. I had nowhere to go, and no way to get there. I remember driving the car, the long black hood disappearing into the black pavement, the road reflected so well I couldn’t tell where the car ended and the road began. Things faded into each other like that a lot, and I moved without direction, with no boundaries, between what I held inside and what spilled out onto those closest to me. Life was an open road, but I was no longer driving. I had become passenger to a mind run amuck on a highway leading away from home, without headlights on a road unfamiliar.
On July 31, 1999, we left Phoenix for good. Theresa, not happy being a prison doctor or a wife, had been accepted into law school in Boston, and on the way back east she needed to drop me off with my family in South Jersey. So much happened among the grand cacti in the city consuming the desert, but that’s all I’ve got. I left much of my memory in Phoenix and have never gone back there again.
I can't know how much of what you write is true, particularly because *you* don't even know how much of it is true -- as you've mentioned. But it is intense, to say the least... and it brings me back, to a lot of things I haven't thought about in so long. I was 93 lbs when I started anti depressants, which a year later made me 125 lbs., and still increasing. The pills were barely helping me, so I stopped them on my own, which gave me surreal experiences as I was withdrawing. A reassuring talk with a pharmacist saved me, on the most unsettling night, when somehow I was able to drive to the pharmacy through the haze of paranoia I was feeling. Years later I would go through ECT -- a regrettable decision -- but I wasn't presented with any other option at the time, and I had a what-the-hell attitude, of thinking that I couldn't go any lower. Much of that feeling resulted from so many of the men I'd dated abusing me -- the mirror image of what you've written about, in your autobiography. I remember, with incredible clarity, waking up my boyfriend, every time he fell asleep -- his only escape from the searing pain from a shoulder injury -- waking him up to have sex, because I thought he might buy that -- he might believe that I was waking him up for sex, rather than my real reason: to interrupt his only escape from his pain, which he found in slumber. And he did indeed, buy it. Knowing he was in no shape to have sex, but I could try to get him aroused in a show of sincerity, made this an effortless and safe endeavor. It was an incredibly satisfying thing to watch him try, but unable to have sex -- but still it came nowhere close to "causing" him just a drop, of the pain that he had inflicted on me, for years. I was amazed that he didn't catch on to what I was doing -- but it assuaged any guilt I may even have potentially felt -- because he didn't think I was smart enough, or had enough power in the relationship, to even try to pay him back for all that he had done to me for years. If there is any power women have in living with the near constant abuse by men, and the life endured as second class citizens - it's that they never think we're smart enough, capable enough or fed-up enough (because we're not actually human beings, not really people, we are simply devoted servants) to cause them pain. It doesn't come close to inflicting the amt of pain that they casually and routinely cause us -- still, I'll take the win.