The right book at the right time: Just Like Someone Without Mental Illness Only More So

“There are no people anywhere who don’t have some mental illness. It all depends on where you set the bar and how hard you look. What is a myth is that we are mostly mentally well most of the time.”
– Mark Vonnegut, MD 

A couple of years ago I happened to hear an interview on CBC radio, as part of a series on mental illness. I was, at the time, of the mind that my own issues with mental illness were well managed. A present fact but a distant reality. However, something about this conversation stayed with me.

The guest was Mark Vonnegut, son of the late author Kurt Vonnegut Jr. Mark grew up in Cape Cod, in the years before his father’s writing brought fame and fortune. I listened with interest to his very personal account of how, despite diagnosis with a serious mental illness, he applied and was accepted to Harvard Medical School. He went on to become a respected pediatrician. After my breakdown this summer I debated returning to the the fine accounts, like An Unquiet Mind, that had originally guided me to an understanding of my newly acquired label. Then I remembered Mark’s memoir Just Like Someone Without a Mental Illness Only More So and within minutes it was on my Kindle. But I only decided that I really needed to read it this weekend as my symptoms and anxieties continue to persist.

7816284Mark writes in an honest and matter of fact way about the trail madness has left through his family, tracing a legacy of depression, suicide and alcoholism going back generations. His mother heard voices and received message from license plates but once the episode passed she was able to rationalize it. When Mark’s aunt and uncle died within a month of one another leaving four troubled orphans, his parents took them in even though they had neither the money nor the capacity to manage. His oddly prescient mother had been stockpiling supplies for their arrival in advance, as her helpful voices had advised.

Mark was a loner spending a lot of time fishing and playing imaginary games in the woods around his home in Cape Cod. The oldest child of the family he grew up poor in the fallout of the the Depression. His father was a ineffectual used car salesman for many years. Mark was 21 before his father became a rich and famous author seemingly overnight.

Caught up in the hippie movement of the 60s, Mark followed many of his peers to Canada to join a commune in BC. He lived off the land, contemplated the meaning of life and experimented with drugs. And that is where he first encountered his own voices. In 1971, at the age of 23 he experienced three major psychotic breaks that landed him behind the locked doors and plexiglass windows of a Vancouver hospital.

“Among the things I grew up thinking about mental illness was that it was caused by other people or society treating you badly.I also knew that once people were broken they didn’t usually get better and the ones least likely to get better were paranoid schizophrenics, which is what I seemed to be.”

Retrieved by his father, Mark returned to the US where, with ongoing treatment, he continued to recover. The voices faded to the background. He published a book about his experiences and articles advocating for an understanding of mental illness as a biochemical condition, in strong opposition to the RD Laing inspired philosophy that was popular at the time (and has recently resurfaced). Somewhere along the way he decided that he wanted to go to medical school himself. Against all odds, and with pathetic math and science marks, he applied to one school after another. Incredibly Harvard gave him a chance.

Over the years that followed, Mark dedicated himself to his studies and his internship. By this point he had recognized that he was bipolar (not a schizophrenic who responds to lithium as he had been told), but even then, the schedule of an intern is grueling. During these years he also married, bought a house and started a family. The model of normal and healthy he figured his mental health issues were history.

Then 14 years after his third psychotic break, several years into a successful pediatric practice, the voices returned to taunt him. The trigger was his realization that he was fueling his high stress schedule with a two pack a day smoking habit along with 5 or 6 beers, half a bottle of wine, a few shots of bourbon and a sleeping medication to round off the day! Hardly a surprise then that his effort to quit cold turkey should trigger a psychotic break.

Although he sensed things were falling apart he resisted seeking help in a hospital. Driven by an absolutely irrational fear planted in his head by his voices he attempted to throw himself through a third story window. The window smashed but he fell back into the room. Unfortunately he ended up in a straightjacket on a gurney in the hallway of the very hospital where he had completed his internship and taught a course.

Although my own manic resurgence following an extensive period of wellness was somewhat less dramatic than Mark Vonnegut’s, it is only a matter of degree. Yet in time he was able to return to work and it has now been more than 25 years since his last manic break. His ability to rebuild his life and career even in the face of abject humiliation is an inspiration. And I am fortunate that I have neither smoking or alcoholism to contend with. But his story stands as stark reminder that with bipolar you must take the medication that keeps you stable and monitor your own level of energy. If we become complacent we risk an unwanted replay, no matter how long we have been well.

This book was published in 2010, so It was not available when I was first coming to terms with my diagnosis. Perhaps if I had read it when I first heard the interview I might have been able to head off my more recent experience. But then again, a manic person is a slow learner because that high just feel so good. Especially in contrast to the draining and  despondent opposite end of the cycle.

I would recommend this memoir to anyone interested in mental illness, especially those who understand what it is like to experience psychosis. Its casual, relaxed style makes for an easy read but, as a practicing physician, Vonnegut has some depressing observations about the decline of health care in his own country. Most importantly though, he leaves those of us who live with mental illness with a sense that we can get better, we can stay better and if we fall, we can get up and move forward.

That is exactly what I need to remember right now.

The detective and the end of the world: The Coming by Andrej Nikolaidis

If you are a bit of a news junkie like I am, there is a lot of bad news on our TV screens and computers each day. Violent political upheaval, deadly viruses, floods and fires. But it is scattered and for so many of us our complaints are relatively minor, isolated. What if the signs suddenly started to rapidly multiply and spread across continents and communities. Would it herald the end of the world? Would we know or even agree on the meaning of the signs? Assign them to God, reduce them to science?

Translated by Will Firth Istros Books, available through Dzanc Books in North America
Translated by Will Firth
Istros Books, available through Dzanc Books in North America

The Coming, a wonderful novella by Montenegrin novelist Andrej Nikolaidis explores such questions from a rather unconventional perspective. Our hero is a private detective, a small town Philip Marlowe based in the ancient city of Ulcinj. He finds himself most comfortable providing his clients with the answers they want, regardless of whether or not he even manages to find the truth behind a crime or infidelity. This approach makes him popular with the locals who prefer to approach him  rather than the authorities. Consequently the quiet life he seems to desire tends to allude him. As the book opens he has become obsessed with the particularly brutal murder of an entire family which appears to have coincided with the burning of the local library.

Yet even stranger phenomena begin to threaten his routine. Snow starts to fall in June and does not let up. Around the world catastrophes – earthquakes, floods, raining amphibians – are reported with alarming intensity. Is this the Apocalypse, is the Second Coming finally at hand?

For our poor detective who faces this most peculiar string of circumstances with cynical humour and frustration, there is an added factor. Emmanuel, a child he fathered during a brief affair with an irresistible client, is now grown and has tracked him down from an asylum in the Alps where he has been confined after some serious mental breakdown. Through a series of emails Emmanuel shares details of his childhood with the father he has never met and offers his curious knowledge of messianic mystics, millennial cults and numerous attempts to calculate the date of the end of the world throughout western history. Perhaps because he himself has a mental illness, Emmanuel interprets the reported behaviours of many cult members or their charismatic, wildly erratic leaders in reference to what would be probable modern psychiatric diagnoses.

For myself, personally, in the months that followed my diagnosis with bipolar, I struggled to make sense of the role of my illness in the intensely spiritual experiences that I had periodically encountered growing up. During full blown psychosis, I could imagine that the frantic notions that I had the answer to the meaning of life were indeed in keeping with mania. I had the cramped and panicked nonsensical documents to prove it. But what about the earlier visions and spiritual experiences? Far less dramatic, frequently beautiful, these moments had filled me with such an assurance of the existence of God that I completed an honours degree in philosophy without once being troubled by any ontological questions. I could argue for or against the existence or nature of God while my own personal spirituality remained intact.

However, as I started to read about psychotic symptoms, I began to recognize similar features in the visions of Biblical prophets, the martyrdom of saints, the trance states of mystics and other ostensibly spiritual experiences. I could not divorce my own experiences from an underlying framework of biochemistry. My sense of personal faith crumbled.

Over the years as I have watched good people of faith rejected by their churches following mental breakdowns, I have been increasingly concerned by the double standard. After all who draws the line between mystical vision and clinical madness?

The Coming sees no need to draw those distinctions. I loved the way the pragmatic emails from the detective’s estranged son reach out to a world that may well be facing its final hours with the observation that the human desire for an Apocalypse can be compared to our urge to fast forward through a detective movie because we can’t wait to see how it ends.

We want answers – but we those answers to come from God or from science, not from the visions of those who are determined to be not in their right minds.

Leaving the Atocha Station – The neurotic American poet in Spain

I recently read Ben Lerner’s acclaimed first novel Leaving the Atocha Station. I bought the book in 2012 but had put it aside, uncertain I wanted to spend time with a narrator I expected to be a misanthropic American slacker poet slouching his way through the streets of Madrid. When I happened to catch the replay of a CBC radio interview with the author my interest was rekindled, especially in light of my recent breakdown and the therapeutic comfort I have been finding in poetry.

indexSure enough our narrator Adam Gordon is an ambivalent and emotionally insecure young poet who has chosen to spend a fellowship year in Madrid. Ostensibly his aim is to explore, in verse, the impact of the Civil War on Spanish society although he seems to have precious little direction or inclination of how to begin his project beyond attempting to improve his comfort with the Spanish language. He seems to have a cultured skepticism in the value of art and the validity of the artistic experience which in turn causes him a healthy dose of self loathing. He passes his days smoking hash and cigarettes, while relying on the security of tranquilizers and mood stabilizers. He reads Tolstoy, Cervantes, and John Ashbery. Beyond that he parties and awkwardly attempts to conduct love affairs with two Spanish women.

The resulting novel is a surprisingly humourous and engaging exploration of the struggling artist who refuses to struggle. Adam spends much time trying to make sense of what his new Spanish friends are saying and attempting to compose the facial expressions that he assumes will be appropriate for the circumstances. If in doubt he hides behind the prop of a cigarette. Yet it is not only the dislocation of being in a foreign country that accounts for Adam’s feeling of always being one step out of sync. He also believes himself to have bipolar disorder although it is never entirely clear that this is a confirmed diagnosis or a justification for the little yellow and white pills that he relies on. I’m not certain if Lerner, himself an established poet, is playing with the idea that neurosis is an essential element of the artistic process. Nonetheless Adam embraces it fully, manipulating his medication to ramp up the production of poems for a Spanish translation without any real sense if he is producing anything of worth.

Ultimately he crowns this phase of intense creative production with a grand manic splurge, thanks to his parents’ credit card, to impress one of the women he imagines himself in love with. An insanely expensive dinner and a night at the Ritz Carlton coincides with a tragic early morning blast at the busy Atocha Train Station, the 2004 attack by Islamic militants that killed 191 commuters. The street protests and the involvement of Adam’s wealthy young Spanish friends in the demonstrations and elections that follow this terrorist attack serve to force him to ground himself, even just a little.

The most engaging aspect of this book for me was the continual sense of self consciousness that pervadesAdam’s thoughts, plays with his confidence and keeps him from ever feeling that he is at home in any setting. His anxiety causes him to sabotage his potential relationships (or at least believe he is sabotaging them). He is alternately cocky and absolutely certain everyone else is humouring him. He spends time composing his face, adopting poses and pulling himself together in public settings. If you have never lived with a mood or anxiety disorder such obsessing might seem like poetic license. I found it uncomfortably familiar.

And those little pills Adam keeps reaching for… I have had to rely a lot on those myself lately.

The courage to write

For some 30 years I have packed and unpacked, shelved and reshelved a library full of books that I have not yet read but would not dream of carting off to a charity sale. Naturally I assume that the day will come when that book will come to my attention and, conveniently I will have it at hand. Of course, in the meantime a wealth of new books have joined my libraries, actual and electronic, so that all those long held treasures run the risk of absolute obscurity. I suspect more than a few book addicts can relate.

And sometimes the tendency to hoard a book pays off, though sadly that time is too often heralded by the death of the author.

20140809_222130I must have purchased Nadine Gordimer’s Burger’s Daughter, in the very early 1980s. I was studying anthropology and working part-time in a bookstore. South Africa and the struggles against Apartheid would have held a particular resonance for me through the presence of a number white South African ex-patriots who had found their way to the Anthropology department of a Canadian university for their own safety. However, had I read this novel when I first bought it, I am not sure if I would have been able to fully appreciate this powerful testament to those men and women, white and black, who risked their freedom and too often their lives to fight for justice. But with 30 year’s perspective, the hard won experience of middle age and the political changes that have marked South Africa in deeply complicated ways both positive and negative – as history tends to unfold in real life – this is one of the most rewarding reads of the year for me to date.

Ms Gordimer’s writing is rich, complex and worthy of a careful read. The shifting perspectives take the reader in and out of internal monologues that Rosa Burger, the daughter of a doctor and Communist activist who has died in prison, holds with the many individuals she encounters or remembers as she struggles to find an identity for herself in the huge shadow cast by her famous father (a fictionalized tribute to the lawyer who defended Nelson Mandela). In the infinite wisdom of Wikipedia, Burger’s Daughter is described as historical fiction. Of course, it is no such thing. Rather it is a time capsule, a deliberately political novel, but written without the advantage of knowing that Mandela would walk to freedom, become President, and pass away leaving a society where so many still live on a razor’s edge even if the tapestry has changed.

The final pages of Burger’s Daughter paints an uncertain future. Yet like life itself, the novel is brimming with vibrant, colourful characters brought to life with keen and loving detail.  The complexity of the politics presented at the time of writing combined with the critical distance of three decades impressed me deeply. It takes courage to speak to injustice. Nadine Gordimer herself knew that her work not only took risks but would also be forever defined by her colour. Moving beyond colour, religion, ethnicity, culture, gender, ability, orientation or the myriad of other divisions we seem to be able to construct as to divide us as humans is a seemingly impossible task. But by taking that one piece to which a writer, by virtue of fate or circumstance, is able to address and telling the stories that matter, small changes may be possible.

“Writing is making sense of life. You work your whole life and perhaps you’ve made sense of one small area.” (Nadine Gordimer)

Nadine Gordimer was a writer of courage and I am ashamed that it took her death to bring her into my focus.

Reflections on a most intriguing Booker nominee – The Wake

6898212431_742cf14ae7_zSo the Booker Prize Longlist for 2014 was announced this week and, as much as I like to think that this is a list that does not hold quite the same seal of approval and impact that it once had for me I must confess that I am a sucker for these lists all the same. Generally, over time, I do manage to read more more than a few of the long and or short listed titles, and in doing so, I am invariably exposed to authors I might not have otherwise read. I am not likely to radically alter my looming to be read list just to have a go at a few of these titles in advance, but I did want to take a moment to look back on the most unlikely contender and, as it happens, the only one of these books that I have already read. The Guardian review that brought this title to my attention was so deeply intriguing I just had to read it as soon as possible. I have only just learned that it was a crowd sourced project, a factor that makes its appearance on the Booker Longlist that much more, shall we say, against the norm.

The Wake by Paul Kingsnorth is an historical novel set in the years immediately following the Battle of Hastings from the perspective of the very ordinary and simple farm and townspeople who were watching the world they knew turned upside down by a foreign invader. The magic of this amazing tale comes through a very creative and effective use of language. It is written entirely in a shadow tongue designed to evoke the feel and mindset of Old English while retaining accessibility for those of us who are not OE scholars. It may sound like a gimmick but the approach actually affords a unique immersive experience.

WakeKingsnorth relies on much authentic vocabulary without being unnecessarily rigid, while recreating the syntax and common spellings of Old English (using only the letters in use at the time). As a reader it takes a while to develop a feel for the language. At the beginning I found myself translating the directly in my head, the way I do with my rudimentary French, but soon that process fell away. It helped when I discovered that there was a most illuminating author’s note on the reasons for his approach to creating this language and I would suggest that a reader review this early on. I read the book on a Kindle as that was the only edition readily available in Canada at the time so I did not realize the supplementary sections, glossary and extensive bibliography existed until I was well into the book!

What takes this small novel beyond a purely literary or historical exercise is the skill with which Kingsnorth brings his chosen narrator to life. Buccmaster of Holland, is a proud socman or freeman landholder, who leads a small band of self-styled greenmen in guerilla warfare against the Norman invaders. They make for a rather motley crew and our leader is no Hollywood inspired superhero. As the tale unfolds we become increasingly aware that this coarse, paranoid, prejudiced man is clinging to a deeply superstitious tradition that was on its way to being replaced by Christianity long before the French arrived. We find ourselves bound to an increasingly delusional man with dark secrets of his own. Kingsnorth himself describes this novel (his first) as a post-apocalyptic tale set 1000 years in the past. Of course it also has strong echoes in the vast number of occupations and conflicts, large and small, that continue to haunt communities and cultures throughout the world today.

I first read this novel three months ago and loved it. However I look back on it with some measure of discomfort as I now continue to come to terms with the fall out of from a serious manic episode. In the leadership role I held at my workplace I became increasingly stressed under mounting pressure and, although I can’t remember, I must have seemed erratic, irritable and well, unstable. The truth of madness, is that you cannot see it from inside. For a long time you may sense that something is wrong but in the end you lose all insight and judgement. The narrator who guides us though The Wake, is a complex troubled character, but given his challenges and his panic at seeing his world – on the fundamentally economic and spiritual level – slipping out of his grasp, his sanity is at stake. I cannot imagine I would have fared any better.

Literary prescription: The Sound of Things Falling

I am now a few weeks beyond the significant manic episode that has ground my life and work to a halt and precipitated a sudden crash into depression, anger and frustration. The crisis did not happen overnight and the healing will take time but I feel some measure of relief that my ability to lose myself in a book has been returning. Some additional anti-anxiety meds are helping too but I am trying to remain open to literary whims – reviews, suggestions from readers I respect, stray quotes that catch my attention. It seems to be critical medicine for me.

Fortunately there is also that wellspring of rewarding fictional riches, The International Impac Dublin Literary Award. Each year nominations are commissioned from public libraries around the world to create an extensive longlist from which a shortlist of 10 titles is ultimately drawn. It is inevitable that works in translation tend to feature prominently both  in the shortlist and among the archive of winners. Purists can argue over the Booker all they want, this is the award I watch.

winner_slide_2014This year’s winner, just announced in June, is The Sounds of Things Falling by Colombian author Juan Gabriel Vasquez, translated by Canadian Anne McLean. This book had been waiting on my ereader for some time, but in light of its recent honour, I thought it might be time for a closer look. A few pages in and I was hooked. Billed as a literary thriller I was expecting a perhaps an entertaining diversion from my own troubles but in truth I soon found myself  deep in a remarkably intimate account of the impact that traumatic experiences have on those directly effected and those around them in ways we often are powerless to predict or prevent. Whether the trauma results from actions chosen or events over which an individual has little or no control the fallout over days, month and years can lead to fateful decisions, ruptured relationships and deep wounds. At the core of this novel are two strangers, brought together through an act of violence who find temporary refuge in a sharing their own experiences of coming of age in Bogota at the height of the drug fueled wars of the 1970 and 80s.

Personally, as I struggle to make sense of the pressures, stresses and events that collaborated to make such a mess of my recent months, it is difficult not to vacillate between anger and regret. Although I know that mood disorders play havoc from the inside out and that the person who is suffering knows something is wrong, they may be slow or even unable to define the nature of the condition, and most certainly incapable of stopping it on a dime. Playing the “if only” card serves no significant benefit. As Vasquez’s narrator Antonio muses as he sets to record the experiences he wishes to share:

“There is no more disastrous mania, no more dangerous whim than the speculation over roads not taken.”

I was able to lose myself in this novel but it did not serve as quite the distraction I expected from a “literary thriller”. There was a disturbing real world resonance that I could not have anticipated. The Sounds of Things Falling is more than simply a title, it is an experience repeated and echoed throughout the novel. From a airshow stunt gone terribly wrong, to a fatal drive by shooting, to the devastating crash of a jetliner. Because a key character was a pilot, de Saint-Exupéry‘s The Little Prince also features as a beloved childhood tale. It was disturbing to imagine the little prince asking the pilot if he also fell out of the sky when bodies were literally falling out of the sky as Malaysia Airlines MH17 exploded over a disputed region of the Ukraine.

Trauma, small and personal or wide-reaching and global and all shades in between have always marked human existence. It divides and unites us in large and small ways. the complexity of that experience is, for me, one of the primary themes explored in this worthy literary award winner.

Stubbornly reading through a breakdown

With sincere apologies to David Mitchell, I have been reading myself through the crest and early weeks of the fall of a mental health crisis with his novel The Ten Thousand Autumns of Jacob De Zoet. Probably not fair to him or me. I am not a speed reader but I can7141642 generally manage 4-5 books a month. I embarked on this voyage with the Guardian Reading Group in early June and finally closed the last page today.

I know that reviews were mixed when this book was published in 2010 but I would not suggest this as a companion for a manic episode. It was not bad or entirely uninteresting (though I confess I preferred the graphic turn of the 18th century medically graphic scenes, shades of Patrick O’Brian’s Aubrey–Maturin novels where you have to wonder how anyone survived the surgical interventions, let alone the nautical warfare). Although the era and setting of this historical – and for Mitchell of Cloud Atlas fame –  remarkably straighforward tale I think it could have been much more coherent and tightly paced.

I think that I stuck to this book more as a testament to myself that I could pull myself through this period of turmoil which has left me depressed, angry and confused as I sit on sick leave and wonder if my career is in shambles. I was afraid that if I stopped reading, even with the idea that I might return at a later date, I would be giving in to the mass of tangled emotions that my breakdown has left me struggling with. Some level of normalcy has to be maintained and, at this time it has meant reading.

So where now? Something shorter, something magical I should think.