Reflections on the Day of the Dead

For years a small sugar skull sat on one of the bookcases in our house. Eventually it had yellowed and aged to a point that its value as a keepsake was minimal. One day with a last glance I tossed it out. There were two originally so somewhere in the accumulated detritus of twenty years in this house, another little skull is probably decaying.

Inician la temporada de alfenŽiques2_0The skulls were mementos of a special Members-only preview of an exhibition which passed through our city in November of 2002. ¡Viva Mexico! featured a selection of the glorious huge colourful murals of Diego Rivera, striking photography of Day of the Dead celebrations by Graciela Iturbide and a display of shaft-tomb figures. As a family event, there was also a wide range of hands on creative activities for the kids.

I had been, at the time, a single parent for a year or so, my children would have been coming up on 10 and 13 years of age. It was an era of fundamental change and transition in my own life, but it was also a time when my kids were young enough to really enjoy this type of outing. I had a family pass and the museum was a common weekend destination.

However, until that day I had, somehow been unaware of the importance and spectacle of the Day of the Dead. Hallowe’en was fun of course, and a highly anticipated event for the children in their younger years. But the magic and energy of the the Day of the Dead celebrations captured in the photo gallery left a deep and lasting impression on me.

Many years later it all came back when tackled Malcolm Lowry’s classic Under the Volcano. I read it with The Guardian Reading Group, a three or four week monthly on-line opportunity to tackle a book with fellow readers. It is a challenging work to fully appreciate and before the month was out I found myself reading the text on an e-reader with the paper copy open beside me on the sofa so I could readily flip back and forth to cross reference and the link open on my computer to a brilliant website, The Malcolm Lowry Project, which provides chapter by chapter guidance and assistance to the humble reader along the way. Simultaneously long conversations were unfolding on-line within the Reading Group.

Now I can no longer divorce the Day of the Dead from the tale of Gregory Firmin, the alcoholic British consul in a small Mexican town, and his slow, tragic unraveling and demise throughout the course of one November day. Impending celebrations lurk in the air, but his desperate mental waltz with the push and pull of liquor, the reasoning and rationalizations he plays with himself held my greatest fascination. I have been lucky that alcohol has never held a serious allure for me, and my tastes tend to be above my discretionary budget anyway. Dedicated alcoholics don’t care and my family history has known its share. Especially on the side through which the mood disorder runs.

By the time I sat down with Under the Volcano, my son had been a heavy drinker for several years, although there is a long time before he finds himself in a state of crawling across the lawn toward the vision of a half empty bottle like the poor consul. I should hope. The struggle is a delicate matter for us to balance. He is almost 25, gifted and anxious to an extreme and over the years he has been on his own, on the street and now for the past few years increasingly isolated at home. Over a month ago he had a break of honest self recognition and quit drinking. But for many and complex reasons, especially some particularly horrific experiences in what passes for an adolescent mental health system, he has a complete aversion to any counselling or support.

Today, on the Day of the Dead, he is working a couple of beers back into his routine and I am trying to maintain the boundaries. Our relationship as father and son is complicated, we are close, share many character traits and insecurities. With a history working in social services I am also acutely aware of the limitation of practical services out there. And the cost of living in this city currently precludes even his younger sister who has a profession from moving out. But I know I cannot own his issues.

So with this November 1, I will honour the Dead with hope and ambition for all of us trying to pull together and move forward with Life.

Myself included.

Want to write? Start with reading.

It has taken me over a week to come down after volunteering with and attending events at our recent word festival. I entered into the week slightly down and was spiraling up within a few days. If it was a test of my ability to return to regular work, this is clear evidence that my mixed state is still far from stable. But I would not have missed it for the world.

It was an absolute thrill to mingle with people who are passionate about books and listen to Canadian and international authors talk about their craft. Whenever an author was asked about his or her influences, a love of the magic of books and literature shone through in their responses. If asked about advice for want-to-be writers, the common answer was read, read, read… read widely and drink deep from the wealth that books have to offer.

The stash of books I bought at the event, not including the titles I purchased or read in advance. Volunteering in the bookstore can be expensive!
The stash of books I bought at the event, not including the titles I purchased or read in advance. Volunteering in the bookstore can be expensive!

And so there was this man I crossed paths with at various venues throughout the festival. He told me he was a writer. Patting the breast pocket of his jacket he indicated that he felt he was getting ready to pull together his work. He had a gold pass so I saw him a number of times but always alone, ordering a coffee or buying a glass of wine at the bar. He would acknowledge me and we would exchange a few words on whatever interview or panel we was waiting for. But I never witnessed him engaged in animated discussion with fellow attendees.

The solitary man at a venue where excited discussions about books were regularly erupting between strangers is an anomaly.

On Saturday afternoon I encountered him in the lobby. He was carrying a copy of Sweetland by Michael Crummey. I got the impression he was done with the festival regardless of the major authors still to come. He said, “I have decided, this is the one that impresses me. Let’s see if he writes as well as he talks.” I responded that I had recently obtained a copy of his previous work Galore, the novel Crummey described as the one he feels he was born to write and that I wanted to read that first. He looked at me with surprise and said, “You mean you have heard of him?”

Suddenly it dawned on me that this man, the self-described writer, does not read at all. I suppose he thought he he would be able to absorb all the final inspiration and direction from this one book. If he did not know one of the best known Canadian contemporary authors and poets, even if he had never actually read one of his books, I could not help but wonder how he imagined himself ready to pull his accumulated scratchings into a final product.

With a full evening and day still ahead, he had selected his role model. I never saw him at the theatre again.

Even if it left me swinging up on my attempt to stablize this recovery from my recent manic episode, I was deeply inspired by the talks I attended, delighted by the company of fellow book lovers and especially grateful to a few authors who took a little extra time to encourage me as writer. I was regularly reminded that it is never too late to start.

And I am never lacking for books. In fact they seem to multiply in my life on their own as any truly avid reader knows.

Further reflections on the void left by suicide: deeper appreciation for Miriam Toews

Miriam Toews is one of Canada’s most celebrated novelists. She has drawn heavily on her Mennonite heritage filtered through the ability to explore the messiness of ordinary life with a wonderful sense of humour. Recently I reviewed her Giller nominated All My Puny Sorrows, a novel which is deeply inspired her sister’s suicide. The novel itself, while wicked funny in places, left me wanting more of a connection to Elf, the deeply depressed character. Her “healthy” sister, the narrator, never really seemed to understand but rather struggled with her own reactions – the practical and the reckless.

Tonight I had the good fortune to attend a panel called “Darkness Visible” in which Miriam participated. The theme explored by the three somewhat diverse novelists was focused on looking at whether dark themes, personal or political, can be fully examined in literature. The consensus I suppose was that despite the challenges and limitations, the ambition is valid and important.

swing lowBecause I already own a digital copy of All My Puny Sorrows I purchased a copy of Swing Low: A Life for this event. Written in memory of her father, a well loved teacher and pillar of the community who took his own life about a decade before his daughter followed suit, this slim volume deals more explicitly with manic depression and suicide. I only recently became aware of it. Given my own recovery process I am thinking this is more the story I was looking for with All My Puny Sorrows. Coincidentally, an audience member at the event had grown up in the same Manitoba community as Toews. Her father had been his teacher and he began to cry as he shared his shock when he had learned how much pain and sadness the family was going through. Miriam had to dry her eyes as well.

That is the true impact of suicide and it spreads beyond families.

When I had the pleasure to speak to Miriam after the event I confessed my experience with All My Puny Sorrows, explaining that I was reading it in the aftermath of my own breakdown and, sadly, in the light of Robin William’s suicide. I told her I suspect that the book I was hoping for probably lies in part in this earlier, more serious volume. But then we both admitted that unless we are ourselves are burdened with the desperate desire to let go of this life, we can only ever observe from the outside. We also shared our mutual fears for our children inheriting the same genetic disorder.

I am deeply impressed with Miriam Toews’ desire to speak about mental illness and with her wide appeal in this country, hopefully her message will reach an audience that needs to hear it. I am looking forward to finding out how she explores the bipolar disorder in her family through her father’s story, unaware at the time of course, that the same event would strike her family again.

She told the audience that if writing her most recent book taught her one thing it is to hold tight to the joy in life.

A worthy goal for us all.

Good words and a smile (oh and a good book too)

Wordfest, our annual literary festival is underway. After several months struggling with the fall out from a serious mental health episode this week is my first serious self test, my chance to explore my level of stamina and commitment. It is also an opportunity to spend time with people who love books and listen to great writers talk about their work.

I started with two volunteer shifts and some selected presentations I wanted to see and, as you might suspect, the volunteer commitment portion quickly expanded.

Am I exhausted yet? A little. I will likely sleep for a day when it’s all over but I have so desperately needed to get out in the world. Admittedly I am buffered with medication but the creeping anxiety stays in the car when I get into the venues.

Now if I can find a way for the medical system to prescribe a literary solution I might just be able to live with this bipolar beast. I just have to be able to afford to eat too!

Today has lifted my spirits more than I can remember in months. I had one single volunteer shift as a bookseller at one of the smaller venues, but I was nervous simply because I was expecting a panel discussion featuring one of my favourite authors. When I arrived to discover that the other writer had been forced to cancel at the last minute, the presentation had been redesigned as an hour long one-to-one interview with South African novelist Damon Galgut.

The host was scrambling but I could not have been happier.

American edition of Arctic Summer in case anyone is wondering -a nicer cover than the Canadian/UK I think.
American edition of Arctic Summer in case anyone is wondering -a nicer cover than the Canadian/UK I think.

I have always been apprehensive about meeting my heroes, for fear of disillusion. Nonetheless I had come prepared to have my books signed and hopeful for even a few words with a writer whose works I admire so much. Although we did have books to sell I noticed that I was not the only person who had arrived with their own copies of his latest work, Arctic Summer, already in tow. This novel is an imagined biographical account of the complex personal and emotional factors that led E M Forester through the extended  writer’s block that ultimately produced his greatest work, A Passage to India. As an historical novel it is a departure for Galgut (and one he admitted he would be in no rush to repeat) but rich with a deep affection for India and the driving forces of unrequited desire.

I confess I abandoned my post presentation bookselling duties early to make sure I didn’t miss out on the opportunity to have my copies of In a Strange Room and Arctic Summer signed. To be honest I have yet to see an unpleasant author at any of the events I’ve helped with, but it meant more than I can measure for Damon to take the time to, ask me about myself and encourage me that it is never too late to start writing. I am grateful for his kind words.

This experience, simple and important for me, has lifted my spirits in a way that feels healthier than the meds alone. It feels good to be human again. I have commitments with Wordfest right through until Sunday evening, but for now I am enjoying this warm feeling.

What fresh yellow is this? (With apologies to Dorothy Parker)

Typically I love autumn – the crisper weather, the bright blue skies, the excuse to pull out sweaters. Normally this is the busiest time of the year as new programs and courses start and activities halted for the summer resume. More than New Year’s, this can be the season for resolutions, goal setting and looking forward.

Copyright JM Schreiber 2014
Copyright JM Schreiber 2014

Unless you are depressed.

Without the structure of work I feel lost. And unlike regular unemployment I am in a holding pattern, uncertain what type of work I may be able to return to when I do recover, if I recover, should I even recognize recovered if I meet it in myself.

I feel tired and agitated. Irritable and unfocused. I try to push myself out every day and have an exciting literary festival to look forward to in just over a week. Yet I am terrified that I have taken on more than I will be able to manage and I find myself fighting off regular amorphous panic attacks.

I feel like a wrung out dish towel. I miss having energy and enthusiasm but I have to guard against a reckless flood of these sensations lest they indicate trouble at the opposite end of the bipolar pendulum arc…

Copyright JM Schreiber 2014
Copyright JM Schreiber 2014

For now I am looking toward the brilliant yellows of the moment. Apparently yellow is the colour of the mind and the intellect, it lifts the spirit, stimulates creativity but can also heighten anxiety and emotional instability.

Sounds like a bipolar hue to me.

When even a sibling’s love is not enough – All My Puny Sorrows by Miriam Toews

The title and binding imagery that fuses the latest novel from Canadian author Miriam Toews comes from a poem by Samuel Taylor Coleridge to his friend, the poet Charles Lamb. Both men had their own struggles with mental illness but Lamb’s beloved sister Mary had an especially prolonged and devastating battle. Coleridge commiserates with his friend’s tireless care for his sister, reflecting that he, Coleridge had had a dear sister upon whom he “pour’d forth all his puny sorrows”. Elfreida (Elf) the suicidally depressed character at the centre of this novel drew her signature theme from this line , but it is her sister Yolandi (Yoli) who brings her to life and devotes herself to trying to keep her alive as she narrates this funny, heartbreaking tale. As such, All My Puny Sorrows is well named.

all my puny sorrowsColeridge was the first poet who caught my adolescent attention, much to the shock of my high school English teacher. However I confess it was the rugged adventure of “The Rime of the Ancient Mariner” and “Kubla Khan” that sparked my enthusiasm. The Romantic poets, so many of whom seem to have suffered from mental illnesses seemed kindred spirits ( although this would have been long before my own diagnosis). They loved passionately, often tragically, and became addicted to opiates. For the teenager falling well short of cool, the appeal is not hard to imagine.

SamuelTaylorColeridgeFor Elf and her sister growing up in the confines of a small Mennonite town, the arts were an acceptable outlet. Elfreida channels her energy into the piano eventually taking to concert stages around the world and winning the love of a man so patient he’s surely destined for sainthood. Yolandi opts for a less glamorous route, including a couple of failed marriages, children, meaningless affairs and a career pumping out rodeo themed YA novels.

I was attracted to this book when I heard Toews on the radio explaining that this novel began from a deeply personal space. Her father, a respected teacher despite a lifelong battle with depression, took his own life in 1998. Almost 12 years to the day later, her only sister followed suit in the same very way and location. Having already memorialized her father in non-fiction, Toews felt that fiction would free her up to address this very real and difficult subject more openly. But that is also where it falls apart for this reader.

She is able to make some very astute observations about the failings of the mental health system and sadly demonstrates that, in the end, there is no way that anyone or any system can ever do more than delay the efforts of someone truly committed to stepping off this mortal coil. However I never felt that Elf was more than a tragic figure in a hospital bed. Yoli’s childhood memories and the accounts of her sister’s glorious career rang hollow. The real strength of this book for me lies in the the indomitable spirit of the characters who survive against all the odds and resist the despair that mounts around them.

And maybe that is the point. It is not for us – friends, family, observers or readers to judge. In a few weeks I will be able to see Miriam Toews take part in a panel exploring the ability – or limitations – in being able to make sense of the darkness in life through literature. I will be interested to hear what she has to say.

Some ghosts have rougher journeys than others

- Copyright JM Schreiber 2012
– Copyright JM Schreiber 2012

O! WHY was I born with a different face?
Why was I not born like the rest of my race?
When I look, each one starts; when I speak, I offend;
Then I’m silent and passive, and lose every friend.

Then my verse I dishonour, my pictures despised,
My person degrade, and my temper chastise;
And the pen is my terror, the pencil my shame;
All my talents I bury, and dead is my fame.

I am either too low, or too highly priz’d;
When elate I’m envied; when meek I’m despis’d.
-William Blake, from a letter to his patron Thomas Butts, 1803

I first encountered these words in the months following my first manic breakdown in the late 1990s. With a diagnosis at hand I needed to understand its meaning so I read  the standard popular memoirs of the time. But I found myself drawn into the work of William Blake. Although many readers reject the notion that madness may have fueled his tireless creative energies, his hours conversing with angels and his periods of darkness – I found comfort in his artistic conviction even if he was destined to die without ever receiving the recognition of understanding he deserved.

For every person who successfully rises above the challenges of mental illness and negotiates the pitfalls of drugs and alcohol, there are those who spend their lives living rough. And others who lose the battle altogether. But Blake drew inspiration from his angels and demons with his loving wife by his side until the end.

Today is my birthday, and having found myself back trying to figure out what I am supposed to learn from this second mania and unexpected fall from grace, Blake’s lament has a special resonance once again.

But this time I am reflecting on a very different face than that which I confronted 17 years ago. From the time I was very young I could not make sense of the face with which I was born. The eyes that looked out from within that visage threatened to give me away. The body I struggled to feel at home in never felt like mine. The girls I befriended seemed like aliens and, with no other explanation for my discomfort I assumed that I had never learned the tricks, never tried hard enough.

The idea that gender or identity could be misaligned never occurred to me when I was growing up. At least not in the context I needed to hear. And when It did start to seep into my awareness I was already well into marriage and motherhood. It was a complicated comfort to realize that there was an explanation for my feelings. It was even more terrifying to know what to do with this information.

I know well that my mood disorder runs back through my family, that it has a genetic basis somewhere. I have no idea what course it might have followed without this added sense of being out of step with rest of humanity. But my hospital psychiatrists were certain that my apparent gender dysphoria was simply a psychotic symptom that would resolve itself with the right dose of lithium.

They were wrong of course. Now, 17 years later, the average looking middle aged man who confronts me from the mirror is not special, but he is one I feel at home with. For many years I thought that was enough, as if I had found the magic bullet, the key to moving forward on all fronts. My family have been supportive, I recreated my identity and built a new career.

But I still found that the manic-depressive monster has followed me all along. Making sense of recovery this time around, I find myself doubly invisible. Behind a face that accurately reflects my sense of self identity, is a whole life I cannot fully share. Talking about being bipolar has been the easy part.

But moving forward from this birthday, I want to find a way to be whole.

Inhale deeply : Reflections on Breath by Tim Winton

Take a deep breath and hold it as long as you can… I imagine there are few children who have not engaged in some variation of that form of super hero training. I am aware that some push it to an extreme, driving for the physiological high induced by oxygen deprivation, but in my day it was an exercise in imagining oneself capable of surviving one of the daring challenges we set up for ourselves. Where I grew up that generally involved challenging one another to crawl through one of the long corrugated metal culverts under the rural road ways. I never heard of any unfortunate incidents resulting from such an activity but my overactive childhood imagination manufactured many. Either way, being able to hold one’s breath for at least 60 seconds seemed to be skill worth developing.

At this end of life I no longer maintain this practice, but despite the fact that tests have assured me that I actually have very good lung capacity, panic and anxiety attacks can leave me struggling to fell like I am getting enough air. Breath deep, stay calm, focus on your breath.

1414720The arrival at the scene of an apparent suicide is the impetus for paramedic Bruce Pike, the narrator of Tim Winton’s novel Breath, to return on the pivotal events of a summer many years earlier and the struggle to relieve himself of the baggage he believed he carried on well into adulthood. What follows is a gripping coming of age tale featuring the young Pike (or Pikelet), a slightly bookish, awkward outsider, growing up in an unremarkable mill town on the edge of western Australia. His encounter and ensuing friendship with Ivan Loon (Loonie), the restless and reckless son of the local publican, leads him away from the safe an predictable confines of life with his reserved parents and into the aura of a former champion surfer who becomes their surfing coach, hero and guru.

Under Sando’s fickle attention the boys are introduced to the thrills of confronting nature in one of her most dangerous and unpredictable forums. Even if you have never fancied that you have an interest in surfing, Winton’s spare, confident writing pulls you right into the swell, creating vivid and heart stopping scenes that leave you gasping for air. Under the equally reckless attention of the aging surfer’s bitter and damaged young wife, our narrator is left with emotional scars that are even slower to heal than any physical beating inflicted by the surf.

This is my first encounter with the work of Tim Winton, chosen at the fine recommendation of whisperinggums as a suitable (i.e. shorter) introduction to his work in advance of his visit to Wordfest next month. It will definitely not be my last. I reveled in the exotic setting, a sharp contrast to my own landlocked prairie childhood, yet I fully related to the awe with which Pikelet and Loonie held their flawed hippie heroes. As a teenager in the 1970s myself I can remember clearly how the hippie movement of the 60s still held this magical allure that had not yet faded. On an even more personal level I was moved by the sadness and regret that drives the narrative on into the complications of adulthood. Pike’s adjustment is not easy. He has a breakdown, makes a mess of his life and has to find his own way to pull it together.

This wonderful book is more than a classic Bildungsroman. Youth and adolescence are never the full picture. When has anyone truly come of age? And by what measure of ordinariness are the true heroes assessed? Ask someone trying to live well with a mental illness.

Haunted by the unanswerable

Under the bipolar microscope, The who am I? question becomes Which me is me?

The depressed world weary me? The hyper productive hypomanic me? The over the edge manic me? Or that nebulous normal, somewhat sponged and effectively medicated me?

Or possibly all or none of the above.

I don’t remember exactly when I first started to swing between up and down, enthusiastic and anxious, outgoing and withdrawn. I suspect I didn’t really begin to articulate the patterns until my early 20s but I am sure the tendencies were there much earlier.

I was an awkward kid, lonely and odd. My brothers had friends in a our rural area but there was no one my age. I was frightfully shy and unpopular at school. I lived for books and music.

And it was music that offered a hint of another world gleaned through the Sunday edition of the New York Times that arrived each week, belated and a little worse for wear. Although I existed in a place where 70s rock bands dominated the radio and occasionally passed through, New York City was home to The Ramones, Patti Smith, Lou Reed and so much more.

For someone so miserably out of step with others, confused by questions of identity and smart when smart was not something to be, New York seemed like mecca. It was, after all, the city my mother came from and where my parents met even if we had ended up in another country some 2000 miles to the west. I was not the only isolated kid hunting out obscure copies of Velvet Underground albums back in the late 1970s, but in my hometown at the time I sure felt like it.

My mother tried hard to provide me with extracurricular activities upon the advice of a guidance counsellor who had picked up on my round-peg-square-hole. I started with drama lessons and moved on to guitar lessons. Not a natural musician like my son, I needed all the lessons I could get. My teacher was patient, guiding me along from “Jingle Bells”, through a year or two of classical, but his heart was with blues. Not a good move. I was too self conscious to jam and too bored to play twelve bar blues runs ad infinitum. So one day he asked me to bring an album and play for him something I really wanted to learn.

I arrived the next week with The Velvet Underground and Nico under my arm and played my favourite tune, “All Tomorrow’s Parties”. My teacher’s face fell.

That’s just discordant, he told me. I can’t do anything with that.

It was my last lesson.

The timelessness of that album and its influence on decades of musicians has amazed me. Both of my children even fell in love with it in their own time. And in honour of Lou Reed’s death an ensemble of Canadian artists from rock starts to opera singers and our own musical astronaut performed a tribute concert.

This most amazing cover of “All Tomorrow’s Parties” takes me back to a space before my mental health started its slow unraveling and reweaving of my self identity to bring me here. When I listen to this I feel like I am beginning to come full circle. Much older, much wiser but still figuring out who I am.

Enjoy.

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.