Solstice to solstice: Reflections on madness, identity and writing

It is winter solstice, exactly six months since I left my job. At the time, a year and a half of toxic work-related stress had taken its toll. Had been taking its toll for months. But by the time I managed to pull enough awareness together to face the harsh reality that the mental illness I imagined to be long stabilized had resurfaced in full manic glory, irretrievable damage had been done.

I left in shame. A shame that can not be absolved. I have been shut out, I have no idea what my relationship with my employer is, or if I have any income going forward. When I can eventually return to work I wonder where I will go. And so I enter the shortest day of the year reflecting on what I have learned and looking ahead.

Copyright JM Schreiber, 2012
Copyright JM Schreiber, 2012

I loved my job. I managed a small agency supporting survivors of acquired brain injury. I worked with a wide range of remarkable people and their families, walking beside them as they struggled to recover and rebuild their lives, to regain independence, to battle their own challenges and demons. It gave me refuge from the demands of single parenthood, provided human and social contact against my tendency to isolate, and confirmed my value as a man. But the price I paid was huge. I believed it was enough in itself and had not imagined it would end.

Suddenly I was tragically alone in the world. My closest friends were far away. In a city of over a million, there was no one I could call. No one to have coffee with, no place to go, no arms to lie in.

How had I managed that? Well temperament in part. But much more critically I began a transition from an externally female existence, to a more true, coherent identity as male at 40. I built my career in social services after that process began.

In transition I did not move from my neighbourhood, I remained actively engaged in ensuring that the schools my children attended were open and diverse, and experienced no rejection from my family. However to create a whole and consistent space in which I could live where no one knew my past, I guarded my history closely at the workplace. Over time I constructed walls, mastered the ambiguous answer whenever asked about my life, and even managed to successfully neuter and closet myself years after originally coming out.

Somehow this practice bled into my engagement with the community. Fourteen years on it came to colour my identity in the world.

This extended time of reflection from solstice to solstice, aided by a wonderful therapist, has been a time of learning to open and reclaim my identity. To understand how trans, gay and queer relate to me. To put it out in the world. To own it and to write it into being.

As the days grow longer I face an uncertain future financially. Yet slowly I feel the fire of anxiety and agitation that have marked this recovery from my breakdown losing some of its intensity. I have been filling notebooks with writing hoping that maybe some gems might emerge, for the sake of catharsis if nothing else.

Copyright JM Schreiber, 2012
Copyright JM Schreiber, 2012

So more than New Year’s Day, solstice holds the resonance of new beginnings for me this year. Happy solstice – winter to those of us in the the north, summer to my friends in South Africa and Australia.

Manic Implosion: Venturing into the third section of Damon Galgut’s In a Strange Room without warning

About a month ago I had an opportunity to talk briefly with Damon Galgut following his appearance at Wordfest here in Calgary. He published his first novel at 18 and I shared that I had wanted to write when I was younger but wanted to live first, completely unprepared for the messy and complicated path my life would take. So we spoke about the challenge of winnowing out a story that runs close to bone from the detritus of life lived. He pointed to my newly signed copy of In a Strange Room, his 2010 Booker short-listed novel, and admitted that in this, of all his works, he felt that he had most closely captured the essence of his self. And he achieved it, I later learned, by telling three tales which recount actual events from his life and feature a character named Damon from perspectives that often shift from first to third person to a detached observer, sometimes within the same sentence or paragraph.

So far so good.

7199962The first two sections involve travel and more or less unresolved interactions and attractions between the remembered Damon character and people he meets while he frets and wanders through parts of Europe and Africa with a restless inablity to settle himself. The prose is tight and evocative with the open ended reflections and ambiguity that feature in my favourite of his writings. But I was sucker punched by Part Three: The Guardian. Not only is it harrowing in its intensity, but the devastating action centres around a woman in the throws of a full-blown suicidal manic pychosis. I could not help but relate as a caregiver but more critically as someone who has experienced the full impact of manic psychosis from the inside. My blessing, if there is one, is that I have never been especially suicidal or inclined to self-harm, nor do I drink or use drugs. All of those factors are added to the mix in this account.

And it takes place in India.

It is not a secret that his close friend Anna is not in a good way, when Damon agrees to allow her to accompany him on the first part of a trip to India. He has been before and intends to stay and write for several months, but it is thought that the change of scenery might be a positive and healing experience for Anna. Her life is beginning to unravel around her and the creative, vivacious woman he has known for many years is tipping dangerously close to the edge. With a stock of mood stabilizers, tranquilizers and sleeping pills she promises not to drink or indulge in recreational drugs on this excursion – a vow sullenly defied as soon as they take flight. Her mood escalates, and behaviour becomes increasingly frenzied and unpredictable from there, culminating in an intentional overdose while her already weary guardian is close at hand but not paying close attention.

Throughout this process and the weeks that follow, Damon’s concern is stretched beyond affection to annoyance to guilt and back again. While Anna fights for her life in ICU, a British nurse and another couple from the village where they are staying are co-opted into a tag team to provide support and relief for Damon at the hospital where cockroaches and rats scurry about and, although care is free, all supplies from bandages to drugs to all other medical items much be purchased by friends or relatives who trek back and forth to the pharmacy with lists. As Anna begins to recover and relocate to more crowded and unattended wards, she not only becomes increasingly volatile and unpredictable, but her erstwhile crew of attendants have to attend to all her care including propping her over the bedpan and cleaning up the splashing mess afterwards.

Care for her actual mental health concerns is not part of the treatment plan.

To make matters worse, attempted suicide is a criminal offense in India and the police are awaiting Anna’s release so they can detain her. An escape must be planned and executed. Finally she is safely returned to South Africa, but she and her support network are shattered and strained at both ends. Sadly her successful suicide is only delayed, not avoided. And her traumatic spiral leaves those who love her and even those who get caught up in her whirlwind of self destruction, with wounds that will take their own time to heal long after she finally achieves the rest, or self martyrdom, that her illness drives her to desire.

No one wins.

My own manic psychosis was maintained to my home where the refrigerator filled with inedible meals and my children destroyed the yard while I struggled to make it through the days. As my grasp on reality slipped and the long standing issues I had been fighting off for years bubbled and distorted in my mind, a month of growing horror ended in a morning of escalating fear and violence before the ambulance finally arrived. Diagnosis and treatment of my bipolar disorder helped explain much, but in the end the very real issues of identity that had haunted me for most my life still existed. The difficult years that followed would see the end of a long marriage and, the beginning of a new authentic existence for me.

Anna was committed to death in her madness. In mine I found life.

I finished reading this book late this afternoon at a cafe where I frequently go to clear my mind and write. I could not put it down until I reached the final pages. As I stumbled out of the cafe into the biting cold and snow of this premature winter evening, I felt devastated and emotionally wrung out. As painful as it was to read, for those of us who live with manic depression or care for someone who does (and I do both), the third part of In a Strange Room is essential reading.

But consider yourself warned.

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.

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.

Capturing madness on the page

I started this blog in a fit of manic energy not realizing how very close I was to running over the edge into full blown madness. And now I find myself writing in and around the experience as best I can, unpacking and worrying myself into the future with a level of anxiety that seems to greet me refreshed every morning before I even crawl out of bed.

Taken in the aftermath of major flooding last year this looks like how I feel sometimes... Copyright JM Schreiber 2013
Taken in the aftermath of major flooding last year this looks like how I feel sometimes…
Copyright JM Schreiber 2013

With my original diagnosis I read all the available materials and although it was pre-internet (imagine!) I spent a lot of time at the library. This time around I find myself in world where so many fellow travelers on the road in and out of sanity are busy scribbling their way along. I have been and will always be selective in what I chose to share about myself with others. Great for maintaining privacy, not so great for making new friends. So I struggle every day with how or what to add to the dialogue.

I think I am personally drawn to creative expressions… photography, poetry and writing but am not sure where to start. I suspect madness, sanity and that huge area in between is best met sideways. So no memoirs for me. Photography is good outlet but I lack the discipline to take it to the next level. I would like to capture that moment when reality and one’s experience of reality begin to part ways. It is such a subtle process with manic depression the way I experience it and I imagine I am not alone in this regard. To those outside, unless they are highly attuned to changes in your patterns of behaviour, the transition can be unnoticed for a time.

And then before you know it you are picking up the pieces or retreating from the world or both.

To date, the finest literary account of slowly growing madness, that I have read, is William Golding’s The Spire. This novel imagines the construction of a 404 foot spire atop a medieval cathedral (inspired by Salisbury Cathedral in England) and is narrated from within the mind of Dean Jocelin. The dean is a man who has attained his position by curious family connection rather than earning it on a solid foundation of faith. As he envisions and directs the construction of the spire, tuberculosis in his spine advances to the point of driving him into a psychotic state. At first he interprets the sensation caused by his infection as angels at his back, sure evidence of God’s blessings. However as his pain and madness grows he becomes increasingly erratic, unstable and irrational. It drives him to conflicts with the master builder, sexual obsessions with a woman, paranoia, jealousy and possibly murder.

William Golding - The SpireReading with an online reading group added to the richness of the experience of this novel, but for me personally it captured so vividly the sensation of gradually and fully losing grip on reality that I had during my first severe manic episode. By the final moments before the ambulance arrived to whisk me away I was no longer able to distinguish between what I had interpreted as a mental breakdown that I could handle and the creeping fear that the Devil was tormenting me. It was a horrifying moment.

For poor Dean Jocelin because he is not only mad but dying of tuberculosis, his last days and hours are vivid mental and physical torment. It is up to the reader to decide if his soul finds any peace at the end.

Luckily my more recent manic episode did not end with as much drama as the first because someone finally commented on how fast I was talking and I had the shocking realization that I was sick. But the damage was already done all the same. I just wish I could help those who experienced my behaviour understand but I am not certain they wish to listen. And honestly, can I be a more reliable narrator of my own manic experiences than The Spire‘s mad dean?

Draw me a map to my self

Yesterday I took a small road trip with my son out to visit my parents. It’s about a two hour drive each way and this is the first time I felt that I had sufficient stamina and concentration to manage it since my breakdown in June. The countryside is beautiful but the journey did not really offer me more than time to sit and fret behind the steering wheel.  I thought about how I used to need a road map to navigate the back highways when my 86 year-old father’s ongoing retreat from civilization first drew them out there a few years back. I no longer need a map and know the route well.

Copyright JM Schreiber 2013
Copyright JM Schreiber 2013

I could, however, use a personal map or trail of bread crumbs to follow back to make sense of the past year or two of my life.  A mood disorder can wreak havoc on one’s internal compass. In the hazy debris of an extended period of hypomanic energy sliding into manic, I am finding it impossible to make sense of where I was or where I go from here.

At a deeper, more fundamental sense I have lost faith in myself. Or rather my ability to make sense of my self.

It is likely that this is the affect of depression. It’s hard for me to know because I have rarely ever experienced the sort of black dog depression that many others describe. I tend toward anxiety and a bone weariness that weighs me down, but I do not crawl into bed and pull the covers up. I don’t sleep well, in fact I tend to insomnia. But I don’t recall experiencing the all pervasive lack of physical energy that haunts me now. I find it hard to remember how I ever managed to accomplish all of the projects, personal and professional, that I tackled during the many years of relative stability I experienced over the past ten to fifteen years.

At the moment, the fact that’s really eating away at me is that the last impression I left at work was of a manager who was increasingly high strung and finally quite stressed and obnoxiously concerned that he alone had the skills and perspective to resolve the challenges facing the agency. The manic Mr Hyde side. But how long was he showing his face? And now that I am living with a shy, anxious shadow of my Dr Jekyll self (assuming I even have one) I wish I had GPS system of some kind to help me retrace my steps.

A good therapist would help, and I do have one, but at $180/hour I won’t be seeing her much and if I am going to spend that much I would rather wait until I have figured out where I have been so she can help me figure out where I go from here.

Or maybe it’s better to accept what cannot be changed and look forward instead…

Shame, guilt and absolution

Shame: A painful emotion caused by a strong sense of guilt, embarrassment, unworthiness, or disgrace.
Copyright JM Schreiber 2014
Copyright  JM Schreiber 2014

A severe manic episode leaves a residue of shame that no magic formula can resolve or wash away. Your behaviour, actions, words and deeds – no matter how out of character – are remembered by others while you, yourself, have only the foggiest sense of a hellish few days or weeks.

As the weeks pass I find myself unable to shake thoughts of my workplace, the environment in which my manic drama played out. I don’t think about returning to work and I know that at this point I could not even mentally or emotionally entertain that notion even if they would accept me. I realized today that it is the unbearable shame I feel for actions and words I could not control and can never properly apologize for that is eating me up inside.

A post on a blog I follow inadvertently put me in mind of a poem I discovered in the wreckage of my first manic psychosis many years ago. The poem, “Deceptions”, by Philip Larkin was inspired by an account from Henry Mayhew’s London Labour and the London Poor of a young girl who was drugged and raped by her master.

The poem is exacting in its depiction of her grief and the poet admits, unapologetically, that there is no consolation he can give her; recognizing that both victim and perpetrator were deceived in the violent act. I think it is this very measured recognition that there is nothing that he can offer to absolve grief and shame in the sufferer whether the event is recent or buried by the sands of time that gives the poem its power. The following lines struck me when I first encountered them and this time around, perhaps because my manic episode was a much more public event, they clearly articulate the feelings with which I am currently trying to come to terms.

… light, unanswerable and tall and wide,
Forbids the scar to heal, and drives
Shame out of hiding.  All the unhurried day,
Your mind lay open like a drawer of knives.

This too shall pass, I know, and I will ease the drawer closed and the emotional scars will fade with time.

Absolution is not the issue. Mental illness is not a sin.