All the Things We Never Knew (25 page)

Dr. Kay Redfield Jamison appeared in the search as one of the leading experts on bipolar disorder, a condition she has survived since college. She writes intimately about her condition: “About 5.7 million American adults or about 2.6 percent of the population age 18 and older in any given year have bipolar disorder. The disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life.” I drew in a breath and forced myself to continue reading. The house seemed to go completely still, and every keystroke I made sounded abnormally loud, underlying the gravity of what I was learning.

“Manic depression is far more lethal than the nomenclature suggests. Cycles of fluctuating moods and energy levels serve as a background to constantly changing thoughts, behaviors, and feelings.” This is what I saw in the final weeks before David was finally admitted to the hospital: the extremes of the human experience, the breaking of every boundary I'd ever thought existed in David's personality. He had swung from psychosis to a condition that resembled retardation. It was all there in the literature.

I put my hands to my forehead and felt overwhelmed, stupid. How had I missed it? The early years with David were confusing and erratic. I chalked his behavior up to a million different things—moving, too much stress at work, too little exercise. David refused to talk with me about how he was really doing and instead blamed demanding clients, the cold, the rain, me. But in the last three years, it was all there to see. Every question about David's behavior was answered in clinical terms—his seductiveness, his reclusiveness, his frenzies, his abnormal intellect, and his creative side.

I pulled my robe tighter around me and read what I should have been told the first time David attempted to cut his wrists, the first cry for help. “Patients with depressive and manic depressive illness are far more likely to commit suicide than individuals in any other psychiatric or medical risk group. The mortality rate is higher than it is for most types of heart disease and cancer. Yet the lethality is underemphasized, a tendency traceable to the widespread belief that suicide is volitional.”

The computer burbled out the time. “It's 1:00 a.m.” I dug further.

One study, reported in
The New York Times
, called into question whether nature, not nurture, was the single factor making a person prone to mental illness. “The new report, by several of the prominent researchers in the field, does not imply that interactions between genes and life experiences are trivial; they are almost certainly fundamental, experts agree. But it does suggest that nailing down those factors in a precise way is far more difficult than scientists believed even a few years ago, and that the original finding could have been due to chance.”

The article concluded, “The findings are likely to inflame a debate over the direction of the field itself, which has found that the genetics of illnesses like schizophrenia and bipolar disorder remain elusive.”

Even if David had a genetic predisposition toward mental illness, he'd functioned, albeit with mixed results, until the strain of our divorce and the death of his father. Dr. Jamison cites the risk factors for suicide: “losing a spouse, living alone, not being married, the death of a loved one.”

The stress of our divorce, the lack of sleep, and the side effects of antidepressants that should never have been prescribed created a lethal trifecta in David's body.

I propped another pillow behind my back while reading about the psychiatric topics that I would now need to thoroughly understand: depression, bipolar disorder, suicide. Suicide is now the third leading cause of death in young people in the United States, and
the second for college students.
The 1995 National College Health Risk Behavior Survey, conducted by the Centers for Disease Control and Prevention, found that one in ten college students had seriously considered suicide during the year prior to the survey; most of those had gone so far as to draw up a plan.

In the next room, Sophie slept. Even though I was no longer in love with David, I adored him for what he gave our daughter. I would always care for him, if allowed.

The house was quiet, except for the low hum of the furnace. Sophie dreamed, but of what? How would I ever really know her mind if I couldn't understand David's? How might his life have turned out differently if he'd allowed true intimacy, a deep connection with someone he trusted? What should I have done differently? I vowed then to teach Sophie everything I had learned and would learn about the nature of mental illness, however confusing and contrary the information seemed. She needed to understand her risk. She would not be able to do recreational drugs, or work in overly stressful jobs, without learning how to cope first. She would need my help, help I would have gladly given my husband if he'd been willing to take it.

The information gave me a sense of confidence. Now that I finally understood what I was up against, I thought I could help David in a way I hadn't been able to previously. I thought it would all work out.

 

WORKING ON MENTAL HEALTH CHALLENGES TOGETHER

Organizations around the country are stepping up to support families and instigate changes to the way research is conducted on mental health. However, most data is funded and provided by pharmaceutical industries, and while this is enormously helpful, there are inevitable concerns that big pharma's top priority when conducting research and sharing data isn't necessarily the wellbeing of the consumer.

However, there is one community foundation that focuses solely on supporting research that has no commercial interest or benefit. Dr. Gina Nikkel is the CEO and president of the Foundation for Excellence in Mental Health Care, a nonprofit organization with the ambitious goal of bringing new and effective recovery practices to every community in the country. By joining the efforts of private philanthropists, public policy analysts, and top medical researchers, the organization strives to provide support and tools not just for those experiencing mental illness but also to those who treat them—psychiatrists, psychologists, and other mental-health clinicians.

Nikkel says, “The strategy is threefold: research, recovery, and program development and education. It's clear that we must pay attention to what research actually says, support a wide variety of bio-psycho-social research that is not paid for by a commercial interest group, and join together to fund programs that are trauma informed and promote recovery.“

In addition to allowing donors to create their own funds, the organization engages with investment advisors to carefully choose the existing funds it supports. As many charitable organizations do, it invests widely, and seeks improvement through innovative and creative solutions from all over the world. One fund it supports is the Hearing Voices Research & Development Fund, a UK-based nonprofit that brings peer-group support to communities in the
United States. Another is the Bill Anthony General Research Fund, an educational grant focused on research into early treatment methods, better standards for evaluating children, and long-term use of antipsychotics in the treatment of schizophrenia.

For more information about these organizations and others, contact the Foundation for Excellence in Mental Health Care at
www.mentalhealthexcellence.org
.

Chapter Eighteen

Two more weeks passed. It was a gorgeous Indian summer day in mid-October when Colin called. “Look,” he said softly. “You're going through hell. But so is Sophie. You've got to get her out of the house. The Willamette is green again.”

In the rainy season, sometimes the river looked muddy brown. Sewer pipes couldn't hold all the rainwater, and sometimes they overflowed into the Willamette. But now, thanks to a lot of work, the river was relatively healthy again. “Please,” Colin said. “Please come out on the boat with us.”

I hesitated, wondering whether I could, or should, enjoy myself while David was locked up in such a hellhole. But Colin was right. Sophie needed the sunshine and a break from the house, and I did too. Her face lit up when I told her we had an invitation to go boating. She dressed in yellow shorts and matching flip-flops and grabbed a jacket, and we were out the door. Alice and Adele were planning on spending the rest of the day at the hospital anyway.

“I'd like you to meet a friend of mine and his kids,” I told Sophie as we drove. “We can get some air.”

“Okay,” she said. “How old are the kids?”

“Eight and six,” I said. “Girls.” This brought a smile to Sophie's face.

When we got to the dock, Colin and his kids greeted us. He was dressed as casually as I'd seen him, in cargo shorts, a black T-shirt, and a baseball cap. “Girls, you remember Sheila.” The girls wore shorts and flip-flops. They nodded shyly.

Sophie held out her hand, looked him straight in the eye, and said, “Nice to meet you, Colin. You the captain?”

He saluted. “At your service.”

The dock was busy with trucks and boats and people trying to get in or out of the water. A heavyset man carrying an ice chest to his boat looked at the five of us together and yelled to Colin, “Man, you've got your hands full!”

Colin laughed. “How bad can it be, surrounded by beautiful women?”

The girls reluctantly donned life jackets and then chatted as we motored down the river, wind in their faces. Colin navigated the busy water conscientiously, taking wide turns away from any boats pulling skiers or where people appeared to be drinking. He stood while he steered the boat, looking backward, then forward, then to the side, occasionally shouting something to the girls. “Look at the bird's nest.” Or, “Do you guys see the ducks over there?” He captained the boat to an area that wasn't quite so busy.

Sophie moved from where she was sitting and came to sit next to me. I held her hand while we watched for herons and eagles near the shore. I'd stopped at a sandwich shop on the way and had bought huge subs for each of the girls. We pulled over to a riverside dock and squeezed onto a single picnic bench to eat our snack. Sophie and Charlotte laughed about their enormous appetites. They were a year apart, of similar height and build.
People would guess they were sisters,
I thought to myself.

Olivia picked out her pickles, tomatoes, lettuce, and olives until all that was left was turkey, mustard, and bread. Seagulls picked at the pieces she discarded. The setting sun cast pink and gold reflections off the glass towers of the city; the colored lighting over the bridges illuminated the river in pinks, purples, and blues—a rainbow
of light. Colin was proving himself to be a patient, loving father. He made a good living as a high-tech sales manager, but he'd passed up several opportunities for advancement because it would have required him to move away from his girls. Good priorities, as far as I was concerned.

As we drove home, Sophie turned to me, her cheeks pink from the sunshine and air, and said, “Colin and his girls are really nice.”

“I think so too, love,” I said, squeezing her hand.

We passed the ice cream shop where David, Sophie, and I used to sit outside on summer nights and eat big scoops on sugar cones. Sophie's eyes lingered on the Ben and Jerry's sign as we drove by. “I miss Daddy,” she said. The excitement of the day dropped to a soft thud.

“Me too, Sophie. I miss him, too.”

I watched her closely as she sat with her thoughts. She'd always been so reserved. Once, as a toddler, a pediatrician had told her she was “brave” because she didn't wail during a needle poke. Sophie refused to cry in doctors' offices after that. She was the kind of kid who, when trying out a new sport or activity, sat on the sidelines until she'd figured out exactly how it was supposed to be done. While other children rushed to the roller skating rink floor, falling and laughing their way to learning, Sophie quietly observed others who did it well. When she finally, gingerly skated out on the floor, she skated slowly and proficiently enough not to fall. She wore her stoicism and cautionary nature like a protective coat, never really letting on how troubled or scared she was by the terrifying events of the past few weeks.

“Soph,” I said gently, “you can talk about how you feel. Please don't keep it all bottled up.”

She kept her head turned, away from me, toward the light fading over the tall trees that surrounded our home. “There's nothing to talk about,” she said.