It was not difficult to imagine how her mother's whirlwind social life and repeated illnesses, plus the early death of her father, had made Claire's young life a chaotic experience, depriving her of the stable attachments from which most of us securely explore the world. She longed for intimacy and considered her isolation a mark of her unworthiness. Such patterns of thinking, common in those who suffer depression, can be shed through psychotherapy, an essential part of the recovery from any depression. Claire and I worked on reorganizing her thinking while she was still in the hospital, and we continued after she returned to Montreal. She was committed to change; each week she employed her commuting time to review the tape of our therapy session. All together, Claire and I worked intensively together for almost two years. It was not all smooth sailing. On more than one occasion, in the face of uncertainty, hopelessness returned, and sometimes Claire succumbed to the anesthetic beckoning of too much wine. But slowly she was able to put aside old patterns of behavior. While it is not the case for all, for Claire Dubois the experience of depression was ultimately one of renewal.
One reason that we do not diagnose depression earlier is that--as in Claire's case--the right questions are not asked. Unfortunately, this state of ignorance is often present as well in the lives of those who experience mania, the colorful and deadly cousin of melancholia.
STEPHAN'S TALE. "In the early stages of mania I feel good--about the world and everybody in it. There's a sense that my life will be full and exciting." Stephan Szabo, elbows on the bar, leaned closer as voices rose from the crush of people around us. We had met years earlier in medical school, and on one of my visits to London he agreed to a few beers at the Lamb and Flag, an old pub in the Covent Garden district. Despite the jostle of the evening crowd, Stephan seemed unperturbed. He was warming to his topic, one he knew well: his experience with manic depression.
"It's a very infectious thing. We all appreciate somebody who's positive and upbeat. Others respond to the energy. People I don't know very well--even people I don't know at all--seem happy around me.
"But the most extraordinary thing is how my thinking changes. Usually I think about what I'm doing with the future in mind; I'm almost a worrier. But in the early manic periods everything focuses upon the present. Suddenly I have the confidence that I can do what I had set out to do. People give me compliments about my insight, my vision. I fit the stereotype of the successful, intelligent male. It's a feeling that can last for days, sometimes weeks, and it's wonderful."
A TERRIBLE TORNADO. I felt fortunate Stephan was willing to talk openly about his experience. A Hungarian refugee, Stephan had begun his medical studies in Budapest before the Russian occupation of 1956, and in London we had studied anatomy together. He was a wry political commentator, an extraordinary chess player, an avowed optimist, and a good friend to all. Everything Stephan did was energetic and purposeful.
Then two years after graduation came his first episode of mania, and during the depression that followed he tried to hang himself. In recovery, Stephan had been quick to blame two unfortunate circumstances: He had been denied entry to the Oxford University graduate program and, worse, his father had committed suicide. Insisting that he was not ill, Stephan refused any long-term treatment and over the next decade suffered several further bouts of illness. When it came to describing mania from the inside, Stephan knew what he was talking about.
He lowered his voice. "As time rolls on, my head speeds up; ideas move so fast they stumble over each other. I begin to think of myself as having special insight, understanding things that others do not. I recognize now that these are warning signs. But typically, at this stage people still seem to enjoy listening to me, as if I have some special wisdom.
"Then at some point I start to believe that because I feel special, maybe I am special. I have never actually thought I was God, but a prophet, yes, that has occurred to me. Later--probably as I cross into psychosis--I sense that I am losing my own will, that others are trying to control me. It's at this stage that I first feel twinges of fear. I become suspicious; there's a vague feeling that I am the victim of some outside force. After that everything becomes a terrifying, confusing slide that is impossible to describe. It's a crescendo--a terrible tornado--that I wish never to experience again."
I asked at what point in the process he considered himself ill.
Stephan smiled. "It's a tough question to answer. I think the `illness' is there, in muted form, in some of the most successful among us--those leaders and captains of industry who sleep only four hours a night. My father was like that, and so was I in medical school. It's a feeling that you have the ability to live life fully in the present. What's different about mania is that it goes higher until it blows away your judgment. So it is not simple to determine when I go from being normal to being abnormal. Indeed, I'm not sure I know what a `normal' mood is."
EXHILARATION AND DANGER
Tags:
afflictions,
anhedonia,
depression,
emotion,
everyday experience,
everyday speech,
exhilaration,
friends and lovers,
gloom,
illnesses,
lifetime,
mania,
melodies,
mood disorders,
personal world,
social situations
