What I think is so interesting and unnerving about this illness is that my entire life can change within a day. The moment I emailed my friends, it was as if I had begun linking anew to everyone.
Once again, the visual image of hibernating animals came to mind. At first I pictured bears in caves, waking up, and going forth into nature. Since they know that every other bear has been sleeping for months, reentering life is a natural part of their cycle. And that must be quite comforting.
When I looked up "hibernating animals" online so that I could learn about other animals, I found the picture on the upper left of a marmot who's on display at a $5 million marmot interpretive center in Europe.
Actually, I was jealous when I realized that scientists can raise this kind of money to study marmots and yet no one has funded a Bipolar Wellness Center. However, my envy quickly faded when I thought about reawakening from hibernation and finding myself in a glass case with a bunch or psychiatrists, psychologists, and medical residents starring at me.
All kidding aside, I think this is an important issue and one I don't want to diminish through humor. In my first post on reentering life, I said I believe it's okay to "drop out" for awhile. And I do feel that way. Maybe it's not the best response to depression but it's a realistic one. What was always interesting and disturbing to me--was that none of my doctors seemed to understand this.
So, I stopped talking about it. Since I'm an intelligent person, I obviously knew that "dropping out" was not the optimum response to a depressive episode. What made me angry was that my doctor's advice was so ridiculous. Yes, it's easy to say to a severely depressed person, "You should maintain relationships with your friends. You should continue to exercise. You shouldn't withdraw from life because it exacerbates the situation."
In response, I wanted to say, "Surely you realize that if I could do all that, I obviously wouldn't be clinically depressed. And your telling me to do this isn't helpful. How can I be with my friends when I cannot speak? Or do you not understand that depressed people physically find it difficult to talk? How can I exercise when I can barely get out of bed to go to the bathroom? Or do you not understand that depressed people have so little energy that it's almost impossible to get out of bed? How can I engage in life if I feel so debilitated that it takes every ounce of energy I have to engage with my son, who I love more than life itself?"
What would have been far more helpful was if any of my doctors could have said, "I understand how debilitating a depression is for you. I'm so very sorry that there is no medication that works for you. I'm so sorry that the pharmaceutical companies haven't been developing new mood stabilizers for bipolar depression or new antidepressants for bipolar depression, which won't throw you into a hypomania.
"But rest assured that all of my colleagues in the international psychiatric and psychological communities and all of our professional organizations have been participating in a huge letter-writing campaign to the National Institutes of Mental Health (and like organizations worldwide) about this. We've used our clout to force them to contribute $100 million annually to this effort and we won't let up until there are better medications for bipolar depression that are faster acting and don't have such awful side effects. We're also working hard to push through legislation for expanded insurance coverage and parity."
"In the meantime, I want you to know that we're offering new treatment options to try and accommodate your needs, and those of others, during your depressive episodes. Because you've survived so many depressive episodes--and I'm assuming I've told you how much I admire your resolve in doing so--with your permission I would like to enroll you in a pilot program that I think will be very beneficial for you. It's fully funded and we hope to replicate it on an international basis.
"When you're feeling truly despairing and can't come in for treatment, I will be offering online therapy sessions as well as a series of adjunct treatments. Because we know that depression is more debilitating that many physical illnesses, during a severe depressive episode, I will be sending a psychiatric nurse to your home once a week. She can take your vital symptoms and assess your situation. If necessary, she can have a bathing nurse visit you twice a week. When you're feeling better, we will start a physical therapy at your home. We recognize how important exercise is but we also realize that it's almost impossible for people who are deeply depressed. However, we've found that a gentle program of physical therapy works wonders.
"We have also learned that massage is a critical element of healing and I am prescribing a weekly massage. Although we know that deeply depressed people may not like physical contact, we have found that a masseuse with proper training (she doesn't expect you to speak to her) can make a big difference."
"We will also provide educational classes for your friends and relatives. We'll explain to them that we now understand that while people undergoing a depression need social interaction, they obviously can't communicate in 'normal' ways. So, we'll teach them how to be with you without talking. We'll explain the physical and psychological aspects of clinical depression so they can understand it. We'll discuss how sometimes, it just helps if they can sit by your bedside and read to you. And we'll also offer immediate family members, a wide array of services to help them while you're incapacitated."
Well, the fantasy is over but perhaps I'm making my point. For most of us who experience debilitating depressions, our needs are great but we are offered nothing but insipid advice. If we were truly given the services we need, we might not have to disappear for months on end.
But since we're not (offered helpful adjunct services) and we do disappear (and I believe it's okay given the circumstances), tomorrow I'll talk more about reconnecting with friends and relatives.
P.S. If you've thought of other services you'd like to receive during a depression, I'd love to hear about them. Quite honestly, I've just touched the tip of the iceberg here. Given how many depressions I've survived, I have quite a rich fantasy life.
(to be continued)