Hollow On The Surface
More, December 2007

de•pres•sion

1 Severe despondency and dejection, accompanied by feelings of hopelessness and inadequacy.

2 A sunken place or hollow on a surface.

I’m never happy in December. But this year my winter doldrums came on early, and strong. One day I was living my wonderful life–putting the final touches on my first novel, buying a bikini for the tenth-anniversary trip to Costa Rica that Katrine and I had been planning for years, energetically re-organizing every closet, drawer, and cabinet in the house–and the next I was sitting at the top of the stairs, looking down at Katrine as she got ready for work, and I couldn’t stop crying.

"What’s wrong?" Katrine asked, with equal parts compassion and compassion fatigue. I hadn’t had a period for a year, but for the past few weeks I’d been having hot flashes, headaches, and what the menopause books cavalierly call "mood swings" all over again.

"Nothing," I sobbed.

"It’s just your hormones, honey," she said. (One of many benefits of same-sex marriage: unlike husbands, wives may attribute erratic behavior to hormones without risking divorce, or worse.)

The crying spells went on for days. Weeks. I didn’t mind them, really. I re-read the Marge Piercy poem, "For Strong Women:" "She doesn’t mind crying, it opens the ducts of her eyes." My ducts were a 24-hour Safeway, open all the time. I listened to Marianne Faithful sing flatly, dispassionately about watching tears go by. I worked and cried. Cooked and cried. Pulled my car to the side of the freeway and cried. If I’d had a bumper sticker, it would have read, "I brake for tears." I positioned Kleenex boxes in strategic locations around the house, next to my reading glasses, and adopted a Marge Piercy/Buddhist/Marianne Faithful approach. I was a strong woman, observing my tears. I was a strong woman, watching my tears go by.

Thanksgiving was–should have been–a wonderful day. Cooing over my five-month-old grandniece with my brother and his daughter. Talking deeply, sweetly, with my seventy-eight-year-old dad. The meal was delicious, the conversation real, the tulips on the damask-dressed table trembling with dew.

And then, suddenly: I was there, but not there. My face was frozen behind my smile, my laughter rasped in my throat, my hand was someone else’s hand, stroking the baby’s downy head. I was in a movie, playing the part of me. And I was on the ceiling, watching the movie.

"What a great day," Katrine said as I drove us home across the long, low-slung San Mateo Bridge. Had the lanes on the bridge always been so narrow? Had the span always dipped so treacherously close to the dark, choppy surface of the bay? My hands were sweating, gripping the wheel. My heart was thundering in my chest. Katrine feathered her fingers along my thigh. "You’re so quiet. Didn’t you have a good time?"

I opened my mouth to answer her. And saw myself in the movie, gaping mutely like a fish. "Yes," I said.

Liar. "And no."

What’s that strange echoing sound? My voice, reverberating in my ears. How can I tell her what’s happening to me? "I don’t feel well," I said.

Katrine isn’t the worrier in the family (that would be me). But she looked worried now. If she’s scared, I thought, this must really be bad.

"Maybe I’m just tired," I said. See? I’m talking like a normal person. If I’m talking like a normal person, I must be one.

"You’ve been working too much." Katrine touched my cheek. "We’ll go to bed early tonight. You just need some rest."

But as Katrine’s breathing eased into sleep, my body went rigid; my eyes were stuck wide-open, scanning for dangers in the dark. I got up and roamed the house, turning lights on in every room, hoping to ground myself in the mundane details of my life. But our overstuffed, rumpled couch; my meticulously organized office; the big, beautiful yellow Le Creuset pot–they were the same, but not the same. The quiet house was my house, but not my house. Where I was, there was no quiet. Where I was, demons keened and shrieked.

What’s wrong with me? I walked the stairs, the halls, silently reciting my litany of riches. My career was exciting and satisfying. My marriage was joyful and secure. My sons were thriving. I had smart, loving friends, money in my checking account, a warm, welcoming home. I’m a strong woman, I chanted to myself. And then I remembered the last line of the Piercy poem: "A strong woman is a woman strongly afraid."

I had nothing to be afraid of. So why couldn’t I beat back my demons, climb into bed, and get the good night’s sleep I needed to write the story I owed my editor tomorrow?

I’m going crazy. The thought sent a hot shot of venom through my veins. The more I thought it, the truer it became. What if I never come back?

Days went by. I didn’t come back.

* * *

Katrine and I paid our first visit to the behemoth HMO we’d joined weeks earlier. Our broker’s advice had been convincing, if not uplifting: at our ages, he’d warned us (55–me; 49–Katrine), "You should get yourselves into an HMO that won’t drop you when you get really old and sick."

My new doctor strode in and positioned herself at her computer. Smooth-skinned and skinny, she appeared to be fourteen years old. "What can I do for you?" she asked.

"I’m having a hard menopause," I said.

I get up in the morning feeling like I’m falling down an elevator shaft. I toss and turn all night, feeling the same way.

"And…" Katrine prompted me.

"I’m crying a lot." I must be crazy, I thought. I’m telling my problems to a person young enough to be my child. "I can’t sleep. Or think."

If I can’t think, I can’t work. If I can’t work, I’ll lose my house, my career, my mind.

I drew a ragged a breath, resisted the urge to press my hand to my heart to contain its wild galloping. My face was hot with shame.

Dr. Teenager hit a key. Pages spewed from her printer. "The latest research shows Effexor to be very effective in treating menopausal symptoms." She handed me a sheaf of study results and side-effect disclaimers. "And I’m giving you Trazodone for sleep."

"Isn’t Effexor an…antidepressant?" I shot Katrine a sidelong look. I’d been taking Zoloft in the wake of a vicious breakup when she and I first met a decade ago. It was a point of pride for both of us that I’d thrown the pills away three weeks later; that we weren’t like so many people we knew, living a pseudo-life on pharmaceuticals, that we were each other’s happy pills.

"Yep," Dr. Teenager said cheerfully. "Hang in there…." She glanced at her computer screen. "…Meredith. You should feel better in a few weeks."

That night I took the Trazodone, slept four hours, and woke up with the worst hangover I’d ever had. I shuffled downstairs and swallowed my first dose of Effexor. My head started spinning; the room tilted; sweat dripped down my face. The next thing I knew I was prone on the floor, clutching fistfuls of rug in my hands. I pulled myself erect and called Dr. Teenager.

"Hmm. Maybe you should make an appointment with Psychiatry." She lowered her voice to a whisper. "If you want to be seen anytime soon you’d better say you’re…you know..."

"Suicidal?" Instantly I felt better. I hadn’t once considered killing myself. Things could be worse.

The "S-word" earned me a spot on the unyielding couch of a scowling, gray-haired psychiatrist. "Don’t think of me as your therapist," she greeted me, her hands on her keyboard. "I’m just here to prescribe your meds."

Dr. Pill ran through a checklist of questions: nature of symptoms, date of onset. "Family history of mental illness?" she asked.

I shook my head. She squinted at me skeptically.

"Well, both of my parents are on anti-depressants," I admitted. "But isn’t everyone? That doesn’t mean they’re mentally ill."

"You have a chronic, genetic disease," Dr. Pill said flatly. "But you’re lucky. Depression is highly treatable."

"Lucky?" Suddenly I was furious–and glad to be. It felt good to be flooded with a normal emotion for a change.

"I’ll give you Ambien for sleep," Dr. Pill went on. "And I’m switching you to Wellbutrin. It’s better tolerated over time."

"I’m only planning to take the stuff for a few weeks," I said. "Just till I pull myself together."

Dr. Pill frowned. "This disease is caused by an imbalance in your brain chemistry. It’s not something you can control." For the first time since I’d walked into her office, I felt slightly soothed. It’s not my fault, I thought. It’s physical.

"I guarantee that if you go off your meds, you’ll keep having episodes like this," she added. "You’ll need to be on antidepressants for the rest of your life."

So much for feeling better. Standing on line in the crowded, chaotic HMO pharmacy, I tried on my new identity. I have a chronic, genetic disease. I looked around the room, trying to distract myself from the seductive spin of another downward spiral. My eyes darted past the bored, impatient, normal people and zeroed in on the not-so-normal ones: a young Kate Moss look-alike curled into a fetal lump in a plastic chair. A man mumbling to himself in the doorway. An overdressed woman yelling into the cell phone pressed to her ear. Poor things, I thought–my standard response to the public displays of affliction I encounter regularly as a resident of Berzerkely, whacko capital of the world.

I plucked a two-year-old TIME magazine off a chair. The text swam in front of me. I flipped to the next page and couldn’t comprehend a word. Since Thanksgiving I’d been too wigged out to read–until then one of my greatest pleasures. As I put the magazine down the emaciated girl lifted her head and caught my eye, nodding as if she recognized me. No! I shouted at her silently. I’m not one of you. I’ve published eight books. I’ve been interviewed on national TV!

"Next." The cashier took my credit card and handed me my bagful of drugs. I slunk out of the pharmacy and onto the bustling street. "Spare change?" a homeless man mumbled. I’d never once given a cent to a homeless person before. Now I stopped and gave him all the coins I had. As his scabbed, filthy hand brushed mine I felt my heart groan, then crack open like a polar ice cap in my chest. Crazy people aren’t ‘them’ anymore, I realized. All those people I’ve pitied, judged, avoided, been so grateful not to be–the ones who can’t do what they want to do because their wounded psyches or bodies won’t let them–they’re my people now.

* * *

Despite Dr. Pill’s dire diagnosis, "depressed" didn’t feel like the right word for what was happening to me. I wasn’t lying listlessly in bed all day; anxiety’s insistent thrum left no room for lethargy. I spent my days hurtling from one seemingly crucial errand to the next, a futile frenzy of task completion that never succeeded in outpacing my inexplicable, relentless fear. I’d turned our house into a living tribute to the Container Store, but the order I imposed on dozens of obedient objects–plastic boxes of ribbon inside plastic boxes of tissue paper inside plastic boxes of gift wrap, each with a lid that snapped sharply, satisfyingly shut–failed to calm my raging mind, or slow my hammering heart.

Crying, I told Katrine that I was too sleepless, too panicky, too desperately clinging to the familiar to go to Costa Rica. Crying, I filled out and assembled the thick stack of receipts and forms that filing a travel insurance claim required. A week after I mailed the claim the adjuster called to say they were denying it. "Your doctor’s diagnosis is Recurrent Major Depression," she said. "The policy excludes cancellations due to mental disorders."

I gripped the phone so hard it hurt. "But it’s a chemical imbalance," I pleaded. "It’s genetic." If I’m well enough to make a coherent argument, I worried as I spoke, how can I be too unwell to travel?

"Company policy," the adjuster said. "We don’t consider a mental disorder a disabling disease."

I’d spent weeks trying to convince myself that what was wrong with me was an illness, not an irreparable rip in my moral fiber. In an instant, all that convincing: undone. I wasn’t a strong woman. I was a weakling. Fittingly, I burst into tears.

"I know what you’re going through. I have a bipolar daughter," the adjuster said gently. "I wish I could help you, but I can’t."

Weeks went by. I couldn’t tell if the Wellbutrin was working. I was better, but I certainly wasn’t well. The term "wet blanket" had taken on new meaning for me. I felt like I was walking around with the weight of a hundred-pound blanket draped over my head. I’d lost my joy as if it were a set of keys. One minute it was right where I’d left it, my entree to the things I wanted to do, the places I needed to go. The next minute it was gone and I was stranded, no way to get anywhere other than the awful place where I was.

Night, my worst enemy, became my best friend. At bedtime I got to take a sleeping pill and dissolve, for a few hours, into blessed, blacked-out oblivion.

Everything changed. I couldn’t do or be what I’d done or been before. My friends used to call me Uber Mom. Now I was all curled up into myself like the thin girl in the pharmacy: unable to lift my head and notice, let alone take care of, anyone else.

My body became an animal. It knew exactly what it wanted, and had zero tolerance for what it didn’t. I’d been limiting myself to two meals a day since the birth of my twenty-seven year-old son, eternally trying to lose five pounds. Now my body left me no choice but to eat the moment I felt hungry, and it craved strange, simple foods: apples, almonds, red meat. When people started saying I was too thin, I knew it wasn’t envy talking. I’d lost twelve pounds in two weeks. I was eating like an animal that’s maintaining its fighting weight, always fit to defend its life.

For the past fifteen years my workout routine had consisted of twice-weekly racquetball games with my friend Julie–always after 5 p.m., only after I’d put in a ten-hour day at my desk. When Julie and I met at the gym after the two-week Christmas break, I got as far as the turnstile and stopped stock-still. For years Julie had been complaining that I didn’t put my heart into the game. Now, listening to the going-nowhere drone of the treadmills, breathing the stale stink of the humid air, I understood why. "I don’t like this gym, and I don’t like playing racquetball," I blurted. "I’m sorry. I can’t do this anymore."

I headed for the steep hills that stand sentry over Berkeley. My heart pumped as I climbed, but for good reason. Keep going, I told myself, breathing in the scents of eucalyptus and honest sweat. Put one foot in front of the other. Good. Do it again. The trails became my gym, the silencing exertion my best medicine. I started taking two-hour hikes, alone or with friends, nearly every day.

Opinions abounded as to what had caused my "episode," and what to call it. Breakdown. Breakthrough. Hormonal surge. Creative crisis. Chronic disease recurrence. Post-novel-partum depression. The "To Do" list I kept taped above my desk pointed to overwork, the cause Katrine suspected. In the six months before I started hearing double I’d turned in twelve magazine articles, two anthology chapters, and rewritten my novel twice. I’d never missed a deadline in twenty years of freelancing. Except for business lunches, I’d eaten most meals at my desk. Now, between bouts of paralyzing panic, imagining the professional and financial consequences of this involuntary slowdown, I worked in fifteen-minute increments, if I was able to work at all. I’d earned a living writing candid confessionals. But now, afraid of the damage my diagnosis might do to my career, I told my editors that I had "unexpected holiday obligations," so the stories I owed them would be late.

I substituted ginger tea for coffee in the mornings, stopped reading the paper and watching the news, started meditating every day. Still, my anxiety kept escalating. A doctor friend told me that Wellbutrin often exacerbates anxiety. Could the pills I was counting on to make me better actually be making me worse? I needed to talk to a compassionate psychiatrist. That ruled out Dr. Pill.

Over the years I’d interviewed dozens of Bay area therapists for the stories I’d written. Any one of them could give me a trustworthy referral–if I were willing to risk that they’d see me as client material, instead of the respected journalist they’d known. As I deliberated another wave of dizzying anxiety crashed over me. I picked up the phone and dialed.

At 8:30 the next morning Katrine and I sat in a private psychiatrist’s office. Dr. Lexus rummaged through the bagful of drugs the HMO had dispensed to me in the past few weeks, then told me how wrong for me each drug was.

I asked him the $64,000 question. He shrugged. "Genetics, menopause, psychological issues, brain chemistry–everyone’s got a theory. But the truth is, no one knows." He handed me a prescription for Zoloft. I handed him a check for two hundred dollars. He told me to call him if I had questions, or when I felt ready to stop taking the pills.

A month later I made another appointment. "I feel a lot better," I told Dr. Lexus, "but I’m still a lot more anxious than I’d like to be."

"You told me you’ve been anxious all your life," Dr. Lexus said. "All the Zoloft does is modify your brain chemistry. It can’t change who you are."

"But I don’t want to be who I am," I said without hesitation.

"Who, then," the doctor asked me, "would you like to be?"

* * *

Was it the Zoloft, the meditating, the hikes, the steady love, listening, and faith of my wife, my family, my friends? Was it the acupuncture, a more favorable hormonal hiccup, a bit of good news about my novel, the eight nightly hours of medicated sleep? The Anxiety Management class at the HMO on Wednesday nights, the yoga class at the gym on Thursdays, the warmer days and braver light of spring?

I’ll never know why, but I started feeling better. Standing back up happened much more slowly than falling down. Voices stopped sounding as if they were coming through an echo chamber. I worked productively for two hours straight. I accepted a friend’s invitation to dinner, and ate heartily, and didn’t cry. And then one day, sitting at a stoplight in my car, I realized that I was singing "R-E-S-P-E-C-T" along with Aretha.

Singing! I didn’t care where feeling better came from. I fell on it hungrily; I let it fill me, let it chase the feeling bad out. I closed my eyes and thanked God, Pfizer Pharmaceuticals, the East Bay Regional Parks Department, and everyone who’d loved me through my...my…

My what? Illness? Weakness? Which was it? Neither? Both? As I began to breathe and eat and sleep and laugh on a regular basis, the question became uninteresting. I hope it remains so when I stop taking Zoloft, which I aspire, someday, to do. But first I want to solidify the gains I’ve made, make good use of the gifts that my illness left behind. Compassion for myself and others. Less focus on the future; more being here now. Less spinning out worst-case scenarios; more gratitude for the good stuff–the little blue pills and the purple eucalyptus mountains, the crisp, juicy apples and most of all the love, the love, the love–that make me the strong (and chemically balanced) woman I am.

Desperation lent me some good habits. Reduced to my animal essence, I was forced to make time for the human necessities that modern life denies us. Good food, eaten slowly. Deep breaths, taken mindfully. The use of one’s body to get from one place to another. Daily communion with nature, with spirit, with friends. It took a howling crisis to make me stop and smell the ginger tea. I’ve promised myself that even when I’m back to coffee, I’ll go on listening to what the crisis had to say.