My nervous breakdown, not yours

Because we're all entitled to at least one nervous breakdown. It can't be, Let me tell you about my nervous breakdown, and someone else chimes in with a story about their own.

What is fascinating, in our tolerant, (almost) anything goes culture, is that there is still shame in having one at all. But there is, probably because mental illness can be debilitating and burdensome, so much so that when we are in the middle of a nervous breakdown, people fear the temporary debilitated and burdensome as symptomatic of something more permanent. But it usually isn't.

Not that a nervous breakdown isn't mental illness; it is. And we're all predisposed, vulnerable to something, under the right circumstances, some biological fever or another. What manifests to whom, and how-- that is the question.*

And another dissertation question of the week: Is the stigma we associate with mental illness due to  unfamiliarity, fear, helplessness, or a combination of all of the above? Or is it about anger, having to shoulder all the work. Somebody has to get the kids to school.

Somewhere in the Stuff That Makes Us Sick section of this blog, we talk about how there is no designation, nervous breakdown, in the Diagnostic and Statistical Manual of Mental Disorders. The DSM defines episodes of depression, all kinds, mania, too, and an entire nosology of dreadful symptoms associated with anxiety. But the syntax nervous breakdown is nowhere to be found.

It is most familiar to the generation that relates (really relates) to Mad Men (the TV show). In the fifties you had to have one to get attention for feeling mentally ill.

We omit it because it is defined by better differentiated disorders.  Yet, that perfect storm of anxiety, panic, blinding fear, and catatonia, an inability to communicate well, a feeling of shutting down, symptoms of several Axis I disorders all rolled into one isn't close to feeling healthy.

And it happens to many, if not most of us, and for some people, it happens at the worst of times, the beginning of a new job, the birth of a baby, making a wedding, graduating high school, college, moving away or moving toward.  Certain diagnoses are more likely to manifest at certain ages.

There's never a good time, is there?

If it is ubiquitous, and symptomatic of some type of mental illness or a combination of disorders, then perhaps the stigma about the nervous breakdown isn't about misunderstanding or unfamiliarity, rather it is born of a sense of dire helplessness in the face of the collapse of another. Not knowing what to do, wanting to help and not knowing how, we displace our anxiety, judge, blame the victim. And the victim isn't doing much around the house, is the truth, which can make us very, very mad.

Caregivers who come to the rescue will need therapy themselves if the fever of their partner, friend, or family member doesn't resolve soon enough, or keeps recurring. They deserve more than the tee shirt, I'm Working on Surviving His (Her), My Mom's, My Kid's Nervous Breakdown.   But a tee shirt is a nice gesture.  The one who crashes gets to wear Lost It. 

So many opportunities to lose it in a lifetime.  There's little chance of coasting without being affected, if only temporarily, little chance of not hurting to the max emotionally.  No longer grounded, sanity is penciled onto the loss list,  if only temporarily. (I have my patients write one, everybody has to grieve, tee shirts aside.) Here's a short summary of family developmental steps that threaten ours.**


(a) Pregnancy

By far one of the most pathological conditions known to man, hormones shifting, bodies changing. Yet people make comments about size and weight gain, comparisons to animals (whales, mainly). It is one thing for me to describe my pregnancy as capable of filling out a hula hoop, quite another if you do.

A woman carrying a child needs nothing but love, as those of us who have survived it know. Carrying alone is justification to kvetch, we don't need much advice or personal solutions to the inevitable problems. There's enough information on the Internet to reinforce our insecurities. Ask benign questions, smile at pregnant people. That's all they need.  The looming fear of parenthood will go away, if only temporarily.

(b) Better out than in, owning an infant

Babies cry so much, and sometimes they're sick, and their sleep schedules are unpredictable.  Their insecurities (I'm so small, hasn't anyone noticed? Why did they leave me alone in this crib?  It's freezing in hear and they don't care.  Life has changed for the worse!)

Their insecurities are contagious, and parents feel a loss of control.  Sleep deprived, reality isn't real, lovers become enemies. Decision-making is compromised.  Life is all about four little words, Is the baby okay? When both parents are up all night no one feels good and self-pity or blaming the other natural.  The best fights begin. Happiest times of our lives, for sure, those moments with the little bundles of joy.

Infancy is relatively short, and if handled graciously, with few preconceived expectations, can be delightful, delicious, and unforgettable in a positive way.  It is obvious we forget how bad it can be because we keep on doing it, some of us, live to repeat the mistake.  Someone's teleological trick.

(c) Parenting toddlers

The diapers, seriously, as babies morph into little people who walk, make us sick, and we feel a sense of failure as the little one, all of three years old, (usually a boy, most girls train sooner) refuses to use the potty.  The pleading cry of infancy has matured to a respectable tantrum.  Things break, fly across the room.  Bites happen.  Parents feel they must be able to control this cub-like behavior, and surely they should, but how?

And if a child is sick, has a disorder of some type, perhaps isn't progressing or begins to slip developmentally, that sense of failure becomes identity without support from friends and family.  Support is of the essence and it isn't always there.  Neighbors run from problem children, hope someone else is picking up the slack.

(d) Having children five and under

Little people, little problems, but no, not really. Children are complicated and because their verbal communication skills aren't perfect yet, hard to read. We send them off to school expecting them to behave, and they look around and find other little people wearing better clothes, with better phones, and better manners, or they are bullied. Their teachers are critical and not always good at what they do.

Under all kinds of pressure and social stress, missing home and picturing Mom or Dad with the new arrival, little people act out, have even better ways, demand, or sulk and hide in their rooms. We don't know how to respond to their nervous breakdowns except to say, Snap out of it or no doughnuts. This usually works.

(e) Having children in latency

Freud named the elementary school years latency, pre-puberty, a stage of development theoretically sexually dormant. Children in his world (who were these children?) settled into academics, worked hard at school. Erickson called the stage Industry.

Now, of course, there is no latency and the age of puberty has dropped, probably due to the sexual stimuli in our world or nature's way of demanding we recreate. The stress doubles as parents return to work, children aren't supervised, homework isn't done and food isn't on the table. Perhaps, by now, the slightly alcoholic tendencies of our twenties manifest as truly alcoholic, and sober partners shoulder a disproportionate amount of stress. Marital conflict warms up. Kids get symptomatic, take the hit for everyone. Good times.

(f) Parenting adolescents

By now we have shown our true colors to our partners and whatever marital issues we have, or what is thought to be a mid-life crisis, is a movie the kids have seen at least once. One of us has abandoned the other emotionally, or physically.

Divorce is imminent or discussed in front of children and friends, anyone who will listen. The stresses of money, keeping up appearances, aging, coping with the ghosts of our own childhood-- all of this crescendos as the children smugly look on and get stoned. Who has the nervous breakdown? Any or all of us.

(g) Launching

The kids are off to college or getting married, traditionally the best time for mental illness to manifest. Oh, wait. Nobody's leaving home anymore. Now the nineteenth nervous breakdown*** is about everyone living in the same house. Nobody's off to college, and if some of them managed to go, the parents are in hock for student loans they will never pay off.

Launching, when it does happen, traditionally tips the relationship system in the family, not always in a good way. The suicidal mom, you know, is a kid-magnet, ruins a perfectly good launch.

Oh, we could go on and should, but that's enough for now. The first thing the therapist is going to tell you, if you are lucky enough to get one, is that you are entitled, or you were entitled, to your nervous breakdown. And we want to know if somebody was there for you, what happened at the time and what happened later. Because frankly, the aftermath is so much more important than the crash.

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* Jews thought they had no alcoholic gene until recent history. Our ancestors didn't drink to excess, not only because they were too poor, but you can't learn anything when you're drunk! So there was no such thing, in most families, as drinking for fun. You have a glass to toast to a new baby or a marriage, or to bring in the Sabbath. But now, as a culturally assimilated people, we drink along with everyone else. And what are we finding? Alcohol dependence! Crazy, I know.

**By no means the full list. We have to quit while we're ahead, at about the time the kids start having kids of their own. That softens some of the pain of impending sickness, coping with aging parents and helping our children who have new problems, similar to our very own, that sandwich thing. Hardly worth talking about.

***Ninteenth Nervous Breakdown is an old Rolling Stones song.

Water, water everywhere: David Foster Wallace

This is where the waters meet the sky.

If you look really hard you can see buildings and seashore below, the Atlantic Ocean meeting Fort Lauderdale. But from above, it's the horizon that's truly sensational.

I have the window seat and the African American mother to my left is teaching her three year old to recognize words in a picture book. The three seats behind us are all empty, so Mom packs up the crayons, books, and child, and moves. I can put up my feet if I like.

After learning a little and saying a couple of prayers, I'll get comfortable and do that, put up my feet.

The son of a close friend is now married to a lovely Miami girl, the reason for this short trip. I actually asked his mother, "How would you feel if I missed it? It's going to be hard to get away."

She looked at me as if to say: Fine, so I'll hate you forever. Miss it.

Gotcha'.

The day before that Sunday wedding, I took a walk over to see #3 son's latest additions to the family, the new Grandfish. He bought me a couple of new fish, too, baby clowns.



It's a new tank and not yet furnished. We take time buying furniture around here.

My son is now best friends with every salt water aficionado on Craig's list in Chicago, and gets us fish at rock bottom prices. When he was in high school he started a micro-business as an aquarist, set up tanks for people, helped maintain them. He called it Rock Bottom and we had fun making the business cards. Rock Bottom didn't exactly take off, but we've always found a certain reliable joy in this family hobby. Keeping fish alive ratchets down the anxiety for those of us who lean toward Type A.

So when he called to ask if I wanted the two clowns, of course I jumped at them. They huddle together and dance in the corner of the tank in the family room. They seem very happy, and yes, are eating well, for those of you worried about such things. (They looked like babies when I left. FD has done a nice job feeding them out of their infancy in my absence).

This is the late David Foster Wallace, a picture from the Wall Street Journal. He knew about fish, too. You can read DFW's commencement address to the 2005 graduating class at Kenyon College online. It begins like this:

There are these two young fish swimming along, and they happen to meet an older fish swimming the other way, who nods at them and says, "Morning, boys, how's the water?" And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, "What the hell is water?"

Born February 21, 1962 in Ithaca, New York, Mr. Foster died September 12, 2008, a suicide. For more biography, read Richard B. Woodward or Whitney Pastorek's features online. Books about him must be in the making, perhaps they're already in the stores. This gentleman who took his own life (not unexpected, we hear) authored 8 books, including novels and critiques of American life, and one on infinity, as in math. Wildly popular, literary magazines cleared space for David Foster Wallace, as much as he wanted.

Writers worship him.

Mr. Wallace tells over the fish metaphor about consciousness to the graduates at Kenyon College and continues, unless I'm interpreting the speech incorrectly, to say that water represents everything outside our immediate consciousness, that our awareness is hopelessly bound by our self-centered (through no fault of our own) perspective, and that none of us can be anything but wrapped up in ourselves, as much as we try to get out of our heads, thus we don't notice the water until we are older, and even then it is on the cusp of consciousness, and noxious.

Rather than the usual commencement pep talk:

Seize the world, you're all young, good-looking, and above-average,

Mr. Wallace tells the class, basically,

Good luck, suckers. Life is a bear and then you die.

I finished reading the speech, put down the newspaper and thought to myself,

"This is what it is to be someone like DFW, impossibly stuck in the world inside his head, stuck in words."

And I related just a little, as perhaps you do, too, as a writer. But what a terrible waste of a beautiful mind, one that surely couldn't take the madness of it all, so many, many words. Then perhaps, all of a sudden, none. Or none of them good, none of them gratifying.

When I was in my late twenties, a friend of mine called me with a post-partum depression. She said that everything she saw, everything she read, became exaggerated somehow. Things that should be upsetting, but only marginally, now distressed her, terrified her. She couldn't watch the news or pick up a newspaper without dissolving into tears. She didn't want to hold her baby for fear that she would drop him.

These can be symptoms of a pending catatonia, the worst of the depressions imaginable, a psychotic withdrawal into the recesses of the mind. Medical intervention is critical, will save such lives, preserve the parents of the next generation.

David Foster Wallace will be the subject of many a thesis, but to me his decision to suicide, the ultimate withdrawal from life, withdrawal from the water, makes him a casualty, another person I would have wanted to shake, to scream at, insisting, "Just try another medication! There's an agent for everyone!"
Or even a little electricity, just a little.

If I didn't believe in the impervious power of mental illness,* I would say that he needed meaning in his life, too. When he saw the water, and he did, he knew he existed in there, but saw no purpose, not enough. You could say that to him, his pond was more than half empty.

As prolific and productive as he was, Mr. Wallace either didn't want to connect to life, or couldn't, hadn't the energy to make the effort necessary to swim, until finally he found it, the energy, and used it to take his own life. At the age of 46.

With the best years, for a writer some say, yet to come.

Although I haven't read his books, I'm guessing, from his speech, that he failed to see meaning, characteristic of depression, and that hurried his decision along.

To some of us, it is so simple, meaning. Go out there. Do your best. Say Yes when you can, say No when you really know that Yes will come at too great a price.

Give, give, but not too much, and the self will feel worthy, satisfied on more than one level, will know where and how to rest comfortably. The self is that which we can never escape, you see, even if it is not always obvious to us and operates subconsciously; changes imperceptibly, with every sensory impact. The brain, interpreting sensory data, is our first reference point of awareness and self. It is the brain that subsists in the water, or swims, if you prefer, in the sea, the self tucked inside.

We do things as people, and our self-images, what we think of when we say our selves are interwoven into consciousness with our actions, our roles. We call this stunningly complicated weave our identity. Self is separate from the water, but inevitably connected, more or less, depending upon how busy we are. We're going to get wet, regardless, when the waters get rough.

Consciousness, whether it is involved and interacting in life or not, is the water, and it can be unbearable. Our awareness is ours, no one else's. It is private. Our realities are all different, some more negative and disengaged than others. Dr. Wallace understood this, probably, but could not change that experience, couldn't find a more comfortable pond, because of his illness, through no fault of the Pond-keeper. If he were alive he would say, I don't like living in the sea of humanity. It is too hard.

The plane is heading northwest now. I no longer see the ocean, but the memory trace of that place where the ocean meets the sky will basically keep a person like me happy for a long time. Just that sensory data is enough.

And I'm going home, did I tell you? Because Nemo 1 and Nemo 2 are probably looking for me. The impact of little fish, oceans and sky, people in our personal worlds, things we must read and do, the mentoring of our children, sharing life's bookmarks, our missions, meaning, make all the difference. Our commitments shape this thing we call meaning; they guide us, help us move the furniture, improve the clarity of the water in the tank. It can be about as simple as that.

Unless we're really sick. Then there is absolutely nothing simple about the water.

For a real look at DFW and what we've lost, read Carol. She embedded video.

And a writer writes about the writer, Mark Caro, Chicago Tribune.

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*In his case, Bi-Polar Disorder, read the comments.