All Shall Be Well: Mending My Life in the Middle
Author’s note, January 2014: I wrote this piece in 42 paragraphs in 2006, using third-person voice because it was easier to deal with the difficult subject matter with that distance. I’m currently expanding this into a memoir manuscript (written in first person) and working on the recurring themes of space (and how we occupy it) and connection — the idea that everything is already here.
“I want to reassure you that your daughter doesn’t have an active plan to commit suicide.” With those words, she and her daughter are dropped down the rabbit hole of mental illness. The doctor’s careful respect and sad eyes convey more than the words: profound depression, elements of anxiety, medications are effective, this is treatable, teens respond well to talk therapy. She reaches for her daughter’s hand. With each new phrase, Caroline sitting next to her seems smaller – twelve, ten, then six, three, a toddler who loved “Twinkle, Twinkle Little Star” and could spot the Big Dipper. The light which left those stars when she was born has not yet reached the Earth. Caroline is fifteen years old.
Later that evening, the doctor calls to say that it would be wise, for the time being, to keep all medications out of Caroline’s reach. He says she’s indicated her awareness that overdosing on prescribed medication might be one way to end her life, were she to make that decision. The doctor emphasizes again that Caroline says she has not made that decision and has no active plan. No active plan, she thinks. No active plan. Is there a reserve plan? An outline of a plan? A sketch?
Within the hour, every medicine cabinet and drawer is cleared of old prescription bottles, cough syrup, aspirin, Tylenol, Motrin. She kisses her daughter, asleep, hoping there is peace in her slumber. She goes to bed, where she listens for – what? – until morning.
And all the while, Earth turns around the sun, 66,000 miles per hour. We don’t feel the wind rushing past because our atmosphere – as delicate as a layer of varnish on a cardboard globe – moves at the same rate, every day, for all of the 365.25 days it takes our planet to orbit the sun. There are, at the moment, nine planets, in order from the sun – Mercury, Venus, Earth, Mars, Jupiter, Saturn, Neptune, Uranus, Pluto. From Pluto, whose slow, looping journey around the sun takes 248 years, the sun looks like a small, bright star, a lamp left burning for someone coming home late. Pluto has only five more years to be called a planet; it will no longer fit the definition of “planet,” according to a vote of the International Astronomical Union. On August 24, 2006, the number of planets in our solar system is reduced from nine to eight, just like that.
Caroline finds comfort in her faith, her Confirmation group. She is a reader, a thinker, though not, her mother thinks, a brooder. Her Bible is tabbed with tiny Post-Its, marking favorite passages.
Her mother finds little comfort in sacred texts, other than the reality that these are words created by humans, for whatever inspired or uninspired reason. She sees, instead, the despair and desperation in the Psalms. Did David suffer from depression?
She knows there are people who demand absolute certainty from religion. She knows there are religions which require followers to accept any number of tenets as absolute authority. She believes that these people, and these religions, find each other – or create each other – throughout the course of human history. She notices that people who find this appealing, find it perhaps, necessary, often insist on certainties everywhere, in all matters. Things are black, or they are white. On a good day, she thinks the more realistic among them might concede to labels of blackish or whitish.
She’s seen enough of mental illness to know that it clouds the colors of the world with infinite shades of gray. She decides it’s not for nothing that the human brain is called gray matter.
The earliest archaeological records of human worship show a fascination with the sun and moon, and the unreachable heavens. But wonder, then reverence, precede worship. More than 10,000 years ago, the Mayans noticed and recorded patterns in the night sky. Thousands of years later, Mesopotamian cultures – Sumerian, Egyptian, Babylonian – measured time with the moon and the sun, and seasonal changes against the return of the constellations. They seem not to have feared change, but to have anticipated it, awaited it, wondered what it meant. What was it like, not being sure?
Here are both the beginnings of reason and of religion: using what we think we know to discover what we don’t.
Pluto is not named for the Disney cartoon dog. The cartoon dog is named for the planet, which was named for the Roman god of the underworld, whom the Greeks called Hades. The name seems to have been chosen to symbolize what looks like utter darkness surrounding Pluto.
The darkness, though, is an illusion caused by our perspective from the opposite end of the solar system. In reality, the space around Pluto contains as many stars as the space we see around Earth.
Caroline’s medication is ramped up. She meets with a therapist twice each week to work on coping skills, cognitive behavior therapy. The school social worker insists that kids with depression do best if they keep their normal routine at school. Caroline sits in class, present in body (which is what counts for school funding) if not in mind. When her mind wanders, it often alights on ways to kill herself (were she to make that decision, as her doctor keeps reminding them). But she is so forgetful that by the time the forty-five minute class period is over and she moves to another class, she’s forgotten most of what she was thinking about. So she starts over.
This happens in Caroline’s sophomore year of high school. There are meetings with teachers, guidance counselors, the school social worker and nurse. A plan is made to keep her in school as much as her illness will allow. She’s been an outstanding student, but now – now, she cannot rely on her brain. She relies on her wits instead.
“We are made of star stuff,” said Carl Sagan. The elements in our universe, 13.7 billion years old, are the same elements in the human body, in the mountains, the beaches, the water we drink, in every living thing on Earth.
Everything we will ever have to work with is already here.
The middle school PTA sponsors a speaker from an advocacy organization for special education students. The room is full of parents whose kids receive special education services, or who hope their kids will be eligible for services. Something. Anything. She listens closely to all of the acronyms for all of the permutations of programs which might help someone’s child, or her child. She remembers this advice: When you go to a meeting with school officials, bring a folder. Everyone else will have one. Even if yours is empty, bring it anyway. You will be grateful for something to hold onto.
She has wondered what the onset of madness might look like, and is surprised to see it almost everywhere except where she expects to find it. Caroline’s uncle is a sergeant, a cartography specialist in the U.S. Army, working with the Saudi military near Riyadh in a year when the United States and Saudi Arabian governments deny there is a U.S. military presence in Saudi Arabia. The Saudis are not particularly happy to have his unit there, but this is a promotion, with better pay, and the chance of wider opportunities when he returns stateside. Travel within the country is so dangerous, he must wear traditional garb, which does nothing to hide his blue eyes and freckles. He does not speak more than a few words of Arabic; none of the American military with him speak it, either.
This is the beginning of madness.
And later, this is when she begins to understand that there are places a mother cannot go with her child: She is sitting at brunch with her mother, who has been a rock of support throughout this adventure with mental illness. It’s her first trip away from her children in two years. She hears her mother say, about her brother, “He’s in much more danger in Saudi Arabia than in Iraq.” Her mother is afraid.
And she thinks, You don’t know. You really don’t know. Fear for your child’s life is sitting next to her on the couch in your comfortable, book-filled living room, in the safety of your own home, and realizing that if she wants to kill herself, were she finally to make that decision, you are, in the end, powerless to stop her.
The constellation we call Pegasus is visible in the night sky above the Middle East to anyone who looks up into the dark. It was charted by the Babylonians, who lived in present day Iraq five thousand years ago. When President George W. Bush declared “Mission Accomplished” on May 1, 2003, the warriors on the ground were seeing almost the same sky that warriors saw in 3000 B.C.
She wonders if they had similar questions, and similar certainties.
“You didn’t cause your daughter’s illness, and you can’t cure it.” Caroline’s therapist tells her this each time they meet. She knows from the first that it’s meant to reassure, remove guilt, encourage her to back off enough so that Caroline can do the work she needs to do to regain her health. But if her role is not to fix what’s wrong with her child, what, exactly, is she to do?
Once, there was a power outage on a cold winter night. She went out with the dog, shivering, wanting only to get back to the fireplace inside, when the black stillness stopped her. The horizon between the bare trees was sparkling with stars. Overhead, more stars. To the east, the north, the west – still more. Astonished, she gazed up at more stars than sky. So many. So many.
By her sophomore year of college, Caroline’s mental illness is determined to be primarily anxiety. The depression four years earlier was a response to untreated anxiety, certainly present during adolescence. Probably, it was there even earlier.
In her junior year of college, Caroline and a new therapist uncover an obsessive-compulsive tendency, manifesting itself in a desire, sometimes a need, to count things most people wouldn’t bother to count. Like the number of letters in a word, or the number of words in a sentence. Further exploration leads to the discovery of disturbing thoughts – random, persistent, and at odds with Caroline’s intellectual view of herself and of the world. Counting is a distraction from these thoughts; counting calms her. Caroline can barely remember a time when these thoughts were not present.
One day, her youngest son, John, comes home with a question from recess on the playground: Is Santa real? She is not ready for this. She plays up the magic part, concedes that Mom and Dad are Santa’s helpers, talks about the spirit of giving. She tries to explain that we need magic and enchantment and faith; we need to believe in things we can’t see.
“If there’s no magic, how do the stars light up at night?” she said.
“Mom, that’s not magic. It’s science.”
True. His dad and his older siblings all confirmed their belief in Santa’s magic, even if we have to make it ourselves. They read “Yes, Virginia.” They decorated the tree, reminiscing with him about his younger years, before he was in on the secret. It turned out fine, as these things usually do. Still, she wonders what she’ll say if his next question turns out to be about baby Jesus. And, Mom, how could Mary be a virgin and be pregnant and be engaged to Joseph and have a baby before they were married? Isn’t that backwards?
How will she explain the story of the Son of God?
Ninety-five percent of all the matter in our solar system is contained in our sun. If the sun were the size of a child’s small playground ball, the Earth would be a grain of sand. If the Sun-ball were resting under the maple tree in your front yard, say, then the Earth-grain would be about eighteen paces away, perhaps near the edge of your driveway. Between the Sun and the Earth would be Venus, a slightly smaller grain of sand, and Mercury, a very tiny grain of sand. Jupiter, our largest planet, is the dime that fell out of your pocket and onto your neighbor’s driveway across the street, when you stopped to talk, about ninety-two paces away from your maple tree (and the Sun-ball). Poor lonely Pluto is a speck of dust at the outer edges of your neighborhood, seven hundred paces away. The nearly level plane from your front yard to the outer edges of your neighborhood resembles the flat pancake of our solar system, with the planets circling in their elliptical orbits. The exception is Pluto, whose non-conformist orbit arcs high above and below the pancake. This is the truth.
We know these things not because they are written in a book, but because human beings – standing on a tiny grain of sand in the middle of unimagined vastness – wonder, have always wondered, will always wonder, about what they don’t know. This, too, is the truth.
Isaac Bashevis Singer, the great storyteller, said the three most important words are, “It doesn’t matter.” Most of us, had we to choose only three words, would choose these three: “I love you.” Singer means, of course, not that love is unimportant, but that forgiving ourselves, forgiving others for being human, because we are all human, comes first.
How can human beings, inconceivably small on our little grain of sand, matter, when we are such an infinitesimal fraction of the universe? And yet we do matter – to each other.
Her friend’s son has a chronic illness which isn’t responding to the standard treatments. Her friend is given a couple of hours one afternoon at the hospital, while her son’s pain is controlled with morphine, to choose a treatment he will use for the rest of his life, or until medical science comes up with a better idea in five, or fifty, years. One option involves more of the medications he’s using now, which may or may not work, given her son’s history, and which will certainly result in nasty side effects and impair his quality of life. The other option is an IV drug, extremely effective and easy to use, but which carries a high risk of cancer with long term use. Her friend chooses the latter option and vows to pay more attention to cancer research.
This is the part of being a mother that no one talks about.
Her favorite artwork in the collection at the Minneapolis Institute of Arts is a small sandstone figure from the Paleolithic age, about 20,000 B.C.E. It’s just over five inches tall, small enough to hold in your hand, and it’s carved to represent a pregnant woman. There she is – rounded head, full breasts, bulging belly, curved thighs. We don’t know, of course, what the people who carved her called her. We call her Venus, for the Roman goddess of love and fertility. Anthropologists tell us she was almost certainly a ritual object meant to celebrate or worship or secure reproduction, fertility, survival. All that, contained in a figure you could hold in the palm of your hand.
The year Caroline is diagnosed with depression, Paul and Suzanne are thirteen. She spends a lot of time watching the twins, who alternate between calm and volatility, as children are wont to do. Next time (please God, no) she will recognize the early signs of mental illness. They are: irritability, moodiness, loss of interest in activities previously enjoyed, lack of concentration, changing sleep patterns. Some days, she’s hard-pressed to see even one. Other days, this could be a laundry list of their behavior. Is this depression, or is this just being thirteen?
The family, small as families go, has a family tree starred far and wide with various mild forms of mental illness. You wouldn’t know it to look at them, or their ancestors, and you might not even notice it after prolonged association. They look and act exactly like the people they’ve lived near for several generations. They are typical Midwesterners, salt of the earth, descended from the original do-it-yourselfers who emigrated to the North American continent when the welcome, for whatever reason, wore out in their ancestral homeland. There is nothing, and no one, out of the ordinary.
She thinks, but is not certain, that she is a good mother. “Parent” became a verb about the time her oldest was born, requiring an attention to detail her children’s grandparents never bothered with. Still, didn’t it all boil down to common sense? Lots of love. (Or was that control, repression?) Lots of free time. (Or was that neglect?) She’s been a parent long enough to know that children rarely learn the lessons you think you’re teaching them, and may be learning something else entirely. She’s convinced she’s done the best she could. But three children facing mental health issues in five years – it gives one pause.
The pleas, or prayers, if that’s what they are, don’t work. Suzanne is diagnosed with depression, then an eating disorder, when she is sixteen. The whole thing is a little bit easier the second time around. It’s Suzy’s twin brother, Paul, who insists that something is really wrong with Suzy – have they asked the doctor about an eating disorder? As it happens, yes, several doctors and two therapists, all of whom seem to think Suzy’s weight loss is part of her depression. She reassures Paul that Suzy is getting good care and will be fine, but she goes to the library for every book she can find on eating disorders. In the back of one is an index of resources and treatment centers, organized by state. The Eating Disorder Institute at Methodist Hospital in Minneapolis, not ten miles from their house, is listed as an outstanding regional center. Within days, Suzy is diagnosed with anorexia. She begins intensive outpatient treatment, which is effective in a matter of weeks. Not everyone is so lucky; they meet families whose kids have been dealing with eating disorders for many years, families whose kids are irretrievably damaged by the physical and psychological toll. No one can explain why Suzy has the disease, or why she responded so well to treatment, continues to do well more than a year later. For the rest of her life, Suzy will be at risk for this disease, and other mental illnesses, but there is the hope that therapy gave her the tools to recognize quickly the next time she’s in trouble. Still, the questions nag: why didn’t they think of this sooner? Why didn’t someone else?
Therapy and mental health care have their own language and she does not know it, can’t conjugate the verbs or parse the sentences. A neurologist who saw Caroline for chronic headaches two years before the diagnosis of depression said, “We may be looking at a mood disorder here.” It sounded so benign. Why didn’t he just tell them to take her for a psychological evaluation?
Paul is the one she thought was safe – easy-going, sure of himself, empathetic to a degree she has yet to attain. He’s gotten himself to age eighteen with a minimum of trouble. It looks at first as if his weight loss is related to a body-blow during a hockey game; his sternum is injured, causing chest pain and nausea, loss of appetite. But it continues, off and on, for months, despite good medical care from various specialists. Even his pediatrician, who’s known him for years, thinks any depressive symptoms are due to frustration with the gastrointestinal symptoms. But Paul’s weight continues to plummet and he’s clearly unhappy. She schedules an appointment with a therapist a friend recommends; this counselor, Greg, confirms her suspicion that Paul’s physical symptoms are caused by depression and anxiety. Paul likes Greg and is willing to work with him. She sets up more appointments with Greg and calls Paul’s pediatrician about medication. Round three begins.
On the insurance company web site, she navigates through the required paperwork. In the links for locating a provider, she’s surprised at the way behavioral health care providers are categorized. Not only as she expected – by psychiatrist, psychologist, licensed social worker – but by gender, by specialty – chemical dependency, relationship issues, anxiety disorders – and then, of course, by geographic location. So in a major metropolitan are, one could choose a gay-identified psychologist of color who specializes in gambling addiction and whose office is within two miles of your home or work. Assuming, of course, that this therapist is taking new patients.
Later that week, she has time to read through the brochures she picked up while Paul spoke with Counselor Greg. Most of it is familiar by now. “Establishing Accountability” is the title of one. She thinks this is a good concept to teach a boy about to leave for college, but is appalled to find it doesn’t mean being accountable to himself. It says he’s supposed to be accountable to Jesus.
When she asks about this, and about the concepts of sin and Satan also outlined in the material, Counselor Greg is quick to say he didn’t write the brochure, the director of the center did. She presses again, saying she doesn’t believe that physical or mental illness is caused by sin or Satan, and how do those concepts fit with his practice of psychotherapy? In the end, he assures her, and Paul, that he’s worked successfully with many teens with many different philosophies and that the therapy tools Paul will learn will not depend on his holding any particular religious beliefs.
On the ride home, she says, “He didn’t answer my question, you know.”
Paul says, “I noticed.” He is grinning. She decides Paul will be fine. And maybe Counselor Greg will learn something, too.
Once, when she attended a therapy session with Caroline, the therapist addressed a question to her: “If you could wave a magic wand, what would you wish for?” She answered that she’d wish this had never happened to her daughter. Of course. Eventually, she realizes that a better answer is along the lines of hoping for some positive change, growth, insight, something to make the unbearable worthwhile. It was a trick question: the magic wand cannot undo the past. It turns out that both magic and mothers have limits.
Pluto was a planet for 75 years, the average life span for a person born in a developed country in the mid-20th century. It’s important to remember that Pluto did not change. What changed is the way we see it, and the words we use to describe it. Pluto is still there – a rocky, icy mass, doing what it was doing when humans first saw it in 1930 – rocketing around the far reaches of our solar system, orbiting the same sun, but a little out of whack, asserting its individuality by arcing far above and below the almost flat plane the other planets occupy. This, however, is not what disqualified it from “planet” status; the International Astronomical Union made the decision on size alone, it says. Pluto sails on, oblivious. It’s likely to continue doing this for the foreseeable future in geologic time, and for almost all of what humans perceive as eternity.
Her father suffers a stroke one spring day, a hemorrhage in his cerebral cortex. At home recovering, he falls to the kitchen floor a second time, and lays there, her mother crouching over him, murmuring, “We got him home. We got him home.” They are sure he is dead. But within moments, he is crossly pushing them away. By the time the paramedics arrive, he is sitting up, smiling shakily. He makes as close to a full recovery as is humanly possible, resuming hiking, kayaking, woodworking. Later, she adds the episode on the kitchen floor to the long list of things which are not worse than the possibility of her daughter committing suicide (were she to make that choice).
Her father has had a few health issues related to his heart disease which sometimes involve a visit to the emergency room. Her mother tells her that she followed the constellation Orion when she drove behind the ambulance on one such night. Her mother doesn’t know, but she does, that the two brightest stars in Orion are Betelgeuse, Orion’s right shoulder, and Rigel, Orion’s left foot. Betelgeuse is 425 light years from Earth; the light her mother saw that night left the star around the time Anne Boleyn was engaged to Henry VIII and Atahualpa was winning the Incan civil war. Rigel is 775 light years from Earth; the light her mother saw left the star after the Magna Carta was signed and before Marco Polo reached China. Thirty-one generations of human beings have seen the light from this constellation.
Following the silent ambulance on dark country roads, these stars seemed intensely, intimately, personal, shining just for them.
All of what we know about the human brain we’ve learned by observing other mammals, because the structure of the mammalian brain varies little, species to species. We are very much like, and inextricably bound, to every other life form on our planet. For humans, this connection is fortuitous, allowing research and medical advances most people couldn’t imagine ten years ago. This connection exists whether we choose to thank a benevolent, designing God, or the process of evolutionary biology. No one who offers medical care – not the emergency room doctors, not the family physician, not the medics in Iraq – will ever ask us which we believe before treating us. At least not yet.
Everything we will ever have to work with is already here.
They have their own beloved mammal, seventy pounds of black lab mixed with God knows what else. Caroline finds Abigail online through a pet rescue organization, and convinces the family that owning a dog will do more to cure her depression than the two aloof cats who are already household members. Abby’s coal-black coat is splashed with white at her chest, and her paws look as if she’s danced through white paint, which is just exactly the sort of thing she’d do if the opportunity arose. When they drive her home, she barks at every passing car and farts uncontrollably. Her age is estimated at fifteen months, mid-adolescence for a dog, which seems appropriate, given all of the other teens in the house. She has an insatiable appetite for food and attention and chasing anything that moves. She is eager and excitable, and endearingly enthusiastic about the humans she lives with, the smells in her yard and her yellow bowl. She is joy, condensed.
Sirius, the Dog Star, is the brightest star visible from Earth, except, of course, for our sun, and one of the closest at 8.6 light years away. Sirius, the faithful hunting dog, sits near the right foot of his master, the great hunter, Orion. By about 4000 B.C., the Egyptians knew that this star, which they called Sopdu, rises with the sun at regular intervals at about the same time as the longed-for and necessary flooding of their farm fields along the Nile.
In 1930, Walt Disney named his cartoon dog, Pluto, after the newly discovered planet because, he said, he wanted to do something “fun and creative” to counter the Depression taking hold across the country.
NASA launched a spacecraft, New Horizons, in January of 2006, headed to Pluto and the Kuiper belt beyond. Its itinerary reads like a leisurely travel log: February 2007, Jupiter; March 2007 – June 2015, interplanetary cruise. The spacecraft is scheduled to reach Pluto in July 2015. We make the journey because, based on everything we know, Pluto will be there. By then, the light which left the stars of the Big Dipper when Caroline was born will almost reach the Earth.
How she knows it will be all right: She is lying on the dock in the dark of a northwoods night, the summer smell of the lake below her. She twists a little to face north, away from the faint lights of the town ten miles south of the lake. She can see more stars tonight than there are minutes to count them, and she knows she’ll see more as she waits, gives her eyes time to adjust to the new direction. Nearby, a fish jumps. Then another. Further down the shoreline, some nighttime creature slips into the water. The stars from here look like they’re painted inside the dome of a bowl suspended above, protective and enclosing. We see the dome; we miss the depth. There is so much space, that were we to travel straight up, we could fly for years, decades, centuries, far past Pluto, and still not run out of stars, still not reach the edge of space, or of what it’s possible to know. Some of this travel, for a very small number of humans, is now possible with the human body. Most of it we still have to do with our minds.
We forget: in the darkest of nights, during the most dangerous storms, on a brilliant blue day when the sun blinds us to everything else, we are still – always – surrounded by the steady light of more stars than we can count.
Almost directly above her, the light from Rigel pulses across seven centuries. These words from Julian of Norwich ride along:“All shall be well, and all shall be well, and all manner of things shall be well.” We are the stuff of stars. Everything we will ever have to work with is already here, waiting for us to begin, were we to make that choice.
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