Lots of Options

I forget her name as soon as she says it to me.  Her ID badge is turned around backwards, so I never relearn it.  Her frizzy black hair forms a near perfect triangle with the baseline just about at the middle of her neck, and her eyes are either a little too close together or she is somewhat cross-eyed.  I can’t tell which,  I don’t want to stare, although I probably already am.

She is a fourth year medical student.  Not the doctor I am supposed to be seeing.  Who had received a call from my therapist earlier in the week in anticipation of this meeting.  So I have to rehash it all again.  Which I don’t mind terribly; I’m just a little talked-out, a little worn from having to discuss my feelings with someone all over again.  It had been my hope that the phone call would have saved me the trouble.

But it doesn’t.  So I tell this med student the recent developments; her enthusiasm is equal parts reassuring and creepy.  She has upbeat speech patterns and perky “OK!”s as I narrate how I haven’t been cutting, but that I’ve been wanting to.  That a few weeks ago, at a wedding, I wanted to slit my throat right there at the dinner table, and just go blanche and slump forward into my food while the music played, everyone bantered, and the colleagues of the bride to my left and right discussed the humor of two of them having the same first and last name, second marriages, and hair extensions.

It was supposed to be a six month check in, just a routine visit.  Two months ago, it would have been my hope that this visit would initiate a conversation about me getting off of anti-depressants.  My recent mental state, though, made that highly unlikely.  We discuss treatment options as the doctor knocks and comes in.

She gives a summary of everything I had just told her.  She refers to me in the third person as he takes notes.

He’s thought about slitting his throat and hanging himself; he has a razor that he uses to slash bread that he’s used to cut himself before, but he hasn’t just taken it out and stared at it while having suicidal thoughts.  He was recently at a wedding where he thought about slitting his throat.  He says that he has suicidal thoughts a few times a week, sometimes daily.  He says that this is the third fall in a row where he’s had thoughts of self-harm or has actually self-harmed.  He feels overcommitted with a lot of his personal engagements.  He says his main reason for wanting to get off of SSRIs is because of the effect it has on his libido.   

He scribbles diligently.  The pen makes quite a bit of noise as it scratches the paper.

We were just beginning to discuss treatment options when you came in, so perfect timing!

Well, the good news is that there are lots of options, he says.

This is exactly or almost exactly what he said when I first met with him a year ago.  His outfit was also similar, if not the same:  khakis, white collared shirt with some kind of pattern to it, black jacket vest.  Fluffy beard.

Dear Jesus God, I think.  It’s been almost a fucken year since I started on these things.  I think back to the meeting with my therapist in which we first broached the subject.  Me on the couch, with my girlfriend at the time, telling my therapist that I had texted her after some argument saying that, to paraphrase, this shit made me want to die.  And that she couldn’t handle that.

I think about my girlfriend getting up to go (was she a little teary, a bit sniffly?  I can’t remember), telling me she’d see me later that afternoon, thanking my therapist for letting her sit in on the first twenty minutes of the session.  I think about how I felt like shit.

 

I think we need to discuss the possibility of getting you on anti-depressants, my therapist said, seconds after the door closed behind my girlfriend.

I must have looked a little shell-shocked.  She hadn’t used the word before.  Technically, she still hadn’t; rather, she had suggested a solution to it.

So this is depression, I said, or asked, or something like that.  I told her something to the effect that this was the first time we had actually put a label on what I might have.

Your is an anxious depression, she responded.  The ownership of it all:  my depression.  My anxiety.  My self-mutilation.  My current mental state.

She zoomed out for a second, mentioned that the label doesn’t carry the stigma I think it carries, that one-third of Americans are diagnosed with depression.  If that were true, that would mean that there are more depressed Americans than there are total French citizens in the world.

I couldn’t be certain if knowing that I was among a third of all Americans made me feel any better at the moment.  This banality of depression juxtaposed with the possessive:  societal, personal, the fucken brain and all of its dysfunctional glory.  A shared mania 100 million strong.

I told her that I had to think about it, that I would do some homework, do some reflecting.  As she closed the door behind me and I was excreted from her office back into daylight, into reality, where the neat categories and parts of me that we dissected were all at war.

I didn’t let on that I was leaning towards saying yes on the spot, that I would welcome any fucken remedy to stop the cutting, stop the thoughts of chucking myself off the bridge, stop the daily conversations in which I raged at my girlfriend for not understanding, for not getting how fucked up it was in my head.  After all, how could she, why would she?  She was far too well-adjusted, far too optimistic about life in general.

I took two weeks to deliberate.  I asked a friend who I knew had taken anti-depressants.

Things just roll off you more easily, he said to me over the phone.  It sounded appealing.

The steps:  as boring as they were simple.  Tell my therapist that I’m on board.  Call my primary care physician.  Tell him all about it.  Get drugs.

This is too fucken easy, I thought, walking away with the prescription in my hand.

It was that first meeting, just under a year ago now, when he first said, Well, the good news is that there are lots of options.

C PODY.  Code I recognized from my days working in a pharmacy.  Take one capsule by mouth once daily.  So I took my first capsule, two shades of blue on the morning of my 27^th birthday, on my way out the door to drive to a funeral four hours south.

And now, I am back at his practice, in an examination room, with a fourth year medical student referring to me in the third person.

Lots of options.  As though I were choosing breakfast cereals at the supermarket.

Really, though, there don’t seem to be that many.  As far as I can tell, my options are:

1. Increase my dosage.
2. Keep my dosage the same.
3. Try a different SSRI.
4. Change the class of medication so that it isn’t affecting my serotonin levels.
5. Combine an SSRI with a different class of medication.

Those options become even fewer as the three of us discuss what is actually the safest, the most logical solution.  My own vote is to get off of SSRIs so that I can have the functional sex drive of a late-20-something who’s trying to date and not have to explain with each new partner why, in fact, I haven’t orgasmed despite a half hour or more of vigorous humping, blow jobs, and self stimulation.

Babe, my legs aren’t meant to stay open that long, one said.

Your hip bone is digging into me, sweetheart, said another.

My mouth is numb now, said another.

The wisest decision, it seems, is to increase my dosage back to twenty milligrams of fluoxetine, back to what I was taking when I first had a lot of options.  I am to touch base with my doctor in a month, to discuss switching off of this class of anti-depressants, in the hopes of getting on something that won’t affect my libido.

My libido.  My depression.  My anxiety.  My desire to self harm.  My desire to maintain a goddamned erection.  A third of all Americans have what I have.  50 million men.  A little more than 50 million women.  I wonder what their struggle is like.  I wonder if they find themselves with fewer urges to self harm, but dampened desires.

I practically apologize to the medical student for putting such a heavy emphasis on the sex drive.

I know that shouldn’t be such a huge driver of my decision, I say.

It’s part of your mental health, she responds.

Mind and body are one.  One of the most basic tenants of my martial training.  So of course it should be a fucken driver.

But we agree, or I agree with them, that we should wait until I restabilize to change the class of medication.  I reflect that earlier this week, I was ready to call it quits, ready, as I told her, to get in the tub and cut myself open.  Like a goddamned fish, I don’t tell her.

They say some clinical things to one another.  We up the dosage.

Let’s see how you’re doing in a month.  If things get worse, definitely call me, because we don’t want that, he says.

They show me out, pointing me down the hall.  I schedule an appointment for a month.  The piece of copy-proof prescription paper in my hand.

Fluoxetine 20 mg.  CPODY.

Take one capsule by mouth daily.

Like that’s supposed to solve it all, I think.

But then I think:  I fucken hate to admit that this actually makes things better.

Things just roll off you more easily.

I sure as shit hope so.

Relapse

I didn’t know that there was a right way to go about it.  With most things in life, I had been able to quit cold turkey.  Cigarettes, dessert, relationships, for example.  So how was I to know.

Yes, there were stories of teens committing suicide after not tapering off of their anti-depressants, but somehow, I thought myself different from them in age and temperament.  I figured it would be unpleasant.  My successful escapades at quitting did involve pain:  I had nicotine cravings for over a year; I still do whenever I smell a cigarette, see some particularly attractive individual dragging on one.  I had caffeine withdrawals when I switched to drinking coffee only on the weekends so bad that my boss put me in charge of firing staff for almost a month because I possessed a cranky cold-heartedness that he did not.

But with the anti-depressants, the cold-turkey approach presented unforeseen challenges.  I hadn’t thought about the how the withdrawals would feel, would affect me.  I hadn’t thought about the fact that it was almost exactly one year ago when this all started again, when I took a picture of my sliced stomach in the mirror as a reminder, as a don’t let this happen again, fucker photograph (but of course it happened again).  When I thought about the lamppost on the bridge over the creek as the foundation of my mortal escape.  When my therapist looked at the underside of my forearms and frowned.

When during a fight in the car with my girlfriend at the time, while we waited for another friend who was making out in the club, I thought to myself that I was going to drive us into oncoming traffic on the way home.

I hadn’t thought about the fact that the turmoil endemic to dating, and more specifically, the possibility of rejection, might trigger something within me.

Your cutting is set off by your relationships my therapist observed on day one, two years ago, me on the couch, her on the white chair.  My reaction to this was silence, awe at how easy it was for her to see that.  She’s fucken magical, I thought.

I would think about all of this later, once I resumed my dosage.  I stared down the barrel of the green bottle on Wednesday morning, somewhat hung over.  Split tablets, whole tablets looked back at me.  I looked back at them.  I took a half tablet out.  Changed my mind.  Took a whole tablet out.  Admitted defeat.  Swallowed.  Back on drugs.

So I’m back on the couch.  The same one I found myself on almost exactly two years ago.  For the same goddamned reason.  A cutter in love.  Now, as then, on the center cushion.  Now, as then, my therapist looking back at me with her ambiguous gaze, one that says, I’m not entirely sure what to do with you.

She does, though, of course.  She asks me how I’m doing.  Over the past couple of months, we’d been meeting weekly as my travel schedule allowed to discuss any number of topics:  body dysmorphic issues, why I’d been pushing myself so hard over the past two years, being closeted in my youth.  Normally, we’d begin by talking about the week that had passed, recapping various small events in my life.  Normally, I would tell her when asked how I was doing, at least at the outset, that things were good, that I was tired, but good.

You’ve been saying you’re tired for the past six months, she said once.

This time, though, I just say it.  Dive right into things.  I’m not doing too well¸ I tell her.  And then I tell her why.

You did?

Yeah, I did.

Why?

I just wanted off, I tell her.  As though it were as simple as getting off the goddamn bus.

She explains what I had at that point learned:  that I had to taper, slowly.  Then she explains things that I did not know:  that people often try to quit in the fall, coming off of long daylight hours in the summer.  And that that’s a recipe for failure.  She brings up the lack of vitamin D in most Vermonters because of all the darkness during the winter, mentions how it affects our immunity and our moods.

Really, most of us here should be taking it as a supplement, she adds.

I hedge whenever telling her bad news.  I explain that I didn’t cut, that I wanted to, that I wanted to do more.  But that I didn’t.

I tell her about Tuesday, how it felt as I drove.  I wanted so badly, so urgently to slice myself open, the only thing preventing me was the constant motion north, my eyes monitoring the speedometer and the double yellow, my hands squeezing the steering wheel, driving towards the company of my friend and colleague.  Even with the absence of sharp or puncturing objects (well, there was a pen, a corkscrew, in the car), I told her that my skin tingled.  As though it were reaching out to me, as a friend, as though to tell me it would be okay I defaced it.  As though to say:  if it will make you feel better, I’ll let you do this to me again.  A pretty face looking to be beaten.

Sometimes, simply changing the sensation on your skin is enough to re-engage the frontal cortex, my therapist had explained in our first meeting.  Going outside into the cold, or taking a hot shower were both examples.  That was two years ago.

I tell her that during the drive, I rubbed my right forearm, pinched it, felt the friction.  That that provided some satisfaction.

I was doing this, too, I say, flicking my wrist, mimicking the cuts I would have made.  She nods, making the face that she makes when she wants to tell me that she isn’t pleased, that she is concerned.

It’s also the one year anniversary of me being suicidal again, I think out loud, to her, to me.  Which, again, I hadn’t thought about until I went back on the medication.

We dissect anxiety, sadness for the remainder of the session.  We talk about the imagined child in me cowering in the corner, screaming, mouth wide open, improbably so, bright lights shining down on him.  Terrified, existentially, of being left, of being alone, of being the undesired body in a sobbing, flabby heap.  When asked how I feel towards this part of me, I tell her I don’t know, that I can’t separate myself from him at the moment.

Let’s put him in the chair over here, she tells me.  Let him know you’re still here, that we’re not leaving him.

I do; we discuss a recent love interest gone awry for the remainder of our time.  How that, more than the pending office move, the stolen bike, the overloaded calendar, was likely the cause.

During the phone call, I felt stunned, concussed, I say, wobbling my upper body on the couch to illustrate.  I tell her that it felt like it did when I beat myself over the head with a frying pan years ago.  She says that the reaction could have been exacerbated by the withdrawals that I was likely experiencing.

Then:  We had an agreement, she tells me as a concluding remark to the session, referencing the fact that I was supposed to call her when in a distressed state, when about to self-harm.  She looks not quite upset, not quite disappointed.  The borderline of emotions:  the most unsettling of them all.

As I’m writing the check for the appointment, I ask her, for clarity’s sake, at what point I am supposed to call.

I didn’t cut myself, so I didn’t call.  I was thinking about it, though.  I had my phone unlocked, ready to call you.  But I didn’t know if I needed to, so I didn’t.

She didn’t come down one way or the other as to whether I had erred.

I just want to remind you that it’s an honest request.  That you really should call me if you’re in crisis. 

I don’t want to be anti-depressed anymore.  It’s not the same as being happy.  I want to tell her this.  I don’t, though.  Instead, I smile and thank her as she closes the door, and I am shat back out into the world, trudging back to my office, retreating to and from a number of invented situations.

At the office, I create a new playlist entitled “Mood Swing Mix 2011.”  On the cover of the CD, I wrote those words, and then, bullet points around the rest of the disc’s face.  A summary of the past month, the rising, the crashing, the epiphanies that lie in the settling dust.

• A day at a time
• A brown autumn
• Love and falling down
• Failed attempt @ quitting SSRIs
• Return of past urges
• Heavy drinking
• Dysmorphia rendered clear
• Accomplishments
• Breathe, fucker, breathe

The Quiet Manifestations of Masculine Sadness, Part 5

London and Drunken Laundry

I don’t think she had intended for the phone call to result in her breaking up with me, but we got there all the same.  I had suspected that the end was in sight, so I preempted things.

“Are you breaking up with me?” I asked her on the phone.  “Because the sense I’m getting is that you’re breaking up with me.”

She answered that she didn’t know, that two years inLondonwas a long time, that we’d already been long distance for two years, that my last visit to her in upstateNew Yorkfelt a bit contentious.  That we started dating when she was seventeen, that’s so young, Jeff.  We got so serious so quickly, but it seems like it’s going to take forever for us not to be long distance.  You seem settled back inVermont, and I don’t see myself back there soon.  It’s so hard, baby, and I mean, I thought maybe we’d stay together until I left in August, but now, I don’t know, are we breaking up?  I mean, I guess that’s what this is, then?  You’re one of the best people I know, Jeff.  No, I don’t, I’m not just saying that.  I talked to Mum and my sister yesterday.  This is so hard; she’s so upset about it, she still sees you as the older brother she never had.  That’s sweet of you, she’d love to hear from you.  Okay, well, I guess that’s it, then?  We’ll talk again, though, right?  Okay, I’m sorry, I love you, good-bye.

I had been lying down on my back, my feet draped over the foot of the bed.  I hung the cordless phone, looked at the red talk light go out, observed the number pad for a lengthy moment.  I got up, heard the creaking of the box-spring, noted that I felt a little dizzy.

I should be crying or something, I thought.  I tried to conjure up tears.  None appeared to want to come, which I found somewhat disappointing.  You’re in a relationship; the phone rings.  You talk for a few minutes.  You hang up.  You’re single.  She was right, though.  Not that that made me any happier about it.

I walked around my apartment, dragging my feet on the carpet and taking stock of the scratching, scuffing sound that I made.  I called my friend Mary, who lived down the street.  I asked what she was doing tonight.  She mentioned her plans.  I asked her if she wouldn’t prefer coming over to do laundry and kill a twelve pack or two with me.  I explained that I was newly single.

She was over later that evening; she did laundry; we drank beer.  She said how breaking up over the phone is so not cool.  As I got drunker, I began to disseminate the news to other friends online.  Michael and Rich said that they would be up fromBostonin thirty six hours.  Another friend would also come.  Another friend would say via chat that the upside was that I got to watch all the porn I wanted, and sent me a few links.  Mary and I were proper drunk, and I think I acknowledged out loud that tomorrow was going to hurt more than today.

The weekend would be spent drinking more, playing games, walking around town, and drinking again.  They all drove home on Sunday.  I washed the dirty glasses.  I took pictures of myself without a shirt on.