Archive for January 9th, 2010

Love and Pain by Edvard Munch

Today, we went to see an excellent, though disturbing, Broadway musical: Next to Normal, a Tony Award winning rock musical with book and lyrics by Brian Yorkey, music by Tom Kitt of High Fidelity fame, and directed by Michael Greif (who also directed the original production of Rent). It focuses on a family, their daily interactions and conflicts, and the anguish that lies just beneath the surface.

A married couple, Diana and Dan, go through the motions of being in a deeply loving and close relationship as they pursue their clockwork efficiencies and complete their daily rounds (10 minutes of sex in the morning, little by way of meaningful communications about what people are thinking, feeling, and experiencing, they shower, dress, Dan goes off to work, Diana does many domestic tasks with clear anxiety, emptiness, and disgust reaching a boiling point, and the cycle repeats the next day). Diana and Dan have a college aged daughter, Natalie,  a very bright and successful student, obsessive, with not much of  a social life.

The dark truth underneath the early action is Diana’s manic-depression, and her delusions about interacting with her 18-year-old son, their first-born, who  died at 8 months of age of an “intestinal blockage”.  [ His memory is portrayed as another character, the son, Gabe, as the 18-year-old with whom Diana delusionally interacts.] As she goes from one wardrobe of pharmaceuticals to another, all miserable failures, she finally gives up on all pills, feels briefly like her old self again, and then attempts suicide.  Diana receives electroconvulsive shock therapy (ECT)  next, prompted by the family’s desperation to find relief from the emotional torture of the 18-year-old open wound.

The ECT disrupts Diana’s memory so extensively that she loses all recollection of even being married for 18 years to Dan, who has stood faithfully by her side, and of having a daughter, Natalie. Slowly, her memories begin to return, but she senses a missing piece, a hole somewhere deep inside of her. At a critical moment in the play, she suddenly recalls the loss of her son, and Dan then reluctantly shares the details of his death. Diana’s delusion of seeing her son as an 18 year old returns, and her psychiatrist recommends another round of ECT. However, this time, she refuses, deciding instead to take her chances, knowing full well that there are no guarantees. Ultimately, she decides to leave the house, her husband and daughter and goes off on her own to work things out: a decision devastating to Dan, though he and Natalie find a way to carry on, as they hope for her eventual return.

The play is a very sincere and emotionally compelling piece of theater with music well matched to the action. We were all deeply moved by it. There were few dry eyes in the theater. The reason it had such an impact is that many could identify with one character or another. Those married for a long time could easily relate to awakening one day to find that you can’t recall the man or woman you were when you were in school and chose to marry, or the person you fell in love with when you made that youthful choice. You don’t know how it happened, but now you tire quickly, and everything seems a chore.

In addition, grief strikes every family with the loss of loved ones eventually. For some, recovery never quite happens. Many can also relate to the cornucopia of medications prescribed in our times to deal with it all ( e.g., xanax, valium, wellbutrin, elavil, celexa, leaxapro, paxil, prozac, zoloft, effexor, cymbalta, trazodone, and on and on) and their potential side effects which may include: weight gain, weight loss, sexual dysfunction, dizziness, chest pain, nausea, vomiting, anxiety, constipation, bladder problems, insomnia, stiff neck, headache, etc.

Only upon dumping all of her pills, does Diana feel like herself again, but her protracted and unresolved grief and depression reach a peak, and she tries to commit suicide. Many people I treat, friends and acquaintances, suffer from a variety of mood disorders ( often major depression). Combinations of psychotherapy and medication sometime bring a modicum of relief, but the battle is long and hard, and there are no definitive “once and for all” answers. In such instances, we especially need to broaden our view as caring for “souls” and not merely treating mind and brain alone. This is the proper place for spiritual dialogues wherein we face our existential terrors together.

The healing professions have established a litany of proscriptions about how therapy is best conducted. For the most part, the training includes an admonition to keep an objective “clinical” distance from the person being treated, and not to share too much of yourself. This builds into the psychotherapeutic regimen a professionally schooled institutional neurosis that can only make matters worse. This is what the depressed person already experiences : a sense of alienation, disconnection, a growing sense of being “a burden”, the object of critical attention, failure to find a reason to get out of bed, a loss of meaning, and lost intimacy. Those who suffer from this so often feel as if they are walking in a fog, going through various motions that are an all-too-thin shield against the strong desire to scream.

While it is imperative that therapists  know why they might share something about themselves with a client, to guard against projecting their own needs and psychic material, this guideline, blindly applied, can too easily appeal to half-trained professionals who carry unexamined complexes into such conversations. They may unwittingly “go through the motions of caring” in the name of being professional, while not really caring at all. They are, after all, too often, in their own minds, treating “patients:” a word that itself makes them more objects of care than subjects of authentic regard.

That presumed objectivity becomes too easily  a power trip and, potentially, a professionally sanctioned act of violence dressed up as treatment. So, how can hope be returned to the depressed and the grieving? How can we help each other relate to the shadow times and the existential chiaroscuro that we inevitably all face as we age? How do we come to grips with life when it loses all its taste; when, as said in the play to Dan by Diana, ” You say you know what I’m going through?! Do you know what it feels like to be dead while still alive?”

The answer lies in accepting the fact that there may not be one. It just may be that we will struggle throughout or lives. The roller-coaster of life has moments of quiet with many troubling and emotionally tumultuous punctuations. We are emotional creatures first. Some people are especially sensitive, and these are the souls that suffer greatest anguish.

Part of the darkness of depression is the belief by the depressed that they are defective, diseased, abnormal, incapable of functioning, too fragile to survive. The way out is to stop looking so hard for a way out. The sensitive soul has a faculty that is powerful and it can be put to work in response to the darkness. It is imagination, and the very capacity to experience life’s emotional challenges in exquisite detail.

While medication certainly has its place in acute circumstances, when one simply needs the help, it is not an answer. The answer lies within. It is a spiritual matter. So, in the face of the monster of dark days, how do we claw our way back:

  • Express it – in words, sculpture, painting, movement, song; run toward it, not away from it, since there is no way to outrun ourselves;
  • Embrace the beautiful – whatever you find beautiful, surround yourself with it; throw rose petals on your bed, open up all the shades and let the light stream in, play the music that creates pleasure, find fragrances that lift you, get a massage ( best from someone you love);
  • Act “As-If” – as if you are already beyond the darkness and out in the light, already embracing the wonder and joy of being alive, seeing yourself as strong, and as an artist ready to discover something new;
  • Adventure – plan an outing to a place you haven’t been, look it up online, read about it, visualize it;
  • Spend time talking to others like yourself – create or join a group of people who share the experience of these days of listlessness and inner pitch, talk about it all, describe it all, hold each other in a place made safe by authentic fellowship and friendship;
  • Examine it – with a professional who can engage with it as a matter of life’s complexity, not solely as a disease that warrants a bucket of pills, and who can join you in finding a new language to apply to acknowledging what you’re feeling without minimizing, labelling, making you feel small when you are truly grand, or merely getting frustrated when the challenge simply refuses to go away.

We have become an over-diagnosed and over-medicated society, and we’ve come to believe that we are our diagnoses. No! Hell no! It’s time to reclaim our souls. Enough already.

Look at the lives of the poets. So many of them lived complicated and often anguished lives, and they used their creativity to make beauty out of dark days. Look at the philosophers. Many found the courage not to run to pills, but to grapple, hand to hand, with the complexities of living. They were courageous in thinking through to all the edges. The answer lies in putting aside the belief that we are ‘”not supposed” to be depressed, to grieve, or be anxious, lost, and confused. We compound life’s real challenges by adding self-denigration and self-loathing to the mix. Let us find our voice with each other’s help. In doing so, life will still have its dark days, but the burden will be easier to carry.

The poet, Anne Sexton, beautifully captures the spirit that helps her work through her pain in the poem, The Fury of Rainstorms. She describes depression with such emotionally honest precision, along with the alchemical moment when she transforms it into a life-affirming choice.

First, she moves in, and then, she moves on.

The rain drums down like red ants,
each bouncing off my window.
The ants are in great pain
and they cry out as they hit
as if their little legs were only
stitched on and their heads pasted.
And oh they bring to mind the grave,
so humble, so willing to be beat upon
with its awful lettering and
the body lying underneath
without an umbrella.
Depression is boring, I think
and I would do better to make
some soup and light up the cave.

In the spirit of the Broadway play, it would be good if we all aspired to a life “next to normal.”

© Brother Anton and The Harried Mystic, 2009. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited.

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