Gradually and then suddenly

As I think about World Suicide Prevention Day, it’s in a fortnight, I can’t help but wonder how effective that initiative will or won’t be, and I’m drawn to recall Elizabeth Wurtzel’s dark and compelling work, her experience of depression. The World suicide Prevention Day site is rudely smiley and brightly coloured, it almost chuckles at me. The site irks me, as does the notion of a prevention day. Why link something that can’t always be conquered in weeks, months or even years with ‘a day’. Isn’t that a bit of whack for those who can be gripped with depression for endless periods? The notion of WSPD is all out of kilter, to prevent suicide wouldn’t we need to address depression first? I do acknowledge that depression is not the only cause of suicide but the major one.

Elizabeth Wurtzel doesn’t pin down a cause of depression, what she does is describe the burden, it’s overarching breadth and seemingly bottomless depth of the affliction. I believe understanding depression and people afflicted by depression, people Wurtzel describes as the walking waking dead, a greater priority than suicide prevention. To me, prevention is not a position to start from, it sets up an adversarial (helping?) relationship between preventer and the suicidal. Ready for battle? Building understanding is my preference.

This is one of Elizabeth Wurtzel’s descriptions of what depression can look like from the inside:

“… Depression is a lot like that: Slowly, over the years, the data will accumulate in your heart and mind, a computer program for total negativity will build into your system, making life feel more and more unbearable. But you won’t even notice it coming on, thinking that it is somehow normal, something about getting older, about turning eight or turning twelve or turning fifteen, and then one day you realize that your entire life is just awful, not worth living, a horror and a black blot on the white terrain of human existence. One morning you wake up afraid you are going to live.

In my case, I was not frightened in the least bit at the thought that I might live because I was certain, quite certain, that I was already dead. The actual dying part, the withering away of my physical body, was a mere formality. My spirit, my emotional being, whatever you want to call all that inner turmoil that has nothing to do with physical existence, were long gone, dead and gone, and only a mass of the most fucking god-awful excruciating pain like a pair of boiling hot tongs clamped tight around my spine and pressing on all my nerves was left in its wake.

That’s the thing I want to make clear about depression: It’s got nothing at all to do with life. In the course of life, there is sadness and pain and sorrow, all of which, in their right time and season, are normal — unpleasant, but normal. Depression is an altogether different zone because it involves a complete absence: absence of affect, absence of feeling, absence of response, absence of interest. The pain you feel in the course of a major clinical depression is an attempt on nature’s part (nature, after all, abhors a vacuum) to fill up the empty space. But for all intents and purposes, the deeply depressed are just the walking, waking dead.

And the scariest part is that if you ask anyone in the throes of depression how he got there, to pin down the turning point, he’ll never know. There is a classic moment in The Sun Also Rises when someone asks Mike Campbell how he went bankrupt, and all he can say in response is, ‘Gradually and then suddenly.’ When someone asks how I lost my mind, that is all I can say too.”

Prozac Nation: Young and Depressed in America: A Memoir, Elizabeth Wurtzel

A dear friend told me the same thing, gradually and then suddenly, that was her experience. In retrospect I can see the same in Mottsu and how he lived and left, it helps me to know that. That simple statement does more to encourage understanding and support depression than any number of world-wide prevention days.

Suicide toll on the front page?

The Australian of the Year, Professor McGorry, told the National Press Club last week that there were over 2,000 (and mostly preventable) deaths from suicide every year.

Apparently figures report that more Australians die by suicide than die due to road accidents. I am startled as I recall that suicide statistics are widely regarded as under-reported. It is accepted that many more die by suicide than is recorded, and the misrepresentation in reporting is largely for reasons around the unwanted stigma of suicide for affected families.

In taking to task the misguided reticence of newspapers to publish suicide statistics, Professor McGorry said “People aren’t aware of these facts and figures because of this shroud of silence over this issue.

I support Professor McGorry’s stance that, “It should be on the news every night. There should be a toll on the front of every newspaper, every day.”

In effect someone dies of suicide every four hours, the real hidden toll is the destructive affect on family members and friends. The more we talk about suicide the more understanding can be shared and the more support and treatment options can be openly discussed.

“May you live all the days of your life.” Jonathan Swift

The right to die

She can be like a storm, today she is a strong and raging storm. The strength is inner fortitude, the rage is anger. The characteristics unleashed today as a perfect storm have brewed a lifetime.

She’s angry and raining down tears. She want’s to die, she’s had enough. She has been in hospital for 7 weeks. The operation was this week, she feels worse than before, the patient has lost patience…

Dark clouds circle and our non-linear conversations span hours.

It was a success, says the doctor.
She says “I can’t bear it any more.”

“Tell me one thing that’s good about me…”
I tell her ten.

“Get a nurse ask them to give me something, please help me end it.”
The nurse can’t do that, it’s illegal.

“It can’t be illegal, please tell the nurse.”
A nurse comes, not on her shift she explains. That isn’t why she studied nursing she claims.

“You wouldn’t do this to your dog. You wouldn’t keep Shortie alive, you wouldn’t do this to Shortie…”
I wouldn’t, and I plan to make sound decisions for Shortie’s end of life when I need to. My Vet, her doctor, will support my choice.

“I have nothing to live for”
I tell her I love her.

If you love me, do this one thing for me. Go upstairs and tell the doctors I can’t bear this anymore.”
No.

“Please ask the doctor, I don’t want to live like this. I can’t.You have to do this for me.”

Three doctors came by and try to placate her. They named her state ‘delirium’. One doctor told her she is much better. “No I’m not” she wept. He told her that’s because she can’t remember how sick she was before. The doctor’s left.
She was not calmed.

Hours pass and her anger doesn’t subside. She is distressed, she hasn’t planned her funeral, she’s not prepared. We plan it together. No flowers, no music (really, not a note of a threnody – I couldn’t convince her), no church, a simple casket. Cremation.

I promise.

She’s ill and apparently gripped by delirium. For days, she rages, argues, begs, entreats. I would say she was beside herself, only it was more like she was inside herself.

She is despairing, her frustration with her illness and the medical system manifests as helplessness and is expressed as anger.

Gradually the storm subsides and she stops speaking of dying. I buy her cakes, tiny petit fours, sweet things to enjoy. Normalcy reinstated, we talk of cabbages and kings. Looking through the window, we marvel at the sunshine occasionally breaking through the clouds.

The doctor had said she was delirious, was it the subject matter? Do we need to be delirious to speak of dying, to not want to live beyond an existence that can be enjoyed?

Voluntary euthanasia and assisted suicide are illegal in Australia, no-one can be helped to die. Life itself is a fatal condition, and untreatable. I want to be permitted and trusted to make an informed choice. To say ‘when’ for me and for those few who who trust me with Medical Power of Attorney. I already make those decisions for some I love best.

I do want the choice to be within my power, to die quietly with medical assistance, when it is my time.

Beyondblue neglectful of gay youth?

A story that saddened me was published today in The Age on-line:”The national depression initiative beyondblue has been called negligent for ignoring gay and lesbian young people in new guidelines to help doctors diagnose and treat depressed teenagers.

The agency’s 127-page document includes just two sentences about gay adolescents, although their rates of self-harm and suicide are up to eight times higher than those of heterosexual teens…”

That’s after assuring lesbian and gay groups, earlier this year, that beyondblue had not abandoned them.

I know there will be more to the story than has been reported, I only know what has been reported.

beyondblue say that “Depression and anxiety can affect anyone, anywhere, at any time” so it is doubly distressing that beyondblue has been accused of being “”incredibly neglectful” for failing address the particular needs of a (more) vulnerable group.

Situation not good enough, and I know I just finished saying that we each do what we can, I know that and I am trying to believe that good intentions are enough, but not always and not today.

Bring it on world 2

I mentioned feeling invincible, it happened.

I went on living, kept breathing. I didn’t crack up and quit. With that came a sense of wonder, a sense of boundlessness.

It wasn’t like having super-powers but I did have an unusual sense of safe.

I was working in Tampa, Florida as hurricane Charley approached. There were warnings and mounting concern, the almost 400,00 people in the area were advised to evacuate. I decided to stay. I envisioned standing by the quay, leaning towards the sky, lashed by wind and rain. Defiant.

First the office closed and everyone was required to go home. I thought I could ride out the storm in my hotel. The hotel closed, I had to check out. By the time I arrived at the airport there were actions afoot to close that too. So much for pitting my self against the elements.

I made arrangements and brought my flight across the country to Portland forward a few days. The airport was crowded and filled with nervous energy. I was bemused, feeling cosseted from the building threat. It was odd to feel so removed.

I think that facing down the wind would have been and expression of the anger I hadn’t felt thus far. Good old stage 2 of grieving full of anger and resentment could have manifested, except that I had to leave town.

It’s to die idiom

“Also, it is to die for. It's extraordinary; it's deeply appreciated and/or greatly desired. For example, Her performance, it's to die! or That mink coat—it's to die for! This hyperbole is usually put as an exclamation. [Slang; 1970s]”
http://www.yourdictionary.com/idioms/it-s-to-die

Now, if you are a mink that contributed to the aforementioned coat, then the statement is true rather than an idiom. I know, I know, it’s not meant to be taken literally.
It’s an i-di-om (id-i-ot)… I tell myself.

The phrase raises my hackles (or they would raise if I had hackles). I simply don’t like how it trivialises what it might be worth dying for. A promotional email, received today, talked about an upcoming film, Fantastic Mr Fox, mentioning that “The production design alone is to die for.” I don’t think so Palace Cinemas.

I do note the rise of disparaging anger, along with hackles, I’ve added a new tag to these posts ‘Anger’. Seems the emotion must have been here all along. Sorry Dr Kuebler-Ross, for claiming not to get angry. I do experience anger and with a capital ‘A’. Anger is secondary to my everyday identity, a little quashed and now it pops out inappropriately in disparaging posts.

Anyway, my point is made, to die for is not a way to describe a film’s production values, nor a cheese cake, it’s not, not, not…

Displaced Anger

I am still pondering on Stage 2 of Grieving. The stage about Anger and Resentment, how I did and didn’t experience anger.

003
Dr Kubler Ross suggested that Stage 2 is characterized by fury at whatever caused the loss and that I might find myself enraged at the world. I don’t know about enraged with the world but there was a moment one evening when I was outraged/enraged by a friend of a friend. I think it was displaced anger, something undoubtedly well intended that the antagonist, Mikey, said ignited instant sparks of temper.

Mikey was someone I didn’t know very well, but had known over a long period. A friend of a couple of friends. In the early days of my aloneness he had suggested that it might be nice to catch up occasionally to go to the movies, an outing usually enjoyed more with a friend than on ones own. I was enthusiastic about the idea, I was keen for company, and Mikey would have been company. Time ticked by and we didn’t made it to the movies, one never made a call to the other.

The mutual friends, Mikey and I went to dinner one night. We dined well, we shared banter. I was a little tetchy and sensitive, it was becoming my modus operandi, wounded, prickly and defensive. 004Nonetheless we enjoyed the evening, but we didn’t linger. It was a work night, each had to get home.

We stood in the street to say our farewells. That’s when Mikey made his offer, in a moment of unprecedented and unparalleled chivalry Mikey asked if he could walk me to my car. Anger ignited and I held it in, smiled, shook my head, and walked away fuming. Furious with (possibly) displaced anger.

Here I was coping, grieving, taking my bins out on the right night of the week, alone, bereft, abandoned and often longing for company. Of all of the things Mikey could have offered to do, walking to my car was the least of them. I did it all the time, walked myself to my car, I mean, – a necessity.

He could have offered to change a light globe, clear the gutter of leaves, mow the grass, chat over lunch or go to the movies with me. Walk me my car? I was angry hurt and scornful, I haven’t seen those friends again. Long story, the loss of a player in our relationship(s) was too much, we didn’t ever recover (maybe it was me and my scatter gun approach to expressing anger).

I walk to my own car. I always did. I felt anger too, from time to time…

Where could 10,000 Frequent Flier points take you?

There are lots of obvious reasons for not mailing people who aren’t alive. Mottsu still gets regular mail from his Credit Union, his bookie, and a couple of vineyards whose mail lists he signed up for. He doesn’t respond, hasn’t for years, neither do I, and the letters keep coming… Apparently mail lists can take a while to catch up with departures.

He also gets gas bills, I don’t mind paying those after all there is no denying it’s me who uses the gas. I do mind that I can’t easily get the account transferred into my name. Some organisations make it difficult, wanting documentary evidence of a person’s passing. Do they even think about what it might be they’re asking for?

A death certificate can be a messy document. A death certificate lists the cause of death, as determined by the coroner. In this instance, at least, it’s truly more than the gas company needs to know. I don’t necessarily want the grim details of Mottsu’s demise on file at the gas company. Instead of me proving their customer is dead maybe they should prove he is alive – or do they take payment of his bills as proof? Perplexing.

I opt for the path of least resistance and leave the account in his name.

003 Recently an offer from a bank and an airline arrived. I think it was offering my dearly departed a credit card. The bank was one he didn’t bank with, so maybe the contact details were generated via the airline’s customer database. The envelope annoyed me so much that I didn’t open the letter, it still annoys me. The front of the envelope boldly asked “Where could 10,00 Frequent Flyer points take you?

I don’t know what perturbed me most about the question posed on an envelope addressed to a man who has been dead for over 5 years. I think it was the ridiculousness of the question; phrased to evoke a dream of flight, that angered me. I was exasperated, and wounded too, the junk mail came through the slot in the letter box and slipped right through my protective armour. Stupid unanswerable question…

I can’t reach him with a million Frequent Flyer points and I can not imagine where 10,000 points could take him. Honestly, I can’t imagine where he’d want to go if an airport were handy. Maybe the answer was inside the envelope, I didn’t look.

Anger, it seems I do have some tucked away.

Stage 2

The second stage of grief as Dr Kubler-Ross describes it:

Anger and Resentment: “Why me?”
This stage is typically characterised by fury at whatever caused the loss and you may find yourself enraged at the world, at your higher power, at yourself, or at that which was lost. Nevertheless, this outcry should be accepted and not judged because it is part of the process of working through grief.

The second stage of grief as I experienced it:

Guilt and self recrimination: “I did it”
If you don’t really understand what happened (I don’t) and you’re left behind (I am) then it is sort of inevitable (I think) that you’ll feel a little responsible. There must have a thousand things I could have done to help him and maybe ten to save him. The guilt was punishing and I felt I deserved it. The beautiful life I had lived was gone. Endless rounds of counselling and therapy achieved small improvements and hoards of psychics were consulted for good measure. A future must be possible even if undeserved and I wanted a future.

Sadly the world at large look for your experience of anger as an indication that you’re progressing through the stages. “Are you angry yet?”

I was often asked that question and I did have to wonder what or who I would be angry with… Mottsu and his altered state? It was impossible to judge his actions by our everyday rational standards.

” Angry? Oh…. Do I have to be angry? Is it really required?”

I didn’t get angry, apologies Dr. Kubler-Ross.
Sorry Mottsu, I was never good at angry, and now what would it have changed?

Anger was just too hard, I didn’t have the resentment or the energy, and anger would have felt like blaming. I was determined not to blame…

I still hold that determination, without anger.