Category: Depression

An Open Letter to U.S. Representative Jesse Jackson Jr.’s Mayo Clinic Physicians

~ Harlan Didrickson ~ 3 Comments

Dear Dr. So-and-So, et. al.:

I read with tremendous interest and a degree of de ja’ vu the front-page story written by Ms. Michael Sneed in the Sunday, August 5, 2012 Chicago Sun-Times which reported that U.S. Representative Jesse Jackson Jr. recently collapsed and had become completely debilitated by depression.  Upon reading the story, I experienced a staggering degree of recognition, for I too, have (and continue to do so) hit the same kind of wall as Representative Jesse Jackson Jr.: A crippling mental illness diagnosis, specifically major depression (changed later to Bipolar II) following gastric by-pass surgery.

The story reported that Ald. Sandi Jackson (wife of Representative Jesse Jackson Jr.) doesn’t know if her husband’s depression is connected to his weight-loss surgery.  As a person who finds himself in a very similar situation the development of major depression after elective gastric by-pass surgery) I would like to suggest that determining the cause of this on-set of depression is irrelevant and nearly impossible to determine.   Based on the past four years of failed orally administered pharmaceutical treatment attempts, I strongly suggest that you titrate the dosing levels of psychotropic therapies dramatically (50%-75% higher) or increase the potency of the psychotropic therapies to compensate for the substantial degree of malabsorption (the basic tenet of Duodenal Switch Surgery) caused by the significant reduction in stomach volume (up to 70%) and the dissection and rerouting of a large percentage of the small intestine (which is largely responsible for caloric absorption).  If the goal of the Duodenal Switch surgery is to limit volume and reduce absorption of food ingested orally, then common sense suggests that anything ingested orally will greatly lose its effectiveness (especially if the drug’s efficacy during clinical trials was based on subjects that did not undergo weight-loss surgery).  Except now we want the body to absorb what it’s ingesting!

I endured two needless years of trial and error attempting to discover pharmaceutical regimen which would lift me from depression and put a lid on my mania.  My psychopharmacologist knew I’d undergone gastric by-pass surgery a decade earlier yet refused to consider malabsorption as the cause of the ineffectiveness of every single prescription.  Frustrated by my psychiatric team’s myopia, I returned to the care of my internist; he was the first doctor to consider that my body’s ability to absorb oral treatments had been reduced by as much as 75%.  If an increase in dosage is impossible, then a different delivery system (IV, inhalation, transdermal patch, suppository) must be manufactured.   Please don’t waste Representative Jesse Jackson Jr.’s time prescribing the usual litany of drugs at their recommended doses: It’s akin to trying to stop a charging elephant with a water pistol.

Morbidly obese patients who were diagnosed as depressed and were being treated successfully through oral medications prior to gastric by-pass surgery discovered that post surgery their depression worsened and their pre-surgery oral medication treatment failed to reproduce the expected degree of pre-surgery success and relief.   Your patient is in crisis; your patient is experiencing a major depressive episode; your patient’s natural ability to absorb what he ingests has been compromised to the degree of ineffectiveness; your patient needs an extraordinary, preposterous, wholly unimaginable antidote, not a boilerplate solution. 

I salute the Jackson family for supporting Representative Jesse Jackson Jr. through this difficult period and wish them all God’s speed.

Called Life This Morn: Took A Sick Day

~ Harlan Didrickson

It took me much longer than I’d expected to find their number.  Having never actually called before, it took me a while to figure out how to reach them.  Liz, one of my friends who decided to resign all together said that they found her.  “Oh yeah,” Liz said, “as soon as I took the exit, there they were at the stoplight.  Waiting.  Walked right up, smiled like we’d known each other forever.  I’m thinking, easy-sneezy: this guy’s going to give me directions!  Then he pokes my shoulder and says “You didn’t call this morning,” he said sounding serious, “Why is it, do you think, that people don’t call?”  I said I just wanted to quit.  Figured if I never showed up you’d get the message.  Then we were nose-to-nose, “The only time I get a message is when people don’t call.  Then I’ve got to waste my time to come out here and drag you back. . .”  That’s when I became aware. . .aware of my failure. . .aware of all the facial. . .”

Liz never finishes that story; she always stops right before she describes her consequence, which is evident when you meet her, but of which she just can’t describe.  The best she can do is, “I avoid mirrors.”

Because I couldn’t find the number and when I did, I was still on the fence about calling and just punching in, I greatly increased my chances that someone would answer.  It’s Saturday I thought, maybe they’re off.  Slowly I dialed the number; by the fifth ring I knew I was in the homestretch and could leave a mes. . .  “Department of Human Services, Life speaking,” he said, and then repeated, “Human Services, Life speaking.  Hello?  Hello?”  Uhm, yes. . .Life this is T.M. Mulligan, I said sheepishly.  “Yes Mr. Mulligan, why do I have the pleasure of this call?” he asked.  I told him I was ill and taking a sick day.  “So you’re taking a day away from the human race, Mr. Mulligan?”  His interrogation could be found on any page of a dime-store detective paperback.  Yes, I replied, I’m just not up to the task today; not even the battalion of amphetamines could take command of depressions beachhead; everyone’s at a block party, my spouse made brownie’s, the dog’s been there twice already.  I just can’t go.

“Can’t be part of the party?  Rather be alone?” Life asked.  Today, yes.  Not every day.  Just today, I answered.  “How many people do you think call Time and tell her they’re taking off?  And Birth, do you think those kids call Birth and threaten a sit in?” he asked.  Well, I don’t think they have phones in there. . .  “Or Death?  Death never answers, and they don’t have voice mail; they’ve dumped their phone into a trash can and threw it in the closet.  But Life?  Life’s phone is always answered; even if I personally believe you could act as if you were having fun, you’ve had your share of suffering recently and, except for once in July, 2008 you’ve always managed to drag yourself out of abysmal despair and try to live life.  I’ll mark you down as sick today, and we’ll see you tomorrow?”  Yes, I stammered, yes I’ll definitely be in tomorrow.  “Until tomorrow, then.  By the way, I’ve sent you a little sunshine.  Good-bye, Mr. Mulligan.”

The line went dead and then the doorbell rang.  Cupped in the hands of a delivery person was the essence of Life: A bouquet of sunflowers.

The Rough Patch

~ Harlan Didrickson ~ 1 Comment

The thoughts washed over me like a warm dishcloth in the hands of my mother, softly scrubbing the days grime and grit away.  The thoughts brought comfort and tenderness.  The thoughts eased my anxiety.  The thoughts allowed deep breaths out of shallow breathing.  The thoughts had me wonder, “would anyone care?”  The thoughts came to me through cupped ears, uncertain of the message and always certain of the sound.  The thoughts came to me in hushed tones, as though they were being spoken in a pew in church, or a movie theatre, or a play.  The thoughts popped into my head like bread from a toaster, but with less fanfare.  The thoughts came to me like a piccolo in the distance or the bark of a dog through a curtained open window in summer, somewhere far away, present and avoiding distance.  The thoughts always came to me as I was thinking of nothing else, crept in like an intruder or a rapist.  But the thoughts were always the same, “it would be better if you were gone.”

When you live with mental illness, you also live with suicide.  Not as a threat, or a cry for attention, or a misdirected plea for help.  A life with mental illness means a life with suicide.  And thinking about it daily is a good thing.  For me (and many of my friends who live with mental illness), we understand the destruction, the collateral damage, the years of anguish suicide dumps onto those left holding the bag; this bag, now empty, once held a precious life to those it touched.  But to the person to whom it belonged?  It became too heavy to carry or too light to matter, too crazy or too solitary, too depressed or too manic, too congested or too separated, too observed or too ignored, too involved or too bullied.

To those of you without mental illness a word of caution:  Suicide isn’t the end.  Suicide is the beginning of horrific nightmares, overdue and now regretful answers to calls, lamentable hours sorting things which recently were belongings but no longer hold meaning, the gash of your disappearance which takes years to heal (if ever).  It will never be an answer: it can only be a question.

Journal Entry: July, 2008 (three weeks post diagnosis)

~ Harlan Didrickson ~ 1 Comment

After yesterday’s euphoria (the hopeful effect of an increase of medication), I thought, if this is the way I’m supposed to feel then I’ve been depressed for a very long time; I thought, if this is the way everyone else feels, then what have I been missing all this time? The grip of my obsessions were like strong hands around my throat; vaguely familiar hands determined; patty-cake hands.  But yesterday they loosened, fatigued by their own doggedness, they let go as a whistle floated past my lips like the sharp squeak of a slowly deflating balloon.  I saw light for the first time. There wasn’t that constant dullness. In one night my life had been rubbed free of tarnish and shone as though it were new: sparkling like a new silver tea service.
Last night was fitful.  I wasn’t sleepy when I retired though I was extremely tired and the meds kicked in rendering me dopey. I laid awake wondering when my eyes would close, wondering if the next day would see a marked improvement over yesterday. Once I did fall asleep I kept waking at two-hour intervals and needed to use the restroom. I awoke to the smell of fresh coffee which Nick was kind enough to brew, but I felt like the Golden Gate Bridge encased in fog.

Again, today was disappointing. I had blue moods; not quite the deep azure of days past, but not Nick’s sky-eye-blue either.  I felt listless. I pushed myself to work on my blog and again experienced difficulty in navigating through the myriad choices of photographs, layouts and information. I became exhausted quite quickly and felt tension in my head. I realized finally that though I had shown improvement, I was not healed.

I’m a problem-solver by nature and not prone to patience. Get them in, get them out. No problem is ever to great. I can solve anything. Except this damned disease! And it’s in a place I can’t see or touch or feel. It’s up there, back there, behind my eyes, under my scalp, between my ears. I can’t scratch its itch. I simply rub my forehead trying so desperately to relieve its grip like you’d soothe a Charley horse or tired feet.

And so I sit tonight again fearing my bedtime. Wondering if sleep will overtake me quickly as it did when I was a child. My mother used to tell me that the last thing you think about before you fall asleep is what you’ll dream about. I’ve been thinking of sunny days when I laugh and enjoy the loves of my life and am happy.  Disappointingly, the mornings have always come up a bit short.

Oomphlessness

~ Harlan Didrickson

It’s odd, this.

All my life I carried some kind of drive, as though the first-baseman-mitt-sized hands of a dad pushes a shy son to join the group; nudging, like the dog’s wet muzzle flips your hand like a pancake in order to be petted; knocked, like the brass-ring a toothless lion holds loosely between jaws, and which falls against a brass plate sounding more like the dinner bell than the formal announcement of a visitor.

This propulsion, like a jet plane, carried me to soaring heights where earth stretched like a night watchman and people, critical to life, shrunk so small so quickly that they hardly mattered.  Wouldn’t you think things of such importance could be seen from above?  Monuments can be seen; impact can be seen; destruction can be seen.  But people or their self-designations like importance or starvation or anger or bigotry or religion or anything, anything they’ve said or thought or threatened you can’t see.  You can see evidence, like ugly scars; at night lights dot the darkness like worn drapery holding back dawn, but some areas appear engulfed in flames, such a wide swath of light that I’d heard it told that the moon, once proud of its subtlety, is thinking of moving on, to Mars or Neptune maybe, a planet looking to adopt a real satellite, not some space junk.

The experts (who, self-admittedly, know very little about mood disorders, and even less about proper treatments) have identified this lack of oomph as a signature symptom of depression.  Ironically, the less oomph the more depressed.

Perhaps people have created a number of different systems all designed to manage oomph.  Clocks are oomph speedometers; birthday’s are oomph reminders; corner offices are oomph autobahn; retirement accounts are oomph cruise control.

Without oomph it would appear that I have no where to go and no reason to go there.  When you live with a mental illness you’re still in the same pool with everyone else.  It’s just that you’re knee-deep at the shallow end while everyone else with oomph keeps swimming back and forth and back and forth and will eventually join you here at the shallow end.  As they pass one or two might’ve noticed your inertia and may ask why you weren’t swimming, do you know how to swim, are you afraid to swim?

Oh no, I reply, I am oomphless; my brain doesn’t produce oomph; but in a world that places a high value on one’s degree of oomph, I think it’s better that I look like I have oomph because everyone that has it, is absolutely convinced that everyone has it, and those that aren’t using theirs are. . .

Are not oomphless.