August 2014 – Life and Lims

One of Robin Williams’ final gifts? Getting us talking about mental health

I love this tribute to Williams by Disney.

Four days after the devastating news of Robin Williams’ suicide, I’m still feeling the loss of someone I never even knew personally. Perhaps it’s because his genius acting work has been a part of my life pretty much ever since I can remember (oh, yes, I was watching when he first hit the airwaves with “Mork and Mindy”). I can mark important times in my life with what movie he was doing at the time; for instance, my husband and I saw “Aladdin” on our first date nearly 22 years ago. Even now, our family quotes from that movie.

But another part of the reason this event has affected me so deeply is that it strikes close to home. I started this blog to write, in part, about mental illness, to just put my own experience out there. And Williams’ death has had me thinking a great deal in relation to how I can understand it and how I want to be able to continue to share my feelings with others. There have been some poignant tributes and some spot-on blog posts and articles about suicide, about depression, about the almighty struggle some experience with their mental health. I don’t think I can do any better, but I can just share my viewpoint.

Just a few weeks ago, I participated in a study focusing on cognitive issues in women who have breast cancer (I was part of the control group). I was happy to do my part for science, even if I had to drive a few hours away to get to Stanford University. Since the study is looking at cognitive effects of cancer or the treatment for it, it included questions and assessments not only about impairment of cognitive processes overall but also about emotional status. Since I had indicated on the questionnaires and intake forms that I take medication for depression, the researcher who worked with me asked me at the end of our time a little bit about my feelings and opinions on it. She said she focuses on psychology and has noticed in her time studying it that there are still not nearly enough treatments available for depression and other mental illnesses. Some people in the blogosphere and media have wondered why Williams, for example, didn’t just “get help.”

Here’s the sad truth: there isn’t nearly enough adequate “help” out there, whether it’s in the form of medications and other medical interventions and treatments or it’s in the form of professionals and non-professionals who really are good at what they do and can give superior guidance.

There is still an epic shortage (in my experience and opinion) in the number of qualified professionals who can treat people from all economic and health-care-coverage situations. This is particularly true in the case of the number of doctors or other practitioners who specialize in and are licensed to provide medications. In my experience, for instance, there are three psychiatrists covered by my health insurance (which might also be the total of all the psychiatrists in my city), and only one is taking new patients. That one I didn’t particularly like, and it’s crucial to have a certain level of rapport with someone who’s treating you for your brain chemistry. So I was lucky enough to hear about another provider who ended up being a better fit for me, but her office is an hour’s drive from my home, and her practice is not covered by my insurance. I am also lucky enough to be able to afford paying out of pocket for her care. But what about those who don’t have insurance at all, who can’t afford out-of-pocket costs, who don’t have access to transportation, etc.? There are a LOT of people not being served.

Then we move on to the issue of actual treatments available, even when one has unlimited access to doctors, therapists, and whatever medical intervention is available. And as the researcher and I discussed a few weeks ago, there are far too few options. I’m on an antidepressant that’s worked well enough for me the past couple of years to get me to where I can cope adequately with life’s challenges without being taken down completely. But there have been times medications weren’t doing enough for me, and it was hard.

There have been at least the number of times I can count on one hand, and possibly up to two hands, moments I’ve been in the blackest and deepest abyss and felt suicidal, even if it was only briefly. And I could go on and on about how if you haven’t been there, you can’t possibly know what it’s like. Logically, in a part of my brain, I knew I didn’t want to hurt my loved ones, didn’t want to deprive them of me. (That’s addressing the “selfish act” observation…) But it was a very distant part of my brain and one that was clouded over by the overwhelming despair and hopelessness of my feelings. As I’ve written before, it’s those times and others that I now feel my brain chemistry betrayed me. And it’s a very weird, unnerving feeling to have your brain working against itself and yourself. Even though I could logically call to mind times I enjoyed life and felt fulfilled and useful and vital and important to others, to the world, I just didn’t FEEL it. And it became impossible to imagine or believe I would feel that way again.

No amount of love and support and encouraging words from others (assuming the best, that one does have that kind of support system — believe me, there are plenty who don’t have that, making things even worse) can make that feeling go away. If your brain chemistry is off, it’s off. And that’s why we absolutely MUST find more options to treat that chemistry. There are far too few options now.

I appreciated this one article on Mashable, for example, that asserted, “Finally, We’re Talking About Mental Illness Like Adults.” People have generally been very thoughtful this week as they’ve discussed Williams. I sincerely and strongly hope that this discussion can continue, that a few important good things may come from this tragedy: 1) Let’s stamp out the stigma for good. Let’s work towards a culture in which people who experience any kind of mental illness can talk openly about it without fear of being judged or misunderstood or mistreated. Let’s make it as easy to talk about as any other illness that’s more “physical.” 2) We need to push for more research into more varied medications. There are a number of drugs out there (but not nearly enough) that are made for the treatment of mental illnesses, but a lot of them are similar to each other and work the same way. Pharmaceutical companies need to branch out and work on far more kinds of medications that attack mental illnesses in different ways, from different directions, etc. 3) We need more doctors. We need more prescribing practitioners available everywhere to everyone. This will not only be the kind thing to do, but one that will contribute to reducing many other existing societal problems: homelessness, joblessness, some violent crimes.

These aren’t easily attainable goals. But we certainly need to work towards them. It will make a world of difference to millions.

Rolling on in to middle age

Recently I took my girls roller skating. The 12-year-old had been going somewhat frequently of late and had gotten pretty good but the 7-year-old and 15-year-old (my child with Down syndrome) hadn’t been in ages and were like baby deer out on the rink. But they got better and enjoyed themselves during our two-hour visit.

As for me, I love donning the wheels and racing around the rink. It was my weekend social activity when I was a tween, and decades later, I still can hold my own. It’s an interesting/frustrating kind of challenging to “race” around when the rink is full of little kids — it’s like a slowly shifting obstacle course. So I was excited when the DJ announced it was backwards-skate time. I can still do it, after all these years, and since most of the little people jamming the floor could barely move forward, let alone go backwards, the time meant I had a much emptier space for skating. Yes! Only difference at this stage in my life is that I wasn’t just focused on my skating: I was also looking around to see where my kids went. And that meant loss of focus on the specialized form of backwards skating. As Queen sang so often when I was skating socially, I bit the dust. Big-time. And falling when going backwards means a particularly spectacular, unbroken-by-arms fall. OUCH. I got up and kept on going and my lack of focus had me back on the hard floor pretty quickly. I could feel my brain shaking around in my head, so I decided it was time to remove myself from the floor for a while.

A little while later, my perceptive and sensitive 12-year-old looked at me with concern and said, “Mom, people were laughing at you.” I realized then that it just didn’t matter. It didn’t bother me at all. I told her so. Maybe it’s because they’re a bunch of kids and it doesn’t matter to me if a bunch of snotty kids are laughing at me, or maybe I’ve finally started reaching a point where it doesn’t bother me quite as much what other people think. I just told my daughter, “You know what? It doesn’t matter to me. I was having fun. Don’t you worry about what people think about me.”

It’s made me think more about how I’m at an age where I can and should stop worrying about what other people think. I’ve read so often about how older women say they live so much more freely and contentedly because they just don’t care about how they look or what other people think, and it seems like a great thing to me. But as our society holds on so tightly to youth and beauty, allowing/encouraging women my age and even into their 50s and 60s to still look “traditionally” young and beautiful, i.e., desirable, sexy, etc., I wonder if that transition into that delightfully free mindset will take even longer.

‘Cause here’s the thing: how long do any of us really need to be beautiful, to have that be one of our defining characteristics? On one hand, I felt uncomfortable in my skin, didn’t feel thin and pretty, when I was growing up, but then around the age of 17 or so I grew to appreciate that I was attractive, that a fair number of guys considered me pretty. And I realized I could use that, I could “work” it. I could flirt, I could be cute and attractive. I could just have fun dating. My attractiveness was a tool, one of the arrows in my quiver. The quiver also included my smarts, my talents, my wit, my personality, my character. But my “beauty” was almost of equal value at that stage in my life as any of my other arrows. I carried around that awareness of its presence for a long time, even past its “usefulness” in “securing a mate.” (That’s a topic for a whole other blog post, methinks.) Two decades into my marriage and my parenting life, it’s honestly just not necessary or important, definitely not like the other valuable arrows I have cultivated. But everywhere I look in our society, I still see messages that tell me my beauty should be treasured above all, should be curated, should be preserved. There are plenty of options for that preservation, after all, and whole multi-billion-dollar industries begging for my attention and money.

No, society today is not at all supportive of a gracious and peaceful acceptance of aging, of losing youth and “beauty.” We don’t get to just comfortably slide into older age. We fight it, we see others fighting it, we are encouraged to fight it. But eventually, whether we get to slide comfortably and willingly, or we fight it the whole way, all of us who make it to old age will be old. We will lose our youthful appearance. What if we actually just accept and embrace the inevitable instead of fighting it tooth (yellowing) and nail (thinning and cracking)? What if we came to appreciate all the other things that make us who we are and stop worrying about the thin veneer of attractiveness, of appearance? What a world that would be! Think of the inner peace! Think of all we could do in the world without using up our (yes, finite) energies on something ridiculous like how we look!

So I’m encouraged a bit by my reaction to my ridiculous-looking falls at the roller rink. Maybe I am just starting to accept the fact that I’m middle-aged. Maybe I’m starting to not worry so much about how I look and how I think others think about me. Maybe. Because I’d like to use my limited energies on the things that matter the most to me, and there are lots. My family, my friends, worthy causes deserve my full attention. And all they need of my appearance is my smile. I still have that, and the only thing I need to do to keep it in top condition is keep using it.

Book endings and authors’ obligations to readers

Deborah Harkness provided me some useful information but no answers.

It’s been several weeks since I finished reading the final book in the “All Souls” trilogy by Deborah Harkness, The Book of Life, and after writing a few reviews of it for various sites and chewing on my ideas for some time, I had the opportunity to attend Harkness’ book signing in San Francisco a couple of days ago. After asking the author two questions during the open Q&A and then one “spoiler” question while she signed my books, I still have mixed feelings about how the series concluded.

I’ll just say that this observation is a little spoiler-ish but not in detail, so if you have not read the final book, then skip over this paragraph: I felt that many of the questions I had about Ashmole 782, the elusive and strange magical manuscript introduced in the very beginning of A Discovery of Witches, were not answered. And while some of my questions may be just “my own” or somewhat indirect, some were directly brought up by the characters in the book quite early on. And THEY WERE NOT RESOLVED. ARRRGGGGH. Considering that this was a huge part of the plot of the series, I felt gypped as a reader (of 1700 pages, no less) that they were left open. Talk about unsatisfactory. So I asked Harkness this: “Do YOU know where the book came from, who made it, etc.?” And she immediately and firmly responded with a “yes.”

She KNOWS, and she did not tell readers? Whaaaat?

Harkness told me this: “Everything readers know in the book comes from the point of view of Diana and the other characters. She doesn’t really know (at the end of the series) yet the answers to these questions, so readers don’t.”

During the hour of the author reading from the book, talking about it and herself, and then doing Q&A, she said a few things that are relevant: One, she really intended to keep the series as a trilogy, so as she explored the story while writing, she had to limit herself so it wouldn’t get unwieldy. Two (and I’m piecing this together a bit), I think she said, essentially, that anyone’s full story is never contained in a book. Things happen before and things happen after. The book is then a part of the whole story. And (after someone observed that the last book was the darkest of the series) she was trying to show what happens in a relationship after the fun, easy, falling-in-love part, where it gets trickier and is more work, and so on. So I’m going to extrapolate that she doesn’t intend for her writing to “tie everything up in a bow” at the end. But the part of their lives that is the pertinent story is captured and pinned down a bit within the pages of the series.

Now here’s where this gets interesting. Some readers can get up in arms when a story doesn’t end the way they expect, or it doesn’t end “happily” or it doesn’t tie up all the loose strings. And it may show a sign of reader immaturity when one gets mad that a story doesn’t end with a happily ever after — life, after all, is never that simple and “satisfying,” and books are best when they reflect the messiness and realities of life. So at what point should readers rightly expect some kind of conclusion?

Here’s my take: it depends on the type of book (genre) and how thoroughly expectations were set up in the book and plot. In a mystery, for example, it’s understood that various disparate elements are going to be introduced and then the mystery “solved” at the end, with those elements put together in certain ways to provide a satisfactory ending, leaving the reader with the “aha!” feeling of “That’s why all those items were important.” In a memoir, one may fairly reasonably expect the author to recount parts of his or her life that relate to a certain theme, a story arc that includes pertinent facts, experiences, and observations, because it would be impossible and undesirable for that person to just sit down and write everything that’s happened without giving it shape, form, or meaning.

Regarding the expectations, if a few things are simply mentioned as facts that might give a better idea of characters’ personalities, motivations, expectations, development, etc., they don’t require further attention by the author. But if the book frequently mentions certain plot elements and has the characters and readers questioning them as a large part of the book and plot, they need to be answered.

In the case of the All Souls series, as Harkness put it in her talk, the three “main characters” are Diana, the historian and witch; Matthew, the vampire and researcher; and Ashmole 782, the manuscript. Since she herself said that explicitly and since all of the book’s promotional materials and synopses focus on those three characters, one rightly expects to get questions answered about them. We learn quite a lot about Matthew and Diana’s histories (where they came from), their personalities, and their fates. We don’t know all the details about what will happen to them in the long term, but their stories as presented in the books are concluded well and make sense. But Ashmole 782, as a “main character,” gets short shrift. We know where it ends up, but we still have no idea where it came from and why. I appreciate that Harkness says readers only know what Diana and the other characters know, and that she had to keep the series to a manageable size, but I still feel she did not do her job as an author and conclude that part of the story. If she had to cut out other things to still keep it manageable, or if she had to make it a little longer so readers could come along to the point Diana knew more, then so be it.

Harkness did make one comment that gave me some hope for future satisfaction: I said, “I’d really like to know what you know!” and she responded something along the lines of “You will.” But since she said she won’t be writing more about Diana and Matthew, but may revisit the “world” of the books to explore other characters and stories, I’m not sure how that might come about. So we shall see.

What do you say? How much should readers expect in these situations?