Depression and Lithium

All over now: Foreman's voice commands you to surrender, not only the present but the past. "You were wild, you were wacko, you were high as a kite.'' How the hell does he know --- isn't Sophie his only source of information? But he's the doctor you've come crawling back to at sixty dollars per half hour. For these endless reproaches, couched in clinical terms like "psychotic break" and "manic episode," the phrase suggesting a rat at the end of a pincer. "You were just uncontrollable, you drive everybody up the wall, you've gotta realize that. You had all the people around you frantic --- they just didn't know what to do with you." He looks to Sophie; he has ordered that she should come with me today, his witness.

She says nothing; he speaks for her, though he was never there himself and must go by what she told him on the telephone. Months ago, when I stopped taking lithium and went mad, when she pleaded with me to go back on it. That failing, since I refused, she called him for advice. "You should have been institutionalized right then --- as a matter of fact," he thunders.

This is my arraignment. I must be made to admit my crimes before a witness now. I admitted them last week. Why again? Why before Sophie? Even coming here was admitting all: he was right, I was a manic-depressive, had the disease, was its victim, desperately needed his cure. Two appointments later he decreed I bring Sophie. It had pleased her that I went to see him but she had little relish for seeing him herself. She is here unwillingly.
Again he looks over to Sophie. "She was all over the place, wasn't she, last summer?" Sophie nods, deeply embarrassed, her slender arms on the chair rests, her face looking straight ahead. How she must dislike this American emotional vulgarity. Not that Foreman is of our sticky therapeutic "inner feelings" school; he is biochemical, crisp and pharmaceutical. But he must establish the insanity in order to effect his cure. So that I will never stop taking the medicine again, so that I vow and vow again I am the prisoner of an illness, and this its cure. Sophie's face stares straight ahead; I see it out of the corner of my eye from the chair where I am placed. She is here to be sealed into complicity; like a contract, she is hereby being enlisted on the side of the cure, adjunct to the doctor in watchful control.

Does Foreman wonder how long she will be with me? Coming over here, I had the impression this might be the last time I'd see her. Manics always lose their mates, Foreman has given me to understand. Abandonment is the customary punishment for them. No one can put up with a manic, he assured me. And once it's over and you're depressed and diagnosed and repentant, husbands and wives and lovers depart anyway. The damage is done. This pattern is an established fact. So in front of Sophie I am convicted again. All her own sayings are evidence now: her complaints, her fury against me.

I would only complicate matters by pulling my oar and remarking that she was as irascible as I. Why delay the process? I fervently want this interview to be over. Today is the special appointment, the one to determine whether he will truck with me at all. For three weeks I have been on trial, but he is still reserving judgment.

I hear the verdict now. It seems I am a dubious ingrate, probably not worth the effort. This doesn't bode well for recovery; I may be abandoned to this disease. I who was once the star patient at the university clinic, invited to benefits that raised money for its continuation. A well-known figure they could point to, though, thank God, they didn't.

Foreman has his own fine practice now; I am expendable. How prosperous he is, how secure; no blight will take him off, no misfortune strike him. He will go on making more and more money, become more and more entrenched as an authority in his field, rise higher and higher in psychiatric circles and university tenure. In his beautiful clothes and surroundings. The walkie-talkie on his belt: he is so busy, so needed everywhere. The sixty-dollar check I will write in ten minutes will have to be covered first thing tomorrow morning. I am the end; he is the beginning, the future assured. I hate him at this moment, find his bullying beyond anything called for. Sophie trembles.

"You've got to admit the state you were in."

"I've admitted it," I say, my voice as crumpled and inaudible as I am, making no difference at all. The question is still one of my worthiness: "Because there's something else I have to tell you --- so I waited till she was here," he says, nodding to Sophie. He addresses everything to her; they are the adults, the sane, the whole and hale, his figure vital and energetic in his beautiful suit in his beautiful big chair. A pronouncement is about to be made .

"You have to quit drinking," he announces dramatically.

"But I don't drink," I protest. Surely not as he means it; this drinking business is one of the libels against me.

"You were drinking plenty last summer, don't tell me you weren't."

"I probably was then." Under stress, under attack. "Yes, I suppose so." I have drunk martinis most of my adult life, ever since graduate school introduced me to them; the rigors of Columbia and two hours in the subway made them a necessity I have since enjoyed as a pleasure. A martini before dinner, one of the solaces of life. "But I am certainly not drinking much now. A martini before dinner and a glass of wine with the meal --- is that drinking in the sense of 'She drinks, you know,' or 'The problem of her drinking...'"

"It is." He is passionate now; he is doing autopsies at the university, he and his colleagues. And they are coming upon great kidney damage in lithium users.

"If you weren't taking lithium you could drink your head off, you're healthy enough. But not with lithium; you cannot take lithium and drink, you absolutely can't--you should see these cells." Next we begin on the brain: alcohol destroys the brain as well. One shouldn't drink anyway; he sounds like a teetotaler now.

"Do you drink?" I ask him, irrelevantly, trying somehow to dispel the atmosphere of prohibition. Surely drinking is a part of life, a happiness, not a contagion of devastated cells.

"Socially," he says.

"What does that mean?"

"When you go to a party you have a drink. You could have a drink once in a while on social occasions --- but you're going to have to give up the martinis. Forever."

A little nervous laughter all around. "It'll hurt, sure. Maybe it's part of your life, but you cannot, you absolutely cannot, continue if you want to take lithium. Not if you're going to be my patient. There are other guys will dole it out to you no matter what, but not me." Not him, he has rules. I almost like him for being so fierce about this. I also think that he is pompous and impossible and his method of telling me this is obnoxious. It would be very simple to describe the autopsies and the results of lithium on the kidneys, and then urge a conclusion.

The drug is still new enough that there is little evidence of its effect over a long period of time. Sophie need not have been summoned to hear this. I am the more humiliated for getting an alcoholic's lecture in front of her, not being an alcoholic to begin with.

In fact, when we finally hit the door of the our next stop, the blood clinic, safe beyond bureaucracy and institutionalization, coercion, conformity --- all of which have taken their toll on Sophie --- our first and concerted thought was to find a bar. "It's terrible, of course, but it seems so necessary just now." We giggle, sitting down in the Chelsea, a first-class drinking establishment. She has even telephoned Marcy from the dispensary, as I have called Monika, both of us creating this time and this place for ourselves, carving it out of the others. We will buy a chicken and a log for the fireplace on Fifteenth Street. But for now what one needs is a martini, and some scotch for Sophie.

"Will you give it up, what do you think?" Sophie sips her scotch.

"Wasn't he awful?" She shakes her head in bewilderment.

"I had no idea he'd be like that."

"And that place, my God, that place." She closes her eyes. Probably the people got to her too, the sad-faced patients, the despair in the waiting room: the hush before the throne: the gorgeous bourgeois fittings paid for by the sufferers. I had been embarrassed sitting with her in the waiting room, embarrassed to be one of the mad among the mad before her uncomfortable gaze. And when admitted. to be flagellated by the doctor for mania, for the sins of the summer, naked before her eyes --- at that moment finally she was no longer accusing. He did it for her. All her own insistence that my behavior was outrageous, tainted, unclean: now when authority shouted it, heaped me in obloquy for my sins, I could see her soften, even wince.

I have assented to something infinitely demeaning, which she has been made to watch; in a certain sense, we have been had, both of us. The relationship between us, this vulnerable bond, has been pried open, invaded by another. Not the usual appeal to legal mates and relatives. Two women: fragile, unacknowledged. To keep her, I have accepted her as keeper. He has sent us away to "think about it." It never occurs to him that I give him no argument or reasons of my own, pretend to agree, only because I want a prescription. Months ago, even weeks ago, I would have denied all that stuff --- it would have been my word against Sophie's. But then I wouldn't have been in his office begging him for lithium.

§ § §

In this bar we are only at the beginning, with the surrender of the martini --- following upon the initial surrender, the resignation of self back to psychiatry, independence relinquished for medication. And now I must submit everything, beginning with this by no means small daily sacrament of light: the clarity in the glass at evening, the float of joy in a summer sunset --- the whole Atlantic is in its clarity, I used to think. Making drawings, abstract spatters and brush lines, homages to the martini. Even drinking a martini while drawing, the first half a very productive tonic.

Though I tell myself I will not give up my martini life, my carefree-artist downtown-raffish talker-of-an-evening life, I know I will. I am furious he can dangle the drug they say is the only thing that can cure me, dangle it before my eyes --- and then pull it away on the strength of a martini. Beyond question I'd miss it: my way of life a long day's work that led to the happiness of a snifter of ice and lemon and the restful gin before a fire in winter, before the pond in summer. Days when I could work and had a life. Now, in the vacuous nowhere of depression, a drink can still call the end of a day's panic and dread; food, a fire, some solace. Now there will not even be that.

Why do they put you on this stuff before they realize it may eat out your kidneys, the lithium lodging there and retained by alcohol? Side effect after side effect. Autopsies, the gray, hard bodies of the dead. It's all gone anyway. What the hell. Even Sophie is gone, lost to me. But tonight I have her, depression at bay for a moment as I go for our supplies, the log we have just enough money to buy after the chicken at the store around the corner. Just tonight. Like the last drink.

"What are you going to do, have you decided?" That insistence of hers.

"I guess I'll have to quit drinking martinis. And I think I'll quit Foreman as well."

''Where will you go, then?"

"Maybe I'll try to get in the clinic at St. Vincent's." I do the impossible, almost deciding something out of the chaos of indecision I live in now --- seeing the corridors of St. Vincent's before me, charity hospital of the poor, all I can afford and so much more agreeable and honest than where we were today.

Driving over to her place, I thank her with some dishonesty for going with me today, for sticking by me. I ignore her crossness, her bitchiness as we near her house --- a fury emanating from her having a date she cannot keep tonight, or as she calls it, an "appointment" with Marcy. Tonight she has elected to spend the evening with me out of pity, or goodness, or maybe even preference. The scale between me and my rival tips one way or another from day to day. The very situation is my loss anyway, since once I had no rival, once I lived with Sophie.

This strange life we lead now --- she says it herself, bringing it up the bewildering painful change, whenever some errand has brought her to the Bowery, and she looks around and sees the house she used to live in. Every board, chair, plant, rug, bookcase, table, the Franklin stove, the little kitchen, the dressing room --- l suppose she sees the bed, too. It happens as well, she says, when she looks around Fifteenth Street, her own place, wondering why she lives there. In fact, she hardly seems to; there is never anything in the icebox. The room is bright and orderly; she has a nice fireplace, a fine big skylight, another little room to work in. A bedroom I regard as alien territory and have never been comfortable in, since Marcy also sleeps here on other nights. On my sheets: Sophie has pinched or borrowed two sets of sheets, and put them on her bed for Marcy, for herself, even for me.

I ignore the bedroom for the fire in the living room. The roasted bird. I do not stay overnight, have only a few hours of grace. I prefer the rug before the fire, making love to Sophie that night as if passion could bring her back, aware of passion, able after so long in apathy and numbness, able to feel. One of the few times. For there is no sex in me now either. Only the great rise on that night, her breasts dearer to me than life; the grief of love gone, going. A little while and it will all be gone, I will never see this place again. It will finally be over and she will have tired of me past any further invitation. The passion in each of us only sorrow.