David's Inferno (40 page)

Vision is about looking
forward
. That's why all three books end with the word “stars,” even
Paradise
where, by definition, all distinctions are rendered meaningless. Yes, even in
Paradise
, Dante is still looking
forward
. Because, brilliant as his masterpiece is, Dante knows he's really still telling an old story. He's just telling it better than anyone ever told it before. And telling it. And telling it. And telling it. If only he could tell it once and for all. Certainly he doesn't want to go through all
that
yet again. And he wouldn't wish it on us either! He's ready to move on.

In other words, all this time that I've been looking
back
on my experience … all this time that I've been looking
back
at
The Divine Comedy
, Dante's been looking in the other direction. Past me, past all of us, and beyond.
Forward
.

No copy of
The Divine Comedy
written in Dante's own hand has ever been found. While, for emotional and financial reasons, he had started passing around
The Inferno
as early as 1314 and
Purgatory
a few years later, he was undoubtedly holding back
Paradise
, waiting to do his own complete three-volume “authorized” edition only after he had written the whole book. But, by then, he might have been too tired, felt it was too late, or that it didn't really matter. Because even though transcribers undoubtedly let their own prejudices creep in (who could resist casting their own favorite political or religious enemy into eternal Hell?), the poet's genius was so refined, intricate, and yet inviolable, that its multiple levels of ever-evolving meanings remained intact—and the most profound ones remain invisible.

The legend is that Dante actually never “released”
Paradise
. He never gave the entire manuscript to his patron—which he always did before letting it into the world. His children easily found most of it after he died. It was sitting on his desk, right there out in the open. He'd been working on it just a few days ago, before he'd been bedridden with malaria. He'd arranged it in a nice tidy stack, the way writers do to punctuate the completion of anything from a chapter to a whole book. But it was missing a few final cantos. One morning, several months after he died however, his son Iacopo claimed he had a vision that they were hidden behind a wall hanging. And sure enough they were.

Dante was only 55. He hadn't planned on dying anytime soon. Figured he had plenty of time for a last read. He probably told Iacapo where those pages were … in case something happened.

It's hard to let go. But, whether you're transformed by outer events, inner cataclysms, or just the inexorable passage of time, there's no going back. And how far you can go forward is limited only to the extent that you are able to be renewed in your own rivers
Lethe and Eunoe. Limited only to the extent that you can make firm in yourself what you are now and let go of what's held you back in the past. Limited only by your vision.

T
HE FOLLOWING IS A RUNNING CHRONOLOGY
of my doctors' notes from 1999 through 2007. I've been on the same medications since then and go only every six months or so to check in.

Although I've seen a few different practitioners—professional depressives use the phrase
pdocs
—I present them as if they were one doctor. I have a great deal of appreciation and respect for all of them.

As you can imagine, their notes are virtually indecipherable, so I've incorporated some of my own notes from those appointments and translated their jargon, abbreviations, and hieroglyphic scribbles as best I could. You'll get the idea: (1) Medication is a long and winding road. (2) It can be
really
hard to hang in there. (3) It's worth every step when it works.

Interestingly, when compared to other things I wrote at the time—and the observations of friends—I seem to have over-dramatized or under-dramatized my condition at any given appointment. I think a lot of psychiatric patients do that. It may have to do with how you feel about the drugs you're taking and whether consciously or subconsciously you want to keep taking them or go off them. Also, that you really don't realize how “out there” you were until you're back—something friends and family appear to have realized all along.

[First ever visit to a psychiatrist.]
Wife's urged him to come for a long time. Recurrent depressions. Can usually use vitamins and exercise. This
fall, exhausted … [those strategies] not working. Works all the time, anxious. Wakes up early both wired and exhausted. “At recent meeting felt I just couldn't do this.” Next day, presentation to client, “almost ranting.” Coworkers said, “out of control.” Some
A.M
.s have to play racquetball to get energy out—others just dragging. Alcohol … usually wine. He went off it years ago for a few years. In past, depression for several days to weeks. Mania—usually hours—great times. Can focus and be productive. Borderline crying but can't. Frantic drive. Can hyper-concentrate if no stimulus
.

Sleep—goes right to sleep. If wakes, can go back. Gets up 5-6
A.M
.. Not rested this winter. Naps don't work now. Can be irritable. Concentration either on or off—15 minute cycles now. Memory? No long term. Yes at work
.

Sadness, yes. Some hopelessness. Not suicidal. Has to be busy. Frantic drive. Sex drive okay but less so. Hyper as a kid. “My mouth caused problems.”

Diagnosis: Major Depression. Rule Out Bipolar. Trial of Wellbutrin
.

OCD helped by meds (not really depression and anxiety). Some side effects at first but less now. Relaxed this weekend and didn't work all the time. “I don't have to go on a tangent and worry about things. Can say no.” Still sad and anxious but better! Wife agrees—the layer of manic-ness is gone now—he can see problem and work on changes. Able to slow down and “stop the train.” Continue Wellbutrin another 10 days then consider medication for anxiety
.

Off caffeine a week. No change. Still wakes with a chest buzz. “Think I'm getting better.” Feels Wellbutrin helps but still fragile. Hard for him to stop taking on any new obligations from others. Much worse
A.M
.. Better during day. May warrant going up on the dose
.

“The same.” Much more relaxed and less compulsion but more sad … will
still burst into tears Monday before work. Mood was better for two days doing Wellbutrin 2x day. Helps with anxiety and obsession. Not depression. Continue Wellbutrin. Add Celexa 10 mg three days then 20 mg
.

Stayed at 10 mg Celexa. Jaw ached—fading some now and he felt better. Does get lift but fades. Relief from ADD. Depression is more prominent. No stomach upset. No impotence. Worth continuing Celexa trial. He's still sad … not looking forward to Monday
A.M
.s. Co-workers still see difference from Wellbutrin. Continue trial. Then go up to 20 mg Celexa 2x Day
.

Phone: He'll go up to 40 mg Celexa
.

Somewhat better on 40 mg Wellbutrin still working. Relaxes better and can stop and do things. Better mood. Sleep's fine. No big side effects. A little spacy and yawning. No other side effects. A little loss of mood past few days. Wife worries he'll get compulsive again—people are easier around him—he finally can sit still and watch movies or play card games. Energy to only plan a small garden at new house. Good diet. Several cups coffee/day. Takes B vits daily
.

Seen with wife. She sees major improvements in depression since adding Celexa. Calmer. Likes staying in bed in
A.M
. Not as driven. Still gets things done. Much better mood. Minimal side effects. Mild shakiness, yawning. Clearly better since upping Celexa to 40 mg. Sustained response
.

Survived the move to new house! Meds working well. Minor tremor. Blood pressure 118/76. Can't complain. Doing well. Wife and co-workers agree. “I can go out to lunch and not feel I have to rush back. I enjoy work, biking, working on house, etc. Work piling up—a busy time.” Sustained benefit
.

He says, “Best two months of my life.” Except for 36 hours when he felt it was all coming back. But he survived and recovered. Work's fine. Busy again, but “I can leave work at work and go home.” A complete turnaround. Not exercising compulsively. Continue meds. Wellbutrin SR 150 mg 2X Day. Celexa 20 mg 2X Day
.

Great. “2
^nd
greatest 2 months of my life.” Vacation w/wife on Lake Champlain. First vacation since depressed. Sustained relief. He'll continue this regime through the winter. Possibly go down in spring
.

Still great! At times forgets
A.M
. dose … no loss of benefit. And he's willing to continue thru winter. Still office politics a problem but he's coping
.

Missed Celexa one day—tears and down the next. Work's fine. Home's fine. Asks for tranquilizer for plane flight. Prescribe 10 Xanax .25 mg
.

Doing well. Work's okay. Feels a little scattered on Wellbutrin—sometimes skips pm Wellbutrin. Still feels absentminded but tolerable. Plans to take January off from work to write
.

Taking B Vitamins helps. Feels meds interfere with his ability to recover from exercise some, but tolerable. Some up and down mood but okay. Thinks Wellbutrin helped with his compulsiveness. Celexa with mood. He wants to consider going down in spring
.

Plans a month working at home. Built a small cabin house to work. Starts Thursday. Tried Alpralozam [Xanax] for flying. Went okay. Not sure he needs it
.

Almost went off meds in August—was on ½ pill each. Then crashed and back on in September. Going to sell his business. Will stay on as creative head. Took Jan 15-Feb 15 off. DSM Axis I: 296.32 Major Depressive Disorder/Recurrent - Moderate. Axis IV: Moderate: Management responsibilities. Had to fire an employee. Current GAF (Global Access of Functioning) 80
.

Phone message asking me to call in an Rx for Celexa. I'll call him back. Thought he was off. Have him make appt
.

By summer 2002 was off all meds and okay. In fall 2002, thought maybe he just had S.A.D. Felt he didn't need Wellbutrin. Restarted Celexa, In April 2003, tried to wean off again but in a month felt worse. So back on Celexa 40 mg. Finally kicking in. We discussed options. Would like to try Lexapro 10 mg and then go up to 20 mg. Will phone report
.

Doesn't like Lexapro. Asks to return to Celexa
.

Lexapro didn't seem to work as well, so back to Celexa. In winter 60 mg; summer 40 mg or 30 mg. November is too late to go up on dose. Will go up in late September or October. Ending 3-year contract with business at end of the year. Has another part-time business. May go on a road trip in spring
.

Took year off to write. Travelled for a month through South and back. Going to France. After he left business went down to 40 mg Celexa and felt okay. Maybe after return from France he'll go down to 20 mg. Maybe off in summer. Cautioned re withdrawal effects
.