Death Grip (30 page)

On day three, I return to Dr. Porridge's office. I mention that the Paxil might not be working, but he urges me to give it a few more days. That night the myoclonic jerks start, those seizure-like spasms and plummeting sensations we all get just before falling asleep. But these “sleep starts” are so violent that they jolt me off the couch as if it were electrified. I float inches above the cushions before slamming back down, arms outstretched and hands fluttering like a skydiver's. This will go on for the next year. As soon as my eyes droop another myoclonus comes, my body kicks, and I wake up in fresh terror. My lower back is getting sore from the spasms, and often the jerks are accompanied by a sonic boom, as if a barrel of gasoline has exploded beside my head. Between that and the gnashing-pillow hallucinations, I develop a Pavlovian abhorrence of anything to do with sleep. A psychiatric evaluation done at Mapleton one week later will read: “[Matt] stated that sleep was especially problematic as he would doze off and then suddenly awaken in a panic and have vivid feelings, which he acknowledged were not literally true, that someone was in the bed with him threatening him.”

At my behest, Kasey calls my parents to explain this dire turn of events. My mother drives up from Albuquerque. She takes charge, drives me to my various appointments, gets me and Clyde out on walks, but it's no use—I still can't sleep. One golden afternoon we hike up Sanitas Valley, a gradually inclined, bow-shaped cleft between Mount Sanitas' eastern slopes and the sandstone hogback, Dakota Ridge, that sequesters it from town. Piddling red-brown rocks protrude from the ridge, peeking between the Ponderosa that spill off the spine. I look over and see two people bouldering, a mother and her teenage son, moving crashpads about as they attempt traverse problems. That's how I got my start, asking my mother to take me to the rocks. Now, plying clifflets barely taller than VW vans, these two look like superheroes, remote and courageous in a way that I never will be again. I point them out to my mother, tell her how much I miss climbing. The anxiety has grown so all-pervasive that just
looking
at photographs of people climbing, seeing them high off the ground, gives me panic attacks.

I return to see Dr. Porridge first thing Monday. I creak and crack into his office, flop down in a chair, and tell him I now feel incredibly sick on the Paxil and describe the insomnia. I have not slept in five nights. I'm no longer sure if I'm alive or dead. The doctor takes notes, pauses, chews on the end of his pen, and looks up at some phantom point in the middle of the room. He pauses again. Then:

“You know, Matt,” he says, “I think I've got it!”

“You … you do, Dr. Porridge?”

“Yes. I can't believe I didn't see it sooner.”

“You—you know what's going on?”
A solution! Finally!

“Yes. You're
bipolar.
It's been in front of me all along!” He's so happy with himself, so pleased to have cracked this great medical mystery—the man grins from ear to ear.

“I am? But I don't get manic, I mean—”

“You don't necessarily need to be a classic manic-depressive to be bipolar, Matt,” the doctor continues. “You can be what we call bipolar type 2, which is more of a depression with episodes of milder mania called hypomania.”

“You mean, like in summer when I've had more energy or—?”

“Exactly!”

“But why would I be bipolar now of all times? I mean, why didn't we see it sooner? I don't quite understand how…”

“We've been seeing more and more of this lately, Matt, which is a bad reaction to an SSRI that indicates some sort of bipolar or cyclothymic condition.”

“Cyclothymic?”

“Sorry: mood cycling.”

“But I mostly feel one way, Dr. Porridge, and that is ‘scared-all-the-time.'”

“Yes, Matt, but we've also talked about the better periods you've had, the ‘ups,' if you will, when you were climbing well and feeling good and had energy. These mood shifts can be very insidious, very subtle—I have one patient, a woman, who can cycle through different moods four or five times a day. And it just tortures her. Heck, she's even changed moods right here with me in the office!”

No comment.

I ponder that. For months the only two moods I've been cycling through have been despair and terror; no euphoria. There has been nothing to be euphoric about. Something doesn't quite add up, but I'm not thinking clearly enough to put my finger on it. What an ex-girlfriend, Katie, will later relate after discussing my situation with her mother, a psychotherapist, is that the “bipolar” diagnosis due to a bad SSRI reaction is currently all the rage, and should not be implicitly trusted. Later my own research will reveal that, in my chemically fragile state, I've had an understandable reaction to Paxil, a drug I never tolerated well at high doses anyway. I believe I suffered “serotonin syndrome,” a toxic overload of serotonin that in cases can be fatal—this serotonin dump is what's fueling the akathisia. So much again harkens back to the interdependency of the neurotransmitter systems: With GABA receptors down-regulated, a rift in the armor that widens with each Klonopin cut, there is nothing to countervail the excitatory neurotransmitters, and on a higher dose of Paxil my brain catches fire like dry tinder sparked by lightning. Moreover, the benzos have for years been dampening the action of the excitatory neurotransmitters, so to suddenly, artificially increase the activity of one, serotonin, yields a double insult to unprepared neurons. As Dr. Ashton framed it in a scholarly paper, “As a consequence of the enhancement of GABA's inhibitory activity caused by benzodiazepines, the brain's output of excitatory neurotransmitters, including norephinephrine (adrenaline), serotonin, acetyl choline and dopamine, is reduced.”
20
In other words, I have no business attempting to “cure” benzo withdrawal by artificially increasing serotonin activity—it just unbalances my brain even further.

“And how do you treat mood cycling?” I ask. “Or if I'm … I'm bipolar?”

“Well, we need to get you off the Paxil right away and try you on another mood stabilizer.”

“Which one?”

“Depakote, for mania,” the doctor says. “I'm sorry about the Paxil, but it will have to be tapered quickly, which is going to be unpleasant. But you can't stay on it now that you've had an adverse event.”

I ask him why Paxil has affected me this way. The doctor speculates that it's triggered a “mixed state,” a dastardly blend of depression and mania peculiar to the bipolar spectrum. Then he reiterates that Depakote will fix this.

I know about Depakote: A climbing buddy once spiraled into a depression after his beloved grandfather took his own life. A doctor told my friend he was bipolar; he then prescribed Depakote, or valproic acid, an anticonvulsant used for treating seizure disorder and bipolar mania. My buddy, in all the years that I'd known him, had never been the least bit manic. He took the pills anyway. After gaining twenty pounds in two months, and tired of being foggy-headed, my friend stopped, confronted his grief, and healed on his own. But me, I'm still spellbound by this doctor, as if he and he alone has the answer.

“Do you really think it will help, Dr. Porridge? Another … another pill?”

“Yes, Matt. I do. It's clear to me now that you're bipolar,” he says. “I don't know how I missed it all those years, but it explains everything: your bouts with depression, your sensitivity to antidepressants, the weird way you metabolize benzos.”

Weird way I metabolize benzos?

“I'm not sure I follow.”

“What I mean is the fact that the benzos appeared to work for many years but then just stopped, or only worked erratically after that. That is another classic sign of bipolar disorder, as, Matt, was your substance abuse.”

Voila!
The blame has been shifted firmly back to the patient: It is his individual failure to metabolize the drugs properly. It is he, the drug addict, who has unhinged his brain and no longer responds properly to a “safe, effective anxiety treatment.” Of course it is not that the patient listens attentively to brain and body signals and has for years been on the roller coaster of tranquilizer addiction, but that he's a manic-depressive junkie in need of thorough, ongoing medical intervention.
Voila! Hallelujah! Eureka!

One more night without sleep is what does it. A great pressure has built inside like a swollen volcano. Kasey and I are having an out-and-out spat or perhaps just another dead-end kafuffle when I go into the kitchen, fetch the red-handled steak knife, and begin cutting myself, slicing gill-like slits along the outside of my thumbs where the hand-meat is thickest. Red blood drizzles onto the kitchen floor, onto the white-green linoleum tiles lifting at the edges where they're cracked by the laundry closet. This duplex is so old, so rickety, so battered and used up.

“Look at this!” I'm yelling at Kasey. She stands in the living room wide-eyed. “Look at this look at this look at this look at this! I can't fucking take it
anymore! I can't fucking take it!!!
”

I've cut myself to release the pressure, but also to show seriousness of intent. I don't know what else to do. I throw down the knife and make for the front door, trying to squeeze past Kasey. I'm not a cutter and never have been, but later, during my first year post-withdrawal in Carbondale, I'll often sport half-moon welts across my cheeks and brow: fingernail crescents, cicatrices of pain and self-hatred to vent inner torment. My plan—one I've been cogitating on for days—is to hurl myself off a cliff. There is an eighty-foot bluff at the southern toe of Mount Sanitas, with a tangle of stones, vines, and briars below it upon which to dash my brains. I've also fantasized about throwing myself off the Naked Edge, a cleaved sandstone arête in Eldorado Canyon. The Edge rounds off onto a great slab eight hundred feet above the silver tumble of South Boulder Creek. Romantically, I've pictured myself scrambling up the back of Redgarden Wall by moonlight, the air cold and crisp, the lights of south Boulder and Louisville twinkling in the distance. I walk out to the point, take a deep breath, and then swan dive, a final few seconds in freefall. But the route is iconic to climbers, and I don't want to sully it so. This cliff on Sanitas, however, has been closed for years due to nesting birds, so no one should care if I explode myself in the talus.

I've got one hand on the doorknob when Kasey stops me.

“What about me?” she's screaming. “And what about Clyde?
You can't just leave us like this!”

Kasey is right. I fall to the floor, convulsed with sobs, wracked with guilt. This is some black, horrible shit I've laid on this poor girl. We've only been together a year and a half, and the last six months have been this nightmare. We're both crying and crying and clutching each other. I can't leave now when I really don't know what's going on, when my departure will forever scar Kasey, and my friends and family. So we cry and cry, there on the floor, until there are no more tears. Kasey leads me to the kitchen where the knife lies in its bloody Rorschach blot. She picks it up and drops it in the sink. Kasey runs my hands under cold water, bandages my thumbs, and calls my mother at her motel. A plan is made for the following morning.

One and a half milligrams a day, Klonopin, Boulder, Colorado, early October 2005:

You know those dreams in which you're back in high school and will never, ever graduate, no matter how many classes you take, and your despair when you realize your predicament? These are like that, only worse—seven years later I still have them, the dreams in which I, for whatever reason, am permanently stuck on the last milligram of benzodiazepine. Usually I'm with friends at the cliffs or in some public place—a rock gym, movie theater, or restaurant—when the hour comes for a pill. I take out the orange bottle, uncap it, and shake out an Ativan. “But didn't you quit, Matt?” someone will ask, to which I'll reply, “I did—well, almost. Okay, I tried, all but for this last milligram. It has been impossible to stop.” And then I add: “The doctors say I need to be on it for the rest of my life.”

I swallow the pill and the panic starts, percolating upward through my consciousness. Until I wake up thrashing in the sheets.

The seed for these nightmares is sown at the Mapleton Center where, locked on the ward for the second time in my life, they triple my Klonopin dose, moving the goalposts nearly off the field. This will be done against my will to “stabilize” me. This second time it's not a voluntary committal but instead a seventy-two-hour mental-health hold. I
will
take my meds or else. My mother has brought me to the emergency room. We wait together on black Naugahyde chairs in the lobby, me red-eyed and sniffling, until an intake coordinator leads me away to a hospital bed and starts recording my history. I can recite the story by rote, even in this zombie whisper. I'm like a lump of jelly, answering her questions through copious tears, passive and balled up on myself, cradling my belly like it's a colicky baby. No, I tell her, I don't have insurance. No, I tell her, I don't abuse drugs; I just take the ones that have been prescribed to me. Yes, I tell her, I have stopped drinking. No, I tell her, I have not slept in six nights. At all. Six nights. It is driving me batshit bonkers. Six nights. From here it will be a two-minute ambulance ride, lashed Hannibal Lecter–like to a gurney, to the Mapleton Center. Because I've shown suicidal tendencies I'm strapped in just like that. How humiliating, to be wheeled around like some freak. I will sob in the ambulance, and one of the EMTs, a girl really, pretty with deep-blue raccoon eye shadow, will tell me that she was in the suicide gurney herself only a few years earlier and that she wants me to hang on. She calls suicide a permanent solution to a temporary problem, and adds that she's glad she didn't succeed because life got better.