The invader and the antidote
It began in springtime, at a conference in Ireland. I was lonely and the town where I was staying was dismal and it rained. On the third day a fierce headache tightened across my temples until I had to go back to my hotel room and lie down. By the evening it had faded, but I was exhausted and went to bed early. The next morning I woke at 5 with nausea and a strange stiffness in my hands. I took paracetamol, which seemed to help a little, struggled through the final conference session and then flew back to London.
The next day I still didn’t feel well – by now my hands were so stiff that I couldn’t hold a pen – so I phoned in sick to work. When I got out of a hot bath, the parts of my body that had been in the water were covered in raised, red welts, each one as big as the palm of my hand. Over the phone my mother said I had once had something similar as a baby, something viral she had thought at the time. The welts went down but over the next few days I didn’t feel any better. I slept badly, my body aching all over, as if I had flu. The nausea was continuous, and the only thing I could bring myself to eat were bananas, half a banana at a time. When my girlfriend got home from work she found the uneaten halves all over the house.
Over the next two weeks, the symptoms came and went. For a day or two my appetite returned, I had more energy and I began to think about going back to work; then the symptoms came back. I began to worry that I would not recover permanently from whatever this illness was. My father had been sick for three years with ME and I became obsessed with the idea that this was what was happening to me. My thoughts circled continually around an image of myself as chronically feeble, bedridden, housebound. In the middle of my third week off work I was lying on the sofa in the middle of the night, completely unable to sleep, when these fears gripped me completely, apocalyptically. Looking back, I think of this as the moment when the true nature of what was happening to me revealed itself. It was as if all the physical symptoms of the past weeks had been a kind of phoney war going on inside me, the pre-tremors of a coming earthquake, the swaying palms and rain-lashed streets of a city waiting for a hurricane to touch shore. I knew, suddenly, that I was extremely unwell, but not in the way I had supposed. I woke my girlfriend and told her I was going mad.
At the doctor’s surgery a few hours later, I shook and wept while my girlfriend explained what had been happening. The GP diagnosed me with acute anxiety. She gave me a prescription for a week’s worth of sleeping pills and for Citalopram, an antidepressant that, she said, would probably ease the anxiety after three or four weeks. I couldn’t imagine how I would cope until then. It seemed impossible that I would have to go on feeling this way for even a few more hours.
‘Isn’t there something that can help me now?’ I said.
The doctor shook her head. ‘I’m afraid not,’ she said.
It should have been a good time in my life. I had a young daughter, was about to get married, and my first book, a collection of short stories, was due to be published later in the year. There is depression and anxiety in my family – both my parents were ill during my childhood – but after thirty-five years of uneventful mental health I felt I had, as I told my mother at the time, ‘dodged that bullet’.
It is impossible, I think, to describe what this kind of anxiety feels like, to properly convey it, to anyone who has not experienced it. When I am well, I cannot even imagine it myself. The best way I can put it is that during those times it was as if I had forgotten how to be. By this I mean that every passing moment was intolerably intense. I felt that some internal switch had been flicked or shorted, leaving my body and mind in a state of unrelenting and unsolvable emergency.
The subjects of my anxiety were various and interwoven: that, aside from the anxiety, I had developed ME and would be sick for years; that I would lose my job; that I would never have the clarity of mind to be able to write again; that I would not be able to look after my daughter or have another child; that my girlfriend would leave me or send me away; that my incurable anxiety would cause all these things to happen. At other times, the anxiety detached itself from these specifics entirely and simply became the thing itself. This was anxiety in its purest, most concentrated form, an abstraction with almost no relation to the world around me, as rampant and absolute when I looked out of the window and watched a boy kicking a ball against a wall as it was each time I phoned work to say I would not be coming in.
The sleeping pills knocked me out for a few hours at night but I woke up at four or five every morning, exhausted, with the anxiety at full pitch the instant I became aware of myself. Even the smallest action, making a cup of tea or cleaning my teeth, was fraught with difficulty. I could not bear to be alone, at the mercy of these feelings, so when my girlfriend took our daughter to nursery and then went on to work, other family and friends were timetabled to come over and be with me. When I was very bad I stayed in bed and asked my visitors to sit or lie next to me. One friend, who was free to visit because he had just lost his job, did not want to sit on the bed. He brought a chair from another room but left after an hour. Only later did I see how alarming it must have been – for him and for everyone else – to see how utterly changed I was, how awkward for them to sit there in my stuffy sickroom while I cried and apologized for making them spend their time this way; how much this friend, who had his own troubles after all, had wanted to get away.
I hung on desperately to the hope that the Citalopram would work. Each day I took the drug was one day closer to the three or four weeks when this feeling might begin to be relieved. I was terrified, however, of what else the tablets might do to me and this became a toxic new strand to my anxiety. The doctor had said the drug could cause nausea, could make you feel worse before you felt better. Google searches confirmed this and much more. There were infinite numbers of forums and chat rooms where anxious, depressed people reported violent physical side effects, psychotic episodes, and suicide attempts as a result of taking Citalopram. It seemed entirely possible – probable even – that it was now the pills themselves that were making me ill, and every time I bent the packet and popped a pill out of its blister I braced myself as if I were swallowing some kind of poison.
I spoke to my mother several times a day on the phone, and when she came to visit she lay on the bed with me, put her arms around me and stroked my hair. She talked to me constantly, reassuring me, reminding me of things from my childhood. She talked about a family holiday when she and I had walked around Ullswater in the Lake District and my father and brother had rowed across the lake to meet us. ‘That was a happy day,’ she said to me, over and over again, like a mantra, an incantation, ‘that was a happy day.’
Around this time, a friend – I’ll call him Daniel – persuaded me to take an Ativan, a tranquillizer he was prescribed himself. (By agreement with Daniel, I won’t be telling the story of his experiences with anxiety and medication in this essay.) The day he visited I was in a wretched state. I had not slept at all the night before, was so exhausted that I found it difficult to get around the house. Daniel said the Ativan would help me rest, but I was reluctant. I felt I was taking too many pills already – paracetamol, sleeping pills, the Citalopram. I had not eaten since the day before and was sure that anything I took now, on an empty stomach, would make me sick. On top of all this, Ativan had not been prescribed to me, presumably for a reason.
In the end, my desperation outweighed my fear. I sat up in bed and ate a little yoghurt to line my stomach. Daniel broke the pill in two and gave me half. After thirty minutes I felt no different, so I took the other half.
Lorazepam is a benzodiazepine that was first sold under the brand name Ativan in 1977 by the US pharmaceutical company Wyeth, as a treatment for short-term anxiety, insomnia, acute seizures and the sedation of aggressive hospital patients. It is regarded as more powerful and longer acting than most other benzodiazepines, with comparably greater potential for dependency and addiction. An early advertisement shows a rising sun bursting out from behind a vast and shadowy mountain, its rays fanning out over the dark terrain, a sort of Blakean vision of enlightenment or paradise found. ‘Now it can be yours’, it reads, ‘The Ativan Experience’. Another ad, from 1987, when the risks of benzodiazepine use had become more widely known, opts for the same kind of sublime imagery, although this time the vision seems a little more downbeat: a blue and green Earth suspended in black space, the sun reduced to a pale glow behind the top-right-hand side of the globe. ‘In a world where certainties are few …’ it reads, ‘no wonder Ativan is prescribed by so many caring clinicians.’
Despite its hubris, the first ad, the blazing sun bearing down on the shrouded valley, is the kind of metaphor I might have come up with myself if I had had to describe the experience of taking the drug for the first time. Thirty minutes after taking the second half of the pill I got out of bed and went downstairs. The physical symptoms that had been afflicting me had evaporated entirely. The nausea had gone so I made myself a sandwich and ate it sitting at the kitchen table. The stiffness in my hands had faded. I had strength and energy. I felt mellow, but not dozy – alert, clear-headed, my thoughts no longer running into and climbing on top of each other. The feeling lasted for the rest of the afternoon and evening. When my daughter got home I played with her in the garden. Later on, I ate another meal with my girlfriend and we watched TV together.
Daniel left me with a strip of pills, ten in total – ‘make them last’, he said, ‘it’s not an endless supply’ – and over the following few weeks I took one from time to time, not every day, but whenever I could not cope and needed a break. I was uneasy, having read online about the dangers of benzodiazepine addiction and withdrawal, but I told myself that it was only a stopgap until the Citalopram began to work. The websites seemed to agree that there was little risk of addiction if you took benzodiazepines for less than three weeks.
Each time I took one the effect was the same: I felt an immediate relief, the sure knowledge that in a few minutes the world would take on a far better shape. Within an hour I was transformed, restored to myself. I felt my thoughts settle and begin to focus. The terror of how to get through the rest of the day and the days after it started to fade, and I could think about things I needed to do, now and in the future. The pill – this tiny, pale blue, slightly chalky, bevelled oblong, grooved down the middle to make it easy to break in two – seemed a perfect antidote to what I was suffering. It was astonishing, and strangely reassuring too, to know that in fact there was no virus, that all along the physical symptoms I had been suffering had been inflicted on me by my fevered mind.
By now it was a very hot summer, and neighbours whose garden backed onto my own barbecued in the afternoons, played loud house music and became rowdy. There were several days when, after I took a pill, I went out and lay in my own garden in the sun. I tried to read the newspaper for a while as I waited for the pill to take effect. Then I closed my eyes, listened to the neighbours talking on the other side of the fence and let the beat of their music carry me along.
On days when I had not taken an Ativan, I felt just as bad as I had at the beginning. After four weeks on Citalopram, I went back to the GP and told her it wasn’t working. She doubled my dose, from 20 milligrams a day to 40. ‘Sometimes it needs that much,’ she told me. ‘Give it another few weeks.’
I had not planned to, and Daniel had made me promise not to, but I told the GP that I had been taking Ativan. I told her how well it worked and asked if she could prescribe it. She frowned.
‘I’ve worked a lot in this area,’ she said, ‘and we only give this type of drug to people who are terminally ill in hospital. They make you feel good because they are very strong. Your friend isn’t doing you any favours.’
She wrote me a prescription for another week of sleeping tablets.
For the next two weeks, with the doctor’s warning in mind, I tried to take even fewer Ativan than I had previously allowed myself. Sometimes I took just half a pill, and the effect was barely noticeable. I endured terrible days. I clung to the hope that the increased dose of Citalopram would make a difference, but hardly believed it. I read more online. Citalopram was not an anti-anxiety drug as such. It was a selective serotonin reuptake inhibitor or SSRI that, like Prozac, had been found to have anxiolytic properties for a high percentage of people who took it. Anxiety and depression were very often diagnosed together, co-morbid was the term, and this seemed logical to me – they might have similar causes, and one might feed into the other. I recognized some aspects of depression in how I was feeling but I felt strongly that this was not the right term for what I was going through. Depressives usually described an absence of feeling, a numbness. If anything, I was experiencing an overabundance of feeling. Everything was heightened, excruciatingly so: I was over-stimulated to the point of paralysis. Also, I had an objective sense that my life was good – I had a family, a home, my dream of publishing a book was coming true – if only I could solve the problem of this anxiety. I saw it as something distinct from me, something other, something attacking me, an invader. And where depression usually seemed to be discreet, shameful, a private torture, my anxiety was florid, public – I talked about it to anyone who would listen.
After six weeks on Citalopram I went back to the doctor again. I asked her if it ever took that long to start working.
‘It can,’ she said, but she didn’t sound convinced.
She said we could try another SSRI, but I could not face the prospect of withdrawing from one drug – I had read how horrendous this could be – and beginning on another. The doctor nodded. ‘In reality,’ she said, ‘there isn’t much difference between them. It’s just branding.’
She wasn’t unsympathetic. She said she would refer me to the counselling service they ran at the surgery. I started to cry and she told me to just keep going, things would get better. I didn’t mention the Ativan this time and she didn’t ask.
I left the surgery in despair. As far as I could tell, the doctor had run out of ideas; there was nothing more she could do for me. While it seemed impossible that my anxiety could continue at this intensity and not somehow burn itself out, everything I read said that it was a chronic condition, manageable perhaps, but not curable. So I had changed and would never be quite the same. A switch had been flipped and could not be flipped back.
I tried to understand what had happened to me. My life seemed, suddenly and profoundly, to have split into two parts, a before and an after. The person who had managed to get to this point in life – to go to school and university, to work, to travel, to make friends, to find places to live, to have a child – was unrecognizable. I thought often about a recurring nightmare I had as a child, which seemed now to have the blunt symbolism of a premonition. In the dream I was walking alone up the side of a grassy hill amongst trees and flowers in bright sunshine, happy and hopeful of what I would find on the other side. But each time I crested the hill I would begin to sense something ahead of me, something formless and intangible, but utterly dreadful. The feeling grew and grew but I was powerless to stop walking towards it, until the dream ended in a crescendo of terror.
I wondered at the cause of it all. There had been stresses before I became ill – money, work, parenthood, the things that take a toll on people – but these hardly seemed enough. Did it go deeper than that, something entirely personal that had been waiting for me in my future, embedded in my genes or in my childhood, a fate that was unavoidable and beyond my control, a ticking time bomb? My parents – endlessly sympathetic and supportive – were, of course, part of the problem. My fear of my father’s ME had been at the heart of my initial descent. Now it seemed more likely that I was suffering from the same anxiety that had dogged him since his twenties. But when, in my anxiety, I trawled the websites, I saw other possibilities, too. If this could happen, then what else might be possible? Could I be bipolar like my mother? I felt that I was in freefall and had no idea where it might end. Both my parents had spent time in the local psychiatric hospital and if I lived in different times, I reasoned, I might already be there myself.
Meanwhile, my grim perspective saturated the wider world, too. I was excruciatingly sensitive to the pain and suffering that I saw everywhere. I couldn’t watch television. The soaps were full of misery, cranked up to the maximum. The relentless and hollow cheeriness of children’s television presenters was an expression of the futility of everything. The news was out of the question – if I was suffering like this then what about people who were being forced to leave their homes or whose families had been killed? Only the blandest, feel-good radio was manageable. I took a ghoulish and obsessive interest in the personal traumas of celebrities, their addictions, overdoses and breakdowns, and felt a special connection to them. When I was driven – I was in no state to drive myself – down streets of houses belonging to people I did not know and had never seen, still I felt the weight of all their sadness and difficulty, their tragic fences and pitiful garages.
Against all this, I had the Ativan: the only thing that, for six or seven hours at a time, allowed me to put these fears and sensations in perspective; the only thing that showed me that, underneath all this, my old self – my true self, I felt – was still there and that I was not entirely lost.
Without the hope of some other resolution to the problem, I began to take Ativan more often. When the sleeping pills the doctor had given me ran out, I began to take Ativan at night too. Supplies arrived in the post every week or so from Daniel, the foil strip of ten wrapped inside a tissue with a post-it note on it with the same message: As promised – try and make these ones last!
I did try. I obsessed over each one, weighing short-term relief against the dangers of addiction. I reminded myself that, even now, the quantities I was taking were very small, no more than a single one-milligram pill at a time, and there were days when I did not take one at all. I reminded myself that I had never been addicted to any other drugs or alcohol. In fact, even before this crisis, I barely drank and had not so much as smoked a joint for nearly ten years. I pointed out to myself that I was not taking them for fun or to get high, but out of a kind of necessity, in order to feel normal.
But I read the online testimonies of people whose problems had escalated from just such a minimal, temporary benzodiazepine habit as this. People with wives and husbands and kids and jobs and mortgages. I read about how quickly your tolerance developed so that you had to take more to get the same effect. How the more you took the more fiercely the anxiety responded, a monster that only became hungrier. All this made sense to the puritan in me. You could not take something that made you feel so much better without paying some kind of price.
It was a dreadful, tightening spiral that led to long-term dependency and addiction, ever-increasing anxiety and depression, or, if you tried to cut down or stopped taking them altogether, the hallucinations, seizures and psychosis of withdrawal. It was striking how often Ativan, among the many available benzodiazepines, specifically came up in these horror stories. Valium, it seemed, was often used to wean people off its more dangerous sister drug. Perhaps I was not yet physically hooked – it was hard to tell – but the psychological dependency seemed clear enough: the way I fretted when my supply ran low and counted out the days I could make them last, the relief when the envelope from my friend dropped onto the doormat. And it was true that the days off between pills were becoming fewer.
Then there was the nature of my supply. It would be one thing to be using a drug like this when the doctor was giving it to me, for it to be part of an approved clinical treatment, but it was another to be taking it illicitly, to be making my own amateur judgements about what was safe and sensible. I remembered the doctor’s words at my second appointment. These days they only gave benzodiazepines to the terminally ill – as pain relief? To take away the fear of death? – presumably because they wouldn’t have to live with the consequences of becoming hooked. And anyway, how reliable was the supply from Daniel? What if his own prescription was cut or stopped? I found myself wondering – a sign of how narrow and obsessional my fears had become – what would happen if he died.
It is hard to recall now how little I knew about benzodiazepines when I first took Ativan. For me, tranquillizers had always been a vague category. People sometimes talked about downers. I had heard of Valium, of course, diazepam, temazepam and Xanax, from books and newspapers and film and music, but nothing else, and certainly never Ativan. But now I was taking it myself, and as I haunted the websites I began, like so many others on the message boards and in the chat rooms, to turn myself into expert.
Librium, the first benzodiazepine, discovered accidentally during tests on a newly synthesized chemical dye, was released onto the market in 1960 for the treatment of anxiety, insomnia, alcoholism and seizures. Valium followed three years later. These new drugs were more effective and had significantly less risk of overdose than barbiturates, and quickly became a phenomenon, as significant a reference point for the historical moment as the contraceptive pill. From 1969 to 1982 Valium was the best-selling drug in the United States. Then things began to go sour. The massive scale of dependency, the long-term side effects and the difficulties of withdrawal began to become clear and the popularity of benzodiazepines steadily declined. In the UK in the mid 1980s, they were the subject of the largest ever class-action lawsuit against drug companies, with patients alleging that manufacturers knew the potential for dependence but concealed it from doctors. The culture, the medics and – crucially – the drug companies moved on. As Prozac and the other SSRIs took over the market for the treatment of mental distress, benzodiazepines became, at least in the UK, mainly a hospital drug.
But even before the health risks became widely known, benzodiazepines had a PR problem. The Rolling Stones nailed it as early as 1966 in ‘Mother’s Little Helper’. Loaded on heroin and cocaine, they patronized the suburban housewife and mother who, unable to cope with the trivial strains of cooking for her husband, overdosed on tranquillizers. Valium and its equivalents represented the other drug culture. Not the subversive, counter-cultural, technicolor, epiphanic visions of LSD and marijuana but the greyness, conformity, passivity, stultification and control of consumerism, the suburbs, the Military-Industrial Complex and The Man. You dropped acid to become truly alive, to open the doors of perception and see the world as it really was or could be. You took a Valium to anaesthetize yourself against a reality you couldn’t cope with.
Still, it was hard to get my head around – how taking a legal drug, developed to treat exactly the illness I was suffering from, felt like the most transgressive thing I had ever done.
I had been taking Ativan for months now, on and off, and the habit had taken on a different texture, both more prosaic and more covert. I kept one in my wallet at all times, pressed down into a corner behind my bankcards, and often checked for it with a finger, the hard, sharp edge of the foil-covered plastic. I no longer told my girlfriend every time I had taken one, though often I felt that she knew. When I was expecting an envelope from Daniel I lurked around the front door around the time the postman was due, and then smuggled it upstairs to my desk drawer. On occasions when I took one in a public place, on a train or in a supermarket, I turned against a wall or a window and fumbled over my wallet. I stopped mentioning Ativan to friends, who I felt would be alarmed to know I was still using it. If I was out and I did take a pill, the first thing I did when I got home was to replace it in my wallet with another from the drawer.
After three months on sick leave, I went back to work. On my first day, without planning to, I told my close colleagues about the anxiety and the anti-depressants, but I did not mention the Ativan. Work was hard, and sometimes horrible, but it was preferable to the churning worry of not being there and fearing I might lose my job. I was so anxious about not coping that, to my surprise, I found myself oddly efficient and conscientious, probably a better employee than I had been before.
But, in front of a computer all day, I spent more and more time in the forums and chat rooms dedicated to anxiety and how to treat it. The internet might have been created for just this purpose – an anonymous, unregulated, limitless frontier for the troubled, frustrated, desperate legions to expand into. They were not out in the world but they were here. I gravitated to the sites that focussed on benzodiazepines, looking, I suppose, for some defining piece of information that would finally reassure me or convince me to stop. I did not find it. I found other sufferers with usernames like BenzoBoy or QueenOfPills or DrVacant and an atmosphere concentrated with their misery, self-pity and anger. I minimized the windows whenever someone passed my desk and deleted my browsing history several times a day.
Throughout this time I carried on taking Citalopram, not because I thought it had any positive effect, but because I was afraid of withdrawal symptoms. I went to a series of counselling sessions at the doctor’s surgery where I was constantly asked to rate my feelings on a scale of one to ten and set targets for things I felt I ought to do – drive the car, go out in the evening and see friends, or start writing again. When these sessions ended and I told the GP I did not feel any better, she referred me to a psychiatrist. The appointment was at a scruffy, slightly fortified-looking building on a South London high street. There was a series of security doors to be buzzed through, and inside the comfortless waiting room a receptionist sat behind a thick glass screen. I thought immediately of lunatics attacking people or having to be restrained. This was a step further into the system, I felt, unmistakably. The psychiatrist, when I saw him, seemed worn out and disengaged, used to dealing with much more desperate cases than my own. He mentioned the names of some other drugs that he could prescribe, but without great conviction, and when I looked them up later they were all anti-psychotics of the kind given to people with schizophrenia. The psychiatrist gave me an appointment for three months’ time but I did not go back.
Somewhere in the middle of this, my book of short stories was published. When the first box of copies arrived I could hardly bear to look at them. My girlfriend had had the cover of the book blown up and framed, but I could not bear to look at this either and, instead of putting it on the wall, I gave it to my mother and father. I had worked on the book for nine years and fantasized about it for much longer. The thing I had wanted had become a reality but now I could take no pleasure in it. The gap between how I felt and how I knew I was supposed to feel was too great and too painful.
There were some good reviews, some mediocre reviews and a couple of bad ones. It was all the same to me. I went through the motions of promoting the book in a nightmarish daze. I took part in events where I stood up in front of audiences and pretended to be the same person who had written the book and was thrilled to see it published, when in fact it was all just a reminder of how I would never be able to write again. One of the interviews I did began, ‘Tom Lee must be a happy man …’ and this seemed like a cruel joke at my expense.
The irony – that between signing the contract for the book and seeing it published I should unravel so completely – seemed too great to ignore. At a time when I should have been happiest, I was unhappier than I had ever been. Sometimes, I wondered if it could be that, after years of work, of hope and frustration, of maintaining the conviction that the idea of being a writer would work out, of holding my nerve, the realization of this dream had fatally weakened the structure I had built to preserve myself.
And when I went to events and read the stories themselves out loud – grim, claustrophobic, paranoid stories – I suddenly saw what I had somehow missed before, that here was an intimate record of my own increasingly fraught mental state. They ended, almost every one of them, on a cliffhanger of unresolved anxiety, their characters apparently on the brink of psychic collapse. I had anticipated myself.
Quite often, to get through these readings, I took a pill.
Then, gradually, things got better. Being at work helped – the distraction, being busy, feeling that I was fulfilling my obligations and earning a living. I had more and better counselling, started on a different anti-depressant that may or may not have helped. I stopped spending so much time online and took an Ativan when I needed to. After a year or so I began to write again. My girlfriend and I got married and we had another baby.
Less than six months after the birth of our son, I became critically ill with pneumonia and spent three months in hospital. Massive amounts of diamorphine and other drugs were used to keep me in a coma and, for several days when they brought me out of it, I was delirious, hallucinating, paranoid – a condition known as intensive care psychosis.* The experience of intensive care often leaves long-term psychological scars even on people who have spent a short time there, a kind of post-traumatic stress disorder. My wife and brother, who were at my bedside throughout, were aware of this and joked – they told me later – that given my history and my marathon stay in intensive care, as soon as I was well enough to check out, they would escort me straight across the road to The Maudsley, the UK’s largest psychiatric hospital. In the event, I felt no long-term trauma from intensive care or exacerbation of my existing anxiety. This seemed surprising and when I met one of the consultants later and tentatively suggested that my previous psychological experiences might have better prepared and protected me for this kind of thing, he agreed that this was possible. In reality, I doubt this explanation. Rather, it just confirms the arbitrariness and lack of logic to the progress of anxiety, subject only to its own entirely mysterious cycles and triggers.
I never decided to stop taking Ativan; I just stopped needing to. I haven’t taken a pill at all for nearly two years. If things were to get bad in the future, I would take them again. It is hard now, five years on, to understand why I was so neurotic about those pills. The amounts involved were small: a normal daily dose might be two or three times what I had been taking. But everything seemed to be telling me that the pills would wreck my life. In the long run, for me, I think the truth was just the opposite: that during the worst time in my life, Ativan was the one thing that allowed me to keep going, to sleep and to go to work, to be with my family until, like a bad weather system, the anxiety moved on. And if I had been born at a different time, thirty years earlier, all the people I knew who had been prescribed Prozac or Seroxat or Citalopram – I could count ten friends without any effort at all – would, like me, have been on benzodiazepines. Some of them, I think, would have been better off.
How much difference would it have made if my GP had prescribed a benzodiazepine to me, as some doctors still do? A great deal, I think. With a prescription, I could have gone to my only source of relief without fear or guilt. It had been a strange position to find myself in: a cautious, rule-abiding sort of person, with no history of drug addiction. I was just trying to stay well enough to tie my shoelaces.
Over time, I have come to think of Ativan as my drug. I still keep a single pill in my wallet, a kind of insurance policy, and from time to time I check for it with a finger, the hard, sharp edge of the foil-covered plastic. A ‘safety behaviour’, therapists call this, disapprovingly.
I have been well for a long time now and the fear of another breakdown – or ‘freak-out’ as I tend to call it, or ‘the madness’ – has faded. But it doesn’t completely go away. Once your body and mind have known these feelings and this experience it is impossible, I think, to entirely un-know it. I wonder, still, where it all came from in the first place, what factor or combination of factors plunged me into this vortex. It was a particular time in my life, undoubtedly; I was under more pressure than I realized. Perhaps if I had lived my life differently I could have avoided it, though I do not know what that alternative life would have looked like. Perhaps it was an inevitability, something hardwired into my DNA, even something purely chemical, or seeded in me at an early age. Perhaps there is another bomb around the corner and there is nothing at all I can do to stop it going off.
In A Farewell to Arms, Ernest Hemingway wrote, ‘The world breaks everyone and afterward many are strong at the broken places.’ I came across this line when I was ill, posted on an anxiety forum somewhere, and it stuck in my head. Now, though, if I have understood it correctly, I think it is exactly wrong, something that should not have got past the ‘built-in bullshit detector’ Hemingway said was necessary to all writers. There is another phrase, which I hear a lot and have occasionally, glibly, used myself, something from Nietzsche: whatever doesn’t kill you makes you stronger. They are both wishful thinking, sentimental, a little macho, articulating the myth of growth through suffering. Whatever doesn’t kill you might still weaken you in the long run. The places where you have been broken remain your structural weaknesses, the places most likely to bend, or crumble, or snap under the strain.
In August this year, when I was visiting my parents, we drove the few miles over to Severalls Hospital, where, at different times, they had both been in-patients. Severalls, originally The Second Essex County Lunatic Asylum, then Severalls Mental Hospital, was built in 1910, a large complex of buildings in the Queen Anne Style with further ‘villas’ or accommodation blocks set around its extensive landscaped grounds, home at one time to as many as two thousand patients. It was closed in the early 1990s as part of the general shutdown of hospital-based psychiatric care and, with the exception of one or two of the smaller buildings repurposed for mainstream hospital services, has stood derelict since.
Severalls was not far from where I went to school and even then, in the late 1980s, it carried a potent mythology: a place where the strange, the deranged, and even the dangerous were kept in isolation from the rest of us. It was part of the everyday threat and abuse of school – that you would be sent there, that you belonged there – made almost banal by over-use. It spoke, I suppose, to the fear and mystery of mental illness, our undeveloped but intuitive sense of what it would mean to be cast out of normal society. Fear of the other, fear of the other within ourselves. The name alone – Severalls – carried, for all the kids I knew and perhaps many of the adults too, a powerful taint of fear and shame.
My mother and father had not been there, I think, for nearly thirty years and I was surprised when they suggested that we drive over and have a look. The whole area is being redeveloped – a new junction on the A12 to provide access to Colchester United’s football ground – and at first we could not find the entrance. The main buildings are behind wire and fencing. There has been trouble with trespassers and over the years one or two buildings have collapsed. The Great Hall, where dances were held for residents on Saturday nights, was gutted by fire. But there was nothing to stop us driving through the main gates, slowly up the wide, oak-lined drive and then along the perimeter fencing, feeling like trespassers ourselves, expecting at any minute to be shooed away.
My parents pointed things out to each other and to me, orienting themselves, and it was possible to get a sense of the scale of the place and its past grandeur, like a country estate or up-market spa hotel and golfing resort, the looming water tower in the central square now listed for its architectural importance. My father recalled that on his first morning in the hospital he had sat, in a wheelchair, at one end of the main hospital corridor, unable to see where it ended. They both recalled the layout of the wards – the mildly afflicted in the villas around the grounds, those considered the most disturbed deep inside the main building, and everyone else somewhere in between.
It was a strange pilgrimage. My parents seemed relaxed enough, more curious than alarmed, perhaps pleased to have survived the place and see it abandoned, and, in the late afternoon sun, with the undergrowth climbing about the dilapidated and broken windowed, bat-roosted buildings, and the orange builders’ tape, blue tarpaulin and signs advertising the long promised redevelopment – ‘248 Affordable Homes’ – the place seemed melancholy, mournful, a dead and harmless relic, a failed enterprise. But I could not entirely shake the whiff of institutional power and abuse, of a place where psychiatrists were at liberty to experiment with new treatments, where, my mother told me, women had been incarcerated for their whole lives and given electric shock therapy to treat them for the illness of having had an illegitimate child or of being raped; a place that, at times and for some people, must have been quite as dreadful as anything our childish imaginations could have conjured up.
We debated letting the dog out for a run and a crap in the long grass, but no one much wanted to get out of the car, so we drove home.
*I wrote about that experience in The Dublin Review number 51, Summer 2014.
To read the rest of Dublin Review 57, you may purchase the issue here.