Im
no stranger to depression.
But
what I still didnt know during my first psychiatric consultations
is that,
in the definition of bipolar disorder,
the pole opposite the dive into depression isnt necessarily
a state of spectacular euphoria and disinhibition
that leads to social suicide and often to suicide itself,
but just as frequently what psychiatrists call hypomania,
which means in plain language that you act like a fool, but not
to the same extent.
It was totally predictable, since manic excitement is invariably
followed by a dive into depression: an atrocious period. In the
first phase I was elated at the prospect of a new book and a new
life, full of promises and conquests. I rented quite a nice apartment
on the rue du Faubourg Poissonnière in Paris. I bought a
Bluetooth speaker and took out a subscription to Deezer,
both of which I imagined, oddly enough, as attributes of my new
life. Then I end up as lonely as a rat, without a woman, or impotent
when by chance I bring one home, my neck covered in dandruff, my
cock blistered with herpes, unable to write, having lost all faith
in a book project which a few weeks earlier seemed so right, so
necessary, so doable, as all I had to do was start by describing
what was happening to me. The problem is that I dont know
whats happening to me, and Im no longer able to tell
myself or anyone else anything at all.
To live, you need
a story, and I no longer have one. My life is reduced to the path
between my bed, where I bathe in a terrible sweat, and the terrace
of the café Le Rallye where I spend hours smoking
cigarette after cigarette in a dazed stupor. Even today I cant
walk past this cafe without a shudder. For almost two months I barely
washed or changed my clothes. The bathtub got clogged and I did
nothing to fix it, and even when I went to bed I barely changed
out of my depressed mans garb: shapeless corduroy trousers,
an old sweater full of holes, trainers whose laces Id removed
as if in anticipation of the precautions that would soon be imposed
on me in psychiatric hospital. I dont stop trembling, objects
fall from my hands. If I put jars of yoghurt in the fridge, they
slip and crash on to the kitchen floor. Yoghurt I can deal with,
but one day I wanted to move a little statue of the Gemini twins,
which Id placed on a shelf like an altar, by a few inches,
and I dropped it, too. It shattered. I stood there for at least
an hour, looking at these pieces of terracotta which had been the
secret symbol of my love, between my feet on the parquet floor,
and I thought: there you go, you couldnt say it more eloquently,
everything was broken, nothing could be repaired, it was all over.
My internment at the
Sainte-Anne psychiatric hospital in Paris lasted
four months. The medical report, which I have in front of me, begins
with this summary: Characteristic depressive episode with
melancholic elements and suicidal ideas in the context of a type
2 bipolar disorder. And, a little further on, heres
how the patient is described on admission:
Moderate
psychomotor retardation with hypomimia, sad expression but emotional
reactivity. Despondency, anhedonia, abulia, significant moral suffering,
asthenia with a considerable psychic and physical toll incurred
in carrying out daily activities. Melancholic elements with pejoration
of the future and a sense of incurability. Ruminations, feelings
of guilt towards loved ones, invasive suicidal ideations
You dont have
to master psychiatric vocabulary to understand that I wasnt
doing well. If you want to go into the nuances, significant
moral suffering is worrying, but less so than intense
moral suffering, which I was soon to experience, and which
is itself less worrying than intolerable moral suffering.
Ive experienced that too, I dont know if theres
a fourth. In the past few days, my already not very glorious state
has worsened.
From one day to the
next, from one hour to the next, I had gone from agitated to catatonic,
and this state so alarmed my sister Nathalie that she made an appointment
for me at Sainte-Anne. Thats how we ended up on the top floor
of a modern building on the edge of the hospital compound, in front
of a cordial, 60-year-old man in a white coat, with bright blue
eyes and the quiet authority that characterises whats known
as a bigwig even though no one ever talks of anyone being
a little wig who, seeing me in the state described in the
report, decides to admit me straight-away. I dont go home,
they put me to bed, well have to wait and see for how long.
He stresses the notion
of illness very different from that of neurosis, which has
dominated my adult life. The question is not to discover its origin
or to understand why Ive spent my life lugging such a big
load of shit around in my head. The fact is that Im sick,
just as sick as if Id had a stroke or peritonitis, so theyre
going to lay me down and look for the right treatment, and they
dont hide the fact that theyre groping in the dark and
that they might not find just the right thing for me right away.
But what we can do until we find it, says the bigwig,
is keep you out of harms way. And dont worry,
well get you out of here as fast as we can. Hearing
this, I heave a sigh of relief: Im sick, Im going to
lie down, stop fighting, let things take their course, theyll
take care of me, and for starters theyll shoot me up big time.
To return to the medical
report: Inclusion in a protocol with twice-weekly administration
of ketamine. First three infusions: good tolerance, thymic improvement.
Ketamine, for those who dont know, is a horse anaesthetic
that people use to get high, and which in recent years has been
found to have antidepressant properties. This is my introduction
to high psychiatric chemistry. Before and after each session, the
protocol includes my being given a questionnaire about my desire
to live or to die, my suicidal impulses, my deprecation
of the future, etc.
First infusion: 40
minutes, not one more or less, and when its over, its
over, from one moment to the next. But during these 40 minutes its
an XXL high. Lying in bed, I remain conscious, perfectly conscious.
I can feel time passing. I can hear the doctor and the nurse talking
softly. But I get the impression that theyre far, far below
me, lost in the landscape above which Im floating. Because
I am floating. Im drifting. I see everything. Im perfectly
calm, perfectly fine, Id like it to last for ever. Its
like the descriptions of near-death experiences, and of heroin,
of course. The heroin that you should never touch because its
so good. Im glad Im interned at Sainte-Anne if theyre
going to drug me so wonderfully. I feel good. After the first three
infusions I still feel good my tolerance to the drug is so
encouraging and my thymic improvement so obvious that Im already
talking about leaving, and not just about leaving the hospital,
but about leaving the country. With ketamine, work is back on the
agenda.
Fourth injection:
bad tolerance with intense moral suffering and request for euthanasia.
Things take a turn for the worse, were into the rough.
The night before the
infusion, I freak out. Although Ive forgotten so much, I remember
very well that my anxiety had its starting point in one of the most
perfidious aspects of bipolar disorder. When youre in the
depressive phase, theres no getting around the fact that youre
there: its horrible, its hell, but at least you cant
be wrong about it. Whats insidious about the manic phase is
that you dont realise its a manic phase. Especially
when its only hypomanic and youre not stripping off
in the street or buying a Ferrari. You tell yourself that youre
fine, that everythings all right. After all, that can happen:
its normal, desirable even. You know it wont last for
ever, but when it happens you have every reason to be happy and
not to tell yourself that its a trap. In my case, however,
theres a good chance that it is a trap, another blow that
the disease has in store for me. Because its no longer me
but the disease that wields power over me.
In the morning, all
I want is the ketamine shot that will send me to heaven for at least
half an hour. I want it so much that, fearing I wont be given
it if I confess to my psychological state, I say in the questionnaire
that I didnt sleep well and that I had some dark thoughts
but that in fact Im fine. The drip begins. I welcome with
gratitude the blissful liquefaction, and then very quickly things
take a turn for the worse. Im heading for death. Its
clear: Im heading for death. The doctors murmur softly to
the right of my bed, I dont understand what theyre saying
but they must be reciting verses from The Tibetan Book of the
Dead to accompany me to the Bardo. Theres a light above
me. I have to go there. I have to go there. I mustnt miss
the exit. I mustnt remain in this in-between state, this bad
life. Everything must end and the suffering must stop, for good.
Several times I go to the enormous effort when youre
on ketamine, every word costs you dearly of repeating I
want to die, I want to die. Instead of two doctors there are
now four or five in my room, which becomes too small, much too small,
a small box that shrinks even more, and, stuck to the ceiling, I
start to cry. I cry, I cry, I say that I want to die, that I know
very well that its not their job to kill me, but I beg them
to do it anyway. Finally, in response to my moans and my begging
that they kill me, or failing that, that they at least turn off
my mind, thats what they do, and quickly. One shot, the fuses
blow, everyones gone. Then begins a blank that lasts several
days and would end this chapter if I didnt have one more sentence
to add. What Im saying here is brutal, but my condition was
brutal and Id like it to be clear that the doctors I dealt
with at Sainte-Anne were and are all very competent, but hey! there
are jerks everywhere, and as things turned out, there was one who
called Nathalie after this episode and asked: Your brother
has made a request for euthanasia, what do we do?
The psychiatrist who
treats me has seen a lot of melancholic depressives in his time.
He knows how to assess the risk of suicide, which he considered
to be very high in my case, and I myself realise on rereading these
pages that I can find no words to adequately convey the intolerable
moral suffering mentioned in my medical report. If I can find
no words, its because Im too distant and detached today
to be able to remember, describe or name the horror in which I was
then immersed, and above all, I think, because there are no words
for it. What Im saying here sounds horrible, but in fact it
was much more horrible than that. It was an unspeakable, indescribable,
unqualifiable and the word hardly exists, but no matter
immemorable horror. When youre no longer there, you can no
longer remember that thank goodness. Would I have made it
through without Electro-convulsive Therapy? How would I have fared?
I dont know, and Ill never know. But yes, maybe the
ECT did save my life. But whatever the case, the improvement wasnt
spectacular. All during the treatment, my hospital report speaks
of non-linear development with moments of thymic improvement,
without a clear recovery of vitality, significant thymic
decline with anxiety and negative thoughts and increasing
memory problems.
In my experience,
these memory lapses are the major and most serious
side-effect of ECT. Youre told that theyre temporary,
that your memory will come back, that at most the loss will only
last as long as the treatment period, but its not true. Im
writing these words three years after the fact, and my memory is
still a field of ruins.
It often happens to
me that I talk to a friend without remembering what we said the
day before, or even that we spoke the day before. Im constantly
afraid that the people I love will think Im either neglectful
or inattentive, or that I have the beginnings of Alzheimers
which wouldnt be unlikely, because the risk of Alzheimers
is much higher than average among people with bipolar disorder.
There is, however, a silver lining to all this, because if memory
loss is the collateral damage of electroshocks, they also had a
totally unexpected collateral benefit.
One day, in the cafeteria
of Sainte-Anne where hed come to join me for a hot chocolate,
I complained about these memory problems to my friend Olivier Rubinstein.
He said: You should memorise poetry, thatll take the
rust off your neurons. And in this horribly difficult time,
it made my life more bearable.
Im discharged
from Sainte-Anne at the end of April, and the report ends with this
observation: Good transient recovery but frequent relapses.
The fact is that for at least three months Ive been doing
better, much better even. The medication seems to be working.
Lithium is an alkali
metal, an element in the periodic table, and, when administered
as lithium salt, has proved surprisingly effective in treating mood
disorders since the 1970s. I take it every day now, and when I take
it I think of the melancholy reflection by the American poet Robert
Lowell, who suffered from manic depressive psychosis in its most
acute form until he started taking it:
Its terrible
to think that all Ive suffered, and all the suffering Ive
caused, might have arisen from the lack of a little salt in my brain,
and that if the effects of that salt had been known earlier, if
Id been given it earlier, I might have had a happy or at least
a normal life, instead of this long nightmare.
I wouldnt say
anything so radical, because even though I sometimes think it was,
my life hasnt been one long nightmare. Still, I too belong
to the group of bipolar patients who respond well to lithium. It
makes my highs less high, my lows less low, and Im so afraid
to find myself once again back at the Sainte-Anne psychiatric hospital
that Im ready to take it, obediently, for the rest of my life.
This is
an edited extract from Yoga by Emmanuel Carrère,
translated into English by John Lambert and published by Jonathan
Cape in June 2022
AT
LEAST HE DIDN'T BECOME A VICTIM OF OXYCONTIN!
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