May 8th

      Each year, I start to get a little depressed in April. Some years, I am prepared for it. I expect to be visited by various symptoms, and check them off as they occur. Somehow, knowing what's coming makes it more manageable. It's the other years, when the depression sneaks up on me, that kind of hit me the hardest. It usually starts with some irritability and some cynicism about life. It keeps creeping up until I find myself abnormally saddened or irrationally angered over some random events or events by early May. That's usually when I remember, "Oh, yeah, May 8th is coming." 

                                                                                                                                    

     For much of my 20's, I was a mental/ behavioral health worker. I worked in group homes with people who had mental illnesses that were so severe that daily functioning was impaired. One of these homes was for young men, in their late teens and early 20's. They were only a few years younger than I was at the time. Many of them had spent their teenage years in lock-up facilities for kids with serious mental health problems. Our goal was to help them to become more self sufficient—to learn how to get around in the community, how to cook and clean for themselves, how to seek out jobs and education, and how to deal with the bureaucratic system that was in charge of their mental health needs. Ideally, they would gain enough self management and life skills to move on to a less supervised apartment setting or eventually just move out on their own.

     I have endless amusing “cocktail stories” about all the characters I've met in those homes over the years, as I had experiences that not many sane people can imagine. There are also the sad or poignant stories that I only share when trying to reflect or make a point.

     Today's story is about a young man that I will call Steven*. At the age of 14, four years before Steven had come to the group home, he had been diagnosed with clinical depression. Doctors don't like to place mental health diagnoses upon children, despite what the popular media says. Children usually have to have something pretty severe and ongoing in order for a doctor to make a diagnosis. In Steven's case, there was something severe. He had attempted suicide at the age of 14 by putting a loaded gun to his head and pulling the trigger.

     Amazingly, he had survived this event, but he still had quite a bit of lasting damage even after a few years of various rehabilitative therapies. A big chunk of one side of his brain had been blown away, leaving him partially paralyzed on one side. He wore a brace on one leg and shuffled when he walked. There was also a speech impediment. He frequently drew blanks for words or stammered, troubles that he tried to conceal with filler words like “basically” and “obviously” when he was trying to gain the listener's respect. And then there was the missing eye, since one of his eyes had been blown out by the gun shot. He had a glass eye that he wore occasionally. I suspect his inconsistent use of this ugly prosthetic was because the hard, unseeing, lifeless piece of glass didn't do much to disguise the fact that he was missing a real, living eye.

     One time when we were on an outing, I watched Steven take out the glass eye and hand it towards a stranger who had been peering with some pity at his obvious disabilities. His whole twisted defiance and warped sense of humor earned him some respect from me.

     I suspect that some of the motivation for the eyeball episode also came from Steven's intense dislike for being pitied. He preferred the stranger's shocked and disgusted recoiling to his pitying sideways glance. It was another aspect of Steven that I both respected and empathized with. He exhibited that same defiance when trying to manipulate a pan, pancake batter, and a spatula with his one good hand, while stammering at me, “No.... I d-don't....want any...h-help.” He also displayed it when he shuffled and dragged his bad leg ½ mile to the bus stop so that he could go to volunteer at the library, where he someday hoped to work for pay.

     Steven and I didn't just share the traits of demented humor and defiance. We also shared something deeper—the depression. I looked at him and wondered what it must have been like to have the guts to pull the trigger. Having been troubled by suicidal thoughts of my own since the age of 10, I could relate to his predicament. I also feared his outcome—a botched attempt that left him crippled, maimed, brain damaged, and dependent. I feared that outcome enough to not have executed any of my plans yet. I still sometimes entertained these plans in my late 20's. Plans, that, due to my professional position, I would never share with any helping professional. I didn't want to be identified, ostracized, or imprisoned by the system in any way, and especially not in the way our clients experienced it. For me, freedom and dignity were more important and more likely than receiving questionable help from the system. So I sucked it up and suffered silently, hoping to eke out a living while helping a few people to get out of this mess. I thought that it was my role to model for the clients what healthy people do. And I thought a model healthy person could never be known as having depression or suicidal thoughts. So, using descriptions from various self help books, I faked being “healthy” the best that I could.

     Yet, in one way I didn't have to fake it. The system didn't seem to care that we all shared the unhealthy habit of smoking. For a large majority of seriously mentally ill adults, cigarettes and smoking are a focal point through out the day. Smoking and cigarettes play a predominant role among the seriously mentally ill, just as they do in prison culture. Cigarettes are sometimes rationed, bargained for, and fought over. Every smoke “break” represents the passage of time just as much as any clock does. Each shared cigarette represents a time when people can relax enough behind a cloud of smoke to socialize a bit. Nicotine can also be used to self medicate for anxiety, depression, and even hallucinations. Mental health staff often smoke with residential clients in order to bond. Sometimes, the offer of, “Hey, come outside and have a cigarette with me” is just enough to get an angry client calmed down and redirected. The staff also smoke with clients out of necessity, since there are no real breaks for staff members who smoke. Generally, staff can not leave the facility. So staff and clients share smoke times. If someone were to see the group of people smoking at cigarette time, it would be difficult to distinguish the staff from the clients—both compulsively sucking smoky toxins through thin white cylinders and chuckling together over their temporary relief from the pangs of withdrawal.

     I can remember years worth of shared after-dinner smoke times in which clients amused me with jokes, funny stories, sad stories, crazy tales from the state hospital, memories of the streets where some had lived at points, and even hallucination-inspired rants. Although I had become well addicted to nicotine before working in the mental health system, my association with the clients' regular smoke times helped to further solidify the behavior.

     Steven was no exception to the smoking culture. He carried one of those Zippo metal lighters that you have to refill with fluid from time to time. It seems that there is an ideal level of fluid to put in those so that the flame won't be to high or too low. Either that, or it was an excuse for him to play with it like a little torch when we sat outside. There was probably just as much fussing, fiddling and outright playing with the lighter as there was smoking for him.

     Steven liked cigarettes, but he liked cigars even more. If he was able to beg a little extra money from family, he would buy a pack of cigars. We would smoke together out on the porch after dinner, with him usually telling me about whatever science fiction or philosophy book he was reading. It was a slow, tedious process, with him struggling for words and stammering. But listening was one of the reasons I was there, and I could always suck in another drag while waiting for the words to come out.

     Other times, we would just sit silently, sneaking short peeks at one another's shyness and anxiety through the twisting ribbons of smoke before putting our eyes back down in silence. I was supposed to be the staff person: the older one, the knowledgable one, the sane one who was there to help. But in those uncomfortable smoky moments, there was no telling who was really there to help the other.

     Then one day, Steven just left. He had been getting more and more negative for a few weeks, making bitter comments towards both staff and other clients in the home. He had also stopped going to his volunteer position at the library. So, one afternoon, when a staff member was occupied with some other client cooking dinner or something, Steven just vanished from the premises. It happened on someone else's shift. I was told about it when I came to work. An incident report had been filed. Police, administrators and Steven's family had been notified. We were simply to go about our normal routines and hope that he would be found or return to his family or the group home. I was instructed to allow him in and notify my supervisor if he returned.  

     As it turned out, he decided to return on my shift, around 7 or 8 PM on a Saturday evening. He tooled in with a couple of cigars, his Zippo, some lighter fluid, and a few war stories from hanging out with homeless people. Apparently, someone on the street had taken this 18 year old boy under his wing, keeping him safe and sharing food with him for a few days. When the guy learned that Steven had the option of sleeping in a bed in a home, he encouraged him to return. And so he did.

     After he had dinner and told his tales, Steven asked if he could talk to me about something important.

     “Sure,” I said. “That's what I'm here for.”

     “Do you remember ...when I told you …that I have a problem ...with religious people ...and God?” he asked.

     “Yeah, it's OK if you don't believe in a God. You don't have to....”

     He interrupted before I finished. “It's not that I don't believe. ….I do. ...It's...b-basically...that I am angry at God.”

     “Why is that?” I asked.

     “For letting me....(sigh)...live,” he answered. “...I wanted to kill myself...but I didn't die. ….I'm mad ...because..he...he let me live.”

     I paused, and took a breath, not knowing quite how to answer. I certainly couldn't tell him that he represented a fear worse than death for me. The idea of living with the consequences of a botched suicide was what had kept me from doing it myself all these years.

     Before I came up with any words, he continued, “I'm scared...of myself right now. …I'm scared ...that I might try it again. ...I want to go... to the ...hospital.”

     I did know how to respond to that part. I had suicide prevention training under my belt from a previous mental health job.

     “Do you have a plan?” I asked.

     “Yes, I do,” he told me. He would not, however, share the details of that plan. I believed that he was serious.

     I knew from training at a previous job that I needed to make an agreement with him to stay safe until additional support could be provided. I also knew that the odds of reaching his case manager or getting him into a hospital on a Saturday night were low unless he was actively trying to kill himself, which he was not. After talking, I asked him to wait for 72 hours before taking any action. I told him that I would contact the people who were needed to help and that I would explain to them what he had told me. He just needed to wait for a few days so that actions could be taken within the system. He agreed. This is what is known as “contracting” with a suicidal person. It serves some functions. First, it allows the person to cool off without making any rash decisions. Second, it does allow for further assessment to determine the severity of the suicidal threat. Third, it allows people to set up any additional needed supports (like hospitalization) to protect the suicidal person.

     His threat to suicide was initially deemed not serious by my supervisor, who told me to “orient him back to reality” when I called her right after contracting with Steven. I told her that I felt that he was oriented to reality and not currently in danger. He had gone off to bed, agreeing to leave the door open so I could monitor his safety. I re-explained the agreement we had made; he would wait, and she and his case manager could explore hospitalization options with him on Monday. I argued that she needed to be aware of the reality that he had already made one very serious suicide attempt in his life, and that we needed to take his statements seriously.

     By Monday, Steven was calmer. Case manager had been contacted, but the decision was made to not hospitalize Steven. Case notes indicated that our clinician had advised him that hospitalization was not an option and that he needed to face reality where he was. The talk seemed to have some effect on Steven, as he had an attitude change after that. He had been edgy from the depression. But his demeanor changed to calm and pleasant. He started doing his household chores and volunteering at the library again. Even though only a week had passed since he had run and came back threatening suicide, life was pretty much back to normal.

     Then, not too long later, Steven vanished again. Once again, he didn't do it on my shift. He left on the shift of the staff who had told him to just deal with reality. This time, he didn't come back.

     From the time it happened and in all 17 years since, I have never questioned Steven's decision to leave us. I know why he did what he did, and I can accept it.

     Instead, what haunts me is the collection of images of him at different points:

     I am haunted by the image of that very prideful, defiant, strong young man having to humble himself enough to ask for help, to ask for hospitalization even. And then being given a loud, “NO!” from the very system that was designed to help him.

     I am also haunted by the image of that same young man, feeling that he had exhausted all options, taking the loneliest walk of his life. That night, he didn't just leave us. He walked to the neighborhood grocery store and purchased 5 bottles of lighter fluid and a box of matches. He then walked out to an alley somewhere between the group home and the store, dumped all 5 bottles of fluid on himself and lit a match. Neighbors called 911 when they heard him screaming, “No! No! I don't want to burn anymore!” and saw his blazing body through their window. Apparently, he had changed his mind, but it was too late. That was May 5^th, ,1996. It still took him 3 more days in the County burn unit to die. That was on May 8th.

     I am haunted by the sense of how deep and painful his depression had to have been. To be willing to kill himself in such a horribly violent manner. To be willing to try it a second time, he had to have been suffering deeply.

     I am haunted by the mere description another staff person gave me of Steven's mother's reaction when they told her what had happened: “A long, shrill wail that came from deep within in her that I will never forget. It was a mother's cry. It was just...raw pain.”

      I am haunted by the fact that I didn't scream louder, that I didn't advocate for him more. Although I sincerely believe that his life was ultimately going to end in suicide at some point, it still bothers me that the one time he asked for help, he was given none. I did what I was supposed to do, took all the steps I was supposed to take, and made my argument loud and clear for my supervisor. But still, it wasn't enough. If I had to do it again, I would have screamed louder. I wouldn't have trusted the judgment of my supervisor, the case manager, and a clinician, whom I had assumed were all better trained than me and knew what they were doing. I would have remembered that people who are serious about suicide often act calmer and happier once they have decided to do it. I wouldn't have been fooled by his seeming turnaround, and I would have screamed louder. (Perhaps this is why I can still get very passionate and even disrespectful towards authority when advocating. I learned from that incident that sometimes I really do know best and that the stakes for wrong decisions are very high.)

     Staff and clients from the group home attended his funeral. There I saw how much one seemingly messed up and insignificant person can mean so much to others. As I watched Steven's brothers and mother weep at his funeral, it occurred to me for the first time how my own suicidal intentions might end up causing pain for others. For some reason, it also occurred to me that death will find us all, one way or another. We don't need to seek it out.

     After that, I stopped seeking it out. I decided that I was going to be on this planet for a while. I decided that maybe life sucked a little bit less than the alternative. I guess that, in a way, his death saved my life. 

                                                                                                                                 

     This year, 17 years later, it is nearly a lifetime since it all happened. That is, of course, if you count Steven's short 18 years on this planet as a lifetime. This year, nearly 17 years later, it hit me harder than usual. It wasn't because I didn't see it coming this time. I did see it coming. I remembered well before the change in mood hit me this time. Nonetheless, by mid-April this year, I found myself unexpectedly hijacked by blinding, irrational rage over a couple of mildly irritating events. These were little things that might not even get my attention on most days.

     But the days of spring aren't like most days. Bursting with flowers, sunshine, color, and hope, the spring months also bring in the crazy winds. Winds that give me anxious butterflies in my stomach. Spring butterflies that remind me of the potential for spring madness, the road rages, the school mass killings, and the suicidal thoughts that seem to ride in on the April gales. The winds and the butterflies have been especially active this year.

     Maybe I'm getting a double dose of butterflies because I didn't notice them so much last year. I was preoccupied last year with my own tediously slow tapering off cigarettes and replacing them with nicotine lozenges, one or two at a time. I started the process of quitting smoking in January of last year, making adjustments to my behavior every two to three weeks, until the last cigarette was smoked on April 30. I had planned to hold on to the lozenges for while, until I got fully used to the idea of not smoking. Within a week, I was worriedly doing research on whether nicotine lozenges could be harmful, and I started feeling queasy about using them. I started reducing the number of lozenges and cutting them in half.  Things began tapering off very quickly until my body simply began to detox what little nicotine was left in it. In effect, my body decided to begin rejecting nicotine on its own. I decided to stop sucking on the lozenges and let it happen. Although I didn't plan it that way, May 8^th ended up being my first completely nicotine free day in nearly a quarter century. Withdrawal and nicotine detox had already started on their own, leaving me sweating and cramping in some 3 day, withdrawal-induced, altered state of mind. At some point in the middle of one of those nights, the physical hold that the nicotine had on me was broken, and the addict within finally stopped screaming. And that's when I remembered. Once again, the tension and drama of spring had passed. I could finally breathe a sigh of relief. May 8^th had come and gone.

                                                                                                                                      

     The past year has been different in many ways. Quitting smoking is only the beginning of a journey that almost can not be described to those who haven't been through some type of addiction and recovery.

     Although I stopped seeking death when Steven burned all those years ago, I never fully embraced life. Instead, I continued to burn. At points, I was painfully aware of the suicidal nature of smoking. At those points, I rationalized it as at least being slower and hopefully, a reversible decision. And then I'd continue to blaze up and burn those embers. Other times, I would simply ignore the implications of the habit.

     Addiction is a habit that both requires and facilitates denial. For me, denial of fear, anger, sadness, anxiety, and any other disliked emotion could be sucked up and cloaked in smoke for decades. What I didn't realize was how so many other emotions were cloaked, as well. Excitement, pleasure, joy, and serenity that once appeared as distant images through a cloudy haze now appear with crystal clarity. There was also an awakening of the senses. 

     According to both quitting literature and logic, a person's sense of taste and smell return with vibrancy after quitting cigarettes. But in my case, the sense that returned most powerfully was sight. Despite the inevitable degeneration of vision that comes with age, my post-quit eyes no longer serve as simply functional organs. No longer hard and devoid of vision, my eyes now search for all the powerful visual sensations in life—the well coordinated colors of a colleagues outfit, the rippling of sunshine through the leaves of a tree, the breathtaking quality of a horizon at different points during the day, the unique and ever changing essence of a blooming flower. In the past, I might have noticed these items, usually after they were pointed out to me. But without the metaphorical, and sometimes literal, cloud of smoke, they seem to spring into my line of vision and pull me into another previously unknown dimension. Some days, I feel like I can not see enough. I try to visually absorb more and more images in an attempt to feed the soul that has been starving inside me for so long. Life, both good and bad, is truly beautiful and miraculous. Why did I try to avoid it for so long?

     My eyes concealed my own emotions so well for so many years that I, too, began to believe that those emotions weren't there. But in the past year, my eyes have betrayed me many times by randomly filling with unpredictable and embarrassing tears at both awe-inspiring and sad moments. My cold, glassy hardness is being replaced by more the more lifelike quality of emotion.

     Spring time, which for so many years has been a source of controlled dread, has come alive for me this year. Like the bud of a flower, my heart opens with pleasure. The butterflies dance wildly and uncomfortably within my gut as the wind wildly twists around, repeatedly deciding and then changing its mind on direction. And like spring rains that bring promise of new life, my tears have also fallen.

     This year, for the first time, I have been able able to cry real tears for that lonely, depressed 18 year old boy. This spring, I have wept several times for that child, who all those years ago, suffered so deeply that death seemed like the only alternative. A boy who had so much inner pain that he could look neither outward nor forward. Even with his remaining eye, he simply could not see.

     I've also wept tears for the much younger me, who, for similar reasons, was also unable to choose life. I've shed tears for that sad, lonely, and defiant girl who at least held enough hope to keep on surviving. The girl who desperately fought to keep on going even when it seemed she was traveling blindly down a dark tunnel to nowhere. I am so grateful for her ability to endure the struggle. If she had given up back then, there would be no now.

     I am coming to terms with the idea that depression is not actually sadness. Instead, it is absence of emotion and a failure to fully experience life. Ironically, the random flashes of anger and the sudden impulses to cry signal represent the absence of depression. Their presence represents the presence of life. Heartache and pain are not longer feelings to be hidden but experiences to be celebrated. For they are signs that I am truly and totally here, breathing, feeling, and sharing in this crazy experience made possible by all the random cosmic events leading to the union of a single sperm and egg on this planet. Like my newfound feelings of pleasure, serenity and joy, those pangs of anger and sadness are signs of life that I am slowly and hesitatingly learning to embrace.

     Today, on May 8^th, the one year anniversary of my freedom from nicotine, there are no guarantees that I will keep seeing life this way. There are no guarantees that I will stay off cigarettes. There is only the sensation that, unlike Steven, I have a second chance. For today, I have a second chance to experience both the light and the darkness, to comprehend the forces of both life and death, to feel both joy and despair. For today, as long as I am breathing, I have the choice to be alive or to merely exist, to feel or not to feel.

     For today, I choose to be alive. For today, I choose to accept what is without trying to hide behind a wall of smoke. For today, I choose not to burn.

     Because I don't want to burn anymore.

     Good night, Steven. May you rest in peace.

                                                                                                                                     

   
  This story is dedicated to those I know who have struggled with or continue to struggle with depression and/or addiction to any substance. I suspect that the internal struggle between the forces of light and darkness, life and death, and joy and despair are common threads that weave through many of us.

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     * Some names and details have been changed.