A personal expository essay about mental health by Nancy Townsley.
My mother always liked Easter lilies. Every spring, she would give my sisters and me each one of the plastic-potted kind they sell in the big grocery stores. I’d try to remember to give her one, too, in time for the holiday but at least before her birthday, which is on April 29. If I forgot, I’d be sure to give her an orchid corsage for Mother’s Day two weeks later, even though it was not at all the same thing.
The lilies would sit on our kitchen tables, perched like stern, paste-white sentries, reminding us that our mother really wanted us to keep going to church. Originally that meant going to the Missouri Synod Lutheran Church, but later on it meant practically any church, as long as it was a Nicene Creed-believing one. If the service included communion and a long sermon connected to a particular Bible verse, it would be ok with her, and the thicker the bulletin, the better.
One time my mother said to me — with true concern on her face — that she was worried my older sister wouldn’t get to heaven because she had stopped going to church. That was years ago, before she fell into the dark vortex of dementia and it sucked her down, never to return. It was when she still lived at home with my father, who tried to take care of her and did for a long, long time, before we had to put her in a care facility where she would be safe and wouldn’t wake up in the middle of the night and yell or turn on the stove or wander off, which she tried to do from time to time. We worried mom might accidentally burn the whole house down. We feared the situation would be dad’s undoing.
When my mother was healthy, or at least much healthier than she is today, she made ground-beef casseroles and fudge cakes and a flank steak recipe my father loved. She did the washing and ironing, kept a meticulously-detailed checklist of the pills they each were supposed to take every day and went on rides with him in their 1970 convertible Volkswagen bug, a powder-blue job with a license plate holder bearing the words “Super Mom.” My dad adored her, and even though he sometimes grated under her insistence that we all attend Sunday services unless we were sick in bed, he followed her lead on most other things with little complaint and no real resistance. Around 2004, when she began to forget more than a few little things — she’d start a sentence and trail off in the middle, unable to remember what she’d intended to say — her embarrassment and frustration made everything harder. Dad would try to fill in the blanks for her. Sometimes she’d get mad and shut him out for days, or say she didn’t love him anymore. My father became older and more bent over before my eyes. Later on she came down with Pick’s disease, a cousin of Alzheimer’s that causes aphasia, a disorder of the part of the brain that controls speech and language, and she fairly quickly fell nearly silent. Since then my father has coveted every monosyllabic intonation of her former self: a giggle, a sigh, a “yes,” a “no.”
I drive to my mother’s care center in Tualatin, Oregon, with my husband every Thursday and find it quite ironic that I see her more often now than I did when she could still speak and move and reason and worry. It’s been three years since her incarceration and she is still alive, in the eating and breathing sense anyway, with god only knows what thoughts going through her shrinking, snow-white-capped head. I hope she is free of the fears and anxieties that gripped her for most of her adult life. She’s 82 now, a thin shadow of the person she used to be. She is — as she used to say of some of her patients when she was a practicing nurse in the intensive care unit of a Portland hospital during the 1970s and 1980s — an invalid. It’s hard to tell, impossible really, to discern what’s occurring in her mind, even when I stare intently into her dark brown eyes after my father exclaims, “Isn’t she pretty?” — more as a statement than a question because he has been in love with her since they were in high school in Algona, Iowa, and their families lived two streets over from each other.
His daily life’s rhythm is dictated by hers now, a complete role reversal from all the years she spent moving across the country and even to Puerto Rico with him while he was a pilot in the U.S. Navy, from 1953 to 1973. Wearing sleeveless rayon dresses, high heels and Jackie O-style sunglasses, my mother would proudly stand inside cavernous squadron hangars, my sisters and me wiggling in our folding chairs beside her, whenever our father received a promotion. He was a commander when he retired from the military. I thought they were pretty happy then — and now, even in her silence and his sorrow, they seem to be again.
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My father stomped out of the house more than once when I was a teenager, the middle child and the peacemaker, and I was afraid he would never come back because my mother was kind of crazy then, not lunatic crazy but a bit batty from her own sense of inadequacy in a pathological way that could probably have been made better with drugs or counseling or both. That was not the way it was back then. Today women pop Prozac, Zoloft and Paxil like they’re eating M&Ms, but in the ’70s few people talked openly about taking medication for anxiety or depression or even bipolar disorder — least of all in my family. As far as I know my mother was never diagnosed with any of those maladies, but I suspect she suffered from two of the three. Her highs were so high, and her lows so low, that when I was fifteen I would regularly hide out in my bedroom after school, avoiding the whole situation, listening to Carole King’s “Tapestry” album over and over, until my sisters and I were called down to dinner. I’d descend the stairs with trepidation, hoping that all would be convivial during the evening hours, but it often wasn’t. On good days my mom would chatter incessantly; a frequent rejoinder in our family was, “Mom, I can’t get a word in edgewise.” She could appear euphoric, smiling and laughing, then turn vitriolic. Her critical words stung and her withering looks caused me to seek refuge at my friends’ houses, in smoke-filled party rooms, losing myself in the heady lyrics of rock music or the arms of bad boyfriends.
When things would reach a certain level of nastiness at our house my father would attempt to intervene on our behalf, but his pleadings were often no match for the rising tide of my mother’s wrath. Like a prosecuting attorney on a tear, she’d spiral quickly, spewing accusations and allegations — our aunt was a self-righteous so-and-so; our dad was her willing prey — until she was done and there was nothing left for her to say. Afterward, red-faced and weeping, she’d ask our forgiveness and forbearance while we were still reeling from her most recent emotional explosion.
I resented my mother for her outbursts, but mostly I felt sorry for her. Somewhere inside, I understood what she was going through: the guilt, the insecurity, her inability to reach beyond her pain to a place of balance in her life, because as an adolescent I lived the same questions. Many of her miseries spilled over, awkwardly, into ours — ruined holidays, lost moments, unexplored ground were prices we all paid, including my mother — and I often wondered why. Why wouldn’t she talk about what she was going through? Why couldn’t our family negotiate our troubles together, communally slaying mom’s dragons with sabers and swords and tiny relentless pickaxes until they stopped breathing such destructive fire?
So many females in my mother’s generation — and some from my own and that of my daughter — have fallen victim to a culture in which conversations about women’s mental health have been painfully slow to evolve. We put our best feet forward, we avoid conflict, we keep stiff upper lips. It bites us in the ass.
It was against that backdrop of emotional ebbing and flowing that I grew up, went to college and flew from the nest. After I was married I spent my 20s and 30s trying to resist falling into my mom’s self-destructive pattern. For at least a decade I tried things her way. I went to church, I led the children’s program, I joined a women’s Bible study. Instinctively I recognized that road would eventually diverge and the uneven pathway would crumble, that the pieces of my personal puzzle would fit no more neatly inside my carefully constructed house of cards than had my mother’s. But it was a familiar script, so I got up each day and tried very hard to be someone I wasn’t, to my peril and to the consternation of members of my own young family. It was a very bad idea. So many females in my mother’s generation — and some from my own and that of my daughters — have fallen victim to a culture in which conversations about women’s mental health have been painfully slow to evolve. We put our best feet forward, we avoid conflict, we keep stiff upper lips. It bites us in the ass.
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The notion of mental fragility associated with the “weaker sex,” including the term “female hysteria,” predates the erratic on-screen behavior of Vivien Leigh’s “Gone With the Wind” character, Rhett Butler’s nemesis Scarlett O’Hara, by a good century or more. And in an even earlier real-life example, Mary Todd Lincoln’s reputed frequent tantrums made her the poster child for mental instability among women in Civil War times. Whether Abraham Lincoln’s wife, the mother of his four children, suffered from borderline personality disorder, bipolar disorder, depression, textbook insanity or straight-up narcissism is a matter of conjecture in biographies and documentaries to this day. Yet the contemporary debate over the reality of women’s emotional issues, as well as their perceived severity and recommended treatments, seems to trace its roots to Mary Lincoln’s lifetime.
Fast-forward to today, and as recently as late April, Welsh-born actress Catherine Zeta-Jones is reported to have checked into a mental health facility for the continued management of bipolar disorder, a condition revealed by her husband, Michael Douglas, in a 2011 interview. There are also other less-famous folks working behind the scenes to destigmatize issues surrounding women’s mental health. On the weblog Ex:Change, Mary M. Clare, Ph.D., a cultural psychologist and a professor of counseling psychology at Lewis & Clark College in Portland, writes about the journey women have taken over the last 40 years as they’ve negotiated the sometimes-rocky terrain of their own mental and emotional well being. She says that since the 1970s we’ve been slowly chipping away at the male-dominated system — “the feminine is still less valued,” she believes, presenting gender-specific problems that bleed over into women’s unhealthy responses to home and workplace pressures — but we’ve still got a long way to go, baby.
With an orientation “more toward civil rights than toward pathology” when it comes to her interpretation of multi-axial mental illness, Clare laments the struggle of a longtime friend and her daughter, whose bipolar disorder nearly undid the lives of two generations of women. They’ve been in and out of treatment, boomerang fashion, seeing doctor after doctor and submitting to biochemical alteration — when, in Clare’s estimation, a finely-tuned, empathetic ear might have been the best intervention of all.
“What begins as a conversation about the trouble someone is having can fairly quickly turn into a conversation about their diagnosis and treatment — the person gets lost,” notes Clare, who is not opposed to targeted therapy — she just wants the afflicted to get regular and genuine hearings from their practitioners. “The one who is most able to tell you what they’re going through is the person herself,” Clare says. “Where we’re failing is that we’re not listening. We’re so captivated by the technology that we forget the person. To me, listening and being listened to are major antidotes to mental illness.”
Of society’s marginalized groups, Clare believes, “people with mental illness may be colored most invisible.” Indeed, she says, “so frightening is mental illness to those who consider themselves free of it, that the whole world would rather not speak of it except to exaggerate it in the way of absolution,” as occurred after the mass shootings in Aurora, Colo., and Newtown, Conn., last year. The absolution corollary — that none of “us” would do that because we’re sane — creates a “locus of blame,” Clare says, with a bright-white light firmly trained on those perceived to be mentally ill.
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My mother never wanted it to end this way, that she’d inherit “This Thing,” as she called it, the trouble that befell her father in his later years, an ailment that took his mind and most of his memories and mixed them all up in a confusing emotional stew of bitterness and anger and fear. But it is her fate, and perhaps her salvation. The other night I sat with her and held her hand, with its blue-veined paper-thin skin, and kept it from trembling while she wept and looked at me with her brown pleading eyes, a frail octogenarian’s version of the ones in which my father became lost more than fifty years ago. I saw so many things: the teenaged mid-western beauty queen who shucked corn in 100-degree summer heat and once climbed to the top of a building just to get a better suntan when she was in nursing school in a single rebellious outburst over a lifetime of stolid obedience. The young military wife who followed her officer husband to duty stations near and far, three small girls in tow, hosting cocktail parties and teasing her hair and smoking menthol cigarettes and proclaiming Tuesday her “ironing day” and always, always looking for herself amid all the noise.
The anxious involved mother who sometimes was overwhelmed, who took us to horse shows and ballet lessons and dental appointments, who bought us matching car coats and mixed up identical glasses of Tang, trying to make sure everything was equal in our sibling rivalry-driven world. The doting grandmother who sewed pinafores and read books and braided hair for the first members of the coming-up generation who are now mostly grown and off on their own adventures, whose pictures are pinned to the bulletin board in the stark room she shares at the care home with Marilyn, who also cannot think or speak much at all and who drools when she falls asleep and her head nods forward.
My mother, who used to dance the Charleston in the living room and introduce me to women my age at her church because she thought we might become friends. My mom, who had such distinctive, part-cursive, part-printed handwriting and who loved to laugh and still does, but who now barely resembles the woman I have known since 1957, the year I was born and the one in which the motto “In God We Trust” started appearing on U.S. currency. She delighted in her grandkids — loved their silly rhymes, their made-up games and the way the first one, my eldest daughter, couldn’t pronounce her ‘Rs’ when she was two. “My bifday is Mahch twenty-fuhst,” Lindsey would say, to which my mother would throw back her head and erupt in gales of laughter. I think she was far more comfortable being a grandma than she had been being a mom. The latter held too much responsibility for her fragile emotional countenance to bear.
The mother of my high school best friend, Mary, had electroconvulsive therapy up at the old Holladay Park Hospital in Portland in the mid-1970s because she was sometimes manic and other times depressive, making life hell for her and everyone who lived at Mary’s house. A two-story contemporary with a manicured lawn.
A memory pierced my mind a few weeks ago that provided me a stunning lens through which to view my mother’s issues and those of many women in the generation before me. The mother of my high school best friend, Mary, had electroconvulsive therapy up at the old Holladay Park hospital in Portland in the mid-1970s because she was sometimes manic and other times depressive, making life hell for her and for everyone who lived at Mary’s house, a two-story contemporary with a manicured lawn around the corner and down the street from mine in a quiet, upscale neighborhood in Lake Oswego. She and I had moved with our respective families from California to Oregon in the summer of 1973, and we bonded over a shared loathing of Pacific Northwest rain and our appreciation for the handsome young men who roamed the hallways of our high school.
“When mom was good, she was really good,” Mary says today of her mother, Margaret, who was born in 1921 and died in 1998, not from the effects of mental illness but from bone cancer, leaving behind three grown children and Mary’s only daughter, Claire, now 16. “But when she was bad, she was really bad.” Margaret underwent a hysterectomy when Mary was in elementary school, and the doctor failed to get her hormone replacement formula right. “From there, she just kind of went off,” says Mary. Once, when she hit rock-bottom during a particularly bad depression, Margaret’s physician prescribed lithium, a drug first used in the 19th century as a remedy for gout and one that became popular for the treatment of mania in the 1870s, nearly 100 years before Margaret began wrestling with mental issues. The medication helped, but not all the time. “My mom started getting really sick,” Mary recalls. “She’d withdraw and get quiet. That was really strange, because she was usually so gregarious. Normally she was fun, and funny — she was a blast.”
Sometimes Margaret would say she was going to commit suicide, and that frightened Mary a lot. “I’d come home from school and stand outside my mom’s bedroom, listening for her voice to make sure she wasn’t dead,” says Mary. “I’d call, ‘Mom? Mom?’ It was awful. I lost so much respect for her; I thought she was crazy.” Margaret’s struggles affected her daughter and husband, Bill, in other ways, too. “I ended up doing all the housework, making our meals,” says Mary. “Dad was definitely in denial, and he traveled a lot, so those times were pretty bad. I don’t think they knew what to do back then.”
Someone suggested ECT, and Margaret agreed to try it. “She would go to the hospital and be committed,” Mary notes. “There were very few doctors who’d do the therapy. The ones who did said it wasn’t a last resort — they said it worked for some people. Mom would stay a few days and when she came home she was better. We noticed some short-term memory issues, but that was never all that troubling to us. We were just happy to have her back.”
A few times I rode with Mary to Margaret’s appointments in the back seat of her green Mustang fastback and stayed there while the two of them went in, Margaret talking nonsensically as they headed through the door. By the time they came back out, both were subdued, Margaret catatonic and Mary sometimes crying, her mom leaning heavily on her arm for support. “It was hideous, and it was the scariest thing,” Mary says of the therapy sessions. “But after a couple treatments, she’d be back on track.”
By the time Margaret’s cancer reached the point of no return in the late 1990s, she and Mary had come to a place of acceptance and understanding in their relationship. “I think she had a lot of guilt about what she put me through,” says Mary. “I had seen her at her worst. She got the raw end of the deal for many years.”
Margaret, who came of age during the Great Depression, was a petite, welcoming woman with a broad smile. When she lived in California she was “involved in all kinds of politics,” notes Mary, never lacking in her ability to carry on an informed conversation about current affairs. When I’d hang out at their house in Oregon she’d regale me with stories that inspired and challenged me beyond the Republican roots of my own upbringing.
But then I’d go home, where I wouldn’t say a word.
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In a recent blog post, Clare, who maintains an office in the Graduate School of Education and Counseling at Lewis & Clark, writes that electroconvulsive therapy — formerly known as electroshock and in which seizures are electrically induced in anesthetized patients for therapeutic effect — can be a salvific formula for some women who have exhausted other avenues for relief, including cognitive therapy and psychotropic medications. “I understand from women who have depression or bipolar disorder … that it can be a welcome alternative,” she writes. Clare notes that her conversion to this way of thinking occurred only seven years ago. She admits to “having dismissed ECT as arcane” prior to 2006.
“I have not always been a fan of ECT,” she says, but in at least one case she firmly feels the procedure saved the life of a young woman she knew. Her friend, who was not a candidate for ECT, took lithium — which can serve as a mood-stabilizer in the treatment of bipolar disorder — and at one point experienced poisoning from the drug so severe that it “destroyed her cerebellum’s function,” Clare says. On the other hand, ECT therapy “has probably been used carelessly, sometimes maliciously” over the decades, she opines, “and likely caused great harm.” However, beyond triple-bind studies and volumes of research pointing both directions, neither approach gets a double thumbs-up from Clare. “I am a fan of peoples’ well-being,” she concludes.
Most ECT patients, about 70 percent, are women. Exhaustive studies (and conventional wisdom) show females are at twice the risk of depression as men. Documented concerns over ECT’s side effects have been said to run the gamut from slight memory loss to extreme cognitive impairment, permanent amnesia and an inability to effectively work. Writer Sylvia Plath’s 1960 poem, “The Hanging Man,” is widely considered to be a six-line summation of her own electroconvulsive therapy treatments in the mid-1950s:
By the roots of my hair some god got hold of me.
I sizzled in his blue volts like a desert prophet.
The nights snapped out of sight like a lizard’s eyelid:
A world of bald white days in a shadeless socket.
A vulturous boredom pinned me in this tree.
If he were I, he would do what I did.
American author Ernest Hemingway took his life shortly after receiving ECT at the Mayo Clinic in Rochester, Minn., in 1961.
In a more contemporary story, a friend of Clare’s describes her experience of treatment for bipolar disorder on Clare’s blog: “It’s possible that the ECT administered in the ’90s caused some word-finding difficulties. If it did, the changes were so subtle that they were not quantifiable in a neuro-psych evaluation,” she recalls. “By contrast, lithium has permanently altered the function of my cerebellum, teeth, thyroid gland, parathyroid gland, kidneys and endometrium.” Still, she writes, she feels fortunate to have access to the drug, because it worked when nothing else did. “As my psychiatrist said, discontinuing the lithium in order to preserve my renal function would likely result in my death by bipolar and [produce] a corpse with very healthy kidneys.”
My mother would never get help and always feel she got cheated. My father would stay by her side, loving her, trying to smooth her self-inflicted emotional rough places.
The main difference between my friend Mary’s mom and mine was that hers got help and mine didn’t. When we were in high school, they were the only two moms I knew who appeared to be afflicted with such issues, though I sensed they were not. For the most part hers seemed healthier, and that was something that always bothered me, though I couldn’t see any way to change the trajectory of the way things went. It shamed me that I wished my own mother would have undergone shock therapy, and I shielded my awful thoughts from the family, because it wasn’t something we could have talked about — the stigma seemed too great. My sisters and I found ways to be out of the house whenever we could, but like our father, we always returned. We did the right thing. We persevered.
“Isn’t it nice that your cousins can go to parochial school?” my mother would venture at the Saturday supper table, to which my sisters and me would look down at our plates, fumbling with our vegetables, and my father would roll his eyes but stay silent. “I wish you girls could go too, but it’s so expensive.” It was a dig we kids tried to take in stride. Even then I knew it was my mother’s projections, and not our failures, that were at the root of her passive-aggression. What I couldn’t abide was the look on my father’s face — hurt, beleaguered, angry, resigned — and the way it diminished him just a little bit more each time. Still, they went on. After my parents’ grandchildren came along, things seemed better for her. She was mellower, I thought, though I acknowledged, subconsciously maybe, that the reality really was mostly the same. My mother would never get help and always feel she got cheated. My father would stay by her side, loving her, trying to smooth her self-inflicted emotional rough places. In her, he found and kept his own identity.
Why did she suffer from mental health problems, and not him? How come mom developed dementia, and not dad? It’s hard to know, but there are some clues. Genetic predisposition is one. Another is that because women live five years longer on average than men do, advancing age makes it more likely they’ll develop a dementing illness. A 2012 Alzheimer’s Disease Facts and Figures report published by the Alzheimer’s Association notes that 3.4 million of the 5.2 million Americans over age 65 living with dementia that year were female. And other studies, including one in 2012 published in the Archives of General Psychiatry, say middle-aged women with depression are two to three times more likely to eventually develop dementia than their depression-free counterparts. So I wonder: As my sisters and me progressed through our teen years and needed our mother less and less, did she experience an existential crisis that pushed her toward depression? She had returned to her nursing profession by then. Did she find it overwhelming and confusing in its juxtaposition with her former life as a stay-at-home wife and mom? As always, there are more questions than answers.
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Every day now, twice a day, my father gets in his car and drives ten miles each way to sit by my mother’s bedside and give her sips of water, smooth her silky hair, kiss her unmoving lips. “Isn’t she pretty?” he says, and means it. He hasn’t been to church since we moved her out of their home, and for a long time he was angry with the Baptist and Lutheran gods of his youth and young adulthood. I don’t know if he still prays, but when I do (and that’s rare), I petition the keeper of the universe to free my mother from her demons. I like to think that even as she continues to decline, the perpetually half-empty glass of her life will become half full of all the things she missed out on before — calm, breath, kaleidoscopic color.
A few nights ago I had an epiphany at the care home. Sitting on the faux leather loveseat next to my mother’s rolling bed, tucked into a corner of the TV room near the fireplace’s river rock façade, I looked into her fading eyes. I saw past their deeply creased and heavy lids, which close so often and obscure that’s going on inside her, which is mostly a mystery even when they’re open. I saw the sorrow and the frustration and her fervent longing to go home, as my father has suggested regularly — meaning it, not meaning it — since that blindingly bright late-May day when she sat in the passenger seat of the car that brought her to the care home and cried and cried, refusing for more than an hour to get out. “If I could just do that,” she seemed to be saying to me, “it would be all right.”
She could accept everything, her befuddled and truncated thinking, her inability to speak and make people understand, the parade of strangers who feed her and wash her and help her into and out of bed now, the relative absence of modesty and dignity and utter dearth of freedom in the locked facility she shares with 15 men and 35 other women whose minds have been plundered by the plaques and tangles that drive this horrid wretched disease that has no remedy. My mother laughed, mildly chuckled really, between jags of soft crying that crumpled her beautiful face and made her sparse eyebrows look almost translucent in the light of the dining room where we all were listening to piano music. Her tears fell most when the pianist played “What A Friend We Have In Jesus,” but I don’t know whether that was because she remembered the tune or sitting in a church pew all those Sundays while her minister father preached or her own mother’s efforts at the keyboard or what. I never will know.
What I do know is that Alzheimer’s is a torturous, unforgiving disease that somehow paradoxically, mercifully imbued her waning life with the peace and tranquility that were so elusive to her in earlier years. Some call it the long goodbye. My mother, who was so verbal and engaging and who was loved by practically everyone who knew her, lost her ability to tell me how she felt about where she was going after dementia started steering her down a dimly lit, one-way road. Sometimes she smiles, and that’s nice. It helps me to think she’s been heading home the whole time.
Nancy’s mother passed away on May 30, 2013, of complications related to Alzheimer’s disease.
Writer and marathoner NANCY TOWNSLEY is slowly approaching the finish line of a 30-plus year career as a community newspaper journalist in the Pacific Northwest. Her work has most recently been published in the anthology Brave on the Page: Oregon Writers on Craft and the Creative Life and at runnersworld.com. She lives and runs near the mighty Columbia River in St. Helens, Oregon, and blogs at nancytownsley.com.
