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Guilt: My Last, Worst Addiction

People have different definitions for "recovery." Mine is doing what it takes to reduce one's worst symptoms and learn to manage the stubbornly-irritating ones that remain.
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"Have you had any serious health conditions?" asked my son's psychiatrist (who I'll call Dr. C.).

It was just after 5 p.m. on the day I brought my 18-year-old son Alex to UCLA Neuropsychiatric Institute to find out why, over the course of 12 months, he'd lost the ability to complete a sentence, wear shoes, sleep through the night or face the other kids at school. Later I would learn the term "psychosis" to describe the cliff that he'd nearly gone over.

"No, none," I answered.

"All right," she said. "Shall we go on to your siblings?"

I'd been giving Dr. C. a family mental health history, after she explained its importance in coming up with a proper diagnosis for Alex. I presumed her questions were designed to track down the most likely culprit among several candidates in my family who might have passed a fatal genetic flaw on to Alex.

I didn't expect to have to talk about myself. I'd just told her that I was a 43-year-old single mother of two sons, that I worked as a freelance TV writer and I was in fine health. Of course I didn't say I'd been depressed for as long as I could remember. Nor did I mention my drinking. I'd always worked around it, hadn't I? I flashed on the debris I'd left at home after staying up all night waiting for word of Alex's whereabouts and then rushing to get out to the hospital first thing in the morning. The empty bottle of cheap chardonnay on my coffee table, the expensive concealer I'd used to cover the dark circles under my eyes left on the sink, the flinty smile still imprinted on the bathroom mirror, the one I'd practiced in hopes it would disguise my pain when I delivered my firstborn son to this state-of-the-art kiddie psych ward.

"Do you think I could have depression?" I finally asked.

"Without a thorough interview," Dr. C. began. "I can't diagnose you."

Of course, stupid me. She's not going to want to mix it up here.

She continued. "But I do see indications... certainly with your family history. If you would like a referral -- "

"No, not yet," I interrupted. It would take me another six months to finish that conversation with Dr. C. and another 15 years to understand why I waited so long.

By then, I was broke, alone and drinking -- more. I had no job and no health insurance, so my only option when I finally decided to seek treatment for my depression was to go to the nearest public mental health clinic -- where they take everyone, no questions asked.

I waited 45 minutes before my name was called by the receptionist at the L.A. County Mental Health clinic, tucked into the rear of a Van Nuys strip mall. The psychiatrist -- let's call him Dr. B. -- quickly got down to business, asking my reason for coming. I told my story as briefly as I could, although I half expected him to tell me to just cut the booze and get out of there. Instead he put down the file and made eye contact.

"There's no question you have dual depression," Dr. B. said instead.

"Can you explain that?"

"It sounds like you've had mild depression since late childhood. As you get older, you're having longer episodes of severe major depression, which your alcohol intake is only making worse. The crisis with your son has pushed you into the severe episodes of major depression you're dealing with now."

Getting a diagnosis for something that has been part of you for your entire life is truly a strange experience. The fact that depression is so constant, especially in families filled with it, we come to think of it as an acceptable personality trait. I'd gone to therapists since age 25 -- cognitive, primal, Jungian, you name it -- but I'd always felt that my therapist and I were cleaning up the messes I'd made in my life without touching on their common cause.

Obviously, talk therapy alone didn't work for me. Not if success is defined as becoming a self-sufficient, functional person and parent. People who speak negatively about antidepressants often complain that they mask your deeper issues and treat only symptoms. As if this is a bad thing.

When I hear this line of argument, as I still frequently do, I detect in it the unspoken message that depressed people are getting off too easy, presumably by skipping over the hard stuff in life with the help of a drug. The opposite is actually true: Only with the help of a drug can some of us tackle the hard things in our lives -- like mothering children with their own mental health issues.

I was a poster child for the benefits of antidepressants. Within a year, my income tripled. I moved from Los Angeles to my present home in San Francisco, leaving behind the last of my unavailable boyfriends and years of underemployment in the chaotic TV business. Doing a brief run of therapy again -- this time while on medication -- helped me finally let go of many self-defeating parts of my old identity. It also made room for me to acquire some new ways of thinking and behaving: having an expectation that I would be liked or conducting a healthy romantic relationship, hell, just doing my taxes or the dinner dishes on time. When you've rarely if ever done these things easily, doing them can be jarring at first, and then incredibly joyful.

But the thing that neither medication nor therapy could help me stop was the guilt I still felt over my prior poor performance as a mother. Painful memories of postpartum misery, when my infant son would wake up crying and I'd wish myself -- or him -- dead, would come regularly to send chills (and self-hate) up my spine. Knowing that I'd stayed in that depressed state until my sons reached adolescence -- and in the process raised their risks for the mental disorders that did develop -- filled me with even more regret.

Only after I had made it past the halfway mark of my 50s did I realize that this pile of guilt had become my final and most tenacious addiction. The only cure for it I have found has been to let go of my façade of "normalcy" (or what passes for it in northern California) and tell my story publicly.

That led to a professional U-turn wherein I quit trying to write the next great American novel to become a mental health care advocate. At least, I felt, by speaking out other women might act sooner to help themselves, knowing that by doing so they were helping themselves and their children. This common sense is now supported by elegant research (from Columbia), showing that when depressed mothers were treated, one-third of their children with symptoms of depression and anxiety went into remission -- without direct treatment. Those children of depressed mothers who didn't have symptoms at the start of the study didn't develop them.

I no longer drink alcohol, and I plan to stay on antidepressant medication for the rest of my life. The data on getting off them after lifelong major depression is not very encouraging. Most people relapse within a year. I don't plan to be one of them. People have different definitions for "recovery." Mine is doing what it takes to reduce one's worst symptoms and learn to manage the stubbornly-irritating ones that remain.

As for Alex, and for his brother Sammy (who would eventually be treated for depression and anxiety disorder), the good news is that recovery for them happened in a much shorter time -- after less medication and more targeted psychotherapy to help them manage their specific symptoms. That's because the longer you wait to seek treatment, the more time it can take for the brain to come back from a diseased state caused by mental illness. But by intervening early, mental health practitioners can usually begin with less onerous treatment, such as parent education and family therapy, and keep childhood mental disorders from becoming adult disorders.

As my sons and I learned, the next best thing to "fixing the mother first" is getting help together.

Victoria Costello provides daily news on mental health research concerning mothers and children at the Mental Health Mom Blog. Her new memoir, A Lethal Inheritance, A Mother Uncovers the Science Behind Three Generations of Mental Illness, from which this essay is drawn, is available from Prometheus Books and booksellers everywhere.

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