serena burnam

BEFORE I HAD A NAME FOR IT

I’m an unlikely medication proselytizer. I was raised by parents who believed in natural medicine, in the body’s ability to heal. I had a few vaccines as a kid, but they had concerns about the spiritual implications of immunization. I never took Tylenol. Fevers were good, the body’s way of fighting an invader. I grew up understanding symptoms had meaning and required inquiry. 

“Something must be off with my hormones.” I’d started menstruating again a few weeks before my daughter's first birthday and had noticed an emotional void. “I’m not really feeling feelings.” I’d say this dozens of times over the next few years. 

I’d prepared for pregnancy. I stopped drinking, went to a naturopath and took out my IUD—well, Ken did. With the gentleness of no gynecologist I’ve met, he removed my IUD on our kitchen table. I sterilized it and hung it on our bedroom wall. We took a baby-making road trip down the west coast in our VW van.

At home, I bought a box of two pregnancy tests, though I knew it was too soon to tell. I used both and bought two more. In the bathroom at dawn, I tore open the new box, peed on the stick and watched as an ever-so-faint horizontal line emerged to cross the vertical one. I ran to the bedroom and jumped on Ken, still asleep. “Look!” I whispered. He didn’t have to. I crawled back under the down comforter and layers of doubt melted. I was so prepared for this.

“Remember, whatever you’re feeling, it’s because you’re tired.” We wrote this advice on a big sheet of paper and taped it to the fridge where it hung for months. You could see it from almost anywhere in the house. In the moments you needed it most, all you had to do was turn to be reminded: It’s because you’re tired.

We’re tackling fears in birth class with our doula. “What are you afraid of?” she asks Ken. “I’m afraid Serena will get postpartum depression.” He has a way of looking at me when he’s answering others’ questions. Sometimes it irritates me, but not today. I’m afraid of that too.

We were vigilant in the first weeks and months, but as time passed it became clear I’d been spared. I was completely in love with our round, smiling daughter, happy in motherhood. Maybe the placenta smoothies had worked. Before pregnancy, I cried all the time, triggered by beauty or sadness or stumbling upon a truth. Anger was never my thing. I’d rant about the world’s skewed priorities, but could count on one hand the number of times I’d actually lost my shit: when I was eight and my best friend accused me of cheating at cards; when I discovered a boyfriend was continuing to lie after I thought we’d come so far. I’ve worked in alternative preschools—rooms that require patient adults to quietly observe children—and restaurants, where I refined the ability to see that people’s needs are not about me.

She was a toddler when she started waking around 11pm, screaming possessed, bloody murder. We tried all the tricks: walk outside, bounce her, sing to her, but nothing made it stop. A crazed spirit had replaced my bubbly girl. I wanted it out of my life. It was not her, and I was not me. Months later, we learned the term night terrors. 

I began to hear the haunting of the night in her daytime tantrums over snacks and toys. Breastfeeding, once a sweet, soft time of connection, agitated me. The sensation of anything on my nipple made me want to throw something. When an anticipated nap stood me up, I punched the giant painting over our bed, fracturing the glass. I meant to hit the wall. I could see how people kill their babies. It’s everywhere: Don’t shake the baby. On pamphlets in the doctor’s office, in every book on parenting. No one shakes the baby because they’ve calmly decided it’s a good idea. 

My mom’s journal, April 1994. My brother had just called from jail. She’d been to her mother’s recently for dinner and was thinking about the billboard she saw that afternoon of a small boy in a jail corridor broadcasting “All criminals were children of violence.”

 [My mother] was describing the scenes at the dinner table in our childhood when my father knocked Winky across the room. I have quite conveniently forgotten those incidents. My son is in jail . . . and he was abused as a child. I abused him. I hit him. I was completely unable to separate myself from [my father] when I was hitting Jess. All I could do was follow the pattern. 

I lay awake in the night with visions of leaving my family. A few years later, on a trip to New York City, I’d see comedian Mike Birbiglia’s The New One on Broadway. He’d describe strapping himself to the bed in a locked room to protect his infant daughter from his potentially violent sleepwalking disorder. He’d say he felt like an accessory, like he’d lost his place in the family. He’d say he was ashamed to admit he understood why fathers leave their families. “But if your dad left, I want you to know it is not because of you. It’s because . . . you exist.”

Parents often hold timid confession for each other, inching toward admitting our darkest moments. “I was too rough with her yesterday,” someone will admit, and a chorus of me toos will rise up, each calculating how much can be said without someone calling CPS. We laugh about things that aren’t funny and downplay the severity of our desperation. We’re trying to comfort each other, normalize these moments, hoping if others share the experience we can validate our own. But the risk of normalizing something is you begin to think it’s not a big deal.

“Have you ever taken medication?” I’ve asked several friends this question in the past year. I heard on a podcast that the average time it takes someone to seek help with mental illness is five years. Five fucking years of suffering before we believe we’re worth it, before it occurs to us that this inability to manage daily life is real.

After struggling for too long, a friend finally scheduled a telemedicine appointment. The male doctor told her she didn’t seem to need meds since she was wearing earrings. 

I hear it all the time: “You, depressed!? You don’t seem depressed.” I’m energized in public, often too energized. Where I live I can’t go to the store without seeing people I know, mostly people I know too well to ignore, but not well enough to have a real conversation with. I become animated, trying to keep the momentum up. I say things I don’t mean, things that are more crass, more irreverent than I intend. Minimizing doesn’t erase suffering, just multiplies doubt. You believe it’s nothing. And you’re pretty sure you’re going to die.

Getting help sounds simple, but if your mind is disintegrating, small roadblocks are impenetrable. Even on my best days, I hate making phone calls—it’s disturbing to dial into a void with no hint of what you’ll meet. When I do take on the sisyphean task, I’m met with automated messages. I get a call back: “There are no psychiatrists that take your insurance in your area.” I lie on the porch sobbing.

It’s my first time to a mental health clinic. “So, it won’t surprise you that I’m giving you a diagnosis of depression.” The disappointment is instant. I’ve been in the counselor’s office for over an hour, reading from my exhaustive list of symptoms. She’s the first one to make it official, but by now the fog has consumed all corners of my life and I’m convinced I have dementia. I’ve recently learned the word anhedonia—the inability to feel pleasure—and am clinging to it as proof of another affliction. Depression doesn’t feel like an acceptable reason to not function; I know depressed people and they all seem fine.

She’s given me a form—The PHQ-9. It’s not the first time I’ve filled one out. The answers fall into four categories: not at all, several days, more than half the days, nearly every day. 

Little pleasure or interest in doing things.

Nearly every day.

Trouble falling or staying asleep, or sleeping too much.

Nearly every day.

Feeling tired or having little energy.

Nearly every day.

Poor appetite or overeating. 

Nearly every day.

At first I thought it was allergies, but it settled in heavier each day. I walked up to people I knew with no memory of their name. I broke down in tears at a job I’d been doing for seven years, completely unable to comprehend multitasking. I stared at the kitchen counter, incapable of telling one object from another. It’s hard to write about the lowest moments. Not because the feelings are so dark, but because there aren’t any. Just murk everywhere. Murk over the sun, over your family, over the space where thoughts used to occur. 

I’m on the phone with my friend Jacob after he opens up to his family about his depression. They meant to be supportive. “We’re so sorry you’ve been so sad.” He was frustrated. “No, I wish I felt sad. Depression isn’t feeling sad, it’s feeling nothing.” Even when we have a name for it, it can be hard to comprehend.

In a clinic 3,000 miles away, the doctor is wearing a blue mask. It’s a full six months before they’ll become commonplace and a symbol of political warfare, and it’s jarring to see only her piercing eyes. “So, why are you here?” I’d spent the last two weeks collecting my medical history and delivered the folder personally earlier in the week with a succinct list of symptoms. I’d anticipated the fifteen-minute window and knew I couldn’t count on myself the day of the appointment. I mention the folder and she waves her hand dismissively, “Yeah, this doesn’t help me. These are summaries. There aren’t any physician’s notes.” I’m distracted by her toes. She’s wearing leather sandals, Italian maybe. I point out the results of my hormone testing. She’s growing impatient. “Look—have you seen a psychiatrist?” She asks like I’m in the middle of a psychotic episode. I explain the visit to the mental health clinic and the depression diagnosis. “Ok, so why are you here?” I’m determined not to leave empty-handed—I’m trying to rule out all possibilities, would like to see an endocrinologist and get a referral for an MRI. She writes the referrals, adding one for Psychiatry and ushers me out the door. 

I’m staring at a poster of adrenal glands when the endocrinologist walks in. After I make my case, she shrugs. “I don’t know what you want me to do for you.” I stare at her. Her specialty includes hormone disorders. I try a question, “Could my anhedonia be caused by hormonal imbalance?” She sighs. “Look, I don’t really know why you’re here.” I don’t know why I’m there either because I’m not a doctor and I haven’t felt anything but anger and irritation in years and I’m clinging to any clue like it might hold the answer and if I need to be pointed in another direction fine but don’t just stand there saying you don’t know what to do. I leave, shaking. 

Savannah is warm and patient, the kind of primary provider I’ve been looking for. I’m reaching for my coat as she swivels on her stool. “From everything you’re describing, it really sounds to me like bipolar disorder.” We’ve been through all the rapid-fire questioning.

“Let’s start with your mom’s side. Siblings?”

“A half-brother.” 

“Any illnesses?”

I say he’s bipolar, maybe schizo-something, that he had hallucinations and mania. If you learn a story in fragments, years later and from multiple sources, it can be hard to paste together. 

“Living?”

“I don’t know.”

He first showed up six months after Mom died. Her best friend delivered the news: “Jesse’s on island. He’s down at Vern’s.” We’d assumed he was in Oaxaca, where he’d fled years ago to avoid going back to jail. None of his three recent cell numbers had worked and Mom hadn’t gotten any responses to her emails. 

I walked into the basement bar at 9am, greeted by the waft of liquor-soaked carpet. I found them at the pool table. “Hey Jess.” He spun, greeting me with a huge grin and giant hug. “Ser-eh-na!!” He always pronounced the middle syllable that way. He turned to introduce me. “Greta, this is my little sister! Sis, this is Greta! We just got married! Greta’s pregnant! We’re having a baby!” 

Smoke circled us. I’d just gotten home from a ten-day silent meditation retreat, thinking maybe I’d start grieving now that it was winter. Greta’s face broadcast the early aging of a drug-user, but her eyes were bright. “It’s nice to meet you,” I smiled.  Jesse put his arm around her shoulder. “I brought her to introduce her to Mom!” He’d been in Port Townsend the whole time, just two ferry rides away. 

When he was eighteen and I was six, my parents arranged for me to go to a neighbor’s house, telling me they’d pick me up after I’d gone to sleep. My friend had a red gumball dispenser in her attic bedroom. I knew I was in my dad’s arms when I felt him walking down the stairs. “We’re going to go potty,” he murmured. When I was fully awake I realized I’d peed on him there on the stairs. That was the night Jesse was admitted to the psych ward. 

The questions continue. I count off the uncle with schizophrenia they called Winky, who committed suicide in his twenties, and the other—Uncle Bob—who climbed the cables of the Golden Gate Bridge in hopes of being put in a mental hospital and avoiding the draft. It worked. When I lived in San Francisco, I’d drive down to the marina to see if he was around. He’d been living in his meticulously-organized storage unit for years and everyone knew him. I’d bring a six-pack, he’d offer to fix something for me. When around him, I was a carbon copy of my mother-in-the-presence-of-family, a blend of total familiarity and course detachment with a dash of salty sailor.

Sometime that year he invited me to breakfast. He had an exciting new plan. Seated against the window of a cramped Noe Valley restaurant, his eyes twinkled with inspiration. “I’ve decided to commit suicide!” He looked like Sam Elliot: tan face, silver ponytail and signature mustache. The reasoning was logical. He was out of money and didn’t want to burden anyone with loaning him more, hadn’t had contact with his two sons since they were small, was in his late 50s. “I don’t think the best is yet to come!” He laughed. He was still mulling over the method, probably jumping from a bridge or something equally unmessy. 

“And your mother?” Savannah asks.

“Deceased. Metastatic breast cancer. And depression. And alcoholism.” 

All my adult life I’ve answered these questions. I’ve described my mom’s family as riddled with mental illness. I’ve laid out the list like I should get a prize for being ok. I’ve been spared, due to my rhythmic upbringing, evidence of the power of nurture over nature, a shining example of how to interrupt the ancestral chain.

The bipolar suggestion gets my attention. “Well that really scares me,” I allow. I’m 33, a mother in a solid partnership and have never had a manic episode. I tell my friend Sara. She’s been through similar challenges and is the reason I sought antidepressants in the first place. At the time, I worried I was “copying her,” making her story mine. Maybe what she was going through was much worse, maybe I wasn’t even depressed. It's a scarcity mentality: doubting your struggle when held up to someone else’s, like there’s not enough to go around.
 

I tell Sara it would be weirdly relieving to have something serious to validate my daily struggles, but I can’t identify any manic episodes. “I don’t know,” she ventures, “that trip you took to New York . . . it sounded a lot like mania. You described feeling really high and not needing to sleep.” 

It’s occurred to me before, but I’ve been clinging to that trip as proof that I can feel again; as proof that I’ll come alive and engage in the world. I was happy. What if it wasn’t joy, it was crazy.

The day of my neuropsych evaluation, I don’t feel crazy at all. I feel clear-headed and capable. I sit down in the small, tidy office and tell the neuropsychologist I’m not remotely the same person I am at home. The test is largely oral and visual. She asks me to list a group of words back to her. Later, when the world is laughing at Donald Trump for boasting “Person, woman, man, camera, tv,” I’ll think of this test and how it took me a few repetitions to realize the words could be sorted into four categories. Am I oblivious or observant? 

She hands me a set of square cards, divided diagonally into red and white and holds up patterns for me to recreate. As they get increasingly difficult, I smile. There’s no commentary during the test, but as she puts the cards away, she says, “Just so you know, I’ve been administering these tests for years and you’re only the third person who’s been able to do all of these.”

I stare at her blankly. “What does that mean?”

“You have very strong visual skills.”

“So I’m an artist?” It can be nice to have science confirm what we already know. 

Savannah has referred me to Kim, a psychiatric nurse practitioner who listens patiently to my story. “I think if I got to go to New York without my family, I’d feel that high, too,” she laughs. She’s seen the results of the neuropsych exam and is not sold on the bipolar II idea. “I’m going to second the depression diagnosis; these symptoms you’ve been having are all signs of depression.” She suggests combining Wellbutrin and Prozac, a blend that often prevents low lows, and tells me we’ll talk in two weeks. 

It happens infrequently—maybe twice a year—and always when I’m home alone. It’s not a voice, not even a whisper, but a presence. It comes up from behind and hovers over my shoulders. It’s muted, but the pulsing is unmistakably diabolical, carrying the promise of failure and darkness. It’s psychosis with the volume turned way down; an exhausted Dementor. It is not in me nor of me. To comfort myself, I usually talk out loud. “Keep folding the laundry. Remember to breathe. It’ll pass in ten.” I feel like I’m left with the remaining thread in a lineage of mental illness. Superstition tells me the less attention it gets, the smaller it becomes. 

“You’re an artist.” Lisa has said with confidence for more than a decade. We met working at a restaurant, our friendship consecrated when we found ourselves in the same Abnormal Psychology class. Later that semester, our professor—Dr. Phyllis Grilikhes-Maxwell—would drive home the importance of not confusing human beings with their illnesses. “We don’t say someone is a schizophrenic, we say they are a person suffering from schizophrenia.” An illness is not a whole identity.

In the hours Lisa and I spent behind the host stand she lovingly dubbed The Corner, she taught me that play and magic and time travel don’t have to disappear when you grow up. She owned a collection of found baby shoes. She left notebooks in the park for strangers to find and would bring me little presents for no reason. For her, headphones was an activity—she’d sit in her room alone and be transported to the world according to Björk. She texted cryptically and renamed the boys in her life: The Skeptic, The Vegan. She saw in me what I couldn’t; she taught me to uncover what’s already there. 

“Go deeper.” It became a joke in high school English. Teenagers can make anything sexual and Mr. Gross said it all the time. But I liked that we weren’t let off the hook for making one observation, were asked to follow it to the root. When I’d pat myself on the back for sharing an insight about whatever book we were reading, he’d nod solemnly. “Good. Take that deeper.” 

Lisa was right about my creative identity, but I needed to figure out its form. I moved to the island and gave myself permission not to finish college. Soon, responsibilities replaced play and I started to accept my life would be smaller (tiny), more contained (claustrophobic), more conventional (boring) than I’d imagined. How could I be an artist if I still hadn’t made anything by my 30th birthday? Then angry nights, exhausted days, a mind made of molasses. 

For a while I wondered if I’d been misdiagnosed—I read that there’s such a thing as late-onset postpartum depression and that mania in bipolar II can masquerade as anger and aggression. Depression is more than just chemicals, it’s an indicator that something needs attention. But how the hell are we supposed to start investigating without a brain? Many medication-hesitant friends express a fear that drugs will make them feel foreign to themselves or give them weird side effects. Medication returned me to myself. I’d thought of it as a last resort on a list of more holistic options, but it opened a door I couldn’t. I was a perfectly capable person that couldn’t function and now I can. I sit at a tidy desk in a cabin in the woods writing words that make sense about a time I can barely remember. 

I’m talking to Jacob again and he mentions his short-term memory isn’t working. I make my medication plug and there’s no resistance. “Honestly, I’m not at all opposed. I just don’t know how to get there.” I feel like an idiot—I’ve forgotten what it is to sob on a porch. I give him a simple assignment: “Write yourself a note to call your psychiatrist friend.” I can see his future, see him glancing back, aware of how small the obstacles look. Sad stories are marked by things we wish hadn’t happened; tragedies are the ones that didn’t have to be that way. I tell him I’ll check in tomorrow. 

___________

SERENA BURMAN IS A NONFICTION WRITER LIVING ON A SMALL ISLAND IN THE PACIFIC NORTHWEST. SHE RECENTLY LEARNED NO ONE HAS ANY IDEA WHAT THEY'RE DOING. THIS IS HER FIRST PUBLISHED PIECE.