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There’s a little gland wrapped around the base of your throat that, when it goes off the rails, makes you insane.
I know this firsthand, as did my mother, as does my father. Mom had her thyroid partially removed before I was born, and took pills thereafter to make up for its lack. Dad’s thyroid issues crept up on him at an advanced age; his thyroid medication is the most important element in keeping his affect positive. And as for me…
A few years ago I thought I was going mad, and not in the conventional sense of I’ve-lost-my-keys-and-now-we’re-late-and-oh-God-one-of-the-dogs-just-threw-up-I’m-going-crazy! I had serious and fundamental concerns that I had fallen quickly down a steep slope into mental illness.
This was when my sons were pre-K, when I was working nights, making my way as a latecomer in a new career as a medical editor. I had published a couple of well-regarded genre novels, but 9/11 had destroyed the market for thrillers a month after my first son’s birth, and I had of necessity made the jump into an interesting, rewarding, and altogether different line of business.
Five years later, walking the dogs one crisp, sunny workday morning, I found myself, for no obvious reason connected to anything in my outside life, filled with a indiscriminate and inchoate strain of dark, hard fear. I had been experiencing this for some time: I knew well the thick sorrow routinely called depression, had experienced it before and gotten out of it before, but this was different. There I was, sunlight beaming down on sandstone buildings and wrought iron, and the universe I inhabited was sour and rotting, utterly devoid of any sort of hope. To make matters worse, I had, there on the street, come to the realization that my short-term memory was rent and fragmented. I had walked two blocks with our large scruffy standard poodles, was now on the way home, and I could not remember if, since leaving the house 15 minutes before, either of them had shat. Had they? Had I gone through the New York City protocol of readying a plastic bag over my hand as they squatted, then grabbing the feces off the concrete, flipping the bag inside out and tying a knot and dropping it in a street can? Had that happened? Or was I still waiting for either dog to make a move? I searched my mind, I went through everything I knew about the last quarter hour of my life, and I had absolutely no idea.
I had learned from depression. I had gone into it and come out of it several times when I was younger, and knew it well enough to recognize it as an aberration from my natural baseline state of being, the mental reality I awaken to when life is normal, which I had come to call my zero state: neutral to just short of glad. But this was not depression, I realized, standing there on the street as my dogs debated hydrants. This was a new mental disease. I had been grappling with it for months, seeing it in glimpses, a weird thing that kept happening. But that morning I saw it whole: my short-term memory, previously integrated seamlessly with the rest of my brain, had become uncoupled, and was now a tattered remnant of something I had never been without.
I became terrified. This defined losing my mind. And, so far as I could see, it was gone. This was not an ongoing process. This was over, and I had lost.
And then another piece kicked in: I had, over the course of the last few months, lost a lot of weight. As I hadn’t been dieting, and being overweight has been a stubborn reality in my life, this had not been entirely unwelcome. At odd moments, in my depressed state, I had mordantly considered the scary truth that unexplained weight loss is often a symptom of cancer. I had seen cancer metastasize to the brain in two people very close to me; one of them, a brilliant cellist with tremendous math skills, with whom I dined routinely, had one night been unable to divide a restaurant check. It was the first sign that his cancer had spread; he was dead within months. Now, with my sudden recognition of this new change in my own mental functioning, all the pieces abruptly fit together: somewhere inside me lurked a cancer, it had spread to my brain, and I was going to die.
The ramifications of this spiraled around me: my own death, the destruction of my family, the crushing of a lifetime of dreams. Hopelessness, at that moment, would have been an exercise in optimism; what I was feeling was fully justified despair.
Allow me to back up: my schedule at that time was particularly unruly. I was working nights in the Editorial department of a medical advertising agency, specifically a 4:00 pm-midnight shift, which, because this was advertising, could end anytime: midnight, 2:00 am, 4:00 am; there were nights when I left after dawn. Advertising is client-driven; if a client is expecting a 40-page disease-state monograph to be submitted via e-mail at 9:00 am, that means the agency has until 8:57 am to make it perfect. As clients pay agencies millions of dollars and expect a constant stream of perfection for that money, all hands are expected to remain on deck until the pieces are clean. Editorial is a huge part of that, and if it takes all night, then we stay.
So: 4:00 pm until midnight, but usually later as I was a recent transplant into this industry, and wanted to make my mark and rise. I became the volunteer, the one who stayed the latest, the one who left work last, because I had young children at home and I needed this to succeed.
And then: home to sleep. Up at 7:00, no matter what time I’d come in, to walk the dogs and take the younger son to preschool while my wife took our elder son to kindergarten. Then I’d come back, try to attend to the invariable chores a household demands (Cecilia was working the opposite of my schedule: daytime hours at her job and keeping the two-kid-two-dog boat afloat from 4:00 pm until whenever I got home), and after a while put myself back in bed for more sleep. Then the alarm would wake me at 2:15 pm, and I would walk the dogs, then go pick up my older son, bring him home and let in our child care worker of the minute, who had picked up the younger son from preschool. With the boys covered at home, I would then go to work.
Every day I was getting two distinct periods of sleep, three to four hours each, one in the early morning, one in the afternoon. All for beginner’s wages in a new industry.
And now I had no short-term memory. Soon thereafter, on a doctor’s visit, I haltingly brought up the fact that my mind had taken a terrifying turn, that something had changed irrevocably, and that I was honestly afraid I was losing my sanity.
My doctor immediately took bloods to check my thyroid. Based on that, he sent me to an endocrinologist. She took more bloods, and came to a diagnosis: Hyperthyroid.
Thyroids are little glands that secrete several important hormones into the bloodstream. These hormones control the pace of metabolism through the sympathetic nervous system. In hyperthyroid disease, the gland overproduces hormones, which stimulate the nervous system and speed up metabolism. In hypothyroid disease, the gland produces too little hormone, which slows down metabolism. There is a constellation of symptoms associated with each disease state; some of these symptoms overlap. Sometimes people can be both hyper- and hypothyroid. And, as a special extra added bonus, thyroids, when they go wonky, can grow nodules, which may or may not contain cancer.
What I was going through—weight loss, depression, short-term memory loss—turned out to be classic symptoms of hyperthyroid disease. My endocrinologist—shout-out to Dr. Zweig!—put me on medication to slow down the thyroid overproduction.
I began taking the pills on a Monday morning. On Wednesday, I got on a bus, took a seat towards the back, and as the bus rumbled into motion I looked around and realized: my zero-state was back. All at once, there it was: I felt normal.
A year of agony, three days of meds.
Thyroids are weird.