Looking at the World Through Paxil-Colored Glasses
New York City, New Year's Eve: The best time in the best place on Earth, and, in 1991, with the twin towers vaulting into the black sky, the stage is set for celebration. My husband, young son and I have just gotten into town and are staying with friends on the Lower East Side. Gina's been like a sister to me since we met as book designers at Random House 10 years ago. She and Scott took over our loft when my boyfriend and I married and moved to Washington. Parents now, they live with their toddler near Alphabet City. I am at home in their place, I think, because it is so much like our own. Comfortable and eclectic, it is filled with books, photographs and the visual ephemera designers tend to collect.
This visit is such a luxury. Gina and I are already gabbing and drinking tea. We will set out soon for a big party at the loft of a mutual friend. A pizza has been ordered for the children, a sitter is on the way. My husband goes out to pick up the pizza, taking our son in tow. It seems they are gone only seconds before I hear my son's voice echoing through the hallway: "Mommy!" He is limp from the train trip and melting down, so my husband delivers him back to me and resumes the errand alone -- at which point Sam decides he wants to go with Daddy after all. This boy sailed through the "terrible twos" like a champ. He is 4 now, and the tantrums are something new.
No, I say, we are staying put until Daddy gets back. Sam's thunder erupts again, but I have to let it pass. I can't give in to these irrational demands.
How ironic, then, that a darker, more furious storm of irrational thinking is happening inside my head. The truth is, I am afraid to venture out to find my husband. Why? There is crime in the neighborhood, sure, and drugs abound, but I am a seasoned New Yorker, and the East Village streets are alive with everything I love: art and music, great food, galleries and the high-church eccentricity I so sorely miss in Washington. The truth is, tonight I am terrified. But I am not afraid for myself. I am afraid of myself.
I am afraid I will do shameful, filthy things.
Last month, I was afraid of causing arson, so I could not touch or even look at matches, ashtrays, cigarettes, lighters or anything else associated with fire. Right now, I am afraid of AIDS, so I'm afraid of these streets and of being alone for even a minute. My mind swims with an inventory of possible mayhem: I might have unsafe sex with someone -- a crack addict! -- in the shadows. I'm afraid of the sidewalks, which glimmer with miscellaneous gobs of spit. I'm afraid of the shabby bodegas, abandoned cars, the bottomless dumpsters and scummy gutters running with God knows what. I might stomp in a puddle, splash something onto my mouth, then kiss a friend Happy New Year. The friend might have a tiny cut -- a shaving abrasion! -- get HIV and eventually die because of me. But the friend is sexually active and might get HIV anyway, so I'll never be sure if it was my fault and I'll spend the rest of my life punishing myself for his death, worrying that I'll go to Hell after I die for killing him.
The anguish I feel is unbearable. I excuse myself to go to the bathroom. Safe behind the closed door, I stand, perspiring, and whisper feverishly into a towel to myself, to God, the things I must say to neutralize the horrid possibilities. I can hear Gina in the kitchen, talking to her daughter and to Sam, rinsing the dishes and clearing the mugs. Even though she and I have just been talking and sitting in close proximity, Gina, like virtually everyone else who knows me, has no idea this opera is playing out in my head. And all the while it is playing out in my head, I am fully aware that it is crazy -- the fact that proves I am sane. I am absolutely sure I will not do any of the things I fear. I know how HIV is spread. I have never done anything antisocial. The thoughts that torment me are a loop in the fugue that is OCD: obsessive-compulsive disorder.
Although I am sane, some part of my brain bubbles with repulsive thoughts and intolerable images that come completely against my will. But I cannot shrug them off; my brain is not satisfied by the knowledge that I will never do terrible things. A grievous feeling persists in me that demands, "How can I be sure?" The result is a jarring and inexplicable disconnect between this insuperable anxiety and everything I know to be true. How is it possible for me to carry on as I do, social on the outside and seething on the inside, with a sort of bifurcated brain? I've gotten awfully good at it. In 1991, I'd been doing it for almost 30 years.
Although the doctor's office was tucked among familiar things -- my son's school, the Whole Foods where I shopped, our veterinarian -- I sat in the waiting room tense and febrile, making eye contact with nothing. I was emotionally threadbare, red-eyed and rawboned, so thin I disappeared inside my dress. It was just after that New Year's Eve in New York, and I recognized the signs of a breakdown. My anxiety level was spiking, my symptoms were insistent. I was slipping and could not get purchase on my slide.
I had been through this several times before, but there was a difference in 1991. I was a mother and, for the sake of my son, could not go haywire. I was also a wife. The stress of getting married and moving to Washington in 1984 had ambushed me, and my husband had been forced to deal with a doppelganger of the woman he loved, one who couldn't eat or sleep and engaged in bizarre rituals -- like turning the same page in the New Yorker back and forth for hours on end. I could not put him through that again.
Therapy usually worked to help me manage my symptoms, but something engulfing was coming, and I needed help to stand my ground. That meant medicine. I'd sworn off psych drugs forever after a wretched experience with a crude anti-anxiety medication in the 1970s. But the word was that the new antidepressants, the SSRIs -- selective serotonin reuptake inhibitors -- seemed to work well for OCD and had far fewer side effects. I was willing to try them.
When I returned from New York after New Year's Eve 1991, I called the Obsessive-Compulsive Foundation, which referred me to T. Allan Ramsey, a psychiatrist in the District who specializes in psychopharmacology.