Head Case (8 page)

I ask my mom about that time, and she says definitively, “It was just a cry for help.”

The way that I remember it, it wasn't a question of whether I wanted to kill myself but how badly I wanted to. I was unconvinced at the time that I wouldn't just self-immolate of my own will. In no manner did I believe that my feelings alone were not enough to kill me.

By 2006, exhausted by my behavior, my parents sign me up for Dialectical Behavior Therapy, a new form of behavioral therapy that consists of a series of weekly group workshops, individual counselor appointments, and phone calls to my counselor that are supposed to be reserved for emergencies, but people in DBT, people who are on the last stop before the hospital or institution (where some of us have been before and will return to)—people like us have a lot of emergencies. At first, I call my individual therapist almost daily to report a panic attack or a deep certainty that I'm slowly, invisibly seceding from the world.

My individual therapist is a mild-mannered middle-aged woman whom I never take to. (She says to me, “We are climbing a mountain together, you and I. I am holding the rope for you, Cole. I am here, holding the rope while you are climbing the mountain. I've got you. I'm not going to let go of this rope.” She makes two fists, one on top of the other, as if grasping an imaginary rope. I think,
That thing don't look too sturdy, lady.
) We begin each weekly appointment by going over my diary card, a DBT staple. The diary card has the days of the week listed down one side followed by boxes to check. On the top are lists of emotions (sadness, shame, anger, fear, joy) and of actions or idealizations (suicide, pain, lying, drug use) and the instruction to rate one's experiences from 1 to 5 each day in the appropriate box, including a box to rate my urge to quit therapy. I want to believe that recording, rating, and reporting my emotions and urges is a step toward mastery of these emotions, and sometimes I do. Mainly, the card gives my therapist raw data on my otherwise intangible internal experiences. This raw data is then used in part to determine whether therapy is working. Not unaware of the charted weight of each number in a box, I deliberate gravely over the difference between a 4 or a 5. Anger and suicidal ideation usually get a five, along with the desire to quit therapy. I want to telegraph as much urgency as possible. I want to prove to her that my anger, sadness, and pain are so epic as to only be properly graphed seismically.

The dialectic, in short, is the concept that two opposites can both be equally true, rather than canceling each other out. The dialectic is what I hold on to in DBT; it is the concept that keeps me receptive to the program because it is what I need to hear and what I need to believe in. By my own logic, if I can start to wrap my head around the concept that I am healed and I am broken, that there is room in me to be both, then maybe I don't have to give up being broken in order to be healed.

Group is in the evenings, at seven. It always begins with meditation and then check-in, where we go around the table and talk about whom we interacted with over the past week, and it always ends with checkout. We learn a new skill, documented on a worksheet, take a break, talk about an activity in the world that we're all assigned to practice that week that involves last week's skill. (For example, if the skill is asking for things, you go into a store and ask for change or ask someone the time. I remember this assignment especially because a few people in the group reported that this particular assignment was ridiculously easy; I found it hard and kept quiet when no one else admitted to it.) We note how successful we were in completing the task and how it made us feel.

My individual therapist told me that I'm a little old for the young adult therapy group, but I find a pretty wide range of ages. There's a high school–aged boy who wants to become a weatherman. When we go around the room for check-in at the beginning of every session, each one of us talking about the past week, he always includes a report. “This week we were supposed to have showers, but the clouds didn't ever break, they just hung over us.”

There's a waiter in his early twenties with big dark eyes and a scraggly beard, who often fidgets with a safety pin he's stuck through his jeans. “I pin this here on purpose. It's a coping mechanism.”

The group member whom I admire and want to befriend is a young woman in law school with tattoos all over her body. The first day of group she wears short sleeves, even though it's the beginning of winter, and you can see the cuts all up and down her arms. She wears cardigans every day after that. “The group leader told me that it might be triggering for people to see my scars,” she tells me once, during break. The DBT rules state that we are not allowed to make friends in group. We must never see each other outside of group or exchange information. We may be cordial but never personal. This makes the ten-minute break sandwiched between the two hours of our session predictably awkward. Most of us check our cell phones; a few go outside to smoke cigarettes.

We cannot talk about triggering in group. If we have what is called
target behavior
during the week, we can only say, “I had some target behavior this week. I called my individual therapist.” Otherwise, naming your target behavior risks triggering someone else's target behavior. It also prevents us from bonding over shared behaviors, which could spin into encouraging each other in those behaviors.

Everyone in DBT has a target behavior. There are the more obvious ones: addictions, eating disorders, and self-mutilation. Then there are the less easily quantifiable, the borderline personality characteristics that the program was designed to treat.

My target behavior is freaking out. Freaking out consists of slapping myself in the face over and over. I'm pummeling my most wild self into submission. It is an urgency fueling a singular focus: destroy. Destroy self, destroy lamp, vase, turn the house over like a burglar, as if comfort is a physical object stored in a lockbox hidden behind a painting, next to my grandmother's wedding ring. I must turn everything over to find it.

I am trying desperately, with all of my force, to rip a physical rupture in the fabric of reality that I can slip inside of and disappear. In DBT language, this is referred to as
crisis behavior.

I am taught by one of the counselors to put an ice cube on the back of my neck when I am having a panic attack. Studies of people saved from drowning in freezing water show that the heart rate and pulse are slowed by cold temperatures, she says. The freezing water that is killing them slowly is also what keeps them from dying of shock. You can get the same reaction from your body by holding a piece of ice to the back of your neck. I try it one night when I can't breathe, forcing myself to keep holding the ice to the back of my neck even though it's already freezing in the house on Belmont Street because we can't afford the heat. The water trickles down inside the neck of the heavy raincoat I've taken to wearing inside. Eventually it works—the ice water trickles down my back, dampening the neck of my sweater, and I can breathe again.

When I first entered DBT, it had never once occurred to me that I could navigate my own emotions.
Self-soothing
, as it's called in DBT, was foreign to me. We were given a Xerox with a list of “skills,” actions to practice when we're feeling emotionally overwhelmed: take a hot bath, go for a walk, listen to happy music—strategies that are obvious to most people. I don't know if the reason that I did not already have this programming is neurological. I don't remember if it was a neurologist or a therapist who years later told me, “You have to stop compartmentalizing; your brain affects everything about who you are.” It could have been either of them.

DBT is based on Eastern philosophy; there are worksheets with mottos and goals and drawings of lotus blossoms. Something about the roots and the muck and the beautiful flower, but it just makes me think about lotus eating and that makes me think of drugs. Engaging in drinking or drug use is another behavior that we're all supposed to avoid because it often triggers target behavior. There is a separate DBT group to treat addiction but the lines of who belongs in what group often blur in our young adult group. I switch counselors from the woman who tells me that we are climbing a mountain together and I stay in the program for so long that everyone in my original group graduates before me. The new group is all female; the one who talks the most wears scrubs with teddy bears on them to every meeting but never mentions anything about being in the medical industry. Eventually, my insurance runs out, and my period in DBT ends abruptly with a phone call from my counselor telling me that she can't see me until I get my finances figured out. We both know that there is no figuring out to do.

It wasn't so much that I decided to live as I decided not to die; setting up house in a sort of vaguely suicidal purgatory. I hadn't forgotten being hooked up to the biofeedback machine my final year of college, the rabbit ears. I don't know what people trained in biofeedback are called or how to find them; the woman who first hooked me up to the machine was trained as a naturopath, but for all I know that's a coincidence. I do an online search for “Biofeedback, Portland, OR” and email the first person to offer a free consultation, Nell, who happens to specialize in a type of biofeedback more specific to the brain called
neurofeedback
.

The afternoon after my first consultation with Nell, I walk across Northwest Twenty-third Avenue to the bar inside a trendy Thai fusion restaurant. I order a martini and pull the paperwork she had handed me out of its manila envelope. As I wait for my mom to pick me up in the family minivan, I fill out Nell's intake form.

Reason for seeking neurofeedback:

Without hesitation, I write:
I am out of options.

I don't fully understand neurofeedback, although Nell has explained it several times. I understand that pills treat the chemical aspect of the brain, while neurofeedback treats the electrical aspect. Your brain runs on electricity. You can treat the chemical aspect of depression, but if the brain's electricity is out of whack, the pills can do only so much. We have to teach my brain to stay at a certain wavelength, a healthy one. Her computer system will train my brain to stay at a healthy wavelength, like Pavlov's dogs. What really sells me is that Nell practices neurofeedback because she walked into someone else's office thinking it was her last stop and it saved her life. Also, she's willing to work out a plan with me to pay her in installments. Sitting in Nell's office for my first consultation, I feel safe for the first time in a very long time. She says a curse word,
bullshit
, which makes me like her.

It can take anywhere from a matter of days to weeks to see results in neurofeedback, as reactions to the treatment are as varied as people's brains. For one year, twice a week, I remember to wear my hair in a ponytail. I take the bus from the essential oil factory where I'm still working when we first meet to Nell's office in the trendy shopping district. I sit in a black leather lounge chair while Nell attaches electrodes to my head. The placement of the electrodes corresponds with where the trouble is in the brain.

She hands me a clipboard, and I rate my depression and anxiety, circle numbers. I try to clear my head and stare at the screen, to relax. I tell myself that all I have to do is sit. There is a spaceship motoring through a tunnel with clouds of smoke trailing behind it on the screen before me. My brain is making the spaceship go; I can “try” to make it go, but it doesn't matter—the electricity in my brain will make it go no matter what I do. When my brain is tired, the spaceship stalls. As my brain waves become more used to being exercised, the spaceship goes more steadily.

Nell and I become friends; I trust her with my brain, which is to trust her with my life. As I sit in her chair with electrodes glued to my head, we chat about naturopathic remedies and what she feeds her cat and the continuing reign of terror brought on by her roommate's small dog. Eventually, my brain begins to go quiet. I start to scale back from seeing her twice a week.

I've already been seeing Nell for several months when I find out about the hole in my brain. She recommends Dr. Z, a neurological chiropractor. I resist. I am broke, only able to see Nell because she allows me to pay when I can, and what the hell is a neurological chiropractor anyway? I can take only so much alternative healing. “I can't afford him,” I tell her dismissively. Anyway, I'm leaving for grad school in September, so we would only have the rest of the summer to work together.

The first time that I applied for MFA writing programs, in a halfhearted attempt to grab hold of some idea of a future to get me through my depression, I couldn't keep track of all of the forms, and all of my applications were either late or incomplete. This year, just getting the applications in on time felt like a major victory. Getting into California Institute of the Arts means that I get to feel good at something again for the first time since I graduated from college, three years ago, and I am desperate to feel good at something again. My gut instinct is that in order to do that I have to leave the “broken” parts of myself here in Portland; as if I could pick and choose what parts of my brain get to go to grad school.

I am trying to appear firm in my arguments, which is difficult to pull off with my skull covered in electrodes. The gooey paste that attaches them to my skin is sliding down my forehead. “Well, he'd probably treat you for free because he'll want to write a case study on you for a medical journal.” I imagine myself on the cover of
Neurological Chiropractor's Weekly.
I relent and call his office, leaving a cryptic message with his secretary about being a special case recommended by Nell. He calls me the next morning. He talks like a surfer: “Come into the office. We'll figure out this whole strange trip you're on.” As when I started seeing Nell, I tell myself that I don't have much to lose.