[My breakdowns were] the reason Dr. Shere had said that for her money she wouldn’t think I’d get better as long as I had a job, unless I could find a job that paid enough to live but produced zero stress or grief and let me take hours and hours off every week for therapy and for yoga and for the days when I lapsed into psychosis or depression. This was why Dr. Shere had suggested that I not work at all.
“Ohhh, fuck that,” Denise had said when I’d pass this advice along.Irritable Hearts, p 206
Content warning for this post, and for the final third of Irritable Hearts: Suicide.
A dear friend is going through some heavy shit. A loved one — actually two loved ones, or maybe three — are quite ill. She’s balancing work and caretaking and her own need and feelings, too. The situation has taken a turn for the dramatic.
“Here’s the one thing I wish someone had told me at the beginning,” I say, “Find the one thing you know that you can’t give up. And then don’t give it up.”
I said at the time that the thing I couldn’t give up was sleep. I am a person who absolutely requires eight hours a night, and if my sleep is interrupted I feel physically ill the whole next day. My refusal to give up good sleep drove many of my decisions in PTSDLand. My decision to sleep apart from Jason. How I structure my days. My request for sleeping pills from my doctor when all the alternatives — melatonin, triptophan, sleep apps, white noise machines, exercise — failed to keep me from waking up several times a night with nightmares.
I could roll with other losses: physical intimacy, seeing friends, enough money, a clean house. Other people’s unalterables are surely different. Spending time with your kids may be the one un-give-up-able thing. Or financial security. But I couldn’t — I wouldn’t — give up my sleep.
I thought this was my only lodestar, the only to-do I wouldn’t erase from my list, until I reread Mac McClelland’s* Irritable Hearts. And I remembered: work. I wouldn’t give up work.
A GOOD JOB IS BEST: My work is my sanity. It takes me away from my pain and gives me a break. I have such support from my colleagues. At work I’m glad they don’t ask how Sandy is — it’s boring to talk about it. Yet a meal is always brought when I need it, somebody’s husband helps fix my car, another..takes over my desk if I have to run for a prescription.Kathy, from Mainstay: For the Well Spouse of the Chronically Ill, by Maggie Strong, p 199
When you feel so out of control, so unable to help a person you love, it’s good to feel competent. Jason and I needed the money I made finishing my last book, doing speaking engagements, taking assignments from newspapers. But also, I liked it.
PTSD has made her terrible at so many things she used to be good at, writes McClelland, including sex and breathing. “But work! There was something I could do. Something I loved to do. Assign me a story, and maybe there would be some nervous breakdowns in between then and the deadline these days, but I would get it done, and it would be good.”
McClelland describes an exercise offered by her therapist for moments when she felt hopeless: Put the things that are most important to you an inch below your navel, in your “somatic core.” And when things get disorienting, press down on that spot to invoke what makes you who you are and why you want to heal. McClelland put two things in her core: her partner Nico and her work.
For me, one of the things that normally lives in my core — Jason — was one of the things giving me PTSD. So what was left there was the purpose, efficacy, and joy I derive from my work.
Like McClelland, my work has helped me to make sense of what I’m going through, to understand and address my symptoms, and to figure out who my people are. So it’s not surprising, perhaps, that I’ve written about poorhouses, what happens to families under stress, losing your home, being preyed on by the government, economic violence, and carework in the six years since the attacks.
Reporting these stories sometimes activated and worsened my PTSD. But mostly, what I took from the work was courage borrowed from the extraordinary people and families who shared their stories with me. People who, under the very worst of circumstances — losing their children’s health insurance or living in a grey tent on an LA sidewalk — demonstrated almost unimaginable generosity, courage, and even humor.
As I’ve gotten better and my capacities have expanded, I’ve added other things back into my somatic core, things that had to be removed when all I could do was doggie-paddle ahead of the tsunami. I value my friendships, my health, good food, nature. I want to get better so I can enjoy these things. But reading this final third of Irritable Hearts, I find myself so, so grateful for my work. And for you, lovely readers, who have borne witness as I’ve tried to figure it all out, to turn chaos into story.
Before we move on from Irritable Hearts, I’d like to highlight one more crucial contribution the book made to my understanding of PTSD — McClelland’s matter-of-fact acknowledgement that it is a chronic and regularly fatal disease.
From a caregiver’s point of view, it would have been very helpful if medical professionals had told me this up front. But it would have left me in a hell of a bind, particularly because my PTSD-having partner is not a veteran. Like the great majority of PTSD sufferers, he got it from assault, sexual violence, or natural disaster, not combat. What they would effectively have been saying is: Your partner has a chronic illness that might kill him. But we have no help to offer you. There will be no treatment unless you aggressively research, pursue, and pay for it yourself. They would have had to tell me that the trauma of fighting for Jason’s healing might well give me my own case of PTSD.
The acknowledgement that PTSD is chronic and regularly fatal forces us to recognize how deep our cultural denial of trauma still runs. If even after all this research and rallying of resources, your PTSD partner still succumbs to the most serious impacts of the disease, such as addiction or suicide? So many people would shake their heads, tsk tsking, and say, “How selfish.”
McClelland writes of her friend Chris’ death,
I dropped into a quick deep hole of grief, shaking my head, gasping and sobbing, wondering what had happened. But I knew what had happened. Every day, the VA said eighteen veterans committed suicide. One every eighty minutes. It was the pinnacle of bullshit: The very thing that made the ones with PTSD want to die were the symptoms their body produced because it so badly wanted to survive. Chris had PTSD, and PTSD was regularly fatal. They never said it like that, and I didn’t understand why. When you had cancer, they told you that you had x percent chance of dying, especially if you didn’t get y and z treatments. No one says that unresolved trauma can kill you. If anyone did, maybe people would take it more seriously. Serious as cancer.Irritable Hearts, p 205
* The author of Irritable Hearts now goes by the name Gabriel Mac (@GayyybrielMac, http://gabrielmac.com/) and uses he/him pronouns. When referring to the main character and author of Irritable Hearts, I’ll refer to Mac by the name and gender he was inhabiting at the time of the writing and publication of the book. I don’t want to dead-name him, but many of the points about PTSD and relationships made in the memoir are gender-specific and I want to stay true to those original observations.