"Did you go out for dinner?" my boss, Matt texts me.
"Is there anywhere with live music you can go enjoy?" my Dad asks me.
"What have you been up to?" my best friend Mazyar asks me
"Have you gone to any of the beaches?" my friend Tony asks.
"Are you doing okay? Did you get your hot water working?" my mom asks.
"Are you meeting any people?" asks my friend Ziv.
There's a note of concern in each of their voices as they ask. And understandably. Going somewhere along for a long period is risky. Human beings don't do well in isolation under the best of circumstances and I'm a guy with a lot of emotional weight to carry – and a mood disorder to manage. Going where no one who knows and loves me can keep an eye on me carries risks.
As my friend Alex says, I'm tricky. I am good at concealing my problems, writing a plausible narrative that might throw people off track. I can usually function well in even in my worst of times. And part of the reason Alex knows is because we were roommates and working together in 2005 when I was diagnosed with my mood disorder. Even a close friend with an MFT who was living with me struggled to nail down what was going on as despite my depressive side, I could get up, work long hours, be proactive and provide very rational explanations for my stress and feelings. In the end it took at least three people besides myself to figure out – and one of them, the Oxford educated psychiatrist in Singapore that I went to see was more of a helpful participant who listened to well considered reasoning, rather than a leading figure in my diagnosis. His greatest contribution was finding me the right medication that as luck would have it was not only highly effective but for those it benefits, has the fewest – or for me, no – side effects.
For a small few of us, what exactly transpired in that time became almost less clear later. As I've learned, Psychiatry may be a science but given it relies heavily on the reporting of the patient and those around the patient, it's almost as much of an art and leaves much room for Monday morning quarterbacking. At lease one clinician has questioned the original diagnosis – concluding that while it may not be right, the treatment would probably remain the same since it's so effective and that there's no need at this time to split hairs. Alex, on the other hand thinks my high functioning abilities had little to do with the hypomanic side of Bipolar 2 (again a diagnosis in question) but was a testament to my intelligence and sheer will that I could compensate against my depressive side so effectively – hiding in plain sight. In 2005, Bipolar 2 (depression with hypomanic, rather than the manic tendencies of classic Bipolar I) was new in the DSM and since then Psychology and Psychiatry have come to see mood disorders as more of a spectrum rather than a list of a few big name diagnoses – which again brings my original diagnosis into some question because it is possible that Bipolar 2 was overreaching. But again, to some degree it's an academic exercise when there's a highly effective treatment in place that has worked consistently since 2005. And with some yoga and a daily supplement of high EPA fish oil, I can do anything from thrive in good times to hold together under tremendous stress.
Most friends and family don't know any of this – and those who do know mostly pieces of the story. To actually go back and reconstruct the days of spring and summer 2005 is an almost impossible task even for me and Alex. When they ask their questions and express their concern, they have no frame of reference for what we can safely call my unspecified mood disorder. Nonetheless, I assure everyone that I'm fine – and of course I am more conscious of what I need to do to stay emotionally healthy than most people think – it's a necessary part of my life strategy and success. On a side note, despite knowing about all of this from the beginning, throughout most of our 14 years together, Emily has been completely dismissive or overlooking of my mood disorder – but that's a topic for another time.
But again, isolation is a danger for anyone. When I hear people's concerns, I sometimes think of the novel Papillon (which is much better than the Steve McQueen movie that my dad so likes for some reason). Henri Charriere's autobiography is a harsh and sometimes thrilling account of the incarceration and multiple escapes of a prisoner in France's Devil's Island prison in French Guiana. While there is room to believe Charriere (whose nickname was Papillon) may have embellished here and there for literary effect, he reports having been kept in solitary confinement for almost two years with only brief encounters with the occasional guard or doctor. Most prisoners would go crazy or kill themselves in less time – but Papillon uses strategies involving pacing, exercise and storytelling to get himself through. It seems unlikely anyone would survive two years in isolation – but whatever amount of time it was in actuality would still have been brutal and inhumane.
While my beautiful apartment with its view of the sea is a far cry from Papillon's dark and miserable cell on Devil's Island – I have to be careful not to spend too much of the time there – although it's tempting because, what more could one want?
At this point, isolation and space is still therapeutic. Letting go of the pressures of daily life at home – the schedules, expectations, tensions, myriad needs to satisfy - is both a process and a relief. Yesterday I found myself anxious about getting the laundry to Michaelis before 1pm. There was no reason for it – just leftover shpilkas that have yet to make their way out – maybe a sense of structure and obligation to which I'm still clinging. Sleeping in the past two days has been VERY helpful as has yoga, a long FaceTime with the kids, exploring some of the less-traveled parts of the island yesterday and today's walk into town. The island is peaceful – especially on a Sunday – and it's funny in the off-season to see how ill-prepared restaurants are to fulfill their menus. Today's cafe could make omelettes – just not their signature one because they are out of onions and peppers (two items that the supermarket 200 feet away is full of).
Making my way out and about is a good and easy way to not be alone. Patmians are warm and welcoming people. Besides those who remember me from past visits, new people are always quick to learn who I am and welcome me (especially if I'm a paying customer). I chose a locals' cafe today by the port and two older gentleman who were bullshitting away the afternoon over coffee and backgammon were eager to know where I was from, to welcome me to their island and to advise me of when the best times of year are for everything. Apparently, I have May two look forward to – May and October are top in their book. The owners of the cafe couldn't have been kinder - and the embarrassing onion and pepper incident was all the more endearing. These little interactions are perfect for where I am and what I need. And as they build so do the waves and smiles as I walk around town – ever less anonymous. Stay on Patmos more than two weeks and locals will start to recognize and count you in to the flow of their community. Needless to say, the bakery lady and I are already old friends.
In 2005 and for awhile thereafter I felt like my mood disorder made me different – that I had a something wrong with me – a secret struggle that most people do not have. But what I've come to understand is that almost everyone struggles with something. And in fact, as I get older, I've come to believe that almost everyone struggles with just about everything. I can't think of anyone my age who doesn't live at the edge of overwhelmed if well into it. But from what I've seen, even younger and older people are increasingly more stressed in their lives. And perhaps mental health in general is a struggle in a world to which our brains are ever-less adapted?
Think of how many passwords you have. The number of websites, software programs, apps and devices that are essential to your life. The amount of screen time you spend – and must spend to work and live. The amount of communication you have across increasingly numerous modes of communicating. The increasingly numerous choices of products and services. The options for your leisure. The demands on your time and money. The tax implications of doing this or that. The kinds of insurance you should have and the fine print you have to be sure to understand so that you're not stuck without coverage when an unexpected natural disaster occurs. The concerns for climate, war, human tragedy that permeate our world. The magnitude of the choices you make for your kids. What the right thing to do in response to COVID is at any given time in a constantly fluctuating situation with overwhelming informations and competing if not conflicting opinions? How to operate all the features of your car. Is the product you thought was safe and good killing children in Burma? Is the stock you own causing deforestation in Brazil?
Our world is so intricately woven with so many variables that no one person can actually understand all the ways it works and all the implications of our actions and choices. And even those we do require lots of knowledge and detail. At work alone, I must use at least 10 software product and five apps. And that's just work – personal life and my volunteer work have additional items I must engage. Even for those of us who succeed in understanding and managing it all, it takes a toll. I don't think we were made to live like this.
Not surprisingly, anxiety is bountiful in our society. Therapists have no shortage of work – especially since 2020. And so I am far from the only person who uses chemistry to get through life. Who among us doesn't have pills of some kind or another? Sure, they may not all be for psychiatric purposes – but they are all ostensibly designed to help us against the forces of nature and life that wear us down. We fight cardio-vascular disease, diabetes, inflammation, pain, acid reflux, osteoporosis, arthritis, epilepsy, cancer, hay fever, allergies, rosacea, depression, anxiety, the entire family of auto-immune disorders, hair loss, hypothyroid, hyperthyroid, and let's not forget Alzheimers. We fight off age and fortify ourselves against genetics and our environment. The goal is a longer, healthier, happier life. Certainly, we can prove longer is working. But are we happier? I have no idea. Are we getting by better? Probably.
I believe that so often, even when we are physically with people, we often feel alone. Being with people is not a guaranteed cure for loneliness - and that itself is a major reason for breakups and divorces. In order to be together, we have to be present with someone. And in an increasingly complex world with more to manage than we necessarily can – it makes sense why people spend more time with Netflix than with each other. The need to turn-off, to escape, to NOT be present is real because navigating the world is challenging if not draining.
But how many of us are Papillon who could seemingly will his way through isolation? And our isolation is hiding in plain sight as much as me and my mood disorder were. So often we share physical space without being present. And no one's needs are met. We want the break from our overwhelming reality and we also crave the community and togetherness we so often don't find or invest in.
At home, I have a wife who wants me present when she needs me, who wants to be checked out when she doesn't feel like being present and who wants me not to demand she be present. It's not a great deal. So, in reality, I'm not lonelier here than at home. If anything, I appreciate the honesty and presence of my own company and the presence and engagement I get in my calls with friends or my casual visits with locals. They may not be the deepest relationships, but people here are warm, direct and you can see the light in their eyes when you approach them. Isn't that really what any of us want of another person?
