Scotch Double, Please.

I drank normally for most of my adult life.  Really.

Two beers was a typical limit.  And even that was occasional.  My typical pattern was to have beer in the refrigerator during the summer months and into the fall during football season, but often there would be no alcohol at all in the house, not by any intentional choice, but simply because I didn't bother to pick any up.  I mean really, 30 below zero, with a thirty mile an hour wind does not stimulate a desire to have a cold one.  I might have a glass of wine when we went out for dinner.  Pizza and beer was a good combination.  And when I would go to the pastor's convocation, I would sit with colleagues till closing, sharing a few pitcher's of beer.  This was the only time I would regularly become intoxicated, and that was only once a year.

When I was first diagnosed with depression, my psychiatrist told me I'd have to refrain from alcohol or else the treatments he could offer would be ineffective.  Alcohol is a depressant.  Taking both anti-depressant medications and drinking alcohol simultaneously simple doesn't work.  They counteract each other.  So I didn't drink.  No big deal.

What ended  up being a big deal was that the psychiatrist put me on an anti-anxiety drug called Ativan, or lorazapam, both for anxiety and to aid my sleep.  It is highly addictive.  A number of years later, feeling better, I decided it was time to go off my medications.  This was before I was diagnosed as being bipolar.  I was being treated for dysthymia at the time, a long term moderate depression, and so it was not untypical to come to a point where discontinuing medication was an option.  When I went off the Ativan, my doctor weaned me by putting me on half a dose for a few weeks, and then off.  I think he may have warned me about alcohol use, but I'm not sure about that.

What happened was that I immediately, as in overnight, began having a couple of scotch doubles per night to ease the anxiety and help with sleep.  Prior to this time, I had resumed drinking once a week, or so, rarely more.  A friend would come over on Wednesday nights, and we'd share a couple of drinks of scotch.  That's it.  Once a week.  Then, I stopped the Ativan and it was every night.

Having a couple of drinks per night is generally, socially acceptable.  And in the beginning it was not much of a problem.  At least I didn't think it was a problem.  In the beginning I didn't realize the extent to which I was dependent.  What I discovered later was that I had become chemically dependent on the Ativan, and then when I went off the Ativan, I experienced a "cross addiction" to alcohol.

I realized at one point that if I didn't drink, I couldn't sleep.  So I went to my physician an shared that I felt that I had become dependent on alcohol for sleep.  He put me on Ambien, which produced horrific nightmares.  Then Lunesta. When I went to fill the Lunesta prescription, my pharmacist informed me that Lunesta should not be taken nightly, because it is potentially addictive, habituating, and in the end, could cause significant liver damage.  "I wouldn't recommend using it anymore than once every three nights."  My solution was to alternate between the scotch and the Lunesta.  I preferred the scotch.

The thing was, it worked.  It did what I wanted it to do.  When my wife would raise concerns about my drinking, I would defend it by pointing out that whether it was scotch or Lunesta, the fact was that without help I could not sleep.  It was simply a matter of choice which drug I would use.

The problem is that alcohol is not only addictive, but habituating.  As time went on I needed more to achieve the desired effect.  My two scotch doubles (specifically 6 to 7 fluid ounces per night) became 3, (over 10 fluid  ounces) per night.  And that was the average.  I know this because I have a record of all my purchases of scotch.  I did my finances on Quicken and could look back and itemize every purchase at the Idaho Liquor Store.

What I now realize is that when I would cycle between hypomanic highs, and depression, my consumption would increase at both ends of the spectrum.  As my drinking increased, my tolerance level did as well.  I used to joke that it took two doubles just to feel sober.  It actually did.  There were three phases in my drinking.  First I drank because I liked the taste.  Then I drank for the effect, I liked the buzz.  And finally, I drank to feel normal -- that is to alleviate the symptoms of withdrawal.

Toward the end of my drinking this became quite pronounced.  I had decided I would not drink on Saturday nights because I didn't want my congregation to smell alcohol on me Sunday mornings.  On Sunday mornings I would shake to the point that I could not pour the wine from the pouring chalice anymore.  I thought it was stress.  Turns out that to avoid smelling of alcohol, I was actually detoxing in front of  my congregation each Sunday.

I reentered psychiatric care in 2012 and the psychiatrist put me back on Ativan, hoping I wouldn't need to drink as much.  It didn't work.  On my last night drinking, I was in a rage over some issues at work, trying to 'drink it away', and I decided I'd need the Ativan as well.  Not a good choice.  It nearly killed me.

Alcohol worked until it didn't.  Now it never will again.

Post Script on "Into Your Hands"

Quotable Quote from my first psychiatrist:
"The likelihood of your dying of a self-inflicted gunshot wound is much greater if you actually have a gun. . ."

Into Your Hands. . .

I am in a good place.  Don't call my doctor.  Don't worry.  But I write to share my experiences, now past, but which are a very real part of this disease.

"Into your hands I commend my spirit."

These words which Jesus spoke from the cross just prior to his death spoke to me on numerous occasions.  I contemplated speaking them myself, and with them, breathing my last as he had.  I didn't.

Its interesting to hear people talk about suicide and the judgments that are often rendered.  "Suicide is an unforgivable sin for there is never any chance for repentance."  "Suicide is such a selfish act."  "Suicide is the ultimate lack of faith."

All I can say to those who say, have said, and perhaps continue to say things like this, is that this has not been my experience.

"I haven't been suicidal," I have told my doctors, "but I can see it from here".  I know the feelings of despair and hopelessness that give rise to such thoughts.  The weariness.  Oh, the weariness.  How many times can you hope that a new medication, or counseling, or life changes will bring about healing, only to have those hopes shattered as the day to day grind of depression resumes?  How much of life can be endured during the dark lonely nights of despair before it is finally too much?

To those who would talk about "unforgivable sins" I'd suggest that it is more helpful to recognize the struggles of living with "incurable diseases".  To those who consider that suicide is a "selfish act" I would suggest that for one so burdened with mental illness there comes a point where the "self" is simply lost, destroyed by the disease, with no capacity for consideration of others.  And to those who would suggest that suicide is the ultimate lack of faith, I can only say that as I have contemplated those words "Into your hands I commend my spirit" it was not for lack of faith.

Sometimes the simplest things might be the most important things to remember as one struggles with suicide.  "Take two aspirin and call me in the morning."  Actually, to be serious, dead serious, (pun intended) the most helpful thing of all for me, and I believe many struggling with suicide is to have a reference in the future (hence 'call me in the morning').  Something concrete.  If I were living with someone who was struggling the way I have struggled I would try this simple thing.  Get out a daily planner.  Tomorrow we will go to dinner.  Friday, lets walk to the beach.  Lets talk to the doctor on Monday.  We're going to have eggs benedict in the morning. Next week we will spend some time with the kids.  You don't have to plan a trip around the world, but simply help to build a vision of tomorrow.

During those times when I have been borderline suicidal, it was because a massive curtain was being drawn that closed off all vision of a future.  People commit suicide not because they want to end their life, but because in their perception, there life has already ended. They simply cannot see the future. That is the tragedy.  Its just a perception.

There has got to be something, perhaps simple, but significant nevertheless that is coming, that can be anticipated, that will give reason to pause.  Today is not a good day to die.  The trick you see, is not dying now.  If somehow there is something, no matter how simple, to focus on then the thoughts of 'no tomorrow' will pass.  That's what I believe.

Today, I'm in a good place.  I do have hopes which sustain me.  There are frustrations.  I'm on yet another medication to aid sleep, and the results are mixed.  I've had some good night's sleep, and some nights where it was just more of the same.  But the depression is in check.

And I hope that it is never by my own choice that I utter those words "into your hands I commend my spirit" and then die.  But if you know someone, have loved someone, and grieve the loss of someone who "died by suicide" after a long battle with mental illness -- know that it was the disease that finally killed them.  Their life was taken from them, just as it would have been had they died of cancer.