The Awkward Pose

The last in a series of five essays about Mental Health to celebrate the dog days of August.

Mental Health I: Why Do I Write?

Mental Health II: Suicide is Painless

Mental Health III: You Were Never Sick; Get Yourself Better

Mental Health IV: Cognitive Behavioral Therapy

The United States is the most individualist society on earth. Our relentless quest for autonomy causes us to suffer high rates of consumption, isolation, and loneliness. The internet and social media laid the foundation for online society and planted the confusion that virtual friends were equivalent to physical ones. When COVID-19 made virtual encounters the default choice, our atomization accelerated.

Weathering the shut-down was easier for me than many. I was already retired, so didn’t need to go anywhere; I enjoyed the company of a pleasant housemate; I live in a walkable city. Still, the pandemic left me, like so many, more isolated than ever. It also shut down my particular magic pill for mental health: without my gym, I atrophied. The careful balance I’d crafted through applying Cognitive Behavioral Therapy (CBT) slipped away.

An ugly exchange with a cherished friend spiraled me down. I spent a week in a swamp of despair, maybe longer. Time is an unreliable construct when I’m depressed. When the curtain of solace slowly ascended, and I was able to see how irrational I’d been, I realized it was necessary—once again—to reach out for help. I was more amenable to therapy this round, as my experience with CBT had been positive. I needed a CBT booster.

Instead, I enudred a series of interactions with health care providers so pathetic (yet common) I need not elaborate here. I finally found a large therapy group that advertised accepting new patients, persevered through applications and interviews, only to be told their practice was full. I suppose these frustrations provided therapy in themselves, as my exasperation with our miserable healthcare system eclipsed the emotional space occupied by depression.

At peak anger, three months after my initial quest for therapy, with nothing even potential, I posted a scathing Google review of the practice who advertised taking new patients, and then reneged. Guess what? Within an hour, I received a personal call from the head of the practice, with effusive apology. Would I rescind the review? Absolutely not! What can I do to make this right? Set up an appointment with a CBT therapist. Doctor Apology did not do that. However, a few days later, I received in the mail, The Cognitive Behavioral Workbook for Depression, by William J. Knaus, EdD.

It is a sad world, when a person only gets heard when he goes postal. I can understand people who say, “What’s he got to be depressed about?” I can understand that there are others with greater mental instability. I’m not trying to trump anyone else’s problems. My problems are not relevant to the cosmos, but they are real to me. They hold me back, and they make me miserable. Here I am, trying to steady myself before I slip into the trauma that once led me to suicide, yet no attention gets paid until I do something extreme.

I appreciated the gesture of the workbook. And I used it. Twice a week, for over six months. I read, I notated, I wrote responses to the guided questions; an entire folder of essays that I’ll spare those of you who’ve read this far. I worked, I learned, I felt better, and I became more self-aware. I likely got more out of the workbook than I would have from another round of talk.

Then, something both strange and amazing happened to me.

One morning last year, at age 66, I woke up and my initial thought was, “Hmmm, I could live to be ninety.” And the idea did not fill me with dread. Actually, it was satisfying.

Waking to the pleasant prospect of life may not seem amazing to many. But this was the first time—the very first time in my entire life—that I woke in the morning and greeted the day, the week, the year, however long the gods choose to keep me around, with equanimity. For a guy who’s suffered morning dread for…ever, this was a superb beginning to the day.

This new mindset of awakening occurred, again. Then, with increased frequently. These days, waking to calm is my usual mode. And on mornings clouded with angst, I am quick to soothe myself. When stuck, I go back to the book, review how to direct my thoughts, and thereby modulate my feelings.

I know I’ll weather more episodes of mental anguish; my pot-stirring brain demands constant diligence. However, the stasis I’ve enjoyed over the past year is a revelation that will not easily dim. I have the tools and the confidence to vanquish the forces that made my days so grueling for so long. Confident enough to write publicly about my journey.

As I neurologically whither and physically deteriorate, new challenges will arise. I may yet choose to end my life someday: I am a strong believer in the right of a person to orchestrate their finale. But end it in depression? I don’t think so.

We have created a world fueled by competition and aggression, fixated on physical enticements, bereft of mental stability. Mental illness will surely escalate as the human psyche is further starved of calm, repose, reflection. I feel blessed to have found a path to peace of mind. I hope that others can find their own.

The fourth in a series of five essays about Mental Health to celebrate the dog days of August.

Mental Health I: Why Do I Write?

Mental Health II: Suicide is Painless

Mental Health III: You Were Never Sick; Get Yourself Better

Mental health is a different animal than physical health, and though it’s important that we destigmatize mental illness and provide access to services and medications, our tendency to treat psychiatry as simply another medical specialty is misguided. Western medicine is rooted in considering the human body as a machine. When the machine is broken, we fix the components. Thus, we excel in treating physical trauma: repairing a broken bone is a matter of physics; installing a stent a function of fluid mechanics. Complicated chronic conditions are trickier: the same chemotherapy that remisses one person’s cancer may well kill someone else. The more complex our mind-body-societal interrelations, the more we flounder: no drug cocktail can calm a brain and alleviate all the stress our society inflects on a person’s sanity.

In the 1990’s, I was a forty-ish gay man in tumult, grappling with the realization that I’d spent most of my life running from a so-called mental illness that, turns out, had been redefined into the range of normal.

A psychiatric diagnosis is a reflection of the society that ascribes the label. Although mental illness may have roots in organic brain function, it often triggers in response to our over-specialized, hyperactive, competitive society; in revolt or capitulation to norms and expectations. By definition, a person who conforms to the basic standards of their culture possesses positive mental health, whereas a person at deviance to those norms is considered ill.

When I came of age, testosterone-fueled antics, heavy drinking, and sexual bravado were tolerated, even encouraged, as healthy signs of manliness; whereas male sensitivity was suspect, sodomy a crime, and homosexuality a certified mental disorder. Sixty years later, young men who drink, drug and whore to excess get shuttled off to twelve-step programs, while my particular predilections are legal and, in some sectors of society, my brand of masculinity actually embraced.

The proclivities of human males have not evolved all that much in two generations: we all still try to do whatever we happen to like as much as we can. What’s changed are society’s standards.

You’d think I’d be happy to learn, “You used to be sick but now you’re not.” Yet I suffered psychological whiplash. Years of having one’s nature bullied and denied hard-wires inadequacy. I was unable to simply rise one morning all Happy Gilmore, and during dark days I still knew depression as my oldest, truest friend. He might not be good for me, but he was a known quantity, and my life was so upended—marriage kaput, children by schedule, finances teetering, old friends grown distant—I welcomed depression’s familiar anchor.

I still dreaded mornings. I suffered doubt. I became jittery. I averted panic through constant activity. I read deep into sleepless nights, and immediately upon finishing one book, started another before turning off the light. I needed the illusion of required tasks to fill the abyss that loomed over my next day, week, month. The line between depression and anxiety blurred. And even though I no longer believed that therapy or psychopharmaceuticals offered anything to me, sometimes I felt so lost and unable to find a way through, I returned. To talk, and more talk.

One of my iterative searches—in my Fifty’s now, wondering when the hell life would ever start to smooth roll—led to with a therapist who practiced CBT: Cognitive Behavioral Therapy. The gist is: thoughts influence feelings; we have (at least some) control over our thoughts; therefore by directing our thoughts, we gain mastery of our feelings. CBT struct me as cookie-cutter, more pop-psych than careful analysis. However, over our allotted eight sessions (plus assigned homework), several things became clear. First, all my previous talk therapy, premised on the notion that mine was a unique case of singular mental struggle, simply resulted in circular conversation. Second, CBT was practical: I could actually apply what we discussed in therapy to my life beyond. I reported concrete examples of catching runaway thoughts, slowing them down, and in the process, calming my feelings. Third, CBT played to my strengths. It’s a structure, a discipline, it lends itself to study. And if there’s one thing I’m good at, it’s studious discipline. When I applied the same skills that enabled me to escape my family and rise in stature, I yielded something more important: a deeper understanding of me.

CBT aligned with other aspects of my life at that time: my emerging yoga practice; exploring meditation; the conscience decision to cap my career. I still felt anxious, but less often descended into depression. I still responded to mental agitation with hyper-action, but my busyness turned inward, channeling energy into personal enlightenment rather than professional perfection. I became more comfortable with my introverted nature, neither needing nor wanting as much social life.

I’d never contemplated retirement, but when intriguing options presented, I stopped working. At age 58. Unstructured time had always been a challenge, but self-motivation kicked in. I volunteered, many gigs. I read, all variety of topics. I travelled, very slowly. I wrote: one book, then another; a play, then another, and another; and so many blog posts. For nearly a decade, I faired pretty well. Conscious adherence to the discipline of CBT helped me manage my life.

Then our nation grew ugly, isolated and divisive; and a pandemic hit. And the diligence required to sustain equilibrium became too great to sustain.

The third in a series of five essays about Mental Health to celebrate the dog days of August.

Mental Health I: Why I Write

Mental Health II: Suicide is Painless

When you have a substitute school bus driver, it doesn’t much affect your life. When you have a substitute teacher, you know you’re in for an easy day. But when you walk into a room to encounter a substitute therapist, you think: this will be useless.

That actually happened to me in 1990. I was still pushing the Sisyphusian rock uphill against my nature, juggling my own firm with a toddler at home and second on the way. My usual therapist, a mousy woman who was neither effective nor harmful in the futile struggle to be happily straight, was absent. In her place sat a man in his early thirties with thick black hair and chiseled features. If he smiled he might have been handsome, though I intuited immediately I would get no smile out of him.

I figured the next forty-five minutes would be a waste, but I’d already forked over my co-pay, so I rattled off my mental health history. By this time, I could hit the high points in eleven minutes, twelve tops.

“You’ve been telling yourself this story for, how long?” His opening gambit was different. “You are gay. There is no doubt about it. Until you acknowledge that, and accept that, you can come to therapy forever, but your situation is not going to change. The only way to get your life on a path that makes sense, is to come out.”

“Who do you think you are? I’ve spent fifteen years, with too many therapists, trying to find balance. My whole life is structured around this.”

“And you’re still miserable.”

Thus we volleyed through the remainder of the session. I left, angry. Angry at having a substitute. Angry at his insistence. Angry at him even questioning the construct all the other therapists had drilled into me. I had a child, another arriving soon. I was dug very deep; I could see no option but to keep burying.

Yet even in my anger, I realized solace in finally hearing the truth. He challenged me, yes. But he did not condemn me. And though it took several more years, that single interchange with that abrasive therapist was the turning point in my understanding. I might well suffer mental anguish and depression my entire life, but if there were any chance of easing it, I would have to true to that aspect of my nature that lay contrary to the rest of me.

Truth is an invasive species: once it finds fertile ground it spreads. The storyline of my life became increasingly tenuous. I finally decided to tell my wife, which I did in a therapy session (we were also in couple’s therapy). I recommitted my love for our family, I reinforced there had been no affair, nor even dalliance. It had not occurred to me that this would be the end of our marriage (the forever part of Catholicism obscures the reality of actual living). Yet by the end of the session, I knew we were through. My wife was not entirely surprised. But in stating the verboten aloud, I had broken the spell. We were through. She would set the terms.

Within the year I was living alone in a half-furnished house, working out of the attic, spending too much time with myself and two toddlers, more depressed than ever. Suicide was no longer an option: I was responsible for two children. Beyond that, my will to live was zilch.

Talk therapy was unthinkable: all those years of misguided talk soured me on psychotherapy. I’ve always been sensitive to medication: two aspirin will squelch a splitting headache. However, I finally agreed to the lowest dose of Zoloft. My doctor cautioned me to side effects that could flower in three to four weeks. On cue, three weeks from kicking off my daily dose I found myself sitting on the carpet mid-afternoon, watching a TV game show. Laconic…subdued…alien. I skipped my pill the next day, and the next. Called my doc, told him thanks but no thanks.

Thus, I had no faith in religion, talk therapy, or meds. Yet depression continued to cyclone through me. The only thing that was ever going to help me feel better: was me.

Over time—a lot of time—the fact of I was the only one who could truly help myself became clear. And with that realization came a sharper perspective. I was not mentally ill. I had never been sick. There was never anything wrong with Paul Fallon aside from not fitting the expectations of family and church and community. Expectations that I absorbed as inviolable truths, even as they labelled me faulty.

Long ago a therapist asked, “When are you going to get angry at your parents?” I laughed and replied, “Never. I was the last of four kids in four years. They had no idea what they were doing. They were clueless and probably harmful, but they weren’t malicious.” Unsatisfied with my detached perspective, he counselled me to get angry, to embrace catharsis.

Perhaps he, and all my other therapists, would be relieved to know that I bear none of them any ill. Like my parents, they operated within the spectrum of their own constraints. Once I realized that I was not ill, had never been ill, I had no need for therapists or drugs to cure me.

But even as the major identity confusion of my life got resolved, depression continued to strike, erratic yet deep. And anxiety started coming at me with greater velocity.

The second in a series of five essays about Mental Health to celebrate the dog days of August.

Mental Health I: Why I Write

On Friday March 28, 1975 I tried to kill myself.

I failed.

I hadn’t failed at much in life, at least not on paper. I was a twenty-one-year-old junior at MIT, son of a lower-middle class family from Oklahoma, on a full-ride. Honor student in Civil Engineering. Devout Catholic. Fraternity brother, acapella singer, fair runner, excellent dancer. Not bad looking. Nice girlfriend from Wellesley. Terrific sense of humor. Distinguished laugh.

In my head, I was an utter failure. Fat. Pimply. Uncoordinated. (Ignore all photo and complementary evidence to the contrary.) Academic sham. (Everyone knows Civil Engineering is the easiest major.) Landed where I did by geographic affirmative action.

I suppose one way to slice mental health is to measure the discrepancy between our objective and subjective selves. Narcissists’ internal thrall with their own greatness outstrips actual evidence. Depressive’s certainty of their worthlessness ignores realistic assessment.

My action didn’t erupt out of nowhere. I’d always been temperamental and judgmental, especially against myself. I minimized the pressures of school, though I vomited several times a week. I’d seen an in-house therapist; a jovial, patrician man, all hale and hearty. The first person to whom I revealed discomfort around other guys. He offered the word ‘homosexual,’ which I denied. Then he replied, “Well that’s good. Tell me about your girlfriend.” Thus began the mantra that haunted my next twenty years: I suffered inappropriate feelings about men, which manifested as depression. The therapeutic solution was to learn how to ignore the feelings, thus alleviate the desperation.

Spring of sophomore year I came unglued in the middle of structures lab. I removed myself to a bathroom stall, where I cried. And cried. I tossed a few things in a backpack and caught a bus to New Jersey, where my parents had moved. “What are you doing here?” sums up the limit of their understanding. We circled each other in wary politeness for a few days, until I bused back to school. I cannot recall why I thought my parents would offer solace to my confusion; I never entertained that fantasy again.

So when I hit a dark place the following Spring, the options were few, the prospects illegible. I rummaged through the medicine cabinet of our communal bathroom and opened a bottle of pills labelled with the name of a brother I could not admit to fancy. His remedy would be my end. I downed the bottleful, felt woozy, and fell asleep. In keeping with this B-movie script: I tried to kill myself on Good Friday.

I woke Saturday; disappointed. Hauled myself out of bed and went about my day. I don’t remember who I told, or when, but after our Easter Sunday meal, I endured what these days we call an intervention. I promised my sister and brother-in-law, girlfriend, and several brothers not to do it again. I knew the promise was hollow. Next time I’d plan better, and avoid this whole scene. They also coerced me into real therapy. An actual shrink.

By 1976 the American Psychiatric Association had struck homosexuality from their legion of disorders, but apparently that news had not yet reached the provinces of Brookline, where I paid $75 per session out-of-pocket—money I scarcely had—to hear again and again how I must divert my feelings about men by focusing on the little woman. I suppose I got off easy: ten years earlier my complaint would have sent me straight to electroshock therapy.

By fall, I was declared ‘cured,’ and equally relieved for two reasons: I could no longer afford the advice; and my girlfriend had broken up with me. Who could blame her? I actually preferred to be a jilted male with a bruised heart than an actual boyfriend.

My attempted suicide and subsequent therapy set in place a mindset that remained intact for fifteen years. I made the conscious decision to be straight, earnestly believing it was my decision to make. My girlfriend returned, I never understood why, though I suspect my non-traditional masculinity appeals to strong women, and I’m a few digits away from being a full-on Kinsey Six. We married.

The ground rules of our marriage were clear, though never discussed. I was a presentable spouse on the outside, though damaged goods within, which only she could repair. I leaned on her to understand me better than I understood myself. Followed her for her career. Went to therapy whenever she told me I needed it.

This balance held through graduate school and first jobs and two children and buying a house. Until I disintegrated in grand scale at rapid speed; the exploration of the next essay.

My attempted suicide colors my life in constant ways. One unconventional attitude I took from trying to kill myself holds fast. I have no regrets about what I did on that black night. Never have. I feel no blessing in having failed. I no longer wanted to live. I believe that every human should be allowed to take their own life, and their suicide should be honored by those who remain. This is, of course, at odds with a society that abhors the idea of suicide, reinforced by a mental health establishment that rejects the action. As a gay man who attempted suicide in large part because the mental health establishment labelled me ill, forgive me if I don’t buy that line.

I often wonder what my life would have been like if any therapist in 1974, 75, 76…even 1986, had said, “Paul, you might be gay and that would be fine.” No one ever did. Instead, dozens told me over those years, “Paul, you might be gay and we can fix it.” They never could.