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There's no lab test to diagnose clinical depression, no scan to define its ravages. But it's as real as a tumor, as devastating as a stroke. Just how real, how devastating, is evident from this saga of one patient's struggle with seemingly intractable internal demons.

By Nancy Price Graff

Ten years ago I made a promise. Several months earlier, I had been released from the psychiatric ward at Dartmouth, and I was trying to make peace with the ways I had changed. They were not pleasant changes, and, if my son and daughter ever faced mental illness themselves, I wanted some assurance that they would not suffer as I had or make the same mistakes.

If this misery befell them, I prayed they would accept their illness as a genetic anomaly that runs rampant through their family and not as a character flaw. I hoped they wouldn't berate themselves if their brains gradually shut down, or see themselves as weak if their intellectual, emotional, and social worlds contracted until normal public intercourse became impossible. I didn't want them to feel, as I so often did, like a dunce as they foundered while trying to follow the threads of a conversation or agonized while trying to remember some recent event. If I could not guarantee their mental health, I desperately wanted them to understand that the illness they might one day face was more powerful than all their best intentions to be and stay well. Most importantly of all, I prayed they would not be too embarrassed to seek help. In return, I promised anything, anything at all.

I knew that mine was a naive wager—the kind that children offer up as they lie in their beds on the threshold of sleep, hoping someone will surprise them in the morning with a new bike. Yet I wanted to believe. Everything I had—my health, my intelligence, my compassion, my creativity, my sense of humor, even my life—did not strike me as too much to offer up in return for the security of knowing that my son and daughter would grow up safe and happy.

Looking back a decade later, however, I can see that I wished for the wrong things. Yes, I'd pledged my soul in exchange for matters that were indeed of great importance. But from what I've learned in the intervening years, it's clear that there are bigger stakes here than I recognized back then. I was bargaining with something that depreciates every day, like a piece of ripe fruit, when the real currency is more precious than diamonds. All I can hope now is that I haven't squandered my three wishes.

For the first 12 years after my son's birth in 1981, I felt as if my life's trajectory resembled that of a 25- cent carnival ride. Within weeks of his birth, my days filled with nervous energy, beset by ups and downs. The peaks and valleys were bearable, however, even when they seemed extreme. (Little did I know how my definition of "extreme" would change.) When I needed stability, I sought the help of counselors and eventually a psychiatrist. During the worst spells, I took medicine that made me feel better by clearing my head and stopping my crying. I would become a social being again. A year or so would pass, and I would be allowed to cut back on the dozen or so pills I took each day. Then, inevitably, at some point after I had pared my medicine to a minimum (usually several months later), my little carnival car would lead me into another dark

tunnel and the light in my life would dim. And the cycle would start all over again.

My situation was very unpleasant but not dire; I had tools and people to support me. Primarily because my husband has worked heroically over the years to keep everyday life in our home close to normal, our children were protected for years from the worst that befell me—even during the dark episodes, when my crying, impatience, and quick temper were difficult to hide.

Then suddenly, about 12 years ago, when my children were 8 and 12, the light didn't just dim; it nearly went out. My son and daughter knew something was wrong with me, but they were unaware that I woke up early each morning terrified that I was drowning. They knew nothing of the bizarre images that raced through my

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Graff—a writer, editor, and historian who lives in Vermont—has to her credit three nonfiction children's books, two young-adult novels, several books on Vermont history and culture, and dozens of articles on a variety of topics. She is also the former editor of Vermont Life magazine and has taught at the University of Vermont and Community College of Vermont. She wrote a feature for Dartmouth Medicine's Spring 1996 issue after her first hospitalization for depression—an article that won the Association of American Medical Writers' national Frances Larsen Memorial Award and that has remained one of the most-often-requested articles the magazine has ever published. She has been a member of Dartmouth Medicine's Editorial Board since 2003.

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