I arrived ten minutes early to my appointment and the waiting room was empty. It’s a very small waiting room. There are a total of six chairs. The lights are dimmed, there’s a small water fountain on one of the two bookcases (neither of which holds any books, only magazines, plants, and a water fountain), and a single computer speaker on the ledge of the receptionist’s window playing classical music at a very low volume.

I get it. I know what’s happening here. Everything about this waiting room screams, “Relax.” The first time I visited this waiting room (empty then, too), I cried. But I’ll get back to that in a minute. My second appointment was later in the morning, eleven a.m. instead of eight-thirty. I sat down, and the receptionist opened her window and asked, “How can I help you?” I told her. She closed her window and disappeared into the back. While she was gone a woman with a small child came into the waiting room. They sat down across from me and the mother began to speak to her daughter.

“Now, when I go in there, I want you to wait right here, okay? Don’t go out in the hall and don’t come back into the doctor’s office, okay?”

I was looking at my shoes. I didn’t want to make eye contact. But I was listening. The child didn’t respond.

“I need to you acknowledge me,” the woman said in a calm voice. “Yes ma’am or no ma’am?”

“Yes ma’am,” the girl said.

I continued to stare at my feet. Out of the corner of my eye, I noticed that the receptionist had returned. I hoped it meant the doctor knew I was here and would come to get me any minute. My introversion had skyrocketed and I wanted nothing more than to be away from this woman and her child. They weren’t doing anything wrong; I just didn’t want to be around anyone.

“Excuse me?” the woman said.

I looked up from my shoes and made eye contact with her.

“Do you know this area pretty well?” she asked.

I shrugged. “Sorta.”

“Do you know where Urban Outfitters on Lamar is? Not the one south, but the one that’s north?”

I thought for a second and then said, “The only one I know of is on Guadalupe, across from the University.”

Her eyebrows crinkled in, confused. I added, “Do you know where Tower Records used to be?”

“Yes,” she said, a little too exuberantly if you ask me.

“It’s in that same building, just a few doors north of that.”

“Is the parking still pretty bad down there?”

“Yes.”

The receptionist opened the window again and motioned for the woman to approach. The woman got up from her seat and–while I prefer not to use verbs like this in normal conversation, it fits here–she pranced up to the window. At the window, she stood on her tiptoes even though she was tall enough to see over the counter. This woman, I thought, is really fucking happy. Too happy, if you ask me.

The door to the back opened and the doctor poked his head out. “Michael? Come on back.”

I got up and followed the doctor, thinking that despite how desperate I am to be happy, I don’t think I want it to be like that. I don’t ever want to prance anywhere and I certainly don’t want to stand on my tiptoes unless I absolutely must.

* * *

Around May 23, 2008, I had the first of a series of breakdowns. I told my doctor that I thought I was having a nervous breakdown but he said that’s kind of an ambiguous term and isn’t really used to describe anything anymore. After I told him what my symptoms were he said I might be experiencing a major depressive episode. A week later, I was diagnosed with “adjustment disorder with mixed disturbance of emotions and conduct.” Athealth.com says this about adjustment disorders: “A person with adjustment disorder often experiences feelings of depression or anxiety or combined depression and anxiety. As a result, that person may act out behaviorally against the ‘rules and regulations’ of family, work, or society.”

As for the major depressive episode, here’s what Wikipedia says about it:

Over a two week period, the patient has consistently experienced five or more of the following symptoms, and these behaviours must be outside the parameters of the patient’s normal behaviour. Either depressed mood or decreased interest or pleasure must be one of the five (although both are frequently concomitant).

• For the better part of nearly every day, the patient reports a depressed mood or appears depressed to others.
• For most of nearly every day, interest or pleasure is markedly decreased in nearly all activities (noted by the patient or by others).
• Although not dieting, there is a marked loss or gain of weight (such as five percent in one month) or appetite is markedly decreased or increased nearly every day.
• Nearly every day the patient sleeps excessively, known as hypersomnia, or not enough, known as insomnia.
• Nearly every day others can see that the patient’s activity is agitated or slow.
• Nearly every day the person experiences extreme fatigue.
• Nearly every day the patient feels worthless or inappropriately guilty. These feelings are not just about being depressed, they may be delusional.
• Noted by the patient or by others, nearly every day the patient is indecisive or has trouble thinking or concentrating.
• The patient has had repeated thoughts about death (other than the fear of dying), suicide (with or without a plan) or has made a suicide attempt.

The first time I visited this office, I was going through the worst of it. I’d been experiencing a lot of these symptoms off and on for weeks but I hadn’t experienced so many of them at once until recently.

Although I said it had been building for weeks, years is probably more like it. In fact, I’m sure I’ve had this adjustment disorder for a very long time. The depression appears to be a side effect. I should have gotten help sooner, but I didn’t. In my family it is a strongly held belief that if you are blue you just need to pull yourself out of it. Feeling down in the dumps? Go have some fun and get over it, the implication being that depression is something we can control; it is something we have power over; it is something we bring upon ourselves. It was very difficult for me to admit that I needed outside help. And so when I walked into the doctor’s office that first day, when no one was there, not even the receptionist, I cried because I was terrified. I was afraid that I was going to tell the doctor what had been going on with me and he’d say, “You know, chief, those aren’t very big problems. You just need to go out and have some fun and get over it.” The thought that I would have to get over this whatever-it-is by myself had kept me awake for days.

In the waiting room that first day, there was a clipboard next to the stereo speaker on the receptionist’s ledge with the paperwork I was supposed to fill out. I began writing down all the pertinent answers, sometimes having to wipe my eyes in order to see the forms clearly. At the top of the stack of forms was a note that read, “WHEN YOU ARE FINISHED, PUSH WHITE BUZZER ON WALL AND DOCTOR WILL COME OUT.” I did as I was instructed and within a minute the doctor came out, just like the note said he would.

* * *

Several people have told me over the last several years that I might be depressed. It’s not that I didn’t believe them, but the idea that depression is something I’ve brought upon myself kept me from seeking help. If I did this to myself then surely I can undo it, too. Right?

On Thursday, July 17, I took the kids to Schlitterbahn. I’d only been there once before, on a Saturday last summer, and it was incredibly crowded. Every single patch of water was occupied. People were standing shoulder to shoulder. To say that it was a miserable experience for me would be an understatement. But this year, my friend Mike went with me. Being there on a Thursday meant it was appreciably less crowded. Mike spent the day watching the older kids while I spent the day hanging out with Gabriel at the kiddie pools. It should have been a better experience than the summer before, but for most of the afternoon I sat in the shadows fighting back the urge to cry. And for the most part I was successful. But a couple of hours later I met up again with Mike and the older boys. I asked, mostly as a courtesy, “How’s it going?”

“I’m fine,” Mike said. “It’s you I’m worried about.”

I’d been trying very hard not to burden other people with my problems, but Mike’s subtle invitation to talk opened the floodgates. I told him that I thought I might need to be on medication.

“I’m surprised you’re not already on it,” he said.

At work the next day, I spent most of the morning scouring my provider directory for a psychiatrist who could see me as soon as possible. I was surprised by how hard it is to get a quick appointment in this town. Apparently, there is a shortage of psychiatrists here. Some had openings in October; another had an opening in two weeks. I made that appointment thinking that I might have to go see my primary care doctor for some interim help. Just as I was about to make that call, I received a callback from one of the psychiatrists I’d left a message with earlier. He could see me the following Wednesday.

* * *

When describing what medication does, my doctor said, “Imagine a bowl holding all your emotions. Sometimes, your emotions become so intense that they spill out and cause a disturbance in your thinking, behavior, sleep … in every aspect of your life really. Medication doesn’t take away any of those emotions but it makes the bowl bigger. It makes it easier to handle the emotions.”

* * *

I’ve been in therapy since March of this year. One of my biggest problems is negative thinking. I tend to read a lot into things. You can look at me a certain way and I will probably manage to take it as a criticism of some sort. I don’t do this voluntarily. I can’t help it. My therapist has given me a lot of good advice on how to re-frame negative thoughts. The best advice came in the form of a worksheet. On this worksheet, I am supposed to write down my immediate negative response to something. Then, I’m supposed to write down the facts of the situation. Then, in the succeeding columns, I am encouraged to isolate the source of the initial negative thought and re-frame it in logical, more positive terms. Nine times out of ten, I was successful in doing so. But then came the first of these breakdowns. With it came a profound sense of hopelessness. None of the advice my therapist had given me worked; I couldn’t re-frame the negative thoughts. I ended up riding it out, just like I’d been taught to do as a kid. Just get over it. Within a week I was feeling better. But I hadn’t gotten over it.

Over the next several weeks, I noticed a significant change in my behavior. I found myself making impulsive decisions. A friend told me that all I seemed to be doing was reacting. And it was true. I wasn’t making deliberate, sound decisions but merely reacting to these useless, negative thoughts that I’d been mostly successful in re-framing prior to the first breakdown. What I understand now is that, to use the doctor’s metaphor, the bowl wasn’t big enough. My emotions were spilling out and I found myself doing things that I knew were irrational, but I couldn’t stop myself. I kept trying to re-frame the negative thoughts but I couldn’t. At one point I began to feel guilty for not being able to apply my therapist’s advice. So feeling like I’d let her down, my sense of hopelessness had given way to worthlessness.

* * *

On July 15, I made a big deal over my two year anniversary of sobriety. I posted the news on my website and on Twitter. I decided to make it a public announcement for one reason: accountability. I wanted everyone to know that I had made it two years because had I kept it a secret I might have started drinking again. The Saturday before, I hosted a cookout at my house for some of my kids’ friends and their parents. One of the parents brought a bottle of wine. I helped her open the bottle and then poured her a glass. For the first time in almost two years, I felt the urge to pour a glass for myself. Now, this type of event has worked out quite well in the past. I’ve hosted several parties at my house wherein people brought their own alcohol but I never once felt the urge to drink on any of those occasions. But that Saturday in early July, I really wanted a drink. I had a cigarette instead.

* * *

As best I can tell, there is no pharmacological treatment of adjustment disorder. Therapy is it, which I’m in. There is, however, pharmacological treatment of depression, and as soon as I left the doctor’s office that first day I went to fill my prescription: Lexapro, 10mg per day for the first week, then 20mg everyday thereafter. Apparently, I’ll be taking it for a while.

* * *

Over the past few weeks I’ve made some regrettable decisions, which I suppose is part and parcel of an adjustment disorder. But I’ve made some good decisions, too. The decision not to drink was a very good decision. The decision to get help was also very good. And while they haven’t made up for the bad decisions, I’m hopeful that in time I’ll learn to forgive myself; I’ll learn to focus on the positives instead of the negatives; I’ll learn to adjust. I think the medication is helping. I don’t feel any happier yet but my thinking is much more clear, my decisions more deliberate. And right now that’s enough. I know I just need to be patient.

I just need to wait.