High Anxiety, Maggie Dietz’s "Zoloft," and the Curse of Being an Interesting Case

The crucial component of successful treatment is the willingness to experience anxiety (including panic attacks) during portions of the treatment. —From the Center for Anxiety and Related Disorders material on Exposure Therapy

The anxiety doctor and I met in the Starbucks in Fresh Pond a couple times a week. She was one of the country’s top researchers in the field of severe anxiety, especially phobias. I think she was a doctor, but I couldn’t remember, so I tried looking her up on the Center for Anxiety and Related Disorders website. Even clicking around the website made me sweaty and nervous. I’ll just call her “the anxiety doctor.”

She had an aquarium in her office full of spiders for arachnophobes, and another with a pile of snakes for patients with ophidiophobia. It was unusual. She took people with aerophobia up in small planes and had them pilot. See? Just turbulence! And me? We went driving on the highways, and we didn’t just stay in the right hand lane, or go at specific times of day or on specific highways with a backroad plan just in case. 

The anxiety doctor had a long waiting list, but she took me because I was an interesting case. 

Sometimes, it’s not  good to be interesting. Like that ancient Chinese curse: “May you live in interesting times.” It usually doesn’t augur well when someone in a medical or mental health field considers you an interesting case. Take my newborn son, for example. In 2003, a week after he was born, Emmet, 8 pounds, was admitted to Mass General with breathing problems. They didn’t know what was wrong with his lungs, but they knew it wasn’t good. 

One prematurely confident resident thought the oxygen saturation machine was broken until a nurse/perfect person shoved him out of the way, grabbed Emmet, and sprinted into the depths of the ER. Doctors circled around our new baby. It was a blur of yelling, fluorescent lights, and white jacketed arms all moving so fast but in sync. My husband and I stood out of the way, stiff with grief, saying oh my god oh my god and ignoring the ominous presence of the social worker who’d appeared beside us.

For two dark and awful weeks after that, our hospital room was a popular place. Teaching doctors and their students filed in and out, standing around our new and interesting baby, asking each other questions that started with “could it be…” and “what about…” Emmet looked like a small UPS parcel in the middle of his adult-size hospital bed, flanked by machines, a cannula taped to his cheeks. One monitor signaled five beeps whenever Emmet’s oxygen levels dipped. If no one else was in the room, my husband and I would sing along: “Baby not breath-ing, baby not breath-ing.” Because what else do you do. When the cohort’s numbers dwindled to just the one main doctor, we felt so relieved and elated. We would have danced a jig if we weren’t so tired. It meant our baby was getting better. 

It took me years to stop saying “be careful” to Emmet. It’s a useless thing to say. 

***

I was an interesting case for the anxiety doctor not just because I’d developed a phobia of driving on the highway, which isn’t that uncommon.  It was because I’d also had a seizure disorder, which made my case and its treatment more complicated. They said.

Exposure therapy is usually pretty straightforward. All phobias start to look the same once they get bad enough: Avoid the threat, believe the fear, try again, panic, avoid, be ashamed, avoid. Exposure treatment calls the phobia on its complete shit by doing the thing you’ve been avoiding, over and over. With enough exposures, your brain and your body realize it’s been in your head the whole time. See? Silly.

I have a subtype called PTSD highway phobia, which is more about the fear of losing control while driving. It always has a trigger. So, the thing I feared more than the highway was the unpredictability of my body. And my trigger was the time I thought I blacked out driving home on 93 from my parents’ house in New Hampshire. I was about 25. Over the next years and decades, my brain attributed a moment of dissociation at the wheel to the seizure disorder I’d had growing up, even though the seizures had mostly stopped by then. Most drivers would just say Argh! I spaced out and missed my exit! and then circle back and carry on. Not me. I thought my consciousness and my body had both ditched me, leaving no one in charge. No one to drive.

For the first few years, I overrode the panic. I even took a solo driving trip across the country, camping and mountain biking and visiting old friends along the way. So normal!  I should tell you, too, that I’m a good Boston driver, and I don’t mind being a passenger on the highway or anywhere else, really. But after years of tweaking and accommodating my elaborate and specific made-up rules, I stopped being able to drive on the highway at all. Until now, only a couple close friends and family know anything about it, and they don’t really know specifics. Even though I try not to feel ashamed about anything, ever.

***

The anxiety doctor and I didn’t do a lot of small talk. During our first meeting, I told her about my rules and avoidance patterns, and then we got in my car and started on Route 2, which my phobia counted as a lesser highway. Just a humble two lanes, mostly bound by trees, and no medusa of on and off ramps.

Every driving session after that got harder. I drove further out beyond my rules each time. And every time, I’d feel so free and proud. Then fresh terror about the next session. I told my husband I’d rather give birth than go out again. A couple times I tried to cancel. But I had to admit it was starting to work. After Route 2, I graduated to major highways, even that stretch of the Mass Pike flanked by high walls of cement with no breakdown lane. It was a miracle. I could feel my brain retraining itself right up until the day it all went wrong.

We were on 95 during morning rush hour. Cars were cutting and near-missing even more than usual, even for Boston. The anxiety doctor told me to loosen my grip on the wheel and I did. Then I stole a glance over at her and realized she looked nervous, and that was it. My arms felt funny, my heart pulsed in my head, and my breathing needed me more involved. Even she didn’t think I could do it. My body felt like a mirage. The highway and other cars– all mirages. I was in charge of our safety and not in control.  

The anxiety doctor’s voice came at me garbled. She told me to breathe out and hold it and tighten my diaphragm. But then she wondered aloud if that was smart to do given my seizures. Then she apologized for saying that. I don’t remember anything about the drive back to the Fresh Pond Starbucks. I never talked to her again. 

Goldilocks Theory

Most of the mistakes I’ve made as a teacher, and a parent too, were caused by misreading a kid, usually because I didn’t know them or the context enough. I’d give them too much or not enough– whether it was help, support, benefit of the doubt, whatever. I’d either over-challenge them when I should be backing off, or go too easy when I should have been pushing. I made many, many such mistakes.

In graduate school we learned about a theorist named Lev Vygotsky, and his concept of the Zone of Proximal Development (ZPD). One of my high school students renamed the theory of ZPD the Goldilocks theory. It says that if you want to teach someone something, it can’t be too much, too soon, or too easy. It has to be just right. For learning and growth to happen, you have to know the learner enough to be able to aim for their sweet spot, which is just a hair under “too much/too difficult.”  It’s not a perfect theory, and I’m simplifying here, but to me it’s pretty on the money. Vygotsky recognized that teaching isn’t just transactional. It’s relational. 

You can apply the theory to algebra or relationships, potty training or highway driving, social anxiety or Mandarin. But again, you have to know who you’re dealing with– the learner’s idiosyncrasies, body language, inclinations, tolerance for fatigue and ambiguity, and even their fake-outs. Like when I pretended to be helpless in woodworking class in 8th grade because the teacher didn’t think girls could make things, so he made my pump-lamp, step by step. It was the best one in the class. I gave it away to someone.

The anxiety doctor must have overshot my ZPD that bad day. I’ll never really know by how much, or when I would have been ready, and I don’t blame her. I just don’t know. Maybe she hadn’t settled on how to deal with the complicating factor of my prior body stuff.  Or she didn’t know me enough. Or maybe it was bum luck that the highway was so chaotic on that particular day. 

I’m not sure when or if  I’ll try again. I hope I do, and I think I will, because it’s a thing about my life that feels limiting. I don’t feel brave, and I would prefer to feel brave than how I feel about it right now. In the meantime, if I’m driving to you, and you’re far away, know that I love you so much that I took back roads to get to you, and that I’ve been in the car for hours, and that you’re worth it. Of course. Now you know.

***

I’ve noticed looking back over these Substack essays that a lot of the poems I keep close have to do with the body and our negotiations with it. Being anchored by it, transcending it, worrying about what it will do next, wondering who we’ll be without it. And as with the body, so too with our children. When to protect, push, weigh in, shut up, leave them alone. And when to go cry in a corner (or “fold laundry”) without letting them see.

It’s a challenge to look at any murky thing long enough for it to come into  focus, but not so much that it burns you. The poem Zoloft by Maggie Dietz gives us a way to think about the twin pains of too much and not enough. About how much help is too much and which kind of help cultivates the too easy that nothing should be....

When a friend moved back home to Boston a few years ago after a stint in California, she said “I’ll take sincere hostility over pretend kindness any day. I just wanna know what’s what..” Same here. The poem makes me think of that, too. It was a student favorite, too, and a favorite of mine to teach.

Zoloft by Maggie Dietz

Two weeks into the bottle of pills, I'd remember
exiting the one-hour lens grinder at Copley Square—
the same store that years later would be blown
back and blood-spattered by a backpack
bomb at the marathon. But this was back when
terror happened elsewhere. I walked out
wearing the standard Boston graduate student
wire-rims, my first-ever glasses, and saw little people
in office tower windows working late under fluorescent
lights. File cabinets with drawer seams blossomed
wire bins, and little hands answered little black
telephones, rested receivers on bloused shoulders—
real as the tiny flushing toilets, the paneled wainscotting
and armed candelabras I gasped at as a child in 
the miniature room at the Art Institute in Chicago.

It was October and I could see the edges
of everything—where the branches had been a blur
of fire, now there were scalloped oak leaves, leathery
maple five-points plain as on the Canadian flag.
When the wind lifted the leaves the trees went pale,
then dark again, in waves. Exhaling manholes,
convenience store tiled with boxed cigarettes
and gum, the BPL's forbidding fixtures lit
to their razor tips and Trinity's windows holding
individual panes of glass between bent metal like
hosts in a monstrance. It was wonderful. It made me
horribly sad.

                                                      It was the same
years later with the pills. As I walked across
the field, the usual field, to the same river, I felt
a little burst of joy when the sun cleared a cloud.
It was fricking Christmas, and I was five years old!
I laughed out loud, picked up my pace: the sun
was shining on me, on the trees, on the whole
damn world. It was exhilarating. And sad,
that sham. Nothing had changed. Or
I had. But who wants to be that kind of happy?
The lenses, the doses. Nothing should be that easy.

Maggie Dietz, "Zoloft" from That Kind of Happy.  Copyright © 2016 by The University of Chicago.

What the students and I said and wondered…

At some point in the discussion and often in students’ writing, there’s talk about antidepressants.  Kids aren’t unfamiliar with antidepressants, or with the rub/tension that animates the poem.

Wearing glasses…Interesting that taking the pills makes the speaker remember the before and after of seeing clearly, and how seeing everything so clearly isn’t all it’s cracked up to be…Maybe she missed her sort of impressionistic way of seeing, because it made it hers. Antonia says  (in a paper)

We talk about the differences between seeing and looking, and talk about Berger’s Ways of Seeing, which we’d read earlier in the semester and keep going back to.

One kid wonders whether this is an “anti-anti-depressant poem.” Another says she doesn’t think so, pointing to the poem’s tension and ambivalence…like a pro and con list coming out in poetic form. 

And it’s not shaming at all, another kid says.  

It’s the speaker on a journey trying to figure out the right amount of help she needs. Yes; and what the cost of that help is. And then the sadness when something becomes… not itself because you’re not yourself, or not looking fully.

We look at the line “it was all horribly sad”...The fulcrum…the hold on a minute here moment.

We talk about this kind of horribly sad, and when we’ve felt it…Like a cheap unearned thing, sometimes a beautiful thing made less so by the way it came to us. Kids mention hook up culture…Horribly sad.

One kid noted that the glasses in the poem are like a primer for this question of aids. Because you really need them to see, and not just metaphorically either. Are they kind of a foil, or prep, for what comes later, for the Zoloft? Could be.

It’s about how much relief from pain do you really want? And when does it become inauthentic and unreal? I think we all ask that. 

Another imagines the last line being “Who wants to be that kind of unhappy”

I tell kids about the time I went off Wellbutrin when my dad died because I wanted to “really feel it all.” My therapist at the time, a real straight-shooter, said No, what? Nonsense. Not now! She was right about most things, including that. 

Some kids wonder whether the speaker here is being too impatient with herself, with the Zoloft. Some think it’s brilliant to use the Zoloft as a narrative driver, but also as itself…so it functions on two (or more) levels…The Zoloft in the immediate and the glasses, and then the cascading questions of  Is it real?, and What’s real? and With how much help? 

When does a helper become the “too easy” that “nothing should be?”....

The veering over into false happy, false okay? Should we tame our sadness?  We talk about ease and difficulty, and the importance of choosing your difficult things and moments well.

And the weird time shift in the way she brings in the the Boston Marathon Bombing. Like a Dickensian ghost of future pain. 

What is it to get too much help with a problem, a thing, a leg up onto the horse?

Who wants to be that kind of happy? is a question that kept coming back to help and haunt us as we read our novels, our stories, our films, our poems. What is that kind of happy? What’s the other kind? And truly– who does want to be that kind of happy?