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Living with Depression BENSON STEWART AND HIS FAMILY COPE BY TAKING ONE DAY AT A TIME

THE BALTIMORE SUN

Benson Stewart runs cross country, quotes Socrates, loves the music of Andrew Lloyd Webber and has a knack for surprisingly astute puns. A junior in the honors program at Towson High School, he is called brilliant, wry, involved, compassionate, curious by his teachers. And original -- his mother confirms it: Before he could write, Benson would dictate stories to her conceived from a dog's point of view.

Tall and slender, just growing into his expressively mobile face, he's also a typical 16-year-old who plays video games and can spend half the night on the phone with his friends.

But there's a darker side.

Benson suffers from chronic depression caused by chemical imbalances in the brain. Since third grade, he has often reached the level of desperation that makes people feel that life is not worth living. Although medication helps control his illness, it does not cure it. He remains vulnerable to periodic bouts of depression that leave him helpless, hopeless and unable to attend school.

His illness causes a lethargy others have trouble imagining. Merely getting up each morning is an ordeal.

"I try to pull him up and he just flops. Sometimes I scream, I holler," says his mother, Bette Stewart. "And when Benson finally emerges, he has one speed: slow."

Benson missed at least 30 days of school this past year; he stopped counting the number of days he was late. His schoolmates can't understand why he never gets in trouble for being late: Why can't he just get to school on time like everyone else?

"They feel it must be an effort thing," Benson says. "I've heard comments, even from my best friends who are very understanding, as to 'Well, I'm tired as hell when I get up and I'm here on time.' It's a different sort of tiredness."

Part of the anguish of mental illness comes from living in a world that believes you'd be fine if you would only try harder, says Benson's father, Cary Stewart. Benson and his family members agreed to talk about this anguish, and how it affects their relationships, with the hope that people would better understand those for whom mental stability is a goal rather than a guarantee.

Mr. Stewart, 50, knows the stigma of mental illness firsthand: First hospitalized for manic depression in 1967 -- a time when much mental illness was still attributed to bad parenting rather than bad chemistry -- he grew up hearing a lot about laziness and slovenliness, about getting himself out of a rut and up to snuff. His illness -- marked by swings from abnormal elation and impulsiveness to severe depression -- became disabling during his first year of medical school at Duke University and prevented him from becoming a doctor.

With the help of their medication, Benson and his father struggle every day to maintain equilibrium. They share a harsh knowledge of mental illness as well as the despair it causes in families.

"Depression can make a person intolerable," Benson says. "They're edgy and irritable, and it's hard to understand what's happening to them. . . . A whole family suffers when a person is mentally ill. It has a big impact on the family -- and that compounds the problem."

Bearing the burden

In the Stewart household, the burden has fallen primarily on 41-year-old Bette Stewart.

During the past 20 years, she has weathered her husband's unpredictable delusions, diagnosed as psychotic mania, and his eight hospitalizations between 1983 and 1987. She has persevered through dozens of fights with her depressed son when he refused to take his medication. She has battled an insurance industry that she believes discriminates against mental illness by not reimbursing its expenses at the same rate as for other disabling illnesses.

Mrs. Stewart credits her faith to a decade of support from the Alliance for the Mentally Ill of Maryland. (She recently became executive director of the organization, which was created in 1983 to serve relatives and friends of the mentally ill.)

She also has the help of her 14-year-old son, Emerson, the boy who's never late for the 7 a.m. school bus and who does not suffer depression.

"Emerson is a self-motivated, self-starting child. He swears he's adopted, that he's got none of our genes in him," says Mrs. Stewart.

"The perfect boy," says Benson. "Can you imagine growing up in the shadow of someone who's three years younger than you? It's not easy."

The brothers embrace decidedly different styles: While Benson plays military-strategy games with his friends, listens to the music from "Camelot" and devours books by Isaac Asimov, Emerson plays baseball, plugs into Bob Marley and Jimi Hendrix, and hangs up posters of Cindy Crawford.

As brainy kids -- Emerson is in the gifted-and-talented eighth-grade class at Dumbarton Middle School -- the brothers share many of the same friends. On weekends, the house crawls with "absent-minded-professor-type kids," says Mrs. Stewart. They also enjoy baby-sitting the children of their neighbors and parents' friends, and sometimes shoot baskets together out back.

But while Benson is apt to forget what his mother just asked him to do, Emerson is the type to get dinner started. He not only notices the overflowing clothes hamper but actually throws a load into the machine. By the time he was in kindergarten he was answering the phone "Stewarts' residence, Emerson speaking."

Mrs. Stewart describes her sons as precocious and competitive.

"Benson used to get furious with Emerson because Emerson is a doer. And Benson is a thinker and a sayer. When Emerson was 4, he said, 'Mom, the difference between us is that Benson always has great ideas. I have decent ideas but I'm able to carry them through. So I'm much more successful than Benson.' "

So far, Emerson has shown no evidence of the family's genetic curse. He has not faced the emotional and physical challenges of living on the edges of sanity.

Depression at 8

Benson remembers his most frighteningly severe depression occurring when he was 8 years old. Standardized academic tests had pronounced him mentally gifted, but his then-undiagnosed illness prevented him from meeting the expected achievement standards.

"I felt not only that the teachers were annoyed with me, but that it was insulting to them and disrespectful to them not to do the work," he says. "It made me feel very upset that I couldn't get anything right, that I could never do anything the way I wanted it to be.

"After a while of just feeling as though you have no control over your life, as though there's nothing you can do that can possibly rectify all the things that are going wrong, you begin to see death as the only escape.

"What I felt is that there was nothing else I could do. I felt that if I

ever did get out of school, that I would have a lousy life as an adult. And it seemed like there was no possible way to change the path that my life was taking.

"It's very demoralizing to feel that your life is over when you're 8."

Until recently, medical wisdom said 8-year-olds couldn't feel that way. Physicians did not believe that children and adolescents could suffer the major depressions they were learning to treat in adults. Now they realize that about 2 percent of children -- and 5 percent of adolescents -- have biologically based depressive disorders, according to the National Alliance for the Mentally Ill (NAMI).

"People used to think that it was normal for children and adolescents to be somewhat depressed, that they would 'grow out of it' without treatment," says Dr. David Epstein, the clinical psychologist who treats Benson. "Depression in children can be as debilitating and painful as it is in adults."

A sudden slump

The popular notion of depression includes such symptoms as loss of energy and appetite, low self-esteem, sleeping too much and sadness. However, equally common symptoms, reports NAMI, are weight gain; insomnia; loud, obnoxious, anti-social behavior and violent outbursts; difficulty concentrating; and trouble with self-control. Depressed persons also may seem very indecisive, show inappropriate levels of guilt, lose interest in things that usually bring them pleasure and have trouble remembering things they've been asked to do.

At school, children often suffer a sudden slump in grades, skip classes and drop out of clubs or sports.

Depressive disorders often run in families. For instance, the most severe cases of manic depression seem to occur in children of families with a strong genetic predisposition.

These mental illnesses can wax and wane. Even with medication, Benson has little control over sudden flare-ups of his illness.

"There are times when I can get up in the morning. And that makes it worse," he says. "Last year, in ninth grade, I was there at school on time every day for the first part of the year. I didn't feel I was trying on a different level, I didn't feel like I was doing something better. I simply somehow was able to get out of bed in the morning.

"I was very scared that eventually this would fall apart, that I couldn't hold it together. Lo and behold, by second semester, it was deteriorating. I can remember feelings of dread that this wasn't going to last, that my grades were going to drop."

They did, from A's and B's to C's and D's.

"People thought I had just stopped trying, when, in fact, I was trying just as hard if not harder," he says. "I feel this illness is sort of like resistance in a wire: If you change the metal you're using, the number of ohms is different. While the power output may be the same, you don't get the same result on the other end. I don't know where all that goes exactly, but it's very difficult to do anything -- and especially to convince people that I'm trying."

"The teachers like Benson because he's the kind of kid who does try," says Ben Petrilli, a guidance counselor at Towson High School.

Brad Lear, Benson's track coach and honors science teacher, says Benson couldn't run around the track without stopping at the beginning of last year's season. By the end, he was running 2- to 3-mile races.

Mr. Petrilli wonders if last year's slump was tied to Benson's growth spurt, when his height shot up several inches. He now stands about 5 feet 11 inches and weighs about 125 pounds. As a teen-ager with a rocketing metabolism, he must often adjust the levels of his medication.

His mother says she can tell the dosage is working if they can drive past a dead animal without Benson starting to weep.

He visits a psychiatrist every two or three months for a medication evaluation and sees his psychologist once a week.

"Despite his emotional problems, Benson is very resilient," says Dr. Epstein. "He fights through his own depression and gets a lot of encouragement from his mom. He is doing as well as he's doing for many reasons: It's medication, psychotherapy, support from his family and friends -- and his own character."

"I've had several bad depressions, but at least I can tell when I'm depressed," Benson says. "It used to be I couldn't tell when I was depressed -- because I always felt like that."

Signs of difference

As soon as Benson was born, his parents knew he was different: He was awake 23 hours a day.

And it became evident very early on that he was precocious.

"As a 4-year-old, he would watch these cartoons. Then he would turn them off -- I couldn't make this up -- and say, 'Let's talk about the social issues that were brought up in that particular cartoon.'

"I'd say, 'Well, all I saw was the dog chasing the car.'

"And he'd say, 'What did you think that was representing?'

"Both my kids were very late talkers, but Benson used words that I didn't even know the meaning of. I'd look them up in the dictionary and they'd be real words," Mrs. Stewart says. "I remember one time we were driving along and he was in the car seat saying something about 'linear this' and 'the universe that' and 'how does God fit into this plane of thought.' And I was saying, 'Benson, I have no idea what you're talking about.'

"People often couldn't understand what he was talking about. . . . They thought we pumped him up with information."

Benson's precocity was intriguing to grown-ups and "a pain" to live with. His mother remembers the years before he began taking medication as tension-filled and very demanding.

When his illness was diagnosed, he initially resisted taking medication. One time he locked himself in the car with the windows rolled up. Another time his therapist climbed into the top bunk of his bed to try to reason with him. Benson was afraid drugs would strip away his personality.

"When I was younger, I thought, 'Where would this end?' It seemed to me that they were trying to make everyone the same, that it was a process of homogenization, that they wanted me to fit better into society," he says. "It was a hard thing to come to grips with. It's worked and it's made my life a lot easier. I feel I am a different person. But I don't regret it."

Mrs. Stewart believes Benson was finally convinced of the importance of his medication last year. After his semester of unparalleled success at Towson -- "I never lost a single point on any of the writing assignments until the last one" -- he was hit by a severe episode of depression.

"Benson got sick, real sick. He didn't get out of bed for several weeks," she says. "He cried all the time. He came into my room at 5 o'clock one morning and said, 'Mom, make it go away! The thoughts keep coming to kill myself, I can't stop thinking about it -- death is the only way out, it's the only answer -- it's all I can think about. It's so horrible.'

"He went on and on and on. Then and there, he said, 'I will take whatever medicine they can give me because I cannot stand these feelings. It's been a long time since I've felt like this, and I never want to feel like this. . . . Load me up with everything.' "

Exepectations

Life in a family with mental illness means learning to live with exaggerations; success means learning to tell which ones are dangerous and which aren't.

Mrs. Stewart often questions her own sensitivities.

"It's hard sometimes to say, 'Is Cary just really excited about something or is this the beginning of a manic phase? Is Benson just normally discouraged because school is not going well or is this the very beginning of a depressive episode? Then I become preoccupied with watching to see what other things I will see."

Benson points out that one of the greatest difficulties in treating mental illness is determining where the illness leaves off and the person begins.

When do you insist that your son finish his homework?

"Since kindergarten, Benson has said, 'Mom, these are the options: I can go to school and not do my homework. I can go to school on time and just not be with it the whole day. But I can't go to school on time every day and do my homework.'

"I can tell you he doesn't enjoy sleeping in in the morning. How can he enjoy it? He knows all his friends are at school, he knows that if he doesn't go to school, he can't go out in the evening and do something with his friends.

"But it's the idea of the expectations. . . . And I fall victim to that, too. I look at him and I think, 'He's a perfectly normal kid; why can't he do it?' "

Lurking in every molecule of this family's life together is the knowledge that their present degree of stability is precarious.

Cary's biggest fear is slipping back into mania.

Benson's biggest fear is developing the mania that has crippled his father.

Bette's biggest fear is that their depression will strike Emerson.

Emerson says there's no point in worrying about something he has no control over.

Everyone shares the hope that things will stay the same. Benson is managing his schoolwork. For the past four years, Cary has held jobs -- first as a janitor, then as a counselor at ReVisions, an organization that runs supervised group homes for the mentally ill and mentally retarded. Because mental illness does not go away, the best hope is to control it.

Meanwhile, Benson is looking forward to taking honors physics next year. He is considering a future in science or anthropology. He has decided against the law career his brother wants because it would bring too much pressure.

"One thing you have to respect is Benson's processing of all of this -- his courage and perseverance," his father says. "It takes an awful lot of energy to fight at the bottom line. Benson does a very good job -- at a very tough time in life."

Just as some teens become experts on baseball batting averages and heavy-metal bands, Benson has become an authority on his illness and depression in general. He has testified before the state legislature about the need for better insurance coverage. He can talk about physiological changes that occur in the brain during the emotional changes of mood disorders. He can quote the Freudians or "the modern-day fatalists who think everything's genetic, down to the course the person's life takes."

Perhaps most important, he is getting better at detecting those mental and physical changes that often mean it's time to call the doctor.

SG "Socrates said, 'Know thyself,' " he says. "I'm trying to do that."

Linell Smith is a features writer for The Sun.

IF YOU NEED HELP

The Alliance for the Mentally Ill of Maryland serves families and friends of those suffering from mental illness and also acts as an advocate for improved health care for the mentally ill. For information about support groups, referral services and educational meetings, call (410) 837-0880.

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