“What’s madness but nobility of soul at odds with circumstance?”  —Theodore Roethke The second time was much worse. During the latter half of 2017, a series of misfortunes ranging from an unexpected medical crisis to loss of a part-time job teaching writing that I loved and was driven from by erroneous accusations collected into a full-blown breakdown by the beginning of 2018. I spent that entire year enjoying the best that the American mental healthcare system has to offer, with a few side forays into physical illness and injury care thrown in. My former anxiety of a few years earlier came roaring back intensified with a generous portion of depression on the side. 1. “This is what bothers me, then way people (and NAMI, the National Alliance on Mental Illness, doesn’t help) embrace diagnostic identities—for themselves or their family members. However useful it may be, it is often another way to get stuck in a limiting story, someone else’s story.” —Suzanne Scanlon* This particular story began as described above. At Thanksgiving with my brother and family in Dallas, I noticed I was becoming irritable and out of sorts sporadically, especially regarding my very young nephew. By Christmas I was consumed with anxiety-depression (I don’t know a clinical term that covers such a combination of conditions). I begged my psychiatrist for a renewal of my Ativan so I could handle the post-Christmas trip with my partner to Portland. I managed to keep it together while feeling absolutely miserable, but when we returned, I was barely functional. I spent a huge amount of time in bed, managing with difficulty to get myself to an AA meeting once in a while, eating little, and rationing my Ativan to get through the day. The tipping point arrived on an unseasonably warm day in late January. My anxiety had ratcheted up to a near panic attack, ironically enough as I was heading for an appointment with my psychiatrist. Long after I should have quit or tapered off, I still wanted Ativan. I had noticed the doctor growing increasingly impatient with me, as if my failure to improve was somehow my fault, and on this visit she grew angry and told me not to make any more appointments. If I really felt overwhelmed by anxiety, I should go to an emergency room. I believe now, especially after other experiences with psychiatrists, that she was angry at her own inability to make me well and turned that outward to me. I didn’t fit the diagnostic identity, take my place in the required narrative. 2. “We had an obligation to recover. The narrative of progression. This was not only for the medical-pharmaceutical establishment which required our before and after stories, but also for a culture that locates mental illness in the self and not the society.”   After this summary dismissal by my doctor, I was left completely adrift. I tried changing prescriptions from Ativan to Xanax—no help. Thinking I was possibly becoming addicted to the benzodiazepines I decided to check into a drug rehab. The folly of this decision soon became apparent. I was not addicted, I had only been desperate for some relief from the overwhelming symptoms of anxiety-depression. I suffered no withdrawal or craving. (The day I made this decision was a cold, wet, January day and my partner was away and unavailable to discuss the matter with. I mention this not to blame her in the slightest, merely to show how poorly I was functioning and unable to avoid sudden compulsive choices.) Unsurprisingly the stint in rehab made no improvement in my condition, though it did bring a couple of new psychiatrists to poke and prod my “sick” mind and continue the search for the right treatment, primarily the right meds. This unsuccessful endeavor led to the last step off the ledge. ***to be continued***