River of Time

Even in the darkest days of my severe treatment resistant depression, I was never blinded to the compassion from my beloveds who continually reached down with loving hands and lifted me out of my harrowing nightmare of despair. Because of you, I can tell my story. I wrote it with the sincere hope of offering encouragement to the forty million Americans who suffer from depression and anxiety every minute of every day and night. I want them to know that I understand, and I'm here to help.

FOREWORD

Many brilliant, amazing, talented individuals have suffered from depression, including Ludwig van Beethoven, Vincent van Gogh, Isaac Newton, Abraham Lincoln, Patty Duke, Jon Hamm, Billy Joel, Robin Williams, and Kirsten Dunst. Naomi is in good company. Of the ten professions most common among people who suffer depression, Naomi has devoted herself to two of the listed careers: entertainment, as a performer and writer, and the health care profession as an RN nurse.

When I first met Naomi, I was lecturing at a conference on complementary medicine, speaking on the connections between the brain, the mind, health, and intuition. I saw this woman, from a distance, who couldn't be overlooked. She had big red hair, full makeup, and a clothing style that very much set her apart from the "usual" crowd at these events. When my presentation was over, Naomi marched up to the podium and introduced herself. Later that day we had dinner. She invited me to visit her farm, and since that time, almost two decades ago, I've been making regular visits to Tennessee to stay with Naomi at "Peaceful Valley."

But Peaceful Valley hasn't always been so peaceful for Naomi, suffering a mind-body disorder like depression for more than three years, and for those of us who care about her. Yet, unquestionably, through the years when others of us—including me—have suffered our own health problems, Naomi has always been there. She is an unbeatable combination of intelligence, knowledge, personal experience, and compassion.

During the past years she has gone through unrelenting sadness, fatigue, panic, and insomnia. Still, Naomi pushes it aside to function—maybe even transcending the pain—to work, relate, love, and learn.

How is this possible? Let me try to explain.

Naomi's abundant talents in music, media, and communication, as well as her natural inclination toward stellar comprehension of medical knowledge and natural intuition, may bias her brain development in one direction, one that has generated her extraordinary life and career. The downside? Her immense sensitivity to environmental, social, and emotional nuance may, unfortunately, make her prone to depression. The great behavioral neurologist Dr. Norman Geschwind talked about the "pathology of superiority": When someone has an exceptional talent or skill in one part of his or her brain, another part of the brain may suffer. The most obvious examples of this are autistic savants, individuals who have an incredible capacity for attention to minutiae (left brain) but a developmental problem with social and emotional processing (right brain).

Perhaps you're thinking, Dr. Mona Lisa, use plain English, please. What are you saying? Well, the actual brain science can be simplified to a representative quote from my aunt Evie, a woman with a sixth-grade education who emigrated from Portugal. I never wanted to be like Aunt Evie, because she was uneducated, so I pursued my education to the highest achievements (PhD in neuroscience and an MD in psychiatry). She was simple folk. Though undereducated, Aunt Evie was very loving, compassionate, and intuitive, and possessed a valuable amount of common sense. Ironically, she described the connection between extreme talents and brain disorders in much the same way Dr. Geschwind did. Aunt Evie used to say, "I've never known a genius who didn't have a screw loose somewhere."

Aunt Evie's proclamation could describe us all. We all have some genius capacity in one area of our brain and a problem in another. Maybe your problem is depression, like Naomi's? Then one part of your healing may be to find out your unique genius that complements your uniquely sensitive, empathic, intuitive brain.

Naomi has an extremely fine-tuned brain. She was a registered nurse before beginning her music career, but definitely could have been a doctor. She devours medical literature, using a yellow highlighter and a slow, methodical method of taking notes, like a scanning electron microscope, taking in enormous amounts of scientific minutiae.

Naomi is actually ahead of her time. For more than a decade, she has told me about meeting with this noteworthy scientist or that scientist, this or that Nobel laureate, and so on. I used to wonder, how many of those scientific terms did Naomi really understand? Well, Naomi really understands those scientific terms from physics and medicine and more. One of the words that she used to toss around was epigenetic. I would think, Where did she get that word? When I was researching my latest book, I ran across the term epigenetic in a study on treating anxiety. Now in the latest scientific publications, news, and bestselling books we hear of the power of epigenetics and I am left to once again hand it to Naomi for being way ahead of her time.

There's another reason Naomi is highly qualified to write this book. Many people at Harvard, Stanford, the Mayo Clinic, the best universities and teaching hospitals, do research in labs or study patients in clinics, and they teach us about the brain and science. We may stand in awe of their minds and their genius. Is that what will help us understand suffering of the mind? Perhaps. In the last decade, psychiatry has made major inroads into medical treatment for major mental health afflictions. But when we're asking about these researchers' credentials—do they have an MD? a PhD? are they board-certified?—we may forget yet a final and oh so very important credential: Have they experienced the illness they treat?

Naomi has this credential. She has experienced severe depression and made major inroads into getting it treated. Yes, she has won many music industry awards and has created timeless music with her daughter Wynonna. Yes, as a nurse, she spent years studying the anatomy and physiology of the body. But one of Naomi's biggest credentials is that she has in fact suffered from depression, one of the most common and most significant disorders in humanity. I've watched her struggle with this illness, the ups and the downs and the sideways. I've seen medicines begin to work, then stop working. And through it all, I've seen Naomi's indomitable spirit.

I remember when I was first in medical school, I wanted to be a surgeon. It seemed that surgery could be so straightforward. You simply cut out what was wrong and stitched it up, or put some rods in. The first rotation that I went through was psychiatry, and I thought, Oh, this is the last thing I'd ever want to go into! But then my own spine fell apart, and suddenly I was the one who needed the rods put in. And as I figured out what further training I would need to get for a medical license, ultimately I ended up going into psychiatry simply because it was a branch of medicine in which I could sit down! Having since earned a PhD in neuroanatomy and behavioral neuroscience, I now ultimately have my practice in neuropsychiatry. I'm specifically poised to take a multifaceted view of all the treatments and the medicines prescribed to Naomi.

Of all the fields of medicine, psychiatry may be the most difficult, because it is in its infancy. Psychiatry is now where neurology was two decades ago. Whether it's the grossly unfair stigma or the lack of scans or blood tests to validate diagnoses, many people with depression, anxiety, moodiness, irritability, and so on suffer in silence or hide, for fear that people will think they're "touched." Well, I've been touched by watching Naomi valiantly struggle, and I'm touched that in writing this book she allows all of us, through her vulnerability, to see how she continues to fight this terrible disease of the brain.

Why do I say "continues"? It goes back to where I started this foreword.

Depression may be part and parcel of the "pathology of superiority." It may be the downside of the type of brain, the genius brain, that gives us the sensitivity and compassion we need for careers in entertainment and health care. In this, Naomi is perfectly poised to give you this book, whether it's through her knowledge of healing as a nurse, her sense of how to touch us with music and art, or the compassion she's developed for all of us who have suffered from one baffling ailment to another. Depression may be part and parcel of Naomi's genius.

You too may have your own ups and downs. You may use medicines, supplements, psychotherapies, prayer, and so on to try to heal your depression. Let Naomi's intelligence, knowledge, compassion, and personal experience give you hope that you can heal, and find your own genius, and have your own exceptional life.

—MONA LISA SCHULZ, MD, PHD

Author, Heal Your Mind: Your Prescription for Wholeness Through Medicine, Affirmations, and Intuition (Hay House, 2016)

AUTHOR'S NOTE

Memory is often a subjective and imperfect recorder of details. My book is a stark look at my experiences of severe depression and anxiety and the treatments I underwent for both. I have brought forth the best of my recollections, though I am aware that my own memory is informed by the subject matter itself. It's rare for each of us to recall conversations exactly word for word. The ones that appear in the book have been paraphrased and convey my feelings and experience of them. We each have our own perceptions and realities. This is mine.

INTRODUCTION

It's impossible to survive a 155-foot fall from a bridge over an asphalt highway. In 2013, I reached the conclusion that the only direction left for my worthless life was down. I was convinced that a sudden fall from a high bridge was better than the slow-motion emotional decline I was enduring day by day. I was drifting, alone in a murky ocean of guilt, anger, confusion, and unrelenting sorrow. I had done everything I could to climb out of it by following each psychiatrist's directions and giving any and all promising prescriptive cures a try. Nothing proved to be a lifeline I could grab. Nothing changed the reality that my once full and colorful life now looked empty and gray. I had tried "pulling myself up by the bootstraps," in true Judd style, for many months. But now I could no longer even stand up under the boulder-like weight of my severe treatment-resistant depression and terrifying panic attacks.

One bitterly cold and dreary morning the urgent thought came to me that if I couldn't get myself out of this despair, I should end my misery quickly. Death would be instantaneous relief. I would no longer be an emotional burden to my family and friends. I was in such a state of serious brain fog that I wasn't able to consider the effect my suicide would have on my fans. I imagined that the impact of my body hitting the highway would leave me unrecognizable. It would be a logical end, because I no longer recognized myself.

The world knows me as the Mom half of the Judds singing duo. My daughter Wynonna and I were the most documented and commercially successful duo act in the history of country music during the 1980s and some of the 1990s. The public saw me in concert, singing and dancing at world-famous venues from Carnegie Hall to the London Palladium, the Houston Astrodome to Madison Square Garden. We performed for the millions of people who watched Super Bowl XXVIII, as the 72,000 football fans filling the Georgia Dome sang along to the popular ballad I had written, "Love Can Build a Bridge." The Judds' singles were number one hits, fourteen topped the Hot Country Songs chart, and our albums went platinum, selling more than 20 million worldwide. We were undefeated at every awards show, with eight Country Music Association awards. The Judds won six Grammys and I won my own, as writer of the "Best Country Song."

Then, just when we were cresting the top of the show business world, in 1990, doctors told me that I had only three years to live. I had been diagnosed with hepatitis C, which I had unknowingly contracted while working as a nurse, before the Judds took off. The virus usually takes several years to produce severe symptoms.

Born an optimist, I chose to not accept the fate with which the doctors had sealed my future. I was offended by their "curse" of a rapid decline. I angrily rebelled as if a medical hex had been placed on me. As an RN I've witnessed what can happen when a doctor gives a patient a grim prognosis. All too often the diagnosis determines the outcome of the disease. Our beliefs become our biology.

I had been on my own since the age of seventeen. I learned very early in life that when anything went wrong, I was the one who had to take charge and figure out what I needed to do to survive. Now I was very sick, but I faced hepatitis C with my fists up. There was no known cure at that time, so all I could do was fight to survive.

I spent the next couple of decades learning about the human brain and the state of neuroscience, delving into the findings of brilliant researchers who were making breakthroughs on the mind, body, and spirit connection. I applied to my own life everything I was learning about how our personal beliefs affect our body, mind, and spirit. I met with many of these scholars and doctors, even Nobel Prize–winning geniuses in medicine like Dr. Francis Collins, who decoded the human genome and is now the director of the National Institutes of Health, and consider many of them to be my friends. Books on the most cutting-edge discoveries in science and health would predictably be found stacked on the night table beside my bed.

I have always been intrigued by health care and thought it would be my lifelong career when I was a single mother with two young daughters. My plan was to work full-time as a nurse and find a way to enroll in medical school at the University of Louisville, in my home state of Kentucky. I wanted to work with underserved people in the Appalachian region. My plan was set aside, unexpectedly, when Wynonna and I began singing in public and were encouraged to perform more often. After every appearance audience members would inquire why we weren't already living in Nashville. Singing was and is the only career Wynonna ever desired. Performing is what she does brilliantly. As her mom, I knew we had to move to Nashville, to give Wynonna the best chance at a career in music. I believed her destiny was already stamped on her forehead. Yet my own interest in holistic medicine never waned.

By 1995 doctors proclaimed me completely free of the hepatitis C virus. I felt radiantly healthy again and buoyantly happy. I wrote a book about my miraculous recovery and became a sought-after speaker on many topics. I had gained a comprehensive understanding of the body-mind-spirit connection and was asked by professional medical and social service organizations to be a keynote speaker at their national gatherings. I was honored to pass along any information that could possibly help someone else. My point of view was that there could always be healing, even if there isn't always a cure. At the same time, I had a national talk radio show on Sirius XM, a Sunday morning talk show for Hallmark Channel taped in New York, and was cast in a number of made-for-TV movies. I was thrilled to be busy every day of the week.

Still, the fans demanded a reunion of the Judds. At their request, Wynonna and I paired up for a North American tour in 2000, called "The Power to Change" tour. The response was overwhelming and the enthusiasm of the sold-out crowds was electrifying.

Then, in 2010, we came together for another widely anticipated tour. The Oprah Winfrey Network (OWN) heard about our plans and requested the opportunity to film our "Encore" tour, both behind the scenes and onstage. The resulting footage would be a reality show for the launch of the inaugural season of Oprah's new network.

My life was filled with interesting people, different scenery, new things to learn, and exhilarating events. I had plenty of reasons to jump out of bed every morning. Never did I expect that only months after the Encore tour ended I would feel I had every reason to jump off a bridge to end my tortured existence.

How could that be possible? I've asked myself that question countless times. I had always been an eternal optimist. I was thought of as the caring, wise one with the sympathetic ear, whom everyone else came to for encouragement and answers. Who had time to be depressed? But depression had time for me, stole time from me.

This book is the story of two and a half years of my life, during which I went through the hell of mental illness. It isn't just about a victorious recovery, but about a wary and humble gratitude for persevering through thirty terrifying months and regaining hope and a purpose for living once more. It's the account of hitting rock bottom and rising again to be thankful for taking my next breath, for the gift of a clear thought, for wresting from a nightmare a way to find joy in each day.

You might question how someone in my situation, with my financial and educational resources, could have languished for two and a half years without a resolution to my depression and anxiety. Before 2011, I would have asked the same question.

Isn't America a medically and technically advanced country, where almost everything can be treated? This may be true for many of our physical illnesses, but in the United States, treatment for mental illness lags far behind the advancements made in other countries. According to Dr. Allen Frances, professor emeritus and former chairman of the department of psychiatry and behavioral sciences at Duke University, "For people with severe mental illness, there has never been a time and a place worse than now in the United States." (New York Times, October 20, 2015.)

I learned the hard way that mental health issues cover a wide scope of disorders and can be hard to diagnose. No one can see or easily pinpoint the problem because it's all in the mind. Unlike a broken arm, there's nothing to detect in an X-ray. There are 100 billion neurons in the human brain. Christof Koch, the world-renowned neuroscientist who is the chief scientific officer at the renowned Allen Institute in Seattle, has described the brain as "the most complex object in the universe."

Adding to the difficulty, many types of anxiety and depression have been identified. Dr. Daniel Amen, a double-board-certified psychiatrist and neuroscientist, names seven:

Psychiatrists now realize that depression and anxiety are more commonly found together than separately. Only about one-third of sufferers are treated for both.

In my case, I was unaware that I had post-traumatic stress disorder from pathological situations and issues passed down through generations along with the traumatic events of my own life. I felt humiliated and emotionally weak and I deluded myself that I could pull out of it alone because I've always been such a strong-willed woman. I denied the problem and it lingered until it became unbearable. Finally, others forced me to get help. Unfortunately, I wasn't in a good place, emotionally or mentally, to choose the best treatment for myself.

The stigma around mental illness comes with the dangerous and erroneous message that we are weak in character and that we should be able to "snap out of it." Wrong! It's a brain disease. Depression and panic attacks are not signs of weakness. The chemical imbalance in the brain is very real and it takes both understanding and courage to live with it until a trained psychiatrist can figure out a course of treatment. The worst thing you can say to a depressed patient is "Just snap out of it!"

Because I survived, I feel a responsibility to share what brought me hope and what's kept me alive. What carried me toward recovery was the relatively recent discovery by geneticists like Dr. Francis Collins and neuroscientists that only one-third of your genes are actually inherited from your family of origin. The good news is that you can alter about two-thirds of your genes by making good choices, even if you were born into a long line of pathological, depressed, mentally ill, and even suicidal family members, like I was.

I certainly wasn't alone in my despair. Twenty million people in the United States suffer from one of the forms of depression (350 million worldwide), and two-thirds of us wait too long to seek help. Forty million of us have legitimate anxiety disorders that can shatter our peace of mind. Suicides outnumber homicides every single year. In June 2013, the Centers for Disease Control and Prevention showed that suicides among middle-aged people have gone up nearly 50 percent since 1999. Roughly twenty of our brave veterans commit suicide every day. For women over age sixty, the rate rose by 60 percent. With the divorce rate between 40 and 50 percent, nearly nine million people being displaced by downsizing and layoffs (especially for those over age fifty), and the social isolation created by our transient, fractured society, there are millions of people who feel "dumped." Baby boomers, who number over 76 million, are the largest demographic in the United States and also the most depressed age group. Antidepressants are the third most common medication taken by Americans, according to the National Health and Nutrition Examination Survey, including 23 percent of women over age forty.

At the same time, our life expectancy in the United States has risen to an all-time high. What are we to do with the last twenty or thirty years of our lives? Who can serve as examples of living with purpose and happiness, if so few have ever lived as long as many of us likely will? When the children are grown and gone, the source of your livelihood has come to an end, and the busyness of a daily full schedule has diminished, what is left to give you a sense of purpose?

I wasn't prepared for this new chapter in my life. It opened the gateway to severe loneliness, depression, and anxiety. I had never identified or processed the hidden trauma of my past, the pathology of my family of origin, and it moved into my open calendar to demand my full attention every agonizing day and night.

As you will read in this book, I have had to excavate long-buried feelings about my family ties. Because I grew up in a household where the mottos were "That's just the way it is" and "Don't talk about it," anger and resentment had a lifelong grip on me that I wasn't fully able to accept until I was willing to open up and get treatment for my depression and anxiety.

I was stunned by how many of my adult reactions were in response to my early programming by my parents and older relatives. As a typical firstborn child, trying to satisfy my relatives' expectations and create happiness for them became my daily and ultimately my lifetime goal. I set unreasonable benchmarks of perfection for myself. Any dip below those standards created another layer of unresolved guilt.

I know that our perceptions are always subjective and that what is true for one may not be at all true for another. Each of us has a perception of how another person treats us. That person has their perception of us, as well. The two realities are rarely the same. Although my siblings were born of the same parents and raised in the same household, we have very different perceptions of reality and, as a result, have become very different adults.

However, to help myself heal I had to accept that my feelings were true for me. I had always pushed my negative feelings far down in my psyche and labeled them as odd or self-indulgent because I was told, as a child, that they were. I know there are reasons each of us becomes who we are and why we do what we do. By the time a child is three years old her self-image is formed.

My own daughters have each spoken publicly and written about how their childhood experiences and growing up with me as their mother had both a positive and a negative effect on the adults they have become. The good memories they have of the three of us make me smile. For any sad or angry memory they have, I can truthfully declare, "If I had known better, I would have done better." I think that is true of most people, but not all. For example, people with a narcissistic personality disorder or borderline personality disorder may know better, but are often too self-absorbed to be able to do better.

The unarguable fact is that we are responsible for our actions and our reactions, too. You can be inactive, reactive, or proactive. As an adult, understanding this helped me to uncover and directly face what I experienced as a child. There were so many buried feelings that I couldn't develop healthy emotions. It's not my intention to incriminate my relatives. What I want is to identify, accept, and heal my own long-held pain from these unprocessed experiences. For me, it's a matter of life and death.

Long before recorded history, storytelling was the way one generation passed along news, gossip, insight, and humor. Often the stories carried hard-earned wisdom, meant to spare the next generation the heartache the elders had been through. The stories also connect us to the range of human experience.

I am giving you my unvarnished story, to encourage you to look at every past and current aspect of who you are today, whether you suffer depression or simply want to lead a more fulfilling life. I hope my story will encourage you to begin your own voyage of self-discovery leading to wholeness of body, mind and spirit.

Change is the true nature of this world. Change will happen for all of us. We can find our way out of self-punishment, anger, and depression. My case is extreme, so if I can make lifesaving changes, I know you can, too.

Chapter 1

Shhh… Don't Tell a Soul

It's not a bad dream or even a horror movie nightmare, though it has become the most harrowing aspect of what is now my constant personal torment.

It's three in the morning and I go from a deep sleep to standing bolt upright on my bed, the covers draped around my feet like the Statue of Liberty, but I am not free. I am imprisoned in my body; my mind has taken me hostage in ways that are unbelievably terrifying. I reach up to my throat, expecting to find a pair of hands belonging to an intruder who is out to kill me with a grip that is slowly closing down on my windpipe. I am hyperventilating. My heart is beating so rapidly that my eardrums are throbbing. I am in danger, but I don't know the reason why. My vision blurs. The room spins. My face, neck, chest, and palms are covered with sweat.