Chapter 14: Breakdown

NOTE: Four months after the events narrated in this excerpt from my forthcoming book, Girl of Light & Shadow, my daughter killed herself—stigmatized, ostracized, and socially isolated by the malignorance and implicit bias of the U.S. Peace Corps and, worse, of every so-called “mental health” provider who held her future in their hands. This, by the way, was her second botched “rescue” by the paternalistic machinery of “suicide prevention” in America. FYI, names have been changed.?

DAYS BEFORE ARRIVING IN NAMPULA City, the evening of March 5, 2018, for the three-day Moz 28 North Region’s Project Design & Management Conference, Elissa penned a note in red ink on her calendar for March:?

Goal #1: Survive!

She knew, as she scribbled elsewhere, that this conference would probably be “like pre-service training on crack.” In other words, “super crazy fun,” but monumentally stressful and exhausting as well. Survival, therefore, was a sensible goal—especially for this first, fraught meet-up with her mates in months.

Why? Because, as she confessed later, speaking of her hapless habit of social drinking, “I seem consistently to lose my mind at all these volunteer get-togethers.”?

And, holy shit, did she lose her mind. Quite literally, this time.

So far as I can tell—after synthesizing references scattered among the poorly lit stacks of the Elizabeth Anne Valusek Memorial Library—three interlocking forces in evidence that week drove my daughter to the breaking point at breakneck speed: binge drinking, sleep deprivation, and exposure to toxic levels of fofoca (gossip and rumors).?

A perfect storm.

Tellingly, Elissa was not subject to a single one of these malignant energies back at site in Metarica, sozinha (alone), as it were, far from the madding crowd.?

Who, then, should be held to blame, at fault, guilty, liable, culpable, complicit, morally and ethically responsible, or existentially accountable for what happened next??

I mean, once again: did she do this to herself, alone? Or did “the world”—indeed, the Cool Kids Club—do it to her?

Intentionally or otherwise.

* * *

The purpose of the conference was for new Peace Corps volunteers to design a sustainable community health project, which they would begin to implement on return to site. Fourteen volunteers from three provinces attended, with an equivalent number of their Mozambican contrapartes, and four senior volunteer leaders and staff facilitators.

Intensive training and working sessions took place at the “luxurious” Seasons Hotel in downtown Nampula City, a half-km southwest of the North Region Peace Corps office, Tuesday through Thursday, from eight in the morning till five in the evening.

Elissa not only shared a hotel room with Isadora by night, “as always,” but the two of them and their “counterparts”—Carlotta and Gabriel—brainstormed and fleshed out their projects in the same conference room by day. As Isadora explained:

I hung out with Elissa 24/7. Both of us woke up around 5 a.m. to go running, since she was training for the Victoria Falls Marathon, and we loved running together. In the evenings, we would go eat dinner in the city and drink until perhaps 11 p.m. or so. Each night, we would stay out later.?

She and Elissa met up with a number of their compatriots every evening. Anna, for one, told me she “went out all that week” with them. Who else, I don’t know. Maybe everyone.?

In subsequent medical reports and her blog, Elissa stated that she had “consumed large quantities of beer and tequila” during their nights out, and that “other Peace Corps volunteers were drinking a lot of alcohol,” too.?

Unlike her “usually healthy, small-town routine” where there was “very little drinking,” her final blowout get-together in the big city was, she added ruefully, “quite a celebration.”

Alcoholism is rampant in Mozambique and, yes, it happens more than you’d like to know in the Peace Corps as well. Volunteers are not nearly the saints that certain people (mostly our elderly family members) seem to think that we are.

It’s true. I checked.

In 2018, according to the Peace Corps’ annual health survey, over 46 percent of volunteers worldwide freely self-reported that they engaged in binge drinking—which, for women, begins at four drinks per party—while a whopping 66 percent of volunteers in Mozambique were binge drinkers.?

That, my friends, was the highest rate of any country where the Peace Corps operated.

O God, cried one of Shakespeare’s characters, that men should put an enemy in their mouths to steal away their brains!

Elissa, of course, was one of those brainless boozers. Maybe the worst of ‘em, for all I know. But, statistically speaking, of the 14 Moz 28 volunteers present for the conference that week—ignoring for the moment counterparts, staff, and senior leaders—eight other members of her cohort would have been binge drinkers, as well.

Therefore, my daughter’s ill-advised behavior that week was anything but anomalous.

In fact, in telling the terrible tale a fortnight later, she would recall just one other volunteer in the North Region, Kelsey’s former sitemate, Damien, who “knew how to party and have a kick-ass time without the booze.”

That’s right. One.

Why, then, when the dust settled, was Elissa left holding the bag??

Because, well, she was driving the getaway car . . . and fell asleep at the wheel.?

* * *

It’s impossible to know precisely what went down that week, but it appears that Elissa began to come apart at the seams by Wednesday—a mere 48 hours after her arrival.

Imagine that the drinking began Monday evening, forthwith, as all the volunteers converged and celebrated, pumped up on dopamine and adrenaline, their small-town isolation interrupted for a few delicious days and nights of unregulated revelry.

Work hard, play hard.

Imagine that, as Isadora told me, they drank until “11 p.m. or so,” at first. Then, “each night, we would stay out later.” So, let’s assume they partied until 11:15 on Monday and, say, midnight on Tuesday. Imagine, further, that by Wednesday—on a roll—they hung out past midnight, perhaps as late as 1:00 a.m.

Remember, too, that these two “eternal roommates” were waking at 5 a.m. every morning for a five-mile run. Do the math. They were getting only four or five hours of sleep per night, if that. “It was tiring,” Isadora added, “to keep up this type of schedule.” Duh.

Yet, mindlessly, they kept it up. All week.

As sleep researcher, Thomas Roth, dryly observed: “The number of people who can survive on five hours of sleep or less without any impairment, expressed as a percent of the population and rounded to a whole number, is zero.”

It gets worse.

* * *

As Elissa reported a week later to a Peace Corps medical officer, the volunteer she shared a room with during the conference “talked all night and didn’t allow me to sleep.”?

Well, shit.?

So, even after they had stumbled through the darkened streets of Nampula after turning into pumpkins, found their hotel and slipped into their peejays, the compulsive extrovert in the neighborhood didn’t know when to shut up. My daughter, already teetering on the brink of exhaustion, lost yet another chunk of her wee hours to thoughtless yakking.?

As Isadora had admitted once before, while Elissa was drinking, “I was talking, typical.”?

Wednesday morning, March 7th, after a mere two nights of insouciant socializing, Elissa tagged a bedraggled selfie that she posted on Instagram: #insomnia and #nosleepnampula.

Sometime during the day, she also jotted an unusual comment in her spiral notebook:

I go very quickly from, yeah, I’m good, this is great, it’s fine—to—nope, fuck this shit. Get out. I can’t, I just can’t do this anymore.

Clearly, she was reaching some sort of psychological or physiological breaking point. What, though, was the “shit” she could no longer tolerate? It definitely wasn’t the conference itself, or the health project she and Carlotta were designing together. As she explained, in retrospect:?

I was stressed, sure, but it was positive stress—excitement! The possibilities seemed limitless. I dreamed about all the glorious options my future could hold, from Peace Corps projects in Mozambique to a career in Africa, to grad school and continuing education courses, and traveling around the world.

She was, as she put it, “wired.” There was, however, one thing, mentioned with increasing frequency in her journal, which caused her considerable distress: fofoca:

If a volunteer shits their pants without someone announcing it on WhatsApp, does it make a smell?

Try to get people to stop telling me other people’s secrets—the gossip train hurts my heart.?

Instead of talking shit about people, let’s talk nice about people.?

Anti-fofoca catch phrase: “When you hear some crazy news, cite your sources.”?

If you must talk about people, focus on the positive, start nice rumors like: “Nick is really smart! I heard it from the South Region VAC.”??

Fofoca about volunteers. Fofoca about staff. Fofoca about our counterparts and communities.

The fofoca echo chamber drove me to the brink of insanity.

It isn’t entirely apparent who was gossiping so maliciously, and persistently, that week. Maybe every one of ‘em. Again, I can’t know for sure.?

What I do know is that Elissa spent 24/7 with someone. I know someone talked all night. The question is: about what? I know, also, that Elissa wrote: “Don’t tell Isa anything if you don’t want everyone to know.” Was her beloved mana, in fact, a sort of Grand Central Station for the Moz 28 Fofoca Train that drove my daughter’s socially sensitive soul off the rails?

The circumstantial evidence is pretty compelling.

Besides, according to a recent paper on the psychology of gossip, “the more social ties an individual has”—like, say, an extravagant extrovert—“the more likely that individual will gossip.” Sadly, anthropologists have found that “two-thirds of everyday conversation” is gossip and, insidiously, the “vast majority” skews negative.?

No wonder Elissa, an instinctively inclusive introvert, had #insomnia.

“Somos amigos, colegas, um equipe,” she observed. (We’re friends, colleagues, a team.) Why, then, she must have fretted in the dark, are we talking shit about each other? And, perhaps: What are they saying about me, when my back is turned?

With so many jaws flapping, who, really, could she trust? Who could she open up to, safely, about things that mattered—like ongoing grief over her mother’s death, which, as I learned later, lurked well within the periphery of her consciousness that week?

No wonder, too, that when Anna invited her to join her Cabo Delgado colegas for a party in Pemba after the conference, “like old times”—?

Elissa responded: “This time, I don’t think so. I plan to go back to site, and I’m not planning to leave unless I really need to. I love being there and how it makes me feel.” She even said she was giving up her position on the VAC, because she didn’t want to have to travel all the way to Maputo for meetings. I was impressed and fascinated and remember thinking: “Wow, I wish I felt that way about my site, and my service.”

* * *

Meanwhile, to compensate for her creeping sleep deficit, she drank copious amounts of coffee every morning and cans of Coke throughout the afternoon. Sometimes, she popped a Walgreen’s brand Stay Awake tablet, as well. Two hundred mg per pill.?

Binge caffeinating, so to speak.

“I got into a cycle of caffeine to wake me up during the day and booze to tire me down at night,” she said, “which led to a brief but epic crash—an existential meltdown.”

Elissa found herself locked in a losing war with one of her best amigas.?

No, not Isa. Adenosine.?

“At this very moment,” writes Matthew Walker, sleep scientist and author of the New York Times bestseller Why We Sleep, “a chemical called adenosine is building up in your brain.”

It will continue to increase in concentration with every waking minute that elapses . . . One consequence of increasing adenosine in the brain is an increasing desire to sleep. This is known as sleep pressure . . . When adenosine concentrations peak, an irresistible urge for slumber will take hold. It happens to most people after twelve to sixteen hours of being awake.?

You can, however, artificially mute the sleep signal of adenosine by using a chemical that makes you feel more alert and awake . . . Caffeine works by successfully battling adenosine . . . acting as a masking agent. It’s the equivalent of sticking your fingers in your ears to shut out a sound.

Nevertheless, the sly sleep substance keeps rising like a tide behind “the wall of caffeine” you have erected. When your liver inevitably dismantles the dike, “you feel a vicious backlash.”

“Caffeine,” he notes, “is the most widely used (and abused) psychoactive stimulant in the world.” Global consumption of caffeine, “represents one of the longest and largest unsupervised drug studies ever conducted on the human race, perhaps rivaled only by alcohol.”

* * *

Thursday, March 8th—the third full day of the conference—Elissa phoned the Peace Corps medical office and went on record, for the first time, that she was suffering from “nightmares and difficulty sleeping.”?

Here, both she and the Peace Corps made a strategic error. The first of many.

Despite having taken her anti-malaria meds for more than ten months, without incident, they cluelessly decided to swap out her Malarone tablets for doxycycline on the assumption she might be suffering the exceptionally rare side effects of “sleep disturbance and abnormal dreams.”?

They failed to explore what else might be going on, to consider at least a few, statistically more probable “differential diagnoses.” Like, you know, those rampant, unhealthy social behaviors, which tended, historically, to cluster around Peace Corps conferences on crack.?

Why didn’t it occur to anyone to ask what and how much she was drinking, given the glaring fact that both caffeine and alcohol (and, okay, not going to bed) have long been known to disrupt restorative sleep??

“Alcohol,” explains Walker, “is the most misunderstood of all ‘sleep aids’.” It “sedates you out of wakefulness, but it does not induce natural sleep.”

The electrical brainwave state you enter via alcohol is not that of natural sleep; rather it is akin to a light form of anesthesia . . . Yet this is not the worst of it . . . alcohol dismantles an individual’s sleep in an additional two ways. First, alcohol fragments sleep, littering the night with brief awakenings. Alcohol-infused sleep is therefore not continuous and, as a result, not restorative . . .?

Second, alcohol is one of the most powerful suppressors of REM sleep that we know of . . . It’s rather like the cerebral version of cardiac arrest, preventing the pulsating beat of brainwaves that otherwise power dream sleep. . . Going for long stretches of time without dream sleep produces a tremendous buildup in, and backlog of, pressure to obtain REM sleep.

Elissa & Company, therefore, were doing everything wrong at once. Whittling her time in bed to mere hours each night, and relentlessly sabotaging every minute she spent there. Her brain was under siege.?

Unless she raised the white flag soon, there would be blood.?

* * *

Friday morning, March 9th, after yet another night of indiscriminate bombing, everyone checked out of their rooms. The conference was over. Some went back to site; others booked a bed or bunk at Ruby’s—a popular hostel five minutes from the regional Peace Corps headquarters.?

Elissa, however, had had enough noise and chaos. And jumped into her getaway car.

“She wanted time to herself,” Isadora recalled. “So she moved to City Hotel Friday and Saturday night, rather than Ruby’s, where I was staying with other volunteers. I didn’t see much of her and didn’t hear back from her when I texted.”

Huh.?

She ghosted her best bud. Curious.

In her journal that weekend, Elissa wrote, mysteriously: “Some people need to wake the fuck up; some need to chill the fuck out.”

Curiouser and curiouser.

On her to-do list for the next two days, she reminded herself to run by the Peace Corps medical office and pick up her new anti-malarials; to resign from the Volunteer Advisory Committee so she could focus on her Mozambican community; to fill out a Volunteer Report Form on her recent activities; to call Carlotta and schedule their return trip on Sunday; to purchase five inexpensive flip phones for her friend Ilda back in Metarica; to get some parmesan cheese for Clarence; (wisely) to “avoid drinking,” and (finally) to say goodbye to people, “especially Kelsey”—who, although she was not in Elissa’s cohort, happened to be in Nampula, too.

Friday night, predictably, my daughter’s renewed resolve to resist the allure of alcohol disastrously dissolved as she reluctantly revolved around her sacred circle of foolish friends.?

Tragically, she decided to play one last game of Russian roulette.

* * *

In a parallel universe, one of her fellow volunteers (whose job was, after all, to prevent risky and unhealthy behaviors in their community)—long aware of Elissa’s problematic relationship with Shakespeare’s “enemy in the mouth,” having seen it “steal away her brain” time and time again—placed a gentle hand on her arm, early that evening, as she reached for another shot, and said, quietly, “Maybe you’ve had enough?”

Elissa paused, looked at her friend with weary eyes, and slumped. “Sim,” she sighed. “You’re right.” She shrugged sheepishly and, shaking her head, added, “Sometimes I just get carried away, you know. Trying a bit too hard to be something I’m not.”?

She recalled two prior moments of enlightenment—after yet another immoderate night out in Guatemala, and at the end of her alcoholic misadventures in Botswana—when she had suddenly seen the whole party scene for the hollow substitute that it was; when she had journaled:

That ain’t me . . . I need to stop trying to fit in with the party crowd . . . I should write about who are my real friends, too, who are only party friends or fake friends or no friends at all . . .

“I’m going to head back to my hotel and get some sleep,” she said. “Obrigada.” She gazed affectionately at her friend. “Bye, Kelsey.”

They hugged. Several others, going with the flow, decided to call it a night, too. Some were staying at the same hotel. They all walked back together, arm in arm, wisecracking and bursting with laughter.

The best medicine. Well, besides a bit of shuteye.

Sunday morning, after hibernating beneath her covers most of the previous day and night, in blessed solitude and quiet, my daughter’s doppelg?nger and her counterpart’s contraparte—with whom she enjoyed what someone called a “sweet sort of sister bond”—caught an overcrowded bus to Cuamba.?

This other, newly awakened version of Elissa spent much of the next week at home, queasy and depleted, slowly recovering from the effects of alcohol and caffeine abuse, clearing the grit and grime from her neural machinery, gratefully accepting meals brought round by her doting família —“Servido!”—and slumbering deeply under her mosquito net from dusk to dawn.?

Then, she and her colegas at the hospital and secondary school in Metarica and Servi?os Amigos dos Adolescentes e Jovens launched a surprisingly successful, new sexual health series for high school girls and young women in the district.

One of those young women, freed from the scourge of HIV, started a novel “income-generating project that enabled other women to start their own businesses, so they could pay for their daughters to go to school”—tipping over the first in a long row of cosmic dominoes that ended, far in the future, with “the whole Earth flourishing in strong, natural health.”

Elissa’s rambling, brainstorming train wreck of thought.

On July 20, 2019, therefore, my daughter stood proudly with the tenacious, remaining Health Outreach Volunteers of her beloved Moz 28 cohort at their official Close of Service ceremony at Peace Corps headquarters in Maputo, grinning mischievously like the Cheshire Cat.

Unaware that, in another universe, the first anniversary of her death had just passed.

* * *

12/9/2018 6:36 PM

RE: A few brutal thoughts for you and your Peace Corps friends

Isadora:

Thank you for the additional insights and memories. However, let’s talk about that letter you read at Elissa’s memorial service in August.

You need to know that Elissa never read that letter, which you originally wrote in November 2017. I found it unopened in a pile of papers she had shoved into a box after her monumental breakdown in March. So, I’m the only person in the world who has read it.

After I watched the video of her memorial service recently, I realized that you had edited your letter for public consumption. And, of course, what you altered and left out got me thinking.

While I appreciate how you celebrated her positive qualities, I’m sorry, but I need to say a few brutal things about other parts of the initial version of your letter.

First, if you were ashamed enough to transform “drinking a beer tower” into “eating a pizza,” maybe you already know you’re drinking too much. Maybe you need to reconsider the damage you’re doing, and stop now. She’s dead because, among other things, she didn’t know when to quit.

Second, if the only way a person like Elissa, who suffered from catastrophic social anxiety, could “fit in” or “have fun” in Peace Corps circles was to “party really hard,” as you put it—until she was shit-faced, blacking out, and losing her mind—maybe you need to rethink the whole sick concept of partying as a substitute for meaningful social connection and inclusion.

By “you,” I mean all of you.

If what Elissa said in her final blog is true, the Peace Corps in Mozambique is suffering an epidemic of alcoholism. Maybe she was the Queen of Alcoholics. But if you’re as intelligent and caring as you appear to be, Isadora, then please grow the fuck up and get over this destructive excuse for social engagement before you kill yourself or someone else.?

You were a vital part of her web of social belonging. Yet, you praised her for her “ability to party,” for “flocking to parties,” for “drinking the whole fucking thing.” In other words, you praised her for being a flagrant alcoholic. What’s more, you told her to party hard—for you.?

That’s not “chill.” That’s not harmless fun. That’s fucking stupid. Own it.

And, in case you’re wondering, yeah, I blame Elissa too. I’m furious at her. I want to scream at her for never learning how to talk to anyone, about anything that matters, for destroying her precious brain cells, for pissing away her entire future—for jumping off that goddamn bridge and obliterating her body. For turning my life into a nightmare that never ends.

But she can’t hear me. You’re still alive. Learn something from this, for god’s sake. You don’t want to be Elissa’s “eternal roommate” at the bottom of the Royal Gorge, do you?

* * *

At 3:26 a.m. Monday, March 12, 2018—in effect, the middle of the night—Elissa emailed Romana, the Peace Corps medical assistant, to inform her that she was, as the subject line stated: Sick in Nampula.?

Sometime well beyond midnight, Friday, out with more of her friends, Elissa had pulled the pin on one too many pharmacological hand grenades . . . and blacked out. Since then, she hadn’t touched another neurotoxic explosive.?

Nevertheless, she made one more stupid mistake.

When she regained fragmentary consciousness, sometime Saturday, she tried to drag her ass out of bed, to take care of unfinished business before her planned departure on Sunday.?

But the sleep pressure from five days and nights of adenosine buildup and psychoactively fractured REM sleep had grown so monstrous, Elissa found herself swimming against a tsunami. In a ridiculous attempt to jolt herself fully awake, after pinching her skin to no avail, she bit first one arm, then the other. Ouch.

Leaving teeth marks that would soon be grossly misinterpreted. Like everything else.

When that failed to do the trick, the dogged bonehead gulped down five Stay Awake tablets—a thousand mg of caffeine, the equivalent of ten cups of coffee—apparently all at once.

And finally blew the central circuit breaker in her brain.?

Monday morning, then, some 48 hours after her ultimate binge, she was experiencing common symptoms of alcohol withdrawal compounded by uncommonly ferocious sleep deprivation.

Bom dia, Romana: I wanted to leave back to site yesterday, but I have been feeling really unwell. Constant headache, my heartbeat feels weird, I’m exhausted and thirsty. I have not been able to sleep more than an hour or two at a time, all week. I have been drinking oral rehydration solution, trying to rest, and eat healthy. But I missed my bus Sunday morning, because I was too exhausted to hear my alarm or get out of bed. I ended up in bed off and on all day—but it felt like I was never asleep. Can I please stop in at the office, since I’m still in Nampula? Obrigada, Elissa Valusek (Moz 28)

This was the second time she went on record, even more forcefully, that she couldn’t sleep.?

For the time being (and for good reason), she withheld a few other terrifying symptoms that had begun to assail her over the past 24 hours. Nor did she mention that she had barricaded her hotel room door and spent last night on the bathroom floor.

The only place she felt safe.

* * *

The last time Anthony—the North Region senior volunteer leader who helped run the Moz 28 training that week, who lived in Nampula—had seen Elissa, he knew something was wrong.?

“She just kind of disappeared that weekend,” he told me. “After Friday, she wasn’t hanging out with everyone else.”

Saturday afternoon, I remember being at my house with some of the other volunteers and going out to bum a cigarette from a friend who had a little stand on the corner, when I saw her. I said, “Hey, Elissa, what are you doing out here?” She said, “Oh, I’m looking for the hostel. Where is Ruby’s?” That’s weird, I thought. She forgot where the hostel is. I pointed the way, she said thanks, and walked off. I thought maybe she just wanted time to be alone. Whatever was happening to her, psychologically, took a day or two to play out. It didn’t happen all at once.

Broken by alcohol, soaked in adenosine, stoked on caffeine, her cerebral data banks littered with disconcerting blanks, she had wandered the streets of Nampula Saturday—disoriented, but still nominally functional.?

Sunday, lying in bed for most of the day, never quite able to achieve REM sleep, scribbling chaotic notes on the backs of random conference handouts, her threat detection and reaction circuitry had kicked into overdrive: grasping threads of thought, image, mood, and memory; spinning them into frightening fantasies.?

In effect, dreaming while awake.

“It felt like lucid dreaming,” she explained, later. “But sometimes the dream turned into a nightmare.”

Even in the thick of it, however, she seemed to understand what had triggered her disintegration. ALCOHOL IS POISON, she inked in big red letters. “Elissa is not allowed to drink alcohol, or caffeine. Why?” she asked herself. “E muito complicado,” she answered. It’s very complicated.?

On the same page, she sketched a complicated circular diagram, as if to illustrate.

The little diagram began at the top with “social anxiety.” Arrows pointed clockwise to “too much drinking” and “not enough sleep,” which led, unexpectedly, to “diabetes” or “cycles of overloading on sugar and binge-eating chocolate,” and onward, finally, to “traumatic brain injury.” Yikes.

She wondered, seriously, if she had just suffered a seizure or diabetic stroke—like her mother. Whose slow erosion and abrupt extinction, alas, she was still secretly struggling to make sense of.

Sometime later that day, she found herself “caught in a loop,” as she put it, a “nonstop brainstorming sesh,” in which she began feverishly speculating with escalating irrationality about certain disturbing ideas that had come into her head . . . as if from outer space.?

The next time Anthony saw my dear, delirious daughter, she had deteriorated dramatically.?

* * *

Around 4:30 p.m. on Monday, Anthony got a phone call from one of his friends. He didn’t say who. “There were maybe two or three people that Elissa trusted, if that,” he told me. “This was someone she knew well, a senior volunteer, not in her cohort.”?

From Elissa’s notes that weekend, and other clues, I surmised it was Kelsey.?

Since her phone had run out of credits and she was too exhausted to go buy more, she couldn’t call for help. WhatsApp and email were her preferred means of communication anyway.?

As was her habit (thinking before speaking), she had scripted a message to Kelsey on paper before hitting send. I don’t know if she included all (or any) of these points in the final version:

First of all, I really like you. And I’m very attracted to you, in case that wasn’t clear already. Second, I’m sorry if I did anything bad while I was drunk. Drinking is no excuse. But I blacked out, and I don’t remember. Third, I could use your help. I need to talk to the Peace Corps Medical Office again, but I’m afraid of being medsepped.?

Elissa thought Kelsey was staying at her hotel. She needed someone she could trust to call on her behalf—hoping, I suspect, to obtain some sort of medication that would enable her, finally, to sleep through the night. At this point, she was planning to leave Nampula Tuesday morning.?

However, after firing off her email to Romana twelve hours earlier—from the hotel bathroom, as we know now—her symptoms had snowballed. Her body was debilitated. Her emotions dysregulated. Her cognition disjointed.?

And at least one of her ideations had blossomed into a full-blown conspiracy theory.

Of course, no one knew any of this yet.

Kelsey reached out to Anthony. “I got a message from Elissa,” she informed him. “Something didn’t seem quite normal. Would you go check on her?” She gave him the hotel name and room number.

“That’s strange,” he said. “Maybe she took some extra leave.” Everyone else had returned to site by then. Even Kelsey, I assume.?

He went straight to the hotel, still wearing dress clothing from a conference with the NGO funding his own Peace Corps project. Knocked on the door.?

When Elissa saw who it was, presumably through a peephole, she opened the door and let him in, because, as Anthony noted, “she trusted me.” At that point, he discovered, oddly, that she had blocked the door with a desk, a chair, her backpack, and a heavy suitcase.?

Afraid of something. Or someone.?

It took him 30 minutes to convince her to let him call the Peace Corps office. He could tell she was in severe distress, but did not yet understand why. “To keep her calm, I acted as if everything was completely normal.”?

Finally, she allowed him to call someone on the administrative staff, and they sent a vehicle to pick her up. When the car arrived, however, she grabbed his arm and said, “I don’t trust them.”

“She didn’t want me to leave her side,” he recalled. “Even though she knew these people well. I realized, then, that this was far more serious than I had imagined.”

Anthony accompanied her to the regional Peace Corps headquarters about a km away, leaving her belongings in the hotel room. For the next 45 minutes or so, they remained in the volunteer’s lounge on the ground floor, before she let him call the medical office upstairs.?

At 5:49 p.m., he spoke with the nurse, Romana. “Elizabeth Valusek is not well,” he told her. “She needs medical attention.”

Romana came down to check her out. “How are you doing?” she asked, kindly. To which Elissa responded, several times in a row, “It’s very complicated to explain, very stressful.” E muito complicado. But she refused to elaborate.

Together, Anthony and Romana coaxed her upstairs, where the nurse contacted the head office in Maputo and conducted an impromptu video conference with Drs. Isabella and Alberto, the senior medical officers there.

That’s when Elissa dropped the other shoe.

* * *

In November 2018—a couple weeks before I viciously eviscerated her for vacuously endorsing my daughter’s alcoholic behavior (thereby terminating our communications forever)—Isadora told me that when Elissa had visited her in Mozambique, in June, three months after being cruelly evicted from her Peace Corps home, she had confessed that “she still felt guilty for not having kept her thoughts to herself that night.”

She desperately “wished she had just gone to sleep.”?

The moment she opened her mouth, that fateful Monday evening in March, her life’s dream morphed into a nightmare . . . from which she never awakened.

* * *

“MY FATHER KILLED MY MOTHER!” she cries, kicking off—with a zinger—the first of many well-meaning medical interrogations she will soon endure.?

Didn’t see that coming, did you? (Neither did I, to be quite honest.)

Imagine, as I have, that you’re a fly on the wall, after reading all the Peace Corps medical reports, emails, files and documents, the psychiatric case notes, and dozens of scientific papers and books.

Imagine, like me, you know what’s really going on here. What no one in the room, either in Nampula or Maputo, ever understands, except for Elissa herself. Too late, of course.

My daughter is talking in her sleep.?

She is describing the long, lucid nightmare she’s having—right now—trying helplessly to wake herself out of it. Nothing she’s saying actually matters. The narrative plot of her nightmare is, I mean, nearly irrelevant. She has simply incorporated distorted bits of memory and emotion into a blasted dreamscape of pure, unchecked fear and imagination.?

A Freudian psychoanalyst might find her references to Mom ‘n Pop tantalizing. Tell me more, he or she or they might say, with a distinct Austrian accent. Hmm. Ja. Go on.

Or, if Elissa were replaying a normal, albeit nasty nightmare, with coffee cup in hand, sitting downstairs in the volunteer’s lounge with (real) friends the next morning, everyone might be laughing at the moment. Or cringing. Oooh! No! Really??

But, no.

Everyone here is keeping a straight face, nodding knowingly, trying not to spook her, taking every word she utters at face value. Thinking: Oh shit, she’s psychotic. Delusional. Mentally ill.?

Clueless about what they’re actually seeing and hearing.

* * *

So, let’s hit pause for a minute. Bear with me.

I’d like to invite Matthew Walker, sleep scientist, to explain the neurobiology, so we don’t make the same looney mistakes everyone else will make—like Keystone Cops—from here on, in Mozambique and Washington DC and Colorado, over the next seven days, blinded by implicit institutional bias. Matt?

Ahem, thanks, Jay.?

Well, first, remember what I said earlier, about what transpires when people who consume large quantities of alcohol deprive themselves of restorative dream sleep for a long stretch of time, as Jay’s daughter has done. The sleep pressure becomes so great, as I describe in Why We Sleep—

that it inflicts a frightening consequence upon these individuals: aggressive intrusions of dreaming while they are awake. The pent-up REM-sleep pressure erupts forcibly into waking consciousness, causing hallucinations, delusions, and gross disorientation. The technical term for this terrifying psychotic state is “delirium tremens.”?

You may not realize it, but as I explain elsewhere in the book, even in the absence of alcohol, every time you have an ordinary dream at night, you become “flagrantly psychotic.”?

You see things that are not there; you believe things that are not true; you’re disoriented with respect to time, place, even your own identity; your emotions undergo wild gyrations; and, when you awaken the following morning, you often suffer from amnesia. As I observe:

If you were to experience any of these symptoms while awake, you’d be seeking immediate psychological treatment.?

In 1907, Carl Jung noted the similarity between psychosis and dreaming, when he wrote: “If we could imagine a dreamer walking around and acting his own dream as if he were awake, we would see the clinical picture of dementia praecox”—the old term for any psychotic disorder.

This is probably why, as early as 1919, Emil Kraepelin, one of the founders of modern biological psychiatry, suggested that the “most important treatment” for psychosis was: “Rest in bed, supervision, care for sleep and food.” Safety, sleep, and sustenance.

In a well-known paper published in 1960, researchers confirmed that “extended sleep deprivation produces a type of model psychosis,” characterized by “waking dreams” or “sleeping while awake” and “paranoid behavior”—which Elissa is exhibiting, as we speak.

Unfortunately, therefore, as a medical professional, if you don’t understand sleep deprivation, you’re likely to misdiagnose the person sitting right in front of you. As I write:?

Psychiatry has long been aware of the coincidence between sleep disturbance and mental illness. However, a prevailing view in psychiatry has been that mental disorders cause sleep disruption—a one-way street of influence. Instead, we have demonstrated that otherwise healthy people can experience a neurological pattern of brain activity similar to that observed in many of these psychiatric conditions simply by having their sleep disrupted or blocked.?

Experimentally, too, we know that a third to a half of the most salient emotional concerns people have while awake “powerfully and unambiguously” reappear in their dreams. Which illuminates the terror Elissa is feeling now, as well as the content of her delusions about dear ol’ Dad.

As you discover later, Jay, your daughter has been covertly grieving and ruminating about potential causes of her mom’s death all week, or longer. Recalling, apparently, at some point, what you had told her last summer: namely that, once, long ago, you had wished her mother had killed herself.?

And that you had done, or said, something that might have caused her to do so.?

This seems to be the fuel propelling her getaway car. Her amygdala is the accelerator. And, as we can all see, the driver is—paradoxically—asleep at the wheel. In our MRI studies:

After a full night of sleep, the prefrontal cortex—the region of the brain that sits just above your eyeballs; is most developed in humans, relative to other primates; and is associated with rational, logical thought and decision-making—was strongly coupled to the amygdala, regulating this deep emotional brain center with inhibitory control . . .?

Without sleep, however, the strong coupling between these two brain regions is lost. We cannot rein in our atavistic impulses—too much emotional gas pedal (amygdala) and not enough regulatory brake (prefrontal cortex). Without the rational control given to us each night by sleep, we’re not on a neurological—and hence emotional—even keel.

In other words, Elissa is, at present, pardon my French, scared shitless by a phenomenological phantom fabricated by her own amygdala.?

Putting all the pieces together, then, her brain appears to be undergoing well-known, albeit physiologically, psychologically and socially damaging consequences of both acute alcohol withdrawal and chronic sleep loss—including (temporary) paranoid delusions.?

Aka waking nightmares.

Sadly, too many healthcare providers are grossly out of date on the science of sleep. Which, as you know, Jay, is one reason I wrote the book.?

Don’t you say in there somewhere, Dr. Walker, that researchers in Japan also proved that short-sleeping healthy volunteers to five hours for five nights could sever the emotional brake lines as efficiently as blocking their sleep completely for a single night?

Yes. The impact on their brains was the same as what we saw in our lab.

And that, or worse, is what happened to my daughter. Thanks, Matt.

Let’s hit play again.?

* * *

“My mother had a stroke a few years ago,” she explains further, everyone listening, rapt. “The final one was supposedly in June, last summer, just as I was starting phase two of pre-service training.

“I was informed that Mom died in the hospital, but . . .” she pauses, “I know it was my father who killed her.” The medical officers exchange looks, I imagine, wondering—however briefly—if there might be something to her creepy story.

“When I flew back to the U.S. on emergency leave, I stayed with my dad, stepmother, and older brother.”

She lowers her voice, then, conspiratorially: “My father drugged me the entire time I was home. I was blacked out most of the week. He didn’t want me to come back to Mozambique.

“But I managed to escape.” How, exactly, she does not say. They carefully compose their faces, furiously scribbling notes, getting it all down.?

“I’m afraid he killed my brother, too, because I haven’t heard from him in weeks. I tried to contact him via Facebook . . . and someone replied. But I’m not convinced it was actually my brother.”

They ask a few follow-up questions. Offer to call her brother, to find out if he’s okay. She exclaims: “Not now!”

“I don’t feel safe,” she states, shivering. “I’m afraid my father will kill me, as well!”

Two weeks hence, she will describe her experience tonight: “My head hurt, I was so scared, I couldn’t breathe, could barely hear over the ringing in my ears. I would be talking to one person and a second person would comment, but I couldn’t hear over the sudden ringing noise.”

At some point, she reiterates—for the third time—“I have not been able to sleep since last week.” This started, she reminds them, “during the conference.” She mentions, with frustration, her roommate jabbering all night. #nosleepnampula.

She effectively hands them the key to the whole conundrum. They’re not paying attention.

Since Sunday, holed up in her hotel, she adds—inadvertently distracting them, right at the moment of truth—“every time I try to fall asleep, these thoughts about my father come to mind. I am afraid to be alone! I’m scared!”?

They ask, unironically, if she has any intent or plan to harm herself. “No,” she replies, perhaps a bit perplexed. Didn’t she just barricade the door to her hotel room to prevent someone from hurting her? Does this sound like she wants to harm herself??

She’s acting transparently self-protective, not the teensiest bit self-destructive. Rote queries can be so stupid.

In terms of preexisting conditions, they add a note here, from Elissa’s Peace Corps Clinical Intake Questionnaire in April 2017: “her family has cases of major depression and bipolar disorder.”?

You can almost see the cartoon light bulb flip on over their heads.?

Soon, it will blind everyone.

Wisely, they ask about drugs and alcohol. “Volunteer denies intake of alcohol since Friday night,” they dutifully record in their report. Weirdly, again, they fail to investigate how much she drank Friday, or before Friday, for how many nights. They simply check the box and move on.

This, my friends, turns out to be the only reference to alcohol in Elissa’s medical record until five days later, when she’s stateside again, and the bulldozer has long since buried the truth under a mound of assumptions, misinterpretations, and foregone conclusions.?

What’s more, they show zero interest in caffeine, another psychoactive drug she had ingested in prodigious quantities. They are, it seems, asleep as well. On the job.

From this evening forward, due to unconscionable levels of groupthink and confirmation bias, almost everything that Peace Corps decision-makers—and subsequent medical and mental health professionals—do to, and ostensibly “for,” my daughter will cause short- and long-term harm.?

Iatrogenic harm. Ring a bell?

The interview continues.?

When they ask about physical symptoms, she complains of a moderately intense headache centered in her forehead “with radiating, dull pain,” which appeared gradually over the weekend, although, she adds, “today it’s getting better.”?

Fifteen hours earlier, she had reported “constant” headache (and tachycardia and dehydration). Just what you might expect from alcohol withdrawal, more than two days since her epic episode of Epicurean excess. Symptoms typically peak within 24 to 72 hours, with after-effects that often persist seven to ten days from the last drink.?

This is common knowledge, folks.?

No one makes the connection. Even though Alberto and Isabella are practicing medicine in Mozambique, the Número Um alcoholic nation in the entire Peace Corps. Astounding. What’s more, everyone knows she had indulged in binge drinking.?

The Country Director admits as much, later, off the record: “Medically, something was not right. She went to that conference in Nampula, drank too much, and became extremely paranoid.”

Nevertheless, at the conclusion of their initial report, the medical officers in Maputo record their Clinical Impressions, still tentative: “Acute psychotic episode? Bipolar disorder?”

Fixated on delusion, they never even contemplate delirium, which, according to the Mayo Clinic, can be triggered not only by abrupt drug or alcohol withdrawal but also by stroke, metabolic imbalance, fever or infection, dehydration or malnutrition, and, yes, sleep deprivation.

“We need to bring you down to Maputo, for a proper medical exam,” they tell her over Skype, a reasonable next step.?

“I don’t want to do that,” she says, flatly, narrowing her eyes. “I don’t trust any of you.”?

“Would you feel more comfortable if Anthony came with you?”

She thinks about it. “Sure, okay,” she replies, unsurely.?

After the interview, Elissa implores Anthony not to leave her alone. He agrees and crashes in the lounge, still wearing his conference clothing. Heroically, he sticks with her for the next three days, until she boards a plane for America.?

Give that young man a medal.

Thoroughly exhausted, she spends Monday night in a bed at the infirmary in Nampula. Romana remains nearby, to keep an eye on her patient. Elissa trusts her too, now. She tumbles into a troubled slumber—truncated by anxiety about what her devious dad may be up to, back in the US of A.

At this stage, both her presence and participation are still voluntary.

In two days, however, she will vehemently retract her consent.?

And things will get ugly.

* * *

What I was “up to,” here in Colorado, was (nearly) the apex of my aspiring new career as a chronic pain coach, educator, and psychotherapist on staff at Longmont United Hospital.?

In 2013, when I graduated from Colorado State University with my M.Ed. in Adult Education & Training—specializing in psychoeducation, experiential and self-directed learning—I had been studying and teaching meditation and other contemplative practices from the Eastern and Western traditions for 20 years, part-time, while Beth was growing up.?

Since 2004, I had been working with people in chronic pain—a pernicious, often trauma-related condition from which I had suffered myself, since the year before she was born.?

In 2007, during my nine-day Practicum for instructors of the eight-week protocol known as Mindfulness-Based Stress Reduction (MBSR) at the University of Massachusetts Medical School’s renowned Center for Mindfulness, someone had asked what had drawn me to my personal practice of meditation.

Sitting cross-legged on a zafu in a room full of educators, mental health professionals, physicians and nurses, I pondered the question for a moment, then said, quietly, “I was attracted, originally, as a way of ‘getting rid’ of my pain.” We made eye contact and she smiled, knowingly.

“When that didn’t work out quite as I had expected,” I added, with a shrug, “I realized I had had a deeper motivation all along: I wanted to learn how to face death—my own and others’—with open eyes, and heart.” She nodded.?

Three years later, I published my third book, a sustained meditation on existential grief and pain, loss and gain, entitled The Secret Sorrow: A Memoir of Mourning the Death of God.?

Over the past five years, since I had “lost my faith,” as they say, I had attended two full-fledged Buddhist death meditation retreats, where I had sat for hours in searing silence, contemplating my own mortality, allowing all the horror and denial and bittersweet anguish to bubble up to the surface . . . and float off into the night sky, like so many dandelion seeds on the breeze.

Only to plant themselves and rise again, the way of nature.

I didn’t know it then, but I was training to absorb the cosmic blow of my daughter’s unthinkable self-annihilation. With heart and eyes wide open.?

Not, mind you, to escape the pain that binds us all.

Those who will not slip beneath?

??the still surface on the well of grief,

turning down through its black water,

??to the place we cannot breathe,

will never know the source from which we drink,

??the secret water cold and clear,

nor find in the darkness glimmering,

??the small round coins,

????thrown by those who wished for something else.

—David Whyte“The Well of Grief”

As Rainer Maria Rilke (translated by Stephen Mitchell) writes in Letters to a Young Poet:

If only it were possible for us to see farther than our knowledge reaches . . . perhaps we would bear our sadnesses with greater trust than we have in our joys. For they are moments when something new has entered us, something unknown . . . is already in our bloodstream.

We could easily be made to believe that nothing happened, and yet we have changed, as a house that a guest has entered changes . . .

And that is why it is so important to be solitary and attentive when one is sad . . . The quieter we are, the more patient and open we are in our sadnesses, the more deeply and serenely the new presence can enter us, and the more we can make it our own . . .?

In 2015, at 60 years of age, I posted an overdue goodbye letter to the oil business on LinkedIn, and embarked full-time on a thorny, financially uncertain path as a helping professional. Building, of course, on two decades of therapeutic work with people suffering the variegated slings and arrows of outrageous fortune.

After years of sadness and guilt at participating in an industry that is consciously destroying the global ecosphere, without remorse, it was time to give the new thing room to breathe.

A year later, I teamed up with the Integrative Medicine clinic at the hospital to conduct a small-scale pilot study of a novel, biopsychosocial self-management program I had developed for patients wrestling hopelessly with chronic pain—grounded both in evidence-based practice and hundreds of tiny experiments I had conducted on my own mind and body, over the years.

I dubbed it, playfully: Pain Sucks, But Life Goes On.

The initial results were promising, so much so that, during the next two circumnavigations of the local star, I was awarded $22,000 in grants to fund my work with seniors and low-income patients in the community.?

The clinic brought me onboard part-time, and I began receiving referrals from nurses in the hospital and physicians at primary care clinics in town, who were hoping to offer patients something in lieu of dangerous, addictive opioid medications.?

Which were killing tens of thousands of Americans every year.

In March 2018, therefore, I was frenetically preparing a major new grant proposal for a larger-scale randomized, controlled clinical research trial for opioid users, expanding my original design and rigorously measuring outcomes. We were seeking an additional $46,250 for a one-year study. I was crackling with ecstatic electricity.?

A decade-long vision was unfurling, inch by blessed inch. Right before my eyes.

Then, late Wednesday afternoon, March 14th, an email pinged my inbox while I was at work:?

Hello Mr. Valusek: I have important information regarding your daughter and must speak to you asap. She is safe but is being brought back to the U.S. Please contact me on my cell phone below at your earliest convenience. Kind regards, Carrie E. Sloane-Dudley, DNP, United States Peace Corps, Washington DC

This was, it turned out, the first nail in the coffin of my career. Like my daughter, it would not survive the coming year.

* * *

Tuesday morning, March 13th, Isabella calls the 24-hour emergency line of the Peace Corps’ Office of Health Services (OHS) in Washington DC to report a “mental health issue.” Nicole picks up. Her handwritten notes include the following highlights:

Psychotic break? No suicidal ideation. Saying father killed mom . . . History of bipolar + major depression. Couldn’t sleep last week. Afraid to leave hotel room . . . Barricaded herself inside . . . Memory issues. “Very complicated. Very stressful.”

Alcohol intoxication or withdrawal? Nope. Mental illness? Hmm: psychosis, delusion, bipolar, depression, insomnia, paranoia, amnesia and stress. So, yeah. If it looks like a duck and quacks like a duck, well, guess what.?

Around noon, Alberto informs the staff in Maputo that Elizabeth Valusek will be arriving tomorrow “for medical reasons.” He asks Inacia to book the flight—“one way.”?

Shortly after four o’clock, Brygid Hanssen, PsyD, a psychologist with the Counseling & Outreach Unit (COU) of the OHS in DC, conducts a phone consult with Elissa, while Isabella listens in. Hanssen’s Patient Encounter Form summarizes much the same backstory, then adds:

She said these new thoughts regarding her father were brought on by “lots of things,” but she refused to say what . . . PCV [Peace Corps Volunteer] spoke softly and declined to elaborate on answers, saying that she was tired and wanted to sleep and talk tomorrow instead.

Notice how, despite her apparent impairment, my daughter has sufficient “mental capacity” to make three appropriate “medical decisions” for herself and to express them both firmly and succinctly. She requires: (1) sleep, (2) silence, and (3) patience.?

She is, after all, an introvert. Easily overwhelmed by sensory stimulation. Especially now.

Utterly depleted. As Isabella reports, in her own case notes, Elissa says she feels “very tired and very confused,” to be precise. If you’re counting, this is official declaration Número Quatro. Sleep deprivation is literally staring the psychologist in the face.?

But, oops, she can’t see the patient. She’s on the phone—a clinically and ethically dubious way to conduct such a critical mental health assessment.?

Blind in one eye, as it were.?

Nevertheless. The patient encounter proceeds without respect for the patient’s needs.

PCV denies any suicidal ideation, but reports history of SI in 2012. She reports being previously diagnosed with major depressive disorder (no pre-service history on record), and has a family history of bipolar disorder (mother), depression and alcohol abuse (father).?

Wait, what? Her father—?! Okay, so she’s not firing on all cylinders. Whatever.

Meanwhile, let’s pause and parse this new piece of data. Think about it. Years ago, she says, she was temporarily suicidal. Diagnosed with “depression.” Does Dr. Hanssen ask the obvious question: “Why, what happened to you?” No, mysteriously, she does not.?

If she had, she might have learned that this particular PCV had only become suicidal in the aftermath of two sudden, earthshaking losses of love, attachment, social connection and belonging in a single year, blowing all meaning and hope to bloody smithereens. Shredded by grief—squared.?

What, then, does the psychologist do with this little bombshell??

Shortly, she will use it against Elissa, like snatching a grenade from the air and flinging it back into the enemy’s bunker before it explodes. (Stay tuned.)

Despite “anxious mood,” “paranoid ideations” and “delusions,” Hanssen reports that this volunteer displays “normal speech rate and rhythm”—in other words, there’s no evidence of rapid, “pressured speech,” a common sign of mania, one of the “poles” of so-called bipolar disorder. And although she’s “somewhat illogical,” she is “able to come to appropriate conclusions” and shows “coherent thought patterns, at times.”?

According to Isabella, indeed, Elissa exhibits “no agitation.” Why? Because, for now, at least, no one is actively threatening or attempting to hurt her.?

Bottom line? “Psychotic episode.” No question marks. No differential diagnoses.

The It’s-Gotta-Be-Mental-Illness snowball is rolling now. Downhill. Toward the edge of a deadly drop-off, shadowing the walls of a deep, dark gorge. Unstoppable.?

Growing as it picks up speed.?

* * *

Sometime early Wednesday, March 14th, before leaving Nampula, Elissa finally phoned Kelsey—to say goodbye, I suspect. Something she never got a chance to do before. No idea what passed between them, but I’m pretty sure she endured pangs of unrealized or unrequited love.?

Which, ultimately, is why I keep dragging poor Kelsey on stage for this Greek tragedy.?

On Elissa’s high school bucket list, 50 Things to Do Before I Die, #19 had been: “fall in love (haha . . . seriously).” Within four days of this phone call, my daughter will tell a psychiatric care manager in Denver that she has not had a meaningful romantic relationship (sex, yes; love, no) since her boyfriend died in college. Six long years ago.

In her many scribbles and journals during that period, she never wrote about any girlfriends or boyfriends, other than Brendan (and Noah). Then, suddenly, Kelsey’s name appeared on a handful of random documents in the Elizabeth Anne Valusek Memorial Library.?

Meaning . . . what? I dunno.?

On page four of Elissa’s Personal Health Plan, dated July 26, 2017, under question 6(b)—“What are your ideas about having a romantic or sexual relationship during Peace Corps service?”—she had written, weeks before meeting Kelsey (whom she came to trust and open up to):

I need to be able to trust the person by having lots of open communication.

Before I burned my bridges with Isadora, I had asked her point blank if Elissa had been “involved” with anyone in the Peace Corps. Hoping, in fact, that she had found happiness or love before her premature departure from the planet. Something any decent father would desire for his beloved children.?

“I wasn’t aware of her dating anyone,” she averred. Which made me infinitely sad.?

Lovelessness, like unresolved grief and loss, was another excruciating trap from which it seemed she could not escape, without gnawing off her own leg.

Among her “suicide notes” in the margins of that health and wellness textbook she was reading in Malawi—marinating in solitary silence and sorrow—Elissa penned a number of poignant allusions to her yearning for love again. A month before she anesthetized her intractable pain.

It’s June, and I’m still knocked down on my ass.

“All you need is love.” I just need friends and love and support. But I’m feeling pretty lonely.?

Be patient. Love yourself. Keep going.

I just don’t want to be alone. I’m hurting so fucking much.

I need a win. I need to be good at something. I need a way to feel better about myself, but how?

What should I do? I don’t know.

Job? School? Car? Student loans? Health insurance? Car insurance? Gas? Bike? Rent? FRIENDS? LOVE?

There is no “fatal flaw.” I’m not defective, just shy and sad. But that’s okay. Eventually I can and will make friends, find meaningful work, and have relationships again.

I want to live. I want to love.

But if I never finish my Peace Corps service, I’ll never get into a good grad school program or get a good job, I’ll never make close friends or be in love, and I’ll die alone.

I wish I could’ve just finished my service I just want to go back god damn please – WHY?

She died as much from a broken heart as she did from her own inscrutable why question, which, in the end, broke her spirit as well.?

In late July, only four, carefully vetted Peace Corps volunteers in Mozambique were informed directly, by phone, that Elissa was dead. Clarence, her former sitemate. Isadora, her eternal roommate. Anthony, her guardian angel. And, yes . . . Kelsey.

Which says something.

* * *

Before the flight to Maputo at 10:50 a.m. Wednesday, Anthony and Romana swing by City Hotel to pay the bill and pick up Elissa’s scattered belongings.

These include four pages of kooky, private speculations and paranoid ramblings in various colors of ink—mostly red, like blood—later confiscated without her consent, which come to constitute Exhibit A in the Peace Corps’ case for medical separation without due process.?

As if the contents of a dream journal would ever hold up anywhere but in a kangaroo court.?

“I sat right next to her on the plane,” Anthony tells me. “She spent the entire two-hour flight staring at her Peace Corps ID, muttering and shaking her head. She didn’t seem to believe her government job was real, or something like that. I didn’t catch the whole story.”

Don’t worry, Anthony. It’s just a dream.?

A driver picks them up after lunch in Maputo and takes them to the medical office, where Isabella runs a tox screen (negative for all drugs) and conducts the first hands-on examination. Elissa doesn’t trust Alberto’s hands.

She explains more clearly now that she has been frightened, not just of her father, but also of the volunteer with whom she shared a room at the conference. An unsurprising cerebral seed to sprout, in such a fertile field, from the fetid ferment of fofoca.

Her handwritten pages confirm this. Sometime on Sunday, she had scribbled: “I’m scared to leave this room. I do not and will not trust Dad or Isa! I don’t know if I’m crazy, but please don’t hurt me. I’m tired.”?

Isabella notes that my daughter’s facial expression is “flat,” her hygiene “poor.” She has worn the same clothing for days. Showering is superfluous, of course, struggling as she has been to snatch a sliver of shuteye, here and there. People keep shuttling her from place to place, jostling her, jangling her nerves, getting in her face.

“I noticed, over the few days I was with her,” Anthony recalls, “that she would seem normal, but a little bit off. As if she were waking up slowly from a really long sleep.” Bingo. Give that man an honorary degree in medicine.

Remember, her french-fried prefrontal cortex is still mostly offline. Trying to reboot.?

When Isabella asks about her mood today, she cries, “I’m freaking out! I’m confused. I forget things. I don’t know who will hurt me or not.” She complains of “frequent nightmares”—“all regarding her safety”—and “constant hypervigilance.”

Finally, Elissa divulges the reason why she was diagnosed with depression during college. It was, more accurately, grief. “My mother suffered her first stroke and then my boyfriend died suddenly, at home, during an epileptic attack.” This revelation lands with an audible thud. No one picks it up.

Although her voice is (understandably) “very soft” now, Isabella reports that she’s generally “alert and collaborative.” Still voluntary. Another hour or two.?

Unsuspecting.

Upon physical examination, the medical officer finds her heartbeat is regular, her pulse rate normal, her headache has gone away. Physiologically, my daughter is already recovering. Sans “treatment.” Just sleep, and relative safety.

Neurologically, well, it’s gonna take a few more days. Spoiler alert: three, to be exact. (No one knows this yet, but you and me.)

Next, Isabella observes that, curiously, Elissa had written with blue ink on both of her legs. (Something the silly girl has been doing, to my knowledge, since college, at least. Medically, it’s meaningless. And, from her own notes, I know she did this on Sunday or Monday.)?

Furthermore—and this is the shockingly inconsequential moment when the whole enchilada goes right down the proverbial crapper—she discovers a “bruise on each arm (internal face) from self-bite,” done last Saturday. Already healing nicely, thank you.?

She concludes: “otherwise intact.”?

Oddly, apart from the when, she doesn’t ask Elissa to elaborate on the why of the biting. Or the writing. Perhaps because they’re no big deal. Her patient is in no imminent danger. There’s no apparent cause for alarm.?

Finally, faithfully, she forwards her findings to Brygid Hanssen, PsyD, in DC—who promptly goes apeshit and phones Maputo immediately for “Crisis Consult #2,” her knee jerking spasmodically. As if she, herself, is having a seizure.

Blind in both eyes now.

* * *

Elsewhere in (our) universe, Carrie E. Sloane-Dudley, Doctor of Nursing Practice and one of the Peace Corps’ finest International Health Coordinators—my daughter’s advocate and case manager—has been anxiously googling Ms. Valusek’s now infamous father, trying to determine if there’s a smidgeon of merit to his daughter’s allegations. (There is, but she’ll never know that.)

Thankfully, he’s all over the internet. Looking pretty innocuous. In healthcare himself. Huh. No hideous hitman, after all. Whew. Soon, she’ll make contact . . . and judiciously omit a few juicy bits of medical malfeasance unfolding in real time, halfway around the world.

* * *

Dr. Hanssen talks rapidly, her speech pressured by propaganda manufactured from thin air by her increasingly constricted cognition. Manic, you might say. Afterward, Elissa complains to Isabella: “The person from COU talked so fast, I’m exhausted.”?

She doesn’t remember conversing with the psychologist yesterday, in Nampula. A dinky hole in her hinky hippocampus. All she knows is that this “person” keeps prattling on about the “urgent!” need to medevac her to Washington DC for hospitalization. She doesn’t understand.

She tells Hanssen she’s scared. “I don’t want to leave Maputo for a few days,” she begs, stating clearly why she needs more time: “I get confused when I move around too much.” She’s still trying to defend herself, for Christ’s sake. From them now.

Hanssen doesn’t give a fig. To rationalize her precipitous overreaction, the psychologist asserts that Elissa is “more psychotic” today, whereas Isabella reports more accurately that she is simply “more descriptive.” Her muddy waters are slowly starting to settle, if no one stirs them up again.?

No such luck.

Although the patient impatiently “denies suicidal and homicidal ideation” for the umpteenth time, Hanssen has gone deaf, as well, the sound of Elissa’s damning confession, just yesterday—of her ignominious “history of SI”—still echoing cacophonously in the psychologist’s ears.?

She-lock Holmes, master detective, puts zero and zero together. Voila!

“Peace Corps Medical Officer found evidence of self-harm,” she punches triumphantly into her electronic record system, malignorantly misconstruing those bite marks and shoving that stupid snowball farther down the sickly slickened slope. “PCV appears to be an acute danger to self at this time and requires STAT medication.”?

Yowza! They slam Jack Nicholson back into the Cuckoo’s Nest for the long-awaited sequel.?

And begin boring holes in his cranium. Lickety-split.

To get the evil spirits out.

* * *

Around 4:00 p.m., COU Doc Ratched orders her minions in Maputo to give my daughter an intramuscular injection of 5 mg of haloperidol, an antipsychotic drug, and 25-50 mg of diphenidramine, a sedative, and to repeat every 4-6 hours “as needed for psychosis or agitation.”?

Oh, now “agitation” is grounds for involuntary psychiatric medication, as well. Convenient.?

By the way, haloperidol is a first-generation neuroleptic cooked up way back in the 50s, which, according to a 2017 review paper in the Annals of Clinical Psychiatry, “exerts measurable neurotoxic effects at all doses . . . that lead to neuronal death.” That’s right, brain damage.?

Brilliant. Just what the doctor ordered.

What’s more, “very common” side effects include, of all things, “insomnia” and “sleep disturbance”! Recall, too, that pharmacological sedation does not induce restorative REM sleep. Terrific. Let’s administer two drugs that exacerbate Elissa’s already catastrophic sleep deficit.?

Oh, sorry, I forgot we’re choosing to ignore snoozing, as well as boozing, cuz they’re confusing to the party line. So, go right ahead.

But wait. What if our persnickety patient tries to exercise her constitutional rights as a free citizen of the United States of America—and graciously declines to invite a bunch of scary strangers to impale her with sharp objects? Cuz, you know, she’s kinda jumpy at the moment?

(As the saying goes: “Just because you’re paranoid doesn’t mean they’re not out to get you.”)

“PCV cannot refuse medication,” proclaims the Orwellian Office of Health Services’ Omnipotent Memorandum of Ultimatum, “as this is an emergency treatment order, and she appears to lack the capacity to make medical decisions for herself” (i.e., we don’t like her ditzy decisions; they’re not hasty or aggressive enough).

Big Brother hath spoken. So be it. Amen.?

At 4:45 p.m., Isabella nervously reports that Elissa has been hospitalized at Clínica de Cuckoo, a full-service medical facility nearby, for “medication management,” because, er, um, the “PCV started to become agitated when”—and, mind you, only when—“we tried to medicate her.”?

That, she notes, with chagrin, “is why hospitalization was indicated.”?

To be clear, “agitation” is a technical term in psychiatry that refers to a vaguely defined mental and/or physical state of unease, tension, anxiety, restlessness, irritability or lack of cooperation deemed (by whom, exactly?) to be “excessive, inappropriate or purposeless.”?

What a conveniently circular argument, given the excessive, inappropriate and purposeless level of threat they’re throwing at our defenseless patient.

Things do, indeed, get ugly when my belligerently bull-headed daughter refuses to comply—with uncommon ferocity.?

It takes four, count ‘em, four full-grown adults to wrestle her down (onto a bed, I hope, not the fucking floor), to restrain her and inject her against her wishes. Which, apparently, she expresses. Loudly.

During this terrorizing, unjustified, whole-body trauma, the inexplicably resistant patient’s “left upper arm” apparently slams into something—or someone grips her flesh a bit too harshly—leaving a fresh “abrasion” still visible three days later at the ER in Longmont, Colorado.?

Dr. Noorjehan (known affectionately as Noorje), an eyewitness to the “incident”—which a redacted Peace Corps email euphemistically dubs “uncomfortable”—admits that she is seriously shaken by what they do to my daughter this afternoon. Presumably, assault isn’t in her contract.

What did Hippocrates say, again? Oh, that’s right: First, cover your ass.?

In accordance with their sacred oath, therefore, the medical personnel involved unanimously neglect to report this incidental scuffle.?

Even Elissa seems to brush it off, as if somehow she deserved this sort of institutional violence, when she journaled: “I know that no one intentionally hurt me at that clinic in Maputo.” But—if you fill in the ellipsis—they did hurt her. Bastards.

It gets worse.

In the heat of the moment, due to the outrageous opposition Elissa puts up, I imagine, her medical team in Mozambique unilaterally tosses, not just one, but two blasted benzodiazepines—lorazepam (Ativan) and diazepam (Valium), so-called anxiolytics—into the toxic cocktail, no doubt, to muffle the absurdly amplified anxiety and panic her unprovoked attack has evoked.?

Hmm. Meds to counter the trauma inflicted by coercive medication. Genius. “Given directly to PCV,” March 14th, declares Ms. Valusek’s official Record of Medications Dispensed.?

And this, my friends, isn’t just a medical curiosity. It could kill her. As Gerardo Sison, Doctor of Pharmacy, explains somewhere in googlespace:

Benzodiazepines should not be mixed. Taking Ativan and Valium together can lead to overdose. This, then, can lead to severe respiratory depression, coma, and/or death.

That’s right, coma or death.?

What’s more, benzos, according to a 2012 research paper by sleep scientists in the U.S. and Italy, “adversely affect sleep architecture” by significantly reducing REM sleep—which, they warn, is already in short supply if you’re hospitalized—thereby creating a “strong independent risk” of inducing (or, in this case, perpetuating) “delirium”!

All this due to conflation of perfectly innocent, four-day-old bite marks with my daughter’s perfectly understandable, six-year-old reaction to traumatic death and loss.?

Excuse me, while I mindfully breathe jets of blue flame and acrid smoke through the blackened grill of my clenched incisors, for just a moment. Ahhh.?

Okay, where are we?

Predictably, they place their floridly “suicidal” patient under 24-hour watch, like the mentally incompetent threat to society she has proven herself to be. Agitated, fer cryin’ out loud!

Through the wee hours of the night, too, they thoughtfully rotate her prison guards and bedside attendants every sixty minutes, like a clapper clanging in a clocktower, to ensure she’ll snooze as serenely as a breast-fed infant, without a worry in her pretty little head.?

Still, futilely, she attempts to escape. On top of everything else now, she fears her compassionate caregivers are poisoning her food and, uh, milk.?

What a funny girl.

* * *

The second I see her email at 3:39 p.m. U.S. mountain time, hours after the shitshow in Maputo, I dial Sloane-Dudley’s cell phone, pacing the beige carpet in my office at the Integrative Medicine clinic of Longmont United Hospital—(ironically) agitated.?

Beth’s been raped, I think, starting to hyperventilate. Why else would they be so vague?

“No,” Carrie says. “Elissa suffered a complete psychotic break. Thinks you murdered her mother. Needs psychiatric treatment they can’t provide in Mozambique. The only reason we can disclose this to you, in fact, Mr. Valusek, is because she’s mentally incapacitated.

“She’ll probably fly out of Maputo tomorrow. We’re planning to treat her at a facility in Washington DC . . . unless you’d prefer somewhere else,” she adds, tentatively.

“Bring her here,” I say, urgently, breathless with fear, “to Longmont, to the emergency department at the hospital. I know the head of Behavioral Services. They do psychiatric triage all the time. We can take care of her closer to home.”

“How would you describe your relationship with Elissa?” she asks, innocently.

“Beth,” I blurt. “We call her Beth. We’re close,” I say, stretching the truth just a tad.?

“What in hell brought this on?” I ask, hot springs erupting unbidden from my eyeballs. “Something must have happened to her!”?

“Seems like it came out of nowhere,” Carrie muses. “She did lose a lot of sleep last week, at a conference, but . . .” She trails off. Not a peep about alcohol. “We’re trying to figure out now if there’s a genetic angle. Eli—uh, Beth reported that her mother was bipolar?”

“Maybe,” I say, frowning. “I don’t think she was ever formally diagnosed. You think Beth might be bipolar?”

“That’s just one disorder that can present with psychosis. Schizophrenia is another. The first episode often appears in young adults around Beth’s age, I’m sorry to say.” Such a delightfully reassuring bedside manner.

Jesus, I scream inside my throbbing head. Schizophrenia! What if this is just the beginning of a revolving door of hopeless hospitalizations and endless medications? Will she have to live with this for the rest of her life?!

Dear god please no. (Be careful what you wish for.)

“What about sleep deprivation,” I interject, sharply, picking up both Occam's Razor and the clue she dropped. I had just read Walker’s Why We Sleep, scrounging for solutions to assist patients with chronic pain, most of whom, like me, suffer all sorts of persistent sleep disruptions.?

“I can’t tell you how many times I’ve seen this kind of thing,” she replies, obscurely, with a sigh.?

Foolishly, I assume by “this” she means sleep deprivation, that she—and they, the Peace Corps, and all my daughter’s attending physicians—understand the psychiatric impact of severe REM sleep loss, as I do. It isn’t rocket science. It isn’t even new news in the field.?

A ridiculously misplaced flicker of hope arises in my chest and throat.

Maybe, I think, all she needs is a good night’s rest.

* * *

Despite the artificial urgency of the emergency, the wheels of federal bureaucracy turn with glacial mediocrity, hence Elissa and her reluctant zookeepers—Drs. Alberto and Noorje—don’t board a plane until 6:50 a.m. Friday, a whole day behind schedule.?

Meanwhile, they keep pumping her full of fucking pharmaceuticals, to tame the wild beast.

When she arrives in Atlanta at 6:45 a.m., Saturday, March 17th, therefore, after a grueling transglobal journey of flights and layovers across six time zones (so far), not only is she gruesomely gorked and (still) grotesquely short-slept, but comorbidly jetlagged now, as well.

The intrepid trio meet up there with Dr. Sloane-Dudley, DNP, from DC, who takes custody of the prisoner and gets the skinny, from Noorje, on the horrifyingly “uncomfortable” incident Wednesday afternoon. With trepidation, I imagine, Noorje also hands over Exhibit A—those four, colorfully incriminating purloined pages of paranoid scribbles, which the Good Doctor reviews with relish.

In boring accord with her implicit bias, Carrie, like everyone else, narrowly views the whole debacle as confirmation that, indeed, Elissa has a psychiatric brain disease. I mean, why else would she so inappropriately reject the kind intentions of so many experienced professionals!

Poor thing. Just look at her. So sad.

Within hours, she’ll strut Elissa’s pages of crazy ravings across the stage, luridly retelling the exotic story of her brutal involuntary commitment both to me and to the triage specialist here in Longmont, with almost orgasmic ecstasy. I’ll squint at her, incensed at her insensitivity.

First, however, she calls me from Atlanta, to update us on the timing of their estimated arrival in Denver, around 11 a.m. Impulsively, I ask to speak with my daughter. Hesitantly, she agrees.

I talk to Beth as if she’s a child with nothing more than a boo-boo on her knee. I tell her I love her. She listens. Finally, she says, in monotone: “I still don’t trust you.” Hands the phone back to Carrie.

An iron anvil crushes my ribcage.

We decide it would be too disturbing for me to pick them up at the airport. I ask Carrie to ask Beth if she’s okay if John and Barbara meet her, instead. She says yes; they’re safe enough. I’m wounded beyond imagination.?

Her brother, the poet, eloquently describes the reverse culture shock awaiting Beth in Denver. Thankfully, his sensitive presence and personality rather cushions the blow.

In the airport, I asked if you’d packed African bowling balls

inside your oversized bag, after my offer to carry

your bulging luggage at the check-suitcase carousel.

You were like a time traveler from a clockless

darkness, reborn to an alien moment,

nowhere, and not your own,

slow to sync, with little overall to be said;

but you laughed, in fact, a glimmer

of the girl we knew, under the sheen of travel.

In all fairness, bits of psyche and soul were likely

still catching up to the heart, in the body,?

at Denver International Airport, some half dozen,?

thirty-hours-spanning sequence of flights later;?

a jarring ascent through six circles, if not

of hell, then through at least the baffling rings

of an alternate universe.?

The Western cadence of commercial American English,

with its grunts and faceless ghost-groans, in all its

jaded, dumbed-down, weary glory filled the air.?

How would this not slap-shock the spirit-nerves?

of one but one day previously immersed in

an old-ways, village-centric culture,

still perfumed in the customs and the dust

and the textures of her chosen home in Africa?

—John E. Valusek, "Baggage"

* * *

Sometime during her ultimate, mythic return journey—which will commence spontaneously six weeks from now—through old-ways, village-centric Africa, to look up friends and contemplate her frighteningly blinkered future, she’ll visit Phil, a Moz 28 volunteer in a town in the central province of Zambezia, who will tell me, months later:

With regard to her medical separation, she mentioned that she felt stupid about the whole situation. She didn’t really recall what happened during the days that led up to her evacuation, and once she was back in Colorado, she felt like she sort of just appeared there for no reason. Maybe she was in shock. I know that suddenly being moved from here back to the States is overwhelming for Peace Corps volunteers.

* * *

As if my daughter isn’t juggling enough balls of molten lava already, her ordeal continues for 48 more exasperating hours—first, in Longmont United Hospital’s Emergency Department, where our delusional Peace Corps Representative (the DNP, not the PCV) groundlessly transforms that benign mention of “writing with ink” on her leg into “stabbing herself with a pen” (I am not making this up), while distortedly reporting that Beth is “preoccupied with death.”?

Further fueling the phantasmagorical illusion that this young woman in “protective” psychiatric custody is suicidal. As if Carrie is consciously maneuvering, under orders from Orwell, to undermine Beth (and build an airtight case against her) at every turn of the twisted path.?

Advocate, my ass.

In an irony of, let’s see, international proportions—given Sloane-Dudley’s remit—this fine representative of the U.S. government is, today, in private practice in one of our rapturously retrogressive Republican states, diligently diagnosing diverse disorders and managing malignant medications, while teaching and speaking on (of all things) “moral injury.”

Which, in case you’re unfamiliar with the term, refers to the cognitive dissonance and emotional damage inflicted on those whose vocations require them to harm or kill other people.?

I wonder if this is, for Carrie, a form of penance. I certainly hope it doesn’t keep her up at night.

In any case, Beth is placed by the powers that be under yet another pernicious 72-hour M-1 Hold, Saturday evening, and shipped off after midnight (“too exhausted to sign” the requisite consent forms) in an ambulance to a residential psychiatric facility called North Forest Behavioral Health in Denver—where yet another inattentive, snow-blind mental health professional will nonchalantly pathologize her without a stitch of scientific proof.?

Stigmatizing her for the rest of her (abjectly abbreviated) life and issuing, in effect, if not intent, a sentence of social ostracism and solitary confinement.

Score two for evidence-based healthcare and “suicide prevention” in America!

Regardless of the mindless machinations of our misguided mongers of madness, early Saturday afternoon, a mere two hours after her arrival in the ER—resting quietly, tenderly attended by two therapeutically introverted members of her família Americana, especially her mano—my daughter’s battered prefrontal cortex lurches back online, and she allows her fearful father into the room.?

He sits down carefully at the edge of her bed, takes her hand, and gazes into her bleary blue eyes. “Hi,” he says, blinking back tears, trying not to embarrass her unnecessarily.?

She replies softly, “Hey, Dad.” And slips him a crooked smile.?

By Sunday afternoon, free of dastardly shoelaces or belts or pointy objects, Beth is entirely herself again. Sans meds. Flushed, now, of those noxious neurotoxins. Bored, painting childish watercolors, rolling her eyes, and jotting down psychologically astute observations of her babysitters and fellow inmates on the backs of bland institutional handouts.

Scribbling again with impunity. Rational, this time. No tinfoil hats.

At noon on Monday, March 19th—ten days since her last drink, and seven from her initial, ill-fated cry for help—my darling daughter is discharged (36 hours early) from her last, fruitless exercise in psychiatric theatre. Pooped, but nearly recovered. Having received, again, no “treatment” whatsoever.?

Apart from several beatific stretches of unencumbered slumber. Almost by accident.

(Price tag for two days of substandard room and board, without privacy: $26,298.)?

Duly humbled, incrementally wiser, she’s ready to return home to her beloved community, to pick up where she left off, to refocus her energies on the “underserved Makhuwa-speaking population of Metarica.” Having learned a few, abominably painful lessons about party friends, psychoactive substances, sleep deprivation and (tragically) . . . the risks of asking for help.

“I understand,” she journals, “how to prevent this from ever happening again.”?

An unfortunate double entendre, if ever I heard one.?