40 – Dodging the Magic Bullet

A version of this piece was published in Transition, a Canadian magazine on mental health.

Photo by Ross Sneddon on Unsplash

In 1980, the year I was born, the board of directors of the American Psychiatric Association voted to allow pharmaceutical companies to offer paid symposiums at its annual conference. Thirty years later I was sitting on coarse beige upholstery in a doctor’s surgery in Glasgow. “Are you sure the results are normal?”

He sighed and repeated that my blood, hormones, iron level and thyroid were all fine.

Disappointment lodged in my oesophagus. Please tell me something’s wrong: hypothyroidism, Vitamin D, anaemia, hormone imbalance, anything.

I had moved to the rain-wracked west coast of Scotland to do a Master’s degree in writing but, after a few weeks, I could barely read. Obsessive thoughts snarled and snapped: you’re stupid, you’re hopeless, you’re a failure. Glasses leapt from my hands at my part-time waitress job. Burns crept up my arms as my reflexes slowed. My boss reprimanded me for being “snappish”. I craved sugar, wolfing my flatmate’s ice cream and cereal then slinking out the next morning to replace them. I slept 12, 15 hours a day, exhausted by the weight of my body.

One more test. The doctor gave me a single sheet of paper. I tend to score well on tests; this was no exception. The Beck Depression Inventory1 is a common screening for depression, intended to “identify [its] presence and severity”2. He skimmed my responses about sadness, guilt, irritability, hopelessness, sleep disturbances, and suicidal thoughts.

“I’ll write you a prescription.”

“Is there someone I can talk to?”

Referral in hand, I walked to another basement office.

That doctor cut me off after ten seconds: “Do you want a prescription?”

He huffed audibly. “If you want to talk to someone go to the counselling service. All the other American students are on meds.”

***

In Anatomy of an Epidemic award-winning journalist Robert Whitaker describes how the “notion that [pharmaceutical] ‘magic bullets’… would bring miracle cures”3 became psychiatric dogma — despite the fact no one fully understands the organic processes of mental illness. Do psychotropic “bullets” hit their target? If so, what happens? No responsible physician would prescribe thyroid and hormone treatment without a lab test. But nobody checked my serotonin or dopamine levels. My doctor had never seen me before. He knew nothing of my family, temperament, or situation, but on the basis of 21 questions offered a drug that would dramatically, maybe irreversibly, alter my brain chemistry.

Photo by Aliane Schwartzhaupt on Unsplash

The most common antidepressants are selective serotonin reuptake inhibitors (SSRI)4 like Prozac. As it happens, I spent several years toying with a fast-acting antidepressant. Methyl​enedioxy​methamphetamine, like SSRIs, boosts serotonin levels in the brain. It obliterates unhappiness in a rush of euphoria, confidence, clarity and empathy. Everything is better: music, lights, colour, conversation, friendship, sex, and cigarettes.

Until the comedown.

“Suicide Tuesday” was a semi-serious joke among club kids. We compared notes on nightmares, hallucinations, and memory loss. We counted the days till jaws stopped aching and appetites returned.

Prozac is legal but brain chemistry is no respecter of legislation. Trials on SSRIs show that “rats fed high doses… ended up with neurons that were swollen and twisted like corkscrews”5. The human evidence is compelling: the Food and Drug Administration received 39,000 complaints about Prozac in the nine years following its approval, including reports of suicidal and homicidal outbursts, “psychotic depression, mania, abnormal thinking, hallucinations, hostility, confusion, amnesia, convulsions, tremors and sexual dysfunction.”6

***

Instead of antidepressants I took the second doctor’s advice and went to the student counselling service. Every Friday afternoon between three and four (after dark, for most of those moths) I went to a basement room where a white-faced, gold-rimmed Seth Thomas clock sat in a disused fireplace. A tiny glass pitcher and two small glasses stood on the hearth beside a box of Tork tissues. I had fold them in half to blow my nose.

“I’m scared.”

“Of what?”

“I feel like I’ve lost control.” I threw another fistful of sodden tissues in the bin. “You know the Rolling Stones’ ‘Paint It Black’? It feels like that.”

Words that come to mind now are no less true for being clichéd. Nouns: storm, cloud, void, chasm, maelstrom, black hole. Verbs: choke, crush, frighten, smother, horrify. Adjectives: miserable, catatonic, helpless, damaged, trapped, angry, sad, frustrated, lost.

***

In 1988 the United States Food and Drug Association green-lighted Prozac and America’s National Institutes of Mental Health set up the Depression Awareness Recognition and Treatment (DART) program. Its mission was to promote “greater acceptance of depression as a disorder” and, perhaps not incidentally, spread the word that “antidepressants produced recovery rates of ‘70% to 80% in comparison with 20% to 40% for placebo.”7 Eli Lilly, which held the patent on Prozac, helped pay for eight million DART brochures that highlighted the merits of serotonin-boosting pharmaceuticals.

***

Photo by Wherda Arsianto on Unsplash

If you’re trying to dodge the magic bullet you need other weapons. I’ve been running since age 13, hooked on the peace and clarity that follows the effort. In Glasgow I got up at 5:30AM, pulled on ski socks, leggings, sweatshirt, jacket, hat, gloves and battered Sauconys then ran for an hour. I swapped my restaurant job for a coffee shop and found comfort in the routine of making espresso, toasting sandwiches, and gossiping with the regulars. At home I baked caraway rye bread, bagels, and lemon cookies to combat the chill seeping through the single-glazed windows. I bought kilos of oranges and taught myself to make marmalade; experimented with vegan mac-and-cheese and coconut milk smoothies. On black afternoons I tiptoed up the ice-slick hill to the gym and did squats, bench presses and seated rows. I used holiday photos for bookmarks and saved quotes on index cards: “A book must be the axe for the frozen sea inside you,” wrote Kafka.

***

“In a [1998] World Health Organization study of the merits of screening for depression,” writes Whitaker: “Those diagnosed and treated with psychiatric medications fared worse – in terms of their depressive symptoms and their general health – over a one-year period than those who weren’t exposed to the drugs.”

***

One year is 365 days of wondering why am I still breathing? It’s a long time to resist the temptation to drag the tip of a knife down your arm just to see how it feels. I scurried and feinted but depression was a patient cat to my mouse. There were still tears in writing workshops, still mornings huddled beneath the espresso machine gnawing my fingers, still cake binges followed by penitent cups of vegetable broth.

Depression is a black-hearted octopus tenderly, insistently probing for weakness. Resistance is the only secret to survival; fight the beast with every cheap, inadequate weapon at your disposal. Work and running were my best allies. I got better at snatching pleasure and being selfish about delight. When insomnia chipped at my fragile defences, I went to the doctor for sleeping pills. At the end of the year I left Glasgow, bruised but stronger. A magic bullet might have been swift relief. But the grit, patience, and humility I learned on my way are side-effects worth having.

Photo by Nathalie Désirée Mottet on Unsplash

Do Less, Accomplish More

Sleeping in

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Photo by Zohre Nemati on Unsplash

Over the holiday period I’ve fallen into the habit of sleeping till 9 or 9:30 – some 90 minutes longer than my usual routine. For the pats few days, I set my alarm for the normal hour, but hit the off-button and go back to sleep. This feels indulgent, borderline sinful, most certainly lazy.

On the night of 1 January, my husband and I settled in to watch The Big Lebowski.

It was an individual favorite when we met; since then, it has become a totem for our relationship – a source of private idiom and in-jokes on loop.

The opening voice-over informs us that the Dude was a lazy man. What a contrast, I thought, to the expectations a new year brings.

Resolutions

New Year arrives with a cultural imperative to improve. What are your new year’s resolutions?

The noun resolution, in this sense, alludes to a determined wish, or decision.

It is worth remembering that another definition of resolution is ending, or conclusion.

Linguistically, all unwitting, we start the new year by demanding conclusions.

Is it any wonder they fail to materialize?

If there is one thing writing teaches it is that you cannot force a conclusion. They are reached by patience, effort and serendipity.

Let it be

The Big Lebowski is a tale of serendipity.

Sheer coincidence brings together two characters who clumsily try to exploit their chance encounter. The lostness of this cause is what makes the film funny; the universality of the impulse to connive and manipulate makes it poignant.

That The Dude comes off better in the end has nothing to do with effort and everything to do with his ability to, in moments of crisis, tune out and go bowling.

The other foot

As a stone type A, with a self-perpetuating to-do list I love Jeff Bridge’s character because The Dude is my antithesis.

Worry… it’s how I stay in shape, poet Maggie Smith writes in ‘Let’s not begin’.

Me too.

I crave resolutions – the conclusion kind – and if one isn’t plain I’ll fret all day and toss and turn all night, trying to wrestle one into being. If I can’t see how a thing will turn out, I’ll manufacture an ending, toss a match to see what sparks.

Wearing out

This leads to plenty of fractured nights, followed by days where tiredness clouds my senses like swamp gas. The demons of weariness are legion: irritability, forgetfulness, poor hand-eye coordination, binge eating, anxiety, tearfulness. If I get less than eight or, preferably, nine hours, they swarm – shattering my mood, judgment and productivity.

Given my love of ticking items off a list, you’d think that alone would be enough to ensure I got enough rest, but something in my wiring (Puritan genes + protestant upbringing perhaps) gibes me to try harder.

One of the first rational things lost when I’m tired is the ability to admit I need a break.

Instead, I try to fix myself by doing more.

I’m almost done…”

My husband has heard these words too many times to count. They are always a lie. He’s learned to spot them for what they are: a self-sabotaging effort to put my life and spirit in order by crossing off one more line on my to-do list.

Being the partner of a perpetual fixer must be a massive drag. The nearest I got was a long-running infatuation with a man who refused to date me because he had to much to do. At the time, I thought it was a terrible, bogus excuse. We stayed friends, though, and now I’m grateful to have someone who understands the ridiculous compulsion to seek solace in busy-ness.

Even The Dude falls into this trap, lamenting that his thinking had gotten very uptight.

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Photo by Tiago B on Unsplash

Corridors without doors

When I get tired, my brain ceases to create and wallows in endless grooves. Instead of romping through fields of possibility, it marches along grim, fluorescent-lit corridors without doors. Inspiration and joy are things that happen to other people, in other places; for me, the grindstone, the factory clock; the slow treadmill.

This is lethal for my writing, and sense of self.

As someone who struggles to stay ahead of clinical depression, self-care is essential. Skimping on sleep is the first domino; next come exercise, eating, socializing, work, creating. Then the need to do more panic kicks in and flattens what is left of a painstakingly built structure.

Do less, accomplish more

My guilt at “over”-sleeping is rooted in a real fear that it’ll turn me lazy, like my good friend The Dude. Life is no movie, my brain chides. In the real world, the other Lebowski was right – you gotta get a job.

Yet this fixation with being busy is, as many wise souls have remarked, antithetical to actual accomplishment. Presenteeism is malingering for suck-ups. Most of the things I busy myself with, from house cleaning to answering email, have little bearing on the things that bring me satisfaction and joy. These things – reading, writing, time with my husband – get shoved into corners and fed scraps of my energy and attention.

Fail again

Instead of resolutions, I made a list of new year’s goals. It felt good to write them down, better to fantasize about completing them.

The next day, I woke under a cloud: sad, drained, mind blank. After drinking coffee, I got back into bed and cried for no explicable reason.

It felt like I’d put too much of myself on that page. Once again, I was looking for validation in tasks, instead of being open to what a new year might bring.

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Photo by Stijn te Strake on Unsplash

Start simple

Later, my husband and I went for a walk. The sky was bright and the air smelled of wood smoke and bales of sweet straw. We said hello to cows and picked windfall apples. The world began to resume its correct proportions. Cresting another hill, I realized it was time to edit the new year’s goals: sleep, move, eat, love. Everything else will come.

How will you honor yourself this year? 

Blame it on the rain

Why do I feel uprooted (panicked, dismayed, trapped)?

I blame a four-letter word: Rain.

Remember Milli Vanilli? I was nine when “Blame it on the rain” came out. We weren’t supposed to listen to “secular” music but my big sister sneakily tuned in Casey Kasem’s Top 40. The chorus never left me: “Blame it on the rain/that’s fallin’ fallin'”.

 

Growing up on the central Oregon coast rain was a constant. The occasional days a high north wind pushed away the clouds were bitter. Wet and cold were the warp and woof of my childhood. They crept past windowpanes and under doors of the crumbling ex-holiday cottage where we lived. The small, square black wood-burning stove and ancient electric heater never made a dint.

The other constant was the wild fluctuation of my father’s moods. Fear permeated the air like water, raised goosebumps like a chill.

The things I carry

My brain learned, fast and young, to blur the present and project itself to the safety of the future. This let me survive and escape. It also sapped my ability put my experiences and emotions in context, leaving vast gaps in my self-awareness.

It took moving to Glasgow in an unusually cold, wet year to acknowledge rain’s hold over me. Rainfall elicits anxiety, hopelessness, depression, anger, helplessness. I feel like a child again.

Living in Glasgow catapulted me into clinical depression. I wanted to die; also, stubbornly, I wanted to live. Which, at that point, meant leaving as quickly as possible and promising myself to never again live somewhere that required GoreTex.

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Photo by Milada Vigerova on Unsplash

Plotting the resistance 

Now, I’ve broken that promise in style, husband and cats in tow.

Maybe it’s a dumb risk to leave a lazy, sunny town for a cold house in rain country, thereby putting my mental health and relationship on the line.

How else can I overcome my fear of rain?

I don’t want to be a prisoner of my childhood anxieties. Avoiding uncomfortable emotions and circumstances is a strategy, not a solution.

To be happy anywhere, I need to cultivate my capacity to be happy everywhere.

As Rainer Maria Rilke wrote:

People have (with the help of convention) found the solution of everything in ease and the easiest side of easy; but it is clear that we must hold to the difficult…. We know little, but that we must hold to the difficult is a certainty that will not leave us; it is good to be solitary, for solitude is difficult; the fact that a thing is difficult must be one more reason for our doing it.

Whatever the year brings, I want to live with intention and integrity, in the rain.

 

Uprooted

Life in motion

My husband and I just moved house. Actually, moved to a house across the country, with our three cats and a motley assortment of possessions in a hired camper van.

Haphazard, yes, but not the worst of my moves. That would be the time I had to drag my possessions across town in a suitcase because I didn’t have a car; or the time I had to leave my cat with my ex-boyfriend because I was moving across the Atlantic.

This move was anticipated and embraced.

Until it happened.

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My road warriors

Feeling the fear

No single thing triggered the panic. It is the house’s accumulation of dust, spiders, cobwebs; the discarded shoes in cupboards and underwear jammed beneath beds. It is lukewarm water, cold floors and incessant rain.

Panic started in my belly, rose, rolled around. For my husband’s (and cats’) sake I’m trying to quell it but the effort is short-circuiting my brain. I can’t understand simple statements, nor follow directions.

It took all my willpower to not utter the phrase “I want to go home” — that and the knowledge that I can’t. Not after quitting my job, ending our lease, and spending all our money to move here.

Get up, or give in

Right now, I want nothing more than to curl in a ball and weep. I want to tell someone, anyone: “I’ve made a mistake, please let me go back.”

But of course, that’s not an option. Chris is already back at work. The cats are doing their best to acclimate. It’s still raining.

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Three’s company

I’m scared. But somehow, I have to keep moving.