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

22 – Glasgow Stories

These are unpublished, linked flash-fiction pieces. Contain strong language.

Photo: Cila Warncke

The Teacher

The aristocratic houses along Park Circus, above Kelvingrove Park, look like mausoleums and for much of the year must be as cold. A triumph of wealth over pragmatism, they boast lofty ceilings and vast windowpanes unsuited to the bitter climate. They hold themselves frigidly above the street, conscious of their status as monuments to consumption. The builders intended them for men rich enough to afford endless fuel. Now they rise in listed splendour, proud architectural affronts to democracy. I imagine the inhabitants prize their expensive discomfort.

My students are unmoved by the honour of being chosen for special study sessions. The group changes every other week, but they all look alike. The boys are thin, their truculent adolescent faces sharp and pale as wedges of cheese. They wear Nike or Adidas tracksuits and hoodies, or jeans belted below the hips. Despite their collective swagger the boys are careful to not infringe on the scented feminine clusters that form around forbidden iPhones. The girls are coy, aware their power lies in commanding attention. They flutter, fiddling with necklaces and earrings, or combing strands of hair with bright acrylic nails.

None of them take an interest in my lessons. They are obedient and indifferent. I am a novelty, like the star-nosed mole I point out on a trip to the zoo. “Do you like living in Glasgow?” One asks. Another: “Do you have a girlfriend?” These questions are automatic. The products of a lifetime habit of using interrogation to distract authority figures. I tell them I am interested in post-industrial cities, wondering if anyone will ask me what I mean. No one does.

“Did any of your family members work in the shipyards?” I ask once.

A girl looks at me pityingly: “It’s lunchtime, you know.”

They regard the future with suspicion. Like misers, they are averse to even modest speculation. “What do you want to be?” I ask. “If you could visit any country, where would you go?” The girls’ eyes flicker like snake tongues. The boys nudge each other. At first I thought this was a silent protest against my accent, age, and shirt-collar. But my self-consciousness exceeds their curiosity. Glasgow is the universe; I’m a transient alien.

Photo: Cila Warncke

The Friend

I walk from town early, as the shopkeepers and street-sweepers perform their daily rituals of addition and subtraction on Woodlands Road. Passing taxis throw sheets of water across the pavement. The shop windows contain rickety furniture; mediocre paintings; comic books; or sour-smelling vegetables. A mattress slumps against a parking meter, the legs of a decapitated office chair poke the air next to it.

Alma works in a coffee shop with frosted-glass tables and bookshelves lining the walls. The first time I went in she overheated my cappuccino and, smiling, urged me to try an almond croissant. There was something in that smile I couldn’t place, a kind of play-acting. Calum was her lifeboat. Her eyes held premonition of the end but she hung on, even as the waves ran high towards the rocks. Mornings, he would dash into the shop on his way to work. Jeans sagging with the weight of keys, wrenches, pliers and a spare sprocket; Adidas baseball cap rearing back from his forehead. After he left Alma would stand by the espresso machine, arms crossed, eyes distant. Glasgow’s West End pulsates freely with details of private lives. She made only perfunctory efforts to mask her unease. I would see them walking, her hair brushing his shoulder as she tried to match his stride. Many cappuccinos later, after we become friends, she volunteered information. Her smile hid a terrible need to be heard.

One Friday I asked her what she was doing that night. “I have a spare ticket to a show, would you like to come?”

She said, lightly as she could: “Sure, what time?”

I asked her out most Fridays after that. She was always non-committal. If Calum was there when I passed the café I would go to the cinema. Otherwise, I would go home and shower. By the time I was dressed there would be a message: “Want to get a drink later?”

You walk down half a dozen steps to enter the Drake. On the left a gas-fire, straight ahead amber whisky bottles twinkle in a setting of highly polished cherry. She drank Glenfiddich 15, neat. “It’s Calum’s favourite.” She tried to not mention him but always slipped. Calum. She would mould the word carefully with her lips then glance away, or push the whisky glass back and forth between her middle fingers.

Photo: Cila Warncke

The Lodger

Rupert Street runs perpendicular between Great Western and Woodlands Road. A square tower of yellowish brick rises above the rust-coloured tenements at the junction with Woodlands Road. At the corner is a pub, the pavement marked by coronas of vomit. In weeks of walking this street I can count on my hand the number of times I have passed another human. But detritus hints at life behind the blank windows. Someone has placed a half-drunk bottle of Irn Bru inside a horizontal refrigerator. A bike with one wheel is chained to a lamppost. Cigarette butts cluster on the pavement in front of some doors, tiny piles of dog shit near others. Perhaps the inhabitants are elderly, or just lazy.

I arrived here after my city centre flatmate came home drunk one night and urinated on the television. Calum and I met by chance. If I had thought he would offer me a room I might not have mentioned my housing difficulties, but he did and it seemed foolish to refuse. There are other coffee shops.

Calum and his father Alan live at number 10. Moving in, I slipped on a worn concrete stair and twisted my knee. “Sorry,” Calum said, pushing his hat back. “There’s no point fixing it till the workmen finish. They’ll just fuck it up again.” It was originally a three bedroom flat. His father divided the master bedroom: half for each daughter. This arrangement no longer serves a purpose but Calum and his dad occupy the flat as if the women were still there. The builders have knocked through the wall but Alan is in no rush to reclaim the master bedroom. He urged me to make myself at home and wrestled in a mossy log of a sofa. The springs gouge my back.

I don’t know what Alan does for a living. Sometimes I walk to the kitchen in my shorts, thinking I’m alone, and he’s slumped on the sofa, watching chat shows on mute. He sits up, tugs at the frayed sleeves of his cardigan and smiles nervously, revealing absent teeth. Calum is missing the same premolar, as if they were removed in some atavistic ritual. Their voices are indistinguishable on the phone. Most nights they eat pasta and garlic bread, or chicken and chips from Styrofoam boxes. Since Calum’s mother died they have built a cocoon of habit.

I am a permanent house-guest. To be a lodger you need to be ignored and slight quirks in their domestic rituals betray an awareness of my presence. Alan runs the tap when he uses the toilet. If Calum is home when I return from work he loiters while I heat up soup and butter bread, bragging about cars he’s fixed and girls he’s groped. I know his anecdotes are fiction but something in is eyes make me ashamed of my scepticism.

Photo: Cila Warncke

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.

rain1.jpg

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.