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

35 – Is Marrying Absurd?

An unpublished essay.

Photo: CW

The night before our wedding my fiance and I sat bed with glasses of wine and I read aloud Joan Didion’s essay ‘Marrying Absurd’. I am always rapt by her diamond-cutter prose. Chris was not. He stared at me in the silence after the final sentences, wide eyes asking: What are you trying to say?

“Another round of pink champagne, this time not on the house, and the bride began to cry. ‘It was just as nice,’ she sobbed, ‘as I hoped and dreamed it would be.'”

His wide, wary eyes signaled perfect comprehension. He knew I was using Didion to ask the question I couldn’t. Are we doing the right thing?

On our first date we went to a Mexican restaurant with orange walls, purple tables, and a crowd of drunk Santas in running shoes. We both ordered vegan mole, looked at each other and said, “You too?” Two margaritas on the rocks, salt for me. My body was strange. No crackle-and-static of attraction but expansive euphoria, as if every electron in my blood had leapt an orbital, opening me from the inside out. I’d never seen such eyes: a coruscating handful of sapphire chips.

I lived in Spain at the time; he lived in Memphis. For the next few months we found ways to meet in London, Manchester, Brussels, and Rome. We hoarded time together, constructed intimacy from daubs of conversation and torrents of text. At the end of the year, inevitable as a rock rolling down a cliff, I moved to Memphis. One night we sat in bed, where we conduct most of our powwows. He was adding me to his car insurance. When it came to the Relationship blank he looked up: “Fiancee?”

Sure, I said, why not.

A couple of weeks later, for my birthday, we rented a cabin in Arkansas. It was too cold to sit on the porch swing and watch the stars blaze so we sat on padded vinyl dining room chairs to eat rice and beans washed down with red wine.

“Are we really going to get married?” I asked.

“Do you want to?”

“Yes.”

“Good.”

Why marry? We don’t want children and I won’t take his name. Our bank accounts and tax returns will stay separate. We don’t believe in God, monogamy, or the sanctity of marriage.

Yet by our second date I wanted to marry him. Not just be with him. Not just be his girlfriend/partner/significant other. I wanted to be his wife, with all the weight that word carries; wanted him to be my husband. Not because those words are a talisman against conflict or even heartbreak – everyone knows they aren’t – but because marriage (however devalued, degraded, or deflated) is our culture’s apotheosis of commitment. Like the Supreme Court, it is fluid and fallible, but still the last word.

Wanting to be married, though, and marrying are as different as climbing the ladder to the high dive and jumping off.

Photo: CW

Chris and I were in down town Las Vegas just after Christmas. We drove past wedding chapels that caught Didion’s gimlet eye fifty years ago, parked in a cavernous underground lot, surfaced at Best Buy and wove through steel drummers, midget Elvis impersonators, and bikini-clad girls dancing away the cold on Fremont East. “We could get married in Vegas,” we teased, testing each other. Instead, we found a Mexican bar and drank jalapeno margaritas. Not wanting to marry in Vegas had something to do with the vision of Joan dancing in my head. But she wasn’t writing about Las Vegas eo ipso. It was journalistic shorthand for dangerous impulsiveness, failure of decorum, fractured social mores.

Didion’s specific grievance with Las Vegas was that its wedding chapels were “merchandising ‘niceness,’ the facsimile of proper ritual, to children who do not know how else to find it… how to do it ‘right’.” Inverted commas notwithstanding, she suggests that parents, at least some parents, know how to do it right.

Believing that must help. Children of happy homes can borrow courage. Skin puckering in the chill, toes hooked on the beef-tongue surface of the diving board, they can at least look down on faces that made the leap and emerged smiling.

Those of us with no family account of goodness or goodwill stand alone. Poised on the proverbial edge, we can only count the mistakes, comic and awful. My mother hooked up with my (still married) father while pregnant with another man’s child. Chris’s mom married and divorced three times, one on either side of his dad. In fact, his parents’ marriage was annulled by Papal pronouncement which makes Chris, technically, a bastard. The second time around, his dad went for a straightforward decree from the State of Arkansas. My dad’s second divorce was in Alaska; the first who knows where.

Then there’s our previous marriages. Mine ended with a gentle parting from a friend who happened to be my husband. His came with the sting of surprise: an email with legal papers and a note to say his stuff was in storage.

Nine divorces altogether. Worn notes of anger, betrayal, and disappointment bundled and stashed like junk bonds. We’d be fools to not wonder if we’re being foolish.

And.

Every card Didion played as a damning signifier of what it meant “to be married in Las Vegas, Clark County, Nevada” in 1967 – well – Memphis, Shelby County, Tennessee will see and raise in 2017. Like Vegas, Memphis “demands no premarital blood test nor waiting period before or after the issuance of a marriage license.” Unless the celebrant is 17 or under, in which case Shelby County imposes a three day wait. In other regards this Delta city is as careless in love as any neon-spangled desert oasis.

Photo: CW

Want to cut down on the ten minutes it takes to apply in person? Fill in the online form then collect the license at the county clerk’s office.

Previous marriage, or a few? No problem. Choose a number between one and thirty-one on the drop-down menu. It will ask for the date of your divorce(s) but don’t worry if you don’t remember. Neither clerk nor judge will request any proof of dissolution.

Once you receive a license you have 30 days to marry.

Chris and I took forty-eight hours.

“Dressing rooms, Flowers, Rings, Announcements, Witnessess Available, and Ample Parking,” Didion writes. “All of these services, like most others in Las Vegas… are offered twenty-four hours a day, seven days a week, presumably on the premise that marriage, like craps, is a game to be played when the table seems hot.”

We married at 12:30 on Thursday the 9th in Room 226 of Shelby County Courthouse. Before us went a group that fit Didion’s description of “actual wedding parties… The bride in a veil and white satin pumps.” What would she make of my well-worn silk dress, fishnet stockings and vintage heels? Chris’s charcoal Merino sweater and Doc Martin Chelsea boots?

The judge twinkled and swished in his black satin robe. Potted plants with thick stems and dark, glossy leaves lined the window, tinting the bright, thin February light semitropical green. Beyond, a wind-scrubbed blue sky. I held Chris’s hand, bracing myself for a spasm of doubt that never came. My spine stretched like a tether drawn tight between my buoyant heart and the anchor of his touch. Tears softened the blaze of his cobalt eyes.

My name echoed like foreignly in my ear as I repeated the vows, but my tongue didn’t fumble.

“Will you love, honor and cherish… till death do you part?”

“I will.”

Walking to the car I found a way to hold my handbag so the wind didn’t froth my skirt. There were still forty-five minutes on the meter. “We should do something,” my husband said. So we went to our favorite taco spot for Prosecco and black-eyed pea hummus with corn chips.

‘Marrying Absurd’ appears in Didion’s classic essay collection Slouching Towards Bethlehem. Its eponymous centerpiece opens with this report: “The center was not holding…. Adolescents drifted from city to torn city, sloughing off both the past and the future as snakes shed their skins, children who were never taught and would never now learn the games that had held society together.”

Photo: CW

Chris was born in Arkadelphia and lived in Salt Lake City as a baby. He was raised in Little Rock, branched out to Baltimore, bought and sold houses in Moline, Charlotte and Memphis, all while travelling 200-plus days a year. I lived at dozens of addresses in four countries by the time I was thirty. We live out of suitcases and send mail “care/of”. Movement is a choice, a manifestation of our mistrust in the games that are supposed to hold society together. Marriage is not, appearances notwithstanding, a contradictory choice. We’ve studied and sifted the claims of religion, society, and status quo. We spent long, separate years learning who we are, what we want, and what we are prepared to do. So we can take from ritual as much as has meaning to us, and leave the rest without regret.

Marrying is absurd. So are all acts of courage. For those of us whose accumulated experience of marriage veers from farce to disaster, to marry is to stake a claim to our own lives. Marriage is precious to us because we know how easy it is to fail, to fall apart. For us, to marry is a refusal to be defined by the past. It is a pledge to believe the best of one another. To say we’ll try again, no matter. To love again, love better.