Tag / self-care

by Cila Warncke

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
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by Cila Warncke

16 – Letting Go of Emotional Baggage

Gradually, my writing moved beyond all music, all the time. There is a heart of darkness in Ibiza’s club world; the shadows got long. It was time to look at things differently. This piece was written for Tiny Buddha. You can read the full article here.

Photo by Waldemar Brandt on Unsplash

“Sometimes the past should be abandoned, yes. Life is a journey and you can’t carry everything with you. Only the usable baggage.” ~Ha Jin

You’ve probably heard of the fear of missing out but what about the fear of letting go?

My father was volatile and mentally unstable. Criticism was his preferred method of communication. As a child and teenager, I learned to keep my thoughts and feelings locked away and became an expert at deflecting personal questions.

Without realizing it, I carried this habit into adulthood, avoiding any talk about my feelings or turning them into a joke. When a friend finally called me on it, the shock of self-recognition quickly turned to resistance. This is who I am, I thought. Why should I change?

I plodded on, working as hard as ever to keep my fortress intact. It wasn’t making me happy yet I wasn’t ready to change.

As I struggled with my desire to cling to hurtful memories and self-defeating behaviors, it dawned on me that I was afraid to let go because defensiveness was part of my identity.

The problem wasn’t that I had baggage—everyone has baggage—but that it had come to define me. I didn’t know who I would be without it. At that point it hit me: I had to dig deep, discover the person I wanted to be, and then act on it.

After I identified that I was holding on to the past because it seemed too important to jettison, I discovered that letting go is harder than it sounds. Relaxing a long-held belief isn’t a one-day, one-week, or even a one-year process. However, it is possible.

Read the rest at Tiny Buddha.

by Cila Warncke

Embodying Empathy

It is apropos that I missed posting last week due to lack of sleep. My tiny black ninja cat decided that 2:30AM was an excellent time to sit on my pillow and conduct intensive grooming. If you’ve ever had a cat bathing in your ear, you’ll understand why this put a kink in my sleep schedule.

A day later, Chris had a trip so we were up at 5AM to get him to the train station. Then something came up workwise and I had to get up early the following day to write.

black cat

Photo by Hannah Troupe on Unsplash

Just a normal conflux of niggles and responsibilities, in other words, but enough to throw my system into a spin. My mouth was dry, my head ached, I yelled at the cats for getting underfoot. A layer of chill wrapped me that had nothing to do with the cold, damp day. Every small task was aggravating, painful, like a shoe-bound pebble that swells with each step.

As an adult with, heaven help us, responsibilities, it is up to me to negotiate sleep deprivation without becoming a danger to myself or others. Babies, on the other hand, are immune from expectations about how they should act when they are tired. Well into childhood, Richter scale meltdowns are excused because “s/he’s tired”. Rightly so. Being tired is harmful to health. According to the International Journal of Endocrinology, “sleep deprivation and sleep disorders may have profound metabolic and cardiovascular implications.” It is, “adversely affects the physical wellbeing and quality of life of participants, demonstrated in bad mood, somnolence, and tiredness” (Journal of Family Medicine Primary Care).

Babies, kids, are responding appropriately when they have a tiredness-induced crying jag or temper tantrum; their bodies need rest and are wired to seek it at whatever cost to adult sanity. This is reasonable.

What isn’t is that as adults we expect/are expected to have a different – unnatural – relationship to sleep. Instead of acceeding to our physical needs, we are supposed to keep going, as if our bodies are wrong for needing what they need.

work

Photo by Carl Heyerdahl on Unsplash

Cultural deprivation

There is a certain cultural tendency to fetizishation of work at the expense of sleep. Margaret Thatcher famously slept four hours a night. “For the Iron Lady four hours was a badge of almost superhuman strength. It fits the narrative of the “warrior” prime minister…” wrote Tom de Castella in a BBC News Magazine piece. The same article noted that Trump claims to only sleep three hours a night.

That suggests something with deep implications.

As a baby, we are begged to sleep; as a small child, we are made to sleep; as an older child/adolescent we still have bedtimes or curfews. As a young adult, we have the giddy freedom of being able to stay up as late as we want – and do all sorts of dumb things as a result. Then, at some invisible point, we suddenly find ourselves expected to function perfectly, whether we’ve slept or not. We’re running to stand still and those bitterly resented childhood naps sound idyllic.

This was my experience, in any case, with minor variations. When I was very small and expected to take an afternoon nap I’d lie awake, telling myself stories to pass the time. Staying up till midnight was a once-a-year occasion, a thrilling New Year’s Eve pressed up against a space heater, eating Planter’s Honey Roasted Peanuts, turning pages with sticky-sweet fingers until the clock reached 12.

When I was a young adult, immersed in music and club culture, midnight was a starting rather than an end point. The delirium of those years seemed, at the time, like part of the fun. Now, I feel anxiety amounting to dread at the thought of being out at two or three in the morning, much less four or five.

Unrested = unhinged

When duty and distraction combines to keep me from sleeping my first reaction is anger. And, because I’m tired, it is irrational rage. I am minimally patient at the best of times; sleep-deprived, I’m plain mean. I lose the ability, or will, to see things from a different perspective, or have a sense of humor. Incidental slights – a rude driver, a slow shopper – become personal affronts.

Is it coincidence that a three-hour-a-night sleeper is unhinged and meglomaniacal? Or that a four-hour-a-night sleeper was willing to crush entire industries and thousands of lives on an ideological whim?

Trump is, and Thatcher was, remarkable for lack of empathy shading into brutality. It is horrible to witness; like a toddler’s tantrum, a sign of something amiss.

It makes sense, though, that people who deny their own basic needs are willing, even eager, to deny the needs of other. I feel bad, so why should you feel good?

A couple of years ago I had a student who responded to a prompt about homelessness with a devestating account of her own struggle with poverty, homelessness and mental ill health. It was a brave thing to write. Her conclusion shook me: “Nobody ever helped me, so I don’t think they deserve any help. If I had to do it myself, so should they.”

There is a cold, undeniable logic to her statement, but it is a building block to a society I don’t want to live in.

kindness

Photo by Matt Collamer on Unsplash

Cultivating kindness

We have two options: value ourselves and others; or not. If we truly value ourselves, we can’t denigrate others; if we don’t value ourselves, we can’t then magically summon goodwill towards those around us. For all our intellectual capacities, we operate as physical beings. When we are rested, nourished, and secure, we are capable of being expansive, creative, contributing members of society.

If anxious, tired, and hungry, we can’t think about anything beyond meeting those immediate needs. We can scrape by for a while, but we can’t consistently deprive ourselves of essentials without getting pinched and wild-eyed.

Kindness has to begin with ourselves. Respect and compassion for self begin with taking care of our needs – without guilt or apology. Then, fortified and of sound mind, we have the capacity to care about other people.