WillSpirit

Where Will meets Spirit
∞ A Blog Devoted to Balance, Peace, and Clarity ∞

A formerly depressed physician tells stories of trauma, grief and recovery, and offers suggestions for emerging from darkness, living with mood swings, and awakening to life.








  • Red_Exclamation_DotDisclaimer
    • Dear Visitors:
      Although I trained and practiced as a physician, my background does not include formal instruction in psychiatry beyond basic medical education. This journal presents ideas about treatment philosophy, but must not be considered therapeutic advice. Abrupt changes in one's psychiatric medications can trigger profound cognitive, emotional, and physical symptoms, including suicidal thoughts and actions. Consequently, pharmaceutical agents should not be increased or decreased without supervision by a mental health clinician.

    • ON THE OTHER HAND, your brain belongs to you, and your opinion counts. If you decide that changing your medication regimen will serve your best interest, then I believe your providers have an obligation to help you try to achieve your goals. I want everyone to be educated about their options, and do what will be most helpful for themselves. No one should feel pushed around by dogmatic and/or limited viewpoints, whether those of psychiatrists, anti-psychiatry advocates, or myself.




‘Progress, not Perfection”

(Click image to go to the 'Vintage Calculator Museum')

(Click image to go to the 'Vintage Calculator Museum')

Although no posts came out of it, I have actually been working quite a bit on WillSpirit. In the first step, I found software that would allow me to run Internet Explorer on my Mac. I had tried this before with a product or two that did not work, but at a local ‘Mac’ store I came across a sale copy of ‘Crossover’. I am now able to run IE6 and IE7. Crossover won’t run IE8, however. Despite that, I was able to move on to figuring out what the problems were when I saw my blog behaving so shabbily at the library. Just being able to use IE7 and IE6 puts enough in hand for me to feel comfortable putting the old WillSpirit theme back up. It appears the problem was limited to IE6. For instance, the pernicious gray box around the ‘roots’ photo only shows up there, not in IE7, or Firefox, or Safari. Also, the ‘disclaimer’ did not work in IE6, but did in everything else. (Actually, the footer is way too long with Opera, but so few people use opera on home computers I’m not going to worry about it.) Something got fixed between IE6 and IE7 so that it complies with the standards better. I’m assuming Microsoft would not have gone backwards and made IE8 noncompliant, so I put the old theme back in place. (If you are using IE8 and see problems, however, you would win my eternal thanks if you told me about them.) I am also grateful to anon, who pointed out that many of the glitches I saw at the library may have just been one-time loading errors. I believe that to be the case now, since they have never reappeared. Sadly, I was forced to set things up so that IE6 users no longer get to see the awe-inspiring ‘roots’ graphic, and might have to suffer with a small but always-visible disclaimer (that will probably be temporary). In case these awful losses prompt some people to upgrade their browsers, I am providing the link to the free download for Internet Explorer 7 and/or 8. That’s the technical update.

As for a personal update. My mood has lifted. I had a session with a therapist (and to tell you the truth, I’ve just about given up on therapy), that really made a difference. The experience could have been out of a movie: deep seated wounds, fears and anxieties that I’ve repressed since childhood came roaring to the surface. I wept with a mixture of sorrow about the past, and relief that I can finally let it go. The therapist validated the trauma I suffered and guided me through the pain. I actually feel freer today. It’s only taken about a thousand (literally, a thousand) therapy appointments over thirty years to finally have a session that made a decisive difference. There are a number of reasons why this happened, one being that coming off Cymbalta has released my emotions. Silly things, like cheesy inspirational emails, right now have the power to spur a rivulet of tears. I don’t want this to be my emotional condition for the rest of my life, so that my eyes well up at the slightest suggestion of something sad. But it is nice being able to let down my guard and experience some deep emotions. For years my feelings have been limited to little more than an oppressive fist of depression on my chest. I am tired of watching the angry teeth of cynicism bite the flesh off my experience, in service of guarding my most sensitive wounds. Yes, without flesh there is less pain, but there is also neither movement, nor passion, nor embrace.

Adding to the good feelings brought on by that ‘breakthrough’, I came home to find my email box holding messages from members of Lon Gallagher’s family. Lon was my very good friend during the years after my hospitalization in 2000, until his death a little over a year ago. I posted a tribute to Lon in July, and his daughter came across it. She and some others of Lon’s family wrote nice comments and/or emails to me. It feels good to know they saw my little piece, and so understand how much Lon meant to me, and also what I observed as he deteriorated toward the end of his life. Best of all, it seems to have brought them some comfort, too.

The internet continues to astound me with its power to help people communicate despite the distances that separate us, and the fact that we are lost in an ocean of six billion people. Just to give a sense of how many human animals the planet holds, if you said one person’s name every second, it would take 190 years to say the name of every individual on Earth. The internet helps people with similar interests and concerns find one another in this unfathomable crowd.

Such a thing was unimaginable when I saw my first hand-held calculator in 1971 (or so). It cost almost $400 (US) at a time when you could by a VW bug for $2000. All it did was add, subtract, multiply, and divide. Not long after, I hitchiked over a long distance in the middle part of the US. I got a ride from a man in an unremarkable light blue sedan, covered with dust on the outside, and reeking of tobacco inside. We talked for hours as we rolled through miles and miles of late season cornfields, the stalks froming green walls on either side of the road. The terrain had no hills, and the road had few curves. As we travelled through this monotonous landscape, I told him my grandmother’s story. She had been born in a time of horse-drawn carriages and kerosene lamps. By her ninth decade, she lived in a world of color televisions, jumbo jets, interstate highways, and telephones she could use to call relatives across hundreds of miles of separation. The complexity of all this ’stuff’ almost overwhelmed her, but she knew she had lived through a landmark epoch of human history: the rise of the technological age. As this man and I zipped along at seventy miles per hour, I related what my grandmother believed: that my own life would not see anything like that much technological progress. I tended to believe her.

My companion disagreed. He told me that before I died, computers would have spread to involve every aspect of human life. Even simple household appliances would be run by computer. Everyone would have a computer at home, and it would be more used more often than the television. Medical technology would be unrecognizable in its advances. He had many predictions along these lines.

I did not disbelieve him, exactly, but it sounded pretty far-fetched. Then, in the early eighties, I watched as magnetic resonance imaging scanners were first deployed in clinical use. Still in medical school, I happened to be at the University of California, San Francisco, which had a lot to do with the technology’s development. The pictures of the brain those machines provided (the brain having always been my major interest), seemed literally miraculous. Without surgery, or (ionizing) radiation, you could see nerves exiting the brainstem that aren’t much thicker than spaghetti strands. This is old news, now, but at the time the advance thrilled anyone involved in the field. Perhaps that marked the time I realized that the anonymous guy who drove me across Indiana had quite likely given me a true picture of the future.

childreninternet

Looking back, it is obvious that he articulated a clear and accurate vision of the world we now inhabit. I don’t know if those ideas were in common parlance among computer specialists in the seventies, or if he was a visionary. Maybe a little of both. I wish I knew his name, so I could look him up and see what his role was in bringing about this computer-run world, where I can make friends with someone in Australia, exchange messages regularly, and have the communication pass instantly and without charge. Or where I can write a note of affection for a deceased friend on my computer one month, and have it reach his family and make a difference to both them and me several months later. Best of all, we have this forum where people affected by the mental health system can interact, share stories, strategize, support one another, and work together to improve a bad situation.

Computers are not always positive forces, of course. They allow our governments to keep tabs on our activities in ways Hitler could only have dreamt of. They tag people with mistakes they made as youths, so that they can never fully remake themselves and leave the past forgotten. They allow corporations and swindlers to shuttle fortunes from one corner of the globe to another with a few keystrokes, thus evading government control and opening whole new universes of expolitation and fraudulence.

But for once I would have to say that this particular technology is actually doing more good than harm (though I would not argue strenuously with someone who believed the opposite).

Writing this blog has brightened my life in countless surprising ways. I had hoped to build a platform for an eventual book. I don’t see that happening, but so many other connections and projects have blossomed, that it no longer matters. To tell the truth, I feel like I was born to blog. I’ve always enjoyed writing short essays about controversial, complex, or just interesting subjects (for instance, this was a role I got to play regularly when I served as Editor-in-Chief of the campus paper at UCSF). I’ve always liked to toy with visual imagery. I have a short attention span, but a wide ranging field of interest. I know a little about a lot of subjects (though a lot about almost none). I am not a very private person, and have never been uncomfortable discussing personal issues with groups of people I hardly know (like Alchoholics Anonymous). And I have a strong belief, bordering on a sense of obligation, that I should make my opinions known. I tend to think my ways of seeing things are unique, and that I have something to add to discussions about subjects that matter. (It is perhaps my one and only area of true self-confidence.) All-in-all, it makes me feel like I have at last found my true vocation: blogging. Too bad it isn’t an income, but it’s a good occupation.

Not many people read this blog. But those that do mean the world to me. Because of them, I write many days a week, for hours at a time. I explore other sites, read the opinions of others, and communicate with kind and fascinating people across the globe. I think more deeply and organize my ideas more thoroughly than I would otherwise. In the process, I learn more about the topics that matter to me, and begin to see ways I can use my education and (hopefully not imaginary) talents to further important causes. Most of all, I get to make friends with people who can understand what it’s like to live with a mind that operates differently than the norm. Who know the stigma and shame that mental conditions can bring. But who also share the hope that things can get better, and validate one another that very often, ‘different’ is another word for ‘better’.

I modified this post a bit on 3 September 2009. Mainly, I added the photo of the children learning about communication via computers at the Museum für Kommunikation Berlin (obtained, as usual, from Creative Commons–click on photo to see source.)

Freedom from Cymbalta, Flights of Fancy, and Highfalutin Philosophy

contrail

Last night sleep came. Since stopping Cymbalta 13 days ago, most nights have provided only a few hours of true dozing. Once or twice in the past fortnight I took zolpidem to knock myself out. But that does not lead to refreshing slumber, just a kind of drugged unconsciousness. Even with the sleeping pill, no more than five hours were spent sleeping; the rest of the night passed with me either laying in bed trying to relax, or else reading and eating blueberries (there must be a bumper crop this year, the prices are so low). But yesterday I retired early, then slept almost ten hours without awakening. What’s more, after arising I sat in our hot tub like I often do, but afterward got out and dozed for another hour.



We have a two-person spa on our deck, with a fine view to the east. Most mornings as dawn brightens I sit in water heated to 104° F (40° C), while I take in my surroundings in a silence broken only by a few buzzing insects and the first active birds. I leave the nozzles turned off, since I dislike the mechanical noise. I overlook a line of forested ridges rolling toward Yosemite, where the horizon is jagged with granite peaks. With an early enough start I am rewarded by a view of the sun rising into a salmon-colored sky, usually cloudless and marred only by the contrails of passenger jets in the stratosphere. These aircraft cross over the Sierra Nevada mountains on the last leg of their flight to San Francisco. One time I looked out the window during such a flight, and saw Yosemite Valley below the wing, looking like a small broken slab of gray stone. As I soak in the morning, loosening the tension in my damaged neck, I look up at those specks gliding through the twilit sky, and wonder about the travellers drinking morning coffee while looking down at the expanse of conifer forests and rock mountains. I wonder if it occurs to them that someone lives among those trees, watching them as they soar in the upper reaches of the atmosphere. I think about how insignifcant my corner of the world must look from their perspective, my home invisible in the green carpet of sugar pines. It amazes me that we will never know each other, that we will each live our entire complicated stories, each entirely unaware of the other’s drama. Our only connection is my fifteen-second reverie about a stranger in a jumbo jet, drinking coffee as her plane travels hundreds of miles per hour, drawing a rose-colored line across the dome of morning sky. Today such warm water thinking put me back to sleep.

After all that, my point is that I feel better. Yesterday my mood stayed pretty solid, with only a slight dip toward depression in the afternoon, something I experienced my whole life up until starting SSRI antidepressants. This morning, after finally getting up for good, I have been productive and energetic. Could it be I am finally getting past the Cymbalta withdrawal syndrome? The past two weeks have been brutal. If I did not have a strong commitment to survive and be here for my wife, suicide would have been the likely result of how badly I felt. Life seemed so very pointless, and not at all worth the torment roiling in my heart and soul. Countless times each day I dreamt and prayed (to the extent that I pray, since the God of my belief is not the kind that keeps an ear to the mutterings of mammalian nervous systems) that I just drop dead on the spot. Now I feel ready to engage my corner of the earth once more. Not that I am thrilled to be alive, singing like Julie Andrews on a grass-blanketed mountainside. No, I am still the not-too-optimistic failed surgeon. I sit before a small computer screen connected by a wire to my even smaller laptop, typing with nine fingers and one elbow (actually a finger in a thick dressing). The hillside I gaze upon is covered by an expanse of dead weeds baking in the August afternoon sun. But today I am pleased enough with this little drama of mine to stay in the production until it finishes its natural run. Once more, I survived all-out assaults launched by the mood-demons who dwell in darkest recesses of my mind. Thank you, big Pharma, for marketing a drug that required me to weather such torment in order to release myself from its grasp.

That altering my brain chemistry by withdrawing a drug had such an effect on my worldview brings to mind, once more, my curiosity about what it means to exist as a human consciousness. I wrote earlier about the origins of decisions and intention. This ordeal has made me wonder, too, about the locus of attitudes and feelings about life. When something as fundamental as whether I think my story is worth living can be affected by removing a synthetic chemical from my bloodstream, then who am I? Is there ‘nothing’ more to ‘me’ than proteins, and cell membranes, and DNA, and myriad organic molecules? That kind of musing resurrects my whole philosophy about the relationship between living things and (what I for convenience call) ‘God’.

Aside from feeling that the Cymbalta wash-out may be behind me, I also cheered up after looking a bit at my web statistics. OK, OK, I know doing that is pointless. Numbers are not my objective, and obsessing about how many computers connect with my site will drive me (even more) nuts. Still, I noticed that my post ‘Is Depression Sane?‘ has been viewed two-and-a-half times as often as any other. This strikes me as great news, because I enjoyed writing that essay, and it touched on a number of philosophical points. I like to include in my blog my homespun views about the mind, mental distress, and how one can lead a satisfying life. Knowing that one of the essays that most does that also attracted the most interest encourages me to continue.

I resolved to keep my posts short. What I’ve written so far is the introduction to my real topic: the relationship between the chemicals that traverse my brain and the ‘person’ that the organ produces. In particular, how does an organism acquire the gifts of pleasure and pain, instead of just having a drive to move toward or away from certain stimuli and experiences? Rather than launching into that now, and even further exceeding my supposed daily word quota, I will put the topic out there as something to either look forward to or avoid, depending on your attitude.


(I modified this post on 2009 August 13, c. 23:00 PDT.)

Cutting off Cymbalta, and other things.

fingers

I have no choice but to make this short (or what counts as brief for me): I only have one hand. Slicing broccoli normally doesn’t cause me problems, but as my mental condition deteriorates off Cymbalta, even routine tasks are becoming hard. The knife careened off the stalk I was skinning.

I like to put broccoli flowers in salads, and after I chop up the tops I always split the peeled stalks with Ralphy, one of our two dogs. Tonight the blade slipped as I was cutting off the rind, and I somehow managed to slide the tip of my left ring finger between the knife’s edge and the cutting board. The blade nearly sliced off the part of the figertip distal to (sorry for the medical term–’distal to’ just means ‘further out than’) the nail. My pain tolerance is high, but this surprised me with how much it hurt. The end of the finger obviously contains a dense network of nerve endings. Luckily, there was enough of an attachment remaining that after a long period of washing, and then even more time placing pressure to staunch the bleeding, Mandy was able to secure the little flap in place with an adhesive strip. As an operating room nurse, she would have preferred to drive to the emergency department to see if they could stitch the tiny piece down. As a former (ophthalmic) plastic surgeon, I felt that a successful job would have taken very fine suture and a high degree of skill. I did not think I would get that level of care for this minor problem, and a trip to the ED would only waste 3-4 hours driving, and who knows how long waiting to be seen. In the end, I would have come out with an adhesive strip–much like the one Mandy already attached.

Time was I never would have been so careless with a sharp blade. I prided myself on being able to handle knives, scalpels, etc., skilfully and safely. Now, ten years later, I am very much out of practice. My acquired ineptness with cutting instruments, combined with antidepressant withdrawal (which floods me with the distracting conviction that life is pointless, and also saps my energy levels) caused me to stupidly cut myself. So here I am typing with two fingers and a thumb on one hand, while I keep the other elevated to reduce swelling.

Before this injury, I had toyed with making my next post about the dreadful and permanent side effects I’ve suffered from taking psychiatric drugs. That would have been a big step, because I feel a great deal of shame. Yet doing so will ultimately help me heal and, more importantly, might serve as a warning to others. Maybe cutting off a part of myself was an unconscious way of putting off this decision. So, another time.

I would have a better outlook, increased energy, and sharper judgment if I went back on Cymbalta. But, mainly because of how similar drugs have wrecked my body, I just can’t bring myself to swallow that nasty little green pill. So I keep on in this deteriorating mode, hoping that things don’t get too much worse before they start getting better. I suspect my body needs to regrow a huge number serotonin and/or norepinephrine receptors, as per a post I wrote not long ago. Given how far I’ve sunk since I penned that essay, it seems like it could have been in another lifetime.

Mandy thinks I need to take a break from writing, and a number of other activities important to me, in order to give my fingertip the best chance of healing properly. Since my mood continues to take me to more and more maudlin and self-pitying places, that might be a good idea even without the finger issue. So for a little while I may spend less time blogging. If nothing else, I can concentrate on learning how to customize my blog functionality and layout. I have a stack of books on html, css, php, java, mySQL, etc, that I’ve been unable to devote time to because of the hours spent drafting posts and exploring blogs. I figure if writing never leads to an income, by acquiring programming abilities as I work on my site I will be in a position to look for work in computers instead. But to achieve that objective, the books need to be read.

Nothing as ambitious as success (either as a writer or programmer) will be attained if I don’t recover my emotional equilibrium. I can’t express how much regret consumes me when I think about how a therapist finally talked me into taking medications, and how I went ahead despite a lifetime of opposition to psychiatric drugs. My hesitation was born of watching my mother destroy herself with drugs given to her by psychiatrists, and now I have done exactly the same thing. Except that unlike her, I remain alive… Barely.

Cymblahta Redux
& writing about feelings.

Photo of tree and bruised sky.Five days ago I quit Cymbalta. Because of some its side effects, periodically I stop it for two days. This time It ended up being three, and after that I just could not bring myself to restart it. Today, day five, passed with little problem. I feel a bit nauseous, kinda sweaty, and I am not sleeping well at all. I have a familiar aching dread in my chest, and a sinking feeling in my gut, as I always get with depression. But I am not depressed. My body feels all the awful stuff, but my mind is staying pretty upbeat, or at least neutral. I am prepared for a rough few weeks coming up. Don’t be surprised if I give up and start the drug again. Somehow, however, I think this might work. My attitude has shifted. That last post really cemented my developing philosophy of accepting and even savoring my ‘negative’ moods. So they don’t scare me as much. So I can tolerate the feelings better. So maybe I’ll succeed.

Wish me luck. I’ll probably need it.

I am keeping this post short. The last one consumed time and, more to the point, energy. I have needed to recharge. Plus, I imagine my readership, to the extent I have one, gets tired of the long and confusing essays. They don’t say much about me after all. This little post is to just keep the habit up, to say hello to all, and maybe open up a little more. Not that I have fear of letting others know me, but my natural tendency is to think and write about my thinking, rather than feel, and write about emotions.