WillSpirit!


∞ Where Mental Skills Heal Mental Ills ∞

A former physician writes about mental health and recovery using insights from life, science, and spiritual practice.








  • 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.


Springtime Among The Ruins

The MR scan result came back with bad news on two fronts. First, it failed to explain the pain shooting down my left arm as something simple and treatable. Second, it showed that a previously normal disk is now protruding to the point of slightly flattening my spinal cord. As you can imagine, this is a discouraging and frightening finding.

Spinal canal stenosis in the neck can become a big problem. It can cause numbness, paralysis, and incontinence. Surgery, though available, is highly risky and entails a long recovery time. It’s not always successful. But as I keep reminding myself, the problem hasn’t gotten to that stage yet. Right now, the only ominous indicator is a gray and white image on a computer screen. No tingling, no weakness, no leakage.

Ah, to live within a frail biological organism. And not within, truly, but as one. We all know our human forms don’t last forever, and with aging we see signs of the inevitable. Granted, not everyone faces such looming problems at age fifty-three. It’s tempting to feel sorry for myself, but that would be short-sighted. Sooner or later we all confront serious difficulties with our bodies. Some expire in infancy due to prematurity or genetic disease. Some succumb to accident, murder, or suicide as young adults. Some confront a diagnosis of lethal cancer in midlife and wither away within months. Some endure to die of old age and its accumulating vulnerabilities. And everything in between happens too.

Just moments ago I watched our eleven pound poodle mix, Ralphy, reclining in front of the wood-burning stove. He looked blissful with his half-closed eyes, ears flopping on the fireside cushion we lay out for the dogs. I feel happy knowing he rests peacefully without worry nibbling away at his serenity. It pleases me to provide safety and comfort for such a darling creature.

Then I extend my perspective. Somewhere, perhaps not far from this little mountain cabin where we take our vacations, a young man and woman are cuddling in front of a similar fire while a frigid storm rages outside. They are freshly in love and holding each other with a mixture of desire and affection. They are not troubled by ragged vertebral columns and endangered nervous systems. They are enjoying youth and all the pleasures it brings, even as they remain ignorant of how transient this vitality will someday seem.

I feel exactly as satisfied envisioning their happiness as I do watching my little dog. If my wife and I had children we’d no doubt be living vicariously through them as they ventured forth in the world and sampled its allurements. In absence of such immediate family, I do something similar by imagining how life keeps marching forward with each young generation. This lessens my concerns about my own future. I see how much bigger the human story is than my own little mix of fortune good and bad.

So much gratitude: for my loving wife, two sweet tiny dogs, a comfortable home and even a vacation cabin. So much pain: shocks down my arm, cramps in my gut, endless aching in my spine. Pleasure and pain. Joy and sorrow. Contentment and regret. On and on and on.

Biology is a dual process of growth and decay. Today my ego can’t help but contemplate an undesired medical result and the deterioration it announces. But my larger mind remains focused on the timeless majesty of life, which keeps cycling through its appointed seasons. There is ruin. There is springtime. And there is springtime among the ruins.

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Darkness in the Wake of Antidepressant Withdrawal

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.

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Tales of Youth, and What I’d Like to Regain

Photo taken by Mandy on a (recent) trip to Yosemite!

At age sixteen, I planned to hike the John Muir Trail with my friend Jack (not his real name, though why would it matter if the world learned about our teenaged foolishness 34 years after the fact?). I did eventually complete the trek, but a few glitches arose. The problems started after we rode a Greyhound bus north from Los Angeles. We boarded with a number of outdoorsy types just like us, carrying bulging backbacks and bota bags, who chatted the whole trip. There were mothers holding their small children on their laps, trying to calm them as they stood on mom’s jeans, riding to homes or relatives in small towns along the eastern Sierra slopes. One or two men in faded business suits sat near the back, a lonely type I always used to see on intercity rides. Are they salesmen? Fathers working away from their families? A contingent of older folks had also boarded; they shoved shabby suitcases overhead, and leaned against the windows to nap until Reno, saving their energy for the casinos. Like them, Jack and I slept most of the way, under the influence of pills I had borrowed from the medicine cabinet of an elderly woman whose garden I tended.

We awoke to disembark at Lee Vining, a minute hamlet close to Yosemite National Park and (coincidentally) not far from where I now sit. I swiped a bottle of rum from the local general store, being an ignorant but fearless young delinquent. Jack and I sat on the shoulder of the road with our spanking-clean packs, and shared the bottle down to its last swig. As we became more and more drunk (a process aided by the the Valium we’d taken on the bus) we kept our thumbs out over the road, until a young man in a yellow Porshe at last pulled over. The car looked new, and smelled like a shoe store with all its fresh leather. Jack, being smaller than me, squeezed into the cramped back seat, and I ‘rode shotgun’ in the shiny black passenger seat as we wound our way toward the high mountains. I don’t remember much of that drive to the trailhead. It must have taken over an hour, and we arrived after dark. Our benefactor abruptly dumped us with our backpacks on the side of the road. He had figured out right away that we were tanked (how hard could it have been?), and made it clear he regretted stopping for us. Although he may have picked us up to show off his new car, by the end he probably feared one of us would throw up on the carpet.

Wilderness at last! In the dark and moon-less summer night we looked around and marvelled at the narrow pines silhouetted against the stars, and the flat expanse that lay between us and the forest. Taking in the majesty of the mountains quickly got replaced by our exhaustion, bordering on coma. On the cliff’s edge of collapse, we decided that rather than thrash our way into the dark groves to set up camp, we’d do the easier thing and unroll our sleeping bags where we stood. Within minutes we were passed out in our bags. Funny thing, this cop car drove by and blasted us with a searchlight. I vaguely remember their P.A. system barking something about moving our camp site. It did not sound like a bad idea, but it would have been a lot of work. So we fell back asleep instead. As you might guess, that turned out to be a big mistake. When the police returned, they had little patience with our drunkenness. It also turned out we were camping in a parking lot, which was probably what tipped off the cops that we were not too sober. Within about thirty seconds they found the fifty joints of marijuana Jack had carefully concealed in his pack. Uh oh.

For the next ninety minutes we slammed from side to side in the back of a cold steel-walled van, trying to stay perched on the single steel bench. Hands cuffed behind us, we had little chance of holding on as the vehicle roared down the twisting road toward Yosemite Valley. Once we arrived the two officers, already divided into the good-cop/bad-cop routine that I learned about later, shined intense flashlights in our eyes and told us to get out. Dizzy from the drive and the booze, and blinded by the glaring white beams, we tumbled out of the wagon and more or less landed face-first on the oily asphalt. As the cops chuckled, we writhed our way to standing positions, hands still pinned behind us. They marched is in to the little jail and spent (what seemed like) most of the night interrogating us. What they hoped to get out of two high school kids is a mystery still, but early on I confessed the location of the rest of the drugs. I should have kept my mouth shut, since I doubt they would have found the stash otherwise. They thought everything had already been located, and their search of my pack had been cursory. But the ‘good cop’ won my trust, and I decided to help him out. Their whole attitude changed after I fessed up. Both became cold and efficient, and they went through every last rolled-up sock. By the time they unlocked our hands and pushed us into the four bed cell, the pleasant stupor of near-lethal intoxication had long-since worn off. As I lay on a one-inch thick mattress staring at the underside of the upper bunk, with the corridor lighting making the room almost as bright as day, the depressing fact of our arrest for marijuana possession began to sink in. I had ample time to contemplate this giant screw-up, and what looked like the end of the John Muir Trail adventure.

How stunning the view from the front steps of Yosemite Jail! Few lock-ups let you out into a plunging chasm lined by vertical granite, with a thousand-foot-high waterfall thundering to your right as you stagger down the redwood stairs. The photo with today’s post, taken recently, reminds me of what a glorious sight opened before me as I exited the jail. Sadly, Jack’s parents were not enjoying the vista. After driving most of the night from an L.A. suburb, they seemed a bit peeved. They hammered Jack with their anger and accusations, once in a while staring at me, eyes almost bleeding with contempt. This was not fun for any of us. Jack and I had been ordered to depart the park and not return for at least a month, if ever. Jack’s folks led us to their car like executioners loading horse thieves into a gallows-bound carriage. I worked to reinforce my defences for a drive south under a barrage of criticism, but before we took off my father granted a reprieve. We spoke for the first time since the arrest as I stood at a phone booth under an enormous cedar, the morning air pungent with a scent of damp pine needles. I gazed with longing across a vast meadow the color of limes, toward sheer rock faces that loomed above me despite the distance. My father could not be predicted under even normal circumstances, so I had no idea what to expect as I told him the story. Since the police had been unable to reach him the night before, I was free to slant things to make my behavior sound pretty innocent. Those arrogant park rangers had rousted us as we slept, just to harrass us. It must have been our long hair that made them decide to frisk us. They had no probable cause. I thought it best to leave out the parts about camping in the parking lot, or how we were so stoned we could barely talk. Knowing how furious it would make my stepmother if I ruined her summer by returning to L.A., my dad only surprised me a little when he suggested I stay in the mountains. “Keep a low profile,” he directed after I told him how the rangers had banned me for thirty days. Why not just leave the park via the trail, and commence backpacking by myself? The drugs had been confiscated, so he did not see how I could get into any more trouble. (Six weeks later I would talk to him from inside the Fresno County Juvenile Detention Facility.)

Sounded good to me. With a widening smile, I pulled my disheveled and ransacked pack out of the family car’s trunk, said goodbye to a brooding Jack and his fuming parents, and trudged off into the trees. I moved quickly, before any cops noticed I wasn’t rolling out the gate. The next two weeks gave me my first taste of adult freedom. Friendships formed easily among the shaggy young drifters hanging out in the walk-in campground (no cars allowed). With our down sleeping bags stretched out on beds of pine needles, we slept randomly grouped in an open grove of ancient conifers. We all wore the same uniform: plaid cotton shirt and blue denim jeans. We ate Fruit Loops cereal for breakfast, and then broke into groups to hike, or ride the open-air trams, or maybe swim in the freezing currents of the Merced River swollen with snow-melt. We drank lots of booze, once or twice dropped LSD, smoked pot day and night, ate slices of pizza outside the Yosemite Valley store, and pretty much created a ruckus wherever we went. Every day I got an adult to buy me a half-gallon of cheap chablis, which I passed around the campfire with my new pals. That helped get me past the obstacle that as a high school kid I was the youngest and most naive of this group of youths. Most of the girls I met in the park seemed far older than me (even past the advanced age of twenty), or else they were my age but kept on a tight leash by their parents or chaperones. I lucked out, however, and managed to spend one whole night with a college-bound girl I’d met that afternoon, but in my nervousness I drank so much I passed out with my clothes on. She still seemed to like me when we awoke the next morning, fully clothed but wrapped in each other’s arms. To my chagrin, she left the park that day with her tour group. So much for my hopes of ditching my virginity in Yosemite.

I struck up a friendship with a guy named Paul, who had no fixed address and worked odd jobs when he needed cash. He latched onto the John Muir Trail idea like a tick on a poodle, and we started collecting food for the first leg of the walk. He taught me that uncooked pasta, pankcake mix, Lipton soup packs, and dry salami fed you just as well as pricey freeze-dried dinners. He helped me get rid of useless items and employ the extra space in my pack for more food, so we could go further before restocking. He showed me that you can burn a camp stove on unleaded gasoline from a service station (back then they sold gas in Yosemite Valley, and unleaded fuel was still a novelty), which was cheaper than the less toxic white gas available in camping stores. Paul made me realize that Jack and I would have smacked into problems soon after starting, given how we planned our aborted trip with such ignorance. Shorter than me, but stocky, Paul’s curly hair was so blonde it looked almost white. He only shaved often enough to keep the stubble from turning into a beard. I thought he seemed worldly and street-smart. The night before we hit the trail, I called my dad and told him I was finally launching my adventure. To my surprise, he cautioned me to be on my guard with my new friend. A few weeks later I found out he had given me good advice, which of course I did not follow.

The next morning we pulled our weighty packs up on our shoulders, cinched the waist straps, and embarked on the 211 mile trail. The first day we spent climbing out of Yosemite Valley, past the roar of Vernal and then Nevada falls. Each is a thundering column of white water that kicks up a cloud of mist. The spray drifts over the trail to either freeze or refresh you, according to the day’s weather. Above and below both waterfalls the river tumbles steeply over enormous granite boulders, roaring loudly.

The trail started out crowded with visitors, so that we had to squeeze by balky children or stomp impatiently behind older couples breathing in heavy sighs as they made the ascent. Most hikers turned around so we saw fewer people as we approached the Valley’s rim, where the terrain opened out into large expanses of granite sparkling with feldspar. I watched the snowmelt-swollen river feeding the two falls surge in vigorous currents next to the trail. The icy, clear water swept through a narrow sluice that a glacier must have carved into the massive blocks of stone that formed the mountain.

This story forms a diptych, and one main panel of it happened as I attempted to cross the granite sluice through this muscular flow. For today, I want to skip ahead to the first night Paul and I spent on the trail. We set up camp in a grove of conifers stunted by poor soil layered on top of a hard pan of rock. That evening, as we sat with a Boy Scout troop around a toasty campfire (back then hikers were still allowed to burn open fires), we heard a loud thrashing and the sound of breaking branches. By the flickering light of the blaze I spotted a bulky shadow under the tree where I had suspended my sac of food. We all stood up, but only I rushed into the grove to find that my bag, and only mine, had been swiped by a bear. I had dutifully suspended it from a branch but underestimated the reach of a bear extending on its haunches. As an unrepentant petty thief, I suppose it served me right to get robbed by a wild animal. But it did not bode well for the success of my trip if I ran out of food in the first twenty-four hours, especially if it wasn’t me that consumed it.

I was young. I was stupid. I took off after the lumbering bear. It looked like it moved slowly, but that illusion came from its gigantic size. The animal’s gallop rapidly outstripped me as I sprinted in pursuit, screaming and throwing rocks. The moon was full by this time, two weeks after the dark night when Jack and I camped in the parking lot. So I dashed through the open forest in pursuit of the bear’s gigantic contour which I only glimpsed now and then, shouting at full volume. Somewhere along the way I pulled a thick branch into my hands, and I brandished it like a baseball bat. If I had caught the bear, if it had waited for me, or if it had headed back my direction, I would have swung that branch at its head. Which probably would have been my last living act. Luckily for me, after the bear paused to rip open the sack and rummage its contents, it loped onward and disappeared into the trees. Badly winded, I was relieved to see my food containers and torn ‘stuff sac’ scattered on an open face of rock the size of volleyball court. I gathered up my items: a can of spam had been punctured by the bear’s fangs; the box of pancake mix was ripped and dampened with slobber, but still held most of its powder. Cans of evaporated milk had rolled into crevices unharmed, but the beast had ripped open my box of brown sugar and licked out every single crystal. And I never saw the dried salami again.

Why did I take the time to put this really long story on my blog? Especially when I know that few people have enough interest to read all the way through such lengthy posts. As I said, this tale actually forms part of a diptych. The second part is short, and tomorrow or soon after I will publish it on the site. Both anecdotes show my courage as a teenager, and how blind I was to my own vulnerability. I suspect young soldiers at war have similar ‘bravery’. Generals count on their troops to act with little caution when engaging the enemy. I would have done well in a war, until my brashness got me killed.

I am different now. Very timid about risk, and ever-mindful of consequences. One advantage of my former bouts of hypomania, which medications no longer allow me, is that I would lift my blanket of caution. I would recover some of my adolescent wildness, and its creative impulses. As I pull myself out of my decade-long pit of despair, I want to recover some of that bravery. I’d like get reacquainted with that young man, who chased a three hundred pound fanged and clawed wild animal through a moonlit forest. Who never worried that the bear could have sliced his gut open with a swipe of its paw. Stupid, yes. But also bursting with vitality. Better to be alive in one’s heart and a bit foolish, than be dead in one’s soul and ever-so-wise.

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Is Depression Sane?

My last several posts talked about depression. Actually, they mainly discussed anti depression, but that prompted the rationale for today’s installment: you can’t consider how to cure an illness (if it is one, vide infra) without knowing a little about it. So, what is depression, anyway?

The word gets tossed about more often than it gets defined. Here is the MedLinePlus medical dictionary definition:

(1) : a state of feeling sad (2) : a psychoneurotic or psychotic disorder marked especially by sadness, inactivity, difficulty with thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal thoughts or an attempt to commit suicide

Definition (1) is straightforward: feeling sad. Number (2) starts with feelings: sadness, plus dejection and hopelessness. It then captures both thought dysfunction (impaired thinking and concentration) and the ‘vegetative signs’ of depression (inactivity, appetite changes, and disordered sleep). The final component is suicidality, either in thought or action.

So to simplify we have: sad feelings, impaired thinking, changes in bodily functions, and suicide. Does that sound like depression to you?

Everything listed can be true for me to varying degrees at different times. What this source fails to mention, though other dictionaries probably would, is ‘anhedonia’ or loss of ability to experience pleasure. Inability to enjoy anything often constitutes the crux of depression for me. If I could experience pleasure, life would not look so hopeless. Maybe I would then be motivated to eat, sleep, and think properly. Life is meant to be enjoyed, after all.

Or is it? In my opinion, our culture has fed us a huge depressing lie: that the purpose of life is enjoyment. More likely, the purpose (if there is one) is to experience what life brings, whether good or bad. Enjoyment is nice but not central to a meaningful life.

I grew up in a well-to-do household with many financial advantages. I attended good schools, went to a fancy summer camp, and lived in a house with a panoramic ocean view. The neighborhood had lovely landscaping, access to mountain trails, and a kid could bicycle to the beach in twenty minutes.

However, it was not a happy childhood. For those interested, here is an incomplete list of the traumas I experienced:

  • Intense parental discord starting with my earliest memories.
  • Prolonged and isolated hospitalization at age three.
  • Parental divorce at age four.
  • Annual moves for the next six years.
  • My mother suffered from clinical depression, with numerous hospitalizations and shock treatments.
  • She killed herself when I was six.
  • My father’s second wife (his former mistress during the marriage) abused me with breathtaking sadism.
  • My father was narcissistic, suffered from alcoholism, and disliked children.
  • My sister a psychotic break (precipitated by heavy LSD use) when I was ten.
  • My stepmother inflicted sexual humiliation on me between the ages of eleven and fourteen.
  • I became involved in drugs and alcohol at age twelve (daily use by age fourteen).

So I suffered a traumatic, unhappy childhood in pleasant and prosperous surroundings. My high school had its share of celebrity children, and the prevalent attitude was that life should be happy and fun. Money worries should not exist. Everyone should be gorgeous and sexy. The neighborhood was not far from Hollywood, and many of the kids I went to school with grew up to continue the tradition of exporting these standards to the entire world.

How realistic are these expectations? Not long ago I attended a support group where one African-American attender came from a different environment: crack sales on the corner; imprisoned or dead fathers; drive-by shootings; endemic destitution; pervasive squalor. He had trouble understanding the concept of depression. When he first received the diagnosis, apparently, he told his psychiatrist that his feelings of despondency and hopelessness were normal. That would be the natural conclusion for someone growing up in such a habitat, wouldn’t it? How many of his classmates expected to some day meet a gorgeous spouse from a well-to-do and intact family, spawn a couple of genius kids, develop a fascinating and lucrative career, and live to an advanced age surrounded by loving children and grandchildren? White middle to upper-middle class people do not think such dreams to be wildly unrealistic. Improbable, perhaps, but not out of the question. In the American ghettoes, however, to fantasize like that would appear psychotic to your companions.

pollution

Maybe we ought to look again at what modern life typically brings. A huge proportion of marriages end in divorce. Financial security is a fading dream. Death is inevitable and illness almost so. The chemical byproducts of industrialization degrade the planet, posing a very real threat of ecological collapse. People move all the time, making stable communities a historical memory. War never ends. We’re no longer surprised by genocide and terrorism. And meeting people who grew up in truly loving and healthy families happens almost as rarely as finding four-leafed clovers.

Does this sound like a world where we might expect to be happy? You could even ask, of course, if human existence has ever been conducive to widespread joy and contentment. So maybe sad feelings, dejection, and hopelessness are not pathological. I realize this is a ‘depressing’ viewpoint. But before we start drugging ourselves because we feel ‘sad’, we might ask if it is really a sickness or just a normal human reaction (especially for sensitive people with concern for others, like most of us who get diagnosed with depression).

I am not suggesting we just live in misery. I will continue to work against depression until my last breath, if necessary. But it helps to know the true enemy. Is it really my brain, the way the mental health system teaches? Do I need to conclude I am a ‘sick’ person because the combination of a horrible upbringing and living in a discouraging world has left me susceptible to sad feelings? Maybe those of us who feel the pain of this life are actually the sane ones. Could it be that happy people are just in denial?

OK, that last statement probably takes the point too far. Still, I do believe that sadness must be considered a natural reaction. Any discussion of depression treatment would do well to start from that realization. Then we can proceed to identify endless despair and lack of pleasure as on over-reaction, but perhaps not an entirely pathological one. So when we look at what we should do, we will know that what we are fighting is, in part, the state of the world. Then the problem becomes, how can we find tranquility in the face of all the problems?

band_aid

Starting from that position, using a psychiatric medication is nothing but a band-aid that covers rather than heals. After all, we could suck cocaine into our noses and feel better. But is that the best way to deal with life on this planet? Psychiatrists and drug companies, if they bothered to read this, would go bananas at the comparison. They would insist that psychiatric pharmaceuticals have long half lives, produce sustained benefit, and don’t lead to life-destroying behavior. And in truth there is a quantitative difference in side effects and social problems. But there is no qualitative difference in philosophy. Whether you buy the drug in a pharmacy or on the sidewalk out front, you are still treating life’s pain with chemicals.

Personally, I think that is not the best approach. Better to learn tools to cope with the tragedy and hardship than to drug yourself until you no longer care about it. And it is possible to retrain yourself to find peace and satisfaction in life in the face of its heartache and struggle. However, you will probably still feel sad. Part of the reason I became so miserable was my belief that things should be better. As a child, I saw relatives with happy families, and I envied them. As an adult, I resented that my colleagues continued in their careers, while mine ended because of a badly damaged neck. My resistance to making peace with my fate, not the misfortune itself, made me miserable. Now that I can accept my hardships as not being all that unusual, and certainly not ‘unfair,’ I can just be sad, without abandoning all hope for joy. It is OK to be sad. It is natural, maybe even healthy. My goal is to learn to experience the sadness but also allow myself to bask in contentment from time to time.

I believe that sadness is not the problem, despite how the definition of depression emphasizes it. Anhedonia is the real enemy. The inability to enjoy anything because of sorrow is a confusion about how feelings work. You can be sad a lot, but still find things to enjoy. But to get to this point I have had to abandon the unrealistic expectations fed to me by our modern culture. What a lie to believe one should get through life without being seared to the bone by tragedy and suffering! The fact is, every human frame will sometimes feel the flames of hell. But in our hearts we can look around, see the autumn trees outside the hospice window, and smile despite the pain.

Not long ago I posted a ‘Tweet’: The surest path to satisfaction is to lower your standards. What surprises me is that I now actually accept that to be true.

hollywood_parade

In closing, I would like to point people toward Acceptance and Commitment Therapy. It is not a therapy so much as a philosophy of recognizing the truth, and even the beauty, of pain. You don’t need a therapist to ‘get it’ (try this book–and I’m not getting a kickback from Amazon). ACT is not all that different from Buddhism, actually. But it is a good path for westerners who need to escape our society’s crazy message that life is supposed to look like a TV commercial, while grief, defeat, illness, and pain are for losers.

In the end, every one of us loses everything we love. What could be sadder? The trick has been to allow sorrow to rain on my parade, and just keep marching and pounding that drum.


Note: the author of Health and Life directs me to this article which expands on the topic of antidepressant (in)efficacy. It also cites the STAR*D study, which made a mammoth attempt to assess and compare treatments. The short form of their result is that drugs, and even accepted therapies, don’t work all that well. But such a short wrap-up does the project a disservice, since it studied issues that always get ignored by drug companies. Some day I may devote an essay to it.


(I modified this post in several places on 2009 August 4, c. 13:45 PDT. I did not introduce any substantive changes in the message or opinion.)

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