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.


Do Medications Change Who We Are?

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 the 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.

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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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Stopping Medication and Wondering What’s Next

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.

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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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Wouldn’t it be great if long-term antidepressant treatment worked?

Before antidepressants.

Before antidepressants.

After 1 year on antidepressants.

After 1 year on antidepressants.

This is a response to a post on the Hopeworks Community blog.I’m sharing it here because it rebuts arguments one commonly hears in favor of antidpressant medication.

Dear Hopeworks Community,

Personally, I believe you overstate the value of medications, especially in bipolar II/depression. (They are indeed quite effective against manic escalation. It is not impossible for someone with Bipolar I to go without meds, but it is difficult and takes discipline.) However, the efficacy of antidepressants is regularly exaggerated by psychiatrists and pharmaceutical representatives. Are you aware of a single long term placebo-controlled study that demonstrates sustained benefit of any antidepressant over time frames longer than a few months? I’m not. Approval trials typically last six weeks. And even in that short time period, usually not much more than half the population benefits (compared to 30% that respond just to placebo). Yes, when people first start antidepressants, they often feel better. But if they are someone with longterm problems with low moods, and many recurrences, (which is the story for most bipolar II patients) when you look a year later they are usually back to fighting depression. Only now they are stuck on medication that causes even worse moods and other symptoms if they try to halt drug treatment. Realistically, don’t you notice that mental health clinics are filled with clients in awful depression who also happen to be taking 3 or 4 or 5 medications? If pharmaceutical therapy works so well, why are there so many people like this? For acute depressions, especially prolonged situational depression, psychoactive agents can really help. They may also give those with more chronic problems a bit of relief while they learn better ways of dealing with their moods. But as a sustained strategy: medication just does not work. If long term antidepressants were often effective, I would be in favor of them; I am not reflexively anti-medication. But they are not.

The psychiatrist who claims he has “seen a few BP2 people who do not have deep depression make it [without medications], but they are the rare exception” is a psychiatrist who loses his patients after they realize they can find ways to deal with recurrent depression and hypomania without drugs. The only ones he sees are those who come back asking to be restarted on pharmaceuticals. Not only that, but once established on long-term drug treatment, it is all-too-true that patients find it exceedingly difficult to stop. But to say that bipolar II patients can’t come off drugs is very different from saying they are better off than if they had never been established on longterm treatment in the first place. And how hard does he work to very slowly taper his patients while providing behavioral means to manage their moods? A close family member required a 2-year taper off prozac, and she was just on the one drug. Imagine how much patience it would take for a psychiatrist to help patients get off 4 or 5 medications. Does he work that hard to achieve something he obviously does not believe in?

Therapy and counseling are indeed helpful. Not always those based on opening up (though for clients coming from traumatic backgrounds, as many with bipolar II diagnoses have, it may be vital), but especially those that provide behavioral advice (including promoting exercise) and cognitive training, along with something like meditation or spiritual support. And peer interaction can be lifesaving. But meds? They are not a rock opposing a hard place. They are just an ineffective pebble (with crushing, boulder-like side effects and dependence potential) opposing a condition that can often be ameliorated without longterm drugs. Unfortunately, those who have difficulty succeeding with behavioral/cognitive changes are unlikely to be helped by ongoing medications. Instead, they will just have drug dependence, with attendant adverse effects, added to their list of woes.

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Mind, Moods, and an Organic God

dnasculpture

My last post wore me out, emotionally and physically, so I’ve needed a break. But here I sit again, ready to write. The prior essay centered on structural changes in synapses, and how those relate to difficulties with changes in either behavior or medications. Loss of serotonin receptors following SSRI antidepressant use (e.g. Prozac), leads to a dependence on the medication. When SSRIs are withdrawn, the brain no longer has the receptor capacity to work with the lowered serotonin level which follows. So we get depressed. I have experienced this repeatedly in my efforts to lower my antidepressant load.

The brain gets used to certain inputs. Many pleasurable activities and drugs of abuse increase dopamine. Like serotonin, dopamine is a neurotransmitter used by a minute fraction of the brain’s neurons. When the nucleus accumbens, or ‘pleasure center’, gets flushed with this chemical, one feels deep satisfaction, sensual gratification, or even euphoria. Later, when dopamine levels drop, one may develop a desperate craving to get another burst of it. Hence: addiction. Possibly behaviors that lead to unpleasant moods, like isolating or ruminating on worries and problems, provide short term release of neurotransmitters that our brains ‘like’, even though the end result is depression. This portrayal simplifies the situation, like describing an epic film with one paragraph. But my point is just that on some level much of how we feel, and what we think or do, comes from shifting movements in the symphony of chemical interactions in the brain.

So what does this all say about human nature? Are we ‘nothing’ but conglomerations of proteins, neurotransmitters, and other biological molecules? In the last post I also mentioned Jeffrey Schwartz, MD, and his hypothesis that in addition to neurons and associated brain cells, our minds consist of something non-material, which he calls ‘mental force’. This entity could just as well be called our ‘soul’, since he believes it determines our decisions under the principle of free will.

I don’t accept this proposal. Not because I think free will is an illusion, or because I don’t believe in souls. I have conviction that both exist and are the vital organs of human life. My opinion, however, is that both human ‘spirit’ and ‘will’ arise from the matrix of matter itself. The intricate and finely woven fabric of our brains makes freely determined decisions, and houses our divine spark. Humans look for miracles, yet all the time we seek them we are living in their midst. Not only that, but each one of us is divine in every sense of the word. We don’t need to postulate some ethereal force that exists detached from the trillions of cells, each a tiny universe of activity, which have grown in unison and become the mysteries we call bodies. God does not need to speak outside of matter, because our atoms and molecules already sing God’s song.

pieta

To those who have faith in a different sort of deity: Maybe we aren’t of such opposing opinions. If you can accept that whatever God is, we don’t really understand it, then there is no disagreement. In that case, every sculpture humans carve of God or spirit must be incomplete. So who is to say whether we are looking at completely different icons, or just viewing the same monument from different vantages? If, on the other hand, your belief system is more fundamentalist and inflexible, and you cannot accept that other views might also carry a little truth, then you are probably not even reading this. But if you are, I hope you will just ignore my attempt at spirituality. Go ahead and consider me morally misguided, but still listen to the basic message: We have more power to improve our minds and lives than an industry based on selling psychoactive chemicals wants us to believe.

Even with the above proviso, I suspect that my spiritual ideas do not particularly interest those who visit this blog. So I’ll stop here with the philosophy. I only want to convince readers that whether by taking medications or changing our behaviors, we are tinkering with the intimate particles of our being. However, the two approaches (drugs and action) differ as coal differs from diamonds. They may be in the same category on some molecular level, but they diverge in beauty and endurance. Ingesting a chemical to improve one’s experience is akin to to reshaping an ice sculpture with a blow torch. The tool carries too much power, and acts too crudely to result in anything fine. “If you can’t feel better, drugs at least make you feel different.” At the price of (possibly) lifelong dependence on psychiatric chemicals, one (typically) gains a few months of relief from pain. Then, all too often, the pain returns. Only now depression comes encumbered with an addiction (what else to call it?) to drugs that no longer work. Stopping medications takes one from depression into the pounding heart of hell.

ice_torch

Much better to work on meditating, improving spiritual sensitivity, exercising, and adjusting thought habits. Maybe drugs can help for a little while. If so, doctors should remain ever-vigilant for the first opportunity to start withdrawing them. Let us use finesse to chip and carve the ice that encases our moods. Take our time and work hard, and we can sculpt our depression into tragic but nonetheless beautiful memories.

I guess this is a repeat of my last message. Hopefully, since it is (a little) shorter, it will be more widely read. I yearn for it to help someone. This kind of thinking comes too late for me. I am already addicted to psychiatric medications and must struggle my way free. This writing project would fulfill both my spirit and my will if a recently diagnosed reader found it useful, and if it bolstered a non-medicated regimen of mood care. If you are that reader, I pray that the uncountable molecules of your brain begin to dance in harmony. I have faith that you will choreograph a lasting peace.

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Prozac & other Bad Habits: how they affect neurotransmitters and brain circuit paths, and why they are hard to quit.

neurons

Today, my decision about topics comes down to two choices, both born of recent posts or replies to comments: 1) Bad Thought and Behavior Habits and how hard it is to change them; or 2) Discontinuing Psychiatric Drugs and how it is made difficult by receptor downregulation. The first has to do with why I often ignore the things that have been taught to me about how to be healthy. The second is about why I get so depressed when I try to stop (e.g.) Cymbalta. Then I realized that the two are related. They both have to do with fixed patterns of response in the brain. So this essay deals with both those issues. It is long (despite my resolution to keep posts under 500 words), and involves some physiology. But I think the connection between habits, drugs, and changes in the brain lies at the heart of many difficult emotional problems.

Of course, science understands drugs better than habits. When a negative behavior becomes habitual, so that we repeatedly cave in to it rather than do the harder thing that will make us feel better in the long run, millions (or billions) of cells across the brain may get involved. Many complicated neural centers of thought and action determine such bad habits. On the other hand, when our brains become habituated to the effects of psychiatric medications, the problem largely can be explained by changes in the levels of one or a few proteins. Since I know little about the psychology behind habits and resistance to change, most of this post will focus on receptors. I will try to draw (hopefully not make up) parallels between the brain’s adjustment to pharmaceuticals and its development of habits.

Many people on psychiatric medications have found that a drug may improve ‘symptoms’ after a few weeks, but then gradually works less and less well. This happens, in part, because the body reduces the number of receptor-proteins that respond to that drug, or to one of the natural chemicals the drug increases.

I started my medication odyssey with Prozac (fluoxetine). This drug blocks the removal (reuptake) of serotonin from the synapses in parts of the brain that use serotonin as a signalling molecule. The synapse is the small area that separates the pre-synaptic cell that sends a signal, in this case one carried by serotonin, from the post-synaptic cell that receives it. Removing the released serotonin from the space between the cells–the synapse–attenuates the message, so that it is time-limited, and doesn’t just go on ‘forever’. Since compared to earlier antidepressants Prozac is relatively selective in blocking reuptake of serotonin–but not other transmitters, it is an example of the SSRI class: Selective Serotonin Reuptake Inhibitors.

Under normal circumstances, the pre-synaptic cell releases serotonin, but then sucks it back out of the synapse using ‘reuptake’ proteins. Without the reuptake mechanism, serotonin would persist in the cleft for much longer times, and at higher concentrations, than normal. In fact, Prozac accomplishes exactly that: it blocks the reuptake protein and so causes an increase in synaptic serotonin.

serotonin necklace

As an aside, only about one-thousandth of one percent of brain nerve cells use serotonin to send signals. Despite their small numbers, serotonin neurons affect many different parts of the brain. That explains, in part, why they have unwanted side effects: areas of the nervous system we’d rather not mess with (like parts mediating sexual response) are modulated by serotonin, just like the parts that alter moods. Another important point is that to date there is no evidence that depression results from an actual deficiency in serotonin levels, even though increasing serotonin activity does elevate moods.

So why does Prozac often quit working over time? In part, it may be because the cells respond to abnormal increases in serotonin by reducing the number of post-synaptic receptors for that transmitter. It’s kind of like what happens with noise. If you want to hear something really faint, like a soft whisper, you cup your hand behind your ear to increase your ability to make out the words. As the person speaks louder, you remove your hand because it’s not so hard to detect their voice anymore. If they start yelling, you might even plug your ears to tone down the volume. The post-synaptic neuron that detects the serotonin signal no longer has to listen so hard. So it reduces the number of proteins in its cell membrane that ‘hear’ the serotonin molecule. And the drug that increases serotonin, and that once had terrific effectiveness, now has less.

Naturally, there are complicating factors. For instance, Prozac may have an immediate stimulating effect, but much of its antidepressant activity is delayed by several weeks. This is thought to be due to changes in receptor numbers on the pre-synaptic cell. I won’t go into this wrinkle, because it does not change the basic fact that eventually serotonin levels increase, and that soon after the system adjusts to the elevated transmitter levels. Regardless of the details, the end result is that the brain settles back toward its natural state. It adapts to the increase in transmitter by reducing its sensitivity.

What happens when you stop the Prozac? At this point, your neurons are accustomed to increased serotonin levels. What was once abnormally high is now, according to your brain, the right amount. When you take the (reuptake inhibiting) drug away, reuptake goes back up, which (probably along with other changes) reduces synaptic serotonin. Since the brain has adapted to high serotonin, this reduction (back to levels that once were normal) feels like a deficiency. The serotonin system is under-stimulated, and you feel depressed. And because serotonin neurons are so widespread, other withdrawal symptoms are not uncommon. You might even be more depressed than when you first started Prozac. If you can weather the depression without killing yourself, there is a pretty good chance that your neurons will return to their original condition. Or maybe not. There is also a risk that not all of the changes are reversible. One line of evidence that suggests receptor downregulation may sometimes be irreversible comes from the fact that some people have long-term sexual dysfunction that continues after SSRI agents have been discontinued.

Either way, the habituation of your brain to the presence of Prozac (and other SSRIs) makes it a difficult drug to stop. The same thing happens with heroin users: the number of opiate receptors drops, and the addict feels horrible if her or she can’t get enough heroin. (In the brain, ‘opiate’ receptors normally detect peptides called endorphins; heroin and related drugs stimulate those receptors and thereby promote analgesia and euphoria.) Hence they have trouble springing back from ‘receptor downregulation’ just like Prozac users. A common name for this is ‘addiction’. For obvious reasons, drug companies and psychiatrists resist applying this term to the withdrawal symptoms people have when psychiatric drugs like SSRIs are stopped.

Now, back to habits. Could it be that similar adaptations to signal strength, protein levels, and other features in various parts of the brain account for why habits are so hard to break? When we try to alter our behavior away from the established pattern, do we experience a seeming deficit in some chemical important to feelings of well-being? This mechanism must be operative in bad habits involving substance abuse, like cigarette addiction. But would it be extending the analogy too far to suggest it explains my habit of retreating into depression after minor setbacks? Or how I avoid doing the things that I know will gradually lead to less depression (e.g., distraction, exercise, positive self-talk), and instead curl up in a darkened room because it somehow feels better at that moment?


To answer that, one confronts the question of whether all of our decisions result from neuronal activity. Surprisingly (to me) not all scientists agree with that notion, or at least not entirely. Jeffrey Schwartz, MD, published a book in 2002 with reporter Sharon Begley called, The Mind and Brain: Neuroplasticity and the Power of Mental Force. In it, he uses obsessive-compulsive disorder (OCD) as a model for how the mind and brain interact. On the one hand, he reports that PET imaging data imply that OCD results from faulty action patterns in the frontal lobe. he goes on to show how entraining OCD patients (via CBT techniques) with new behaviors changes those circuits, and that the better the patients become, the ‘better’ the circuits look. This supports the idea that bad habits can result from changes in neuronal circuitry (note that OCD behaviors are particularly bad and pernicious; I want to reassure OCD sufferers that I am not saying their condition is something you can just ‘quit’ like cigarette smoking–hard as that is).

OCDPETOCDPET improved

(Note: these images taken from the site linked by clicking on them. They were not obtained via CC license. Since they are promotional pictures on an OCD clinic’s website, and this is a mental health blog, I assume the developers would not mind. I do not have any affiliation with that organization, by the way.)

Schwartz also conveys the optimistic message that with training and intention we can change cellular connections. In other words, we can physically alter our brains to improve our lives (which brings up the giant topic of neuroplasticity, a subject for another blog). So Schwartz agrees that structural and functional elements in the brain determine habits, and that changing those elements is the key to improvement.

On the other hand, however, he argues that the intention to change behavior (and hence the brain), originates from something outside the physical structure of the nervous system: a so-called ‘mental force’. He is doing nothing less than postulating a new physical entity to add to the nuclear strong, nuclear weak, electromagnetic and gravitational forces already known by physicists. His argument is well-constructed, though it fails to convince me. (That does not mean I don’t believe in forces outside of matter, only that his reasoning and supporting data are insufficient to establish non-material forces acting in this instance.)

Whether intention originates in neuronal tissue or outside of it, it is nevertheless clear that behavior is grounded in the brain, that we can and often do change our behavior, and that doing so probably involves changing the structure and/or function of neural circuits. My whole reason for this long discussion is to make the point that while drugs quickly and efficiently change synapses and brain circuits, we can do the same thing (more slowly) with willpower, training, and practice. Breaking the habits that promote depression is then not all that different from recovering from long-term use of psychiatric drugs, although it is probably easier. In both instances we need to readjust synaptic activity.

Cognitive research has shown that to some extent persistent depression is about bad habits of thought and action. If we can break those habits, we can reduce depression. It may even be that improving thought and behavior increases brain serotonin activity, just like Prozac. However, unlike using a synthetic drug, in this case the neurotransmitter gets increased in just the right locations, not the whole brain. There is no problem with, for instance, anorgasmia or weight gain. We can accomplish the same thing as drugs, but without the side effects. It just takes the desire to change, and enough motivation to step off the easy and well-worn path. One needs to muster the courage to forge new trails and conquer new horizons. But drugs are not required.

Medications all-too-often only provide temporary relief. In some cases, a period of drug-mediated improvement in depression can give one the solid ground needed to step in a new direction. After that, the ideal decision would be to withdraw the drug in short order. I believe medications can play a useful, even vital role. But pharmaceutical agents can not, and should not be the only compass used to find a new way to live. Lifelong treatment with psychiatric medications is questionable, and despite what we are led to believe, most pharmaceutical agents lack scientific evidence of usefulness over long term treatment. So if drugs are used at all, they should be used in the lowest number, at the lowest doses, and for the shortest time possible. It takes much effort and time to change neural pathways without drugs, but the improvement is longer lasting, without side effects, and far more natural.

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Meltdown as Mentor: Examining Insecurity

Note: the attribution for photos can be found by clicking on the image. Most are used via Creative Commons license, as is indicated in my footer. But it does not hurt to state it up-front occasionally.


moving van

It helped so much to get such kind comments after I blogged about my discouragement. How wonderful that the blogging community (at least in the mental health realm) is so supportive.

Today I worked at putting fixtures back up in our bathroom, after Mandy painted yesterday. It took the better part of a day to get it all restored to order. That normally would be fine, but I really wanted to write something extra interesting today. I wanted to show how much it meant to me that people responded, even as I thought no one was coming around anymore.

I like to look at meltdowns like the one just ending, and ask what can be learned. I already mentioned the problem with being too sensitive. The other issue that I see is the ever-present fear of abandonment. On another page of this site I placed the recent essay I wrote about my last memories of my mother. Watching her fade into deepening depression, and then die, left me with a sense that even those who love me (and I know my mother did) cannot be counted upon. Then I think about all the moving we did as I grew up (every year until I was ten), and the fact that I would go spend the summers relatives who would be really nice to me, but then force me to return to Los Angeles to be assaulted by my ‘evil stepmother’. So the idea that anyone will remain in my life seems pretty unrealistic.

Hence, I am always ready for the inevitable disappearance of those who matter to me. The surprising thing is that in the short time I’ve done this blog, having people read my little essays has become very important.

I could walk away with some growth here: 1. a sense that even people I’ve never met care; 2. a realization that feeling abandoned because my site statistics dip is not too healthy; 3. knowledge that I have found an activity that’s important to me, after years of little enjoyment of anything. (I could also add: 4. a reminder that to some extent I am still stuck in my childhood.)

So in the end, a valuable experience. Thank you to all who read this: you have helped me rediscover joy.

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Depression & The Agony Disappointment

koala

The last few days have been grim. As much as it seems like I can now manage my depression, can modulate its intensity, and tolerate it (or even appreciate it as a kind of privileged insight), those concepts have been just that: concepts. No heart. No ability to give me a will to do anything. It started when the readership on the blog dropped off. That, in turn, began with my idea of putting my ‘spiritual philosophy’ out there. Either that direction bored, annoyed, or just did not get picked up in search engines. The problem for me was not the lack of readership, which no doubt will wax and wane. Rather, my incredible sensitivity to adversity has become a handicap.

The good news is, today I feel better. I awoke with a better perspective, and got the courage to turn on the computer and check out the inevitable fact that my blog has dropped off the radar. At first I had a rush of excitement when my email downloaded: a bunch of comments to my posts had rolled in! Then I realized that all of them were spam. And because I’d left them sitting there for two days, they encouraged more spam. So my site had been flooded. At least I was able to chuckle at the irony of my ‘popularity’ only being junk mail.

So, this blog isn’t supposed to be about me anyway. I started it to help others. From that view, if others don’t come, at least I’m fulfilling my intent to try. The tenderness of my feelings is the big problem. I’ve always been touchy, but now it’s become almost ludicrous. Having had so many disappointments and perceived failures in the past decade has taken my original sensitive area and rubbed it raw. I will try to use this last mood collapse as a lesson to not allow setbacks, actual or not, big or small, to affect me so deeply.

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