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.


My Life as a Doctor on Disability

birdintree

Since I started this blog at the end of May (and ramped it up in July), most of my posts took on a rhetorical style. In college (UC Berkeley) I took a year of Rhetoric rather than Freshman English, for reasons I no longer remember. Ever since then, it has been hard for me to write without composing an argument. My guess is that readership will not be attracted to an endless column of that stuff, as much as I enjoy logical analysis of issues.

While I cannot change into someone new, as much as I sometimes wish it, it is important for me to also be ‘real’ in this project. So what follows gives a brief sketch of my current lifestyle, at least as I lead it when in the Bay Area.

After waking up early, I sit at my computer for an hour or more looking at any comments that might have come in, writing responses, and visiting blogs. Then my wife and I walk our two little dogs: Emily, a chihuahua-dachshund mix, and Ralphy, who is some version of a poodle. Both weigh 10-11 pounds, and are the cutest dogs in the world (but it’s possible I’m a little biased). Some days I also go to an AA meeting a few miles from home; it’s a daily meeting, and it is one of the few places I’ve made friends as an adult.

After the dog walk, Mandy and I usually go to the gym. This takes us to noon, or a little later. The afternoon I often spend running errands, though I prefer to have time to write. That is one of the reasons I prefer living in the foothills (where we spend 1/4 to 1/2 of our time); it presents fewer distractions to my writing.

Mandy usually cooks dinner, and I either do the clean up alone, or with Mandy’s help. I actually prefer to do it by myself because, truth be told, Mandy does 90% of the housework; I have never been one to assist much. I feel guilty about it, but evidently not enough to pitch in on a regular basis. That’s another reason I like being up at our mountain place: there is a great deal of work to do outside, around the land. That way I can contribute to the function of the household, since I am poorly motivated toward cleaning and doing the indoor work.

In the evening we typically watch a rented movie. Then I do one of two things. If I am feeling OK, I spend more time at the computer. Unfortunately, very often I get depressed as the day ends, and I retreat to a dark room, curl up in a ball, and try not to think. I focus on my body and its sensations in order to escape the torment of my thoughts. Not a pretty picture, and obviously not one I am proud of, but there it is.

When I am writing, my guilt about not helping around the house gets alleviated slightly. Since my surgical career ended in 2000, I have spent six months in graduate school, three months teaching high school, and eighteen months doing public speaking for the California Department of Public Health (about childhood lead poisoning). I’ve also done some volunteer computer programming and other unpaid work (including a little recent work as a mental health patient advocate). But you can see how I do not have any earning capacity. For now we are coasting along OK, but someday an income will be needed. Since I have crashed at every endeavor since my surgical career ended (due to neck problems), the only thing I have left is writing. Although it may never pay actual money, at least it feels like work rather than mere laziness.

Writing as a living is obviously a very, very uncertain thing. Especially for someone with so little background in the field. I have what I think is an interesting story to tell, but whether I can tell it in a compelling way is an open question.

Believe it or not, those eight (rather short) paragraphs sum up the better part of my current life. It is simple, uncluttered, and sometimes boring. The difference between what I do now and what things were like back when I had a clinical practice is impossible to overstate. Back then I worked fifty hours a week (half of those in the operating room), fixed up our vintage house in San Francisco on the weekends, and spent the rest of my free time either sculpting or reading about sculpture. I was busy as hell. I felt productive and proud of myself. I was probably a little arrogant.

In those days I had minimal spiritual sensibility. I tended to see things from a materialist perspective and gave almost no attention to the murmurings of my heart. Stress consumed me.

Which is better? For all the loss, grief, depression, and defeat, I am now a more enlightened, understanding, and humble person. Admittedly, I sometimes take the humility thing too far until it borders on humiliation. But most of the time I see myself as a better person than before. (I admit my wife might have a different take on things.)

So that’s my story. I don’t know if anyone will care, or even read this far into my post. But I want this site to include some of my real day-to-day experience, rather than just arguments. Besides, I see now that my opinions about mental health topics sound naive compared to what I read on other blogs, where similar topics have been kicked around for a long time.

Lately, I’ve been battling a low-grade conviction that life is s**t. My grip on living has been slipping, and I find myself dreaming of the long fall off the Golden Gate Bridge, just like the old days. (When I was in the hospital, the therapists grilled me about why I was fixated on the bridge, when as a doctor I could–they thought–easily get my hands on some pills to die painlessly. My answer came down to what I mentioned in another post: my mother loved the bridge before she died. It seemed to represent something to her, even as she faded into the mists of depression back in Michigan.) That’s why I gave in and boosted the Cymbalta again.

Since the dose increase, my mood is perking up. Of course, I pay the price of diminished sexual responsiveness and the discouragement of losing ground in my project of breaking free of pharmaceuticals. But at least the nagging feeling that life just isn’t worth the trouble has lifted–sort of.

I’d like to end on a better note, but that would not be true to my current condition. When I started this blog my hope had been to show everyone a path to freedom out of depression: I actually believed my progress exemplary enough that I could begin to teach others. Rather predictably, however, I’ve slipped back into the pit, though fortunately not too terribly far. I have every expectation that things will look bright again before too long. I even have hope of feeling connected, once more, with the cosmic resonance that I feel at my calmest times, especially when surrounded by arrow-straight pine trees and dozens of birds, whose clicking, chirping and trills remind me of God’s voice.

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Do Medications Limit Spiritual Growth?

Mandy has an eye for God in Nature.

This is another addition to the ongoing conversation between me and Marian at Different Thoughts.

Believe me when I say that it pleases me to the core to know that you have attained a place of peace and connection with the central currents of creation. I am very happy that you have found your suffering to be a path to such a healthy and profound axis. I do know of St. John of the Cross and believe wholeheartedly in the concept of suffering leading to wisdom. At my best, I have found myself in such a state of grace.

Unfortunately, I am not there right now. It has been an impossible condition to maintain, as you said. Right now, the suffering just feels tiresome. I experience the world as a place that doesn’t fit my psyche, like I should have been born on a different planet. I’ve been trying meditation, retreats, groups, reading spiritual books, attending mystical services, hanging around people with values I respect, finding those who believe in deeper realities. Yet that state of grace is outside my reach, for now. I don’t mind that, because I don’t expect life to always be bliss. But I do get very exhausted having no energy and no enjoyment. That is the feeling the pills reduce.

I don’t like the medications. I think they are my enemy. But one way or the other, my brain is now adapted to them, and the pain (withdrawal symptoms?) I feel when I cut back too quickly gets to be too much if it goes on for more than a month or so. That’s when I raise the dose again, in order to catch my breath before the next attempt at reduction.

But for my part the drugs do not feel deadening. The antipsychotics did, but not the antidepressants or the mood stabilizers. They just don’t have an effect on my sense of reality that I can detect, except that they take away the experience of my days as exercises in pointless pain. I am not talking here about existential suffering, awareness of the aching heart of human tragedy, or connection with the streams of sorrow that run like lifeblood through the history of humanity. I am talking about dull, meaningless pain that I get sick of and can reduce with a chemical. Am I happy about needing to do that? NO. Do I feel weak for resorting to the pills? Sometimes. But I do what seems like the right thing for me, for now.

At the same time, I don’t believe the medications block me from spiritual awakening, or connection with divine consciousness. Our brains are biological. I suspect there is a non-material spirit too, but the organic matrices of our brain play at least a large role in our experience. If you add a foreign chemical you alter the biology, but you do not change the brain into something entirely new. I don’t think every chemical has the effect of blocking spiritual growth, though some might. I have not found the drugs to be a barrier to spiritual connection. In fact, my peak spiritual experience in life, which far transcended anything else that’s ever happened to me, and was very similar to what the saints describe, actually occurred while I was on Effexor and Depakote. I don’t think those drugs did anything to cause my epiphany, of course, but they did not prevent it either.

It is also important to remember that some spiritual traditions actually employ chemicals to foster spiritual enlightenment. Even the Roman Catholic church incorporates wine in its services. I know, at present the little sip of wine at communion is purely symbolic. I strongly suspect, however, that the early church founders did some actual drinking as part of their rites.

My point is still the same: each person is unique, and every path is different. I am relying on chemicals right now because I am trying to make my transition off the drugs without killing myself or making my wife miserable. And yet, I have had many days (not very recently, but not all that long ago, either) when my spiritual state was such that everything made sense and suffering became irrelevant: I was on a higher plane. I know that condition exists, but I can’t be there all the time, and as long as I’m living an ordinary existence I want to try to enjoy it.

I am glad that you have found your way to union with the grand consciousness. I fully respect that for you that has meant clearing your brain of pharmaceuticals.

Not everyone can reach union, whether they take medications or stop them. And for those that do, not everyone will do so the same way. There are many paths to God. For some, drugs may slam the door. For others, they may open it. For me, they do neither. My path to the heart of creation is open sometimes, and closed others, without regard to how much medication I’m on. It may have to do with lunar cycles, or simply with some variable rhythms in my body. Or perhaps I just try harder sometimes than others. But I am absolutely convinced that it is possible to get there now, or at least sometime not too long from now, and I don’t need to wait until every last psychiatric medication is out of my system.

Please understand that my ultimate goal is to be drug-free. So I embrace your philosophy on its basic level. However, I am not sure if I will ever achieve total freedom from psychoactive agents. It would be very discouraging if I thought that I would never experience God as a result. Fortunately, I know that to be false. I have before and will again experience the divine touch; I will feel in my innermost self the purpose, beauty, and power of suffering. In the meantime, I choose to live my life with a little less of the dreary kind of pain that is about as enlightening as pounding my thumb with a hammer.

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Antidepressant Addiction?

antidepressant pictureApologies to the many talented, ethical psychotherapists in the world. My last post demonstrated my bitterness about some bad experiences I’ve had with counselors, but I painted with too broad a brush. I do think clients need to use caution in choosing a therapist. And they should always make their own decisions without feeling pressured by any professional. That said, there have been times when going to see a therapist has helped me weather rough periods better than I would have alone. Many of us missed out on large families and large circles of friends. We are often isolated, and a therapist can be a beacon in the midst of loneliness.

On the other hand, I believe starting medication for my mood issues was a mistake. I would never have begun psychiatric drugs if without unshakable faith in my therapist at the time. Yet my life now seems to revolve around pills. I take six different medications for various aspects of my mental health. A year ago I was on seven. Currently I am in a pitched battle aimed at trying to reduce my medication load. The war is not going well.

Case in point: I have been on SSRIs (selective serotonin reuptake inhibitors) for almost fifteen years. Currently I take duloxetine (Cymbalta) which increases synaptic norepinephrine in addition to serotonin. I have been working hard to reduce my dose of this drug. A year ago I took 120 mg each day. About six weeks ago I took my latest step down, and limited myself to 20 mg per day.

It has been a rough six weeks. I find myself saying things like, “if someone told me I only had five minutes to live, I’d be upset: I wouldn’t be able to say goodbye to my wife and dogs. But if they gave me an hour, I’d be fine with it.” Or words to that effect. Not a very positive outlook, is it? For the most part, I haven’t been bothered by the melancholy, since one of my projects this year has been to learn to tolerate adverse moods more. After six weeks of feeling like life is nothing but a chore, however, I broke down and went back up to 40 mg. I just got tired of the dreariness, and it did not seem to be going away. So today I increased the dose. No doubt my mood will improve, but I hate to retreat in this way. I feel trapped by my body’s habituation (addiction?) to these medications.

My psychiatrist says she could switch me to fluoxetine (Prozac); it has a longer half-life and comes in smaller dosage forms. So it would make for an easier taper. The problem is, I’d be left anorgasmic. Ever since I started SSRIs my sexual sensations have been diminished. Cymbalta at least wears off quickly, so I can stop it 48 hours before sex and things feel mostly normal. If I go back to Prozac, I won’t have that option. So I hesitate to travel that route. I don’t want to give up something that brings me joy, at least not when I my life already feels so ‘blah’.

Like I said, a well-meaning therapist convinced me to start psychiatric medications back in 1995, after I had spent the previous 20 years refusing them on the grounds that they had not helped my mother. (She died in a mental hospital in 1964, after years of psychiatric medication and shock therapy.) Since I had benefitted a lot from this therapist’s help, I took her advice. I did well on Prozac (and lithium) for several months, but then became depressed again. So the dosage was increased. Later, more drugs were added. Then yet more again to deal with side effects. That has been the story of my life ever since: transient improvement, followed by increased need for drugs. It is hard not to conclude I’d be better off without any of it. Not to mention that I’d have a more normal sex life.

So even though I extend apologies to all the hard-working therapists out there, I still end on the same note as last time: I wish I had exercised more caution, kept my own counsel, and pursued less therapy.

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Computers Instead of Therapists?

computer eyes

Insomnia? Depression? Anxiety? Soon, you will be able to turn on your computer and learn how to work with these problems.

Widely recognized as effective, Cognitive Behavioral Therapy (CBT) has been demonstrated experimentally to improve emotional health. The theory behind CBT, as most people involved in mental health care (whether clients or providers) understand, is that you can change how you feel by changing how you think. Leaving aside the question of whether you should change how you feel (I’ll deal with that in a later post), if you learn the techniques, they seem to work. At least they did for me. I learned to cut my depression and anxiety in half, easily. I also started sleeping better, just by not driving myself nuts with worry. Good stuff!

It’s called ‘therapy’, but is it? In truth, it is a set of methods for working with thought to keep it from wrecking your life. Person-to-person ‘therapy’ is not absolutely necessary. I got most of what I needed from a book or two, and you can search Amazon to find any number of texts on the subject. (They all look about the same to me.)

So how about learning the techniques from a computer?

I was not surprised to find out this is already possible. I came across one article about an internet-based protocol for teaching CBT techniques to manage insomnia.

I am not a big fan of therapy, even though (or because) I have undergone more than 20 years of weekly sessions. In truth, I have found it almost as often harmful as helpful. Maybe someone with a good, strong sense of identity and purpose could visit a well-skilled and careful therapist and do really well. At my best, and with the best therapists, that has been my experience. The problem has been that usually by the time I’ve stumbled into therapy I’ve been pretty well crushed emotionally. Desperate for guidance and support, I have given my counselors far too much control over my decisions. Later on, when I’ve felt better, too often the choices made under a therapist’s influence look like his or her choices, not mine. His or her values shine through, and mine get obscured.

Maybe a computer therapist would have been safer. I would not have leaned on a computer for support in the same way. I could have just learned the techniques, and relied on my own personality for courage and strategy. Given the never-ending effort by insurance companies to reduce mental health expenses, it is safe to assume that this method of delivery will become widespread. As much as I think psychiatry services should be covered by health plans, perhaps it would not be a terrible thing if some of the care came from silicon circuitry rather than the neuronal networks of a (fallible and corruptible) human brain.

I like people. There is no substitute for the warmth and support of another human being. But paying a therapist to guide me through life has not always worked well. I would not have become a doctor and a surgeon had it not been for a therapist who vehemently encouraged me to look for the highest paying job within my reach. Without those choices, I might not have damaged my neck by leaning over an operating table four days a week. I might not have lost my career at age 42, and might not have had a nervous breakdown. Who knows how my life would have gone? There’s little benefit to thinking about ‘what if..,’ but obviously therapists with poor boundaries can push vulnerable clients in directions that may prove disastrous.

The crucial decision about my career direction should have been made by me under the influence of family and friends. A person paid to help me (especially one who later admitted he was a cocaine addict and alcoholic) should not have been the one to choose. I was too young and emotionally weakened to understand how vital it was to make my own choices, and I allowed myself to be swayed away from my heart’s native desire (to study nature and ecology).

So I applaud the development of computer systems to teach mental health techniques. Psychotherapy can be helpful, but sometimes it is better to let people find strength and solutions on their own. Therapy should be a tool, not a crutch.

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Needing Care, But Wishing I Didn’t

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Amanda (my wife) and I spend part of our time in the mountains, and part in the city. We go back and forth regularly. This morning we head back to town.

I hate going back. It would be easy to live up here full-time. I’d like to. Ultimately, and not long from now, we’ll need to choose one or the other. I choose here.

Amanda worries about me, however, and my occasional need to be close to doctors. She had a dream last night that showed that: we were about to jump a car across a ravine. She did not think it could make it. I ‘floated’ ahead to show her it was OK. Halfway across I plummeted to the floor of the canyon, and all she could hear was faint whimpering. A pretty clear message?

It’s tough having an illness of any kind. Between my bipolar disorder and my neck issues, I used to need doctors a lot. Right now I don’t, and I’d love nothing more than to get away from them for good. I see no advantage in living near ‘advanced’ medical care. My body has been badly damaged by medications. My father probably died as a result of a medical error. My mother had severe depression in the early 1960′s, and they treated here with valium, barbiturates, and shock therapy. Probably she had tricyclic antidepressants, too, but all she did was get worse and worse and die anyway. As a six-year-old, I was convinced that the treatments were bad for her. I still hold that view.

But what if my neck worsens, and I need intensive care just for daily life? Or if I get so depressed I need partial or full hospitalization? (As much as I am skeptical such a thing would help, sometimes it is reassuring to loved ones.) When here in the mountains, we are an hour from the nearest hospital, and almost two from the HMO of our choice. As people who have lived our whole lives in urban areas, we find it hard to imagine living so far from services. Yet I see people dwelling all around us up here in the mountains, and some of them are quite elderly. If they can do it, why can’t we?

You have to listen to your spouse’s dreams, however; both the dreams for the future she or he has by day, and the terrors by night. I hate feeling like my fate is in the hands of illnesses I can’t control. I’m not giving up on the move, but there probably needs to be a compromise here. Right now, the answer is not clear. I have made some catastrophic decisions in the past, and I don’t want to repeat the mistake of acting on poorly conceived impulse. On the other hand, my heart yearns to live in the forest.

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Entering the Crowded Field of Mental Health Blogging

Wow! There are so many mental health blogs to read. It’s enough to make an insecure manic-depressive jump off a cliff. How can I possibly stand out in such a throng?

Oh well. I’m used to being put in my place. If this past decade had a purpose, it was to teach me humility.  Where once I could tell people I was an oculoplastic surgeon, all I can say now is that I have started a blog. Well, who hasn’t? I’m trying to show up in mental health circles on the internet. I read the successful blogs about the subject. (I’d read less successful ones, but how do I find them?) Since I always think I have something to add, I post lots of comments. I keep plotting a direction for my own work.

As I write my comments, It seems inevitable that one of my insightful observations will attract attention, bringing readers back to my own site, but no luck so far. Maybe the comments aren’t all that insightful after all. Inevitability inevitably fails.

It’s not easy being a psychiatrically ill former physician (is it easy to be any kind of human?); I feel like people should take me seriously, just because I was once successful and my history is fairly unique (you’d probably agree if you knew even half of it). But in this society the question often is simply, “what have you done lately?” Watching my past glory fade into my current obscurity hurt for a long time, but not anymore. I now feel happy to be free of the pressure to compete. It is a pleasure to be an ordinary human, and not worry about trying to be better than others.

On the other hand, I would like my message(s) to get out. If I could get someone to listen, I think I have important stuff to say about mental illness and psychiatric care. Maybe my experiences would help others. Maybe they could avoid my mistakes, and reach happiness sooner. Nothing would please me more than having someone struggling with mental illness derive benefit from my history.

Believe it or not, I used to think it would be kind of cool to have a bipolar I diagnosis. So much more interesting than ‘mere’ depression. It pleased me when I started to come out of my manic psychosis/religious ecstasy and I realized that I was now officially manic-depressive. I had always read about bipolar artists and writers, and I was happy to join the club. Pretty naive, don’t you think? I now realize that many people are frightened and turned off by mental illness. I understand that it looks like weakness to others (even though I know it takes strength to survive the storms of emotion that come with bipolar disorder). I see now that it might have been better to hide my psychiatric problems. But I already  told everyone who would even half listen about my religious ‘delusions’, my hospitalizations, medications, and so on.

Since everyone around me knows the story, whether they wanted to or not, I figured I had nothing to lose by starting a blog. So what if the whole world knew my story?

It is now obvious that the whole world could not care less. There are so many bigger problems, more famous people, and better writers. Not to mention more than a hundred million blogs! (Or is it two hundred million?) What’s a poor former surgeon to do?

Keep writing. Keep hoping. Keep living.

I am prepared to fulfill my mission–to bring light to others with mental illness. But will anyone ever hear me? What can I do to make it happen?

Keep writing. Keep hoping. Keep living. My new motto.

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Atypical Antipsychotics: A Typical Big Pharma Story

The so-called atypical antipsychotics are the pharmaceutical industry’s new SSRIs. In the 1990′s the Selective Serotonin Reuptake Inhibitors came on the scene like an explosion. The hype was enough to convince almost anyone with depression to give the drugs a try. Prozac looked like the answer to all sadness: just take the pill and feel better. No need for therapy. No need to work on your attitude or lifestyle. No need to increase your tolerance for adverse moods. Just pop a pill and go on with your life.

Years later, we now know that the SSRIs do not exceed the older drugs in effectiveness. Compared with ‘tricyclics’ (the older antidepressants), drugs like Prozac have different side effects, but not fewer. Perhaps the only real advantage of SSRIs in treating depression is that they don’t kill you if you take too many. Tricyclics are notoriously lethal in overdose.

So the dust has settled, and SSRIs no longer look like wonder drugs. Worse (from the standpoint of the drug companies) most of the patents of the original SSRIs have expired (long acting preparations and other alterations may still be available only in branded forms). So the pharmaceutical industry needed to move on to something new.

Enter the ‘atypical antipsychotics.’ They are ‘atypical’ because they work differently from the old antipsychotics. The old drugs were essentially dopamine blockers. The class had been discovered because of an herbal folk remedy for insanity, from which a very effective anti psychosis drug was isolated. It turned out that it worked by blocking the effects of dopamine in the body. This led to the ‘dopamine hypothesis,’ which postulated that schizophrenia results from excess dopamine. That idea was eventually proven too simplistic, though there is little doubt that dopamine is one of the neurotransmitters that goes awry in psychotic illnesses.

Atypicals, however, are less specific for dopamine than the older drugs, having widespread effects on serotonin and other neurotransmitters. (They also may be more discriminating in which of the body’s several types of dopamine receptors they target.) The prototype was clozapine (Clozaril), which had tremendous antipsychotic activity, but life-threatening side effects. Working from the structure of clozapine, researchers created the other atypical agents. These include: olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and risperidone (Risperdal).

Unfortunately, I have taken all of them (except clozapine) at one time or another. I have had only one episode of so-called psychosis, which was relatively short-lived, but the psychiatrist who followed me during that period continued the atypical antipsychotics long after my spiritual euphoria had resolved (religious ‘delusions’ and ‘hallucinations’ were my only psychotic symptoms). She continued the atypicals because the drug companies started promoting these agents for mood disorders. The pharmaceutical manufacturers first succeeded in expanding the scope of the agents for non-psychotic mania. Eventually, they began touting them as helpful augments in intractable depression. These potent ant highly toxic agents are being used more and more for such reasons (Abilify, in particular, gets promoted for this purpose).

When I took them, they mainly felt like strong sedatives. Sure, they helped with agitation. They made me feel like I’d been hit with a hammer.

Problem was, they had terrible side effects. Well-known problems include incredible weight gain, increased cholesterol, and diabetes. I got the first two, and was well on my way to the third by the time I finally quit the drugs. There are other side effects, it turns out, when these drugs are used in combination with different classes of psychiatric medications. I won’t go into detail right now, because I am still getting up the nerve to talk about how these drugs have harmed me: it is a very sensitive subject for me.

My point right now, however, is that these are hazardous drugs. Their side effects are far more dangerous than, say, those of the SSRIs. Given the escalating epidemic of obesity and ‘metabolic syndrome’ in this country, we really should question whether these drugs are good choices when so many people already have trouble controlling their weight. Especially since the evidence for the effectiveness of atypicals for mood disorders is not all that convincing.

Addendum:
Here is a link to a good site to check out if you want to know more about the controversies surrounding atypical antipsychotics. I also just came across an article about the problems with big Pharma and atypicals (with reference to a recent major legal settlement involving Zyprexa) on HuffPost by Dr. LLoyd I. Sederer. My thanks to Liz Spikol for her The Trouble With Spikol blog post summarizing the article.

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Surviving Two Days of Depression

Saturday and Sunday were hard for me: depression and frustration. In the ‘old’ days, I would have been flat-out miserable. These days, however, I am able to tolerate the ‘down’ feelings without believing it to be torture. There are two good movements that support the idea that depressed moods don’t have to be hateful: Acceptance and Commitment Therapy, and Tom Wootton’s Bipolar Advantage. I suggest checking out both. They helped me sit with my depression and experience it without judgement. I found that there is physical pain, especially in my chest/heart area, but also throughout my whole body. There is a sense of melancholy, and it is difficult to feel excited about anything. However, I also feel a kind of ‘wisdom,’ a way of seeing the world that transcends ordinary values. If you can learn to be OK with depression, then you are freer than before. You can see how so much of what people run away from (and sometimes spend their whole lives avoiding) can actually be growth-enhancing.

So I got through those rough days. So far today feels lighter, but it is not even 7 am in California yet, so there is still plenty of time for that to change. Either way, however, I will be fine.

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A Blogger in Need of a Plan

Sometimes I just don’t know what to say. It is hard to write words of wisdom when you don’t feel wise. This has been a rough week for me, and I am just going through the motions to get through it. Doing the minimum. About all I can say that’s helpful is that things will get better. I know that now. There have been times (many of them) when if I felt crummy like this I did not know if things would ever improve. Now, however, it is clear that they always do. It’s just necessary to wait, ride out the hard time, and wait some more. Eventually, the light will return. So I’m waiting. 

I’m waiting, too, for some ideas about how to make this a real blog, with actual readers, etc. That will come with time, I’m sure. At present I’m not putting out product that I think is terribly compelling anyway. So I don’t mind just writing to myself while I get the hang of blogging, develop a voice, and chart a clear direction. Someday, maybe, I’ll go back and restate the concepts I started with, only in a more compelling a readable fashion.

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The Mental Ecology of Will & Spirit

Continuing from where we left off last time…

Sometimes the will needs to step in and help the spirit. My spirits have been low today, and I am using thought to give them a pep talk. It is easy to fall into the trap of believing the spirit is smarter than the mind: more wise, more able to see what is really important in life. But because the spirit is not analytical and does not deal well with the concepts of  ’past’ and ‘future’, it can get overwhelmed by feelings in the present. I find it vital to prevent my will from sinking downward with the spirit when things start feeling bleak. Otherwise I have part of me suffering from negative emotions, and another part thinking about how bad things are. They feed off each other and spiral quickly into a dark place.

Instead, if I can keep the will, (i.e., the verbal mind), working hard to resist the pressure of darkness, it can help my spirit heal. After all, the spirit is tender and vulnerable. It needs the will to protect it. The will can be the strong partner at these times, holding the spirit’s hand (so to speak), helping it get past the pain. I like to look at the two as marriage partners, who work best when they play to each other’s strengths and work together toward health.

There is a complicated ecology in the mind. Similar to the biological ecology that surrounds us, the mind has distinct components that are partly but not completely separate from one another. There is constant interplay and resource cycling. Thoughts affect feelings, and vice versa. The goal as I see it is to become a good steward to this system. Like a diligent gardener, I try to spot the weeds of sadness and negativity, keep the soil fertilized with good thoughts and positive feelings, and water well with creative ways of seeing things.

Does any of this make sense to anyone else? Do others pay attention to the different aspects of their own mind, and tend the interactions? I’d be interested to hear another’s thoughts.

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