It’s funny how just when Western healthcare had almost completely alienated me, it saved my life. Having studied a holistic tradition (Chinese medicine) to a certain depth, my portrayals of conventional medicine had become dominated by the shortcomings of its clinical care: overly technological, narrowly focused, insufficiently personal. It seemed obvious that healing requires more human touch and less electronic gadgetry. Just six days ago I railed against modern inpatient treatment (see Hospital, Heal Thyself).

And then…

It turns out a ligament occluded my celiac artery, which supplies many abdominal organs. This led to enlargement of vessels around my pancreas, one of which became so thin and weakened that it bled. During a four-hour procedure, an interventional radiologist embolized this aneurysm to prevent further bleeding. But the hematoma remains in place, where it has totally blocked my small intestine. Since no food can get through my digestive tract, the doctors ordered a semi-permanent venous access and started IV feedings two nights ago. Without nutrients dripping directly into my bloodstream, I probably wouldn’t survive long enough to permit my intestine to reopen. And if the problem doesn’t correct itself with time, I’ll need surgery. My life is likely to continue, but only because of modern medical techniques.

So it appears I need to soften my stance against contemporary biomedicine. To remain contemptuous would be hypocritical and ungrateful.

I still see problems, of course. More artwork, nicer paint jobs, some soothing music, fewer computer screens, and more patient contact would all be nice. On the other hand, technology does demand we tolerate a bit of depersonalization and indignity.

This became clearest as I rested on a rigid radiology table during my procedure. After the third hour my bladder was so full that the discomfort made it difficult for me to remain still. The team members, who had already shaved my groin to my slight embarrassment, now placed a plastic urinal between my legs and dropped my appendage into it. While five people watched impatiently (four of them women) I was commanded to pee into the bottle. Can you imagine how difficult that felt? I tried very hard, which was of course the wrong approach. A nurse placed my fingers in a cup of warm water, but nothing flowed. Finally, I had to endure the dreaded Foley catheter, the fear of which was a large part of the reason I was so desperate to urinate on my own. As they inserted the tube, it hurt just about exactly as much as I’d expected. I felt mortified by the entire experience, though at least I managed to lighten the mood with a small joke about my situation.

Although the process involved pain and a dose of humiliation, the angiographic procedure clarified a confusing clinical problem. It cured me of my aneurysm. Yes, attempting to micturate publicly under duress felt embarrassing, but I don’t see how the awkwardness could have been avoided. Three of the staff were scrubbed and gowned, so they couldn’t leave the bedside. One was monitoring the equipment and the other dealt with positioning the bottle relative to my anatomy. It was dehumanizing but unavoidable.

There are trade-offs in life. Although I resist viewing the body as a device, it does have mechanisms that can fail, and which can be corrected by technological procedures. This requires a team of health care workers, lots of machinery, and sometimes compromise of modesty. But if the alternative is death, why complain?

Over and over in the course of writing this blog I’ve found myself modifying earlier narrow views with later expanded ones. These days a popular buzzword is integrative healthcare. It suggests that we can combine the best of technological and traditional healing. I suppose it’s our most promising option, as difficult as it might be to achieve. It would also be the equivalent of clinical medicine maximally enlarging its range and acceptance.

Unfortunately, we are in an era of diminishing resources, so integral approaches will need to be developed on the cheap. Yet that may be a good thing. It might force us to trim the waste of natural resources that is so rampant in hospitals. It might reduce the use of expensive and ineffective medications. It might result in fewer unnecessary procedures.

As always, life is teaching me to extend my awareness, soften my criticisms, and increase my thankfulness. This illness has been painful, frustrating, and discouraging, but it has aided my maturation. I now remember the tremendous power of a health system I’d nearly rejected. I recognize that although there are many insensitive hospital workers, there are also legions who are dedicated and compassionate. I better understand that you sometimes need to sacrifice dignity and comfort in service of survival. It’s been a tutorial, finally, in letting go of rigid demands.

I’m seeing, once again, that learning to be flexible and open-hearted in the face of fate’s trials is the ultimate lesson and reward of living. Adopting levity helps too, as in joking while trying to ‘produce’ under trying circumstances. It never hurts to milk a little humor from humiliation. Life is, after all, at turns both sublime and ridiculous.

Thanks to modern medicine, my life will go on despite this setback, and perhaps I will be wiser, jollier, and suppler from here on out.

What if instead of psychiatric hospitals, we created spirit-healing camps?

Not long ago I wrote a post proposing that Mental Health Day be renamed Spiritual Health Day. In that essay I explained how it seems to me that spiritual malady would be a more accurate and less damaging label than mental illness. With that in mind, I submit we should work to create crisis centers that nurture the soul.

Whenever people felt crushed by unrelenting sorrow, or burned with too much energy for normal life, or heard persecuting voices, or felt like God’s chosen child, they would be offered escape to a pleasant retreat in the countryside. Once onsite, they could work in an organic garden, or staff the stables, or help build a new lodge. They could ride horses, paddle in canoes, and play frisbee on the lawn.

They could come and go when they pleased. They would learn about the brain, and about psychiatric problems, but they would also hear how mental conditions have been positively viewed by other cultures. They could attend meditation sessions, practice a spiritual tradition if they chose, and they could make art of all kinds. Groups would play music and sing in the evenings. There would be no television, and no computers, but lots of books and endless craft supplies.

The tenants could choose whether to stay in dormitory-style lodges or camp alone in the wild. They would be encouraged to keep regular hours, to exercise, and to participate, but they would never be coerced. And each day a bus would arrive to bring in newcomers and let those who wanted to depart go home.

Those who felt in contact with mystical forces would be guided by spiritually advanced peers who had passed through similar gates. Those who wanted to talk about their problems could meet in groups. Others could journal on their own. Attendees would learn about the inspired but troubled minds of Mozart, Lincoln, Van Gogh, Nietzsche, Plath, and many more. They would be taught to harness the positive aspects of their condition and minimize the negative. They would be guided by others like themselves instead of ‘normal’ professionals. A prerequisite for employment on the grounds would be direct experience with personal or familial psychiatric distress.

Medications would be available, maybe, but they would be voluntary only, and prescribed by doctors who understood the dangers of pharmaceuticals. There would be just as much emphasis on bodily as on mental care. Aerobics, yoga, Qi Gong, running, and many other physical activities would be offered. The camp would emphasize good food, socialization, and fun. At the same time, anyone who needed solitude could readily find it.

People would be asked to securely store their valuables prior to entry, so there would be no concern about theft or jealousy. And if anyone became unacceptably disruptive, the worst consequence would be a bus ride back out.

Perhaps this sounds too utopian to ever be realized, but there have been several programs along these lines over the years. Unfortunately, few have persisted and the model has not spread. The Quakers rejected dungeons in favor of humane asylums long ago, but in an era when few knew how to manage powerful mental states or transform them into positive experiences. Nowadays reimbursement issues and the dominance of drug companies have produced the modern mental ward, complete with little paper drug cups and heavy steel doors.

The new model might succeed where earlier experiments broke down, because it would emphasize management by those who had been through psychic torment but grew beyond it. This would not be a paternalistic asylum, but a fraternal refuge. The staff would not be guards, but guides. Without enforced confinement, with little reliance on drugs, and in a rustic setting, costs could be minimized.

Perhaps I’ll be accused of living in a dreamworld, but the vision of a naturalistic healing center has been on my mind since childhood. Why must mental health care be administered in sterile hospitals? It’s not like psychiatric problems are transmitted by germs.

We don’t lock the grieving widow in a mental ward because she feels overwhelmed by sadness. We take her to a chapel, surround her with friends and family, and honor her departed husband. When people die we use the inevitable emotional turmoil as the pivot for a ceremony calling Grace into the world.

Or consider that when people feel powerfully moved at weddings we don’t hand out Ativan; we encourage the full expression of Bliss.

When emotion occurs in a group setting it becomes a shared and sacred event. Even tragedies like earthquakes and terrorist attacks bring this quality to light. Look at the rituals and monuments built around 9/11.

So why can’t we use the same tactic to deal with the isolated breakdowns and breakthroughs that occur sporadically every day in every culture? Why not emphasize the power of these experiences rather than their pathology? Why not offer the suffering a setting where they can be safe while they rattle their mental cages and seek a path toward peace?

Mental turmoil can be used as the base metal for an alchemical transformation of spirit. Agony can turn to insight with the right support. Maybe what I’m suggesting isn’t the best answer, but to me it sounds better than Bedlam.

Sharing my journey through the mental health system, and especially my successful withdrawal from psychiatric medications, seems to have struck a chord with readers. Many have left comments stating their own desire to break free of pharmaceuticals. A few visitors have expressed reservations about my stance on these issues, because they have found psychiatric drugs helpful and life-enhancing.

The two positions (a belief in the value of medications and a desire to break free of them) are not mutually exclusive. There is no reason a person couldn’t credit drugs with saving his or her life, and still hope to someday be liberated from taking them. But there is obviously a tension between faith in pharmaceuticals and the desire to live without drugs.

The following text was cobbled together from my replies to the desires and concerns of readers. It explains at some length the fallacy in believing pharmaceuticals to be potent weapons against mental chaos. The next post will argue against long-term use of medications without trials of drug reduction, and also offer some suggestions for tapering off pharmaceuticals.

It is undeniable that people seem to get better on drugs. However, although there can be little doubt that the active agents in medications are sometimes responsible for the observed improvement, the placebo response and other factors need to be kept in mind. Pharmaceuticals are seldom prescribed in isolation. When someone presents to a psychiatrist for care and gets better after receiving a drug prescription, it is hard to dissect out how much of the recovery comes from the active agent in the pill, versus the support, encouragement, and therapy that go along with participation at a mental health clinic. Many people who get better on medication are recovering because of their mind’s own hidden powers, elicited in the context of a supportive environment, and not because of the pharmaceutical chemical.

One commentator pointed out that patients may try several medications without success, and then finally be given the ‘right’ drug combination, after which they get better. This sounds suggestive, and perhaps in these cases the pills are making a big difference. But in every real-world situation many other factors are at play, so it’s also possible that the supposed ‘ideal’ drug cocktail is merely a coincidence: it happens to be chosen around the time when improvement would have happened anyway. Only controlled, randomized research could settle this question definitively.

When placebo-controlled research is performed that adjusts for the myriad other variables in treatment, drugs never appear particularly decisive in their effect. In a typical ‘successful’ study, 60% of those who take a medication show some level of improvement, whereas 40% of those on placebo recover just as much. By these numbers, only one person in five who gets better on a psychiatric drug is doing so because of the chemical agent in the pill. Four out of five are improving for other reasons.

And of course the published research has been heavily biased to demonstrate efficacy. When all of the suppressed, failed studies are added to the analysis, the active agents in drugs look even less helpful. On the basis of careful review of both published and buried research, Psychologist Irving Kirsch has concluded that antidepressants depend almost entirely on placebo action for their effectiveness.

The tendency of the mind to respond to suggestion can hardly be overstated. Although the word ‘placebo’ carries a connotation of ‘fake,’ it really should awaken us to the healing power of expectation. In a future post I’ll explore placebo action more deeply. For now, I just want to highlight that medications may help us feel better for reasons other than the neurological effect of the synthetic chemical.

Having expressed some reasons for doubting the widespread perception that these drugs have nearly miraculous powers, I must emphasize that medications may be useful in the short run in many cases. Possibly they are also necessary on a more chronic basis at times. But given that research evidence supporting their value is weak, whereas their ability to cause serious side effects is undeniable, drugs should not be looked at as the most important, reliable, or safest tools available to aid those suffering psychic distress.

DRUGS FOR LIFE?

Although my last post argued against viewing psychiatric drugs as scientific miracle pills, it remains true that some patients experience decisive improvement on medication. I believe such individuals are fortunate. As my writings have made clear, I did not enjoy much success with drug treatment.

Lack of efficacy combined with dreadful side effects led me to taper off the medications, slowly and over several years. If the pills had worked for me over the long haul, I’d probably still be taking them.

Pragmatics, not ethics, determine my opinion here. I see little reason to argue against pharmaceuticals in those cases where life feels enhanced and neither adverse effects nor expense have proven troublesome.

Even so, as a physician I can affirm that limiting the number and dosage of medications to the minimum necessary for the desired effect is always a good policy. As a human, I can endorse occasional reevaluation of life strategies as a wise practice.

The pharmaceutical industry promotes the misconception that psychiatric drugs are, essentially, vitamins: permanently necessary for mental health. This is simply untrue. Some patients may need medications for life, but clinicians do us a huge disservice when they assume this without proof. The only way to know for sure is to occasionally try the alternative: professionally guided drug reduction.

Lacking helpful clinical advice, and often out of frustration, many patients stop taking pills in hope of living drug-free. Unfortunately, abrupt cessation of pharmaceuticals almost always leads to decompensation. Although the desire to discontinue medications is natural, quitting too quickly can cause profound deterioration if not hospitalization. Unthinking clinicians view the downward spiral that follows sudden drug cessation as evidence that the patient has an illness that requires chemical treatment, but it’s more likely a sign that the brain has become habituated to the drug and that the withdrawal was too rapid. Only by slow, careful tapering can a person’s condition on less or no medication be fairly assessed.

Pharmaceuticals too often get prescribed for years and decades despite a striking lack of controlled evidence for benefit with such prolonged treatment. At the same time, it’s all too easy to substantiate the harm drugs can cause when used for extended periods. Unfortunately, it is easier for psychiatrists to keep writing scrips than it is for them to undertake the difficult work of assisting with medication reduction. They also fear malpractice liability should a patient harm self or others (though this risk is probably minimal when tapering is done properly and with good communication). So countless patients end up on potentially toxic pills for life without ever getting a legitimate try at doing without.

Drugs can be helpful, especially early in one’s recovery. But after a time on medication, as one gains familiarity with calmer, more balanced mental states, one often feels ready to cut back on pharmaceutical support. It may make sense at that point to try measured reductions to see if the recovery remains stable with less intensive treatment. One might find that hypomanic energy (for instance) that once felt intolerable can now be managed or even used to advantage. Such a trial would be a personal choice that should made in consultation with clinicians.

Getting completely off medications once seemed impossible to me, but it turned out to be achievable. Most important to my success was learning to tolerate uncomfortable feelings without acting them out. Acceptance and Commitment Therapy (ACT) was instructive in this regard. Cognitive Behavioral Therapy also helped, as it taught me to avoid exacerbating psychic distress with distorted thoughts. In addition, mindfulness meditation practice helped me observe my feelings and thoughts without buying into them. Regular exercise, helping others, and like-minded social contacts were also vital in supporting this work.

For me, successful drug tapering hinged on my going slowly and remaining in touch with mental health professionals who supported my goal of drug reduction. Since I knew they shared my long-term agenda, I trusted them when they suggested I should increase the dose of a medication temporarily. I did this several times in the four years I spent tapering. I’d go up on the dose until some transient stress resolved, or the winter days got longer, or I simply felt stronger. I tried to avoid rigid refusal to take pharmaceuticals, but I never let go of my long-term hope of reducing the medication load as much as possible. In the end, I was able to completely stop, but if it had been necessary to continue on a low dose, I would have done so without feeling bad about it.

What matters is balance and contentment, not some misplaced philosophical purity. If medications bring a person to a better state, feel like the right choice at the time, and don’t cause harm, I see no reason not to use them. But it still makes sense to take a second look from time to time.

The American Psychological Association is sponsoring a mental health blog party. Those of us writing in the genera have been invited to post an essay as a sign of solidarity and empowerment. I’m in favor of joining others with psychiatric histories to increase awareness and reduce stigma, but I also feel conflicted because I no longer believe ‘mental illness’ serves as a helpful concept.

Let me be clear: people sometimes behave in ways that look incomprehensible or even insane. Suicidal behavior, profoundly delusional speech, and irresistible compulsions are severe behavioral problems for individuals and society. No doubt they stem from cognitive activity and emotional tones that differ from average day-to-day awareness. These sorts of disordered conduct are clearly mental in origin, but do they qualify as diseases?

It seems to me that to define something as an illness implies that we can identify its absence. But this isn’t always easy. Take the example of suicide. Frank attempts on one’s own life lie at the extreme end of a spectrum of self-destructive thoughts and actions. Some of these get labelled as mental illness, and some don’t, but the distinction is rather arbitrary. I suspect a majority of the population would have to admit to moments of wondering if life is worth the effort, and to brief thoughts of ending it. They aren’t mentally ill just because they have moments of doubt, but where do we draw the line? How frequently or how seriously does a person have to question life’s value in order to be deemed sick? Or consider how a man with advanced emphysema who continues to smoke kills himself just as surely as a woman who takes an overdose of pills. But our culture doesn’t define the dying smoker’s senseless behavior as mental illness. What’s the difference? Does the fact that a man doesn’t admit to wanting to end his life relieve him of responsibility for doing so? I might even submit that the honestly suicidal woman is more rational and clear than the smoker steeped in denial who works toward the same end.

Or consider delusions. If a man believes the CIA has implanted thought control devices in his brain, everyone agrees he is out of touch with reality; we call this paranoid schizophrenia. But if a political leader proclaims that environmental exploitation isn’t a problem, even as the ecosystem destabilizes, no one considers her delusion a sign of mental illness. Director Tom Shadyac’s delightful documentary, I Am, makes a similar point about how many of the values our culture accepts as admirable are actually insane.

What about obsessions? Someone who won’t leave the house without checking the doors and windows two dozen times earns a diagnosis of OCD. But a billionaire obsessed with accumulating ever more money gets worshiped like a modern deity.

Furthermore, psychiatrists dismiss highly positive spiritual experiences as delusional and hallucinatory simply because such states hint at phenomena that aren’t endorsed by materialist science. When for a time I entered what seemed like profoundly awakened consciousness back in 2000, I wasn’t congratulated. The psychiatrists labelled my experience a ‘manic psychosis’ and started me on Haldol. I was too trusting to doubt them at the time, but now I wish they’d referred me to a spiritual leader rather than the psychiatric ward.

Obviously, people spiral into all kinds of behavioral crises and need help. Sometimes they recognize their need for assistance, and sometimes not. But whether a particular maladaptive conduct gets labelled as mental illness or not has to do with cultural values, not medical science. If there weren’t so much stigma, and so much risk of over-medication, it wouldn’t matter. But a life may be derailed for years (or forever) after the hammer of a major psychiatric diagnosis shatters a person’s reputation and self-image.

Tradition tells us that the seventh century Korean Buddist Wonhyo achieved enlightenment when following an exhausting journey without water he collapsed at night in a deep cavern. He found an ivory bowl while groping in the dark, and relished the sweet water it contained with a rush of relief. But when he arose the next morning he realized he had reclined in a tomb. The ‘bowl’ was the cap of a human skull, and he saw that he had not drunk clean water but a putrified soup of decay. At first nauseated and repulsed, he ‘awoke’ shortly afterward when he recognized how what he thought about reality (and not reality itself) so decisively determined his experience.

The conditions we label mental illness are a bit like that, only in reverse. In my case a lifetime of profound sadness, plus the ministrations of countless therapists and doctors, convinced me that I suffered from a severe psychological disease caused by my upbringing (which included early bereavement and severe child abuse) and genetic endowment (my depressed mother committed suicide). This view of myself had a major impact on my self esteem for much of my life, but I don’t believe it anymore. Now I understand that my sadness was a natural grieving reaction that may have been prolonged because no one validated my understandable sorrow after such a childhood.

No longer do I see my melancholy as the psychiatric equivalent of a putrefied skullcap. I now appreciate that life dealt me hardship early on, and I reacted normally. With time I overcame my grief, so that the traumatic past now stands as one of my most important teachers. Despite its ordeals, it led me to how I feel today: contented and more than a little knowledgeable about difficulty and its transcendence. The skullcap has transformed into the ivory bowl. Of course, neither perspective is actually ‘correct’ in any objective sense. But which picture I hold in mind has a huge impact on how I feel.

I’ve already sketched how psychiatrists diagnosed as mania an experience that in another time and place would have been viewed as a divinely granted spiritual awakening. What might have been seen as the ivory of grace became the corpse of mental illness.

How experiences are framed determines how we feel about ourselves and how others view us. Does the frame of mental illness serve the majority of patients? Or does it more often sap vitality and confidence? I read in many blogs of the relief people feel when doctors finally define their problems as diagnosable mental diseases. I remember feeling similarly myself when a lifetime of moodiness finally earned me the bipolar label. It felt so comforting to have my condition named and seemingly validated. But instead of decisively helpful treatments, the mental health system strung me along with decades of therapy and thousands of little pills, none of which improved my mood or outlook very much. It seems to me that if psychiatric diagnoses were truly valuable, they would guide clinicians to life-changing therapeutic choices. But how often do people diagnosed with ‘major mental illness’ leave the Psychiatry Department with an effective cure? Although they may feel transiently relieved, they and their family now must endure the burden of ‘knowing’ their minds are sick.

Only during the past few years, as I took up meditation and began exploring holistic methods of healing, did I begin to feel well. In fact, the change occurred rather quickly once I started meditating, tapered off the cocktail of psychiatric drugs, and quit hanging out at the mental health clinic. My once rock-solid conviction that my mind was ill gradually dissolved, and I began to wonder if I’m perhaps one of the healthier persons around, simply because I’ve worked so hard to achieve balance and peace. And if my ‘symptoms’ forced me into this growth, shouldn’t I be glad they afflicted me?

In many other cultures the kinds of malaise we now define as medico-psychiatric illnesses have been considered spiritual crises. In my own case, after fifty years of struggle with sadness and mood swings, I would have to say that such a view would have been far more helpful and more like an ivory bowl than what I heard during my decades within the mental health system’s well-meaning skullcap.

You may be dismissing all this as the ranting of a newly converted fundamentalist, but that’s not who I am. Although I believe spiritual transformation finally solved the problems that clinical psychology could not, I don’t hold any particular religious belief or adhere to any specific tradition. I don’t presume to know the nature of God or even to be sure of its existence. My own recovery convinces me that it is possible to find a ‘spiritual’ cure without abandoning reason or science. Not to mention that modern physical theory describes reality in terms that sound essentially mystical.

In any event, a spiritual approach to mental wellness has little to do with ideas about God or the nature of reality. It has everything to do with how we see ourselves. If we think we are fragile and isolated personalities adrift among unfriendly and predatory human apes, we are likely to feel and act badly. On the other hand, if we see ourselves as sacred beings enmeshed in a grand tapestry of life and mutual interdependence, we feel uplifted and at peace. Which view is ‘correct?’ I don’t believe anyone can say. But I am utterly convinced that embracing the latter view is healthier than clinging to the former.

I’m not advocating the end of psychotherapy or the closure of mental health clinics. In fact, I like the phrase ‘mental health.’ What I’m suggesting, however, is that we replace the DSM‘s ‘mental disorders’ paradigm with something different. The Positive Psychology movement is a great idea. A catalog of spiritual practices might also help. But while the biomedical doctrine of ‘mental illness’ caters nicely to pharmaceutical interests, it serves patients poorly. Let’s give the skullcap a nice burial, and start over with some more elegant and uplifting concepts.

Several recent interactions have pointed out to me that I am way too sensitive. A good friend and I passed emails back and forth, each of us angry about the behavior of the other, and all of it traceable to overreaction on both our parts. Then there was the confusion around my new blog at PsychCentral. I applied for the chance to write for them, and when after a week they had not yet responded, I assumed (incorrectly) that they’d turned me down. Not only that, but I took it personally. There have been some other emotional missteps, but I’ll concentrate on these two.

In both cases, my emotional reactions were too strong and too swift. In both situations, I’d have been better off slowing down, asking for clarification, and maintaining a thicker skin. With my friend, I ended up hurting his feelings and stirring up needless stress. With the blog, I indulged in some online whining and almost abandoned blogging altogether. In each case if I had asked for information, and waited for things to work themselves out, considerable inner and outer turmoil would have been avoided.

There’s a hidden ingredient here. Several months ago I quit my final psychiatric medication. In the bad old days with the psychiatrist who treated my moods between 2000 and 2006, I was overmedicated. At several points I was taking six different medications for my mental health. The side effects were dreadful and humiliating, and my depression hardly improved at all. The only benefit was a generalized emotional numbing. I was free of intense anguish, because I had no strong feelings at all. This seemed like a good idea at first, but I soon recognized that life was passing by while I lingered in a medicated haze. My wife hated the zombie-like affect I presented, and it was impossible to accomplish anything under such sedation.

Since 2006, I’ve been tapering off the medications. I feel more sadness, but also more happiness. I can laugh and cry and think once again. My former passion and creativity have been restored. Unfortunately, many of the damaging side effects appear to be permanent, so I will always be scarred by my foray into the world of psychopharmacology. But if I don’t dwell on the injuries, I feel pretty contented. Or at least I do today. Coming off the drugs has been very good for me, although I am by no means suggesting it would be right for everyone.

And in fact it wasn’t completely right for me. One of the reasons I became so hypersensitive was that, like I said, I had quit the final antidepressant back in March. It had been challenging reducing the medications at every step, but when I discontinued the final drug, I slowly spiraled into a very unpleasant space. To my great relief, I did not contemplate suicide. However, joy and interest drained from my psyche. I continued all my normal activities, but I enjoyed few of them. Worse, I began to overreact to perceived rejections.

Since I restarted that final drug, things have gotten dramatically better. The lesson, I suppose, is that extreme positions are always suspect. I had decided that since six drugs were disastrous, the answer was to take none at all. That turns out to have been too drastic. It looks like I am better off taking a modest dose of one antidepressant, rather than trying to live with no psychiatric medication at all.

It’s been an enlightening experience. My anger at the psychiatrist who treated me so aggressively, and the side effects that resulted, had pushed me to decide that everything about psychiatric medications, at least in mood conditions, is suspect. Now, I’m not so sure. Although I wonder if the antidepressant would be as necessary if my system had never been exposed to any such drugs, the fact is that life is much easier on one medication than it was on none. It’s a good reminder to watch myself, and question my motives at every step. It is very easy to get swept away by strong emotions. As much as I believe feelings are necessary to live fully and happily, it is also the case that when they get too intense they cloud judgment.

It is also vital to keep an eye on what works. If a single antidepressant can make such a big difference, and if it also happens to be one of the few medications that causes me no side effects, why not take it? Is philosophical purity more important than pragmatically doing something to make life more livable? One of the biggest problems in the world today is the very human tendency to get locked into behaviors and attitudes that are rigid and extreme. Inflexible and dogmatic attitudes are damaging. This is as true in an individual life as it is in the case of religious fanaticism and political extremism. As the Buddha said, it’s best to follow the middle way. In most circumstances, the middle position is the most accurate and the most effective.

Patience. Moderation. Trust. Communication. Flexibility. Pragmatism. You’d think by this age I would have mastered these basics. Better late than never…

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 native 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’, where schizophrenia was postulated to be the result of excess dopamine. That idea turned out to be far too simplistic, but there is little doubt that dopamine is one of the neurotransmitters that goes awry in psychotic illnesses.

Atypicals, however, have less effect on dopamine than the older drugs, and more effect 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 at one time or another. Oddly, although I have had one episode of psychosis, my psychiatrist at the time prescribed atypical antipsychotics long after the psychosis had resolved. That’s because the drug companies started promoting these agents for mood disorders. First they were proposed for manic symptoms, but eventually some of them were touted as effective agents for severe depression. They are being used more and more for such reasons.

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 toxic drugs. Their side effects are far more dangerous than, say, those of the SSRIs. Given the epidemic of obesity and ‘metabolic syndrome’ in this country, we really should question whether these drugs are being overused. Especially since the evidence for their effectiveness in many conditions 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.