WillSpirit

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

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








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

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




Truth or Dare?


This post is one in a string of essays about spirituality. It may make sense to start with the first entry in the project. On the other hand, the writing gets easier to read, and the posts shorter, later in the series.


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Looking at the wretched state of humanity, it can be hard to believe in a caring, guiding power. But one can remember that we often watch those we love come to harm, while we remain powerless to protect them. A God-like entity could be overflowing with affection, but lack the ability to guide us away from mishap or cruelty. Another objection to faith comes from the perception that scientific findings rule out mystical forces. But later posts will show that our understanding remains incomplete, with corners of mystery that might harbor a universal consciousness. Finally, if one remains locked in verbal mode, and never relaxes into wordless wonder, it can seem impossible that anything ‘mystical’ could exist. But sometimes it’s healthy to remain childlike, and open our hearts to magic.

Many of us have trouble healing because our ever-reasoning brains refuse to relax and let faith emerge. In discussing a possible universal consciousness, or BIOPE, these posts suggest ways that one can use established facts to overcome the logical mind’s resistance. In pursuit of this goal, everything has been kept as ‘rational’ as possible. Even so, the endeavor will help only those who want to believe. It is aimed at the seeker who has difficulty feeling comfortable with faith. Which convinces me it’s a mistake to bypass discussion of my personal spiritual experiences in the service of avoiding ‘irrational’ content. If it’s a given that readers are seeking transcendent support, why not share what seemed like messages from God? Those who would be alarmed by such material won’t read these posts anyway.

William James and many others have noted recurrent strains in religious experiences. The themes my visions shared with those of others included: 1) a feeling that the universe is filled with love; 2) an awareness of the unity of creation; 3) an understanding that all is somehow ‘right’ in the cosmos. As will be spelled out later, a few additional insights came my way. But for now, let’s stick with the basics, begining with universal love.

In the midst of my ecstasies, I felt the love of creation in much the same way one feels heat radiating from an open oven. The first time it swept over me, the vigor of God’s affection nearly knocked me down. It was the end of an Alcoholics Anonymous meeting, and a surge of spiritual awareness had been building inside me for an hour. As we said the Lord’s Prayer in a circle, it felt like I was standing in the path of a breaking wave of love. My body and heart filled with warmth, and I knew with utter certainty that God loved me. Within moments, the relief of learning how much the universe cares about people reduced me to wordless weeping, much to the dismay of those present. As outlined elsewhere on this site, my childhood included maternal suicide and sadistic abuse at the hands of my stepmother. Until those moments in the AA meeting, love never felt real or trustworthy to me. Never before had it seemed like my welfare mattered much to anyone, and suddenly a force as powerful and vast as creation held me in its palm and said, “you are precious to me.” The words were not audible like speech, but they rang through my awareness like a bell on an open plain. A group of alarmed alcoholics huddled around me for several minutes as I crouched near the floor awash in tears. They thought something awful was wrong, but nothing had ever felt so right.

That the universe loved me, and everyone, seemed like the most obvious fact in the world. How could it have been missed for so long? It was as if my entire life had been lived in darkened rooms, and suddenly the curtains were opened to reveal the sun. The events of those days taught me that even though it remains unseen, God’s affection is as real as the air we breath, invisible but sustaining us every minute. It’s a lesson that is easy to forget or discount. But if you want to believe that what I experienced holds truth, then rest assured there is as much love in this universe as there is space and time.

“Wait a minute! It was just a spasm of brain cells!” the atheist in me says. He chalks it up to “an abnormal release of neurotransmitters; maybe a flood of dopamine in my nucleus accumbens. It was a psychosis brought on by acute distress, and aided by changes in psychiatric medications. Nothing but an emotional hallucination.”

Should that skeptical voice be handed the reins? Is it be better to be ‘realistic’, and believe the universe has no heart? Or does the wise person suspend judgment, and accept love?

***Click here for the next entry in this series.

“Let ‘em jump”

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In an email, a reader suggested I take up the subject of the murderous army psychiatrist in Texas. I had not paid much attention to the awful tragedy; I find it helps me little to follow such events. In fact, I get demoralized thinking about the wretched state of modern culture, where fallible humans can handle weapons capable of wiping out dozens of lives in just a few minutes. The first news reports, to the extent I could not avoid the headlines, seemed to indicate the guy ’snapped’ because of impending deployment to Iraq. That would have made a more interesting and less inflammatory subject, but now there are suggestions he had ties to Muslim extremists. Predictably, that possibility has summoned the nastiness out of the rotting foundation of this country’s democracy. A senator from Illinois is blaming Barak Obama, because the President’s father was Muslim. His comment lacks honor, like much of what I hear today. Regardless of how one feels about the leader of this nation, accusing him of causing this nightmare is simply silly and opportunist. But this is not a political blog, thank God. Since it’s so sparsely read, I imagine I can get away with the fractious sentiment I just inserted. But I’ll say no more along those lines.

That a psychiatrist committed such an act, and that there is at least a suggestion he did it because of mental stress, is interesting to me for other reasons. In general, people do not expect well-educated, successful, established doctors to lose their grip. I was once insane (technically, ‘psychotic’.) And I was once a physician. Unless you count depression as delusional, I was never out of touch with reality and practicing medicine at the same time. The point, however, is that lots of training and responsibility are no insurance against insanity. (Whether this particular psychiatrist lost contact with reality, or committed insane acts with full awareness of the humanity of those he was killing, is immaterial to my point. Either way, he quit acting in a rational fashion—and I would hold that to be true even if he killed because of extremism.) Mental illness, unlike humanity, does not discriminate. All races, classes, occupations, genders, and ages can be struck by it. Yes, the psychiatrically disordered as a group have less-than-average income and living standards, but poverty is more often an effect than a cause of psychiatric conditions.

Not very long ago, I tried to become a psychiatrist (I also applied to PhD and master’s programs in psychology;) this was back when I still sought a ‘secure’ career. Now I am only interested in writing, and can be free in what I reveal about myself. But when I was still interested in working as a clinician, being open was a risk. And I was too open in my applications. Foolishly, I thought having a life history saturated with family and personal mental health problems made me a better candidate. I thought the admissions committees would recognize my increased empathy toward patients, and better understanding of their situations. Instead, I was told I showed ‘lack of boundaries,’ and demonstrated ‘too much self-disclosure,’ to be a successful applicant. Personally, I think this was code that told me they did not want to knowingly accept someone with a history of psychosis, however remote and circumscribed it was. At the time, I felt furious. Friends encouraged me to launch anti-discrimination lawsuits. Obviously, the programs did not want to accept a psychiatry resident who might go on to, for instance, fire upon dozens of people at an army base. My belief is that they could have looked at the utter absence of violence in my story, and seen that a childlike conviction that God walked beside me was fundamentally different from being lost in a homicidal obsession. Or that a single event many years ago, one prompted by an antidepressant drug, did not put me in the mass-murderer category.

There is such fear of mental illness, however, that no one wants to take responsibility for making such distinctions. It’s easier to just be cautious and say ‘NO.’ I encountered the same roadblock at Big Brothers, Big Sisters. After a long vetting process, including interviews and fingerprinting, the director of our local chapter told me they could not accept me because of my psychosis history. I don’t think the guy even knew the precise meaning of the word, ‘psychosis;’ it was just too scary and seemingly too risky for him to accept. I thought the way I’ve overcome a stormy upbringing, broken family, history of child abuse, and so on, would help me be a good mentor to a troubled youth. But by being honest, and admitting my psychiatric problems, I ruined my chances.

I understand better than before why many African-Americans are burdened with chronic anger. It is maddening and humiliating to have people judge you on the basis of category rather than capability. To have skin that is brownish rather than pinkish, and so be out of the running regardless of who you really are, must be an excruciating experience. Fortunately, overt racism is no longer tolerated. But the historical memory, and covert discrimination, will continue to harm for a long time.

There is little societal proscription against discrimination on the basis of mental illness. There are laws, but people ignore them. Few seem to think twice before making jokes about ‘crazies.’ A few days ago I was drifting (there was almost no wind) in a sailboat under the Golden Gate Bridge. The group I was with had been put together through an online social network. I did not know any of them. Naturally, at some point people asked me what I ‘do’ for a living. The answer is complicated, but mainly I write. Not for a living, but as an occupation and with a tiny prayer of someday making money. The next question, ‘what do you write about,’ brought us to the topic of mental illness. With my usual lack of boundaries (vide supra,) I told people that my interest in the subject started around the time my mother killed herself.

An hour later, when we approached the Golden Gate Bridge, someone brought up the fact that plans are in place to put a net underneath to curtail the frequent suicides (which average two a month.) One enlightened sailor retorted, “Aw, just let ‘em all jump!”

I was too shocked to respond at first. Was he being deliberately cruel to me, after what I said about my mom? Or was he just ignorant and rude? By the time I organized a response, the conversation had moved on. I tried to bring it up again, but someone changed the subject before I got too far. So I gave up, and came home feeling very different from ‘normal’ people.

I started this post with the intention of writing about how despair and mental illness can strike anyone. I ended up talking about discrimination. Both are important subjects, but I find writing about them in this direct way less engaging than my more emotionally immediate pieces. The best solution to ignorance and prejudice is to enlighten others by putting human and close-to-home faces on psychiatric conditions. That is the direction I am hoping to go with my writing. Not addressing discrimination in exposition, like I just did, but by helping others glimpse the inner landscape of mental distress. My hope is that I can help people who, like me, battle psychic demons. I also pray that I can move people who think they are ‘normal,’ and harbor hostile attitudes about mental illness, to adopt a more compassionate stance.

Atypical Antipsychotics

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 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.