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.




Why does a flower bloom?

daffodiltrail

Feeling rather discouraged.

This day should be filled with joy and light. Mandy and I have been married 14 years as of today (we’ve lived together for 18 years). In many ways, our relationship possesses more strength, intimacy, and passion than ever before. We have been through many trials, and have weathered them well. The decade after losing my career made life difficult for us both. Much uncertainty, regret, and fear. Most of that has passed. I no longer have physical spasms from anxiety, a face permanently frowning from depression, or nonstop obsessions about suicide. And Mandy no longer has to carry the entire emotional burden of our life together. We’ve survived. Adversity has tempered our relationship, and we step into the arms of the future knowing we will be there for each other “as long as we both shall live” (quoting our vows). Even the recent uproar around lingering effects of sexual abuse, and the medication-induced anatomical damage that triggered it, have improved our connection. We approach each other with more gentleness, but also more fire. More vulnerability, but also more confidence. After all the trials, recent as well as remote, my marriage today provides me strength, pride, and love. I should feel great. But I feel distress.

Another reason I might be joyful is that we have undertaken a delightful project. We may be moving to Mendocino, a very nice village on the Pacific coast several hours north of San Francisco. Rugged and unparalleled terrain treats the eye at every turn. Artists and writers in residence comprise a community of interesting and forward thinkers. Sedate rivers winding through primeval redwood forests almost beg us to launch our canoe. The relocation forms an exciting prospect. We await to hear if an offer we have placed on a lovely house and nice patch of land will be accepted. Exciting.

And yet, my mood struggles with angst and fatigue. Yes, the expectation of selling this home, buying another, moving, and living in a new environment cannot help but create stress. Yet that is not the problem. Yes, the anniversary stirs mixed memories from the past, troubling reminders of mortality, and unanswerable questions about the future. But that is not the problem.

The problem is this blog. I’ve been writing in recent posts about two of the topics that prompted me to start this project: the lingering effects of childhood abuse, and the side effects of a certain combination of psychiatric drugs. Both these subjects mean more to me than I can express in words. My conviction remains strong that writing about this material is necessary for me and for the world. But I am realizing that a delusion has crept into my plans. I thought that opening up on this blog would spread the word about a dreadful potential side effect of psychiatric medications. I hoped that my story of attaining peace after so much trauma would help many others. In my typical grandiose way, I believed this undertaking would make a big difference. I expected a sense of accomplishment. Instead, I just feel impotent.

That’s a loaded word in the context of sexuality. As it happens, the side effects I keep alluding to did not cause functional impotence. They marked me with more insidious and far less common changes. But impotence can also mean ‘ineffectual’. More than anything else, the side effects make me feel inadequate. In an echo of the way my stepmother robbed me of my power, the drugs have left me feeling like I am insufficient. I chose the ‘bull fighter’ analogy in yesterday’s post because the worry I have, that many men have, is that I am not ‘macho’. If any occupation epitomizes the machismo mentality, it is that of the matador. What my stepmother did to me, and the damage the medications have inflicted, strike at the heart of my sense of being a forceful man. A ‘bull among men’. I will gradually work into more specifics about the side effects, but for now I want to focus on how this sense of not being effective, or powerful, or worth taking seriously, interacts with my experience of journaling on line.

Endlessly competitive, I cannot help but notice other blogs in this genera that get dozens of comments for posts about day-to-day things like landscaping, or coffee shops. Yet I write about the most intimate feelings and experiences, and get only a smattering of feedback. This response (or lack of it) makes me think of a few possibilities: 1) no one is reading, or 2) people read, but don’t relate to what I’m writing, or 3) people relate, but are too uncomfortable to go on record with a comment, or 4) people feel disgusted that I disclose so much. My guess is the problem is mostly with (1), but my fears are mostly with (4). The end result is a mixture of impotence (from 1) and shame (from 4).

The feeling of shame I expected. I even started this whole line of discussion in order to address how the pain of humiliation drives so much of our behavior. But I did not foresee that opening up about these delicate and personal matters would leave me feeling disempowered. In fact, I had hoped for the opposite: that expressing myself would make me feel stronger. But having revealed so much, and received so little response (even after I went fishing for comments yesterday), gives me a strange sense of weakness. Like I have this momentous story to tell, but no one is listening. Anyone who wanted to damage me could devote just a little time on line and connect my name with these intimate stories I’ve told. But that does not scare me. I don’t mind being public, if it serves a purpose. But to put all this out into cyberspace, and have it just blink out like a wavering match in a gale, makes me realize that what I went through is not likely to help others after all. I can write the whole shameful story of how I’ve been abused, first by my stepmother and then by the Goliath pharmaceutical industry, but I am not going to be like David. I am not going to slay any giant.

I am launched in this. I have disclosed enough so that the necessity to finish the tale weighs heavily on me. There is nothing more for me to fear, as I have already expressed my deepest self-doubts. I have yet to spell out the damage wreaked by the medications, but the truth will not exceed whatever people imagine on the basis of what I’ve written so far. And even that assumes, of course, that more than a handful are reading. I have revealed my scars, gone public with my shame. There is no reason not to continue. But I cannot say this is working like I planned.

The act of writing about these intimate issues touches me to the quick, to the heart of the fears that the abuse and the side effects have provoked. I am handling the emotional third rail I’ve shied away from for many years, even my whole life, until now. What I am finding is that the fire and raging emotional currents from that live wire are different in character, more intense, and also less injurious than I expected. Different, because the fear of being exposed is being replaced by a fear of being ignored. More intense, because instead of feeling shame from having people know ‘the real me’, which I was prepared to deal with, I feel an unexpected and abysmal terror that no one gives a damn. And less injurious, because I also realize nothing substantial is changing in my world as I write this story. My little narrative goes on as before. I make my plans, plot my moves, and live my life as if nothing unprecedented was going on. As if I wasn’t unhusking the delicate creature that lives buried in shame, and fear, and loneliness. As if I wasn’t shucking off the chrysalis, and flying on unstudied wings into an unknown world.

I feel like a blossom opening to the broad sun of day. Only instead of a sunny public park, I find myself in a shadowy glen, far from the path, where no one sees or cares. That distresses me until I recognize, and this comes to me just now, that daffodils don’t bloom to attract the attention of people walking the garden trails. They bloom to draw butterflies and honeybees. Gentle critters that don’t traffic with human society, but live for the nectar and the joy of life itself. Nor do the daffodils intend to heal the bees, or gather their applause. They flower because they follow their innate rhythms and unfold in due time. They serve the purpose of genetic diversity, but they blossom because they must. I am opening because of my own inner cadence, because it is my time. All along I thought there was a ‘reason’. I would free myself, or help others, or expose the pharmaceutical industry. All wrong.

This blog, this story, is what I do because I must. If others find the journal helpful as they wander the labyrinthine trails of the internet, so much the better. But I have to let go of the expectation that there is anything being accomplished. I’ve written poetry most of my life, and not one piece has ever ‘accomplished’ anything. I write because I must.

nettleEMpicture

The easy thing might be to stay tightly folded and covered with bristles, like a nettle, and not open up. It would be safe. I could hide what happened to me from everyone but my wife. I could pretend I was OK. But I was raised in enforced secrecy, never able to reveal the truth. Now, as an adult, I find telling the ‘whole story’ gives me strength and purpose. Now, I feel the words drawn from me by the same natural forces that draw water to rush downhill. And what I realize in scribing this post, is that I have no choice but to spell everything out. Despite my belief at the start, this blog is not fashioned so others can read it and be healed. That would fulfill me if it happened, but does not account for my hours spent writing. Nor does the journal get produced in order to garner attention, though it appears becoming noticed matters more to me than I thought. This site of mine comes from an inner program that says I must speak.

I need to tell the truth for the same reason the redwood grows, the moon orbits the earth, and the sun never ceases exploding. I tell my story because I must.

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.