WillSpirit!


∞ Where Mental Skills Heal Mental Ills ∞

A former physician writes about mental health and recovery using insights from life, science, and spiritual practice.








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

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


Do Medications Change Who We Are?

contrail

Last night sleep came. Since stopping Cymbalta 13 days ago, most nights have provided only a few hours of true dozing. Once or twice in the past fortnight I took zolpidem to knock myself out. But that does not lead to refreshing slumber, just a kind of drugged unconsciousness. Even with the sleeping pill, no more than five hours were spent sleeping; the rest of the night passed with me either laying in bed trying to relax, or else reading and eating blueberries (there must be a bumper crop this year, the prices are so low). But yesterday I retired early, then slept almost ten hours without awakening. What’s more, after arising I sat in our hot tub like I often do, but afterward got out and dozed for another hour.



We have a two-person spa on our deck, with a fine view to the east. Most mornings as dawn brightens I sit in water heated to 104° F (40° C), while I take in my surroundings in a silence broken only by a few buzzing insects and the first active birds. I leave the nozzles turned off, since I dislike the mechanical noise. I overlook a line of forested ridges rolling toward Yosemite, where the horizon is jagged with granite peaks. With an early enough start I am rewarded by a view of the sun rising into a salmon-colored sky, usually cloudless and marred only by the contrails of passenger jets in the stratosphere. These aircraft cross over the Sierra Nevada mountains on the last leg of their flight to San Francisco. One time I looked out the window during such a flight, and saw Yosemite Valley below the wing, looking like a small broken slab of gray stone. As I soak in the morning, loosening the tension in my damaged neck, I look up at those specks gliding through the twilit sky, and wonder about the travellers drinking morning coffee while looking down at the expanse of conifer forests and rock mountains. I wonder if it occurs to them that someone lives among those trees, watching them as they soar in the upper reaches of the atmosphere. I think about how insignifcant my corner of the world must look from their perspective, my home invisible in the green carpet of sugar pines. It amazes me that we will never know each other, that we will each live our entire complicated stories, each entirely unaware of the other’s drama. Our only connection is my fifteen-second reverie about a stranger in a jumbo jet, drinking coffee as her plane travels hundreds of miles per hour, drawing a rose-colored line across the dome of morning sky. Today such warm water thinking put me back to sleep.

After all that, my point is that I feel better. Yesterday my mood stayed pretty solid, with only a slight dip toward depression in the afternoon, something I experienced my whole life up until starting SSRI antidepressants. This morning, after finally getting up for good, I have been productive and energetic. Could it be I am finally getting past the Cymbalta withdrawal syndrome? The past two weeks have been brutal. If I did not have a strong commitment to survive and be here for my wife, suicide would have been the likely result of how badly I felt. Life seemed so very pointless, and not at all worth the torment roiling in my heart and soul. Countless times each day I dreamt and prayed (to the extent that I pray, since the God of my belief is not the kind that keeps an ear to the mutterings of mammalian nervous systems) that I just drop dead on the spot. Now I feel ready to engage my corner of the earth once more. Not that I am thrilled to be alive, singing like Julie Andrews on a grass-blanketed mountainside. No, I am still the not-too-optimistic failed surgeon. I sit before a small computer screen connected by a wire to my even smaller laptop, typing with nine fingers and one elbow (actually a finger in a thick dressing). The hillside I gaze upon is covered by an expanse of dead weeds baking in the August afternoon sun. But today I am pleased enough with this little drama of mine to stay in the production until it finishes its natural run. Once more, I survived all-out assaults launched by the mood-demons who dwell in the darkest recesses of my mind. Thank you, big Pharma, for marketing a drug that required me to weather such torment in order to release myself from its grasp.

That altering my brain chemistry by withdrawing a drug had such an effect on my worldview brings to mind, once more, my curiosity about what it means to exist as a human consciousness. I wrote earlier about the origins of decisions and intention. This ordeal has made me wonder, too, about the locus of attitudes and feelings about life. When something as fundamental as whether I think my story is worth living can be affected by removing a synthetic chemical from my bloodstream, then who am I? Is there ‘nothing’ more to ‘me’ than proteins, and cell membranes, and DNA, and myriad organic molecules? That kind of musing resurrects my whole philosophy about the relationship between living things and (what I for convenience call) ‘God’.

Aside from feeling that the Cymbalta wash-out may be behind me, I also cheered up after looking a bit at my web statistics. OK, OK, I know doing that is pointless. Numbers are not my objective, and obsessing about how many computers connect with my site will drive me (even more) nuts. Still, I noticed that my post ‘Is Depression Sane?‘ has been viewed two-and-a-half times as often as any other. This strikes me as great news, because I enjoyed writing that essay, and it touched on a number of philosophical points. I like to include in my blog my homespun views about the mind, mental distress, and how one can lead a satisfying life. Knowing that one of the essays that most does that also attracted the most interest encourages me to continue.

I resolved to keep my posts short. What I’ve written so far is the introduction to my real topic: the relationship between the chemicals that traverse my brain and the ‘person’ that the organ produces. In particular, how does an organism acquire the gifts of pleasure and pain, instead of just having a drive to move toward or away from certain stimuli and experiences? Rather than launching into that now and even further exceeding my supposed daily word quota, I will put the topic out there as something to either look forward to or avoid, depending on your attitude.

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Tales of Youth, and What I’d Like to Regain

Photo taken by Mandy on a (recent) trip to Yosemite!

At age sixteen, I planned to hike the John Muir Trail with my friend Jack (not his real name, though why would it matter if the world learned about our teenaged foolishness 34 years after the fact?). I did eventually complete the trek, but a few glitches arose. The problems started after we rode a Greyhound bus north from Los Angeles. We boarded with a number of outdoorsy types just like us, carrying bulging backbacks and bota bags, who chatted the whole trip. There were mothers holding their small children on their laps, trying to calm them as they stood on mom’s jeans, riding to homes or relatives in small towns along the eastern Sierra slopes. One or two men in faded business suits sat near the back, a lonely type I always used to see on intercity rides. Are they salesmen? Fathers working away from their families? A contingent of older folks had also boarded; they shoved shabby suitcases overhead, and leaned against the windows to nap until Reno, saving their energy for the casinos. Like them, Jack and I slept most of the way, under the influence of pills I had borrowed from the medicine cabinet of an elderly woman whose garden I tended.

We awoke to disembark at Lee Vining, a minute hamlet close to Yosemite National Park and (coincidentally) not far from where I now sit. I swiped a bottle of rum from the local general store, being an ignorant but fearless young delinquent. Jack and I sat on the shoulder of the road with our spanking-clean packs, and shared the bottle down to its last swig. As we became more and more drunk (a process aided by the the Valium we’d taken on the bus) we kept our thumbs out over the road, until a young man in a yellow Porshe at last pulled over. The car looked new, and smelled like a shoe store with all its fresh leather. Jack, being smaller than me, squeezed into the cramped back seat, and I ‘rode shotgun’ in the shiny black passenger seat as we wound our way toward the high mountains. I don’t remember much of that drive to the trailhead. It must have taken over an hour, and we arrived after dark. Our benefactor abruptly dumped us with our backpacks on the side of the road. He had figured out right away that we were tanked (how hard could it have been?), and made it clear he regretted stopping for us. Although he may have picked us up to show off his new car, by the end he probably feared one of us would throw up on the carpet.

Wilderness at last! In the dark and moon-less summer night we looked around and marvelled at the narrow pines silhouetted against the stars, and the flat expanse that lay between us and the forest. Taking in the majesty of the mountains quickly got replaced by our exhaustion, bordering on coma. On the cliff’s edge of collapse, we decided that rather than thrash our way into the dark groves to set up camp, we’d do the easier thing and unroll our sleeping bags where we stood. Within minutes we were passed out in our bags. Funny thing, this cop car drove by and blasted us with a searchlight. I vaguely remember their P.A. system barking something about moving our camp site. It did not sound like a bad idea, but it would have been a lot of work. So we fell back asleep instead. As you might guess, that turned out to be a big mistake. When the police returned, they had little patience with our drunkenness. It also turned out we were camping in a parking lot, which was probably what tipped off the cops that we were not too sober. Within about thirty seconds they found the fifty joints of marijuana Jack had carefully concealed in his pack. Uh oh.

For the next ninety minutes we slammed from side to side in the back of a cold steel-walled van, trying to stay perched on the single steel bench. Hands cuffed behind us, we had little chance of holding on as the vehicle roared down the twisting road toward Yosemite Valley. Once we arrived the two officers, already divided into the good-cop/bad-cop routine that I learned about later, shined intense flashlights in our eyes and told us to get out. Dizzy from the drive and the booze, and blinded by the glaring white beams, we tumbled out of the wagon and more or less landed face-first on the oily asphalt. As the cops chuckled, we writhed our way to standing positions, hands still pinned behind us. They marched is in to the little jail and spent (what seemed like) most of the night interrogating us. What they hoped to get out of two high school kids is a mystery still, but early on I confessed the location of the rest of the drugs. I should have kept my mouth shut, since I doubt they would have found the stash otherwise. They thought everything had already been located, and their search of my pack had been cursory. But the ‘good cop’ won my trust, and I decided to help him out. Their whole attitude changed after I fessed up. Both became cold and efficient, and they went through every last rolled-up sock. By the time they unlocked our hands and pushed us into the four bed cell, the pleasant stupor of near-lethal intoxication had long-since worn off. As I lay on a one-inch thick mattress staring at the underside of the upper bunk, with the corridor lighting making the room almost as bright as day, the depressing fact of our arrest for marijuana possession began to sink in. I had ample time to contemplate this giant screw-up, and what looked like the end of the John Muir Trail adventure.

How stunning the view from the front steps of Yosemite Jail! Few lock-ups let you out into a plunging chasm lined by vertical granite, with a thousand-foot-high waterfall thundering to your right as you stagger down the redwood stairs. The photo with today’s post, taken recently, reminds me of what a glorious sight opened before me as I exited the jail. Sadly, Jack’s parents were not enjoying the vista. After driving most of the night from an L.A. suburb, they seemed a bit peeved. They hammered Jack with their anger and accusations, once in a while staring at me, eyes almost bleeding with contempt. This was not fun for any of us. Jack and I had been ordered to depart the park and not return for at least a month, if ever. Jack’s folks led us to their car like executioners loading horse thieves into a gallows-bound carriage. I worked to reinforce my defences for a drive south under a barrage of criticism, but before we took off my father granted a reprieve. We spoke for the first time since the arrest as I stood at a phone booth under an enormous cedar, the morning air pungent with a scent of damp pine needles. I gazed with longing across a vast meadow the color of limes, toward sheer rock faces that loomed above me despite the distance. My father could not be predicted under even normal circumstances, so I had no idea what to expect as I told him the story. Since the police had been unable to reach him the night before, I was free to slant things to make my behavior sound pretty innocent. Those arrogant park rangers had rousted us as we slept, just to harrass us. It must have been our long hair that made them decide to frisk us. They had no probable cause. I thought it best to leave out the parts about camping in the parking lot, or how we were so stoned we could barely talk. Knowing how furious it would make my stepmother if I ruined her summer by returning to L.A., my dad only surprised me a little when he suggested I stay in the mountains. “Keep a low profile,” he directed after I told him how the rangers had banned me for thirty days. Why not just leave the park via the trail, and commence backpacking by myself? The drugs had been confiscated, so he did not see how I could get into any more trouble. (Six weeks later I would talk to him from inside the Fresno County Juvenile Detention Facility.)

Sounded good to me. With a widening smile, I pulled my disheveled and ransacked pack out of the family car’s trunk, said goodbye to a brooding Jack and his fuming parents, and trudged off into the trees. I moved quickly, before any cops noticed I wasn’t rolling out the gate. The next two weeks gave me my first taste of adult freedom. Friendships formed easily among the shaggy young drifters hanging out in the walk-in campground (no cars allowed). With our down sleeping bags stretched out on beds of pine needles, we slept randomly grouped in an open grove of ancient conifers. We all wore the same uniform: plaid cotton shirt and blue denim jeans. We ate Fruit Loops cereal for breakfast, and then broke into groups to hike, or ride the open-air trams, or maybe swim in the freezing currents of the Merced River swollen with snow-melt. We drank lots of booze, once or twice dropped LSD, smoked pot day and night, ate slices of pizza outside the Yosemite Valley store, and pretty much created a ruckus wherever we went. Every day I got an adult to buy me a half-gallon of cheap chablis, which I passed around the campfire with my new pals. That helped get me past the obstacle that as a high school kid I was the youngest and most naive of this group of youths. Most of the girls I met in the park seemed far older than me (even past the advanced age of twenty), or else they were my age but kept on a tight leash by their parents or chaperones. I lucked out, however, and managed to spend one whole night with a college-bound girl I’d met that afternoon, but in my nervousness I drank so much I passed out with my clothes on. She still seemed to like me when we awoke the next morning, fully clothed but wrapped in each other’s arms. To my chagrin, she left the park that day with her tour group. So much for my hopes of ditching my virginity in Yosemite.

I struck up a friendship with a guy named Paul, who had no fixed address and worked odd jobs when he needed cash. He latched onto the John Muir Trail idea like a tick on a poodle, and we started collecting food for the first leg of the walk. He taught me that uncooked pasta, pankcake mix, Lipton soup packs, and dry salami fed you just as well as pricey freeze-dried dinners. He helped me get rid of useless items and employ the extra space in my pack for more food, so we could go further before restocking. He showed me that you can burn a camp stove on unleaded gasoline from a service station (back then they sold gas in Yosemite Valley, and unleaded fuel was still a novelty), which was cheaper than the less toxic white gas available in camping stores. Paul made me realize that Jack and I would have smacked into problems soon after starting, given how we planned our aborted trip with such ignorance. Shorter than me, but stocky, Paul’s curly hair was so blonde it looked almost white. He only shaved often enough to keep the stubble from turning into a beard. I thought he seemed worldly and street-smart. The night before we hit the trail, I called my dad and told him I was finally launching my adventure. To my surprise, he cautioned me to be on my guard with my new friend. A few weeks later I found out he had given me good advice, which of course I did not follow.

The next morning we pulled our weighty packs up on our shoulders, cinched the waist straps, and embarked on the 211 mile trail. The first day we spent climbing out of Yosemite Valley, past the roar of Vernal and then Nevada falls. Each is a thundering column of white water that kicks up a cloud of mist. The spray drifts over the trail to either freeze or refresh you, according to the day’s weather. Above and below both waterfalls the river tumbles steeply over enormous granite boulders, roaring loudly.

The trail started out crowded with visitors, so that we had to squeeze by balky children or stomp impatiently behind older couples breathing in heavy sighs as they made the ascent. Most hikers turned around so we saw fewer people as we approached the Valley’s rim, where the terrain opened out into large expanses of granite sparkling with feldspar. I watched the snowmelt-swollen river feeding the two falls surge in vigorous currents next to the trail. The icy, clear water swept through a narrow sluice that a glacier must have carved into the massive blocks of stone that formed the mountain.

This story forms a diptych, and one main panel of it happened as I attempted to cross the granite sluice through this muscular flow. For today, I want to skip ahead to the first night Paul and I spent on the trail. We set up camp in a grove of conifers stunted by poor soil layered on top of a hard pan of rock. That evening, as we sat with a Boy Scout troop around a toasty campfire (back then hikers were still allowed to burn open fires), we heard a loud thrashing and the sound of breaking branches. By the flickering light of the blaze I spotted a bulky shadow under the tree where I had suspended my sac of food. We all stood up, but only I rushed into the grove to find that my bag, and only mine, had been swiped by a bear. I had dutifully suspended it from a branch but underestimated the reach of a bear extending on its haunches. As an unrepentant petty thief, I suppose it served me right to get robbed by a wild animal. But it did not bode well for the success of my trip if I ran out of food in the first twenty-four hours, especially if it wasn’t me that consumed it.

I was young. I was stupid. I took off after the lumbering bear. It looked like it moved slowly, but that illusion came from its gigantic size. The animal’s gallop rapidly outstripped me as I sprinted in pursuit, screaming and throwing rocks. The moon was full by this time, two weeks after the dark night when Jack and I camped in the parking lot. So I dashed through the open forest in pursuit of the bear’s gigantic contour which I only glimpsed now and then, shouting at full volume. Somewhere along the way I pulled a thick branch into my hands, and I brandished it like a baseball bat. If I had caught the bear, if it had waited for me, or if it had headed back my direction, I would have swung that branch at its head. Which probably would have been my last living act. Luckily for me, after the bear paused to rip open the sack and rummage its contents, it loped onward and disappeared into the trees. Badly winded, I was relieved to see my food containers and torn ‘stuff sac’ scattered on an open face of rock the size of volleyball court. I gathered up my items: a can of spam had been punctured by the bear’s fangs; the box of pancake mix was ripped and dampened with slobber, but still held most of its powder. Cans of evaporated milk had rolled into crevices unharmed, but the beast had ripped open my box of brown sugar and licked out every single crystal. And I never saw the dried salami again.

Why did I take the time to put this really long story on my blog? Especially when I know that few people have enough interest to read all the way through such lengthy posts. As I said, this tale actually forms part of a diptych. The second part is short, and tomorrow or soon after I will publish it on the site. Both anecdotes show my courage as a teenager, and how blind I was to my own vulnerability. I suspect young soldiers at war have similar ‘bravery’. Generals count on their troops to act with little caution when engaging the enemy. I would have done well in a war, until my brashness got me killed.

I am different now. Very timid about risk, and ever-mindful of consequences. One advantage of my former bouts of hypomania, which medications no longer allow me, is that I would lift my blanket of caution. I would recover some of my adolescent wildness, and its creative impulses. As I pull myself out of my decade-long pit of despair, I want to recover some of that bravery. I’d like get reacquainted with that young man, who chased a three hundred pound fanged and clawed wild animal through a moonlit forest. Who never worried that the bear could have sliced his gut open with a swipe of its paw. Stupid, yes. But also bursting with vitality. Better to be alive in one’s heart and a bit foolish, than be dead in one’s soul and ever-so-wise.

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