I’ve been on and off psychiatric medications since…oh…1995 or 1996. I’ve been on Prozac, Paxil, Cymbalta, and a bunch of others that I’d need to try hard to remember. I’ve been on a single med to deal with depression, two meds to deal with depression and anxiety, a single med to control both depression and anxiety, and–most recently, on three meds: one for depression/anxiety, one for ADHD (!), and one to reduce the side effects (excessive sweating–I know, eww) of one of those other medications.
I’m a pretty bad patient, I guess. Not in counseling–I’m really good at getting counseled! I mean, I’m very smart, introspective, and articulate, and like most people (some deeper down than others) I like talking about myself and my life. But it’s been a while since I’ve been in talk therapy, and way longer since I feel I’ve benefitted much from it. Recently, I’ve resorted to a meds-only approach, partly in despair of finding a good talk-therapist, partly because it’s expensive to take meds (with co-pays up to $50 a month), see a psychiatrist to maintain the meds (at this point, that’s only one short visit every three months, at a co-pay of $30), and see a talk-therapist, the best of whom tend not to be covered by my insurance. (Plus, it seems to me that one visit per week is the absolute minimum frequency required for effective talk therapy, and that gets costly quick, especially if the therapist is “out-of-network.”)
No, I’m a bad patient when it comes to medications. Or, I should say that I’m very good for months at a time, but if I hit a snag (run out of medicine at a very busy time in my calendar, experience problems with my insurance company’s prescription coverage, etc.), it can sometimes derail my entire discipline. Even worse, I’m one of those who often un-medicates when things start feeling pretty good, only to believe in a couple weeks, months, or a year or two later that life when I was on meds was pretty (or at least relatively) sweet.
Part of the problem is that I’m very sensitive to how subjective the whole arena of mental health and mental illness can be. I’ve certainly never had a blood test or a brain scan or anything that demonstrated to me (or a doctor) in some “objective” (I know–huge problems with that word/concept) way that I do, in fact, have some problem in the way my brain/body handles emotions/thoughts, and that it might best be addressed by some particular treatment.
No, quite the contrary: every psychiatrist I’ve ever seen (not all that many–maybe a half-dozen total?) has scribbled me a prescription for something at the end of our first session together, based on nothing more sophisticated than a 5-, 10-, 30-minute interview or (oooh, high tech) a 5-, 10-, or 20- question, badly re-re-re-xeroxed worksheet about my mood, diet, sleep patterns, etc. (problems sleeping? YES, not getting pleasure from things you used to enjoy? YES, gaining/losing weight? uh, is there any other answer besides YES? feeling hopeless or helpless or guilty or sad or angry or unfocused? YES YES YES YES not usually YES!).
And, if that medication doesn’t work, all I have to do is say a discouraging word about it, and the prescription pad and stack of drug samples magically appear on the psychiatrist’s desk, and I get to choose from a menu of other, more-or-less similar drugs with other, more-or-less concerning side effects. Sometimes, the doctors even ask me what dosage I want! In the past, I’ve often compared the psychiatric profession to a drug vending machine, where pressing a series of buttons and swiping my debit card ($50–exact change only, please) dumps a month of pills into my eagerly outstretched hand. Forget the War on Drugs–the Mall of Drugs is what we white, middle-class, educated, suburbanites get to enjoy! I talk to my dealer and then continue on down to the corner pharmacy to pick up my next fix, and there’s not a narc in the country who gives a shit. (Pardon the coarse language, but I do get a little mad when I write about this because it’s a frustrating part of my personal life and, I think, a serious social problem on a larger scale.)
Like I was saying, I’m sensitive to the subjectivity of this stuff. What defines ADHD, depression, anxiety, and where’s the line between personality traits and illness? When is it best to learn to cope with sadness, lack of focus, and worry, rather than trying to medicate them? Is mental illness just like any other illness or injury, as my doctors and counseling-savvy friends keep telling me? Or is there something odd about a condition that can be a disease one day and a normal state of being the next, and then–maybe–a disease again in the future–all depending on the deliberations of the American Psychological Association? (BTW, the first link in that sentence will take you to a fascinating This American Life radio story about the APA’s 1973 decision to stop defining homosexuality as a psychological pathology, while the second link will take you to the APA’s website, where you can offer input on their revised edition of the Diagnostic and Statistical Manual of Mental Illness [DSM], the book that defines what is and isn’t mental illness.) After all, medical doctors don’t get together every 10-20 years to ask whether a broken arm should still be considered an “injury” or whether setting the broken bones and guiding the re-knitting process is a good way to treat that injury (making my friend’s favorite analogy–broken arm is to cast as depression is to anti-depressant medication–seem facile at best).
So, when I’m feeling all right–perhaps not when I’m doing great because then I don’t ruminate as much about whether my life is on the right path–I start to question my decision to use medication to treat my admittedly mild manifestation of depression, anxiety, and/or ADHD (that last one’s the newest one, but at the time I was pretty happy to try the diagnosis–any diagnosis sounds pretty good when you’re feeling fucked up but can’t figure out how you got that way or how to un-get that way) or whether it would be better, more responsible, more intelligent, more healthy, more Christian, more human to learn to cope in some non-pharmaceutical way, I don’t know: write poetry, read self-help books, meditate, do yoga, learn biofeedback, pray harder/more, take steam baths or ocean vacations, whatever.
So, while listening to This American Life’s story on the APA’s homosexuality definitions, the decision to un-medicate started to crystalize again in my head. Just listening to how social, political, relational the process of defining (or un-defining) mental illness is brought the whole mess back to the front of my mind…again…for the umpteenth time in the last 15 years.
After all, I’m feeling pretty good right now. Not great–I’m not even sure what it would mean to feel great. But I’m not unhappy–in fact, I would say that I’m often happy. At the same time, I feel generally disconnected, like I’m not maintaining or deepening my old friendships or making new ones, and although my brain tells me all the reasons why that’s a problem, I’m not feeling it. That is, not feeling the urgency or motivation to do better. And that lack of urgency or motivation is a general feature of my adult life. It lends itself nicely to another pervasive reality of my make-up: guilt. And the guilt helps me focus on my laziness, and that laziness seems manifest in a special way in my choice to “deal” with my mood issues with medicine rather than with learning, discipline, or conscious effort. (Plus, to go ahead and plunge fully into my cynicism about myself, it’s a heck of a lot easier to deal with my feelings of laziness and guilt by stopping my medication than by starting to be a better friend!)
So, I thought I had decided to stop medicating, but now that I’m writing about it, I’m not so sure. I decided to start this blog for a couple of reasons. For one, I wanted to have my own record of what I experience when I stop taking my medications. I know, in a logical, rational way, that I’ve forgotten exactly how I felt when I agreed to take the medicine, so maybe writing about the process will give me a kind of removable memory that I can plug back in later, when I’m taking meds again (knock wood) and thinking about going off. But, another reason–the reason why I thought to blog instead of just keeping a journal, because I’m really not that egotistical, honest!–is because I think this is an issue that lots of people in our culture are wondering about. Whether it’s journalist Ethan Watters writing about how America exports its conceptualization of mental illness, a similar mini-rant by Ian Bulloch in Adbusters, or the APA revising its own definitions of what constitutes mental illness, or yet another article about American psychiatrists overprescribing antidepressants (I chose the Psychology Today article linked here at random from a long Google search results list), this topic is out there in the cultural conversation, and I just thought I’d contribute my voice.
Who am I? I’m not a countercultural rebel like the folks at Adbusters, nor am I a shill of the pharmaceutical industry. I’m not a doctor, but I am a patient, so I’ve had some direct experience (and may well continue to have some experience) with the mental health profession/industry, and I think I’m able to share that experience in a thoughtful manner. I’m not looking to jump to any particular conclusion so much as to tell my own story of moderate or mild “mental illness” and the cultural, personal, and corporate contexts in which I make decisions about how to address that alleged illness.
This was a long entry, I know, but I wanted to do some work to establish my project here. Of course, if I don’t decide to go off these meds, maybe this blog will founder a bit–at the very least, it’d have to be re-purposed. But if I do, then I’ll continue to write here, as often as the mood (uh-oh) strikes me. Warning: I’m one for starting blogs and then letting them languish after a few initial entries. But I’ve been looking for an outlet for more personal, focused writing, so maybe I’ll do the work needed to make this blog “it.”
Thanks for reading–I welcome your comments, now and always.
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