JANE'S MHSP ARCHIVES: 2001

No longer fighting the waters

Recently a friend said that her medication was “working”, and she was experiencing a new-found desire for being social. She was concerned about this cheerfulness overtaking the intense creativity and sensitivities she has come to treasure. I had harbored these very concerns before. Many of you may wonder about the same: will medication therapy “change your personality” especially the creative and sensitive part?

I am not talking about overt “apathy”, a severe numbness that has been listed as a side effect of various psychotropics including antidepressants. Rather, I am talking about a change toward a hopeful attitude and a positive outlook. This change is what medical professionals would describe as ” medication kicking in”. Will this change come at the expense of creativity?

It may be helpful to describe what “medication kicking in” feels like: You feel as if someone has flipped a switch and the world looks more likeable. You stop dreading being alive. You do not become a chatterbox, but you open up a little more, and talk a little more – and you enjoy this connecting to other people. You feel good in people’s company. You like yourself when you are with other people. You like yourself when you are alone.

I don’t know what “normal” is and I wonder if anyone really knows; “normal” is subjective. “Normal” can be a physical and mental standard of well-being that is measurable by tests. Many of those tests, however, are subjective. Some degrees of depression is normal as a response: we need to be able to express depression when confronted with a depressing situation. Grief and sadness accompanying loss are completely “normal” even when a grieving person displays many of the symptoms of a depressed person: change in appetite, sleeping patterns, outlook on life, feelings about self and the world.

Depression becomes “abnormal” when it persists for longer than “usual”. How long is too long? Six weeks? Six months? This can depends on the situation causing a depressed mood. However, living in a constant state of despair can begin to injure our other states of being. Our physical body becomes weak from neglect. Depression suppresses immune functions, making us vulnerable to diseases (and that begets more depressed mood). Our mental body becomes an enemy that tortures us with self loathing. Our emotional body becomes an unpredictable outlet.

When depression persists in the lack of a continual stimulus, it has assumed “a life of its own”. This is when depression takes over our lives, and it warrants help and treatment. An analogy may be drawn with a cancerous growth. Cancer cells persist in the lack of a continual stimulus, growing when they should not grow. Early detection and treatment of cancer improves survival. Early detection and treatment of depression improves survival.

We may write prolifically and appear more creative when we were depressed. These expressions had remained our only outlets to communicate when we had shut ourselves off from the world. When I had revisited my writing during a depressed state, I was amazed at how dark and depressing my writing was. Poignant? Sensitive? Yes, but overshadowed by despair and dread permeating each sentence.

As we proceed along therapy, we may stop writing continuously about pain or suffering or hurt or betrayal or fear. This does not mean we are no longer inspired. Instead, we may be experiencing a different way of being alive. Since for many of us, we were rather new at “feeling alive”, we may want to stop writing and just “live”.

Normalcy is not superficiality. Being “creative” does not require pain or despair. In time, you will begin to explore the depths of your new perspective. You can still evoke the intensity of feeling or passion that you had evoked when you were depressed. When depression no longer acts as your master, but serves you as it should as an emotional response to a situation, you can choose how to feel about the situation.

Depression was being on a boat in stormy waters. You were in constant fear of capsizing. Normalcy is being on calm waters. You can sit still and rest, because the boat was no longer rocking. At first, the water may seem was too quiet, everything may seem too quiet. Then, you re-shift your focus from this new quietness, and look to the horizon for all the places you can go and explore.

Let the quietness come. Let the living come. Let the joy come. Let the changes come. Creativity was never a part of the “temporary”. Creativity is always a part of you. Depression was always a part of the “temporary” and is never a part of you. You can now sit back and enjoy the scenery instead of fighting the waters.

Treat the Individual – Not the Diagnosis

We live in a society of “medicating where it hurts”. We have encouraged this trend by neatly packaging our illnesses with a scientific name. We hoped in doing so, the illness magically becomes more manageable, more treatable, and that everything can be under control. Then we can go back to what we were doing before we were “so rudely interrupted” in our heads.

How do we tell “normal depression” from “chemical depression”? Stressful situations can induce a depressive state as a normal response. In time, with support and lifestyle adjustment, we may recover and be “mentally robust” again. However, we are now quick to seek medication, doctors have less time to diagnose (correctly), managed care organizations are keen on money-sparing “treatment algorithms”. We no longer treat complex individuals with complex problems. We have come to a state of reduction, a state of “take this once a day and come back in 4 weeks.” (IF your insurance covered the visit, that is!)

Mental health professionals may be pressured to prescribe the conventional, because they are liable if something goes wrong under a “non standard of care”. Insurance companies know this, thus “experts” design “algorithms” to ensure that most patients are treated “appropriately”. The current healthcare milieu makes alternative therapies risky business for many health care professionals.

Even therapy has become a game. If you recover too quickly, your therapy sessions will no longer be covered under insurance, because you are”well”. If you recover too slowly, your therapy sessions will be terminated and replaced with something “that works”, because the insurance company does not want to lose too much money on lost causes.

Many psychotropics available on market are useful. I have personally benefited from medication therapy for severe depression. I may never know whether my depression would be alleviated just as well if I had intense psychotherapy accompanied by lifestyle changes including exercise, adequate sleep, balanced nutrition, and meditation (all foreign concepts to a typical graduate student). Would all this worked just as well for my depression as a 20-milligram-per-day dose of Prozac?

I subscribe my own recovery from depression to a combination of medication therapy and psychotherapy. Did my unhealthy life situations contribute to my depression? I have no doubt of it. I wonder what would happen if we treated depression like diabetes – aggressively intervene with lifestyle changes first, before we start prescribing medications. Eat well, exercise, get enough sleep. For even better results, identify external or internal triggers and learn coping skills or eliminate those triggers altogether. Just like diabetes, if you’re in the ER because your illness has landed you in a dangerous predicament – medications are immediately used – with careful follow up and lifestyle intervention close behind, but the goal is to prevent that train wreck in the first place.

Do psychotropic drugs have value? Absolutely. Do psychotropic drugs need ten different indications? I doubt it. I believe in proactive self-education and patients taking responsibility for their own mental health management. I don’t believe we should leaving it solely to healthcare professionals to make decisions for us. We can’t expect others to help us if they can’t access inside information on our overall health and mental state of mind. We must communicate this to our physicians, and be accountable for restoring our health as well.

Many illnesses – not just mental illness – are becoming more complex, because we live in a world of accelerating paces and increasing socioeconomic complexity. Unfortunately, as a society, we have become lazy. We often allow others to decide for us rather than remain an active partner in decision making that intimately affects our lives. After all, can’t we simply sue if someone did us wrong? We’ll let money take care of our pains.

My prescription – and one that gives the consumer the greatest chance of success at finding the right treatment for their mental illness – is for the consumer (and the loved ones/friends/family) to be as involved as they expect the doctors to be in their own mental health care. We all have to take responsibility and not give up our rights to that responsibility. But it is our burden to communicate this to the physician, who is doing the best he or she can.

Scariest thing to lose

The scariest thing to lose is your Self.

Not parents,spouses,friends,money,

Not even the roof over your head or knowing where you will be tomorrow.

Often when we grieve for the loss of a treasured one, we are struggling to understand the loss of Self, for the ones we love and treasure give our lives meaning by reflecting the value of our Self. In our giving and receiving with love, we experience the beauty that exists in our soul – beauty that many of us don’t fathom as possible. Beauty that some of us continue to believe is impossible or nonexistent.

Perhaps this is why some people with depression kill themselves. I am talking in the context of depression because depression is an illness I have experienced most of my life.

How much of your mind is shaped by your body? How much of your body is directed by your mind? Studies have shown that children who were emotionally abused exhibited abnormalities in brain development that may well predispose them to depression. I was emotionally abused, and I had depression most of my life. I fit the statistic and observation.

As I grew up, I believed more strongly and blindly that in this dance of life, I was dancing alone. I believe I will always dance alone. Since I built a wall around me to protect me from being hurt, I also kept my soul from receiving and giving love. I also kept myself from feeling joy and uncertainty and I stopped dancing altogether. I stopped participating in the dance of life that showed us what it means to be alive and who we are on the inside.

Even when I began help for my depression, during the trial and error phase with medications, I danced alone. One night I arrived at the point where I decided that not only was I going to stop dancing, I was going to leave the floor altogether.

As I gathered my thoughts to writing letters of goodbyes to those whom I had danced with, those who still wanted to dance with me, those whom I knew I can never dance again with – I faltered. I had no words adequate to describe the pain of dancing alone, and I had no words adequate to explain why I believed I gave myself freedom by leaving.

One night I lied on the carpeted floor in my little room, alone, and wondered what I’d feel like as a corpse. I had lost my Self, I believed. I had lost the little sense of purpose that I felt was necessary to be alive. I lied on the floor, supine, with my eyes closed. How cold would I be? Would I feel at all? I didn’t want to feel at all. Because I was dancing alone, I didn’t want to dance at all. I didn’t want to feel the sadness of watching others dance from my glass cage.

Somewhere in my fantasy, I heard a voice calling.

“Get Up!”

I opened my eyes.

“Get Up!” The voice called again.

The voice was mine. I was telling myself to get up. After thirty minutes of yelling “get up” to my Self, I sat up.

That night, I knew I hadn’t lost my Self. My Self wanted me to get up from the floor, sit up on my butt, stand up on my feet, and walk out of my glass cage.

My Self wanted me to dance again. My Self wanted me to embrace every dancing partner who waltzes into my life, and cherish every dance with each one of them. It doesn’t matter if the dance ended too soon, it doesn’t matter if my partner kept stepping on my toes, it doesn’t matter if I accidentally stepped on their toes. What matters was we danced, what matters was we are still dancing, what matters was my Self continued to dance so that other Selves continue to dance.

And in our Dance of Life, my Self sings my Freedom.