More Than “Three Hots and a Cot”

Three hots and a cot. A casual phrase, but one that provokes an immediate, visceral reaction for me. The first time I ever heard anyone use the phrase was when I taught freshman composition at a local community college. I had assigned my students  an article to read about prison reform or unjust sentencing, and the class was discussing the author’s ideas. One young man defended the existing state of prisons and concluded by saying something along these lines, “Look, they get three hots and a cot, TV, and a workout room. In lots of ways, life in prison is better than where those people come from.”

The River of Uncertainty

Those people. The very anonymity of the description renders imprisoned people faceless shells of who they actually are. And for the past three years, I’ve volunteered in a local prison and gotten to know a lot of “those people.” Getting to know several of the men and women who are incarcerated in our state prisons has erased any stereotypes I previously held of who they might be. And the food and living conditions in our prisons are far from being better than where anyone came from, at least in my experience.

So when I heard a new friend use the phrase “three hots and a cot” in relation to patients in a psychiatric hospital, I was shocked into silence. To be fair, this woman, a physician’s assistant, was talking about the need for in-patient psych facilities run by the state as opposed to our current situation that leaves many people wandering the streets or being imprisoned. But again, the phrase was casually tossed into the conversation where she advocated for “three hots and a cot, a safe place to regroup, counseling, and meds for two to three weeks to help people get back on their feet.”

My reaction was instinctive, but I was mute. I listened and pondered what I could say. “Better than putting those people in prison, which is what we do now,” one woman said. And while I agree that we have a need for more care for people who suffer from trauma-induced emotional distress (I refuse use the term depression because of what it connotes), I know that the solution is not as simple as providing in-patient facilities for emergency care. And I wondered if any of the women in my circle had ever been psychiatric patients themselves. Like I had been. Like my mother had been. But I was silent.

I didn’t want to get emotional–passionate, really–with my response. This is what I wanted to say:

No, we can’t just medicate people, hospitalize them for a week or so (if you are very, very lucky) and then discharge them without addressing the environment that they will be returning to.  Have any of you ever read about what psych drugs can do to people over the long-term? Do you know about the dangers and difficulties  of discontinuing psych drugsonce you start? Do you know there is no scientific proofthat a lack of serotonin or an excess of dopaminecauses depression, schizophrenia, or bipolar disorder? Do you know that sometimes taking antidepressants can actually causebipolar disorder?

And how about this admission (excerpted from “More on the Chemical Imbalance Theory”on the Mad in America website) from Dr. Ronald Pies, a highly-regarded psychiatrist?

The “little white lie” is, of course, a reference to the 2014 articleby the very eminent and influential psychiatrist Ronald Pies, MD.  In that article, Dr. Pies characterizes the chemical imbalance theory as “…this little white lie…”

Dr. Pies has also insisted – arguably delusionally – that psychiatry never promoted the chemical imbalance theory of mental illness.  In a 2011 articlehe  wrote:

“In truth, the ‘chemical imbalance’ notion was always a kind of urban legend – never a theory seriously propounded by well-informed psychiatrists.”

But Dr. Pies’ words haven’t filtered down into mainstream knowledge. Part of the reason I didn’t speak up is because I meet so much resistance when I present the information about lack of evidence for the chemical imbalance theory  and the harm that can come from psychiatric drugs. But I am convinced, based all the books and articles that I’ve read over the past five or more years. And I’m convinced by my own life-experiences and the experiences of other people that I know.

Because I know that there is a desperate need for compassionate, community-based care,  I’ll be posting a blog on what would I advocate for in the next few weeks. In the meantime, here is a poem of mine, recently published on the Mad in America website, about my experience visiting a friend in a local psychiatric hospital and recalling my own experience.

A Therapeutic Environment

I bring a small basket of flowers
for my friend in the psych unit,
the nurse buzzes me in.
She silently yanks
the plastic card-holder,
then chides me,
It has a pointy end.
My friend tells me later,
“No one gets flowers here.”

My friend wears
blue paper pajamas—the only thing that will fit over her cast—
until I bring new sweatpants
“No drawstrings,” she tells me. “The nurses will take them out.”
Other patients wander
as if in an endless maze
blankets over their heads,
eyes trained on the ground.

The nurses stare into computer screens
behind thick walls of safety glass
—barricaded against what danger?
Perhaps mindful that one day they too
might be lost
like the wandering “others”
in the blue paper pajamas.

My friend is hospitalized
because she tried
to hang herself. She had stopped eating.
Has your appetite returned? I ask.
“We had fish sticks for lunch.
They were so hard I couldn’t chew them.”

She recites the meds in her psych-cocktail—
Lexapro, Topomax, Prozac, and Zanax.
She shrugs and whispers
“I don’t feel any better,
and the weekend doctor
wants me to add Ritalin.”

We move into the dayroom
and I step across a stream of time
to the same place I left in 1997.
The same tattered furniture,
the same dull green walls,
punctuated by a lone picture hanging
crooked and uncentered.

Board games thrown on the shelves—
lids with no bottoms,
scattered pieces from the “Game of Life.”
“No one bothers
to start a puzzle—
we can’t find all the pieces,”
my friend tells me.
A bin of crayons
sits on the shelf,
but there’s no paper.

When I see the flip chart,
I flash back 18 years and remember
the goals’ group twice a day,
but still no art classes.
No dance, no movement
except the aimless wandering
of the blanket people.
No way to shape the confusion
churning inside.
No play dough.
No glue.

Two nursing assistants
fill chairs on the perimeter of the room.
They poke their heads up quickly,
like prairie dogs scanning for predators,
then return to the games
on their mobile phones.

References for further reading:

See The Hidden Epidemicby Robert Whitakerfor more information on the history of developing psychiatric drugs, long-and-short-term effects, trends in rates of mental illness and disability, and alternative treatments.

See Psychiatry Under the Influenceby Robert Whitaker & Lisa Cosgrove for an exploration of the mutually-beneficial relationship between the pharmaceutical industry and the psychiatric community, including medical schools and professional development.

See Prozac Backlashby Joseph Glenmullenfor research on the clinical trials related to antidepressants and the numerous side-effects that patients experience. The book also includes a section on alternative treatments for emotional distress (depression).

 

 

Reblogging: Are You Better Off Medication-Free?

A few weeks back, I posted my story of being overmedicated and getting off of pain medication and psychiatric drugs.  So when I read the blog post below, I thought it was a good follow-up to my story. I, too, was a victim of polypharmacy, which is why this post resonated with me. What is polypharmacy?  Here is a definition that is included in Dr. Brogan’s post below:

Polypharmacy is ambiguously defined as the prescription of 2-11 or more medications, simultaneously, 6 encompassing more than half of the American population. 7

For those of you who are interested in exploring this topic further, Dr. Brogan includes links to a lot of good resources. If you what to read my story of overmedication, here  is the link to the blog post–How Methadone Saved My Life–and if you prefer to listen,  here is a link to the the audio of my performance at Stoop Stories.

Deprescribing: Are You Better Off Medication Free?

I know that strategic medication tapering can be a ticket to an authentic experience of yourself. I get feedback like this, every week:

Is Gloria some kind of freak anomaly of someone who could possibly feel better off medication? You can see that part of her process was shifting out of a mindset that she was fundamentally broken, in need of medication as some sort of normalcy prop. I believe deeply in personal reclamation through a rewriting of this story of the broken self. But what if medications actually contribute to a poorer quality of life, not because of their metaphysical role in self-identity and outsourcing of power, but simply because of their toxicity, particularly in combination?

The Problem With Pills

We know that it’s not a matter of opinion, (despite what the NY Post would have you think!), that medications – properly prescribed – are the third leading cause of death in this country. 1 This does not include the quarter of a million deaths from medical errors 2 3and overdose, which in 2016 killed more than the entire Vietnam War. 4

These reasons and more are why I was delighted to read Poly-deprescribing to treat polypharmacy: efficacy and safety 5 in the journal Therapeutic Advances in Drug Safety. This longitudinal, prospective trial addresses the major symptom of our fragmented, specialist-driven, the left-hand-doesn’t-know-what-the-right-is-doing-health care system: polypharmacy.

Polypharmacy is ambiguously defined as the prescription of 2-11 or more medications, simultaneously, 6 encompassing more than half of the American population. 7

The author, Garfinkel, states that the epidemic of polypharmacy is driven by:

(1) the increased number of doctors/specialists and clinical guidelines; (2) the lack of evidence-based medicine (EBM) and knowledge regarding drug–disease–patient interactions in polymedicated; (3) barriers/ fears of medical doctors to deprescribe.

His study was conducted on patients >66 years old taking >6 prescriptions (never mind the 666!), and this intrepid clinician endeavored to offer them the opportunity to discontinue more than 3 of their meds, strategically assessing quality of life parameters.

Getting Free, One Med At A Time

After approximately four years, Garfinkel found that: Overall, 57.4% of PDP patients/ families reported an improvement as early as 1 month after the intervention. In 82.8% health improvements occurred within 3 months of the intervention and among 68% improvement persisted for more than 2 years.

Like the parable of the blind men and the elephant, feeling and describing only their part, neglecting the comprehensive appreciation of the whole animal, Garfinkel states:

…all too often specialists who treat patients ‘by their book’ have but one aim, to deal with their one aspect of the disease spectrum; no in depth consideration of the ultimate effects of medications they prescribe combined with other consultant’s interventions on patients’ overall welfare.

He also references the domino effect of prescription toxicity leading to new diagnoses and new medications, stating:

“The problem is further aggravated due to ‘prescription cascades’ where symptoms resulting from ADEs are perceived as representing ‘new diseases’.”

So, it turns out that when real life studies assess the effects of medications, stopping them – several if not all of them – can lead to a better quality of life.

I love his hopeful message, in conclusion:

Conclusions: This self-selected sample longitudinal research strongly suggests that the negative, usually invisible effects of polypharmacy are reversible. Poly-deprescribing] is well tolerated and associated with improved clinical outcomes, in comparison with outcomes of older people who adhere to all clinical guidelines and take all medications conventionally. Future double-blind studies will probably prove beneficial economic outcomes as well.

The study doesn’t particularly reference psychiatric medications (in fact, he references starting them during the study window), which, in my opinion, are the most difficult chemicals on the planet to detox from. While I acknowledge that the physiologic relief from discontinuing a medication may, itself, result in near-immediate improvement in quality of life, psychiatric medication taper seems to ask something more of patients intending for a medication-free life. The taper process asks for healing. Physical, emotional, and spiritual…and this healing does more than improve quality of life…it sets you free.

References:

  • 1 https://www.ncbi.nlm.nih.gov/pubmed/25355584
  • 2https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us
  • 3 https://www.ncbi.nlm.nih.gov/books/NBK225187/
  • 4 https://www.vox.com/policy-and-politics/2017/6/6/15743986/opioid-epidemic-overdose-deaths-2016
  • 5 http://journals.sagepub.com/doi/abs/10.1177/2042098617736192
  • 6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635569/
  • 7 https://newsnetwork.mayoclinic.org/discussion/nearly-7-in-10-americans-take-prescription-drugs-mayo-clinic-olmsted-medical-center-find/

Deciding When Something is Too Small

The change of seasons is here once again, and that always means looking at my wardrobe and deciding what to toss and what to keep. My philosophy is a little soft in this regard–I’ve tried Marie Kondo’s advice to only keep what makes me joyful, but I don’t always succeed.  I waver when deciding what to do with favorites that are a smidge too tight–sometimes finding a way to creatively make them fit with “design details” and sometimes keeping them as a reminder for where I feel most comfortable in my body.

But when I need to make a decision or answer a question about life’s more profound changes, I turn to a different voice–the voice of David Whyte in his poem “Sweet Darkness.” Do I leave my marriage? Do I stay in this relationship?  What should I do about my job?  And after I ask myself a question, I know that I am more than halfway to the answer when I hear David Whyte’ powerful lines reverberating in my mind: “…anything or anyone that does not bring you alive is too small for you.”

While those words provided guidance for me, they did not make it easy for me to make any life-changing decisions, especially the decision to leave my marriage, even after years of depression and verbal abuse by my ex-husband. While I was no longer a practicing Catholic, my values around marriage and family were firmly rooted in my upbringing which stressed the power of commitment and the necessity to work things out no matter what. And sometimes, to suffer in the process.

But after 25 years of marriage, many trips to the counselor, several deep depressions, and a widening gulf between how much joy we shared versus how much suffering I endured, I realized that my marriage was too small for me. I wasn’t thriving in the way I’d hoped for. I was merely surviving. And I deserved so much more. My children deserved more. And I wanted to offer them an example of choosing self-respect over tradition.

While deciding to leave my marriage was the most life-changing decision regarding what was too small for me, I’ve returned to the wisdom in “Sweet Darkness” many more times in the past 17 years. I’ve ended relationships that were less than satisfying, refusing to settle for the sake of companionship. I’ve left jobs that no longer provided a nurturing professional space. I’ve learned the signs of good fit and can more easily walk away from those things that are too small–except for a few pairs of capris in my closet! I hope David Whyte’s poem can offer you some wisdom. It’s been life-changing for me.

Sweet Darkness by David Whyte
~The House of Belonging

When your eyes are tired
the world is tired also.

When your vision has gone
no part of the world can find you.

Time to go into the dark
where the night has eyes
to recognize its own.

There you can be sure
you are not beyond love.

The dark will be your womb
tonight.

The night will give you a horizon
further than you can see.

You must learn one thing.
The world was made to be free in

Give up all the other worlds
except the one to which you belong.

Sometimes it takes darkness and the sweet
confinement of your aloneness
to learn

anything or anyone
that does not bring you alive

is too small for you.

How Poetry Heals: A Personal Story

How can poetry help depression?  Aren’t medication and therapy the best ways to treat the illness? My story may surprise you.

When I suffered from depression in the early 1990s, Prozac was the new “miracle drug.” Along with this so-called “miracle drug came a physical explanation of causation: that depression is caused by a chemical imbalance in the brain. This thesis is still widely promulgated, though much research is coming to light that disputes and even negates this biomedical explanation for the darkness that is so prevalent in our modern world. More information on the research side can be found at the website Mad in America, curated by science reporter Robert Whitaker. As part of Whitaker’s work to educate the public, he invites doctors, psychologists, counselors, and patients from all over the world to share research, essays, and personal experiences on the issues of depression and its treatment.

Ancient doorway in Rome
The other door to healing

Even in the 1990s when I  struggled to climb out of depression and tried numerous medications for several years with no results, the idea that the chemicals in my brain were out of whack did not provide a solid answer. Instead, I pursued a more metaphysical explanation for the questions that haunted me:  “Why am I depressed?” and “What longings are unfulfilled?”

And that’s what led me to poetry. One of the most valuable resources I found to aid in making sense of the gifts of depression was poet David Whyte’s 1992 CD entitled The Poetry of Self Compassion. Whyte’s recitation of Mary Oliver’s poem “The Journey” confirmed my feelings of being on a perilous but necessary quest through darkness and confusion. And I was deeply confused by the all-encompassing psychological pain that I was experiencing. But once I heard Whyte recite “The Journey,” I knew that someone understood a piece of what I was experiencing. And that the way I was feeling  had nothing to do with messed up brain chemistry. My depression had everything to do with self-discovery and taking charge of my life.

The Journey

One day you finally knew
what you had to do, and began,
though the voices around you
kept shouting
their bad advice–
though the whole house
began to tremble
and you felt the old tug
at your ankles.
“Mend my life!”
each voice cried.
But you didn’t stop.
You knew what you had to do,
though the wind pried
with its stiff fingers
at the very foundations,
though their melancholy
was terrible.
It was already late
enough, and a wild night,
and the road full of fallen
branches and stones.
But little by little,
as you left their voices behind,
the stars began to burn
through the sheets of clouds,
and there was a new voice
which you slowly
recognized as your own,
that kept you company
as you strode deeper and deeper
into the world,
determined to do
the only thing you could do–
determined to save
the only life you could save.
~Mary Oliver

I remember listening to the poem over and over–as if rolling around a mysterious new food in my mouth, trying to figure out why it tasted familiar. What was it I was determined to do?  What else besides raise my children, serve my community, and be a good wife? I just knew there was more. And Mary Oliver’s words gave me the courage to make the journey that would save my life.

The answer was slow in coming, but I gradually began to  realize that my struggles with depression and a migraine headache exacerbated my ex-husband’s verbal abuse to the point where I could finally see his behavior for what it was. Depression and chronic pain became my crucible for change and my pathway to a new life. My body and my mind were finally aligned. Poetry became my way to unlock the profound secrets that illness led me to discover. Poetry helped me to have compassion for my journey and for all the mistakes I had made along the way.

Whyte ends on a note of great compassion in the poem “The Faces at Braga” as he compares surrendering to the fire of depression and embracing your flaws in this way: “If only we could give ourselves to the blows of the carver’s hands, the lines in our faces would be the trace lines of rivers feeding the sea” and we would “gather all our flaws in celebration, to merge with them perfectly…”  What a compelling call–to celebrate one’s flaws. What a gift of healing.

How Poetry Heals: A Personal Story

How can poetry help depression?  Aren’t medication and therapy the best ways to treat the illness? My story may surprise you.

When I suffered from depression in the early 1990s, Prozac was the new “miracle drug.” Along with this so-called “miracle drug came a physical explanation of causation: that depression is caused by a chemical imbalance in the brain. This thesis is still widely promulgated, though much research is coming to light that disputes and even negates this biomedical explanation for the darkness that is so prevalent in our modern world. More information on the research side can be found at the website Mad in America, curated by science reporter Robert Whitaker. As part of Whitaker’s work to educate the public, he invites doctors, psychologists, counselors, and patients from all over the world to share research, essays, and personal experiences on the issues of depression and its treatment.

Ancient doorway in Rome
The other door to healing

Even in the 1990s when I  struggled to climb out of depression and tried numerous medications for several years with no results, the idea that the chemicals in my brain were out of whack did not provide a solid answer. Instead, I pursued a more metaphysical explanation for the questions that haunted me:  “Why am I depressed?” and “What longings are unfulfilled?”

And that’s what led me to poetry. One of the most valuable resources I found to aid in making sense of the gifts of depression was poet David Whyte’s 1992 CD entitled The Poetry of Self Compassion. Whyte’s recitation of Mary Oliver’s poem “The Journey” confirmed my feelings of being on a perilous but necessary quest through darkness and confusion. And I was deeply confused by the all-encompassing psychological pain that I was experiencing. But once I heard Whyte recite “The Journey,” I knew that someone understood a piece of what I was experiencing. And that the way I was feeling  had nothing to do with messed up brain chemistry. My depression had everything to do with self-discovery and taking charge of my life.

The Journey

One day you finally knew
what you had to do, and began,
though the voices around you
kept shouting
their bad advice–
though the whole house
began to tremble
and you felt the old tug
at your ankles.
“Mend my life!”
each voice cried.
But you didn’t stop.
You knew what you had to do,
though the wind pried
with its stiff fingers
at the very foundations,
though their melancholy
was terrible.
It was already late
enough, and a wild night,
and the road full of fallen
branches and stones.
But little by little,
as you left their voices behind,
the stars began to burn
through the sheets of clouds,
and there was a new voice
which you slowly
recognized as your own,
that kept you company
as you strode deeper and deeper
into the world,
determined to do
the only thing you could do–
determined to save
the only life you could save.
~Mary Oliver

I remember listening to the poem over and over–as if rolling around a mysterious new food in my mouth, trying to figure out why it tasted familiar. What was it I was determined to do?  What else besides raise my children, serve my community, and be a good wife? I just knew there was more. And Mary Oliver’s words gave me the courage to make the journey that would save my life.

The answer was slow in coming, but I gradually began to  realize that my struggles with depression and a migraine headache exacerbated my ex-husband’s verbal abuse to the point where I could finally see his behavior for what it was. Depression and chronic pain became my crucible for change and my pathway to a new life. My body and my mind were finally aligned. Poetry became my way to unlock the profound secrets that illness led me to discover. Poetry helped me to have compassion for my journey and for all the mistakes I had made along the way.

Whyte ends on a note of great compassion in the poem “The Faces at Braga” as he compares surrendering to the fire of depression and embracing your flaws in this way: “If only we could give ourselves to the blows of the carver’s hands, the lines in our faces would be the trace lines of rivers feeding the sea” and we would “gather all our flaws in celebration, to merge with them perfectly…”  What a compelling call–to celebrate one’s flaws. What a gift of healing.

 

Are These Feelings Normal?

Last fall I saw the play Next to Normal at Center Stage in Baltimore. All I knew about the play was that it was a rock musical about a woman with depression and  the harm that the  disease inflicts on  both her and her family. “Great storyline,” I can hear people saying facetiously. “I think I’ll pass. “ But the storyline in Next to Normal is very much like my story.

I had no idea how closely the scenes of the play would mirror my own experiences, especially as the mother. The main character, Diana, has suffered from depression on and off for years and is currently entering another very dark place. Her husband, Dan, struggles to keep his job, help his daughter, and support his wife. The daughter, Natalie, feels alienated and confused, and the son is a mystery. I had a lump in my throat as I watched the story play out.

The playwrights, Brian Yorkey and Tom Kitt, captured the experiences of this family and their struggles so well that the play won a Pulitzer Prize for Drama and a Tony for Best Score. I was stunned and felt like I was watching my story in many ways. Especially when the Diana sang “I Miss the Mountains” where she mourns the loss of the peaks and valleys of emotion she used to feel. And of course, the character in the play was supposed to have bipolar disorder, so she had to take mood regulators, which flatten out your personality and render you “normal.” And indeed those drugs often help people to live happy and productive lives. But as someone who has experienced mood regulators, I resonate with Diana’s yearning for the mountains.

IMG_0243

My doctor labeled me as bipolar II, mostly because he thought I was “too happy” when I took antidepressants to get out of my first depression. I describe how I felt about that exchange in the poem “The Hopkins Doctor Diagnoses Me” which is in my memoir in verse The Altar of Innocence. I disagreed with his diagnosis and fought the idea of mood regulators, but because my depression was so long and so deep, I acquiesced and tried several versions of them. (Full disclosure, I have been depression-free since 1997 and medication-free since 2002.) I remember feeling like I had a heavy, wet, Army blanket on my personality. I had word-finding problems, and I gained 50 pounds. But the doctor would not listen to me when I said that I had a higher-than-average happiness level and lots of energy to get things done. “I’ve always been like that,” I told him. But when you’re a psych patient, you are easy to dismiss as non-compliant if you don’t want to take drugs.

Thankfully, I got well and eventually got off of all the medications, and I’ve been well for a long time. I do have highs and lows, and I have the coping skills to manage them. I journal, meditate, and go to acupuncture regularly. I have a good mix of social time and alone time. But most of all, I see those rolling hills of emotion as vital to who I am. Those rolling hills are normal for me.

Here’s an audio version of the song followed by the lyrics. Enjoy! I’d love to hear your thoughts about how we define “normal” in our current paradigm of treatment. Is there room for disagreement? For nuance? Is there only one “normal”?

Mountains By Yorkey and Kitt

There was a time when I flew higher,
Was a time the wild girl running free
Would be me.
Now I see her feel the fire,
Now I know she needs me
There to share
I’m nowhere.
All these blank and tranquil years
Seems they’ve dried up all my tears.
And while she runs free and fast,
Seems my wild days are past.

But I miss the mountains.
I miss the dizzy heights.
All the manic, magic days,
And the dark, depressing nights.
I miss the mountains,
I miss the highs and lows,
All the climbing, all the falling,
All the while the wild wind blows,
Stinging you with snow
And soaking you with rain
I miss the mountains,
I miss the pain.

Mountains make you crazy
Here it’s safe and sound.
My mind is somewhere hazy
My feet are on the ground.
Everything is balanced here
And on an even keel.
Everything is perfect
Nothing’s real…
Nothing’s real.

And I miss the mountains.
I, I miss the lonely climb.
Wand’ring through the wilderness.
And spending all my time
Where the air is clear
And cuts you like a knife
I miss the mountains…
I miss the mountains…
I miss my life.
I miss my life.

Freedom to Question Authority

When I was a little girl, I asked lots of questions. My grandmother, who seemed too busy to bother with explanations, always answered, “Curiosity killed the cat, Ann.”

That response, which I heard over and over, probably kept me from questioning any further when I asked my first grade teacher to explain adultery to me as part of learning the Ten Commandments. Here’s a link so that you can listen to my “Adultery” poem and find out what happened and why I believe it’s vital for all of us to question authority.

One aspect of questioning authority has particular significance for me: questioning the need to take medication for depression and other mental health issues. The doctors I worked with all told me the same thing regarding medication and depression—it seemed to be the answer that science had found to ease the suffering of countless people.

“Depression is a chemical imbalance in the brain. You need to take medication to correct the imbalance, and you may need to take drugs for the rest of your life.”

When I questioned my doctors and expressed my reluctance to take any drug for the rest of my life, especially one that altered my brain chemistry, they spoke to me in a patronizing tone. “Depression is just like diabetes. You wouldn’t argue about taking insulin for the rest of your life, would you?”

That kind of response from a trusted authority figure will shut down questions every time. It did for me—but only when I was face to face with my doctors, and only because I had struggled for years to find a way out of a very deep depression. But the idea that chemicals could just go off in my brain for no apparent reason never satisfied my curiosity. I found more answers about reasons for my depression by working with a poetry therapist, journaling, reading poetry, and exploring the relationships in my life than I found in all the pat answers from my doctors.

But when I read Prozac Backlash by Dr. Joseph Glenmullen, a professor of psychiatry at Harvard Medical School, I found hard evidence to substantiate my fears of long-term medication. Dr. Glenmullen spends considerable time exploring the clinical trials of Prozac and other SSRIs that were conducted by the drug companies and he exposes many seriously questionable practices used to justify bringing the drugs to market. In addition, Dr. Glenmullen uses stories from his own research and his patients’ experiences to explore the very harmful side effects that can result from taking antidepressants:

“include[ing] neurological disorders, such as disfiguring facial and whole-body tics that can indicate brain damage; sexual dysfunction in up to 60 percent of users; debilitating withdrawal symptoms, including visual hallucinations, electric shock-like sensations in the brain, dizziness, nausea, and anxiety; and a decrease of antidepressant effectiveness in about 35 percent of long-term users.”

When I read this book in 2002, I had been depression-free for five years, but my psychiatrist insisted that I continue on a lifelong course of numerous psychiatric drugs: Wellbutrin, Elavil, Topomax, and Valium If you take a look at the side-effect profiles of these drugs, you’ll see that I was exposing myself to a lot of potential harm, especially if I were to continue on the drugs for life.

I worked with a social worked for over a year, exploring the reasons for my depression as well as looking at the other reasons for my continued healthy state. After more reading and many months of discussing the ideas with my therapist, I decided to stop all medication.

My psychiatrist warned me that because I had suffered from repeated bouts of depression, my brain was damaged and I could easily slip into depression. He cautioned that my next depression was likely to be much worse than the last. I’m happy to report that he was wrong. With using a combination of journaling, meditation, Heartmath (a combination of cognitive therapy and meditation), and poetry, I have remained medication and depression free for the past 13 years.

More recently, I’ve read two books by Robert Whitaker that take an exhaustive look at the studies behind psychiatric medications—including SSRIs, anti-anxiety drugs, ADHD medications, and antipsychotics—and my decision to discontinue my medications has been confirmed by the wealth of studies and analysis that Whitaker and co-author Lisa Cosgrove provide. Take a look at Anatomy of an Epidemic and Psychiarty Under the Influence for more information. Here are just a two pieces of information that I found especially compelling:

  • “Long-term antidepressant use may be depressogenic[cause depression]. It is possible that antidepressants modify the hardwiring of neuronal synapses [which] not only render antidepressants ineffective but also induce a resident, refractory, or depressive state.” R. El-Mallakh, 1999, Journal of Clinical Psychiatry (Anatomy of an Epidemic)
  • “Of the 1,1518 patients who had entered the follow-up study [of the effectiveness of Celexa vs Cognitive Behavioral Therapy or placebo], only 108 had stayed well throughout the 12 months. All of the others had either dropped out or relapsed back into moderate depression (or worse). Given that 4041 patients had entered the study, this represented a documented stay-well rate of 2.7 percent at the end of one year.” Ed Pigott, psychologist (Psychiatry Under the Influence)

I’m glad I’ve read books that challenged the prevailing wisdom of the day. I’m glad I explored my options and made decisions for myself. Most of all, I’m glad I questioned authority.

For more information on this topic, here is a good resource: CCHR International, The Mental Health Watchdog

I am Not What Happened to Me

Last week Aaron Henkin interviewed me about my memoir in verse, The Altar of Innocence, on The Signal, a radio show he produces for WYPR in Baltimore. The call came on Monday morning at 9am, and he wanted me in the studio the next day to tape the show that would air on Friday. Of course, I said an immediate “Yes!” to his generous offer, then I went to work, barely able to keep my mind on the tasks in front of me. I’d been on the radio a few times before, so it wasn’t the interview that scared me. It was the subject matter.

Depression. Self-medicating with alcohol and drugs. Suicidal ideation. A car crash. Electro-convulsive therapy. Hospitalization for depression. Verbal abuse. The silence surrounding trauma. Keeping secrets. SchoolUniformWhy, you might ask. Why talk about all of those dark and private things? Many have told me, “They’re in the past. Let them go. Move on.”

All of those things are true. And to keep silent about them is to allow them to have power over you. In AA literature they tell you, “You’re only as sick as the secrets you keep.” Well, I’m not “sick” anymore—and now I strongly reject that label for my mother’s and my own experiences with depression, anxiety, and self-medicating. My mother and I were doing the best we could to cope with deep and painful wounds. Trying to live day after day—take care of children, cook meals, run households, even run a business (in my case). Trying to carry the awful weight of sadness that enshrouded our spirits. Trying to find some light.

Sadly, in my mother’s case, she never seemed to be able to find her way back to the woman she was before she fell into depression. And neither she, nor my father, seemed to have any understanding about the deadly interplay of psychiatric medicines and alcohol. Neither one understood how that daily cocktail could keep my mother imprisoned in her darkness when she so wanted to escape it.

I never knew my mother as the delightful free-spirit my dad used to reminisce about when the two of us sat in the kitchen and had a few moments of vulnerability together. I never knew the woman who played tennis or designed amazing dresses. I never even saw my mother paint anything, except a room in the house.

But, as the oldest daughter, I was often privy to her pain. She confided in me. She depended on me—to cook dinner or take care of my siblings. She sobbed in my arms.

How does a young girl hold all of that pain inside and still walk into the world and do what a child, an adolescent, needs to do? How does one keep silent about the pain all around her? Sadly, the times I grew up in offered no answers. No comfort. The only thing I knew about therapy was that my mother went once a week, and we never saw any improvement.

My pain, the pain of my father, the pain of my siblings was never disclosed in such a way that we could get help. So, when I experienced my own multiple depressions, finally culminating in a major depression that lasted four years, I had a lot of pain to unpack. And a lot of shame.

Brené Brown defines the difference between shame and guilt. She says that guilt is feeling bad about what you’ve done. Shame is feeling bad about who you are. I went back to the journal I kept for the duration of my depression, I found page after page filled with my own feelings of shame for experiencing depression.

And writing my book was about unpacking all of that pain. Hanging it like laundry in the warm sunshine of love. Finally realizing the truth of what Carl Jung tells us when he wrote:

“I am not what happened to me.
I am what I choose to become.”

That’s why I wrote The Altar of Innocence. That’s why I spoke on the radio. That’s why I am letting go of secrets.

Ann_Valerie