Call it what you will: autonomy, agency, self-determinacy. The simple freedom to move about the world and map out your next act: “Will I take this step with my left foot or my right?” Or, “Should I go for a walk and get some air, or brew a pot of tea and read my book?” And finally, “What makes me ‘me,’ and who has the final authority to define my personhood?” If you’ve never been locked up in a psychiatric ward or medicated against your will, such questions will seem obvious, pointless even—Of course it is me who decides these things, you say, because they pertain to my person.
If, however, you have been hospitalized, and diagnosed, and forced to swallow meds at pill time, you’ll realize that these simple questions can come to mean everything. At the root of the self lies autonomy, and once autonomy has been stripped away—one of the many undesirable side effects of today’s label-mongering, pill-pushing bio-psychiatry—the self crumbles into so much dust.
I should know. I lost my self for many years due to substance abuse, a dependence on psychiatric medicines, and a dependence on the diagnostic labels that justified the continued prescription and ingestion of those medicines. The greatest irony is that before things got their very worst, I had a strongly defined sense of self due to immersion in the sport of climbing.
I’ve been climbing for a quarter century, quite possibly because it’s one of the few arenas in life in which you have complete control over your fate. Whether or not you protect a climb adequately—it’s up to you. Whether you steady that quivering leg or shake the lactic acid from your cramping forearms in time to avoid a fall—that’s up to you. If you like, you can even climb unroped and court death itself with every move. You hold your life literally in your hands.
You get to define what it means to be you in that precise moment, what it means to be an alive, sentient human being attached to the rock by only fingers and toes, gravity ever ready to dash you into the talus below. You have ultimate agency over selfhood and, by extension, your fate. Want to die, to obliterate your self? Simply will your fingers to uncurl, and then release the stone. Want to live, to climb another day, to grow as a person, and be there for your family and friends? Then keep hanging on.
I tapered off my last psychiatric medicine, nortriptyline, in October 2006 and have not set foot in a therapist’s or psychiatrist’s office since, nor will I again. That final taper bookended a long, complex, byzantine story that began in 1981, when at age ten I began to see a child psychiatrist for depression pending my parents’ divorce. Between then and 2006, I was hospitalized five times, abused marijuana and black-market Valium and Vicodin, became dependent on prescribed benzodiazepine tranquilizers, was on and off a king’s ransom of antidepressants, mood stabilizers, and antipsychotics, and was variously diagnosed with agoraphobia, panic disorder, major depression, and bipolar disorder.
In a phrase, I was a chemical and diagnostic sewer. Never, ever have I been sicker, more depressed, more anxious, or more confused than while medicated or struggling to quit a psychiatric medication. For me, the bugaboo was benzodiazepines, and after seven years of continuous use that climbed to four mg of clonazepam a day, I went through a living nightmare to quit, made all the worse by further drugging and red-herring misdiagnoses of mania, mood cycling, and major depression.
Today, living drug free and a solid, healthy, thriving, productive life, I refute that I ever needed any of these pills. I eschew psychiatric labels. I repudiate the way in which they reduce your world to the confines of some arbitrarily defined “disease” and strip you of your autonomy. I abjure the way in which they force you to self-identify as chronically ill, chronically compromised, chronically “other,” as if the darker variances in mentation were flaws to be fixed and not just natural expressions of the human condition.
I do not agree with the possibilities denied us by such easy labels as “anxious” and “depressed.” Just because I for one have a dark, sensitive, probing, vigilant, and ultimately dim worldview does not imply disease or limitation. It rather implies cognition and contemplation in the face of the brute, violent, elemental chaos of our sadly Burroughsian “war universe.”
A couple instances come to mind of this clash, between reality as I know it and that defined by psychiatry, from my benzo-withdrawal anni horribili of 2005–2006. As I prepared to discharge from the final hospital in which I found myself, the Johns Hopkins Institute, my father and I had a medication and treatment-plan meeting with two psychiatrists and a social worker. I was profoundly ill at the time, dizzy, foggy-headed, stiff with neuromuscular pain, lingering about two seconds behind in the sort of time-delay you get with a bad live-television feed.
I’d just been rapidly tapered off benzos and placed on lithium, Neurontin, and nortriptyline, snowed under by the mind-numbing side effects of these new drugs but also acutely fearful and half-psychotic from benzo withdrawal. As we sat there in a drab little ward office, the gauzy November sky outside stained dishwater brown by anti-glare coating on the window, I told the doctors that I didn’t want to be on meds anymore. I felt that I’d reached the end of the road and wanted to see what life would be like off medication. I mentioned that I wanted to resume my life as a climber upon discharge, and feared lithium toxicity should I become dehydrated in the mountains.
“Well, Matt, I don’t think you need to worry about lithium poisoning if you’re too depressed to get out of bed and go climbing in the first place,” said the social worker. “Which is why we think—insist, really—that you continue with your medication.”
I said nothing. The implications were clear: According to this paradoxical paradigm, only through giving up my autonomy—my core desire to be off drugs—could I attain the freedom to move about the world again, to somehow through the “miracle” of bio-psychiatry reclaim the energy and desire to get out of bed and go climbing, or do much of anything, really. Never mind that it was benzo withdrawal plus the avalanche of meds that had rendered me so very depressed, a truth I knew deep down inside but was too shattered to argue at that point.
The only freedom in the eyes of these mountebanks was the one obtained through accepting their diagnosis and dutifully swallowing meds to combat my “disease.” It was a sham freedom, one that proscribed the ability to be a happy, fulfilled, integral person without accepting a DSM diagnosis and the deleterious side effects of an attendant cocktail of toxic psycho-chemical agents. It denied the possibility that I might ever be a realized human being without medication.
There is no you without us, they seemed to be telling me.
Back in Colorado that Christmas (2005), away from the hospital and able to make my own decisions again even if I was sicker than hell, I began to taper the three medicines. At that point, I could continue no further down this path because only death awaited me, either at my own hand or those of the doctors. During my final visit to my psychiatrist here in Boulder, I had a panic attack in his office, which had never happened before. Even as I knew the fit was brought about by benzo withdrawal, I found myself again too weak and demoralized to voice my inner truth. The doctor brought me a glass of water and said, “Well, Matt, it looks like your original panic disorder is coming back with a vengeance.” I had told him a week earlier that I was tapering the meds prescribed at Hopkins, a decision he didn’t agree with, and now he twisted his knife deeper into my gut: “And based on that, I’d certainly say now is not the time to stop taking your medication. It could be very dangerous.”
I said nothing. I kept the truth for myself. For years I had unquestioningly believed and accepted that I was broken somehow—anxious, depressed—and that only medication and therapy would fix this. At times, I had escaped also through substance abuse. We are trained, in the West, to seek out the appropriate specialists when something isn’t quite right, even our brains, and to implicitly trust their judgment and treatment. And so I had done, until the pills stopped working and instead made any initial issues a thousandfold worse, until I suspected I hadn’t been told the entire truth, or had been given only one version of it.
I had surrendered my self to these people with the notion that they would repair and render that self back to me, like the wrecked and rumpled car you drop off at the body shop one week and pick up the next looking good as new. Never had I stepped away from this disease model long enough to ponder, Maybe this is just who I am. Maybe I know more about who I am and why I am such than anyone else. Maybe if I accept my darkness it will lose its power, and I’ll be much calmer and more contented in the long run. Maybe it is my responsibility, and lies in my power alone, to fix this.
After some minutes, I finished the water, thanked the doctor, left his office, and did not look back. It took me another nine months to get shut of psychiatric medicines, but I did what I’d set out to do and, in the end, did it my way. With the autonomy to make this decision for myself, I could abide whatever mental and physical torment came, and thusly empowered shuffled through years of physical, emotional, and psycho-spiritual agony to find myself again. It was a choice freely made by a man who, in a black box in hell and not knowing if he’d see daylight again, stuck by his decision because it was one that he—and not others—had made.
That is autonomy. That is what psychiatry takes away. That is it’s fatal flaw, the hubris to suggest that one man can know another man’s brain better than he himself. No one, no matter how many years of school at whatever elite East Coast institution, can know your mind in its infinite complexity better than you. Even if you, amidst the mental/emotional/spiritual crisis of a depressive or psychotic episode, cannot entirely trust your mind, you still know it best. The brain is the seat of both consciousness and the soul, not just the sum total of the physical organ’s neurotransmitter activity.
If on your darkest day some internal voice chimes in to say, “The doctors are wrong; don’t take that pill,” or, “Don’t let them label you this way and use that label to make decisions for you for the rest of your life,” then listen to it. Acknowledge it. Heed its truth. Don’t just glibly swallow another pill like I did to make the pain go away, because all you’re doing is chasing a false freedom that ever recedes like a mirage in the desert.
I’m much better now, thanks to the healing power of time and to the sense of ownership of my life I take from having recovered my autonomy. I climb three or four days a week, am a parent, a husband, and a full-time self-employed writer and editor. I couldn’t be any happier. I rarely climb unroped anymore, unlike as a young man, but every now and then I’ll get a wild hair and try some mildly dangerous climb. When I do, it never crosses my mind to do anything other than hang on.
The concept of being so miserable that I would simply let go and fall to my death is entirely alien. But if I did, that would be my decision, right? It would be my choice to let go. The power to create the self or to destroy it is what makes us free men and women. It’s what makes us conscious, purposeful human beings, aware of our short time on this earth, and not just rats in a laboratory maze. We should all be so humble as to recognize this universal truth. We should all be free to create our own reality.
Matt Samet is the author of the upcoming memoir Death Grip: A Climber’s Escape from Benzo Madness, out February 11, 2013, from St. Martin’s Press.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.