My Place in the Crisis

Editor’s Note: To ensure the security of her job, the author has opted to use only her first name.

My relationship with the mental health crisis laid out in Robert Whitaker’s book, Anatomy of an Epidemic, is deeply personal. Not only have I seen its effects on my clients, but I have experienced the effects myself.

There is no way to briefly summarize the enormousness of the epidemic. However, the story we have been told by psychiatrists and the pharmaceutical industry backing them is one, like many in our country, that has been deceitfully woven over time to profit business over well-being. The story that mental illness is a chemical imbalance of the brain that requires a specific combination of medications to correct it, just like diabetes requires insulin – a story I actually taught for years as a volunteer for NAMI (National Alliance on Mental Illness) – is incomplete at best. I personally find it to be false.

As difficult as it is to admit, I feel I must share some of my mental illness history as a thread in the fabric of rampantly accumulating evidence that medications used to manage mental illness have gotten completely out of hand.

As a result of unresolved childhood trauma, I am aware of being diagnosed with at least nine psychological disorders over the past fifteen years: major depressive disorder, dysthymia (chronic depression), bipolar disorder – type I and II, post-traumatic stress disorder, obsessive-compulsive disorder, attention deficit disorder, generalized anxiety disorder, dissociative identity disorder, and borderline personality disorder. While I agree that I meet the criteria of most of these diagnoses as they are outlined in the DSM-IV-TR, I have come to realize that these labels are only shadows of my true identity. However, the twenty medications I have been prescribed (some multiple times) to control my mood have transformed me into less than a shadow of a person at times. Zoloft, Paxil, Wellbutrin, Lexapro, Prozac, Seroquel, Zyprexa, Depakote, Efffexor, Klonopin, Abilify, Geodon, Risperdal, Celexa, Lorazepam, Invega, Latuda, Lithium, Lamictal, and Ritalin are the ones I have records of being prescribed. I know first-hand the effects of short- and long-term use of psychotropic medications, and I consider myself one of the more fortunate ones. Due to my sensitivity to immediate side effects and my skepticism of medication in general, I have not stayed on many medications longer than a few months. Those I have stayed on for more than a year, however, are still battling their way out of me.

I am quite certain I am still experiencing long-term effects from taking Lorazepam, Lamictal, Risperdal, Lithium, and Ritalin. I do not have specific evidence of the direct effects of Lorazepam on my health, but I took it regularly for more than two years every night to help me sleep. Researchers have found that there is a great increase in depressive episodes and generalized anxiety disorder, as well as long-term cognitive impairment for those who have used Benzodiazepines regularly. Lamictal and Lithium markedly deepened my depression and perpetuated a numbing apathy I have not been able to overcome. Risperdal, which I was prescribed upon being hospitalized in 2009 to stabilize me for having a suicide plan, I actually took for only a few months. I stopped only because I had such painful tension in my neck that I could hardly move. I still have a facial tremor in my mouth from taking it.

Ritalin, which a seasoned psychiatrist offered me as a last desperate attempt to revive me out of deep depression in January 2010 – just after I was released from my psychiatric hospitalization – has had the most severe short-term and long-lasting effects on my being. I was technically a few pounds underweight to be taking the adult dose, but my doctor allowed me to take 60mg of Ritalin a day – the maximum adult dose. The morning I took my first dose of 10mg, I knew deep down it was too good to be true. I literally felt a switch go on in my brain that awakened me into a state of motivation and focus I did not even know existed. It was beautiful and frightening all at once. I felt I could accomplish anything. I had experienced mania and hypomania before, but I had felt really out-of-control and quite delusional during those episodes. This was different. About forty minutes after taking a dose, I felt completely in control . . . for less than two hours . . . and then the dose wore off and I experienced great anxiety, followed then by an extreme let down leading to more fatigue and apathy than I had in the first place. I had to strategically time when I took the next dose, and the cycle began again.

To get through grad school while raising three children, I stayed on 60mg of Ritalin per day (eventually switching to an extended release caplet to ease the transitions between doses) for about eighteen months. It was enough time to trigger some intense mania, followed by several months of sheer anxiety, which had me in a constant state of panic. I also believe that my already sensitive skin and teeth further deteriorated from use of Ritalin, not to mention the experience of other physical side effects I will not describe here. There seems to be no end to the negative long-term effects from using this drug. I should not have been surprised, since it was similar to being on a daily dose of speed or meth. But I was desperate, and I trusted my psychiatrist.

I knew I had to stop taking Ritalin by the middle of 2011. I also knew by then that drugs would not cure my anxiety, so I rarely used the Lorazepam I was prescribed, and heavily relied on mindfulness to endure the extreme bouts of panic during the summer of 2011, often when I was alone late at night. There is no other way to describe the depth of my panic than sheer hell. I felt completely alone, as if there was not even the existence of any kind of higher power that could help me. In fact, I actually believed that I would eternally live in a state of pure terror; almost exactly as outer darkness is described in the religion of my upbringing. I came close to being hospitalized several times that summer, but somehow was able to avoid it. I think it was the miracle of mindfulness practice and a merciful God, whose presence I could not feel, but who must have cradled me through those dreadful episodes of panic.

Since going off of Ritalin about a year ago, the panic has settled back into generalized anxiety, but my depression has continued to deepen. My apathy is so debilitating that unless I am at work, or I have to do something for my three children (such as meals or getting them somewhere), I can be found in my bed. I am not always sleeping, but I can barely function if I do not have a specific plan or obligation. It is another kind of hell. Thoughts of suicide constantly invade me and I fight them with my best Dialectical Behavior Therapy (DBT) skills. Otherwise, I begin justifying why my death might actually be a good wake-up call to society. But the truth is, hundreds are taking their lives every day, and society is not waking up for the most part. Even recent tragic events in our country, such as mass shootings, seem to instill more fear and create more bi-polar reactions from society than meaningful change.

While there are some valuable efforts being made in the mental health arena, there has not been a drastic decrease in the use of psychotropic medications to control moods. To me this is catastrophic. Not only do I feel the effects personally, I see the effects first-hand as a mental health counselor. I could tell you multiple stories of how medications have exacerbated mental illness symptoms in my clients and their family members. There are some stories I am not able to shake, but I will not be sharing them here, out of respect for the confidentiality of my clients. I hope, in time, that these individuals will be able to share their stories in the way that will best help those they have the ability to influence.

For now, let me be clear about this: most of the clients I have worked with who have taken more than one psychotropic medication at a time have felt that these drugs – meant to control their mood – end up taking control of them in some way. They have often expressed that they were not given enough information by their health-care providers, and have found that they have had to taper medication use to combat negative side effects. They have most often experienced confusion over clarity, and have attempted to put together a puzzle for which there is no complete picture available. In some cases, the result has been death – often after months or years of losing themselves slowly through the use of too much medication.

This is the truth. I have seen it over and over again as a volunteer for NAMI, and as a professional in the mental health field. While those taking one antidepressant, usually for mild to moderate anxiety or depression, seem to be the least affected, they are the exception and not the rule to “success” with use of medications used to manage moods. Even in those cases, the most common report I hear is that the medication “takes the edge off” so that the person can get through a difficult time. Stimulants, Benzodiazepines, and antipsychotic drugs seem to have the most negative effects on individuals with whom I have worked.

But don’t simply take my word for it.

Robert Whitaker’s book contains many individual accounts of people he met with, along with lengthy chapters containing hard evidence that these medications used to treat moods are literally creating mental illness instead of eradicating it. At best, they have only been proven to temporarily help people with symptoms of mental illness. For some, years go by before the negative effects truly set in, and for others the effects are immediate.

When I began reading Whitaker’s book, I decided to gather all of my remaining medications – some of which I have had for several years – and take them to the police station, where they have a place to dispose of them. It was an extremely freeing moment. I recognized that the only reason I had been hanging on to them was for a possible suicide attempt, and I knew that I could not leave that open as an option. Besides the fact that I could never leave my children, I could not let the pharmaceutical industry have yet another victory.

I have now been virtually free of these medications, with the exception of taking a small dose of Lorazepam occasionally (maybe twice a month) for sleep, for over a year. And still, I do not feel like myself. It is fair to say that before I ever took any medication, I did not feel like myself in many ways, due to issues from my childhood. However, the use of medication has only worsened my condition, and I do not yet feel like I have crossed a threshold in my journey where I have confidence in living a full life. Even as I write this, I am deeply aware of my limitations. It is still difficult to form sentences and connect thoughts, due to lingering cognitive impairment from psychiatric medications . . . and yet I must speak. Even if what comes out on the screen seems like a conflicted mess. Even if people I am trying to please or be strong for discover this post and wonder what in the world I am doing with this much baggage. I simply am not able to keep quiet.

So what now? A combination of reading Whitaker’s book, my own life experience, and witnessing the experiences of my clients and close friends has fueled in me a rage I hope I can channel into something that will help people instead of leading to my own death. I know that sounds dramatic, but I can hardly stand to sit in my office helping one person at a time, when there needs to be a massive revolution in the way mental illness is managed. The current trend appears to be a magnifying of the crisis through avoidance of the actual problem. I want to join the forces that are opening eyes to reality and actually helping work through what has become a mental health nightmare in this country and throughout the world.

Who is with me?