I am a proponent for the limited use of psychiatric medications. As such I have some fear of being misjudged by the Mad in America audience, whom I gather are categorically opposed to the use of such drugs. By the same token, my experience over the past number of years is largely consistent with what I read on the MIA website and Facebook page in terms of a common goal to raise awareness and change the mental health status quo.
I began this piece one day after the death of Debbie Reynolds and two after that of her daughter, Carrie Fisher, both strong advocates for mental health and the eradication of stigma. It is encouraging that there have been many changes in policies, laws, treatments and public perception in the era covered by those two lives. Lobotomies were still being performed in Ms. Reynolds’ time but are unthinkable now. That’s the good news.
The discouraging news is that there have not been nearly enough changes, that no matter who speaks out — prominent politicians (Patrick Kennedy, Senator Deeds), celebrities (Glenn Close, Catherine Zeta Jones, Demi Lovato) or sports figures (Terry Bradshaw, Brandon Marshall) — the public outcry soon dies away. Until that changes, my role as a writer, advocate and survivor of serious mental health challenges is to keep speaking out. Partly to put a face on those who still struggle, but also to share my own recovery experience. Like most who have been though the mill and exited the other side, psych meds played a large part in my journey.
Being from the South (born in 1953 and raised in Atlanta), my story is properly melodramatic: Gone with the Wind meets One Flew over the Cuckoo’s Nest. Our house indeed looked more like Tara than Tara itself, with servants who came with the property. We were served our meals on silver platters by a privilege that did not, however, insulate me from bouts of depression and anxiety and frequent forays into binge eating. Such afflictions are nothing if not democratic.
My struggles began in 1960, when I was seven years old. They were manageable, albeit debilitating, for many years. Silent endurance characterized my teens and twenties, but that changed abruptly when my attention was drawn to the beguiling world of psychiatry and psychiatric medications at age twenty-nine. Imagine my excitement, the hope that relief from the sucking tar of misery that dogged too many of my days was within my reach. From that moment and for thirty years to follow, I was the willing guinea pig for any number of drugs. During the first twenty-five years of my treatment, the usual suspects were prescribed and combined and titrated up and then down to attempt to address my issues of depression and anxiety. Nothing helped for long. Some of the drugs hurt.
In 2005, the bottom fell out of my life. A painful divorce sent me into a nosedive, spiraling lower and lower, unable to gain any traction at all. My descent into a place where suicide seemed a viable option and my subsequent climb back to mental health are memorialized in my memoir, Southern Vapors.
As recounted therein:
The trial and error associated with prescribing my medication was usually fairly orderly, but during January of 2008, when I was deteriorating fast, my doctors changed my medication seven times in two weeks. I kept a journal: “started Vyvanse, Trazadone and Effexor 1/11/08. Started having symptoms—anxiety, shortness of breath, dry mouth, trembling hands, trouble concentrating and focusing. Stopped Vyvanse 1/13. Still had symptoms. Stopped Trazadone 1/14 per nurse practitioner. Still had symptoms. Restarted Vyvanse 1/16. Stopped Effexor 1/17. Stopped Vyvanse again after a few days—still had extreme anxiety symptoms. Started Zyprexa 1/23.”
I would not like to repeat those two weeks. Ever.
In desperation and with some much-needed financial support from my family, in the summer of 2008 I checked myself into The Retreat at Sheppard Pratt, a highly reputed treatment facility near Baltimore. It is no overstatement to say that the professionals there saved my life. With a combination of drugs and therapy, they stabilized to me to the point that I could be released ten weeks later to return home, resume work and continue on with my treatment. With me I carried a new label: “medication resistant.”
Considering that none of the entire arsenal of traditional psych drugs had made me well in twenty-five years, that seemed to me a reasonable diagnosis. For a few years after, I dutifully sought the care of psychopharmacologists specializing in medication for the treatment resistant. New drugs were tried. One, two, three, more; they all failed. By “failed,” I mean that I still fell into periods of depression, still became anxious, and when I felt overwhelmed, I binged. At the same time, I continued with the fairly intense course of talk therapy recommended by my doctors at The Retreat — individual therapy twice a week and group therapy every Monday.
I began to get stronger. Maybe not exactly happy, but more sanguine about my emotional upsets. Maybe not exactly centered, but experiencing smaller swings for shorter periods.
In time, even the slowest learner, as I must be, can still get the lesson. As my strength and some measure of stability returned, I began to question the logic that insisted that drugs were the answer to my troubles. Was it possible that “medication resistant,” far from translating to “needs different drugs,” could be interpreted to mean “no diagnosable illness?” Simply put, if the pills didn’t work, maybe I wasn’t sick. At least not in the traditional sense.
But if I did not have a diagnosable illness, why did I continue to fall into spells of feeling so damn bad?
Through many hours of talk therapy, I figured it out. Here’s the deal. My early environment, training and experience all left me with a deeply held belief that I was caught in a Leviathan struggle with my mother, a competition as fundamental to my existence as breathing. I believed at a primal level that this competition would be, could be, survived by only one person. I believed with every fiber of my being that my mother would be that survivor each and every time — not me, not ever, not once. That always and forever, in any contest between us, she would be the winner.
Since most everything between us did in fact devolve into a contest, I became programmed for defeat. Which explains why, every time I got to feeling good about myself, I self-sabotaged. Convoluted? Yes, I’ll be the first to admit it. That doesn’t make it untrue. Nor is this a rant against my mother. She died not long ago and my grief is deep. She was a complicated woman and we had a complicated relationship. The point is that my lifelong struggle was generated by an unfortunate combination of nature (my tendency to be vulnerable) and nurture (being raised by an angry and critical parent). It was not born of chemistry.
Feeling scared, impotent, desperate and hopeless became so familiar to me that I did not recognize them as distinct from depression and anxiety. Moreover, in the last couple of decades the words “I am depressed” and “I am stressed out” or “anxious” have come to be used as casually as “I have the flu,” and diagnosed as liberally. No wonder I never thought beyond the labels.
Once I committed to this new way of thinking, I gave up all psych drugs. Klonopin was the last and a real challenge; everything they say about withdrawal from benzos was true for me. When the shakes, insomnia and raging anxiety persisted, I sought the help of an addictionologist. On his advice, I titrated down very slowly, finally ending a dependence I didn’t know I had after six full months.
Once clean, for a short time I became a full-fledged opponent of psych meds in any setting except the treatment of psychosis, an exception based on my minimal understanding of that category of mental illness. They say there’s no one who can be as judgmental about his or her former substance of choice as a reformed addict, and I was no different. I had earned my suspicion, even contempt, for drugs the hard way. In short order, though, I began to feel uncomfortable with such an inflexible point of view. I met too many people I respected who insisted that their lives had been changed by medication. After a couple of years, mine was, too, or if not changed, then improved by an anti-craving medication that tamped down the compulsion to consume food even if it meant crawling across broken glass.
The drug worked well for the first eight months. When the honeymoon period ended, as it always does, the drug’s efficacy began to slip. Falling back into my old ways, I ran to my doctor and asked whether he could bump up the dose. Chasing the dragon. God bless him, the doctor said: “No, this is on you. The drug can’t fix your problem, it can just help. Beyond that, your behavior is a choice.”
Bingo. It was a lesson I had already learned, but wanted to ignore. My life is my responsibility, no one else’s, and everything I do is a choice. I can choose to engage in activities and practices that support mental and emotional wellbeing and address my urges to do things that are unhealthy. Or not. It’s not about the drugs. It’s about working to heal myself to the point that I want to make healthier choices more often. It’s about practicing new behaviors over and over and over again so that they become second nature, replacing the old tendencies to soothe myself in ways that are maladaptive. It’s about choosing community and connection over isolation and the comfort of habit.
In pursuit of those goals, I’ve made some progress in cultivating more self-compassion, resilience, perspective, patience and mindfulness. Unlike drugs, they won’t fail me.