As so many of us struggle with impeding symptoms brought on by mental health conditions, we have grown increasingly convinced that hope for improvement lies tightly packed inside a pill. Tempted by the seductive promise of self-improvement, I eagerly accepted this offer without warning of the tangled strings attached. What would result was an upending of how I would view mental health as a whole and the fundamental approach we take in treating psychiatric symptoms.
In an age which affords us the luxury to command a solution to virtually any conceivable problem from the palms of our hands, why should our expectations be any different when suffering emotional pain? Common afflictions such as anxiety and depression have been widely accepted as intolerable disorders that, by routine downing of a capsule each morning, can easily be remedied. We have trustingly embraced a doctrine that, in effect, promotes the removal of all discomfort from our lives. This 21st-century Western paradigm has germinated prolifically, spilling over national and cultural boundaries and reaching a designation of established wisdom throughout much of the world. But is it truly the safest and most effective approach to mental health treatment? What are the costs of exuberantly embracing drug after drug as the new solution in a fix-obsessed culture? We are heartened to think that doctors and drug makers know best — as they often do — but these institutions are only as knowledgeable and principled as the information made available to them. When we pull back the curtain, will we find that our sources of care adhered to honesty, transparency, and the safety of their consumers? Or, are we likely to uncover a culture of profit-driven misinformation propagated by minimal oversight and loose regulation?
A few years ago, as a patient desperate for relief from debilitating anxiety, I unwittingly ran head-on into this reality. I had reached a point where anxiety had regularly prevented me from engaging in many parts of life that were essential. I had trouble attending social engagements, school, work, and eventually found it difficult just to leave the house. I became desperate for a solution. I needed a way to knock this disruption out of my life and I was willing to try anything. I did what most of us would do when presented with a pressing health issue and paid a visit to my primary care physician who, following a hurried two-minute chat, recommended a commonly prescribed medication called an SNRI (Selective Norepinephrine Re-uptake Inhibitor) to treat the anxiety.
As directed, I began taking a 75mg capsule each morning, did indeed begin to feel much less anxiety over time, and eventually noticed that my overall mood had improved dramatically. I no longer felt on edge throughout most of each day and was finally able to feel emotionally comfortable. Social exchanges weren’t awkward anymore and concerns of potential hazards the future might bring quietly evaporated, turning a once steady stream of worry into a parched, empty tract. All of the fog and obstruction that anxiety produced calmly dissipated. It was a very new existence for me. One in which I could maintain an unwavering calmness that allowed me to actually enjoy myself and not drown in gratuitous concern over inconsequential details, as I had for most of my life up to that point. I felt great. I was convinced I had found my key to happiness.
As I settled comfortably into this new existence I became much less inhibited. I began to engage in uncharacteristically risky behavior, without much care at all. No longer confined by the shackles of worry that had previously instilled in me an ever-present sense of caution, I became drunkenly carefree. I lost interest in maintaining social relationships and remained perfectly content as many once meaningful and lasting friendships fell by the wayside due to an absence of effort on my part. Socializing and interacting with people didn’t cause anxiety anymore but, instead, just wasn’t appealing and had become an arduous exercise that offered no stimulation. Nothing was engaging. Everything just felt good, regardless of the circumstance. An abysmal numbness had consumed me to the extent that I cared very little about anything in life, including very real consequences.
When I began taking the medication, I had been working on a horse farm as a painter and carpenter while I finished my graduate degree. It was an ideal job for someone who was required to dedicate a few hours each day to schoolwork. I came and went to work as I pleased, reported my hours, and received a respective check at the end of each week. I worked diligently and dependably at the farm for years, always completed work as instructed, and had never produced a reason for anyone to suspect wrongdoing. But as I adhered to my prescribed regimen, I remained silently void of the cognitive and emotional mechanisms that produced concern or fear.
It was in this condition that I began to report and receive extra pay for hours that I hadn’t worked. I felt no guilt about it and not for a second even considered that what I was doing was illegal — or even dishonest — and therefore continued on without thinking anything of it. Seeing that nobody had seemed to notice my alterations, the risky dabbling swiftly surged into a reckless habit. It wasn’t long before I was stealing blank checks from my employer and forging them for amounts that far exceeded my earnings. This was behavior I had never even contemplated before. I had endured the first thirty-four years of my life without having committed any crimes and had no history of theft or deception whatsoever. Yet, there I was, forging $20,000 in checks every week and I couldn’t have cared less. There was no end in sight beyond that point. The selfishness and sheer risk involved in what I was doing didn’t register. I simply acted without acknowledgment of the future and thought nothing of the well-being of myself or anyone else. I had become an emotionless zombie carelessly adrift without regard for anything or anyone in my path.
After more than a year of this calamitous existence, I had totaled a million dollars in forged checks, accompanied by four luxury cars, a spare condominium, countless home improvements, and lavish vacations. It was a life I had never imagined — nor even aspired toward — that centered around a constant insatiable thirst for more and knew no limits. I was on full-throttle all of the time without any sense of an impending collision.
On a quiet and unseasonably warm February day, I was at home alone when I heard a firm knock on the door that would mark the end of my rampage. I opened the door to a pair of straight-faced men in suits and casually invited them in. I wasn’t entirely sure why they were there, but I cooperatively responded to questions as my curiosity grew. Before long I was informed that I was at the center of a very serious investigation regarding the theft of a large amount of money. Even as I processed the words I didn’t feel anything. I could discern that this was a very heavy situation, but I couldn’t feel the weight. I just felt detached, like I was watching a scene from a movie unfold in front of me and could turn it off at any moment. I simply couldn’t grasp the enormity of what I had done and what it all meant. As the circumstance slowly became evident, I garnered enough sense to request an attorney and agreed to meet with representation the next day at the police station.
Ripped from the delusional fantasy I had cultivated and thrown vigorously back into a cold world of cause and consequence, I remained in a state of utter confusion, even disbelief, about the world I thought I had known. Rules I had adhered to over the previous years had held no regard for any moment other than now. They dictated that feelings were merely obstacles, phenomena that others exhaustingly wrestled with, but were no longer a hindrance to which I would be tethered. I couldn’t reconstruct the path that had led me to a place so apart from the world, while the rest of its inhabitants appeared harmonious, compassionate, empathic, and all of the other seemingly-innate human traits. My existence had been saturated by a soullessness that rendered me the lone passive spectator in a theater of engrossed actors. It was undoubtedly an alienating state — one that soon led me to believe with full conviction that I had become insane.
Countless subsequent days were spent ruminating desperately over how I could have allowed myself to arrive at a place so foreign. While images of my withdrawn face lit up nightly news broadcasts and reporters swarmed outside clamoring for a comment I quietly sat in wait, incarcerated within my own walls, and pondered. Self-disdain rooted itself deeper and anger melted into confusion. Confusion became stale, fermenting into inquiry. I had never felt anything more unsettling than an inability to account for my own actions over a period of several years, especially when those actions had caused significant detriment to others. How had I become so detached? And how could I have let myself behave so recklessly? I was not short on questions, nor time to occupy, as I painfully awaited the date of my sentencing hearing. Ironically, I would turn to the virtual world in dire search of some actual answers.
Acting on a growing hunch and a driving hunger for an explanation, I began searching side effects related to the medication I had been taking for some time to see what I could churn up. The results listed familiar side effects from various medications (nausea, dry mouth, insomnia, drowsiness, seizures, and believe it or not, anxiety, huh?). It was confounding how an unintended side effect of a product could actually be the very condition that product was intended to treat (like purchasing a lawnmower that had the potential to leave your grass longer than it was before you cut it). These self-defeating contradictions peppered the back-label warnings of medications that were each intended to treat certain conditions. This tempted my intrigue. I pressed on for hours, wading through the murky waters that flood the world of psychopharmacology and its encouraging promises to treat, if not cure, any of a plethora of benign afflictions that often define what it is to be human (sleeplessness, wakefulness, anxiety, situational depression, mood changes) while quietly making mention of the intrinsic risks.
Beneath a glossy controlled facade of hopeful solutions flanked by subtle disclaimers, I eventually arrived at a realm in which presumed actual consumers shared and discussed their experiences with various psychiatric medications. This was naturally a more transparent place for sharing information, free from the burdens of watchful legal teams or the interests of nervous investors. It was clear that these were personal and honest accounts presented by individuals whose earnest motivations were merely to seek help or to provide help to those who had dug deep enough through the intricate tangles of a disciplined bureaucracy to reach a place of genuine authenticity. While I combed through what became countless personal stories of patients who had experienced difficulties with various symptoms, conditions, and side-effects, a pattern began to take shape. Among two prominent classifications of drugs (SSRI’s and SNRI’s) — both prescribed to treat anxiety and depression interchangeably — consumers appeared to be unanimously reporting a number of significant mood alterations that had presented beyond their intended result.
In many cases, this had resulted in behavior well outside the scope of what would be deemed healthy or functional, often becoming detrimental. One contributor to a forum dedicated to warning consumers about the dangers of these drugs reported inexplicably cheating on her spouse after thirty years of sound and faithful marriage. Another recounted a story in which he had blown through his entire retirement savings in one weekend at the casino while taking the medication. Both were notable in their emphasis on a departure from prior (normal) behavior. The stories piled up. As I read on, I was further struck by a common thread between these accounts illustrating an extreme degree of carelessness and a deficit of contemplation or planning. This phenomenon rang very familiar to me, sparking the impetus of a potential explanation for my mysterious onset of insanity.
I was enthralled by the potential in what I had discovered. Following months of public shame, humility, self-hatred, and the very real expectation that my wife and kids would permanently abandon me, I suddenly felt a small sense of hope. The feeling, though barely discernible beneath the mountain of misery that had become my life, was enough to inspire a simple experiment I hoped might lift the fog of numbness and reconnect me to the emotions that I had inadvertently shut off. I would try to ween off of the medication I had been diligently taking for several years in an attempt to determine whether it had perhaps played a role in my own mystifying behavior. This was not an easy task, as the withdrawal symptoms are notoriously unbearable. Ever determined, I devised a plan to disassemble each capsule and divide the beads from inside into increasingly smaller amounts every day over the course of two weeks. Still, I became plagued with menacing nausea, pounding headaches, and crushing fatigue throughout the process, but was able to get through it and stop taking the medication altogether.
As the SNRI molecules sluggishly evacuated my bloodstream and I progressively regained my emotions, the gravity of what I had done descended upon me. I became unbelievably devastated by the sheer callousness of my behavior. The world became real again. I thrashed uncontrollably beneath a deluge of guilt, shame, and emotional pain I had never known, with no visible way out. I couldn’t believe I had actually been capable of committing several crimes over an extended period of time, without stopping to think about the risks to my wife and kids, or even myself. Unable to bear the pain of letting my family down so hard, I began planning to end my life. Until then, I had considered myself a loving, caring, law-abiding person with no intentions of even bothering anyone. How could I have allowed myself to embody such disgrace?
I thought a lot about my kids, while giving my best effort not to accept the pervading belief that they would be far better off without a criminal low-life as a father. Surely, any old schlub could come along and do a much better job than I had. They deserved a hard-working, capable, dependable, and trustworthy role model and that was light-years from what I had become. Their respect — or lack thereof — meant absolutely everything to me and I simply couldn’t handle the prospect of not having it. No matter how hard I tried, there seemed to be no way out of this disaster. After deliberating obsessively during the ensuing days, I eventually found myself in a decidedly different place. I wasn’t going to end my story there. I realized that if my life were to end right then and there I would forever be a failure to my kids. They would grow up and live their entire lives knowing not only that I made several terrible mistakes but that, much worse, I crumbled when faced with them. I made a decision at that moment that I would step up, pay the price for what I had done, and spend the rest of my life tirelessly working to regain the respect and trust of my kids, wife, friends, and family. I had received a massive blow. But I sure as hell wasn’t going to let it be the end of me.
As of today, I have been arraigned, convicted, sentenced, and released for my crimes. I hold no one other than myself accountable for what I did. I wish I had had the wherewithal to notice the strangeness in my actions and had been able to put a stop to what I was doing. The painful paradox presented, however, is that SNRI’s effectively removed these basic abilities from my mind, rendering me childlike in my affective response and reasoning. Put simply, consequences were not considered until they were met head-on. And life was lived as though it were a game, detached from the statutes of fear and pain. This condition is certainly unsustainable in adulthood as we are rightly expected to have intuited such essential functions long ago. Many psychiatric medications present a very real potential to drastically impair these basic judgments. Presented as hopeful solutions, these drugs too often inadvertently charter patients on a crash course, wreaking havoc on the lives of those in their path as well as their own.
SNRI’s and SSRI’s — as do many prescription medications for anxiety and depression — have a way of slyly muting a person’s natural ability to react emotionally to an environment, while delivering a steady signal of positive reassurance. They produce a persistent imperviousness to circumstances that would normally trigger fear or concern, while a constant feeling of affirmation reinforces a sense that everything is wonderful. While this might sound like an appealing and blissful state on its face, I can tell you with full confidence that wandering through life robbed of crucial — though occasionally uncomfortable — emotional mechanisms is one of the most potentially destructive situations imaginable.
Still, a demand for these drugs appears to be as robust as ever. We have adopted a habit of attacking discomfort with a magic bullet seeking to instantly eliminate the issue from our lives. Perhaps a measure of how convenient our world has become, we reflexively point and shoot at anything in our way, ignoring the inevitable ricochet. While a state of minimal discomfort may or may not be attainable, it is surely misguided and, I would argue, downright irresponsible to pursue it by method of callously terminating any and all undesirable feelings. Perhaps depression and anxiety should alternatively be approached as functional challenges we can learn to harness and more thoughtfully overcome. By embracing these challenges and recognizing their greater purposes we have the ability to transform many symptoms into valuable assets, and ultimately into strength and empowerment.
It is my hope that this message and countless similar narratives from individuals all over the world who have had their lives upended by an imbalanced system of mental health treatment will instill caution in those who seek or receive help with challenging issues. I have no intention of blaming any single entity for my or others’ adverse experiences. I believe that this issue is rather one of systemic perpetuation. It is the culmination of a steep, decades-in-the-making imbalance of a vast and complex structure of power and interests. It is an inequity that inherently leaves consumers at a disadvantage and with little recourse.
I also hope that we begin to explore alternative approaches to treatment that aim not to remove crucial adaptive elements from the brain, but instead help to minimize and adapt to disruptions. As consumers we hold the individual power to educate ourselves and make sounder decisions based on our knowledge. If we remind ourselves that an integral part of mental health treatment ought to be learning to cope with symptoms we can then begin to move forward in a much safer and more efficient way. These approaches might involve meditative or mindfulness treatments, evidence-based therapy methods, acupuncture, neurofeedback, or any of an array of alternative methods that have shown to be as effective as modern pharmaceutical treatments, if not more. Approaching mental health from a holistic perspective allows us to sidestep the elimination mentality that has been fed to us for so long, setting a course for achieving significant improvement with minimal side effects. Although this idea may seem foreign, it is likely worth taking seriously when considering the very real damages that can result from many psychiatric medications.
As we drift with bountiful optimism into an alluring paradigm of simple fixes and life-hacks our individual judgment grows evermore imperative. Far more is at stake today — with more companies than ever clamoring to get our next dollar, often with little oversight — than was thirty years ago. With the fascination of capabilities we had previously only imagined we can hardly help being giddy at almost any opportunity to take a bold leap toward an ideal simplicity, convenience, or comfort. Sure, there is much to celebrate in the monumental progress achieved. Still, we are indentured to an increased responsibility to value our own health and well-being over the lure of profits and pleasure. The irony of this idea is palpable, coming from someone who brashly embezzled a million dollars. But the fact is that my unsavory acts were born of the same inability to see what lay ahead due to a deficit of concern for what truly mattered. I thought nothing of the pain I might cause. I remained pathologically focused on my own personal gain, regardless of expense to anyone else. No one in this world could have convinced me that what I was doing was wrong until my whole world collapsed around me. Only then was I forced to take a hard, objective look at the way I had been living and begin the painstaking effort to rebuild from ruin.
History has displayed time and again the hazards of pursuing magic elixirs as a means of achieving an ideal outcome. Yet, the hunger for a true panacea persists, ever commanding us to forge on in hunt of an increased quality of life. We helplessly navigate between screens and billboards splattered with seductive possibilities, but invariably continue unappeased. We are pelted by an endless parade of products and methods promising hope and relief, yet faithfully continue unfulfilled. Powerful pillars of the modern global economy depend on this Sisyphean cycle. It is the fuel that propels an endless stampede toward an unachievable paragon. By this process, perhaps no other industry has amassed as much power, wealth, and dominance as the pharmaceutical industry — while, ironically, none has remained so opaque as to the true effects of its products on the public. An unbalanced power to this degree beckons concern as it is inherently unjust and, historically, has rarely resulted in a fair and virtuous outcome.
We may never determine the full impact of this paradox. But it is our duty to see the road ahead and to steer with caution. It is our responsibility to understand that virtually everyone is touched by mental health afflictions, whether directly or indirectly, to a degree of commonality that harnesses a potential to bind us in support of one another. We hold the ability to utilize remarkable social and technological capabilities not only to support one another in our struggles but also to expand our knowledge base and learn to embrace challenging conditions as remarkable facets of life and beautiful parts of who we are. We need anxiety in our lives. It is an essential alarm system, without which our entire framework will set ablaze long before anyone upstairs smells a hint of smoke. It is the slap on the wrist that keeps us from taking a precarious step toward an unfortunate result. It guides us around the pitfalls that curiosity and temptation love so dearly. Without it, we are impaired. We are left unbalanced and unchecked in a world with disastrous potential. Perhaps most importantly, anxiety allows us to care deeply for our loved ones and feel concern for the well-being of others. It is for these very reasons that, regardless of its discomfort or seeming oppression, we must decide to appreciate, perhaps even embrace, this quality that we are each so fortunate to have.
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.