Why I Love My Pills

I love my pills, yes I do…I love my pills, so why can’t youuuuu?

Anyway. Serious writing time.  Let me put on my Serious Writing Hat.

Upon occasion, I’ll share bits of my journey with people I know. I’ll tell them that I live with anxiety, and they’ll get stars in their eyes and tell me how incredible I am, and how they couldn’t possibly do what I’ve done, and how strong I must be to manage this…without medicating myself into a stupor.

Huh.

I suppose I should start leading with, “So, I take fantastic pills every day that keep me from getting too crazy all up in here.  How about you?”

Apparently the fact that I’m not a drooling, spaced-out wreck popping pills every five minutes means that I can’t possibly be one of those people.  You know, those people who take dangerous chemicals that mess with their brains until they stop being people and start craving human flesh.

First of all, that’s offensive to Undead Americans everywhere.  Also, that’s not how antidepressants work.  We have a dangerously inaccurate popular understanding of this kind of medication and of the people who take them, and it has grown tiresome.  I’ve got enough in life that causes me anxiety; I don’t feel like dealing with people who think I’m taking “the easy way out.”

According to this article in the Scientific American, more Americans are taking prescription antidepressants than ever before. The estimate is somewhere in the realm of 8-10% of adults.  This rise was characterized by an editorial in the New York Times as – wait for it – “a glut of antidepressants.”

If you’re like me, you’re now imagining Jabba the Hutt sitting on his throne on Tattooine, surrounded by piles of pills.  “Eee choota, Solo!  Conda Wookiee chibiti ootaskoota Proooozac!  HO HO HO HOOO!”

If one were to believe the opinions expressed by the popular media, antidepressants are dangerous, mind-numbing chemicals handed out like Halloween candy to criminals and psychopaths by shady, uncaring doctors in Big Pharma’s pocket.  It’s the last line before the first-quarter commercial break in an episode of Law and Order: Special Victims Unit.  The hardworking but oh-so-broken detectives find an unlikely suspect for a rash of human dismemberments, only to discover, to their horror, that the all-star college valedictorian has an open prescription for Prozac!  He must have a lair filled with human toes.

That doesn’t even touch on the world of internet comment boards and opinion pieces.  You shouldn’t touch on it, either.  It’s a dangerous place, and you’ll need to take a shower and cuddle a puppy right afterwards.  Because I care for each and every one of you, my lovely readers, I’ve already taken a long, sewage-y swim in its waters, and collected some of the choicest bits of poo just for you!

“Anti-depressants are pushed as a ‘magic pill’ by Big Pharma to make money off of you.”

“The side-effects are enough to make anyone depressed!”

“Doctors and Big Pharma are over-medicating the population. It’s a conspiracy to keep us in their pockets!”

“It’s just a placebo effect.”

“The real danger is in the side effects – it’s dangerous to just put chemicals in your brain!  A natural life is the only way to live!”

According to the internet, antidepressants are either the biggest joke being played on us by Big Pharma, or they’re going to give you radioactive super-powers and sparkly farts.

Where does that leave us?  It leaves us squarely in the middle of a culture in which one out of ten people take medicine meant to make them feel better, all the while being vilified for deciding to feel better.

If you’ll allow me to roll up my sleeves, I’m going to lay down some Truth.

Ready?

1. Psychiatrists don’t just “hand out” drugs as a whole.  Yes, there are bad apples in every profession, but most psychiatrists – and doctors – want their patients to feel better.  Dr. Evil is the exception, as is Dr. Strangelove. Just use your judgment! If your doctor doesn’t seem to listen to you, find one who does.  Feeling better is good, and trained psychiatrists will not simply stuff pills down your throat like you’re a reverse Pez-dispenser.  When I first started seeing a psychiatrist for my anxiety at age 24, she required that I make lifestyle changes to alleviate my anxiety and continue seeing the counselor at the Student Center who had referred me to her in the first place.  She also prescribed me medication.  I needed every aspect of my treatment.  I made huge dietary changes and began working out every single day.  I haven’t kept up the every-day exercise to the rigor that I initially did, but I remain active.  I continued talk therapy.  But you know what?  The medication made it possible for me to do all of those things.

Let me explain.  As soon as I began taking Zoloft, I saw results.  Not in my anxiety and intrusive thoughts – those took weeks of retraining to reduce – but in other, purely physical symptoms of anxiety.  My insomnia lessened, so I could get sleep and have the energy to leave the apartment in the morning, to go to the gym, to walk across campus to go to counseling.  My constant nausea – what I’d always thought of as my ‘fussy tummy’ was gone. I was hungry, for possibly the first time in my life.  I gained weight. This may not seem like a positive – we live in a world where thinner is better – but I’d spent years as a 115-pound, 5 ft. 10 beanpole. I used to get sick constantly.  I was frail, y’all.

The best part of getting the right medication was that it got rid of symptoms that I didn’t realize weren’t normal.  People with anxiety often suffer from something called depersonalization: the feeling that your body doesn’t belong to you. You feel like your face is made out of rubber, and when you do move, it feels like you’re starting out of a dream.  It’s irritating.  And I thought everyone had to deal with it.

Yes, therapy is vital.  Yes, reworking the mental pathways that allow anxious thoughts to spiral is important.  Exercise and diet and forming positive relationships are all integral parts of living with mental illness.  Medication can be life-changing as a part of that process.

2. Big Pharma is real, but it’s not a reason to deny yourself or anyone else the care they need. Yeah, the pharmaceutical industry is full of all kinds of nastiness.  And yeah, its goal is to make money.  These are reasons for reform, not rejection of all medications.  The oil industry is one of the dirtiest in the world (in more ways than one).  Are we rejecting automobiles?  No.  No we are not.  Automobiles make our lives easier and better.  What we are doing is breaking the monopoly through alternate-fuel and electric cars.  We have to reform the pharmaceutical industry, but that’s not the point here.  They may be the Evil Empire, but you’ve got to occasionally admit that they make really quality stuff.

Most doctors, as a matter of fact, will do whatever they can to keep their patients from being under the thumb of insurance companies and the pharmaceutical industry. This includes using samples to try different kinds of medications and making the referral process as easy as possible.

3. Side effects are nothing to sneeze at. They’re real, and they can be scary.  However, every drug is different, and it takes time to find the right one for your brain.

When I first started taking SSRIs, my psychiatrist prescribed Prozac.  It was the most commonly-prescribed SSRI, and it had shown success in helping some people with anxiety.  She told me that I was to keep in contact with the Health Center and to call the 24-hour emergency line if I had any side effects that alarmed me.

I did end up calling the emergency line, at 2:00 in the morning, when it felt like bugs were crawling all over my skin.  I couldn’t sleep.  My panic had gone through the roof.  If my brain had been the Oval Office, the inside would have looked very much like that scene in Independence Day after Jeff Goldblum showed President Bill Pullman that the aliens were using our satellites against us.  My sense of self-preservation was on the first Air Force One ride out of that mother. Somewhere in the midst of DEFCON 3, I was able to dial the emergency line. After the on-call psychiatrist calmed me down, I made an appointment online for the very next morning.  I told the psychiatrist about the side effects and said, “I know that there are adjustment periods for medicines – I get that.  I just don’t think I can make it through this one.”

She listened to me.

She listened to me and prescribed me a different drug.  Prozac just wasn’t a good fit for me, she explained.  Everyone’s brain works differently, but the goal is to make me feel like I can function.  Zoloft might be a better choice for me, and just to be on the safe side, she put me on Valium temporarily.  SSRIs change one’s brain chemistry, so sometimes you have to grease the wheels with a mild sedative.  She also gave me the choice: I could try another SSRI, or we could keep working without medication.

I’ll admit it: the side effects of Prozac had been so horrific that I was hesitant to try something else. It was like I’d taken an acid trip with Lord Sauron.  I wanted to get better so badly, though, that I went for it.  It was the best decision I have ever made.

4. Yes, drugs are chemicals that you’re putting in your bodies.  You know what else is a chemical? Absolutely everything.

I hate to break it to you, but you’re made of chemicals.  So am I.  So is the Pope.  So is Beyonce.  We are all made of chemicals. Even Moby is made of chemicals, because we are all made of stars…which are all made of chemicals.

Every single thing you put in your body, from water to potato chips to plutonium to the fresh blood of your enemies, is a chemical.  Some chemicals are good – like water.  Some chemicals are bad – like heroin.  The “naturallness” of a substance is no measure of its goodness, by the way.  I’m all in favor of making natural food, like vegetables and fruits, available as a healthy alternative to chips for people who are not me.  However, let’s not pretend that Nature hasn’t been doing her damndest to kill us over the last few million years.   Hemlock is totally organic and it will totally kill you. Yes, I choose to put a chemical in my brain because that chemical makes my life better.

I know that there are people who manage their mood disorders without medication. They use exercise, diet, neurotherapy, and essential oils.  For them, I have nothing but love.  Respect.  But what I don’t have is admiration because I don’t consider them to be any stronger than someone like me, who uses medication as a part of my treatment.  If you’re healthy, then that’s fantastic, and it doesn’t matter to me how you got there.  What I do object to, however, is the “helpful” advice on how to “kick” my “chemical habit.”  These well-meaning people only contribute to the stigma surrounding antidepressants that causes people to quit their regimens without consulting their doctors.

The fact remains that many people who take prescription medication to help them with depression, anxiety, schizophrenia, or any other mental illness feel like they have to hide that fact from others – even the people they love the most.  How many people feel like they have to lie about their Lipitor?  How many people feel that they have to hide their Prednisone in their sock drawer? Would you ever tell someone that they didn’t “need” their chemo?

I remember having to take a deep breath before telling my boyfriend about my nervous breakdown two years ago and the resulting regimen of diet, exercise, and, yes, Zoloft that keeps me healthy in mind and body.  I trusted him – of course I did – but I’ve spent a quarter of a century in this culture.  He didn’t bat an eye, of course, because he’s sensible and compassionate, but my own internalization of our cultural norms did surprise me.

So here I am.  I take pills.  They keep me sane.

It’s awesome.

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The Riotous Courage of Being: Bravery and Mental Illness

I have never understood people who sleep easy. For as long as I can remember, I have struggled with falling asleep. Don’t get me wrong: I adore dreamland, once I’m there. The passage over, however, tends to be rough. I have the most difficult time turning off my mind. As an example: I’m writing my first draft of this piece at approximately 12:34 AM on my iPhone, after several solid attempts at slumber. Insomnia hasn’t been as bad of an issue lately, but my old friend visits from time to time. When I was a child, though, it was unbearable. I spent the first 45 minutes to two hours every night trying to stop the day from wheeling about in my head.  It was in those moments that my constant companion, Fear, would crawl into bed next to me like the worst housecat ever.  Every shadow was a monster, and even the air was suffocating and foreign, as if my lungs belonged to someone else.

When I got older, those first few hours would play like a blooper reel of my most embarrassing moments from the day, paired with contingency plans for every horrible event that could possibly happen.  What would happen if my parents suddenly vanished?  Who would take care of us? These questions were punctuated by mental calculations: if it was 1:03 right now, and I have to wake up at 5:15 to catch the bus at 6:00, how much sleep can I get tonight? And what if I don’t get enough sleep and something terrible happens?

My mind is a busy place.

And so I developed a method for helping myself to sleep, which worked about half of the time.  I would make up stories.  If I didn’t think about my own life, I could usually lull myself to sleep.  I usually made up stories about my favorite cartoon characters and put myself into them.  That’s right: I was writing fanfiction before I could actually write. If I’m being honest, I made some vast improvements to the canon of The Cowboys of Moo Mesa.

I still put that technique to work when I can’t sleep.  Some of my best stories have come from those pre-slumber moments. When I was trying my hardest to fall asleep, I used to tell myself stories about bravery.  When I was a child, I knew what bravery looked like. Bravery meant women warriors in fantasy lands, starship captains, queens and princesses and sacrifice. I knew that I wanted very much to be brave. I used to imagine what would happen if an adventure were to appear at my window. I used to dream that I would be brave enough to take it, but as I couldn’t recall reading about any heroes who had to sleep in their own bed with exactly three pillows and a stuffed animal on each side for symmetry, I felt that I would be ill suited for bravery. I didn’t think that brave people spent most of their time being wary of the toaster or checking the under-the-bed every half-hour or telling themselves stories so they could get to sleep every night. Brave people, I reasoned, could do things I couldn’t.

Later in my life, bravery came to mean different things. Bravery meant going on dates with boys, driving on the highway, and studying abroad in France.  Bravery meant throwing parties, going to parties, and deciding to road-trip at the last minute.

I did none of those things.

Because I had such conscripted ideas of what courage was, I felt as if I were a coward. A coward with an advanced degree and a stellar work history, but a coward nonetheless.  I felt that I spent so much time managing my anxiety that it took me twice the effort to maintain what other people thought was a “normal” life.  Constant policing of my mind left no chance for valor. I was afraid of spontaneity because I thought it would break the brittle ice standing between my outside composure and the maelstrom of tics, compulsions and noise that threatened to spill out of my mind. I saw other people my age dropping everything to travel abroad, to pursue a calling in New York or Los Angeles, to fall topsy-turvy in love and embark on a romance for the ages.  I didn’t understand how I was supposed to go out and chase my dreams when it took all I had to hold myself together, and I was ashamed of my fear.

I’ve learned, however, to both forgive myself for my perceived shortcomings and to redefine courage in the face of all I have undergone.  I’ve learned to weather life in a world that I find often overwhelming and frightening.  I’ve overcome the clamor in my head and the roaring in my ears enough to engage with the life all around me.  I’ve moved through the panic to form attachments – which, if we are honest, are messy, entropic things by their very nature.  Love is complex, intuitive, and absolutely terrifying. People are unpredictable. If courage is defined as moving outside of one’s comfort zone, then I may be the bravest of people.  Do I take medicine to help me do this?  Yes. Yes, I do.  But the fact that I take medicine to keep myself healthy in mind doesn’t undermine the strength I have at my very core.  The courage.

Mental illness has a pronounced, devastating effect on one’s sense of self.  I don’t mean “self-esteem” in the fabricated, superficial way we so often encounter.  I mean, rather, the connection between our minds and our inner selves – our personality, if you will. As a person of faith, I think of that transcendent part of myself as my soul. Mental illness kills your ability to recognize the value of your own soul, because your perception of reality is skewed and sick.  I know that from first-hand experience, and having people pat you on the back and tell you “You’re all right,” does very little good.  It feels like charity.  And you know for a fact that it’s a lie. You’re not “all right.”  I certainly wasn’t.

Instead, let me reassure everyone who suffers from mental illness that you may not be “all right,” but you are brave.  When you feel as if every breath will collapse your lungs, breathing is brave. When you are frightened of the Outside World, going to work is brave. Holding conversations is brave when you feel yourself drifting away inside yourself whenever you start to speak. You may never travel abroad. You may never “find your calling.” For some of us, life itself will be the greatest battle.

Simply being is act of riotous courage.

Yes, mental illness is “all in your head.” By it’s very definition, it is in your mind.  But that doesn’t make it any less real.  This is something that is happening to you, and it is real, and you are brave – however you choose to weather this storm.  And once I realized that – once I realized that forgiving yourself is wonderful, but not as wonderful as not punishing yourself to begin with – I started living my life, not in spite of my anxiety, but with it.

I decided what I wanted and threw out the list of “Things You Have to Do Before You Die,” because life cannot be a checklist governed by the fear of Death. I accepted that my fear will always be with me, but that I am powerful because I stand in the face of Fear and know it by its name.

I did drive on the highway – at age 24, on my own terms.  I never lived abroad – but I learned to treasure the close relationship I gained with my parents in its place.  I did quit a job to pursue my passions – though I still have to manage the panic caused by jumping out without a safety net.

I’ve even fallen in love.

All of that seems pretty courageous to me.

We Didn’t Start the Fire: “Just Get Over It” Has Never Been Sufficient

“Everyone ‘these days’ has got depression.”

“We used to just call it being sad – I didn’t need to pop pills after [insert traumatic event].”

“People in America only think they’re depressed. Try being in a third-world country. I went to Africa on a mission trip and everyone was so much happier. Maybe it’s because everything is simpler there, or people are more grateful.”

“Americans eat too much fast-food and spend all their time on their phones. Want to be happy? Go outside and get some exercise!”

“People would rather take medicine than deal with their problems, and that’s really sad.”

Have you ever heard any of these lines?

Have you ever said any of these lines?

The number of people being treated for mental illness is on the rise.  Now, science tells us that we can’t confuse incidence with diagnosis: just because a disease is being diagnosed more, it doesn’t mean it is actually happening more.  We might just be more aware of it than we were.  Our standard of living is better than it has been, and maybe we’re just less willing to put up with debilitating fear and depression than our forefathers were.

But if you read the comments on any article about anxiety, depression, or any other mental disorder, you get the sense that there’s a large group of people who just want you to get over it.  They think that depression and anxiety and schizophrenia are modern conditions, caused by a society of smart-phones and easy answers and divorced parents and gay marriages. They think that doctors give out drugs like candy and that there is a cabal of psychiatrists and psychologists who profit from this new “American hypochondria.”  They will tell you that people weren’t depressed during the Great Depression, that no one had anxiety during Vietnam, and that the cure for all ills is taking walks in the sunshine, turning your phone off, and being grateful for what you have. People who are not doctors will tell you that you don’t need medication.  People who are not psychiatrists or psychologists will tell you that you don’t need therapy.  In short, if you can’t manage your life, then it is your fault, and America is riddled by people who can’t manage their lives.

Let’s get one thing straight: mental illness is not new.

The Ancient Greek physician Hippocrates hypothesized that mental illness was a biological, not spiritual, condition in 400 BC.  If the name Hippocrates sounds familiar to you, it’s because doctors to this day take the Hippocratic Oath.  Hippocrates is possibly the most influential figure in Western medicine.

Anyone versed in medieval literature is familiar with the humors.  I don’t mean Eddie Izzard. For those of you who aren’t gigantic nerds, the humors are bodily fluids that ancient and medieval doctors and scientists theorized were responsible for various aspects of personality.  The big four are black bile, yellow bile, phlegm, and blood – they represent the four major temperaments, or moods.  If a person is healthy, then Hippocrates theorized that all four humors are balanced. An imbalance in the humors caused any number of personality issues – what we now think of as mental disorders.

Melancholy or melancholia was one such condition.  A person suffering from melancholia (comparable, though not completely, with modern-day depression) was thought to have an excess of black bile. They were often despondent and prone to uncontrollable mood swings.  Now, modern medicine has punctured the theory that the body is made up of four fluids.  We also no longer believe that blood causes anger or phlegm causes apathy. I think the hypothesized cause of mental illness is a lot less important than the fact that doctors were asking questions in the first place.

What does this mean? It means that even though ancient and medieval doctors weren’t able to see inside the body and the brain – like we can now – they accepted that there is a distinct link between our mental health and our physical one.  The ancient Greeks also tried to treat mental illness using herbs and therapeutic activities.

The smartest people in the world have been treating mental illness as a biological condition for thousands of years.

Let that sink in.

Not only did ancient and medieval doctors try to treat mental illness, but authors also featured people with mental illness in some of the most famous works in the Western canon.  You can’t read Hamlet without thinking the Prince of Denmark’s life would be better if Elsinore had a grief counselor on hand. Poets like Goethe explored the “melancholic” temperament that led young men to commit suicide for love or grief.  People with mental illness are everywhere in literature and history.  Abraham Lincoln wrote often of his depression and suicidal thoughts.  Winston Churchill called his recurring depression his “Black Dog.” Leo Tolstoy suffered from “hypochondriasis,” a constant fear of illness.  And there are more.

We live in a linked-up society, in which we know far more people than ever before. Our social networks are a web that stretches wider than the village or city block of our grandparent’s day. Of course we’re going to know more people who suffer from mental illness.  Not only that, but we are privy to a host of information – constantly streaming – that makes it seem like we’re in the endtimes when it comes to mental health.  But it’s simply not so.  Go through any Southern family album with a grandparent. Do it. I dare you.  You’ll hear all about Cousin Louis, the recluse (agoraphobia or social anxiety); Grandpappy Turner, who burned hot and cold all his life (bipolar disorder); Aunt Millie, the hypochondriac (acute anxiety). We have always been here.

And there have always been names for our diseases.  In the 19th century, a person suffering from what we now call clinical anxiety would be called a “neurotic.”  A person suffering from depression might be called “melancholic” or “depressive.” “Nervous illnesses” were considered to be a phenomenon of wealthy women, but now we know that biological factors – particularly childbirth – wreaked havoc on the physical and psychological wellbeing of women, particularly those without proper support.  “Rest cures” were prescribed for the wealthy, but if you were of the working class, you were out of luck.  We don’t know how many people in the pre-NIH era suffered from these ailments because people didn’t talk about them.

Well, now we do.

We talk about our breakthroughs and our breakdowns, but we didn’t invent them.

We’re just unwilling to simply live with them.