depression

Meditation and the Kozmic Blues

I’ve recently begun the practice of meditation, actually I’ve been doing it most of my life, I just called it watching baseball. (Still deflecting serious issues with humor.)

I’ve been using a program called Headspace and like it very much. It’s a painless entry into the daily practice of meditation and it helps. I’m especially taken with the idea of looking at not only how meditation helps me, but how it also benefits the people closest to me. Anxiety makes me stupid; it blinds me to reality and causes me to obsess over fantasy. Depression makes me numb, forcing me to withdraw from relationships. Not a very healthy way to live. I believe meditation can help clear the fog and allow me to more openly conduct honest relationships, to recognize and accept their true nature, and to enjoy. Early days but that’s the goal.

If you’ve been with me for a while, you’ll know I quit antidepressant medications earlier this year because I thought my senses had been dulled to the point where I couldn’t feel anything at all. I believed, and still do, that the moderating effect of the drugs deepens the shell of depressive isolation by making it acceptable: “I can’t help it, I’m depressed.”

The emotions began to build and I had to learn how to deal with it. It’s been slow going – the drugs have been out of my system for nine months now – because so much of my time is spent alone. Writing takes up much of my day, baseball much of the rest. So it’s been a slow build but seems to be peaking now and not just because the season is coming to an end and the Giants look like they’ll fall short of the playoffs, but also because I’m planning a trip to France and the experience there that led to writing Angle of Reflection still resonates with me. It was intense in many ways but the medication prevented me from processing it all.

The latest rewrite of Angle of Reflection is a much truer emotional narrative. It is deeper and darker, reaching places I could never go before. It’s better, but still doesn’t go far enough. A recent reading has convinced me that I’m still not hitting the essential, honest emotional core I’m seeking.

In other literary news, I’ve completed the first draft of the second novel, Rivesaltes. This is an entirely different book, composed of several stories about people caught up in the violence that engulfed twentieth century Europe from the Spanish Civil War to the French/Algerian War. One of the things I’ve learned about writing fiction is just how rough a first draft really is. There’s a long way to go.

Gateway to Understanding

Is emotion the gateway to reason or is it an obstacle to understanding?

I had always believed in the power of the intellect, that an educated intelligence should be sufficient to decode the clues and understand the opportunities and conflicts we all face. Now I’m not so sure. In fact, I’m pretty sure the opposite is true; it is only through emotional engagement that we can truly understand anything at all. How we respond to art offers a window.

Angle of Reflection contains a scene in a museum where Ben and Emma are discussing a Picasso exhibit. Ben is able to admire the technique and appreciate the results from an intellectual distance but maintains that Picasso never moves him. (Let’s assume he’s never seen Guernica.) Emma tells him it may yet happen and to beware of sealing his emotions in today’s opinion.

Later he reflects on a painting that moved him more than most: Vermeer’s, A Maid Asleep. “I couldn’t turn away. I was immediately and profoundly drawn into that world, I could walk into that woman’s dreams and imagine stories that explained all the elements Vermeer chose to include.” We can’t know whether the artist had the same stories in mind but it doesn’t matter, what is significant is that the emotional reaction to the image made the content knowable.

Here’s where we get back to the question of antidepressant medication: it is my contention that one of the severe effects of many years on SSRIs was a stifling of emotion, which led to a failure to understand what was happening to me. I couldn’t get to it because I couldn’t feel it.

I’m not the first to report this. “SSRIs also cause a multitude of troubling side effects. These include sexual dysfunction, suppression of REM sleep, muscle tics, fatigue, emotional blunting, and apathy. In addition, investigators have reported that long-term use is associated with memory impairment, problem-solving difficulties, loss of creativity, and learning deficiencies.” Robert Whitaker: Anatomy of an Epidemic, Broadway Books, Random House, 2010.

I’m beginning to feel that I’m nearing the finish line for Angle. Could be wrong, of course, I’ve thought this before, then I sent it to my editor. I began to wonder how you know when you’re done with a novel. There is no requirement for length, no facts that have to be explained, no rules to follow. Thinking won’t get you there. I suppose you can say that it’s finished when someone decides to publish it, but Fitzgerald was still trying to rewrite Gatsby as it was on the press. I asked a friend who is a wonderful painter how she knew when a painting was finished. She said: “I don’t know, I just feel it.”

Feels right to me.

Mom

Mom is 97 years old, suffering from severe dementia; her mind is no longer connected to reality, yet the burden of her body continues. One dark, unseeing eye bulges out of her head; the other struggles to focus through a cataract. She cannot hear much. Her arms are covered with purple bruises, her legs bandaged to cover skin too thin to protect her. She is tiny, except for a severely bloated stomach that houses the tumor that refuses to kill her.

Her thoughts are trapped somewhere between disappointment and fantasy, in a world that never existed. It was never a happy life and that it continues in this painful demented manner is a terribly cruel punishment. She lost her parents at the age of twelve: her mother died, her father sent her away. She never recovered. Such an unhappy life that refuses to end.

Yet there is nothing we can do. We cannot end her life. That decision is not for us to make. She is in pain, partially controlled by morphine. She is agitated: perhaps frustrated by growing mental incapacity, perhaps fearing death. Xanax helps a little. She is depressed, always has been, and there is Zoloft for that. This is maintenance, not life. We give her all these meds because she is demented and we fear she will succumb to the pain and despair and kill herself. What is rational behavior in this circumstance? Is it reasonable to preserve a worn out body by controlling a dysfunctional brain with drugs that render her senseless?

She can no longer make her wishes known to us, but this is consistent with a life-long pattern. In our family, no one ever makes clear what she really needs; we all persist in equivocating and deferring until we get what we want because some decision had to be made, or, more frequently, just move on, unsatisfied and slightly resentful. So mom wouldn’t tell us what she wanted when she was able, now she cannot.

She was frightened when we first arrived, not knowing my sister and I, perhaps thinking we were the ones who would take her away. I sat with her a while, holding her hand, offering what comfort I had to give. She became calmer. I wanted to will her to die. I told her to let go. She would fall asleep, I’d watch her breathe, wanting to make it stop. Then she’d wake with a small spasm, turn to me unable to see, not knowing who I was. Once she said she wanted to go home and I thought she really wanted to die, but it may be that she was still looking for a place for herself that she had never been able to find.

We were going to take her away, we came to move her to a home for people with dementia, but there’s not enough left to move. She is beyond the attention they would give her, more dead than alive.

There is nothing to be done. She has an aide who bathes her, feeds her, changes her diapers, and laughs at her plight in the kindest way. “That’s what they do when they get old,” she says, and then cleans up the mess. She makes her comfortable and mom kisses her hand in appreciation.

We don’t handle death very well in our culture, partly because we have huge industries manufacturing drugs and services whose sole purpose is the preservation of life, regardless of the quality of that life. We crucified Kevorkian and only a few states allow a person to choose the time and manner of death. We consider suicide to be insane. We need to rethink our priorities and reimagine our death. There comes a time, as in mom’s case, when preserving a useless body is the truly irrational act.

ANGER

From Angle of Reflection:

“Ben wanted to see Michel’s organic vineyards and chemical neighbors again. It wasn’t far. He couldn’t look at these two plots of land without believing the absence of intrusive chemicals just had to be better for everyone, for the entire ecosystem of the vineyard, including the people and animals who worked there. So why was he introducing foreign substances into his own body to alter the natural balance? Anti-depressant medications were unnatural and they worked in subtle and insidious ways: reinforcing harmful behavior by making you comfortable with it, reinforcing passivity by making it seem acceptable behavior. Depression is difficult, but rounding off the edges doesn’t help. It just makes it worse. He had made his decision.”

Ben decided to change because he didn’t like the way he felt, or didn’t feel, and because he had come to believe in the need for man to live with, and work from what nature gives.

Now I’ve begun to look into the research on anti-depressant medication – something I should have done long ago – and what I’m reading is making me angry. Whether I would have had this reaction while still taking the meds is an open question, but I feel healthier just being able to feel the anger.

The first stop was the first of a series of NY Times opinion articles by a writer named Diana Spechler called “Breaking Up With My Meds.”

http://opinionator.blogs.nytimes.com/2015/02/12/breaking-up-with-my-meds/?_r=0

Her condition would seem to be more severe than mine, but her description of some of the side-effects of the medication was similar.

Here’s the paragraph that hit home:

My thinking is slowed, my creativity stymied. When I work, I feel as though boulders are strapped to my brain. I’m constantly thirsty. I’ve lost my taste for exercise, a mood-enhancer I’ve long relied on, and become more sedentary than I’ve ever been. Perhaps most disruptive of all, depression still lies, dead weight, on top of me — a few hours here, a few hours there — and medicated, I feel less motivation to wriggle out from under it.

Embedded in the article was a link to a piece from 2011 in The New York Review of Books titled: “The Epidemic of Mental Illness: Why?” By Marcia Angell, Senior Lecturer in Social Medicine  at Harvard Medical School and former Editor in Chief of The New England Journal of Medicine. She discusses three books on psychiatry and the use of anti-depressant drugs

http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/

Here are the three books she discusses:

The Emperor’s New Drugs: Exploding the Antidepressant Myth by Irving Kirsch

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker

Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations About a Profession in Crisis by Daniel Carlat

I don’t intend to summarize or criticize any of these works, read Angell’s article, but as always with this blog I want to explore my personal reactions to what is significant in my world and, specifically, how it affects creativity.

I feel so strongly that trashing the meds has enabled me to reach an emotional awareness that has, in turn, allowed me to write with a greater precision, clarity, and depth than ever before. That’s only my belief, but at this stage, it’s the only one that counts.

Kirsch has two major theses, both strongly supported by the data he presents. One: anti-depressant medications are no more effective than the placebos used to control clinical trials, and this fact is well known to the pharmaceutical companies, the FDA, and doctors who have taken the time to read the literature. It is easy to understand why nothing is done about it: the drug companies make a lot of money selling these meds, the FDA receives half its funding from the drug companies, and the doctors don’t have anything else to offer their patients.

Two: The marketing and prescribing of these meds is based on the theory that depression is caused by a chemical balance resulting in a deficiency of neurotransmitters in the brain. There is no evidence that this is true. None.

The meds are designed to increase the amount of neurotransmitters in the brain, thereby acting on a condition that is not proven to exist.

Here, from Angell’s work is the nut of the problem:

“…because certain antidepressants increase levels of the neurotransmitter serotonin in the brain, it was postulated that depression is caused by too little serotonin. (These antidepressants, like Prozac or Celexa, are called selective serotonin reuptake inhibitors (SSRIs) because they prevent the reabsorption of serotonin by the neurons that release it, so that more remains in the synapses to activate other neurons.) Thus, instead of developing a drug to treat an abnormality, an abnormality was postulated to fit a drug.

That was a great leap in logic, as all three authors point out. It was entirely possible that drugs that affected neurotransmitter levels could relieve symptoms even if neurotransmitters had nothing to do with the illness in the first place (and even possible that they relieved symptoms through some other mode of action entirely). As Carlat puts it, “By this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain.” Or similarly, one could argue that fevers are caused by too little aspirin.

That’s interesting and amusing, but here’s the real problem for me: once a person is put on a psychiatric medication, which, in one manner or another, throws a wrench into the usual mechanics of a neuronal pathway, his or her brain begins to function…abnormally.

So here’s the deal: these drugs (SSRIs) increase the level of serotonin in the brain, but there is absolutely no scientific evidence that my depression or anyone else’s resulted from a deficiency of serotonin. In my case, the result was an enormous dulling of emotions, loss of mental acuity and creativity, and an increase in passivity that kept me from trying to overcome the effects of depression. I believe it worsened over time but can’t say for sure; it may be that changed circumstances finally forced me to recognize what was happening all along.

For me, the only way past this was to quit taking the meds. I feel very strongly that this has resulted in reversing these debilitating conditions and that has, in turn, freed me to write the insight and clarity I was seeking. We’ll see.

Charting Progress

It’s been a month without medication. I’ve been keeping a journal, a daily emotional temperature chart, and a few trends have emerged.

One: I’ve been able to stabilize sleep patterns and that’s a big relief. I sleep through the night now and wake feeling rested, most of the time. Occasional glitches, but that’s always been true.

Two: the Hallmark emotional moments continue, but there was also genuine bad news this week and my response was real, nakedly emotional, and appropriate. My emotional range has expanded and I’m grateful for that. The medication was designed to flatten the roller coaster, but I don’t think I need that anymore. I need to feel it all.

Three: My internal censors are breaking down. I’m much more inclined to say what I’m feeling and I tend to think that for the most part, this is a positive thing, as long as it doesn’t become a burden to others, and as long as I don’t use it in a constant search for positive reinforcement.

It is definitely a good thing for the development of Angle of Reflection, allowing the exploration of Ben’s character to deepen and to provide the opportunity for change and growth. In early chapters, while searching for intimacy, Ben tends to deflect challenges to his defenses with humor.

“So making the photo becomes a way of making the connection?” Emma asked.

“It does, usually the object is nothing more than a good portrait, one that reveals some truth about the subject. By the way, I’ve always wondered about the method, I mean seeking to make a connection with a camera hiding your face? Anyway, it worked for us and the connection was profound, and I have the photo too. Someday that might be all I have.”

“Do you worry about that?”

“I think about it. I try not to. I try to just enjoy what is happening now, but sometimes I can’t help it.”

“You need a bit of the yogi in you. Live in the moment.”

“The only Yogi I know used to be a catcher for the Yankees.”

This will change.

Creativity is Risk

The decision to de-medicate really began last year with a simple question from a very good friend: I was thinking last night that I’ve never seen you be aggressive. Have you always been like that?

I was surprised by the question and it has haunted me ever since. To some extent I’ve always been more passive than was good for me, but I also think it’s become worse over the years. There are really two indivisible issues: passivity and timidity. They start with hesitation and develop into a rigid shell; together they create a kind of death of the soul.

Depression can be the precursor of both conditions; the usual medications can make them worse because the effects put a limit on your presence in the world. They allow you to accept what should be an unbearable way of life. The shell forms and within it there is never enough air or water to allow anything to grow. You begin to die inside: old relationships wither, new ones never have a chance.

The timid and passive don’t take risks and there is no creativity without risk.

It is an act of courage to walk out on a stage and play a sonata before an audience. Or sing an aria, or paint, write, or photograph. It’s not just the risk of failure and humiliation, although that can be a powerful stop sign, the bigger risk is in opening yourself and finding out what’s inside. And you do have to dig because anything of value emerges from the core of your being. Call it soul, or heart. It doesn’t matter. It’s the only thing you have to give and if you can’t open enough to tap into it, you can’t produce anything of value. I’m talking about works of art, but also about what you give in a relationship, the love you give to a friend, a lover, or a child. It’s all risky, but essential.

Here’s a bit from Angle of Reflection in which Ben acts against type and takes a risk because he just had to photograph that woman, in that place, at that time.

“They came out of the gallery into a small stone courtyard with indirect sunlight bouncing off the walls and up from the ground, creating a lovely portrait light. He asked Emma to pose for a moment and started shooting before she could say no. He was keenly aware of the crowd around them in a city full of photographers, but he had to do this. He shot and moved, asking her to turn to him sometimes, look away at others. He wanted to juxtapose her youthful skin against the ancient stone walls, but more than that he wanted to capture the light that made her glow with a beauty that made his heart ache. He had her bring one hand up to her face for a few frames but it didn’t work. Then he had her turn her back to him and made a few images of her hands and hair as she did that twirly chignon thing. After a few minutes, she became self-conscious, turned around and made a funny face at him, and he stopped. It was too late, he was in love and frightened by the intensity of the moment and his feelings for her. His hands were shaking and his heart was beating much too fast. She looked at him and seemed to understand. Very quietly she said “thank you,” and quickly squeezed his hand before they walked in silence to the next venue.”

Ben had to take the risk, the opportunity would never have come again. I missed too many moments. No more.

Ben and Sarah Talk About Medication

“Ben, you need the meds. They help you function. They’ll help you make sense of things.”

“No, they make it worse. I can function. I’m not even sure I could write a novel if I were taking them. I mean. I’ve never written one before, never tried while I was on the drugs.”

“Ben, listen to me. I’ve known you and loved you for a long time. You have depression. You can’t change that. It’s some kind of chemical imbalance and the meds get you part of the way back. Going off the medication only makes it worse.”

“I don’t think it does. I think I’m pretty stable. I just wish I slept better. But there’s something that keeps me from making a real connection to others, to someone I really need, like Emma. And I think it’s the meds.”

“Think, Ben, maybe it’s not you or the meds, maybe it’s her. It’s not hard to imagine that your relationship just isn’t right for her.”

Ben fell silent for a moment, just long enough to consider that and reject it. “But what if that’s true because she hasn’t been able to get close enough, because I won’t let her, even if I think I am?”

“Ben, what separates you from connection, from emotion, is not the meds; it’s the depression. Think back to before you were on the drugs. Remember your family, how you always felt disconnected. That’s who you are. It’s not what the drugs do to you. You know this. I’ve heard you say it yourself. Please trust me.”

“Sarah, I know you mean well; I’m just not sure you’re right. You’ve been on these meds as long, maybe longer than me. Maybe this creates a challenge to you. Maybe I’m leaving your sphere of influence and that threatens you. It shouldn’t. It has nothing to do with you. This is about me, only me. I really want to write this novel and I think I have to get as close to the bone as possible to do it. I can’t be removed and dispassionate and still convey passion.”

“That’s nonsense Ben and you know it. You’re confusing your book and your life and making about as much sense as a Raymond Chandler plot. You don’t have to experience something to be able to write about it; did you have to drive into that cliff so you could write about it, or did we have that accident because your mind was elsewhere?”

“God damn it, Sarah. It’s my fucking life. Stop trying to produce it.” His anger was so rare, it startled both of them. Sarah was reeling. This just wasn’t Ben. “You’re wrong, Sarah, this is me. Me without the drugs. Me being honest. Not afraid of the anger. I need to feel this.”

“Ben, I don’t know what to say. You have reasons to be angry with me but this isn’t one of them. I’m trying to help.”

Angle of Reflection

Chapter Two

Here’s a bit of text from Raffi Khatchadourian’s article in this week’s New Yorker on the development of emotion recognition software. He’s writing about a scientist named Rosalind Picard who did much of the early work in this field that has now been hijacked by ad agencies and phone companies.

“She became convinced that reasoning and emotion were inseparable; just as too much emotion could cause irrational thinking, so could too little. Brain injuries specific to emotional processing robbed people of their capacity to make decisions, see the bigger picture, exercise common sense…”

I don’t mean to suggest that I have some kind of brain injury, I don’t, but symptoms described here very closely mirror some of the trouble I’ve had using anti-depressant medications, which makes me wonder if the effects of the medications might not be compared to brain injury.

I’d expect the medical and pharmaceutical industries to argue that it’s not the drugs, it’s the depression, but I’d counter with the idea that the meds exacerbate the problems by making the patient comfortable with his condition. By rounding off the rough edges, dulling emotions, and allowing one to function, the drugs extend the damage caused by the depression.

If I can’t feel the anger, how can I summon the will to fight it?

I’m not suggesting that everyone quit the meds and sue the drug companies; I’m only talking about my reactions and desire for change.

Almost two years ago, when I first began writing the semi-autobiographical novel now called Angle of Reflection, I made my first attempt to quit the meds. Early effects including disturbed sleep patterns and overreaction to sentimentality were the same then as now, but then things got a little out of control. Just beginning to write fiction, I became a bit confused about reality, and a phone call from a friend who is the model for a pivotal character drove me over the edge and back to the meds. Looking back at that now, I’m not exactly sure what happened. I tend to think I got caught up in my own fantasy, resulting in an extremely exaggerated reaction. Whatever it was, it’s different now, well some things are. I’m still working on the book, but I’ve learned a lot about the process of writing fiction and a few things about myself.

And now that I’m learning about withdrawal from the medication there are several scenes that will need to be rewritten – again.

By the way, the New Yorker piece is terrifying to those of us who still think we have some privacy. It’s in the current issue.

Depression

I decided to stop taking anti-depressant medication and thought I should tell my friends so they could keep an eye out for erratic behavior. Then I decided to write a journal in order to monitor my feelings; finally I thought I’d publish the journal on the blog. The reasons for that are a bit more complicated but I’ll explain.

One of the symptoms of my depression is isolation: the feeling that I can’t really connect with anyone on an honestly emotional level. When the depression is at its worst, I compound the effect by physically isolating myself from everyone. So, in an attempt to counter these tendencies, I decided to violate my own predilection for privacy by publishing my thoughts and reactions on this issue. That may not be as radical as it seems because the audience for this blog would fit nicely in my living room, probably has.

Saturday, 10 January is Day 6 of this experiment and I’ve been beset by a cold throughout, so it’s difficult to gauge the effects so far. Let’s start with a bit of history and the events that led me to try to quit the medication. A diagnosis of major depression has been consistent through several shrinks for most of my adult life although I really think it goes back to my childhood. I’ve been on a several different medications for 15-20 years, not sure exactly when it started. With the occasional help of therapy, I’ve been able to function throughout, making a living and sustaining, to a point, loving, romantic relationships.

But writing a semi-autobiographical novel spurred profound changes: everything in my life was subjected to critical self-analysis and I began to look at many events and relationships as failures. Naturally, I wondered about the role of depression in everything I had experienced. Thinking and writing about my parents, I saw my mother as someone who had encased herself in a protective shell. Nothing could touch her, therefore nothing could hurt her again. Merde, I thought, that’s exactly what I had done. My mother had very good reasons to seek emotional protection, but I could not recall anything to justify my response.

For me, the instinct to guard my emotions led beyond isolation to timorousness; when I tried to breach the isolation, I did so with a guarded reticence that was no more effective than staying home. I thought to adopt Stuart Brand’s advice to “Stay Hungry, Stay Foolish” and maybe that helped me begin a novel but couldn’t help beyond that. Writing is, after all, a solitary pursuit, so it wasn’t too hard to work it into my comfort zone. Elsewhere, I was timid, apprehensive, unable to break through the shell even when the stakes were high and, I was sure the goal was worthy.

Given all this, why quit taking the medication? If behavioral patterns extend back before the meds, what can be gained by stopping? Just this: I’ve come to suspect that while the drugs have a moderating effect that keeps me on an even keel and allows me to function, it is precisely that effect that hardens the shell around me. In other words, getting by isn’t good enough and I think I’ve learned enough to be able to cope with whatever comes along. If a deeper emotional response fractures the shell just a little bit, that’s a positive result worth pursuing, before it’s too late.

One other thing: in a successful autobiographical novel the reader makes an emotional connection to the protagonist. In reading my work I saw that I wasn’t getting deep enough, revealing enough to allow this to happen. Self-censorship undermines emotion in fiction and in life. I’m hoping that losing the medication will allow me to pierce the protective skin.

This blog will use the journal of reactions to explore some of the issues raised in the novel and, maybe, create a blueprint for better fiction. If I’m able to maintain the blog as planned, you’ll be able to follow along on this adventure and, I hope, contribute some feedback.