by request: an angel at my table (jane campion, 1990)
music friday: bruce springsteen, “if i should fall behind”

on depression, suicide, and medication

I’ve been thinking about writing on the career of Tony Scott, but I don’t have a lot to say. At a time like this, it’s best to say something nice, or to say nothing at all. I like True Romance, although it seems more like a Tarantino movie to me than a Tony Scott movie. The truth is, though, I have purposely avoided most of his films, because I hate Top Gun so much. I think I need to take a look at Scott’s other work, hopefully with a fresh eye.

Meanwhile, there’s the way in which he died. Roger Ebert tweeted a link to an article by Charles Raison, a professor of psychiatry at Arizona, and Roger’s correct, Raison’s piece is wise and realistic. When he says, “as much as I hate suicide, I also understand it”, he earns some good will as I read the rest of his piece. He writes evocatively about depression:

Depression is different. Because it is at its essence a perceptual disorder, it causes one to see the entire world as pain. It feels painful inside, but it also feels painful outside.

When a person is depressed, the entire world is disturbed and distressed, so there is nowhere to escape. And it is this fact that makes suicide so seductive, because it seems to offer the one available escape option.

He then speaks to why suicide seems so tragic. For one thing, “depression often passes on its own accord. It is not an incurable cancer that offers a guaranteed foreshortened future of unbearable pain. Because of this, depressed people kill themselves over something that would have lifted had they just been able to hang in there.” He also notes:

[A]lthough our treatments for depression are far from perfect, they are nonetheless effective enough to help the vast majority of depressed people feel well enough to forgo killing themselves.

I’ve been on psych medication for more than seven years. While the first psychiatrist I saw said she wasn’t comfortable with labels, feeling that individuals are always more complex than the label implies, she also noted (perhaps knowing I’d be on the Internet the minute I got home) that my “symptoms” suggested what they call “bipolar II disorder”. And it is true, for seven years I’ve taken two medications, one for depression and one for anxiety. I’ve found the anxiety meds to be especially helpful, feeling soon after I started taking them that the weight of 50 years had been lifted off my shoulders.

But I waited 50 years because I feared becoming a zombie. (Well, not 50 years … if memory serves, and it rarely does, my parents had me on “nerve medicine” at one point in my childhood.) I may have been miserable, but at least I was “me”. It was only when I finally realized that being “me” sucked that I went for the meds.

And, sure enough, I am still me. I’m not sorry I’m on meds. But, as I often tell people, I have most of the same thoughts I had back in the day. It’s just that I have better impulse control, and I have more of a “who cares” attitude, which is why there isn’t the anxiety of the past. I still have the ability to care … just think of the 2010 Giants if you need proof … but I don’t get freaked out the way I used to.

Yet, there is a way in which this is a problem. Sometimes I think the purpose of psych meds isn’t to make me feel better, although I do, but to make me easier to be around. I’m not the asshole I used to be, I don’t act out the way I used to, while I’m far from perfect, I think before I speak/type more often than I used to.

This came to my mind when I read Dr. Raison’s comment that treatments for depression “help the vast majority of depressed people feel well enough to forgo killing themselves.” I’m an example of how this works, and I’m glad of that. Nonetheless, Raison’s statement points to a serious problem: meds don’t make the world better, they just make you feel well enough to stay alive. You are, in effect, pacified so you don’t bother other people.

I’m reminded of the one time I went through an extended period of therapy (I think it was several months, no more than that). I was working in the factory, and I’d ended up standing in the middle of the street one night, screaming, and so I started therapy. And the purpose of the therapy was to help me cope. Granted, this was partly because I was only going to see the doctor until my insurance ran out, even if I needed years of therapy. And it is true that I don’t think much of long-term therapy (when I finally decided to get better, I went straight for the meds). Still, the idea was to help me cope, and it worked OK, and I lasted another two years before I couldn’t take it anymore. For two years, I was more or less a reasonable person who went to work and did his job like everyone else.

Similarly, meds for depression bring you back from the precipice of suicide. They let you be reasonable, let you do your job like everyone else. What they don’t do is change your circumstances. What they don’t do is remove the reasons for killing yourself. They just make you care less, so you no longer want to go to the precipice.

I’m not saying this is a bad thing. But part of me thinks it’s a trick, wherein I take my medicine and pretend everything is OK, all the time knowing that if I quit taking the medicine, the world would be just as it was seven years ago. Nothing has changed at all, except my own personal chemistry.

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