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🎧You Stay on the Wrong Path
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At our next appointment, Dr. R’s office looks even tidier than usual. Spare. Clear. His pants have their usual luster.
I look out the window at Michigan Avenue at the pedestrians and tell him I want off all my meds.
His brow furrows with concern or confusion. I can’t tell which.
It’s logical—or so I think. To recover from twenty-five years of serious mental illness, I can’t take psychotropic medications. People with mental illnesses take meds, ergo, if I want to heal, I can’t.
This is the second mistake I make in my recovery. The first was believing that I shouldn’t be in therapy, which I’m not anymore.
This time, the idea is that being psycho-pharmacologically pure signifies recovery. Never mind that few medications have been studied long-term and most lead to dependency. Regardless of how recovered someone might become, they may have to remain on their meds to maintain a state of homeostasis. Never mind that the last time I tried to go off the SSRI, the withdrawal effects were so severe—involuntary muscle twitching, paranoia, nightmares, crying spells, brain shivers that made me feel like a waterfall of needles were cascading down the back of my head, brain shudders that felt like my mind was trembling, and brain zaps that made me feel like I was being electrocuted—I wanted to end my life.
“It’s not worth it,” Dr. R says. “Those medications aren’t hurting you. Low-side-effect profiles.”
He uncrosses his leg and breathes deeply. “Okay, we can try with the lamotrigine, but why?”
I don’t share with him my plan to heal; I’m still too scared he’ll tell me it’s not possible. Here, I’m missing out on the collaboration of care that might have helped my recovery.
“We’ll go down twenty-five milligrams,” he says. “Start there.”
Out the window on the street below, the pedestrians again seem like toy figures. Their outlines are stark. The buildings’ too.
Psychiatric medications have harmed and helped many people and may help many as they work toward recovery. Demonizing psychotropic drugs and shaming those of us who take them doesn’t serve anyone. Like many businesses, Big Pharma is mercenary, sometimes criminal, but we have to separate the CEOs from the researchers and others who truly want to help people. And sometimes, their efforts save lives.
Most psychiatrists and researchers agree that medications are best used to relieve acute distress. Often, clinicians either don’t know about this or haven’t told patients this. In tandem, they present a diagnosis as chronic and/or lifelong and don’t offer patients an exit strategy for tapering off medications. The result is that patients are kept on drugs for five or ten or twenty or thirty years instead of three months. Our bodies become dependent on the drug, and withdrawal attempts throw us into psychiatric crises, which we see as evidence that we haven’t recovered and start taking the medications again.
Dependence on psychotropic medications and their adverse side effects—not to mention how little we know about how they work and their dangers—complicate the very idea of mental illness and what causes it. The journalist Robert Whitaker offers compelling evidence that the rise in mental illness is correlated with the wide prescribing of psychotropic medications for long-term use. Studies show that long-term recovery rates have been higher for nonmedicated patients diagnosed with depression, bipolar disorder, and schizophrenia.
Forced medication is sometimes necessary but can also rob patients of their autonomy, worsen their conditions, and even lead to death. The psychotropic drug industry is a multi-billion-dollar machine, the aim of which has been profit, not public service. Side effects are listed, but clinicians aren’t required to discuss the risks with patients, thereby not procuring true informed consent. Taking medications long-term can mean having to remain on them indefinitely despite sometimes life-threatening side effects (e.g., antipsychotics that cause weight gain, diabetes, etc.).
In recovery, psychotropic drugs are just one small part of what Patricia Deegan calls Personal Medicine. Deegan was diagnosed with schizophrenia, healed, and became a psychologist, innovator, and professor at Dartmouth College School of Medicine. As she healed from schizophrenia, Deegan developed her own personal medicine: “Medications were just one tool in an entire set of recovery tools I slowly pulled together for myself. I built my recovery toolkit over time, intuitively, and without even having heard the word ‘recovery.’”
Personal Medicine is a strategy built on individual needs: “Personal medicine reminds us that there are many ways to change our body’s biochemistry and that, within the task of recovery, pill medicine must complement and support Personal Medicine, or the things that give one’s life purpose and meaning.”
If I’d known of Deegan and Personal Medicine, I wouldn’t have felt shame for taking medication or risked going through withdrawal again. But I have no awareness of the recovery community and no guidance.
A few mornings later, still in my pajamas, I pace my apartment. Voices come from the hallway. My neighbors are leaving for work. An hour ago, it came on fast: the heaviness, the sodden pit in my stomach, the jitteriness. I’m weighed down and revved up.
I dress and put on my coat and running shoes. Riding the elevator takes a long time. The lobby of my building is empty of people. Outside, it’s damp, the sidewalks wet with rain.
In the park, where I walk every day almost without fail, I wait to feel better. Moving will lighten me, steady me.
I circle the pond. A family of turtles sits on a rock. They’re placid, pure, unbothered—together.
It happens to be Thursday—the day when my group therapy session is held. The group I’ve rejected. I have to wait hours, but that evening, I ride one of Chicago’s Divvy bikes to the partial hospitalization program downtown and wait for group to start.
The others arrive. I know them by their diagnoses, not their names: PTSD and her emotional support dog; borderline personality disorder and depression; anxiety disorder, ADHD, and PTSD; depression, obsessive-compulsive disorder, and PTSD. I want to know their names, who they really are, and if they’ve ever thought of healing, but it’s not something anyone talks about in group.
The woman with bipolar I enters and sits across from me. Her short brown hair is functional, her deep voice commanding. In group, she was my ideal of what it means to accept your illness. I’ve envied how high functioning she is—a tenured professor with a life partner and an adopted son. Her stories of manic episodes (nights without sleep, maniacally working on spreadsheets for her job) and depressive lows (able to get out of bed and teach but with disassociation and hopelessness and anhedonia so extreme she finds it hard to hold a conversation, even with her wife) have held me rapt.
The counselor with waist-length hair comes in late. She wears black jeans and a black shirt. Her face shows no emotion. It never does. She reads the group rules, including how we should respect other people’s views and be punctual.
“And, of course,” she says, “give others space—”
The woman with bipolar I interrupts. She talks and talks, her words moving quickly, almost blurring into each other.
The Klonopin I’ve taken must make her seem like this. The scrappy emotional support dog breathes unevenly. The other women in the group seem to be listening. The counselor turns the pages of her notepad.
The woman with bipolar I says she’s been sleeping on the couch again. Actually, she hasn’t been sleeping. Her partner is angry at her. They both knew a manic episode was coming on. She laughs. We knew. We knew. We knew. We knew.
At some point, she stops talking. We all sit without speaking. Finally, the woman with the emotional support dog says she’s brave for coming to group.
The woman with bipolar I tugs at the collar of her shirt and says, “I guess I shouldn’t have stopped taking my medication.”
Maybe I shouldn’t have either.
The next day, I stand behind a podium teaching my Introduction to Literature course. We discuss Amy Tan’s essay “Mother Tongue.” Tan tells of the discrimination her mother has faced since immigrating to the U.S. because she speaks what Tan calls “broken English”—a mix of English and Chinese.
I start to sweat. My insomnia has been at a pitch. Last night, I paced and paced. My inner motor has been on high. There seems to be a constant hum in my ears.
A student raises his hand and shares that he’s a child of first-generation immigrants and has had the same experience with his parents.
My cheeks go numb.
Another student raises her hand.
Her words are indiscernible.
Ten minutes left of class. Sweat soaks my bra, my camisole, and my shirt, and is starting to go through my blazer. Luckily, my blazer is black, so maybe the students can’t tell.
The student is still speaking. I want to hear what she’s saying. I nod. I need out of this room.
After white-knuckling it through class, I hurry back to my office. Before the door is even closed, I pull my phone out of my bag and begin scrolling to find Dr. R’s number.
I leave a message. My shirt and bra are so wet I have to peel them off. I hang them on the bookcase to dry. Waiting for him to return my call, I sit shirtless, feeling my heart pound.
When he returns my call, I tell him about the withdrawal. I’m half-naked and don’t care.
He reassures me—genuinely—that it’s okay. He tells me to go back up on the SSRI to my usual dose.
We end the call. My next class starts in five minutes. I put on my wet bra and shirt and use the blazer to cover up what’s happened.
Continue to Chapter 9.