Mental illness has a stigma. The term “crazy” is certainly a pejorative, even if it refers to an incorrect idea, and not genuine mental illness. We often recoil from strangers in public who behave erratically, as we assume they may be mentally ill. Some homeless people are significantly mentally ill, and because of this appear physically disheveled. These are not people with whom we would breathless anticipate going on a first date.
Where do the mentally ill homeless fall on the social spectrum? That is, how do they fare in opinion polls of things like trustworthiness? Some advocates for movement atheism like to point out how low atheists fare as far as electability to public office, or as candidates for their children to marry. Indeed this is a significant problem, but as Ryan Bell pointed out, our society includes an “untouchable” class of people that are not even included in opinion polls, namely the homeless. Would you want your daughter to marry a homeless person? Would you vote for a disheveled schizophrenic living on the streets for president? Yes, atheists face silent shunning and prejudice, but nothing like street people.
Because mental illness is now seen as an illness, and not a result of demon possession, at least in 21st century America, we can study it and treat it. The current gold standard text on the subject is the DSM V, or the Diagnostic and Statistical Manual of Mental Disorders, version five. Within that text is listed the criterion for major depressive episode. Major depression is thus “officially” a form of mental illness.
So it is with some degree of trepidation that I have decided to write about my own struggles with depression, and how it eventually intersected with pseudoscience. Weirdly, I am far more uptight about discussing my own struggles with anxiety and depression than being “out” as an atheist. But there is simply no good reason to consider major depression to be anything other than a result of events not of our own choosing. There is no act of “free will” involved; by no means did I choose to become depressed. I think I retain some inhibition about discussing anxiety, which, if sustained and untreated, can most certainly lead to depression. Anxious behaviors are often perceived by others as demonstrations of being “uptight” or emotionally rigid. We all want to be thought of as cool, whatever that means, and avoid “uncool” people. When I was younger, I’d worry I was “hung up Mr. Normal” from the rock opera Tommy.
Hey hung up old Mr. Normal
Don’t try to gain my trust
‘Cause you ain’t gonna follow me
Any of those ways
Although you think you must
My first bout of significant depression occurred during my first year in college. I was living at home with my parents, and attending the University of Montana. Our family lived a block and a half from campus. The situation was a perfect storm of multiple emotional problems. I was never a particularly good student in grade school or high school, and college is certainly a more demanding academic environment. I retain the conceit that I’m an intelligent person, but I willingly concede that I simply didn’t work very hard in school. My hand printing is poor, and I never took good advantage of the notes I took in class. I attended class regularly, but relied on reading textbooks to pass classes. I was not failing my classes, but I was not thriving, either. Some of my good friends from high school had gone to other colleges, and thus my social circle was diminished. My relationship with my mother was becoming chronically antagonistic. She constantly derided the rock music I loved, and my deconversion from Christianity added a new layer of criticism. I was not aggressive about finding good summer jobs, and the ones I had in college were really poor. My parents gave me little or no spending money. Because they had grown up in the Great Depression, the idea of discretionary income for kids was anathema, particularly for my mother, who controlled the family finances. I had not had sex at this time, and I had to deal with raging hormones. To this day, I have to wonder how men can attain anything higher than a bachelor’s degree without regular sex. Even the hours of concentrated attention to dry and abstract concepts needed to earn a bachelor’s degree seem to me threatened by virtually continuous sexual ideation. I consider it possible that I simply have a higher sexual drive than other men, but this verges on a humblebrag. It’s possible that other men more academically successful than me have similar or even greater sexual drives, but that they have greater powers of concentration. Sexual frustration is clearly more than not experiencing sexual pleasure, as it factors deeply into one’s sense of sexual value to others. Who wants to have sex with someone deeply unattractive, or grossly uncool? If one is not having sex, the mind easily flows into considering the deeply upsetting prospect that this is because one is ugly or grossly socially maladjusted. “Hung up Mr. Normal” indeed.
Because I was living at home at this time, my social life was limited in ways that those living in the dorms did not experience. Thus I fell into the easy trap which we see on Facebook today of imaging that everyone else is having more fun than me. Everyone else is going to parties, driving around in cars, having sex, and going out to bars.
I discovered a University program ostensibly designed to help academically struggling students with study skills. The man who ran the class was also one of the student psychological counselors. One day I approached him to ask if I could see him privately for psychological counseling. He agreed, and we began to meet in his office. I believe he was not an MD, as we didn’t discuss psychiatric meds. Frankly, I remember very little about our conversations, and my real take-away memory is that he smoked a fucking pipe in his office.
My conflicted and depressive emotional state was somewhat lifted by moving into the dorms the next year. I ~literally~ moved out that previous summer, as I had a marginal job doing maintenance at a motel, and living with my mother was becoming intolerable. I had actually rented a room, and planned to keep my job. I think I went so far as to buy dried beans and rice to live on…
Not surprisingly, my father quickly interceded. The boiling emotional conflicts with my mother which he knew nothing of were publicly voiced, and he allowed me to move into the dorms for the next year. I abandoned my plan of living in a basement room and living on beans and rice.
While still in college a few years later I experienced another bout of depression, probably triggered by ongoing academic struggles. I recall making an appointment inside the student health service to see a psychiatrist after a particularly grueling emotional situation in pharmacy class. The appointment was weeks in the future, and when the time came I canceled, imagining that to see a psychiatrist was a sign of weakness.
Eventually I graduated with a degree in pharmacy and moved to Seattle in 1987. I was free of depression for a number of years, but it came back with a vengeance in the mid 90’s. I believe this bout was triggered by a number of factors, which include a relationship with a physically abusive woman, transition away from a dream job, excessive alcohol use, and simply job stress. In the late 80’s and up to the mid 90’s I was involved with a woman who physically assaulted me on multiple occasions. Domestic violence is one of those situations that people imagine will never occur to them, or that they are too smart or cool to befall them. I believed that. I fell into the trap of believing that she was the only woman for me, that I was simply too weird to be loved by any other woman besides her. The first time she assaulted me was in our Mountlake Terrace apartment, and I called the police and she was arrested. I do not know the outcome of that arrest, and I believe she escaped any sort of legal punishment. But as the abused often do, I rationalized that she “turned a corner” on her behavior, and that she wouldn’t do it again. We moved into my house in South Seattle shortly thereafter. I believe it was on my birthday in 1994 that she hit me again, after a night of carousing at Moe’s bar on Capitol Hill. A neighbor call the police, and she was arrested again. I remember the indignity of going to work afterwards with a black eye. I didn’t achieve cognitive clarity about this person until about a year later, when I demanded she leave, and in fact obtained a restraining order against her.
I had a “dream job” of being a sideshow performer from 1991 until 1994, and going back to pharmacy was a giant emotional let down. I went from being treated as popular performers are treated to facilitating the insurance claims of people who don’t want to be in the pharmacy in the first place. While it’s a well paying and esteemed job, retail pharmacy is a grueling, anxiety provoking, and demanding job. I still have nightmares to this day about having to “fill in” for a day at a pharmacy!
I started drinking when I was about 19, and by the time I moved to Seattle it became a nightly ritual. Alcohol is deadly dangerous for the depressed, as it provides momentary chemical solace, but in a crude and rather addictive way. For years, most of my days were spent in vaguely hungover states, which acts as another stimulus to drink again that night. I never missed work because of alcohol, unlike my brother who lost his job because of it and eventually died of cirrhosis of the liver.
The first psychiatrist I saw during this period gave me a long multiple choice quiz to fill out. I remember crying while doing this, as it felt like I had ended up in such a worthless and degraded state as to necessitate filling out a form to ~quantify~ how degraded I was. My shrink sat behind the largest and most imposing wooden desk I had ever seen in my life, which was positioned between us in his office. At some point he obtained the results of this test I’d taken and advised me, essentially, that I was depressed because I was an asshole.
I found this weird and dispiriting, as I genuinely don’t think I’m an asshole, but someone who suffers from a condition I was powerless on my own to correct. I was put on Paxil, and probably dosed too high, as I found myself suddenly experiencing anorgasmia. I decided to find another shrink. I asked Giant-Desk-Guy for my medical records, of which I was legally entitled, as I wanted to understand how he came to conclude I was an asshole. Even the direct intervention of my new shrink, and my own registered letters requesting my records were stonewalled.
My new shrink’s office was on Capitol Hill in Seattle, and I drove my 65 Mustang there on many occasions. Despite hours of conversation and thousands of dollars, my only real take-away wisdom from the experience was that untreated anxiety can easily result in depression. I believe this to be true. I was prescribed Serzone, an SRI which did not result in anorgasmia, and clonazepam, a benzodiazepine for anxiety. While the efficacy and wisdom of using pharmacological therapy in depression is controversial, it must be conceded that the drugs really work. They do abate unnecessary suffering. In retrospect, my great failure at this time was to understand the detrimental effect of alcohol, whose use it took me until early 1998 to stop. Depression is a condition that often resolves on its own, but my recollection is that I discontinued treatment because I became “sick of being sick.” I became sort of ~angry~ that I was participating in this process, and simply chose to stop.
As I mentioned at the beginning of this essay, there is a stigma about mental illness. I was frightened, probably irrationally so, that other pharmacists might discover I was being treated for depression. I would read the law book of Washington State regarding pharmacy practice, and worry if I could be disciplined or stripped of my license for “moral turpitude” which is a term literally on the books. Despite the meds and the psychiatric counseling, this episode of depression was especially dour and dark, and resulted in significant suicidal ideation.
I was free of depression from the time I discontinued that period of psychiatric treatment until about 2007 or 2008. This bout was triggered by the breakup of a significant relationship. I contacted a doctor I knew in Seattle for a recommendation for a psychiatrist, as the shrink on Capitol Hill declined to take me again. I don’t know why he declined.
The new psychiatrist advised me straight away that he didn’t engage in psychotherapy, but simply prescribed meds. I was OK with this, because as I mentioned earlier, I simply don’t recall that I assimilated much therapeutic wisdom in the long run from my previous shrink. I believe he prescribed nefazodone, the generic version of Serzone, and clonazepam. At this time I was working at a local metal fabrication plant, as I had given up pharmacy in 2002. Less money, obviously, but less job stress. Eventually I left the fabrication plant and returned to school at South Seattle Community College.
The climax of this story should be of interest to skeptics. One day I arrived at my psychiatrist’s office and was expecting a routine and prosaic session. This was anything but. He began to describe how a female patient of his was entirely refractory to pharmacological therapy. The drugs didn’t work for her. But something else did, and he wanted to show me!
What was this magical thing? A Power Balance band!
There is a significant power imbalance between any sort of doctor and their patient, especially in the doctor’s office. This was made overt by my previous shrink, with his brobdingnagian desk, and more disturbingly, his unwillingness to relinquish my medical records. While I’d love to tell a courageous story of reason battling nonsense, I simply acquiesced to participating in his bizarre performance.
He produced a Power Band, complete with magical hologram, and asked me to stand up. I engaged in at least some of the usual demonstrations, using my arms as levers to demonstrate strength and/or flexibility. It was a surreal experience, sort of like when Mandrake is forced to listen the psychotic ravings of Jack D. Ripper in Kubrick’s Dr. Strangelove. Neither Mandrake nor I considered it reasonable to dispute their interlocutor in that moment. I can only speculate why he did this. Did he truly believe it worked? Did he know it didn’t work, but believed that a placebo effect might help some people? Did he no longer want me as a patient, and was “clowning” me so I would leave? I have no idea.
To be clear, Power Bands are not evidence based, nor effective medicine. His behavior is an example of egregious malpractice.
I was so angry with this treatment I decided I must do everything to stop the therapeutic relationship. As a person obsessed with losing weight might do, but in an unhealthy way, I went on a “crash diet” by abruptly discontinuing my meds, albeit not both at the same time. The side effects of sudden withdrawal are nasty, and produce a weird phenomenon in the case of SRI’s know as “brain zaps.” This is a sudden sensation akin to being severely startled or electrically shocked. The more serious side effect is simply a continuous and deep malaise. I remember driving to a Super Bowl party in heavy traffic during my SRI withdrawal period. While traffic jams are no fun, this took on Apocalyptic seriousness, as though I was in Hell itself.
Yet the depression abated, largely because I found meaning in moving back to Montana and helping my father near the end of his life.
I am like all other human beings, and wish for happiness. We spend the majority of our lives trying to manipulate our circumstances to augment this sensation. I can’t claim to have discovered a magical formula for happiness, or even claim to know how to avoid depression, but I’m currently convinced of the virtue of meditation. I’ve only been meditating for about three years now, and in moments of meditation, I experience an anxiolytic effect as profound as that of benzodiazepines. Even as a beginner, it’s a sensation that’s eminently reproducible. I never experienced euphoria from benzodiazepines, as some evidently do, but in meditation I can experience an altered state of consciousness and euphoria analogous to that of cannabis.
Clearly other fundamental processes must be in order for one to experience real happiness. These include financial security, exercise, good health, freedom from physical pain, mobility, social connection, and sexual health. I recognize that I still remain in a higher risk demographic, being single and having no family. For this reason, and the reason of my history, I take the pursuit of happiness quite seriously and find myself something of an evangelist for the virtues of meditation.
I do not believe in “free will.” In an ultimate sense, I believe depression is something that simply occurs to us, in the same way as catching a cold simply occurs to us. Nevertheless, I’m also convinced, at least in my case, that we have it within ourselves to avoid or mitigate anxiety. Learning to “key in” to states that meditation can produce enables one to “fall into” these states in the real world. I am now convinced that real happiness is largely the ability to be mindful, to experience states of “flow” and to learn how to live in the moment. It takes real work, just as exercise is real work. My promotion of this comes at a time in history when meditation and yoga have a certain faddish quality about them, which might be reason enough for some to reject them, but this would not be based on the reality of the virtues of meditation.
For those unfamiliar with meditation, I highly recommend Sam Harris’ book Waking Up.