Meds – one side of the story
Medication as a treatment for depression is a vexed issue, with many valid persepctives. I don’t say yes or no, to pyschiatric meds. I do advocate for making an informed choice and seeking the advice of a trusted professional.
My Psychiatrist friend, the one I met in aerobics classes, once shared that not all meds work on all people. It was a casual off-the-record conversation and I can’t recall the percentage he quoted but I do remember thinking it was a surprisingly low effectiveness rate. He also said that something will work for each person seeking relief, and that medication for the symptoms of depression is far from an exact science. That’s a hurdle right at the start, any given antidepressant that’s prescribed might or might not work for any given individual.
The medication you’re recommended may be effective for you, it takes some days to establish if a particular antidepressant medication is effective or not. That should be part of the advice you receive. It is necessary to come ‘off’ one before going ‘on’ another.
It’s a difficult time for a person who is possibly at their lowest ebb and seeking relief, but finding medication that works can take time. This is a time when both support and perseverance need to be called upon.
Peter D. Kramer a clinical professor of psychiatry at Brown University, argues the case for meds in the NY Times. There have been responses to the article, including this one from the President of the American Psychoanalytic Association and then more responses from other qualified readers.
There are the professional opinions and in our flat and interconnected world many people have shared their personal experiences on-line. One is here in David Stein’s blog he describes his experience with Seroquel, “…horrible side effects but a positive outcome.”
I have a number of friends who take antidepressants they deal with an array of side effects and they get relief. Their experiences are diverse. Personal experiences are helpful, use them inform but not predict. Antidepressants offer relief from the symptoms of depression and there are ‘ifs’ and ‘buts’ to be aware of.
There’s more written and more to discover and consider in order to make an informed choice.
If you, or someone you know, needs emotional support, in Australia, call Lifeline on 13 11 14. Crisis counselling is available around the world.
That’s what harbours are for
“A ship is safe in the harbour, but that’s not what ships are for” said William Shedd. I quoted him a few days ago. I went on to talk about the exhilaration of confronting dangers, now I want to back-track a little in support of personal safety.
I admit I tend to underestimate dangers, like a falling cat, I land on my feet. It’s something I’ve learned through experience. It is a hard earned super-power, and as much bounce as I may have, I bruise easily too. Sensitivity is also a super-power.
I enjoy some privilege in knowing I have a store of innate resilience. That resilience when measured against others is a form of social rank or status, and I sometimes underestimate the vulnerability of others. At my most unobservant, I can override the fears while hardly noticing my transgression. I tend to bounce along with difficult conversations, sometimes I sail my ship right out of the harbour and straight into headwinds.
A friend just reminded me that safety is not something that can be taken for granted.
Even seasoned sailors don’t take their boats out of the harbour into a storm. Storms are to be avoided, that’s what harbours are for. William Shedd was clear about what boats are for, but forgot to mention what harbours are for. Safe shelter is needed from squalls. I find that shelter/support in talking to my therapist, and even so I don’t know that I ever feel really safe. Sometime more safe and at others less so, but never totally safe.
Safety is different for each. Mottsu, for example, would not disclose his depression and distress to those he worked with. Saying something could have compromised his well-being in his hardened work environment, by changing how he was perceived. As tormented as he was, preservation was paramount – somewhat paradoxically as things transpired.
Be safe and well, safety first. Torment should be avoided, wherever possible, that’s what harbours (and therapists) are for.
“I never feel completely safe.”
Sometimes I don’t know if I find the stories or if the stories find me. This essay by Anita Darcel Taylor is an exceptional study of the authour’s melancholia, her “normal existence”. I am grateful that this story and I discovered each other so that I can share it here.
Her description of suicidal intent affirms the understanding I’ve gained after wrestling to comprehend what I didn’t understand; “I know that, inconceivable as it may be to loved ones who believe that their love alone is enough to save someone, sometimes a person decides that the stopping of the pain must be permanent. In this situation, suicide is not a selfish, deliberate act of cruelty against loved ones; it is a frantic final act against continued anguish. If there is a rational thought in choosing suicide, it is that the sufferer hasn’t the strength to live through that agony again, much in the way that a cancer patient may not be able to withstand another bout of chemotherapy. Mental anguish can be as unruly as any terminal illness. It can, unfortunately, orchestrate its own end.”
Anita Darcel Taylor writes of reading William Styron while listening to Donny Hathaway on a train. Either one on his own would induce melancholy in me, let alone as a duo, brave woman.
She writes a hypnotising paragraph about train platforms, never feeling really safe, and seeing ways she might die in every situation. Her revealing essay is truly awe inspiring.
This post is for Anita Darcel Taylor and anyone who doesn’t feel safe from themselves, while standing on a train platform.
Crisis counselling is available around the world. In Australia Life Line 13 11 14.
No way to communicate, no way to understand
I was going to talk about Marsha Linehan in my previous post and I got distracted by something the journalist wrote. Today back to Dr. Linehan who said of her own experience with depression: “I felt totally empty, like the Tin Man; I had no way to communicate what was going on, no way to understand it.”
Tin Man, there is something about depression that, like the Tin Man, has no heart, no feeling. With all that he was experiencing and feeling Mottsu was convinced he couldn’t connect with anyone, that he couldn’t feel anything. Not knowing how to reassure him and feeling confounded about how be in any way helpful I cast myself as the Scarecrow with no brains, no ideas. Wally, our timid terrier, was the Lion without courage. Shortbread was just going to tag along, our own Toto.
I didn’t appreciate how helpless the Tin Man was or the depth of what must have been a hopelessness. I was a bit consumed by my own helplessness, I didn’t know what to do. His despair bought him to a crisis and left him isolated and without hope. I couldn’t make things better with a story, not even a cute one where we might dance down a yellow brick road.
I can’t quite reconcile that he didn’t feel anything, that’s what he believed and I don’t know for sure. I do believe he was overwhelmed as the full force of his feelings were all turned inwards back onto himself. Unknown dark feelings. There is a line from a very odd song by America that has been playing in my head “But Oz never did give nothing to the Tin Man, That he didn’t, didn’t already have… “. The dear Tin Man in my life had no way of knowing what he already had, he was convinced that he was malfunctioning and he was wretched. I couldn’t reach him, and he in turn didn’t find the words to tell me how it was for him.
Dr Linehan’s approach, when faced with a suicidal Tin Man, is acceptance, she has “…found that the tension of acceptance could at least keep people in the room: patients accept who they are, that they feel the mental squalls of rage, emptiness and anxiety far more intensely than most people do. In turn, the therapist accepts that given all this, cutting, burning and suicide attempts make some sense.”
By understanding and accepting as she listens to her clients experiences, maybe Dr Linehan restores their voices, and in doing so provides some hope.
Crisis counselling is available around the world. In Australia Life Line 13 11 14.
Depression in 20 words or less
I have heard a lot about the Icarus Project and finally looked them up today.
The Icarus Project is a mental health movement characterized by the view that many phenomena commonly labeled as mental illness should actually be regarded as “dangerous gifts”. The name is derived from the Icarus mythology and is metaphorically used to convey that these experiences can lead to “potential[ly] flying dangerously close to the sun.” Wikipedia
Describing depression is not easy when you’re in it and that’s not necessarily why depression is misunderstood and misjudged. It might be a part of the silence. I don’t know. Here are lots of little descriptions posted on the Icarus Centre’s site by many people describing their depression in 20 words or less.
Depression in 20 words or less written to publish here by someone who knows what they’re talking about and who can place you right inside their experience:
A low slow slide down a glacier, only to fall off the face into the freezing water way below.
Driving at night out in the country towards a town, headlights out, and can’t find the switch, trusting the road is straight.
I am starting to know it – that dark morose ‘it’ we label as depression.
Stephen Fry is frank
Stephen Fry is a well known actor author and comedian. In an interview this week he revealed his fears that he might kill himself one day.
I remember reading of research about typical responses in the workplace to someone admitting they were depressed or suicidal. It was depressing research, with ‘get over it’ and ‘buck up’ being the regarded as most helpful by colleagues of someone with depression. Those same responses were probably regraded as least helpful by those affected by the condition.
A person with depression can’t just get over it or snap out of it. Rather than being helpful, those types responses highlight a lack of understanding about mental health conditions. Lack of understanding and misconceptions about depression contribute to the stigma associated with it, and to the isolation of those afflicted.
Reading the responses from readers posted against the Stephen Fry article I am dismayed. The research was many years ago and I thought, I hoped, we had made some progress. Maybe not. Reading those comments I can see the stigma around mental health is as pervasive as ever.
Stephen Fry was asked about his bi-polar condition in an interview and he was frank, realistic, in his responses. Empathy, it seems,from we the readers, is still too much to ask for.
*I have written about what you can do if a friend is suicidal. There are links to information about what to say, what not to say and how to support a friend in need.
Crisis counselling is available around the world. In Australia Life Line 13 11 14.
Not selfishness or cowardice
To every action there is an equal and opposite reaction, that’s one of Newton’s laws of motion.
This post is required by Newtons law to balance the view expressed in my previous post. Back in May 2009 Andrew Stafford wrote of his own contemplation of suicide “…to level accusations of selfishness and cowardice against those who succeed in taking their own lives, however understandable, is simply not helpful to anyone.”
He explains with heart:
This is impossible to understand from a rationalist viewpoint. Attempts at self-harm and/or suicide are, by their nature, not rational.
When you are mentally unwell to the point you want to die, you are — quite literally — not in your right mind.
This is, in my view, the single most vital insight necessary for those dealing with depression — not only those struggling with it, but those around them.
I have battled depression on and off throughout my life. Interestingly, the most serious episodes come in an almost clockwork-like seven-year cycle (apparently, I’m told, due to hormonal changes in the brain as we age, which affect different people in different ways).While at times the illness has been dangerously debilitating, since that act of serious self-harm I’ve learnt to recognise it for what it is.
Accordingly, I’ve developed medical and psychological strategies to deal with it when it arises. I treat it like I would treat any other illness: I go to the doctor, get a prescription, get a referral to a specialist, talk through the relevant issues and, most importantly, follow advice until I’m well again.
This can take up to six months or even a year. In the meantime, I do my best to remain personally and professionally functional.
But depression is an insidious bastard — insidious because you don’t realise what you’re dealing with until it’s got you in its grip.
Although the trigger can be pulled overnight — be it a death, a relationship breakdown, a family or career crisis — its onset is subtle.
And once you’re “down there”, getting back up is invariably a steep climb.
It’s also heartbreaking for those around you, who find themselves in a uniquely disempowered position.Andrew Stafford. (May 13 2009). A death wish isn’t selfishness – it’s an illness. In The Age On-line. Retrieved May 30 2011, from http://www.theage.com.au/opinion/a-death-wish-isnt-selfishness–its-an-illness-20090512-b1xt.html#ixzz1OBphReNt
You can try to rationalise the actions of someone with a mental health condition or you try to empathise. It’s a difficult discussion, and necessary if we are to reduce stigma and engender understanding. I am talking about topics, that in my experience, we don’t talk about. Judgement is too readily made though, without discussion or perhaps instead of discussion and attempts at understanding.
With sadness, I note that both articles point out the real and heavy toll of suicide on those close to someone who chooses suicide.
Crisis counselling is available around the world. In Australia Life Line 13 11 14.
Is suicide the ultimate act of selfishness?
I am inclined to be one-sided and I don’t believe that suicide is a selfish act. I wrote exactly that recently.
It’s a difficult impassioned discussion.
I know that something shared by those who’ve had someone close to them die by suicide is the struggle to make sense of something seemingly senseless. I’ve heard many speak of the ongoing guilt of not having been able to help more.
All of the scenarios that haunt you in bereavement start with ‘if’ and ‘why’.
Living with loss is difficult, the wound is indelible.
Living with depression can be even more unbearable, I think of William Styron’s description, found in the Wonderer’s Heart archives, of the “gray drizzle of horror” he recorded as “totally removed from normal experience”. No wonder suicide is unfathomable to those who have not suffered through a severe depression.
Then there is the another pained and moving view, like that described by Gabrielle Carey in an article from May 11 2009.
It is said that for every suicide, on average there are eight people left behind who are seriously and often permanently damaged. When it comes to my father’s suicide, I am one of those eight. Twenty-one years later I have concluded that suicide is — not always but often — an act of anger and revenge; ultimately an act of selfishness.
… I have had many years to contemplate how I might have prevented my father’s death. By forcing him to see a doctor (he hated doctors) who might have prescribed anti-depressants? That might have seen him through the worst of his depression and then out the other side. But what if the doctor had recommended a psychiatrist? And what if the psychiatrist had recommended scheduling him because he was clearly such a high suicide risk? Would the family have agreed to admitting him, against his will, so that he could be monitored day and night? Would we have been able to save him from himself? I don’t know. But I suspect that, if someone had walked into my father’s house at the right moment, and had seen the rope he was preparing, had realised the extreme torment he was suffering, and had taken him by the hand, led him away, talked to him, kept him close, told him that he was loved and wanted and needed, he might well still be here today. I also suspect he would have wanted that. That he would have enjoyed getting to know his five grandchildren. But, of course, I don’t know for sure.
Unlike my father, whose final act I now consider to be cowardly and selfish, when my mother was suffering intensely she behaved quite differently.
Gabrielle Carey. (May 11 2009). You do not have the right to die. In The Age On-line. Retrieved May 27 2011, from http://www.theage.com.au/opinion/you-do-not-have-the-right-to-die-20090510-az6t.html.
I understand that I don’t understand.
Concession
From time to time it is necessary to concede that the advice of a Professional is necessary. There are many reasons one might consult a Professional; health, money, job seeking are a couple of areas where advice can be helpful. Unfortunately said Professional is prone to labelling conditions after a diagnosis. You may find yourself regarded as depressed, in debt, or unemployed. Labels that stick.
The naming, or labelling, of an ailment can provide relief, instructing us about courses of action. For family and friends a diagnosis can bring information, understanding. A diagnosis can also come loaded with fear, dread, misinformation and pre-determined treatments.
Why is seeking care a concession?
For me asking for help requires a concession that I am unable to look after myself and that’s a position of vulnerability. It’s hard to do and exacerbated, in part, by the attitude of some medical practitioners, not to mention the resource constrained system in which they operate. The readiness with which a prescription is dispensed scares me, I worry that my natural immunity may be compromised by medication. I have no patience for being an obedient patient whose treatment is dictated to her. I expect my health advisors, doctors and specialists, to consider me a client,and one who wants to be informed about treatment options and active in decisions affecting her well being..
Mottsu did not wish to give up, or concede, his powers of self determination to any helping authority who might have forcibly held him and drugged him. He knew better than to disclose his darkest thoughts and be detained in treatment. He held onto himself and used his strength for his own self determination. The church, the law, and society in general condemn his suicide as wrong. I mourn for my loss but I think it is the medical system and not the man who needed to concede to the wishes of the other.
Better ways of caring are required.