by David Brooks
“Do you think they’ll insure me?” I ask the phlebotomist as we both peer at my spinning blood and the lipids lining its surface.
“I see this with lots of folks,” the kind man says to me. But I’m not reassured. I am now a member—along with “lots of folks”—of the American obesity club, a club I’d do almost anything to leave, the badge stuck to my bulk with an adhesive that is out-of-this-world strong.
This is not a story about how hard it is to get life insurance when your cholesterol, like mine, registers at 405—healthy is anything below 200—and your triglycerides are over 800, or 650 mg/dL higher than they should be. In fact, I got the life insurance, but that didn’t change my predicament. Every night I take a handful of pills, all of them psychotropics. Way back when, in my lean, clean twenties, I needed only one pill to keep my mind aloft, but the brain is a sneaky, needy organ, and even though the psychiatric profession likes to deny it, it’s an organ that becomes tolerant to the chemicals you ingest—often necessitating what is called “polypharmacy,” or, more colloquially, “the cocktail.” My cocktail at this point consists of 300 mg of Effexor XR, 300 mg of Wellbutrin XL, 90 mg of Vyvanse, 2 mg of Suboxone, 1 mg of Klonopin, and, last but not least, 7.5 mg of the fattening drug called Zyprexa.
Nearly all psychotropics cause some weight gain, but Zyprexa is in a class by itself. It was prescribed to me last year during a horrific depression. I saw black hats roll across roads and heard the crying of a child I could never find. At night, the darkness was intense, all-consuming, like liquid coal I tried to move through.
I’d always known, at least for as long as I’ve had my psychology degree, that severe depression can have psychotic features. But knowing is one thing, experience so entirely something else, that I was humbled, thinking I’d ever understood. In the summer, the psychosis worsened, in part because I could not stand the contrast between my blackness and all the beauty everywhere around me and utterly inaccessible. From the window of the kitchen I could see my garden, full of bee balm and mint, loosestrife and arctic daisies—big wheels of white with florid amber navels packed with pollen. My garden bloomed profusely all that summer, calling to it butterflies and bees and birds with yellow vests. And yet this beauty seemed somehow menacing to me. The flowers—some had the heads of serpents, others flamed in the high heat, causing the air to warble, as though the whole world were wavering. If I stared at my garden long enough, it would dissolve into thousands of Pissarro points that then lost their shapes and dripped downward.
That was when my psychopharmacologist, alarmed at my state, decided to add another drug to my mix. First he put me on Abilify, which is used in some cases to boost the efficacy of Effexor XR and Prozac. It didn’t do the trick. Next he prescribed Geodon, also used to punch up Prozac and its close companions, the SSRIs. Geodon also failed. The third SSRI amplifier was Zyprexa, a name that made me think of an instrument, or a scooter.
Of all the so-called atypical antipsychotics, which are often prescribed as adjuncts when your plain old antidepressant fizzles out, Zyprexa is most associated with weight gain, and the weight gain, in turn, is linked to a host of dangerous conditions—diabetes, for one.
At the time I was given Zyprexa, I was so desperate I couldn’t have cared less about diabetes, and my doctor’s warning that I might plump up as a side effect of the drug fell on fairly deaf ears. What did it matter to me that in every study I saw comparing “weight-gain liabilities” among the atypical antipsychotics, Zyprexa always fared worst, with some patients gaining more than one hundred pounds. I knew how bad a rap Zyprexa had; I’d seen a friend pop those pills and go practically elephantine. But from my point of view just then, I would’ve rather been a happy elephant than a miserable hominid. Thus, I filled my script ASAP. I took my first white pill the same night. Three pills and three days later, my depression lifted, just lifted like a wet velvet curtain, heavy and dripping and hauled up high above me, so I could see the air and my garden and my entire life as it once was—no, even better. Zyprexa seemed to add a little zip, a little zing, so the edges of everything had a merry sparkle, and I could laugh. I did laugh, finding my children’s antics delightful, loving the way my dogs danced for their food.
Food. Food. For the first time in months I had my appetite back, and everything looked good; it looked downright delicious, in fact, the lasagna steaming in its pan, the hot melted cheese crisped at the outer edges and bubbling on top. I couldn’t get enough; I had the hunger of a wolf after winter, when he’s gone a whole season with no prey. I was insatiable, every bite packed with complex flavors: a simple pistachio nut both fruity and salty, with the wet tang of earth in the background. I rose each morning full of enthusiasm, my desire for food spilling over onto other things, each day filled with appetizing possibilities, as if I were choosing from a delectable buffet. I packed my children’s lunches in the morning and licked the Fluffernutter off the knife’s blade, the taste of sweetness and sunlight. Once the kids were headed off to camp, I began my own breakfast, practically panting with excitement. Some mornings I might make oatmeal, seasoning it with cinnamon and nutmeg and several dark drops of vanilla, which gave it such a fine scent I had to have seconds, even thirds. At this point I wasn’t giving much thought to my increase in appetite or weight, focused almost solely on how happy I was to have my life back, though I did register it as odd that my stomach could hold so much food.
I kept going.
There were baked apple crisps with brown-sugar topping; ice creams filled with chunks of fresh peach; french fries, the outside browned, the inside soft and white—I ate it all. And then more. As with many drugs I’ve taken, Zyprexa’s side effects were more intense in the beginning; I gained about fifty pounds before coming up for air. What happened is, I saw myself. I was walking down the street toward a glass door reflecting my image back to me, and it took me several seconds to recognize myself, to realize that the woman I was seeing was me. I’d grown so stout, my cheekbones were buried in slabs of fat. I thought, Oh my God. I went to the gym and StairMastered in a frenzy, but the exercise didn’t seem to help. By this time I’d been on Zyprexa for many months, and its appetite-heightening effects had diminished, yet I was still gaining weight. “I swear to God I’m eating less than twelve hundred calories a day,” I told my psychopharmacologist. He plainly didn’t believe me. “We always eat more than we think we do,” he responded. I responded by keeping a food diary to prove him wrong, and I did prove him wrong, although I think he doubted the integrity of my reportage.
Some researchers say that, indeed, Zyprexa makes you fat because it radically alters how the body metabolizes calories, not just because it stimulates appetite. Others—most, in fact—aren’t convinced. “Although Zyprexa may alter metabolism to some degree,” says Alexander Vuckovic, MD, a psychiatrist at McLean Hospital in Belmont, Massachusetts, “the main problem is the relentless hunger it causes. You can’t stop eating.” My experience, of course, contradicts this. After seeing my enormity in the reflection, I went back to eating bunny food—sliced carrots and salted celery and diet drinks for dinner—and still the scale went up, the digital red numbers burning in their black display, even my feet widening so my shoe size went from 7 to 7½. My fingers, according to my eleven-year-old girl, look like “sausages.” I find I am shy around my husband, and not in a flirtatious, come-hither way. “Could you have sex with a fat woman?” I asked him the other day. To his incredible credit, he smiled softly and said, “I’m sure willing to give it a try.” I’m not. Damn that drug! Why does it have to work this way?
It doesn’t really matter why Zyprexa makes you fat. The bottom line is that it does, and with the excess of adipose tissue comes a raft of health issues. At 180 pounds, I have a body mass index of 35.1, which means that I’m more likely than a person with a normal BMI to develop diabetes and something called metabolic syndrome, which is essentially a collection of risk factors for heart disease and stroke ranging from hypertension and elevated triglyceride level
s to a waistline of 35 inches or more (for women). I also have a higher risk of contracting most cancers, according to the American Cancer Society—cancers of the colon and gastrointestinal system among them. So many patients have become diabetic or suffered from cardiovascular problems on Zyprexa that its maker, Eli Lilly, agreed in January 2007 to pay up to $500 million to settle lawsuits from plaintiffs who claimed they became ill after taking the drug. Many more suits are still pending.
I’m certainly not going to sue Eli Lilly for making a drug that saved my life, even as it may be leaching it away. I went into this with my eyes wide open. I do not feel fooled or tricked. Still, I’m not at all happy about the news I received after my most recent doctor visit, that my blood sugar is high enough to render me prediabetic. What does this mean? At some point, the nurse practitioner told me, I’ll likely be officially diabetic. The standard advice for prediabetics is to exercise and lose weight, but while the nurse recommended I take those steps, there is no guarantee I’ll be able to reverse the impact of my Zyprexa.
Zyprexa raises some interesting, if painful, philosophical issues along with its fleshy miseries. Well before Zyprexa or any psychotropic hit the scene, Descartes, in 1641, famously came to conceive of the body as one thing and the soul, or mind, as another. According to his reasoning, one could be sure he had a mind because he could think; not so the body, because a person could dream it up, or be under the influence of a delusion created by an evil spirit. And thus, the French philosopher concluded, the mind and body were so different as to practically exist in separate realms. Dualism was born, or, specifically, Cartesian dualism, and it ruled the intellectual roost until, in the twentieth century, we all grew hip to the notion that mind and brain could not be separated; that mind, like body, was matter.
Zyprexa, or the experience of taking Zyprexa, moves one out of the twenty-first century and back to the age of reason. It makes clear to the patient taking it that she must choose between her mind and her flesh. The result of my choice is that I often feel as if I live hunched up in my head, which has to drag this offending, unfamiliar carcass all around town. “Go! Go now!” my mind orders the lipidinous tyrant, the carcass I’ve had to disown, but she only laughs long and hard.
So while Zyprexa has helped at least some of its twenty million users worldwide to banish depression and even psychosis, at the same time it’s ushered in a whole new/old way of living: divided. I could go on for quite a while about this (the history of dualism, its appearance in the book of Genesis, in Plato’s writings, the role of the pineal gland in Descartes’s mind-body split), but it would just be a form of evasion. What matters in the here and now is not some philosophical construct unwittingly resurrected by big pharma but rather what it feels like living with the consequences of that construct. I’m killing my body to save my mind—and it’s downright scary. I can practically feel the sugar in my blood, practically hear the crystals clanking. I can feel myself living at the cusp of some physical mishap, perhaps even disaster. I can’t see what I might do about this, about any of these facts, other than accept them as the manifestation of my decision to do dualism, to side with my mind while sending my flesh down the river.
Because of Zyprexa, I no longer see my life too far into the future. When I was trim and healthy, I silently assumed, due to the ever-increasing advances in medical care and my level of fitness, that I’d live well into my nineties. I had for inspiration my maternal grandparents, who entered their tenth decade swimming laps and playing cards on their screened-in porch. Thus being thirty, forty, forty-five—it all still seemed young, the road ahead unfurling, its endpoint still impossible to see. I even toyed with the idea that I might be a centenarian, what with thinkers like Ray Kurzweil and Aubrey de Grey suggesting that, with a few tweaks to our telomeres, we could reverse the aging process radically. On the February 21, 2011, cover of Time was the picture of a cyborg under the headline: “2045: The Year Man Becomes Immortal.” Once, I would have read the accompanying article with gusto, but now I read it as a curious and wistful onlooker, as a woman who does not see herself surviving past her seventies if she’s—if I’m—lucky.
My potentially foreshortened time on the planet isn’t all bad, however. I take my days more seriously. I touch my children whenever I can. In a so far unsuccessful effort to reverse the effects of Zyprexa, I exercise hard almost every day, with the result that now my weight has stabilized, albeit at a very high number. Every day I step on that scale and every day it stays the same, no matter how many buckets I sweat. But that’s just one sort of scale. In reality, my life is full of scales, what one might call the measure of our days, and on that scale I think I’m winning. I am tremendously grateful to be free of the mind-distorting depression. I take my raft of medicines at night. I always take the Zyprexa last. It’s just a plain white pill—who would’ve guessed it could resurrect Descartes in addition to treating mental illness? The other drugs I slug down fast, sometimes two or three at a time, but when it comes to the Zyprexa, I put the one pill in the center of my palm. I put it right on my lifelines, smack in their center—a reminder, a reassertion that this is the choice I’ve made—and then I send it down the chute, while high up in my head I look all around. My bedroom is white, my curtains so sheer they seem to be made of mist. My child comes in and wants to sleep as a sandwich tonight—can he? He asks to be between me and his father, for no particular reason, and I tell him yes. Of course. When we turn out the light, I hear my husband on the far side snoring, and my little boy talking in his sleep of sailboats and sand. With all this hubbub, I’ll probably be up all night. It’s all right. The crickets call. A car booms as it backfires. Somewhere the ocean surges. I lie very still, surrounded. I listen, hard, to life.
JOSE ANTONIO VARGAS
Outlaw
FROM The New York Times Magazine
ONE AUGUST MORNING nearly two decades ago, my mother woke me and put me in a cab. She handed me a jacket. “Baka malamig doon” were among the few words she said. (“It might be cold there.”) When I arrived at the Philippines’ Ninoy Aquino International Airport with her, my aunt, and a family friend, I was introduced to a man I’d never seen. They told me he was my uncle. He held my hand as I boarded an airplane for the first time. It was 1993, and I was twelve.
My mother wanted to give me a better life, so she sent me thousands of miles away to live with her parents in America—my grandfather (Lolo in Tagalog) and grandmother (Lola). After I arrived in Mountain View, California, in the San Francisco Bay Area, I entered sixth grade and quickly grew to love my new home, family, and culture. I discovered a passion for language, though it was hard to learn the difference between formal English and American slang. One of my early memories is of a freckled kid in middle school asking me, “What’s up?” I replied, “The sky,” and he and a couple of other kids laughed. I won the eighth-grade spelling bee by memorizing words I couldn’t properly pronounce. (The winning word was indefatigable.)
One day when I was sixteen, I rode my bike to the nearby DMV office to get my driver’s permit. Some of my friends already had their licenses, so I figured it was time. But when I handed the clerk my green card as proof of U.S. residency, she flipped it around, examining it. “This is fake,” she whispered. “Don’t come back here again.”
Confused and scared, I pedaled home and confronted Lolo. I remember him sitting in the garage, cutting coupons. I dropped my bike and ran over to him, showing him the green card. “Peke ba ito?” I asked in Tagalog. (“Is this fake?”) My grandparents were naturalized American citizens—he worked as a security guard, she as a food server—and they had begun supporting my mother and me financially when I was three, after my father’s wandering eye and inability to properly provide for us led to my parents’ separation. Lolo was a proud man, and I saw the shame on his face as he told me he purchased the card, along with other fake documents, for me. “Don’t show it to other people,” he warned.
I decided then that I could never give anyone reason t
o doubt I was an American. I convinced myself that if I worked enough, if I achieved enough, I would be rewarded with citizenship. I felt I could earn it.
I’ve tried. Over the past fourteen years, I’ve graduated from high school and college and built a career as a journalist, interviewing some of the most famous people in the country. On the surface, I’ve created a good life. I’ve lived the American dream.
But I am still an undocumented immigrant. And that means living a different kind of reality. It means going about my day in fear of being found out. It means rarely trusting people, even those closest to me, with who I really am. It means keeping my family photos in a shoebox rather than displaying them on shelves in my home, so friends don’t ask about them. It means reluctantly, even painfully, doing things I know are wrong and unlawful. And it has meant relying on a sort of twenty-first-century underground railroad of supporters, people who took an interest in my future and took risks for me.
Last year I read about four students who walked from Miami to Washington to lobby for the DREAM Act, a nearly decade-old immigration bill that would provide a path to legal permanent residency for young people who have been educated in this country. At the risk of deportation—the Obama administration has deported almost 800,000 people in the last two years—they are speaking out. Their courage has inspired me.
There are believed to be eleven million undocumented immigrants in the United States. We’re not always who you think we are. Some pick your strawberries or care for your children. Some are in high school or college. And some, it turns out, write news articles you might read. I grew up here. This is my home. Yet even though I think of myself as an American and consider America my country, my country doesn’t think of me as one of its own.