Death Grip

by Matt Samet

  Nothing is accomplished by this hospitalization. Not one thing. They increase Klonopin, step up Depakote, add Ambien, and halve the Paxil. The Depakote erases my short-term memory, puts me in an affectless mist in which I find myself fumbling for words. The first morning, a nurse acts like I’m junkie scum when I ask that they split my benzo dose three times across the day as I’m accustomed to instead of two. The doctor has ordered the Klonopin only in the morning and night, but by 11:00 A.M. I’m twitching with interdose withdrawal. I approach the nurse’s station to plead my case. We go back and forth, this slack-jowled, clown-whore-makeup apparatchik and me. Finally, she agrees to call the doctor. He will not budge: “I look at the brain as a bathtub,” he tells me during consultation. “You can pour the meds in all at once and they’re not going to drain out. It’s perfectly fine to stagger your doses out morning and night. Your net intake will be 1.5 milligrams of Klonopin, which is where we will keep it.”

  “But I—”

  “You should feel the antianxiety benefit of the medicine throughout the day, as it’s designed to do.”

  “But you don’t understand,” I continue. “Two hours after every dose I get so—”

  “And besides,” he cuts me off, “I don’t think it’s good that you’re used to taking the Klonopin three times a day—that’s too many. We need to break you of the habit.” This doctor, apparently, has studied neither interdose withdrawal nor the fact that different people metabolize benzos at the different rates. Two years later I’ll bump into him and his wife leaving a Boulder restaurant and he’ll look at me with puzzlement, as if seeing a ghost, as if marveling at the fact that I’m even still alive.

  During the days I sit around watching TV and coloring for art therapy, chatting with the only other patient. Her name is Emily, a sharp young woman and a recovering heroin addict. We talk about her daughter and my dog, Clyde, while we trade crayons back and forth across the table. This is what goes on in psychiatric wards: People like us, high-functioning adults, are given coloring books, key-ring kits, modeling clay, grade-school-level mood worksheets, puerile journaling assignments. Goo-goo gaa-gaa: What time are my meds? Emily has an IV in, pumping high-test antibiotics to fight off a nasty leg infection, the IV stand her constant companion, humming and clicking and pushing liquids through a snarl of tubing. She has recurrent dreams about a long bridge under the Texas sun, she tells me. Emily runs toward the center where her daughter cries out. Her husband runs from the opposite side. In the middle, they fight over the girl; they rend the child in two. And then Emily wakes up. She always wakes up at that point. She misses her daughter, she tells me, terribly. Emily talks quickly, flitting from topic to topic, her speech pressured. She tells me the doctors think that she’s manic, and I say allegedly so am I. “Really, you, manic?” she says. “I don’t think so. You’re too depressed to be manic. They just tell everyone they’re ‘bipolar’ these days. It’s the big, new thing. Bipolar, bipolar, bipolar. Bipolar this, and bipolar that.” It’s just us for two days, then a few other sad sacks trickle in.

  I’m allowed without fanfare to leave after three days. On my final morning, I spot a flyer on the wall, a tear-off sheet with a number for a benzo-withdrawal support group. I rip off a stub, put it in my wallet, and forget that it’s there. Or maybe I don’t forget; maybe it’s that I’m too scared to call, that I don’t want to hear how bad off I am. I come to the hospital’s afternoon outpatient program for the next two weeks, another stop on the list of daily appointments. I’m tired of expending so much energy fruitlessly trying to “get well”; going from here to there and back again. My life has become so empty now, however, the blank hours so imbued with nameless horror, that it’s good to have somewhere to go. The only person who seems to get what I’m going through is the yoga teacher Steven, whose sister faced a similar struggle. When I tell him that I’ve been diagnosed as bipolar and that I have a new medicine for that, his face falls and he says, “Matt, I worry that they’re undoing everything you and I are trying to work on here.”

  I am not yet ready to admit that Steven is correct. I continue to seek external fixes: I cut out gluten after reading somewhere that it heightens anxiety. I put full-spectrum light bulbs throughout the house, having read that they help with depression. I try the seasonal affective disorder lightbox my mother gave me, but it makes me feel speedy. And I take a magnesium-calcium supplement for muscle spasms, which the psychiatrist has said will help with myoclonic jerks.

  I only get sicker.

  I have no optimism left—zero. The updose of Klonopin has made sure of that. I now fear, and for good reason, that I will never get off benzodiazepines. I visit a general practitioner associated with Mapleton, who runs bloodwork and diagnoses vitamin B deficiency and hypothyroidism. I dutifully take vitamins and Synthroid. I only get sicker. My mother, as eager as I am for a tangible, treatable malady, is excited that we finally have a working diagnosis: bipolar disorder plus hypothyroidism. Me, I’m not so sure. Needing to resume her work as a pet sitter, she returns to New Mexico. I ask Dr. Porridge to switch me from Klonopin to Ativan, as Ativan was my original benzo and thus might be easier to quit. I immediately begin tapering but it scarcely matters. I only get sicker. Every step now is the wrong one. Too many wrong turns have been taken.

  I only get sicker.

  I attend group at Mapleton each afternoon with the other outpatients. There I encounter a middle-aged woman, a benzo lifer who was taken off seven milligrams of Klonopin at detox back East—in three weeks. She sits beside me with her straw hair and her black, unblinking, stuffed-animal eyes, takes my hand, and says, “You can do it, honey. If I did it—and lord knows, five times in thirty years now—then you can too.” Her skin is cool, papery; she drops my hand. She’s not all there. I ask how she is doing after benzos, and she says, “The truth is, honey, that I’m in hell. I’m burning all over, itching and burning everywhere on my skin. And I don’t get to sleep for the burning. But you’re young, honey—you can do it. Don’t you let them keep you on those pills all your life. Don’t be like me. You should do this for yourself.”

  It is mid-October now, a time of darkening. I tote my climbing pack to group and try to boulder on Sanitas afterward, squeezing in an hour on the rock before dusk. It was my promise to myself on the ward that no matter how poorly I felt, I’d return to the rocks. So I go, but when I get more than five feet up a coppery taste floods my mouth and I start to tremble, even on huge holds off which it should be impossible to slip. I can’t trust my feet—they’re at the end of a stumblebum’s legs—and I picture my hands rocketing off apropos of nothing or the holds spontaneously exploding. Throngs stream past on the trail, their voices tinny and reverberant, conversations incomprehensible and polyglot as if I have aphasia. I’m splintered, shattered, refracted into shards; the center cannot hold because there is no longer a center.

  One day during session with a hospital therapist I tell her that my goal is to quit benzos. After we finish she leads me over to meet Mapleton’s addiction specialist.

  I stand before this latest expert’s desk, asking if she has any insight, extending little hope that she will.

  “Benzos are terrible,” this woman says. “Really addictive, really terrible, really hard to quit. I’m surprised that a doctor had you on them for so long.”

  “I know,” I manage. “Me, too.”

  “But you took them, right? You knew what you were getting into.” She frowns at me, another humorless devotee of the addiction and recovery school of tough love. Jaded, I’m sure, by years of having to hear out prevaricating parolees, years of crappy, linoleum-floored barracks offices, rickety desks, missing pens, continual relapsers with crocodile tears, methadone stragglers, DT veterans, the whole drab, shabby addict parade.

  “Yes … and no. I guess so. It’s a long story.…”

  “We need to get you off of these drugs,” she says. “Right away.”

  “Okay, but how?” I ask. “That is the thing that keeps happening
—no one can tell me how. Or how quickly to go. Or where to go to do it. Or where to even begin. Or what to expect…”

  “Well, that’s going to have to be up to the doctors,” she says. “I’d suggest you check yourself in as an inpatient. They’re very smart and can help sort it out for you.”

  “I see,” I say. “Thank you.”

  The woman then suggests NA and hands me some addiction pamphlets. Hospitals are full of pamphlets, kiosks of them in every corner, bouquets of booklets, leaflets, and free magazines on whatever condition: bipolar, ADD, ADHD, schizophrenia, substance abuse, depression. Most of the literature tout the benefits of pharmaceuticals and most, if you stop to look at who produces them, have been paid for by Big Pharma, the American Psychiatric Association, patient-advocacy groups, and other vested interests. I’ll take her pamphlets home and drop them atop the free bipolar “news” magazine in which a famous cartoonist rah-rah-rah’s the curative effects of ECT. Later, I will dump this propaganda in the recycling bin where it belongs.

  I shuffle two blocks home through dry, drifting leaves, beneath streetlamps humming white pools into a blue-black gloom. Two cyclists breeze past, half-shouting at each other in conversation, while a runner with a headlamp trots fleetly along the sidewalk opposite, heading for a night lap up Sanitas. The air is clear and cool, devoid of substance. The Boulder überathlete mill grinds on, but it’s alien to me. I’m now an outsider in my own town. I now realize, perhaps for the first time, that if I don’t research and solve this nightmare myself, no one will. These so-called mental-health professionals are not equipped to help someone like me, nor do they seem particularly willing. All they can do is get you on drugs—not off. It’s not in their financial interest to wean you from the pharmaceutical teat, and hence they have not studied the issues. They’d phase themselves right out of a job.

  It is in their interest to keep you eternally sick. To diagnose you. To re-diagnose you. To superimpose new diagnoses atop these. To hospitalize you. To remove the power of decision from your hands. To infantilize you. To lobotomize you with chemicals and shock treatments. To cram your individual story and personality into a diagnostic box. To poison you pill by pill until that box is all that remains—Schrodinger’s cat both dead and alive, crated up and observed unto its own quantum demise.

  Either I solve this now, or no one will.

  I go home and hop on the Web, staying up all night feverishly researching on Kasey’s laptop in our spare bedroom. Finally it’s two simple keywords—“benzo” and “withdrawal”—which will reveal that I’m not an aberration and that the symptoms I’m feeling are in fact my nervous system’s natural response to withdrawal from the tranquilizers. Thank God for the Internet: Before it, benzo people had hardly anywhere to turn. One of the first sites I visit is benzo.org.uk, which is exactly where anyone interested should start. This online clearinghouse, with twelve-hundred-plus pages of articles and information, including survivor stories, was founded in 2000 by Ray Nimmo of the United Kingdom. Nimmo was on Valium for fourteen years. Only two years into taking the drugs, he had to quit his job as director of a successful company due to escalating anxiety, agoraphobia, paranoia, and depression. (Nimmo was originally prescribed benzos as a muscle relaxant, for abdominal pain. In an interview, he said, “I was … told I needed to take this medication for the rest of my life because I developed symptoms of anxiety and later depression.”21) Nimmo successfully sued the doctor who’d strung him out, winning £40,000 in 2002.22 To this day he maintains and continues to add new content to his invaluable online resource.

  The crucial document at benzo.org.uk is The Ashton Manual, or more precisely, Dr. Heather Ashton’s three-chapter protocol, “Benzodiazepines: How They Work and How to Withdraw.” For benzoheads looking to quit, it’s the Holy Bible. In it, Ashton promotes a gradual taper via Valium, as she writes, “… usually over a period of some months.” She recommends Valium because it has a much longer half-life (twenty to one hundred hours, and up to two hundred hours before the active metabolites leave the body) than the fast-acting benzos like Ativan, Klonopin, and Xanax. If you’re on the fast-acting drugs, she recommends that you first switch over before you taper; as Ashton points out, this is because they “are eliminated fairly rapidly with the result that concentrations fluctuate with peaks and troughs between each dose.” You therefore need to take the fast-acting forms several times a day, with many people experiencing, as I have, interdose withdrawal, i.e., “a ‘mini-withdrawal,’ sometimes a craving, between each dose,” as she writes. However, tapering via Valium facilitates a more gradual drop in blood level (“the blood level for each dose falls by only half in about 8.3 days,” writes Ashton) with which the body can more readily keep pace, letting your GABA receptors slowly come back online to minimize symptoms. As Ashton codifies it in her manual, with Valium you “obtain a smooth, steady and slow decline in blood and tissue concentrations of benzodiazepines so that the natural systems in the brain can recover their normal state.” Valium also comes in handy ten-, five-, and two-milligram pills, letting you customize doses.

  I’m reading this at 1:00 A.M., eyes bright for the first time in months but my spirits also falling because I know that, having abused Valium in the past, I’ll be hard-pressed to find anyone to prescribe it. (And anyway, precisely because of this abuse it might not work for me.) Then I find it: Schedule 7 in Ashton’s high-dose timetables—“Withdrawal from alprazolam (Xanax) 4mg daily with diazepam (Valium) substitution.” According to this table, from my high point of four milligrams of Xanax/Klonopin, going at Ashton’s suggested pace with a Valium switchover, I should have tapered over 62 to 115 weeks: one to two years, not the seven-odd months that brought me precipitously to this point. No wonder I feel so rotten. Confirmation of my misstep is found in chapter two: “Abrupt or over-rapid withdrawal, especially from high dosage, can give rise to severe symptoms (convulsions, psychotic reactions, acute anxiety states) and may increase the risk of protracted withdrawal symptoms.” I lived this firsthand back in 1996—I should have known!—though it seems odd that I should feel even sicker this time around. As I’ll discover later on a Yahoo support group, likely because of that cold-turkey jolt and the subsequent years of on-again/off-again use, I’ve yo-yo’ed my nervous system around and set the stage for a most grueling final withdrawal, perhaps even a protracted one.

  I Google “protracted benzo withdrawal” and end up at a now-defunct site called benzoliberty.com. “Benzos Aren’t Us” is their motto, and the site incorporates a header graphic with the stars and stripes, an upbeat, spiritual tone, and links to tips and graphic creations by survivors. One section in particular catches my eye: “Old Timer Stories,” a list of thirty-one names hyperlinked to their respective tales. It is all there, my story as reflected by others: years on the drugs, a host of baffling, creeping, worsening problems like insomnia, agoraphobia, emotional blunting, bowel distress, depression, tinnitus, muscle weakness or spasms, and anxiety. Various attempts to quit, many of them cold turkey or close enough, often upon physicians’ advice or at hospitals or detox centers. All hell breaking loose. A denial by the professionals that benzos have anything to do with the insanity, perhaps with more psychiatric drugs added to treat various red-herring diagnoses. And then months and sometimes years of illness before a gradual return to health. One story in particular stands out: that of “Rik.” Rik was placed on a low dose of Xanax, a drug to which he became “severely paradoxical” within twelve weeks. In his quest to get off, he writes, “I was in and out of four treatment centers, two mental hospitals and more doctors than I can count and at one year [off benzos] was so sick on the drugs I had to hire a live-in caretaker.” Rik rented an apartment one block from a hospital during his eight-month titration, preparing for what lay ahead. His first two years off benzos were the worst: He maxed out at only two hours of sleep per night and passed his days walking constantly, sometimes up to eight hours. Rik’s nights “were passed screaming into a pillow or curled up in a fetal
position rocking myself.” He bought police handcuffs to chain himself to the bed, so as not to commit suicide on the worst days. Rik describes this dark night of his soul: “I prayed to see the next sunrise and the tiny bit of reality the daylight brought.” He became immuno-compromised—cold and flu viruses persisted for months, and his liver felt poisoned “from all the drugs I took to stop the symptoms.” Rik experienced “hundreds of physical breakdowns due to the stress and lack of sleep, and was on a first-name basis with the local ER staff for years.”