by Matt Samet
After South Park ends I fall asleep on the couch. I wake up back in hell, but it scarcely matters because I’ve seen the other side. Soon windows come every day between 11:00 A.M. and 1:00 P.M., and I start “slobbing”—laughing plus sobbing—with relief when they arrive. One comes at a bank ATM on Canyon Boulevard downtown; I deposit a check and stand there slobbing onto the keypad before I realize other people might see me.
A few days later, I have a med check-in with Dr. Porridge, my second since Hopkins. I drag myself to his office, this cursed and familiar place. I do not want to see him again—I’m not really sure what I’m doing here, other than I must rely on him to prescribe nortriptyline. I sit in the lobby, chewing on a sesame bagel. Ever since Hopkins I’ve had a bothersome lump in my throat on which food seems to stick, creating scary sensations of choking. A doctor there told me it was psychosomatic, a globus hystericus, the throat walls swelling due to overbreathing. But even knowing this isn’t enough, and as I take small bites of bagel I feel the lump grow, and start to obsess over it. My mouth is dry, and the bagel has only butter for lubrication. It’s clumping up like bread crumbs. I need some water.
Just then the doctor comes to fetch me. I follow him to his office, casting about for a drinking fountain in the hall but not seeing one.
I sit down in a big chair, and before we start I ask Dr. Porridge for a drink. I’m freaking out without something to wash this bagel down.
“I’m, like, choking or having a panic attack!” I squeak. My heart slams unchecked and wild; my throat feels like it’s closing up. This is the first time I’ve panicked in this man’s office, ever. Dr. Porridge leaves the room, fetches a cup of water, and returns. I drink, and feeling the water go unobstructed down my throat calms me enough to tough out the remainder of the appointment. I just need him to sign off on prescribing more antidepressants and I can get the hell out of there.
“Sorry, Dr. Porridge. I … I just had a panic attack.”
“Well, Matt,” Dr. Porridge jokes, “I’d like to think I don’t have that effect on people!”
“Oh, no, I—It’s not you, Dr. Porridge. I just felt like I was choking and started freaking out a little,” I stammer. “I’ve been on edge … as you know … ever since I came back from Baltimore, and any little thing sets me off. I … I just have no buffer.”
“Well, that’s not good, Matt.”
“No, I suppose it isn’t. But I … I know we’ve talked about this, but I’m really starting to be certain that this is all benzo withdrawal. I talked to a woman a few days ago who’s been through this, and she said it can take months, not just weeks, to feel better.”
Dr. Porridge pauses, writes something on his pad.
“Now, Matt, you know that’s not possible. I’ve told you and the doctors at Hopkins have told you that it should only be two to four weeks. Well, it’s been a month now and you certainly don’t seem to be feeling any better. In fact, you seem much worse, which is very alarming to me! I’d like you to stop obsessing over this benzo-thing and instead focus on your treatment. We need to move you past this anxiety.”
“And how would we do that?” I ask. “I’m tired of taking pills.”
“Well, Matt, are you taking any of your medicines, the ones they prescribed at Johns Hopkins?”
“Yes and no. Like I told you last time, I’ve stopped two of them. I’m not taking Neurontin anymore, Dr. Porridge, and that’s pretty much that. I’m not going to start again—it’s expensive and I don’t have the money. And I didn’t like lithium either. It made me feel terrible. Dizzy and terrible. So I stopped.”
“Now, Matt, Neurontin is a perfectly safe anxiety drug. And I think we were seeing some good mood stability with the lithium. It’s a good first-line treatment for the sort of emotional lability we’ve been seeing with you. I’m still not sure why you would want to give up your treatment now, of all times.”
Emotional lability: I’m labile only because of the benzo rollercoaster, because of all the other crazy pills.
“It doesn’t matter, Dr. Porridge. I didn’t like taking them. And … and I’m starting to feel the same way about this antidepressant, nortriptyline.”
“Which is quite a good one, Matt. The doctors back East were right to put you on it. It’s an old antidepressant and has been very well studied.”
“Well, I’m not sure I like it either,” I say. “It dries my mouth out and makes me superdizzy when I stand up. And I think it’s giving me heart palpitations.”
“I see.” He jots more notes. Then: “You know, now’s absolutely not the time to stop, and again I’m dismayed, to be honest, that you’ve taken yourself off the Neurontin. We need to treat your anxiety, Matt.”
“It’s seizure medicine. I don’t have seizures.”
“But it was helping your anxiety.”
“Was it? I’m not so sure of that anymore either, Dr. Porridge. I think it was mainly helping me with the symptoms of benzo withdrawal.”
“Um-hmm. Matt, I’m just going to say it again: There is no ‘benzo withdrawal’ going on here. What you’re experiencing right now is a flare-up of your original panic disorder, and it’s very dangerous for it not to be medicated. I’m worried, Matt. Frankly I’m very worried for you.”
“I see, Dr. Porridge,” I say. “So am I.”
Because this is only a fifteen-minute check-up, our time has ended. I say good-bye to Dr. Porridge, the last time I will see him professionally. I go to the bathroom, splash water over my face, and look at myself in the mirror. A fierceness burns in my eyes, some flicker of the old me. The way the doctor phrased a few things has triggered a connection in my mind: “your medicines,” “your anxiety,” “your panic disorder,” as if they were a part of me, as if they were appendages or facial features. As if no matter how fast I run, they will always keep pace, nipping at my heels. I never really picked up on that before, on the intonation and its connotations. Because they’re not really my medicines nor my anxiety nor my panic disorder anymore, are they? The wrong living—the starvation, the drugging, the addictive, obsessive tendencies, the pillhead mindset—that fueled the fire have ended, so why is it still my panic disorder? Why do I still need my medicines? I don’t. I absolutely do not. It might be panic attacks that I’m experiencing now, but they don’t belong to anybody in particular, especially not to me. They arise from an ocean of disembodied chemical terror, as ephemeral as sea spouts that twist above the waves only to vanish. As I’ve always sensed with anxiety, what I’m feeling comes from without myself—that external, spectral presence—and my chat with Alison Kellagher has finally proven correct the notion that benzos are the root cause. The fear needn’t belong to me now or ever again. There is a wonderful essay online called “Decolonizing Our Minds, Freeing Our Spirits,” by the survivor of psychiatry Leah Harris, that warns against letting psychiatric lexicon consign you to a life sentence as a patient. Harris speaks to the power of thought and language to determine “the course of our individual and collective existence,” then points out how dangerous it is to let psychiatric labels like “sick,” “disordered,” and “mental patient” alter that course. “These labels shut down understanding,” she writes. “They reduce the mystery and complexity of our experiences into a diagnostic category that impedes healing. These terms colonize us, and foster dependency on a system to ‘fix’ us.”
Indeed: “my” panic disorder. I have let them colonize my mind. I have let them call me “depressed” and “bipolar” and “anxious” and “cyclothymic” and “drug addicted” and “panic disordered,” but I have never requested that they simply call me “Matt.” My birth name: Matthew Samet. That’s who I am: Matthew Samet, a climber, a writer, a son, a guardian to my dog, a friend, an intact human being. Not patient number “0-394-27-11” as my Johns Hopkins Hospital ID card identified me. Not a “troubled young man with a history of anxiety, substance abuse, mood-cycling tendencies, and a chronic panic disorder.”
As they say in the mafia movies, “Fugge
daboutit.”
Something in me releases, and a decision has been made: I am done with psychiatry, forever. I will not continue down this dead-end road another second, spiraling down into ever more serious diagnoses, serial hospitalizations, med roulette, and polydrug cocktails. I’ll stay on this antidepressant until I feel strong enough to taper, but then I will find a general practitioner, outside the system, to help because I am done with psychiatry forever. I need to find the real me again—the one without chemicals—no matter what may come. I will not set foot in Dr. Porridge’s office again. I will not take his free samples. I will not share with him the details of my life.
I’ve bumped into Dr. Porridge in town a few times since, but it’s easiest, I’ve learned, if we pretend not to know each other—merely seeing his face uncorks a host of bad emotions. And besides, what really is left to say? I’m not going to change his mind about anything. I last saw him three years ago at the mall as I was leaving a massage appointment. I came out to the parking lot and hopped on my motor scooter, parked up on a sidewalk island. I keyed the ignition, revved the engine, and got ready to bounce down into the lot when, lo and behold, who should be walking toward me, latte in hand? I had my helmet on, Darth Vader black to match the scooter, eyes obscured behind wraparound sunglasses. Dr. Porridge didn’t appear to recognize me, but I certainly knew who he was. I had him in my sights, there on the sidewalk, ambling along. I revved the engine, thought about it, looked past my front tire at him, revved the engine again, thought about it some more, then with the briefest pang of regret cranked the wheel hard left and bounced over the curb just as he scattered to the other side, nearly spilling his latte.
The sorry bugger: He almost spilled his drink. Think of how tragic that would be to have to start over again, to have to go buy another coffee.
* * *
For the first time in a long time, I don’t have to explain myself. The woman sitting across from me knows exactly how I feel. I’ve met Alison Kellagher at the Amante coffee shop, a European-style, cyclist-friendly café with tiny granite tables in a new mixed-use building along Broadway in far north Boulder. It’s afternoon, bright and empty inside, a rerun of last year’s Tour de France playing on a flat-screen in the corner. I drink steamed milk while Alison sips chai. The sun is streaming in, keen light bouncing off dirty snow heaped on the sidewalks. I’m still locked in hell, but at least for this hour I needn’t explain its specific contours.
“You know, they thought I was bipolar at one point, too,” Alison is saying. “My moods were all over the place after I stopped benzos, let’s see, the fourth time? Fifth? I kept bouncing around—high, low, high, low—and so they put me on mood stabilizers, but I didn’t take them for very long.”
“Yeah, I can see why,” I say. “I’m all over the place too most days.” It’s true—I’ll be almost manic, rushing around in a frenzy, then feel fatigued and depressed, then flatline at neutral all in the space of an hour.
Eventually, Alison continues, her moods got better, more predictable and consistent. Alison is fifty-one, pretty, petite with the lean build of the cycling champion that she is, her blond hair piled high above bangle earrings. She lands somewhere between Boulder athlete and New Age hippie, but not in the flaky, airy, spacey way. This woman is sharp. At present she is completing her master’s in counseling from the Naropa Institute, a private Buddhist university in town. Alison is four years out from taking benzos, no longer takes any meds, and has been winning her age category in cycling and cross-country-skiing events. She feels, she tells me, healthy, strong, and normal, like the Alison before benzos. She’d first started taking the pills in 1986, but before then she’d been a competitive road biker for six years, named to the national cycling team for 1983–84 and earning a bronze medal in the National Championships in 1984 in New Hampshire. At her peak, Alison rode two to three hours a day, six days a week, before retiring from competition to design cycling clothing. Like me, she even had equipment sponsors.
Alison’s story is so much like my own, it’s uncanny. Perhaps because of pushing so hard athletically or perhaps because of her high-pressure job, she began to have panic attacks in the mid-1980s, around the time she retired from competition. A doctor—the same doctor she would see all along—prescribed Xanax, and Alison’s usage became a daily fact of life in 1986, even as she soon began “waking up in absolute terror” and having to take her first dose immediately to beat back the fear. By the time she’d shed benzos, seventeen years later, she was taking seven milligrams of Klonopin a day, all prescribed by the same physician. (Alison did her final withdrawal at detox in just weeks.) Like me in my bleary tolerance-withdrawal years, Alison came to dwell in a “weird twilight existence,” “fading away with a whisper,” a “shadow person” who disappeared from her friends and even quit riding her bicycle in 1991. As she will tell me later, “I wasn’t interested in anything really. I lost interest in my career. That part of myself was just missing, that part of myself that really wanted to even do much of anything.” Alison was a shell, functioning at the bare minimum, taking the benzos solely to stave off withdrawal. She wanted to quit but was perpetually unable. Alison tried four times before it stuck, each time reinstating at the four-month mark because the symptoms were so extreme.
And because nobody told her what to expect, as she is telling me right now.
“So, you said you’re having some pretty weird symptoms, right?” Alison asks.
“Yes, you could definitely say that … nutty stuff, crazy stuff like a bad acid trip. Only this one doesn’t stop. Everything is distorted, like a kind of waking nightmare or…”
Her eyes light up: “Yes, exactly! You just described it so perfectly. It is like a bad acid trip … which I know about, unfortunately.” She laughs, then says, “I remember that: Everything is distorted and scary and coming at you so quickly; nothing looks like itself or sounds like itself, even your face in the mirror or the sound of your own voice. How horrible that was … you poor, poor man.”
“Yes, like that!” I say. “Like, way overstimulating. And I can smell everything way too much, and I keep hearing sounds and, like, well, like music one room over but there’s never anything there. Music and dim, kind of, voices? It’s scaring the shit out of me, Alison. Some of these symptoms are almost supernatural or something. It’s been positively demonic.…”
“Ohhh, I know what that is,” she says. “That’s actually no big deal. I used to call that ‘hell music.’”
“Hell music?”
“It sounds like the music you’d hear in hell.”
“Yes, precisely!” I say.
“Are there any things around your house that make constant noise, like a TV or water pipes or a refrigerator? For me, the hell music went on for months,” Alison says, “until I found the source.”
“It did?” I ask.
“Yeah. I’d hear it every morning when I was home alone, and it scared me senseless until I realized it was just sprinklers in the park behind our house.”
Sprinklers …
“Oh, wow, you know something, Alison?” I ask. “We live in this old rental, and the refrigerator buzzes and vibrates like crazy when it kicks on…”
“Aha!”
“It must be then that I hear the music … Holy shit, it’s all right there in front of me: hell music. My brain is hearing the refrigerator and turning it into something else. I guess I’m not going crazy after all.”
“No, you absolutely are not.”
We talk symptoms for another hour, and Alison says that she’s felt every last thing I’m describing. Each time I hear her confirmation, I relax a little more. In Alison’s opinion I’m very strong to have come this far. She says that many people in my situation simply give up and go back on the pills—and adds that if she were me she’d consider staying the course because reinstating probably won’t help at this juncture. I’m too far along into the cold turkey. The damage has been done. Finally I ask, when will I get better?
“Wel
l … my sense is that if you can get through these first few months,” Alison says, “you’ll start to notice milestones, with certain symptoms dropping away at three months, then six months. Then more at a year, then feeling pretty good at a year and a half. Most of the benzo people I’ve talked to recall noticeable milestones of wellness around these markers. Eighteen months is a pretty standard timeframe for healing.”
Eighteen months: It sounds like an eternity, but then Alison reminds me that I won’t feel this particular way the entire time. Each month will elevate the floor such that the very worst days one year from now will be better than the best days at present. She says that I might not be symptom free in a year or even eighteen months, but that I might feel well enough to no longer be symptom-focused. I also ask Alison what she knows about protracted withdrawal. Alison again urges me not to worry too much about labels or timeframes, but to just believe that I will get better given time. Time: It’s every recovering benzohead’s worst enemy but also his primary ally. Never have I seen time, which I wanted to fly by, instead creep by so slowly—to protract, as it were.
In her paper “Protracted Withdrawal from Benzodiazepines: The Post-Withdrawal Syndrome,” Dr. Heather Ashton defines protracted withdrawal in medical terms. It is, she writes, a “post-withdrawal syndrome, which may linger for months or even years” and affects 10 to 15 percent of chronic benzo users.1 Dr. Ashton suggests two possible root causes: the slow reversal of receptor changes in the brain, and the exposure of poor stress-coping abilities and other personal difficulties previously masked by benzos. (In other words, if you never learned to control panic attacks without benzos, a bad withdrawal will only highlight that shortcoming.) Going off cold turkey can also put you at greater risk for protracted withdrawal, by essentially shocking down-regulated GABA receptor sites. However, there’s so much variance in individual tolerance and history (some fortunate souls do seem to come off quickly or without trouble) that it’s often difficult to pinpoint where a long, painful but “normal” withdrawal ends and a protracted one begins. In other words, there’s no clear, objective measure of the point at which withdrawal becomes protracted. For myself, seven years out with recurrent (but background) difficulties breathing, I certainly qualify as protracted, though I no longer have panic anxiety. In any case, I don’t think of myself as still in withdrawal, having resumed 90 percent of my normal activities.