David's Inferno

by David Blistein

  But, if you have been depressed, intractably depressed for months—so much so that you have trouble getting up in the morning and feel like you have to fight your way through a thick curtain of sadness just to do a simple task—medications may not only make you feel a whole lot better, but could save your job, relationships, and make it far easier to parent and parent well. (Since you may have already passed the DNA along, it’d be nice if you could spare your kids some of the more troubling emotional displays—especially of the more violent type.)

  And/or if you are so agitated you can’t sit still, every thought sends an adrenaline rush through your body, and the smallest life challenge can paralyze you …

  And/or if you’re so manic that you can’t sleep, have racing thoughts, feel what is politely called hypersexual, and are one blink short of hallucinating, only to crash a few days later so badly you can’t leave the house …

  … It’s time to consider anything you think might help—from radical lifestyle changes to antidepressants and antipsychotics. Frankly, if you’re suffering that much, I’d start with the drugs. But I’ll keep to my pledge of not taking sides …

  Except to say that if you are entertaining thoughts of suicide, it’s important to know that there are medications that can keep those thoughts at bay and make you pretty glad you didn’t go through with it. If you don’t believe me, at least call 1-800-273-8255 because there’s a good chance they can convince you.

  Yes, let’s all take a deep breath … it’s time to talk about suicide. In most cultures, suicide is the ultimate taboo. But how can something almost a million people a year do (including 30,000 Americans) be, as the Encyclopedia Britannica so indelicately puts it, “too accursed for ordinary individuals to undertake, under threat of supernatural punishment”? That’s a lot of supernatural punishment to go around.

  Dante isn’t any help. Back in Hell, he consigned suicides to the Seventh Circle, where they’re transformed into stunted, twisted trees that are continuously pecked upon by harpies.

  I have the feeling he protesteth too much. Surely, those many years of exile, unsure whether anyone will ever truly understand his masterpiece, could make a guy wonder if it’s all worth it. Interestingly, he did have a soft spot for Cato, a pre-Christian era Roman consul. Dante let him out of Hell so he could guard the gates of Purgatory, allegedly because he chose to commit suicide instead of submitting to tyranny.

  Maybe the taboo shouldn’t be committing suicide … the taboo should be not making the effort to understand the tyranny that people feel within themselves that can drive them to do it.

  I could write a book about suicide. Fortunately, I don’t have to. Because Kay Jamison already has (Darkness Falls Fast). Her lifelong study of bipolar and suicidal urges—in herself and others—puts her in another league. It might not be the best birthday present for a depressive, but it’s a must-read for anyone involved in suicide prevention.

  Suicide is often an impulsive act. Even if someone has planned it for a long time, the final decision is often impulsive. We cannot stop all suicides. But we can try not to be inadvertent accessories-before-the-fact which, as Jamison puts it, means doing whatever we can to keep the tools of self-destruction from being readily available … and making sure that resources to help severely depressed and agitated people are readily available.

  A suicide is not a wasted life. As she points out when discussing the controversy over the probable suicide of Meriwether Lewis (of Lewis and Clark fame), he “should be allowed to keep such a disinterred peace as he might have. He has earned his rest and in me and for all of us, it is his life that remains.”

  I smile (wryly) when people say someone who committed suicide had so much to live for. Or they ask how she or he could have done this to his family. Yes, suicide is an unfathomable tragedy for family and friends. But, it may not be for the person who commits it. I can’t speak for that person, but I’m fairly certain the reason he or she could do it is because the unremitting chemical processes in his brain made any other option seem impossible. He carried out suicide because he couldn’t imagine carrying on any other way.

  So, when I hear that someone committed suicide, my response is never “how awful.” Instead, I instinctively but gently set my jaw, purse my lips, nod my head, and think, “Hmmm …” the way you’d think about someone who went exploring, perhaps recklessly, to a distant and dangerous land and never returned. Who am I to say that what was probably the most important decision of that person’s life was wrong?

  Janis Joplin, Jimi Hendrix, Phil Ochs, Jim Morrison, Brian Jones, Sid Vicious, Rory Storm, Del Shannon, Richard Farina, Keith Moon, Richard Manuel, Kurt Cobain … I had a really good time at the Rock & Roll Hall of Fame in Cleveland when I visited it in July 2006 with my brother and nephew—even though it was a rather odd choice of venues for a mentally-tentative relative. Particularly considering that all of the above died of suicide or overdose (or both).

  Tentative though I may have been when I walked in the door, I was soon overwhelmed by the shameless outpouring of creativity in every single acoustically shielded exhibit. I walked out after about an hour, still gasping at the synesthetic connections that had taken me back 35 years faster than a speeding bullet (poor choice of metaphor there).

  The specter of suicide and drug overdose floats gently through the place: the childhood drawing of a flock of sheep by Jimi Hendrix (with one black lamb off to the side), Kurt Cobain’s electric guitar, Brian Jones’s dulcimer, Keith Moon’s velvet outfit trimmed in white squiggly fringe, Janis Joplin’s ‘65 Porsche, Jim Morrison’s baby book …

  I don’t glorify their suicides … I doubt many people in my generation do. But I certainly don’t blame those people for what they did. Or think it lessens in any way how potent a role their music plays in my generational DNA.

  Indeed, Neil Young, who is going straight to rock & roll heaven if, by any chance, he actually dies, has written several lines about suicide/drug overdose, including the iconic (and ironic) suggestion that for some of his fellow famous musicians, it may truly have been better to burn out than fade away …

  Extensive studies have been done on whether antidepressants increase the risk of suicidal thoughts and behaviors. And the subsequent headlines, like those based on many such studies, have generated a whole lot more fear than insight.

  Just as chemotherapy can make some patients feel worse, and ultimately, even shorten their lives, so antidepressants can make some patients feel worse and, sadly, be a contributing factor in suicides.

  These are strong drugs. But the underlying diseases are pretty virulent to begin with—which makes the attempt to draw direct causes-and-effects seem a bit simplistic. Is it fair to say that trying an unproven chemotherapy drug is brave (which it is!) even though it may “hasten” death, while, at the same time, saying that taking an antidepressant is foolhardy because it can “cause” suicide?

  While the link between taking antidepressants and suicidal thoughts is somewhat tenuous—albeit enough to require careful monitoring of anyone taking them—the link between hopelessness and suicide isn’t.

  So to imply that medications “cause” suicide feels like a disservice to all of those who are or might be helped by them. And even a disservice to the unique individuality of those who, having tried everything, feel there’s simply no more hope.

  Ultimately, we’re all part of a clinical trial. And the results may never be in. Without discounting the possibility of sudden, miraculous out-of-nowhere cures, it can take a long time and some serious help to recover your balance. We’re talking months. In my case, almost two years. In some cases, it’s the work of a lifetime. While that may make our lives a little more scary, it can also make them a little more sacred.

  Alternative Medicine

  The fact is that those who are enslaved to their sects are not merely devoid of all sound knowledge, but they will not even stop to learn.

  —GALEN

  WESTERN = Eastern = Alternative = Traditiona
l = Complementary = Conventional = Holistic = Integrative. I have extraordinary respect for both modern medications and alternative therapies. While we may or may not be over-medicated, we’re certainly under-cured. But that’s not for lack of trying.

  The much maligned drug companies are trying to help. Overworked psychiatrists, doctors, and nurses are trying to help. Supplement companies are trying to help. Non-traditional practitioners, nutritionists, and alternative healers are trying to help. Sure, these people and companies all have a vested interest in wanting their cures to be the ones that work. But to cast aspersions on a whole class of businesses or professionals seems unfair. About twenty years ago, practitioners of “alternative” medicine started referring to their practices as “complementary.” By then, they’d seen enough patients who’d benefited from combining their treatments with Western medicine that there was no longer any reason to draw lines in the sand. Fortunately, Western medical professionals were seeing the same thing.

  More recently, the phrases “holistic” and “integrative” have become popular—honorable attempts to acknowledge that practitioners should do everything they can to learn all about their patients and find the best combination of all possible treatments. This approach is not new. Centuries before Dr. Andrew Weil (who, I must admit, never seems to age), holistic medicine was recommended by healers from Hippocrates, the “father of modern medicine,” to Paracelsus, the great alchemist of the Middle Ages.

  This mutual medical peace accord continues to progress in fits and starts. While there’s still some shoulder shrugging, eye rolling, equivocating, and outright cynicism on both ends of the healthcare spectrum, those of us on the receiving end no longer feel that we’re caught in middle … except by the insurance companies who feel they’re caught in the middle and spend a lot of time number crunching trying to figure out how to make sure we stay in there with them. (A Chinese-finger puzzle of socio-political complexity that strains even my commitment to neutrality.)

  I like the phrase “continuum of care.” No boundaries, no either/or. Your complementary medicine is my traditional medicine. And vice versa. Professionals can call it whatever they want. All we patients care about is moving toward greater health any way we can.

  One of the tenets of complementary medicine is that it treats the whole person, not just the symptoms. This is quite a claim, considering we’re talking 11 systems, 22 internal organs, 206 bones, 600 muscles, 60,000 miles of arteries, veins, and capillaries; 100,000 hairs (on a good day); and 100 trillion cells of which a billion are replaced every hour; plus individual combinations of genetics, lifestyles, environment, and astrological influences; plus individual mental, emotional, physical, sexual, and spiritual capacities and/or experiences. As I’ve said before, under the circumstances, it’s amazing that any two individuals can ever be cured with similar medications or “modalities.”

  Mental illness is not just a disease of the mind. It puts down roots throughout your body, emotions, and spirit—implicating every organ and system. Sometimes your thoughts weigh on you; other times your heart is heavy, your throat is wired, and/or you sense that life has no meaning. At its worst, all of the above.

  The fact that depression can be a contributing factor to heart disease is now scientific knowledge as well as common wisdom. And a dermatologist once told me, only in part tongue-in-cheek, that she can see mental illness written all over the faces of her patients.

  The mind-body connection is real. And it goes every which way. Constantly.

  The idea that every part of you is implicated in your mental illness is humbling, but empowering. Because while it explains why there’s no panacea, in the process it restores your own intuition to its rightful place as the ultimate arbiter of your own care.

  Say you have weak adrenals, thanks or no thanks to something that happened to mom during her pregnancy. Over the course of your life, your adrenals have become increasingly stressed by environment, diet, life circumstances, and/or other factors until by now they’re thoroughly compromised. If those weak adrenals are one of the proximate causes of your anxiety, you may be helped by anything from bodywork to taking licorice root. If, however, some childhood trauma is constantly pumping out traumatic childhood memory vibes into your whole system, no amount of bodywork or licorice root is going to provide a long-term cure.

  On the other hand, if your adrenals are totally shot, maybe you need to heal them while you’re doing the therapy you need to do to release those childhood traumas. And, if you’re binge drinking you may have to go to Alcoholics Anonymous to get a handle on that first or else you’ll keep missing your therapy appointments. And, maybe you can’t deal with any of this until you find a medication that lowers your cortisol levels or raises your dopamine levels.

  In other words, the issue isn’t necessarily figuring out what’s going to work, it’s making your best determination of the most effective way to begin untangling this tangled web.

  Some people with mental illness might be helped by a prescription drug; others, a drug and a therapist; others, an herb and acupuncture; others, blood-pressure medication and a two week vacation; others, a regular meditation practice; and others, the spiritual/karmic purging of their choice. Or any of many combinations of the above.

  The important thing is that there’s a wide range of places where you can introduce some healing. There’s no absolute right way. Rest assured that in some way—no matter how inscrutably personal or even karmic—you are doing exactly the right thing for you. There’s no need to suffer the truly debilitating anxiety that can come from thinking you might be doing the wrong thing.

  There are times, of course, if you pose a threat to yourself or to others, that others may intervene. Hamlet, for example, felt the only cure for his misery was karmic intervention—which involved killing his two-timing Uncle Claudius and committing suicide. I’m not sure either licorice root, Valium, or family therapy could have helped, but who knows?

  To add convolution to complexity, different treatments work at different speeds. So, while as little as .25 mg of Klonopin could calm you down pretty quickly, it might take 300 mg of valerian root a couple of hours for a similar affect. Of course, if your anxiety is genetic, you might have to wait for the latest breakthrough in gene therapy in order to get to its roots. And that past life when you had a stake driven through your heart? Jeez. It’s amazing you even make it through the day.

  I know there were probably times I would have felt better faster if I’d done what some person, book, or website told me; and other times when I took advice that increased the suffering. But, ultimately, I’d rather follow my own intuition and own innate intelligence—informed by any knowledge I can garner, advice I can get, and any experience I’ve had—than live chained to the idea that someone else always knows what’s best for me. To return to the wisdom of Paracelsus: “If you’re not your own man, you’re someone else’s.” That was his motto. And he was a doctor.

  My 2006 calendar is cluttered with appointments with alternative therapists. Including a homeopath, an acupuncturist, a Rolfer, a Craniosacral practitioner, and a Shiatsu therapist. I also spent a lot of time standing indecisively in front of the supplement section at our health food store. You could say this demonstrates an unwavering commitment to restoring my mental health, a heroic Dantean journey through various alternative purgatories, or simply indiscriminate flailing.

  Regardless, I can’t remember a single “treatment” that didn’t help at least a little. To me, the issue was how long it held. A few hours were a relief. A day was even better. A few days … unlikely. In fact, at one point I realized that there was a good chance that if I had gone to the acupuncturist every day, I might have muddled along fairly well. Or, if I could have daily blood tests so I could fine-tune my supplements with a really experienced naturopath, I’d have been able to stay closer to fine. It’s as if alternative therapies also have “half-lives” that are, unfortunately, even more unpredictable than medications:

 
June 4, 2006 [email]

  A couple of days ago I took a bunch of magnesium and it really calmed the flutter in my throat. For the next 24 hours, I had energy and enthusiasm for all kinds of different projects and ideas. But the next day and now, after two days of rain here, my head/heart balance is all jumbled again. The “coarser” outside elements (amount of sunshine, balancing certain nutritional elements, and exercise) seem to be the only things that make a noticeable difference in how I feel. But they don’t last. I’ve tried just about everything: Chinese herbs, amino acids (SAM-e seemed to help for a while but then not—the others seem to just make me more jazzed), B vitamins, Bach Flower remedies, avoiding caffeine, cutting out sugar, etc. etc. etc. They all seem to help and then not. My system can’t get any traction.

  Within alternative medicine, there are four types of overlapping complementary therapies. These categories are not cast in stone. In fact, I made them up. But they’re useful for discussion purposes.

  • Diet/Supplements

  • Bodywork

  • Energetic Treatments

  • Meditation/Positive Thinking

  My first attempt to “heal” myself through diet was in the summer of 1971. I had heard somewhere that it was a good idea to do a one-day “rice fast” every few weeks. On the self-designated day, I skipped breakfast, and when I went out for my lunch break, I walked with profound esoteric seriousness to the local Chinese restaurant where I bought a container of rice and walked back to the village green to eat it.

  I vividly remember the feeling of those tasteless globs of white rice, which I managed to chew and swallow with ascetic determination.

  We didn’t really know about diet back then. (I didn’t even know about brown rice back then!) Diet was something you did if you wanted to lose weight or, maybe, pump yourself up for sports … but not as a form of healing.