David's Inferno

by David Blistein

  Meditation is another way to bring some balance to your fractured body, emotions, mind, and/or spirit. There’s no need to limit yourself to traditional forms of “meditation.” As far as I’m concerned, anything that calms any part of you down is a meditation. If you’re too agitated to hold a yoga posture, you can always do some aerobics or take a fast walk in the woods. If you find it a wee bit difficult to open your heart to accept all that is—which is understandable under the circumstances—watching “stupid” TV sitcoms is an excellent alternative. In fact, anything that helps you laugh is a meditation.

  Most teachers of mind-stilling meditations believe that those techniques can help reduce or eliminate the need for medications. Even the Dalai Lama, who tends to look at all phenomena with phenomenal equanimity, has said, “Those emotions that disturb our peaceful mind must be eliminated. In times of great distress, our best friend is inside the heart … it is our compassion.” While he and others usually make exceptions in the case of severe depression or bipolar, I’m not sure whose criteria they use to decide if you qualify. I am sure that words like “must be eliminated” can be extremely agitating, especially for someone who has, for many years, put his “faith” in meditation and finds that stillness is currently the last thing from his mind. Several times I’ve heard of long-term depressed meditators whose teacher and fellow students are convinced that meditation is the “true” way out. Which seems kind of, well, closed-minded for an open-minded practice.

  By the way, if you do manage to achieve some stillness from meditation, when you get up from your cushion, look out! Because the demons may just be biding their time. Talk about mixed states!

  Sex is also a great meditation—no special technique required. It can give you a sense of balance and help you feel connected to something other than that black cloud swirling inside you. It helps to have a patient and understanding partner—the last thing you need is performance anxiety, on top of everything else. At the risk of seeming schmaltzy, a long heartfelt hug can be remarkably soothing. If even that feels intimidating, you can always hug a tree. Maybe you can even find someone to hug it with you.

  Positive thinking, chanting, and other kinds of affirmations are safe and low-cost treatments for depression. Once in a while, I would repeat the words, “I feel great,” over and over. Just for a minute or two. I took my measure. Any time I vowed to say it for a lot longer, I risked feeling guilty for forgetting. Maybe if I had more discipline and had kept it as my anchoring mantra, it might have made a more serious dent in my state—or, rather pulled some of the dents out.

  As it was, I have no idea whether, over time, it had any effect on my cerebral wiring. But, there was something empowering about doing it. Like I’d at least taken a swing.

  When all else fails, or even if it doesn’t, there’s the popular Coffee-Drinking Meditation. (Make it decaf.) There were days when the refuge of sleep was no longer possible, but the thought of another day brought such a wave of mental anguish—such a nausea of the mind—that I was too exhausted to even get it together to go outside and walk. On those days, if the agitation wasn’t too bad, I could occasionally just get up and sit in front of the sun, or even one of those full-spectrum lights, with a cup of coffee. If I managed to wait patiently, after maybe a half hour, a thought or two of some bearable human activity might arise. Nothing too strenuous. Maybe trimming a tree. Raking some leaves.

  Obviously, there’s nothing wrong with encouraging someone to meditate if they’re depressed. Just remember: asking a serious anxiety-riddled depressive to quiet his mind, get over it, and/or not be so attached to his/her state can be like asking someone who’s color-blind to see red.

  Self-Medication

  COOKIES!!! UMM-NUM-NUM-NUM-NUM

  —COOKIE MONSTER

  WE ALL “SELF-MEDICATE.” We started doing so the moment we realized that we felt better after eating a chocolate bar, which affects the action of serotonin, dopamine, endorphins, and opioids. Or that we felt kinda nice and drowsy after having a spoonful or two of cherry-flavored cough syrup, which can really do a number on your histamine and serotonin receptors.

  Considering that Coke, Mountain Dew, and that sweet, milky, Swee-Touch-Nee tea my aunt used to give me all have plenty of caffeine (which affects dopamine and glutamine) I unwittingly developed a limited but fairly high-powered neurotransmitter pharmacopoeia by the time I was in elementary school. To paraphrase Bob Dylan: I started out on mother’s milk, but soon hit the harder stuff.

  Between 1969 and 1999, alcohol, caffeine, sugar, cigarettes, and the occasional illegal drug were, for me, part of a well-balanced emotional life. The first three still are. I gave up cigarettes when I was 36. I did all my LSD before age 21. And it’s been many years since I’ve done any other illegal drugs. (Okay, fine, I have developed a fondness for marijuana tincture, but I only do it on very special occasions. Medicinal grade, of course …)

  Until I started writing this book, I didn’t know that alcohol affects serotonin, dopamine, and GABA. I did know that it could help me relax and, in the right measure, let my creativity flow a little more easily. I didn’t know that cigarettes are powerful regulators of acetylcholine and dopamine. I did know that they picked me up and helped me focus. I didn’t know that marijuana increases serotonin levels and activates cannabinoid receptors. I did know that it could turn a relaxing evening into a really relaxing and/or erotic evening. I didn’t know that the LSD molecule bears a remarkably close resemblance to the serotonin molecule. I did know that it took me to the outer limits of mania, depression, and insight.

  1969 to 1999. That’s thirty years during which I never saw a psychiatrist. Thirty years during which I never took a prescription antidepressant. Thirty years during which I was never hospitalized (for anything!). Thirty years during which I never physically harmed myself or anyone else. Thirty years during which I got married, had a child, and ran a successful business. Thirty years is a long time. At what point is effective long-term “self-medication” as good as a traditional cure?

  To give credit where credit is due, I should mention that my dad, like many in his generation, set a great example of successful “self-medication” with alcohol or cigarettes. I don’t even like using the term … it was how he lived. I mean at some point, if your “steady state” is having a couple of drinks every night, where’s the harm? In your liver, perhaps. But given the choice of relentless depression and a challenged liver, I’d take the latter. He never took antidepressants until the last months of his life when his doctor prescribed a tiny dose of Prozac with his morning orange juice to ward off any morbid melancholy. While my dad did enjoy listening to Wendy read him Wordsworth “Intimations of Immortality” during his last days (and was able to recite along from memory) it wasn’t the Prozac as much as his well-practiced professorial bemusement that took the edge off any melodramatic angst.

  You don’t have to read reports by the Surgeon General to know how these substances in excess (an ever-moving target) can cause long-term damage to various parts of your body, other people, and even society at large … at least financially.

  You also don’t have to read lurid memoirs to know that addiction sucks. I never did heroin, but cigarette withdrawal was hard enough for my taste. And, although at various times I’ve gone years without drinking, I still have an emotional reliance on alcohol. Dependency? Depends on your definition.

  You don’t have to walk down more than one big-city block to realize that virtually everyone is doing something to manage their moods … in many cases, making life more challenging for various parts of their bodies and society, in the process. Can I offer you a double-latte? How ’bout a burger and fries? Hi, kids! Would you like a 32-ounce soda?

  In the name of full disclosure, here’s the complete list of things that I’ve taken to regulate my moods over the last 50 years or so:

  Everyday: (not every day, mind you) Sugar, coffee, black tea, green tea, herb tea, and various other over-the-counter drugs including aspi
rin, ibuprofen, acetaminophen (and their nighttime versions), naproxen sodium, and various cold remedies.

  “Alternative”: Vitamins, minerals, run-of-the-mill herbs, Chinese herbs, homeopathic remedies, and those mysterious glandular supplements whose source I never really liked thinking about.

  Controlled: Cigarettes, wine, beer, and hard liquor of all kinds, including long-term relationships with cognac, bourbon, and Irish whiskey (fortunately, not at the same time). You’ll be happy to know I gave up cigarettes in 1988.

  Illegal: Marijuana—including brownies and tincture—hashish, mescaline, LSD, mushrooms (although, as I remember, I didn’t get off), MDA and its more famous bastard child Ecstasy, cocaine, and the very occasional amphetamine. No needles.

  Prescription: BuSpar, Celexa, Klonopin, Cymbalta, Depakote, Effexor, Lamictal, Lexapro, Lorazepam, Lunesta, Ambien, Seroquel, Valium, Wellbutrin. And let’s not forget Versed (the best reason to have a colonoscopy) and nitrous oxide (the best reason to have a root canal).

  I provide this shockingly extensive (even to me) list in order to explain why I will not be running for president and to remind us that, whether consciously or not, we all try to fine-tune our synapses. On the one hand, it’s kind of sobering. Shouldn’t we be satisfied with the simple gift of being alive? On the other hand, isn’t it amazing how willing we are to explore new ways to feel, think, and be all we can be?

  Regardless, if the extensiveness of this list makes you feel I “deserved” to be depressed, that’s fine. If it makes you feel I’m lucky I’m not dead, well, I’m not sure how much luck had to do with it. If it makes you think I should have my own talk show, maybe you should think again.

  It’d probably be best if my grandchildren or yours don’t read this until they’re grown up … if ever … but, before you cast the first stone about what anyone else ingests or inhales, you might want to see how many words you can check off above.

  To quote Paracelsus, “No thing is without poison. The dosages make it either a poison or a remedy.” Whether we praise, judge, ostracize, or jail people for ingesting one of these substances is based largely on current societal norms.

  Admittedly, safety is an important issue. But let’s not forget that cocaine used to be in coca cola, ibuprofen used to be only available by prescription, vitamin D therapy is now mainstream, prescription drug overdoses are now the leading cause of accidental death, marijuana is being legalized, and a few people have almost died through an overdose of bikram (hot yoga).

  For some people, self-medication, particularly with cigarettes and alcohol—plus generous amounts of sugar, caffeine, and chocolate—may lead to longer, more enjoyable lives; lives in which their depression is at least manageable. For others, the same things may lead to deeper sadness, addiction, and even death.

  I’ll never know whether all these different forms of self-medication precipitated my breakdown or, on the contrary, delayed it for many years. Certainly, I exhibited depressed and hypomanic symptoms back in elementary school—well before I’d even heard of most of the stuff on this list.

  We all have the ability (and, I daresay, right) to try to feel better—however we experience that. It’s one of the things that make us human. And the way we use that ability is an essential part of our individuality … for better or worse, in sickness and in health, ’til death do us part.

  Understanding and regulating our moods isn’t rocket science. It’s way, way, way more complex than rocket science.

  Who Knows?

  It seems that I am wiser than he is to this small extent,

  that I do not think I know what I do not know.

  —SOCRATES

  HELL IS OTHER PEOPLE’S OPINIONS. Dante was pretty lucky. Except for that sign telling him to abandon all hope, he only had two people giving him advice—Virgil and Beatrice—with a little kibbitzing from a few other folks they introduced him to along the way. Since no other living person had ever been in those realms before—and the Internet hadn’t been invented yet—if Virgil told him that the way through Purgatory was to walk stooped over, find his way through thick black smoke, or stroll through a wall of flames, he couldn’t exactly get a second opinion.

  I was lucky too. With very few exceptions (actually, none I can think of at the moment), my family and friends didn’t second-guess the various paths I chose to negotiate my personal purgatory. They shared their ideas, made appropriate suggestions, and only gave opinions or advice when I asked for them.

  But many people aren’t so lucky. They’re continually dealing with the opinions of family, friends, and casual acquaintances.

  There’s always someone who’s just read something in a magazine or book about how there’s a new medication that works better than all the previous ones combined; or that placebos actually work even better; or that the right combination of herbs or amino acids or both will definitely make you feel better “without any side effects”; or that if you’d just give up sugar, alcohol, coffee, and/or sex, you’d be fine in no time at all.

  They’ll tell you about some psychic or energy healer who cured someone they know in three seconds flat. Or worse, tell you that someone they know saw the healer you’re seeing and got way worse. They’ll say you should just snap out of it. They’ll say you should take a vacation. They’ll say you should read this book or that book, listen to this music or that music, go to this self-help group or that self-help group. Oh, and by the way, depression is genetic so you better keep an eye on your children.

  Maybe it was better when people were in denial. When everybody wished that whatever was bothering you would just go away. At least then, you could suffer in peace. Just kidding. Kind of.

  The hardest opinions to deal with are those of so-called “experts” on TV, radio, newspapers, magazines, and most of all, these days, the Internet. (Even I wasn’t totally immune to those.) With 43 million search results and counting, finding your specific solution under “How to Cure Depression” takes on trappings of the quest for the Holy Grail.

  Most of these sources of information are well-meaning. Some are well paid. Many acknowledge that in some cases of major mania or depression, you can throw their theories out the window … although you can always tell they’re including that caveat with a certain reluctance, as if it were fine print. (You gotta say one thing for drug companies. They spend a lot of time and money telling you the ways their cures might not work. Of course, “We the People” had to pass laws to make them do it, but sometimes it seems that they go overboard.)

  All “cures for depression” work some of the time. A few work a lot of the time. None work all of the time. Having people second-guess you just increases the sense of self-consciousness, self-criticism, and terminal anxiety about doing the “wrong” thing that nips at depressives’ heels all day. Nothing wrong with gentle suggestions. Gentle. Non judgmental. Given with explicit or implicit permission.

  Maybe the fine print on every article about depression should be the Socrates quote above.

  I’m always surprised—and, of course, occasionally astounded or annoyed—when people have the chutpah, hubris, or clinical narcissism to believe that their perspective on mental illness represents any kind of ultimate truth.

  My perspective, of course, does represent the ultimate truth! I think everybody who writes about depression should start their article, book, or blog with the following:

  WARNING: I don’t pretend to know the best way for you to deal with your depression. I’m writing this because [select one or more]:

  1. I’m under the delusion I do know.

  2. I’m fascinated by the subject and think maybe I can help you understand it a little better.

  3. I had (or am in the midst of) a paralyzing depressive episode and I need to write about it because, well, I need to write about it.

  4. I’m working on a Ph.D. or trying to get tenure.

  5. I make my living by selling some product or service related to depression and:

  a. I’m under the delusion
that it helps all of the people all of the time.

  b. I need money real bad.

  c. I’ve found it helps some of the people some of the time and believe it’s worth a try.

  6. I’ve treated a whole lot of patients with all kinds of psychological conditions by using all kinds of prescription and/or alternative medications. I’ve also read a whole lot of books and survived some professional meetings and workshops. So I believe that I might have enough knowledge and experience to help you. But I have a lot of respect for the fact that the mind is a strange and wondrous thing.

  These are all legitimate reasons to write about mental illness—although several are somewhat suspect. I’m a Category #2 and #3 kind of guy myself. More important, the health professionals I’ve trusted have implicitly fit into Category #6.

  Many people have serious objections to the use of prescription drugs. And yet, for each, there is a balancing point of view:

  Spending on antidepressants is bankrupting our healthcare system.

  What isn’t bankrupting our healthcare system? Mental illness represents about 7% of our total healthcare costs. Undoubtedly many people could deal with their mental health problems in less costly ways. (Ditto, by the way, for many physical illnesses.) The federal per diem base rate for inpatient psychiatric care is about $700. The per diem cost for even three brand-label psychiatric meds would rarely be more than $40 … and often way less. A savings of $660 per day if those meds manage to keep you out of inpatient psych. This book is about people, including myself, who have major depressive episodes that severely impact(ed) their ability to function. People who could, if things got worse, end up hospitalized. In our cases, meds are a bargain—in more ways than one.