No one identified Maria’s drug use as the basic problem, and no one made any attempt to help her stop it. Instead they just kept piling on new diagnoses and throwing new drugs into the confused mix. When she didn’t respond to one pill solution, her diagnosis would be switched, and a different one would be tried. Soon she was pronounced bipolar and even more medication was prescribed. “I was taking a mixture of many illicit and legally prescribed drugs and began to feel very depressed. I had a hard time getting up in the morning, quit school, and for the first time since I was fourteen, did not have a job. I no longer answered my phone, my shades were always drawn, and my days consisted of leaving the house only to buy drugs and sitting around watching TV. I was in full, addictive mode, seeking meds by manipulating my psychopharmacologist—especially the Klonopin, which had a pleasant and immediate effect of relaxation. If I mentioned trouble sleeping I could always get him to prescribe more ‘fun’ drugs.”
Who needs a drug dealer if you have an overly compliant doctor who is no more than a pill pusher? Maria was hooked: “If I feel this bad on medication, how bad would I feel if I stopped it? My life became increasingly chaotic and unproductive. I lost hope.”
Nothing was working, and Maria’s psychiatrist recommended she be placed in a closed psychiatric facility. He told her father that Maria’s condition was genetic and permanent, would always require intensive medical care and medication, and that he should “let her go.” A different consulting psychiatrist confirmed her previous diagnoses and managed to add three more—obsessive-compulsive disorder, borderline and passive aggressive personality disorders. “I was twenty-four years old, had at least eight diagnoses, was taking fifteen pills a day, and seemed like a totally hopeless case.”
Luckily Maria’s father, a successful businessman expert at finding solutions to difficult problems, would not accept doctors telling him there were no solutions. He arranged for Maria to enter a long-term therapeutic community specializing in addictions. “I was sure of two things—that I would need to continue medication and that I would be out of the facility in a couple of months.”
Both predictions were wrong. Maria stopped using street drugs, gradually weaned herself off prescription drugs, and stuck with the program. She couldn’t believe how good she felt. “How strange that I could be normal. Difficult and happy periods come and go, just as they do in everyone’s life. But I learned to accept them as part of life. Twelve years have passed, and I am now thirty-seven, with a rewarding job and a wonderful man at my side. It often occurs to me: What if my father had given up, had listened to the professionals? Where would I be? I also think I am lucky that the mix of prescribed and illicit drugs did not kill me. Contrary to what I had always believed, contrary to what psychiatrists told me, I was normal when I got off the drugs from the street and the ones they had prescribed for me.”
Balancing the Bad with the Good
Wherever the art of medicine is loved, there is also a love of humanity. Cure sometimes, treat often, comfort always.
HIPPOCRATES
The next part of this chapter is devoted to providing just a few commonplace illustrations of the day-to-day successes of psychiatry—a much-needed balance to put its occasional failures and mischiefs into proper context.
Roberta’s Story: Pets Kept Her Alive; Pills Cured Her Depression
Roberta is a fifty-eight-year-old high school English teacher who laughingly describes herself as “a spinster, a crone, and a hag in the very best sense of each of these words.” But she is not alone in life. She has many good friends, lives in the cherished home where she was born, and is surrounded by beloved pets—a pig, three dogs, four cats, an iguana, eight chickens, and twelve songbirds. Her father died suddenly when she was only eight and her mother three years ago after a long illness that required much care giving. Roberta had always handled all of life’s stresses with great grace and infectious good humor.
Roberta’s psychiatric problems came as a complete surprise and began when her brother sold off her mother’s jewelry and treasured antiques to buy himself a boat—doing this without consultation, without permission, and without apology. She couldn’t forgive him or forget the blow to their relationship. Her brother had been her best friend and was her only remaining family member. “I felt alone—and now understood why Dante reserved his lowest circle of Hell for those who betray a trust. I was stunned and spiraled downward into deep depression.”
Roberta cried constantly and couldn’t eat, sleep, concentrate, speak to friends, or smile. Getting out of bed was a struggle. Each day at school felt like torture and lasted for an eternity. She was agitated, with an “awful pit-of-the-stomach feeling” that ruined her waking hours and churned her through fitful sleep. “The deeper I sank, the more I wanted to die. One day I was at the laundry and I crawled on the floor, praying for death. It is said that there are no atheists in foxholes. Perhaps the same could be said of the deeply depressed. At home I would pace the floor.”
Roberta met with a sympathetic therapist who correctly diagnosed depression. “But she didn’t seem to understand the depth of my pain. I needed someone who was willing to do something for me now! Not just talk.” Then things got dangerous. “By this time I was ready to commit suicide. I would get through the day only by telling myself I could always go home after work and take all my heart medicine in an overdose. This gave me a feeling of peace—I could end this misery whenever I needed to. The only thing that kept me alive was holding my pets and that I couldn’t bear the thought of leaving them behind. Life or death was a day-to-day decision. Friends rallied around and gave me support in wonderful ways. Even so, the depression and feeling of isolation continued and got even worse. I thought I would never get better.”
Roberta’s story has a happy ending. A friend who also had depressions convinced her to go to a doctor. “She prescribed an antidepressant and said it would take weeks to feel a difference, but assured me that I would get better.” Eight weeks, four doctor visits, and three increases in dosage later, Roberta actually did begin to feel better and soon recovered completely. “One day at a school meeting, I made a smart-ass remark to a friend sitting next to me, and she said, ‘You’re back!’ I was. I could laugh and smile again. My appetite for food and life returned, and I stopped having that sinking feeling in my stomach. I was able to look at things more objectively and to make plans for the future. Looking back, the combination of my pets, loving friends, and medication brought me back to normalcy. I have my life back and I am so thankful. Now my fear is that someday, for some reason, the depression will return. I want never to feel that again. At least this time I will know what to do about it.”
Bill’s Story: Keeping Mood Swings Under Control
Bill’s bipolar disorder has not prevented him from having a wonderful thirty-five-year career as city planner. At twenty-nine, Bill was on top of the world, serving as project manager for a major urban renewal project—a highly stressful but “dream” job. Then the bottom fell out—the funding was pulled, the job was lost, and “my hypomanic energies turned into depression.” He was successfully treated with medicine and psychotherapy, a new job came along, and everything went well for six years, during which he needed no medication.
Bill’s second depression hit out of the blue and was much more dangerous. “I dragged myself to work but felt listless, hopeless, distractible, and severely suicidal. I was referred for hospitalization and ECT, but luckily the antidepressant medicine kicked in just in time and the depression lifted. Then I went overboard in the other direction with full-blown mania—racing thoughts, grandiose plans for multiple impossible projects, and strange ideas. I thought everyone was watching me and reporting to the police or FBI. And I did strange things—like buying thirty huge books on the universe and the history of mankind without thinking about the fact that they were far too heavy to carry home and far too long for me ever to read. Fortunately, lithium worked, and soon I was back on even keel.”
Bill stayed sta
ble for the next fifteen years until he, his wife, and doctor all agreed it was worth a try going off lithium because of the long period without episodes and the fact that the medicine seemed to dampen his personality. The trial failed. “Within three months, I was hypomanic again and realized I’d always need medicine. So we switched to another mood stabilizer, which has worked like a charm for the last seventeen years. I believe I will always be vulnerable, but the medicine gives me stability.”
Bill retired from city planning at sixty-five to begin a second career. “And now I am a psychotherapist in training with fifteen patients, most of whom are doing well in treatment with me.”
Susan’s Story: Controlling Panic Disorder and Agoraphobia
Susan is a thirty-five-year-old caretaker, volunteer, writer, and self-described collector of college degrees. At age twenty, she was a college student looking forward to a bright future, a social butterfly with many friends. Then suddenly without warning, rhyme, or reason, Susan’s life turned into a living hell filled with panic attacks and constrained by the urgent need to avoid anything that might provoke them.
“The first one came out of nowhere. I planned to meet friends for a movie and started having strange thoughts of getting sick in the theater, or going nuts in front of everyone. I couldn’t breathe, my chest was pounding, and I felt terribly dizzy. I had no idea what was happening and felt terrified I was going crazy.”
Attacks gradually became more frequent, occurring whenever Susan tried going out to a movie, dinner, or party—any social event or place that she couldn’t escape if she felt panicked. “Slowly the list of things I avoided grew longer and longer until I was a total homebody, leaving my apartment only when absolutely necessary, and only with a friend. I wanted more than anything to die.”
After eight years, twenty-one primary care doctors, dozens of medications, and far too many MRIs and other tests, Susan still had no answers. Medical doctors frequently miss the diagnosis of panic disorder because they don’t know that its physical symptoms are caused by hyperventilation. This leads to unnecessary testing and aggressive treatment of imaginary medical problems.
At wit’s end, Susan finally saw a psychiatrist, Dr. S. An hour later, she had clear answers to what caused her physical symptoms and could control them by slowing down her breathing. Her world brightened when Dr. S. confidently said she would definitely get better. He was right. Susan used her treatment to gradually face down her fears and regain her life. “Now I go out with friends, shop at the mall, go to the cinema, use public transportation, and do anything I want on my own. I continue to improve and set realistic goals each year. Flare-ups of agoraphobia come back when stress gets high, but because I am aware of what is going on, they are short and I know how to fight through them to stop avoiding. I love my life and want to share what I went through with others to help them not suffer needlessly the way I did.”
Paul and Janet: Facing Down PTSD
The car spun out of control and crashed into a tree—instantly killing Max, age fifteen. The family tragedy happened on a slick and curvy road during a ski trip to Switzerland. Max had occupied the vulnerable front seat because he was most liable to get carsick. His parents and sister Annie were all badly injured but survived and rehabilitated physically within a few months.
Paul and Janet never talked about the accident, but they never recovered emotionally from it. Max’s room was left as a shrine to his death in the same chaotic mess that always characterized his life—not a paper moved, not a shoe or baseball cap put in place, his last half-completed homework just where he had left it. He was constantly in their thoughts, but neither dared speak of him or cry or share their suffering openly for fear of upsetting the other. “We were both in suspended animation. Going through the motions of life, but numb and not really living. We grew apart, blaming ourselves, blaming each other. Neither of us had much to give Annie—our hearts were broken, our brains in turmoil, our tanks were empty.”
Both parents were outwardly stoical, inwardly seething with nightmares and haunted with constant daytime images of Max’s limp and mangled body. Paul could no longer drive a car for fear he would lose control of it again and kill someone else. Car trips were avoided by both parents whenever possible or were endured with dread. A year after the event, they still startled at the sound of a car horn, or skid, or acceleration. Neither could concentrate, or eat, or sleep well; both were irritable, living under a cloud, walking on eggshells.
Annie was subdued and intermittently tearful, but far less psychologically damaged than her parents. She missed her brother and felt very sorry for him and for her parents, but she had no memory of the crash and was better able to go back to her previous life of school and friends. For Paul and Janet: “Our lives stopped when Max’s life stopped. It should have been us, not him. He had everything to look forward to. We have nothing to live for. What a criminally stupid idea to go on a ski trip and to drive on unfamiliar roads.”
Paul is a cardiologist, Janet an OR nurse. It was four months before he was physically and emotionally ready to return to work; three months for Janet. Work was a salvation for both—the only place where they could function near normally. But Janet had panic attacks when dealing with trauma cases and had to restrict herself to elective surgery. And Paul felt unable to treat teenagers.
“Neither of us wanted psychiatric help, but we both knew we needed it. Our family doctor did his best, but the antidepressants and sleeping pills didn’t help. The psychiatrist said we would never get over the pain of losing Max, but that we could and had to find a way forward—that we owed it to Annie, to the memory of Max, and to each other to make the great sacrifices treatment would require. We would have to face fully and share the pain of losing Max—no more suppression of feelings or secret grieving. That meant going over our memories of him together and finally accepting his death by clearing out his room. We came to understand that we could be true to the memory of Max without trying to stop the clock or pretend he wasn’t dead. We would also have to face, not avoid, the horror of the accident. That meant discussing it, looking at the horrible pictures, beginning to drive again. The treatment was a wrenching, dreadful experience, but it did give us back not all, but part of ourselves and our lives and freed us up to love each other again and to be parents to Annie.”
There is no pill for grief, and the medications for PTSD are not very effective and sometimes add new problems. Everyone has a personal way of grieving and dealing with catastrophic life experiences. For many, the best approach in the long run is the most painful in the short. Acceptance and catharsis require the reliving and sharing of the horrible memories and the gut-wrenching feelings. Facing the event rather than avoiding it is often the only way of gaining a measure of control and peace of mind. This can be done with family and friends, but if the feelings are tightly sealed, then a therapist is helpful, sometimes essential.
Peter’s Story: Beating the Family Curse of Melancholia and Suicide
It looked like Peter had somehow defied the odds. Despite a strong history of depression and several suicides on both sides of his family, he had happily sailed through a charmed life, succeeding brilliantly at everything. At age forty-six, he ran a large business, had a lovely and happy family, and was a pillar of his church and community. Then, after a relatively trivial business reversal, things quickly began to fall apart.
“I don’t know why, but I gradually lost all confidence in myself and in my ability to make the right decisions in business and with my family. I started ruminating about all the mistakes I had ever made in my life and felt that I was letting everyone down at work and at home. I blew up little worries all out of proportion and couldn’t sleep because my mind was churning with catastrophic scenarios of future failures. I lost fifteen pounds and felt agitated and frozen at the same time.”
Peter’s brother, a physician, suggested he get a thorough medical workup and also consult a psychiatrist. Peter was fine with the workup but opposed to the psychiatri
st. He was an independent and private person and was fearful he might be succumbing to the illness that had caused so much suffering to his family. Instead he hoped to ride out the storm and pull himself and his business affairs together on his own.
All the medical tests came back negative, but Peter’s symptoms worsened. “I became completely irrational about money—convinced I was driving myself and the business into bankruptcy, even though my wife and accountant both kept showing me healthy balance sheets. I insisted that the IRS would audit us and that I would wind up going to jail. I began to feel hopeless and suicidal—if I had had the energy and the means, I probably would have killed myself. The pain was that bad, and I couldn’t get over the crazy conviction I had done something criminal and had to be punished for it. I didn’t want to be a burden on my family and put them through my public humiliation. It was all completely nuts, but I believed it.”
The family gathered together and prevailed on Peter to see a psychiatrist. After hearing him out, the psychiatrist advised Peter that he was right to think the diagnosis was depression, but wrong to think the prognosis was bleak. It might take time, but the treatment would almost certainly work if Peter would suspend disbelief and really put his heart and his hopes into it. The first step would be medication, to be augmented next with cognitive therapy as soon as Peter began to feel up to it. Suicide as an option had to be taken off the table—it would create a much worse burden on the family and made no sense when the odds for recovery were so favorable.
“What a relief. We really hit it off on a personal level, and I felt hopeful again for the first time in months. It took me a while to really come out of the depression, but I never hit bottom again and was able to treat my worst fears as fears, not realities. It has been three years now and I haven’t had a relapse. I will never feel completely safe about having another serious depression, but at least I can catch it sooner and get it fixed.”
Saving Normal : An Insider's Revolt Against Out-of-control Psychiatric Diagnosis, Dsm-5, Big Pharma, and the Medicalization of Ordinary Life (9780062229274) Page 28