I had just carried a bottle of black cherry soda in from the car. Heard my answering machine beeping when I walked in the door. Ran to it with the speed and pathetic
anticipation of one recently dumped.
Went back into the kitchen, tossed some ice in a glass and opened the bottle of soda. The soda foamed out of the bottle and all over my hand. I looked at the hand, slowly touched my thumb to each tacky finger in turn, and returned to the task of preparing my lunch.
It wasn’t until ten minutes later when it finally occurred to me to wash my hand.
I wish all the biologically-induced, serotonin deprived existentialists and Holden Caulfield wanabees would get a clue. There is nothing noble about walking in circles, sad, dejected and rejected, year after year. Maybe flunking a course or not getting your dream job, dream girl, dream car--WHATEVER--isn't supposed to feel like the end of civilization as we know it.
My “prozac moment”, part II. Don’t get me wrong, the wrong psychotropic meds in the wrong person can turn a sensitive and thoughtful human being into a taciturn individual who forgets everything they knew about personal hygiene.
Most people, and probably about half the psychiatrists and GPs, forget that the current official listing of psychiatric disorders (DSMIV) is full of what are generally psychiatric syndromes—i.e., collections of nominalizations which simply point to groups of subjective experiences and objectively observed behaviors. These nominalizations are then associated with specific pharmacological agents in keeping with the medical model. E.g., auditory hallucinations + “flat” affect+ unusual ideas (– ) any know organic metabolic or neurological disease or lesion = Schizophrenia. Prescribe antipsychotic medication (e.g., Haldol).
The simplest errors in prescribing come from misdiagnosing. I knew a fifteen-year-old precocious girl who was misdiagnosed as having Bipolar Disorder on the basis of erroneous observations made by her depressed and socially isolated mother who was in denial about her own state of mental health. The girl had been depressed because of her home situation. She tried to explain this in vain. When she was mistakenly put on Lithium, she became so sedated that she did worse in school and in her social life than she had without treatment. Fortunately, she had the good sense to rebel, take herself off the medication, and find a good psychotherapist.
In reality things are much more complicated than simply matching medication with disorder. In biological psychiatry it is becoming clearer that there are few (if any) unequivocal dividing lines between, say, anxiety disorders and mood disorders. Nor is there such a line between endogenous and exogenous disorders. Anxiety is often accompanied by depression and obsessive thinking. The most noticeable symptom in some cases of clinical depression is irritability. So psychopharmacological agents seldom effect only one underlying biological system. Haldol works for individuals with good reality testing with Tourette’s Syndrome. SSRIs can provide relief for people with Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, and Social Phobia. There is good research suggesting that undergoing severe stress or trauma during one’s formative years can change neurotransmitter functioning permanently. In many ways, prescribing psychotropic meds is something of an art form.
In my own case, if you had asked me, I could have told you that I met the criteria for Dysthymic Disorder, a kind of “low grade”, chronic, clinical depression. But I was around when the term was first coined and was seen as the modern equivalent of depressive neurosis which has connotations of being a situational depression, so it never occurred to me to seek medication to treat my own depressions. I did a lot of “soul searching” and making useless attempts to “pull myself up by my own bootstraps”.
Now the thinking is moving in the direction of believing that Dysthymia can have biological underpinnings, and is in many ways more crippling (if you factor out suicidality) than “simple” Major Depression. Individuals who meet the criteria for Major Depression seem to have a stronger, more straightforward response to antidepressants, and on the whole, do better in remission. In contrast, the dysthymic is mildly and moderately depressed so early and for such long periods of time, never quite chinning themselves over the bar to a neutral or “good” mood, that they have no reference point for what constitutes a “normal” mood and are more subject to major depressions anyway.
So, for longer than I care to think about, I would look at people in social situations who seemed to be having a good time for more than a few minutes, or who were constantly overflowing with energy and good will as being theatrical or histrionic, driven—or God forbid--shallow. While I occassionally felt “happy”, my primary emotion was unrelenting anxiety that I didn’t always recognize as such and which effected each and every thing I did—school, work, social relationships. So for those who followed my earlier Prozac Moment rant, I, too, am a Holden Caufield wanabee (not to mention, Sylvia Plath, Anne Sexton, yadda yadda). These days I still appreciate dear Holden—I just really, REALLY, appreciate not being him any longer.