Excerpt from Chapter 12: Who Knows?
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. […]
[…] One clinical trial is a proof. Two clinical trials is half a proof. And three clinical trials are no proof at all. I’m paraphrasing one of the great philosophers of the twentieth Century. Well, he was actually the beloved seventh generation Yankee who owned the orchards that surround my home. That’s how he described managing the teenage boys he hired to pick apples: “One boy is a boy. Two boys is half a boy. And three boys is no boy at all.”
There are articles, dissertations, complex research reports, and entire books—all with countless caveats and footnotes—written about whether antidepressants work. We’re not talking your basic incoherent academic dispute. This has turned into one giant medical cluster f—.
Many experts use clinical trials to prove convincingly that mind medications are
effective. According to their studies, meds work about 60% the first time around, with the likelihood of success rising for those who can keep it together enough to try another one or two if necessary.
Others use clinical trials—and often the same ones!—to prove equally convincingly that clinical trials have proved beyond a shadow of a doubt that placebos work just as well as antidepressants.
Even more impressive, there’s now some evidence that the exact same experiments, following exactly the same rules of scientific protocol, can yield significantly different results over time. Makes you want to take two aspirin and call Hippocrates in the morning.
Then there’s the quantum issue. Oh yeah, the quantum issue. The one that says you can’t ever really measure anything because the act of measuring changes the thing being measured. Can we just agree not to mention the quantum issue?
One thing everyone does seem to agree on—although some rather begrudgingly—is that the controversy primarily involves people with mild to moderate depression. Once they see you sobbing uncontrollably in the waiting room, they’re usually willing to let you give drugs a try.
I accept that the occasional scientist will fiddle with results— consciously or subconsciously—based on who’s paying for the research. More important, you don’t have to be Einstein (or Heidegger to be imprecise) to realize that researchers’ conclusions are inevitably influenced to some extent by their own assumptions and conventional wisdom.
William Blake, a guy who knew a thing or two about mental illness, wrote, “What is now proved was once only imagined.” I would add that what many now consider imaginary may one day be proved.
Academic disputes aside, there are several questions that every self-respecting gobbler of anti-depressants, anti-psychotics, and anti-all-kinds-of-other things will eventually wonder: Why are clinical studies such unreliable predictors of which treatment(s) will help me? Why can a drug/remedy that was perfectly effective for me for many years suddenly stop working? Why can it have an entirely different effect when I start taking it again after stopping for a while? Why should I worry about having an erection for four hours when I can barely get up in the morning?
They are excellent questions. And, since the scientific answers are all over the place, I’ll stick with the philosophical and the commonsensical:
Humans evolve. All the time. Individually. And as a species. So does all of nature. So does the entire universe. Every “subject” in those clinical trials is a swirling mass of energies in constant flux, whose individual complexity can make a mockery of any particular data point.
As I’ve said, we admire the determined fight of someone with cancer who insists on breaking down doors to get into the latest clinical trial, even though the treatment could be more fatal than the disease. Why don’t we equally admire people who will try an antidepressant even if it hasn’t been clinically proven and may also prove to be more fatal than the disease? Why don’t we talk about how they
, too, fought a courageous battle with their illness, and tried everything they could in an attempt to ward off an inevitability they felt they couldn’t avoid?
Whatever you decide to do, it is really helpful to have one or more professionals go along for the ride. Maybe if your depression is situational, your psychological immune system can manage to remain intact—the exposed inner “skin” slowly scarring over while your neurons and/or esoteric energetic patterns find other ways to get the job done. As your life improves or at least evens out over time, your moods may improve or even out accordingly.
In cases of clinical mental illness, however, the neural patterns are usually so out of kilter that changes in external circumstances have minimal effect. That’s when it’s probably time to call a professional.
By professional, I mean anyone who has a lot of experience working closely with people suffering from big-time depression or mania. It could be a psychiatrist, psychologist, chiropractor, homeopath…even a psychic or priest. Or any combination of the above. As long as they are open to discussing any possible treatment you’re curious about without making you feel like an idiot; as long as they answer your phone calls when you’re desperate, or at least call you the next morning; and as long as you feel that they are truly committed to your healing…partners, I daresay, in the process.
Fortunately, everyone’s become a little more open-minded. Nobody ever told me that prescription meds were the devil’s work. A few people suggested that natural remedies were better, but even my most rabid vegan, natural-remedy-adherent therapists and friends acknowledged that sometimes medications might be necessary…at least temporarily. By the same token, no conventional medical professional ever gave me a hard time about having some needles stuck in me from time to time.
Still, it can feel weird to tell your psychiatrist that you’re also taking mega B-vitamins, SAM-e, tryptophan, and doing full-spectrum light therapy. It can make you squirm to tell your homeopath that you’ve decided to go back on your meds, just when she or he is convinced they finally figured out the right remedy for you.
I’m a big fan of putting your cards on the table. Their opinions and prejudices aren’t your problem. By the same token, they don’t have to agree with what you’re doing. They just need to do their best to understand where you’re coming from and explain the potential risks and rewards as best they can. And you owe it to them to provide as much information as you can before they prescribe anything, natural or otherwise.
I don’t know, for example, if combining acupuncture, herbs, deep tissue massage, and prescription drugs helped trigger my breakdown. For all I know, the combination kept it from being more severe. I have no regrets. But I know that, at times, by not coming clean, I missed an opportunity to work more openly and closely with my psychiatrist, in a way that might have been helpful to both of us.
The important point is that most professionals—conventional or alternative—don’t have a whole lot of experience in how other
therapies might interact with theirs. An herb or pressure point over here is likely to affect a gland or neurotransmitter over there. And vice versa. Same is true for massage, meditation, prayer, illegal drugs, and SSRIs. We’re still in uncharted waters here…and it’s best if we admit it.
Bottom line: It’s a miracle that any one treatment can help more than one person. We’re dealing with more synapses in our brains than we can imagine. Our thoughts, feelings words, actions, and biology emerge from our distinctly individual history, physiology, genetics, environment, culture, race, color, and creed, as well as our astrological sign, karma, past lives, energetic body, and a host of other factors that aren’t quite so apparent to the naked eye. (You may not believe in those last few. That’s fine. I think that means you’re an empiricist.)
That’s why so many different people are convinced there are so many different “best” ways to treat major depression.
Some people insist natural remedies are better. Others say only pharmaceuticals have been proven effective.
Some people think alternative treatments are weird. Others think that electrical stimulation of deep areas in your brain is weird.
Some people think you’ll get fired if your boss finds out. Others figure your boss will get sued if she or he fires you.
Some people think seeing a psychiatrist is a sign of weakness. Others think it takes courage.
Some people think medications are too expensive. Others think it’s worth begging and borrowing if you have to.
And, just when you think you’ve found a treatment that works, winter comes…there’s less sun…so you start producing less vitamin D which somehow affects your serotonin levels. So maybe you take a vitamin D supplement and feel a little better. And then you have a massage and feel a lot better. And then you wake up with your mind racing down roads that are best left untaken, so you roll over and take a .5 mg tablet of Klonopin and doze off for an hour, but when you wake up an hour later you’re still agitated, so you do an intense workout to calm down. Which leads, after breakfast, to a surprisingly pleasant early-morning nap, only to wake up wired again, so you take a little calcium-magnesium and call your psychiatrist who suggests that instead of taking 60 mg of Cymbalta every day, you do 60 mg one day and 30 mg the next.
And then, just when you think you’ve got things in balance again, you get fired or divorced or start to have unrelated angina, or break a leg so you can’t work out, which confuses your neurotransmitter systems in a whole different way.
That fictional scenario might make you question the possibility of ever
stringing together more than a few blessed moments of sanity. But, lest I scare anybody who is currently on a similar roller coaster, I’ve been good—really good—for years
with only a very few very brief relapses.
There are countless treatments for this disease, many of which I have had the
pleasure of experiencing. I’m as tempted as the next “expert” to offer an opinion on what someone is doing or taking. But, I know that what helped me could have an equal and opposite effect for someone else…or even for me the next time.
Fixed opinions are luxuries that I, and I daresay most depressives, can ill afford. We may ask you what you know about depression and meds. We may want to hear about your experiences or those of your friends. We may ask for your suggestions. But ultimately, what we really need is as much support as possible, regardless of our choices. […]
Excerpted from David's Inferno by David Blistein; Foreword by Ken Burns. Copyright © 2013 by David Blistein; Foreword by Ken Burns. Excerpted by permission of Hatherleigh Press, a division of Random House LLC. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.