I’ve always believed that the strategy that has enabled me to avoid mania and hospitalization over almost thirty years has been to use whatever medication is needed to ensure that I sleep. Sometimes powerful stuff is required. This TED talk does not come as a surprise.
Upon persistent examination I have always found that I am depressed for a reason. That is not the harsh truth that motivated this post. However identifying the reason, and recognizing a need to do something about it, is a significant step in improving. There are certainly other paths to feeling better, but understanding what is provoking a depressive response can create a significant foundation upon which to build lasting, improved mental health.
Determining what needs to be done is rarely easy. In the simplest of situations there is a problem — more often several — that needs solving. The problem may not immediately be evident. The solution is usually even less so. Sometimes the situation is one in which current circumstances provoke an excessive response because they resonate with a past experience which was especially painful or traumatic. The work of identifying origins is rarely easy. The work of setting the past aside is even harder.
However, until a reason is found, the harsh truth that it important to confront when I am depressed is that if I do nothing, nothing will improve. If I grasp this truth carelessly I can wound myself deeply with self-blame. But if I grasp it gently, with compassion for myself, it becomes a tool with which to cut myself free.
This is a harsh fact to confront because so often depression is the experience of feeling incapable of doing. One loses both a sense of motivation and of agency. Doing nothing becomes a habit of mind from which it feels impossible to escape. However seeing the opposite of doing nothing as making even the smallest, most incremental of intentional choices is an approach that can enable things to change for the better.
If I recognize my capacity for intentional choice, without burdening myself with judgement about all that I am not doing, I start a process of healing. Sometimes the first step is accepting that I am choosing to withdraw and retreat from life, rather than feeling powerlessly drowned and overwhelmed. Owning, without negative self-judgement, a choice to make that retreat is still an improvement over being trapped in a belief that I am powerless.
Accepting, and actually validating, the choice to take a break from the perceived intensity of life is still a far healthier choice than actions that are more immediately harmful. And for those who suffer from serious depression the capacity to turn away from drastic actions like suicide, or reckless substance use, is an achievement worthy of celebration, even if the alternative is a period of time spent achieving little else.
Almost two months ago I started medication that I haven’t taken in years. A drug called lamotrigine that is both an anti-epilectic and mood stabilizer. After gradually increasing the dose for two months this is the first morning that I take what is considered a therapeutic amount.
Lamotrigine’s two advantages are a very low side-effect profile (provided one escapes Stevens-Johnson syndrome — the reason for the gradual increase) and a benign mode of action which is mildly (at least mildly for me) anti-depressive. It is the only mood stabilizing drug I have ever taken that does not have any noticeable negative effects on cognition or emotional response (lithium, antipsychotics, and clonazepam all noticeably affect both thinking and feeling in ways that are often disturbing) .
I started lamotrigine primarily so that I could once more try medication to deal with my challenges with focus and attention. Although I’ve been on meds for ADHD before, and they have never precipitated mania, it is a rare doctor who would prescribe them to a patient with a medical history such as mine, if that patient was not also taking a mood stabilizer on a daily basis. Indeed the reason I stopped using ADHD meds in the past was partly because the psychiatrist who was prescribing them to me did not believe that I was manic depressive and so was not particularly worried about the possibility that the meds he was prescribing might end up making me manic. One of my more unsettling observations has been the degree to which doctors frame my symptoms and diagnosis in terms of their area of expertise or therapeutic philosophy.
While my primary reason for starting medication was to facilitate further trials with meds for ADHD (and whether this will work when I go to see a specialist remains to be seen as lamotrigine is not a recommended medication for controlling acute mania) I was also curious about the impact it would have on my mood, which, while relatively stable, was often noticeably on the depressive side. While I’m hesitant to say it has had an effect, it certainly has done no harm (not always true for drugs like the anti-psychotics), and I am beginning to feel hopeful. Because the effect is subtle it can be hard to tell, but in time perhaps an improvement will be clear.
With all the blame placed on mental illness by the media since the Navy Yard shooting, it was a relief to read this article talking about evidence that schizophrenic hallucinations are shaped by the cultural environment of the people who experience them.
The author, who is a professor of anthropology at Stanford, discusses how mental illness and well-being, including treatment strategies, are shaped by culture. I was reminded of this amazing woman. Reading the piece made me sad at the degree to which psychiatry in North America has moved away from creative therapeutic approaches to almost exclusively embrace medication, much of which is so new that it is impossible to know long term side effects.
What was disappointing was the article’s conclusion. It seems vague to say that the nature of US culture “may … be responsible for making these terrible auditory commands that much harsher”. As an academic Luhrmann may feel a need to be cautious. A more direct conclusion is that culture could be a reason that some people’s hallucinations, and consequent actions, are violent.
The article does obliquely make the point that in a culture where guns are considered a constitutional right, and violence is endemic in mainstream entertainment, it is not enough to link mass shootings to mental illness. We need to recognize that delusions and hallucinations that give rise to violence are a symptom of something broader than individual mental illness. If we want to prevent incidents like the Navy Yard and Sandy Hook shootings, we need to look beyond just trying to identify and treat the mentally ill. We also need to address broader factors that are shaping mental health.
As someone whose ancestry and appearance seem to fall outside of most North Americans’ understandings of race, I frequently deal with the crude, clumsy efforts of others to satisfy their curiosity about my appearance. When I meet new people these are some of the conversations I often find myself having, and their pitfalls (and yes, I really have heard all of these questions, more often than you’d believe):
1) Where are you from?
Ummm, is this what you really want to know? I was born in Jamaica and lived in three other countries before moving permanently to Canada. But there are many Canadians who look a lot like me and who were born right here in Canada. Some of them have ancestors who have always been “from” here. Why are you assuming I am “from” somewhere else? As importantly, when I answer you, why can’t you accept my answer? When you reply to my “I was born and grew up mostly in Jamaica” with “But you’re not black”, you are taking your already problematic assumptions to a whole new level of offensiveness.
2) What are you?
Right!?! Okay I may not look like most of the human beings you hang out with but I still think you already know the answer to that question. Either you can’t fathom how offensive you are being, or you are intentionally trying to be a neo-Nazi. If English is not your fourth language our conversation ends now. Byyya!
3) Was your mom black and your dad white or the other way around?
Score! Points to you for figuring out that my recent ancestry is mixed. Now can we get you to expand that perspective a bit? And really, you find it good form to ask me a question like that right after we just met?
In many parts of the world people from different backgrounds have been coming together and having kids for many, many generations. North American society overlooks this reality by consigning most of us to simple racial categories*. Despite appearances that consignment fails to respect the true nature of everyone’s ancestral history.
How about we try another approach?
4) What’s your background?
This is the question which so far works the best for me. It’s the question I ask when I am curious** about someone’s family history and heritage. Asking “what’s your ancestry?” also works, but is a bit presumptuous (see #3). Asking “what’s your background” gives others the opportunity to understand and respond to your question in a way that works for us. Some of us will tell you about our education and interests, others about our careers. We will tell you about parts of ourselves that maybe are the things that are important to us in revealing more about who we are. And people like me, who recognize your desire to satisfy your curiosity about our perceived racial ambiguity, can satisfy your curiosity, if we wish to, in a way that is most comfortable and meaningful for us.
* By all means others are free to identify as they choose, but I cringe at the term “biracial” because I think it’s applying a pointless and impossible precision to what is in fact a very fuzzy and superficial construct in the first place.
** Being curious about someone’s heritage and ancestry is natural and not intrinsically offensive; how you choose to act based on that curiosity is a whole different thing. If people who look different from you fascinate you, and particularly if people of a particular perceived background are consistently the focus of your fascination or desire, you could do everyone a favour by taking a closer look at what’s really going on when you think about and interact with people who are the occasion for this fascination. To some degree many of us do this, and your attraction may be impossible to change, however it’s not as innocent, harmless, or acceptable as it may seem.
More than six weeks since I last updated here. I’ve been okay to fine. Busy. Grappling with a lot both practically, psychologically, and actually also in terms of this blog. Have a few significant pieces that I want to get out. One tentatively titled “I’m not racist” and other misadventures in anti oppression… and another series about coping strategies (Awareness, Attitude, Action…) that I had actually written a fair deal of and then lost to a WordPress/internet connection hiccup. There is also a third about hierarchy and male desire that I need to flesh out. None of them short, simple, or sweet.
The racism/anti-oppression pieces have been weighing on me with the Treyvon Martin verdict and the growing awareness of some of the impacts on me of living in Toronto, my own internalized racism, and how that racism and an ability to protect myself from it depend significantly on my sense of self and thus my mood.
So stay tuned …
We both knew about our respective mental health histories but had not seen one another in years. It was both reassuring and disconcerting to talk about our experiences since we had last seen each other. Reassuring because we were both grappling with similar issues (particularly around accessing care, and the impact of not finding support that we found helpful) but disconcerting to recognize in someone else the same kind of impact that sub-optimal functioning was having on his life. It is frustrating to feel you can do better, to want and try to find help in doing so, and to encounter, in those efforts, a system that does not listen, will not value personal experience, or use its expertise to truly respect and support personal choices.
and other stories from an ADDled mind.
Really hope I get to see this!!
Got my ticket!!