Pharmacopeia, or, The Drugs Don’t Work

TW for talk of suicide

Some days, as I rush around the apartment trying to get ready to face the world, I can’t help but feel like a traveling pharmacy. Inside the vast expanses of my purse, along with my laptop, my wallet, my keys, my book-du-jour, two shades of Sephora lipstick (neutral pink “charmer” and come-at-me crimson “tango”), my headphones, my phone, assorted bandaids, bobby pins and hair elastics, I neatly arrange the bottles of multicoloured pills through which I measure out my life like those metaphorical coffee spoons. Blood-red prescription iron supplements, safety-vest-orange Zoloft, dingy red-brown Seroquel, electric blue Imovane and, of course, the virginal pink birth control pills. My own private stash.

The pills are like little hand-holds to grab onto as I swing myself through my day. Orange and red with my breakfast, to keep my mood somewhere above apocalyptic-crying-level and to boost my energy, red again with supper, to keep my iron levels up over night, then red-brown, pink and blue at bedtime to respectively “enhance” my anti-depressant, make sure that I don’t accidentally bring forth another life onto this dismal planet, and then float me off to sleep the sleep of the innocents.

I’ve been on psychotropic drugs since I was sixteen, and can give you a poetic sort of laundry list of all the different types I’ve tried: Paxil, Prozac, Remeron Effexor, Elavil, Ativan, Wellbutrin, each at varying and increasing dosages. Paxil was the first one they tried on me, and when it perform as expected, they kept increasing the amount until I was a miserable wreck: twenty five pounds heavier, lethargic, awake all night and falling asleep in class. The funny thing was that my doctor kept telling me that it was working, that he was seeing improvements. Never mind that I felt worse than ever – to him, it definitely seemed as if I was getting better. It took months of arguing before he agreed to try a different drug.

The latest addition to my personal valley of the dolls is the Seroquel, typically used as an antipsychotic. I wondered if my doctor was trying to tell me something. I asked Nathan if he thought my doctor was trying to tell me something.

Me: It’s an antipsychotic. Do you think my doctor thinks I’m psychotic but just doesn’t want to say anything in case it upsets me? Am I psychotic?

Nathan: The medium isn’t always the message, Tiger. [Editor’s note: he likes to call me Tiger. Sometimes also Buddy or Slugger or Buckaroo. One time it was Tex.]

Me: But Marshall McLuhan said it was!

Nathan: Heritage Moments aren’t always right.

But then again, sometimes they are. So put that in your pipe and smoke it.

I’ve never really been able to tell if these drugs help at all (except for the sleeping pills, which are an insomniac’s best friend, and, of course, the birth control, thank god). Sometimes I take them and things get better, but it’s hard to know if that’s from the pills or from the natural dips and rises of my inner life. But I keep taking them, even after I swear that I won’t. They’re well-marketed, these drugs, and at my weakest moments I always find myself acquiescing. The doctors make a good case for acquiescing.

Those doctors always sell me on the antidepressants by telling me that I have a chemical imbalance, a lack of serotonin that causes my brain to short circuit and makes me want to die. That’s the best way to describe what it feels like to be suicidal – a short circuit, a glitch in the system, a design flaw. Killing yourself becomes the answer to everything. Your mind becomes like a record needle that jumps the groove, a sort of skip in your mental process where instead of going forward and thinking up solutions to your problems, all that you can come up with is, the only way out is to kill yourself. And the drugs are supposed to fix that skip, supposed to make it so that your record can play all the way until the end, and then you can flip it over, then put on another record, and so on ad infinitum, happily ever after.

The idea of a chemical imbalance is supposed to make you feel like you’re not crazy in the 19th century meaning of the word;  you’re not some kind of incurable case about to be shipped off to Bedlam. What’s wrong with you is physical – like a diabetic who lacks insulin (they’re always comparing selective serotonin reuptake inhibitors, or SSRIs to insulin for some reason), you just need a little medical help replacing something that your body is failing to make on its own, and then you’ll be fine. It’s not really a mental illness so much as it is a physical condition with mental manifestations. You’re not like those people.

By those people they mean, of course, the people with schizophrenia, or borderline personality disorder or some kind of nonspecific psychosis. Doctors never let you forget that there is a hierarchy of mental illnesses, one which you might slip down at any given moment. Doctors want you to remember that your place in the mental illness food chain is a relatively coveted one, lest you get any big ideas about going any crazier.

It’s easy to internalize the stigma against mental illness. Sure, you’re mentally ill, but you’re not like them. You don’t ever want to be like them.

Never mind that you already are one of them, no matter how you frame it. Never mind that all of your attempts to distance yourself, to other, only make things worse for everyone. Because you’re basically giving healthy people permission to other you.

You and your delicately imbalanced chemicals.

The chemical imbalance theory has been around since the 1960s. There was never much research done into the idea; it was just something that seemed like it could be right, and everyone sort of ran with it. Maybe they couldn’t properly test for that sort of thing back then. Maybe theories were the best they could go on. But now, fifty years later, it might be time to re-examine those theories.

According to Robert Whitaker, author of Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, doctors have known for a long time that the chemical imbalance model is likely flawed. In an interview on CBC’s The Sunday Edition, he says,

“And as early as 1998, the American Psychiatric Association in its textbook says we’re not finding that people with depression have any abnormality in their serotonin, but because it’s such an effective metaphor for getting people to take the drugs and sell the drugs, it’s continued to be promoted.”

According to Whitaker, people who take psychiatric drugs were more likely to still have symptoms five years later than those who didn’t take psychiatric drugs. Because, see, here’s the catch – people who take SSRIs but don’t have low serotonin to begin with begin to rely on those drugs to manage their serotonin levels. SSRIs actually reduce the brain’s ability to produce serotonin.

So maybe the drugs have never actually been helping me, or any of us; maybe all they’ve done is create a population of people who are dependent on psychiatric medication.

And maybe The Verve were right after all, and the drugs don’t really work, they just make you worse.

It bears thinking about, anyway.

I’ve been reading about lobotomies recently (as any good mental health patient does, I suppose), and I came across this gem in Ronald Kessler’s The Sins of the Father describing Rosemary Kennedy’s lobotomy:

“We went through the top of the head, I think she was awake. She had a mild tranquilizer. I made a surgical incision in the brain through the skull. It was near the front. It was on both sides. We just made a small incision, no more than an inch.” The instrument Dr. Watts used looked like a butter knife. He swung it up and down to cut brain tissue. “We put an instrument inside,” he said. As Dr. Watts cut, Dr. Freeman put questions to Rosemary. For example, he asked her to recite the Lord’s Prayer or sing “God Bless America” or count backwards….. “We made an estimate on how far to cut based on how she responded.” ….. When she began to become incoherent, they stopped.”

Sometimes it’s hard not to feel like doctors take the same approach – albeit on a much smaller scale – with psychiatric drugs. Increase the dosage until the patient becomes incoherent, or at least docile. Push the pills until they don’t feel anything, because feeling nothing is better than feeling sad or confused or anxious. Don’t offer counselling, or therapy, or life management skills. Just fork over pills pills pills until some kind of effect (or affect – little psychiatric joke there for you) is achieved.

The truth is that we don’t know how psychiatric medication works – we just know that sometimes it does. If you’ve ever taken the pills, you know that it’s a lot of trial and error until you find something that gives you some kind of relief. Which is great and everything for the people who benefit from it, but where does it leave the rest of us? We become guinea pigs of a sort, choking down brightly-coloured pill after pill, praying that something, anything will work. Because, honestly, it’s better than the alternative.

The alternative is, of course, that the brain is still a vast unknown. That we are only just barely beginning to grasp its complexity, and we may never fully understand it. That those of us who suffer from mental illness are sailing in uncharted waters, with no stars to guide us. What looks like Cassiopeia or Orion to everyone else is just a jumble of unknown lights to us. And maybe for some, the drugs make the stars realign into their proper order – but for the rest of us, maybe we need to begin creating our own private constellations to ferry us from one point to another.

The thought is terrifying, and I feel unequipped to deal with it. I’m not an astrologer. I just want the same stars as everyone else.

I’m going to keep taking the drugs, at least for now. They feel like a sort of safety net, and I know that I’m not ready to walk the high wire without them. But someday, someday soon, I want to begin to chart my own inner universe. I want a map of my own personal stars, and there isn’t anyone else who can do that for me. If I’m not willing or able to play amateur stellar cartographer, well, then, what’s the point? A lifetime of one brightly-coloured pill after another, each with its own dreary side effects, none of them even remotely effective. I can’t live like that.

But I haven’t lost faith that I can, somehow, find a way to live.

Tags: 90s music, anxiety, depression, happiness or something like it, mental health, mental illness, psychiatric drugs, suicide, the drugs don't work