Milligrams

There’s a metaphor many people use when talking about being on anti-depressants: the floor. The idea that a floor is raised when you take anti-depressants, up from a nearly bottomless chamber, to the light, where it stops just short of feeling normal, and rests. This recessed floor serves as the bottoming-out point for the patient from now on. They’ll say, “There was a floor past which I could no longer go down.” That’s why it’s called a floor – you can’t go down from there. And anti-depressants raise that floor for everyone I’ve heard from who took the drugs.

I think there must be something in the metaphor here, that “the floor” means something. Of course, it’s obvious that the floor is the bottom, what we tread upon, which is how the depressed person often feels: walked all over by life.

But is there something else to the “floor” metaphor? I think it’s about the return to feeling like other people. Walking around without a floor, the depressed person is lacking something that everyone else has, a bit of architecture. When the floor is raised, or created, by the drugs, the depressed person suddenly feels human again, a part of the collective, because they, too, now have a part of their house that’s so important.

This leads to a loss of that solitude that depression brought on. The depressed person begins to feel the inklings of connection with other people, an affinity, an understanding of one another. Hey, I’ve got a floor under me, too! I can live with the confidence that any little thing that might happen today will not destroy me, as it used to.

Having a floor brings us back from depression in two ways: by providing a baseline of mood that cannot be crossed, a new bottom that’s acceptably high enough to keep us out of trouble; and it gives us a metaphor for our intangible emotional disturbances, making them easier to visualize, to see finally that we’re back from the brink.

I haven’t written in the blog in forever. I don’t know what to write about. My wife says I have plenty to say, but I don’t know that that’s true. I don’t want to sound whiny anymore, I want to sound strong willed and able, capable. I know there aren’t many readers out there, and that’s possibly my fault for not writing top ten lists, lists of how to get better, lists of how to avoid holiday stress, lists about medications. The truth is, I don’t put much thought into these posts before I send them out. This is more like a LiveJournal than a blog. I’m not writing essays. That kind of intense writing I save for other pursuits, which will also not be read by anyone. So, welcome, all you Googlers looking for cheap and easy clonazepam! Happy New Year.

I’ve been having flashbacks — not of the LSD variety, but just as vivid. Ordinary revisits of scenes from a life, nothing particularly significant. In fact, notable only in their total lack of note. The flashbacks don’t seem to have anything to do with what’s going on around me, what I’m thinking about at the time, they’re not situational. They come on quickly and fade quickly, leaving an emotional residue, usually one of wistfulness, although many have been neutral. They occur most frequently when I’m bored at work, doing repetitive tasks. In writing, I’ve been taught never to rely on the flashback to move the story forward, but how can I not think that’s bad advice when it seems to happen so often in real life?

They disappear almost as quickly as they appear. I’m going to start keeping a journal — that makes three journals now — of them, and I’ll be back with a couple of the buggers soon. Hopefully with some insight into what’s causing them. Wikipedia

focuses on childhood abuse. Mine are garden-variety memories, no abuse here.

I imagine this is how other people feel all the time, but I know intellectually that this is not true. Too many speak of the pleasures of Zoloft, too many people are afflicted with anxiety, for this to be the case. But when I take clonazepam it’s like the world shifts and I want to re-embrace it.

I don’t know what I want to do first, read, write, talk to my wife, go see a movie, fuck around on the computer composing 2,000 word journal entries. Anything to keep my brain engaged and my feelings focused on the present moment. This is why reading’s out most of the time. I don’t want to escape this feeling, this relaxation of anxiety, don’t want to miss out on it while I inhabit someone else’s world. I want my own world, transformed by sheer lack of hard-driving fear and self-hatred. I can almost literally feel the hand that had been gripping my skull relaxing itself, and I wonder why so many people I encounter on the web have come out against milligrams of all kinds. I know that my life has improved dramatically through the introduction of a large amount of medications and I wouldn’t have it any other way now.

I may occasionally threaten myself with discontinuation for reasons I can never remember just a few days after I have the thought. So goes the bipolar mind — always thinking that everything’s either all right or permanently fucked and nothing in between. But clonazepam allows me a brief window into that time when things don’t have to be black or white, when there’s a nice grey zone of neither here nor there in terms of mood, a respite from the spikes I’m prone to. I feel less lonely on clonazepam, understanding that I can always get in touch with any friend I wish to at a moment’s notice. But I normally don’t, which is a topic for another post.

Relatively soon, I’ll switch psychiatrists. This is some occasion for relief, because I’m going back to my original doctor, the one who diagnosed me and prescribed me all these grand milligrams. I had to leave him because of an insurance problem, but that looks like it’ll be cleared up by the beginning of the new year. I most definitely don’t have mixed feelings about this. Some doctors just “get” you, and many don’t . Unfortunately, this doctor is the first in a long line to get me, so going back to him will in many ways be like going home. The others in the long line simply prescribed me anti-depressants, which kicked me into a mild hypomania. A not-entirely unpleasant hypomania, but, according to my wife, I was not myself on those particular milligrams, so I stopped them. (more on this later)

I’m concerned that the new-old doctor will have forgotten many details about me and my situation, and that we’ll have to play catch up. But if that’s the price to pay, so be it. I’m extremely lucky to be able to go back to him, so I won’t look this gift horse in the mouth.

Bipolar seems to have this way of robbing you, when you’re not manic, of decent conversational skills. One day you’re doing fine, talking to everyone you know, having a fucking ball, then the next you’re barely able to smile when you’re supposed to. The people around you get that particular rhythm in their conversation — they pause, ever so imperceptibly, for something from you. And of course it never comes from you, because it can’t come from you because you’re feeling like this, so incapable of speech.

My doctor calls it self-censorship, but I think he’s wrong again and think it’s something deeper. I think there’s a biological component to this lack of speech; verbal portions of the brain are shut down during depressive bipolar attacks. People talking circles around you, stunning you not so much with their wit as with their capacity to access phrases, and even words, at the right time and pace. No amount of milligrams seems to have protected me against this deficit. This is where the drugs have let me down the most.

How do you know what’s working is working in the highest degree possible? You can’t know absolutely that the medication you’re taking for major depression or bipolar disorder is the best for you, and that drives me nuts. Whenever I’m feeling better — right now, for instance — I tend to get greedy: But I could be feeling so much better than this, I reason. Because getting better always involves a gaining of perspective, it invariably follows that, getting better, you look around yourself, see the devastation that the disease has caused, and think, I have to run from this as fast as possible. That’s when you start questioning your medication choices. Are they doing enough? How happy am I supposed to be? What’s my baseline? Am I getting better quickly enough to gain some ground, to gain some momentum to get me over the next hurdle? Because getting better isn’t good enough. What’s well? Greedy thoughts again. It can only be measured by time, how much time you get to feel better. Quality of life questions come into play — is my life so much better than when I was depressed, or am I just fooling myself into feeling better about things? I tend to forget about stressful questions, like how I’m going to do my taxes now that I’ve set myself up as an LLC, and just begin to float, so thankful that I’ve Gotten Better. It’s like a vacation: don’t bother me with the tricky stuff, I’m feeling better and I’m going to hold onto this sensation for as long as possible. Sensation. That’s what it feels like, like a strange sensation, a rare emotion, this smoothness of mood, and I’m so sensitive to it that it only takes a good morning to make me think — hope — that it’s going to be the way I’m going to feel for the rest of my life, or at least for the rest of the day. And I start to wonder, again, is this the best I can possibly be? I make resolutions, plans, for how to maximize my time feeling this way. I’m going to start this and that good habit, I’m going to be like a better person from now on, I’m going to show myself a better time. Better and better. I suppose this is hypomania expressing itself again, or I’ve drunk just the right amount of coffee this morning, who can tell? I just want more. Now I’m thinking that I should be more self-sufficient. Wait — that’s not the word. I’m just thinking that I shouldn’t be mentally challenged, mentally ill, whatever you want to call it. I’m just tired of it, so I’m not going to be that way today. I’m going to be well today, and get some work done and be happy, or at least normal, average, level, sane.

Someone left a comment asking that we talk more about shame, and so
I’ll keep going with that.

I don’t think the constant feeling of shame that he experiences is in
any way related to reality, or that it’s rooted in the events of his
childhood. It just persists, on and on and on, constantly misfiring.
Studies like this one show that shame is not just cultural, but part
of our physical makeup.

As members of an innately hierarchical, social species, then, this
trait is innate, just like fear and love; and just like the structures
that are responsible for fear and love, this can sometimes go amok.
As it has for him.

I say this partly because nothing about his childhood or background
accounts for his persistent, long-lasting anxiety and shame, which go
back to early adolescence, and appear to have grown stronger every
year. The events that he has told me about in no way warrant such a
strong reaction. There doesn’t seem to be any trauma, only these two
symptoms, which tells us that the source is biological rather than
external.

Also, I’ve been observing him closely for nearly eight years, and the
waxing and waning of his anxiety/shame experience appears to be
entirely organic. I prefer to use these words rather than the blanket
term “paranoia,” which is imprecise and has such negative
connotations. Sometimes one aspect is dominant, sometimes the other.

Though there are many treatments for anxiety and the related spectrum
of illnesses, as far as I know, persistent shame is not considered a
treatable illness in itself. My husband is treated for paranoia and
anxiety, not shame and anxiety; again, this seems like a broad target,
rather than a surgical strike. Maybe some grad student will someday
improve the lives of millions by coming up with an anti-shame pill.

So rather than rooting around in his past, which seems to be not just
pointless, but stupidly counterproductive, I’m working on coaching him
to observe the anxiety and shame and treat these signals from his
brain as part of his illness, thus to be ignored for the most part,
rather than believed and acted on. Very difficult, but in our
experience, the best way forward.

This post – http://www.milligramsblog.com/2009/11/23/the-best-street-sweeper/
- plus a few remarks you’ve made about your colleagues at work and
feeling embarrassed in public tell me that your paranoia is more
pronounced than it was in October.

(Oh, if only you and the doc hadn’t decreased the Abilify dosage.)

When the meds aren’t working right you gradually lose touch with the
distinction between events that you do cause and those you do not
(“ideas of reference”). Two months ago, this faded entirely for the
first time ever. At your worst, you were almost unable to go outside
at all, for fear the people in the street were thinking negative
things about you.

Our mantra: ideas of reference. The truth is that almost no one in NYC
pays much attention to anyone but themselves. There’s too much noise,
too many people. They really don’t care who you are, what your job
is, or how you look. It doesn’t even register. There is no one who
passed us in the street today who is now thinking about you, or even
remembers your face. At work, it’s true there’s a pecking order but
your perception of your place in it varies a lot, depending on how the
BP is affecting you that way. So your understanding is often
distorted.

Your fears of not being a great writer, and worries about the pecking
order at work, and also those moments of self-consciousness on the
street are all rooted in the persistent BP feeling of shame. That
emotion and the thoughts that spring from it are entirely due to your
illness; you’re not the center of the world, but neither are you an
embarrassment. You’re equal. You’re my Mr. X, living out his life as
best he knows how. Do that.

Push the shame aside. Trust me. It’s not rooted in reality. You can
discount it.

I thought that post was a very important first step away from the
shame emotion and the patterns associated with it. So, yes, you’re a
shrub. But the point is that every writer starts this way. The
acclaim, the storied title of “great writer,” etc. – these accolades
don’t necessarily fall to the people who have earned them. It’s
better to look for the satisfaction in being the best shrub you can be
– the route to happiness is this way, darling. Please keep going.

Learning how to view my own work has been one of the biggest challenges lately. It’s so, so easy to slide into self criticism, self loathing, especially in my writing. Both my day job and my writing early in the mornings and in the evenings have been feeling like insurmountable challenges. These two days off have given me a chance to crash. I feel helpless in the face of despair right now, but I’m able to go on through habit. I want to add the phrase “right now” to the end of every sentence in this post, because that’s what’s going on — something is going wrong right now, not forever. That famous Beckett line, “fail better,” has become my mantra. Just getting better at failing seems to be the best thing to shoot for. A habit: getting up early. Getting up early is said to help. Getting up at the same time of day, every day, is supposed to be one key to happiness. Mindfulness of my impatience when I get like this helps, too. Things will take as long as they will take, I must remember. I just have to fight the urge to lie down and go to sleep wherever I am. A rambling post, it’s true, but all I’m capable of… right now.