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The "Black Dog", Winston Churchill called it. People think "depression" means sadness, and while that is sometimes a symptom, that's like calling vehicular homicide a matter of scratched paint.
Last week's episode of House, the popular series about a misanthropic gimp who's a brilliant diagnostician, contained the best depiction of life inside a loonie bin since One Flew Over A Cuckoo's Nest". I didn't know whether to cheer their accurate depiction as "therapists" were sadistic to those enslaved there, or cry. When I was inside a loonie bin, I wanted to cry - and I was afraid to, because I was vulnerable, too.
Like House, I was there on a voluntary commitment, and like House, once the door clanked, I was told that if a voluntary patient wanted to leave against medical advice, that was grounds for seeking a court order for an involuntary stay. They kept asking me if I wanted to hurt myself or others, and I said not since I was in the third grade, when I really wanted to flatten a classmate. We were told, they would say, that you have been talking about suicide. Oh, sure, I said, that, sure, and I'd start singing the M*A*S*H theme song, quietly: "Suicide Is Painless".
Just yesterday morning they let me know you were gone
Susanne the plans they made put an end to you
I walked out this morning and I wrote down this song
I just can't remember who to send it to
In M*A*S*H, about the only character that didn't make it from the movie (with blood spurting from injured bodies) to the television show (that sanitized the Korean war and thus made VietNam seem like family entertainment), was Painless. John Shuck (Sgt. Enright from McMillan and Wife) was a dentist who was hung like a horse. When he had an episode of ED, he considered suicide. JoAnn Pflug, playing Lt. Dish, administered "The Black Pill", a placebo, and used her dishly skills to show Painless that it was not a permanent condition. The look on Pflug's face afterwards was priceless. She could surely cure any man's depression, couldn't she? Except that's not what depression is.
In any case, I was suicidal, and my family physician, who was an incompetent psychiatrist, wanted me locked up in a place where people would prevent that from happening until the new meds kick in. It's no sin to be incompetent in psychology or psychiatry, of course, and he was only claiming to be a family doctor. I ran across a black man, son of a Methodist preacher, at Dartmouth Hospital who was phenomenally good. There was a therapist, a man who had one leg that bent at the knee and one that didn't, but none the less raced bicycles internationally who did me more good than I realized at the time. There was one psychiatrist, Steven Schneider, who quit the group practice he was in, the city's leading group, and the stories were that he wanted them to care better for patients, but they wouldn't. The difference is that my family physician recognized that he was not capable of rendering help, and of all the others, only those three were capable of "first do no harm."
Am I a loon for saying most shrinks are bad? I think it's more a case of Sturgeon's Law. "Ninety-five percent of everything is crud" is how many express it, although Theodore Sturgeon said considerably more than that. In fact, our standards are established by experiences with the best, and by comparison, the merely average is, well, not nearly as good.
I've seen fire and I've seen rain
I've seen sunny days that I thought would never end
I've seen lonely times when I could not find a friend
But I always thought that I'd see you again
Depression is a fundamental malfunction of the central nervous system. It's like running your engine with fouled spark plugs. The depressed have no strength, neither mental nor physical, can derive joy in nothing, and as House expressed it, note that success is temporary, but failure is permanent.
There are meds that do some good for some people, but the problem is that the patient gains the strength to do what long has needed to be done long before the pain that makes it neccessary is gone. At first, they didn't realize that Prozac and similar drugs would result in more suicides, because of this, rather than fewer.
Once they figured it out, they started locking people up for 23 days - nope, that's all the insurance will cover - until the meds would kick in. Of course, if you have trouble with one anti-depressive, and have to switch meds 10 days in, you only get 13 days on that new med before you get streeted. The insurance companies can count to 23, and they don't give a damn if you've been kept safe, they only care about the numbers.
Everybody talks about the third generation anti-depressants as if they are something special, and, well, I suppose they are. The first generation were the MAO Inhibitors, and they're rarely prescribed any more. Monoamino oxidase inhibitors conflict with certain foods, especially the ones that taste especially good, such as pickles, or sharp cheese, and cause your blood pressure to shoot up, giving you a stroke.
The second generation were the tri-cyclics. Elavil is an example. Mostly, the tri-cyclics put you to sleep. Actually, there's a lot to be said for that. While you're awake, you experience stress; while you're asleep, your mind unwinds. Spend 20 hours a day in bed for a month or two, and you'll develop a new perspective. It's sorta hard to explain to your boss, "My doctor says I need to sleep around the clock for the next two months, see you later," so it's not a popular medication choice. What's more, it's hard to show, with statistics, that 60 days of sleeping on high doses of Elavil does you any more good than just lounging around all day and all night for 60 days, with no medication at all. If you need a safe sleeping pill, though, you might want to ask your doctor for some Elavil. It's almost as effective as Benedryl (the anti-histamine) but it doesn't dry you out.
Won't you look down upon me, Jesus
You've got to help me make a stand
You've just got to see me through another day
My body's aching and my time is at hand
And I won't make it any other way
Prozac came out in the late 1970s or early 1980s, and it was the first medicine that patients really notice working. They'd walk into their doctor's office two weeks later and say, "Hey, doc, what was IN that stuff, I feel like someone has opened my eye lids!" If you think it helps people who are sad because of a death in the family, or getting divorced, or something like that, you're probably right. It appears, though, that there are two categories of depressives. There are people who are temporarily depressed because of events, and there are people who are just plain suicidally depressed. Prozac helps the first group, according to tests they give depressives. With all those pills being handed out, though, you'd think that the suicide rate would be dropping. In fact, it's increased substantially since Prozac came out. That doesn't mean that Prozac itself is to blame. It could be that the insurance companies cover Prozac, which does less good for suicidal depressives than the older treatments, which insurance companies don't want to cover.
At OSU Medical Center, a woman named Susan came in every Sunday night. (Well, not really. I try very hard to disguise identities here, so I can tell the real truth.) She'd settle down on Monday, and was a good ole girl. On Tuesday morning, they would take her in the back and perform electroconvulsive therapy on her. On Tuesday afternoon, she would be a zombie. She'd be doing better on Wednesday, and her family would pick her up Wednesday night. Then she's arrive next Sunday night.
I asked her what she thought about the treatment. Was she doing it voluntarily? Yes, she said, my family says I am getting happier and happier. And you know what, I think maybe she was - in a gibbering idiot sort of way. She was no genius the first time I saw her, and over the weeks, her IQ seemed to approach room temperature.
They called me a "high-functioning depressive" in the loonie bin, and I said, "Are you a fucking idiot? If I was functioning well, why in the world would I be locked up? Is a desire to kill yourself functional? I kept asking this question over and over again, every some damnable fool would utter that phrase.
Oh, I've seen fire and I've seen rain
I've seen sunny days that I thought would never end
I've seen lonely times when I could not find a friend
But I always thought that I'd see you again
Treating highly-intelligent people with talk therapy, one of the kids - I'm sorry, this was a physician in training at Ohio State, but he still looked wet behind the ears to me - anyhow, one of the kids said it's difficult, because the intelligent person's mind is not easily changed. He needs to convince himself with self-talk, he said.
Now let me get this right. If I tell myself lies, you call that self-delusion, and that's a pathology. So I have a pathology, and you want me to tell myself lies, and call that treatment, right? Can you explain to me whether I'm supposed to believe in the truth or believe in lies? He mumbled, and walked away backwards, almost stumbling.
A couple of days later, he came into my room to talk to me. "We were discussing things, and we were wondering what you would think about ECT - electroconvulsive therapy. That's a therapy that your intelligence cannot outwit.
I leaned over on my left elbow, and said, "That's what Susan gets, right?" He looked puzzled. "That plumby woman, really appealing, comes in on Sunday nights, and gets treated on Tuesday morning. I think her husband is a farmer." He nodded, yep, that's the one.
I said that it appeared that she's getting progressively dimwitted each week, and her husband must want a zombie for a wife. The intern mumbled around, not finding the phrases convenient to his argument. I said, "Tell me, if it were you, would you consent to ECT?"
Been walking my mind to an easy time my back turned towards the sun
Lord knows when the cold wind blows it'll turn your head around
Well, there's hours of time on the telephone line to talk about things to come
Sweet dreams and flying machines in pieces on the ground
He was quick to shake his head. No, he wouldn't. "If the choice is between this body being planted in a grave, or someone else living in this body once I disappear, I'd rather not audition for Night Of The Living Dead. If I go, this body's damned well gonna go with me." He nodded, mumbled about only wanting to make sure I knew I had the choice, and again, stumbled as he backed out of the room.
I won't deny that some facilities are better than others. Dartmouth Hospital was the best, and paradoxically, they had some of the worst-off patients I've seen anywhere. No mental hospital shows respect for the individual patient, but Dartmouth seemed to be trying the hardest. OSU Medical Center had a brand-new building, brand new furnishings, and as a teaching hospital, should have had the most talent on staff of anyone, but they sure seemed to make cruelty a policy.
Caffeine is a psycho-active drug that's fairly addictive. Nobody got anything with caffeine in it, including chocolate, period. On the other hand, they made smokers dance like marionettes in order to get a smoke break. On the other hand, smokers got to go outdoors and see the sky. Non-smokers didn't even have windows to look out.
There are people who look at the sky, and people who don't. People who grow up on farms look up at the sky because, well, your dad screams at you if you try to sneak comic books with you when you drive the tractor. I can give you a good forecast for the next three hours, out in western Ohio, telling you within 15 minutes when it's gonna start raining. Here in Lancaster, the mountains screw up everything, and so the weather comes from different directions, and I'm not nearly so good.
Oh, I've seen fire and I've seen rain
I've seen sunny days that I thought would never end
I've seen lonely times when I could not find a friend
But I always thought that I'd see you, baby, one more time again, now
Maybe I should mention, the last week, I've been dreaming of gathering clouds. Each time I sleep, they get heavier, darker, and lower. One or two more nights, and it'll break into a really heavy storm, a gully-washer. Maybe that means I'm going to have a stroke. Maybe it just means I need to make sure my bladder is empty before I sleep.
People who are struggling with SIs - suicidal ideations - together tend to draw very close. Even before HIPPA came along, they made an effort to keep everybody anonymous. No rule, of course, against telling each other your name, and enough information that you can find each other after you get out.
And there were a number of people I started to feel very close to. Daryl, for instance, had tardive dyskinesia. It wasn't a problem he started out with, but his family physician, thinking he was competent, prescribed too high doses for too long of a certain psych med, and even ignored the tics that develop first. Once the damage is done, going off the medicine is of no avail....
And there was Sally. She had been abused as a child. Her mother was, herself, a loon. She didn't have use of her legs, and her mom thought she was evil. At times, her mother would take a needle and thread and sew her genitals shut. Another time, her mother rented her out to a group of men who wanted to make a porn movie featuring a goat. Sally was numb; she had no trouble talking about it. I was partially numb from the depression, partially numb from the meds I was on, so I didn't act shocked, only concerned. She thought I could be a friend, and at that point in my life, I didn't think I deserved any, so when she wanted to be my friend, this gorgeous young woman with the curly red hair cascading over her shoulders, I wasn't about to say "no".
We weren't allowed music. That didn't keep her from teaching me the lyrics of James Taylor's "Fire and Rain." He wrote it for a girl he was in the loonie bin with, she said; when he got out of the loonie bin and tried to look her up, she had killed herself. And some of the lyrics are confusing, she said, but mostly, you need to know the one is about flying machines in pieces on the ground. JT, she said, had once had a combo called the Flying Machine, and the group fell apart. He considered it his personal failure.
Thought I'd see you one more time again
There's just a few things coming my way this time around, now
Thought I'd see you, thought I'd see you fire and rain, now
She got out first. Her parents were both dead, and she lived with a cousin, she said, that she loved dearly. I told her, when we got out, that I'd come get her, and take her to a soda fountain for an orange ice cream soda, and then I'd take her to the canoe livery, and we'd spend an afternoon paddling down the river. It was late enough spring that the river wouldn't be swollen, fast, and dangerous, but early enough that it wouldn't be boring. And we'd be able to talk for hours, just paddling - she said that because she didn't have the use of her legs, she had very strong arms, and she'd like an afternoon at a sport where she had an advantage over most athletes.
I called her up when I got out. Her cousin answered the phone. Who was this strange man calling Sally? I was a friend of hers, I said. Sally didn't go anywhere, she said, never met anyone. Who was I? I said that I met her three weeks earlier, if she remembered where Sally was three weeks ago. Oh, she said. I'm sorry, she said. Sally died in a crash the day after she got out. A drunk driver t-boned the taxi she was riding in, and she died instantly.
I asked her if she mentioned meeting me, and she said no, that she never wanted to talk about anything that happened when she was, ahem, mumble mumble "inside". But in the background, I heard the phonograph playing. It was James Taylor's "Fire And Rain".
Some people say nothing ever happens by accident.
Other Bloggers On Related Topics:
Benedryl - Dartmouth Hospital - depression - ECT - Elavil - Fire and Rain - high-functioning - James Taylor - JoAnn Pflug - John Shuck - Lt. Dish - M*A*S*H - MAO inhibitors - OSU Medical Center - Parkview South Unit - Prozac - skies - Theodore Sturgeon - tricyclic antidepressant - Winston Churchill - zombie
