Coming of Age on Zoloft (29 page)

At twenty-seven, Denise said, she felt like she needed to start taking the same kind of responsibility for her emotional life that she had long been used to doing in the world of school and work. “I feel like I’m on my own,” she said. “I don’t have a family. I have close friends, but they’re scattered all over the place, so I feel like I’m on my own, which creates a lot of anxiety and issues. But I also feel like I’m teaching myself a lot of things. I’m introspective. I know what’s wrong. And I feel like I can do something about it.”

FOR DENISE, A
big part of feeling better about using medication was finding a doctor she could communicate with. In fact, improved relationships with doctors were a theme running through the stories of people who stayed on antidepressants. An alarming number of the people I talked to described having adversarial feelings about psychiatrists, particularly in their younger days. “I’ve never had a good interaction with a psychiatrist,” said Alexa, twenty-four. “Not meaning they were mean to me, but they don’t look at you as human.” Sophia, twenty, said she didn’t like entrusting herself to “psychiatrists who don’t know who I am, anyway. My last psychiatrist forgot I was anorexic! He asked me how the OCD was.” Nathan, thirty-one, remembered feeling objectified by psychiatrists’ diagnostic labels. “Once you’re put into that hole, that category, I don’t feel like curing the person is even something that enters the doctor’s head anymore.”

Others, though, reported that their relationships with doctors improved over time; as they got older, they learned what they liked and didn’t like in a doctor-patient relationship, and came to feel that they had more power in the exchange. Heather, thirty-nine, said that she had a string of psychiatrists in her teens and twenties whom she disliked or found ineffective—but that by now, she’d become much better at picking doctors who will give her the care she needs. “Now I feel like I’m pretty much an expert at it,” she said. “I can tell immediately if I like a doctor or not. I had a doctor not that long ago who had a fancy office with Oriental rugs. He had a scale, every time you went he would weigh you, he’d type everything into his computer. But I was on something, some medicine, and I was on too much of it; my hands were trembling all up my whole arm, and I was just like, ‘I feel crazy with this arm shake.’ I’d complain about it a bunch of times and he was just like, ‘No no, stay on it, we’re doing good.’ A lot of doctors don’t want to mess up their track record by listening to the patient [and changing] the medication again. And then I stopped going to him, and got another doctor I’m going to now, and he is good. If that much is off, he’s going to change it up for you.”

Denise also wasn’t the only person who described medications as a “tool.” The word popped up again and again, particularly among people who’d once felt dubious about using them. For these people, the word
tool
was a metaphor that allowed them to feel a greater sense of agency around medication: to think of an antidepressant as a tool is a way to emphasize the power that the user of the drug has over the decision to take it, and de-emphasize the idea that the drug might be controlling its user instead. “I didn’t like the idea of having my mood, my feelings, in some way my personality—I mean, that’s how I thought at the time—depend on some kind of drug,” said Elizabeth, twenty-five, about when she started to take antidepressants at fifteen, “because it felt creepy, and scary, and yeah, artificial.” She often felt “like I’m admitting defeat if I’m taking medication, like I can’t deal with something myself.” But, she continued, “I do see it differently now. I think there’s something to be said for the idea that if you can help take the load off, if there’s some kind of medication that works and helps you feel better, it is so much easier to climb out of a hole if you already have a shovel.”

Mia, an outspoken twenty-three year old, highlighted the role of language and metaphor in her own tempestuous relationship with medication. Mia described herself as a strong critic of “the mainstream mental-health system,” which she blamed for making her feel “broken and bad and wrong and Other and all these things” when her mother first started taking her to psychiatrists at age thirteen. After ten years of involvement with that system, Mia spoke of it in somewhat jaded terms. While she didn’t deny that her mother had reason to be concerned, she said that she was often nonplussed by the care she’d gotten. “I have been on every medication under the sun,” she said. “I’ve been diagnosed with everything from depression to anxiety to bipolar. I had a severe eating disorder in high school. I was diagnosed as borderline by one guy, I mean just endless anything—PTSD, body dysmorphic disorder, all these different disorders. And ‘Let’s blast things on her and give her drugs’ was sort of the thinking. Just a slew of chemical cocktails, from age thirteen till now.”

But despite being critical of the mental health system, Mia had to admit that she’d also benefited from that system. Like a lot of people she knows, she said, she struggles to balance the fact that “I hate the idea that something chemical could be helping me” with feeling that medication is useful or even necessary for her. While she cited a lot of sources of solace in her life, such as “learning how to eat well, and building community, and getting involved in activism and organizing when I got to college, especially around mental health and women’s mental health,” she also allowed that “I think the different medications I’ve been on, antianxiety, antidepressants, antipsychotics, some have saved my life at moments; I’m not going to say they didn’t.”

Mia said that over time, largely thanks to her activism and her reading, she’d become interested in how language and narrative shape experience. Gradually, she had devised a way of talking and thinking about herself that allowed her to take what she wanted from psychiatry and leave the rest behind. She said that she chooses to think of her problems as being tightly enmeshed with her personality. “I am an incredibly emotionally intense person,” she said. “I feel things deeply and strongly.” While she was comfortable seeking treatment, she refused to accept a narrative about being “ill” or “sick,” preferring to think of medication as something that she uses to manage her sometimes difficult temperament rather than something she uses to treat a disease. (She told me that while she identifies with many aspects of the DSM
-
IV description of the mental disorder known as bipolar II, she is careful to make a fine distinction: “I am
not
bipolar II. I
have
bipolar II
tendencies
.”)

Mia’s philosophy has led her to invent her own style of interacting with mental health practitioners. “Whenever I go to start a new relationship with a new provider of whatever sort,” she said, “they’re a provider to me, they’re not—perhaps they are a doctor, but they’re not treating me, they’re not
fixing
me, they’re not fixing a problem.”

I don’t like to think of my experiences as problems, as illnesses. I have experiences; I’m sensitive, I’m intense, I’m passionate, I’m fiery. I am not broken. I say “crazy” with a very loving spin on it. I don’t like being identified as a patient. And so when I’m interacting with someone and they call me a patient, I tell them, “I’m a client here. I am a consumer, and I’m consuming your ser-vices.” I am coming to you, and what these words mean to me is that I want to interact with you as someone who is giving me a ser-vice. Just like I am not the patient of an acupuncturist, I am not the patient of the psychiatrist. You have a resource that I find helpful, so I am asking you for it. But that doesn’t mean that I am in your power. It’s not about “I am weak, and I am needy.” At times I feel weak and needy. But what I choose to do with that is an empowered choice, even in my weakness.

—Mia, age twenty-three

OF ALL THE
antidepressant stories that I heard, Anastasia’s provided the fullest example of the many adjustments that can lead a person from feeling that medication is hampering the self to feeling that it is supporting it. Anastasia was thirty-five, with big blue eyes, and curly brown hair stuffed loosely under a sporty stocking cap. She grew up in San Francisco, the only child of two college professors who separated when she was young. In person, she made a number of impressions at once, striking me as a unique blend of sharp, restless, idealistic, sensitive, tender, angry.

Like James and Denise, Anastasia reported that her early experiences with medication were mixed. She first began taking antidepressants in the midst of a rough transition out of college. “At college I had felt smart, I had felt validated, I had felt important,” she said—but figuring out how to enter the larger world with that sense of self intact was anything but obvious. After graduation, she continued, “I moved to Seattle, where I didn’t know a soul, and I was trying to figure out how to be myself in the world and I didn’t really know how to do that, in the working world.” Anastasia had studied fine art in school and eventually found a job working at a large commercial photography studio. The position was administrative, and the work didn’t provide Anastasia with any of the good feelings she remembered and missed from school.

Anastasia had been feeling low even before she took the job, and as the months went by, she became more and more severely depressed. “I was having to do this whole thing of going to work and pretending that I was okay, which was becoming almost intolerable,” she said. Her relationships with her coworkers, never good to begin with, worsened as she had a harder time concealing how upset she was and how much she resented her job. Laughing a little at the memory, Anastasia explained that when she found herself sometimes wearing a certain knit hat to the office, because she liked to imagine that it afforded her some kind of psychic protection from the toxic work environment, she decided it was time to take some action.

At the time, Anastasia had a therapist who recommended that she try an antidepressant; he referred her to a psychiatrist who got her started on Zoloft. “[Zoloft] allowed me to function at my job,” Anastasia recalled. “But it definitely didn’t lift me to any very tolerable level. It just sort of made it easier for me not to want to kill everybody at work and storm out in the middle of the day.” In fact Anastasia often resented Zoloft because she felt that it might be making her able to put up with a situation that she would have preferred not to be in at all. “I remember feeling a certain kind of anger,” she said, “and worrying, like, I used to joke that I was taking the drugs so I could keep the job. And there was something that seemed very wrong about that to me, for obvious reasons. You know, ‘Why should I be working at a job that I have to take an antidepressant to tolerate?’ ” In a way, she felt like Emily, the writer who believed that Prozac made it possible for her to perform in her career, but with one crucial difference—Anastasia believed that Zoloft was supporting a life that she wanted no part of.

Eventually Anastasia quit, took another job that she didn’t find so oppressive, and stopped using Zoloft. A couple of years had passed but, she said, she still hadn’t put down roots in Seattle the way she had hoped to. (“There were a lot of people that I would go to a bar with or a show with,” she recalled, “but I didn’t have that many intimate friendships.”) Her transition out of college still felt incomplete, and her career direction uncertain. She decided to spend some time traveling around the country, with the idea that a trip might give her time to do some thinking about herself and the future; she said she conceived of it as a “delayed adolescence.”

Things began to go wrong before she even left town. During the planning stages, “I fell into a state of being paralyzed and unable to make a decision about where I was going to go, so I started temping,” Anastasia remembered. “At this point, I wasn’t seeing a psychiatrist and I wasn’t taking meds, and I fell into an even deeper hole, where I was temping part-time and the rest of the time I was in my apartment, which was all packed up to leave, but I couldn’t leave; I was in suspended animation. Eventually I got out and went traveling around the country. I was riding around on buses and sleeping on people’s couches, except I was so distressed that I began to sort of think of myself as homeless. I was acting free and easy, but I was actually feeling really tormented.” The more she traveled, the more lost, illegitimate, and indecisive she felt. After several months all over the U.S. and Central America, “I ended up on a friend’s couch back in Seattle. I hit a wall and I was like, ‘I don’t know what to do with myself. I don’t know how to stop moving around. I don’t know where to live.’ I felt like I had lost my whole internal compass somehow.”

Like James and Denise, Anastasia was having an experience that would make her reassess her need for help. Using money that she had inherited when her grandfather died, Anastasia decided to check herself into a residential treatment program in the Northwest that she’d heard about during her time in Seattle. She stayed at the program for two months, and called her choice to go there “one of the best decisions I have ever made in my life.” At the treatment center, she worked with a psychiatrist who put her back on Zoloft and also on an atypical antipsychotic called Zyprexa, which Anastasia remembers as “kind of a miracle drug for me at the time. It got me out of the state of total paralyzed hysteria I’d been in for months.” Just as important, Anastasia said, the act of deciding to go into treatment made a difference in itself. “It got me moving,” she said, “and it created this internal sense of ‘I am taking this seriously, and I am doing something about it; my health is important to me.’ So I think the statement that I made to myself by doing that is part of what was healing about it.”

Going into treatment changed Anastasia’s attitude about medication, which she went from seeing as something she was using to make a bad situation tolerable, to something that she could do to create a better situation on her own behalf and no one else’s. She has continued to use medication since. Her experience hasn’t been trouble-free. She has reshuffled her regimen many times, often to try to minimize side effects; drugs in Zyprexa’s family are especially known to cause weight gain and metabolic changes. (“I used to make a joke, when I was on an antidepressant and a mood stabilizer,” Anastasia said, “that the mood stabilizer made me chubby, but luckily it didn’t matter because the Zoloft killed my sex drive, so you know, if I wasn’t appealing to anyone, I wouldn’t have to worry about wanting to be.”)