David's Inferno (23 page)

You don't have to walk down more than one big-city block to realize that virtually
everyone
is doing
something
to manage their moods … in many cases, making life more challenging for various parts of their bodies and society, in the process. Can I offer you a double-latte? How 'bout a burger and fries? Hi, kids! Would you like a 32-ounce soda?

In the name of full disclosure, here's the complete list of things that I've taken to regulate my moods over the last 50 years or so:

Everyday:
(not
every day
, mind you) Sugar, coffee, black tea, green tea, herb tea, and various other over-the-counter drugs including aspirin, ibuprofen, acetaminophen (and their nighttime versions), naproxen sodium, and various cold remedies.

“Alternative”:
Vitamins, minerals, run-of-the-mill herbs, Chinese herbs, homeopathic remedies, and those mysterious glandular supplements whose source I never really liked thinking about.

Controlled:
Cigarettes, wine, beer, and hard liquor of all kinds, including long-term relationships with cognac, bourbon, and Irish whiskey (fortunately, not at the same time). You'll be happy to know I gave up cigarettes in 1988.

Illegal:
Marijuana—including brownies and tincture—hashish, mescaline, LSD, mushrooms (although, as I remember, I didn't get off), MDA and its more famous bastard child Ecstasy, cocaine, and the very occasional amphetamine. No needles.

Prescription:
BuSpar, Celexa, Klonopin, Cymbalta, Depakote, Effexor, Lamictal, Lexapro, Lorazepam, Lunesta, Ambien, Seroquel, Valium, Wellbutrin. And let's not forget Versed (the best reason to
have a colonoscopy) and nitrous oxide (the best reason to have a root canal).

I provide this shockingly extensive (even to me) list in order to explain why I will not be running for president and to remind us that, whether consciously or not, we all try to fine-tune our synapses. On the one hand, it's kind of sobering. Shouldn't we be satisfied with the simple gift of being alive? On the other hand, isn't it amazing how willing we are to explore new ways to feel, think, and be all we can be?

Regardless, if the extensiveness of this list makes you feel I “deserved” to be depressed, that's fine. If it makes you feel I'm lucky I'm not dead, well, I'm not sure how much luck had to do with it. If it makes you think I should have my own talk show, maybe you should think again.

It'd probably be best if my grandchildren or yours don't read this until they're grown up … if ever … but, before you cast the first stone about what anyone else ingests or inhales, you might want to see how many words you can check off above.

To quote Paracelsus, “No thing is without poison. The dosages make it either a poison or a remedy.” Whether we praise, judge, ostracize, or jail people for ingesting one of these substances is based largely on current societal norms.

Admittedly, safety is an important issue. But let's not forget that cocaine used to be in coca cola, ibuprofen used to be only available by prescription, vitamin D therapy is now mainstream, prescription drug overdoses are now the leading cause of accidental death, marijuana is being legalized, and a few people have almost died through an overdose of
bikram
(hot yoga).

For some people, self-medication, particularly with cigarettes and alcohol—plus generous amounts of sugar, caffeine, and chocolate—may lead to longer, more enjoyable lives; lives in which their depression is at least manageable. For others, the same things may lead to deeper sadness, addiction, and even death.

I'll never know whether all these different forms of self-medication precipitated my breakdown or, on the contrary, delayed it
for many years. Certainly, I exhibited depressed and hypomanic symptoms back in elementary school—well before I'd even heard of most of the stuff on this list.

We all have the ability (and, I daresay, right) to try to feel better—however we experience that. It's one of the things that make us human. And the way we use that ability is an essential part of our individuality … for better or worse, in sickness and in health, 'til death do us part.

Understanding and regulating our moods isn't rocket science. It's way, way, way more complex than rocket science.

H
ELL IS OTHER PEOPLE
'
S OPINIONS
. Dante was pretty lucky. Except for that sign telling him to abandon all hope, he only had two people giving him advice—Virgil and Beatrice—with a little
kibbitzing
from a few other folks they introduced him to along the way. Since no other
living
person had ever been in those realms before—and the Internet hadn't been invented yet—if Virgil told him that the way through Purgatory was to walk stooped over, find his way through thick black smoke, or stroll through a wall of flames, he couldn't exactly get a second opinion.

I was lucky too. With very few exceptions (actually, none I can think of at the moment), my family and friends didn't second-guess the various paths I chose to negotiate my personal purgatory. They shared their ideas, made appropriate suggestions, and only gave opinions or advice when I asked for them.

But many people aren't so lucky. They're continually dealing with the opinions of family, friends, and casual acquaintances.

There's always someone who's just read something in a magazine or book about how there's a new medication that works better than all the previous ones combined; or that placebos actually work even better; or that the right combination of herbs or amino acids or both will definitely make you feel better “without any side effects”; or that if you'd just give up sugar, alcohol, coffee, and/or sex, you'd be fine in no time at all.

They'll tell you about some psychic or energy healer who cured someone they know in three seconds flat. Or worse, tell you that someone they know saw the healer
you're
seeing and got way worse. They'll say you should just snap out of it. They'll say you should take a vacation. They'll say you should read this book or that book, listen to this music or that music, go to this self-help group or that self-help group. Oh, and by the way, depression is genetic so you better keep an eye on your children.

Maybe it was better when people were in denial. When everybody wished that whatever was bothering you would just go away. At least then, you could suffer in peace. Just kidding. Kind of.

The hardest opinions to deal with are those of so-called “experts” on TV, radio, newspapers, magazines, and most of all, these days, the Internet. (Even I wasn't totally immune to those.) With 43 million search results and counting, finding your specific solution under “How to Cure Depression” takes on trappings of the quest for the Holy Grail.

Most of these sources of information are well-meaning. Some are well paid. Many acknowledge that in
some
cases of
major
mania or depression, you can throw their theories out the window … although you can always tell they're including that caveat with a certain reluctance, as if it were fine print. (You gotta say one thing for drug companies. They spend a lot of time and money telling you the ways their cures might
not
work. Of course, “We the People” had to pass laws to make them do it, but sometimes it seems that they go overboard.)

All “cures for depression” work some of the time. A few work a lot of the time. None work all of the time. Having people second-guess you just increases the sense of self-consciousness, self-criticism, and terminal anxiety about doing the “wrong” thing that nips at depressives' heels all day. Nothing wrong with gentle suggestions. Gentle. Non judgmental. Given with explicit or implicit permission.

Maybe the fine print on every article about depression should be the Socrates quote above.

I'm always surprised—and, of course, occasionally astounded or annoyed—when people have the
chutpah, hubris
, or clinical narcissism to believe that their perspective on mental illness represents any kind of ultimate truth.

My
perspective, of course,
does
represent the ultimate truth! I think everybody who writes about depression should start their article, book, or blog with the following:

These are all legitimate reasons to write about mental illness—although
several are somewhat suspect. I'm a Category #2 and #3 kind of guy myself. More important, the health professionals I've trusted have implicitly fit into Category #6.

Many people have serious objections to the use of prescription drugs. And yet, for each, there is a balancing point of view:

Spending on antidepressants is bankrupting our healthcare system
.

What isn't bankrupting our healthcare system? Mental illness represents about 7% of our total healthcare costs. Undoubtedly many people could deal with their mental health problems in less costly ways. (Ditto, by the way, for many physical illnesses.) The federal per diem
base rate
for
inpatient
psychiatric care is about $700. The
per diem
cost for even three
brand-label
psychiatric meds would rarely be more than $40 … and often
way
less. A savings of $660 per day if those meds manage to keep you out of inpatient psych. This book is about people, including myself, who have major depressive episodes that severely impact(ed) their ability to function. People who could, if things got worse, end up hospitalized. In our cases, meds are a bargain—in more ways than one.

Different drugs are popular during different decades (e.g., tranquilizers in the 1950s and 1960s). So, clearly a lot of diagnosing and prescribing is based on what's trendy
.

What's wrong with being trendy? Attaching electrodes to a patient's brain … a treatment that was trendy for a while and then considered, uh, shocking, has become far more sophisticated lately and is now being used again with reasonably good results. Eventually, prescribing meds will
not
be considered trendy … probably soon. Something else will come along. I can't wait to try it. But, I won't be first in line.

Prescription medicines may help one disease, but throw other things off balance
.

That's true of all “interventions,” natural or pharmaceutical. Of course, by the same token, those interventions can bring a lot of other things
into balance
. The body does seem to try to maintain some kind of homeostasis and will use all the help it can get.