Death Grip (41 page)

Authors: Matt Samet

BOOK: Death Grip

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When the
DSM-IV
came out, in 1994, it had grown to 886 pages and boasted thirty-two tasty new entrees. The latest iteration, the
DSM-IV-TR
, which came out in 2000, contains 365 different diagnoses (and there is a
DSM-V
under way, due in 2013). But the book is not some pure, unsullied holy text, free of pharmaceutical industry complications: Ninety-five of
DSM-IV-TR's
170 contributors had financial ties to drug companies, including, wrote Marcia Angell in
The New York Review of Books
, “all of the contributors to the sections on mood disorders and schizophrenia,”
13
and a recent study of 141 members of the work groups drafting the
DSM-V
found similar numbers, with 57 percent having such linkages.
14
The book is now so heavy you could lobotomize someone with one whack to the head. The result of this disorder multiplication has been that the boundaries of mental illness are pushed farther into the realm of normalcy. It's prime new real estate the drug companies have been happy to claim, for example GlaxoSmithKline marketing Paxil for the nebulous “social anxiety disorder,” a pathologization of what we once called “shyness.” Or most nefariously, “childhood bipolar disorder,” a murky catchall that lets parents and schools medicate the unholy hell out of “irritable” children, sometimes to death, as in 2006 with four-year-old Rebecca Riley of Boston, who had been prescribed Depakote, Seroquel, and Clonidine.

We must imagine that psychiatrists keep a brain with perfect chemical equilibrium in a vault somewhere in the Psychiatry Super Friends Fortress of Power, probably next to the cryogenically frozen “Ideal Human Being”âone with no quirks of character, mood fluctuations, or anomalous personality traits. Otherwise, none of this polydrugging, electroshocking, overdiagnosing, off-label prescribing, overprescribing shitshow would make sense. Otherwise, this taking of marginally anxious, depressed people and this placing of them on four, five, six, or seven drugs designed for hardcore mental disorders like psychosis and schizophrenia would be morally reprehensible. Otherwise, this instatement and removal of powerful psychoactive drugs with careless haste, this abandonment of patients to find their way alone through the desert back to chemical-free living would be abominable. Otherwise, promiscuous psychiatry would be one of the most frightening and objectionable trends in the world, up there with corporations filing patents for the human genome. If we keep heading in this direction, you might someday be able to open your thirty-thousand-page
DSM-XI
and see a yearbook photo of yourself, right next to the label “Your Name Here Disorder,” perhaps even with a logo of the pharmaceutical company sponsoring your personalized genetic therapy.

However, the good news at least for now is that you can still walk away. No one is
forcing
you to take drugs. They're out there, they're for sale, and they have their dangers, but unless the courts, jails, hospitals, your family, or you yourself have mandated it, no one can stand there and make you swallow pills. You do have some minor say in the matter. For this, I am grateful.

I'm not oblivious to the fact that I put all those pills in my mouth and swallowed them thousands of times: for use, for abuse, for whatever you might call it. I do share some responsibility. And from a psychiatrist's point of view, I'm sure my history looks somewhat inevitable: a continuum of anxiety and depression reaching back to my parents' divorce at age ten, reappearing in high school as agoraphobia, and then thanks to poor self-care finally becoming chronic depression and a panic disorder in my early twenties, all with intermittent bouts of substance abuse that eventually fostered a mood-cycling disorder. To them, I am a classic addict-neurotic in need of ongoing pharmaceutical intervention. But again, from where I sit, this paradigm only served to make me sicker, crazed and fragile in a way that I have not felt since shedding the drugs. Bad things happened in my life that might or might not have sensitized me to anxiety, but that doesn't mean they permanently define my identity. All such thinkingâand a search for an external, chemical fixâever did was strip away my personality and extinguish every last vestige of hope.

In 2011, Dr. Ashton released an update to her original manual, called “The Ashton Manual Supplement,” an important document I'd urge anyone interested in the subject to read.
15
In it, she laments the fact that little clinical progress has been made since 2002, when the manual first came out; that the pills are still overprescribed globally, “often in excessive doses, and frequently for too long,” with prescriptions on the rise in some countries; and that doctors on the whole still lack the expertise to help long-term users taper. However, Ashton also extends a sprig of hope: Based on a CAT-scan study of a small sample of longtime users, benzos likely don't cause lasting
structural
damage to the brainâno “death of neurons, brain shrinkage or atrophy, etc.”âbut instead might only cause
functional
changes. That is, even if you take benzos for years, you haven't permanently fried your hardware; it's just that the software runs a little differently. This is incredibly hopeful, especially given what I've been through. It affirms the fact that I can remain the primary architect of my reality now and forever. To me, despite any lingering symptoms, this more than anything equals a full recovery.

“It is important to remember that by far the greatest majority of long-term benzodiazepine users do recover from withdrawalâgiven time,” writes Ashton in the supplement. “Even protracted symptoms tend to decrease gradually, sometimes over years. The brain, like the rest of the body, has an enormous capacity for adapting and self-healing. That is how life survives and how ex-benzodiazepine âaddicts' can be optimistic about their future.”

Optimism about one's future: It's all I ever asked for during the worst years, and it's the one kindness that the doctors never extended. Hope: It used to be a four-letter word to me in my cynical, druggie years, but now it's everything. If my friend Andrew hadn't given me hope that day in September 2006 after my blowout at Rifleâif he'd yanked the wheel left to take us to the hospital instead of continuing straight up the highway to Carbondaleâhope would have vanished for good. The doctors would have put me back on psychotropic medicines, maybe even benzos, and I wouldn't have had the strength to taper again. I would not exist, this book would not exist, and you'd not be reading this last word here.

APPENDICES

Web Resources

Useful sites for further information about benzodiazepines and benzodiazepine/psychiatric-medicine withdrawal, as well as support for those going through withdrawal:

â¢
benzo.org.uk

â¢
The Ashton Manual:
benzo.org.uk/manual/index.htm

â¢
benzobuddies.org
(with a forum for advice and questions)

â¢
benzosupport.org

â¢
bcnc.org.uk/

â¢
paxilprogress.org/forums/