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I first tried to read Sylvia Plath’s novel The Bell Jar twenty years ago, while I was in college.  But I got about fifty pages in, just to the mass food poisoning scene, and I quit.  And I didn’t pick up the novel again until this past weekend.

I wish I’d finished the book twenty years ago;  I also wish that I hadn’t had a serious case of OCD and depression, both of which are what stopped me from finishing the book.  I had such fear of food poisoning that I couldn’t even read about it. How’s that for neurosis?

Esther’s descent into depression is one I’m well familiar with, and Plath is able to nail it with poetic language and startling imagery.  Esther seemingly has it all:  she’s smart, driven, focused.  She wins a scholarship and travels to NYC.  But during this trip, as in everywhere else in her life, she fails to connect to others.  As she grows more and more depressed and realizes that she can’t envision her future, she starts planning her suicide.

Esther becomes very paranoid about others; as her own confidence fails, as her disinterest in her life grows, she begins to distance herself from others, and from her life.  This is classic depression:  losing interest and beating a quick retreat from everything.  If life is too painful, just quit.

After Esther makes a good attempt at suicide (modeled after the author’s own first attempt), she is sent from hospital to hospital, eventually ending up in a private country club sort of facility, the 60’s version of a psychiatric hospital.  She has shock treatments, first at one hospital, then the private hospital.  There aren’t many details about the treatment itself, but it was common at the time.  ECT is still in use today, but not as common as chemical treatments.

The other treatment Esther is given is Insulin Shock treatment, which makes her gain weight, but seems to have little other effect.  Talk therapy is ineffective as well, so what is it that changes so that she is freed from the hospital?  Is it time that makes her better? Is she really better?  Is she back to her ‘normal’ self?

In the throes of depression, this is a thought that often surfaces for me:  why can’t I just be myself again?  The problem with this line of thinking is that, most likely, I wasn’t really feeling like myself before the sudden onslaught of depression, and most likely was already feeling unlike myself.  Romanticizing the past (and thinking of what you’ve lost or given up) is detrimental to you, but it’s a self indulgence few can resist.  Esther is no exception:  she looks back at her life and wonders why she couldn’t enjoy her achievements.

Again, is she cured?  Has she improved?  In the last few pages of The Bell Jar, Esther’s thoughts:

“I took a deep breath and listened to the old brag of my heart. 

I am, I am, I am.” 

Bragging over still beating, or bragging because she failed at her suicide attempts?  The ending can be seen as positive, with Esther returning to school and leaving the hospital.  But what has changed?  Is she cured, or will she return to a similar state in the future?

The answer depends on your view of mental health and psychiatry.  There are no known cures for depression or anxiety or bi-polar disorder; there are only ways to control the symptoms.  Every generation has its panacea for these ills:  electroshock therapy, lobotomy, life commitment.  Our generation has seen Prozac and other SSRI’s claim to battle our ills with little white pills.  Even further in our past, there were holes drilled in heads (trephining), blood let from our veins.

Mental illness doesn’t happen in a vacuum; it’s more of a spectrum.  It can also be episodic, with remissions lasting years, decades.  I don’t know what happens to Esther after she is discharged from the hospital, but i do know what happened to the author.

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This year began with a bang, and the pattern continues. 

Patterns:  this is part of what life with OCD is made up of.  Patterns, rituals, behaviors that seem like habits but are much more deeply rooted. The accompanying anxiety comes just at the moments it should, and is comes out as everything from anger to tears to pacing the room. 

The tears hit me the hardest; tears are the classic sign of weakness. You’re either crying like a girl or like a baby, both of which diminish the underlying reason. Both minimize the fact that crying can be a response to anxiety, overwhelming fear.  Feeling weak undermines confidence, which is said to be a factor in anxiety.

My ‘anxiety spiral’ goes something like this:  

Big/scary event===> anxiety===> rituals/tears/attacks===> SHAME, loathsome thoughts===> harsh rules to control===>more anxiety

I know it’s difficult to understand the kind of debilitating anxiety that some of us suffer from because at some point, most people feel anxious or nervous about something.  But this is different; it’s not just nerves, it’s literally a stress response to life or death; it’s the flight/fight response gone out of control.  It’s having a three hour anxiety attack in response to just lying in your own bed, your own personal safe spot.  It may just be a matter of semantics:  Anxiety is an all-purpose term, and does not describe my feelings exactly. 

Just get over it:  this is the pat response that I’ve heard more times than I care to remember.  If I could indeed just get over it, then it wouldn’t be a daily life issue.  I’d just get over it and move on to the next issue.  But I’m stuck; this is the hill or mountain that I can’t seem to get over.  Aren’t metaphors fun? 

I had a medical procedure scheduled for this morning.  My spiral started yesterday afternoon, after I’d done all of the chores I could think of and had nothing left to occupy my mind.  I got angry; I picked fights.  I drank chamomile tea.  I watched the Grammy awards and tried to think of anything else but this appointment.  Nothing worked; my thoughts grew obsessive and by midnight I could think of nothing else.  I lay awake until nearly 2am trying to convince myself to do this thing. 

I cancelled 30 minutes prior to the appointment. I feel guilty and the tone of the receptionist’s voice made me feel even more so. 

Amazing the capacity of others to make you feel badly for cancelling an appointment or rescheduling.  Shouldn’t healthcare professionals have more empathy?  Shouldn’t they be more understanding of anxiety?  I may be asking for too much. 

The thing is, I have fairly severe anxiety.  It’s been worse over the past year than it has my entire life.  My file reads like a case in the latest DSM.  The numbers are adding up:  300.3, 300.01, etc. (An amusing aside about numbers: they figure heavily in my OCD thoughts, and revolve around the number 3.  Irony is fun, isn’t it?) 

Louis Menand wrote about anxiety in The New Yorker recently; she reviews a new book written by Scott Stossel titled 
“My Age of Anxiety” (just out this month).  Menand not only discusses Stossel’s book, but also the (short) history of modern psychiatry, and the mentality of the way in which we (in America) approach the subject, both philosophically and medically.  Where does anxiety come from?  How do we treat it?  Depends on who you ask, really.  If you ask Big Pharma, anxiety is a transmittable disease and pills are the answer.  Ask a Freudian, and it’s psychoanalysis.  Ask a nutritionist, it might be a vitamin deficiency.  

What I gathered from reading the review (and a short excerpt of Stossel’s book in The Atlantic), is that no one really knows where anxiety comes from.  Could be genetics, could be environment.  Could be the stress of Modern Life.  Could be a stew made of all of these things.  And treatment might focus on many things.  And, most importantly, there’s no cure. I think this is the downside of Stossel’s book:  he has severe anxiety and self medicates, but nothing really works for him.  For another sufferer of anxiety, that’s downright terrifying.

Modern psychiatry has given us some hope, there are some pills that do work for some folks.  Yoga, meditation and diet changes work for others.  I’m hoping some combination of these things will help me, and soon.  I don’t mind feeling bad about missed appointments, but I do mind feeling anxiety for no reason.   

 

 

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