Why Psychiatric Drugs Only Do Half the Job

tmb_5097_480First, if you haven’t read this article  – The Problem With How We Treat Bipolar Disorder  – in the NYT, please do.

I’m fortunate. I was diagnosed with bipolar disorder at the age of 26. It was a very mild version of the disease, the drugs (Tegretol) worked well for me, and I was lucky enough to be treated by an excellent psychiatrist who was also a Jungian psychoanalyst. I don’t want to get into different flavours of mental health treatment, because that would fill several books. What I’d like to strongly advocate for is ‘talking cures’.

If now, at the age of 50, you encounter me relatively sane, I can assure you, it’s not the drugs. It was 4 years of weekly (sometimes bi-weekly) work with a very talented and compassionate man who cared about the totality of my personality and not just hell bent on curtailing my obsessive, insomniac work ethic, or my propensity for sleeping with anything that caught my manic eye.

I won’t describe my descent into psychosis. It followed pretty much the same trajectory it always does. What I’d like to describe was my ascent into sanity and, more than that, back into creativity.

The problem with almost all the pharmaceutical approaches to treating mental illness is that they leave you feeling like half the person you were. Yes, you’re in control of yourself. You have a far better grasp on some semblance of objective reality, but it is through a very hazy, weary eye.

After about 20 days of stepped, increased dosage, the Carbamazepine (Tegretol) worked its way past my blood-brain barrier, life became manageable. At first, that was a real relief; it felt good to stop feeling like I was trapped in a speeding car with no breaks. It was wonderful to notice that I did not consider hanging myself from my closet railing as a viable option anymore. But it became clear, very soon, that I had not come back whole.

Many mental health professionals simply write this off as patients missing the elation of their mania, but my doctor knew better. He had done extensive work with bipolar disorder. He’d pioneered the use of the anti-convulsant drug Tegretol, at a time when there was only one accepted treatment: lithium. He’d lost his position at a university battling the established order.

From the moment the drug kicked in and my weekly sessions with him began, he told me: you do not want to live on this drug. If you are patient and do the work, over the long term, we can wean you off it eventually. And perhaps, there will be times when you have to go back on it, but hopefully we can prepare  you well enough to know when that will be. You need to learn yourself. I’m going to help you.

Thus began four years of the thorough and intense examination of the landscape of who I was under a variety of conditions. I cannot lie; many of my weekly sessions with him were boring for both of us. There were times when I felt truly sorry for him, having to take me over the same territory again and again. There were times when I resisted him, fought with him, was rude, hostile, poisonously sarcastic, incredibly uncooperative and doggedly held onto the secrets of my past and how I had been formed. To say that man had the patience of a saint would be not only an understatement, but an insult, because he was a devout Buddhist.

But every week, he’d ask what I had created. At first I’d just lie and make up something, but week after week, it became clear that, although the Tegretol was controlling my moods very effectively, it had also made me a thoroughly uncreative human being. My mind had become stable but utterly unfertile. This, although I didn’t really grasp it until much later, was his concern. He pegged me as an essentially creative person, and his goal was, ultimately, to restore me to that state.

In the middle of the second year, he began to lower my dosage. The first time, I immediately returned to a hypo-manic state. It felt good, but I reveled in the crazy. I was far too in love with the rush of it to notice I had given up any self-mastery. Up went the dosage again, and we went back to work. The work entailed deconstructing what I loved about my manic state, but what the dangers of it were. The next time we dropped my dosage, I was fine for a while, until I hit a very stressful period in my work. Then I lapsed into an almost catatonic depression. Back on the full dosage, we examined what had precipitated the downward spiral, and I learned that a combination of helplessness and sleep deprivation was the trigger for my depressive episodes.

He was teaching me to understand that although bipolarity was primarily a genetically inherited condition, there were environmental triggers. That if I could recognize these early, avoid them, mitigate them, I could eventually do without the drugs. It wasn’t enough just to recognize them. I had to understand what, uniquely to me and the constitution of my personality, made them dangerous conditions.

I’d like to say that, after four years of analysis, I went off the drugs and never looked back, but that isn’t the case. Life is unpredictable. It’s simply not always possible to avoid the things that make me ill.  But one of the longest lasting gifts my psychiatrist gave me what the knowledge that creativity is integral to my personality. It allows me to make very creative decisions about what I do and how I live. That nothing is truly impossible, sometimes it is just hard to achieve and I can’t always get it perfectly right, but compromise isn’t defeat – it’s a creative act of negotiation with my environment.

Five years after I first fell ill, I began a new career as a graphic designer. I had been a musician. At one point, I would not have been able to imagine doing anything else. Psychoanalysis helped me learn that although I felt truly realized as a songwriter and a performer, the environment of that particular industry would place me in positions where I absolutely lacked control. Where I could find myself in positions of a poisonous combination of stress and helplessness, and this was not survivable for me unless I was on the drugs – and that would render me uncreative. It was a catch-22 situation. I needed other, more controllable avenues through which to be creative.

It was the dawn of the internet, and I became very interested in its visual technologies. I quickly taught myself how to translate my visual creativity into digital mediums. Yes, I had difficult clients, and yes, there were times when I found myself again in those positions of stress and lacking control, but I learned to back away from those situations.

At the age of 37, I started writing creatively. This was a danger for me. Because my father was a writer from whom, in my youth, I had sought but never received any encouragement or support. It is a testament to my psychiatrist that, without even being conscious of my decision, I chose to write in a genre that would mean I would never be able to seek – and fail to obtain –  approbation from my father.

I firmly believe it was all the incredibly hard, boring, navel-gazing, history rehashing work I did with my doctor that equipped me so seamlessly and elegantly to make the decision to be a creative writer in a way that would not trigger my illness.

People belittle ‘talking cures’. They see them as a waste of time and a waste of money. We live in an age of miracle drugs and there is no doubt that many of the drugs that treat mental illness are incredibly helpful. But they don’t address the patient as a sovereign person, they address them as a working cog in the wheel of society. They make us good citizens, but not complete people.

What I was lucky enough to have is a doctor who cared more about who I was as a singular human being than that I was just a safe, manageable peon. It occurs to me that we are probably missing a lot of very bright lights, eclipsed on a regimen of drugs, kept docile and harmless and ‘sane’ with pharmaceuticals.  We need a lot more mental health professionals who act, not as mental keepers of the peace, but enablers of complete lives. Sadly, our society has little value for them anymore except as the butt of jokes about Freud.