Chapter 3 Mental Health and Medication
After reading the previous chapter, you may think I am opposed to medication. I am not. Medication can be quite helpful, and has likely saved lives. I am not too surprised that people don’t seem to know a great deal about medication, but I am still astounded to meet people who have families telling them they don’t need medication. You need Jesus. Well, I Jesus was still doing the rounds, I’d give that shot, but in the interim- medication is reasonable. Why suffer needlessly from depression, when medication can help? The research is clear on this- you can get better with therapy, you can feel better with medication, and if you don’t both therapy and medication simultaneously- you maximize the benefits and likely shorten the duration of needing to take meds.
Many people won’t have to take medication for life. Some will. If you are diagnosed with Bipolar, you can expect to be taking medication for life- based on our present understanding of that condition. I am not a doctor- I am qualified to speak on drugs, and make referrals to a psychiatrist if med management seems appropriate.
Here is what you need to know about psychotropic drugs. They are not happy pills. They will not make you happy. If you are on the right med, the right dose, and have been on them long enough to have arrived at therapeutic levels- you should find that you have a normalized range of emotions. It’s not supposed to zombify you. If after about three weeks you haven’t acclimated to the medication, you’re feeling tired, having other symptoms you did not have previously, or had an increase in suicidal thoughts- tell your doctor. You are either on the wrong medication, or the wrong dose, and going up or down on the dose may change things. We do not have the ability to draw your blood and say you need X in your system. Yet. There is evidence that day is coming.
Again, medication is not a happy pill. Hypothetically, if you have never been happy in your life, and you get on the medication- you will feel different. Most people don’t like different. If you never felt happy in your life, if you never had a normal range of emotions- it will feel ‘unusual.’ It’s not changing you, you’re just used to feeling like crap. In terms of emotions, we are not supposed to be SixFlags. That’s exhausting. Up and down and around again. What humans are supposed to have is some happy, some sad, and whole hell of a lot of neutral. So, the right medication does two things- it adjust the amplitude- the height of the highs and lows, and it adjust the set point.
Imagine a zero line. No emotions. You’re walking and you come upon some flowers. You feel an increase in pleasantness. Flowers are nice. Most people feel nice. If you tend to ride above neutral, where you’re already happy- flowers take you to outer space, “yay, rainbow!’ with unicorns and Leprechauns popping out of the sky. Dead puppy brings you to zero. “Oh well. I ran over a squirrel yesterday. Life goes on.” If you were below zero, where you’re a little grumpy, not like dying or wishing you were dead, but it takes a little energy to get going, and anger can actually energize you enough to get going- you come upon flowers and your response, “Yeah, so? There’s a whole field there. Go pick yourself some,” and you walk on. Dead puppy takes you down to “Fuck, why is this world so hard, I want to die.”
We’re not supposed to get stuck. You’re supposed to feel nice with good things happen, and you’re supposed to feel bad when shit happens. If you’re not sad when confronting dead puppies or babies with cancer, I am going to wonder where your set point is.
One of the things that is necessary to explore when you come to a counselor is are your feelings appropriate. Right now, the world is fucking nuts. COVID has decimated the social and economic landscape. Public protests. Riots. Police clearly pushing back harder than seems warranted given legitimate concerns. People are afraid and hungry. People are genuinely concerned for themselves and their families. If you’re telling me you’re anxious, have you considered maybe you’re normal? People may not get jobs back. More people may be homeless in the next few years than we have seen in a long time. We as a society have not invested in sufficient Social Services to respond to the level of need this crisis has generated. It is likely to get worse before it gets better.
There are some serious reasons to be concerned. And if you lost a love one during the pandemic, well- I can’t even imagine. How many people died? How many went to a mass grave because funerals were not allowed? How many of us have suddenly realized we can’t trust elected officials. That one surprises me. I haven’t found one person who doesn’t agree that Jeffrey Epstein was a song of a bitch- and that it is very likely he was murdered. The highest profile prisoner of all time dies, with 8 malfunctioning cameras? And he’s linked to Presidents, and Kinds, and Princes, and- clearly the laws that regulate us don’t apply to people in authority? Seriously, you and friends go to a store and one of your friends shoplift- you all go to jail for shoplifting. They’re not even talking to Clinton. It’s the very thing that might make people want to riot- like seeing a man snuffed on television. Like seeing an old man shoved, the blood flowing away from his head.
We are in some fucking crazy ass times. And in some ways, it’s kind of surreal. How many of us are actually staying at home and we see this reality unfolding on television and YouTube…
Mental health problems are likely going to increase. We know for a fact that domestic violence and child abuse has gone up. One of the safety nets for children was the ability to go to school and have a break, and also mandatory reporters might get lucky and identify something that could be disrupted. Some people who were already likely suffering from OCD kinds of behaviors might likely become more tyrannical in policing their homes. OCD is hard to live with. People with psychosis can be hard to live with.
That doesn’t mean there isn’t a hope. One of the things I noticed, and was actually happy to see- the earth improved. Seriously, air quality improved. Visibility of waterways, like the canals in Venice, improved! Air in China improved! Who would have thought, just taking a break would allow the Earth to recover. It’s also true for humans. If they get a break, they recover- physically and mentally.
As an advocate for health, I recommend we all have like a three or four week mandatory vacation every winter, not just bankers and teachers. We take a break in December, allow the Earth to rest. We spend quality time with family, and disrupt the flu season by interrupting the chain of infection because we’re all staying away. Then we come back in January, not with the intentions of trying to catch up with a loss, but with the idea that this is a new year and chance to live in harmony with each other and the world. We need a new normal. We give lip services to the need to take care of ourselves, but rarely do we advocate for positive social change. When it comes to physical and mental health, it has always been better to be proactive than reactive. Maybe this is our wake up call. This is also medicine.
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Something that interests me in medication is there are some people who absolutely do not want to take meds for any reason, will have lots of rationale for not wanting it, many of which I find valid, and yet- they’re using street drugs and or alcohol to self-medicate. I am quite open about drugs, and likely unconventional in my approach. If we can’t agree on zero, I am super okay with harm reduction model. I do not like stage of change model. I can use it, but I find it over all unhelpful. I also tend to prefer dual diagnosis, leading with a Mental Health diagnosis- because I suspect that most people use due to an underlying, untreated mental health conditions. Is that always true, no- of course not. There are some people who say they just like drugs. Okay. I can accept that reality, too.
I also like it when I asked if people use drugs and they say no, but it turns out later- they use cannabis. Lots of people don’t think it’s a drug. I am not sure where that comes from. Caffeine is a drug. Nicotine is a drug. Alcohol is a drug… “But dude, it’s called drugs and alcohol, right?” Okay. You got me. Chocolate is a drug. Probably not going to OD on chocolate. Probably not going to OD on cannabis. But here’s when you might need to consider it’s a problem. If you’re parole or probation and using can violate you, but you can’t stop long enough to complete your obligation- that sounds like a problem to me. Jail, smoke this joint… That one sounds like a no brainer. Also, in Texas- the state will take your kids if you’re using- even if it’s ‘just cannabis.’ I know parents who have an active CPS case, the kids are removed, and they won’t stop. That’s a problem. I have this bias that I assume everyone will do whatever it takes to not lose their kids.
One great thing about a being a counselor, I never get picked for jury duty. So, there’s this case where the bio dad had a lawyer, the guy’s girlfriend had a lawyer, the ex-wife had a lawyer, and CPS has a lawyer. And the CPS lawyer, was making this argument: “So, if the guy was doing cocaine, you’d want us to take the kids-” and people kind of nodded. “If it was meth?” Yeah, there seemed to be consensus. “What it was cannabis? And only on the weekends that he didn’t have the kids?” And I laughed out loud. A real LOL. Lawyer runs his finger on the map. “Mr. Ege, can you explain that?”
“Yeah,” I said. “If the state deems it necessary to take all the kids from all the parents using marijuana, the state’s going to need a bigger nursery.”
The judged LOL. Layers all agreed I was dismissed.
You can be mentally ill and have your kids. You can be homeless and have your kids, sleeping in the care with you. But fuck, if you test positive for cannabis they’re yanking your kids? Texas is stupid, and might be the last state to legalize cannabis use, even with Oklahoma over their flashing their medical license for it. Seriously, we don’t need license for it- just legalize it the same as alcohol.
As for alcohol, I am not a fan. Several significant family members abused it. One still is. It’s so bad for her she has alcohol induced psychosis. I have some personal bias with this one. But I can tell you this much, in metaphors.
People think alcohol allows them to sleep. It does not. It actually interrupt sleep. This is how it does it. Imagine a car. You have an RPM gauge that tells you how the car is performing. Cars idle at 700 to 900 RPMs. Cars drive in the 1,200 to 2,400 RPM range. Car rev up to about 6,000RPMs when one switches gears, but drops back to normal driving RPMs. If you put jet fuel in your car, your car now runs hotter. You’re idling near 2,400, you’re driving in the 4k range. You keep driving in this condition, you will likely blow out your motor.
Drinking alcohol is the equivalent of putting jet fuel in your car. You’re now running at full performance speed. Your brain is running at full performance speed, even when you’re passed out. Being blacked out or passed out is not the same as sleep. If you go to a hospital for surgery, they knock you out. You wake up groggy because they knocked you the fuck out. Normal sleep means your brain drops down into idle- like theta waves, this is where you get your best dreams– but with alcohol in your body, you’re brain and body is metabolizing as if your car is still on the freeway.
I am not telling anyone they shouldn’t drink. It took me a long time to where I could even drink a glass of wine because so many people in my family were abusing drugs and alcohol that I didn’t want to have anything to do with it. It wasn’t that I feared addictions. No one gets out of a family suffering from addictions without something. I spent years in depression and anxiety, suffered from OCD. I was isolated throughout most of my life, but it was significantly poignant in my teenage years- because there was no way I was bringing anyone home- and I was so weird I didn’t even know how to socialize. Brother got his first dose of heroin at age 14. My father smoked three packs a cigarettes a day for forty years. He’s dying of COPD… This was not good for my family. My mother is the kind of nuts that comes from experiencing generational physical and sexual abuse- I swear if you look up personality disorder, you will find her picture. The first time she attempted suicide, I was seven.
Lots of people suffered from diagnosed and undiagnosed mental health problems- yeah, people were self-medicating, and in that- more abuse came in the front door made itself at home. I am not a fan. I have suffered from persistent suicidal thoughts since childhood. I ran away from home age 6, which resulted in me being brought back home and to a psychiatrist at Scott and White Hospital, Temple Texas. I have been in and out of counseling throughout my life, on and off antidepressants.
It’s my relationship to OCD that makes me think ADDICTIONS and OCD are really one and the same, if not kissing cousins. One of the distinctions made is that OCD isn’t a compulsion that leads to the experience of pleasure, whereas addictions are. OCD is a form of thought suppression. Addictions are the same- in that, people don’t want to feel something, so they take a drug to feel something else. If we assume thoughts and feelings are integrally linked, then both OCD and addictions is a form of suppression of something in the inner psyche that the personality has locked down on because facing that is tougher than anything else it has to contend with. It is my opinion that we need more openness about drugs, more conversations, and we need to stop criminalizing this. It is a medical problem. A mental health problem. I know hearing that messes with people’s heads because they will say, “depression just happens to people, but people choose to do drugs.” I submit they don’t chose. We know there is a genetic component with alcohol. Native American are especially susceptible. We don’t know how many drinks turns on that gene, but once it’s on, it’s on. Yeah, they still chose to drink that first drink- but how many of us actually engage in things that on the surface innocuous, but in times causes harm?
This thing is complex, and it’s a bio-social-psycho thing. Better social understanding results in different outcomes. Better biological understanding of how things affect us. Better understanding psychological states and how those change under the myriad bio-social factors is also necessary. We need all three to get better outcomes. We have lots of challenges in our society, but this shouldn’t be one of them. We have too much knowledge at our disposal. We bring it into the open, and maybe we can reduce the harm that happens when people are trying to skirt the radar. When you think about the people that get hurt, killed, or rape- looking for their fix- the last thing you should be looking to do is assess blame. More than likely they are looking for a fix because they got hurt or molested earlier in life, or didn’t get a fundamental need met.
Whether you consider dual diagnosis valid or not, people using are suffering- and when any person in our society suffers, we all suffer.
If you are struggling, there is help available. Quitting some drugs, and alcohol, can be deadly and so medical advice should be sought. “The Easy Way to Stop Drinking” and “The Easy Way to Stop Smoking,” both by Allan Car was found useful by several of my friends who were not fond of the AA model. I personally do not believe in will power. For example, I am more salt and spicy person, not a sweet person. If you set a cookie on the table, I will not eat it. The first time I pass it. Or the second time. But every time I pass that cookie, I am thinking ‘why is that still there?’ It’s going to go waste. I can’t waste it. I eat it. Cookies left will eventually get eaten. I don’t keep ice cream and sodas in the house. If I am depressed, I will eat a quart of ice-cream in one sitting. If it’s not in the house and I am depressed, and not likely driving to the store to get that. Set yourself up for success in small measures, and in time you will find you are winning more often than not.