Friday, August 15, 2014

On Surviving - I Wish Robin Williams Had

Nearly a week's worth of reporting on Robin Williams' death, some of it heartfelt, some of it educational, some of it ignorant bloviating -- even if you have been living under a rock and not heard any coverage at all, you can name the bloviators, can't you.  By now, my readers surely wonder, What is the Prozac Monologues take on his untimely death?

I have written reams on suicide and suicide prevention.  Click on those two links and take your pick.  But skip the Suicide Monologue, at least for another week.  It is inappropriate for another week.  And if you do go there, then mind the humor alert.  I am serious -- about the humor alert, that is.  Some of you won't find it funny. It wasn't written for you.

But before we abandon the suicide conversation in favor of the next thing, let's expand the frame.  Here's the deal.  Of all the people alive on the planet today, 50,000,000 will, at some point in their lifetimes, struggle with suicide.

I can't say we will think about suicide.  Those of you who think about it in passing seem to think that the seriously suicidal think.  There is lots going on inside our burning brains.  But thinking doesn't really describe it.

Anyway, of those 50,000,000 pitiful souls, 5,000,000 will die at their own hand.  That number could be a lot smaller, if there were sensible and serious suicide prevention available to anybody who needs it.  Suicide happens when pain exceeds resources to deal with pain.  We could use some more resources.

But let me remind you that Robin Williams had loads of resources, loving friends and family, economic security, and excellent health care to boot.  And he used those resources.  For years, decades, he used those resources.  They weren't enough.  Depression killed him anyway.  Like how people with health care can recover from cancer.  But some of them, even those with the best health care in the world, die of cancer. Just like that.

Back to the 50,000,000.  Do the math.  45,000,000 people are alive today who will at some point in our lives struggle with suicide, and will survive.  Note that I am placing myself, God willing, among the 45,000,000.  I have a lot of resources, too, among them the good sense not to own a gun, which significantly improves my odds of survival -- a side note there.  But back to my point.  Gosh, I am having trouble sticking to the point.  Psychiatry has a word for that...  But back to my point.

What about the 45,000,000?  We are cautioned this week.  We are reminded that we struggle against a fearsome beast.  We cannot be careless.  We have to get rid of the damn gun, and the leftover meds, too.

We also have to live.  We have to celebrate every day a victory.  Those of you who love us, maybe you could, too.  That would be really nice, to have somebody celebrate that we are surviving depression, like you would celebrate our surviving cancer.  Why not bring us some flowers?  Or bake us a cake?

If you are one of the 50,000,000, aspiring to be one of the 45,000,000 -- don't wait for somebody else to bake you that cake.  Bake it yourself.  Even if nobody around you celebrates, there are 50,000,000 people alive today who know something of what you are going through. And we rejoice that you are still here.  We are all in this together, us 50,000,000, even if we do not speak a word when others are bloviating about those of us who stumble on the way

In that spirit, I repeat a post from September, 2009:


Cut the top ten and go straight to the number one reason why Willa Goodfellow should never get herself committed to the psych ward:


I suck at arts and crafts.

I didn't used to.  I used to produce Christmas cookies and gingerbread houses that made adults and children alike respond, "Oh! My! God!" -- though not the way this cake does.  I used to make big gingerbread houses.  No kits. and no showing off with royal icing and special decorating tips (which might have improved this cake, if I had been able to find them).  I used Golden Grahams for shingles, individually placed sprinkles on the door wreaths, graham bears ice skating in the yard, pretzels for fences.  I made Dr. Seuss-like trees out of marshmallows and gummy savers, M&M's for roofing material, or maybe candy-canes for the Swiss chalet touch -- those were a bitch to hold in place until the frosting glue dried.  Once I used peanuts to construct a fire chimney.  All color coordinated.  I must have made thirty of those suckers, and each an original masterpiece.

Then I took Prozac.  And Celexa, and Cymbalta, and Effexor.  And part of my brain has never come back.  I think the part that departed included the "good taste" part.  Also the "give a damn what you think" part.

This cake and the guerilla party I held in the hospital lobby to celebrate the 45,000,000 people at risk for suicide who will survive it, the same hospital whose psych ward I hope never to call home, definitely come out of the Prozac Monologues spirit.  So does the grammar of that last sentence.

This one, I am submitting to cakewrecks.com.  So, Elaine, (a friend who happened by the party and was speechless) you can go ahead and say it.  Yes, I know.

Some people actually do get it.  One of the guests was a psychiatrist who laughed along when I bemoaned having thrown away all the meds I have stopped using over the course of the Chemistry Experiment, so that I was reduced to Smarties and Mike and Ike for decorating material.

So...

"I have a dream. Okay, technically it's a fantasy." [Elmont, Doonesbury]  That when people who survive self-injury are transferred from ICU to the psych ward, they will be greeted with a cake.  That when they get home, there will be a party, just like the party that will greet my friend who just made it through colon surgery.  A quiet party, befitting the energy level of the guest of honor.  But a party with a guest of honor, for having survived this latest round with a disease that has a 15% mortality rate.  I have a fantasy that people who survive self-injury, or manage to avoid it altogether, will be treated like people who survive breast cancer.

I have a fantasy that next year the Psych Department itself will host the party for Suicide Prevention Week, with both Emergency Room workers and the patients, out on a pass, sharing the honor.

For sure, the hospital-catered cake will look better.

photo of Robin Williams by John J. Kruzel/American Forces Press Service, in public domain
flair from Facebook.com
photo of cake by author
photo of Prozac by Tom Varco, used under Creative Commons license
photo of miscellaneous pills used under Creative Commons license

Friday, May 2, 2014

Antidepressants and Suicide: Defending Prozac

It amazes me how many research scientists seem to have flunked statistics.  Or ought to have.  Me, I majored in the liberal arts.  But at Reed, even those who took Science for Poets would be required to rewrite some of the scientific papers I have read on the subject of antidepressants.

So the vocabulary terms for the week are observer bias and confounding variables.  No worries -- lots of pictures.

Clinical Experience in Defense of Prozac

Let's say you are a doctor treating 100 patients with severe depression.  You give them all antidepressants.  It seems irresponsible not to, doesn't it.  Thirty of them get better.  Fifteen do not make a follow-up appointment.  You switch the fifty-five who are still trying to another antidepressant.  Another fifteen get better.  And another fifteen do not make a follow-up appointment.

Over the course of a year, you get up to fifty whose depression is remission and ten who are still struggling.  You don't know what happened with the forty who are no longer seeing you. They couldn't afford treatment; they didn't like your face; they couldn't find parking; they got worse on your medication. You have no idea.  But you have fifty patients who think you saved their lives.  You feel pretty good about yourself, don't you.

Friday, April 18, 2014

Antidepressants and Suicide: A History

Do antidepressants prevent suicide, or do they cause it?

Yes.

Well, maybe.

It's a no-brainer, right?  People who commit suicide are depressed.  Take away the depression, and how better than with an anti-depressant, and you decrease the risk of suicide.

So what's with the question?  Here is the story:

History of Antidepressants

Thursday, April 3, 2014

How To Tame Your Mind -- Ruby Wax

It's like training a dragon, only harder.

Ruby Wax nails depression: when your personality leaves town, and suddenly you are filled with cement.

She nails the problem: our brains don't have the band width for the 21st century.  Nobody's brain does.  Yours doesn't, either.

And she nails the solution: learning how to apply the brakes.

Monday, March 24, 2014

Richie Cox, Rest Easy Now

Any story worth telling is worth improving.

Richie had a fisherman's philosophy when it came to story telling.  He inspired, or provoked, or was co-conspirator in many of the Bar Tales of Costa Rica.  The following excerpt is my tribute to this cowboy/hippie/mystic who will be sorely missed.

Apology

There is one particular table at the Pato Loco where deals get made over American breakfast.  Mama, who has overheard a lot of deals being made, said, “It gets so you can tell the real ones from the ones who are all talk.  Paul, he never talks about his deals.  He’s one of the real ones.  But that Jerry who reneged on the house, you could tell he was all blow.”

Saturday, March 8, 2014

Christina the Astonishing!

Basil the Great vs. Christina the Astonishing – Lent Madness begins.

Saints and Lent – is Prozac Monologues straying from its mission, reflections and research on the mind, the brain, mental illness and society?  Hardly.  First, note the Madness in Lent Madness.  Then wait ‘til you see the saints.

Lent Madness

The forty days before Easter are traditionally a time to focus on one’s spiritual growth.  But there is a looniness built in from the start.  Ash Wednesday to Holy Saturday – count them – 46 days.  Oh yeah, Sundays don’t count.  Does that mean I can smoke and eat chocolate on Sunday?  Opinions vary.

And once you are debating whether you can smoke on Sunday (does it depend on what you’re smoking?), you have already leaned in the direction of madness.  Leaning, leaning…

Wednesday, March 5, 2014

Suicide Is Not a Choice

I peered over this very overpass on the Eisenhower Expressway.  Years ago, there was no the fence along the top, just a rail.  It was pie that brought me there.  Yes, pie.  It was Thanksgiving night, and the holiday was ending without pie.

Of course, it wasn't a reason to commit suicide.  Of course, suicide is a permanent solution to a temporary problem.  Don't treat me like an idiot with your clever lines.

No, pie brought me there, but that was not why I would jump.  Pie was a match, a tiny little three letter match.  My problem was a brain filled with gasoline.  And one tiny match, that I should have been able to snuff with my fingers, threatened to ignite it and send me over the edge.  The shame of being powerless over one tiny match poured on more gasoline.