David's Inferno (19 page)

But what about me? What should
I
do? I've done my damnedest to explain just how hard it is to diagnose mental illness, give it a name, understand the different types of drugs available, and why they may or may not work for some of the people some of the time.

So, if you're able to get out of that funk by working out every day, eating less sugar, taking some vitamins, getting more sunshine, and/or meeting with a therapist every week, you might consider holding off on the meds.

But
, if you have been depressed, intractably depressed for months—so much so that you have trouble getting up in the morning and feel like you have to fight your way through a thick curtain of sadness just to do a simple task—medications may not only make you feel a whole lot better, but could save your job, relationships, and make it far easier to parent and parent well. (Since you may have already passed the DNA along, it'd be nice if you could spare your kids some of the more troubling emotional displays—especially of the more violent type.)

And/or
if you are so agitated you can't sit still, every thought sends an adrenaline rush through your body, and the smallest life challenge can paralyze you …

And/or
if you're so manic that you can't sleep, have racing thoughts, feel what is politely called hypersexual, and are one blink short of hallucinating, only to crash a few days later so badly you can't leave the house …

 … It's time to consider
anything
you think might help—from radical lifestyle changes to antidepressants and antipsychotics. Frankly, if you're suffering that much, I'd start with the drugs. But I'll keep to my pledge of not taking sides …

Except to say
that if you are entertaining thoughts of suicide, it's important to know that there are medications that can keep those thoughts at bay and make you pretty glad you didn't go through with it. If you don't believe me, at least call 1-800-273-8255 because there's a good chance they can convince you.

Yes, let's all take a deep breath … it's time to talk about suicide. In most cultures, suicide is the ultimate taboo. But how can something almost a million people a year do (including 30,000 Americans) be, as the
Encyclopedia Britannica
so indelicately puts it, “too accursed for ordinary individuals to undertake, under threat of supernatural punishment”? That's a lot of supernatural punishment to go around.

Dante isn't any help. Back in Hell, he consigned suicides to the Seventh Circle, where they're transformed into stunted, twisted trees that are continuously pecked upon by harpies.

I have the feeling he protesteth too much. Surely, those many years of exile, unsure whether anyone will ever truly understand his masterpiece, could make a guy wonder if it's all worth it. Interestingly, he did have a soft spot for Cato, a pre-Christian era Roman consul. Dante let him out of Hell so he could guard the gates of Purgatory, allegedly because he chose to commit suicide instead of submitting to tyranny.

Maybe the taboo shouldn't be committing suicide … the taboo should be not making the effort to understand the tyranny that people feel
within
themselves that can drive them to do it.

I could write a book about suicide. Fortunately, I don't have to. Because Kay Jamison already has (
Darkness Falls Fast
). Her lifelong study of bipolar and suicidal urges—in herself and others—puts her in another league. It might not be the best birthday present
for a depressive, but it's a must-read for anyone involved in suicide prevention.

Suicide is often an impulsive act. Even if someone has planned it for a long time, the final decision is often impulsive. We cannot stop all suicides. But we can try not to be inadvertent accessories-before-the-fact which, as Jamison puts it, means doing whatever we can to keep the tools of self-destruction from being readily available … and making sure that resources to help severely depressed and agitated people
are
readily available.

A suicide is not a wasted life. As she points out when discussing the controversy over the probable suicide of Meriwether Lewis (of Lewis and Clark fame), he “should be allowed to keep such a disinterred peace as he might have. He has earned his rest and in me and for all of us, it is his life that remains.”

I smile (wryly) when people say someone who committed suicide had so much to live for. Or they ask how she or he could have done this to his family. Yes, suicide is an unfathomable tragedy for family and friends. But, it may not be for the person who commits it. I can't speak for that person, but I'm fairly certain the reason he or she could do it is because the unremitting chemical processes in his brain made any other option seem impossible. He carried out suicide because he couldn't imagine carrying on any other way.

So, when I hear that someone committed suicide, my response is never “how awful.” Instead, I instinctively but gently set my jaw, purse my lips, nod my head, and think, “Hmmm …” the way you'd think about someone who went exploring, perhaps recklessly, to a distant and dangerous land and never returned. Who am I to say that what was probably the most important decision of that person's life was wrong?

Janis Joplin, Jimi Hendrix, Phil Ochs, Jim Morrison, Brian Jones, Sid Vicious, Rory Storm, Del Shannon, Richard Farina, Keith Moon, Richard Manuel, Kurt Cobain … I had a really good time at the Rock & Roll Hall of Fame in Cleveland when I visited it in July 2006 with
my brother and nephew—even though it was a rather odd choice of venues for a mentally-tentative relative. Particularly considering that all of the above died of suicide or overdose (or both).

Tentative though I may have been when I walked in the door, I was soon overwhelmed by the shameless outpouring of creativity in every single acoustically shielded exhibit. I walked out after about an hour, still gasping at the synesthetic connections that had taken me back 35 years faster than a speeding bullet (poor choice of metaphor there).

The specter of suicide and drug overdose floats gently through the place: the childhood drawing of a flock of sheep by Jimi Hendrix (with one black lamb off to the side), Kurt Cobain's electric guitar, Brian Jones's dulcimer, Keith Moon's velvet outfit trimmed in white squiggly fringe, Janis Joplin's ‘65 Porsche, Jim Morrison's baby book …

I don't glorify their suicides … I doubt many people in my generation do. But I certainly don't blame those people for what they did. Or think it lessens in any way how potent a role their music plays in my generational DNA.

Indeed, Neil Young, who is going straight to rock & roll heaven if, by any chance, he actually dies, has written several lines about suicide/drug overdose, including the iconic (and ironic) suggestion that for some of his fellow famous musicians, it may truly have been better to burn out than fade away …

Extensive studies have been done on whether antidepressants increase the risk of suicidal thoughts and behaviors. And the subsequent headlines, like those based on many such studies, have generated a whole lot more fear than insight.

Just as chemotherapy can make some patients feel worse, and ultimately, even shorten their lives, so antidepressants can make some patients feel worse and, sadly, be a contributing factor in suicides.

These are strong drugs. But the underlying diseases are pretty virulent to begin with—which makes the attempt to draw direct causes-and-effects seem a bit simplistic. Is it fair to say that trying an unproven chemotherapy drug is brave (which it is!) even though it may “hasten” death, while, at the same time, saying that taking an antidepressant is foolhardy because it can “cause” suicide?

While the link between taking antidepressants and suicidal thoughts is somewhat tenuous—albeit enough to require careful monitoring of anyone taking them—the link between hopelessness and suicide isn't.

So to imply that medications “cause” suicide feels like a disservice to all of those who are or might be helped by them. And even a disservice to the unique individuality of those who, having tried everything, feel there's simply no more hope.

Ultimately, we're all part of a clinical trial. And the results may never be in. Without discounting the possibility of sudden, miraculous out-of-nowhere cures, it can take a long time and some serious help to recover your balance. We're talking months. In my case, almost two years. In some cases, it's the work of a lifetime. While that may make our lives a little more scary, it can also make them a little more sacred.

W
ESTERN
= Eastern = Alternative = Traditional = Complementary = Conventional = Holistic = Integrative. I have extraordinary respect for both modern medications and alternative therapies. While we may or may not be over-medicated, we're certainly under-cured. But that's not for lack of trying.

The much maligned drug companies are trying to help. Overworked psychiatrists, doctors, and nurses are trying to help. Supplement companies are trying to help. Non-traditional practitioners, nutritionists, and alternative healers are trying to help. Sure, these people and companies all have a vested interest in wanting
their
cures to be the ones that work. But to cast aspersions on a whole class of businesses or professionals seems unfair. About twenty years ago, practitioners of “alternative” medicine started referring to their practices as “complementary.” By then, they'd seen enough patients who'd benefited from combining their treatments with Western medicine that there was no longer any reason to draw lines in the sand. Fortunately, Western medical professionals were seeing the same thing.

More recently, the phrases “holistic” and “integrative” have become popular—honorable attempts to acknowledge that practitioners should do
everything
they can to learn
all
about their patients and find the best combination of
all
possible treatments. This approach
is not new. Centuries before Dr. Andrew Weil (who, I must admit, never seems to age), holistic medicine was recommended by healers from Hippocrates, the “father of modern medicine,” to Paracelsus, the great alchemist of the Middle Ages.