The Stress Doc continues his path from depression to Prozak rejuvenation, and the unexpected revelation comes during a movie tear-jerker. The Doc also illustrates some mind opening metaphors that put depression and the purpose of medication in a new light.
The Prozac Paradigm Shift
In the last depression series column, I surveyed some startup side effects of my trial on Prozac - from short-lived violently liberating dreams and manic moments to ongoing effects related to sleeping, sex and chocolate eating patterns. The Prozac, by increasing the shelf-life and functionality of that brain chemistry catalyst, serotonin, was sparking a rejuvenation. The changes were provocative and mind opening. And then, at the three month mark, I had a revelation.
The Crying Scene
The revelation occurred in a movie theatre watching, "Uncle Vanya On 42nd Street," a film about the making and performing of the angst-ridden Checkov play. In a closing soliloquy, one of the main characters, a young woman and daughter of the family, makes an impassioned plea about the painful nature of life, loss and love. Intently listening to the monologue, a profound awareness suddenly strikes: I'm not crying. I always get tearful during poignant movie scenes...and this one is just about off the Emotional Richter Scale! I'm moved, just not watery-eyed. How is this possible?
Let me place my capacity for copious tears in context. I have always been "the sensitive one" in my family. At clan gatherings, while others were dry- eyed listening to the trials and tribulations of immigrant relatives and the first generation, my cheeks were invariably tear-stained from softly sobbing. And not just in my family. For example, as a young adolescent my sensitivity and lack of integrity - meaning significantly underdeveloped self-awareness, self-affirmation and assertive interpersonal skills - made me an easy target. Attacking a wounded psyche was blood sport for piranha peers. As I once penned in "The Poetic Scream":
The vacuum shrieks, the hours weeks The wail of solitaire. A wall leaks, piranha beaks Affixed the meat of prayer.
The last line is a metaphor for desperate, mind numbing, adolescent masturbation. Surely, overt and underlying issues of abandonment and rejection, raw fear and learned helplessness absolutely reverberated in my psyche and soul...or so I thought.
Clearly, various stressors and traumas of childhood primed my sensitivity well. But my capacity for emotional discrimination that night at the movies - being moved, not flooded - could only mean one thing: the Prozac was impacting the deepest parts of my primal pool of pain. Some of my sensitivity went beyond "personality" and family history and surely sprung from my current biochemistry and, perhaps, a long-standing predisposition toward depression.
Coming Clean, Getting Current
Five years ago, with the help of my resident psychiatrist and a friend who was already taking Prozac, acknowledging my clinical depression and need for medication had finally been possible...and a true relief. In addition to increased energy, now I could more objectively survey and review jarring and eroding life experiences and memories without feeling like such a wimp or a failure. There was a definite genetic and biochemical component; my depressive adaptation was not simply a by-product of an intractably deficient moral character and motivational nature. Ultimately, I was still personally responsible for my life choices but, fortunately, not existentially culpable for my genes.
Especially when the depressive condition is not so blatant or when a pathological process is slow building, it's hard to know what is normal. (Though with hindsight, the psychological eruptions and tremors seem hard to miss. Denial can range wide as well as run silent and deep.) Gradually, one begins to perceive and respond to life through a depressive lens and dark filter. Sort of like wearing sunglasses all the time, indoors or out, rain or shine. The depressed person can lose much of life's color and shading - things are either black or gray. Equally sad, outer shades and inner shadows block access to the windows of a melancholy soul.
Of course, a person laboring under a clinical depression rarely wants to get genuinely close to others. He or she anticipates with dread (though sometimes, alas, with relief) the possibility of being fatally swallowed in one's own emotional abyss. Then, again, depending on the depth of despair and dysfunction, the depressive may want to cling for sheer survival. Or he may need others for distraction if not as an addiction.
Not surprisingly, the chronic low grade depressive, having constructed a lifetime of adaptation processes and compensations, some of which are "functional" if not successful, finds letting go of and recalibrating one's coping patterns profoundly disorienting. And it's not just in the person's head. The scenario is not unlike an individual who has gradually and steadily lost his eyesight or has only limited tunnel vision. And then, with successful surgery, he or she finds comprehensive sight and the adjustment to this new perspective and forgotten world, initially disturbing. With repetition, over time, our convincing take on "reality" is colored by psychophysiological blindness, fearful tunnels and/or by those ever present, indiscriminately shaded, if not jaded, sunglasses. The current challenge: how to unlearn depressive, repressive and habitual perceptions and belief systems; how to modify and transform self-defeating styles of thinking, feeling and reacting?
Reflecting and Reframing
Shortly after the three month revelation, my mind spun off vivid analogies illustrating the burden and danger of chronic depression and why Prozac was a necessary, though not a sufficient step, in recovery. (Maybe I should carry around a flashing yellow sign: Paradigm Shift in the Making -- Approach with Caution.) Anyway...One analogy involves the absence of a negative, the other the addition of a positive.
First, low grade (and not so low grade) depression is like having to run constantly both short races and marathons with a heavy weight around your ankles. Granted, you've got pretty impressive thigh muscles and a high capacity for empathy - you feel others' pain - but it's damn demoralizing and exhausting so often feeling shackled and empty. A constricted life is rarely a confident life or a life of emotional freedom and exploration. Why shouldn't you be able to run full speed for a change?
The next analogy requires imagining yourself as an automobile with a slow leak in your oil casing. You're also leaking power steering fluid. You can still drive yourself around but, slowly, inexorably these compromised conditions will take a toll on the engine, transmission and other operating systems. And the longer you put off fixing the leaks and getting a full complement of oil and other vital fluids, the greater the likelihood of secondary damage, major breakdown and lengthy, expensive repair. Why shouldn't you be able to cruise around fully serviced?
Over forty years of challenging life stress was wearing down my psycho- biochemical apparatus, especially with some of it's built in genetic vulnerability. Therapy had enabled me to carry on, sometimes quite productively, but always straining mightily to do so. With therapy and Prozac there was hope that I was out of the depression closet for good. And in the next series column, I'll examine sharing my startup experience with a family member, ongoing adaptations and experimentations with the medication and how I began using my hard-earned wisdom with clients. Until then, of course...Practice Safe Stress!
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Mark Gorkin, "The Stress Doc," Licensed Clinical Social Worker, is a nationally recognized speaker, workshop leader and author on stress, reorganizational change, anger, team building, creativity and humor. He is also the internet's and the nation's leading "Psychohumorist." The Stress Doc is a columnist for the popular cyber-newsletter, Humor From The Edge -- <A HREF="http://hfte.funnytown.com/">HUMOR FROM THE EDGE HOME PAGE</A> . Mark is also the "Online Psychohumorist" for the major AOL mental health resource network, Online Psych -- <A HREF="aol://4344:972.doc.1264535.556723207">ONLINE PSYCH: THE STRESS DOC</A> and Financial Services Journal Online -- http://fsc.fsonline.com/fsj . And he is an offline writer for two mental health/substance abuse publications -- Treatment Today and Paradigm Magazine. His motto: Have Stress? Will Travel: A Smart Mouth for Hire! Reach "The Doc" at (202) 232-8662, email: Stress Doc@aol.com, or check out his "Hot Site" website: www.stressdoc.com . (The site was selected as a USA Today Online "Hot Site" and designated a four-star, top- rated site by Mental Health Net.)