Things lithium has stolen from me, or the drug of forgetting

My love of aviation. I am too nauseous all the time to continue.

My love of reading. I can still read poetry or essays, but I cannot read a novel because I simply don’t remember what I read the last time.
If I weren’t so drugged, this could be a like a Borges story: The Drug of Forgetting. Lithium puts one in a neutral gear; there is no thought of the future, nor of the past, only an empty present. In this lithium carbonate universe, one does not think; the brain is silent except when given an explicit direction. It can then fulfill the direction, mechanically, with neither willingness nor resentment. Love is absent, as are hate, anger, pleasure, ecstasy, and color. There is hardly sleep nor wakefulness, tired or alert. It all blends into gray. Entire days could be spent in neutral, turned off, staring at nothing and waiting for commands.

While it is a relatively older drug, I wonder if this isn’t the ideal post-modern drug, turning people from fiery madmen, poets and prophets, to industrial drones, cubicle zoos. Not even Thoreau’s quiet desparation remains under the surface, rather an all-consuming hollowness swallows even that. Perfumed, pleasant, efficient, and utterly empty – an old-new drug for the new century.

Lithium Carbonate Shells

It was a harsh night in the ER. A rate of something like three chest pains per hour between 3 and 6 AM.

The doc who went on after me last time was there. Of course, that patient had not had a stroke, so that was just my crazy.

One thing I am jealous of is how most of my co-workers consider the day after call a “day off.” I can’t do anything but sleep, lest I go fucking nuts.

Lithium is a strange drug. It doesn’t exactly drug you, but you don’t feel quite right either. It seems to perform a turning-off function. Rather than a million racing thoughts, I am now in neutral if not directly stimulated, with no initiative. I do what I have to do, but nothing else. Not quite depressed, but certainly not not-depressed either. Psychiatric limbo. I suppose that is why most people end up having to augment with an antidepressant. If that could restore some feeling, I would be rather pleased. But antidepressants mostly have toned me down too. Which, I guess, is the desired treatment effect for me.

Still, I don’t think I can stay on this drug long-term. Even though objectively I’m good – look, Ma, I’m even writing a little – there’s too much of a pervasive low level dysphoria, lack of enthusiasm. I never want to do anything, I only have to.

I have developed a tremendous amount of sympathy for the poor, negative symptoms-riddled schizophrenics. I wonder how much of that is the disease and how much is medication.

Somewhere, even though I’m calmer, unshakable even, I know I won’t stay on this drug forever. I can’t bear the idea that if I stay with it, I will never again feel the cosmic unity. Life without this feels unbearably sad. I can’t really talk to anyone about this, because we have decided that in this day and age, this is a sign of a broken brain. Hell, I know it and preach it myself. I drug up someone who comes in claiming to be the Messiah at least once every few months.

And yet, while I’m not a religious person otherwise in any way, not a believer in much of anything, and while I do know that it does come to me through neural wiring, I don’t want these few experiences of creativity, of heightened awareness, of the few moments in this lonely world in which I have had real true faith that there is something other than this mire and abyss – I don’t want these experiences turned into something pathological.

Blake's Jacob's Ladder

So I won’t tell a shrink about this.  I know that I am crazy. But rarely, that crazy gives me a gift.  The gift never stays long. Once out of that state, I don’t continue to believe; I can’t recapture that feeling, it does not change my life in any appreciable way. I don’t turn into Jodie Foster at the end of Contact trying to evangelize based on my experience. I stay the same old cynic I always was.

But maybe that’s why I need to know so badly that someday it will come back.

Even if it is just an extension of brain wiring, full of sound and fury and signifying nothing, it is a facet of human experience for which I am grateful to have been able to partake in. They say maturity is the point where you recognize your wound as your gift. Much of the time, I do. The lithium has made me realize even more how much I do – even the shitty feelings without it have depth – a depth that, despite its ability to deliver horrible wrath and writhing pain, is mine, my wound, and sometimes my gift.

Doubt

I just got off one of those hellacious emergency room shifts. And now I am torturing myself. Did I miss a subtle stroke? Send away a 19 year old who fainted who will later go into cardiac arrest?

I am not sure how much of this is me and how much is the drug and how much is the general ambiguity of medicine.

The stroke – an elderly patient with multiple comorbidities, fell down. Seemed to be an inocuous story, but in the morning the patient was still dizzy, so I had to think of a vertebrobasilar stroke. Did I miss it before? Can you have a vertebrobasilar stroke without nystagmus? Should I have called neurology sooner? I don’t think he would have been a candidate for any kind of reopening anyhow. Worst of all, is the lithium slowing me down cognitively and causing me to think less clearly?

And the 19 year old with the simple faint. Most probably nothing, but you never know. Lots of “malingering” hints in the story, but that’s an easy way to make an error. The fact that this case bothers me, however, makes me wonder if I am not medicated enough – this should be open-and-shut; the fact that I doubt what I did makes me think that the problem is my doubting.

I hate being so responsible, so young, without much backup. I hate being unable to separate how much is the job, how much is me, how much is the meds. I really shouldn’t have started this new job. The contract is up in April. I definitely will not renew.

In somnium veritas

I thought this blog was getting too self-centered, but it seems like people are likely to visit any blog that is regularly updated. So here’s a dream update. Why can’t I listen to my gut, my dreams? Especially when they tell me something I already know.

It’s the end of an appointment with the shitty shrink. I get up, head for the door as usual. As I get there, he stands next to me at his work table and I look over as I’m on the threshold, and see that he is doing something so unprofessional, so inappropriate, some total violation of medical ethics, something illegal. I’m not sure what it is – maybe something I see written on something on the desk, but I know that it means that unequivocally there is no way I’m coming back. And I’m glad. The decision has been made for me, that I have proof of what I suspected all along – that I should not be there.

So much pathology in this that I don’t even know where to start. One, if I know this, what the fuck keeps me from acting on it? Why does a situation have to get to full-on abuse before I say enough? This echoes so many situations in my life, such as my partner. How bad does our relationship have to be before I say “enough” if even now I know it isn’t right? Or being a doctor?

I also wanted to thank everyone who has commented. I am always happy to hear that someone else can relate, might have found a bit of comfort or sympathy or feeling like they aren’t the only one in the world to live through this shit. I guess the way to get more readers is to write regularly. I will try to be better. I had a mild hypomanic blip (let’s hope for that to continue) as I dropped the lithium dose after the accidents started again. Most of the writing inspiration during that will not be for writing here, I don’t think. But thank you nonetheless for reading and commenting. Believe me, I have been helped by this blog far more than I have given help. And I’ve learned a tremendous amount about psych medications…I suppose the internet is a good counter to the drug company propaganda. Maybe I should open a site: “Where to Go When Your Wonder Drug Isn’t.”

Dammit, lithium, again

Fell down the stairs to my house today. The lithium problems are back. I’ll take only a half dose today, but I just don’t know. The thing is, I’m actually functioning okay right now – not depressed, though not exactly feeling good. This could potentially be such a decent drug for me…if not for the insane crashing around like a cartoon character.

Stimulus-Response

Dr. Rob, whose blog I have recently discovered and started to enjoy, asked me this question:

All of my non-psychiatrist doctors tell me that psychiatrists are a joke.  They say it’s the easiest residency to get, by far, and that they are the bottom-of-the-barrel of physicians, a pseudo-science.  Is there any truth to this?
Why yes, Dr. Rob, unfortunately there is. Quite a bit; in fact, I have made many a similar comment in my days. In medical school the joke goes: there are two kinds of people who go into psychiatry: the bottom of the class, and the top of the class who are themselves mentally ill.

In this one-liner, the “mentally ill” isn’t meant as derogatory, as in “they have to be crazy to do that, but rather describes a real phenomenon of how mental illness is hidden in the world of medicine – if someone like me (top of the class, full of energy, didn’t “have” to go into psychiatry because of lack of better opportunities),  chooses psychiatry (as I might have considered doing, for both obvious and less obvious reasons), the diagnoses start flying.

As to the other type, I’m not sure I’m so derogatory. Family docs are just one rung on the ladder above psychiatrists for “touchy-feely” soft medicine and I admire them. A lot of people go into psychiatry because they really really hate medicine, or aren’t very good at it. Others can’t take clinical medicine – don’t like blood, the smells, illness, the general grossness dealt with day to day by most docs. Or they really wanted to help people and just don’t see how medicine does that, which is fair enough. So I do share a lot of their viewpoints about medicine in general. Unfortunately, I don’t see a career in psychiatry as being the solution – more on this in a minute.

This view of psychiatry makes it harder for a doc to actually go to one. There’s always that learned contempt under the surface. There’s probably a lot of truth to the idea that a psychologist is more likely to be the type who excelled and worked hard in school and be brighter and better at what they do than the bottom rung of medical school.

But the problem is, when a lot of them aren’t too bright, they get educated mainly by the drug companies, the only ones funding ANYTHING in their departments. They hated medicine, and forgot as much of it as possible after going into psych, therefore they aren’t really familiar with medicine even in the minimal way they need to be. This means other docs get patients who had, say, seizures, from an electrolyte imbalance due to a psych med…and the shrink just doesn’t get it. “But Pfizer said it has no side effects.” This gets them a bad name. Using psych meds is pretty much a crapshoot, but made so even more by the types of people practicing psychiatry. Very few of them understand much nuance.

As to my friends in med school who went into psych, I like them a lot. They liked the humanities, the human side of medicine, had interests outside of medicine, and saw the ridiculousness that is so prevalent in hospital medicine. The problem is they burn out hard, lose any idealism that they started with. Some of that is understandable – think of a counselor or psychologist who only dealt with the severely psychotic all day. I assume that some of their patients do get better, are grateful, make changes one can see, and allow their therapist to have meaningful interactions with them. Imagine a psychologist’s job without that.

The brighter psychiatrists end up in research, but most of them are the ones who went into psych because they were grossed out on medicine, but also hate patients, or because they just burn out on patient care. It is also the only place there is any money or prestige, which attracts those seeking ego strokes. Research psychiatrists and drug company ones are usually jerks.

This line of thought has made me think I would probably be better off with a good counselor of another discipline. I just needed this guy to manage meds (which he also doesn’t do very well, but nobody does). And then it was sort of nice, despite all that, to be with someone who had been through medical training and understands how horrific it is. But I’m thinking now that maybe I might be better off with someone who can see it from the outside as sort of sadistic and ridiculous, not someone equally indoctrinated. Give me some reality testing about how crazy it all is.

And this guy is very therapy-analysis oriented. I’m still reeling from the bipolar diagnosis, from how crazy I was, how this will affect my life and coming to terms with being “second-rate” or “damaged” on some level…but he doesn’t get that – he thinks that now if I’m balanced out medicinally, it should just fade away, I shouldn’t even be thinking about it.

Also – more and more, family docs are receiving further training in psych, and in some countries, Canada and South Africa at least, there are also advanced counseling trainings for family docs. I think there was one South African family doc I met who was doing a lot of family counseling. I’ve thought of one of those kind of training programs.

Thanks for your thought-provoking question. I guess somehow this blog is getting more and more mental health-oriented with every post.

More hurtful psychiatry

I went to another appointment today, partly to get meds, partly to try to have some kind of useful session. I am in a shitty work environment now, and it’s bothering me, but I didn’t want to waste time talking about it because it is temporary, but he kept poking at that, and once again, ended up being hurtful – describing incidents I’ve discussed in the past with a totally different spin, missing the point of stories I’ve told in the past, etc. One example: I told about my first weeks as a doctor, being in the emergency alone with a terrible resident, and a very sick baby. I was terrified.

I had forgotten I had even discussed this with him. But today, he repeated the story to me, but rephrased it totally differently. “You were just as unhappy then, remember, talking about how there was such a critically ill baby, how thank God you were there to take care of it because everyone else was such an idiot.” Made me out a total narcissist. Believe me, I remember that night well, and I was terrified, not knowing what to do, worried that the resident knew even less than I and also didn’t recognize the seriousness of the situation. I certainly did not think, thank God I was there. In fact, I wished anyone else would have been there except me.

So I wonder – this is what he thinks of me? This is what he hears? It’s a long pattern of him hearing things that are irrelevant (I had forgotten the conversation entirely until he brought it up – it must have been months ago), and missing things that are critically important to me, such as, oh, my saying repeatedly that Cymbalta is making me have suicidal thoughts, wake up at 3 AM crying every day, etc.

I suppose I really should look around. For a woman. Closer to my life experience, more liberal, LCSW or MSW, not one of these dynamic type crap things. Or, once again, quit therapy altogether and go back to this plan. One thing I should not be doing is repeatedly going back and paying money for a situation that hurts me. Yet I do. Sort of like my career, my partner, and everything else in my life.