A TOUGH PILL TO SWALLOW

May is Mental Health Awareness Month. Part of shedding stigma involves talking and writing about our experiences. In this post, I discuss my ongoing resistance to medication as a means of treating my bipolar diagnosis.

I suppose it was foreboding that, during the summer after my first year of law school, I landed an internship with a non-profit called Mental Health Advocacy, just off skid row in downtown Los Angeles. On my first day, a client walked in and wanted to speak to an attorney about filing a lawsuit against whoever was misappropriating his image everywhere in public. He claimed to be the guy in the WALK signal at traffic lights. It would have been funny, but the guy wasn’t joking. He was agitated, incensed even. A coworker quietly leaned over to me and said, “Ronnie’s off his meds again.”

So funny was actually sad. During my stint with the agency, I heard many sad stories and a lot of them—but certainly not all—had a common theme. Things got messy whenever a client decided to go off medication.

I didn’t get it. I knew I wasn’t supposed to be judgmental but privately I did an awful lot of head shaking. Just take your meds! A pill a day, maybe a handful. Before or after a meal. Or after every meal. What was the big deal?

That was three decades ago—1990—when I was twenty-five and thought I knew everything. Okay, not quite. I didn’t have a cure for AIDS, I didn’t know how to serve and volley like Stefan Edberg and I didn’t have a clue why Jon Bon Jovi’s “Blaze of Glory” was a number one hit. (No, I’m not adding a link for the song. You’re on your own with that.)

As mental health has established permanent residence in my life, the medication issue has become far more complex. Muddled even. I frustrate healthcare professionals. I make their lives difficult. I’m one of the resistors. I hate meds.

Some of it may be rooted in childhood. While I reported daily tummy aches in kindergarten—we didn’t know much about anxiety a half century ago—I was an incredibly healthy child. Nothing to report other than a case of the chicken pox that I don’t remember and the occasional fever that would make me think the chair in my bedroom had mutated into a murderous monster. Piddly stuff. My mom was trained as a nurse and my dad was a doctor. I never ever went to a doctor’s office or a hospital. If I complained of an ache or a pain, my parents would pull out a thermometer and maybe let me lie down with a water bottle. But days marched on. I was the kid who got a perfect attendance certificate at the year-end school assembly. Every year.

In the ’70s, the main thing people talked about for staying healthy was Vitamin C. My parents went through phases when they’d make my brother, sister and me take a vitamin pill each morning. I always made it an ordeal. “Can’t I just have an orange? Isn’t that more natural?”

My parents held a united front. “Just. Take. Your. Vitamin.” I’d shrivel up my nose as I stared down at an approximation of a Flintstone character in the palm of my hand and then I’d put it in my mouth and swallow. No, not exactly. A bunch of water would go down the wrong way and I’d have a coughing fit, the vitamin still hanging out under my tongue. I’d try again. And again. I’d conjure up contorted facial expressions to convey the notion that I was being tortured but my mother would turn to the sink and my father would bury his head in the sports pages. Eventually, the chalky, half-dissolved mess would go down and I’d be left to face my now soggy, cheerless Cherrios.

“Tim Goodwin’s mom let’s him eat Froot Loops,” I’d say. Cue newspaper rattling and increased volume on AM radio station.

There was a period in my twenties when I could have veered into pill-popping territory. I was playing a lot of tennis and experiencing sidelining back pain. Hello, Advil. Hey, Motrin. Somewhere I’d heard something about long-term liver damage and I would give the handful of pills—usually twice the recommended dosage—the evil eye before swallowing them. Luckily my back pain went away and the lone bottle of pain relief currently under my bathroom sink has an expiration date from five years ago. Nasty habit averted.

Six years ago, I had my first ever hospital stay. Psych ward, involuntary admission. I’ve mentioned it in many previous posts. After twenty-four hours in lockup, I was ready to leave, but that wasn’t my decision. I learned to follow the rules—not a natural thing for me—and fake fine. A psychiatrist prescribed an antidepressant and I obligingly took it whenever a nurse showed up with two little paper cups: one with the pill, one with water.

On the night I got my freedom back, I drove to my local drugstore to fill the prescription and was mortified when the pharmacist on duty was the parent of a student who utterly adored me. She’d read my children’s novel and wanted to be a writer, too. He saw the hospital identification on the prescription pad, looked at the drug name and startled me by saying, “It must have been really difficult.” How much did he know? Was there some sort of code for “suicidal” scrawled on the paper? In my tiny community, I was a pillar; now I was damaged goods. I’d heard the compassion—no, pity—in his voice. I turned red, broke into a body shellacking sweat and hid in the toilet paper aisle for twenty minutes until my order was ready for pickup.

The medication interfered with any attempt to sleep and, at home, there weren’t nurses hanging out at three in the morning peddling blue tablets that offered a Fast Pass to dreamland. After a few days, I took myself off my meds. I was still emotionally frail, existing with zero sense of purpose, but rejecting pills felt like a teeny tiny victory. If I were going to carry on, I’d have to find the will and the resources on my own.

For the next two and a half years, I dutifully attended weekly therapy sessions, two different psychiatrists pushing pills to no avail. Even when I finally assented to give meds another try, the twice daily ritual met with a resistance not much more nuanced than my childhood vitamin protests. At best, I’d tell myself, “This is temporary.” Surely I’d pick up tangible, effective coping skills through psychotherapy, by attending peer-led mood disorder groups, while flipping through much buzzed about books on mindfulness and dialectical behavior therapy and from participating in a series of eating disorder interventions.

Dammit, nothing stuck. I’m mental health Teflon. Insert asterisk here.

Asterisk explanation: The meds kinda sorta sometimes worked. Things might have even been better if I remembered to take them every day. Maybe I’d be fine if I didn’t secretly go cold turkey off them a couple of times with disastrous results. Maybe I’d get to a point of happiness—instead of just being functional—if I didn’t keep demanding that psychiatrists change up the drugs and refusing to allow them to up the dosages. Maybe all that My Body empowerment is just self-destructive nonsense.

I can’t count how many times a medical professional has given me the diabetes speech. (They always unpack it like they wrote it from scratch while I do my best to appear curious and not roll my eyes.) “If you had diabetes and had to take insulin for the rest of your life, you’d take it wouldn’t you?”

I don’t have diabetes.

Diabetes is a not a mental health condition. Give me strategies, not dependency.

“What you’ve got is biochemical...” they’d say next. Whatever that is. “You can’t just rely on coping tools.”

Whenever the duel looks like it’ll end in a draw, I pull out my trump card. “I don’t like the side effects.” Sleep disturbances, grogginess, dizziness, flatness of affect. These concerns are real. With my current medication, I can’t skip a day. No pill means no sleep. Zippo. Midday naps are a thing of the past. I’m one hundred percent dependent on Seroquel if I want any shot at rest. The dreams are surreal and/or vividly annoying when they’re not wake-up-screaming nightmares. This supposedly beats the six months I “lived” as a walking zombie on my previous meds—I completely lost my laugh.

My Body...

If needed, I vaguely refer to possible long-term damage. There’s a page and a half of fine print that comes with each new medication. If I read it, I’d be so freaked out the entire contents of the bottle would instantly get flushed down the toilet. My Body...

When all this COVID-19 focus quiets down, I’m due to visit my family doctor. If I’m staying in this city and not moving, I need a referral for a new psychiatrist. (My last session with my current psychiatrist—the first in three months—was a phone call that lasted three minutes, sixteen seconds. Has he given up on anything but meds?) I need to try a different medication. It means another period of trial and error regarding the dosage and new side effects to navigate.

I now have much more empathy for Pedestrian-Walk-Symbol guy. I see my own likeness in him, if not the traffic sign. I get the appeal of going off medication. In my mental health social circles over the past six years, I’ve watch many stare down at their kneecaps as someone else in the room complains about a new med—what is does, what it doesn’t do. I’ve heard others speak with pride and determination about no longer taking medication. The struggles remain to some degree but I recognize the sense of control and autonomy that persons with mental health challenges desire. We all have our issues.

It’s four and a half hours until I’m due to pop my evening pill. I’ll do it. No scrunching up my nose, no gagging. Still, I’m holding out hope that one day antidepressants and mood stabilizers won’t be necessary and that healthy food, exercise, travel and an ability to ride out the lows will be enough.