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.

A TARNISHED JEWEL

I picked this place. Not once but twice. And it’s not a wholly irrational decision. After all, Vancouver is beautiful. It consistently makes top ten lists for world’s best cities. Usually it’s number one in North America unless you count affordability. A trivial factor, right? Just peek out from under your umbrella and look at the mountains as you amble along the seaside walkways and get passed by Lululemon-uniformed joggers pretending sun is overrated. Our license plates say, “Beautiful British Columbia,” an intentional act of brainwashing as we wait through a succession of ill-timed red lights in a city that refused to build a highway.

And when I returned to Vancouver, I specifically chose my neighborhood. It was a matter of convenience in that I still faced a major commute and needed to be near a particular transit line. I’m in a central location, mere blocks from the sports arenas, parks, the water and the oldest parts of the city in Chinatown and Gastown. It’s a vibrant scene, peppered with trendy businesses. But even at surface level, all is not bliss. I am adjacent to the poorest part of Vancouver and the most troubled place in the country, an area bursting with people struggling with homelessness, drug addiction and untreated (or undertreated) mental health issues.

A block from home

Most of the time, that’s a part I like. Reality in Pleasantville. I chose this area because I’m a do-gooder by nature, a naïve liberal who has in the past spouted off all sorts of cures for the struggles of the less fortunate based on a reading of a few newspaper articles, a free lecture at the library and some documentary downloaded online. I’m done with being naïve. I know there is much more that I don’t know than that thimble of insight I’ve gained from hearing a few interviews and digesting statistics in colorful pie charts.

This morning, as I walked to a local café to write, I cut through an alley littered with the discards from a shooting up session. Heroin? FentanyI? I confess, I don’t have a clue how you consume either. And I still have no idea when to call for medical attention. Is it when I pass a person who is semi-catatonic? Because I see that an awful lot and everyone just steps around them.

I emerged onto a sidewalk where a young woman berated a pigeon. Seriously. It was all-out harassment as she ridiculed its “rude voicebox” and followed as it pattered in semicircles on the concrete. The bird appeared unflappable but it must have wondered how much more of a dance it had to do for a handful of breadcrumbs. A half-block later, a man seized on the opportunity to manipulate some premature festive goodwill, wishing me “Happy holidays” as an icebreaker to “Spare some change?” I walked on and overheard a brief exchange between a customer exiting a Chinese bakery and a man sprawled on the sidewalk. Was the patron ridiculing the man? Or was this some sort of happy banter after the patron had perhaps done better than me and parted with a quarter or two?   

In a year and a half in this neighborhood, I confess that I haven’t learned much. I’ve gained a clear sense that there is absolutely nothing to fear here. We coexist. Parallel societies. Aside from the gentle requests for money, we don’t interact. I’m a Have here. The Have-Nots don’t even see me. I’m not prey. I am nothing. There is a social fabric amongst the Have-Nots. It’s genuine. In fact, they seem better connected than the rest of us in this pristine city which is routinely regarded as a tough place to connect. (Maybe we’re too busy staring at mountains.)

I don’t have any clearer idea for how to foster positive change. Only a few surface-level improvements. More trash cans, emptied more often. The Give a hoot, don’t pollute message never made it here. There are too many more pressing needs. Social and environmental responsibility are not the focus of day-to-day survival. Of course, the garbage improvement makes things better for me, not them.

But I think everyone can agree on more bathrooms. I smell urine as I pass alleys. At this very moment as I type, a man is pissing against a wall behind a telephone pole across the street from the café. The restrooms are locked in many of the local establishments. You have to be a paying customer. You have to ask for a key or a combination. (I hate handling these keys. I know too well that there are many soap-averse paying folks.) I’ve seen arguments between shop owners and the downtrodden. And I get it. I’ve heard two homeless people having sex in a café bathroom—sex should be a basic right, shouldn’t it?—before employees and an apparently bloated customer started banging on the door. I’ve seen another person doing an impromptu laundry load with liquid soap in another café sink. And, yes, I’ve noticed syringes on the bathroom floor.

But where do they go? Can’t there be a shred of dignity in a blatantly undignified existence? Whoops, that’s my naïve, liberal voice creeping back in. All I know is the few public bathrooms that do exist cannot meet the needs of all the people here who have no other options. Don’t we all deserve a few private moments for whatever reason? Despite our progressive-sounding mayor, this city, the provincial government and the federal government don’t have the will to handle the influx of desperate people, many of whom migrated to the West Coast from colder, even less hospitable environments. So much time gets sucked up by jurisdictional buck passing.

And I continue to spin in place, ever aware of my ignorance, ever hopeful that I should come upon an epiphany. I’m fortunate that it’s in my backyard. There is no chance for change if we strive for NIMBY-thinking—out of sight, out of mind. Please don’t let me ever come to accept things as they are. This too is Vancouver.