February 2015

Mom

Mom is 97 years old, suffering from severe dementia; her mind is no longer connected to reality, yet the burden of her body continues. One dark, unseeing eye bulges out of her head; the other struggles to focus through a cataract. She cannot hear much. Her arms are covered with purple bruises, her legs bandaged to cover skin too thin to protect her. She is tiny, except for a severely bloated stomach that houses the tumor that refuses to kill her.

Her thoughts are trapped somewhere between disappointment and fantasy, in a world that never existed. It was never a happy life and that it continues in this painful demented manner is a terribly cruel punishment. She lost her parents at the age of twelve: her mother died, her father sent her away. She never recovered. Such an unhappy life that refuses to end.

Yet there is nothing we can do. We cannot end her life. That decision is not for us to make. She is in pain, partially controlled by morphine. She is agitated: perhaps frustrated by growing mental incapacity, perhaps fearing death. Xanax helps a little. She is depressed, always has been, and there is Zoloft for that. This is maintenance, not life. We give her all these meds because she is demented and we fear she will succumb to the pain and despair and kill herself. What is rational behavior in this circumstance? Is it reasonable to preserve a worn out body by controlling a dysfunctional brain with drugs that render her senseless?

She can no longer make her wishes known to us, but this is consistent with a life-long pattern. In our family, no one ever makes clear what she really needs; we all persist in equivocating and deferring until we get what we want because some decision had to be made, or, more frequently, just move on, unsatisfied and slightly resentful. So mom wouldn’t tell us what she wanted when she was able, now she cannot.

She was frightened when we first arrived, not knowing my sister and I, perhaps thinking we were the ones who would take her away. I sat with her a while, holding her hand, offering what comfort I had to give. She became calmer. I wanted to will her to die. I told her to let go. She would fall asleep, I’d watch her breathe, wanting to make it stop. Then she’d wake with a small spasm, turn to me unable to see, not knowing who I was. Once she said she wanted to go home and I thought she really wanted to die, but it may be that she was still looking for a place for herself that she had never been able to find.

We were going to take her away, we came to move her to a home for people with dementia, but there’s not enough left to move. She is beyond the attention they would give her, more dead than alive.

There is nothing to be done. She has an aide who bathes her, feeds her, changes her diapers, and laughs at her plight in the kindest way. “That’s what they do when they get old,” she says, and then cleans up the mess. She makes her comfortable and mom kisses her hand in appreciation.

We don’t handle death very well in our culture, partly because we have huge industries manufacturing drugs and services whose sole purpose is the preservation of life, regardless of the quality of that life. We crucified Kevorkian and only a few states allow a person to choose the time and manner of death. We consider suicide to be insane. We need to rethink our priorities and reimagine our death. There comes a time, as in mom’s case, when preserving a useless body is the truly irrational act.

ANGER

From Angle of Reflection:

“Ben wanted to see Michel’s organic vineyards and chemical neighbors again. It wasn’t far. He couldn’t look at these two plots of land without believing the absence of intrusive chemicals just had to be better for everyone, for the entire ecosystem of the vineyard, including the people and animals who worked there. So why was he introducing foreign substances into his own body to alter the natural balance? Anti-depressant medications were unnatural and they worked in subtle and insidious ways: reinforcing harmful behavior by making you comfortable with it, reinforcing passivity by making it seem acceptable behavior. Depression is difficult, but rounding off the edges doesn’t help. It just makes it worse. He had made his decision.”

Ben decided to change because he didn’t like the way he felt, or didn’t feel, and because he had come to believe in the need for man to live with, and work from what nature gives.

Now I’ve begun to look into the research on anti-depressant medication – something I should have done long ago – and what I’m reading is making me angry. Whether I would have had this reaction while still taking the meds is an open question, but I feel healthier just being able to feel the anger.

The first stop was the first of a series of NY Times opinion articles by a writer named Diana Spechler called “Breaking Up With My Meds.”

http://opinionator.blogs.nytimes.com/2015/02/12/breaking-up-with-my-meds/?_r=0

Her condition would seem to be more severe than mine, but her description of some of the side-effects of the medication was similar.

Here’s the paragraph that hit home:

My thinking is slowed, my creativity stymied. When I work, I feel as though boulders are strapped to my brain. I’m constantly thirsty. I’ve lost my taste for exercise, a mood-enhancer I’ve long relied on, and become more sedentary than I’ve ever been. Perhaps most disruptive of all, depression still lies, dead weight, on top of me — a few hours here, a few hours there — and medicated, I feel less motivation to wriggle out from under it.

Embedded in the article was a link to a piece from 2011 in The New York Review of Books titled: “The Epidemic of Mental Illness: Why?” By Marcia Angell, Senior Lecturer in Social Medicine  at Harvard Medical School and former Editor in Chief of The New England Journal of Medicine. She discusses three books on psychiatry and the use of anti-depressant drugs

http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/

Here are the three books she discusses:

The Emperor’s New Drugs: Exploding the Antidepressant Myth by Irving Kirsch

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker

Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations About a Profession in Crisis by Daniel Carlat

I don’t intend to summarize or criticize any of these works, read Angell’s article, but as always with this blog I want to explore my personal reactions to what is significant in my world and, specifically, how it affects creativity.

I feel so strongly that trashing the meds has enabled me to reach an emotional awareness that has, in turn, allowed me to write with a greater precision, clarity, and depth than ever before. That’s only my belief, but at this stage, it’s the only one that counts.

Kirsch has two major theses, both strongly supported by the data he presents. One: anti-depressant medications are no more effective than the placebos used to control clinical trials, and this fact is well known to the pharmaceutical companies, the FDA, and doctors who have taken the time to read the literature. It is easy to understand why nothing is done about it: the drug companies make a lot of money selling these meds, the FDA receives half its funding from the drug companies, and the doctors don’t have anything else to offer their patients.

Two: The marketing and prescribing of these meds is based on the theory that depression is caused by a chemical balance resulting in a deficiency of neurotransmitters in the brain. There is no evidence that this is true. None.

The meds are designed to increase the amount of neurotransmitters in the brain, thereby acting on a condition that is not proven to exist.

Here, from Angell’s work is the nut of the problem:

“…because certain antidepressants increase levels of the neurotransmitter serotonin in the brain, it was postulated that depression is caused by too little serotonin. (These antidepressants, like Prozac or Celexa, are called selective serotonin reuptake inhibitors (SSRIs) because they prevent the reabsorption of serotonin by the neurons that release it, so that more remains in the synapses to activate other neurons.) Thus, instead of developing a drug to treat an abnormality, an abnormality was postulated to fit a drug.

That was a great leap in logic, as all three authors point out. It was entirely possible that drugs that affected neurotransmitter levels could relieve symptoms even if neurotransmitters had nothing to do with the illness in the first place (and even possible that they relieved symptoms through some other mode of action entirely). As Carlat puts it, “By this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain.” Or similarly, one could argue that fevers are caused by too little aspirin.

That’s interesting and amusing, but here’s the real problem for me: once a person is put on a psychiatric medication, which, in one manner or another, throws a wrench into the usual mechanics of a neuronal pathway, his or her brain begins to function…abnormally.

So here’s the deal: these drugs (SSRIs) increase the level of serotonin in the brain, but there is absolutely no scientific evidence that my depression or anyone else’s resulted from a deficiency of serotonin. In my case, the result was an enormous dulling of emotions, loss of mental acuity and creativity, and an increase in passivity that kept me from trying to overcome the effects of depression. I believe it worsened over time but can’t say for sure; it may be that changed circumstances finally forced me to recognize what was happening all along.

For me, the only way past this was to quit taking the meds. I feel very strongly that this has resulted in reversing these debilitating conditions and that has, in turn, freed me to write the insight and clarity I was seeking. We’ll see.

Reading Aloud

The hardest part of the transition from photographer to writer is mastering the difference in the creative process.

In many types of photography the creative act is instantaneous. To reduce it to its most basic Cartier-Bresson decisive moment: see it, shoot it. Of course, there’s a lot that must happen before that moment in order to be in position to capture it, but the act of creativity really does take place in an instant. This is true of almost any journalistic type of photography but also holds for portraiture, fashion, even landscapes; any time the subject is alive, or changing light is an element.

Even when there’s a great deal of pre-production preparation and post-production processing and elements of creativity are spread throughout the process, even then, the critical creative act is the instant of releasing the shutter.

Only still life photography is exempt from this and only when the lighting is fully controlled. Maybe that’s why the French call it nature morte.

The act of writing a novel is a very different process.

Larry Walker sent me a quote from William Faulkner on the subject:

“It begins with a character, usually, and once he stands up on his feet and begins to move, all I can do is trot along behind him with paper and pencil trying to keep up long enough to put down what he says and does.”

That was certainly true of my first novel – but then the work began and hasn’t yet been completed. The creative process evolves from writing to editing and the number of revisions mounts at an alarming rate. It amazed me how often I could revise the same text and still find absolute clunkers that had to go. I would repeat the process until I hated every word then take a break and ask a friend to read it, after which I could admit that not every word was worthless and revise yet again.

Now, I’ve revised my revision process. I found that when I had trouble with a passage, reading it aloud would often point to the problem. When I stumbled over the reading, it was because either the thought or the language was unclear. In dialogue, it showed mostly in the placement of the “he said, she said” attributions. But in expository passages, reading aloud revealed awkward structures or fuzzy thinking. Enough time and consideration would eventually lead me to an improvement, often after several iterations, and I learned that when the words flowed easily from my mouth they were just better written.

I mentioned this to my friend Jess, who said she’d love to hear my reading, so I recorded the first chapter and sent it to her. In doing so, I discovered a new process: record, then listen while reading the text, stop to revise where needed and record again. Repeat until the words sound right.

Not exactly ready for “This American Life,” but Jess now has a podcast for one, and I’ve discovered an editing tool that works well for me.

I don’t know if other writers work this way. I’d love to hear from anyone who does.

Charting Progress

It’s been a month without medication. I’ve been keeping a journal, a daily emotional temperature chart, and a few trends have emerged.

One: I’ve been able to stabilize sleep patterns and that’s a big relief. I sleep through the night now and wake feeling rested, most of the time. Occasional glitches, but that’s always been true.

Two: the Hallmark emotional moments continue, but there was also genuine bad news this week and my response was real, nakedly emotional, and appropriate. My emotional range has expanded and I’m grateful for that. The medication was designed to flatten the roller coaster, but I don’t think I need that anymore. I need to feel it all.

Three: My internal censors are breaking down. I’m much more inclined to say what I’m feeling and I tend to think that for the most part, this is a positive thing, as long as it doesn’t become a burden to others, and as long as I don’t use it in a constant search for positive reinforcement.

It is definitely a good thing for the development of Angle of Reflection, allowing the exploration of Ben’s character to deepen and to provide the opportunity for change and growth. In early chapters, while searching for intimacy, Ben tends to deflect challenges to his defenses with humor.

“So making the photo becomes a way of making the connection?” Emma asked.

“It does, usually the object is nothing more than a good portrait, one that reveals some truth about the subject. By the way, I’ve always wondered about the method, I mean seeking to make a connection with a camera hiding your face? Anyway, it worked for us and the connection was profound, and I have the photo too. Someday that might be all I have.”

“Do you worry about that?”

“I think about it. I try not to. I try to just enjoy what is happening now, but sometimes I can’t help it.”

“You need a bit of the yogi in you. Live in the moment.”

“The only Yogi I know used to be a catcher for the Yankees.”

This will change.