MEDICALIZATION OF SYMPTOMS: "IT WAS LIKE SOMEBODY HAD PULLED UP A SHADE AND ALL THE SUDDEN, I COULD SEE THE WORLD."
Early on in our discussion, I got the sense that Steve viewed his feelings of depression and anxiety as conditions, rather than as symptoms of interconnected underlying issues. He demonstrated great insight in reflecting on his childhood experiences and how they shaped his development in many ways. But when it came to treatment, there was a way in which he spoke about his “depression” and his “anxiety” as if they were reified entities. For example, he referred to having “major depression,” “generalized anxiety disorder,” and “seasonal affective disorder.” And although he may, indeed, have been suffering from all of these things, they were treated separately rather than as different components of a unified experience. Steve spoke at length about the many medications he had been prescribed for different symptoms as if they were distinct and unrelated to one another. The first time he consulted with a doctor, the psychiatrist gave him labels for his experience: “chronic depression” and “generalized anxiety disorder.” It is possible that this medi- calized framework for looking at psychological disturbances contributed to Steve’s conceptualization of his experience as biological, and therefore not as much as products of his inner experience in relation to environmental factors.
When his sister was diagnosed with schizoaffective disorder, Steve and his family made contact with an organization that offers education and support to individuals and their families who struggle with mental illness. He was given access to literature about many different conditions that people sometimes suffer from, and this marked the beginning of his own exploration into his subjective darkness. Steve recalled reading some literature on depression in men that described the symptoms that are commonly exhibited. The descriptions resonated with his own experience, so he decided to seek a professional opinion for further assistance. The psychiatrist with whom Steve consulted confirmed many of the things he had always felt:
I went to a psychiatrist and he told me in a matter of, in- after a conversation of of about fifteen minutes, he said uhm you’ve got—very matter of factly— he said “you’ve got chronic depression,” he said “you’ve uhm and you’ve got chronic depression, and uhm generalized anxiety disorder.” And he said, “You’ve probably had the depression your whole life.” I said hmm (laughing) okay. That makes- now that, that explains a lot of things.
Steve’s psychiatrist prescribed medication to treat his symptoms, and Steve felt that the results were remarkable. He suddenly felt a sense of clarity about his life that he hadn’t felt earlier. It was as if before taking medication he had been consumed by a fog of self-denigrating negativity, and with the medication he could recognize his former perceptions as inaccurate and negatively skewed. This resulted in drastic changes in the way Steve viewed his life:
In less than two weeks, from taking of uhm I think I started ten milligrams of Lexapro. In less than two weeks i- i- everything changed. It was absolutely a miraculous uh change in my life. And I tell people this all the time. It was like it was like somebody had pulled up a shade and all the sudden, I could see the world but I saw it really clearly now.
Steve’s description of a shade being pulled up so that he could more clearly see can be seen in light of Kristeva’s (1989) concept of the “black sun” enshrouding a depressed person’s inner world in darkness. The medication alleviated this fog, which allowed Steve an entirely new way of seeing his life. Steve experienced these changes during an exceptionally difficult time, so he could not attribute the difference to easier circumstances. He emphasized this point by saying,
I should also tell you at the time I was going through a very difficult period with my business. My business was basically failing, I was working like a slave and I wasn’t progressing. It was getting harder and harder. And I was getting to the point where I knew I had to close my business. And all of the anxiety that goes with that, was probably what pushed me to to actually go to the doctor. But uhm, (cough) despite all of that, and I tell people this all the time, despite all of that, the the being on the Lexapro made it- made it possible for me to see things . . . for what they were, rather than for what I thought they were.
Steve initially tried what he called “talk therapy” in addition to taking medication and consulting with his psychiatrist, but he had a bad experience with the new therapist that turned him off from it entirely. He had been seeing her for a short while when his best friend, who lived in another state, died suddenly. Steve boarded a plane and immediately began making arrangements for the funeral. This was a period of mourning and a devastating loss for Steve, and his therapist at the time seemed more concerned with the fact that he missed an appointment than with how he was coping with this tragedy. He recounted the story accordingly:
When I got back the first thing she wanted to talk to me about was how inconsiderate it was of me to cancel the appointment uhm as, as close to the appointment and, and I said “Wait a minute. Did you not hear the message I left you?” I said “the the- my best friend literally including my wife, the person I was closest to in the whole world . . . died. And I had to go take care of his family. And you’re telling me that that’s not a sufficient excuse?” She said “Well you could have-” uh she told me some things I could have done. I said “You have (laughing) got to be out of your mind.” And I just said I’m done. And I walked away from it.
So I was kind of put off you know from the talk therapy but I continued with uhm you know going to my doctor for the medication.
After some time, Steve and his doctor decided to try to taper him off of the medication. However, within a month or so of the “miraculous change” he had experienced with the medicine, his old symptoms returned. He said,
I was very judgmental. Uhm I was easy easy to anger I was easy to emotion,
I cried at the drop- I still cry very easily and I do- I don’t I don’t I’m not the least bit ashamed of it it’s just you know I I feel things I think b-more than some people do. Which I think is a gift. But at the time (laughing) you know it was it was excessive I was- you know I could be brought to tears over most anything.
With the return of his symptoms, Steve decided that he was going to go back on the medication. He accepted that taking medication was going to be a part of his life indefinitely because he wanted to continue to feel as good as he had felt while taking it. He said, “I realized at that point, you know. I’m one of these people that’s just gonna have to take medication if I wanna l- be as happy as I am now for the rest of my life. And so I do.”
Steve credited the medication he was prescribed with radically altering his view of himself and the world in a positive way, and it is by no means my intention to invalidate his experience. However, my training in psychodynamic therapy brings its own biases, and as a result there were times when I felt uneasy listening to the seemingly haphazard way in which Steve was prescribed drugs to treat symptoms, which then created their own symptoms that were even worse and required further medication adjustments. For example, Steve began experiencing sexual side effects from the Lexapro that he wanted to eliminate. In an attempt to alleviate them, his psychiatrist decided to taper him off of Lexapro and to replace it with Wellbutrin XL, which was supposed to have neutral sexual side effects. Steve didn’t feel that the Wellbutrin was as effective in treating his depression, but the sexual side effects were gone, so it was acceptable. However, Steve noticed that his symptoms increased with the change of seasons. In order to treat Seasonal Affective Disorder, his psychiatrist said, “When it comes up to to that period, we’ll increase your dosage from three hundred milligrams to four-fifty. Of the uh Wellbutrin, and you know for that period of time, uhm, and then we’ll bring it back down in the spring.” They implemented this plan, but the results were devastating:
What that produced for me was unbelievable uhm panic disorder. I mean panic episodes I had I think three of them. I mean the scariest things I’ve ever been through in my life. Feelings like I’m you know I can’t be alone. You know I just can’t be alone because you know I’m going to lose my mind and not- never be able to get it back. (Coughs) It was unbelievable. So in the in the (laughs) during the worst one of these that I ever had I wasn’t able to sleep. You- I, I couldn’t close my eyes ‘cause I couldn’t be alone with my own mind. That’s what it felt like. I just couldn’t under any circumstance.
The statement “I couldn’t be alone with my own mind” reveals an element of absolute terror in direct response to this shift in medication. Steve decided to look up the medication on the internet and found sources that indicated that
Wellbutrin in large doses increases anxiety symptoms in people who tend to suffer from anxiety. This alleviated some of his concern because at least he had an explanation, but Steve was “in a bad way for . . . four (or) five days.” So in the meantime, his psychiatrist prescribed him Xanax to treat his anxiety. Steve said, “You know it helped me when I was really anxious. ‘Cause I had to continue to work and you know it was hard (clears throat). But ultimately uhm . . . I, I tapered back down off of it. Back to three hundred (milligrams).” After this incident, Steve went back to talk with his doctor about what had happened and told him, “You, you screwed up doctor. (Laughing) You know you made a mistake.” His doctor apologized and then continued to adjust his medication by adding five milligrams of Lexapro, in addition to the 300 milligrams of Wellbutrin. Steve still seemed to be struggling with the same concerns that he had initially voiced to his psychiatrist, and the resolution they came to did not seem to directly address these additional side effects. He said,
That combination seems to be seems to work just fine for me now. So uhm . . . sometimes I think about getting off the we- the Well I mean getting off the Lexapro altogether. Because now there is a little bit of the sexual side effect. But really not so much that I can’t deal with it.
Steve’s conclusion about this experience left me feeling unsettled, for it seemed that he would be stuck indefinitely with negative side effects. It appeared that any attempts he made to eliminate them resulted in shifts in medication with even worse side effects, so he was forced to tolerate his initial discomfort. Reflecting back on this conversation, I find myself wondering whether this was really the only option for Steve, or for the many individuals in similar circumstances who become reliant on medications that help them in many respects but affect them negatively in others. However, Steve believed the benefits significantly outweighed the cost. In fact, when he first sought treatment, he was excited because he knew he would be put on medication and he was hopeful that there would be a positive change for him.
When I stepped into the doctor’s office that first time I was excited. Because I knew that he was going to tell me I was depressed. And I knew that he was going to (laughing) put me on an anti-depressant and I was looking forward to the results. So uh, and the results were just magnificent. They were just unbelievable.