Going Off

There can be very good reasons to refuse medication for psychiatric disorders, and everyone has the right to determine the course of their own medical care. In addition to concern about physical side effects, it’s a lot to ask people to just wave away the felt symbolism of taking pills. People have idiosyncratic meanings they attach to all kinds of medical care, and those meanings need to be explored and questioned, but they can’t necessarily be erased. Managing without psychiatric medication may, for some patients, always symbolize being independent, healthy, or authentic, and they may not want to give up this goal. It’s also reasonable to choose recurring depression if treating it with medication takes something away from you that you value deeply, for instance, if you find yourself less able to creative work. People vary in what’s important to them, in their tolerance for different kinds of risks.

All that granted, if you’re going to write a series about going off of medication for the New York Times, and if you are the Times and you’re going to publish it, you have a responsibility to push a bit beyond romantic, exploratory introspection and consider carefully how that writing contributes to the social meaning of psychiatric medication. Sadly, Diana Spechler’s series about weaning herself off Wellbutrin and lorazepam for depression and anxiety is so muddily poetic, non-linear, and confusing that it obscures her and her providers’ reasoning about “going drug-free,” instead wallowing in her complicated private fantasies. One commenter on the most recent installment said “I’m having trouble remembering why you’re going off your meds, at this point.” Understandably! The series is a mess. If the answer to that question is: “because I don’t like the side effects, and I analyzed the pros and cons with my psychiatrist and together we decided I could manage without them,” it would model agency and rationality in the decision to treat mental illness without medication. Instead, from the first installment, we get:

When I reduce, my anxiety and depression creep back in; when I increase, my side effects range from grim to unbearable. Even at my current low doses, my hair is falling out. 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.
…

Years ago, I had a boyfriend who had two benign cysts removed from his scalp. He kept those cysts in a jar on his bookshelf and liked to show them to house guests. Grotesque as I found those fatty little things, I understood the pleasure he took in them. Stray hair-tweezing gives me comparable satisfaction. Splinter-removal. Pimple-popping. I’m not alone in that: For example, even though we’re told over and over that colonics, detoxes, and prepackaged “cleanses” don’t do much good, that they might even cause harm, they remain as popular as ever — we’re so certain there’s a way to expel excess from the body, to become spotless on the inside. We blow our noses and look at the tissue, perversely enthralled by what we’ve eliminated, by the passageway we’ve cleared. We go to the gym to “sweat it out,” watch tear-jerkers to “cry it out,” endure talk therapy for years, even decades, to identify the source of pain, as if it’s one, immutable contaminant lodged somewhere it shouldn’t be, a pea under a mattress that once found can be removed.

Psychiatric disorders are no pea. Depression and anxiety are diffuse, nebulous, ever-mutating. Pills, on the other hand, are concrete little things — pebbles to pluck from the bottom of a shoe. And that’s my goal — to pluck the pebbles, to get back to basics, to believe in my body as a self-sustaining ecosystem.

The first one of those paragraphs makes her sound like someone making a reasonable decision based on pros and cons. But even then some of them need clarifying — she is less motivated to feel better when she is less depressed? What form does that take in her thoughts and her behavior? What does it mean?

The second two paragraphs make it sound like she has fantasies about the purity and virtue of abstention not that distant from the fantasies that motivate her compulsive dieting. Maybe it’s both/and! But in this venue she has an obligation not to promote the idea of medication as corruption, to cast a critical, reasoned eye on the way her contamination anxieties are playing into this decision, not to write from inside them. She may well be making a conscious literary choice to revel in her distortions, but it isn’t fair to everyone else who has to deal with stigma and their own ambivalence about medication. I would feel less moralistic if she were writing in a venue more clearly contextualized as art, but journalism ought to serve the social welfare. For that matter, since her portrayal of her medication an impurity she can expel, closely followed by “I’ve got this, my body is telling me” is such a close ideological cousin to the belief that you can “cure cancer with carrot juice” or that “vaccines damage the body’s natural immunity,” this recklessness has reach into the narratives of other illnesses. The phrase the Times chooses in its intro blurb, “going drug-free,” is heavily value-laden, suggesting a virtue to ridding your body of toxins.

It’s not totally clear from reading the series that some of the side effects she reports can be laid entirely at the feet of the medication. She characterizes her anxiety after reducing her dose as “withdrawal” without explaining why that’s a better characterization than simply the return of the symptoms of mental illness. Sometimes she has been able to write on Wellbutrin. In 2014, apparently, she couldn’t (but it took me multiple readings of this series to understand that; on the first I thought Wellbutrin had consistently spared her creativity). What was different about those times when she could write? A report of a side effect like diminished creativity deserves to be both taken very seriously and carefully examined. Included in that examination should be the possibility that she holds some beliefs about the relationship between her illness and her work (for example, “I am only interesting because I suffer”) that inhibit her when she’s feeling better. I don’t mean to suggest she hasn’t done this work—I don’t know—but she is not transparently sharing it with us. Instead, the series reads as a romanticization of suffering for a purity that demands refusing beneficial medical care.