Monday, May 11, 2015

Man Meets Diagnosis

At the end of last year, I got a customer service job at a regional bank.

We got through training and were put on the phone.

Calls were coming in constantly and a lot of callers were elderly people.

A man I spoke to informed me that he was one of the Flying Tigers from WW2.

"Do you know who they were?"

"Yes," I replied, "I am interested in history."

"Well, I am history." he said with a tone of resignation.

I am history. An interesting remark said almost as if he saw himself as a piece of outdated equipment on its way to a junk yard. In a way, a very worldly statement, un-American in its weary fatalism. Or maybe I should be better at customer service small talk.

I transferred him to the mortgage department.

Quickly this exchange with a veteran was becoming an existential flash-point in a wave of dread that was sweeping over me. The man was a data point for a bank, with his credit score, his mortgage metrics all carefully noted somewhere (in the mortgage department?) and I was another data point. The length of my calls, my breaks, my surveys, my pay. Also registered somewhere as a unit in an excel spreadsheet. We were human beings interacting.

Once he was a vigorous youth, flying a plane in the good war. Now ironic cat pictures populate social networking sites and he is history.

I started to zone out on calls. I spent 30 minutes with another elderly caller concerned with his balance. Money was was take out form the account, taken out by him, he thought there should be more there. We were going over the same transactions again and again, until a supervisor reprimanded me. "You've been on this call for half an hour, just give him the balance and end it."

Maybe his mind wasn't as sharp as it once was and mine was being interrupted by a thumps of urgent melancholia.

They had some fancy and condescending word for chatty, elderly callers. "Senior customers" something like that. Though in the way it was used it was synonymous with geriatrics. Get them off asap, was the message.

I stopped coming in to work.

I thought that a driving job will do the trick. Driving is simple, you go from point a to point b. You see your surroundings, its a very plain job. Fulfilling in its simplicity. You're also alone for much of the time.

I got a job driving a medical van aka an ambulette. My ability to focus on life was beginning to break down. I drove to the interview to a far away small town in a daze. It was on a day after a snowstorm and I hardly cleaned my windshield. White was everywhere. I was in a daze, like some brain dead zombie going through the motions of being a human. Moving through space and time, a conscious primate named Ivan.

On the job my trainer was named Mary Joe, an American proletarian. She tried to make conversation. She liked the humorous movie Ted and had a season pass to the Kings Island amusement park. She complained about how the company neglects their good drivers. She liked Hillary Clinton and thought she made a lot of decisions during the Clinton presidency; she thought Obama did a decent job given the circumstances. I mentioned how my problem is living in my head and said a few incoherent words about depression. I introduced her to electronic cigarettes, she gave up her pack a day habit for the innovation.  

On my way to and from work, I was listening to an audiobook called the Confessions of a Buddhist Atheist by Stephen Batchelor.

Stephen became a Buddhist because as a lost youth in post-war Britain. On the radio he heard about Tibetan monks avoiding stepping on insects during their circumambulations. These acts of compassion awoke something in him. He went to India and became one of the first westerners to wear the robes of a monk. He learned Tibetan, found his guru and translated the classic text "Guide to the Bodhisattva's Way of Life."

Then after a few decades in the life, he lost the certainty of his faith. He woke up in cold sweats over his doubts over reincarnation. He left the fold. The intelligence of his writing and the honesty of his journey were hard to deny and my own faith began to loosen, until I lost it altogether.

One of the wheelchair-bound persons Mary Joe and I transported in our ambulette, was a man taken from his doctor to a retirement home. He didn't speak and seemed gone. But his mind wasn't snatched by Alzheimer's. Instead his medical file revealed that after the death of his wife (who was afflicted with dementia), he attempted suicide multiple times but was stopped by the staff. Now he was so depressed that he was mostly unresponsive to human interaction.

When we brought him to the home, positive thinking posters adorned the wall, and the friendly nurses cooed hollow pleasantries at him, as if he was goofy kid.

I thought about his youth and long life. Thought about the strange indignity of not being allowed to take your own life. He was forced by society to remain in the matrix of life that he dreamed of abandoning. Retained here on earth and transported in a strange, bleak daze that was hard to reconcile with the smiling face of the Dalai Lama.

The Buddhist goal is to erase the barrier between self and other. For no good rational reason, I saw myself in that old man, I empathized with him totally. A one-sided delusion of selflessness that brought comfort to neither.

Another man we're transported was partly paralyzed by a stroke. One of his legs was to be amputated for some medical reason. As we passed by some old people's home he mentioned that his mother died there, she seemed to be depressed about not being be self sufficient and stayed alone not socializing or taking part in the fun activities the home had on offer.

"Poor thing," he said. "Poor thing" - what a strange turn of phrase. That exact word combination used for a person would sound ridiculous in Russian.

The comfort of religious life is the absence of tragedy. Christ was not a wild homeless man, a forsaken loser who met a horrible end. He rose from the dead and his grace illuminates our life.

Death is not the end in the Buddhist system, its a point of continuation. The body expires -but carried by karma- the mind continues in one of the six realms of existence.  

Behind the veil of randomness, a universal metaphysical order tics and determines life with a promise of justice. Alas, I no longer believed in this promise. I believed in the depressed, suicidal old man. Believed in the unholy incoherence of it all.

My mother took grandma and I to a Chinese buffet. I announced that I quit my driving job. She yelled at me asking why. I said that I couldn't handle the sad stories of the people that I needed to drive. Like a strange, overgrown moody teenager I began crying, left the restaurant and drove home.

My latest mental collapse was in full throttle now. My ability to concentrate was greatly diminished. My level of perception called forward the comparisons with the dashboard of my Acura when it's alternator was failing, with the happy lights of functionality flickering off into darkness.

"How strange that you care so much about these people unrelated to you" my mother remarked.

I stayed in my room, ate little, and spent my time watching documentaries on youtube.

My mother found a government mental health clinic and sent me there.

The counselor gave me the diagnosis of bipolar which was confirmed by a psychiatrist.

This sounds true, I did become fully manic when given an anti-depressant in Seattle. But even aside from that. I did have many moments in my life when my mind would speed up, I would be filled with ideas and would spend my time pacing around in circles in my room, listening to music, experiencing a natural high similar to the one that may be had by those consumed in a tribal dance. Thoughts of grandiosity, a keen sense of meaning. A sketch book filled with peculiar ravings that sound pretty manic. Arrows in circles, Russian orthodox crosses, strange sentences in bold print.

From reading a book about bipolar I found out that it has seasonal patters, with mania statistically picking up with warmer weather. I found out that people with bipolar are off on their circadian rhythms, their sleep is irregular in time frame and this impacts mood. The afflicted have the highest suicide rate with 25% trying it and 10% succeeding. I guess this and other factors contributes to an overall lower life expectancy that was found for this category of humanity in longitudinal studies conducted in Sweden and the Netherlands. Some believe that this affliction is associated with higher rates of creativity.

The gold standard for bipolar treatment is lithium. The salt from the table of elements was first injected into guinea pigs and they chilled out then the same was repeated with human in an asylum. They relaxed as well.

But that is not what I was prescribed. I was given an atypical anti psychotic. This is supposed to tamp down on mania. But I don't have mania now. I have a disorienting depression. The double blind placebo studies I saw online seemed to uniformly confirm that this med is found to have no advantage over sugar pill for bipolar depression. But when I brought this up to my doc, she insisted that she saw it work on her patients. She's the professional so I have to go by her anecdotal and study-defying words. She said it will take more than 4 weeks to work. But since I've been out of commission for months this episode might just end of its own in due course and then it will be unclear whether the alchemy worked and whether it will help me at all if this ocean of dread will sweeps me up once more.

Funny how modern psychiatry is still blurry in its fights with invisible ailments behind the thick skulls of their patients.

All of this already feels pretty old, worn out and dull. Sad feelings, self-pity, diagnosis, meds, blah.    
There is a strange subculture online of people reviewing their medications and telling their stories of woe in awful, online prose. Their profiles include a list of medications, a typical message tagline includes stuff like:

Current Meds: Lamictal 300mg, Wellbutrin XL 450mg, Neurontin 900mg, Klonopin 1.5mg,  Trazodone up to 300mg and Inderal 20mg PRN
Past Meds: Siniquan, Elavil, Imipramine, Zoloft, Seroquel, Abilify, Nardil, Emsam, Rozerem, Celexa and Ambien
Current Non-psych: Soma 350mg PRN, Norco 10mg/325 PRN, Percocet 10mg/325 PRN, Advair, Nasonex, Ventolin PRN, Allegra, Benicar, Dexilant, Levothroxine, Pravachol and Nexium.

Maybe this is what the future holds, a strange cycle of looking for the happy pills and being continuously disappointed when they don't work.

Meanwhile,  "People with bipolar disorder suffer from an accelerated shrinking of their brain, UK researchers have found."


"A new study has confirmed a link between antipsychotic drugs and a slight, but measurable, decrease in brain volume "


So that, my friends, is the story of how Ivan found out he's bipolar.

Wednesday, May 6, 2015

The Will To Live... Where's Mine?

As the 2 or 3 die-hard fans of my blog may recall, my favorite job out of the few I had in my life was one where I drove poor people to their doctor's appointments.

I enjoyed driving a car for a living. I enjoyed being an observer of the gritty neighborhoods in the forgotten America and I enjoyed the stories people told me when I got to play a type of a traveling psychiatrist without a prescription pad.

One lady I recall driving told me about her life of woe. She was a recovering heroin addict. Her former husband, also an addict, abused her verbally and physically. Because he had a car body repair shop and was financially successful he took away her kids. She had multiple heart attacks. She lived at a subsidized apartment in a bad neighborhood. One time a fella offered her a ride on the back of his motorcycle. She liked speed. It turned out this bike was stolen. He was chased by the cops. The bike crashed. He ran off. She landed FACE DOWN on a pavement and had all her teeth knocked out.

I was driving her to dentist. I complimented on her smile when she got new teeth. I was happy that the remnant of the American welfare state paid for her teeth. She deserved them. Thank God for medicaid.

This lady had two men in her life. One was a sweet guy who bought her flowers and chocolates. The other was a colder dude who held her at a distance. Of course, she was in love with the latter.

She had memory lapses. She had no career and little money. Her children were socialized against her and she suffered greatly as a result.

But she had something I never did as an adult. And uncritical embrace of life. An unquestioning will to live.

Mine flickers in and out. It always cries out like a toddler with diarrhea. It needs to be constantly massaged and justified. It has no automatic momentum of its own. It circles me around and around the old, worn-out, drifting questions that most abandon in their teenage years if they ever pick them up at all.

Tuesday, May 5, 2015

Pavlovian Demise

The deaths of two unsuccessful defenders of Islam in Texas fall into a strange reactionary rhythm.

A heavily guarded contest to draw the prophet Mohamed is organized by critics of the religion.

A self-professed ex-Muslim who now draws right-wing cartoons wins the $12,000 prize for his effort.

Two extremists show up to defend the honor of their creed, wound a guard and end up being shot dead by the police.

While perhaps none of these events could be exactly predicted before they occurred, all of them seem completely predictable in retrospect. Like a well-rehearsed opera playing out in the heat of a Texas summer.

"America will call evil by its name." was one of the more memorable quotes of the Bush presidency.

Its the very idea of evil that made this event possible.

The desire to break through the politically correct wall and properly mock Islam on behalf of the organizers of the contest and the spirit of holy revenge animating the two dead men, have in common a notion of moral certainty that cries out to be affirmed.

The idea of evil is an interesting one.

Certain crimes, like ones committed by serial killers, are condemned by all societies. These crimes are, by definition, anti-social.

But then all of the worst crimes in human history are social crimes committed in the spirit of moral certainty. The certainty of 9/11 hijackers fighting a bloated empire of oppression. The certainty of the Third Reich out to eliminate a parasitic race. The certainty of communist fanatics mowing down the enemies of the people.  

All those folks had the notion "evil" on instant replay.

Whether all the genocidal henchmen were animated by moral certainty is up for debate, many were just sadists for whom history presented an opportunity. But the idea of fighting evil, at the very least provided a cover. Fighting evil gives killing a proper scale. Evil also allows for self-sacrifice on behalf of those fighting it.

Evil needs to be called by its name for any state to wage war.

Otherwise, why would a soldier lay down his life?

And since all human tribes at one point or another need people to die for them, we can rest assured that evil will remain as an animating force in human life for as long as it continues.

"Imagine there's no heaven," sang John Lennon.

Certainly the two dead men never imagined there was no heaven, nor could they imagine a world where evil should not be called by its name.

And so they burst out of their car with guns, ammunition and a certain spunk in their step that could only be assured by total moral certitude.

The Texans though, they had better aim.