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28 August 2014 @ 01:25 pm
In defense of drugs, apparently  
I had two conversations two days in a row that in some ways overlapped and in some ways were different but still felt the same, and now, coming here, I see that the main idea that I find tying the two together was almost the last thing I wrote about here.

The strains of the conversations mainly centered around my depression and included the following:
Whether or not I can/should describe myself as insane, and what I mean by that
The validity and desirability of labeling myself as 'having depression'
The ability of a human to make psychological choices and control their behavior internally rather than externally
The legitimacy and usefulness of pharmaceuticals, antidepressants in particular in one conversation, and more the idea behind altering your brain through whatever means, particularly chemical, in the other

And one last thing that drew my attention to the parallels between the two conversations was that in both cases, the other conversant had a strong, negative, personal experience related to the topic. I have a strong, personal, negative experience as well, that is, my entire life. So of course I thought that this background can't be disregarded as a reason why each person holds their opinion (see also this post).

So apparently in my last entry I already explained how I never originally thought of myself as depressed or having depression, nobody told me so, I just cried and hit myself in the face and thighs and spent far too long in the tub staring, frightened, at razors, and paced my room or the streets in the middle of the night barely holding any coherent thought beyond 'I don't want to live anymore', all through high school. I generally consider myself a relatively self-aware and introspective person, even then, but I don't think I really analyzed it; I didn't so much think there was something wrong with me or my brain in terms of me being unreasonably sad and frequently nonfunctional, I just thought there was something wrong with me in that I was inadequate to the task of living, that it was a personal or moral failing, or else I just thought about how I couldn't bear to face, well, anything, and didn't really suss out the causes beyond the undeniable fact that things are unbearable to face. At 18, near the end of my first year of college, a friend sort of brought me to the counselor to see if I couldn't get drugs or something. I took Zoloft for a week or two, and seemed sort of ok at first, then got even worse, then there was a slight hitch in insurance that I don't remember but the barest difficulty was enough to stop me getting them. Then that summer (after dropping out) another friend's mom got me to the free clinic to get me more drugs, I don't remember what kind, and I don't really recall how long or whether I took them or why I stopped (all I remember was the psychiatrist's name was Dr. Ahkter). I'm not sure what my conception of myself was at this point, I think I just felt desperate.

Sometime in the next year, when I was 19 or so, I went to a psychiatrist again, and started taking something more regularly. For the next 6 years I was on medication and/or in therapy pretty much nonstop. I tried most of the SSRIs, a number of supplements, a number of methods. I went back to school, I started doing well, I got worse, I got much worse, I dropped out again. Somewhere in there I'm sure I developed the identity as someone with depression. I resisted it the whole way, I think. I would always talk to other people, or read about depression, and it never seemed like me. People with real depression were usually less functional than me. They usually felt more apathetic and emotionless, whereas I more often felt sad and despairing and hysterical. They couldn't sleep or eat, whereas I did too much of both. Everything about me seemed easily explained by my just being too self-absorbed, lazy, never having learned self-discipline, buying too much into dumb dramatic narratives; in short, deep personal failings reinforced by years of conditioned behavior and bad habits. They describe it as a disease that's not the 'real' you; well, there's no such thing as a 'real' you, you're just the collection of your thoughts and actions, and, well, my thoughts and actions have been this way since puberty, so whether it was originally me or not, it's etched into my neural pathways inextricably by now. If I were to say, as was repeatedly suggested to me, 'Oh, I did alright, considering that I have this mental disorder' I was lowering my standards, allowing myself excuses to not improve or do better, which I'm clearly capable of doing if I could just get my goddamn SHIT together.

About 5 years ago I stopped taking medications and I stopped going to therapists. I concentrated on reformulating my beliefs and expectations about the world; how not to be attached to emotions, how not to desire after accomplishments, how not to judge myself or think my self really mattered that much at all. I paid attention to environmental and physiological factors that affected me, I reduced my indulgence in emotions overall really, and I seemed to be doing better. I went back to college and finally finished, did some other things, made ever so glacial improvement, still fell apart and wanted to die not infrequently, still was often incapable of performing simple everyday tasks, but maybe not as much as before? Maybe. I considered myself to be doing better than I ever was with professional treatment for depression, but maybe it was just age. But I guess this must have seemed to me like evidence for the view that I just, one way or the other, learned particularly bad habits and perspectives that led to these depressive feelings, thoughts and behavior, rather than having any sort of disorder or disease.

But the whole 'still fell apart and wanted to die not infrequently' thing? That's... that's not insignificant. That's not nothing. And I do have all these opinions about the whole mental health industry, where I'm uncomfortable with the way they are conceptualized and probably believe that if a person gets the idea in their head about something like 'depression' then that sort of gives them a blueprint to fill in about how to feel and think and behave that they wouldn't have done without the concept handed to them from outside. I have no idea how to substantiate this belief though; the only thing I know about is schizophrenia, which for sure occurs whether or not people know about it in all cultures, just the form it takes differs. But to make a distinction between a disorder that can be explained neurologically and something purely psychological I think exhibits a lack of understanding of the brain, remnants of dualist thinking that I don't ascribe to.

So did the idea of depression guide me into being more depressed? Probably. Would I have had similar problems without it? Steven Pinker had a good section in 'The Stuff of Thought' on causality and the closest possible world. We light a match: it wouldn't have caught fire if we hadn't struck it. So that act by us caused it to light. But it also wouldn't have caught fire if there hadn't been enough oxygen. Or it had been wet. Or too windy. We focus on agent-driven acts we can identify as the causes of events, and everything else as mere helpers. He says "we can say that striking the match caused it to burn because the match does not burn in the closest possible worlds to ours in which it was not struck." The idea of the closest possible world is that you can't hold everything else equal and change only one thing - everything's far too interrelated for that.  I don't know what the closest possible world is where I wouldn't have ended up with the idea that I had something that could be described as depression, and that it's not just a sensible and expected reaction to being alive (although I could argue on that one), and that maybe there's something else to it than just bad character.  It would require a different society or a different time, I would be in a different situation where I was aware of different things, and I would be a different person anyway.

And so that's also why I don't think it's actually helpful to classify it as a disease that 'isn't me', to distinguish between the 'true bria' and the 'depressed bria'.  I know they are very very different experientially, but it's not like there's two separate entities, just a variety of different modes of behavior that can be roughly categorized into two main camps, with really a lot more blending and mixing and in-between than the binary description would suggest.  And honestly I think the entire idea that there is a distinct self, separable from environment, chemistry, circumstances, history, &c &c, although potentially at times useful or comforting, is at its heart entirely inaccurate and more often unhelpful or at least misleading.  It might not be possible to avoid using a general heuristic or threshold to divide what counts as 'me' from what counts as 'me, altered', if only because the more realistic concept of a 'me' just isn't sustainable in the entire context of everything else we have learned to think and do.  But if you read or learn absolutely anything about neurology, the brain, neuropsychology, or give any measured thought whatsoever to a clear definition of a person's boundaries, you find that it's not just difficult to do so, it requires a concept of people as containing some sort of immaterial immutable essence that really doesn't hold up under a consistent understanding of how the universe actually is.  It's convenient and soothing to our psychology to hold a notion of this sort, given that we already have the notion.

Maybe I'm just particularly flawed and inconstant, but the general effect of having one's thoughts, opinions, feelings, and actions largely influenced by completely random environmental and other external factors is commonly demonstrated.  Maybe we can be cautious about what sort of conclusions to draw from studies that suggest just how malleable people's opinions are due to smells, temperature, comfort, hunger, appearance, etc etc, but it seems much more likely to me that the main reason to resist believing that these effects are real would be because we want to believe we are 'better' than that.  It doesn't have to mean we're completely incapable of awareness of these effects, or completely at the mercy of everything outside of us, but I think these are significant enough to require taking into consideration.  I have become increasingly aware over the years of just how much physiological and environmental circumstances influence things about myself that I would want to believe are more constant.  The stupidest things like making sure I have eaten enough and well, slept enough and well, and am generally physically fit and healthy are some of the largest factors in my basic mood, which in turn heavily influences every decision I make and thought I have.  I can't make the moral choices I would prefer if I'm tired or sad, I can't be kind and understanding to others if I feel hungry or despairing, I can't think clearly or rationally about almost anything if I'm sick or anxious.  Some people are more ethereal than I, I've noticed, but for most of us, I believe this generally holds to some extent.  And it's not easy to be aware of it: especially since what's often being affected is how I'm thinking about things, how important I think any particular event is, or what it means, or how I feel about it, or what I feel capable of or interested in doing; if what's being changed by circumstances is how I'm thinking then I won't necessarily notice how I'm thinking.

So of course this is all mediated by, or simply is, distribution of chemicals in the body and brain.  If we say that I have some sort of abnormal method of releasing or reuptaking serotonin, which effects my thoughts and feelings and behaviors, that's based on some model of what's normal.  And of course there's 'normal' as in, most common throughout the population, but inherent in this notion is that what neurotransmitters are doing what, when, in what circumstances, in what areas of the brain, are what decide how anyone thinks or feels about anything.  And whatever is 'normal' as in, 'most common' or 'was mostly useful when it evolved that way' doesn't by necessity hold up to an objective view of reality or what's most useful or reasonable according to actually consistent models of the world.  It might be common and 'normal' and evolutionarily useful to feel a rush of rage and inclination to violence when one feels threatened, physically or sexually, but that doesn't mean that, in whatever situation you're in, that both you can reliably expect that threat to be real and that rage and violence are actually a productive response.  I recognize that a lot of my emotional responses to things are extreme or irrational or otherwise what I consider to be 'insane'.  This is a little bit hard to explain or to come up with good examples, but I often find my emotional reactions to not be particularly reasonable or rational or constructive, which doesn't do much to stop me from feeling that way (sometimes maybe a little, but not enough), and the way I feel puts severe restrictions on what actions I feel capable of doing. (Of course feeling capable and being capable don't always or even often correlate, but the feeling part has a strong correlation with what actually ends up happening.)  There's no necessity for however we evolved and learned to be able to think and feel to have an exact correspondence with reality; only enough to keep up generally alive and reproducing.  So once things get outside that realm, the fact that we have consciousness is just sort of an accident, and the way that emotions are mediated and happen is sort of an accident as well, and just because it's normal doesn't mean it's an objectively optimal way of existing.  Maybe some sort of nash equilibrium where, once everyone feels and thinks that way, it's difficult for anyone to change.  So even if I think, as rationally as I can manage, that certain elements of my appearance can't possibly matter and aren't terribly reliable indicators of relevant facts about myself, since in general most people have the general emotional, subconscious response to judge others (more than they'd like or think they are, generally) based on how attractive they are or what they're wearing, it's hard for me to disregard that unless everybody does.  And it's just not a given that any way that I think about things, or am capable of thinking about things, is going to be accurate or optimal.  There's no reason why the way that I am, as is, is preferable to any other way; almost undoubtedly it isn't.  And it's not clear to me that there's any correct way of determining what 'counts' as 'legitimate' ways to improve or change myself, and what's cheating.  You can consider the extended mind theory to be a bit extreme, but somewhere in there are some strong arguments that almost any line we draw between our 'selves' and the 'rest of the world' is partly arbitrary and a matter of convenience.  'I Am a Strange Loop' by Douglas Hoftstadter is another work that I think makes some good points about how hard it is to distinguish the self from everyone and everything else.  If a different mix of chemicals in my brain makes me more 'normal' but my brain doesn't seem to manufacture or process those chemicals correctly without some intervention, then that intervention might seem acceptable or warranted.  But if 'normal' isn't really that great either, and if I had yet a third mix of chemicals that maybe kept me 'abnormal' but actually more functional, or smarter, or kinder, or calmer, or whatever kind of mental or emotional improvement I prefer, that doesn't seem fundamentally different to me.

So in the end I think trying to stick to some pure notion of self, independence from the rest of the world, relying on some sort of internal strength or character over and above whatever tools are handy, although incredibly appealing and really a general rule that I still try to follow when possible, overall isn't sustainable.  I'm not sure what principle I'm trying to uphold or why it would be important to uphold it over and above the consequential results of what happens.   Given that I've proven to be woefully inadequate in many ways, it seems unreasonable to expect me to not attempt to be different, mentally, emotionally. And given that what makes me think and feel and act the way I do is such a complex and intricate mix of physiological, environmental, historical, and whatever other factors, it's not obvious to me which methods are acceptable, or legitimate.  Many people have, and I mostly do too, negative opinions about antidepressants; like they deaden you or make you not 'you', or are crude attempts at minimizing the symptoms without addressing the causes.  I mostly agree.  And although it seems more noble or admirable to draw on my own inner strength and stay true to myself without using external means, if that's even consistent or possible, that has only got me so far.  And in the meantime I've suffered and brought my closest friends with me in my suffering.  It's not like the, suffering-makes-you-a-stronger-and-better-person type of suffering, but one that weakens and destroys and prevents me from acting in ways I would like that would have a more positive effect on the world.  Maybe I wouldn't have ended up doing any good for anybody, but surely anything I would do is more constructive and useful to humanity and the universe than crying on my floor 3 days a week.  I generally had a pretty negative opinion of antidepressants and therapy and psychology; I avoided them for years.  But the whole point is to make me not 'me'.  'Me' is not really that great a person.  Me is desperate and irrational, needy and inconsistent, greedy and self-centered and empty and unproductive and in terrible, unnecessary pain uncaused by really anything in the actual world, which I then spread to those around me.  Holding to some notion of how I 'am' or 'should' be, or how to and how not to maintain my 'self', seems to me to disregarding the facts of how the brain actually works, the world actually is, and the actual results of maintaining those beliefs.