Monday, February 20, 2017

SSRIs & Walking Upright

Anonymous Cartoon

"Just as we know our walking to be
only a constantly prevented falling,
so is the life of our body only
a constantly prevented dying,
an ever - deferred death."

Arthur Schopenhauer
from The World as Will and Representation

quoted by David Shields in
The Thing About Life Is That One Day You'll Be Dead

Writing of some health issues (bad back, stuttering), Shields repeats his doctor's directive:
"I have to become my own authority and view my recovery as an existential journey. I reassure him that I do, I do. I see going to the drugstore to get toothpaste as an existential journey.

"And what existential journey hasn't been aided by chemistry? I've been in and out of speech therapy all my life, but nothing has mitigated my stuttering as effectively as taking 0.5mg of Alprazolam before giving a public reading. The ibuprofen, the muscle relaxants have certainly helped my back, but the antidepressant Paxil has been transformative. . .

"Paxil has apparently been used to treat chronic pain for more than a decade. For the past few years I've been taking one 10mg tablet of Paxil a day. I worry a little about becoming a grinning idiot, but I figure I already have the idiocy part down, and I'm so far over on the grouchy side of the continuum that a little grinning isn't going to kill me.

"Maybe it's all just the pure dumb rush of selective serotonin reuptake, but now, rather than endlessly rehearsing how my life might have been different, I tell myself how grateful I am for my life – with Laurie and Natalie and our relative health and happiness together. (Knock on lumbar.) I'm newly in love with Laurie – aware of her weaknesses and accepting of them, because I'm so blisteringly aware of my own.

"I like the humility and gravity and nakedness of this need, for – and this is apparently a lesson I can't re-learn too many times – we're just animals walking the earth for a brief time, a bare body housed in a mortal cage. . . .

"A while ago, I asked [the doctor] why I have a bad back. He explained that the ability to walk upright was a key evolutionary adaptation for mankind, but vertebrae that are aligned in the same direction as the force of gravity often become compressed, leading to pinched nerves and ruptured disks. Then he said, 'In your case, though: bad attitude.' He was joking, but I think I got it."
(9, 119 - 20, emphasis added)
What I definitely get is Shields' reference to the repeating mental tapes and the compulsive habit of re-writing history.

I was also reminded of an explanation that I came across a few years ago in Time or Newsweek at the dentist's office. I think I'm getting this right:
Talk / Cognitive Behavior Therapy
1. mutes logic (in the frontal cortex) -- e.g., turns off the repeating decimal "if only" tapes, otherwise known as "hey, let's rewrite the past" with focus on living in the present & turning off the tapes

2. raises emotion (in the limbic hippocampus) -- e.g., allows "ownership" of appropriate responses such as anger, disgust, etc., with focus on acknowledging suppressed feelings and feeling something instead of nothing

Medication (SSRI)
1. raises logic -- e.g., improves the "oh well" / "re - set" function

2. mutes emotion -- e.g., alleviates non-stop crying
It's still a struggle for me -- both understanding the concepts and applying them. But, just like Shields -- and Brian Andreas -- I'm going to keep trying.

Worrying about the SSRIs, I was reminded me of the mask in The Fantasticks. As El Gallo is taking Luisa out to see the world, The Mute hands her a mask to take along for the journey:
" . . . a paper mask of a blank face; a laughing - hollow mask; a stylish face that is frozen forever into unutterable joy. This mask is upon a little hand - stick -- so that when held in front of one's visage, it blocks out any little tell - tale traces of compassion or of horror. . . .

Luisa: That man -- look out; he's burning.
My God, he's on fire!"

El Gallo: Just put up your mask --
Then it's pretty.

Luisa: Oh yes, isn't he beautiful!
He's all sort of orange.
Red - orange.
That's one of my favorite colors! . . .
You look lovely! . . .

La, how gay. . .

That man -- they've hurt him!

El Gallo: Put up the mask.

Luisa: But he is wounded.

El Gallo: The Mask! The Mask!

Luisa: Oh, isn't that cute.
They're beating a man in a monkey suit.
It's a show. La, how jolly.
Don't stop; it's charming.
(105 - 08)

from The Fantasticks
Tom Jones & Harvey Schmidt
So, my concern was what if the Paxil (Celexa, Effexor, Lexapro, Wellbutrin) was like Luisa's mask, enabling you to put a good spin on a bad scene. Or could it be the opposite? As my friend Katy wisely pointed out, perhaps we also have a mask that makes everything seem worse than it really it is, and taking the SSRIs allows us to bring that mask away from our eyes and see things as they really are? Maybe that's it.


  1. Most unfortunate: