"This Is She"

Just a quick plug for Grace Rex's 2014 short "This Is She," an enigmatic piece that uses some horror tropes but is more of a mystery/drama (dramstery?) than a fright flick. More obliquely and cleverly than many filmmakers have, Rex uses an unexplained, shape-shifting blob on the unnamed protagonist's apartment wall to represent depression.

We get small hints of this symbolism throughout the film's 10 minutes. For example, a person we assume to be the woman's mother calls to make sure she's doing okay, using a tone and language that implies she's recovering from some kind of difficult, or even traumatic, experience. At one point, the woman scrolls through pictures of, presumably, her previous apartment, which looked horribly colonized by some kind of black mold... which bears a resemblance to the little blob she's currently interacting with. When you move, from a chapter of life or an apartment, or both, a little bit of your depression inevitably follows?

After she breaks a mirror by accident, the woman picks up a piece of the shattered glass and contemplates it for a moment. But perhaps it's her interactions with the strange blob during the film that clues us in the most. Initially startled, then curious, the woman soon decides to do battle with the blob, covering it up and pretending that means it's gone. Ultimately, she comes to a relatively peaceable arrangement with her odd little housemate.

"This Is She" reminded me of "The Babadook" in its suggestion that even if we can't completely shed our most deep-seated demons, we can at least learn to live more harmoniously with them. Ideally, we can accept that a smaller, more manageable version of them is somehow part of us and will therefore be with us, in one form or another, forever.

Louis Menand on psychiatry

He's been one of my favorite New Yorker writers for nearly 10 years, and his new piece on psychiatry is as witty, wise, and humane as anything he's written. Highly recommended.

Here's the exchange that followed my posting a link to the article on Facebook:

Neal Schindler
I love Louis Menand. This piece is a great reminder that the debate about psychiatric meds is much more complex than we're generally told it is. Big Pharma may have an agenda ($$), but proselytizers against psych meds piss me off just as much sometimes. But of course they're not The Man, so they must be right. Gwen Davis, thought you might appreciate this especially.

Thursday Rome
word.

Gwen Davis
That was a good piece. Newsweek, a couple weeks ago, came out with a similar story. It is toss up whether to take meds for depression and other disorders; though, I am probably of the opinion, if something is going to take away suffering -- however good-nothing the something may be -- take it. If it improves the quality of life, most likely nothing to lose. Leave it up to scientists and physicians to fix the psychiatric mess.

It is important to also be aware of the difference between mild depression and other more critical mental illnesses. For severe conditions, medication all the way. Don't want to return to pre-1950s, where people were locked in insane asylums for life, because they could not function in regular society.

It's a confusing, world! Hopefully as time goes on, treatments (or lack thereof) will improve.

Neal Schindler
Agreed re: severe vs. mild. I certainly know of people who can't function without meds, and anti-meds advocates probably don't want those people stuck in completely dysfunctional lives when there's an alternative. What bugs me about anti-meds proselytizing sometimes is the same thing that bugs me about the Republicans' obstruction of health care: It's easy to object, but it's hard to come up with a superior real-life solution. Objecting to meds on principle is fine and good, but some people need something to actually make their daily existence bearable. Their situation isn't outside the realm of principled argument, but sometimes practical necessities are the priority over principle. That isn't always giving in; sometimes it's just compromise, of the kind that adults sometimes have to do in a complex world.

Winter blues

I've been feeling blue for at least a couple of weeks now, and though I know progress isn't an upward slant but an upward-slanting sine wave, periods like this can be hard to ride out. I've got my wonderful community, of course, and my involvement with it still brings me joy on a pretty regular basis. But I feel stuck with regard to work -- no NWsource.com projects on the horizon, very few phone screens since I turned down two job offers a couple months ago -- and uncertain about my current academic path, such as it is. When people ask me what I'm studying, I'm more weary of repeating myself than excited to tell them.

I've considered the possibility that the antidepressant I'm on is contributing to my general sense of emotional flatness, but I wonder if I suspect the Lexapro because I've heard other people say that SSRIs can cause emotional flatness. The power of suggestion works both ways; it can make you feel like your meds are helping you, or it can make you wonder whether they're hurting you. I imagine the increasingly gray Seattle skies, my singleness, my overweight, the overeating that's sustaining that overweight, and the lack of exercise in my life are all contributing factors to this year's early-onset S.A.D. Last year at this time, the Kibbutz was still something new in my life, and New Year's Eve brought the beginning of a relationship that lasted longer, and became more emotionally significant, than I expected. This year, the Kibbutz is still meaningful but not nearly as novel, and I don't feel particularly confident about presenting myself to the world, whether in a dating context or just socially.

I think my #1 problem right now is sagging self-esteem due to physical inactivity. When I danced at the Moishe House Chanukah party the other night, it only took about 10 minutes, if that, to utterly exhaust me. I was practically wheezing, and I felt a desperate need to lie down. There have been times in my life -- my bar mitzvah, the year 2004 -- when I was so out of shape that I couldn't dance for very long. Here I am again, in the middle of one, only this time it happens to coincide with a unit on fitness in my nutrition class. Looking at all the toned models in the book's supposedly helpful pictures, I felt that the distance between where I am and where I want to be is vast. Even moderate fitness feels unattainable.

My main goal for 2010 is to make exercise a regular part of my life. I want to do on the fitness front what I did this year, with the help of my wonderful life coach, in the area of money management. Thanks to our work, I make a budget at the beginning of each month and am much more conscious of how and why I spend money the way I do. Prediction: If I can make the sort of progress with exercise in 2010 that I did with money in 2009, I'll be much happier by 2011.

Antidepressants on KUOW

This past Monday on KUOW's daily show "The Conversation," host Ross Reynolds interviewed Columbia University psychiatrist Dr. Mark Olson about a study that lasted from 1996 to 2005. During its span, Olson found that antidepressant use doubled among Americans. Currently, roughly 10% of us are on some form of psychiatric med. Some of his findings were surprising. Antidepressant use is lower among African-Americans and Latinos; Olson believes this is because medication is less culturally accepted than other treatments, such as talk therapy, in some minority populations.

The largest groups of antidepressant users? Young women, and women between 50 and 64. Women's rate of depression is double men's, and Olson noted that it can be tricky to diagnose it among older people, since aging brings certain challenges that may manifest themselves as forms of depression, even if the individual's all-around psychological condition isn't that of a depressed person. Perhaps the study's most troubling discovery was that doctors are more likely to prescribe medication if a patient mentions an advertisement he or she saw for a particular drug. (Actors were sent to doctors' offices to complain of depressive symptoms; only some of them mentioned having seen an ad, and they were given meds much more frequently.)

Also interesting: Olson said around 40% of antidepressant users quit after a month, which means they don't get the full benefit of the medication. (Mine took a month just to kick in at all; I imagine that some users who feel desperate for relief aren't willing to wait that long.) A few callers talked about their experiences with meds. One woman complained that Paxil proved extremely addictive, even though it had originally been advertised as anything but. She mentioned that Paxil is illegal in the UK and parts of Europe. Another caller said she was on Paxil for eight or nine months, and it saved her life. The change was "like night and day," she said. Yet she, too, had a tough time getting off the drug.

Olson said that patients who are aware of the risks of taking an antidepressant tend to stay on them longer; he advised an extensive conversation with a doctor about the pluses and minuses. He said the study made him think more about how patients are chosen; people who are less depressed may actually benefit less from meds than those who are severely afflicted. The interview wasn't groundbreaking, nor were the callers' comments, but it's interesting to hear media coverage of the issue now that I'm part of that 10%.

Bipolar babies

Just in time for April Fools' Day, Philip has pointed out an Onion item about manic-depressive infants.

A supposedly fun thing

D.T. Max's article in this week's New Yorker explores The Pale King, David Foster Wallace's unfinished third novel. The quietly iconic author of Infinite Jest committed suicide last year; my favorite of his works is the long essay "A Supposedly Fun Thing I'll Never Do Again," which lays bare the creepy nature of luxury cruises. Wallace's voice was consistently dazzling in its intelligence, and his sense of humor was both pointed and good-natured.

His superficial cleverness tended to give way to a kind of aching sadness, and Max's excellent piece reveals that this melancholy existed both inside him and in his vision of America, and Americans. His dissection of media and marketing, of the tiny tragedies of our consumerist society -- like his examination of the "courtesy smile" that's become a cloying, wholly counterproductive staple of customer service -- was rarely less than brilliant. I found a few of his observations, as noted in the article, particularly compelling:

In a letter to Nadell, he had made a promise: “I will be a fiction writer again or die trying.”

This, it seems to me, is precisely the kind of fervor that aspiring writers want; to those who possess it, however, it can be more affliction than blessing.

Wallace was pushing himself to get beyond the facile skepticism of “Broom.” In 1993, he told Whiskey Island, a literary magazine, “This is a generation that has an inheritance of absolutely nothing as far as meaningful moral values, and it’s our job to make them up.”

The quote above leads nicely into the next one:

As he told Salon, “I get the feeling that a lot of us, privileged Americans, as we enter our early 30s, have to find a way to put away childish things and confront stuff about spirituality and values."

Indeed. That's more or less what I'm working through these days; no wonder Wallace resonated with Generation Y. And finally, the quote that might hit closest to home for me:

To DeLillo he wrote, “I do not know why the comparative ease and pleasure of writing nonfiction always confirms my intuition that fiction is really What I’m Supposed to Do, but it does, and now I’m back here flogging away (in all senses of the word) and feeding my own wastebasket.”

I feel this way about writing journalistic pieces versus writing fiction -- the former isn't that hard for me, whereas I can barely get myself to contemplate the latter. Writing, it seems, was the ultimate "supposedly fun thing" in Wallace's life. Yet unlike the frighteningly prepackaged cruise he describes in the essay, he could never get himself to abandon writing, to never do it again. For that, at least, we can be grateful.

My chemical romance, part two

At the beginning of this month, I switched from Basic Health to Group Health Cooperative thanks to my job at Childhaven. I hoped that the Lexapro I'd been taking since late October would be covered, but alas, GHC only covers it if you've tried a variety of other SSRIs and they've all failed you. So I, like my friend Elana, agreed to make the switch from Lexapro to Celexa. This is likely old news to those of you who've been on Lexapro and tried to get it covered by health insurance, but it made an impression on me.

Specifically, it reminded me that people on prescription medication are at the mercy of a system that's looking out as much for its own good as theirs. (In other words, Sicko was right.) I was reluctant at first to give up the medication that had helped me so much, but my doctor quickly assured me that Celexa is simply a less concentrated formulation of the same stuff that makes up Lexapro. (Hence, 20 milligrams of Celexa is a suitable dose for someone who, like me, was on just 10 milligrams of Lexapro.) The fun part is that Celexa, with insurance, costs me $13 or so per month, versus nearly $100 per month for Lexapro.

I've been on Celexa for a couple of days now, and I haven't noticed anything out of the ordinary. The pharmacist told me that some people have side effects when they switch, but those tend to be the people who are more prone to SSRI side effects in the first place. Since I experienced only mild side effects when I started Lexapro, and those went away quickly, I decided to do what the pharmacist said works for many people: take my last Lexapro one day and my first Celexa the next. So far, so good.

Of course, there's something slightly troubling about the fact that insurance rules prompted me to switch medications, rather than any kind of problem with the Lexapro itself, but if they really are virtually the same, and I don't notice a difference, I'm not sure it's worth getting too worked up about. I've been thinking about my previous (non-Group Health) psychiatrist's statement that if a medicine works -- that is, if it makes you feel better -- it must be a good idea to take it. This, I'm finding, is also a very popular view among people who aren't psychiatrists. When I mentioned the Lexapro to my dental hygienist, she regarded it the way insulin is seen vis-à-vis diabetics, or heart medication for cardiac patients -- a targeted drug for someone with a diagnosed problem.

While this view might not apply to SSRIs, whose exact way of working scientists remain notoriously unsure of, it's hard not to value the experiential over the theoretical. Theory suggests that SSRIs might merely mask whatever problems led the troubled soul to seek them out in the first place; the moment he or she goes off them, back come the various problems, and has any progress really been made? In practice, I think, there are rough patches in life, and antidepressants can help us out of them and onto higher, more stable ground.

I have no idea what happens when I quit an SSRI, but I've heard accounts from other people who have weaned themselves off antidepressants, and they're mostly positive. My meditation teacher in Brooklyn emphasized that we, his students, shouldn't take his word for things; instead, we should try out his suggestions and see where they lead us. Experience can be deceptive, but at certain points in our lives we lean harder on experience than on theory, and I think that's okay.

Update, 10:09 p.m.: Just looked at Philip Dawdy's latest post about the maker of Lexapro and Celexa. Troubling.

The rise of cell-phone novels

Dana Goodyear's article on cell-phone novels in The New Yorker brings up age-old questions about high vs. low art, but it also demonstrates that high-tech convenience can make it easier, psychologically, for someone to write a novel. To a writer like me who struggles mightily to escape his perfectionist tendencies and actually write, the cell-phone novel makes sense, if not as a genre than certainly as a way of making writing both more accessible and less high-pressure. (Shades of NaNoWriMo, come to think of it.) Blogging, which has an air of informality that opening a blank Word document does not, is a pretty good way for nervous writers to make the leap on a regular basis, but the article's image of a depressed young woman lying in bed on her side, typing away, really drives the point home. Now there just needs to be a J-Horror movie about a cell-phone novel that kills you seven days after you read it.