"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.

Comment of the week

Julia responded to my recent post about antidepressants and weight gain:

You might want to try fish oil or flaxseed oil supplements instead of (or in addition to) meds. A Harvard study found that omega-3 fatty acids help with bipolar disorder and depression. I have used it for about ten years with no need for antidepressants or other meds to regulate my moods. And, whether or not it helps with moods, it's good for your heart and HDL. Good luck.

Good advice. Someone recommended St. John's wort before I started on Lexapro, but I've heard mixed things about it. Re: fish oil, I'm vegetarian, but flaxseed would work. I could even eat it on popcorn. Thanks, Julia!

Lexapro vs. everything else

Someone responded to my most recent post about antidepressants by asking whether I'd tried non-Lexapro meds. The short answer: Yes, I gave Celexa a whirl, and it seemed to diminish my verbal abilities. This was upsetting but not entirely unexpected, as I'd been warned many years before that some SSRIs have that effect.

Lexapro is ridiculously expensive at roughly $100 per monthly supply, but I'm reluctant to mess with other meds when this one has worked, on the whole, so well. I also know that my weight gain is almost certainly due to a variety of factors -- Kibbutz food, waves of mild depression that elude the drug, etc. -- so I'd be more likely to drop meds in general than to go searching for a "better" one. It probably doesn't get a whole lot better than this.

Antidepressants and weight gain

The other night at the Kibbutz's second-night seder, someone I know asked me if I'm on an antidepressant.

"Yep," I said. "Lexapro."

"I figured," he said. "That's no normal weight gain."

In the past I might have been upset, but he's right: I've gained a lot of weight since I went on Lexapro in October of 2008. Then again, my weight has gone up and down pretty dramatically throughout my life, and living at the Kibbutz exposes me to a lot of good food, and a lot of communal meals, where the social aspect of eating often gets the better of my willpower. Yet I do think that the antidepressant has something to do with my ascent to 225 pounds, possibly my highest weight to date.

While some Lexapro users attribute their weight gain to the drug's biochemical effects, I believe that, at least in my case, its psychological impact is just as significant. In the past, when I put on weight, I felt bad about it. I would eventually reach a point where I started feeling fat and unattractive, but I'd continue eating too much and not getting enough exercise until I finally snapped. Then I'd begin combating my overweight with a combination of exercise and self-deprivation, a tactic I learned as a teenager with anorexia. My weight would drop, and I'd feel better about my body on a superficial level, but I'd remain extremely afraid of relapse -- i.e., gaining the weight back. Since depriving oneself isn't a sustainable long-term strategy, I'd suffer the sad fate of many a yo-yo dieter: I'd end up even heavier than I started.

Even though unemployment is hard and I have a lot of work ahead of me if I want to attend Bastyr (for nutrition and health psychology, of all things!) in 2011, I'm thinking about going off Lexapro on a trial basis, to see how I feel without it. I'm unlikely to start losing weight simply because I drop the drug, yet I can't help but be curious about what would happen. Not freaking out about being overweight is a double-edged sword. It opens up the possibility of more fully accepting my body, flaws and all, which is something I'm eager and determined to do. On the other hand, overweight isn't healthy in the long run, and being too okay with it -- indifference isn't the same as acceptance, after all -- might not be such a good thing. I'll consult my therapist about it and do some soul-searching, but I imagine that if I go without the meds for a while and I feel the weight of the world return, I can go back on them.

I'm pretty pleased, all in all, that I've been able to use an antidepressant without taking an absolutist view of a complicated issue: the question of whether the positive effects of SSRIs outweigh their downsides. In my 18 months of use, I've decided that they help, but they alone are obviously not enough. And no, they don't steal your soul or make you an unwitting slave to the Man. If anything, people who aren't completely demoralized are more likely to stand up for what's right and fight against what's wrong. There are few simple choices in this world, and to inhibit serotonin reuptake or not to isn't one of them.

Abnormal psychology

I've written here about my struggles with depression and disordered eating, but not so much about my obsessive-compulsive tendencies. They've died down a bit since I went on Lexapro more than a year ago, but I still find myself battling irrational cause-effect relationships in my mind. It's not "If I lend this camera to my friend for the night, he'll break it," but instead: "If I lend this camera to my friend for the night, I'll be unable to stop worrying about whether he'll break it and thus my work will suffer." It's a step removed from actually not trusting the friend.

It's not (usually) that I'm an ungenerous person, it's that I let my neurosis hijack my behavior and prevent me from being as giving as I want to be. (And yes, I'm the one letting this happen. I'm getting better at fighting what I call "pre-worry" or "meta-worry" -- worrying compulsively that I'll worry -- but I still have a ways to go.) Sometimes it's hard for me to separate my mind's obsessive-compulsive "reasoning" from valid logic or meaningful emotion. It's the same problem I've long had with ambient noise, a big pet peeve of mine.

Sometimes I have reason to complain about noise (i.e., a "normal" person would), while at other times I'm unusually sensitive to unwanted sounds (a "normal" person wouldn't be upset, but I am). Figuring out the boundary between reasonable and unreasonable discomfort remains tricky for me, though again, I'm improving. Using earplugs, which I began doing when I moved to the Kibbutz in August of 2008, has been a minor revelation. How did I survive without them all those years? How much tension could they have relieved when I was in high school and college?

I don't have a lot more to say about this at the moment, except that I've gotten better at making decisions, and not whipping myself into a total neurotic lather in the process, since starting therapy in late 2005. I'm grateful to have somewhere to go each week -- or every couple weeks, now that I'm in a money crunch -- where I can decompress, talk through my issues du jour, and realize how much stress I carry around. I still prescribe exercise and meditation for my problems, but I'm having a devil of a time getting myself to fill the prescription.

How (not) to raise a(n) (un)healthy eater

Michelle pointed out this excellent Times piece about the dilemmas modern parents face when it comes to teaching (and modeling) smart eating patterns. The following bit, about everyday disordered eating that lies outside the realm of diagnosable conditions, is especially sharp:

Neither of these children, with whom I interact occasionally, comes close to being a statistic or case study. He isn’t obese; she isn’t anorexic.

But they represent a larger group of young people between those widely publicized (and much more complicated) extremes. And they speak to a subtler parental challenge: how to coach children away from unhealthy eating without sowing panic; how to make them conscious of their intake without making them too self-conscious about its consequences.

See also: "I Was a Baby Bulimic."

One in ten

My reaction to recent growth in antidepressant use differs from Philip Dawdy's. He declares: "Yes, America is one doped-up nation"; I think that's awfully glib. I actually found comfort in the news that slightly more than 10% of Americans are using some form of antidepressant, because while Lexapro has hardly been a panacea since I began taking it last October, it's certainly helped me battle a sense of hopelessness that was keeping me in bed, in the house, and unemployed for a bit too long. It's reassuring to me that an increasing number of people see medication as an option, even if it's a flawed one.

Dawdy points to a particular doctor as a voice of reason in the debate over antidepressants. Here's the excerpt from Reuters:

Dr. Eric Caine of the University of Rochester in New York said he was concerned by the findings. "Antidepressants are only moderately effective on population level," he said in a telephone interview.

Caine, who was not involved in the research, noted that several studies show therapy is as effective as, if not more effective than, drug use alone.

"There are no data to say that the population is healthier. Indeed, the suicide rate in the middle years of life has been climbing," he said.

Moderate effectiveness isn't the same as scant effectiveness or ineffectiveness, and it's well known that drug use alone isn't nearly as helpful as medication combined with therapy (which is what I'm doing). Finally, a lack of data doesn't prove or disprove the population's increased health, and who can say why more middle-aged people are committing suicide? Dawdy notes that it's nice to see his opinions echoed by a professional, but I find Dr. Caine's points pretty unconvincing.

Ebert on food, Dawdy on mental health

Roger Ebert's review of the documentary Food, Inc., which is based on Michael Pollan's The Omnivore's Dilemma, makes me want to see it this coming week at the Egyptian. Anybody care to join me?

In other news, former Seattle Weekly reporter Philip Dawdy's recent post "Study: Serotonin Gene Not Linked To Depression" is a reminder of what makes his blog so valuable. I found the impassioned back-and-forth among the commenters especially compelling.

SIFF Report #3: "A Woman Under the Influence" and "Prodigal Sons"

John Cassavetes' 1974 film A Woman Under the Influence feels astonishingly fresh and intense 35 years after its initial release. Gena Rowlands' performance is a wonder to behold; much of it is both awful to watch and supremely compelling. The word "towering" came to mind; I learned after the screening that it's considered one of the finest performances ever captured on film.

That's not hyperbole as far as I'm concerned. Rowlands acts with her eyes, face, body, and voice, and her portrayal of a woman plagued by an unnamed psychological malady never idles for even a moment. Her Mabel is always up to something, and Rowlands lets the character's thoughts and emotions play powerfully across her face without giving away too much. Peter Falk, as her husband, Nick, shifts believably and very movingly from affection for his troubled wife to frustration, and finally to violent outrage at his own helplessness in the face of her demons.

Rowlands' performance reminds me somewhat of Sean Penn's in Milk, inasmuch as both actors throw themselves passionately into their characters and are riveting to watch but never draw undue attention from their costars. They aren't chewing the scenery, merely acting with rare force and intensity; despite the attention-getting nature of their portrayals, they give their fellow performers the space to develop their characters and provide a rich human context for the protagonist's trials. "Elemental" is another word I'd use to describe Rowlands' acting. There are moments in which she seems possessed, bringing to mind films like The Exorcist, and the fact that she adds this layer to the performance makes her character's plight that much more terrifying. It also explains why her husband might resort to physical abuse in an effort to snap her out of it.

The SIFF program mentions the movie's feminist leanings, and there's certainly the implication that a familiar domestic trap exacerbates Mabel's condition. To me, however, the film played more as a story about mental health, and to some extent the mental-health system. That no one, including the family doctor, attempts to name Mabel's malaise seems unthinkable in light of the 21st-century tendency to assign nearly every kind of problem behavior a multipartite name with a handy acronym and a future spot in the DSM. Poor Mabel, however, is just "nuts" or "crazy" in the eyes of her friends and family, and the treatment she ultimately gets is the usual Cuckoo's Nest cocktail: sedatives, group therapy, and electroshock -- in short, everything but lobotomy.

The Mabel we meet after six months of treatment is a quieter woman, a woman careful not to get too "excited" when she sees her kids for the first time in half a year. It's arguable that her condition needed some form of professional attention, that she wasn't simply a harmless kook dancing to a strange beat, but it's also apparent that her husband, an overworked construction-crew chief, simply doesn't have the resources to stand up for Mabel -- something she explicitly asks her father to do toward the end of the film.

The ending Cassavetes chooses only makes the movie even stronger: As Nick and his newly returned wife clear the dishes following an uncomfortable party in her honor, cheery instrumental music plays. Nick has shown that he regrets having Mabel committed; he's also made it clear that despite his questionable behavior toward her throughout the film, he loves her very deeply and would, as he says, lie across train tracks for her. Mabel, for her part, emerges from the hospital in an altered state, but the ending's upbeat tune isn't a sick joke at her expense, nor is it simply a satiric poke at fraudulent domestic bliss or the horrors of psychiatry.

The closing scene is, instead, a bittersweet way of saying that life goes on, though Cassavetes pointedly avoids picking sides or predicting the future. Nick may or may not become a better husband, Mabel may or may not improve over time, and who can say if this deeply burdened marriage will survive? All we know is that these two characters have chosen, this night, to pick themselves up, dust themselves off, and clear the dishes. I don't think their ease and slight playfulness with each other during the credit sequence is anything less than a glimmer of hope; what it isn't is a guarantee of a neat and tidy happiness. Only a less masterful film would give us that.

Kim Reed's autobiographical documentary Prodigal Sons also examines the impact an individual's mental instability can have on family life. In this case, it's the director's adopted brother, Marc, who suffers from mood swings and erratic behavior. He always played a bit rough, according to Kim's biological brother, Todd, but only after Marc sustained a head injury at the age of 21 did he begin to act out in frightening ways. The film was originally intended to follow Kim's appearance at her high school reunion in small-town Montana. The catch: She's transgender, so the person her classmates knew, a star quarterback named Paul, no longer exists.

Somewhat surprisingly, most of Kim's friends and acquaintances take her transition in stride. One woman asks a bit rudely how she can be female but still attracted to women, but that's about as much flak as the filmmaker takes. Marc's breakdowns, outbursts, and sorrowful apologies end up hijacking Kim's documentary, but she seems much more interested in helping her brother than hogging the spotlight. She isn't a tremendously sophisticated director; her movie is technically average, structurally imperfect, and thematically unfocused. But Marc's fascinating, contradictory personality -- his rudeness, sweetness, anger, fear, self-hatred -- held my attention through most of the film.

In a particularly strong sequence, we hear one of Marc's sadder apologies over footage of Kim hauling various items through the snow from their late father's truck to her cabin. Kim's determination as she loads one heavy thing after another onto a plastic sled and tugs it to the house touchingly reflects how hard both she and Marc are trying to have good lives. We suspect, sensibly, that only one of them will succeed. Prodigal Sons isn't as startling as Cassavetes' film in its depiction of mental illness, but both stories force us to consider anew the definition of that term, and to think, however fleetingly, about what we'd do if someone dear to us was similarly afflicted.

Bipolar babies

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

The art of autobiographical blogging

I feel a tad bit schooled by Sasha. But when isn't that the case?

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.

My chemical romance

I've been on Lexapro for almost exactly six weeks, and as far as I can tell, it's helping me. I first noticed its effects the day before Thanksgiving, when I spent hours on a plane in front of two people who insisted, while everyone else tried to sleep, on having an animated conversation. I'd forgotten my earplugs, and I felt it wasn't my place to tell them to hush so I could try to get some rest. So I boiled and bubbled with frustration, as I usually do in such circumstances, and shot meaningful glances their way from time to time. (Meaningful to me, that is; evidently, not so much to them.) Finally, I put on my headphones and distracted myself with the soundtrack from Avenue Q. When I finally left the plane, I noticed that my frustration over the in-flight annoyance was melting away; it was harder than usual -- nearly impossible, as a matter of fact -- for me to hold onto it, nurse it, make it into something that could ruin my morning. I didn't think too much of my unexpected ability to release my tension, but it was the beginning of a string of changes to my normal way of thinking that would continue throughout the weekend, and that would follow me back to Seattle.

I'm not always aware of what my daily dose of 10 milligrams is accomplishing. Last night, I spoke warmly to a friend who was about to go on vacation, and I detected something in my tone -- an unusual generosity, a carefree quality, a greater concern for another person than for myself. A short but memorable trip outside my own personal travails, in short. It's a wonderful feeling, to be the kind of person you've watched others be for years. I've also recovered, partly, the feeling I had about writing as a teenager, and to some extent as a college student: that life is too rich with incident and meaning to go unanswered, and that the best way for me to answer is in writing. Writing, in other words, as a necessary, vital activity, not something I have to drag myself into. Also: writing without crippling perfectionism. It's like Roger Ebert's description of why characters burst into song in musicals (he was talking specifically about Everyone Says I Love You): They simply don't know what else to do. There's nothing else they can do, no other form of expression that's conceivable. That sense that I need to write, that I can't let life go by without responding to it, is a welcome sensation -- one that I hadn't felt in years.

I've also been experiencing an increased sense of gratitude for my friends, and I've tried to show it as best I can. I know that what I'm able to feel and do thanks (in part) to the medication is stuff that was already inside me -- tendencies I had in the past and lost touch with. During a particular evening of my Thanksgiving visit to Detroit, I felt a bit adrift, unable to connect with anyone the way I wanted to. In the past, such a turn of events might have plunged me into (unproductive) despair of the teenage-melancholia sort: Why am I such a hopeless case? Why can't I make connections like normal human beings? Why does everyone smile when inwardly they must be roiling the way I am? And so on. Of course, some people smile precisely because they're happy, not because they're "phonies" in the Catcher in the Rye vein, but that fact used to escape me. Now I kinda get it, because sometimes I'm actually one of them.

As surely as I know that Obama isn't the Messiah and won't solve all of America's problems, I know that Lexapro isn't a panacea that can make life's every difficulty evaporate. But that's not what I expect it to do. I felt stuck and needed a push, and now I'm more able to give myself that push. Like so many things we consume -- food, shoes, clothing, alcohol, cars, jewelry, travel, cultural experiences, and on and on -- this kind of medication is a mixed bag. Do I feel, sometimes, the sense of emotional mutedness that's often cited as a drawback of SSRIs? I do. Does it trouble me more than my depression did before I got started with the drug? No, it does not. I believe life is full of trade-offs, and we don't always know what to give up and what to hold onto. Our principles naturally evolve over time, and while we may cling to some -- vegetarianism, teetotalism, religious faith -- even they can and do change in small ways. For now, this medication has given me a sense of capability and hope that I appreciate, and as long as I dutifully observe its influence as best I can, I think I'm doing what's right for me. There's no certainty, of course, but that's something I'm trying to learn to live with, too.