Brave New Kitty

Earlier this year new evidence, well summarized here, came to light that “the miracles promised by antidepressants may be largely due to the placebo effect.” This finding was not due to new studies, but rather, a re-examination of data from the original studies undertaken for FDA approval. The data from these studies had apparently been interpreted in an overly positive way, exaggerating the desired effects while largely ignoring the neutral or non-existent ones. Over at pubmed.gov, a website of the National Institutes of Health, the study is summarized, its conclusion being “Drug-placebo differences in antidepressant efficacy…are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication.” In other words, even for severely depressed patients, the effects of the antidepressants are not statistically more significant than placebos.

I have to say, I was not surprised by these new findings, for two reasons. The first is my personal experience with antidepressants, and the second is my belief—an outcome of this experience—that depression is not a medical problem and thus it does not have a medical solution.

First, my experience. When I was about two years sober, my world kind of came crashing down around me. Many wise AA old timers say that this is normal and expected if a person is “working the program.” The first-year newness wears off, and all the reasons we drank in the first place start to surface, and of course, they feel bad. Anxiety, insecurity, fear, resentment, low self-worth, and all the problems of living that result (e.g., social anxiety, relationship issues, trouble completing tasks and achieving goals). After several months of feeling utterly hopeless—this was the only period of my life where I ever considered death as a possible solution to my pain—I decided to try antidepressants. I visited a psychiatrist, and after about a five-minute consultation, he wrote me a prescription for Paxil (this was the mid-90s, when Paxil was popular). The literature that came with the drug said that it helped only about 25% of the people who used it, so I wasn’t expecting great results. But I took it anyway, carefully following all indications in hopes of alleviating my misery.

I understood that it took several weeks for the drug to get into my bloodstream, and that during this time, I could experience unpleasant side effects, which I did. I was severely nauseous and sleepy all the time; I actually found it harder, not easier, to adhere to my normal daily routine. But I stayed on it, and around week three or four, I actually began to feel better. I had one glorious week during which I felt happy, positive, and capable of surmounting my personal demons, even if I had to endure nausea and fatigue to do so. The good feeling faded, but it gave me hope. When I went back to the psychiatrist and shared this experience, however, he told me that it was too early for the medication to have produced such a feeling, and that it was just placebo effect. He wrote me out another prescription and sent me on my way.

I never filled the new prescription. Something about the whole experience—the impersonal five minute meetings with the psychiatrist (how can he know what’s right for me when he has no idea who I am?), the awful physical side effects (how can I make progress if I’m feeling physically ill all the time?), the low percentage of people who were helped by the drug (shouldn’t the doctors, for starters, figure out which 25% are helped and why?), the controversy within AA about antidepressants (in which I found myself intuitively siding with the “against” folks, who sometimes referred to these drugs as “dry booze”)—turned me completely off. And I’m glad it did, because I began to look at my problems in a new, much more rational, much more liberating, and, I believe, much more dignified way.

I had problems of living, I realized, not problems of pharmacology. In fact, using drugs to solve my problems of living had gotten me in a lot of trouble in the first place: they relieved my anxiety, but temporarily, and at what cost? It just made sense to me that drugs—whether self-prescribed or other-prescribed—to improve my mood were not the answer, that such an effort somehow missed the point. Further, that it was an extremely important point to get right, one that involved my whole life philosophy.

Anxiety, fear, low self-esteem, resentment, and poor coping skills: these were my problems. A mood-altering drug can certainly alleviate the bad feelings that result from these (and personally, I think if you’re going to medicate these feelings, marijuana is a much better choice than antidepressants, particularly in light of the new evidence), but it can’t cure the underlying problems, the source of the bad feelings. Why? Because the source issues are not medical problems.

And yet, people want to believe feeling bad is a medical problem for two very big reasons. The first is a professional one and applies to workers in the mental health field. Psychiatrists and psychologists want to believe depression, as well as other mental “illnesses,” are medical problems because they have a need to legitimize their work; if they can reduce human behavior to chemistry, then they can be seen, and taken seriously, as real scientists. This problem of scientific legitimacy has existed almost since the very beginning of psychiatry, and to this day, such legitimacy has not been fully granted, for the simple reason that no evidence has yet been found to trace behavioral problems to biological causes. For example, despite decades of research, no one has yet isolated an addiction gene (p. 8), a depression gene, or an organic cause for schizophrenia, despite popular belief to the contrary. The psychiatric establishment has done a wonderful job of obfuscating facts about their profession, to such a degree that the general public takes for granted that such phrases as “alcoholism is a disease” and “depression is biological” are literally true. They are not.

I am not saying that emotional problems don’t exist or that people need not seek help for them. Of course they exist, and of course people should seek help for them if they so desire. I’m saying that these problems are not medical in nature, and claiming they are has resulted in a society dependent on pills that do nothing, prescribed by authority figures pretending to be solving medical problems, thus leaving the root causes largely unaddressed. Such an approach is like putting a bandage on a tumor, exacerbating the problem twofold: allowing it to fester and grow by ignoring its true nature, and decreasing the likelihood that people will seek solutions that can actually help them.

In such an environment, is it any wonder that both addiction and antidepressant prescriptions have reached epidemic proportions?

The second reason, and the other side of this coin of collusion, is that people want to believe bad feelings can be “cured” by a pill. We want to believe that the solutions to our problems of living lie in a chemical, and not in our morals, beliefs, and choices. We want to believe that modern science has a cure for feeling bad. Why? Because chemicals are the easier solution, of course. If given the choice between examining behaviors that have not served us well and figuring out how to change them, or taking a pill, how many would voluntarily choose the former? So when medical authorities tell us this is a viable answer, we want to believe it.

Furthermore, the belief has somehow evolved in modern society that feeling bad is bad, that it is something to be ashamed of, something that requires a cure. Perhaps this is the logical outcome of medicalizing such states as depression and addiction; perhaps it’s mass media advertising that encourages us to believe that a normal, healthy state should be one of constant euphoria and bliss; I don’t know. But I do know that feeling bad is not only part of life, it is a normal and healthy part of life. If we treat it as something to be avoided at all costs, we miss out on the lessons it has to teach us, and we miss out on feeling good as well.

Feeling bad doesn’t just come upon us by chance; it happens for a reason. It’s the emotional equivalent of the reflex causing us to pull our hand from a hot stove: it’s trying to tell us something is wrong so we can attend to it. Taking medication, whether antidepressant or alcohol or anything in between, to alleviate bad feelings without addressing their root cause is like numbing the sensation of the hot stove so you can keep touching it.

Sometimes, probably most of the time, feeling bad is caused by something very old and deep and problematic, something that we’d rather not deal with because doing so is likely to be messy and complex, and might mean more pain rather than less before we get to the other side of it. So while it’s understandable that people would rather avoid this process, doing so only keeps you in a state of unresolved limbo; it’s like constantly touching the stove and believing it isn’t a problem because you can’t feel the pain.

Avoiding feeling bad also prevents feeling good. One can’t exist without the other. They are emotional complements, yin and yang, defined by their opposite, both essential to wholeness, so if you don’t allow yourself to experience one, you will never be sure whether you are experiencing the other, either.

All of this is what I figured out after my stint with antidepressants. I was feeling bad for a reason, the same reason why I had been chemically dependent, and I knew that if I wanted to stop feeling bad as a matter of course, I would have to address those underlying causes, those problems of living for which I had thus far not found satisfactory solutions. I would also have to figure out new ways to see my problems and new ways to deal with them. In short, I was going to have to do some work.

This work has not been easy, and I did feel worse before I felt better. It was like cutting open an infected wound to clean out the pus: painful, but necessary for proper healing. Because I realized going in that this would be the general process, the pain was tolerable, and so was the fear. Eventually, I began healing. I was able to measure my healing by my more effective coping skills, improved relationships, and more positive attitude about myself and about life in general. Such achievements, I learned, were the key to permanently feeling better: achievement feeds on itself just as negativity does, and learning how to accomplish one’s desires and goals is the way out of depression. And this was the new, rational, dignified, and self-respecting way I learned to view my problems and my life. Complex and messy, yes, but infinitely worthwhile.

Drugs, prescribed or otherwise, can never, ever have such a result. Doctors must know this, and I think most other people do as well, and even as we opt for the easy way out we’re rationalizing to ourselves why this is okay. If this weren’t the case, we would have a fraction of the social problems rampant today: depression, addiction, overspending, divorce—all of these are symptomatic of a culture unwilling to look at its underlying moral and emotional issues, a culture willing to accept a medical cure for a non-medical problem for purposes of avoiding the truth about our complex, messy human nature. By doing so, though, we also miss out on the upside of human complexity: just as we never get to feel truly good if we’re unwilling to feel bad, we never get to experience true personal autonomy if we avoid personal responsibility.

It’s a sad state of affairs indeed.

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Lord, help me to shoulder this burden of freedom, and give me the courage to be what I can. –Kris Kristofferson

Recovery is not meant to be a lifelong process. The purpose of recovery is to get to “Now what?” That is, to asking yourself, “What do I want?”

The name implies it. Dictionary.com defines recovery as “restoration or return to health from sickness.” In terms of human development, recovery is growth for people who’ve had a rough start in life, usually due to a traumatic childhood of one sort or another, who need to learn or re-learn basic living skills like self-care, impulse control, and how to have satisfying personal relationships. The time needed to acquire these skills can vary greatly, depending on the level of trauma, the approach one chooses, and the amount of motivation and energy one is willing to expend on the process. But, with the exception of people who find recovery past middle age (and even for them, there is more hope possible than if they’d not found recovery at all), there is one amount of time that it definitely does not require: the rest of your life.

This is not to say that we are “cured” of our struggles: Fear, anxiety, self-doubt, and conflicts with other human beings are life, and it is not possible to be cured from life. Nor should we want that, because being cured from life (were it somehow possible) would also mean missing out on joy, a sense of accomplishment, and the great feeling of connecting with other human beings (to name just a few). So if we accept the premise that at no point do we stop having human experiences, and that recovery is a return to health from sickness, then we could look at recovery, as it applies to human development, as being about getting to a point where the issues of living fall into a more or less normal category. By “normal,” which can be a tricky word, I mean that a person is able to attend to their daily responsibilities and interests satisfactorily and meet the basic moral and functional obligations of the society they live in.

When we get to this point, we are ready to ask “Now what?”

This is the most important question you will ever ask yourself. Why? Because this question marks your shift from recovery to actualization. You’ve done the work. You’re better. You’ve restored yourself to normal functioning. Now what?

My personal experience with recovery is a good example of this process. I got sober at 27 and I worked hard to feel better about myself, have good relationships, and build a career. I went to AA meetings regularly and got involved in my group, went to therapy and group therapy, eventually began meditating, graduated from college, embarked on a new career. I learned to have healthy relationships (the romantic love thing taking the longest to figure out!). I also quit smoking and started working out and taking better care of my body. In short, I created a life that I could feel good about. Around the age of 35—about eight years into my sobriety—I began to think in different terms; I began to think about things I wanted to do. Where did I want to travel? What hobbies and activities sounded interesting to me? How can I fulfill my creative urges? And slowly I started doing some of those things. I quit my job and started my own writing business. I bought a house. Two years later, I got my motorcycle license and bought a motorcycle, something I’d always wanted to do. That fall, I took a month off work and traveled out to the east coast for a meditation retreat and two weeks of solitary exploring (something I’d always wanted to do). The following spring, I took a ten-day, cross-country motorcycle trip—by myself. Also around this time, I’d completely stopped dating and stayed single for two solid years until I got together with Jim, my life partner.

Now, you may not consider motorcycling and traveling as self-actualization kinds of activities. But for someone who had never been able to enjoy life and struggled greatly with taking on new challenges (because I was so terrified of looking stupid), it was huge stuff. It was indicative of a new period in my life.

As is usually the case, I wasn’t consciously aware of it while going through it; I didn’t step back from my life and say, “Okay, now I’m past recovery and into self-actualization.” But that’s exactly what was happening. While I still struggled with many of the same issues I always had, they weren’t so debilitating that I needed to focus on them as I’d been doing. They slowly faded into the background of my life, still part of who I was, but I became less interested in them and more interested in what I wanted to do with the rest of my life. And, also usually the case, the process wasn’t linear. It progressed in jerky leaps and starts, in some areas first and then in others, but with a gradual movement forward, until one day, around age 40, I realized that a sea change had occurred: thinking in terms of my creative potential and how to most fully experience life had become my default point of view.

Wow. What an exciting thing to realize about myself.

I think there is a tendency, in the recovery world, to feel guilty about moving on. We can get so emotionally attached to our meetings and our therapy and our support systems that we don’t want to experience a life without. We may be afraid that striking out on our own is foolhardy, self-destructive, or even heretical. And in some cases, it may be one or all of these things.

But it also might not be. And if you truly desire self-actualization, then you have to be able to determine whether your recovery activities are still essential to your well-being, or if they’re holding you back from achieving your highest potential: Woundology is a very valid concern. I was scared when I terminated therapy, and felt horribly guilty when I stopped going to AA meetings (and even as I write this, I can hear you 12-Steppers out there gasping in horror). But I knew it was time. I knew I needed to devote my energy to different aspects of myself if I was to accomplish things that were important to me. I knew that my self-actualization and my contribution to making the world a better place lay elsewhere. I am so glad that I found the courage to listen to my inner voice and move in the direction calling to me. I haven’t regretted a moment of it.

Not everybody has to move on from recovery activities; some people find self-actualization in AA, for example, devoting their lives to helping others get sober and “carrying the message.” This is vital and wonderful work. But it is clearly different than going to meetings out of guilt or fear or unwillingness to move on. If you’re participating in recovery activities for these reasons and not out of a true need or a desire to be of service, then the recovery is as self-destructive as were the reasons you got into it in the first place; both limit your worldview and squelch your potential, making self-actualization pretty much impossible.

So not only is it okay to move beyond recovery, it’s normal and healthy and essential. This process is different for everybody, and we all get to define for ourselves what it looks like. But define it we must if we want to be fully functioning adults who think in terms of being, doing, and getting what we want out of life.

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I’ve recently gotten hooked on Sex and The City reruns, thanks to my TIVO. At first it was a guilty pleasure, but I’ve decided that this show celebrates some lovely and important feminine ideals, like friendship, self-esteem, and unapologetic sexuality, which are all paths to self-acceptance and maybe even (eventually, and with the right focus) self-actualization. Last night, I watched an episode where one of the characters, Samantha, was diagnosed with breast cancer. When her doctor told her that childless women had a slightly higher risk factor for it, she interpreted this as a subtle judgment about her chosen lifestyle. “You’re saying this is my fault?” she cried, and stormed out of his office then and there, without a second thought, in search of a more supportive doctor.

The doctor wasn’t really saying that; he was merely prattling on about statistics, as doctors are prone to do. That isn’t the point. The point is that, at the slightest hint that she brought the cancer on herself, Samantha had heard enough, and was off in search of a doctor free of judgment and personal opinions about the cause of her illness.

This scene brought tears to my eyes. Sure, Samantha overreacted. But still, wow. For a woman to be that sure of herself, to believe the cancer was bad luck, nothing more, and to be completely unwilling to be in the presence of someone who gives off the slightest whiff of disagreement on that point…just, wow. It’s an utterly rational, utterly self-affirming reaction to a cancer diagnosis. It’s also tragically rare, an upstream swim against widely accepted notions about disease.

We have a tendency to believe that if we contract a serious illness, we’ve somehow brought it on ourselves. The first place we tend to go is inward, as in “What did I do to deserve this?” Diet? Lifestyle? Stress? And if we find nothing conclusive in any of these areas, then: Karma? Which, of course, can’t be disproved, so we settle down firmly on it, because it’s the only thing that can make sense of contracting a serious illness, whether it’s us or someone we know.

This “Blame the Victim” mentality goes at least as far back as The Inquisition, and rears its head today even in modern medicine with notions such as those challenged by Susan Sontag in her now classic study, Illness as Metaphor, which was “the first to point out the accusatory side of the metaphors of empowerment that seek to enlist the patient’s will to resist disease.” In other words, the way the medical establishment encourages sick people to fight their illnesses carries with it an implicit message of blame. Perhaps this happens because the doctors are victims themselves, of a mentality so ingrained in our culture (and I think in most others as well) that such blame is our default outlook unless we consciously seek to challenge it.

Sadly, most of us do not.

Even those who are supposedly on the cutting edge of higher consciousness are guilty of this. Some of the worst purveyors of the “illness is deserved” mentality today are various New Age groups, such as certain Buddhist practitioners (for example, this site, claiming that “Buddhism attributes karma as an important contributing factor to health and disease” or this one, which claims that proper meditation can cure illness) and the entire holistic healing movement, which, while fundamentally rational, is generally practiced under a grave misconception: that we have complete control over our health.

We simply do not. And I think this whole misinformed notion is epitomized by the Law of Attraction. In recent years, the Law of Attraction has become wildly popular, promising its practitioners everything they want in life if they really believe in it and if they practice it “correctly.” It’s really just a bastardization of positive thinking, cloaked in pseudoscience to make it sound both weightier and loftier than it really is. (This article at ZenHabits.net is a good introduction to what’s wrong with the LOA and why.) In relation to getting sick, it’s easy to see the logical shortcomings of this “law,” and thus by induction, the shortcomings of all philosophies that implicitly purport blaming the victim. All you have to do is carry this type of “positive thinking” and “empowerment” to its logical conclusion, which is: if you have complete control over what you want, then you must have wanted to get sick.

That’s preposterous. Does this mean the millions of poor, suffering third world inhabitants who are born into suffering and have almost no hope of getting out of it want this misfortune? Or that, if you want negativity in your life, because of self-esteem issues or the like, you would have to wait for a serious disease to strike? That’s just silly. It’s ridiculously easy to make negativity happen; you can just go out and get into a car accident, or overdose on drugs, or commit a crime, or engage in any number of other dangerous and self-destructive acts. If you want negativity in your life, you can find it. People do so all the time. You can see examples everywhere you look. And not one of them has anything to do with waiting around to contract a serious illness.

But the most glaring logical fallacy is, I believe, this: Say you’ve practiced the LOA and have had good results; good things have come into your life and you’re an outspoken proponent of its power and virtue. Let’s also say you’re health conscious, eating well, exercising regularly, and keeping your stress level at a minimum.

Then you get sick.

How do you explain that to yourself?

You have to come up with all sorts of Ptolemaic circles of logic to uncover your hidden negativity, the “source” of your illness. And you’ll find something, because we all have buried pain, and telling yourself you’ve figured it out will make you feel better, giving you a sense of control over your fate.

Then you get sicker.

Now what? Do you dig deeper? Look even further down for the negativity “causing” your illness? Commit to even greater levels of wellness and nutrition and meditation and positive thinking? All of which are fine, but none of which guarantee—and in your heart of hearts, you know this—a full recovery?

Because the truth is that sometimes we get sick. In fact, we’re all going to eventually get sick and eventually die. If we’re lucky we can put it off until old age, but there’s no way to avoid it.

And this brings us to the real reason for all blame-the-victim—oops, I mean “empowerment”—mentalities: they allow us to feel in control of things we have no control over. If it’s ourselves, we can “take charge” of our health and figure out where we “went wrong” so we can fix it. If it’s somebody else, we can feel immune, safe in the belief that he did something to bring it on himself. Nobody wants to believe it could be as simple as bad luck because that means we, too, are susceptible.

But it is that simple. Otherwise, everyone who’s “deserved” to suffer and die a horrible death (such as Hitler, Stalin, and maybe Dick Cheney) would, and decent people would never have bad luck or illness. That’s just not how life works. People can be fastidious about their health and still get sick; they can be cautious and sensible and still get unlucky. Conversely, people can smoke and drink and eat junk food and live to be 90, and they can live recklessly and never have a single repercussion. Sometimes, people get what they deserve, but not always. Luck, good and bad, is a huge part of life, and while we have control over our choices (and should exercise that control to the best of our ability), we have no control whatsoever over our luck.

It’s not that positive thinking and healthy habits aren’t good; of course they are. But believing that they can save us from being human, and that being human—that is, getting sick—is somehow bad or immoral, well, that’s an unhealthy extreme that does way more harm than good in the world. It’s a childish, unrealistic, and highly negative way to view illness, misfortune, and life in general.

In many ways, people have personal agency exactly backwards. We tend to blame external factors for things we actually do have the power and responsibility to change (our career, our weight, our anxiety, our depression, our relationships), but hold ourselves accountable for misfortunes we have almost no control over at all. In matters of life and death, it seems, the illusion of control takes precedence over accepting our fate and doing the best we can with it. I find it absolutely, tragically insane that the most popular “empowerment” movements of today support this illusion, implicitly or otherwise.

So when Samantha vehemently refused to see her cancer as her fault, she wasn’t rejecting treatment and care and good health; she was rejecting the facile idea that she was to blame for getting sick. Talk about life-affirming! There is no better way to look at illness than this. It is the most life-validating view, totally judgment-free, and it liberates you to pour all your energy and focus into getting better. You may or may not, but at least you’re seeing your fate through mature eyes and dealing with life on life’s terms. And if you’re doing that, then even illness can become an avenue for growth. Such was the case with Treya Wilber in Grace and Grit, a remarkable story about a woman’s journey of self-actualization through her battle with cancer.

That’s really the best any of us can do.

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