[Part I] Prozac Nation Comes to Visit

Some people have wondered why exactly it is that I have so much focus on mental health-care issues when it's clear that I'm not exactly incapable of logical thought or keeping a fairly even keel even under occasionally outrageous pressures.

Well, I'm used to dealing with mental health-care issues because there are people close to me who have these issues.

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My own problems are pretty much cured with a daily thyroid pill. Without it, I will always feel very cold, and otherwise will have symptoms almost identical to severe depression: lethargy, poor appetite, and very muddled thinking. Yet it's medically quite easy to distinguish between a thyroid problem with that set of symptoms, and major depression. You do a blood test for thyroid hormone stimulating hormone, and if there's a shortage of that, you treat with synthetic thyroxin. If, after the thyroid levels stabilize, there are still other problems, you treat those as a separate issue.

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Everyone in my family, myself excepted, has been diagnosed with depression at one time or another, and treated for it. Most of them responded very well and are not merely successful by most standards, but happy by any objective and by most subjective measures.

I had a lot of different diagnoses before someone finally got around to checking my thyroid. Why nobody ever did, I can't imagine. Yet it's amazing how quickly appropriate treatment will clear up this sort of thing. I might add, in passing, that treating a thyroid deficiency with antipsychotic drugs might help with symptoms but do nothing about underlying problems, and untreated thyroid conditions tend to lead to lasting and potentially-permanent organ damage, in the adult-onset variations of the disorder. Juvenile thyroid deficiency has a classic and easily-recognized syndrome. As many as 1 in 20 adults have an undiagnosed thyroid disorder.

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Dealing with people with major mood disorders can be a challenge. With certain depressive disorders, it's particularly challenging when they are effectively unaware of the degree of their disturbance, when they have no insight into their condition at the moment. Depression is both a disturbance of mood, and of thinking processes. One thing I've had to learn to deal with is that a lot of modern medications will do a lot to help the mood problems, but not much to deal with the cognitive defects.

We've all read stories about so-and-so who seemed to be doing so well on Luvox, well, until they went batshit crazy and killed dozens of students at Columbine High School.

It seems to be unfortunately common.

As I see it, there's the classic problem of people on Prozac, which as best I can tell works by suppressing the cortex of the brain that produces the higher mammalian emotions. This, of course, mostly leaves the reptilian cortex in charge of emotion, and reptiles are pretty much noted for caring about little other than guarding territory and eating anything they can fit in their mouths and digest.

I know lots of people who are taking medications for depression. Almost all of them are very intelligent, many are artistically talented as well. Usually they have excellent educations along with all of this.

But I have had to learn, from every last one of them, that you simply cannot take for granted that they'll react to anything in a reasonable way, nor that they'll act in a reasonable way even with nothing to which to react.

I know, I am a close relative of, someone who once said "I got so tired of people asking me 'what's the matter' that now I just keep a happy face on all of the time".

To them, that's making them feel a little better knowing that they're not making other people concerned for them.

To me, that means that I cannot tell from looking at their face whether they are feeling pretty good today, or are entering the emotional domain of the homicidally insane.

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Conversations with most people who are drunk, or who are using recreational chemicals to get high, tend to be characterized by a lot of non-sequitur changes in subject, free-association taking over the direction of conversation as this or that thought flits past like some shiny butterfly at which the disordered mind must, if only for a moment, reach.

I've spent so much of my life around people being treated for depression -- and many of the anti-depression long-term medications have this exact same effect -- that for perhaps most of my life, I thought that this constant flitting from one thought to another was normal.

Literary traditions make use of this sort of thing, with foreshadowing, flashbacks, changes of viewpoint, or multiple threads following various characters, in synchrony, in different places and in different situations until their paths are crossed by the plot to generate the conflicts and resolutions so fundamental to storytelling.

Normal thinking -- at least before the so-called "ten second attention span" was forced on us by radio sound-bites and television advertising -- was characterized by linearity. The real story of our real life had a beginning, a middle, and an end, and in between those points, ideally it was the smooth segue of one moment into the next, along a continuum of emotion and experience generally as predictable as the day itself. Yet as the modern pace of life evolved, the pace and structure changed from a fairly relaxed affair (with linear structure) into a jerky and semi-random clock-driven thing. A woman might wake as a wife and within two hours be deep in a boardroom power-struggle, but only after 45 minutes spent as a super-mom getting breakfast into the kids and the kids onto campus. At lunch she might be flirting with a new love interest and an hour later she'd be eating her dead (so to speak) after taking no prisoners at a sales conference where the next six months of production hang in the balance along with her hopes for promotion or continued employment. And in the evening, you run the household at full speed until bedtime and then you have to take Ambien and hope you don't wake up in the next county.

So, increasingly, the flitting from one task to another, from one emotional state to another, from one cognitive style to another, from one milieu to another... people are living their lives in the same way that people on drugs, or with major depression, think. And somehow, despite the fact that this flitting around is diagnostic, this has become normal.

How did this happen?

And if this way that we live our lives, is in the exact mode that is diagnostic for mania and manic-depression, shouldn't we all be on lithium or something?

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More to come, as long as I have relatives, I guess...

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