The Birthday Blues

Oh God, how much I love The Guardian. Or The Observer as it is called on this long soapy showering, real coffee drinking, should be eating hot buttery croissants (but actually eating lukewarm ready break) day of rest. And God, how much I love the fact that it is free for me to read on the internet. I truly hope it always stays that way. There are some thought provoking articles in there this Sunday, including this article about Prozac, which got me thinking:

Prozac is twenty years old this week. Somehow I didn’t think it was as old as that, but then don't listen to me, occasionally I still go to write 1999 when signing in the date box next to my name. Sometimes I think I might, on some level, not have fully left behind my A level years. Part of me, somewhere, still longs for a headspace free of responsibilities. I hark back to a time when I carried around volumes of my mispelt stoner poetry that, naturally, was on the verge of getting published. Back then, everything that was happening to me was the first time it had happened to anyone. I was so irresistible that my religious studies teacher was about to leave his much loved wife and kids for me. I just knew I could get straight A’s without doing any work. Of course I could single-handedly bring down conservative Christianity, Patriarchy, and Right wing politics in general just by reading Bukowski, Nietzsche’s ‘The Antichrist’ and Greer’s ‘The Female Eunuch’ like they had only just been published and were written for me alone. Back then, consuming Marlborough reds, tenner deals of petrol laced ‘rocky’ and whole bottles of Jack Daniels comprised the highlights of my tiny self absorbed existence. Delusion was piled upon delusion but I never quite managed to kid myself. Inside me a tornado whirled and consequently the year 1999, the last of my school career, was also the date I first got treated for depression.

The doctor’s appointment was short. That’s mostly what I remember. I was very nervous, my hands were shaking. I think, although I am embarrassed to admit it, it might have been the first time I had been to the doctors without one of my parents present and I was terrified. In hindsight now I know my symptoms were pretty mild. I wasn’t sleeping well, was feeling agitated and distracted, couldn’t concentrate on schoolwork and was off food. My thoughts, although often intense, had been getting darker and bleaker in nature. In short, I just wasn’t feeling my usual chirpy self. It was like I was trying to run a race with treacle on my shoes. I also was worrying a bit obsessively about some stuff that had gone on in the past, and this was manifesting itself in some ways even I knew were strange; like not being able to sleep unless I counted to a hundred twenty five times without missing a count and if I did then starting back at the beginning (hence the not sleeping). But in no way was I chronic. I was not suicidal, I did not self harm, I was functioning in my day to day life. I wasn’t crying non stop, my mood wasn’t all that low a lot of time, even my attentive parents hadn’t really noticed a dramatic change.

In other words, the weird counting thing aside, most of my symptoms could have just been put down to A’ level stress or teenage angst. Maybe in a different age they would have been. But there are three key details I remember about that doctor’s appointment:

a) There was a Prozac clock on the wall tick tocking away as we spoke.
b) The doctor was writing with an Eli Lilly pen.
c) Her coffee, which smelt nice, was contained in a mug that proudly displayed the word ‘Prozac’.

And less than five minutes later, I left her room, clutching a piece of paper in my hand that said words which amounted to the same thing: ‘Fluoxetine: 20 mg (one to be taken twice a day)’

Questions asked to me in that interview:

What’s the problem? (I told her the above symptoms)
Are you feeling suicidal (I laughed and said no)

Diagnosis after that literally three minute assessment:

Mild to moderate clinical depression. Possible obsessive compulsive disorder.

Treatment:

Prozac for six months to a year. Then come back and see me.

I don’t even think this is a bad diagnosis in terms of our health care system. Something wasn’t quite right with me and I think many psychiatrists and doctors up and down the country would have made the same call. As skeptical as I am about the psychiatric classification system you have to have some kind of guidelines for diagnosis, I suppose. The real beef I have is with the thoroughness and type of treatment that was offered to me and the care that was available. First of all, taking three minutes to diagnose someone with a mental illness, even if it is one of the milder so called common colds of the mental health spectrum is simply not good enough. The patient education and aftercare system was appalling, after being diagnosed with what to me was quite a significant problem, I was just left to get on with my life. Not even a fucking leaflet or a Samaritans phone number. This is worsened further by the fact that I was, technically at this time, a child. I had just turned seventeen years old and I was very confused about the whole thing. I was somewhat educated, I knew from reading bits and bobs on the internet and from knowing friends of the family with similar problems that having this diagnosis didn’t make me ‘nuts’. But no one, not even the doctor checked to make sure I knew that.

When I left that appointment, and for months afterwards, I felt dramatically more ill than I had done before I went in, simply because my symptoms had been given a name and had been categorically brought into the realm of ‘sickness’. It reminded me of when, as a kid, you went to the doctors with a sore throat thinking you might, if you’re lucky get given a day off school and then are told you have tonsillitis and need antibiotics. From that moment on, even if previously you had been feeling okish, for the next week it takes a crowbar to prise you from the sofa, you feel like you have swallowed sandpaper and all you can eat is ice cream and tomato soup. It's genuine, but it is also, to a certain extent, psychosomatic. Firstly, this is a very common reaction to being diagnosed with any illness, but especially mental illnesses, and someone should have been there to talk me through that. Secondly, I’m not saying my symptoms should have been ignored, but by medicalising them and giving me a diagnosis when I was so young, sending me into the wider world with a label (always a dangerous thing to give a teenager), rather than to a counsellor to talk about some of the stuff that was bothering me and thoroughly assessing my case, was, in my opinion, wrong. Also, unhealthy aspects of my life that I now know were having a massive impact on my mental health, such as my bad diet, my excessive alcohol and drug use and lack of exercise, were never even mentioned, let alone explored. If all the ‘common sense’ stuff had been dealt with before telling me I was sick and pouring Prozac down my neck, well things could have turned out very differently.

They talk about cannabis being a gateway drug for heroin and crack. Now, I don’t personally follow that logic, but if I did then I’d have to concede that Prozac was my psychiatric gateway drug. Since that day I got written the prescription, nearly a decade ago, I have not been off psychotropic drugs. In a typical dealer fashion, they have got harder and harder, pushed with more and more force and coercion. As my mental health deteriorated further over the years following that appointment, I moved from Prozac and Seroxat to Lithium and Valium to Risperdone, Stelazine, Beta Blockers, and dozens more. It’s got to the point now where I’m practically a drugs connoisseur.

There are, it seems, two ways of looking at this:

1) The official line. My episode, at the age of seventeen was clearly worrying, with the potential to develop into something disastrous. The experienced doctor who had seen this thing many times before was good to pick up on these signs and treat them accordingly. Drug treatment is the most quick acting and effective treatment for depression recommended by the NHS, and Prozac one of the most effective in this family of drugs, especially considering the OCD type symptoms I was displaying. The doctor followed what was the recommended course of action at the time. It was simply unfortunate that I was resistant to Prozac, and many of the other drugs she and subsequent doctors threw at me, My illness, now rediagnosed as the more chronic and lifelong bipolar disorder is notoriously difficult to treat, and with hindsight, it is unsurprising that a small dose of Prozac didn’t make me better. However, the doctor, not knowing those facts, acted correctly.

Or

2) My line. If I had been offered counseling in that first appointment which had been the course of action I wanted (I was, in fact astounded that it was that easy to get a prescription) rather than the tablets that the drug pushing companies pressure their GPs to prescribe, then I may have got to the root of the problem a lot quicker and never needed drugs. Also, If my symptoms had been treated as normal and teenage, rather than sick and mentally ill, at least in the first instance, then I may have thought of the situation in a whole different light and who knows where it would have ended up. I just have this nagging feeling in my head that without all the mind fucking chemicals that were relentlessly pumped in experimental cocktails and huge quantities into my head at such an early age, my brain could be a very different place right now. Also, from a psychological point of view, without all the confusing (and often conflicting) diagnostic labels being stuck on me like superglue, maybe I would have a better self image and be leading a healthier, happier life. There is something fundamentally damaging to be told your brain and personality isn’t working right before you even hit your eighteenth birthday. After all, self perception is of paramount importance. As a young woman to be told by those in authority that you are sick in the head, with all the stigma and implications of such a diagnosis, could be something that, in itself, makes you sicker. In other words, maybe I’d be better if I’d have never gone to the damn doctors in the first place.

I’ll never prove it of course. The establishment will always argue that I needed the medicine, that it has been good for me, that without it I might even be dead. And maybe they’re right. But I will never forget that doctor sipping from the Prozac mug, and the way she didn’t even pause for thought before signing the brain of a child away to a chemical that, I later learnt, was surrounded even back then by controversy and doubt. So happy birthday, Prozac. You may have saved a lot of lives, but you’ve also helped trivialize and oversimplify a complex and dehabilitating illness, and have changed the face of psychiatry to one dominated by branding, advertisements, and false, false promises. Once, back in 1999, I believed them. Now I can’t help but feel a little bitter. Forgive me if I don’t sing whilst you blow out your candles.