Surgically Bombing Your Brain

The term “surgical bombing” refers to situiations when an aircraft places a single munition directly on the target rather than flying thousands of feet overhead and dropping dozens of bombs in the hope that one of them will hit the intended target. By definition a surgical strike puts “warheads on foreheads”. [Warning! While not graphic (i.e. no blood or gore), the following link leads to a video that includes the explicit war death of several individuals from one precision guided bomb. Viewer discretion advised.] For example, see this video where a precision munition changes targets after it is released from the aircraft to engage several moving targets. However, even in a “surgical strike” with a bomb composed of 500 pounds of plastic explosives so called “collateral damage”, or unintended damage, is likely to occur.

Medications can be the same way. Modern American life includes advertisements on prime-time television for everything from Aspirin to Zyrtec, each of which includes a long list of possible side-effects. Side-effects, or collateral effects, are usually fairly benign – dry mouth, fatigue, etc. All of that tends to change when the medication is designed to “surgically strike” the chemistry of the brain. Most would think that the collateral effects of mood stabilizers or anti-depressants would be clear and severe, like so. [No warning needed this time :) ] But, just like the subtle distinctions between a mentally ill person’s actions and inactions, the subtle collateral effects of medications that affect the brain can be difficult to detect or determine.

Changes to libido (increases and decreases) are not uncommon as collateral effects, but such ‘hot and cold’ periods are really not so uncommon among the non-medicated. Increases of risky behavior, such as gambling or aggressive driving can occur – but so can mid-life crises as well. High blood pressure can be the bane of many in our society, but one medication that I took in my quest for the right balance caused my blood pressure to soar until I suffered persistent headaches. By the time I got in to see the doctor, my blood pressure was something like 160 over 100.

All of the foregoing is once again complicated by the presence of diagnosed, or misdiagnosed, illnesses. If a heretofore shy medicated depressed person suddenly becomes very sexually active, does this indicate that the person is suffering the collateral effects of the medication, or a perhaps a manic episode from previously undetected bipolar disorder?

And just how does the doctor go about determining which drugs to prescribe in what amounts. Pretty much trial and error.
“Did you feel better for the last couple of weeks?”
“Well, I think so…”
“Good, then we will up your dosage a bit and see if that helps more.”
Or, worse yet:
“No, I still feel depressed.”
“Ok, lets try something different then.”
There are no blood tests, no x-rays, no objective standard for determining if you *are* in fact getting better – only your ill, possibly misdiagnosed and improperly medicated brain to inform the doctor of you subjective feelings.

Changes to medications usually mean weaning you off the first drug and then slowly upping the next. This process can take weeks. If there is anything worse than starting the medications, it is weaning off of them. – dizziness, nausea, fatigue, confusion – all of these have happened to me while changing medications.

The only thing worse than the medications is to not have any medications. I must say, having finally found a good balance for myself that the collateral effects fade over time and the renewed ability to address life is worth the trouble. Despite all of my groaning and moaning, the long journey of finding the right medications has been worth it.

What does strike me as odd, however is the universal condemnation society places on those who have been prescribed these medications and refrain or refuse to take them. The person with a diseased heart who refuses medication or surgery and has a heart attack while driving, killing others, is not blamed – there is no mention in the popular press about this person’s irresponsible maintenance of health. Those diabetics who choose to eat themselves into an early grave and burden the insurance and medicare system getting self-propelled carts at “little or no expense” to them are rarely mentioned with ire, only sympathy. And yet if a mentally ill person does anything negative – from loosing a job to committing a murder – the first question asked is whether that person was on their medications. If the answer is “no” there is much wagging of heads and clucking of tongues by all, with perhaps the odd call to make sure that some further control is made on such people to keep them on their medications.

Medications: Damned if you do, committed if you don’t.

New Beginnings

There is something intoxicating about new beginnings. The yellowed and dim page filled with eraser marks and interlineations ripped aside to reveal a bright clean sheet. Of course, as one gets older, the page beneath the one you just tore aside carries the impressions from the prior page -- dim reminders of hasty notes written in a powerful hand. And, of course, there are some notes that you want or need to carry forward with you. That list gets longer, and longer, until a 'fresh start' is rarely the blank page of earlier years.

I find myself now with a fresh start in some sense. Tomorrow I begin a new job, and really a new profession, although the new job is based upon knowledge gained from my old profession. The indentations of the law have dug deeply into the next page for both weal and woe. The indelible ink of my three sons seeps deeply through the pad of paper that is my life, never to be forgotten no matter how often I tear at the pages. Once I thought the same was true of my wife, but now time will only tell if this is so, or if my marriage is another set of deeply inscribed indentations from the page before -- making it difficult to write fluidly on the new sheet of paper but otherwise the ghost of a hope that died unfulfilled.

New beginnings are intoxicating, but they are a young man's heady drink. The older we grow, the less we taste the wine of new beginnings and the more we taste the dregs of what might have been.