The Devil I Knew

Yes, I hated my profession by the end. Actually, I hated my profession quite some time before the end. But, there was one advantage to practicing law – when I could force myself to do it I was a damn good lawyer. I know it sounds conceited, even arrogant, to say it in that manner. But it is the truth. Other attorneys, some quite senior to me, would often pop into my office and bounce ideas off of me. Usually, I could add to what they had already come up with. Where other attorneys came to a stumbling block, I could often point out a theory or case that would allow them to at least have a fig leaf of an argument if not a winning case. This was, perhaps, the only aspect of practicing law that I did not completely hate. Not that it did myself or my clients much good.

I could help others with legal theory, but especially at the end, I could not bring myself to do so much as make a phone call, or even answer a phone call. The other attorneys in the building would drop by and I would offer sound advice on their cases, then immediately go back to navel gazing. But, in my heart, I knew that I could do it. My competence was in no way in doubt.

Then all of that changed. Regardless of the “prestige” of being a lawyer, I recognized the need move on from the law. Now that change has arrived, I find myself again at the foot of a steep learning curve in my new profession. Perhaps it is a bit of an exaggeration to say “the foot”, but I do have much to learn. After having achieved a high level of competence in my prior profession, this can be difficult to take.

At each misstep or error, which happens more often than I’d like when dealing with math, the critical voice inside my head goes into overtime. Perhaps you have heard this voice as well, the one that tells you, “You are a fool” “You will be fired” “They’ve seen through you now”, etc. ad nauseum. No, again not an actual voice, thank God, but feelings of doubt, low self-worth, and pure fear. The fear is the worst part. It is the part of my mind that unleashes the primal monkey in my brain and makes me want to climb chittering up the nearest tree and hurl feces at passersby.

All of this is coupled with the damnable self-examination to which I must constantly subject myself. “Am I being manic, or is this a normal reaction to a stressful situation?” “Is it normal to feel this frustrated at the end of a difficult day at work, or am I sliding into a depression?”

Someone asked me the other day if I missed practicing law. I answered honestly that I did not miss it one teeny tiny bit. I still believe that to be true. I am still relieved not to deal with the problems and emotions of others (dealing with my own are enough, thankyouverymuch). But what I do miss is the feeling of absolute competence. The feeling of mastery of a profession. The positive part of my mind tells me that I will learn this new profession in time as well – perhaps becoming as fluent in this as in others before. But at present this is cold comfort. No matter how it galled, how much it burned, I miss dancing with the Devil I knew.

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.

One Flew Into the Coo-Coo's Nest

I had the distinct privilege of spending my 40th birthday in a mental ward -- to be more specific a "crisis intervention" center. The Sunday before my wife and I spoke in great detail. For the first time, both she and I came to a true realization of the magnitude of my problems. Suicidal thoughts, or simple thoughts of fleeing, were regular for me. For months I suffered from paralyzing inaction at work and allowed almost every client and matter to stymie. The real prospect of financial ruin, bankruptcy and perhaps even disbarment loomed before me. While my wife had guessed at some of this, the sheer magnitude of it all surprised her. For sometime our relationship had been rocky, even before this revelation. The remaining flex turned brittle and broke. Faced with the magnitude of my problems and likely the end of a thirteen year marriage, I broke as well.

Monday afternoon found me in the facility (at my wife's urging, I might add -- she is not a completely heartless person). Life in the facility is difficult to describe. You find yourself returned to childhood and beyond. Your belt , your watch, your keys, even your money are taken away from you to keep you from presenting a threat to yourself or others. Your clothes are washed for you by an attendant, not as a point of customer service, but again to keep you from harming yourself or others with the washing machine or dryer.

Breakfast, Lunch and Dinner are all at set times -- much earlier than you are used to (dinner was at about 4:20). Not only was the food the typical bland institutional fare but there was only one choice of food with scanty servings -- I lost about 10 pounds while in the facility. However, because the dining room was on a different wing of the unit, the walk to and from each meal constituted the only real excitement for the day. For the remainder of the day I was free to watch television, to read one of a couple dozen dog-eared and decades old books from genres that were wholly unappealing to me, or to sleep. As the adjustment to my medications made me very drowsy, sleeping during the day became a very viable option. There were also board and card games led by the assistants, but I could never bring myself to get involved in these. My only responsibility was to metabolize the medications I had been given. Otherwise, I was free to do nothing -- and as little presented itself to do, doing nothing became amazingly easy.

My fellow denizens were a mixed lot. Several were drug addicts sent to dry out by the various local townships before continuing with their judicial process. I carefully avoided any mention of my profession to avoid the incessant requests for free legal advice that necessarily follow. Others were individuals such as myself, professionals and working individuals who needed to have a 'time out' and a readjustment of medications including a self-employed plumber, a business man, and a carpenter. I tended to spend time with these folks. Then there were the truly ill -- those being held until a court order requiring them to submit to long term treatment at the state's mental health facility could be obtained.

The truly ill presented the most uncomfortable aspect of the stay for me. Not because I ever felt endangered by them, but because part of my work as an attorney had been to work the very docket that they would appear on. The town where I reside has the largest mental health facility in the state, and attorneys in this town on a fairly regular basis are called upon to represent the severely mentally ill as they went through the process. Now I found myself on the other side of that system. Thankfully, as I came into the facility voluntarily it did not become necessary for me to appear as an inmate of the asylum before the judge that I had argued many cases before, represented by an attorney who knew me.

As for the conduct of the truly ill, it was mostly benign. One lady kept trying to pull down her pants and would regularly walk around the unit doing the 'tomahawk chop'. One older gentleman seemed fairly lucid until he began to tell you about the scar between his shoulder blades where his ancient ancestors cut off his wings. Another younger gentleman walked around the ward, regularly stating in a loud voice the first three or four "steps" of the twelve step program of Alcoholics Anonymous. The drug addicts would often sit in corners, trading information on the best and most undetectable means of cooking meth or passing drug screens. Me and my cohorts generally spent the day watching daytime television and/or watching one of the five DVDs available to us (I saw entire showings and scenes of "Napoleon Dynamite" and "Gone in 60 Seconds" more times than any human being should be subjected to over the course of one week).

The treatment I received itself was, in fact, pretty good. An RN there was the first person ever to ask if in addition to suicidal thoughts if I had ever developed a plan -- to which I honestly had to answer "yes". Why had I not acted on it? Well the ultimate conclusion that I came to mirrored that of Hamlet in the famous "To be, or not to be" soliloquy -- "And thus does conscious make cowards of us all." Weeks before I had even begun memorizing it as a mantra to keep myself from "tak[ing] up arms against a sea of troubles, and by opposing them end[ing] them."

During my stay my condition was stabilized and my medications were adjusted. In addition I received a much needed "time out" from the 'slings and arrows of outrageous fortune' as good ol' Willie put it. I felt ready by Friday of my stay to return home. First I would need to pass the shrink test.

Forever I have used humor, especially self-deprecating humor, in everyday conversation. It is part of my nature. So, when the shrink asked about what I thought of my stay I told him that, having turned 40 in a mental ward, that I'd been cheated out of my rightful mid-life crisis -- I should be chasing blondes with big boobs and driving gaudy sports cars. The shrink, of course, felt that I might be getting a little bit manic and ordered that I stay the weekend for further observation. (Note: I really did say that to the shrink and he really did make me stay an extra 2.5 days as a result. Shrinks have NO sense of humor.)

I do not think that it will be necessary for me to ever return to such a facility, but it holds less fear for me now than it did before. I would just be sure to bring several books with me that I would like to read.

Oh, and I wouldn't crack any jokes around the shrink, either.

To Boldly Split Infinitives and Self-Observe Like I've Never Done Before

The distinction between mental illness and mental health is not a bright-line distinction. On one end of the spectrum are the "healthy" and on the other are the clearly ill, those experiencing hallucinations or who simply cannot function at even the most basic level. Between the extremes are the depressed, the bi-polar, the ADHD, the high-functioning Autistic.

To the extent that it is clear that their actions stem from their mental illness, those who are very ill are excused to an extent by society. Problems arise, however, when unraveling the actions of the less ill.

Certainly there are many among the mentally 'healthy' who make fools of themselves. The question arises then, whether the foolish actions of the marginally ill, such as a bi-polar person, stem from a manic episode or from the unfiltered poor judgment of the person. Is the depressed person merely lazy, or has that person's condition made it impossible to carry on? Even the affected person can find the question difficult to answer.

Looking back, I can see decisions made during my life that I feel were definitely made under a manic influence. Decisions made that I knew at the time to be completely out of character with my basic nature, but with which I felt compelled to proceed. Others foolish mistakes are more difficult to quantify. I cannot say definitively whether they were made under a manic influence, under my own poor judgment, or some combination of the two.

Of course, suffering from bi-polar, the opposite is true as well. There have been times where I have been paralyzed with inaction that I am quite sure have been linked to depressive episodes. But there also have been those times when I cannot say definitively that depression played a major role, or any role in my inaction. Even the most 'healthy' person can need a break or even just be lazy.

I know of no magical key that will allow me to open this mystery. Nonetheless, much of my life seems to rest on making this determination. If I cannot recognize and take active measures against a manic episode, how can I take the appropriate actions to minimize its influences? Likewise, if I cannot recognize in myself the depressive cycle, how can I expect myself to seek the required help? It is not logical for me to trust in the observation of others. My wife of 13 years could not truly detect these shifts. Apparently, within me is the ability to cover up and lie to one and all, including myself, when these episodes strike. I have hope that the modifications to my medication have taken sufficient hold that the extremes do not manifest themselves often or at all. But, can I be sure?

That is the Gordian Knot, the $60,000 question, the continuing hero's quest of self-realization -- whether I train myself to be sufficiently self-observant and disciplined to recognize and correct irrational mood swings. The answer to this question will determine whether the rest of my life will fulfill the promise behind this Blog, or whether my life will result in a smoking ruin.