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.