Confessions of a Pill Eater
“The only people for me are the mad ones, the ones who are mad to live, mad to talk, mad to be saved, desirous of everything at the same time, the ones who never yawn or say a commonplace thing, but burn, burn, burn, like fabulous yellow roman candles exploding like spiders across the stars and in the middle you see the blue center light pop and everybody goes “Awww!”
* Jack Kerouac
All this started with the chest pains. I was fairly sure it was not a heart attack even as the band tightened around my chest because I experienced this symptom all my life. It is an anxiety attack and they were becoming more frequent. At my age I thought it worthwhile to mention these to my doctor, who put me through a full cardiac screening. I passed. (Can I have some more mayonnaise on that fried oyster po-boy?) The problem is I’m more anxious than in the past. When the severance from my Big Bank job came, I breathed an immense sigh of release. I was the master of disaster, could step in and pull things back together when the wheels were coming off. My bosses thought I was King Kong Superman. I could do a week’s work in two-thirds the time, and steal the rest of the hours to write. Then the all-night IT conference calls and constant emergencies, the emails sent by coworkers at midnight read on my Blackberry leash, began to wear me down. I started to refer to work on my blog as Moloch. I was a burned-out speed freak. Still, I lost my job and the money slowly runs out. Now I am a contractor with no vacation on the horizon. A day off costs me $500 I can’t afford. A bitter divorce does not help. I know the domineering and unstable person behind the mask of exaggerated civility and even cheerfulness. I read the strings of ranting passive-aggressive text messages and sit through tense meetings with lawyers. After 20 years she knows every soft spot, every hot button. I am the favorite toy in her infernal claw machine. Some mornings before I’ve had my second sip of coffee something comes to me, a remark from the past, the ghost of tomorrow, and I can feel the razor sharp claws digging into my skull.
The formal diagnosis from my therapist and the medication maintenance practitioner is Generalized Anxiety Disorder. We all know what an anxiety attack feels like. The boss calls you into the office and you know why. Your friend drags you to a party where you know no one else, abandons you in a circle of strangers to go say hello to someone else. You are ill-dressed, ill at ease and keep the bar constantly in sight. You are silently circling your spouse in the kitchen making dinner waiting for the unspoken to explode, notice the trembling in your hand as you wield the knife and pour another glass of wine to steady yourself. Do you take another glass of wine or two, or the Klonopin? Now imagine you lay awake too late at night or snap awake too early some mornings with all these thoughts running through your head like a bad, lucid dream you can’t escape. Stretch out that feeling to most if not all of your day. I have worked for the last ten years as an IT project manager and in quality assurance, writing test cases. It is my job to imagine everything that can go wrong. This is not an ideal line of work for someone with GAD.
My routine doctor wrote the first prescription for Klonopin. I stopped having the heart attack-like symptoms. I could handle the confrontations with my future ex with an extra half a tablet. After six months I had to go back to the clinic for another refill and she asked if I still needed them. I said yes, so she shipped me off to the Ochsner Clinic to see the pill doctor. He is not actually a doctor but a nurse practitioner with a license to write prescriptions. He is one of the nicest guys I have ever met, and one day when the air conditioning went out I noticed he had a fabulous tattoo on one forearm. He is earnestly trying to help but if you are the pill doctor everything looks like a prescription. That’s when the tinkering with my mind began.
Side effects of anti-anxiety drugs
Anti-anxiety drugs like benzodiazepines work by reducing brain activity. While this temporarily relieves anxiety, it can also lead to unwanted side effects . . .The higher the dose, the more pronounced these side effects typically become . . .Benzodiazepines are also associated with depression. Long-term benzodiazepine users are often depressed, and higher doses are believed to increase the risk of both depressive symptoms and suicidal thoughts and feelings. Furthermore, benzodiazepines can cause emotional blunting or numbness. The medication relieves the anxiety, but it also blocks feelings of pleasure or pain.
I take four pills for breakfast. Lisinopril 10 milligrams for high blood pressure, which is fine. It runs in the family. The rest of my bottled breakfast consists of clonazepam, 0.5 milligrams for anxiety, the first of three today. We tried Xanax for a week but it did not play nicely with my 400 milligrams of lamotragine so it is back to Klonopin and only half a tablet of lamotragine. I take the latter off label as a mood stabilizer. It is meant for manic depressives. A friend tells me 400 milligrams is more than her manic-depressive husband takes, and I started to break the tablets in half. We switched out the lamotrafine after my fourth or fifth fall from dizziness and switched to citalopram, an “an antidepressant drug of the selective serotonin reuptake inhibitor (SSRI) class . . . frequently used off label to treat anxiety, panic disorder and OCD.” I stopped taking the SSRIs a while back because of a side effect: anorgasmia. You have enough Latin to figure that out. The SSRIs also have the danger of prolonged erections. I joked with my pill doctor, said: Are you trying to kill me, giving a guy my age something with these side effects?
He didn’t laugh.
Anorgasmia, the loss of coordination that led to that tumble into the bayou helping some guy launch his kayak, and strict directions for lamotragine not to change any of my body care products because the drug can cause what Crazymeds.com calls The Rash. Some of these are fatal. Who knew you could die of a rash? Just as bad, friends tell me that there is something different about me, some change of personality they find disturbing, gradual at first but the lamotragine buried the needle. I have become anti-social. I don’t call friends so friends don’t call me, or I let them go to voicemail when they do. My social awkwardness as a child taught me to value solitude. I escape into my comfortable cocoon and wait to take the next pill.
Worse still: I can’t write. I am amazed I made it to 600 words without a syllabus and a deadline. The first draft of this was created at the end of June (2012). Two months to manage 3,800 words. I try write, to do the Work, just as I can get up and make my daily 7:30 a.m. conference call for Moloch. You set a time, you sit down and do it because writing is The Work, but now I find myself staring at my reflection in the blank page. It just doesn’t come. I started a long poem a while back and that is The Work, sitting down and filling in the plan, adjusting as you go along, finding the lines and fitting all the pieces together, but I can’t focus enough to make progress. Most of my poems are different: short lyric echoes of the wrinkles in the way things ought to be to which some people are sensitive. I had that, once. Perhaps my writing was an ephemeral phenomenon, a temporary imbalance in the brain waiting to be set right. Maybe I am no great shakes as a writer, as a poet. I’ve published some; nowhere big yet. An erratically published but prestigious local journal with hundreds of library subscribers has accepted a poem. I’m disappointed that The New Yorker only accepts email submissions and sends email rejections. I wanted that damn letter, even a postcard with the logo on it to tack on my wall, a reminder, a prompt for Samuel Beckett’s worlds: “Ever failed. No matter. Try again. Fail again. Fail better.” The blank page stares back at me, and I turn away.
When the horses are in season, I sit on my stoop in the morning with coffee and a smoke, watching them exercising. The crows come in waves to see what the hooves have turned up for breakfast. The street is quiet, hidden, four blocks of blacktop known only to the oldest of the cabbies and those of us who live here even though a hundred thousand people pass each day during Jazz Fest. Bicycles equal the cars. I hear a horse at full gallop, that peculiar rumble, probably not running today but stretching out the muscles for tomorrow. I try to sip the coffee slowly, let it clear my head and not invite the frantic little demons, the constant worries of a constant worrier, to let the horses and morning be enough. Most mornings it is enough.
I believe I need to take the Klonopin for GAD and the accompanying panic attacks. My grandfather had this condition, my mother has it, and my sister has it. Even my children have it. Anxiety and panic attacks are just a fact of life, just another inherited disorder like high blood pressure and elevated cholesterol. This is not the pills talking but my life. I know the difference. I spent seven years of my life with an alcoholic partner. I know the addict talk, heard it from my first wife bellied up to the bar, screaming in the kitchen, as pillow talk. Without the Klonopin I could not function, not at this point in my life. It is the piling on of prescription after prescription, trying to fit a square peg into the round hole of happiness, which is damaging and coming to control my life. Each and every medication I take has its side effects, but what are the limits? Emotional blunting or numbness. Blocked feelings of pleasure or pain. Depersonalization. Is this what it means to be happy, to be normal? The side effects coalesce and crystalize until you are frozen in place. You call up the doctor. He tinkers with the mix, a little less of that, and let’s try this. Friends wonder what has happened to you and they do not realize you are sitting in front of a typewriter with a blank piece of paper because the blankness itself is the most intense expression of your interior life, your diminishing imagination. I took Klonopin for almost two years without noticeable effects but over time I slowly stopped returning friend’s telephone calls, found excuses not to get together. I was a tremendously shy child but no one I know now believes that. Now that I know this is a side effect, I know I have the power to overcome it because once someone does drag me out of the house into conversation, drinks, music, the anxiety slips away. This social lethargy is no worse than a hangover. Get off the damn couch and get outside and do something if you want to feel better.
There is something about my girlfriend’s company, sitting in her high-backed wing chairs and talking for hours and the anxiety goes away. I worry about her advanced fibromyalgia; she is suffering more than I am. She listens to my problems and I listen to hers. Every time one of us mentions some idea or pleasure we learn we share, one or the other wets their finger and marks an imaginary chalk board, and I think we need a bigger board. When we first met we had great sex, a lot of it. We both had done mostly without but she was delighted to find that at 57 that it was still possible. Lately this has tailed off. To blunt the pain that wracks her body it takes a Loritab and a couple of cocktails. We spend more time in the wing chairs talking and laughing. Some nights I just crawl into bed beside her, cuddle up to her back and fall asleep to the quiet rhythm of her breathing. I forget to take my pills. I don’t notice.
I don’t remember my first real anxiety attack but it likely came early in life. I was a socially awkward child, introspective, imaginative, and slow to learn the ways of social interaction. Like many awkward, shy children I was bullied. I arrived at my cousin’s house once and dutifully kissed all the women relatives. Then I walked up and kissed my uncle. I was old enough then I should have known better. You don’t kiss the men, someone said, and the entire room broke into cocktail laughter. I slunk off toward a corner near the hallway, and when no one was looking I slipped through the kitchen into the backyard and sat alone, trembling. All through my life I invited anxiety attacks. I was smart enough to try to coast through school but there were inevitable deadlines once I reached high school, papers due and comprehensive final exams for which I was not prepared the tightening in the chest I was too young to recognize as a possible sign of a heart attack, the cold sweat, the trembling clumsiness. At college I drifted into the college newspaper. We published a fat broadsheet and turned a profit on ads, embarrassed the state’s big school and its vaunted journalism program with its tiny tabloid. It was here I learned to love the frantic deadline, anxiety heightened by a flush of endorphins and too much coffee, a buzzing high to which I was soon addicted. I dropped out and drifted into another frantic deadline-driven newspaper job, then hired on with a U.S. Senate campaign with its 24-hour days, lurching from crisis to crisis. I set myself on a rodent wheel of exhilaration and the inevitable crash afterwards. I had become an anxiety junkie.
I need to hang onto the Klonopin until I can climb off of the ceaseless roller coaster I built for myself. I eventually need to learn to live without it, perhaps to take the occasional tablet when I cross the threshold into full-blown panic. I know there are other ways to handle the daily GAD. I need to go back to tai chi, which worked when the job became too much ten years ago, when the anxiety first became a problem. I need to jump off the rodent wheel and relearn how to read for escape when the anxiety starts building. I need to be able to write, to turn that manic energy into something productive. The entire body of human literature and science was created in part by people who were driven by some internal engine to vent their own nervous energy into equations, paintings, poems, novels. I could do that once but was also trained by life to be an anxious rat, to scurry down the maze that leads to panic attacks that leads to the doctor that leads to the drugstore. As the side-effects gradually gain equal footing with the symptoms, the Klonopin less effective after three years and as the doctor adds new drugs to the routine, that creative engine slows to an idle, leaves me in a faraway calm, robbed of my writing, of my life.
I have a blog where I wrote incessantly what I hope are phenomenal personal dispatches from a place of constant wonder, Leopold Bloom crossing Bourbon Street. It is sometimes a personal journal as well, what most writers keep but don’t publish. I have another Beckett quote in the sidebar of the blog: “I write about myself with the same pencil and in the same exercise book as about him. It is no longer I, but another whose life is just beginning.” I was not afraid to write about myself when it was true and right and burned to get out. The pieces don’t come anymore, the spontaneous energy that drove it all dissipated. When the local newspaper folded its book section I started up a weekly feature called Odd Words. I listed all of the local readings and book store signings because no one else was doing it. Recently I published the 130th Odd Words, two days late. I started the project 132 weeks ago. I missed posting two weeks in the last month. The pill doctor would diagnose this as depression. I think it is a dulling of the senses, forgetfulness, the drugs struggling one against the other until I’m late and frantically struggling to keep up, drinking too much coffee, the cocktail aggravating my GAD. (Take an additional half a clonazepam PRN). When I am not anxious I float like an exhausted balloon, tail dragging on the ground. Untie the bag of sand and I believe I can still fly.
Lying on the couch napping, a primary symptom of male menopause, is something like chi gong if I get my head set just so and do not snore. Is it the memory of a mother’s lap or simply surrender to one’s own needs, letting the world and its worries go on without you for a while, relaxation for its own sake. I am a vivid dreamer but slumber undisturbed half an afternoon upon the couch. Something escapes with each breath. I consciously clench and relax my jaws, to stop the constant grinding. I drowse past my afternoon clonazepam and don’t notice.
The other day it was all too much by noon and I wasn’t due for a pill until two. I stood in the kitchen for a minute, then opened the other medicine chest and poured two fingers of Buffalo Trace bourbon into a 4-ounce cocktail glass and downed it. In a matter of minutes calm returned, faster than a speeding Zanax, more powerful that a bottle of Klonopin. I went outside to smoke a cigarette of relief and realized bourbon for lunch was not a good idea. I saw what it did to Marianne, my alcoholic partner. I am not going down that road. The pill doctor and I agree that I need something, but it is not that midday drink. I have not opened that bottle again but it is yet another nibble in the back of the brain, temptation and guilt, the hidden nun coming up to twist another screw of Catholic guilt into my skull. That afternoon, I started this piece.
I sat on my back stoop one afternoon, smoking my third cigarette, emotionally flat and exhausted after a frantic afternoon and thought about depression. Suddenly it occurred to me: I am not frequently depressed, although it is a noted side effect of my medication and I have my well-deserved episodes. Given my circumstances if I wasn’t occasionally depressed I would be a sociopath. What I perceived as depression (Zoloft, Cymbalta, Celexa) is coming down from an anxiety attack. I was crashing. I grew up in the 70s whirl of psychotropic drugs and let’s just say I recognize the condition.
I tell the pill doctor about my epiphany and he says, Let’s try a little Celexa. He is my personality shopper, trying to help me find the perfect-fitting suit.
There is a hole in my head where the writer used to live, or rather still lives (I hope) but he’s on the nod. Friends wonder where he’s gone but are afraid to call, wondering if they have done something. “I feel like I’m on an AT&T plan with Mark Folse,” one said. I want to find that Mark and drag him out, get him clean and in front of a notebook, his beautiful 1960’s Italian typewriter. I want Beckett’s becoming. I want him to sit in bars and talk all night, dissecting literature and life. I want to be there to take my friend’s hand when her own problems are overwhelming. Now I sit at home, just another guy sitting on his stoop drinking coffee and smoking a cigarette. The whimsical distractions that turned into poems don’t come anymore. I walk down the street and instead of that perfect moment of New Orleans for the blog I look for a good place to put out my cigarette.
If I haven’t hit bottom yet it’s coming up Wiley Coyote fast: the nip of bourbon, the shelf full of pills. I want my life back. I want my friends back. I want my words back. I am listening to the Byrd’s [Untitled] acoustic disk as I write this and think: could Roger McGuinn and Jacques Levy and Gene Parsons write these songs on my routine of medication? A friend was re-reading The Subterraneans and had come to the part where Kerouac poses the question: Would have you Baudelaire rescued from his miserable life or his poems? I asked her which she chose. She chose Baudelaire. I chose the poems. I don’t believe in the myth of the suffering artist but there is a certain disturbance, a tilted reality from which art is born, and the pills are slowly correcting that, leaving behind the man who wasn’t there. I want those lows that birthed the blues. I want those firecracker Kerouac highs when I would wake up in the middle of the night to scribble in notebooks. I don’t want the flat-line soma happiness of Big Pharma. I want to burn, burn, burn until I can’t contain the words anymore.