Enter/Return

a brief time away and an apology?

I return to this platform today because I needed to take time to step away not just from writing about my work but also from it entirely. What I can say is that I’ve learned a lot but also gained some distance with the time spent getting better. It’s a real trip to help treat people with severe and/or suicidal depression and also suffer from it yourself, having a severe episode of it about every decade, and I guess I was due.

Here’s what I learned after managing to, by combination of good doctors, therapists, and my own doctoral level knowledge (which doesn’t really help when you’re in the thick of it, trust me):

The model of psychiatric prescribing or “psychopharmacologist” is easy to distill a modern psychiatrist down to. My own experience was that this work was not only unsatisfying, but also nearly lethal.

See here’s the thing: most clinicians come into a field of study for a few reasons: some may choose a surgical specialty for prestige, recognition or salary, some may choose a subspecialty of internal medicine for lifestyle, or perhaps someone in their family is afflicted with diabetes and they resolve to go deeper into endocrinology. Perhaps someone themselves suffers from Lupus and goes into rheumatology. For a lot of specialties, the reward/years ratio of time invested to money output doesnt make sense. In that sense, psychiatry makes very little sense. It is a career lacking in prestige (my own experience is nothing clears a room quite like announcing at a party that you are a psychiatrist), subject to public derision in the media, especially now, and it deals with the very most traumatizing narratives from humanity, and the prospect of healing truly is quite low, but rather we manage conditions with a feeling often of futility, especially when we rely primarily on chemistry to fix injuries to the psyche that arrived by entirely different means.

I suffer from major depressive disorer, and OCD. It’s a nice gift from my ancestors. When the going gets tough, I retreat into a shell and my metabolism slows to a crawl as I hibernate and survive. My ancestors made it through famine, war, genocide and religious persecution, and invasion/colonization. I suspect in some small part because rather than rising to fight heroic battles, we quietly whittled away at wood isolated in our workshops, obsessively saved, and managed resources with exacting detail to ensure our survival, in a state of constant hypervigilance. I imagine my grandfather, the carpenter, surviving british colonization, caste discrimination, and his own great grandfathers escaping what is now Iran, fleeing to India, when persecuted for not changing their religion when Islam became the dominant paradigm (though eventually integrating into the landscape of Hinduism either through loss of patrilineage or as my preferred imagination story tells it: a classic Bollywood worthy love story.

None of that has done me much good in my 40 some years of existence on this planet. My grandfather suffered terrible depression, a cousin spent time time in an institution, possibly getting ECT years ago, my father suffered severe depression around age 40, seeming to be the time where the worst episode germinated for all of us. Until my father’s generation there was no solution but to turn inwards, survive until our life had extended past our feeling of being useful then give up. My father had options: he tried a few SSRI and settled on a new exciting SNRI called Effexor and was able to get back to working, being a father, and being a leader in his community in medicine.

I had hoped to follow that path, however I had a pre-loading of intense trauma that made the 40 year tidal wave even more severe. The same trauma that drove me to delve into science and medicine as a child, obsesssively reading adult neurology books, watching public television science shows, and asking to go to work with my father developing film and reading X rays. I am not without gratitude for how it shaped my life, but I am also with great weight able to accept how it has been a weight dragging behind me, the first and oldest memory I possess of watching my younger brother die from a neurological disorder, epilepsy while I sat in the bathtub door open viewing the unfolding of events through a narrow sliver of light.

I hit the wall around 39-40 years of age. I had been practicing as an eagerly optimistic psychiatrist in a large system, and I had my first few brushes with trauma. A few incidents of experiencing stalking and death threats, a murder of a neighbor upstairs that I heard unfold as a result of a severely mentally ill roommate suffering from extreme paranoia, and a few crisis of health in my family including neurological disorder that was elusive and mysterious in my mother, and my wife becoming ill with yet another difficult to pin down rheumatological disorder. Initially? I was Atlas. I didn’t even shrug. I held the world down with humor and a little more cynicism.

Eventually? I crashed. Childhood OCD roared back into existence. I was unable to complete even basic tasks much less work. Documentation at work became an unscaleable mountain. I was unable to sign a note, worrying I had made a mistake ranging from misdiagnosis to misgendering a vulnerable patient in a tough time in my documentation. I couldn’t even purchase clothing, and I had very little ability to decide what to even eat, at one point going into the grocery store, spending time reading each label of items i would have normally eaten, feeling like none of them were the right one, then becoming syncopal during band practice shortly after work.

This was a hurdle I did manage to win against, and I hope that some of you reading this were there with my on that journey. This is something I feel I have mostly learne to manage, and my inner child that suffered similar afflictions with contamination (especially as I became particularly interested in microbiology and created an award winning published science fair experiment on effective hand washing that took us to a regional/national level submission ).

What ensued afterwards was my largest mistake: rushing back into life full force thinking I was fine. My problems were clearly labeled: OCD exacerbation and I was cured and I could rush back into the system that had caused a lot of the traumatic experiences I had recently seen that reactivate the old defense mechanism and weaposn systems of OCD.

A short few months later, I had finished recording an album with my band. I had recorded it all in the midst of intensive outpatient hospitalization for OCD taking 2 days off treatment, with massive amounts of support clinically from my therapists, and using a technique to avoid obsessional repetition: recording live to tape, just like Black Sabbath. There was no way to ritualize. There was only “fuck it, we do it live.” I’m proud of what we created. However when I went back into the world, it came time to release our album. What should have been a celebration of triumph was one of the worst periods of my life.

I’m not sure when, whether it was after the record release or before, however my last memory of working was sitting, managing the crisis line, essentially the psychiatric 911 operator, fielding crises from people who were suicidal, or having an exacerbation of their psychiatric condition and needed urgent help.

While I sat, during a brief interlude of crisis calls, I began to write a note in the nicest pen I could find, my pilot vanishing point fountain pen. It started with “to my esteemed colleagues and friends” and it was a note of my resignation, and was to be the last thing anyone professionally and personally ever heard from me.

My interest and obsession with the act of suicide is a long standing one. I lost a good friend, a brilliantly humorous young man and network engineer (self taught) by firearm suicide. A childhood friend we had a feud and separated, later reconciling in an apology and conversation that was one of her last conversations on the planet (and the family being highly religious still denies it as a suicide, though she had confided in me she was in that state of mind. I guess I was safely in another country with no way to intervene so I was the outlet disconnected but caring enough in our childhood friendship to listen). These are the two most poignant but there are many others. A friend, and artist in the automotive hobby community, musicians I had admired (I was young but conscious when Kurt Cobain died by suicide, and old enough to really hurt when Chester Bennington, and Chris Cornell died as well. All of them were a part of my own musical DNA). To make matters worse, I had been awkward around patients experiencing crisis, having to refer out to a colleague for a consult when a patient’s own suicidality was too close to my own experiences, and landing myself afoul of the institution I worked for. It wasn’t a lack of knowledge, but a rememberance of my oath as a physician that when I couldn’t find an answer to seek consultation and counsel from my peers and colleagues. If I were a neurologist, I would have been safe to allow a colleague to treat a case of the super rare neurological disorder that has my mother on hospice without question. But even the idea that I was at risk in the same way was inconceivable.

So there I was in the midst as the architect of my final words (I had also some to post here, to be bluntly honest) when my pen ran out of ink. I shoot it, dipped it in the cold stale coffee from that morning, wrote a few more words, it ran out of ink again. I grabbed another pen, started writing and it too had dried up. (as it turns out depression is great at making you forget to maintain your fountain pens). I screamed out “FUCK” and threw the pens at the wall. In my mind I had failed even at this. I resolved I would type it and print it and sign it on a letterhead. I opened a word document, and the phone rang. I had a patient experiencing suicidal ideations that urgently needed my help.

When I think of the last words of some of my favorite people, I remember the words of George Eastman, founder of Eastman Kodak, patron of the city of Rochester’s education system and university and historic inventor of the process of consumer level approachable and accessible photography. Eastman transformed the way we access visual information, journalism and even a fundamental appreciation for the way light itself works as a paintbrush. Upon reaching an older age, having accomplished a great deal in his life and suffering chronic debilitating pain from spinal stenosis he left a chilling and crushing final note “To my friends, my work is done — why wait?”

For staying in the physical world, I like to remember that I’ve picked a few pursposes on this earth for which I don’t think I’ll ever be able to say “My work here is done” and I hope that’s enough for the next time the wave hits me.