SALON OFFERS A WEEK'S WORTH OF SPECIAL FEATURES ON LEGAL DRUGS. HERE'S THE LINEUP: MONDAY, JULY 14, 1997:
IN DRUGS WE TRUST
TAKE THE PILLS, GUYS
TUESDAY, JULY 15, 1997:
FIGHTING THE BIG MONSTER
GEN RX
MELATONIN MANIA
WEDNESDAY, JULY 16, 1997:
READIN', RITIN' AND RITALIN
>MEDITATION VS. MEDICATION
THURSDAY, JULY 17, 1997:
NO SEX PLEASE, WE'RE MEDICATED
FRIDAY, JULY 18, 1997:
THE COFFEE CONNECTION
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BY JOAN SMITH | i was 12 when I came across a poem by Muriel Rukeyser that seemed, at the time, to have been written for me. Called "Effort at Speech Between Two People," it is a dialogue between two unhappy strangers, an attempt to make contact and ease a lonely despair that renders contact impossible. It is a lovely poem, but it is difficult to read it now without cringing at the narcissism of Rukeyser's lonely protagonists and my childish understanding. I identified so completely with the speakers and their painful longing, I thought the poem was a pure lament to alienation. For me, there was no irony. I never saw how Rukeyser's conversationalists, obsessed with their wounds, canceled out their attempts at contact. Instead, I remember reading, "When I was 14, I had dreams of suicide,/and I stood at a steep window, at sunset, hoping towards death," and being comforted that my own dreams of suicide were just a bit precocious, an inevitable adolescent phase. Later, I fell in love with a song from the Beatles' "White Album," without quite knowing why. "I Will" is a deliciously, ridiculously lilting paean to eternal longing. "Who knows how long I've loved you? You know I love you still. Will I wait a lonely lifetime? If you want me to I will." At the time I identified with the longing, I suppose. But I think the song's appeal is its absurd elation -- its pledge of tragic fealty set to so sweet, silly and quite cheerful a melody, all in a major key. I am now 42, and these insights are relatively recent. I think they are what we call perspective, if perspective is simply the capacity to see beyond what seems at first to be the only, the natural, the true point of view. You can sometimes feel hurt and longing and sometimes feel joy and sometimes feel that the world is so funny and lovely and wide that your own feelings of hurt and longing and even joy are irrelevant. Or absurd. Or apt but not The Only Thing. I am sheepish to admit how late I have come to this awareness. Because, for me, dreams of suicide were not an adolescent phase. I have been capable of enormous optimism, of periods of elation linked mostly with grand plans, new love and the unexpected approval of strangers, but I have felt mostly afraid. Obsessed with rejection, no matter how trivial or impersonal. Obsessed with how I was performing in the world -- usually badly. Someday, I dreamed, I would be perfect, invincible -- thin and graceful and well-read in at least a half-dozen languages and as fine a pianist as Arthur Rubinstein. In the meantime, I had no right to exist, and for most of my 20s I had trouble leaving the house without the reassuring presence of someone who unaccountably loved me. I spent a dozen years in psychotherapy, and it helped. I achieved a certain amount of what we so lovingly call insight. I was able to pursue a career in journalism. I was finally able to live alone without acute anxiety. I could leave the house and look in the mirror without cringing. I was able to see, to some extent, how my habits of thought were simply habits -- self-destructive and self-fulfilling. But they were so relentless, those thoughts. You had no sooner laid one accusation to rest than a dozen others had sprung up in its place, an ambush by superior forces. I was functional, but I was still in pain. I studied Zen and it also helped. I was impatient and furious at first with the practice of meditation and all who espoused it. How stupid it felt to be sitting still when I was feeling terrible, how little comfort there was in a blank wall and aching back and knees, how alone I felt with those stupid thoughts. How I cried and was distracted. It was as if there was a cloud bank of discomfort and grief through which I had to descend to meditation. But I was desperate and wanted to believe in the possibility of serenity promised by the old teachers. And eventually I was able to settle down, to follow my breath, to observe the thoughts, at least on my cushion. After a month in Hawaii studying with the extraordinary Zen teacher and author Robert Aitken, I discovered that there is an inner world larger than the emotional/psychological world I had learned to navigate in therapy, a world in which the thoughts and feelings that seemed to define my life were not only optional but even, perhaps, irrelevant. It was such a relief to find that I could, after five days of intensive meditation, achieve a state of mind in which all of existence seemed a perfect harmony, in which my emotional pain seemed superficial and small. John Tarrant, a Sonoma County, Calif., therapist who is one of four teachers Aitken has appointed to succeed him (Zen Buddhists call them dharma heirs), calls the everyday vulnerable self the "small i" and that sense of being part of something more expansive the "large I." And it is true that, from the perspective one sometimes achieves in deep meditation, it seems easier to be large in the sense that we often use the word -- generous, altruistic, noble, empathic, kind. But if Buddhist meditation can help us achieve insight into our mental processes and into a larger, more generous reality, it does not cure the psychological problems we bring to the cushion. Aitken himself has said, rather ruefully, that Zen does not address the psychological. There have been truly gifted and enlightened teachers who have been hopelessly troubled human beings. Aitken compares the phenomenon to a house in which the lights are turned on upstairs but in which the lower floors are dark and neglected. For when we finish meditating, the small "i" is still there with all of its ignoble problems. So that even with the newly reliable comfort of meditation and the insights of therapy, when a deeply significant relationship ended badly two years ago, I was inconsolable. I was seeing a therapist twice a week, going to work, which I loved, and meditating, exercising and taking yoga classes daily. Yet my grief and anxiety seemed increasingly impossible to bear. One day an old friend asked if I'd considered Prozac. If anyone else had suggested it, I'd have been offended. Drugs seem the very symbol of failure. I might feel better on an antidepressant, but would I be myself, would I be skipping all of the real work I needed to be doing, both psychological and spiritual? Still, I was desperate and my therapist and doctor concurred with my friend's advice, so I decided to try one of the new Serotonin Reuptake Inhibitors. My doctor warned that it would probably be a month before I started feeling better, but the impact, for me, was immediate and dramatic. An hour after I took my first pill I was blissfully hypomanic. It was not a state that would have been permanently comfortable and, within a week, it had settled into a simple and, to this day, ongoing sense of well-being. The drug was an immediate revelation. I have all of the same self-destructive thoughts, the same anxieties and fears, but they are no longer overwhelming. It is as if the thoughts arise, sting, and are gone. There is no reverberation, no magnification. The pain does not seem to howl. I am more assertive. I no longer need the constant reassurance of my friends. Most of all, I do not feel the old suffusion of shame, like a hot chemical bath, at the thought of my flaws. I am blessedly free to think about things that are not me at all. I am more patient with and interested in my family and friends and ideas that have nothing to do with despair. As Peter Kramer so aptly put it in his enthusiastic book, "Listening to Prozac," I am more "available." I have stopped taking the drug twice for a few months at a time because I am still afraid. Am I me on the drug? I do not weep so readily at movies; music no longer invariably moves me to tears. I thought of this for a long time as a new insensitivity, a drug-induced lack of depth. Isn't depth, after all, the metaphor we use for the place of despair? Once, just a month after I'd stopped taking the drug, I was up all night playing the piano. I'd been to the opera and had thrilled to the music, felt it in a way I hadn't felt music for more than a year. But after struggling with the old feelings for a few more weeks, I was standing in the shower one night, weeping, convinced that I simply could not endure, and decided that a hypersensitivity to music was not worth this hypersensitivity to all of the possible repercussions of my own shortcomings. Critics of antidepressants often say that depression can be treated in other ways, and I'm sure that there are cases in which it can. In "Talking Back to Prozac," Peter Breggin, like other critics of the drug, writes that depression and manic-depressive illness are simply the results of misdirected energy and that treating them is simply "a matter of overcoming the dreadful legacy of childhood, especially self-hate and loathing, and learning to direct this remarkable energy into more productive channels." After all these years of working on my "dreadful legacy of childhood," I have to laugh. If it were only so simple. Read Kay Redfield Jamison's "An Unquiet Mind: A Memoir of Moods and Madness." A professor of psychiatry at American University and a noted expert on manic-depressive illness, she confesses to her own struggle with the condition, the wonderful periods of mania, the awful depression, her avoidance of lithium, the treatment for manic-depressive illness, because it flattened the world that seemed so glorious during her manic episodes. She writes that she is grateful for her illness, for the remarkable energy of it, only because lithium exists and it can therefore be managed short of psychosis and/or suicide. Andrew Weil, bestselling author and guru of alternative medicine, makes an argument similar to Breggin's in his book, "Natural Healing, Natural Medicine." Weil, in fact, invokes what he calls "Buddhist psychology, which he says "views depression as the necessary consequence of seeking stimulation." He recommends meditation as the "best way to get at the root of depression and change it." I think that Weil is confusing depression and pain. The Buddha said that life is suffering, and that suffering is the result of attachment, but he did not say that life is depression or manic-depressive illness, any more than he said that life is heart disease. Depression is not simple grief, and most Buddhist teachers would advise a student to seek psychological help for psychological problems. It is possible to achieve certain insights into the working of the mind through meditation, but depression itself actually interferes with spiritual practice. My own fear was that I would not be able to meditate while taking antidepressants, or that my meditation would not be as profound. But I have actually found that deep meditation is easier to achieve. And the metaphysical questions that antidepressants raise -- Who is meditating? What is the nature of this consciousness that seems to be me if it is so profoundly malleable? -- are the very questions posed to Buddhist meditators. "That's right. There's nobody there anyway," laughs Sylvia Boorstein, a popular Buddhist teacher and bestselling author who is also a psychotherapist. Boorstein says that, in her experience, the SSRIs have been very helpful to longtime meditators. To use Kramer's word again, they make us more "available" to do the real work of meditation, which is not to cure depression or manic-depressive illness, but to achieve spiritual insight.
"The SSRIs bring people to a place where the mind has a certain
amount of energy, clarity and resiliency," says Boorstein. "Not an
extraordinary amount, but the amount they were meant to have. So they
are able to bring to their meditative endeavor all the energy and zeal
that people who are not fatigued by depression have normally. My
friends who have struggled with depression for years, and have found
some consolation in meditation, tell me it is as if somebody washed the
windows, or lifted a 50-pound load off their backs. These drugs, in my
opinion, simply level the playing field."
Joan Smith is the former book editor of the San Francisco Examiner. Are meditation and medication compatible? Talk it over in Table Talk. |
