2008 February 16

When I’m depressed, suicide is never far from my mind. It’s kind of like a favorite song that is constantly playing in the back of your mind, but you only become aware of it from time to time. I can walk around all day not really concentrating on it, but knowing that it is just below the surface.

So, I figure that I might as well bring it out into the open, just so that you know my feelings about it.

Of course, I have thought about killing myself for years and years. When I was a teen-ager, it was constantly thinking about suicide that first drove me to talk to a high school counselor. I guess that was the beginning of letting the world in on my thinking. Just for the record, talking to that counselor was a mistake. Oh, well.

At the time, of course, I didn’t really have enough courage to kill myself. And I would have done it for the wrong reasons. Basically, I was just in so much psychological and emotional pain that I wanted to do anything to get out of it. Hence, killing myself. I even made a couple of fairly feeble attempts. But, fortunately, I didn’t have nearly enough courage to go through with it. What actually stopped me was that the pain of death seemed to be greater than the pain of living. Pretty cowardly not to do it. On the other hand, it was the correct decision.

Over the past year, I have formulated what I believe to be the correct reason and the correct method of suicide.

Before I get to that, however, let me just say that suicide is a very drastic step. It cannot be undone. I strongly, strongly urge anyone reading this not to do it. There is a wonderful book called Etiquette For Outlaws. It deals with situations about which you probably were not instructed, such as how to behave in a tattoo parlor, or a strip club, or a jail, or around a motorcycle gang, and so on. (Basically, the advice is: treat everyone with respect. They all deserve it.) Anyway, they have a section about suicide, just in case your outlaw ways become too much for you. As I recall, their main advice (other than not to do it) is to think about everyone who will be affected by your decision. For example, who will find your body? How will your loved ones be notified? What happens when someone is going through your effects and finds all your kinky porn stuff? That sort of thing.

I must emphatically second their thinking on this. You can’t just kiss off this life and leave a huge mess behind. It’s really not fair to a lot of people who had nothing to do with your decision. And, if they did have something to do with your decision, then you made your decision for the wrong reason. I mean, look at it this way. Let’s say that you have just been spurned by a lover. So you think, “I’ll kill myself as revenge!” Big mistake, Skippy. Remember: Living Well is the best revenge. Dying is the worst possible revenge of all. If the person who spurned you doesn’t really care about you, then you killing yourself will have no effect on them, and a BIG effect on you–you lose. On the other hand, if the person who spurned you does care somewhat about you, then you are doing a really, really shitty thing to someone who cares about you. And what kind of person does that? Not you, certainly.

I could go through lots of other examples, but I think you see the idea. Suicide is a horrible substitute for just about everything for which it can be substituted. Look at much, much easier methods to solve your problems: divorce, bankruptcy, going to jail, taking that Ethics final. All of these things are temporary. You’ll get over them.

So, let me get back to what I started with: why and how suicide is OK. I have decided that suicide is acceptable if, and only if, life has nothing left to off you, and you have nothing left to offer it. If you have given everything that you possibly can to life, and to the world, and to the people in the world–that is to say, if you cannot make one more contribution of any kind to any living creature in the world; and IF life has nothing left to offer you: no more simple (or non-simple) joys, no more beauty, no more surprises, no more learning, no more discovering something that you didn’t know before. IF those two things are true, then suicide is the only viable (if you’ll pardon the term) option.

So, how to do it? I have two plans. Here is one of them. You must, of course, have absolute respect for everyone who will be affected by your decision. Typically, many, many people that you leave behind will blame themselves for not having done more either to foresee what you are about to do, or to stop you from doing it. You must not, under any circumstances, allow this to happen. So, the first step is to make a list of everyone who will be affected. The second step is to write an individual letter to each person on the list, telling them what exactly your reasons are, and why they should not feel any regret or remorse about your decision. As I mentioned earlier, finding the body of a person who committed suicide can be enormously traumatic. So, I won’t allow it to happen. Also (and this is just personal to me), I can’t allow myself to be in a situation where I could second guess myself for even a second. So, no jumping off of cliffs or high buildings. I would hate to get halfway down and have second thoughts. Also, the method must be absolute. Again, I could think of nothing worse than trying to poison myself, only to fail but destroy my liver or kidneys in the process. Then I have all of my original problems, plus a bad kidney or liver. So, for me, a shotgun is the way to go.

In detail: If I ever decide to kill myself, I will obtain a shotgun. I will engrave my name and the telephone number of the local police department on the barrel of the gun. I will then drive a long way away from civilization. I’m not talking about two minutes off the local bike path. I’m talking about going to the Rocky Mountains, fifty miles from the nearest city. Then hiking so that I’m two or three hours from the nearest road. That should be remote enough. You find a good, solid tree and sit down at its base. You lean back against the trunk of the tree, and take a last look at the world. You put the shotgun in your mouth and fire.

Of course, before you do this, you will have written all of the letters to all of the people who will be affected by your death. You will have mailed them so that they arrive at the recipients on the day of your death. You will also have written a letter to your local police department alerting them that at some time in the future they may–may–get a strange phone call about a shotgun with their telephone number engraved on it. If they do get such a call, someone has just found you.

The reason you are doing this is because death by shotgun is an unbelievably messy ending. Messy, of course, in human terms. Mother Nature, however, has all kinds of scavengers–from microscopic on up–who will delight at the good fortune of finding your corpse. Given enough time, they will leave a very nice, clean death scene. And that’s why you want to be someplace remote–you want to give Mother Nature lots of time to clean up. Two seasons is the minimum, the longer the better. Imagine, for example, if a dead body appears in the fall. The winter snows will settle over it, and, as the snow melts, gently wash away blood and other liquids. In the spring, as all of the hungry scavengers arise from their winter slumber, they will start in on your remains. Of course, if you are really lucky, it may be years and years before someone finds you. However, so as not to disturb people with trying to track down a mystery, you will engrave your name and a phone number on the gun barrel, because that will remain immutable evidence for decades, and so, the finder’s mystery will soon be solved.

So, that’s it. If you have any questions, or think that I may have left anything out, please leave a comment. If I think of anything else, I’ll come back and amend this post.


Why I Missed A Post

2008 February 8

I’ve been thinking about writing a post about suicide. Of course, that’s all that I’ve done with it–think about it. Obviously, I have not yet made the post.

But, that’s the way that it is with depression. You get an idea. It seems possible. It is possible. But you just can’t seem to get the motivation to actually do anything about it. It’s that sense of dread. I’m sure that reading this is very frustrating to most people. It sounds whiny. “What’s the big fucking deal?” you want to ask. “Just get on with it!!!” You want to scream. Exactly.

For myself, I don’t know how to explain it. I can talk about the sense of dread. That I don’t want to begin because … well, because … well, I can’t explain why, I just don’t. I can say that something else always comes up. That I sit down to write, but that I get distracted by something more important. Or, usually, I get distracted by something less important. But, at the end of the day, nothing gets written.

And then I go to bed feeling like a failure. How could I not bang out a few hundred words on suicide, since I spend all day thinking about it? Actually, I’m hoping that medication will soon start working. Have I talked about that yet?

I think I did, and I made a horrible mistake a couple of months ago. The situation was this: I had L-Methylfolate prescribed for me, on top of an SNRI (Duloxetine,I think–for some reason I’ve decided not to use brand names, and I know the brand name, but I’m too lazy to go look up the generic name right now) and a form of Valproic Acid (a mood stabilizer). So, the L-Methylfolate worked a treat, but I was just given a 4 week sample by the Doc. So, after 4 weeks, I send the prescription off to the mail-order pharmacy that I must use due to my insurance (the bastards). Then, they took a while deciding whether they were going to fill the prescription, and then, after they told me that L-Methylfolate is not covered by insurance and that they were not going to fill it, they took about another month sending the prescription back to me. So, did I do the rational thing, call the Doc, ask for more samples? No.

What I did was, after the L-Methylfolate wore off, I started thinking that not having it wasn’t so bad, after all. The bigger problem, I decided, was having everything working and feeling great, and then, all of a sudden, something starts not working, and I feel absolutely horrible. So, I thought, if I feel pretty good–not great, but pretty good–all of the time, isn’t that better than the up and down? Well, of course it would be. Except. Except that I don’t feel pretty good all of the time. Without the L-Methylfolate, I still have ups and downs, but it’s at a reduced level. In other words, the “Up” is about 75% of the best “Up,” and the “Down” is about 75% of the “Down” with L-Methylfolate. If that makes sense.

But, of course, once you start not feeling so good, it’s too late, and you’re not thinking rationally anymore, so you just don’t give a crap, so why bother? So, even after getting the prescription back, I decided just to hang onto it, because, well, who needs it?

So, anyway, I finally got well enough to see that I had made a big mistake, and I got the L-Methylfolate filled, and started taking it last Friday. It should take about a week or two for its effects to really kick in. I’m a week into it, and I’m not feeling anything yet. And, of course, I’m kicking myself everyday for ever getting off the stuff, because if I had just kept on it, I might have been feeling good these last 10 weeks, or whatever it’s been. But, I’ve felt pretty much like crap, and, of course, now I’m also starting to wonder if it actually will kick in. Maybe it was just a placebo, and if I don’t believe, nothing will happen.

Well, now I’m just watching my life slip past, week by week, and not doing all the things that I’ve wanted to do, or that I know that I should be doing if I felt better. Anyway, that’s enough for now. I’m sure that you can’t take any more of this. Neither can I.

So, this Sunday I’m kind of hoping to discuss suicide, and, also, at some point in the future I’d like to get into whether or not I should feel that my life has been a waste up to this points (there are some big issues on both sides), and I want to re-do that green block at the top of the blog, because that’s what WordPress gave me as a default, and I really don’t like it, but I haven’t gotten enough motivation yet to change it.

One of the big problems of mental illness is that it is so poorly understood. This may seem self-evident, but there are a lot of different facets to the misunderstanding. For example, when I was a kid, my various emotional problems all seemed to me (and, I believe to my entire family) as “character flaws.” The inability to concentrate was a lack of will power or rebellion. My perpetual feelings of doom were seen as “pessimism.”

“Mental illness” itself was seen in terms of severe schizophrenia: delusions, hallucinations, incoherent speech, disconnection from reality. By that standard, no one, of course, would want to be considered “mentally ill.” And yet, I was. Based on my most recent experiences (in other words, the experiences that have given me the most value in my life), I would say that I have been severely mentally ill my entire life.

My earliest memories are from about age 5. In these memories, I recognize the sense of alienation, of “separateness,” of hopelessness, and of lack of connection by which I have come to define depression. I suppose it is possible that I have imposed these feelings on early memories. After all, memory is a fragile thing. It can be influenced by later events, and false memories can be easily implanted. However, in my own memories, the feelings that I have described at age 5 also show up in my memories of age 6. And 7. And 8. And 9. And 10. And 11. And 12. And 13. And 13 is the magic number where someone else, a teacher, apparently noticed that there was something “different” about me. (Not that she did anything about it, bless her heart. It was an incident that popped up and receded without any further consequences. My secret was safe for another three-and-a-half years.) The point is that I know that I have not somehow changed all of the emotions of my very un-joyful childhood. So, I am confident that I have been mentally ill my entire life.

As I have said, had anyone known when I was a child that I was mentally ill, no one would have known what to do with me. I probably would have been institutionalized. So, perhaps it was better that I just snuck through. Unfortunately, I’m not sure that, 50 years later, things are any better today. What can we do with a severely depressed 7 year old? Do even the best medical professionals have any ideas?

And what about severely depressed 50 year olds? Fortunately (or, maybe, not), mental illness is completely hidden. I am free to walk the streets, and no one who sees me has any idea of my state of mind. Of course, for someone like me, that is a very scary thought. I know what my state of mind is, and sometimes even I am scared of it. What would other people think if they found out? How many more people are there just like me out there?

Sometimes I ask myself, if I ran a company, how would I feel about having mentally ill people as employees? Well, knowing what I know about myself, I don’t think that I would really want to have many (or any) mentally ill working for me. I know that there are lots of days when I feel like I’m on the edge and just about to go off. What would it be like to have an entire office with those kinds of people? Of course, I suspect that the feeling of being on the edge is part of the depression. I think. See, I’m not sure how close to the edge I really am when I get that feeling. I have gone over the edge (twice), and neither time did I feel like I was in any worse shape than I usually am. So, it’s a tough call. Of course, in my own case, I could never, ever work for me (that is, if I had a boss who was exactly like me), and if I were a boss, and I had an employee like me, I would fire me after one, or, at most, two days. I am just not a very good employee.

I hope some of this makes sense. If it’s all kind of jumbled, that may be because I am kind of jumbled right now, too. I hope the next post is more organized. Maybe I’ll make an outline!

The Brain

2008 January 25

Before I get too far into other topics, I thought I would discuss the brain. This is what I know about the brain. It may be right. It may be wrong. It may be partially right. But this is my understanding as of today. At least anyone reading this will be on the same page with my understanding.

The brain is a huge mass of neurons. Neurons work by sending electrical signals from one end of them to the other. At either end of a neuron (at least, I think that neurons only have two ends–maybe they have more) is a gap between the neuron and one or more neighbors. This gap is called a synapse. To communicate with another neuron, a neuron will release one or more neurotransmitters. These are special chemicals that will fit into receptors on the adjacent neurons. The neurotransmitters that seem to matter most (at least to me) are serotonin, norepinephrine, and dopamine. It seems that a lack of serotonin has something to do with depression.

I have no idea what, exactly, norepinephrine and dopamine do, but I know that they are important. The current way of boosting serotonin (and norepinephrine) is through a mechanism called a re-uptake inhibitor. That is, when a neuron releases a neurotransmitter, the neurotransmitter traverses the synapse and attaches to the receptor of another neuron. However, the neurotransmitter cannot stay attached because, after all, that would prohibit other neurons from sending their own neurotransmitters. So after the receiving neuron has received the message, it releases (through magic) the neurotransmitter. Now, neurotransmitters are, apparently, complex and expensive to manufacture. The released neurotransmitter, therefore, is not just discarded, but, rather, re-absorbed by the neuron that originally released it. The neuron can then re-use it. Very efficient. A re-uptake inhibitor, however, interferes with how quickly the neuron re-absorbs, or re-uptakes, the neurotransmitter, so that the neurotransmitter stays in the synapse longer. The net effect is that if a neuron is not releasing enough of a given neurotransmitter, a single glob (a molecule, I guess) of the neurotransmitter has time to connect with more than one receptor, mimicking the effect of having more of the neurotransmitter material available at any one time. Clever, huh?

So, there is a class of drugs called Selective Serotonin Re-uptake Inhibitors (SSRI’s). There are called “Selective” because they selectively only inhibit the re-uptake of serotonin. Re-uptake of other neurotransmitters (like dopamine) is not affected by SSRI’s.

One of the first SSRI’s available in the United States was Fluoxetine Hydrochloride. I had a very brief, very unpleasant experience with this in 1990. Maybe some time I will tell you about it. (While we’re one the topic, I also was given some sort of antidepressants in the early 1970’s. My guess at this time is that they were tricyclic antidepressants. They didn’t do bupkis.) In January of 2000 I was given Citalopram by a real ass-hole of a psychiatrist (and, yes, to be an ass-hole by psychiatrist standards is quite a feat). Despite the fact that this guy’s only redeeming feature for using oxygen for many, many years was that he prescribed Citalopram for me, it did wonders for me. Well, after a while. Getting onto it was a real bitch. Lots of nausea and other side effects. In order to help with the side effects, Dr. A-Hole prescribed something else for me (I don’t remember what) that made the nausea go away. Unfortunately, it was at the cost of hallucinations and manic episodes. I opted for the nausea. But, after getting over the nausea, Citalopram worked a treat until August, 2006. Then, all of a sudden, it just gave up. I have no idea why.

So, I started on Duloxetine Hydrochloride. Duloxetine inhibits the re-uptake of not only serotonin, but also norepinephine, so it is known as SNRI. It was even better than Citalopram! But, it only worked for about a year. Then, all of a sudden, it just gave up. The Doc upped the dosage, with no effect. So he added a form of Valproic Acid. Valproic Acid is supposed to affect the re-uptake of a neurotransmitter called GABA, about which I know nothing. It worked a little. He upped the dosage on that, but things didn’t get any better. Then he gave me some samples of L-Methylfolate. It was wonderful. L-Methylfolate is, allegedly, necessary for the production of various neurotransmitters. (I have no idea what the “L” stands for, if anything.)

Apparently, some people (I guess I am one) have some kind of problem generating L-Methylfolate. So, taking a supplement helps.

But, here is where things get complicated. While I was taking the samples, I sent the prescription to a mail-order pharmacy, as my insurance company instructed. After about a month of studying it, they decided that they (either the insurance company or the mail-order pharmacy, not sure which) wanted nothing to do it. So they sent the prescription back to me, taking another three weeks or so to get it back to me. Of course, my samples were long gone. So, here’s the conundrum: Do I stay where I am, operating at about 75%, but figuring that I probably won’t have any more of the medication suddenly giving up on me? Or, do I buy the L-Methylfolate, feel great, and worry about what happens when I suddenly plunge back into depression?

Well, anyway, that’s more than I wanted to say in this post. I’ll have more thoughts on it later.


2008 January 23

The genesis of this project was in Autumn, 2007. My medication had stopped working, so I had been to see my family physician about a change. During a follow-up visit, a medical school student preceded the doctor. He began asking about my symptoms. I was, of course, irritated by his questions. Afterward, however, I decided to list all of my symptoms, so that, if faced with another medical school student, I could present him or her with written documentation, instead of trying to remember all of the symptoms. It would save us both a lot of time. The list of symptoms has been through several revisions. Generally, while depressed the language becomes much harsher. When I am feeling better, I try to clean up the language a bit.

The second step in the process came from Chris Matthews’ wonderful book, Life’s A Campaign. He speaks of the importance of a “Rite Of Passage.” Conquering depression, which has dominated my entire life, is to be my Rite Of Passage.

Third, for the past few days I have been considering blogging about the entire experience. I’m not sure if I was thinking about this while I was awake or asleep (because I have been asleep for most of the last two days). But, I finally decided to start this blog.

I will be discussing how Depression has affected my life to this point, and chronicling my efforts from here on out. Please be aware that the language will often be vulgar, and the ideas disturbing. I, myself, am disturbed and repulsed by many of the ideas that originate inside my own head. But, such is the nature of Depression.

So, to begin, here is the List Of Symptoms that I generated for medical school students.

Depression Symptoms

These are the symptoms of depression as I experience them. I have no idea if other peoples’ symptoms are the same, nearly the same, or completely different.

I am writing this while I am in a depressive state, because when I resume full functioning I have a hard time remembering exactly how bad things can get.

You may get the feeling as you read this that it has been written to heighten dramatic effect and to intentionally elicit more sympathy for me from the reader while at the same time diminishing any responsibility that I feel for my own actions. You would be right.

Most of these symptoms are relieved to some extent by Celexa (when it was working for me). A few were only relieved by Cymbalta (when it was working for me). A few were relieved more by Cymbalta than by Celexa. None were relieved more by Celexa than by Cymbalta.

One more thng. Maybe it’s just me, but I keep thinking that “depression” is supposed to be about sadness. But, in writing this paper, I didn’t find that I’m sad about anything. Frustrated and angry, sure. But not sad.

Predictors Of Depression

You might think that a predictor of depression would be classified as a “symptom.” Well, fuck you. This is my list.

Of course, before 2006, I did not know about Predictors of Depression. That’s because I was always, constantly depressed until 2000, and from 2000 to 2006 I was always, constantly not depressed. It was only in 2006 that I realized that depression could come and go. So, here are the two predictors.

  • Procrastination
    When I’m depressed, I procrastinate on everything. The most trivial things I put off. When I am not depressed, I procrastinate nothing. It never even occurs to me to not do something when I should be doing it. And, when I do think about procrastination, it seems like about the silliest thing that a person could do. I am trying to train myself so that when I start procrastinating I know that depression is coming on, and maybe I can do something about it. Maybe.
  • Active vs. Passive
    When I am depressed, my thinking becomes very passive. In other words, I want things to happen to me, without me doing anything. Like, I’ll wish that the earth would just open up and swallow me without a trace; or I’ll win the lottery; or a bridge will fall on me. It doesn’t matter what it is, I just want something to happen where I can be completely passive. When I am not depressed, I want to be active. My thinking focuses on what I can do to influence my future.

Symptoms In Order Of How Much I Hate Them

  • Dread
    Dread is probably the most overwhelming and persistent of all the feelings. When I am depressed, it never leaves. Dread goes from one minute to the next. It covers everything. It’s a feeling that whatever I am about to do will be unpleasant, and that I would prefer to avoid doing it. Sometimes the elements causing the dread can be identified and concrete. For example, if I am about to drive to work, I foresee a flat tire, overheating, blown gasket, failed transmission, engine seizure, brake failure, and on and on. Other times, the causes of dread cannot be identified. For example, if I am about to put on a shirt, I can never figure out exactly what could go wrong, but I still have a feeling that something bad is going to happen while putting on the shirt, and that I would really prefer not to put the shirt on. I have this feeling for absolutely everything, every moment of the day. Except for getting into bed. Going to sleep is the happiest time of the day, because I will be free for a while. When I need to do something that is actually difficult or really unpleasant, I usually can’t talk myself into it.
  • Lethargy
    I’m always tired. I can’t usually move very fast. Sometimes when I’m walking, I get the feeling that if I tripped and fell down that I would not have the energy to get up, but would prefer to lie there until I died. Some of the tiredness, I think, is genuine fatigue. The problem is that I know how I am supposed to act, and I know how I really want to act, so a lot of effort and energy goes into just trying to be socially presentable when I am around other people. The constant stress of keeping my real feelings and inclinations bottled up can really take a toll. So, there is a lot of actual fatigue in addition to the lethargy of depression.
  • Alienation
    I am completely apart from every other human being. No one could possibly understand me, or value me. No one wants to be near me. No one likes me. Even among people that I characterize as “friends,” I always believe that they are merely tolerating me. Given a choice, they would prefer that I not be around, but they will put up with me for some reason (usually because it is financially advantageous for them to do so). This is why I practice so hard being funny. I figure that if I make people laugh they might let me hang around a little bit more. I actually see this as a successful strategy. The funnier I am, the more people tolerate me. So, I always try to be very, very funny. Not that anyone ever likes me for anything other than my ability to make them laugh.
  • Loneliness
    This is tightly related to the Alienation. I’m not sure if there is a difference. I guess there is. Anyway, I am always, constantly, day and night, for ever and ever, lonely. When I was a teen-ager, I thought that having a girlfriend would help break up the loneliness. Even though I didn’t have many girlfriends (three, maybe, if you are loose enough with the term “girlfriend”), none of them ever broke through the loneliness. Later on, I thought that certainly getting married would break through the loneliness. It didn’t.
  • Desire For Connection
    A desperate desire to make some small, tiny, insignificant connection to some other human being haunts me day and night. If I am awake, I am thinking about it. Even when married, it seems that I can never get physically close enough to my wife to overcome this. There is, however, one thing that makes it go away–holding an infant. As long as I actually have an infant (say, under five or six months old–the younger the better) in my arms, I feel this connection to the baby. I could hold babies (especially sleeping ones) forever. Of course, the moment the infant leaves my arms, the search starts for my next “fix.” And, just in case you are curious (I know you are), sex does not help. The pleasant physical sensations and endorphin rush are temporary distractions, but the endorphin rush from watching a funny movie is also a distraction. In neither case is the desire for connection abated past the conclusion of physical sensations.
  • Irritability
    Everything, and I mean everything, gets on my nerves. People get on my nerves; dogs get on my nerves (please know, when you read this, that I absolutely love dogs; some guy once said, “The more I learn about people, the better I like dogs;” he was right; a bad dog has yet to be born); sudden sounds get on my nerves; silence gets on my nerves. I am always right on the edge of erupting. Except when something pushes me over the edge and I blow up. Then I get to feel horrible for blowing up at someone or something that didn’t deserve it. By the way, I’m sure that something that you are doing right now is irritating the hell out of me. Maybe you’ve got a hair sticking up on top of your head, maybe some of your clothes are slightly askew. But, I’m pretty sure that I’m staring at you, because you just irritate me to the point of almost screaming. But don’t look–then I would know that you are scared. Looking to see if I’m staring means that you’re scared. So don’t look. Just know that I’m staring.
  • Loss Of Identity And Personality
    I have spent decades in reflection, introspection, and self-analysis, and many, many years in therapy attempting to form a well integrated and well adjusted identity and personality. When the medications fail, anything that I have discovered about myself goes away. I cannot tap into my identity or personality in order to discern the correct action or reaction in any situation. So, I usually fall back on one of the basic tenets of behavior–when in doubt, be a total jerk. I also cannot find any of the confidence, self-esteem, self-worth, pride, or any other positive attribute that I have built up over the years. What I am left with is to be a worthless shit-pile that acts like a jerk.
  • Inability To Concentrate
    The inability to concentrate is a fairly persistent problem. Also a very frustrating one. There are times that I can concentrate, so I know what it’s like. The problem is that I have no control over concentration. Concentration comes on its own schedule. It cannot be summoned. And, by the way, its schedule is sparse. If I could just rein in the ability to concentrate a little bit, life could be so much better.
  • Inability To Focus
    The inability to focus is kind of like the inability to concentrate, but shorter term. It’s like when you are trying to read a book, and you read the same sentence over and over and still don’t know what the sentence says. Lack of focus is rarer than lack of concentration, but more disturbing when it happens.
  • Distractibility
    The World Wide Web is tailor made for distractibility. I can surf for hours and have no idea what I might have originally been looking for. Distractibility is the enemy of focus and concentration. Distractibility sucks.
  • Fear
    Fear is not always present, but when it comes on it is just about unbearable. It always comes the same way: I am going about my day, and suddenly I get this feeling that something is about to go wrong. And I know that if anything, the slightest little thing, goes wrong at that moment, I will be overwhelmed by it and start crying. And I will never, ever, ever be able to stop crying, and everyone who sees me will realize what a worthless piece of shit that I really am. I spend a lot of time almost crying. I never have cried from fear, but I still get the feeling that I’m about to break down.
  • Nausea and Anxiety
    Like fear, these are not always present. Well, some anxiety is always present, but here I am talking about a particular type. I get this sudden feeling that, unbeknownst to me, I have committed some terrible transgression. At this very moment, some great power (a boss, God, my wife, the entire federal government) is planning my doom as punishment and retribution for a transgression. I know that the plan will inflict great pain and embarrassment on me, but I have no idea when or where it will be applied. I also don’t know what it is that I’ve done to bring about this punishment, or how to correct it. When this feeling comes on me, I always feel that I am about to throw up.
  • Intrusive Thoughts Of Suicide And Self-Harm
    Let me distinguish “Intrusive” from “Non-Intrusive.” “Non-Intrusive” thoughts of suicide are usually entertained when sitting quietly, and wondering if life is really worth living. These are long, carefully considered thoughts. “Intrusive” thoughts, however, are more immediate, and, more to the point, arise from unknown places in the mind. I might be having a not-too-bad day, when I’m waiting to cross the street, and suddenly I’m thinking, “You know, if you step off the curb in front of that bus, it could never stop in time.” Self-harm is much more common. It is rare for me to pick up scissors, a sharp knife, or any other sharp object without wondering how it would feel if I would just plunge it into my abdomen or one of my eyes. Curiously, I never consider mutilating my genitals. I’m guessing that there’s some meaning in that, but I don’t know what it is.
  • Intrusive Thoughts Of Guilt And Shame
    Again, these are thoughts that suddenly spring themselves on me, usually with no apparent association to anything going on at the time. I’ll be having just a regular day when something hugely embarrassing from 40 years ago, which I have not thought of in 20 years, suddenly pops up. Of course, that incident leads to another, and another, and another, until I am consumed in guilt and shame, and whatever kind of good day I might have been having is ruined.
  • Really Scary Intrusive Thoughts
    So, I’ll just be sitting on the couch, watching a football game, when the thought pops into my mind, “Wouldn’t it be cool to write a book that’s a stream-of-consciousness, first-person account of what it’s like to kidnap, torture, and kill someone? But I have no idea what that’s really like. I wonder how hard it would be to kidnap, torture and kill someone…” Note that this is one of the tamer ideas that has suddenly occurred to me. I have no idea why this happens. It doesn’t happen when my medications are working, so I would assume that it doesn’t happen to most people most of the time. When I’m depressed, it happens maybe two or three times a week. Then I’m caught up in trying to figure out how to make the project work. It’s kind of like a reverse concentration problem. I can’t seem to get my mind off of this particular topic. On the plus side, I’m not emotionally and psychologically organized enough to carry out all of the planning that these “projects” would take, and I’m not disorganized enough to go off on one of these projects without some planning. At least, so far. The ideas can be really, really scary sometimes, but when they are happening, I am more fascinated by the details of feasibility than I am aware of the horrendousness of what I am thinking about. (Please don’t lock me up for this.)
  • Flatness Of Emotions
    When I first started on Cymbalta I was surprised by how some (actually, a lot of) emotions became not only stronger but also more variable. For example, imagine that you can grade “happiness” on a scale of 0 to 10. Without Cymbalta I would have only levels 0, 2, 4, and 6.
  • Inability To Feel Some Emotions
    Again, after Cymbalta established itself, I was amazed that I was experiencing nuances of emotions and moods that I had never felt before.
  • Lack Of Empathy
    I think this is related to the two previous symptoms. It used to be that people would say, “Gee, can you imagine how that guy must feel?” And my inner response would be, “Actually, no, not at all.” But, of course, I knew the correct answer and always gave it. With Cymbalta, I think that I actually can imagine how other people feel in a given situation.

If you enjoyed reading this paper, or thought that maybe one of the ideas in it was new to you, or you learned something, or something like that, please give the nice man a hug. I promise that he won’t hurt you, or get wierd on you, and he could really, really use a hug right about now.