Category Archives: Deep Thoughts

There was a long arti­cle in the NYT Mag­a­zine Sun­day about whether psy­chophar­ma­col­o­gists do their patients a dis­ser­vice because their med vis­its are short (20 min­utes) and they focus on symp­toms that can respond to drugs that those self-same doc­tors are able to prescribe.

And yet.  The doc­tor describes the slow creep of doubt, of the grow­ing belief that he does his patients a dis­ser­vice in these short vis­its, that per­haps he’s not get­ting all of the pic­ture because he doesn’t prac­tice psy­chother­apy and get into the issues that also occur in his patients’ lives.  You know– the things that make those chem­i­cals in the brain get all wonky, because eggs don’t occur with­out chickens?

It was, in some ways– in many, I’ll take it that far– a good arti­cle.  His cri­tique of the con­straints placed by insur­ance com­pa­nies on med­ica­tion vis­its was valid.  In so short a time, it’s impos­si­ble to get at all of the things that go on in one patient’s head.  And he acknowl­edged that he hadn’t gone far enough in know­ing his patients– that as he dug fur­ther with one, he learned that there was more going on, and that he had in fact, either under or mis-diagnosed, and what the patient needed was a whole dif­fer­ent cock­tail of drugs, one that suited much better.

There were prob­lems, how­ever.  The doc­tor acknowl­edged that he, as a pre­scriber, did not have time to pro­vide ther­apy.  Acknowl­edged, too, that ther­apy is often looked-down upon even as it can be mar­velously, incred­i­bly help­ful.  And yet, there was no indi­ca­tion that this par­tic­u­lar doc­tor had ever reached out to his patient’s treat­ing ther­a­peu­tic providers.  His assump­tion seemed to be that instead, he should be the one pro­vid­ing the therapy.

Um.

Yeah.

Ever heard of a phone call?

Email.  That could work too.

And also, there’s such a thing as a detailed his­tory, and learn­ing to fina­gle the insur­ance com­pany forms so the patient’s diag­no­sis is such that the extra time you spend with them on intake and the occa­sional longer med visit is jus­ti­fied and gets paid for, so you can ask the extra ques­tions about sit­u­a­tion stres­sors that are nec­es­sary to find­ing out how your patient is doing– to observ­ing if your patient fid­gets, is avoid­ing your ques­tions, seems really dis­tressed, all of that jive.

Now.  I don’t know this doc­tor from Adam.  And he teaches at a respectable med­ical school, has had respectable hos­pi­tal affil­i­a­tions, too.  But there was a cer­tain arro­gance under­ly­ing his writ­ing in pre­sum­ing that hey, presto, it’s just time for him to rein­cor­po­rate ther­apy into his prac­tice when he hasn’t been doing it for what sounds like at least sev­eral years and he’s been almost entirely med-focused.  Why not work col­lab­o­ra­tively with the peo­ple who do it day in, day out?  You know, like doc­tors and nurses do on a care team in a sur­gi­cal ward?  (Oh, wait.  Did I say some­thing shocking?)

I shared the arti­cle with my ther­a­pist.  I’ll share it with my shrink when I see her next.  She is one of the good ones– she col­lab­o­rates with my ther­a­pist– and takes time dur­ing our med vis­its to ask those detailed ques­tions, to ask after the stres­sors, to call me after hours if that’s what is needed to see how I’m doing.  It’s clear that psy­chophar­ma­col­o­gists do need to change. I could give Mr. Car­lat a ref­er­ence, if he were interested.

—

I saw Noah Baumbach’s Green­berg yes­ter­day.  Or per­haps I should call it Ben Stiller’s Green­berg.  Because for all of the beau­ti­ful shots, all the won­der­ful writ­ing and cast­ing, all the whole-ness and fractured-ness of it all, this is Ben Stiller’s movie.  David Denby did a review of it in the New Yorker, and there was a sep­a­rate pro­file of Stiller in a dif­fer­ent New Yorker issue (sub­scriber access required) as well as a review in the NYT by A.O. Scott that was like­wise full of praise.

I wavered a long time about see­ing this movie.  And yet I went to see it.  The reviews tell you what it’s about– but here’s what I saw, and let me try to at least link it to the first part of this post and the last.   (Themes, Erika, themes.  We can haz them.)  Here’s a man let out of a men­tal hos­pi­tal, seri­ously frag­ile, adrift in his brother’s empty house, peek­ing out the cur­tains at neigh­bors who use the pool while his brother’s away.  He’s tak­ing the pills he’s been given and reach­ing out– grasp­ing at straws– at peo­ple he hasn’t talked to in years.  He also grasps at his brother’s PA, the young, lost, doesn’t yet know what she wants Flo­rence, who’s lovely and despite her own lost­ness sees past Roger Greenberg’s dam­age to what lies beneath.  (Roger doesn’t yet know it’s there.)

At no point does Roger see some kind of ther­a­pist.  But he asks all kinds of ther­apy ques­tions to all kinds of peo­ple unqual­i­fied to give him any answers that are going to do any­thing except hurt him some more and make him lash out– be angry– be hurt­ful and hate­ful and self-focused because, well, yeah, um, he’s still kind of crazy.  (Every­one around him hates him for that.  What they don’t see is– they’re also a lit­tle bit crazy too.  All of us are.  Roger’s just more crazy than most.)  And Roger, because he sees some­thing in Flo­rence– oh, but she’s lovely and good– he hurts her a lot, even as he does some awfully nice things for her too.  He grasps too hard at the bird in his hand, and it’s crushed and wounded and messy, flap­ping away one-winged and squawk­ing.  He should’ve had a ther­a­pist there, ask­ing him ques­tions that let him think about it when ses­sions are over in a way that let every­one feel a lit­tle less reeling.

There are lots of great cin­e­mato­graphic metaphors– him walk­ing alone in LA in places where no one should walk, sound effects coin­ci­dent with panic attacks, things that he sees on the out­side that mark what’s going on his very, very still face (Stiller does some­thing won­der­ful here with his expres­sions, he’s really got the blank face of some­one on a lot of anti-anxiety meds or some­one in such denial until the rage just comes pour­ing out, blast­ing past that self-preservationist wall) that just from a film student’s per­spec­tive, it’s a movie worth seeing.

But if you’ve ever been depressed, in denial, been some­one try­ing SO FUCKING HARD to keep it under con­trol, and then you just can’t, and you lose it, hurt peo­ple you don’t really want to and then fuck, what do you do, you still have to get out of bed the next morn­ing, and the sun hurts, it’s too fuck­ing bright, Ben Stiller does some­thing amaz­ing.  He just totally nails it.

See­ing this movie hurt, yet there were some won­der­ful, won­der­ful moments that gave me such hope for the char­ac­ter, because given some­thing con­struc­tive to do, out­side the lull in his head, god­damnit, he did it.  He made the dog­house, even if it took him a while.  He took care of the dog.  He took care of Flo­rence when push came to shove, even if it was within the lim­its he still had to work in.  He put up that pic­ture on the wall, and that moment of care when with soft, ten­der fin­gers he mea­sured off where the framed niece’s pic­ture should go?  And though it took too much booze, some coke and a joint to break through that wall of denial he’d built between him­self and the denial of “I’m try­ing to do noth­ing” he kept telling every­one he was there in LA to do?  He was finally hon­est.  Painfully so, awk­wardly so, and oh, with poten­tially great and unknown con­se­quences, since the movie fades to black just as Flo­rence gets to Roger’s voice mail con­fes­sion of like-maybe-love with per­haps the great­est end­ing line I’ve heard in a movie in years.

“This is you,” Flo­rence says, and Roger’s eyes dart away, because he can’t bear to look as she lis­tens.  We can only guess what hap­pens next.  But yes– that is Greenberg.

—

Last spring, I stopped work­ing.  I just couldn’t do it any­more.  And I couldn’t tell any­one how depressed I was either.  Not my ther­a­pist, not my hus­band, not the peo­ple at work, not one of my friends, online or in life.  I felt help­less and hid­den and awful and use­less and while I didn’t actively con­tem­plate sui­cide, I did wish there were days I wouldn’t wake up or I’d just not pay atten­tion and get taken out by a bus.  So I hid.  And I wal­lowed.  And then hid some more.  There were lots of rea­sons why I couldn’t admit how depressed I felt, lots of old issues and new, some of which involve peo­ple whose feel­ings I won’t drag into this blog.  But suf­fice it to say it was messy and awful and com­plex and I felt utterly, totally, lost.

I stopped tak­ing my meds, stopped tak­ing show­ers, avoided phone calls and emails, didn’t eat much, all sorts of things.  And peo­ple knew some­thing was wrong, but I wasn’t talk­ing, and every so often I could put on a facade of half nor­mal and go out to a fam­ily din­ner– and it wasn’t like I was cut­ting or burst­ing into tears or doing some­thing so obvi­ous as drink­ing myself into a coma.  Things occurred– like in Green­berg– that forced me into func­tion– and those were help­ful, because the focus on some­thing besides myself got me mov­ing.  (And I was never so mean to other peo­ple as he.)  There were wed­dings to attend, my mother-in-law’s apart­ment to clean, other out­side things to get done, and my truly Bet­ter Half sat my ass down and said– “I don’t care what you do, but you need to get out of the house every day.”

Thus the bookstore.

I have got­ten out of the house every day and smiled and sold mem­ber­ships and looked up books for eight hours a day and been com­pe­tent and slowly– so slowly– got­ten back some of the sense of self-worth that I utterly, totally lost by giv­ing up on my legal career and some kind of proof that I was smart and knew what I was doing despite all the feel­ings inside my head that tell me I’m stu­pid and worth­less and not wor­thy of love, even when the med­ica­tion is working.

To date, despite the fact that I see a very good ther­a­pist and keep up my vis­its with my excel­lent shrink, I have walled off those feel­ings and not thought about them and taken my meds and got­ten out of bed every day and con­cen­trated on doing my job really well– my stu­pid retail chain book­store job, because that’s how most rich, “suc­cess­ful”, pro­fes­sional peo­ple think about peo­ple who work in book­stores, didn’t you know?  I have made friends with kooky book peo­ple who love all my bak­ing and think I am smart and amaz­ing to recall all the names of those books and come to me to ask me what I think about X because some customer’s ask­ing.  I feel bet­ter because I have reg­u­lar cus­tomers who come to me for book rec­om­men­da­tions and think I have excel­lent taste.  I feel bet­ter because my bosses tell me I’m awe­some on a reg­u­lar basis and I can tell that they mean it. I felt bet­ter because  my shrink and my ther­a­pist ask me excel­lent ques­tions, and even if I haven’t been entirely hon­est with them about how depressed I have been, they ask me excel­lent ques­tions that make me think about things I don’t want to think about and yet, with the increas­ing effec­tive­ness of the meds, I can’t help but do.  I have been tak­ing my meds.

But it’s spring, and spring is a bad time for me.  So a few weeks ago, when it rained and rained and rained, I used my high-intensity-UV light a lit­tle too much to com­bat the hor­ri­ble weepies I get, and after a few days I was wash­ing dishes and could get the new-fangled dish soap IN THE CUCUMBER SCENT AND I HATE THE CUCUMBER SCENT AND JESUS FUCK WHY WON’T THIS OPEN WHAT THE FUCK IS WRONG WITH THIS FUCKING CONTAINER?

Yeah.  Some­thing was wrong.  It’s just dish soap.  So the Bet­ter Half came and opened the dish soap, retreated, and I went back to wash­ing the dishes.  When I was done, I took an ati­van and real­ized I was prob­a­bly manic and told the BH so.

Ati­van is a won­der­ful thing, and we went to a fam­ily party for my nephew’s first birth­day that night, and except for need­ing to go be off by myself for a lit­tle bit when there were a lot of peo­ple all laugh­ing at his smear­ing the cake that I made him all over his head (noth­ing so sat­is­fy­ing as a baby lov­ing your cake enough to smear it all over his hair)– and there’s a scene in Green­berg where Rhys Ifans comes in to ask Ben Stiller if he’s going to play Gatsby the whole way through the party that spoke to me oh, so very deeply– so I was mostly bet­ter by the next day and kept up with the ati­van, except by the end of the next week I was spi­ral­ing deeply again and wishes of buses and not wak­ing up and let­ting go of the steer­ing wheel, while not yet man­i­fest­ing, were edg­ing toward con­scious­ness again.

I called the doc­tor this time.  And the ther­a­pist.  And told my Bet­ter Half.  And we’re work­ing my way up through new meds.  And I am feel­ing bet­ter.  Still tired and weepy.  Still prone to need time to myself.  But I am see­ing it’s time to break down that wall that I’ve had because I have to get out of bed every day and just get to work, because you know what?  I have.  And I also saw that I almost couldn’t, and yet I still did. I’m kind of proud of that bit.

So.  I’m blog­ging and blath­er­ing again, and I’d sug­gest to Mr. Car­lat and Mr. Baum­bach and Mr. Stiller (espe­cially Mr. Stiller, even though you’ll prob­a­bly hate his char­ac­ter as much as you love him, and yet Roger Green­berg is now for­ever a hero of mine).  Talk to your patients.  Talk to your ther­a­pists.  But most impor­tantly?  Talk to yourself.

I’ve been avoid­ing what Flo­rence said in so very clear-eyed a way.

This is you.