For those of you who are relatively new to following me: I have long term issues with depression and anxiety which I occasionally post about, partially for my own catharsis and partially as part of an effort to tackle the stigma around mental health issues. Stuff below may trigger feelings of depression, anxiety, etc. if you have them, so trigger warnings, caveat emptor, and so on apply.
For the latter half of 2016 my anxiety was worse than it had been in a long time, I was having trouble sleeping, and most of all I was having trouble getting up in the morning. I was often sitting paralysed with anxiety and unable to move, when I wanted to get up and leave the house. Since the beginning of this year my anxiety has been much better, probably better than it was before. So what happened? Did I come to some personal revelation? Understand the source of my fears? Master some advanced meditation technique? Not really. I changed the pills I take. In June I switched to a new medication recommended by my doctor in Beijing, hoping to reduce my anxiety and my daytime tiredness. In December I spoke to my old doctor in the UK, and switched back to my old medicine plus another one. In between I took various medicines to help with concentration and anxiety in acute times, none of which seemed to help.*
So far so obvious right? Medication designed to change how your brain works changes how your brain works. But in some way I find it very difficult to internalise that that is what happened. Hell maybe it wasn’t, it took me so long to notice it because there were so many other variables in terms of lifestyle and stuff that the change of medication was lost in the noise. It was only when I talked to my UK doctor, who was not a fan of the medication I had been given, that I made the change back.
If you will forgive my jargon, I think the reason this feels like such a narratively unsatisfying explanation to me is implicit dualism. We (by which I mean the vague set of modern western intellectuals) are intellectually aware that we are physical beings in a physical world, which to a large extent has predictable rules. Hardcore dualism, that posits the existence of a separate soul, consciousness or whatever, has rather gone out of fashion among philosophers. The closest you will get these days is mealy mouthed talk about qualia and “irreducible mental phenomena”. No-one seriously denies that neurochemistry is what determines us, to a large, if not necessarily complete, degree.
But that doesn’t satisfy us emotionally, and doesn’t fit with how we think day to day. Have you ever had the experience of being incredibly angry or upset about something, and knowing in the moment exactly why, and that it makes perfect sense. But later finding that once you have eaten, or slept, or recovered from an illness, you feel completely differently? Even knowing that happens, it still doesn’t feel like a real explanation. Yes, I was tired, but he was still being an asshole, right? Our internal introspective sense of why we think and feel the things we do always takes priority in our minds. Even if, in some abstract way, we might agree it was influenced by other more pragmatic factors.
There’s also a sense in which we want the narrative of our lives to make sense. We think in terms of stories, not detached cause and effect. Protagonist overcomes fears by soul searching and introspection is a compelling story. Protagonist changes their diet, isn’t.**
One of the fundamental lessons I’ve learned from dealing with and reading about mental health is that our instincts are not always to be trusted. Our brains lie to us all the time, about little things like optical illusions, as well as big things about how we relate to the world, and why we do the things we do. But that’s a hard and (if you’ll forgive the pun) depressing thing to learn. Knowing that your brain misleads you can leave you in a state of perennial uncertainty, never quite trusting yourself to judge situations. External validation helps a little, I’m sure even people who have no known mental health issues frequently ask their friends “I’m I being oversensitive or ….” But that doesn’t change the underlying disconnect between how we feel we are and what we really are. Maybe this is one of those things you have to slowly internalise over time, I don’t know yet.
*If anyone wants to chat to me about my experiences with different medications let me know. I left out the names because I didn’t want to distract from the larger point of the story.
** I wonder if this is also true at a social level. If some group of university researchers showed we could make violent criminals into safe law abiding members of the public by increasing the amount of iron in their diet, I doubt our society and legislators would accept that as a policy response. It just fundamentally doesn’t fit with our view of how human beings work.
