Part II: Fluoxetine
And suddenly nothing I have learned seems of any use.
Actually, this is what I’m telling myself: “I have learned nothing in all these years. What a failure I am!” Decades of practice vanish in a black hole of a very different nature. I wake up in the morning and the first thought is: Oh no, I do not want to be conscious! I cannot stand being awake. Pressure and burning in my chest, fatigue, despair.
Can I be present with it? For a moment – but that only increases the agony.
I have to get up, it is time to make breakfast for the family. I go downstairs, put a kettle of water on the stove. I do not know how to make breakfast. I open the fridge, peer into it, hoping that something in there well give me a hint. I stand and stare, pressure is building up in my chest and tears start rolling down my cheeks. I wish I could die.
Footsteps in the bedroom above me and then noisy little feet running down the stairs. My son enters the kitchen, excited about the new day, happy to see me and ready to do something together. I quickly dry my tears, turn around and smile at him. “I need to make breakfast. Can you play on your own?” No, he cannot. He wants me.
I cannot either! I can’t be with anybody right now. I can’t make breakfast. I am bursting – and I push it all down. I have to function now. How to make breakfast? Okay, I need to ground myself, feel the floor under my feet, feel the cool milk container in my hand, follow breathing. I know how to do this.
Fuck! I can’t, I can’t stand being present. It hurts too much. I’m about to explode.
My wife has since arrived in the kitchen. She notices my state immediately, asks: “You’re having a hard time, don’t you?” I can’t stand that question. I do not trust that it comes from a place of care. I hear it like a complaint. I mutter: “I’m okay”, and continue with the impossible task of preparing breakfast.
Somehow, I manage to, I even get lunch together for Julian, but when it takes him forever to brush his teeth and hair, the buildup of pressure gets to a point where I start loosing it. My voice gets louder and more impatient and I finally break out in tears. “Just do what I ask you to do, please! I can’t deal with this any longer!” The result is as immediate as it was predictable: now Julian is upset too and won’t brush his teeth at all. My wife is upset because my state is affecting everyone.
Driving to school goes well. Julian has regained his good mood, we chat and have a nice time together. I drop him off and head back home. The person in the car in front of me is driving very slowly. Pressure building up again. “I need to get to work!” I shout. I can’t stand this anymore. Suddenly I have a very strong urge to drive off the road, crash into something and kill myself. What a relief it would be to put an end to this misery. I cannot see another way out. This has been going on for too long. Then I think of my son, I think of my wife, and I know that is not an option. I drive home, devastated, full of shame.
Such a predicament, like anything, arises through causes and conditions. When a lifelong predisposition finds fertile ground the beast can mature. I’d been there before. I will not expound on the causes for the current bout of depression; they shall remain private.
The buildup was slow and steady. It did not go unnoticed but I am a meditator with lots of practice, I’m a Sensory Awareness leader, I should be able to help myself. That is, in part, an honorable attitude. I really want to find out how I can heal by applying all that I have learned. But there is also this kind of thinking: This shouldn’t be happening to me considering all that I have done!
But life is not a rewards program and here it is: suicidal depression. Nothing seems to help. Shame certainly doesn’t and neither do guilt and pride. Alas, here they are, mixed into the poisonous brew. I try all kinds of natural remedies and supplements but nothing does the trick. Therapy doesn’t seem to help either, nor does talking with friends, or running or hiking, though these attempts at least give me some relief. It is good to have friends.
When these friends suggest that I take medication for depression I do not want to hear, though. That is not a solution for a person of my stature. My practices must work. How could they not? And if I can’t help myself how can I help others? What “helps” the teaching role: As a long-time meditator I have the “advantage” of being able to keep a good posture even when my limbs are in danger of withering away.* Actually, I have always been good at that: looking calm while screaming on the inside. I received compliments for my composure even as despairing teenager.
For how many months can I make myself believe that I can get through this with my skills? Three, six? How about a year? It only gets worse and finally I come to a point where I have to admit to myself that I can’t go on like this. I may be a failure but I need medication now. The shame! But I had come to this point once before in my life and was helped by antidepressants in a short time. Could I let myself be helped again in this way? Oh, the humiliation!
I finally give in. Within three weeks I feel much better and able to cope with life again.
This was last summer. In the fall I stopped taking fluoxetine and for a while I seemed fine. But then came our move from the Southwest to New England. All I’ll say is this: moving, selling and buying a house – very stressful! I had to resort to the pill again, even take something for anxiety and sleep for a short while. Don’t tell anybody. It will ruin my reputation of always being calm and dispassionate, even funny – and an accomplished teacher too.
The medication made all the difference. As we are settling in now I can begin to consider going off fluoxetine again. But tricky is the mind and ambition is not a good advisor. I’ll consider the decision carefully and I will allow myself to get outside help to support me in the transition.
Addendum for Buddhists
About 15 years ago, when I found myself in a similarly severe depression, I decided to go on a ten-day silent Vipassana retreat with a well-known monk and teacher from Sri Lanka. I was hoping that would help me but after only one day it became clear that I was spiraling down even more. I often sat on the cushion in tears. It did not help that the teacher had decided not to give any individual interviews at all. After the second day I went to the retreat manager and urged her to talk to the teacher. I really needed help. To make a rather long story short: after another day or two I got to talk to the teacher. His first words were that I surely must already feel better because thanks to me everybody was getting interviews now. Furthermore, he suggested that I stay with the breath and also memorize the Metta Sutta, the Buddha’s teaching on loving kindness. That would open my heart. With this advice I went back to my cushion. After ten days I was in such deep misery, I was barely able to travel home. This is when I knew I needed to see a psychiatrist. He prescribed Prozac and Charlie Chaplin movies. That helped.
(I should add that I memorized the Loving Kindness Sutra and recited it daily for some years. It’s good practice and I enjoyed it. It did not help with depression.)
(I should also add that when I decided to go off Prozac after only three months, the psychiatrist told me that was pretty stupid. I’d only feel that I was fine because of the medication. If I stopped now I would go down again quickly. He was wrong.)
In a recent conversation with Stephen and Martine Batchelor, two Western Buddhist teachers I cherish deeply, I mentioned my predicament. Their response was very clear: going on retreat is not how you treat depression. Stephen recalled an incident in a Tibetan monastery where he saw that a monk with what appeared to be a psychotic breakdown was taken to a hospital to be treated. Stephen said that he learned (and I’m paraphrasing here) that mental illness, such as depression, was considered by the Tibetans a “physical illness”. It was not seen as a “mental object” caused by craving and healed by letting go of desire, aversion or delusion but that it called for medical treatment.
Postscript: Practice? Practice!
Even though I wonder at times if all this meditating and sensing have had any profound effect on my life (or, frankly, that of many practitioners I meet) I know not to kid myself: if not for the teachings of the Buddha, the Sensory Awareness work of Charlotte Selver, and other modalities I have practiced over the years, I would probably not be here to tell the tale. The willingness to be present has been crucial even when it seemed useless. To meet and truly, deeply connect with what is, – to awaken – has a great healing capacity, and what is more, it brings about the deepest joy. It has also enabled me to recognize the beauty in the beast.
* Occasionally, I would let my guard down in my teaching when it seemed appropriate, and I do it more so now. That’s also the purpose of this blog. It turns out that people like to work with the real Stefan just as much as with the unwavering Buddha statue look-a-like.