Tuesday, October 14, 2008

On Medication Compliance, Poetry, and Cat Portraits

It surprises me, but since I've been feeling better I have developed a slight resentment against all the medication I must take in the morning. It takes three swallows. Here's my menu:

Morning:

Lamictal: two 100 mg. tablets
Adderall: two 20 mg. tablets
Abilify: one 5 mg. tablet
MS contin: two 30 mg. tablets
Effexor: three 75 mg. capsules
Celebrex: one 200 mg. capsule
ASA: one 81 mg. tablet

Afternoon:

Adderall: one 20 mg.

Bedtime:

Klonopinone: one 1 mg. tablet
MS contin: three 30mg. tablets

So, that's five medications for mental health, two for pain, and one for preventing vascular problems (aspirin).

At my last visit to my shrink I wondered if we could cut anything. He responded by saying, "You haven't been stable very long, Craig. Just keep taking them and enjoy yourself."

Great shrink! Like all mental patients, as soon as I start feeling better I want to take credit for it, thinking my naturally defective chemistry overcome by my newfound health. This is a fatal misapprehension; fatal.

How many times have I had a patient in practice who felt better, unilaterally stopped their medicines and relapsed?

My worst case was my father. He wouldn't see a shrink so I slipped him some antidepressants and an anti-anxiety agent. After a couple of weeks he felt better and stopped the medicine. After two partial responses to the medicine in the midst of a serious depression, he quit both times. Then he suicided.

Was I a bad son and a good doctor? A good doctor and a bad son? I lacked the authority of a real doctor for my dad, thus the treatment was partially undermined by that, the lack of the empowering mysterium tremendum of the white coat. As a son I had to plead with and cajole my father to take his meds. Perhaps it forestalled his suicide for a time, as we discovered after his death that he had been writing suicide notes since March when he finally committed the deed in November. But it was all for naught. He was from the John Wayne generation and his last note said something like, "It's either the hospital or the end. I can't bear to go to the hospital." His mother had been hospitalized twice for shock therapy and I don't think he could stand the shame. Tragic but predictable, although his death wasn't; we all thought him a survivor.

Thus I adjure you, all mood-impaired citizenry, to keep taking your meds as the price of sanity. It's been shown that if you have one clinical depression, your odds of a second one are great, and your chance of responding to your first successful medicine are reduced in the second go-round. Many psychiatrists advocate a lifetime of medication for one serious depression. I favor giving people one chance with their first depression, maintaining them for a year and then gradually withdrawing the medicine. But in cases of manic-depression, medication is surely needed lifetime, and many first time depressives are later diagnosed with manic-depression.

If the pancreas and liver can become diseased and need insulin replacement and interferon, respectively, we have no qualms. But if the brain is diseased we confuse it with our "personality" in what Ernest Becker calls "the causa sui project," where we attribute the success to ourselves and think that it's actually our own power that has delivered us, when in fact it is simply the treatment of a diseased organ.

You are not your depression; clinical depression means a diseased organ, save in this case it is the organ of consciousness and easy to mistake for your self, a fatal mistake. To all of you who don't know better, and to all you who do, remember to take your meds faithfully until your doctor lessens your dosage. To do otherwise is stupid, and as in my father's case, may result in tragedy. He never got to meet his great-grandson.

Lately I've been happy about poetry again, its possibilities, how the pleasure of a good reading can exceed the joy of a movie or a book of prose. That I labor in this antiquated and unpopular field does not minimize its impact for a few. And the purpose of poetry? No one has said it better than Sir Phillip Sydney of the Elizabethan age, though he stole from Aristotle: "To teach and to delight." In other words, a sugar-coated reality pill (to speak somewhat derisively), or better, an adventure in words that lifts you up out of your reality and gives you the perspective of another, which can be salutary. As for contemporary poetry, there is too much striving for "delight" and not enough teaching, but given the state of culture, any morality is usually rejected out of hand as a violation of boundaries, unless the morality is insinuated so carefully that the reader doesn't know it until it is too late.

I have a little essay in Melic entitled "Poetry and Morality," and another on "Prophetic Poetry," (begin with the tenth paragraph), if any should be interested in further speculation along these lines.

I'm busy proofing the proofs of my "Selected Poems" from my publisher now. It's tedious to proofread. You can't really "read" the poems while doing it; it's more of a housekeeping exercise, and in that frame of mind many of the poems seem limp to a glancing eye. But I know better; I believe in my poetry; my poetry often has the power to get through the modern multi-tasking brain and sometimes stop it cold. This has always been my ambition, a poetry of power, or as I have defined it, "Language distilled into its most powerful form." More thoughts on this in my essay in Tryst.

Here I will break continuity and post a picture of each of our cats for LKD, though I'm sorry to report that I don't know how to transfer new photos from our digital camera directly into my computer through Kodak Easy Share; it seems only the pictures held in the card memory, and not the current pictures, can be uploaded.

Here's Topaz:



And here's Jojo:



The pictures don't do them justice, especially Topaz, who is a beauty and whom we sometimes call "Remedios" after a beauty in "One Hundred Years of Solitude." As you know, our dog's name is J. Alfred Prufrock and I hope to have a picture of him soon.

Meanwhile the weather is brisk and sunny, the pineapple sage is blooming, in fact I have a haiku about that:

pineapple sage blooms
hummingbirds flitter and sup
from the long, red tubes

If you have never smelled pineapple sage, you're in for a treat when you encounter it. Great for iced tea!

And how about a short example of a poem of power?


Keep the Faith

You say two friends were murdered
but it's a nice day
and there must be middle ground
between the abandoned mineshaft
and the Holstein sky.

Ants kill ants as easily as popping sodas.
Some father fish swallow their fry,
others rock them gently inside their jaws.
Sometimes an ox is gored
by another ox and dies.

Sometimes a country sends its young
to float like dynamited carp
in distant rice paddies.
If mercy were based on evidence
I'd shoot you.


So, with medicines and poetic morality, cat portraits and poems of power I leave you.


2 Kilobunnies,

CE

9 comments:

  1. Hey, thanks for posting the pictures of your kitty cats. They're both nice-looking animals. Did they come as a pair? Or did you adopt them separately.

    Can't wait to see a picture of your mighty cat-chaser, Pru.

    ReplyDelete
  2. As secretive as a cat.

    You know me.

    Ha.

    Hey, thanks again for that purrfect birthday card. It made me laugh out loud. I could use a lot more of that, frankly.

    ReplyDelete
  3. Anonymous9:43 AM PDT

    Craig, I read the essay in Melic about poetry and morality and I agree that if we say, even operationally, that God exists and he is good, this is "already too much for many." For us common thinkers the burden of proof is more than we can lift and we will not experience an "outbreak of joyous heterodoxy" but abandon the work for the comfort of orthodoxy.
    So perhaps this question should be avoided and energies applied elsewhere. But where? Like you I believe a poets first moral obligation (I'd like to call it duty) is to write well. As perfection of the craft is approached, truth and beauty begin to be unvieled. Then I believe we have art. And art reveals the artist and where the artist is in the Journey will determine the capacity "to teach and to delight."
    Of course the striving to "delight" will not produce art, nor will the attempt to teach (morality or anything else). The striving should be to reveal oneself and all one feels and senses of the world and universe. Then I believe knowledge is conveyed and the delight experienced is not without the melancholy that adheres to truth.

    your friend,
    fshmstr, aka le PIG!

    P.S. It gave me much pleasure read you print the words "my publisher". Congratulations, I knew hanging onto your coat tails would eventually pay off.

    ReplyDelete
  4. You certainly give good advice about the meds. It is true...you think you are doing well and your forget what things were like when things were hell. Love the kitty pictures...they are both beautiful cats. And your poetry...as always...is phenomenal. I am quite envious of your talents.

    ReplyDelete
  5. LKD, "nice-looking animals."

    Damned with faint praise!

    Meryleme, you are always an encouragement. Be sure to rejoice in your own talents.

    Ralph, self-expression isn't enough. Art has been glutted with it until it has come to the end of the self, which is easily exhausted. I don't want to read another poem about self-exploration, thank you. Art must have some transcendent value to even survive, much less be art of quality. But you know this. You were just balsncing out my opinion.

    Art must have an ideal of some kind, some Logos toward which to strive that strangely, also grounds us.

    CE

    ReplyDelete
  6. Thank you for your blogs, I am BiPolar and have been searching for an online and ongoing discourse of the illness. And a doctor to boot. And an artist (poet), I am a graphic artist struggling with both my illness and art, so finding your blog
    is a Godsend. Thanks. KLivingston

    ReplyDelete
  7. Dear K,

    Glad to be of service. For more meditations on my illness, simply search under "depression."

    One thing you may not know as an artist is that medicated bipolars are actually more productive long term than those left to their cycles of "inspiration."

    What saves me as an artist is the discipline of my craft; I work hard at it, whatever my mood. A dark poem I wrote during a depression, for instance, was recently published by a pretty good print journal, A Capella Zoo. If I hadn't persevered in my illness I wouldn't have the credit.

    Good to have you come by, hope to hear from you again.

    CE

    ReplyDelete
  8. Cool cats, enjoyed my trip here today Doc. I'll will return again, thanks!

    Peace and love!

    lol... my word verification below was just
    medcausc

    how profetic huh...
    smiles!

    ReplyDelete
  9. Ah Calder, I must know you by a different name. Glad you stopped by. I let it all hang out here, down to the mg. dosages.

    "Another day, another dollar,
    Another blow job, another swaller."

    Dr. C

    ReplyDelete

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