Every day, unless I forget, I take two pills. One is oblong and beige and burns my throat quite badly if I attempt to swallow it dry. The other is round and white. They are antidepressants, though different kinds. I have been doing this for years.
Quite a lot is said and written about psychiatric medication. For people who don’t have much experience with them, medication for a condition like mine tends to be a philosophical problem: if you could take a pill to be happy, should you? Here we are in the realm of thinkpieces about anxiety and depression and medicalizing normal human experience. On the other hand, when it comes to mental conditions that are genuinely stigmatized and feared, like bipolar or schizophrenia, meds are the thing we are assured separates your coworker from an axe murderer, and refusing treatment for these conditions should be something where the law is allowed to take a firmer hand.
The truth is that medication is both overprescribed and somewhat stigmatized, with the levels of each fluctuating depending on what sort you need. It is unclear how the pills work, or even if they do. They can come with side effects that are almost as bad or worse than the condition they are meant to help — and seem, anecdotally anyway, to be far more likely to cause side effects the more necessary they are for a person not to spend their life in and out of hospitals. But pills can also work, as mine do for me, with minimal negative effects in my daily life except for very vivid and unpleasant dreams. For other people, they do nothing at all, not even as a placebo.
I’ve tried to get off one of the medications, because I find taking them in the first place irritating, and I find taking two even more irritating, as if I’m some kind of flower that can only flourish in very specific conditions, or a panda that has to be prodded to perform even the most basic biological functions. But here I am, a panda to the core, albeit a begrudging, cranky one. Every time I unscrew the bottle and swallow the pills I make the choice to be present in my own life even if it’s embarrassing. Whether or not I should need the pills, I do. Maybe there’s an alternate B.D. McClay who doesn’t need them because she bikes and eats spinach. She’s not me.
Anyway, as I sometimes remind myself, W.H. Auden spent his whole adult life doped up or down on something. “About suffering they were never wrong, / the old Masters,” he wrote in “Musee des Beaux Arts,” and we could I suppose include him in that if we want to, and I do.
But I actually want to go back to the philosophical question — because I do think there’s something interesting there, even if medication doesn’t really make you happy. The fact is I’m one of the group of people where psychiatric meds did exactly what they were supposed to do: promptly and painlessly took a part of my internal life and turned the volume down to where I could think and do other things. It took no work, no self-discovery, no fixing of some inner problem. Instead, like a cartoon character, I discovered that if I just didn’t look down it didn’t matter if I was standing on something or not.
Is suffering valuable? That’s the question, and the answer antidepressants give is: no. A viral set of tweets to this effect went around a few weeks ago, for instance: “The core assumption behind SSRI use is the assumption that your suffering is meaningless and you’d be better off without it.… It is a crime to consider suffering as an error to be corrected rather than as a signal to be heeded.” In the end, I side with the pills: Suffering isn’t valuable. It’s just suffering, nothing more and nothing less, sometimes necessary and sometimes not. It is bad to suffer for no reason. It’s better not to suffer. And it’s bad for our character: suffering can make us smaller people, less generous, less kind, more fearful, more angry.
Now — like any girl with brown hair and glasses who reads poetry — I am, of course, in love with suffering, too. All I want to do is suffer. I collect the writings of the female saints who inflicted suffering on themselves because we are sympathetic in this way. Except we really aren’t — because the first thing these women will tell anybody like me is that seeking out suffering for its own sake is a dangerous, even sinful game. There’s something comic about saints who chewed plants and spat them out in lieu of eating, scolding others for not feeding themselves, of course, but they’re right. Everything, suffering and self-denial included, is a means and not an end. In themselves, they are nothing. And if taking on suffering is the right thing to do, it’s not because suffering itself is meaningful, but because there’s some other end that is important.
Is suffering valuable? That’s the question, and the answer antidepressants give is: no.
Because I am religious, my scope for what that end could be is slightly wider than other people’s and the range of obligations is wider. There are lots of things that I do that would strike someone else as making my life pointlessly hard. But even then, there are rules and guardrails, because in the end, pain is just pain, and you can’t run around inflicting as much pain on yourself as possible for the souls in purgatory. You’re going to be in pain in this life. Take the outs you can.
When, after taking meds for a little under a year, I eventually went to therapy, the idea that life could be as simple as just choosing not to look down drove me crazy. It still does. To me my issues were an intellectual problem about whether my life meant anything or not, whether I should take up resources or not, and I didn’t want the answer to that question to be that I had to stop asking and just move on with living. I stubbornly refused to acknowledge that I could just make my life better by doing things that made it better and not worry so much about if it should, or how it did, or why. I don’t think being happy is the point in life — or being comfortable, for that matter. But misery isn’t the point either.
Suffering is big and suffering is satisfying. When it’s a chronic condition, it’s simply always there, a vast scratchy blanket, and it will swaddle you up forever if you want it to. It feels meaningful when you’re in it. You’re afraid to leave and find out it wasn’t. But if you do, you know the truth you were so afraid of — it was just a waste. You knew it then and you know it now. All the time I spent running from medication was time I could have spent reading books, writing, making friends, going on long walks, developing hobbies, loving other people, relishing the taste of things — even being genuinely sad, one of the many feelings major depression, for me at least, completely blunts. That is the world where meaning is.
I still don’t like this; I probably never will. I don’t like a solution that takes no brainpower and minimal effort. I don’t like being dependent on two stupid little pills and having to talk to a doctor every so often so I can keep on taking them. I don’t like knowing that there are questions I can’t answer, just live out. I hate entrusting myself to the fluctuating, intense world of emotion instead of the flat solidity of dull depression. I hate being alive, most of the time. But it beats the alternative.
There’s a scene in Star Trek IV — the one where the USS Enterprise travels back in time to save the whales — where Dr. McCoy is horrified to find a woman on dialysis and to find doctors practicing chemotherapy, muttering that it “sounds like the goddam Spanish Inquisition.” I suspect that this is how most of psychiatry is going to look in the future: that what’s being prescribed will be better understood, and that procedures will look inept or cruel that are now considered normal. It might even be the case that heavily stigmatized treatments today, like electroconvulsive therapy, will turn out to have been more valuable than one-time reformers thought. It could turn out that all of this is like scurvy, and we just have to discover whatever the vitamin C is that people are missing that makes them spiral in anxiety, perform self-harming rituals, or unable to get out of bed. Maybe we’ll live in a society that’s so fixed it doesn’t make people crazy. I have no predictions, except that we will know more and that knowledge will change what we do.
Well, and that there still won’t be a pill that makes people happy.
I don’t really know why happiness is so much more complicated for me than pain, why I am so much more suspicious of it, more likely to discount it as a justification. Most of the things I’ve done that I really regret in my life I did because I was in pain, and was willing, or thought I was, to do anything not to be, except get help. It’s always been suffering that’s made me sealed-off and selfish and paranoid, not its alternatives.
But maybe I’m suspicious of happiness just because there’s something there to think about; because it isn’t the monotonous, solipsistic world of my own pain, where there is nothing but myself, and nothing matters. Like the Little Mermaid in the fairy tale, sometimes being alive feels like walking over glass. But at least I’m walking. And at least I can feel it.
B.D. McClay is an essayist and critic.