Tuesday, August 16, 2016

My Faustian Bargain






Seven years ago, the minute my Clinical Pastoral Education internship as a hospital chaplain in San Francisco was up, I made an appointment with a psychiatrist in Berkeley. I had managed to live functionally without being medicated since moving to Berkeley a year prior to begin seminary, but my major clinical depression roared back with such a vengeance in years two and three that I had to return to the care of a psychiatrist, and have remained treated and medicated every day since.

Except the medications themselves hardly made matters easy. Celexa, the antidepressant I was prescribed as a teenager, now produced severe mood swings in me, and I remained on it only a matter of weeks. I was happily on a combination of Prozac and Wellbutrin for years, until side effects with that combination likewise proved to be a significant obstacle.

Because a number of physical and sexual side effects are common to the family of medications Prozac belongs to, known as SSRIs, my psychiatrist recommended switching me to an SNRI anti-depressant, and thus began my now-two-year-old relationship with Effexor.

With Effexor, I can live, function, and work without any side effects to the drug that keeps me sane, but only if I take it at precise 24-hour intervals. Effexor has by far the shortest half-life of most common antidepressants, and I'm a pretty big chap. If I forgot a day, by the next morning like clockwork, I would be laid out but good with dizzy spells, vertigo, and nausea.

Lately, I haven't even had to forget a day--just take a dose later than I had the previous day. Which is why I'm sitting here on the couch at home, writing this in between dizzy spells, to quite simply say, on behalf of all of us who do suffer from mental illness:

It isn't always the illness that you see affect people. Sometimes it's the treatment.

Think of chemotherapy. The side effects you associate with cancer patients--the loss of hair, the emaciated figure, those come from the treatment, not necessarily the illness. Chemo can save a cancer patient's life, but enough of it would almost certainly kill them as well.

Antidepressants can have the same effect, albeit in a much less extreme way, in that sometimes, the symptoms are from the medicine, not the illness it is treating.

I remember when, while in seminary, the HIV+ pastor of the church plant I was worshiping at shared that he had to go on a new regimen of drugs, and one would likely either cause some weight gain while another would adversely affect the quality of his sleep. Either symptom would result in visible outward signs, but not from the far more dangerous disease the medication would be fighting.

It is a Faustian bargain we make with our treatments, because while we know they work, we also know what else such potent cocktails are capable of doing. When I take my Effexor at exact intervals, I can live symptom-free with my depression treated, which is something I quite simply have never been able to say with another medication.

But if I miss a dose? Woe be to my equilibrium and sense of stasis.

So, on a rare day when the side effects of my medication are rearing their ugly head, I felt it important to say this:

This reality is why, even though I have been under no obligation to do so, I have revealed my diagnosis to church committees and pastors who have considered hiring me in previous search processes before any vote was taken. Not because they should discriminate on the basis of mental health--they shouldn't--but because it is possible for not only my diagnosis but my cure to adversely impact my ability to work, even if only for a few hours at a time, especially considering that solo pastors in particular are functionally on call 24/7.

Fortunately, I can work from home most days of the week--much more than I actually do. I usually only work from home on Wednesdays, which is my sermon writing day--I need as much control over my writing time as possible, and the distractions of ringing phones and visitors at my office tend to detract from that. But if I wanted to work from home two days a week, I really very easily could--I could still keep office hours two days a week while combining my home/hospital visitations with excursions for coffee, lunch, or meetings.

But not everyone else has that luxury. So, if you see someone else who has made a similar bargain with the medications that keep them sane or alive, please, show some patience and some humility in the face of what is for them sometimes a daily struggle. And if you have someone in your life for whom that is the case, I promise that the good karma you are reaping for walking alongside that person does not, and will not, go to waste.

Vancouver, Washington
August 16, 2016

Image of the structural formula of venlafaxine (Effexor) from Wikipedia.

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