Recovery Michigan

I am walking towards the Post Office with humdrum thoughts roiling in my head of things I need to do, wondering if I’ve got everything I need for tea, pondering a response to an email: the flip-flop ordinariness of everyday worries and concerns.  Nothing unusual, nothing remarkable.   And then.  And then. I can’t even tell you what happened next because it’s snap-click-snap, in a moment, in an instant, and I’m not conscious of it happening at all.  But my heart wants to burst like ‘Alien’ out of my chest, there is a rage of energy rippling up my legs and I can feel myself falling inwards and losing touch with myself.

Then it is minutes later, maybe even hours – time has no meaning, and my brain is scrunched up inside my skull with weariness and confusion.  What just happened?  It was a man with a camera, a dog, a child crying … I don’t know what it was.  But I was triggered by something and it’s seriously messed up the last few minutes or hours or even days of my life and I feel indignant and huffy with myself for it happening, and in roll the accusations and the razor-like mental barbs … You’re stupid, why did you have to react like that, what’s the matter with you, you’re pathetic, get a grip, this is ridiculous and then, like glaze on the top, the despair … I’m never going to change, I can’t do life like this, this is hopeless.  And, possibly just for good measure, a dollop of panic … I’m never going to get my work finished now, everything’s going wrong today, I can’t cope with all of this!!!

One of the hardest things I found in dealing with triggers was the aftermath: the shame, the self-blame, the sense of failure and powerlessness that once again something had happened that I’d had no sense of control over.

Probably, though, those of us who have personal experience with depression have arrived at more subtle conclusions—neither the cheerleading of the drug companies nor the jeremiads of their critics, but something approaching the ambivalence of Andrew Solomon’s magisterial 2000 book The Noonday Demon, which explored how pharmaceuticals can help, but not always, and not as often as they’re prescribed.

Abilify, though, might give pause even to moderates.   There’s not even an accepted theory here, as there is with SSRI’s (which prevent the reuptake of serotonin, thus enabling higher serotonin levels in the brain), to explain why the drug works. And this is extremely powerful medicine, being prescribed at an astonishingly high rate.

http://goo.gl/jJ3lmK

All kinds of cross-connections become evident as you work with people to try to improve the quality and safety of patient care, as we seek to eliminate preventable harm.  But I never expected a psychiatrist's book about combat trauma to offer an insight.  The book (recommended by Budd Shenkin), is Jonathan Shay's Achilles in Vietnam, Combat Trauma and the Undoing of Character.  And a powerful book it is, a must-read to understand the devastating long-term impact on personality that can result from wartime situations.

At our Telluride Patient Safety Camp, it is not uncommon to see evidence of trauma in the faces and stories of our residents and medical students.  A common theme is that they had witnessed a senior physician engaging in a practice that harmed a patient, followed by (at best) a lack of disclosure and (at worst) a lack of acknowledgment that such harm had actually occurred.  The young doctor's shock is exacerbated by the feeling of guilt that he or she had not intervened in the procedure to stop the harm from taking place.  Whether or not the resident had been required to participate directly in the actions being taken or was simply observing was not necessarily germane to the reaction.

There is a growing consensus among people that treat PTSD that any trauma, be it loss of family in a natural disaster, rape, exposure to the dead and mutilated in an industrial catastrophe, or combat itself, will have longer-lasting and more serious consequences if there has been no opportunity to talk about the traumatic event and those involved in it, or to experience the presence of socially connected others who will not let one go through it alone.