Screams and disconnections

I started reading the two bestsellers by Johann Hari (Chasing the Scream and Lost Connections, about the war on drugs and about the modern epidemic of depression, respectively) after hearing him on Sam Harris’s Waking Up podcast.  They’re powerful and well-written books, though reading them can be quite upsetting, as they both deal with issues that have profoundly affected my life.

As may be obvious to anyone who’s read this blog much, I’ve had a lifelong struggle with depression, which is often quite severe.  I say lifelong; it really began in my early teens, and I think in my case it may be more endogenous than reactive.  Thus, I might be a slight outlier in Hari’s thesis on the illness (but I haven’t finished the books yet, so I may be wrong in this).  Nevertheless, Hari’s point about missing connections and support is one that resonates with me.

I’ve never been great at making many or close friends or at opening up about my own emotions (though I say it as shouldn’t, you might think), and it’s gotten worse over time.  I’ve never been good at reaching out to people.  I often feel a powerful awkwardness even when people invite me to connect with them.  I never feel quite worthy of other people’s attention or caring, to be honest; I feel that I have no right to burden anyone with my concerns or even with my existence.

Therapy has been useful at times as a way around this block, but there’s a certain sense of shame involved in it:  it feels somehow humiliating to have to pay someone to let me talk about my thoughts and feelings.  It’s rather akin, in my mind, to the idea of paying someone to have sex with me.  I don’t think there’s anything morally wrong with it, but it ends up somehow making me feel even worse about myself in the long run (the former, that is; I’ve never done the latter).

I took antidepressants for relatively long stretches of time, rather like Hari himself, though not as much nor for as long as he.  I think I gained a slightly more consistent benefit from them than he did, but then again, as a doctor, maybe I was just better at initiating a placebo effect in myself.  I know more than a layperson about the proposed mode of action and the research that the manufacturers made available regarding the drugs’ function, as well as other research by less partisan investigators.

And, of course, I’ve been personally involved in the war on drugs.

I suffered a back injury leading to chronic back and leg pain (which continues to this day) starting in about early 2002, and for several years I took chronic opioid medications for it.  Surgery finally reduced my pain somewhat, and over a long period of time I was able to wean off the meds—I was never “addicted” though I was physically dependent for quite some time.

I used pain medications because without them the pain made me unable to function.  Even with them—and partly due to their side effects, I must be honest—I had to take time off from work for a while.  The pain and its complications also contributed strongly to the failure of my marriage…a loss of connection that certainly didn’t help my depression.

I’m not someone who does well with idleness, though, and when I heard of pain management clinics seeking doctors for part-time, locum tenens work, I thought it an excellent opportunity to try to help others like me.  These were people struggling to work and to live normal lives, despite injuries that would have probably killed our ancestors, but that the modern world allows us to survive. Though we do survive, we are not left unscathed, but are often condemned to pain that would also—albeit more slowly—have killed most of our ancestors, and for which we have a limited and blunt repertoire of available treatment options.  (My short story Prometheus and Chiron deals with some of these issues.)

I was a bit naïve.  I also largely eschewed “the news,” especially local news, so I knew but little about the pain clinic “problem” in Florida.  I had, however, experienced firsthand the discourtesy, unkindness, and open contempt with which even doctors were treated by pharmacists and insurers when trying to fill prescriptions for pain medication.  It was outrageous that so-called professionals treated suffering people so badly.  I wanted to help some of those who were going through such ordeals, trying to work and to feed and house themselves and their families, despite chronic pain.

I tried very hard only to treat people who really needed it; I certainly never worked in any “pill mill.”  At the peak of practice, the clinics in which I worked never saw any more patients than any traditional medical practice, and usually saw far fewer.  I’ve always tended to spend more time with my patients than my schedule strictly allows, so I would almost always run behind schedule.  Many patients explained—to my face, anyway—that they were fine with that, because they knew they would be given the same time and attention that were given to others.  I’m not ashamed of this, but it was often embarrassing.

Anyway, though I always at least unconsciously knew that a few of my patients were probably using their medications inappropriately—as is likely the case with most medical practices, at least with certain classes of medications, of which antibiotics come strongly to mind.  At least one patient admitted that she occasionally bought extra meds illegally when her prescription wasn’t enough, and alternately sold a few when she really needed extra cash.*  But, at both conscious and unconscious levels, I decided that I’d rather err on he side of making sure that people who were suffering got what they needed to be able to live their lives with as little pain as was manageable than to try paternalistically to protect adults from themselves by withholding adequate treatment from everyone.  If one knows that there is a real illness present, it seems better to me to overtreat slightly than slightly—let alone grossly—to undertreat.

Of course, the state (the US and Florida, in particular), as Hari well describes, sees things differently.  As part of a larger operation—politically motivated, as is much of the work of prosecutors, it seems—I was set up by undercover officers pretending to have pain problems (with MRIs and convincing symptom constellations), and I was charged with drug trafficking.  In Florida, one such count can be brought for every prescription written.  Thus, even though it became obvious to all who commented that I was at most an afterthought in this operation—the DEA was satisfied when I voluntarily relinquished their certification, without prejudice, and pursued no charges of their own—Florida was certainly not just going to let me go.

I’ve written about the evils of the plea bargain system before, and it was based on personal experience.  I maintain my innocence from start to finish.  I can honestly say that I never had any criminal intent, which is supposed to be a requirement for conviction for any type of serious crime.  I was inclined to go to trial and face a jury.  If I had any faith in jurors’ ability to recognize the truth—especially juries in Palm Beach County—or in the general workings of the legal system, I might have done so.  But my lawyers, who obviously knew the system better than I did, noted that if I were found guilty of even one count among the numerous ones that had been brought against me, I could spend fifteen years in prison.  And unfortunately, my difficulty with connection, to say nothing of the public panic about pain pills, would work against me.  So, when I was offered three years, I decided to take it.  I figured, after three years, my kids would still be kids, and I could still see them again before they were adults.

Thus, I lost my medical license, and everything I’d owned, as well as such reputation as I might have had.  I also, unfortunately, lost my children anyway, because by the time I got out, they didn’t want me in their lives; they were old enough for me to respect their wishes, though I could have legally enforced visitation.  My son wouldn’t even speak to me, and he still won’t; it’s hard for me to do more than guess why, since, obviously, I can’t speak to him about it.  My daughter stays in contact with me, but she asked me, gently and earnestly, not to enforce visitation, since it would disrupt their lives, and they were stable and safe with their mother.

This was heart wrenching, but honestly, I’m in no position for them to live with me, anyway.  There’s no place for them to stay.  Also, jail and prison have not been kind to me, physically and mentally.**  I’m embarrassed to be seen, or to have my life seen, by the people I used to know.  Obviously, this all hasn’t helped by depression much…though it does at least let you know that you’re able to stand a lot more than you might have thought you could.  I’ve always been terribly stubborn, anyway, so I wasn’t really surprised that I got along okay in prison and have survived since.

And now, at least, I’m making use of the change and writing my books, my short stories, and my blogs.  So, some benefit has come from this, though it remains to be seen whether my writings will ever truly benefit anyone but me.  Still, at least they’re out there, and more are coming.

You have been warned.

I’ll have more to say in future posts about the combined subjects of depression and the war on drugs, and the overall human problems of which they represent two faces—as described by Johann Hari, and from my own point of view as well…which may not perfectly coincide with his, though I suspect differences will be quite small.  But I’ve written enough for today, far more than I expected to write.

Thank you for reading.  I hope it’s been interesting.

*I strongly advised her against this as being both personally dangerous and quite illegal, with the potential to get her into a lot of trouble.  I wasn’t wrong.

**Now there’s a fuckin’ surprise, right?