Author Archive for LenouryJo

Bruce Springsteen: Born with an Inner Restlessness

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Further excerpts from Bruce Springsteen’s Born to Run. Bruce looks like he had a dependence syndrome and perhaps even organic damage or dysfunction linked to an antidepressant – See Born to Withdraw. Did he also have akathisia?

Akathisia (restlessness, agitation & turmoil): A disorder characterized by an uncomfortable feeling of inner restlessness and inability to stay still; this is a side effect of some psychotropic drugs.

Akathisia on antidepressants may occur within hours of starting treatment or take weeks to appear. It can manifest as a physical discomfort or inability to remain still, but it can also be less obvious, presenting as anything from a constant and disturbing unease in the mind, through to an intense emotional turmoil.

See our main page on akathisia for more information.

And MISSD, who among other things drew our attention to the fact Bruce has a song called Restless Nights – although this doesn’t appear to be about akathisia.

Home front

Mild post tour depression can usually be expected. Sometime in June I noticed I wasn’t feeling all that well. The shows are an insane high. The adulation, the touring company, the fact that it’s all about you. When you come off the road, that stops on a dime and you’re a father and husband but now the kids are driving, so you’re an out of work chauffeur. The bump is natural but the crash that I experienced this time was something else altogether. It was hard to explain, bearing symptoms I’d never encountered before in my life.

I had an attack of what was called “agitated depression”. During this period, I was so profoundly uncomfortable in my own skin that I just wanted OUT. It feels dangerous and bring plenty of unwanted thoughts. I was uncomfortable doing anything. Standing …walking …sitting down…everything brought waves of an agitated anxiety that I’d spend every waking minute trying to dispel. Demise and foreboding were all that awaited and sleep was the only respite. During waking hours, I’d spend the day trying to find a position I would feel all right in for the next few minutes. I was not hyper. In fact, I was too depressed to concentrate on anything of substance.

I’d pace the room looking for the twelve square inches of carpet where I might find release. If I could get myself to work out, that might produce a short relief, but really all I wanted was the bed, the bed, the bed, the bed and unconsciousness. I spent good portions of the day with the covers up to my nose waiting for it to stop. Reading, even watching television, felt beyond my ability. All my favorite things – listening to music, watching some film noir – caused such unbearable anxiety in me because they were undoable. Once I was cut off from all my favorite things, the things that tell me who I am, I felt myself dangerously slipping away. I became a stranger in a borrowed and disagreeable body and mind.

This lasted for six weeks. All the while we were overseas. It affected me physically, sexually, emotionally, spiritually, you name it. It all went out the door. I was truly unsure if I could ever perform in this condition. The fire in me felt like it had gone out and I felt dark and hollow inside. Bad thoughts had a heyday. If I can’t work, how will I provide for my family? Will I be bedridden? Who the fuck am I? You feel the thinness of the veil of our identity and an accompanying panic that seems to be just around the corner.

I couldn’t live like this, not forever. For the first time, I felt I understood what drives people toward the abyss. The fact that I understood this, that I could feel this, emptied my heart out and left me in a cold fright. There was no life here, just an endless irritating existential angst embedded in my bones. It was demanding answers that I did not have.

And there was no respite. If I was awake, it was happening. So …I’d try to sleep; twelve, fourteen hours weren’t enough. I hated the gray light of morning. It would mean the day was coming. The day, when people would be waking up, going to work, eating, drinking, laughing, fucking. The day when you’re supposed to rise and shine, be filled with purpose, with life. I couldn’t get out of bed. Hell, I couldn’t even get a hard-on. It was like all my notorious energy, something that had been mine to command for most of my life, had been cruelly stolen away. I was a walking husk.

Patti coaxed me out of bed and tried to get me moving. She steadied me, gave me the confidence to feel I’d be all right and that this was something that was just passing. Without her strength and calm, I don’t know what I would have done.

One night in Ireland Patti and I went to dinner with a group of people. I was doing my best to fake that I was a sane citizen. Under these conditions that can be hard to do. I had to leave the table somewhat regularly to let my mind off its leash (or to keep it on). Finally, on the street, I phoned my pharmacologist. I explained to him things were condition red.

He asked, “Does anything make you feel better?”

“If I take a Klonopin,” I said.

“Take one,” he said.

I did and it stopped. Graciously, mercifully, thankfully, yes there is a God, it stopped. After a short period on Klonopin I was able to stop the medication and the agitation did not return. But it was a terrifying window into mental debilitation and I don’t think I could’ve done on like that indefinitely. All of this brought back the ghost of my father’s mental illness and my family’s history, and taunted me with the possibility that even after all I’d done, all I’d accomplished, I could fall to the same path. They only thing that kept me right side up during this was Patti. Her love, compassion and assurance that I’d be all right were, during many dark hours, all I had to go on.

Mentally, just when I thought I was in the part of my life where I’m supposed to be cruising, my sixties were a rough, rough ride. I came back to the States slightly changed and still wrestling with myself day by day. But things became a little more normal as time passed. I’ve long ago stopped struggling to get out of bed and I’ve got my work energy back. That feels good. Two years have passed and it can feel like it never really happened. I can’t specifically recall the state. The best I can do is think, “What the fuck was that? That’s not me.” But it’s in me, chemically, genetically, whatever you want to call it, and as I’ve said before, I’ve got to watch.

It’s not absolutely clear but this looks like treatment induced akathisia rather than agitated depression.

Doctors Writing Scary Scripts… Saving Grace

Saving Grace by Jane Green

By Joanna Le Noury

Saving Grace is the latest romantic novel by Jane Green. It tells the story of the perfect life of the beautiful, elegant Grace Chapman, married for 25 years to the very successful and respected author, Ted. Graces juggles stylish literary events, glamorous magazine galas, helps run Harmont House, a refuge for homeless women, and meets the demands of her egotistical husband.

When their long standing assistant leaves she hastily hires Beth, a young woman who quickly makes herself indispensable to them both.

Grace increasingly forgets things, loses her temper, experiences anxiety attacks and insomnia. Is she paranoid, is she going crazy, is she premenopausal?

The reader knows that the situation is being orchestrated by Beth, whose motive is to take over Grace’s life. Obviously Ted is oblivious to all this, and unable to see past the ‘svelte legs’ is susceptible to Beth’s ‘powers of suggestion’. He convinces Grace that she’s going crazy and needs to see a shrink.

The diagnosis (p160-163)

‘We have spent several sessions talking about what you have been going through, particularly the mood swings and the anger. We have also talked a lot about the lack of sleeping and the bursts of energy you get. You’ve talked about your mother and I know how difficult it has been for you to admit your fear of turning out to be like her.

The first thing I want to say is that today, bipolar disorder is entirely manageable. If your mother were alive now, the chances are she would be on medications that would make her very normal. Even though you clearly don’t have the illness to the extent of your mother, I am pretty clear that everything you’ve been going through is indicative that you are on the spectrum.’

‘I don’t thing that’s a correct diagnosis.’ Grace shakes her head….. ‘it’s being up all night, that’s what it is. It isn’t depression. I don’t feel depressed. And the being up all night isn’t mania, it’s just….a phase. It’s more likely to be perimenopausal than mania for God’s sake.’

‘Being up all night is very common. Mania usually isn’t what people think, nor depression. This illness, it can manifest itself in a myriad ways, sleeping being one of the most common. As for being up all night that is a typical example of hypomania, and what we call rapid cycling….’

‘I’m sorry.’ She says when he has finished explaining why he is so sure. ‘But I disagree with you. It just doesn’t resonate with me.’

‘Why would it?’ he said gently. ‘It doesn’t resonate with anyone. This, unfortunately is something we see in almost all patients who have bipolar disorder….. it can take people months to come to terms with something so huge, and most struggle with acceptance until they realize the difference medication can make in their lives.’

‘Medication,’ he pauses, ‘will give you back your life. It will give you back yourself.’

‘But…but.. are you sure? Are you absolutely sure?’

‘Grace.’ He smiles an indulgent smile. ‘I’ve been doing this a very long time and I’m very good at what I do. I’m not saying I’ve never been wrong, but in this instance there is no hesitation in my mind whatsoever. What I’d like to do it start you on a medication called Depakote.’

‘Grace, this is important. I don’t want you to go online and read about it. Don’t read up about the side effects, because there is so much false information online. I advise all my patients to come to me if they have side effects, and we can deal with them together.’

Grace, unfamiliar with doctors at every level, finds herself regressing back to a child, where doctors were akin to God, where when they told you they knew better than you, you believed them. Who is she, wife, mother, friend, who is she to tell the psychiatrist he might be wrong?

He does, after all, do this for a living.

If he says this is so, then what else can she do but let it be so?

What if he is right, and my resistance, my lack of willingness to believe in the diagnosis, is part of the disease? What if these pills do indeed turn out to be magic, and I am restored to my old self?’

The side effects (p.167-180)

Never in her life had Grace slept as much as she has been sleeping.. since starting the bipolar medication…. I feel as if I’ve been drugged she kept thinking, remembering the irony that she has been. Frank [the doctor] has assured her this …. is temporary…

The thought if getting out of bed, getting dressed … is too exhausting to even contemplate.

All she can think about is junk food. The very foods she has spent her life avoiding. She is filled with blind cravings that are all-consuming, that are all she can think about.

He prescribed more pills to try to help – something to try and reduce the tiredness…and Metformin…something to do with blood sugar. It isn’t used as a diet pill exactly…but it would stop her cravings.

I must have put on three stones, she thinks…. She hoped the Metformin would make a difference to her appetite… but so far there has been no difference at all. Frank had mentioned another pill, Topamax, which Grace wanted to try immediately, desperate for anything to stop this ravenous hunger.

‘I’m putting you on Lexapro as well,’ he says. ‘And we’ll see how that goes. You have to give these medications a chance to work.’

‘How long?’ Grace pleaded.

‘Let’s try it for a month.’

He cannot hear the wail of anguish inside her body and chooses to ignore the look of horror in her eyes.

‘Grace,’ he has said more than once, his voice gentle. ‘I want you to focus on the good that the Depakote is doing. Look at how calm you’ve been. Look at how stable your moods have been. You’ve been sleeping all night. And all in all you’re in a much better place. I want you to acknowledge that, Grace. It’s very easy for you to slip into binary thinking for you to focus only on the bad but its really important for you to see the good its doing.’

‘But I’m not sleeping at night,’ Grace said. ‘I’m sleeping all the time. I can’t get out of bed.’

‘What I’ve just given you should change that. And if it doesn’t, we’ll give something else a try.’

Grace and Sybil

‘Literally all the time I am hollow with hunger.’ …’ Nothing fits. Honestly, if I wasn’t depressed before, I’m definitely bloody depressed now.

‘You’re just not yourself… I have this really weird sense that you’re completely disconnected from everything…. If the bipolar disorder thing is correct, then these pills surely aren’t the right pills, no? Isn’t any medication of this kind meant to bring you back to yourself? Make you more of yourself? Its not supposed to eradicate you.’

‘I keep telling Frank my doctor, that I feel awful, but he says this is what it’s like to be calm, this is normal. He says I’m so used to being in a state of hypomania, that what other people consider normal feels flat to me.’

The white coats (p.196-199)

Beth gets Grace kicked off the Board at Harmont House. Grace then finds Beth in a ‘clinch’ with her husband, and losing her temper slaps her. She gets carted off to the local psych hospital for assessment. With Ted and Beth keeping quiet about their encounter, Grace is left trying to prove that she hasn’t had a delusional breakdown.

Jack Nicholson in One Flew Over the Cuckoo’s Nest flashed into her mind. But that wouldn’t happen to her. Dr Ellery knows her. He knows that while she may be many things, a fantasist she is not.

‘Frank!’ She blinks back the tears as she stands. ‘Thank God you’re here! They wouldn’t let me talk to anyone, wouldn’t let me explain anything..’

‘That’s all right, Grace’ Frank says, in a tone similar to the one he uses when talking to very small children. ‘Why don’t we go somewhere and talk, and you can tell me all about it.’

Grace takes a deep breath and explains to Frank what happened tonight. That she caught Ted and Beth…. she had… lost control, shocked at herself for having lashed out…. Mindful of keeping her voice calm, knowing her only chance… was to make herself credible.

‘Frank I know it sounds absurd, but there is no reason for me to make this up. You do believe me, Frank?’

Another silence. ‘I believe that you believe it to be true,’ he says softly….. no one’s talking about having you committed. I do think, however, that a stay here for a few days would be valuable. It will help stabilize you and get you to a better place…. a few days here is a very good idea. We can always re-evaluate when things are a little calmer.’

Grace stares at him, Jack Nicholson back in her mind. Oh shit, she thinks. It can happen to someone like me.

Doctors write scripts…

Saving Grace is a cautionary tale about the dangers of allowing a stranger into your life. How easy it can be to relinquish power and control in fifty different ways.

How, when faced with an encounter with a doctor at a time when you are feeling vulnerable, it is easy to be reduced to feeling like a small child, whoever you are. Easy to be convinced that what you are hearing is the truth despite your gut instincts telling you otherwise.

Green is a hugely successful author. In real life this happened her. Hear her being interviewed here on Woman’s Hour explaining just how easy it is for an intelligent person to let a doctor put her on multiple meds despite her friends screaming from the sidelines.

This is exactly the RxISK message. Its easier to see sharks from the shore. It’s agonizing to see someone we love being dragged into a horror story scripted by some doctor? A RxISK report is the clearest way to find out if the doctor is a shark or not – no one should go swimming without one.