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No sooner had I posted yesterday about the case of Lindsay Clancy than I chanced upon a new David Brooks op-ed about a friend of his who had committed suicide.
Brooks’ friend, Dr. Peter Marx, was not suffering from postpartum depression. And yet, being a physician he had access to the best medical treatment.
It all failed.
Brooks explained:
The years went by and medications and treatment programs continued to fail. Pete and Jen began to realize how little the medical community knows about what will work. They also began to realize that mental health care is shockingly siloed. Pete saw outstanding doctors who devoted themselves to him, but they work only within their specific treatment silo. When one treatment didn’t work, Pete would get shuttled off to some other silo to begin again.
And also, consider that Marks, like Lindsay Clancy, was put on a large number of different medications:
He thought part of his illness was just straight biology. Think of it like brain cancer, he’d say. A random physical disease. I agree with some of that, but I’m also haunted by the large number of medications doctors put him on. He always seemed to be getting on one or getting off another as he ran through various treatment regimens. His path through the mental health care system was filled with a scattershot array of treatments and crushing disappointments.
Of course, diagnosis is tricky, especially when you have no contact with the person in question. Had it been about biology, you would have to assume that the doctors would have figured out a way to treat it.
Surely, the situation indicts psychiatry-- but that assumes that the problem is mental, not physiological:
It’s ridiculous that we still know so little about the illness and how to treat it. I find it unfathomable that it’s been well over a century since Sigmund Freud started writing about psychology. We’ve had generations of scholars and scientists working in this field, and yet suicide rates in 2020 were 30 percent higher than they were in 2000 and one in five American adults experience mental illness each year. We need much more research funding to figure this out.
The puzzling part is that Dr. Marks had everything going for him. One would be hard-put to suggest that he was in despair because he had failed. And we do not know whether or not childhood trauma had come back to haunt him. Then again, we do not know the whole story.
He seemed, outwardly, like the person in my circle least likely to be afflicted by a devastating depression, with a cheerful disposition, a happy marriage, a rewarding career and two truly wonderful sons, Owen and James. But he was carrying more childhood trauma than I knew, and depression eventually overwhelmed him.
What can a friend do about this? Brooks tried to help his friend, eventually to discover that acting normal is a better course. You do not want to be the person who is constantly reminding someone that he is ill:
In the beginning, I made the mistake of trying to advise him about how he could lift his depression. He had earlier gone to Vietnam to perform eye surgeries for those who were too poor to afford them. I told him he should do that again, since he found it so tremendously rewarding. I did not realize it was energy and desire that he lacked, not ideas about things to do. It’s only later that I read that when you give a depressed person advice on how to get better, there’s a good chance all you are doing is telling the person that you just don’t get it.
And,
I learned, very gradually, that a friend’s job in these circumstances is not to cheer the person up. It’s to acknowledge the reality of the situation; it’s to hear, respect and love the person; it’s to show that you haven’t given up on him or her, that you haven’t walked away.
Then again, Peter Marks was trying to analyze the anguish. So says Brooks and obviously it did not work. Perhaps the truth of the matter is that one should not analyze the anguish:
There was the one enveloped in pain and the other one who was observing himself and could not understand what was happening. That second self was the Pete I spoke to for those three years. He was analyzing the anguish. He was trying to figure it out. He was going to the best doctors. They were trying one approach after another. The cloud would not lift.
Brooks eventually decided to remain normal:
After a while, I just tried to be normal. I just tried to be the easygoing friend who I always had been to him and he had been to me. I hoped this would slightly ease his sense of isolation. Intellectually, Pete knew that his wife and boys lavishly loved him, that his friends loved him, but he still felt locked inside the lacerating self-obsession that was part of the illness.
4 comments:
You could have ended your headline a bit sooner, as in, "Psychiatry failed." I know of no other branch of medicine that is so abjectly lacking in successful outcomes, except perhaps for that branch known as "palliative care." I do not fault the practitioners of that dismal specialty; I'm sure they are well intentioned. However, the entire theory of psychiatric care is based on a physical model of illness, whereas it is my suspicion that much of what passes for "psychiatric" illness has its wellspring in matters spiritual. Certainly, not every case of demons possession we read about in Scripture was necessarily that, but I believe that the malign forces that dwell in the spiritual realm are responsible for a lot more "mental illness" than we oh-so-rational moderns would admit. I do find it more than coincidental that we have been witness to a decrease in Christianity (or to an extent, organized religion in general) accompanied by a rise in the use of mind-altering drugs and increasing acceptance of and participation in deviant lifestyles keeping pace with a rise in mental illness and suicide. When a society decides that there is nothing transcendent to look forward to, the ultimate existential futility of life begins to weigh more and more heavily, until it becomes unbearable. All the while the demonic entities that surround their victims whisper false promises of relief by means of ending life by one's own hand. Those demons howl with glee when the suicide realizes, too late, that an eternity of utter suffering and horror is his fate.
It's a case of Humpty Dumpty; no body can really fix it.
But, I do know what will work for awhile and that is love. Take your typical bi-polar or schizophrenic and they fall in love and it's mutual and they will do OK. Until the love ends but that could be years. Another temporary fix is a genuine crisis. It could be a man or woman working hard during the great depression to just keep the family fed and housed. It works, usually. The hard work, stress and the immediacy diverts the energy and attention to deal with the bigger problem. I don't know if there is a clue in these two things that would lead to some cure or if those conditions simply cannot be contrived. But, there it is.
I’m curious, Stuart, as to what you think is the cause and what you think might be the cure.
Let’s see, the father of psychoanalysis was an atheist, so am wondering what kind of comfort and healing an atheist ideology can provide for patients? If the purpose of life is simply to perpetuate itself, and outside of that is meaningless, what fills the hole in the soul that can lead to suicidal despair? I guess modern day psychologists do concede that belief in the supernatural can be a useful crutch and that such make believe is harmless. But for those who lack a basic enjoyment of existence and cannot “live vigorously in the face of uncertainty,” as Bertrand Russell would put it, that spiritual hole needs to be filled with hope, and that hope stems from the Divine.
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