Pain Killing

More women are dying from overdoses of narcotic pain medication than cervical cancer or homicide. They tend to be poor, older white women living in rural areas who are also taking medications for depression and anxiety.

Some of the reasons for this trend are as follows: Pain medications are readily available; women are prescribed pain medication at higher doses; women are diagnosed with depression and treated with medications at a higher rate. Women who are single mothers struggling financially are more likely to experience symptoms of depression and anxiety (duh!).

It’s somehow rational that an unhappy or depressed person would succumb to the quick, narcotic relief delivered in a pill. Why not take a respite from pain when it simply means swallowing a pill, even though taking this short cut can mean dealing with serious consequences such as full-blown addiction and even overdose. One symptom of depression is a shortened sense of time or the inability to consider the future at all; so the depressed person is not likely to consider the risks involved when self-medicating with an opiate.

This phenomenon illustrates the fact that substanceabuse and mental illness are two sides of the same coin. It also shows that personal choices and lack of proper planning can cause stresses later on. At the same time, government policies also create hardship that contribute to poor mental health. And, pharmaceutical industry is guilty of profiting from products that are often abused as a quick fix to escape the hardships.

It also shows us that managing symptoms with medication alone is inadequate because it only cushions our ability to handle anguish. A pill cannot change the facts of a life and its context. Experience of pain can be temporarily delayed but it cannot be erased. Soon or later one must begin the tough work to locate the source or the cause of emotional pain. And, if the source of pain is outside ourselves then we must adapt to it or work on changing the environment.

Molly Will Make You Pay

Disclaimer: I am not a medical professional nor a scientist. Following article may contain inaccuracies, and it is not my intention to disseminate medical information or advice. It is my personal take on drug use and its effect on mood and emotional health. Also, I am not endorsing or condoning recreational or pharmaceutical drug use.

In my work as a drug/mental health clinician at an outpatient mental health clinic, I was recently introduced to Molly. I wasn’t sure what it was and thought it was one of the newer synthetic drugs that are named to sound either like a candy or a cleaning agent. But The New York Times set me straight in a recent article. Molly is supposedly short for "molecule," convincing the user that it's pure MDMA (concocted in a laboratory by scientists!). And, it is a white powder, making it more difficult to adulterate than as a pill. Users are marketed to believe that it's purer and cleaner than Ecstasy, making it safer. And, because of its reported potential benefit as a tool for psychotherapy and treatment of PTSD, Molly can't possibly be harmful, and it may be actually beneficial! So goes the justification. 

The article quotes a drug user of notoriety who says cocaine is grimy and dirty (First World drug user's awareness of War on Drugs and narcotrafficking?) and marijuana is smelly and no longer fashionable. It's entered popular culture big time, and its touchy feely, feel good vibe makes it all the more attractive. It promotes a heighten state of sensuality (not just sexuality), and a simple loft dance party has the potential to become a spiritual happening among one's tribe. 

But is there ever a free ride for a neurotransmitter flood that makes you feel euphoric and at peace with yourself and strangers? Unless you are a disciplined meditator or a runner who experiences runner’s high, the short cuts, such as Molly, comes with a hefty price tag. The serotonin rush, Molly-induced euphoria, depletes the brain of serotonin and so for a few days afterwards, until the brain rebalances itself, you will experience depression and dysphoria.

For those of you who are susceptible to symptoms of depression or clinically depressed (now or in the past), post MDMA blues can mean suicidally dark moods, or it can trigger another major depressive episode. And continued use (abuse) of MDMA can permanently upset the balance of serotonin, which I interpret to mean that your ability to experience pleasure and happiness is permanently lowered, in addition to higher likelihood of memory and attention problems. However, it’s impossible to predict how someone will react, not just to one-time use but repeated use over time. This is especially worrisome with people with preexisting mental health issues.

I also want to caution that if you are taking one of the more popular antidepressants such as SSRIs (selective serotonin reuptake inhibitors: Prozac, Celexa, Zoloft, Lexapro, Paxil) or SNRIs (serotonin-norepinephrine reuptake inhibitors: Effexor, Pristiq, Cymbalta), you won’t feel Molly’s full effects since your brain is being treated to avoid serotonin flooding to maintain a steady supply. So it’s really just a waste of money and effort. But, more importantly, why mess with your brain while you are being treated for a mental illness?

And if you are taking something more serious like older antidepressants or antipsychotics (Nardil, Parnate, Abilify, Seroquel), please reconsider using Molly or any other street drugs. Combining serious prescription drugs with street drugs can be dangerous and it is never a good idea. If you are considering using, I hope you feel comfortable enough to bring it up to your psychiatrist or GP, whoever is doing the prescribing of your psychiatric medications.

Even though I try not to advise, one bit of advice I find myself repeating is, especially to clients with substance abuse issues, to consider the consequences of a decision before acting on it. It’s a simple act of reflection, checking in with yourself before acting on a desire mindlessly. Of course, it’s easier said than done, but with practice it does get easier. 

We are constantly offered short cuts and conveniences that promise quick jolts of pleasure instantly. Drugs such as Molly can deliver what it promises, but like making a major purchase on credit, you have to pay it back, with interest. 

Suicides in Spring

I found this article titled “Clues in the Cycle of Suicides” in the New York Times. It dispels a popular belief about suicides: it is during spring and early summer when suicides peak, not winter, which I thought would be the period with the highest number of suicides. Winter’s long stretches of darkness and cold, along with the holidays that tend to intensify loneliness and isolation contribute to increased symptoms of depression. In contrast, spring brings warmth and a promise of hope with another cycle of natural life.

To explain the connection between spring and suicides, article summarizes very interesting recent research concerning the relationship between inflammation and depression, and the decreased production of melatonin to the spike of symptoms of agitation and mania for those diagnosed with bipolar disorder and depression, raising the point that genetics (nature) contributes to development and symptoms of mental illness.

What I found most fascinating was the concept of the “broken promise” syndrome, which I interpret as the feeling of being let down because spring did not eliminate their despair. Maybe the bright cheeriness of spring made despair seem even darker – hopelessness worsened because spring’s promise of hope and renewal did not apply to them, unlike rest of the natural world. Not feeling better in spring became yet another indicator of their emotional and spiritual alienation.

When thinking about it this way, I realize I am only beginning to grasp the enormity of human despair and suffering and the interplay between nature and nurture. But rather than feeling overwhelmed by it I feel emboldened to meeting the challenge of helping people reconnect to themselves and to help them understand that nature does indifferently work against them. In my experience working with clients, understanding the genetics component can help ease the stigma that often comes with a diagnosis and help them take steps toward self-acceptance.

Fatherless on Father's Day

Fatherless on Father's Day. Some thoughts.

Holidays, even Hallmark holidays like Mother’s Day and Father’s Day, can be difficult for those of us with atypical childhoods. Rather than a celebration these "holidays" can, if not downright depressing, be a reminder that you are missing out on something, that you aren’t quite normal. This is how it feels. However, if you look at statistics, father-absent households in the US are quite common (one in three children). Still, if you have lost your father or never had a father to begin with statistics will not soothe how you feel.

Loss is part of everyone’s experience. At times, especially like today, Father’s Day, your loss can feel significant. You feel life has treated you unjustly. You may even feel resentment towards others who appear to have it all (like a loving, caring and strong father). 

The following are some points to reflect on to gain some perspective.

1. Be grateful for what you have. 

This may be difficult, if you’ve had a very difficult history with your father or with your family. There are many of us who have suffered sexual, emotional or physical abuse by our fathers, and the scars will forever haunt us. But the fact is you have survived it, and there is help to undo some of the damage. Remind yourself that you are not alone, and many of us have overcome our traumatic histories. Also, the miracle of being alive means accepting its unpredictability and our humanity – we are capable of great love, but we also have the potential to cause great pain to others, even our children. 

2. Acknowledge the feelings of loss, sadness, anger and pain.

Emotions, like energy, is in a state of entropy. This means unconsciously we are trying to achieve a state of equilibrium, a state of emotional balance. Physical pain is avoidable and something we can manage. But psychic or emotional pain – a defining feature of human experience and therefore unavoidable – must be felt and accepted. It cannot be stuffed away. This would upset the natural course of emotions. Unprocessed emotions will surface down the road, and often it will be more troublesome.

Practically, it means reaching out to someone on a difficult day (Father’s Day, anniversaries, etc.) and talking about how you feel. You will still feel blue afterwards, but you will find comfort. And if your history contains significant loss or trauma, psychotherapy or talk therapy is something you should seriously consider. Avoidance and denial can contain our pain only to a point. Pain needs to have light shined upon it so that it can’t fester in the darkness of memory.

3. Step back from yourself. 

If you are reading this chances are you live in the “developed” world. When we become absorbed in our pain and confuse it with physical pain, the primacy of our feelings can skew our perspective. The fact that you are reading this on a computer (whether it’s your own or shared) you are part of the fortunate minority. We have in common a standard of life and freedoms that most people in the globe can’t take for granted. We can bitch about our own lives, the politics of our imperfect countries, but the fact is our lives could be intensely more difficult. This does not mean your private sorrows, losses, and painful biographical facts are meaningless. But, it means recognizing that you are not alone in the world who is suffering. Emotional pain is one thing, but consider what it might be like to lack adequate shelter, access to health care and education, and food and water.

Practically, this might mean paying more attention to world affairs, for instance getting a more global perspective from news sources that are more international in scope, reading books on public health,  volunteering, and donating money to organizations. 

How Do You Know If You Have a Problem with Alcohol?

Check out the clip below on detecting alcoholism in yourself and/or others.