“I too, feel depressed,” I texted my mother from an island rock perched in crystalline Lake Tahoe.

My mother’s passing feeling of depression was referring to two suitcases in the back of a storage closet. They hadn’t been used in twenty-three years, relics from the trip she and I were on when my father died. My feeling of depression wasn’t so much wrapped up in luggage, although the reminder didn’t help. Instead, it was—is—caught in the tendrils of a long, ongoing list of personal and professional misfires capped off with a full ACL tear. (I am in surgery as we speak. Or as you read, rather.)

Although nothing about my career, relationships, or general life satisfaction is thriving, most of my inner torture is attached to the actions of someone else. Without getting into specifics, I am waiting on a response to an inquiry that could change my entire life. I have formally been waiting since March, but really, I’ve been waiting for a year and a half. What began as a zygote of an idea grew into curiosity and was then fed with just enough fodder and uncertainty to create a perfect storm of compulsion, passion, and confusion. The torture is less about what answer comes from the inquiry and more about the insanity over why this is happening in the first place. Is it destiny? Life purpose? Misguided desperation? I fixate on concrete interactions that brought me here and then fight the delusion that comes from dreaming so big in the first place. I search Twitter and Google News for updates and extrapolate data from folks who have no idea they’re supplying breadcrumbs to someone desperate for a nourishing meal. The whole thing has pulled a melancholic veil over my world, something that even a Wednesday lounge by the blue waters of Tahoe couldn’t lift.

I came home from the lake and turned to my coping mechanism—oil painting—until it got dark. Mid brushstroke, egged on by the minor chords of Shane Smith and the Saints’ “Little Bird,” I failed to fight back tears of exhaustion, longing, and frustration. While chewing on a (bad) idea I thought might take the edge off the ache, I remembered an old journal scribbled with something relevant to the bad idea and, upon cleaning my brushes, went looking for whatever I’d written down.

In big letters, I’d written a word I’d never heard of and had never bothered to look up: limerence.

A quick Google took me to The Attachment Project’s definition of limerence:

The experience of having an uncontrollable desire for someone – an obsession that consumes the limerent person’s thoughts, feelings, and behaviors. It usually involves two people: the person who desires the other (the limerent) and the desired person (the limerence object or LO).

Essentially, limerance is a state of being stuck between uncertainty and hope: will they or won’t they return the sentiment? For instance, perhaps this person hasn’t rejected them entirely, but they haven’t confessed their love either. 

This state of irresolution causes the limerent to become preoccupied with the LO, closely analyzing their behavior and body language to look for signs of reciprocation. They may also ruminate about past encounters with the LO and fantasize about what might happen between them in the future. The key feature of limerence is that these thoughts and yearnings are uncontrollable and all-consuming. 

As I went down a limerence rabbit hole, I wondered how I’d gone 38 years without learning this word. Limerence is usually associated with romantic love, but it doesn’t have to be. Friendship, family, mentor/mentee—any relationship involving two people can go wayward with limerence. For me, it explained everything.

Instantly, I felt better. I even looked dog and said, “Holy shit, that’s it!” How good it felt to be seen, to have the irrationality explained, to read accounts of other folks on r/limerence whose crazy was just as bad (and worse) than my own.

The epiphany gave me odd permission to do all the things I knew I needed to do but couldn’t quit. I unsubscribed from news platforms that might carry a snippet of information, unfollowed a few players in the space, and muted decision-makers. I will get an answer this year. Everyone involved has each other’s phone numbers. That was true before and is still true now. The difference is that in putting a name to the crazy, I am now able to shift into waiting without being consumed by thoughts.

It didn’t take long for me to draw a parallel between my elation over having a name for my distress and the (sometimes literal) party people throw for themselves when, after years of suffering, they get a formal mental disorder diagnosis. Twitter is full of tweets (and arguments) over adults to celebrate the ADHD, AuADHD (Autism/ADHD), or bipolar diagnosis they receive in midlife. People become so enmeshed with their diagnosis that it ends up in their bio, right next to their other primary descriptors: proud mom of 3, chemist, AuADHD.

I am, admittedly, quite judgemental over this kind of behavior. I can’t pinpoint exactly what bothers me, but it lies somewhere in the space of over-medicalization + over identification + taking resources away from folks who actually need it. Marcia, the offbeat, fiftysomething part-time jewelry maker may feel quirky and “off” in the world, but if she lives independently, pays her bills on time, and contributes to society, is she really “disordered”?

Hell, my sensory issues, mood swings, and general frustration with people land me on the spectrum of high-functioning autism. More than one person has asked me if I’m neurodivergent, which pisses me off. Again, I can’t pinpoint exactly why. Perhaps it’s because the suggestion itself indicates that someone wants to force me into a box, which, if you know me even a little bit, is the quickest way to make sure we never speak again. My gut reaction to the question is even less attractive. It’s something along the lines of: Who gives a shit? Stop searching for trendy explanations and go create something with your life.

And yet, learning the meaning limerence was like someone taking off mental handcuffs.

I am well aware of my bias. After seven years in the antidepressant withdrawal and overmedicalization space, the three words most likely trigger an eye roll are stigma, treatment, and validation. Drug makers are advocacy groups biggest donors, which puts a damper on “awareness” and “anti-stigma” campaigns. May may be “Mental Health Awareness Month” but if it were honest, it would be called “Psych Drug Advertisement Month.”

Treatment is a sneaky little way of using common languange to medicalizing a psycho/social/emotional issues. Just like Eli-Lilly’s clever 2023 tagline rebrand from “Powered by Purpose” to “A Medicine Company,” it’s about treating the patient, or ensuring access to treatment. What sort of monster wouldn’t want someone suffering to get the treatment they deserve? “Treatment” is medical care for an injury or illness, synonomous with drugs and diagnosis. It is not healing, building resilience, facing issues, making difficult decisions, or daring to accept that sometimes you are the problem.

And then there’s validation, both a powerful force for positive change and destruction. Validation when it comes to sorting out an issue and being understood by another human? Good. Validation from external sources and the constant need to have feelings recognized? Not so good.

The difference, I think, is what happens after validation is received. Productive validation identifies an issue and, through the act of recognition, diffuses its intensity. I recognized myself in the definition of limerence and used the tools provided to quiet the symptoms. Unproductive validation is righteous and only intensifies the feedback loop. Had I seen the definition of limerence, felt seen but not taken action, all I’d be doing is shifting the blame. A lightbulb that illuminates the whole picture versus a spotlight that blinds everything outside a defined edge.

Or, as Oxford researcher Lucy Foulkes recenty said in her New York Times opinion piece, “High-Functioning Anxiety isn’t a Medical Diagnosis. It’s a hashtag” :

All this awareness oversimplifies and maybe even popularizes mental disorder…and over interpretation can become a self-fulfilling prophecy…if everyone is ill, no one is.

Ever since MAY CAUSE SIDE EFFECTS was published in 2022, I’ve done as much press as I can without bankrupting my savings account or my soul. Podcasts are my favorite outlet, and after years of refusing, I finally caved and got on TikTok with the intent of reaching a withdrawal-specific audience. 

A few weeks ago, I shared a clip from my episode of Relatable with Allie Beth Stuckey, a massive podcast with loyal listeners. On both Instagram and TikTok, the post blew up, launching me into the weird world of internet virality. In many ways, I’ve been training for this since I started speaking publicly on antidepressant withdrawal in 2018. I’ve honed my message, backed up my personal story with research, and learned how to talk about it without treading into the litigious world of formal medical advice.

Still, nothing quite prepares you for the onslaught of notifications when a post goes viral. Instagram has a short half-life. Viral posts die within a week or so. TikTok is different. The algorithm keeps feeding it back into the funnel, like riding the same ride at the carnival over and over again. Combined, the clip has over half a million views with around two thousand comments. 

What I am most surprised by is the lack of pushback compared to the volume of psychiatric horror stories. Typically, anti-antidepressant content generates a decent amount of criticism. Whether it’s my work or someone else’s, you see a lot of, “Antidepressants save lives!” and “Stop shaming people for seeking the treatment they need.” Point out the FDA-supported data suggesting that antidepressants actually take lives in people under 24 and have no effect on suicidality for those 24-65, and I’m usually met by a reductionist, personal anecdote that culminates in, “What you’re doing is DANGEROUS.”

Sometimes people get cranky because I’m not a doctor or researcher, to which they say, “and what are ur credentials?” Unbeknownst to them, this is the one line that makes me doubt what I’m doing, so much so that after some rando made this comment I started researching online masters programs to see if I could get a quickie degree. I’m not bothered because I don’t have letters after my name. I’m bothered because I don’t know what I don’t know. I wonder if my bias is causing me to miss something that could hurt someone. Somehow, my lizard brain thinks having an advanced degree would protect me from that bias, which is ironic because the whole problem with the current standard of care in mental health is that clinicians are blind to the pharma/diagnostic bias programmed into them during their advanced degrees. 

Credentials buy you an expensive certificate that says, “I’m good at memorizing the stuff required to pass a test.” The art of medicine or therapy—and the critical thinking required to question why people aren’t getting better despite more intervention—only comes with time and practice. And after 10+ years of by-the-book education, very few practitioners have the self-awareness or balls to say, “I don’t know what I don’t know. I wonder if my bias is causing me to miss something that could hurt someone?” 

Thus, millions of people around the world are being hurt by people with letters after their names, yet somehow I’m the problem. 

When these comments get to me, I try to remember that being an MD doesn’t shield you from bullshit. Dr. Will Cole, a major player in the functional medicine space, recently shared a post on Instagram about the evidenced-based placebo effect with antidepressants. It garnered so many negative comments that the post is now deleted. Will told me in a podcast we did together that the response made him not want to talk about the topic at all. 

For my posts that went viral, the ratio of positive/like minded comments to nasty ones is about 100:1. Whether it’s sample bias from the algorithm or people finally feeling safe to air their grievances about shit doctors and bad drugs, I don’t know. But in the comments of one video, there are over 1600 horror stories just about Effexor. If this were in a specialty that uses lab tests to determine disease, that would be a class action lawsuit. It’s not a class action lawsuit in psychiatry because there aren’t any empirical tests to measure mental and emotional symptoms. A group of people claiming Effexor-induced suicidality cannot prove that Effexor was at fault, and all the pharmaceutical lawyers have to do is point to the patients’ clinical history and blame their suicidality on the depression diagnosis the patient inevitably received. Clever, innit?

The deluge of comments does inspire me to keep chugging along, though. Many folks talk about how they thought they were alone until they stumbled upon my post. This work can feel meaningless because it feels like the needle isn’t moving, and I often wonder if I’m wasting my time. I needed this boost as much as the folks in the comments did. 

So, if you’re new to my substack from one of these podcasts, thank you for being here. I’ll keep doing the work if you do. 

The title, basically, which is why this issue is a day late.

Last week, I tore my ACL after taking a bad landing during practice for a gymnastics meet I was supposed to compete in this week. Everyone who hears about it wants to tilt their head and make some comment about getting older, which pisses me off because this injury was the result of gravity and physics, not age. The only time I’ve been feeling my age is when I look around at the world and simultaneously think, my god, I’ve been around long enough to see the bullshit double back on itself and come back again and also I’ve still got a lot more of this left to go.

In theory, anyway.

I can’t say I’ve been thriving over the past eight months, and this injury and its long road to recovery isn’t exactly righting me on the road to flourishing. I’m not looking to beleaguer you for pity or words of encouragement. They’ll roll right off me and I don’t want to hear it. I only bring it up to convey the state of mind I’m in, which is probably why I’m purposely picking a public fight with Harvard psychiatrist Roy Perlis, who with all his Ivy League wisdom, truly thinks it’s a good idea to make antidepressants available over the counter.

On April 8, Stat News posted an opinion piece by Perlis titled, “The time has come for over-the-counter antidepressants,” wherein Perlis argues that antidepressants should be available without a prescription, just like ibuprofen or laxatives. (Don’t bother rewarding Stat with views by clicking the link. I’m going to break it down below.)

As sure as I am about the overall harm caused by casual, mass psychiatric drugging of the human psyche, I still leave the door open for counterarguments. I consider it part of my duty to stick to my guns only if they’re loaded, which means forcing myself to get out of the echo chamber and hear opposing opinions. So I read the piece, expecting a Harvard professor to at least make a well-substantiated argument, even if I didn’t agree with it.

Instead, it’s 900 words of one of the dumbest, most poorly cited pieces of “journalism” I have ever read in the mental health space. And that’s saying a lot, given the drivel that comes from pop-wellness websites.

Let’s take a look, paragraph by paragraph. Perlis begins:

Anyone can now walk into a pharmacy in the United States and buy oral contraceptives over the counter without a prescription, thanks to the FDA’s approval of norgestrel (Opill). This change reflects the drug’s safety and the public health imperative to ensure wider access to birth control. But another safe class of medicine that addresses a massive public health need remains unavailable except by prescription: the antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

Let’s start with the immediate oddity. Why in the world is Perlis comparing an SSRI to hormonal birth control? What do these things have in common other than being a political football? If he’d instead compared an SSRI to over-the-counter supplements that act on the serotonin system, like St. Johns Wort or tryptophan, then maybe we have the basis for a relevant argument. Instead, he chooses birth control (in all likelihood to signal that he is not one of the Bad Men who took women’s rights away) and throws the word “safe” in front of both of them, as if there is any 100% safe medication. All interventions carry risk, and half the point of a doctor is to assess whether the risk of treatment outweighs the risk of the illness. Perlis sort of addresses this later in the article, but even by using the word “safe” in such a casual way, he is grossly generalizing while also patronizing readers.

These medications, which have been used in the U.S. for three decades, have repeatedly been shown to be safe and effective for treating major depression and anxiety disorders.

There’s that word again, right above the fold. Note how there is zero reference to support this. We are supposed to take his word because of the letters after his name. When someone else on Twitter pushed back against the safety claim with a study questioning antidepressant safety, Perlis chastised the user for “spreading misinformation” and then linked a meta-analysis he co-wrote along with a dozen others as evidence for antidepressant safety. I looked that paper over and noticed that at least half of the authors had declared conflict of interest statements. I responded to the tweet, asking Perlis why he would use a paper with so much declared conflict of interest to support a pro-pharma argument. Perlis blocked me along with the original user who called him out, and his response with the problematic paper is now deleted.

Perlis goes on to list the usual mental health woes including increasing rates of depression, long wait times for mental health services, and oddly, telehealth services whose quality of care is “difficult to measure.” He does not elaborate on how removing any clinical professional from the equation would improve measurement, but that’s par for the course for this dialogue, so I’m going to blow past it and focus on more egregious issues.

In reality, many OTC products treat symptoms or rely on consumers to diagnose themselves — think yeast infections, acid reflux, or respiratory infections. In the case of major depression or generalized anxiety, screening surveys have been developed for primary care that could help people determine their likely diagnosis with at least the degree of confidence of many OTC applications.

Ah yes, the screening survey. In no other area of medicine does a doctor make full diagnoses and prescribe solely based on a patient’s answers to a handful of leading questions. It’s working so well, too! People are thriving after being asked if, in the past two weeks, they’ve felt hopeless. Please circle “a little, sometimes, a lot of the time, or all the time.” And after you do that, we’ll give you a drug for the despair we can’t measure and convince you it’s your brain chemicals, stupid.

What about use or misuse? Depression is associated with increased risk for suicide, and medication overdose is among the most common methods of suicide. But walk through the aisles at your local pharmacy and pick any given medicine off the shelf: the odds are good it is more dangerous in overdose than an SSRI. Fatal overdoses are far more likely to involve drugs other than antidepressants.

Here’s where he really starts to lose me. Perlis uses overdose to defend his reasoning for the safety of SSRIs, claiming that it is more likely to overdose on other OTC drugs rather than SSRIs. This is bizarre because a Harvard psychiatrist should know that most people commit suicide by firearms or hanging and that even amongst poisonings or overdoses, people aren’t using their bottle of Zoloft to do it.

I’m unclear if Perlis was trying to make the argument that antidepressants are less fatally toxic at high levels than other OTC drugs, or if he’s trying to create a red herring that distracts people from the fact that suicidality and suicidal thoughts can be induced by antidepressants. I initially thought it was a poorly constructed argument for the former, but the next paragraph muddles it.

Among people age 25 and older, there is clear evidence that taking antidepressants does not increase the risk for suicide — in fact, the risk of suicidal thoughts or acts is reduced in this group, particularly among those 65 and older. For those younger than 25, the risk for suicidal behaviors or thoughts in clinical trials was modestly greater than that of placebo. So buying SSRIs over the counter could be restricted to people 25 and older, at least at first, just as some states restrict OTC pseudoephedrine (Sudafed) purchases to people age 18 or older.

Perlis is pulling data from a review by the FDA that examined the effects of black box warnings on antidepressants. Thanks to this study and others, it is well known that antidepressants increase suicidality significantly in younger populations. (A recent study used to approve the use of Lexapro for 7 to 12-year-olds documented a 6x increase in suicidality among kids who were put on the drug…and yet it was still approved by the FDA. See Dr. Roger McFillin’s take on that absurdity, here.)

It is incomprehensible to me that a psychiatrist in good standing would not only suggest a drug with a black box warning should be available over the counter, but that we can mitigate that risk by simply ID’ing whoever is buying it, as if the drug couldn’t then just be given to those under 25 as soon as the buyer walks out the door.

If Perlis ever grants me the interview I asked of him on Twitter**, my first question would be this: If some fifteen-year-old hangs themselves two weeks after starting OTC sertraline bought for them by their parents, who is responsible? The kid? The parents? Or the teller ID’ing folks at CVS?

Another objection to over-the-counter SSRIs is that not everyone believes in pills for depression. Some still question the biological basis of this disorder, despite the identification of more than 100 genes that increase depression risk and neuroimaging studies showing differences in the brains of people with depression.

Perlis goes on to draw an odd line between people not “believing” in the biological basis for depression and a study that looks at neuroimaging biomarkers as well as a Scottish study that concluded that people who “carried over 100 [changes to their DNA] were much more likely to develop the disorder in future.”

First off, the neuroimaging study he linked was connected to identifying the individuals who are most likely to benefit from targeted neurostimulation therapies, NOT antidepressants, which makes that reference null. Second, even if we did have the ability to easily test for these 100 or so mystery genes that cause depression (according to one study), does Perlis expect every person who walks into a CVS to have completed a full neuroimaging evaluation or DNA test before purchasing their sertraline with their toilet paper? If not, then how can you argue that this would be a broadly effective strategy?

To be sure, there are alternatives to pills. Certain talk therapies, like cognitive behavioral therapy, can be as effective as antidepressants, and some people prefer talking with a therapist to taking a medicine. But not everyone: weekly visits for eight to 12 sessions or more can entail substantial time and money. Here too, access to psychotherapists is a massive problem, particularly for individuals who seek to use insurance, or have none.

What this is saying is that Perlis is perfectly okay mass drugging lower-income folks under the guise of do-gooder benevolence. Please refer to the rise of Nazis for historical precedence on how that works out.

No treatment works for everyone, but around one in three people with depression get well with an initial antidepressant medication. Allowing over-the-counter access is not a panacea, but could open the door to a safe, effective, and inexpensive treatment for many who need it.

Perlis uses the STAR*D trial to report that one in three people who take antidepressants get well. Putting aside the recent calls to retract the STAR*D trial results due to significant violations of the originally submitted research protocol, Perlis’ own argument still suggests that the majority of people do not improve on antidepressants. Yet his strategy would expose 2 out of 3 people to iatrogenic risks and side effects of these “safe” drugs including but limited to suicidality, violent aggression, irreversible sexual dysfunction, mania, and damage to fetal development.

What’s needed to make this happen? An SSRI manufacturer with the courage to engage with the FDA and invest the necessary resources for a prescription-to-OTC switch, a well-trod path that has previously included medicines for allergies, acid reflux, and emergency contraception, among others. This process would primarily involve studies to prove that consumers can understand and follow the medication label, not new clinical trials, because more than three decades of evidence shows that SSRI antidepressants are safe and effective.

Perlis closes with a call to action from pharmaceutical companies, convenient because it absolves him of any downstream responsibility. He also continues to push the thread that depression is just as simple as contraception or acid reflux, even though those ailments occur due to a single, easy-to-explain mechanism. The same cannot be said of depression. Even in a world where biology was the sole explanation, it involves various processes (and apparently, over 100 genes) which means no single antidepressant would be suitable for all.

**Since Monday, this article is making its way around Twitter and I’m now not the only one picking a fight with him. However, in an odd twist, Perlis agreed to an interview with me. We’ll see if that materializes.

Inevitably, when you write a book about a growing global concern like antidepressant withdrawal, people reach out with questions. And even though I’ve received hundreds of inquiries in the year and a half since MAY CAUSE SIDE EFFECTS came out, I haven’t bothered to create an FAQ. As much as general themes repeat, people’s stories are unique, and canned answers rarely come in handy.

Instead, I try to answer each person individually and at the very least, ensure that they feel heard for a moment. In most cases—80%—this is all that’s needed. When people have been gaslit by doctors or have spent the majority of their lives under the influence of powerful psychiatric drugs, sometimes the difference maker is nothing more than someone validating their experience. That little bit of encouragement is enough to keep them on course and usually, I never hear from them again.

The remaining 20%, like all 80/20 relationships, take up most of my correspondence time. Typically these are the more complicated cases, usually from folks whose friends likely describe them as “a little neurotic.” These are the overachievers, the philosophers, the Type-As control freaks who did not schedule antidepressant withdrawal into their five-year plan.

This phenotype wants to do everything in their power to make withdrawal go away as fast as possible and can be found furiously googling and going down unhelpful rabbit holes on withdrawal forums. They also usually have money—depression is a privilege as it turns out—and are willing to spend it if they only knew what tests to get.

Of course, their doctor doesn’t have a clue, so when a basic blood panel comes out clean, the prescriber dismisses the idea of running more tests. The patient, though, knows something is amiss. Inn googling, these people find me and fill my DMs, which leads me the meandering point of this issue: every medical test I’ve been through to heal myself after fifteen years of antidepressants.

I took my last antidepressant in 2016, considered myself fully through antidepressant withdrawal in 2018, and spent the better part of 2021 – 2023 healing my body from the ordeal. I spent 2019 and 2020 tinkering with my diet in hopes of figuring out what was causing my gut issues and general I-feel-like-shit issues. I cut gluten or dairy or coffee. I ate less protein. I ate more protein. I juiced celery and drank fennel tea. I went to gastroenterologists who looked at me over a clipboard and said, “We can schedule a colonoscopy?”

Finally, in 2021, I called Andy Galpin, PhD., an old friend who, along with nutrition savant Dan Garner, was working with professional athletes to heal their lingering issues and improve their physical performance. Dan & Andy let me go through their program, which kicked off a two years of lab work and serious dietary changes that have finally allowed my body to heal and perform its best.

(I’ll cover my diet and the results of these tests in another issue. I’m on the road doing press for the paperback release of MAY CAUSE SIDE EFFECTS.)

Over a two year period, I’ve spent well over $10,000 out of pocket on lab tests. It is no small amount of money, especially given my super-lucrative career as a freelance writer and chef. (I recently received a royalty check for the amount of thirteen cents!)

Insurance hasn’t covered a dime, and still, it’s the best money I’ve ever spent on myself because I actually feel better. The key is to get all the testing done in a 1-2 week time period so you have a full picture of your health, all at once. This allows for the Dan Garners of the world to connect the dots between the body’s different systems, rather than isolating the endocrine/gut/blood labs in a vacuum and assuming nothing is connected, like allopathic medicine likes to do.

So, have at it folks. Go forth and figure out your shit. Literally.

Food Sensitivity:

MRT test

Hormones:

Dutch Test

Gut/GI:

GI Map

Heavy Metals:

Doctor’s Data Toxic & Essential Elements: Hair

Genetic:

GeneSight

Blood:

Complete metabolic blood panel

HNK1 (CD57) panel

Microscopic examination

Urinalysis, complete

C-Reactive Protein, Cardiac

Ferritin

Fibrinogen Activity

GGT

Hemoglobin A1C

Homocyst(e)I’ve

LDH

Lipid Panel with Chol/HDL Ratio

Magnesium

Phosphorus

Reverse T3, serum

Thyrogobulin Antibody

Thyroid Peroxidase TPO Ab

Thyroid Profile II

Thyroxine (T4) Free, Direct

Triiodothyronine (T3), Free

Uric Acid

Vitamin D, 25-Hydroxy

For months, I’ve felt like I just got on one of those carnival rides where you sit down, strap in, and let a rusty elevator take you to the top of a tower. Even though the elevator is gently taking you away from familiar ground, you know that at some point, the elevator will stop, open its doors, and give you a view of the world you’re about to drop into. And then, just as you relax into the view, the floor will fall away and gravity will take over, leaving you with no option other than to feel the rush.

I keep waiting for the elevator doors to open and show me a new world. It is coming. I can feel it and I’ve been feeling it for months. In October, I lost my main client and most of my work evaporated overnight. I challenged myself to simply wait, as itchy as it was because I could feel this something coming. I could feel myself standing in line, putting on a seatbelt, and waiting to move.

Every few years I seem to come back here, to a place of uncomfortably long stagnancy with no clear direction. The last time this happened was in August 2017. I was at the tail end of both a year of international travel and a year and some months of antidepressant withdrawal. I didn’t have a job or an address, but I had signed a flimsy book deal for a book called LADYBALLS. Though I still love the title, that book never came to be, but its existence contained the zygote of what would eventually become MAY CAUSE SIDE EFFECTS.

On a rooftop in Buenos Aires, I wrote myself a letter and dated it January 1, 2018. Why I thought six months was an appropriate open date, I don’t remember. But I do remember that when the new year rolled around, I looked at the unopened letter and knew it wasn’t time to read it. Days before, the book deal for LADYBALLS fell apart. I fired my agent and my publisher in a blind move that turned out to be the best career decision I’ve ever made. I couldn’t remember the specifics of the letter, but I knew if I opened it, I would only feel frustration and shame. So I stuffed it in a folder and forgot about it.

Until yesterday.

My strategy for dealing with general overwhelm is to spontaneously deep clean my home. Typically, a stressor appears—good, bad, doesn’t matter—and within a day, I decide my house is unacceptable. I am already known to vacuum in the middle of a dinner party, but this takes it to another level. In the words of Monica Gellar, the compulsive chef on Friends: “Not just health department clean. Monica clean.”

Yesterday, I signed a contract with a new client, thereby imbuing me with all sorts of problems to solve. After attempting—and failing—to solve all those problems in one morning, I came home and began scrubbing the screws on my toilet. Which led to re-lining drawers. And going through my closet. And cleaning out my desk, where I found a brittle, unopened yellow envelope dated January 1, 2018.

I smiled, sure that inside the letter was something about a $50,000 book deal that never materialized. Enough time had passed and I figured I could handle whatever was in there, even if what was in there was nothing but disappointment.

The back side:

I chuckled at the line, “By the time you read this, you’ll know where you’re going to live.” That is the only bit in there that isn’t quite settled. Something on the carnival ride feels like I’m not staying put much longer.

Everything else, though, has manifested. I wrote the book. And it’s good. And I finished on time, and I am happy with the words I wrote and the things I believe. The money came, too. And that independence. Real independence, because that year and these years gave me the gift of confidence and a voice—a true voice.

By the time I opened this, I had an address to come home to. And I can pay for it. And I am surrounded by people who love me. The negativity that followed me is a distant memory. I am me. And I am paid to be me. I am content, happy, full, and free.

I can’t remember if, when I wrote the letter, I really believed any of it would come true. I knew I wanted to believe, and that I’d seen glimpses of light during antidepressant withdrawal that at least taught me I was capable of experiencing a life I never imagined.

I share this with you because I can feel that I’m reaching the top of the elevator and that when it opens up and the ride truly begins, I know my story is going to reach even more people. So far, I’ve been able to keep up with the amount of correspondence I receive from people suffering from antidepressant withdrawal. Sometimes it takes a while, but I get there. I don’t know how much longer I’m going to be able to respond to everyone.

So, for everyone who is suffering, let this letter serve as an example of possibility. This can be your future if you keep the course and keep doing the work. Most times, the hard way is actually the easy way. Let it be hard. Feel it. Process it. Because at the other end is light.

Light

Light

Light

Light

Light

Light

Light

Joy

Love

Acceptance.

Hi friends,

When you’re reading this, I will be on my way to another continent to celebrate both my mom’s and my birthdays. And on the day of my birthday—February 1—I will have 16,715 more days to live. 

Maybe. Hopefully.

My father died suddenly when he was 54. That means he was halfway through at 27 and still had 13 years of living before I came along. I don’t have the vocabulary to express how much that twists my mind, and yet it’s been a constant thought over this year. I don’t know if it’s because 54 no longer feels all that old or far away, or because no one ever knows when they’re halfway done. 

I turn to numbers for comfort. Always have. Even as a girl, when I felt overwhelmed, I would quietly calm myself by counting ceiling tiles or cars passing in the other direction. 

In the depths of depression—despite years of antidepressants—I took a dozen life expectancy tests, sourced from life insurance companies and accounting firms. I averaged the results for a total of 83 years, 9 months, and 6 days on this planet. Or 30,595 sunsets.

I didn’t want those sunsets until I got off all the antidepressants and came out of a year of severe antidepressant withdrawal. But after all the suffering and all the deep work, finally, I want time. I want all the days I never thought I’d have. 

If I am so lucky to see them all, that means I get to watch the leaves turn 46 more times. 

And read just 920 more books. 

And watch 11 more Summer Olympics. 

There will be maybe 138 more pizzas and 33,430 cups of coffee. Assuming there’s always a canine by my side, I’ll take 66,860 more walks with 4 more dogs. 

I’ll hug that friend I only see once every few years about 15 more times. 

And feel lucky if I laugh until I cry 92 more times. 

Maybe I get half a dozen moments of complete and utter awe. 

And one great love. 

Maybe. Hopefully. 

All this to say: 

I don’t know how many more mother/daughter trips I have left, especially grand international ones. I will be happily unavailable for a few weeks and want to make sure you have your fill of the latest news on antidepressant withdrawal, so I have compiled a bunch of recent articles below.

There was a time when maybe one article was written on the topic every three months, and now I’m starting to see weekly (and even daily) headlines. Something is shifting. I can feel it, and I welcome it.

The STAR*D trial, once considered a landmark study in psychiatry, is now mired in controversy due to findings of protocol violations, inflated remission rates, and a general lack of accountability from its investigators.

One of the largest and longest studies on antidepressants, the trial initially reported a 67% effectiveness rate for antidepressants, which became the basis for the pharmaceutical focus that has shaped much of modern psychiatric “care.” However, the trial has come under scrutiny for several reasons, revealing a far different picture of its findings:

I awoke this morning, on New Year’s Day 2024, from one of those deep sleeps that makes you wonder if you ever really sleep at all. I have been sick for the better part of the holiday season, in every sense of the word—physically sick, heartsick, lovesick, grief sick, job sick—and most of my nights have been fitful, either because of a hacking cough or the prickly agitation that comes with the sort of longing that NyQuil can’t shake off.

The chest infection combined with other people’s holiday obligations meant that I spent most of the back half of December alone, an experience I am deeply familiar with after years of working in the Manhattan restaurant industry. In food service, someone has to work the Christmas Eve rush, frost New Year’s cupcakes, and cater Thanksgiving dinner to folks who don’t cook. Even if the business is closed on the actual holiday, someone has to work the day before and after, rendering cross-country travel impossible.

Thus, my clearest holiday memories are not of cozy, matching pajama-clad mornings, but of a Christmas dinner of Caesar salad and buffalo chicken wings at the Jewish diner underneath my apartment, long walks with my dog down silent Manhattan streets, the deep sense of toska pulling at my heart.

Goddamned toska.

A Russian word with no English equivalent, Vladimir Nabokov said it best: “At its deepest and most painful, it is a sensation of great spiritual anguish, often without any specific cause. At less morbid levels it is a dull ache of the soul, a longing with nothing to long for, a sick pining, a vague restlessness, mental throes, yearning. In particular cases it may be the desire for somebody of something specific, nostalgia, love-sickness. At the lowest level it grades into ennui, boredom.”

Perhaps, given my pockmarked history of holiday experiences, I am primed to feel the weight of toska each year. Or, perhaps this is something experienced by those who have lost a core member of the family. The holidays, for all their cheer, will always be a quiet reminder that my father is not around to throw a tantrum over tangled Christmas lights. Or maybe it is the mark of adulthood, when the magic of the morning is tempered by all the work it took to create it, and all the impending work it’s going to take to erase it.

But the stupid heart always has hope.

This year, while a campy holiday Hallmark movie chirped in the background as I loafed prone and achy on my mother’s couch, we talked about uncertainty. My illness, it seemed, was the physical manifestation of everything I don’t know going into the new year. And I don’t know anything right now.

I have had a sense, for months, that big change is coming to my world. And yet, there is no indication of what that might be or where it might take place. All I know is that in October, my income evaporated when a client’s situation changed, and since then I have watched lead after lead dry up while I anxiously monitor my bank accounts.

My heart, too, is searching for a signal, but the frequency I put out keeps getting lost in static. And yet I cannot shake the situation, the person, and how their existence in my life has fundamentally altered my perception of myself, my abilities, and what I want to experience in the world.

Meanwhile, in my Instagram DMs, a woman reached out to tell me that after 16 months of tapering, the last night of the year would also be her last time taking an SSRI. I reposted this on my Instagram stories, thrilled to get a bit of good news given that most of the messages I receive are of the opposite ilk.

The post gained attention, at soon folks were messaging me with other antidepressant withdrawal wins. One woman went to her first concert in four years, armed with earplugs to combat withdrawal-induced noise sensitivity. Another shared a story about her first trip to the grocery store after coming out of Zoloft withdrawal. Another recently gave birth to a healthy baby fourteen months after horrific Effexor withdrawal.

These little messages, most from folks who’d contacted me in the depths of suffering, lifted me not because of any hand my work may or may not have had in their healing, but because it reminded me that blind conviction is a requirement during fallow seasons. The other side of toska is hope. It is hope that lets us endure the pining, restlessness, and yearning for the magic to return, for the static to clear, and for the body to find health and equilibrium.

And so I awoke lighter this morning, the pull of toska not quite as heavy, the phlegmy cough a little less rough, with a little more patience to let the signal of work and love travel to their receivers.

Bestill the stupid, stupid heart.

Earlier this year, in Issue 107, I wrote about a two-month-long experiment where I drastically distanced myself from all current events and news media. Though I’ve never been a news junkie and loath all politics, I am curious and want to learn, so I spent a few years attempting to balance the wave of fear and doom by listening to science-education podcasts like Huberman Lab, following good news Instagram accounts, and subscribing to Wired magazine.

Just before starting this experiment, I’d also come off a long stretch of health-related inquiry after learning I carry the BRCA gene. In my spare time, I was reading books on longevity, distilling the pros and cons of preventative mastectomies, and annoying the hell out of a genetic counselor by asking who funds the institution that recommends annual mammograms and MRIs for folks with BRCA, despite conflicting research that indicates excessive radiation from mammograms could actually be harmful for BRCA carriers because “Women who carry deleterious BRCA mutations have an impaired ability to repair damage that arises in the DNA that makes up genes…the small amount of radiation exposure due to a mammogram – essentially an X-ray – can contribute to DNA damage.”

The National Cancer Institute is government-funded by the way, which is a benign way of saying it’s run by lobbyists. This isn’t necessarily bad—most research is publicly funded—but let’s not pretend we’re frolicking in a field of altruism. Cancer is big business. My experience in the world of mental health x pharmaceutical influence means I cannot approach a health issue without looking to see who is pulling the narrative strings. A guideline is never just a guideline. It always comes from somewhere. Typically, the end point is a multinational organization that oh so coincidentally makes a lot of money off of the story being told (Coca Cola funding, influencing, and owning the URLs of anti-obesity groups) or a wartime guideline that no one ever bothered to dig into. The Recommended Dietary Allowances of nutrients, for example, were introduced during World War II in order to advise “on nutrition problems in connection with national defense.” This was about the minimum required to survive another day of battle. Yet, every nutrition label and marketing scheme still reflects these antiquated numbers.

Knowing how all this works, my personality left me with only one choice: go HAM on my own reading and research.

I found a functional medicine doctor and ran dozens of labs, listened to health and longevity podcasts while driving, and read the latest books on preventative medicine and mind-body health. My diet, which already underwent a big overhaul in 2021, tightened up in the most unexpected of ways: more red meat, fewer vegetables, no seed oils, and little to no alcohol.

I’ll never know how, or if, these changes actually prevent or delay a cellular oopsie. Carrying the BRCA gene does not guarantee mutation. But all the research and changes gave me a sense of control over the situation…until it didn’t.

We glorify learning, as if knowing more information is always the right call. But knowledge has diminishing returns; there comes a point where you know what you need to know, and knowing more actually causes more issues because it interferes with your intuition. Yes, I had gained a rudimentary understanding of one possible health future. But I was also fried, anxious, and no closer to figuring out what in the hell to do about it.

So I decided to stop learning.

Midway through the year, fresh off the unexpected glory of staying away from all news and current events, I put myself on a learning embargo for an undetermined amount of time. No more doctor’s appointments. No more medical books. No more podcasts. No more fear-based learning. I was to be purposefully dumb!

My god, what freedom. Between no current events and no learning, all my free time went to reading fiction, painting, and running in the hills. I listened to music while driving, found a group of old men to play chess with on Saturday afternoons, and used up all the hot water during daily, mind-wandering showers.

In time, I came to find a sense of peace around my persnickety genetics. If it becomes something I need to deal with, I trust myself to deal with it. In the meantime, I know I’ve made the best changes with the information I have in order to give myself the best shot of never having to deal with it. Really, what more is there to do?

All this to say, look at your life. Where might it be beneficial for you to actually learn less? Consider it addition by subtraction. In going on a learning embargo, I wasn’t practicing denial. Instead, I was making room for integration, understanding, and the quiet voice that always knows.

The act of reading—specifically sitting down with a physical book or Kindle—tells me a person has the ability to focus, slow down, and live life with intention and curiosity. Whether they read fiction or nonfiction, sci-fi or biographies, they are likely to contribute to conversations and process ideas that may not be in line with their own beliefs. In short, it demonstrates that they are open and capable of growth.

Books are also the fastest and cheapest way to change your life. I have little patience for people who can’t solve their own problems when there are literal libraries filled with free resources to address your exact issue.

This year’s roundup of books is very much focused on troubleshooting existence. From breathing to protein to getting what you want from others, here are the 10 books I read that will make for a happier life.

Landbridge: A Life in Fragments by Y-Dang Troeung

This is the best, most impactful book I read all year. It earned rare display status in my living room, and I tear up just looking at it. It’s also written by a friend who died a year ago this week, so I’m feeling especially tender.

Though you can get creative and get this book in the US by following my link, it’s currently only available in Canada. The US release date is set for later this year.

“In 1980, Y-Dang Troeung and her family were among the last of the 60,000 refugees from Cambodia that then-Prime Minister Pierre Trudeau pledged to relocate to Canada. As the final arrivals, their landing was widely documented in newspapers, with photographs of the PM shaking Y-Dang’s father’s hand, reaching out to pat baby Y-Dang’s head. Forty years later, in her brilliant, astonishing book, Y-Dang returns to this moment, and to many others before and after, to explore the tension between that public narrative of happy ‘arrival,’ and the multiple, often hidden truths of what happened to the people in her family.

In precise, beautiful prose accompanied by moving black-and-white visuals, Y-Dang weaves back and forth in time to tell stories about her parents and two brothers who lived through the Cambodian genocide, about the lives of her grandparents and extended family, about her own childhood in the refugee camps and in rural Ontario, and eventually about her young son’s illness and her own diagnosis with a terminal disease. Through it all, Y-Dang looks with bracing clarity at refugee existence, refusal of gratitude, becoming a scholar, and love.”

Breath: The New Science of a Lost Art by James Nestor

In the realm of books that will solve most of your problems, Breath is #1 on the list. Told with a journalistic flair that keeps you reading, Breath explores the most basic, common thing humans do—breathing—and explains exactly why you’re doing it wrong, how it’s creating your physical problems, and how to fix it with a quick trip to the drug store.

The Medium is the Massage by Marshall McLuhan

It’s been six months since I stopped consuming any news or current events, and I cannot overemphasize how much this choice has positively affected my life. McLuhan’s book is a meta, visual explanation of why this occured, showing how we are unconsciously influenced by media through brilliant illustration.

And lest you think this book falls into the camp of “dangerous alternative media,” know that it was first published in 1967, establishing it as one of the rare works that stands the test of time.

Forever Strong: A New Science Based Strategy for Aging Well by Dr. Gabrielle Lyon

Much of my year has been focused on understanding how nutrition affects mental and physical performance. I’ve ditched dozens of foods I thought were helping but turned out to be hurting—oats, kale, and seed oils to name a few—and am focusing on a more primal, stripped back diet that leans more into red meat.

An easy read with a focus on unraveling the false narrative surrounding meat, Lyon touches on the history of our bogus food pyramid, why so many people are physcially weak and overweight, and how more muscle means better health and longevity.

Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen by Christopher McDougall

I picked this book off a friend’s shelf when I was too jetlagged to function, and it changed my entire perspective on what my body was capable of doing.

In less than three months, I went from someone who hated running and thought I wasn’t “built” for it to someone who is excited to spend an hour in the woods, running six miles with 2000 feet of elevation.

Plus, it’s a damn good story that will speak to anyone with any inclination towards physical activity.

Walking in Wonder: Eternal Wisdon for a Modern World by John O’Donohue

I like to read philosophy or poetry before bed, and John O’Donohue is the perfect lullaby.

“Widley recognized as one of the most charismatic and inspirational enduring voices on the subjects of spirituality and Celtic mysticism, these timeless exchanges span a number of years and explore themes such as imagination, landscape, the medieval mystic Meister Eckhart, aging, and death. Presented in O’Donohue’s inimitable lyrical style, and filled with rich insights that will feed the ‘unprecedented spiritual hunger’ he observed in modern society, Walking in Wonder is a welcome tribute to a much-loved author whose work still touches the lives of millions around the world.”

The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture by Gabor Mate

Read this book. Just do it. Listen to it on audiobook if that’s what you need to do. Make it the only book you read if you only choose one.

“Over four decades of clinical experience, Maté has come to recognize the prevailing understanding of “normal” as false, neglecting the roles that trauma and stress, and the pressures of modern-day living, exert on our bodies and our minds at the expense of good health. For all our expertise and technological sophistication, Western medicine often fails to treat the whole person, ignoring how today’s culture stresses the body, burdens the immune system, and undermines emotional balance. Now Maté brings his perspective to the great untangling of common myths about what makes us sick, connects the dots between the maladies of individuals and the declining soundness of society—and offers a compassionate guide for health and healing.”

Crazy Like Us: The Globalization of the American Psyche by Ethan Watters

If you’re a regular reader of HIAS, you’ll recognize this book from several of this year’s issues. This book should be required reading for anyone in the mental health field, becuase it’s going to force you to re-evaluate what you think mental illness is.

A Walk in the Physical: Understanding the Human Experience Within the Larger Spiritual Context by Christian Sundberg

By far the most out-there reccomendation on this list, A Walk in the Physical is the account of a man who was born with the spiritual veil “half open.” He remembers life before life, and attempts to explain what happens to souls before we come into human form—and after we leave through death.

Though the writing isn’t going to win any awards, it’s worth reading simply for the premise. Whether you belive what he’s saying or not, its sure to make you think.

How to Win Friends and Influence People by Dale Carnegie

“Why are you reading Dale Carnegie? He was old when I was your age.”

This is what said to me when she saw this book on my coffee table, indicating just low long this book has been around. Classics are classics for good reason, though, and there are plenty of nuggets in Carnegie’s book that are still relevant today.

The trick I use the most: Using people’s name to get what I want.

When you’re interacting with people, whether it’s a cashier or someone you know personally, play around with saying their name when making a request or giving a complement. We are conditioned to respond to our name, and assuming the tone is in kind, you’ll be shocked at how much easier it is to get people to help or respond to you.

A new study on publication bias of the benzodiazepine Xanax has been released. According to researchers from Harvard, Massachusetts General Hospital, McLean Hospital, and former FDA reviewer Eric Turner, four of the five original studies on the effectiveness of alprazolam (Xanax) found it to be no better than a placebo. Furthermore, only one of the five studies reviewed by the FDA showed a positive result. It is curious when you consider that the FDA “expects that the drug maker will submit results from two well-designed clinical trials to be sure that the findings from the first trial are not the result of chance or bias.”

Publication bias is the practice of picking and choosing what gets published and how it gets published. This is extremely common across all hard and soft scientific disciplines, and it’s a big reason why relying on published, peer-reviewed research should not be the be-all, end-all of human existence.

Negative and neutral trials, for example, often don’t make it into literature. Not only do the researchers not want to draw attention to a failed hypothesis, but journals don’t want to waste space on science that doesn’t work. Furthermore, the media rewards breakthroughs, not duds. Thus, an unknown amount of research is left on the cutting room floor.

The problem with this is that when you look at the body of research that does get published, it tells a very different story. British physician Ben Goldacre explains it well. I’ve fast-forwarded to the most relevant part for your convenience:

This is exactly what happened in the Xanax approval process. The FDA received data on five Phase 2 and Phase 3 trials. They considered four of them to be negative but approved the drug due to the strength of Study 2. Furthermore, the results of Study 1 were spun to look positive, despite the FDA statistician determining the study failed because improvement was not noted in all seven primary endpoints (the FDA deems “studies positive only if all primary endpoints achieve statistical significance”).

Studies 3, 4, and 5 failed or were nonsignificant, and none of these studies were published.

Thus, the published literature reflected that Xanax was a successful intervention for panic disorder, which led to a frenzy of prescriptions thanks to media and marketing departments that use published literature for headlines and campaigns.

And here we are, thirty years later, with a raging global opioid crisis, in part thanks to the misuse of benzodiazepines.

You know Big Pharma is prepping to push a new class of drugs when the narrative starts changing around the golden pharmaceutical children of yore.

Drug patents in the United States typically last 20 years, and given that there’s been no meaningful pharmacological advance in the mechanism of antidepressants during that time, most SSRIs and SNRIs have fallen off the patent cliff and are available in generic form. Generics, of course, don’t bring in the dough. So, pharmaceutical companies use a variety of tactics to bury generic competition, including but not limited to:

Two themes are appearing in the media that make me think we’re heading for a classic shift. First, we’re seeing headlines about new antidepressants, specifically Zurzuvae (zuranolone) and Zulresso (brexanolone), both of which act on GABA receptors (like benzodiazepines) and are being targeted at vulnerable new mothers with postpartum depression.

Zulresso, by the way, costs $34,000.

The New York Times reported on these new drugs on August 4, 2023. On November 9, 2023, the New York Times also reported on Post SSRI Sexual Dysfunction, a devastating and often permanent side-effect of antidepressants that can rob people not their libdo, function, and feeling in their genitals. Chemical castration, effectively.

Both articles include a pithy offer of journalistic objectivity, adding a quote or two from the “opposition” to satisfy the reader with an attempt at balance. But the tone of each article is clear: New shiny drugs, good! Old generic drugs, beware!

Curioser and curioser.

In good news, SNOMED (Systematized Nomenclature of Medicine Clinical Terms) has created code 1285639002 for “Protracted antidepressant withdrawal syndrome (disorder).”

SNOMED is a non-profit organization responsible for determining global standards for health terminology. It is designed to support a wide range of healthcare processes, including clinical documentation, decision support, and data analysis. It encompasses a broad spectrum of clinical concepts, relationships between them, and associated terms. This standardized terminology helps ensure consistency and interoperability in health information systems.

Without a formal code, an ailment essentially doesn’t exist. That means that prior to code 1285639002, precisely 0 cases of protracted withdrawal have been formally recorded because there wasn’t a way to do it.

In the UK, doctors have to activate the code in order to use it. Once that happens, researchers will be able to start tracking case rates. In the US, it’s irrelevant because of our dumbass system. I’m told that we likely won’t have a code until the DSM recognizes it, which would lead to a bit of the emperor has no clothes situation. But SNOMED is a start, and I’ll take it.

On October 9, 2023, the United Nations and World Health Organization jointly released a 184 page report addressing the massive human rights violations that occur in mental health “care” all over the world—including the United States and Canada.

After looking through the document, I’m at a loss for words. I’ve spent years speaking alongside other titans, all of us trying to blow the whistle on the corrupt, evidence-less, biomedical model of mental illness that leads to detrimental over prescription, forced institutionalization, and “treatment” without consent. This work has opened all of us up to a special portal of hell, where defamation, academic mobbing, death threats, and the constant risk of getting sued is always on the mind.

(Never have I been so happy to not be associated with an institution. I have a lot more latitute to speak freely when I am not at risk of losing a license or my job with a University.)

And yet, this is a 184 page report effectively says we were right all along. Addressing the harm of the biomedical model, it proposes new legal objectives and a clear mandate for mental health systems to adopt a rights-based approach as opposed to a containment-based approach. It also admits:

Mental health and well-being are strongly associated with social, economic, and physical environments, as well as poverty, violence, and discrimination. However, most mental health systems focus on diagnosis, medication, and symptom reduction, neglecting the social determinants that affect people’s mental health.

Imagine that! Living under constant threat, whether familial or political, isn’t the way to health and wellness. Whoda thunk?

Furthermore, the document goes into considerable detail on informed consent in psychiatric care, which is generally nonexistent in current practice. This manifests in a variety of ways, from involuntary psychiatric holds to general practioners handing out antidepressants after five minute appointments to psychiatrists refusing to support their patients in tapering from psychiatric drugs.

The document says, specifically:

Countries should adopt a higher standard for the free and informed consent to psychotropic drugs given their potential risks of harm in the short and long term. . . . Legislation can require medical staff to inform service users about their right to discontinue treatment and to receive support in this. Support should be provided to help people safely withdraw from treatment with drugs.

More than anything, though, I am shocked and impressed that the WHO and UN admitted the following:

An additional concern is the explicit use of a reductionist Western biomedical model in mental health law, which works to the detriment of other holistic, person-centred and human rights-based approaches and strategies for understanding and addressing distress, trauma, and unusual perceptions or beliefs (2, 86).

Reductionist Western biomedical model! My god, if this was a snark Substack, that statement would come with a dramatic reaction gif.

Actually, fuck it. My filters are gone.

It’ll be interesting to see how—and if—this document has any real impact on legistlation and operating procedure. I doubt there will be a rush to change any laws any time soon, at least in the United States, as long as Big Pharma continues to hold their lobbying power.

However, one major change is that for those branded with scarlet letters ranging from “dangerous” to “anti-medicine” to “anti-science” we can now point to this report for hard-to-argue-with evidence and support. As I’ve said all along, change on this front is not going to come from the top down. It’s going to start with each individual taking control of their own care, and finally, there’s a document to support it.

Download the report.

How small a thought it takes to fill a whole life. – Steve Reich

I have spent the last year bewitched by a singular thought. It began as a wonder, planted unintentionally by multiple people who independently came to the same conclusion, well before the idea ever dawned on me. There was—is—an energy behind the idea. Though it was slow to root, once it took hold, its vines tangled itself in every corner. The details are ever changing based on how the scenario is or isn’t playing out in my reality, taking me on a wild ride of highs and lows. As my mother put it, “It’s like you are on a river, rafting through rapids, completely unaware if you are heading towards a cliff.”

Another person is involved, of course. Isn’t that always how it is with these sorts of things. And they have no idea what I’m experiencing, of course. Because isn’t that always how it is with these sorts of things? And now is not the time to say anything, of course, because when it comes to these sorts of things, timing is everything.

So I sit. And think. And try not to think. And push it away and watch it come roaring back again.

It manifests in my body, sinusitis combined with a heaviness that creeps through my limbs. I cut through it by watching my dog frolick on a dirt path behind my home, willing myself to hear the birds while I observe her canine joy and force myself to think, “If this is my last moment on Earth, my God, it is beautiful.”

Another thought: Don’t decide your failures in advance.

There are two forces at work here. First, a lesson on perception. Due to the nature of the situation, most of it is playing out in my own mind. Over the past month, new information has come in that has me questioning my interperetation of the last year. My mental and emotional assumption of What Is has taken a sharp turn, veering away from one of hope and possibility to one of frustration and stupidity.

And yet, objectively, the situation has not changed. It is identical to what it was six months ago. All that has shifted is the story I tell myself. Still, it is maddening that I can’t find the line between intuition, instinct, and fantasy. That is not often a line I struggle to walk.

Which leads me to the second lesson, a perennial lesson it seems I am constantly forced to learn: the art of waiting.

Back in Issue 22, I wrote: We have conditioned ourselves to think that when we are presented with a choice, our only options are to pick one or the other and to do it fast. But there is an ever-present third choice that often holds the most power — the choice to wait.

I am fighting a sinking feeling telling me that I was wrong, that what I thought this was, isn’t. I want to chastize myself for being so foolish, box up the embarrassment of ever mentioning it at all, and pretend it never happened by engaging in whatever or whoever pulls me in to break up the thought pattern. But even if this path turns out to be true, it is too early to decide my failure. Frankly, there is little evidence to support the Stupidity Theory. But there is some evidence, albeit not an overwleming amount, to support the Original Theory. The truth is likely somewhere in between. I am sure I have overcorrected on both ends.

So I must wait and find a way to tend to the roots without letting the vine suffocate its host, one thought at a time.