In The Middle Of Things

It’s as good as any place to start. But where, exactly, is the middle of things?

I am in the process of proving to my current proscriber of pills that the medication I’m taking isn’t working any more (if it ever did.)

How that came to be is this:

Half way through the first year of my Master of Fine Arts degree I was in the middle, or the tail end of, or the beginning, of a major breakdown. I didn’t know it at the time. What I knew was that regular, weekly meetings at my university’s counseling services offices weren’t cutting it. I found myself in the offices, with alarming regularity, struggling to breathe, fighting tears, and considering the merits of dramatizing my distress for the sake of an emergency visit when I arrived either too early or too late to be seen during their “walk-in” hours.

What else I didn’t know at the time:

Most counseling and health services available to students in colleges and universities are not equipped to handle the mental health needs of the students they are meant to serve, either through a lack of funding, a dearth of qualified professionals on staff, or a combination of all of the above.

Even where there enough staff on hand and adequate funding, most of these clinics are not the sort of places where people with serious mental health issues can find long-term treatment, or even the sort of engagement from professionals that would allow for finding long-term solutions. Most often, the staff handle the students who are having some trouble adjusting to college life, or who need some help learning healthy coping skills for the challenges of adult life. Clinics, in other words, are mostly for the support of students who are otherwise mentally healthy. Whenever a student wanders in, or in my case, drags themselves in during the middle of full-in mental health crisis, the triaging is centered around determining whether or not the student needs to be hospitalized, as in: call 911 because this person is suicidal, or a danger to others, or both.

If the student/patient is determined to not be in immediate danger, then – if there’s someone available – then they will get to speak to a counselor, who might suggest that they consider taking some deep breaths and getting a good night’s sleep and making a regular appointment to talk things out. There isn’t much in between.

(During those subsequent, regular appointments a counselor will spend time listening to you talk and suggesting basically the sort of self-care advice you, the student, could find on the info sheets in the waiting area. The same sort of advice and guidance they might give to any other student, the mentally healthy ones who just need a little guidance because despite your vocalized suspicions that this is something more serious will continue to treat you as though you, for some reason, don’t know what you’re talking about. It isn’t the counselor’s fault, though. She’s a student in a graduate program too, and she’s just learning about all this stuff, and her supervisor  – it turns out – is a woman who has one of those Live, Laugh, Love decals – the physical embodiment of the unexamined life – on her office wall.)

This isn’t a problem, per se, except that the common misconception among educators and communities where these sorts of clinics operate is that these clinics can do all of those things, or at the very least know how to recognize when they have a patient who needs more care than the clinic staff can or should provide.

So. There I am, going to my regular appointments, feeling more and more unstable and undermined, because all-and-sundry seem to think that I am receiving the care I need. I don’t know enough to know better, so I do, too. Yet I quietly feel more and more desperate because those around me – especially friends and acquaintances who have also sought and got professional help, including medications – begin to hint that perhaps I’m not taking my treatment seriously enough because I should be getting better, instead of worse.

Cut to six months later. Approximately June 2014. I am worse. It is summer time, and the regular counselor I was meeting with has finished her clinical rotation and I’m now in the hands of her supervisor, she of the Live, Laugh, Love decals, who cannot be bothered to re-read her notes on appointments. I know this because she twice confused me with other patients, once calling me by another woman’s name and another time by asking me about “homework” she had most definitely not asked me to do during our last session. This is the woman who suggested I consider prozac. At that point, I was game for anything.

Referral to on-staff psychophramacologist. We try Prozac. It lifts my mood, but gives me anxiety attacks. Switch to the off-brand of Effexor, the OG of SSRIs, designed to help with depression and anxiety. We try 75 mgs to start, then up to 150mgs by the following summer. At 75mgs, I can get out of bed and I don’t cry every day, but 150mg I am swinging back in the direction of suicidal.

2015 is the summer I learned that anti-depressants have a misunderstood reputation, at least where it concerns “thoughts of suicide” and the observed tendency of those taking anti-depressants to sometimes attempt suicide. The medications don’t, as some might imagine, “make” a person suicidal. There’s a popular theory (and boy, is the study of mental illness just full of fun little theories) that what anti-depressants actually do is get someone to the point where they have enough will to act on the thoughts of suicide they’ve already been having for quite some time.


But I survive that, and there is some more tinkering. By fall of 2015, the addition of a medicine I must take every twelve hours, along with a 75mg dose of OG Effexor. I called it the Sad Russian Clown medication, because what else comes to mind when one hears the word Buspirone?

In the spring of 2016, having graduated from my university, and all the medical records and documentation I had acquired through my treatment at my university is not available to my new psychopharmacologist, and instead of asking me to sign a release and transfer form for those records she’d prefer to just tinker with my dosage and see what happens for herself. I’m medicated, but there was a gap in my coverage, and now I’m having to demonstrate that things are not working by slowly unraveling.

I know I’m unraveling because my pre-treatment, pre-diagnosis patterns of behavior are beginning to reassert themselves. I am irritable. Prone to crying. More prone to paranoia. Insomnia. The battery of bad habits. Sleeping too little or sleeping for twelve hours at a time.

It might be that I need a new doctor. It might also be that the medications weren’t ever very effective, and now aren’t effective at all. It might be a little of both.

It might also be that my life stressors have increased. I’m now teaching four classes at two different campuses. But a look at the actual work load shows that I’m not that stressed out. It’s tough to tell. And this whole list of middle of the process factors and question marks has left me worn out. Tired.

Tired because I have begun to feel as though I’m treading water. Tired, because I’m over learning about the preconceived notions about mental health and treatment by falling victim to them, in the sense that they either delay my treatment, or cause me to remain in dangerous and deteriorating states for far longer than I should.



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