Category Archives: on the mind

Timpanogos

I’m terrified of heights. For nearly all of my life this instinctive fear has kept me far, far away from yawning chasms, precipitous drops, and freaky precipices. But somehow, in recent years, I’ve found myself called by the allure of high places—their very horror makes them weirdly attractive, and they’ve become a challenge, a quest.

That’s how I found myself yesterday morning on a narrow, washed out trail hundreds of feet above Timpanogos Basin, pinned against the crumbling rock wall and fearing for my life. Along with my friends Daniel and Becky, I was climbing Mount Timpanogos, the massive 11,572 ft. ultra-prominent peak that looms over Utah County. (I didn’t know what that meant before so I looked it up and it’s really cool. End of brag.) The sun had not yet risen; my trusty headlamp illuminated the way before me. Daniel and Becky had just crossed over a completely washed out section of trail that so completely unnerved me that I would not follow:

The "trail"

The “trail.” Somehow it wasn’t helping me feel secure in my footing.

It didn’t matter that I had spent five hours hours climbing 3,000 feet of elevation gain over six miles. It didn’t matter that I wouldn’t get the magnificent sunrise view from the summit, or even the saddle. I was terrified, and I was turning back. In the Inside Out-style emotional headquarters within me, this guy was calling the shots:

Fear

Just doing his one job: keeping me alive!

And so I turned back. I’ve done this many times. After my self-preservation instinct screams at me for long enough that my life is at risk, it becomes impossible to ignore. So I turn around. I leave the situation that so terrifies me.

It is the lot of the perpetually anxious to be overwhelmed by things that have little or no impact on other people. It’s our lot to turn around when the danger signals are too intense, but when nobody else is turning around. And it’s our lot to feel cowardly for doing so, to wonder if we’ve done the right thing.

But I believe it is the right thing. Because the agony of ignoring the self-preservation instinct is real. And because turning around and giving up are not the same thing.

I retreated down the trail a ways while Daniel and Becky pressed on without me. I felt beaten, but relieved. I took pictures. I watched a mouse scurry about looking for fallen bits of trail mix. I sat by myself in the dark and watched the stars. I felt the wind and enjoyed the night solitude.

It was peaceful. I felt serene. But somewhere within me a voice began calling. I realized I wanted to try again.

So I returned to the washed out section of trail. I took it at my own pace, in my own way, for my own reasons. And I crossed it, no problem.

I continued up the path a ways, but soon found myself confronted by yet another disintegrating trail segment that I could not stomach. So again I stopped. Again I turned around.

I went down to the basin. I watched the dawn first simmer on the horizon and then roll over the valley:

Dawn

I explored. I saw what seemed to be moose, but which turned out to be a hunter’s horses. I talked with him about mountain goats and the whereabouts of Emerald Lake. I watched a noisy squirrel drop pine cones from from the tree tops down to the ground. I saw this:

Timpanogos Basin

It was marvelous.

But in full light of day a voice seemed once again to be calling to me. I had to try again.

Back up the trail I went, back up toward the saddle. In the darkness my fears had filled the information vacuum, making everything seem more dangerous than in reality. But in light of day, my fears had less power over me. I could see that the slope beside me wasn’t completely shear, but often was somewhat gradual. With this encouraging observation I was able to advance up the trail much farther than previously. But again, at some point I encountered the limit of my appetite for risk, and I turned around.

I’ll say it once more: turning around and giving up are not the same thing. Sometimes we need to retreat and regroup. I turned around because my anxiety level was intolerable, and I would not have been a safe, surefooted hiker. But I returned again and again because the challenge remained, and it beckoned to me. I’m proud of that fact.

Ascent to saddle

My progress can be seen here. The red indicates my best estimate of the trail route as it climbs up to the ridge. The numbers 1, 2, and 3 indicate my three turnaround points.

Each time I returned I made it farther than before. I didn’t reach the summit, but I achieved what for me were great things. I believe that the following helped me:

  1. Familiarity. Some things are frightening largely because they’re unfamiliar. It’s easy to overestimate the risks of things unknown. The first time I faced the washed out section I couldn’t pass it, but the second time I did so easily.
  2. Going at my own pace. Knowing that nobody was waiting on me to make that daring leap ratcheted down my anxiety level.
  3. Knowing more. When the sun came out, true information about the lay of the land replaced fearful speculations about what might lie in the dark.

Though I’ve previously blamed my childhood anxiety on my family environment, further reflection leads me to believe that mostly I’m just an anxious person, and that there’s nothing wrong with that. Anxiety is natural—everybody has it, and it helps to protect us against dangers. People’s sensitivities to anxiety vary widely, from the stupidly reckless who really have no fear, to the anxious overwhelmed whose lives are dominated by it. We’re all on the same spectrum, and one person’s shameful cowardice is another’s prudent caution. I’m not sure how much we can change our temperament, but I believe we can learn to work better with how we’re built, whether by reining in our dangerous risk-taking or by finding ways to dare things we never believed we could.

Hiking Timpanogos was incredible. For me it was a truly intense experience. Magnificent. Terrifying. Beautiful. I’m so glad I made the attempt. I’m grateful for the patience of my friends, who helped me to achieve far more than I would have on my own. Which leads me to:

  1. People. You don’t have to face your fears alone. And that makes all the difference.

The Klonopin Kid

A Young Josh Hansen

I was eight years old. It was a day that most kids would receive as joyously as a mountain of Christmas presents: the last day of school. Yet there I was, past my bedtime, curled up on the floor outside my parents’ bedroom door, sobbing, sobbing.

I was crying because second grade was over, and so was my access to my second grade teacher—the most stable, warm, and motherly person in my life.

I was crying because I felt so loved by my teacher, and because I knew in my heart that, though she surely strove her best, my own mother didn’t have the mental and emotional resources to make me feel so safe and loved.

Enter Klonopin

Fast forward to third grade. Another scene at home: this time, I’m sitting in the living room talking to Dad.

“How many times does your heart beat in a minute?” he asked me. We probably stopped and counted my pulse for a minute to find out. Maybe it was something like 58 beats per minute. “And how many minutes have you been alive? 60 minutes times 24 hours times 365 days times 8 years….” He did the math, maybe on paper, maybe on a calculator. “Your heart has beat 243,878,400 times in your lifetime already. What makes you think it’s going to stop now?”

I had been having trouble sleeping on account of anxiety. I would lie in bed at night fearful that my heart was going to suddenly stop. Dad was trying to talk me through it rationally. And somehow I found the calm reasoning and the authority of math comforting.

It was enough for that night. But as convincing as the probabilistic argument was, my anxiety remained.

Soon Mom took me to see a pediatrician (Doctor Zirkle) about it. At the doctor’s office, I sat on the edge of the exam bed, white paper crinkling beneath me, and answered questions about my fears. We left with a prescription for Klonopin, a benzodiazepine tranquilizer.

The time soon came for my first dose. One night I went to the kitchen with Dad. It was dark, lit only indirectly by the hallway light. From the medicine cabinet above the dish washer Dad brought down the bottle of Klonopin pills. He gave me a glass of water and a tablet, and told me to swallow the tablet whole.

Until that time my experience with taking medicine was essentially cough syrup and other liquids. I had never swallowed a pill whole before and felt like I’d choke on it if I tried. I was an anxious kid! I couldn’t do it. In my fear I dropped the pill, and Dad swore and left me to overcome my fear alone.

I picked the Klonopin tablet up from where it fell and there in the dark of the kitchen at the age of eight, I taught myself to swallow tranquilizer pills.

A tree’s extensive roots, absorbing whatever comes their way. Only metaphorically relevant to this post. Photo by Wing-Chi Poon. CC-BY-SA 2.5.

First Do No Harm

I kept taking Klonopin through third grade. Eventually I seemed to grow out of the need, and by fourth grade I don’t think I was taking the drug at all.

Why was I such an anxious kid? I think I was just sensitive to the instability around me. By fifth grade I was conscious of feeling that my parents and my family were “different”, that there was something wrong with what I experienced at home. If that’s when I became aware of it, then when did the dysfunction really start? Surely it must have been substantially earlier.

Significant anxiety returned to my life in ninth grade, and with it came Klonopin as well, first as illicit doses given to me by my mom, then as a prescription of my own. My anxiety at the time was overwhelming and it was reassuring to take a drug I knew was supposed to calm me down. But it seemed to make things worse in the long run—I continued to have debilitating panic attacks, which didn’t actually go away until getting off of the medication.

If I had a child in third grade experiencing anxiety today, I would absolutely not put them on medication—how could the long-term effects of psychoactive drugs on still-forming brains and personalities be anything but harmful? I would consider seriously whether there was anything in the home environment I provided them that might be cause for anxiety.

Kids are like plants and will grow or thrive in relation to the environment they are planted in. If that environment contains submerged conflict between adults, age-inappropriate roles for children, or anything else amiss, it will subtly warp the child’s development over time. I think that explains my childhood anxiety completely. I was simply internalizing the dysfunction I lived in.

It’s been a decade since I took my last tranquilizer pill. I’ve been vastly less anxious since quitting them. Those things were an albatross around my neck and I’m glad to be rid of them.

Painkillers for the mind

Pills in need of popping. Photo: David Richfield.

Pills in need of popping. Photo: David Richfield.

Once upon a time as a 14 year-old I became very depressed. I was told I had depression, a serious illness that I would have to treat by taking antidepressant medications for the rest of my life. I started taking Paxil (a drug since linked to increased suicidality in young people) and it seemed to help me feel better.

A year later, I wasn’t feeling so well—Paxil’s shine had worn off, and I was depressed again. So the doctor switched me to Zoloft. Aha, relief! But six months later, I wasn’t feeling so well anymore, and they increased the dosage. Then again. And again. Until I arrived at the robust dosage of 250mg a day—that’s a quarter of a gram of mind-altering, liver-assaulting SSRI goodness daily.

I stayed at that dosage for a long, long time. I was not cured—I was still depressed and lived in a doldrums of grey-blue numbness. I also began taking a drug for anxiety—Klonopin, a benzodiazepine. I took that drug for some six years. (Long-term use of benzodiazepines is associated cognitive impairment.)

From the very beginning of my experience with psychiatric treatment I was taught and believed that my sufferings were caused by intrinsic problems with my brain chemistry, and that the solution lay in the ingestion of mind-altering substances. I wondered what past generations had done who had not had access to modern wonder drugs like Zoloft and Klonopin—how had they survived? But I accepted the premise: my brain was the problem, and drugs were the answer.

But drugs were not the answer. Not even close. Each new medication, each new dosage gave me a high and let me forget my problems for a while. But eventually the stimulating effects diminished and I was back where I started, depressed and anxious, living in a tumultuous life with no idea how to make things better.

It’s taken me half my life, but I have come to see depression in a very different light than that showed me by the doctors of my youth. I can sum up this new viewpoint in five simple words:

Depression is not an illness.

Sertraline, my old frenemy

Sertraline (Zoloft), my old frenemy

I used to see depression as an illness, as a biochemical disorder whose causes and cures had little to do with the agency of the sufferer and everything to do with neurotransmitters. In this paradigm, depression is a random happening, much like cancer or kidney disease may seem. You don’t choose to get depressed, it just comes upon you. It’s beyond your control. That was almost the point.

The idea of depression-as-illness hinges upon a belief that depression originates when serotonin and other neurotransmitters in the brain of the sufferer are “out of balance.” I genuinely believed as a teenager that I suffered a serotonin deficiency that had to be corrected by medication. Yet the science does not bear this up, and in the absence of a clear “chemical imbalance” to correct, the rationale for antidepressants is weakened.

“But,” my informed reader protests, “randomized controlled trials have proven the efficacy of various antidepressant medications, so regardless of whether they correct any imbalances, we know they work.” Good point, Informed Reader—there have indeed been numerous randomized, placebo-controlled experiments that seemingly show the efficacy of the drugs. But the studies in question are, in fact, highly suspect, for a variety of reasons.

First, the vast majority of drug studies in the United States and Europe are funded by the drug companies themselves. In other words, an organization with a vast financial interest in achieving a positive outcome for their drug—“blockbuster” drugs make billions of dollars annually, after all—is financing the study. The researchers they work with are dependent on the drug company for access to medications and data, and thus they are incentivized to provide favorable outcomes as well. The drug companies often retain editorial privileges over the research and can even block the publication of results that they do not approve of.

Thus the published studies are only a sample of all those performed—the “unsuccessful” studies have been omitted from the literature completely. And wealthy drug companies with a huge interest in the outcome are willing and able to perform these studies over and over again until the randomized controlled trial dice come up sixes.

Second, the placebo control in studies of antidepressants is faulty. Antidepressants are known for a number of fairly obvious side-effects, from dry mouth to erectile dysfunction. Inert placebos have no such side-effects, and thus study participants can often discern whether they have been given the drug or the placebo. Studies performed using “active” placebo (a placebo that mimics the side-effects of the drug) greatly narrow the advantage of the drug over the placebo.

There are numerous other reasons the “proof” studies tend to be flawed, anywhere from experimental design to statistical analysis. The point is that apparently, when you dig into the science, very little has actually been proven regarding the “antidepressants” other than that they induce a strong placebo effect and that drug companies will do almost anything to get them approved.

Without a causal mechanism, and without robust evidence that psychoactive medications are any more effective than placebo in treatment of depression, the idea of depression as illness appears suddenly shaky.

If depression is not an illness, then what is it?

I can’t answer that question definitively. Nobody really can. Depression is actually very many things—an emotion, an experience, pain, suffering, personal transformation, spiritual struggle, and so on. Here’s the one that makes most sense to me:

Depression is psychic pain.

Sadness

Sadness. It’s an emotion. Photo: Vassil.

I experienced intense physical pain when I broke my collar bone at age 17. The pain made it clear that something was wrong, that I needed to get to a hospital for treatment, and that I should not use my left arm until the bone healed. Physical pain is a vital signal, and we ignore it (or numb it) at our peril. Suppose that upon breaking my collar bone I just took some drugs to make the pain stop and then went back to what I had been doing. I would still have been at risk of shock. By continuing to use my arm, I would have greatly worsened the fracture. Perhaps the next day I would have noticed renewed pain, and taken more painkillers. The bone might have never healed. Nerve damage could have occurred, and who knows what else. All because I ignored my body’s messenger: pain.

For me the same occurred with depression. Depression is psychic or psychological pain, telling us that something is wrong and needs to be fixed. Not a neurochemical imbalance, but something about our emotional and inner life. I grew up in a turbulent family where I had plenty to feel depressed about. Depression was telling me that something was wrong, that there was something that needed to change. But doctors and others, instead of helping me fix the real problems, gave me antidepressants—the painkillers of the mind—to numb my pain. The real issues stayed broken. I was told the drugs were the solution, but though they may have played a helpful role for a moment, drugs were ultimately part of the problem.

I can’t prove that this is the right paradigm, but it makes sense to me. Though I’ve heard objections that there really are people with wonderful lives, loving families, fulfilling careers who feel inexplicably depressed, I stand by the belief that depression is pain telling us something is wrong. The inability of the sufferer to immediately identify the thing that is wrong (like I was unable to as a teenager) does not make it less true. After all, physical pain very often comes in advance of our awareness of its cause—why shouldn’t psychological pain as well?

There are so many things that could be getting people down, from relationships to diet to the inhospitable surroundings of modern urban life, unrealized ambitions, unmourned losses, lack of exercise, lack of love, and whatever else. Maybe there isn’t a chemical imbalance, but there are many other ways our lives can become imbalanced, and I believe depression can help us to notice when this happens and set it right.

Next time you encounter somebody feeling depressed (maybe it’s you), sure, give them some antidepressant “painkillers” for their sorrows if you have to, but don’t leave them with those numbing drugs indefinitely. Help them get to the bottom of the pain. Healing and transformation are so much harder, but so worth it in the end.