Death Grip (29 page)

One half milligram a day, Klonopin, Boulder, Colorado, late September/early October 2005:

Autumn—not “fall,” which is a dirty word to climbers—is a sacred time for Colorado rock jocks. We call September “Sendtember” for its cool, dry conditions, and October can be even better. The cliffs, etched against azure skies, ripen to their full beauty, dark smudges of stone emerging from red, sienna, and golden stands; underfoot ferns turn yellow then dry, flaky brown, and even noxious plants like poison ivy glow vibrant crimson. Unlike late spring, with the whole climbing season before you, in autumn you feel the clock ticking—it's time to finish up any outstanding projects before the snow starts to fly.

Too bad I have to sit this one out. Tragic, really—it would tear at any climber's heart. You get only so many autumns in a lifetime.

Before my father left, we devised a plan to see me through my taper. He wanted me to return to Hopkins, but I just couldn't. I agreed to start seeing a therapist in addition to working with Dr. Porridge. This therapist came highly recommended, an anxiety expert who'd mentored the woman I used to see back in Glenwood Springs. I approach it all with fresh optimism, at least for the first week or two, happy for my nominal freedom. The therapist isn't cheap—she works from her stately Victorian home—but my father is paying and seems fine with doing so. I feel guilty, a broke and uninsured thirtysomething leech, until he tells me he just wants me to get better.

This therapist: It's complicated. She is a well-meaning woman who did come to care for me, who once came and plucked me from my house when I'd stopped answering phone calls and become semisuicidal. She helped me to leash-train Clyde by showing me how to use a Gentle Leader and how to bribe him with bits of frozen hot dog. She visited at Mapleton when I ended up back there as an inpatient. And she would have me come over for an oatmeal-and-blueberries breakfast, and then take me walking around the Pearl Street Mall, downtown's pedestrian area, to show me how to be out in the world again. But she is also distinctly overbearing and takes a narrow “tough-love” cognitive-behavioral approach, which means she operates only within certain paradigms. She really does not know the first thing about supporting benzo withdrawal, a fact borne out by her confession to me, after I returned from Hopkins, that not one of her patients had ever successfully tapered without hospitalization. Things could have been framed so much better, so much differently.

Early on, this therapist gives me solid tools: a bag of birdseed in a pillowcase that I heat in the microwave and then place on my belly for breathing exercises. The heat, weight, and pressure are reassuring, and it's nice to have something I can reach for other than pills at sundown. And she refers me to a healer and yoga teacher, Steven, who leads therapeutic-yoga classes in Boulder and does private sessions at home. With Steven, I work on chi breathing exercises, stretches, and “bottle work”—using the neck of a plastic bottle to massage my belly as I visualize breathing through it, drawing the air down deep using the diaphragm instead of taking nervous upper-chest breaths. Steven has a theory that by using the bottle until your guts soften and burble, you're stimulating the enteric nervous system to promote calm. I begin carrying a Perrier or Vitamin Water bottle with me—it will become a talisman, my only solace on nights of unending agony.

I also start visiting a massage therapist, a beauty with a South American accent and miracle hands. I have a secret crush on her, so it's no problem battling my way across town for an appointment, and I always leave feeling better … at least for a half hour. Between the psychiatrist, the therapist, Steven, and the massages, I have at least one appointment every day: all the king's men, trying to piece Humpty Dumpty back together again. These visits provide the only structure to my days—a raison d'etre when the ones that matter most, climbing and work, have been stripped away. I've taken to lifting weights at home, using chi exercises between sets to temper my breathing. I will keep to the weights religiously for the next two years because it's often the only exercise I can do.

The therapist promises that if I can “withstand some strong sensations” she will get me off benzos. I'm encouraged. We start with a benzo-tapering workbook. It's written by two psychiatrists who, given their breezy, clinical tone, have clearly never undergone withdrawal. It's on loan to me, the pages coming loose from the binding, the glue old and cracked. I take the book home, start reading, dutifully tracing the withdrawal timetables onto paper of my own so I can track my progress. According to these experts, I should be done in four to six weeks—not so long at all. I can't wait! I have it in my head that once I'm off, the anxiety will, lacking fuel, smolder and die out. I just need to be shut off this last half milligram. Then I see it: an equivalency table. It reveals that my “tiny” dose of four milligrams of Klonopin a day actually translated to eighty milligrams of Valium, as much as I was abusing in 1996. Right now, at a half-milligram of Klonopin a day, I'm still on essentially ten milligrams of Valium: an entire Roche Blue Note. I flip the page, landing on a random paragraph: “There is some evidence that the higher the dose and the longer the duration of use, the more symptomatic will be the withdrawal process, though the patient should not let this fear impede his or her progress off the drug.”

I don't like this book so much anymore. I also don't like a couple things the therapist lets drop, careless tidbits discouraging in timbre, things not to say to someone as fragile as I've become: Namely, that she can't be certain that Vicodin abuse hasn't left me permanently panicky, like a musician client of hers she mentions who fried his circuits with cocaine, and that I have the absolute worst anxiety of anyone she's seen. When you've lost all sense of yourself in a crisis and your brain has been chemically rendered so malleable, ideas like these congeal like footprints in wet cement. They're dangerous. They extinguish hope. As she tells a roomful of fellow panic sufferers one night during weekly group therapy, “This is Matt, who's joining us for the first time. And can you believe that his anxiety was so bad that his doctor had to put him on
four milligrams
of Klonopin a day?”—the implication of course being that the problem is intrinsic to me and not entangled with these addictive pills.

Bullshit—I'm a climber. I deal with more fear in a year than most people will in their lifetimes, wasting away before the idiot box second by brain-dead second.

Remember, we go to health-care practitioners for, if not perfect wisdom, at the minimum an infusion of hope to empower us to keep fighting.
Primum non nocere
—“First, do no harm”—is the guiding principle of modern health care. This should also extend to the way one's condition is verbally framed by a caregiver, especially if the patient is psychically vulnerable.

Housebound and hopeless, I've lost all sense of myself, all discernment when making decisions, especially when it comes to my health. I'm able to work a little, on freelance transcription and copyediting projects for a local publishing house, but besides my various appointments this work is my only contact with the outside world. I dwell in a thickening twilight, a fear-fog teeming with winged bugaboos, howling banshees, and fanged demons. There are no longer any boundaries between the anxiety and me: I've
become
anxiety, though a better word really is
terror.
It is existential terror—not a fear of any particular thing, but a bottomless horror at simply existing so lancing it precludes rational thought. As my father would later put it, “You certainly didn't have control over your thinking.” My brain is like a sponge, but not in the good way, like a toddler soaking up language. It's more like a cinder-block wall on which any gangbanger can spray-paint his tag because the ego boundaries that make me
me
, my assembled years of opinions, emotions, thoughts, and experiences, have been obliterated by benzodiazepine withdrawal.

Little wonder then that I continue to drink the Kool-Aid when Dr. Porridge reiterates that this taper must be approached from a “place of strength” and that “not having other meds on board could be very dangerous.” I still trust and believe him that there mustn't be any “gaps in treatment.” I am the empty, shocky vessel into which he can pour his steaming elixirs, a walking, talking human-test-tube experiment. I find myself at his office on a dim late-autumn afternoon, the sky snot hued and gauzy out the window, telling him how much trouble I've been having sleeping and focusing. I ask the doctor what he thinks about taking another month to get off Klonopin, and he says that I could easily cut a quarter milligram every three days, which would mean I'd be done in, well, a week.

Only a week?

“And you've seen other patients do this, Dr. Porridge?” I ask.

“Yes, certainly.”

“Tapering this quickly, without any problems?”

“No. No problems—they were completely fine, with no spike in anxiety after a week or two. You might feel some flu-like symptoms for a few days, a headache, fever, and chills, but that's about it.”

“And I'm done.”

“Yes, you'd be done.”

“Just like that?”

“Just like that.”

Dr. Porridge writes a prescription for a few sleeping pills, Ambien, which he assures me won't interfere with my taper. What I don't know and what the doctor doesn't bother to relate is that Ambien, like Lunesta and Sonata, is one of the “Z drugs”—for their generic names zalpelon, zolpidem, zoplicone, and eszoplicone—which despite being labeled “nonbenzos” because of structural differences have a nearly identical chemical action. The drugs bind selectively at BZD receptor sites and can cause similar problems to benzos, among them rebound insomnia when you quit taking them. I shouldn't be on Ambien, especially not now. But he doesn't tell me that. He also gives me samples of Risperdal, an antipsychotic.

I have just one more question:

“Dr. Porridge, what do you think about doubling my dose of Paxil, like the doctor at Hopkins suggested?”

“Well, Matt, I think that's probably a very good idea. It might give you the foundation you need to get off benzos.”

“Should—should I try it?”

“Yes, I think you could do that.”

“Okay. I'll try it starting tomorrow and see what happens.”

“Great. We'll see you back here on Friday. Let me know how it goes.”

“Okay, then. Friday…”

The Paxil blows up my world. I become suicidal.

One old chestnut the psychiatry establishment likes to trot out to explain away any such adverse reaction to antidepressants is that the risk of suicide goes up your first few weeks on a new drug because the drug has “activated” you. (I heard this echoed again and again at the hospitals.) In other words, you, the poor, shambling, hapless depressive, newly recharged by said miracle potion, have finally found the energy to exact your undoing. It's a drive that you lacked earlier, being somehow too enervated to walk to the garage, turn the car on, and run a hose from the exhaust pipe into your window. To me it's a specious argument: Look at how many people commit suicide every day—32,637 in America alone in 2005, for example.
17
They
all
—sadly, horribly—found the energy to kill themselves, and it's highly unlikely that every last one of them was just starting antidepressant therapy. In fact, I'd hazard to guess that most of them were indeed massively depressed at the time.

The fact remains that if you want to kill yourself, you will find a way. Man always has and always will. What antidepressants can do—and what twenty-five milligrams a day of Paxil did to me—is foment an insidious condition called akathisia, which we might call “activation times one thousand.” Dr. David Healey, a psychiatrist and author, in 2004 published a book called
Let Them Eat Prozac,
an unsparing look at the known dangers of SSRIs, including akathisia, and how they were nonetheless kept on the market. The word
akathisia
was coined by two German-speaking psychiatrists in 1955 and literally translates as the “inability to sit still,” though it is best understood as “agitation” or “inner turmoil.”
18
(The condition has been associated with the antipsychotics as well.) In 2004, the FDA directed manufacturers to put a “black-box label warning” on SSRIs for children and adolescents and proposed an extension extended up to age twenty-four in 2007, warning of the risk of suicide and suicidal thoughts early in treatment. But what drives this risk? Well, according to Healy, iatrogenic akathisia. As he summarizes, “Prozac and other SSRIs can … cause suicide in individuals who have no nervous conditions, primarily by inducing mental turmoil during the early stages of treatment.”
19

“Turmoil” is a nifty term—we use it to talk about the Middle East or that troubled uncle who never quite finished high school. But akathisia is something different; a better synonym would be “hades.” For me, one day after increasing my Paxil, it begins with a manic, dissociated, rushing feeling, like I've taken too many truck-stop energy pills. By day two I experience heart flutters, random flurries of palpitations that trigger heart-slamming panic attacks. Very little fear accompanies the attacks, however, almost as if they are happening to someone else one body away; my psyche feels distant, shellacked in Pepto-Bismol. Kasey and I go to Target one evening and bump into Rolando and his wife; just seeing them there, the first time I've run into Rolo since the First Flatiron debacle, triggers the response. Rolo is a good friend and would never judge me, but just a moment's flashback to being trapped on that ledge with him sets me off.

The worst part is, I stop sleeping. It's not a quaint, Bohemian “trouble sleeping,” with thirty minutes here and there adding up to a few hours each night; it's straight-up not sleeping. I'm too agitated to read or watch TV, out in the living room so Kasey can slumber in the bedroom, adjusting and readjusting my position on the couch in the hopes of tricking my body to shut off. I thrash, I sweat, I tremble; I watch paramecia whip around the corners of my vision. After two nights of this, the world takes on a white insubstantiality as if being rendered into paste. Day and night become one vast, gray, unchanging crepuscularity, the hours and minutes like blank, effaced mile markers on some unending purgatorial highway. I feel a high, hollow nausea like I've consumed too much coffee. My bones
itch,
like my skeleton wants to peel free and run away from my muscles. This is akathisia: inner turmoil. I can see why it might drive you to suicide.