Wednesday, April 18, 2012

Performance-enhancing drugs

Rx reminder
About two years ago I was suffering from a debilitating and possibly deadly illness. Sadly, I was suffering because I was refusing to get treatment. I had seen others get this illness treated with medication and some of them had suffered from bad side effects, which scared me. I convinced myself that I could beat my illness without medical attention. But my condition worsened and it was affecting everyone around me.

If I told you that condition were cancer or Parkinson's or some other obviously physical ailment, I'm sure you would be scratching your head as to why I refused treatment for so long. However, my ailment wasn't obviously physical. Instead, it was mental. When I finally sought a diagnosis, I learned that I was suffering from an extreme anxiety disorder and moderate depression. 

When I tell this to people who know me well, they're almost always surprised. This is because I was generally pretty good at hiding my symptoms. It was only when I was alone that I would obsess for hours about some interpersonal interaction from earlier in my day. It was at night when I couldn't sleep. It was in the mornings, in the shower when I battled the voices that told me I wasn't good enough, and I shouted back in irrational but real anger. It was in my office that I continually looked over my shoulder for my colleagues to find out that I didn't belong at Caltech (impostor syndrom is a real thing!). 

Near the end of my refusal to seek treatment, I wrote a blog post for Astrobites entitled Zen and the Art of Astronomy Research, which pretty much went viral within the astro community. In it, I said:
Most people find the topic of mental health a bit unsettling, so I made sure to qualify what I meant by the term. I wasn’t insinuating that anyone in the room was crazy or mentally unstable. And I wasn’t trying to get all squishy with my audience by talking about warm fuzzies, or fuzzies of any [temperature] for that matter. But in the same way that it’s important for you to take care of your lower back by lifting with your legs, it’s important to take care of your mental state while you tackle the rigors of science. After all, you can in principle reduce your data with a bad back. However, if you’re not thinking clearly, or if you are perpetually unhappy with your lot in life, your astronomy research will certainly suffer.
I think it took writing this down on the page in order for me to recognize and come to terms with my own problem. Soon after writing this article, and obsessing endlessly about others' perception of it, that I decided to seek help. 

My first stop was to Caltech's excellent Staff and Faculty Consultation Center. After a few sessions there focusing on my fear of being discovered as a fraud by my colleagues, I came to realize that what I was going through wasn't as rational and as firmly rooted in empiricism as I had convinced myself it was. I also realized that my tendency to endlessly replay interpersonal interactions wasn't just a part of my personality, but related to a chemical imbalance. I had the equivalent of a herniated disk, but in my brain. And just as if I had injured my back, there exists a variety of treatments for my ailment. Further, I didn't have to be "crazy" to need treatment for my mental state. There's no shame in seeing a physical therapist. There's no shame in seeing a mental therapist.

The first couple counselors I met with didn't really work out. One even tried to engage me in an academic pissing match, touting his credentials and bragging about the various institutions in which he held appointments. Next! I was tempted to give up and attribute the shortcomings of those first few therapists to a failure of counseling in general. But with the encouragement of my wife I pressed on and settled on Dr. Delker. She really understood me, was patient, yet knew when to be direct with me and call me on my B.S. On that latter point, she kept pushing me on my fear-based refusal to try medication.

Counseling was going well for a few months. But then one day I found myself at a stop light with someone tapping their horn behind me. I looked up and realized that not only had I been stopped at a green light, but it was now turning yellow. Further, the reason I was stopped there was because I was yelling at myself. Why? Because I had said something to a colleague that belied my ignorance about an aspect of a astronomy. Now, I can look back and see how ridiculous that was. I was just over three years out of grad school (at the time), of course I haven't mastered GR by now! But my sprained mental state was forcing me to beat myself up about it, much like an allergy suffer's immune system overreacts to pollen and attacks its own body. Just as I take a daily dose of Zyrtec, I needed to start thinking seriously about meds for the chemical imbalance my brain.

Hence the screen cap of my morning inbox, pictured above. Every day I take an allergy pill and a dose of Lexapro (similar to Prozac). Ever hear the tearm "miracle drug"? Man, Lexapro is the bomb! After a month of minor side effects, including a mild upset stomach (I now take the pill with food), I found myself in a whole new world. Suddenly I was able to make mistakes and...not think about it for days. I was able to hear criticism. But more importantly and amazingly, I was suddenly able to hear compliments and not assume I had fooled the person complementing me. I was finally able to hear praise. I could give a colloquium and not obsess about the slide transition I missed and I was actually able to hear it when people said, "That was a great talk!" I can't tell you how good it feels to hear someone say that and not have to brush it off. It wasn't humility that caused me to do that before. I was that I truly couldn't hear it.

Now, to be sure, the solution I found is not a magic bullet. I also put in a year of weekly therapy sessions that helped me uncover and deal with uncomfortable events in my past that trigger certain reactions in me. Also, I'm fortunate in the extreme that the first medication I tried worked so well. This is not the case for everyone. Finally, I'm currently working with my psychiatrist to ween myself off of the drug now that my brain has been retrained (I can feel habitual reflexes to react the way I used to, but I can coldly refuse to follow those reflexes). Drugs are not the ultimate and final solution (like Patton Oswalt, I can't help but worry about being dependent on medication after the pending apocalypse :)


Back when I was suffering from my ailments, one of the recurring ideas that I used to dwell on was what I would do if I had one wish. What I'd always come up with was not riches, nor super powers or anything like that. My single wish used to be that I could truly be as exceptional as people in my department and science field thought I was. My wish was that I could be like that guy in the movie Limitless, and I could take a pill that would make me as smart as my colleagues at Caltech.

In many ways I found that pill...and much, much more! (plus it didn't involve a fight to the death with the Russian mob at the end of the story :) But instead of adding something, all the pill did was remove the barriers that prevented me from seeing the truth that, you know, I'm actually pretty good at what I do.

It is now my goal to be an outspoken advocate of mental health in my community. Now that I'm "on the other side" I can clearly see how many other scientists suffer in varying degrees from what I suffered. This widespread problem is resulting in a large impact on scientific productivity and a lot of unhappiness in the halls of our highest places of learning. It needn't be that way. We need to start recognizing that mental health is not a matter of crazy vs. sane. It's a matter of happy vs. unhappy, productive vs. destructive, and no different than physical wellbeing. Just as I wrote in in that Astrobites post, 
This might sound like strange advice coming from a professor. Shouldn’t I be telling you about publishing or perishing? Shouldn’t I tell you to suck it up and pull an all-nighter again? Well, science is fundamentally a human pursuit and we do ourselves and the field a disservice by forgetting this simple fact. Unhappy graduate students tend to be sloppy, less productive researchers. Happy students, on the other hand, vigorously pursue interesting science questions, give outstanding talks and churn out well-written papers. Thus, as a professor, it’s in my best interest to work in a science field full of mentally-healthy [individuals].



9 comments:

Unknown said...

Maaaaaan.... thanks for sharing this. Been there, or I should say, am still there. I have been dealing with anxiety/depressive disorders since high school... mostly under the radar to 99% of people. I would go through long periods of deep depression & anxiety, suppressing it because I didn't want to be judged. Unfortunately, anxiety finds a way to express itself, so I developed obsessive/compulsive hypochondria. I literally had a breakdown where I was convinced a minor scratch from a friend's puppy gave me rabies. The scientific, logical side of my brain tried to reason with myself that this was absurd, but emotionally, I was 100% convinced... if you know anything about rabies, there is only 1 case per year in the US on average, and it it is symptom free for about a month... I would break down in crying fits on the bus, in the grocery store, etc... but at school, I was the happy professor. At night, I would cry myself to sleep convinced that I could literally feel the rabies attacking my nervous system... After a particularly bad day of panic attacks, I finally called the hospital. I remember apologizing to the doctor, saying that I was a scientist and I knew how absurd this all was... the doctor could hear my shame, and stopped me... all he said was, "You do not need to live like this. This is not your fault." Wow... I needed to hear that... I had episodes like this on and off since my 20's... months and months of anxiety that I suppressed until it would explode for a month in obsessive-compulsive panic attacks... Fortunately, I was able to get on an effective anti-anxiety med, and have been panic attack free for a couple years now. There is so much fear and shame related to mental illness... we often act as if it is a character flaw. I applaud your honesty. More of us need to step out of the shadows.

kelle said...

oh JohnJohn, thanks so much for sharing this! I think so many of us struggle with anxiety and imposter syndrome to varying degrees and we really can help each other recognize our mental demons, accept them as legitimate problems, and deal with them so that we can be a community of productive, creative, and happy scientists!

Marshall said...

John -

Major kudos to you for speaking out like this in support of mental health in our community. I know exactly how hard it can be to struggle with depression, and how much harder it can be to admit (to yourself, and to others) that you're not some superhuman Platonic ideal of a flawless scientist, capable of leaping tall proposal deadlines in a single bound. We all aspire to that, yet the end result is that the vast majority of us just end up suffering from "Imposter's Syndrome", and beating ourselves up to no good end. We're our own Kryptonite...

Like you, I've wrestled with depression at times, and like you, I've found SSRI antidepressants to be a pretty powerful boost to my mental well-being. I agree completely with your point that Lexapro et al. aren't magic bullets in the long run, but they're pretty damn close for the short to medium term - like a pause button for all those negative brain subroutines, that gives you a chance to catch your breath and start forming some more positive mental habits without having to fight so hard against yourself every step of the way.

It's funny, I remember quite clearly talking with one of our mutual grad school mates back in '08 or so, as she told me she didn't think she had what it took to make it in astronomy, figured she'd be found out for a fraud sooner or later. Meanwhile, as I told her about my own ups and downs, her response was total surprise at how I could possibly not feel like I had my act together, given that from her perspective I was completely on top of things and doing great work. Yet in my head was that same refrain, "I'm not good enough / They'll figure it out sooner or later / I'm not as smart as <insert name of senior faculty member or Nobel laureate here>" Then the next year she ran the table on prestigious fellowships and today has a great faculty job, while I meanwhile have ended up doing work I utterly love at an institute that feels like a perfect fit.

Moral of the story: we are all terrible at assessing our own competence much of the time, as our own harshest critics inside our heads get caught in vicious cycles. The negative consequences of this can range from lost sleep and reduced productivity all the way up to death, as in the tragic cases of Andrew Lange, Sam Roweis, and Weidong Li.

Heck, if I'd been asked an hour ago before I read your post, I'd have placed you in the camp of "people who are clearly doing awesome and can't possibly be worried about anything." Ha - just goes to show that merely having been down this road myself before doesn't mean I'm any better at spotting the signs and symptoms in someone else. So… that makes it at least 50% of our grad school entering class. Small number statistics, yes, but I think it's safe to say this is not a rare problem. On the bright side, 2/2 data points suggest that seeking professional psychological/psychiatric help can be very effective!

Marshall said...

[Continued - this comment ran past the string length limit on Blogger!]

The counselor I worked with in L.A. described people like us as "high functioning cloaked depressives", meaning folks whose innate level of skill and competence makes it possible for us to function for the most part normally outwards regardless of internal mental state. We don't end up not getting out of bed in the morning or drinking to excess or otherwise really obviously displaying signs of major depression, we instead just rattle around in our own brains, hitting the same negative triggers over and over again to our own detriment. And because there's less of an outward cry for help in such cases, it's all the more important for everyone to know that it's OK to ask for help when you feel like this. More than OK - it's one of the best things you can do.

So like I said above, I think it's awesome that you've decided to be an advocate on this issue. As the first commenter said, there's too much fear and shame. Hopefully if enough people speak out, if enough prize-winners and prestigious professors and students and staff at all levels let their own struggles with depression be known, it will be easier for those who come after to seek out and get the help that they need, to be the best (and happiest!) scientists and humans that they can be.

- Marshall Perrin

JCH said...

Hello John, Thanks for this post. I will share it as needed with my students and the African American Astrophysics community. Don't forget to support "Black Sun" http://kck.st/J2q1qy!
Jarita

JCH said...

Hello John,

I will be sharing this post as needed with my students and others in the African American astronomy community. Continue to make Caltech a better place!

Jarita
http://kck.st/J2q1qy

Vicky said...

I know I'm late to the party, but thank you so much for writing this. Looking at the date of the post - I wish I'd read it that day. That's the week that I finally started on anti-depressents after months of my doctor suggesting it may help while I pretended that nothing was wrong.
To say it's completely changed my life would be an understatement. This time last year I almost quit my job as a postdoc because I was worried that I may have made an error in a paper. I was convinced I would be laughed out of the department and never find another job. There were weeks of sleepless nights, panic and desperation. I don't even want to write about it now, it upsets me too much. And it got much worse.
Now I'm like a different person. I still get the odd jolt of feeling like an imposter, or worrying about my work but I don't hide for days, or drive around Pasadena for an hour so I don't have to go to my office.
Thank you so much for writing this. Seriously, it's so important. Thank you.

audra said...

Well said, well written, and so important that a post like this comes from a professor.

And important point from Marshall about how depression can look totally different in each person. The first time for me, right before I quit astronomy, was the classical world-drained-of-color and uncontrollable despair most of my waking hours. The second time, after having a child, involved no tears and no despair but lots of irritability and anger. A good psychiatrist will ask for a detailed history and symptoms and hopefully prescribe something appropriate.

The fact that impostor syndrome might also be a sign of depression...that is some interesting thinking. I'll have to mull that over.

Rob Knop said...

Lexapro only worked for me for a couple of years. It helped a lot at first, but after a while I must have "developed a tolerance" for it or some such. I switched to Effexor, which does seem to do the trick a bit better. At least, most of the time.