Dear Kayla,
Not many people are aware that I have successfully managed to go off psychiatric medications. When people do find that out, they urge me for advice or suggestions. I actually do not have that many suggestions. But I wanted to tell you the little I have learned.
My last psychiatrist realized I was over-medicated. He took me off some psychiatric meds within months or a year or so after I started seeing him (I forget the exact time frame). At the time, I did not realize how unusual this treatment was. I have since learned that most doctors will insist their patients remain on medicines regardless of what the patient wants. I did not personally encounter that situation, and I am not sure how to advise people about it. I apologize for that.
After a while my psychiatrist decided to take me off my primary antidepressant. I knew it was not the right time - I despised the place I was working at the time - but I was too meek to speak up. That was a considerable mistake. I grew increasingly miserable and ended up going back on a higher dose of the antidepressant than I was originally taking.
In theory, the doctor was supposed to wait a year after that before trying to take me off medicines again. Eight months after that failed first attempt I was in a much better job, feeling better about myself, and essentially told my psychiatrist, "Take me off these things now." He agreed on the condition that we go slowly. I think (it was about five years ago and I don't remember all the details perfectly) we started at a dose of 300 mg and reduced it by 75 mg each month. When we first started cutting the doses it would take a day or two for my body to adjust and then I would be hit with depressive symptoms. I would need to withdraw from activities as much as possible and figure out ways to cope. After a few days both my body and my mind would start to adjust and I would be able to function more fully. Usually after a month I would be more than ready to reduce the dose again.
One time I asked to postpone our scheduled dose-reduction because I was dealing with considerable external stress and knew that I could not deal with both issues at once (the changes while reducing the dose and the external crisis). That proved to be a very wise decision. After two weeks I was able to continue going off the medication. I think if I had tried to keep the schedule I would have relapsed.
After a few months I started being able to anticipate and plan for dose-reduction problems ahead of time. After that it grew much easier.
My antidepressant was the most difficult medicine to stop taking. There are a few lessons I can give you from my story: (1) Do not attempt to stop taking medicines unless you are reasonably satisfied with your present life. I think waiting a year - the psychiatric recommendation - is excessive, but you need to be fairly happy with what you are doing and what you are feeling at the present time (2) Go slowly and give your mind and your body time to adjust (3) Don't hesitate to postpone reducing the dose if your life circumstances change and/or you have a crisis. Going off medicines is difficult enough. If you add outside stress it can be overwhelming.
I hope this is helpful.
Saturday, December 29, 2012
Monday, April 9, 2012
4/9/12
Dear Kayla,
I have been working toward learning to interact more with the world.
When you are interacting with someone you don't know well, it is easy to feel slighted. When people don't know you well, they don't understand how you will feel and react to certain small things. Chances are they don't even know what bothered you. I know I have done that to other people on numerous occasions. But it can be really difficult to tell: When is someone's slight genuine and when is it your imagination?
Part of many people's mental illness is a difficulty distinguishing between the two. Some people ignore legitimate threats, and a greater number interpret insignificant nuances and coincidences as intentional threats. I can't tell you how to distinguish real threats from misinterpreted ones in a single letter. That takes years: Frankly, I think that NO ONE, with or without a psychiatric history, is able to perfectly distinguish real threats from imagined ones. But I can give advice.
I have learned that if someone slights you or seems annoyed at you, one thing to examine is whether they are treating everyone that way or just you. Other people have their own problems, they have their own bad moods, and as I said before they can slight people without even knowing it. If you can, watch them closely as they interact with other people. Try to emphasize with the "other people," not the person who upset you. Do your best to imagine how those "other people" feel as they are interacting with this person. Would they feel slighted or upset or put off, too? That is a really clear sign it is not just you.
As I said, social interactions are extremely complex and take a long time to learn. But I can share what works for me.
I have been working toward learning to interact more with the world.
When you are interacting with someone you don't know well, it is easy to feel slighted. When people don't know you well, they don't understand how you will feel and react to certain small things. Chances are they don't even know what bothered you. I know I have done that to other people on numerous occasions. But it can be really difficult to tell: When is someone's slight genuine and when is it your imagination?
Part of many people's mental illness is a difficulty distinguishing between the two. Some people ignore legitimate threats, and a greater number interpret insignificant nuances and coincidences as intentional threats. I can't tell you how to distinguish real threats from misinterpreted ones in a single letter. That takes years: Frankly, I think that NO ONE, with or without a psychiatric history, is able to perfectly distinguish real threats from imagined ones. But I can give advice.
I have learned that if someone slights you or seems annoyed at you, one thing to examine is whether they are treating everyone that way or just you. Other people have their own problems, they have their own bad moods, and as I said before they can slight people without even knowing it. If you can, watch them closely as they interact with other people. Try to emphasize with the "other people," not the person who upset you. Do your best to imagine how those "other people" feel as they are interacting with this person. Would they feel slighted or upset or put off, too? That is a really clear sign it is not just you.
As I said, social interactions are extremely complex and take a long time to learn. But I can share what works for me.
Wednesday, February 29, 2012
2/29/12
Dear Kayla,
I forgot to add a piece to my last letter.
When I was first working on my reading comprehension, I started with short stories. I thought if the materials were shorter they would have fewer pieces and would hence be easier to follow. I still read slowly, and with short stories I could read them in less time; I could read them over and over again; and I could figure out the pieces.
I have since realized that I was wrong. I needed longer novels with more clues and more opportunity to develop the story. In longer novels there is more of a margin for error and more chances to correct misinterpretations. Also, it takes me a while to grow used to a writer's style, which means I need more opportunity to organize and process the story. Short stories are simply too short to provide that opportunity.
Of course, I needed to be careful not to err on the other side. Books which are too long are often very complex and can become overwhelming. But I learned that I needed some time to grow used to the writing style and the story. Right now I try to work with novels that are about 150-300 pages.
It has also helped me to go back and read some of the literature which was assigned to me in high school. Now that my comprehension and interpretation is improved, it helps me to go back and try to pick up some of what I missed then. Those books were chosen for a reason, and they are likely at the difficulty level I need right now.
Again, this is just me. I don't know what worked for other people.
I forgot to add a piece to my last letter.
When I was first working on my reading comprehension, I started with short stories. I thought if the materials were shorter they would have fewer pieces and would hence be easier to follow. I still read slowly, and with short stories I could read them in less time; I could read them over and over again; and I could figure out the pieces.
I have since realized that I was wrong. I needed longer novels with more clues and more opportunity to develop the story. In longer novels there is more of a margin for error and more chances to correct misinterpretations. Also, it takes me a while to grow used to a writer's style, which means I need more opportunity to organize and process the story. Short stories are simply too short to provide that opportunity.
Of course, I needed to be careful not to err on the other side. Books which are too long are often very complex and can become overwhelming. But I learned that I needed some time to grow used to the writing style and the story. Right now I try to work with novels that are about 150-300 pages.
It has also helped me to go back and read some of the literature which was assigned to me in high school. Now that my comprehension and interpretation is improved, it helps me to go back and try to pick up some of what I missed then. Those books were chosen for a reason, and they are likely at the difficulty level I need right now.
Again, this is just me. I don't know what worked for other people.
Sunday, January 15, 2012
1/15/12
Dear Kayla,
There were many dimensions of learning how to learn, probably because there are so many ways to learn. As I said before, I am still working on that myself. But I can tell you what I do know.
Learning how to read was a large project in itself. In retrospect, I wish I had pushed myself more aggressively in that area.
To be clear, I was always able to read the words well. My mother, an elementary school teacher herself, said I learned to read right with the system. But I had considerable problems with comprehension. In hindsight, that makes sense; if I couldn't comprehend the world I observed around me, I certainly couldn't comprehend someone else's world I was reading. I watched the same television show over and over again until I was better able to follow situations and pick up cues from the broader context. I expanded to watching several seasons in this same television series and watching longer movies. But learning through reading was a separate skill, and I wish I had worked more on that.
Eventually I started reading at a level I could comprehend. For me, I needed to go back to upper elementary school books (grades 4-6). I read some of the books I remembered reading as a child, some of the books I wanted to read as a child and never did, and some more recent childrens' books which looked interesting. After a while, I moved to young adult fiction and then to easy adult fiction. It took an enormous amount of trial and error, figuring out which authors worked for me and which did not. (For a brief period afterward, I went back to childrens' books so that I could focus on speed.)
All this was for reading fiction. Nonfiction took even more potential for trial and error and error and error. I eventually learned that different subjects require different approaches and forms of concentration. The skills you need for reading history are different from the skills you need for reading biology. Obviously, in the beginning you need to start with topics you know and enjoy. For unfamiliar topics, I start with the Great Courses lectures. Once I watch or listen to those lectures in a particular topic, it is no longer unfamiliar. That being said, it can still take a while to find appropriate books and learn how to focus on them.
All this comes down to the lesson I give to people who are just starting a task or who are stuck: Do what you can do, not what you most need. If a book looks unappealing or it is a struggle to follow the author's style, then in the beginning you cannot learn from it. Later on, when you become more skilled, you will probably grow more flexible. But in the beginning you simply need to start simply and slowly.
There were many dimensions of learning how to learn, probably because there are so many ways to learn. As I said before, I am still working on that myself. But I can tell you what I do know.
Learning how to read was a large project in itself. In retrospect, I wish I had pushed myself more aggressively in that area.
To be clear, I was always able to read the words well. My mother, an elementary school teacher herself, said I learned to read right with the system. But I had considerable problems with comprehension. In hindsight, that makes sense; if I couldn't comprehend the world I observed around me, I certainly couldn't comprehend someone else's world I was reading. I watched the same television show over and over again until I was better able to follow situations and pick up cues from the broader context. I expanded to watching several seasons in this same television series and watching longer movies. But learning through reading was a separate skill, and I wish I had worked more on that.
Eventually I started reading at a level I could comprehend. For me, I needed to go back to upper elementary school books (grades 4-6). I read some of the books I remembered reading as a child, some of the books I wanted to read as a child and never did, and some more recent childrens' books which looked interesting. After a while, I moved to young adult fiction and then to easy adult fiction. It took an enormous amount of trial and error, figuring out which authors worked for me and which did not. (For a brief period afterward, I went back to childrens' books so that I could focus on speed.)
All this was for reading fiction. Nonfiction took even more potential for trial and error and error and error. I eventually learned that different subjects require different approaches and forms of concentration. The skills you need for reading history are different from the skills you need for reading biology. Obviously, in the beginning you need to start with topics you know and enjoy. For unfamiliar topics, I start with the Great Courses lectures. Once I watch or listen to those lectures in a particular topic, it is no longer unfamiliar. That being said, it can still take a while to find appropriate books and learn how to focus on them.
All this comes down to the lesson I give to people who are just starting a task or who are stuck: Do what you can do, not what you most need. If a book looks unappealing or it is a struggle to follow the author's style, then in the beginning you cannot learn from it. Later on, when you become more skilled, you will probably grow more flexible. But in the beginning you simply need to start simply and slowly.
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