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L.B.: 28:06:42:12

Left Behind, pp. 387-391

“I felt my heart strangely warmed,” John Wesley wrote of the moment of his conversion. Something similar is happening to Buck Williams in this passage, but his warmness is far stranger than Wesley’s:

Buck did not trust himself to respond with coherence. He still had chills, yet he felt sticky with sweat. What was happening to him? He managed a whisper, “I want to thank you for your time, and for dinner,” he said.

I don’t know if you do this too, but sometimes when I read a scene — particularly one with a vivid description of some gesture or facial expression — I find myself imitating that description.* That response is a kind of test, a way of verifying whether the description is realistic, whether it rings true. With scenes like the one above, I find myself mentally re-enacting them. Try it yourself here. Does Buck’s “whisper” make any sense? Rayford gives his hour-long, uninterrupted speech on End Times prophecy. He finally reaches the end and Buck doesn’t comment, doesn’t say, “Well, that was fascinating/interesting/different,” he just whispers — whispers — “I want to thank you for your time, and for dinner.”

I just can’t see that happening.

The authors’ task here is not an easy one. Buck is on the verge of an epiphany, of one of those magical, transforming moments when we catch, or almost catch, a glimpse of something transcendent and our heart is “strangely warmed.” You don’t have to have experienced a religious conversion to appreciate what Wesley meant by that. If you’ve ever had any such glimpse — any moment of grace, or clarity, or of the sudden onrush of overwhelming beauty, insight or love then you know what Wesley’s talking about. (Kate: “Yikes. It sounds like you’ve had an epiphany.” Angel: “I keep saying that, but nobody’s listening.”)

Nothing like that seems to be happening here for Buck, who seems to be experiencing flu-like symptoms. The authors want us to interpret this scene as the working of the Holy Spirit through Rayford. It comes across more as the working of salmonella through, perhaps, the chicken.

Buck’s spiritual crisis might be easier to understand if the authors ever actually let us hear what it was in Rayford speech that gave him chills. Then again, knowing what we know about the authors and about their decidedly uninspiring prophecy checklist, that might make Buck’s spiritual sweatiness harder to understand. Based on the rough outline of Rayford’s speech that we are given, he never deals with what you’d think would be the key point: The world is going to end. Soon.

If I were Rayford, I’d have led off with that fact: “How old are you, Williams? 30? You’ll never be 38.” That would seem like an attention-getter. Rayford should be offering a constant running countdown, like Frank the rabbit in Donnie Darko.

Instead, Rayford tells Buck his whole life story and then babbles about the Two Witnesses in Jerusalem. He knows that the world is going to end in almost exactly seven years — knows this with certainty, having read it in the Bible, or at least on the back cover of Left Behind — but he doesn’t seem to think this is pertinent information to share with his reporter friend.

Thus when Buck asks Hattie for her take on Rayford’s theory, she responds:

“I think Rayford is sincere and thoughtful. Whether he’s right, I have no idea. That’s all beyond me and very foreign. But I am convinced he believes it.”

That’s the kind of abstract opinion that you might offer if you’d spent the last hour discussing Rayford’s theory of, say, the Tunguska Event. Rayford’s presentation seems to invite just such an abstract response because he neglects to include the salient bit about the end of the world. If he had seen fit to mention, when they started dinner, that the world was going to end in 6 years, 357 days and 16 hours, or if he had mentioned when they were finished that the world was going to end in 6 years, 357 days and 14 hours, then “Whether he’s right, I have no idea” would have been a mind-bogglingly inadequate response.

The more you consider this, the stranger it seems. Rayford is portrayed throughout this chapter as speaking with a desperate urgency because he knows the clock is ticking. He grows increasingly frustrated that no one else seems to appreciate his urgency, but he steadfastly refuses to fill them in on the whole ticking-clock aspect. Maybe he noticed the looks being exchanged between Buck and his daughter and he decided to withhold this information. After all, you tell two young people that the world is going to end in 6 years and 357 days and they’re probably not going to want to take things slow.

“I will get back to you before using any of your quotes,” Buck says (possibly still whispering, it’s not clear). He says this, apparently, to give Jenkins the opportunity to insert some of his research into the exotic world of professional reporters:

That was nonsense, of course. He had said it only to give himself a reason to reconnect with the pilot. He might have a lot of personal questions about this, but he never allowed people he interviewed to see their quotes in advance. He trusted his tape recorder and his memory, and he had never been accused of misquoting.

Buck looked back at the captain and saw a strange look cross his face. He looked — what? Disappointed? Yes, then resigned.

Suddenly Buck remembered who he was dealing with. This was an intelligent, educated man. Surely he knew that reporters never checked back with their sources. He probably thought he was getting a journalistic brush-off.

A rookie mistake, Buck, he reprimanded himself. You just underestimated your own source.

Buck was putting his equipment away …

If you’re interviewing someone and you may have further questions later, there’s no reason not to say, “I may call you later to follow up.” But that wouldn’t have allowed Jenkins to show off what he’s learned about reportering, or to remind us again about Rayford’s Ph.D. from Embry-Riddle. For all of that research, though, Jenkins still seems to think that a reporter’s tape recorder is some kind of giant reel-to-reel machine with a detachable microphone — the sort of “equipment” one would have to “put away” rather than just tucking back into one’s jacket pocket. (He refers to it later in this scene as “the machine.”)

Buck was putting his equipment away when he noticed Chloe was crying, tears streaming down her face.

Apparently Chloe also had the chicken.

What was it with these women? Hattie Durham had been weeping when she and the captain had finished talking that afternoon. Now Chloe.

“What was it with these women?” Gender isn’t the common variable here. The common variable is Rayford. Spend an hour with this guy and you’ll wind up sobbing uncontrollably or shivering through your sweat. Both of these have happened to me just from reading about him.

Buck could identify, at least with Chloe. If she was crying because she had been moved by her father’s sincerity and earnestness, it was no surprise. Buck had a lump in his throat, and for the first time since he had lain facedown in fear in Israel during the Russian attack, he wished he had a private place to cry.

Buck assumes he knows why Chloe is upset, so he doesn’t bother to ask her if she’s OK, or to offer her a handkerchief, or to make any of the other sort of feeble gestures we humans tend to make when we notice that someone sitting next to us has tears streaming down her face.

It’s at this point that Buck asks Hattie for her opinion, “off the record.”

“Why off the record?” Hattie snapped. “The opinions of a pilot are important but the opinions of a flight attendant aren’t?”

No, silly. It’s not because you’re a flight attendant. Your opinions don’t matter because you’re a woman — which is also why the only opportunity you’ve been given to speak in this chapter is just one more attempt to portray you as thin-skinned and bitchy. That attempt backfires again. Score another point for meta-Hattie.

Rayford was not surprised at Hattie’s response, but he was profoundly disappointed with Chloe’s. He was convinced she didn’t want to embarrass him by saying how off the wall he sounded.

He doesn’t even seem to notice that his daughter is sobbing. Yet he’s still “convinced” he knows what she’s thinking and, based on that assumption, he is “profoundly disappointed” in her. I’m sure that comes across as comforting. What is it with these men?

“Mr. Williams,” he said, standing and thrusting out his hand, “it’s been a pleasure. The pastor I told you about in Illinois really has a handle on this stuff and knows much more than I do about the Antichrist and all. It might be worth a call if you want to know any more.”

So thanks for the interview. Oh, and I almost forgot, the world is going to end in exactly 6 years, 357 days aaaaaand … 13 hours. ‘Bye now.

In these parting words, Rayford summarizes what he considers the key point of his hourlong speech. Here is the core of his message — of the authors’ message — of his and their version of the “gospel”: “The Antichrist and all.”** Again, consider how strange this is in the best-selling “Christian novel” of the last two decades. Not, “Jesus and all,” or “Jesus’ return and all,” or even “God’s righteous wrath (and our righteous schadenfreude) and all.” The Antichrist and all.

The central figure in this message is not Christ, but the Antichrist. It’s fair to ask, then, if LaHaye and Jenkins’ religion might not be more accurately called “Antichristianity.” In their defense, however, we should note that the essential focus of their religion is not to celebrate or serve the Antichrist, but rather to oppose him. That would make their religion something more like “Anti-Antichrist-ianity.” To their way of thinking, Anti-Antichristianity is pretty much the same thing as Christianity. That’s not unreasonable, if the same semantic logic that makes “not unreasonable” mean the same thing as “reasonable” were to apply here. But opposing Christ’s opposite doesn’t make you Christian, and the enemy of God’s enemy isn’t necessarily God’s friend.

Here, as usual, Left Behind presents an extreme example of a more widespread problem in American evangelicalism. Evangelicals these days don’t stand for anything, they only stand against. And as it turns out, being against unrighteousness and being for righteousness aren’t the same thing at all. This isn’t merely a problem for evangelicals, either. Consider how rare it is nowadays to hear some say they’re “pro-America” without meaning, by that, that they’re anti- something (or everything) else.

The foursome moseyed to the lobby.

OK, yes, bonus points for use of the word “mosey.”

“I’m going to say my good-nights,” Hattie said. “I’ve got the earlier flight tomorrow.” She thanked Rayford for dinner, whispered something to Chloe — which seemed to get no response — and thanked Buck for sticking her with the cabfare his hospitality that morning. “I may just call Mr. Carpathia one of these days,” she said. …

Chloe looked as if she wanted to follow Hattie to the elevators and yet wanted to say something to Buck as well. He was shocked when she said, “Give us a minute, will you, Daddy? I’ll be right up.”

The point of this exchange, for the authors, was to arrange a chance for Buck and Chloe to talk one-on-one. They seem not to have noticed that this put Rayford and Hattie together. Alone together. On a hotel elevator.

Buck and Chloe talk about their mutual admiration for her father:

“Your dad is a pretty impressive guy,” he said.

“I know,” she said. “Especially lately.”

Lately her dad has been forcing her to tag along while he torments his former pseudo-mistress, but that’s not what Chloe is referring to. She means she’s starting to think her father might be right about “the Antichrist and all.” Buck agrees. At this point a good-night kiss is pretty much out of the question. If you’re a guy, standing awkwardly outside her door/elevator at the end of an evening together, then you should, as a rule, avoid the following topics: 1) her father; 2) weird religious theories; and especially 3) her father’s weird religious theories.

“I just met you and I’m really gonna miss you,” Chloe tells him. “If you get through Chicago, you have to call.”

Buck has already, somewhat creepily, booked a ticket to Chicago in the seat next to hers on tomorrow’s flight. He doesn’t tell her about this here, opting instead to up the creepy factor:

“It’s a promise,” Buck said. “I can’t say when, but let’s just say sooner than you think.”

The clock is ticking.

- – - – - – - – - – - –

* I once got caught on the train making faces while reading Bryce Courtenay’s desciption, in The Power of One, of Pastor Mulvery’s “lightning on/off smile” with his “escape-attempting teeth.” To explain myself to the amused couple across the row, I read them the passage and soon they were trying to smile like Pastor Mulvery too. The Power of One is very good, by the way. Skip the movie, read the book — it’s like a South African Huckleberry Finn.

** Makes me wish Sellar and Yeatman were still alive to write The Antichrist and All That, at the end of which history really would come to a .

  • Froborr

    Carvelle: Yes, but you said it more rigorously.

  • http://profile.typekey.com/boldfacelie/ practicallyevil

    Actually, if you really want to get technical, with anti-depressants the question is “How can we make the brain react as if it were functioning normally?” That is not to say they aren’t a valid part of the overall treatment regimen.
    Thats just semantics really.
    Giving insulin to someone with diabetes doesn’t fix the underlying problem. But we don’t have a good way to fix the pancreas so the disease isn’t there any more. The day we can, insulin won’t be an on-going solution.
    In the same way, we don’t know how to fix the messed-up brain chemistry that causes depression. So Prozac, Paxil and their milder forms will have to do.

    Alright, dropping the diabetes metaphor for a moment, because I don’t have enough familiarity with it to discuss depression in relation to it, and going back to for a second the metaphor of the severe physical injury.
    A patient experiences pain as a result of a compound fracture, and they prescribe painkillers, (no problem so far), however the doctors don’t know yet that the patient has a fracture, but they know he has pain. So the obvious thing to do is to perform some tests to figure out what the problem is, it could be caused by any number of problems that could be identified by the tests. They identify the problem and do the best they can to fix it, depending on the situation they might just have to be on painkillers for the rest of their life.
    In my experience, (I do not personally have depression, but I do know people being treated for it), being diagnosed with depression is only treated with anti-depressants. The patients in question are diagnosed based on psychology and then treated medically. Wouldn’t it make more sense to attempt to diagnose them medically as well, and possibly, if the case called for it treat them psychologically. However, my experience doesn’t account for everyone, everywhere, so fellow slacktivites with depression, I’m curious as to how your treatment of depression was handled. Where there medical tests involved like CAT scans, or MRI’s, some form of neurological examination? If you had these what did the doctors say? Did they describe what they the cause may be, but then say they would be unable to treat it with the medicine available?
    Also, drat near homonyms!

  • Froborr

    CAT scans and MRIs are expensive and not actually needed to diagnose depression. They are useful in *researching* depression, but not every patient is or should be a research subject.
    My treatment for depression began with therapy. The therapist recommended I go to a psychiatrist and find out about medication as well. After interviewing me and reading the therapist’s notes (I had to sign a release permitting the latter), the psychiatrist prescribed a medication and set an appointment for one month later. At that second appointment, the medication was having a very limited effect, so he upped the dosage and set an appointment for another month. About two weeks later, I started having serious side effects (I became unable to sleep for more than three hours a night), so I called him and we had an emergency appointment, after which he prescribed me a second medication to ameliorate the side effects. After that, I settled into a steady, regular dosage of those two medications, plus the aforementioned magic Clonopin as-needed. I see the psychiatrist every other month, and he recommends lifestyle changes and things I might want to explore with my regular therapist.
    Throughout the process, I asked questions about why he chose a particular treatment option over another, and he answered them. As is unfortunately often the case, trial and error is the best available method for treating depression — you try various combinations of drugs, lifestyle changes, therapy, and so on, until you find something that works. And, of course, I’m still in biweekly therapy, as I’ve been for some years now. There has been clear improvement in all aspects of my (two, closely interlinked) disorders, but there’s farther still to go.
    I’m not sure how to explain your experience, prac. Did your acquaintances visit a general practitioner or a psychiatrist? While a GP can prescribe antidepressants, he’s hardly an expert on psychiatric disorders, and indeed may not have studied them in med school at all. A good GP would recommend that the patient first go to a licensed counselor or psychologist, who would then make the recommendation to see a psychiatrist if antidepressants are needed.

  • borealys

    practicallyevil, I would argue the cause/symptom dichotomy differently.
    When I was severely depressed I was stuck in toxic thought patterns. Those toxic thought patterns were a symptom of my depression, and were caused by my neurotransmitter imbalance. For me to have gone to therapy, without taking medication to remedy that imbalance, would have been treating the symptoms while ignoring the cause.
    Of course, then we get to the question of what caused the neurotransmitter imbalance. That, I can answer to some degree– genetics, and stress. How, precisely, those factors plunged me into the downward spiral of depression, I don’t know, but there are thousands of medical researchers working on that and similar questions. If someday they find a simple, noninvasive way to eliminate my risk of relapsing, fantastic. But until then, I fully intend to keep the option of Cipralex on the table.
    It isn’t that I don’t understand the reasons why depression gets singled out so often, but the rationalizations I hear so often are just plain stupid. Yes, depression is often triggered by stress. But so is hypertension. That doesn’t make either one less of a physical disease, nor does it guarantee that reducing stress will reduce the illness. Yes, treating the chemical imbalance in depression without treating the organ malfunction that causes the imbalance is a stopgap. But the same is true of medical treatments for diabetes, for Parkinson’s disease, and for chronic pain. Why is treating depression that way unethical, while treating other illnesses that way just fine? Yes, pharmacologic treatments for depression have side effects, some of them pretty nasty. So do other medications for other conditions.
    There is no rational, empirically-supported reason to treat depression differently from other diseases, only emotional and philosophical reasons. And while I don’t deny anyone the right to their emotions and their philosophies, if it comes down to science versus philosophy, I know which one I’m going to base my treatment choices on.

  • borealys

    As for how I was treated, as I said before, the first time it was with counseling alone, and that worked. For this summer’s bout, the situation was much more complicated.
    For starters, because of my schedule and where I was living and how long and awkward a commute I had, I couldn’t get into counseling, which was the first thing I tried. When I went to my doctor, the first thing he did was order a bunch of blood tests to rule out hypothyroidism, anemia, and other conditions that are known to have symptoms that are similar to the symptoms of depression. Every test came back normal.
    (As an aside, as far as I know, there is no way to diagnose depression using neuroimaging. Granted, I have limited training in the interpretation of CT and MRI, so I may be wrong, and feel free to correct me if I am.)
    After a lot of discussion with my doctor, I agreed to his recommendation that I try a six-month course of Cipralex, one of the newer-generation SSRIs. His recommendation was that I take the drugs for six months, then wean off them and go to counseling and/or get a full psychiatric workup as needed. It was never intended at any point that the drugs would be a long-term solution, just something to get me functioning like myself again so that I could better choose the long-term solution that would be best for me.
    I was reluctant to just take the meds without trying counseling or getting full psych testing, but at the time, I had no choice. Fortunately, I had an excellent GP who had dealt with a lot of cases of psychiatric disorders over the years.

  • Jeff

    Presuming a soul would be a problem if the purpose of the analogy was to prove the existence of a soul, which it isn’t in my case. My friend was specifically countering the argument that the fact that drugs can affect consciousness disproves the existence of a soul.
    Got it. Thanks for the clarification.

  • http://profile.typekey.com/boldfacelie/ practicallyevil

    Thanks Froborr, my acquaintance was diagnosed by his psychiatrist and prescribed anti-depressants by his GP. The neurological examination doesn’t have to be CAT scans or MRIs, but at least something to determine what in the brain is “malfunctioning”. Otherwise how do they know the treatments will help from a medical perspective?
    borealys, I’m asking why they are only diagnosing a problem psychologically, that they are treating medically. If they are going to treat the problem from a medical perspective they should understand it from that perspective too.

  • http://jesurgislac.greatestjournal.com Jesurgislac

    practicallyevil: In my experience, (I do not personally have depression, but I do know people being treated for it), being diagnosed with depression is only treated with anti-depressants. The patients in question are diagnosed based on psychology and then treated medically. Wouldn’t it make more sense to attempt to diagnose them medically as well, and possibly, if the case called for it treat them psychologically. However, my experience doesn’t account for everyone, everywhere, so fellow slacktivites with depression, I’m curious as to how your treatment of depression was handled.
    First time, my doctor listened to my account of myself, and said that he could prescribe anti-depressants if I wanted, and I should come back for another appointment to talk this through if I did, but my depression fairly definitely had an environmental cause (which it did: I was in a toxic work situation): and he handed me a list of therapists I could ring to fix up an appointment, and within a month? About that – I was seeing a therapist I liked once a week, talking through my life situation, and he was helping me figure out ways to change the situation I was in. In less than four months I’d turned my life around, changed jobs, changed employers, moved, and was feeling extremely damn good.
    Second time, my doctor (different one) listened to my account of myself, and said that he could prescribe anti-depressants. I also asked him for a list of therapists, started taking St John’s Wort, rang, fixed up an appointment, saw a therapist for about six months, had an epiphany that changed the way I feel about my life, stopped seeing the therapist, tapered off the St John’s Wort. I took SJW for six months at a later period without seeing a therapist because I knew exactly why I was depressed, knew it would pass, and just wanted a mood booster to keep me going over a bad time.

  • Froborr

    prac, you seem to be drawing a distinction between “psychology” and “medicine”, but no such distinction exists. Therapeutic psychology is a branch of medicine — psychiatrists are licensed MDs who specialize in psychological disorders. Psychologists and licensed counselors are not MDs, which is why they’re not allowed to prescribe anti-depressants; think of them as analogous to physical therapists.
    What you seem to be saying is that, since we aren’t completely sure *why* anti-depressants work, we should ignore the fact that they do. You’re casually condemning a great many people to unnecessary suffering, and to me that is far, far more unethical than the necessity of playing trial and error with anti-depressants.

  • ako

    I’m very leery of the “disability makes you stronger and more independent” type of arguments (I realize ako was only talking of his/herself and was not generalizing; I’m not picking a quarrel with him/her). Sometimes it does. Sometimes it does the opposite.
    Yeah, I wasn’t going for ‘hardship makes you stronger’; more that disability is a complex factor in life experience, with good and bad elements, that affects who you are as a person. How it affects you tends to be influenced by other factors in your life, such as who your family and friends are, what your economic situation is, how the culture around you approaches things, and all of that.
    For some people, it’s a great big bundle of bad things, with nothing good in there. Or so little good that they’d gladly give that up in order to get rid of the bad. For some people, it’s a lot more mixed, and leads to a lot of good things that we don’t want to erase or throw away in favor of a more normal life. And it’s not just the hardship; it’s a lot of fun little things, like ordering new crutches and finding out they look like something from the Matrix. Or this little twist-jump thing in getting down from the bus that scares the crap out of people, but is really fun. Or in elementary school having everyone decide your crutches are the anti-alien death ray, and getting to blast the imaginary space-aliens at recess (I’d let people borrow one, but I always had one). Or being able to hop enormous mud puddles. Or taking fencing in college, and learning that the habit of walking on crutches makes swinging a fencing foil around for an hour dead-easy, giving you far more stamina than any of the other beginners. That’s all been part of my life, and I think it’s contributed to who I am in good ways, as much as the difficulties and struggles have. And I think if you erased all that, I’d lose something.
    I’m not claiming that it’s like that for everyone; just that the people who experience disability as an overwhelming negative don’t define what it’s “really” like any more than I do. My experience doesn’t disprove theirs, and theirs doesn’t disprove mine.

  • http://profile.typekey.com/boldfacelie/ practicallyevil

    What you seem to be saying is that, since we aren’t completely sure *why* anti-depressants work, we should ignore the fact that they do. You’re casually condemning a great many people to unnecessary suffering, and to me that is far, far more unethical than the necessity of playing trial and error with anti-depressants.
    Wait, I thought we did know why anti-depressants work, we know what they do and we know they combat depression, so whatever they do must treat the symptoms of depression. What I’m saying is that we need to know what is causing the depression, in some cases it might be difficult to determine he cause, but in Jesu’s (I know that is not how you pluralize Jesu, but then it would’ve looked like Jesus, and that would make it a sticky situation), example a cause can be found for the depression, (his toxic work environment), and the cause should be eliminated in order to treat the disease. A simple Prozac regiment to get you through a temporary imbalance is fine, but it’s not going to work on everybody. However in the cases I’ve experienced it seems like the standard assumption is a regiment of anti-depressants will fix the problem no matter what the cause. That I take issue with.

  • cjmr

    Jesurgislac’s a woman.
    But it is all too common in the US for health insurance to be willing to pay for up to 90% of the cost of anti-depressants, but only 25-50% of the cost of a limited number of psychiatric visits per year (and then, only from selected providers). That tends to pressure people into going the pharma-only route, which can be monitored by much less expensive GPs and internists, but which seems to me to be treating only the physiological symptoms, while hoping the event triggers will resolve by themselves.

  • http://profile.typekey.com/boldfacelie/ practicallyevil

    Jesurgislac’s a woman.
    Whoops, sorry Jesu, I’ve made a note of it.
    But it is all too common in the US for health insurance to be willing to pay for up to 90% of the cost of anti-depressants, but only 25-50% of the cost of a limited number of psychiatric visits per year (and then, only from selected providers). That tends to pressure people into going the pharma-only route, which can be monitored by much less expensive GPs and internists, but which seems to me to be treating only the physiological symptoms, while hoping the event triggers will resolve by themselves.
    And thats a bad system, and I’ve every right to not like it.

  • borealys

    practicallyevil, a lot of disorders are diagnosed solely or primarily by their symptoms. Alzheimer’s Disease is one that comes to mind, diagnosed based on symptoms, because the characteristic brain changes (as far as I know) can only be seen on autopsy. Neuroimaging can be used and will usually show generalized brain atrophy, but there are a lot of diseases that cause brain atrophy, so a CT or MRI is not enough to confirm or rule out the diagnosis.
    In the case of depression, the symptoms are mostly mental and emotional. There is no brain atrophy, no visible malformation of the subcortical structures, no characteristic skin discoloration or bacterial growth. The only distinctive physical change is in serotonin levels, and, as far as I’m aware, there’s no way to accurately measure the serotonin levels in a person’s brain while they’re alive (again, I could be wrong, I am not a psychiatrist or a medical researcher).
    You may think it’s somehow wrong to diagnose a disorder based solely on symptoms, but not every disease has a visible anatomical change or an easily-measurable chemical change. If my blood tests had come back with clear chemical indication of hypothyroidism, that would have explained my symptoms right there, and I would be taking a different medication now. But according to the tests I went through, everything was normal. Then I started taking a drug that increases serotonin, and, what do you know, I felt better. Not just happier, but physically stronger, less tired, less achy, and able to think more clearly. If the problem wasn’t the serotonin levels, would I have responded in the way that I did? Not likely. Could there be another underlying cause that might be treatable without having to take directly serotonergic drugs? Of course there could. But if there are tests available at this time that could detect that cause, I’m not aware of them.

  • http://jesurgislac.greatestjournal.com Jesurgislac

    I think that almost anywhere it’s going to be easier to get on anti-depressants than it is to find a therapist, for simple logistical and emotional reasons.
    I paid a bit more to go on St John’s Wort than I would have done to go on prescription anti-depressants: if I’d waited to go see a therapist on the NHS that would have been free, but I used one of several free-but-donate-what-you-can-afford services in the city where I live.

  • Anonymous

    In my experience, (I do not personally have depression, but I do know people being treated for it), being diagnosed with depression is only treated with anti-depressants. The patients in question are diagnosed based on psychology and then treated medically.
    That’s far from universal; like I said, I know of a lot of people who, while recovering from trauma, got anti-depressants and therapy (and sometime social workers intervening in their life circumstances). Anti-depressants were frequently a big help in relieving symptoms so someone with severe depression stemming from circumstances would make more of an effort to engage in therapy, and adopt the healthy habits and lifestyle changes. Which is the sort of thing you think should happen, if I’m reading you right.
    For some people it really is pure biochemistry, and while researchers are making efforts to work out the root causes of these malfunctions (ongoing genetic research, and some interesting potential connections with malfunctions of the immune system), if all they can do for a particular patient is treat the symptoms, they’ll only treat the symptoms. Because it’s better than nothing. Just like with chronic pain; if doctor know how to treat both the root cause and symptoms, they’ll do both. If they can only alleviate the symptoms, that’s still making a person suffer less, and more capable of living their life. Which is good.
    You get bad doctors who just throw pills at a problem without working out what’s really going on (this applies to prescriptions of anti-depressants, painkillers, antibiotics, and probably a lot more types of medication), and I don’t think anyone here favors that. But I’m not going to think the entire state of medicine is like that doctor I met who favored the, “antibiotics and see if it goes away” approach to anything potentially infectious, or assume until proven otherwise that people taking antibiotics don’t have a legitimate need. And I’m not going to assume that kind of sloppiness when it comes to depression treatment is happening unless I have reason to believe it’s true in that particular case. I have met people who I thought got unnecessary antidepressants, and were better off without them (including someone who went off antidepressants, made a commitment to healthy living, and wound up a lot healthier and happier in the long run). I don’t think that proved anything about most or all depression, antidepressants, or people on medication.

  • pepperjackcandy

    It’s not just “talk to a psychiatrist and if you’re sad enough they’ll give you pills to fix it.” A strong familial and personal history of depression goes a long way to get a diagnosis.
    I first went to my psychiatrist because of a family history on my father’s side of alcholism and suicide.
    I also had depressive episodes going back at least 20 years at that point (my earliest memory of suicial thoughts was my sophomore year of high school).
    After I was diagnosed, btw, I found that, of my maternal grandparents’ four grandchildren, three of us, in different states, at different times, for different reasons, and unbeknownst to each other, not only were diagnosed with depression and put on meds, we were put on very similar drugs (citalopram and escitalopram).

  • ako

    However in the cases I’ve experienced it seems like the standard assumption is a regiment of anti-depressants will fix the problem no matter what the cause. That I take issue with.
    This, I actually agree with you on. Treating only the biochemistry, without investigating whether or not there are other treatable factors, is a bad approach. As much as possible, everyone should get a thorough examination and careful diagnosis, to work out what the best treatment plan is for them, and if an approach that’s heavily reliant on medication is the right way to handle it or not (I think in some cases, it might be the best treatment currently available, and if that’s what the doctors find, that’s how they should treat it). And it is wrong that so many people get inadequate health care so the insurance companies can make more money.
    I do think medication is sometimes the best way to go, and that staying on medication indefinitely may be best option for some people. I’m not sure if we disagree on this or not. We definitely have different impressions on how prevalent the pill-pushing approach it, but I don’t have any way to prove my impressions are more typical than yours. I only know that I’ve nearly always seen antidepressants prescribed responsibly to good effect, with few people getting them needlessly or without additional help.
    Also, it was me at 7:53

  • hapax

    I’m not going to comment anymore on the medical treatment for depression topic, because so many people have said so much better than I what I was thinking. But I can’t let this pass:
    Thats just semantics really.
    Dear sweet Cthulhu-onna-stick, I hate that argument. I really do. Let’s look up the meaning of “semantics”, shall we?
    From Merriam Websters:
    1: the study of meanings: a: the historical and psychological study and the classification of changes in the signification of words or forms viewed as factors in linguistic development b (1): semiotic (2): a branch of semiotic dealing with the relations between signs and what they refer to and including theories of denotation, extension, naming, and truth2: general semantics3 a: the meaning or relationship of meanings of a sign or set of signs; especially : connotative meaning b: the language used (as in advertising or political propaganda) to achieve a desired effect on an audience especially through the use of words with novel or dual meanings
    Now if we are using words to carry on a conversation about something that is presumably of some significance, can anyone tell me what topic on earth is MORE important than what those words actually mean to the people using them?
    Anyone?

  • hapax

    Or taking fencing in college, and learning that the habit of walking on crutches makes swinging a fencing foil around for an hour dead-easy, giving you far more stamina than any of the other beginners.
    ako, it’s none of my business, but I have a serious interest in fencing and have a friend active in promoting para-fencing, so I’m trribly curious: What kind of fencing? Did you do wheelchair, fence with the crutches (how does that work?), or regulation strip fencing? If the last, how did you manage the footwork?
    Please forgive me if these questions are rude and intrusive. But I’m always interested in learning something new about l’escrime.

  • http://d-84.livejournal.com cjmr’s husband

    @Hapax: I don’t think I’d want to do “strip fencing”. Ouch.

  • Rosina

    I don’t know if my experience is common, or unusual, or too trivial to mention (which may be why I don’t know how common it is). About 20 years ago I started an early menopause. The first sympton, unrecognized, was irritability – a sort of PMS while at the same time my periods because irregular. The irritablity (in the bio-function sense of responding to stimulus as well as the normal meaning of being an irritable cow) caused me to lose my rag over things that I’d have been cool about, burst into tears over imagained injustice, and pick arguments with people. For about 6 hours – then it stopped, and for about 4-6 weeks I was my normal placid self until it started again. On the third occasion, including crying over a file, I got slightly worried, although it didn’t last much longer. A couple of days later I was in the chemist, buying tampons and wondered if I ought to invest in Royal Jelly, or something. And then I thought – last month I was here at the same point with the same thoughts – it’s PMS!!! The Chemist gave me vitamin B6, which was treatment du jour, and I took a few.
    But the point is that the next time I felt myself getting into a pointless, irrascible argument, I could think – this isn’t an important argument despite how you feel. You need B6, and it’s a good time to stock up on Tampax. And as it were the irritability slunk away like a monster that had been named and shamed.
    Depression is different. I think mine – in so far as I get depressed – is reactive rather than neurochemical, though if stress causes chemical imbalance then it might be both. If I believed it was just hormones and chemicals I might be able to combat with or without the medicine du jour just as I did PMS, a lot more successfully than coping with and ignoring the grinding nature of an ongoing problem.

  • ako

    Regular fencing. I can manage without the crutches for short-to-moderate stretches, and as long as I got to sit down for a couple minutes between bouts, I was fine. Not the fastest on footwork, but passable, and good with the foil.
    Never tried wheelchair fencing. It looks wild. I’m reasonably good with the close-quarters stuff, but being stuck that close and just going after each other? That’s got to get crazy.

  • borealys

    I think the one thing we can all agree on here is that, with mental illnesses as with all other illnesses, we need to look at the whole picture.
    I, for one, know that my doctor would not have prescribed a “meds for now, counseling later if you need it” approach if I hadn’t told him all about my horrid circumstances at the time, and, particularly, the fact that those circumstances were due to change in about six weeks. In fact, in addition to the prescription for the drugs, I was given an order to take the entire month of August as a vacation. Which I did.
    Based on the timing of when I started to feel better, I can say with reasonable confidence that the meds were a huge factor in making me well again, but the fact that I was able to escape my stressful situation, I’m sure, helped just as much, probably more in the long run.
    In my case, and this is only my case, it was the meds that got me well enough to get through what I had to get through, and the improvement of my life situation that has allowed me to stay well, to improve further, and, hopefully, that will keep me from getting sick again.

  • hapax

    Hmm. In my case, borealys, the very clear symptoms of depression began in early childhood, just as they did with my mother, my sister, and my maternal grandmother (although hers was not diagnosed until much, much later.)
    There is no question that it is a matter of genetically faulty brain chemistry, just like the fact that our myopia stem from genetically malformed corneas (although some of my particular problems are teratogenic and elsewhere in the eye). Neither is “situational” (I don’t suddenly descend into bad vision when unemployed), neither can be improved by counselling (although counsel and talk has taught me some effective coping strategies for both, e.g. how to compensate for weakness and pain, and how to find alternative visual tricks to mimic binocular vision) and neither can be medically cured at present, so I must use medical means to treat the symptoms.
    But I certainly would not recommend my approach to you, or yours to me. Anymore than I would expect put on somebody else’s eyeglasses and expect to see.

  • aunursa

    Hapax: Now if we are using words to carry on a conversation about something that is presumably of some significance, can anyone tell me what topic on earth is MORE important than what those words actually mean to the people using them?
    I agree. What if everyone uses the same word, but each person has a different idea of what it means?

  • Jeff

    @Hapax: I don’t think I’d want to do “strip fencing”. Ouch.
    Depends on what you use for your “blade”. [BEG]

  • hagsrus

    What if everyone uses the same word, but each person has a different idea of what it means?
    Pay it extra!

  • http://www.kitwhitfield.com Praline

    The two people I knew who were suffering from depression flat out refused to see a doctor for fear of getting involuntarily committed for the rest of their lifes. Was that the depression speaking or reasonable caution? Hard to say…
    Very hard – but based on my own, admittedly anecdotal, experience, I would consider that excessive caution at best. Everybody I know who’s reported depression to their doctor has simply been offered meds and referred to a counsellor. I have to say, I think depression might have had some hand in their fears; unreasonable fears are part of it, especially fears of doing stuff that would actually help you. Having seen it affect people, I find it hard not to personify it, and depression tends to have an attack-dog attitude towards everything that threatens it, such as treatment. 75% of depressed people don’t seek treatment, and there’s a reason for that. Depression whispers in their ear: ‘you’re just being self-indulgent; you wouldn’t feel so bad if you weren’t so worthless; the doctor will despise you and kick you out; the doctor will think you’re crazy and lock you up forever…’
    There are over-the-counter remedies that may be effective for people who are frightened of seeing doctors. Like Jes, I’ve seen St John’s Wort have good effects; the same with Omega-3 supplements. As with Prozac, just taking something without some kind of therapy or emotional-mental work is probably going to be a palliative rather than a cure – but sometimes you need to be a bit palliated (word?) before you can face a cure.

  • inge

    Froborr: That sounds like a pretty flawed system you have there, if it’s that easy for the mentally ill to be locked away.
    Tyranny of experts. Usually the person concerned can override experts’ opinions, but if the person is incapable of acting in her own best interests, the experts decide. As in this case the difference of opinion between the person concerned and the highest-ranking expert around (the doctor in the clinic) is whether she is capable of acting in her own best interests, it becomes nasty. Basically she needs to come up with a higher-ranking expert, and as the head doctor of a clinic is already pretty high-ranking, those are hard to come by.
    And even then, doctors, especially high-ranking ones, didn’t get where they are by readily admitting mistakes, correcting errors becomes a battle of egos.
    One might also suspect more sinister motives: a warm body in a hospital bed brings in money. Or a more beneficial one: had the woman been sent home and killed her children (happened a few weeks ago), the doctor would end up with some of the (moral, not legal) responsibility.

  • inge

    Caravelle: Hardships can make you stronger, or they can destroy you. Or just kill you.
    I have heard the Nietzsche quote “That with does not kill us makes us stronger” countered with “Yeah, and that’s why he died in a madhouse.”
    Which is not an entirely fair counter, but occasinally a useful one.

  • http://profile.typekey.com/boldfacelie/ practicallyevil

    Now if we are using words to carry on a conversation about something that is presumably of some significance, can anyone tell me what topic on earth is MORE important than what those words actually mean to the people using them?
    Well we were both interpreting the definition of what anti-depressants do with slightly differently from each other. I didn’t mean to dismiss your comment out of hand, I was just saying that your definition was technically correct but matched up with mine enough as to not change the argument. I understand how some people use, “that’s just semantics,” to dismiss a claim in contempt, but there was no disrespect meant in this case. I’m sorry, I was discussing a concept with many people at once, and went with my instinct to use an economy of words rather than over specifying, but still your definition of the effect of anti-depressants, and my definition of the effect anti-depressants are only different in terms of how we interpret certain words, so it was semantics. So many people mis-use the term it is easy to see the perceived problem, but I used it as it was defined by Websters.
    My definition: The question with anti-depressants is how to make the brain normal.
    hapax’s definition: The question is actually how to make the brain react normally.
    The way I see it, normal reactions go hand in hand with normalization, rebalancing the chemicals in the brain so a person reacts to their life situation from a neutral standpoint instead of one of sadness. Unless you mean by reaction that anti-depressants cause the brain to react normally in some other sense of the word, in which case we have a miscommunication, and I owe you an apology, (in addition to the one I owe you about not explaining what I meant about semantics, sorry).

  • http://jesurgislac.greatestjournal.com Jesurgislac
  • http://angelika.gnomehack.com/blog/ Angelika

    Praline: Like Jes, I’ve seen St John’s Wort have good effects; the same with Omega-3 supplements
    St John’s Wort works like a treat for people suffering from depression because of lack of sunlight. It makes the skin more light sensitive and speeds up the metabolism, which is great in dark northern European winters, as long as the person taking it is not too fair skinned – otherwise you might be in for sunburn in December. And of course, everything that speeds the metabolism can interfere with all other medication one takes, including oral contraception…
    Omega-3 supplements are similarly nice. Just keep in mind they are made out of marine fish, and taking omega-3 supplements in very high doses can cause lead poisoning.

  • http://jesurgislac.greatestjournal.com Jesurgislac

    I don’t do fishy omega-3 supplements because I am vegetarian: but flaxseed oil contains omega-3, omega-6 and omega-9 fatty acids. You can buy vegetarian/vegan supplements made with flaxseed oil in health food stores or over the Internet.
    (You can also buy the flaxseeds, and add them to cereal, bread, salads, etc…)

  • Tonio

    There is no question that it is a matter of genetically faulty brain chemistry
    Dumb question – why isn’t depression brought on by physical or emotional abuse in childhood? Everyone I know who had depression grew up with that abuse.

  • Praline

    From what I understand, it does increase the likelihood, but depression is complicated, and affected by a number of factors: traumatic past, stressful present, perfectionist personality, genetic vulnerability, lack of support, misuse of alcohol and drugs… They can combine, and from what I read, usually depressed people have several things on the list.
    So I would guess that many people who were abused in childhood do develop depression, because it increases their vulnerability. Other abused children may grow up to be more fortunate in other areas of their lives, and not become depressed – though all the best-adjusted people I know who were abused in childhood have invariably had some form of therapy.
    Just as another thought, which might show a correlation between nature and nurture, I suspect that at least some children are abused because their parents suffer from some form of depression. That gives you the hereditary vulnerability and the abused past together in one horrible package.

  • borealys

    I’m probably oversimplifying matters a bit, but, as I understand it, stress is a general overall health risk, not just to the brain, but to the heart, and the immune system.
    Stress can be brought on in varying degrees by a lot of things … traumatic memories, grief over the loss of a loved one, a toxic work environment, a poor self-image, attempting to juggle too many things at once, etcetera. The extent to which we can manage stress without getting sick will vary according to our coping skills as well as with our physiological makeup. Some people are more physically vulnerable to diseases like depression than others. Some people are remarkably resistant. I suspect that depression could be induced in just about anybody, given enough stress, but I doubt I could get ethics clearance to conduct a study on that question.
    So, yes, horrible traumas like childhood abuse would definitely increase the risk of depression. But it’s far from the only cause. I can tell you that of the people I know who’ve experienced depression, not one was abused as a child. If anything, the pattern I’ve seen is for it to occur in high-achievers and perfectionist types who expect way too much from themselves (and yes, I’m including myself there).

  • http://www.kitwhitfield.com Praline

    Yes, the high-achieving, perfectionist type being prone to depression is something I’ve seen as well, in all the depressed people I’ve known. I think that kind of personality naturally demands high standards of itself and is bothered when it fails to meet them; that can tip over into self-hatred, with awful results.

  • ako

    Dumb question – why isn’t depression brought on by physical or emotional abuse in childhood?
    I’ve met plenty of depressed people who had fairly happy and healthy childhoods. Certainly, there’s a higher chance that someone who’s been abused will be prone to depression, but not everyone who’s depressed has been abused in some way.
    Genetics, general stress, traumatic childhoods, more recent traumas, lack of sunlight, certain medications, and some illnesses that involve the immune system can all make a person more prone to depression. And putting that together still doesn’t account for all instances of depression, or explain why one person with a certain risk factor can wind up with no depression, and another persion with the same risk factor can wind up clinically depressed.
    Basically, no one’s completely figured out the causes, yet.

  • Brian Miller

    Hey, just another new reader bowled over by the genius of your LB exposition.
    Wondering if you’ve ever checked out Black Easter by James Blish? All I can say is its
    Left Behind as Madame Bovary is to an actual cow . . . pie.


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