Dear Psychopharmacologist

Dear Doctor:

I would like to make an appointment to see you, although I can't really afford it.  I have bipolar disorder but I am functioning which means that in the eyes of the NHS and my health insurer, I have nothing, I am fine.  I need some sort of "separate episode" to trigger coverage.  I could tell you I was suicidal, and that would get me in to see a harassed shrink once, maybe, but then you might take me away from my children.  And really, I'm not suicidal.  A web of love and promises keeps that option from ever gaining purchase in my thoughts.  I do not let it become, in the recent faddy parlance of contract negotiation, a "load bearing idea".   My own effort keeps me away from that. But that effort is ongoing, no separate episode, just increasingly harder from time to time with no relationship with a doctor to help.  

I could use some help, though.  It's been a while since I even spoke to a shrink.  Nearly two years.  Have you come up with a pill yet that would take away all the hatred I feel toward myself?    Have you developed, say, a nasal spray that would stop me from despising what I see in the mirror?  Stop my judgment coming down so hard that in seconds, I break my own spirit with my own crushing criticism of my reflection, and it becomes insanely courageous that I can even walk out the door to pick up my children from school, so horrible and damned am I.  I was wondering if you had some kind of cream that would smooth away the shame and anxiety I feel about my entire life and all my choices, so that there is something other than the red hot buzzwords:  failure!  crazy!  idiot!  pathetic!  zinging around my brain when I try to sleep.  Maybe I can rub some new words into my skin so they can be under my skin instead of these old, awful ones.  Maybe if you don't have some kind of cream, some kind of gum?  Some kind of gum to take away the craving for self-condemnation that consumes my brain?  If you could do it for nicotine cravings, can't you do it for condemnation?

And maybe in the past couple years, you have some up with something I can take for my nastiness and anger.  You see, now that I have had a couple decades of therapy, on and off, I am - and I understand this is late in the game at age 43 - I am ready to see now where I am angry and where I am nasty.  It is another little death to find these things out about myself every time, but such is the quest for truth.  In retrospect, of course, I should have seen it sooner.  I remember one Washington Post reporter introducing me as the woman who ate CEO's for breakfast and I thought he was just being nice.  My experience of myself was of a fearful, incompetent fool.  So eager are the children of Evangelical Christians to not be bad, to be good, that we hide our own badness from ourselves, we hide our own anger from ourselves.  Really, quite incredible if you think about it:  I thought he was just being nice.

 And I finally see, thanks to a patient husband, that I am angry sometimes and I am nasty sometimes but always in those times, in those moments, I feel I am only defending myself from the eternal endless criticism, the eternal threat of sin, the unfettered fear occasioned by a cortisol dump created in my youth now unregulated and unfixable.  In those moments I am threatened and I am afraid.  Please tell me you have come up with something for that?  Please?   How about some kind of insight spray?    

No?  Nothing like that?  Just the same old heavy-handed anti-psychotics that make me a zombie?  The ineffective SSRI's?  The lithium that made my hair fall out?  Shit!  You should get on that self-condemnation gum, I think it could really sell.  As a spray or a gum or a pill!  Anything else for me?  No?  Really?  Nothing?  No?




  1. Rachel, you are an amazing person; a good friend, great writer, a good mother and I'm sure a lot of other things a don't know. I hope they will develop that magic gum so that you can see it for yourself.


  2. Since a psychotic episode triggered by Climate Camp at Heathrow, General Assemblies, lack of sleep and the police, I am on a low dose of Dekapotl 250mg 2x per day, which takes away the sharp edges. I'm 70 yrs old and the wonderful psychiatrist does not want me to have another 'episode' as recovery is more difficult as you age, if you have repeated episodes. It is the manic manifestation of bi-polar and I have known only too well deep depression also.

    It took a while for me to adjust to and absorb the drug - I noted the loss of the keen edge of reality. I no longer do - I feel sufficiently 'sharp' but the extreme highs and lows are lessened, for which I'm grateful.

    And I may not have the name of the drug quite right but it might be worth discussing with someone. No problematic side-effects, either.

    You have an extraordinary, open honesty and insight. But it's not always enough, is it?

    By the way, someone asked permission yesterday to translate the only story I've ever written into Hebrew. It's not on the web - the man looking for God. I must get you a copy.

    Anyway, between us, do you think we might recruit Stephen Fry for Winter Carnival?


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