Gone at Midnight. Jake Anderson
psychiatric illness are principally to blame for their condition—is one of the social stigmata that has carried into the modern era.
Barbaric and ill-informed treatments for mental illnesses also marked the twentieth century during the age of institutionalization. Before the discovery of neurotransmitters and drugs like chlorpromazine and lithium, doctors induced horrific seizures in patients, injecting them with animal blood, castor oil, massive doses of caffeine; they experimented with sleep therapy, early barbaric forms of electroconvulsive therapy (shock therapy, or ECT), psychosurgery (including transorbital lobotomies performed with ice picks).
Depression has never felt psychological to me. I know that sounds counterintuitive, but when it strikes it feels overwhelmingly physical, chemical. My emotions are the resulting glitched interface of flawed circuits. It doesn’t matter how positive I try to be, how much yoga and meditation I do, how healthy I am—the chemicals always win. Untreated depression is like arguing with chemicals and, in the long run, I always lose.
This goes a long way toward understanding my empathy for Elisa. I understand the frustration of not being in control of your own thoughts, of wanting to be happy but instead seeing the darkest contours of your own mind on a regular, hourly basis. It’s demoralizing and exhausting. It’s like swimming with weights attached to your limbs and a bee in your mouth. Simply getting out of bed is a Herculean challenge; returning phone calls from friends becomes an existential crisis, a clinic in how to conceal a panic attack during small talk.
Your self-image is perpetually shattered as you struggle to put together the shards of your own identity. Simply holding it together for an hour can feel like sitting in the captain’s deck of the Titanic, watching the pressurized cracks lengthen as you idly wait for an oceanic wall of icy water to demolish you.
Reading Elisa’s passages on depression are heartbreaking for me. Parts of it feel as though she was describing my own internal landscape. But Elisa does a pretty incredible job at advocating for “those of us who don’t have standard-issue brain chemistry.”
“I have clinical depression and generalized anxiety disorder,” she wrote. “I have a fancy piece of paper from a real doctor that says so, and I have a little bottle of pills that I have to take every day or else I want to kill myself.”
The general practitioner I went to in San Diego had me on a cocktail of Prozac, Wellbutrin, and Strattera. Prozac, the most common SSRI, works to boost and regulate your brain’s serotonin production. Wellbutrin (which, I would learn, Elisa also had taken extensively) is an “atypical” antidepressant and increases the brain’s production of dopamine; it is commonly prescribed to help people quit smoking, which was one of the reasons I took it. Strattera is an SNRI, a class of meds that works to regulate norepinephrine. It is one of the only non-stimulant ADD medications.
I remember what my very first doctor said to me about using meds to treat depression. At the time I was eighteen and concerned that antidepressants would make me less creative. He said that the goal in that case was to allow me to go to my edge without falling off the cliff. I always thought that was kind of a weird thing to say to a depressed teenager—but it makes sense.
Elisa wasn’t on any SSRIs; however, she was on an SNRI (serotonin-norepinephrine reuptake inhibitor), called Effexor, or Venlafaxine, which she described as the only drug in years that had actually helped her. I tried this one for about six months. It had worked well but caused my blood pressure to rise.
The search for a compatible antidepressant is a maddening experience that can go on for years, even decades. There is simply no metric for understanding someone else’s psychiatric disorder, no diagnostic for determining how a person’s unique personality, history of trauma, genetic makeup, and neurochemistry will interact.
This is why the discovery of Elisa’s blogs marked a seismic shift in my perception of the investigation. While the surveillance tape offered a portal into her final moments, the blogs offered a portal into her final years, which, some would argue, can be just as significant in determining a cause of death.
As I dug into Elisa’s autobiographical prose, I identified with her struggle against depression and forged a powerful emotional connection to the case. At the same time, disturbing new questions arose.
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