“depression drives me to gaze into abysses.”

I’m quoting Jake Jackson, from this article at phdisabled, which I skimmed when it was published but read more closely yesterday, on the subway, legless and crawling before the realities of health care. Again it brought me to the edge of tears, as words do when they tell my experiences back to me in a form I was previously unable to grasp.

This is my current abyss.

Given that the (subject to market value, of course) costs of medication on my new insurance plan are more than I can presently afford, and I am still struggling to pay off debts incurred years ago, I have a brutal choice to make if I want to survive the semester with an emergency fund intact for the spring. I could go on the graduate student diet of coffee and ramen, which will undoubtedly exacerbate my pain. Or I could stop seeing my psychologist. Or I could stop taking my medication and abuse the corticosteroid supply I have left until I’m fit for life again.

I should mention I’m teaching 3 courses, working as a program assistant, and reworking a novel. I’m also technically a Ph.D. candidate but my brain will be in no shape to perform difficult academic thinking.

I know myself. I estimated costs earlier in the summer from last year’s benefits sheet. I didn’t tell my doctor and I started tapering off Lyrica, the most expensive and beneficial medication I’m presently on. Aches returned immediately. It has a short half-life, so the fact that I still started and ended my day with a dose probably diminished the withdrawal effects. I’m titrating up on an arthritis treatment given a sternoclavicular joint problem and costochondritis, which I recall having even as a teenager. I’m not sure yet if it’s going to work, but guess what? It’s significantly cheaper. The other drug I’m on is to combat the Lyrica lethargy; it’s less expensive than Lyrica but like Lyrica is still under patent. This two-pronged cocktail has worked for me for three years. The new treatment is cheaper. I can’t stop taking everything. But.

So I’ve tapered down even further on Lyrica, which doctors call an easy taper and the Internet calls a horror show, preferring the opiate shakes to Lyrica withdrawal. I’ve heard that coming off of methadone is purely physical, flu-like, but Lyrica withdrawal is physical and psychiatric. “Side effects” sounds so innocuous until you spend an entire day too clumsy to handle a toothbrush, vomiting and shitting your life out, exhausted and insomniac, hearing noises in the walls. Day 2, the voices were malicious whispers in my closet. Day 3 I spent suicidal, anxious, too paranoid to socialize. Day 4 seemed fine until I fell asleep on the subway and woke up disoriented, panicked, and unable to speak, even if I recovered that faculty within the half-hour. Day 5 is today. Everything, including my clothes and my glasses and the chair I’m sitting in, is causing me pain. Being upright is causing me pain. The severed nerve from my lymph node dissection is electrified wire. I’m a little less suicidal, even if depression is again that companion I can always rely on to be there. I am desperately, painfully grateful that I’ve never owned a belt, because otherwise?

I don’t know if it makes it better or worse to remain self-aware enough to know that this is the medication speaking, not me.

In theory, the taper can be completed in a week, meaning two more days, meaning that if I really want to, I can wean myself off the medication completely before October.

As I’ve written in “White Van Fear”: I’m anxious when it comes to writing about this in a form that makes it true.

But I recognize that radical transparency is an important step toward combating the stigma around mental illness and shaming and blaming victims, who are supposed to be stronger, or truly carefree, or as Jackson writes, dishonest about their emotions. I was told in college that my baseline emotional state was mild depression. I have mild bipolar swings into manic energy and contemplative slumps. Like Jackson, I too don’t know if it’s the program I’m in or the turn my life has taken in the past five years, but I have been significantly more depressed since my first year as a Ph.D. student. I alienated myself from most of my Ph.D. community after honesty about my emotional state in my first year resulted in a dramatic falling out. The spiral worsened. It made more sense to protect myself from further criticism and mockery by lying through my teeth, preemptively mocking myself, shutting everyone out, sticking to the tiny support network that’s worked for me without letting in anyone new. As a result, of course, I feel isolated, save one person I’m able to be emotionally honest and intimate with and who, I think, returns the favor.

This year I became a Ph.D. candidate, I lost my good insurance, I completed a body modification project that integrates and memorializes self-inflicted wounds, and I shame myself into thinking, with all the people who have it worse than me, who am I to say I’m tired of fighting? Conrad’s Marlow steps back from the abyss, but I’ve never been able to turn my eyes away. I’ll never be well, but I want to eat more than once or twice a day, and if the abyss is calling to me I shouldn’t cancel on my shrink. It’ll be the medication talking when I stop the Lyrica completely, saying it’s no joke that I won’t make it past December, and didn’t I used to say I wouldn’t make it past 30, by my own hand?

My depression drives me to write about what we do at extremes, what we choose to sacrifice and save; and about my own experiences living with it, with self-injury, and associated stigmas; it drives me toward a course of study that attempts to propose alternatives to a system that is overdue for dismantling and reconstruction; it drives me to teach students to think critically about the world around them. I’m the product of a system that silences, stigmatizes, and shames even when I make the effort to reach out for help, whose costs of living and self-care, even with insurance, are prohibitive. The academic year is imminent. When I stop taking this, I’ll remain professionally functional, I’ll be inviting suicide back into my bed.

This is the abyss. Never knowing if self-awareness is enough.

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