In my last Interlude, I discussed my recent semi-annual visit to my psychiatrist.  I look at that post now and realize some of what I wrote is rather snobbish and, perhaps, a bit arrogant.  Let me pick up a few of the over-arching threads in this series and use them to draw this entire cycle of posts to a conclusion.

First and foremost, I’d like to discuss why I have such a knee-jerk gut reaction to discussions of music on a purely emotional level.  For those of you who have not read my blog post Snake-Pancake-Ball, where I use a metaphor to discuss the compositional process, I would encourage you to read it before continuing.

Whenever I tell nonmusicians that I write music, their eyes go wide and they tell me that writing music is a very cool thing to do.  Most of these people exclaim, “Oh, I could never do that!” and then proceed to tell me that, as a child, their parents made them play the flute or trumpet or piano and they really hated it and quit.  Quickly following this is a wistful confession of how they wished they had continued playing.  From here, they ask me: What kind of music do I write? and Who or what do I listen to?  I try to tell them about composers I really like that they’ve probably never heard of before or about genres of music turning me on now that they have no idea exist.  This used to make me very angry.  Now it makes me sad because it is extremely difficult to express my true artistic feelings and interests to these people.

So I tell these people, “I like Beethoven.”  And I do, I really appreciate and enjoy Beethoven the more I study his music.  But his music has become entangled with popular culture and the “sound” of Beethoven is something everyone can easily relate to.  The usual response I hear about Beethoven is that, they, too love Beethoven.  They tell me his music is passionate and dramatic.  They own a CD or two of his.  So I ask, “What about Beethoven’s music is so passionate and dramatic?”  The answer I receive almost always boils down to one thing: it makes them FEEL drama.  It makes them FEEL like there’s passion in it.  I want to ask them exactly WHY it makes them feel a certain way but these people are hard pressed to come up with a reason.  The music JUST DOES make them feel that way.

This conversational impasse is my fault and I accept full blame.  The people I’ve described above come from all walks of life, education levels, and socioeconomic backgrounds.  They aren’t stupid and I’d been treating them like they were idiots because they did not try to understand me.  I’ve come to the following conclusion: I need to make a better effort to bridge the gap between myself, the “academic” musician, and the general public.   I need to find a way to express my musical interests to nonmusicians who don’t share the same background that I do.  I need to find a way to express new musical ideas to the general public in a way that’s informative, interesting, and absolutely not condescending.  And I have to be prepared to meet nonmusicians who love music and have interesting ideas from which I can learn.

In my previous posts, I’ve discussed my own battles with cyclothymia, a mood disorder similar to manic depression.  From my own experiences, I’ve seen how sometimes my own feelings betray me.  How, sensing a manic or depressive episode coming on, I have to think about my actions to see if what I’m doing is really warranted by my external circumstances or if I’m being over-controlled by my internal, out-of-whack emotions.  In short, I’ve tried to separate the rational and non-rational thinking processes in my mind.  In musical terms, I try to feel the passion of Beethoven’s music while also analyzing the structure and thematic development.  I want to be overjoyed by the chorale finale of Beethoven’s 9th Symphony and analytically bewildered at his radical departure from traditional form.  I want the “balanced life” the ancient Greeks espoused.  I want to be in awe of the magician, to learn how his trick worked AND marvel at his stage craft.  I want a Rational Life.

Counter to my desires is the general public perception that we artists and musicians are flighty people.  We live on another planet.  We write or paint or sculpt with magical inspiration that comes out of the sky and winds up on the page or canvas.  Many people do not understand the hard work that goes into the act of creation, that the creation of an artistic work is a tangible skill.  To make the assumption that music is only a vehicle for emotional expression is to deny the very skill we musicians spend our lives cultivating.  It is a craft honed over many years of hard work.  This work can take many forms including instrumental practice, critical listening, or writing/rewriting a score.  Also, artist’s mental state is not necessarily conveyed in the work or performance they create.  People make the same mistake with actors assuming that the actors ARE the characters and feelings they portray on stage.

I’d like to conclude this post with the strategy I use when confronted with manic/depressive episodes and hope this may be of help to others.  My process involves two simple words:  WHY and THINK.  I ask myself: Why do I feel this way about X?  Why did X happen?  And then I THINK.  If I cannot come up with a good reason WHY then perhaps my feeling needs to be examined.  It’s extremely easy for me to lapse into emotional, gut-level reactions and I cannot tell you how many times that has gotten me into trouble.  If someone did something and made me angry, it’s very easy to act on that anger.  It’s much more difficult to figure out WHY the person did what they did.  These two words, WHY and THINK, now saturate my day to day living as well as my own music composition and research processes.  While some might think that I’m hindering my creative impulses by analyzing my thoughts in detail, I can tell that I’d rather live this way than in an unfiltered emotional roller-coaster.  The fact that I can still ask WHY and THINK let’s me know that I’m still in control of my own mental faculties.

Today I had my semi-annual meeting with my psychiatrist.  These are “medication monitoring” sessions, short meetings meant to gauge my mental state and the effectiveness of my current doses.  My doctor likes to talk about his interest in music during our sessions as he knows that I’m pursuing an advanced degree in music.

While waiting for my doctor today I was staring at a poster on depression in his office.  This poster had a cross-section of the human brain with regions of the brain colored and a paragraph explaining their name and how depression effects them.  It is interesting to note that some of the same brain regions effected by depression are the sames ones being studied in musical cognition (thalamus and amygdala, parts of the basal ganglia region I’ve discussed in a previous post).  When the doctor entered, he noted me staring at the poster and we started to discuss research into depression and how prescription medications effect the brain.   I usually enjoy these discussions because I respect my doctor as, I’d like to think, an educated person in the sciences.

I listened to him discuss how little is known about the exact causes of depression and the exact mechanism by which drugs such as Prozac works.  You may notice that in the medical brochures for most of these mood stabilizer and anti-depressant medications, the phrase “It is believed that Drug X works by…”  In other words, these medications’ effectiveness are gauged by observation of subjects who take the medicine.  Their behaviors are recorded and, if enough of them show improvement without too many side-effects, the medication is sold.  So far, NO ONE, neither the FDA nor the drug companies themselves, have a perfect model for the mechanisms by which these medications work.  In other words, no one knows exactly why they do what they do.

My psychiatrist likes music but he is not a musically educated individual.  He likes to talk about his young son’s  piano lessons and music education and today I learned his son might be a budding young composer.  As it so happens with young children, piano practice time frequently turns into music-making time.  We started discussing suitable (inexpensive) music software and compositional process as well as “meaning” in music.  I asked him how music can have meaning, hoping his training in psychiatry and medicine could give me insights into musical cognition.  Furthermore, I asked how music can cause an emotional response in listeners as this, along with cognition, is an area of great interest to me.

His response was that he believes music is a “universal language.”  When people hear music, the music references in the listener thoughts and ideas that lead to an emotional response.  He was also very emphatic about the emotional expressiveness of music and was adamant that music IS emotionally expressive.  I did not press him further as I have grown weary of the “universal language” theory of music.

Finally it was time to discuss how I was doing and if the medication was continuing to help.  With our conversation thoroughly blended between music and pharmacology, we discussed in vague terms how mental illnesses can strike artists.  In response to me discussing my doctoral thesis, a large work for wind ensemble, he remarked the following.  I am going to try to quote directly what my doctor said but, since the appointment was several hours ago, this is probably a paraphrase.  He said, “Perhaps you should have a little depression.  Some of the most beautiful music has been written by composers who were depressed.”

I was a little flabbergasted by this comment.  The anger I felt only grew afterward during my drive home.  Having taken several deep breaths since, I wanted to figure out why exactly that statement angered me so.  I believe part of my anger stemmed from the context of our conversation.  My psychiatrist discussed his musical ideas in terms of pure, emotional expressivity.  There was no discussion of craft or skill.  When he talked about his own son’s piano playing, he praised its expressiveness but never once mentioned HOW it was expressive.  I realize I’m asking for a lot from a person who has no formal training in music and I’m also beginning to realize that part of my frustration comes not FROM him, but THROUGH him.  The “universal language” theory and discussion of music in purely emotional terms is, I believe, symptomatic of a society where music education is not taught or not emphasized.  This is, in essence, the same discussion I’ve had or listened to from scores of other people.   Perhaps what upsets me most is that my doctor, a man of science, can not admire the beautiful craft of a work of art or virtuosic performance and is, instead, reduced to such hackneyed comments.  Finally, assuming ANYONE needs depression to help them work or be creative is horrifying to me.  I would not wish a depressive episode on anyone.  Although I still respect my doctor, it’s disheartening to hear him talk about music in this manner.

I realize that the drugs I’m taking now do help me and I feel better with them.  However, I still find it a bit scary that no one knows exactly how the drugs I’m using work their “magic” to make me feel the way I do.  I also wonder what kind of medications there could be if more was known about depression and mental illnesses.  If we knew what the exact problem was and how it worked, perhaps there would be a lot fewer depressed people in the world.  However, for my doctor to know as little about the prescription drugs I take, as he does the music both his son and I create, is surely a cause for depression.

(This posting is a continuation of my previous post.)

Rational: Adjective.  [Of a person, a person’s soul, or mind] That uses, or is capable of using, the faculty of reasoning; having sound judgement; (in extended use) sensible, sane, lucid. Also: characterized by reasoning, as opposed to emotion, intuition, etc. [Oxford English Dictionary, spelling preserved]

Reason: Noun.  The power of the mind to think and form valid judgements by a process of logic; the mental faculty which is used in adapting thought or action to some end; the guiding principle of the mind in the process of thinking. Freq. contrasted with will, imagination, passion, etc. [Oxford English Dictionary, spelling preserved]

Logic: Noun.  The branch of philosophy that treats of the forms of thinking in general, and more especially of inference and of scientific method. [Oxford English Dictionary]

Scientific Method: Noun. Principles and procedures for the systematic pursuit of knowledge involving the recognition and formulation of a problem, the collection of data through observation and experiment, and the formulation and testing of hypotheses. [Merriam Webster Dictionary]

A Rational Life: Noun.  A philosophical attitude towards life that values hard, tangible evidence when making decisions rather than relying upon intuited, emotional reactions.  Accepting that decisions, thoughts, and actions may need to change as new evidence is uncovered.  Ignoring opinions, no matter how supportive or caustically false, that do not document the source of their supporting evidence or supply any evidence at all.  [My own view.]

(This is and brief interlude between my previous post and Part 3.)

At a magic show there are usually three kinds of audience members:

Type 1:  Everything this kind of audience member sees happen onstage is real to them.  If a woman is sawed in half and put back together, there is no question in this person’s mind that the poor stage assistant was cut into two separate pieces before being restored to an unblemished whole.  These audiences members are usually children.  After the show, they go home and yell phrases of gibberish at overturned cardboard boxes hoping the power of their words magically transform the box’s contents into a bunny rabbit or tiger.  The disappointment on their face at each failed transformation in readily apparent.

Type 2:  This is the kind of audience member for whom everything is a sham.  They look not for the presented illusion but for the hidden compartment or device that allows the trick to work.  Their satisfaction from the show is derived from their ability to outsmart the magician at his own game and discover the secret to the trick before it even happens.  Phrases such as “I could’ve done that,” or “That’s not REAL magic,” are in this person’s daily vocabulary.  Frequently, this kind of audience member is the parent of a Type 1 audience member.  These kinds of parents usually scold their children for trying to  imitate the magician after the show.

Type 3:  This kind of person knows that the magic performed on stage is physically impossible.  Yet, this kind of audience member is able to attend the performance and enjoy the spectacle of the illusion.  This person does not care where the trap door or hidden compartment is.  As long as this person feels convinced by the performance of the trick then they are satisfied.  Hours, days, or months later, this kind of audience member may begin to wonder how the trick was performed.  However, unlike the Type 2 audience member, the Type 3 member seeks to understand the illusion for the enjoyment of knowing.  If he should figure out the “secret” of the magic trick then this only adds appreciation for the magician’s ability to perform the trick well.

I believe all children are born Type 1 with wide-eyed wonder.  I believe as they grow, sometimes the need to explain every phenomenon around them leads these children to become Type 2 people.  Many people settle here at the Type 2 level.  Some move into Type 3 and some skip from Type 1 to Type 3.  Some people never leave Type 1: the world and all its happenings are magical.

I believe that how I feel about a magical illusion and how the actual mechanism of the trick works are both fascinating and important.  I believe that it’s important to remember what IS possible versus what COULD BE possible.  I believe we must always remember where the line between reality and illusion stands and what happens when the line blurs.  Most importantly, I believe in magic.

(FYI: This Part 2 of my previous post.)

Ancient Greek philosophy suggests that balance is the key to a good life.  Thinking about the field of medicine during the time of the ancient Greeks, it is no wonder they had this viewpoint.  If you were to visit a Greek physician 2000 years ago, any problem with your body could be summed up in one word: imbalance.  To the Greeks, the emotional and physical temperament of the human body was based upon a balance among the four humors: blood (sanguis), yellow bile (cholera), black bile (melankholia), and phlegm (phlegma).  Perhaps you had too much black bile or not enough yellow bile or blood.  Feeling hysterical?  Perhaps you need more phlegm, believed necessary for a calm mindset.  Depressed?  Too much black bile.  Need more courage?  Increase your blood!  Balance the humors and balance the patient.

I find it awfully humbling that modern psychiatrists take a very similar approach to treating mental disorders today, albeit with a more sophisticated approach.  Instead of blood, phlegm, and bile, we use words like seratonin, norepinephrine,  and dopamine.  Allow me to briefly summarize from the book The Chemistry of Joy, by Dr. Henry Emmons:

-Feeling sad, irritable, low stress tolerance, anxious, fearful, impulsive, chronic pain, suicidal?  You have low serotonin levels.

-Feeling restless, angry, irritable, indigestion, high blood pressure, flaring temper?  You have increased norepinephrine and dopamine levels.

-Feeling depressed, sluggish, passive, suicidal, low brain-power, withdrawn?  You have decreased norepinephrine and dopamine levels.

Balance your serotonin, norepinephrine, and dopamine levels and you’ll live the good Greek balanced life.  Lots of drugs are available now to help you do just that.  Prozac, a drug which helps boost serotonin levels, is one of the most common of these medications and, in its generic form, will cost you about $10 (without insurance!) for a three-month supply.  Zyprexa, an example of an antipsychotic/anticonvulsant, works by blocking or inhibiting the brain’s use of  serotonin, dopamine, and possibly norepinephrine.  In other words, match your symptoms to the list of problems, determine the incorrect balance of brain chemicals, fix the balance, and enjoy your life!

Does anyone see a problem with this?  Modern pharmocology has turned emotions from naturally occurring phenomenon into problems fixable with medication.  If you don’t like how you feel, CHANGE IT.  Yes, from my own experiences I can personally vouch for the wonders of anti-depressant medications in making my life more livable.  But why should I stop at a “more livable” life when, with more drugs, I could have a SUPER-DUPER HAPPY LIFE! As I talked about in my previous post, Effexor made me feel like a million bucks and I felt like I had more energy than ever.  Why settle for anything less?

Throughout the history of the human race, many people have decided not to opt for a “livable” life.  Instead, they’ve used drugs to search for new levels happiness or to block current feelings of unhappiness.  These drugs range from legal (alcohol) to illegal (marijuana, cocaine, acid, heroin, etc…) and somewhere in-between (abuse of prescription drugs like oxycodone).  Having suffered some major depressive episodes myself, I do not fault these people one bit.  I do not wish a depressive episode on anyone.  It is a dark place.  Is there any wonder that a growing body of research shows a link between depression and illegal drug use?  For those of you who attended public school in the 1980s and 1990s, the height of the United States’s “War on Drugs,” you probably remember the underlying message instilled in your classes: “Drugs control users lives.  So don’t do drugs!”

What about the rest of us with diagnosed mental disorders who are actively taking theraputic medications?  Long-time illicit drug users become addicts because their body becomes physically dependent upon the drug to feel “normal.”  I can tell you that if I stop taking my medication I slip into that dark place again because my body NEEDS the medication to feel normal.  Taking a pill, or not taking the pill, has a HUGE effect on how I feel.  Even if I were to have the best day of my life, if I miss taking my pills then I’ll feel like crap.  Conversely, if something horrible were to happen and I doubled-up my dose then I’d face the terrible situation with a big grin on my face.

This leads me to a huge philosophical question that I continue to wrestle with: Are my emotions “real?”  Are my emotions connected to the world and events around me or are they a byproduct of my disorder and the medication I take?  How should I act if I FEEL one way but the events around me seem contrary?  How can I trust my emotions?

My answer for now: I don’t.  My emotions have lied to me.  They’ve lead me astray at times.  They can be controlled with a pill.  They frequently exist in their own world without connection to events happening around me.  Therefor, there is only one way I can deal with them.

Reason.

Fall 1998:  Central Pennsylvania for undergraduate degree.  Summer days shortened and sunlight faded.  With the dwindling light my energy fell, as did my moods.  Cranky.  Irritated.  Lethargic.  Headaches.  Lots of headaches.  It was suggested that I suffered from Seasonal Affective Disorder (SAD).   I muddled through the season.

Fall, 1999:  Living in Ann Arbor while attending graduate school at the University of Michigan.  Possibly one of the few cities in the continental United States that gets cloudier and more gloomy than central Pennsylvania.  SAD symptoms grew over the previous year.  Much less energy.  Much crankier.  More headaches.  Pangs of sadness for no discernible reason.  Bouts of sudden anger.  In a word: miserable.  I muddled through the season.

Fall, 2000:  Still in Ann Arbor.  Lost entire afternoons and evenings lying on my bed.  No energy or desire to get up and work.  Sadness.  Lots of sadness.  Occasional bouts of rage.  I bought several bottles of St. John’s wort and popped several capsules a day.  The university ran a free health screening for students as part of a mental health day.  I took their quiz to see if I might be suffering from depression.  The result: Please make an appointment with one of our counselors.  I did.  I discussed my symptoms with one of the counselors and it was decided that I should make an appointment with one of the university’s psychiatrists.  I still wasn’t convinced I needed any help.

A week or so later:  A Saturday evening. At my girlfriend’s (now wife’s) apartment feeling bad.  Really bad.  Sadness and utter gloominess impossible to describe.  A dull, throbbing headache.  I reached the point where I couldn’t take it anymore.  I asked her to drive me to the emergency room to see a doctor.  Waited for an hour.  Saw a therapist who politely empathized with my problem.  I told her I don’t need counseling, I just want some sort of medication.  It was time, I thought, for help.  I waited for another 2 hours to see a doctor.  Finally, it was my turn.  The doctor on duty was probably a young, med student resident.  I told her my symptoms and asked if there was anything she could prescribe.  Nope, she couldn’t.  I had to see a psychiatrist.  3 hours.  Still felt miserable.

Another week or so later: Finally saw a psychiatrist.  Diagnosis: CYCLOTHYMIA with possible seasonal variation.  In other words, my condition was a mild form of bipolar disorder  with more depressive episodes in the fall and more manic episodes in the spring.  Treatment: Light box therapy in the morning and evening as needed and Celexa, an anti-depressant.  The light box helped, somewhat.  I remember the Celexa, however.  Within a few days I was pretty happy.  Life was pretty darn ok.   I still had some manic episodes (as I learned what to look for from the psychiatrist): accelerated thoughts, fast talking, darting-around-like-a-madman, and anger.  Anger, even violent rage, is another form of mania.  I still had depressive episodes as well: low energy, sadness, gloomy outlook, and no brain power.  But the Celexa took the edge off so life was ok.

2001: Moved to Tucson, Arizona.  The daylight problem was fixed, that’s for sure!  Had to find a new psychiatrist.  New doctor wanted to try new drugs to alleviate even more symptoms.  I tried Lexapro.  The doctor said that Lexapro was like Celexa but they took the active ingredient and made ir more potent or something like that.  Didn’t work as well for me.  Went back to Celexa.  Six month recalls.  I could handle that.

2003: My psychiatrist left Tucson so I found a new doctor.  He wasn’t satisfied with my current level of symptom recurrence and wanted to alter my treatment.  He had me try different medications.  His theory was this: emotions are like an Oreo cookie.  He wanted his patients to live in the creamy middle between the two cookie outsides, neither manic nor depressed.  Can you tell he treated a lot of young patients?   As a result, he added anticonvulsants (mood stabilizers) to my regimen. We tried a bunch.  Ready for the list?

I tried Effexor.  It WORKED!!  Holy shit I felt like a million bucks!!  I woke up in the morning, popped one with coffee and then BAM!  WOW, I mean, that stuff made me feel completely energized and invincible!  I felt great!  And then it triggered the other kind of manic episodes: anger.  Only this time, the anger was magnified as well.  Ladies and gentlemen, I have never, ever once hit my wife or even threatened her with physical harm.  Effexor almost pushed me over the edge.  I was scared and stopped taking the drug within a week of starting it.

I tried Lamictal.  Zzzzzzzzzzz.  Talk about a walking zombie!  That stuff knocked me out but I was stable.  Hell, I was so level that you could have knocked me over and I wouldn’t care.  Nice and passive and stable.  I was so zonked I made an emergency appointment to switch to something else.  Next drug!

I tried Depakote.  This drug required blood tests to ensure I was at the right medication level.  Too much will fry your liver.  First evening I took Depakote my mood was squashed the same zombified, passive level as Lamictal.  Allow me to add another weird and scary side effect that no one has reported: Within a few hours of taking Depakote I lost the ability (that evening) of being able to feel a musical beat.  My ear/foot-tapping connection vanished.  Unacceptable!!  Next we have:

Symbyax.  Part Prozac, part Zyprexa!  We have the antidepressant and anticonvulsant in one easy-to-swallow pill!  Only problem: Zyprexa is powerful stuff!  I started on the lowest dosage of Symbyax and became another zombie.  To make a long drug-adjustment story short, I ended up taking separate Prozac and Zyprexa tablets.  The level of Zyprexa I settled on was one-quarter my initial dosage!

This treatment combo carried me for several years until I eventually weaned off the Zyprexa.  Now I just take Prozac with occasional Deplin in the Fall.  Deplin: a medical-grade “food” that costs more to purchase then generic Prozac.

So what have I learned from this?  I can alter my moods (and emotions) by popping a pill.  I can feel happy or sad for no apparent reason.  I can become the most angry and violent person or the most placid zombie you’ve ever met.  How do I know if what I’m feeling is “really me” or something out of a bottle or some messed-up cyclothymic reaction?  My emotions seemed to be lying to me.  If cannot trust my emotions, what can I trust?

Reason.