BY PHOEBE RUSCH
I’ve been on my OCD medication for almost six years. Without Luvox, I’d be bombarded by mental images of having sex with you, your parents, my parents, a seventy-five year old lady at the grocery store, pre-school children and some one’s pet dog. Un-medicated, my mind becomes an absurd, pornographic hell. The images cause a sensation of existential dread, like a churning in the gut from drinking too much coffee, not pleasure. Still, the physiological experience of fight or flight is sexual excitement’s twin.
Male participants in a 1974 study rated their female cohorts as more desirable after walking across a rickety rope bridge, misattributing their own shortness of breath and racing heartbeats to attraction. Even without intrusive thoughts and compulsive ruminating, discerning our true feelings can be difficult. OCD seeks absolute certainty, rears up when faced by conundrums like human sexuality; when the two become entangled, as they did in my case, it’s monstrously painful and confusing.
We all have bizarre, disquieting thoughts sometimes. What kind of person has such sick, evil thoughts,we may ask ourselves. If you, like me, have OCD, your mind will begin to imitate an oil derrick, relentlessly mining itself for answers. Instead of dismissing disturbing thoughts, you will become convinced that they reflect the fundamental truth about you. The conviction that you are in fact a sick, evil person will only further lodge whatever mental flotsam you desperately want to wash away. Too terrified and ashamed to ask anyone for help, you will probably, understandably, become suicidal.
When I’m on OCD medication, I don’t feel harassed by my own mind. Even if it’s a bad day, I’m able to laugh at the intrusive thoughts, to recognize them for what they are, which strips away their power. Cognitive behavioral therapy has provided me with excellent training in this regard. Still, without Luvox the volume turns up and my head once more becomes a weird, terrifying place to be. I can’t live that way. It’s not a life, really. If Luvox is the easy way out, I’m happy taking it. If I’m a pill-popper, so be it. No amount of ruminative talk therapy is going to calm my hyperactive amygdala; analyzing someone’s childhood won’t cure their diabetes.
Even as Americans turn to SSRIs at unprecedented rates (the CDC estimates that antidepressant prescription increased 400% between 1988 and 2008), this supposed “quick fix” remains stigmatized, suggesting a level of cultural shame. New York Times columnist Diana Spechler has chronicled “breaking up” with her anxiety medication, citing concerns about the pharmaceutical industry and long-term side-effects. In her XOJane essay It’s Fine If Other People Want to Come Off Their Psychiatric Drugs, But I Am Never, Ever Quitting My Meds, LGBT mental health advocate Teresa Theophano argues that while she respects Spechler’s decision, natural remedies don’t work for everyone and reinforcing the idea that mental illness can be overcome by strength of will is dangerous.
In my case the biomedical model really does fit. Aside from my OCD, I’ve led a fairly charmed life. I used to feel embarrassed for fitting the stereotype of someone on SSRIs: white, navel-gazing, suburbanite. With no real problems, the privileged invent problems or Americans have taken to medicating away their problems instead of facing them head on: these narratives trivialize pain, shaming those lucky enough to be able to afford the thing that might very well keep them alive. They also pivot on the assumption that anxiety disorders and depression are a form of pain only rich white Westerners experience.
The converse of the myth that mental illness is a first world luxury, invented out of the boredom of lacking nothing, is the myth that poor people, especially poor people of color in non-Western countries, are simple and happy, facilitating the revelations of voluntourists: I learned so much from the way they’re able to be so joyful, even though they have nothing! Or, as is often said of Haiti, a country ravaged by natural disaster, political corruption and foreign intervention, I’m amazed by their resilience in the face of so much suffering. This supposed compliment dehumanizes Haitians, denying them vulnerability, conflating survival with an infinite capacity to endure pain.
The same line of thinking that shames privileged people suffering from mental illness renders marginalized sufferers invisible. Articles that treat the subject of mental health outside the U.S. and Western Europe tend to focus on the lingering trauma of war and natural disaster, the daily grind of poverty, but not less sensational issues like familial strife, domestic abuse or chemical imbalance that people may also lack the framework to talk about. When I shared my story with a college friend from Madagascar, he told me that if I was Malagasy my family would probably take me to an exorcist.
Conventional wisdom holds that OCD is a first-world malady, a product of Western individualism and atomization; searching for studies on OCD in the non-Western world turns up very little. But I’m willing to bet that this vacuum is due to scarce resources and cultural taboos which prevent self-reporting. The human mind is not somehow stranger and more complex, more prone to malady, in some parts of the world or in some demographics than others.
My (excellent, effective) OCD therapy cost $125 per session after insurance. The specialist I consulted also offered group therapy sessions for those who couldn’t afford to see her individually. Several participants were black and from the South side of Chicago, where racist federal housing policy denied people of color the ability to build equity for the next generation.
While these group members knew that they had OCD, that they weren’t really going to burn down their house or get AIDs from a public restroom, didn’t actually want to push people off train platforms or molest their daughter or stab their husband with a butcher knife, that didn’t stop their obsessions or help them resist the momentary comfort of giving into the compulsions that soothed their fears, routines so exhaustively time-consuming it often became impossible to hold down a job. Imagine checking, for hours at an end, to make absolutely sure you haven’t run over anyone with your car or poisoned your aging mother’s food. Then add to that the stress of dealing with institutionalized racism, which increases one’s chances of hypertension, compromises the immune system and can cause ulcers.
Unfortunately, Luvox, which allowed me to stop running on the endless hamster wheel in my mind and begin functioning, can cost hundreds of dollars per bottle without decent insurance. Instead of perpetuating narratives which frame mental illness as privileged white self-indulgence--narratives premised on an understanding of mental illness as a purely social phenomena rather than a biological one--we should fight for everyone’s access to psycho-pharmaceuticals. Instead of simply dismissing pharmaceutical companies as evil, we should demand transparency and equitable pricing, not only in America but across the globe.
Taking medication for psychological ailments is not a weakness or a character flaw. No one should be judged for being proactive about their health.