I’m thrilled to have my memoir, Crash, reviewed on the Mad in America Blog by the fine reporter, writer, and storyteller Amy Biancolli.
Crash: A Memoir of Overmedication and Recovery by Ann Bracken (Charing Cross Press)
“Have you ever done everything a doctor told you, only to find yourself sicker than before you began treatment?”
So asks Bracken in the first paragraph of her memoir, a devastatingly honest, ultimately hopeful account of personal and family anguish marked by crashes both literal and figurative. She zips back and forth in time, describing both her mother’s decades in the system and her own long arc of anguish and recovery—and touching on her daughter’s story as well.
The multigenerational saga begins in 1959, with her mother’s hospitalization for depression, and cycles through a decades-long ordeal that led to 37 ECT sessions (with minimal anesthesia) and psych drug upon psych drug upon psych drug. As a kid, Bracken had questions (where’s mom? why are the grownups whispering?); as an adult, she found answers in 30 years’ worth of medical documents meticulously preserved by her father.
The revelations were many. A full list of Helen Dempsey’s meds in the appendix includes barbiturates. Amphetamines. Tranquilizers. Antidepressants. The benzodiazepine Dalmane. The anticonvulsant Dilantin. Beyond all those medications and ECT, Dempsey also received some talk therapy—“but I’m not sure how helpful it was for my mother to talk with her male psychiatrists,” Bracken writes, “especially given the medical establishment and cultural attitudes toward women at the time.”
You can read the rest of Amy’s review here, and check out the other books featured this month as well.
Author’s note: This essay forms the foundation for my memoir-in-search-of-a-publisher, Putting the Pieces Together: A Story of Overmedication and Recovery.
In 1959, my mother suffered what people commonly referred to as a nervous breakdown after my youngest sister’s birth. Mom spent six months in a local, Catholic psychiatric hospital while Dad and Grandma assumed command of the household. I was seven years old, the second-oldest of five children. Eventually, Mom visited us a few times on Sundays, and then returned home in November, presumably ready to assume her duties as a wife and mother. Sadly, Mom remained gripped by depression for the rest of her life.
Because my memories of that time are wrapped in thick layers of gauze, I’ve had to rely on others to fill in the gaps. My father, grandmother, and Mom’s close friends believed that Mom experienced postpartum depression, starting after my birth, and worsening with each successive child. My older brother shared this memory about a year ago when I asked what he remembered about Mom’s 1959 illness: “I came home from college and found her in the basement, banging her head against the wall, moaning, ‘I can’t take it anymore.’”
My heart ached when I heard that story, but I still puzzled over why Mom never recovered. Until I found Dad’s collection of records in a dusty box stashed in my sister’s attic. Old insurance and medication records, newspaper and magazine articles, and letters to doctors were neatly organized in an unassuming manila folder. As I leafed through the contents, intuition whispered that I’d finally have the missing puzzle pieces I’d searched for all my life.
Some of the most valuable clues were in a letter, typed on onion skin paper, that sat on top of the file. It was dated 1-17-83 and addressed to Dr. L., one of Mom’s many doctors. Dad wrote the following notes:
5th child born Feb.59. Normal birth and she carried baby in good spirits. About mid-April started having problems and had first visit with psychiatrist of May 8, 1959. Between then and June 22nd, ’59, he treated her with Amytal, Ritalin, Nardil, Trilafen, NaBu-4, Dexamyl tabs and spansules, and Tofranil. By the end of May ‘59 she was so bad, that even to my nonprofessional eye, I didn’t see how she could avoid hospitalization… She remained there to late Nov. 59. During this time, she received medicine and numerous EST [electroshock therapy] treatments.
The only drug I recognized in that long list was Ritalin, an amphetamine that had been widely prescribed for depression in the 1950s and ’60s. I quickly set to work looking up the rest, all the while screaming inside, How could anyone give a nursing mother with three small children and a newborn so many drugs in such a short period of time? A quick search on the website drugs.com helped me to understand the other drugs my mother took when she first got depressed. Amytal is a long-acting barbiturate; Nardil is an MAO-inhibitor (a type of antidepressant); Trilafon is an antipsychotic; Nembutal is a barbiturate used as a sedative; Tofranil is a tricyclic antidepressant; and Dexamyl is a combination of an amphetamine and a barbiturate.
It was easy enough for me to find the commonly listed effects of all of those drugs, and I wondered how Mom’s doctor could have prescribed all of them in such a short time. Dad’s records don’t indicate if she took all of them together, but even if she took a few, discontinued them, and started a few others, the chemical load must have overwhelmed her system. What struck me in looking at the effects of all the medications was that many of them could cause anxiety, sleeplessness, and agitation—three things I clearly remember my mother struggling with.
Now my brother’s story made more sense—I think Mom was banging her head on the wall because she couldn’t tolerate what the drugs did to her. Her doctor told a different story in the diagnosis that my father noted: “This psychiatrist [Dr. S.] diagnosed it [Mom’s illness] as severe depression with agitation and not due to childbirth.” The doctor’s assessment rang true in one sense—it seemed pretty clear to me that Mom’s severe depression with agitation was due to the massive amounts of drugs she was taking and was, indeed, not related to childbirth. But somehow, I don’t think that’s what the doctor meant. While I have no doubt that my mother struggled against overwhelming feelings of sadness and fatigue, which led to the initial appointment with Dr. S., I believe Mom’s breakdown was probably chemically-induced due to overprescription of drugs.
Dad had also kept some of the original prescription bills related to Mom’s 1959 hospitalization, and between August and October, she took Thorazine, Nembutal, and Tofranil on a regular basis, in addition to receiving an undisclosed number of electroshock therapy treatments. When she came home, the doctor had her on a regimen of Phenobarbital, Miltown (an antianxiety drug), and the tricyclic Tofranil. Dad supplemented that regimen with carefully measured decanters of white wine that I once caught him cutting with water. When he saw me watching, he cautioned, “Don’t ever tell your mother what you saw.” Nowhere in the thirty years of records is there any indication of Mom’s drinking, which all of us tacitly accepted as a significant part of her daily routine.
I also found homemade spreadsheets where Dad listed the dates and medication amounts for Mom’s drugs, often annotated with notes about her responses. The information in those charts prompted me to investigate possible medication effects that may have influenced Mom’s internal state which led her to attempt suicide in 1967. At the time, she was taking a combination of Aventyl (a tricyclic which can cause restlessness, agitation, and anxiety), Dexamyl (amphetamine and barbiturate combination), and Phenobarbital (a barbiturate which is linked to nightmares, nervousness, depression, and anxiety). The effects of all of these medications, combined with Mom’s continued daily drinking, probably led to the intense feelings of despair that drove her to slit her wrists in December. Dad found her in the bathroom that night. I accompanied my parents to the hospital, while my two siblings, ages twelve and thirteen, stayed home and cleaned up the bathroom. None of us ever spoke of that night again.
What about therapy, I wondered, and how did Mom’s psychiatrist treat her after that tragic night? One would think the doctor should have increased Mom’s routine visits to keep a closer watch on her. But according to Dad’s records, that’s not what happened. In fact, Mom’s doctor saw her twice a month, beginning in January of 1960, only about two months after she was released from the hospital, and continuing through June of 1968. However, in the weeks immediately following her suicide attempt in 1967, he did not see her more frequently, a fact which seems to indicate a lack of support and concern. By August of 1968, Dad’s notes indicate that Dr. S. wanted to hospitalize my mother. Dad’s notes and the conversations I can remember ring with the angry charge that “Dr. S. just threw up his hands and gave up on her.”
Because Dad was adamant about keeping Mom out of the hospital, he sought out Dr. M., a well-known psychiatrist who performed electroconvulsive therapy (ECT) treatments in his office. Between August of 1968 and June of 1970, Dr. M. administered thirty-nine ECT treatments to my mother, sometimes giving her as many as five treatments in a month. The one time I remember accompanying my father to help him bring Mom home, I was shocked by her dazed look and unsteady walk. I remember her sleeping through the next day and experiencing memory loss from that time forward. Dad told me that Dr. M. did the procedure without anesthesia, but from some of the reading I’ve done on earlier ECT administration, it seems likely that Dr. M. probably used a short-acting barbiturate to sedate Mom. Otherwise, how could she submit to so many treatments? And how could Dad willingly put her through that pain? I think both of them must have been more desperate for relief than any of us kids could have guessed.
I wish I could say that Mom got better after all of that ECT, but she never attained such a reward for all of her efforts and suffering. In 1973, after suffering from mysterious dental pain for several months and finding no relief, a neurologist helped Mom and Dad to see that she was suffering from depression. Mom was hospitalized for at least a month and endured detox for both barbiturates and alcohol, but she was unable to maintain her sobriety once she came home. I was sickened to learn that Mom’s doctors routinely prescribed Thorazine for her from 1969 to 1983, a practice which would explain why she suffered from tardive dyskinesia and later from severe full-body trembling, possibly akathisia. Mom was hospitalized again for several weeks in 1993, and for the first time, her psychiatrist confronted the family about her alcohol dependence and informed all of us that her MRIs showed evidence of small strokes and blood in the brain. He asked all of us to pledge to refrain from serving alcohol at family gatherings, but we were split on the issue of whether Mom had a problem or not, so she continued to drink along with all of her medications until her death in 2002.
I remember my mother suffering from horrible, visceral anxiety where she would take deep, fast breaths and then wring her hands as if she were Lady Macbeth. Now that I understand more about her medications, I realize how impossible it is to determine if my mother was actuallyvery depressed and anxious or if she was one of the early victims of polypharmacy, trapped in physical and emotional pain due to overmedication and a lack of supportive therapy. It seems clear from the records that Mom’s doctors saw her condition as biochemical and treated her accordingly, tweaking the pills as they went along, and in a sense, resigning themselves to maintaining her “treatment resistant” condition with the only tools they believed in.
Despite all of her sedating and numbing medications, Mom lived a rich and meaningful life. She cared for us, made sure we had regular, nutritious meals and provided a supportive presence when we needed help. Mom hosted her bridge group, participated in a book club, and made weekly trips to talks at the local art museum with one of my aunts. She was also a gifted artist with a degree in costume design from Maryland Institute College of Art, but her talent never matured once all of us were born. Sadly, she never picked up a paint brush in all the years I knew her.
As a child, I made two vows: to help my mother get well and to never be like her.
Want to read the rest of the story? Please hop on over to the Mad in America blog where this essay was originally publishedin May of 2019.
Mad in Americarecently published one of my poems that deals with mis-diagnosis and a careless rush to judgment. In “The Hopkins Doctor Diagnoses Me,” I tell the story of how I acquired a diagnosis of bipolar II and how that diagnosis resulted in an unnecessary hospitalization in a psychiatric ward.
Back in the 1990s, I had felt depressed for a couple of years and had seen a few doctors for treatment–which consisted of trying numerous psychiatric drugs without any relief. One of my doctors got so frustrated that he threw my file across his office and said, “I’m sending you to Hopkins. They deal with people like you all the time.” The doctor never revealed that antidepressants can often worsen a depression or even cause a state of chronic depression that is pretty much untreatable. (Giovanni Fava wrote about this in 1994, when I was experiencing depression)
Several months later, a doctor at Hopkins finally saw me for about an hour. I’m guessing he’d read my file and seen all of the drugs I’d taken, none of which were helping. He noted that twice before when I’d felt depressed, I’d gotten relief for my symptoms from an older drug called Elavil.
And because I reported that I “felt like a party girl” for a couple of days once the depression lifted, the Hopkins doctor diagnosed me as having bipolar II–a milder form of bipolar disorder. He refused to listen to me when I enumerated the symptoms I didn’t have–insomnia, overspending, and grandiose thoughts among others.
I tried to explain to the Hopkins doctor that I had a higher than average “happiness level” and frequently felt upbeat and energetic. But he put that information down to confirming his diagnosis rather than listening to the truth of my life.
He told me that sometimes antidepressants can “reveal” an underlying bipolar disorder, which sounded like a medication effect to me, not an actual illness. And he never told me that research had shown that some people who take antidepressants for depression alone can begin to experience cycles of depression and mania.
And the problem with his overly simplistic diagnosis is that every other doctor who read my records saw me as someone with bipolar II disorder and dismissed my concerns and explanations. Worst of all, they continued to prescribe me unneeded mood stabilizers.
Later, when I was hospitalized for mania–which was due to taking prednisone for three weeks–the doctors there also dismissed my explanation of having a reaction to prednisone because of my bipolar II diagnosis.
A needless hospitalization could have been avoided if the doctors had done two things: listened to me when I described my upbeat personality and taken into account the very common effect of mania due to prednisone. And the years of taking unnecessary and mind-body altering mood regulators could have been totally avoided.
I’m one of the lucky ones–I got off of antidepressants, mood regulators, anti-anxiety drugs and pain medication in the early 2000s and haven’t had any recurrences of depression. And I’m glad that my negative experience led me to reading and research that I can share with others.
Anatomy of an Epidemic by Robert Whitaker is a good place to begin if you want to know more about psychiatric drugs and their effectiveness. You may be as shocked and surprised as I was by what you find.
Dorothy Wetzler Bracken designed and painted this dress as a student at Maryland Institute College of Art in the 1930s. Although she graduated in 1935 with a degree in costume design, she was never able to pursue her artistic talents. Mom kept her dreams to herself until the late 90s when I discovered a portfolio of her designs and she confessed, “I always wanted to be a fashion designer.”
Dorothy’s story could have been a happy one—she married, had many friends, and eventually had five children. “I was thrilled every time I found out I was pregnant,” she often told me. Yet, postpartum depression plagued Mom following nearly every birth. After her fifth child arrived, Mom was hospitalized, received electroconvulsive therapy treatments, took copious amounts of psychiatric drugs, but sadly, she never recovered.
Because I always managed to recover from my own depressions, I puzzled over Mom remaining trapped in chronic depression for over 40 years. Until I found Dad’s collection of old insurance and medication records, newspaper and magazine articles, and letters to doctors stashed in my sister’s attic.
Those records told the story of my father’s futile attempts to get help from Mom’s doctors, most of whom only saw her twice a year despite a suicide attempt, hospitalizations, accidents (probably due to overmedication), and many electroconvulsive therapy treatments. Most troubling of all were the lists of Mom’s prescriptions that Dad had saved: Thorazine, barbiturates, antidepressants, amphetamines, and benzodiazepines.
Mom’s doctors were practicing polypharmacy: giving a patient more than one drug to treat a condition. The same thing that happened to me with opioids in the late 90s; the same thing—with different drugs—that’s happening now. And oftentimes the chemical load becomes so great that it’s impossible to tell what’s actually going on for a patient vs. the interactions of the medications. Now I know at least one reason Mom never got well.
When I went through training in journal and poetry therapy, one of the mantras threaded through our work was “Change your story, change your life.” We spent a lot of time rewriting stories and talking about how shifting the narrative could result in a more positive outcome. That’s why I wrote my post for Mad in America about overmedication and recovery–I couldn’t change my mother’s story, but I was determined to change mine.
The post details my story of overmedication and its harm, along with my mother’s story. When I found my father’s records about her illness, I was shocked to see that Mom received very little therapy over the years, but year after year, psychiatrists prescribed barbiturates, amphetamines, Thorazine, and antidepressants. People tell me that wouldn’t happen now–but my story, 35 years later, parallels Mom’s. Mom and I suffered needlessly because of overmedication, and I hope to be a voice for change so others don’t experience the same fate.
A few weeks back, I posted my story of being overmedicated and getting off of pain medication and psychiatric drugs. So when I read the blog post below, I thought it was a good follow-up to my story. I, too, was a victim of polypharmacy, which is why this post resonated with me. What is polypharmacy? Here is a definition that is included in Dr. Brogan’s post below:
Polypharmacy is ambiguously defined as the prescription of 2-11 or more medications, simultaneously, 6 encompassing more than half of the American population. 7
Is Gloria some kind of freak anomaly of someone who could possibly feel better off medication? You can see that part of her process was shifting out of a mindset that she was fundamentally broken, in need of medication as some sort of normalcy prop. I believe deeply in personal reclamation through a rewriting of this story of the broken self. But what if medications actually contribute to a poorer quality of life, not because of their metaphysical role in self-identity and outsourcing of power, but simply because of their toxicity, particularly in combination?
The Problem With Pills
We know that it’s not a matter of opinion, (despite what the NY Post would have you think!), that medications – properly prescribed – are the third leading cause of death in this country. 1 This does not include the quarter of a million deaths from medical errors 23and overdose, which in 2016 killed more than the entire Vietnam War. 4
These reasons and more are why I was delighted to read Poly-deprescribing to treat polypharmacy: efficacy and safety5 in the journal Therapeutic Advances in Drug Safety. This longitudinal, prospective trial addresses the major symptom of our fragmented, specialist-driven, the left-hand-doesn’t-know-what-the-right-is-doing-health care system: polypharmacy.
Polypharmacy is ambiguously defined as the prescription of 2-11 or more medications, simultaneously, 6 encompassing more than half of the American population. 7
The author, Garfinkel, states that the epidemic of polypharmacy is driven by:
(1) the increased number of doctors/specialists and clinical guidelines; (2) the lack of evidence-based medicine (EBM) and knowledge regarding drug–disease–patient interactions in polymedicated; (3) barriers/ fears of medical doctors to deprescribe.
His study was conducted on patients >66 years old taking >6 prescriptions (never mind the 666!), and this intrepid clinician endeavored to offer them the opportunity to discontinue more than 3 of their meds, strategically assessing quality of life parameters.
Getting Free, One Med At A Time
After approximately four years, Garfinkel found that: Overall, 57.4% of PDP patients/ families reported an improvement as early as 1 month after the intervention. In 82.8% health improvements occurred within 3 months of the intervention and among 68% improvement persisted for more than 2 years.
Like the parable of the blind men and the elephant, feeling and describing only their part, neglecting the comprehensive appreciation of the whole animal, Garfinkel states:
…all too often specialists who treat patients ‘by their book’ have but one aim, to deal with their one aspect of the disease spectrum; no in depth consideration of the ultimate effects of medications they prescribe combined with other consultant’s interventions on patients’ overall welfare.
He also references the domino effect of prescription toxicity leading to new diagnoses and new medications, stating:
“The problem is further aggravated due to ‘prescription cascades’ where symptoms resulting from ADEs are perceived as representing ‘new diseases’.”
So, it turns out that when real life studies assess the effects of medications, stopping them – several if not all of them – can lead to a better quality of life.
I love his hopeful message, in conclusion:
Conclusions: This self-selected sample longitudinal research strongly suggests that the negative, usually invisible effects of polypharmacy are reversible. Poly-deprescribing] is well tolerated and associated with improved clinical outcomes, in comparison with outcomes of older people who adhere to all clinical guidelines and take all medications conventionally. Future double-blind studies will probably prove beneficial economic outcomes as well.
The study doesn’t particularly reference psychiatric medications (in fact, he references starting them during the study window), which, in my opinion, are the most difficult chemicals on the planet to detox from. While I acknowledge that the physiologic relief from discontinuing a medication may, itself, result in near-immediate improvement in quality of life, psychiatric medication taper seems to ask something more of patients intending for a medication-free life. The taper process asks for healing. Physical, emotional, and spiritual…and this healing does more than improve quality of life…it sets you free.