“Hey doc, I’ll have mine on the rocks with a twist of lime …”
27th April 2004
I was at a cocktail party (there's that annoying word again) in Los Angeles about a month ago, talking about what seems to be the illness of the decade, manic depression, (which also happens to be mine). Someone came right up to me and asked, "So, what 'cocktail' are you on?" This brings up an entirely different issue about the appropriateness of asking complete strangers at a social function about their medication. But let's put that point aside for the time being.
I made the decision to confront the question directly, responding openly and honestly by telling the questioner (a dead ringer for Johnny Depp) that I was on the 'Hollywood Cocktail'. The Johnny Depp look-alike looked surprised.
"What's in the Hollywood Cocktail?" he asked, with an extremely curious look.
"It's Depakote, Topamax, Geodon, Klonopin and Sonata," I responded, sputtering off a long list of 'meds'.
And that's why psychopharmacology really is - guess work. It's one of those weird sciences (I don't really even consider it a science - it's more like a hobby, like stamp collecting or knitting, except you need a degree and a license to practice it) where I imagine doctors wearing white lab coats, white caps and protective booties while mixing pills and potions. You're in a huge laboratory and there's steam coming out of all kinds of glass flasks and the doctors are feeding these concoctions to innocent rats and rabbits, and teams of scientists are observing their behaviour and taking copious notes while the animals spin around their treadmills. Psychopharmacology is not an exact science at all. Sometimes I fantasize it's much like Italian cooking - some extra spices thrown in here, a splash of wine there. Let's just see how the rats and rabbits like that. It's embarrassing to say, but I got my own doctor to admit that psychopharmacology is a tiny bit like decorating and a lot like bartending.
Let me explain. A decorator chooses paint colours for the walls and fabrics for the couch and chairs, and gets a feel for how his client will feel living in this space. Will the inhabitant feel cosy or too cold? Is the room too uptight? Then the decorator can make changes - he can 'warm up' the paint colour, add some fabrics or some pillows or some antiques to give a different feel to the room. So, ultimately, the 'patient' will be able to live in comfort. A bartender, too, has to get a sense of what his customer wants. Does he just want to drink a few beers through the night and get 'toasted', or does he want to get blasted within the first hour with a strong few shots of a good Mexican tequila?
"I'll have another cocktail," is a common line you'll hear in a bar. But it's also one you'll hear around a psychiatrist's office, because psychopharmacology is a science of trial and error and it takes quite a few attempts to find the right combination of 'meds' - the right cocktail to stabilize people with psychiatric illnesses. In my case, it took nearly seven years to stabilize my manic depression, and by the time we had dealt with that successfully we had a new issue to deal with - an illness referred to as schizoaffective disorder, which required finding the right anti-psychotic that wouldn't leave me with crazy side effects such as shuffling feet and twitching.
But I've finally found my cocktail. I take it once a night, and it's paid for by the American government - that's probably a bigger feat than actually finding the right cocktail. But that's a huge issue. We can talk about that over a drink.
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