First, let me say I’m so sorry for this recent shakeup in your body and in your mind. It appears you are dealing with persistent depression and anxiety, which can be lifelong challenges for a variety of reasons. I do hope you will keep doggedly on — talk with your therapist —do all that stuff we are told to do. It’s fair to tell the therapist you need more information, and it’s fair to tell them you felt they let you down in that regard. A good therapist will help you get perspective and clarity on what you need and how best to get it.

To offer my empathy credentials, I can say I’ve had similar struggles over decades of managing medication for what the insurance companies call a “serious mental illness” — though of course, some of us can be high functioning despite a poor diagnosis, so I’m not so interested in the labels any more.

But with regard to the responsibility we have for our own self-care, I want to offer that it is not always as simple as some would make it out to be. It is the nature of some kinds of illnesses (mental and otherwise) that the patient will continually cycle from compliance to denial and back again. And for many, the denial works as a sort of insidious amnesia. It is entirely possible that you did read the package insert, or you did see on the label that you should not stop the medication suddenly — you’re obviously a smart, conscientious person. But maybe the deep desire to be brave, to be well, to walk among the neuro-typicals all independent and such, short-circuited your knowledge and… “Ooops! I’m out of medication…!” And you know the rest.

This might not be how you interpret your recent experience, but if it resonates — well, I’ll share back that last fall, after DECADES of appropriate medication, and hours of conversations and multiple experiences tapering off one med and starting others, I did that very same, exact thing. I “forgot” to get a refill; thought I’d tough it out; didn’t even think about it until the shakes started. And, like you, I didn’t even connect the two things — I actually told myself I might be getting the flu! It was mortifying to me when reason returned and found me weak, sick, and penitent. Denial only lasts until reality bitch-slaps you back into compliance, because you really do know that maybe some illnesses have no cure.

I say maybe, because I, too, am cynical about how some illnesses get treated by the medical community. I believe your suspicions that the medical community might not be racing to find a cure is well-founded. I’m not implying any evil intent on the part of pharmaceutical researchers — it’s just that our profit-based health care system offers perverse incentives to make and market maintenance medications, rather than curative treatments. Case in point: did you know there is evidence that proper clinical administration of ketamine can sometimes stop depression that day? I’m not a doctor, but I am a witness to its effectiveness in the life of someone close to me. Of course not everyone’s a candidate, but why isn’t there a pamphlet about that treatment in every therapist’s office? Clinical trials are probably going on now. Providers need to do a MUCH better job educating their clients, so that the conversation isn’t just about Pink Pill Forever vs. Yellow Pill, also Forever.

And there are always people who don’t understand your illness who will try to instruct you in bootstrapping it, or managing your gut bacteria, or meditating, or doing goddamned yoga — maybe with goats — and fixing yourself right up. And then we feel the denial and the self-doubt: “Am I just being a big baby? Should I just tough it out?”

The only advice I have is just to please forgive yourself. So you zigged when you should have zagged. Oh, well. That’s not a sin and it’s not being stupid. It’s being human. You made it through, and that’s a triumph and a blessing — which you are now paying forward by learning and sharing in this space.

So… keep the faith, Liz.