A few months ago, I was doing a puzzle-solving game with a friend. It required the ability to be at least moderately observant of my surrounding environment to look for clues, though the clues were designed to be relatively easy to spot.
I couldn’t find them. I got frustrated, and failed, and felt humiliated and awkward, although my friend and everyone else were very gracious and friendly and easygoing about it and helped me get on the right track. I didn’t feel judged by them, but, rather, infuriated with myself: I should have been able to follow basic directions. I should have been able to see things that were literally right in front of me. I shouldn’t have missed something so simple.
It wasn’t a coincidence that right around the same time, I was changing medications, tapering off one drug and going on to another, which, for anyone who has never dealt with changing medications, is a nightmarish experience. It’s not just that your brain chemistry is suddenly completely disrupted. Nor is it just that you have wild side effects as the blood levels of one drug drop and another medication go up. It’s not just because as you taper up, everything seems horrendous and huge and you have emotional outbursts for no real reason and know why they’re happening but still can’t get them under control.
Bluntly, a lot of psychiatric medications tend to blunt your cognitive skills, although people can experience this side effect to varying degrees. As a usual rule, the heavier the dosage, the greater the cognitive effect, which is one reason why psychiatrists try to taper up very slowly to find the minimum effective dosage (there are also concerns about side effects at higher doses). The stereotypes about people with mental health conditions who can barely put sentences together and struggle with what seem like basic tasks date back to the days when we were extremely heavily medicated with aggressive drugs that effectively turned us into zombies, but there is a note of truth to them.
Since I went back on psychiatric medications and stayed consistently on them, I have noticed my cognitive decline. It’s not just that I’m fatigued much more than I used to be and need more sleep, but that I can feel the cognitive slowdown. I used to read more, for example, and I used to read more complex things. Now, I sometimes I have trouble following an entire article, let alone a book (there’s a reason I’ve been reading much more YA lately, aside from the fact that I love the genre and I’m doing a great deal of reading for work and research — sometimes, YA is all my brain can handle). I have much more trouble with puzzles than I used to. Scrabble can be a slogging nightmare.
When I was a child, lots of people used to call me smart, and things came very easily to me — and I definitely became rather spoiled as a result. As I aged, though, that same reinforcement came through time and time again — not just that I was smart, but that much of my value was derived from my intelligence. It was one reason I feared going on psychiatric medications and allowed my mental health to become so precarious. Because I was afraid of turning ‘stupid.’ And now, my medications have slowed my cognition significantly.
There’s a myth that creative people are crazy — that it is our mental illness that makes us so creative and that our abilities are blunted and dulled by psychiatric medications. I already know how I ‘function’ off medications and am fully aware that going off medications might make me cognitively sharper, but the cost would counterbalance that — I can’t exactly be cognitively productive when my mood is completely irregulated, when I’m having extreme depressive episodes, when my anxiety has me climbing the walls, all of which happened before I went back on medication.
But there are times when even though I know this, I become frustrated to the point of tears and exhaustion with the way my medications interact with my brain. I know that this is the price I have to pay for having the brain that I have and for seeking treatment instead of letting my mental illness get out of control — but I wonder if society and the people around me fully understand that cost. People might make comments about how psychiatric medications interact with cognition, but they don’t seem to fully understand what it means to watch your cognition shift in response to your drugs, and how frustrating and humiliating it is.
When you were taught for much of your life that your sharp cognitive skills were the most valuable thing about you and you are forced to give them up for your own health, it’s hard not to feel worthless sometimes, to wonder if you’re even contributing anything to society. Even as I produce a huge volume of work while still on medications (but, my brain reminds me constantly, not as much as when I was at the heights of uncontrolled mania and could write 100,000 or more words a week), even as I do contribute to conversations and play games and interact with the people around me, even as I do benefit from a new generation of psychiatric drugs that are designed with cognition issues in mind, sometimes I just feel stupid.
And when someone mocks me, or makes a comment about it, or doesn’t get why something is difficult for me, it’s a reminder that the world expects me to be ‘smart,’ that if I can’t think quickly on my feet, I’m worthless. There are two ways to approach someone who is obviously struggling at a cognitive task; one involves compassion and respect without comment or judgment, and the other involves making that person feel even more humiliated and miserable about being able to do something like read and follow directions.
It might not seem like a big deal — it’s just a subway map, or directions for using a device, or a task to complete as part of a puzzle game, a typo — but it’s worth thinking for a moment about why that person might be having trouble, and considering how to reframe your relationship to the situation to be helpful and supportive, instead of judgmental. Because yes, sometimes I do have trouble reading the BART system map and get on the wrong train, but that doesn’t make me worthless.