My blood is in a blender. It’s just about the only bit of brightness in this drab office of a life insurance company that, before it’ll bet on my body, feels the need to sample its various fluids—specifically urine in a tiny pleated cup and, now, my blood in some sort of centrifuge the phlebotomist switches on. It circles, at first slowly, then picking up speed until it’s whipping my life-source so thoroughly that, at last, the lipids separate from the fresh red liquid and rise to the top—that’s cholesterol I’m seeing, a custardy yellow substance that reminds me of the pudding my mother used to make. Damn my mother! It’s her cakes and tarts and tortes that have put me in this position, which is precisely . . . what? I’m a forty-seven-year-old fatso with a penchant for Belgian waffles. In truth, though, it’s neither my mother nor those waffles that are responsible for my body’s breakdown. Isn’t this terminology odd? Breakdown. My body is having a breakdown, for sure, yet instead of atomizing into pieces and parts, I’m doing just the opposite. I’m acquiring a perverse sort of solidity that belies the real crux of the matter. For sure, no breeze will blow me over, but that doesn’t mean I’m strong. My breakdown is a kind of hyperplasic excess that renders me easily winded and, nearly worse, has exiled me to the X section of clothing stores, where I now must buy clothes in a 1X or even 2X size. Once I was five feet (I’m still five feet) and weighed one hundred pounds. What has happened here?
“Do you think they’ll insure me?” I ask the phlebotomist as we look at my spinning blood and at the lipids lining its surface.
“I see this with lots of folks,” the kind phlebotomist says to me, but I’m not reassured. I am now a member—along with “lots of folks”—of the American obesity club, a club I’d do almost anything to leave, the damn badge stuck to my excess skin with an adhesive that is out of this world.
This is not a story about life insurance and how hard it is to get when your cholesterol, like mine, is 405 and your triglycerides are over 800. In fact, I got the life insurance, but that didn’t change my predicament. Every night I take a palmful of pills, all of them psychotropics. Way back when, in my lean, clean twenties, I needed only one pill to keep my mind aloft, but the brain is a sneaky, needy organ and even though psychiatry denies it, the brain becomes tolerant to the chemical you drink down, more often than not necessitating what is called in certain learned circles “polypharmacy” and in less learned circles, “the cocktail.” My cocktail at this point consists of Effexor, 300 mgs; Wellbutrin, 300 mgs; Vyvanse, 90 mgs; Suboxone, 4 mgs; Klonopin, 1 mg; and, last but not least, the fattening drug called Zyprexa, its zippy little name not to be confused with its stuffy side effects.
All, or almost all, psychotropics cause some weight gain, but Zyprexa is in a class by itself. It was prescribed for me last year during a horrific depression. I saw black hats roll across roads and heard everywhere I went the crying of a child I could never find. At night the darkness was intense, all consuming, like liquid coal I tried to move through.
I’d always known, at least for as long as I’ve had my psychology degree, that severe depression can have psychotic features, but knowing is one thing and experience so entirely something else that you are humbled, thinking you had ever understood. During the summertime season, well before I’d ever heard of Zyprexa, the depression’s psychotic features worsened, in part because I could not stand the contrast between my blackness and all that beauty, everywhere around me but utterly inaccessible. From the window of the kitchen I could see my garden, full of bee balm and mint, loosestrife and arctic daisies, big wheels of white with florid amber navels packed with pollen. My garden bloomed profusely that summer, calling to it butterflies and bees and birds with yellow vests. And yet all this beauty seemed somehow menacing to me. The flowers—some had the heads of serpents, others flamed in the high heat, which caused the air to warble, as though the whole world were wavering. If I stared at my garden long enough it would dissolve into thousands of Pissarro points that then lost their shapes and dripped downward.
That was when my psychopharmacologist, alarmed at my condition, decided to add another drug to my mix. First he put me on Abilify. It didn’t do the trick. Next he prescribed Geodon, which also failed. The third drug was Zyprexa—Zyprexa—that zippy little name that put me in mind of an instrument or a scooter. I liked it from the start.
No one knows exactly why Zyprexa increases your appetite, but everyone agrees that it does, and does so dramatically. Of all the atypical antipsychotics, which are often prescribed as adjuncts when your plain old antidepressant medication poops out, Zyprexa is most associated with weight gain, and the weight gain, in turn, causes a whole host of other dangerous problems, like diabetes, for one. At the time I was so desperate I could have cared less about diabetes, and my doctor’s warning that I might plump up as a side effect of the drug fell on fairly deaf ears. What did it matter to me that in every study comparing “weight gain liabilities” among the atypical antipsychotics, Zyprexa always fared the worst, with some patients gaining over a hundred pounds, while those on Geodon often lost weight. I knew how bad a rap Zyprexa had; I’d seen a friend pop those pills and go practically elephantine, but from my point of view, just then, I would have rather been a happy elephant than a miserable hominid. Thus, I filled my script ASAP and took my first white pill the same night. Three pills and three days later my depression lifted, just lifted, like a wet velvet curtain, heavy and dripping and hauled high up, above me, so I could see the air and my garden and my whole wide world as it once was, but no, even better. Zyprexa seemed to add a little zest, a little zing, so the edges of everything had a merry sparkle, and I could laugh, I did laugh, finding my children’s antics delightful, loving the way my dogs danced for their food. Food. Food. For the first time in so many months I had my appetite back and it all looked good, or better than good; it looked downright delicious, the lasagna steaming in its pan, the hot melted cheese crisped at the outer edges and bubbling on top. I could not get enough. I had the hunger of a wolf after winter, when he’s gone for months with no prey. I ate mayonnaise straight from the jar, scooping it up with my paw and aiming for my face. I was insatiable, overcome, every bite was packed with complex flavors that my tongue could somehow sense, a simple pistachio nut both fruity and salty, with the wet tang of earth in the background. I rose each morning now eager for my day, packing my children’s lunches and licking the Fluffernutter off the knife’s blade, the taste of sweetness and sunlight. Once the kids were gone, headed off to camp, I began my own breakfast, practically panting with excitement, I’m sad to say, but it was so. Some mornings I might make oatmeal on the stove, seasoning it with cinnamon and nutmeg and several dark drops of vanilla, which gave it such a fine scent I had to have seconds and even thirds. Although at this point I wasn’t giving the appetite increase and associated weight gain much thought, focused almost solely on how happy I was to have my life back, I still registered it as odd, that my stomach could contain so much food.
I kept going.
There were baked apple crisps with brown-sugar topping, expensive ice creams filled with real pieces of peach, and french fries, the outsides browned, the insides white and soft. I ate it all. And then more. Like so many drugs, Zyprexa’s side effects were more intense in the beginning, during which time I gained about fifty pounds before coming up for air. What happened is that I saw myself. I was walking down the street towards a glass door that reflected my image back to me, but it took me several seconds to recognize myself, to register that the woman I was seeing was really me. I’d grown so stout, my facial structure buried in slabs of fat, and I thought, Oh my god. I went to the gym and Stairmastered myself into a frenzy, but, oddly, the exercise didn’t seem to help. By this time I’d been on Zyprexa for many months and its appetite-increasing side effects had deeply diminished, and yet I was still gaining weight. “I swear to god I’m eating less than twelve hundred calories a day,” I told my psychopharmacologist, but he plainly didn’t believe me. “We always eat more than we think we do,” he responded. I responded by keeping a food diary, just to prove him wrong, and I did prove him wrong, although I don’t think he believed in the integrity of my reportage. “The fact is,” I said to him, “based on my experience, Zyprexa makes you fat whether you eat a lot or not.”
Some researchers agree with me, agree with the idea that Zyprexa makes you fat not because it so expands your appetite but because it radically alters how your body metabolizes the calories it takes in. Other researchers, most, in fact, see things more simply and propose that Zyprexa makes you fat simply because while on it you eat so much more. My experience with the drug contradicts this idea. Yes, I ate a lot for the first months, but after seeing myself in the door, seeing that fat reflection, I went back to eating bunny food, sliced carrots and salted celery and diet drinks for dinner, and still I put on weight, the scale going up, the digital red numbers burning in their black display, even my feet widening, so I went from a size six shoe to a seven to a seven and a half.
The bottom line, however, is not how or why Zyprexa makes you fat. The bottom line is that it just does, and with the excess of adipose tissue comes a whole raft of health issues, like diabetes, heart disease, and cancer, to name a few. So many patients have become diabetic on the drug that its maker, Eli Lilly, on January 4, 2007, agreed to pay up to $500 million to settle lawsuits from plaintiffs who claimed they’d developed diabetes after taking Zyprexa. Thousands more suits are still pending.
I don’t plan to sue Eli Lilly for making a drug that saved my life even as it is slowly leaching it away, because I’ve gone into this with my eyes wide open. I do not feel fooled or tricked. Still, the fact remains that I am taking a drug that has radically raised my triglycerides and cholesterol, and put my weight at well over 150 pounds. It’s not Eli Lilly’s fault that I am now a prime candidate for any of the diseases mentioned above. That said, I suspect I have already succumbed to type 2 diabetes. During a visit to my ob-gyn, I had some blood work done and my sugar was sky high. I haven’t gone to see my general practitioner to confirm the diagnosis because, well, that would have further tangled the already thorny thicket I’m caught in.
Zyprexa, as a drug, is not just about the corporeal. It actually raises some interesting, if painful, philosophical issues. A long, long time ago, well before Zyprexa or any psychotropic had yet to hit the scene, Rene Descartes, in 1641, famously came to conceive of the body as one thing and the soul, or the mind, as another. Descartes could not prove to himself that he even had a body; he could be dreaming it up, or it could be a delusion created by a demon. The mind, however, was a whole different story. Descartes knew he had a mind, and thus he came to the conclusion that the mind and body were so different as to exist in practically separate realms. Dualism was born, or, to be more specific, Cartesian dualism came into being, and it ruled the roost for thousands of years until, in the latter half of the twentieth century, we all grew hip to the notion that mind and brain could not be separated and, thus, mind, like body, was matter.
Zyprexa, the experience of Zyprexa, moves one out of the twenty-first century, out of the twentieth century, and back to the time of the Enlightenment, when the mind-body split was a well-accepted trope. Zyprexa makes it clear to the patient who imbibes it that she must choose between her mind or her flesh, and by doing so she is thrust back into old-fashioned dualism, ironically propelled there by one of the most high-tech drugs we have. I, for one, for now, have chosen my mind over my body, with the result that I often feel as if I lived hunched up in my head, which has to drag this offending, unfamiliar carcass all around town, the carcass being, of course, the me I have had to disown. “Go! Go now!” my mind orders the lipidinous tyrant, but she only laughs long and hard.
So, Zyprexa has banished depression and even psychosis for so many millions, while ushering in a whole new/old way of living: divided. I could go on for some time about this (the history of dualism, its appearances in the book of Genesis and in Plato’s earliest writings, the role of the pineal gland in Descartes’s mind-body split), but I’d be doing so as a means of evasion. What matters in the here and now is not some philosophical construct unwittingly resurrected by Big Pharma but rather what it feels like living with the consequences of that construct. I’m killing my body to save my mind, and this is downright scary. I can practically feel the sugar in my blood, can practically hear the crystals clanking. I realize that I am now at significantly higher risk for a heart attack or stroke as well. I can’t see what I might do about these facts except to accept them as the manifestation of my decision to do dualism, to side with my mind while sending my flesh down the river.
The main effect my newfound dualism has had on me is that I no longer see my life too far into the future. When I was trim and healthy, I silently assumed, with the advent of superior medical care combined with my level of fitness, that I would live well into my nineties. Thus, being thirty, forty, forty-five—it all still seemed young, the road ahead unfurling, the end point still in mist. I even toyed with the idea that I might be a centenarian, what with thinkers like Ray Kurzweil and Aubrey de Grey suggesting that, with a few tweaks to our telomeres, we could, we can, reverse the aging process radically, perhaps indefinitely. Years ago, the cover of Time showed a picture of a cyborg and the headline “Can We Live Forever?” Once I would have read the accompanying article with gusto, but now I read it as a curious and somewhat sad onlooker, as a woman who does not see herself surviving past her seventies, if she’s—if I’m—lucky.
My foreshortened future has some positive aspects: I take my days more seriously; I hug my children whenever I can. In a so-far-unsuccessful effort to reverse the effects of Zyprexa, I exercise hard almost every day, with the result that my weight at last has stabilized, albeit at a very high number. Every day I step on that scale and every day it stays the same, no matter how hard I sweat. But that’s just one sort of scale. In reality, my life is full of scales, what one might call the measure of our days, and on that scale I think I’m winning. I am tremendously grateful to have my world back, to be free of the distorting depression. I take my raft of medicines at night. I always take the Zyprexa last. It’s just a plain white pill; who would have guessed it could resurrect Descartes, in addition to treating mental illness? The other drugs I slug down fast, sometimes two or three at a time, but when it comes to the Zyprexa, I put the one pill in the center of my palm, right on my lifelines—a reminder, a reassertion, that this is the choice I’ve made—and then I send it down the chute, while high up in my head I look all around me. My bedroom is white, my curtains so sheer they seem to be made of mist. My child comes in and wants to sleep as a sandwich tonight; can he? He asks to be between me and his papa, for no particular reason, and I tell him, Yes. Of course. When we turn out the light, I hear my husband on the far side snoring, and my little boy talks in his sleep of sailboats and dolphins. With all this hubbub, I’ll probably be up all night. It’s all right. The crickets call. A car booms as it backfires. Somewhere the ocean surges. I lie very still, surrounded. I listen, hard, to life.