Recently, one of my patients commented, a few weeks after starting lithium: "One day I was watching a movie, and suddenly I was just watching a movie."
This is a good description of how to judge when our medications work for psychiatric conditions: there is a recovery of the ordinary. One is able to feel things normally, not too strongly, and not too weakly.
In the face of the many critics of psychiatric drugs, and the claim that they alter brain states in an abnormal way, this experience reminded me that when they are used correctly, for the right conditions, they take an abnormal brain state and make it normal. The end result of being on lithium, if one has bipolar disorder and if the drug works for that person, is ending the natural abnormal states of one's mind and brain, and making them normal again.
My patient could not sit and watch a movie. She thought too much of her life's troubles, her problems, her weaknesses. Her depression ran her mind, and it was like a train conductor who never stopped at any station. It kept going and going and going, all day and all night, reminding her of all her worries, blanketing all her life experiences with the dull grayness of her sad interior.
When the depression had gone, after using lithium, she could sit and watch a movie, losing herself in it, and enjoying it, as a good movie or a good book should allow us to do.
Getting better is about being able to lead an ordinary life, with the many little joys of quotidian living, the petits bonheurs of domesticity, noticing good weather and appreciating it, seeing little children and enjoying them, hearing laughter and sharing it, observing sadness and comforting it.
The recovery of the ordinary is not much to ask, and yet what a great achievement when one sees it.
