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"  My blood is in a blender. It&amp;#039;s just about the only bit of brightness in this drab office of a life insurance company that, before betting on my body, wants to sample its various fluids. First, it was urine in a tiny pleated cup, and now in some sort of centrifuge, my blood. It begins circling slowly, before picking up speed and whipping around until, at last, the lipids separate from the fresh red liquid and rise to the top. That&amp;#039;s cholesterol I&amp;#039;m seeing, a custardy yellow substance that reminds me of the pudding my mother used to make. Damn my mother! It&amp;#039;s her cakes and tarts and tortes that have put me in this position, which is precisely...what? I&amp;#039;m a 40-plus fatso with a penchant for Belgian waffles. In truth, though, it&amp;#039;s neither my mother nor the waffles that are responsible for my body&amp;#039;s breakdown. Isn&amp;#039;t the term odd? Breakdown. My body is having a breakdown, for sure, yet instead of atomizing into pieces and parts, I&amp;#039;m doing just the opposite. I&amp;#039;m acquiring a perverse sort of solidity that belies the real crux of the matter. Certainly no breeze will blow me over, but that doesn&amp;#039;t mean I&amp;#039;m robust. My breakdown is a kind of hyperplastic excess that renders me easily winded\u2014and possibly worse\u2014and has exiled me to the plus-size section of clothing stores. Once I was 5 feet (I&amp;#039;m still 5 feet) and weighed a pert 100 pounds. What has happened here? &amp;quot;Do you think they&amp;#039;ll insure me?&amp;quot; I ask the phlebotomist as we both peer at my spinning blood and the lipids lining its surface. &amp;quot;I see this with lots of folks,&amp;quot; the kind man says to me. But I&amp;#039;m not reassured. I am now a member\u2014along with &amp;quot;lots of folks&amp;quot;\u2014of the American obesity club, a club I&amp;#039;d do almost anything to leave, the badge stuck to my bulk with an adhesive that is out-of-this-world strong. This is not a story about how hard it is to get life insurance when your cholesterol, like mine, registers at 405\u2014healthy is anything below 200\u2014and your triglycerides are over 800, or 650 mg/dL higher than they should be. In fact, I got the life insurance, but that didn&amp;#039;t change my predicament. Every night I take a handful 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 the psychiatric profession likes to deny it, it&amp;#039;s an organ that becomes tolerant to the chemicals you ingest\u2014often necessitating what is called &amp;quot;polypharmacy,&amp;quot; or, more colloquially, &amp;quot;the cocktail.&amp;quot; My cocktail at this point consists of 300 mg of Effexor XR, 300 mg of Wellbutrin XL, 90 mg of Vyvanse, 2 mg of Suboxone, 1 mg of Klonopin, and, last but not least, 7.5 mg of the fattening drug called Zyprexa. Nearly all psychotropics cause some weight gain, but Zyprexa is in a class by itself. It was prescribed to me last year during a horrific depression. I saw black hats roll across roads and heard 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&amp;#039;d always known, at least for as long as I&amp;#039;ve had my psychology degree, that severe depression can have psychotic features. But knowing is one thing, experience so entirely something else, that I was humbled, thinking I&amp;#039;d ever understood. In the summer, the psychosis worsened, in part because I could not stand the contrast between my blackness and all the beauty everywhere around me and utterly inaccessible. From the window of the kitchen I could see my garden, full of bee balm and mint, loosestrife and arctic daisies\u2014big wheels of white with florid amber navels packed with pollen. My garden bloomed profusely all that summer, calling to it butterflies and bees and birds with yellow vests. And yet this beauty seemed somehow menacing to me. The flowers\u2014some had the heads of serpents, others flamed in the high heat, causing 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 state, decided to add another drug to my mix. First he put me on Abilify, which is used in some cases to boost the efficacy of Effexor XR and Prozac. It didn&amp;#039;t do the trick. Next he prescribed Geodon, also used to punch up Prozac and its close companions, the SSRIs. Geodon also failed. The third SSRI amplifier was the Zyprexa, a name that made me think of an instrument, or a scooter.  Of all the so-called atypical antipsychotics, which are often prescribed as adjuncts when your plain old antidepressant fizzles out, Zyprexa is most associated with weight gain, and the weight gain, in turn, is linked to a host of dangerous conditions\u2014diabetes, for one. At the time I was given Zyprexa, I was so desperate I couldn&amp;#039;t have cared less about diabetes, and my doctor&amp;#039;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 I saw comparing &amp;quot;weight-gain liabilities&amp;quot; among the atypical antipsychotics, Zyprexa always fared worst, with some patients gaining more than 100 pounds. I knew how bad a rap Zyprexa had; I&amp;#039;d seen a friend pop those pills and go practically elephantine. But from my point of view just then, I would&amp;#039;ve rather been a happy elephant than a miserable hominid. Thus, I filled my script ASAP. I 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 up high above me, so I could see the air and my garden and my entire life as it once was\u2014no, even better. Zyprexa seemed to add a little zip, a little zing, so the edges of everything had a merry sparkle, and I could laugh. I did laugh, finding my children&amp;#039;s antics delightful, loving the way my dogs danced for their food.  Food. Food. For the first time in months I had my appetite back, and everything looked good; it looked downright delicious, in fact, the lasagna steaming in its pan, the hot melted cheese crisped at the outer edges and bubbling on top. I couldn&amp;#039;t get enough; I had the hunger of a wolf after winter, when he&amp;#039;s gone a whole season with no prey. I was insatiable, every bite packed with complex flavors: a simple pistachio nut both fruity and salty, with the wet tang of earth in the background. I rose each morning full of enthusiasm, my desire for food spilling over onto other things, each day filled with appetizing possibilities, as if I were choosing from a delectable buffet. I packed my children&amp;#039;s lunches in the morning and licked the fluffernutter off the knife&amp;#039;s blade, the taste of sweetness and sunlight. Once the kids were headed off to camp, I began my own breakfast, practically panting with excitement. Some mornings I might make oatmeal, seasoning it with cinnamon and nutmeg and several dark drops of vanilla, which gave it such a fine scent I had to have seconds, even thirds. At this point I wasn&amp;#039;t giving much thought to my increase in appetite or weight, focused almost solely on how happy I was to have my life back, though I did register it as odd that my stomach could hold so much food.  I kept going.  There were baked apple crisps with brown-sugar topping; ice creams filled with chunks of fresh peach; french fries, the outside browned, the inside soft and white\u2014I ate it all. And then more. As with many drugs I&amp;#039;ve taken, Zyprexa&amp;#039;s side effects were more intense in the beginning; I gained about 50 pounds before coming up for air. What happened is, I saw myself. I was walking down the street toward a glass door reflecting my image back to me, and it took me several seconds to recognize myself, to realize that the woman I was seeing was me. I&amp;#039;d grown so stout, my cheekbones were buried in slabs of fat. I thought, Oh my God. I went to the gym and StairMastered in a frenzy, but the exercise didn&amp;#039;t seem to help. By this time I&amp;#039;d been on Zyprexa for many months, and its appetite-heightening effects had diminished, yet I was still gaining weight. &amp;quot;I swear to God I&amp;#039;m eating less than 1,200 calories a day,&amp;quot; I told my psychopharmacologist. He plainly didn&amp;#039;t believe me. &amp;quot;We always eat more than we think we do,&amp;quot; he responded. I responded by keeping a food diary to prove him wrong, and I did prove him wrong, although I think he doubted the integrity of my reportage.  Some researchers say that, indeed, Zyprexa makes you fat because it radically alters how the body metabolizes calories, not just because it stimulates appetite. Others\u2014most, in fact\u2014aren&amp;#039;t convinced. &amp;quot;Although Zyprexa may alter metabolism to some degree,&amp;quot; says Alexander Vuckovic, MD, a psychiatrist at McLean Hospital in Belmont, Massachusetts, &amp;quot;the main problem is the relentless hunger it causes. You can&amp;#039;t stop eating.&amp;quot; My experience, of course, contradicts this. After seeing my enormity in the reflection, I went back to eating bunny food\u2014sliced carrots and salted celery and diet drinks for dinner\u2014and still the scale went up, the digital red numbers burning in their black display, even my feet widening so my shoe size went from 7 to 7 1/2. My fingers, according to my 11-year-old girl, look like &amp;quot;sausages.&amp;quot; I find I am shy around my husband, and not in a flirtatious, come-hither way. &amp;quot;Could you have sex with a fat woman?&amp;quot; I asked him the other day. To his incredible credit, he smiled softly and said, &amp;quot;I&amp;#039;m sure willing to give it a try.&amp;quot; I&amp;#039;m not. Damn that drug! Why does it have to work this way?  It doesn&amp;#039;t really matter why Zyprexa makes you fat. The bottom line is that it does, and with the excess of adipose tissue comes a raft of health issues. At 180 pounds, I have a body mass index of 35.1, which means that I&amp;#039;m more likely than a person with a normal BMI to develop diabetes and something called Metabolic Syndrome, which is essentially a collection of risk factors for heart disease and stroke ranging from hypertension and elevated triglyceride levels to a waistline of 35 inches or more (for women). I also have a higher risk of contracting most cancers, according to the American Cancer Society\u2014cancers of the colon and gastrointestinal system among them. So many patients have become diabetic or suffered from cardiovascular problems on Zyprexa that its maker, Eli Lilly, agreed in January 2007 to pay up to $500 million to settle lawsuits from plaintiffs who claimed they became ill after taking the drug. Many more suits are still pending. I&amp;#039;m certainly not going to sue Eli Lilly for making a drug that saved my life, even as it may be leaching it away. I went into this with my eyes wide open. I do not feel fooled or tricked. Still, I&amp;#039;m not at all happy about the news I received after my most recent doctor visit, that my blood sugar is high enough to render me prediabetic. What does this mean? At some point, the nurse practitioner told me, I&amp;#039;ll likely be officially diabetic. The standard advice for prediabetics is to exercise and lose weight, but while the nurse recommended I take those steps, there is no guarantee I&amp;#039;ll be able to reverse the impact of my Zyprexa.  Zyprexa raises some interesting, if painful, philosophical issues along with its fleshy miseries. Well before Zyprexa or any psychotropic hit the scene, Descartes, in 1641, famously came to conceive of the body as one thing and the soul, or mind, another. According to his reasoning, one could be sure he had a mind because one could think; not so the body, because a person could dream it up, or be under the influence of a delusion created by an evil spirit. And thus, the French philosopher concluded, the mind and body were so different as to practically exist in separate realms. Dualism was born, or, specifically, Cartesian dualism, and it ruled the intellectual roost until, in the twentieth century, we all grew hip to the notion that mind and brain could not be separated; that mind, like body, was matter. Zyprexa, or the experience of taking Zyprexa, moves one out of the twenty-first century and back to the Age of Reason. It makes clear to the patient taking it that she must choose between her mind and her flesh. The result of my choice is that I often feel as if I live hunched up in my head, which has to drag this offending, unfamiliar carcass all around town. &amp;quot;Go! Go now!&amp;quot; my mind orders the lipidinous tyrant, the carcass I&amp;#039;ve had to disown, but she only laughs long and hard. So while Zyprexa has helped at least some of its 20 million users worldwide to banish depression and even psychosis, at the same time it&amp;#039;s ushered in a whole new/old way of living: divided. I could go on for quite a while about this (the history of dualism, its appearance in the book of Genesis, in Plato&amp;#039;s writings, the role of the pineal gland in Descartes&amp;#039; mind/body split), but it would just be a form 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&amp;#039;m killing my body to save my mind\u2014and it&amp;#039;s downright scary. I can practically feel the sugar in my blood, practically hear the crystals clanking. I can feel myself living at the cusp of some physical mishap, perhaps even disaster. I can&amp;#039;t see what I might do about this, about any of these facts, other than accept them as the manifestation of my decision to do dualism, to side with my mind while sending my flesh down the river. Because of Zyprexa, I no longer see my life too far into the future. When I was trim and healthy, I silently assumed, due to the ever-increasing advances in medical care and my level of fitness, that I&amp;#039;d live well into my nineties. I had for inspiration my maternal grandparents, who entered their tenth decade swimming laps and playing cards on their screened-in porch. Thus being 30, 40, 45\u2014it all still seemed young, the road ahead unfurling, its endpoint still impossible to see. I even toyed with the idea that I might be a centurion, what with thinkers like Ray Kurzweil and Aubrey de Grey suggesting that, with a few tweaks to our telomeres, we could reverse the aging process radically. On the February 21, 2011, cover of Time was the picture of a cyborg under the headline: &amp;quot;2045: The Year Man Becomes Immortal.&amp;quot; Once, I would have read the accompanying article with gusto, but now I read it as a curious and wistful onlooker, as a woman who does not see herself surviving past her seventies if she&amp;#039;s\u2014if I&amp;#039;m\u2014lucky.  My potentially foreshortened time on the planet isn&amp;#039;t all bad, however. I take my days more seriously. I touch 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 now my weight 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 many buckets I sweat. But that&amp;#039;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&amp;#039;m winning. I am tremendously grateful to be free of the mind-distorting depression. I take my raft of medicines at night. I always take the Zyprexa last. It&amp;#039;s just a plain white pill\u2014who would&amp;#039;ve 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. I put it right on my lifelines, smack in their center\u2014a reminder, a reassertion that this is the choice I&amp;#039;ve made\u2014and then I send it down the chute, while high up in my head I look all around. 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\u2014can he? He asks to be between me and his father, 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 talking in his sleep of sailboats and sand. With all this hubbub, I&amp;#039;ll probably be up all night. It&amp;#039;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. "^^<http://www.w3.org/2001/XMLSchema#string>
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