Over the Rainbow: Expectation Management for Depression

My therapist once told me that a study done showed that for most people, the best parts of a vacation were the anticipation of it, and the memories of it.  I found this fascinating, since I have a rule about anticipation of anything.  It's a pretty simple rule: I don't do it.

My sister was recently pregnant with the first kid between me and my two siblings.  People kept asking me if I was excited, and I kept lying and saying yes.  The truth is, excitement is part of anticipation, so if I can help it, I don't do it.

Here's the problem with anticipation and excitement: both are forms of expectations.  And expectations, more often than not, at least for a depressive, are a really good way to get yourself disappointed.  And disappointment is a stronger trigger than almost anything I've run into over the years.

So why do I lie about this?  Do you know how it sounds if someone asks you if you're excited about your soon-to-be-born nephew and you say, "Not really," and shrug?  All of sudden, you're somehow that psycho.  You can try to explain that expectations are a thing you don't do, but people just look at you and nod, and you can tell they're thinking there's definitely something wrong with you.

I could be wrong, but I don't think depressives have any more unrealistic expectations of life than anyone else.  I think it's that we don't handle the disappointment of life not conforming to our expectations as well as someone with "normal" brain chemistry.

I suspect this is also related to why depressives have a reputation as being pessimists.  Honestly, science itself is kind of all over the place on this issue.  One theory suggests depressives hold a negative bias on the world, the next suggests that depressives are realists and non-depressives hold a positive bias.  It really just depends on what you're reading.  But science aside, popular views of depressives are as pessimists, or persons with a negative bias.

I'm not coming down either way in this post.  But I definitely do not believe that striving simply not to have expectations of a situation--positive or negative--makes me a pessimist.

The reason I'm writing about this is that lately my ability to suppress expectation has been, at best, fluctuating.  And in fairness to the popular view of depressives as pessimists, it is easier when, if I'm going to have expectations, they're low, or even negative.  That means anything greater than what I was expecting is a pleasant surprise.

Positive expectations, however, are a real problem.  A couple of months ago, for reasons that are too long to go into, it looked like I might get a full-time job.  And for the two to three weeks where this seemed like a real possibility, I was incredibly happy, which might be an argument for positive expectations.  The problem is, when it didn't happen, I spent the next month so low that my therapist consistently kept me late and was worried that I was a danger to myself.  I probably was.

I like to think I'm getting back on track of being even keel and without expectations.  A lot of times to do that, I have to hold to negative expectations until I can wipe the slate completely.  Again, this probably leads people to believe I'm a full-time pessimist.  Instead, what I strive for, and what I suspect a lot of depressives strive for, is a completely neutral slate.

All this is to say, next time you ask a person if they're excited about something, be it a new job, a trip, a new baby, whatever, if they hesitate, or don't give you the exact answer you're expecting, consider for a moment that excitement might be a dangerous state for that person.  Better yet?  Ask the person how they're feeling about the subject, rather than asking them if they're feeling the "normal" emotion, or what they're "supposed" to be feeling.

Everyone, depressives or otherwise, deals with life's events differently.  Not making assumption goes a long way toward making those who don't function within what we've codified a "normal" emotional sphere less like outsiders.

Not-So-Happy Holidays

It is common wisdom that the holidays can be a hard time for people.  However, when people say this, what often follows, to describe whom holidays are hard for is, "people without family."

Let's be honest: holidays are hard for people WITH family, too.  Family, for all its good, and sometimes not so good intentions, is stressful.

If you think it's stressful for non-mentally ill persons, multiply that by infinity-squared, and you'll have roughly how it feels for the mentally ill.

Depressives, since that is who this blog is about, in particular, accumulate certain labels within  families.

"She's so lazy, she spends days in bed."

"He's so undependable, every time we have plans, he has to cancel."

"She's such a debby-downer."

"What a glass half-empty guy."

The thing is, as depressives, we aren't generally super fond of our own brains.  Our brains tell us we are worthless, that nobody cares, that if we were to kill ourselves, everyone would be better off.  Our brains, put simply, are not our friends.  If anything, they function as the enemy a good half or more of the time.

This means that anything a family member says?  Even if we know that person is generally bitter or cruel or otherwise not someone we should listen to?  Echoes three to four times as hard in our brains as they will in a non-depressive's.  We already believe all those things about ourselves; being told them just solidifies the belief.

In turn, this means that a person who's depressed is likely to stress for a month if not more about a big family gathering, such as one during the holidays.  The stress turns itself into depression and frustration with ourselves about not being able to handle a "little family affair," which also then spins out into more depression.

Don't get me wrong: I don't believe in letting depressives off the hook for doing things we shouldn't just because we're depressed.  But gossiping about us, or saying mean things to our faces isn't going to make us do the right thing.  It's just going to further convince us of our worthlessness.  If you hear someone talking about the depressive in your family in a way that's not going to be helpful, it's probably a good idea to gently remind the person speaking that the depressive doesn't want to be that way, and likely needs help.

Additional to this, even with the kindest family, depression is isolating.  And isolation at the holidays drives even non-mentally ill persons to self-medicate and engage in other dangerous behaviors.  Depressives, however, are more likely to isolate themselves out of a sense of being unwanted, and then spiral from that sense of being alone.

Honestly, there may be nothing you can do about this.  If the isolation aspect of the illness is bad enough, there might just not be a way to reach the person.  On the other hand, if it's not, a little bit of reaching out goes a long way.  Maybe sitting next to that person at dinner and asking her how she's doing, then really listening.  Or, if you play games where teams are needed, including her in your team.

The happiness of depressives in your family is NOT your responsibility.  But if you love that person, or simply have compassion for them as a person, single instances of kindness and understanding can have considerable impacts when a person is in a bad place, and the holidays are often a time of bad places.  Think on it, on what you want the spirit of your holiday, and the meaning of your family gathering to be.  From there it's up to you.

Level-Headed Pills: Prescribing Doctors and Medication

For those of us who need meds, getting on them is almost as difficult--sometimes more--than finding a good therapist.  For one thing, medication culture has made it harder to find a good prescribing doc.  For another, meds take time to work and are fraught with possible side effects.

Let's start with finding a prescribing doc, since, obviously, meds can't happen without one of those.  The safest way, I've found, to find a psychiatrist, is to ask your therapist for recommendations.  She will usually know of someone safe and good.

What makes a prescribing doc safe and good?

1.  One who listens to you.  Appointments are generally fifteen minutes long.  About five to ten of those should be spent talking about how you're feeling.

And--this--is a really important note: you HAVE to be honest with your prescribing doc.  If you're just feeling "not suicidal" but you tell her you're "fine," she doesn't know any better.  She can't read your mind.

But if you DO say "fine" and she doesn't press, doesn't ask questions about, say, sleep patterns and enjoyment of regular activities?  Find another doc.  Depressives are taught by society not to express themselves.  Any doctor should know that's a self-protective measure.

2.  One who explains things.  You're NOT a doctor.  You don't know what one drug does as opposed to the next.  It's your doctor's responsibility to explain that to you, and to make sure your questions are answered.

3.  One who gives you choices.  You're the person who has to go on these meds.  If you're doc is telling you something is imperative, i.e., "this is the only med that will work for you," something is hinky.  Instead you're doctor should say, "there are a couple of routes we can go, here are the pros and cons of each," and leave the final decision up to you.  It's rare that there's only one treatment option, this is not an exact science.

Let's assume you've found a doctor who fulfills all those prerequisites, now what?

Well, first of all, it's going to take about six weeks for the meds to kick in if this is your first go around.  Do not freak out if nothing happens--that just means you need to try something else.  Alternatively, also do  not freak out if what happens is you stop sleeping and/or start gaining crazy amounts of weight, or some other serious side effect.  Again, this probably just means you need to try something else.

TALK to your doctor about all these things.  Tell her what's bothering you about it, what's working about it.  Meds can be tweaked time and again--and need to be.  I've had to change meds seven to eight times in the last seven years due either to them ceasing to be effective, or having counter-indications, or just side-effects that I couldn't stand.  For instance, when I first when on Prozac, I stopped sleeping.  Like, at all.

Sometimes, it takes a combo.  I'm currently on a cocktail of Welbutrin, Lexapro, AND Abilify.  There are side effects.  There are going to be side effects with almost any of these drugs.  It's a matter of whether you can handle them, or if they are worth the trade-off of not being suicidal and never wanting to get out of bed. For me, Lexapro and Abilify cause weight gain, something that is hard, because I have body dysmorphia.  It's another reason why I exercise so much.  But I make myself handle it in order to enjoy daily things like writing and spending time with my pets.

Medication is NOT for everyone, but if you've spent significant chunks of your life feeling hopeless and wanting to just close your eyes and sleep forever?  It's definitely worth a shot.

I was amazed to find, when I first got on meds that worked for me, that there was someone underneath all that pressing, obliterating hopelessness, someone I actually found pretty interesting and diverse.  There might be someone inside of you who you want to meet.  It really is worth a shot.

The Head Shrinker: Finding the Right Therapist, When and How

This may be the most true thing I say in this blog, ever: finding the right therapist is a gigantic pain in the ass, and it sucks.  However, while I've known a few remitting-relapsing depressives who are ridiculously high-functioning and who didn't feel the need for therapy, most depressives need it.

Truly, I feel like MOST people could use at least a little therapy.  It helps with self-awareness, which in turn aids how we treat and deal with other people.  But depressives?  Definitely.

As such, a few rules for finding the right therapist:

1. Do it when you're not depressed.  This is huge.  And not always possible.  But IF it is, if you can start looking at a time when you have the mental resources and the drive to do so, do it.  When you're depressed there's almost no way you will find the energy to try different therapists out, find one who actually clicks.  Not to mention, figuring out sliding scales, insurance, and other such issues when depressed can be near to/completely impossible.

A sub-rule to this is: Don't quit because you're "feeling better."  You're not going to magically decide you feel up to going back when you hit another depressive episode and don't want to get out of bed in the morning.  Therapy needs to be established as a regular thing in good periods, so that it carries out through bad periods.

2.  Look for professionalism.  Yes, this seems obvious, but let me tell you: not so much.  For one thing, the top two reasons therapists of all ilk lose their licenses are either breaking confidences or, yup, that oldie but goodie, sleeping with their patients.  Get recommendations, find out what reputation the doctor you are looking at has.  If you have the slightest inkling something is wrong, get out.

Small story:  I once had a therapist who fell asleep in a session.  I gave him the benefit of the doubt.  Everyone has a bad day, right?  Then he did it a second time.  I never returned.  Professionalism in therapy means that person is paying complete attention to you.  Make sure you feel that way.  If you don't, move on.

3.  Your therapist should be friendly, but not your friend.  Yes, you should be able to call your therapist in an emergency.  She should not, however, be the first person you think about calling no matter what happens.  What is more, she's not there to just support your feelings.  If you're being out of line or doing something stupid?  You want her to call you on that.  You WANT her to be that objective third-person view on your life, because without that, there's no way for YOU to learn things from her, and in turn, from yourself.

A corollary to this: your therapist should be able to say, "Hey, you need to put yourself in the hospital," and to press the issue if she feels it is necessary.

4.  There are a billion and five kinds of therapy, find the one that's going to work for you.  Talk therapy not working?  Have you tried art therapy?  Music therapy?  Cognitive behavioral therapy?  Those are the three that pop up right off the top of my head.  Any quality therapist, if you say, "Hey, I don't feel like I'm getting anywhere," will either, a) suggest a different tack to take, or b) suggest a different kind of therapy.  Listen and try new things.  You never know when you're going to hit that right one.

5.  If you feel like there are things you can't tell your therapist, you've got the wrong therapist.  I'm dead serious.  If you can't talk about that sex dream you had that's freaking you out, or something traumatic from your past, or your "guilty pleasures" with your therapist?  Find a new one.  A therapist can't help without seeing the things nobody else gets to.  That's the whole POINT of a therapist.  Feeling like you've got to hold back means you're holding yourself back from whatever your therapy goals are.  (And any decent therapist will create goals with you at the outset.  They don't have to be quantifiable, but they will be present.)

And this is huge: if at ANY point, you tell your therapist something and feel judged?  Run, don't walk.  A therapist's job is to take you as you are and help you to be the happiest and most comfortable you can be.  Tell your therapist you look at members of the same gender in a sexy way and they suggest religion?  Get the hell out.  Tell your therapist all you can do when you're at your worst is cry and watch football and they tell you you need more productive hobbies?  Pedal to the metal, my friend.  Yes, as I said above, it is a therapist's job to tell you when you might need to look at something differently, or interact with someone in a different fashion, etc.  It is NEVER their right to judge you, and if that happens?  Guess what?  You've got the wrong therapist.  Get thee a new one, anon.

Sparkle Motion, or, Just Keep Swimming: Exercise and Depression

With the exception of exercise addicts, nobody gets up in the morning and thinks, "Man, I can't wait to hit the gym."  Depressives even less so than the average person.  Which is why movement, any kind of movement, is pretty vital when it comes to handling depression.  Well, at least for me, and for a significant number of the other persons who suffer from depression I know.

Personally, I have three days to not do any kind of movement before I turn into a raging nutball.  Hormonal imbalance has nothing on three days of absolutely no working out for me.

That said, I'm too impatient and fidgety personality-wise to always do the same kind of workout.  In general, I think a lot of people need variety in their workout schedule.  If you're someone with depression, and you live in a cold place, if you can afford it, joining a gym with a wide variety of options is probably the best investment you can make in your mental health, aside from a therapist and possibly medication.

My personal workout schedule goes something like this:

Monday:  Usually swimming.  Aside from being a lot more gentle on a body that's seen its fair share of damage, swimming forces my mind to count.  Counting helps my brain slow down.  Swimming is generally a good alternative to meditation for people like me, who aren't great at consciously working to shut our brains down.  As such, swimming has a number of benefits: it's strengthening, it builds breath capacity, it's meditative, and it's exhausting, and almost always guarantees a good night's sleep for me.

Tuesday:  This usually becomes my abs-day.  Having some workout equipment at home, even if it's just a jump rope, or an exercise ball, is, in general, a good plan.  I keep both of those things, as well as an ab roller, and a hula hoop.  The hula hoop is great, because it works my abs while I zone out to an episode of Agents of Shield, or something like that, most weeks.  It allows my brain some free time, while my body works off some of the worst of my tension.

Wednesday:  I usually go walk with my sister in the winter.  In the warm months, my walks are outside, and I much prefer that, but since I can't walk outside for a significant portion of the year here, having my sister available to go pass the time on the treadmill is super helpful.  In general, if you can find a gym-buddy, it will help you to get to the gym, not only as a way to hang out, but because you're not the only person who knows you're supposed to go.  Sometimes peer pressure is a great thing.

Thursday:  Again, in the warm months, this is usually my bike ride day.  The bike KILLS me, but it's also pretty sweet, having that wind in my face, and it's a great all-over workout.  In the cold months, this might be another gym day.  About a year ago, when I was in taekwondo full time, Thursday was a tkd day.  If something programmatic like that appeals to you, that's another great option, because a) you're paying for it, and want to get the service, and b) people expect you to show up.  Also, forms are very meditative, it's a great way to slow down your brain.

Friday:  In the evenings, I go swing dancing.  Dance lessons/social dances provide fantastic cardio and when you're following, there's the plus of just letting go, of going where your lead takes you, which is meditative in its own way, as is following the beat of the music.  If you have a dance studio near you, the money to take a class, and any interest, I highly recommend this.  Not only is it good for you on several levels, it gets you out among people, which is another helpful aspect of it.

Saturday:  In the warm months I do long walks or bike rides early in the morning with Team & Training, which is an outfit that trains for endurance events.  I try to do one endurance event per year, at least.  Long-term goals, and just a little bit of that peer pressure I mentioned, help me to get through the every-day types of trainings, it might or not for you.   But any of the above options are good ones for Saturdays.

Sunday is my rest day.  You SHOULD have a rest day.  Two isn't the worst idea, either.  Your body needs the down time.  It's just that it really, really needs the activity as well.  Trust me, at first it might suck, but sooner or later you will start to realize that the irritability that comes along with depression is worse when you haven't done something in a while.  And it can be as little as jump roping for ten minutes, taking your dog for a walk around the block, or doing some yoga stretches.  Everyone's needs are different.

Our bodies, though, especially the bodies of depressed persons, need that activity.  And for the most part, our minds are perfectly willing to enact revenge when it's not engaged in.  Do your best to get up, and disallow at least that much of your mind's trickery.  Or, if it's a friend or family member struggling, be that friend who goes to the gym with her, comes over to do a workout, takes a walk, takes a dance class with her, whatever gets your loved one moving, be the person to make sure that happens.

Reach Out and Touch Someone: the Effects of (In)Visibility on a Community

For the most part, response to the article I shared in lastweek's blog was positive.  Those who were upset by it mostly kept quiet, which I consider to be the high road, and appreciate.  I had some people disagree with me, which was also fine, in that I could listen to them and then move on.  I don't need the world to agree with me on my personal opinions.

I chose to write that article for a couple of reasons.  Right now, Jewish Family Services ("JFS") has paired with National Alliance for Mental Illnesses (NAMI) to do a mental health awareness campaign.  So far as I can tell, this largely involves sending out fliers that proclaim, "It's okay to talk about it."  Not that I don't appreciate the funds spent on the fliers, but visibility, especially for something with this much stigma attached, takes a little more effort than that.

The other, connected-but-not-identical reason, is that I think visibility is important in and of itself.  Regardless of my community's "push" for it, just standing up and saying, "Hey, I have this problem," allows other people with the problem to feel less alone.  More than that, it allows them to feel less broken.

So, why did I write the article?  I've talked about visibility before in this blog, and I will probably talk about it again.  As far as I'm concerned, particularly for persons with mental illness who are out in the day-to-day world, visibility is the number one issue facing mental health awareness.  As such:

I did it for the mom who contacted me and said, "Thank you," because her daughter suffers from mental illness.

I did it for the wife who called me, and thanked me, because after reading it, her husband finally opened up and talked a little bit about his depression.

I did it for the aunt who talked to me about her nephew's struggles.

I did it because mental illness, by definition, is invisible.  If I get up in the morning, and do what I am supposed to do, be that work, or chores, or my volunteer positions, I must not be depressed because depressed people don't get out of bed.  Complete, disabling depression is really the only "visible" kind.  And even there, the problem is still invisible, which is why persons who are entirely disabled by it get comments like, "You just need to try harder," or "Staying in bed isn't working for you, why don't you try something else?"

I recently read about a friend of mine's mother asking her why she was so depressed when her life was going so well.  She had no "reason" to be depressed.

My friend's nephew, who's in his teens, said, "Saying you don't understand why a person is depressed because their life is going well is like saying 'I don't know why you have asthma, there's plenty of air in here.'"

Asthma is visible.  Nobody doubts somebody is asphyxiating, or thinks someone is doing it for attention, or because they're just not thinking positively about it.  This is the same with every virus, bacterial infection or disease we can "see" in some way.

Depression, particularly depression in functional depressives, is invisible, which heightens the isolation that the disease already causes.  If you are able, if it is safe, and you are comfortable, standing up and saying, "Hey, I have this disease," takes just that little tiny bit of stigma away.  It might let one person know she is not alone.  It might let another person say aloud, "I have that, too," which might affect yet another person.  You never know.  But it might.

Oh G-d: the Intersection of Depression and Religion

Sorry about my absence last week.  This week I am acually posting something I wrote for my synagogue's newsletter.  I intend to discuss why I chose to write this and the aftermath of it in my next post.

Caveat: this post is not meant to imply in any way, shape or form that having a relationship with a higher power is necessary to better the lives of those who are depressed.  There are significant periods of time when I find it much more comforting to believe there's nothing out there, because at least then there's a reason nothing CARES that I feel like this so much of the time.

That said, to the article:

I am mentally ill.  I suffer from severe clinical depression.  Let me be clear about this: this does not mean I am sad.  This means that, when not properly medicated, I spend most if not all of my time thinking how much I would like to kill myself.  This means the desire to be dead is all I feel in those periods of time.  This means that, I can be on medication that works, but isn't quite right, and think the best I am going to feel—ever—is simply not-suicidal.  For most persons who suffer from mental illness, medication is helpful, if not an absolute necessity.  In many cases, it is the latter.

Medication for mental illness has almost as much stigma attached to it as the illnesses themselves.  People who take psychotropic drugs are weak, we "just want to feel good all the time," we "are not strong enough in our connection to G-d."  That last one is something I learned about from a friend.  Evidently, in certain sects of Christianity, taking medications for mental illness is frowned upon because if the ill person "just believed in Christ enough," they would feel the joy they do not feel.

Judaism, to its credit, does not approach treatment for mental illnesses in precisely this way.  The torah has examples of depression in figures like Saul.  Saul has periods of extreme dejection, jealousy-fueled rage at David, and otherwise irrational melancholy.  The torah tells us that David playing the harp for him helped somewhat with these emotional periods.  In the torah, David's music is the "therapy" Saul needs.  Obviously, in biblical times, the type of drugs we have today weren't even a thought.  There might have been homeopathic remedies for cuts and burns, bruises and infections, and alcohol or the like for self-medication, which is a far different thing than being properly medicated and seen to by a physician. Saul, though, didn't have the option of taking Prozac or Celexa and remembering that, oh, yeah, he was king, and things were pretty good.

From the outside looking in, it's hard not to see Saul's depression, his illness, as the reason David takes the throne instead of Jonathan.  Jonathan essentially comes from tainted blood.  Saul cannot trust in G-d enough, cannot connect to the divine enough, and therefore, David, who can, succeeds to the throne, and leads our nation, becoming a legend.  Saul's legacy is far less brilliant.  Although he is a byword for wisdom, his time as monarch is deeply overshadowed by David.  It is really no wonder persons who suffer from mental illness feel turned away by Judeo-Christian religious communities.

To make more comprehensive what I am trying to get across, telling a person who is depressed to trust in G-d, or be grateful for what G-d has given him or her, is much like telling a deaf person to just listen harder.  Helping a person who has depression (or is manic, or having a panic attack, or in crisis in any other way) to get help, however, is a way to bring him or her back to a place where s/he has the basic ability to trust in G-d, to appreciate what G-d has given to him or her, to do things with what s/he has been given in life.

I am not saying medication is right for everyone.  I am saying that a general reliance on religion has healed absolutely nobody I know who struggles with mental illness, and in many cases has made the illness worse.  I am saying that therapy of some type, or a mix of therapies, be it animal, music, art, physical, talk, medicine, or otherwise, is absolutely necessary for alleviating the worst of the symptoms of mental illness. 

We as Jews pride ourselves on taking care of our own, on tikkun olam, on our compassion.  Let us be leaders in showing compassion to those with mental illness, in helping them to get what they need, instead of judging them for their inability to be who we expect or want them to be.  Let us be leaders in caring enough to help people like me reach a place where a positive relationship with the divine is a possibility, rather than an ever out-of reach desire, another failure on our part, one more reason to leave the community.   

Fur and feathers: animals and depression therapy

Today's post is going to be short.  I missed last week because things have been crazy, and this week, to be honest, I'm having a really hard week.  My meds are working, but I'm deep in circumstantial depression and while it's not as bad as the chemical, it's a very close call.

As such, I want to talk about the import of animals to the overwhelming majority of people who suffer from depression.

I am actually not one of those people who believes that animals in general have high levels of recognition that "their human" is feeling badly, and therefore they need to provide comfort.  Nor is this a highly scientific article on the benefits of pet ownership for the mentally ill.  All I want to talk about here is how I, personally, am one hundred percent certain that the positive benefits from animal ownership are often lifesavers in the case of depression and anxiety.

To be clear: I am not speaking of trained therapy animals.  I am speaking of your every day rescue.

I am alive because of my rabbits.  I am alive because they are high-maintenance, and they might not even necessarily love me, but they need me.  And that's the core issue.  Animals need us.  And for people who suffer with not feeling worthwhile or necessary, having that one being who absolutely thinks you are?  Essential.

And yes, there are other benefits.  For most people, pets make them laugh.  Laughter is hard to come by when depressed, but pets are one of the few things that can generally cause it.  If the pet is a dog, it tends to force the depressed person out of her house and to physically move, both of which are beneficial to working one's way toward a semblance of functionality.

Pets will not make everything better.  But they will, almost always, provide significant aid in a number of areas and be something to focus on at the worst of times.

The person you know who has depression--or yourself--not a dog or cat person?  Okay.  Some other options are: guinea pigs, rabbits, hamsters, rats, mice, iguanas, geckos, frogs/toads, fish, snakes, birds, even farm animals, like pigs, horses, or goats.  Obviously those last three require the ability and space to care for them, but my point is, not even this is an exhaustive list.  There is an animal for just about anyone, it's simply a matter of finding that animal.

Whether the animal works as a calming device--fish often work this way-- a comfort source, something to laugh at, something to make a person more active, or just a reason why the person has to get out of bed, pets aren't magic, but they really do come very very close.

It's Not a Happy Pill, It's an Anti-Depressant

In 2007, I went on anti-depressants.  This is notable, because I was diagnosed as needing to be on medication in 1999.

Why the eight-year hesitation?  A few things:

1.  Anti-depressants have a HUGE stigma to them.  The term "happy pills" in an of itself is an issue, it suggests that people who need--not want, NEED--to be on these kinds of medications are in fact just looking for an easy out.  It's as if we're somehow just going to our doctor instead of down the street to score some illegal substance that makes us feel better for a few hours.

To illustrate, here is a comment once directed at me by a family member.  A family member, who, by the way, is nominally in the health industry:  "Yeah, anti-depressants are great in the wake of, say, a tragedy.  I took some [when my father died] and they helped me to get through it.  But you can't live your life on a pill just to make everything easier."

In other words: stop being weak.  The rest of us are just fine without pills to help us get through the day.

2.  Anti-depressants come with side-effects.  One of the most common is significant weight gain, which isn't fun for anyone, but for a woman--and, in my case, a woman who already has societally-induced body dysmorphia--that can be devastating.

On one of them, I stopped sleeping.  On another, I was so nauseated that even basic toast wanted to come back up.

Additionally, they can have counter-indications.  I was on Prozac long enough that it started CAUSING suicidal ideation, rather than alleviating it.  They also cause long-term liver damage, which means they essentially shorten the lifespan of almost anyone on them.

To sum up: they are not fun and are terrible on your body.

3.  For me, I was terrified.  What if I went on them and they didn't work, and this was what life was like for the rest of it, a very possible seventy or more years?  More importantly, what if I went on them and they didn't work because there was nothing wrong with me other than being lazy and pessimistic and a bad person?

In the end, though, I had to try.  Because, honestly, things couldn't get worse, and the hope, however small, that they might get better was impossible to turn away from.  My medication history has been full of ups and downs.  It took several tries to find the right medication the first time, but I will never, not if I live to one million and three, forget the feeling I had when the right one--Lexapro, at that time--kicked in.

It wasn't sudden, it was slow, but there was one day when I got home from work and the gym, and wanted to do something that wasn't sleep.  I had the feeling tomorrow might be a pretty good day.  I felt like ticking a few things off my to-do list.  And I thought, "Huh, look at that.  There's a person in there."

And then I cried.  Because for the first time since I could remember, I could feel something that wasn't soul-numbing hopelessness.  Even if it was sadness that I'd waited so long to go on the meds, it was real, an emotion, not just a blanket of brain chemical malfunction.  And, as it turned out, when on meds that work, I'm actually pretty chill about a lot of things, even things that objectively suck.

Now, let me be clear: when I am on anti-depressants that work, not everything is easy.  Life is still life.  It is still stressful, and I still have to accept that I am not going to get a lot of things I want or wish for.  People can still be hurtful, and loss still occurs.

The difference is, my brain's default reaction to all of this is not, "What's the point?  Why should I bother with this anymore?" or, at the worst, "Everything and everyone would be so much better off if I just sat down with a bottle of pills and disappeared."

That's not a happy pill.  I've never taken any hardcore street drugs, but from what I have been told by people who have, it's a COMPLETELY different sensation.  What's more, it's ephemeral.  You come down from it.

Anti-depressants don't cause happiness.  They cause the brain to work the way it's supposed to.

Here's the truth: being on anti-depressants is a pain in the ass.  Forget all the stuff I mentioned above, okay?  Your body gets used to them.  And you slip back into depression.  And sometimes the best they can manage is to keep you from living in a haze of suicidal ideation.  Sometimes it takes years to find the right combo, because just having that much help makes it feel like they're working.  And, to some extent they are.

I have changed meds seven times since 2007.  Every time is a gamble.  And for years at a time, I have been willing to accept, "not actively suicidal" as "meds are working."

I'm lucky right now.  I'm on the one-two-three punch of Welbutrin, Lexapro, and Abilify and it WORKS.  It works in the way where, when I have free time, I actually want to read or write or watch some television, instead of sleep.  It works where I can do things like plan ahead: go to the grocery store with an actual list, and come home and make meals for the week.  It sounds simple.  It's not.  It's the difference between a life that is just made up of days of forcing myself out of bed and to do every little thing that has to be done until I can get back in bed, and days where my life is actually happening, and I'm an active participant in it.  And because they actually work, instead of just providing base-stabilization, it's the first time since 2011, which was the last time I was on a combo that fully worked, that I can remember who I'm like as a person underneath the depression.

Right now, my insurance is refusing to support the Abilify, which means I'm going to have to appeal and try and figure out another way if they still refuse, since it is $830/month, which is, you know, outside my ability to afford.  I'm still underemployed, and still have been for over two years.  My rabbit has an ear infection that will not go away, and my dog vomited directly where I sleep on my bed while I was dancing Friday night.  And you know what?  It's all okay.  I'll find a way to afford the drug, because I need it, and I have always figured out ways before.  My rabbit is almost nine years old and this is her first ear infection, which is a near miracle.  The puking forced me to clean my mattress, which really needed it.  And I'm in the process of interviewing for a job I might get.  If I don't, well, back to the drawing board.

I cannot emphasize enough: these drugs aren't happy pills.  They do not blind me to the things that I'd rather NOT happen in my life.  They don't give me moments of ecstasy.  They allow me to COPE and to live my life without the constant specter of suicide.

If you or someone you know is avoiding medication because of stigma or fear, I cannot stress enough that neither of those are good enough reasons to continue being miserable.  Please, please try, or get them to try, talking to a prescribing doctor.  Maybe meds aren't for you.  But maybe they are.  And maybe underneath how terrible everything is, there's a person, screaming that zie just needs a little help, just a shove in the right direction.  Get yourself, or try to help the person you love get that shove.

"It's like...": Talking About Depression Through Similes and Metaphors

As someone who was on Prozac for two years, the thing I still think of immediately upon hearing the word is the commercials they used to have, with a cartoon person under a cloud that followed her around.  I remember thinking, "Yeah...no, it's not like that."

It's not that the single-person-rain cloud is a terrible metaphor, but it's really not a great one, either.  For one thing, we use that particular metaphor to refer to people who bring drama or other things we don't like to a situation, regardless of whether that person is actually mentally ill.  It's specificity, therefore, leaves much to be desired, and  more than that, it lumps those of us who are actively fighting against that "cloud" with persons who embrace it.  Another thing is, while we all might find Pigpen from "Peanuts" cute, we also all think he could go and find himself a bar of soap and some water.  In other words, when we see artistic representations where only one person is being affected by something, we tend to put the onus of dealing with it on that person without much consideration for what that means.

Obviously, metaphors and similes are contextual.  Not every one is going to apply in every situation.  But, here are a few solid and decently transferable ones.

1.  The broken arm:  I cannot take credit for this one, it comes from a friend whose brother is on the Autism spectrum.  Hir mom once told hir that if hir brother had a broken arm, nobody would expect him to pitch a baseball game with that arm.  But because nobody could SEE the Autism out front, people often expected life skills of him that were the equivalent of asking a kid in a cast to pitch that ball.

Depression is the same way.  No, you can't see it.  That doesn't make it less real than a broken arm and it certainly does not make it less debilitating or limiting.  Some people with depression CAN do everything persons without can.  Others cannot, plain and simple.  And even the ones who can?  Are struggling at least ten times as much as a person with normal brain chemistry to complete the same exact task.

2:  The minefield:  Also not mine.  I wish I could remember who I picked this up from.  Living with depression is like walking through a minefield every day, except that only the person with depression knows there are mines.  She spends all day avoiding them, and if she gets to the other side of the field, everybody acts like it's not a big deal, no accomplishment, nothing to give her a shoulder squeeze about and say, "Hey, well done."

HOWEVER, if she accidentally trigger one of those mines, it's huge and ugly, there's a good chance others get hurt and everyone blames her.  She didn't actually SET the mines, she just couldn't avoid one.  Whether she couldn't see it, or it wasn't possible to jump over, or whatever, the triggering was not intentional.  But she gets in trouble for it, all the same, when every other day, hurtling and running and desperately trying to cross that damn field, everyone takes her actions for granted.

3.  The monster:  This one is mine.  Every day I get up and I'm being attacked--think of this in physical terms.  The attacker is up to the person creating the metaphor.  Mine is amorphous and monstrous.

But I'm being attacked.  And I'm struggling against my attacker, throwing kicks and punches, screaming for help, trying all kinds of things, waving my hands.  It's not just that nobody hears me--although many people don't--it's that people hear and walk by anyway.  In my head, I'm always on a busy street, and people know what's happening, but they still walk on by.

The thing is, at the end of every day, the monster resolves itself into me.  Because, as one of my friend with depression once said, "The problem is, my brain is trying to kill me."

I agree, to a certain extent.  But really, my brain is trying to do the maximum amount of harm UNTIL it can kill me.  Which means that, yes, the monster I'm fighting?  Me, and only me.

This is a short post, because I don't want to muddle this issue, it's too important.  Verbal and visual representation of mental illness in a positive way is sorely lacking, and if I can inject just a little bit of it into the common rhetoric, I will be pleased.

To sum up: things to avoid are more broad metaphors and similes--pick something specific, like a broken arm, like a physical attack, a minefield.  Avoid metaphors and similes that are used for sadness, because sadness is different.  Use descriptive terms and EXPLAIN why the two are good comparisons.

And please, if anyone has other good metaphors/similes, leave them in the comments.

ETA:  A comment was left with the World Health Organization's video on depression.  This metaphor did not work for me, because it needed a LOT of narrative explanation, which I try to avoid, and because it's based on a dog, which is something I have positive associations with.  That said, it might work for others, so I am glad to have the resource.  Thanks, Jay!

The Honey-Do List: or, some basic DOs

I apologize for this being a week late.  My sister was doing her first half-Iron distance triathalon last week, and for those of you who aren't familiar, spectating that kind of event is an endurance test in and of itself.

In any case, as promised, the flip-side of my last blog post: or, what TO do as the friend/family member of someone suffering from severe clinical depression.  Sticking to the five number format, since it worked well last time and I like symmetry.

5.  Take care of yourself.  I'm willing to bet this seems self-evident, but only from the outside looking in.  It is incredibly easy to lose sight of self-care when being a support system for someone who is spiraling.  Self-care is a lot of things.  It is eating right, it is sleeping enough, it is physical activity, but most significantly, in this situation, it is the ability to say no, to look to others for help.

I had two friends once, and one was a depressive.  She was a self-harmer, and I'm pretty sure she had borderline personality disorder.  The other friend was someone who had never really dealt with self-harm and the threatened potential of something worse.  Both women were young at the time, and the support-friend got to the point where she was the ONLY support for the self-harming friend.

Support-friend wasn't sleeping enough, was very worn down and at one point, I asked, "When Other Friend asks you to come over or if she can stay with you, do you feel like you can say no?"

And after a long moment, she shook her head, "No."

Trying to get help while depressed is hard.  It sucks.  It often doesn't work quickly, so it seems like all the effort was pointless.  If you allow yourself to become the sole support system for someone who is depressed, that person may very well take advantage (knowingly or unknowingly) and use your support until YOU are the one whose health is suffering.

Learn to say, "No, I cannot help you right now," and to put yourself first.  Realistically, unless you are taking care of yourself, making sure that you are steady and grounded, you're not able to help us anyway, you're just creating an enabling loop.

4.  Encourage us to get help and to KEEP AT the things that are helpful.  This, obviously, ties in with the last one.  Here's the thing about depression: when we're in a depression cycle, we have neither the energy nor the mental strength to seek out aid on our own.  We don't believe it will help.  Many of us have been and been and been to professionals to no real advancement or change.

We still need it.  Not only because professionals are the best suited to know when we need to be put in a hospital and make that choice dispassionately, but because they are paid to take care of us, and therefore are an essential part of the support system.

When we're doing well, we often tell ourselves (and others), "Oh, I don't need that right now."

When we're doing well is EXACTLY when we need to be working on it.  It's when we have the best ability to do so.  Chances are, though, that we won't unless encouraged.

What's more is, we probably won't stick with it unless we see support from our friends and family.  Asking a person who is depressed what she's getting out of her therapy sessions?  An absolute no.  Saying, "Hey, I really think you're doing better at __________ since you've been in therapy,"?  Go for it.

This is the same (maybe even more so) for meds.  A lot of people seem to think psych meds are the same as say, cold meds, where once you start feeling better, you can get off of them and your body will take care of the rest.  That's not how it works.  These meds are more like something you would take for an auto-immune condition, or something else chronic.

A lot of people DO get off their meds when they start feeling better and then spiral back because the improvement stemmed from the meds fixing the problem.  Psych meds are often a lifelong deal for people with depression.  Being meds positive is a HUGE help, since there's already a stigma on mental illness and using meds for them.  Not to mention, every one of these meds comes with a barrel of possible side effects and the probability of long-term liver or kidney damage.

I avoided meds for SEVEN YEARS for lots of reasons, but definitely among them was the idea that taking them made me weak, that "now we just prescribe a pill for everything" and I didn't really need them.  I needed them.  I still need them.  And I still hate that I need them.  The last thing I need is people making me feel like I'm weak/stupid/bad for taking them.

Finally, we also need to be encouraged to build up community.  Whether this is through support groups, or hobbies where we meet other people, the more community we have, the more help YOU have when things get bad.  Community is essential.  If there's a way to help us create some, even if it's just having a few dinner parties and trying to introduce us to people you think might make good friends?  In the long run, that's going to be better for everyone involved.  You will have people to turn to for support and support for us can be diffused among a larger group of persons.

3.  Aid in good habits.  This is a little like four, but slightly different in that this is talking day-to-day behaviors.  So, for example, depression tends to breed a lot of "side effect" conditions, such as eating disorders, insomnia, agoraphobia, etc.

For example, let's say your friend's problem is agoraphobia, in the sense that she refuses to leave her hosue.  Create a standing "date night." This is important: be the one to drive, to pick the place and be ready to have to do the work of basically dragging her with you over protests. But do it.  Make sure she gets out of the house, even if it's only for an hour.

If the problem is compulsive overeating?  Do activities that don't involve food or at least involve healthy foods.

Help us to live in clean and safe environments.  Maybe this means coming over on a Saturday and making us sort out our closets with you, if you're good at that kind of thing.  Maybe this means helping us to find a cleaning company, if financially viable.

Get us to exercise.  Physical movement helps with the depression, even if we don't want to do it.  If the weather's nice, get us to take a walk around our neighborhood.  Or maybe find a yoga workout online that can be done inside, together.  Just something to get our blood flowing.

Like I said last week, do not do these things FOR us, do them WITH us.  And if you cannot get us to leave our house/help with tiny things/etc.?  Call our doctor.  Let a professional handle the situation.

2.  Listen.  Listening is hard.  It's hard to just take in a flood of "I hate my life," and not try to help, not try to make us see where there's a flaw in our "logic," but here's the thing: you can't help, not in the big picture of actually clearing up the depression, and our logic is flawed because our brain is misfiring.  No amount of arguing is going to change that.  Chances are we KNOW our logic is flawed and it doesn't matter, because we cannot emotionally feel that.

There's a comic of one person having a panic attack, and another person says, "Calm down," and then the person panicking says, "It worked!"  When put into stark relief that way, we can all see how ridiculous a comment like that is, when someone's brain is telling her to panic.  It's the same with depression.  You can tell us to "cheer up," or "think positively," or that the "past does not define the future," or that "hope exists," and you're basically just talking to yourself.  And probably making us feel like you weren't listening or you are dismissing the way we feel.

But listening to us, listening and just saying, "man, that sucks," or, "can I hug you?" or "I'm here," any of those things, it may not make it BETTER for us, but it doesn't make it worse and it does remind us that there is someone out there who cares enough to just let us be who we are, mental illness and all.

It's not fun for the person listening, believe me, I get it, I've been that person more than once.  And it feels helpless and sometimes really eye-rolly.  But to the person to whom you're listening?  It feels like, for once, someone is actually HEARING us, and we don't get a lot of that.

1.  Be persistent/annoying.  My best friend texts me every day.  Every single one.  Without fail.   And most of the time I'm kind of like "yeah, I'm here, yeah."  But on those days where I'm holding onto things with broken fingernails and the skin of my teeth?  That grounding moment is huge.  It says, "Hey, there's someone out there who would be really upset if you did what you want to do right now."

Bug us.  Sometimes, we're probably going to be dicks about it, wanting to be left alone to ruminate, let the depression marinate.  It is very seductive in that manner.  Be that third wheel.  Disrupt our date, bring pizza we didn't ask for, and a board game.

Try to do it in a way the person in question handles well.  I'm best at text and email, so that's what most of my friends do.  They'll call in a pinch, but I don't like being on the phone, so they try and avoid that.  Other people like that voice connection, or, if you're near, maybe they'd sometimes prefer actual face to face.  You have to determine what works best for you and your loved one.

I recently saw an article about how people disappear in times of grieving to "give the mourner space."  Except that, in most cases, what the mourner needs most is a community of support, rather than "space."  Depressives are the same way.  We put off vibes that we want to be left alone, and maybe some of us even really do, but we shouldn't be.  We need to have people showing they care, making sure we're responsive, and generally just pecking at us until our brain lets up and we settle into a remission phase.

Some Basic Don'ts

I know, I'm supposed to balance the Dont's with the Dos.  But, a) Don'ts with depression are easier, and more universal, and b) relax, next week's edition is on the Dos.  I've got to maintain a little mystery, right?  Keep you coming back for more?  Or something.

Again, I really cannot speak for all persons with depression.  This is more about me and all the people I've known with the condition than the world at large.  But pronouns are tricky and not always as varied as I might desire.

I am going to do five of these, since that's a nice, round number.

5.  Do not take it personally if I don't seem terribly present.

As I've talked about in this note, depressives are taught early--and later internalize--that our tendency to be "sad" means we are self-involved.  This often creates a defense mechanism which turns us into people who automatically de-prioritize ourselves.  As such, when we are at all, even just a little bit able to be, chances are we're going to be the best person in your life for listening, empathizing, and trying to support you.

If you notice we've stopped really paying attention, say, we're nodding our heads but not responding the way we normally might, chances are a few things are happening.  Depression robs people of the ability to concentrate.  It might be taking us all our energy just to focus.  It's also possible that we don't have the energy to care at that time.  This is NOT personal.  It's not even close to personal.

We have stopped caring about OURSELVES.  We have stopped caring about everything that previously made us happy.  In my case, when I get to this point, if I COULD care about anything, it would be what's going on with my friends and family.  But I'm so far beyond that, it's generally all I can manage just to be physically listening/hearing.

You don't have to stop talking.  Just be compassionate if the response you usually get is unavailable.  And don't get mad because we can't be the person you need right at that moment.  At least in my case, I'm trying as hard as my little heart can manage.  Also, getting mad isn't going to get you what you need or want.  In my case, it's going to mean I withdraw emotionally from you long term, because I have learned you have no ability to consider my emotions, and because the last thing I have the ability to do at that moment is say, "Hey, I need you to realize I'm having a hard time right now and that doesn't mean I don't care about you."

4.  Do not let us disappear.

This is a hard one.  Especially if the depressive you know and are trying to be there for is an introvert.  Because that person NEEDS time alone to even have a chance of functioning in the rest of her life.

If the person is an extrovert, don't mess around: make sure that person is going out with you, even if you have to provide rides, or set up hanging out at her house with some friends.  This latter is a good way to handle an introvert if you cannot get her to come out: take food to her place.  It allows her the safety of her surroundings, and means that she's eating.  Depression can cause emotional over-eating, but it can also cause a complete lack of interest in food, ESPECIALLY if it has to be made.

I am someone who's really awesomesauce at making myself eat when depressed and last night I had a bowl of cereal and an apple for dinner because I couldn't rustle up the mental energy to actually figure out a meal plan and enact it.

A sub-tip to number four is, if you get to her house and basic things, such as taking out the trash, laundry, etc., need to be done, help.  DO NOT do it for her.  Unless you physically cannot drag her out of bed--in which case, call someone stronger than you, put her in your car, and take her to the nearest hospital--have her participate in some way.  It can be small.  You can have her sit down and sort the laundry.  Or walk with you to the curb with the trash cans.  Anything.  But force her to take part in her own life.  I am not saying this is easy.  She might be a total crab-ass at you.  Or say terrible things.  Or cry hysterically.

Get her some water or Gatorade, and make her participate in her own life anyway.

At the VERY least, call or text and check in with her.  Suicide happens, in my experience, when people reach a crucial clusterfuck nebula of two points: the sense that things are hopeless, cannot get better, and things will always be this terrible and painful, and that the world, even the people in it who love us, is better off without us, and things will be easier for everyone that way.

This is possibly the most important point of this post: nobody can stop another person from committing suicide.  At the end of the day, it is the person who takes that step's choice.  That said, letting a person know you care day in and day out, even if it's just by saying "hi, thinking of you," can go a long way toward slowing or even halting the cycle of "nobody needs me" thoughts.

If you can--and being the friend to someone suffering from depression is grueling, so if this means too much mental and emotional energy on your part, just don't--occasionally find a reason WHY you care about that person to mention.  It doesn't have to be epic.

A friend recently told me she needs me to hang on because she learns things from me.  That's an A++ reason.  Any reason that's real will help.  It won't FIX anything, but it will help.

3.  Do not expect miracles from medication and therapy.

Speaking of fixing...

In some people, these steps do cause miracles.  And if that happens to someone you love, be thankful, because miracles are rare and precious.  But if what you get out of that person is instead two days out of the week that are better than they were before?  Or the ability to communicate frustration where she could not before?  Take that and run.  And be proud when those moments happen.  Let the person KNOW you are proud, not only for the progress, but for being willing to get help, to try different things, when, frankly, it's one of the hardest things.

On Thursday, I went to my prescribing doc.  He really wishes I would go to the hospital, because I have hit the space where I genuinely have no capacity to believe life will get better than it is right now, and I have no interest in continuing on in this space.  Or, as I said to my therapist when she asked me if I planned on doing another triathalon, "The thought of being alive long enough to do that is depressing."

I won't go to the hospital because I cannot afford it, either financially or time-wise, and because all it would mean is a bigger mess when I come out the other side.  Additionally, I have a bunny who just got an ear infection, and I'm the only person who can take care of her the way she needs.  My bunnies are actually my last line of defense.  I remind myself regularly that nobody is going to take an almost nine year old and almost seven year old bunny and really pay attention to them and love them if I'm not around.

So, instead, my doc doubled my dosage.  If this doesn't work, the next step is putting me on a THIRD anti-depressant, co-currently.  Being honest, I sincerely doubt any of this will even take the edge off.  Changing meds hasn't worked the last two times we've done it.  I don't think it will now.  I don't think going to therapy is doing anything, because I've reached the point where there's nothing more to say: something I straight up told my therapist this week.  And that's the disease.  It tells me, in no unclear manner, that nothing I do will help, that things will always be like this.

And I believe it, because I have no other choice.  But I go to therapy and doctors because I know its the right thing to do.  If you know a depressive who constantly goes and does the work, at her worst, she's not doing it because she believes it will change anything.  She's doing it because she's supposed to.  Hug her and tell her she's doing a great job and you're proud of her for keeping it up, even when it seems hopeless.   Because, trust me: it does.

2.  Do not let us go silent.

This is another hard one.  For me, talking, really talking, when I'm like this, is a chore.  I'm tired of hearing my own voice in my head.  I don't have anything new to say.  I don't want to pretend to be happy.  Silence is my best option.

Which is why, once a week or so, it's important that someone find a way to get me to talk, even if I am saying the exact same thing.  Things haven't gotten better for me in two years.  They're unlikely to anytime in the foreseeable future.  I'm not going to have a lot that's new and interesting to say.

Ask leading questions and listen anyway.

It's like this: I may be tired of hearing my voice in my head, but that's not going to shut it up.  And a lot of the poisonous shit it says?  Is just plain better getting released.  When someone overdoses, we pump her stomach, because "better out than in."  Depression is the experience of constantly overdosing on hopelessness without any affirmative action on one's own part.  Someone's gotta go in and make us bring it all up every once in a while, because just like the drugs, if not as immediately, it will kill us.

1.  Do not, do not, do NOT, EVER, say the words "things could be worse," or "just cheer up," or any variation thereof.

I actually get that for some people this helps.  Those people are not chemical depressives.

Have you ever broken a limb, or had a bad flu, or cut yourself deep enough to need stitches?  Out of curiosity, did thinking positive thoughts about getting better hasten your healing process?  Because, if it did, you might have either mutant or angelic powers, and you should consider a career in televangelism, or something.

I can think all the positive thoughts I want.  Realistic ones, even.  Ones like, "I write well and research like a boss and have a really interesting professional and academic background: someone has to hire me sooner or later."  Or, "Lots of people meet life partners much later in life, things are just taking their time."  I can repeat them in front of the mirror every morning.  I can use them as a meditation, whatever.  My BRAIN does not believe them.  Because my brain does not function correctly.  Much like a broken arm, the essential function of my brain is in a state of disrepair and works on a basis of limited functionality.  The difference is, fixing a broken arm is a decently exact science at this time.  Fixing my brain?  Not so much.

As far as the "things could be worse" approach, let me quote something I saw on tumblr, the font of all true wisdom.  (That is a lie.)

"In breaking news, the person in the worst situation on planet earth was finally found and THAT person is allowed to be sad.  No sads for anyone else, though, ever."

Like I said, I realize that for non-clinical depressives, this sometimes helps.  I've met people who find it useful to think about the fact that they could, say, not have a home, or be going hungry, or be physically ill.  And I envy the crap out of those people.  Man, if I could make myself better by thinking about all the things that could be worse?  I'd be the world's happiest chickadee.

For a moment, though, let's take it for granted that I don't actually want to be so miserable all the time that I would rather be dead.  And from there, let's take the logical step that if it were that easy for me to feel better, I'd have already fixed the problem.  I talk in this note about how, not only is using this approach unhelpful, it's DANGEROUS.  It tends to cause a guilty reaction, which will not only make me stop talking--see point number two, this is NOT a good thing, it doesn't mean I feel better, it means I've been made to feel like my pain does not matter--but will stay with me, and very possibly trigger a cycle of even worse feelings of worthlessness than are usually an issue.

A sub-suggestion here is, "things will get better"?  Also not helpful.  I cannot convince myself of this.  You telling me it?  Feels dismissive, even if it is not intended to be.  And again, it makes me feel foolish for not being able to make my brain believe it, makes me feel like I should stop talking, like I should go away.  Away away.

So what DO you say to a person who's depressed?  *grins slyly*  Come back next week, mes amis.

Some Housekeeping

One of my favorite essays in the world is "Axiomatic," by the late Eve Kosofsky-Sedgwick.  At its most stripped bare, the point of the essay is this: assume nothing.  I try to live my life by that approach.  I fail a lot.  But I try.

As such, I want to set up some basics here, so that when I say certain things, at least some of the guess work that might be inherent gets taken out.

1.  I am in no way, shape, or form, a psychological or psychiatric professional.  I did not so much as take Psych 101 at any point in my education.  I have no social work background, or any type of work that might enable me to call myself an "expert" on the topics I'm speaking on in this blog.  This all about personal experience and observation, absolutely nothing else.

2.  I experience this world through the filters and privilege and lackthereof.  This is to say:  I am white, cisgendered, middle-class, American, a native-English speaker, able-bodied, thin, decently attractive by societal standards, and highly educated.  All of those afford me privileges that both "normalize" me, at the same time as giving me chances others are not allowed, chances I might not even realize I've been given.  Alternately, I am female, occupy a strange space between pansexuality and asexuality--which I generally describe as "queer" for simplification reasons--I am Jewish, and I have a chronic auto-immune disorder as well as the serious depression, generalized anxiety disorder, and avoidant attachment disorder diagnoses.  These aspects of selfhood help me to see exactly how privilege operates, if they do not always give me the ability to see every aspect of it.  (As a sidenote, it is because I am female and cisgendered, and for no other reason, that I will use female pronouns in this blog as the universal.)

3.  Although I use the tags "mental health" and "mental illness" in this blog, let me be specific: this blog is about depression.  Not bipolar disoder, not borderline personality disorder, not any other mental illness in the world.  I do not suffer from those.  Do I know people with them?  Yes. Do I think that gives me the right to speak to them?  Nope, not even just a little tiny miniscule bit.  Depression is a mental illness or a mental health issue, hence I feel justified using those tags.  But this blog is not meant to be a broad-spectrum mental illness discussion spot, please do not read it expecting such.

4.  I want to set up some definitions.  Again, see point one, these are not technical.  They are definitions I've built up through common sense, and a lot of therapy--the receiving end.  But these are three terms that I see confused and misused a whole wooly bunch, and in order to talk about depression-related topics, I need to separate them and clarify how I will be using them.

Sadness:  Sadness is an emotion.  It is in relation to something happening to a person that causes the emotion.  It can be about loss or grief or fear.  It can be confusing, and weirdly, it can be wonderful.  Some important things about sadness are this: one, it is a real, justified response to something that has happened to a person, two, with time, it will go away--it might be a lot of time, depending on the cause--but it will resolve, and three, it can often be mutually exclusive from forms of depression.

Wait, what?

Yes.  This is vital to understand: depression can be something so removed from sadness, that quite literally the person suffering from it cannot even reach a place where she can feel sadness, which is about connection to things.  Sadness is, first and foremost, an emotion, and depression pushes a sufferer to a place where emotion is beyond them, ALL that exists is the depression.

Circumstantial Depression:  Like the term would suggest, circumstantial depression is depression triggered by things that are happening to a person.  I use the word "trigger" specifically.  A trigger is not a cause.  A cause has a causal relation, i.e., "my cat died, this makes me sad."  Triggers are buried minefields.  Yes, they CAUSE the reaction, but there's not an obvious A to B to C that can be uncovered and pointed out.  For instance, a woman I once knew has PTSD from childhood sexual abuse.  Her episodes are triggered by algebra for reasons she was later able to determine, but it's not as if the two had an obvious connection.  Triggers are psychological, and therefore not always self-evident.

Circumstantial depression is usually caused by a type of "cascade failure" in life.  For example, a quick series of major losses can trigger circumstantial depression.  That does not make the depression about the losses themselves, but more about what a person might read as those losses saying about her.

Circumstantial depression is the baby brother to clinical/serious depression, and, IF THE PERSON HAS THE BRAIN CHEMISTRY FOR IT, can trigger a serious depression episode.  (Sadness can do this as well, although it is less likely.)  If the person does NOT have that brain chemistry, circumstantial depression WILL resolve, so long as the community of the person suffering from it are supportive, rather than suggesting that if the person would just cheer up/relax/do this/do that.  Circumstantial depression, like serious depression, causes suicidal thoughts and ideation, and people in the midst of it can be driven there by surrounding factors.  Circumstantial depression looks almost identical to serious depression, but because it is environmentally-based rather than brain-chemistry based, with help and the right community, can be conquered and has the possibility of not returning.

Serious/Clinical Depression:  Here is the single biggest differentiator between the first two terms and this last one: serious or clinical depression is the result of a chemical misfire of the brain.  Yes, it CAN be triggered by environment and circumstance.  It can also be triggered by a depressive's brain firing the wrong damn signal one day, and deciding to every single long dreary day after that.

Unlike the other two, which might--note my prevarication--be resolvable without intervention, serious/clinical depression requires treatment.  There are some people who swear by so-called alternative therapies, such as acupuncture.  There are others for whom meds are the only option.  There are people like me who would have sworn meds were at least a stabilizing option who find that not even those work, and further methods have to be explored.  But depression does not get better just because someone "should" be happy.  It does not get better because a person "works hard enough."

It gets better--if it does--because the person finds the solution that kicks her chemical balance back into being.  And I have yet to meet a single depressive who managed that by thinking positive thoughts.  Depression, like, say, migraines, is real.  Migraines don't go away because you don't want them to happen.  They go away because you realize that caffeine is causing them, and you take yourself off all caffeine, so as not to have that chemical interaction in your body.  They go away because your doctor finds the right pain medication to hold them off.  Or maybe, sometimes, they don't go away, and that's just something you have to live with for the rest of your life.

Serious/clinical depression has no time frame and, at this time in medical science, has no surefire cure.  And it has one purpose: to kill the person whose mind it has infiltrated.  Depression steals hope, steals belief, steals the bright moments of reality.  It steals and it lies and it cheats until it kills its intended target.

People who survive depression--by living long enough to die of some other cause--like people who survive other fatal diseases, survive because they fight with the ferocity of trapped rats and because, frankly, they are lucky enough to somehow be spared.  We do not know why some people survive and others do not.  We do not know why some can be "cured" or at least placed in remission, and others cannot.  Mostly, those of us who live with it just know that it is our enemy.  And it tells us that in fact, it is not an external enemy at all, but really who we are.  That we, ourselves, are the ugliness and fear and terror and hopelessness.  That we are the weapon cutting away at ourselves.

And so, when the outside world tells us the same?  A lot of us hear.  A lot of us listen.  A lot of us destroy what we have come to understand as nothing more than a weapon, a device of destruction.  We destroy ourselves.

The depression takes another life, tallies it to its win count, and laughs.

THAT is what defines serious/clinical depression.

What You See Might Be What You Get, But It's Not Who I Am

In the past two weeks, I have finished writing two stories, each over ten thousand words long, and edited them in order to send on to outside editors.

I have walked ten miles in two-and-a-half hours, and I have swum a mile in a flat fifty minutes.  I've biked fifteen miles.

I've taken the ice bucket challenge, donated to two charities, and volunteered for another two.  I've also been to a meeting as part of the executive board of my synagogue.

I have been on time to both my jobs every day and taken care of every piece of business that has come up, including a surprise clusterfuck with the courts that occurred twice last week.

These are some of the things I've done in the past two weeks.  In that time, I've also spent almost every waking moment reminding myself that if I kill myself, nobody is going to take care and love my two rabbits.

Hi.  My name is Leslee.  I am thirty-four.  I have a Masters and a JD.  I am licensed to practice law in two states.  I have been published three times in academic books and trade journals.  I have a black belt in taekwondo.  I finished an Olympic-length triathalon in 2013 and will be walking a half-marathon in about a month.  I have had people respond to my fiction stories, posted under a nom de plum, and tell me that those stories have helped them to deal with serious emotional traumas within their lives.  I have a dog and two rabbits.  I love to lindy hop, and have been swing dancing for fifteen years.  I played bridge against my grandparents twenty years ago, and now I play it in bridge studios.  I'm part of a Toastmasters group full of crazy-awesome people.  I love to read.  I like to bake and I like eating what I bake even more.  I've been to China and Israel and a number of other places and I want nothing more than to go to a new and different places around the world.

And I am seriously, clinically depressed.

I have been in talk therapy on and off since 1992.  I have been going consistently since 2006.  In 2007, I finally consented to being put on meds.  They worked for about six years.  I had to change them four times in that span of years.  They have not been working, despite new changes, for about six months now.

I exercise, I watch what I eat, I get the sleep I am supposed to get.  I have been trying neuro-feedback for six months.  If it was going to help, I probably would have seen a change by now.

I would like to try electro-convulsive therapy (ECT), and my therapist agrees it's probably my best option at this point, but it is $300 - $800 a treatment, and you start at two treatments a week.  I could MAYBE afford one a month.

Lately, I've talked a few times on Facebook or at a Toastmasters meeting about how I "pass" as mentally healthy.  About how that means most people do not understand what I am telling them when I say I'm depressed.  And about how that makes it almost impossible to get real help or support outside of mental professionals paid to provide aid.

About how I taught myself early on--out of fear of the consequences of doing anything else--to believe that nothing in life except things that are pleasureful for me is optional.  In other words: going to work?  Not optional.  Getting writing done?  Optional unless I owe someone else a story.  Then non-optional.  Going to a board meeting?  Non-optional.  Reading a book?  Optional, with a side of only-if-you-have-finished-everything-else.

This means I am insanely efficient, and if I tell you something is going to get done, it will either get done, or, on rare occasions, I will let you know well in advance that it is not going to be possible.  This means people see me as put together, as "fine."

This means that in the eyes of the world, I am not depressed.  I am maybe, perhaps, sad.  Sadness is an emotion.  It is an important emotion.  It is not an emotion that makes death the only thing a person wants out of life.  Depression does that.

Because my depression is even more invisible than that of the person who won't get out of bed, or who cuts herself, or who can afford, time and money-wise to go to the hospital, I spend a lot of time pushing back against people's misconceptions about depression, and how it functions.  Those misconceptions have been rife in the media and popular discussion in the wake of Robin William's suicide, and I've felt more and more that I have some responsibility, because I have the ability to do so, to talk about what depression, and particularly functional depression looks like.  And how functional depression requires as much support as the kind that keeps sufferers in bed.

Since I am working on being kind to myself--an uphill process--I am setting the goal of updating this blog once a week to talk about something related to functional depression, anything.  And maybe people will read, and maybe they won't.  Maybe someone will see this, and feel less alone, and maybe nobody will.  But words are one of the few things I've always had control over, in a world where I have very little control over anything.  They are the way I have met most of the people I am closest to in the world.  So I am going to try this.  Try and see if it helps me, if it helps others, if it helps.