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.