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.