Month: April 2014

Can I Just Say #6 – A Note on Psychiatry

Operating SystemI am grateful for the work that medical science has done on depression. I am grateful (really!) for the medicine, which I’m taking and which is helping. But can I just say that I would appreciate some humility from the psychiatry crew?*

Your science is very young. You have no idea of the actual mechanism of most of your tools, and most of your interventions work only in the short and medium term. You don’t know my body better than me. You don’t know my mind better than me, and you don’t know which meds will work.

You ask me to track my symptoms and then ignore me when I say that it’s driving me crazy. (Are these thoughts worse than yesterday? These feelings? Oh. That was a bad one. Is this anger or anxiety…).

What’s the point of a bunch of painfully collected data if you can’t even begin to infer causality? Am I more anxious than a week ago because of the meds or is it because I just started a job at a call center where customers tell me to go fuck myself? Please stop acting like we have a counterfactual, an alternate Mfupi who didn’t start that job. Another Mfupi with my biology and history who’s not on the meds you recently switched me to. Just stop.

Also, there aren’t that many drugs for depression. You should be familiar with them.

I appreciate your help. I believe you have my best interests at heart, just have some humility. Please recognize that “everyone is different” means that you don’t actually know how to help me.

So don’t act like my doubts = noncompliance. This isn’t a relationship in which one person should comply. This is a partnership. You bring your imperfect understanding of my condition. I’ll bring my imperfect interpretations of my thoughts and feelings. And we’ll figure it out together.

Thanks.

 

*I’m a huge fan of psychology, where PhDs and other experts provide talk therapy. This post is about the medical field of psychiatry, which, for depression, mostly concerns itself with managing medication regimens.

Photo by Mark Anderson on Flickr

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Chilling the fuck out

I’m reading a book on mindfulness and depression. The authors posit that people are more vulnerable to depression and relapse when they spend a lot of their time in a ‘comparing’ state of mind – that is, when you’re noticing the difference between how things are and how you’d like them to be. They contrast that with a ‘being’ or ‘observing’ state of mind, which is characterized by noticing the present moment and accepting it for what it is.

Comparing state of mind? That’s me.

It makes sense to me that you appreciate any given moment less when you’re preoccupied with changing it, when you’re comparing it to the past or planning ways to make it different in the future. It makes sense to me that a ‘comparing’ state of mind would be exhausting, because the call to action is constant. A ‘being’ mind sounds like a welcome relief – peaceful and calm.

(I’m reminded of my attempts to notice those moments when I feel like my mind can rest.)

To develop their mindfulness-based treatment plan to avoid relapse in people who have had depression, the authors looked to a program designed for patients with chronic pain. Instead of fighting the pain, the patients learned to regard it with a gentle, kindly awareness.

(I’m reminded of my friend who eventually came around to loving the mean voice.)

This approach to avoiding relapse does not emphasize the content of your thoughts, such as getting over your specific triggers. Instead it tries to change the relationship you have with your thoughts. It tries to help you understand that not every thought reflects reality. Not every thought deserves a reaction.

My Dog: Not Excellent in the Fetch Department. GENIUS at Chilling Out

My Dog: Not Great at Fetch, GENIUS at Chilling Out

I realized after (during?) my first(?) major episode in college that what I needed, in a very serious way, was to chill the fuck out. Mindfulness-based approaches to depression seem to be saying the same thing.

When you can spend less time fighting and more time with a gentle awareness, it makes sense to me that you’ve made a big step toward resilience – a step toward the source of your happiness being within you.

Sounds nice, right?

Mind Monsters on Spring Break

Scary BirthdayThe best thing about anniversaries is that they pass.

It is totally common to have parts of the year that fuck you up. Birthdays, New Years, the anniversary of a death. It happens to depressed people. It happens to totally healthy people who’ve suffered a traumatic loss. It happens to a lot of us who would normally have a very clear mind about whether the anniversary of a person’s death makes them more dead.

It doesn’t.

The date is a trigger. Like funerals, like violence, like anything that takes you out of where you are and thuds you down in the middle of some shitty past event. Then the anniversary itself is kind of traumatic, and, for me anyway, the date amasses bad experiences and connotations until the month or two leading up to it are filled with an overwhelming sense of dread.

That kind of anniversary becomes a fucking beach party for all sorts of unresolved little mind monsters. It’s spring break and they’re out in force, shocking their parents and appalling their more responsible peers.

The mind monsters are myriad and you can’t tackle them all at once. It can be impossible to even approach them when they’re all riled up like that. Sometimes the anniversary is the worst time to address the underlying issue. (I’m not thinking clearly right now. I don’t have to solve this today.)

This year I’m working on letting the anniversary pass. Then, when the monsters are back home, in bed, surrounded by calmer thoughts, we’ll sit down, as gently as possible, and we’ll have a chat.

In the meantime, the anniversary will pass.

 

Photo from TheMetaPicture

Plan P: Acceptance

A lot of talk and writing about depression emphasizes the beauty of getting “back to normal.” They emphasize the goal of “feeling yourself again.” For people like me who missed the Treatment Train and the Full Recovery Boat during their first one or two or four major episodes of depression, such talk sounds like high pitched jibberish.

How far back would you have to go to be “yourself” again? So far back it’s not really you anymore.

At best, you realize that recovery for you will mean reinventing yourself. At worst, you are paralyzed by the ‘realization’ that depression has become one of your defining characteristics (Enter dejected apathy).

Either way, it’s hard to imagine a future without depression because it would have such little resemblance to your present or your past.

For some, this can be a rallying cry. I will FIGHT until I WIN and depression DOES NOT OWN ME. It WILL NOT define me! If that’s how you’re feeling and it’s motivating, that’s great. Go with it.

For me, it feels more like a call for acceptance.

Fuck it. It’s true. The experience of depression has changed my life. Forever. In terribly negative ways. Ways that can’t be undone. Maybe I lost a few years. Maybe I lost some potential. Maybe I lost a job, a partner, a friend. Maybe my family fell apart. That hurt really really bad and fuck it. It happened. I wasn’t dealt the best hand and I wasn’t dealt the worst.

It feels like accepting the fact of depression in my life is a prerequisite to moving on.

I’m told that the experience of recovery will change my life forever too and that sounds right. I don’t think recovery will bring me “back” to normal. I don’t think it’ll bring me back to anywhere. I imagine a new calmness, a peace I can’t yet picture – because it is so blessedly different from the present.

A peace that feels like moving on.

Moving On

“Led by Earth’s endless quest to equalize the dispersion of heat, winds whip around the world…”

Photo by NASA Goddard Space Flight Center on Flickr

Can I Just Say? #5

learn_hard_wayCan I just say that I hate it when people act like depression is a valuable learning experience? That it is an “all is for the best in the end” kind of thing?

Depression is a learning experience like stubbing your toe is a learning experience – it hurts like hell and yeah, you learn things. You learn not to do things you never wanted to do in the first place. Things you never meant to do, things you never realized you were doing, things that you surely would have avoided if you had known.

I’m not saying that there are no positive outcomes of depression. You delve. You awaken to deeper truths about what you want. It’s just that it’s not worthwhile. It’s not worth it.

‘Cause you know what else teaches you things? You know what can open your eyes to the beauty of the world around us? Not having depression. Having the confidence to get that better job. Still enjoying that relationship. Getting out of bed every day. Those are the learning experiences.

You wouldn’t tell someone with migraines how much they’re learning. You wouldn’t say it to the victim of a car accident as they’re laying on their back in the hospital, looking for a helping hand. Sure, I’m learning. Because I’m hurting. I didn’t mean to stub my fucking toe. I didn’t mean to fall ill like this. I want to get better and lecturing me about lessons learned is not helping.

Lord, what I’d give to be learning something besides how to not be depressed. That’s what I’m striving for. To get back to that learning. To get back to the world.

 

Photo: Learning the Hard Way by Ludovic Berton on Flickr