At My Worst

I recently read Sara’s post “Depression Does Not Make You a Monster” and her follow up post, and felt compelled to finally put pen to paper, so to speak, on something that has been on my mind for a long time now.

I’ve spent a lot of time mentally processing my diagnosis, and here’s what I’ve concluded: Depression is and is not controllable. Depression is disabling, sometimes. And trying to tease out whether any particular bad patch could have been prevented is not worth the effort.

Most advice about depression is contradictory. That doesn’t mean it’s incorrect; depression is just complicated. The advice about how to help people with depression is similarly full of conflicting ideas.

On the one hand, I have had days where I agree with Sara’s advice to “ignore the depression, not the person suffering from it.” Sometimes the only way to feel better is to escape the thoughts in your head, which cannot be done if those around you are constantly asking you what’s wrong, why you’re not happy, and if there’s anything they can do. If I’m out and about, trying to distract myself, the last thing I want is to be pulled back to the thoughts I am trying to get away from. I certainly don’t want to feel like a burden, or like everything needs to come to a standstill while I get my emotions back in check.

All that being said, it is my responsibility to communicate my needs. If I drag my husband to the beach in an effort to lift my spirits and am still in the dumps, it is only natural for him to ask me why I’m upset. He is not a mind reader.

On those days, the best thing I’ve found to do is to go somewhere I’ve never been before and focus on the new surroundings. Otherwise, I read, sing, or otherwise find a way to silence the unwanted thoughts.

I should note that my therapist has also recommended focusing on sensory information. For example, think about the way your body feels against whatever furniture you’re in contact with. Now imagine what the furniture feels like supporting you. It’s slightly different, but it effectively changes the flow of your thoughts. (Aromatherapy can also work wonders.)

On the other hand, there are times when you need to express what you are feeling. I’m going to borrow again from my therapist. If you are worrying about something, imagine your brain is trying to send you a letter. It wants to tell you something important. First it’s going to knock on the door. If you ignore it, the mailman is going to start ringing the bell. Then, he might start yelling or trying to shove the letter through the cracks.

Once you acknowledge the mailman, he stops trying to break down the door. The urgency is gone and you can peruse the contents of the letter and move on. This is partly why it is so therapeutic to journal (or blog).

However, even writing about your experience has some problems. I experienced this when I tried online therapy. I spent so much time finding the words to describe what was happening to me and waiting for a response that I never gave myself the chance to bounce back from my bad times naturally. Writing is wonderful, but it makes you revisit your old emotions so you can immortalize them accurately. Then later on you might notice a typo. Before you know it, you’ve read your own angst-ridden sentence twenty times. Sure, your creative head space is probably not as bad as your original raw emotion, but you still relive that moment every time you interact with your writing.

All this is to say that there isn’t a “right” way to handle your depression. There isn’t a “right” way for others to interact with you. Every day, you have to assess your capabilities and determine what you need to do to maximize your productivity. Some days, all you may be able to do is cry over your failed drawing of a Tyrannosaurus rex (my Tuesday afternoon). Other days, you can muster the determination to clean half your house, put in a few hours of professional work, and write a blog post to boot.

What’s important is that you give yourself an A every day you do your best, even if your best today isn’t what it was yesterday.

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Logic and Mental Illness

Sometimes, mental illness feels like a self-fulfilling prophecy. When I have the worst of my worst days, it is easy to write off what I’m feeling as a consequence of being mentally ill. I am anguished, disconnected, and listless because I have anxiety and am depressed. There is no logical reason for me to feel so incredibly low. Therefore, it is just a thing that happens to me.

That is how I viewed my depression for a long time. There was just this cloud of sadness that followed me around, and sometimes it would come low and I would be forced to wait for the fog to clear to be able to interact with the outside world.

Any alternative solution seemed completely dismissive of what I was going through. If I divulged that I was having a hard time with my depression, I would get angry and defensive if someone asked me why I was depressed.

depressed

What do you mean, why am I depressed? I am like this because I *have depression* and my emotions aren’t logical. If I knew why I was like this, I wouldn’t be like this. Don’t you get it?

When I was diagnosed with depression several years ago, I didn’t think I viewed myself any differently. It just felt like a logical conclusion for my behavior/my personality. I accepted the label as an explanation for why it was always nigh impossible for me to get excited about anything, an explanation of why I was so passive about everything, and I moved on. The diagnosis was a means to an end; because I was depressed, I could receive therapy and try different medications.

A few months ago, I called my mother specifically because I knew I needed to go back to therapy, but I couldn’t afford it. Yes, I called my mother to ask her to pay for my therapy. It was embarrassing and the whole conversation just made me want to puke and punch things at the same time. I’d definitely say it was one of the lowest points in my life.

When we got off the phone, my mother had agreed to pay for one month of therapy. But I was infuriated. She had asked me, “what are you depressed about?”

“Well, I quit my job…  and now we could be homeless in a few months… and other things.”

“Don’t you think you’d be better off to spend your time looking for a job, then? If you’re stressed about money, spending money on therapy is probably just going to make it worse.”

“Mom… no. Did you miss the part where I was having panic attacks at my last job? I had to quit. Getting another job isn’t going to magically make me better. It’s so much more than that. I feel like I am actually losing my mind.”

At that point in the conversation, I completely lost control and started sobbing hysterically, so it took another twenty minutes for me to work up the nerve to ask for money.

The whole conversation just reinforced my belief that depression and anxiety make zero sense. In my mind, yes, they were triggered by the stress of my everyday life, but trying to say, “I am depressed because x, y, and z” would never be able to cover it. There was no explanation for what I was feeling, and trying to answer why I was broken felt like a huge slap in the face.

The next day, my mom e-mailed me and said I should try taking St. John’s wort. I had never heard of it, so I did a quick Google. This was the first thing I saw:

Psychosis is a rare but possible side effect of taking St. John’s wort.

St. John’s wort is not a proven therapy for depression. Do not use St. John’s wort to replace conventional care or to postpone seeing your health care provider. Inadequately treated depression may become severe and, in some cases, may be associated with suicide.

Um… thanks, ma? I know you’re trying to help, but this isn’t the right way to go about it. Just let me go to therapy.

The thing is, her suggestion actually fit with what I was thinking. If depression/anxiety is totally random, there’s nothing you can do about it except medicate and hope that it goes away. I have never thought that medication is my only treatment option, but I have always felt like it can’t be helped that depression is a condition that I have.

Something finally clicked in my brain this week. Last week, my therapist stressed the importance of allowing yourself to feel what you feel without guilt (something I struggle with). However, she also said (for probably the tenth time and it was only my second session with her) that one way I can help ward off panic attacks is to acknowledge what is making me anxious. Accept that my emotions are, in fact, logical and use my emotions as information.

What does this look like?

When I am nervous about taking my trash to the dumpster, I will remind myself that my reaction isn’t crazy since we’ve had so many car break-ins and we live in a rough area. I will try to not let my feelings hold me back.

When I am scared of going to the store by myself because something could happen to me, I will acknowledge that there are good reasons to be cautious. I will be grateful that I wasn’t at the mall when the shooter was there and say a prayer for the victims and their families. I won’t tell myself I’m being stupid or to get over it.

When I am angry, I will try to stop feeling guilty about being angry and not tell myself that I am overreacting. That doesn’t mean I give myself free reign to be hurtful and say horrible things when I’m angry. Rather, it means that when I am angry, I won’t tell myself that my feelings are illogical and I shouldn’t be upset.

I won’t write off doing fun things as a waste of time because I could be making money. My happiness is important and worth setting aside time for.

When I feel like I’m going to have a panic attack, I will try to tell my husband so he can help me through it instead of hiding my anxiety. I shouldn’t be ashamed.

I will try to not feel weak when I cry. When I start feeling guilty for being sad, I will remind myself that I am trying to get better.

When I wake up feeling anguished, I won’t dismiss my feelings as a side-effect of depression.

And, most importantly, I will remember that my past failures are not indicative of my future successes.

Thoughts on Square Breathing

The basic premise of meditation is that our lives are too busy and we need to take time to slow down and smell the roses. Therefore, we sit down for 15 minutes once or twice a day, focus on our breathing, and arise, fresh and ready to battle the world again.

This might work for very busy people like overbooked celebrities and mommies that just need some time alone, but for those with mental health issues, the idea of devoting more time to sitting still and being in your head does not make sense. Ideally, we want to gain momentum, not lose it.

Instead of meditating, then, the idea is to practice mindfulness. While meditation, very generally, is about letting go and learning to dismiss unwanted thoughts, mindfulness is about focusing your thoughts – thinking more actively.

If you are depressed, the best thing you can do for yourself is chase your happiness. Of course, if you are depressed, that feels impossible. Mindfulness is like taking baby steps.

This week, I was advised to try square breathing up to 6 times a day. If that seems like a lot, I would have to agree. I’m lucky if I remember to do it two or three times a day. However, I get the logic behind it.

So, what is square breathing?

Breathe in for 4 beats, hold 4 beats, breathe out 4 beats, hold 4 beats. Repeat until completed 4 times.

Super simple, right? Too simple?

For me, I do think this is too simple. I’ve played piano since I was 5 and was in choir for several years, so I have so much practice doing this that I barely have to focus to do it. That’s why, in my very unprofessional opinion, this should be modified. If you can do this and still have room to think about other things, you’re either doing it wrong or you need to make it more difficult. Count backwards, count in a different language, count backwards in a different language, count backwards in intervals of 7, etc.

If you’re wondering about the method behind the madness, let me explain further. If you’ve ever thought to yourself, “depression is caused by a chemical imbalance in the brain, so why should I bother with talk therapy or this weird mindfulness stuff when I can just take antidepressants,” I totally get it.

Think of every thought you have as a chemical reaction in your brain. If you have a bunch of sad thoughts, your brain is going to be full of sad chemicals. In a way, mindfulness helps your brain take a break from having so many incoming “sadness chemicals” because you are focused on something else. Over time, this helps improve your emotional baseline. While you’re probably not overjoyed when you practice square breathing, it makes it easier for you to be happy every day.

Harry Potter and the Reason I Stopped Trying to Meditate

I would not be the person I am today if it were not for the Harry Potter series. Harry Potter was the first thing in my life that I was truly passionate about. It was such a big part of my life that I really struggled to understand why anyone who enjoys reading wouldn’t like the series.

In high school, one of my friends revealed that she didn’t like Harry Potter. I was flabbergasted. My reaction was honestly just downright unreasonable.

What didn’t you like about it? How long ago did you try to read it? Have you tried to read it since then? Maybe you should try reading it again. It really is great – I think after you get past chapter 2 you will find it is so much better than you’re giving it credit for.

Luckily, my friend was very sensible and rightly told me (as kindly as possible) that I was being an idiot. You can’t expect people to keep trying to read a book they don’t like and hope that one day it will click with them.

I felt like a real dummy after that, to say the least.

It’s pretty well known that treating mental illness in some ways is more of an art than a science. You never know what to expect from a new medication. It could make you as chipper as a squirrel or you could be suicidal. If you do have a good few days or even weeks, you have to wonder if it’s because of the medication, because the circumstances of your life have altered for the better, because you’re proud of yourself for even trying something new, because you listened to your therapist and are trying this other thing, or simply because of the placebo effect.

If you go up and then down again, does that mean the medication isn’t working anymore? Should your dosage be adjusted? Should you try something else? (By the way, if you want to try something else, remember you have to detox for about 2 weeks and will likely feel mentally wretched during that time period and have a lot of headaches.)

I think, regardless of whether or not you have a mental illness, part of maturing into a successful adult is being able to not only set aside emotions and only deal with them when you are in the right setting, but also to dismiss unhelpful or unwanted thoughts. For instance, if your home life is making you miserable, you are expected to function like nothing is wrong at work or vice versa.

Meditation is one way for people to practice dismissing unwanted thoughts. Focusing on your breathing, your surroundings, or recalling a good memory, imagining you’re in a peaceful area, or otherwise finding ways to make your body relax when you want to panic or are having a bad thought spiral makes perfect sense.

That doesn’t mean it has to work for everyone.

One of the most common things people say about meditation is that it takes a really long time to master it or to get what you’re supposed to out of it. Just keep trying.

Finding inner peace through meditation is something that is never going to happen for me, just as trying to reread Harry Potter every few months is not going to make my friend like the series any better than she did the first time she put the book down.  No amount of telling me that I am simply doing it wrong or need to be more patient is going to make meditation more effective. And that is okay. Meditation is not the way to better mental health, it is just one of many ways.

Just like you have to learn to trust yourself to gauge whether or not your medications are working for you, you have to figure out for yourself what non-medical practices are going to help you feel better. I personally find exercise, talk therapy, reading, writing, and otherwise expressing myself creatively to be much more efficient uses of my time than meditating.

My Experience with Online Therapy

I guess you could say I “celebrated” Mental Health Awareness Month by going back to therapy. This time, though, I didn’t have to physically go anywhere. Instead, all I had to do was either visit the website or use the app to send messages to my therapist.

I’ll admit, I was a bit skeptical about trying it out. I probably would not have, but it seemed like kismet; I had just told my husband that I felt I needed to go back to therapy, had checked out our insurance coverage, and was feeling overwhelmed by the prospect of finding an office (do people leave yelp reviews for counseling services?), and the next day, I happened to watch a video talking about online therapy.

(If you were wondering how I found a therapist previously, I took advantage of my college’s psychological services.)

Choosing the Platform

The week before I became 100% convinced I wanted to seek professional help, I had tried using Headspace, partially because John Green had recommended it, and partially because I figured guided meditation would be free – like a podcast. The letdown of finding out you have to pay for it coupled with the fact that most meditation exercises remind me of the time my best friend was hypnotized made me quickly abandon it.

With renewed vigor, I tried the app the YouTuber recommended: TalkLife. The second I opened the app, I knew it was not for me. Simply put, there were too many people. There was too much suffering and whining. I needed something that was going to be uplifting. I was struggling myself and was not in a position to deal with a feed of “pity me” status updates. I’m sure that some people get a lot out of TalkLife, but it made me sick. It’s also worth mentioning that in addition for basically being a Facebook for people with mental health issues, TalkLife does allow you to connect with an actual therapist.

But I did not give up! The next app I tried was 7 Cups of Tea. This was a step in the right direction. While people could post in a general feed, not everything looked like a failed meme. Additionally, 7 Cups has a group of “active listeners” that you can connect with at anytime for free. I would say that if you absolutely cannot afford therapy and need someone impartial to listen to your problems, this is the way to go. Active listeners will not give you advice. They simply listen to your problems and empathize with you. This is not a good long-term solution, but if you are having a really bad day and need to let everything out to someone immediately, it’s a good option. If meditation works for you, 7 Cups also has guided meditation available. Finally, I did not like that you can see when your therapist is active. Anything that makes me stare at my phone and wonder why the person hasn’t responded yet is not fun for me.

While I originally thought 7 Cups might be the one for me, it didn’t work out for quite a few reasons. The main one is that I hated the user interface. It was very hard to navigate the app because there were a lot of menus within menus. There were also a lot of notifications that I didn’t care to figure out how to disable. Finally, even though the app has a free trial period, you have to give them your credit card information to be matched with a therapist. While they advertise that it is $5 a day, you are billed monthly. I asked what would happen if I cancelled in the middle of the month – would the charges be prorated or would I be charged for the whole month – and didn’t get a clear response. That lack of transparency, the problems I had with the app, and the fact that the app really pushed you to not just get help yourself but to join in the general discussions all made me decide to delete it before my trial period was up. I was matched with a therapist but didn’t hear anything within the first 48 hours and I didn’t want to be tied to that service when I might only get a “hello” message from my therapist before the trial period was over. I was really turned off by the fact that you can only change therapists once a month as well. One good conversation with a therapist is usually enough to know whether or not you are going to click and I want the freedom to change my mind as much as I want. Luckily, I have never had the issue of feeling uncomfortable with a therapist, but that doesn’t mean it will never happen.

I was feeling a little discouraged when I decided 7 Cups of Tea was not going to work out for me. This time, instead of browsing the app store, I did a quick Google for online therapy and settled on using Talkspace. Talkspace was what I anticipated online therapy would be like. When you open the app, you can open the menu to view your account details, but otherwise it is just a focused conversation with your therapist. The website is the same. I also appreciated that when I was picking my plan, the person that helped me decide and matched me with a therapist was upfront about the billing details. Talkspace does not have a trial period, but your billing period does not begin until your therapist has responded to your first message. You can choose to mix up how you talk to your therapist – you can add scheduled video chats or live sessions to your plan or you can just use text. Even if you choose to do just texting, you still have the option to send your therapist pictures and voice messages.

What It Actually Involves

My therapist messages me twice a day, 5-6 days a week, which is pretty typical for online therapy. Usually her messages are a paragraph long, though when we first started talking, some of her responses were much longer. When we discuss complex issues, she frequently sends me links to additional resources. She also sends me voice messages sometimes, which makes the whole thing feel less like I am talking to a robot.

What I Like About Online Therapy

  • If I am having an existential crisis at 3 AM, I can write my therapist a novel that she will respond to. I have never and will never receive a complaint about writing too much.
  • Talking to my therapist every day helps me stay accountable and motivated to keep trying to get better.
  • I don’t have to worry about not remembering what we talked about.
  • I don’t have to worry about missing an appointment. (In college, I sometimes missed appointments because I needed to recover from an all-nighter. Now, I am worried I would miss appointments because I can’t be bothered to drag myself out of the house.)
  • I never have those “I wish I would have mentioned ____” moments.

What I Dislike About Online Therapy

  • It takes up a lot more time than traditional therapy for me. My first week, I had so much to say that I easily spent several hours every day writing essays to my therapist. This is not good because I work from home and the time I spend writing to my therapist is time I could have spent working.
  • Sometimes, it feels a little less personal. Yes, I can spend hours writing novels to my therapist. That doesn’t mean she is obligated to send me novels back. Getting links to outside resources is great, but they obviously aren’t personalized and sometimes the temptation to skim is a little too overpowering.
  • The discussions are a little less focused than when I went to traditional therapy. Because there were longer periods of time between visits, it made sense to make a weekly goal. When you talk twice a day, you don’t take as much time to reflect on the past week or however long it has been since your last appointment to monitor your progress. I also feel less motivated to make big goals because there’s such a short time period between messages.
  • Going to an appointment helps you focus – sometimes what I spend an hour trying to write I could have easily explained, albeit less eloquently, in 5 minutes.
  • Therapy dogs are great.

Overall, I think online therapy was the right decision for my current circumstances. For the same amount of money as I am paying for a month of online therapy, I could have gone to about three traditional appointments. I don’t think I would have been able to get as much out of three appointments as I have with online therapy. With my current financial situation, this was what I could afford. Now, I will have resources to fall back on in a few months. I can pick up where I left off if things change financially or if I move (which will hopefully be happening very soon), too. Would I recommend it? Yes and no. If you have never been to traditional therapy, I would strongly suggest that you give that a shot before trying online therapy. However, it has been extremely helpful for me and I think if you put the time and effort into it, you can get back on track in a short period of time.