Secular Meditation: How It Helps With My Depression

I’m going to preface this right off the bat by saying: I am not a doctor. I am not a therapist. I am not a mental health care professional, or indeed a health care professional of any kind. I’m just talking about myself here, and my own experiences. If these ideas resonate with you, and you’re thinking of trying this practice, talk with your mental health care provider. Also, while evidence does suggest that Mindfulness Based Stress Reduction can be an effective part of a treatment plan for depression, it is not a treatment all by itself, and it is not a substitute for therapy, medication, or other medical care.

Content note: Depression. Obviously. (Also note that this post has a somewhat different comment policy than usual: it’s at the end of the post.)

I was on Facebook a little while ago, and the subject of depression and mindfulness/ meditation came up. And someone (of course I now can’t remember who it was, or what their exact words were) said that they were baffled about how meditation could possibly help with depression. How, they wondered, could focusing their full awareness on their experience of the present moment do anything other than catapult them even deeper into the depression?

I can see that reaction. There is something counter-intuitive about this. Sure, there’s a reasonable amount of research suggesting that Mindfulness Based Stress Reduction can be an effective part of treatment for depression — but I can see how some people might go, “But how on earth would that even work?” So I want to write a little about how, exactly, using meditation to help manage my depression works for me. There’s almost certainly neurological and neuro-psychological stuff going on that I don’t know about or understand — but this is what my subjective experience of it is like.

camera lens1) Practice in shifting focus. I’ve written before that meditation is a practice — not in a vague woo-ish sense, but in the most literal sense of the word. It’s like practicing a tennis stroke, or practicing the piano. I set aside time to practice certain skills, so I can get better at those skills and use them when I want them or need them.

And among those skills is the ability to shift my focus. Much of what I do when I meditate — in fact, the core of what I do — is to focus my awareness on something (my breath, a part of my body, an activity); notice when my awareness has drifted away; observe this without judgment; and gently return my awareness to its intended focus. So in my everyday life, if my awareness has drifted into something that tends to drop me into a cycle of depression (pessimistic thoughts, worst-case scenarios, terrible memories, etc.), it’s now easier to shift it into something else. I am, literally, more practiced at moving my focus to where I want it. I’m far from perfect at it, but I’m better than I was. And that helps with my depression enormously.

no judgment2) Acknowledging my experience without judgment. One of the central features of MBSR meditation isn’t just focusing awareness on one object or experience — it’s noticing when that awareness has drifted, observing this drift without judgment, and gently returning the focus. And when it comes to helping with my depression, the “observe without judgment” part is, I think, almost as important as the “focus” part.

For me, a big part of what makes depression worse is judging myself for it. That can turn into a nasty feedback loop: I get down on myself for being unmotivated, torpid, self-destructive, etc…. and then that self-judgment makes me feel worse about myself, and adds to my depression… and then I get more unmotivated, torpid, self-destructive, etc…. and then I get down on myself for it… around and around and around. Depression can be very self-perpetuating, and a lot of what I’m looking for in depression treatments are ways to cut into these vicious circles.

And the “observe without judgment” part of meditation is one of those ways. When I notice that my awareness has drifted from my intended focus into feelings of torpor or pessimism or despair — and instead of hammering myself for that, I observe these feelings, acknowledge them without judgment, and return my focus to my breath or whatever — it’s extremely liberating. It doesn’t make the feelings of depression go away — but it makes them less all-encompassing. It makes the depression feel more like something I have, rather than something that has me, or that is me.

This even helps with the meta aspects of depression. If I notice that I’m getting down on myself for being depressed or for having a hard time keeping my focus where I want it… that’s also something I can observe, and acknowledge without judgment, before returning to my focus as best I can.

serenity-rock3) Letting my feelings be, instead of frantically trying to fix them. MBSR isn’t just about formal, set-aside meditation sessions. It’s also about being more present in everyday life. So in everyday life, if I’m having a moment where I’m feeling anxious or restless or sad for no reason, I’m now better able to just notice that, and acknowledge it, and let it be. I’m less likely to desperately search for the non-existent reasons behind my anxiety, restlessness, or sadness. And I’m less likely to immediately try to fix the feeling or distract myself from it.

I don’t know about any of you, but for me, the frantic search for things that make me feel better is often part of what makes me feel worse. (Especially since things that make me feel better in the short run — television, junk food, long stretches on Facebook — often make me feel worse in the long run, and even the medium run.) The frantic search to fix my feelings and perfect my life just makes me feel anxious. It makes me even more aware of all the ways that my life falls short of perfection. It makes me feel like there’s something wrong with me, because I feel anxious or restless or sad for no reason, and because I can’t find a way to make myself feel better. And it makes it nearly impossible to really savor, and really experience, the parts of my life that are wonderful and satisfying. (Plus, it’s just fucking exhausting.)

Since I’ve started practicing mindfulness, I’m better able to just sit with the anxiety, the restlessness, the sadness. I’m better able to let myself simply… have it. I’m better able to say to myself, “I’m just sad right now. I don’t know why. My brain sometimes gets sad for no real reason. I don’t have to fix this feeling. I don’t have to figure out what’s wrong. There isn’t anything wrong, other than the fact that I feel sad for no reason.” This doesn’t make the sadness or restlessness or anxiety go away. But it does help keep me from throwing gasoline on the flames. It helps keep me from adding self-judgment to the mix, or anxious and exhausting and utterly pointless attempts to find the non-existent problem and fix it. And that makes it easier for the anxiety or restlessness or sadness to pass. It doesn’t make the emotions better, exactly, but it helps keep me from making them worse.

question mark sign4) I don’t know how or why it works — it just does. Apart from everything I’ve been talking about here, there seems to be something going on, on a deep neurological and neuro-psychological level, when I meditate. I don’t know what, and I don’t know why. I just know that when I meditate, I feel better. I feel both calmer and more energetic. (Very much the opposite of depression, which tends to make me feel both twitchy and torpid.) I feel more focused. I feel more at peace.

Meditation helps with my depression in the long run and the middle run, in the sense that when I meditate every day, I’m less likely to get depressed, and my depressive episodes tend to be shorter and less severe. But it also helps in the short run, in the sense that if I felt depressed when I started meditating, I almost always feel less depressed when I’m done. I don’t entirely know why it helps me. I just know that it does.

Again — your mileage may vary. I really am just talking about my own experiences here. And again, if any of this resonates with you and you think you might like to try it, do talk with your mental health care provider, and remember that this is not a treatment all by itself, and it is not a substitute for therapy, medication, or other medical care.

Other posts that might interest you:
Some Thoughts on Secular Meditation and Depression/Anxiety
Secular Meditation: The Serenity to Accept What Could Be Changed, But Doesn’t Actually Need to Be
Secular Meditation: Formal and Everyday Practice

Comment policy for this post: It sucks that I should have to spell this out, but past experience has taught me that I do: Please do not give unsolicited amateur medical advice, to me or to anyone else with mental illness, in the comments. Or anywhere, for that matter. Talk about your own experiences until the cows come home; ask questions until you’re blue in the face (except for douchy passive-aggressive question like “Why don’t you understand that psych meds are poison?” or “Will you read this article explaining why psych meds are poison?”). If you need this spelled out in more detail, please read Why You Really, Seriously, No Fooling, Should Not Give Unsolicited Amateur Medical Advice to People with Mental Illness (Or to Anyone, Really), Episode 563,305. Thanks.

Imposter Syndrome, and What It Means to Be an Adult

“I don’t feel like an adult.”

Perhaps that or any of the following statements sound familiar to you: “My adult life looks nothing like I thought it would. I thought I’d have it a lot more together by now. I thought by now I’d be finished with school, or have a stable job, or be married and have kids. Sure, I’m doing (insert list of awesome, inspiring, difficult things) but I can’t balance my checkbook/ I do my laundry at the last minute/ I eat like a teenager/ I’m scrambling for money at the end of every month/ I have eight thousand unanswered emails/ I clean my house for parties by shoving all my junk into grocery bags and sticking them in the closet. What’s wrong with me?”

I can’t tell you how many people I know who feel this way. In fact, I’d be hard-pressed to think of an adult in my life who doesn’t feel this way, at least to some degree. And recently I’ve started wondering: What’s up with that?

*****

humanist magazine coverThus begins my latest Fierce Humanism column for The Humanist magazine, Imposter Syndrome, and What It Means to Be an Adult. To read more, read the rest of the piece. Enjoy!

Are Addicts and the Mentally Ill Responsible for Their Behavior?

Are people with mental illness responsible for their behavior, and for how their behavior affects others? If so, to what degree? Does the degree of mental illness affect how we answer this question?

I’ve been thinking about this question for a long, long time. Many years, in fact. I’ve been thinking about it harder in the last year or so, since my father died, and since my most recent bout with depression. I’ve been thinking about it in terms of my own life and my own mental health; I’ve been thinking about it in terms of the lives and mental health (healths?) of my friends and family members who are dealing with mental illness, or who have dealt with it in the past. But mostly, I’m thinking about it in terms of my father.

My father died on Oct. 1, 2012. Dad was a pretty mixed bag: many wonderful qualities, many not-so-wonderful ones. Specifically, he was an alcoholic, apretty bad one for many decades, and a significantly worse one as the years and decades wore on. And largely due to his alcoholism, he often behaved very badly. He wasn’t abusive, but he was often selfish, irresponsible, callous, quick with a barbed comment or a cruel joke just for his own entertainment, dismissive of other people’s feelings, unconcerned with how his actions affected others. It got worse, much worse, as the years went on and the disease of alcoholism progressed.

By the time he had his first stroke, the alcoholism had advanced to late-stage, brain-damage, memory- and speech-impairment territory, and the accompanying selfishness and irresponsibility got worse with the deterioration. (According to the doctors, the years of alcoholism almost certainly contributed to the stroke itself, and may have even been a primary cause.)

I don’t want to get into the litany of the details of his behavior right now. It’s too upsetting, and it’s kind of not the point. The point — the question I’ve spent decades asking myself, as I kept taking step after step away from my father and it kept not being far enough — is this: To what degree are mentally ill people — including alcoholics and other drug addicts — responsible for their behavior?

*****

Thus begins my latest piece for AlterNet, Are Addicts and the Mentally Ill Responsible for Their Behavior?. To read more about some of the many sides of this complicated and difficult question, read the rest of the piece.

Some Thoughts on Beauty and Ownership

“At last, something beautiful you can truly own.”

jaguar xke in mad menThis is the fictional tagline that Sterling Cooper Draper Price comes up with for the Jaguar ad campaign in “Mad Men.” (It’s in the episode The Other Woman — warning, synopsis has spoilers. Yes, I’m re-watching old episodes, it’s getting me caught up on where we are in the new season.)

And it’s gotten me thinking: What does beauty mean?

So the idea behind this tagline, and the ad campaign, and indeed this entire episode, is that the Jaguar XKE is like a mistress: beautiful, sexy, desirable, impractical, temperamental, unpredictable. And the tagline is, “At last, something beautiful you can truly own.” The implication being that you can’t really own beautiful women, and that many men feel this is a sad sad thing (one of the major themes of this episode) — but you can own a Jaguar XKE. You can get that sense of deep satisfaction from it — and you can keep it, and own it, and have that experience of beauty whenever you like.

But the thing is, as Michael Ginsberg himself says (the copywriter who comes up with the campaign and the tagline): It isn’t just people who you can’t own and keep. It isn’t just people who are elusive and changeable. Possessions are like that, too. Or at least, the experiences of pleasure we get from possession are like that. As Michael says when he’s pitching this idea to Don: Even very rich men, who already own many beautiful things, are still dissatisfied. The beautiful things they have aren’t enough. The Jaguar ad promises that this thing — finally, at long last, unlike all the other things — will satisfy their longing for the unattainable.

It’s a false promise, of course. And I started thinking about why that is.

Beauty is, literally, in the eye of the beholder. And by that, I don’t mean that it’s a matter of taste or opinion (although of course, that’s also true). I don’t mean that different people experience different things as more or less beautiful, or that duck-billed platypuses see each other as beautiful and see us as fugly. Well, what I mean is close to that.

I mean that the experience of beauty is literally in the eye, or the brain, of the beholder.

I mean that beauty is an experience.

And that means that it can’t be owned, or kept, or held onto.

Some objects or people are “more beautiful,” in that they’re more likely than others to evoke that experience in more people. But the beauty doesn’t really reside in the objects or the people. It resides in the mind and the heart and the body of the beholder. And trying to hold and own and keep this experience of beauty is actually what makes it slip through our fingers. Letting transitory experiences be what they are is what lets them sink in deeply and resonate throughout our lives. Struggling to keep them, to make them permanent, is what makes them slip away — and makes us miss the point.

megan-don-draper-mad-menIt’s one of the themes of this episode (and indeed of the entire freaking series). When we try to hold and own and keep the people in our lives who give us pleasure and satisfaction and a sense of beauty, we actually drive them away. And when we take them for granted, when we act as if they’re ours forever and we never have to do anything else to keep them around, we drive them away. It’s only by letting people be who they are, by not taking them for granted and respecting their right to make their own damn decisions, that we deepen our connections with them — and increase the chances that they’ll stick around. If you love something, set it free, and all that. Except that if it comes back, it still isn’t yours. It never was. We don’t own each other. We can’t.

blue suede shoesEven with objects, ownership often doesn’t work. Often, the experience of beauty is one of surprise. We tend to get inured to the beautiful things that are all around us. (I think this is one of the reasons I like buying new clothes and putting together new outfits: I like seeing myself in a new way, so I can more easily see myself as beautiful.) Part of the experience of beauty is the experience of the extraordinary — and when something is in our life every day, it becomes ordinary. We can find the extraordinary in the everyday, but it takes more work.

And you know how, if you’ve had an amazing vacation someplace, you often have this desire to try to re-create it, to go back to the same hotel and eat at the same restaurants and visit the same museums — but if you do, it isn’t the same? And if the place is amazing again, it’s because you did something different, or saw something you weren’t expecting? That.

We can certainly load the dice. We can own beautiful objects. We can make connections with beautiful people (beautiful in all senses of the word, not just physical). We can create beautiful experiences for ourselves — or experiences that are likely to be beautiful. We can work to make a life that is more likely to create the experience of beauty.

We can own beautiful things. But we can’t own beauty.

In (Moderate) Praise of Not Being Yourself

legally-blonde-movie-posterElle: “No more trying to be something that I’m just — I’m just not.”

Emmett: “What if you’re trying to be somebody you are?”

-Dialogue from “Legally Blonde” (a surprisingly good, smart, funny, and feminist movie).

We talk a lot about how important it is to “be yourself.” And of course I see the great value in this. When you live in a culture that has powerful and unreasonable expectations about what you’re supposed to be like — based on your gender, your race, your age, your upbringing, your looks, your geography, and more — of course there’s value in pushing back against that. Of course there’s value in insisting that as long as you’re a basically decent and ethical person, you shouldn’t have to try to force yourself into boxes you just don’t fit into, and you don’t have to live up to anybody’s standards but your own.

Totally agreed.

But I think that sometimes, in some situations, there is value in not being yourself.

Here’s what I mean. I started thinking about this when I was talking with a fellow writer, someone a couple/few decades younger than me, who was talking about their anxieties about self-promotion. I said that I totally understood this anxiety: I have it as well. Writers tend to be introverts, remote observers, the exact opposite of the personality required to be a publicist. And self-promotion requires a degree of self-confidence, and confidence in the value of your work, that borders on arrogance — confidence that many people lack, and that women especially get pounded out of us from an early age.

But I also said that my greatest regrets as a writer were regrets over missed opportunities: large, exciting doors that opened briefly, and then closed, because I didn’t have the gumption to walk through them and announce myself. And I said that a huge part of the reason I’d gotten to a place where I could work as a writer full-time — something I wanted passionately and had been working towards fiercely, for decades — was that I was willing to suck it up and do self-promotion. Despite the fact that I hated it, that I wasn’t any good at it, that I had no aptitude or stomach for it, I had to suck it up and do it anyway. If I was going to do the thing that was most deeply in my nature — writing — and devote myself to it full-time, I had to be willing to do something that was entirely antithetical to that nature. And I had to get good at it. Or at least competent.

Learning_curve_chartI’ve found that many smart, talented people have a stumbling block: We don’t like to be bad at things. We’re used to learning things quickly, and we’re used to being good at things. So when we come across something that’s hard, something that doesn’t come naturally, something where our learning curve is slow and torturous, something that makes us actively uncomfortable, we tend to give up. Because we’re used to picking things up quickly, we often assume that, if we aren’t picking something up quickly, we’re never going to pick it up at all.

But I think that there are very few areas in life where we’re naturally good at every single aspect. You might have an aptitude for medical care, but not have an aptitude for rigorous record-keeping. You might have an aptitude for plumbing, but not have an aptitude for customer relations. You might have an aptitude for scholarship, but not have an aptitude for bureaucracy. You might have an aptitude for starting a business, but not have an aptitude for bill collecting. You might have an aptitude for writing or painting or music or just about any art form, but not have an aptitude for the self-promotion that just about any artist needs. If you want to do the thing you most love, the thing at which you would excel, you might have to learn to do something you hate, and are not very good at.

And I’ve found that, at least sometimes, learning to do things that didn’t come naturally to me had unexpected payoffs, in surprising areas of my life. I worked for years as a bill collector for a local LGBT newspaper — a job that absolutely, 100% did not come easily to me. But learning how to do it didn’t just give me the opportunity to work at that newspaper. It taught me how to ask for what I need and want and deserve, clearly and firmly, while still being respectful, being reasonably flexible, and maintaining an ongoing friendly relationship. And learning how to do self-promotion has done wonders for my self-confidence as a writer. I think I write better, with less self-doubt and more strength and clarity, because of it.

We should absolutely be who we are. (As long as “who we are” isn’t “total raging asshole.”) But if we’re going to be who we are, I think we sometimes have to work to be things that we’re not.

Thoughts?

Should You Give Amateur Medical Advice to People With Mental Illness? A Flowchart

And now, for those who learn better with visual aids, I offer: Should You Give Amateur Medical Advice to People With Mental Illness? A Flowchart. (This is my very first snarky flowchart: I’m proud of it out of all proportion, and hope to do more in the future.)

Should You Give Amateur Medical Advice to People With Mental Illness? Flowchart

Context:
On Being on Anti-Depressants Indefinitely, Very Likely for the Rest of My Life
“The drugs are hurting us more than they are helping us”: How Not to Talk to People With Mental Illness, Episode 563,304
Why You Really, Seriously, No Fooling, Should Not Give Unsolicited Amateur Medical Advice to People with Mental Illness (Or to Anyone, Really), Episide 563,305

Why You Really, Seriously, No Fooling, Should Not Give Unsolicited Amateur Medical Advice to People with Mental Illness (Or to Anyone, Really), Episode 563,305

Sigh.

In response to my recent post, “The drugs are hurting us more than they are helping us”: How Not to Talk to People With Mental Illness, Episode 563,304, I received this comment from one Timothy Matias:

Just my two cents:

“It is seriously fucked-up to undermine people’s [efforts to improve the lives of mentally ill people] for the sake of preserving their ” relationships with their health care providers.”.

Here’s a bit more than two cents, based on my experience:

[link edited out, since I don't want to reward him with blog traffic; if you really want to see it, I have not edited the link out of the original comment -GC]

Everyone’s entitled to their opinions. When you call them “fucked up” for expressing their opinions about medication, the only “fucked up” person is you!

This kind of closed-minded, self-righteous response is no different than a Christian telling an atheist that it’s fucked up to suggest that a person should quit God. HOW DARE they risk damning the person’s soul to hell because of personal experiences of feeling better living without God. HOW DARE they undermine the relationships and trust between Christians and their church elders and leadership?

This kind of closed-minded approach to medicine, and the application thereof, is nothing short of RELIGIOUS :/

I will say that again: I received this comment, in direct response to my post explaining why it was a bad idea generally to give unsolicited amateur medical advice to people with mental illness (or with any illness, for that matter), and specifically to tell people with mental illness to ignore their doctor’s advice and not take prescribed psych meds, and saying that the blog posts here discussing this matter were not the right place for these debates. (And yes, just to be perfectly clear, that policy applies to this post as well. Meta-discussion of how to discuss mental health care with people who have mental illness is acceptable (although I’ll be keeping a close eye on it); unsolicited medical advice to people with mental illness is not, and will result in the commenter being put into comment moderation.)

Sigh.

Okay. I’m going to spell this out as clearly as I possibly can.

Do you really not see the difference?

Apparently not. Okay, I will spell out the difference.

God from Monty Python and the Holy GrailFirst: There is a significant difference between offering your unsolicited advice about religion, and offering your unsolicited advice about people’s medical care. The existence of God is not a topic on which anyone is an expert. Some people are experts on religion, theology, apologetics, etc. — but nobody is an expert on God. You don’t need any special training to reasonably come to the conclusion that there are no gods. (The fact that nobody is an expert on God, and that nobody can say anything about God with any degree of certainty or hard evidence, is actually one of the best arguments supporting the conclusion that God does not exist.)

This is not the case with medicine. Medicine is a field where some people really do know more than others. Trained medical providers are very far from infallible, but they still know a hell of a lot more about medicine than Some Guy On The Internet. (It’s hard not to notice that the link you linked to doesn’t actually contain any research, or even any links to any research — it’s just your opinion.)

At the same time, medicine is a field in which some people have special training and expertise — but it’s also a field in which, by its nature, that expertise is often not precise or universal. This is especially true for psychiatry and mental health care. What works for one person often doesn’t work for another, and providers often have to proceed with some degree of educated trial and error to find a care plan that works for each particular person. Therefore, it is incredibly arrogant for Some Guy On The Internet to assume that they know what mental health care plan would work for me — better than my medical providers, who have detailed information about my particular condition and priorities and medical history, and better than me, who knows more about my condition and priorities and medical history than anyone.

It is depressingly common for sick people — people with mental illness, with chronic non-mental illness, even people with common colds — to get deluged with unsolicited amateur medical advice. At best, it’s annoying; at worst, it undermines your ability to make your own decisions, and your confidence in that ability. When you’re trying to make medical decisions for yourself, it’s already difficult enough without a barrage of uninformed, under-informed, and ill-informed advice filling your head. And it’s already difficult enough without advice that amounts to the message, “You’re doing it wrong. I know better than you. If you want to please me, you’ll do it my way.”

And for people with mental illness in particular, this is especially difficult. Mental illness has tremendous stigma, which people with mental illness often internalize, and we often (a) feel like we’re letting people in our lives down by having mental illness, (b) feel like having to get treatment for mental illness is a sign of weakness, and (c) are barraged with paternalistic messages telling us that simply having mental illness makes us incapable of making any decisions about our care. Unsolicited advice in this area is more than just annoying. At best, it is patronizing and demoralizing, which itself undercuts our mental health. At worst, it can lead people to make terrible decisions about their mental health care, with devastating results.*

Homeopathic Dilution RhustoxSo unless someone tells you that their health care provider is prescribing actual quackery (like homeopathy or something), or unless you have some crucial piece of information that you’re pretty sure the person you’re talking with isn’t familiar with (and “Psych meds are all horrible and nobody should take any of them/ the entire mental health care profession is borked and is not to be trusted” doesn’t count — believe me, we’ve heard that before), or unless you have some more substantial evidence for your position than “I know that the established standard of care is (X), but this one guy disagrees and wrote a book about it,” it is seriously fucked-up to undermine people’s relationships with their health care providers.

I absolutely want for there to be vigorous, rigorous public discussion and debate about medical standards of care — especially when it comes to mental illness. I am well aware of serious problems in the medical system (especially in the United States), and people speaking out about those problems is how they get addressed. And I understand that there is serious debate, even within the medical community, about how to best handle mental illness. I want that debate to happen, and I want people in the general public who are affected by the medical system (which is to say, everyone) to participate in that conversation. But have that discussion and debate in public spaces, where people agree to discuss and debate. Don’t shove it in people’s faces who are trying to make good decisions for themselves, and who haven’t asked you for your opinion. People who want advice will generally ask for it. If they don’t, then offer empathy, and shut your cakehole about how much smarter you are than they are.

Which brings me to my other point.

Second: Even if you don’t accept this difference between debating religion and debating medicine? There’s a difference between simply debating religion, medicine, or anything else — and doing so in a space where the host has specifically said that they don’t want these debates.

Yes, I am a big advocate of arguing with believers about their beliefs in God (for atheists who want to do that, that is). But even I don’t advocate telling believers, “You’re wrong to believe in God, here’s why,” in spaces where people have specifically said, “I don’t want to debate this.” There are plenty of other spaces for those debates.

You have every right to express your opinions about mental illness and mental health care. You do not have the right to offer these opinions in personal spaces, to people who have not asked for them. And you definitely do not have the right to offer them in spaces where people have specifically said that they don’t want to host that debate.

You have violated my clearly- and repeatedly-stated request about comments. I am putting you into comment moderation. Future comments from you will have to be approved by me before they are posted.

* Here are a few particularly eloquent things that other people have said on this topic in these discussions here. [Read more...]

Things People Said Here About Mental Illness That Were Extremely Helpful

I realized that in much of my recent conversations about mental illness, I was showing a tendency to focus on, and reply to, the small number of comments that annoyed me, more than the many many many many comments that I found helpful. Partly, I think, this is a symptom of the depression, which is mostly waning but is still leaving me more easily irritated than I usually am. (And partly it’s a symptom of my often ornery, contrary, ranty nature — especially as a writer.)

But a huge amount of what people have been writing has been very helpful. So I wanted to bring out a few particular comments that have particularly stuck with me, and call attention to them. (If I don’t mention your comment here, btw, it doesn’t mean that what you said didn’t help — almost everything that everyone said, with a couple of obvious exceptions that I’ve already responded to, has been helpful, including “That sucks, I’m really sorry.” These are just the comments that particularly resonated with me, in my particular situation.)

I understand that the doctors use “chronic,” but try to think of it as “intermittent depression” instead.
-tychabrahe

YES, THIS, OMLOG SO MUCH THIS. Calling this “chronic intermittent depression” or “chronic episodic depression” instead of just “chronic depression” is already making a big difference in how I see myself in relation to this illness.

In your place, I’d see it as a mental health seatbelt.

We always use our seatbelts to reduce and avoid injuries. We don’t know for any particular journey whether it’ll be needed at all, or just to restrain us when the car brakes or turns sharply, or to save our lives in a major accident. Your medication at this dosage is ensuring you don’t have major problems from minor incidents. And that if you do have a major “incident” the system is all primed ready to reduce the impact on you and make it easier for serious rescue and repair work without waiting the obligatory try this one now couple of months to see whether/ which, what/ which dosage will help you.
-mildlymagnificent

A hugely useful analogy, which I will be using a lot.

Maybe instead of diabetes as your go-to simile, try using asthma.

I’ve had asthma for as long as I can remember. I’ve been on maintenance medication for it since I was in junior high. When I’m on the meds, I can run, exercise, do all the things that normal people do. When I’m not on the meds, running might put me in the hospital.

When I was diagnosed with chronic depression, I was thrilled. I was doing something about the thing that was holding me back from being the me I wanted to be. As far as I am concerned, it is just like getting on asthma meds. I fully expect to be on them the rest of my life, and I’m happy to do so.

I think the “chronic” part of “chronic depression” might be what is throwing you for a loop. It doesn’t mean you’re constantly depressed. It just means that you’re at an elevated *risk* of having an attack of depression. I.e., it isn’t the episodes of depression itself that the “chronic” is referring to. It is the elevated risk. In that way it’s a lot more like asthma. And just like my asthma medications help me be the person I want to be who can run and exercise and stay in shape, the medication for depression helps me be the version of me who has motivation, loves a challenge, loves to learn new things, and has decently high creative output.
-Commenter on Facebook (I’m keeping Facebook comments anonymous unless they self-disclose, out of a possibly misguided and over-cautious notion that people have a slightly higher expectation of privacy on Facebook than they do on blog comments)

Another really useful analogy — for me especially, since I also have asthma (pretty mild), and take meds for it prophylactically, specifically so I won’t have an episode.

Both my wife and I have chronic depression issues, so it helps us to sort of keep an eye on each other, rather than ourselves. That way, we don’t focus on our own anxieties and we can (hopefully) catch the other person before it gets worse
-UnknownEric the Apostate

Good suggestion, and one that a number of people made. I’ll ask the people around me to help me monitor, so I don’t have to do as much of it myself.

Count me among the people who find it very important to not monitor my mood too closely. I suffer from idiosyncratic short-term (few hours to few days) episodes of suicidal ideation and self-loathing. Comparing my current mental state to my “ill” mental state is too close to being in that bad state and can put me there. Like infophile, I use puzzles to distract myself as necessary, or sometimes research.

Instead, I monitor externalities. Did my appetite change? Does a shower seem like too much work? Have I gone a few nights without being able to fall asleep at a reasonable hour? Am I keeping up with housework? Those kinds of things help me know when a bad spell is coming.
-Stephanie Zvan

Another good way to deal with the possibly overzealous self-monitoring. Thanks. [Read more...]

“The drugs are hurting us more than they are helping us”: How Not to Talk to People With Mental Illness, Episode 563,304

From Facebook, a comment responding to my post, On Being on Anti-Depressants Indefinitely, Very Likely for the Rest of My Life, in which I discussed my diagnosis of depression and the meds I’m taking for it.

If you haven’t read Anatomy of an Epidemic by Robert Whitaker it’s a must. The director of a leading psychiatry association finally acquiesced and said he was right. The drugs are hurting us more than they are helping us. I’ve been on a slow ween and feel so much better. I drive my husband crazy sometimes, more than I used to, but it’s nice to be me again.

(I’m not going to name the person who said this, since people on Facebook often expect marginally more privacy than they do on blog comments and other public Internet spaces. If they want to disclose who they are, they may do so.)

Here’s my response.

I realize that you probably mean well, but can you please not tell people with mental illness to ignore their doctor’s advice? Unless someone tells you that their health care provider is prescribing actual quackery (like homeopathy or something), or unless you have some more substantial evidence for your position than “I know that the established standard of care is (X), but this one guy disagrees and wrote a book about it,” it is seriously fucked-up to undermine people’s relationships with their health care providers.

What’s more, people with chronic illnesses, especially mental illnesses, get a bellyful of unsolicited amateur medical advice along the lines of “I know better than you how you should take care of yourself.” It is really not helpful.

If the preponderance of hard medical evidence starts shifting away from “A combination of meds and talk therapy is often effective at treating depression, and right now for most people it’s the best we’ve got” and starts shifting towards “Meds are not generally effective and they can actually do harm,” I will reconsider my treatment plan. In the meantime: There are appropriate places for debates about how the medical establishment should be dealing with depression and other mental illness. A personal post from someone with depression talking about their experiences with it is not one of them. Thank you.

On Being on Anti-Depressants Indefinitely, Very Likely for the Rest of My Life

So I have to rethink some things. Specifically, I have to rethink some things about mental illness and me.

As regular readers may already know, I had a recent bout with depression, starting in late 2012 when my father died and I was diagnosed with cancer. It wasn’t my first time at the rodeo: I’ve had two or three other fairly serious depressive episodes in my life. But I’m not someone for whom depression is a staple of my everyday life. My depressive episodes haven’t been trivial, but they’ve been intermittent. If I added up the months that I’ve been depressed, I’d put it at about 10% of my adult life.

And until recently, I thought of myself as a basically mentally healthy person, with something of a vulnerability to situational depression.

But apparently, I have to re-think that.

Wellbutrin_SR_tablets_150mgIn my last couple of sessions with my psychiatrist (I’m seeing a therapist weekly for talk therapy, and a psychiatrist every few months to talk about meds), now that I’m feeling better, we’ve started talking about my long-term care plan, and my future with meds. I’d been assuming that we’d eventually taper me off the anti-depressant meds, and that we’d just be discussing the when and how of that. But apparently, not so much.

Apparently, if someone’s had three or more serious depressive episodes in their life, the current standard of care (as my psychiatrist understands and interprets them, anyway) is for them to stay on anti-depressants. If someone has had three or more serious depressive episodes, the chances are very high that they’re going to have another one — and when that happens, it’s better, for a zillion reasons, to already be on medication. So the current standard of care is to stay on anti-depressants. Indefinitely. Forever.

Whoah.

I don’t mind being on the meds per se. Especially now that we’ve dialed down my dosage. I’m on Wellbutrin, if you’re curious, and the side effects for me are pretty minimal: I’m a little jumpier than usual, my attention span is a little spazzier, and my alcohol tolerance is lower (I can only have one drink per evening, one and a half tops). Big whoop. When I hear about other people’s side effects with their anti-depressants, I thank every non-existent god there is that I got off so lucky. The meds are fine. And I can absolutely see the reasoning behind staying on them. This is not a care plan that’s been foisted on me in any way: my doctor suggested it, but we discussed the pros and cons, and he made it clear that it was my choice. We decided on this plan together, and I’m completely in agreement about it.

But I’m definitely unsettled by it.

I’m unsettled because I now have to shift the way I see myself: from “basically mentally healthy person with something of a vulnerability to situational depression,” to “person with chronic depression who is going to be on medication for it for life.”

Some of that unsettlement is the stigma, for sure. There is a stigma attached to mental illness and the people who have it. As I wrote before when I first started on anti-depressants: Once I started taking actual psych meds for depression, it felt like I’ll have “Mentally Ill” stamped on me forever. That’s even more true if I’m taking those meds forever. But honestly, I’ve dealt with so many stigmas in my life, one more hardly seems worth worrying about. Given the stigmas against being queer, being bisexual, being kinky, being poly, being an atheist, and more — having a diagnosis of chronic depression, and being on meds for it, doesn’t add that much to the pile. I’m okay with that.

Smiley faceI think most of my unsettlement is the significant shift in how I see myself. I’ve always seen myself as a basically upbeat, optimistic, happy person: seeing the bright side, finding silver linings in clouds, putting the most generous interpretation I can on people’s behavior until I’m absolutely proven wrong, hoping for the best until it’s certain that those hopes have been dashed. Sometimes annoyingly so: I have a tendency towards reflexive Pollyanna optimism, and I’m not always good at commiserating or even just listening sympathetically without trying to find bright sides and solutions. And I’m awful to be around on election day. (“Prop 8 could still go down! The votes aren’t all counted yet! Don’t despair!”) But on the whole, seeing myself as a basically upbeat, optimistic, happy person… well, it makes me happy, and it works pretty well for me and those around me.

So now I’m trying to figure out how I can see myself as a basically upbeat, optimistic, happy person… who suffers from chronic depression, and who is going to be on medication for it for life. That almost seems like a contradiction in terms. I’m trying to find ways that it isn’t. (Maybe I could look at the meds as preventative, rather than as a treatment? Almost like a vaccine against depression?)

And I’m somewhat concerned about what seeing myself as someone with chronic depression is going to feel like: day to day, week to week, year to year. When I’m in the middle of a depressive episode, or when I’m coming out of a depressive episode and my mental health feels somewhat fragile, I make an extra-special effort to make time for mental health care — getting exercise, getting time outside, getting social time — even if I don’t really have time for it. Will I have to keep doing all of that forever? I mean, I like exercising and being outside and hanging out with my friends. But I also like staying inside for eighteen hours working and dicking around the house all by myself. I don’t want to have to give that up. Plus, when I’m in the middle of an episode or coming out of one, I do a lot of careful monitoring of my emotional state. “Is this a torpor that’s turning into a vicious circle, or am I just tired and needing to rest?” “Am I being anti-social and isolating myself, or do I just want to focus on my work for a day or two?” Do I now have to do that for the rest of my life? That seems seriously no fun.

In fact, it seems downright depressing. Seriously. I’m somewhat concerned that rigorous monitoring of my mental and emotional state, and constantly asking myself, “Am I depressed now? How about now? Okay, now?,” could itself contribute to my depression. And I’m somewhat concerned that simply seeing myself as someone with chronic depression might, in and of itself, be somewhat… well, depressing. Obviously, knowing the early warning signs of depression and knowing how to take action on them is a whole lot better, a whole lot less likely to result in a bad episode, then not knowing. I just need to find a way to do that — not just temporarily, not just while I’m in an episode or emerging from one, but as a permanent fixture of my life — that doesn’t result in hyper self-consciousness, hyper self-monitoring, and a re-assessment of my basic identity and character that is, in and of itself, depressing.

Of course I’m going to accept this reality. That’s what I do. Whenever I hear religious believer tell atheists, “You can just choose to believe in God,” I literally have no idea what they mean by that. I don’t understand how you could choose to not know something once you know it. So now that I know this truth, now that I know that I am someone with chronic depression, I can’t un-know it. Even if I wanted to. Which I don’t. And not taking the meds wouldn’t make that make this reality go away. In fact, it would make it a whole lot worse. I get that. I’m not questioning this decision. I’m just looking for ways to come to terms with it.

Thoughts? If you, yourself, experience chronic depression, how do you manage that? How (if at all) do you keep an eye on it without a constant self-conscious self-monitoring that is, in and of itself, anxious and depressing? And how do you accept yourself as a depressed person without it… well, being depressing?

Wellbutrin_SR_tablets_150mg image by SergeSF, licensed under Creative Commons, found at Wikimedia Commons.