Psychiatric Philosophy

One of the things you hear said a lot from those who have depression is that it is a "disease." You usually only get the two opposing views of it; either it's a disease or "it doesn't exist." You are either crippled or you are just lazy, and neither of these views are particularly helpful.

If you are in the mindset I discussed in the previous post, then the disease model sounds the most accurate: it is crippling, you're not faking, and for many people, it feels like a "forever" thing.

Before I go any further, I just wanted to let you all know that I'm not suddenly going against the disease model just because of what my therapist told me on Tuesday. This is a question I've been struggling with since I was coached in Behavioral Activation: if depression is a disease with real, biological causes, how is it that something like getting out of the house more often can be "prescribed" by real doctors--isn't this just the medical equivalent of "just get over yourself?"

Well...the answer is a resounding kinda.

Depression, as far as we understand it, is caused by a combination of bio-psycho-social influences. This means that there is a physical (biological) component, a social component (where the people around us as well as the environment itself have influence), and a psychological component (our thinking habits, to put it simply). 

It is these three things that combine to make us depressed. Once one or all of these become a little too strong or a little too "depressive" in nature, then we start to spiral down. This can happen slowly or all at once, but it is something that snowballs, meaning the individual components stack up against you if you let them.

Obviously, we can't change our genetics. If depression runs in our family, then there is a good chance we're going to become depressed. It's not set in stone exactly, but the possibility still remains. For the other components, however, we have some control.

In a perfect world, we have loving, supportive families that accept us no matter what and always have our back. We have many close friends that help us to better ourselves and see the good in the world. We have a loving significant other who it is always a joy to be around. How many of you are laughing cynically right now? Yeah, that's what I thought.

BUT we can make sure that toxic relationships (SOs who abuse us, friends who degrade us, and family who uses us) are cut out of our lives. We can also take the lead when it comes to finding new friends. This is one area where behavioral activation comes in.

This is obviously easier said than done, especially when in the middle of a depressive episode. Also, depending on how deep you've gotten, this may very well be impossible for the time being. So then, aside from getting psychotropic drugs (which I really do recommend if you need them), you have your thought patterns left.

This is where CBT, or cognitive behavioral therapy, comes in. This is where you take every thought you have and analyze it until it is no longer harmful in nature. I won't go too in depth about it right now, but basically you try to get yourself to stop thinking distortedly. 

So how does this get you better?

Imagine for a second that your brain is a lump of clay and your thoughts are pressurized water streams. Right now, as a depressed individual, you have certain ways of thinking (depressed thinking) that are the easiest to you. These thoughts run a specific course (hypothetically) in your clay-brain, and this course is the path of least resistance, pre-carved for you by a lifetime (or whatever) of those pressurized water streams blasting away at specific spots.

Now think about if you try to get yourself to think differently, more positively. It's still a stream of water, and even at the same pressure as the depressed thinking, but it's trying to go through a pathway that's either not there at all, or at least very narrow and unused. But the more you keep at it, the more you are going to carve yourself a new way of thinking. These ways will be just as easy to use as the old, depressive ways. 

This process will be made a lot easier if you make other changes: to your environment, to your physical chemistry (through drugs), to your social circle, and to your physical health (through proper diet and exercise, sun exposure, etc.). It takes a lot of work, but depression doesn't have to be the end of your life. It doesn't have to control you. 

And don't think for one goddamned second that this post invalidates your suffering: this shit is real and harmful and it sucks. But just like having to relearn how to walk after an injury, you can relearn how to be happy again (or even for the first time), it just takes a shit load of practice.

I hope this helps you understand depression a little better, and maybe helps a couple of you get the help you need and set you on a path to recovery...

~ <3

Weird and Wonderful News

My last psychology appointment was on Tuesday the 6th, and I was told something I had never heard before: I was at a good enough place, mentally, that we could forego making another appointment until I felt I needed another.

This is, obviously, good news. But it's strange all the same. Those of you who are depressed or have been depressed will totally understand this line of reasoning: it is very hard to admit that you are getting better.

So many people (well-intentioned or not) will be quick to point out that depression is just a "phase" or just a fleeting "bad mood" that will pass just as quickly as it came. We have to fight to be taken seriously, so it is hard to show others when we have our occasional good day. A good day is very often taken as fodder for why depression really isn't a "thing" and so we should just snap out of it because we "totally did it the other day."

None of us want to be depressed, but partaking in Behavioral Activation can be misconstrued as "bucking up." The very methods for getting better are loaded situations, and this makes for an even harder recovery. It's bad enough trying to recover with someone who understands it having your back!

So to be in a situation where I have been free to try out different methods, to get better, to celebrate the good days instead of hiding them...I have finally gotten to a good place. My wonderful, fucking amazing husband has supported me and I have had an awesome, knowledgeable doctor, too, so I am indeed extremely lucky.

To those of you who are struggling to get better, know that it is possible. Know that it may take years, and so much trial and error that it all feels like a mistake, and there will be pain and hardship and idiots that stand in your way, but it is worth it, and you are worth it. Trust me, if no one else, okay?

I started this blog long into years of therapy and drugs and research and I don't want to misrepresent what a recovery looks like. Hell, that road looks different for every person anyway. And there is something else to remember, too: I can't stop here. There is a lifetime of monitoring ahead, and when (not if) that fails, the inevitable battle to get back to where I am today. I'm also still not 100%, either, I'm just good enough right now that I don't need a therapist holding my hand.

I have taken these things into consideration and, though it wasn't required, I went ahead and made an appointment for a month from the last one, just in case. I know myself enough to know that I might slip between here and then and may need some encouragement (beyond my husband's capabilities), and if there is no appointment scheduled, I'll just put it off. And put it off. Until I'm back again, hiding under a blanket, locked in my closet, wishing I were dead.

I don't want to get to that point again. But I could. Knowing that about myself is the most important step, tied with admitting that I may be on that path again. And really, that's what mental health is all about: learning enough about yourself that you can take every step possible to make sure you stay okay or are working to get there. Even those who have never had problems need to keep tabs on their stress levels.

So everyone who is reading this right now, do yourself a favor: pay attention to how you feel. What your moods are telling you, what your body is telling you, what your friends are telling you...it could literally save your life. Or at least save you a hell of a lot of money and misery!

What's been going on lately...

So I have been handling my realization that I'll never get a degree a little harder than I originally thought. I was surprised at my ability to handle it, but it turns out I was just suppressing my feelings about it.

I am disappointed in myself and angry at the system. I feel like psychological community is missing out on someone who could have helped out a lot, and this makes me sad. And then, of course, the inevitable embarrassment at not being able to function like a normal human being...

Needless to say, it's hitting kinda hard.

I had tried to use the military as my "one last chance to not be a failure," and then once I got medically retired and emotionally worked through that train wreck, just jumped headlong into this one...I don't know what the hell I'm going to do with myself now. I had plans of writing and just working where I can for now--which I'm still planning on--but it just feels so...hollow. Pointless. It isn't, but my emotional state at the moment is making it seem that way.

So today's lesson, I guess, is that just because something seems hopeless or worthless or even good and worthwhile, doesn't mean it is--it just means that that's how we are viewing it at the given moment. Everything is in flux. This line of thinking can be humbling or uplifting, depending on how we see ourselves at the moment, knowing that--given some time--it'll change, but either way it's okay because this just means we're human. That we are alive. Things that don't change, that remain in stagnation, wither and die. So even thought that's kinda what I want to do right now I know that I'll feel differently soon because I'm still alive.

It's easy to forget how you felt when you were depressed while in remission, or the other way around, but it's important that you don't. While your head is above the waters of despair you can gather information and insight to cling to once the current inevitably pulls you back under, and that insight can help sustain you. The more you practice, the better you'll get, and maybe--just maybe--you'll break free of the cycle.

I'm mainly just rambling now and I need to get ready for work, so I'll just stop here.
Stay well, guys.

Journaling Hows and Whys

Okay, so after having my terrible Wednesday and taking Thursday to chill (and work, admittedly), I feel like it's officially okay to attempt this again.

When it comes to the internet (and official literature that didn't have a paywall), so many people say that journaling is a good idea. It is a good idea for psychoanalysis, CBT, treating PTSD, behavioral activation, migraines, and just regular life among a million other applications as well, I'm sure. However, it's not necessarily something one is apt to do naturally. It feel silly, if I'm honest, at least until you get used to it. I only got really into it in the past year or so and even then it took awhile to get somewhat consistent about it.

I guess, technically, it was always "journaling," but it didn't feel that way. I had read somewhere that you can improve your working memory if you always write everything down. Supposedly this allows your brain to stop trying to hold on to a bunch of unnecessary information so you can focus better on what matters. So I wrote everything down. Grocery lists, schedules, room numbers, directions, idle thoughts, story ideas, complaints--everything. It was mostly on loose leaf paper in my school binder, but eventually I got little notebooks that I could carry around. This might be the beginning of my "pretty journals" obsession...Anyway, this note-taking led to journaling. Kinda. I didn't notice an increase in my mental powers, so I tapered off fairly quickly. When I switched over to journaling about my day, I completely stopped. Eventually I stopped carrying a notebook with me. I didn't really start back up until a couple years ago, and it didn't really get serious until last year, I think, when my depression bottomed-out again.

So what do I journal about now? Anything. Everything. I write about my day, my thoughts, I bitch about people/classes, I record my physical as well as mental health (though not as much as my doctors would like). I evaluate how I handled different problems and why, I make plans for Christmas decorations...

Do you want to start? Find a notebook that you like, or bind some loose leaf together in a folder. Then...well...start. There are a bunch of different techniques you can try, but research has shown (if you read any of the six links up top) that the most beneficial way to do this is to write about potential gains from problems you face. Basically just re-evaluating shitty situations and trying to find anything you could learn or grow from. This keeps you focused on more reflexive topics while not just dwelling on the negative.

If this deeper writing isn't for you, you can try more surface things like the route I took, writing everything down. There is also even more subtle things where you simply record the weather for each day. You can even take the more CBT-focused route and just record thoughts and feelings that you have.

If you are more creatively inclined (you don't have to be good at this, just enjoy it), you can start something called an art journal, too! Basically you take a topic and you draw/paint/photograph/sculpt/modge podge/collage it. It can be something really emotional such as a break up, or it could be fairly simple like taking a concept ("freedom") and making an entry representing that. To get the most out of this, I would suggest writing something alongside these entries so you can have something more concrete to look back on.

And for the most benefit, make sure you do look back! You can compare and see how you've grown or find patterns that are destructive. And if you have a therapist, then I would suggest bringing up your journal with them and seeing if they want to go over certain things with you. Having a trained second set of eyes can help eliminate some bias that may blind you to certain defenses or faults.

I think I might start posting journal topics for you guys either on a separate page or on the side bar, I don't know.
There is now a journaling topics page! Last update to it was on 11/25 at 1:26 am.

Have you had any experience with journaling you'd like to share? Maybe pictures of your journals themselves (I'm a sucker for a nice notebook)? Please comment below!

Little Slips

Last post I wrote about the anxiety that's always there, just waiting for myself to slip back into months-long depression and hopelessness. Well, I'm still waiting for "the big one" but little ones have been cropping up here and there.

I don't even know where the last one came from, just that it happened and it was annoying (after I got over bawling my eyes out). But really, it was survivable. I wonder if that's what my life has in store for me from now on: little bouts of mini-breakdowns every once in a while for no reason whatsoever. I hope not, but if so, then I guess it is what it is...

I just have to try to remind myself that it is happening now, yes. And it sucks ass, yes. But just because I am spontaneously depressed today doesn't mean it is going to be months of a downward spiral until I want to shoot myself in the face. It could just be for tonight, and even if it isn't, I'll deal with it like I have for 20ish years prior. Just to wait it out until tomorrow and try not to get too existential about my suffering until then.

And breathe. As much as I hate admitting it (it sounds like a tree-hugging, new-age, hippie thing), breathing exercises really, really help. Just concentrate on the fact that you are breathing in, then out and all the sounds and physical sensations in between...when you start to think about anything else (good, bad, or not), just go, "nope," and breathe in again. Breathe out again. It won't fix anything necessarily, and it takes a lot of strength and practice to bring yourself back to it, but it certainly doesn't hurt.

Anyway, that's been my week.

Doc and Chaps: Normalizing Psychology and Implementing Prevention Strategies

I've noticed quite a few articles that talk about prevention (including the first two articles for my positive psych class) and also trying to spread the word that psychology is not "just for crazies." But how do we do this?

The real life attempts I've seen have been interesting. Mental health fairs, talking posts, and advertising campaigns involving posters with a simple message: anyone can go to a therapist. But if you search for these terms, you'll see a lot about "awareness" themes focusing a lot on suicide and depression, or even just everyday stress. But these topics (while absolutely relevant and important) are the very reasons why the general public get scared away from us! 

Think of all the reasons why people don't want to see a therapist: 

• Freud. He is popularly known as a perverted psycho. While this may or may not be true, this is how a lot of people still see psychotherapy as a whole. They don't want to lay down on our couches and talk about how they want to bone their mother. That's just weird.*
• Avoidance. People spend a good portion of their lives trying not to think about sad or scary things. And, since this is what people think therapists are for, they try to avoid them. It's not necessarily healthy, but you can see where they are coming from, right?
• Misinformation. I'm sure that, if you are in the field of psychology or have told friends and family that that is what you are studying, someone, at some point in time, has asked you if you can analyze them or asked if you can read their mind. They feel like you are going to start probing their thoughts or some other crazy stuff (that would make therapy a lot easier, I bet). 
• Finally, a big part of it is that people feel like if they are associated with a therapist, they will be judged. A big movie trope is the lunatic who starts a date off with, "well, my therapist said..."

How can we change this?

Well, my first thought goes to the Navy, and the stark contrast between Naval physicians and chaplains versus the psychologists. "Doc" and "Chaps" were like local rock stars: they would walk around high-fiving, fist-bumping, telling jokes; even in their intimidating officer uniforms, you felt safe talking to them. When they just acknowledged your existence you felt special. But the psychologists, uniforms or no, hunkered down in their offices. They were stiff and uninviting, and if you had to go see them, it was usually because you were in trouble. 

So:

What if we took this route? In schools and colleges and even in larger workplaces, have a different kind of "Doc" running around? Obviously, they wouldn't be seeing patients all the time, but they would be a kind of "ambassador," if you will, to the rest of the psych department. Someone to monitor morale and spread the word about these "mental health fairs" and "talking posts." But they wouldn't have to focus just on mental health, either. They could be the ones to announce different club meetings (at schools) and occasionally hand out treats, or whatever. 

The only real drawback I see is if this person can't be seen as genuine. If it's too forced, it'll be obvious; introduction of this person would have to be slow. But I think if this idea is implemented all over the country (even the world, really), psychology as both a means for healing and for prevention could truly benefit. 

What do you think?

*Not judging, just sayin'.