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!

PIOP

Psychiatric Intensive Out-patient Program, or PIOP, was something I got put into by one of the good doctors I saw while in the military. It was basically a two-week long, seven to eight hour therapy group. The "curriculum" used several different techniques such as art therapy, psychodrama, CBT (cognitive behavioral therapy), and just regular talk/group therapy. I think there were six of us.

PIOP was the first time I ever did any kind of group therapy, and I was nervous as all hell. I don't particularly like speaking even one-on-one with someone I know, but this was in front of a group of strangers. Needless to say, Clonazepam was my best friend those two weeks.

The schedule differed a little everyday, and certain things like art and drama were only used a few times, but everyday we started with saying how last night went and then with a kind of warm-up. The warm-up was fairly simple--a family-friendly mash-up of musical chairs and "Never Have I Ever," or a race-type game involving CBT trivia--just to make us a little more apt to talk later.

This was a few years ago, so I can't remember all of it. I do, however, remember getting caught up in other people's therapy. This was after I decided I needed to be a therapist, so I was fascinated by the process.
Basically, one person would be convinced to talk about why they were there and about their past, and the rest of us were encouraged to comment, ask questions, and challenge that person's inconsistencies and distortions. I, being the weird, awkward fuck I am, really enjoyed this part. Listening to their stories and then giving them feedback.

Then it was my turn.

One of them expressed some solidarity when it came to my past abuse, but when it came to my biggest problem, no one--not even the facilitators--know what to say. I was struggling with the concept of self-worth. Not self-esteem, but worth. You can't have self-esteem unless you also agree that you are not simply taking up space and resources with your existence. It was a kind of existential crises that I was dealing with everyday, that no one there had even considered. They took their right to exist for granted. I'm sure it is probably an evolutionary thing. I did eventually figure this out, but that's another post. Basically they told me I "think too much."

Art therapy was fun, but not really helpful at the time. Psychodrama was lame except for a quick moment where I actually believed myself when I said that "I'm not worthless," and CBT and learning the drama triangle were enlightening, but I wouldn't use that until later.

All in all, it was a great experience. Most hospitals don't call it PIOP, but I'm willing to bet a lot have something similar; so if you need it, I'd totally recommend it.

Friday is another check-in, and Monday I'll write more on the whole "self-worth" thing.

Be well!
~ML

The Stupid Journey

So I have already talked about my general life story leading up to this point. It was long, depressing, and possibly boring for you all to read it. Now, let me tell you a little better of a story: my string of therapists.

My first one ever was when I was about 16. He seemed friendly enough. This is how our first (and only) session went:

"Hi, ML, I'm Dr. ____"
"Hi."
[insert forty minutes of silence]
"Okay, that's all we have time for!"
"...Al-alright..."
The end.

Yes, this guy decided to go all psychoanalytical on a sixteen year old girl without ever explaining the process. I was already really shy and nervous, why the hell would I ever talk to this guy without any kind of lead? Ah, well, maybe the next one will be better. (Spoiler alert: not really)

The second guy, I saw twice. The first time, mom and I sat in his office and we talked in a really vague manner about what was going on, and then he proceeded to diagnose me with ADD. Then he decided I should get an IQ test (which apparently is a good measure for ADD? I have no idea), just to be sure. I took the test a couple days later, and then the second appointment, he wanted to dive right into my issues for real (after "confirming" ADD)....with my mom still in the freakin' room.
So, no. But I did get to find out my IQ, which was pretty cool.

The next one was a lady. She was older, friendly, and actually seemed to know what she was talking about (in retrospect), but she talked to me like a kindergartner. Literally.
"OMG, hi, you must be ML! Well I'm ____ and we're going to have such a fun time!" What can I expect, really, mom chose her because she was a child therapist. I saw her one more time before I just couldn't take it anymore.

After her, I gave up on therapy for quite awhile. I just went to a psychiatrist for years. I hated it; I would get asked how I'm doing, and quickly get shot down because I'm talking too much. She was somewhat nice about it, but it was still jarring. Eventually, I ran out of insurance and then I moved when my husband got stationed in VA.

I didn't see anyone else until I after I joined the military. First, they put me on some horrible medication; it caused "brain-shivers" so badly that I almost crashed my car multiple times. Then they absolutely denied that a) it would cause side-effects and b) it would cause any kind of withdrawal symptoms (they called it "discontinuation effects" instead). Anyway, I got put back on Zoloft which is what I'm still on now. After pushing for it, they finally let me see a therapist.

This guy was very nice, sensible, knowledgeable, and not even too bad to look at--the only problem I had with him is that he was a newbie, so his idea of the human psyche was fairly inflexible. I am told that my insight is fairly high ("impressive" I've been recently told), and he didn't seem capable of understanding that. He just needs practice. I stopped seeing that guy because he got deployed.

They decided to shove me onto the civilians then. The first one I already mentioned here. She really needed her own bit of therapy and a refresher course in anxiety.
The second one was the miracle lady who made me realize that I should become a therapist myself. I say "miracle lady," because it was through her absolutely terrible therapy that I got over a pretty big hump in my life.

The next pair of people, a psychologist and a psychiatrist, were awesome. They cared, they knew what they were doing, they were easy to talk to (as much as military officers for a little E-2 can be), and they gave me a little more faith in finding someone in the profession to help me once I got separated from the military. It was also them who sent me to a military program called PIOP: psychiatric intensive out-patient program. I'll talk more about that later, but it was a really neat experience (not therapeutic, but neat!).

After them I had a pretty good string of civilian therapists in STL, only to have two of them leave because of job promotion or relocation. Those are, I think, the worst. You develop a rapport, spill your guts, cry a little, then you have to try to start all over again with someone else who you are terrified will suck or move, too.
Now I have a great (probably even the best, for me) therapist who really seems to understand both my issues and my dark, sarcastic humor. She is great and--surprise!--works at the VA. Who'd've thought anything good could come out of that hellhole?

To anyone who still hasn't yet found that "special someone" for your therapeutic process, just know that they are out there--you just have to keep looking for them. It may take a really, really long time (I don't sugarcoat this shit), but once you find them, it is SO worth it. My experience is that those who are actually psychologists tend to do better than social workers or counselors, but this is only me--I could just be a special case.

Anyway, I hope my story has been enlightening, hope-inspiring, or at the very least entertaining. I'd also LOVE to hear your stories--both good and cringe-worthy--so leave'em in the comments!

Keep lookin'!
~ML

Friday Check-In

Alright, so how do I do one of these? I guess however I feel like, huh? Don't worry, I'll get better at this one day...

This week was my second week of doing a Behavioral Activation time sheet. Week 1 is just putting down what you did everyday, and Week 2 is all about having a couple goals for yourself: having certain activities that will make you feel like you accomplished something, activities that you just really enjoy, and others that get you out of the house/socializing.

My goals this week have been journaling, writing, and taking my dog on long walks everyday. I had a trip to the grocery store and a trip to a great little coffee shop to get me out of the house, each instance planned for just one time at some point during the week. I also had a couple papers to write (big, final papers for my two summer courses at college). All of this seemed like it was going to take a lot out of me, but I started off excited, nonetheless.

The papers did NOT go well. I did, however, journal everyday (except yesterday, I'll get into that). Writing entails the revision, etc. of a novel I started in 2009. I'm on the third-ish draft right now, and haven't really been doing as much as I would like, this week included.

Blogging was a goal that I kinda made myself, since I just randomly decided to do in this new direction. I have to keep reminding myself that it won't be perfect, and (especially since I don't have an audience right now) doesn't have to be. This reminder should also help out my writing and schoolwork...perfection is something I really need to let go of.
Anyway, blogging--as you can see--went pretty well for this week.

Dog walking has been a little iffy, since it's been hotter than Hades's Ballsack. But what walks we have been on, she's loved--we have a lot more squirrels and such for her to want to murder.

I actually went out quite a bit. My husband has been rather supportive, and he tends to either drag me along for errands or send me out to get stuff. It also helped that I had to go to class (and I can't cook), so I was also motivated by hunger.

Socializing is a lot easier now, too, as I have two extra people living in my house.

So how has Behavioral Activation worked so far? ...Meh. But it's only been one week of adjustment. Like I said, I started off pretty excited (like usual) and really tried hard to get everything done. This excitement and hope gave me a lot of energy, but soon it wore off and I started to slack off on different things. After the paper fiasco, I really kinda just stopped caring again.

But that's where therapy comes in handy: talking through my issues with perfectionism helped me articulate my reasons behind why I put so much pressure on myself, which in turn helps the outside party (aka, Dr. S.) help me find a way to satisfy the needs that aren't being met.

SO
My goals for next week are the same, minus the papers, and adding on a) finding a job (that's not a part of the therapy, I just need monies), and b) finding a place to volunteer. Baby steps, guys, baby steps.

How's your week been? Any goals completed or new ones for the next week? I'd love to hear it, and even if you don't post them, I wish you luck on new ones, congratulate you on benchmarks reached, and know that ones on which you fell short, you will get eventually--just don't give up!

~ML

On Monday, I'll talk about my beautifully dumb string of terrible therapists as even more testament to not giving up, provide entertainment to those who don't need therapy, and hopefully make a nice connection with those who have had similar experiences. 

Biography Lite, pt. 2

Last time I talked about my early childhood, and it was kinda depressing as hell. This is the second half of my story, and still kinda depressing/infuriating depending on where you are...but after this, I swear it'll be much better!

Socially, I was now awkward and nervous, always afraid I'd have to live through my experiences again due to trusting the wrong student. So friends were out.
Schoolwork was a no-go.
My parents were still too distracted to care or notice.
I was alone with no reason to feel any sense of self-worth.

When I was young, I wanted to run away, but I was too afraid I'd run into more evil people. When I started to understand I could die--around fifth or sixth grade--I was suicidal. My anxiety saved me, however, as I knew that even one minor miscalculation and I could end up paralyzed, brain-dead, or worse. So that's basically how I've spent the rest of my life to this point.
I graduated high school by the skin of my teeth, dropped out of college, then started a long, unfulfilling career in customer service. My boyfriend at the time--in 2007--dropped out of college and joined the Navy. I supported his decision, but was really jealous myself: I come from a relatively militaristic family. When he left boot camp, he went to 'A' school in Great Lakes, IL.
It was one particularly shitty night for me--sitting in my stained Taco Bell uniform, about to go to work--that he called. The conversation was fairly short as I had to leave soon, but it was the call in which he proposed to me.
Me? Really? The borderline hysterically depressed bitch who can't make anything of herself and can barely handle food service?
Yep.
I still can't quite figure it out now, but we've been married since November of that year so I must be doing something right. Anyway, 2010 rolls around and I'm now fairly stable, emotionally. I'm healthy, mostly happy, getting better by the day...so fuck it--let's enlist!
Now I'm not Wonder Woman, but I'm not the Penguin, either, and I made a 90 on the ASVAB so I could pick any job I want; AD, no contest. I was so ecstatic that I cried all one and a half hours home from MEPS. Finally--I get to make myself and my family proud and have a job that actually means something.

In boot camp. I'm fucking loved the physical side of it all; the recruits are all stupid fucks, but I was in the best shape of my life and I still felt like I'm going to make a difference.
One month in--halfway through--and something's wrong. I was bleeding like crazy every night, and it felt like I was shitting razor blades. Everything else was fine, so the HMC told me to just stop eating peanut butter (because he doesn't bother to listen to more than half of what I say). This didn't help, obviously, but I push through to 'A' school in FL. The doctor there took one look and told me that I have Crohn's disease.
"It's incurable, but it's treatable, and you'll probably have to be medically discharged."
He set me up with a GI doc at the hospital and practically shoved me out the door. My only information about Crohn's at this point was Google and WebMD.
So now I'm alone, about to go through physical hell, and terrified. I've always had a fear of doctors, so this doesn't help. One day I write to my husband, telling him we need to find him a good mother for his future children, and how I loved him and just wanted to best for him and how I couldn't give that to him anymore...basically, my plan was find him a good wife and then off myself.

Because I was already given shore duty, they allowed me to transfer despite my medical condition. I really wish I hadn't. My new command hated broken people. And that's all I was to them: broken. I couldn't do heavy lifting, I couldn't exercise with them, I couldn't stand for too long...I was useless, and they made sure I never fucking forgot it.

It actually got so bad that my GI doc asked me if someone was hurting me. My posture, demeanor, and even vocabulary had changed to the point where he thought someone was beating the shit out of me. Nope, I'm just hated and verbally berated everyday because I'm a useless human being, is all...I was told I could change commands, but they said they couldn't guarantee that it was going to be any better.

During this time I was seeing different therapists, psychologists, psychiatrists, and counselors. I won't go into all the different people I saw, as that's another post, but one of them was particularly helpful in how fucking awful she was as a therapist. After not listening to a word I said and asking me about my sister for the third time that session (the one that I have never had), I had a mini-breakdown. I felt like no one understood what it was like to just suddenly become disabled like I had. No one cared. And mainly, no one could help. But here's where it gets awesome: I realized that I understood. I cared. And with training, I could help others like me.

I was already going to be kicked out of my life purpose once. But this gave me hope that I would find it again. I just have to get through school...

And that's where I am now.

This Fall will be my third year in school majoring in psychology. I'm still battling depression, and have resigned myself to the idea that I probably will be forever. But my struggle has purpose now, and I'm trying my damnedest to remember that.

Next time I'm checking in, and I encourage all of you to do so as well--I'll be setting goals for myself for the next week, and evaluating how I did this week, so come join me! Monday will be a sort of fun shaming of the process I went through to find a therapist worth talking to, and hopefully these stories will help someone realize that it just takes time (and a LOT of trial and error) to get in a good spot.

Thanks, guys!
~ML

New Direction and Goals

So as I already said on the sidebar, I am thinking about taking this blog in a different direction. I'm going to keep the previous posts up, and I will not entirely abandon the academic angle, either. I just really need to stop trying to be what I am not. I am not a doctor, an academic (I'm a college student, but not a very studious one), or even a fully functioning individual at this point.

This does not mean I have nothing of value to say, however! I just have nothing truly to say from those viewpoints. So then, what am I?

• I am a depressed person; I have Major Depression Disorder, as a matter of fact.
• I am a medically retired Navy vet due to Crohn's Disease.
• I am in an awesome marriage with an even more amazing husband.
• I am a writer.

The depression and Crohn's sucks, but that doesn't mean I have to suffer quietly. This blog will be an active stand against succumbing to the effects of these illnesses, and hopefully a place for you to join me on the long journey to recovery. And it is a journey, not a road--not a long, gray slab of asphalt for us to stare at and hope it ends soon--this is an opportunity to become better than we ever have been before, or even better than we could have ever been without this crazy challenge to face.

So here's what's going to happen: I'm going to start on Monday. July 21, 2014, I will begin writing a sort of biography to catch you all up on what brought me to this point. Most likely it will be a 2-part post ending on Wednesday. On Friday, I will start the weekly tradition of checking in: looking at what I accomplished throughout the week, how I've felt emotionally and physically, goals I can set up for the next week, and so on. I encourage all of you to check in as well! Post your goals, express concerns, share your triumphs, and give others a kind word or two.

The other two days (hopefully always Monday and Wednesday), I'll write on different topics: what depression is like, resources, tips, different therapies I've tried and what I thought of them, etc., and I will try my best to cite peer-reviewed sources as appropriate.

I admit, I definitely got the inspiration to start this due to the BBC's show Sherlock. John Watson's blog is far more entertaining than anything I'll write here, I'm sure, but this is more therapeutic for me. This is also in conjunction to the recent introduction of Behavioral Activation therapy into my regimen. I'm supposed to be writing something daily, so I figure this would be a good excuse as any to share my story.

Here's to better health, yeah?
~ML