I Can (Actually) Do It!

“One of the things about being a slave and being forced to do things is that when nobody is forcing you anymore, you find you have almost lost the power of forcing yourself.” -CS Lewis (The Horse and His Boy).

I was thinking about that quote this week. I recently started working with a UNC student, helping her with her papers and other coursework. A few days ago, a morning appointment forced me to get up and head out after a night I had had trouble sleeping. I showed up on time, even though I was so tired I felt physically ill and had to fight off waves of nausea.

A month ago, with only freelance writing to do and with no fixed time to do it, I’d have stayed in bed. I would have thought “there is no way I can function feeling like this.” A few days ago, I got up and drove to the library.

The difference reminded me of many “so tired I’m sick” days at a previous job. Just like I did then, I got on the road because I had to. Someone was counting on me. I needed the money. And at the end of the day, I felt pretty darn good about myself. I felt like I was a functioning member of society rather than a hermit who hides in her apartment all day.

Hubby’s therapist mentioned to us that one of the first things she encourages people with depression to do is work or go to school (if they aren’t already). Now I see why.

Working requires that you have your symptoms under control enough to function, and yes, there are certainly jobs that aren’t good for your mental health. I do think, however, that getting out and doing something with your life is an important step on the road to recovery. It allows you to connect with your world, be around other people, and (perhaps most important of all), regain some sense of self-worth.

And it reminds you that even if you do feel like spending all day in bed, you can do more if you put your mind to it.

Patience and Creativity

Little By Little, One Travels Far
-JRR Tolkien

Mental illness is, in many ways, a study in patience. Like any serious medical condition, depression does not get better overnight. Despite doing everything you’re supposed to, despite taking your medications, despite exercising and eating right, despite seeing a therapist, there’s some days you just can’t shake the symptoms.

When that happens, I’ve found a little creativity will help me get through. I have already written about how, on the really bad days, I would do my chores in the commercial breaks while watching TV. It let me feel like I had accomplished something, even when I could only stand to do 5 minutes of work at a time.

Today, I found another creative way of dealing with things. My physical health is not very good right now, plus there are days when low energy, anxiety, or combination of both makes me want to just hide under the covers. When my head is pounding, or my heart is aching, sitting upright at my computer is up too much effort. Having a laptop helps but it’s never really easy to type while lying on your back.

Today, I started learning how to use windows speech recognition to type with my voice. It is not perfect, I am still working on training the software, but being able to work with my eyes closed is pretty neat. If my eyes are hurting from too much crying, or I just need to shut out the world for a while, I can still get something done.

I also think that typing with my voice of will help me deal with another symptom: mess stress. David is incredibly supportive, but he has health issues of his own. Sometimes he simply can’t help, and when he can, I notice that he and I have a different definition of the word “clean”. Just knowing that I can fold laundry and outline an article at the same time helps relieve my stress level. I don’t feel as overwhelmed by the chaos around me, because I know I can do something about it without sacrificing my work. In short, I can be responsible and neurotic. Not bad.

Depression Diagnosis: When Not to Tell

“Teaching the concept of privacy is difficult when the general consensus is that anything not paraded around in public must be a source of shame.”

This quote, from a Miss Manners column, is in my opinion the best ever commentary on one of the disadvantages of living in a Facebook world.

I have nothing against Facebook. It’s one of the primary ways I stay connected to my friends, especially on my low-self-esteem days when I don’t want to leave the house. However, I’ve also maintained a policy of talking about my illness in only chat, and only with certain people.

It hasn’t always been that way. When I was in college, (before Facebook was even a thing) I hadn’t yet been diagnosed, but I’d blab about my college-student struggles to anyone who would listen. I lost some friends because of it. for others, the consequences are even worse. Blogger Theresa Bouchard, talked about her bipolar diagnosis at work and “coincidentally” got laid off.

The temptation to reveal all doesn’t just come from our overshare-addicted culture. For those of us used to hiding our true selves, it’s liberating to be honest. But there is such a thing as too much honesty.

There are those who can’t handle us. The most cowardly turn tail and run. Others deny our illness, telling us we’re “just feeling sorry for ourselves.” Still others appoint themselves to the role of Savior and attempt to “fix” us.

Whether it’s unreturned phone calls, a lecture on self-pity or an invitation to dump our meds down the toilet and take up yoga, unsupportive people aren’t especially helpful to someone who already struggles with feelings of worthlessness.

That’s why I’ve adopted a “need to know” policy.

My immediate family and close friends need to know about my condition so that they can understand why I sometimes behave as I do, why it doesn’t have anything to do with them, and what they can do to help. When I write about mental illness, my editors and networking contacts need to know I’ve been there, as it ads to my creditability.

For everyone else, my therapy sessions and support groups are “a doctor’s appointment.”

Image “It’s a Secret” by www.sxc.hu user “bigdodaddy.” Image ID# 1074578. Used with permission.

Myths and Facts about Inpatient Mental Health Care

Five days ago, David told me he was feeling so out of control that he needed to go to the hospital. That night, he was admitted to an inpatient mental health facility. Yesterday, he came home. As we drove the short 1.3 mile route from the facility to our apartment, he said “I don’t know what I would have done without that place. It saved my life. I feel happier than I have in years.”

Go to Netflix and look for movies about mental institutions. You aren’t going to see compassionate trained professionals helping troubled people start a journey toward recovery. In film, mental health care providers are at worst abusers and at best incompetent nincompoops who never help anyone. If a patient gets better, it’s because some maverick, or the patient himself, decided to “buck the system.”

People are paying for it with their lives. Fear of “the Loony Bin” is keeping those who desperately need help from seeking it until it’s too late. It doesn’t have to be that way. My husband experienced inpatient treatment firsthand. I spent the time he was away learning about the system. Together, we’ve come up with a list of the most common myths about inpatient care, and some information about how things really work. We hope it helps someone.

Myth: They’ll lock me up forever and I won’t be able to do anything about it.

Fact: It’s pretty darn hard to keep you against your will.

Go to the emergency room for a mental health emergency and you’ll usually get sent home with a mild sedative and a list of counselors to call. If you’re actively suicidal or psychotic, staff can order you held in the hospital’s psych ward or another “acute care” or “crisis stabilization” facility for a maximum of 72 hours. If you don’t want to stay after that, it’ll take a court order to keep you.

Myth: They’ll strap me down and shoot me up with drugs.

Fact: You decide what goes into your body (as long as you aren’t trying to off yourself or hurt someone else).

Federal law requires informed consent for the administration of all prescription medications, and there are even more laws restricting the use of psychiatric medications. The doctors have to tell you what the drug is, what it’s for, and what the benefits and risks are. You will have to sign a consent form before taking anything. Only if you pose an immediate, physical risk to yourself or others can the staff use restraints or administer drugs without your consent. Keeping you on medications longer than that, just like keeping you in the hospital, takes a court order.

Myth: They’ll lobotomize me or shock my brain.

Fact: No they won’t.

Though some standard hospitals still have psych wards, the majority of acute care/crisis facilities are stand-alone buildings that don’t have any medical equipment (except for instruments used to track vital signs, like blood pressure cuffs and thermometers). The only treatments they are equipped to provide are medication, group therapy, and one-on-one counseling.

Lobotomies haven’t been widely used in psychiatric care since the 1950s and there hasn’t been a report of one being done in the United States since the early 1980s. Though electrical convulsive therapy or ECT (formerly known as electro-shock therapy) is sometimes used to address treatment-resistant depression, it’s a last resort option when counseling, lifestyle changes and medication haven’t worked. ETC is simply not used when they’re just trying to get you stabilized enough to go home and see a therapist on your own.

MYTH: If a judge orders me to get treatment, I’m stuck.

FACT: You can fight the court’s decisions.

If, in the unlikely even the court has to order you to stay longer than three days or given medications, you have the option to fight it. Just like if you were accused of a crime, you have the right to have a lawyer, and you have the right to have the system provide you with one if you can’t pay for one yourself.

“Ambulance” photo by stock.xchng user “linder6580″. Image ID # 1334532. Used with permission.

Attack of the Clones

Ok, I admit it, I didn’t watch all (or most) of the three most recent Star Wars movies. I haven’t watched all of the first three, for that matter. Nothing against them, just not my cup of herbal tea. However, when I started reading comments on mental health blogs like Beyond Blue and Coming Out Crazy, I started wondering if the Lord of the Sith took over the world when I wasn’t paying attention.

Apparently the human race now consists entirely of clones. A vast host of identical, one-size-fits-all human beings.

Browse the comments of any well-traveled mental health blog, and I’ll bet next month’s salary you’ll come across at least one version of “X worked for me, so it will work for you.” Whether it’s a vitriolic attack, a shameless shill promoting his new book, or a genuine attempt rescue the blogger from her own disillusions, only an unconscious belief in the cookie-cutter nature of the human race can account for the assumption that one treatment will work for everyone.

To be fair, there’s a world of difference between hateful attacks and good-hearted (though misguided) attempts to save others from themselves. I have no problem at all hitting the “Report Abuse” button when I see a Scientologist calling a Prozac user a drug addict, an atheist mocking a Christian for believing in a “supernatural zombie,” or one member of a religious group telling another member of the same group he’d get better if he’d “repent” or “have more faith.”

I also have no problem with bloggers mentioning techniques, strategies, or ideas that they’ve had success using. I do so on this very blog, and the experience of others who share my illness has proven invaluable in my recovery. Without Beyond Blue’s post on when you should seek help, I might not have gone to the hospital when I needed to. Maternally Challenged helped me understand the value in some of the more aggressive depression treatments.

I just wish we could all accept, at a deep level, what we intellectually know to be true after one walk through a crowded city: every person is unique. Humans come in all shapes, sizes, and colors, with different genes, interests, personalities, talents, and struggles.

To return to science fiction metaphors, our world is not the Galactic Empire of the clones. It is more like the United Federation of Planets, filled with a vast diversity of sentient beings who can only survive by learning to respect, even celebrate, those differences. The ubiquitous refrain of “it worked for me, it will work for you” is a form of stereotyping. Like all stereotyping, it is, as Mr. Spock would say, “illogical.”

“Clipping” image by Sxc.hu user “recorte”. Image ID# 700613. Used with Permission.

Coping With Depression, One Task at a Time

“You can do anything for five minutes.”

That’s a quote I read in Guideposts. Though the original context was a personal trainer helping an overweight individual begin a fitness program (walking for five minutes on a treadmill), I’ve found it applies to other health conditions too, including depression.

One of the symptoms of depression is lethargy, probably because the same neurotransmitters that control mood also affect energy level. During an episode or even just a bad day, it feels like everything is an effort. The sufferer has to drag herself to work, to errands, to school, to everything. Sometimes it gets so bad that even putting away the groceries or taking out the trash feels like trying to climb Mount Everest.

It’s in those times I’ve found the simplest techniques often work the best. I remember learning, in gradeschool no less, about breaking big projects down into smaller ones. I did it all the way up through college, and it’s one of the reasons I was able to get a Bachelor’s degree in spite of my ADHD.

I was rather surprised when a similar technique showed up in a Mayo Clinic article on clinical depression. I was even more surprised that the same technique that helped me deal with a term paper helped me deal with a messy kitchen. On my worst days, I’d lie on the couch, watching a favorite show, and use the commercial breaks as “cleaning time.”

The sight of the dishes piled in the sink wouldn’t send me into a panic as long as I knew I could stop dealing with them once my program came back on. By the end of the day, the kitchen was clean, and I could take a small amount of comfort in the fact that, even if I wasn’t able to work, even if I felt like the worst failure that had ever walked this planet, I had accomplished something.

I kept using the same technique as I recovered. I’d set a timer for 20 minutes and tell myself all I was going to do was outline one piece, and if I felt like the effort was crushing my chest into the spinal column, I could stop for the day. More often than not, I was able to keep going once I’d started. A full day’s work looked too overwhelming, but I could do one thing. Then I could do another. Then I’d do another. Before I knew it, I’d accomplished what I felt was impossible.

“To Do” Image by SXC.HU user Mattox. Image ID# 1151807. Used with Permission.

Dealing with Sleep Problems

It’s no secret those who struggle with depression experience sleep problems. Insomnia and oversleeping are on the Mayo Clinic’s list of depression symptoms. Whether there’s a diagnosed anxiety component or not, finding oneself tossing and turning until the wee hours is a common experience among depressives. Insomnia is annoying for anyone, but when you’re the primary breadwinner, as I am, it can cause serious problems. I’ve learned a few ways to deal with it.

Turn Off the Screens

Laptops, smart phones, tablet PCs and other electronic devices have become such as major part of our lives that putting them down for an hour or so before bed seems odd. In fact, it’s been so hard for me that I’ve had to ask David to take my laptop and phone away at 10pm. But it’s worth it. Without a light box (also known as an LCD screen) shining into my eyes and waking me up, I relax more easily.

Be Careful About Evening Light

The electric light bulb may be one of the 20th century’s greatest inventions, but it’s played havoc with our sleep schedules. David and I, for that reason, have invested in three-way bulbs. As soon as the sun sets, the lights get turned down to the dimmest possible setting. That tells our bodies it’s time to relax and wind down.

Keep Your Mind Off Worry

I’ve found my most frequent sleep problem comes from my brain refusing to shut up and shut down, though worries also sometimes keep me awake. It isn’t exactly easy to just stop thinking, but I have found a technique that works. I learned it from author AJ Jacobs. It involves picking a color and a category, such as “yellow” and “food,” then mentally listing everything I can think of that fits that color and category. For example, “lemons, bananas, corn, buddha’s hand fruits….”. I’ve usually dozed off before I get to the end of one category.

However, despite all efforts, sometimes sleep deprivation still happens. In those cases…

Get Wet

Water can help with sleep issues whether you’re trying to fall asleep or trying to deal with getting too little sleep the night before. A relaxing bath or shower — preferably with lavender-scented body wash — is one of the most relaxing things I know. On the flip side, a quick dip in a pool or a shower with the water set on cool (not cold!) helps me wake up.

Have a Drink (of Water)

Few people get even the minimum eight glasses of water all the white coats tell us we need. Even mild dehydration can cause sleepiness and loss of mental acuity. I keep a glass of water by my desk all day long, as it’s easier to sip small amounts throughout the day than to try to get it in all at once (not to mention the restroom issues that can arise from trying to pound a lot of water at once). A few glasses and I’m usually at least a bit more energetic.

Get Active

As odd as it sounds when you’re tired, a little moderate activity can actually help your alertness level. A walk, some light housework, or a quick game with the pets all get the blood flowing and help you feel more alert. In fact, I know for a fact that health experts recommend exercising in the morning, rather than at night, for just this reason.

“Lampshade” image by sxc.hu user OeilDeNuit. Image # 1354294. Used with Permission.