Not My Fault

I had been an inner-city teacher for two years when the gates of anxiety and depression came crashing down.  One day I just couldn't do it anymore.  I resigned for "health reasons," though I didn't tell anyone that it was my mental health.  I honestly felt like I was lying at the time.  All I could think at that moment was, "I can't do this.  Something horrible is going to happen if I walk into that classroom again."  So I quit.  And my depression seized the moment – like it does – and beat the hell out of me for quitting.  For more than a year, I felt great shame about that.  At the same time I was trying to claw my way out of the pit through therapy, and trying to figure out what I was going to do with my life.

After some CBT work on the subject, a light finally turned on in my head – a dim light hanging from the rafters and swinging in the dark, but a light nonetheless – that I was not lying when I quit my job by saying that I was resigning for health reasons.  I was sick with a fatal illness.  Not my fault.  Not a made-up story to get out of working.

If I'd had cancer, I would have walked into the head office upset and concerned for my life, but unashamed.  I would have told my principal and she would have understood that I needed to take care of my health.  She would have perhaps checked up on me later on to see how I was doing.  People at the school would pass around a card and maybe send flowers.  I would have visited when my chemo was over, wearing a bandana over my bald head, and been welcomed as a hero, "fighting" cancer.  Instead, I quit in ignominy, sent a letter via email and hated myself for it, which made it that much harder to get better.  

In Kay Redfield Jamison's book on suicide, Night Falls Fast, she tells the story of Drew, a student at the Air Force Academy, who'd excelled in school, but months before his graduation became mentally ill with manic depression.  Rather than receiving his commission and slot in flight school upon graduation, he was excused from the Air Force for mental illness.  While he was back home with his parents and recovering from his psychotic manic episode, the guilt and shame he felt for having a mental illness and being forced out of the Air Force held his recovery back and kept him from discussing his problems with friends and family.  Just a few days before his suicide, his psychiatrist noted that he was, "continuing to struggle with coming to grips with seeing himself as an individual with an illness."

While I am starting to accept that I have a serious mental illness, I still feel shame and guilt at my situation.  I wish I didn't, but if I'm totally honest, I do.  While my depression had slowed down my life's progress, like Drew, I was on the road to success.  I'd gotten straight A's and won awards in college.  I was in a rather selective graduate program when I was teaching that I just had to quit.  I came out to my mother (yes, it's a little like coming out), but I haven't said anything to my dad about it.  I'm selective with whom I share my experience.  – Except for this totally public (but anonymous) blog.  It's flippin' hard to feel like you're starting life over in your 40's, and you can't just drop the mental illness bomb every time someone asks you what you're up to.  Sigh.

But that light hanging from the rafters is a little brighter today.  It's not my fault I have a funny brain.  Just like it wouldn't be my fault if my kidneys were defective.  I'm not ashamed to know I have a mental illness, and I believe that that is what will get me through to the other side. 

My Happy News About Antidepressants

First, I want to say that antidepressants work for me.  In the past four years, I have found myself in a suicidal tailspin twice and both times antidepressants brought me back to safety.  I believe that I may not be here if it wasn't for these drugs.

That said, I had life-squandering depressive symptoms off-and-on for about 20 years before I went to a psychopharmacologist, so I understand people's reticence to go on medication.  I also know that, for me, drugs alone are not a cure.  Medication has pulled me out of the abyss so that I could get busy getting better through therapy (a longer, slower haul).

Recently, a friend who is struggling with depression and wondering if he should go on medication informed me that a lot of people were saying that antidepressants did not work better than placebo in scientific studies.  So I did some quick googling and found this Newsweek article from a couple of years ago entitled, "The Depressing News About Antidepressants."

This article, written by Sharon Begley, introduces the reader to Irving Kirsch, who researched the studies showing the efficacy of antidepressants and found that even these studies showed that antidepressants only worked about 25% better than placebo.  Now, this was a couple of years ago, and there may be a great deal of research refuting Kirsch's findings today, but my friend's knowledge of it and the easy google search tell me that this article may be affecting whether or not people choose to go on medication today.

Begley says that, being a mental health writer, she has a moral dilemma when approached by friends about whether to go on antidepressants.  This because of her knowledge of Kirsch's findings.  However, in her 5 page article, there are two sentences that should help her out of her quandry:

"Only in patients with very severe symptoms (scoring 23 or above on the standard scale) was there a statistically significant drug benefit. Such patients account for about 13 percent of people with depression."

HELLO!  (Waving hands in air)  That's the kind of depression that you die from.  The kind that my grandfather probably died from.   When I'm wrestling the black dog, I score way above 23 on the Burn's scale.  So maybe Begley should simply check her friends' depression rating before recommending (or not) medication.  (And remove the "Only" from the beginning of the above sentence.)

I can't help but feel that this article is somewhat weighted by the social stigma of depression as being something one can think herself out of.  By definition, you cannot snap out of it on your own.  Thank goodness there's medication that works for many of us who suffer.

Little Changes Add Up

My depression tells me that I have no power to change my life, that things (my thoughts/employment/job/career/finances/relationships) will always be the way they are, which is unsatisfactory,  and there is nothing that I can do about it, so I may as well die. 

That was a year ago, and things are starting to look better... in small ways that seem oh-so-huge when compared with the bleak, black future depression likes to lay before me.

A year ago, or maybe just eight or nine months ago, I hated my life.  I couldn't imagine how I was ever going to have a profession again, or even a job where I could just make money.  I could hardly do anything at all.  Taking a shower was an insurmountable task.

Ever so slowly, with medication and therapy, I started making little changes that I can see now have built upon themselves and given me the strength to make bigger (albeit still smallish) changes.  I was amazed to have the insight the other day that I do have the power to make changes.  I have a long way to go and I'm going to need a lot of help getting there, but change is happening.

I think it started with helping my friend with her one-year-old baby.  Her husband got a good paying job (hard to do these days) on the road six weeks out of eight.  She needed a hand, and something told me that helping her out would help me out of the house.  And it did.

Through her, I heard about a small room for rent.  Something told me that room could be my office, and if I had an office to go to, I would start writing again.  At first I just worked on the office, painting it and furnishing it.  That got me moving, too.  Once it was ready, I decided to write this blog, which has the double bonus of getting me to put words in print and keeping me focused on my recovery.

Then I decided that I needed a job in the neighborhood of my office to give me some money to pay for it as well as structure that will get me there every weekday.  To my amazement, I think I have a job now.  After two years of not working.  It's a part time job in the neighborhood.  It took me two days to write a resume and cover letter, but I did it.

So here I am now - probably (not yet definitely) employed and writing.  All of those little changes are adding up.  Now if I can just apply this theory to exercising.

Stigma busting!

This week in the U.K., during a debate in Parliament on mental health care, several members came out about their struggles with mental illness.  Can you imagine a Senator doing the same in the U.S.?

MPs Reveal Their Battles with Depression

I've read several great blog posts from the U.K. on the subject.  My fave is THIS ONE by James Rhodes.  He gets it so right.  "What is necessary to combat the stigma surrounding depression is a humble and honest relating of the experience of it. Nothing more, nothing less."  


Sing it, Sistah!  

Cognitive Behavioral Therapy for $16.99

Somewhere in the dark morass of my lowest points last year, I reached for a hold of sanity that has been invaluable throughout this year of recovery, David D. Burns's workbook for cognitive behavioral therapy.  It has an unfortunate title, in three inch tall letters, no less.  One that I cannot proudly display on the subway.  Here it is:
TEN DAYS TO SELF-ESTEEM.

The title aside, this workbook has been a great help to me.  Dr. Burns is the psychiatrist who popularized CBT in the 1980's with his book Feeling Good: The New Mood Therapy.  In a nutshell, CBT helps one to find, name, and reframe the distorted thinking that is at the core of a depressed mood and depressive (sometimes suicidal) thinking.

It's a write-all-over-it kind of workbook, with charts, checklists, and inventories as you progress through the steps.  While my work with my therapist is not on a strict CBT regimen, I would share my work with her and get her validation and insight on my distorted thoughts.  Even though I have only worked through about 3/4 of the book in the last year, I can see the progress that it has helped me to make.

In the beginning, in my suicidal panic, I was having horrible difficulties dealing with people.  I learned to grab a pen and work through my thinking before saying and doing things that would bring on regret and shame and only make me feel worse.  It was miraculous how feelings of intense anger could disappear in a few minutes of scribbling down my thoughts.

More recently, I used the workbook to do some deep work on how I feel like I am a failure because I didn't finish my master's degree.  (Mental breakdown was the cause.)  The workbook helped me see how it is my own distorted thinking that is punishing me and holding me back from moving ahead.  I didn't feel that miraculous lift from the feelings of self-blaming that I did from the earlier work, but over the last few weeks, I have felt my thoughts and feelings shifting closer to self-compassion and understanding.  Not all there yet, but making progress.

Low Cost Therapy, or, How Therapy Saved My Life

Here’s an ironic story.  In my first Composition class in college, I was assigned Kay Redfield Jamison’s memoir of manic depression An Unquiet Mind to read.  When she lists all the famous artists and authors who may have suffered from the illness – people like Virginia Woolf, Van Gogh, and Ernest Hemingway – I remember being disappointed that I didn’t have this disease.  Damn, I thought, I could make great art if only I had that mental illness.  Some people have all the luck. 

Be careful what you wish for.

But I still don’t have manic depression, or bipolar disease.  I have major depressive disorder, and even though they put ‘major’ in front of it, it still sounds like one just has a situation that will pass, not a serious mental illness like manic depression or schizophrenia.  But it is, and it’s taken me years and years to come to that realization.  It even took four years after I was first diagnosed by a psychiatrist (who was amazed that it had taken me so long to get medical help).  The illness had to almost pull me under the water line before I could scream for help. 

Maybe it took those four years because at first I was only treating my depression with antidepressants, which worked great at first, until my life got ridiculously stressful and I found myself seriously planning my own demise.  I needed more than 60 second meetings and prescriptions.  This time I sought therapy as well.

Therapy has helped me immensely.  I am on medication as well, and I’d say the help is about 50/50 therapy and medication.  The medication takes care of my physical symptoms, while therapy helps me to reframe my depressive thinking.  She was also, I felt, the only person who got that I was suffering from a serious illness at the time that I first started seeing her.  As I went through hating myself for my symptoms, thinking I was hopeless and useless, she constantly reminded me that I was recovering from depression.  Having her on my side against the onslaught of self-hating thoughts and misunderstanding friends and family was and is invaluable to my recovery.  Probably saved my life.

Therapy can be expensive for those without the resources (read money or mental health insurance).  One thing to note is that many therapists state on their website that they will work with you on the fee, so while their normal fee is maybe $200, maybe they will see you for $100, or even less.  As a doctor at the NYS Psychiatric Institute said to me, “You’re worth it.”

I know of one place in NYC that offers psychotherapy on a sliding scale: The Washington Square Institute.  I went there myself years ago for a while, and was charged $30 per session.  It did me some good, although I wasn’t ready to accept that I had a mental illness or needed medication at the time. 

Their website is here:  Washington Square Institute 

I'm sure there are other options for low-cost therapy in NYC, but I don't know them yet.  I'll keep my ear to the ground, though, and post anything else I find.  For those who don't live in the city, try googling "low cost therapy your city here," or "low fee psychotherapy your city here,"or some combination of those words.  Of course, the bigger the city, the more available resources.  

There is also the Psychology Today website that can help you find and shop for the right therapist.  That is how I found my therapist that I see today.  Go to their website and do a search for your city.  The psychologists listed have a short blurb about their practice and philosophy, and many have links to their own websites, as well.  

That website is here:  Psychology Today Therapy Directory.  

On The Mental Illness Happy Hour this week, Paul had a guest, Mike Carano, who questioned whether therapy really worked because he knows some people that it hasn't seemed to help.  I'm here to say that it works for me.  I've had many therapists over the years – some better than others.  It's a lot like my search for the right psychiatrist, if one wasn't working, I had to find someone else.  There are good ones out there.  This time around, I chose three from the listings and saw each one for one session before making my decision.  Many (not all) will see you for a free consultation, or have one with you over the phone.  

You're worth it.

The Chillout Song

A few months ago I discovered this TED talk with Ze Frank talking about all the ways he tries to truly connect with people over the internet.  "To feel and be felt," he says, "Really connecting with people isn't easy."

That is more than true for me when I am in a depressive cycle.  I say, 'more than true,' because it's nearly impossible unless it's with a professional who understands depression because most laypeople who are untouched by the disorder just.  don't.  get.  it.

Anywho - I was and am touched by this 18 minute TED Talk.  So here it is for you:

Ze Frank TED Talk

The main reason I'm so moved by this talk is because of the "Chillout Song" at the end.  Ze writes a short song for a follower because she sounds like (to me anyway) she's going through some anxiety and depression after moving to a new city.  Then he has followers from across the world record themselves singing it.  He puts their voices together to create a soothing, choral hug for this woman.

I've downloaded the song and listen to it every now and then when I'm feeling down.  It has not yet failed to make me feel a little better.

The web page showing the story of the creation of the song is HERE.

You can download the song for $1 HERE.

And hey – you're okay.  You'll be fine.  Just breathe.