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Tag Archives: Anxiety

Hanging in the Balance

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You know what it’s like having a mental illness? It’s like being Homer Simpson in that episode where he ate that Fugu puffer fish prepared by a rookie chef. That’s the fish that, if not prepared correctly, can kill you. He had to wait 24 hours to find out. Great episode, if you haven’t seen it.

Or it’s like hydroplaning on the highway, trying to figure out which way you need to turn the wheel so you don’t crash. That actually happened to me. I don’t think I turned the wheel the right way. I ended up going backwards in the median, wondering what was going to happen to me when the car finally stopped. Thankfully, miraculously, nothing happened. Except to my car. Which I got rid of.

I found out in the book “The Art of Racing in the Rain”–which is a fantastic book, if you’re looking for something to read–that when you’re hydroplaning, you actually need to accelerate to engage the wheels. It’s a fictional account, but that makes sense to me. So now I drive really slowly in the rain so that I can speed up if I start to skid.

But I digress. The reason why having a mental illness is like the Fugu puffer fish and racing in the rain is that there are so many things you have to do to maintain your balance, and it takes so little to throw it off.

Take sleep, for example. I am a night owl, but I’m not supposed to stay up late, because reversing my sleep cycle triggers a depressive episode. But when I try to go to bed earlier, I can’t fall asleep because my obsessive brain is wide awake, chatting up a storm. I am also supposed to wake up early, but I’m usually too freaking tired. And because I need more sleep than the average person, I still have to take a 3 hour nap.

I have similar difficulties regarding eating that is equally complicated because of my inability to wake up early, restrictions in what and when to eat because of my GERD, my tennis schedule, my inability to tell whether or not I’m hungry, and that I hate planning meals, grocery shopping, and cooking.

I also have to manage my anxiety by avoiding almost everything, lately–Facebook, the news, conversations about Trump, certain family members, relationships, looking at my schedule for the week so that I don’t get overwhelmed (which has gotten me into trouble with my colleagues).

Despite all of this effort I put into maintaining my mental health, I frequently wake up feeling anxious or depressed or both. Because it’s impossible to keep all of this stuff in balance. Which really frustrates me. Sometimes I’m mad at God. Sometimes I wonder if it’s all worth it, all this work to be mentally stable given that I am inherently unstable. Sometimes I feel alone in it, because despite having my brother and friends to talk to, in those moments when you’re lying in bed trying to find a reason to face the day, there’s no one who can really be there for you.

Thankfully, those moments usually pass, often some time later that day. Or at least they fluctuate throughout the day. Or I’ll go play tennis.

On a moment to moment basis, practicing mindfulness and self-compassion are the most helpful tools to make the pain bearable, but it still hurts like hell. I remind myself that it’s OK to be in pain. That this moment will pass. That although my thinking may be irrational but convincing right now, at some point I will be able to see things more clearly. That it’s not my fault. I’m doing the best that I can. And then I try to think of things I can do to make myself feel better. Like watching “Trolls.” Really cute movie, if you haven’t seen it.

The other thing that has helped is reading Richard Rohr’s books. The one I’m reading currently, Eager to Love: The Alternative Way of Francis of Assisi, is a much tougher read, but he says some thought-provoking things. Like, he says that the best healers are people who have suffered greatly themselves. I know for sure that my own experiences have made me better able to sit with and relate to other people’s pain, and I know how much better it feels to talk to someone who really gets it because they, too, have suffered greatly.

We all have roles that we have to take on that will involve pain and suffering–being a parent, a firefighter, a soldier, Wonder Woman (I loved that movie, too), just to name a few. Any role entails pain and suffering, really. I guess the difference is whether you’re going to rail against it or accept it–choose it, even–because there’s something that you care about that makes it worthwhile. And because not choosing it just magnifies your suffering.

I know for sure that I was meant to be a healer. Sometimes I wish I could say no thank you, God, but I appreciate your confidence in me. But I can’t, because I really don’t know what else I would do. So if trying to find that balance moment to moment, day after day, helps me to be a better therapist, then so be it. I will choose it.

Appearances Can Be Deceiving

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You know what’s hard about having depression and anxiety? Having to go about your day, looking like you feel fine when you’re not. I know everyone feels this way at times, but it’s something that I have to focus on a lot. Like, perhaps people have to prepare for the possibility of a thunderstorm every now and then, but it is a daily threat for me. So I always have to carry an umbrella and think about what shoes I want to wear. Whether my outfit is appropriate. Whether or not I’m at risk of getting struck by lightning.

But then again, perhaps I underestimate how bad the weather is for everyone. Because when I listen to my clients and read my friends’ Facebook status updates, I am reminded that there are all kinds of people walking around in pain, looking normal on the outside. We all feel broken in one way or another. It’s so convincing, though, when people look like they have it all, isn’t it? So easy to believe that you are alone in your pain.

When people tell me they read my blog, they always say something about how vulnerable I am in it. They mean it as a compliment, but even though I’ve been doing it for over 3 years now, it always makes me feel self-conscious. Have I said too much? Did they read something that makes me look bad? Do they think less of me as a person? As a psychologist?

Still, it has been worth the risk, both because of how much I have helped other people and because of how freeing it has been. Of all of the things that I have done to battle my demons, blogging has been one of my most powerful weapons. And if there are clients who choose not to see me after reading my blog, I am learning to accept that I can’t be all things to all people.

I realized recently that choosing vulnerability is like choosing love: it’s risky, and you’re bound to get hurt, but it’s better than spending a lifetime trying to play it safe. It’s still hard to put myself out there and risk judgment and criticism, but most of the time it results in a meaningful connection with someone–perhaps even a complete stranger. Because now they know they are not alone. And I am reminded that I’m not alone, either.

Wouldn’t it be nice if more people were willing to take the risk of being vulnerable? If instead of seeming like we had it all together, we could be honest about our pain? I know it would be unrealistic to go around telling everyone about the holes in our hearts all the time. Sometimes when someone asks how you are, you just have to say fine or you won’t have time to get a coffee before your first client. But if you want to know the truth about how I’m feeling, I’ll tell you. And if you read my blog, you will definitely find out.

In Transition

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If you’ve been reading my blog for a while, perhaps you remember my inner infant–that part of me that gets anxious for apparently no reason but has no words to tell me what she’s upset about. I am still like a new parent who is getting to know their child for the first time. It is a very slow, painstaking process. But I came to a realization last week that has been helpful in being more compassionate towards this anxious baby, who I will call Amygdala for scientific reasons that are too technical to get into, but if you’re interested, you can check out this article.

Every morning when I’m getting ready to leave for work, Amygdala gets anxious and I have to say my standard mantra to her: It’s OK. Everything’s going to be OK. You’re fine. Everything’s going to be fine. And when I’m frustrated, I add although I have no idea what you’re anxious about!  Which is not very compassionate, and therefore not very effective in soothing her.

For some reason, last week I realized that Amygdala gets anxious when I am in transition–from sleep to wakefulness, getting dressed, getting into the car, getting out of the car, leaving work, going to play tennis. I imagined what it would be like for a baby during these times, and I could see why Amygdala would be anxious.

For example, when I am spending the night in a different place for the first time, I will often wake up and have a split second where I don’t recognize my surroundings and not remember where I am. Then I’ll be like, oh yeah. I’m at districts. But babies don’t have very good memories, because their brains aren’t fully formed. So for them, every time they wake up, they probably don’t recognize their room. Or they could have been moved to a different room while they were sleeping. And they’re probably like, where the hell am I?! (If it were a baby that cursed, that is.) What am I doing here? Where is that person who is supposed to be taking care of me?!

Or like how when my niece was younger she never wanted to go to dance class, even though she loves dancing and always enjoys it once she’s there. I never understood why kids do that, since I’m not a parent. But I do know what it feels like to be all content doing whatever you’re doing and then having to get up, change clothes, drive somewhere, and see people, even if it’s to do something I love, like play tennis. It’s hard to overcome the inertia of doing nothing. So I can see why that might be upsetting.

But since I’ve realized this, I’ve figured out something more compassionate to say. Whenever Amygdala cries because I am in transition, I tell her that it’s OK, she’s just anxious because we’re doing something different, but once we get there, everything will be fine. And it usually is.

So maybe I’m becoming a better parent after all.

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I found this while I was looking for quotes on transitions. My inner infant has no idea what it means but she thinks it’s funny.

A Compassionate Take on Why Misery Loves Company

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A few years ago I had the pleasure of listening to the the President of Washington and Lee University speak to the parents of the freshman class that year, appraising them of some of the things they could expect to encounter in their child’s first year of college. A frantic call in the middle of the night about something. The transition to being a little fish in a big pond. The Turkey Drop–which happens over this very break, when some poor girlfriend or boyfriend is informed that this long-distance relationship thing just isn’t working out. Hope we can still be friends.

Students in counseling often talk about “losing the breakup.” I like that term, because it so accurately captures that feeling of being left behind with your heart broken, stalking your ex on social media as they post pictures with their new significant other. If I have to suffer, they should have to suffer, gosh darn it! I hope they get what’s coming to them.

It’s true; misery loves company. And sometimes it’s because people who are miserable want other people to be miserable so that we can all feel sucky together. But sometimes it’s not because people are mean and hateful. Sometimes it’s because we don’t want to be left alone in our pain and suffering.

In self-compassion speak, this is called common humanity. It’s one of the things that comforts us in the midst of our pain in suffering. To know that getting your heart broken is an inevitable part of experiencing love. It sucks for everyone. It did not happen to you because you are uniquely unlovable. And it’s not your fault that it hurts so much that your friends are tired of listening to you talk about your ex.

As I mentioned in my last post, it’s that time of year when my inner demon of depression rears its ugly head. It’s better this year. I’ve made it to work every day so far. I have not fallen into a pit of despair. But it’s still painful.

One of the best and most unexpected benefits of having a mental health blog is that, in the midst of my lows, some reader will reach out to me and thank me for sharing my pain because they have known that pain, too, and it’s comforting to know that they are not alone. It is as therapeutic to me as it is to them to know that there are people in the darkness with me, reaching out to me so that I know that they’re there.

Last week, as I was describing to one of my clients the types of obsessive thoughts that often go through people’s heads, she asked me if I knew what this inner dialogue was like because I studied it or from first-hand experience. I was a little taken aback. I’d never had a client ask me directly if I had an anxiety disorder. But I told her the truth. It’s both. I know her pain because I studied it, and I feel her pain because I, too, struggle with it.

I know what it’s like to suffer alone. So I became a therapist. Because misery loves company.

Perception is Reality

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In “A Beautiful Mind” John Nash, a Nobel Laureate in Economics, talks about how he learns to cope with his hallucinations by ignoring him. That is a pretty amazing thing to do for someone who has schizophrenia. There are several disorders in which the person’s thoughts are so convincing, despite being false, that it is difficult to cope with them by deciding that you’re not going to listen to them.

For example, someone with anorexia may truly see herself as being fat, even though intellectually she knows that she is not. But her inner critic is so persecutory in its insistence that she not eat, not take up space in the universe, that she ultimately gives in. People with eating disorders often conceptualize their inner critic as having a relationship with ED, and ED is the most abusive partner I have ever met in therapy.

Or someone who is psychotic might be convinced that he is going to win a million dollars because Publisher’s Clearing House has told him that he may have already done so. And despite the fact that the check has not arrived in the mail after several years, he makes outlandish purchases based on the prize money that he is convinced is on the way.

I do not have delusional thoughts, but sometimes my obsessive brain tries to convince me of things that are not as insidious but still cause me to suffer. No one gives a crap about me. I am incompetent. Sometimes I can convince myself otherwise with objective evidence, but sometimes my inner critic is relentless in trying to convince me of the veracity of these assertions. It will repeat them hundreds of times a day. The effort to refute them is exhausting.

My psychiatrist tells me that I should put myself out of my misery at the beginning of this barrage by taking an Ativan as soon as the thoughts begin. But often I don’t because, despite all I’ve said about the importance of taking meds, sometimes I still don’t want to. And because, unlike depression, anxiety feels so normal that sometimes I forget that it is not. The meds definitely help. Most of the time I know that when the thoughts come, they are not true. But sometimes it takes a lot of work to keep them at bay.

Practicing mindfulness helps, too. One of the benefits of practicing is that it helps you understand the nature of the mind. Even for “normal” people, this is how the brain works. Random thoughts will pop up. They may not be based in reality, may not reflect what you actually believe. And in the next moment, the thoughts may be completely different.

But it’s really hard. Maybe if I dedicated my life to meditation like Buddhist monks do, my inner critic would be less effective in undermining my self-worth. Or maybe Buddhist monks don’t suffer from mental illness.

But my psychiatrist supports my mindfulness practice, in addition to my meds. He confirmed that it works, even for people with mental illness. But it takes a long time, and it happens very slowly. I know it works because I remember what I used to be like. And now when I go several days without meditating, in my moments of weakness the thoughts creep in and become more convincing.

So I continue to practice, and in the moment, I feel loved, competent, and worthwhile. So I’m writing this post to remind myself that this is true because, in the next moment, I may feel differently.

Strength and Weakness

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In a previous post, I wrote about how using post-apocalyptic strategies to motivate yourself by turning everything into a crisis is not an effective way to manage your psychological resources. If you use shame and fear to motivate yourself–Get up and go to work, you loser! You’re just being weak and lazy!–it may work, but there’s a high price to pay.

Last week my 40 year old brother, the one who struggles with depression and anxiety, had a mild heart attack and had to undergo quadruple bypass heart surgery. They said it was amazing he was walking around at all, given that his arteries were 99% clogged. The only reason he saw a doctor is because he felt guilty for being too weak to go to work and wanted medical evidence to verify that he wasn’t just being lazy.

In fact, because he thought he was just being weak, he tried to overcome his fatigue by drinking Red Bull and forcing himself to do rigorous cardio workouts.Willing himself to commute 2 hours to and from work, to override his anxiety about his job with drill sergeant self-talk. And it almost killed him.

I’m beginning to think that reincarnation isn’t just about life after death. It’s about the opportunities for rebirth, here on earth. That’s why we celebrate the new year. Birthdays and anniversaries. That’s why people who go through personal tragedies often say that the experience saved their life.

Before the surgery my brother felt like his life wasn’t valuable because his depression and anxiety made it hard for him to hold a job. He’s not married and doesn’t have kids. He hasn’t done anything heroic. The thing that he was the most proud of was his physical strength. But right now plugging in the charger to his phone is challenging and leaves him out of breath.

Apparently it’s common to feel depressed after heart surgery, and given that he’s already prone to depression, I was worried about what his mental state would be. Surprisingly, this is the most at peace I’ve seen him. His goals are different now–to give up stressing about the little things, drill sergeant strategies, and other people’s definitions of success. He is more appreciative of the small things, like being able to sit without being in pain. And, perhaps most importantly, he finally understands how strong he is.

This ordeal has been helpful to me, as well. I still struggle with feeling weak and pathetic because I can’t do the things that other people do. My colleagues are able to handle their case load and responsibilities without becoming depressed and suicidal at the end of the term. Our services are in high demand, which is good for job security but not good for setting limits. I feel pressure to push myself beyond what I know I can handle, and I berate myself when I crash and burn.

But to see the undeniable evidence that my brother was insanely mentally and physically tough when he felt weak and irresponsible reminds me that I am strong, too. I don’t need to prove it by pushing myself to my breaking point. Trying to live up to other people’s expectations isn’t worth dying over. I’m going to accept my limits without being ashamed. I’m going to start standing up for myself. I’m going to say no when I know it’s too much.

One of the most valuable lessons that my brother learned from this experience is that you don’t have to train yourself for every possible crisis to prove that you’re strong. You can just have faith that when you need it, you will have the strength to face whatever comes your way. That you already have everything you need to survive.

The Cost-Benefit Analysis of Pain and Suffering

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It was 7 years ago that I had my most severe depressive episode. It began because I decided to try to wean myself off my meds. It was a reasonable thing to try; I had been stable for a while. I got off them very gradually. By the time I was completely off them in January, I could feel the difference immediately. I was a little more easily irritated without them. Things were a little more painful. But I was willing to live with the pain if it meant that I didn’t have to be on meds.

But then things got worse. I remember being on vacation in February and screaming at my husband over fairly insignificant things. I don’t even know how he put up with it. And the last straw was some tennis drama thing in March that would not seem serious enough to make my mind unravel, but that’s how depression is; sometimes it doesn’t make any sense.

It took a long time to get back to “normal,” and I often berated myself for this costly mistake. For sacrificing my mental health so that I didn’t have to take that little pill every day. Now I have to take a bunch of them every day, twice a day, but I do so religiously, because I will do whatever it takes not to feel that way again.

Lately, since I’ve been practicing self-compassion, it strikes me how the road to recovery is complicated by our unwillingness to give up our suffering. Who knows why. Because we don’t believe we are really suffering. Don’t believe we deserve to be free of our suffering. Think we should be able to free ourselves on our own, without help, without drugs.

So taking each of those steps is a long and arduous process. I was depressed in high school but didn’t go to my first therapist until I was 25. The first time I went on antidepressants I was 30. I went back on them when I was 35 and went off them again when I was 39. By the time I was 40, a good 25 years after I first experienced depression, I accepted that I needed to be on meds for good.

Before this last depressive episode, I used to present a more neutral position on medication to my clients. But now I encourage them to give it a shot. I tell them that everyone is willing to tolerate a certain amount of pain in order to be able to say that they are not on meds, but I encourage them to ask themselves at what point this is no longer a good tradeoff.

Had someone phrased the question to me in that way, perhaps I would have taken them sooner. But I did not know how to practice self-compassion back then. I did not understand the concept of being kind to myself because I was in pain. I was not motivated to alleviate whatever suffering was under my control. Because so much of anxiety and depression are not in your control. But asking for help, going to therapy, taking your meds, and learning how to care for yourself are in your control.

I’m not going to lie–depression and anxiety still cause me quite a bit of suffering. Anxiety, in particular, has been kicking my ass today. And being diligent about all of the things that I have to do to strike that delicate balance of mental stability is effortful and time-consuming. But in a cost-benefit analysis, it’s still worth it.