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Declaration of Independence

I am working with a client who was sexually assaulted and is thinking about taking her case to our judicial board. We talked about the levels of awareness that she went through before she could be ready to take this step. How at first she didn’t want to acknowledge what happened. Then she opened up to a few people who felt safe. Now she wants to make sure he understands that what he did was not OK. To force him to think about it the next time. She hopes to eventually share her story at Take Back the Night so that other people can benefit from it.

She knows that there will be people who won’t believe her. Who will blame her for what happened. She prepares herself by reminding herself that as long as she knows what happened, that’s all that counts. But that’s a hard thing to do–to face the judgment within us and around us. It takes a lot of courage to face that kind of scrutiny.

I like to think of this process as a kind of declaration of independence–from our demons, from judgment, from fear. It happens every time someone goes to AA and admits they’re an alcoholic. Every time someone finds the courage to say I have an eating disorder. I struggle with depression. I live in fear. In making this declaration, they take away the power that their condition has to make them feel weak. Defective. Crazy.

To a lesser extent, I think of my blog as a kind of declaration of independence. I’ve tried to hide these things about myself all my life. I don’t want to be held hostage by them anymore. I want to be able to embrace everything that makes me who I am–especially the things that I am ashamed of.

The president of the student organization I advise, Active Minds, told me that he reads my blog, which kind of freaked me out at first. But he thought it was the most powerful way to fight stigma and to let other students know that they are not alone in their struggles with mental illness, which is the primary goal of Active Minds. So he is finding ways to give students the opportunity to make their own public declarations. It is a wonderful feeling to know that this has come out of my willingness to share my vulnerabilities.

I’ve always liked the expression that freedom isn’t free. You have to fight for it. Although blogging has been a surprisingly supportive and positive experience, I am well aware that there will be times when someone will judge me for what I say. I try to prepare myself for it by doing what my client is doing–to remind myself that ultimately, the only person who counts is me. Then I take a deep breath and hit Publish.

Declaration of Independence

The Battle Against Depression

I really wish that so much of my existence did not revolve around obsessing about sleep. I’m tired of writing about it, and I’m sure you’re sick of reading about it. But this is the reality of my existence at the moment, and I am committed to being honest about my current state of mind.
 
Today was another day that was filled with sleep. It makes me feel like such a failure. My colleagues don’t struggle to make it to work because they can’t get out of bed. The physicians in my family never even take a sick day. Some depressed people manage to take care of their families. I can barely take care of myself. What is my excuse for my weakness?
 
Then I thought of physical conditions that leave people debilitated. Migraine headaches. Chronic Fatigue Syndrome. Lyme disease. Do the people who suffer from these conditions feel paralyzed with guilt and shame when they can’t get out of bed? Or do they accept their fatigue as being part of their illness rather than a personal failing?
 
I think about the recommendations I give to clients who are depressed. Exercise. Get sunlight. Be social. Regulate your sleep cycle. If someone had the flu, you would tell them to rest. Listen to your body. But with depression, we tell people to ignore what their bodies and minds are telling them and to do the opposite. Fight it! Don’t give in!
 
Don’t get me wrong. I do all of these things when I can, and they work. After sleeping most of the day, I forced myself to do laundry, get some lunch, wave at my neighbors, put together my tennis schedule for the new league, and play tennis for 3 hours to make up for my lack of steps from yesterday. And I’m writing this blog post now.
 
Because if I gave in to the desire to do nothing, I wouldn’t really be trying to get better. I wouldn’t be taking responsibility for my illness. But I don’t think it’s fair to hold it against someone if their depression is so severe that it’s too much effort to go outside and get sunlight. Because sometimes I’m that person, too.
 
When I have a client who cannot will themselves to follow these recommendations, I don’t judge them for it. But I tell them to keep trying to do them. And no mental health professional that I know would tell a client that if they felt like they need to sleep they should listen to their bodies and rest.
 
There is an article circulating on the internet about how for some depressed people, positive reframing doesn’t work. Telling the person to be positive actually makes them feel worse. That it’s better to support them by expressing empathy for their feelings.
 
Perhaps someday, researchers are going to find that listening to your body when you are depressed is sometimes more effective than fighting it with wakeful activities like forced exercise and socialization–two things that can be difficult to do even when you’re not depressed.
 
I’m going to do my own case study to see if this works.
 

A Just World

I am having deja vous.  Before last term, we had not had a student death related to a car accident in over 10 years. Yet once again, another student died in a car accident earlier this week. Like the student last term, this student was very involved and visible in the community, was known for helping others, and was on the verge of graduating with a bright future ahead of her.

We tell students that there is no right or wrong way to grieve. But some coping mechanisms are more hurtful than others. She was probably driving too fast. People shouldn’t drink and drive.  Stupid people die. 

When I was a graduate student, one of my favorite theories was the Just World Hypothesis. Because we want to believe in a just world, when something bad happens we assume that the person must have done something to deserve it.

I often hear just world explanations after a sexual assault. She was making out with him on the dance floor. She went back to his room. She didn’t fight it so she must have wanted it.  

The Just World Hypothesis is closely related to the problems with free will and blame. In order to preserve the belief that we control our destiny, we are willing to take responsibility for things that we don’t actually have control over.  

I can understand the need to believe that if you make the right choices you will be safe from harm. I want to believe this, too. Usually my attempts at control manifest themselves in perfectionism and excessive guilt.

I don’t know how much blame a person should be held responsible for. I don’t know how to make sense of all of the suffering in the world. But I know that the more I blame someone, the less compassion I have for them.

So I try to approach suffering in the same way I try to accept my feelings: it doesn’t have to make sense. I don’t have to know the reason why for suffering to exist. And I try to have faith that when something bad happens, I will be strong enough to handle it.

No Good Reason

Most people who come to therapy for depression berate themselves for not having an excuse for their feelings.  Even when they can identify the stressors that led to their depression, they claim that these aren’t good enough reasons to be depressed.

Sometimes people try to make them feel better with the “count your blessings” approach.  This usually makes them feel worse, because now they don’t deserve to be depressed since they have so much going for them.

In cognitive-behavior therapy (CBT), therapists challenge irrational beliefs as a way to help clients see that their depression isn’t logical.  Sometimes this works.  But sometimes they know their depression isn’t logical, and pointing this out makes them feel even more ashamed for not being able to control their feelings.

For clients with the “no good reason” problem, I have found that the most useful strategy is to debunk their myths about feelings.  Since you probably believe these myths, too, I thought I would go through my whole therapy spiel.

1.  Feelings don’t have to be rational.  That’s why philosophers make such a big deal about distinguishing reason from emotion.  Sometimes they coincide, and it feels better when they do.  It feels better when we can say I’m sad because I’m sick of winter versus I’m sad and I have no idea why.  But we don’t have to know the reason why for our feelings to be valid.

2.  There is no right or wrong way to feel.  We have a lot of implicit rules for what we should be feeling in a given situation.  Take my Ph.D. example in my post on self-worth.  I thought I would feel ecstatic after defending my dissertation.  Instead I got depressed.  Positive events don’t always lead to positive feelings.

3.  We can experience positive and negative feelings at once.  Researchers say that we can’t do this, but I think they’re wrong for reasons that are too complex to explain in this blog.  But I’ll give you an example to prove that I’m right.  People cry at weddings because they are both happy and sad at the same time.

4.  Your feelings aren’t your fault.  We like to believe that we have more control over our feelings than we actually do because…well, because it makes us feel more in control.  But this illusion comes at a cost.  Which is why I wrote the posts on blame and free will.  You didn’t choose to be depressed, and it’s not your fault that you can’t stop the depression.

5.  If you try to make yourself stop feeling, you’ll just make things worse.  Because this will involve some level of deception, like denying or suppressing or minimizing your feelings.  And at some point, this will blow up in your face when you least expect it.  Plus it will make you less empathic when other people tell you how they feel, which will lead to relationship problems.

Although I can write logically about these myths, I still fall prey to them, because feelings aren’t always logical.  Knowing isn’t enough to solve the problem; you still have to practice.  Which is why I practice mindfulness and self-acceptance.  And I encourage you to do the same.

So the next time you catch yourself saying that you have no good reason for your feelings, remind yourself that you don’t need one.


Fear of Sadness

Most people find it difficult to tolerate negative feelings like sadness.  This task is even more difficult when you suffer from depression, because any time your sadness feels too intense or lasts too long, you worry that the depression is coming back.  And if you’ve ever been depressed, you know how terrifying the prospect is of going back to that dark place.

Your loved ones also become hypersensitive to your sadness, which just exacerbates your fears.  If you’re feeling down, they ask you if you’re taking your meds, or if maybe your meds need to be adjusted.  Don’t get me wrong–I’m all for meds.  I’ve tried to go off them several times, and each time I got depressed again.  But it’s unfortunate that once you’ve been depressed, every feeling has to be scrutinized for potential pathology.

There’s also this added sense of failure associated with relapse.  Like you should have been able to prevent it this time, since you’ve been there before.  And even though you recovered before, you fear that if it happens again, you won’t be so lucky the next time.

And even if you do recover, you fear that the wait will be agony.  I fear depression much more than anxiety because when I’m anxious I can take an Ativan and I feel better immediately.  But antidepressants don’t work that way, so there’s not much I can do to feel better right away when I’m depressed.

Whenever I am afraid I’m becoming depressed, I journal about my fears, my sense of failure, and my pain.  And when I look back at these entries, I realize how strong I am.  There are a lot of things that suck about depression, but I have no doubt that it has made me a stronger person, even while it tries to convince me that I’m weak.

But how do I know when I’m sad versus depressed?  To be honest, I don’t always know.  Sometimes I feel depressed for a day.  Sometimes I feel sad for what feels like an eternity.  The line is not as clear-cut as we’d like to think.  But regardless of whether it’s sadness or depression, the best I can do is to control what I can control.  This includes therapy, meds, stress management, and self-care.

And most importantly, for me, it means practicing self-acceptance–of my sadness, my depression, and everything else that makes me who I am, for better or worse.

How to Save a Life

A few years ago a client told me that I saved his life. Well, he didn’t tell me directly.  He told my colleague when he was drunk at a gala. But he told her to tell me. Although I’m not sure he remembers doing so. Still, I was humbled by this. I knew therapy was important to him, but I didn’t think his life was in danger. But then again, even when clients are in therapy, they don’t always tell you the full story.

Once I had to cancel a session with this client and he stopped coming in for about a month. Apparently he got depressed because he felt like I had abandoned him. A professor contacted him because he had also stopped going to class. When he came back to therapy, he told me that his professor saved his life. That was the first time I really understood how much therapy means to some clients, even when they say they’re not sure they want to be there.

Last week I went to a threat assessment training, and the first case that the presenter discussed was a student who had to go to the police department because she told her roommate she was suicidal. While she was there, she asked for a piece of paper and a pen. She drew what appeared to be a bunch of random doodles. But later when they looked at the drawing, they saw that she had embedded the word help three times.

This, too, reminded me that people may say they don’t want help but their actions tell you otherwise.

Before I started blogging, I thought blogs were just another example of our narcissistic culture in that journaling, which is supposed to be a private experience, was turned into something that you shared with the world and everyone was free to comment. But now I realize that blogs can be a way for people who have never had a voice to connect with people like themselves.

My favorite blog is by Nelly N. She writes passionately and honestly about her struggles with obsessive-compulsive disorder, among other things. She shares her most painful experiences so that other people who suffer in silence will realize that they are not alone. And it works.

A few days ago the student group that I advise had their annual eating disorder panel. It consists of students in recovery who are brave enough to share their story. On our campus, people with eating disorders are blamed and judged more harshly than any other disorder. Not surprisingly, no one wants to admit to having one publicly.

Every year, at least one student seeks treatment after attending the panel. And the next year, those students volunteer to speak on the panel so that they can help someone else who is alone with their eating disorder. Sometimes they use the opportunity to speak as motivation to get better.

We don’t have to be able to leap tall buildings to save someone’s life. Sometimes heroes are ordinary people who take action when someone needs help.

                    

God’s Will

It feels incomplete to talk about blame and free will without also talking about God’s will.  This one is the scariest of the 3 to write about, but I’m committed to being honest, so I’m making myself do it.

When I was in high school, my best friend’s father died of a heart attack in his early 40’s.  During the funeral, his best friend broke down crying while giving the eulogy.  My friend’s mom calmly took his place, saying that she believed her husband’s death was God’s will so she was at peace with it.

That really bothered me.  I was glad that it gave her comfort, but I could not fathom how God could want someone to die.  If deaths are God’s will, how can it be a sin to commit suicide?  Or murder, for that matter.  Or acts of terrorism.  All of these deaths would just be a part of God’s plan; these people were simply fulfilling their roles.  In fact, sin wouldn’t even be possible.

There is someone in our tennis community who is reaching the end of her battle with cancer.  Although I did not know her well, I was struck by how positive and kind she was when I met her last year.  She was in the midst of chemo at the time, and she was my opponent on the court.  And she kicked my ass.  Which was both impressive and upsetting, given my competitive nature.

I have been praying for her and her family, but I struggle with what to ask God for if death is, in fact, part of God’s plan for her.  I know some people don’t believe in God for this reason.  Or if God exists, they don’t want to worship a God who would allow people to suffer.  I wouldn’t go that far.  It is clear from the life of Christ and the teachings of Buddha, and probably most religions, that no one is immune to suffering.

I accept that, but it’s still hard to tolerate.  I try to imagine what it would be like to be her or her loved ones, but I can’t.  My brain won’t let me go there.  It’s too painful.  Too much to bear.  I can’t envision surviving a loss like that, even though I know that somehow I would if I had to.

I do my usual prayer.  Because we’re allowed to ask, even if we don’t always get what we want.  God, if at all possible, please let her have a miraculous recovery.  And then I say a more realistic prayer.  Please minimize their suffering to the extent possible.  Please  surround them with love, to mitigate the pain. 

I am no theologian, but based on the story of Adam and Eve, one thing is for certain: God wants us to have free will.  We, too, have the power to say no.  We can choose not to follow God’s plan.  We can choose not to love God, or not to love at all.

In the midst of tragedies, the people involved always say that they are humbled by the outpouring of love and support from people they don’t even know.  That it does mitigate the pain.  So I will continue to pray for this member of the tennis community and her family.  If love can ease their pain, then I will choose love.