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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.

Where the Heart and Mind Meet

Heart and mind

Last week I had someone contact me out of the blue because she needed to interview a mental health counselor. She heard about me through her aunt, who directed her to my blog. I like being interviewed, and I like being helpful, so I said yes. One of her questions was what my theoretical orientation/approach is. I haven’t answered this question in a while, and the longer I practice, the harder it is to answer.

These days I would say that I teach people how to accept and tolerate pain. Which is not a popular response for some clients. Usually their goal is something like, help me get rid of my pain. And believe me, if I had the power to do that, I would. It’s just that pain doesn’t often work that way.

We believe that we can make our pain go away because we think we have more control over our feelings than we actually have. This is a misconception of what it means to have free will. Not everything that happens in our minds is a matter of choice.

For example, I struggle with being obsessive. This seems like it should be under my control, since I should be able to stop my obsessive thoughts. In fact, for a while, one popular cognitive-behavioral therapy (CBT) technique was called thought-stopping. For some reason, it took decades for researchers to figure out that this doesn’t actually work.

I still try it, though. I tell myself to stop obsessing all day long. In fact, I do all of the CBT strategies that are supposed to help. I challenge my irrational thoughts. I avoid the word “should.” I use positive language. Practice gratitude. But still. The obsessing continues. To those people for whom being rational is sufficient to stop your pain, all I can say is, lucky you.

Most people don’t like medication because needing it seems to signify a lack of control, which signifies personal weakness. I have to admit, I had the same bias. If you read my blog, then you know it took me many years to start and stay on my meds. Even now, I try not to use them until the obsessing becomes unbearable. But then my psychiatrist phrased taking my meds as a way to have control over my anxiety. A novel idea. I like control. So now I take them sooner than I used to.

These days I tell clients to ask themselves, how much pain are you willing to tolerate in order to say that you don’t need meds? Rather than feeling like a failure because they need meds, they can think of taking them as a choice to alleviate their suffering.

The other thing I do is teach clients how to practice self-compassion. All of those rational strategies work better if you express compassion for your pain first. If you say things to yourself like, obsessing is painful. I’m sorry you have to be in pain. It’s not your fault that you can’t make it stop. Why don’t you try ______ and see if that helps? And I go through my arsenal of strategies until something helps. Or until the obsessing subsides.

Having compassion for my suffering frees up some of the energy that I spend on beating myself up for not being rational. Which, paradoxically, allows me to have more control. More free will. Perhaps compassion is the place where the heart and mind meet.

Don’t get me wrong–it’s still hard to practice self-compassion. It does not come naturally to me. My automatic response is still to tell myself to stop being obsessive. But there’s no question that it works. My blog is proof of that. Because it’s been a long time since someone has told me that I’m being too hard on myself after reading one of my posts.

In This Moment

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I’ve always been reluctant to tell people what kind of music I like, because it’s pretty mainstream. In fact, I’ll make that #11 on my list–my preference for Top 40. Some of my friends have criticized me for what they consider my poor taste in music: it’s so unoriginal. So superficial.

And it’s true that the lyrics usually aren’t profound, but sometimes they still touch upon universal feelings. That’s why even the sappiest of love songs can be appealing when you have a broken heart.

Yesterday on my drive home the song “Daylight,” by Maroon 5, came on the radio. Every time I hear this song I think of one of the long distance relationships I was in during high school. My boyfriend went to college 5 hours away, so we didn’t see each other often. And when we did see each other, I was so anxious by Saturday about him leaving on Sunday that I couldn’t enjoy our time together. No amount of reasoning could stop me from obsessing.

That’s what happens when you have an anxiety disorder. The things that other people find difficult, like saying good-bye, are intolerable. Adam Levine can still hold her close for one night, even if he’ll have to go in the daylight. I, on the other hand, would obsess about how sad I was going to be when that moment came and would end up ruining the whole evening.

Despite the intensity of my negative feelings, I have often chosen relationships that have been characterized by a high level of drama. Which doesn’t make any sense, I know. You would think that I wanted to be miserable. But love is like a drug–especially in the early stages–what with all the obsession and longing and all. Even though the cons outweigh the pros, you get addicted, anyway, because it’s not a rational process.

My relationships were like an addiction in that I craved connection, but no amount of contact was ever enough. And I would experience withdrawal during even the smallest periods of separation, yet I still preferred long-distance relationships.

That’s why I’m proud of myself for not being in a relationship. I’m learning how to tolerate my fear of being alone. And I’m learning how to live without the addiction of drama. And my behavior doesn’t seem as crazy and contradictory–in relationships, at least.

Other things have helped with my anxiety, too. I resisted meds for a long time, even though people begged me to take them for their sake, if not for mine. But I have to admit, even though I don’t like taking them, they make my anxiety bearable.

I also have a therapist who I can call when I’m freaking out. I meditate, which has helped me tolerate my feelings. And I practice mindfulness as often as possible.

One of my favorite mindfulness mantras is any sentence that begins with “in this moment.” In this moment, I am anxious. It’s hard to breathe. I am in pain. But in the next moment, I will feel differently.

And I always do.

I Prefer Moths to Zombies

I was having dinner with a friend last night, catching up on how the holidays went. I told her that this Christmas was not as stressful as it usually is. But as I related the details, I broke down crying. Because even when things are going pretty well, there are still always crises when you have this much mental illness in your family.

In a previous post I talked about the stress of dealing with a family member who is currently manic. But in all honesty, I prefer the mania to the depression. I’m sure I would feel differently if I had to live with someone who is manic, but luckily I don’t. And regardless of what pole they are in, I still have to keep a safe distance, lest I trigger my own depression and anxiety. Still, when I’m with my brothers or my dad when they are at one of the extremes, I prefer the over-the-top version of their best self than a shell of the person they normally are.

I understand why people with bipolar disorder don’t want to take their meds. I didn’t want to take my meds, even though they made me feel much better. People use drugs to create the feeling of mania. So it’s understandable why someone would not want to take a drug that keeps them from experiencing the highs.

I’ve had hypomanic episodes, and they were great. I had energy, despite my lack of sleep. I was productive and creative. And I didn’t do any of the destructive things that my family members do when they’re manic, like spend all their life’s savings. Or quit their job, move to another city, and become a dance instructor. Or get kicked out of a bar for starting a fight with someone because they’re certain that guy was making fun of him.

The most extreme thing I can recall is that I made mixed tapes for each of my brothers, and they all had different songs on them. That’s like, over 100 songs. For those of you who are too young to have made a mixed tape, it is way more time-consuming than burning a CD from iTunes.

Plus, there was no crashing and burning after my hypomanic episodes. If anything, the hypomania was a reprieve from the depression. Still, I have no problem giving them up in order to have stability in exchange.

I do have one brother who consistently takes his meds and has been stable for years now. He could be the poster child for bipolar disorder, illustrating how it’s possible to live a normal life if you’re compliant with treatment. The other two, however, live most of their lives at one extreme or the other.

I was looking for a picture of my niece the other day and ran across a picture of my dad while he was depressed. I had to turn away. Any of the pictures taken from that 4 year period make me want to cry, because he looked like someone who was barely alive. Ordinarily he is larger than life. Unforgettable. But when he’s manic, he is a moth to a flame and believes he’s fireproof. But when he’s depressed, he is a zombie, sleepwalking through life.

If stability is not an option, I prefer the moth.

Crisis

Why I Blog About Mental Illness

Yesterday someone asked me to write a 1,000 word essay on my personal experience with mental illness. After I wrote it, I realized that I have never told my story to anyone. I have now added it to the menu on my blog, but I thought I’d include it in a post, too. Here it is:

I come from a family with a history of depression and anxiety. My dad and two of my brothers have bipolar disorder. My mom has an undiagnosed anxiety disorder. And I struggle with both mood and anxiety disorders. Because of this familiarity with mental illness, I played the helping role in my family for many years before I chose my profession. So becoming a clinical psychologist almost felt like a calling rather than a choice.

I first became depressed in high school. It’s hard to separate the angst of adolescence from clinical depression, but I had thoughts of suicide by the age of 15, so I’ll say that it started then. At that time, my diagnosis would have been dysthymic disorder—a more chronic, lower grade version of depression.

When I left for college at 18, I crossed over to major depression. However, I didn’t do anything about it for a year. At 19, I had my first therapy session with a psychiatrist who confirmed my diagnosis of depression. At the time, that was enough to make me feel better—to have someone tell me that what I was going through was real.

So I didn’t follow up with therapy until after I graduated from college, when I was 22. I can’t say I thought that therapist was particularly helpful. He never told me his opinion on anything, never gave me homework, never offered me another way to look at things.

The 3rd time I went to therapy was with my boyfriend right before we got engaged. I was 25 at the time. It was clear that she thought that our relationship problems were because of my depression and suggested that I go on meds, which really pissed me off. We didn’t see her for very long.

Still, she planted the seed of meds in my mind, and I started a trial of antidepressants about 6 years after she suggested it. And it did help. But after a year and half, I stopped taking them because I didn’t want to have to rely on meds to feel “normal.” Then I started them again a few years later when my husband and I started talking about separation.

I also went back to therapy. And she is the therapist who I have seen on and off for 13 years now. Her unconditional acceptance and belief in me, over time, has allowed me to accept and believe in myself. Still, I would see her for as little as I could get away with until I became functional, because I didn’t think I deserved to take up more of her time.

My 2nd major depressive episode happened almost 6 years ago when I was 40. I had stopped taking my meds again, and about 3 months later, I got depressed again. And it was even worse than the first time. It probably took me about 9 months to recover completely.

This time I was not able to just restart my meds and return to normal, so I saw a psychiatrist for the second time. Surprisingly, he was more concerned about things like light therapy, sleep hygiene, and supplements (Omega-3, NAC, Folic Acid) than he was about antidepressants. But I had to take those, too. He also added Ativan, because my anxiety had worsened, and lamotrigine for bipolar depression, because of my family history and my hypomanic episodes.

It was difficult to accept that for the rest of my life I would be on a regimen that requires an AM and PM pill box. But I had suffered so much through this last depressive episode that I got over it and was thankful to pharmaceutical companies for coming up with drugs that could make me feel like myself again.

Since that last depressive episode, I have gotten much better at taking care of myself. Mental health professionals have a tendency to put other people’s needs first, usually to their own detriment. I guess it’s sort of like how physicians make terrible patients. However, my determination to avoid a 3rd major depressive episode has motivated me to make my well-being a priority.

I have never shared this detailed of an account of my mental health history with anyone because I was ashamed of my depression. I felt like a failure. I was supposed to have everything under control, but sometimes I was struggling more than my clients were. But then a few years ago I decided to write a book about self-acceptance where I make use of both my personal and professional experience.

I decided to start with a mental health blog where I would be open and honest about all of the things that I ordinarily try to hide as a way to demonstrate how to practice self-acceptance. Because it’s that hard to do. Even when you know what you’re supposed to do.

Surprisingly, readers are more interested in my personal experience than my expertise. Although I think it helps them to know that I am a psychologist, because it’s further proof that everyone struggles. Being an expert doesn’t make you exempt from suffering. From avoiding help. From resisting treatment. It is all a process that slowly improves with time. And as I blog and get feedback from readers, I become increasingly more comfortable with being me.

So even though I started this blog to help other people, it has turned out to be the best gift I have ever given to myself.

Happiness vs. Mania

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In my family, sometimes mania can look like anger, irritability, and paranoia, but most of the time it looks like happiness. It looks like the life of the party. The person who lights up the room. The person who leaves a lasting impression because his energy is so infectious.

I admit, I’ve had hypomanic episodes, and they did feel good. I become a more extreme version of the way people already see me: happy, loud, and energetic. But there are things that I do that are uncharacteristic. I will compulsively shop rather than obsess about money. I don’t need much sleep. I attract a lot of attention from guys.

Often mania is followed by depression, but that isn’t the case for me. In fact, sometimes I would intentionally will on a hypomanic episode to pull me out of a depressive episode–to get me out of bed, make me be productive. And it worked, too. Often it was the first step toward getting out of that dark hole. Still, with my family history, I am hypervigilant of any signs that I may be heading in that direction.

That is definitely one of the things that distinguishes me from the rest of my bipolar family. Because they never think they are manic. Once my brother wanted to scale the wall outside of a restaurant, but he knew this seemed crazy. So he preemptively reassured us that he was not manic; he just really wanted to climb that wall.

One of my family members is manic right now. This summer I finally worked up the courage to tell him this, and of course he disagreed. But it wasn’t completely pointless, because he did agree to see a psychiatrist. But since you can’t force someone to take meds, he assumed that the psychiatrist confirmed that he wasn’t manic, since he didn’t prescribe lithium or an antipsychotic. At least he started taking the meds that prevent bipolar depression, which is what I was the most concerned about. But then again, I don’t have to live with him.

And thank God for that. Because it’s unbearable to be around him for more than a few minutes at a time. What may seem entertaining to other people is absolute torture for me. It’s a terrible feeling to love someone but to not want to be in their presence. It fills me with guilt and makes me feel like a bad person. But I have my own sanity to protect, so I do my best to keep my distance.

I wish I could end this post on a positive note and say that things are looking up. But that would be lying, and this blog is about honesty. He’s still manic. Things are getting worse. And I am powerless to do anything about it.

So I just pray and hope for divine intervention. And if you believe in the power of prayer, then perhaps you can say one for my family, too.

Darkness and Light

Sometimes I feel like a less murderous version of Jekyll and Hyde. That’s one of the reasons why it’s so hard to get my sleep cycle under control.

I feel the most alive late at night. Before I go to bed I have all these ambitious plans for what I’m going to get done the next day. My mind is racing with ideas for my blog. It’s all I can do to keep myself from starting a post at 3 a.m. But I can’t, because I’ll run the risk of staying up all night and reversing my sleep cycle. A big no-no when you struggle with depression. So I take drugs to force myself to fall asleep, even though I like this version of myself the best.

By morning that cheery, motivated version of me is replaced by this sullen person who prefers sleep over life itself. No amount of yelling, begging, or bribing can get her out of bed before she wants to. And even after she gets up, she’s still in a bad mood for several hours. Why would anyone want to go to sleep at night if that’s who you have to face the next day?

In Jungian psychology, Jekyll and Hyde is an example of the persona/shadow archetype. Jung argued that, although most people would prefer to identify with their persona, it is important to acknowledge our shadow in order to be whole. Dr. Jekyll is so horrified by his dark side that he commits suicide in order to destroy it–which is the exact opposite of being whole.

This blog is probably the first time that I’ve publicly acknowledged my shadow. And I have to say, it is the thing that people thank me for the most. Because it gives them permission to acknowledge their own darkness. It assures them that they are not the only ones who feel and think the way they do. So Jung has a point. Who would have thought that acknowledging one’s darkness would be the thing that makes people feel the most connected to one another?

So maybe I shouldn’t be so hard on that sullen person I will see when I wake up tomorrow afternoon. She’s given me a lot of material for blog posts.

Mental Hygiene

Negativity is like a virus. Even if you are vigilant about taking your meds, challenging irrational thoughts, praying, meditating, and practicing self-acceptance, forgiveness, and compassion, it just takes one negative comment–one careless psychological sneeze–and you’re contaminated.

I’ve had 3 people sneeze on me today. In an effort to avoid contaminating you with too much negativity, I’ll just tell you about the most egregious of the 3 incidents.

I had my follow up appointment with my psychiatrist today. Thank goodness I only have to go twice a year. It’s a 3 and 1/2 hour drive round trip for a 30 minute appointment, and there’s very little about that 30 minutes that is therapeutic. While my psychiatrist knows his drugs, he’s not a particularly good therapist, to put it mildly. Which is OK, I guess, because I have a therapist. But I have to talk about something.

Because I have chronic sleep issues due to my night-owlness, I confessed that I’ve been struggling with regulating my sleep cycle now that I’m not working. Every time I tell him what time I go to sleep and wake up, he makes this judgmental face that looks like he just sucked on a lemon. Then he proceeds to tell me what the research says about the importance of waking up at the same time every day, especially when you have a history of depression. How I need to get morning sunlight, I shouldn’t take naps, I need to be more disciplined, blah blah blah.

I am not good at constructive criticism, but I did manage to say that I’m trying. That I spend an inordinate amount of time obsessing about sleep. So much so that it probably interferes with my sleep. He can read my blog if he wants proof.

But I wish I could say something more honest. Something like, you make me feel like crap when you make that stupid face and give me a lecture on sleep hygiene that I already know by heart because I am a clinical psychologist, in case you’ve forgotten. Every time I see you, you just give my inner critic ammunition to tell me how I’m failing at sleep hygiene and that I suck. You are supposed to be helping me with my mental health–not making it worse. Oh, and by the way, your waiting room smells like mold and you need to clean your freaking office and water your damn plants. It doesn’t reflect well on you that your plants are dying! 

But I don’t want to come across as being too negative.

Does anyone ever give their doctor honest feedback when they do something unhelpful? I try to imagine what my reaction would be if a client brought to my attention that my facial expression conveyed blatant disapproval of what a terrible job they’re doing of trying to get better. It would be a shock, no question. But I don’t want to convey disapproval and judgment, so I think I would want to know. I think I would try to be more aware of my facial expressions. But as I mentioned in a previous post, we are terrible predictors of how we will act in the future. So maybe I would just be pissed off.

Maybe I can think of this as an opportunity to practice constructive criticism. Maybe I’ll talk to my therapist about it and see if she thinks it’s worth it to say something. Not what I wrote above, of course. But something.

Or maybe I could just tell him that my latest blog post is dedicated to him so he should read it. That would be hilarious!

I’ll let you know what I do. In the meantime, I encourage all of you to do your part in preventing the spread of negativity. Please remember to cover your mouth before your criticize. (And not in that passive-aggressive way where you cover your mouth while you fake cough and mumble something critical under your breath, either. You know what I’m taking about.)

I think this doodle looks like germs.

Telepathy

I went though a period where I was really into books about Near Death Experiences. It started when I went to this training on positive psychology, and the presenter said that the book My Descent Into Death, by Howard Storm, is the only written account of someone who went to hell before he went to heaven.

I already knew all the stuff about positive psychology since that’s one of my areas of expertise, but the story about this guy got my attention. I had to find out what someone could have done that would be bad enough to go to hell. It was surprisingly innocuous. But I’ll save that story for another post.

One of the things that struck me the most in the book was Storm’s assertion that we are capable of communicating with other people without words and across space and time. I’ve always felt this was true–especially with people whom you’ve known. You know that expression about someone tugging at your heartstrings? That’s how I imagine it happens. Some invisible wire connects your heart to theirs when you meet someone, and you can communicate with them through this wire.

I actually tested this out last week. I was thinking about this guy and I texted him later to find out if he could feel it, and he said he did. He named the time of day and everything. And he’s not someone who would ordinarily be thinking about me.

Sometimes I’ve tried to communicate with people after a break up. Usually there are things that I want to say that I no longer have the opportunity to say. Things that I could never say in person, or that I didn’t realize at the time.

For the longest time I was mad at my first husband for ruining our marriage. But every now and then I’ll remember something about the way I treated him, and I’ll tell him that I understand why he had to leave. That I’m not mad anymore. It makes me feel better to think that I can still tell him things, even if we never see each other again.

This is also the book that went into great detail about how angels play a role in our day-to-day life. So when there are important messages that need to be delivered, I pray that God will send an angel to someone. My high school teacher and her daughter recently lost their husband/father, so I’ve asked God to send extra angels their way to surround them with strength and love. He can even take some of mine if they need more. Sometimes that’s what I do for clients, too, when I don’t know how else to help them.

You know that confrontation problem I mentioned in my last post? So far, the closest I’ve come to telling him that he needs to get on meds is to ask an angel to whisper it into his ear while he’s sleeping. Because if the message comes from God, he might believe it. If it comes from me, not so much.

Maybe I can even do the same thing I did with my friend: ask him if he’s gotten any messages from God lately. If nothing else, it could be a good opening for the conversation.

Interventions

I’m not good at confronting people. Which is ironic, because one of the things I do in my job is coach students on how to confront their friends about having an eating disorder. And I think I give pretty good advice, too. But I guess I’m not as brave as these students are.

Because confronting their friend will most likely put a strain on their relationship. It’s rare that the person who is being confronted says, you’re right. I do have a problem and I want to get help. Thank you for saying something. Confronting them may just be one step in a long series of steps toward getting help. It may not get the person into the counseling center right away, but it may plant the seed of recovery in their mind.

I’ve had many clients with eating disorders acknowledge that even though they would have denied having a problem at the time, they still wanted someone to say something about their 30 pound weight loss. And I’ve heard many clients in recovery say that although they were mad at the people who tried to help them at the time, they played an important role in the process of accepting their disorder.

I know all of this, but I’m still afraid to do it. Maybe they’ll be angry and yell at me, and I hate being yelled at. Or maybe something else will happen that will feel terrible, but I can’t put into words what it is that I fear. So I have to think about what day I want to ruin. What day I want to be incapacitated. I haven’t found that day yet. But I need to, because I gave my word that I would say something.

I don’t even have to do it in person, since I live so far away. I just have to make a phone call. And in my defense, I have tried to call a few times, but the whole time I was praying that he wouldn’t answer. Luckily for me, he didn’t. He never answered and never called back, which is unusual. Perhaps he knows why I’m calling, and he doesn’t want to have this conversation, either. Which makes it that much harder to force it to happen.

I ordinarily pride myself on accepting challenges, mental toughness, and doing the right thing. But in this case, nothing has motivated me to move closer to having this conversation. Not prayer, or meditation, or talking my therapist. Not even guilt and shame.

So I thought I’d blog about it and see if that helps. I’ll let you know.