Identifying and Accepting When External Events Are Hard

Of late my to do lists have been piling up in a stressful way. I get home from work, and instead of jumping in to my blogging or editing, I just fall into bed and play Pokemon for 5 hours. Now I’m not one to knock playing Pokemon for 5 hours, but this is leaving me feeling like I’m being lazy and useless, and the things that I had intended to get done don’t get done…which means more on the list for the next day.

Of course my first impulse on seeing that is to get angry at myself. I berate my lazy self and ask why I can’t just do my work. I tell myself that I have tons of time, that I wasted time doing something unproductive. And I get more and more frustrated that I can’t seem to focus.

Now (totally unrelated) to all of this, I increased the dose of my antidepressants a few weeks ago and have been dealing with some nasty side effects since then. Serious exhaustion, twitchiness, anxiety, heartburn like a mofo (up to and including vomiting), and a complete inability to tolerate alcohol of any kind.

Wait, what’s that you say? Spending multiple nights puking and incapable of sleeping will affect one’s ability to get their work done? Messing with your brain chemicals takes time to adjust and might mean you have to cut back on other work for a while? Sometimes your body and brain require care that doesn’t allow you to keep going at your normal pace?

Of all the ironies in my life, I think my inability to recognize and validate my own mental health as an actual legitimate concern in my life is probably the best one.

Despite the fact that I’ve been bitching about these side effects to anyone who would listen for the past two weeks, it took until yesterday for me to realize that the reason I have felt so behind and had so much difficulty with my work recently is because making this transition is affecting me. And it took that realization for me to accept that I might need to take things easy until I can get my brain sorted out.

This is one of the most difficult things for people with mental illness, or at least I have witnessed people with mental illness struggling with it. We’re willing to accept when we need to make accommodations for ourselves, we can accept when our bodies start to give out, but so often I and others with mental illness discount external factors that might exacerbate our mental illness, or just make life harder. I’ve had multiple therapy sessions in which I walk in thinking I have nothing to talk about and halfway through my therapist will say “Sounds like there’s been a lot going on. A lot of stressors. How are you handling that?”

The question usually confuses me because I forget that much has been going on.

I suspect that for many others, just like myself, when you’re used to operating on full anxiety alert all the time, it’s hard to recognize when that anxiety really does match what’s going on around you. That means that it’s hard to cut yourself slack when the world really is making things harder for you. That’s one of many problems with living in a state of constant crisis. You cannot recognize and deal with actual crises.

With the realization that a change in medication is actually a pretty big shift and these side effects are really hindering my ability to do anything, I’m cutting back on extra stuff. Going into survival mode until I can get back in to my shrink and get a different med. That’s ok. It’s temporary. But I wouldn’t have done it if I hadn’t realized that bad medication is a minor crisis that needs to be dealt with.

So if you’re noticing that you’re falling behind and feeling overwhelmed with everything…it might not be the time to try to get rid of those emotions. It might be time to listen to those emotions and see if there’s something going on in your life that needs addressing. It’s far too easy for us to invalidate ourselves, since we spend so much time dealing with emotions that don’t make sense, but sometimes we do need to trust those emotions.

You got this friends. And so do I.

Now excuse me, I have more Pokemon to play.

Featured pic is me, self caring.

Taking Anti Depressants Is Actually Really Hard

Last night I got drunk. Really, surprisingly drunk.

That in and of itself isn’t news, nor is it something much of anyone needs to know. It’s the why of it that’s important. You see I am not a heavy drinker and I don’t usually get drunk, definitely not on Wednesday nights. I just went out and had a couple ciders with a work contact. Normal.

Except that less than a week ago I doubled my dosage of my anti depressants. And so halfway through my second cider everything went swimmy and it was hard to focus on words and faces, and it was taking all my concentration just to nod at the right times in the conversation.It was completely unexpected, and entirely disorienting.

But more than that it meant I had to call my boyfriend for a ride home because I couldn’t drive, and cancel plans to see a family friend one last time before she flew home to Germany, and couldn’t do the last hour of work that I had intended to do that night. It interfered with my life to become suddenly, unexpectedly drunk.

Ok, so I’ll take full responsibility for the fact that I drank. I made that choice and I didn’t have to. But what’s difficult about meds that many people don’t always get unless they experience it is that your body will react to all kinds of things in unexpected ways. You can’t always predict how your body will react. There are side effects galore, and even if you find a med that works for you and whose side effects you can handle, it’s incredibly likely that after some amount of time you’ll need to adjust dose or type because brains adapt and change.

So that means that I will periodically not know what I can reasonably expect from my body most likely for the rest of my life. Sure, I can take precautions. But even as my medications make it possible for me to live my life with minimal intrusion from my mental illnesses, they leave me with different kinds of uncertainties. Will my sex drive dry up if I change meds? Will I start gaining weight? What happens if this one gives me side effects like Effexor, and leaves me shaky and weak for days if I miss a single pill?

One of the things that grates on my nerves in discussions of whether medications are the devil beast that’s ruining everyone or the godsend that’s curing all of mental illness is a serious lack of focus on the actual experiences of people who actually take psychiatric medications. Like most of life, it’s a mixed bag. It’s often confusing. And it often seems as if every time you find something that helps there’s some other effect hiding behind it. For me, meds have stabilized me enough that therapy works. But the downside is that they leave me even more out of touch with my body, and even less capable of predicting how basic things like sleep, food, and alcohol will affect me.

I would really love more discussions of what the actual experience of taking anti depressants is like. So here’s what it’s like for me: it’s incredibly helpful because it gives me some breathing room from overwhelming emotions. I don’t feel completely flooded on a regular basis when my meds are working. But it’s confusing and frustrating too. I’ve had meds with awful side effects, and even the meds with reasonable side effects are annoying. They make me sleepy and hungry, they mean I can only have a half a glass of wine before getting unreasonably buzzed, sometimes I can’t tell if my brain is fuzzy and hard to focus because of depression or because of the medication I take for my depression. It’s a confusing experience. You can never suss out exactly what things (good or bad) come from meds or just from life. But so far they’ve helped. And I’ll accept that.

Treating Depression Is Not Medicalizing Sadness

One of the criticisms I often see leveled at therapy and medication is that it’s turning basic human emotion into an illness. There was a huge outcry of this when the DSM V took out the grief clause from the diagnosis of depression (previously one could not be diagnosed with depression 6 months after a major loss), people often throw this at ADD, and in this otherwise lovely article about chronic depression, one psychiatrist refers to diagnoses like dysthymia as follows: “The ‘thymias’ which the DSMs discover – cyclothymia, dysthymia – are helpful for private practitioners in the States. They provide another disorder to be diagnosed, treated and billed for.” The author follows this up with “We’ve reached a point where if you are not actively experiencing ‘happiness’ then you feel you are ill. And if your friends and family think you aren’t happy enough or making them happy enough, they advise a trip to the doctor. “

Now don’t get me wrong, I do think there are many ways that our society fetishizes happiness. Many people find ways to run away from any negative emotions, and those who do act down or angry or sad are generally encouraged to do whatever they can to change that. Those of us with fairly pessimistic temperaments are accused of self-sabotage, of choosing a bad attitude, of being debbie downers. No one really much wants to be around us and we are informed in no uncertain terms of that fact.

But where I do want to differ from these criticisms is that they seem to equate the treatment of depression, even low level depression, with our society’s inability to handle negative emotions. These are two very different things. There’s an odd perception from those who haven’t actually experienced therapy that it’s about getting rid of all the bad feelings and that the end goal is to create someone who is happy clappy skippy doo. At the very least, people who go to therapy are supposed to come out “well adjusted” which for some reason is often associated with a Stepfordish oddness or calmness. We imagine Chris Traeger bouncing around like a hyperactive puppy when we think of those who have overcome depression.

 (not me)

In reality, this is exactly the opposite of the experience that I have had with therapy, and I suspect that many other people have had to delve into some extremely unpleasant emotions as a result of therapy. One of the main elements of therapy for me has been learning that negative emotions are necessary, provide information, and can be tolerated. I have learned tools to be able to feel bad and not immediately spring to fix whatever is wrong (which oftentimes is nothing).  My therapists have repeatedly told me that they want to find the appropriate place for all of the elements that make me up, including such winners as ennui, existential angst, and an overactive sense of guilt.

Here’s the clear and defining line between depression and normal, healthy sadness: depression affects your ability to function in your life. Whether that’s because it’s major depressive disorder and you have reached a point where you can’t shower in the mornings or whether that’s because it’s pervasive depressive disorder and you’ve felt low level emptiness your entire life and you just can’t handle it anymore, what makes something a problem is when it starts to interfere with someone’s life in a negative way. Now this isn’t as clear and defining of a line as we would like, but there it is and most individuals would be able to tell you if they feel like their emotions are getting in the way of their life.

Treating depression, whether with medication or with therapy, is about allowing an individual to function again. A functional human being feels painful feelings sometimes. One of the most obvious examples of the ways in which treatment of depression is actually antithetical to happiness obsessions is in mindfulness practices, particularly DBT. These ask an individual to simply notice their feelings without judgment, letting them happen without trying to change them.

One of the many reasons that people often end up in therapy or on medication is because they have been too afraid to honestly look at their negative emotions, feel them, and let them go. Of course there are some therapists and clinics that may go too far and end up treating any negative emotions as problematic, but overall the profession’s aim is to help people who are struggling.

The other piece of the puzzle is medication, which many people view as a “quick fix” for those who refuse to deal with their problems and just want to be happy all the time. Now I haven’t been on every medication ever so I can’t speak to all experiences, but that really is not how medication works most of the time. I have never had medication actually lift my mood, it simply has held back some of the negative so that I have space to work towards positive for myself. It allows me to go about my daily life in a relatively normal manner so that I can find ways to be effective long term. Again, it’s about keeping depression from drastically impacting my life.

Perhaps the reason that so many people point towards the prevalence of therapy and medication in our society as evidence that we refuse to be happy is because of a basic misunderstanding of what those treatments do. If someone’s emotions are keeping them from achieving their goals in life, from having relationships, from effectively doing their jobs, then the aim of treating those emotions is to help that person live their life. That doesn’t require happiness, but it does require the ability to cope with negative emotions.

I do think that it’s important to address our societal phobia of sadness, grief, and pain. But the way to do that is not to throw the mentally ill under the bus by implying they are running from their negative emotions when they seek out treatment. A diagnosis of depression does not say “this person is too sad”. It says “this person can’t function the way they would like to because their emotions are consistently out of control”. There is a world of difference between those two statements.

Ok, maybe I’m a little bit Chris Traeger.

I’m Afraid of Identifying As Asexual

This weekend was the fantabulous Skeptech, a conference about skepticism and technology. As per usual I had a great time and am currently quite exhausted (despite the fact that like a good little introvert I went home before midnight most nights).  I have lots of Thoughts spinning around in my head from the weekend, but for now I’m going to focus on one interaction in particular. In the Twitter feed I got into a discussion with Kate Donovan and Tetyana about asexuality and eating disorders in response to a panel regarding bias and science. Without really thinking, I mentioned that I was afraid my ED would turn out to be the real reason that I haven’t felt sexual in quite some time, and it grew into a conversation about why that would be a bad thing.

The topic was a bit too large for Twitter, so I’ve been pondering it a bit further and I’ve come to the conclusion that it’s a combination of fearing that I’m relying too heavily on my own privilege, and an internalization of many of the myths about sexual identity and the process of finding one’s sexual identity. I am tentatively taking on the label of “asexual” but I’m terrified that at some point in the future I will feel a wave of sexual attraction and it will turn out that I’ve been lying to everyone and that the real reasons I feel this way are medication, my eating disorder, and depression. Here’s why that seems so scary.

One of the things I worry about is taking the name and label of an oppressed group if I have not truly experienced the oppression that they live. It’s somewhat akin to a white person claiming that they’re racially oppressed. It’s an offensive concept at best, and at worst it muddies and obscures the real struggles that people of color experience, delegitimizing their words and stories and thus making it harder for them to make changes to improve their situation. While asexuality isn’t quite on the same spectrum, I am afraid that I will be claiming their oppression when I’ve existed in privilege. If I say that I’ve had those experiences, that I am oppressed in the same ways they are, but it turns out that I’m really allosexual, straight, cis, monogamous…how hard will it be for others to take the worries of the ace community seriously? I’m also afraid of calling on the resources that have been put together for asexual people because I’m worried I’ll be taking something from those who actually need it.

I believe that these are important fears to have, especially for someone who is as privileged as I am. It’s important to think about whether your future actions and identifications could have harmful repercussions for an oppressed group. I don’t want the ace community to be taken less seriously because I casually started identifying as ace and then nonchalantly went back to allosexual. Aces are already criticized for identifying as queer because they aren’t oppressed enough, because they are supposedly all white, cis, het girls who have privilege shooting out of their asses. I don’t want to contribute to this stereotype. These are important things to consider when thinking about whether to take on a certain identity or not. I don’t want to be the ace whose asexuality is actually a disease, the person that others can point to whenever someone else says “I am ace” as a way to remind them “but what if you’re really not”.

But there is a whole other level of worry that comes on a personal level which is fully wrapped up in the expectations that society has for a woman to be available constantly, for women to make perfect choices, and for sexuality to be a linear progression. If my “asexuality” were actually just a result of my eating disorder, I would actually just be a broken straight person, someone who wants to be able to have sex but isn’t interested because of trauma/disease/stupidity. It’s scary enough if I am asexual to look at the past 10 years of my dating life and think that I’ve spent all that time chasing after the wrong things. It’s even worse if I was just horribly broken and made choices that hurt myself because I am so disordered that I can’t find healthy relationships and wouldn’t even pursue something that would end up being good for me. It’s too cliche to be a girl with an eating disorder who can’t have sex because she’s too self-conscious.

There is a large part of me that is feeling imposter syndrome around this. It’s not necessarily that I think being ace is preferable to being allosexual, but rather that actually finding out who I am feels too good to be true. This can’t be right, I’m too screwed up, I’m too lost, I’m too confused to actually have found some small piece of identity that is truly me. I have spent so much of my life with no identity but my eating disorder that accepting something else as an integral part of me feels wrong in many ways. I suspect that others who are in the process of recovery feel this way when they start to find good things.

Partially it’s that I’m convinced I’ll never know who I am, partially it’s that if something is going to replace the eating disorder in any way it needs to be quite strong, and partially it’s a fear: what if I try to find something that’s really me and it turns out it’s just the eating disorder in disguise? What if every part of me is just my eating disorder in disguise? What if I can’t even trust something as basic as my sexual impulses? This is deeply tied to the mental illness. I’ve been told so many times that I can’t trust things like my hunger cues, or my desires, or the voices in my head. This one must be wrong too, especially if it’s something so out of the ordinary as asexuality. I think it can be really damaging to teach people as part of their recovery that they have to stop listening to things that feel perfectly real and important.

I’m also a rule follower, a big part of having an eating disorder. A perfectionist. Everything must be just so. I can’t make decisions until I explore every possible angle and even then I often can’t because there is no right or perfect answer. The idea that I might identify as something and then find out that it’s wrong is terrifying. I’ll have embarrassed myself, I’ll have gotten the WRONG ANSWER about something incredibly important. I won’t be doing things right, I’ll have screwed up. That would be the worst thing ever, even worse than that time in first grade I got time out that I still remember.

There’s also an element of internalized misunderstanding of how sexuality works. One of the things we’re taught is that you figure out what you are and then you be that thing. Usually you figure it out in high school or college: you “experiment” and then realize you’re gay/straight/bi/whatever. Then that’s your life. It’s fairly simple. You might make one mistake and date the wrong gender or try a poly relationship and realize it’s not for you, but then everything is figured out. This isn’t actually how sexuality works, in reality there’s some fluidity, there’s often a lot more confusion, you may think you’re one thing and then discover a new term or community that you think fits you. There’s absolutely nothing wrong with trying on different sexual identities to see which one feels the most like you.

But I’ve internalized that you figure it out and then that’s it, anything else is wrong or improper or a LIE. You might be repressing part of yourself if you ever end up changing. You’re probably misleading your loved ones. You’ve probably destroyed at least one relationship asking for something, setting boundaries when you really didn’t need to, trying to be something that you’re not: there was no reason to ask for space to try something new if you aren’t going to identify that way FOREVER, and doing so was really quite selfish. At the very least you’re just a really screwed up person who’s flip floppy and shallow and attention seeking because there isn’t any other reason to change. Obviously none of this is true. We all get to ask for whatever we need when we need it, but the implications for my relationships if it turns out I’m allosexual are confusing and frightening.

I think one of the things that makes recovery from an eating disorder so difficult is trying to suss out which parts of your life are you and which belonged to the eating disorder. For some reason coming to the wrong conclusions (even if you can change your mind later) feels like the end of the world. It seems as if more of your life has been stolen from you, as if you’re doing recovery wrong, as if you’re just too stupid to realize that your whole life was the eating disorder.

This is one of the reasons that I wish labels were both more common and less important. Reality is that people probably have some core identity but that they have some fluidity. For some reason taking on a label has reached a level of importance that people view it as All That Defines You. Particularly if you come out or have a few relationships in the mold of that label, you’re never ever allowed to change. If identity labels were more like career labels or relationships, something that’s important but that you can grow out of, it might be less scary to try some things on as you, then realize that you’ve grown into something else. That fluidity is hugely important in reducing the shame that people feel when they realize they might not be what they thought they were. I think we all deserve the space to learn.

 

“Mental Illness is Not Biological”

I am a big proponent of being careful with language. I don’t think that we should oversimplify something simply because it sounds better or is better marketing. Especially when it comes to mental illness, we are so sloppy with our language as it is that I think we must be careful. I don’t like the idea that we should describe mental illness as “a chemical imbalance” because it deeply oversimplifies things. So I was fairly dismayed when I sat down to read an article in my local paper about the need to talk more about mental illness and it simply repeated over and over “mental illness is not biological” and that we need to spend more time talking about the pharmaceutical industry.

Many people do not pay enough attention to the biological factors of mental illness. Yes, we recognize that genes can cause a predisposition, but more than that, basic biological systems can deeply affect your mental health. A few examples: sleep deprivation can easily cause symptoms of mental illness. It can deeply affect mood, emotional stability, depression, anxiety, and other brain functions. Continual sleep deprivation can spur a mental illness. I’m not sure what one would call that if not a biological factor.

Similarly, food deprivation is deeply correlated with some serious signs of mental illness. In the hunger studies performed at the University of Minnesota, individuals who willingly deprived themselves of food became depressed, anxious, obsessed, violent, withdrawn…they had diagnosable mental illnesses that were not present before the removal of food. Again, this seems to be a strictly biological change that triggered a mental illness.

Factors like these are often heavily discounted when we talk about mental illness, particularly when we’re attempting to recover from mental illness. Not enough time is spent focusing on the fact that if you don’t have a healthy biological basis with adequate sleep, nutrition, and exercise, it is significantly more difficult to have a stable mood and recover from a mental illness.

In addition, we do know that genes play some role in mental illness. We know from twin studies that many mental illnesses are far more likely to occur in an individual if they have close family members with that mental illness. For some mental illnesses, we have identified specific genes that might be linked to that mental illness. The most likely theory about mental illness right now is that we are genetically pre-disposed to an illness (to varying degrees depending upon the person) and social or environmental factors then can trigger that mental illness. And yes, neurotransmitters and brain chemistry are implicated in that mental illness. Yes, there are physical processes that have been disrupted when we are talking about mental illness. No, it’s not just a chemical imbalance, yes it is more complex than that, but of course it’s biological because our brains are a biological organ.

This is intensely frustrating, because it makes it seem as if the social factors that affect our mental health have no bearing on the physical existence of our brain. In fact studies done on chimps have shown that certain brain chemicals are altered over the course of years by trauma or isolation (if a chimp is isolated at a young age they will have different levels of certain brain chemicals when placed in isolating situations than a chimp not isolated at a young age and these effects last for many years). This is a physical change brought on by an environmental factor.

Of course it’s important to be careful not to oversimplify, but obscuring that there clearly is a biological factor to mental illness is not helpful either. In addition, the fear of labeling mental illness as biological plays directly into the fear of overdiagnosing and overprescribing. When we repeat over and over that mental illness is not a biological illness that revolves around neurotransmitters and brain chemicals, we become even more paranoid about prescribing medication (something that people are already worried about in the case of things like ADHD and Xanax). Speaking as someone who takes medication, this is incredibly damaging. Medication can be a complete life-saver: it made my anxiety manageable and so it gave me a window to actually begin dealing with some of my underlying issues. I was afraid to begin taking medication because I didn’t want to “alter my brain”. Repeating the myth that pharmaceutical companies are out to get us all and that medications are not the proper way to treat mental illness reinforces that stigma.

Of course we should include various kinds of therapy when we’re working on mental illness, but it is actually incredibly difficult to get medication for many mental illnesses and particularly difficult to get insurance to cover it. People are already afraid of medication. People are already afraid of being turned into zombies by pills or having unknown side effects. It is possible to advocate for improved standards for pharmaceutical companies AND accept that medication can be an incredibly important part of treating mental illness.

We need to recognize that mental illness is complex, requires a number of kinds of treatments, and involves a variety of factors including the biological, social, environment, genetic, chemical, and situational. While it is important to move past the “chemical imbalance” trope, that doesn’t mean completely removing any mention of chemistry or biology from our descriptions of mental illness.