My hermitification: Depression and isolation

woman behind a curtain

Okay, so I completely made up a new word in the title of this post, but I’m guessing you can tell what I mean.  Depression is a profoundly isolating illness, as many mental illnesses can be, and as my illness progresses in many ways I find myself evolving into a hermit of sorts.

I have always been an introvert, but I used to really value time spent with close friends.  And then depression hit, and everything changed.  When I am depressed, I hate being around people.  Depending on my particular set of symptoms at the time, being around others can be exhausting, irritating, overstimulating, anxiety-provoking, or mood-lowering.  I used to try to push through this, thinking that I “should” socialize even if it made me feel worse, because that’s one of the things you’re “supposed to” do to get better.  But that now feels like a dead horse that’s been beaten long enough.  Over the last year and a half of this current episode of depression, I have systematically cut almost everyone out of my life.  I don’t have the internal strength or resources to have a mature adult conversation with anyone about this, so I have taken the path of least resistance and just stopped responding to calls/texts/emails.

I don’t like being this person that depression has made me.  My family and friends (now former friends) certainly deserved better.  I feel like they must hate me for my ghosting behaviour.  Yet that hasn’t been enough to stop me from this pattern of behaviour, because it’s not about them as much as it’s been about retreating as a perceived path to self-preservation.

Looking forward into the future, it’s hard to imagine how I would ever rebuild a social life, knowing that I will get depressed again, and I will hide out in my figurative cave again.  Why would I let people in knowing that I would most likely at some point just slam the door shut in their face?  Guilt plays into this too – if I am such a terrible daughter/sister/friend, why should I even deserve to have people in my life?

face partly obscured by handsAs much as I might wish to be able to hide out 24/7, it’s just not feasible.  Yet even when I venture out into the world, it feels like there is a self-imposed barrier that isolates me.  I either am not able or don’t remember how to have a genuine connection with another human being.  So I put on the mask to try to hide the darkness inside of me, and struggle with those superficial social interactions that normally wouldn’t merit a second thought.  It makes for a very lonely existence, one that is entirely of my own making.

Strangely enough, the only setting in which I feel comfortable emerging from my cave is with my patients (I’m a nurse).  Somehow that part of me is still able to function interpersonally, and I’m not sure why that is.  I think it might have to do with spontaneity.  I’ve been a nurse for 13 years, and by now I don’t even have to think about what my response is going to be; I just know, and I do it.  At least it gives me reassurance that i haven’t fully transitioned to hermit mode.  Not yet, anyway.

 

Photo credits:

Steinar Engeland on Unsplash

Elijah Hiett on Unsplash

The magic of animals in mental illness

guinea pigs

I am the proud mama of 4 guinea pigs, each one full of personality.  They mean the world to me, and sometimes they’re my reason to get through the day.  When my depression has left me feeling like I’m too tired to go out of bed, I can count on them to be very vocal about reminding me I need to get my butt up and give them their veggies.  When I have felt suicidal, they have given me a reason to carry on.

I’m a mental health nurse, and I’ll often take some of the piglets to work.  They are always a hit, and I find that the clients who are the most ill tend to be the ones who are the most drawn to my little furballs.  Sometimes I’ll feel like the most effective therapeutic therapeutic intervention I provided during a shift was my animals.  They can help people who are paranoid, anxious, or depressed.  Sometimes I’m able to give an agitated client a guinea pig to hold rather than giving them extra medication, and it can be just as effective.  Clients who have been quite disconnected from the world because of their psychosis will sit for hours holding a guinea pig.  Cookie (in the bottom picture) has watery eyes, and one client believed that her tears were because she knew what he was feeling.  He expressed a sense of appreciation that finally he felt understood.

guinea pig

So how are they able to work their magic?  I think it’s something along the lines of what psychologist Carl Rogers termed “unconditional positive regard”.  We may be broken and battered by our illness, feel like a failure, and be ready to give up, but none of that matters to our animals.  They will never judge us, and they will always accept us.

guinea pigI truly believe that our pets can tell how we’re doing.  Of course my little ones’ brains are far too small to have any grasp of human emotions, but they always seem to know when something’s not right.  My little Cookie (in the picture to the left) is crazy in love with me.  She likes to make sustained eye contact, and it feels like she’s looking straight into my soul.  Oreo (that’s her above with the white hair on her head) likes to give kisses, especially when I need them the most.

My guinea pigs, like many pets, love routine.  They know what they want and when they want it, and get pretty thrown off by changes.  That forces me to stick to a routine even when I’m feeling really low and amotivated.  With them around I’m never really home alone, which is particularly valuable when I’m isolating due to illness.  I also find them to be a helpful focal point during mindfulness meditation, as watching and listening to them do their thing really grounds me in the moment.

There’s a lot of literature on the internet about animal-assisted therapy and emotional support animals.  While dogs may be the most recognized support animals, there are many animals (including guinea pigs!) that can engage with humans in meaningful ways.  If you are thinking of getting a pet, please consider a shelter animal – they can’t wait to shower you with love!

 

Update (Nov 19/17): I have just added a 5th member to my guinea pig family.  I may be well on my way to becoming the guinea pig version of the crazy cat lady, but my mood has improved, and I’m feeling less isolated.  Magic.

 

 

Coming to meditation: From skeptic to believer

girl in seated meditation poseI was initially reluctant to try meditation.  My thinking went something along the lines of… I’m so f***ing sick of being inside my own head, so why on earth would I want to spend more time up in there?  But my depressive illness was kicking my butt despite being on a hefty load of meds, and I was willing to try just about anything that might help even a little bit.  Meditation seemed like a good fit with the holistic approach I was trying to put together, so I downloaded a couple of meditation apps (I’ve made some suggestions on my mental health apps resource page) and decided I was going to meditate for at least 5 minutes first thing every morning.

I remained unconvinced in my early days of meditating.  Most of the beginner meditations I was listening to focused on the breath, and the cynical part of me thought that seemed like a big waste of time.  I still had no real desire to focus inward any more than I already was.  I was horribly sick of myself and couldn’t avoid myself even if I wanted to, so the idea of sitting back and watching my thoughts go by didn’t seem much different from the average moment in my day.

Once I began to realize what wasn’t working, I started looking for something different.  Then I stumbled upon Cory Muscara’s 31-day fresh start podcast on Simple Habit, and something clicked.  This was the well guided mix of inward and outward focus that I hadn’t realized I was looking for, and I was hooked (along with a bit of a virtual crush, I must say).  Around the same time I also started doing restorative yoga, which incorporates a lot of meditation.  I could listen peacefully for hours to my teacher Tianne, whose voice is almost as soothing as Bob Ross from the Joy of Painting.

omMy meditation practice has since expanded to at least 15 minutes every morning and 5 minutes every night at bedtime.  I’m proud of the 140+ day meditation streak I’ve got going on my favourite meditation app.  I’m starting to understand the meaning of the quote often attributed to Victor Frankl: “Between stimulus and response there is a space.  In that space is our power to choose our response.  In our response lies our growth and freedom”.  Meditation can help to expand that space, and since I tend to be quite an emotional reactor (more like nuclear reactor what I’m not well), I’ll take any space I can get.

Some simple tricks I’ve learned are using a finger to trace an outline of the other hand, breathing onto the back of the hand, and effortless hearing (being a wide-open receiver to all the sounds around you).  I’ve found some breathwork to be really helpful, such as extending the exhalation or thinking of breath as an anchor, while other strategies are less helpful (alternate nostril breathing leaves me feeling like I’m gasping for air).  Like anything else in life, you take what works and leave the rest.

Mindfulness has become a bit of a buzzword lately, but this is not a new concept – mindfulness meditation is something that has worked for people for a very long time.  I started off a skeptic and am now a believer, but I still find I’m very particular about what resonates with me and what doesn’t.  Plus I’d probably be useless at trying to meditate without guidance.  There’s a lot of options out there to explore, and  I think that for anybody with mental health issues it’s worth doing some digging into meditation – some of it might work, some of it might not, but being able to widen that space between stimulus and response can be golden.

 

Image credits:

Pexels on Pixabay

Clipart Library

Living in fear: The tsunami of depression

crying woman inside a rainy window

While fear may not be a symptom of depression, it is certainly something that has become tightly woven into the fabric of my illness.  When I am well, I am fearful of when the next relapse might be, when the ground might disappear beneath my feet.  When that relapse happens, I am terrified – here we go again with yet another tidal wave to wash my life away.  And as a depressive episode stretches out, I am scared that I won’t get better, that I will drown in this mental pain.

What is probably the most frightening is the lack of control.  I can be doing what would appear to be all the right things, and I will still get sick.  As the years have passed it has become harder and harder to control my illness, so the fear only escalates.  This current episode has lasted for almost a year and a half, and I am utterly terrified that I will never get my well self back again.  I miss her so much, but she is either gone, washed away in the tsunami of my depression, or drowning in a dark basement somewhere.  If only there was a “find my iPhone” for the real me, to give me a life preserver to hold on to.

A few years ago I was making my case before a review board about why I should not remain committed to the psychiatric ward.  As a mental health nurse, I’m a bit of a research geek, so I was talking about the STAR*D research study, which essentially showed that the more treatment failures a patient has the worse the prognosis.  I argued that my suicide attempt stemmed from “evidence-based hopelessness” (although looking back, I’m not sure why I thought that would help my case).  Perhaps a better way to put it, though, would be evidence-based fear – fear based in the evidence of my personal experience and reinforced by the research evidence I was reading.  If I am already fearful that I won’t get better, it becomes very hard to challenge that kind of thinking.

woman drowningI’ve been learning recently about acceptance and commitment therapy (Russ Harris’s ACT Mindfully site is a great resource if you’re interested in reading more), and contemplating how fear fits in with this idea of acceptance rather than resistance.  Is this fear a form of resistance?  And if so, maybe it’s resistance in a good way – a reason to keep fighting for recovery.  Or maybe acceptance lies in making space for this fear, acknowledging it as a neighbour that’s not going to be moving away any time soon.

As I struggle to tread water in the sea of my depression, perhaps I have to both accept and resist.  Resist the urge to stop struggling and just drown already, and accept that another wave might come at any time and push me under.  In the end, whether I feel fear or not, que sera sera.

 

Photo credits:

Milada Vigerova on Unsplash

Christopher Campbell on Unsplash

Taking a holistic approach to mental illness and wellness

elements of wellness: yoga, sleep, nutrition, activity, physical health

In school, we study a lot of different subjects in order to get a well-rounded education that helps us to understand the world around us from different perspectives.  Yet when it comes to our mental health, it’s easy to to narrow our focus and come at the issue from one very specific direction.  Treatment providers can certainly contribute to this by emphasizing one particular approach over all others.  Working in the field of psychiatry, I’ve certainly encountered people who see meds as the be all and end all, but this sort of tunnel vision is by no means unique to the medical system.  There is also the opposite approach that is fervently against standard medical approaches, which can be equally problematic.

What if instead we took a holistic approach to mental health, coming at it from as many different angles as we could?  There are many treatment modalities that do not have to be mutually exclusive.  Certainly medications and certain types of psychotherapy have a strong scientific evidence base, but there are many alternative strategies that can be incorporated into a holistic approach that not only targets illness but aims for wellness.  I will elaborate more on these other strategies in future posts, but for now I’ll just say that the more tools we can add to our toolbox the better off we are.

connecting puzzle piecesKnowing whether a particular treatment is likely to work in a given population is useful on a broader level, but the science isn’t quite there yet to know what specific treatment will work for a specific individual.  We can’t know what will or won’t work for us until we try it.  For example, I’ve found that, despite being a huge proponent of psychotherapies such as CBT in my professional practice, in my personal experience it just hasn’t felt like a good fit for me.  Does that mean there’s something wrong with CBT? Absolutely not; it’s just not a piece in my puzzle at this point in time.
My current wellness plan includes:

Medications play an important role in managing the way that my depressive illness manifests, and I am lucky to have found a med cocktail that makes me feel more like myself and doesn’t cause a lot of side effects.  Still, targeting the symptoms of my mental illness with medication is not enough; I need to do more to work towards mental wellness.  The holistic plan I’ve arrived at makes me feel like I’m targeting mind, body, and soul and working as hard as I can at getting better.

What are the ingredients in your wellness recipe?  What pieces of the puzzle might be missing for you?

 

Image credits:

Clipart Library

senjinpojskic on Pixabay

 

 

 

The lies we tell and the secrets we don’t

person making shush gestureAs a mental health nurse, I always hope that my clients will feel comfortable and safe enough to be open and honest with me.

As a person with depression, though, being open and honest is likely to go straight out the window if it appears to conflict with whatever goal feels most pressing to me at the time.  While this may sound manipulative, it is something I do for the purpose of self-protection and self-preservation.  It is part of the armor that I put on when my illness leaves me feeling weak and defenseless.

The topic I lie the most about is suicidal thinking.  Based on past experiences, I never want to be hospitalized again.  Disclosing thoughts of suicide is probably one of the quickest ways to get committed to hospital, so I keep my mouth shut.  Is that a safe, healthy way to approach the issue?  Of course not.  But in the balance of pros and cons that goes on in my head, there is little that would win out against my desire to avoid hospitalization.  I try to consider this in my professional life and be very mindful of how I’m reacting when clients disclose suicidal thoughts to me.

I also omit symptoms that I either do not want or do not feel ready to talk about.  At one point I had gone off meds for a while after a 3-strikes-you’re-out series of negative experiences with doctors.  After a couple of sleepless months I realized that I really needed to find someone to order some drugs for me.  I didn’t want to talk about my depression for fear of getting a similar reaction to the last few doctors I’d seen, so I only admitted to being unable to sleep.  In doing so I could get my mirtazapine and quetiapine back on board, and after a while I felt safe enough to disclose the rest of what was going on.

girl and face mask juxtaposed on blue eyeIn the end, I can only conclude that we just try to do the best we can with the situation we’re faced with.  And I think the more that health care providers understand that, the easier it might be  for us to start to remove some of that armor.  It’s not realistic to think that we will never feel the need to resort to lies and secrets, but it’s worth reflecting on what underlies them so they don’t end up coming back to bite us in the butt.

 

Image credits:

Kristina Flour on Unsplash

Kellepics on Pixabay

The semantics of “depression”: the power of word choices

“Sticks and stones may break my bones but words can never hurt me.”

That may have worked in the school yard at recess, but language has tremendous power, both to communicate and to miscommunicate.  Take the word “depression” for example.

Depression is often used in everyday language to describe an emotion like sadness.  This is a very different creature from major depressive disorder, which can be debilitating and affect almost every aspect of a person’s functioning.  Similarly, bipolar disorder is a whole different can of worms from short-term mood fluctuations.  If people are lightly tossing these words around to describe transient emotional blips, it dilutes the social understanding of these terms and minimizes the experience of those suffering from mental illness.

dictionary excerptWhen we use language that minimizes mental illness, we are likely to propagate stigma.  If we think someone is “just depressed”, the same way we might be if our favourite sports team didn’t win the championship, then we’re more likely to think “they’re just not trying hard enough”, and they could feel better if they would “just get over it already”.  But in reality, we’re not comparing apples and apples, we’re comparing mice and elephants.

Depression is the example that resonates the most with me, since it’s the illness that I have, but there are many other examples, many of which are pejorative.  “Psycho.”  “Crazy.”  Or perhaps using the word “suicidal” to describe feeling disappointed over some minor event.  People may be describes as “schizophrenic” as if that defines who they are as a person.

We could all do well to reflect a bit on the language we choose to use and what that might mean for those around us.  Sticks and stone may break my bones, but words can wound me far deeper.

 

Image credit: Pixabay on Pexels

Depression giveth and depression taketh away: Anhedonia and apathy in depression

There have been a lot of horrific events in the news lately.  Hurricanes, the mass shooting in Las Vegas, terror attacks…   As I saw these events on the news, I knew cognitively how terrible they were, but on an emotional level, I just felt nothing.  I am not a cruel, heartless sort of person, but I still felt nothing.

Many people have some idea of the “gifts” that depression gives: low mood, anxiety,  suicidal thoughts.  There is often less familiarity with what depression steals away from those who suffer from it.  Anhedonia refers to the inability to feel pleasure, and apathy refers to a lack of interest.  These deficits that people can experience due to depression may sound relatively minor, but in fact they can be soul-destroying.

person in darkness silhouetted against sunshinePart of what makes us human is the ability to feel things in response to what is happening around us.  If depression takes that away, what does that do to our humanity?  I feel like a monster for not caring about tragic devastation and loss of life, but it’s as though the ability to feel in that way has been turned off in my brain and my heart, and for the life of me I can’t figure out how to turn it back on.

Depression can leave a darkness and emptiness on the inside that can’t be lit up no matter how bright the sun shines.  Perhaps that is harder to understand than that which depression giveth, but the greatest impact on my life has without question come from that which depression taketh away.

 

Photo credit: Spencer Pugh on Unsplash