Thursday, May 31, 2012

Will God zap me if I'm too happy?

I have been feeling a lot less depressed lately. I have more energy. I don’t want to sleep as much. I have a more positive attitude. I’m able to accomplish more. I laugh more. I feel more capable of handling personal interactions.
I will never know exactly what is causing me to feel better. Most likely, it is a combination of things. My doctor recently adjusted my medication, and I’ve been in CBASP (Cognitive Behavioral Analysis System of Psychotherapy) treatment weekly for a while.
I am happy and grateful that the depression has lifted as much as it has. I am hopeful. Life is good.
So what is my concern? That it won’t last.

Why I am afraid

During one of our sessions, my therapist talked about the associations our brains make and the way we can end up with beliefs such as, “If I’m too happy, God will zap me.”
When I was a child, I thought that God would make me sick when I became an adult. I wasn’t born with physical handicaps like one of my brothers, and I didn’t have the other health problems he and the rest of my family had.
I thought I would get my share of the sickness when I grew up.
Why did I believe that?
I would guess that it stems first from feeling helpless about my circumstances. I could not keep my brother or other family members from getting sick and going into the hospital. I could not make everything OK.
I also felt a lot of guilt as a child, a result of my relationship with my parents, especially with my mother, which I’ve written about before.
My sense of guilt grew as my obsessive compulsive disorder developed and got worse, and my religious scrupulosity led me to pray compulsively for the safety and health of my family. If someone got sick, then, I reasoned, my prayers hadn’t worked because they hadn’t been done right, or because I had sin between God and me.
I didn’t realize it at the time, but I started to believe that I deserved the illnesses that I did get, the OCD and depression.
And if I deserved them, then any improvement would be just a mirage, something that would disappear as soon as I started believing in it too much.

How I’m going to handle it

I don’t want to feel this way. I don’t want to expect to fall back into depression. I don’t want to miss the improvement because I’m paying too much attention to the possibility of it ending.
And I’m aware that down times will still come around.
I’ve decided to be proactive about this.
*I try to be grateful, mindfully appreciative, that I am doing better.
*I am continuing to do the things that seem to be helping me: taking my medication as directed and going to therapy.
*I know I can continue to develop practical skills to handle life’s problems better, to avoid a sense of helplessness.
*I try to cultivate an active sense of hope.
I don’t believe that other people “deserve what they get.” They don’t deserve to be sick, physically or mentally.
I need to keep reminding myself that I don’t deserve to be sick either.

Have you ever been afraid that improvements in your health and life wouldn’t last? How did you handle the fear?

Wednesday, May 30, 2012

Beginning my 50th year

Today I turn 49 (I’ve already updated my blog profile to reflect the new age).
I don’t mind birthdays. In fact, I like them. I like turning a new age. It’s like turning over a new leaf for me.
I think I’m wiser today than I ever was at 19 or 29 or 39. I wouldn’t want to go back. I’m happy with where I am now at 49.
As I face turning 50 next year, I see it as an opportunity to get some parts of my life in better order. So I have been writing down some goals over the last several days, some things I want to get better at and some things I want to accomplish by the time I turn a half-century old.

Me as I begin my 50th year.
In doing this, however, I don’t want to look forward to turning 50 so much that I forget about now. I just want to begin a process of mindfully trying to improve my health in all areas.
So here are some things that I’m going to be working on over the next year and will continue to work on even after I turn the big 5-0.
I will be more specific about these as time goes on, so bear with me if what I write seems to be too general.

My physical health

I’m in pretty good health. I have asthma and high blood pressure, but I handle those pretty easily.
A special concern of mine is that I have a family history of stroke. My father had a major, disabling stroke when he was just 54, and my mother has had several strokes.
I know I need to take better care of my health now for better outcomes in the future.
Exercise, nutrition and stress relief will be part of my ongoing plan of action.

My mental health

I haven’t yet discussed a specific timeline with my therapist, and I know it’s hard to predict how quickly therapy will move forward, but I hope to be done with the CBASP therapy for the chronic depression and the CBT for the OCD in a year.
I’m talking about formal therapy here. I know I’ll continue to work with the techniques I’m learning for the rest of my life.
I want to focus on taking my medications properly, participating in therapy and studying and reading on my own.
I also want to add more fun and joy to my life. Or perhaps I should reword that. I want to recognize the things around me to be joyful about.

My spiritual health

I want to further develop my meditation practice and incorporate mindfulness more deeply into my everyday life.
I also want to be more in service to others. I want to more clearly understand my faith tradition while honoring other faith traditions.
I want to be at peace and be a source of peace.
I also want to be confident about my purpose, my work and my vocation.

My intellectual life

I want to keep learning until the day I die. I want to die with a book in my hands.

Who is this person?

Have I just described a perfect person? It sounds like it, doesn’t it? I fully realize that I probably will never reach the ultimate in any of these areas of health. My goal is to move forward, though. Keep moving forward and changing for the better.
The next year will also be a time for my husband and I to consider how we want to spend the rest of our lives. Larry is 15 years older than me. He’s already retired. We would like to have plenty of time to spend together as we get older. Figuring out how that would play out with me working or not working a formal job is an ongoing discussion.
Thus I begin my 50th year. I am thankful that I’ve made it this far, and I’m looking forward to the future.

  What is your attitude towards birthdays—love them, hate them, somewhere in between? Do you have goals and plans for improving your health? Do you see your health as more than just physical health? If so, how?

Tuesday, May 29, 2012

How I use "Brain Lock" to fight my OCD

   I’ve turned off the shower, but I want to push on the water turn-off again to make sure it’s off.
I’ve turned off the light in the laundry area, but I want to turn around and check and make sure it’s off.
I’ve turned off the ceiling fan, but I want to check one more time to make sure the blades aren’t moving anymore.

Are those blades moving?
I want to pray again for forgiveness, for the safety of Larry and the cats and my relatives and the whole world. And again. And again.
I want to drive back and make sure the pothole in the parking lot that I see everyday really isn’t a person that I just hit with my car.

The role of “Brain Lock”

These all are daily, or almost daily, compulsions that I feel the urge to do. Slowly, but surely, I’m following through with the urge to do the compulsions less and less.
The steps that Dr. Jeffrey Schwartz outlines in his book “Brain Lock: Free Yourself from Obsessive-Compulsive Disorder” is helping me to do that.
When I started cognitive behavioral therapy, I wrote about how my therapist uses a form of the four steps Schwartz advocates in fighting OCD: Relabel, reattribute, refocus and revalue.
Basically, to relabel is to recognize obsessions and compulsions and call them what they are, OCD.
To reattribute is to name the cause of the obsessions and compulsions: a medical condition.
To refocus is to do something else instead of giving in to the compulsion. It’s learning to shift the attention elsewhere and tolerate the anxiety until it goes down on its own, without doing the compulsion.
To revalue is to place a lower value on the obsessions and compulsions because you know what is causing them.
My therapist taught me to combine relabeling and reattributing and then move on to refocusing.

How I do it

Here’s an example of how I do that.

Is the water turned off?
   After my shower, I turn off the faucet. I want to keep pushing on the turn-off handle. I’m afraid if I keep doing that, though, that I’ll break it. And it’s unnecessary and takes up time. Most importantly, it’s giving in to a compulsive urge.
So after I turn it off, I make myself get out of the shower. I feel some anxiety because I am afraid it’s not turned off properly. I want to reach back and push it one more time. Instead, I focus on drying off and then start blow-drying my hair or getting dressed.
Another example: I turn off the light in the laundry area in the basement. I see the darkness. I turn around and start walking up the basement steps. I really want to turn back and look again. I feel anxious, and I think I won’t be able to relax or forget the light unless I do.
But I keep moving and don’t allow myself to look back. I get to the top of the steps, turn off another light and close the basement door behind me. Then I go off to do something else.

What I’ve learned

What I’ve discovered is that the anxiety doesn’t last very long and I actually forget about the obsession pretty quickly.
If I do give in and perform the compulsion, I still try to tell myself that it was the OCD that wanted me to do it, not me. That’s something that Schwartz recommends.
If I give in to the compulsive urge, I have also discovered that I get more anxious and it’s harder to turn away from it. It’s just not good for me to give in.
I’ve learned the following:
*I can tolerate more anxiety than I thought I could.
*Uncertainty is not fatal.
*I don’t have to have an in-depth thought session on every obsession and compulsive urge. I don’t have to resolve anything about it. I just have to move on.
*The anxiety will eventually go away if I don’t perform the compulsion.
*Focusing on something else is the key to my forgetting about the obsessions and compulsions.
*It’s not the end of the world if I give in and do a compulsion. It just means that I will learn better for the next test.

Have you tried the “Brain Lock” steps? If so, how did it go? How have you learned to tolerate and deal with anxiety that is a part of everyone’s life?

Monday, May 28, 2012

Memorial Day and my father's legacy

Flags covering the National Mall.

Note: Today is OCD Monday, but more importantly, in the United States it is Memorial Day. So this post is mainly about what Memorial Day means to me.

A year before my father died, I visited him and my mother on Memorial Day. As I walked up the steps of the deck in the back of their house, my father came to the door to greet me.
“Happy Memorial Day,” I said. “I don’t actually know if you’re supposed to tell people that.”
My father smiled and said, “Well, I’m just grateful to have made it home.”
This was 1996. My father had been discharged from the Army on Dec. 25, 1945. Fifty-one years after he “made it home,” he was still grateful.
On Memorial Day, I, along with millions of others, think about the soldiers that didn’t make it home. I think of the families grieving for the child, sibling, parent, relative or friend that didn’t return home from service.
I also think of my father on Memorial Day, and his gratitude and his service to his country during World War II.
My father was drafted in 1942. He was a young farmer who had lived in rural Central Virginia all his life.
He was pulled from basic training before he was finished in order to begin training as a medic.
His company was eventually sent to the Pacific Theatre.
He was on the island of Peleliu on Sept. 30, 1944, in combat when he was shot in the arm. He recovered on a hospital ship and then returned to combat.
When I was growing up, my father didn’t talk specifically about his time in service. We met some of his former Army buddies and their families, and he told general stories of life in the Army, but not what it was like for him.
My father was not a person to talk about emotions.
Have you ever read “The Greatest Generation,” by Tom Brokaw? It tells the stories of people who returned from war in 1945 and took up their lives with purpose and resolve?
My father was like that.
When he was in his early 70s, I asked him if he would write down his life story for me. To my surprise, he agreed, so I bought a notebook for him and he wrote.
He needed a second notebook to finish.
In those written words, he was much more open about what it was like for him going into battle. I found out things about him that I never would have known otherwise.
So on this Memorial Day, I think about him and his gratitude, and I think, how can I be less grateful for life?
To my readers who are in the United States, may you have a safe Memorial Day. And to all my readers, may we be grateful for every bit of time we have.

  What does Memorial Day mean to you?

Friday, May 25, 2012

My medication story,_medicine,Taccuino_Sanitatis,_.jpg

The first medication I took for depression and obsessive compulsive disorder was Anafranil. This was in early 1990, right after the FDA approved the drug for use in treating OCD.
My psychiatrist told me it was the first drug approved for OCD specifically. Since Anafranil is a tricyclic antidepressant, it would work on my depression too.
Anafranil did help me. It took about three months before I saw the full measure of its help.
It took away the worst of my cleaning and checking compulsions. It made it easier for me not to give in to compulsions. And it lifted me out of a deep depression.
I will be forever grateful for Anafranil and for other medications that I’ve taken since then that have helped me deal with my mental illnesses.
Janet at the blog ocdtalk inspired this post. In an excellent post called “OCD and Medication,” she wrote she thought it was important to share our stories of our experiences with medications, because medication was a sometimes controversial topic when discussing treatment for mental illnesses.
As Janet points out in her post, people have different experiences with and attitudes towards medication.

Let me preface my story by saying that I know not all medications are for all people. And what works for me may not work for someone else. Not everyone needs or should take medication. Any decision about medication should be made in conjunction with your doctor.

Medications have been quite literally a lifesaver for me. I don’t think I’m being overly dramatic when I say that I’m not sure I would be here today if I had not had the help of medication.
I have had serious bouts of depression. Long ago, I made plans to end my life. Medication combined with talk therapy kept me alive.
Anafranil was not the first medication I took. I was prescribed Prozac and took that for about a month before Anafranil became available in pharmacies.
Anafranil was not without its problems. I gained a lot of weight while I was on it.
I also eventually fell back into depression and lethargy. For the past 20 years or so, I’ve been on Zoloft, Luvox, Celexa, Buspirone, Seroquel, Abilify, Wellbutrin, Cymbalta and Klonopin, and different combinations of the drugs, for depression, OCD and anxiety.
My family doctor told me once that medications could stop working. That seems to be my story.
Some of the medications helped, some didn’t. I felt horrible on some of them. Seroquel and Cymbalta were not good for me at all. It was during a period of trying different drugs, including those, under the care of my family doctor that I developed paralyzing anxiety.
I was afraid all the time. I would lie in bed at night, whispering over and over, I’m so afraid. I couldn’t drive. I didn’t want to be around people. I faced any task with extreme anxiety.
I couldn’t concentrate enough to read or write. I felt antsy and ready to leap out of my skin.
It was one of the worst times of my life.
I don’t know for certain that the medications caused my problem, but I do believe they contributed to it.
When I finally started seeing a psychiatrist again, he just shook his head at some of the medications I had been on, saying, “You should have never been on that.”
He is treating me for OCD, depression and generalized anxiety disorder.
He started me on Lexapro, which I’m still on. It has been of tremendous help to me. I haven’t had a difficult time with side effects either.
I am on 30 mg/day of Lexapro, which is a high dose. This is a problem only when my insurance company refuses to pay for that dose, and my doctor has to send authorization showing that I really do need that amount.
My doctor said the insurance company really isn’t concerned with the dosage I’m on. They are concerned by the fact that I have to get 45 of the 20 mg pills for a 30-day supply of the medicine. In other words, they had to pay for 45 pills instead of 30 pills.
My doctor eventually added Wellbutrin. I was on 300 mg, but I asked him to cut it down to 150 mg because I believed it was making me hyper.
And he recently added just 2 mg of Abilify, which has been very helpful for the depression.
I also take a low dose of Klonopin every day. I wasn’t taking it every day, just when I thought I needed it, but the doctor told me he wanted me to take it every night, that it would help with anxiety the next day.
Years ago, another psychiatrist told me that Klonopin was good for people with OCD because it gradually went into the system, instead of giving a quick relief.
I’m also prescribed Trazodone to help me stay asleep during the night. My doctor said that it’s not addictive. I don’t take that very often, though, because even a low dose makes me feel groggy the next morning. I’m doing this with my doctor’s knowledge.
That’s a lot of medicine. But it’s a combination that works. I don’t feel drugged, sluggish or hyper like I have on some medications.
Here are some things I’ve learned along the way about medication:

*Not all medications work the same way.
*Not all selective serotonin reuptake inhibitors (SSRIs) are the same.
*Some medications work faster than others.
*Combinations of different drugs can be very helpful.
*It’s important to discuss any concerns you have about medication with your doctor.
*For me, a medication plus therapy is working the best.
*There is nothing to be ashamed of in taking medicine for mental illnesses.
*Taking medicine does not mean that you are not working hard to battle mental illness.

What are your thoughts on taking medication for depression, OCD and/or anxiety? What have your experiences with medication been like?

Thursday, May 24, 2012

Swing at that ball: Coping with chronic depression

I was 20 years old, walking across my college campus, in front of one of the main buildings. I don’t remember where I was going and or where I was coming from. What I do remember is thinking, I don’t look forward to what the day might bring anymore.
I no longer thought of the day as open to anything good or surprising. It was open to only the same thing, the numbness and sadness I felt everyday.
That is my personal definition of dysthymia.
My therapist has diagnosed me with dysthymia, or chronic depression.
From what I’ve learned in therapy, chronic depression is not an unending bout of deep depression that leaves me unable to function.
Rather, it is a consistent and constant low mood. I may drop into deep depression, but when it improves, it will improve only so much. My mood doesn’t lift above that low level.
My therapist said one of the hallmarks of chronic depression is a sense of hopelessness and of helplessness. People with this disorder tend to believe that no matter what they do, it won’t make a difference. They may stop even trying.
Hopelessness is what I felt that day on campus. No more hope that the day might bring something good.
Another characteristic of people with chronic depression is that they sometimes can’t even pinpoint what they want, because it has never been about what they want. They’ve never seriously considered it, because, again, what good would it do?

My interpretation of chronic depression.
According to the National Institute of Mental Health’s website, dysthymia is defined as “depressive symptoms that last a long time (2 years or longer) but are less severe than those of major depression.”
I like to look at a list of the main signs of depression every now and then and remind myself that it is a disorder with symptoms, not just a word we throw around to describe a bad day.
The NIMH website provides the following information about the symptoms of depression.

Different people have different symptoms. Some symptoms of depression include:
*Feeling sad or "empty"
*Feeling hopeless, irritable, anxious, or guilty
*Loss of interest in favorite activities
*Feeling very tired
*Not being able to concentrate or remember details
*Not being able to sleep, or sleeping too much
*Overeating, or not wanting to eat at all
*Thoughts of suicide, suicide attempts
*Aches or pains, headaches, cramps, or digestive problems.

How has having chronic depression affected my life? I think about that often. And I wonder what my life would have been like if I didn’t have OCD either.
Being depressed and having OCD have affected my life in some concrete ways.
For example, I never finished my doctorate. I was so close. I was ABD, which stands for all-but-dissertation. But I never finished—I never really started writing—my dissertation.
I also never aimed high in my career. I stifled what I really wanted to be—a writer—and did what was safe. I spent years working as a public servant, first at the state employment agency and then as a health educator for the health department. They were rewarding jobs in their own way, and I enjoyed much of the work, but it wasn’t where I wanted to be.
And my interpersonal interactions are affected by chronic depression. I tend not to ask enough questions of others. I make a lot of assumptions. I stuff a lot of anger instead of expressing how I feel because I fear conflict.
The thought and behavior patterns that perpetuate chronic depression run deep, but we can learn new ways of thinking and behaving.
I want to get out of this cycle of chronic depression, deep depression, back to chronic depression. I am afraid that I never will.
But with the CBASP therapy (Cognitive Behavioral Analysis System of Psychotherapy), and what I’m doing on my own with study and practice, I am trying.
My therapist loves the analogy of the baseball player who is afraid he won’t hit the ball. He’s so afraid of not hitting the ball that he won’t even try. So he’s guaranteed never to hit the ball.
But if he goes up to bat, and practices good form, and makes an effort, he might hit the ball. Even if he doesn’t, he tried.
I’m up at bat, and I’m practicing good form. I’m doing the therapy assignment each week, and my therapist and I work hard during each session. I read, I listen, I think, I write. I practice what I’m learning.
And I am getting better. I am feeling more positive. I have more energy. I’m stopping the negative thinking more quickly.
I still have doubts. I still get anxious when I think about the possibility of not getting a lot better. I worry about not trying hard enough, or not doing the right things, or missing something vital my therapist tells me, or not understanding the therapy.
At least part of that doubt comes from my obsessive-compulsive disorder. I want to ensure there is no miscommunication. I want to make sure I’m not doing something wrong. I’m obsessing over it.
But despite my fears, I am doing my best. I will arise above that low level.
And I will look forward to each day.

Is there something you are up at bat for? How do you practice good form and swing at the ball?

Wednesday, May 23, 2012

Play a song: The power of music

Girls at the Piano, by Renoir.

I’ve written about books and cats and mandalas and other things I love, but I haven’t written much about music, other than my post earlier this week about my first piano recital.
Music can be one of my most effective anxiety busters. It has the power to change my perspective.
I listen to music for different reasons: to relax, for pure enjoyment, to feel more energetic, to think, to not think, while reminiscing, to inspire myself.
Some nights, I play music to help me fall asleep. These two CDs usually put me out—I usually wake up later and realize I never heard the end of the CD—Yoga Journal “Pure Relaxation” and Lifescapes “Meditations: Native American Flute.”
Monday night, Larry and I listened to some music by the Bee Gees in remembrance of Robin Gibb and the loss of the musical group. We sang along and in a real way rejoiced in the music, even though we felt sad.
I have sung, played music on the piano and organ, and listened to music most of my life. Some of my earliest memories involve music.
When I was perhaps 6 or 7 years old, my mother got a boxer puppy, Boots. While he was a puppy, she kept him on the enclosed back porch, with the fireplace guard around him to keep him from wandering.
Boots didn’t like to be alone. When he was, he would cry.
I couldn’t stand to hear him cry. He sounded so sad and lonely. So I would sit on the floor beside him and talk to him. I also sang to him from the Methodist hymnbook. One of my favorite hymns was “Standing on the Promises,” and Boots heard that one a lot.
My taste in music grew as I grew older. I spent my teen years listening to a lot of John Denver. I still like listening to his music.
College widened my musical world as I listened to roommates’ favorites that became my favorites. My dorm was full of a wide variety of music: James Taylor; Linda Ronstadt; Carly Simon; the Commodores; the Beatles; Peter, Paul and Mary; the Rolling Stones, the Go-Go’s. Have you ever heard of such a combination of music?
As I grew older, I became more interested in folk and bluesy music. I discovered Van Morrison and Nanci Griffith.
I can’t pin down my favorite type of music or even my favorite artist, though I suppose if I had to choose a favorite singer, it would be Alison Krauss. She has the voice of an angel and can harmonize beautifully with anyone.
I took a look at my playlist in my iPod and found evidence of my inability to focus on one type of music. Here are some of the artists:

Alison Krauss
Alan Jackson
Amanda Marshall
Bon Jovi
Bruce Springsteen
CeCe Winans
Celine Dion
David Cook
Dixie Chicks
The Eagles
Elton John
Gordon Lighfoot
Hootie and the Blowfish
James Taylor
John Denver
Josh Groban
Judy Collins
Kate Rusby
Luther Vandross
Martina McBride
Mary Chapin Carpenter
Miriam Makeba
Roberta Flack
Sarah McLachlan
Sheryl Crow

On Monday, I listened to Amanda Marshall’s “Believe in You” while I was walking. I thought about how the message of the song means so much to me. I feel like it’s a message that I want to give to others.
So I leave you with her song. And yes, dear readers, I believe in you.

What does music mean to you? What role does it play in your life? What are your favorites?

Tuesday, May 22, 2012

Anxiety on the bike trail

Part of the road in English Park.

On Saturday morning, my husband and I decided to bike in English Park, the park that runs along the river that I wrote about last week.
Last summer was the first time we rode our bikes in the park, and we biked on the road that circles the playing fields. It was good exercise, but we were literally going in circles. And we had to watch out for cars and walkers and slow down periodically for the speed bumps.
This spring, there’s a new road leading from the old part of the park to the new, still largely undeveloped part of the park. That’s the road we took Saturday.
The new road is gravel set in asphalt, a little rough, but smooth enough. It winds under a train trestle, but there’s a shelter built underneath to protect walkers, runners and bikers as they pass under.
Me before the coughing started.
Further back, the road narrows and is made up of dirt and gravels. It winds along beside the Staunton River, and soon all we could hear were the sounds of the water, birds singing, the wind in the trees and our own voices.
The road is fairly level, so we made good time, slowing down periodically to enjoy the sights. We were surrounded by green: trees, bushes and weeds. Sometimes rocks rose to our right, part of the river bluffs.
Then I started coughing.
I have asthma. My doctor calls it of medium severity, but I think I do pretty well most of the time. I use a maintenance inhaler, Advair, and I have a rescue inhaler.
That morning before we left for the park, I used my rescue inhaler because I was feeling a little wheezy and exercise sometimes brings on an asthma attack.
I didn’t use the Advair, and I’m sorry to say I had not used it the night before either.
I am usually a compliant patient in that once I’m on a medication, I take it as directed unless I have a problem with it, at which time I call the doctor.
But I’m different with Advair. It’s silly, really. I am supposed to take one puff twice a day. Easy enough. But I have to rinse my mouth after I use it, and sometimes I don’t think I have time to do that. So I skip a dose. Yes, that’s pretty silly.
Back on the trail in the park, we had biked through a section where something—blooms, pollen, something—was heavy in the air, and I started coughing.
We stopped and I drank some water. Still coughing. I was out of breath, and I just couldn’t bike any further. I took out my inhaler and told Larry I’d stay where we were and he could go on.
He rode further down the road.
You might wonder why I would have him go ahead of me when I was starting with an asthma attack. It’s because we’re used to them. I cough, get short of breath, use my inhaler, and get back to normal, and everything’s fine.
He rode out of sight, and I shook my inhaler and squeezed. Nothing came out. It was a dead inhaler.
By then, tears were running down my cheeks from the exertion of coughing, and my hands were shaking. I was coughing so hard that I thought I would surely throw up.
We were at least a mile from the truck, and even if I could get there, I didn’t have another inhaler. My extra was at home.
With no option of an inhaler, I decided I’d try to calm down the attack on my own. I let the coughs come out, and then I pushed my bike slowly back up the trail, towards the truck and towards some shade.
I drank some more water.
A photo I took while I was trying to calm down: rocks and trees.
And I tried to concentrate on the sounds around me. I don’t often get to a place where I can hear no human sounds, only nature’s sounds. I decided to savor them.
By the time Larry got back, I was calm and could breathe better. I was grateful that it had been a mild attack.
We rode on back to the truck, and I made it fine, though I was still coughing a little.
And when I got home? Yes, I used the Advair. It’s not a quick fix, but it’s time I started using as directed to help stave off these attacks.
Will I check my inhaler before the next bike ride? You know I will.

What’s the hardest thing you have to be willing to do to maintain good health?

Monday, May 21, 2012

OCD and the piano recital

Early guilt and early perfectionism. Early signs of obsessive-compulsive disorder?
When I was about 5 years old, I started picking out tunes on our piano.
I remember sitting at our black Kurtzmann upright piano in the living room and sounding out “Jesus Loves Me.”
But my mother didn’t want me to play the piano by ear. She wanted me to wait and learn the notes. She played mostly by ear and saw that as inferior to playing by note.
So she told me not to play any more. I did anyway. I’d wait until she went outside to do something like hang up clothes to dry, and then I’d run to the piano and play.
Years later, my mother told me she could hear me playing but just didn’t say anything.
She talked with a local piano teacher, who agreed to try lessons with me. I started lessons and thrived on it.
The following spring, Mrs. Carwile decided to include me in her yearly piano recital. Her piano students at a local elementary school gave a yearly recital. For this recital, I would be a “special guest” and play.
She picked out a song for me, “Voice of the Heart,” Opus 51, by Henri van Gael. She modified which parts I would play to fit my abilities.
Then she broke the big news. She wanted me to memorize the song and play with no music.
I don’t remember being afraid at that point, but my mother was worried. Mrs. Carwile reassured her that I could do it.
I remember practicing and practicing, getting ready for the recital, which was taking place exactly one week before my sixth birthday.
My mother made me a long white dress with a white satin ribbon to wear for the occasion. I wore white sandals, and, much to my embarrassment, white socks with the sandals.

Standing on our front porch before we left for the piano recital.
I was excited about playing, but I also was very shy. It was difficult for me to be around so many other children backstage at the school. I remember that someone pinned a carnation to my dress.
All the other students sat on the stage, but I sat with my family in the audience. About halfway through the program, Mrs. Carwile called me up on the stage.
She asked me what my name was and then she asked me how old I was.
“Five,” I said.
But I felt guilty saying five. I was just a week from being six. Shouldn’t I say I was almost six?
Even at that age, I understood that Mrs. Carwile wanted me to be five for the audience. She wanted to impress upon them my young age before I sat down and played a song without the sheet music in front of me.
But I felt guilty.
Then I walked over to the piano and sat down. I was afraid, but I didn’t think I had any choice. That was what I was supposed to do.
I started to play and my fingers moved automatically through the song. I had practiced so much that I played without thinking.
I made one mistake. I hit one wrong note.
No one noticed, my mother said. I don’t think she noticed. But I did. I knew I had not played the song perfectly.
From the outside, my first piano recital was a good experience. I took piano lessons for another six years and took one year of organ lessons. I made it through other performances.
Today, I still love playing the piano, though I play on a keyboard now. I play by note and by ear, a combination.
But looking back on my first recital, I wonder if my OCD was showing itself in subtle ways: worrying about whether or not I was being totally truthful about my age, and being focused on the one mistake I made and not the rest of the performance.

If you have OCD, do you remember the first signs of it? Even if you don’t have OCD, do you remember a childhood moment when you felt great anxiety such as performance-based anxiety?

Friday, May 18, 2012

Treatment journey: Not straight, and certainly not quick

There are two main ways to get from my town to the county seat, where I do a lot of my reporting for the newspaper.
One way is mostly on a four-lane major highway. The speed limit is 60 mph. Even when I have to turn onto a two-lane road, it’s wide and well marked and I can make good time.
The other way is mostly on back roads, narrow and curvy secondary roads. It’s a more direct way to get to the county seat, but narrow and sometimes unmarked roads slow down safe drivers. You will eventually get to the county seat, but it will take longer than if you take the major highway.
Some journeys are straight and true, some not. Figuratively, the same could be said for the journey to effective treatment for mental illnesses.

My fantasy journey

I would have begun exhibiting obsessive-compulsive disorder and depression symptoms, which would have drawn concerned interest from my parents, which would have led them to take me to a doctor, who would have referred me to a psychiatrist, who would have diagnosed me and begun treatment.
Admittedly, since I started showing strong symptoms of OCD in the early 1970s, treatments would not have been what they are today. But as the years passed and knowledge of and research into OCD increased, I would have gotten better and better treatment for both the OCD and the depression.
And so, in my perfect dream, I would have spent my 20s, 30s and now my 40s living a life with OCD and depression, but a life not as greatly affected by them.
Yes, it’s just a dream. My treatment journey wasn’t that straight and true one, and I would bet that most people’s journeys aren’t either.

My real journey

I remember being taken to the doctor when I was about 9 or 10. My mother told me it was because I was crying at night and I wasn’t eating a lot. I don’t remember this. But according to my mother, the doctor said that even though it had been my brother who was in the hospital a lot, I had been through a lot, too, with being away from home and having to stay with relatives.
That was the end of that foray into medical diagnosis. The next time I saw a health professional for anything other than a physical ailment was when I was 25 and started seeing a counseling psychologist for my depression.
That was talk therapy. I talked about my life, and she listened. But she also taught me that my patterns of thinking were not healthy and were not a reflection of reality. For example, just because my mother told me I was lazy didn’t mean that I was.
When I was 26, I saw my first psychiatrist and was officially diagnosed with OCD and depression. I started medication, which greatly improved my symptoms.
In the years after that, I was in a little more talk therapy, but I focused mainly on medication therapy. I thought I was as well as I could hope for.
But in January, 22 years to the month that I was diagnosed with the mental illnesses, I decided to try cognitive behavioral therapy for OCD. Later this spring, I started Cognitive Behavioral Analysis System Psychotherapy (CBAS) for chronic depression, which was getting in the way of my OCD therapy.
I am finally on the road to real recovery.

How can we make it better?

What are some ways that we can better ensure that the road to good treatment is more straight than curvy?
Recently, Elizabeth, of Into My Own, reminded me of the importance of being our own health advocate in a great post.
When I worked as a health educator, I became interested in health advocacy because I saw so much need for it.
Advocacy is “(t)he act of pleading or arguing in favor of something, such as a cause, idea, or policy; active support,” according to The American Heritage Dictionary.
Being an advocate for yourself means asking the questions, educating yourself, and getting the care, including proper diagnosis, for yourself as you navigate the health care system.
Being an advocate for others means doing the same thing, but for others.
Being an advocate or even having an advocate may help you get a diagnosis sooner rather than later and may help you get on the road to recovery more quickly.
The following are ways that I have discovered to be helpful in being your own advocate or an advocate for someone else (Note: I use the term “doctor,” but you can insert therapist or any health care professional):

*Research respected sources for accurate and up-to-date information.
*Before you go to the doctor, make a list of questions to ask.
*If you don’t understand something the doctor says, ask for clarification.
*Take notes and/or ask for available handouts about a diagnosis, test, or treatment.
*Consider taking someone you trust with you to the doctor so you’ll have a second pair of ears to listen and take notes. (I realize this may not be desirable or appropriate if you’re going to a psychiatrist or therapist.)
*Find out the best way to get in touch with the doctor between appointments.
*Don’t be afraid to change doctors if for any reason you are not comfortable or cannot build a trusting relationship with him or her.

Was your road to diagnosis and treatment long and winding, or was it more straightforward?
Do you consider yourself to be a health advocate? How do you advocate for yourself? How have you advocated for others?

Thursday, May 17, 2012

Depression back story: How I allow the past to negatively affect my present

It has never been easy for me to be with my mother.
We have argued through the years far more than you would expect from a stereotypical mother-daughter pair.
I remember once as an adult, arguing with her with my father present, and he looked up and said with what sounded like pure frustration, “Why don’t you just get down on the floor and fight it out?”
That’s what my mother and I did for most of my life: rolled around on the floor, fighting, figuratively at least.
It was from my mother that I learned to read minds and make assumptions. I wrote about my tendency to read minds in a recent post.
Mind reading, making assumptions about what another person means by what he or she says, is one of the ways that I allow my past to dictate my present. It’s an example of distorted thinking.
In providing this back story, I am not trying to cast blame or throw a pity party. Rather, I want to show an example of how the patterns that we develop in the past can make the present more complicated and difficult.

Back story

I watched my mother closely when I was a young girl. I watched her facial expressions, the speed of her hands as she washed the dishes. I listened to the degree of vibration her feet made as she crossed the floor to tell me how heavy her footfalls were. I listened to her tone of voice.
I did this to try to determine her mood, her level of anger, what she meant when she spoke, how serious she was about what she said.
My mother could make me feel as loved as any child could hope to be.
“I love you so much, I wouldn’t trade you for a million dollars,” she’d say, and I believed her.
She took pride in her housework and was a fine homemaker, a wonderful cook.
She took time away from sewing clothes her family needed to make Barbie clothes for me. She even made a miniature satin and lace wedding gown for my Barbies, complete with veil and a tiny string of faux pearls.
She often allowed me to read instead of helping with chores, and she made sure I had plenty of opportunities to visit the public library.
My mother also told me I was lazy and selfish. I was shy, and she said sometimes said I acted “like a lump on a log.” She smacked me in the face. She told me my friends wouldn’t like me if they knew what I was really like.
She yelled at me for wasting water, wasting time, wasting toilet paper, being slow—all of which I did because of my OCD.
She yelled about her fate in life to “work like a dog” and get no appreciation for it. She threatened on numerous occasions to pack her bags and leave.
She tried to control what I thought, what I did, what I became. She tried to manipulate me into doing what she wanted me to do or giving her what she wanted.
She still does some of these things when I allow it. But I don’t allow it very often any more.
What I learned from my mother was to be ready, to leave the room if I could or stand and fight, whatever seemed best at the time.
I learned it was best not to ask questions of an angry woman who might lash out at me verbally or physically.
So I was often fighting blindly, responding to her in anger, not in any kind of rational way.
How it affects me now
My therapist says, and I recognize, that I don’t always address what is actually happening between another person and me. Instead, I respond as if I’m in the past, trying to read minds and blindly responding, mostly in anger.
Or I respond in silence, stuffing down the anger.
I end up thinking the worst, assuming that the other person meant something negative when actually the interaction we’re involved in provides no evidence of it.

What can I do about it?

I am learning that I have to ask questions like, what did you mean when you said that?
I may not like the answer, but at least I will no longer be responding blindly.
I will no longer give in to the hopeless thought of, why should I bother asking? I already know the answer, and it’s not one I want to hear.
Part of my therapy includes working on skills so that I feel more comfortable and competent at asking questions, throwing away the assumptions that get me nowhere.
I am trying to be more aware of my mind reading tendencies and recognize the thoughts for what they are: a coping mechanism I learned as a child that no longer works for me.

How does the past affect your present life? How do you keep your past from negatively impacting your present? What is your favorite technique for reminding yourself to stay in the present?