Friday, June 29, 2012

Can you please turn that down?

This week I’ve been building my posts around the five senses. Today, I consider the sense of hearing.

Loud noises bother me. A lot.
Noisy restaurants, crowded parties—I can stand only so much, and then I have to get out. And the silence that comes once I escape seems heavenly to me.
Loud noises make me anxious, and anxiety makes my OCD more difficult to deal with and can even make me feel depressed.
I’m reading the book The Highly Sensitive Person: How to Thrive When the World Overwhelms You, by Elaine N. Aron, and I suspect that I am a highly sensitive person—prone to not liking loud noises, lots of chaos, bright lights and other stimuli that most people handle just fine.
I found this passage interesting:

“One general rule is that when we have no control over stimulation, it is more upsetting, even more so if we feel we are someone’s victim. While music played by ourselves may be pleasant, heard from the neighbor’s stereo, it can be annoying, and if we have previously asked them to turn it down, it becomes a hostile invasion” (p. 22 of e-edition).

When I’m in the car by myself, I turn up my music, and usually sing along. But I remember the days when I lived in apartments and it drove me crazy to have to listen to neighbors’ music, especially pulsating, booming music that shook the walls.
After a while of listening to loud music in the car, I do like some silence, and I’ll turn it down or turn if off completely. And chronic noise bothers me.
But noisy restaurants and crowded parties probably bother me in part because I can’t control the volume.
Sometimes my husband has the television turned up louder than I’d like it. In the room across from our bedroom, where he sometimes watches TV, the television is old. You have to turn it up to hear the dialogue in a show, but then the commercials blare out.
It used to really bother me, especially if I was trying to go to sleep. But since I’ve been working on being more mindful, I’ve tried to actually tune in to the TV’s sounds and sense them as part of many sounds around me.
That said, I still prefer quiet. The quiet helps to soothe my anxiety.
When I want sounds to be soothing, music will sometimes do the trick, usually instrumental music with no words. But some artists, like Alison Krauss, can soothe me even with words.

Here are some other sounds that soothe me:
*The sound of my husband when he loses himself in laughter.
*His soft breathing as he sleeps.
*The purrs of my cats.
*The soft pad of the cats’ paws on the floor.
*The birdsongs in the early morning.
*The slight whirl of the ceiling fan over the bed.
*The wind high in the oak trees.
*Gentle wind chimes.

What sounds drive you crazy? What sounds soothe you?

Thursday, June 28, 2012

What I don't see when I'm depressed

  This week I’m building my posts around the five senses. Monday I used the sense of touch, Tuesday, the sense of taste and Wednesday the sense of smell. Today, I consider the sense of sight.

A few years ago, I was taking a morning walk/jog before work. I went my usual route. As I ran slowly down the street, I was thinking, but not about my form, my rhythm, or about anything I saw around me.
I was thinking about how depressed I was. How hopeless I was about my job, my future, my life. My feet seemed to plod more than fly. Just one step in front of the other. Just going through the motions.
Sometimes going through the motions is all we can do. Sometimes it’s helpful to do the action first. The motivation will come later.
But sometimes the plodding is just getting through time.
And when I’m just trying to get through time, I miss a lot of what is happening around me.
I miss the sun breaking through the treetops to give a little light to the dark woods beside the road.
I miss the blooms of the flowers.
I miss nature.
I miss life.

I’m in a better place now, but I still find that it’s too easy to get wrapped up in my thoughts and not notice what’s surrounding me.    
Here are some photos of some things I don’t want to miss on my walks.

What do you miss seeing when life gets too anxious or seems too difficult?

Wednesday, June 27, 2012

Smells bring out the back-stories

This week I’m building my posts around the five senses. Monday I used the sense of touch. Yesterday I used the sense of taste in my post about cooking. Today, I consider the sense of smell.

I walk up the sidewalk to the porch of the red brick building. It’s hot, in the 90s, and muggy. The humidity seems to bring out the odors around me, and I smell the boxwood near the porch.
The smell of boxwood outside my doctor’s office on a summer day takes me back.

Do smells ever evoke memories in you? Research shows that they can.
An example of this for me is the scent of that boxwood.
We had boxwood at my first home, where I lived until I was 10. One was a huge, thick one at the corner of our front yard.
In that front yard is where I often played cars with my second brother, who was two years older than me.
He had lots of Hot Wheels. I didn’t have any of my own, but he loaned me his lesser cars so we could play together.
Between two oak trees, where grass wouldn’t grow (or maybe didn’t grow because we played there so often), we built roads in the dust for our cars. We each claimed a tree.
I had my house up in the roots of one of the trees. I created long meandering driveways to the house. I scratched lines in the dust with a small stick, and then looked for seeds to place along the lines for a garden.
There were some soft green seeds we found in the yard, and those were my watermelons.
I was the only girl in my family. My brothers wouldn’t play dolls or house with me, but I could play cars or sports with them.
I found a way while playing with cars to also play house.
When we moved, we took some of the boxwood with us. My parents planted them in front of the house, around the carport, the front porch and the flowers on either side.
It was my job to water them every night until their roots were set. That meant filling up a gallon bucket from the water hose and pouring it on each bush.
It was boring work that took a while, so to make things more fun, I named each of the shrubs. I named them in alphabetical order, so the first one was named with an A name, the second with a B name, and so on.
I don’t remember the names now, but I remember that they were all girl names. And since I loved making up names for my future children, and often used the names of characters from books I enjoyed, the names were probably something like Amelia, Betsy, Catherine, Daisy, Emily, etc.
I never had children to receive those names, but I had fun making up the names and weaving stories around them.
Those are pleasant memories. Of course, smells can evoke unpleasant memories, too. There is a certain perfume that, when I smell it, takes me right back to my first year in college, when I started my real struggle with depression. Those feelings of isolation momentarily surround me again.

What smells evoke memories in you?

Tuesday, June 26, 2012

Cooking was an OCD nightmare, but the food tasted good

I cooked on Sunday. I used the stove. I mixed ingredients. I cleaned up after myself.
On the outside, it probably looked like it went OK, but on the inside, I was a nervous wreck.
Ingredients minus the pasta.
On Sunday I fixed a simple pasta salad. I cooked the tri-color rotini and mixed it with kidney beans (rinsed), sliced black olives and broccoli flowerets. Then I mixed it all with balsamic vinaigrette and chilled it.
Boiling pasta.
It was very easy to fix.
I managed to turn off the stove, but I did turn it back on and then off again to satisfy myself. So that needs work.
I didn’t ask my husband to double-check behind me, so that was a good point.
The finished product.
I made an important discovery, too. What bothers me most about cooking is the cleaning up afterwards.
All during the preparation, I thought about the mess I was making and how hard it was going to be for me to clean it up.
It’s not that I made a huge mess. But after I used the electric can opener to open the can of beans, I had to carefully wipe around its edges. I didn’t see any food on the appliance, but I had to clean it to make sure I was getting rid of any invisible residue.
I was so thankful the can of sliced olives had a flip-up top. I love cans like that because I don’t have to use and then clean a can opener.
While I as cooking the pasta, the water ran over the rim of the pan a couple of times, so I had that to clean up.
And then I had to gauge whether or not I was cleaning every bit of counter that I worked on.
My anxiety level was probably at a 7 while I was cooking and cleaning. But afterwards, I felt relief and the anxiety lessened to about a 3, which for me right now is pretty good.
I clean much easier now than I used to before treatment, but I still worry that I’m missing something, and I know I perform a bit of overkill in wiping the counters.
It was all worth the effort, though, because my husband and I had a salad to enjoy, and I knew I had stepped in the right direction, towards cooking more.
And the salad tasted good.

Which do you enjoy the least, cooking or cleaning up afterwards? Do you have any easy pasta salad recipes or other salad recipes good for summer that you’d like to share?

Monday, June 25, 2012

OCD and touching

Note: My blogging friend Rebecca Lane Beittel recently did a week’s worth of posts on her blog “Rebecca of Tomorrow” using the five senses. She invited readers to consider the examples of sounds, tastes, textures, etc. that she provided and choose their favorites.
With a nod and thanks to Rebecca, I’m using the theme of the five senses to connect my five posts this week. With each day’s topic, I’ll focus on one of the senses. Today’s is touch.

When I was in high school, I loved basketball. I loved watching college basketball on TV and dreamed of the day when I would be attending the University of Virginia and would be able to see games in person at University Hall.
In high school, I played basketball for two seasons, my ninth and tenth grades. I was not a good player. I spent a lot of time warming the bench.
That said, I did practice, even without a ball. Our house had a long hallway that went almost the entire length of the house and ended in the kitchen. I’d pretend to be dribbling down the hall (real balls not allowed) and then I’d do a lay-up at the doorway into the kitchen.
What I was really doing was finding a new way to cover up a habit I had. I had to touch the top of the doorframe before I could enter the kitchen.
My “lay-up” was a chance to tap the top of the doorframe.
I don’t remember when I started the tapping, and I didn’t have a particular harm obsession connected with it. In other words, I didn’t think anything specific would happen if I didn’t tap the doorframe. But I didn’t feel “right” and felt anxious if I didn’t do it.
It eventually spread to all the doors within the house—I had to tap the top of the doorframe once before entering a room.
The doorframe touching stopping mostly after I started taking medication for the OCD, but I think ERP would definitely work with that, too.
The odd thing is that if I do happen to touch the top of the doorframe now—for example, I may be standing and talking with my husband and grab the frame with my hands over my head—I can see how easy it would be to get back to the compulsion. So I try not to touch it.
My checking compulsions also involve some touching. At times, I become obsessed with whether or not the light switch is “really” turned off. I fear that I’ll leave it halfway between on and off and it will cause an electrical short and a fire will erupt.
I have to use one finger, usually the forefinger of my right hand, to turn off a light switch. It has to feel a certain way—not too light of a touch and not too heavy—or I have to turn the switch back on and off. There is no set number of times I have to do this. I have to do it until the light switch feels off in the “right” way.
I have to pull out the “Brain Lock” and exposure and response prevention tools to fight this light switch compulsion. I have to make myself turn the switch off once and then walk away and concentrate on something else. It’s hard, but not impossible.

Do you have any touching OCD symptoms? If so, what are they and how do you manage them?

Thursday, June 21, 2012

Chronic depression and discerning what I want

Claude Monet, "Weeping Willow."

When my therapist and I do the CBASP therapy (Cognitive Behavioral Analysis of Systems Psychotherapy) for chronic depression, one of the key points in the session is to pinpoint my desired outcome of the specific interpersonal interaction we’re discussing.
Those specific interactions are what the therapy is built around. Every week I bring in an example—positive, negative, or a little of both—of an interaction with another person, and we analyze it in a systematic way.
There are two types of outcomes we discuss.
The actual outcome is based on what actually happened. It’s the last thing I did or said during the interaction.
The desired outcome is the best possible outcome given the circumstances.
That’s where I’m having the most trouble, deciding what the desired outcome should, or could, be.
Sometimes I literally draw a blank when my therapist asks me, “What did you want to happen during this interaction?”
It’s not unusual, my therapist said, for people with chronic depression to not know what they want.
In my mind, I view “the right thing” or “the best thing” in opposition to “what I want.” I tend to think of “what I want” as the selfish thing.

What I want?

I don’t mean I have trouble deciding what flavor ice cream I want, or which outfit I should wear.
I mean decisions about what I want out of life: what is good for me and what is not, when to speak up and when to be quiet, how I want to spend my time, what I should be doing with my life, what my purpose is—the big but basic wants.

Effects of depression

Depression can suck the energy right out of me. Sometimes I feel dull and lifeless and all I want to do is sleep. I don’t want to do the things that I usually enjoy, like reading or cross stitch. The thought of doing anything overwhelms me, so I don’t spend a lot of time thinking about what I want. I don’t care.
I also sometimes have a difficult time knowing if I’m making a decision based on my depression or on an understanding of what I want in life.
And the hallmark of chronic depression is a sense of hopelessness. So to consider what one wants begs the question, what does it matter?

So how can I help myself?
At this point, it’s important for me to consider what I want—something novel to me—and then consider whether or not it’s the right thing.
There are some ways that help me decide what I want. Most of them involve quiet activity:
*Writing helps me sort through my thoughts. Often while writing a post, I will figure out what message I’m trying to convey only after I write it.
I can relate to the writer Joan Didion, who said, “I write to find out what I’m thinking, what I’m looking at, what I see, and what it means.”
With better thinking, I can gain better self-understanding.
*Quieting my mind helps me to focus. The best way for me to slow down my thoughts is to sit quietly in meditation, listening to my breath and the other sounds around me, imagining my thoughts passing through my mind.
As the frenetic pace of the thoughts slows, I can pay better attention to what’s going on now.
I have found that if I meditate regularly, I am calmer and better able to attend to now. The key is regular meditation.
*Nature helps me. Sitting by the river and listening to the water, talking a walk, and biking through fields and trees soothes me and calms me.

It’s a process. I’m still having a difficult time discerning what I want out of an interaction. But I’m working on it.

  Do you ever feel that what you want is in conflict with what is right? How do you resolve that conflict? And how do you discern what it is that you want?

Wednesday, June 20, 2012

Animals don't care if I have OCD

Thunder Cat, our wonderful boy we lost in February 2009.

8 reasons why I love animals:

*They are God’s creatures.
*They are a beautiful and integral part of nature.
*We share the earth with them.
*They don’t judge me for having obsessive-compulsive disorder, depression and anxiety.
*Our pets want to be around us even when we’re grouchy and are having a bad day.
*Our pets help us when we’re lonely.
*They are honest and don’t put on a show.
*Our pets help teach us responsibility, selflessness and unconditional love.

From the website of The American Society for the Prevention of Cruelty to Animals, here are some of the ASPCA’s top ways to help animals in your community (for more details, see the ASPCA website):

*Learn how to report animal cruelty.
*Start a neighborhood watch program for animals.
*Volunteer at your local shelter or animal rescue organization.
*Become an animal activist.
*Help your neighbors help their animals.
*Start a pet food bank.
*Promote spaying and neutering.
*Clean up for wildlife.

  What is your relationship with animals like? What do you appreciate about animals? How have animals helped you?

Tuesday, June 19, 2012

Bring Change 2 Mind

Last week, as I watched TV one evening, I saw a commercial that addressed the stigma of mental illness. It blew me away with its effectiveness:

I got up right then and went to my computer to look up “Bring Change 2 Mind.” I found a website for the nonprofit co-founded by actress Glenn Close.
Its mission is the following:

To emerge as the world's most effective organization working to eradicate the stigma and discrimination surrounding mental illness through widely distributed Public Education Materials based on the latest scientific insights and measured for effectiveness.
To act as a portal to a broad coalition of organizations that provide service, screening, information, support and treatment of mental illness.

Its partner organizations include Mental Health American, the National Alliance on Mental Illness and the National Institute of Mental Health.
On the website, you can find facts about mental illnesses and and resources for finding out more.
There’s also a space for sharing your story about mental illness and reading the stories of others.
The website includes helpful videos, including an interview with Close about why she became a mental health advocate. Her sister has bipolar disorder, and a nephew has been diagnosed with schizophrenia.
While on the website, I chose to take the pledge to work to erase the stigma of mental illness. The pledge reads in part:

“For people living with mental illness:
*I am living with a mental illness that is treatable and manageable.
*I am a valuable and valued person and I deserve to be treated with respect.
*I am responsible for the decisions and choices I make in my life.
*Educating myself about the symptoms of my illness, and any side effects I may have from treatment, will help me find and use the resources I need to work toward stability.
*Communicating about my experiences with others will help them support me in difficult times and keep me “on track.”
*If I am feeling suicidal, it is critical that I reach out for help, for in the face of real pain and suffering, it is others who can help me with a commitment to live.
*I can reduce stigma in myself and in others by being open about living with mental illness, naming it out loud, and raising people’s awareness.”

  I'm glad to see an organization dedicated to something as important as this. The stigma of mental illness causes a lot of pain. I realize that I must do my part to fight it.

I encourage you to check out the website. And please come back here and comment about what you found.

Monday, June 18, 2012

OCD and choosing prayer and faith

I’ve written in this space before about my prayer life: how obsessive-compulsive disorder has led me to try to build an imaginary shield of protection around my loved ones and how I have struggled for years to get constant prayers and chants for forgiveness and help out of my head.
If I’m not very mindful and careful, my prayers morph into repetitions of words said until I feel “right.”
Whether they are prayers for others or prayers for myself, prayers said aloud, prayers said silently, prayers written down—they can all end up being a mess of words.
I pray, but I’m not communicating with God. I’m communicating with myself.
For all the pain I’ve had over religion and prayer, I still want to nurture the spiritual in my life. I want to be part of an organized religion. So I am making some choices.
Meditation is working better than prayer for me, and I will continue to practice.
And I’m making other choices.
Jonathan Grayson, Ph.D.
In his book Freedom from Obsessive-Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty, Jonathan Grayson, Ph.D. wrote something that made me consider the whole way I approach prayer and faith: “Many of you have focused so much on following rules that you have forgotten to think about the nature of your faith.” (p. 222).
Grayson said people with religious obsessions believe in two Gods, “a loving and forgiving God who cares about their souls and well-being” and “a stern and exacting God who will damn them for the slightest misstep” (p. 222).
We have the choice of which God to believe in, Grayson said. Religion is full of guesswork, and people decide what to believe as a matter of blind faith: “Most people like to think of faith as a feeling that gives strength, but it can also simply be a decision you choose to follow” (p. 224).

My minister

That reminded me of something a former minister told me when several years ago I discussed with him my lack of faith and my trouble with praying. He told me not to focus on how I felt but on what I believed and to do things that could help me be closer to God, like having regular devotions.

There it is again

So I’m back to the same thing I’ve faced before with OCD and depression: I place too much importance on feelings and not enough on action.

My choices

I still have many reservations about prayer. But in addition to meditating, I am choosing to pray, not as I have in the past, not in the OCD way, but in a way that I am able to. I am choosing to pray to the God whom I choose to believe in: a loving and forgiving God.
I will never know in this life whether or not I am doing it “right.” I cannot be certain that I’m praying in the way I’m supposed to, if there is such a way. But I will take action to try prayer to better my life.
For the time being, that will probably be saying prayers that have already been written, like the St. Francis of Assisi prayer.

How do you nurture your spirituality? What choices have you made about spiritual practices? Are there any prayers that you particularly like?

Friday, June 15, 2012

She called me high functioning: My first visit to a psychiatrist

Dear readers,

This is a very small excerpt from the book that I’m writing about my experiences with OCD and depression. It’s the story about my first visit to see my first psychiatrist when I was 26 years old.
I’d like you to read this not just to find out about that experience, but to also give me some feedback on how you think this would fit into a memoir. What would you like to learn more about? What needs to be fleshed out or clarified? Are you interested in reading more?
And please share your experiences as you feel comfortable. If you’ve been treated by a therapist or psychiatrist, what was that first visit like? If you were diagnosed with a mental illness, how did the diagnosis make you feel?
I always appreciate your comments and feedback. Thank you!

She called me high functioning.
What the psychiatrist actually said was something like, “I would consider you high functioning since you have managed to stay in school and do your work.”

Me at 26.

High functioning seemed to be more than generous, because I certainly didn’t think of myself that way.
I spent countless hours cleaning my small bathroom. If I cooked or even just cleaned the top of the stove, I spent several hours checking to make sure the stove was turned off. Any cooking, whether it was on the stove or in the microwave, produced repeated and careful washing of the countertops. My hands and wrists were red and chapped from my repeated washings to rid myself of any germs that might hurt others. I couldn’t walk up a sidewalk or path without starring at the ground, looking for sharp sticks or rocks that could possibly harm someone. My mind was full of prayers and chants to a God I couldn’t really talk to.
I didn’t consider myself to be high functioning.
I had never been to a psychiatrist’s office before. I was 26, and after a year of talk therapy, the psychologist had decided that my depression was not going away and I probably needed some medication.
I had also revealed to her my obsessive-compulsive disorder symptoms. That surprised her.
“All the time we’ve been talking, and you never mentioned it,” she said. “I would have never known.”
So perhaps to her, too, I was high functioning.
When I arrived at the psychiatrist’s office, which was located in a town north of the town I was living in while attending graduate school in northwest Ohio, I wasn’t sure what to expect.
Would I lie down on a couch? Would she ask me questions about my childhood that I wouldn’t want to answer? Would she judge everything I said through the lens of Freud?
I admit that I was glad her office was not in the same town that I lived in. I desperately wanted to keep this visit secret.
The waiting room looked like all the other doctors’ waiting rooms I had been it. Muted greens and blues. Semi-comfortable vinyl-covered furniture. Magazines.
I was embarrassed as I stood at the counter in the waiting room and paid for my visit. What was the receptionist thinking? That I was crazy? That something must be scarily wrong with me because I had an appointment with her boss, who was a head doctor?
When the psychiatrist called me back to her office, she had me sit down in a chair, directly across from where she sat behind her desk. There was a window behind her desk, shining light on me.
She then started with the business of the visit. She asked me a lot of questions, questions I’ve since been asked many times by any new counselor or psychiatrist.
Why are you here today? What problems are you having? Are you sleeping too little or too much? What are you eating habits? Do you get pleasure from daily activities? Do you feel hopeless? Have you ever considered suicide?
For the OCD, the questions were along the lines of, what do you obsess about? What kinds of things are you doing compulsively? How do they interfere with your life?
It was more like a job interview than a doctor’s visit.
Eventually, she diagnosed me with depression and OCD. I wasn’t surprised by what she said. I certainly felt hopeless, suicidal and dead inside. And I had read enough to know that my bizarre habits indicated I had OCD.
But hearing her say the words, officially diagnosing me, was an experience that I would now call life changing. Before, I could simply hypothesize that I had these disorders, especially the OCD. I could always imagine that I really didn’t have OCD. I was just a sinful, bad and weird person who wasted time, water and money, all in the name of my strange habits.
With the diagnosis, I had a stamp of officialdom on my habits. They were weird, yes, and wasteful, yes. But they were also symptoms of a disease, albeit a disease I felt humiliated for having.
The psychiatrist talked about a new drug that had just been approved by the FDA called Anafranil. It was the first medication that targeted OCD specifically. She had seen it used in drug trials, had seen its effectiveness.
But it had just been FDA-approved in December, and this was January. It wasn’t yet available to the general population, she said.
So she prescribed Prozac. It would help the depression, and it might help with the OCD. Time would tell.
I walked out of her office with some hope of help. But I also walked out with self-consciousness and a sense of shame.

Thursday, June 14, 2012

Book Review: Depression: A Guide for the Newly Diagnosed

Depression: A Guide for the Newly Diagnosed. By Lee H. Coleman, PhD, ABPP. New Harbinger Publications Inc. 2012. 166 pages.

Note: I was provided with a free copy of this book by New Harbinger Publications and asked to write a review on my blog if I felt comfortable doing so. The opinions in this post are my own.

Depression: A Guide for the Newly Diagnosed is a well-written, engaging book that would not only be of help to the newly diagnosed, but to those who have long been diagnosed with depression.
While I am not newly diagnosed, I found it helpful to review what depression is and what treatments are available. I found good information in the sections on how people can help themselves and how they can ask for help from others.
Lee H. Coleman, PhD, ABPP, writes in a straightforward manner without a lot of jargon. It’s a book that would be accessible to most readers picking up the book to get help with their own depression and for family members and friends of depressed persons.
It is truly a guidebook, because it details the journey from experiencing the first symptoms of depression to lifestyle choices that help in the aftermath of a depressive episode.
Coleman stressed the importance of treatment for depression. In fact, it’s his main point: “If there’s just one message you take away from this book, it should be that depression can and should be treated” (p. 10).
He notes that most people who get treated for their depression get better and do so more quickly than people who don’t get treatment.
He advocates getting the treatment that works best for the depressed person as an individual, stating that less than half of depressed people get a proper diagnosis and treatment.
His rallying cry is to keep on seeking a treatment that works: “If you were diagnosed and treated properly but your depression still didn’t remit, don’t despair! Depression can be tenacious, and what works for one person might not work for another. You’ve got options, and there are different kinds of treatment you can pursue . . . (p. 11).
He doesn’t advocate any one treatment, but he speaks of his own experience in using different treatments with patients and also refers to scientific studies that have been done on the treatments.
Those he discusses include psychotherapy, cognitive therapy, cognitive behavioral therapy, interpersonal psychotherapy, psychodynamic therapy, mindfulness-based treatments and medication.
The book also discusses what depressed people can do to help manage their symptoms while they are in the midst of treatment. I found this chapter to be particularly unique and helpful. The author makes it clear that “these strategies are ideas for symptom management, not symptom removal” (p. 71).
He provides ideas on how to manage low energy and fatigue, the loss of interest and social isolation, sad moods, sleep disturbances, changes in appetite, guilt and problems with concentrating and making decisions.
This commonsense approach to symptom management would be helpful to the depressed person who is not yet seeing results in therapy and/or from medication.
He does an excellent job in describing what a new patient should expect from therapy. This would be particularly helpful for those who have never experienced therapy and for those who may have had a bad experience with therapy and still have some concerns about it.
Coleman underscores the seriousness of depression by devoting a chapter to managing suicidal thoughts, with a section for the depressed person and a section for the depressed person’s family and friends. He includes sections on decreasing the risk of suicide, increasing protective factors, and how to let others know help is needed.
He includes an amazing chapter on resources. It’s one of the most detailed resource lists that I’ve seen in such a book, and I plan to keep it handy for my own research and guidance.
The book includes the Patient Health Questionnaire (PHQ-9) for readers to take and show their physicians to have the number and pattern of symptoms checked.
I wholeheartedly recommend this book for the newly diagnosed. And I also recommend it to those who have been diagnosed but want to read more deeply about what treatments are available and things they can do for themselves to manage their symptoms and decrease the chances of a relapse or recurrence.

Wednesday, June 13, 2012

Books: Wonderful things indeed

Some books on my "read soon" list. My Nook sits on top.

Books on bookshelves and on bedside tables at home; books in the public library; books in bookstores: I love to be surrounded by books.
My love affair with books began when I was a child. I remember taking books down from the bookshelves in the living room before I could read. I searched the pages for the one word that I knew, the word “the.” I ran my finger along the sentences until I saw my word, and then I would say it aloud: “the.”
I don’t remember learning to read. I just remember being able to read and loving it.
Even as a child, I enjoyed reading more than one book at a time. I carried a little stack of three or four books around with me, from one reading spot to another, entering first one world and then another as I switched from book to book.
I probably very much needed books as a child. Sometimes I needed the comfort, and I certainly needed something constructive and beautiful to do while I waited in hospital waiting rooms, doctor’s offices and at relatives’ homes.
I loved mysteries from the start. My favorites were the Trixie Belden books and the Nancy Drew books. I also loved the Laura Ingalls Wilder books, books by Maud Hart Lovelace and any book about horses.
I liked biographies, too, especially about strong women who made their way in the world like Amelia Earhart.
I like to say I practically grew up in our local public library. I loved walking the aisles, looking for something new. I loved the smell of the library. I loved the quiet. I loved the love of books that hung in the air.
During high school, I usually had a pleasure reading book with me so that, if I finished my work in class before everyone else did, I could bring it out and read a few pages before class picked back up.
I loved books so much I majored in English in college and got a master’s in English.
I have written before how obsessive-compulsive disorder has affected my reading on and off for years. I obsessed over whether or not I had “really” read every word and would reread passages until it felt “right” to move on.
It’s one of the most awful ways OCD has affected me because it hits at part of what defines me.
Thankfully, I can now usually push through the obsessions and keep reading until the anxiety subsides.
Most of the fiction books I read now are mysteries and thrillers. My favorite authors in those categories include Sue Grafton, Kathy Reichs, Meg Gardiner, Lee Child and Nevada Barr.
I also enjoy memoirs and other nonfiction books. Some recent reads include

*The Mindful Writer: Noble Truths of the Writing Life. By Dinty W. Moore
*The Foreign Language of Friends. By Nadine Feldman.
*Here If You Need Me. By Kate Braestrup.
*Blue Nights. By Joan Didion
*The Memoir Project. By Marion Roach Smith

Some books I hope to start soon:

*Behind the Beautiful Forever. By Katherine Boo
*The Animal Manifesto. By Marc Bekoff
*Freedom from Obsessive-Compulsive Disorder. By Jonathan Grayson, PhD
*The Affair. By Lee Child
*Wild: From Lost to Found on the Pacific Crest Trail. By Cheryl Strayed

  How much do you like to read? What are some of your favorites? What have you read lately? Please share!

Tuesday, June 12, 2012

It’s probably more than just separating your clothes: explaining OCD

When an acquaintance said he was a little OCD and used as an example the fact that he kept all of his Virginia Tech clothing in a drawer separate from his other clothes, I wanted to ask, “Are you kidding me?”
If he had told me that he constantly thought about that drawer, that he got up during the night to make sure all his Virginia Tech clothes were in that drawer, that he left work to go home and make sure no other clothing was in that drawer, that he stared for hours at the clothing in the drawer to make sure it was all Virginia Tech—then I would have felt differently.
How should I react when I experience an encounter like this when people say they are OCD and give as an example something that shows they are merely particular in how they store their clothes?
How do I find a middle ground, something in between saying nothing and beating my chest and saying, “People with OCD suffer.”
But maybe I’m not being understanding enough. Who am I to tell someone else that he or she doesn’t “really” have OCD?
I turned to the International OCD Foundation website for a formal definition of OCD: “Obsessive Compulsive Disorder (OCD) is [a] disorder of the brain and behavior. OCD causes severe anxiety in those affected. OCD involves both obsessions and compulsions that take a lot of time and get in the way of important activities the person values.”
It goes further to say that people “tortured with OCD are desperately trying to get away from paralyzing, unending anxiety….”
So the anxiety a person experiences and the degree to which the obsessions and compulsions interfere with life seem to be key components of OCD.
Should I have told my acquaintance this when he declared that he was OCD? Should I have told him that people suffer from OCD to differing degrees, but simply organizing his clothes a certain way probably was not OCD?
When we’re faced with an encounter like this, what should we do?
When do we need to explain OCD? How do we educate the public about OCD? How do we take the opportunities to do something? What is an opportunity?
I don’t have any definitive answers. But here are some guidelines for myself that I came up with:

*If someone asks me directly about OCD, I will explain what OCD is and how it affects me.
*If someone I barely know says something about being OCD, but doesn’t ask for help or ask me about OCD, I won’t explain anything.
*If someone says something about OCD that is blatantly incorrect, I will say something politely but firmly to give the correct information.
*If someone makes fun of those with OCD, I will politely but firmly say something that makes it clear that OCD is not a laughing matter.
*I will use my blogging platform to continue to get the word out about OCD.
*I will continue to educate myself by reading other blogs and news and research articles.

What do you think is the best way to respond to people who seem not to understand the seriousness of OCD, or any mental illness? When do you think it’s best to say something and best not to?

Monday, June 11, 2012

OCD and why I don't cook

I actually own some cookbooks and have a couple of my mother's recipe boxes.

It’s messy and there’s the whole stove thing.
I don’t cook because cleaning up during and afterwards brings out my contamination and cleaning obsessive-compulsive disorder symptoms.
No matter how careful I am, I sometimes spill food onto the kitchen counter when I mix together ingredients. Or I put down a bowl that held one of the ingredients and it leaves behind a ring of sauce, milk or whatever.
If I have to use the can opener, then I have to carefully wipe that off after I finish using it.
I worry that in cleaning off the counter, I may miss a spot and then ants or bugs might come around.
I don’t cook because a lot of cooking requires the stove. I can turn on the stove OK, but turning it off brings checking behavior with it. Is the stove really off, or do I just think it is? If I leave it on, a fire could start, or my husband might lay his hand on the stovetop, not knowing it was on, and burn himself. So goes my thinking.
Pans on the stovetop can also lead to food on the stovetop, leaving another surface to carefully clean and worry about.

Cooking anxiety

I have all this anxiety even though I’ve come a long way in my contamination and checking OCD symptoms.
I used to wipe the counter over and over, leaning down to view the countertop from different angles to make sure every bit was covered with cleaner. Then I’d clean it again. And again.
I used to check the stove for literally hours, staring at the on/off button, turning it on and off again and again, trying to get to the place where it felt “right” that the stove was off.
I no longer take so much time cleaning and checking the stove. I don’t follow through with all my compulsive urges. I can actually clean fairly quickly and turn off the stove in one attempt.
But the obsessions about cooking are still there, and it’s hard to face them every time I want something to eat.
So I avoid cooking.
Oh, I’ll put something in the microwave. But it’s rare that I mix ingredients and cook them on a conventional stove.
When I do cook, it’s a burden. There are so many things to worry about.
And I just don’t like to cook. I don’t read recipes with the same enthusiasm as my mother, who was a wonderful cook when she was still able to do it, and many friends, who discuss cooking like I would discuss a good book or movie.
I wonder if my dislike of cooking is directly related to my fear of cooking. I would guess that there’s at least a partial connection.

So how do we eat?

Breakfast is easy enough with oatmeal or grits cooked in the microwave, cold cereal, fruit or yogurt. I can eat sandwiches or snacks for lunch. My husband and I eat out for lunch sometimes, for dinner a lot.
We fix a couple of meals at home each week, usually using the microwave. We usually cook things separately, since I’m a vegetarian and Larry is not.
Sometimes my husband fixes spaghetti, with one pot of meat sauce and one pot of meatless sauce for me.

I want to cook

I want to cook more. I want to make food so we eat at home more often than we eat out. Cooking would result in healthier meals for me and for my husband. It would save money.
I want to enjoy cooking, because I feel like I’m missing out on something. I even recently bought a new vegetarian cookbook.
And I want to stop avoiding cooking. I want to stop giving in to the OCD and just push through and cook.

  Do you have any suggestions on how to do that? Do you like to cook? What about cooking do you enjoy? How did you get to that place of enjoying cooking?

Friday, June 8, 2012

7 things I've learned about treatment for OCD and depression

*A combination of tools works better than any one thing.
My treatment has included medication, talk therapy, cognitive behavioral therapy and CBASP, and well as self-treatments such as exercise, yoga, meditation and relaxation techniques.
None of these by itself has been enough. And that’s OK. I know there’s no magic pill. And I like the idea of a synthesis of treatments working for the good of my health.

*You’ll notice improvements before anyone else will.
  My first signs of improvement were so subtle that I thought perhaps I was imagining them. I felt a little less down, had a little more energy, was able to stop washing my hands a little more quickly, didn’t check the stove as long.
But I noticed them. Maybe no one else could see a change, but I did. And my therapists and doctors needed me to tell them of any improvements.

*At first, you won’t necessarily see the connection between the treatment and improvement.
My therapist told me that people tend to not want to believe that medication, for example, is the reason for the improved symptoms. It’s hard for us to make such a connection. A pill can help me not have obsessive thoughts? A pill can help me feel less hopeless?
I’ve found that to be true of medication and with the CBASP. I’m feeling better, but it seems like it is a little too good to be true.
And it’s hard for me to see the forest for the trees, so to speak. Therapy is intense and detailed. It’s hard sometimes to lift my head and see the results.

*It’s not easy.
The CBASP is hard. ERPs are hard. Dealing with medication side effects is hard. It takes dedication and discipline to keep doing the things that will make me feel better.
And there’s the fear of failure. Sometimes during a therapy session, I worry that I’m not doing it right, that it’s not going to work.
That’s when hope is so important.

*It’s usually not a quick process.
  I’ve been in treatment of some kind, even if it has just been medication, for 22 years. That’s hard to admit because there’s a part of me that believes I should have gotten it right by now. But that brings me to the next point.

*It will never actually end.
  Treatment for OCD and depression will go on indefinitely because there is probably no cure, only remission, by which I mean a lessening of symptoms. Even when I’m no longer in active therapy, the exposures will continue, the self-talk and learning will continue.

*Any treatment works better if you take care of yourself in basic ways.
It’s important for me to get enough rest and to eat properly. If I get very tired, I first get very anxious, then I crash and get more depressed.
If I eat too much or too much junk food like sweets and simple carbohydrates, I feel sluggish and my stomach bothers me, which in turn makes less energetic.
And having time for myself to read, think, and just relax is key to me being better able to handle what life brings.

What have you learned about treatment for OCD and/or depression or other mental illness? What suggestions do you have for others going through treatment?