Anticipating the worst gets you nowhere

"A bit of autumn"

Every time I woke up Saturday night into Sunday morning, I thought about the upcoming Confrontation.

They won’t believe me.

I’m going to get upset.

I’m going to start crying.

If they can’t help me, I’m going to have to go probably a week without enough meds.

It’s going to be too hard.

I turned over and told myself that I couldn’t know then, in the middle of the night, lying in my bed, what would happen. It might not be so bad. I’d deal with it then.

I fell asleep.

Then I woke up again, and the fears would take over again.

I was experiencing classic anticipatory anxiety, where I was getting anxious about an upcoming event or interaction. I was feeling the anxiety as if I were in the middle of the situation, and the situation was going badly.

What was the Confrontation I dreaded?

A talk with the pharmacist at the local drugstore.

I hate confrontations. I have a lot of fear about people being angry at me or thinking ill of me. I have kept quiet and suffered the consequences of not speaking up, not asking for better service, not asking for what was rightfully mine.

I know at least some of this tendency is because of my intense anxiety.

The situation I faces was this: When I got my antidepressant refilled, I thought the bottle felt light. But the bottle was small and the pills were large, so it was hard for me to tell.

I pushed aside my worry. Surely, the pharmacy staff would have gotten it right.

On Saturday night, I really looked into the bottle, and I could see the bottom, with only six pills left. I checked the refill date, and it was just two weeks ago. There was no way that I started out with 60 pills.

I told Larry about it.

“They’ll think I’m lying to get some free pills,” I said.

I was also worried that they would think I was taking extra pills. That I was one of those “mental” people who couldn’t keep track of her meds.

Yep, I was self-stigmatizing too.

There was nothing concrete that Larry could do, of course. It was too late to go the pharmacy. I’d have to wait until the next day.

So I had the difficult night.

Morning came, and I got showered and dressed and drove to the pharmacy. It was just about seven minutes away, but I wanted it to be longer.

I walked into the store and asked to speak with the pharmacist on duty. She met me at the counter. I her my story.

“I don’t remember for sure if I started that prescription the day I got it. It may have been the following Monday or Tuesday. But I only have six pills left,” I said.

I was nervous. I talked faster than I usually do.

She looked at the bottle and said, “It looks like we probably gave you 30 instead of the 60. We’ll fix that.”

“I don’t have any way to prove that you didn’t give me the pills,” I said.

“That’s OK,” she said. “We believe you.”

And she put the extra pills into the bottle and apologized for shorting me.

And that was all.

No accusations. No rebuffs. No anger. No tears.

I felt the light-headed feeling I get after an anxious experience is over.

I had spent all that time worrying and creating stories with negative outcomes. I expected a bad experience, even though I knew I couldn’t know for certain what would happen.

In truth, the reality was not nearly as bad as I had anticipated. And it usually works out that way, if I’m honest.

Sure, we all have difficult interactions with others sometimes. And bad things happen to all of us. Maybe we had times when we expected good things and they never happened.

But there’s no need to worry about something that might not happen.

This seems to be a lesson that I have to learn over and over.

How about you—Do you ever experience anticipatory anxiety?

OCD and fear of change

My blogging friend Keith recently wrote a great post about change called “If you do what you’ve always done . . .” on his blog Musings of an Unapologetic Dreamer.

In the post, he ponders the quote, “If you always do what you’ve always done, you’ll always get what you’ve always got.”

This resonated with me because I want to make some positive changes in my life, and my tendency is to think about them and wait for them to happen to me.

As Keith says in his blog post, “if you want something different, you need to do something different.”

I want to do something different. I want to start my own business. I want to start a freelance editing business.

Just telling you that is kind of scary. But the real fear has come as I’ve gotten deeper into planning.

Many people have fears when they consider starting a business. They worry about being able to get clients or customers. They worry about being able to make money. They wonder if they have what it takes to be successful.

My biggest fears are connected to my OCD.

I have OCD about reading and writing. When the reading OCD is active, I have a hard time reading a passage without compulsively rereading it. When the writing OCD is active, I may write and rewrite, worrying about whether the correct meaning is being conveyed with my words.

Would having OCD make it impossible for me to be a successful freelance editor? Would I get so bogged down with OCD that I wouldn’t be able to perform the job?

I could physically feel the fear Sunday afternoon as I read about starting a business. My heartbeat quickened. I felt nauseated. I felt a sense of foreboding.

But I also recognized what was happening. I thought about all the times I’ve been excited about making a change, then let fear stop me. I thought about how I want my life to be different, a life lived according to my priorities and values.

I thought about how I want to do something different.

I have OCD. And I have generalized anxiety disorder and depression. But I’m also being treated for them. I’ve learned ways to manage them. I’m so much better than I used to be, and I have every hope that improvement will continue.

The fears I’m feeling are understandable. They are not an excuse to stop my plans.

I didn’t intend to write a post about freelancing yet. But I decided to tell you what I was planning and what I feared. Being open with you about my fears helps me push them back. It makes it easier for me to take the next step in putting together a business.

So more news to come. Stay tuned!

When have you had to push past fear to accomplish something important to you? How did you do it?

Getting around on my extra paws

Despondent. I admit that’s how I felt on Monday afternoon. I felt despondent.

I went to see my orthopedic doctor for a recheck of my broken foot. After looking at the new X-rays, he told me he saw “the beginnings of healing,” but I would have to stay on the crutches for at least three more weeks.

After the three weeks, he will check it again. If it’s still moving in a positive direction, if it’s no longer hurting when I put weight on it, and if the tenderness is gone, I’ll be able to just wear the orthopedic boot and walk on that, with no crutches.

If it doesn’t heal in three months, then he will do surgery on it.

He reminded me that a Jones fracture takes a long time to heal because it’s located in a part of the foot that doesn’t have a good blood supply, and tendons run over the fractured area.

And he cautioned me to stay on the crutches and not put weight on my foot except in the shower, where I could put weight on the heel.

OK, not horrible news. The bone is healing. I don’t need surgery now. I don’t have to do anything different at this point except be more vigilant about staying on the crutches.

So why the despondency? The doctor’s visit didn’t meet my expectations, and I came face to face with my nemesis, uncertainty.

I expected to be told Monday that the bone was almost healed. I had no proof that it was, but it didn’t hurt nearly as much as it did before, and I reasoned that it must be well on the way to complete union.

What I got was a reminder that this is going to be a long process. I’m going to have to be patient with it.

And I also expected to be told Monday whether or not I would need surgery. This was a misunderstanding on my part. Even the doctor is uncertain about the need for surgery.

But it still bothered me that I won’t know for a number of weeks whether or not, after all the travels on crutches and all the hours in the boot, I still might need surgery.

If you’ve been reading this blog for a while, you know I don’t naturally do well with uncertainty.

Uncertainty feeds my OCD and generalized anxiety. Uncertainty leaves me open to unlimited anxiety about what the future brings.

So I felt despondent. But I soon pulled myself together. Larry reminded me that the foot is healing. And I remembered that times like this are good practice for living with uncertainty.

I’ve decided to make friends with The Monster Boot. It’s a support system. It allows me to move around even with a tender, broken bone.

As for the crutches, I have a new attitude there, too. Larry told our cats that my crutches were “Mama’s extra paws.” I like that: extra paws.

The Monster Boot and I will be getting around on the extra paws.

Do your expectations about the way things should be ever result in disappointment? How do you handle the disappointment?

A week of awareness: I will no longer be ashamed

This week is OCD Awareness Week and Mental Illness Awareness Week.

I have mental illnesses. I also have physical illnesses.

It’s much easier for me to tell people I have high blood pressure and asthma than it is to tell them that I have obsessive-compulsive disorder, depression and generalized anxiety disorder.

Why is it easier for me to talk about physical illnesses? In large part it is because of the stigma about mental illness.

I’ve written about the stigma of mental illness, including obsessive-compulsive disorder, before. But I thought it worth exploring again, especially during this week of awareness.

In that previous post, I gave the definition for stigma found in The American Heritage Dictionary: “A mark or token of infamy, disgrace, or reproach.”

Stigma about mental illness gives the impression that people with mental illnesses have something to be ashamed of. And it has negative effects on those who do suffer from such illnesses.

The book From Within Our Reach: Ending the Mental Health Crisis, by Rosalynn Carter with Susan K. Golant and Kathryn E. Cade, states the following:

“One of the most insidious effects is that stigma gives rise to stereotypes: People experiencing mental illnesses are considered to be lacking in judgment or weak willed; they are seen as incompetent, unreliable, and unable to make decisions for themselves. It is thought that they can’t work, hold public office, or even live on their own; they are dangerous, unpredictable, and violent; they have brought these problems on themselves; and they will never get better.

The truth is very different. Most people with serious mental illnesses recover and do well in the world—go to school, flourish in their jobs, own homes—yet they are considered to be rare exceptions. The stereotypic beliefs held by the general public and by many people who experience the illnesses do not reflect what modern science and other people living with mental illnesses themselves have to tell us” (p. 22-23 in electronic edition).

  So when people find out that someone has a mental illness, they may automatically think the worst of that person. If they think that person is unreliable and lacking in judgment, someone who isn’t competent, then it’s likely they will treat him or her differently than they would someone without a mental illness.

As the authors of From Within Our Reach state, “Stigma is the most damaging factor in the life of anyone who has a mental illness. It humiliates and embarrasses; it is painful; it generates stereotypes, fear, and rejection; it leads to terrible discrimination. Perhaps the greatest tragedy is that stigma keeps people from seeking help for fear of being labeled ‘mentally ill’” (p. 21 in electronic edition).

  And when people don’t get help for their mental illness, they suffer needlessly.

  So what we do to get rid of the stigma about mental illness?

Authors Carter, Golant and Cade state that people may fear someone who seems different and not have compassion for them (p. 24 in electronic edition). Therefore, interaction with people with mental illness may help: “Researchers have shown that having contact with people who have mental illnesses helps to reduce stigma because it fosters empathy” (p. 28 in electronic edition).

  The authors state that “research shows we are not making any meaningful progress in accepting those with mental illnesses. We can only hope for this to change when more and more individuals are willing to talk openly about their experiences” (p. 29 in electronic edition).

  So where does that leave those of us with mental illnesses? Does that mean that we need to go out and tell everyone we know that we have mental illnesses?

  I don’t think so. I think we can be selective in choosing the people we tell and how we tell them.

  Those of us who choose to blog about our mental illnesses are telling a potentially large audience about our disorders.

  In the offline world, we can be even more selective, telling people we think will be supportive.

  We can begin to inform more and more people about the realities of mental illnesses.

  And we can choose to tell no one. There is no shame in that.

  One thing I think all of us with mental illnesses should do is to begin to work on our own attitudes and to try to erase any shame we may feel about having mental illnesses.

  I’ve set the intention to no longer feel ashamed of having mental illnesses. I may continue to have moments of embarrassment and shame, but those will lessen over time as I work on that intention.

  Have you ever experienced or witnessed stigma about mental illness?

Top 5 things that hurt my OCD

  On Monday I wrote about the top things that help my obsessive-compulsive disorder, so I thought I’d look at the opposite and discuss things that hurt my OCD.

Not getting treatment

I wasn’t diagnosed and treated for my OCD and depression until I was 26, after suffering from both for much of my life up until then. That was a lot of needless suffering because help was available.

Even after I became an adult and was responsible for my own health, I didn’t speak up and tell my doctors what was going on with me. I didn’t tell them about the strange thoughts and even stranger compulsions that were wreaking havoc with my life.

I was in talk therapy for about a year before I even mentioned my obsessions and compulsions to my therapist.

I was ashamed of my bizarre habits and thought I was the only person in the world who did such things.

Depending on medication alone

For more than 20 years, the only treatment I had for OCD was medication.

I am not discounting the tremendous help I have received from medication. It lifted me out of the worst of my OCD and depression and allowed me to live a better life.

But I ignored doctor’s suggestions that I get therapy specifically for OCD, like cognitive behavioral therapy. I didn’t want to take the time or spend the money, and I really didn’t think I needed it.

Now I recognize that medication can do only part of what I need to rid myself of the subtle ways OCD intrudes on my life. I need practical therapy, and I’ll be back to it soon.

Not taking GAD seriously

In addition to OCD and depression, I have generalized anxiety disorder. I tend to forget that and focus all my energies on fighting the “top two” disorders in my life.

But GAD has a very real effect on my OCD. The more anxious I am generally, the more I have to deal with the OCD. The generalized anxiety feeds the obsessions and makes it harder for me to fight the compulsions.

That tells me that I need to consciously take steps to lower my anxiety overall.

Giving in to compulsions

I know by now that giving in to compulsions just makes the cycle of OCD worse. The more I check, for example, the more I want to check, and the more I check.

I can’t let up. I can’t give myself a break from tolerating the anxiety until it goes away instead of performing the compulsion.

Not taking care of my health

If I get really tired, I find that I am more prone to anxious feelings and depressive thinking. Those just feed my OCD. So I have to get plenty of rest.

That’s not always easy, especially on days when I have to work late. On such days, I also tend to eat erratically and too much. Then I don’t feel like going to bed and stay up too late. Then I don’t sleep well. And the cycle continues.

I feel so much better when I get enough but not too much sleep, when I eat several small meals of healthy food, when I exercise. When I don’t take care of my health, it shows in my level of anxiety and thus, my OCD.

  What things make your OCD and/or other anxiety worse?

Snippet of a memoir: Anxiety at the football game



Me in sixth grade.



  In the fall of 1974, I was 11 years old and in the sixth grade. I was very shy and timid. I could talk with my friends, but being around people older than me—teenagers—or anyone I didn’t know made me silent and unable to carry on a conversation.

  It was hard for me to know what to do with myself when I was part of a group. I stood awkwardly or looked for somewhere to sit that seemed safe. I felt like everyone was staring at me. I felt like everyone thought I was ugly and stupid and certainly not cool.

  I didn’t know it then, but I was probably suffering from generalized anxiety disorder and social anxiety even then.

And obsessive-compulsive disorder was beginning to make stronger claims on my life.

One Friday night, my second older brother and I went to the local high school football game with a neighborhood group of kids, siblings that lived nearby. I wanted to go because I liked to hang out with these other kids, and it was fun to go on outings despite my shyness.

When we arrived at the gate to the football stadium, my brother and friends went up to the ticket counter and bought their $1 tickets.

I hesitated. I was too scared to go up to buy the ticket, not sure how to act. I had the money in my pocket, but I was too afraid to get it out and offer it to the people at the ticket counter.

Then my brother and friends started walking away, into the stadium. I didn’t want to be left behind—the idea of being alone there was frightening—so I followed them in. Without buying a ticket. Without paying my way.

I can still feel how guilty I felt, the heaviness that hung over my chest, the adrenaline that shot through me.

My brother said, “You didn’t pay. You need to go back and pay.”

“I did pay,” I said. I was too embarrassed to admit what I’d done, but I was also too afraid to go back and pay for a ticket.

So now I had a lie to add to my crime.

I didn’t watch the game. Even if I had understood football, I wouldn’t have been able to get the guilt out of my mind and my heart. Every now and then my brother would remind me that I hadn’t paid, and I would lie again.

I was near the breaking point by the time we got home. I went into my room, took out the dollar that I should have spent going into the football game, and tore it up. My reasoning was that I wouldn’t benefit from having an extra dollar.

Of course, that was just one more crime I committed that night.

I don’t know how much time elapsed before I told my mother, but I do know the sense of guilt hung on me and didn’t let go. I knew what I had done was wrong, and I was sure I was in trouble with God because of it.

One day I started crying and couldn’t stop. When my mother asked me what was wrong, I told her the whole story.

My mother did not tolerate stealing or lying. But she was gentle with me on this one, probably because I was so upset and so obviously sorry.

“Well, ask God to forgive you,” she said,” and put an extra dollar in the church collection plate.”

And I did.

I was wrong to go into the football game without paying. But this incident illustrates to me my burgeoning case of OCD.

That was the first confession that I remember giving to my mother. It would soon become the norm for me to ruminate over my sins, or what I thought were my sins, and confess them, known sins and all, to my mother.

I would desperately search for forgiveness from her and from God, praying the same words over and over, trying to get them right.

“Oh, Lord, please forgive me. Please forgive, please. Oh, Lord, please forgive me. Please forgive me, please.”

  Have you experienced anything like my football game experience because of anxiety?

A way through anxiety: Accepting ourselves

Imagine you’re holding an ice cube in your hand.

You concentrate on the sensations doing that causes.

Eventually, you begin to have thoughts unrelated to the sensations, thoughts like, “This is really uncomfortable,” or “How much longer do I have to do this?”

When those thoughts come, you notice them, acknowledge that you have them, and then go back to concentrating on the sensations of holding an ice cube.

Acceptance

That is an illustration that my therapist used to explain acceptance in terms of generalized anxiety disorder or any anxiety.

On my last visit, I told him about the increased anxiety I’ve had lately. I’ve felt revved up and unable to settle down and concentrate.

So he talked to me about accepting my anxiety. He said it’s not the same thing as liking the anxiety.

And it’s different from actually making the anxiety worse by worrying about the bodily sensations of anxiety, worrying about worrying, “catastrophizing” the fact that we feel anxious.

We can practice acceptance by focusing on the bodily sensations that come from feeling anxious. When an unrelated thought comes along, we can acknowledge it but then return our attention to the sensations.

With this mindfulness, we can begin to accept that our body is expressing anxiety.

Acceptance is to acknowledge what we’re experiencing and then to go on to something else.

Ironically, that makes the anxiety easier to deal with, my therapist said.

Mindfulness

The ice cube example also helps to illustrate the importance of mindfulness. We can choose to focus on our anxious feelings, but I’ve learned that we can also choose to focus on something like the breath, or our senses.

Every time we realize we’re thinking of something other than the breath or what we’re hearing, for example, we can bring our attention back. Usually I have to do this again and again

That puts me in the moment. It takes me away from my worries. It takes me away from worrying about my worries.

And even a little while away from the worries provides me with relief. And a little more acceptance.

What about you? Does accepting the anxiety make sense to you?

Worry and tension: Generalized anxiety disorder

I feel the effects of the adrenaline, a hyper feeling. My heart beats faster. Sometimes my arms feel numb. I can’t settle down to do anything. I walk around the house a lot, watch TV for a couple of minutes, go into the kitchen and eat something, fast, then open up a book and try to read, then walk around some more.

If I’m at work, I get up and walk around, too. When at my desk, I swing around in my chair. I write in spurts before I have to stop again.

My jaw stays tight. Every now and then, I realize I have my lips pursed, held firmly, tightly.

I may have nausea. I may have diarrhea. I may get a headache. My hands may shake.

I feel exhausted much of the time. But my sleep is interrupted—I wake up numerous times during the night and sometimes have trouble going back to sleep.

I feel like something bad is going to happen. I don’t know what, but it will be bad, if I go by how I feel.

Sometimes I lie in bed at night and say over and over to myself, I’m afraid. Sometimes I whisper it aloud if Larry hasn’t come to bed yet.

I’m afraid and I don’t know why.

That is my generalized anxiety disorder. Most of the time, I don’t have all of these symptoms, but I’m a worrier and I’m tense most of the time, finding it hard to relax.

According to “Generalized Anxiety Disorder: When Worry Gets Out of Control,” a publication on the website of the National Institute of Mental Health, generalized anxiety disorder, or GAD, is an anxiety disorder that causes sufferers to worry about things without a clear reason to:

“All of us worry about things like health, money, or family problems. But people with GAD are extremely worried about these and many other things, even when there is little or no reason to worry about them. They are very anxious about just getting through the day. They think things will always go badly. At times, worrying keeps people with GAD from doing everyday tasks.”

The publication goes on to list the symptoms of GAD:

*Worrying very much about everyday things

*Trouble controlling constant worries

*Knowing they worry much more than they should

*Not being able to relax

*Hard time concentrating

*Easily startled

*Trouble falling asleep or staying asleep

*Feeling tired all the time

*Headaches, muscle aches, stomachaches, unexplained pains

*Difficulty swallowing

*Trembling or twitching

*Irritability, sweating a lot, feeling light-headed or out of breath

*Having to go to the bathroom a lot

The booklet goes on to say that treatment for GAD is usually psychotherapy, especially cognitive behavior therapy, medication or both.

I take medication and I’m in therapy, both of which help my GAD. I’m finding that meditation, being mindful as often as possible and deep breathing also help. So does reading or doing some other enjoyable activity.

And I’m working on changing the way I think about things. For example, I try to catch myself when I’m in catastrophe mode and remind myself that I’m making the situation bigger than it is.

Still, I have those times of anxiety. Sometimes I don’t know what causes them. I go through all the things that could be worrying me—personal, work—but sometimes I can’t figure it out.

Do you ever have episodes of generalized anxiety? What are they like? How do you cope?

May is Mental Health Month

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May is Mental Health Month, and it has me thinking.

Mental Health America is the sponsor of Mental Health Month. This year’s theme is “Do more for 1 in 4.”

According to the MHA website, “an estimated 26.2 percent of Americans ages 18 and older—about one in four adults—suffer from a diagnosable mental health disorder in a given year.”

One in four. That’s a lot of people.

I’ve written before about working as a health educator for nearly eight years. One of the things I did in my job was to keep up with national health observances. (You can find a list of them at Healthfinder.) There are a lot of them throughout the year: months, weeks and days dedicated to observing a particular health condition or concern.

Health observances mark a time for people to be especially focused on raising awareness about and educating people about a specific health condition.

While as a health educator with limited time and funds I couldn’t raise awareness about all the observances, I knew each was important to someone.

I have a special interest in Mental Health Month because I suffer from and people dear to me suffer from mental health disorders. I have obsessive-compulsive disorder, depression and generalized anxiety disorder.

According to the observance promotion materials provided on the MHA website, many people—as high as 50 percent—who have a mental health disorder don’t seek or get treatment because of the stigma of mental illness, lack of information, cost or lack of health insurance coverage.

How many of you can relate to that? I can.

I remember thinking that I would never see a counselor—it would be too embarrassing. I remember thinking I would never see a psychiatrist—anyone who found out about it would think I was crazy. I remember crying before I took my first antidepressant pill because I believed that I must be a weak person. I remember not having health insurance and making decisions about treatment based on how much money I had.

It shouldn’t be that way for people with mental health illnesses or physical illnesses. Everyone should have the ability to get the basic health care they need.

I realize that as a country, we need to figure out the best way to reach that goal. But figuring it out should be one of the top priorities of our leaders.

Funding for and access to mental health care should not lag behind that of physical illnesses either. A lot of people suffer from a mental illness at some point in their lives. Look around the room at work, or in a restaurant or at church. One in four.

One of the most frustrating things about knowing that people are not seeking treatment for mental health problems is the fact that, as MHA states in its materials, they are treatable.

People don’t have to continue to suffer.

They do need to know about the diseases they suffer from, that help is available and where that help is. And they need to have a means to access that help.

I don’t have all the answers. But I know some things I can do.

I can take care of myself the best I can to be an example to others that treatment can help in living a wonderful life as well as to have the health I need to help others.

I can keep up with current legislation that affects health care, including mental health care, and communicate my concerns to my representatives.

I can, as I am able, educate and advocate for others, whether that’s by listening to a friend who suffers from a mental illness or a family member of one who suffers; writing a letter to the editor of the local newspaper calling for less stigma and more help; blogging about my own experiences; or speaking about mental health issues to a local group.

One in four. That’s a lot of people, don’t you think?

What are the best ways to advocate for those with mental illnesses? Can you see yourself doing any of those things?