Update: my 50th year

About two and a half months ago, I started my 50^th year with some plans. I thought I’d update you on how I’m doing.

My therapy is continuing. My therapist wants me to make weekly appointments through at least October for the CBASP for chronic depression.

I hope then we will have done enough work that I can focus more on cognitive behavior therapy for the obsessive-compulsive disorder.

My therapist and I are already seeing results from the CBASP therapy, so I feel like my time with him is well spent.

And my own efforts with the OCD, with encouragement from my therapist, are helping me.

One of my 50^th year goals is to get in better physical shape. I am using the plan to participate in the Giblet Jog 5K, on Thanksgiving Day to inspire me. I’m scared to death to participate in a race—I never have.

And I’ve started my “training”—if you can call it that—very slowly, without consistency.

So I’ve got some work to do within the next three months.

Another one of my goals for my 50^th year is to finish a draft of my first book. I’m not aiming for a perfect draft or the last draft, but a first draft.

I have finally written down details of how I’m going to accomplish this.

I will be continuing the writing that I’m doing now—scenes, vignettes and stories—until Nov. 30. I’ll use December to go through everything and find a structure. Then I’ll start the actual draft in January and have it finished by May 30, my 50^th birthday.

Keeping to this schedule will mean early mornings and late nights, but I am quite determined to get it done.

To accomplish these goals, I’ll have to fight the procrastination that seeps into my activities. I’ll be writing more about procrastination in a future post.

If you’ve been reading my blog, you know that a few weeks ago I decided go from posting every weekday to posting three times a week.

That didn’t work out. I just seemed to have more to say than three posts a week could take care of.

I’ve decided to compromise with myself. I will post Monday, Wednesday, Friday and Saturday. That will give me some breathing room while also giving me the time for doing something I love so much, blogging.

Are you working on some projects that you’ve set goals for? What would you like to share about them? Do you have any advice on how to stick to goals?

Tell them how I feel: my battle with chronic depression



http://en.wikipedia.org/wiki/File:Vincent_Willem_van_Gogh_041.jpg



What exactly does it mean to “stuff your feelings”?

The image that comes immediately to mind is of me pushing hazy objects down into my chest, literally stuffing my body and keeping the hazy objects, or my feelings, hidden.

I have learned as I’ve gone through Cognitive Behavioral Analysis System of Psychotherapy (CBASP) for chronic depression that I have a habit of stuffing my feelings.

But I thought of it as more of a problem of holding anger in and not expressing it appropriately. Expressing and releasing those feelings would just ease up on my anxiety, I thought.

I’m learning there’s more to it than that.

During our last session, my therapist and I talked about an interaction that had occurred at work.

It was a situation where I felt angry and annoyed that I had not been kept in the loop of what was going on in the office.

When this happens, I feel like I’m unimportant in the workplace, and feel very frustrated.

Or, more specifically, the effects of my co-worker doing this is that I feel like I’m unimportant in the workplace, and I feel very frustrated.

It may not be what he intends, but that is the effect.

During said interaction, I was able to express what I would and would not do during the situation we were discussing, but I did not express my problems with what was the larger issue to me: that this is a repeated instance of this co-worker not including me in conversations and decisions pertinent to my work.

In other words, I’ve discussed this with him previously. I’ve had several conversations with him about how I dislike him keeping me out of the loop.

He has been receptive, at least on the surface, but nothing changes very much.

And so we were right back in an interaction where, once again, I found out about something at the last minute and felt blindsighted.

According to my therapist, it was a good thing that I was able to state clearly what I did not feel comfortable doing in this particular work situation. To move the interaction up a notch, to make it even more effective, I could have brought up the larger issue and how I felt about it.

The co-worker might have been understanding. He might have made an effort to change how he did things. He might have told me something along the lines of “so what.” My therapist said. I couldn’t control that.

What I could control was my expression of how I felt.

“But why bother if it isn’t going to change anything?” That was my question.

“Even if it doesn’t change anything, you have reminded yourself that your feelings are important,” he said.

Oh.

It was one of those “aha” moments for me.

He said after being told explicitly and implicitly while growing up that what I felt wasn’t important, I believed that my feelings weren’t important. That made me believe that I was helpless to change anything in my life, leaving me feeling hopeless.

I need to start reminding myself that my feelings are important. It’s not that everything needs to go my way or that my feelings are more important than anyone else’s feelings.

But they are just as important.

So even if telling someone how their behavior affects me, and how I feel about that, doesn’t change the circumstances, it can change me. It can help me feel less helpless and hopeless.

That’s a powerful tool in my work against chronic depression.

Do you have trouble expressing how you feel? If so, how has that affected you? If not, how does expressing yourself make you feel?

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?

Treatment journey: Not straight, and certainly not quick

http://en.wikipedia.org/wiki/File:The_Doctor_Luke_Fildes.jpg

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?

CBASP at work

From http://en.wikipedia.org/wiki/File:Brooklyn_Museum_-_Blue_2_-_Georgia_O%27Keeffe.jpg

I’m a mind reader.

Don’t worry. I’m not claiming to know what you’re thinking right this moment, while you’re reading this.

But if you and I were talking with each other, I would be able to interpret the true meaning behind everything you said.

I would not need to nor would I want to ask you what you meant by something you said.

Because I’m a mind reader. Or, rather, I practice mind reading.

That’s one of the lessons that was brought home to me in today’s session of Cognitive Behavioral Analysis System of Psychotherapy, or CBASP.

I first wrote about my therapist using CBASP to treat my chronic depression here.

During our first two sessions of this new (to me) therapy, we discussed my significant other histories, the stories of the people in my life who have had big influences on me and on how I view other people and myself.

Today we completed our first situational analysis questionnaire, which is a form that guided us through analysis of “an interpersonal problematic event.” The analysis included role-playing to give me the opportunity to practice new coping skills.

Before the session, my assignment was to select the interpersonal event—an exchange between another person and me—that troubled me and write a brief “slice of time,” with a beginning, an end and a short story in between.

Then working with my therapist, I did the following:

  *Described my interpretation of what happened, or how I “read” the situation.

  *Described what I did during the situation, which included what I said and how I said it. This was what someone else would have observed if he or she had been able to see me during the situation.

*Described how the event came out for me. This is called the actual outcome. Outcome has to do with the last thing I did, not what the other person did.

*Described how I wanted the event to come out for me, which is called the desired outcome. I arrived at that description by considering the end point of the situation and what would have been the best I could have done at that point.

*Answered whether or not the desired outcome was achieved and why.

What I discovered was that I tend to assume I know what the other person means when he or she says something. I don’t ask. I just assume. And I tend to read a situation with my past rather than staying in the moment and dealing with what is.

I didn’t do the very simple but very important thing that would have changed the whole dynamic of the “interpersonal problematic event.” I didn’t ask, “What do you mean when you say that?”

I was trying to avoid conflict. I am afraid of conflict. But when I avoid it, when I avoid asking questions because I’m afraid of the answers, I stuff my feelings. The more I stuff my feelings, the more they fuel my depression.

There is no guarantee that if I ask the question, I will get the answer I want. But I will have something real to cope with, instead of something that may or may not be true.

My therapist likes to use the example of the baseball player who is petrified of not hitting the ball. There is no guarantee that if he swings at the ball, he will hit it. But it is guaranteed that if he does not even go up to bat and try, he will not hit the ball.

People with chronic depression tend to not even try, to think there is no use in trying, because we’ll just fail.

So why should I explore the meaning behind what another person tells me that upsets me? I already know what he meant, right?

Well, no, I don’t. I am going to need to practice staying in the present and tackling what is, not letting the past dictate how I interact with others.

This therapy is not particularly pretty or easy. I had to face some things about myself, and I cried. That box of tissues on the therapist’s bookcase is going to come in handy.

But I feel heartened by it, too. My therapist and I are not spending time analyzing why I interact with others like I do. As he said, what happened in the past can’t be changed. I can learn how to act with more strength and assertiveness now.

I may sometimes believe I’m helpless, but I’m not.

You don’t have to have chronic depression to sometimes make assumptions about the meaning of the other person’s words. Are you a mind reader? Do you sometimes let the past dictate how you act today?

Depression: I will not be empty



From http://en.wikipedia.org/wiki/The_Starry_Night



 

February 6, 2007

  I went to see my family doctor today. I told the nurse that I was there for three reasons: blood pressure recheck, antidepressant discussion and my right ear. But I was really there for one main reason—the antidepressants and the fact that they didn’t seem to be working anymore.

The doctor listened to me tell him how I felt empty (I didn’t tell him that my heart felt empty, something that had come to my mind yesterday and seemed to really describe how I felt.)

He talked about upping one medication and keeping the other at the same dose and coming back in three weeks to re-evaluate.

I was tearful and said that I didn’t even know what I was like normal. I guess I was getting that idea from some of the essays that I’ve been reading in that book about depression, writers on depression. The doctor said, probably when you are really low—and he meant the low without any meds—that is your normal.

That struck me. That was my normal? But that wasn’t normal!

But the doctor said that a bright side to it was that there were so many meds that could lift me up from the bottom and things were getting better in the treatments for depression. He said that I would probably always—the rest of my life—have the low times and have to have the meds tweaked and changed. But like people who were born with something physically wrong with them, I could learn to adapt.

So I up the one medication, keep taking the other, try to get more light (because he said that it could be partly the time of year and the darkness that was affecting my mood), and try to have a more positive outlook.

And that I needed to go to work. I asked him if it would be a good idea to miss a few days of work. He didn’t think so, because he said being at home might make my depression worse. He thought I needed to be out there.

That didn’t please me much, because I was hoping for at least a short reprieve from work. He said that he could write a note for work, but that he thought the best thing for me was to work. So I didn’t push it.

He also brought up the possibility of seeing a counselor, preferably a psychiatrist, if things didn’t get better within the next two or three months.

Is my normal depressed and OCD? Or just depression? Is the OCD keeping me from being normal? So many questions. I wish I was a happy spirit. I wish that I had faith and belief in God that would sustain me. I don’t have enough faith or belief though—it’s so fleeting and so nebulous, I don’t think that I can build a life on it. And I don’t like that feeling of not being able to.

I wrote the above in my journal more than five years ago. It’s a picture of one of the many times I’ve found myself sinking into hopelessness. One of the many times I’ve had to admit to myself, I’m depressed again.

I think differently now about those words “depressed again.” I’ve haven’t been “not depressed” for many years, if my therapist is right about my having chronic depression.

Has my life been all bad, all sad? No. I’ve had many good times and happy times. And I believe that there’s a firm base within me that is content and hopeful.

But depression comes calling with more subtlety than the obsessive-compulsive disorder. I feel exhausted even when I’m not busy. I complain more. I sleep a lot. I have a hard time concentrating. I have a hard time caring about my life. I feel like I’m heavy and have a hard time moving. I don’t want to do things that I enjoy other times. My heart feels empty.

And I don’t even realize it until I’ve been experiencing those symptoms for weeks.

I am doing more now to fight the depression, though. My psychiatrist tweaked my meds, and I’m already feeling better. And I am doing the Cognitive Behavioral Analysis System of Psychotherapy. We start the real work on Friday.

I told my therapist that my family doctor had told me that I would have to adapt to life because of the depression. My therapist told me, “Oh, you’ll do better than that.”

I believe I will.

OCD and depression: starting on a new path

Is this one step forward and two steps back?

That’s what I was thinking as I left my therapist’s office yesterday evening.

Today I considered the possibility that it was a leap to a new path.

I will be starting a new course of therapy tomorrow, one that will focus not on obsessive-compulsive disorder, but on another problem that has accompanied me for most of my life: depression.

I have written about my battle with depression before, but in my therapy and my own work with exposures, I’ve been focusing on improving my OCD symptoms. The OCD is getting in the way of my living a full life.

But depression is getting in the way of the OCD therapy.

My therapist is very perceptive. I wrote about how he called me out on my avoidance of the paper pile.

Yesterday, he cut to the heart of things again.

He always begins a session by asking me an open question like, “So, how are things going?”

I talked about what I had done and hadn’t done and how overwhelmed I felt. The words kept coming. And then I started crying.

He reminded me of our discussion in the past where he said other things like anxiety and “stuffed” anger and emotions can feed OCD.

He believes it’s chronic depression that is feeding the OCD, and as long as I don’t deal with that, I won’t get very far with the OCD therapy.

I knew he was right. I knew intuitively, right away, that he was right.

Chronic depression, especially when it’s early-onset, which mine was, is particularly hard to treat. Medication has helped me tremendously, but some people have drug-resistant depression. I am, my therapist said, one of those people.

Though I was never diagnosed as a child, I probably suffered from dysthymia, which Medline Plus defines as “a chronic type of depression in which a person’s moods are regularly low.”

My therapist said in those with chronic depression, the more severe depression episodes improve only so much—to that same low level.

He said the best therapy for chronic depression is called Cognitive Behavioral Analysis System of Psychotherapy, or CBASP.

He wrote it out for me, and I focused on one word: psychotherapy.

I’ve been through talk therapy before, and it was helpful, but it was also a meandering, nebulous experience with no end in sight.

But my therapist said CBASP is a very active and practical type of therapy. The treatment usually lasts approximately 26 weeks, but it could go faster for me, he said.

CBASP can put people into remission from their depression.

I’ll always be on medication, but the medicine provides a floor for me, he said, that enables me to do other therapy more effectively.

I’ll still work on the OCD, but we won’t spend time in our therapy sessions on it while I’m doing the CBASP.

I feel like I’m starting over. I’m almost 49 years old, and I still have to work on depression. But I could also experience remission for the first time in my life.

Those are the thoughts I’ve been having today and the hope I’m clinging to. Remission. An ebbing away of the depression that causes me to feel hopeless, helpless, fatigued and irritable. Hopeless and helpless.

I imagine the depression as a dark knot down inside me, surrounded by the more visible OCD and anxiety. Getting that knot to come loose and work itself through the OCD and anxiety is my goal.

Here I go: another therapy, another path, a new hope.