You Can't Handle the Truth!

Oh, I think that Jack Nicholson was right on target with this one. Can we handle the truth? Perhaps a better question is, what IS the truth? The notion of a universal truth has been on my mind a lot lately. Well, actually, the idea that there is no universal truth is more accurate.

I have recently had the opportunity to reconnect with someone from my past that I have not been in contact with for many years. As we emailed each other back and forth about what we each remember, I was struck by how differently we recalled people and events. My truth is certainly very different from what the other remembers.

The truth of depression - what is it? Well, my truth is that it sucks. I don't like to be uncomfortable, and I fully admit that I am high-maintenance. I need creature comforts - my computer, cell phone, Internet access, purified water, wheat-free bread, and a decaf non-fat latte. I think this is why I have fought so hard to get my depression treated. I don't like the way I feel when I am depressed. I want to live my life, and when I am depressed, life comes to a grinding halt.

But for a long time, there was value in being depressed. Looking at what being depressed meant to me and why I would sometimes sabotage myself was pretty scary. I did it again recently, and it shook my world to the core. Here's why...
As part of my therapist training, I have been studying family systems. One of the theories that many therapists in this field espouse deals with how an individual will mold his or her behavior to maintain the homeostasis of the system. From this perspective, someone who becomes depressed or addicted or skipping school or generally "acting out" is doing so in order to divert attention away from the "real" problem in the family system. Here's a generic example: in the Smith family, 15 yr. old Suzy gets depressed. Mon and Dad take her to a therapist to get her "fixed". From a psychological standpoint that only focuses on the individual, Suzy is pathological. She has a problem that only she can fix, most likely with the help of meds and maybe some therapy. From a family systems standpoint, Suzy is depressed because it gives her parents something to focus on other than Dad's infidelity or Mom's drinking. This is not to say that Suzy is doing this on purpose; instead, many see this as a diversion tactic that is done on a subconscious level. If one is able to step back and look at this pattern from a bit of a distance, it starts to make sense. Have you even been in a situation that is really tense and someone will crack a joke or make small talk to help calm things down? The family systems viewpoint sees depression as something similar to the small talk - a way to redirect attention from the tense issues that may be tearing the family apart.

Now this is a very simplified version of a complex theory. But hopefully it gets the point across. My family was a very tense place with a lot of rules that could not be broken. One of the biggest rules was not talking about the alcoholism that both my parents were embroiled in. I don't know if they were ever happy together - I don't remember a lot of fighting, but they didn't seem to have much fun together either. Did I try to maintain the status quo in our family? Did my depression in high school give my parents something to focus on so that they could avoid the reality of their respective addiction? The very notion chills me to the bone. Did I really have that little choice in the situation? What ever happened to free will?

I can, and often have, argued with myself about this subject. Did a condition that has become so intensely personal to me start (at least in part) as a way to protect my family? I have tried to convince myself that there is no way this could have happened. After all, recent neuroscience research has demonstrated that depression has a biological basis. So it must be that my wiring got a screwed up and I just needed some medication to help patch up the short circuit, right?

Such an argument may have worked if it wasn't for my younger sister. She went through her own struggle with mental health demons too. And it just happened to fill the void my wellness left behind. My depression started when I was in high school. I started to "get better" after family therapy my sophomore year. I began spending a lot of time with my boyfriend my junior of high school, so I wasn't home as much as I had been the year before. Then little sis started having problems. She had always had a temper, but her tantrums became explosive. She ran after me with a butcher knife, tried to stab my fingers on the cutting board, got into physical altercations with the parentals. So off she went to the hospital and my parents went through the therapy routine with her too.

Now some people may argue that she wanted attention. On the surface, that may seem plausible. However, if one digs a bit deeper, the notion of family systems doesn't seem so far fetched. At the same time that my sister and I were having our respective issues, my family was indeed going through a very stressful time. My mother's mother and my father's father had died within the last three years. My dad's best friend died of cancer. My dad had been laid off, and my mom was looking to get back into the work force. We were struggling financially, cramped in a small house that didn't offer much privacy to anyone. My grandpa had moved in with us after my grandma had died. To top it off, my parents techniques for reliving stress consisted of yelling at their daughters and drinking Scotch every night.

This is not to say that many other families go through similar difficulties. In fact, that is the point. In the family system, all the members do their best to cope with the stressors the system is undergoing. Some turn to alcohol or drugs, others may become sexually promiscuous. Mom may become depressed and spend all day in bed, while Dad goes to the track and gambles away the rent money. Sister becomes an overfunctioner to compensate, and takes care of the cooking and cleaning, while little bro slacks off at school and starts to fail. I see it in my family, as well as the clients that I am working with. We all do the best we can to cope, but many of our coping techniques are flawed.

So where does the truth lie? I suppose that we each need to discover it for ourselves. For some people, depression is simply a matter of taking his or her meds. Others experience depression as a life-long pattern of struggles to overcome low self-esteem or abandonment issues. Those with dysthymic disorder may not even know that they are depressed. Depression may be a necessary part of existence for some of us - the paintings of Picasso and Van Gough would not have been the same without it.

To me, it appears that America has labeled depression as a medical illness that needs pills to fix. While the meds certainly are helpful for many, my truth says that the use of so many pills without exploring other contributors to depression is akin slapping a Band-aid on a festering wound. It may stop the pus from oozing out, but the real issue is not addressed.

More posts will come as I start to explore how we have come to view depression in our culture. I am in the process of redefining it for myself. I invite you to do the same. We can shape our reality, including how we dialog about issues surrounding illness and wellness. What does it mean to you?

The red pill or the blue pill?

This post has been taking me a while to write, not because I have a lack of subject matter, but because I have so much I want to blog about. I've been thinking about my meds a lot lately, and how I have struggled with whether or not to pop antidepressants. This train of thought always reminds me of The Matrix. One of my favorite scenes in The Matrix is when Morpheus offers Neo his choice of pills. Take the red one and go further down the rabbit hole. Take the blue one and go back to a life of oblivion. This scene strikes me the perfect analogy for taking antidepressants and other psychoactive meds. Do I want to see if the pills work? Or do I want to go back to my depressive norm?

I am currently reading a great book, Is It Me or My Meds?: Living with Antidepressants by Paul Karp. Karp has struggled with depression a long time, and as part of his treatment, he's taken meds for many years. Karp relates how he attempted to stop taking his meds, and how it affected him mentally and physically. He then presents a variety of stories he gathered from a group of 50 who also struggle with depression. Is It Me or My Meds? presents an interesting viewpoint on how patients deal with this aspect of depression treatment. Where other books are written by doctors analyzing how meds metabolize in the liver and affect neurotransmitter levels, this one presents patient stories about individual battles with the biochemical treatment of depression.

This book really hit home. One of the worst parts about depression is the self-imposed isolation depressives seem to prefer. I have certainly experienced this, and I have seen others pull into the turtle shells of their self-contained world. This book allowed me to peer into the minds (so to speak) of other people who have grappled with defining their depression, and consequentially, how to treat it. I can certainly relate to many of the struggles that Karp so eloquently articulates. And I think the analogy to the Matrix is really applicable here. I have gone down numerous rabbit holes in search of medication that actually works. I have taken 7 medications in my quest, and I feel extremely lucky to have found a pill that actually works. I have heard about people who are treatment-resistant and never respond to meds. Or have to undergo electroconvulsive therapy to find relief. If you're not familiar with it, it's what was called shock treatment in the old days. So I thank my lucky stars that my current pill of choice does what it is supposed to.

But what are we supposed to do if the pills the doctor gives us DON'T work? And what if we are too tired/exhausted/paranoid/panicked to get out of bed, much less leave the house? How can we trust our physician - is he or she someone that we can really count on for help? I have struggled with this issue of trust, and pretty much decided that I had to count on myself. I figured out what meds to take, and asked the doc to help me adjust the dosage.

But there was never a chance to discuss my any of my frustrations within the severely flawed American medical system. A perfect example of how the system failed occurred in 2005. I went to Kaiser Permanente for treatment for my fourth major depressive episode. My depression was bad. Really bad. When I selected my insurance plan the previous year, I was lured by Kaiser's "Living Well" campaign, and I clearly remember the images of blueberries and praises about the anti-oxidants they contain. I went in at my scheduled time to be evaluated by the intake team. I have been through assessment many times, and I had my answers down pat. I was assigned a therapist, and when I asked to see a psychiatrist for meds, I was told that I would have to wait for 3 months. WHAT??? I can barely get out of bed, have a history of self-injury and suicidal ideation, and you want me to wait 3 months for meds that I KNOW will work??? What the f*#k??!! I asked for an earlier appointment, desperate for the relief that I knew my medication would provide. When I asked the receptionist to call me if there was a cancellation, I was informed that I would have to call in every day to see if there was a cancellation.

I felt abandoned and alone. If any of the staff or clinicians knew what it felt like to be depressed and desperate for help, they sure weren't letting on. I had a history of cutting when I was younger, and when my depression gets really bad, it is almost as if my brain reverts to an earlier mode of operating and lures me into thinking that cutting will indeed help to alleviate my pain. I hadn't cut for many years, but the fact that the idea popped into my head told me that I was on a slippery slope, and that I needed help. NOW.

So I add one more reason to become a psychologist to my list - to see if I can help work out a kink or two in the system. I would love to hear your side of the story. Leave me a comment if you want to pass it along.

Brains....

I have had a soft spot for zombie movies for quite a while, particularly those featuring brain-eating zombies. When I was in high school, one of my favorite movies was "Return of the Living Dead". The zombies in this series of films claim that eating human brains helps to relieve the pain they feel as their flesh rots on the bone. One of the taglines for the movie is "Brains....more brains!". When I was 15, I heard a radio commercial with a zombie growling this line out of it's half-rotted mouth about 9:30 at night. The house I lived in at the time was less than a quarter of a mile away from a cemetery, and I was so creeped out that I couldn't sleep that night. When was a zombie going to lurch down the road and come after MY brain???

What do zombies movies have to do with depression? Brains, of course! For many depressives, biology plays a significant role in dealing with this disorder. I have found that it is essential that I take my meds everyday, or I am in big trouble. The issue of taking medication for depression or other mental illnesses is very complex, and I plan on tackling that later. But I think it is important that we (patients) have a better understanding of how our brains work (or don't) when we are depressed. The question for today's post is: Who will help us figure this out?

With the advances in research on the human brain, scientists have discovered a lot about how neurotransmitter imbalances can affect how we think and feel. The pharmaceutical companies use this information to create new and improved drugs to help correct these imbalances. Psychopharmacologists work with meds to try to provide relief to the depressive. And therapists work with clients to help in resolving issues that lead to the on-set of the depression. However, I don't see a lot of interdisciplinary cooperation happening to assist patients in dealing with depression management. For some people, depression is a one time event, and after some therapy and meds, life resumes as normal. For others, such as myself, recurring depression is a reality, and constant vigilance is necessary to figure if another major depressive episode is on the horizon.

I am fascinated by how the brain changes and adapts to emotional disorders, and I like to know how depression has changed my brain. By that I mean structural changes, not just how chemical imbalances affect my thought patterns. As I progress through my studies to become a therapist, my interest in neurobiological research is growing. On the other hand, most of what I have been studying in class deals with psychosocial issues when working with clients. These are issues such as how you interact with your family or environment. Other schools of thought focus on your internal unconscious conflicts (psychoanalytic), how your thoughts impact your feelings (cognitive behavioral), as well as a combination of many other theories. These theoretical frameworks focus on depression as a symptom of another problem. For example, you're depressed because you are stuck in a pattern of negative thinking (cognitive behavioral). Or your family is screwed up, so you learned how to interact with people in a dysfunctional way (systemic).

But I digress. What I am not hearing much about is working with clients by addressing what it means to be depressed. This is an element that I found missing not only from my treatment, but also in my education. Many therapists take the stand that depression is the symptom of another issue. And I believe that is the case. But for a number of people, myself included, our genetic make-up endow us with a predisposition for depression. This aspect of our mental health has often been left to psychiatrists to discuss. Unfortunately, changes in the health care industry shifted how these doctors work with their patients. Now psychiatrists dole out pills, and check to make sure that your liver isn't overloaded with the junk you are forcing it to metabolize (the last time I saw mine the appointment lasted all of 5 minutes). But no one is talking about how to discuss depression as a combination of biology and psychology. I want to talk to someone about my brain! More precisely, how my neurotransmitter imbalances impact how I think with meds and without. How the meds make me feel. How I am scared that my poor liver will get tired of working so hard and conk out. How I want to have a baby, but I can't go off my meds to get pregnant. How I wonder if I should even consider having a child knowing that my family has this predisposition. And just HOW do I cope with depression as management of an ongoing condition?

I see a real disconnect between the "harder" science of neurobiology and the "softer" science of therapy. I think this combination is an essential part of treatment for depression, particularly recurring depressive episodes. After all, this is a condition that I have to deal with everyday. And parts of it stress me out. Now don't get me wrong - I feel incredibly fortunate that I found meds that work, and that my therapy helped me resolve many of my issues. But who, as a trained professional, understands how to talk about these long-term mental health issues? And that says it in a nutshell. That's why I decided to go to graduate school to become a therapist. I want to be the one who can have that discussion with other people struggling with similar issues.

I am curious to know if your experience reflects or contradicts my own. Please feel free to leave a comment and let me know. I am drawing on my own experiences, and I would love to add other perspectives to my knowledge base. And zombie movie recommendations are always welcome.

You already know WHY it sucks...

If you made it to this blog, I am guessing that you already know why depression, or any other mental illness, sucks. You feel like you are defective. There is something completely and utterly wrong with you. Why can't I be like everybody else? Why do I feel this way? What is wrong with me? And WHY can't I fix it? And I can't tell anyone about it, because they don't understand. Or they don't want to know. Or they tell me it's all in my head. Or I should do some cognitive behavioral work. And smile. Don't forget to smile. Then go for a walk - that will make you feel better!

Yea right. Been there, got the T-Shirt, then I went to the hospital. 4 times. I cut, I self-medicated, then I was medicated. Most of them didn't work. But one did. As for the therapy, I really should have a Master's by now. 20 years in a seat across from psychologists, psychiatrists, and therapists taught me a lot. And some of it stuck. When combined with the meds, I am actually feeling OK. In fact, I feel pretty good most of the time. But I am a depressive. And chances are I always will be. So now what?

Go to school and become a therapist. Why? Because I know what it felt like. I have been diagnosed with Major Depressive Disorder and Dysthymic Disorder, so I know what it was like for me. When I get that piece of paper when I graduate, I hope that I can help someone else who is there too.

Why a blog? Because I want to talk about it! I have spent too many years being ashamed of my depression. It's a part of me, has shaped who I am, and how I live my life. But I am living. So let's get on with it. Check out the ground rules. Tell me what you know. What you want to know (about my experiences). And let's see what happens.