Depression Introspection and the Dark Passenger

Hi all,

A depressed gal named Kass has a blog called Depression Introspection. It is a great resource from an experienced and articulate woman. Today's post, My Dark Passenger, is all about that crazy voice that interrupts your life in order to make you feel bad. We all know that voice. On our good days it's the annoying little mosquito buzz in the back of your head that spouts crazy-talk. On our bad days it's the overwhelming voice of conviction that stymies us and worries us and encourages us to do things we would never normally do. If you're already having a bad day, today might not be the day to read her post, but if you need to know you aren't alone go check it out!

Love,

Laura

Psychological Tweezing (and other thoughts on emotional honesty)

I've meaning to blog lately. Catch up on life and explain a little. Because I'm trying something new and it feels significant. But it also feels painful. Very painful. And personal. So it's hard to put it down here.

How's this for a really vague start? Some stuff happened a while ago that shouldn't have and the consequences just keep raining down.

An odd thing: every time I go off my antidepressants I have these same impressions about the "stuff that happened a while ago"--not like testimony meeting impressions--but like strong, emotional messages that require some sort of action. In the past the only action that has made sense is self-harming options. Like I used to get frenetically and abstractly suicidal. Or I would have visions of carving my arms and stomach up, like I was a surgeon cutting out some sort of contagion. Or like I was too full inside and if I could just bleed a little there would be some relief to the emotional congestion. At the other end of the violence was always the possibility for someone else to take over, for escape, for rest.

I never acted on that stuff, it was just always presenting itself as the answer. But, probably thanks to all my friends who tried to kill themselves in high school and my sister who got her undergraduate work in psychology and because my grandma tried to kill herself but went to a sanitarium instead and was open about it, I knew there was another option--a good option: medication and therapy.

And it was good. It was helpful. But it didn't make the impressions go away (which always disturbed me a little). The medication made the impressions quieter so that I could start to examine the pieces that didn't overwhelm me. Therapy gave me the tools I needed to figure out how to examine them. (The tools I use most often are self-observation techniques and self-questioning processes, in case you were wondering.)

So now I'm here and something clicked and I'm taking on those impressions. I'm looking those emotional messages square in the face and unraveling the facts from the fiction. Well, that's the ultimate goal. Right now I would say I'm just allowing the impressions their space. I'm hearing them. I'm accepting them. I'm letting them say all the things they've been trying to tell me for years--all the hurt, anger, frustration, desperation, and confusion. And, the hardest part, I'm relaying the messages to the other people who need to hear it.

That last paragraph makes me sound nuttier than a fruit cake, but I don't know how else to describe it. For the first time in a long time I know I'm not crazy. I saw my psychiatrist, just to be sure. And she agreed. She said, "You're not depressed. You're not overly anxious. You just have some huge things facing you. But you are handling them as well as any person could." I don't feel cosmically out of control or overwhelmed. I'm surprised by the intensity of the emotional torrents playing out but they feel honest and, surprisingly, empowering. Not in the moment of it all. But later.

This whole process reminds me of that aphorism, "Depression is just anger turned inward." That reductionist aphorism gets a lot play and I wasn't entirely sure how I felt about it until recently. I think I was afraid of certain situations in my life and of their consequences--emotional and spiritual and physical--and so I had to protect myself and my family. The only way I could protect us all was to hide the reactions and feelings and the only place to hide them was inside myself. I would never say depression is just any one thing, but we do put ourselves at risk when we inappropriately limit how we are allowed to express ourselves.

But you know, I was scared and alone and I think I did what I had to do at the time. And I'm doing what I have to do now.

What comes later, after the emotional swells and storms, is a cleaner feeling. A lighter feeling. The only way I can pin it down is to say it feels like honesty. I never thought such a simple idea would be so powerful in my life but I've come to realize that honesty is a big deal because it--our willingness to be honest with ourselves and the people around us, our integrity--is a large part of what keeps our agency in tact. Now that I'm being honest with myself and the people closest to me (which at this point is, like, two people) about what is really going on, I have so much more freedom. My choices are no longer limited to repression or desperation. Things like hope, forgiveness, change, and soul-restoring rest are finally, truly on the table.

When I was kid we had those Standing Tall tapes and there was this story that is pretty cliche but has stuck with me. I'm sure you've all heard it before, but I'm reiterating it because it has taken on new meaning for me.

This girl fell and got a splinter but instead of pulling the splinter out, she just put a band-aid on it and tried to tell herself she was better. But the splinter was still in there and her body was trying to push it out so the wound kept swelling up and filling with pus and aching. No matter how many times she replaced the band-aid the wound couldn't heal because of the splinter. She had to pull the splinter out--even if it was going to hurt a lot--because it was going to save her pain in the long run. It was the only way her wound would ever go away.

(This is similar to President Monson's talk about Hidden Wedges. Tangential, perhaps, but worth thinking about.)

I think this is how a lot of us function emotionally. We have emotional splinters that we keep trying to cover up, but the wounds will keep producing pus and swelling until we yank those nasty, infection-riddled suckers out. To be clear, medication and therapy are not the band-aids. The band-aids are our unhealthy coping mechanisms like anger, addictions, avoidance, overeating, overexercising, or dishonesty. Medication and therapy are the tweezers, the tools, that we use to extract the offending shard. They pave the way for healing.

There's still a long way for me to go and I'm still struggling with some very fundamental questions and I do still doubt my emotional stamina to see this process through, BUT there's a little hope out there now for me. I don't feel like I'll be stuck in the never ending spiral of depression. My wounds can maybe, hopefully, finally close. Counseling and medication may still be necessary for the long haul (my psychiatrist wants me back in a month), but they are no longer stop gaps for the suicidal eventualities.

And that feels good.

From the Ensign: "Suicide: Some Things We Know, and Some We Do Not"

Since it's Wednesday I thought I'd get back on my on Ensign articles addressing depression and mental health issues. For the first post, click here, and for the second, click here.

When I was in high school one of my good friends had a dead dad. It wasn't just that his dad had died, rather, he had a Dead Dad. See, a lot of people thought his dad had committed suicide and when people kill themselves the grief process is made even crazier. There are too many complications, questions. It's hard to put it to rest.

By the time this kid and I were friends his dad had been dead for a few years and I don't remember much about what actually happened--I think his death made the local papers--but I do remember the gossip and that's because it was still going on. Years later, people were still talking about what did or did not happen, what that man had or had not done. What the spiritual consequences were for his actions. Lots of people were talking but nobody really knew what they were talking about. It was hard enough for my friend to deal with his father's death, but it was even more difficult with people speculating and whispering and insinuating.

Elder M. Russel Ballard addressed the issue of suicide in his talk, "Suicide:Some Things We Know, and Some We Do Not". The title alone says volumes.

Suicide is on the rise in the United States--especially among the middle aged--which perhaps makes it a more pertinent issue than most of us think. It's a hard topic to broach but Elder Ballard's talk strikes the perfect tone:

I feel that judgment for sin is not always as cut-and-dried as some of us seem to think. The Lord said, “Thou shalt not kill.” Does that mean that every person who kills will be condemned, no matter the circumstances? I feel the Lord recognized differences in intent and circumstances: Was the person who took his life mentally ill? Was he or she so deeply depressed as to be unbalanced or otherwise emotionally disturbed? Was the suicide a tragic, pitiful call for help that went unheeded too long or progressed faster than the victim intended? Did he or she somehow not understand the seriousness of the act? Was he or she suffering from a chemical imbalance in their system that led to despair and a loss of self-control? Obviously, we do not know the full circumstances surrounding every suicide. Only the Lord knows all the details, and he it is who will judge our actions here on earth.

He also quoted several apostles and President Kimball (along with scripture) to establish what doctrine exists. An especially pertinent one came from Elder Bruce R. McKonkie,

Suicide consists in the voluntary and intentional taking of one’s own life, particularly where the person involved is accountable and has a sound mind. … Persons subject to great stresses may lose control of themselves and become mentally clouded to the point that they are no longer accountable for their acts. Such are not to be condemned for taking their own lives. It should also be remembered that judgment is the Lord’s; he knows the thoughts, intents, and abilities of men; and he in his infinite wisdom will make all things right in due course.

I hope you all will take the time to read Elder Ballard's article. It's a hard topic, but hope is always available through the gospel of Jesus Christ. Maybe next time the topic comes up we can offer insight, instead of insensitivity. This was one article I was glad was in the Ensign.

p.s It's the first day of spring on Friday. Hooray!

Book Review: Room for Two by Abel Koegh

I usually end up posting my in depth reviews on my other blogs: A Motley Vision and LDS Readers, but my reaction to this book was too personal (and therefore unprofessional?) for AMV and too conflicted for LDS Readers (they have a policy of not saying anything negative--which makes it difficult to review stuff. . .) so I'm posting this here.

Anyway, the book was a memoir, Room for Two by Abel Keogh. It literally starts with a bang--that of gun that Keogh's pregnant wife's has aimed at her own head. He runs to the bedroom of their apartment and holds Krista while she bleeds to death. You see Krista was born to two people who met in a mental hospital--her father was manic depressive and her mother was schizophrenic--and was given a genetic legacy of mental illness which manifested itself as severe depression. Keogh sits numbly through the police investigation and then struggles through the nine days of his little baby girl's life. Because Krista killed herself the baby had to be delivered nearly four months early after being deprived of oxygen for an extended period of time. It is a sad, sad, complicated story.

But that only occupies the first fifty pages--less than a quarter of the book. The other one hundred and sixty-six pages chronicle Keogh's search for a new wife and drives home the point that a person can get over these things. You can love again. You can be happy again. You can move on.

I should probably stop at this point in the review and say this: I respect Keogh's experience and his right to move on. I am glad for him and his current wife and children. I'm sure he has helped a number of people through his openness and honesty about the pain he suffered as a widower. I applaud his courage to tell a story a lot of people in LDS culture wouldn't. I am glad he is happy.

But. . .

As a depressed LDS woman, I'm a little hurt. As a woman who struggled with perinatal depression three times and with PPD three times and is now fighting run-of-the-mill depression every day, I feel a little betrayed--not by his remarriage or his eagerness to move on, but by the fact that he abridged his wife's incredibly complicated and IMPORTANT story into fifty pages and managed to spend one hundred and sixty-six on what it was like to hold hands for the first time again. I mean, love IS magical, but depression is a transforming experience too. If his book is a true reflection of his experience, he didn't seem to spend more than few days wondering what his wife must have been suffering. And, what is perhaps the worst part to me, he didn't seem to even try. It was as if he thought that since he wasn't mentally ill there was no way to comprehend the strangeness of her experience so he closed himself off completely from any type of sympathy for her. He missed her after she was dead, but, from the way the book reads, he seems to have misunderstood her while she was alive. And that makes me sad.

Granted, I might have taken Keogh's book a little too personally and my reading may not be an accurate reflection of his experience; he might be horrified to find that I feel this way. But I wish that he had chosen to spend a little more time in the rush and tumble of the storm cloud and a little less on the silver lining.

It also angered me that this book perpetuates a lot of stereotypes about depression:

*His wife had been on Prozac for a long time previous to her pregnancy and chose to go off it because of the baby. Now, he may or may not know this, but SOME antidepressants are safe to take during pregnancy and most OBs and psychiatrists agree that if the mother's health--mental or physical--is at risk. I wish he had taken the time to correct this misconception while he had an audience.

*As luck would have Keogh's second wife also has depression--although obviously not as severe as his first wife's. She herself says she's never been suicidal. When his soon-to-be second wife tells him this he praises her for not taking medicine and handling it through excessive running (I say excessive because she ran at least three marathons in a single year, one of which was run on a broken femur). He says, "Her [solution] intrigued me. Maybe it was because I had spent so much time with Krista's family, where prescriptions were preached as the cure-all for every ailment; this was the first time I'd heard someone say they'd rather not be on anti-depressants [sic] . . . Some people would say there's nothing you can do about the way you feel. Take a pill and enjoy the ride." His soon-to-be second wife replies, "I'm not saying the medication isn't helpful. I just think people have more control over the way they behave and act than they think" (165-166). Now there are a lot of things that bother me about this conversation but the glaring misconception is that medicine is an exclusive option, an all-or-nothing deal, a zero-sum game. I've blogged about the stereotypes surrounding antidepressants before and I've blogged about the wonders of CBT and therapy too, and I hope that people are beginning to understand that antidepressants and therapy (and exercise) work best in combination! It's not an either/or scenario. Taking medicine is not a cop-out. What it is, is a responsible choice. Oh, and it doesn't take away your agency. If anything it restores it after illness has taken it away.

*Another problem in the book's treatment of depression was its complete silence on the fact that depression has spiritual ramifications. The above conversation illustrates this and the implication--and all too Mormon idea--that we are better off doing things ourselves and not asking for help. This is echoed by the author's insistence that he doesn't need to see a therapist and that others around him aren't "progressing" as much as he is because their grief lingers longer than his. The way he present himself in the memoir, he comes off as proud that he was the one who actually suffered the most and needed the least help. This idea of needing to do things alone and for ourselves is not only untrue, it is absurd. Yes we have our agency and we are accountable for our actions, but the point of this life is to learn to partner with Christ. There is no way to yoke ourselves with Him without asking for help--both temporally and spiritually. The idea that we need to pull ourselves up by our spiritual/emotional boot straps keeps too many depressed people from seeking the help they need and from building the support structure they cannot live without.

I could probably go on but it would cease to be helpful. There's just one more thing that I feel like I need to mention: depression is a deadly illness. For all the pain Keogh's first wife's death caused, he only barely links her death with her depression. If the memoir is an accurate depiction of his mind's workings it takes him months to realize/accept that Krista was not in her right mind when it happened--that she could not have done something different. So I'll say it again: depression IS a deadly illness. It needs to be taken seriously.

Anyway, I'm not trying to slander Keogh or disrespect his experiences. They are his and I'm grateful to him for being willing to start a scary conversation. I just disagree with the way the story was framed. Like I said before: I would have appreciated a little more time of the storm cloud and a little less on the silver lining. It might not only have been more interesting, but have done a lot more good.


P.S. It is interesting to me that Keogh blogged through much of the aftermath of his wife's suicide and almost none of it is included in his book. The blog posts are raw and, a few of them, powerful and interesting. It seems natural to me that, as a writer, you would want to use some of what you had already written about the experience. After looking at his blog his memoir feels sanitized.

Since We're on a Roll with the Daddies . . .

I thought I'd mention this:

I came across this blurb from the BBC, Antidepressants "may harm sperm", and I couldn't resist commenting. One because it is informative (sort of) and two, well, I don't know, it was just too interesting to pass up! (I trust that we're all grown up enough to use the word "sperm" without giggling . . . well, that's all right. If you laugh no one will know. You can pretend you were mature about this in the comments.)

Basically the article talks about a study that found that men who were on antidepressants had a higher rate of defective sperm. The sperm in question weren't lower in quantity, just quality. That is, men who take antidepressants have a higher percentage of sperm with damaged DNA.

Now, reel in your disaster-scenario-seeking brains (my brain isn't the only one that does that, right?), because that actually means very little. The study was so small that it in no way supports conclusions like "men who take antidepressants have lower fertility" or even "ALL men who take antidepressants have harmed sperm". I repeat: those conclusions cannot be drawn!

Here are few facts worth keeping in mind:

*The study only looked at Paxil and other antidepressants in that family. It didn't look at any other type of mood disorder meds.

*The study didn't examine if the damaged sperm actually had an effect on fertility.

*The study didn't look if the effects were reversed when the medication was stopped.

So what to take away from all this? I think the one thing this new information points to is that antidepressants do a lot of things scientists and doctors don't understand. We need more research behind the meds and more research into treatments for mood disorders and into mood disorders themselves.

Also, keep in mind that past studies have shown that people with high stress levels (like depressed people) do have lowered fertility rates. If you are worried about fertility talk to your doctor (obviously!), but an antidepressant probably isn't a big factor.

Other things to remember: When it comes to serious illnesses like depression, OCD, anxiety, or any mix thereof, it is probably safer to side with taking the medicine if you need it. Since the Surgeon General required the "black box" warning to be put on antidepressants prescribed to teens, teen prescriptions rates have gone down and teen suicide rates have gone up. Nobody wants a crazy dad. Or a dead dad. And that's just the facts.

Heavy on my mind

So I've had suicide on the brain lately. Not because I want to kill myself--if I did I wouldn't post it on my blog--but because, well, suicide is sort of always around.

See, when I was really little my grandmother tried to kill herself. She was depressed after the death of my grandfather and she decided a big ol' bottle of pills was the best course of action to take. One of her sons had a premonition to check up on her. He called her house and she didn't answer so he went over. He found her passed out on the floor. He took her to the hospital and had her stomach pumped. After that she spent some time in a sanitarium and it came out that she had struggled with depression and bulimia/anorexia for most of her life. It was sad and she was sad. At the end of her life (she was killed a few years later in a car accident) she was almost always sad. Her suicide attempt left a strange legacy in my young mind. Like maybe suicide was an option.

Then when I was thirteen my best friend tried to kill herself. She too took a bottle of pills--but this time I was the one on the phone. I listened as she told me all about how her parents hated her, about how she had been sexually assaulted at a party, about how she couldn't deal with anything anymore--the pills rattling in the background as she dumped them out of the bottle and then put them back in, not sure how many to take. I listened as she cried and swallowed the pills. It never occurred to me to tell my parents. I just prayed over and over, "Please, God, don't let her die. Please God, don't let her die. God, don't let her die!" I started to cry and made her promise that she'd show up for school the next day. She didn't make it to school and I started freaking out. That evening I got a phone call. Her parents had found her in the bathroom piles of pills still clutched in her fists. She was calling me from the psychiatric unit of the hospital. She kept saying, "I just want you to know it's your fault I'm alive. You made me promise I'd come to school and I couldn't break a promise to you. This is the most horrible place. I just want to get out. But it's your fault I'm alive. It was your promise." I mourned her life and I mourned my promise.

In high school seven of my friends tried to kill themselves--none of them were successful, thank heavens, although my ex boyfriend did come close when he threw himself off a (small) cliff and took up driving with his eyes closed. It was strange, listening to all my friends' goodbyes and hearing their tales after the attempts. Sometimes I was sad. A lot of the time I was scared. Eventually, I got angry.

After awhile I began to draw cut marks on my wrists and have dreams about watching myself bleed out. It made me anxious because I didn't really want to die but, maybe, I did. Things were so overwhelming--AP classes, theater rehearsals, Young Women's responsibilities, I was Seminary class president--sometimes I just couldn't figure out any way to make it all slow down. Death seemed so still and quiet and sounded so peaceful. However, because I knew the plan of salvation, I knew that there would just be more questions to answer and more work to do on the other side. When I got my patriarchal blessing it said I had a long life to live and I took it as a sign. The suicidal thoughts were pretty much gone then.

Things were good for a number of years, but then I got hit with postpartum depression and felt crazier than I ever knew I could. I really wanted to kill myself because I deserved it. I was such a horrible mother and such a failure and a latter-day saint it just wasn't worth it. I figured I could pay the hell on the other side. The suicidal visions returned but with much more detail and color. They were scary. Anger seemed the best way to fight off the fright--until I started therapy and antidepressants.

These days the images come and go but I mostly ignore them. The medicine helps them disappear.

I guess the reason I've been thinking about this lately was the legacy all those attempts left me. I was sad and scared and angry for a long time--especially at my grandma and my best friend. They had introduced so much anguish into my life and for what? Even though I imagined I knew how they had felt I still didn't understand it. And I really didn't understand what part I had to play in all of it. I prayed a lot (and wrote a lot of bad poetry) about it. But, still, my feelings roiled around inside me.

Given some time, though, the sting lost its venom. The ache began to heal. I still don't understand all of it. I still have a lot of questions, but the anger is gone. I think what I struggled with was my own responsibility in relation to all of it. I began approaching peace came when I began trying to give it up to God. He was the one who was responsible for it. This life, is after all, a part of His plan. And, I came to understand, He was planning on being responsible for it. He planned for His son to come to earth and suffer, bleed, and die. God was in control.

I also began to feel better when I realized that my grandma, my friend, and I might all have had the suicidal thoughts simply because it is part of an illness--not because of what my grandma did or because I hung out with the wrong crowd or some other nebulous sin. It was an illness and illnesses are covered by the grace of Christ through His atonement and resurrection.

I still need the therapy and the drugs, but my testimony helps with the healing too. These days I admire my grandma. Her struggle and her faith are inspirational to me. She survived and I can too. I pray for my long-ago best friend. I don't have contact with her any more, but I know she is in God's hands. I pray for me, too. And I'm working on forgiving myself for my own weaknesses and self hate. And I'm working on accepting myself--craziness and all--for what I am now and for what God can help me learn to be.