What if Nothing Ever Works? Is Life Worth Living?

This post is just another blah, blah, blah about how desperate I feel. Please do not read if you are annoyed by me and my morose being, or if you are triggered by dark thoughts.

I am not writing this to reach out, or to help anyone. I am writing this because the urges and images inside me are overwhelming me. I need to get all these bad thoughts out of my head...I guess in a sick way my writing like this is a coping strategy.

Given my decision to write this blog, not just for myself, but for others to read, I often find myself afraid to write what I really feel. I try really hard to be genuine and honest, but sometimes I feel my unrelenting, chronic illness, its symptoms, my thoughts and behaviour might annoy, overwhelm, trigger, or burden other people.

This feeling of overwhelming and burdening others happens in my "real" life too. I feel if I share the truth, speak the truth, open up completely to my family and friends it places a heavy load on their shoulders. What the hell are they supposed to do with the information? It feels selfish to share such detailed and frightening imagery and information with them. So I keep the heaviest part of my load inside me, and then days like today happen and I feel like the load will tip me over and flatten me.

I have been sitting here on the verge of tears for the past few hours. At one point I called my Dad, ostensibly about something he might be able to help me with, but really I wanted to scream..."help me". Reason took over. My Dad doesn't even think I need help...definitely not the person to reach out to.

When my Stepmon asked me how I was, I so desperately wanted to reach out for help. I heard my voice quiver. About to break into tears I managed to squeak out, "fine". She did not notice and took my "fine" at face value.

I am not fine. My suicidal thoughts are so strong right now. I was in the gas station today, staring at the packages of rope. My brain kept saying buy it, buy it, buy it...do it, do it, do it. I managed to move away from the rope, only to be drawn to it again...three or four times. I left the gas station with no rope, but not without an intense desire to die.

How do people survive chronic MDD. As the years go by with nothing able to help me for any length of time Iam losing my resolve, my will to fight, my desire to live. I cannot see how it is possible to keep trying when I still feel so much severe depressive pain, isolation, fatigue, attention difficulties, memory loss and amotivation...these things have completely destroyed me.

I had lots of friends, went to school, worked hard, , both physically and socially. I did everything you are supposed to do to have a happy life.

I am not the person I see inside me now. I have become some monster. I have become the epitome of hell. I have become an empty vessel, an inanimate being, the living dead.

I am a zombie; dead inside, but walking directionless, searching and praying for a way to make the death destroy my shell as well. Why did this happen to me. I always tried so hard to be alive, vivacious and passionate about my life, and other people's lives.

Now, everywhere I look I find myself searching for a way out of this life. I see an car accident taking me away, a truck running me over, a rope hanging me in a tree, a dog leash and choke chain slipped around my neck and over the bathroom door, a leap from the Alex Fraser Bridge, a fall in front of the train, ...a note pasted on my door...someone help my dog.

What's Wrong?

I adore and love my boyfriend "I". He is one of the most interesting, funniest, warmest, sweetest and sexiest men I have ever known. I am at a loss in one area though. I feel really confused when the topic of my mood disorder comes up. It is as though he is in complete denial that I am depressed.

He "knows" I am depressed. We met at an art clubhouse for people with severe and persistent mental illnesses. That is one of the criteria for joining this particular art program. We both have mental illnesses. We have talked about how important it is for us to support and care for each other both when we are well and when we are ill.

"I"'s perspective on mental illness has been extremely complicated by his father committing suicide when he was a child. It becomes even more complex when you learn his father was a psychiatrist.

This is how the conversation that confounds me goes:

I: How are you.
Me: I am not feeling well.
I: Why not?
Me: I am depressed.
I: What are you depressed about?
Me: I don't know. No reason. I just feel intensely depressed. It never seems to be about anything. It just comes upon me for no reason.

This conversation may seem innocuous, but the fact that I have to tell him I am depressed, and that he wonders why I am not feeling well, and what I am depressed about...over and over and over...makes me feel really misunderstood.

I have tried to explain my symptoms to him; my suicidal ideation, my severely low mood, the fatigue, the amotivation, the anxiety etc. He sees me cry, and unable to clean, or cook, or do much of anything, but he keeps telling me I am not depressed and/or asking me why I am depressed. Having all these symptoms is depressing. How can he not understand that.

I have to admit that I hold back when I tell him how depressed I am. He is still traumatized by his Dad's suicide. I do not want to trigger him by talking openly about my suicidal ideation; especially because I ideate about hanging myself over and over throughout the day, everyday. His father hung himself.

While I do not relay the vivid details, I do express that I am desperate, that I want to go in for ECT, and that I cannot manage this illness much longer. He sees that I see Dr. X each week. For some reason he thinks I do not need to see a psychiatrist. He says I am not sick.

I think he sees me as being funny, supportive, loving and functioning maybe on a level above many who have the same symptoms I do. Maybe what he sees and experiences does not match what I feel, or what I tell him I feel. Maybe his experience of his own depression is different. Maybe this suggests to him I am not as depressed as I think I am.

He is so wrong. I am so depressed I feel like I might not survive if something doesn't change very soon.

What's wrong?

• I have to take so much medicine, just to still feel this bad...a Mood Stabilizer,an antidepressant, sleep medication(another antidepressant), thyroid medication, and a stimulant)
• I cannot stay out of bed I am so exhausted.
• I can't eat properly both because I cannot walk, or drive three blocks to the grocery store to buy decent, healthy food, and because I have enough energy and motivation to eat Cheetos and cereal...that's it.
• I feel sick inside all the time...physically sick, like I can barely move, am nauseous and I feel blah.
• I want to crawl into a fetal position and pray my life will end
• I see ways to kill myself everywhere I go: a car crash, pills, a bus running me over, being hit by a car as I cross the street, falling from a bridge, drowning in the ocean etc...
• I feel dissociated much of the time; detached, depersonalized.
• I feel desperately isolated, alone, lonely. I feel so alone through this. It is impossible for anyone to understand what this feels like. There is no one who understands the level of depression I feel.

I want to kill myself, I want to die, I don't want to live if this is what my life will be like...that is what is wrong.

Invalidated

Sometimes my therapy works to help me understand why certain patterns repeat in my life over and over again. Today's therapy was like that.

Therapy always leaves me feeling "heard", and (mostly) understood. This is something intensely important for me. I think today's session revealed why these two things are extremely interconnected and even more importantly, why they are so important to me and my well-being.

I just returned from a short vacation at a horse ranch and spa in the B.C. interior. I went with my beau, my friend E and my sister and 2 nieces. I haven't seen my sister for a while. When she came to my house in preparation to leave she told my boyfriend and I that my Dad might "pop in" to the ranch to visit.

This information put a damper on my vacation from the start. I love my Dad, but he is often not very nice to me. I find him very difficult to be around. To me it seemed intrusive for him to jut show up.

When I mentioned my stress about Dad coming my sister began saying things like:

• "He's not like that".
• "You need to give him a chance".
• "He does not treat you poorly".
• "He is always nice to you".
• "You know Dad, he just doesn't know how to talk, and you make it worse by getting hurt by him"
• "You have to get over your problems with Dad"

I felt completely letdown by my sister. She has seen my Dad reduce me to tears more times than probably I can remember. She hears and watches him ruthlessly tease me and belittle me. I thought she recognized why I so often feel hurt by how it treats me. Apparently, according to her, Dad isn't the instigator, in fact, he does not treat me poorly at all. It is just my wrong perceptions that hurt me.

I am willing to concede, that after years of emotional, and at times when I was a child and a young teenager, physical abuse, that I am sensitive to how he treats me. I know sometimes I overreact to small triggers. I believe though, that this overreaction is not my fault, but the fault of a man, who is supposed to be my father, continuing to abuse me, and destroy what little self-esteem I have left. At times I think he belittles me, and holds back his love from me, for the fun of it, just to watch me fall apart and cry.

It is funny (not ha, ha...but strange funny) that this weekend when my sister and I were canoeing near my Dad's canoe, we sped up really fast and in unison yelled, "Dad, look at us". We both cracked up when we realized some small child inside ourselves was still screaming, "Daddy, Daddy, look at me, look at me".

To make things worse my sister also began lecturing me on how:

• "no wonder you are depressed. you sleep so much, how are you ever going to get well if all you do is sleep?". (this comment came 1/2 way through the vacation, just when I was marvelling at my ability to do as much as I was, when I felt as depressed as I felt)
• "If you did more you would get better" (neglecting that to do more I would need to have the missing motivation, energy, and mood, and ability to do more...all these have been ripped from me throughout this MDD
• " You are never going to be someone unless you get doing things." Translation: your life will never amount to anything if you do not get back to work. You are choosing to stay depressed. You are only an important person if you are working and contributing to society.

There were more comments like these throughout her lectures...the thing that really hurt me, was that I thought she was the sister that understood how hard I try. I thought she understood how depressed I am, and how that impacts my ability to do things.

On top of this my boyfriend talked to me about how, "You are not sick, nothing is wrong with you" A statement that left me feeling really unheard, and misunderstood. It is not that I want to be sick, or seen as sick, but I also do not want others to think nothing is wrong with me, and I am just to lazy to try harder in my life.

I talked to Dr. X about what went on with my sister and my boyfriend, but I could not really place why I felt as hurt as I did. Dr. X said maybe it was because I felt invalidated by their comments.

That is EXACTLY what I felt and feel when these kinds of discussions take place. My family is not listening to me. They are not understanding how difficult this battle is for me. I feel like I am battling for my life, but they do not even acknowledge I am in a battle. They see my difficulties as a character flaw.

Dr. X and I discussed how both my sisters', and my Dad's expectations of performance are mirroring the malevolent feelings of guilt I have about not working; how the family belief system is so ingrained in all of us that it just keeps replicating this guilt, and guilt inducing, behaviour in everyone in our family. It is true. I belittle and poke and prod myself to do more, do something, get going, get active....Get better...get back to work. I have become the voice of my father, and the voice of my sister...that why it hurts so much to hear. I am hearing the same guilt producing words I hear every single day from myself.

I know my sisters both love me. I think my Dad probably does too. When I realize their voices are replicating negative patterns that are held deep within our family's psyche. I recognize these thoughts and feelings are held unconsciously, and so deeply they may always be there.

On many levels I know my sisters, my Dad, and my boyfriend are really trying to help me. I understand they may see their comments as encouraging, and helpful. I think they want what is best for me. Sadly, when I hear these kinds of comments I feel he exact opposite: I feel unbearably guilty, alone, unheard, and invalidated.

20 (More) Things I Love

I am sitting in a black pit of depression. My sister and nieces are coming over tonight and her, my friend E and my boyfriend are going on a vacation together. I hate it when I am this depressed around my favourite people (well her and her kids are "one" of my favourite families...my other sister and her family are my other favourite;>))

When I feel this depressed, even with all the love, all the people I love, and all the things I love to do surrounding me..I feel nothing but my emptiness and almost an intensified depression. I don't know why, but sometimes I feel even more alone than when I am really alone.

I do not believe in "the power of positive thinking". I think those who suggest that thinking positively will make good things happen are suffering from a bout of magical thinking. This does not mean I do not believe positive thinking is a good thing.

I definitely believe that gathering all the good things in my life together and making lists of things I feel good about, grateful for, or that increase the likelihood of my being happy, if only for a while, even a brief moment; I absolutely believe that focusing attention on the things I DO have helps me at least momentarily. I also know that for me it sometimes takes my attention away from all my morbid and self loathing thoughts.

These lists are never easy to start, but once I begin I can usually think of more things than I expected I would be able to. This list was started because I read Eliza Jane's post about reading my post of the 20 things I love...kind of funny, but here I go:

1. I love the smell of the dirt in the early evening, on a hot summer day


2. I love long walks in my bare feet in the wet sand left behind by a retreating tide


3. I love tidal pool full of starfish, sea anemones and all kind of tiny little creatures.


4. I love seeing wildlife when I go for a walk, or am on the ocean; white tailed deer, elk, raccoons, squirrels, chipmunks, skunks, crows, whales, dolphins, all kinds of fish...and a couple times a black bear...I love all animals.


5. I love it in the morning when my dog wakes up and pushes his head into my belly and gives me a "hug".


6. I love a (reasonably) warm summer day.


7. I love a crisp autumn day...sweater weather is my favourite time of year.


8. I love looking over at my boyfriend in bed and seeing him sleeping like a baby. he is so beautiful I wish I could capture that moment forever.


9. I love those flitting, seductive kisses where you look into your partner's eyes and kiss softly, and pull back, and kiss lightly again, and tease, and touch lips, and so on, and so forth. I love the feeling that rushes through my body during these kisses.


10. I love the intense and deep kisses that happen during lovemaking, when you and your partner are trying to take each other deeper into your being.


11. I love sharing stories with friends and/or partners late into the night. It is the feeling of growing closer and closer with each shared story that intensifies my relationships with others. (sort of like logging and reading blogs).


12. I love my family: my boyfriend, my two sisters,my nieces, and my dad and stepmom.


13. I love going for coffee with my girlfriends E and H. Actually I love spending time with them anytime.


14. I love, and look forward to seeing Dr. X. Even if I feel awful he always calms me and helps me feel a bit of hope. He is such a beautiful human being. Very much like my Mom.


15. I love seeing the moon in the sky. I see it as a symbol representing my Mom...so when I see it I always say, "Hi Mom". It makes me fell like maybe, just maybe, some part of her still exists and is loving, watching over and protecting me.


16. I love an interesting movie. Here are a couple I recently saw and found fascinating... "Chapter 27"(about John Lennon's killer's state of mind...very interesting. Despite what he did, I found myself feeling so compassionate for him), "Million Dollar Hotel", (about some mentally ill patients truly lost in a SRO hotel)


17. I love it when I finally get the energy to paint and hours go by and I find I was completely lost in my painting...not a single bad thought...just creative energy flowing from hand to brush to canvas.


18. I love reading my blogger friends blogs. They inspire me, and make me feel less alone.


19. I love cooking for other people. I can't manage to cook for myself, but on Tuesdays I join my boyfriend and we cook for about 20 people. I love it and always put a lot of thought and effort into the meal. For some reason cooking for all these people seems easier than even making myself toast. go figure.


20. I love the a good massage, the smells, sounds and feel of horses, a horseback ride and swimming...and that is what I am doing for a few days this week. I am going to a relaxing dude ranch to do some dude ranch stuff...like rides, and spa treatments and farm animal sightings, and multiple swims in the pool everyday...

Yeehah!! Ride em cowboy!!!"

Resisting Trust

In my last post, "What a Difference a Day Makes", rather than feeling better, (I am not), I think despite feeling unwell I was able to have some insight into how my perception of other's motives might be skewed by my own beliefs about how I want and need to be supported when I am unwell.
I feel like I had an epiphany about other people. It seems obvious now that I have embraced the idea, but I am NOT the centre of the universe. Ha, ha...sort of:>( I often worry that I am narcissistic...can you be narcissistic if you think you might be? Hmmm).

Given that others deal with their depression in many different ways, it is probable, and even likely, that if they try to support me or you, or help us, they will do so in the way they understand to be helpful to them. This may or may not be the way in which you want to be supported or helped.

I know I try hard to approach friends difficulties the way I think they might need supporting, but I bet I get it completely wrong much of the time, because of my reference point. I need love and affection, nothing that indicates dismissiveness, or anger, and honest feedback.

I realize now that I block people from providing me with honest feedback because I so often feel hurt and criticized by what others perceive as honesty and even support. Difficulty trusting others is a key component to my reacting negatively i.e. fearfully, or hurt) to honest feedback.

I have great deal of difficulty trusting others, even those who consistently prove themselves trustworthy, (eg. Dr X, my boyfriend, friends etc.). I think I have made progress in this area, especially with Dr. X, but I falter all the time.

I remember just last week how intensely hurt I felt by a letter he had written to my Family Doctor (in Canada specialists need re-referrals from the referring physician every 6 mos...seems ridiculous when a psychiatrist has been seeing me this long). In the letter to request a re-refferal he said something like (paraphrase), "Aqua's mood cycles. She sees this component of her mood and is afraid to commit to regular activities". Honestly, I feel okay about what he wrote now because he and I talked about how I felt hurt by his comment.

At the time, after I left his office and read the letter, I was so hurt and angered by his comment. I felt so bad about myself and the way I was, that when I wrote my post, "Concrete and Practical Help" I could not even write about the situation that lead to my needing this help.

I felt like he was saying that I "could" commit to work etc., if only I would; that it was ME stopping myself from committing and not the fact that my mood disorder, my depression, was so intensely unpredictable and severe. It felt completely contrary to what I thought he had been telling me for years; that my mood disorder and its cycling affect my ability to maintain the momentum, motivation, mood, and energy to commit to regular scheduled activities. As I read the letter, all the trust and honesty Dr. X had worked so hard to maintain dissipated in front of me.

Obviously, not ALL the trust disappeared, because I was able to discuss my anger and hurt with him in my next appointment. The discussion helped me understand what his intentions had been. I understood more clearly. What really strikes me today, as I write this, is how, after years and years of building a trustful relationship, I can so suddenly feel hurt and distrustful.

As I read the letter to my physician I tried so hard to tell myself I was mistaken in my interpretation of the words. I tried so hard to believe and understand that Dr. X was so good to me, was so compassionate, honourable and trustworthy. I tried to remember how consistently supportive he has been all these years...but the worm of distrust, suspicion and paranoia kept digging itself into my brain.

...and I wonder why Dr. X and others might be apprehensive and not completely forthcoming about providing me with open and honest feedback. Given my pathological difficulties with trust, given my fear of being punished and plotted against, how can he be sure I will accept his feedback is thoughtful, caring and therapeutic?

Why do I resist trusting people so much?

What a Difference a Day Makes

I am okay. I will survive. I just so often wish I wouldn't. This is not what I thought my life would be like.

Last night my boyfriend called me and asked if could come over and help.

I have a friend coming in from England (actually she is moving back here) to stay with the next couple days. I had not cleaned my house in a long, long, long time. My floors were filthy, dishes literally ALL dirty, my kitchen a mess, bathroom disgustingly dirty...basically my whole place needed cleaning and I had 24 hours to do it.

Given I had months prior to this to clean and tidy my houset and hadn't been able to, things were not looking positive on the "clean the house" front. My boyfriend asked if he could come over and help me clean the house.

Can you believe that? He's a keeper...really!!!

When I was upset yesterday it was mostly because I was so depressed and needed so desperately to be heard. My friend E called me yesterday and really, really listened. We went for coffee this morning and she listened again. I hope she knows how much that means to me. I feel heard by her, and being heard makes me feel like others get me and can relate...and that I am not as freakish as I feel.

The people who commented on my last post heard me too. Thank you so much. I needed to be cared for and understood.

I know "I" (my b'friend) cares for me. He is so funny and cuddly, so passionate and charming, so thoughtful and kind in so many ways. Today I can see that maybe he approaches my depression and my reaching out the way he needs to be supported or cared for when he is depressed?

Maybe he needs people to tell him he is okay, or to tell him to try harder, or to tell him he can challenge his depression, to tell him it has no control over him? I suspect we each have different needs when it comes to feeling supported. Maybe he was supporting me the only way he knows how? Who knows.

The funny thing is that last night he said to me, "I am sorry I came across as a jesus freak last night" (apologies to anyone who has god in there live)...

I was a bit perplexed until he reminded me that, when he was trying to "help" me, he kept telling me to pray. When I said I didn't believe in god he kept saying sure you do, what is the first thing you do when something really bad happens? I had to laugh because he is right...the first thing I do is say, "Please god, don't let this be happening". Last night he told me that when he was really depressed, after he tried to commit suicide, he went to the mosque everyday and prayed to god.

We support, and show others support in a myriad of ways. I need to know that sometimes my depressive perspective skews my ability to accept feedback. I so often feel criticized when I am depressed. I need to think less about what is actually being said (from my perspective), recognize others have a different perspective than me, and think more about what the person who is speaking to me is like. If they are trustworthy, compassionate, honourable, loving and kind towards me the rest of the time, it is more than likely there ways of supporting me are intended to be that way as well.

Suicidal Ideation

Last night my boyfriend looked at me and said, "don't go to the hospital. You are not that depressed". A few days back I told him I was thinking of having ECT done again. He was adamant that I not do this.

If I try to express how depressed I am he has a tendency to say, "You are okay", "You aren't depressed", "Your not that depressed". I have tried to explain what it feels like to be inside my head. It never seems to register with him. Either he does not understand how desperate I feel, or he does not want to understand.

I know some of it might be that I try hard to be as okay as possible around him. Two reason drive this: my fear he will leave me if he knows how messed up I am, and my respect and support for his own difficulties with mental illness.

He has attempted suicide before, years ago, and I see the external and internal scars from his internal pain, his sadness, the scars on his arms from cutting. This, and my knowledge that his father committed suicide, stop me from openly and honestly expressing how I feel. I also know he was hospitalized against his will; so I recognize his distrust of the system. I do not want to add to his stress in these areas.

Our relationship feels strong and intensely beautiful in so many ways, but it is new for both of us. I do not want to risk losing him by exposing myself as fully as I need to for him to see how desperate and depressed I feel, for him to understand what I am fighting against, for him to know I need to get better than I am to survive my illness.

He kept saying over and over last night..."you are okay", "You are not that depressed", "We are all depressed", "Just get more exercise", "Push yourself, you just need to force yourself to exercise and it will be better". I found myself sobbing silently beside him, looking the other way, feeling completely misunderstood; my symptoms and their power over me dismissed outright.

Last night, as I sat beside him, I could not say "I am so depressed I want to hang myself". I did not express how my wanting to hang myself is a desire gaining so much power I am afraid I will succumb to it. I did not say these things because his father hanged himself to death, and he attempted suicide in this manner. I was afraid the information would be too much for him to deal with.

I want him to think I am strong and powerful. I want him to feel attracted to me, not repulsed by me...so I cover my true feelings up, and then cry and feel isolated when he does not understand me.

In my life talking about wanting to commit suicide is so taboo that I feel intensely alone in my thoughts. This divide, this avoidance of the awful suicidal ideation I deal with on a regular basis, creates a cavern between myself and the people I love. It makes me feel intensely alone in my struggle to survive my depression. It makes me pull away and isolate myself from those I love.

Today my mood is crashing again, after lifting for a few days. In part I think the fall is a reaction to feeling misunderstood and isolated from my boyfriend and family. When I crashed a few weeks ago, and as I was crashing last night, I tried to reach out or support. Both times I hit a brick wall with my family.

I rarely mention my suicidal urges to my sisters, or my boyfriend. If I do try to be open out of fear and desperation for myself , I sometimes try to explain how depressed I am; "so depressed I don't want to be here" might be what I say to my sisters. Instantaneously they brush my feelings off with an, "Oh, don't say that. How do you think we would feel if you did that?" I know it would hurt them if I commited suicide, but what about me? I hurt all the time.

My sisters do not want to hear how sad I am, and my Dad, he has never once ever asked me if I am okay...not once. He has phoned me to say my stepsister was depressed and needed help. He has told me how crazy he thought my going in for ECT was...4 years after the fact. He has never asked if I was okay, or if I needed help, or if I was having any success with my treatment. He has certainly never asked me if I was at risk of committing suicide. I am.

When my Mom wasalive she was a nurse. She used to talk openly with me about suicide. She would even ask me if I was having suicidal thoughts or urges. With her I would always leave the phone call feeling heard and relieved that someone knew, someone wanted to know. Someone loved me enough to ask and actually listen to my answer. Why is it so important to me that others understand how depressed I am, and how hard it is to be this depressed? I have no idea why.

I wish my family (and my boyfriend) understood how desperate I feel; how much I need and want them to understand me. I want so badly to be able to tell them my truth, for them to talk openly with me even if it is difficult to do, and for them to acknowledge that I am ill. I want them to say this is not my fault. I want them to say, "I AM trying hard enough". I don't want them to feel hurt by me and my awful thoughts, but I need help with them or I am not going to survive.

Whatever...I don't know why I need so desperately to be understood; maybe because I don't understand either. Last night my boyfriend kept saying, "you need to address what is making you depressed. Nothing will get better if you don't change those things".

At that point I began sobbing so hard I had to leave the room. I have been in therapy for years a fact that screams to others and to myself, "things" are causing my depression, and I need to change those things." Despite a sense that there must be things that are making me depressed...I honestly feel like all the things I want to change, would fall into place if I was not depressed.

I would get a job, clean my house, do more things, isolate less, stop obsessing about suicide, dance, play music, ski, eat well, sleep less etc...if only I weren't so severely depressed.

No one wants to acknowledge this raging rhinoceros, named "Suicide", rocketing towards me and racing after me every where I go. So I write here, because at least I can say how I feel.

Things That Make You Go ...Huh???

I usually let these kinds of ideas wash over me, but this article, "Depression is Not an Illness" is so draconian, and, from my experience, mistaken that I had to respond.

The writer claims to be a retired , licenced psychologist. I worry others will read his post and feel their illness is their fault, or that somehow they are to blame for being depressed. I find it hard to believe that a person could be in the field of helping others...especially as a psychologist, and be so judgemental and mistaken in their understanding of a very difficult to deal with mental illness. My experience has always been that the major depression always shows up before all the activities he suggest cause depression show up/or disappear. My depression leads to my eating poorly, isolating, becoming inactive etc. Not the other way around.

This was my comment to him about his article...long-winded, but in support of all who struggle with MDD (or any other mental illness, I needed to say what I said...

"[My comment on his site...]
I am actually flabbergasted by this post. Not sure if it is satire (I hope so) or for real. I hope you post my response so others like me do not feel blamed for not relieving and avoiding their MDD. In case you don't I am going to post it on my website.

I struggle with MDD. I have had numerous clearly defined episodes throughout my life. Until this current episode I was the epitome of what you suggest makes a person happy, yet I still fell into severe and often lengthy depressive episodes:
good nutrition
- fresh air [I routinely biked, skied, swam outdoors and indoors, hiked, camped, canoed, gardened, walked everywhere was outside much of the time]
- sunshine.[.see above]
- physical activity[...ditto]
- purposeful activity[...worked(loved it), went to school(really, really loved it), danced, played music, created art, wrote, helped others]
- good relationships, [beautiful friendships, very open, nothing we could, and did not talk about.]

For me severe depression really did just pop out of nowhere. There was nothing wrong with my life during these episodes...I had a great life. It was the depression that stopped me in my tracks, not the other way around.

When you wrote, "When things are going well in our lives, we feel good"...I understood immediately that you misunderstand MDD. The sad thing about MDD is that even if things are going well this illness destroys a person's ability to feel good.

I find it difficult to understand how you treat people with depression when you place so much distance and dogma between yourself and your patients. When you say,

"Many of these individuals lived on a diet of soda pop [I can count on my hands the number of sodas I have drank in the last 5 years], cigarettes[don't smoke], and salami sandwiches[I think the last salami sandwich I ate was in high school...I'm 44]. Others drank enormous quantities of alcohol [I used to drink periodically...like many other happy people I know...until I got as severely depressed as I am now. In which case it drove me to drink more to try to help my symptoms]. Few ate vegetables regularly[ was vegetarian.so did well here]. Many stayed indoors almost all the time [see my above list of favourite and common activities]. Physical activity was almost always minimal [ditto]. Purposeful activity – i.e. activity directed towards some kind of goal – was seldom present [university? , and good honest, open relationships almost non-existent...[great friendships?]...

...Chronically depressed people, however,are individuals who have been neglecting these areas for years. They spend the vast majority of their lives indoors, watching television and eating snack food. They are often over-weight, have no goals other than the next TV show, and although they may have many acquaintances, they do not share their concerns and worries in an open and honest manner"

...it struck me that you believe very strongly that "we"are so very different from you. We just don't try hard enough to be happy. If only "we" would try harder, "we" could be as happy as "you".

Have you ever really worked with someone with clinical depression? Contrary to your statement that we are indoorsy, crappy food eating, inactive, solitary, lazy, unfocused, fat, slobs.. [actually slob is my word...it's how i sense we seem to you) people with MDD are a wide range of people...some of us even active, outdoorsy, friendly and friend supporting, anti-t.v., fit and interested and interesting people.

It becomes clear you have never understood what it is to be depressed when you state, "Depression or despondency is not as acute a sensation as pain". In the past I broke both my elbows at the same time, had a severe case of CMV related hepatitis that required hospitalization, have broken my leg, my ankle, my wrist, had three concussions, was injured in a car accident, had a doctor drill into my leg bone for bone marrow, basically have suffered a lot of physical pain.

NOTHING is as painful as severe and chronic MDD. When I broke my elbows I had just come out of the hospital after having ECT. For the first time in years I felt mentally well. I REFUSED any pain medication for my physical pain, for fear that my psychic pain would recur. NOTHING hurts like mental pain...NOTHING.

"It is the Relationship That Heals"

If this is your psychiatrist or therapist run...

I am always struck by how much support I get in my comments and how many thoughtful people comment. This was going to be a response to the comments in my last post, but it has turned into its own post instead...

I love to hear from people who comment on a regular basis. I feel like over the years I have developed relationships/friendships with many of these people. I also feel really good when I hear from those who rarely or never write. It feels like the beginning of a mutual support system. I am glad my writing reaches out to people. I hope it continues to do so. Your comments often inspire posts...like this one, so comment away.

I write this blog, not just for myself, but also for others trying to work through and battle the same or similar issues and demons. People sometimes comment about how open I am. My original intent for my blog was to try really hard to make this as close to therapy as possible. I wanted to push myself to be open and as completely honest as I thought I needed to be for therapy to work for me.

I also planned to use it to prepare for my therapy sessions, to debrief after my sessions, and to push myself to become brave enough to talk about deeply personal, and often scary thoughts I have. In writing I hoped I am able to show others that therapy is a rewarding, and helpful process, even if it is sometimes really, really hard to fully participate in.

I was hoping that if others could be "insiders" in another person's therapy sessions, if they could see my process, my difficulties, my struggles, my successes, my cycling, my wingbat thoughts and ideas, my creativity, my attempts to get better, and even my failures: I was hoping others might take a chance with their therapist; try hard to open up in therapy, to go to therapy if they never have, to address there darkest secrets, to address any patient/therapist disconnects in therapy, and to find the therapist or psychiatrist that truly fits their needs.

Before I met Dr. X. I had already been to therapy numerous other times each with varying degrees of success, and sadly often failure. With most of the therapists I saw there was either a complete disconnect between myself and them, or if it worked I was in need of a longer course of therapy, and I believe medication which no therapist ever mentioned was available.

I now believe I needed to somehow muster up enough energy to be more of an advocate for myself...Though I know, when severely depressed that may not be possible. If I were to have a second chance to be start at 19 again, if I needed to see a new psychiatrist/therapist, I would approach it as a customer trying to find the best "product"/"service"/treatment for me.

I would be more assertive, have greater expectations, ask more questions and not settle for the first person who comes along. I would have looked for someone like Dr. X from the start. Of course, that is easier said than done.

Below are some of the things I would look for in a psychiatrist/therapist if I had to look again:

When meeting a new psychiatrist or therapist, make a list of the types of behaviours that are important to you in someone you are seeking help from.

Be open to new ideas and approaches.

Ask them questions.

Listen to how they answer your questions. Are they welcoming? Do they sound put off by your questions? Are they caring?, or pushy?, or short?

Do they have time for you?

Are they just medication oriented?

or Do they provide therapy? (I find it really helpful to have a psychiatrist who does both).

Do they LISTEN?

What are there credentials?

What kind of experience do they have treating people like you?

What type of therapy do they practice? I find the less dogmatic about a particular therapy style the better....Use whatever works!

How flexible are they?

Do you feel comfortable around them?

The last sentence...Do you feel comfortable around them? ...is tricky, because many many times, probably during each of my sessions, there is some degree of feeling uncomfortable around Dr. X. Even 8 years into therapy I feel guilty, or ashamed, or afraid, or even angry at him periodically. The test of being comfortable lays in whether I can talk about my uncomfortableness...even if it takes a few sessions.

If I feel he has said or done something I am uncomfortable with, and I can safely work through and see this as an opportunity to discover something about myself and others...then it is indeed a powerful and psychically "comfortable" relationship.

The question I try to ask myself when this happens is whether these feelings are coming from me and my mood or experiences, or whether the psychiatrist or therapist is doing or saying something, that promotes my feeling ashamed, afraid, intimidated etc

I "understand" (in my rational mind) Dr X. is NEVER judgemental, or angry, or pushy, or authoritative, or any other way that might increase or promote my feeling bad in therapy. That does not mean I do not ever feel these things. Who I am, what I have experienced etc. impact my reactions towards all my relationships' experiences and interactions

Some Psychiatrists/Therapists (like some people of every persuasion or occupation) are pushy, or arrogant, or sure whatever they say is right, and the patient knows nothing about helping themselves. They tell the patient to just do whatever they tell them to do etc. This is the kind of therapy/doctor, that I always found did not work for me. For me a good therapist and/or psychiatrist forms a partnership with their patient, values their patients ideas and lets the patient know they are valued

Some of my readers have expressed difficulties, or difficult relationships with, with their psychiatrists and/or therapists. I believe it is important to delving into into why I might feel that way. What kinds of behaviours, exchanges, actions, thoughts are taking place both in and out of therapy that are leading to your feeling a disconnect?

In his book, "Love's Executioner" and in his novels and psychotherapy textbooks, Psychiatrist Irvin Yalom writes and expands upon the idea that, "it is the relationship [between patient & psychiatrist or therapist] that heals". My experiences in therapy with Dr. X have reinforced and proven this to be the case for me.

I try to remember therapy is sometimes difficult. During some phases it can see impossible a lot of the time. As people with depression, or other mental illnesses, (really as people even with no mental illness)... as people period, we may have difficulties with some relationships in the first place; maybe that is even why we are in therapy.

If I find something happening in my sessions that disturbs or perturbs me I always ask myself is the difficulty in therapy the therapist, or have I not opened up and taken the chances I need to take in therapy.

• Is it my issue clouding the session,
• Are my symptoms such that they are affecting my judgement (not always easy to know)
• or is the therapist doing something hurtful that negatively impacts my ability to open up?
• Is my therapist a good therapist?
• Did they just make a mistake,
• or is their attitude always this way?
• Is it my approach to therapy?
• or is it the therapists approach that is making it not work?

The most important thing I can do as a patient is talk to my psychiatrist or therapist if I am feeling uncomfortable, or hurt, or diminished or disconnected in any way. I may not have the courage to bring it up while it is happening, or even during the next session, but if something about my therapy is festering inside me...I always bring it up.

Everytime I have brought difficulties up he is completely open to discussing what went on. He apologizes if a mistake was made on his part, or we discuss my reaction if we discover my perception might be coloured by other things. He accepts and encourages my feedback no matter what. This is part of what makes our relationship so important and the bond so strong.

I guess what I am trying to say here is that the first therapist you see, even the fifth and sixth therapist you see, may not be right for you . Don't give up because your therapy does not seem to be working for you.

Therapy, and good relationships in therapy, is/are hard work. If the relationship between you and your psychiatrist or therapist does not seem to have a positive impact on you maybe try approaching your therapy a different way, or try a different kind of therapy, tell your therapist how you feel. If it still is not working perhaps trying a different therapist or psychiatrist would be the positive change you need.

Concrete and Practical Help

The idea for this post came from Eliza Jane's comments about sometimes needing "concrete" help...thanks EJ

On Sunday I left a message at my pdoc's office to see if I could get an appointment before my scheduled appointment. They called me this morning and booked me in for 4pm. Even as I spoke to the secretary I thought maybe I don't need the appointment now. I was still depressed, but not as acutely so as the past few days. I went against my avoidant self and took the appointment.

A few "concrete" things helped me in my appointment today:

• Dr. X's welcoming attitude when I expressed how I was happy to be able to see him earlier in the week. He said he was glad that I felt comfortable enough to call when I needed to.
• Both his offer to write, and his taking time after my appointment to write, a letter for me to take to the emergency room if I ever felt I needed to go to the emergency because I was suicidal

This letter was brought up after I explained to him how I was afraid to go to the hospital because I felt like I might get there and my mood might lift momentarily, then the Dr. would dismiss my symptoms, reject my cry for help and send me home, where I would feel even more depressed that no one "heard" me, recognized how depressed I was and that I needed help.

In the letter he wrote about my mood disorder symptoms and the intensity and severity of my suicidal ideation. He also said that I would not bring myself to the hospital if I was not ready to put my suicide plans into action.

• As I read the letter it became really clear to me that he really did understand how much I was hurting; how much pain my symptoms were causing me.

I feel now, that if I were to be suicidal I would take myself, with the letter, to the hospital.

• We discussed possible medication strategies...this gave me some hope that there are options we have not explored and many combos we have not tried.

Thanks Dr. X for listening and helping me take care of myself. It really helped me to see you today.

Thanks too to my friend "E" who encouraged me to see him in the first place.

How do I Keep Trying if Nothing Works?

I have been both afraid to write and too unwell to do much of anything. I want my blog to show how I keep trying, but I am having trouble with that right now. A therapy appointment a week and medications that do not work are not enough to support me. I am really struggling to continue.

Why is it with physical pain they give people in excruciating pain some type of pain relieving medications? Yet when a person is in intense psychic/mental pain there is nothing that can at least numb that pain until the medications work? In fact for me, it seems, nothing will ever work.

Do you know how many years of my life have been spent in Major Depression? I wasn't diagnosed before, but I figure it works out to close to twenty years altogether. That is almost half my life.

The irony is that until this MDE of 8 years and the 4 years prior, I saw myself as a pretty happy person, except during the periods of depression: Happy go lucky, funny, charming, loved life, a bit wild, creative, outdoorsy, ntelligent, flirtatious, well read etc..

I am no longer happy go lucky. If my mood switches upwards I spend all my energy trying to maintain that mood. I don't have time for happy go lucky. I am fighting a brutally difficult and deadly battle now.

I don't want to keep trying. I am worn out. I am so exhausted by all my trying and failing. I am so sick of using every ounce of my energy to complete the smallest of tasks. So often I find myself unable to muster the mood, motivation and momentum to even do those.

I am not talking about tasks like getting back to work . I mean things like doing my dishes, my laundry, cleaning my bathtub, cooking food or eating better than Cheetos and peanut butter oatmeal cookies, even walking my dog sluggishly around the neighbourhood, or visiting friends who I truly love. For years these have been intensely difficult tasks for me.

These past few weeks I have been even more intensely depressed than my usual. I do not know what to do. I think of suicide, and plan how I am going to go, much of my waking hours. I have written my goodbye to my sisters, I feel so depressed that I feel sick to my stomach. My body aches. I feel like I can barely move. I have been sleeping, or trying to sleep much of the afternoon. The rest of the time I sit in my chair and stare at the wall. I am completely unmotivated, so fatigued that getting up to walk the dog takes me forever, just to get out of the chair, I sit in my p.j's all day. I am even too tired to put my suicide plans into action. It is possible to be to depressed to kill oneself.

...so I cry and cry and cry. I feel so alone. I feel hopeless and exhausted.

I am afraid to really tell people in my life how depressed I am. I am afraid of them leaving me because I am too difficult to be around. I feel like life is impossible to continue. I feel it is not worth continuing. I have tried so many things and still here I sit severely depressed faced with the rest of my life continuing like this.

Please there must be something to stop this pain. How the hell do I keep trying when nothing works?