Merry Christmas

I had the best pdoc appointment on Tuesday. It was a session of sharing and caring, of experiencing and being in the moment. Yesterday's session felt like the essence of what I wish Christmas could be for everyone.

I am not a "Grinch, but I do not care for what Christmas has become. I am sickened by Christmas's increasingly obnoxious focus on consumerism and how much the gap between the rich and poor, both between people in our well off countries and between our wealthy countries and other entire nations throughout the world. It saddens me to watch so many people struggle when I believe there is enough for everyone if we would open our minds and hearts and learn to share.

While I was raised Anglican, I would not call myself religious. I do however, believe that most religions, Christianity, Judaism, Buddhism, Islam, Hinduism, Sikhism, Aboriginal and First Nations Spirituality and the many and beautifully diverse spiritual beliefs people hold can each be strong building blocks for a great world if people listened to the messages the prophets, the gods, the earth and the writings of each religion are trying to teach us.

Every single one of these religions attempt to teach us of love and understanding, caring for others and giving, teaching compassion and forgiveness. They help us remember our traditions and our families. They all engage us in something bigger than ourselves, a collective consciousness of sorts.

My belief is that the essence of most religions, no matter how, on the surface, they look completely disparate, or incompatible, are in their essence teaching humankind the same sorts of values. We are to love and care for one another, Do no harm to anyone and beyond that they tell us we have an objective to make the lives of all the people and beings, whose live's paths we cross throughout our lifetime, better for having met us.

As a bare minimum this objective exhorts us to harm no one. At its best the objectives of all religions endorse the the platinum rule: "First do no harm and then do unto others as they would have done unto them". This means opening our eyes and arms to others beliefs and values. It means recognizing that what we want is not always what someone else may want or need.

Deep in my heart, despite my depression and negativity, I am an idealist. I want so badly to believe we can all make this world a better place for ourselves and others.

The following is a list of people, beings, experiences, places and things that have made my life better for having been blessed with the gift of crossing, or continuing to cross their paths (in no particular order):

1. My Mom. I am blessed to have experienced her complete and unconditional love. To me, my mom was a goddess personified. She was so loving, kind, caring, passionate, available, hopeful, helpful, trustworthy, honest and compassionate. It is impossible for me to imagine anyone having had a better Mom. I miss her so much.
2. My sisters, both of them. They are both like my Mom in so many ways. Our love for each other is unbreakable. They are both beautiful examples of what it is to be a good person: to their children, to me and to their friends and even to people they do not know. I love them and their children more than I love anything in this world.
3. My four nieces: S, J, J an A. From 5 years old to 10 years old, they all are incredible examples of children at their best. They are loving and caring towards me, their families and friends. All of them understand the importance of giving to people they do not even know. They each understand the principles of compassion and sharing. They are adorable little girls who have made my life much, much better than it would be without them.
4. My appointments with Dr. X. and the man himself. I often feel this blog is a testimony to how much he means to me. He is so kind and thoughtful that he feels like a family members to me. He has enhanced my life in so many ways it is impossible to list them all. I know I have said this before, but it needs to be said again: He has been the one person in my life I can be entirely open with. He is the person in my life that helps me continue to choose to life over death, despite my depression and anxiety. He even takes it further than that. I both choose life and my life becomes more and more enriched through each of my experiences in therapy with him. He is engaging and easy to talk with. I am blessed to have him as a psychiatrist.
5. My husband...While we have some difficulties in our marriage...(who doesn't?) I love him and he loves me. There is a great deal of caring that goes on in the relationship. He is a caring, loving man. He just has a difficult time expressing it.
6. My friend H. She has been my friend since I was 19. I love and value her with all my heart. We do not always agree, but that would be boring. I love her more than the differences could ever divide us. She is intelligent, artistic, creative, caring and a great friend. She really makes a difference in my life. I love you H.
7. My friends V and R. I met both in a Group therapy program years ago and I feel close to them even if I have not seen them for a long period of time. It is easy to meet with them and just begin from where we left off. Beautiful people.
8. My friend E. She is so thoughtful, kind, artistic, interesting and very thoughtful. We are helping each other in practical ways, like her helping me go grocery shopping, and me phoning to wake her up. Her help and her friendship are and have been priceless.
9. Each of the people who read my blog, whether you comment or not. The commenters engage me, support me and help me move farther forward with each comment. Both commenter's, and the people who silently read, provide me with a sense of purpose and meaning in my life. I hope my writings reach others. I sense from the repeat visitors that there are others out there who I share experiences with. I hope we are helping each other learn we are not alone.
10. My puppy...his love and companionship have enhanced my life significantly. He MAKES me get outside a few times a day. My desire to care for and love him provides me with a sense of meaning and purpose. He makes me laugh, even when all I want to do is cry. He is adorable, cuddly, loving and best of all he loves me absolutely unconditionally.
11. The ocean...It calms me to walk by the ocean. My husband just bought a boat, so soon we can be ON the ocean. I can't wait.
12. My new car. It is reliable, great on gas and I love driving it. It has taken a lot of stress out of my life knowing I have a reliable and enjoyable means of transportation.
13. Living on a farm...It is so close to the city, but is also away from the cacophony of the city. It is peaceful to walk through the fields
14. Learning to paint. Wow. I cannot believe I have an artist inside me. I never in a million years would have thought I could paint, or draw. Both calm me and I feel a sense of purpose and meaning in the activities.
15. Teaching drawing, printmaking and some of the other classes I teach at the Art clubhouse. I am learning to believe all is not lost to my illness. I have talents and skills that are transferable from my previous job. While I stress out every time I have to teach, each time is a little less difficult. I hope one day I can believe in myself enough, and be well enough, to take what I learn from teaching and make it a job.
16. The people whose blogs I read: (see my blog's front page for a full list) Off the top of my head: My pdoc's blog...it is so interesting and helpful...I feel a connection is always there because the blog is available 24/7 , Dr. Shock, Jcat, Polar Bear, Lola, Sara, SV, Deepblue, James (AKA HBW), Jazz, Tamara, Hannah, The last Psychiatrist, Postsecret, Dr. Jest... the list goes on...Each of your blogs, ideas and writings enhance my life each time I read them.
17. My friends at the ART Clubhouse. The people I have met through their are so great. It is a powerful type of therapy to watch people who are having the same level, or more difficulties than me, succeed and be such great teachers, mentors and artists.
18. My country and the freedom, democracy and protection it provides me. I believe I live in a great country. Not perfect, there are lots of things that could be better, but most of us have a pretty good experience in this country. The one thing I would like to see get better is ease of accessibility to both physical and mental health care, not just the people to help, but the means for an patient to figure out how to get help, to understand what is available for them and a more easily dealt with bureaucracy.

Merry Christmas to everyone in the world. My Merry Christmas message embraces all people, of all religions and cultures, all beings, all plants, the entire earth and the universe.

Creating a Community For Myself: Part 2

My last post about this topic was a bit long winded...so here is a brief overview of both why I think all I said needed to be said, and the major points that I found important for myself (and I hope for others) while I was writing the piece.

There are so many aspects of "creating a community" that are helping me and, I think can help others who are having difficulty with their mental illness, gain some hope. I think some of the most important points in the previous post "Creating a Community for Myself: My Path towards Resiliency" are:

1. That my illness has been refractory to all treatments and has been severe (I hope that will help others in similar situations see it is possible to begin the healing process, even if other treatments aren't working). It is not as though I had/have an easy illness to treat or help. I know when I was/am really ill I get really annoyed when people, whose illnesses seemed less aggressive than mine, wrote uplifting pieces about how they "healed" themselves. I never felt they spoke to me. I wanted others to see it is possible to really be struggling with symptoms and, with enough of the right support and structures in place, still manage to help themselves.

2. That I had to try many things and make many attempts before I began to feel comfortable and confident. Creating a community has not been easy and has been fraught with setbacks...but with the support of my psychiatrist, and finally the community I fit into, I have been able to keep trying.

3. That external motivation was one of the most important forces that helped me succeed. I didn't succeed because of will power. I succeeded because I had responsibilities, schedules, expectations and tons and tons of non-judgemental support , from my pdoc, my new found community, the Occupational Therapist who believed in me and took me on as an apprentice.

4. That there is a sense of spiritual connection and personal feelings of being valued that helps one begin the healing process when they find, accept , create and become involved in, the community that is right for them.

I am not saying this discovery has "cured me", or "healed me"...but it is definitely increasing my quality of life and my ability, and desire to live with, and in spite of, my mental illness and its disabling symptoms.

Creating a Community for Myself: My Path Towards Resiliency

This is a long post. I was asked by someone at one of the Mental Health Teams in my city to write about my experiences with creating a community for myself and how it has helped my mental health. They want to share it with people they are trying to help. I thought I'd share it with you.

Creating a Community for Myself: My Path Towards Resiliency

Social isolation has been one of the most difficult symptoms of my depression for me to overcome. When well I am open, bubbly, extremely extroverted, trusting and want to be around people. When I am in a Major Depressive Episode (MDE) I turn inwards and isolate myself from the world, even from close friends and family. Seemingly simple social tasks, like answering the phone, or returning e-mails, become experiences that fill me with dread.

My illness presents itself as Major Depressive Disorder: an illness that consists of "episodes" of Major Depression, usually followed by periods of wellness. My depression is anxious and there is a component of "bipolarity" to it; meaning my mood cycles between severe lows and extreme highs. Both these symptoms make my depression more difficult to treat.

My most recent MDE has been treatment resistant, or "refractory" to medications and other treatments for 7 years. This means despite my trying literally more than 30 different medications and combinations of those medications, having ECT and participating fully in psychotherapy once, and for long periods, twice a week, I remained severely depressed and anxious, while periodically cycling up close to hypomania for a few days for most of this entire 7 year period.

With my depressive symptoms refusing to budge with medication, my psychiatrist and I work in therapy to help me in other ways. One of the major areas I have been working on in therapy is lessening my social isolation, and increasing meaning and purpose in my life by "creating a community for myself". This is a very difficult endeavor because my symptoms: Depression, Social Anxiety, Isolation, Amotivation, Fatigue Concentration and Memory Problems and Cycling Moods, work against my ability to help myself change, meet people, keep social commitments and often do anything beyond survive. Even that seems hard sometimes.

The process of change and creating a sense of shared meaning and community with others has been very slow and has never followed a direct upward trajectory towards wellness. I move forward, only to have my symptoms drag me backwards again. It has been a one step forward two steps back experience. I am, however, moving forward slowly. I do see this improvement. Before I just kept going two steps back over and over again.

When my psychiatrist first introduced the idea of creating a community for myself, a community that would help me become more resilient, that would accept me for who I was, that would add meaning to my life, that would help me move out of my isolation and into a world that both interested and supported me, I thought he was the crazy one. I felt so depressed and anxious, and I was so isolated; literally laying on the couch, or hiding in my bed all day. The task seemed impossible. How did he think I was going to manage such a difficult task?

I started safe and small. I was afraid to be around people, so I thought maybe being around animals would help. I began walking dogs for the SPCA. It got me out of the house. That was a big step.

Then a year or so later I began volunteering for [an arts festival in my city ]. To volunteer I needed to write my resume and go for an interview. I was absolutely terrified, but I pushed myself to do it with the help and support of my psychiatrist and with the belief that I might find a community that interested me.

I was very sick at the time and switching medications periodically. I was so scared each day I was scheduled to volunteer, sometimes even for days before my scheduled volunteer day, but each time I went I was greeted by my co-workers and my supervisor, people did not seem to notice I was sick, even if I thought I was not doing a good job I seemed to manage the tasks, the people I volunteered with were very nice. Each day I volunteered I gained a bit more confidence in my abilities. My second year with The festival I became so depressed I could not continue volunteering. To take care of myself I gave notice and stepped back from my commitments. This was a setback, but not a failure.

A few years prior I had become a member of a therapeutic art clubhouse that offered art classes to people with mental illnesses. The first class I took was Beginner's Drawing. I remember being so anxious about going to the classes. I was afraid I would be rejected, or not fit in, or be so bad at drawing I would be humiliated by my failures.

The instructor allowed me to be whoever, and however, I was on any given day. By the end of the 10 classes I felt a sense of community with the instructor and the people in the class. Motivating myself to reach out to other human beings and to leave my house and participate in a community was a huge step for me.

Still very ill, I took a Pottery class at the Clubhouse and then an Intermediate Drawing class. Each time I had to go to class I would feel sick and anxious. There were days when I really have no idea how I managed to get there. I believe my commitment to joining and participating in each class, having a scheduled and structured activities for myself and my psychiatrist's support, provided me with enough external motivation to go to each class.

It was not easy. I was always so anxious before I went to each class. Usually that anxiety stuck around for the first hour of the class, however often it never left me the entire class. It was hard to stay, but with the supportive environment and the support of my psychiatrist I forced myself to stick with my commitments. As each class went on I became more and more comfortable with the environment and with the people around me. Showing up to these classes was like behavioural therapy: A type of therapy that desensitizes a person to things they fear by slowly introducing them to the thing or things they are afraid of, until finally they become no longer afraid of the thing they fear.

My experiences at the [Art Clubhouse] awakened the slumbering artist inside me. I had never been artistic. In fact, drawing stick figures was the extent of my experience with the fine arts. I had always loved art; other people's art, but never believed it was possible for me to learn what I loved. With the [Art Clubhouse] experiences and successes to back me up I took a huge step from the Art Studios and decided to try an Adult Education class at [a local Art College]. It was a difficult, but rewarding experiences and my love for drawing began to grow.

Driven by my new found joy of art I began volunteering at the [Art Clubhouse]. I participated in cleanup days, and showed up for their monthly meetings. I began to meet more people in that community. The more I participated in the community the more it began to feel like an even safer and welcoming community. I had discovered a group of peers who not only shared my love for art, but who also understood and accepted me for who I was.

One day I saw a posting for an assistant to the printmaking instructor. I took another large leap and applied for the position. I cannot even express how difficult this was for me. I was very depressed at the time and cycling rapidly between severe and anxious depression and a sense of euphoria brought on by my new found feelings of social freedom and a sense of meaning and purpose I had not felt in a long time. After being the Printmaking Assistant I applied to be the Beginner's Drawing instructor's assistant. Each time I assisted the instructor my anxiety became less and less and my comfort level, and my enjoyment the studio's community improved more and more.

I now volunteer to teach Art classes. I teach Beginner's Drawing, and have taught a short Printmaking group for young adults. I am about to teach my third session of Beginner's Drawing classes and a session for young adults in drawing, printmaking and painting. Even better than this I have discovered I have both a love and a developing talent for acrylic painting. To top it all off I have somewhere to go to share this joy with and even more important, I now interact regularly with people who support my artistic endeavours.

Through a supportive and caring community I have discovered meaning and purpose in my life. I am becoming the person I always wanted to be. Never in my life have I felt like I was on the right path. I feel like that now and this feeling has healing power. My experiences at the [Art Clubhouse] have opened a world for me I never knew existed. This community has lifted me out of isolation and is moving me closer in my quest towards healing my soul. I cannot say enough how important creating a community for myself is contributing towards my climb out of depression and towards resilience and increased wellness.

Am I Forever Broken?

"How can you go so many years and not know you liked something so much?

My sister said those words to me yesterday when I was expressing how much joy I was getting out of conceptualizing, planning and painting the five paintings I have on the go right now and the others I have completed.

A comment Dr. Shock made on one of my past posts, about wanting to see my other art work, stimulated me to pull together and photograph an array of some of my early drawings from when I was learning to draw. I see so much progress and the switch into painting has increased my desire to create art tenfold.

How could I never have known I wanted to draw or paint? In university it was the pursuit of knowledge and that which was intellectually challenging that brought happiness and excitement into my life. I graduated with two degrees, one in Philosophy and one in English literature. My last 3 years of university were the best years of my adult life. To do well in both of those majors you had to love to read and write. I loved both. I never foresaw that it was the creative process, and not necessarily the intellectual process I may have been pursuing.

I am struggling now with how my love for art can fit into the life I want for myself. You may, or may not know I am on disability for my Major Depressve Disorder (MDD), and have been since early 2003. I really hate that I am on disability. It may be my Dad's voice that I have internalized, but I feel it is a societal voice as well. I feel I am not contributing, that I am using up precious resources, that I am a bad person for being unable to work.

I know that while I am having some good days my mood is extremely labile, and my anxiety is still not under control. For the past month or so I have felt better than I usually feel, but I am far from well. I also understand that the progress I have made is precarious and could topple with the slightest amount of pressure.

My pdoc has explained this to me, and even took the time to write me a note outlining why I am unable to work right now; a note I can read, and reread when I am feeling like I am today, when I feel guilty and unsure that I am doing the right thing. I have reread it today, but it is difficult for me to accept its contents.

What if I can never work? How am I going to deal with my negative self image for not working? Dr. X. keeps telling me I am working. He means all the work I am doing to try to become well, but also the volunteer work I am doing. I get that he is trying to make me see that work has many definitions; that work is not simply working for an organization for a twice monthly pay cheque. I get it, and I get that others need to step back from work to take care of themselves. I just cannot accept that for me. I define myself by what I do; by what I work at. I always have.

I want so badly to work again, but I know I cannot manage that yet. I can barely manage what I am doing right now: volunteering two half days a week. I feel exhausted after doing those things.

Also, I am not certain if anyone else is like this, but I am a "one thing a day" person right now. I can paint, or I can volunteer, or I can visit with someone, but I can't do them on the same day, and if I do those things I cannot manage to cook dinner or clean the house, or keep up with my domestic duties, actually even if I don't do those things I cannot manage the domestic stuff.

Will I ever get my life back? By that I mean will I ever be able to work a full time job, keep the house clean, go grocery shopping, mow the lawn, tend to the garden, help my husband on the farm, have a social life, have dinner parties every few weeks, and do continue working on and developing my art work? Will I ever be my old self?

Will I ever get my life back, or am I forever relegated to the sidelines; surviving and struggling so hard just to manage to complete, or sometimes just start, one thing a day?

Will I ever get my life back, or do I have to accept a new way of being. Has being this depressed for so long, and so often, destroyed my fortitude, my drive and my abilities? Has my depression and anxiety toppled the old me forever? I want to know what it is I am supposed to do. What is expected of me? What should I expect from myself? What does society expect of me? Does Dr. X. know what I can expect from my future? Does anyone else know?

I do know that I have an intense desire to paint and create. That is good, I have no formal training in art, I'm 43 I am certain I could not manage the stress of things like exams and essays.; the exams especially. I have too many problems with my memory and cognitive abilities. I feel so lost and so scared I will be stuck either on disability, or at a low paid, disatisfying job for the rest of my life. If the latter I know what will happen. I will spend all my time and energy trying to be the best low paid employee at "whatever company" , and all the things that bring joy to my life will be left undone and I will once again fall into severe depression and then I will be on disability at an even lower rate than I receive now.

I am stuck in a no win situation.

Death Anxiety

Aqua, "Destination Unknown" (linocut 1/5) 2007

Me: (Among a list of other things) "I have been sleeping a lot. I'm not sure if it's because I am tired or I just can't face doing things. I feel like I just don't want to do anything, or I have too much to get done and it's overwhelming. I can't face all the things I have to do, so all I want to do is sleep."

Dr. X: "Tell me your list of things you want to accomplish."

Me: (Completely misinterpreting "why" he is asking this question, because all I am worried about is losing him) "Why? Is this so if I need to be seen by someone else they will have a list of all the things I need to work on? So, they will know what I need to address in therapy?"

Dr. X: (Looking really perplexed, but trying hard to hide that) "No, you just said you were sleeping a lot to avoid things, or because you were avoiding getting things done. I was wondering what those things were."

Me: "Oh! Getting a job!"

Dr. X.: "You have a job. (referring to my volunteer work)"

Me: "I mean a job where I get paid; where I stop being a drain on the social services system; where I can take care of myself; where I don't rely on anyone else. All I ever heard from my Dad when I was growing up was how awful "those" people were (Hippies, the unemployed, anyone who wasn't working and paying there own way, anyone who needed help from anyone else). I have internalized my Dad. On top of that all I'm hearing from him and my one sister right now is do more and you will feel better, or (from my Dad) Why don't you get a job? A "real" job. Get it together."

Dr. X. "You are working at a real job. The system sets it up so you cannot win one way or the other. Maybe the Art Clubhouse should pay you a higher wage, so it would be seen more as work and more valuable by you and by others, where it could help support you. The big thing here though is your internalization of your Dad's criticism."

Me: (Feeling cared for and supported by Dr. X, but dejected; like I will never be a valuable human being). "I know. I am doing things that are important to me. If I worked for $10/hr doing something I felt was meaningless or purposeless I know I'd be even more depressed. I just never thought I would end up like this. I always thought I would move up the ladder in life (always moving forward, getting better jobs, getting ahead). I never expected to be on disability, to not be working, or to be unwell. I always thought I would do something with my life."

Dr. X: Silent (His specialty: a safe, reflective silence...like he is when he waits for me to figure out for myself that I am not thinking clearly)

Me: "I guess it is like the print I made for you last year..."Destination Unknown". (Thinking to myself how making that print for Dr. X may have been eerily full of the bizarre sense of magical foresight I seem to have sometimes. I made it to represent my struggle and how it is taking me in directions I never expected; and often didn't want, to go, but he clearly sits on that same bus with me now...that I never expected).

I was driven to make that print for him. I felt I had to give it to him. I messed it up so many times and did it over and over until it came out right. An intense dream created the metaphor of a bus taking me in an unexpected direction; I added the Raven; a trickster figure. He is devising, overseeing and fully intending whatever outcome occurs.

None of us knows which way our lives are headed. None of us can foresee the outcome. We are all on that bus whose destination is unknown. That scares the hell out of me.

Stream of Consciousness

Jazz over at "In Pieces" has a great blog where she provides us with a writing prompt each day. Today I was stuck for something to say and her prompt sounds like an interesting exercise:

"Writing Prompt: Set aside twenty minutes or so and do a brain dump. Just write whatever is on your mind no matter how mundane or boring. Even if you have nothing to say, write that. The trick is to just keep your hand moving the pen across the page for twenty minutes. When you have finished, sit in silence for a few moments and ask yourself how you feel. Do you feel more collected? Less scattered? Consider whether or not a morning brain-dump might be a helpful thing to add to your arsenal of wellness tools."

Here goes:

I am really worried about Dr. X. His office called to say he was away sick this week. He is never away, for any reason. He hasn't seemed well the past couple weeks, in fact the past couple months he's seemed a bit distracted. Now I am really worried. Worried he is sick like my Mom was sick. What if he were. I couldn't bear to lose him. How would I deal with that? I know my mind is taking me down that negative road, and for all I know he could just have the flu, but it seems like he has been worried about something lately. I even brought up my attachment to him, and how much he means to me in our sessions a couple times, because I felt something was wrong.

My mood is dropping again. Part of it is that worry about Dr. X and his well being, and part of it is the letter from my insurance company. I now feel like I am being watched (once again). At the bottom of the request for detailed minitue (sp?) of my day and any work or volunteer work I do they are making me sign the form saying I understand all my statements will be investigated and that they will contact the people I volunteer for etc. They don't get it. The more they put the fear of being spied on into me, the more I believe i am being watched, and the more I am afraid to do anything that might indicate to the non-psychiatrist eye that I am well and ready to return to work.

I am one of those people who is able to put a face on when I have to, so the studio I volunteer at, and even when i was working, my workmates and bosses, never had any idea I was sick. I can hide behind a type of false boisterousness for short periods of time, but the price I pay is exhaustion and an intense need to be alone. I believe I am working really hard at getting well, but I know I am no where near well. I need more "safe" time more time to slowly build my stamina. 5-6 hours a week volunteering in a supportive environment, where I can call in sick anytime I need to, where I have complete backup, in no way resembles a fast paced and highly stressful workplace where I am in fear of losing my job all the time.

Last week I wanted to commit suicide so badly. It isn't even that I feel as bad as I did before. I just feel like I will never get WELL...the capitals are intentional and represent the well that is me when I feel empowered, completely not depressed, powerful and excited about life, social and extremely outgoing.

All I want now, even though I feel better than I did, is to hide away at home, not answer the door, keep the curtains closed (so no one can watch me).. I have the means and opportunity to commit suicide. Last week I didn't because all my nieces have birthdays in these two/three weeks. I do not in any way want my death associated with such joyous occasions. I just want to go, and i feel like the time is getting closer and closer.

I wish my family could understand that my going would be a blessing. My pain would end. I do not know if they understand how painful it is to feel depressed all the time. Even I did not "get" what depression really could become until these last 6-7 years. Before I was depressed, but nothing I went through came even close to the length and intensity of this major depressive episode.

I have to teach today. I feel stressed out and angry that i have made that commitment. All I want to do is crawl into bed and stay there. Hide form the world, hide from myself, avoid life...this in itself is a "little death". Maybe if I do this long enough I will disappear.

20 minutes is harder than I thought. I don't know if any of you get what I mean when I see death as an intense relief. I think anyone who has not been depressed has a difficult time getting it. Even my pdoc. I think he gets it on an intellectual level, but I think he believes the desire to die will end with the relief of symptoms. I don't think that is true for me, because for me...I KNOW the symptoms will return, They never go away for ever, and every time they return they are worse. What kind of existence is that. I wish we were allowed to be put to sleep. My biggest fear is surviving suicide. I am so afraid I will miscalculate my plan and end up both severely depressed and lose my brain, or be completely physically trapped in a body that won't work. I would choose euthanasia if it were available.

I still have one more minute. I guess there is an upside to my depression. I met my pdoc and he has enhanced the life I have. I also met lots of people online who have also enhanced my life. I am grateful for that. Thanks for listening.
(20 minutes are up)

I feel exhausted. This might not be a good idea for me when depressed. It was why I stopped writing in my journals...I became too negative and focused on my depression. When well I can see how it might help me get ideas out on paper. Thanks Jazz for the idea.

Managing my Depression Getting Through the Toughest Days

In a previous post I welcomed my 5000th visitor to ask me a question, or suggest a topic for a post. Deepblue being my 5000th visitor posed the question/s:

"I guess the question I'd have to ask is: what has been the most helpful thing you have done to help manage your depression? or, how do you get through your
toughest days? I guess you can answer either of those".

I am not sure how long Deepblue has been following my blog, or what s/he knows about my situation. I have had Major Depressive Episodes (MDE) since I was 17 or 18. I always managed to pull out of them either on my own, or with a small amount of counselling, until I was 31 or 32 (I'm now 42). At that time I sought long term counselling (2 years/once a week), and then I was referred to an outpatient Cognitive Behavioural Training (CBT) group and then a group therapy program, both of which did not help me at all. I had tried CBT in therapy when my MDE's were mild to moderate, but this time my depression was become far worse than ever before. For about a year my MDE went into remission on it's own (with some residual symptoms...not sleeping, irritable, fatigue).

In the summer of 2001 I became despondent and requested more help from my family Dr. She referred me to the Mood Disorders Clinic and on October 3, 2001 I met my pdoc. He invited me to become his patient. I knew as soon as I began talking with him, that were a perfect match. I agreed and began seeing him for therapy and a search for medications. He and I have worked for 6.5 years to try to help me manage my symptoms and my depression. It has been a brutal and tough journey. No medications worked for me; and I tried almost everything you can think of (more than 35 different medications in total, either alone or in combination with other medications) Part of the problem was that not only do I have MDD, I also have anxiety and OCD problems. I think this makes my depression harder to treat.

Back to your first question: " What has been the most helpful thing you have done to help manage your depression?

Until the last month or two, I would not even say I was managing my depression. I was literally trying to "Survive my Depression". There have been a few things:

1) The first most helpful thing I did was find a pdoc that I could receive both therapy and medication advice from. A pdoc who was supportive, authentic, available, hopeful, intelligent, and who I connected with on a personal level. There were weeks and weeks where all that kept me going were thoughts that "I have an appointment in three days. I can survive until then".

In some of my worst moments I would visualize myself laying on the floor in Dr. X's office (no I have never really laid on his floor). The thought of just being near his calming presence helped me calm down.

I never have told Dr. X. this, but one day he left a message on my voicemail at work asking me to call him. I never erased that message until the day I left work. Whenever I was so stressed out I wanted to kill myself in the staff washroom, instead, I would go to my phone, pull up the phone message, listen to his voice, maybe repeat it a few time and something about his voice magically helped me survive...I know it's weird...but it helped

2. Medication that worked is the second thing.

Years of therapy and support helped me survive and try to get going and begin to "live with my depression", but as soon as I found a medication that helped, I was suddenly able to make a huge transition. Suddenly my anxiety dissipated, I lost most of (not all) my fear of people. I wanted to leave the house (vs.having to force myself out of the house), I wanted to see people, I wanted to experience new things. I felt hope. I saw the possibilities. I became more motivated. I began sleeping better. My mood lifted.

I would not say the medication was a miracle, because I had been working so hard on setting up a foundation to begin with, but suddenly, along with medications that worked, my foundation became like rich soil feeding growing plants and I was finally able to grow and blossom very quickly.

I have to say, the bloom has fallen off my plant a bit lately, but I still feel like I am strongly supported by the medications. I think in the beginning, when the medications first helped my mind was so blown that I actually could feel okay, that I ran with it above any of my expectations. Now I feel more like I have a long way to go to get well, but the medicine will help me get there.

3. Build and Create a life that has meaning and purpose. I have always been angst ridden about my life. Except for the time I was in my third and fourth years of university, and doing EXACTLY what I thought mattered, and exactly what supported my feeling that I was doing something meaningful and purposeful, I have always had a sense that I am wasting my life; that I will die and my life will have been meaningless.

I am really interested in existential psychology, because it speaks to this exact thing. So Dr. X. and I have worked really hard to help me slowly build a life full of meaning and purpose. It began slowly, but initially I thought, maybe if I give back to the world somehow I would feel better about my existence. So I began volunteering to walk dogs at the local SPCA. It was a start. I felt that no matter how depressed I was being around a dog would help me, and it was a flexible, drop in when you can situation, so days I couldn't leave the house, or even my bed, I didn't have to.

I realized I needed something more meaningful than walking dogs, so the next year I volunteered for our city's Shakespeare festival. This time I had to commit to one shift a week. That scared the hell out of me. It meant even if I was sick I had to go. It came with many therapeutic moments. I worked with people who either did not have a mental illness, or were not "out" about it. I struggled. My medication and medication changes made it difficult for me to think straight sometimes. I felt really self conscious. I was terrified. I did it anyways, and I got through the first season. The second season was less difficult, except I became so severely depressed part way through the season that I left, thinking I was going in for ECT. Even though I had to leave it helped build my confidence to try something even more challenging.

I began volunteering at the Art Clubhouse for people with severe and persistent mental illnesses. I took classes there, and eventually I began volunteering to apprentice classes with an O.T. and now I am volunteering to teach classes there. This all during the period before my medications worked.

It was hell, but I also loved it. It was hard to manage my responsibilities when I was so sick, but the structure really helped me leave the house, get out of bed, relearn to communicate with people, learn to lessen my social anxiety by exposing myself to more and more social situations: meetings, classes, and teaching. A structure to depend on, and one that was meaningful, and purposeful to me, helped me live with my severe depression.

4. Writing in this blog

For lots of reasons. First I have met some really interesting and caring people in the blog community. I feel like I able to be so open and honest here. It feels purposeful to me. I really hope that people who come here and are struggling with mental illness see what I write and realize they are not alone. I never want to provide false hope, because so many times I have written about feeling completely hopeless, but I know for me there is something about knowing I belong to a shared human experience that lessens my load. I hope that is what I help people with; providing a sense that we are not alone in this world, or in this battle.

The last question you ask is: "how do you get through your toughest days?"

I wrote a post a while ago titled: "Coping Strategies for Treatment Resistant Depression (TRD)"

probably provides my most comprehensive answer to this question. Honestly, some days I just cling to my life; curl up in a ball and just get through the obsessive suicidal thoughts, plans and urges. Those thoughts always pass eventually, and they always come back too, but I try really hard to just get through each tough moment as it comes and try to not think it will always be this way. Ant then there is always the thought...."three more days until I see Dr. X." I can last three days. I can manage knowing I have his support.

I Survived 2007

This was another really difficult year for me. I spent much of 2007 battling severe depression and many months struggling with brutal anxiety attacks and unexplained panic attacks. I was extremely close to being hospitalized by mid-July as I was having obsessive, unrelenting suicidal thoughts and urges. For all the struggles I had in 2007 I somehow managed to get by without giving up.

I attribute my sticking around to a few things:

Firstly, I attribute my survival to myself. Despite how depressed I have been and how long I have been depressed I am one stubborn and resilient person. Some days I lay in bed, or on the couch, curl up in a ball and pray I will make it to the next day, but I make it. That's the important thing.

Secondly, my Pdoc, Dr. X. definitely played a big role in my making it through this year. He never gave up on me, always supported me and was tireless in his efforts to help me. Over the years we have been through literally hundreds of therapy sessions together, more than 30 different medication trials, plus combos of those trial and an 8 session trial of ECT. He helped me with my depression, my anxiety and the loss of my much loved Mom. This year I recognize he will not leave me unless I decide to leave. Even then he will see me anytime after that.

I learned this year that I can trust him; something I suspected before, but learned to believe this year. I was sometimes fearful or angry about what happened in our sessions, but he always made it so easy for me to talk openly about these. He showed me that dialogue about how I am feeling, no matter what those feelings are, is safe with him. I am thankful for that.

Thirdly, my friends and family stood by me. We have all had a difficult time with so recently loosing Mom, but despite my sister's own struggles they called me even if I could not return the call. They made sure I had the support I needed and I felt deeply loved by both of them. My husband and I had a hard time this year, but we made it through and I believe we are on the way to healing our relationship.

When I say my family helped me I include the support and love of my dog "Bert" here too. He is the family member that, due to his living with me, and his inability to criticize me, was the most help to me. Every time he saw me he came up to me and "hugged" me; tail wagging and pushing his head up against me. He got me out of the house everyday. He made me get outside and go for a walk at least 3 times a day and he never ever judged me, or stopped loving me. In return I loved him, and that helped me too.

My friends most of whom live far away, were there and are there to help me. For this I am eternally thankful.

Fourthly, medication has helped me. In September I began a new mood stabilizer: Carbamazepine (Tegretol). It was not immediately apparent that it was helping me, until about 2 months after I reached a dosage of 800mgs. At that point I began to notice my mood did not feel as labile. I was still severely depressed, but the negative energy was not as bad. I did not feel as angry all the time, I wasn't breaking into tears at really inopportune times. I felt like I had a bit more control over my mood cycling.

In Late November I began taking Prozac with the Carbamazepine and almost immediately I felt my mood lift. Even at a really low dose I feel my mood has lifted. I am still depressed, but I'd say many days moderately versus severely depressed.

Lastly, participating in therapeutic art classes, taking art classes at the local art college and the opportunity to co-teach printmaking and beginner's drawing with one of the occupational therapists at my city's Mental Health Art Clubhouse have all provided my life with more meaning and given me more self confidence. Through volunteering to help others with mental illnesses learn art I see how important it is to have a job that is meaningful. I always loved teaching and facilitating learning, I did this for a huge corporation before I became so ill, I was simply doing it for the wrong organization.

Today, this last day of 2007, I believe 2008 will be a much better year than than this one. Although it was only through the struggles and successes and the support and love others provided me this past year that I can make such a bold prediction.

Happy New Year everyone. I hope 2008 is better than this past year and I hope it is happier than you expect it to be.
...aqua

Why Don't You Work?

I am terrified of this question. I am starting a volunteer position this week at a very busy live theatre in the city I live in and I am so scared I am going to run into someone I used to work with. I am anxious they will judge me and think I am just "faking it" to get time off work. So My pdoc suggested I try to think of the questions that scare me and come up with responses.

I decided to come up with two types of responses. The first response to each question is based on my being very private about my mental illness. The second response is an honest, very open answer based on my experience with depression. As I wrote the "private" responses I started to think that in being secretive I was allowing myself to feel stigmatized by my illness. I would not be afraid to say "I have MS, that's why I can't work"...so I am not going to be afraid to tell the truth about being mentally ill.

Here's my list:
Why did you leave work?
- I became ill and was unable to work. or...
- I have an illness called Major Depressive Disorder. In me severe depression and anxiety make me feel very unwell. This made it exceedingly difficult for me to work in a high paced, high stress environment where the expectations and environment aggravated my illness.

You don't look sick.
- There are lots of illnesses where people look fine, but are unable to work. They are called "invisible disabilities" or...
- People with Major Depression often have okay days/moments. In particular people with atypical depression find our mood lifts when we are in situations we enjoy.

What did you become ill with? Are you okay?
- I would prefer not to discuss my illness. I am working towards recovering my health. or...
- I have a mental illness called Major Depressive Disorder. I have had difficulty with depression my whole life. This episode happens to be really bad and long-lived.

What happened at work?
- Nothing happened at work, I simply became unable to work due to an illness. or...
- Work became extremely stressful and demanding. I tried numerous therapies, I tried cutting down my hours, but ended up working more than full-time anyways, I had competing demands from several different businesses, I moved locations to a place where I knew no one. With all these factors and my depression I simply became more ill and decided that leaving work was the healthiest thing for me to do.

Why aren't you getting better?
- I am slowly becoming healthier. I have good days and bad days. or...
- Contrary to popular belief antidepressants do not always work for all people. I am working with a doctor to find a medication and therapy that will help me.

If you can work here, why can't you work at the your old workplace?
- I am a volunteer and can call in and say I am unable to commit to my shift. Also, my commitment here is for 3-5 hrs a week. At this point in time I am unable to work a work week at the bank.

What have you been up to?
- I have been exploring ways to create meaning in my life. I am volunteering and taking some art courses. I am spending more time with my family.

Why can't you work?
- My illness is unpredictable. It would not be fair to my employer to commit when I am unable to predict my ability to work on a regular basis.
What do you do for a living?
- I have the means to take care of myself...so I try to do the things that make me feel good.

Why aren't you working? Why don't you work?
- I worked from the time I was 15 and at 40 I feel it is time to reexplore my options and discover a career that speaks to me or...
- I have an illness that prevents my working right now.

What do you do?
- I garden, and draw, meet with friends, walk my dog, visit my family, spend time with my husband, go to the theatre, to the VSO, recitals, art galleries...all sorts of things