Existential Nihilism

I feel empty. My life has no meaning, no purpose. I am lost. I have been lost my whole life. I will be lost forever. Nothing fills me me up, makes me feel completely connected to my world for any length of time.

There are moments in my life where I feel connected, even happy, perhaps even joyous. Those times are always short lived, impossible to hold on to. As the moments quickly disappear I slip, once again, into an intense sense of existential nihilism.

I am nothing. I have been nothing. I will be nothing.

When I was a teenager, and as a young adult I used to believe these feelings were part of growing up, part of my immature self trying to discover its own definition. Why then does the emptiness and lack of a self definition continue into midlife? I still feel so lost and undefined. I fear I will always live a life like this.

My life will have woven its way through decades of experiences and I will have known no cohesive "me". I will not have been someone. I will have no one to remember me. My life will have been one long struggle to simply manage to be. My life will have been meaningless. I will disappear as though I had never existed.

The nothingness, emptiness and meaninglessness of life disturbs me

Here is My Truth

My appointment today was at first a bit stressful, but mostly it was uplifting. I am blessed to be a patient of Dr. X. I have known that from the first day I met him. I connect with him in a way that I cannot seem to with anyone else. I am learning, slowly, that connections like this are important to me and I need to search out other people I feel this way about.

I once again felt worried I had destroyed my therapeutic alliance with him, by "outing" my crush on him. A big part of why I am afraid it was the wrong thing to do is that it seems that everyone I say I love you to, or anyone I really really like and say so, always disappears in my life. It is so hard for me to get to the stage where I can actually speak my truth about someone. By the time I do it is too late, or the words magically destroy the bond.

Dr. X told me he was glad I told him, and that it was always important that I speak my truth with him. He also said we have a very strong alliance. I felt he was speaking truthfully, and that it was okay for me to feel whatever I did, and to talk about it openly, safely.

Part of the reason I feel drawn to him is the way he is: introspective, interesting, interested, thoughtful, never angry, calm, compassionate, always supportive, always available.

I have never met any man, my entire life who is these things. It's strange, but I was always drawn to the "bad boys". The men who always wanted to use me, or who wanted only one thing (I wanted that to)...but I also wanted more...and could never figure out why I always received less than I needed.

I watched as all my friends met men, who cared for them, and fell in love with them. By the time I was 27 I had slept with too many men to count, always enjoyed the experiences, but was always left wanting more than sex. I don't know what it is about me, but it seems I am not a lovable person. On top of that I am not sure I have ever loved. I guess that explains not receiving romantic love...you need to feel it to receive it.

This is my truth:

• The first man in my life, my dad, was the pattern from which all my relationships with men were cut. It was the relationship I learned to emulate. Unfortunately I have some of my dad in me. I get angry, and irritated, I am a bit overwhelming sometimes. I don't listen enough. I talk too much.
• My father was controlling, punishing, physically abusive and even worse a dismissive bully who believed the only correct views were his own. He scared me to death. He used intimidation; mental and physical abuse to keep me in line. I am still terrified by him. Almost every time I see him he does something that elicits tears in me. I know I am responsible for the tears, but I cannot make them stop. I cry on the way to his house. I don't want to go, but feel an intense sense of duty to be a good daughter. I humour him when with him to protect myself, but it always backfires. I never mange to stand up for myself.
• I left home the week after high school and moved to a different province. Less than a week after I moved far away from home I was date raped by the first boy I dated in my new town. I don't know what I was thinking, but I went back to his place after going to a club with him. We started kissing and then he began to take my clothes off. I tried to stop him, but he kept saying it was okay, we didn't have to do anything. When I was laying on the bed with him, partially clad, feeling cared for and enjoying the intimacy, feeling attractive and attracted to this man, he began trying to have sex with me. I said no numerous times, but he pushed me down and forced himself into me. As soon as it was over he told me to leave. I got dressed. Left, and cried all the way home. I felt dirty and used. I showered and cleaned myself up. Then I went to the payphone to beg my Mom to let me come home. She kept telling me I was just homesick and I had to stick it out longer and I'd get over it. I was so ashamed that I had let myself be in the position to have sex, that I had led the person on, that inside I had kind of wanted to make out, that I had not fought harder to get out of there. After that night I let men do whatever they wanted with me. If it got rough, something about that turned me on. It was like my being "taken" triggered a need to be taken. I think I lost my ability to love that night.

The truth is, the only man, in my real life (vs. people online), that has ever treated me respectfully is Dr. X. Even with other doctors, or professionals I have always felt either condescended to or dismissed. I can see that maybe my first male role model made it impossible for me to trust men, so all men get painted with the same black brushstrokes. Dr. X is consistently respectful. I need that.

My truth is that I have a lot of pain inside about how my relationships/nonrelationships with men have gone. I don't feel love, because I don't trust anyone. I always expect them to hurt me. I get what I expect.

I don't mean I get what I expect in a "The Secret" kind of way. I don't believe simply expecting others to be honest, fair, truthful and loving will make it so. That is magical thinking. I know that.

I mean I get what I expect, because I act and react to the people I would like to love me, in a way that creates a wall between us, in a way that projects fear and self consciousness. In a way that doesn't come across as genuine, or authentic.

When I am my authentic self I am full of intense passion and a desire to love. I sing loud, and laugh louder. I am overjoyed with being here on earth. I want to experience more, to witness more, to learn more. When I am my authentic self I draw people to me. Unfortunately my authentic self always eventually disappears for days, or weeks, sometimes months, and over the past 10 years into 2 and then 10 years of depression...which leads me to recede, to make myself small, to lose touch with all my talents and skills.

In therapy I think I have finally realized my truth. My truth is that I will always be besot by depressed periods. This is true. I will always have some sort of cycling appear here and there. This is true. What isn't true is that there is no hope, no way out. I have the power, both within me, and by reaching out to others, like my pdoc, to MANAGE to live with the depression.

If I have a structure to at least part of my day everyday, if I have other people or my cats and dog that I am responsible to, if I take my medication regularly, if I keep a regular sleep schedule, if I sit in front of my S.A.D. lamp every morning, if I keep in contact with people who care about me, if I continue to see Dr. X. for support...and maybe especially because I like seeing him, if I create art, if I sing everyday...even if I am sad...actually ESPECIALLY is I am sad, I can manage my life. I can make my life, even if it is a sad one, a life worth living.

It seems ironic, but without my struggles with depression, especially the intense despondency, hopelessness and despair I have felt this last depressive episode, I don't think I would ever have discovered my love for creating art. I may not have rediscovered my intense love for music and singing, I would never have began volunteering. I am not saying depression is a gift...I hate that misplaced platitude. I am saying that without my depression I would never have questioned what I wanted, or who I am. I would have continued on my weary way to a hellish existence. I would never have looked at my life from an existential perspective and asked myself if I loved the life I was living. I did not, but I am beginning to create the life I want. It is remarkable what I am learning about myself. It is remarkable that I am slowly learning it is okay to feel joy.

Lost and Need to Find...

Lola, over at "Marine Snow" has written a brilliant post that struck me to the core of my being. I feel so very much like she expresses. She thought of her post at the same time I was writing my last post, so there is an eerie sense of synchronicity for me in what she writes.

My last post makes me cry when I read it. I feel like that little girl, who had so much hope and promise has disappeared. She is forever gone.

This morning I woke up and wanted to write to myself:

• "Shut up! Shut up! Shut up!
• Shut the F$&# up!
• Get all those words and noises and condemnations and all that self-hatred out of my head!
• Please stop!
• Stop thinking! You will never "think" your way out of this mess you have created.
• What the hell did you do to yourself? How did you become this person?
• How did you so drastically lose your way?
• How did you destroy that beautiful and promising little girl?
• How did you become so worthless, when, as a child, you were so valuable?
• What have I done to myself?
• I worked so hard and did so well in school, how did I allow myself to sink so far?
• Why did that sweet little girl become the waste of space she has become?
• Why is she so filled with so much self loathing?
• Was there an exact time I became "worth" less?

I feel so existentially lost and empty. I have absolutely no idea how to survive this life and manage to find something that I am consistently able to do, something I find fulfilling and something I feel contributes, rather than takes away from, society.

I have no sense of purpose, or meaning. I have no sense that I have any value, or any worth. I feel like all I do is take and take. I'm a burden on my family, on the medical system, on the government. I have lost my intrinsic value. I have no idea how to create, or make myself, a useful and valuable human being. I feel really, really lost.

Is Returning to Work an Essential Component of Wellness?

I have haven't slept well the since my last therapy appointment. Something in my session triggered some kind of potentially life changing thinking. I cannot sleep because I keep waking up thinking about how to change, accept and move on. When I wake it seems to take forever to fall back asleep. My mind has been racing with thoughts of how to make the leap, the decision, to change; how to create the will and motivation to change; and finally how to create change for myself despite my lingering and often paralyzing symptoms.

My appointment and meeting with a friend afterwards instilled a sense in me that I have been approaching my mental health "healing" and expectations of what is "well" from the wrong angle. I have been trying to get the old me back, but I suddenly recognize the old me, in many ways, is gone. My job now is not to recreate who I was, but to create a new me. Who I was led to my depression and anxiety. Who I was led to increasingly worsening Major Depressive Episodes)MDE's. Who I was is not a desirable goal to have. I need to be different than who I was in order to heal.

My entire life I expected that I would get meaning and purpose from my job, from working. I never wanted children, so that was not the way I sought meaning or purpose. It has always been through my job, or my schooling. School was extremely meaningful for me. Although I had two MDE's; one first year university and the other a few years later during second year university; both times the episodes were not triggered by lack 0f purpose/drive/interest/or meaning about school. Both were triggered by indecisiveness and fear of failing at something that mattered so much to me; although these may have been symptoms of an already "creeping in" of depression.

Once I came out of my depression in 2nd year I was happy for the next three years of school. I loved school. I loved the challenge. I had a sense of enjoying the moment, being IN the moment, feelings had not had for a long time. While going to school I worked part-time, but for the first time since I began work with babysitting when I was 12 years old, work became secondary to something more important to me. It was a means to and end, a means to do what I really liked to do; which was learn.

Until yesterday I did not realize what I have been doing for the last 7 years of depressive hell, and for the 11 years of my previous career. I have/had been trying to hang onto the job I had because, I thought it was the only way to create meaning and purpose in my life.

It never crossed my mind (even when I was doing the parts of the job that I hated) that my work was not the path to creating meaning and purpose. I just thought maybe I was not on the right work path. I even turned my favourite hobby (gardening) into work, because that is how I understood meaning could be found: through work.

As I left Dr. X's office I thought..."what if my volunteering really is work like he says?" Or what if even a more dramatic shift is taking place and work (volunteer or otherwise) is not my path to happiness?"

The former thought is a bit easier to accept; although I am loathe to concede Dr. X. may have been right all along. Only because I told him his insistence that "I was working" (i.e. volunteering) was really starting to annoy me. However, maybe I am working. Maybe it is important work. Maybe I am helping more people than I am taking from people? Maybe my volunteering balances out the disturbing thought that I am accepting disability money when so many others struggle more than me and deserve the help more than me.

The latter thought, "That maybe work is not my path to happiness" comes with all kinds of emotional baggage. Not the least of which is my fear of avoiding responsibilities, or feeling like I owe it to society to work, to not receive money for nothing; that awful feeling that I am a drag on my countrymen and women for being on disability, that I am shirking my duties and responsibilities; that I am doing something immoral or unethical in deciding work is not healthy for me. These thoughts are hard to manage.

Yesterday I just tried to take a Utilitarian approach to the idea of not working. I tried to imagine how my not working might be helpful, not only to myself, but to the greater good of society.

Perhaps, if I did not work, did not think of how to get working, did not try to find ways to work I would become well. Perhaps all that energy I spend negating and berating and hating myself for not working would go into constructive enterprises, painting, drawing etc.

Maybe, if I became well, Dr. X could help another person. Maybe, if I stopped worrying about work and focused on the things that bring meaning and purpose to my life: things like art, or music, or building and maintaining friendships, I would have more energy and the means to spread the joy to others who need more joy in there lives.

A tiny part of my mind is willing to concede that "work" as I define it is not healthy for me. Unfortunately, the largest part of my mind is preoccupied with what others will think, what is the right thing to do morally and ethically (for my community's greater good). It always appears that the point of wellness, (according to most mental and physical health providers), seems to be defined by an ability to return to work. If that is so, then how can the counter intuitive idea, that not working may help me become well and stay well, be correct?

Am I supposed to decide to not work? And if I decide that and become well, will a return to work make me unwell again? Am I forever unemployable, yet able to help others while helping myself? I cannot understand what it is I am supposed to be doing; what it is that will KEEP me well if I manage to get there?

Am I misunderstanding what Dr. X is trying to express to me?

"[R]ound [s]he throws [her] baleful eyes"

May trigger...(Please click here before reading if you are thinking of suicide)

In my blog I want to be able to write EXACTLY how I am feeling. I do not want to worry about what how I write things will affect others (although I try to be conscious that others who are struggling may read what I write, and I try to ensure others are supported and cared for in my writing), but I do not want to censor myself and my thoughts. This is me. The (unfortunately) sad me.

I need the freedom to use my blog as I used to use my journal. It means that at times I NEED to write things that are difficult, or may be scary for others to read. Without that freedom my blog becomes less effective for me.

In my last post perhapsI should have prefaced it with "these are just thoughts". The problem is, when I was writing them they felt like more than thoughts. It felt like if I hung myself the feeling would be the same, but the thoughts would finally end.

Over the past few days I have been having increasing thoughts of suicide again. It's strange because on some level I feel like my mood is better than before, but on another it feels just as bad, only different. I feel nihilistic now. Like nothing is real. As though the entire structure of my belief system is crumbling beneath me. Like everything I thought my whole life is a lie.

It's a lie that I will get better.

Feeling desperately anxious and sad last night I typed "CPA (Canadian Psychiatric Association), Treatment Resistant Depression" in google search. One of the papers that came up was so harsh towards those of up struggling to find a way to get well.
http://publications.cpa-apc.org/browse/documents/236&xwm=true

The position was basically, ... (my interpretation): "people with TRD take up to much of a psychiatrist's time, that time could be better spent on helping people whose mood disorders were fixable, psychiatrists should try to end therapy with these patients and have them taken care of by a GP, and the principles of care should be that as a patient with TRD you have to understand your problems are psychosocial, not chemical/biological in origins, therefore we can't help you unless you are willing to change your life. Go see your GP.

I have suspected I won't get well for some time now, but telling me to go see my GP when I feel like this? Saying that patients need to reduce their expectations of recovery? When all I want is some symptom relief?

Am I supposed to simply tell myself..."its a fact of life, you will have suicidal thoughts, often obsessive and violent thoughts, for the rest of your life. Learn to accept that. You want to work? Learn to accept you will always be depressed, have memory and cognitive problems, be on medication that maybe, sort of, kind of helps some things.

Why don't you just tell me to kill myself and have it over with?

That's where the suicidal thoughts come in...the belief I will never see me or my old self again. Even beyond that, the old me is a state too which I cannot return. That that part of my life is over and unobtainable again. Not only is it unobtainable it is undesirable given how much stress I was under. I sense my life has been minimized. I have become less valuable, less desirable. I have become an outcast. Heaven on earth, or maybe even just a life worth living, is unobtainable.

That meaning and purpose are a bad joke, do not exist, they are an illusion that only proves to make me desire them more.

I feel stuck with the belief that my depression has made me become like the depraved and soul starved Satan miserable in his Hell in Milton's "Paradise Lost", when God kicked him and his miscreant, and treasonous army out of glorious heaven, and into the depths, and fiery darkness of Hell. "Who durst defy th' Omnipotent to Arms" forever lost to God and his previously shared Angel's heavenly home above:

"...Him the Almighty Power Hurl'd headlong flaming from th' Ethereal Sky
With hideous ruin and combustion down
To bottomless perdition, there to dwell
In Adamantine Chains and penal Fire
Who durst defy th' Omnipotent to Arms.
Nine times the Space that measures Day and Night
To mortal men, hee with his horrid crew
Lay vanquisht, rolling in the fiery Gulf
Confounded, though immortal; But his doom
Reserv'd him to more wrath; for now the thought
Both of lost happiness and lasting pain
Torments him; round he throws his baleful eyes
That witness'd huge affliction and dismay
Mixt with obdurate pride and steadfast hate:
At once as far as Angel's ken he views
The dismal stuation waste and wild,
A Dungeon horrible, on all sides round
As one great Furnace flam'd, yet from those flames
No light, but rather darkness visible
Serv'd only to discover sights of Woe,
Regions of sorrow, doleful shades, where peace
And rest can never dwell, hope never comes
That comes to all; but torture without end
Still urges, and a fiery Deluge, fed
With ever-burning Sulphur unconsum'd:
Such place Eternal Justice had prepar'd
For those rebellious, here thir Prison ordained
In utter darkness, thir portion set
As far remov'd from God and light of Heav'n
As from the Centre thrice, to th' utmost Pole."

(Paradise Lost, John Milton, 1674
(Book I, Lines 44-74)
(Note: I have highlighted the bold and blue section)

Like Milton's Satan, I feel "unjustly" sent to Hell, although I know full well actions in my life that I take, and cannot seem to manage to take are/were complicit in sending me here. That is what my treatment resistant, chronic MDD, my anxiety, and my mood cycling feels like. It feels like I will never return from where I came. I am lost forever. I especially feel like the part that is made bold and blue...like my world has become this blackness with no light, like in the darkness all I can see is woe and sorrow.

I have thoughts of suicide still. I used to have them all the time. I have them less now, but they are still there. They come at me almost everytime I cross the bridge. I envision my self stopping the car and jumping of the bridge deck. I look for back packs and coats of those who have jumped before me. The thoughts come at me when I see strong solid trees or giant wooden beams; beams and trees that I could throw a rope over and end it all. They come at me on the ferry, where I try so hard to make myself step into the dark water and disappear. They come at me often, but less than before.

I write about them because getting them out of my head and onto the page seems to alleviate some of the power behind them.

I am sorry if I concerned anyone with my previous post. If I AM suicidal (vs. thoughts, images, and fantasies) I probably would call Dr. X. I lived 7 years, and a few more, in Hell. I am sure I can last a bit longer. They are thoughts. Bad thoughts, anxious thoughts, thoughts that are plans for relief. Sometimes the thoughts themselves ARE the relief. I know, I always know, there is a way out if I cannot keep trying. I have it within my power to decide enough is enough. There is relief in knowing I am never completely without choices.

Ask Me a Question Part II

First Dr. X was my 9997th visitor. So close to the 10,000th. Wouldn't it have been mystical if he were the 10,000th visitor...yet there he sits three visits away. I wonder what he would ask if he could ask me any one question? Hmmmm?

I want to write, and I'm stuck for a topic, and my 10,000th visitor: Mr/Ms " Minneapolis, Minnesota. [who] started their visit at 12:09:56 pacific time (3:09:56 their time)and got to my blog by Googling "My Therapy Sessions" Did not or has not (yet) asked a question...the offer is still open...ask away.

So I thought I'd try to answer the 3 questions that were asked:

1) On Friday, October 17, 2008 11:08:00 AM Lola Snow from "Marine Snow" asked...

"If you woke up tomorrow and your life was perfect, what would have to change?"

Well...if it was perfect? Nothing! ...Sorry Lola I couldn't resist.

I will assume your question is an existential one, as in "what would I have to change to make my life perfect"? Is that what you are asking?

If so, that is a question to which I have been searching for the answers to for years. Today I said I was going to be honest in my answers. This will be hard, because I know I control some of the things that keep me down, but sometimes it is easier to live with the life you have, than make the changes you need to make.

a) I would have a job that I loved. One that required creativity and caring for others. A job that was stable and I was not alway afraid of losing, that did not change all the time, but that had change within it...i.e. one that required me to to think on my feet, utilized lots of different skills, was interesting in its variety and challenged me intellectually. I would work four days a week.

b) My husband would actively participate in marriage counselling with me. We would both work on completely overhauling how we communicate with each other. I would want to have sex again (I have completely lost my desire) and we would enjoy it at least a few times a week. On top of that I could actually manage to orgasm again. So, both my desire, and my ability to have enjoyable sex, would return. If my husband did not participate in counselling and work to help us change the way we communicate with each other I would divorce him.

c) I would not live in my old, falling down rented place. I would own my own home somewhere in Vancouver or east Richmond....just a small place with a yard. Nothing extravagant. All I want is a small home of my own that is not a a condominium. Unfortunately in this city, that dream is impossibly expensive. Maybe one day I can buy a lane home, or a carriage house. I need my own quiet space. I need a space I know is my own, where no one else (except my husband...who of course has gone to marriage counselling with me) has any power over my living situation.

d) I would swim everyday for at least 30 minutes (my perfect home would have a narrow 25" lap pool in the back yard)

e) I would WANT to live. I would not be plagued by depressive thoughts, or thoughts of suicide. I would no longer have all those thoughts of stabbing myself, or hanging myself, or shooting myself in the head, going through my brain over and over and over. I would give up the stash of medications I have hoarded for when I decide to kill myself.

f) I would not have any depression or anxiety symptoms. I would not have anxiety attacks, or panic attacks. I would not have any mood cycling. My mood would be level most of the time and my depression and anxiety would have disappeared. I would feel good like I did a couple years before this depressive episode and like I did in my last two years of university.

g) I would not stress out around others. I would look forward to going out to see others. It would be easy to go out with others. I'd stop feeling like I was in a bubble, or outside the circle at large social functions, or in stores and other places with lots of people.

h) I would not need a couple drinks every night. I would be able to drink socially like I did before; when I go out, never at home alone.

i) It would feel good and I would have the energy to do my housework. It would be enjoyable to cook dinner etc. It would feel good having a neat and tidy home.

j) I would enjoy gardening again.

k) My sisters and nieces would live closer to me.

l) My puppy would grow up to be well trained, behave like a saint, and be just as cute and cuddly as he is now.

m) I would have less things. No more clutter, or sentimental nic nacs. I would have a warm, yet calming zen like home...without all the accouterments of life I have gathered or been given over the years.

n) My Mom would be alive

o) I would make enough money to not worry about my bills or the things I need. If I made lots of money I would give away the amount I did not need to set up an art therapy foundation to help others with mental illnesses

p) I would spend at least 1 hour everyday creating art.

q) I would have an art studio in my house, where I could leave half done things up, and things I needed to create art were easily accessible at all times.

r) I would feel loved, cared for and wanted by those around me.

s) I would participate and join organizations that helped me feel a strong sense of community both culturally and spiritually with other people.

t) I would volunteer at least once a week

u) I would have season tickets to the Vancouver Symphony (and a companion who I didn't have to drag there to go with me each time)with me.

v) I would eat lots of veggies and take my vitamins. I might even become vegetarian again.

w) All my fatigue would disappear and I would sleep 8 hrs straight every night. I would have the energy I had during periods when I was not depressed.

and finally...
x) I would see Dr X once in a while because I enjoy his company, not because I need to see him. When I met with him we would have joyous discussions about all aspects of a good life, art, literature, intellectual ideas, friends, etc.


2) On Friday, October 17, 2008 11:11:00 AM deepblue from "Out of the Blue" asked:

"how do you afford/pay for your therapy?"

This is easy. I don't. In Canada we have nationalized health care. All doctors visits are covered by my province's medical insurance. I see my Psychiatrist for therapy, so the therapy is covered.

Having said that, before I met him I paid for therapy on my own for two years, once a week as psychologists are not covered. I really shored up how many times I went out for lunch and coffee etc. to save the $100.00 a week it cost. Also, on top of that I worked for a large corporation who allowed 6 free visits a year to a therapist...not great, but it helped. The only problem was I had to see psychologists covered by their plan, and I did not do well with any of them.

3) On Friday, October 17, 2008 11:55:00 AM Hannah from "Becoming Hannah" asked:

"Why you?"

I will answer this with a few different "voices":

a) The voice of reason: Depression, bipolar disorder and anxiety runs in my family. My maternal grandmother took antidepressants for years. My Mom was depressed for at least 10 years I can remember. My cousin has Bipolar Disorder and while undiagnosed, I am certain her Dad, my maternal uncle had bipolar disorder. It explains his bizarre, unpredictable and impulsive behaviour and his poor judgement.

My Dad has had a panic attack and I recently found out my paternal Grandma frequently had anxiety attacks. She also had an intensely hyperthymic temperament, the same way I feel better than most people when well.

My paternal Grandparents were alcoholics. I am pretty certain my Dad is too. Irritability, anger and a propensity towards emotional abuse and violence run in my paternal side as well. I was a worrisome child, and prone to insomnia, anxiety and dark thoughts from a very young age. It appears obvious I have a strong biological/genetic disposition to mental illness and alcoholism.

On top of that environmental factors made things more difficult for me. Our family moved almost every two years when my Dad was transferred with his job. So I was constantly in the mode of trying to please people, or trying to make new friends. As a coping strategy I tended to sever ties with those I left and form instant attachments to people in our new town. I always felt like an outsider.

My father was often away during my younger years as he was a police dog handler and was often called out for weeks at a time to search for people. He was emotionally abusive, distant and at times, a physically abusive father.

My parents divorce and how it proceeded in secret, how my Dad secretly remarried, how my Mom remained depressed for most of her life after my Dad left. This all affected me. I lost many friends to death in high school and was in a car accident where my best friend had a permanent head injury. That affected me.

With all that behind me it seems I was left unprepared and less resilient for all the regular sad and bad things that happen in everyone's lives. My depression and anxiety are not my fault. They are caused by a mix of environmental, genetic and biological factors.

b) The depressed voice: It is my fault I became this way. I had everything; a good job, a good family, (maybe my Dad was a bit harsh), but all in all my family cared for me. I just don't try hard enough. If I tried harder I would get better. I am too dependant on Dr. X. Maybe if I hated him I would get better so I would want to leave. Maybe I chooses to be this way? Maybe I stay this way because I get something out of it. Look I don't have to work, I can do whatever I want all day etc...but that's not true, because I am to depressed to do what I want and I want to work.

Well maybe I am being punished. Maybe I did bad things when I was young and I am paying penance for being a bad person. Maybe I deserve to feel this bad because I am a bad person. I think bad things about people. I hurt people. I don't deserve to be happy.

c) My Husband's voice: It's the medication and the help. If you hadn't tried medication you wouldn't be so sick. If Dr. X just refused to see you, you would get better. You will never get better while you have someone to help you (huh?). The day he cuts you off seeing him and off medication is the day you will start to feel better.

d) My Existential Voice: You continue to be depressed and anxious because you have intense death anxiety. Life is short, limited, it ends. You are not well because you are not living the life you want to live, you are not using what little time you have on this earth wisely. When you discover what it is you want and pursue that dream the depression will subside.

e) Dr. X's Voice (my interpretation): You have an illness that is caused by genetic, biological and environmental factors. Medication can help, but it will not be the only thing you need. You need to work hard to become well. To do all the things you can to feel better. I think he believes, like I do, that there is a strong existential angst component to my depression as well. He knows that finding and creating meaning in my life, and creating a purposeful life for myself are essential to my becoming well. They are not all I need, but they are a huge part of it.

Lola, Deepblue and Hannah:

Thanks for the questions. they really gave me both a lot to write about, but also a huge amount to think about and work on in therapy. Thanks.
...Aqua

I Never Would Have Guessed it, but There is Hope.

I think I am becoming the person who always annoyed me. Let me explain.

It is coming up on the 7th "anniversary" of my having my first scheduled visit with Dr. X. "Officially" this MDE has been 7 years of chronic major depression as of August this year. Unofficially I'd say longer than that. Since at least 1999 I have been almost always depressed except for a one or two months. Before that I have had MDE's continuously off and on since I was 16 or 17. Between some I had one or two years of feeling good, but as the years have gone on there has been shorter and shorter times of feeling well/good between episodes.

This episode has been, by far, the worst. Not necessarily in terms of how bad the symptoms were, because in 1988 or 89 I had a 3 or 4 month depressive episode that was similar in terms of symptoms. It has been the sheer length AND severity of symptoms combined that until recently, completely enveloped me and stole me from my life.

As I approached 1 year in the MDE I couldn't believe the tenacity of my symptoms. Two years and I was completely overwhelmed, hopeless and distraught. Three years and I was certain I was going to kill myself, because I would always feel this way. 4, 5 and 6 years the same thing. Everyday felt like the only thing I could do was survive.

I would become so annoyed, and sometimes to the point of feeling enrage by the comment "Depression is a treatable illness". I felt like: Fuck you it is!! That's bullshit! What about the 10-20% of us who do not seem to respond to medications or other treatments.

No matter what I tried, or how hard I tried to get better, I seemed to sink further and further into the hell that was my depressed life. Honestly, I think the harder I struggled AGAINST it, the worse it got. I would repeat over and over to myself, "I am NOT this person. This is NOT me."

It is. It is me. I have a chronic mental illness. I can try all I want, but I cannot make it go away. That would be like wishing away heart disease, or diabetes, or whatever physical illness you can think of.

People often say "You are not your illness". I always found that trite and unhelpful. When you are depressed you are consumed with your illness. It makes you stop going out, stop eating, or eating to0 much. It jams its way between you and your partner. It takes over your thoughts and replaces them with often obsessive, violent and/or intricately detailed thoughts of exactly how you are going to kill yourself and make your hell end. Depression takes you away from your friends. It turns you into a pariah. It insists you never try anything, because you will fail. It tells you things are hopeless and that you will always feel this way.

When severely depressed you ARE your illness. It chains you to an agonizing life I would not wish on my worst enemy.

So, over the last 7 years I have obsessively read self help books, blogs, and any article I could find anywhere about depression; hoping I would find the secret to getting out of this way of living. I survived only because I had a pdoc who never gave up on me, who never once seemed overwhelmed, or discouraged. I am sure he must have been discouraged with my inability to make progress, or my lack of progress, but not once did he ever let me see that. He always provided(and provides me with hope). I so desperately needed hope, and the more I trusted him, the more I began to believe his hope was realistic.

So now I notice my mood is beginning to lift. Honestly, I am in shock that this is happening. I cannot believe I am changing before my eyes.

That's where I find myself becoming the person who always annoyed me. I am becoming the person that believes either that depression is treatable, or that it is self-limiting and eventually each episode ends. I am beginning to really believe (not just hope) that a combo of medications can be found for even the toughest of depressions. Oh my God....I am actually becoming optimistic...That, I absolutely am astounded by.

I am not well yet. In fact I am not certain I will ever return to the "well" I knew before. I am changed by my experiences with depression and anxiety. I am beginning to believe that, though my life will be different from well, it might be a better life. I cannot explain it, but it is as though the depression informed me, albeit in an extremely roundabout, and horrifying way, that my life needed changing. I'm not sure if the change is helping me, or the medicine, or my therapy. It is probably a combination of all of these.

Whatever it is. I hope it sticks around and I have hope that it will.

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.

The Photographer in Me

July 2006, In memory of my Mom the summer following her death I planted dark flowers all over my deck; almost purple/black salvia, and deep purple heliotropes and I found this deep, dark colour of nasturtiums and planted them everywhere. My Mom absolutely loved nasturtiums and I absolutely loved my Mom. I love this photo. It feels so solitary, yet peaceful.

I have a thing for fungi. I love all the different kinds of mushrooms, toadstools, and fungus I find everywhere. You have to click on this image to make it huge to appreciate the beauty and perfection of these tiny fungi.

I took this in December last year (2007). I was walking my dog Bert in the blueberry field, as I turned the corner the sky in front of me turned black, but the sun shone intensely behind me. I ran all the way back to the house (few acres) to get my camera, because the light behind me was bouncing off the the white bark of the birch trees and they were almost glowing in front of the black sky. The dark and light intensified the red in the wintering blueberry bushes, and the green of the moss. It was not quite as dramatic by the time I made it back with my camera to take the picture, but I still love the contrast and intensity of the red and green.

This is a similar shot, and only a week or so later. I liked the contrast of the dark sky against the snow and again the intensity of the fiery red blueberry bushes.

In my photography I try to relay my spiritual connection to the natural world. Nature always astounds me with her variety, her perfection and the ingenuity with which she encourages and brings things to life, but also in the beautiful ways she assists in the process of death and decay; which itself becomes imperative for her process of renewal. She is pure poetry.

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.

My Soul Wants to Trust

Me: You must have noticed I have trouble trusting?

Dr. X.: No, I haven't really noticed that.

Me: You have to be kidding. I waffle back and forth between totally and completely trusting you and then thinking you are being disingenuous. It is not you though. You have shown you are completely trustworthy. It is me. I don't trust people.

Dr. X. : I have not seen that.

These are moments that make me go huh?

How can I think this, feel this, KNOW I am like this and no one sees that in me. I told him he would see what I meant if he read my blog, because while I believe he is an incredible doctor and I believe he is knowledgeable and I believe we have the best therapeutic alliance I could ever hope for, I often still feel scared. I sometimes feel suspicious or paranoid or afraid of him and our work together.

Dr. X., "You mean like you are afraid it is too good to be true?" [Our therapeutic alliance, his caring about me, his compassion and trustworthiness etc.]

Exactly! Exactly!

Everything I believe in, everyone I trust hurts me or dies, or disappears. I am afraid that if I believe and trust in him I will be hurt the same way the other important men in my life hurt me. It is like I think he is my Dad; someone I always try to seek approval from, try to make care about me and every time I let my guard down and think I can trust him, I can let him in....every time he dismisses me, or does, or says something that hurts me or that reminds me I am nothing. Every time I try I get sent back to square one. The unpredictability destroys my trust (though you would think by now I would just stop trying...but to me that is not an option)

Maybe it is not that I don't trust, but that I trust too much. A friend at the Art clubhouse and I were talking and he said it was funny how you would think so much depression and mental illness would make me jaded, but I'm not.

Me (To Dr. X.): I know you think I am jaded, because you see me when I am so sad all the time, but really I am not jaded. When I feel well I feel like the world is this perfectly beautiful place. I don't know if it is just me, but I am astounded by all the details in life and in everything on this earth. It almost feels like I have achieved some godly state of being when I feel well...I am ensconced in this world that simply is total beauty and it feels breathtaking to stand amongst such sublime surroundings.

Dr. X.: I do not think you are jaded. I think sometimes when you are really depressed you sometimes struggle against being jaded.

I was glad he said that, because I think, in spite of the hell I go through, when I am on the other side I want so hard to believe. To believe in love, to believe in caring and kindness, to believe I am likable, to believe I will be loved, I am loved and cared for. I want so hard to believe that I do make a difference to some people; that it matters what I do, that one day my purpose will become apparent, or even better I will choose my purpose. I want my life to matter.

My Senate Hearing on Guilt

This past week I have been really thinking about how to rid myself of the guilt I feel for not working and relying on disability payments from my work to take care of myself. I have been off work for more than 4 years now due to my depression and it's symptoms. I swear everyday I feel bad about not working, about not getting better so I can get back to work, about collecting money for doing nothing, for being a drain on society in this way.

So in my session today I tried to get rid of this obsessive guilt once and for all...but the guilt is so huge...it is unreasonable to assume getting rid of it that easily is possible.

However, my pdoc used a good metaphor for working through this problem. He said there were varying opinions in my "senate" about the best way to deal my guilt and the factors contributing to my guilt. So we spoke of having a hearing and giving voice to all those opinions so I can see everything clearly defined and then vote.

Factors contributing to my guilt:

1. I have a strong work ethic and I want to work. In fact I have never not worked since I was 15. When I am well I love working and feel good about contributing.
2. While I can see other people on disability because of similar symptoms and accept that it is okay, and in fact beneficial, for them to not have the pressure of working while they are trying to recover or become well; I think I should be able to work despite my illness. (Don't ask...even I don't understand how/why I can feel this way).
3. I know that it took 2 years of coaxing and coaching from my pdoc in order for me to feel I could leave work to take care of myself. I also know that when I finally got the courage to leave work to save myself, I was the closest I have ever come to committing suicide. Still, there is a part of me that thinks it was just too convenient that I was able to leave a high stress job that was killing me and still be receiving money.
4. I have a very black and white view of what is considered work..."being off disability, and making enough money to take care of myself" ...volunteer work is not work...I need to make enough money to feel safe.
5. I know, that even if I become well enough to work again, I will never be able to return to my employer's workplace. The work and the company is just too stressful and competitive for me to stay and remain well while working there.
6. Although I enjoyed the teaching aspects of the job, I felt a complete and total disconnect with the moral structure of the organization. Everyday I went to work I felt like I was doing and being the opposite of who I believe I am. This destroyed me. I require a job that is meaningful, purposeful and fundamentally in line with my belief systems.
7. If I know I cannot go back, then I should resign. If I do not resign, I am not telling the whole truth and am receiving money under the pretense that I will go back to work when well.
8. I worry I am not getting well because of this existential nightmare...Maybe because I hated my job, I got sick because of that, and I remain sick because I am afraid I will be forced to return to the job I hated.

If I feel so guilty...why not quit my job and discontinue my disability payments?:

1. I worry that I will quit to relieve my exitstential angst and guilt...and it won't help. I'll still be sick and in an even more stressfull situation...(i.e. sick, unable to work, and have no income). I honestly cannot handle getting more sick than I already am.
2. My symptoms are as bad as when I left work...intense anxiety, suicidal ideation, mood cycling up and down, fatigue, lethargy, amotivation, irritability, agitation, difficulty concentrating/focusing, memory problems (ECT related? depression related? and/or often medication side effect related....remember Epival? Benzodiazepines?), poor sleep.
3. So far my depression and its symptoms have remained treatment resistant to all therapies and medications... and I've tried tons...Antidepressants (SSRI's, SNRI's, Novel Anti-d's, Trycyclics), Mood Stabilizers Anticonvulsants, Antipsychotics, sleep medication, Benzodiazepines, and stimulants, weekly/or twice weekly therapy, hospital stay, ECT, outpatient day program, group therapy...etc., etc.
4. If I am still sick, but I am continuing to try to get well, but nothing is working...is that my fault?
5. Isn't the disability insurance there to protect me when I am ill and unable to work?
6. What if I never get well, or it takes years more to get well...I need to eat and pay for my rent. If I just give up disability and do not become well enough to work I will run out of money and end up mentally ill and living on the street.
7. I am trying...so why do I feel bad about feeling too sick to work?
8. My pdoc, although he said it would be a powerful decision for me to make, said it would be rash to call up the insurance company and cancel my insurance given the symptoms that made me leave work are still with me.

What are my options?

1. Resign from my job, lose my benefits and my disability insurance...I think this would be the dumbest move. It may relieve the guilt, but I can see it would increase my anxiety about not being able to care for myself, and my frustration with not getting well/ or even better, in a timely manner. I think overall, this would destabilize my mood even more.
2. Return to work while still in a MDE and unstable...I would kill myself.
3. Continue on disability leave until my pdoc/ or my self decides I am well enough to return to work, and then resign and look for another job. Note: If I choose this option...I have to know I will be able to do it "guilt-free" and accept I am sick, this illness is disabling, I have disability insurance for this very purpose. Accept that.
4. Phone the insurance company and tell them I will not be able to return to my workplace regardless of my health and ask if their is any provision for retraining into another occupation. (maybe Dr. X. would help me call, or meet with an insurance representative?). Note: If I choose this option I still have to be well enough to learn another occupation. I have been practising with my volunteer work, but even with the work I love to do I have been plagued with symptoms. Also, the stress of making commitments and then being unsure if I will be able to follow through is overwhelming.