I May Feel Depressed but...

I may have been feeling extremely depressed today, but this evening I feel really good about what I accomplished despite, and in spite of feeling so bad I want to give up.

Recently I have been volunteering some of my time to help others with mental illnesses learn about, and apply for a disability savings plan and tax credit that has become available to people with mental illnesses in Canada as of last year. I applied for it myself and found it to be so difficult to both understand the process, the eligibility, the criteria to qualify, the steps needed to open an account and to apply for an investment and to finally apply for the government portion of the savings plan.

Luckily I used to be a banker so I managed to get through it because I had a pretty good idea about how the banking system works and how investments work. When I finished doing it for myself I thought others not as well groomed in the mysterious ways of the finance industry, others trying to apply for themselves, or their family members might have an incredibly hard time doing so.

With that in mind I have volunteered my knowledge and set up an information session to help people make sense of, and get started on the process of applying for and opening an account. Tonight I offered to speak at a local mental health team's "Family Support Group" meeting. I was there to help people who had family members who may be eligible for this government program learn how to help their family members.

When I first got there a woman asked me what organization I was with. I said, "the organization of me", (I thought that was pretty funny!!) and explained I was doing this to help myself recover and gain confidence again. She was dumbfounded that someone would do this. I stayed and spoke and helped them with questions and information for about 1.5 hrs. About mid way she said to me, "but you are not like others with mental illnesses, you can do all these things. How are people who are really sick going to do this? (Ugh!)

I looked at her and told her I put a great face on. I could come do these sessions, and then when I left the building I struggled to want to be alive. I told her I was one of those people with an invisible mental illness. Ill inside, and well, to most, on the outside. Many of us are like this. She was a bit annoyed with me...but I felt it had to be said. Not everyone with a severe mental illness is recognizable as that. In fact I bet most of us are invisible to the world. Anyways...

At the end the only man in the group looked at me and said he wanted to say something to me.

He told me my talk was so helpful, and that I was an inspiration for all people with mental illnesses and to all their families. He said I could be an advocate for people I was so good at it. He went on and on...of course I couldn't hold back the tears. I felt really good about contributing to the community and helping others advocate for themselves and others. It felt really nice to have someone express that what I was doing was valuable.

On the way home I stopped at an expensive grocery store and spent my money frivolously on premade organic meals; a reward to myself for what I had accomplished. As I walked out to go to my car a man had his cap out asking for money. I glanced the other way, feeling guilty for doing so. As I looked away I found myself staring at his old, frail and grizzled black lab just sitting on the pavement in the cold waiting for his owner to take him to the next corner.

Something about the lab woke me out of my stupour. What I couldn't feel for the man as I passed him, I felt for his dog. As I felt for his dog I began to feel for the man. I put my grocery bags down and walked back to the man and gave him $20.00 and smiled and told him to buy himself and his dog some food. The man looked twice at the money I gave him and then looked up at me in disbelief. Thank you so much he said. I felt good about reaching out to someone who I could tell really needed an act of kindness at that very moment.

Nevertheless

Wow, I really am "on". I have felt so good the past few weeks I am beginning to feel like maybe, just maybe I am beginning to heal. I am super energetic and driven much of the day. Driven, is an understatement. I am so enthusiastic and energized much of the day, that I feel wired for sound...revved up, speedy, high on something. Unfortunately, this is leading to my maybe overdoing life, planning and doing too many things, which I can see may be leading to my becoming sickly exhausted later in the afternoon. I am trying to accept my afternoon exhaustion and do all the things I want to do anyways. The past few weeks I have set up so many incredible things in my life.

My singing lessons and choir are unbelievably good for me. In fact, they are so joyous and soul defining for me that I wonder if it is the singing that is making me feel so high. Something about singing fills me with passion and lust for life. The more I sing, the happier I become. I feel like a bird in the springtime, compelled to sing my song loud to the world.

While I am singing I feel so intensely happy it is beyond words. Sometimes I am quiet in my song at choir or in my lessons, because I fear making a mistake, or embarrassing myself. However, when I loosen up and let my voice loose I have an incredibly powerful and beautiful voice. My song is nowhere near as gorgeous if I try to hold back. I need to remember that.



Yesterday in my singing lesson I learned a new Jazz song: "Nevertheless". My version is better than this version, but you get the idea of the song. I sing it with a bit more punctuation on some of the words and a slower sexier feel. It is so sexy and sultry. I feel like I am myself when I'm singing it.

We also transposed "Bluemoon" into a lower key and it is much more sensual and alluring. I love it. We did the same with "Somewhere Over the Rainbow", changing it to Eva Cassidy's version, which is lower and has quite a different feel to it. Oh, I love it soooo much. I am learning the intro to it too, something I have never heard before.

As I left my lesson yesterday my voice instructor expressed to me that I was learning the songs, and able to improvise interesting takes on the songs, extremely quickly. I felt really good when she said this because in my pdoc appt yesterday morning I was stressing about my difficulty remembering songs. It seems it is the words I am struggling with, not the melodies. The music seems to latch onto my brain more easily than the words. Not sure why. I learned "Nevertheless"in two tries and it sounds amazing. Of course I need more practice, but I know how I want to sing it and it sounds pretty good already.

This high feeling, intensified, and perhaps bred by music, reminds me of the times I feel really well. When well I sing all the time. When well I sing in the streets, in the shower, when I'm with people, when I'm out and about doing my daily tasks, when painting, when teaching, when driving. I sing unselfconsciously and joyously. I don't care who is listening. Thanks Dr. X for the encouragement in our session yesterday. It helped me address my fear in the moment.

I feel I am close to attaining unselfconscious joy right now. In fact my instructor's son came home part way through the session and was going to leave...and I said, "no stay. It doesn't matter to me if you are here while I am singing". That is a monstrously huge step towards letting go of my fear.

The Value of a Powerful Therapeutic Alliance

I am falling deeper and deeper into depression; again. I feel so helpless as I feel myself falling farther and farther down. I went to my appointment with Dr. X yesterday, and all the way there I kept thinking: "I have had enough, I cannot take this anymore. I am quiting everything: medication, therapy, and if that doesn't work, life.

I sit down in my chair, across from Dr. X. and I feel an intense shame come across me. It is as though I feel not worthy to be in his company, to take up so much of his time, to have him see me for so long. I feel that same shame right now. How can I get so much help, and such good help, and still remain unwell?

I sit facing Dr. X. and I feel certain I must be exhausting to him. I must frustrate him so much. I cannot imagine how he manages to meet with me week after week, after week. How, after seeing me crash, seeing me unable to manage simple tasks, seeing me fail over and over again, how can he not be intensely frustrated, or in my mind even worse; how can he not have given up hope for my ever becoming well?

I manage to ask him if I frustrate him. He explains frustration is not the right word; sadness, a sadness that you would feel for a friend, or family member who remains chronically sick, that is closer to how he feels.

I feel touched by his saying that. No one except my Mom, when she was alive, has ever said that to me before. No one says they are saddened by my struggle to become well. My family mostly tries to make me believe that everyone has depressed days, shifting moods, anxiety, etc. That depression is normal. This makes me feel completely misunderstood. I am certain this state of mind is not "normal". They assure me I am strong and need to step out of this hole I am stuck in. Either that or they say "get a job", as thought that will fix me.

Even my Mom used to say I needed to accept my illness, get a job and I would become better. My husband says I am sick because I focus too much on my depression, am in therapy, and take antidepressants.

People without this illness have no concept of what it is like to struggle, and then often to even lose the ability to struggle. Life is hellish, empty, frightening, worthless, hopeless. I wake up everyday hoping today is the day, but most often I realize and know it will never end. It has been part of me for too long.

Sometimes I wake and think: " Today is the day this MDE will end". I have glimpses of joy, moments of laughter throughout the day, but after the moment ends it feels as thought the moment is mocking me; laughing at me, not with me, showing me a moment in time that will only ever be that: a moment, a split second of freedom, an infinitesimally small break in the darkness.

I sat in my appointment yesterday, ashamed of who I have become, wanting so badly for Dr. X. to know who I have the potential to be. In the moments we talk I believe he may know my real self. He may understand I am a better person than the one I have become. Actually he sounds like he accepts both of me: the sad one and the bright and joyful one. In fact, it appears he sees us as neither one or the other. It seems he sees the real me through the sadness. During the time I sit in that chair, across from Dr. X, I feel that the sad and joyful me are seen as one and the same.

I am not two people. It is not fake for me to be joyful for a few hours and barely able to move the rest of the day. Dr. X even says it is not a facade when I laugh gleefully at my puppy running and jumping for a Frisbee, and moments later feel sad. My sadness, and fatigue, and amotivation, my wanting to sleep all day are all symptoms. We will continue to work to address these. He seems confident that wellness is a possibility, that I will not be stuck in this hell forever, that we can, at the very least, help me lengthen and intensify the good moments.

I feel myself laugh when I think of my dog. He is bringing so much joy, and at least some fresh air and exercise into my life. He drags me out of bed, deserves a walk and play time. I am fully responsible for his care. Which at times seems overwhelming, but also is a responsibility that protects me and gives me energy.

Dr. X and I begin to talk about how we, as Dr. and patient, interact. He begins asking me questions I do not know how to answer. He asks me how my interaction with him differs from my interaction with a friend. I try to express how a friendship is a two way relationship and we have a one way relationship. I feel distanced from him by that separation; the him and me.. The game we play has rules and strict boundaries. The playing field looks different to each of us. We are playing entirely different games and I do not completely understand the rules. I only know there are strict boundaries that I need to guard.

I feel intensely uncomfortable asking him questions. I feel like it is not my place to question. That is how I was brought up. Call people Dr. Sir, or Cst.,Cpl, Sgt, Staff, or Inspector. They ask the questions. You answer them. I try to ask him questions like he seems to want, but I feel awkward and nosy. He insists I keep asking. I'm thinking it is a type of behavioural therapy. He wants me to see and believe he is a person like any other, that he cares about me, that I can ask him anything.

All I keep thinking is he must think I am a complete loser. I bet doctors make fun of people like me. Sit in their offices and laugh about how bizarre people like me are. Over coffee, having conversations that begin with: "You would not believe the patient I had today...". I feel scared people do not like me, make fun of me, are secretly talking about me behind my back.

At the same time I feel so disrespectful of Dr. X. for even thinking he might be like this. How rude. How unthoughtful am I to think this man, a man who has always been there for me, who is consistently caring and goes out of his way to help me, how can I even think he would be like that? I feel like I have hurt his feelings for even suggesting this might be possible.

I cannot, however stop worrying that he will give up on me, or that he is exhausted by me, or simply cannot take it anymore. It is always what happens. I wear people out. They leave me. I even used to ask my Mom, every time I spoke with her, if she loved me. As though her actions never screamed those words loud and clear. They always did, but something inside me felt I was unlovable.

My husband and I have been together 16 years and everyday I think he wants to leave. Everyday I ask him: 'Do you love me"? and everyday he answers yes, but I cannot believe anyone would love me, or care deeply and honestly for me. Not really.

This is what I need to work on in therapy. I need to learn to believe I am likable and worthy of people caring about me, and for me. This is where a powerful therapeutic alliance is intensely important. If I can work through my conflicting feelings about Dr. X., maybe I can reflect the behaviours and beliefs I learn onto the rest of the relationships in my life. Even if I am scared, what I do know, is that Dr. X is the safest person with whom I can to practice and relearn better personal and social skills.

Puppies and Behavioural Therapy

Dr. X said something interesting to me in my session yesterday when I was telling him about how my new cute little puppy and I are doing. I was explaining that I was taking a bit of an authoritarian approach with the him (the dog...not Dr.X ;>)

From my perspective it is better, and more manageable, to begin to set clear boundaries and expectations with a puppy who is 22.5 lbs, than to try to get an 80lb dog to change it's behaviour, or do what you want it to do

When I say "authoritarian"...I don't mean my Dad style, scare the crap out of you so you never make a mistake type treatment. That kept me in line while my Dad was watching, or if there was a possibility I would get caught, but left with difficult to control wild streak the second I left home.

With my puppy I am setting clear boundaries and using praise, not punishment, and a few other techniques that really work. I believe in the idea that dogs are pack animals and still maintain many of the behaviours of pack animals. In keeping with that I believe every pack has a leader, its Alpha dog. The job of the Alpha is to protect the pack and ensure it continues to exist and flourish. That's my job

It is up to me to establish my being the Alpha while little puppy is still a little puppy vs. a big dog . I do not want an 80lb boxer trying to become the head of our pack. My husband really should be second in line...but he is not being as consistent as I think he needs to be

Anyways, I have had the puppy a week and he is smart with a streak of stubbornness in him, but here are some tricks I've learned...and it really works. (I got some of these out of the "Puppies for Dummies" book...you know those yellow and black books that teach you all kinds of things. Some of these books are very good (the drawing one is great) and they are easy to read if you have difficulty reading, or with concentration, because you can just read snippets of sections to get really clear ideas. Other things I learned from my Dad when he trained and worked with police dogs

First thing that is going well. I have established a "potty" place and am teaching him to pee/poo on command. He pretty much has it down. I just repeat, go pee, or go poo...and the important thing...do not look at them, ignore them while you say it...as soon as I stopped looking at him ...he began to go. The idea is that an Alpha would not keep looking back on the pack. They LEAD the pack. This idea is great because it is easy to cleanup after the dog

Second thing I have taught him...and he's REALLY good at it, is to heel. I immediately insisted the puppy either walk behind me or directly to the left of me. if he tries to move ahead I just give him a bit of a quick tug, reposition him and walk a bit faster. Within two days he was walking slack leashed beside or behind me MOST of the time...a few little hierarchy takeover attempts, but a polite correction by me and a hug and "good boy" when he gets back into formation and we are off again

The other thing I learned about this behaviour is that if you walk ahead with confidence, even continuing walking if they sit down, they catch up quickly, because they want to be near you...so just keep walking if they stop and they will follow

The coolest thing is that today, because he was so good at heeling I took out my bike and taught him how to run beside me on my bike through the blueberry field. We did a few slowish, short runs, because young puppies shouldn't be exercised to much, but he was awesome at it. We had great fun.

I am teaching him to sit when a car comes in the driveway, and when someone approaches us. Both for the safety of the dog, but also for the people. There is nothing I hate more than an adult dog who jumps up on you when they greet you. 20lb puppy...sort of cute jumping up to say hello...80lb dog doing the same thing a disaster waiting to happen

All the stuff I am teaching him are like games to him. He's sucking it all up like a sponge and loves the attention he gets when he "gets" a command.

Lastly, one of the first things I read was to introduce your puppy to as many sounds: loud, shrill, sharp, annoying etc, as you can before they are 16 weeks. So I have been doing that in the house with the vacuum cleaner, the hairdryer, mixer, etc.

I learned yesterday that if your puppy is scared of a noise, or scared of something the last thing you are supposed to do is bend down, pet the dog, make eye contact and reassure him. (Which is definitely what you have the urge to do...i.e."Oh poor puppy, its okay" ) This places you (in the dogs eyes) in a subordinate position, where now it's his job to protect you. It can lead to a over protective dog, which can lead to aggressive behaviour.

Instead, you are supposed to pull the dog on the lead closer to you. Place the puppy between your legs, hold them slightly tight between your legs (this reassures them that you will protect them...like an Alpha would), stand tall, remain calm and say good boy/girl in a calm, firm voice, while the noise or thing scaring him goes on.

I was skeptical of this one, but today when I took my bike out it needed to be washed (I haven't ridden it in years years..argh! The noise of the power hose spray freaked the puppy out, so I left the hose on, went over to him and put him between my legs, stood tall, no eye contact, acting like the noise was not significant. He immediately sat down. I returned to hosing of my bike and he sat there super calm, no longer afraid of the noise.

It happened again when I took out the air compressor to pump up my tires. I did the same thing and "voila" he could have cared less about the sound after that.

This whole post does actually have something to do with my mood disorder, or at least some of the symptoms and behaviours I have that feed my depression. One of them is difficulty being an authority figure. I am always afraid I will be rejected, or not cared for, or thought as mean, or uncaring. Afraid I will be unloved. This has greatly affected me in the jobs I have had, because each promotion brought on more 'authority" which to be became synonymous with stress and isolation.

The interesting thing Dr. X. pointed out was that this puppy training is great behavioural therapy for me to practice being the authority figure in a way that is loving and respectful, but also ensures I get what I am requesting and still remain cared for.

He's right. In one week I have taught the puppy a lot, but he has taught me that he loves me even more when he knows what is expected of him.

Oh yeah...note to self: the bike ride and running made for a much calmer dog this evening. Keep this up. We both need the exercise.

A Perfect Day

Today was a really good day. I met with a friend and we went for a walk on the beach. I felt like I was with someone who gets me in all sorts of ways. Someone who sees the world around her like a child discovering new things all the time. I am like that too when I am feeling well and to some degree when I am depressed. I always have marvelled at how it is that such beauty exists in such a difficult world.

I marvel at nature and its awe inspiring beauty on every level. Natures colours and geometric patterns; her perfection and her ingenuity; her attention to detail and yet alternately her oversights. Nature amazes and enthralls me.

I watched my friend react with that same passion; both of us gasping in awe at the giant gelatinous masses of beached jellyfish on the shore. The translucent bodies magnifying and intensifying the colours of the rocks, sand and debris upon which they were trapped. I watched her try to save a jellyfish. An act of compassion and love for a creature so different from ourselves.

We both walked staring at the beach, searching for treasures to take home, or to take pictures of, to take home. She had better eyes than me and found the most interesting and unique items. She saw all the details I was missing and shared them with me; the spores of some kind of mold forming on a side of seaweed; the molds patterns made it so beautiful in it's own way; miniature seashells perfectly formed and teeny barnacles on a small stick, tiny, but no less magnificent.

Today felt like a perfect day. I was aware of myself; aware that I was very talkative, yet I tried to accept that overflowing bubbly talkativeness as myself and an expression of my joy and my feeling happy with what I was doing and who I was with. She in turn expressed how she is not as talkative, but that is just the way she is. We are who we are. We were who we are. It felt good to just be whoever I am; to revel in the sun, the ocean and the company surrounding me.

High and Full of Creativity

This is only the second painting that I have ever completed. I'm just learning to paint, but I think it turned out pretty well and I feel good about my attempt. For me to even say that I must be feeling better.

Dr. X adjusted my medication yesterday and today I have been feeling so incredible. He increased my Dexedrine to 10mg spansules (time release capsules) twice a day, once at 8am and once at noon. It did wonders for me today.

Before I was taking a 10mg Dexedrine spansule in a.m. and then a 5mg regular release Dexedrine at noon. I was crashing big time at 3pm. I had to sleep for 2-3 hours and had no energy or motivation to make dinner, eat dinner, clean-up. It was awful.

Today I didn't crash like I have been doing. In fact, I painted all day and only noticed it was 7:30pm when I was finished my painting. I even forgot to eat. That is a sure sign I feel better. Whenever my mood goes up I get creative and I stop eating.

This painting is a rendition of a picture I found months ago in the newspaper when the Myanmar riots were going on. I changed the original picture, but used its idea as a reference. I loved the idea of the peaceful resistance vs. the armed guards, the dark vs. the light, the good vs. the evil (and/or the difficulties in deciding what is right/wrong). I am sure the soldiers believe what they are doing is right, as do the Buddhists.

I also thought the picture reminded me of the yin and yang of life. I was also struck by the dichotomous nature of the physical government authorities and authorities of the soul being combined in one picture.

Why Do Doctors Say these Things?

I do not know if it is me, or if everyone has stories like this, but here is an example of what NOT to say to a patient:

I decided to go to the walk in clinic two days ago because I was unable to get in to see my GP until mid-January. I went because about a 10 mos to a year ago I got this small bump on my right eyebrow. I had no idea what it was, but it did nothing until about 4-5 weeks ago when it began growing rapidly. It had also become very itchy. I looked at it the other day and wondered if it was ring worm, although it didn't quite look like that because it wasn't exactly round like ringworm is. It was more uneven around the edges. Anyways, I had ringworm from my cats years ago and I didn't want it again, so relatively unworried, (because it's completely curable), I went to the clinic.

The doctor looked at it and said it definitely wasn't ringworm and that she wanted to get a second opinion; so she asked another doctor to come look at it. He looked closely at it and said: "There is a type of skin cancer that is very deadly, and it kills a person very quickly". He then paused for what seemed like an eternity.

During that pause I think, "Great, I have found medication to stop my depression and suicidal thoughts, only to find out I am going to die in the next few months". The irony of this situation is not lost on me.

As my panic begins to build he pipes in, "...but this isn't that type of cancer". I think: "WTF?" He leaves and I cannot remember what he said after he said it isn't the deadly cancer. All I still hear is "deadly cancer" and "kills very quickly". This phenomenon, not hearing things after devastating news, happened when my Mom was diagnosed with pancreatic cancer. I used to carry a notebook to my Mom's Dr's appointments, because I'd leave the appointment and not have a clue what had been discussed.

I asked the initial Dr. what the consulting Dr. said. She said, "it is either Basal Cell Carcinoma (BCC) or it is a wart (although it does not really look like a wart)". She said it does not matter because BCC is a very slow growing cancer and the treatment for both is the same...freeze off with liquid nitrogen over a period of 4-5 weeks. I let her freeze it and booked another appointment, but when I got home I felt really angry at myself.

Why had I not insisted on a biopsy? What if it was cancer, how am I going to know if it is gone? She seemed really unsure about what to do if it was cancer. She even asked the other doctor if she should refer me to a dermatologist. I do not feel confident about the projected treatment.

I also have read that BCC can be really disfiguring if it is not dealt with in a timely manner and can metastasize if not treated properly. The growth is on my face, on the far right of my right eyebrow. I do not want a huge scar on my face. Something happens when I am faced with an authority figure. I shut down and do not have the ability to stand up for what I want.

I got home and decided I needed to see my Family Doctor. I phoned and told them what had happened and I have an appointment late next week. I am going to ask for a biopsy and a referral to a dermatologist. Even though I really trust and like my Family Doctor this request will be so hard for me, because it means questioning the original Doctor's authority. A task I dread.

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