Two Oil Changes in One Month?

Now that I'm on the other side of that last mini-update, things are actually looking brighter. Perhaps it's because it isn't raining every minute of every hour of every day. Perhaps my work-related "transition-blues" have worn off. Perhaps it's due to the fact that I'm not at work as much, especially at the times when I'm most likely to be triggered. Perhaps it's because the Black-headed Grosbeaks have returned to my feeder from their wintering grounds in Mexico. Perhaps it's a result of long nights of deep conversation at Saturn. Perhaps it's a temporary high resulting from the fact that we were very short-handed at work this past week (a state that tends to pump me with adrenalin - or something). Perhaps it's due to the "catching-up" outside of work that I've been able to do now that I'm only working part-time. Perhaps the new book on depression that I'm reading is having a positive effect. Perhaps it's because of the wonderful card I got from my coworkers on Wednesday for "Administrative Professionals Day." Perhaps it's because I got even more hugs than usual this week. Perhaps it's due to some factor that I'm not aware of. Or perhaps it's just completely random. Or perhaps it is due to Oil Change #2 . . .
Oil Change #1 was Easter weekend, and it was my poor car's first oil change in almost a year. Oil Change #2 was last Tuesday, but it doesn't involve my car. Well over a year ago I added Flax Seed Oil to my daily dose of vitamins and supplements - I'd read that it was an excellent source of Omega-3 fatty acids, and that my brain might function better if I added it to my diet. After taking shots of the nasty stuff every morning for a year, however, I can't say that I noticed anything different. This past week I switched to Cod Liver Oil. Although oil from a plant sounds rather more palatable than oil from a fish's liver, I must say that the Cod Liver Oil that I'm taking actually tastes good (but probably just because they add flavoring to it). Anyway, a reliable source indicated that in terms of depression, Cod Liver Oil is molecularly superior to Flax Seed Oil - or something. I can't say that I really understood the explanation, but suffice to say it was convincing. (See the National Institutes of Health website for tons of info on fish oil.) My doctor suggested taking two tablespoons a day for a couple weeks, and then scale back to the normal daily dose of 1 teaspoon a day. (The brand he suggested is Nordic Naturals.) Perhaps it's too early for this new oil to have had any effect (beyond a "placebo-effect") - but I'm certainly in a better head space today than I've been in a long while.

If the entire month of April had resembled the week leading up to Earth Day, then April would have sucked mightily indeed. That particular week certainly sucked mightily, but the difficult moments during the other weeks in April were sufficiently diluted by a mixture of "ho-hum" and "really good" stretches of time that, overall, April turned out to be the best month since October 2005 by most (but, unfortunately, not all) measurements - and, by some measurements it was the second best out of the past twelve months. (See the Monte Mood Scale Blog for the actual numbers.) Despite some really awful days, I used less Xanax this month than during any month since April 2005 (excluding October when I didn't use any at all). My "Perky Point" score was similarly high, and the negative emotion scores were noticeably improved over recent months. The one arena where things worsened is actually an arena that I wasn't even "measuring" - that is, actual self-harm. While I've long been measuring the intensity of the urge to hurt/kill myself, I hadn't actually intentionally harmed myself in more than ten years. However, as foreshadowed in my report at the beginning of April, on three occasions this month I did cut myself. The actual "damage" inflicted each time was really quite minor, though sufficiently unsightly as to warrant the wearing of long-sleeve shirts for the past two weeks, and probably for another week or so as well. Although self-injury is a dubious coping mechanism, I think it is plausible that my improved mood comes as a result of having finally "succumbed" to the temptation. It is no longer some abstract fear dangling five minutes into my future. It's too early to tell, but perhaps that was one of the walls I just needed to fall off of in order to get past it. We'll see what the month of May brings in that regard.

A new line of thought:   When I started this Blog I wasn't exactly sure how it would evolve, or even whether it would actually serve its intended purposes of keeping others informed while minimizing my communication-related stress level. I know that it has certainly accomplished the latter (minimizing my communication-related stress), but in terms of keeping others informed I'm not so certain. I sense that this is evolving more and more towards an ongoing analysis of my illness rather than simply a report on how I've been doing lately. Perhaps the Mood Scale Blog will serve better as a "quick update" source of information. What I seem to need most right now, however, is a forum in which to explore the roots of my depression. I know that the more I understand about the way my brain works, the better off I am. I don't necessarily expect that everyone in my life has the time, energy and/or interest to learn the minutiae of the multitude of paths that lead to illnesses like mine. But for those who do, I suspect that you may also benefit by having a better understanding of why I think/act/feel the way that I do.

The reason I'm doing as well as I am just now is probably not a direct result of fish oil or any one of the things mentioned at the beginning of this post - but rather I think it is due to a combination of all of those things. Right now I am in the middle of a brand new book called Coping With Depression: From Catch-22 to Hope by Jon G. Allen, Ph.D.     Dr. Allen is one of the doctors I worked with when I was in the hospital in 2003, and I found him to be quite an extraordinary healer and educator. Not surprisingly, his talent translates well through print, and this book is providing me with a wealth of insight, information and ideas to ponder. The book includes a discussion of the sorts of life situations that tend to lead to depression, as well as information about how/why the mind of a person prone to depression tends to mishandle stimuli and thus lapse into a depressed state. Dr. Allen emphasizes the critical importance of understanding and truly accepting the notion that depression is not a character defect but rather a serious illness, and that, more so than most "typical" illnesses, depression itself hinders one's ability to take positive action on one's own behalf. Yet, at the same time he gently but persistently communicates that one can, and must, take positive action on one's own behalf.

Coping With Depression: From Catch-22 to Hope

The book actually begins with a fair bit of gloom and doom, emphasizing the seriousness of depression and the extreme difficulty faced by those who are trying to battle it.

[A]ll the things you need to do to recover from depression are made difficult by the symptoms of depression. [pg xx]

Although that's old news to me, Dr. Allen's upfront acknowledgment of the Catch-22's that I face in my struggle strengthens my trust in what he has to say in the rest of the book. Throughout the book he cites studies that throw light on the subject, and which confirm what seems obvious: chronic depression is an extraordinarily difficult disease to treat: "There's no single, simple solution to persistent depression." [pg 25]   and   "[U]nderestimating the difficulty of recovering from depression contributes to hopelessness." [pg xxi]   I realize more than ever that a significant part of me does fail to grasp the fact that my depression is not simply a character flaw that results from me not trying hard enough to be happy - and the result is guilt and hopelessness that serve only to make matters worse. After pressing his argument that depression is not just a fancy version of laziness but rather a serious disease that has incredible impacts on the lives of millions of people, he wraps up the introduction with:

We are off to a rather heavy start . . .   Plainly, I am making no effort to cheer you up. When you're seriously depressed, all such efforts are bound to fail - or to disappoint, if you're temporarily seduced into an unrealistic view of the illness. [pg 22]

A few pages later the news seemed even more grim:

Sadly, research findings clearly indicate that depression is often a recurrent illness.   . . .   Moreover, the more recurrences you have, the shorter the time interval from one to the next.   . . .   The risk of recurrence also increases directly with the number of prior episodes. [pg 29-30]

And yet there is reason for me to be hopeful:

[T]he vast majority of persons with depression do not receive adequate treatment. Herein lies hope: obtaining adequate treatment - and persisting in it - will enhance both the likelihood and the rate of recovery.   . . .   [Y]ou are not constrained by the statistics. You can do something about your illness. Knowing what you're dealing with and understanding how to cope with depression, you can improve your odds of recovering fully and remaining well. But you must take an active role in this process . . . [pg 31-32]

I would like to think that I take an active role in the process of tackling my depression. At times I wonder if all the "work" I'm doing - my statistics and graphs and blogs and therapy and medication - is really just window dressing, and that I'm not "really" trying to get better - that my time would really be better spent doing things like socializing, exercising and coming up with a healthier diet. But that line of thinking spirals me towards hopelessness because those are some of the very things that the "Catch-22 of depression" is all about, and so I've got to believe that I'm at least moving in the right direction. Dr. Allen goes on to emphasize that, despite the depression, chances are we can do at least a little bit to help ourselves - that we still probably have a little bit of "agency" in us. In a chapter titled "Agency and Elbow Room" he explains the importance of recognizing what our limits are, and the importance of pushing those limits:

In profound depression - when you're essentially bedridden, for example - your agency is almost completely abolished.   . . .   More commonly, depression diminishes your agency rather than completely abolishing it. You're depressed to some degree, but you still have some capacity to take action on your own behalf - some elbow room. [pg 34]

After pounding into the reader's head that illness of any sort constrains your agency, he points out that there is generally still some level of agency left over. I am reminded of my kidney stone attack last October. To say that my agency was "constrained" that morning is the understatement of the year - the pain was so intense I could barely walk or talk. But I was still able to get myself into my car and to the emergency room (though just barely!) - I still had some agency left in me. On this matter Dr. Allen makes what, for me, is the most powerful point I've ever encountered in my quest for wellness:

I am emphasizing agency for two reasons: first, I want to encourage active coping; second, I want to discourage self-blame. Many depressed persons add insult to injury by blaming themselves . . .  .   Feeling guilty only compounds their depression. I'm striving for a delicate balance: to the extent that your illness constrains your agency, you can absolve yourself of responsibility for your plight;   to the extent that agency is preserved, you must take responsibility for your plight. [pg 35]

To think that I am absolved of responsibility - to the extent that my depression prevents me from helping myself - that is such a liberating thought! The relief I feel when I read that sentence is palpable. But determining what I "can" and "cannot" do really is like walking a tightrope. I am only just realizing the extent to which guilt is a problem for me. After all these years of suffering, after spending so much of my (and my family's) money on treatment, after so many people have helped me in so many ways - and I still haven't figured it out? Feeling guilty, I'm realizing, not only doesn't help - it hinders. In order to get well, I not only need to do all that my remaining agency will allow - I also need to come to believe that I really am absolved of responsibility for that portion of my plight that I presently haven't got the agency to deal with. Accepting that - really and truly accepting it - is not going to be easy, even when Dr. Allen (and others) tell me unequivocally that I'm "excused." Having spent so much of my life believing that "doing my best" wasn't good enough, it will be challenging to let go of the guilt I feel - guilt for not devoting more time to friends and family, guilt for not being able to take on more responsibility and hours at work, guilt for going weeks without taking out the trash, or doing the dishes, or doing my laundry. Although reducing my "effort" in those ways is something I've been doing for a long while, the fact remains that I feel incredibly guilty for needing to do so. And I'm starting to see that the path to wellness requires me to let go of that guilt.

Thanks for slogging through my report.

Love,
Monte

[Black-headed Grosbeak photo courtesy of the National Park Service - photo by Bill Ratcliffe]

Earth Day Mini-Monte Report

It will be Earth Day in about an hour, but really I just want to say that things have not improved since the reduction in my hours at work took effect four weeks ago. In fact, on the whole, things are significantly worse - but more on that later. Right now I'm struggling to extricate a worm from my computer. Doing any sort of search using the worm's name somehow triggers the bastard to "attack," so I'm having trouble getting information on how to remove it. My ISP printed out some instructions for me, but they didn't work. In the meantime, I'm afraid to even open my email program for fear it will open a flood gate of misery for both myself and everyone listed in my address book.

Spring is Here - Maybe It Will Stop Raining Now

"The struggle of today is not altogether for today, it is for a vast future also." — Abraham Lincoln

Well, March was another very difficult month. Perhaps the fact that Mother Nature tried to squeeze 40 days and 40 nights' worth of rain into a 31-day period contributed to my despair. But I like rain. I think.

This past week — my first week with my new reduced-hour schedule at work — was especially rough. A variety of easily identifiable triggers, at a time when my ego is especially fragile due to yet another voluntary demotion, left me struggling to keep up the fight. Three consecutive nights of extreme insomnia were followed by a complete mood collapse a few days ago in which I indulged in Xanax for the first time in eleven days, my longest Xanax-free stretch since October. (On only five occasions have I've gone without Xanax for more than two weeks.)

It is worth mentioning an important change that has been evolving in my thought patterns when I'm at my worst. Over the past couple years, one of the (many) "tricks" that I've employed to keep myself from hurting myself is forcing myself to play the scenario out in my head. That is, after slitting my wrist what do I imagine happens next? If the scene in my head ends in a hospital (as it usually does), followed by the need to wear long-sleeved shirts every day for a few weeks to hide the stitches, then I conclude, "Why bother?" Why bother hurting myself and causing a hullabaloo if I'm not really intent on dying? In those situations I generally just resign myself to being miserable, and then usually drown my woes in Xanax, popcorn, ice cream, pink-and-white animal cookies, Nutter Butters, Vicodin or tequila (or some combination thereof). In recent weeks, however, when I am in a space where I've lost the ability to think rationally, I've been having trouble coming to the "Why bother?" conclusion — instead, I am beginning to believe (at such times) that there might be some sort of relief to be found through an act of non-lethal self-injury.

I know a number of "cutters" — people who, in times of psychological distress, intentionally injure themselves — generally in a manner that is clearly neither lethal nor resembling an actual suicide attempt (for example: scratching a word into one's skin). I am certainly not an expert on the phenomenon, but I was once a cutter myself. From age 18 to 24, on a number of occasions (primarily during my first year of college), I cut my left forearm — usually with a razor blade, though once or twice with a pocket knife and once with a shard of broken glass. Each of these incidents occurred at a time when I was in intense emotional pain, and I think that at the time I believed that I was actually trying to kill myself. In hindsight, it seems pretty clear that I was simply trying to swap the psychological pain for some more-understandable physical pain. In any case, I seemed to outgrow it, and I've not cut myself in more than ten years. But something tells me that, without some clear and rapid improvement in my mental state, I'm likely to resume this questionable coping mechanism. In a way, I suppose you could say that I've been engaging in self-harm already, in subtle ways: gorging on ice cream night after night (and gaining thirty pounds in ten weeks); by going months without doing laundry, to the point where my bedroom becomes uninhabitable and so I end up sleeping on the living room floor for weeks. Over the past few days I've had to struggle with a nearly unquenchable urge to cause myself serious bodily harm. In those moments the thought of having stitches and wearing long-sleeved shirts for weeks seems a small price to pay for the relief that I imagine would come in the aftermath of hurting myself.

But why would relief be found in such an action? Is there some weird subconscious belief that emotional pain will drain out of me along with the blood? Is it just some ploy for attention? Since I imagine I would come out the other end of the experience feeling shame, embarrassment and regret, I don't think very many people would even find out about it. Is it possible that the few who would find out are the ones whose attention I'd be trying to manipulate? Perhaps. Is it possible that there are people that I would secretly hope would find out and who then might feel guilty, as though they somehow "caused" me to do it? Perhaps. That's a fucked up thing for me to do to someone, of course, and at times like right now, when I'm thinking fairly rationally, I know that it's a bad idea. But, when I'm not rational, it's getting harder and harder to talk myself out of it.

---

Wednesday, April 5th marks the three-year anniversary of the day I was discharged from the hospital. I spent nine weeks there, and in the course of my treatment I came to understand that my illness is not the mysterious, random affliction that I had thought it was. By beginning to understand how and why I suffer the way I do, a spark of hope ignited within me — hope that was non-existent when I was first admitted. It is now crystal clear to me that my best hope in conquering — or, at least, taming — my depression lies in gaining a clear understanding of the inner workings of the disease: not just "What are my triggers?" (a question I can readily answer), but also: Why do these triggers have such power over me? Why am I triggered when Person X says or does something in particular, but not when Person Y says or does the same exact thing? For that matter, why does Person X's actions trigger me some days but not on others? Why do certain people get caught in my "tractor beam" — and how do they escape it? Many have been trapped in my tractor beam over the years — generally just one person at a time — and though some spend years caught in the glare, eventually they always escape. But how did they escape? Why were they caught in the first place? What do each of these people have in common? And what can I do to turn the goddam thing off once and for all? Over time, the tools that I've learned to use (for prying myself out of the molasses and back to reality) begin to wear out and lose their effectiveness. What new tools are available to me? How can I resharpen the old ones in order to get more use out of them? And so on.

For me, this learning process has two significant components: open communication about my depression with the people in my life; and second, reading and researching the topic of depression. I'm going to assume that if you are reading this then you are probably interested in hearing some of what I've been learning. I, at least, think I would benefit by being surrounded by people who are well educated in the details of depressive thinking. — Last month I mentioned a book I was reading that chronicled Abraham Lincoln's struggle with depression. The book is Lincoln's Melancholy by Joshua Shenk (see www.lincolnsmelancholy.com). Although the author is not a trained psychologist or counselor, he nonetheless was very well informed about depression, and much of what he said strongly resonated with me. In large part I think this is due to the fact that Lincoln is one of my heroes, and the fact that he was able to accomplish so much, while suffering so greatly, is truly inspirational to me. For example:

From a young age, Lincoln experienced psychological pain and distress, to the point that he believed himself temperamentally inclined to suffer to an unusual degree. He learned how to articulate his suffering, find succor, endure, and adapt. Finally, he found meaning from his affliction so that it became not merely an obstacle to overcome, but a factor in his good life.

At the age of 32, Lincoln wrote the following in a letter to a colleague:

I am now the most miserable person living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth. Whether I shall ever be better I can not tell; I awfully forebode I shall not. To remain as I am is impossible; I must die or be better, it appears to me.

Shenk says:

One of the reasons depression is so problematic — and deadly, leading to 40,000 suicides in the United States each year — is that people are loath to admit they are suffering, let alone explore it in detail.

Hopefully, by exploring my depression "in detail" I can avoid an untimely demise. More from Shenk:

It is a signal feature of depression that, in times of trouble, sensible ideas, memories of good times, and optimism for the future all recede into blackness.

I couldn't have said it better myself. — In a letter to his best friend Joshua Speed, referring to Speed's upcoming marriage, Lincoln wrote:

How miserably things seem to be arranged in this world. If we have no friends, we have no pleasure; and if we have them, we are sure to lose them, and be doubly pained by the loss … I feel somewhat jealous of both of you now; you will be so exclusively concerned for one another, that I shall be forgotten entirely.

… which is often a typical unconscious reaction of mine when friends pair off, get married or have a child (or, sometimes, when a friend just goes away on vacation; or, sometimes, when I'm REALLY a mess, when they simply leave for their lunch break). There's some sort of fear that they will never come back, and/or that they are going away (or getting married, or having a baby, or whatever) in order to escape from having to endure my presence. — The following quote, which Shenk attributes to a psychiatrist named Peter Kramer, aptly describes me (at times, at least — especially at work):

Throughout history, it has been known that melancholics, though they have little energy, use their energy well; they tend to work hard in a focused area, do great things, and derive little pleasure from their accomplishments.

Getting back to Lincoln, Shenk writes:

Whatever greatness Lincoln achieved cannot be explained as a triumph over personal suffering. Rather, it must be accounted for as an outgrowth of the same system that produced that suffering. This is not a story of transformation but one of integration. Lincoln didn't do great work because he solved the problem of his melancholy. The problem of his melancholy was all the more fuel for the fire of his great work.    …     [T]he temple of reason became his place of refuge; humor and poetry gave him relief … . [H]is work kept him connected to the world around him … . Lincoln knew what he wanted to live for; but for years he suffered without any clear prospect of how he would achieve it. He continued to plod ahead, even as clarity about why eluded him.

Finally, one of Shenk's concluding remarks:

The overarching lesson of Lincoln's life is one of wholeness. … [I]t is easy to be impatient with fear, doubt, and sadness. … Yet no story's end can forsake its beginning and its middle. … The hope is not that suffering will go away, for with Lincoln it did not ever go away. The hope is that suffering, plainly acknowledged and endured, can fit us for the surprising challenges that await.

But what surprising challenges await me? And at what point in the story am I? The beginning? The middle? The far end of the middle?

Lately I have been consuming episodes of "The West Wing" like an addict (I purchased the first six seasons on DVD). In a way there is something self-abusive about my obsession with this show. I was still a teenager when I first did the math and figured out that the Presidential election of 2004 would be the first in which I would be old enough to run — and for many years I kept that thought in the back of my head. As 2004 got closer and closer, though, it was plain that I was not on a track to the Oval Office — not by a long shot. But somewhere along the line I began to be interested in a different occupation: the United States Secret Service. Alas, the minimum age for President is about the same as the maximum age for the Secret Service, and so neither of these paths seem to lay in front of me. So, again I wonder, just what are the surprising challenges that await me? And do I have the fortitude to do as Lincoln did, and keep on plodding ahead despite the dark moments that are accompanied by a complete lack of clarity about what the future could possibly hold that will render all this suffering worthwhile?