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]