Self-Stigma

Generalized anxiety disorder, panic disorder, social anxiety disorder, depression, bipolar II, cyclothymic disorder, dysthymic disorder, and being in the midst of a major depressive episode, are a few of the diagnoses that doctors have suggested to me during the last 10 years. Crazy, hopeless, and weak are a few of the terms that I have used to describe myself during my darker and/or more frustrated times. My personal diagnoses aren’t exactly corroborated by WebMD and have never been supported by my psychiatrist, but inevitably I would fall back to these conclusions. Essentially, because I couldn't "fix" what was wrong and make it go away, I was indeed a “crazy”, weak person whose situation was ultimately hopeless.

I have suffered from depression and anxiety for as long as I can remember. As a child my moods would go up and down dramatically. I developed rituals to simultaneously punish and protect myself from these mood swings – methodically touching a series of objects in my bedroom and then hoping over a wrinkle in the carpet perfectly before I would allow myself to walk through the doorframe. Over time the number of objects and hops increased to the point where I would avoid entering my bedroom because of the effort it would take to leave again. In college I can remember having panic attacks and deep waves of debilitating depression but never understood what these were or even that not everyone else was experiencing exactly the same thing. My fear of failure (mixed with an intense stubbornness) allowed me to remain incredibly high functioning. It wasn't until it got to the point where I couldn't function or at least fake it until I made it that I finally agreed to seek treatment. Even then I clearly remember thinking that I would go see a therapist for roughly two weeks and that would be it; I would be fixed. I would not go on medication. I would not see a psychiatrist. I didn't need too. Those steps were for people who suffered much more than I.

When it was suggested to me that I might be Bipolar II, I was thrilled. I use the term “suggested” because my psychiatrist needed more time to evaluate to make an accurate diagnosis. Nevertheless we discussed this as a possibility and I left the appointment feeling excited. Excited that I may be Bipolar II. Relieved to know exactly what was wrong. Happy to tell my family the news. And the reason for my excitement had very little to do with having possibly gained a better understanding of what was wrong, or navigating a new approach regarding my treatment, it was solely based on my belief that “Bipolar II” was a more believable, credible, and serious illness than depression alone. In my mind, depression and anxiety were overused terms used to describe a fundamentally weak person who just wasn’t trying hard enough. Nice – right? And this from a woman, who had been taking medication for depression and anxiety, seeing a therapist, and writing a blog about these experiences (titled “Depression Awareness” no less) for the better part of 7 years.

This experience wasn’t unusual. Over the years I have rejoiced at every possible new diagnoses that has been communicated to me by a trained professional or that I have stumbled across online. The end result though is always the same – the diagnoses was never enough for me; not strong enough, not big enough, not scary enough, to truly describe what I experience on a daily basis. And it’s not enough in part because I didn’t have the courage to begin to reject years of stigma and self-judgment that constantly threaten to derail any progress that I make towards a healthy mind and possible recovery. If I can’t accept that my depression and anxiety are real, that they are crippling and terrible and need to be carefully treated and managed, then I will continue to exist in my own whirlpool of anger and sadness.

There is no blood test for depression, or vaccine for anxiety. I don’t have test results to refer to when I become confused, or a cast to wear when I feel broken. I can't find the location and size of these illnesses on an x-ray. For so many years I craved this kind of proof as much to prove to myself that I am sick as to show others. My acceptance of my own, internal stigma prevented me from accepting the diagnosis that I had already been given: depression and generalized anxiety disorder.

Here's to rejecting the stigma (inside and out) of mental illness.

Balance.

Long before I was diagnosed with depression/anxiety, I had heard stories about people who took anti-depression/anxiety medication, started feeling great, and then quit the medication cold turkey. The consequences of quitting the medication without tapering off slowly had a variety of effects; deep depression, suicidal thoughts, nausea, dizziness, lack of sleep, as well as the impact on their personal and professional lives. Some repeated this cycle multiple times, others tried this approach once, and never did it again. As a born worrier, these stories terrified me, and I swore that if I ever did take anti-depressants, I would work with my doctor to increase or decrease as necessary.

For the most part, I have been faithful to my decision. I take my medication daily and I stick to the prescribed dose that my doctor and I have decided upon. I am still reluctant to switch medication, but slowly I am gaining the courage to trust my doctor and be open to change. I understand that I feel better because of the medication, and that to suddenly stop taking my anti-depressant would be incredibly counter-productive and dangerous. What I have a harder time understanding is that it is just as dangerous for me to stop all of the other activities and healthy habits that I have built into my life to help me manage my illness. So while I continue to take my medication, when I am feeling better I often stop doing all of the many other things that help to keep me going.

When I feel good, I feel great. I am seeing my trainer, making my appointments, reaching out to friends, and going to bootcamp at 6 in the morning. My energy is up, and my ability to challenge the negative and anxious thoughts is high. I am rational, I make better decisions, and I laugh more. And it is in this positive and healthy place that I begin to relax a little, to let simple tasks slide, to miss a workout, to have an extra glass of wine. Why work so hard when I am feeling great? It's not easy to wake up at 6 for bootcamp, and to check the job advertisements every day. It's easier to not pick up the phone, and to sleep in in the morning; In a sense, I begin to think of it as a way of rewarding myself for working hard and feeling good. Sadly, this way of thinking, the "reward" becomes my downfall.

Medication alone cannot erase my mental illness, or even fully manage it. For me, being mentally healthy will always be a delicate balance of medication, exercise, socializing, eating right, drinking little, therapy, and hard work. Quite often I succeed in achieving this balance, more often I fail. I don't know if I will ever get it right, find my stride, or fully trust my mind to make the right choices for myself long-term. I do know what happens when I stop trying altogether, and that is reason enough keep pushing myself to find my balance.

I bought the t-shirt.

I bought a t-shirt from To Write Love on Her Arms (TWLOHA); a wonderful organization that I encourage everyone to check out: http://www.twloha.com/vision/. The name, graphics, and design are awesome. I love my t shirt. I love wearing it. I love that it can communicate for me when I can't speak. 

Tonight I rescheduled my therapy appointment because I had to stay late at work. When explaining the schedule change to my husband, I tried to think of a creative way to explain that the appointment I would miss was my therapy appointment; without actually having to use the words "therapy or therapist". I was on an a crowded escalator with complete strangers and I didn't want anyone to overhear that I see a therapist. I catch myself doing this fairly often; more than I would like to admit. I am scared of what people will think, even in the middle of a crowd of people in a city where I have few connections and no family. I am afraid of what people will think partly because of what I think, my own destructive stigma about what having a mental illness really means.

Recently I was told that the holes in my heart may be growing. Did this phase me? No. Did I blame myself for not trying hard enough, eating right. excising or thinking positively? Of course not. There was a hole in my heart when I was born, it was patched and a few new holes have been discovered. No big deal. If I require an operation, they will operate.  Doctors can monitor this, employers will understand this, more importantly I can see this. Proof! Proof that I can show everyone. Proof that I can explain and that people will know how to react to. Dates and times and numbers to provide.

To admit that my mental illness isn't the result of a major character flaw, or of an emotional weakness that I selfishly allow myself to indulge in, is to admit that I lack complete control over my depression. If it's my fault, I can "fix it". If I work hard enough, I can make it completely disappear. It is easier to rely on my own stigma and blame myself than to acknowledge that this is an unpredictable illness that I may or may not live with for the rest of my life. By blaming myself, I feel as though I gain control over my depression, and continue to make myself dangerously miserable in the process.

Is this a productive way to approach "dealing with your depression"? No. You probably won't find this as one of the 10 tips on the wikipedia page. It's harmful, i's angry, and it's untrue. To admit that this disease isn't my fault or for lack of trying is to also admit the truth; this illness is powerful, unpredictable and deadly. I work at managing and controlling my depression and anxiety every day. It is, at times, exhausting and frustrating. Small setbacks feel much larger and "good" days are difficult to enjoy without thinking of the crash to come. Progress is not made without several wrong turns, self sabotage, and hard work.

So yes, I bought the T shirt, I wear the bracelets and when I'm feeling confident, I can easily discuss and joke about my own experience with anxiety and depression ...  but deep down, I struggle to reject my own internal stigma and accept the truth; this is a disease, it's not my fault, and I am not a weak or lazy person.

Here's to changing the stigma (inside and out) of mental illness.

Emergency

In early December I took a cab to the Emergency Room at the Health Sciences Center here in Winnipeg. I cried the entire way, pulling my hat down and shoving the money to the front seat to cover the cost. I cried as I registered, struggling to calm down enough to articulate what the problem was. I even cried on the table during the EKG. I was too distraught to care what I looked or sounded like. I had lost control and was unable to stop.


My trip had been motivated by chest pain and pressure. These symptoms had been happening since July, but had become increasingly painful and pronounced. I dismissed them as a side-effect of anxiety and chose to ignore them. Instead of realizing that my body was sending me a strong message, I choose to live with the discomfort. I had many moments when the pressure was so bad that I thought my heart would actually stop. I began to envision myself dropping dead at work or passing out on the bus. The bizarre thing is that these thoughts were not uncomfortable. On the contrary, they felt logical and realistic. It's incredible that the pain was so bad that death (or at least unconsciousness) was a calming alternative. Nevertheless, shame and embarrassment continued to prevent me from being proactive about the situation and actually doing something about it.


While waiting for the results of the EKG and blood tests in the Emergency waiting room, I hoped that the doctors would find something physically wrong with me. I understood that people go to emergency rooms as a result of panic attacks, but could not believe that this would happen to me. I am embarrassed to admit now that I secretly believed that those who wound up in Emergency for panic attacks were overly dramatic, had no concept of what real health problems were, and were not in tune with their own bodies. Despite the fact that I strive to be open and accepting regarding my mental illness, I could not accept that my chest pain was a result of the anxiety. In essence, I would have rather heard that I had serious heart problems than had suffered a panic attack.


The experience was humbling. Not only had my symptoms reached a point where I truly believed that there was a serious, physical problem, I had to confront the fact that I did suffer from painful and uncomfortable panic attacks. I was not imagining them. They are real, as are the physical symptoms that accompany them. Because they are caused by anxiety and not by my heart does not mean that they should be taken any less seriously or that their impacts are less hurtful. Imagine feeling panicked with heavy pressure on your chest and palpitations all day long. It's terrible. How can you feel normal and relaxed when your body is so stressed? Once again I was backed into a corner and needed to make changes.


My experience at the ER does not mean that I have conquered the panic and the anxiety. Boredom at work coupled with the prospect of losing my job in a few weeks is the perfect breeding ground for worry and panic. I still have bad nights and bad days. I still have difficult Sunday afternoons. However, I have begun to take baby steps in analyzing these thoughts and trying to evaluate their relevance. Talking the fear through with someone also helps immensely, and as always, exercise and volunteering continue to help manage this illness.


I wrote this for everyone who suffers from panic attacks. It happens, it's real, and there is nothing to be ashamed about.

Broken Record

A broken record …

I am rarely proactive unless I am backed into a corner. I didn’t take anti-depressants until I realized that I could not imagine the future because living in my current state of mind was unbearable. I was fired from a miserable waitressing job in the Highlands of Scotland because I didn’t have the courage to walk away. I played junior/high school basketball for 5 years because I thought I should, not because I was happy doing it or even had any kind of talent for it.

Whatever my reasons for not leaving or quitting, these circumstances were certainly character building. Being one of the worst players on the team is a magnificent way to fully learn the meaning of humiliation, compassion, and determination. I have plenty of humorous and painful stories regarding my time as a waitress in the highlands. My favorite being the time that, in lieu of extracting the wine cork in a more civilized manner,  I placed the bottle between my knees and yanked out the cork in front of a table full of American tourists. Thankfully, they found this amusing rather than rude, but ultimately not the best decision to make when wearing a tight, black skirt and your boss is watching over your shoulder. Needless to say, it did not come as a complete surprise when I was let go.

Nevertheless, being proactive earlier rather than later in many life experiences would have been the better choice. This is certainly true in the case of my illness, and is something that I continue to struggle with. If it’s not so painful that I can’t get out of bed, then I don’t force myself to make even minor changes.  I still struggle with taking the occasional sleeping pill, or trying anti-anxiety medication. I am resistant to changing the dosage of the anti-depressant, despite medical advice from my doctor. I have been referred to an anti-anxiety support group, and am terrified to go. Rather than fully come to terms with the situation, I still rail against it and settle for the uncomfortable, but familiar, daily struggles.

The positive out of all this is that I do eventually learn from my mistakes. I may not push myself as hard as I need to be pushed, or be as easy and forgiving with myself as I need to be, but changes are being made. Rather than waiting for the depression to become completely overwhelming, I am trying to think ahead and implement changes; taking the medication, scheduling time for exercise, and retraining my brain’s way of thinking. It has taken numerous bouts of anxiety and depression to fully realize the strength of this illness, that it is real, and that I need to begin to gain a level of control and acceptance over it.  If I continue to do nothing, I now understand what the inevitable outcome will be. Having done exactly that so many times in my past, it is finally beginning to sink in. I am beyond stubborn and impatient, but I don’t give up. It just may take me a few years to truly form a new habit or allow for a new way of looking at things. 

To learning from all of our mistakes.

Speak ...

I was incredibly saddened to hear of Wade Belacks death, one in a series this summer/spring of hockey-related suicides. I am not a Leaf's fan, did not know who Wade Belack was, and was completely unfamiliar of his career. I will make no attempt to convey that I know anything about hockey beyond what my brothers and Don Cherry have taught me. Nevertheless, I was both sad and frustrated to hear of his passing.

When I began to write this blog, I received a number of emails from friends and acquaintances who congratulated me, but expressed their surprise that I suffered from depression. To them, I came across as happy, funny and (relatively) outgoing. To me, my depression was so intense that I felt that it must be physically visible as well. I knew that this wasn't the case, but it could be so deep and crippling that I couldn't believe that others hadn't noticed. In retrospect I realize that there was no way they could have. I had become an excellent actress. If I needed to laugh and have fun, I usually could muster the energy. If I couldn't handle seeing people, I didn't go out. If I needed to leave early, I had excuses ready. If I couldn't cope, I didn't let anyone see me. Only my sister, mother and very close friends knew what was going on, and then only pieces of the whole story. I was responsible for keeping people in the dark with regards to what I was going through and how bad it became. Despite my outward appearance, I was often drowning in anxiety and depression.

Many of the articles and reports regarding Wade Belacks death mentioned his promising post NHL career. He had a number of irons in the fire, more so than many other retired professional sports players. He was scheduled to participate in the CBC show, "Battle of the Blades", and was pursuing sports commenting work. He was a father, a husband, and as teamates and colleagues recollected, "comedic, great personality, good looking and talented." In short, he had everything going for him.

The problem with depression is that, good fortune does not necessary alleviate or protect one from this illness. Neither does career success, age, colour, marriage, religion or gender. It rarely manifest itself physically. We can't see it on a bone scan, or diagnose it from a blood test. I'll never have a doctor point its location out exactly for me on an X-ray. What so many fail to realize is despite the lack of visual proof, mental illnesses are real, complex and can be crippling, confusing, and terrifying. In short, mental illness can be deadly. 

Talk about what is going on. Reach out to someone and explain. Don't assume. Ask questions. Stop judging (both yourself and others). It's the only way that we're going to all get through this.

Sweat, Meds and Therapy.

On Saturday I had my first personal training session with my trainer here in Winnipeg.

As a result, I am sore, covered in a "sore muscle rub", and will be soaking in my second bath of the day before bed.

But you know what? I feel amazing:)

The sore muscles are worth it. The pain, creaky joints, and raw muscles are a physical reminder that I got off of my ass, got out of bed, and started to fight back against my constant companion, my very own "black dog". Yesterday's training and this morning's sweat session on the treadmill are an outlet for my anger and a reminder of what I am capable of; physically and mentally. I am not my depression, it does not define me. However, we do exist together as of now, and in an effort to manage this illness, I need to take my daily dose of exercise. It's as important as the anti-depressant, as eating healthy and of seeing a therapist. I only wish I had learned this earlier.

During my late 20's, I realized that I had a problem. I was depressed, couldn't control it, and it was becoming progressively worse. The anxiety was out of control, and I wasn't sleeping. Work, social events and sometimes just leaving the house, became major hurdles. Lunch times were spent crying uncontrollably. I needed help.

In an effort to find a solution, I read blogs and websites about how to manage and alleviate depression and anxiety. Exercise and therapy were the two biggies, anti-depressants were advised if the depression had reached a point where a doctor or therapist thought that it was necessary. I tried therapy, but felt that the therapist didn't understand. I pushed myself at the gym, but inevitably the "high" would wear off. I refused to try medication. In lieu of listening to experts or to friends and family, I was treating myself. My mistake was to fail to realize that I needed multiple forms of treatment. Therapy, exercise, and anti-depressants on their own are no match for this illness. Together, they are an incredible tool to combat (or help cope with) depression.

For the first time in my life I am seeing a therapist, exercising and on anti-depressants. I have signed up for a yoga class, and am searching for a more regular and social volunteer opportunity. A year and a half ago, I would have been unable, or opposed to, all of these. By learning to rely on many different forms of treatment, I am doing better than I have in 30 years.

Please keep moving, stay open, and keep talking.
As difficult as it is to make a change or try a new tactic, it's worth it to feel amazing once in a while :)