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I am struck by the idea that this week has been a major downer. Lots of negative posts; well, if not negative, then certainly gloomy and depressing (sorry, I couldn’t resist!). So there are some final thoughts I want to share with you.

I am thankful that I had my breakdown. Yes, very thankful.

The first reason that comes to mind is that at the time, I was involved in an abusive relationship with The Narcissist. (I used to call him The Bastard, but The Narcissist fits him better.) I didn’t know how to leave, and my breakdown was one way to do it (not the best way, but hell, it worked).

The second, and more overall reason is that I am so much better off now than I was then. It seems like a bizarre thing to say, but it’s true. If I had kept living the way I was, I probably wouldn’t be alive today. I was headed toward suicide if I didn’t get help, and the ways I tried to get help didn’t work. So, big reason to be thankful.

Also, through my years of therapy, I’ve learned more about myself than I ever knew in the preceding 28 years I’d been alive. There are some unflattering things I’ve learned about myself, more than I’d like to admit. And there are some amazing things I’ve learned. But more importantly, this knowledge is genuinely, truly about me. Not about the person I thought I was supposed to be, or the person that other people wanted me to be. About me, the person I am when I look deep inside myself and leave behind the Mask.

I’ve learned better coping mechanisms. I’ve learned how to make my life better, by not listening to my negative automatic thoughts, for instance. I know how to change those automatic thoughts (although it’s always easier said than done, and by no means am I able to do it all the time). I know how my thoughts can set me up for painful feelings. These are all things I probably wouldn’t have learned, but for my breakdown and illnesses.

Most importantly, perhaps, I’ve learned that I can make my life better. I know that the darkness always ends, it just takes time. Feelings are transient; if you wait them out, they’ll change. I know I will feel better, because I have felt better before. I know I can come out of a depressive episode, because I’ve done it before. I might relapse again, but I can hold on to the knowledge that this too, will pass. And I will not only survive, but I will learn from each relapse. I might always have chronic depression and anxiety, but I don’t have to always suffer from them.

Thank you for sticking it through this week. I hope that you learned at least one thing here that you didn’t know before. And that today’s message that there is hope and that things can get better reached at least one person who needed to hear it.

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Today was the Kamloops SPCA’s annual Paws for a Cause Walk for the Animals. I was in charge of registration again this year, and we had 143 registrants. We don’t have a final total, but it’s over $30,000, which is awesome!

I spent over seven hours going full bore today, and have exhausted myself. So I might take a day or two (more!) off from blogging, but I’ll be back! I just need some sleeeeeeeepppppppp!

I’ve written mostly about depression this week. It’s hard to write about my anxiety, especially at a time when I am at a really high level of anxiety, which I am right now.

My anxiety adds a whole other dimension to everything else I’ve written this week. Anxiety is an energy waster. I’m going to write more about energy tomorrow in The Spoon Theory, but for today, I’ll just use this analogy: Think about a big pot of water on the stove. Imagine that this is your water for the day, for cooking and cleaning and bathing. You turn on the burner when you wake up, and you leave the burner on all day. Even if you never take a drop out of that pot, at the end of the day, you will end up with less water than what you started with. That’s what chronic anxiety is like. A constant simmer of worry or dread, that is always happening in the background, wearing you down. Even if you’re not conscious of being anxious, you are still wasting energy.

Which is not to say that there is any fault or blame to be attached to a person who always has a low level of anxiety simmering away. Everybody knows what it feels like to be anxious about something; imagine if you had a feeling very similar to that, but ALL THE TIME. Trust me, if people who have chronic anxiety knew how to make it go away, we would give all our fingers and toes, and maybe even an organ or two, to do it.

So there’s this constant level of anxiety going on. Then there are the specific things / tasks / people that cause a spike in anxiety. These can be anything. For me, hearing the phone ring provokes panic. If I have to make a phone call, I will often have a panic attack. You will never know that when I call you, however, because the Mask will be firmly in place when I pick up the phone. Which will make some people sceptical that I am truly phobic of the phone. But I am, and whether they accept that or not, it’s the way it is for me.

Other things that provoke anxiety for me can include having to leave the house, thinking about having to interact with people. Or even the thought of having someone look at me. If ebay sold an invisibility cloak, I’d buy several. Sometimes it’s a clutching fear that something bad will happen to my dog, that I’ve poisoned him with the bug spray I used the other day to ward off the spider invasion, that I’ll never be well again, that I won’t have enough money to get groceries at the end of the month, that my parents will die and I’ll end up homeless and alone. Some of these fears are not rational (some are, though); knowing that they are not rational does not make them go away.

Again, in some people’s reaction to chronic anxiety, there can run a thread of “well, just get over it already!” or “that’s a silly thing to worry about, so why don’t you stop?” As I wrote above, if I could do that, I would.

I’m not going to write much more about chronic anxiety. Just imagine, if you would, how all this background static of anxiety adds to the effects of chronic depression and the side effects of the meds and the mind games we all play with ourselves about expectations and what we should be doing and accomplishing and being. And then, suddenly and often out of the blue, there is a big explosion of fear and anxiety that is right in the forefront of everything. And imagine that this happens many times a day, sometimes. It sounds debilitating, no?

I had originally planned to write about Stigma and Skepticism yesterday, but I guess I get a little side-tracked….

My point was going to be that it’s a double whammy when you have an invisible chronic illness and that illness is psychiatric in nature. The first whammy is that it’s invisible; in our advanced Western society, we don’t believe what we don’t see. We are empiricists; we want to see it. If you’re sick, show me your symptoms.

Well, invisible chronic illnesses, by definition, can’t be seen. You can’t see anxiety or depression (or fibromyalgia, or Chronic Fatigue Syndrome, or Crohn’s disease, or rheumatoid arthritis, or any of dozens of other illness I could name) by looking at someone. The illnesses do often have physical manifestations (e.g. someone with rheumatoid arthritis might have swollen or differently-shaped knuckles), but most of those physical manifestations of invisible chronic illness are not considered evidence of the illness that caused them.

The second whammy is “psychiatric in nature”.

There are still people, even in this day and age, who think that depression and anxiety (and for all I know, schizophrenia and bipolar disorder) are “all in your head”. I cannot tell you how many times I’ve heard “feel the fear and do it anyway!” or “can’t you just decide to be happy?” There is a pervasive belief that “getting over” depression and anxiety are a matter of willpower. Either that, or that we’re all a bunch of hypochondriacs who imagine that we’re ill. Or even worse, that we’re doing it deliberately for attention, or to take advantage of someone.

When I wear the Mask, I know I make it harder for people to understand that I am ill. I can seem confident, capable and competent, but it’s only for a short time, and I will pay a significant price for the illusion. The Mask and my illnesses don’t square well with each other.

Another unfortunate belief is that a person with depression or anxiety is somehow to blame; either for having the illness in the first place, or for failing to “get over it”.

When this perception is still not uncommon out there, is it any wonder that people who have a psychiatric illness don’t want to tell people about it? Trust me, even if you think you can tell, you really can’t tell whether a person harbours this perception.

This belief works nicely with the stigma still attached to mental illness to make the double whammy even stronger. This links back with the “blame” aspect: if I was only strong enough, or had enough determination and willpower, I could get better. Since I’m not better, I’m obviously not trying hard enough.

Well, I’m here to tell you, I am as strong as a bull. I have enough determination and willpower to choke a whole herd of your choice of animal. I have tried and tried and tried, more times than you can even imagine. And I’m still ill. If strength, determination, and willpower could make me well, I’d be the most damn well person you’d ever meet.

I guess I should define my terms here. Stigma is a mark of disgrace or shame. When something has a stigma attached to it, what it basically boils down to is this. A label is applied to that thing (or person). That label comes along with negative stereotypes (see above), and those to whom that label applies are considered to be of a lesser status. They are marked because of it, and seen as somehow “less”. Less worthy, less deserving of respect. And then, stigma is often followed by discrimination against those who have been so labelled.

The stigma and the skepticism often will keep me from revealing my illnesses. Why would I set myself up for all that? If I don’t know you well enough to know what your reaction will be, I probably won’t bring it up in casual conversation.

When I was first recovering, I thought, “To hell with the stigma! I’m going to be a one-woman anti-stigma crusade!” I thought I would tell everyone, and single-handedly change the world. As time went by, I discovered that this attitude set me up for unnecessary arguments about the nature of mental illness and the quality of my character. So now I’m more selective in whom I tell. Not everybody needs to know.

People with mental illness are no different from people with other diseases, like diabetes. When we’re recovering, we’re no different from people who are recovering from heart attacks. Doctors say this all day long. But people… people just don’t buy it… or get it, or something.

One thing that my favourite psychiatrist told me (I affectionately called him Psydoc) was that it took me twenty or more years to get to the point of breakdown; why did I expect that in a few weeks, or even a few years, I could recover? He often told me that we don’t expect someone who has a heart attack to get up and run marathons, so why would we expect someone recovering from severe depression to be well overnight?

Psydoc was also fond of reminding me that not so long ago, people with depression as severe as I have were not out in the community, getting well. They were in sanatoriums, or institutions. But he was right; even a couple of generations ago, someone with a severe case of depression would live in a psychiatric facility, undergoing treatment every single day, under care 24/7. And I was out in the community, having therapy at most once a week, doing try-it-and-see-if-it-works with meds. In a facility, meds can be given intravenously, and it is MUCH faster to do it that way. It takes a certain level of many meds in your bloodstream before they become effective, and it takes time to reach those dosages when someone is taking meds orally. And with inpatient care, they are constantly monitoring the patient, able to adjust meds as needed, and to try many more types of medication in a much shorter period of time.

Psydoc was a wise, wonderful man. I miss him. Psydoc, if you’re reading this, please move back from the Yukon!

This is my first official post for National Invisible Chronic Illness Awareness Week (NICIAW). Today, I wanted to write about my reality: invisible chronic illnesses that are psychiatric.

First, some background. I have chronic depression and anxiety. Scientists have discovered that once a person has had one cycle of clinical depression, that person is more likely to have another cycle. The more cycles one has, the more likely it is that one will have more.

I cannot tell you how many cycles I’ve been through. I do know that since my breakdown in 2000, I have relapsed every year at least once. Some relapses are mild, but others are quite severe. None have been as severe as my breakdown in January of 2000 (thank the universe or whatever’s out there!), and I’ve heard many times in treatment that once we start treatment, we can never be in the same place again because we know more than we did at that time.

I’ve done many different kinds of therapy, the most helpful of which have been Cognitive Behavioural Therapy (CBT) and regular old talk therapy. I’ve done group therapy, which was important at the time, but I’d prefer not to have to go through it again. I’ve had psychiatrists and therapists, psychiatric nurses and occupational therapists. The important thing is to find the thing that works for you, with the “therapeutic person” that you have a connection with. As far as I know in Canada, psychiatrists mostly just prescribe medications, and don’t do a letyot of therapy. That means that a patient has to have some other variety of therapeutic person in order to do therapy. I firmly believe in the importance of therapy in the treatment of mental illness.

However, I also believe in the importance of medication. Depression can be caused by life circumstances; usually, this is the kind of depression that goes away with time, as those circumstances change. But depression is also caused by brain chemistry, and often medication is vital to changing that brain chemistry. I take more pills than I’ll list here, but I do know that I will always take an anti-depressant, for the rest of my life. My brain just doesn’t work as well without it.

And as far as anxiety goes, I believe the same thing: therapy is critical, and medication can be a lifesaver.

You can’t tell by looking at me that I have chronic depression and anxiety. Part of that is because I’ve probably had clinical depression since high school, if not earlier, and I developed a Mask. My Mask is one of competence, confidence, and capability. I have had literally YEARS of practice at appearing to be well (or at least okay and functioning) when I was in fact far from it. One of the phrases I particularly like is “hiding in plain sight”, which I read in someone’s blog. (Forgive me, lady blogger, I thought I’d bookmarked the post where you said that, but I apparently didn’t, and I can’t find it again. If you’re reading this, please let me know!)

One of the negative outcomes of having this kind of Mask is that it’s like a default position for me. I can assume my Mask in all but the most severe and dire relapses. This is hard for people to square with the idea that I am disabled and debilitated by my illnesses.

The Mask won’t stay on forever, though. It is a limited time coping mechanism. (And not a very good one, at that. I do not recommend it.) I can keep it up for a while, but after a couple of hours of smiling and nodding and seeming to be very capable, I will go home, collapse, and quite often cry for hours. And then I will be out of it for days.

When my anxiety is really high, the Mask slips somewhat. As I am writing this, I just received an email from an SPCA colleague of mine. We have our annual Walk for the Animals on Saturday the 13th, and I am in charge of the registration process and all of the money. This is Year Three of the challenge, and I haven’t been very happy with the way it’s worked either of the past two years. So my anxiety level is really high, and it obviously came through in the email I sent to her asking if she’d gather some materials for the booth at which she is working that day. Her response began, “Linds, relax a little.” I know I’m bad when my Mask doesn’t even work over email.

I’ll talk a bit more about the Mask in my next NICIAW post, which will be called Stigma and Scepticism.

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