#therapy

Consistent Upturn

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I have been feeling it. That spark that starts small deep within and gets bigger and bigger until a strong flame emerges. I just keep feeding it with small weak kindling at first, then twigs, and finally I am throwing entire logs to keep the fire alive.

This is life now. I found happiness. I almost pause at saying that so as not to tempt God to take it away once more. It feels like this consistent upturn for me though, a mindset that is not going anywhere. And I embrace it.

It is interesting though, the timing at which this steady feeling of fulfillment and satisfaction has come into my life. I question really what I can attribute it to often. After all, I went through probably the second most traumatic loss of my life this last August. I also had to find a new job. My house was a mess. Nothing was pointing to a moment of happiness, let alone a whole season.

I believe that this is where the lesson and the truth is. Sometimes it is in the darkest of times that we can clearly see the light. We can decipher between something that is pretending to bring happiness and what truly does bring happiness. We know what direction we need to walk in.

I don’t feel like I have been in a storm and am now out of it. But perhaps that is exactly what has happened to me. When storms come and we don’t sway or falter, when our foundations are laid so strong and solid, when we are steadily growing in our good habits and our faith, we realize the storm raging outside of us isn’t getting in.

It has been stormy for months. Things are getting even more volatile with the transfer of my fiancé to a permanent facility. Yet our love and our bond, and my life’s endeavors, remain strong and safe inside.

Sometimes I open up that door just a crack and let the rain and the wind sweep in. I am reminded how warm and comforting it is inside of myself and inside of my love for others, and I go ahead and shut the door once again. It is a fleeting occurrence and nothing more.

Sometimes I feel like an imposter still. I feel like I am not qualified to weather this storm. I feel like I am not disciplined or simply just enough for all that I pile up on my plate.

My therapist suggested instead of feeling this way, I should reach out to people who know more than me so I can receive advice and answers and eliminate that fake feeling. So that is what I’ll do.

I never know how long the reprieve from depression will last. The brain has a good way of tricking you to believing you will feel whatever emotion you are having now, forever. But I do know that is never the case. Until then, I will be grateful for all the things I do have and like Blue October sang, “remain independently happy.”

Consistent Upturn

Hit the Snooze button

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***Trigger warning: suicidal ideation***

Everyone says I am depressed. I go to my weekly therapy and my therapist listens to me talk ten minutes straight how life is going and then says “Sound like you are really depressed.” I send off a video message to my best girlfriends who live in different states. The reply comes back and says “I don’t know but it sounds like you are depressed right now. Go sit outside and soak up that vitamin D.”

How am I missing this? I am a self-proclaimed expert in the self awareness arena. I know depression. Very well. I think it must be that I have never in my life been depressed when a desire to sleep forever is not part of it. Yes, I am talking about suicidal thoughts. I don’t have any of them.

This surprises me a lot. Everything that I know about the disease that is called depression lends to the progressive nature of suicidal ideation. I am at the stage of this disease that a minor bout of depression invokes the full ideation gameplan.

Before I go further, I need to reiterate that I have done A LOT of therapy on this topic, and it is a solid agreement with myself, a promise, that I will not entertain any of these wild thoughts that come about due to depression. So we are all good there.

It is just I have never had every physical and emotional symptom of depression without the desire to not be alive. It almost messes with my head. It is a sneaky tactic of my enemy, depression. The alarm didn’t go off or in my stupor, I hit the snooze button instead of deploying the arsenal of coping mechanisms.

So where does it leave me now? Where do I go from here? Now that I am convinced by my trusted friends and professionals that I am depressed, what is the next step? I mean, have you ever heard of a depressed person who has a solid sense of joy? I am grateful constantly, but the emotions don’t match.

I know…. This doesn’t make much sense. I don’t understand it. I am in love. I am grieving a loss. I laugh every day. I have no motivation. I perform well at work. Sometimes I sleep all through the day. I am textbook confused.

I have decided it is okay and safe for me to just continue. To be sad and grateful. To be sleepy and productive. I will feel what I need to feel when I need to feel it.

It is okay for me to hit snooze right now. Slow down, make the problems wait just a bit longer. When I do wake up, I know I have everything I need to shake off the depression.

Hit the Snooze button

The Cost of Happiness

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Several months ago I started a new “add-on” antidepressant medication to be taken in addition to my current medication regimen. The doctor handed me a small white paper bag containing a few months worth of pills in sample packs for me to “try before I buy.”

Much to my surprise, they worked! I had a long and disappointing track record of medications not being effective for me. The new technology in pharmaceuticals really is something! My brain fog lifted, I felt more grounded, engaged, and energetic.

The next visit followed suit like the first. I reported the great results and we adjusted the dosage slightly and I walked out with my white bag of happiness. A couple months later just before Christmas break, I phoned the doctor’s office requesting a script to be called into my pharmacy as I was running low.

My pharmacy run went smoothly, $57 for my first medication, and $32 for my new one. Despite a stressful holiday season, I made it through with a little more motivation and peace.

Last week, I needed a refill of my fancy new drug. I called up the doctor, and shortly after received a call from the pharmacy. I thought it was a bit odd because usually I just get a text notification when my scripts are ready. The pharmacy tech politely said, “We have your script here, and we already applied the manufacturer’s coupon for $400 off. But the balance for one month supply is $900, and we wanted to see if you still wanted this filled?”

*Gasp* NINE HUNDRED DOLLARS for 30 pills?? How in God’s green Earth could a tiny pill cost so much? Without the coupon, that is roughly $43 per 1mg pill. That is more than I spend to feed my whole family of three in one day, at a nice restaurant nonetheless. That is like me going out to eat a filet minion every day of the year. Apparently the last time it was filled, I had met my deductible and out of pocket max.

I smiled and thanked the pharmacy tech for the call and let her know I would pass on filling the script. Flashbacks to when I found the only effective medication was not labeled for depression and the typical administration of it was intravenous infusion, costing $500 each time. Thankfully, I was able to manage to convince the doctor to order me the oral compound version for $1,943 less each month.

What I can’t understand is how we expect society to avoid constant mental illness crisis among the poverty-stricken. To obtain my medication, I am required to visit my psychiatrist every two months, by law. If I had no insurance, this is $250 for 15 minutes, or $1,500 a year. Medication is not enough though. For my therapy every week, it costs me $70, or $150 for uninsured. That is another $7,500 a year. So sure, let’s go ahead and tack on another $15,000 for medication.

This is what I need to live. I know I quip this is the cost of “happiness” but it isn’t even that. It is the cost of functioning at a job, parenting my children, keeping myself alive. I have a terminal illness called major depression, where if untreated has a fatal prognosis.

So what can I do? What can anyone do? How does it change? I do the only thing I know… I go to my doctor and ask for another white paper bag, praying the day never comes that they stop receiving samples to give.

The Cost of Happiness

I Survived

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Last week I went to therapy without a voice.

Literally, no voice! Just faint whispers and head nods to indicate the person I was communicating with understood what I was trying to say. So, how do you think it went? I’ll tell you… it was flawless and epiphanic!

I began the session half-whispering, half-mouthing the words “I know this is less than ideal. On the way here, I quickly realized how poorly thought out this was.” But I did in fact think it through. I had a plan. Today, the therapist was going to talk to me and I would listen and take notes.

While slightly reluctant, but completely in sync with my master plan, my therapist started out saying, “I have observed a common pattern resurfacing once again. You do extremely well for a period of time, then you flip a switch and decide to exorbitantly overwhelm yourself. This continues to a degree that can bear no more, and you fall apart and spin down the spiral to despair.”

He looked into my returning stare as if to siphon out a response from my mute vocal chords. “Ah! But there is also THAT! You have the innate ability, the extreme talent, of rationalization and justification right to the very edge before you plummet. I fear you are very close to that edge right now.”

Readers, my therapist gets me. I mean, he really GETS me! Without a single syllable vocalized, he knows what I would say. “But, I actually survived this time. I came out the other side. I compartmentalized my life to a measure that prevented the world from collapsing. Sure, I didn’t eat, sleep, laugh, or live for four and a half months while my work life dominated every waking minute of my day.”

“Absolutely, I drive myself to the point of physical illness that robbed me of the very thing I needed to be successful in my job at the most critical moment, two days before the hard deadline. I had no voice. I had no energy. But I also had no emotion. So I survived.”

This is what I said without the sound waves crossing the room. This is what he already knew I would say. He agreed, although not with approval. He told me how I had practiced a new level of coping skills that had served to make the outcome of a outrageous stress level a positive one. He said, “You know, you really don’t need to come every week. Once or twice a month, maybe. You have elevated to being able to be your own therapist.”

This isn’t something I hadn’t heard before. After all, 8 years ago when I began weekly therapy with him (sometimes twice weekly those first years), I had already navigated three decades of my life with depression. There wasn’t anything new he could tell me.

I regulated my breathing, and whispered, “I know that. But this is one thing that will never change. The same day I came to terms with the solid fact I would take one or more pills every day for the rest of my life to save my life, I also knew I would enter this office once a week for as long as the door was open and the lights were on. Besides, this is my one hour a week to lay it all out there, to process, to laugh or cry or yell or rest.”

He nodded, “Yes, I will say this was likely your only act of self care these last five months.”

Yes, and because of it, I survived.

I Survived

Day Two: Ring Theory

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**This week’s blog posts are dedicated to advocating for effective mental health treatment and educating patients, family, and friends in all areas of inpatient psychiatric care. The perspectives shared here are not that of a mental health professional, but rather someone with lived experience. Information shared may not align with every circumstance or viewpoint of readers, but is meant to offer guidance in an area that is often confusing and holds little resources.**

Oftentimes when we know someone facing a crisis, whether it be a close friend, family member, or just an acquaintance, we don’t always know the right words to say. We may also have a difficult time processing the crisis through our own emotions and actions and before long, the wrong words come out to the wrong people at the wrong time. Several years ago, I was introduced to something called the Ring Theory and it became a very simple tool to use in any crisis, mental health related or otherwise. It saves friendships, relationships with family members, and ourselves from embarrassment and bitterness.

Essentially, this is how it works:

  1. Draw a circle with the name of the person in crisis written in the middle. In our case, this is the person being admitted to a psychiatric hospital. This is the first ring.
  2. Draw a second circle and name the person(s) closest to the person in crisis in terms of relationship. This is most likely a spouse and any children.
  3. Draw a third circle and name close family that is not part of the second circle, such as parents, siblings, very close relationships with aunts, uncles, cousins, or grandparents. For minors, this circle would actually be the second circle.
  4. The next rings are completed unique to whomever is using the tool. For example, if the person in crisis is your family member, the fourth ring and beyond will people in relation to you from closest in relation to furthest in relation. These rings will likely be filled with people that may know of your family member but don’t know them directly, like your coworkers, friends, church leaders, and your personal therapist.
  5. Using the tool: When communicating about this crisis and how it impacts you, the rule is “Comfort In, Dump Out.” What that means is anyone in a smaller circle than where you place yourself should only receive support and desire to understand. Anyone in a larger circle moving outward from where you are on the rings are safe to vent to, seek advice, and generally receive support from. The closest outward ring from you is typically the safest group to disclose details in confidence and less details should be shared the further you get from the center. Likewise, be accepting of negative dumping from anyone in a smaller circle than you, including the person in crisis. See below for a diagram of what this looks like.

In practice, this would look like a close aunt to their adult nephew in crisis phoning their best friend to entrust their emotions regarding their nephew being hospitalized. But when she is getting updates from her nephew’s spouse, she should refrain from expressing these emotions (don’t say “I can’t handle this! I have never seen him like this. What in the world are you going to do?”). She would offer comfort, help, and advice if solicited to the nephew’s spouse, and dump out the stress and fears and emotions to her best friend.

So what do you do if you are on the same ring as someone else? How do you communicate to other close family members? or what if one of your tight-knit group of friends is hospitalized? This is where judgment comes to play. Evaluate if factors exist that would place you or the other person closer to the situation or the person in crisis and apply the theory. Seek an outer ring connection to be safe if it is unclear. But, in reality, this most often looks like mutual support, a give and take from both people. Share when the other person is strong to support you and be strong when they need support.

As the rings go in, the emotional stress of the situation increases. This means the highest stress level outside of the person in crisis is usually the spouse and children. In the same respect, the further in, the harder it is to reach out. Many times, a spouse struggles to share with anyone how the situation is making them feel. My best theory for why this is, is because when they are in personal crisis, their closest confidant is usually the one who is in the center of the rings at this moment. The person they usually dump everything on should only be receiving support right now. It can leave a person feeling isolated, alone, and seeing their negative emotions build up. Empathy and understanding in the silence can go a long way, and providing practical help is sometimes the only avenue we can take to support.

In closing, there is one person that trumps all of the rings. And that person is your personal therapist. Having a therapist, you can always rest assured you are dumping everything to an appropriate person without question and you can ensure you are receiving the support you need to be better equipped to be an asset to the ones closer to the crisis. It is typically overlooked when someone has a mental health crisis that anyone other than the person in crisis is in need of professional help. In reality, friends and family members having an outlet in speaking to their personal therapist actually is in benefit to everyone involved. Practice using this tool in small ways and prepare for when it can be used in the hardest of days.

For more information on Ring Theory and its origins, please click on this link.

Day Two: Ring Theory