Mental Health Awareness Month

April was Autism Awareness Month and May, among other things, is Celiac Disease and Mental Health Awareness Month: two other causes near and dear to my heart. There’s been a boom of awareness around celiac disease, though partly convoluted by the gluten-free fad, yet I don’t feel I need to devote much attention to it at this point.

Mental health awareness, on the other hand, is more important to discuss, primarily because mental illness still seems to carry a stigma that it’s a weakness and should be hidden, something disgraceful that should be covered up—a coveted secret not to be confessed. Even when I was in graduate school last year, I remember telling a classmate that I wanted to adjust the arranged meeting time for a group project because of therapy and he replied, “oh, what injury do you have?” assuming that it was physical therapy to address a running injury (an innocent, and reasonable mistake). I said, “no, psychological talk therapy for depression and anxiety.” “Uh woah, yikes, weird. Uh yeah, let’s just pretend it’s physical therapy.” He, by no means, said this with any ill-intent; on the contrary, he was trying to protect my ego and present the “safer” or more respectable alternative to the group to spare me the assumed embarrassment.

I’m so accustomed to mental health treatment and therapy at this point that I’m not afraid to admit that I need it, use it, and find it helpful. Of course, I prefer not to broadcast it and it certainly would never have a place on a brag reel, but mental health services are simply another legitimate, and necessary facet of healthcare. Like physical illness, which can range from acute viruses or injuries to chronic illnesses like multiple sclerosis, and range in severity from mild infections requiring a short course of antibiotics to intensive or emergency care situations or terminal cancers, mental health illnesses run the gamut. Some conditions are acute and short-lived, while others are chronic; some are more of a mild nuisance while some are debilitating. Even depression can be experienced in an acute bout in response to a difficult situation and some anxieties or phobias only crop up when encountering a specific stimulus. Other people, myself included, have chronic depression and generalized anxiety (and PTSD) that are regularly present. Beyond anxiety and depression, there are probably hundreds of other recognized psychological conditions with just as many varied presentations as people afflicted with them. Also like some physical illnesses, a variety of mental health conditions go undetected or untreated. This can happen in cases where the umbrella of symptoms is hard to identify or they exist at a low enough level or persist for so long they become the individual’s “normal,” or because of lack of awareness that there is help, or one’s pride or lack of insurance/resources preventing one to seek help.

Mental health awareness, or increasing the frequency with which these conditions are discussed is therefore important for two key reasons: to increase the general public’s understanding of symptoms and available resources (to aid diagnosis and treatment so that individuals don’t suffer in silence or from an uniformed place) and to show the variety of shades and types of psychological illnesses and their common prevalence (to help reduce the stigma of it being “weird” or “shameful”). Anyone can experience mental health problems, although some people are more susceptible to certain illness than other people. Receiving a diagnosis and participating in treatment is a critical step in managing or mitigating symptoms and reducing risks associated with symptoms or behaviors of such diseases. I can speak to the fact that left unaddressed and unchecked, mental health problems can escalate to severe issues or dire situations. Like physical problems, the earlier a mental illness is addressed, the better. It would be dangerous to allow bacterial pneumonia to fester for weeks, lest it turn into a more critical condition; it is equally risky to sit with depression for weeks on end, allowing it to spiral into a more critical condition. Then, instead of responding with more conservative treatment or improving more quickly, it can stick around longer and necessitate more comprehensive measures, not to mention the unnecessary suffering.

I hope that people will continue to speak up about their battles with mental illnesses. Discussions and admissions are some of the best ways to increase awareness, educate others, reduce the stigma, and potentially help or save someone else’s life. I vow to do my part and try my best to be brave, honest, and open and engage in conversations, even if personal or uncomfortable. I’d rather be slightly embarrassed (though my whole point is that I shouldn’t be, it’s natural to be in our society’s current attitude towards such issues) and divulge certain parts of my life that are nowhere near pretty or perfect, and potentially help someone else who is suffering alone, confused or worried, or too shy to take the next step.

Here is a resource that may be helpful

:

http://www.mentalhealthamerica.net/may

 

Takeoff

Yesterday my mom visited with my nephew who is just two weeks shy of his first birthday. My mom forms one of the three vertices of my triangular support system. In fact, we talk every day and those conversations (which are always the real stuff of life and not just about the weather) are often a highlight of my day! She’s also my dog’s favorite person in the world: one mention of the word “grandma” and she starts cocking her head to hear more and whimpering in excitement. String together “grandma coming” and you’ve got a full-on frenzy of jumping, sneezing (her excitement reaction), and whining. I’m somewhat the same way, albeit with a bit more of a muted and controlled reaction.

Though she always makes me feel better, I push my mom (and others) away when I’m at my very lowest. I tell her not to come, I cancel plans, and while I keep up the daily phone calls, I keep them brief and more impersonal than our normal deep talks. Part of this is the social challenges of autism intensified by the depression, which makes the mental picture of entertaining “company” completely exhausting and unappealing. As depression zaps my energy even more than it is already usually taxed with SPD, this becomes an insurmountable ask. Secondly, it’s self-preservation. Such a deep state of depression feels shameful and I want to hide from those I love so they don’t see how much I’m struggling. It’s too tiring to cover it up and pretend to be “fine” and it’s too embarrassing to be real and authentically express my emotional pain. With that said, ultimately, it’s self-sabotage. By avoiding my mom (or others), I’m denying myself the opportunity to get help with my problems, to talk and spend time with someone who not only loves me unconditionally, but is an amazing listener and resource. I wish I didn’t do it and even when I cancel plans, it sends me deeper into despair and I immediately regret the decision and start crying. I’m crazy!

My nephew is a real charmer and my sister and brother-in-law have done an amazing job raising him so far and he is their first. The kid exudes happiness and wonder like nothing I’ve ever seen. He approaches everything with a smile so big and unwavering that it looks like his happy cheeks will topple him over they are so bright and expressive. There’s something about young children that’s always been reassuring and soothing to me.

For instance, I used to be so fearful of airplanes that I chose not to travel when certain opportunities presented themselves. When I did fly, my phobia was so debilitating that I’d break into a panic attack as soon as we pushed back from the gate and started taxiing toward the runway. Even though a space shuttle and an airplane are quite different, after watching a video of the 1986 spaceship challenger’s launch, I could not separate the vision of the plane blowing up in flames at takeoff. Flying is also a sensory nightmare. The rumbling engines, the hissing cabin air, the sudden lowering or raising of the wheels that make an audible and perceptible clunk, the stuffiness, the inability to move freely, the ear pressure, the nauseating sensation of changing directions or altitude quickly, turbulence, and the inability to regulate your own temperature easily are just a few of the flying challenges that are particularly exacerbated for those with SPD. Those, I can manage a bit now like anyone else. The crippling fear the plane was going to be engulfed in flames? I got over it. I’m not afraid at all anymore. I just started watching young kids around me on the plane. Although most people hate being seated near a toddler or small child because of the inevitable crying, I hoped for those spots. Watching children’s reactions during takeoff calmed me. Babies rarely cared. Toddlers went along playing and were blind to the fact that the engines were roaring, our altitude was rapidly changing, and that stomach-turning feeling of lifting off was upon us. Even more, young kids excitedly pointed out the window, shrieked with glee, or clapped. The naivety of children is refreshing and can be reassuring for someone who is constantly fighting the chokehold of anxiety. Their ignorance is bliss, even for me.

A parallel can be drawn between the reassurance I felt on planes with children and the power of my nephew’s awe, enthusiasm, and undeniable joy to elevate my mood and reestablish some pleasure in the simple things around me. It was impossible to not smile while watching Eamonn (my nephew) totter around stumbling towards things with such palpable exuberance. A stick. The arm of a chair. An old plastic cup. His favorite, of course, the dog. How thrilling!

Even though social interactions are exhausting for me even when I’m not depressed, they come with an inherently wonderful tradeoff: they are able to refill the tank. When they left, I felt a familiar sadness creep back over me. This isn’t as bad as it sounds because it meant that I was afforded a pause from such pain while in their company and some of that goodness and love lingered with me even after they were gone, bringing my baseline up. My takeaway for myself on this one is two-fold: don’t hide from those that love you just because you’re too depressed to be social (it’s worth the effort and transparency) and approach the little things with joy and wonder because life looks even more beautiful and less hostile with those glasses.

 

Is the Sinkhole Escapable?

The beautiful weather this weekend helped wrap a strong rope around me and took me back a little further from the edge of my depression canyon. I can still see too easily for comfort over the edge into the sinkhole, but I’ve got at least one foot on some solid soil. Now I’ve got to harness all my physical and mental strength and pull the rest of my dangling body up onto the ledge.

At the risk of over-analyzing things and scaring this slightly elevated mood back into its shell, I want to consider what made this weekend a little better so that possibly I can identify strategies to keep things trending in this direction. Of course, weekends are always nice because I get to spend much more quality time with Ben and we had fun together this weekend. Unfortunately, the way that our schedules (don’t) line up during the week prevents this from transferring easily to a weekday luxury. The weather was great, and I thrive on sunshine. With the significant limitations of my injury, this is actually a positive and negative. It’s almost more emotionally painful to weather the tease when the warm weather and sunshine beckons me to be out walking, running, biking, or playing outside than suffer through the gloomy, rainy days we’ve had lately; at least in the latter, I don’t feel like I’m missing much. The weather will only get better as we enter spring and summer, so I guess this will be mostly good.

Ben and I had some difficult talks this weekend but they enabled us to make some big steps forward together so I think that feels good. It reminds me that I’m healing. Sometimes progress seems so stagnant and possibly even reversed, but then suddenly, an impressive step is taken and rewards the patience and toiling that was previously invisible.

What else? A few people reached out after my last post about depression and that helped me feel connected and understood. I’m quite socially isolated, so sometimes it can feel like my struggles fall in uncharted human territory: I’m the sole soldier in such battles. Even with others who are far away and whose lives have seemingly little parallel with mine, it feels validating and somewhat relieving to know the struggle is not only mine (not that I would ever wish an ounce of emotional or physical pain on anyone).

Not that much else this weekend was radically different. I just tried to ride on the coat tails of my own inertia and bounce between activities a bit to keep busy and distracted. I also made a list of things I’m grateful for as I strongly believe there’s nothing as powerful as gratitude (outside of love) that can elevate one’s mood. I’ve restarted my daily morning practice of jotting down three things for which I am grateful, even if they are ostensibly small; it’s remarkable how quickly a list of life’s beautiful gifts amasses and that bounty is plentiful enough to keep my head and heart reeling me away from depression’s cliff.

 

Is the Sinkhole Inevitable?

I’m in a tough place today and there’s not really any specific reason or excuse for it. I suffer from chronic clinical depression. Most days, I’m actually “fine” because I’ve become so accustomed to the depressed feeling that the bar against which I compare my emotional state has been permanently lowered. On these days, I grind through the motions, keeping busy with work and daily obligations, peppered with (hopefully) some leisure activities to lift my spirits. Other days, like today, for no obvious reason, I’m not fine. Everything feels like an emotionally draining chore and my resilience seems completely dried up. On these types of days, I may even cry with just the slightest frustration or discomfort because I’m in a perpetual state of straddling the precarious threshold between holding it together and completely falling apart.

On days like today, I feel deep and genuine loneliness. I am alone all day every weekday, but even if I was blessed with company today, I’d likely still feel loneliness in my heart. That’s one of the challenges of true clinical depression—it can be virtually impossible to ease the suffer during a low because the real things I’m depressed about are just that: they are real, they are heavy, and they are virtually impossible to change. Add those factors to a neurochemistry that predisposes me to emotional lows, and it’s more of a mystery as to why I (thankfully) have mostly “fine” days versus the more occasional bad days. (For the record, I’ve been doing therapy for several years and still actively do so and I don’t respond well to anti-depressants so I steer clear of those.)

Why is today worse than usual? Like I said, it’s unclear. The weather is awful and I’m in a lot of physical pain, so those two variables don’t lend themselves to the easiest of days, but honestly, I’m in pain most days and New England weather often graces us with less-than-ideal and erratic conditions. It’s probably somewhat of a chicken-and-egg situation. The more depressed I feel, the more I become aware of the reasons behind my depression and my powerlessness (coupled with impatience in some instances) to improve these. For example, when I’m really down, it helps me to get outside and run or take a walk with Comet. Right now, it’s pouring rain and I am on crutches so this is not going to happen. That makes me feel more trapped and takes away one of the few effective coping mechanisms I have. The frequency and severity of PTSD flashbacks is significantly magnified when I feel trapped and depressed. There’s an exponential relationship between the number of flashbacks I have in a day and my depressed mood, so as they come with increasing frequency on days like today, the emotional pain I feel skyrockets. It’s pretty impossible to have a good day when your brain will not bring you peace from violent memories. I think my PTSD has been particularly bad lately because of my broken foot. It just so happens that when I was attacked, I was also in a boot with a broken foot. The injury did not contribute to the traumatic event but my brain still relates “broken foot” with “attack” because in the weeks following the attack while I was healing, I was also painfully aware of my foot situation because again, it limited how well I felt I could cope. Now when my body sees “boot” it thinks, “attack.” (Pavlov was onto something…)

I’m depressed about things other than the attack and its aftermath (the ways it still affects me today), the foot, and the weather, but the other stuff feels even less topical and more stubborn or impossible to change. For instance, I’m upset that I have all the sensory processing challenges with autism because they are so limiting. Even with dedicated OT (occupational therapy), these aren’t going to go away. I can’t change my neurology. There’s an actual issue in my brain. The only thing that I can control is my attitude toward the issue and that forces me to abdicate the captain’s chair from which I’m a lot more comfortable. It puts me in more in the passenger’s seat: a less powerful, more hands-off role, with significant limitations in my ability to effectuate change. I’m not steering the ship and it’s not going where I want it to, yet I’m told to just take out my camera and enjoy the view. Sure, a bunch of pictures of glacial bays may be pretty, but if I actually want to be sailing by a coral reef, there’s only so much satisfaction that icy vistas will give me. One of the autistic brain’s modus operandi is ruminating on something and not being flexible to change course or stop fixating. When my brain decides or wants something, it’s all in and there’s virtually no way to convince it otherwise. This isn’t always a negative trait; in fact, I’m sure it’s helped me remain steadfast in many pursuits and goals, but such inflexibility can also be frustrating and annoying (to others for sure, but to me as well!). Even when I want to change course or focus or let go of something, I often can’t and no amount of logical or emotional convincing or targeted strategies will convince the rest of my brain otherwise. Of note, partly due to this reason, I find it nearly impossible for me to transition and switch tasks. Even if I physically move on to the next thing on my agenda, nine or more times out of ten, my brain is still analyzing, cogitating, and deliberating on my last task. I am much more productive if I only take on one or two things per day and do each for an extended bout of time because I don’t waste time trying to wrangle my brain to shift gears and catch up with the new activity.

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Well, this post has been marinating for several days. I’m not doing any better. I’m findings myself clawing at the falling rubble at the edge of the cliff as a dangle and fight the to stay on the solid land above the abyss, above the sinkhole of deep depression below. I’ve been down there so many times and it is barren, dark, cold, and scary. It’s not where I want to be and it’s even harder to climb back out than it is to cling on and try to grab any solid rocks I can find, even though this position is also terrifying and exhausting. I’m trying to distract myself and also dedicate my energy to preventing the fall. Hopefully instead of avoiding writing as I have been for a few days, I will embrace it as a tool to help hold me up where the beauty, the light, and the stability reside. I’m surrounded by goodness when I am brave enough and strong enough to see it, so hopefully admitting my current struggle will help me face the pain and this problem and fight back with the tenacity and resolute that seems hardwired in my steadfast and stubborn ASD brain.