Depression: When It All Falls Apart

There are no words adequate to describe depression. Unless you have gone through it, you never know what it is like. And there are different kinds for different reasons. Many of us will go through situational depressions in our life that may even last a few years from an illness or grief from loss of a loved one. The depression I am talking about is the one that is a mental illness which just lasts and lasts your whole life. Where you go out in public and you look at other people and wonder how they look so normal. How do they get through their day? Why are they smiling? Is life so excruciatingly painful and hard for them as it is for you? Do they live every moment of every day doing only what they have to do to keep their jobs and not look like a freak? Do they count down the seconds and hours until they can go back to bed and stay there until their next required task comes around? Do they wish they enjoyed time with family and friends? Do they have no motivation to wake up in the morning because they know every day will be agonizing and joyless? Soulless almost?

It is sad to have depression because you wish you enjoyed all the things you love, like family, friends, and work. But when you are depressed you want to spend no time with anyone, doing anything. It can also make you mad that you are required to fake a smile and pretend to be happy just so you don't make other people uncomfortable.

Photo by Jeff Norris

It's also annoying because you do the right things and are still sick. I took the medication, which seemed to be working but the side effects were so bad I had to dramatically decrease the dose and see if I can build up more slowly. Any time you change a dose of medication, it can make your symptoms much worse and so my depression now is extremely bad. Also, my Mom has gotten worse and is now in hospice care so I am sure that is adding to my poor mental state. The problem is that normal sad or scary life events are different for people with mental illness. These events may or may not set off your illness and make it much worse. It is not like you can avoid those situations, but you may have to realize you will have months or years of fallout after stressful life events. Even good events like job change or marriage. And right now I have changed medications, changed jobs, and Mom is dying so I should expect that I will get worse, it's just that every time it happens, you have never quite prepared for it.

You are never prepared for how your illness with rear it's ugly head. For me it's how the depression, mania, anxiety, and eating disorder combine to create depths of despair and hell I didn't think were possible.

So, now when all of those things happen in your life, what do you do about it? You have mental illness and can't just "change your mind," "shake it off," "act happy," or "be different." But that does not mean you are lost. Here are a few tips and I know they are not easy to do, but once you do one, it gets easier and easier to do more:

1.  Remember that it is not always like this. It is not always this bad, there are good moments.
2. Ask for help when you need it and will accept it.
3. If you have not exercised, slept, or eaten correctly in weeks, do one of those things right one day, then two the next. Make one good decision every day that makes you feel better, no matter how small it seems.
4. Tell your illness and whatever other factors contribute to it that they won't win. (I would probably use some more colorful language around that to really be firm about that point.)
5. Write about what is going on, that usually diffuses the situation and helps you see things more clearly.
6. Know that you are loved by God or the Universe, whatever you see as greater than yourself. Get in touch with that Spirit of Love through church, prayer, nature, art, animals, meditation, the beauty of science- anything that gives you the "awe factor" and lets you know you are not alone.

Remember that managing mental illness is a process where you will get better and worse. You just can't give up, and that is the hardest part. You are too precious and too important to this world to give up on and you always need to remember that no matter what your illness makes you think or what other people tell you.

Blessings,

Rev. Katie

Ask Me: "Why Is This Happening?"

Recently I have attended some trainings about dementia care from Dr. Cameron Camp who's work has really changed dementia care from leaving people to sit in a bed all day, to teaching people with dementia new things and getting them involved in activities. His approach helps them deal with their illness better, increases quality of life, decreases medication, and decreases stress on both the person with dementia and their caregivers.

Dr. Camp taught us two things which he said he never wants us to forget:

1. When someone presents with a "problematic" behavior ALWAYS ask: "Why is this happening?"
2. The answer can NEVER be: "Because this person has dementia."

This is because way too often when someone with dementia is agitated, like maybe yells for the same person at the same time everyday, typically the first response is to ignore them or medicate them to the point where they are so sedated they stop yelling. Then this behavior happens over and over again every day and you never solve anything.

Instead, you could stop and ask the person with dementia "Why is this happening?" Such as, "Why do you call for Emily every day at 2:00?" It might be because that was the time her daughter Emily came home from school every day. It might be because they need help with something at that time each day but don't know the name of anyone in the assisted care facility so they yell a random name until someone comes to help them.

For people who can not respond to the "Why?" question, you can ask yourself, "Why is this happening?" Maybe someone wanders and is agitated at night and when you ask yourself why, you realize it is because they were a night shift nurse all their life and they think they are at work.

Once you know why it is happening, you can think of solutions. Such as teaching the person who yells the name of their nurse (yes, this can be done) or giving the agitated wanderer work-like tasks to do at night to calm her. If you always just think the behavior is "because the person has dementia" then you automatically stop looking for a way to help them and they spend their life agitated, sad, and unhappy. No one deserves that.

When I was at a different dementia training this week, a caregiver was talking about a problematic behavior from one of their dementia patients. So, I suggested Dr. Camp's teaching to first ask "Why is this happening?" The caregivers response was that she would never ask this patient why it was happening because not only did they have dementia but they also had mental illness like anxiety and Obsessive Compulsive Disorder and you don't ask people with mental illness something like that. I said yes, you do, that is all the more reason to ask why. She did not like that answer and insisted that someone with mental illness should never be asked "Why is this happening?"

This really upset me. Why not ask the patient why? She deserves the same respect as everyone else, and just because she has mental illness does not mean she has no idea what is going on, should have no agency in her life, and should not be given the opportunity to say what she needs. Also, this caregiver was assuming that the answer to "Why is this happening?" would be "Because this person has mental illness." However, if we expand Dr. Camp's teaching to mental illness,  you can't just say something is happening "because someone has mental illness" because that stops you from ever trying to help them.

Here is a simple example. I have had anxiety for my whole life over many different things and I have had many problematic behaviors because of it. For instance, when I was little, I did not flush the toilet at home. For my parents, this was a problematic behavior. Now, if you didn't ask why this was happening because I have a mental illness and you thought I didn't deserve to be asked that question, then you could never have helped me.

E.T. - Photo by Jeff Norris

If someone had asked why, they would have learned that the movie E.T. scared the heck out of me and for some reason I thought the flushing of the toilet sounded like a spaceship and E.T. would come out of the toilet if I flushed it. Due to the anxiety, you may not have been able to rationalize my fear away, but if you asked why you could have thought of ways to help me. Maybe a special "anti-alien" spray (which really would have been air freshener) would have made me think E.T. could not come out of the toilet - I was only three years old at the time. (In case you are wondering, I do flush the toilet now, but I still can't look at E.T. without panicking.)

Just because someone has mental illness, that does not mean they can not speak for themselves and don't deserve some agency in their life. True, our answers may not be logical to you but they are real to us and there may be a way to work with the illness and make our lives better rather than letting us suffer just because we have mental illness. And sometimes when you ask us why (nicely by the way) and we don't know, if you think about it enough, you might know why. I might say I don't know why I am manic but my husband may notice that the mania started when a stressful event occurred in our family. Then we have something to work with.

Asking why is really about discovering the triggers of your mental illness, which psychologists say is essential to do in order to manage your disorder. It can help you avoid triggers, work around them, and find new ways to deal with them so you can still have a meaningful life even with mental illness.

Dr. Camp says you need to change the environment to normalize it for the person with dementia so they can be as successful, happy, and healthy as possible. We can do the same for people with mental illness- if we are willing to do two things:


1. When someone presents with a problematic behavior ALWAYS ask: "Why is this happening?"
2. The answer can NEVER be: "Because this person has mental illness."

Blessings,

Rev. Katie

Medication...Again

As many of you know, for a few months I have been off of medication, except for anti-anxiety medication as needed, and trying to go with just a diet, sleep, and exercise regimen for the treatment of my bipolar disorder. We know 100% that the Paleo diet, regular sleep, and regular exercise keeps my bipolar disorder manageable. However, I can't seem to keep up with those things on my own. I should know that this is not surprising because this is what it is like to have mental illness. The choices many people can make with a reasonable mind are not choices people with mental illness are always able to make. Right now I just can not stick to a eating, sleeping, and exercise plan on my own. So, I am back on medication....again.

Photo by Jeff Norris

One thing we are really coming to terms with is that for me, having a treatment plan that hinges on diet is probably not something I can handle. This is mainly because I have an eating disorder. I guess I have never talked about that on my blog, but I have a binge eating disorder and I just have not been able to stick to the correct diet on my own. So, my eating starts to get worse, which negatively affects my brain chemistry. Then I stop sleeping and exercising and everything goes down hill from there. I end up depressed, manic, suicidal, and back on medication.

I have to admit that I am pretty upset about being on medication again. I really wanted to be able to do this without them. I know it is possible to be well without medication were I able to make the right choices for long enough. The problem with managing mental illness by lifestyle changes is that those changes do not create wellness immediately. You really need a few months of perfect adherence to become fully functional and well enough to have the possibility (not guarantee) of continuing the program on your own. But, if your brain is impaired due to mental illness, many of us can not stick to those lifestyle changes for enough time to truly become well and have a chance of being off medication for long. Some of us can, but not all of us.

My new medication has a host of scary side effects (no surprise there), but one of the medications is supposed to help people with eating disorders so hopefully I can get back to healthy eating. I really do hope that with the medication I can keep the lifestyle changes long enough for them to be part of who I am and slowly decrease the medication so I need less or maybe none one day. That is the goal but in the mean time it is essential to know when you are doing so badly that you need more help.

Right now it is all up in the air. Who knows if I will even be able to tolerate these medications or what will happen over the next few months. I just know we are running around in the same circle and I hope one day we are not doing this over and over again.

Blessings,

Rev. Katie

There is a Difference

There is a difference between the mind of someone with mental illness and someone without it. The same things affect us differently and that became very clear to me one day this week.

My husband Jeff and I did not go to bed until 5am one morning. Why? Because we were both wasting time- him playing video games and me watching a TV series on Netflix. Yes, dumb reasons for both of us to stay up so late, but we did.

Katie & Jeff

The difference is that I was a wreck the next day and Jeff was not. We were both tired, but I could not function nearly as well as he could. He was in a good mood, able to do all the things he normally does. I was extremely irritated and my mind was so jumbled I couldn't even decide what I wanted to eat for lunch. I crave sugar like crazy, Jeff does not and everything aggravates me. Our son had a school picnic and I didn't go to it because I could not handle the chaos of tons of kids, games, socializing, etc... Then when we were in the car we had a paper shopping bag that Jeff was looking through. I had to tell him to stop looking through the bag because the sound of crinkling paper was like shooting pains in my head. As annoying as fingernails on a chalkboard. In fact, every noise in the house made me cringe. When I couldn't find something, like my keys, I immediately thought the world was going to end and nothing would ever work out right. 

Jeff had none of those problems. On lack of sleep his system and brain do not simultaneously shut down and go on high alert like mine do. He can get through the day fine, but I have to struggle to get through every minute.

People ask me all the time: "Why can't you stay up late?," "Why can't you eat what other people do?," "Do you really have be so strict about exercise?" "Other people can handle it, why can't you?" I'm just different. My brain works differently and I can't do "what other people do." And the likelihood is that none of us can. We all have our limitations. Some of us have allergies and can't just go outside like other people can. Some of us get migraines and can't handle bright lights. There really is no "what everyone else can do" because we are all different.

Blessings,

Rev. Katie

Why Do You Choose to Do That?

It must be eternally frustrating for people without mental illness to see those of us with it doing things that are bad for us. Even though we know all the reasons we shouldn't. Even though our loved one told us we shouldn't. Even though to them it seems like our life is perfect, or at least happy enough that we should not have a problem.

The only thing I can tell you is, that's how you know it's an illness.

When we do things that are detrimental, from eating bad food, to spending our savings, even to suicide, we do them because we really think we need to. We think it is the only way to end the extreme pain and suffering we feel.

I have no idea how to describe this to someone without mental illness. I know that being able to understand this would help end one of the biggest stigmas against this illness, which is people assume we choose to be this way and we are just being irresponsible.

Photo by tommychheng, Flickr Creative Commons

My husband still asks me "Why do you choose to do that?," especially when I eat poorly. As if I sat down and thought, "Yes, I know eating this doughnut will send me into a mania risking my health and the happiness of my family. I don't care about myself or anyone else. I would like bad things to happen so I'll eat the doughnut." That's not the way it happens. It's more like this: "I know eating this doughnut will make me worse and cause issues for my family but I am in so much pain that if I have to spend one more second like this I'll die. I am not that important to my family anyway." That doughnut will increase my serotonin and make me feel good, for an hour, before I get worse again.  But when you have a mental illness you often live your life second by second, hour by hour just trying to stay alive and ridiculous things seem rational at the time. Or like how in the middle of the night when my mania is mixed with my depression I truly, 100% believe my husband doesn't love me and we should separate. Seriously? In reality he loves me 110% and we are like Adelie penguins, together for life.

Photo by linpadgham, Flickr Creative Commons

That is just my experience of how my mind can be irrational. For other people with other illnesses, it will present different for them. For instance with manic spending the person may actually think they are invincible and running out of money is not realistically possible.

Expecting someone with a mental illness never to do detrimental things or irresponsible things is like asking someone with an amputated leg to walk. However, you could get the person an artificial leg which could help manage the issue they have and that is what I hope my blog helps people do, manage their illness. While it is essential that we understand mental illness, that does not mean the bad behavior is ok. Particularly if the person is emotionally or physically abusive. Understanding it means we can then discover appropriate ways to deal with it, not that you don't hold the person accountable for their actions.

Overall, I hope that much of my blog talks about ways in which to manage mental illness (please read some of my other posts for more on that), but I really want people to understand the fundamentals of it first. If we don't understand the true nature of the illness we will try the wrong management techniques and not be able to help our loved ones.

Blessings,

Rev. Katie

Making Your Brain Do What You Want

One of the problems with mental illness is that your brain does not always act rationally. You may have anxiety and excessively worry about unrealistic events happening, like someone breaking into your house every night. You may be depressed and think there is nothing good in your life. You may be manic and think you are invincible. One of the things we need to do in times like these it to remind ourselves that this thinking is just a glitch in our system, just our minds being irrational because of a chemical imbalance. Sometimes that helps us not act on the irrational thoughts we are having.

Other times you need to outsmart your irrational brain. For instance, I have been having trouble and I keep staying up all night. I do this partially because that's when my mind goes on overdrive and partially because I think if I stay up late I wont have to exercise in the morning because I will be too tired. I know exercise is good for me and I actually love it, but when I am either manic or depressed I don't want to exercise because it's a lot of work and I just want to stay at home. It's true, if I make myself stay up all night I am dizzy, exhausted, and can't even stand up straight at times. It would not be safe to exercise in that state. So, my irrational brain has been winning over the past few weeks creating a situation in which I can't exercise.

Finally yesterday I realized I just had to outsmart my brain. True, I was too tired in the morning to go to the gym, however, I eventually do fall asleep and the gym is open in the evening. I realized I had no excuse not to get to the gym in the evening instead. I just had to tell myself over and over again that I could get to the gym, that I could do this, that I deserved to get better, and so I ended up convincing my brain that going to the gym in the evening would be ok. It would not be too hard or too scary and I would not be too tired.

CrossFit Cleveland

I know this seems really simple to people without mental illness who have no problem adjusting their schedule or doing the right thing to stay healthy. However, for those of us with uncooperative brains, we have to work very hard to continually say "no" to the illness and say "yes" to health.

Another thing that can help if you need to do certain things to stay healthy but in the hard times your brain convinces you they are not needed is to write down how doing these things make you feel. Don't write all the reasons why you should do them because your irrational mind will think of a million other reasons not to do them. Write down how you feel when you sleep enough, when you eat right, when you exercise, or when you take your medication. Then when your mind gives you a million excuses, you can go back and read what the reality is and get a sense of what it will really feel like if you make the right choice.

So, the other day I wrote a poem of sorts as a fun way to remind myself how I feel when I am exercising at CrossFit and why I love it. If you are a CrossFitter, I share it now with you.

Ode To CrossFit

O, CrossFit how I love thee.
Each time we meet, I can't catch my breath and I go weak in the knees.
You inspire me to work harder than I ever thought I could.
You prove that I can jump higher, lift more, and be faster than I imagined was possible.
And you never care that my higher, faster, and stronger is not amazing,
you are just glad that I did my best.

CrossFit, you have shown me that I am stronger than I think I am.
You make me feel invincible, like I can do what I never thought possible.
You are fuel for my mind and hope for my spirit.

While I often curse at your existence because you require so much,
I always feel blessed that we worked together.
You have proven to me that I can always fight and work hard, even when I feel like I can't go on.

CrossFit, you let me know that if I can be fierce in the gym, I can be fierce in life.
Each time we meet, my mind is more clear and you prove that the illness I have been burdened with can be conquered.

One day my toes will touch the bar. One day bipolar disorder will hit the ground.
And so CrossFit, I thank you, for proving that no matter where I am in life physically or mentally, I can still kick ass.
 
(Sorry for the language at the end, but sometimes you just have to tell it like it is)

I encourage you to write a fun reflection on how it feels when you follow through on a particular thing you need to do to manage your illness. It will make you feel better and be a reminder when you need help.

Blessings,

Rev. Katie

Managing Bipolar Disorder Isn't Easy

If you remember, I was doing very well on my Paleo diet, exercising, and making sure I got adequate sleep. Well, I had a bad week, as happens every month, and I fell off the diet and everything went down hill from there. I have contemplated writing about this as it feels like such a failure for me and who wants to write about their failures? But then again, this is the reality of this illness. It is constantly up and down. Some people do well for years and have the illness come back, others, like me, do well for a few weeks only to have trouble again. I do have bipolar II, which is rapid cycling and I wonder if that is one of the reasons why I don't do well for longer stretches of time like some people with bipolar I do.

Anyway, even though I have not been doing well for the past few weeks, that doesn't mean I have not learned anything. I have learned that of all the things we have tried to help manage my illness, even medication, diet works the best. The problem is, I can't mess up on the diet at all, or I get worse. And a strict Paleo diet is very hard to stick with in our culture, at least it is for me.

I also learned that the week before my period will always be worse (you can read about how common this is here), even with the diet. It may be the one week where diet is not enough to keep me well. We have decided that I will try some medication for that week only and see if that can keep me on track with the diet instead of having everything fall apart. Then eventually, as I am better for a longer stretch of time and the diet just becomes a habit, I will see if I can stop using medication all together.

Photo by Jeff Norris

Part of the problem we fell into this time was that I was struggling because of my hormones, my husband was out of town, and my son got sick. We did not have food and all the things necessary already made and planned out for me to be able to handle everything myself. So, while we are still working out a system of making sure I am never without food I can eat, which is easily accessible when I am depressed, I might need some help during that one bad week.

I am sad, and a bit ashamed, that I could not keep up with the diet that was working so well. The problem is, when the illness gets bad, you don't see reality. I could not see that the diet was working. You think all kinds of things that are not true. Like you will never get better, you have always been miserable, and that no one loves you so who cares if you are sick. You believe it when other people say eating a little bit of something won't hurt you and you wonder why you can't be "normal" like everyone else. That's the illness, the irrational part of your brain will take over and unless you have a perfected system of management that changes with the cycle of your illness, you will have times when you get worse.

The important thing is that you learn what does work and you get back to doing it again. I am back on the Paleo diet now and can tell that just within a day I have started to feel much better. It is a long process to figure out a good system and it takes a lot of time to make sure we have enough of the right food around at all times. It is time consuming to figure out a schedule where I can eat at the right times, exercise the right amount, and sleep correctly. I am actually amazed at the amount of time, effort, and lifestyle change it takes just to stay well. I told my husband today that I wish we could be like normal couples who go out to dinner, eat what they want, have a few drinks, and stay out late with friends. That is just never going to happen for us.

My next tasks are first to find a way to make the diet, exercise, and sleep requirements just a part of my life. Second, I need to work on ways to stop the irrational thinking that happens when I get worse. I have a few ideas for that which I will be posting about soon.

Blessings,

Rev. Katie