That Time I had a Nervous Breakdown – Talking about Mental Illness, Part 4

I’ve been writing about my experience with anxiety and depression on this blog for the last several weeks. In general, things are better. I sleep better. Medication and therapy are doing their jobs. I’m feeling like myself.

I’m at a point where I look back at the last thirteen weeks and think “Whoa. I went through some shit, didn’t I?”  Well, yes. Yes I did. Up until recently, though, I hadn’t really given a name to what I had gone through in those early weeks. I would speak about it and say, “During this current episode…” or “In this anxiety and depression spiral…” I think I found pretty ways to tidy up my experience because subconsciously I wanted to make sure others would respond with compassion and understanding and not with Oh god! What is WRONG with her?! By the way, no one has been so douchey as to look at me like I’m some poor bedraggled head case (but try telling that to my wonky brain.)

I was a little surprised that I didn’t automatically flinch and go on the defensive when last week at breakfast, my mom started a sentence with “When you had your nervous breakdown…”

Nervous breakdown?  Nervous breakdown. Yep. That sounds about right. That night, I ran the conversation by my sister (as I always do when my mom and I have been together):

Me: Mom said I had a nervous breakdown.
Sis: Well… you kinda did. The term is stupid, but I think you had a bit of a crisis.
Me: It was pretty bad looking in from the outside, wasn’t it? Because it was pretty fucking shitty from the inside.
Sis: It was bad. [insert appropriate David Tennant super sad face in the rain gif]

The term “nervous breakdown” has zero clinical meaning. It’s not a diagnosis. It’s a colloquialism. Though I’ve used that term in the past, it wasn’t until this experience did I finally understand what it meant.

If my brain and my psychological state were an electrical system (because they kind of are), I guess you could say I blew a fuse. I became so overwhelmed by anxiety and stress and my emotions that I just shut down. I spent two weeks in such an extremely heightened state of anxiety that at some point my brain just tripped its breaker and said, “That’s it. I’m done.” Then came the depression.

I had been depressed before, but nothing like this. This was very different. This was the kind of feeling that the only safe place for me was under my blankets in bed. I felt exposed and raw any time I was out of that nest. I forced myself to pick up my children from school every day, but as soon as we came home, and I handed them snacks and the TV remote, I was back under the covers.

I began to fear being alone. I didn’t want to be alone with my thoughts. My husband was able to work from home for several days a week. The days he had to go into the office were days that I had appointments with my therapist or my NP. I didn’t have to be alone for long periods of time.

I stopped eating. I stopped caring about how I looked. I stopped doing things I enjoyed. I was so, so tired. I crawled into bed each night just as soon as the we put the kids to bed. Sleeping was safe. When I was asleep, my mind was turned off.

I seriously considered finding an inpatient treatment program to check myself into and my beautiful husband said that if that’s what I needed then we would find a way to make it work. (I didn’t tell him that I had been looking at this super swanky facility in San Diego that probably cost half a year’s salary, but he would have been supportive if I said I had to go there.)

Sleeping too much. Not wanting to do anything. Feeling down and disconnected. I’d been to these places before. I knew what they were like and that I could get out of them. What I didn’t know was this time I felt a despair that was like nothing I had ever felt before in my life. It was so profound. I have never had before and did not have any suicidal ideation during this crisis, but in those brief moments of the most intense and absolutely unrelenting feelings of complete hopelessness, I understood.  I got why suicide feels like the only possible answer to make the pain stop. I felt it in the deepest parts of me. I don’t have the right words in English to really describe it, but it is incredibly powerful. It terrified me.  Somehow I would pull myself back from falling into that abyss but sometimes I would wonder if I would be able to the next time I felt that despair.

I’m thirteen weeks out since my breakdown (mental health crisis? Burnout syndrome? Crackup? I kind of like crackup. LOL!)  I’m moving forward. I’m coming back to myself.  Sharing this story is mostly for me. I don’t want to forget about this because I don’t want someone else to ever wonder if they’re the only ones who’ve been through this pain. I don’t ever want my children to wonder if they’re completely alone in having mental illness should they go through what I’ve been through. I also want to share that mental illness doesn’t make one unfit or broken or weak.  I’m still kind and funny and intelligent and sarcastic and creative and capable.

And I’m strong. So strong.

 

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Living in the “Is-ness” – Talking about Mental Illness, part 3

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I’m a future-living person.  What I mean is that I tend to project all my concerns and feelings and desires and fears on to some non-existent point in time in the future.  What if I can’t get a job (in the future)?  What if I become diagnosed with some horribly painful, dreadful disease (in the future)? What if some calamity of epic proportion befalls me (in the future)? 

I get stuck in this loop of fearing the future. It’s not a constant feeling, thank the FSM! However, when I’m in an anxiety spiral it’s hard to stay out of the future and I become plagued with fear of the unknown. If only I had a TARDIS!

But this is exactly the nature of anxiety. Anxiety is not a feeling you get about the present. You are not anxious about what is happening now. You are anxious about what could happen, what should happen, what would happen. It’s all about the future.  And if you’re someone who is really good at ruminating on all possible scenarios of events because you like to have a plan and you love control (my old friend, Control), when you enter the anxiety spiral, it can make you feel down right out of control. Oh the Catch-22 of it all!

My psychologist Dr. S is a practitioner in many forms of therapeutic modalities but we’ve been working on techniques that have a very Eastern philosophic tone. I’m talking about mindfulness, being present in the moment of now, and a way of giving present moments meaning that  as Dr. S calls the Is-Ness.

The Is-ness is really about how one assigns meaning to current circumstances, but in order to be able to recognize the Is-ness, one must be in the current moment. Mindfulness and Is-Ness are partners.

Here’s an example of Is-ness.  A few therapy sessions ago, I told Dr. S that I was having a “good morning.” A good morning for me was one where I didn’t immediately wake up with the internal trembling of panic. It was a morning where I felt more in control of my anxiety and physical feelings.  A “bad morning” would be the opposite of that.

The tricky thing when assigning words like “good” or “bad” to a present moment is that it can keep you from being in that moment. You’ll start looking to avoid the bad moments in search of the good moments instead of just being in the present moment. So enters the Is-ness. The moments do not have to be good or bad. They can be “is” – simply a present moment of existence. Something to recognize without judgment.

In my practice of mindfulness I’m redefining my moments simply as “is” rather than good or bad.  That doesn’t mean that I don’t feel. Some moments feel painful or scary or sad. Some moments feel exhilarating or peaceful or joyous. But they’re not good or bad moments. They’re simply points of Is-ness.

Asking for Help – Talking About Mental Illness, part 2

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When I published my last post about mental health, I had just learned that designer and fashion icon Kate Spade had died from suicide. It was a blow that no one saw coming and it shocked all of us. Three days later, Anthony Bourdain, an amazing chef, storyteller, and one of my personal idols also died from suicide. It was a horrible week.

It also shined a blinding spotlight on mental illness. The general public was thrust into the reality that millions of people all over the world experience with all too much regularity. Over and over on social media, I read pleas from friends that if you were struggling to please reach out for help. People posted the phone number for the National Suicide Prevention Lifeline. Other people urged those of us with mental illness to seek therapy or medication. All of these suggestions came from a place of love but also from a place of powerlessness. There was a sense of helplessness underlying these messages. It dawned on me that though well-intentioned and coming from a place of caring, many people really don’t know what it’s like to be in the depths of depression and anxiety and how the act of reaching out for help ,many times, feels completely impossible.

I was 25 when I first sought out a therapist to help me with anxiety and depression. I had had a devastating experience six years prior. I had fallen in love with a guy named Doug. Doug was amazing! Funny, smart, a bit of rebel (which really spoke to my rules-following-good-girl heart). Doug was also sick. He had cystic fibrosis. In 1997 the prognosis for people living with cystic fibrosis was grim. He was 24 and and always known and accepted that his life wouldn’t be a long one but he lived it in the best way possible. We fell in love with each other quickly but during that short time he became very sick. He was hospitalized back home in Michigan.  A good friend of his called me up one evening and told me that if I wanted to see him then I needed to get up to Detroit ASAP.

So at 19 years old, I boarded a plane and flew to a city I’d never been to, to stay with people I didn’t know, and to lose someone I had fallen in love with.  Doug died a short four days after I arrived. I had the blessing and honor (I feel that now) to be with him to the very end and to tell him how much I loved him and how much he was loved.

I was devastated. I cried every single moment as I flew back home to Austin. Since this was before 9/11, anyone could meet passengers at the gates. My mother met me at the terminal and wrapped me in her arms. I found myself cycling through moments of numbness and intense, overwhelming emotional pain.  That first night at home was horrific. I had never experienced loss in that way before and it was as if my soul had cracked wide open. I cried in keening wails of grief. It was enough to scare my sister. It was enough to upset my father. That night I remember so clearly the words he spoke, “You can’t bring him back. He’s dead. Crying and carrying on won’t help.”

So that was that. That was how we dealt with pain in my family. I don’t hold it against my father. My father learned to handle grief the best way he knew how.  I repressed my grief as deep as I could. In return, my mind began to toil in anxiety. When those feeling became too much, I repressed those too.

For six years I stayed in this state. I faked it until I made it. No one, at least I thought, was the wiser. And then I broke.

I was lucky that at the time I broke I was also in a relationship with a guy, PM, who had gone through his own trauma and recovery. He and I had been seeing each other off and on for about four years. He was experiencing his battle while I was trying to keep it together. When I finally couldn’t take the anxiety and depression any more, he was the one who said that I needed to talk to someone. He battled anxiety and addiction for a large part of his life and he told me that the best thing to do was to see a therapist. It had really helped him, he told me.

I didn’t want to. I didn’t think I needed to. I didn’t think my problems were significant enough to need a therapist. I’m just a little sad. It’s not a big deal. A therapist will just tell me I’m normal and to just get over it, I thought.  It’s not like anything really bad has ever happened to me. My problems are tiny compared to people with real problems.  I figured since I didn’t try to self-medicate with booze or drugs (I did self-medicate with food, though) and that I could sleep at night (and all day and usually the next day, too.) And that my relationship with PM was fairly health (except I wasn’t always that interested in being intimate because I would rather just sleep), then I didn’t need a therapist. I didn’t have real problems.

But PM kept gently pushing and I gave in. It took me three weeks to actually call the therapist that was recommended to me. I would dial the number and then hang up. I would write it in my calendar as a “To-do” item and then scratch it out. After a particularly awful day, I finally mustered the courage to call and as the phone rang on the other end, I prayed that the therapist wouldn’t pick up.

No such luck. She answered her phone and said, “This is Dr. S.”  I could barely speak above a whisper and then once I found my voice, every thing just tumbled out. I spoke at lightning speed. I remember saying, “I don’t know why I’m calling. I’m sure I’m just fine. But my boyfriend PM said I should call, but I’m sure I’m fine. I’m fine. Really I’m fine.”  Ha! Sure I was fine! I was also crying hysterically and could hardly catch my breath. Dr. S is a fine, compassionate, and very straight forward therapist. That day was one of the hardest days in my life, but it was one of the best. I worked with her for about four years and she helped me move through the grief and taught me how to live with anxiety and depression.

So yes, I had a successful experience (and continue to since I’m back with Dr. S now.) But that doesn’t mean that it wasn’t an extremely difficult process to begin.  Getting help for mental illness is extremely difficult. It’s difficult emotionally and mentally, and for some, physically. The act of making a phone call can seem impossible. Secondly, mental health therapy and services are not available to everyone. There may not be providers in a person’s area. The cost is often prohibitive. Many people don’t have medical insurance and those that do may not have any providers covered under their plan. My two mental health providers (Dr. S, a psychologist and my psychiatric mental health nurse practitioner who prescribes my meds) do not take my health insurance, so I have to pay out of pocket to see both of them.  I have had a total of eight appointments between the two of them in the last two months and have paid over $1,500. But I’m lucky. I’m in a position where I can manage that for now. How many people aren’t?

One question I get when I talk about how cost affects access to mental health care is “Well, why don’t you find a provider who takes your insurance?”  Indeed. Why don’t I? It would only cost me $35 per session as that is my co-pay. However, the rapport and relationship I’ve built with my therapists is irreplaceable.  How many people do you know won’t even change hair stylists? Yeah. So asking someone to leave an established relationship with their mental health therapist is a very tall order.

Therapy is an excellent option for getting help with mental illness. It’s not the only option, though, and sometimes it takes a toolbox of options to help someone achieve recovery. For many years therapy did the trick, but then came a point when I needed more. I sought out a provider who could prescribe appropriate medication and counsel (my nurse practitioner is also a licensed professional counselor). When I began to see her, the medication and counseling combo was what I needed. In addition to two prescription medications (Effexor and Klonopin), she also recommended vitamin D3, B12, a probiotic, and a medical food called l-methylfolate (Deplin). In combination with therapy, regular exercise, some breathing and centering exercises, and better sleep hygeine, my anxiety and depression became manageable.

I’m now back on that regimen in addition to seeing Dr. S. Things are improving. But sometimes a patient will have to try dozens of medications before finding the right one. Sometimes she’ll have to go through a number of therapists to find the right fit. Sometimes the healing process becomes so overwhelming that it can antagonize those awful feelings of despair and worry that it feels like you’ll never feel better.  Sometimes those feelings become so heavy and so oppressive that you don’t remember what it was like not feel that way. The tunnel becomes long and cold and lonely and you can’t see a way out.

This is how mental illness works. It can be a life-long battle as was the case for Kate Spade and Anthony Bourdain. That battle can be so hard and so painful that for the mind in the throes of unimaginable pain, the only way out is suicide. I only say this so those who have never been in that place understand why suicide would ever feel like an option.

So here is what I recommend to my well meaning, very loving, concerned friends who have friends that struggle with mental illness:

    • Reach out first! Call (or text or message) your friend on a regular basis.  Just check in. If you haven’t heard from her in awhile, don’t wait for her to call you.  She might not.  If he doesn’t call back or text back or message back, don’t give up. Keep reaching out.
    • Invite your friend to go out, and keep inviting her even if she says no. If he doesn’t want to go out, then tell him them you’re coming over. Of course, we still want to be cognizant of boundaries, but you know you’re friend. Meet her where she is and hold space for her.
    • Educate yourself on depression, anxiety, bipolar disorder, and other mental health disorders. Try to understand what it means to be struggling with a mental illness. Work on changing your assumptions and when you have the chance, speak up to dispel the myths that seem to be everywhere about having mental illness.
    • Have patience and keep connecting. We’re doing the best we can in the moment and while it may seem that we’re not reciprocating the effort, understand that it isn’t because we don’t love you or don’t care. We just can’t right now.

 

When the lizard goes berserk – Talking about mental health, part 1

I know that National Mental Health Awareness month has just passed, but I wanted to talk about my experience with mental illness*. Like millions of Americans (estimated 40 million), I have anxiety disorder. There are a few – generalized anxiety disorder, panic disorder, specific phobias, social anxiety, as well as PTSD and OCD where anxiety is a major component.

I struggle with generalized anxiety disorder, panic disorder, and depression.

Since I was a little girl, I have been a worrier.  I worried to the point that I would become upset and tremble and have a hard time sleeping.  These feelings would come and go. Some were certainly reasonable feelings, like worrying about the first day of school, worrying about going to a party where I didn’t really know anyone, worrying about going to sleep away camp for the first time.

Other worries, the bulk of which occupied my mind, were arguably unreasonable. For example, the cabinet underneath the sink in my parents’ house held all the cleaning supplies – window cleaner, dishwasher soap, counter scrub – but it also held the plastic Ziploc bags and plastic wrap and aluminum foil.  One day as my dad was getting my lunch ready for school (I was probably 8 or 9 years old), I saw him take out a few plastic sandwich bags from the cabinet and proceed to put my food in them.  I became overwhelmed by a sense of terror. What is he doing!?, I thought. Those bags have been in that cabinet with all the cleaning supplies. All the TOXIC cleaning supplies! My brain was on overload.  I was overcome with the fear that those cleaning supplies had somehow come out of their containers, gotten all over the plastic bags that my dad was using for food storage and were now going to contaminate my lunch. I’m going to die! He’s going to kill me! was the message my lizard brain was screaming at me inside my head.

When I was 12, I wanted a perm (super curly corkscrew curls were in) and my mom decided to give me one at home. If you’ve ever had a perm, either at home or at a salon, you know that it’s a really stinky process. The chemicals are pretty smelly and it’s not fun to breath in. However, they are safe and inhaling those fumes is not going to do permanent damage. But to my young, worrying mind, I was convinced that I was going to die from the smell. I began to tremble, sweat, cry, and scream “You’re going to kill me!” My mom abandoned the hair treatment half way through the process, the result being a calmer child with the hair of a deranged poodle.

Y’all… these are not reasonable reactions.  I feared fumes, chemicals, injury, abandonment, death, and public humiliation all before I graduated high school. You wouldn’t know that I ruminated daily on these potential horrors because outwardly I was happy, friendly, well-liked, smart, and generally appeared to be a well-adjusted kid. I had learned to cope with my feelings by hiding them.

As I got older, it became harder and harder to hide my symptoms. I failed out of my first year of college because my anxiety lead to depression, though at the time I didn’t know that’s what was going on. Even while I volunteered at the Student Counseling Service as a peer counselor (something I excelled at because I could relate so well to other people battling similar demons), I still struggled to get out of bed every morning to make it to class. I couldn’t concentrate to study. I had fought with and lost the friendship of the only person I knew at university and I couldn’t cope.

I moved back home, got a job, became busy and my worrying thoughts went away. Or so I thought. They didn’t really. I just got better at suppressing them. Over time, other triggers would put me in a tailspin. I was in my early twenties when HIV was still the number one concern of casual sex. Even though I wasn’t in a casual relationship and had a partner who I knew was not HIV+, I feared contracting the disease. The Internet was still in its infancy and I spent countless hours on medical sites searching all of my perceived symptoms. I would reassure myself that I was OK and a few days later I was back to seeking reassurance that some new symptom wasn’t an indicator of my impending doom from an incurable illness. I also had numerous HIV tests, all over which were negative. I didn’t and don’t have HIV, but at the time that didn’t stop my constant need to reassure myself that I didn’t have it. I was plagued by this fear and it felt unrelenting.

The fear of death from hideous disease seemed to fade but around that time a new fear cropped up. I had just moved out on my own, had a job, and was making a modest living. It was enough to live on my own and I certainly wasn’t living in poverty, but I became consumed with panic that I would lose my job, lose my income, get evicted, be forced to live on the streets, be abandoned by my family, and die alone in a ditch somewhere all before I turned thirty.  It was and still is an irrational fear, but I would attempt reassure myself by spending hours calculating and recalculating my income and expenses. My fear didn’t propel me to seek a better paying job or talk to my parents about a contingency plan should I have to move back home because I lost my job and couldn’t find a new one. The feelings of reassurance lasted only a short while and then I was back to the frantic rituals I would engage in to stop the pain from my fear and obsession.

There have been seasons in my life where my anxiety and panic were better managed.  Through intense psychotherapy with an amazing psychologist, I was able to manage my condition for many years. I got married in early 2007 and at the end of that year we had our first child, a beautiful son (he’s 10 now.) Having an anxiety disorder made me all the more susceptible to postpartum depression and anxiety and I struggled with those two disorders for many, many months.  I experienced another remission for about 18 months and then became pregnant with our second child (she’s 7).  I knew what to expect with PPD/PPA and I sought help immediately. This was the best thing I could have done for myself and I was able to manage my GAD and panic disorder for several years.  My fears were calmed. I was able to rationally manage the day-to-day and I was living very contentedly and peacefully.

There are some different thoughts as to whether GAD and other anxiety disorders can be permanently cured or if they’re simply managed and we experience periods of remission. For me I definitely think I’m the latter. Three years ago, I experienced a serious interpersonal event that was and has been hard to reconcile.  I have been off and on medication for these last three years and seeing a mental health provider.  For nearly a year I was able to manage my condition with out medication or therapy but in April, I experienced a set back. I’m still in the midst of that episode of anxiety and depression.

My anxiety has always elicited physical symptoms – headaches, stomach aches, heart palpitations, muscle aches, tiredness, overeating or under-eating, intestinal distress – but couple those symptoms with my tendency to ruminate and obsess about my health and it’s a recipe for serious suffering. It’s a vicious cycle. The body experiences unpleasant sensations because you’re anxious and then you become more anxious because your body doesn’t feel right.  Cue Google searches for every single symptom and what comes up? Cancer. Or porn. But thank god my symptoms only came up with cancer.  Knowing that Dr. Google is literally the worst doctor in the universe, normal, rational humans who don’t have anxiety disorder tend to take the information they find online about their symptoms with a grain of salt. Not so someone like me! So I’m back in the throes of reassurance seeking (I’ve been to four medical doctors in five weeks and have an appointment for another doctor next week. I’m not sure yet if I will cancel the appointment yet or not) and ruminating that my inevitable demise will be because of a terminal illness.

These are irrational thoughts, but when you’re lizard goes berserk, they’re all that make sense.

My lizard in the midst of GAD and panic disorder!

 

*This will likely be an ongoing series of posts about my mental health and mental health in general.  I am currently on medication (Effexor ER 150 mg) and seeing my fabulous psychologist who has been helping me for many years, Dr. S.  Writing about my mental illness is therapeutic and helps me gain some clarity and distance from the lizard brain.