Conquering The Valley Of The Dustbunnies

From September to November, I spent a lot of time decluttering my flat, especially the bedroom. But once I made the deadline for the bulky trash collection, my enthusiasm and energy dwindled, and I did not get back at the task for the entire month of December. And now it was another deadline of sorts which got me moving again: my sister bought a new bed and I “inherited” the old one.
I had never before owned a bed big enough for two people to sleep in, and so my husband and I had no other choice but putting our mattresses on the floor – buying one of our own simply exceeded our budget. In the beginning, we joked about camping on the floor, but after a while it got really old, especially since our mattresses are of different heights. A friend offered us her bed when she gave up a rented studio, and at first I accepted – but the problem with the mismatching mattresses, the difficulty transporting it home (my car’s boot / trunk was already permanently locked then), lack of time due to uni projects, and rising depression spoilt the plan.
We spent two days emptying all bookshelves in the bedroom and dissembling the ones which were mounted on the wall above where my desk used to stand. We moved the freestanding shelves to that wall, cleaned them and put the books I want to keep back. Since there will be no replacement for the wall-mounted units, the archaeology, geosciences and geography books  will have their place in the living room from now on.

There is a sense of accomplishment which comes with having your books sitting neatly in clean shelves; especially if it has taken you years to get that far. My husband is a much faster worker, which is rather frustrating because it makes me feel so inferior, but I insist on handling certain things alone, even if that means it will take significantly longer to get everything done. I still have to sort through every single item and arrive at a decision whether to keep it or not, and where to store the pieces which do not end up in trash. Making that decision itself has become easier, though – it is not nearly as agonising anymore as it used to be just a few months ago. Partly that might be simply due to there being fewer and fewer possessions left which are still “unexamined” at this point, partly because I have experienced that discarding them only hurts temporarily.
My method may not be the most effective or stringent, but it is the only one that works for me, and I am almost done with the bedroom. I think from next weekend on, we can sleep in our new bed; my husband is really eager for this to happen and I certainly feel the same way. However, I want to make sure that I have gone through every last item before we move on, because I know from experience that stuff left for “later” will still be around after years. Then, I want to give the room a thorough cleaning, because once all the heavy furniture are up, certain areas will become as good as inaccessible. And, final reason, I have a therapy session on Thursday, which means that a) I am going to be out most of that day thanks to much longer commuting times without a car, and b) I will most likely want some time for reflection afterwards. But the weekend should be a realistic goal.

Fun Facts:
The most common finds in my bedroom were bobby pins (just how many can a single person lose over the years?), literally thousands of paper pieces – notes from class, drafts for letters or uni papers, transcribed poems, cash receipts etc. – and a wild assortment of pens and pencils.
The most unusual find so far was a kitchen knife in one of my handbags, the blade carefully wrapped in paper towel fixated with sticky tape – must be a leftover of some brunch we had at work, or a long-ago Christmas party or something in that direction.

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Cognitive Deficits Revisited: Coca Cola Addiction

Chances are, at some point during the last few days you came across the headlines claiming a link between the consumption of soda, especially diet soda, and an increased risk of depression. The idea itself is not new and has been circulating the media before, but surfaced again this week – even though at a closer inspection there is room for scepticism.
Most of the following text I had written almost a week ago already, but not quite finished the post yet when it suddenly became a hot topic.

Some of the most persistent symptoms of the chronic major depression I suffer from fall into the category of cognitive deficits: word finding problems, temporary inability to access memories, concentration and learning difficulties, generally slowed-down thinking and speaking. There is no doubt that I have improved in all those areas over the past two years, but the progress has not always been linear. The subjectively best I felt in September 2011, when according to the BDI-II my overall depressive symptoms were in the range of 10 points and lower, a score equal of euthymia (non-depressed, reasonably positive moods). That was also the time when I experienced the least cognitive impairment, in all aforementioned categories.
The biggest differences between now and then are that in September 2011, I was not yet back at university, and I had been on a number of short trips that year, providing both recreation and intellectual stimulation. Over the course of just a few short months, my cognitive capacities had improved greatly. In 2012, it was mostly classes, homework, written exams and office appointments instead. As a result, most of the cognitive deficits made a comeback or got worse again. The only exception is access to memories, at least concerning personal history. I remember a lot more now than I did back in May 2011.
It’s a vicious circle: the depression causes cognitive deficits, and I get depressed over those cognitive deficits…

Most days, it is as if I have a cloud in my head; every brain activity appears somewhat hazy. The closest approximation I can give is that feeling when you are just about to fall asleep and your thoughts start drifting, and then you are being forced to rouse yourself and do some task. Except that for me, this sensation can last for hours and is present at any time of the day, without being tied to sleepiness. Brain fog. Mental cotton-balls. A muddy pond in your head.
The only remedy I have for this is drinking Coca Cola – there’s something about the sugar-&-caffeine-rush that clears out the clouds and suddenly makes me more alert, more concentrated, more “intelligent”. Strangely enough, coffee does not nearly have the same effect. Nor do fresh air or anything else I tried. Only cola gets me out of the sedation.

I don’t want to drink coke on a regular base. I am worried about all kinds of negative effects this might have on my health, from diabetes to cavities in my teeth to osteoporosis (the sweeteners in diet coke severely upset my digestion, so that is no option). But more and more, I do crave cola due to the effect it has on my brain and thinking abilities. Nothing else lifts the psychomotor retardation as effectively. None of the blog posts of the last months was written without either a glass of cola standing next to me or having been consumed prior to typing.
I try limiting myself to two glasses a day, one in the early and one in the late afternoon, sometimes coupled with a cup of coffee. The results are about six hours of clarity. But there is no denying that occasionally, I drink more, and that on some days, I already crave cola before breakfast.

As I was going to wrap up this post and googled “cola depression”, I came across another fascinating blog post at Evolutionary Psychiatry, discussing the case study of a woman addicted to coca cola. Until very recently, I was much more worried about the physical consequences of my cola-consumption, and while my own intake is far lower than the quantities mentioned, it does make me wonder about possible influences on my mental health.
There is something of a dilemma: Either I give up Coca Cola and experience even more psychomotor retardation, accepting that the lowered intellectual capacities will depress me even more, and deal with the coke cravings on top of it. Or I will continue drinking soda, but risk possible negative effects for my physical and mental health, in the latter case even increasing the damage my brain has already taken in twenty years of major depression.
Maybe I’m fooling myself into a false sense of security by thinking that two glasses per day are permissible. Maybe I’m fooling myself by thinking that eventually I will get rid of the fatigue and brain fog for good, consequently not needing the cola-boost anymore. Maybe I’m a fool for thinking I will be able to quit the soda eventually. All I know is, right now I will take uncertain and abstract health risks over the certainty of daily psychomotor retardation.

Social Media & Social Anxiety

Where is this blog going? What does it say about me? Since blogs also are representations of their authors (or at least embody certain aspects of their personalities), it is important to me that it looks like something I can identify with, that I want to be connected to. After checking out other blog designs over the last couple of weeks, I finally decided to make the transition to a new look. I really liked the compact layout of the old blog theme, but had grown tired of the colour scheme and tiny font. The new one has a more elegant typography and no visual clutter, and the so-called responsive design ensures that it can be comfortably read from a variety of devices, from desktops to smartphones.
Lugubrious Layara also got an organisational makeover during the holidays: I streamlined the “About Me” section a bit, and reorganized the side-column. After almost two years, the scope of topics written about here became too broad to be faithfully represented by the tag cloud any longer, so I took it out. The “Social Anxiety” tag got turned into a full category, as it is too important a topic about which I write. I added share buttons to the posts and a contact info with an email address to the side-column. Finally, I designed my own header.
And then, I also joined Twitter in an effort to promote my blog a bit. This step I was not sure about, as tweeting does not come naturally to me. I will give it a try and see how I like it in a month’s time, and whether it actually is worth the effort.

I am old enough to still remember the way the internet was when it first became widely available for private homes – back when you could not receive phone calls while being online and loading graphic-heavy websites was a real test of patience. The era of dial-up, when surfing was so expensive that I was limited to two hours per month (sic), and when I could not even have imagined some of the programmes and games I use routinely now. Before web 2.0 became a reality, the internet was a much easier place for people with social anxiety, like me. One felt much more anonymous back then, and conversations took place on message boards or forums. If you wanted to lurk from the shadows, you did just that, and if you wanted to join in, you had plenty of time to formulate a response.
Nowadays, very many places on the internet feel like the virtual equivalent of a party in full swing. Social media live off rapid-fire smalltalk, and like with a real-life party, those who are best at this kind of conversation shine, whereas the rest awkwardly stare at their feet. On a message board, you could drag posts from the archives and revive threads which had been dead for years, and the discussion would simply continue if some other forum members had sufficient interest. On Facebook, a status update becomes obsolete after a few days at the latest (depending on the size of your friends list), and on Twitter the half-life of a tweet is a few hours only.
I am terrible at smalltalking, both in real life and online. I never know what to say, or how to phrase it, and I am also very shy about approaching another person. Fear of rejection, fear of humiliation, fear of boring the other person… the whole palette of social anxiety at work. And social media have a much lower threshold in that regard than old-fashioned forums. Facebook is ok for me in so far as I know all the people there, and the update tempo on my timeline is not quite that high. But Twitter is difficult, because I do not know what to say: for the mindless quips and joking, I’m not nearly funny enough, and generally too long-winded for anything of substance. Some people have the gift to be profound and deep in 140 characters – but I don’t.
However, it’s not only Twitter which freaks me out. I can’t play any kind of online game where I would have to interact with other players; it is especially stressful because I am supposed to be leisurely around them, but can’t relax in such a setting and tense up. I am also very shy on other people’s blogs, more often than not leaving without commenting because a wave of social anxiety washes over me: “What if they don’t like what you are going to say? I’m sure they’ll find it boring as hell! Oh, look, there already are three comments, and they’re all so much wittier than what you were going to write. Just leave before anyone notices you have been here…” Even on my own blog, I sometimes worry about my own replies to visitor comments.

Both in real life and on the internet, I prefer moving in social circles I am familiar with – among friends, I can become surprisingly chatty. Among strangers, no matter how amiable they may be, it takes quite a while until I will start opening up, and one of the advantages of the internet is that through blogs or forum posts, you can get to know another person a little before you even exchange the first greeting. Social media which put more emphasis on exchange than on content (I am somewhat simplifying here, for the sake of the argument’s clarity), like Twitter or Facebook, are not any different from real life conversations to me, in terms of difficulty. Virtual worlds or MMORPGs are even more stressful than attending a party.
The truism that increased internet usage equals increased loneliness is too simplistic in my opinion, because its default assumption is that online interaction is less meaningful than offline interaction. When you suffer from social anxiety, however, chances are that – given a conducive internet usage – you actually are going to have more meaningful contacts with strangers than in the real world, while experiencing less stress at the same time.
Do not misunderstand me, I am not arguing for the superiority of internet contacts. If given a choice, I will always take a face-to-face meeting with my friends over emailing or messaging them. However, the media tend to paint a picture missing crucial details, both when praising the new interconnectedness and when condemning the arbitrariness of the new online platforms. For many people out there, the reality is much more complicated.
Despite occasional bouts of anxiety, I value the contacts I have through my blog, because they make me feel less isolated regarding my mental health problems, because I can learn from other people’s experiences, and because they allow me dealing with my social anxiety on a smaller, controllable scale.

Come A Little Bit Closer

The news about the TV appearance were not the only unusual part of the last session. Two years of therapy mean that eventually, the appointments start to resemble one another; the discussions are important, but you know the routine and after a couple of weeks you recall brief scenes rather than the whole meeting.
Over the course of spring and summer, the hospital wing where my therapist sits got renovated and he had to move out of his office temporarily. He’s been back in the old location since September, but had decided to furnish the room differently: the set-up of desk, armchairs, file cabinets and the exam table is mirrored now. All of this was reason enough to break the routine and to make me feel uncomfortable at first. I got so used to always having the same perspective in that room that the familiarity of sitting in that armchair gave me a sense of security. Before that background, the last session took place.

Practicing alternative behaviours is a huge part of our routine: my problem is that I tend to do nothing at all and just remain silent when I should speak up instead, and so my therapist lets me reenact scenes we discussed, but where I behave the way I should have for getting a more desirable outcome. He lets me repeat phrases until I get the words and intonation just right, and then some more to “hammer” them in.
This is by far my least favourite part of therapy as it goes completely against my instincts of hiding myself away. When the acting was still new to me, I would occasionally break out in giggle fits due to the embarrassment, but that wouldn’t let me off the hook. My therapist would just sit there with a smile on his face, wait until I calmed down, and ask me to try again. Of course, I could just refuse and sit in my chair for the rest of the appointment, but that’s not what I go to therapy for… So, the best way to handle this for me is to get it over with as quickly as possible – the more I concentrate and the sooner I get it right, the fewer repeats we’ll go through.
Last time, however, my therapist decided to take it a step further: he had me stand up from the chair. I repeated my little speech two or three times, then he said:
“Come a little closer, please.”
I made a small step towards him.
“And even closer, please.”
Eventually, the distance had shrunk so much that I could have reached out and put my hand on his shoulder; since my therapist was still sitting in his chair, I had to look down on him – a position which makes me feel extremely uncomfortable, and he knows it. I had to repeat my sentences again, then he asked:
“What did you just think?”
“I was thinking about my arms, about how I have been clasping my hands at this really weird, crampy angle.”
“Your arms looked just fine. Why don’t you try a different position?”
I tried to relax my limbs and folded my fingers in front of me, but since I had also inched back a little in the process, I had to step closer again.
“How does that feel?”
“Ok. Better than the crampy clasp.”
“Try something else – why don’t you just leave your arms hanging?”
I did, but immediately felt like they ceased being a part of my body and turned into two dead appendices rather. I stretched and flexed my fingers nervously, hid my hands behind my back and then let them hang down again immediately.
“How does that make you feel?”
“Nervous. Extremely uncomfortable.”
“But you look more relaxed and more approachable. If you fold your arms, you are creating a barrier. And to me, these positions are comfortable. I don’t feel threatened by you at all.”
In the past, we had talked about how this particular constellation – he sitting, me standing up – made me feel like I was being this huge mass ready to bulldoze him. Like a gross, obese entity crushing him under my excessively large body. I am (by now) completely aware that a lot of the negative self-image and negative thoughts exist in my mind only, and that they are very much over the top, but that does not make them go away.
“How do you feel now?”
“Still nervous.”
“Look at my face. What do I look like?”
“Neutral. Relaxed.”
“How can you tell?”
“There are no signs of stress in your face. No creased forehead, relaxed eyes and mouth.”
“It’s good that you can see this!”
We talked a few moments about how I hardly ever relaxed when sleeping either, that I often woke up with my hands clenched into fists, and the muscle pain I had from that.
“How do you feel now?”
“A little better. Still uncomfortable, but not as much anymore.”
“Good! It’s very important that you experience this!”

When I was finally allowed to sit back into the armchair again, I felt fairly exhausted. We have done similar exercises before, but never that long and intense. Rationally, I know what this is all about: by exposing me to an uncomfortable situation and having me observe that the effect on my therapist is not a negative one, my self-image gets altered. Physical proximity is not a bad thing, and I am not causing negative emotions in another person by standing close to them. At the same time, I am forced to endure a situation I’d usually avoid, so that I can experience how the discomfort starts decreasing after a while.
Strangely enough, despite experiencing mostly negative emotions, thoughts, and despite how stressful this was, I felt really good after the session. In my family, nobody would ask how I felt, and if i talked about it, the standard response would be to pull myself together. In fact, that is what I used to do – so much so that I always downplayed all of that or ignored it even, and it felt good to acknowledge the existence of those emotions and having them taken seriously.

Going Public With Depression – On TV

In the first session after my recent participation in the student class, my therapist paid me a compliment on that. He said he could see a huge difference between the way I carried myself in April and November respectively. And then:
“I think it would look pretty good when filmed, too.”
I didn’t know what to make of this comment, assuming he was talking about having a camera roll in another, upcoming student class:
“You think? I don’t know – and can’t really tell; it’s not like I’d ever watch that anyway.” (We’ve had discussions in the past about whether I wanted to see footage from the early sessions, which were all filmed. I always refused.)
“We are planning a featurette for [news show on TV] next spring and I could imagine you making an appearance as a patient.”
I was rather dumbstruck after that and don’t quite remember what my response was, something very non-committal in any case. We dropped the topic afterwards and it was only after a night’s sleep and some serious thinking that I sent my therapist the following reply via email:

“After giving the TV featurette you mentioned yesterday a lot of thought, I came to the following conclusion: should you really do this and by that time still be interested in having me in it, I would participate.
My biggest question was whether I’d be willing to have relatives (likely), neighbours (possible) and fellow uni students (unlikely) recognize me in the feature and asking questions about it. The result is that I am willing to accept that.”

And he emailed back:

“Thank you. In such a featurette, the main focus is on the treatment method and on what you learned through it. It’s great that you are going to be a part of it!”

I know the news show he was talking about very well; it’s on every day except for Sundays, in the early evening. Each region within the federal state has their own version, where they focus on what is going on in that particular area. It’s certainly not nationwide. Once per week they have reserved broadcasting space where they highlight a medical topic. One week it may be the latest development in terms of laser surgery for cataracts, the next week the specific problems of teenagers with diabetes mellitus, and after that it might be migraines or heartburn or coronary heart disease or hearing aids or dentures etc. They tend to focus on health problems which are common among the general demographic here in Germany and on treatment methods available in the area, including mental health issues, and one of the episodes planned for next spring is going to be about chronic depression and CBASP.

Generally speaking, the filming process shouldn’t be much more difficult than talking in front of the student class. It’s going to be a little different, but it does not spark any more anxiety in me than being in a presentation in front of an audience I can actually see.
However, since the exchange of emails with my therapist, I had time for contemplation and realized that the underlying issue is not so much going public, but rather relinquishing control over who knows and who doesn’t. Right now, I recall exactly whom I told about the depression and psychotherapy, and I have a pretty good idea of who told somebody else. In total, it should be about 25 people who are in on it, give or take a few. Once I appear on TV – with my real name, my face clearly visible, my voice saying the words – it will be impossible to tell who has and who hasn’t seen the feature.
For people who suffer from anxiety, it is very important to be in control of problematic situations, because that is what keeps the anxiety at bay. If I decide who is being informed or not, I also control for whom I’ll be vulnerable and who is excluded from knowing that “secret”.
There has been a similar situation in my life before: when I was in my early twenties and had to decide whether I wanted to come out of the closet or not regarding my sexual orientation. Before I came out, if I got into an argument with someone or somebody hurt my feelings, it comforted me to have a secret. They did not really know me; there was a part of me hidden from them which they could not reach, which they could not hurt. With the depression, it is the same mechanism at work.
Coming to this conclusion doesn’t change my position. I said I’d do it, and I will, but it’s always better to be clear about what is happening emotionally and to adjust one’s behaviour accordingly. I do not want my mood to tank afterwards because suddenly I feel exposed and vulnerable. And everything else is a challenge, I guess.

Looking Back At Two Years Of Psychotherapy

Exactly two years ago, I was officially accepted into the therapy programme and started sessions. I still remember the relief when signing my name under the contract – finally an official diagnosis, finally a glitter of hope.

Psychotherapy is a long process, at least when you are talking chronic conditions. At the age of 30, I had a depression history of almost two decades, and you don’t wipe those away in just a few short weeks. There were aspects of the depression which vanished within a few weeks, and others which I am still labouring around with. But generally speaking, a bad day now still is better than a good day two years ago.
Psychotherapy also is a lot of work. Hard work. You revisit a lot of bad memories. You get confronted with your own shortcomings. You have to practice both in the session and outside of it, relentlessly. I won’t lie: there have been days when I got fed up with all of this. Days when I cried, when I got frustrated with myself, when I didn’t want to do my homework. What’s worse, the majority of people you meet will never know how much effort you put into recovering from depression – be it because they don’t know you are suffering from it, be it because they don’t have enough empathy to put themselves into your shoes.
However, I do believe it was worth absolutely worth it, not only in terms of symptom reduction, but also because it made me grow. I changed more in those two years than in the ten years before. I feel like I am much more in charge of my reactions than I used to be: where I would just run a “standard response programme”once triggered by certain emotional stimuli, I am now actually aware of what is happening, of how I react, and why. I am more confident, more secure of myself.

I already wrote a post exclusively dedicated to my therapist in August 2011, and everything I said there still rings true. However, almost a year and a half later, I find that our relationship has matured. For a while, during the first therapy year, I was under the spell of transference regarding my therapist – not that I was in love with him, but I saw something like an ersatz-parent in him. He gave me the kind of emotional response I would have liked to get from my parents: protective, but not smothering me, and at the same time encouraging me to try myself out.
I think that kind of transference is not only the rule in CBASP, but actually accounted for as part of the therapy process. After all, chronic depression originates in the childhood. I believe my therapist was both expecting and aware of the transference, but never mentioned it to me, and I didn’t breach the subject either. Maybe I was more susceptible for it because at the time my husband was back in the United States and I was feeling lonely without him, and I could talk about this situation much better to my therapist than with my parents. That actually still is the case, but since my husband and I are not geographically apart anymore, the need to talk about this has naturally vanished too.

Back in the day, I would email my therapist at least once every week, to keep him up to date about my life – which had been his idea, not mine. Every other week, I’d have a session and see him in person.
Now, I have sessions in intervals of six weeks, and I email him maybe once per month, if something really important happens. The therapeutic relationship mimics that of parent and child again, and it looks like “I’m growing up” now and become independent from him. In fact, I do not need him anymore for my everyday life. The transference has faded away.
Does that mean I could do without him? Absolutely not. I am still looking forward to every session, but now in a strictly professional way, because I still want and need to work on myself. I still need the “security net” he provides, take great comfort in knowing that I could get in contact whenever the need arose. If shit hit the fan, he’d be only an email or phone call away. And I’m not quite ready to let that go. Yet.

The Jubilee Post

Today, I celebrate the 100th blog post. If the counter didn’t keep track of the statistics, I most certainly would have missed the milestone, but I’m glad I didn’t. When getting started, I had no real direction to follow and was more concerned with not running out of steam early on than with developing a writer’s voice or any long-term goals for “Lugubrious Layara”: I simply talked about what was happening in my life, in therapy and in my head.
There also was (and still is) an educational facet to the blog, even though from a strictly personal, non-professional angle. I get a fairly consistent number of hits through people googling CBASP, and I’m really happy that I can provide links, information and my own opinion – when I was about to start the therapy programme, there was very little to be found online, and nothing in regards to other blogs. Even now, the situation changed only marginally. And despite knowing that there are other people being treated with CBASP all over the world, and even at the same hospital, I have never encountered any other CBASP patient, neither online nor in the real world. If I have accomplished nothing else with this blog, at the very least it added a new voice to the plethora of mental health blogs out there.

Blogging means walkig a tight rope. How much of yourself do you put out there? And how much of the people you write about? I try protecting the privacy of everyone I mention as much as possible, even if it means that my writing sometimes suffers from the vagueness. Occasionally, I don’t post because it would mean discussing the personal history of another person more than I’m comfortable with – I can decide to put my own history out there, but not my husband’s, for example.

Sometimes, I want to post, but don’t have the energy for writing. There’s a good deal of regurgitating going on when developing a new blog post – I type, erase, type again, erase again, scratch certain formulations, phrases or entire paragraphs. And there were a few incidents where I had an entire post ready for publication but never chose to put it out there – because the situation described didn’t exist anymore, or because it had taken so long to jot the story down that I had already moved on from it by the time I was done.
And then, there are the blog posts I would like to write, but that are too emotionally exhausting to go there: for example, my sister’s “borderline meltdown” the day before my wedding. Or the post about my husband’s immigration process I started writing back in September, but the 800 words on that which I got so far only covered everything prior to our marriage day and revisiting the events make me feel depressed, so the progress on that is very slow…

Despite and because of all of that, blogging is very beneficial for me. My therapist always urges me to become “more visible”, to put more of myself out there, and the blog is one way of doing so. My friends and my husband not only know of its existence, but some of them even are somewhat regular readers. This allows me to talk about my feelings and problems at length without pushing them on anybody – they can decide when to visit, and how often.
There is a similar effect to writing about depression as visiting the student classes had; it gives me a sense of not only dealing with it, but of making it a little less like I wasted all those years with the illness. At the age of 32 years, I have spent a minimum of 20 years with the condition, about ten of them severely depressed. By sharing, it does not feel like I wasted those.

Being A Guest Speaker Again

Last week I was a guest at my therapist’s student class again. Unlike the first time in April, when he’d asked me weeks ahead of the event, this time it was on very short notice, less than 24 hours before the class. I gave a positive reply without hesitation. Appearances like that make me rather nervous, but I am a firm believer in doing something for the greater good. If my appearance helps students to see chronic depression as less abstract, if they can put a face on textbook knowledge, it makes me feel a little better about my own mental health history – one positive aspect among so many negative ones.

The class was about the same size and gender ratio as last time (women vastly outnumbering the men); very well-behaved and quiet. The April-group was maybe a little more engaging, but then, they had only seen one other in-patient before me. This month’s group had already met an elderly in-patient with treatment-refractory depression, a bipolar patient and a young woman with chronic depression in the very early stages of therapy. I was meant to be her counterpart, who could talk about the changes which happen when you go through psychotherapy in general and CBASP in particular.
I was with the students for 25 minutes only, so naturally we didn’t go into as much detail as last time, and focused less on my personal history and more on the importance of trust and the professional’s behaviour: that in the long run psychotherapy is more successful if time is allowed for establishing a trusting relationship between therapist and patient first. More often than not, patients battle anxiety in addition to the depression, and they are easily scared away for good if not handled carefully or not taken seriously by therapists and hospital staff.

It is rather ironic that despite my social anxiety, I am a somewhat capable public speaker. I know that you have to enunciate clearly and speak with moderate tempo, that you have to talk louder than in a normal conversation and that eye contact with the audience is important if you want to come across as competent. I have held a number of lectures in university in front of up to a hundred people, and have almost always been congratulated on my “professionalism” afterwards. But it is just a mask I wear and afterwards, I am terribly exhausted and crash, and it takes weeks to fully recover from this.
Generally speaking, I was not as worried this time around, even though there always is this phase a couple of minutes before actually getting started where I become somewhat panicky, cursing myself for saying yes and badly wishing I had avoided this situation. And I’m always afraid of “forgetting” crucial facts, of not being able to access the memories of the early treatment days properly. Fortunately for me, my therapist knows me so well by now that he can anticipate problematic situations and guide the conversation around them, or take the edge off by moderating.

The chart of my depression indices was shown again – I noticed that this time, it had the title of an article printed on the bottom, stating it was “in press”. (For those who are not familiar with the rules of scientific writing: an article being “in press” means it has been accepted by a journal for publication, but has not been printed yet at the time being.) From the very beginning I had known that my anonymised data would get published sooner or later, and in the beginning I was itching with curiosity. Now that I had stopped thinking about it altogether, that silent announcement took me somewhat by surprise.
I can’t help but wonder whether this obsession about the article in the early days had something to do with the urge to chronicle my own life, as mentioned in my last blog post. As if my own thoughts and ideas and feelings about the topic don’t count if I can’t back them up with written proof.

Decluttering: Part II

In the last post, I mainly focused on recounting a chronology of events; in this entry, I would like to highlight the emotional and psychological background of the decluttering process I am still going through (even though I must admit that I’ve been slacking on that front since I wrote the last entry – it’s definitely time to get back in gear).

My household chores consist of cooking and grocery shopping as well as doing the laundry and, once in a while, cleaning something. My husband is responsible for most of the cleaning / vacuuming, he does the dishes and makes the beds. I am now in a state where I can fulfil my share regularly, at least preparing our meals and shopping. The laundry and cleaning get put off sometimes, unless it is really urgent, but overall it is not too bad either and never for longer than a day or two. I actually enjoy the cooking and grocery shopping, which undoubtedly helps a lot.
Decluttering, on the other hand, is a highly stressful process. Every box I open contains a plethora of keepsakes, memorabilia and knickknacks which are ten to fifteen years old: fountain pens, postcards, key rings, fashion jewellery, notebooks, candle holders, foreign coins, bookmarks, rubber bands, hair clips, dices, and pebbles. There are a lot of pebbles and pieces of rock in my flat – picked up at various destinations of my travels as well as just in my home area. This might sound odd to some people, but those pebbles are not only souvenirs, but also bring me aesthetic pleasure. I like looking at them and the way they feel to the touch. However, I got to the point where I just had too many of them and they were sitting on too many surfaces. There are only a few I will keep, but 90% are in a plastic bag now, which I’ll empty into the local river one of these days.

The popular advice to put something into a box and throw that box away unopened after a year if you have not missed any of its contents just does not work for me – it actually creates anxiety for me. Instead, when I “attack” a new box or pile, I have to take a look at every individual piece in it and decide whether I want to keep it or not. It is almost like saying goodbye to the objects that won’t make it.
The more personal the item, the harder it is to let go of it: for example, I had two pieces of rope tied into nautic knots which I had made on a sailing trip to the Netherlands in 1996. They served no purpose, not even a decorative one, anymore. They took up space. They actually bothered me, I wanted them to be gone. And yet I could not bring myself to throwing the ropework away. Doing so just felt wrong. For several minutes, I stood there, holding them in my hands, remembering the day I made them and the time which has passed since, until finally I tossed the rope into the trash bag. I had gotten so stressed out over the process that I had to take a break for half an hour, and that is what it is like every day that I actually find the energy to organize.

Just where does the sentimental attachment come from? In some cases, where we’re talking about souvenirs from vacations, the answer is obvious: they are tokens of happier days. But just as often, they are just remains from the past and don’t evoke particularly fond feelings – sometimes even the opposite happens. Like with the retainers I had to wear as a teenager, which only remind me of all the physical pain they brought and the scars left inside my mouth by the braces and retainers.
The only explanation I can come up with regarding why I kept all those objects is that I tried to keep an inventory of my past. As if little parts of me would cease existing if there was no tangible proof of them. My wish of becoming an archaeologist could just as well be interpreted as a diagnosis – I tried to chronicle my own life.

Decluttering: Part I

Even though there are symptoms which the vast majority of people with chronic depression share, everybody’s got their own personal “bouquet”. In mine, lack of energy features very prominently. To the non-depressed reader, it might sound either very lazy, or pleasant even if I write that I don’t have the energy for anything but sitting on the sofa and watching TV, or browsing the internet, or playing computer games. The truth, however, is that these occupations are not thoroughly enjoyable, but merely a way to pass time. Plans one might have harboured when going to bed suddenly appear impossible to fulfil, turning into insurmountable obstacles when waking up.
There’s hardly a person who does not feel tired and worn out once in a while, consequently putting off all chores. But, for the non-depressed person, these feelings usually vanish quickly, and they go back to vacuuming, cleaning, grocery shopping, mowing the lawn or doing the dishes. For me (and many others out there), nothing changes after a day or two of rest… In fact, it can be like that for weeks or months even.

For about 90% of my adult life, I have lived with the dishes piling up in the kitchen, my entire desk hidden under stacks of paper from the previous year(s), and the bookshelves covered with thick layers of dust. Both my flat and my behaviour lived up to the stereotype of the messy, absentminded professor.
I don’t really like living like this, but whatever little energy I had usually went into whatever was the most necessary at that moment. The last time my entire flat was neat and tidy lies a good ten years back in the past. After my husband moved in and there was someone to share the chores with, things improved visibly, but there still are piles which I have not touched in years.
About two months ago and after a particularly lethargic summer (completely drained from the exam), I found Cynthia Ewer’s “Cut The Clutter” at my local library (the book appears to a more fleshed-out, printed version of the author’s website, organizedhome.com). It did provide the inspiration and motivation so bitterly needed, and a few eye-openers. For example, it never occurred to me that chaos can be described as resulting from put-off decisions – definitely one of my weak points.
Of all the personality types Cynthia Ewers mentions in her book, I have elements of every single one in me: because I’m sentimentally attached to many of my possessions, I have a hard time throwing them away, even long after they’ve stopped being useful or important. Because I tend to think that I might need something later, I’m afraid of getting rid of it. Perfectionism gets in the way of organizing, because I am under the impression that I need a faultless system before I can get started. I feel bad about throwing out items which once were expensive. And a tiny part of me still is in rebellion against my mum telling me to pick up my room, even though I moved out of there a long time ago.
Four out of those five reasons I can overcome with rational thinking: even if an item used to be expensive, its worth usually decreases over the course of time. It’s more important to get chores done than to slavishly follow a predetermined plan. Most of what I was saving for later use could easily be obtained at the time I actually would need it, so holding on to it is just a waste of space. I am a grown-up now and do not need to rebel against my mother – having a nice place should be more important.
That leaves sentimental attachment as the only reason where pure logic alone does not help me changing my behaviour.

The decluttering process began as a rather assessable project, with re-organising my pantry. Certainly not the most pressing matter, but it promised quick results and little risk of running out of steam before completion and thus adding to the long list of problems. I finished within two days and due to instant improvements when cooking (ingredients were so much easier to find), it gave me the motivation to tackle a bigger challenge the following week: sorting out my wardrobe / closet, which I hadn’t done since the day I moved out of my parents’ flat (throwing away individual pieces does not count). By the time this was done, there were two big and four small bags of clothes as well as a bag of shoes waiting for the trip to the donation containers. For the first time in years I was able to move the hangers on the rack – another instant improvement.
Over the following weeks, I would finally put an old glass-showcase outside that had been sitting empty in my flat for at least three years, because I never got around to taking it apart, and then I’d move on to weeding out all the books I’d never read again, with the intention of selling them online. To this date, I have made just over 90 euros out of 87 books sold, with about 100 more titles I hope to sell eventually too. There were about 30 shelfmetres worth of books in my flat, and while I kept the majority, now there is actually enough space to put every single volume on a shelf.
The last week was dedicated to decluttering my desk, because I intended to put both the desk and my swivel chair out for the bulky waste collection. While the collection is free here in Germany, you have to call in and register in advance if you want it picked up, because in the past scavengers used to tear the piles apart, making a lot of noise and strewing the discarded items all over the neighbourhood. In my community, there is a collection every other month and you can order the service twice a year , meaning that you’d better have the bulky trash ready once the date rolls around.
The swivel chair posed no problem, because both armrests had been broken and resisted any attempts at repairing them in the past. It was utterly unusable and actually a minor threat of injury. The desk had two drawers, one of them unfixably broken, but otherwise it still was in a good condition. Had it been smaller, I’d have kept it – however, with dimensions almost as large as a single bed, it was too big for our bedroom and we could not keep it. Decluttering the desk was not as difficult as I thought since it was mostly paper, and after about two hours I was done.

This is the status quo; since I want to move some furniture in the bedroom and change a couple of things, I reckon that I am about half done now. I will keep reporting on the progress.