Forcing Myself To Post

This is not the first time that I’m trying to write a blog post, even though a couple of weeks have passed since the last attempt. The biggest hindrance being my continued inability to express myself – if talking about it poses great difficulty, writig appears an almost Herculean task. So I’ll just try to give a very fragmentary overview in the hope that eventually I’ll be able to express myself more eloquently.

I don’t know how I made it through the semester, in hindsight maybe even less than at the time of living it. In the end, I was so burned out that I pushed all but one of the exams to October, because I wasn’t mentally fit for studying any more, but at least that one exam I passed with an “A minus”.

My husband’s appeal for a residency permit got granted for three years (after that, it’ll be a permanent one). We jumped through all the bureaucratic hoops and in December he can finally start the mandatory German classes, the way there being paved with many frustrations that will require a post of their own.

My old computer broke after five and a half years of faithful service. The power supply unit literally blew up (knocked out the living room’s fuse, smoke curling out of the computer’s back) and damaged not only the PSU, but also the mainboard and processors. It was only because of a financial donation from my mother-in-law that I could buy a laptop as replacement… All my personal data – photos, all my uni files, the templates for the blog charts etc. – still are on the old harddrive, but I hope I can get them back soon.

The last regular therapy session was in April. I had one “on the side” in late June, which my therapist had crammed in between hospital duties one morning, but following up on this, all scheduled appointments got cancelled due to the persisting staff shortage at the hospital, and then August rolled around, which my therapist takes off every year.  I was told to get in touch via email at the beginning of September, so I guess by Wednesday (when the first dust of back-to-work-stress has settled) I will contact him.

For about three months, I have argued back and forth with German Telecom over the cancellation of my landline phone back in February: because I couldn’t pay my phone bill all at once, I had cancelled my phone and arranged for payment of the remaining bill in four rates, due in March, April, June and July.  In May, I received a letter reminding me of outstanding payments on my landline and when I called customer service to clarify the mistake, the ladies I spoke to insisted that my phone had been turned off because I didn’t pay – never mind the fact that if one calls my old number, an automated message announces that the phone number is not available at the moment. It wasn’t turned off, it was properly cancelled. On top of that, they spoke of the fee due in May, when the payment plan I’d received in the mail clearly stated that no rate was due that month, and claimed that a sum equivalent of three rates was still due when I had already paid two rates out of four.
In the end, I got so worried that I even discussed it with my therapist the one time I saw him, even though his suggestion to take a lawyer to sort this out was rather unsatisfying to me – how would I pay the lawyer? I don’t have any insurance which would cover such a case either, and so I could only hope that one of my emails or phone calls would finally sort out the matter.

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These are, in a nutshell, the most important events of the past months. This is the third day I’m “working” on this post, just to give some kind of perspective regarding the difficulty of writing. By the end of June, I was at a score of a whopping 33 points in the BDI-II, which signifies heavy depression, and right now I’m still lingering at around 15 points on good days, or higher on bad days.
The most persistent symptoms are a lack of energy and “emptiness” inside. Not only am I  devoid of any kind of esprit or verve, but sometimes it’s even hard to tell what I’m feeling. There’s… just nothing I could put into words. Which is upsetting when my husband asks me what’s wrong, because I don’t want him thinking it’s something he did. It’s just our circumstances, I guess. We’re on a very tight budget and can’t really afford to go out, much less to go on a trip for a while. So I guess part of that emptiness inside is just boredom, being stifled by the ever-same routine. And part of it is pure dread in the face of having to go back to uni in a couple of weeks. Even though I know that I should take it as a challege and one day at a time, the memory of the last semester is too fresh to actually see it this way.
Around this time last year, I thought if I went back to uni, it would take a couple of weeks and then I would get used to it. I thought that if I did not manage 100% productivity, I would reach at least 70%. Right now, it feels that anything beyond 30% is beyond my capacity, and I wonder if I will ever become “normal”, ever be able to finish uni, get a job – and hold it down. How do “normal” people manage?

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Writer’s Block

Words don’t come easily these days. I’m suffering from some kind of writer’s block, which ultimately is only a symptom of problems in other parts of my life. And the blog isn’t the only way it manifests: my last therapy session was the one I posted about in April and I haven’t written to my therapist either in the meantime. We talked on the phone briefly when he had to cancel my appointment in May due to staff shortage at the hospital, so he has a vague idea that I am not too peachy, but despite a few attempts I could never finish an email even though trying really hard – I can’t put into words what exactly the problem is or what he could do to help me. Same goes for my husband. He asks me to talk to him about it, but I just don’t know what to say. I don’t know where the root of the problem is and I don’t know what to do to make things better – all I can tell him is that I am increasingly suffering from university-related anxiety, but that’s something he can tell without me pointing it out to him.
Yesterday, I woke up two hours prior to the time the alarm clock was set for, and the thought of going to class filled me with such dread that I burst into tears and ended up staying at home. Today was hardly better, just less teary, and even though I left for class, I just ended up counting down the minutes until I could go home again. On the outside, all I have to do is sit there and take notes, nothing more, but inside me there is so much anxiety that even that leaves me completely exhausted after two hours.

Exhibit B: A (Not So) Hopeless Case

Exactly a week ago I appeared in front of a group of 19 psychology students as an example for chronic depression, but was (still am) so swamped with homework that I didn’t have the opportunity to write it down yet.

I went to the hospital straight from university, so I was a good half hour too early and had plenty of opportunity to get nervous. It was a part of the hospital building I did not know too well either, so I did not dare going to the restroom out of the irrational fear I would miss my therapist. Fortunately, we had about ten minutes to spare when he came to pick me up…
We spoke a few minutes outside – about how I was doing in general, and about being nervous and how curiosity got the better of me. We also discussed which personal information my therapist was allowed to disclose (he was very discreet, though, and spoke only of my “significant others” instead of naming a person, and he did not talk about anything personal). I gave him free range on whether he wanted to wear his white coat or not and on whether we’d sit at a table or not, so my therapist decided to recreate the therapy setting – no white coat and no table.

As mentioned, the group was rather small, creating a somewhat intimate setting – as far as that is possible given the circumstances. My therapist acted as a moderator, introducing me and my diagnosis, and I smiled a hello into the round. They had already learned about the characteristics of depression before and seen an in-patient earlier that day, who had also volunteered to talk about her depression. The in-patient, however, had been an example for biological reasons behind depression: a disturbed transmitter chemistry and psychiatric treatment with cipralex. I had come in as a representation of environmental and character-related factors, with the biological components playing only minor roles.
I started off recounting how I got misdiagnosed by my former general physicians, how I suffered from panic attacks in summer 2010, got on citalopram but could not shake the depression, and finally got in contact with the hospital. My therapist elaborated on the importance of behaviour in medical caregivers – had my first contact not been such a positive one, I might never have followed through with everything that followed.
There was a sheet with the results of all the clinical tests I did during the first 48 weeks of therapy – BDI-II, IDS-SR, MADRS and possibly some more I forgot, plus the results of the “therapy cards”. My therapist was not supposed to know the results until recently, because they evaluated the level of trust between him and me, but from the beginning of their evaluation (from therapy week 4 on), they had shown I trusted him. All the other tests showed the same pattern: a very high score in the beginning, then a steep decline over the course of a few weeks only, and a long phase of slowly fading out. Towards the end, my scores went up a little again, when I decided to go back to university.
We spoke about how important it is to trust the therapist and I listed some of the irrational fears the therapy setting could have evoked – fear of being ridiculed, getting yelled at, not being taken seriously, or cancellation of therapy as a punishment for increasing depression symptoms, for example.

I did surprisingly well during the presentation. My biggest fear had been to just freeze or being unable to get proper words and sentences out of my mouth, but I spoke with a loud and clear voice, looking at all the faces around me and also taking in their reactions. Everyone looked friendly, some even smiled encouragingly, and I found it easier to open up than expected. Of course, we did not discuss anything private, but considering that in university I have not told anyone anything that is even remotely close to the truth, it was a pretty huge step for me. Part of what kept me calm was that I knew no matter the outcome, the people would learn something from my appearance. If I could talk about it all, they’d learn from my report, and if I froze up completely, they’d get a demonstration of what depression can cause.

Today, I had a regular therapy appointment, and my therapist said he could tell the very moment I relaxed during the presentation just from observing my body language. He gave me quite a lot of praise and also thanked me for doing this: “Half a year ago, I wouldn’t have asked you. Not that you couldn’t have done it back then, but the risk would have been too high.”
There are several reasons why he asked me: for one, I’ve been long enough in therapy to know the process very well, to have recovered enough for being able to reflect, and something he has been stressing a lot over the last weeks is the fact that I went back to university. Last month, he told me about a colleague’s patient who had a similar diagnosis as I do, and she actually quit her job – whereas I went back to a place that terrifies me quite often. On about four days per week, it gets so far that I think I can’t take it anymore. I fantasize about quitting. But, there’s no realistic alternative, and so I struggle from week to week. My therapist knows this – he gets to hear plenty about that, of course. University was one of the catalysts which propelled me further into depression, so he thinks that it is of utmost importance now that I confront those situations and master them. He never influenced my decision on whether I should go back or not, but clearly approved of it afterwards.

One reason why he asked me might have been that the outlook for me without CBASP would have been pretty bad: “Early-onset chronic depression with life-long co-morbidity of panic disorder.” He called it a “horrible, horrible diagnosis” which without this special therapy programme would be pretty much treatment-resistent. CBASP actually works on both a personal and an environmental level, whereas other schools of psychotherapy concentrate on one aspect onely: classic Freudian psychoanalysis operates on the personal level only, classic cognitive psychotherapy on the environmental level. Neither of them would have been sufficient for me.
They didn’t even put me through pre-treatment self-evaluation as they usually do, because they thought it would trigger my flight instinct and drive me away. Yet, despite the very bad odds, here I was – more or less functioning now, and definitely able to talk to a bunch of strangers without running away.

At the very end of the presentation, everyone clapped and I blushed and looked down to the floor, until my therapist told me: “Look up and take it in. This situation will be over soon, so this is your only chance at grasping of how well it went. You need to take this memory home with you.”

Just A Quick Update

I’m still alive, but very busy. Lectures at university started again – not that I had a lot of free time during the “break”. I attended an extracurricular class in zoology and passed the exam for that, and I didn’t pass the second attempt of physics because I was just too burned out and my brain didn’t cooperate at all. As a result, I opted out of taking maths again.
Currently, I’m writing a report on the field trip I took in February; the text is as good as done, but I still have to put in pictures and so on.

Then, of course, I got married and had a lot of family drama going down the day before the wedding, all of which deserves a dedicated post.

Finally, my therapist invited me to join a class for psychology students next week – as a “living exhibit”. They’ll present my data, including the clinical tests I took (the results of which I’ve never been told), and I’ll be there to answer questions. Bring the person to life, I guess, because according to my therapist, most of these students have no real idea of what it is like to be depressed and what it is like to undergo CBASP therapy. Besides the scientific data, I can provide insight into all of that. Strangely enough, I’m looking forward to this.

Finances, Fear, Family, Frustration

I’ve been in financial trouble lately, culminating in a letter threatening to turn off my gas and electricity if I didn’t pay within the next few days. It came as a really unpleasant surprise, because I was under the impression that I had already paid all I owed last month, but apparently had been mistaken. My boyfriend was able to cover for that and so we’ll continue having warm water and heating, but it still weighs down on me. My mother barks at me that I have to quit university and get a job, my therapist tells me it’s of utmost importance that I finish university, as does my boyfriend… I’m tired of being stuck in the hamster wheel, tired of the perpetual financial strains.

And I feel guilty because I do not have the stamina for handling both a job and uni. I can’t even hold up university alone…

Last week I saw my therapist for a few minutes because he had to give me a doctor’s note so I’d get out of the second attempt of the chemistry exam. He puts a lot of emphasis on the fact that I learn to put up boundaries towards other people and learn to defend myself so I can actually do what I need to make myself feel good. Which is a lot easier said than done, especially since my brain just “empties” under stress and I become completely speechless, in the very sense of the word. It is a reaction to the cortisol surge one experiences under stress: long-term exposure to this stress hormone damages the brain cells in the hippocampus, which results in memory problems, and it also impairs retrieval of already stored information.
This morning, I was crying after receiving the letter from the energy supplier, and despite my boyfriend asking me to talk to him and say something, I just was not able to. I could not form a coherent sentence, neither in English nor in German. Even now, it is difficult to describe what is going on in me in these situations – one should assume that once the problem is taken care of, everything is alright. And my boyfriend echoed what my therapist tells me as well, that I have to stay in the present and not make this about everything that went wrong in my life, but I am not always able to do that immediately. The fear and despair can be faster than any rational thought.

Money is not the only source of stress – there also are the uni exams, of course, family situations, and the fact that the bureaucratic process for our marriage is very frustrating. I had to hand in a statement from my parents that they supported me financially, which got “lost” – even though I handed it in, it never arrived at its destination. Then I brought a second copy of the statement, only to be told that I had to re-write it. It is almost ridiculous that my boyfriend’s American documents are all fine, but my German documents create all kinds of problems…

Defeats & Successes

The week started really badly. I had a confrontation with my mother once again. Or rather, she confronted me, and I stood there, thinking, “Defend yourself! Say something! Don’t let her treat you this way!” But I opened and closed my mouth a couple of times and nothing came out of it. Just stood there like a deer in headlights.
The topics weren’t new either: that I should give up university and get a cleaning job, that I’m ruining the family, that it’s been thirteen years now since I left school and still had not finished university yet, etc. Same old accusations, but they still sting, and I literally cried at my boyfriend’s shoulder.
I have never uttered a word of blame towards my parents, because that is not going to change anything about the position I am in, but sometimes I just want to yell at her that I would not be where I am today if she had not contributed to it, and that her behaviour is very counterproductive. I am not going to become “less of a problem” for my parents if I have to constantly fight battles on the side – getting through university is difficult enough as it is.
Just hours before that, I had a therapy session and it was the first one after over a year in which I felt truly uncomfortable. Not because my therapist was displaying a negative attitude towards me; the negativity came from inside me, because I was projecting my mother’s attitude on him, but I only realized that later.

However, he will sign me sick for the upcoming second attempts in chemistry (and crystallography if I want that), because I still am having cognitive problems. I did sit the physics exams today and during the first half of it my brain was really slow and on the verge of going blank, but I didn’t freak out and just tried the best I could. Not so sure about the result, I would say the chances for passing equal those for failing, but at the very least I got an idea of the requirements now.
But, I did pass the palaeontology/micropalaeontology test and got a placement in the zoology class. They did not publish the grades, so I have no idea how I ranked relative to the other students, but at least it was high enough to get into the class.

Disclosing Depression, Part 3

The appointment with my therapist lasted no more than five minutes; we didn’t even go into his office but talked standing in the door frame. He had my note already prepared, which stated that I was incapable to work or sit exams from Thursday until Tuesday – tomorrow we’ll figure out a long-term strategy in our regular session. I was grateful that he filled in a few more days than just Friday, because it doesn’t look like I only wanted to get out of the exam this way.
I got a little glimpse of my therapist in his role as a psychiatrist, too. Usually, when I come to see him, his business as a psychiatrist is done and he takes his white coat off and sheds the whole “clinician persona” for the duration of the meeting, so the whole scene had a faint hint of strangeness to it. The psychiatrist-character appears a lot busier and, even though still being very friendly, more authoritative.

There’s no diagnosis on the note, but a huge stamp stating “[…] Clinic […] for psychiatry and psychotherapy” above my therapist’s signature, so when I hand it in on Monday, it will be known at the institute that I am being treated for mental health problems. So far, the university administration knew because I had taken a sabbatical a year ago, but none of my professors or other people at the geosciences department are clued in currently.
I am not sure how I feel about the fact that this is going to change: I like to keep some things private. It’s none of their business what I’m struggling with, but I also understand that it is better to be open about it and admit the problems I have – especially since my depression is chronic, not a singular episode. Recovery takes a long time, and I will have many more moments when depressive symptoms temporarily return, so it would probably be better to make it public and then deal with whatever consequences this has. Legally, I am on the safe side: my therapist told me more than once that they must not discriminate against me and have to treat me like anyone else. It is not open discrimination I fear anyway, but the hidden prejudices which are not expressed openly.

Panic Attack

Last night I suffered an anxiety/panic attack over the upcoming exam. I saw it coming in the afternoon already, but tried to ignore it – not that ignoring the early signs did much good. Around 1 o’ clock in the morning I started crying and woke up my boyfriend, who tried calming me down and get me to sleep. When I finally drifted off, I had very unpleasant dreams and woke rather early, being completely cramped – my left hand was so tightly clenched that I had to open my fingers with the other hand.
I’ve also had increasing cognitive problems over the last days, with the ability to memorize going downhill really fast, word-finding problems and slowed speech. All very familiar symptoms, but it is scary how fast they can come back once I am really stressed out. So I emailed my therapist about this and he wrote back that the panic attack is enough for him to give me a doctor’s note which will allow me to not participate in tomorrow’s exam, so that unlike on Tuesday I won’t lose one of the precious three attempts. I see him briefly tomorrow morning, and for Monday I had a regular appointment scheduled anyway.

I think I probably overestimated my mental capacities and, trying to cram as many facts into my head as possible, eventually buckled under the pressure. I guess I should only have registered for two exams in the first place…

Semester Exams

The next two weeks are entirely dominated by exams, plus a palaeontology / micropalaeontology test which got announced on short notice, because too many people want to get into the zoology class. Tomorrow I’m taking the test, Tuesday the chemistry exam, Friday crystallography, the following week physics and mathematics.
Even though I’m rather good at palaeontology, I had to learn for this test because here the absolute grade isn’t as important as the relative placement – in other words, one wants to leave as many people behind as possible, to ensure getting into the class. However, studying for palaeontology is taking away time I meant to invest into chemistry, which is the exam I have the least chances for passing to begin with. At the beginning of the semester, I would have thought that role fell firmly to mathematics, but chemistry is twice the workload and just more than my brain appears capable of handling. I somewhat regret registering for the chemistry exam now as it will use up one of three attempts for taking I have – guess I will just give it a fool’s try on Tuesday and if I fail, I’ll spare the other two attempts for next year…

I’ve written before about the effects depression has on the brain: it alters and destroys synaptic connections in the brain which then have to get re-connected again (through therapy). I really feel the difference between now and ten years ago – I tire much more quickly of learning and have a harder time remembering facts. When working on long-term projects, like writing a paper, it doesn’t create too many problems because I can take breaks as I want and the result depends on continuous effort rather than a moment’s “genius”, but I struggle with preparing and sitting exams. After about 90 minutes, I need a break for several hours, and even though I still have two weeks to go, “learning fatigue” has already set in.
The sad part is knowing that ten years ago, I easily would have excelled in classes where now it takes an effort to be “merely” good. And I know that it could be worse, that after all I still manage to keep pace – but there is a lot of frustration still, and I am constantly afraid that from the outside it looks like I am procrastinating, and I am afraid that I will be judged by the professors and other students, because they are not aware of my background story.

Old Routines

It’s amazing how we spent the better part of a year in different countries, yet settled back into the old routine so fast that it feels like my boyfriend’s never been away. It doesn’t feel like he’s been here for only 48 hours either, so there are moments when the ten months which passed in between morph into a slightly surreal memory which might as well have been an intense dream. He accompanied me to therapy too yesterday – one more reason to feel catapulted right back to last year’s winter, because he was my regular companion on those trips to the hospital.

After having to cancel on me twice in a row, yesterday’s appointment was only 20 minutes long and not counted as a proper session. The situation at the hospital is rather chaotic at the moment, worse rather than better compared to the last weeks. My therapist usually is very neatly groomed, but this time I noticed that he was not properly shaved, probably because of a lack of time.
My boyfriend and I were waiting in the visitor lounge, talking, when my therapist walked by – he knows this is where I am waiting until it is time to go to his office, and he wanted to tell me that he would be a few minutes late. It made me happy to see my therapist and boyfriend exchange a few sentences – they become a little less abstract to each other this way.
I have a new appointment for early February, the first regular one in over two months: the session in December counted as an informational meeting only. Due to the restricted time frame we had yesterday, we only discussed which kinds of behaviour had a positive influence on my depression indices: the BDI-II score is down to 14 from previously 20. It was only just enough to give a rough overview, but for me it was more important to have the personal contact with my therapist, however brief that may have been. Very early into the meeting, when I was just sitting down, he said: “You are looking well!” And I believed him; he doesn’t make insincere compliments, and I felt happy enough to believe it possible that I was looking good too. Not to forget that the last time I saw him, I was so mentally and physically exhausted that it showed on the outside – so that was a valuable feedback for me that I was back on the right path.