Misfortunes Never Come Singly

Over the past few days, I’ve had to deal with a number of frustrations and disappointments.

The aquafit class got cancelled after local authorities closed the pool and adjoining gym. Apparently there’s fault with the ventilation system, and fixing it will be so extensive that it won’t re-open before summer 2017. A number of schools and seven different sports clubs have now suddenly lost their training locations.
As for the group I was part of, any vacancies at aquafit classes held at different pools are first going to those who joined as part of their physical rehab. Anything that’s still available afterwards will be offered to the “prevention group”, or you can simply get your money back.
Financially it’s no loss, but I was so happy with everything concerning this: the group, the instructor, the time slot, the uncomplicated drive… On Friday I’ll find out if I can at least finish the last four weeks before the summer break.

Then, we are having jobcenter problems. My husband has a fixed salary per hour, but there are additional boni for night shift, Saturday or Sunday work. So he never gets paid the same and the difference can be several hundred euros in extreme cases.
As I mentioned before, welfare is slowly phasing out; we are still approved until the end of September and only get substituted right now to make up the difference between the threshold-income and his actual income. We have to hand in a copy of his payslip every month to prove how much he made.
Well, the first month, when my husband’s actual income after taxes was still lower than what we got from the jobcenter, they paid us too little and the missing rest came three weeks later. The second and third month, they paid us too much (way too much this month) – which wouldn’t be such a big problem if we wouldn’t get into trouble for that down the road. We basically have money sitting in the bank that isn’t ours, that we can’t touch because they might ask it back at any given time, and all attempts to contact them have been fruitless so far. They don’t react to emails, phone calls end in the holding line…

On top of all of this, the jobcenter ordered me in Friday morning to discuss my medical report. It makes me nervous as hell, because I don’t know the result and what they want to do with me. Worst case scenario, we would have the means to terminate welfare support on the spot. Last month we were just 60€ below the threshold and this month we’ll be over it, so the jobcenter would have (or should, at least) stopped giving us money anyway – we only wanted to stay until September because we could have used the “mobile pass” still, which gives you percentages off public transport fares, and as a security net until my husband’s probational period at the new job ends at the beginning of September. Last but not least, terminating now would be a nightmare of bureaucracy, whereas just waiting until it runs out does not require anything other than NOT requesting a renewal.

Logically, I am aware that no matter what they are going to say on Friday, they can’t do anything to me. I could just walk out saying “So long, suckers!” if shit hit the fan. But being the unconfrontational person that I am, it already stresses me out.

Advertisement

Thoughts On Psychotherapy

Last autumn, the clinic contacted me regarding a follow-up evaluation for the medical study. Actually, they had first contacted me in summer, but my family and the paperwork for the renewal of my husband’s residency permit kept me so busy that it got pushed out of my mind. After their last reminder, I offered to drop off the questionnaires in person – I had an appointment with the psychiatrist anyway, and it’s less than five minutes driving distance between the two locations. That way, the clinic would have them faster than via traditional mail, and I’d feel a little less guilty for making them wait so long.

The evaluation mostly consisted of self-report questionnaires like I had filled out so many times before in therapy. The most difficult was a section where I was supposed to rate the difference between summer 2011, when the clinical trial ended, and autumn 2015. On paper, my situation sometimes didn’t look all that different, but on the inside it sure felt like a world apart.

So one dark December afternoon, I was knocking at my therapist’s office door again. I felt a lot more nervous than I had anticipated: I hadn’t seen him in three years, and still didn’t know what medical problems had caused him to terminate back in 2013, whether he’d be visibly altered.

When he stepped out of the door, he looked maybe a few pounds heavier than I’d remembered, but definitely healthy. There was an emergency meeting going on in his office, so I couldn’t go inside, and he had only a minute, but “didn’t want me to leave without saying hello”. He showered me with questions, of which I managed to answer less than half, and we agreed to meet again in January after my next psychiatric appointment.

I wasn’t any less nervous about the January meeting than I had been about the December one. It was scheduled as a follow-up, because strictly speaking he was not allowed to see me outside the medical study – the clinic has stopped outpatient treatment completely, with the exception of clinical trials. Which buried my hopes for ever going back to therapy with him for good. Since he had already received my questionnaire, he was somewhat in the loop of what had happened in my life over the past three years.

“What would you say is the biggest difference between now and then?”
I had to think about this one for a moment, then replied that I felt like I had grown up. That I didn’t let people trample all over me anymore, that the person I used to be just a few years ago seemed like a stranger now.

It’s true in many respects. I don’t have that crippling feeling of worthlessness anymore. Not that I think about how awesome I am all day long – I just don’t bother with that topic at all, neither in the positive nor in the negative sense. It’s just become irrelevant for my life as it is now.

Both the therapist and I agreed that I had responded extremely well to psychotherapy. I am convinced that a lot of the positive developments that were planted in therapy only came to full fruition two or three years later, when I was not having sessions anymore. I don’t even know how to describe it properly, other than that my brain got rewired.
He used that phrase a lot when I first started, but I only came to understand its true meaning now: in situations where everything happens too quickly to think about the best strategies, my brain defaults to different reactions than it did in the past. I stand my ground, I defend myself when attacked. All those hours of roleplaying these scenarios during the sessions are paying off.

I also have the situational analyses internalized, so when I find my mood tanking, I ask myself where I did not behave the way I wanted to, and what I could do better next time. I may sound like an infomercial that tries really hard to sell its product, but psychotherapy was the best thing that might possibly have happened to me.

Here’s the catch: it takes a long time to become fully effective. It only happens when you master a situation you would have failed previously – even when you don’t consciously register it, your brain notices that the new strategy was successful and is more likely to try a similar approach next time. So it takes a row of successfully averted crises for the new behaviour to grow roots. If you are like me and try to avoid adversity, it might take a while until you had enough exposure to such “opportunities”.

Of course, CBASP does not change your personality. I am still introverted and shy. But it gave me the tools to fix the holes in the hull that would have made my ship sink in the past.

The meeting with my therapist was over too quickly. I miss him – or maybe not him as much as what he had to offer (that sounds horribly selfish, but essentially what a therapist-patient relationship boils down to): a safe environment to try out new behaviour. Somebody who asked questions that opened up fresh perspectives. Especially the latter.

Of course, I could just start looking for a new therapist, but regardless of who I’d see, that person would never know the “old me”. The Layara who showed up on the clinic’s doorstep in 2010 was so afraid of everything that I’d never be able to properly communicate this to any other psychotherapist.

Then, there’s the question of familiarity. He is “tried and tested”, I know what to expect from him. With any new caregiver, a lot of time and effort would go into reaching that same degree of comfort.

Time is the third problem. Health insurance pays for 26 sessions every two years, and I always wanted to keep that option as my safety net. I don’t want to use them up and then be left with nothing to fall back on if disaster strikes!

And even if I decided to do that, there’s only one CBASP therapist left in my area, with long waiting lists.

When discussing this with the psychiatrist, she basically said she thinks my development over the last six months was promising enough to not necessitate any further psychotherapy right now – that I should see where the new medication and new circumstances (my husband’s new job) take me, and then make a decision. I agree with her – I certainly feel too well to use up my 26 “emergency sessions”. And for paying out of my own pocket we are too poor.

Maybe it is for the best. It took me more than a year to come to terms with the sudden end of therapy, but it also forced me to stand on my own feet. Ultimately, I was ready to do so. And in January, we parted on the promise to keep in loose contact, so unlike 2013, I did not feel like I had to say goodbye for good.

Back From The Psychiatrist

And thus begins the new treatment regimen with Venlafaxine (Effexor), starting tomorrow.

Everything went well; I was a little nervous first and not particularly in the mood for dealing with a stranger, but the psychiatrist turned out nice. He asked: “What leads you here?” I told him that I was in therapy for chronic  depression for two years and generally was really satisfied with it, but couldn’t get a handle on some symptoms like concentration problems and energy, and wanted to see what medication could do for me in that regard. He knows my therapist and has a superficial idea of the CBASP programme I’m in, and I guess that was enough credit to not let me do all the lab tests and ECG again. I also gave him permission to send reports to my general physician.
I recounted a brief history of symptoms and the treatment I received so far: First depressive episode at 12, second at 16 (this time with suicidal ideation), since the age of 19 / 20 only oscillating between different stages of major depression; panic attacks at 30, treated with citalopram, then therapy; therapy major success, but then the start of a slow decline. The psychiatrist asked about living situation, family, family history of depression, school education, what I am studying. Whether I smoke, drink, ever did drugs, take any kinds of medications.
He performed some tests on my cognitive capacities, because I had complained about them:
– “Spell the word ‘radio’ backwards.”
– “What’s the difference between a river and a lake?”
– “What’s the difference between a ladder and stairs?”
He had me memorize the words “street, traffic lights, flower” and asked whether I remembered those in between other questions, and had me do a chain of mathematical exercises: 100 – 7, then subtracting 7 from the result again, and again, and again. I scored 100% and obviously am not demented.
Some questions on differential diagnoses: do I see or hear things nobody else sees or hears, do my thoughts race, do I think I am being watched or that people talk about me behind my back, etc.?
The most difficult question actually was, “How do you feel these days?” I honestly had to think about that, and answered, “On average days, I feel subdued. Pessimistic.” I told him about the insomnia, problems falling asleep and the stomach aches, that I like to withdraw from people, worry a lot and occasionally get anxiety attacks because of the worrying.

All of that took about half an hour, then he proposed that due to my previous experiences with SSRI in the form of citalopram, I should try out what an SNRI does for me. He explained that SNRI give most people more energy, explained possible side-effects and finally gave me a prescription for venlafaxine. Unless I experience really bad side-effects, I’ll see him again in four weeks.

Edited to add: Yikes, maybe I shouldn’t have googled venlafaxine / effexor, because the results sound pretty bad… “The antidepressant everyone loathes to have taken.” Sounds like I am in for a bumpy ride…

Welfare & No Therapy

Yesterday I mentioned going on welfare, and that I had been in the process of writing a blog post about it when the news of my therapist’s illness made some of that draft obsolete. Here follows the part which still is relevant:

Financial troubles have been a steady companion for a long time: I cannot work a job on top of uni, and my husband wants to work, but is currently handicapped by a lack of language skills (even though he is making a lot of progress since he started integration class). We have been living off my husband’s savings, support from family members, and once we also had to borrow money from a friend. Our life is rather frugal: 80% of what I buy is on offer or from the “reduced box” – groceries which are about to expire soon and hence reduced in price. We do not go out or buy anything that is not absolutely necessary.
A while ago, my therapist came up with the idea of me going on social welfare, which would roughly equal the salary of a student job. I could not object based on pride as I am not in the position to turn up my nose at any kind of support available. But I kept putting off visiting the department of social services because frankly I was afraid of doing so. For starters, I have a bit of bad history with administration and it is a very anxiety-laden topic for me. But also, the idea of having a place to turn to in even harder times was so comforting that it was difficult letting go the promise of relief at the expense of possible rejection. It is a pretty stupid concept and I would advise everyone to just get it over with as quickly as possibly if being told this story. Inside my own head, however, things are not always straightforward.
Fortunately, I finally managed to drag myself there, with the result that the state support my therapist suggested is not even available for me. As a student, I fall into a different category of welfare which I have to apply for at the employment agency instead, so the journey continues for a while.

To repeat from yesterday’s post, I need a statement from my therapist that I am not capable of working a job; usually, it would be the employment agency’s own doctors who have to come to this conclusion as a result of their examinations, but with mental health problems, that is hardly possible.
Going on state support was not a decision I made easily, or even voluntarily, but it’s the only practical solution left. It would be great if someone gave my husband a job instead with which he made enough so that we could exist from that income, but that’s unlikely in the current situation. All I know is, if I have to work, that is the certain end of my university career – I tried before, and the result was that I prioritized my job over classes, because “without the money I can’t stay enrolled in uni either”, and I had not enough energy for both. And I do not have it in me to make a third start from scratch, should this second attempt fail. It is all or nothing in regards to uni now.

Life goes on, with or without me. With or without therapy. No matter how unfortunate it is that my therapist got ill just now, when I would have liked to be able to write to him about the whole welfare business, I need to try without him the best I can.
My last therapy session was in early December; the one scheduled for January didn’t happen, and it was a bit of a warning sign already when it took three weeks before my therapist could tell me when he’d have the next opening – we were supposed to meet at the end of March again. He’s been chronically overworked for at least a year: last spring / summer it was pretty much the same, when I’d have a session in April, then an emergency appointment in June, and then nothing until September. My blog is full with comments on staff shortage at the hospital. What’s sad is that on the last day we emailed, he told me he was currently working in a new colleague and that he hoped that we could have “at least one session per month” from April on.

I guess this post is rather all over the place, but all of this has become one huge “cluster” to me anyway.

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.

… And Little Strokes Fell Big Oaks

(Not that I’m a big oak. More like a weeping willow. Or one of those windswept, crippled conifers.)

On my old computer, I used to have a .pdf-file of a text-book on personality disorders. Unfortunately, I do not remember the title anymore, and so this source of information remains lost until I gain access to my old hard drive again. Said text-book not only gave me plenty of insight into the mechanisms of my own mind – many of the characteristics of avoidant personality disorder can also be found in my own avoidant behaviour – but also educated me about my mother’s obsessive-compulsive tendencies (my family displays an abundance mental health problems, namely depression, social anxiety, OCD, and borderline streaks – we’d make for some fantastic study material).
From this book I know that my mum’s rules are just a way of coping with what she perceives as threatening. Her constant criticism is born out of an urge to make a chaotic world appear controllable: for example, by blaming the gastritis on something I did wrong – “you are eating the wrong stuff / cooking unhealthily” – she reduces the emotional helplessness for herself, because in a world where I get gastritis just out of the blue and nothing can be done about it, she is helpless and at the whim of fate.
The problem is, I already am “out of control”: I am depressed and have a plethora of symptoms which come and go seemingly randomly, leaving me unable to function at times. Of course, my mother worries, and tries to bully me onto a path which she believes will keep me safe – oblivious to the fact that her criticism drives me even deeper into depression.
This phenomenon is not so rare, actually: whenever some outrageous crime happens, like a child being abducted and getting killed, you will hear comments from other people afterwards, blaming the child’s parents for something they did wrong or neglected to do – because if they admitted that we are living in a world where such cruelty can happen at random, without anyone who could have prevented it, they would have to face the fact that the same could happen to their own children. This, however, is too painful; it would destroy the illusion of absolute safety – it is so much more comforting and easier to believe the other parents failed and that they are doing a better job.
So, whenever something happens to me, my mother blames it on some shortcoming on my side, because that means she did not do anything wrong and that she is still in control.

From an unemotional point of view, I completely understand her behaviour, and it is obvious that my mum is not aware of the patterns herself. But that does not excuse the fact that my emotional well-being gets thrown under the bus time and again: it’s hard enough to live with what I’ve become, without having to deal with all those other flaws and failings I supposedly am responsible for.
There are a few things I will have to do to ensure my own well-being: short-term, I’ll have to talk to my mum about all of this. The problem is that either I’m in a state of anger about what’s happened, which makes me snappy and defensive – not a good basis for a discussion. Or I am not angry, which by default makes me lack the guts to breach such a difficult topic with her.
Long-term, I need to gain some more distance from my parents, emotionally as well as geographically. And financially. I just want to get to the point where I can have my own life at my own terms, without feeling guilty or pressured all the time.

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.

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.

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.