Disclosing Depression, Part 2

Last Saturday, I attended a meeting with former colleagues from my old job. It was nice, better than I expected actually; my personal criteria always are whether I start wishing I was somewhere else or feeling uncomfortable, and neither was the case.
Before leaving, I had not really been in the mood for going anywhere and the only reason I went was because I had missed my own farewell party back in February due to train strikes. I did not feel like I could cancel without a bad conscience, but the day turned out enjoyable.

I told them that I was undergoing psychotherapy for chronic depression, because I didn’t feel like hiding the fact and pretending everything was ok, always had been. The reactions were positive; I believe a few people were a little uncomfortable because they didn’t know what to say or how to react, but I didn’t mind as I can relate to that kind of discomfort, plus they were still nice about it. One of my former bosses even told me a friend of hers had been an inpatient at the same hospital last year.

Part of the reason why I mentioned it now and not when I was still working there, but already undergoing therapy, is that I do not see them as often anymore. I don’t have to deal with their awareness of my mental state every (work) day, so I can afford to disclose it since it’s not going to affect my job.

Part of the reason is that the whole team had been aware of my health problems for years – they saw me cycle in and out of severe depression without anyone having a clue what was causing the problems, including me. I was good at my job and got an excellent reference letter, despite all my issues (to be fair, they always were understanding of people being sick; not only me, but everyone) – however, I wanted them to know that I finally had an idea of what was wrong. I had never mentioned the emotional distress to them, but they were cognizant of some of the physical complaints: the muscle pain, the cognitive impairment, the insomnia alternating with hypersomnia.

Four days later, I still don’t regret disclosing that I am undergoing psychotherapy for chronic depression. The particulars of it aren’t any of their business, but I feel relieved that I won’t have to lie about what I’ve done during the past four months.

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Disclosing Depression, Part 1

The last week was rather busy. Between job hunting and everyday life (for me still more than a handful to handle), I had an interview with a psychologist last Monday – the MADRS (Montgomery-Åsberg Depression Rating Scale), which is especially sensitive towards changes in symptoms brought on by antidepressants or treatment. I’m already familiar with the MADRS as I used to do the same interview before starting treatment and during the first weeks of therapy. Basically, it consists of similar questions as the self-report questionnaires I usually fill out, except that the interviewer rates each statement according to what you report and on how you appear.

I had also gotten a stack of different diagnostic assessment sheets and questionnaires to fill out at home over the past week, all of it in the name of tracking the progress of the psychotherapy. I did them before starting sessions too, so any difference will become immediately obvious.

Lastly, I also got a new questionnaire, for partner, family and friends of the patient. They are asked to judge the changes in 13 different points, as they perceive them in the patient: visible sadness, communicated sadness, inner tension, sleeplessness, loss of appetite, concentration problems, apathy, lack of emotions, pessimistic thoughts, suicidal ideation, helplessness concerning everyday tasks, hopelessness and worthlessness.
At first, I was going to give it to my boyfriend only, since he has the best insight, but then my therapist said I could also hand it to others additionally, if I wanted to. So I let my mother and my sister fill out a sheet too. I would give them to some of my friends as well, but they don’t see me that often, so points like “visible sadness” – which relates to posture, facial expressions and tone of speech – are hard to judge for them.

All three people stated significant improvement of visible and communicated sadness, the rest very much mirrors how much insight into my thoughts and emotions I allow them: I tell my boyfriend a lot more about my private feelings, for example, and so he reported a more significant improvement in the categories “worthlessness”, “hopelessness” and “inner tension” than my sister and mother did.
Overall, nobody rated any topic as worse than before the start of therapy, though.

When I got the above-mentioned questionnaire, the psychologist said I didn’t have to do it if there was nobody I could give it to; that many people had not told anybody about undergoing treatment. I was well aware that a lot of people don’t talk about it publicly, but it’s hard to imagine keeping it from your partner even. Myself, I have told most people in my personal life: my boyfriend, all my friends, my parents, sister, niece, my maternal grandmother and my aunt – pretty much all the people I would have a personal conversation with.

It took me several years to come out in regards to my sexual orientation, and back then I vowed to myself that I would never go back into the closet. Hiding who you are costs so much energy that I am not willing to do that in my private life: putting on masks for strangers is demanding enough and I want to save whatever little energy I have.

That doesn’t mean I have extensive discussions about my emotional and mental state or that I make public what I am doing in therapy to all of them (quite the opposite), but they are aware that I am suffering from chronic depression and that I am seeking treatment for it. Especially in the beginning, I’d be at the hospital so frequently that it would have been hard to come up with new excuses for every single time I was occupied this way.

Cognitive Deficits

Looks like I came down again for good – no further euthymic phases during the last 48 hours. Which does not mean that I’m doing poorly; quite the opposite. My legs hurt earlier, but I managed to relax them and went for a long walk outside.

Yesterday, I borrowed a text-book for students of psychology from the library, because I want to understand what’s going on better. My therapist always explains everything to me, but if I asked every question which pops up in my mind in between, we’d never actually get to work on my problems.
I’ve always collected as much information as possible about topics that are on my mind a lot, but only now I find myself actually able to do it. Just a few weeks ago, I still lacked the ability to concentrate sufficiently, not to mention the energy. If there is a drop of regret, it is that I was not able to chronicle the whole therapy properly due to those reasons; I’ll have to depend on my unreliable memory for that.

Cognitive deficits are among the most scary symptoms of depression. It is one thing to lie on the sofa without moving for hours on end, and an entirely matter if suddenly you cannot remember facts you usually knew, if your memory gets clouded and you cannot carry on the most simple conversation without frantically searching for words. My brain always had been the one part of my body that I could count on, and suddenly that started to fall apart. More and more often, I would feel like having a wall of opaque glass in my head – I could still tell there was something behind it, but there was no way to access it.
There were days when I was scared about this, especially in the beginning – if your grandmother has Alzheimer’s, that can make you worry quite a bit. Later I had started to accept this state as a given, but still mourned the lost capacities. I could hardly believe it when not too long ago the first cracks appeared in the glass wall, and ever since the impairment has slowly started to crumble away.
Before starting therapy, I had tests done at the hospital where I did not perform too badly, but sitting through exam-like tasks is different from losing personal retention, because on the former you get concrete feedback immediately, but the latter you do not notice immediately. You only know that the recollection of an event, for example, is gone if someone else mentions it and you cannot recall it at all, or if you are asked to name certain situations and draw a blank when searching through your memory for it.
In the very first therapy session, we did an anamnesis of my depression history and I actually had to look through old diaries to get this right, because in my head it was a huge jumble at best. Five months later, this has become a lot easier; I have access to a lot of memories again that were temporarily lost.

Reading As A Mental Strain

After almost a year of lacking even the most basic concentration skills, I read and finished a book again: Jean M. Auel’s “The Land of Painted Caves.”

(Over the next few paragraphs, my spoiler-free opinion: as a huge fan of the series, I was somewhat disappointed in this last installment – the narrative voice seemed changed and the whole novel remained somewhat distant from the characters. For most of the book, Ayla and Jondalar hardly interact and when they finally get a common storyline where they are not just together on stage, this development rather sabotages both their characters and everything we learned about them since they first met in “The Valley of the Horses.” I was silently wailing “Noooooooooooooooooooooooooo!” in my head as I kept reading… Worse, this storyline could even have worked if the execution had been different.

I read the first four books when I was about thirteen years old and the Earth’s Children series has been part of my life for almost two decades. It fuelled my passion for prehistoric archaeology and I really cared about the storyline and a lot of the characters. But after the fourth part, it started to go downhill a little and “The Land of Painted Caves” gives me the impression that maybe the author should have put it to the side for a year and then re-worked and fleshed out certain parts and slimmed others. Given Jean M. Auel’s age, I can understand that the publisher probably was in a hurry to get this printed, but it’s sad to see great writing and great storytelling becoming average only towards the end of a series that started three decades ago.

Unfortunately, the latest addition is still better than any other novel set in those times I ever read.)

At ca. 660 pages, it was not a short book, but once upon a time I would have managed to finish in about a week even if written in English – still takes three times as long as reading German. Here, it lasted 26 days, almost a month, until I was through.

There was a lot of getting used to reading such a long continuous text necessary and in the beginning, I had to put the book aside every few pages. Yet, that already was a progress compared to the last year, when even the average newspaper article demanded more concentration than I could bring up.

Strangely enough, the neurological tests I did at the hospital were within the normal range, while I felt like my cognitive skills had gone down the drain – so maybe the setting plays a role as well. But none of the tasks in those tests lasted longer than a few minutes and, being the model patient, I of course forced myself to give my best.
That’s a behaviour I often exhibit: I’ll give my very best performance, but once I’m within the safety of my own four walls, I will collapse on the sofa and remain there for the rest of the day, completely exhausted. So clinical tests don’t necessarily reveal the full truth in my case and that is what makes it so important that I managed to read a book in my leisure time, at home.

There already is a new book waiting for me that I checked out of the library for the upcoming trip.