Mass Shootings, The Media, And Mental Health

Dear media,

Like so many others, I have been following the events of Munich’s mass shooting on Friday night. Like others, I want answers. The answer cannot be, however, to publish psychiatric diagnoses without further comment or explanation by professionals.

You see, I happen to suffer from the same mental health problems which are now being shoved into the limelight as the Munich shooter’s conditions, depression and social phobia, so I might be more sensitive in that regard than your average person. But it is extremely unlikely for depression or social phobia to result in the desire to go on mass killing sprees – harming other people doesn’t even feature in the diagnostic criteria.

What you are doing is publicising facts which may have contributed very little to nothing to the crime at the cost of increasing the stigma for millions of people suffering from depression and / or social phobia in Germany alone. You are making life harder for all of us who are already receiving psychiatric or psychological help, and you are potentially discouraging others from seeking treatment because they don’t want to be regarded as a “loose cannon” or threat to society.

Next time, please consult professionals and add their opinion before releasing your findings. Instead of trying to be the fastest to get information out, how about striving to be the one who gets the best information out?

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Medical Service Appointment

The worst part is over now that the appointment with the medical service is behind me. It went by no means great, but at least I did not cry afterwards like last time.

The physician took a little more time to ask questions, about 15 minutes, which was the one positive aspect of the appointment. On the negative side weighs in that she tried putting phrases in my mouth that I didn’t mean to say, kept interrupting me, and generally had a brash demeanour.

I wasn’t feeling my best to begin with: slept badly the night before because of anxiety about the appointment; kept confusing words; couldn’t remember which dosage of escitalopram I take, etc. And the doctor’s behaviour made everything even worse.

For example, I had tried to explain why I had not gone back to psychotherapy – that I want(ed) to, but for reasons already discussed on this blog haven’t. She tried to twist it into me saying that because I’d had such a positive experience with my first therapy, I was resisting seeing someone else now and idealising the first treatment. Absolutely not true. If health insurance wouldn’t limit the number of sessions I could have, I’d be way more willing to try things out. And even if, ultimately it was my psychiatrist who suggested to wait with that – and she knows me a helluva lot better than someone who judges me based on a 15-minute-meeting.

The doctor also had never heard of CBASP and when I said that the general consensus is that chronic depression is largely treatment-resistant with standard behavioural therapy, she called bullshit. Whatever, I don’t really care. It’s what the scientific papers say, not my personal opinion. Not trying to convert anyone, least of all her.

Also, she said I was “talking in diagnoses”, not how I felt. Well, last time I tried that with her colleague, he wouldn’t even let me finish. Also, it’s really hard for me to open up to strangers about such personal stuff. There’s a reason why my therapy sessions worked out so well, and that is that he took the time to make me comfortable. I realise the medical service was never meant for that kind of in-depth, trust-gaining discussion, but I had told her half a minute earlier that I suffered from social anxiety, and how at uni I would devote 75% of my energy to not freaking out and 25% to following lectures. It’s kind of a low blow to hold “talking diagnoses” against me after I just divulged that strangers freak me out.

Seven hours since I got out of there, and the knot of anxiety in my stomach only slowly starts dissolving.

To Hell And Back Again

After the last post, I fell into a really dark hole. For every problem solved there appeared to arise two new ones, and between a lack of energy (which was bordering on apathy) and near-despair, I had some really horrible weeks. None of the bills due June had yet been paid, and I’d really had more than enough of those troubles over the last months: we got threatened with having the gas / electricity switched off twice and had to borrow money from a friend to pay those bills. I had my bank account terminated because I accidentally went over the credit limit and (thanks to being preoccupied with the side-effects of venlafaxine) didn’t notice immediately, so I ended up being blacklisted as a “financial offender” for the next three years – it will be as good as impossible to get any kind of loan, and I had to go begging at the bank to be granted another bank account, and on top of everything else I will have to pay off almost 1250.- Euros for the old account and in penalty fees. I tried explaining my situation on the phone, but first I had to wait three weeks for a call-back since the people holding the decision power were always busy, and when they finally did get back at me, the lady berated me for it “being all my fault”.
We just about managed to pay for my husband’s German classes and get some food on the table, even though the latter was perilously close to uncertainty at two times at least. There was one day when we had all but € 9.- between the two of us, and all that was left to eat was a bit of frozen vegetables, half a jar of jam, pasta and potatoes. No bread, fruit, rice, cheese, meat, fish, butter, milk or soy drink or whatever we usually eat. Our options were plain potatoes or plain pasta, with a bit of spinach or peas. Nothing you’d traditionally serve for breakfast – and having just asked a friend to help us out with money so we wouldn’t have the gas / electricity cut off, I didn’t want to go begging again. My mother-in-law unwittingly saved us from this by sending some money, and my friend scolded me for not telling her earlier when I related the story to her… All I can say is that there’s a difference between having to ask for help once, because you got into a tight spot, and having to do it again and again, week after week or month after month. It wears you out mentally.
I believe my husband became more worried about me and my state of mind than about the money, because even though I was not entertaining thoughts of suicide, he made me promise I wouldn’t do anything to myself. Nevertheless, even getting dressed became an almost insurmountable obstacle, and I oscillated between apathy and fits of crying. I felt like I had nothing left in me: no energy, no fight, no will. And even though I had successfully fought off the denial of the application in April, nothing appeared to move forward in that regard ever since – until the beginning of June.

The money came in about three weeks ago, and despite the fact that we didn’t get approved for March (when I was still officially a university student and not available for welfare), we got monthly allowances retroactively from April 1st on. We could pay our bills, and get rid of the debts with the health insurance and the energy provider. I made a payment plan with the collection agency to pay off my old bank account in rates, paid off my sister since she had covered the contents insurance of our worldly possessions earlier this year, and gave two months’ worth of rent to my mother, as a thank you for supporting us when my parents were on a budget themselves.
Having this existential problem lifted off our shoulders has done more for my mental health than any other measure taken during the last months. For the first time in years, I go to bed without being afraid of what the next day is going to bring: even though I still get a fright when one of those “official-looking” letters comes in, I can immediately remind myself that we have the money to take care of whatever is heading our way.
The German welfare system is far from perfect and much criticized, but compared to our situation during the last year – and especially the last couple of months – we are doing peachy right now. Of course, we are not eating steak and lobster, but I can buy everything we need and some more, whereas before I would have to prioritize and calculate whether I had enough money to buy some yoghurt, for example, or whether it had to wait until the next time since it was not strictly necessary.
There was one day when I went to the neighbouring town for shopping, since the local supermarket had some offers which justified spending money on a tram ticket as we would still save compared to buying the same products in our hometown – and I made a mistake when calculating the expense. It was just a minor figure I was off, about 50 cents, but I ended up those 50 cents short for buying the tram ticket back home. I did not dare taking the tram without a valid ticket because of the € 60.- fine if I got caught, so I had no choice but walking home. It was a relatively warm day and I was dragging / carrying about 30 kg (roughly 65 pounds) of bottles and groceries in my shopping trolley and two bags. I had called my husband to meet me halfway, but by the time we got home, I was completely exhausted.
That is only one story out of many about how destitute we were. I walked around in jeans ripped from wear and tear for over a month, because I could not find a pair cheap enough in my size. When I finally found one, it had a bad, unflattering cut and I didn’t like the colour, but at least the prize was very low and the fabric not torn, so I bought it anyway. After just a few short weeks, the pull tab of the zipper broke – cheap material, I guess – so I had to put a safety-pin through the eye of the slider for using the zipper: the result was that every time I went to the toilet or got (un-)dressed, the safety-pin popped open and stung me in the finger. At that point, I made such a pitiful figure that my mother and sister gave me a part of my birthday present, two pairs of jeans, about ten days early.

Maybe that gives a little insight into why I have not been blogging. At some point, I just got too exhausted – all my mental energy went into making sure we would get on state support. And I wanted to escape from the daily struggles, not reflect on them.

Depression Symptoms & Antidepressant Side-Effects Assessed

It’s becoming very clear that despite taking twice as high a dosage of venlafaxine / effexor now, the timed-release capsules work much better for me. The nausea and vertigo vanished completely, and in the mornings I don’t go through withdrawals anymore either. I do feel quite drained from the experiences of the last three weeks, though, very tired and listless. I lost 6 kg (13.2 lbs) – 4 kg over the first weekend and another 2 kg since – and even though I would welcome further weight loss very much, it goes without saying that vomiting, diarrhea and skipping meals due to nausea is not exactly a healthy way to drop the kilos and at least partially responsible for the feelings of weakness. On top of that, venlafaxine also suppresses my appetite for a good part of the day, until it returns in the evening and I suddenly start scouring the kitchen for all the stuff I did not buy when shopping…
There has been no improvements of the symptoms I primarily started taking venlafaxine for yet, the cognitive impairments and lack of energy, but I do feel more emotionally stable recently. Next Friday I have a follow-up with the psychiatrist, when I’ll find out whether I’ll increase the dosage further or stay on it for the time being.

As for the welfare process and related paperwork, the main appointment at the job centre had been cancelled on Tuesday already because the lady had become sick, and the one who works on our case at the employment agency was replaced with a colleague due to illness as well. While being very friendly as well, this colleague could do little more than collect the forms we had filled out at home and the documentation we had brought. Other than that, we will have to wait for them to get back to us. I handed in the questionnaire on my medical complaints today; the question was: “Do you have medical conditions which influence your current job or have done so in the past? Please give a short description of your illness respectively your symptoms and tell us which kinds of occupation would be influenced by these.” The space left blank was less than a quarter or a page, so I could not go into much detail:

“Diagnosis: chronic recurrent depression with comorbid panic disorder.
– permanent / daily symptoms: muscle pain in legs and arms; social anxiety; slowed-down thinking; word finding problems; problems falling asleep (at least 2 hours / night); severe lack of energy; hypersomnia; decreased libido
– frequent symptoms (at least 3 days per week): stomach pains; digestive problems (diarrhea); back pain; memory problems; concentration problems; depressive emotions (sadness, emotional emptiness, hopelessness); headaches
– periodically appearing symptoms: insomnia
– under stress also anxiety attacks
– currently (since mid-March 2013) additionally vertigo, nausea and vomiting due to starting an antidepressant regime (venlafaxine)

Because of the diverse symptoms, I am physically, intellectually and emotionally affected with any kind of occupation.”

That is as accurate an assessment as I could give of my daily problems in such a small space, and each of my healthcare providers should be able to confirm them. I learned today that the medical service will first contact my general physician for information, which is a bit of a problem since at least 80% of my depression treatment has been done by my therapist; the general physician does get reports from my psychiatrist, but except for the fact that I have participated in the medical study he does not know anything about the psychotherapeutic treatment. I do hope they’ll get in contact with him as well – if our regular case worker had been present today, I would have asked her, but her colleague was not familiar with the protocol in such cases.

The End Of An Era

Yesterday, I exmatriculated from university. Thirteen and a half years of fighting, and then it took all of 58 seconds to leave – there is a form you print out, fill in your name, address and student-ID number, give the reason for exmatriculation (I checked “illness”), and hand it over to the student secretary. She double-checked with my student-ID, stamped the form, gave me a formal statement that I had left uni, said goodbye, and that was it. My niece, who had accompanied me, timed the procedure.

That was in the afternoon, however. The morning my husband and I spent at the job centre, where we had an official appointment to start the welfare process, and saw someone from the employment agency afterwards. She might help my husband find a job, and I had to see her to work out the procedure regarding the “impaired working-ability” label. We got a total of about 50 form sheets we have to fill out: the actual application, and different questionnaires on just about every aspect of our existence, from the flat we live in (size, number of bedrooms / bathrooms / kitchens, how much rent we pay, what kind of heating it has, how much we pay for water and electricity, etc.) over our respective job résumés and occupational histories to a questionnaire on my depression history. We have to bring bank account activity statements for the last three months, and attestations of my health insurance, my husband’s integration class, the exmatriculation from university, a copy of my rental contract, yadda yadda yadda. And all of that has to be ready by Friday next week, because then we have the next appointment.
The procedure regarding my medical status will be that I formally release my general physician, therapist and psychiatrist from their obligation to secrecy, so that the job centre’s medical experts can inquire about my depression history, the treatments and my current status. They will then write a formal assessment, based on these facts, and I will get an invitation for discussing the results. If the results are clear and nobody objects, I will not have to undergo any further examinations through a medical officer.
The lady from the employment agency was very nice and sympathetic; she even inferred that she had personal experience with it – I just could not tell whether she meant depression, panic attacks or both. Regardless of what was the case, I felt treated with respect and in a non-judgemental way, which certainly is a first in my dealings with bureaucracy outside of the mental health sector. She’ll also remain our contact person for the rest of the process, so I’m doubly glad about this.

We were at the job centre for over two and a half hours, with over an hour of waiting in chairs in between. I had not taken the venlafaxine that morning, because I didn’t want to go into a side-effects frenzy during the appointment, but halfway through the withdrawal set in and my brain started buzzing like a mobile phone. I hope that for our appointment next week the timed-release capsules will prevent that scenario.

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.

December News: A Short Overview

Sometimes, there are some smaller events which fit into the blog, but don’t warrant a post of their own. Or topics where I don’t want to go into a full analysis right now because that would depress me, but which I might like to come back to later. This blog entry is a collection of such “news snippets” and comments, and I am planning to make use of the feature in the future as well.

1.) Integration Class: When my husband was granted a residency permit for three years in June, it was under the requisite that he attended integration class for learning German. The first vacancy in such a class in our home town was in December: given our financially restrained situation, a different location was no option as the costs for public transportation would have bitten a serious chunk out of our budget. So we had a lot of time to bide just waiting for December to roll around.
On the morning of the big day, he left for class, only to be back home an hour later – the course had been moved to the end of January due to problems with the class rooms available. So that meant waiting for another seven weeks, and on top of that, we had not even gotten the letter informing us about this the week before. Especially my husband was deeply disappointed; he had looked forward to finally getting started after so many months of waiting.

2.) Christmas Party: I attended the Christmas party at the library where I used to work until February 2011. Last year I chickened out of going at the last minute, blaming it on an uni test (which we really had, but it didn’t interfere with the party). This year, however, I was determined to go, and it turned out really nice.

3.) Class Reunion: Just before Christmas, there’s the annual class reunion of my school; basically consisting of having drinks at some pub and catching up with who’s doing what. The last time I attended was in 2009 for the tenth anniversary of leaving school, which proved the kickstart for an episode of major depression that led straight to the panic attacks of June 2010 and consequently to antidepressants and psychotherapy. (So there came something good out of it, eventually.) It made me feel so inferior about myself – labouring around with my university education, a really complicated love life I did not feel like explaining to anyone, and nothing else worth talking about either – while everyone else gave rundowns of their academic credentials and fancy jobs, or not so discreetly flashed chunky engagement rings… It was an experience I have not had any desire to repeat since, especially since hardly any of the people I would like to meet again attend either.
Usually, I’d just ignore the Facebook invites and pretend I hadn’t seen them. This year, however, I felt the desire to actually decline officially. I did not give any reason; I could hardly write the truth (“Most of you are a bunch of phonies and it depresses the shit out of me to see that even the stupidest and those most lacking in positive character traits managed to carve out more of a career than me”). And it’s not so much that I feel ashamed of myself rather than having no desire to share intimate details about my mental health with people I have no contact with otherwise. Maybe by the time the fifteenth anniversary rolls around I’ll give it another try, but for now, I am quite happy to stay at home.

4.) Gastritis: For the last couple of weeks, I have had stomach problems, especially in the late afternoons and evenings. The symptoms match those of gastritis, which I’ve had a couple of times already over the course of the last fifteen years. I didn’t even see a doctor for it, because the advice they give is always the same: stick to rice and apples and drink lots of tea until the symptoms go away. Antacids are not covered by the health insurance in such a case either.
It’s stress-related anyway in my case, and when it did not go away by itself, I switched to a somewhat restrictive vegetarian diet for the last couple of days: apples, bananas, rice, pasta, bread, potatoes, legumes, corn, vegetables. No meat, fish or poultry, no eggs, no coffee, no hot spices, no berries, no citric fruit, very small quantities of dairy products only (which I have to be careful about due to my latent lactose intolerance anyway). It helped a lot, but tonight I’ll try to steer off that list with small portions of the “forbidden foods”, because I start missing them.

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.

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.