Finances, Fear, Family, Frustration

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

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

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

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

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You Better Watch Out, You Better Not Cry…

Christmas usually is an especially difficult time of the year when it comes to family relationships. The stress prior to the actual holidays brings out the extremes in our behaviour. My mother regularly explodes on December 23rd because she has problems delegating tasks, but gets overwhelmed by the load and vents her frustration and stress violently…

Thursday, December 22nd

Twelve minutes into Christmas break on the way home from university, I slipped on the escalator leading down to the tram station and twisted my right leg, while simultaneously tearing my left arm (which was still grasping the handrail). I could still walk, but only with a heavy limp, and had to have my sister pick me up from the tram station in my home town so she could carry my bag.
Over the course of the evening, I got rather upset because while my mother was rather worried, it was over the fact whether I would be able to drive her and my grandmother to the supermarket the next morning, and she didn’t express any concern regarding the pain I might feel. Functionality trumps pain – her problem with my depression was that I didn’t function anymore, too. Now that I appear functional again, my feelings become secondary once more.

Friday, December 23rd

At 9.30 in the morning, I found myself at an overcrowded supermarket. Finding empty space in the parking lot had already been a challenge, especially since my grandmother uses a rollator walking aid and wants to park as close to the entrance door as possible. The situation inside was worse rather than better.
With the need to pull myself together for uni temporarily suspended, my mood had started tumbling down quickly, and the longer we were inside the grocery store, the worse I felt. My swollen foot pulsated with pain and the constant bickering between my mother and grandmother – who were both affected by the general atmosphere as well – grated on my nerves.
After about half an hour, it took a really insignificant event only to push me over the edge: I was waiting for my grandmother to finish her business in the butcher’s section and just biding my time, when suddenly I felt the gaze of a middle-aged man on me. As he noticed that I caught him looking at me, he winked at me. No idea why it upset me, but it did. I wanted to yell at him to stop looking or winking at me.
I hid in the only empty aisle I could find and actually started crying. Because of the limping, I was always behind my mother and grandmother anyway, so nobody missed me, but in order to not rouse suspicion, I couldn’t stay there for long. Managing to pull myself together until it was time to queue at the check out, where people were standing in long lines already, I excused myself and went to wait in the car: officially to rest my foot, but really for calming down. I switched the radio on and concentrated on the music, so that by the time my mother and grandmother had finished their shopping, I had regained my composure.
In the late afternoon, I got once again into my mother’s crossfire when she repeated her threat that I had to move out if I didn’t get a student loan, which caused me lots of anxiety again.

Saturday, December 24th

Christmas Eve is the main event of the festivities in Germany, with big family dinners and the exchange of presents in the evening, and it started even worse than the previous day for me. I was already crying in the shower, with no clue how I was supposed to get through the day, and poured it all into an email to my boyfriend, which I felt guilty for later – waking up to your girlfriend’s hysterics doesn’t make for the most relaxed Christmas either. (He was utterly lovely about it, though.) Somehow I managed to dry my tears and leave, though, so I could help my mother with the preparations for dinner, but what happened then took me by surprise:
The conversation turned to my 10-years-old niece, who had exhibited rather ill-spirited moods that morning too. I remarked that I’d occasionally wondered if she didn’t suffer from the same condition as I do, but had never said anything because that was a hunch rather than something I could back up with solid facts. And that’s the truth – there are certain gazes or the way she holds her head or looks at people that feel utterly familiar to me, like the seed of all that avoidant behaviour, but I cannot present any evidence.
My mother nodded, then asked: “Where does this come from? Is it me?” (My mother looks after my niece when she isn’t in school.) I was completely flabbergasted and utterly at a loss. There are basically three reasons which cause chronic depression: 1.) genetic predisposition – which I certainly have from both sides of the family; 2.) neglect in infancy and childhood – which I can exclude for myself; 3.) repeated experiences of helplessness over long periods of time, concerning “significant others” like parents or other very close family members – which is very much the case with me. I had never told her what caused my chronic depression, because that’s simply too damn difficult a task – I don’t want to hurt my parents, because I know they had to endure a lot worse from their parents and never had a chance to not become slightly messed up either, but I could name dozens of situations that led to me becoming depressed and developing patterns of avoidance. My mother probably noticed that I was looking for the right words a little too long, and when I finally answered, it was just the three points mentioned above without connecting them to any personal experiences.
This was the worst time possible for this conversational topic to come up; on a different day, I might actually have welcomed the chance for broadening this point with her, but NOT ON CHRISTMAS EVE…
Myself, I started feeling better in the afternoon and got through the evening ok. We had all agreed to not buy any presents for each other because money is tight, so the big emotional climax was missing, but at least nobody fussed about it and I wasn’t reminded to get a job either…

Sunday, December 25th

I slept like a stone, until noon almost. The day was quiet, but pleasant. In the afternoon we went to see my grandmother and aunt, and in the evening I met one of my school friends who is home for Christmas. I didn’t feel like crying.

Monday, December 26th

Boxing Day is a national holiday too in Germany and at least in my family entirely dedicated to laziness. This year was in so far unusual as the family had a bowling tournament with Wii Sports – my mother isn’t much of a computer user and doesn’t even have an email address, while the rare behaviour for my father was to actually come out of his office for a family activity. So it was rather strange to see them playing a console game, but I really enjoyed the whole enterprise!

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So that was my Christmas, in a nutshell. In a little while I’m leaving for meeting another friend; I’m trying to fill the days with pleasant and diverse activities, so that my depression index goes down again and I will be fit for the last month of uni and exams once Christmas break is over, because if I learned one ting in therapy, it is that you must “fake it until you make it”.

Last Session Of The Year

Last therapy session of the year; the next one is on Friday the 13th (January 2012), to which my mum will accompany me. Apparently, my regular therapy is also coming to a close – I’ve had 31 sessions so far and if I recall correctly, that means only 4 more in the normal rhythm before drawing them out. Not sure about the time periods between them, but I do know that session 40 is definitely my last one. I’ll part with a laughing and a crying eye: laughing because my life improved so vastly, crying because I will be sorry to say goodbye to my therapist for good. The whole purpose of our relationship was that it would end again eventually, but I’ve grown fond of him… but, I guess that’s a bridge I’ll cross when I get to it.

We took a look at my uni schedule today, trying to find out what I can eliminate – all contact hours, homework and commuting time added up, I had a 50-hour-week and a BDI-II score of 20, with a tendency for the worse. Friday was crossed off the list completely and I’m supposed to figure out what I can do without until I reach a point where the work load does not push me into a depression anymore.
“We are pulling the emergency brake now,” my therapist said. “And if it gets too much,” he smiled, “just scratch another class off the list and go to the cinema instead.”
Eliminating classes wasn’t the problem, I didn’t need help for that. The huge difference is that if my therapist “allows” me to take it easier, I feel like I’m actually doing something pro-active and taking care of myself, whereas without discussing it in therapy, I’d have suffered from a bad conscience and felt like I was only procrastinating. That’s clearly something I still need to learn during our remaining time together: that I have a right to take care of myself and that I’m allowed to set limits.
A job is only possible in summer, because I’m going to have exams and an “en bloc” course and an excursion (probably followed by another protocol) during the upcoming semester break, and during the second semester my situation will hardly be any different…

Our roleplaying exercises were a little different today: not the usual dialogues acted out, but instead my therapist challenged me to defend my position. After I told him that I preferred learning at home over learning at the library, for example, he said: “Convince me! Why should I believe you are learning more effectively at home?” So I listed my reasons – that I felt more relaxed at home and could concentrate better because I wasn’t constantly aware of the people around me, that I didn’t have to watch my stuff if I walked out of sight of the desk, that I had more freedom on when I wanted to learn…
Later he made me stand up while he remained seated (a position I hate, because it causes me to feel vastly overweight – even though he doesn’t get that impression and it exists in my head only) and voice the effects the depression has on me as if talking to my mother: “I have troubles falling asleep and wake up in the night; the muscles in my arms and legs hurt, my joints too. I have headaches and backaches and stomachaches. My eyes are inflamed and hurt and I can’t always see properly because of that. I can’t concentrate very well either and doing my homework gets really difficult because of that. There are cognitive problems which make me forget words and sometimes I don’t even understand my homework anymore because of this.”
Only when looking back I realize I listed exclusively physical symptoms, but didn’t mention the sadness, crying and despair descending upon me. Had I spoken to my therapist directly instead of him acting as a proxy for my mother, I would probably have mentioned this, but since we hardly ever discuss intimate feelings in my family, I didn’t speak about this in therapy either.

One aspect I forgot about and which my therapist highlighted today was exercise. There is no room in my current schedule for any kind of physical activity. He described a scientific experiment to me, in which hamsters had been exposed to stress over a long time, leading to the hamsters becoming depressed. The source of stress was removed then and the hamsters got divided in three groups: group A had a nice cage, plenty of food and social contacts; group B a nice cage and plenty of food; group C a nice cage, plenty of food and an ergometer. Everyone suspected group A to show the fastest recovery rates, but in fact it was group C which was the most successful within the given time frame…
Exercise is supposed to be light and fun – no pressure to achieve any results, but regular periods of physical movement. I certainly remember how beneficial my Tae Bo classes were, even though I have nowhere near the energy for that now. But I’ll try to reserve a fixed time for swimming or cycling or something like that.

The One Where I Almost Cried In Therapy

In therapy, I talked about the upcoming changes in university, explained the original plan of taking my time for coming to a decision about my professional future (which the therapist said was a good strategy) and how I’d chosen continuing university when forced to decide immediately. As a result of the week’s events, the BDI-II score was up to 17 points today.

Half of the session was, as part of our usual routine, spent on a situational analysis of the phone conversation with my mother on Monday morning. This one had been special because even though what I’d felt and thought had set me up for failure (panic, doubt, flight instinct kicking in), I’d managed to get the best out of the situation that was possible considering the circumstances: ending the phone call without making the situation even worse through offending my mother, and thus giving myself time for thinking.
My therapist asked me why that was so, and I couldn’t come up with any other explanation than my reaction being an automatism, developed through seven months of therapy.

I explained my sentiments about prehistoric archaeology and how I felt that changing not only to a different degree, but also to a different subject was necessary if I wanted to go back to taking classes. I had not been entirely certain what he’d think about the latter, but he supported the notion completely and shared some personal experience afterwards concerning his own career choice and how he’d made a new start by becoming a psychiatrist / therapist after he’d started out in a different medical profession which, despite his huge interest in the subject matter, had not made him happy simply because of the way everyday work was shaped. And he said I might actually become able to enjoy archaeology again as a hobby or passion in the future if I liberated myself from all the dreadful negativity and bad memories connected to it.

At one point, I got very close to crying while speaking about this: my voice died mid-sentence and I sat there with a frown and moist eyes, looking out of the window, but my therapist just calmly repeated what I’d last said and I caught myself again. He clearly noticed what a highly emotional topic this is for me and from our discussion I can tell that he understood its significance.
Strangely, I was ok with getting this emotional in front of him – actual crying might have embarrassed me, but I felt no negative response inside myself for displaying so much sadness. Becoming obviously moved is something I rarely do, and never if I can prevent it, because it is very difficult to make myself vulnerable like this without immediately wanting to put the defensive walls up again. The fear of being shamed or hurt is just stronger. Him not fussing about it certainly helped – he acknowledged it afterwards, but didn’t make me talk about it.

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.