Help Me, Zopiclone

I did not think it was possible, but the last night was almost worse than the one before. It started promising: Got tired and went to bed at 10.20 PM, read for half an hour and switched the lights off at 10.50 PM. Fifteen minutes later, I was asleep – until 1 AM, when I woke up and was so alert that I could not force myself back into the realm of dreams. Got out of bed for a couple of hours, then back into bed, where I read until 6 AM. Lay awake for another hour and finally dozed off just after 7 AM again.

At least I did not cry this time, but it was even more confusing than simply staying awake. So for tonight, I asked my sister for one of the zopiclone pills she got prescribed for her insomnia last autumn. A definite first, as I never took any kind of hypnotic agent before, but I just cannot go on like this. I have tried everything to rectify my sleeping cycle and it only got worse, and even though I am generally not keen on using pills, I feel like I am going to lose my mind if I don’t get back to normal hours soon.

In other news, I have an appointment with the psychiatrist in four weeks. As the psychotherapy is covered by the fundings of the clinical trial, he has pretty much free reign to do with me whatever he deems fit, because with the exception of the citalopram two years ago, the health insurance did not have to pay for anything yet.
I’m not quite sure how I feel about all of this yet. I would have prefered to see my therapist as the psychiatrist as well, because nobody else knows my mental health history as well as he does, and quite frankly it would save me the hassle of having to get to used to another “stranger”. However, I have hardly any right to complain, and maybe it will even be good for something to keep the two treatment fields separated.

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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.

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.

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.

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.

Writer’s Block

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

Exhibit B: A (Not So) Hopeless Case

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

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

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

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

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

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

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