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.”


Just A Quick Update

I’m still alive, but very busy. Lectures at university started again – not that I had a lot of free time during the “break”. I attended an extracurricular class in zoology and passed the exam for that, and I didn’t pass the second attempt of physics because I was just too burned out and my brain didn’t cooperate at all. As a result, I opted out of taking maths again.
Currently, I’m writing a report on the field trip I took in February; the text is as good as done, but I still have to put in pictures and so on.

Then, of course, I got married and had a lot of family drama going down the day before the wedding, all of which deserves a dedicated post.

Finally, my therapist invited me to join a class for psychology students next week – as a “living exhibit”. They’ll present my data, including the clinical tests I took (the results of which I’ve never been told), and I’ll be there to answer questions. Bring the person to life, I guess, because according to my therapist, most of these students have no real idea of what it is like to be depressed and what it is like to undergo CBASP therapy. Besides the scientific data, I can provide insight into all of that. Strangely enough, I’m looking forward to this.

On Discomfort & Comforts

After the drama at the beginning of the week, I had to pull myself together for the crystallography exam – successfully enough for passing. The results were in after 24 hours and thus I know that despite waking up to my head spinning with vertigo and my dysfunctional memory, I put that class behind me for good. The results for physics and mathematics still haven’t been put online, so in that regard I’m still biting my nails.

Friday and Saturday I was on an excursion to local sites of geological interest. Since most of the geological outcrops didn’t offer enough space for huge crowds, we got divided into groups of twenty-something people, and each group had slightly different routes and sites to visit. Our guide was very nice, but unfortunately his tempo was so insanely fast that a few of us got close to a physical breakdown. My metabolism is very slow (as a result of both depression and Hashimoto’s) and soon my head started spinning with vertigo. Another girl had an asthma attack, and together with others we soon fell behind. After realizing the effect this had on us, our guide apologized and promised to slow down, but we still kept lagging behind, desperately panting uphill hour after hour. At one point, about ten minutes before reaching the highest peak of the day, I paused and stared into the forest stretching below me, thinking: “Why couldn’t you pick a different subject? Something where you do not have to go on field trips…”
The only thing which kept me going was that we were in the middle of a nature reserve and thus the only way “back to civilization” was to continue walking.
The second day saw us climbing up a mountain through vineyards; not nearly as long a walk as the day before, but so steep that we had to clutch onto the wires for the vines and descend sidewards to prevent falling down the cliff-like slope. In the early afternoon I had to admit defeat because of a black-and-blue toenail – I simply could not walk properly anymore due to the pain. I’ll have to wear open shoes for the next days – very inconvenient, since the weather is rather wet, but that is the only way I can walk without a severe limp – and somewhat embarrassing. I will be rather self-conscious about it tomorrow, but it is my only option.

The best aspect of those two days was coming home to someone. I got served dinner and could rest my legs on my boyfriend’s lap while he massaged my sore feet (and legs and back). Even though most of my body hurt, I actually felt pampered.
He helps me staying in the present, to not worry about the future or think about the past so much. He comforts me emotionally and mentally. I think I wrote in an earlier post already that my idea of happiness is spending an evening on the sofa with him – it might sound utterly boring, but I really enjoy this very dullness. There is enough drama in my life and I am grateful about every time I can just wind down and bask in the warmth of our shared life together.

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…

Defeats & Successes

The week started really badly. I had a confrontation with my mother once again. Or rather, she confronted me, and I stood there, thinking, “Defend yourself! Say something! Don’t let her treat you this way!” But I opened and closed my mouth a couple of times and nothing came out of it. Just stood there like a deer in headlights.
The topics weren’t new either: that I should give up university and get a cleaning job, that I’m ruining the family, that it’s been thirteen years now since I left school and still had not finished university yet, etc. Same old accusations, but they still sting, and I literally cried at my boyfriend’s shoulder.
I have never uttered a word of blame towards my parents, because that is not going to change anything about the position I am in, but sometimes I just want to yell at her that I would not be where I am today if she had not contributed to it, and that her behaviour is very counterproductive. I am not going to become “less of a problem” for my parents if I have to constantly fight battles on the side – getting through university is difficult enough as it is.
Just hours before that, I had a therapy session and it was the first one after over a year in which I felt truly uncomfortable. Not because my therapist was displaying a negative attitude towards me; the negativity came from inside me, because I was projecting my mother’s attitude on him, but I only realized that later.

However, he will sign me sick for the upcoming second attempts in chemistry (and crystallography if I want that), because I still am having cognitive problems. I did sit the physics exams today and during the first half of it my brain was really slow and on the verge of going blank, but I didn’t freak out and just tried the best I could. Not so sure about the result, I would say the chances for passing equal those for failing, but at the very least I got an idea of the requirements now.
But, I did pass the palaeontology/micropalaeontology test and got a placement in the zoology class. They did not publish the grades, so I have no idea how I ranked relative to the other students, but at least it was high enough to get into the class.

Disclosing Depression, Part 3

The appointment with my therapist lasted no more than five minutes; we didn’t even go into his office but talked standing in the door frame. He had my note already prepared, which stated that I was incapable to work or sit exams from Thursday until Tuesday – tomorrow we’ll figure out a long-term strategy in our regular session. I was grateful that he filled in a few more days than just Friday, because it doesn’t look like I only wanted to get out of the exam this way.
I got a little glimpse of my therapist in his role as a psychiatrist, too. Usually, when I come to see him, his business as a psychiatrist is done and he takes his white coat off and sheds the whole “clinician persona” for the duration of the meeting, so the whole scene had a faint hint of strangeness to it. The psychiatrist-character appears a lot busier and, even though still being very friendly, more authoritative.

There’s no diagnosis on the note, but a huge stamp stating “[…] Clinic […] for psychiatry and psychotherapy” above my therapist’s signature, so when I hand it in on Monday, it will be known at the institute that I am being treated for mental health problems. So far, the university administration knew because I had taken a sabbatical a year ago, but none of my professors or other people at the geosciences department are clued in currently.
I am not sure how I feel about the fact that this is going to change: I like to keep some things private. It’s none of their business what I’m struggling with, but I also understand that it is better to be open about it and admit the problems I have – especially since my depression is chronic, not a singular episode. Recovery takes a long time, and I will have many more moments when depressive symptoms temporarily return, so it would probably be better to make it public and then deal with whatever consequences this has. Legally, I am on the safe side: my therapist told me more than once that they must not discriminate against me and have to treat me like anyone else. It is not open discrimination I fear anyway, but the hidden prejudices which are not expressed openly.

Panic Attack

Last night I suffered an anxiety/panic attack over the upcoming exam. I saw it coming in the afternoon already, but tried to ignore it – not that ignoring the early signs did much good. Around 1 o’ clock in the morning I started crying and woke up my boyfriend, who tried calming me down and get me to sleep. When I finally drifted off, I had very unpleasant dreams and woke rather early, being completely cramped – my left hand was so tightly clenched that I had to open my fingers with the other hand.
I’ve also had increasing cognitive problems over the last days, with the ability to memorize going downhill really fast, word-finding problems and slowed speech. All very familiar symptoms, but it is scary how fast they can come back once I am really stressed out. So I emailed my therapist about this and he wrote back that the panic attack is enough for him to give me a doctor’s note which will allow me to not participate in tomorrow’s exam, so that unlike on Tuesday I won’t lose one of the precious three attempts. I see him briefly tomorrow morning, and for Monday I had a regular appointment scheduled anyway.

I think I probably overestimated my mental capacities and, trying to cram as many facts into my head as possible, eventually buckled under the pressure. I guess I should only have registered for two exams in the first place…

Spilt Milk

The palaeontology / micropalaeontology test went ok yesterday; I’m so glad I made the decision to study over the weekend even if that meant consequences for chemistry, since the larger part of the test was made up from just these topics and I wouldn’t have passed without revising. The pressing question, however, is how good I am relative to my peers: 120 people can take the zoology class, 157 put their names on the list – so I have to beat at least 37 of them.

I didn’t get to take a look at the chemistry exam, because they told me that if I entered the room to look at the exam, I’d have to stay there for the entire two hours. Staring at the exam for two hours without a chance to solve most of the tasks (we got test-exams from our tutor, so I know I’m not even close to the required level for passing) would have greatly increased negative feelings about myself and caused me a lot of anxiety, so I opted out of that option. The problem isn’t that I couldn’t sit the exam: since the Christmas holidays I’ve been aware that I had fallen way behind my schedule – what annoyed me was that I had learned about the palaeontology test on Thursday, but registered for the chemistry exam on Tuesday. Had I known about the test only a few days earlier, I wouldn’t have signed up for the exam in the first place and thus saved that attempt. But, there’s no use crying over spilt milk…

On the positive side, I got back my excursion protocol from November and was one of the lucky few who weren’t required to re-write it and hand in a revised version.

Semester Exams

The next two weeks are entirely dominated by exams, plus a palaeontology / micropalaeontology test which got announced on short notice, because too many people want to get into the zoology class. Tomorrow I’m taking the test, Tuesday the chemistry exam, Friday crystallography, the following week physics and mathematics.
Even though I’m rather good at palaeontology, I had to learn for this test because here the absolute grade isn’t as important as the relative placement – in other words, one wants to leave as many people behind as possible, to ensure getting into the class. However, studying for palaeontology is taking away time I meant to invest into chemistry, which is the exam I have the least chances for passing to begin with. At the beginning of the semester, I would have thought that role fell firmly to mathematics, but chemistry is twice the workload and just more than my brain appears capable of handling. I somewhat regret registering for the chemistry exam now as it will use up one of three attempts for taking I have – guess I will just give it a fool’s try on Tuesday and if I fail, I’ll spare the other two attempts for next year…

I’ve written before about the effects depression has on the brain: it alters and destroys synaptic connections in the brain which then have to get re-connected again (through therapy). I really feel the difference between now and ten years ago – I tire much more quickly of learning and have a harder time remembering facts. When working on long-term projects, like writing a paper, it doesn’t create too many problems because I can take breaks as I want and the result depends on continuous effort rather than a moment’s “genius”, but I struggle with preparing and sitting exams. After about 90 minutes, I need a break for several hours, and even though I still have two weeks to go, “learning fatigue” has already set in.
The sad part is knowing that ten years ago, I easily would have excelled in classes where now it takes an effort to be “merely” good. And I know that it could be worse, that after all I still manage to keep pace – but there is a lot of frustration still, and I am constantly afraid that from the outside it looks like I am procrastinating, and I am afraid that I will be judged by the professors and other students, because they are not aware of my background story.

Change Of Plans

Due to health reasons, I had to cancel my mother’s attendance for the therapy session on Friday and it will just be a normal appointment for me. My mum had been sick last week already and even though she’s not bedridden anymore, she’s not 100% either. Nor am I, and if being honest, I’m secretly relieved about the turn of events: there are so many other things on my plate that I’d like to discuss with my therapist before my mother joins us – last Friday, for example. Also, I’m going to have a friend visiting all weekend long, and regardless of whether our joint session leads to a long amicable discussion or a long argument between my mother and me, I would need a lot of time for that…

I’ve been put on the sick list for the rest of the week because of a stomach bug myself. There are three general physicians who share the practice I go to; some of the patients only see one of them, others – like me – go to whoever has the first slot available that day. So I ended up with the same doctor as back when I fainted on my way to work and broke down crying in the practice (check the “Pre-Treatment Diary” for the entry of October 19, 2010). He’d urged me very much to find a therapist then, which was just the extra encouragement I needed to actually call the hospital three weeks later.
The memory of losing my composure last time, even though more than a year in the past, embarrassed me a little, but fortunately the doctor didn’t ask any questions about it. He had my file already open when I walked in and thus doubtlessly was reminded of the incident, as well as my stint with citalopram and the fact that I get a referral for psychotherapy from them every three months. He was especially nice, though – a kind of cordiality that goes beyond good manners and agreeable behaviour. It reminded me a little of my therapist. There was nothing he could do about the stomach bug (“That just takes a couple of days to get through.”), but he did inquire about university and I told him about changing to geosciences.

The doctor actually asked me how long I wanted to stay home and despite really being sick, I feel a little guilty for making it the whole week. Not that attending classes would do me any good, and thus (as my therapist would say) there’s no reason to even debate the matter.
It’s more than the stomach bug, though. I’m constantly tired – Christmas break didn’t do much to change that. In fact, only the last two nights I managed going to bed and falling asleep at a decent hour, following several weeks with insomnia.

Not to mention that I have been missing my boyfriend insanely. Now that we can actually count down to the day he’s arriving and almost reached a single digit number of days left until our reunion, it’s worse than all those last months. Like the last mile of a marathon: you know you are almost there, but because you’re so close to the finish line, you just want to be done with it and let go of all the self-discipline which got you so far. Every single step makes you ache more, every muscle is sore, every breath laboured. I just want to be at the airport gate and wrap my arms around him, and then the world may end.