Saturday, June 28, 2014

Sometimes Your Brain Thinks Thoughts

The brain is a truly complex and amazing organ. It does some pretty unbelievable things that we never have to think about, like regulating the pace of our breathing, our heartbeat, some reflexes, vasomotor activity, plus the obvious stuff like generating our emotions and thoughts. The brain, in conjunction with the nervous systems, reaches out to tell our organs what to do, and to make our bodies move around. Our brain allows us to see, to hear, and to feel. Our brain is so sophisticated that it does what no other parallel processing computing device has ever been able to replicate: it allows us to have consciousness.

Kinda makes it sad that the machines are wasting our potential by using us as batteries, right?

I joke, of course. This isn't the Matrix. Whatever you do, don't take the red pill.

Sometimes, our brains think thoughts. If you think about it, we're thinking thoughts all the time, possibly as an outcome of linguistic capability (it might also be the other way around but, really, who cares). It seems obvious that we think thoughts when we're trying to solve a problem, or planning, or listening, or having a conversation, or learning. We think little thoughts all the time as we ask ourselves questions like, I wonder if I'm hungry? What should I have for dinner? We think little thoughts as we keep up a running commentary on things going on around us. Our brain thinks little thoughts to remind us of things, sometimes by interrupting something else that we're doing to tell us something completely different, like if we're doing the dishes and our brain tells us that we have to go to the drugstore tomorrow and buy more cottonballs.

We think thoughts so often that most of the time we don't even notice them; they're part of the background noise of being human. We take them for granted. In retrospect, part of what I find most terrifying about severe acute depression is the moments where the pain gives way to a nothingness where there are no thoughts. People tell me later that it's like I've frozen staring off into space. Subjectively it feels like time has stopped and then picked back up again, except that it turns out there was a gap with nothing in it. I'm lucky that this tends to last only moments at a time. But the idea that it might be possible for my brain to stop thinking thoughts, even temporarily, is chilling.

But I digress.

Sometimes I have thoughts that I don't feel like I'm in control of. Sometimes these thoughts follow moods, but sometimes they just float into my mind like a passing breeze with no obvious genesis.

I wish I was dead.

I should jump in front of that metro.

I want to stick a carving knife into my wrist and pull it up to my elbow.

Do the thoughts bother me? Yes. Partly because anything I don't control bothers me, and I hate not being in control of my own mind. Partly because the thoughts are scary and bad, and I'm afraid that if they start to hound me I'll end up being powerless against them. Partly because it divides my attention away from other things, like data entry, or looking at pictures of cats, or obsessively replaying my rapes in my mind.

I talked a little bit about the hurting-myself thoughts with my first psychologist, whom I will henceforth refer to as Dr. Radio, because he had the best voice I've ever heard in my life. I could listen to him for hours, even if he were just reading copyright information, because the sound of his voice was so relaxing. Anyways.

When I started to get more depressed in the Fall, one of the things that happened is these thoughts about suicide and self-harm reappeared. I was terrified: I hadn't had these thoughts for years. I wasn't suicidal at all since 2006. I hadn't harmed myself at all since 2009, and not seriously since 2006. When these thoughts came back, I felt scared. I also felt like I'd failed. I felt like I was failing God, Who had given me the miracle of healing me from these ideas. I felt like I was failing myself. I fought against the thoughts for months, by the winter for most of the day, constantly. Both the feelings and the thoughts were painful and overwhelming. I was scared I'd have the thoughts forever, and I was scared because I both did and didn't want to do what they were telling me. I knew that at one point I wouldn't be able to stand the thoughts any more and would give in just to get a moment's peace.

When I was released from the hospital in March, I'd had weeks to think about it, and I knew something would have to change in the way I was dealing with the thoughts, especially since my mood was still pretty low. In a way I was also better off than before I went in, thought-wise, because trying to kill myself did work in the sense that it released a lot of the pressure. It was like taking a cork off a bottle of champagne: Ahhhhhh. Suddenly not so crammed-in and tight-feeling, crushed, unable to breathe. I think that's what they call catharsis.

Over the years, I'd taken steps to try and mitigate the potential impact of the thoughts. I don't keep Tylenol in the house because acetaminophen is shockingly hepatotoxic (that shit will destroy your liver). I don't have a gun, and wouldn't have a gun, because shooting yourself in the head is very bad. I keep stainless-steel blades specifically for self-harm because I can sterilize them with alcohol and, at the very least, avoid cutting myself with anything stupid like a rusty nail or a broken bottle I found in the street. At times, I've had my prescription medication locked up so it was inaccessible and gotten it dispensed weekly.

Obviously, these are attempts to control my environment rather than attempts to regulate the thoughts. Leaving St. Mary's, I knew it wouldn't be good enough because it manifestly hadn't been good enough.

The main thing I decided I would do is that I wouldn't chase the thoughts. It's natural, when you have a thought, to have the corresponding emotions. When a thought is powerful, either in the force of its suggestion or the tenor of its emotional implication, it's easy to get trapped in a cycle of thoughts. One thought follows another in an endless train, pulling along emotions that fuel the thoughts running on and on, a conflagration running like wildfire through the kindling of your mind.

You chase the thoughts, following them, fueling them and, ultimately, allowing them to burn uncontrolled. If you ever do stumble across a wildfire - which I sincerely hope you don't - the way to put it out is really to have it run into barren ground where there's nothing to burn. Chasing a difficult thought around is like throwing barns at a fire while you run away, hoping that it will eat the barns instead of you, all the while making it bigger and angrier and more uncontrollable.

Stop. Take a breath. Acknowledge that you're having a thought. I am having a thought. Okay.

Then let it go. You don't have to hold onto it. You don't have to dwell on it, or try to puzzle out what it means, or let it fill you up. It's just a thing that's happening, and it passes.

Talking about the thoughts with Dr. Radio, we discussed the ways that I felt badly about myself for having the thoughts. I felt like I was a sick person, a weak person, like I wasn't ever going to get better. I felt abnormal. These thoughts, these are illness. But he pointed out that, in reality, people with psychopathology and people without psychopathology both have random thoughts like, I wonder what would happen if I stabbed that person, or, I wonder what would happen if I jumped in front of that train. The research supports the fact that everyone is having these stray thoughts. The difference is what people with mental illness say to themselves about themselves because of the thoughts.

I have a thought about killing myself, and I tell myself that I am sick, that I am a bad person, that I am not capable of getting better, and that I am afraid I won't be able to resist the thoughts. So what I have to learn is not to judge or label myself because of the thoughts. Essentially, this involves noticing that a single thought is actually triggering an entire thought-sequence about yourself that really has nothing to do with the original thought and everything to do with your self-conception. So when my thought-train starts up, I take notice, stop, take a step back, and remind myself that the thought doesn't mean any of the things I'm saying to myself about myself, because the thought is just a thought. It takes a lot of time, and a lot of work, to interrupt thought patterns, but I'm sticking it out.

Recently, after rTMS, I've been feeling a lot better and doing the thought-work is easier, but I'm still having the thoughts sometimes, out of nowhere. It doesn't bother me as much as it used to. I do feel disappointed sometimes that they're not completely and miraculously gone, but then I remind myself that it takes a long time to undo thought patterns. Thoughts, like flowing water, carve grooves in the mind so that future thoughts more easily follow the same path. It's not easy to change the course of a river, and it's not easy to change thoughts, either. You definitely end up with two competing thoughts at once where you're telling yourself, gently, that you're wrong. So, at least while you're relearning, what you're having is not so much different thoughts as more thoughts, as you pile new thoughts on top of the old ones to divert them. I had to decide to be patient with myself.

Talking about my thoughts with my new psychologist, she mentioned that I didn't seem very distressed by the fact that I was having them, so I told her what Dr. Radio had told me and how I was trying to learn not to judge myself. She suggested that I take it one step further and, instead of saying to myself, 'I am having thoughts,' to say, 'My brain is having a thought.' This makes sense on multiple levels: it creates more distance between you and the thought by decoupling it from a sense of personal agency; it creates a gap between the thought and the emotional reaction by framing the experience in the most objective way possible; and it interrupts the thought-pattern by adding a new thought about the thought, namely that you are not the same as your thoughts. This last idea is actually pretty radical - the suggestion that you and your thoughts are not identical, or that you, as a person with personal worth and value, are not made out of your thoughts.

So, if you're looking to change the way your thoughts are running around in your head, I hope you find my tips helpful:

Don't chase the thoughts.
Don't judge yourself for the thoughts.
Be patient with yourself as you learn a new way.
Remember that the thoughts are not you, and don't define you, and will never define you. The thoughts are something that is happening, and that you are living with, and that are giving you an opportunity to change. 

If all else fails, just turn yourself over and look for the little button that you can poke with a pen to force a system reset.

Wednesday, June 25, 2014

Remembering Ellen, my Mentor and my Friend

I didn't think I was going to write about how I've been feeling about Ellen's death. It feels so...narcissistic and self-involved to be thinking about how I feel in the face of a devastating loss affecting so many people. Sometimes I worry that years of being in therapy has made me be all me me me. That isn't the sort of person I want to be, but maybe it is, underneath it all, who I am.

Anyway, there was nothing else to write about because this is what's been on my mind.

I first met Ellen in the summer of 2006, when she was the head of McGill' Bachelor of Theology program. She was curious about the unaffiliated woman who was joining the program and asked to meet me in her office. Back then, she was in the basement of Birks, in what I felt was a very comforting and open space; the kind of space that made you feel welcome right away. I don't know if I was what she was expecting, and I never asked her. I never asked any of my teachers or fellow students if I was what they were expecting, or what they saw when they looked at me. I had long pink hair, and a lip piercing. I wore what can only be described as odd clothing. I don't know how she saw me when I walked into her office for the first time, but she was openly curious about what had drawn me to the program, and what I hoped to gain by studying with them.

Ellen was perhaps the most accepting person I've ever met. She was the first person I ever told that the reason I'd changed the whole course of my life to enroll in theological studies was because God had told me to, and had confirmed these instructions in a vision. She listened to me as if I was telling her the most normal thing in the world. She made sure I knew that I was more than welcome to worship with the Anglican College across the street if I found myself searching for a spiritual home during my time in the program. She made sure that I knew that, if I chose to, I could pursue an honors degree that would let me do either independent studies, graduate seminars, or both. Leaving our meeting, I felt more convicted than ever that I had chosen to follow God in the right direction and had found myself in the right place.

As was true for all of us in the BTh program, I had Ellen as a New Testament professor my first semester. Her classes were challenging and invigorating, and - along with many other fantastic courses - made me realize that reading the Bible for the first time was an experience that could draw me ever deeper into relationship with God. While some people did question their faith, the rigorous academic standards to which we were held provided me with a fertile ground to discover the sacred texts shaping the living history of my belief. I began to see that I could find, in these texts and in this research, a space from which God was speaking to me, about the ways in which I must learn to question the ground under my feet that I had felt was solid and really ask God what it is that God wanted from me. I could no longer rely on the answers blindly provided to me by the Catechism and documents of the Roman Church. Instead, I had to discover God for myself. With her and my other teachers' encouragement, I found myself suddenly feeling expansively free. I was ridiculously happy and alive and full of fervor for God. I felt the power of the Spirit running through me as I tackled the work in this program Ellen had welcomed me into.

Ellen made sure I knew I was welcome to worship with the Anglican theological college, she made sure I knew I could join her at her church when I wanted to experience an Anglican Holy Week and Easter celebration, she made sure I knew she was always willing to talk with me. She helped match me with my first spiritual director, with whom I had a rich and rewarding experience that deepened my trust in God. When I began thinking seriously about joining the Anglican church, Ellen helped prepare me to be received, and was there to sponsor me.

Once I left graduate school, I had the unsettling experience of saying hello to a former professor at an ordination we had both attended only to have her walk by me without acknowledging I was there. Ellen was the next person I ran into. She said hello warmly with one of her beaming smiles. I replied, oh thank goodness, I didn't know if you'd be speaking to me. She looked at me, puzzled but still smiling, and asked why on earth she wouldn't talk to me. When I replied that it was because I'd withdrawn from the program (and, frankly, caused quite a fuss over it), she was like, oh, that, and waved her hand dismissively. She told me that I should come to her office and we'd have tea. And I did. I realized that, in Ellen, I'd found not only a teacher, a mentor, and an ally, but a fierce, fierce friend. When I saw her again this Fall for our sporadic tea get-togethers, she became the first teacher in my graduate program to ask me if I was okay, because she hoped the whole experience hadn't hurt me. She was happy that I had a new job, and we talked about our churches and how we were experiencing worship.

When I became very sick this winter, Ellen followed my blog and prayed for me. When she, too, became sick this spring, I prayed for her and read what she was writing. One night, hours after I am usually asleep, I found myself wide awake and praying fervently. I envisioned Ellen and I, and several other people (none of whom I know personally) holding hands with each other as I prayed. I prayed that God Who knew fear would hold Ellen fast and envelop her in love. I prayed that God Who knew pain would take her pain away. I prayed that God Who knew death would be by her side, and that she would know she wasn't alone. I prayed that she could feel all of our love for her. I prayed these intentions over and over again, until the words fell away and I was just praying. I prayed until I fell into a deep sleep.

The next morning when I woke up I found out that while I had been praying Ellen had been praying compline, and then had stopped breathing when it was over. Ellen is one of the most generous, spiritual, and alive people I have ever known. I wonder how many of us received this kind of Consolation during her passing. I feel like God and Ellen together wanted to give us something. She was so concerned that all of us who cared about her would be prepared for her passing.

I don't know what her death means to me yet. I haven't grasped it. It is still, in some deep sense, unreal. At the church hall after her funeral, I saw the back of someone's head and reflexively started to go toward her, thinking it was Ellen and that I must say hello. I feel an emptiness, a sadness, but it doesn't have a shape.

When I think of her death, I feel like I have no right to feel sad, no right to grieve. There are so many people who knew her better,who loved her more, to whom she meant so very much. I feel like I just don't have the right, and certainly not the right to write about it. Of course, I know Ellen would be the first person to look at me gently, and say kindly - but leaving no room for doubt! - that this idea is complete bullshit.

And I feel deeply ashamed and immoral because, just like every time someone I care about has died in the last decade or so, I feel deeply jealous and I don't know how to talk about that because it's absurd. It's absurd to wish that you were the person who got to die instead. I'm pretty sure Ellen would put her arm around me and remind me that I'm human, and it's okay to have difficult feelings so long as they become a space in which and from which to grow.

I feel so sick and so insane sometimes, because I know that what I feel isn't normal. But I am committed to the path I'm following, where God is leading me and where so many people have guided me and are guiding me - toward becoming fully the person I can be, and being able to give back some of the blessings I have been so lucky to receive.

Saturday, June 14, 2014

The Difficulty with a Difficult Recovery

Sometimes people get confused because I'm a chronic optimist despite living under the cloud of depression for so many years. Admittedly, this confusion is understandable since it only makes sense that an illness which robs you of a hopeful perspective of the future would make a person - well - less than hopeful about the future. Lack of rose-colored-glasses and all that. But I feel like looking on the brighter side has, for me, been the natural consequence of spending years searching and searching (and searching!) for the light even when it doesn't appear to be there.

If there's a problem, I think it'll be all right. My life is on fire? Oh, it's not that bad, I can make a new one. Oh, my academic career has been destroyed by my illness? That's okay, I'll find something else to do with my life. Oh, I lost my job? Well, that's not ideal, but I've been meaning to make a change anyway.

Having said that, if I smudge a freshly-painted manicure, nothing will ever be okay again because this is the end of the universe, so I think I'll just sit on the floor and sob hysterically for 20 minutes. I think what I'm mostly lacking isn't a sense of optimism so much as a little perspective.

Anyways, when I heard that having rTMS was a possibility, I was already thinking we are trying something new, and it will work. I was fully prepared for it to work spectacularly well. And it did: it gave me moments of clarity and feelings of well-being that were beyond even my expectations. I feel truly blessed that it worked so well for me. And when I had the opportunity to try adjusting my medication levels to try and alleviate some of my lingering exhaustion and bursts of inexplicable sadness, give me back a little pep-in-my-step, of course I jumped on it. It is a great plan, and this time we are going to go all the way and it will totally work, especially while I'm still in the consolidation period following rTMS.

Well, as it turns out, not so much. Of course, there's always a period of adjustment while medications are being changed, and that's only to be expected. But it might be that more of a good thing is sometimes just too much. I hate to admit defeat, in anything, but sometimes it just has to be done. I was wrong, universe: it is not a smooth line upward - though I do believe that upward will be the ultimate trajectory. Sometimes, it's just hard when the direction is more sideways than you were hoping for.

It's easy to tell people you're doing poorly - that you need their visits, their prayers, their support, and their offers of fresh fruit - when you are so sick that you're an inpatient in a psychiatric unit. It's another to tell people you're struggling when you're doing so much better. You, as well as everyone who has rallied around you, need the story with the happy ending. You need the recovery story. You need to tell it to yourself, and so you tell it to everyone around you. I am doing so much better. I am recovering. I am in recovery. Even, I am better. It's so, so easy to leave out the second half of those sentences: I am recovering, but I am still struggling. I am doing so much better, but the truth is that it's still really rough. I am in recovery, but the road is uneven and I am afraid of falling, and I have fallen.

The logical part of my mind reacts to setbacks as setbacks. I tell myself that this is part of the recovery process, that it will take time, that it will not always be smooth. The part of my brain that is still depressed tells me that this is just like before and I will never, ever be better. The truth is that when you live with an illness in which your brain tries to convince you that nothing will ever be okay, you're going to spend a lot of time arguing with yourself. It takes patience, and self-compassion, and determination to tell your brain that it is wrong. Your brain is saying two contradictory things at once, the one which you encourage and the one which you struggle against.

And it's hard. It's so, so difficult. And part of that difficulty lies in not knowing how to say that this is a story about recovery and also a story of learning to live with not being completely well all of the time, of learning that recovery is a process requiring you to learn and to grow and to stretch your fragile wings, and that you are not quite all the way out of the nest and ready to fly.

Friday, June 6, 2014

Short-Term Disability (Or, the Insurance Policy I Didn't Even Know I Had)

I went into the hospital at the beginning of January to get some stitches, because I knew that I literally couldn't do my job with a gaping hole in my forearm. Oh sure, there were some other reasons. For starters, I'd actually been making incisions in my arm in an attempt to locate my artery, because I was convinced it would look really beautiful when I sliced it open...luckily, my lack of stamina as well as my apparent lack of basic anatomical knowledge meant that I eventually gave up and decided to go to church instead, where a friend helped me get to the emergency room.

For another, I knew I needed some sort of help that I just wasn't getting. I was both relieved and devastated when I was finally admitted to the psychiatric ward at St. Mary's. I was relieved because I knew that I was incapable of doing my job, and this would save me from destroying my fledgling career. I was relieved because I'd been having an incredibly public breakdown all over social media and being unplugged from the internet would keep me from posting any more cartoons about how I wished I was dead, and generally humiliating myself any further (P.S. it's really hard to look people in the face after you've had a complete meltdown in public view for a few weeks). I was relieved because I didn't have to spend any more energy trying - and failing - to pretend that I am perfectly fine, goddamit!

But I was also kind of a little crushed inside, in the part of me that cares, the soft squishy vulnerable part of me that I have to shield at all time because weakness is a liability that just isn't acceptable. Weakness means rape, and pain, and all sorts of failure. I just can't stand it. Every time a doctor talks to me about allowing myself to be vulnerable I want to punch them in the face and throw myself off the nearest building.

But I digress.

It was crushing to call my boss every day during the first week and tell her that I was still in the hospital and wouldn't be coming into the office. It was humiliating to be so...I don't know...a terrible employee. I knew that I was protected from being fired because it's against the law to fire someone for being in the hospital, but I still felt pretty shitty. You've got to be thinking you've made the wrong hiring decision when your employee goes AWOL less than a year into the job; it wasn't fair to either my manager or my team for me to so completely drop the ball. I felt like someone had thrown me the ball, it was busy season and they needed everyone to be on their A-game, and I was like 'Oh, this ball? I think I'll just throw it back in your face.'

I hadn't been hospitalized at all since 2006, and my last significant stay was in 2002-2003. I felt like I'd wasted all this time and all these years only to find myself back in the same shit-hole. I was so disappointed in myself, in my failures, in all the things I should have done to get better but somehow didn't manage to get around to doing.

Me and the hospital. I was like 'Please, please, help me. Please save me from myself,' and also, 'I don't deserve to be here, and I don't have what it takes to get better, so you might at well give me the boot and make room for someone who will.'

Anyway, in one of my many conversations with my manager, she mentioned that we'd been using up the two weeks of sick days I had in my bank, and then we'd be contacting HR to get started on a short-term disabilities claim. I was like, 'short-term what in the what now?'

I'd been thinking that I was really fortunate not to get fired, and that I'd saved up money for years so that if I was ever too sick to work I wouldn't end up homeless and completely bankrupt. But, instead, it turned out I had an entire short-term disabilities insurance policy that would pay 75% of my salary. It had come with my job, and I didn't even know it. I work in the insurance industry, and I knew the insurance they were giving me as part of my compensation package was outstanding, but I didn't even know short-term disability was a thing.

I felt so, so lucky. But, when week three of my hospitalization rolled around and it was time to fill out the complex paperwork, I also felt deeply conflicted. I was basically saying, to my employer and to myself, that I was a failure. I was incapable of working. I was worthless, a financial liability. I couldn't even do my job. I have always tried so hard, worked so hard, kept going no matter the personal cost, and here I was giving up. I mean, why couldn't I just make myself go in to the office? I'd been doing it before, hadn't I? I felt so overwhelmed and incapable. I'm not sure I've managed to work out all the things I was feeling.

When I finally did go back to work on a progressive return, and started to struggle with working four days a week, I wondered if I would ever be able to work a full week again, if I would be able to manage it. I was doing the best I could, but I was failing. And then, I went back on full disability benefits to receive rTMS treatment at the Douglas. I realized, 'I am disabled.' It wasn't something I thought I'd ever have to say about myself. I am disabled.

I still struggle with what saying that means. I was disabled. The part of me that's trying to learn self-compassion tells me that it's okay, that it's not my fault I was sick, that this is something that just happens. I was lucky to get through it. I was lucky that rTMS treatment worked well and I could get back to my old activity level without distress. I was lucky. I know that having been disabled doesn't say anything about my character, or my strength, or my worth as a human being. But I still feel somehow less than I did before. I still wonder what value my life has when I can't be a functioning, productive member of society. Sure, everyone needs a little help sometimes, but not everybody ends up disabled because they just can't handle their workload.

I am so, so lucky to be employed at a place that gave me such great insurance, because not everyone has that benefit. I am so, so lucky that my team and managers believed in me, and welcomed me back so seamlessly. I am so, so lucky that HR and my short-term disabilities case-worker were so compassionate and willing to work out a solution that would get me back in the workforce without making me sick again. But I also feel broken. And I'm not really sure when I'll feel whole again.