Complements are complicated

Compliments are spontaneous words of praise or admiration but for me they are much more complicated than that.

I have lived my whole life with depression and anxiety. My self-esteem has never been strong. I often overthink someone's words and intentions to the point where my anxiety is spun into a tight knot. I am either scared of a new perceived expectation or I dismiss someone's words as unfounded.

When I was a child I hated going to the dentist. Not because it hurt or because I was scared but rather because I had never had a cavity and the dentist, after looking over my chart, always called me his "superstar". I was terrified I would let him down and he would find out his praise was unfounded. If I wasn't his superstar every time,  I was a failure.

Other types of compliments ring hollow. I once had a manager in a grocery store who was very upbeat and positive. He always said "Great work!" numerous times throughout a shift. I never believed I was worthy of all that praise, definitely not that much in one shift. His words were baseless. He didn't see me struggle with the apple display just moments before so I dismissed his compliments.

On the flip side though if he didn't compliment me the same number of times on another day, I interpreted it to mean I had let him down. I know it does not make sense to think his words are not sincere but then miss them when he remains quiet but that is how my mind works. I am either unworthy or a disappointment.

Therapy has helped me to identify this as distorted thinking. In the moment my self-esteem takes a hit but later, when I have the time to consciously go through the facts, I can talk myself down. CBT allows me to pick at the knot and put things into perspective so that I recognize that a compliment is often just a spontaneous comment, a nice thing to say. It is not a future expectation of performance or unfounded praise with some ulterior motive. It is just a kind word shared between two people. It's not meant to define who I am or gauge my value. It's just a smile that someone wants to share.

The five most challenging side effects of my depression medication

 

I live with depression and chronic suicide ideation. Over the years I have tried many different medications and I have experienced many different side effects, everything from dry mouth to a brain fog. It took a while and a lot of faith in my doctor's intentions to continue following a path of trial and error. All along I insisted that the positive effects of any medication had to greatly outweigh any negative reactions. I was not going to take medication strictly for the sake of taking medication. It had to work.

The following are the 5 worst side effects I experienced on my mental health medication journey.

5. Vivid dreams and brain sparks. Any time I laid down I would instantly be caught up in an all consuming, vibrant coloured, hyper-realistic dream. And when I wasn't asleep there were random lighting flashes behind my eyes or, as I called them, brain sparks. While I found these side effects fascinating I was worried they were a symptom of some hyper brain activity that over time might cause permanent damage.

4. Deep sleep. This one was more of a nuisance than anything. I would sleep so deeply that I would frequently wet the bed. I also drooled on my pillows, experienced night sweats and snored. A real treat for my wife. I ended up sleeping in my own bedroom in the basement separate from the rest of the family. It was embarrassing and depressing. My self esteem plummeted. For a time I wore adult diapers to bed and washed my bedding every morning. My drool would soak straight through my pillows and would leave a musky odour. For me, living this way was not an option.

3. Loss of sexual desire. This was not a performance issue that could be addressed by Viagra or Cialis. Believe me, I tried. Rather it was one of desire, or worse. Intimacy never even crossed my mind. Interest in physical contact vanished. I was chemically castrated. Provocative images, words or sounds no longer inspired me. It was as if desire had never existed. What made it even worse was that I didn't even realize what I had forgotten until I purposely stepped back and thought about it. I felt cheated.

2. Over eating and rapid weight gain. For my entire life weight has never been a problem. I was very lucky. If I gained weight over Christmas from all the treats and chocolates and nuts, I could easily lose it all by mid-January by simple eating sensibly. I had never had to diet. But when I went on one particular med I gained 25 pounds seemingly over night. I suddenly had a middle age “beer belly” distending over my waistband. I hated what I saw in the mirror and felt embarrassed to go swimming. This side effect was devastating. It took me a very long time just to claw back half of what I gained. My body image still suffers.

1. Lethargy. The worst side effect I experienced was when I was left sluggish and apathetic. Everything was heavy. Lead courses through my veins. When I tried to speak oftentimes I could not find the words. My brain was filled with cotton batting. My short and long term memory struggled. This side effect was worse than the disease. Sure, it stopped my emotional swings, my anxiety and suicide ideation but all it left was a shell. It was not a side effect. It was replacing one disease with another. What was the point? I did not stay on this med for long.

Every mental health medication has the potential to produce a wide range of side effects. But they can also provide real relief. If you want to try medication understand it will take time to determine the dosage and drug combinations that work best for you. Be patient. Tell your doctor any side effects you experience and work together to improve your mental health.

I still live with some side effects in varying degrees, but none of them are severe. Am I cured? No. I am still in therapy, I still take my meds but at least now a somewhat normal life seems possible.

What helps when I'm suicidal (and what doesn't)

 

I suffer from chronic Suicide Ideation which at times becomes acute. In these moments of crisis, I am often asked "How can I help?" I know it is frustrating but in those moments I have no idea what to tell you. My mind is spiralling and overwhelmed. Part of me doesn't even consider suicide a problem. I have had these thoughts my whole life. They are who I am. Moreover, I am fiercely independent. I don't want to be a bother. I don't want to ask for "help". My answer will usually be, "It's OK. I'm OK."

I know you mean well but there are a number of things that only make the crisis worse. Minimizing my challenge does not help. Telling me a string of positive thoughts just betrays how little you understand. Saying "It's not that bad.", "Look on the bright side.", "You can do this." makes me dismiss your intentions. Your words and thoughts become trivial in my mind because you have no idea what you are talking about. "Don't worry. Be happy." is just a catchy song.

"Count your blessings" is also not helpful. You are just trying to change the subject. "You have so much to live for.", "Other people have it so much worse.", "Don't be so dramatic.", "You are being selfish." They are all insulting. They invalidate what I am going through. I know my thoughts are distorted but they are mine and they are stuck in crisis. At that moment, I don't care about anyone else. You suggesting that I should, tells me that you don't care about me specifically.

When you say "I know how you feel." and suggest my crisis is somehow common, you make me feel less important. I'm a failure. Clearly others have handled this. Why can't I? My thoughts will then become defensive. My SI is not like everyone else's.

The desperate appeal of "I would be devastated if you were gone." also invalidates my own experience. Now I don't only have to think of my own consequences but yours as well. You are guilting me into staying alive. My crisis turns to anger and resentment. It amplifies my distress. I can barely take care of myself and now you're dumping your happiness on me.

Telling me to think of my children, my wife, my extended family only makes me angry. They are already always in my thoughts. I know they will be devastated if I die by suicide. I know it will change their lives forever. Accusing me of neglect is not helpful. Instead you only heighten the guilt I am already feeling. I'm already ashamed of my disease. Your accusation justifies why I should die. Does it make logical sense? No. But that is the inevitable path my thoughts will take. I will shut down and not listen to your words.

Don't ask me for reasons to live. In crisis, there are none. The more you push the more I will dig in. We are not dealing with logical thoughts. Everything is jumbled and hyper-focused on distress and its relief by suicide.

Asking if I have been taking my medication feels like an accusation. It undermines my own emotions. It blames me for the crisis. The dark thoughts are not real. Rather they are just a chemical stew that has boiled over. For the record, I have never missed a dose of medication. The mere suggestion is enough to make me shut you out.

Also, don't tell me to call a help line. If you are there during my crisis that is not by coincidence. I have chosen you to witness me in a very vulnerable moment. I trust you. I understand why you would want me to reach out to professionals but by telling me to do so in that moment you are abandoning me, at least that is how it feels. Similarly asking for my safety plan is dismissive. If you are there, you are already part of my plan.

So, what can you do?

First off, stay quiet. Listen. Be there for me. Let me know I am not alone but don't try to talk me down. The more words you use the less I'll listen. Conversation only amplifies the agitation. Don't bombard me with questions or try to engage me in some sort of verbal distraction. Changing the subject is not helpful. I will just hide deeper in the crisis and put up my usual defences. I will quickly say "I'm fine." in the hope that you will leave me alone.

Demonstrate empathy not judgment. See if there is a way to give me more time, to free up my schedule and relieve external pressures. Is there an upcoming event or appointment or do I have to go to work soon? Is there a way I can cancel or phone in sick? Simplify my day.

Stay with me or arrange for someone to stay with me. I'm not looking for a therapist at this point. Don't try to explore my psyche or uncover past traumas. I'll do that later with my actual therapist. In the moment I just need time to de-escalate on my own. Having someone there keeps me safe. I'll initiate any conversation when I am ready. Just be patient.

If you do want to say something, the most powerful words you can use are: "You are important to me." If you just say "You are important." I will dismiss you because I do not feel that way. In my mind that is hyperbole. But by adding "to me" it changes the meaning. I can't argue with what you believe. These words make me stop and think. They make me see you. They give me value that in that moment I don't realize I have.

I know it is hard to watch a loved one suffer. The most important thing you can do when I reach out for help is to be there for me. Without a word, you are more supportive than you could ever imagine. You give me value so I can breath deeply again.

My experiences with Virtual Mental Healthcare

I have been asked many times what I think about virtual mental heathcare. My experience over the last few years has been mixed. Technical glitches are frustrating and the effectiveness of video calls is definitely not the same as an in-person visit but for now e-health is the safest way forward.

My first experience with virtual healthcare was not positive. It happened prior to COVID-19. I was in crisis and had called the suicide prevention hot-line. The person who answered told me I had the wrong number and that I needed to call the health unit in my region. They provided no assistance, not even the correct number to call. I was stunned. I didn't bother to call the other line. Reaching out for help in a crisis requires a great deal of strength that can't easily be sustained. Instead I rolled up in a ball on my bed, took slow breaths, all the while telling myself that if I moved I would act.

When COVID-19 hit last year all appointments became virtual. My family doctor preferred telephone contact, which is my least favourite form of communication. I often adjust what I say and how I say it by people's expressions. On the phone that's not possible. This means that I often cut our conversations short which is not really ideal for a mental health check in. Nevertheless we continued on for a bit and then one day for some reason she was unable to call me. My doctor said her number was blocked by my home phone. We tried to get in touch on three separate occasions in the fall of 2020. I had no idea what had changed. Again, once the wind was out of my sails, I didn't take up rowing. Sorting out technical problems was too much effort. We haven't talked since.

My psychiatrist uses Zoom technology to conference. Our appointments are also very short. Our sessions include not only him but his psychiatric nurse as well as a student psychiatrist. I find seeing all three faces looking at me at the same time unnerving. With an in-person session, I can focus on talking to one person or, if I choose, I can just look at the space in front of my shoes. In the Zoom call, I feel obligated to look at everyone, to look into their eyes, which I find overwhelming. I try to figure out what they are thinking instead of focusing on sharing my own concerns and challenges. I always shut down the conversation as soon as possible.

My therapist and I meet over a video conferencing program called VSee. It was easy to install and we have not had any technical glitches. It's definitely helpful, though I find our sessions are not as effective as in-person appointments. Much of the progress made in a therapy session is in the pauses, the silent reflections on core beliefs or concerns. In-person, my therapist is patient. She lets me think and process our discussions. Over the video conferencing app I find the silent bits awkward. It's not anything my therapist does. It is just the nature of the technology. We are doing the best we can.

Other distractions don't help, including the clock at the bottom right of my screen and my own face in the upper right. In my therapist's office there are no clocks, at least none that I can see. I don't worry about finishing up “on time” or if I have wasted too much time on a certain topic. Likewise, seeing my face is also distracting. It breaks my train of thought especially since I am wearing noise cancelling headphones. I look ridiculous. 

Virtual mental healthcare will never completely replace in-person appointments. From my experience it has a ways to go. For now though we have to stay safe. We have to do our best to adapt and get the most out of the technology available. Today, more than ever we need to hold on. 

A version of this article has been published on The Mighty. 

When You Live With Constant Suicidal Thoughts

I came across an older article on The Mighty that spoke to me, especially this paragraph.

I purpose another way to view those who battle suicidal thoughts: They are brave and perseverant every moment that they continue living. They are strong for dealing with their vast internal turmoil day after day and year after year. They are selfless for sticking around because people rely on them and they know their death would be a burden to others. They exude hope in each moment that they continue fighting. Sometimes the burden is too much and people don’t have the resources, circumstances, support, or will to continue on, but this isn’t their fault No one gets to choose whether or not they have depression or how depression will affect their mind and body.

When You Live With Constant Suicidal Thoughts by Meghan Hart.

Who's on your playlist?

When I am in the midst of a downward spiral it is not so easy to remember what is important. One strategy I use is to make playlists for each of my children. They are a work in progress over days and months and years. 

When I hear a song that evokes a memory I add it to their list. More often than not the actual lyrics have nothing to do with the memory connected to it. Instead it was whatever was happening at the time.

My son's playlist includes everything from the Wiggles (Hot Potato) to Frank Sinatra (New York, New York). One reminds me of the live Wiggles concert we went to together at Roger's Centre and the other of New Year's eve in front of the TV. 

On my daughter's playlist Coleman Hell (Fireproof) recalls when the two of us hid from a torrential downpour in Ottawa, giggling at getting under cover just in time. Also included on her list is the song Attention by Charlie Puth. We always laugh and sing along to the misheard lyrics "You've been running 'round, running 'round, running 'round, throwing that turtle on my name." 

I rarely listen to the playlists all the way through. In fact I hardly even listen to the songs. Instead I scroll down and review the memories, letting each one flourish inside me.  If I do listen to one of the songs or hear it on the radio, I shut my eyes and float suspended in the moment, mindful of how the memory makes me feel: relaxed, content, complete.

 

When I am in crisis does this strategy cancel my suicidal thoughts? Not really but it does blunt the edge and oftentimes that is all I need.

A version of the article has been published on The Mighty.

New Year's Resolutions When You Live Day to Day for Your Mental Health

I don't make New Year's resolutions anymore. For me they always came from a dark place.  They identified everything that was wrong with me, real or imagined. They stomped on my self esteem. I was fat and ugly and needed to lose weight. I was lazy and listless without purpose. I needed to apply myself more strictly.  Resolutions fed on my insecurities and self-hate. 

 
And of course the moment I failed, which inevitably happened within a couple of days or weeks of the new year, the thoughts pounced even harder, and spiraled out of control. 

To further complicate New Year's resolution, I suffer from Chronophobia, a fear of time and the future. Plans made months, weeks or even just a few days in advance overwhelm me. Every night I hope is my last, that time will stop. The idea of doing something new for a whole year is debilitating. I am scared and more certain than ever that suicide will overrun me first.

So instead of making resolutions, I now make a daily list of things I want to accomplish for next day.

Someone not suffering with mental health challenges might think my daily goals are laughable. Spending time with my children and my wife, reading, listening to music, remembering to breath when anxious all might seem like obvious activities that don't need to be itemized but for me they provide the opportunity of accomplishment. I make sure that each is meaningful and achievable. I write down "eat well" instead of eat less or lose weight. 

Then before I go to bed I reflect back on what I can check off my list.  If there is something I was unable to do, it's not a big deal. I just add it to tomorrow's list and try again. One day I may look to the big picture but for now I live life day to day. It is the only way I know how.

A version of the article has been published on The Mighty. 

How my covid mask helps with anxiety

When you have glasses, wearing a mask can be challenging.  The Covid fog is a nuisance.  With a bit of adjusting though you can minimize the impact. The fabric, shape and design of your mask all play a part. After a bit of trial and error, an effective combination can limit fog due to regular breathing or environmental conditions such as moving from wintery frost to a comfy fire. It took me a while but I finally found a tolerable mask combination only to discover that I still had unexpected and severe fogging episodes. At first I was puzzled and more than a bit  frustrated and then I realized these occasions were tied directly to my level of anxiety. Something was triggering my body's response even before I realized it. The fog and its severity were an indication of my own mental state. At first this insight seemed to double the effect. I crumbled, overwhelmed  by my own anxiety and its relentless pursuit. But then I realized that instead of being a new symptom of despair, the fog could be used as an early warning sign.  Now, the moment my vision begins to cloud, I stop and take stock of what I am doing. I ask myself if my reaction is due to some real threat or are my thoughts distorting the situation. I reflect using my CBT training to identify my thinking patterns, to determine if I am catastrophizing or labelling or something else. I then take a few deep breaths, do a quick body scan to reset and restore myself and then finally consider how best to manage my reaction, how best to prevent my anxiety from escalating out of control.  By stepping back to think about my thinking I have found the fog dissipates and I can begin managing a crisis even before I realized one was building. Rather than a nuisance, the fog has become a very helpful tool.  It helps to challenge my cognitive distortions and let me live with a more balanced and helpful outlook. A version of the article has been published on The Mighty.