Sleep is the fastest way to escape depression. When I feel overwhelmed, I go to bed, where I can drop the Mask and silence The Critic. The worse the depression, the more worn down I feel, the more tired I get, the more I want to sleep. Denial naps during the day, early bedtimes, and late sleep-ins help fill the time without confronting the worst of it.
The better I am managing, the less I sleep.
When you only see some people once a year, it is natural that after the initial Merry Christmas greetings, you compare resumes. "So, what have you been up to?" What should I say? I took a ten-week course on Skills for Safer Living with six other people, all of whom have attempted suicide in the past, just like me? It's not a good way to start a conversation. Nor is telling someone you're trying a new anti-anxiety pill that seems to work well. Once I ignore my depression and SI, there is nothing over the past year worth talking about; at least, that is what the Critic tells me.
It might sound counterintuitive, but once I have my drink in hand - usually a beer. (What am I saying? It's always a beer.) I try to stay with a group of people. This way, you can watch and listen without participating. Let others do the heavy lifting and carry the conversation forward. No one will notice that I am not part of the discussion. If they ask me something point blank, I just nod and agree.
My favourite Christmas Eve - more of a construct than a memory - is sitting alone by the fireplace, with a lazy flame dancing on a log. The tiny coloured lights on the Christmas tree scatter a cozy, warm hue. In my hand, I am sipping a Baileys on ice. In the background, choral carols float quietly, blessing the space. Everything is calm. My mind is clear. Everyone else is already in bed. I'm the last one to turn out the lights.
...
I enjoy writing. I like expressing my thoughts on paper or on my blog. I wish I could get more people to read my stories and poems, but that's not why I write.
I have written a couple of novels. They have been revised over many years. I have been tinkering with one since university. I have carefully sculpted the other over the last 20 years. Neither has been published. I have tried the Literary Agent route, which is very frustrating. You wait so long only to get a form letter rejection. I understand why. The number of "writers" worldwide has grown exponentially since the advent of word processing programs and the Internet. Literary agents are inundated with story pitches. I'm sure they can barely keep ahead of the avalanche. I'm not criticizing them, but rather just sharing my observations.
The non-literary agents in my life - friends and relatives - advise me to self-publish. I am reluctant for a few reasons. First, Literary Agents want to avoid handling spoiled copy. They want the princess to be intact, so to speak. If I self-publish, my novels will be sullied. It is an all-or-nothing strategy.
Second, to self-publish successfully, you need to be able to promote yourself. All authors do marketing, but if you have a Literary Agent, you have some guidance and access to tools unavailable to lone wolves.
Major Depressive Disorder is a severe mental illness which affects 7.6% of the population or nearly 2.5 million Canadians (Statistics Canada). It is a deadly disease which kills, by way of suicide, between 2% to 7% of those suffering from the illness.
The percentage of Canadians 15 years and over who have had a major depressive episode in the past year has increased substantially over the last decade. In 2012, 4.7% met the diagnostic criteria, compared to 7.6% in 2022. Young women between the ages of 18-24 were most likely to report suffering from MDD (18.4%). Among males in my age group (45 to 64), the prevalence is 5.4%.
The most common symptoms of MDD are :
Depressed mood
Feelings of guilt, worthlessness, helplessness or hopelessness
Loss of interest or pleasure in usually-enjoyed activities
Change in weight or appetite
Sleep disturbances
Decreased energy or fatigue (without significant physical exertion)
Thoughts of death
Poor concentration or difficulty making decisions
My primary symptoms are a constant and overwhelming urge to plan and complete suicide, a feeling of being useless and worthless, being overburdened with stress and anxiety, being paranoid of the future, feeling hopeless in the present, and regretting my past. My mind is constantly fatigued by a barrage of destructive thoughts. I'm often exhausted by the noise in my head.
The diagnosis of a mental health disease is unique from other medical conditions. Since there are no objective tests that can be given, it relies on the skill of the psychiatrist or family doctor and the honesty of the patient. Don’t embellish your symptoms or dismiss them as inconsequential (as I did). The only way you will get better is by building trust and sharing how you really feel. By listening to your words and observing your behaviour, a doctor can provide an effective course of treatment.
I was first diagnosed with the PHQ-9. Pfizer released this screening and monitoring questionnaire in 2010. It consists of 9 questions, which are designed to gain insight into a patient's thoughts and feelings. It asks, "How often have you been bothered by the following over the past 2 weeks?" It covers 9 different symptoms of depression ranging from appetite to sleep patterns, from self-esteem to suicide ideation. Each answer is assigned a score. The total of all nine questions identifies the level of depression the patient is experiencing.
The first time I filled out this questionnaire, I was identified as severely depressed. Even today, with my depression somewhat managed, I score between moderate and moderately severe.
PHQ-9
...
All of the following are effective in some shape or form, but for them to be truly beneficial, you must make those that resonate with you part of your daily routine. They must be deeply integrated so that when you need support, a pause or a break, or even just a distraction to get over a crisis, big or small, you will instinctively choose the right strategy for you at that moment. Many of these I don’t embrace that tightly. I hope listing as many as I can remember will give someone else an option they never considered.
Let’s start with ice. Before I experienced modern psychotherapy, I equated Psychiatric Hospitals with 19th and 20th Century Insane Asylums and their notoriously harsh treatment of patients. I have a vivid image in my head of a patient screaming and crying as they were forcibly put into an ice bath and restrained in place. It was a technique used regularly as much as a punishment as a treatment. As it turns out, though, ice baths significantly affect a patient’s physiology. They are routinely used by athletes to reduce muscle soreness and inflammation and to enhance recovery. For patients, if you put your face in ice water and hold your breath, it triggers the dive reflex, slows the heart rate, calms the nerves and makes your body conserve oxygen.
I don’t like being cold. The only ice I want is in a drink, so the idea of an ice bath is abhorrent. Nevertheless, I’ve always been open to trying different strategies at least once, so one day, when I was agitated, I tried it. I filled a large bowl with water and a couple handfuls of ice. I then bobbed for apples, or in this case, ice cubes. As expected, it was not pleasant. Perhaps it would have been refreshing if it had been a hot day. As it was, it immediately distracted my thoughts. Bracing. As a strategy, it was effective, but as a viable option, I would have to pass. There was too much involved in setting it up. When I told my Pdoc I tried it, he was actually surprised. He rarely had patients act on his suggestions. He was more inclined to trust medication, especially PRNs, in such situations. I won’t dismiss this strategy out of hand, but if I ever use it again, it will be in desperation.
...
Prescription medicine is a subject of much debate among mental health patients. Some view it as an unnecessary addiction with zombie-like side effects, while others consider it a lifeline to calm and their only chance of recovery. I have been told that no one, including Psychiatrists, knows precisely how this class of drugs works. It’s not as simple as replacing a chemical deficiency in the brain, as we are sometimes led to believe. Moreover, each drug has its benefits and possible side effects.
Many people have managed their depression through lifestyle changes and natural remedies. If this works for you, keep doing it. I’m not trying to persuade anyone to take psychiatric pharmaceuticals. Likewise, if you need medication, don’t consider it an admission of failure; that you are somehow less of a person because you need it. Medication has nothing to do with strength; it is more about symptoms and relief. Find what works for you.
I have not taken many prescription medications in my life. In fact, prior to the last seven years, I had only ever been prescribed antibiotics. So when my Family Doctor first suggested medication to manage my depression, I was a little taken aback. Was I really that sick? I hesitated for a few weeks but quickly found my symptoms were becoming unmanageable. In the end, I trusted her judgment.
The first drug we tried didn’t go well. To make matters worse, I didn’t tell my family doctor about the side effects I was experiencing; I had terrible stomach cramps but did my best to persevere. I didn’t realize that had I reported my side effects right away, she would have changed the medication immediately. I thought I was being heroic when, in fact, I was just being stupid.
When you mention mental health services, the first provider that usually comes to mind is a Psychiatrist (Pdocs for us in the know, "shrinks" for those over 60). My experience with this profession is decidedly mixed.
First things first, get the traditional image of a psychiatrist out of your head. There are no couches or notepads or ink blots or even a cigar, for that matter. On your first visit, they make it very clear that they are primarily Pharmacologists. Their specialty is medication, not therapy. I have often heard complaints from other patients that psychiatrists are only interested in pushing pills. I admit I said the same thing when I first started on this journey. I have since realized, at least from my experience, that they are supposed to do that. Complaining about a psychiatrist always prescribing pills is like complaining about a dentist who only cares about your teeth. Psychiatrists are what they are.
If you’re looking for therapy, not medication, you must see a therapist. A psychiatric appointment does not typically allow for deep discussion. I saw one Pdoc who started our first session by saying, “I only have 15 minutes, so don’t go into too much detail.” She wanted the current problem with no backstory, pronto. I spoke as quickly as possible and brought up my mom’s Alzheimer’s. The Pdoc stopped me right there and pointed out that we had already discussed this at a previous appointment. She said it as if I had missed the obvious that talking about an issue once would make it magically disappear. I learned to shut up at my appointments and just talk about the effects and side effects of the wondrous drugs she had prescribed. The Pdoc was much happier that way.
This is the most challenging chapter to write. This is the topic I fear the most.
The Critic has been part of my life since I can remember. A voice that amplifies everything I do wrong, that offers suicide as a relief. I don't actually hear a voice; instead, it is an internal dialogue that drowns out every other thought. The Critic tells me I am destined to die by suicide and that my greatest action of free will is choosing when it will happen.
The Critic is not always blunt. In fact, in most cases, he acts as my greatest ally. Rather than dictating what I must do, he often sympathizes with my concerns and offers relief.
He recognizes my weaknesses and offers me peace. His ideas are so seductive that, in the moment, they make complete sense. It's only after the fact that I recognize how dangerous and permanent they are.
I have had many therapists but only one identified and separated out The Critic completely. She set up an empty chair so I could address and directly challenge his assumptions and arguments.
At times, I even sat in The Critic's chair. The dark thoughts I spewed were vicious; the self-hatred was exhausting. He identified every mistake in my life, real and imagined. He told me that I've accomplished nothing and never will, that I am a failed introvert without confidence and friends. My dreams have no hope of fruition. It is a lie that if you just persevere, you will win, so why bother? I have let down myself so many times. Why try? Writing these words is a waste of time. The Critic's thoughts are relentless and know precisely when to strike. All other words escape me, and I'm left to listen over and over, again and again. I am all I'll ever be. You'll cause pain whenever you choose to go, so why delay any longer?
The Critic views suicide as my greatest accomplishment. Even better if it is unexpected. I was proud of my last attempt when I caught my pdoc entirely off guard. The Critic told me it was something to be proud of, to wipe away the doctor's smugness. They locked me up in the hospital for eight weeks. Something else to add to my resume.
I have had many therapists on my mental health journey. Some have taught me what doesn't work in therapy, while others have inspired me to live a safer and happier life. By therapist, I should clarify I don't necessarily mean someone with letters after their name. I count as a therapist anyone I reached out to with whom I had a rapport and who, in turn, provided support. This includes a friend, a sibling, a family doctor and professional therapists. I have had therapists for one conversation and others for weeks, months and years. What is most important to me is that they listened without judgment. I rarely reach out for help, and when I do, I hope they accept me with compassion and trust.
My mental health is not something anyone else can remedy. It has to come from within. A good therapist will not try to solve my mental challenges, but they will listen and, through their patience, help me find my way. A therapist should help me foster self-compassion and encourage me to take the time to step back and recognize my distorted thinking to realize the way forward or at least the next step.
The first official therapist (with credentials and everything) I ever had was in University, right after I was hospitalized for my second attempt. I resented having to go. They told me that if I didn't, they would kick me out of residence. I didn't take kindly to the threat and was prepared to get my apartment when I finally acquiesced.
She was a middle-aged woman. Very relaxed. We started by first sorting out my family dynamic. She brought out chess pieces and asked me to identify every family member with a playing piece. I then had to explain my choices. I selected my dad as king. He was the head of the family. Dinner was served when he got home. He was a family doctor. I love my dad. He was always generous with his time. We played lots of games together. We had pentathlon tournaments where we played five events: ping pong, billiards, cribbage, Pente and chess. My father was my role model. Despite my mental challenges, I have always given my best to my two children.
I identified my mother as the queen because she was the most powerful member of the household. She knew everything that was going on and when it was to happen. The house ran like clockwork. Her agenda on the counter was a blueprint for the week. Every meal was accounted for. Every appointment was recorded. I was the youngest in my family by four years, so "my mother" was different from my siblings'. From about age 14 and forward, I was virtually an only child. While my siblings were off at college or University, my mother and I had extended one-on-one contact. If my dad was not home for dinner, the two of us would go out to a restaurant. At night, we used to watch TV together. Remington Steele was a favourite. We had a very close relationship.
My mother was proud of me when I was young. I always did well in school. It was a running joke between us that she always left the same comment on my report card. "We are very pleased with John's report." In elementary school and high school, my academic trajectory seemed infinite. I had plans to become a Latin Professor, which my mother highly encouraged. She had a friend who was a university professor, and his life was a success. But that didn't quite turn out for me. Unfortunately, in post-grad school, she was no longer pleased with "my report." She never said anything openly about it until much later when, under the shadow of Alzheimer's, she told me none of her children amounted to anything.
Cognitive Behavioural Therapy (CBT) is the darling of mental health treatments. Nearly every therapist I have had has in some way promoted CBT. They tout that study after study has scientifically proven its effectiveness. It’s as if they expect skepticism on the patient’s part, and they are desperate you understand that it is not some wibbly wobbly, cat poster, pseudoscience; that it’s a legitimate treatment. They want you to buy in immediately.
At its core, it is really just thinking about your thinking, about stepping back and observing your own assumptions and reactions to them, separating fact from your “cognitive distortions.” They use bigger words to make it seem more impressive.
The therapy is based on paper worksheets, some of which were photocopied and recopied so many times the hand-out was faded and flawed. As I mention in my therapist chapter, a course of therapy typically lasts 4 to 6 weeks. Some therapists’ whole spiel was just working through CBT questionnaires. They would give me homework to read and thought charts to fill in. It was not very helpful. In the end, I was left with pages and pages of proof that I had been therapized, but I still didn’t feel any better. I was told to review the worksheets again on my own and to keep working on them. I was left feeling that it was my fault it didn’t work.
I never really understood CBT until I was put into a 14-week group therapy series, where each session lasted two hours. It was part of the outpatient services offered by the Psych Hospital, where I was an inpatient for six weeks.
Instead of worksheets, we were given a comprehensive workbook that provided a detailed overview as well as deep insights into CBT. It highlighted the interconnectivity between your thoughts, behaviour, mood, and physical sensations. In other words, if your mood is severely depressed, your behaviour, thoughts, and body will follow that lead. The darkness would then take hold, and your inner critic would have free reign to berate and destroy your self-esteem. The theory goes that if you can improve one of the four, you can lift all four. It encourages you to become your own therapist and use self-talk to calm your own thoughts. The idea is to rewrite your brain, which they confidently declare can be done. Again, they demonstrate more scientific proof that it works. Brain scans have shown changes in brain function before and after treatment.
Everyone who has considered suicide has their own reason why. Suicide is never the answer, no matter what the reason, but whatever your why is, it is important and deserves to be heard. This is the purpose of a suicide note.
For me, writing a suicide note is therapeutic. I never write when I am in crisis. I know that under duress, I will forget someone or something. When I am suicidal, I’m too overwhelmed to put my thoughts down on paper.
Each time I start a suicide note or poem, I take the attitude that I have only one chance to get it right. The words must be perfect, so I rewrite, revise and start over many times. I spell check and fix the grammar. Ironically this engages my creative mind, where my brain forgets it’s trying to kill me. It is where I realize at my core that it is impossible to get it right. A life, your life, my life, is worth so much more than you can possibly compose.
Writing a suicide note is something you have to do yourself. It is your unique thoughts, your purpose and reason but there are some common themes that come up such as feeling sorry for the pain you will cause, being tired and exhausted, dealing with chronic pain and having a feeling of hopelessness. Your note will be different from everyone else’s. You can’t use ChatGPT. I already tried. You have to do it yourself because you deserve the effort. My simplest suicide note was 25 words long.
Please don’t cry.
Be happy with the time we had.
Use our memories as your palette
and paint a beautiful dream
where we’re together again.
Every pdoc and therapist I have ever had has told me I need to exercise; that the research proves that it’s effective at combating depression. I was never happy with this advice. Exercise requires a great deal of motivation, something depression consumes at will. Add to that, I have never been much of an athlete - I’ve always been part of the “rest,” as in when teams were being selected at recess, “You can have the rest.” -so you can understand my reluctance.
The only sport I was any good at was crab soccer in elementary school. I was a beast on the floor. I scurried faster than any crab and had a lethal shot. Alas, after grade 6, my career came to an end.
In grade nine, girls and boys were separated in gym class for the first time, and within the gender splits, there were athletic groupings. During the first three classes, we went through a series of fitness and skills tests; things like how many push-ups or sit-ups can you do in a certain amount of time; how fast can you run 100m; how many baskets can you can shoot, and other such activities to judge our basic athletic ability.
The whole purpose was to separate the wheat from the chaff. Those who were weak and less coordinated were put into their own class separate from the “regular” classes. I was quickly sorted into the “Heebie-Jeebies” - that was what the other kids called us. I’m not sure if this separation was done for our benefit or to prevent us from holding back the other classes.
And so, my only year of high school gym was spent doing more sit-ups, weight training and stair laps than the “normal” kids. Luckily my older brother alerted me to the key to high marks in fitness units. He told me to not try hard during the first benchmarks at the beginning of the year and then try my very best in June. Your mark was based on your level of improvement, and so I managed to get an A. Even my parents were impressed. That was the end of my scholastic PE.
I am trying to write the book everyone has told me to write - my experiences with my condition and mental health care. I started back in 2017 with the "What to expect when your depressed" series of articles. At the time I ran out of content but I have since found other details to relate. I am going to use some of my poems as well. I'm changing the title to What to expect when your brain is trying to kill you.
The first new content I have written is about church.
The original series is here.
As a child, I went to church every Sunday with my parents. It was a weekly routine that I gave little thought to. I didn't see God as a source of comfort and protection. Church was just a part of life.
My Christian life became more active when I was in high school. I followed in my older brother's footsteps and became a server. I wore a long white robe; actually, it was more like a dress, with a silver cross on a blood-red necklace. A white silk rope called a cincture was tied tight around my waist. It was held in place with a "mystical" knot that you can now look up on YouTube. The belt, I mean cincture, had to be positioned in a specific way to designate my ecclesiastical rank.
I never rose above server though my priest often encouraged me to consider a degree in theology, specifically Anglican. After all, our team was British; we prayed for the Queen every Sunday, so of course, we had to be the right brand. At that time, in our small town, the only competition was the Catholics and the Baptists.
There were two servers at each service with two very distinct duties. The first was the crucifer who processed the cross in and out of the service. I held the long oak staff high, with its impressive silver cross on top. The choir, the other server, and the priest all followed as I led them from the back of the church to the sanctuary at the front. I had to walk at a specific pace. It had to be dignified but not too slow. A little bit faster than a "look at me" wedding procession. The goal was to reach the front sanctuary at the start of the last verse of the processional hymn. It took practice, but I soon nailed the timing. I took my cue from the organist, who literally pulled out all the stops on the final verse.
In addition to leading the procession, I had to collect the money. Happily, I didn't have to go pew by pew; that would have been awkward for a sixteen-year-old boy. The sidesmen did the dirty work. Once they received as much as the congregation was willing to give, they brought the silver trays to the front of the sanctuary, where I would meet them like a gatekeeper. They piled their trays on top of mine, then I would turn around, walk up to the altar and hold it above my head. The priest, in turn, would raise his hands and bless the offering. I would then hand the loot back to the head sidesman, who would then take it to the back office to calculate the morning's haul. Every Sunday was the same routine.
The second server's duties were to assist with the eucharist. In the procession, you followed behind the choir and before the clergy. Once I reached my pew at the side of the altar, I took a rough count of how many parishioners were in attendance. I then relayed this information to the priest while he counted the wafers and measured the wine. He didn't like leftovers. Who could blame him? The wafers were dry and tasteless, while the wine was awful. Anything blessed had to be consumed, so any overestimation would leave the priest with an unfortunate brunch.
The biggest show was the midnight Christmas Eve service. That was when the church was packed to the rafters with the annual xmas crowd of prodigal sons and daughters. I remember being nervous while waiting in the "ready room" - the back office. Even more so when the head server told us point blank, "Tonight's the big one, boys, don't fuck up!" That really didn't help. Then the priest came in singing, "While shepherds wash their socks by night." Everyone was both excited and nervous. Although I have to admit the midnight Christmas Eve service was magical. It was the one time church felt truly special, where it felt connected to something more. The music was full of familiar carols. The goodwill and joy of the congregation were genuine. Everyone was happy. Even more so when delicate, magical snow floated down as we left the church.
For the first 18 years of my life, church was about routine and tradition. Prayer was not personal; it was scripted in the Book of Common Prayer. I never felt a spiritual connection, so when I was in crisis, I didn't even think to reach out to the church for help. And so when I made my first suicide attempt in Grade 13, I did so alone and didn't miss a single server shift.
After high school, I moved away and stopped attending church. Even if I was back home from university for the summer, I still didn't go, and I didn't feel I was missing anything. It was no longer part of my routine. If I was back home for Christmas, I tagged along with my parents to be part of the rafters but nothing on any level of frequency.
It wasn't until middle age, after I had been hospitalized for the second time in the same year, that I reached out to God, or rather, he reached out to me.
