Category Archives: living with dysthymia


I’m in a dysthymia support group on Facebook. It’s been an interesting, educational experience that I’ll write about some other time. The group has been of particular interest lately, however, as the group has been arguing over the proper role of religion in such a group. A friend of mine in an illness support group had a similar experience.

The argument was spurred by a couple of posts and comments. First, a participant asked, how can a benevolent god leave me to suffer with this terrible affliction? This is a mild version of the problem of evil, considered one of strongest arguments against the existence of an omnipotent, omniscient, omni-benevolent being. It essentially boils down to this: how could such a being allow the clear evils that occur in our world to happen? Proponents of theism do not have a good argument to defend against the problem of evil other than “god has a plan” or “we’re incapable of understanding such a being’s motivations”. These responses typically are dismissed out-of-hand by most philosophers as the non-responses that they are.

(Did I mention that I’m a recovering philosophy major? If you didn’t know, then you do now!)

The second event that caused the religion flare-up on the dysthymia group was a person saying she didn’t want people to pray for her when someone said as such in response to one of her posts. This woman had poor experiences with religion in her youth, and prayer made her uncomfortable. Others perceived this as an attack on their religion and their well-wishes.

I have a confession to make. Well, okay, I already made it in my very first post: I’m an atheist. Or, more accurately, I’m a humanist. Like many humanists, I dislike the term “atheism” because it defines my belief system in terms of another, more “dominant” set of beliefs, rather than accepting it as a system unto itself. By proclaiming a lack of belief in a supernatural being(s), I am not making an extraordinary claim about the world. Quite to the contrary, those who believe in a supernatural being(s) are making such a claim, and extraordinary claims require extraordinary evidence. Such evidence is lacking (See how easily the cosmological, ontological, and teleological arguments for the existence of a supreme being(s) are dispensed). I also dislike “atheist” because there’s still a significant amount of bias against humanists.

Many people who have chronic or deadly illnesses find comfort in religion. People use it as a source of strength and hope. Step two of Alcoholics Anonymous is “came to believe that a Power greater than ourselves could restore us to sanity”. It’s hard for many to imagine having hope in absence of faith. Otherwise, the world just seems random and cruel. And just as those people in the dysthymia support group think, religion gives people the power to carry forward, confident that things will get better.

Such beliefs seem unnecessary and often counterproductive to me. Nonetheless, I don’t begrudge people feeling comfort in religion, as long as they’re not forcing it upon others, of course.People should find solace where they can. The thought of suffering through an illness such as dysthymia minus the help of the divine likely seems frightening to some, but I receive my comfort from science, reason, interconnection, and our common humanity.

So religion doesn’t help me to live life with dysthymia. What does help me is the thought of how incredibly amazing it is that we’re here. Us. Individually. The specific people that we are. Think about it: in order for the multiverse to have produced you, it took a series of events and choices spanning billions of years. Billions with a “B”. Any slight difference anywhere along that line of happenings could have produced someone or something completely different. But instead, you are the culmination of the multiverse’s work. I think that’s pretty damn amazing, and inspiring. How can I not be spurred to make the world a better place when it took so long for it to make me the person who I am, cosmically and just within my lifetime? Richard Dawkins says it best:

“We are going to die, and that makes us the lucky ones. Most people are never going to die because they are never going to be born. The potential people who could have been here in my place but who will in fact never see the light of day outnumber the sand grains of Arabia. Certainly those unborn ghosts include greater poets than Keats, scientists greater than Newton. We know this because the set of possible people allowed by our DNA so massively exceeds the set of actual people. In the teeth of these stupefying odds it is you and I, in our ordinariness, that are here.We privileged few, who won the lottery of birth against all odds, how dare we whine at our inevitable return to that prior state from which the vast majority have never stirred?” (From Unweaving the Rainbow: Science, Delusion and the Appetite for Wonder)

It’s hard to see such perspective when I’m in the throes of depression (Which, by the way, might very well be an evolutionary adaptation. More coolness about the world!). Then again, as evidenced by the interlocutor in the dysthymia support group, neither necessarily would a religious perspective. But in my stronger times, I find the enormity of the world an inspiration, even if there may be bugger for intelligent life here on earth.


Lately, there’s an interesting synergy between a few of the cultural items I’ve been consuming. I just finished reading Allie Brosh’s great book Hyperbole and a Half: Unfortunate Situations, Flawed Coping Mechanisms, Mayhem, and Other Things That happened. If you’ve never read Brosh’s blog Hyperbole and a Half, you’re in for a treat. She is both brilliant and hilarious, and the simple artwork accompanying her posts just enhances her brilliance and hilarity further. She’s written two posts that are some of the best writing about depression I’ve ever read: Adventures in Depression (aka Depression Part One) and Depression Part Two. If you’re instead up for a laugh, try The Year Kenny Loggins Ruined Christmas, pretty much any post about her dogs, or numerous of her other posts.

Anyway, Brosh’s book is a collection of some of her greatest work combined into one handy volume, <shameless self-promotion>which is probably is conveniently available at your local public library</shameless self-promotion>. Depression Parts One and Two are both included. I’d read them before, but reading them with my new perspective helped me see and identify with far more things. Brosh talks about how her own battle with depression began with a bombardment of emotion but later developed into feeling nothing at all. This seemed awesome at first, she noted, and I totally concur; it does seem pretty great, being supposedly immune to the emotional slings and arrows life directs at you. However, she makes a brilliant observation about the problem with that thought. She says it far better than I do, so here you go (emphasis added):

The beginning of my depression had been nothing but feelings, so the emotional deadening that followed was a welcome relief. I had always wanted to not give a fuck about anything. I viewed feelings as a weakness — annoying obstacles on my quest for total power over myself. And I finally didn’t have to feel them anymore.

But my experiences slowly flattened and blended together until it became obvious that there’s a huge difference between not giving a fuck and not being able to give a fuck. Cognitively, you might know that different things are happening to you, but they don’t feel very different. (Source)

Seriously. I cannot express how true that statement is for me. But before I start trying …

Today, as I was driving home, I was listening to an album I haven’t heard in a long time: Paul Simon’s Concert in the Park, August 15, 1991Simon’s Graceland was the first “adult” music album I ever bought, you know, after I graduated from the California Raisins and The Little Mermaid soundtrack (Sebastian is boss). I still think that’s probably the pinnacle of what little good musical taste I have; I’m not alone in considering Simon to be one of the most brilliant lyricists in recent history.

But enough with my fawning. On my ride home, I heard Simon’s Kodachrome.

I was listening to the song just before I stopped to get my mail, staring up at the beautiful tree-lined mountains visible from everywhere in the town where I live. Now that I’m in a better place, I truly appreciate their majesty, just as I can now better enjoy the stunning range of colors and patterns in a sunset and the magic when the river shimmers in just the right way. Staring up at those mountains, the song’s chorus came back to me.

They give us those nice bright colors
They give us the greens of summers
Makes you think all the world’s
A sunny day, oh yeah
I got a Nikon camera
I love to take photographs
So mama, don’t take my Kodachrome away (Source)

And as I was driving back from the post office, a line from the second verse similarly struck me:

Everything looks worse
In black and white (Source)

In my first post, I described how my dysthymia manifests as an almost complete lack of feeling, an emotional deadness. I felt almost no excitement when I got the call saying I got my current job, despite my yearning for it. Watching my nephews at Christmas, I had no joy. I could muster no sadness when a good friend told me she was raped. As Brosh says, it wasn’t that I chose not to give a fuck; I was incapable of offering up any fucks at all. I lived in that black and white world that Paul Simon feared; everything did indeed look worse because it all felt the same: like nothing.

Feeling nothing all the time is excruciating, just as feeling sad all the time is. You look at the people around you and see them laughing, crying, being joyful, being angry, being something. But you’re stuck with nothing. You know that you should be able to feel these things, although you’re not just “shoulding” yourself. Really and truly, you want to feel something. The world was meant to be experienced in the fullness of its colors, with Kodachrome film, where you’re able to give a fuck what happens.

And those months, those years of not being able to feel, they make you ashamed. You’re have no excitement, no joy, no sadness, no anger, but you know you should. With every fiber of your being, you know. Then comes the shame death spiral: the less you feel, the more shame you feel. The more shame you feel, the more you really don’t see much point to life at all. You feel nothing; wouldn’t it be easier just to not go through all the rigmarole and truly embrace the nothingness?

A couple of weeks ago, I mustered up the courage to talk to a friend and former partner who experienced me at quite possibly the worst parts of my life. That person who I was then – no, who I am – that person is someone I hope no one other than me ever has to experience again (I’m not really thrilled by the idea of experiencing him, either). He was taciturn. Dickish. Mean. Uncaring. That person was so awful, and the thought that someone else had to experience him was so terrible, that I pushed my memories of that time into a deep recess of my mind. He was still there, and still is. But even I didn’t want to face him, so he got shunted off into a corner.

My friend told me what I was like then. I was monotone, pale, clammy, full of contempt, emotionless, unwelcoming of beauty in my life. My worst personality flaws were enhanced to the Nth degree. I was judgmental, dismissive, and close-minded. I was black and white because that’s the world I saw. And it took the amazing support of my friend, and me hitting rock bottom, when I was about to grab the razor blade and crawl to the bathtub, to make me realize that I needed professional help.

That person who I was then is still in me, is still a part of me, but now that I’m in treatment and had a few epiphanies, he’s become someone I’m willing to face. He’s my Dark Link, but I can’t really fight him. He’s me. How am I going to fight myself? Instead, I have to accept him, because, as my friend sagely pointed out, he’s just me with the worst parts of myself front-and-center. I am judgmental. I am dimissive. I am close-minded. I am callous. I try not to be those things, and usually I’m not, but those qualities are always lurking below the surface even in my best moments.

And I am having good moments. More than moments. My life is great, and now I can see that it’s great. I give fucks, Many, many fucks. Sometimes it’s hard to give fucks. I was intensely sad when I discovered that my feelings of inadequacy are from deep inside me, for instance. Since beginning treatment, I’ve been angry, guilty, and frustrated. I’ve also been joyful, excited, loving, playful, and empathetic. Those are colors. I’m seeing them. And I’d never trade them to go back to that black and white world. So mama, don’t take my Kodachrome away.

Perfect the way I am

So I’ve been telling myself that the first post I would write after making this blog public would be about how that decision affects my career prospects. I still plan to write that post, but a lot has happened since the blog became public last week. First off, thank you to all of you amazing people who reached out to me, thanked me, and told me your own stories. Your support is heartening, and admittedly a bit overwhelming for reasons you’ll hopefully see later in this post. Your stories were heartfelt and vulnerable. I plan to respond to each of you when I can. However, the “a lot that happened” to which I referred actually only peripherally has to do with making this blog public.

The treatment for my illness is multi-faceted, involving pharmaceuticals, decent sleep habits, good nutrition and exercise, and therapy. I see a fantastic therapist based here in the Gorge. Initially, when I started seeing him, I wasn’t sure why I was there. I didn’t really have any goals for therapy, as I was feeling pretty damn good when I decided to start seeing him. Really, I was just going to a therapist because I thought that I “should”, given my condition. I was pretty close to deciding not to see him, actually. But as I started opening up, I saw how truly insightful he is and how helpful his perspective can be. He gave me some great advice recently that I’d like to share, though it requires a bit of backstory first.

I’ve referenced my assholish observer several times, that somewhat removed part of myself that constantly criticizes what I do and who I am. He feels a little like he’s the personification of my disease, belittling me so as to make me weak to dysthymia’s ravages. But I had an extremely difficult revelation last week: that part of myself isn’t really a separate “diseased” part of myself that I thought he was. He’s me. The actual me. You know, that person I’ve been trying to discover now that I’m healing.

This revelation came as a result of some things in my personal life that sapped my confidence. I constantly feel inadequate. My colleagues in my community and the library profession seem to have a fairly high opinion of me and what I do. I do not. I’m always thinking that I’m not getting enough done, that I’m doing substandard work, that I don’t keep up enough, that I’m letting people down. There’s a fear that lives with me continually that people will find out these things and realize me for the fraud that I am.

Last week, those feelings of inadequacy were brought to the fore of my personal life in a way that I’m not sure they ever had before. I’ve pretty much always felt inadequate socially. But I’ve never really confronted those feelings head on and stared at them so directly in the face as I did last week. This confrontation made me feel like there was no way that I could be a decent human being, a loving romantic partner, a good role model or parental figure in a child’s life, or even a halfway decent friend. That was the “real” me thinking those thoughts, not my companion asshole.

The culmination of this came when my partner and I were talking through some things. We decided to stop at a restaurant and sat in a quiet corner to chat. In the course of our discussion, when I realized just how inadequate I truly felt, I broke down crying in her arms. I’m not sure I can adequately express how shocking this event is for me. In my adult life, I cry very rarely. I cry around other people even less than that. And I literally had never cried in a public place before during my adult life. Ever. And there were people at the restaurant aside from my partner whom I knew, and who likely could see me. I probably could have stopped the tears, but I didn’t care. For some reason, I didn’t feel ashamed about it. I needed to cry at the feeling of my own inadequacy.

So that was part of my realization: that I had a deep-seated feeling of inadequacy. The rest of it came one night while laying with my partner. We were discussing some of what had happened and what we’d been thinking. Because she’s truly the most caring person in the universe, she said that I was “perfect the way you are”, which caused yet another breakdown. But hey, at least it wasn’t in a public restaurant this time, right? That was the moment when it donned on me that that person who hated me so much, who constantly criticized me, wasn’t some removed, diseased part of myself. It was me.

Which brings me back to therapy. I talked through all of these things with my therapist. He said several amazing things. When I told him about my breakdown in the restaurant, his first word after I told him was “congratulations!” That affirmation meant so much to me. But after he heard everything, he told me the issue: a deep underlying shame that I let control me. And once he said it, I instantly recognized its truth. He recommended that I look into a research professor in social work named Brené Brown. He suggested that I read her latest book, Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead. He also suggested that I check out her two TED talks, in particular her first talk from 2010 called “The Power of Vulnerability”.

This talk was a revelation. I have done so many things over the last several months that have made me extremely vulnerable: admitting the extent of my illness, tackling planning a large work-related conference that I have no experience doing, entering a new relationship with an intense emotional connection and acceptance the likes of which I’ve never experienced before, potentially becoming a larger part of a child’s life in a way that’s foreign to me, writing this blog, seeing a therapist, making the blog public. All that vulnerability digs up my shame, and it’s overwhelming, though in a good way, I think. Brown’s talk, together with all of these recent life events, made me see just how weak I thought vulnerability was.

I don’t know from whence this shame comes. Perhaps it’s from my childhood. Perhaps it relates to my failed relationships. Perhaps it’s me internalizing all of the self-hatred that dysthymia levels at me, because that assholish observer is still there (even if I now know that he’s not really my harshest critic). More likely, it’s some combination of all of these things and more. As Brown mentions in her second TED talk, I have plenty of well-deserved guilt for my actions, guilt meaning that “I did something bad”, according to Brown. But for years I’ve considered those actions as meaning “I’m bad”. That’s shame. It’s going to take me a while to accept that my mistakes don’t make me a terrible human being, but I’m going to try. I may not be perfect, but as a very dear woman told me recently, maybe, just maybe, I’m perfect the way I am.

The Thought

As I’ve mentioned before, I’ve been doing really well these past few months. I’ve had the most emotionally vibrant period I think that I’ve ever had in my life. However, the other day, I got an abrupt reality check.

I’d had a fantastic weekend before I experienced what I’ve come to refer to as “The Thought”. Valentine’s Day was probably the best I’d ever had. My partner and I had an amazing time going out to dinner and a show, and the next day I spent some time away from home with her and her family. Life was good. Great, actually.

Then, early on Tuesday morning, I was driving home when a thought crossed my mind. “I want to swerve this car into a rock and crash. I want it all to end.” This thought seemed to come from nowhere. The weekend had been truly excellent. Then, I want to kill myself. What gives?

While the thought itself came out of the blue, it was not without warning signs. I mentioned once that trying to keep my dysthymia at bay is a little like playing Whack-A-Mole. Treating myself is like smacking a bunch of moles with mallets to keep them in their tunnels. Those moles are my dysthymia, and I keep smacking them down to keep the disease under control. Each of the moles comes out of a specific tunnel, representing the things I need to avoid to keep dysthymia at bay. Poor nutrition. Lack of exercise. Not enough “me” time. Whatever the hell’s going on chemically in my brain that requires a mallet laced with bupropion. Obviously the chemical issue has been a huge problem for me in the past, but my drugs, together with my other measures, seem pretty good at keeping that tunnel mole-free.

My ongoing nemesis throughout my life, and the tunnel from which I have the hardest time preventing moles from pouring forth, has been insomnia. I’ve never slept well in my adult life. Ever. Usually this manifested as difficulty falling asleep and inability to stay asleep once I finally did. When I did sleep through the entire night, it was not a restful sleep. I’d awaken feeling like I’d hardly slept at all.

So lately, moles have been streaming from the insomnia tunnel, although perhaps I didn’t recognize them for what they were. My sleep had been very poor the week and and half preceding the Thought. Those nights, I was getting maybe four hours of uninterrupted sleep, and then my body would wake up. The best I’d get after awaking would be intermittent snoozing. I often simply gave up at about five in the morning and got up to start my day. The night before The Thought, I was up at 3.00a in a state of panic over my lack of sleep, wondering how I was going to make it through my very busy upcoming three months. In other words, I was exhausted. Still kind of am, actually, though I’ve been catching up. I haven’t yet ascertained the reason for my lack of sleep, although I hope that my upcoming doctor appointment can help me figure it out.

Despite the lack of sleep, I still had energy. Large amounts of it, at least to me. Even with sleep deprivation, being on bupropion and treating myself correctly has given me far more energy than I had when my dysthymia acts up. So I hadn’t noticed the lack of sleep affecting me overly much.

Obviously it did, though. I wasn’t prepared for this fleeting suicidal thought; it hit me like a semi. If I’m feeling generally down, I can steel myself for the inevitable deluge of morbidity. But I wasn’t prepared this time. That short moment scared the shit out of me. I didn’t see the warning signs. Aside from my early morning fretting, I still don’t know what the warning signs were, if there were any to see at all. And that scares the shit out of me even more.

Perhaps, by allowing it to scare me as it has, I give The Thought too much power, though. Lately I’ve been listening to National Public Radio‘s fantastic new podcast Invisibilia, about the crazy parts of our brains that govern so much of what we do and who we are. In their inaugural episode, hosts Lulu Miller and Alex Spiegel use the dark thoughts that sometimes pop into our heads as a way to explore the history of psychotherapy.

The main frame of the show is a man who keeps having thoughts of wanting to violently kill his wife. That thought is used to explain how different therapy approaches try to handle the issue. Do you logically challenge the thought? Confront it directly? Push it aside as a random firing of synapses? The way the show explained these different approaches fascinated me. I’d used each of those strategies before to deal with my own dark thoughts. I’d challenge them. I’d confront them. I’d push them aside. But just like those moles, they kept popping back up.

There are good reasons why these strategies don’t always work for me. First off, depression isn’t logical. Challenging the thoughts certainly is useful, but I’m not really in a logical state of mind when having them. The asshole is too loud, too imposing. Confronting my suicidal thoughts also is of limited use in the moment. Death isn’t something I’m fearing, it’s something I’m welcoming. What use is confronting it?

My chosen method is usually pushing aside the thoughts. Ignore them. Bury them. Distract my mind so much that it doesn’t have the opportunity to wallow in darkness. That’s where working has helped. Work has helped keep me from following through on suicide in a few ways, one of which is that it distracts me. Rather than focusing on the train wreck of my life and the morass of my mind, I focused on work. There, I had some control. There, unlike my life, I could improve things. There, I could make others happy, even if I couldn’t do so for myself. Work was my escape from The Nothing.

My reaction to The Thought was similar, although I was far more cognizant of what I was doing. The Thought was fleeting, but my fear of and focus on it was not going away. Was all that work I’ve been doing over the past several months for naught? Before I went into work, I stopped by my partner’s house. She was a rock, someone dear on whom I could focus, to remind me of the happiness of which I was capable of feeling. But we both had to go into work, so I once again forced my mind into work. I had a particularly interesting challenge on which to focus at work, a complex, fascinating one involving our Code of Conduct and a future ordinance and public forums. I threw myself into it with gusto. And it worked. The Thought fell by the wayside.

After work, I was still rattled by this minor relapse. It wasn’t something that would have phased me much before, as it was fairly common. Despite my newfound happiness and positivity, I thought I was still abundantly aware that I have an illness that likely will never go away. The Thought showed me that I must not have really believed it. Now I do. I have The Thought to thank for that. I still don’t know where The Thought came from. Perhaps it was just my dysthymia saying, “Hey, remember me? I’m still here. I can still fuck with you.” And yeah, now I know it’s going to continue fucking with me. But I’ll be ready for the little bastard next time.

Better living through chemistry

Bupropion and trazodone pills

Walgreen’s is my dealer.

These are the pills that keep me sane, or at least keep me in the world of the emotionally-vibrant. They consist of 300mg of bupropion (brand name: Wellbutrin) taken in two pills daily and 50mg of trazodone (brand name: Oleptro) taken at night about an hour before bed. Bupropion treats the symptoms of my dysthymia, the emotional dullness and tendency to lapse into major depression. The trazodone, while technically a very weak antidepressant, helps me sleep.

I was diagnosed with dysthymia by my primary care physician in 2012. It seems like people who receive disease diagnoses fall into one of two categories: glass half empty or half full. The former see the diagnosis as a tragedy, yet another misfortune they must tackle. You’d think, as someone with a depressive disorder, that I would fit squarely into that category. Strangely, I did not, nor do I now. Despite my condition, I’m relatively optimistic. Thus, my reaction was a half full one: now I know what the hell’s been wrong with me all of these years and can take steps to fix it. The diagnosis explained why felt like an emotionless golem. It explained why I often felt intensely sad for no apparent reason. It explained why my mood could be completely divorced from the wonderful things happening in my life. It explained that my emotional distance from the world was not a personality trait, but rather a disease.

Bupropion was the first antidepressant the doctor wanted me to try. There are various reasons for this. Most common depression drugs fit into one of two categories: Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). SSRIs include drugs such as Lexapro, Zoloft, Paxil, and Prozac, and SNRIs include drugs such as Cymbalta, Effexor, and Pristiq. The Mayo Clinic pages to which I link explain them far better, but briefly, these drugs work by adjusting the levels of neurotransmitters in the brain. Both SSRIs and SNRIs have many common side effects: nausea, decreased libido, insomnia, and more.

My antidepressant of choice fits into neither category. In fact, to make things more fun, researchers don’t really fully understand exactly how bupropion works, though they have a general idea. But before I get into bupropion and how it helped me, I should probably explain how I got to the point of getting the prescription in the first place. My doctor’s visit was precipitated by a terrible bout of major depression, one where I got the closest I ever had before to committing suicide. My friend encouraged me to go, and I am so glad that she did. The doctor said that my symptoms are consistent with dysthymia, a word I’d never heard before. She also said, because of the disconnect between my mood and what was happening in my life, that I was a good candidate for medication. She prescribed bupropion.

Before I started the bupropion, I had hardly any energy. After work, I’d come home, collapse, and just read random things on my phone until I gave in and decided to attempt to fall asleep, usually unsuccessfully. When I first started taking bupropion, I felt amazing. It was like I’d been seeing the world in greyscale and suddenly could see in color. These emotions that I’d experienced in full only periodically in my life came flooding in. I don’t think that I really understood the stunning beauty of the Columbia River Gorge, where I live, until I started taking medication. The vibrant green forests, sheer sculpture-like rock faces, and shining river hit me with a wave of emotion. I never really thought of beauty as an emotional attribute before, but that experience changed my view of it.

Most importantly, I had my energy back. Within three days of starting the drug, I not only had enough energy to mow the lawn of the house of was renting, but also the one of the house I was buying and my neighbor’s lawn. In one day. This was unheard of for me. I cleaned the house. Work tasks were dispensed with efficiently and effectively. I felt like a person again, with emotions, motivations, and energy. My initial experience with bupropion made me realize that so much of who I thought I was – that person I hated and criticized – was not actually a part of my personality, but rather an illness.

The honeymoon lasted a few months with bupropion. The first couple of weeks, it ran me through a cycle of side effects. Initially it was the nausea. Then it was the insomnia. Last it was the irritability. Little things would annoy me, things I’d brush off before. Once those few weeks past, it was pretty smooth sailing. Weirdly, though, after a few months, I started getting panic attacks. I would lie on the couch, shaking. They had no apparent cause, and it scared the shit out of me.

Given that strange side effect, my doctor thought it best to try me on other antidepressants. Initially it was escitalopram, an SSRI. Honestly, it didn’t really do much for me. I went back to my emotional dullness within weeks of starting it. Next up was venlafaxine, an SNRI. It seemed to do a reasonable job at elevating my mood, but I was tired constantly. I slept long stretches in an almost coma-like state, nine to ten hours a night, and woke up feeling like I hadn’t slept at all. I took three hour naps on my days off. So despite that my mood was decent, it was hard to notice due to constant exhaustion.

That’s when I decided to go back to the bupropion. This might seem like an odd decision, given the panic attacks, but I thought that 1) now that I knew they were coming, maybe I could predict and control the attacks better and 2) the bupropion’s side effects overall seemed better than the other two drugs. And the bupropion did work better when I began taking it again. The panic attacks never came back; I still don’t know ultimately why they happened. Eventually, the bupropion settled into giving me mild insomnia, for which the doctor prescribed trazodone. However, I didn’t pair my medications with other self-treatment measures. That lack of self-care, and my increasing forgetfulness at taking my medications, led me into major depression, the effects of which were brutal.

After I broke, I got more serious about my treatment. My doctor gave me the option to double my bupropion intake, to 300mg/day, which I decided to try. It made an amazing difference. This time, though, I took on other measures. I started eating better. I bought a rowing machine to exercise indoors during the cold, wet winter months. I improved my sleep habits. After doing some research and consulting with my doctor, I limited myself to one drink per day (bupropion interacts with alcohol even more poorly than other antidepressants), although I was never really a heavy drinker.

Probably my most interesting self-imposed treatment, though, is I require myself to have at least one in-person social interaction per day. Sometimes that interaction involves going out to listen to music or hanging out at the brewery. Sometimes it might just involve interacting with a clerk in a store. As an introvert, I can easily go through an entire day without interacting with anyone, thus further isolating me and exacerbating my issues. My social interaction rule, however, helps keep me connected. Already, that rule has brought some amazing new people into my life

Now that I’m on a positive path of treatment, it’s like I’m discovering the real me. I’m not sure that I’ve ever met him in his entirety, only glances. He’s optimistic. His mind is agile. He loves to hike. He enjoys musicals. He’s a devoted Whovian. Now, all of these things – and more – are coming to the fore. It’s pretty exciting to get a chance to revisit who you really are in adulthood. Chemistry is helping make that happen for me.

Precision of language

I recently reread The Giver by Lois Lowry, a young adult dystopian sci-fi novel written long before such things were cool. For those of you who haven’t read it, and without giving too much away, it’s the story of a boy growing up in an extremely controlled environment, so controlled that people’s families and professions are chosen for them and their emotions suppressed. I cannot recommend this book enough, and I cannot recommend avoiding the movie version enough. Seriously, it’s awful. Just take my word for it.

One of the themes of the book deals with how this society governs the way its citizens communicate. There’s this concept of “precision of language”, the idea that you should use the words that you actually mean, without embellishment (e.g. use “hungry” instead of “starving”). Hyperbole does not exist in this society. As the main character, Jonas, discovers the hidden costs this society imposes, he also begins to see how restrictive this centrally-imposed “precision” is.

“Do you love me?”

There was an awkward silence for a moment. Then Father gave a little chuckle. “Jonas. You, of all people. Precision of language, please!”

“What do you mean?” Jonas asked. Amusement was not at all what he had anticipated.

“Your father means that you used a very generalized word, so meaningless that it has become almost obsolete,” his mother explained carefully.

Jonas stared at them. Meaningless? He had never before felt anything as meaningful as the memory. (Chapter 16, pp.59-60)

Passages like this got me thinking. Dystopias aside, sometimes I think that the language we use to discuss mental illness could use some precision. The terms we use can be interpreted in so many ways, as I noted in my first post; they’re what I like to call squishy.

Probably the obvious terms that fall into this category are things like “crazy”, “losing your mind”, “psycho”, and “insane”. This 2012 article from The Guardian discusses use of these terms quite well. It seems like, while these terms may have started as descriptions of mental states, they’ve gained much more informal use to denote that something’s ill-advised, random, or strange (see the entry for “crazy”). You can see this common use of these terms all over the music world.

I’m guilty of using these terms myself, in the informal sense. I refer to things as being “crazy” or that I’m “losing my mind” in the flippant senses of the terms. The issue, as The Guardian article discusses, is using these terms to refer to people. When used in reference to people, these terms often are pejorative (e.g. “That guy is psycho”.). Mildly pejorative, sure, but pejorative nonetheless.

These terms can be particularly hurtful if used against someone with an actual mental illness, as there’s a good chance one may not even know that the person they just called “insane” has such an illness. Perhaps as a vestige of my undergraduate degree in philosophy, and despite my dark passenger, I have a fairly thick skin in regards to taking offense. However, a lot of my fellow dysthymics have highly sensitive personalities, and I’d imagine that’s the case with people who have other mental illnesses as well. You could unknowingly hurt someone in a particularly painful way by calling them “insane” or “crazy” pejoratively; those people likely already feel deep shame for having a mental illness, and, in a sick cycle, the mental illness itself encourages that shame.

I admit that I’m still pretty bad about using these terms frequently, and occasionally even pejoratively. I’m weak, and it takes time to retrain myself. There is one word, however, that I only use in very specific circumstances: “depressed”. When I was diagnosed with dysthymia, it made me hyper-aware of how people use the term “depressed”. It occasionally gets used flippantly (e.g. “I got really depressed when the University of Oregon lost that game”.), but more often I hear it used by “normal” people to mean that they’re feeling really sad or experienced something sad. “Man, I’m feeling really depressed today”. “The events in Nigeria are really depressing”. “I’m in such a funk; I’m feeling so depressed”. Anyway, you get the point. These statements can be brought on by truly terrible circumstances: grievous injuries, deaths, and other atrocities, to name a few.

Not to belittle other people’s sadness (and keeping in mind that I’m emotionally stunted), there is nothing quite like the intense sadness that you feel when in the throes of major depression. It’s a existential crisis, a crippling weight that your mind cannot unload. This truly terrible and terrifying state has many awful aspects, but it’s made worse by the fact that you don’t understand. You don’t understand why it’s happening to you. You don’t understand what you did to deserve it. You don’t understand how you can rid yourself of it. You don’t even understand how you’re going to make it through another minute, let alone another hour, day, or week. You cannot envision a future for yourself. All hope is lost.

So I don’t use the term “depressed” lightly. If I say I’m depressed, my state of mind is an incredibly awful one. This does not mean that I begrudge others use of the term. Instead, I think that being within the depths of psychiatric depression deserves a new term. I looked through a thesaurus to see if there was any word that comes even close to describing the feeling. “Despair”, “dejection”, and “despondence” get somewhat close, but even they’re insufficient. Perhaps there is a word in another language that truly captures the depths of despair and hopelessness endemic of depression, but I suspect not. Coining new names or words is not a skill I posses, so I won’t punish you by trying. But, alas, until such a word enters the lexicon, I’m afraid that the language of depression will continue to lack the precision it needs.

My harshest critic

I’ve always really identified with the song “Call and Answer” by the Barenaked Ladies.

I realize that the song is about a romantic relationship, but I’ve always thought of the song as somewhat of a metaphor for the warring parts of myself. These lyrics particularly speak to me.

But I’m warning you, don’t ever do
Those crazy, messed up things that you do
If you ever do, I promise you
I’ll be the first to crucify you

Source: MetroLyrics

Before I mentioned I am my harshest critic, and that that critic is a real shithead. As the song says, I’m the first person that will crucify myself if I do something wrong or, as is more often the case, if I perceived that I did something wrong. Many people with depressive conditions like mine judge themselves very harshly, often cripplingly so. Allie Brosh of Hyperbole and a Half depicts this self-destructive tendency brilliantly in her post “Adventures in Depression“. I’m no psychologist, but I think my harsh criticism of myself is amplified in my weaker moments by a warped form of projection bias, namely in that I project my own harsh judgments of myself into other people’s heads; they’re judging me as harshly as I judge myself. My perceived slights against humanity are then amplified, as I fear not only the assholish observer’s judgment, but also the criticism from all of those other people who feel the same way he does.

This feedback effect comes through in my work. When my dysthymia is largely under control, I would say that the criticism is more “tough love”; it makes me work harder, better, faster, stronger, driving me to shut that asshole up and do work about which I can be proud . When I’m not in a good place, though, nothing that I do is right. Case in point from this week: I recently re-designed the website of a local organization with which I’m involved as part of my job. I emailed the membership about the changes and requested suggestions. Someone responded back with a good suggestion. So what do I do? Rather than seeing the suggestion as it was – a good idea that I didn’t happen to think of – I started mentally kicking myself about it. That was so obvious, I said to myself, how could you have missed it? What an idiot.

I’m not an idiot, of course. Or at least I wasn’t in this specific instance; I make no claims on my idiocy in other contexts. I’m human. Sometimes I miss things, and that’s okay. What I am is recovering from a bout of major depression from last month, and hints of it still rear their ugly little heads. Fortunately, since I’m recovering, the better angels of my nature prevailed. That’s what happens when I’m a good state: self-criticism still arises, but the more logical part of myself quickly determines that most of those self-criticisms are crap.

If I give credence to all of those self-criticisms, though, my productivity plummets. Those criticisms suddenly don’t just originate from me; they originate from everybody. All of the membership thinks I’m an idiot for missing that obvious suggestion for the website (a suggestion, I’ll add, that was only sent to me and one other person, but far be it from my addled brain to bring in that fact). Everything I write is awful. I handle every staff interaction horribly, and the staff know it. I don’t do things quickly enough, and everyone notices. I don’t get enough done, and everyone again notices. The self-replicating cycle of criticism gets to the point where I’m only really comfortable doing the things I’m pretty sure that I can’t screw up: getting rid of unneeded items from the collection, going through donations, and getting the bills paid. I’m good at those things. Even I can’t screw them up too much. I hope I never, ever have to go through my rather involved evaluation process when I’m in this state; I’d be suggesting a demotion for myself.

These judgments aren’t based in reality. Everyone is not judging me as harshly as I am. My work isn’t as terrible as I think it is. If my work is suffering, it’s because of the negative feedback loop being created by my diseased mind that makes me scared to even try. As I further learn to recognize when I have valid criticisms of myself and when it’s the dysthymia talking, I’m coming to a better state of mind and a better approach to my work life. It’s proven much more challenging in my social life, but I’m working on that, too. Partly why I enjoy “Call and Answer” so much is it encapsulates many of my experiences into a mere four minutes. It encapsulates not only my tendency to crucify myself, but also my tendency to pick myself back up and keep going. And it’s that tendency that allows me to continue to succeed despite my illness.

I think it’s getting to the point
Where I can be myself again
I think it’s getting to the point
Where we have almost made amends
I think it’s the getting to the point
That is the hardest part

If you call, I will answer
And if you fall, I’ll pick you up
And if you court this disaster
I’ll point you home, I’ll point you home

The S word

I haven’t really talked about the S word other than in passing in my first post. And by “S word”, I do not mean the expletive but rather suicide. Many people are uncomfortable discussing mental illness, but bringing up suicide can bring entire conversations to a halt. Almost everyone to some degree can identify with aspects of depression; we’ve pretty much all had experiences in our lives that sent us to the depths of despair. However, few other than the mentally ill can identify with the idea wanting to kill yourself. To the degree that we are beholden to our genetics, it is a biological imperative to desire to live, which is why it takes pretty severe circumstances or a very high degree of mental perversion to even consider it. Most people have not met those conditions.

Dysthymia is often termed a “mild” depression, an adjective for which I don’t particularly care for a few reasons.

  1. “Mild” doesn’t really take dysthymia’s persistence into account. If you think of major depression and dysthymia like you’re carrying weights, major depression is like trying to carry an extremely heavy weight; it taxes your strength almost immediately. Dysthymia is more like carrying a pretty heavy weight, but carrying it for a prolonged period of time. In other words, both major depression and dysthymia can make you collapse, it’s just a matter of how long it takes.
  2. As my best friend likes to say, having an illness is not a fucking competition. The term “mild” implies something being not as serious, not as important, not as worthy of attention. Mental illnesses certainly have a degree of urgency; major depression is a much more urgent condition, as there is a more immediate risk for suicide. However, all mental illnesses are dangerous if left untreated. To my knowledge, we don’t have antibodies to fight off mental demons.
  3. Dysthymia can easily become major depression, a state known as double depression. As noted in point 1, if you’ve been carrying a heavy weight for a long time, you’re bound to collapse sometime if you don’t shed some of it. There’s a strong link between dysthymia and major depression, as noted by Harvard Medical School:

“More than half of people with dysthymia eventually have an episode of major depression, and about half of patients treated for major depression are suffering from this double depression. Many patients who recover partially from major depression also have milder symptoms that persist for years. This type of chronic depression is difficult to distinguish from dysthymia.”

This is a long-winded way of saying that, despite its generally low level of depression, dysthymia poses a suicide risk, too. This conclusion for the most part seems borne out by research.

I am not without suicide experience. I have never actually tried to commit suicide, but I ponder it often in my darker moments. Like many other depressed individuals, I know exactly how I would do it (slitting my wrists or, excepting that, drug overdose). Plans exist in my head for dealing with my affairs post-suicide: who would receive my meager assets, how would I make sure that my animals were taken care of, what things at work would I need to ensure someone else knew, where would I commit the act to ensure that my friends and loved ones wouldn’t be who found my body. I’d imagine this all sounds grisly and terrible to many people, but such thoughts are not uncommon among the depressed.

In my brighter times, the thought of suicide mystifies me. How could I ever consider suicide when I have such a great life and so many people who depend on me? Those specific plans I made while in the pits fade from my immediate memory. Even as I write this, though I’m having somewhat of a down day, I have no desire whatsoever to go to my grave. The brighter times also are when I protect myself against such thoughts. I do not keep razor blades in the house, nor do I sharpen my kitchen knives very finely. I do not keep large quantities of painkillers in the house, the lethal dosage amounts of which I am fully aware. Firearms are forbidden from my house. (The strong link between guns and suicide is yet another excellent reason to advocate for gun control with your legislators.) I make sure that I have social interactions at least once per day. The numbers for some particularly close friends are in my speed dial. Recently, I put the number for the National Suicide Prevention Lifeline on speed dial as well. The number is 800-273-8255. Please share it with anyone you think might be at risk.

There are a lot of reasons why I have never carried through with suicide. Recently, the most obvious reason is treatment. However, there are many others: the anguish that my friends and family would feel, the mess they’d need to clean up (despite my plans to get my affairs in order), the idea of saddling my mortgage onto my not-at-all-wealthy family.

However, in keeping with the overall theme of this blog, the major thing throughout my life that has prevented me from committing suicide is my work. The reasons above are good ones, but I guess somewhere in the back of my mind I always figured that friends and family would bounce back from my death. (I should mention that having a mortgage and significant other affairs to deal with are a relatively recent occurrence for me.) But my work was always an exception. I’ve always been deeply embedded in the places where I work. I wasn’t really indispensable; I don’t think anyone truly is. However, both others and I perceived me as such. There are always things that only I know, future plans that are only in my head, tasks at which I particularly excel. I don’t think I consciously withhold information from others; it just happens, as I imagine it does in any workplace. The thought of leaving my workplace in shambles, together with my aforementioned reasons, somehow kept me from really going through with it.

Notice that none of the reasons I mentioned have much to do with me or a sincere desire on my part to live for my own sake. That is why, to those who say that suicide is a selfish act, I say only this: fuck you. Fuck you and your ignorant judgment made with no attempt at understanding. While I can’t say they don’t exist, I have never met a depressed person who did not think of others constantly and who was not fully aware of the damage they’d leave in the wake of their suicide. The warped depressive mind is such that you truly think that both you and the rest of the world would be better off if you weren’t in it. You understand that you’ll likely hurt people, but you also think that they’ll get over it and lead better lives in your absence. Yes, this is completely illogical, but depression defies logic.

Since getting diagnosed and learning more about myself, I’ve become much better about succession planning at work and, to some degree, at home. I know this sounds strange, as it seems like I’m removing one of the reasons preventing me from committing suicide. However, I really think this is a sign that I’m in a better place. I now worry about dying in a car accident or falling off a cliff on a hike, leaving my coworkers, family, and friends high and dry. When in the depths of depression, I couldn’t care less if I die in an accident; I might actually welcome it, as it seems easier than killing myself. However, for me, with an actual desire to live came a respect for death. I realize that it could happen at any time without warning, and I want to make sure that the people I love and respect are left in the best possible position should that happen to me.

If you’ve read this far, I heartily thank you. I know that reading about suicide can be grueling and awful, particularly if you’ve lost loved ones to it. And if you’re inclined to worry about me due to the contents of this post, I greatly appreciate your concern but also assure you that you have little reason to fret. That I’m able to write about it so openly and (relatively) objectively shows that I am in a positive state of mind. Suicide is a specter that haunts the depressed constantly, but that doesn’t mean that the specter has to possess you. Its continual presence gives you even more incentive to seek treatment and to better your life.

The assholish observer

The holidays are stressful for everyone, but they can be particularly brutal for people with mental illness. I’m fortunate that the holidays have never been a particular trigger for me. However, as stresses mount and social situations become more frequent, I am provided an opportunity afterwards to reflect on the continuing ways mental illness affects my life. This holiday season, I was reminded of one of the more unpleasant effects.

I noted in a previous post that I’m a introvert, i.e. I refresh myself by being alone or with small groups of friends and loved ones. New Year’s is always an interesting time for me because it often involves going to some party with a whole lot of people I don’t know. I wouldn’t say that I get anxious necessarily – it’s highly unlikely that I have an anxiety disorder – but I nonetheless need to make sure that my batteries are charged properly before the heading out, something I did this year

This New Year’s, some friends and I went to some houses with lots of people I don’t know. Yes, houses plural. It was a “house pub crawl”, which I did not realize was a thing. Anyway, we ended the night at a very cramped house with a dance party going on and 25-30 people shoved into two not-terribly-large rooms, people of whom I knew exactly 3 (one whom I met that day). In other words, it was an introvert battery leech.

I was designated driver, a role I often serve because 1) I don’t particularly enjoy the sensation of being drunk and 2) I really shouldn’t be mixing all that much alcohol with my meds anyway. Being sober and starting to get overwhelmed, I ended up where I often do in such situations: standing somewhere out of the way as inconspicuously as possible. Despite my efforts, people nonetheless would interact with me, including my lovely friends checking up on me.

Meanwhile, back at the point, mental illness, this situation brought up one of the most long-lasting parts of my disorder. My mind since the onset of my dysthymia has always been able to split itself in two. One of those parts is just me in the moment, doing whatever. The other is the supposedly-rational observer me, the part of me that some depression researchers might think of as my brain engaging in “analytical rumination“. I don’t want to give the impression that I hear voices or anything, as that is definitely not the case (and, if true, would mean that I have even more problems). It’s more that my mind is operating on two tracks simultaneously, with thoughts from both tracks occasionally coming to the fore. That observer me is the part that judges, that criticizes, that tells me I’m not good enough and that I could be doing better. That other part of me is kind of an asshole, hence I christen him “assholish observer”.

When I was at the party, the assholish observer was telling me I was lame for not approaching people and talking with them, that I should have been dancing like other people, that I should have tried to talk more to the new friend I met that day, that I looked like an idiot standing alone, that my year had been unproductive and wasted, and that my new year would be similarly so. He berated me when I left a bit early, alone, to go on the long, cold trek back to pick up our vehicle, even though that was probably the best thing that I could have done to get some energy back.

I mentioned that my dysthymia primarily manifests as itself as an emotional dullness. Let me correct that. There are two emotions I feel quite acutely when in the throes of depression: shame and guilt. The assholish observer shames me. He tells me I’m a social moron, and, as if from a self-fulfilling prophecy, I often am. I become less confident in the social skills in which I’m already pretty damn unconfident. In addition to the emotional greyness, the assholish observer is another aspect of my illness that, taken by itself in limited quantities, isn’t too terrible. Taken as a continual life companion, he becomes toxic.

On my good days, my medication and other treatment keeps the assholish observer at bay. Somehow, even before I started getting treatment, I managed to keep him at bay; I wouldn’t be where I am today if I hadn’t. But when I’m weak or stressed or my batteries are running low, as on New Year’s, he comes back, more critical than ever. He’s my (non-violent) dark passenger, and he’s kind of an asshole.

Moments of lucidity

Oftentimes, I have moments. These moments arise because, I don’t know, I’m taking my medications regularly, I’m taking care of myself, the stars are properly aligned, whatever. These are my moments of lucidity, the times when I feel happy and “normal” and like I’m the “true” me. I know that I’ve used a few fuzzy terms there, but I really don’t know how better to describe these times. Sometimes these moments last hours, sometimes days, and sometimes, just sometimes, even months. Last week has been such a moment. Of course it had to happen during a short work week <sigh>.

Not surprisingly, these moments of lucidity are my most productive both at work and at home. So a question arises: how do I best use these productive moments, especially considering that I have no idea how long they might last? I can really use these moments to get a lot of great things done. They’re when I write grants to get cool things for the library. They’re when I plan and arrange neat projects. They’re when I catch up on my backlog of employee evaluations.

Screenshot of my inbox

I may find your views intriguing, but I really don’t need to be subscribed to any more newsletters.

On the other hand, my office and home are littered with half-completed projects begun during my good moments. Cases in point: the rooms in my house with only half of the wallpaper removed, the nearly 5,000 unread messages in my work inbox, the detritus of my plans for a big restoration project of the historic Hood River Library (now happily moving forward once more!), my poorly-maintained heirloom rose garden with plants older than my mother, the general state of my office (that just means that I “break free from tradition” and “produce fresh insights”, right?). I could go on, but I’ll spare you, and maybe spare myself any further guilt.

I don’t have a specific plan to harness these moments, admittedly, but I wish I could figure out a good way to do so. Even if my dysthymia is acting up, I have a decent sense for what I should prioritize at work. Make sure you get people paid. Ensure that the finances are on the up & up. Fix safety hazards immediately. Maintain the work face, even if it isn’t at full strength. Put the library on a positive path to achieve its strategic goals. I think I’m lucky in this respect, as I know that prioritization can be an issue for others with depression.

So basically what I end up doing in my moments of lucidity is jump into things with gusto, as much as I can healthfully muster, to take advantage of them. That’s when my inbox count drops precipitously and I get all those grant applications I’ve been thinking about out the door. Am I burning myself out more quickly by doing things this way? Probably. That habit could even make my worse dysthymic episodes arrive faster. But what else can I do? I know it’s trite to say, but I am truly my harshest critic; I’m pretty brutal on myself in my self-evaluations at work. I come pretty close to saying I suck on some matters where an objective observer might just say I need some work. Thus, when I’m at my best, I want to get my best work out. Along with my personal relationships – and because I’m childless by choice – my work is the legacy I leave. My moments of lucidity are what allow me to leave a decent one.