Category Archives: socializing

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.

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.

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.

The work face

Back in October, I read a Slate article about an amazing photography series called Dualities by Portland-based artist and instructor Liz Obert. The series explores how people with mental illness mask what they’re thinking and feeling from the outside world. To do this, she took two photos of each participant, one of how they present themselves to the world and the other as they are alone when in the throes of their illness. The images depict people in their homes, showing a concept likely very familiar to those with mental illness: our very different private and public personas, or “faces”, as I like to call them. The results are poignant and stunning.

Images of Jason from Liz Obert's series Dualities

Funny, my feline roommates are filthy and unemployed, too.

Obert’s project presents incredible visuals showing the different faces we show the world. In my experience, I have far more than just two faces. Like Obert’s subjects, I have a private face. I also have a social face, a work face, and the face I show only my dearest friends (which is probably the closest anyone will ever see to my private face). If I think about it longer, I could probably come up with even more. I’ve got a whole kabuki drama worth of faces.

My work face is probably the one I wear more than any other than my private face. It is wholly unlike any of the other faces that I wear. The work face is confident, even arrogant. It’s talkative, eager, and full of initiative. With my work face on, I present at conferences, I participate in tongue twister tournaments, and I even get interviewed for local television programs. These are things there’s not a ghost chance in hell you’d catch me doing in any other context. In social situations, I don’t even particularly enjoy being in photographs or hearing the sound of my own voice, let alone getting up in front of other people and doing things.

I’m a classic introvert. My batteries only recharge when I’m alone or with a small group of friends. The work face therefore requires a lot of energy for me to wear, kind of like Ryu’s dragon form in Breath of Fire. (Why yes, I am a nerd. Why do you ask?) This isn’t so much a function of my dysthymia as it my personality.

Everyone, not just those of us with mental illness, has multiple faces they present to the world. If you’ve ever worked a customer service job, you’ll know what I’m talking about. Still, the work face makes me wonder: how can I have exude such confidence and competence in one setting and completely lack them in another? In my worse moments, the very existence of the work face makes me question whether I have a mental illness at all. Part of the perniciousness of mental illness for many is that the illness, combined with the still-present social stigma about mental health, sometimes makes you question whether you’re truly sick. “You’re trying to pass off your deep character flaws as mental illness”, I sometimes think to myself. After all, the very existence of the work face shows that I’m clearly capable of being the things my mind tells me that I’m not. With the work face on, it seems like I can do anything.

To borrow from Dr. Seuss, though, except when I don’t, because sometimes I won’t. When I fall into a major depressive episode as I did recently, even the almighty work face loses its strength. It takes incidents like that to remind me that my different faces are just roles that I play, consuming my stockpiles of introvert energy as I wear them. One of dysthymia’s common symptoms is lack of energy. If I’ve been managing my dysthymia poorly, I lack the energy to do much of anything. When I have limited energy, I end up putting a lot of it into my work because my identity is so tied up in it. But that’s a discussion for another time.

The challenge I’ve set for my treatment is how do I get those faces to converge a bit? How can I get some of that initiative and eagerness when I’m not at work? As an introvert, I realize that my different faces will never completely converge, nor, quite frankly, should they. But some equalization surely would help me both privately and publicly.