Emotional Intelligence, Mental Health, Self-care

The problem with not sitting down to write anything since some time in the last half of November is that, of course, I haven’t actually cracked open the tablet I use for such things since some time in the last half of November. Ergo, first thing this morning it was both (a) utterly out of go juice, and (b) way behind in installing operating system updates. Have you ever watched a device simultaneously try to recharge and update itself? Trust me when I say, it’s not pretty. In fact, from an impatient end-user perspective, it’s really fabulously frustrating.

So as I’m sitting in my favourite coffee shop, masticating my toasted bagel and ruminating into whatever coffee Tori poured for me this morning, forcing myself off the precipice of my own impatience, it occurs to me that this simple piece of electronica is reflecting back at me a valuable learning opportunity. Never mind that I hate being schooled by inanimate objects at the best of times, truthfully over the years I’ve learned to be open to “lessons from the universe” whenever, however, and from whomever (or whatever) they originate.

I’ve been sunk in a massive depression for a while, unveiled finally in late November by a series of confluent precipitating events (aka, “a bunch of shit crashed together and crushed me”). Since then, struggling to retain any degree of functionality has meant circling the wagons ’round, pulling in my boundaries, shutting down every gate and ingress to all comers, and just kind of hiding out, entirely to conserve near-depleted energy. In short, my internal batteries are entirely out of go juice.

Since early December, I’ve been trying to update the operating system: getting back to my own therapist at least biweekly, starting the game of Russian Roulette with antidepressants, making sure I spent the entirety of the holiday season sleeping as much as I could (which might even have been within spitting distance of as much sleep as I need), reintroducing massage therapy as a more frequent thing (the convenience of having the massage college with an excellent student clinic close by), and as of last week, getting back to my nightly meditation practice. I have a nebulous idea about attending to what and how I eat as the next step, and then at some point, trying to finagle an increase in movement back into my schedule.

It all sounds good, doesn’t it?

Now, imagine what it’s like trying to think about/plan, to implement, and then to SUSTAIN, all of this when, on top of normal day-to-day functionality, there is ZERO POWER in the batteries.

Like the tablet this morning: start an update, power cycle into a shutdown, leave the user wondering if the OS is going to boot up this time or if it needs a kick. Some days, you need to lean a little on the Power button; some days the power cycle reboots on its own, gets a little further into the next update process… and shuts down again. Lather, rinse, swear a lot, repeat.

This is, unfortunately, a really exquisite description of my life for the last several months, but particularly since the November crash. On the upside, I have been finding that it gives me a whole new metaphor for talking with clients about their own experiences of depression (especially those who have some experience with the cyclical frustrations of Reboot Hell). For some, a depressive cycle starts with a crash; things may have been going wrong in the OS for a whole, but as long as it wasn’t BADLY impacting functionality, we could ignore the slow downgrade until it crashed out completely–I don’t know for sure what the depression equivalent of the feared “Blue Screen of Death” is, but I’m betting there is one. For others, the slow cascade of fail is something they see yet cannot stop, even as they throw mitigating efforts at it along the way. The lucky ones are those who have some way of actually rebooting in mid-decline AND HAVE IT STICK. I aspire to be one of those people, even though I have zero idea what that actually entails.

The biggest challenge for deploying this kind of metaphor with high-functioners in particular is getting clients to realize that depression recovery isn’t just about the updates and reboot process, it’s about recognizing the dead battery aspect. Even many depressives who otherwise have no trouble recognizing their own lack of energy as a critical feature of depression, will struggle against the imposed limitations. The desire to push to be “happy” means that, like my poor tablet, any process of updating and rebooting is automatically hampered out of the starting gate because there just isn’t enough energy to do both the regular startup AND the additional implementation of updates. The hardline lesson of learning to live with depression, and I see this reiterated all of the place now, is learning to live WITH it like a recurring but perpetual illness. That means learning to accept that it comes with limitations and discomfort, much like anything from recurring cold sores to arthritis flares or MS relapses, will. It will come with the frustrations of watching your core operating system get stuck in a process you can’t clearly see into, and can’t do much about once the process kicks off. You can only sit by in frustration, waiting impatiently for the cycle to finish. Or you can learn to relax into it, do what you can around it, find other ways of doing what little you CAN find energy to manage. (I’ll give you two guesses which category I fall into, and the first guess doesn’t count.)

The stigma around depression prevents many of us from “being okay” with simply being depressed. Most of us work in situations that leave us feeling like we can’t afford to be physically sick, never mind mentally compromised or incapacitated. The pressure to just grit our teeth and get through depression is enormous… and depletive. Culturally we don’t have any good answers for how best to treat depression beyond recognizing it as a legitimate illness encroaching on epidemic proportions, even as mental health professionals grapple with the notions that depression’s causes are almost as numerous and varied as its manifestations and its impacts. (For example, even as we note that depression can run in families, we still have no surefire way of determining whether it’s a nature or nurture effect, genetic predisposition or learned coping strategy; how is it that I remained high-functioning for 18 months and still continued to work through and after a hardline crash, while my mother was rendered bedridden by her depression for long periods of time? Genetics? Situational necessity? Combinations of the two? Who knows?)

My only good answer remains, as frustrating to many as I’m sure it is: slow down. Realize you’re compromised, and will be for a while. If you can’t accept the limitations depression imposes, for whatever reasons, at least be realistic in your workarounds (see previous note, re: compromised functionality). Consider the fact that you may reach the point where you can EITHER recharge your batteries OR upgrade the operating system somewhow, but attempting both simultaneously may make things more complicated and frustrating than you mean them to be.

Sometimes all we can do is wait something out. Eventually one of the interminable reboots will hopefully get us back to the point where we can do something more like what we expect of ourselves. Be patient. It’s been my unfortunate lesson to learn that sometimes there’s nothing else for it but to hang on and ride the ride until it’s over and you can exit the damn thing safely.

Yeehaw… or something.

Emotional Intelligence, Mental Health, Self-care, Uncategorized

[This week’s post is by request. Yes, we take requests! Honestly, anything that gives me some direction more than fifteen seconds before I sit down at the keyboards with the first coffee of the creative day is welcome. Assuming it’s something I actually know something about, of course.]

When I talk about making starting the career change from Hired Pen in IT to Personal Improvement Sherpa, I often use the term, “I hit the wall” as part of the formal narrative explaining what happened. For me, there was probably a large chunk of undiagnosed and probably-not-even-recognized depression already in play, but the biggest factor behind the need to change course lay in a persistent and burgeoning case of burnout. The friend who requested some exploration of this topic is also grappling with something that feels like burnout but with the more pervasive sense that most would more likely associate with depression, in a “absolutely anti-motivated to do anything that is not absolutely mandatory” kind of way; they describe themselves as feeling neither sadness nor despair, nor are they unable to get out of bed. But they do feel “frozen”. There is still a sense of connection to joy and lightness in other aspects of life, but there is no energy to connect with the actions most commonly associated with creating joy and mirth.

Working with as many clients, and still having an exceptionally large number of friends working in IT, I can verify that there is a LOT of comorbidity between the symptoms of depression, burnout, and fatigue. It’s one of the major reasons why, when clients come in with a self-diagnosis of depression, I want to explore more of a general context for what’s happening in their lives to see if there are any systemic factors that might suggest more clearly the predominance of any one of these states.

“Depression is one of the most common mental illnesses, and it can be mild, moderate or serious. There are several different types of depression that can be recognised by different signs. Which symptoms of depression occur and how strong and frequent they are vary from person to person. People in any social or age group can be affected, both women and men. If someone has had at least two of the following symptoms for longer than two weeks, it might mean that they are depressed: deep sadness; listlessness; loss of interest in the things they usually care about.” – US National Library of Medicine

“Exhaustion is a normal reaction to stress, and not a sign of disease. So does burnout describe a set of symptoms that is more than a “normal” reaction to stress? And how is it different from other mental health problems?

Experts have not yet agreed on how to define burnout. And strictly speaking, there is no such diagnosis as “burnout.” This is unlike having “depression” diagnosed, for example, which is a widely accepted and well-studied condition. That is not the case with burnout. Some experts think that other conditions are behind being “burned out” – such as depression or an anxiety disorder. Physical illnesses may also cause burnout-like symptoms. Being diagnosed with “burnout” too soon might then mean that the real problems aren’t identified and treated appropriately.” — US National Library of Medicine

Fatigue as a general symptom runs through a lot of these kinds of conditions, running the gamut from “I’m a little tired today but I can push through it” to “it’s a Blanket Forts Against the World kind of day”. Fatigue’s commonality is also one of the factors that makes it more difficult to differentiate between situational burnout and deeper depression, because fatigue is a profound thief. So when we’re talking in session about what’s going on, we explore the presence and perceived impacts of fatigue: how long has it been going on, how often does it impact functionality, what else is occurring in the subject’s life that contributes to exorbitant and draining stress? What aspects of their lives DON’T currently feel like a drain on their personal energy resources? What restores them?

From there we look for burnout symptoms: what are the high-demand attention drains currently (or recently) impacting the subject’s life and energy levels? Where is the balance with self-care and/or external support? How much of their day is being dedicated to these high-demand pursuits, and over what length of time? What other aspects of their lives still provoke joy, delight, mirth, wonder, passion, even if at lowered levels than constitute their normal baselines? The likelihood of burnout being the dominant effect rather than depression is often tied to these discernible draining factors over an undefined-but-probably-extensive-or-ongoing period of time. Without such key indicators as work stress, family stress, personal health stress, etc., we consider the scales tipping more in favour of depression. We also look at bigger systemic factors including family histories around mental health issues/Family of Origin relational modeling/parental alcohol or drug abuse, etc. when looking for indicators of depression.

And finally, we ask the question, “As difficult as it might be to imagine right now, if we took away the fatigue, what kinds of feelings would be left?” Self-reporting clients have, at least in my experience, been clear to indicate whether they expect themselves to “bounce back” and be right as rain again, or whether the nihilistic disengagement from the world would still be a part of the picture. (Self-reporting measures are generally problematic at best, but lacking a verifiable clinical diagnosis for depression, as counsellors and psychotherapists, we operate largely at the mercy of what our clients tell us.) The clients’ own hopefulness about their potential future state provides at least some degree of useful information, and can often gives us a platform (however small) on which to start building that sense of hope into some sustainable, hopefully realistic faith in change and progress. Clients stuck in depression often cannot connect with hope; hopelessness is one of the most common lies depression tells us. But burnout, while it may not allow for significant enthusiasm about the future, doesn’t completeley dismiss it so much as waves a hand at anything hopeful and begs, “Come back later, please”.

Typically, burnout is the result of specific and identifiable stressors like occupational burnout, persistent relationships stresses, or ongoing/long-term care practices for ailing or high-demand family members, for example. When facing burnout we look at rebalancing self-care practices in the short term, sometimes involving very deep conversations about the willing (often repetitive) sacrifice of self-care in pursuit of project deadlines or the drive to care-take others. We discuss the values keeping clients potentially stuck in these kinds of patterns, a conversation that comes up a LOT with driven professionals. Often we have to normalize the fact that corporate mindsets and project management pay a degree of lip service to the nebulous “work/life balance”, then expect the superhuman in terms of commitment to near-impossible project deliverable dates. And in the case of those who persist in “taking on too much” and deliberately, repeatedly pushing themselves into burnout states, we have some conversations around what’s their return on investment that makes doing this to themselves over and over, worth the costs of the pattern?

With depression, the work is more complicated, and may often necessitate conversations about clinical diagnostics (that psychotherapists are, unfortunately, not trained to do) and/or medications to help level out the worst of the symptoms. Because the depression may not be cognitive, it’s harder to shape a therapeutic conversation around motivations, and we may have to work more fundamentally with the bodily experience of depression, up to and including normalizing it as a chronic persistent or recurrent medical condition like diabetes, arthritis, MS, and others. We change how we consciously relate to the presence and impact of the illness when we can’t shift the illness itself in significant ways.

We can do the same with burnout, but burnout needn’t be a persistent issue for people so it’s sometimes less effective to treat it as a persisting condition (though it can be argued that project cycles increase the likelihood of it being recurrent). When burnout becomes a cyclical factor in someone’s life especially, we could really use some increased self-observation to watch for markers of this state sliding into depression. A pervasive sense of inescapability can shift a mindset from the hopeful, “light at the end of the tunnel” coping mechanism to a fatalistic sense that “it will never be any different or any better than this, so why bother?” Losing hope is fundamentally damaging to our mental health:

“Life is never made unbearable by circumstances, but only by lack of meaning and purpose.” ― Viktor E. Frankl

Burnout can leave us with purpose but no energy to engage without a period of recovery and restoration; depression leaves us feeling devoid of meaning or purpose. And fatigue is the river that runs through both states. How we treat any of this depends on our abilities to differentiate between these conditions, and how willingly our subjects can still feel any connection, however tenuous, to hope.

Mental Health, self-perception

Something I’ve been thinking about lately:

About a week ago, I was speaking with a client about depression, exploring “the lies that depression tells us”. It’s a standard externalizing narrative framework clinicians use to help clients put a little emotional distance between themselves and whatever’s afflicting them; it’s an approach that works for a lot of different things. But I made a mental note in the back of my head that in my own mind, something had started to ring a little hollowly around that particular narrative construct (not for the client; the client ran with the externalization like it was tailored for them). It’s taken me most of the week to figure out what the mischord is. When we talk about depression and “the lies it tells us’, the implication is there’s something inside us that whispers or talks to us and fills us with narratives that are neither helpful nor healthy. This implies that depression functions as a cognitive process, operating in the part of the brain where language and thought processing occurs. When clients respond well to the idea that “depression lies” or tells us things about ourselves, we’re operating in the cognitive realm. We define the cognitive realm this way:

This domain includes content knowledge and the development of intellectual skills. This includes the recall or recognition of specific facts and concepts that serve developing intellectual abilities and skills. There are six major categories, starting from the simplest behavior (recalling facts) to the most complex (Evaluation)
http://serc.carleton.edu/introgeo/assessment/domains.html

I absolutely believe that this definition of depression as a cognitive dysfunction (with all its standard attendant physical byproducts and related chemical imbalance) rings true for a very great many sufferers.

It is most decidedly not, however, true for me. My depression doesn’t talk to me, and I’m increasingly certain it never has. And the more I work with other depression sufferers, the more convinced I am that there’s an entire constituency for whom there is no (or no signficant) cognitive aspect to the their depression at all. For example, my depression says nothing to me about my worth or value. It says nothing to me about my happiness or misery, nothing about the value of doing anything I would normally do, energy I would normally expend. I increasingly suspect that part of the reason why I failed to recognize depression in myself for what it is for as long as I have is precisely BECAUSE the entire internal “demon narrative” has been conspicuously absent. This suggests some forms of depression might operate predominantly, perhaps exclusively, in an affective state, manifesting physically and exclusively without the cognitive narrations::

The Affective domain includes feelings, values, appreciation, enthusiasms, motivations, and attitudes.
http://serc.carleton.edu/introgeo/assessment/domains.html

What I get is something like a gravity well; a thing I fall into in which the weight on my mind and body just increases until I have no tolerance, no strength to move past it. Emotionally I still feel happiness and joy, though muted; I still feel engagement. I’m still reasonably high-functioning, though compromised in scope and sustainability. It’s like something sits on my chest and weighs me down. It can be hard to breathe sometimes, it’s definitely nigh-unto-impossible to move. It’s easier to just stay still, or better yet, just sleep. There’s no judgment, no scripted storyline about what it means; I don’t know if it was always like that. I know I beat myself up fairly heavily the first spring I failed to get back to walking like I had been the previous fall, but that failure and self-recrimination narrative was as much disappointment over lost momentum and gear investment costs as it was anything else. All things considered, it was easy to let go of that cognitive process once I figured out what was going on.

My depression doesn’t talk to me, and I don’t talk to it. At the deepest points of the gravity well, it doesn’t whisper to me to kill myself, that the world would be better without me or that no-one would notice. I actually like my life; I have a mostly-healthy connection with my world and the place I have made for myself within it — not without challenges, but hey, I’m still human. At the deepest points, where people start to have urgent conversations about suicidal ideation, the sensation has been more what I imagine drowning swimmers eventually reach when they are too tired to keep struggling up past the weight of the water to the air, too tired to keep pushing their own waterlogged bodies to draw in breath, and they just… succumb. There’s the instinctive urge to breathe and stay alive, but eventually we can’t keep fighting against the weight and resistance of the surrounding elements. It seems to me that there’s not a lot of internal narrative in those moments, beyond “so tired” and “just let go”. I’m reasonably certain the only thing that pulled me through those times was the utterly unconscious, instinctive urge to keep breathing. In those moments it’s not so much that one consciously care much about living or dying; we can’t battle the weight any more, but autonomous bodily functions keep going. It occurs to me, this is likely where a big part of the mantra that has been a core operating principle for the last five years is rooted: “One day at a time, one breath at a time; one foot in front of the other.” Think no further ahead than the next breath; there isn’t enough energy to invest in speculating any further ahead than that.

A clinician friend in Boston this morning pointed me to the works of Edwin Shneidman, an American psychologist and author who wrote extensively on his work with the suicidal mind. Specifically, she was correlating my thoughts on depression as a predominantly non-cognitive, felt experience rather than a mental, narrative one, with Shneidman’s description of suicidality as a “psychache”, language that I suspect may resonate strongly with affective depression sufferers (even those nowhere near the point of suicidal ideation):

“As I near the end of my career in suicidology, I think I can now say what has been on my mind in as few as five words: Suicide is caused by psychache (sik-ak; two syllables). Psychache refers to the hurt, anguish, soreness, aching, psychological pain in the psyche, the mind. It is intrinsically psychological – the pain of excessively felt shame, or guilt, or humiliation, or whatever. When it occurs, its reality is introspectively undeniable. Suicide occurs when the psychache is deemed by that person to be unbearable. This means that suicide also has to do with different individual thresholds for enduring psychological pain.”
(Shneidman, 1985, 1992a).

Looked at through this lens, we have the option now of language that supports exploring depression as a form of psychache, one with a scope of tolerance for enduring the affective or physiological experience, and how the client is able to function within the threshold of that experience. For clients who get frustrated by trying to use cognitive, narrative process to relate to their depressive experience, we can instead use bodywork language from the likes of Eugene Gendlin or Bessel van der Kolk (whose groundbreaking work on bodily retention of traumatic experiences is a go-to resource for many clinicians). This affective approach also opens up the options of a dialogue with clients around other physiological variables that can impact the physical and affective states. Western psychology sometimes skirts the edge of this holistic understanding when we press clients to consider their sleep/diet/exercise (any energy expenditure) habits in light of their depression, but often stops short of giving legitimacy to depression as potentially being a *wholly* affective state for some people. (The more I recognize this in myself, the easier it becomes to see this as an option for other depressive clients).

So now we can observe when the default cognitive “depression narrative” approach seems to sit badly with clients and others, and offer them this as an alternative to consider. Humans are narrators and interpreters and story-tellers by design, but I think sometimes the words actively get in the way of simply being *IN* an experience, especially if the experience itself is frightening in some way. If we can describe an experience–if we can safely box it up in words and interpreted meanings–then we feel we understand it. We feel we have a handle on it… we feel we have, in that handle, some measure of control, however slim. And therein we find comfort. We’ll invent entire mythologies simply because we experience fear when we don’t know why the sky flashes and rumbles at us.

Sometimes a cognitive, narrative *isn’t* the right approach. Sometimes it *doesn’t* encapsulate the experience. Sometimes it actually distances us from it. Recognizing the physical experience of my depression this week was a massive shift for me. There is no internal discussion or discourse, no whispered threats or seductive emanations. There is simply a force of gravity that is very localized; some days I function at Standard Earth Gravity, and sometimes I am flattened by Jovian Pressure so forceful it feels like it would be easier to stop breathing completely than expand my lungs against my crushing ribs one more time.

Even those words don’t capture the experience. Those are words and narrative elements that only fill in the blanks after the fact, for the most part, when I’m having to describe the experience to someone outside my own head. Most times, it never gets past the sensation of just stopping, letting my eyes close where I sit or lie, and letting sleep take me the rest of the way down into the pressurized deeps of that gravity well.

Now at least I have language to explore that with others as well. See? Even clinicians can learn new (and hopefully useful!) things.