The Word I Have Stopped Using.

     A couple years ago, I decided to remove a word from my vocabulary. A simple 4-letter, 2-syllable word. I had found that I really do not need to say it to anyone, ever again. What is this word you at ask?

Busy.

     Our lives are filled with responsibilities. We have our daily/weekly to-do lists. Goals to meet. Schedules to attend to. Places to go and people to see. Facebook statuses is to update and Instagram photos to upload. Why wouldn't I use this word to describe my life as a response to the question "How are you?"  Sometimes it's out of a need to vent, or a call for some sympathy. 

    Then depression changed my thinking. If I needed help, and someone told me that they were, "busy," am I going to bother them with my struggles? They have their priorities, be it family, work, and home.  Maybe they have more struggles than I do. Maybe they are just trying to make it through the day just like I am. Are they going to have time to sit down with me to talk? Am I keeping them away from their family time?

    But my fear above all, was that I was going to become another burden to them. Will they worry about me on top of all of their other stresses? Am I being a "Debbie Downer" and bringing down their mood? Will I take up more of their time, especially when it could be used with their family? Will they utilize their own resources to help me out? Will additional stress hurt their health?  Am I being annoying? Am I sucking out their energy like an obnoxious parasite?  Some people may already feel like a burden to their loved ones, so they are stifling the urges to scream for help as an emotional riptide pulls them away. Their mind continues to silently crumble. 

     The fear of being a burden to others is one of the biggest reasons that people struggling with mental illness do not seek help and sometimes end their life entirely. It takes a great amount of courage and trust  to ask someone for help, but as soon as the response of "Busy," is registered in a person's mind, a metaphorical brick wall immediately pops up between them, and the suffering person is left to move along; feeling more alone this time, but at least they're not a "burden."

     So next time you are asked, "How are you?" think about the silent struggles the other person may be facing. They might be approaching you for help, and that is worth all of the time in the world. 

"Physician, Heal Thyself."

I was sitting with my new psychiatrist, driven by desperation after yet another medication failure and the intrusive thoughts that disturbed me.  My daily goal for the last few years were to: 1. Do my job,  and 2. Keep it together.  But it was getting more and more difficult to function. This was a psychiatrist that I had traveled four hours to see – making this appointment a literal “mental health day.”   One of the first things she said to me was, “You’re so lucky to be in the medical field, it’s so easy for you to get help!”

Uh, no.

I had to block off a whole day of appointments. When my colleague/supervisor/primary care provider asked me what my appointment was for, I just flatly said, “psych.” I couldn’t lie because – being in the military – we have an electronic medical record system that allows all  physicians, physician assistants, and nurse practitioners to see each other’s records.

I am a military medical provider, which complicates dealing with Major Depressive Disorder. There are some stigmas that I have to get over. Officer.  Female.  Medical  provider. Combat arms. No one wants to think that their depressed doc will “freak out” as they treat a shotgun wound or a mass casualty in a war zone, (I actually have an unusual ability to stay calm in extremely stressful situations).

I tried doing the casual request to my colleague of, “Hey, can you put me in for a refill?” He would go on to talk about “burnout” and would recall jokingly that during his residency that, “Yeah, I wondered what would happen if I just ran into this tree…” Then everything became about “burnout.”

 “Are you okay? Are you burned out?”  

It’s not burnout, I know the difference. I haven’t always been like this. Even when I was going through my medical training, other than the usual anxiety and bruised self-esteem, I never had to deal with this parasitic brain mold and the gradual corrosion of my mind. A brain that has been the source of intelligence, humor, and creativity was now my worst enemy as it was seeking to destroy me from the inside out.

It’s not just one colleague.  Mental health stigma and misconceptions exist among medical providers. I opened up to a couple of other colleagues why I could not pass a flight physical – my antidepressant  waiver was denied. They jokingly talked about their stress coping mechanisms -  usually a beer or two at the end of the day or an occasional tirade of profanity to “let it all out.”

A prior psychiatrist suggested that I added counseling to my treatment. This would lead to more records at risk of being seen by colleagues, so I pay out of pocket for online therapy .  Online therapy is actually a really good fit for me and my schedule.

Then there are those forms for licensing renewal   and credentialing that ask the question, “Have you been under the care of a physician for a mental illness?” Again, my records are open to the physicians of the credentialing staff of the hospital. You could imagine my anxiety when it seemed like my credentialing paperwork was taking longer than usual to process.

Medical providers are still human. We are some of the most resilient people on Earth but we are not invincible. “Physician, heal thyself,” can only go so  far.  We need understanding and compassion not only from our patients and families, but our colleagues and supervisors as well.

Clincal Depression: It's Not About Resiliency

     One of the things that irritates me about the stigma of clinical depression - that makes it even harder to seek help and open up to others - is when people misinterpret depression as a lack of resiliency or coping skills. It often gets confused with adjustment disorder and situational depression. I have seen this a lot.

     A couple years ago I submitted a waiver for an Army flight physical due to being on an antidepressant. I had to  pass this physical in order to qualify for some positions I was applying for  that could propel my career forward and likely guarantee me promotion.  It was rejected, though likely not even looked at as a couple people told me. The stinging comment at the end of the waiver denial statement was that I could apply again, "when the condition clears up."

     I have seen this stigma perpetuated amongst my colleagues, even when they are in the medical field. Some people in response shared their "coping mechanisms" of having a beer at the end of the day, or just being brutally honest, 'instead of keeping my feelings down inside' like my colleague said last week when I mentioned my waiver rejection.

     During my time in the military I have sat through dozens of hours of mandatory resiliency training - both in-person with large groups and  mandatory on-line training. One time it was directed towards medical providers, and the only thing my stressed out colleagues and I could think about was all of the work that we felt burdened with and the charting that we had to get back to. The focus on resiliency, while helpful to some, can be dangerous to those who suffer deep chemical imbalance, and this is why: It puts the focus on healing based on what someone is presumed to lack, and not what they truly need. This stigmatizes depression even more as a weakness, a sign of emotional immaturity, and a  character flaw.

     I consider myself a pretty resilient person. I had a challenging undergraduate degree and  I endured difficult medical training. I have treated victims of homicide and patients of failed attempted suicides.  I have deployed to Afghanistan in a volatile area. I have lived in another country that had at the time been recently affected by economic and political disaster, and I struggled to learn its language. I substitute taught high school. I have had a couple experiences where I could have nearly died. Someone once tried to rob me at gunpoint. My hands have been inside a person's chest more than once - desperately trying all attempts to save them from the inevitable.  I have traveled on my own to six different countries where English is not the primary language. I have ran multiple marathons and half-marathons. I have been to many funerals of friends and family who ranged from young children to young adults to the frail elderly.

I think I am a pretty resilient person;  but resiliency out of my own efforts could only do so much. The feeling of my brain decomposing  and the gravity of a  downward spiral cannot be changed with 'happy thoughts.' I believe in exercise, but it's difficult when it takes 15 minutes just to put on my shoes - if I even do get out of the house. Intrusive thoughts cannot always be calmed with a gratitude journal. Watching a comedy does not always bring back a laugh that has been silent for several months.

     There is a need of resiliency for  everyone, but  for those who struggle with clinical mental illness, sometimes it's just a Band-Aid on an amputated limb.

Leaving Gethsemane

       I reached the point during my last depression crash where I was desperate for some relief. My medication had not really been working for me anymore and I was already on the maximum dose. I was disturbed by some of the intrusive thoughts I was experiencing. I pushed myself - more like dragged- to open up about this with my psychologist colleague, asking for psychiatry consult. It was a  drag to the cliff and then a jump into the unknown. What I said was said. A new path of uncertainty, but possible hope, had just opened up.

     Just before my appointment I said to myself, "I'm ready to leave this Gethsemane."

     Gethsemane, referring to the Garden of Gethsemane, is the place where Jesus Christ prayed, taking upon him all of the sins and pains of the world. He too, asked for "the bitter cup" to be removed if possible.  Gethsemane has been a symbol of grief, suffering, and darkness in many Christian writings.  There's a hymn called, "Where Can I Turn for Peace?" by Emma Lou Thayne and there's a lyric that goes:

     "He answers privately. 
      Reaches my reaching
      In my Gethsemane, Savior and Friend."

I was ready to leave this dark, heavy place.

    One of the actual positive things to come out of depression is that I gained a better understanding of Christ's sacrifice. There is a scripture in the Book of Mormon that says,

"And He shall go forth, suffering pains and afflictions and temptations of every kind; and this that the word might be fulfilled which saith He will take upon him the pains and sicknesses of His people...and he will take upon Him their infirmities, that his bowels may be filled with mercy, according to the flesh, that he may know according to the flesh how to succor His people according to their infirmities." (Alma 7:11-12)

     Jesus Christ had to come to Earth, in a body capable of feeling pain, hunger, and fatigue, to be able to experience every possible feeling that had been felt and will be felt. I don't know how he did this,  especially in the culminating act of the night prior to His crucifixion. However, I did learn something about this.

     I, in my own way and through the past several years that I have struggled with depression, was able in an extremely small way to develop  a  more empathetic heart to the struggles of others. While I know that the choices of others may not be in alignment with human laws or divine commandments, I learned how Christ, in his infinite love, can feel what someone is going through, and love that person as the child of God that they are.

      I knew what it felt like to be frustrated with anhedonia (inability to feel emotion). I had this force field that would not allow any positive emotions to penetrate me. I missed laughing. I just wanted to feel something. One morning I  came to the realization that I could understand why some people addicted to drugs seek them out prior to it becoming a physical addiction. I remember thinking to myself, "Man, if only I could legally get high without ruining my career." Some people seek that physical high to be able to feel something they deem as positive, and sometimes they seek the refuge of drugs or alcohol to find calmness or to dull their pain.  I remember feeling such sympathy upon hearing about the suicide of Robin Williams, the struggle that he had with his mental health as he fought the devastating onset of dementia. I could relate to the feeling of losing one's mind - how scary that it is - and observe its progressive nature without a feeling of hope for recovery. I could find some similarity between myself and a woman who struggles with depression and makes poor decisions in regards to intimacy and morality.  They find someone who finds pleasure in their existence - in their body - when they themselves  struggle with finding pleasure in their own existence. Humility, empathy,  and love is what I learned. Seeing someone a little better through God's perspective - loving the child and not seeing them just for the choices they make. It's a hard price to learn such a lesson, but I find it as something positive  as a product of adversity.

     It was a short stroll through Gethsemane for me, but I know I will return again and again. It's the nature of chronic illness. I will return multiple times and sometimes I will be with someone as they walk through their own Gethsemane. Hopefully they will not have to walk that garden path alone.

Parasitic Brain Mold

     I have often compared my depression to what I call "a parasitic brain mold."  If someone asked me how I was honestly doing, I wish I could just say,"moldy."  Maybe it's because it needs some kind of physical form, at least metaphorical, that can explain the physical and psychological effects, and even more, have people see it as a real disease.

     In 2013, the majority of over 41,000 people in the United States died from a parasitic brain infection. This was almost 200 people less than those who died of breast cancer that same year.  Yet, there were no fundraisers, ribbons, or hardly any "Get Well Soon" cards. No journalist is trying to interview you for a human interest article, commending your bravery. Those who suffer with such infection sometimes "quarantine" themselves from their families, friends, and the rest of society.

     Parasitic brain mold spreads through all sections of the brain, causing a physical heaviness and sometimes irritation. The head is harder to hold up straight under its weight, it requires too much energy. Energy is what is being consumed by parasitic brain mold while the rest of the brain slowly deteriorates. It leaves the host exhausted, even zombie-like.   It's  not just about  a single organism, but a mini-ecosystem - like a petri dish. Other bacteria and single-celled feelings like apathy, irritability, inability to concentrate, and anxiety enjoy a symbiotic relationship with brain mold and often flourish in the darkness of the soul. Often, it serves as a barrier from positive feelings reaching my brain. Joy, amazement, peace, enthusiasm are all unable to penetrate the Gortex-strong mold. As the brain slowly deteriorates, so do cognitive functions. Movement becomes slower and activities of daily living take quadruple the amount of time to accomplish. Existence is hard.

     Many times I wished there was a metaphorical bleach that I could scrub my brain with  that would  dissolve and wipe away all of the grime. Brain mold does not  respond well to positive thinking, counting blessings, or even taking a vacation. Brain mold is sometimes perceived by others to be completely different from what it is. People might as well say that you are suffering from a case of Hobbits' Feet or an allergy to concrete, so the host gives up trying to explain.  The host may wonder even more what others think of their mold, and what they may do with such information.

     How would it be different if clinical depression and other mental disorders were viewed by society like the diseases that they are? We call people with other diseases, "survivors" and "fighters," but many people are trying to survive day by day, quietly, just struggling to function with the demands of their existence. And many do this alone.

     So if you suffer from parasitic brain mold, keep fighting! There are moments of remission ahead, despite the dampness and darkness that you my currently feel. I may even be able to share some bleach.

Soaked Socks

     Have you ever walked through the kitchen at night, wearing socks, and you somehow manage to find the puddle of a dropped piece of ice? Makes you cringe a little.

     Have you ever attempted to jump over a puddle or stream, only to not make it and have your entire foot get soaked? Walking with squishy, wet socks for the next few hours or the rest of the day can feel a bit uncomfortable.

     Now imagine it is dark and you can't see hardly anything, not even your own feet. You're walking through a wilderness and you notice all of a sudden your feet are wet. You don't know why, you just know they are now soaked and your uncomfortable, colder. Blisters will eventually develop as you feel gravel in your shoes. Your skin will feel  raw.  It may have just been a walk through a puddle, across a stream, or into a river. Or,  there may be a small leak in the cracked damn that is just about to burst and drown you.

     You don't know where this is taking you. It may just be a bad hour, a bad day, a bad week, or maybe you're about go downhill for the long-term or maybe permanently. You don't know; the only thing you know is that your socks are wet. You keep walking and you start getting ankle deep, waist, deep, chest deep in water. You are fighting against a current, moving in a direction that you  hope is right.  Each step requires an exhausting amount of energy. You hit some rocks and tree branches scratch at you. You swallow the turbid water, only to choke and cough. You feel like you are not getting anywhere. Your weakness has never become so apparent. Why not let the current just take you? You search for a light on the shore, just something that can orient you back into the right direction.

     Just one light.

     I have been blessed to find some lights, but I have still trudged through deep water over and over again, often getting progressively deeper until I am sometimes treading.
   
   This is my journey.