How Are You Being Treated?

 B"H

As I recover from the freeze, I am thinking about other people I know with mental health challenges.  One thing that stands out to me is how many people I know who are inadequately treated for their mental health.  Why do I say they are inadequately treated?  Because for some people I know, waking up filled with dread or with quiet despair or with anger about being here another day is standard.  That feeling is the primary thing between them and a productive, fulfilling life.  

I certainly didn't know that these unpleasant feelings can be considered depression.  They were just so normal.  After having been treated intensively for depression, I am still building my way out of that dread of the day.  But I see movement, which is how I define the difference between depression that is being treated and depression that is being inadequately treated.

For myself, it was possible to have two therapy sessions per week, plus medication, and still be inadequately treated.  I needed some serious retooling of my thoughts to make better progress away from my depression.  This came in the form of a "PHP" (Partial Hospitalization Program): six hours per day onsite, doing group work in Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Narrative Therapy, Art Therapy, Self-Esteem classes, Family Therapy, Shame Resilience Theory, Goal-Setting, Behavioral Activation, and more and more.  We re-wired my brain with a combination of insight and persistence.  Of course I still need to check and tend the wires regularly.  But I consider myself adequately treated now, because when I do the things I know how to do for depression, they work.  At my best, I can characterize my days as reasonably happy.  Some days are not my best.  But all in all, I'm ready to take on other challenges, like living a meaningful and productive life.  Depression no longer takes up all of my energy.

So I'm putting out a call for everyone who deals with a mental illness to consider: am I being treated adequately for this challenge?  Can I tell that I am making progress?  Do I have times when my illness doesn't define my mood?  If the answers are no, please ask your providers what more you can be doing to heal.

Be warned, though: getting adequate treatment may very well involve going into the parts of your mind you dislike most.  For me, this has meant feeling and acknowledging a vast amount of shame.  Most recently I uncovered that shame is actually attached to taking productive action.  Not handy.  And ever so embarrassing, because it comes from the notion that I am to be so "good" that I don't have to do anything.  If I must engage with the world, I feel I have failed.  If you've ever wondered how people who have privileged identities get so funny about just doing normal stuff, this is part of it.  I squirm greatly at taking effective action, because it is, according to my old beliefs, an admission of being not good.

I would be failing you if I didn't provide some amount of hope for this dismal situation, so here is how I deal with my old beliefs about shamefulness.  Articulating the answers to the following questions begins to help change the feelings.  We think differently about the situation, and it produces different emotions than before.

1. What is an opposite to my old belief that action means I'm a bad person?  

    --It's good to participate in the improvement of our world.

2. Is there any evidence that my old belief is true?

    --One of my parents used to take pride in my accomplishments so personally that it felt like I was irrelevant.  That was an experience of feeling bad/dismissed for having acted.  I also felt like a thief for feeling any pride in my accomplishment, once it became clear that the credit belonged to my parent.

3. Is there any evidence that the opposite could be true?

    --My grandmother was part of the generation that came of age in the 1920s, and truly believed in working for progress.  I respect her lifetime accomplishments.  My religion also specifies that working toward a better world is each of our individual concern.  Finally, there have been times in my teaching career and my dance career when I found out that what I did influenced someone in a very positive way.  The fact and the feeling of making a difference are phenomenal gifts!

4. What belief will serve me best?

  --Opposite belief wins!  It makes much more sense, and is true in my experience, that it is good to participate in the improvement of the world.  The original belief's arguments are less compelling.

If you are at a point of wondering whether it's worthwhile to seek further assistance with your mental health, please try this exercise.  My counselors call it "putting your thoughts on trial."  What belief has kept you from trying to get adequate care?  What is an opposite to that belief?  What evidence is there for your current belief?  What evidence is there for the opposite belief?  Which belief serves you better?

No exercise is a silver bullet, though exercises can be powerful.  If you find it would be best to adopt a new belief, but you can't do it right away, give yourself time.  Look for evidence to support your preferred belief from day to day.  Consider what you might do if you held the preferred belief.  No strings, just become aware of your options and your choices.  May a consciously-chosen future become yours.

Total Mess Does Not Begin To Describe Shame

 B"H

Three weeks ago, we had winter in Texas.  It lasted for just a few days, but it was notable because we not only lost power and water, but also had freezing temperatures for several days.  Managing without power and water is a hazard of living in hurricane country.  But usually the temperatures are more livable.

The loss of power seemed to drain me of power as well.  My routines, from showering to opening the fridge, were gone.  Our diets were gone -- we were eating dry food from the shelves only.  Work was gone, because no power means no access to what you were writing.  Most communication was gone, as we were conserving cell phone power in case of emergency.  

As we timed logs on the fire and estimated how many we could afford to share with other families, I gazed with trepidation at the reality of suburban survival without power and water.  It was chilling.  I mean, I was already chilly, so maybe I overestimate.  But my sense of being powerful and capable took a hard hit.

(Also, we solved the firewood rationing issue.  Rich braved the icy roads in his four wheel drive truck and bought several loads of wood to distribute to those who needed it.  Rich does not lose his sense of power so readily.  As long as he has a way to help someone, he feels capable of pursuing his G-d-given mission.)

For the next two weeks, long after the power and water came back, I struggled.  I coulda woulda done much better in a rural or wilderness survival situation.  But in a nice little neighborhood that lacks good supplies of branches, dry leaves, rocks, and stream water, I was stymied.  There is a great gap in my ability to survive, and help others survive.  We were okay this time, thank G-d.  Yet I was filled with guilt that echoed through my skull until I was good and depressed.

The thought of moving forward with my writing left me baffled.  I couldn't imagine having enough focus to proceed.  Just journaling?  Which helps me get out of depression?  That would involve looking inward, into the mess.  I spent some time looking at the blank page, but couldn't muster the gumption to articulate anything that was happening.  Take a walk?  I can make myself take it, but I don't have to inhale or enjoy it very much.  

The waves of dark grey depression and the resultant ebb of motivation kept coming.  At one point I remember, knowing that anything I could do would chip away at the depression, approaching a drying rack of dishes.  I looked at the dishes.  I looked at my hands.  I couldn't convince myself to move my hands.  I had hit a wall of shame so large that I felt I couldn't bear to make a mark on the world, not even by putting away dishes.

Brene Brown, a researcher here in Houston, works with shame.  She identified four steps that lead to greater "shame resilience."  As in, we may not get rid of our shame entirely, but we can bounce back faster.  Oh boy, do I want to bounce back faster.

1.) Recognize shame and the ways that you personally tend to feel ashamed

2.) Recognize the circumstances that triggered your feeling of shame this time

3.) Tell your shame stories to others, and give and receive empathy

4.) Take apart your reasons for feeling ashamed and reevaluate them

So now I see, in my case, that:

1.) My shame felt like being embarrassed to do anything.  I believed I should feel ashamed for being unprepared to take care of my people.   

2.) The shame was triggered by not knowing how to respond to a weather emergency, combined with the loss of my usual self-esteem reinforcement routines.   

3.) I'm telling the story now.  And finally,  

4.) I need to take a long look at the sense of desperation I have around protecting people under my care.  It probably comes from my desire as a kid to protect my little sister, but being unable to shield her from our parents' divorce and subsequent nuttiness.  It's not wrong to want to protect people, of course.  But to feel desperately bad about oneself for things beyond one's control -- that may be a bit much.

And now, let's open up the shame party.  Consider trying out the exercise above for yourself.  Feel free to share with me, or with a friendly, trustworthy person in your life.  I want to get better at ending shame, because I don't have three weeks to spare for shame-based depression.  Who's in?