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Category Archives: Self-Reflection

(Mental Health) How to Help Yourself

Myth 150If I could have readers leave the Desk at the end of the month with only one new piece of information, it’s that mental illnesses are actual, physical ailments in the brain. While the way we think and perceive has something to do with how the illnesses are expressed, the fact remains that most conditions come down to processes in the brain working in ways that cause significant suffering. For folks like me, these ailments are going to stick around for a while; that means one of the best things we can do for ourselves is develop coping mechanisms and routines that help us have as few bad days as possible. Now that I’ve talked at length about the conditions I have, I’d like to talk about a few of the things I’ve learned to do that help me most.

Before that, though, I do want to make a few disclaimers. First of all I’m not a licensed professional and none of the advice you find here should be taken as gospel; feel free to discard any or all of this if your psychiatrist or psychologist tells you different. Second, this shouldn’t be viewed as the equivalent of professional help. If you have (or think you have) a mental illness, the best course of action is seeking professional treatment if at all possible. Finally, taking these steps won’t guarantee that you’ll never have issues with your mental illness. I still have bad days and I still fall into depressive episodes myself. Hopefully, though, these can help shallow out the emotional valleys and make it easier to recover from them.

THE BORING STUFF

Sleep. Sleep has been the most important thing for me to get under control for my mental health. Back in college during my worst periods I had functionally no schedule for sleep; I would instead spend as much time as possible in my dorm’s computer labs seeking out some kind of human connection to make myself feel better. But the lack of consistent sleep made it so hard to regulate my emotions, pay attention in class, or absorb the day-to-day stresses that come with a full courseload.

While the exact function of sleep is not entirely understood, we do know that a number of important “brain maintenance” processes happen during rest. For those of us who have problems with brain function, a consistent sleep schedule is one of the easiest ways we can help our brain manage what it can. Our internal clocks are different, and for those of us working jobs with variable schedules or have some other function that doesn’t let us adopt a stable routine, it might not be possible to set a consistent bedtime for, say 10 PM – 6 AM. Do what you can, but do something; seven or eight hours of sleep a night are a must before just about anything else.

Diet. Again, I know that this is some loaded advice. There are so many folks who are simply unable to eat well because they can’t afford or find fresh produce, don’t have the time or will to cook for themselves, or have other legitimate reasons preventing them from making big changes to their diet. I get it; I’m not going to ask you to go vegan or only buy organic. But small changes to your diet that recenter focus on nutrients that help your body function better can be made. A good rule of thumb is the classic quote from food writer Michael Pollan: “Eat real food, not too much, mostly plants.”

At minimum, I’d recommend eating less salt, sugar and processed foods; drinking fewer sodas and juices (even diet and sugar-free versions); eating more lean meats and whole grains; drinking more water and tea. Most carb-heavy processed foods tend to convert into sugars within our bodies (at least, to my understandings) and the simpler or more processed the carb, the faster that process tends to be. In the United States we’re all about our processed carbs, and breaking away from them can feel like swimming upstream. It’s hard, I know. But if you can have fruits, vegetables and lean meats — have as much of them as possible.

Exercise. Exerting ourselves can often trigger the body into releasing dopamine, endocannibanoids and other chemicals that lift our mood, and the best part about exercise is that there’s a near-limitless variety of things we can do to work ourselves out. There’s weight training, sure; but there’s also running, sports like basketball or soccer, yoga or tai chi, cleaning the house, or walking along a favorite trail. In addition to the benefits of regular exercise, getting outdoors also helps our bodies to make Vitamin D (which helps build our bones and protects against cancer) as well as serotonin (one of those neurotransmitters I’ve been talking about).

Personally, I love running, but the spirit might move you to try something different. I understand how hard it can be to make time for regular exercise — I still struggle with it myself. But taking even ten minutes a day to walk around the block during the day can help lift your mood and give yourself more energy.

Getting more sleep, eating better food, and developing a regular exercise routine are all suggestions that any of us who’ve gotten professional help for our mental illnesses have heard time and time and time again — but there’s a reason for that. Taking care of our most basic needs is incredibly important. Not only does it help our body develop the tools it needs to manage the imbalances in our brain, but it also encourages us to change our relationship with ourselves. I’ve found that making sure I eat, sleep and move well helps me to think of myself as someone worth caring for and also helps to make me more sensitive to those needs. I have a better gauge for when I’m hungry, or really need sleep.

LESS BORING STUFF

Meditation. There are a lot of misconceptions about what meditation is, and that might be because everyone who practices it has a slightly different concept of what it is. In popular culture, meditation is the emptying of mind and communion with everything around you in the present moment; it’s an act of peaceful enlightenment that you have to do perfectly the first time you do it or you just can’t.

I’m here to tell you that meditation is messy and disorganized. I’ve meditated (almost) every day for seven years or so now, and most days are still a struggle against “monkey mind”. Meditation is not the mechanism we use to force ourselves into mindfulness and peace; it’s the mechanism we use to watch and accept our own thoughts as they arise.

When I sit on the meditation bench, I replay past arguments I’ve had with people; I think about the many mistakes I’ve made; depressed and obsessive thoughts pop up all the time. That’s completely fine — that’s what I’m on the bench for. However, so many of us believe that the thoughts or feelings we have are inherently bad and meditation is the way we rid ourselves of these thoughts. That’s not the case: these thoughts and feelings are natural, and it’s OK to accept that we have them. Acceptance of these difficult emotions and the thoughts they’re associated with is the first step we need to take in order to make peace with them.

Meditation as a daily practice allows us to gain better insights into the deeper layers within our thought process. We might notice, for example, that the same kinds of situations trigger a specific memory or regret; or we might notice that there’s a common thread in the things that make us angry or sad. If we accept this, we can then explore these insights with a gentle and compassionate curiosity. Perhaps, in time, we can even resolve the things that cause us suffering.

That definitely takes work, persistence, and faith in the process. But it’s been worth it to me. Due to my meditation practice, I have a much better understanding of when I’m in a depression or particularly rough bit of anxiety; that allows me to handle myself better when I’m in those spaces so I’m not as likely to do something that I’d later regret. That alone makes the depressions easier to deal with.

Making a care packet. One of the things that I like to do for myself when I’m feeling fairly well is making a “care package” for a future version of myself struggling through a bad depression or anxiety day. This can include one package of my favorite candy, a story or novel that I love, a playlist that lets me “lean in” to that feeling of sadness and turn it into a cathartic experience, or a Snuggie, or a really sweet letter or gift from a friend. Your mileage may vary with this, of course, but now that I can somewhat anticipate when I’m hitting a downward spiral I can look into the small things I’ve left myself to feel better and use them.

Of course, the things in your care packet don’t have to be physical objects: it could be permission to cancel a social engagement without feeling guilty, or a day to binge-watch a show in your pajamas. The main idea is to accept that there will be moments where despite your best efforts you hit a rough patch, and to do little things in advance that will help your future self ride out those times. In addition to giving yourself presents, it also helps retrain your brain to treat yourself a bit more kindly and to recognize that these “flare-ups” aren’t your fault. Sometimes they happen, and it’s important to be kind to yourself when they do.

Engage and learn. For most of us with mental illnesses, it can feel like we’re the only people who have this messed up thing where our brains lie to us about how the world works every once in a while. The terrible thoughts, the embarrassing emotions, the situations that are surprisingly common for those of us with deep depressive episodes — all of these can make us feel alienated and broken beyond the possibility of repair. The stigma that surrounds these illnesses can make it hard to open up about them, to share experiences even with other people we know going through the same thing.

That’s why learning as much as we can about our conditions and engaging with others who are also coping with them can be so important. The messed up things we do or think at our worst might be a fairly common experience; or we might, through the course of consoling a fellow sufferer, learn how to be gentler with ourselves dealing with a similar problem. There are a large number of online resources for depression, anxiety, and ADHD — even grouped by location, background, or lifestyle. The Internet is a wonderful gift here, in that it’s given us the capability to share our struggles in ways we’ve never been able to before. It might help knowing more about what you’re going through, and that you’re not the only one going through it.

These are some of the things that have helped me build better coping strategies and resilience against my mental illness. I sincerely hope they help a few of you out there, as well.

 

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(Mental Health) My Comorbidity

Myth 150One of the reasons it can be difficult to talk about mental illness is the simple fact that so many diagnoses feel poorly defined, or that just when our understanding of terms starts to stick in the public consciousness experts change the game on us, or that those of us with mental illnesses seem to collect diagnoses like Pokemon. Staying on top of the proper terms for mental illnesses or the latest consensus on what those illnesses even are can be frustrating and exhausting, and I get that. It’s even more difficult for us who are having to deal with it.

I’ve said this again and again, but one more time for the folks in the back: the brain is a tremendously complicated organ and our understanding of it is limited for a number of reasons. It can be really hard to know exactly what’s going on in there in real-time, or to concretely map activity in one area of the brain to a specific function. Even when an area of the brain or a neurotransmitter is isolated and understood, the interaction with other areas of the brain shade those known functions to a degree that it gets…murky knowing how one part of the brain influences another. Our ability to gather information about the brain directly is restricted — and rightfully so — by our ability to poke around within it and get feedback from the volunteer. And with something as subjective as personal experience, how can we assign a concrete, scientific measurement to self-reported data?

These are huge challenges that don’t have an easy solution, but scientists work hard to find every scrap of information they can. Through that work, we’ve come to understand a lot more about how the brain works and that’s resulted in a radical shift within the psychiatric disciplines. Filthy, poorly-run sanitariums are a thing of the past, and we now know mental illness affects large segments of the population who nonetheless manage their symptoms to lead productive lives. We have a range of treatments, from medication to talk therapy, that we can lean on to learn how.

Over the past several entries, I’ve talked about my personal experience with Major Depressive Disorder, Generalized Anxiety Disorder, and Attention Deficit Hyperactivity Disorder. Each one of these disorders affects my life in distinct ways, but together they interact with one another in ways that make it much easier to fall into a destructive loop. Comorbidity, in psychology, is the term we use for the presence of multiple disorders in one individual — but it’s also a term that points to the lack of concrete understanding for the underlying causes of many disorders.

Comorbidity frequently occurs because the cause of one disorder can also affect other aspects of the way our brain functions. For example, increased amygdala activity has been noted in individuals with both depression and anxiety disorders; it’s possible that what started out as an anxiety disorder became depression due to an individual’s experience struggling with one issue, or a lack of help, or the effects of anxiety disorder such as isolation, sleeplessness, poor diet and exercise.

Because of the way we classify mental illnesses, and the fact that it can often take a long time before a proper diagnosis is made AND proper treatment begins to take effect, it’s a fairly common thing for comorbidity to occur in those of us with mental health issues. Major Depressive Disorder, for example, is often the first diagnosis and subsequent ones are found through the course of treating it. I learned about my Generalized Anxiety Disorder and ADHD through talk therapy for my depression, when I spoke about my fear about stepping into a new position at my day job, my certainty that I would screw it up somehow.

I’ve thought a lot about the nature of my mental illness, why it’s happened to me. I’ve mentioned that my biological mother was diagnosed with paranoid schizophrenia when I was very young, and I only found out about it as a teenager. For years I was terrified that I would become schizophrenic too, that I would slowly and steadily lose my grip on reality over time. Living through the effects of that myself, and seeing how similar ailments like Alzheimer’s Disease and dementia affect a patient’s loved ones, that kind of progressive and incurable deterioration is still something that keeps me awake at night. The idea of losing myself to a disease that could make me hostile and cruel to the people I love the most is the scariest thing I could imagine for myself.

So I’ve done a lot of digging. I know now that the children of schizophrenics are genetically predisposed to other mental illnesses and yes, do have a higher chance of being schizophrenic themselves. It’s why I’m comfortable saying that my mental illnesses are largely biological; my brain is simply wired differently and that’s something I can’t help. But it’s not the only part of the story. Your environment and experience plays a tremendous role in whether or not these issues develop.

One of the big theories that I find really compelling is the idea of mental resilience — that the mind has variable success with bouncing back from traumatic experiences. If, like me, there’s a predisposition towards depression or anxiety, then these kinds of experiences make it much more likely for that to happen. Someone who is more neurotypical might be able to absorb that kind of trauma better and recover more quickly — again, that’s not guaranteed, but some might be better psychologically equipped to deal with really stressful times.

This is why it’s such a dick move to tell someone to “just get over it” if they’re struggling to recover from a bad experience. For some of us, it might be psychologically impossible to do that without help or a significant amount of time and effort. We might have the ability to absorb some stressors better than others as well, or we might have been marinating in a stew of stress for some time, barely keeping above it before something causes us to sink.

I know that in addition to my genetic predisposition, I’ve had a number of experiences that have knocked me flat. I was bullied almost constantly from elementary school to high school; my relationship with my mother was almost perfunctory; my sister ran away several times; my adoptive parents were divorced and my dad went missing five years later; I learned about my mother’s diagnosis; I was outed before I was ready and disowned by my mom; one of my first real relationships ended incredibly badly; I’ve been sexually molested multiple times; I lost my sister to an overdose. I’ve survived quite a lot, but it hasn’t been without significant consequences that I’m still dealing with to this day.

Despite that, I consider myself incredibly lucky. I’m in a community of wonderful, creative people who support me. I’m in a stable long-term relationship with an amazing man. I have health care that covers mental health services and makes prescriptions for medication affordable. I’m able to build an environment for myself that minimizes stress and allows me the space to find the best coping strategies that work for me.

So many family members, neighbors and friends from back home don’t have this. They’re still stuck in an environment that leaves them up to their necks in stress without the support network, mental health services, or cultural understanding they need to deal with that. Illnesses that could be resolved through therapy and lifestyle adjustments are left to progress, and they’re forced to do the best they can with little to no understanding. There’s no wonder to me that so many of my brothers and sisters turn to reckless behavior, drugs and alcohol, or even antisocial behavior to deal with everything that’s going on.

Mental health is a complicated subject that science is challenged by even under the best of circumstances. When you put the messiness of life on top of that, and the terrible sociopolitical situation we find ourselves in on top of THAT, it becomes clear that this is a big problem that will only get better if we make a concerted effort to address the things that block us from looking after ourselves. Mental illness is almost never just one thing. Sometimes it’s everything, at once, beyond our capacity to cope.

This is part of a month-long series about mental health for Mental Health Awareness Month. I’ve previously talked about my personal experience with depression, anxiety and ADHD; next week, I’d like to talk about ways those of us dealing with mental illness can help ourselves and how our friends and allies can help us in our efforts. If you’d like to know more about mental illness and what could be done to help the nearly 44 million Americans who are coping with them in any given year, visit the National Alliance on Mental Illness, the National Institute on Mental Health, and the American Foundation of Suicide Prevention. And finally, if you appreciate what I’m doing here feel free to buy me a Ko-Fi to keep writing.

 
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Posted by on May 16, 2018 in mental-health, Self-Reflection

 

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(Mental Health) My Executive Function

Myth 150Attention Deficit Hyperactivity Disorder is a bit of a misnomer; I think the name is a big reason why ADHD is so poorly understood and controversial as a mental illness. Those of us with the disorder aren’t necessarily hyperactive, and it isn’t always characterized by a deficit in attention. We aren’t bouncing off the walls from one thing to another, never able to finish a project because we have so much energy to burn off and no way to actually direct it. I mean, it’s partially true — but never in the way that people unfamiliar with the disease or its critics imagine it to be. ADHD is, like almost all other mental illnesses, a fairly complex disorder that can have a variety of expressions.

Also like so many other mental illnesses, the exact cause and nature of ADHD is poorly understood. However, there’s been a lot of research for it possibly because it’s such a controversial subject, with a number of scientists spearheading research to better classify it. We do know that ADHD expresses itself differently in children than it does in adults, primarily because undiagnosed children develop internalization mechanisms in order to “hide” symptoms, cope with them in increasingly complex social or professional environments, and attempt to deal with the lack of support or understanding for their difficulties.

We do know that ADHD is primarily a dysfunction of the parts of the brain that govern executive function, which leads to problems sustaining attention, being organized, and procrastinating. It affects planning, prioritization, time management, impulse control, decision making and mood regulation. In children, this can look like they’re incredibly hyperactive and impulsive, with a tendency to lash out and ignore instruction. In adults, this often looks like someone who is a ‘space cadet’ — lazy and unfocused with no capability of remembering the things they need to.

In any case, it’s generally accepted that the frontal lobes in the brain handle executive functioning. While there may be differences in the structure or volume of brain matter in this region, there might also be really hyperactive dopamine and norepinephrine reuptake mechanisms there. Since those neurotransmitters are very important for brain function in these regions, this can result in the neurons in that part of the brain working “sluggishly” because there simply aren’t enough chemicals within the synapses needed to promote enough electrical activity. This is why, paradoxically, stimulants like Adderall and Ritalin work so well. They increase the level of dopamine and adrenaline (epinephrine) in the brain. It’s also why folks with ADHD tend to seek out constant stimulation; it’s the brain trying hard to get its fix.

People with ADHD tend to have other mental illnesses, either as the direct result of the physical/chemical issues within the brain or due to the struggle to understand and cope with the illness. Depression and other mood disorders, anxiety disorder, low self-esteem and other issues all tend to pop up; I know for the longest time, before my diagnosis, I thought I was simply broken. I couldn’t make my brain do the things I know it needed to, and my focus would just slide off a task that I knew would require sustained, intense effort. This has been the case ever since I entered high school, to be honest — it was then that I realized I couldn’t simply coast through lessons, but I had never learned how to actually work for the consistently high grades I had gotten before. It was a pretty hard crash, and I never managed to recover from it.

For me, ADHD expresses itself in the form of intense procrastination on projects that I know will be difficult and require sustained focus, detailed effort and a lot of moving pieces. The kinds of stories I like to write are the worst for this, and I genuinely wish I could adopt a style closer to, say, Vonnegut or Douglas Adams or Charlie Jane Adams. But stories with tightly-written plots and thoughtful, nuanced takes on difficult themes often require great care, and I so badly want to make sure that I’m treating these subjects with the mindfulness they require. It’s been a great struggle to fight through a brain that simply doesn’t have the equipment to be as organized and detail-oriented as it needs to be.

It took me a long while to come to grips with the possibility that I had ADHD, mostly because of the stigma and controversy that exists in the media. There’s a steady diet of hot takes out there suggesting it’s a made-up disease, or that it’s especially overdiagnosed in children who are just being regular kids, or that drugs like Adderall and Ritalin are abused by people who are looking to stay up all night and crush that exam or work project.

There’s also a heavy stigma around the use of Adderall. Do you remember that (likely doctored) Calvin and Hobbes comic where Calvin is prescribed medication and it forces him to ignore Hobbes? I’m not going to lie, that scared the shit out of me — the thought that my ability to daydream, to be creative, would have to be sacrificed in order to be productive haunted me for a long time.

calvinhobbes

Seriously, this is nightmare fuel.

But now, of course, I know that’s a false dichotomy. ADHD actually hinders your ability to be creative; if you’re like me, you get hyperfocused on one aspect of the story and (because of my anxiety disorder) fall into a loop where you feel you need to rewrite again and again and again before you’re allowed to move on to the next aspect. Then, you get burned out or distracted and end up with three paragraphs that have been polished to within an inch of their lives.

Medication is absolutely a viable option for treating ADHD, especially in adults, but it’s only one avenue of treatment. Cognitive behavioral therapy (CBT) and other techniques are needed in order to unlearn all the bad habits that our own stumbling about to deal with our brains might have introduced. It can also give us a greater understanding of our individual challenges with ADHD and offer ways to cope with them.

Now that I know that my executive function is impaired and that makes it really difficult for me to stay on task, resist distractions, stay organized and deal with my impulses in a healthy manner, I’ve taken steps to address those. Developing routines that teach you how to consciously do what many others can do in their own heads has been a lifesaver; it’s how I make sure I take my medication, meditate, feed and water my rabbit; it’s how I make sure I’ve broken down projects into bite-sized chunks that I can actually handle one at a time; it’s how I make sure I write down just about everything I need to remember and keep on top of my to-do list. It’s still a struggle to get things done, but I’m no longer wondering why things are so hard or what’s wrong with me. There’s nothing “wrong” with me; my brain works differently from most and while that offers certain challenges it also opens up a lot of benefits too.

Hyper-focus, for example, is a tremendous tool. I know that if I’m emotionally invested in something or fascinated on a certain level it’s a lot easier for me to enter a state of flow where that’s all there is in the world. If I can find a way to access that feeling for a certain project, it’s much easier for me to devote a significant chunk of time to it. Learning how to be organized and mindful is also a strange fringe benefit, but it’s served me well. My Bullet Journal and I are super-best-friends, and the organization, mindfulness and productivity it has brought me feels so much sweeter because it’s been so hard won.

It’s also enabled me to recognize problems with executive function in other people. If someone can never seem to be on time, or forget things if they don’t write them down, or constantly misplace things, it doesn’t bother me nearly as much as it used to. Understanding myself and how I work allows me to be more compassionate towards the difficulties that other people face. It’s so very hard to be an adult, where it feels like you’re juggling balls and spinning plates all the time, and people only notice the kind of job you’re doing when something goes crashing to the ground. All of us are trying to keep too many things in our heads at once; it’s kind of a blessing to know how impossible this is and stop trying.

Symptoms and issues of ADHD can happen to anyone, but that doesn’t mean that ADHD isn’t a “real” illness. Multiple symptoms have to be present for a long time in order to be diagnosed, and medication can also have a weird ‘calming’ effect. For example, meditation and Adderall enables me to focus much more easily than I would be able to otherwise and I’m much more resilient against distractions.

If you think you might have ADHD — or even just an issue with your executive function — it’s best to learn more about how executive function works, what it looks like when that region of the brain isn’t working as expected, and schedule an appointment with your doctor to discuss the possibility. Even if it turns out you don’t have that diagnosis, there might be other issues or more information that might help you improve your focus, organization, and memory. Regardless of whether you’re neuro-typical or coping with a mental illness, proper nutrition, regular exercise and enough sleep are foundations for better mental health.

This post is a part of Mental Health Awareness Month; all month long I’m writing posts about my personal experience with mental illness, the stigma that prevents conversation and treatment, and bits of fiction that highlight these issues. If there’s a subject or aspect that I haven’t covered, please leave a comment!

 
 

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(Mental Health) My Anxiety

Myth 150When I was a little kid our family had an ancient brown Chrysler my mom called “Nellie”. I wasn’t sure if it was actually brown, or if the car was covered in that much rust, but Nellie was a formidable vehicle, a 20-foot land yacht with leather seats that gave you frostbite in the winter and third-degree burns in the summer. The space on the floor in front of the seats was so wide we actually sat there during long drives sometimes, watching the sky speed by through the windows. There are a lot of things about that car I miss, but I did not miss the joy-buzzer sound of its alarm system.

Nellie bleated about everything whether it was a problem or not: the oil gauge would light up even when she was half-full, and so did the gas. The temperature gauge was lit no matter what, so we just learned to ignore it. But the bane of my existence was the “door ajar” alarm, which would sound sometimes even when you just bumped the door with your elbow. Sometimes, during long trips, it would just buzz until we stopped and shut it again — and that wasn’t something a seven-year-old bookworm could do easily. Mom would turn up her Motown tape to try to drown out the noise, but really it just made it worse. Even today, “Ain’t Too Proud to Beg” just doesn’t sound right without that buzzy whine.

As ancient as she was, Nellie was a good car — even if her gauge system was completely shot. I think fondly of her these days because I identify with her so much; like her hypersensitive open door sensor, my anxiety trigger will go off for like, no reason.

I am one of about seven million Americans with Generalized Anxiety Disorder, a mental illness that is often found in people with Major Depressive Disorder. People who cope with GAD are natural-born worriers, with anxiety flaring up over just about anything. The anxiety is excessive for the given situation and many of us feel like we can’t control how much we worry. Symptoms often include a feeling of restlessness or edginess, difficulty with concentration or your mind going blank, muscle tension, difficulty with sleep, and/or being easily fatigued. That worry and accompanying symptoms have to be present for at least six months before diagnosis.

GAD is one of those disorders that develops gradually, so the typical age of diagnosis is right around 31. It affects women more often than men, though it’s not entirely clear why. In fact, not much is known about how GAD develops in general; the best guess is that combination of biological factors, family background, and life experiences — especially stressful ones.

In general, GAD is treated with cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), mindfulness training and/or medications like SSRIs (selective serotonin reuptake inhibitors, which prevent your brain from cleaning up free-floating serotonin in your synapses). Cognitive behavioral therapy helped me understand my anxiety disorder much more clearly, and gave me a good framework to deal with it.

I find it helpful to think of my emotions like the gauges and alerts on a car’s dashboard; when they light up, it’s my mind telling me that I need to pay attention to something. Happiness is basically Cruise Control; everything’s good, just keep doing what you’re doing and you’ll be fine. The temperature gauge warns me when I’m getting too hot and need to cool down; the gas gauge warns me when I’m hungry and so on. When the sensors are working properly, emotions are a useful way to bring mindful attention to a situation that might need to be changed. For those of us with mood disorders like depression or GAD, however, the sensors are over-sensitive and tend to light up when they really don’t need to.

Those of us with anxiety disorders tend to have trouble with uncertainty; what’s unknown is dangerous, and our minds tend to jump right into hypothetical catastrophes. So we try to plan or control as much as possible, getting out ahead of any situation that might arise. This can be put to good use in a lot of different ways when the anxiety is mild or even moderate; but when it tips into severe anxiety things get a lot harder.

My biggest stressors are failing at something I really want to be good at, forgetting to do something I’m supposed to, and disappointing someone. For the longest time I refused to move into a position that required more expertise at my day job because I knew in my heart I wouldn’t be able to do it — I’m not detail-oriented enough and the consequences of failure can be pretty high. I didn’t want to be the one person who couldn’t keep up and forced other members of my team to drop what they were doing to bail me out.

Deadlines are a nut I have never been able to crack, especially with writing. I stress about everything when working on a story, and all too often I get caught in a loop where I’ll get stuck on a single aspect of the process, revising again and again and again until I’m exhausted. As the deadline grows closer, that anxiety grows until it feels like I’m physically unable to concentrate on what I need to do: my monkey-brain leaps all over the place, or my mind simply goes blank and I can’t hold on to a thought. Almost always, I’ll freeze in the face of the deadline and watch the opportunity pass me by. Having never tried is almost a relief compared to the imagined hell of really going for it and failing completely.

While this kind of performance anxiety is fairly common, it’s not the reason GAD is so troublesome for me. Like Nellie’s constant open door buzzer, my worry is ever-present and all-consuming. I am in a near-constant state of fight or flight, ready to box any perceived threat or run screaming from it. Right now, as I type this, I’m worried about the following things: the possibility of marijuana addiction; the spectre of a progressively worse anxiety disorder that blossoms into a full blown obsessive-compulsive disorder; all of the people I haven’t spoken to in a while and what they think of me; the last work project I need to turn in; my Patreon; my Pathfinder game; countless other projects I’ve committed to and should be working on; my mother; my brother-in-law; my bank account; my new job; the possibility of dementia at an old age; Trump; Iran developing nuclear weapons; my rabbit; how this post will be received; how much I still need to do before bed; whether or not I’ll sleep well; how much I can get done tomorrow; my upcoming trip to Europe; the possibility of nuclear war or a terrorist attack; my weight; my libido; the length of this paragraph.

My mind gnaws over these worries all the time, from my first thoughts in the morning to those last troubled, fuzzy ones that pop up when I’m lying in bed. I’m constantly thinking about the things that could go wrong, the things that have gone wrong, what’s my fault and how bad it will be when the consequences are due. I’m not going to lie, it’s exhausting; whenever I find something that makes me more relaxed, it’s like discovering Narnia. People who can just wing it, or not care about what happens, are straight-up aliens to me.

But simply knowing that my brain has this hypersensitivity to stress helps me deal with that. It means that building a less stressful life is not just an idle dream; it’s a necessary component of self-care. I’m a bit more watchful for the symptoms of high anxiety, like unfocused near-panic just waiting for something to latch onto or the tendency to take a small annoyance and make it exhibit A for a major problem that we’re screwed if we don’t solve. And when I catch myself feeling overwhelmed, I know that I need to take a breath and a step back, then force myself to take things one step at a time.

Still, it’s a struggle. Knowing that my amygdala is intensely hyper-active doesn’t necessarily make the effects any easier to deal with, especially when they prevent you from doing so much. Anxiety frequently overwhelms the techniques learned through CBT because there’s no one thing that causes it; it really is an omni-present entity, a background static that makes it really easy to be thrown into a state of high anxiety and all that comes with it.

While I’ve been dealing with depression for long enough that I feel comfortable with the coping mechanisms I’ve developed for it, Generalized Anxiety Disorder has proven to be much more difficult to deal with. It prevents me from trying new things readily, or producing stories that I would want to show people. It makes it harder to be relaxed or confident; it affects my ability to be social. I wish it weren’t so, and I wish I had a better way of managing it, but that’s the way it is.

Over 40 million Americans — roughly 18% of the population — has some kind of anxiety disorder, whether it’s GAD, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, or a Specific Phobia. We are a very anxious country, and it shows. I think one of the best things we can do for ourselves and our neighbors, coworkers and fellow citizens suffering silently under this epidemic is foster an environment of safety and acceptance wherever we can, however we can. Making sure those of us who are anxious have concrete feedback that the consequences aren’t as bad as we fear for failure sure helps, but it also helps to ease the ‘background anxiety’ in our culture. That might be the most important thing we can do: removing fear from our lives and our communities as best we can.

This post is part of Mental Health Awareness Month; I’m writing to share my personal experience with my mental health and hopefully ease the stigma around the very real illnesses I and millions of other people cope with on a daily basis. If you’re interested in helping with this work, here are a few things you can do: support the National Alliance for Mental Illness; visit The Siwe Project, which aims to reduce the stigma of therapy and mental illness in the African diaspora; visit and support The Black Emotional and Mental Health Collective (BEAM); and, if you like, chip in a dollar or two through Ko-fi for the blog. I appreciate your support, no matter what form it takes.

 
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Posted by on May 9, 2018 in mental-health, Self-Reflection

 

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(Mental Health) My Depression

Myth 150Back when I was 14 or 15, my sister ran away from home for a month and it straight-up wrecked me. We had no idea where she was or if I would ever see her again, and it was the first time we had been apart for that length of time. Growing up, we were pretty close; she protected me from the neighborhood bullies because she was a little spitfire and I told her stories and made our meals when Mom was occupied. We had often made a game of running away together, planning our escape route and the best time to steal away; but this time, she left without me and I had never seen it coming. She was one of the only people I felt I could rely on.

During that month I was in a haze. I remember being even more quiet than usual, and it felt like I was moving and thinking through cotton — slow, muffled, distant. When I got home from school, I didn’t know what to do or what I had the energy for, so I would sit on the floor and stare at the back of the couch until it was time to go to bed. Looking back through decades of experience, I can say that was the first time I ever had an episode of major depression.

Major Depressive Disorder is a mental illness that affects over 200 million people worldwide; it can strike anyone at any time, but it tends to affect women more than men and first diagnosis frequently happens between 20 – 35 years old. Common symptoms include a persistent, inescapble low mood; anhedonia, or an inability to experience pleasure — even with things that you used to love; feelings of guilt and worthlessness; insomnia; fatigue; loss of appetite. There are a number of depression disorders, besides. Atypical Depression, for example, tends to manifest earlier and sufferers will respond to good news with an increased mood, but also eat more with low moods and tend to sleep more during episodes. People with atypical depression also have a very high sensitivity to social rejection.

There’s Persistent Depressive Disorder or dysthmia, a less-severe but chronic state of depression lasting for over two years. There’s Bipolar Disorder, where a depressive state “swings” into a normal mood or manic state. There’s Post-Partum Depression, in which a woman experiences a disabling episode of low mood after giving birth. There’s Seasonal Affective Disorder, where bouts of depression happen during a particular season. All of these conditions can cause real difficulties in the lives of people who are coping with them. They affect our ability to be consistent with our work, attentive in our relationships, resilient with our setbacks, content with our lives. These mood disorders make it hard for us to maintain an even perspective about ourselves and the world around us, even with treatment.

That’s because depression is a disease that affects the brain, the one organ we rely on to interpret all the stimuli we get everywhere else. Because the brain is so complicated we’re not entirely sure how depression is caused, but we do know there are several areas of the brain that tend to be affected. Neurotransmitters — the chemicals that stimulate brain activity and give us the ability to think, feel, and make connections — tend to have a harder time working in depressed people, and some areas of the brain are different. The hippocampus, the part of the brain responsible for long-term memory and recollection, tends to be smaller in depressed people; the amygdala, a group of structures associated with base emotions like fear, sadness, and arousal, tends to be more active as well. This combination, especially in depressed people, could explain why it’s easier for us to remember past events that are associated with intensely negative emotions while we tend to forget the things that counteract the internal narrative that preserves our low self-esteem.

Because depression can be caused by either having too few neurotransmitters, or having receptors that are too sensitive or not sensitive enough to them, or an overly-aggressive reuptake system that sweeps them our of our synapses, it’s difficult to say with any clarity which treatment works best; every one of us who deals with depression has a distinct mix of physical, neurological, genetic and environmental factors. Some of us that respond well to medication might have a lot of trouble with talk therapy, while some of us who can manage quite well with lifestyle changes and behavioral therapy might suffer intense side effects with medication. For most of us, some combination of therapy and medication often does the trick — though it can be a process finding the right therapist and/or medication. No one treatment is better than any other; the best treatment for your depression is the one that makes it more manageable for you.

Depression can manifest differently depending on your age, gender, environment and cultural background, but there are no hard and fast rules. Men tend to be more irritable or have trouble controlling anger; women might become more withdrawn; young people might become more reckless or less able to concentrate. It can be really difficult for Black Americans with depression to receive proper treatment for a host of reasons — we are often expected to “fight through” emotional pain, and the cultural stigma about mental illness is still fairly strong. There is a distrust of doctors, especially psychiatrists, and there is too little value placed on openly discussing our feelings. Beyond that, the dominant culture often misreads the expression of a mental illness and either misdiagnoses it or misses the diagnosis completely. While the field is just starting to take a culturally competent approach to mental health care, it still has a long way to go.

It can be easy to dismiss depression as an “imaginary” disease simply because the factors that determine its causes, diagnosis, and treatment are so complicated and can often feel subjective. I understand how it can look from the outside that those of us within the mental health space are just stumbling around in the dark, guessing at definitions and such. But just because something isn’t well-understood doesn’t mean it isn’t real; just because our understanding about something is fuzzy doesn’t mean that thing can’t be pinpointed exactly.

I’ve been dealing with depression for my entire life, and I’ve only recently been fortunate enough to have the ability for treatment. I’ve attempted suicide twice due to my depression, and I still fight through it every day in order to live the best life I can. I know that I’m more likely to have depression because I’m the child of a schizophrenic, and the hereditary link between that mental illness and offspring is well-established. I’ve seen every one of my siblings suffer with their own issues; I know one of my nephews will need to learn how to cope with it. These are facts.
My personal experience with depression has taught me a few things about how to relate to it. All the stuff they tell you about sleep, diet and exercise? Absolutely true, with perhaps sleep being the most important. Being active really does help, especially if it gets you outdoors and in the sun for some time. I can often feel when an ’emotional trough’ is coming on, because it becomes harder to concentrate and I find myself unable to be interested in things; when this happens, I can ‘prepare’ for what’s coming by making sure I focus more on self-care than productivity. It doesn’t stop it from happening, but it becomes easier to ride out.

Depression, for me, is intensely associated with self-worth. I become paralyzed by the idea that I have nothing worthwhile to say or that I can’t say anything in a way that engages or affects other people. I feel stupid and boring and permanently, unfixably broken. It becomes too much effort to do more and more basic things, and my world shrinks steadily because so much becomes unreachable. Cooking something to eat feels like an ordeal; talking to someone to explain how you feel is impossible; doing something for the joy of it feels pointless, and doing something productive feels inconceivable.

My worst spells have all heavily featured unchecked emotional eating (candy and salty chips in alternating waves), being unable to leave my bed or couch, and an overwhelming desire to just sleep forever. Being active, sticking to my routine, finding something to stimulate different parts of my brain — that’s something other people can do. I can’t. Sometimes, even breathing feels painful and exhausting. I need some kind of stimulation, like a TV show or music, but the stimulation doesn’t bring pleasure — just a reprieve from my own thoughts.

Thankfully, I haven’t had a really bad spell in about ten years thanks to Prozac and cognitive behavioral therapy. But I know that it’s unlikely I’ll be off medication at any point in the future, and I’ll need to constantly work on myself to develop better habits and coping strategies. For many others, depression can be a more-intense but less-chronic condition. Some of us have very long cycles that enable us to be fine for years before something knocks us back into that headspace. Some of us will have to wander in the wilderness for a very long time before we find a treatment that works for us.

No matter what, it’s important to remember that depression is a real illness and those of us who cope with it must do so with significant complications. We might not be able to put energy into practices and routines that would help our brain chemistry. We might not be able to afford proper treatment or medication. We might not have a support network to rely on for the things we need. We might have cultural barriers that prevent us from seeking the help we need or getting the proper treatment. It’s a hard enough illness on its own; combined with social, economic and environmental factors it can be that much harder to deal with.

So please, if you can, be easy with the people who are dealing with depression. Recognition and encouragement are vital to shift not only our perspectives, but the perspectives of those around us as well. People with depression aren’t hopeless or crazy; more likely, we’ve just never been given the chance to get the knowledge and help we need.

This is part of a series of post for Mental Health Awareness Month. For more information about what you can do to help build awareness for this often-neglected aspect of our personal health, go to this website: http://www.mentalhealthamerica.net/may.

 
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Posted by on May 7, 2018 in mental-health, Self-Reflection

 

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(Writing) A Writer’s May

Self Improvement 150The month of April was…not great for me as a writer. I didn’t make much progress on anything of note, though I *did* resume a long-dormant Pathfinder game that I’ll take as my big win. I could attribute the lack of writing to my day job, or family stress, or the general pressures of being an adult with obligations and such…but to be honest, the biggest reasons are fear and a lack of discipline. I didn’t write because writing has become this internal battle between my willpower and anxiety, and I’m just not mentally equipped to win that battle consistently.

It’s possible that I’m simply trying to do too much. In addition to an ultimate goal of three missives a week on this here Writing Desk, I’m trying to find a way to write consistently for my Patreon project, the Jackalope Serial Company; I’m working on a Pathfinder game that, at this point, is firmly mid-level and I’d like to take to level 20; I’m starting another Pathfinder game that aims to be more of a loose pick-up style campaign; I’m trying to write short stories for two anthologies that I’d love to be included in; I’ve been asked to contribute to other fandom projects and while I’ve said yes I have yet to take any concrete steps to do so. Then there’s the Udemy courses that aim to teach me more about blogging and tech, the Rosetta Stone course for French I’d like to get back to, SO MANY comics, books and short stories I want to read, the clarinet I want to practice, the cleaning and paring down of all my stuff I’d like to get to, the TV and movies I’d like to watch (and maybe review)…

I’m not sure that ADHD/anxiety is a big reason why I commit to so much and achieve so little, but it really can’t help. Because our executive function is compromised, it’s really difficult to set proper priorities and stick with them when we’ve been interrupted; splitting our attention just can’t happen, because we need to be rooted in one thing or else we go flying all over the place. That’s why off-loading your executive function to things like to-do lists and routines is so important; we have to find a way to make an instinctive internal process external and conscious.

I live and die by my Bullet Journal, though that has to be supplemented by other things like Todoist and Google Calendar to make sure I have an eye on deadlines. If I don’t make sure I have some place to put specific information, it’s pretty much gone — but even then, I can write down, say, a submission deadline for an anthology, but unless I take the time to break down the steps I need to take to actually GET to that submission AND make time for it in my schedule it’ll just sneak up on me and then I’m scrambling to meet a deadline. That kind of surprise triggers my anxiety disorder, which makes it more likely for me to just freeze up and watch the deadline go by.

Good project management practice can help with that, but building a project schedule can only do so much when you’re trying to juggle multiple projects at once. When it’s time to put pen to paper (or paws to keyboard in this case), it’s really hard to make productive use of my time. I know that my time with this project is limited, and my goal is…to just get it done. Not to have fun with it, not to engage with what I’m doing — if I’m being honest, most of the time I already have one eye out on the next thing I need to do. That ain’t no way to write.

So this month I’ll have to pull things back a bit and focus on fewer things that I can root myself well in. I have four big goals for this month — write for The Writing Desk consistently; resume regular updates for the Jackalope Serial Company; finish short stories for “The Rabbit Dies First” anthology as well as one other anthology.

Here at The Writing Desk, I’ll be focusing on Mental Health Awareness Month with posts about depression, anxiety and ADHD from my personal experience as well as the things that have helped me deal with them, or the things that I still need to work out. For the Jackalope Serial Company, I’ll be writing four “first issues” of various possible serials to see what folks take to, then continue on the most popular serial through June. With the short stories, I’ll devote as much time as I can to both of them once I’ve made sure the blog and Patreon are squared away.

I’ll also be working through my sky-high book stack as much as possible this month. I’ve got quite a lot of time off this month and I’ll be doing some international travel, so I’m fairly sure there’s a lot that I can knock out. Hopefully I’ll finish “Bluebird, Bluebird” by Attica Locke; “Steppenwolf” by Hermann Hesse; “Radical Acceptance” by Tara Brach; and “The Upward Spiral” by Alex Korb. If I can manage that, there should be a few good bits of reflection out of them.

So what’s your plan for May, writers? What’re you hoping to have finished by the time June rolls around?

 

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(Personal) My Sister, One Year Later

Myth 150

One year ago today, my sister died. My mother, my two nephews and their father were gathered in the conference room down the hall from her room in the hospital when we got the news — even though her heart was beating and she was breathing (with help), her brain hadn’t registered any activity for long enough that the presiding physician called time of death. Everyone cried. It was the first time I had hugged my Mom since I had come out to her. It was the first time I had ever hugged either of my nephews.

I rushed to Baltimore with the small hope that I would get to see my little sister alive one more time. It had been eighteen years; we spoke on the phone sporadically, but we hadn’t seen each other since I left home. The worst thing for me, at the time, was knowing that the last time I saw my sister was when I was being disowned. Between then and last year, she gave birth to four children, tried to take care of my difficult and increasingly frail mother, had a nervous breakdown. For the longest time she had been self-medicating for mental health issues, and in the end that’s what had brought us here.

I think about Teneka every day. I think about how hard it must have been to struggle against your own brain without a support network of people who understood and accepted what she was going through, who were committed to helping her find what she needed to get better. It could have been talk therapy, or cognitive behavioral techniques, or medication. It could have been changing her lifestyle so that she had room to take the time she needed to cope with everything on her plate. It could have been a community of people willing to give her help when she needed it without asking or judgement.

Instead, she was under a system that punished her for finding any way she could to ease her pain without giving her access to the tools she needed to do so in a healthy and sustainable way. The people around her dismissed very real issues she was having and encouraged her to do the very things that would make them worse. Her own mother took whatever help she offered and said it wasn’t good enough, accused her of being selfish and lazy and untrustworthy. My sister was a good woman who needed help, someone to orient her. But there was no way she could get that.

It breaks my heart, because my sister is part of a narrative that’s been used to blame black Americans for our problems since the end of slavery. The truth is, however, much more complicated. The immediate cause of her passing — what’s on her death certificate — is not the reason she died. The real reason is that we, as a civilization, are far more interested in judgement and punishment than compassion and assistance. Instead of recognizing the very real problems Teneka suffered under, we made her feel broken for not being able to cope with them.

Her experience isn’t uncommon. There are so many black women who have to shoulder extraordinary burdens — motherhood and everything that comes with it, often totally by themselves — while being told that they are wrong in every way. Our sisters don’t look the way they should; they don’t talk the way they should; they don’t act the way they should. Their names are wrong, their hair is wrong, their clothes and makeup are wrong. They’re hoes, or they’re stuck-up; they’re too angry and too loud, too ignorant, too dark, too ugly.

Misogynoir took my sister away from me. The stigma around mental health took my sister away from me. Our social inability to address the pain felt by our most vulnerable citizens while placing them under impossible stress took my sister away from me. I’m still grieving about that, because I’m reminded of it every day.

Remember this story about two women being racially profiled at an Applebee’s?

Or this story about a black woman detained by police on the tarmac because the police were called on her for no reason?

Or this story about a black woman being mistreated at a Waffle House and the police receiving no repercussions?

What about the responses Kelis received when she detailed the abuse she received at the hands of Nas?

What about what our sisters have suffered at the hands of powerful men like Bill Cosby and R. Kelly?

These are all stories that have been in the news for the past two weeks. If I started going into the recent and not-so-recent history of mistreatment of black women, we’d be here all day. If I started going into the institutional problems that prevent our sisters from getting the mental health treatment they needed, we’d be here all week.

I don’t want anyone else to feel trapped in a private and invisible hell the way my sister was. It’s so important for me to speak up about mental health because I know first-hand that not doing so literally kills people. We have to be better about this. The lives of our women depend on it.

Dr. Amber Thornton is a licensed black American psychologist who has devoted so much of her time to addressing the stigma of mental health in our communities while also advocating for better cultural competency within the professional psychological community. Her podcast, “A Different Perspective”, has invaluable information about depression, anxiety, and the black experience.

Journalist Imade Nibokun heads up the Depressed While Black Twitter and Tumblr pages, creating an online community of folks across the diaspora who have to deal with the personal struggle of depression and the social struggle of institutional racism at the same time.

The Black Mental Health Alliance is an organization of licensed black American mental health practitioners, activists and organizers dedicated to dealing with mental health issues on a personal, professional, and institutional level.

All of these people are doing much-needed work, helping our community see the problems we face clearly while adapting perspective and solutions built by institutions with little to no insight into how these problems manifest through our shared culture and history. On the anniversary of my sister’s death, I vow to support them and their work and I ask that you please do the same. I want my sister’s legacy to be one that spurred us into action, to finally address this blind spot within our own community.

I love you so much, Teneka. I’m so sorry that we failed you; I will work hard so that we fail far fewer people like you.

 
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Posted by on April 30, 2018 in mental-health, Politics, Self-Reflection

 

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