Depression, etc.: How important is a diagnosis?

At my second therapy session three-ish years ago - right after Therapy Guy finished my intake questionnaire - I asked him what was wrong with me. I wanted a diagnosis. I'd already done my research and had narrowed down the possibilities, so I was quite prepared to handle whatever answer he gave.

"There is nothing wrong with you," he responded. 

Except that answer.

It pissed me off. A lot. How did he know? Had he lived inside my head for the past two decades? Nope. I knew something was not right. He simply didn't know me well enough. Because if he did, he would surely see that there was something very, very, very wrong.

Now that I am familiar with him and his compassionate, kind nature, I know that what he didn't mean was, You're making all this up. You're just some thirtysomething suburbanite with too much time on her hands, and you don't need to be here. Instead, what he meant was, You are perfectly fine and worthy just as you are - you just don't believe it yet. You may be struggling but you can make your life better. 

For a long time, he would give some version of the "There's nothing wrong with you" statement every time I asked him what my problem was. Even when I brought in journal entries that made me sound insane. Even when I cut myself. Even when I called him really late at night from two time zones away, crying into his voicemail. He always insisted that I was an acceptable person, deserving of concern and care, and that there was nothing innately wrong or bad about me.

Therapy Guy is not a big fan of the psychiatric diagnostic manual. He views it as a collection of symptoms ("experiences," he calls them) packaged in a variety of convenient ways. Patients in the mental health system are typically labeled with one of these "experience packages," even though everyone's set of experiences is unique, and even though the labels are often given for the primary purpose of appeasing insurance providers. That is why Therapy Guy doesn't deal with insurance companies, and why he treats the individual, not a diagnosis. I see what he means: looking at the diagnostic manual, I could probably give myself a whole slew of labels, and yet none of them would really fit exactly what I deal with.

On the other hand, his reluctance to offer a diagnosis has always bothered me a little, and when I finally did receive one from my psychiatrist early this year, it was kind of a relief. I deal with symptoms of depression. I deal with symptoms of PTSD. And while that doesn't mean I equate them with who I am or the change I am capable of, yes, it's really nice to have a framework of reference from which to work. (I now realize that Therapy Guy was already working within that general framework, so it's not as if I was totally off track in terms of trying to get better.) My psychiatrist's choice of antidepressant - Zoloft - was based on research indicating that it is effective for PTSD. That's why she picked it as a starting point for me. Pharmaceutically, it gave us a place to begin.

Moreover, it's nice to feel that I am not alone. When I hear someone say that they struggle with depression or PTSD, I know that even though our experiences aren't exactly the same, we share some common ground. I can relate to the challenge. It's comforting. The label - while limiting in some ways, and inadequate - creates a sense of community, and for people like me who often feel isolated and different, that sense of community is meaningful to me.

The important thing to realize about mental health diagnoses (as with many physical health diagnoses) is that they aren't necessarily permanent. Mental health is a fluid thing, and our personal choices play a big role in it. Most psychiatric conditions are treatable. Doesn't mean treatment is easy, but it's possible. So even though I was diagnosed with PTSD in February, I may not always have PTSD (there are many, many excellent treatments for PTSD; with enough time and support, people do recover). And even though I may have a genetic predisposition to depression, I may be able - with help and vigilance - to avoid the worst relapses. 

As Therapy Guy likes to say, People have an immense capacity for change.

Personal history of depression

These are thoughts after having read Going Public with Depression. It's a worthwhile article, as are the readings listed at the end of it.

"It is that absence of being able to envisage that you will ever be cheerful again. The absence of hope. That very deadened feeling, which is so very different from feeling sad. Sad hurts but it's a healthy feeling. It is a necessary thing to feel. Depression is very different.” - J.K. Rowling

The first time I experienced full-blown depression, I was 12 years old. I didn't know it was depression; I thought every preteen who'd just moved to a different state and started at a new school must feel that empty and catatonic. I figured it was part of the territory.

Problem was, it didn't go away. The events of my 6th through 8th grade years range from being nonexistent to fuzzy in my memory, but I can still remember the relentless hopelessness. Even now, I prefer to cast that feeling a peripheral glance; looking at it straight on is still like accidentally stepping into an open manhole.

I slept a lot after school, and when I wasn't sleeping, I was still exhausted. I cried, not that it did much in the way of dissipating my despair. I walked in the rain without an umbrella and didn't care about my wet clothes. I mesmerized and numbed myself by staring at chipped paint in the wall, knots in the wood of my closet door, and patterns in the linoleum of my bedroom floor. I ate and ate and gained weight. I threw things: Books. Clothes. Glass bowls. Whatever was handy. Using stress and work as welcome distractions, I focused on homework, youth group, art, and orchestra practice.  I threatened to kill myself, multiple times, though I couldn't figure out a foolproof way to do it. And I wrote. I saved all of those journals. They're now in a box in the upstairs closet. Sometimes I think about looking at them but, again, it's simply too difficult.

I hated the feeling, and I hated myself for not being able to get rid of it. I hated that no-one was helping me and that I didn't know how to ask for help. I hated myself for not being able to deal with it on my own, which I thought was the only way. I thought it was my problem, my responsibility, alone.

I grew up. I met my husband. We got married. We moved, and moved, and moved again. My life felt okay as long as we kept forging on. I was irritable a lot.  When things got bad, I'd comfort myself by selecting songs to play at my funeral. It always made me feel better somehow, and then life would swing upwards again.

Fast forward to pregnancy. I cried every day, usually in the afternoon. Every morning I'd wake up, hopeful that today will be different, and by 2 p.m. I was curled up on the bed. Sobbing. Hopeless. Losing myself. Not knowing why I was so sad.

Fast forward to two days after my son was born. I should have asked for help. I didn't. The midwife asked me how I was doing, emotionally. My son's pediatrician asked me how I was doing, emotionally. They told me about postpartum depression, how common it is, how treatable. But in my head I was thinking, "If I tell them the truth, they'll take my baby away. They'll see what I already know: I was not meant to be a mother." I was convinced of this. So I lied and said I was fine.

My son was small at birth to begin with, but because we couldn't get the breastfeeding thing down, he lost more than a full pound in his first week. We had to put him in preemie clothes. I still can't look at photos from that time: he was practically emaciated. The doctor told me I needed to supplement with formula. We did, and he gained a pound in two days. I felt like a failure anyway. I thought about leaving. My husband did a lot of the parenting those first two years. I did what I could, but mainly I concentrated on not drowning.

Then my son turned two, and started to talk and walk and display his personality, and things got better. I forced myself to control my emotions in front of him. But I was still angry a lot, and I swung wildly from sad to mad to happy to peaceful on a daily basis. So I found a therapist in an online directory and emailed him. I still vividly remember the reply in his voicemail message: "It sounds like you're stuck. I think I can help."

Fast forward to several months after I started graduate school. I loved school. I loved what I was doing. My son was healthy. Through therapy, I was developing an understanding of myself and coping skills. Yet I found myself self-harming. Killing myself was on my mind a lot. I didn't understand how I could look so normal, successful, and composed to everyone around me, and even to parts of myself, and yet have these horrible thoughts.

Finally, I started seeing a psychiatrist and taking anti-depressant medication. I was skeptical. I was terrified that nothing would work. But miraculously, within a few weeks, it did work. My life opened up. Nothing was different, and yet everything was different, and I knew that I couldn't have gotten to that point on my own.

If I had to place a bet, I'd bet a lot of money that I've not heard the last of Depression. I know from experience that even with the strong mental defenses I've built through a combination of exercise, therapy, meds, a great family, kind friends, and rewarding work, I am not immune. And yes, that scares me.

What I do know now is that I have support, and an action plan. I can tell my husband how I feel, and he will give me space or comfort, whatever I need. I can tell my psychiatrist, and she will tell me what my medical options are. I can tell my therapist, and he will see me - even at the last minute - and listen in the kind, nonjudgmental way that he does. He will remind me that the feeling won't last forever.

If all that fails, if I am still not safe, I know these people will do for me what I might not be able to do for myself and get me to a place where I can focus 100 percent on recuperating. It's not something I want to do, ever, but I've learned that there's no shame in being hospitalized for depression any more than there's shame for being hospitalized for a heart attack.

I don't focus on being "cured." I focus on managing these experiences, and preparing myself for when those experiences are particularly overwhelming. I am trying to let go on the good days and just bask in them.

One thing my therapist keeps reminding me of is that I am not alone. Other people experience this. A lot of other people. "But we don't talk about it. People hide it. No-one knows," I reply. "That's true," he'll say.

Why don't we talk about it? Is it because of the stigma attached? Maybe, though I truly think that's changing. Is it because other people might use that knowledge as a weapon? Perhaps. For me, though, I don't talk about it because I don't really have the words to explain what it's like. Depression is a lot like love in that words fail to describe its depth and nuances. It's as if we need something more than words to convey the experience. We use words to build bridges to one another. And because words fail me when I am depressed, I feel alone.

Looking back at 12-year-old me, I don't know how I survived that depression. I really don't. No episode since then has been as bad, maybe because that was the first time and I wasn't used to it, maybe because at no other time have I had so little support. I might feel like I don't have support, but in reality I do, and so long as the rational part of my brain can speak up long enough to shout "HELP," I know I have a way forward.

Mini-Vacation (Days 3 and 4): Feeling Off

My emotions are so roller coaster-like, even now that I am on an antidepressant and my moods don't fluctuate as wildly as they used to.

Yesterday and today, I struggled. I felt (feel) irritable, distant, spacey, annoyed at silly things, frustrated, unable to snap out of it... I want to be able to enjoy this getaway, but it's hard to do that when I'm overwhelmed.

I'm pretty sure that what has triggered these feelings is the book I've been reading. I thought maybe it could just be a fun, silly, frivolous, tantalizing thing to read. I should know better. Those topics and the explicit nature in which they are described are too close to home. Way too close. I knew I should put it down and walk away, and I didn't.

It's a lot like the times when I have self-harmed (something that's a bit hard to admit, and something I am working to avoid, but there it is). When I do it, it seems necessary. I think about it compulsively until I do it, and at that point it either feels good or I'm so blank that I feel nothing. At first it doesn't seem like a big deal. It's later - usually days later - that I start feeling like crap. At that point it's like a suffocating weight settles over my mind, and I have to ride it out until one day I wake up and it's no longer there.

So anyway. Reading this book was not a good idea. I'm trying to distract myself, and I'm hoping this panicked, strangling sensation will dissipate soon.