A Piece of Should

If you'd asked me a few weeks ago if I was depressed, I would have said "Oh, no. I have a lot of anxiety, but I'm not really depressed." I would have said that because, to me, "depression" was staying in bed for 12-16 hours at a time for weeks, loving the rain and winter because the dreary washed out gray mercifully made the world look the way I felt, and spending most of my free time on weekends researching suicide methods. Fortunately, that is no longer the case.

But I'm beginning to realize that I really am depressed. I'm pretty high functioning, but nevertheless I am depressed. And at the core of the depression, when I really get right down to it, is an unrelenting stream of "shoulds" so integrated into my sense of self that I don't even notice them (you should be better should be smarter should be faster shouldn't make mistakes should be happier should eat better should exercise more should have better work habits should shouldshouldshouldshould)

[I've heard other counselors aptly refer to this as "shoulding all of yourself."]

"Should" is a weird concept. It's pretty much the superego personified in word form. It's a sense of responsibility or obligation instilled from the outside. It's contrasted with "want." That's the id. It's desire, zest, joie de vivre.

Far too often, "want" conflicts with "should." Some "should" is probably a good thing. Much of Freud's theory of the subconscious centers around the idea that socialization happens when parents/society tell a child "no" (and because it's Freud, this is often surrounding sex/toilet training). The child starts to internalize those voices and gradually learns how to regulate themselves to fit in with the rest of society on their own.

And sometimes, that can be pretty great. But for me, I've internalized so much that I've lost touch with what I want. To various extents, it's made me a pretty responsible and conscientious person. But it's also left me pretty unhappy most of the time, too.

But one of the reasons I really like existentialism is because it basically says that we get to decide who/how we are in the world. There are limits on that, certainly, but working within those limits, we get to decide. There's not a clear answer, there's not much direction, it honestly might not work out. But we get to decide. And I am increasingly getting to the point where I want to consider what I want to do and how I want to be instead of how I feel I should be.

So a goal that I want to work on over the next few months is to figure out what I want. And not just in a broad, self-actualization sense. I mean, asking myself "How do you want to handle your mistakes?" Not "How do you feel you should respond to your mistakes?" but how do I want to. What kind of person do I want to be in my relationships? How do I want to approach stress? To approach uncertainty? To approach boredom?

Obviously, wanting alone is not enough. But I think moving away from depression will require some guideposts that I can hold onto whenever I start to slip into a sea of should's. And, at the very least, it will be better than all the ruminating I've been doing. I think that's something we all can want.

Struggling with Acceptance

It's not just feeling bad that's hard. Self-recrimination, doubt, failure, these things seem like natural responses to the inevitable times when we bump up against our limitations. What makes it stick, though, what snares me like a fishhook and keeps tearing tearing tearing is this sense that this is forever. That there was some window, long ago, when I "could have been good." But that window has long since closed, leaving me to forever flounder, futilely trying to 'make good' even as I'm destined to fail.

That's where the belief goes from painful to insidious. "Forever." It's tempting, sometimes, to feel like I can 'atone' for what I've done. If I'm good enough, if I push myself enough, if I'm perfect then maybe, just maybe I can atone. And, in that atonement, I can finally be rid of this agonizing guilt. It's tempting. But invariably, my humanity raises its ugly head and, yet again, I fall back to forever.

And it's in these moments where the strongest feelings are not sadness or guilt or shame. Those are there, of course. But what really aches are the desire and the loss. The throbbing, unquenchable desire to find something that will soothe this pain and this persistent feeling that once there was a time when I could have found that cure, could have been that cure. But now I never will.

*Wanting.* I feel so wanting. It's the perfect word. Filled with a savage hunger. Lacking. Empty. And devastated by the so real fear that I will never, never be whole.

Fuck it, let's go with how I feel as plainly as possible: I just feel bad. I feel like a failure. I feel like I can't do anything right. I feel like that won't ever change. I feel hopeless. I feel unlovable. I feel like I'm wasting my life. I want more. I want so much more. And I am terrified I won't get it. I wish I was better. I wish I was so much better. I wish I knew more, worked harder, was more persistent, was more patient. I wish I didn't make so many stupid fucking mistakes. Hell, I'm not even making mistakes a lot of the time: I just honestly don't know what I'm doing and I'm desperately making it up as I go along. And I want to make up for what I've failed at. I so desperately want to go back in time and undo all the bad things I've done. I want to erase myself from the past-present-future. I want want want.

And it is so hard to accept that I just can't. That I have done so many things imperfectly. That I am so flawed. And that I will always be flawed. That I will have good days and bad days. That I am learning and growing but that I will never be Learned and Grown. That there are things I have done in the past which cannot be undone. That I may be alone for the rest of my life. That I may not get everything I want. And that that might all be fucking ok. It's hard to even type that. It's hard to type that maybe all of that is ok. That it is what it is. And all I can do is live and love and keep learning and growing. And that I will keep being imperfect, keep flailing. But that even as I do that, I can do good. I can be valuable. I can be loved. It is so fucking hard to accept that. That I can be imperfect and fuck up time and time again and still be loved. I don't want to accept it.

But it's true. It is true.

Wanting an End

I have been fighting a losing battle for my life for ten years. Well, maybe not. "Fighting" is a strong word. "Fighting" implies I have been resisting the side of "death," but I have not. There has never been a moment in these past ten years where I have said with conviction "I want to live." There have only been periods, in the past few years, where things have not been so bad and periods when they have.

Some would call this "depression," that my poisoned mind is whispering lies to me. But I don't believe that. I don't believe that there is some foreign voice within me with which I do battle. It is only I who wants to self-destruct. I who wants to give up. I who wants to be punished over and over and over again until I am finally a battered broken husk wrung clean of wrongness.

I want those things. That is real and true. I am doing this to myself.

So why am I still alive? Because part of me has always wondered "What if?" What if things change? What if there are other answers? What if?

"What if?" has kept me alive for a very long time. A tortured living, but alive nonetheless. But I am gradually coming to realize that I am the only thing that can change. I am the only other answer. And I am stubborn, I am exhausting. If I am the only other answer, I am not a good one.

And so I have that old familiar feeling. And so now there is a voice in the back of my brain telling me, in the most seductive of persistent whispers, to kill myself. And so I don't think I'll do it. But I also don't want to spend another ten years making this decision. I need to decide to live or to die. If not forever, then at least for now. I want to end this agonizing debate. But then, if I knew how to do that, it would already be over.

So the voice whispers on. And I go through the motions of my life just in case. And I am making myself so unhappy. And I just want it to end.

The Grate Depression

After a very long hiatus, the wonderful Allie from the webcomic "Hyperbole and a Half" has returned with "Depression, Part Two," a follow up to "Adventures in Depression." Before I go further, I cannot stress enough: I really like these posts. Anything that helps to normalize and destigmatize depression is wonderful, and Allie does it with authenticity, vulnerability and humor in fantastic ways.

The part that elicited the strongest reaction from me, though, was the pervasive sense of powerlessness throughout. Specifically, the sense that depression is just something that "happens" to a person, like one's own personal black rain cloud that follows you around for no reason.

"The Hundred Acre Wood's drought was finally over. BUT AT WHAT COST?!"

I realize that this is the way it feels. That no matter how hard you try, you cannot care. That all of your actions are shrouded in this persistent feeling of incompetency and meaninglessness. That you are alone and your attempts to reach out to other people are met by misunderstanding and incessant problem solving. Everyone encourages you to be "happy" or to "fix it" in some way or another and each time you think "Fuck you! If this was just about choosing to be happy I probably would have done that by now don't you think?" Allie's metaphor of the "dead fish" is beautiful because it so aptly illustrates how people really do want to help, but they're trying to help with the problem they think is there not the one you're actually grappling with.

Indeed, often times you try so hard and hate yourself so much (as wonderfully illustrated [haaah] in Allie's first depression comic), and you find yourself simply incapable of feeling better and hating yourself for your failure to do what "should" be so very easy. Someone at the Counseling Center yesterday said she's been trying to live by a quote to the effect of "Don't let your best days always be in the future," meaning that one should try to find a way to make now be the best. And I love that idea and hate it because I so desperately want now to feel good. However, as you have probably noticed if you've been reading any of me for the past ever, despite trying so very hard I have yet to find a way how to make it so.

I'm trying, goddamn it!

And this is where my reservations come in. It feels like it's happening for no reason and no matter how hard I try I can't shake it. But I also firmly believe that, at their core, depression and anxiety are adaptive. Biology/brain chemistry may predispose us to them or exacerbate them when they arise, but these conditions are not solely the creation of brain chemistry. Brain chemistry may open a gate wider than those found in other brains and brain chemistry may make what we find on the other side more difficult to endure, but we still on some level decide to walk through.

It's important here to be clear: I don't think people choose to be depressed or to be overly anxious. Those things suck, unambiguously. But I do think people choose to stay in situations where they are unfulfilled. I do think people choose to not express their anger towards others. I do think people choose to direct disproportionate anger towards themselves. I do think people choose to remain constantly vigilant for threats to themselves and their loved ones. I do think people choose to be incredibly afraid of the judgment of others. Etc. And I do think those choices have negative consequences which often manifest as depression and anxiety.

The important distinction here, again, is that it's not necessarily that a person wants these bad consequences. But they choose to engage in behaviors that elicit them because the alternative, in their minds (and usually heavily informed by their experiences), is worse. Living in fear gives them some sense of control that they can prevent something terrible from happening. Not expressing anger allows for less conflict with others (avoiding the punishment expressing anger brings). Fearing judgment of others helps keep you from doing things that incur that judgment and its consequences. Etc.

All of these choices are valid. They are not arbitrary or stupid: they make sense and we get something from them. For instance, it was "better" for me to direct my anger at myself than express it to my father because doing so would only end up with me hurt more. I felt miserable, self-loathing, and guilty, but I also gained some control and safety. At the time, those were more important.

So too, it's not someone's "fault" they are depressed. This is not about blame. I made that choice (although it felt less like a "choice" and more like a "necessary adaptation") when I was younger, and even though it did immense damage to me, at the time I really think that was better than the alternative. No one else can judge what is an acceptable risk or the "best" course of action for you to take regarding decisions that affect only you. Hypervigilance to protect against risks may be what you need to feel like you can exist in the world and even as it's incredibly stressful and scary, it might be what you need to feel like you can stop horrible things from happening (usually again). It's not anyone else's place to say whether the stress is worse than giving up that sense of control.

However, I also know that as I have gotten older and my circumstances have changed, the consequences have increasingly been outweighing the benefits. I'm still really afraid of the consequences because I know so painfully what they can be, so change is coming really hard. Yet I've increasingly learned that change is the only way for me to get what I want from life (to wit: close, meaningful relationships and to be a good therapist). That's more important to me than the benefits of this pattern, so I'm trying to do the very hard work of changing.

Sometimes change happens when we explicitly decide to give something up in order to get something different. For instance by giving up the pursuit of perfectionism, we risk and likely endure some disappointment in exchange for less anxiety and guilt.

Sometimes circumstances change and we don't have to make the choice, such as when your partner in a toxic relationship breaks up with you and after initially mourning you feel better without them.

Or sometimes something happens to make the choice easier, such as "My therapist listened to me and supported me; I feel safer because someone is on my side, making the potential consequences of taking this new action less hurtful so I can choose to take it now."

But, at the core, I think we are still making choices, even if the results hurt a whole fucking lot. And deciding that some actions, consequences and risks are better than what we currently have is often how change happens.

I don't know Allie, and I don't know what's happened to her or why she's depressed. I know that not feeling things sucks. That it's frustrating and confusing and feels so damned hopeless. That it feels like it has no reason. But I also know that not feeling often feels better than being hurt (like you were when you did feel, whether you did that damage to yourself or someone else did it to you). I know that it often inoculates from fear, from disappointment, from rejection, from anger. I know that it's a way to protect one's self from fully engaging difficult questions about the purpose and meaning of one's life. Etc.

I don't know if any of those things are happening for Allie. It would be presumptive to guess. And I fully believe that it feels beyond her control. But as a therapist and as someone who's had decades of depression for herself and her family, the brain chemistry black cloud model is just intolerable for me to accept. I have to believe there's a reason. I have to believe there's hope, that change is possible. That Allie can change.

It may not matter that we find the reason; there are options for change that happen when we get certain things we've been lacking that make change seem almost inexplicable. Maybe medication may help. Maybe she'll make an epic pilgrimmage to the corn palace and she'll experience a moment of existential transcendence that will prove to her that though she is but one kernel in the great cob of life, it is the kernels that make corn possible.

I don't know. And maybe this is more about what I want to be true than what actually is. But I really do believe there is a place for hope in depression. And this is how I've found mine.

Kernels of wisdom, cobbled together throughout the ages
as humanity stumbles through this maze we call life.

Feelings Work #1

[I'm going to try something I suggested to a client to prompt better exploration of affect: starting entries "with I feel <feeling word> word." I've been trying to write otherwise, and I just keep getting lost in my thoughts, so maybe this will provide a bit more focus or at least a decent drive to finish a post.]

I feel sad. I feel sad because I'm alone. I don't want to be alone. But there aren't really that many people I'd want to be with anyway. That's a polite way of saying there's no one in my life I want to be with, which is true and it isn't.

It's not true because I also feel really anxious. I feel anxious all the time. It's not always obvious (I hide my feelings well), but I'm worried most of the time. Usually, it centers around all the things I'm not doing. I haven't got my classes planned, I'm not doing x for y person, I've done z to q person and I feel guilty about not properly atoning for it etc. And the worst offender: my predissertation and dissertation aren't done and I'm behind schedule and if I don't finish them when I have the chance I won't get out of Knoxville in time and I'll wither away here and disappoint everyone who knows me because I'm so mediocre and far behind and I won't ever actually get out of this PhD program or this goddamn city and I won't ever form a meaningful relationship with another woman because I can't seem to find anyone I really fit with here and, basically, I am a failure and a disappointment who is destined to be unloved and alone.

Did you catch all that? Kinda spiraled out of control pretty fast, didn't it?

I carry that around most all of the time I'm not working on something else. It's why breaks tend to be so depressing/anxiety provoking: all I do is think about all I'm not doing and then I try to avoid all of the negative feelings that come from all the anxiety of not doing things which makes me get even less done which makes me more anxious about not doing things which, well, etc.

And the worst consequence of not getting something done is disappointing people. I am terrified of disappointing and hurting people. It's one of the reasons I hate gifts and Christmas: I am so terrified I will do something wrong or disappointing with gifts that I'd just prefer not to have anything to do with any of it. I absolutely hate receiving gifts because that puts pressure on me to give gifts which makes me even more anxious about disappointing someone.

It's one of the reasons I don't like to touch people. I'm afraid of doing something wrong and disappointing them or making them uncomfortable or hurting them. It's one of the biggest reasons I don't get close to people: I'm terrified of disappointing them. I push them away so I can't disappoint them. And it's exhausting and it's isolating and it's saddening, but it's so.much.better. than failing them.

Of failing you. Because if I fail you or disappoint you or do something wrong, you'll leave me. Or you won't tell me and you'll resent me for it. Or you'll remember it and hold it over my head and I'll never be able to atone or redeem myself and it will forever be a blight upon me.

I would rather be alone than deal with the incessant prospect of failing you.

That's not the only reason, of course. I'm afraid of you failing me, too. I'm afraid of you not understanding me, not protecting me, not supporting me, not knowing what I need. I'm afraid that you'll let me fade away because I'm not really that important to you. Just like I don't let you be that important to me, so that when I fail you and you leave it won't tear me apart like it does when those I've cared about left.

I'm sad that I'm alone, but it's better than the alternative. I'm terrified of disappointing you, so I don't let you get close enough to need or depend upon me or expect anything from me. And I'm afraid that the only way I know to break out of this cycle is to find one person who loves me so I can't disappoint her because she values some essential part of me, loves *me* and no matter what she'll keep loving me and I'll keep loving her (and because I love her and provide value to her, it constantly atones for all the ways I'll fail her). And what's scary about that is that everyone I've loved like that has left me anyway and it was never because I disappointed them, but because I was unhappy or distant or "too good."

So I know that means that I need to like myself and not be unhappy and be somewhat selfish and take risks by letting others get close. But I can't seem to make that happen because I'm so scared all the time of how I'm going to disappoint and hurt others. And I just don't know how to stop it. I don't know how to break one part of the cycle so the other parts fall into place.

So I feel sad. And anxious. And afraid. And all of these things are so much worse for the fact that I don't know if or when they'll ever be anything different.

Moving On

I'm in an emotional space I've never been in before: stability. Lackluster stability, perhaps; I'm not complacent and certainly not happy. But the multifarious chaos, desolation, and trepidation that's adorned my furrowed brow for the better part of my ever is largely dissipated. 

For as long as I can remember, I was always preparing for the future, always looking ahead, and even when I was significantly unhappy in the present (which was often if not usually), there was always something in the near or distant future that I was working towards. And each realization offered the prospect of some significant change in my day to day life.

That's what transition has been like, but on a micro level. There are zillions of steps in a long process. And I've had it mapped out since deciding to transition, two and a half years ago. I wouldn't say SRS is the "culmination" of the process, but it's certainly the last major step. 

And now? Now I feel kind of... hollowed out. I've been staying with my mom for the past five weeks, and I'm kind of scared to leave. Not just to go back into the world and the grind and the constant demands upon my still recovering body. But to go back out into the world not looking forward to something else.

I think this is what post-op depression is. I've been putting so much planning, putting so much mental energy into getting to this point that, now that I've reached it, it almost feels surreal to move past it. I'm pretty well set, barring economic collapse or unexpected tragedy, in terms of my career path. I'm pretty well done with the "obligatory" tasks of transition. I feel like I'm going to be floating instead of swimming. And after so many years of struggling so very much... I don't know what to do with myself.

I'm sad. And I'm scared. But I'm sad and I'm scared while knowing that I am at a better place in my life than I ever have been before. It's good to be stable. I literally cannot express to you how much even the lukewarm dissatisfaction I feel now is so.much.better. than the very vast majority of my emotional state up to this point. And yet I miss it. Already. I miss the stress, the fear, the tenuous hope mixed with apprehension. Not for a moment do I want it back, but still I miss it.

I know this too will pass. Part of me relishes the fact that, the further I get from the surgery date, the more I can devote myself to so many other parts of my life and growth that I've been delaying while focusing upon the rest. Once the school year starts and I'm seeing clients again, doing the work I was made to do, I will feel that fire and direction again.

But I'm mourning. God help me, I am mourning something which I am glad is dead. And I am saddened all the same.

Depression Update #2

The good news is that the antidepressant I switched to (Celexa) is working. Minimal suicidal ideation. Minimal hopelessness. The world seems flattened, as opposed to oppressive. I'm floating instead of being buffeted. And, given where I was, that's a marked improvement.

The bad news is that the side effects are quite noticeable. My sex drive is noticeably diminished (a good thing, for now at least). I yawn frequently. I sleep so much more (this, at 12:20a, is the latest I've been up most of this week).

This is not a perfect solution. I know people say antidepressants won't "change you," but I'm changed. I don't feel my own pain as much, which makes it somewhat more difficult for me to feel others. I'm perpetually tired, which cuts down on my pseudo-manic exuberance. I'm stable. And stability is dangerously new.

As mentioned, though, it's an improvement. I think I'll still want to try to go off of it again. And again. And again. I'm going to wrestle with this all my life. But I am going to wrestle it. I'm not going to live in fear of it like my mother or drown it like my father. I'm going to keep engaging it. And, in so doing, I hope I can maintain the sense and direction of self I still strive for.

I'm busy, now. Blessedly so. I have ideas for what to write about, but the time's not there and the energy (see above) is lacking. But hopefully I'll have something soon. We're getting into the tofu of our counseling theories, now. And I am embarrassingly excited.

Depression #1

[In order to assess my progress on antidepressants and create a symptom-specific record for how depression feels, I've been keeping track of depressive and anxiety episodes. I'll post past and contemporary posts every so often.]

8/18/11
After months of gnashing my teeth and wailing into the wind, I finally convinced myself to return to my psychiatrist to resume antidepressants. My objections were legion and familiar: they would "cloud reality," they would prevent me from adequately empathizing with others, they would make me dependent upon medication to regulate my emotions for the rest of my life, and, perhaps most heinously, they would require even more monetary expenditures solely for the betterment of my self (as if I could ever deserve such things).

But one night last week, I felt an intense anxiety. As if my chest was on fire, as if sandpaper was rubbing against some deep essential part of my self, a conflagration of irritability and unease that erupted inside me. I'd pace the same three yards in my efficiency apartment back and forth back and forth for hours. And I'd have an urge to rend my chest in twain and let all the venom inside me pour out in a brilliant, beautiful, bloody mess.

This is nothing new. What was new, though, was that I could not articulate what I was so anxious about. Always before there have been things I was not doing, ways I was failing disappointing or hurting others, ways I was not As I Should Be. But nothing, at that moment, seemed to merit the feeling. It all seemed so... disproportionate.

And so I made the call. Because, finally, I am accepting that there are some things I do not have to suffer, no matter how much I feel I deserve them, no matter how ardently I convince myself I should be able to beat them. There is no reason to keep hurting as much I do. It's a lesson I will probably have to reteach myself for the rest of my life. But at least I'm more receptive to it than I used to be.