Monday, April 19, 2010

My experience with depression

My Story
I started thinking about killing myself when I was 13.  I tried cutting myself, just to see if I had the self-control to pull that off--I didn't.  I reached suicide-attempt levels of depression several times before I was 15.  I told a counselor at church who told my parents.  I spent some time in professional counseling then.  I don't remember much of those sessions, but I seem to remember that we focused on coping skills.

I spent more time in professional counseling during college.  I didn't enter counseling because of the depression, but I went through a depressive episode or two during that period.  We discussed depression at length.

And my minor was psychology.  So I've read through the intro and intermediate clinical literature on depression.

I'm not going to air any of my family member's laundry here, but it should suffice to say that I am not the only person in my family who has struggled with depression.

I'm an INTJ.  I accumulate and organize information.  I study and examine.  I form and test hypothesis.  When it comes to depression, I have been experimenting on myself for a long time.

I am going to be brutally honest in this article.  Probably I'm going to be too honest for comfort for my friends and family.  I'm sorry.  I do not think that my thoughts and experiences are terribly unique.  I hope that you can learn something to help you cope with depression.

In my 25-year experience with depression I have taken a methodical self-analysis approach to coping.  I'm writing this article to share my insights, in hopes that someone else will benefit.  Maybe you can apply some of my insights during your own depressive period.  Maybe you can talk to someone else who is depressed.  Maybe you can do some research.

Problem Values
Dr. Chris Thurman wrote a book called 'The Lies We Believe'.  That book is about relationships, not depression.  Dr. Thurman attends my church, and he presented his ideas about relationships in my Adult Bible Fellowship (Sunday School) class a few years ago.  He uses a metaphor to discuss how we react to other people.  When I heard it I instantly recognized the application for depression.

Dr. Thurman says that relationships are filled with opportunities to react to the other person.  They act, I react.  Dr. Thurman's question is, "is my reaction appropriate to their action?"  And he uses the metaphor of money to ascribe value to the actions and reactions.

Someone accidentally steps on your toe.  They realize what they did and immediately step off of it.  They apologize.  It hurt for a second, but no lasting damage was done.  That's a 10-cent event.  If you grimace and give them a stern look for a second, and then mumble that it's ok, then that's a 10-cent reaction.  But if you grab them and throw them to the floor and kick them in the face over and over, then that's a $10 reaction.  Grimacing is appropriate.  Kicking is not appropriate.

Dr. Thurman teaches people to use this money metaphor to discuss their actions and reactions.  "What I did to you was only a 5-cent thing, but your reaction was a $20 thing."  Now you can discuss the values of the actions and reactions.  This starts you down a path of understanding and improved communication where you can discover the real meanings behind inappropriate reactions and begin healing relationships.

When I am depressed I can (more-or-less) correctly identify the values of the things that happen to me.  I know and understand the real value.  But the value feels much much greater than it really is.

For example, a dead car battery is a minor inconvenience.  It will take an hour or so and $30 to $80 to replace.  And then everything will be fine.  No lasting damage.  But sometimes it will feel like a $5,000 problem.  That's how I know I'm depressed.  I can recognize that my feelings are all out of whack with the real value of the problem.

I had identified that pattern while I was still in high school.  Maybe my first counselor gave me that, I don't really remember.  I didn't find the language to describe it until recently, but I have been monitoring myself this was for more than 20 years.

For almost 2 years I kept a journal of how I felt.  It was just shorthand.  "D" meant depressed.  "S" meant suicidal.  "SS" meant that I had actually taken steps to begin attempting suicide, like gathering pills or climbing into the tub with a knife.  If I thought that there was a powerful reason for why I was feeling this way I would note it--usually with a girl's name.  A few times I wrote in big events that failed to make me feel depressed or suicidal.  I loved my grandfather, but his passing did not pull me down into depression.

At one point I looked back through the journal and tried to find a pattern.  There was none.  Less than half of the depressive periods had real triggers--lots of them had something noted, but they were almost all very small things.  Several big things, like my grandfather's passing, were noted without depressive periods.  There was no pattern of days between depressive periods.

Over the long term I was going between 2 weeks and 3 months between depressed periods.  The depressed periods would last 1 to 3 days.  There wasn't a correlation between the length of time between depressed periods and the length of the depressed periods (number of days) or the depth of those periods (depressed versus suicidal.)

Stuff constantly breaks or goes wrong.  Everyone has problems on a regular basis.  Sometimes those problems pile on.  This is common to all humans.  In my experience the triggers are not at all important to the depression.  Triggers are just the coat-hooks where depression hangs its coat when it comes for a visit.  There are always triggers.

What I watch for is my response.  If something breaks that will cost $1 to replace, do I have a $1 reaction?  A $10 reaction is inappropriate, but not outside of the normal boundaries for non-depressed people--so long as the $10 reaction abates and you can "get over it."

When I'm depressed I have $100 reactions to $1 issues, and I can't get over it.  Or nothing at all will happen, but I will start replaying recent events and re-evaluating them:  I might have had an appropriate reaction at the time of the event, but now I'm doing the opposite of getting over it--I'm crawling under it and letting the reaction swell out of proportion.

After struggling with this for years I have developed a habit of asking myself some hard questions when I have a big reaction--an overwhelming feeling.  I force myself to break down the costs of the problem in real terms. How much will it cost to replace this thing?  How long will it take?  What else will it cost me in terms of other peoples' perceptions, etc.  I add up the costs and decide what the real value of the problem is.  And then I compare that to my feelings.

There are some tell-tale feelings that accompany depression.  Tired.  Sluggish.  Lack of motivation.  But those feelings can also be caused by other things, like not getting enough sleep.  So I have an inkling that I might be depressed before I have a big reaction and go through that analysis.  "$10 problem.  $5,000 reaction.  Yep, I'm depressed."

Living with Depression
I've been through hundreds of depressive periods now.  Some of them are mild.  Some of them are severe.  Generally speaking, though, they are getting less severe over time.  I think that this analysis is a large part of the reason why they are getting less severe.

Forcing myself to do the problem-value analysis helps me keep my reactions in check.  It may feel like a $10,000 problem, but I know it is only a $10 problem.  I'm able to tell myself that my feelings are all out of whack because of the depression.  That helps me ignore my feelings (somewhat) and focus on trusting my logic while I am depressed.

I know I've been here before and made it back safely.  I'm no longer afraid.  I know that the depression will ease up in a few days, almost no matter how I react to it.  So I can just go back to bed and wait it out if I have to.  I know I have that option, and that is very comforting.

And I can plot my escape.  I know that the depressed feelings won't last forever.  I can think about the expectation that I won't feel so overwhelmed in a day or two.  It's not exactly a light at the end of the tunnel, but it is a confidence that there will be a light at the end of the tunnel.

I do try to avoid making any major life decisions during these periods.  That is usually not too difficult because I have little energy or motivation to go do stuff.  It's not hard to talk myself into procrastinating during these periods, and so that's what I do.

The first few depressive periods were the hardest, because I didn't know what was happening.  I was lost in a strange place, and I didn't know how long I would be there.  I'm pretty sure that the feelings of being lost and confused made those first few depressed periods much more difficult to endure.

It really hurt the first time I cut myself deep enough to draw a significant amount of blood.  Maybe my knife was just too dull.  But that time I failed to really hurt myself because of the pain.  I just couldn't bring myself to make the second deep cut.  That was well before the first counselor, when I was 15.  After that I got knives out and toyed with them while I was thinking, but I knew that I wouldn't be able to go through with it that way.

I had some experience going in to and out of those woods before I figured out a method of suicide that I thought I would be able to go through with.  By that point I had developed a new coping mechanism.  This was before the journal and my understanding of how long these periods usually lasted.  I decided that I needed to be suicidal for a whole week before I would attempt.  I reasoned out that I didn't want to die over a problem that would go away on it's own in a week.

I got to six days on a few occasions.  That was quite scary.  But during those times I took comfort from the fact that I was trying to find a way out even while I felt so bad.  I would play basketball in the driveway until my parents made me stop, late at night.  I would lift weights or run or ride my bike to the point of exhaustion, so I could fall in bed and sleep instead of thinking.

I'm not a big fan of better living through chemistry.  I don't drink alcohol--I've never been drunk.  I've never tried any recreational pharmaceuticals.  I hate side-effects.  I hate being out of control.

There have certainly been times when I wanted to drink to forget my problems.  Before my first depressive period I had decided to not drink.  That's a story for a different post.  But I can't break that commitment I made myself.

My second counselor was not the type of counselor to prescribe medication.  He offered to refer me to a counselor who could.  I thought about it a great deal.  I decided that I would rather live and die as myself than have to cope with the side-effects of mood-altering drugs.  That's not the right decision for everyone, and I don't think any less of anyone who decides to get that type of help.  It's just not who I am.

Anti-depressants are a major problem for people with porphyria.  That's the disease that killed my sister.  It's a genetic disease.  There is a research center working on genetic tests for the different variants of porphyria.  Connye had HCP, and there is no genetic test for it yet.  So I don't know if I have the gene.

I'm at a place where I don't really fear that depression will kill me.  But porphyria might kill me.  So I am staying away from anti-depressants, at least until I can get the genetic tests and find out if I am susceptible.  That will probably be another 5 to 10 years.

Even though there wasn't a clear pattern to my depression, I still think that probably the root cause is chemical, bio-chemical, or hormonal.  I just don't know.  And at an important level it doesn't matter.

If there were a cure, then I would take it.  Someone will have to work out the causes before they can develop a cure.  Good luck to whoever is working on that.  I'm spending my time just trying to live.

Talking about Depression and Suicide
I'm not depressed today.  I was depressed a few days ago, but I waited it out.

Today I feel safe writing what I wrote.  I'm afraid that I'm going to get a whole lot of questions after my family and friends read this.  I really don't want to answer questions beyond what I wrote here.  I'm also afraid that a potential employer will read this and decide to not employ me because of it.  I can't blame them, although I hope that they will see a life-long pattern of resilience and problem-solving instead of just emotional weaknesses.

When I'm depressed, talking about the current depression actually makes me more depressed.  Personal questions are very painful at that point.  Please tread lightly.

Suicidal thoughts, feelings, and intentions are especially hard to discuss.  On good days it is hard to discuss past suicidal periods.  When I'm actually feeling suicidal it is unbearable to discuss.  If pressed I will lie to cover it up and then feel much much worse.

My advice for friends and family would be to discuss other things.  While someone is depressed or suicidal is not the time to force them to face their deepest fears and biggest problems.  Talk about positive things.  Talk about the future.  Talk about how life will get better.

Don't say clumsy things like, "you're just depressed right now, everything will be better later."  Don't talk about the elephant while it is in the room.  Give the depressed person simple concrete future things to hope for.  I look forward to seeing my kids grow up.  That helps a lot.  I still have things I want to do.  Those wants are powerful, and help me through the bad times.

So ask me about my kids.  What do I think they will be when they grow up?  Will they decide to have kids?  Or ask me to tell you about Democracy 2.0 or one of the books I want to write.  Those things help me find my way out of the woods.

If you have to talk to a depressed or suicidal person about their depression or suicidal tendencies, wait and do it on a day when they are not depressed.  Give them lots of room to back out of the conversation if they start to feel overwhelmed.  Let them get back to you.

If you insist on pressing for specifics on suicide then you should expect lies.  I think suicide is the single most personal topic.  I would rather discuss anything else.  And there just isn't much in the way of a good reason for you to know the details.

I won't say that no one who is truly suicidal is going to tell you their plans.  But that's not my experience.  When I've had friends share their plans I generally thought that they were more focused on hunting for attention as opposed to genuinely suicidal.  Don't fail to take that seriously if someone shares their suicidal plans.  Just don't expect honest answers to probing questions.

I'm more than a decade away from my last serious attempt.  Typing that sentence was very difficult.  I'm not ready to discuss the specifics with anyone, under any circumstances.  I can say that it wasn't rational--the value of the problem was not sufficient to warrant that much reaction.

It's Not Your Fault
You don't have to walk on egg shells around a depressed person.  You should not accept blame for their depression.  Even if you are the former boss who fired them or the former lover who rejected them.  Their depression is not your fault.

You are responsible for your actions.  As I explained above, depression causes an over-reaction.  You are not responsible for the overage.  Their depression is responsible for the overage.

Don't let a depressed person use their depression as a tool to keep you in line.  If they threaten to hurt themselves, and use that threat to force you to do what they want, then you have to get away from them.  Don't let yourself become a secondary victim of their depression.

Even when they are not making overt threats, don't treat them like they are handicapped.  If you need to do something that could be a trigger for their depression, then do it.  Don't be afraid.  Use compassion in your communication, just like you should with anyone.

If someone you love is depressed, don't blame yourself.  Maybe something you did happens to be the trigger for their current bout of depression.  But if you hadn't done what you did then the depression would have found a different trigger.

I know that this is very uncomfortable for my family.  Again, I'm sorry.

This is not some type of twisted suicide note.

I hope I have not given enough away to accidentally help someone who is suicidal.  I edited out some details that I was afraid might do just that.

My purpose here is to help people who have never been depressed to understand it better, and to give them some good ideas on how to help their depressed friends.

Thank you for listening.

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