More Than Thirty-One Tragedies

Everybody knows that the dice are loaded
Everybody rolls with their fingers crossed
Everybody knows the war is over
Everybody knows the good guys lost
Everybody knows the fight was fixed
The poor stay poor, the rich get rich
-- Leonard Cohen

Justice in America, specifically the Sixth Amendment, theoretically requires that a person accused of a crime has the right to a speedy and public trial. In theory there is no difference between theory and reality -- in reality there often is.

I had a backpack years ago that held books and a calculator with a replacement value of several hundred dollars. My backpack was stolen -- it and its contents were never recovered. I was angry at once again becoming a victim. Part of my anger was directed at myself for leaving it where it could be stolen. Several days later I was still in a foul mood which had a negative impact on job interviews I had lined up just ahead of my college graduation.

On Recovery

Do you get scared to feel so much?
To let somebody touch you?
So hot, so cold, so far so out of control
Hard to come by, and harder to hold
Some people get by
With a little understanding
Some people get by
With a whole lot more
-- The Sisters of Mercy

So there are mental health challenges that are debilitating and frightening but once the right meds/treatment are found and taken as prescribed, recovery is absolutely possible. I have met people that this has happened to and have heard their stories. It is awesome that there are happy endings to their challenges which often lead to a renewed lust for meaningful and productive lives.

I also know a few people whose challenges are not only treatment-resistant but, I would argue, recovery-defying. I am one of those people. We are a relatively small slice of the mental health pie -- somewhere around a few percent to 30% depending on which definition of "treatment-resistant depression" is used. I am not the poster child for the group by any means but based on the stories I know about, there are a few patterns. We often hate how misunderstood mental health challenges are -- how often media, both fiction and "news", paint us with a broad brush which perpetuates ridiculous stereotypes. And how often this sets the stage for others offering platitudes, ad nauseam, about holding onto hope, about things happening for a reason, and about curing depression because it was easy for their Aunt Gertrude after she tried a detox cleanse advertized on late-night tv.

Policing My Thoughts

I have stood here before inside the pouring rain
With the world turning circles running 'round my brain
I guess I'm always hoping that you'll end this reign
But it's my destiny to be the king of pain
-- The Police

My anxiety that is frequently triggered by doctors has all sorts of connections to my thoughts. Specifically errors in my thoughts that lead me to a clustering illusion or, perhaps, just plain old confirmation bias. Let me walk through a recent situation and a therapy technique that can help me police my thoughts.

Weeks ago my wife developed joint pain so I took her to a small family doctor's office, with whom we had been established patients for over a year. After the pain was not controlled by the initial suggestions, I took her back to see Dr. A on Friday. Dr. A was late -- my wife was his first appointment of the day. After an exam, Dr. A suggested physical therapy and also a prescription painkiller. Dr. A agreed to write a prescription so my wife could go to a particular physical therapist that I knew was good. Although he could have handed us a paper prescription, he suggested that we use the office's electronic "patient portal" to provide the physical therapist's particulars (name, fax, etc) then he would have a fax sent to the physical therapist's office. At home later that Friday, we used the patient portal to send the info to Dr. A so he could have the fax sent. My wife's next day off was in 6 days so I expected on Monday to make a Thursday PT appointment.

Mileposts I Have Not Passed, Yet

They go:
Me and your mom have been noticing lately that you've been having a lot of problems, you've been going off for no reason and we're afraid you're gonna hurt somebody, we're afraid you're gonna hurt yourself. So we decided that it would be in your interest if we put you somewhere where you could get the help that you need.
And I go:
Wait, what are you talking about, we decided? My best interest? How can you know what my best interest is? How can you say what my best interest is? What are you trying to say, I'm crazy? When I went to your schools, I went to your churches, I went to your institutional learning facilities? So how can you say I'm crazy?
-- Social Distortion

Around kindergarten my dad divorced my mom so he could quickly date, live with, and marry a younger woman who had had a troubled life. This wasn’t dad’s first attempt at playing savior – before I was born he taught history and English to poor, inner-city kids. He remained in the education field after I was born, transitioning into a job to improve teaching methods with the latest theories. How odd it was for him to care so much about helping others while he shifted from being my parent to pretty much being a seagull manager. This term is used in business when a work situation needs attention and a manager swoops in, makes a lot of noise, craps on everything, then takes off. Dad, the eternal optimist, made his noise giving me his assessment seen through rose-tinted glasses, simultaneously voiding my issue of the moment while crushing a little boy’s eggshell-thin ego.

But dad only had me on some weekends – the rest of the time I lived with mom who entered the workforce to keep a roof over our heads. In first grade I convinced both parents that I no longer needed after-school daycare and so became a latchkey child, skateboarding the several miles to and from school alone.

More on Egolessness

Doctor, doctor won't you please prescribe me something
A day in the life of someone else?
-- P!nk

I have a sociological understanding of people but it is startling to me when I see a single person so in touch with one's ego while being out of touch with everyone around her -- a common example is a person talking on her mobile phone when ordering in a Chipotle-type restaurant, as if the time of the people in line behind her (and the efficiency of the workers) never crossed her mind. Another is a person making obviously illegal maneuvers in a car across lanes and around (or over) barricades with the expectation that although he does not have the right-of-way, he expects everyone else in traffic to yield the right-of-way to him (and, stupidly, on some level assuming the road conditions in addition to everyone's brakes, tires, other vehicle systems, and perception-reaction times are sufficient to avoid collisions or worse). I suspect the last time I could tap into that level of self-absorption was during my Terrible Twos.

Certain experiences have made people-watching dull for me. I people-become. Sometimes I come up with a great impersonation and sometimes I have greatness thrust upon me. I have honed my Self-Effacing, Ice-Breaking, Peace-Making, Mind Reader act to near perfection and use it in most social situations. I do not think I can read minds, of course, but I can tell with high precision when someone just wants to talk about themselves and/or is looking for some empathy. I usually make an effort with weary checkout clerks and waitstaff and speak their name as I pay them some compliment (I am reminded of Dale Carnegie who wrote: “Remember that a person’s name is to that person the sweetest and most important sound in any language”). I always make an effort with anyone handling anything I am about to consume -- Paula Poundstone, remarking about customers when she waited tables at an IHOP: "When people would be rude to me, I would touch their eggs. They didn't know; I felt better; it worked out." (I hope this does not make any germophobes reading this avoid breakfasty establishments).

I have radically accepted society as it was and as it is. I have seen the incredible breakthroughs and the gut-wrenching genocides. The promising democracies and the promises of dictators to their nations (and the not insignificant numbers of people governed by one that want to be governed by the other, grass being greener and all that). The peace-makers and the war-mongers. The mutually-exclusive groups that claim to have the Truth and the wise people who nod at them politely then get back to the tasks of recording, archiving, and revising the repositories of knowledge as new information becomes available. Note I did not say I liked or approved of society, just that I have accepted it as is.

Everyone has the potential to improve society, the world, and beyond if we rely more on our brains and transcend primal instinct that has outlived its usefulness. So the next time you refuse to spend the 20 seconds required to return your shopping cart to the cart corral because your time is way more valuable than that of other people, remember that we have abundant resources and so we do not have to behave like cavepeople in life-or-death situations -- we have evolved. What do you say, does it make sense to rationally act evolved as a member of society or to REact on impulse, out of control, like an animal?

Winter Poem

Due to a therapy group that I wanted to attend today being full by the time I arrived, I attended a different sort of therapy that uses one's creativity. I wrote a poem that I rather liked on the topic of winter so I thought I would post it -- I do not plan to have posts like this very often:

Trees with voids
Whistling replaced with howling
Between gusty blusts
There is still no silence, no stillness
The forest does not die
It creeps ever so slowly
And the creaks, crunches, rustles
Push the rotting stuff to become
A smorgasbord for the fungi
For the microbes
For the unsung heroes of
Everything

Depressive Realism

And we'll accept the things we cannot avoid, for now
For now, for now, for now
But only for now (for now)
Only for now (for now)
Only for now (for now)
Only for now
Only for now (for now there's life)
Only for now (for now there's love)
Only for now (for now there's work)
For now there's happiness
But only for now (for now discomfort)
But only for now (but now there's friendship)
Only for now (for now)
Only for now, only for now
Sex is only for now
Your hair is only for now
George Bush is only for now
Don't stress, relax
Let life roll off your backs
Except for death and paying taxes
Everything in life is only for now
Each time you smile (only for now)
It'll only last a while (only for now)
Life may be scary (only for now)
But it's only temporary
Everything in life is only for now

-- Avenue Q Soundtrack

There is a theory, criticisms of which I will set aside for the sake of discussion here, that depressed people make more accurate appraisals of the world than non-depressed people do. This "depressive realism" may be the one thing that depression has going for it.

A positive mental attitude. Always looking on the bright side. A sunny disposition. Seeing the best in people. Wearing rose-colored glasses. With the possible exception of the last term, these are descriptions of behaviors of people who see reality with a good but nevertheless biased worldview. But reality is good and bad. And everything between. So consciously or subconsciously focusing on any part more than the rest of reality can understandably lead to inaccurate appraisals and memories.

Vulnerablity

Today I learned that the emotion of love can make a person feel invulnerable. I thought that was odd since love has allowed me to feel and be vulnerable -- but that probably requires me to feel trust, too. I know vulnerable is not necessarily the opposite of invulnerable but I just considered them opposites for the sake of discussion.

I also met a couple counselors/therapists while inpatient who love Brene Brown since I mentioned how in at least one of her Ted Talks she discussed how vulnerability is a strength and the counselors' faces lit up.

Different regions of the US are known for preferring some emotions, or no emotions, over others. But if vulnerability is a strength as I suspect it is, maybe the west coasters, specifically the hippie sorts there, are closer to having a healthy/appropriate approach of embracing emotions as they are and not judging anyone for their emotions. I always felt hippies got some things right but was not really sure what -- perhaps their acceptance of all emotions and the related vulnerability somehow resonated with me then and now I know there is wisdom in that. Pardon my stereotyping but I thought it would get my point across easier.

Separation From Loved Ones

Being separated from loved ones while inpatient for mental health issues is weird. I am suddenly among patients with similar or relatable issues but with different life circumstances which, in a way, is comforting since it underscores the genetic or at least the biological component for these issues. And if I see other people with depression getting "better" it gives me a bit of confidence that I can, too.

A couple people today talked about their desire to fight their depression and to conquer it. I wonder if these war-like metaphors apply to mental illnesses. Seems to me that first you accept the reality of having depression then educate then practice coping skills the rest of your life. Reduction of symptoms may come with meds but conquering depression is like conquering freckles.

Getting very sleepy so let me just say damn my literalist mind! Since soap was not included in "Each client is responsible for providing personal hygiene products such as shampoo, toothpaste and deodorant" as stated in the copious reading materials and forms I have read through to become inpatient, I thought soap would be provided by the facility. I was wrong so I guess I will just be using shampoo during my showers for a few days. :(

I Am Inpatient, Hear Me Roar

Oh yes I am wise
But it's wisdom born of pain
Yes I've paid the price
But look how much I gained
-- Helen Reddy

I am fairly certain that most of my blog posts will be shorter as I am inpatient for a while. A long while. I will not have as easy access to song lyrics so the format of most posts will necessarily change.

If you are not familiar with someone with long term or acute mental health issues, you may not know that there are different sorts of inpatient facilities. One distinction is some handle patients on a voluntary basis, some on an involuntary basis, and some can handle both. Another distinction is whether it is a locked-door facility or an unlocked-door facility or a mix. As I continue to blog it may become more clear what type I am in but for right now it is not something I am going to share which may make little sense to some readers since I write this using a pseudonym but that is my decision for now.

7 Favorite Assumptions

There is a star in the sky
Guiding my way with its light
And in the glow of the moon
Know my deliverance will come soon
There is a sound in the calm
Someone is coming to harm
I press my hands to my ears
It's easier here just to forget fear
And when I squinted
The world seemed rose-tinted
And angels appeared to descend
To my surprise
With half-closed eyes
Things looked even better
Than when they were opened
--Depeche Mode 

It is good to challenge assumptions. It is wise to challenge assumptions. But are you able to effectively, actually, challenge your own assumptions? I am going to be frank about my seven favorite assumptions and be as critical about them as I am able. To that end I plan to pick one each day of this week and set it aside as if it were 100% false or did not exist as part of my worldview. I think it should be enlightening.

My favorite assumptions, in no particular order:

Metapost: Comments Working?

I learned that comments on this blog are not always working but I do not know why. I confirmed my settings which should allow comments. For the few people in real life that know me, let me know when you are unable to post comments -- feel free to try commenting on this post to see what happens.

Alive With The Sound Of Suicidality

On days like this
In times like these
I feel an animal deep inside
Heel to haunch on bended knees
Living on if and if I tried
Somebody send me
Please
Dream wars and a ticket to seem
Giving out and in
Selling the don't belong
Well what do you say
Do you have a word for giving away
Got a song for me
(Sing)
(Sing)
Hey now, hey now now, sing This Corrosion to me
Hey now, hey now now, sing This Corrosion to me
Hey now, hey now now, sing This Corrosion to me
Hey now, hey now now, sing
I got nothing to say I ain't said before
I bled all I can I won't bleed no more
-- The Sisters of Mercy

For months I have been asking for, pleading for, more help. I went way outside my comfort zone to get all the paperwork filled out and signed to get into the premier mental health facility in the region -- the process would have been drawn out if I let the normal person who advocates for me in her spare time do it so I spent many hours getting to all the doctors' offices to make sure it was done quickly. Then it took more than a week longer than expected to get in for an assessment. Shortly after my assessment I was informed there was approximately a two week wait to get in but I was on the waiting list. Two weeks later I learn it still "will be a couple weeks". If I did not know better I would look at this data of getting put off a week, then a couple weeks, then a couple more weeks -- the trendline indicates the delays are getting longer so at this rate I will never get in. And all the parties involved know I have suicidal plans!

Granted I was not guaranteed to have treatment start quickly but the material I was asked to read during my assessment stated "accepted clients can potentially begin treatment within 48 hours" and my assessor told me I was expected to begin treatment there, once accepted, within 48 hours. My poor verbal memory does not allow me to exactly quote what my assessor told me but I know damn well that not only was my acceptance indicated but also that I was to prepare myself to be a resident there within 48 hours. I had quite an anxious reaction to her saying that because, for one thing, I did not have the suggested 7 days worth of clothes to pack and while a person in a normal state of mind might be able to buy/wash clothes quickly and swiftly get everything else in life put on pause for potentially months (family/pets, work/projects, relationships/friendships, holidays/vacations, and various other appointments and expectations), my anxious state made even deciding where to buy plain t-shirts feel like an insurmountable task.

After Transcranial Magnetic Stimulation

And I still find it so hard
To say what I need to say
But I'm quite sure that you'll tell me
Just how I should feel today
-- New Order

So I completed a normal course of deep transcranial magnetic stimulation (dTMS) treatments for depression. The magnetic fields were focused on the part of the brain that clinical trials have shown can improve mood (decrease the symptoms of depression) on a timescale of weeks to months. It did not have a noticeable impact on my mood. It did cause some unpleasant side affects that were not that common (compared with those observed in the clinical trials) but manageable.

There appeared to be an increase in the amount I wanted to express myself which I attribute to the treatments. I wanted to write more (and blog more) but I had trouble staying focused long enough to write something that others might want to read. I did talk to more friends and family than usual about a wide range of topics -- not the boring small talk people fall into comfortably, either. I tried my hardest to be vulnerable, to say what too many regret never saying. No, I don't want to talk about the weather. Or a sports team. Or a hobby that is only meaningful to one of us.

A Life Worth Living, Goal?

Someone take these dreams away
That point me to another day
A duel of personalities
That stretch all true realities
-- Joy Division

It has taken me years to be able to come up with what makes my life worth living. I had a bit of a breakthrough during the last week and maybe I can record it in some sort of goal.

I want to reduce the sadness I experience when thinking about, particularly when remembering, traumatic events. Trauma hits me often in waves of increasing severity that seem like they will never stop. Trauma that happens to me, trauma that happens to loved ones, trauma that happens to strangers -- continuing the water metaphor it all wells up in me and I cry until the tears and snot stop flowing. After crying myself out I think the next stage is being distracted or the pressure will just build. But the distractions are temporary and I wonder if I heal at all because the next time I recall a trauma, it seems just as intense as the last time (even though I rarely have flashbacks).

Forty-Two

I don't know what I am I don't know where I've been
Human junk just words and so much skin
Stick my hands through the cage of this endless routine
Just some flesh caught in this big broken machine
-- Nine Inch Nails

The long dark tea-time of the soul looms in 42 days. It is my understanding that this is when I learn the ultimate question of life, the universe, and everything but it would be nice to have that knowledge now. Well what's 42 more days compared with 7.5 million years...as long as the gnab gib is not nigh.

Stephen Fry knows. He knows why the answer to the question is 42 and the reason is "fascinating, extraordinary and, when you think hard about it, completely obvious." I am freaking jealous.

Comfortable In Society

I want to take you in my arms
Forgetting all I couldn't do today
Black celebration
Black celebration
Tonight
To celebrate the fact
That we've seen the back
Of another black day
I look to you
And your strong belief
Me, I want relief
Tonight
Consolation I want so much
Want to feel your touch
Tonight
Take me in your arms
Forgetting all you couldn't do today
Black celebration
I'll drink to that
Black celebration
Tonight
-- Depeche Mode

I should make it clear that I am no proponent of going off meds (my shorthand for antidepressants and the like). I have been on meds for over 15 years with only one short break, and that break was agreed upon by my psychiatrist, some other medical professionals I consulted, and family members. AND my psychiatrist directed me how to step down my meds and in which order so it would be the safest and have the fewest side effects. AND my psychiatrist and other medical professionals monitored me during and after. This was done for a few reasons but the main one was I wanted to find my baseline mood.

Hope

You with the sad eyes
Don't be discouraged
Oh, I realize
It's hard to take courage

In a world full of people
You can lose sight of it all
And the darkness there inside you
Makes you feel so small

But I see your true colors
Shining through
I see your true colors
And that's why I love you

So don't be afraid to let them show
Your true colors
True colors
Are beautiful like a rainbow
-- Cyndi Lauper

There is a fundamental disconnect in my brain when it comes to hope. I know the placebo effect helps some people actually get better. I know prayer makes some people feel better and, so, with the mind-body connection, at the very least can work like the placebo effect. I know a positive mental attitude can be the only tool that will bridge the gap between success and failure.

But when it comes to medicine there has to be an actual, quantifiable difference between a given treatment's effects and a person's belief that a "snake oil" will lead to the effects. So I find it odd that a suggestion, in any medical field but particularly in mental health, would be to remain positive that a given treatment will help. It is not isolated -- every mental health professional I have worked with in one way or another has emphasized the importance of staying positive. If I were able to stay positive, I would not need help for depression!

Egoless

If you want a lover
I'll do anything you ask me to
And if you want another kind of love
I'll wear a mask for you
If you want a partner
Take my hand
Or if you want to strike me down in anger
Here I stand
I'm your man
-- Leonard Cohen

I have worn the People-Pleasing Mask, maybe the same thing as the Society-Pleasing Mask, for so long that it has become my primary mask. It has also become second nature to try on masks that others wear to see the world from their perspectives. For example: a bit of research and bang I become, temporarily, a hardcore pro-lifer. A bit more research and bang I become a hardcore pro-choicer. So when I hear, say, a pro choice proponent say, "I just can't understand how anyone can be pro life...", I think that is odd because I find it easy to understand and often sympathize with all sides and their nuances.

When I began developing ideas for a blog I thought of writing as if I were genderless (and attempt to write as bias-less, more on that later) because I have done just that when playing online multiplayer games where people from all walks of life role-play as characters in online worlds created by programmers. It fascinated me when other players would fixate on determining whether I was biologically male or female in real life -- frequently others would conclude if I played aggressively then I must be male but if I played diplomatically I must be female. And this is in the era where most gamers are familiar with sayings like "The Internet: where men are men, women are women, and little girls are FBI agents."

Transcranial Magnetic Stimulation (TMS)

So next time you're in a jungle fight
And you feel the presence near
Or hear a voice that in your mind will lie
Just be thankful that you're not alone
-- Stan Ridgway

TMS tweaks electricity in a person's brain. This causes short-term activity in the brain that has been shown to have longer-term effects in some people. The goal is to decrease troublesome symptoms when the proper parts of the brain are tweaked. That's the summary of how TMS can treat illnesses like major depressive disorder.

In a bit more detail, Transcranial Magnetic Stimulation (TMS, which may also abbreviate the devices "Transcranial Magnetic Stimulators" which provide said stimulation) is a noninvasive way to have neurons fire (or not fire) more (or less) in the targeted region of the brain. It is noninvasive in that the magnetic fields are started outside of the body by a device, typically stationary in a psychiatrist's office, with part of it held to the patient's head. The magnetic fields are directed to pass through hair, skin, skull, etc, then up to several centimeters into the brain without the complications normally associated with electricity contacting the body or invasive anesthesia/surgery. In the brain the magnetic fields "work" on the neurons. How magnetic fields have an influence on neurons and the nervous system in the short-term requires a fair amount of electromagnetism and biochemistry and that, while fascinating, I will not attempt to delve into in this post. How doing this over and over can help some people for weeks or longer after TMS treatments are concluded is a matter of continuing study.