happiness project: one year later

A little over a year ago, I started a happiness project.

I started my project because I was realizing that, while there were a lot of good things happening in my life, I wasn’t feeling good about the ways I was spending my time. I was feeling a lack of emotional engagement in the world around me–a combination of mental/emotional burnout from the work I was doing and the world around me, and my own mental health causing me to disengage. Even though I was surrounded by blessings, in my family life, my friends, my clients, I just found myself feeling unhappy more often than not.

My decision to try a happiness project came from reading Gretchen Rubin’s book by the same name. I wasn’t as focused in my approach as she was–I didn’t try to set a new habit or goal each month, or anything like that. But I did–kind of without really thinking about it–follow the basic outline: identifying what brings joy, satisfaction and engagement (and, on the flip side, what brings guilt, anger, and remorse); identifying concrete actions that will boost happiness; and then, the tricky part, following through on those actions.

This year ended up being a lot more of a roller coaster than I expected when I started my project last summer. I got a new job and changed career paths. I moved to a new state. I took up yoga. I struggled a lot with my physical and mental health. There was a lot of change–and we all know how much I love change.

But there were parts of my happiness projects that stuck. I found things that brought me joy: creating things, sharing things with others, spending quality time with people I love, experiencing media in a comfortable way. And I found ways to bring those into my life as habits: I set myself writing goals. I spent more time with friends. I kept a journal. I got a pen pal. I got a library card, and read more books.

I’m going to do a few more posts to be more in-depth about the different habits that have actually stuck with me about my happiness project, but I know the biggest question I have to ask myself after a year of this is: am I happier?

And the answer is:

I don’t know.

It’s hard to measure happiness when you have depression, and harder still when that depression comes in waves that sometimes overshadow everything else. The last few weeks have been especially depressive, and even though I’ve been engaging in a lot of my “happiness practices”–journalling, writing, yoga–I don’t feel as much connection to them, and it’s been difficult to feel my usual warmth. But I still feel a sense of achievement, and that’s a step on the ladder toward happiness–and a sense of achievement is a hard thing to come by in a depressive episode.

But I think that there’s more to it than just being happier. Because I know now what kinds of things move me toward feelings of happiness. Creating something. Writing out what I’m feeling. Quality time with my husband or a friend. Snuggling on the couch with my dog. Doing something that moves my body, whether it’s yoga or going for a walk. Taking the car for a drive so that I can sing at the top of my lungs and not bother anyone else.

The hard thing for me now is to make myself take those steps toward those actions.

Right now we’re in the Jewish month of Elul, and I’m in the middle of participating in a program through the Institute for Jewish Spirituality (because I have the best job ever) focusing on reflective journalling in preparation for the New Year. It’s combining reflection, poetry, introspection, and future-focused thinking–all sorts of things I actually really need right now, as I work through a combination of depression, stress, and trying to sort out how to merge my own happiness goals with my goal for the coming year, which is to focus on strengthening the primary relationships in my life. And that’s a happiness project in and of itself.

So: a year of happiness projects. Am I happier?

Well…

I’m working on it.

on reconnecting (happiness project, part 7)

So let’s just start off by acknowledging that yep, I fell off the face of the earth. My bad, team!

Let’s reconnect.

I’ve been doing a lot of reconnecting lately, in a lot of spheres: physical, emotional, spiritual. It’s been a long, tiring few months: we’ve moved house yet again (though, hopefully, hopefully, for the last time for a long time), I’ve had a few sporadic illnesses that have taken awhile to bounce back from, work has been a whirlwind of activity and new projects…the list goes on. And my moods have been…well.

For someone who really, really doesn’t like change, the number of transitions, relocations, routine adjustments, and sudden changes of plans over the past few months have been challenging, to say the least. I wish i could say I’ve handled all of those challenges gracefully, but that would be a flat-out lie, so I won’t pretend about it. Spouse has been an absolute champ in dealing with me, but I’m absolutely sure that it has been neither fun nor entertaining to spend your down time with a cranky, over-exhausted, stressed-out wife.

So, that whole happiness project thing.

I’ll be honest: it’s fallen by the wayside in a number of ways. I’ve fallen back into a lot of old habits in the last few months–spending most of my downtime on a screen, not seeing friends as much as I’d like to, getting into a very skewed coffee : water intake ratio that generally left me crankier and more tired than I would have been if I was really hydrating well (and/or not drinking absurd amounts of caffeine).

But I’m trying to be better.

Back in May, I bought a three-month yoga membership to a studio near my apartment. I did a lot of yoga in college and some in grad school, and it was really great not just for my fibromyalgia (though it helped a lot with that) but for my mental health and my sense of connection to my mind and my body. The person in your yoga class that starts borderline crying during pigeon/eke pada rajakapotasana? Yeah, that’s me.

IT’S FINE IT’S PART OF THE PRACTICE

Surprisingly–or not–I actually started feeling emotionally better once I started connecting and crying through some of my poses, especially the restorative ones. I started using my savassana to actually just connect to my breathing, instead of letting myself run through my to-do list or stress list or any other list of craziness that tends to rocket around my head. Since starting to work at an amazing organization that teaches, among other things, mindfulness meditation as a spiritual connection practice, I’ve toyed around with the idea of starting a real meditation practice daily, but for now, I generally localize it to my savassana. But it’s been really wonderful, and since being more mindful in my day to day life was one of my new year’s resolutions, I also get to feel like I’m making progress toward a goal.

One of the most important parts of yoga has been setting an intention at the beginning of every class. When I first started getting back into yoga, my intentions were basically “get through the class without dying and/or falling over in a super embarrassing way”, but as I’ve kept going, I’ve ended up with two intentions that tend to make it into most of my classes: self-compassion and reconnection.

Living with a chronic pain disorder gives me a weird relationship with my body. Being in constant pain means that I’m always aware of my body–it’s pretty much impossible not to be–but I don’t always feel close to or connected to it. Sometimes, I feel like my body is something heavy that I have to drag around. While I’ve tried to take time to thank my body for what it can do instead of focusing on the ways it limits me, it’s an ongoing challenge to do that on a regular basis. Setting an intention at the beginning of class to reconnect with my body–to feel what it’s feeling without passing judgment; simply recognizing where my body is telling me it’s reached a limit and acknowledging it for going as far as it could–has been eye-opening for me because it’s given me space to sit, willingly and purposefully, with my body several times a week for at least an hour: not judging, not frustrating, not grumbling, just connecting and acknowledging.

And it’s…it’s been good. Not quite life-changing, and not quite automatic yet, but good. Meaningful.

In the spirit of reconnecting, I’ve been trying to spread that intention through the rest of the aspects of my life. For a while at the beginning of the year, and again when we moved to New York, I was doing a pretty good job of seeing friends regularly, keeping in touch with family, reaching out to folks I didn’t see often, etc. In the past few months, a lot of that has fallen by the wayside. It’s hard to know for sure if that’s because my commute is longer and I’m just too tired, if I’m mentally exhausted by all the transitions, if it’s just too darn hot for that kind of nonsense, or some combination of the three, but I’ve definitely lost track of a lot of the goals I set for myself at the beginning of the year.

So this month, I’ve been trying to move forward–or go back, I suppose–to the habits that I’ve been trying to build over the course of this year and this happiness project. I’ve been connecting with friends–grabbing a coffee, keeping a monthly breakfast date, doing virtual planner decorating dates, keeping my family group text amused with occasional memes and YouTube videos, even going to a few shows. And even though my inner introvert tends to hate it (kind of a lot, merp), it’s clear–just from my mood and the way I’ve felt at the end of the day–that it’s been worth it.

 

Still–I can’t do it every day. I’m still finding myself running into mental roadblocks with spontaneous plans that throw off my original routine (and things like weather and spontaneous friend/family events have made that a pretty constant reality over the last few weeks, grumble grumble), but the warm fuzzies of spending time with my friends and feeling human connections rather than isolating myself in my apartment has been worth it.

There are some things that I’m still working to reconnect with. My writing time has fallen by quite a bit (hence my very neglected blog), I’ve been journalling less, reading less. But slowly, that’s changing too. I hit the library this week and picked up two new books. I finished the first draft of the novel that I’ve been working on since November (TAKE THAT, WRITER’S BLOCK), and I’m starting some new stories. Slowly, slowly, I’m reconnecting to the the things that bring me joy.

 

When you set an intention for a yoga practice, it’s not meant to be an intention set for the rest of your day or week or life. It’s just that: an intention for your practice, whether that practice is a morning sun salutation, an hour-long class, or a full-day workshop. But you’re setting it for yourself, for the moment you’re in, the body you’re in, the space where you are. So that’s what I’m doing, one moment at a time: setting an intention to reconnect.

One moment at a time.

when happiness is work

One of the odd roles I’ve taken on in a lot of my friendships and other relationships has been “the happy one.”

The first time someone told me that I was the “happy one” in our particular group of friends, I was…well, let’s say “confused,” rather than “offended,” because it sounds nicer. It wasn’t that being happy is a bad thing–it’s obviously not, and the work I’ve been doing on my happiness project is part of my effort to move toward the whole happiness thing–but that I’ve just never thought of myself as an especially happy person. I didn’t (and often still don’t) think of myself as unhappy, either, just not super happy.

At the time, I asked my friend what she meant by that, and she shrugged. “You look on the bright side of things,” she said. “You find good things in people. You smile a lot. You just come off as a happy person.”

Okay. All fairly true things–I will totally admit to being the sort of warm and fuzzy person who hopes that the person tailgating me on the highway is speeding to deliver a baby and not just being a dick, I have one of those weird smiles that seems to prompt people to talk to me and tell me about their feelings (basically the opposite of resting bitch face. Resting therapist face?), I don’t like cutting people off when what they’re saying seems important. But does that really make me seem like a happy person?

Apparently yes, because over the course of the next several years, more people in various walks of life–coworkers, friends, clients, relatives–commented on my positivity, my bright mood, my smile, my idealism, all that jazz. Meanwhile, there I am, looking around in confusion, because my head feels like a jumble of depression, anxiety, chronic pain, and brain fog, and all the happiness that everyone else seems to see coming off me just doesn’t feel visible to me. In fact, I usually feel like I have to force it to show up.

Spending most of my working years in various “helping” fields, from childcare to higher education to mental health, means that I’ve rather inadvertently put myself in professions that require me to be more emotionally “on” than, say…I don’t know, working in accounting or something (sorry, accountants. I just assume that spreadsheets don’t bring that many feelings to the game). For most of my day, whatever my actual mood might be, I needed to be plugged in to the feelings of the people around me to offer support, advice, problem-solving, insight, etc. I’ve been lucky to work at places where I can be a little more “off” when not interacting with whoever the client base happened to be (students, campers, mental health clients, etc), but it still involves a significant amount of emotional labor on a day to day level that can get incredibly draining, especially when the positive emotions you’re expected to display might not be entirely reflective of your genuine feelings. But when people start taking your manufactured happiness as real, they start to expect it, and then you start to assume that you have to project that happiness at all times.

Being and looking happy, then, turns into a job. This is a problem that other women have talked about all over the internet and I won’t repeat their very good points, mostly because this is more about my personal experience than about my feminism, but then, it can be hard to separate the two. Would I be feeling so nervous about not feeling the happiness I project if gender norms didn’t expect me to be smiling and cheerful to every person I meet? I don’t know.

The big question I’ve always had for myself, though, is whether there’s a difference in my mood when I’m not making the effort to act positive compared to when I am. There is something to be said for the “fake it till you make it” effect, and I found that out the hard way over the past few weeks.

I haven’t been shy on this blog about my struggles with chronic pain and depression. Living with chronic physical and mental health issues isn’t a walk in the park, but they’re my everyday existence, and I find myself generally able, for the most part, take a bunch of meds, put some product in my hair, smack a smile onto my face (HELLO HAPPINESS IT’S SHELLY HOW ARE YOU TODAY) and get out the door. But that’s the thing about chronic issues–they’re chronic. You get used to them. You know what to expect, you know what they feel like, you get a feel for your bodies aches and pains and occasional-oh-hey-it-feels-like-there’s-acid-on-my-skin moments. But when you get something else on top of your usual chronic illness (for example, the ass-kicker of a flu I came down with two and a half weeks ago and am still getting over), all bets are off. The things that usually work stop working. All the energy you’ve saved up to get you over the hump of compensating for crummy joints or nerves or serotonin receptors is suddenly gone, and the spoons you’re used to having to get through your day promptly disappear.

Over the last two weeks, all of the positive energy I usually try to summon up to project my happy attitude–to be “the happy one”–went out the window. No more Shelly happy face. I was stuffy and cranky and sleepless and exhausted; I was coughing constantly and couldn’t breathe through my nose (my nose! the only part of my body that I can usually rely on to work! wtf??), I was, in conclusion, a mess. I meandered from my bed to my couch to my bathtub, I slept constantly, I mustered a few smiles for my nephews and family but overall didn’t really even try to be sociable during our Passover seders with my in-laws. I was cranky toward my husband and often asked to just be left alone, and didn’t take much of time to ask how he was doing (except for the occasional thank-you for the many, many sweet things that he did for me while I was being a brat toward him).

It sucked.

But now that I’m finally on the mend and had a bit of my spark back yesterday and today, I’ve started to realize that what sucked about it wasn’t that I felt like crap, but that I was wallowing in feeling like crap. Don’t get me wrong, the flu is miserable, and I think everyone’s entitled to a few “woe is me” days through the worst of it. And in all honesty, throwing a crappy flu on top of an already messed-up body should probably earn me a few extra days. I didn’t bother with any of the usual self-care I took on even on my worst fibro flare days, and losing that probably made things worse. I took baths, but spent them just staring at the wall instead of lighting something that smelled nice and putting on an audiobook or some music. I put the same pajamas on again and again. I didn’t brush my teeth. I didn’t eat and barely drank any water. It felt a lot more like a bad depressive episode than a physical illness, and I think that my total lack of attempt to do anything to take care of myself because I was just in such a bad mood could have very nearly turned it into one.

It’s still strange to think of myself as the “happy one,” as I continue to struggle with the same health issues (both physical and mental), but the past few weeks gave me some insight into just how much I miss that positivity, mostly manufactured or not, when it’s not there. I don’t know if the positive attitude and forward-focused mindset I project are becoming parts of my personality that I like more than I resent, but my time spent feeling miserable and sorry for myself certainly didn’t help me with my healing process.

When we’re kids, no one really tells us that happiness can feel like work, and that sometimes you have to make your own, and that sometimes it sort of feels forced. But I think that I’ll take a little bit of manufactured happiness over my self-sustained misery bubble any day.

It might be faking it until I make it, but I think the faking it helps.

10 things a year as a therapist taught me about life, work & growth

As of 6pm on Friday, I am no longer a therapist.

It’s a strange, bittersweet feeling. For over a year, being a therapist was more than just a job–it was part of my identity. Work didn’t get to stay at work; it was part of my life in a deeply profound way. My co-workers became my supporters in ways that were unlike anything I’d experienced at any other job; the concept of a “mental health day” took on an entirely new meaning, being present in my work became more important than ever.

Looking back on the past year, it’s hard to pick out the things that I learned from being a therapist as opposed to things I learned simply by getting another year older (and maybe a few months wiser). But that, I suppose, is why self-reflection has become such an important part of my growth process. I’ve written before about journaling and how daily reflective practice has changed the way I spend my time, but it really has made a huge difference–not just in my ability to look back at moments of gratitude, but to watch myself experience learning and growth. It’s also allowed me to read old entries and see the places where I learned hard lessons and received some painful reminders of my own limitations–limitations that, thanks in part to that active self-reflection, I was sometimes able to turn into strengths.

But not without challenges, and not without luck, and not without help.

For better or worse, I’m a lists person, and I do my best memory collection through organization. So, here we are:

10 Things a Year as a Therapist Taught Me about Life, Work & Growth

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embracing vulnerability (happiness project, part 5)

Fairly early on in my graduate social work program, our program director sat down with my cohort and talked to us, pretty frankly, about the burnout problem. Some fairly ridiculous percentage (like, 21-67% across multiple studies) of mental health workers report high rates of emotional exhaustion and cynicism with the profession, leading to increases in anxiety, depression, and stress-related health issues. She told us, gently but frankly, that in her experience, a significant number of MSW grads end up leaving the social work field, or at least direct service work, within five years.

I remember, distinctly, looking around that room of bright-eyed, bushy-tailed MSW students, and thinking to myself, “Okay, some of us are gonna burn out, but I’m not going to be one of them.”

What’s that saying about famous last words?

When I chose social work as a field, I knew I was getting into a profession with long hours, low pay, and high rates of compassion fatigue. I’ve written before about the struggle I’ve had balancing my own need for self-care with the desire to spend all of my emotional energy on my clients, and in all honesty, it’s something I’ve struggled with throughout my career–and probably always will, regardless of whether I’m in direct service work or not. It’s just another part of who I am, much to my husband’s chagrin.

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But as convinced as I was at the beginning of my graduate program that I was not going to be one of the social workers who burned out in their first five years, I’m beginning to admit that maybe I am. It’s impossible for me to ignore that in the year that I’ve been in clinical work, my health issues–both physical and mental–have gotten worse, my stress levels have skyrocketed (despite pretty significant work over the last six months on self-care routines), and overall, may happiness has just decreased. I love my clients, and in many ways I feel deeply fulfilled by the work that I do. But I also feel tired, frustrated, angry, sad, fiercely furious with the social systems I’m forced to work within, and overall, exhausted.

So, as I recently announced to my work colleagues–and therefore now all of you readers–it’s time for a change.

Besides being one of my absolute least favorite things on the planet just on principle, being on the job hunt means exposing myself to one of my biggest anxiety triggers: putting my own future in someone else’s hands.

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I spend a lot of time hanging out with my therapist and talking about why this is such a big deal for me, and in all honesty, we’ve been digging around in it for awhile. We’ve spent a while going back and forth talking about how much I love to plan and control things (case in point), and how job searching is basically impossible to plan or control, because all you’re doing is sending cover letter after cover letter out into the void, hoping like hell someone will send you an email.

(Also, can I just say that whoever started the “due to the amount of responses, we will only contact you if you are invited to interview” thing is an absolutely terrible person? Because seriously. Send a batch “rejection” form email if you have to, but leaving everyone else in limbo is awful, and I hate that it’s become the norm.

Anyway. I digress.)

Wrapping my mind around just why it is that this job search thing makes me so uncomfortable–beyond just the aforementioned frustrating limbo–has been an ongoing challenge over the past month or two that I’ve been engaged in this process. I’ve probably spent two or three days’ (or at least nights’) worth of time trying to connect to the feelings of fear and anxiety that come up every time I think about writing another cover letter or sending another email, and each time, I find myself back at the beginning of my thoughts, deciding that this must just be some kind of personal failure.

But help comes through in weird places.

In my post about New Years’ Resolutions, I talked about wanting to make an effort to watch one TED Talk each month. I spent most of January vaguely scrolling through the TED site from time to time and occasionally bookmarking things to maybe watch later, and ended up scraping in right under the wire last night, thanks to a list of 5 Must-See TED Talks for Social Workers that a friend of mine shared on Facebook. The one I picked was “The Power of Vulnerability” by Brené Brown, and you guys, I don’t say this much, but it was actually life-changing.

 

In her talk, Brown talks about the biggest barrier to human connection is shame–something that each and every one of us feels at one time or another. Shame is that deep, emotionally exhausting feeling of not [blank] enough–not good enough, not smart enough, not worthy enough. And that to overcome this shame, what we need to do is allow ourselves to be vulnerable; “to allow ourselves to be seen, really seen,” in order to embrace connection. And that, of course, is absolutely fucking terrifying.

So Brown set out to do some research, to deconstruct shame and kick vulnerability’s ass, and to figure out just what it is that separated the people who were able to overcome shame and believe themselves worthy of love and happiness from those who couldn’t. What she found, at the heart of the matter, was this:

“There was only one variable that separated the people who have a strong sense of love and belonging and the people who really struggle for it. And that was, the people who have a strong sense of love and belonging believe they’re worthy of love and belonging. That’s it. They believe they’re worthy.”

Brown wanted to dig deeper, so she sat down with her interviews and did a more in-depth analysis to see what those people with a belief in their worthiness had in common. And she found four factors. The first three, I thought, seemed to make pretty perfect sense. They had a sense of courage, or as Brown phrased it, “the courage to be imperfect.” They were compassionate to themselves. They had connection.

But the last factor, to both Brown’s and my chagrin, was this: they embraced, wholeheartedly, vulnerability. They knew that in life, vulnerability was a necessary, if uncomfortable, emotion–necessary for connection, necessary for learning, necessary for growth.

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Brown’s reaction, and mine, was essentially this:

What the hell, research?!

(It was at about this point in the video that I realized that Brown and I would probably get along really well.)

I’m not going to recap the entire video, because you should really watch it–please, please watch it–but I will tell you what I really took away from it. Vulnerability, as awkward and stomach-churning and anxiety-producing as it is, is something that we must connect with if we are to connect with all of the emotions that come with growth and progress. When we close ourselves off from vulnerability in order to avoid the painful feelings that sometimes come with it–fear, anxiety, disappointment–we also lose out on happiness, on personal growth, on excitement.

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When I meet with my clients and they bring an uncomfortable feeling into the room–depression, grief, worry, pain–I ask them to spend a moment sitting with that feeling. I ask them where they feel it in their bodies, where they carry it–in their shoulders, in their chest, in their belly? I ask them to connect with the feeling and allow themselves to feel it, rather than instinctively away, because listening to those feelings is part of the process of understanding them. But doing this for myself has always been something I’ve recoiled against, preferring instead to press past vulnerability and project an air of surety or calm.

It may seem strange to bring vulnerability into my happiness project, but the more I think about it, the more I begin to understand that embracing vulnerability is a critical part of practicing happiness. Where my clients need to connect to the feelings they bring into my office, as I prepare to leave that office I need to connect to the vulnerability of allowing others to control where I go next. I need to lean into my discomfort, not push it away, and only through that discomfort and vulnerability will I be able to reach out to opportunities.

As uncomfortable as it is, I don’t know where the next step in my career will be. But I know that vulnerability is part of the journey.

And, strangely, I’m excited to start.

#readingwednesday: is it me or my meds?

“On Prozac, Sisyphus might well push the boulder back up the mountain with more enthusiasm and creativity. I do not want to deny the benefits of psychoactive medication. I just want to point out that Sisyphus is not a patient with a mental health problem. To see him as a patient with a mental health problem is to ignore certain larger aspects of his predicament connected to boulders, mountains, and eternity”

– Carl Elliott

 

I’ve had a complicated relationship with psychotropic medication.

 

When I was in college, I spent a lot of time being not-so-gently nudged into therapy by multiple people (my family, my friends, my then-boyfriend who is now my husband). While it might sound odd coming from a now-therapist, I really wasn’t into it. It seemed very weird to be talking to a stranger about my problems (cue ironic trombone noise), and I didn’t like the idea of doing it–it set off major alarm bells with what I now know is my anxiety. But hey, hindsight is 20/20, right?

 

While I wasn’t in therapy in college, my sophomore year was when I started seeking medication to specifically deal with my fibromyalgia and migraines, and suddenly found myself on a series of antidepressants. I didn’t realize it then, but SSRIs and SNRIs are often used to treat physical  conditions as well as psychiatric ones, and that meant dealing with all of the many side effects, some of which exacerbated the very conditions they were supposed to be treating.

 

Now, working as a mental health therapist for a child and adolescent agency, I often find myself referring clients for medication evaluations with our psychiatrists and psychiatric nurses–sometimes at their request, sometimes at the request of their parent or guardian. In our practice, clients receiving medication are, with some rare exceptions, also required to be in counseling with a therapist. I would estimate that probably about 60% of the clients in our practice take psychotropic medications, which leads to a lot of questions about the nature of how we refer kids for meds, how we decide when they need meds, and what it means to use psychotropic medications on young, still-developing personalities and minds.

 

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I first read David Karp’s Is It Me or My Meds? for a sociology course in college, but found myself drifting back to it a few weeks ago after having a conversation with a teenage client about her difficulty in deciding whether or not she wanted to give meds a try to manage her depressive cycles. Part interview report, part research project, Karp’s text explores the relationship between “pills and personhood”, looking at the ways in which people of different ages, backgrounds, and mental illnesses relate to their diagnoses and prescriptions.

 

When I read this book back in college, my knee-jerk reaction was almost to recoil. It freaked me out to learn about the ways that psychotropic medications changed the way people think and feel. I didn’t like how easily it seemed that psych meds were prescribed and the high rates of people–especially kids and teens–on multiple meds at once. (In all honesty, this is something that still worries me–the CDC reports that one in thirteen American kids between the ages of six and seventeen takes at least one psychotropic medication, and rates of psych medication prescription soars when kids are involved in the special education, foster, and juvenile justice systems.) That said, even in my first read-through back in college, I could see that Karp is careful to take a nuanced approach to understanding psychotropic medications, and for good reason–Karp discloses in his preface that he himself has taken antidepressants for years, and had spent a significant amount of time struggling with the changes he noticed in himself when he began taking medication.

 

Reading the book again as an adult and a therapist, I have a different experience. I’m more appreciative of the way that Karp works to understand the entire system of each person he interviews–looking at the whole person, the context of their experiences. In the work I do now, I’d estimate that eighty-five to ninety percent of my clients come to me with a trauma history–some kind of experience of pain or fear that had a significant impact on the way they currently function. I’ve learned the way that trauma can disguise itself as ADHD and Oppositional Defiant Disorder and depression and anxiety, and while I deeply appreciate the ways in which psychotropic medications allow my clients to function while we work through the underlying issues that contribute to their symptoms, I also understand that without the therapeutic component of their treatment, medication alone would not be sufficient to keep most of them functioning.

 

There’s a reason why the recommended treatment for most mental health disorders is to utilize a combination of medication and psychotherapy. Two of the many medications I take currently to manage my physical chronic health conditions are psychotropic, and even though those meds aren’t prescribed for to treat my anxiety and depression, I’ve found that I do considerably better managing those symptoms when in therapy than I do while taking those same medications without therapy. Is It Me or My Meds? isn’t the most academic or always-engaging of texts, but it is a great read for anyone who is trying to explore the decision to start medication, and I would absolutely recommend it for clinicians who want to improve their insight into what their clients might go through when they make the decision to start–or to stop–psychiatric medication.

 

Karp’s book asks its main question right in the title, and in all honesty, it doesn’t find a real answer. As clinicians, we tell our clients that medication can help them be the best, safest version of themselves; as patients, we do our best to hope that medication isn’t changing who we are. There is no single experience with psychotropic medication, but each person who takes them makes that decision carefully, and often uncertainly. If nothing else, what I take away from this book–and back to my clients and myself–is that medication is a step on a journey to living as one’s best self.

 

It’s not the destination.

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For more great images about conquering the mountain of mental illness, check out The Doodle Chronicles on Tumblr.

world mental health day 2015

Days that draw attention to mental health and mental illness are bittersweet for me.

Working in the mental health field means that I am, on a daily basis, on the front lines of helping others on the road to recovery, whether that means teaching and practicing coping skills for depression and anxiety, processing and overcoming trauma, finding alternatives to self-harm or restrictive eating or substance use, or any other number of therapeutic activities. My clients range from five to twenty, and each of them has their own story, their own journey, and they’re all at different points on that journey. I feel so blessed, every day, to be there to watch them grow and change as they learn more about themselves and take steps—slow steps, baby steps, whatever is the right pace for them—to get to a place where they are safe, and comfortable, and ultimately, hopefully, happy. As stressful and infuriating as my job can be, I deeply love the work that I do.

For me, the part of World Mental Health Day that is the most difficult is the part that is personal.

To be a therapist with mental illness is to feel like a walking contradiction on good days and a hypocrite on bad ones. It’s constantly wondering whether or not it’s safe to self-disclose, not to clients, but to co-workers and supervisors, wondering if they’ll treat you differently if they know that you might be closer to clients at the beginning of their therapeutic journey than to those at the end. It’s teaching coping skills and feeling hope for your clients and frustration with yourself, the constant questioning of why these skills don’t work for you, or at the very least, why you can’t just teach them to yourself.

A note: You can’t practice CBT on your own brain. It doesn’t work.

I don’t know exactly what DSM codes my own therapist has on her paperwork for me, and I don’t spend my own time with that brick of a book diagnosing myself. I know enough about my own mind to acknowledge that I have struggled with depression and anxiety for years, likely for longer than I’ve understood the concepts. It’s only been in the last few years that I’ve realized that the way my mind works isn’t typical. It’s not typical to have to spend five minutes taking deep breaths to work up the courage to make a phone call, to lie awake at night terrified that a conversation in fourth grade might come back to haunt you, to be suddenly struck, in the middle of a perfectly lovely day, by a wave of thoughts that everything you’ve done amounts to nothing, and that you’ll never be the person you thought you could be when you were little. It’s not typical to have to force yourself through things like taking a shower or getting dressed because the very idea of movement seems overwhelming and exhausting, to burst into tears at the smallest provocation, to sit in a bathtub and wonder what would happen if you just put your head under water and let it stay there. It’s not typical to wonder what the world would be like without you in it, to glance at telephone poles and road dividers and wonder what would happen if your car slid on wet pavement or ice. To not want to kill yourself per se, but to think, sometimes, that it would be okay to fall asleep, and stay that way.

Combining all of this with a chronic physical illness compounded things over the past few years. Study after study has found correlations between chronic pain and depressive disorders, and they’re so wrapped up together that it’s impossible to distinguish cause and effect. The addition of pain to existing depressive and anxious symptoms can take an okay day to one where leaving a bed is impossible. Guilt runs rampant; you tell yourself, you should be able to do this, you’re weak, you’re letting everyone down. This is why no one wants to spend time with you.

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(The rational therapist’s mind knows that these are intrusive thoughts, but an anxious mind is louder, a depressive mind more poetic, and the rational mind has a soft voice and is easily overpowered.)

This year, I took the radical step of putting myself into therapy, and that step in and of itself was terrifying. I was scared that a therapist would tell me that I wasn’t fit to work with clients, that until I got my own shit under control that there was no way I could practice as a clinician. After the brief, horrific therapy attempt I made in college, trying again, in a clinical community as small as the one in Berkshire County, made my skin crawl. I’ve been hugely lucky to find a therapist who is kind and comforting and candid, who allows me to take of my therapist hat while using my own background and knowledge to help me understand the way my own mind works—or rather, doesn’t. These last few months in therapy have been terrifying in their vulnerability, but I feel so, so glad that I’ve taken that step.

But even therapists aren’t immune from stigma, from repeating the same harmful statements that keep people who could benefit from treatment from seeking it. I recently had a conversation with a professional who’s been in the field longer than I’ve been alive, and her offhand comment of “Well, there are some people who can solve their own problems, and others who need someone to help them do it, but it really shouldn’t be for everyone” made me feel nauseous and judged. I still feel my heart jump into my throat when I mention my therapist to a co-worker, and I watch their micro-expressions for the tiniest hint of judgment or disappointment. I put on a façade of functionality, because even I have convinced myself that there is a time and place to acknowledge my own mental health needs, and those times are limited, those places few.

I hesitated before writing or posting this tonight, and part of that hesitation came from the internalized stigma I’m still trying to overcome. But World Mental Health Day is important. It’s so important that we tell these stories, that we take these thoughts and feelings out of the darkness and bring them forward so that people know that they are not alone. Depression and anxiety are still daily struggles for me, and will almost certainly remain so for a long time, but even compared to a few short months ago, I feel safer, more prepared to manage those feelings simply by acknowledging that they are there.

For any of my friends who are struggling with mental illness, I urge you to take a step—however small—to move to a safer place. Confide in someone. Start a journal. Reflect on the positive moments in your day, whether it was a hot cup of coffee or snuggles from a pet. Visit a therapist, if that’s something you can do. Ask for help, if you’re feeling unsafe. But know that you are not alone. That however loud anxiety brain shouts, whatever poetic words of despair depression feeds you, that you are loved, and cared for, and the world wants you to stay.

Walking On The Earth