The futility of gratitude – and why it’s so important

I had an interesting realization in therapy the other day, and it led to this blog entry. Stay with me for a second.

My therapist and I were talking about trying to change my mindset from both a depression and anxiety perspective. I think a great deal of anxiety comes from a fear of “not being able to handle” any given situation – be that going to school, work, travel, whatever. I’m not quite sure what “not being able to handle” means, save for turning into a blubbering ball of sad and fear, but whatever. Now, by and large, that’s a silly fear. There’s no such thing – not really – as “not being able to handle” something. Sure, there are some life events and experiences that go better than others, but short of dying, you get through life.

This sort of fear in stressful situations can manifest itself in many ways. One of them is that it causes a shift in mindset. You no longer engage in new experiences to enjoy them or learn from them – instead, you do so in order to say “I survived” them. This mindset can be damning for so many reasons. You start an experience not looking to enjoy it, but to get through it. This kind of bunker-mentality can absolutely destroy your ability to get any joy. To try new things. To adventure or gain new experience. Indeed, it makes you afraid, and it makes you far less willing to be adventurous. You live in a constant state of looking over your shoulder, wondering when the anxiety attack will hit. Wondering when you will get cripplingly sad. Wondering what goes wrong next.

This way of thinking, of living – survival versus gratitude – can be absolutely crippling. And it leads me to the point of today’s entry: I don’t want to just survive. I want to thrive. I want to learn and to live. Don’t you?

How do you do that? Hahaha, yeah come on, you know I don’t have an answer. I only have a piece of one. That’s this: Try to change the way you approach new situations. Approach them from a perspective of gratitude and gaining new experience. Instead of entering an anxiety-provoking situation from the perspective of, “Oh, God, how am I gonna get through this?” ask yourself, “Okay, what can I learn from this?” or better yet, “How can I be grateful for this experience?”

Now, I titled this entry, “The futility of gratitude” because I am not an idiot. When you are depressed or anxious and someone tells you to “Be grateful,” you probably want to punch that person in the face. Grateful? For the crippling fear and sadness? That’s madness.

But, that’s exactly why it’s so important.

The only way to break anxiety and depression is to change the way you think. The way you process thoughts and emotions. And the only way to do that is to shift your mindset. So, just try this. Try, every now and then, asking yourself this question: “How am I learning from this new and difficult situation?” or “What can whatever I am experiencing right now teach me so I don’t encounter these problems in the future?” Fear is only crippling is it denies you the chance to grow, to learn. And there’s no such thing as an experience you can’t handle.

So, try to ask yourself that. Try to ask yourself what you can be grateful for. What you can learn. Shift your mind, and maybe you can shift your emotions too.

“A woodpecker on steroids” – My experience, so far, with Transcranial Magnetic Stimulation

So, for the first time in my multi-decade battle with depression, I’m trying a new type of therapy (other than talking and taking pills). It’s Transcranial Magnetic Stimulation (TMS), and I’ve written about it before.

Here’s the basic gist of how it works:

Transcranial magnetic stimulation (TMS) is a method whereby an electromagnet placed on a scalp transmits magnetic pulses or waves to a small portion of the brain. Repetitive transcranial magnetic stimulation (rTMS) delivered at a low frequency (once per second) has been shown to reduce the reactivity or excitability of the part of the brain stimulated and other brain regions functionally connected to the region stimulated.

I started it Monday, and it is time intensive – not so much in how long you have to sit there (my sessions are only twenty minutes), but in terms of how long you have to do it – for me, it’s six weeks, five days a week. I had to wait until vacation was over and for a break in my calendar to make it happen.

As for how it works: Honestly, it’s not hard. You sit there. You get yourself into a nice and comfy chair and they adjust a couple of things by your head. The right side of your head is lined up with a pad to keep your head still. The left side of your head is where the action is at – a magnet, enclosed in some equipment, is aligned in the right spot. It’s desired location is your frontal cortex, which is the area of your brain where depression apparently can be adjusted. They send one magnetic pulse into your head, and if your hand twitches, they have the right spot.

Once they have the right spot, they save the settings and that’s where you sit. If it’s aligned right, you may feel a little discomfort or pressure during the actual treatment. The actual treatment consists of your head being tapped with a magnet (not directly, but through padding) for four seconds, followed by a rest of twelve seconds. That continues for twenty minutes.

Is it painful? No. The first alignment can be – if it’s misaligned, it hits a nerve and OUCH. It just stings for a few seconds. They readjust, and then it’s fine. Now, is it comfortable? Nah. But you do build a resistance to it. I had a headache and took Tylenol the first three days. By days four and five I barely noticed. They also give you earplugs. Those are optional, but if a Doctor gives you ear plugs, use them, okay?

It’s a strange experience, described to me by the nurse as being hit by a woodpecker on steroids. I love that description, and it’s accurate. I mean, you’re basically getting tapped by a magnet or roughly 30 times over four seconds. It’s weird, but not painful. I’ll putz on my phone, close my eyes and chill, whatever. Honestly, its not that bad. The session ends and you go back to work. There are no after effects, except for maybe a slight headache that Tylenol can bop right out. You can drive, think, function, etc. I’ve left therapy sessions where I’ve been more disoriented.

When am I supposed to see results? The literature I read said week four. They said they thought they had seen some people get more depressed as the placebo effect wore away in week two. I’m hoping I don’t go through that, because I have no illusions that this will work until at least week four.

So, one week down, five to go. Here’s to hoping.

As always, I’d love to hear your thoughts and experiences, and as the process goes on I’ll share more, including some pics. Let us know about your TMS experiences below!

SIDE NOTE: First, again, I’m not a doctor or medical professional – I’m a damn politician and writer. I’m certainly doing my best to write an accurate description, but if you have any questions or concerns, please contact a medical professional. Second, this probably goes without saying, but I’m going through this treatment like any other normal person and paying with my insurance. I am not receiving any compensation or consideration whatsoever for sharing my experiences.

Finding light in the darkness

I’m going to write about two things that personally motivated me to deal with my own demons in a very public way. The short-term inspiration for this is me rereading the acknowledgements section of Redemption. The longer-term inspiration for this is a public tragedy and a low period in my life.

Okay, first, here’s a small section of the acknowledgements in Redemption:

To Robin Williams. Yours was a life well lived, and I hope to be part of a positive story of those influenced by how it ended.

Let me go backwards. Robin Williams completed suicide on August 11, 2014. He had long suffered from a slew of mental health challenges, including depression and substance abuse. However, Williams was suffering from “diffuse Lewy body dementia,” which ultimately contributed heavily to his suicide.

William’s suicide ultimately inspired me to go public with my story. That started when some idiot on Facebook decided to spout off shortly after Williams’ death by saying something along the lines of, “So sad Robin Williams committed suicide. He just needed to pray to Jesus more!”

No, you schmuck, that’s not how it works, and that ignorant comment got me so damn fired up that I wrote an op-ed in my local paper, detailing my own struggles with depression, anxiety and suicidal ideation. That, in turn, set my career in motion in a very different way, making me become much louder about mental health issues. I’ve spoken at events detailing my own struggles, cofounded a mental health caucus, appeared in PSAs and introduced legislation designed to help those who are suffering from mental health challenges. I know that the work I’ve done in this realm has helped people – and I know I have a lot more to do to help more.

It also inspired this speech, the most difficult one I have ever made:

Fast forward about seven or eight months, and I’m struggling, in the midst of one of the most depressed periods of my life. I’m struggling at work, my wife is struggling at work, and life just generally sucks at the moment. I go back to see my therapist. I increase my medication. And then I realize something else: I desperately need an outlet. Something to help get me through everything I am suffering from. I decide to start writing again – I wrote fiction as a kid and had published the non-fiction book I wrote, Tweets and Consequences.

And I remember this goofy plot idea I had as a kid, twenty years ago, about kids getting trapped on a spaceship. And I realize something: That’s not a bad plot. But what if I could make it more? What if I could fold in a mental health message as well?

And thus, Redemption is born.

For what it’s worth: I have a character named Robin in Redemption. In all fairness though, that’s also my daughter’s middle name, so let’s call that character’s naming a 50% tribute to Williams and 50% tribute to my daughter.

The death of Robin Williams helped me and countless others find their voice and seek help. I know that this may be cold comfort to those he loved and those who loved him. But I sincerely hope that they can take some solace in knowing that Williams’ life and death helped so many, including me. His was a life well lived – and, as I said above, I hope to be a small part of that story.

You can always find light in the darkness. Pain makes us great, and with time and therapy, you can turn the most agonizing periods of your own life into something incredible.

As long as you breathe, there is hope. The trick is just finding it sometimes.

Transcranial Magnetic Stimulation?

You know, you first hear about something like this, and you think it sounds like some sort of witchcraft nonsense. Magnets? To help depression?

Apparently. And it’s scientific based.

I write about this now because I had an appointment last week to explore this as a treatment possibility, and it is likely something I’m going to pursue. Here are the basics, per the Mayo Clinic:

During a TMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. And it may activate regions of the brain that have decreased activity in people with depression.

 Though the biology of why rTMS works isn’t completely understood, the stimulation appears to affect how this part of the brain is working, which in turn seems to ease depression symptoms and improve mood.

The most important question, of course, is this: Does it work? According to the evidence I have seen, yes, and that’s in tests involving a placebo. More research is needed, but this appears to work.

Thankfully, the side effects are very mild, per the Mayo clinic.

Side effects are generally mild to moderate and improve shortly after an individual session and decrease over time with additional sessions. They may include:

  • Headache

  • Scalp discomfort at the site of stimulation

  • Tingling, spasms or twitching of facial muscles

  • Light headedness

The biggest drawback, as best I can tell? The Doctor I spoke with told me its most effective to do it every single day, for 4-6 weeks. Session, I think, are 30-45 minutes. That’s a heck of a time commitment. That being said, sucks for me. It’s not the Doctor’s fault that this is the way the brain works, but it’s certainly a challenge with my schedule – going to Harrisburg and vacation means I won’t have that kind of time until August.

So, let me conclude by asking you for your experiences. Have any of you out there had TMS? Any experiences to share? I’d love to hear them!

College and mental health

A friend of mine was kind enough to share with me this article in Time, an extremely eye-opening look at the massive spike in college students seeking mental health services – and college’s struggles to keep up with the demand. For those of you who are interested in this topic, I highly recommend that you read the entire article, because its a very comprehensive look at the issue.

The summary is this: More college students are in need of counseling services, but many colleges do not have the capacity to deal with these students mental health challenges. This shouldn’t be surprising: 75% of all mental health issues onset by age 24, and college is a time of transition where young adults are cut loose from all their previous moorings and experiences – thus shaking loose a good deal of mental illness, sadly.

Unfortunately, suicides in the United States have been on the rise since 1999, cutting across all demographics, and college is no exception. Even worse is that, many colleges do not actually track suicides, creating a major problem for dealing with this issue.

I will say that this is a deeply personal one for me. In the course of my mental health journey, I think I always suffered, even from the time that I was a little kid. It was my freshman year, however, when all hell broke loose. It was the first time I was away from home, from my family, my girlfriend and everything that I had previously known. I wasn’t ready for college and the experience of basically restarting my life, and I REALLY wasn’t ready for the “party” culture of college. I didn’t party – just the opposite – I was intimidated by everyone who did and didn’t know how to deal. As a result, my depression and anxiety exploded. Freshman year became the turning point for me – it’s the year I first started to suffer, but thanks to the counseling center at Muhlenberg, I had access to a great therapist who helped save my life by helping me develop strategies to deal with my depression and referring me to a psychiatrist who put me on the medication I still take to this day.

This issue is one of the reasons that, in my legislative career, I introduced legislation which would require colleges to develop and disseminate plans on dealing with mental health and suicide prevention. It’s a small step, but one that I think is desperately necessary to deal with this issue.

This is a major issue from a mental health perspective in this country, and one that we desperately need to deal with. The good news is that people are paying attention – and hopefully will continue to do so.

Depressed? Try volunteering

I caught this article on Motherboard and it really, really got me thinking.  The article itself is certainly worth the read, but I’ll try to summarize the points and add my own spin on it.

The article notes that volunteering helps with depression.  This happens a few different ways:

  • First, there are mental and physical benefits to volunteering.  Volunteering can lower blood pressure, reduce the risk of hypertension and make you physically feel better.  This happens, in part, by noting that oxytocin (feel good brain chemical) gets released when you regularly volunteer.
  • Volunteering helps you keep things in perspective.  It gets much harder to be depressed when you are working with someone much less fortunate than you.  I’ve always found this to be a helpful strategy, to be honest: On moments when you are depressed, compare yourself to someone who has it worse than you.
  • Volunteering gives you social connections and social interaction, a challenge for people who are depressed.

It’s actually the second point that I want to talk about more than anything else, because that’s something I’ve always found to be powerful: Volunteering gets you out of your own head.  Let me point back to a blog entry I made some time ago about depression and rumination: Thinking obsessively about yourself, and your own problems, can be tied very strongly to depression.

That’s where volunteering can come in.  Not only are you exposed to people in legitimately worse situations than you, but it can help you out of your own head, as it is much harder to think about yourself when you are trying to help others.  Sometimes, your brain needs that extra kick in the butt to stop the thoughts of yourself.  And that’s where volunteering can come in.  According to the article, there is no volunteering that is better than others – doing good means feeling good.

I do want to add one clarification here, however: I’ve made volunteering sound like a selfish exercise designed to the volunteer feel better. That’s not the attitude that you should have when you go to do good. Don’t get me wrong, there is nothing wrong with volunteering because you want to feel better and are hoping to build some social connections and make a difference.  But I would remind you that the only way to truly reap the benefits of volunteering is to do so by approaching it from an ultimately selfless perspective.  Go somewhere with the hope of doing good, and the rest of it will fall into place.

As always, I am curious to hear your perspective.  What good experiences have you had with volunteering in the hopes that it will help control depression?  How about negative ones?  I know I’ve felt both ways when volunteering, and I’m curious to hear other perspectives.  Let us know your thoughts in the comments!

Why talking about mental illness helps

I’d almost make the argument that the thing that makes the most sense about depression is that it doesn’t make any sense at all.

Like, none.

Understand that this is just my perspective, but hear me out on this one.  Depression, anxiety, mental illness, the works, they make no damn sense.  I mean, isn’t one of the things that makes us human the ability to control our own thoughts and act independently?  “I think, therefore, I am?” and all that?

Which is why having a mind that works against you so darn frustrating.

Call me crazy here…okay, don’t, I do that enough on my own…but I think that one of the reasons that depression is so frustrating, confusing and mystifying is that it goes against the very thing that makes us human: Our ability to think.  Humans are fundamentally logical and emotional creatures, right?  I firmly believe that there is a piece of our own minds will always believe that it is in control.

Of course, that isn’t the case.

Even now, even as someone who has been living with depression for years and doing so in a very public forum – it still makes no sense to me.  How is it that people who are so successful, loved and popular can still suffer so?  And I ask myself this question despite the fact that I am someone who has depression.

So, that brings me back to the crux of this blog entry: Why I think that talking about depression/mental illness in an open, honest and public manner helps, and why I always encourage others to do the same.

I think it helps us make sense.

I firmly believe that the idea that we aren’t in complete control of our emotions and thoughts is a truly alien one, something that most of us struggle with on some base level.  To that extent, I think that talking about mental illness helps.  It helps us process what’s going on in our brain and make sense of the thoughts and feelings that we are experiencing.

I obviously don’t have all the answers to mental illness – if I did, I’d be a lot richer, and at least a little bit happier.  But I would suggest this: If you are one of the people suffering in silence, do what you can to change that perspective.  Talk about it.  You may not have access to a supportive network of family or friends, but I think you’d be surprised at the amount of online support groups that you can participate in – anonymously or not.  Even the act of sitting there, and formulating your feelings, can help process your emotions and make a positive difference in your life.

And, on a personal note: I’ve found that this blog has helped my advocacy tremendously, and not just because it gives someone else a chance to read my thoughts.  By putting “pen to paper,” so to speak, it gives me a chance to organize my thoughts, examine my feelings and reevaluate the way I handle my own recovery.  It’s also helped me to rethink some of my public advocacy, in particular the portions related to stigma – it’s not just stigma that matters, but self-stigma.  

As always, I’d love to hear your thoughts.  Am I onto something here?  Let us know in the comments, and have a wonderful day!

What anti-stigma really means

Call this one a brilliant thought that I had in the shower the other day.

There are plenty of anti-stigma campaigns related to mental health.  In many cases, the goal of these campaigns is simple, noble and necessary: to defeat “mental health challenges in the workplace and at home.”  This is vitally important work.

There’s good news related to that though.  In many areas, anti-stigma campaigns have already done their job.  For example, a poll taken in my home state of Pennsylvania (March 2017) shows high levels of comfort in terms of working with someone with a mental illness, a vast improvement over previous levels.  While there is still a long way to go, this poll shows significant movement in the area of mental illness.

I was thinking about this poll the other day, and it had me thinking: What does anti-stigma really mean?  Obviously we need to continue to work on critical areas like discrimination and access to healthcare, but I’d argue there’s more than that.

My argument is this: The most powerful sense of stigma is self-stigma.

Consider this 2012 article, which describes self-stigma as when “patients agree with and internalize social stereotypes,” resulting in:

•Patients often think that their illness is a sign of character weakness or incompetence.
•Patients develop feelings of low self-esteem and become less willing to seek or adhere to treatment.
• Patients anticipate that they will be discriminated against, and to protect themselves they limit their social interactions and fail to pursue work and housing opportunities.

As a result, patients find themselves less willing to seek treatment and social support, leading to lower rates of recovery.

This realization has had me rethinking how I approach the notion of anti-stigma campaigns.  Of course they should be focused on ensuring that all of society views people with mental illness not as sick freaks who are weak, but as real people suffering from real disorders that can be treated like any physical illness.  I want to push society to a place where all of us – those with mental illness and those without – view people who are suffering from a mental illness the same way that someone views a cancer patient.  No one who suffers from a mental illness should do so in fear, shame or silence.  They should talk about their therapy appointments the same way a cancer patient discusses chemo or someone with a broken leg discusses physical therapy.

I suppose, then, that what I am saying is this: Anti-stigma campaigns shouldn’t just address societal stigma.  They should address self-stigma as well.

As always, I welcome your thoughts – am I onto something here?  More importantly, have you found any anti-stigma campaigns that fulfill what I am describing?  Let me know what in the comments!

The importance of telling your story

This is a bit of a different entry: Partially standard, but also partially self-promotional.  Fair warning!

As I’ve discussed before, I made a very conscious decision, about three years ago, to tell my story about my experiences with anxiety and depression.  I made this decision because I thought it was important to put a face to these two largely misunderstood and under-discussed disorders, and because I realized that doing so would help fight the stigma that still surrounds both of these illnesses.  A good friend of mine also told me that going public would change my career in a very dramatic way – he was completely right, in ways that I totally failed to anticipate.

Three years later, this public conversation has evolved into something more.  I’ve always enjoyed writing, but had basically given up the art of writing fiction.  That changed around 2015, when, during one of my down periods, I decided to try it again, remembering the joy and therapeutic value I got from it.  Reading Fan Girl by Rainbow Rowell at around the same time certainly helped remind me!

That, in essence, was the start of Redemption, my fiction book that will be premiering in the first half of 2017.  I’ll have more to say as the book gets closer to release.  The basic plot is this: A group of young adults find themselves transported onto a spaceship, and they have to save the world. What makes this one a bit different is the main character, who suffers from anxiety and depression. Sounds familiar, right?

If you are interested, I discuss the book, my own battles and the importance of telling your story in this podcast with my friend Kim Plyler of Sahl Communications.

Obviously I wrote this book to tell a story, and I think it’s an important one: Depression and anxiety are real, they are treatable, but they don’t have to stop you from doing important things and living/enjoying your life.  I discuss all that and more in the podcast, and I hope it’s something you can listen to!

Reimagining Electroconvulsive Therapy

I had the pleasure of attending an event earlier this week in which another local elected official personally discussed his own experiences with anxiety, all in the name of an anti-stigma campaign by our local chapter of the National Alliance for Mental Illness.  One of the speakers at the press conference was a psychiatrist who discussed stigma surrounding mental illness, but he got a little bit more specific: He discussed ECT, or Electroconvulsive Therapy.

Electroconvulsive Therapy was once one of the cruelest treatments for mental illness imaginable.  It’s common use in American began in the 1950s and was largely brought into public view by the film One Flew Over the Cuckoo’s Nest.  It became a controversial treatment option, and with good reason: Patients were often treated against their will and with dangerously high doses.

That being said, that’s no longer the case.  Indeed, to say that the therapy has changed is an understatement.  From the Mayo Clinic:

Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses.

The article goes on to note that ECT is used when other treatment – medication and therapy – is less effective.

Is it still risky?  Sure, like any therapy, there is the potential for side effects, including confusion, memory loss and other complications.  That sounds bad, but most of those side effects are also temporary.  That, and let’s be honest: Can you find an effective drug without potentially problematic side effects at this point?  Nope.

How effective is ECT?  Well, according to this article from Psychiatric Times, very: 60-90% of people have a positive response.

If you’ve ever read this blog before, you know that the basic gist of my entire mental health crusade is anti-stigma oriented.  It didn’t really hit me until the press conference I attended how that stigma remains powerful when it comes to specific treatment modalities.  Multiple studies proved that ECT is an effective way of treating depression and mania that is otherwise treatment resistant, but older forms of its operation have convinced many people that it’s a terrifying and dangerous way of trying to rid yourself of depression.  Science has evolved to the point that this is no longer the case, and it is vitally important that we recognize this truth.