Anxiety and a Rigid Life

I have a sincere question for you, and if you have anxiety issues, I suspect you know why I ask this.

One of the best ways I think I’ve ever summarized anxiety – at least the really bad, crippling kind – was by describing it as a box. You live inside the box. And slowly, as the anxiety ramps up, it gets worse, and the box starts to compress. Little by little, it squeezes you in, trapping you and stopping you from doing things you previously enjoyed. Going out late at night. Living with spontaneity. And then you just find your life stuck inside this box, regimented by routines and a fear of fear that you don’t fully understand but absolutely cannot conquer.

Here’s my question: Is this you? Because it does feel like me.

As I’ve discussed previously, generally speaking, I feel like I live a life in recovery. That’s a bit of a complicated statement because I unquestionably still suffer from a series of anxiety and depression related issues. But I say it because I feel like I can lead a good life and a relatively happy one.

But, there’s no question about it: I lead a life that has been limited by anxiety.

Examples? I can’t stand surprises. I have to know where I’m going and what I’m doing. Open social situations – parties, etc – can be intimidating. Weird thing for a politician to write out, right?

I crave routine. I like to be doing X at this time and doing Y at this time. I’m obsessed with my calendar and my to-do list because they keep me on schedule and knowing what I am doing, something I crave and need.

Do I think I’m living in a box still? No. I don’t. But I do think there are some ceilings in my life. Some things which are limited by my anxiety.

Huh. This has been instructive to write. Might be something I want to bring up in therapy later because it’s not something I want to live with. I’d love to live with a bit more flexibility and spontaneity. I’d love to be able to go out places without…fear.

It’s a defense mechanism for me. A coping skill, one developed by the unfortunate reward your body gives out for avoiding the anxiety caused by anxiety-inducing situations. Repeat this pattern enough times and you have agoraphobia. No, that certainly isn’t me, but it is something I always feel like I have to watch out for because I am a natural homebody. I think this is a big part of why.

All of that being said, if you know what I’m talking about, if this writing strikes a chord with you, please comment below and let me know what you think. Does this sound familiar? How do you deal?

 

Why Words Matter – Even If It’s Not You

 

As some of you may have seen in the news or on my Facebook page, we had quite the day this past Friday. Governor Wolf was in town, holding the first of what will be many mental health roundtables. He announced the kick-off of Reach Out PA: Your Mental Health Matters on Thursday. It’s an overall, comprehensive effort to reform and improve Pennsylvania’s mental health system. It’s fantastic and desperately needed.

At the Governor’s Press Conference on Thursday, the Governor said:

“For those struggling with their mental health, we have one message: your mental health matters and it’s okay to reach out for help. We are stepping up our efforts to ensure every Pennsylvanian can access mental health care and more agencies can respond to the challenges facing Pennsylvanians struggling with their mental health. The act of reaching out for help – or to help – can make a huge difference for someone struggling.”

I opened the roundtable with this:

Obviously, I’ve discussed my depression and anxiety before. I haven’t quite gotten that intimate with how close I came to a suicide attempt, so that was a bit new.

I actually wasn’t even planning on doing that until a few hours before the event, when it hit me: I was going back to the place where I had seriously considered ending my life, standing with the Governor, my Congresswoman, friends, colleagues, and advocates, with the goal of saving lives.

(Random side note: I actually tagged my ex-girlfriend on Facebook for saving my life. We’re certainly on good terms, but I can’t imagine how weird that must have been – she looks at her phone and goes, “Wait, who tagged me? Why did that happen?)

I have to say – on a personal level – how much it meant to share that story. At the table with me was the Governor, my Congresswoman (Susan Wild, who has become a dear, dear friend) and Dr. Rachel Levine (PA Secretary of Health). Dr. Levine is brilliant and one of my favorite cabinet members with the Governor. She’s also a pioneer, serving as one of the highest-ranking transgender government officials in the United States. I cannot imagine how many kids and adults look at her and draw hope from her success and competence.

Congresswoman Wild is an advocate for mental health in and of her own right after she lost her life partner, Kerry Acker, to suicide. And Tom Wolf is truly one of the most recent people I’ve ever met in this job.

To be able to share that story – with those fine people, and everyone else in the room – that was meaningful. It gave meaning to what I had endured.

So, away from myself now. What the Governor has said about mental health, what others in his cabinet have said…it matters deeply. It matters because the Governor is lending his personal credibility and institutional strength to a push for better mental health access.

Public policy, public statements, and stigma are all interwoven. By doing events like this, there are people out there who are recognizing what the Governor is doing. At least some people will be touched by his words, by all of our words. And hopefully, they will be more likely to get the help they need and deserve.

Look, this system needs investment. Massive investment. We need more workers, more funding and less stigma. That all ties together. I hope and pray this was the start of a more comprehensive effort.

But I know that hearing someone as important, well known and well-liked as the Governor say that it is okay to ask for help – that matters. And it should matter if you say it, too.

“People who conquered depression and/or anxiety, what’s the #1 factor that helps you?”

As some of my prior entries have indicated, I’m a big fan of Reddit. If you use it the right way it can be hilarious, inspirational and adorable.

One of the more popular subreddits – and certainly one of my favorites – is AskReddit. In AskReddit, users can post a question to the Reddit community. Some of the questions are serious: “Why can’t you sleep tonight?” Some are hilarious: “You’re being interrogated and so far you’ve held strong. What song do they play on repeat that breaks you?”

And then there’s moments like these:

This was truly interesting. The top responses are largely along the lines of answers you might expect: Sleeping well at night, keep busy, stay away from social media (irony, right?), stop overthinking, etc.

I answered this question (surprise!), but I took my answer in a different direction. Here’s what I said:

I’m gonna spin this one on its head a bit. I think it’s important to address this answer to those of us who haven’t conquered depression or anxiety, and who never will.

Depression for some is a temporary condition as a result of a variety of factors, including social or cultural experiences, genetics, your upbringing or traumatic events. For people like this, time, therapy and/or medication – as well as lifestyle changes – can result in permanently defeating depression, and never seeing it again.

For other individuals – and people like me – it’s a permanent, chronic condition. Personally, I’m lucky – my ups are relatively long and my downs are manageable. For now. But, for people who will never truly rid themselves of depression or anxiety – who will experience it all their lives – it’s important to realize that this may be your world. Some people are cursed with physical disabilities which dramatically alter their lives and the way they experience it. For others, like us, it’s a mental disability.

What’s the #1 factor that helped me? I honestly think that one of them is this knowledge. The idea that I will never, truly be rid of depression. Why has this helped? It takes the pressure off. It makes me realize that I can lead a good life, even if this is always who I’ll be. That the “black dog” – as Churchill called it – will be a constant companion and challenge.

Second: To an extent, I have power over it. No, I don’t think I’ll ever be rid of depression. I don’t think I’ll ever be rid of the sinking feeling in my chest, the tension at the base of my neck, the imposture syndrome, the constant fear of losing everything and everyone I love. But I do have control. If I seize it, there are things I can do. That means self-care – therapy, medication, writing, working out being a type-A personality, etc. I accept that it has ruined other parts of my life, but strove to make me better in a variety of others.

Third: Accepting the positives of depression. It has made me constantly force myself to do something to improve myself, my life or those around me. It has made me tougher. It has given me a perspective and sense of empathy which I could never have imagined. And it has dramatically and positively impacted my career (I’m a State Representative in Pennsylvania, where I work largely on mental health issues – I also write and blog on the topic).

Yeah, leave it to a politician to not answer the question and answer it at the same time………..

My answer was long enough and pretty self-explanatory, but it’s worth noting again: Some people don’t “conquer” depression. They just learn to live with it, how to manage its ups and downs. I think that’s me. Once I accepted that – once I stopped kicking myself for feeling the way I did – it let go a lot of stress.

That being said, I don’t want to make it seem like my answer to the question was somehow crapping on the other ones. Less time on the internet, sleeping right, etc. – those are REALLY GOOD WAYS of beating depression. I just think that, for some of us, the idea of “conquering” depression is a bridge too far, sadly.

But that doesn’t mean it gets to run our life!

 

“Just Water” – What Happens When You Can’t Drink Thanks to Your Anti-Depressants

The other day I made an obnoxious crack about having never entered a Wine Cave (see the Democratic primary debate for more info, or better yet…don’t):

That tweet inspired this thread:

So, let me expand on this, because I think it’s an important topic – particularly if you are wondering if and how to drink when you take anti-depressants.

I didn’t start drinking until after I started anti-depressants, which was the start of my 2nd semester, Freshman year. Even in college, I wasn’t much of a drinker, but seriously, half a beer, and WEEEEEEEEEEEEEE. As I grew up that changed a little bit, but never much. On my best day, it was never more than two drinks before I got a decent buzz going. I didn’t mind all that much, since alcohol was never much of a part of my life.

As I grew older I came to appreciate drinking for the taste . I’d go out, have a glass of wine and enjoy my night. Unfortunately, at some point in my early 30s, that went out the window: I had one drink AND FELT LIKE SUPER DEATH.

There was no cause for it: One drink, and massive hangover. I guess that’s what happens when you get older. As a result, I cut alcohol out of my life completely. I haven’t had a drink in two years.

Am I alone in this experience? Hardly. Most SSRIs (the type of anti-depressants I have always taken) are known for causing issues when it comes to alcohol. According to the Mayo Clinic, alcohol can cause problems for people on anti-depressants and may result in an enhancement of symptoms or a greater than expected intoxication. I was never more depressed when I drank, but I absolutely had a lower tolerance.

Furthermore, I always felt like different parts of me would get drunk at different levels. There would be times where my hand-eye coordination was clearly off, but my mind felt sharp as ever, and other times where the reverse was true. It always felt like different parts of me got drunk at different rates, and I always wondered if that was just me or a result of the interaction between the booze and the anti-depressants.

All of this has led to a bit of an “other” experience for me, and me saying “Just water” at more banquets and dinners than I care to think about. Yes, I do feel a bit apart from others at social events. I won’t lie about that, and it is a bit isolating. Thankfully for me, my wife doesn’t drink at all (no reason – she just doesn’t have a taste for alcohol), so we hang out together, stone cold sober.

Do I wish it wasn’t like this? Yeah, I do. I wish I could go to the bar and have drink. I wish I could have  glass of wine with dinner. But, that’s the price you pay for taking medication which saves your life. Sure, I wish it was otherwise, but it’s basically a question of this: Would I rather drink, or would I rather not want to die?

I’ll add that my experience is not necessarily going to be yours, or even likely. You should absolutely talk with a doctor before mixing alcohol and anti-depressants – mine told me that everyone’s experience was different and I should use caution. I never had any experience with alcohol until after I started my anti-depressants, so maybe I would have had a different experience if it had been otherwise. I also never drank much as I got older, so perhaps my experience would have been different if I had.

It’s a shame, but it is what it is. No question – it’s worth it.

Any similar experiences to share? I’d love to hear them – let us know in the comments!

 

Will new three-digit Suicide Prevention Hotline lead to a surge in calls?

As you may have seen last week, the FCC voted to formally approve the regulatory process which would take the Suicide Prevention Hotline number (currently 1-800-273-8255) and turn it into a three-digit number, 9-8-8. It will take at least a year for the new line to go live.

For many reasons, this is a big deal in the suicide prevention world, and a wonderful development which will save lives. I can think of two reasons why this is so important off the top of my head. First is obvious: It’s an easy number to remember, like 911. Most people haven’t remembered the suicide prevention hotline number (I always have to Google it when I do blog entries like this, and I’m very in tune with the mental health world), and that’s an extra step. When someone is in crisis, you want to make it as easy as possible to get help. For the same reasons, means reductions matters when it comes to preventing suicide.

Second is the cultural statement: Suicide prevention matters. We all know 911 and understand the importance behind needing to call for help as soon as possible. With suicide numbers continuing to rise unabated, having a three digit number is a statement of priorities. It’s our way of saying, “Yes, this is important – really important. So important that we’re going to elevate the ease of getting help.”

But, that’s not to say that issues may not emerge as a result of this very significant and important change. As noted by this article from Pew Trusts, the new number will likely lead to a surge in calls. That’s good if it helps more people get help, but it can only help people get more help if the hotlines are prepared.

As noted by the article, there is not one massive hotline, per se, but a series of local hotlines, and many of them are “woefully underfunded.” Waiting periods and being bounced to a less local line are already occurrences which occur, and this surge in calls may make things worse. Furthermore, some states are in better shape then others. Six states (Georgia, Arizona, Colorado, New Mexico, New York and Utah) have made substantial investments and improvements in their suicide prevention hotlines, centralizing and standardizing systems while also expanding them. These states will be better prepared for the change over, but others may not.

What’s the solution here? The shift to 988 is great – but only if these lines are adequately funded. State and national governments have to expand funding, and they have to do it now. Pennsylvania and the rest of the nation have been utterly devastated by the opioid crisis which has taken more than 70,000 from us in 2017. As a result, we invested tens of millions of dollars in prevention and treatment. Suicide took 47,000 from us in the same time period, and hasn’t seen anywhere near the same levels of investment.

We need to invest the money here, too.

It’s not your fault: The brain circuits behind rumination, depression & anxiety

A fascinating examination of the brains of people who suffer from anxiety and depression has revealed some really interesting insight about how your brain works, and why its so hard to stop thinking once you get in a negative state.

According to a report on the study from Forbes, an examination of 9,000 brain imaging scans has showed that people who suffer from depression or anxiety show low levels of activity in areas of the brain responsible for “cognitive control,” while showing increased activity the parts of the brain which “process emotional thoughts and feelings.”

In other words: People who suffer from depression/anxiety have a harder time controlling their thoughts and keeping their mind from running away from them.

I mean, realistically speaking, this should surprise absolutely no one. If you suffer from depression or anxiety, you know that it is nearly impossible to control your thoughts or your feelings. But, for those of us who suffer, I would hope you can take a degree of comfort in this study, as it physically explains why your brain simply will not shut off on days where you are in pain: It can’t.

It’s okay. It’s not your fault. It never was. But this is just so interesting to me because it shows the biological mechanisms behind depression and anxiety. And it unquestionably lends credence to the notion that we have to treat depression, anxiety and other mental illness as a physical disease, rather than some separate emotional one.

As I’ve written in the past, there is a strong connection between rumination, depression and anxiety, and this study may help explain why: They are all physically connected.

Of course, this begs the question: What can we do about it? When our brains get “locked in” to this state, how can we alter it?

I mean, there’s the usual stuff: Therapy, medication, meditation, exercise, etc. We know that this stuff works to an extent.

I’m not even sure where to go from here, but I do think this study is absolutely fascinating. It provides a biological explanation that we already knew was out there. It explains why its so hard to stop our brains. I am walking, talking rumination, and I would LOOOOOVE to see what my head looks like when I get into a funk.

Let me wrap this entry up by adding to what I said before. If anything, I would hope that this study provides some perspective and can help get rid of some of the guilt and self-loathing that you may experience when you get into a depressed state. Depression and anxiety are not your fault. They never are and they never will be. And this entry helps to prove it. Your brain is, quite literally, working against you and making it hard for you to break out.

Your weirdest anxiety

The Mighty ran this absolutely fascinating list of 27 of the “weirdest” anxiety triggers which impact members of their community. The list was intriguing, if only for the breadth of seemingly minor things which can negatively impact someone. Examples included:

  • Not knowing where a bathroom is
  • Car headlights
  • The Mailbox
  • Power Outlets

These are interesting. Some of these fears are more common, some less so, but they all seem “weird” enough to the owner that they were willing to share them with complete strangers on the internet.

I don’t know this for certain, but I’d be willing to bet that all of these fears are also a source of shame for the owner. Shame that they’d be embarrassed if anyone found out. That’s how I felt, certainly. For the longest time, I had a “weird” and unexplainable phobia about going on mass transportation – bus, plane, train, whatever. If I wasn’t in control of the vehicle, I was terrified, to the point of a full blown anxiety attack. It wasn’t a fear of death or crashing, I don’t think. I think it was a matter of not being in control of the vehicle, of being stuck somewhere with no way off.

I’m lucky and I was able to get this “weird” fear under control, and while new ones have popped up, this one was put to bed. It took a good chunk of work and therapy, but yeah, eventually I got there.

That being said, if you, dear reader, have some sort of anxiety issue, chances are good that you know exactly what I am discussing when I say that these fears are a periodic source of shame and self-loathing. You feel like such a damn idiot for having such a ridiculous fear of something which the vast majority of people can endure with absolutely zero problem. Why does this fear trigger you so?

What’s the answer? That one is above my paygrade. Some fears are minor things that you can handle, and sometimes they disappear on their own. Others are more serious, rehabilitating issues which require therapy in order to be able to lead a full and productive life.

I do know this one: Don’t beat yourself up over whatever your fear is. You didn’t ask for it, you don’t deserve it, and anxiety doesn’t make you any weaker. If you don’t hate yourself for your random depression or anxiety issues (and you shouldn’t), you don’t need to hate yourself for a phobia.

These “weird” anxieties can crop up for a variety of reasons, everything from negative experiences to trauma. That being said, you don’t have to hate yourself for them. Whatever you fear is, let it go. Self-hatred and anger only supercharges the problem by giving your fuel to burn on.

If you want to share your random anxiety, please leave it below. As always, we welcome your thoughts and opinions!

A More Preventative Mental Health Model

I caught this article in USA Today and it introduced a fascinating concept – one I hadn’t heard of.

Many of you are likely familiar with the National Suicide Prevention Hotline, which has been used to stave off countless crises and has likely saved thousands of lives. Of course, calling this number is what you do at your worst moment – when you are at the bottom of the barrel and feel as if you might hurt yourself because you have nowhere else to turn.

What if there was a way to reach a person before it hit that crisis point?

Introducing the “warm line” from the Mental Health Association of San Francisco. From the article:

Unlike a hotline for those in immediate crisis, warmlines provide early intervention with emotional support that can prevent a crisis – and a more costly 911 call or ER visit. The lines are typically free, confidential peer-support services staffed by volunteers or paid employees who have experienced mental health conditions themselves.

In other words – someone can call, get support, talk to someone, and get access to more resources, thus potentially preventing a more expensive and serious crisis.

This is a great idea, and according to article, a wildly popular one. But, does it work? Will it cut down on arrests, suicides or other mental illnesses? According to one analysis, yes.

Here’s the real reason this appeals to me: It’s a paradigm shift. It’s so much more than just a band-aid or a cure for someone in a crisis. Don’t misunderstand – that’s incredibly helpful, and necessary. But what if we can stop someone from getting sick in the first place?

If you stop a physical illness before it gets infected, you save money, time, pain and lives. Hopefully, programs like this can help push in more into that sort of space when it comes to how we discuss, treat and cure mental illness. It’s why we should try to teach mental health in schools. It’s why physicians should conduct mental health screenings on routine exams. It’s why mental health first aid should be taught alongside physical health first aid.

We can stop these problems before they start.

How To Give Thanks When You Aren’t Sure How

My understanding of Thanksgiving has always been to try and take a step backwards and find the things for which I am grateful: Family, friends, food and safety. It’s a moment where you are supposed to be filled with gratitude.

Of course, if depression is clouding up your life, that can be a difficult experience – to put it mildly.

One of the worst things about depression is that it not only makes you feel sad, but it staves your sense of joy. When you are depressed, you cannot enjoy things. You cannot find the things to be grateful for – your mind is just clouded with sadness and pain. That, of course, is awful on every level.

According to an article from Psychology Today, gratitude can make you feel better:

Scientists say that these techniques shift our thinking from negative outcomes to positive ones, elicit a surge of feel good hormones like dopamine, serotonin and oxytocin, and build enduring personal connections.

Another article, this one from Harvard, notes that there is actual science behind this concept, and that multiple experiments have shown that individuals who actually took the time to decide, discuss or write down things that they were grateful for actually felt better and more optimistic about their lives after doing so.

All of this being said – I’ve been there. I get it. When you are in a hole so deep that you cannot see any light, writing down things for which you are grateful can be a challenge…to put it mildly.

If that’s where you are right now, it’s okay. Don’t feel bad, don’t feel guilty and don’t beat yourself up. That’s a pain which millions of others can share with you.

Instead, my advice to you is this: Try to take a step backwards.

If you are reading this, you’re in better shape than large swaths of humanity. You’re able to read and access the internet. Hopefully, you’re at home now, safe and secure, able to access the basic necessities of life. I hope you are warm and comfortable. You’re able to eat and drink whenever you want. I mean, according to the World Health Organization, 785 million people don’t even have access to basic drinking water service. If you are reading this, that almost certainly isn’t you.

Folks, one of the hardest things to remember – particularly if you are one of the 1 in 5 Americans who has a mental illness – is just how lucky you truly are. Start at the basics, and I mean the basics. The food in your stomach. The clothing on your back. And try to remember that there are billions who aren’t as lucky as all of us are.

Whatever our struggles, whatever your pain, I guarantee you are more fortunate than hundreds of millions. Start from there. Use that as the building block and move upwards. Concentrate on the gratitude and joy you’ve gotten from the smallest moments: The quick laugh with a coworker who likes you. The likes on your Facebook status. You can find joy in even the smallest of moments, and sometimes, that’s enough.

To be clear: I’m not an idiot and I’m not pollyanic. A Facebook like or a shared smile with a stranger will not cure your depression. It will not make you whole. But it may take away your pain, if only for a moment. It may help you regain a sense of control over your own mind, something that is absolutely critical when we are battling our own demons. To that end, try to balance your pain-filled moments with the good ones. Write down what you are grateful for. You may be surprised with how it makes you feel.

Happy Thanksgiving, everyone. I hope you are able to celebrate and enjoy it!

 

Post Traumatic Growth

In the course of discussing mental illness, I’ve written quite a bit about PTSD and its devastating impacts. If you have had the misfortune of experiencing some sort of traumatic event, you don’t need me to tell you just how much this can negatively impact your life, because you live it every day. PTSD isn’t a small problem: According to available statistics, 1 in 13 people will develop PTSD at some point in their lives.

However, I don’t want to talk about PTSD today. I want to talk about a different concept: Post Traumatic Growth.

I’ve been thinking a lot about this one of late – mainly because I want to know what circumstances make it possible. PTSD, or Post Traumatic Stress Disorder, is the concept of showing positive growth or change after a devastating event. It is basically the idea that you can turn a negative into an incredible positive and come out stronger in the aftermath of suffering.

According to this article from the American Psychological Association, PTG is different than resilience, which is the factor that determines if you can recovery from a traumatic event. One inventory holds that these five factors determine if you experience PTG:

  • Appreciation of life.
  • Relationships with others.
  • New possibilities in life.
  • Personal strength.
  • Spiritual change.

How we measure PTG isn’t as important to me as determining how to encourage someone to experience it, and I think this is an important question for people who suffer a traumatic event – how can they not only get through it, but grow from it?

According to the article, some people are predisposed to experience PTG. There are also a variety of other factors, including the type of trauma, the circumstances and the age of the individual in question (being 8 or younger decreases the chances of PTG). Furthermore, people who are more open to new experiences and extroverted are more likely to experience PTG. One study also found that there may be genetic connections to PTG, with individuals who had certain variations of the gene RGS2 being found as more likely to experience PTG.

As I’ve said repeatedly, I’m no doctor or therapist – I just play one on this blog. However, being able to show post traumatic growth strikes me as an incredibly difficult thing, one which requires a ton of support and therapy to prove. I would think that there is a real connection to optimism and resilience – to the notion that you can find light in the darkness. For many, a traumatic event – such as an assault or accident – proves to be too much to ever recover from.

However, I’d also hope that knowing that PTG is possible – indeed, achievable – can give people a new appreciation on life, on trauma, and even on depression. I mean, look at the article above, or just search for the subject. The internet is replete with examples of people finding light in the darkness, of using a traumatic experience to grow and change and become better people. Knowing that this is out there – that there are people who’s lives have been made better by trauma – that should inspire hope in all of us who are suffering.

Folks, I’m grateful for my depression and anxiety. It gave my career purpose and meaning and allowed me to use my experiences to make the world a better place. And, I suppose, that’s the best way I can look at what otherwise could have been a crippling illness.

Any thoughts on the concept of PTG that you want to share with us? As always, leave them below!