Tuesday, 2 April 2013

Notes on Depression: A History of My Mood Disorders

It is terrible to survive
as consciousness
buried in the dark earth.
Louise Glück, The Wild Iris

I have depression.

I have spent a lot of time thinking about whether I would blog about my mental health, and it is with great hesitation that I have decided to go ahead with it. From my experience being depressed I have learned a bit about epistemology, about the mental health system, about myself. Since I am not yet cured I will likely have more experience and will likely learn more. Some of these topics should be discussed publicly and I guess that job is left up to me. I am not sure if this blog is the best place to discuss them--I have lost most of what core readership I once had, I am ambivalent about continuing with this blog at all and have been for years, I am not sure whether a semi-anonymous or poorly-anonymous platform is the best one--and I am not sure that now is the time to make these topics public. But I do not know of a better platform and I do not know that there ever will be a "good time" to release these ideas. Perhaps I will never generate enough writing (or good enough writing) to justify trying to publish a proper book on the subject. So I'll blog about it. (And, let me be clear, I am terrified by this decision.)

I have already written a number of notes on depression which I will post over time. For now, in preparation, I want to write a brief history of my mental health. (Do not worry; all of my other depression-related posts written to date are much shorter.)

Part I: Dysthymia

I have probably had a mood disorder for most of my life, but until recently I was unaware of my disorder because I never knew another way of being. I always attributed my unhappiness to my situation (high school, roommate problems, being romantically single, etc. etc.). Every time my situation changed (I started university, I moved, etc. etc.), I expected that the change in my circumstance would initiate a change in my happiness. It never worked. Finally I moved to Vancouver, and despite a very promising start my mood did not improve at all. I became more miserable than I ever had been before. I was so miserable that I felt I was sure I would not survive for much longer. When it got even worse I realized that in fact I would always survive. Somehow I had imagined that after a catastrophic implosion I would emerge from the ashes as a new and healthy person, but eventually it occurred to me that the accumulated damage might never annihilate me so efficiently. Instead I would just go on the way I was, but with increasing pain. The prospect of such a survival was so horrifying that I felt like that kind of life would not be worth living. That's not to say that I felt suicidal; rather, I became motivated to effect a change.

Around the same time I encountered the phrase "chronic low-grade depression," and for the first time I found a psychiatric term that adequately described my mental landscape. I had never entertained the possibility that I had depression because I knew the symptoms of depression and I did not have them. (While my diet was not the best, it wasn't disordered; I slept well enough; I had an excellent memory, decent concentration, and acceptable motivation.) Other mood disorders, including cyclothymia and bipolar disorder, also failed to explain my condition. So when I was re-reading an essay by Maureen O'Hara and Walter Truett Anderson and encountered the term "chronic low-grade depression," I was excited to find a term to describe me. (When I first read the essay, I was not looking for a self-diagnosis.) I Googled it and found the term "dysthymia," and while it does not exactly describe what I was going through, it was close enough that I felt I could act on it.

I went to UBC's Counselling Services in August 2011, was diagnosed with a mood disorder (Minor Major Depression, according to their schema), and enrolled in a mood disorder workshop. That workshop helped somewhat, but in October-November I was feeling like I still needed a lot more help, so I sought out a referral from Counselling Services and started seeing a therapist. Because I had a mood disorder since (from what I can tell) Grade Five or so, I needed to re-learn how to think. That takes time. With a deal of work, and the recognition that I probably had an anxiety disorder as well as a mood disorder, I felt healthy enough to stop my therapy in late February 2012. (My therapist agreed that I no longer needed therapy.) By the summer of 2012, I was happier and more emotionally capable than I ever had been in my life.

Part II: Depression

My first term of library school (September-December 2012) was a mediocre experience. I blogged a bit about my frustrations, perhaps tactlessly. I was bored for most of that term and struggled with feelings of arrogance. At the beginning of my second term (January in my program), however, I was no longer bored and superior but instead aggressively miserable. I felt out of place, I had difficulty connecting with the people around me, and I was constantly tired. I could not get to sleep at night, and then could not get up in the morning (or at least not as early as I wanted). I had trouble concentrating on my work and I was not motivated. I started skipping classes because I hated going so much (though I was a little bit sick too, so maybe "skipping" is the wrong word). I also began noticing that my memory was not as good as it usually was: I was forgetting assignments, and when I was counting collection after church on Sundays, I could not remember simple sums or do mental arithmetic.

I had started a vegetarian diet in January, so I suspected that some of these mental effects were a result of low iron or low vitamin counts. However, when I was discussing my symptoms and my dissatisfaction in my program with a priest (not the one at my church, but a UBC chaplain), she suggested that I might have depression. I thought it was unlikely because I had had a mood disorder before and this felt different: my frustration was clearly directed to an object (my program) rather than diffuse, and I did not previously experience the cognitive symptoms. However, in the first week of February, not long after talking with the priest, I had a catastrophic burn-out while trying to complete a work-intensive but otherwise innocuous assignment and I realized that she was right: I had depression, and this time it was not minor. Surviving the term was impossible given my mental state; before the month was out I would be flunking assignments.

I immediately stopped attending classes and told my supervisor that I was dropping out of the program (I had looked on-line and it did not appear that the university would grant leave after the add/drop date). He told me that dropping out was not the only option and helped me get started with a medical leave. In order to get that leave I visited a number of UBC services (Counselling, Student Health, Access & Diversity), which also helped me get started on treatment. I started seeing my therapist again (is there a way of phrasing that that is not parallel to a romantic relationship?). After a few rounds on the bureaucratic carousel, I finally got my medical leave. I am now looking for work, but my primary focus is on recovery. I am not looking to the future very much at the moment.

While I have been unable to get a professional diagnosis (that can only come from a psychiatrist, and the waiting list for psychiatrists is six months), all signs indicate that I have moderate depression. My bloodwork came back normal, so the problem is not chemical or dietary. I am not sure whether my depression is situational or clinical, but the former seems more likely. I now suspect that my program was not so bad after all and my incredible misery was a consequence of depression, but of course it is possible that I am not well suited to my program and the resulting stress caused my depression, at least in part. I still do not really know what caused this bout of depression, and I may never know. My treatment is on-going. I am hopeful that I will eventually be free of big-d depression, but I am not hopeful that I will ever really be free of mood disorders in general: it is likely that disordered mood will recur throughout my life.

There is of course a lot more to say about both experiences with mood disorders, and I will do some of that in later posts. Some of it I won't discuss with you at all because it is more personal. But I still think it is helpful to have this history written out somewhere in a reasonably complete form if I want to blog about mood disorders.

(My gratitude to Eve Tushnet, whose writing on addiction has encouraged me to write on depression.)

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