Mental Health Post #16: Suicide

This next post has really been weighing on me because it's a hard topic.  I've been putting off writing it (see my last post about procrastination and anxiety!) because I am scared I won't do a good job of addressing it.  I am, of course, talking about suicide and suicidal ideation.  I have been suicidal in my life, though not for many years.  The first time I contemplated killing myself was when I had expatriate depression (see previous post about this).  I was so low and in so much pain for so long that I wanted only to escape that pain.  And since I could not escape my situation, I started thinking of ending my life.  The very thought of doing so shocked and terrified me so much that I immediately told my dad and thankfully, that's when the ball got rolling and I was able to return home.  

The second time that I considered suicide was a couple years after we moved to our current location.  I had been trending downwards mood-wise for a couple of years, but didn't want the hassle of addressing a medication change (which in the back of my mind I knew was necessary).  I also didn't feel like I had a deep relationship with my psychiatrist and was worried about how to even address the issue with him.  The trend continued until on New Year's Eve, I threw a packet of glitter at Derek in front of a bunch of family members when he didn't listen to me about something, a move so childish and embarrassing that it shames me to even bring it up now.  I was excruciatingly humiliated and ran upstairs and locked myself in the bathroom for several hours where I wept and ignored pleas from my family to come out.  It was not good and I wondered how I could ever leave the room again, or even show my face to my husband and children, much less the other family members.  So my mind started to go down that dark path again.  Unlike the first time, I started thinking about plans and wondered if it really was the only option for me.  Thank God for Derek who must have known how bad it was and talked to me through the door and convinced me that he was worried about me and couldn't live without me.  My children all came by too and pushed homemade cards and beloved treasures for me under the door.  I made an appointment immediately with my psychiatrist and after a few months of medication adjustments, I was on the road to stability that I have thankfully been on for many years now.  

What I realized that second time was that even if I didn't value my life, and felt like I couldn't go on with the pain in my soul, there were people who did and who would be devastated if I did something drastic like take my own life.  I mentioned in my last post the LIE of depression/anxiety: that things have always been bad, and always will be bad.  Do not believe this LIE.  It is wrong and it is not reality.  Reality is that you have been happy before and you will be happy again.  You feel true and valid horrible pain right now, but it will not last forever.  I think many people that contemplate suicide do so because of the intense emotional pain they are experiencing and the need to escape it because they feel trapped.  That was the case for me for sure.  

The second experience was a real wake-up call for me to stay on top of my mental health, to be consistently self-evaluating my trends while taking into account my normal cycles like seasons and menstruation.  I realized that caring for mental health can take the same kind of hard work as any other chronic disease, but that it is possible to remit and to have times of beauty and contentment in life.

Please, if you are having thoughts of killing yourself, reach out to someone.  If you don't feel like you can talk to anyone around you, please call the National Suicide Prevention Hotline:

800-273-8255

Please please believe me as someone who has been so low that I would rather die than continue to bear the burden of extreme pain, please know that you are loved, your life is worth continuing and there is help.  You are needed.

For those who know someone who is struggling with severe depression and anxiety, please take any talk about suicide with absolute seriousness.  Do not disregard talk about death or wanting to get away from such extreme pain.  Many times, people talk about suicide as a way to bring attention to the soul-sucking pain they are experiencing because they are at the end of their rope.  You can also call the National Suicide Prevention Hotline for help as a concerned friend.

Photo note: such a heavy topic, so we'll lighten it up a little with a picture of my zombie dog.  He's all ready for Halloween...  ;)

Mental Health Post #15: How to Help

Sorry for the delay, I was on vacay!  This next post comes by way of request, as well as being something that's been on my mind.  One of the most insidious manifestations of poor mental health for me is procrastination.  You can call it many things, such as shutting down, escapism, dissociation, hypoarousal, but the end result is the same: you are stuck.  I hate when I get stuck.  For me it happens over a period of days and weeks as my mental health declines, but for some people it can seem more suddenly, perhaps in the form of a panic attack that paralyzes them in the moment or several days.  No matter how it expresses itself, I believe it is usually because of declining mental health that happens over a period of time, whether the person is aware of it or not.  Here are a few tips I try to keep in mind when I become stuck.

What TO do:

1. Nip it in the bud: Many people with chronic pain know that you don't wait to take pain medication; you take it as soon as you know the pain is ramping up.  I know people do this for migraines; I used to do it for my severe menstrual cramps.  The longer you wait, the less effective the pain relief and the more you suffer.  I've talked a lot about being proactive with mental health, and here it is again.  When you see that you are spiraling down, get help ASAP.  Sometimes this just means talking with your support network, sometimes it can mean changing medications or dosing, sometimes it can mean in- or out-patient psychiatric care.  The point is to nip it in the bud.  But don't fret over not having addressed something earlier.  Whenever you start is the start of something better.

2. Start with something small: You know how overwhelming it is to see an item from the to-do list in front of you that is large and complex?  I read something awhile ago talking about procrastination in general, and the best thing they said is to break it down into smaller, more manageable tasks.  For me, it means making lists, sometimes on paper, digitally, or just in my head. I do so love my lists.  In the past, that often meant making a rough sketch of my day.  For example, when I had that severe episode of PPD, I started small and (finally) got the help I needed from my OB (aka medication and therapy).  Then since I knew the Prozac was going to take time to kick in (4-6 weeks), I made a plan for my days.  They revolved around the feeding/napping schedule for my baby and taking time for myself.  I remember one of the things I had loved to do before giving birth was the daily crossword in the newspaper.  So in the mornings, I took my baby for a walk to the local gas station and bought a paper.  Then I would do the crossword while she napped, along with other chores.  This small amount of structure helped me move on to bigger things that allowed me to relax into the days, even the ones where things didn't go the way I planned.  Of course, this has taken years of work to achieve and I still get flustered and stuck at times.  Then I do the same thing again where I take something small to get myself moving and make a plan for how I will accomplish what I need to do.

 

3. There are better days ahead: One of the biggest fallacies my mind likes to trap me in is that it has been and always will always be this awful.  It has always hurt like this, and I will always feel trapped by the insatiable emotional pain that I am experiencing.  This is a LIE!  I cannot reinforce this enough.  It is not in any way true.  I have been so down that I have been suicidal and started planning my suicide (in the distant past thankfully), and since that time, I have been so happy I've laughed till I've cried, I've had fulfilling relationships, and I've slept beautifully for many, many nights in a row.  I've also had disappointments and downturns, and challenges that force me to reconsider how I am doing things, but truly the positive has outweighed the negative, despite my many health challenges.  My sister has a little sign on her fridge that says something like "Life isn't all sunshine and rainbows, but most of it is."  (Sorry, Julie, you should post a pic because I'm sure I'm misquoting.)  Know that there are better days ahead even if right now it is almost impossible to slog through a day/night.

 

4. Take time to ponder: when things are rotten is not the time to revamp your life and habits. I feel like we learned this lesson with raising kids: when a kid is having a tantrum, that's not the time to give them a lecture on how they should've eaten lunch at lunch time so they won't have a meltdown now.  Take time when things are good to make plans for what to do when they aren’t good. I like to think through possible scenarios and imagine positive outcomes. 

 

5. Get help from your support network: Of course, no one can imagine every possible scenario, and you can never be truly prepared for when life punches you in the face.  This is when you stop being so damned independent and you ask others for help.  (Can you tell this is something I really struggle with?)  People love you and they want so badly to do things to help you.  Let them.  Let them be needed like we all want.  Accept the person picking up carpool for you, let someone come help tidy your house, and take the hugs that are offered. 

What NOT to do:

 

1.  Don’t continue putting the thing you are struggling off indefinitely because it will only get worse. I guarantee this.  I can count on one hand the number of times that putting something off had zero negative effect on my life.  Give yourself grace and allow yourself time to grieve for what you need to do, but in the end, you must accept that you need help and then go forth and do...

2. Don’t run away from it through escapism (gaming, entertainment, substance abuse, doing anything but the thing you are dreading).  As a teacher (Derek), and as human beings, we have seen people use gaming, TV, substance abuse, and other addictions to put off doing what needs to be done.  It doesn't matter if it's a mountain of homework, or social anxiety and the inability to leave the house: getting stuck and not addressing the problem can lead to addictions and worsening mental health.  This is probably a good time to say that everyone needs downtime: all work and no play right?  But set limits for yourself, be they time limits, chapter limits, minutes watching a show, etc.  (I love using my phone timer functions for this!)

3. Don’t make huge life decisions while having a mental crisis or under a huge amount of stress. Your decision making is deeply impaired and you may well regret what you decide tomorrow.  Kind of like rebound dating right?  It's also so great to have people to bounce ideas off of.  Many times, just making a decision slowly, over a period of days can be super helpful in knowing the right path forward.

*I just want to address one big thing after so many posts.  I hope you don't feel judged by these posts.  I'm not perfect, no one is perfect, and we're all groping our way in the dark.  I hope these posts come off as informative and helpful, and not judgemental.  Believe me, I am the last person to judge someone because of their ability or inability to care for their own mental health.*

Photo note: I voted.  With duck lips of course. ;)

 Mental Health Post #14: Expatriate Depression

When I was between my sophomore and junior year in college, I did a French-speaking study abroad in Belgium as an au pair (nanny).  I was SO excited to travel and to experience language-immersion.  I am pretty decent at languages, probably one of my only intellectual gifts.  I had started learning French in college and just loved the feel of it in my mouth as I spoke.  (Can a language have a mouth-feel like a drink?...)  Unfortunately, things did not go as planned right from the beginning.  To start with, I had started dating a guy immediately before I left (like in the couple weeks before!).  Then my planes were all delayed until I was like a half a day late to the Brussels airport.  Remember, this was back in the stone age when we didn't have cell phones, and I was totally clueless on how to make a phone call from a foreign payphone.  (Or how to pay for it, AND I didn't bring the host family's phone number.)  My host father was understandably upset at going to and from the airport looking for me and worrying.  Finally I got to the home I would be staying at for three months, absolutely exhausted and numb from the stress of the past couple of days of travel.  And I found out that the host mom was in the hospital with pre-term labor, and the toddler I was supposed to care for was with family in another country.  Kudos to my host father for working to get me set up with French classes in Brussels and teaching me how to shop at the local supermarket, how to take public transit to get to my French classes and church, and how to drive an actual VW Bug from the medieval times...  

Almost immediately after arriving, my host father made plans to go pick up his little one in the other country.  Road trip!  It was so cool to drive through the other Western European countries.  We also made a couple stops to see some beautiful sites.  We visited my host father's family and I made a crucial mistake: I brushed my teeth with the local water (they warned me not to drink it, but I guess I was too naive and dumb to think about brushing with it?).  And I got traveler's diarrhea.  Like so bad that I pooped my pants trying to get to a bathroom in a foreign country while my host father was visiting a loved one in hospital.  (Please pardon how vague this is, but I am taking out details to protect privacy.)  I was so sick the entire time we visited with his family and at the hotel on the way back.  Not an ideal way to make acquaintance with the child you are going to care for.  Finally I got back to normal and we settled into a routine at home where I would care for the little one while both parents were gone.  Somewhere in there, the host mother gave birth prematurely and things got even more stressful.  At some point, I realized that I was really struggling.  I had extremely long periods where I was alone and anxious all the time about navigating the foreign landscape and new routine.  I could never get the Bug to start (and I grew up driving a manual transmission), I was so isolated from any other adults, and I dreaded the times I had to myself more than the times I spent caring for the little one and with other family members.  I found myself pulling in, and weeping for hours at a stretch, while I wandered around the house aimlessly.  I became so numb that I tried to make myself feel by eating vast quantities of delicious Belgian Waffles (gaufres), and gained 20lbs in 2 months.  I tried to soothe myself by taking care of errands like shopping, going to my French class, playing piano, and hanging out with fellow au pairs from BYU.  Unfortunately, I fell deeper and deeper into depression and started getting darker and darker thoughts.  One of my lifelines at this time was my dad.  He listened to me and paid for what I'm sure was extraordinarily expensive transatlantic phone calls.  At some point, I confessed that I wasn't sure what what I was going to do next (aka I was suicidal), and things changed rapidly.  Plans were made for me to fly out of Heathrow, and the next things I knew was that I was on the Chunnel and running around London (literally, I walked everywhere in one day because I didn't even know what the Tube was at that point) to see the sites before heading home.

When I look back, I realize that the depression I felt was a combination of factors: obviously leaving my comfort zone, and having so many (what I now know is normal) snafus in traveling and circumstance, plus my own tendency toward mood disorder.  Plus the isolation and the realities of life in a foreign country which I was definitely not prepared for in anyway.  (I am laying no blame here to my host family or BYU--who could've known what was to come or how I had a predisposition to struggle?  There were some issues with oversight that I won't go into which I believe is why my group was the last group to do foreign language study abroad in the same manner at BYU.)  This was my first major depressive episode, and still my longest by far.  Even my first experience with post-partum depression was not as long or as severe (by this I meant, I never truly got to suicidal ideation with the PPD).  Here's the craziest part of it: almost by magic, it was immediately lessened by my arrival in San Fransisco (I literally kissed the ground in the terminal when I disembarked).  I was still cautious and broken inside, but returning to the familiarity of America and my normal routine (I enrolled in summer school at university immediately) dispelled the deep gloom and desire for self-harm within a couple of weeks.  I never needed to go on medication and I actually had a renewed purpose in life and motivation.  I made a couple of big religious decisions (for my LDS friends: I took out my endowments and began weekly time in the temple) and was a star pupil who really attacked my studies with more determination than before.  

The thing about it was that I never truly "got over it".  While I found myself functional and moving forward in life afterwards, I felt deep guilt for my shortcomings as an au pair and a person for decades afterwards.  Even now I have tears welling up as I think about the incredible burden of psychiatric pain that I went through at that time.  I'm pretty sure this qualifies as true PTSD (as more than one psychiatrist has told me), and it's ramifications still affect me today.  This experience is why we did a sabbatical in England: I wanted to start preparing my kids now for culture shock and situational anxiety/depression.  I asked that it be England because then there would at least be a shared language (I mean, at least we share the same root language, right?...).  And it was still hard for me because those feelings from over twenty years ago flared up the minute we set foot on English soil.  Some of my kids struggled too, but overall I feel like we all made progress because we had each other, and we had our support group (including my beloved mother in law who came and stayed with us in a brutal heat wave of July).

Coming back to the purpose of me posting about this experience: I believe it is waaaay more common than is talked about.  I've seen it referred to as expatriate depression on the internet, tho I believe it is commonly referred to as situational anxiety/depression or just plain old anxiety/depression among mental health professionals.  I have felt pangs of it as I've traveled this ginormous country of ours, or the brief trip I took to Toronto with Derek, or Hawaii.  Just pangs, but still echoes of what scarred me so deeply  can be difficult to deal with.  (The irony of this is how much I adore traveling.  Just so much.)  And I don't believe I'm the only one by half.  As a member of the Church of Jesus Christ of Latter-day Saints (aka the Mormons), I have seen many people who go to serve missions, even domestically who struggle greatly with what seems to be this same phenomenon.  

What can be done?  For me, there was no choice but to leave the situation and seek healing over time.  For some people it can mean extra support until they become adjusted to their new situation.  Some people will discover that it is the tip of the iceberg and that they need medication and/or therapy perhaps lifelong to maintain good emotional health.  Either way, it requires patience and compassion from a support group as the person attempts to deal with both internal and external stressors.

 One last thing: I found this blog online that has some really thoughtful write-ups on this very topic.  I encourage you to look through it if it's something you want to know more about.  Like me, the writer is not a mental health provider, but someone who has dealt with expatriate depression.

https://lifeinmerida.com/what-is-expat-depression/

Photo note: A close up of the creepiest part of my Halloween displays, the baby dolls.  Please also note the skeleton on the door that is supposed to be putting her hands on her hips, but instead has a rather unsavory position.  Don't worry, I changed it...  :\

Mental Health Post #13: Seasonal Affective Disorder

Lucky number thirteen!  Seems appropriate since I'm going to talk about something that often comes around the same time as spooky season...Seasonal Affective Disorder (aka SAD).  This kind of depression is one that comes about when there is less sunlight (as in the northern and southern-most latitudes) for a part of the year.  I start to notice about the beginning of September since I live in Northern Utah.  It can also occur in places that are frequently cloudy.  (I definitely had trouble in the Pacific Northwest and in Michigan for the 8 months of winter!)  I know that I have struggled with this for as long as I can remember.  Which is strange because autumn is by far my favorite time of year, and I adore the big holiday season.  Is there anything cozier than sitting in your house sipping a hot drink with a book while the snow falls softly down outside (and a heat-producing chonk snoring next to you)?  For a long time I brushed it off and attempted to not deal with it.  That worked to a certain extent, but I always struggled when I got to January.  It probably should've been a red flag that my birthday month was also the worst month ever.  Or maybe February was...  Either way, I could almost not stand how the end of winter dragged on, especially after the effervescence of the holidays.  I felt so droopy and endlessly listless.  I wanted to sleep all day, but not the escapism of depression sleeping.  I had little ambition to accomplish things I was earlier excited about and I really had to push myself to exercise.  I was emotionally fragile and had a lot more trouble coping with disappointment and challenges.

At some point, I decided to address this issue for me.  I couldn't change the weather, or speed up time, but I could change some of my personal habits and thought patterns.  I was already taking antidepressants by then, so I wondered if I should be taking a different kind of medication.  What turned out to be important for me was to make sure I was doing well in managing my medications: making sure to take them regularly, and watching for signs that I needed to up my dose or switch to different kind of antidepressant.  I also found that if I burned the candle at both ends through the holidays, I would have a sort of emotional hangover in January that would be hard to overcome.  The very most important thing though, was knowing that how I felt wasn't forever.  That in a few months time I would be drowning in hot sun on my skin and even putting aloe on burns.  In fact, this very concept of impermanence is so crucial for all of my mental health ideation.  Knowing that the future will be different and that change will come is part of how I am able to get through harder times.  It doesn't make it easy, but it can make it bearable.  I mentioned before how I love the scriptural verse, "Sufficient unto the day is the evil thereof."  I hadn't thought too much of this verse until one day many years ago, I was talking to my sister and she mentioned that she and her husband had talked about that verse and how important it was to take things one day at a time.  When I have been at my lowest (like my first experience with PPD), there were days where I was taking it every 10 minutes or half hour at a time.  Derek likes to say you can do anything for 10 minutes (this was in relation to doing plank at one point and I don't think I'm the only one who thinks doing plank for 10 minutes is bananas!).  There are days when I think, I can get through this day.  And then we'll see how tomorrow goes, but I bet I will be able to get through tomorrow.  And eventually time is speeding up and I 'm not counting the seconds, minutes, hours.

One other thing that some people really like is to have a "happy light" to bask in each morning.  You can finds all kinds of full-spectrum lamps on the market for every situation, even doing your hair in the bathroom.  I do pull out our little happy light every fall, especially for my kiddos that have to get up so very early for high school.  But what I find a lot more effective is getting outside midday for a run or a walk.  I see people walking on their lunches too which makes me think that they have also discovered the secret of sunlight in eyeballs (albeit weak sunlight).  The combination of exercise with sunlight is magic and tends to rev me up for the rest of the day.

I know many people have winter blues/depression.  I'm curious what things y'all have found to be helpful?

Mental Health Post #12: 10 Things You Shouldn't Say to Someone With Poor Mental Health

This post is for Derek, who has been writing top 10 lists for far longer than I've known him... ;)  Here are the top 10 things you shouldn't say to someone struggling with poor mental health.  (Not in any particular order.)  Many of these are things I have heard or are even things I have said.  I've seen them expressed both explicitly and implicitly.  May we all be better at approaching those who are suffering.

1. "You need to read your scriptures and pray more", for those who are religious, or "Think positive thoughts!"  for those that may or may not be.  Not only does this invalidate what someone is actually experiencing, it also has connotations of shame (as in, you are clearly not being a good enough person).

2. "You need to eat better, take this supplement, or exercise more."  I don't want to step on when people are sharing advice, but I do want to make it very clear that passive-aggressively blaming someone for their mental illness due to their lifestyle does not make mental illness go away.  It makes it worse, and can damage your relationship deeply.  Context is also important: if a friend is trying to help by sharing things that have helped them, then that is a win.  If someone is trying says this to make themselves look better, not so good. 

3. "The antidepressants you are taking are making you this way/the antidepressants you are taking are addictive and dangerous."  Let's just stop with the anti- anti-depressant stuff.  We have plenty of clinical data now that proves in most cases that antidepressants can be a crucial help for those that cannot find relief through other means.  Standard antidepressants (like SSRIs or SNRIs, you can Google these) are not addictive, are not dangerous when taken as prescribed, and do not make people depressed when properly prescribed.  (My only caveat here is that in some cases, teens and young adults who start an antidepressant can initially worsen in the first couple of weeks.  Physicians are aware of this and will hopefully guide parents to keep extra watch during this time.)

4. "You need to suck it up/pull up your bootstraps/stiff upper lip, etc."  This does not work in almost all circumstances for any kind of suffering.  I recognize that this is usually a response borne of frustration, but it is counter-productive and again, invalidates the pain a person is experiencing.

5. " Depression/anxiety are just something you have to live with. Everyone has it and we all just get by. That is how it always has been and how it always will be."  First of all why should anyone accept living half a life?  We have these wonderful tools, medications & therapy, and there is no reason not to do things that improve your mental health.  Also, saying that someone should just accept their pain and live with it seems to me like a form of gaslighting.  Along these same lines I would group things like, "Other people have harder lives than you and look at how they are doing," or "It could be so much worse."  One of the most frustrating parts about these statements is that I find myself saying them to myself.  It's not okay to say to yourself or anyone else.

 

6. "I am frustrated and angry that you aren’t acting how I want you to act." I am guilty of this one, especially in my younger years when I wasn't aware of how pervasive poor mental health is in the life of a child, family member, or friend (or myself!).  A load of patience is required when dealing with someone with poor mental health because they cannot make changes overnight.  Having realistic expectations for yourself or someone else is truly key here.  I love the line from Matthew 6:34: "Sufficient unto the day is the evil thereof."  To me this line says that every day has its ups and downs, and we can save ourselves a lot of suffering by having healthy expectations and not worrying too much about the future.  Another way of saying this would be to "take it one day at a time."  I also love these phrases in the context of managing anxiety. 

7. "<<crickets>>"  I can't think of too many worse things than just ignoring someone who needs help, and yet we all do it because we are scared, or shy, or unsure of ourselves.  Let's all recommit to having the courage to reach out to those who need help, even when it's inconvenient or puts us outside of our comfort zone.

8. "I know exactly what you are going through because I was super sad when my favorite sports team didn't make it into the finals."  I wanna be careful here because I don't want to de-legitimize other people's pain.  But I want to make it very clear that sadness and depression are not the same thing.  Occasional nervousness about a high-stakes experience is not the same as chronic anxiety.  If you do not have experience with mental health, do not say you understand.  There are ways to show compassion without showing false empathy or being derogatory.

 

9. "I’m sure it will go away soon and then everything will be fine."  Brushing off someone's suffering is painful and again can be damaging to your relationship.  It also causes a breach of trust.  When someone doesn't feel safe talking to you, then you are no longer a part of their support system and they will cease coming to you for help.

10. "Just don’t think about it and it will go away."  I hate this one.  Like so many of these other statements, it strips legitimacy from a person's suffering and isolates them.  It also can generate unrealistic expectations.  I like to think often of power imbalances in relationships, and in a relationship where one person exerts a great deal more authority than another (for instance in a parent/child or teacher/child relationship), this can cause a wealth of damage.  Please don't ever say this to someone about any pain they are experiencing.  

If I could sum up this up, then I would say please show compassion and listen when you are needed.  Legitimize their feelings and tell them you love them, frequently.  It's always okay to say that you don't have experience with how they are feeling, and to ask them to explain it to you.  Then tell them that you are here for them and make sure you actually are.

 

Photo note: beautiful autumn mountains highlighted by stormy clouds.