Sticking it Out (The Difference 48 hours can make when the crazies strike!)

Tuesday afternoon I was moving from busy to frantic. Only a week earlier we had record snowfall in my area and it had broken tree limbs all over the city and put thousands out of power. We were slated for another big storm and I felt like I had a lot to do to get ready. The DH had been out of town before the big storm and had been pretty upset by the damage to our trees. He wasn't angry at me but I always take it personally--internalize it and make myself nuts trying to find ways to make it so he will never be angry again. Which is why I was going into frantic-crazy mode Tuesday afternoon.

I spent hours that day (probably 5 or 6) cleaning up the yard, mulching the garden, shaking remaining leaves off our trees, and taking the trampoline down. The first couple hours I was really proud of myself for all the hard work and the progress I was making. I was even humming, "Have I Done Any Good in the World Today?" as I cleaned some leaves out of my widowed neighbor's window wells. But the more tired I got and the more the kiddos got in my way, the more I started to second guess myself. My brain started up telling me that I wasn't doing a good enough job and that the DH was going to come home and be mad because I didn't do things his way--which is sort of a Pure O obsession for me, these hypothetical arguments in my head and the conviction that my DH is going to hate me forever (which is really all in my head; the DH and his attitude/actions have very little to do with it). The DH and I had a short phone conversation that afternoon which I misinterpreted and used as a fodder for the crazy. I began to be afraid of what was going to happen when he got home and started getting more and more frantic in my efforts to make it so he wouldn't--couldn't--be angry at me. (Hm? What's that you say? I should call my therapist and address this issue? Yeah. I know. I should.)

I had also babysat for a friend all day while she went to the temple. Not to mention it was the day after Halloween and we were all fried from the previous evening's festivities. I was tired.

The big kids came home from school and I had to get Princess N off to Activity Days. I got everyone in the car and made it down to the Church and then zoomed home to finish up the backyard work,do some cleaning inside, and make dinner. Then I remembered there was a writing deadline that I needed to submit something for. And then I realized it was raining, the temperature was dropping, and half the trampoline stuff was strewn all over the backyard.

We got home and I started working as fast as I could. But things just kept going wrong. The trampoline parts were stuck together and when I tried to stack them in the garage they crashed all over and made a huge mess where the DH usually parks his car. I had too many dirty dishes to do before I could cook dinner. The file I needed to submit wasn't on the computer I thought it was and my hands were shaking from anxiety. The kids spilled jelly all over the floor and stickiness on the floor is a pet peeve of the DH and I started to lose it. If I'd been frantic before by the time I had to go back to the Church to pick up Princess N I was in complete panic mode.

Driving home Mr. J started yelling at Supergirl E for "thinking a bad word but not actually saying it" and Supergirl E and Princess N started screaming back. I knew that the DH was home staring at the jelly on the floor and my heart was racing. Traffic was heavy and the kids kept getting louder and louder in the car. My hands were still shaking and my heart was racing. I was convinced we were going to end up in an accident. So I started yelling at the kids. A lot. And then felt very bad and started apologizing.

We got home and the DH was cleaning the jelly off the floor and I was a complete wreck. I demanded he come outside and started yelling at him for being so angry with me. He replied that he wasn't angry and I went into how angry he would have been if I hadn't accused him of being angry. Things spiraled from there as the kids watched from the window.

And then, I kid you not, the Relief Society president pulled up in my driveway. (Hi, Coffinberry!)

Low point, anyone??

She's actually a friend of mine and I appreciate her advice and perspective, but it was still pretty embarrassing. Nobody likes being caught at their worst, even when the people catching you love you.

She helped me calm down enough so that I could stop freaking out and make some dinner. But I spent the rest of the evening fight the crazy in my brain. After yelling at the DH the crazy talk in my brain changed from "the DH will be mad at you and your life will be ruined" to "You don't deserve to live. You are a failure and a waste of space. You need to be punished. A lot. You deserve to suffer and be in pain for the kind of person you are." It was terrible. I was trying not to cry too much, but the urge to punish and harm myself was very strong. I can only think of a handful of times it has been stronger. Of course, the worst part of it is that I could see all of it in my head. Technicolor visions of suicide and self-mutilation. Blech.

I knew I needed to get out of my head. Fast. I focused on dinner and turned on some music, repeating the lyrics in my head while singing them out loud. Anything to put the brakes on the hamster wheel of insanity in my brain. I ended up listening to a Mumford and Sons songs over and over. A couple lines from "The Cave" worked as a sort of mantra, "But I will hold on hope/And I won't let you choke/On the noose around your neck./And I'll find strength in pain./And I will change my ways./I'll know my name as it's called again." The lines were soothing and repeatable and, inexplicably, I associated it with baptism and taking on the name of Christ and I started to calm down.

I got through dinner and bedtime but the urge to punish myself was unrelenting. I had a huge headache but didn't want to take any medicine. I was exhausted but refused to go to bed. I didn't really want to hurt myself but I wanted to do something to make the punishing thoughts go away so I ate Halloween candy until I was sick to my stomach. And I drowned my sorrows in a couple episodes of Friday Night Lights. Another lovely low point to my day.

My sleep that night was troubled and the kids were up several times. Around 3:40 am, I gave up on sleep and decided I could take some medicine, even self-punishment was still heavy on my mind. So I went to the kitchen and took some ibuprofen. Then I stumbled across the Conference issue of the Ensign. I thumbed through it and finally came to Elder Utchdorf's talk, "Forget Me Not." (I keep trying to insert a link here to the actual talk but it's not working; sorry.) My head was still muddled enough that it was hard to feel the Spirit but I knew I needed to read the talk anyway. I think I read it in a frenzied manner several times but the only part that made sense to me was this:

Dear sisters, many of you are endlessly compassionate and patient with the weaknesses of others. Please remember also to be compassionate and patient with yourself. . . Sisters, wherever you are, whatever your circumstances may be, you are not forgotten. No matter how dark your days may seem, no matter how insignificant you may feel, no matter how overshadowed you think you may be, your Heavenly Father has not forgotten you. In fact, He loves you with an infinite love.

It had been a dark day. Overshadowed seemed a good descriptor for my mental state. Patience and compassion with myself sounded foreign but good. I told myself to wait this current bout of crazy out. Give it a day or two and see where things were.

So yesterday was a couple days later. A quick rundown: the wonderful neighbor who usually watches the baby when I have to go help out in kindergarten couldn't watch the baby, the DH forgot he was supposed to drive Mr. J to preschool, I lost my car keys, and a dog peed on my daughter's backpack at the bus stop. Later that day, I got to work on the allergen-free desserts I was supposed to be bringing to our school's Harvest Festival and burned two entire batches. After making an extra trip to the store, I got all the kids in bed and was then up until 11:00 at night finishing up the treats. It was a terrible day. I mean, since when do dogs randomly come up and pee on people's backpacks?? The fact is, though, it all worked out. I didn't lose my temper. I didn't want to hurt myself. I didn't hate myself. I didn't even panic. My family was okay. I was okay. The terrible day was okay. 48 hours after the crazy had reared it's ugly head, I was all right.

I'm still a little emotionally hung over from everything; I'm feeling a little tender and my fuse is short. But it passed. So, I guess I just wanted to pass that on to any of you who read this and might be struggling. No matter how many good days you have, your mood disorder will strike again. BUT, be patient with yourself and remember that God loves you. Wait it out, seek help, and be glad when the RS president shows up during your worst moment. Don't do anything you're going to regret because things will get better! I promise. I've been there and I promise.

*hugs*

Laura

p.s. A big thanks to those of you who stop by and tell me that my blog has been helpful to you. Those kinds of comments mean the world to me. I'm not alone--you aren't alone--we are in this together.

Psychological Tweezing (and other thoughts on emotional honesty)

I've meaning to blog lately. Catch up on life and explain a little. Because I'm trying something new and it feels significant. But it also feels painful. Very painful. And personal. So it's hard to put it down here.

How's this for a really vague start? Some stuff happened a while ago that shouldn't have and the consequences just keep raining down.

An odd thing: every time I go off my antidepressants I have these same impressions about the "stuff that happened a while ago"--not like testimony meeting impressions--but like strong, emotional messages that require some sort of action. In the past the only action that has made sense is self-harming options. Like I used to get frenetically and abstractly suicidal. Or I would have visions of carving my arms and stomach up, like I was a surgeon cutting out some sort of contagion. Or like I was too full inside and if I could just bleed a little there would be some relief to the emotional congestion. At the other end of the violence was always the possibility for someone else to take over, for escape, for rest.

I never acted on that stuff, it was just always presenting itself as the answer. But, probably thanks to all my friends who tried to kill themselves in high school and my sister who got her undergraduate work in psychology and because my grandma tried to kill herself but went to a sanitarium instead and was open about it, I knew there was another option--a good option: medication and therapy.

And it was good. It was helpful. But it didn't make the impressions go away (which always disturbed me a little). The medication made the impressions quieter so that I could start to examine the pieces that didn't overwhelm me. Therapy gave me the tools I needed to figure out how to examine them. (The tools I use most often are self-observation techniques and self-questioning processes, in case you were wondering.)

So now I'm here and something clicked and I'm taking on those impressions. I'm looking those emotional messages square in the face and unraveling the facts from the fiction. Well, that's the ultimate goal. Right now I would say I'm just allowing the impressions their space. I'm hearing them. I'm accepting them. I'm letting them say all the things they've been trying to tell me for years--all the hurt, anger, frustration, desperation, and confusion. And, the hardest part, I'm relaying the messages to the other people who need to hear it.

That last paragraph makes me sound nuttier than a fruit cake, but I don't know how else to describe it. For the first time in a long time I know I'm not crazy. I saw my psychiatrist, just to be sure. And she agreed. She said, "You're not depressed. You're not overly anxious. You just have some huge things facing you. But you are handling them as well as any person could." I don't feel cosmically out of control or overwhelmed. I'm surprised by the intensity of the emotional torrents playing out but they feel honest and, surprisingly, empowering. Not in the moment of it all. But later.

This whole process reminds me of that aphorism, "Depression is just anger turned inward." That reductionist aphorism gets a lot play and I wasn't entirely sure how I felt about it until recently. I think I was afraid of certain situations in my life and of their consequences--emotional and spiritual and physical--and so I had to protect myself and my family. The only way I could protect us all was to hide the reactions and feelings and the only place to hide them was inside myself. I would never say depression is just any one thing, but we do put ourselves at risk when we inappropriately limit how we are allowed to express ourselves.

But you know, I was scared and alone and I think I did what I had to do at the time. And I'm doing what I have to do now.

What comes later, after the emotional swells and storms, is a cleaner feeling. A lighter feeling. The only way I can pin it down is to say it feels like honesty. I never thought such a simple idea would be so powerful in my life but I've come to realize that honesty is a big deal because it--our willingness to be honest with ourselves and the people around us, our integrity--is a large part of what keeps our agency in tact. Now that I'm being honest with myself and the people closest to me (which at this point is, like, two people) about what is really going on, I have so much more freedom. My choices are no longer limited to repression or desperation. Things like hope, forgiveness, change, and soul-restoring rest are finally, truly on the table.

When I was kid we had those Standing Tall tapes and there was this story that is pretty cliche but has stuck with me. I'm sure you've all heard it before, but I'm reiterating it because it has taken on new meaning for me.

This girl fell and got a splinter but instead of pulling the splinter out, she just put a band-aid on it and tried to tell herself she was better. But the splinter was still in there and her body was trying to push it out so the wound kept swelling up and filling with pus and aching. No matter how many times she replaced the band-aid the wound couldn't heal because of the splinter. She had to pull the splinter out--even if it was going to hurt a lot--because it was going to save her pain in the long run. It was the only way her wound would ever go away.

(This is similar to President Monson's talk about Hidden Wedges. Tangential, perhaps, but worth thinking about.)

I think this is how a lot of us function emotionally. We have emotional splinters that we keep trying to cover up, but the wounds will keep producing pus and swelling until we yank those nasty, infection-riddled suckers out. To be clear, medication and therapy are not the band-aids. The band-aids are our unhealthy coping mechanisms like anger, addictions, avoidance, overeating, overexercising, or dishonesty. Medication and therapy are the tweezers, the tools, that we use to extract the offending shard. They pave the way for healing.

There's still a long way for me to go and I'm still struggling with some very fundamental questions and I do still doubt my emotional stamina to see this process through, BUT there's a little hope out there now for me. I don't feel like I'll be stuck in the never ending spiral of depression. My wounds can maybe, hopefully, finally close. Counseling and medication may still be necessary for the long haul (my psychiatrist wants me back in a month), but they are no longer stop gaps for the suicidal eventualities.

And that feels good.

Depressed (and sometimes angry) Mormon Mommy

A reader emailed me and mentioned something about anger and three kids and how did I start to deal with it. Well, boy howdy, I wrote her a dissertation! Actually it got so long I cut it out of the email and decided to post it here so all of you could have the joy of reading it. Hopefully it's helpful.

Dear Reader,

Having three kids is like running a marathon one day and waking up to run it again the next. It is SO HARD. I never knew I could feel so tired--physically, emotionally, and spiritually. Most days just keeping them alive feels like success. It's discouraging to set the bar so low, but, honestly, keeping three kids fed and dressed and out of harm's way is full time work. After my third was born I remember praying and praying that guardian angels were real because there was no way I could shepherd my children through one day, let alone the rest of their lives.

I say all this for one reason: don't short-change the enormity of the task you have taken on. It IS hard. For everyone. It means the world to me any time someone at Church points out the four year gap between their third and fourth child or when they shake their heads at the memories of how difficult it was or when they just reach out and say, "It does get better." I cling to those seldom uttered honesties. (I think I just made that word up. Oh well. Whatever.)

I used to scream uncontrollably at my kids. And that was when I only had two. Actually, I remember doing it when I only had one. I would unleash these wordless screams that would leave my throat burning and aching. Sometimes I would scream about how frustrated I was. Sometimes I threw things. Sometimes I broke stuff--a kitchen chair actually fell victim to my anger. It took a long time for me to start to take control of it and there are still days that I struggle. Here are some things that help:

*Yelling and uncontrollable/sudden anger is absolutely a sign of depression. For a long time I thought I was just sinning or that I had no self-control. The truth is that people react to depression different ways, one of which is anger. I think depression manifests that way a lot in women with small children because small children won't/can't leave you alone. If I had had the option I would have stayed in bed all day but my kids wouldn't let me. So I yelled and I broke things. Not too proud of those moments. When anger is linked to depression it is IMPOSSIBLE to change your anger until you have managed the depression. I am always surprised at how effective antidepressants are when it comes to cooling my anger.

*How we handle anger has everything to do with how we were taught to handle anger. When I was having my worst angry episodes I would have memory flashes of my mother screaming at us kids and throwing things. She looked exactly how I felt. (I think she was depressed when all us kids were little. She is definitely a warrior mommy who survived some very difficult times.) Anger is a natural, protective response. It is not a sin (most of the time). It is a warning signal and in order to get a handle on it you have to learn to understand the signals. And, as women, a lot of us were taught that we were not supposed to be angry. Repressing anger doesn't make it go away. It only puts it in a pressure cooker.

*Part of that last point bears repeating: Anger is not a sin. I know that in the scriptures Christ tells us not to be angry. President Hinckley even gave a talk about angry. Elder Bednar has covered it too. BUT that doesn't mean anger is a sin. Like all of our emotions, it is part of this this mortal life. Angry responses are strongly linked to bodily conditions. Hormones that we don't control (the fight or flight hormonal rush is just one example) trigger anger in our bodies. The problem is most of us don't notice those bodily responses (like tensing our jaws or our backs, grinding our teeth, clenching our fists, hunching our shoulders, pursing our lips, etc.) before the anger explodes. The Savior's injunction, and President Hinckley's and Elder Bednar's, are, I think, more about learning to work with and overcome the "natural" man. Anger turns into a sin when we refuse to acknowledge its problematic potential and when we let it propel us to hurt others. But feeling angry is not wrong. It simply is.

*One thing that helped me understand the roots of my anger was a really great book:
She's Gonna Blow!: Real Help for Real Moms Dealing With Anger by Julie Barnhill. Barnhill is a Christian who approaches anger from a no nonsense point of view. She is honest about how her anger hurt her family. Even how it led her to hurt her kids. She encourages the reader to be equally honest with themselves through journaling opportunities and scripture study (prompts are offered at the end of each chapter, if I recall correctly). Her book is also chock full of good information about anger. I wish I had bought this book so I could lend it out to people. It is so good.

*Of course, no discussion about my mental health would be complete without mentioning my therapist. Having a dispassionate, third-party guide can make all the difference. My therapist helped me identify the anger triggers and the warning signals that my body was trying to send me. She helped me increase my self awareness and develop coping mechanisms to stop the anger before it exploded. I think the word she used was "mindfulness". She is also an invaluable source of encouragement when I suffer a setback.

Anger is one of the most revealing things about our psyches. Understanding it is the journey of a lifetime and I wish you luck as you set out. You can do it!

Depression profile: Doc

Thanks to Doc for sending me his story. I found it quite moving. He is one courageous guy! I had to really cut it down to fit here so be sure to check out his blog to get the whole story.

Part I—The Pretender
I have always been painfully, exceptionally, extraordinarily shy. The technical term is social phobia. This has haunted and hamstrung me most of my life, but never at anytime more than when I decided I might have the ability, the drive, and the heart to be a physician.

After surviving the brutal application process, my medical career was born. In my mind though, I had fooled them. I slipped by the gatekeepers whose job was to sift out “losers” like myself.

I did quite well with the first two years of medical school which were all academic. I was a miserable third year for the most part. Surgery in particular was a meltdown month. Otherwise, I learned to keep a low profile and slide along. What I did not learn to do was to become comfortable in my own skin, put patients at ease, and feel like I had a clue doing a physical exam.

There was only one exception: kids. The intimidation factor was not there and I let my goofy self out. I had the patience to get farther with them than other students. My first exposure to them was in Neurology, where I had the luck of being assigned to the Children’s Hospital. I fell in love with it, was fascinated by it and, best of all, there was a massive shortage of pediatric neurologists. I found my calling in medicine.

Unfortunately, I was still compromised by my phobia: pacing around the hospital for 20 minutes to work up the nerve to talk to a nurse; avoiding waking up patients; being terrified of phone calls.

Then it was time to find a residency. I interviewed at every pediatric residency I applied to. Pediatric neurology is the red-headed step child of pediatric subspecialties. It’s claimed by neither Neurology or Pediatrics in training. It requires a partial residency in both which causes political problems.
The fate of the interns is determined by a computer—the infamous “match” system. It works by residencies interviewing great swaths of medical students and medical students interviewing with many residencies. Then the two parties form wish lists and the computer optimizes the list so both students and programs get the places they indicated they prefer to be. In pediatrics, 93% of medical students get one of their top three choices. In my case, due to politics I got into my fifth choice, my failsafe. It was a large program with all the clinical exposure I could want and a bunch of strangely unhappy pediatric residents. I had a deep sense of foreboding.

Part II—Meltdown
Life stressors #1 (the new addition) and #2 (the move): We learned early in my last year of medical school that we were expecting a new baby boy. He was due right about the time we would move, the month after graduation. In order to have him covered by insurance we had to have him before we moved. My residency began orientation mid-June. Thanks to an understanding OB, labor was induced June 6th. We packed up the moving van and my wife was discharged from the hospital 2 hours later. We moved to a computer matched assigned city which, like medical school, was hundreds of miles from any family. I also realized I felt strangely detached from my son, thinking of him more in clinical terms than fatherly terms. It disturbed me.

Life stressor #3 (the heart): In preparing for the move I went into the doctor for a checkup. He thought he heard a murmur (never identified by anyone since) and sent me for an echocardiogram. It turned out I have a rare condition where the pericardial sack that my heart sits in did not form completely. While often not discovered or the cause of any problems, on rare occasion, part of the heart can get caught in the opening, strangulate, and rupture, causing sudden death. I had an MRI done the day before my son was born. I received a call that my cardiologist was discussing it with a heart surgeon (yikes!). In the end, this was all much ado about nothing and I never needed the surgery, but that was up in the air for several months. Death became a consuming theme in my thoughts.

Life stressor #4 (the job): I began the first year of my residency on what was the most difficult rotation for the year, the Neonatal ICU. We had overnight call every third night and put in about 100 hours per week. My head was absolutely swimming. I had to learn emergency care for some sick infants completely on the fly. We dealt regularly with distraught parents in a variety of intense situations. I had to make the dreaded phone calls. I had to learn to speak to the nurses.
I performed miserably, telling myself that all interns perform miserably their first month. To some extent this is true, the learning curve is indeed steep, but I faltered more than most. I walked around like a zombie, constantly exhausted. Some of the nurse practioners became so concerned they had the residency call me one day and tell me to sleep. People were always asking if I was okay.

I moved from this to the general inpatient pediatrics service. It should have been a relief, but I didn’t feel it. I couldn’t concentrate. I would sit on call with the other resident telling me about the patients I would be covering and what I needed to do and I wouldn’t hear anything past the first sentence. My mind was spinning out of control, imagining disastrous scenarios one after another. (This feeling, I later learned, is a hallmark of generalized anxiety disorder.)
Too often, when asking for help the answer was, “Figure it out for yourself. I had to when I was an intern.” I felt incredibly alone. The many critiques and suggestions brought to me a new round of self-flagellation. I was miserable. I began having strange worries. I wondered what it was that made people into child abusers. I started having intrusive, unwelcome thoughts about hurting children. I somehow convinced myself that I was really a monster, hiding beneath a facade. This kind of fear is also a part of generalized anxiety. There was no danger of me acting on these feelings, but they seemed real and distressing. My life was enveloped in guilt.

My wife, desparate for help with the children, left to stay for an extended period with family. I came home to an empty house every night. I began watching the same depressing movie over and over and over. I was living on donuts, boxes of cookies, anything that came in a box really.

The low point came when I was presenting a patient whose mother had Munchhausen’s syndrome. In typical, cynical, burntout MD fashion, we got to laughing about some of the nonmedical complaints the mother brought. I began laughing hysterically. My laughs turned into tears that would not stop. All the pain, all the anxiety, all the insecurity, and all the misery of my training just burst out of me. The tears were unsatisfying and bitter.

My attending was shaken; she quietly and concernedly gave me the number of the medical school counselor and encouraged me to go. I resisted. My senior resident came and told me to go. I resisted. Finally, she went to the chief residents who told me to go. I agreed. But put it off. Then our evaluations came in, my program director became involved and I was dragged into the counselor’s office, immediately suspended from clinical duty.

Part III—Acceptance
Here’s the funny thing: They told me I was depressed and I didn’t believe it. I took a kazillion question test, scored 98/100 on the depression scale, and I didn’t think I was depressed. I mean, aren’t all residents tired? Don’t all residents do nothing but eat work and sleep? I was not suicidal, hadn’t even had the thoughts.

I only knew this because I had had those thoughts before. My medical education alerted me to the fact that I had been in the throes of major depression previously. Junior high was not kind to me. I was an outcast, I was lonely, I was miserable. Young and unequipped to recognize and sort out what was going on with me, I struggled. I am likely the only Mormon kid who ever used to sneak into the chapel when the building was empty and just pour my heart out to God, begging, pleading for him stop the pain. I used to sit, staring at the bottle of Tylenol, wishing, just wishing I could get up the guts to down it all.

I never could. I always came back to the thought, “How could I do that to my family?” I knew they cared.

I moved past it on my own. I maintained high function in high school, having some happy moments and involving myself in extracurriculars and a small group of friends. I graduated fifth in my class. I received a 4 year tuition scholarship to Somewhere Else University.

I served a mission which was no small achievement for a social phobic.I took verbal abuse on what I believed and still presented what I had to offer in a spirit of love. I grew and matured. There was a period at the end where it was hard to do anything. I didn’t enjoy missionary activity or our liesure day anymore. It was a relapse, but I recovered.

Of course, when I returned to college I had my rough patches: periods of melancholy, lack of enjoyment, excessive tiredness. But, hey, I still kept my grades and married my soulmate. I made it to medical school. Sure, I was really disappointed by the general peds rotation, because I was doing something I loved got no joy out of it, but still, I wasn’t tempted to knock myself off.

Well, it turns out you don’t have to be suicidal to be depressed. I was referred to a psychiatrist, started on anti-depressants, and felt totally defeated. I wanted to be mentally strong. I didn’t want my secrets out. I didn’t want the prejudice. I felt like my medical career was slipping away, now that the pretender was caught.
On medication, disaster scenarios raced through my mind and thoughts of ending my life returned, again rebutted by the quandary of how my wife and kids would fare. While this kept me from giving in to suicidal thoughts, it sure didn’t help my guilt.

It took several weeks, but one day I found enjoyment in my old hobbies, in music, in joking around, in my children. I suddenly felt alive again, even though I had no idea previously how dead I felt for so long. I eased back into clinical duty, with a couple of rotations and with supportive attendings my abilities grew. The workload was less intense, but I was moving and thinking a thousand times better. I began to see how counter-productive my fear of weakness had been. I felt like Moroni, a prophet in the Book of Mormon, whom God told “And because thou hast seen thy weakness thou shalt be made strong” (Ether 12:37).

This was so foreign to my previous mindset. I thought I knew all about the wonders of God’s love, and what it meant to be born of God. I thought I had witnessed the transformative power of the atonement. I had read the Book of Mormon; the power of the story of Alma was burnt into my soul. Yet, somehow, I didn’t really understand these doctrines. I wanted to be great on my own, to achieve on my own. I was proud (paradoxically in light of my poor self image) and I wanted to face down my shortcomings on my own.

Part IV—Fight the Power
As I recovered from depression it brought to light my anxiety. One of the first side effects the medication gave me was panic attacks. I worried incessantly about the future, about my patients, about the rumor mill, about the stigma.
My residency program had a reputation for regularly dropping people, but I slowly gained confidence as my performance quickly improved on lighter rotations. Still, as a resident, I was shuffled into new hospitals so quickly it was hard to adjust, which in most medical situations was dangerous. I reluctantly started a low dose benzodiazepine.

As my anxiety became more apparent, my counseling adjusted. I learned relaxation techniques, and learned to stop and evaluate my fears to see if they were founded in reason. I tried to learn to live in the now. While the consequences of failure were real, the doomsday scenarios in my head were excessive. It was more helpful to see what I needed to do right here and now. My anxiety was mitigated but still took a lot of energy to manage.

By the end of that rotation, I could see where my knowledge, comfort level and ability had skyrocketed. I felt competent, especially compared to other interns I performed alongside with. I was climbing out of a huge hole. I realized for the first time that medicine, even intensive care, was something I was capable of.

Unfortunately, the program began to feel maybe I just wouldn’t survive with my fragile mental state. Ironically, as the help they had me get started working and kicking in, the program’s willingness to let it work decreased.
In accordance with my career plans, I moved ahead with a child neurology interview. I was open about my issues. The interview went well. I felt my career was going to be salvaged. I was accepted to a program near my wife’s family. My local program director was not happy, but since I kept passing my rotations he couldn’t actually do anything to stop me.

That changed two months later, when I did the pediatric ER rotation. I wanted to really prove something here so without consulting anyone I stopped taking my benzos. In my mind, I was better now and needed to learn to perform without the drug. This was a horrible, stupid mistake. Things kept getting tougher and without the medicine the only coping mechanism I had was anger. I offended a lot of people and ended up losing my residency contract. I took some bogus limbo rotations and came up with a new plan. It had just one problem: I needed all the people who I offended to come to bat for me. It was awkward. But I knew I needed to reach a peace with them. I needed to forgive. I needed to let go of anger, which was eating at my soul.

Eventually, with a wealth of experience in the school of hard knocks, a dogged determination, a newly developed, hard fought self confidence, and a little luck, I pulled it off. I was accepted into a new child neurology residency and scrambled into a transition year. It was absolutely astounding.

I love what I am doing now. One deciding factor in making the plunge into medicine was the desire to force myself to overcome weakness. I don’t know if I could ever have comprehended what that really would entail. I really don’t know that I would choose to experience it all again if I had the choice, but I have undoubtedly grown.
I know not all bouts of depression end this way. Mental illness and its stigma destroy lives. I know of more than one doctor or medical student who have taken their life. I just hope that telling this story can in some way help others with either the stigma or the healing.

As always if you would like to share your depression story e-mail me at lolapalooza AT hotmail DOT com. Put "depression profile" in the subject line so I know you're not a spammer:)

Slow to Anger

I think the fourth Sunday lessons are different in every ward so I don't know if any of you had this lesson yesterday, but our RS lesson left me with a lot of unspoken thoughts so I thought I'd put them up here and see what you guys think.

Our lesson was President Hinckley's talk "Slow to Anger." As you all may have gathered managing my anger is the central drama of my life. I've spent time in therapy. I've spent time reading. I've spent time praying. I've spent time exercising. All as attempts to manage my anger. The good news is that after four years of effort I've made progress. But I still struggle with explosions that frighten my children and leave me depressed and guilty. Suffice it to say, when I found out the subject of yesterday's lesson I started to get nervous.

I'm glad President Hinckley addressed the topic because I think it is something most people struggle with a lot of the time. Other people's struggles may not be as intense as mine, but I do believe that most women (especially mommies) find anger to be a problem in their lives. So I wasn't upset that the Prophet chose to talk about it. I was nervous because I wasn't sure how all these women--who like to appear pulled together most of the time--would address a subject that is so personal. Ironically, after the teacher said something to the effect of anger simply being a manifestation of the natural man and a sin that we need to shy away from, I was so distraught I ended up missing most of the lesson (so I guess I really don't know what the other women said. These are just my perceptions and they may be incorrect!).

See, here's the disconnect for me: when most of us talk about the "natural man" we mean things that are carnal, sensual, or devilish--and my anger doesn't feel like any of those things. It feels like hunger or fatigue; a kneejerk thing that my body does without me controlling it. Also, as for it simply being a sin that we can pray away or just avoid (as if it were tobacco or alcohol or pornography) that just isn't true. Anger is an amoral impulse. It is neither good nor bad. It simply is. Feeling angry is part of the emotional spectrum, as is the shame that our culture heaps on top of it. But we don't have to feel bad about feeling anger. It's how we choose to process our anger that amounts to a good or a poor choice. It took me a lot of therapy to understand those ideas and it was disconcerting to me to have a church lesson tell me the ideas that have given me sanity were wrong. I'm sure the teacher didn't mean to, but she set off a lot of alarms and destructive thought patterns in my brain.

After chatting with my husband about it over lunch (our kids were totally bored and confused), I came to the conclusion that most of the women in that room haven't felt the anger that I have felt or they are in serious denial. It also occurred to me that I was so keyed up about the issue because the way they were talking about it made me feel excluded, like I wasn't good enough to be in that room and part of that group of women. I had to remind myself that just because I struggle it doesn't mean I'm not a good LDS woman. After all, it is only through the grace of our Savior Jesus Christ that any of us are saved. It's important that I try, but my efforts will always fall short and it is His love and sacrifice that I must rely on.

Thankfully the lesson wasn't a total bust and a few of the women made some insightful comments that I thought were helpful. I figured I'd share them here and add a few of my own tips. I hope you all will chime in too because I know you guys are a lot smarter than me! Here are the tips:

1. Anger is usually a cover for some other emotion (ie fear, embarrassment, a feeling of lack of control, unmet expectations, etc.) If you can look past the anger to what it is covering the anger usually processes faster.

2. You are not responsible for your first thought--it simply is. However, you are responsible for your second thought and any actions you take. Give yourself space to think before you act.

3. Anger, like all of our emotions, creates a physical reaction. Become aware of the physical symptoms of your anger and relieve them. Whether that means taking a deep breath or relaxing your shoulders or getting a drink of water to release a tense gut, make sure you address the physical aspects. The anger won't go away until you do.

4. This isn't really a tip, but I want to recommend a book,She's Gonna Blow: Real Help for Moms Dealing with Anger by Julie Barnhill. This book has been the only place I have found a realistic discussion of anger and trying to live a Christ-like life. Her candor and faith lifted me up during one of my darkest, angriest depressions. It is worth reading.

Be sure to post your tips!

Something everyone should know about depression

So I orginally started this blog because I wanted to start a conversation about what it's like to be LDS and have depression. I felt like there were a lot of stereotypes out there and that members had the wrong idea of what depression was. I really wondered why people didn't talk about it more, didn't try to explain it.

Well, now I know--or at least I have a better idea of why. Turns out it's hard! I do a lot of blogging about books and other literary subjects because it's lot easier than writing about being depressed. I have a few posts about my depression, but I never seem to be able to finish them. Sometimes writing about it alleviates the feelings, but sometimes it intensifies them. Or I find I am simply incoherent when talking about depression. It is a real challenge to put all those things into words.

However, I do feel that being depressed has had an effect on my life and on my testimony. So I guess I'll keep trying.

So here's something that I think everyone should know about depression: Depression isn't just being sad or laying in bed all day. That is how a lot people experience depression, but many depressed people also experience uncontrollable anxiety and anger. That's happens to be my issue.

I guess you could say that I technically have postpartum depression because that was when I was first diagnosed. But I think I had depressed periods as a teenager and I was definitely depressed while I was pregnant. The way I describe my condition to myself is that I have moderate depression with anxiety and some OCD tendencies. (I recently added the part about OCD after reading The Imp of the Mind and finding out that PPD is often characterized by OCD-like "bad thoughts" and coping mechanisms.) That's just what I call myself. Actually, there is no official diagnosis of "moderate depression", but I like the term so I use it. The actual diagnosis is dysthymia, but since nobody knows what that is I'll stick with my term.

So that is the depression fact for the day. You don't have to be laying in bed and avoiding people to be depressed. Sometimes it's the anger and anxiety that define depression.