Do Not Faint

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Dealing With Brilliant Lives Ended By Suicide

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I have been very quiet, as I watch and listen, while tragic events unfold with shocking frequency. I have been careful about what I read, and I want to be careful about the words that I add to the cacophony. My contribution to all of this has to do with when mental illness haunts brilliant minds, and how we react to that, when those minds make their brilliance public.

::trigger warning – suicide, depression, violence::

I have always loved this photograph of Virginia Woolf, because the look in her eyes so clearly communicates depth but gives no hint as to what lies behind them, in the mind that produced the work I love.

I spent several years in a marvelous English PhD program; I went there to specifically to study the work of Virginia Woolf, who happens to have died by suicide at the age of 59. I have heard thoughts about Robin Williams’s death that echo conversations I have heard about the death of Virginia Woolf. You can tell me what sounds familiar to you.

Mourning the work that will never be. I get this. This feels healthy. Loving the work that a brilliant mind has produced naturally leads us to wonder, what will the world miss, because of this loss?

Grief over the loss of a person with whom you feel deeply connected. I get this, too. I understand that a familiarity with her work or even her diary could not make me close to Virginia Woolf, the person, even if she were alive and living next door. Every fan in her right mind understands that she was not related to or friends with Robin Williams. Virginia Woolf feels like an aunt, to me, but that’s just the language I use to express the way I feel about relating to her words and my perception of her personality. If Robin Williams felt like an uncle, and you want to express your grief that way, that seems healthy to me, as long as you don’t claim the same rights reserved for actual relatives who actually spent time with this person. I read The Hours, and I cried as the fictionalized Woolf died. I will watch Robin Williams on screen and experience feelings of loss, particularly during films that I spent a lot of time watching as a child. This is very different from feeling entitled to judge the decisions of Woolf and Williams, which is what I would like to address, next.

Anger at the celebrity for “choosing” death. I don’t think that this is healthy. Let me be very clear that grief often includes anger. But directing anger towards the person who has died feeds a cycle of anger that discourages the mentally ill from talking about suicide, suicidal thoughts, suicide attempts, and it feeds stigma. I can say this with confidence, because I encountered people who are angry AT Virginia Woolf, right now, for having drowned herself, in 1941. This kind of anger feeds on itself and does not end. Even worse, when someone expresses anger about the way a famous person deals with depression, people who are not famous read these generalizations about depression, and we react. Someone I know through Facebook expressed her feelings about this beautifully, this morning: “It’s everyone having their feelings *at* you, instead of with you.” It’s a good question we can ask ourselves. “Am I asking others to simply absorb feelings I throw at them via social media or this conversation? Or, am I feeling grief alongside others who mourn a true loss?”

Feeling entitled to the “lost work” that brilliant minds will not produce. This is not ok with me; entitlement is never ok with me. I love the work these minds have shared with us, and I wish there was more work to love, but I do not DESERVE more. I don’t care how life-changing, helpful, or beautiful the work may be. It is a gift, not something we have the right to demand from anyone. I happen to love the work of a photographer and artist, Dora Maar, who became a recluse smack in the middle of her life, and hid from the world not only her own work, but also work by her partner in love, sex, and art, Pablo Picasso. That was her right. Her life, her work, her things. I do not particularly like the work of J.D. Salinger, nor did I ever find him, as a personality, particularly attractive, and yet, I was offended on his behalf every time someone drove up to his house and demanded that he share the work he was creating with the world. The man did a lot of weird things, and that was his right. His life, his work, his things. Go ahead and long for the work that will never be, but stop yourself before you go so far as to demand work from someone who cannot or will not produce it.

Language that perpetuates the false notion that suicide is always a choice by asking “Would YOU have done it?” This downplays the vast difference between a healthy mind and a mind wracked by the storm of mental illness. Even if you have depression and it is severe and you have struggled with the desire to die, you do not know what you would do, were you standing in the shoes of the people who are gone. I’m not totally comfortable with the analogy I’ve seen between cancer and depression (it seems to be an attempt to lend greater weight to depression as a disease that can lead to death), but I do understand feeling frustration that when someone dies of cancer, *everyone* blames cancer, while someone who has died by suicide receives heaps and piles of blame. I am DONE with the idea that life is the choice that good people make, while death is a lazy choice made by people who are tired of fighting–this is false. Depression is an illness that changes the mind. I’m not talking about psychosis or paranoia, although Woolf certainly wrote that she was terrified of these things. I am simply insisting that we stop equating the way the world looks to a healthy person with the way that the world looks to a person who has depression. I am not saying that suicide is a “good” decision, or a “good” escape from a painful illness. My point is that it doesn’t matter whether YOU, or the writer of a column, or the host of a talk show, or a student in a literature class, would choose to die, if you were faced with terrifying mental illness, a disease like Parkinson’s or even, in the case of Virginia Woolf, the threat of a Nazi invasion and the stress of a world war. I am angry about claims that like “I would never choose death over life,” because this feeds stigma. For me, becoming suicidal happened slowly and insidiously, during a time in my life when I seemed productive and successful. I seemed “have it all” and was about to graduate from an Ivy League College to move on to a prestigious graduate program. And yet, I could only see pain and darkness. I felt numb. It was a terrifying, close, airless space, and suicide seemed like an appealing alternative to living like that. I am alive because I put blind trust in the people who told me that I would not feel that way, forever. Was that my choice? Or was it the time I spent locked in the psychiatric emergency room under suicide watch that let the feeling pass? I certainly didn’t enter that ER willingly. I did willingly go to see the doctor who put me there, and I told him that I had spent the previous night contemplating and even planning suicide. The person that I recognize as ME was so small, so swallowed up by that illness, that I look back on those memories like I’m watching someone else. It doesn’t FEEL like it was actually ME. Here’s my point: no one knows that suicide IS a choice, because none of us have actually been through it, so let’s just stop with the speculation. It does lasting harm. It shames. It stigmatizes.

The importance of our lives does not lie in what we produce or how we might benefit others. Whether or not you possess a brilliant mind and/or produce great work has nothing to do with your worth. No matter what a culture values or celebrates (think about the word: celebrity) I will keep arguing that the truly helpful way forward is to display empathy. We fight the darkness when we show that we care about our own lives and the lives of others. We bring light when we practice self-care simply because we are human, and when we care for others, because they are human, too.

Empathy and valuing humanity for its own sake. We can do that. In the last two weeks, we have seen unspeakable terror and tragedy across the world, and right here in the US. We shook with the revelation that Twitter users in Gaza were giving badly needed advice on dealing with tear gas to American citizens in Ferguson, MO. We have lost beloved American icons Robin Williams, to suicide, and Lauren Bacall, to a stroke. I see only thing that I can actually do for everyone suffering for any of these reasons: empathy, good listening, showing that I value the humanity of the person feeling pain. I hope that this blog post helps you do that, too. Value yourself. Value other humans. Simple, and so difficult.

::Edit:: This op-ed piece for the New York Times contains the best information and response to the death of Robin Williams that I’ve seen. I’m not surprised that author and doctor Kay Jamison is responsible for it. “Depression Can Be Treated, But It Takes Competence.”

A Good-Bye Letter to a Young Woman

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Trigger Warning: This post discusses suicide and depression and may trigger a strong reaction. Thanks to Cristi Comes at Motherhood Unadorned for providing this list of crisis resources:

If you or someone you know is in immediate crisis, please call:

 

I didn’t want to write this post. I just avoided thinking about writing this for so long that I don’t remember when we heard the news. A young woman I never got the chance to meet, a former student of my husband’s, died last year. I don’t know her family or whether her death was a suicide. I strongly suspect that she did take her own life. The last news we had about her, before this, was that she had left school to try and get help for severe depression. As an undergraduate, she confided in my husband in fall, 2011, that she was struggling with depression. With her permission, he shared her story with me. He shared my blog with her. Her name was Rachel.

I wrote a letter to Rachel on this blog and on my blog at Psychology Today, and she said that it helped. I have not gone back to look at the comment she left. I just can’t. She seemed to be doing better, my husband reported, at the end of that semester. It’s time to write another letter; if Cristi can fly across the country for the Overnight Walk for the American Foundation for Suicide Prevention, then I can write this letter.

Dear Rachel,

We miss you. We had so hoped that you would come back to finish college, stronger and healthier. We had hoped that you would come to visit us, and meet our son. I had hoped to get a chance to tell you, in person, that it would get better.

But it didn’t get better. You are gone, and the world will never know what you might have done with the rest of your life. There was so much life ahead of you. I am so sorry that you did not believe in the importance of that life. I am glad that I told you that I believed in you. I am angry that you are not here to be told again and again by many people to just keep hanging on.

I’m crying, holding my infant son in my lap, and grieving that we will never see you smile over him. When I look at him, I think, “My God, if I had gone through with the suicide plan I made when I was Rachel’s age, I would never have known this moment.” There was no way, when I wanted to die, for the people who cared about me to reach into my future, pluck this image, and give it to me to hold as a reason to stay. I had to take it on blind faith. It was hard.

I’m so sorry that you did not stay with us. I’m so sorry that life was so hard. I don’t know what happened, but I desperately wish that you had found a way to be here. I want to put my son in your arms as a symbol of the future and make you understand that the darkness that surrounded you made it impossible for you to see your own. It was still there, your future. You had one, and I believe that it was bright. I’m so sorry that you couldn’t see it. I’m angry that you didn’t hold on.

I believe in reincarnation, truly, and I pray for your soul. It comforts me to know that your journey is not over, but I also believe that it will continue to be difficult. Maybe that’s not what we usually say when a young person has died. But I know that you’re still out there, somewhere, and I want to hold you and tell you that giving up is never the way out. I still have hope for a bright future for your dear soul. However long it takes, no matter how many times you forget that you are loved, I know that you will make your way out of the darkness, someday.

I am holding you in the light, in my heart, always. Good-bye, Rachel.

Love,

Anne-Marie

Hamlet's Ophelia, by Millais, behind a line Laertes delivers at Ophelia's funeral

Hamlet’s Ophelia, by Millais, behind a line Laertes delivers at Ophelia’s funeral: “Lay her i’ the earth / And from her fair and unpolluted flesh / May violets spring!”

Depression: Everything Is Harder

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VirginiaWoolf

My favorite portrait of a young Virginia Woolf, by George Charles Beresford. 1902.

You know those people who say that geniuses had to suffer to be geniuses? They are wrong. Case in point: I used to study Virginia Woolf in an English PhD program, and I came across a few fans of her work who thought that her suicide was terribly romantic. First, there is nothing romantic about suicide, ever. Second, she was not able to write the way she did because she was mentally ill. She wrote in spite of it. My heart breaks every time I think of her suicide note. Her husband, Leonard, wrote this, after her death in 1941:

 The words which she wrote are: ‘I feel certain that I am going mad again. I feel we can’t go through another of those terrible times. And I shan’t recover this time.’ She had a mental breakdown about twenty-five years ago; the old symptoms began to return about three weeks before she took her own life, and she thought that this time she would not recover.

Even in his grief, he felt compelled to write that to a newspaper after it tried to claim that she killed herself because World War II was coming–they quoted the letter as saying “these terrible times.” But as terrifying as the “times” were, she clearly meant that another bout of “madness” was too much to face. No one knows exactly what Virginia Woolf suffered from, but depression was certainly part of it. The poor woman also heard birds singing to her in Ancient Greek, so there was more to it than the kind of depression I have experienced. (Source: I’ve read tons of diaries and autobiographical writings and biographies, so it’s in those, and I’m not in grad school anymore, so I don’t need to find a page number. And yes, she did speak Ancient Greek, despite being self-educated.) Some of her characters experience things similar to what she remembered from being “mad,” but she did not write while it was happening. She couldn’t. Whenever I read that note, I think about what we might be able to read about her or by her if she had had more time. What I just quoted is just a few sentences, but “time” is everywhere. She could not face the time and energy it would take to live through another “terrible time.”

I do not compare my own writing to what Virginia Woolf wrote. My point is really that depression sucks time, energy and reality into its vortex and never gives it back. I had an idea for a post that I’ve forgotten. I don’t even remember when I had the idea, just that it was there and is now gone. But I keep hearing that it helps some of you out there to hear about what’s going on in my little world. And this is what is going on: no matter how hard I try, I am not able to think clearly. I run out of energy in the middle of things. I forget to eat. Hours go by like minutes sometimes, and at other time, minutes go by like hours. I have set alarms on my phone to remind me to take my meds and to eat, because I can’t trust my own sense of the passage of time. It is so hard to do anything that I am not sure I would keep writing here if I had not started this project before this bout of depression.

I learned, before I felt depressed, that writing here made me feel connected to people just like me. I learned that the act of writing and hitting that button that says “Publish” helped me feel like I had accomplished something. I know from my experience with anxiety that if I say my fears out loud, to the dog or to the air, they seem smaller. Outside my head, in the light of day, they are not as big. So it’s important not just to write, but to publish. I am thankful that the internet allows me to do that. To say all of this “out loud.” I have never been able to keep a journal going.

I know many people, many of them mothers, who have a hard time justifying to themselves a project that helps only them. That is not really ok, since self-care is so important for every human being to feel ok. But even though I know that writing here is good for me, I am working so hard to focus my scattered mind and write something today because I know it helps you. When I am too tired to get myself breakfast, I can still somehow get up to change my son or at the very least, feed him. I simply find it easier to do for others.

But this is one of the ways I can trick Depression and its Lies: if I tell myself that this is for the friend who will not talk to me over the phone or answer email but will read this blog, I write. And in writing, I help myself. I just wrote over 800 words that reminded me of the time I beat this at age 22. I remembered that I am smart, well-read and well-educated. I remembered that I have friends and family who wait for these posts because they love me, not because they need something from me. All of that gives me back the pieces of myself that Depression tries to tell me have disappeared.

In the middle of writing this, the baby decided that he was done with his swing. It’s hard to type while holding a baby, go figure. I put him in our Moby wrap, where he nursed and is now sleeping peacefully. Somewhere in that time, the doorbell rang. I was putting on (yoga) pants by the time I realized that I was about to actually DO IT: take the baby and the keys and go outside both locked doors to collect a package.

Friends, I put on my shoes, grabbed my keys, shut our apartment door behind me, shut the entryway door behind me and collected that package. I shook a little bit, terrified that I would lock us out again. But I looked down at the keys in my hand, and I told myself that it wasn’t possible. I felt the fear, but I did not believe the lie. I used my keys to unlock the first door, then the second, and here I am, sitting at this computer, writing the post that I told myself was only for you.

With depression, everything is harder. But it is not impossible. No matter how terrible times, we can always recover.

Help: Depression, Motherhood & Upside-Down-Me

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When I saw the exoression on my face and dark circles under my eyes in this self-portrait of us, I was totally shocked.

When I saw the expression on my face and dark circles under my eyes in this self-portrait of us, I was totally shocked.

I am writing this well after my bedtime, because I don’t want to go to bed. I don’t want to go to bed, because if I go to bed, then tomorrow will get here faster. I know that this is untrue, and that being exhausted tomorrow will not make the day any better. But I have been staying awake to put off Tomorrow since I was a little girl.

What happens tomorrow? I meet with my psychiatrist. I am terrified. Not of her–she’s such a lovely person and so good at her job that my midwife started handing out the doctor’s card to local moms/moms-to-be who need help after speaking to her just once or twice. I am terrified of what she might say, and of what she might not say. It’s been a month since I saw her last, but it feels like six. Two weeks ago (again, feels like six) I told you about my anxiety attack after locking myself and my son out of our apartment. That blog entry is proof that I recognized what was happening and opened up my Anxiety Tool Kit to start dealing with those feelings right away. But they multiplied. I talked through it, but I kept crying. I felt foggy. I didn’t realize how terrified I felt about leaving the house until my therapist challenged me to leave with my son, walk out the front door of the apartment building, turn right around and open the two doors between us and home. I still haven’t done it. I can’t even do it with Nathan inside the apartment, ready to buzz us in. Since the point of the whole exercise is to prove to myself, to that doubting voice, that I can remember my keys, it’s unlikely that I would forget them. I can’t imagine it going wrong. I can imagine doing it. But I haven’t done it.

It took me awhile to realize how terrified I felt of going outside in general, because we were snowed in. As you may have heard, the East Coast, from New York to Boston (and us in between) got a lot of snow. I grew up in Minnesota, so a blizzard is not a scary event, and I can deal with snow. I know better than to drive during a blizzard, but I was not exactly panicked about the weather. In fact, I was thrilled. Thirty inches of snow fell in as many hours. It took days and days for a plow to get to our driveway. There are still major streets here that become one lane due to massive mountains of snow left behind by the plows. My husband, Nathan, couldn’t leave the house to do his grad school work; he usually leaves for a few hours every morning to work at Starbucks or the library.

Here’s the chronology: on Wednesday night, I locked us out. On Thursday, I had a therapy session about that over the phone because I felt too panicked to leave the house to go to therapy. On Friday, a blizzard dropped nearly three feet of snow on our heads. On Saturday, Sunday and Monday, the streets were too blocked to drived anywhere. But on Tuesday, he didn’t go in to school. He probably stayed home in part because of the snow; he had no idea how things looked up north on campus, and our car is notoriously bad in even a few inches of snow. He also stayed home because the thought of him leaving brought me to tears.

In under a week, I spiraled from Thriving all the way down to Crying At Random and shrieking “Take him!” whenever our baby fussed. I suddenly felt like a complete and utter failure whenever he wouldn’t be soothed by nursing or bouncing. I stopped sleeping at reasonable hours. I’d be awake at 3:00, 4:00, 5:30, hours after Walt had fallen asleep, playing games on my phone (and often crying). But this is where it gets weird, for me, because I didn’t feel my heart racing or recognize any anxious thoughts on a loop. I just felt… numb. Or sad. Once, I woke him up so that he could talk me out of self-harm; my urge that night was minor, in the scheme of such things and compared to what I felt in the past. But I have only ever felt those urges when I have also felt trapped and hopeless.

I felt depressed, obviously. But was this depression? Was this postpartum depression?

Obviously, the snow made going to therapy impossible, so I talked to my therapist over the phone. I told her about the crying (mine and my reaction to the baby’s), the fog, the feeling numb. I told her how surprised I was that the change had happened so quickly. I told her about my sleep and losing track of time.

I actually saw her today. Things are a little better, because I’ve been taking Benadryl to get to sleep. Yes, we co-sleep, and taking “something” to sleep isn’t safe for bed-sharing. But Walter is sleeping in his co-sleeper, now, if he must, so it’s safe for me to take something like Benadryl that makes me extra sleepy for a few hours. The sun is out, and I’ve gone outside to appointments (chiropractic! fun!) and even twice just to prove that I could (just not with Walter in tow). I’ve gone out for lunch and shopping with my mother-in-law. But I still feel all wrong.

There was a lovely moment today, with our gorgeous little family all snuggled up for a nap, when my husband told me that he was blissfully happy. The three of us, cuddling, was the best thing he could possibly wish for. He had never been happy like this before Us. I started to cry, because I saw but did not feel that joy. I knew that I should. I knew that I loved my family. I knew that a month ago, I would have felt the same rush of joy he was describing. But I cried today, because I could not feel the joy I had earned.

I’m crying now, as I type this. I’m doing everything I’m supposed to do, and I am not in any danger. I thank God that I have no intrusive thoughts about my son. Most of my smiles have been because of my Walt. He loves to smile up at me during breaks from nursing, and I get a special smile he saves just for me. I have fantasized about being far away, alone in a quiet hotel, because he is fussy almost every night around sunset, sometimes for over an hour, and hearing his cry hurts my heart. It hurt my heart a month ago, too, but I had perspective, then. Now, if I can’t comfort him, I can easily loose all perspective and start picturing a teenager who will hate me for every mistake I have made and will make. I have even wondered, at my lowest, how long it would take before my family realized that I was just weighing them down and left.

Part of me wants to hear my psychiatrist respond to this information with the words “Postpartum Depression.” I want those words as proof that it’s not my fault; a voice in my head has always told me that I am “faking it.” If I just tried a little harder… But do I need the diagnosis? Is it even possible to tell, yet? This could be a relapse of depression–Major Depressive Disorder is already in my history. My major depressive episode had prolonged and extreme triggers, and this just feels chemical. I feel like I got hit by a truck, or by a magic spell that erased my mental-illness-fighting powers. My therapist agreed today that, had I locked us out a month ago, I would have bounced back by now. She has a social work degree and does not diagnose things like PPD.

Something unfamiliar is happening. Suddenly, there’s a kind of distance between me and my own life. Underneath all the chatter in my head about diagnoses and justifications is one desire: find help. I just want to know that it’s going to be ok. I want to know that there is a path back. I want the mood swings to stop–I am scaring myself by feeling so full of rage and sadness that my face actually flushes hot and red. I don’t want to dissolve into tears every time my son cries. A month ago, I was pitching ideas to other blogs and excited about attending a conference, BlissDom, after winning a ticket in a contest. Tonight, I can hardly remember where this post started or where I wanted it to go. Hours go by without my noticing, or I feel like hours have passed after just one. My world is upside-down. I will do anything to make it right again.

The Stigma of Mental Illness: Three Stories from Readers

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In exactly one week, I have received questions from three very different readers about three very different struggles. I love hearing from you. It keeps me writing, and it gives me a sense of purpose for this space. But I cannot begin to express how sad it makes me that these three women have come to me, each asking “Where do I even begin?” While I am a readily accessible voice happy to help, I believe that they are asking me because the stigma of mental illness, the reason so many of us end up feeling ashamed of our struggles, has made it difficult to find help in the “real” world.

I have some ideas specific to each question, but I want to take a minute to say this: if our culture did not stigmatize mental illness, maybe our daughters, sisters, wives and mothers would feel more comfortable talking to professionals. Asking for help in real life can trigger so much: what will friends and family think? What will it cost, financially? How do I find someone qualified to help me? If we were talking about something else, here, diabetes, for example, there would be no end to the resources available to help manage the issue. No one would call us weak for depending on insulin. No one would tell us to “tough it out” or “get over it.” But we say these things to people who admit to struggling with mental illness, so three women who each need a different kind of professional to guide them through very difficult decisions have come to me, a blogger with personal experience but no medical credentials.

I repeat: I love hearing from you. I am happy to help when I can. Overjoyed, really. But it should not be so hard.

Now. Please send your love to three souls in need of support:

Em is thirteen-years-old and at a loss. She has asked me what to do, because the panic attacks and other anxiety symptoms are overwhelming. She feels depressed. She wonders if maybe it would be easier if she were dead.

At 13, I felt every single thing Em described to me. I don’t know if she has “active” suicidal thoughts, but wondering if things would be easier for everybody if you died is called a “passive” suicidal thought. It’s a big step from feeling so tired that you want to give up to actively making plans to end your life. But it’s not a good way to live. It sucks.

In a strange way, being thirteen and anxious/depressed is a bit like being pregnant and anxious/depressed: no one knows what to do with you. It’s hard to find someone to give you a realistic picture of your options, because we are terrified of what the side effects medication might have on a fetus or on a child. There is a bigger risk, there. I truly believe that meds are just one of many tools, but being in a place where no one wants to touch that issue with a ten-foot pole? That sucks. If your doctor isn’t willing to discuss the risks, you may not be able to try something that has the potential to offer relief.

When anyone feels the way you feel, Em, we want relief. We want it NOW, especially when the work we are doing, like your work in counseling, doesn’t seem to help us at all. I am so truly sorry that you have to go through this. It gets better. I promise you that life is better on this side of thirteen-years-old. Please, do whatever it takes to get through this time. It is amazing, the amount of pain a human can feel and still keep going. One foot in front of the other. One day at a time. Just believe that it cannot last forever.

CC is forty-two-years-old and facing an unplanned pregnancy shortly after the death of her mother; she is not thrilled to be finding out this way that, despite feeling sure that she could not become pregnant, surprise! she can. And is. And there’s more. She writes,

“I was taking a boatload of everything and pretty much had some of my issues ironed out until this happened. Now I am told that, oops, that 3 mgs a day clopanpin a day you take could be the worst thing in the world for you. … do you know anyone who took that much clonapin in the early stages and had a healthy baby?”

I wrote back, immediately, of course, that those doctors are OH SO VERY WRONG! And here is where I get angrier than the Hulk. In this country, a woman has the legal right to terminate a pregnancy. But we are talking about a woman who wants to have a baby! CC sat at her computer at 4 am wondering who on earth to talk to, without a cell phone or money for a phone card, because she left a doctor’s office believing that she had to choose between her mental health and the physical safety of her fetus.

Just take a minute to let that soak in. An adult woman left the office of a licensed care provider with the idea that the medicine she considers a lifeline, her only path to sanity, would destroy the health of the fetus she is carrying.

I don’t even know where to begin, there is so much wrong with CC’s experience at her doctor’s office. I reread her letter so many times, wondering if it was possible that she had misinterpreted a responsible doctor’s explanation that there is a risk in taking meds to mean “meds will definitely hurt this fetus.” But she did not leave that office thinking that medication in general is terrible during pregnancy, a myth that many people believe. She left thinking that only one of several medications she takes is basically poison. It takes a special kind of incompetence to so severely misinform a patient.

I don’t know the end of CC’s story. I hope that, whatever she has decided, she is doing ok. Obviously, I told her that she deserves a care provider who can show her enough respect to at least do an internet search on her meds before telling her which to stay on and which stop taking. I also told her that I took four mg of Klonopin every day of my pregnancy and had a healthy baby, but that this did not mean that everyone taking the drug would enjoy the same outcome. But the specifics just don’t matter, here. At the root of this woman’s encounter with a medical professional is the idea that she can just go without the medicine and that she should, because she is pregnant. Did you know that asthma inhalers pose risks to a growing fetus? Did you know that some women end up hospitalized because they try to go without their inhalers? Do you know what doctors tell them? They say, “Use your inhaler! You are breathing for both you and the baby, and neither of you can do without oxygen!” CC told me that she is afraid that she will become suicidal again without her medication. She is also afraid that she will become suicidal if she terminates this pregnancy. If she were not pregnant, every doctor would see the risk of relapse after stopping a medication like Klonopin. But as soon as there’s a fetus involved, most stop seeing that risk to the woman and only see potential birth defects. The worst part is that most of them don’t even know the actual probability of that happening.

And this brings me to the last letter, written by a woman very much like me. Laura put off thinking about the potential conflict between her desire to have children and the use of medication to manage her anxiety and depression. Now that she and her husband of three years want to have a baby, she has no idea where to begin trying to understand her options. She wants to stay healthy, mentally and physically. She wants to have a healthy baby. She went looking for “resources” on this topic and found nothing.

I started this blog in summer, 2010, because I couldn’t find any sort of guide to help me understand my choices. In the eighteen-plus months since I went looking, not much has changed. There are articles about individual studies that have come out since then. There is more information in the world about pregnancy and mental health. But it’s not any easier to find.

I’m simply not qualified to create that resource guide, nor do I have the time and energy to do it. Maybe it should be done. Or maybe our doctors should look up the medical research that exists on databases that are readily available to physicians and, at the very least, translate what they have read for their patients from medical jargon into English. Maybe medical schools should look into training obstetricians to prepare for the fact that this is going to come up, given that, as the Mayo Clinic website reports, “About 1 in 5 women develop depression at some point in life.” You know how I learned that? I did a Google search for “percent of women with depression.”

Somebody. Please. Tell me why it is too much to ask that doctors who exclusively treat women prepare themselves for the possibility that some of us will have such a common illness? Why do we just accept it when a doctor is uneducated or, worse, misinformed, about something that happens all the time.

The only answer I can come up with is the thread that connects these three letters, for me: as a society, we send the message that depression and anxiety are not “real” problems. In a thousand ways, we imply that medical treatment for depression and anxiety is optional. Those of us who struggle with mental illness learn quickly that others become uncomfortable when the topic arises. We learn to hide it. We learn shame. Even if we manage not to feel shame, we hide it for the sake of convenience. We learn to justify taking medicine, going to therapy, seeing a psychiatrist, because our culture still promotes the absurd idea that, unlike a heart condition or diabetes, mental illness can be willed away. It is not a “real” illness; it is more like a weakness.

Just get out of bed.

Just stop crying.

Just go for a walk.

Just talk to someone.

Just go off the meds for the pregnancy.

It’s been weeks/months/years, aren’t you past this, yet?

Are you going to have to take that stuff forever?

It’s all socially acceptable, even for doctors. It’s all wrong. I love that my little corner of the internet is a place where we refuse to accept that kind of nonsense. I have carefully crafted this blog so that it will show up in search engine results for the very specific problems I encountered (“klonopin and pregnancy” is quite common). But my heart aches, because for this one safe space, there are a hundred hostile environments. Em, CC, Laura and all the rest of us deserve better.

Small Mistake, Big Anxiety Trigger

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I was on the phone, wearing a fussy baby in a sling and pacing the apartment to keep him happy, when the doorbell rang. The dog flipped out. I thought the mail carrier was delivering our new phones, and I felt like I had to catch him and sign for the package. Nathan was going without a phone. His was broken, we panicked, we discovered that we were eligible for the 2-year-upgrade, and now we both have new phones. Are you getting a picture of everything that was going on in my head? I managed to cram “put on shoes” in there, and we were out the door. Which locked. Behind us. And I didn’t have the keys.

I locked us out.

I know, I know. The police aren’t coming to arrest me for child endangerment for getting stuck in the hallway. I didn’t even lock us out of the building. I didn’t leave the baby inside. In fact, we ended up spending time with our lovely neighbors. We had a good time! They love Walt. We really like them. In fact, they walked our dog, Lewis, when I was in the hospital having Walt!

So why have I spent the past two days spiraling down a tunnel of anxious thoughts leading to the “I’m a bad mother” abyss?

I am afraid that this was the first of many mistakes. What if I start locking the keys in the car? What if I forget to pick him up from school? What if he has to climb through windows all his life when I lock us out again? What if I do actually put him in danger? What if this just proves what I have suspected all along–that I am not a responsible, trustworthy person?

There is so much anxiety now that didn’t exist on Wednesday morning. It’s really intense! I don’t want to leave the house. I had a nightmare last night that I got separated from Walter while traveling and couldn’t get back to him. I had left him without a bottle of milk, without formula, without a carseat so someone could drive him to me. I woke up fighting my way against the current of a crowd trying to catch a train, knowing that he was already miserably hungry and doubting that I would ever reach him.

Look at this child! He is so perfect!

IMG_1857

Cookie monster tee + Honest anchor diapers + a smile. What else does a boy need to wear?

How can he be mine? Surely, he must deserve a mother who remembers to take a picture of him in the same spot every month to mark his growth or, at least, a mother who leaves the house every day. Maybe even just one who gets dressed every day.

I don’t know how to get out of this, today. It doesn’t seem to be getting worse. His dad stays home to help out on days like today, working on grad school stuff in the mornings, when Walter usually sleeps well. I can feel the panic lurking. It makes me just a little bit spacey, a little distracted. My breath is a little too shallow. I’m not depressed. But I can see it–how I might get from here to depressed. Which is, believe it or not, a good sign.

Jenny Lawson, aka The Bloggess, sums up everything you need to know about depression in one simple phrase: Depression Lies. Watch the video. Do it. I’ll wait.

…

Ok, back? Now: if I were actually depressed, I would really and truly believe that Walter and Nathan and even Lewis would be better off with a better wife/mother/me. As long as I am here, writing about how having thoughts like this totally sucks, then I am ok. I am looking at the thoughts, and pointing at them, yelling at them, telling them to go away. I know that they are lies. When I start believing the lies depression and anxiety spew, it’s time to worry.

Now is the time to fight.

Pajamas aren’t so bad, when I think about how hard I am fighting today to remember the truth. It’s tiring. In fact, I’ll show you, because I am brave and now have a phone that does self-portraits, what days like today look like. I could use a shower, but I’ve looked and felt worse than I do now. Which is like this:

My mother-in-law gave me these pajamas. They are soft and have ribbons and lace and roses. I love them.

My mother-in-law gave me these pajamas. They are soft and have ribbons and lace and roses. I love them.

A Lesson in Manipulation, or SSRI Use In Pregnancy: The Headlines

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When a new study about drugs and pregnancy comes out, it gets a lot of media coverage. Such an event occurred this week, when a brand new study about SSRI use in pregnancy released its results. So, take a look at the following headlines. Which headline tells us the conclusion the latest study’s actually came to? Is it…

A) Study describes pros, cons of antidepressant use in pregnancy

B) The Pros and Cons of Antidepressant Use During Pregnancy

C) Antidepressant Use in Pregnancy Linked to Smaller Heads in Infants

D) Study weighs antidepressant use during pregnancy

E) Antidepressants During Pregnancy: What Are the Risks?

F) Antidepressants in pregnancy affect baby’s head size

That’s right, none of them. Not a one.

C & F get kind of close.

Do you want to know what they found? Women who suffer from depression are more likely than women who are not depressed to have babies with smaller heads, among other issues (low fetal growth and low birthweight included among those issues). Women who take SSRIs during their pregnancies are more likely to have babies with smaller heads than women who take no prescription medication during pregnancy. And here’s my favorite pare: we have no idea whether or not fetal head size matters. So, what did we learn? There may or may not be a correlation between depression/SSRIs and smaller fetal head size. That’s it. There’s nothing else. Does it matter at all? We do. Not. Know.

Go to H E Double Hockey Sticks, you manipulative jerks who write headlines.

UPDATE: Fox news chimed in with this beauty– “Mixed picture for mom, baby with antidepressants” Does that even mean anything?

Here We Go! Rachel, Part II

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In an earlier post, I introduced Rachel. Here’s the rest of her interview:

The happiest nursery!

Can you tell us a little bit about your background? 

i have had severe depression and anxiety since i was born. i remember laying in my crib and being terrified. i remember going to watch my bother, who was 2 years younger than me, take naps because i thought something bad would happen to him. i was always convinced someone around me that i loved was going to die, that a tornado would come during school and kill my parents. if it looked like it may be a tornado day i would fake sick to stay home from school (i grew up in the suburbs of detroit, michigan so the weather could get crazy). i was always creative and very social and somehow managed to keep my worries and depression well hidden.
i had 2 friends that knew of my deepest fears. one was my friend david, who suffered from the same things as me and the other was my friend casey, who was carefree as could be. the 3 of us were super close. in 8th grade casey got a rare case of leukemia. she went home from school on a friday and died exactly 7 weeks later. the disease literally ravaged her. david and i were devastated and i think it just made our fears of losing people that much worse, that much more real. things for both of us went downhill from there.
in high school i began to really think i had cancer ALL THE TIME. i swore i could feel lumps on my ribs, and my mother and i spent many days and nights in the ER only to find out i was fine every time. the strangest part for me, looking back, is that i was incredibly social. i had a huge group of girl and guy friends. i was outgoing, played sports, did well in school. i don’t know how i managed all of that while being such a mess internally?!?!
anyway, things got really bad my junior year of high school and i started reading “Ordinary People” by judith guest ALL the time. i stopped going to class, which was not okay, considering i was in a private school.
i started realizing what depression was and i let it completely take over. i think most of my peers were pretty shocked. i just stopped caring about trying to hide it anymore. by the end of my junior year i had transferred back to my original public high school, where i still had maintained all of my friendships because we had been going to school together since kindergarten and the private school i was in always was social with all the public schools in the area. it was a totally easy transition but my depression was still wicked bad. i began my senior year and within a month i was diagnosed with severe depression and anxiety and put on Prozac. it helped. a lot of people didn’t like the idea of it. my boyfriend of nearly 4 years, my dad etc. but i didn’t care. i was a mess! the Prozac stopped working after i began to take the generic version, about 2 years later, and had to switch to effexor. i learned VERY quickly that it’s just NOT worth it to EVER take generic of your main anti-depresant. i know the costs are extremely high but your sanity is worth EVERY PENNY and way too often do the generics just fizzle out. 


You and I share some anti-anxiety medications in common. Have your anxieties changed since you found out you were pregnant? If yes, how?

not really. i was so sick that i couldn’t focus on anything else but getting through the days. it was HORRIBLY taxing on my body. i think it kept my mind off worrying about anything because i just wanted to get through the sickness.

Did you know immediately that you would have to stay on the meds, or did you think about going off of them? 

my psychiatrist initially suggested i stopped taking everything immediately since the 1st trimester was the most crucial for their development. he also mentioned that i would probably have a seizure from coming off them which would result in losing the babies. it really seemed like lose-lose situation. i was NOT happy with him. but i gave it a week and talked it over with my husband and we decided i was not going to stop my meds. we went to see the OBGYN a few weeks later for my sonigram and his initial reaction was “i hope you aren’t still taking any of your meds now” to which we replied i was. he was NOT pleased about it and said he was going to call my psychiatrist immediately and get back to us. this again was disconcerting but a week later he called us and said after talking to my psychiatrist they both agreed i should stay on my meds and do my best to wean off my xanax and klonopin but that i probably should just stay on them until the end. the plan right now is to wean me off them during my last 10 days of pregnancy so the babies aren’t addicted to them. that’s a slippery slope because with twins the likelihood of my going into labor early is significantly higher so figuring out when the last 10 days will be is pretty unlikely. also, from MANY previous experiences, i think weaning off meds in 10 days will be extremely traumatic for my body. the worst case scenario is i don’t wean off them and the babies will be given drops for a few days after they are born by a neonatologist to help wean them off.

[I am completely appalled by these doctors. First of all, they should not be allowed to recommend that Rachel put her own health at risk without first looking at the specifics of her meds. Just stopping medication like this is miserably painful–it’s painful if I forget to take my meds for just one day–not to mention whatever happens psychologically! Second, the OBGYN sounds completely patronizing and obnoxious, not least because he doesn’t know what he’s talking about. Finally, I cannot believe it took him a week to call back. It took my doctor two minutes to print out stuff from a doctor’s database of teratogens about the risks of taking Klonopin and Effexor while pregnant.]

Has your body’s absorption of or reaction to the meds changed with pregnancy? 

honestly, i think my body is leveling out more, which i had always read could be the case with women who struggle with my disease. it tends to swing one way or the other and i definitely think my body is going to be able to handle being on less meds after my pregnancy. there seems to be a balancing of hormones taking place. before i got pregnant that was one of the scariest things and reasons why i didn’t want to chance getting pregnant. what if things got worse? that was always in the back of my head.

Who was in on your decision to continue with your medication? You and an OB? You, your partner, an OB, a psychiatrist, a neighbor, your friends and your siblings? Or somewhere in between?  

i think i pretty much answered this in the previous questions but since my OB and my psychiatrist weren’t going to pull me off anything it basically became a personal decision between me and my husband. once we decided i was going to continue we also decided that we were going to do our best not to worry about it or flip-flop on the decision. we felt very confident in our decision and had faith we had made the decision that was best for us and our girls

What kind of information did the professional(s) involved give you? What did you find out on your own? Was there any specific source or piece of information that you have found most helpful? 

they didn’t give us much info. it seems more of a “we don’t know so it’s better you don’t take them and we don’t want to be liable”. i’ve read wayyyyy more studies that show that women who are stressed, anxious and depressed during their pregnancies end up having lots more problems with their little ones than woman who aren’t, even if it takes meds to keep you from feeling that way. i honestly didn’t do much research after we made our choice because more than anything our faith and trust in God was what it ultimately came down to. He knew my situation, He was the one who had placed those babies inside me, so we just decided He knew what was best and there was no point in worrying.

Were there any dissenting voices you had to overrule? 

after the year i had in 2010 i don’t think ANY one that was close to our family was going to say a word about me and my meds. i was so bad, so suicidal and so panic-stricken for months that my family and friends were just trying to be as supportive as possible. we have a big family and we are very open with each other. there are lots of people in my side of the family (my dad has 7 siblings and my mom has 3) who struggle with addiction and mental illness so it’s just something that is understood.

How does your partner feel about the decision? 

fully on board  : )

Do you plan to breastfeed your babies? If you have had that conversation with a doctor, do you know if there are any risks associated with breastfeeding that are different from the risks involved in taking the meds while pregnant? 

i will NOT be breast-feeding and decided that a long time ago. quite frankly, i’m completely fine with the decision, especially because there are going to be 2 of them.

Have you started drawing on a crib or diaper bag yet? 

haha, love this question! i actually registered for 2 diaper bags at target, 1 for me and 1 for my husband, and we got them both at my shower. i think i’m gonna use a regular diaper bag in the begininng but i’m sure i will be using all sorts of vintage totes and cases for storage and running around once they are born. i really have been unable to draw throughout this entire pregnancy because of sickness or because of huge-belliness! i have gotten really into cross-stitching for the nursery because it’s light and my tummy doesn’t get in the way. i’m DEFINITELY making them train cases to store all of their baby stuff in once they are born. these will be displayed in the nursery and hopefully they will use them when they are older.

See that little bunny with the heart? That's the cross-stitch! Those button-y monograms are more craftiness.

Do you have any advice for women who are/want to be pregnant but face anxiety and/or depression?

man, that’s a tough question. i don’t feel i have exact points but rather just the sharing of my story seems to be the most helpful thing i can do. ultimately, listen to your body and do what you think is best for you. if you freak out before even attempting to cut back your meds then i would advise you don’t do it. chances are you are going to make yourself sick before the drugs have even begun to leave your system. the mind is a VERY powerful thing. just listen to your body and trust the advice of those people who know you very well and will support you. you really cannot care what others think or say, which i know is easier said than done but remember: people who don’t know you aren’t fit to give their advice. they haven’t walked a day in your shoes and they certainly don’t know the challenges and struggles you’ve faced and will face. there is no way in the world they could come close to being qualified to making decisions about your meds. i would really suggest you just be as open and honest as you possibly can and find some sort of support, even if it’s just one person. that person can make all the difference in the world.

Bed rest. Music and art to keep her company! Grow, babies, grow!


Ready or Not… Rachel, Part I

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Meet Rachel! She’s a talented artist and popular Etsy seller. I happened to be on Twitter one day and saw an announcement: she was closing her Etsy shop for awhile, because pregnant with twins, Rachel’s belly was just too big to keep making, packing up and shipping upcycled vintage luggage. Here’s Rachel before she knew why she was so tired:

"me when i was 3.5 weeks pregnant and, though i was unaware, i vividly remember needing a nap that day and being EXTREMELY EXHAUSTED and all out of sorts. it's one of my favorites because i was watching my friend's little boy and wondering why on earth he was taking all of my energy?!"

Isn’t she cute? Oh, and this is what the Etsy world is missing out on:

Wouldn't you love to have this train case with Rachel's adorable birdie design? I would!

Her shop, Get Ready Set Go, is here, where you can sign up for an update when it opens again.

Rachel contacted me when she read my blog in its early(er) days, and our Twitter friendship was born. Turns out, Rachel has suffered from anxiety and depression for her whole life, too. It’s easy to see myself in her shoes. This? This makes a lot of sense to me:

[quote]i have to preface this by saying that i am by NO MEANS a doctor or claim to be one of any kind. i have however been VERY interested in my disease and therefore have done a TON of research over the years. i’ve always been really open about my struggles which has helped me to gain wisdom from others and learn more about myself. i do not drink alcohol of ANY kind, nor do i use any recreational drugs or smoke. if you do struggle with depression and/or anxiety i would highly recommend you avoid alcohol, recreational drugs and cigarettes because it’s amazing how HUGE an impact these things can effect your mental state, especially when combined with prescription medicine. there are plenty of people, doctors included, that will say a glass of wine here and there or a beer is just fine with meds but if you stop and think about it, it makes ZERO sense. alcohol is a depressant and you are taking anti-depressants. it’s simple math and if you want to stay your healthiest then why would you mix the 2? again, my opinion but i’ve seen how alcohol affects my friends who are on meds and the end results are always extremely negative[/quote]

Whenever I see my psychiatrist, he asks me how many drinks I have per month, on average. Every. Single. Time. Even one beer gives me a migraine the next day, so a glass of something sparkly on a really special occasion is about as much as I allow myself these days. I was at my worst when I smoked cigarettes and drank, in college, and even though things were miserable for very separate reasons, I knew that I was making things worse. So I’d just like to add this to what Rachel says: if you’re anxious and depressed, and you find yourself smoking and drinking, then you have reached the point where you don’t want to take good care of yourself, anymore. It’s sabotage. It’s self-destruction. You are telling yourself and the world that you don’t care very much about your own well-being. Warning! Get help. You probably don’t need to check yourself into a hospital, but you could probably use some therapy. Keeping in mind, of course, that I am not a doctor, either. Just a fan of common sense.

Ok, here’s part I of my email interview with Rachel:

[hr]

How did you feel about the possibility that you might be pregnant, when it first occurred to you? Did those feelings change when it became a reality? 

my pregnancy was a complete accident. one slip up in 8 years of marriage and it happened to be when i was ovulating and wham! pregnant. i was NOT happy about it. i came around surprisingly quick though. i knew it was God’s plan and it wasn’t like i was in a bad relationship. my husband and i have an awesome relationship that has just gotten better over the years. we got married young, 21 & 22, and we’ve spent 8 years of it being just “us” so we were ready to focus on something other than ourselves. in terms of how i was going to deal with my meds was definitely disconcerting because i had just spent 2010 being so depressed that we thought i might have to have electro-shock-therapy treatments. we had finally found a perfect balance of meds about 4 months prior to my getting pregnant and things were finally going so well for me mentally so getting pregnant threw a wrench in everything.

How many weeks were you when you found out for sure? 

about 4 weeks.

How far along are you in your pregnancy? How is it going so far, on a scale from radiant to miserable? 

i’m almost 30 weeks. now, keep in mind i’m having twins so i’ve had double the amount of the HCG hormone running through my body from the very beginning and it was brutal on my body, physically. i had morning sickness 24/7 for the first 16 weeks and had to get IV’S 3-4 times a week because i was so dehydrated and couldn’t keep anything down. now, surprisingly, i was not miserably depressed during this time but just miserable physically. and looking back, i think i was throwing up a lot of my meds, another thing people don’t think about when they get the flu or food poisoning. *when you are throwing up a lot you are generally losing your meds because they are not fully into your bloodstream, even if you took them hours ago.

(*just something to think about that regular psychiatrists will rarely EVER mention or give a second thought to. even when you try to bring things like this up to them they will generally shake their heads and say, “no, that’s not true and the likelihood of that happening are slim to none.” most all of them are sooooo against hearing new ideas and not having all of the answers bothers them. that is another thing i had to get used to. doctors will always act like you are super sensitive or strange when weaning off a med or having a strange reaction to a med. they make you feel like you are the ONLY one who has ever mentioned strange side-effects. DON’T LISTEN TO THEM. YOU ARE NOT ALONE and PLENTY of people have a VERY difficult time with meds and what may seem like small changes in doses to a doctor can GREATLY affect your precise body chemistry. don’t let ANY doctor tell you otherwise!)

[hr]

Strong lady, right? I know! I want to highlight two things, especially for anyone who has wondered why I don’t just let “nature” decide when we have a baby (no one has outright said this, but people who don’t know us well have winked at it): pregnancy is hard and being on medication for anxiety & depression is hard. They key to surviving both pregnancy and psychiatry with your sense of self intact is, it seems to me, a willingness to stand up for yourself. “Hey! This doesn’t feel right!” Scream it until the doctors listen to you. Reading Rachel’s responses, it really struck me how many times she mentions how her body felt at a given moment–it’s that kind of knowledge and confidence in that knowledge that makes her an effective advocate for her own health care and mental health care.

At 20 weeks!

Too Soon to Cry Mercy? I Want My Medication Back!

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“I have no talent for certainty.” Jane Austen

It’s been eight days since I tapered my morning dose of Klonopin from 1.5 mg to 1 mg, and it’s been eight days since I had a good night’s sleep. I wake up soaked from night sweats with a jaw clenched so tightly it aches all day. Sometimes I sleep for twelve hours, sometimes for four. I dream about looking for some lost thing or person, but I never know exactly what I am looking for. My nights are full of problems with solutions that seem just out of reach. I just want to go back to eight hours. I want to fall asleep at 10:00 pm and wake up at 8:00 am again. I want to stop grinding my teeth so hard I’m afraid to knock out a filling.

For the first few days, I thought I just had to tough it out. But when I don’t get enough sleep, I get migraines. Understand this: I do not remember ever getting regular, consistent sleep until my early twenties. I remember watching the clock tick past ten, eleven, even midnight, as a child in grade school. (This is a classic sign of childhood anxiety, by the way.) Regular sleep was the first change that helped my anxiety, outside medication. I want my sleep back!

I’m not sure what to do, except ask my psychiatrist if this will end soon. Maybe I need a sleep aid to get me through this time. Maybe we need to make some other change to my medication. But I’m discouraged. I just didn’t see this coming. I expected harder days; I didn’t expect to feel lucky that I only had one migraine in over a week of terrible sleep. I didn’t expect to fall asleep with the kids I babysit in the middle of the day. [For the record, I wake up at the tiniest noise if I’m babysitting. R (18 months) threw one little teddy bear out of his crib, and the sound woke me up.] I didn’t expect to be baking scones at 3 am and watching Dr. Who. Everyone knows that’s a daytime activity!

Brown Butter Scones, with Teff, Whole Wheat, Oat and So Much Butter.

In the meantime, I think today I’ll go for a very long bike ride and hope that wearing myself out physically helps. Any other suggestions?