Sunday, March 9, 2014

I Got In A Fight Last Week...

I got into a fight. On Twitter. It sounds so lame and immature... But someone needed to say the things that I did, and honestly, I regret nothing.

One night last week, I was scrolling through my Twitter feed, when I can across a tweet claiming that the cure for depression is "a weekend of nature, sit[ting] under a tree and watch[ing] the water cascade over a cliff." As someone who has struggled with diagnosed clinical depression for a very long time, I was offended by this tweet. My response to it was: "Depression is a disease and chemical imbalance in one's brain, not an emotion. Stop #mentalhealthstigma & belittling the problem!" (Let's take a minute and think about how hard it is to tell someone facts and why they're wrong in 140 characters...) The replies I received were less than informed, and in some cases down right mean. I think my favorites were the ones that told me I was "brainwashed" and "Perhaps the chemical imbalance in your brain is a RESULT of you negative thinking/attitude" and "#YourHashtagsMeanAsMuchAsYourDegree #Nothing."

Depression is a serious mental illness that affects 5-8 percent adults in the United States each year. Less than half of these people will get help for their disease. This is a problem. Stigma and misinformed people are a problem. So let's look at some myths (and some arguments) that I came across in my Twitter fight.

Myth #1: Depression is not a disease.
The dictionary defines disease as "a disorder of structure or function in a human, animal, or plant, esp. one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury." By this definition, depression must be a disease because brain scans have shown decreased activity in certain areas of the brain in depression patients, higher levels of stress hormones, and various genetic and biological causes that cause symptoms impacting one's thoughts, feelings, behavior, mood, and physical health. For some, depression is a life-long condition in which periods of wellness alternate with recurrences of illness. Depression is a leading cause of disability worldwide and represents a global public health challenge. According to the World Health Organization, it is the forth-leading contributor to Global Burden of Disease, and by 2020, depression is projected to be the second-leading cause.

There is no doubt, then, that depression is an illness.

Myth #2: Depression is a disease.
This is intentionally contradicting the point I just made. Depression is a disease, but it is not a straightforward medical disease. Confused? So was I, don't worry. Dr. John Grohol explains it in this way:
Diseases are manifestations of a problem with some physical organ or component within the body. And while the brain is also an organ, it is one of the least understood and easily the most complex organ within the body. Researchers and doctors refer to a diseased organ when something is clearly wrong with it (via a CAT scan or X-ray or laboratory test). But with our brains, we have no test to say, “Hey, there’s something clearly wrong here!”
One could make the argument, as many have, that because brain scans show abnormalities in certain biochemical levels within the brain when they suffer from depression or the like, this “proves” that depression is a disease. Unfortunately, research hasn’t gotten quite that far yet. The brain scans show us something, that much is true. But whether the scans show the cause or the result of depression has yet to be determined. And more tellingly, there is a body of research that shows similar changes in brain neurochemistry when people are doing all sorts of activities (such as reading, playing a video game, etc).
Depression is not a pure medical disease in the traditional sense, but a mental illness or mental disorder. It is complex in that reflects its basis in psychological, social, and biological roots. While it has neurobiological components, it is no more of a pure medical disease than ADHD or any other mental disorder. Treatment of depression that focuses solely on its medical or physical components — e.g., through medications alone — often results in failure.

Dr. Azadeh Aalai relates it in this way:
Psychiatrists oftentimes use the parallel of the diabetic who takes insulin to treat his condition; so, too, must the depressive take his or her meds, they claim. This is a wildly inaccurate parallel for a number of reasons. Firstly, one can definitively diagnose and validate diabetes as a medical condition. One can also identify with certainty the underlying medical reasons behind the diabetic’s condition. Lastly, one can also identify with certainty the extent to which the disease can be controlled/treated with the administration of insulin (in the case of type I diabetes in particular). There is no definitive blood test or otherwise physical examination that can determine a depression diagnosis. In fact, contrary to the entire medical paradigm, the symptoms of the illness actually serve as the basis of the diagnosis in the case of depression. Moreover, there is not a clear intervention, medical or otherwise, that can be implemented for a depressed individual that will work in all cases.
Summary: Depression is a mental disorder or mental illness--not a disease purely in medical sense, but it is still a disorder.

Myth #3: Depression is a product of your environment.
This one made me laugh a little bit. The boy who said this was clearly confused because he gave an example of a kid being depressed because his parents were fighting. First of all, that is not clinical depression--that's sadness. The two are not synonymous, but I will get to that later. Second of all, all mental illnesses are biopsychosocial in nature.

The first component is biology, which includes both the biochemical makeup of the brain, as well as inherited genes. Neurochemistry, especially neurotransmitters like serotonin, has been shown to correlate with depression, but the brain is so complex, that much is left undetermined for certain. Lately, research has started to show a genetic predisposition to mental illnesses like depression, but none of this determines if an individual will be affected. Having a relative with depression only increases your risk for getting depression by 10-15 percent. Correlation does not equal causation. The second component of this model is psychological, which includes a person's personality, how he or she was raised to deal with stress, how he or she deals with emotions, and other aspects. The final component of this model is social, which includes relationships and how we interact and communicate with others.

The biopsychosocial model is the most widely accepted model in all of psychology because it states that mental illness cannot be caused by biological or psychological or social factors alone--it takes a combination of all three to bring about any mental illness.

Myth #4: Depression is a choice.
Depression is not something that a person chooses to have! Seriously. A person with depression does not want to feel the way that he or she feels. It is not something that can be willed away any more than cancer or diabetes can. Research has shown depression correlates with chemical changes in the body, which cannot be overcome simply by a change in thinking. Depression is a medical condition that arises from errors in brain chemistry, function, and structure due to biological, psychological, and environmental factors.

Myth #5: Depression is just sadness/laziness/weakness
False. Equating depression with any of these things is like saying a common cold is the same as pneumonia.
Depression is not just ordinary sadness, grief, or laziness. Again, to quote Dr. John Grohol:
Depression is overwhelming feelings of sadness and hopelessness, every day, for no reason whatsoever. Most people with depression have little or no motivation, nor energy and have serious problems sleeping. And it’s just not for one day — it’s for weeks or months on end, with no end in sight.
Depression is not a sign of weakness--it can strike anyone at anytime. It does not discriminate against gender, race, age, sexuality, religion, culture, or any other factor. Someone with depression is not just feeling sorry for him or herself. Some of the most prominent and accomplished individuals have suffered from some form of depression, including:  Alexander the Great, Napoleon Bonaparte, Abraham Lincoln, Theodore Roosevelt, Winston Churchill, George Patton, abolitionist John Brown, Robert E. Lee, Florence Nightingale, Sir Isaac Newton, Stephen Hawking, Charles Darwin, J.P. Morgan, Barbara Bush, Ludwig von Beethoven and Michelangelo.

Myth #6: Depression is just a phase and if ignored, it will go away. 
This is false. Depression is a medical condition that requires treatment and support. In fact, many times symptoms of depression will get worse if left untreated. One of the most effective treatments of depression is through behavioral activation. This is the idea that in order to decrease depressive symptoms, one must act opposite to them--activate one's behavior--in order for them to decrease (which will not be instantaneous).

Myth #7: Antidepressants work no better than a placebo and have dangerous side effects.
This one I had to do some extensive research on and the jury is still out on it, not just in my brain, but in the scientific community. Talking about antidepressants, Dr. Azadeh Aalai wrote:
The standard the FDA requires for psychiatric meds to be approved and sold to consumers is not a high one: only two independent studies that yield significant results in favor of drugs is required, regardless of how many trials may be required to render such findings. In other words, “so long as research eventually yields evidence of efficacy, the failures would remain off the books. This is why antidepressants have been approved even though so many studies have shown them to be ineffective” (Greenberg, 2010, p. 216). Moreover, research suggests that the reduction of depressive symptoms seen with antidepressant use may be more indicative of a placebo effect than the merits of the drug itself. For instance, some sources contend that up to 80% of the effectiveness of antidepressants is due to placebo effects (see Greenberg, 2010). This comes at a high cost, given the documented (and not so documented) side effects—chief among them that in some cases, ironically, use of antidepressants actually increases suicidal ideation (particularly among adolescents).
A study done by Harvard in 2005 more deeply probed the risks of antidepressants, as did a study at the University of Colorado. Multiple studies have shown the effectiveness of antidepressants over the use of a placebo. People will analyze these studies inside and outside and upside down, but the speculation that antidepressants are no more effective than a placebo has not yet been evidenced in research, and like all medications, psychiatric medications come with their risks and side effects. However, if the medications are taken properly, under supervision of a trained medical doctor, the risks are generally minimal.

Myth #8: School shootings are caused by antidepressants, proving they do more harm than good. 
So. I don't even know what to do with this one. To me, it is a clear case of people assuming that correlation is the same as causation. I did a Google search of school shootings and antidepressants and found not a single credible source in the first few pages of results. To make sure that I was not missing anything, I did a search of PsychInfo, which gave me no results. There has been no research done in the academic community which states a definitive link. I read a statistic (and only one statistic, and not from a valid, peer-reviewed source) that stated 90 percent of school shootings could be linked to antidepressants. Since Newtown, there have been 44 school shootings in the United States, as of February. An estimated 31 million Americans are on antidepressants. That is a very small percentage, even if all those involved in the school shootings were taking antidepressants. Correlation does not imply causation. A link between two things, is not always causal, and in this case, assuming that cause is not only incorrect, but irresponsible AND it continues to promote stigma that keeps people from getting help!

Myth #9: The only way to treat depression is through the use of antidepressants. 
Treating depression is not as simple as just taking a pill. Medication alone is not enough and is generally most effective in addition to psychotherapy. Cognitive Behavioral Therapy (CBT) has been shown to be particularly effective in the treatment of depression. Lifestyle changes such as balanced nutrition, regular exercise, and adequate sleep have been shown to help as well as things like mindfulness, meditation, and yoga.

Resources and References:

Sunday, March 2, 2014

Where Nature Meets Nurture

Today at church was Camp Sunday. Unquestionably, it has always been one of my favorite days of the year, especially since I started volunteering and working at camp four years ago. Today, I stood up in front of my church family and talked about how much camp has changed my life. I said something similar to this:

When Kim asked me to talk about my camp experience, I jumped at the opportunity to share something that I am so passionate about, but then, I realized that summing up something that has radically changed who I am in 3 to 5 minutes is basically impossible. I spent only one week as a camper when I was 12, and I honestly don’t remember much of it. I returned to camp at 16 as a counselor in training, at 17 as a volunteer, and at 18 and 19 as part of summer staff, which caused me to experience, in some capacity, almost every camp Outdoor Ministries has to offer. 
Working at camp forced me to do a lot of things that felt uncomfortable and scary to me at the time, like leading songs and talking in front of large groups, thinking on my feet and rearranging an entire day for forty-some kids at the drop of a hat—which is not easy, resolving conflicts between campers and between staff, functioning most days on little to no sleep, meeting and working with a new team of volunteer directors and counselors every week, having to be upbeat, positive, and enthusiastic 100% of the time. I was out of my comfort zone the first day of staff training when I walked into a room of thirty or forty people that I would be living and working with for the next seven weeks, all of whom seemed more adult and much more capable than I was.  
But the thing about being pushed to do something you’re uncomfortable with is that it forces you to grow as a person, learn who you are, and really develop your sense of self. The most important lessons I learned in life, I learned at camp. Every child I worked with had something to teach me. From my kids, I learned to balance a spoon on my nose, to try new things, to be patient, to embrace my own weirdness, to be flexible, to be brave, to laugh at myself, to face my fears, to love... I could talk forever. 
My favorite weeks were the ones where I got to work with middle schoolers. Both summers I worked on staff, I was placed at fishing camp, and the kids I got to work with were all so unique and at camp, they’re free to just embrace who they are. Last year, there was one cabin of girls, all of whom had been my campers before at various camps. They bonded almost instantaneously. We had a lot of laughs that week, but we also had some serious conversations. Every night after the lights went out, my girls felt free to be vulnerable to me and to each other and we talked about their fears and insecurities about growing up, and I shared some of my experiences with them about friendships and life, but I mostly listened as they encouraged one another. 
I chose to work at camp because I wanted to make a difference in the lives of kids. I have no idea what sort of impact that I had on any of them or even if I made one. But what I do know is that these kids—my kids—all changed my life in some way or another. We had a running joke on staff that we didn’t get paid enough for what we had to put up with—the late nights, the storms both literal and metaphorical, the power and water outages, the lack of sleep and sanity—but honestly, I would go back and do it all over again for free because the experiences I had and the lessons I learned are priceless. 
This summer, I will unfortunately not be able to attend camp in any capacity because I have to take summer classes, and this is heartbreaking for me. But I want to encourage all of you to go to camp this summer—either as campers or as volunteers, which camp really needs right now, because it truly is a life changing experience and something you will never forget. If anyone has questions about the different camps offered or about volunteering as a counselor, please come talk to me! I’d love to give you more information!

You would think that something so significant to me would be easy to talk about, but it really isn't. Not when you have anorexia and so much of your recovery journey is tangled up in your time as a counselor (This post only briefly touches on how the two are intertwined).

Camp was the first place that I'd ever "come out" about my eating disorder, my depression, and my self-harm. I was 16 and a counselor-in-training, and something about the stress of the week or just the atmosphere of camp, I felt comfortable being vulnerable and breaking down, first to one of the counselors and then to one of the directors.

It was the director who really got me started on the path to recovery. She called my mom the week after and told her, when I was in St. Louis on a mission trip with my youth group. Enter my mom, enter therapy, enter my life changing. E continued to support me in the coming years--encouraging my recovery, letting me vent my frustrations, and just being a really good friend. I am forever grateful for this relationship.

One year later, I was back at the same camp. I remember one of my campers making a comment at dinner, something like, "The reason you're fat is because you eat too much." That hit exactly where I was vulnerable because I was only going through the motions of recovery. I handled her comment appropriately, but after, completely had a meltdown to another one of the counselors.

The next year, I was working on summer staff. When I was figuring out what I was going to say at church today, I looked back to a paper I had written about my first summer on staff for a class last year. It says this of my fifth week:

On Friday night, I received a phone call from a high school friend of mine.  She was in tears, and I couldn’t really make out what words she was saying.  But eventually I learned that her boyfriend had dumped her and that her battle with anorexia had landed her in the hospital.  Her heart was skipping beats like crazy; she was dying.  I hung up with her and I cried.  
I cried because she was so sick.  I cried because she was both literally and figuratively heartbroken.  I cried because I was two hours away and couldn’t be there with her.  But mostly, I cried because that could have been me.  
What you don’t know is that in the months leading up to my summer at camp, I had been in treatment for anorexia.  It had gotten to the point that my parents were going to pull me out of my senior year of high school and send me to residential treatment.  I wasn’t supposed to be working at camp that summer. 
But I was; pretty successfully, I might add.  So while I was busy taking care of my kids and my camp family, they were also taking care of me in ways they couldn’t even imagine.  They were helping me heal, helping me become confident in myself, and helping me prove that I could go to college in the fall.  Camp had gotten me through treatment and ready for the real world.  
I spent almost my entire twenty-four hours off with my friend at the hospital. I went home only to shower, hand my dirty laundry off to my mom, and sleep.  I arrived late for the start of camp on Sunday afternoon and promptly fell apart.  However, my boss understood and let me talk everything out with her before my kids came that afternoon.

Camp was the immediate reason that I cared about even trying to get better at the end of my senior year of high school.  A couple weeks before it was supposed to start, my doctor told me that I wasn't allowed to go work at camp for the whole summer. I was furious and this fury pushed me to see her concerns and agree to follow what she was instructing, in order for me to work at camp.

That first summer on staff completely changed my life. It pushed me to my limits, but I was also held in by some wonderful, wiser, and loving people that I am so privileged to now call friends. At the time, two of these women were my bosses and were really supportive and encouraging of my recovery and my health, even in the chaos that is summer camp. I developed relationships with campers, counselors, and directors who loved and accepted me just as I was and who gave me the strength to keep fighting, the courage to be myself, and a reason to keep going, even after the summer ended. That week after I spent my time off with my friend in the hospital, I called E and told her how grateful she was that she had called my mom those two years before. I was determined to stay in recovery.

The next year, during my camp interview, my boss asked me indirectly about my ED and how things were going. She felt comfortable enough with my progress to hire me back for a second summer, but she was--and still is--there for me when times get rough.

That second summer was hard. I went through lifeguard certification, which was tough because I had been avoiding exercise as it is an ED behavior for me, but I passed. I dealt with so many insecurities and so much drama from other people on staff. But I also met some amazing kids... Kids who were afraid to be who they were because they were worried about what others thought. Kids who were bullied at school. Kids with appearance insecurities. Kids who thought that no one would ever love them for who they were. And some of these moments, I could share bits of my story with them.

I'm not going back to camp this summer, as I said at church this morning. I have to take summer classes, and honestly, I don't think it would be healthy for me to go back to camp this summer because recovery takes time and I can't force it into a timeline. Lately, I've been feeling so disconnected from this young woman who worked two summers on camp staff--this young woman so determined to recover and be healthy and a good role model for these precious kids. Even talking this morning in church seemed so inauthentic because I couldn't say the real impact that camp had on my life.

As much as camp allowed me to enter into periods of recovery, it also left me vulnerable to relapses later, like the one that sent me home from college this year. But camp also taught me so much. That I am strong. That I am worth fighting for. That I am loved. That I don't have to be perfect. That I don't have to change. That I don't have to be something that I'm not. That I can have questions and doubts and insecurities and still be loved. That life isn't perfect. That I can be flexible. That I'm okay just as I am. That I can make it through anything I put my mind to.

Camp allowed me to become, at least while I was there, the woman who is capable of fully recovering from her eating disorder. In the time since then, I have lost that person. But she's not gone forever. One day, she will be back at camp again.
Camp and my kids have kept me alive thus far. Today, I feel like I have a renewed purpose to fight for my life and health, like I have a renewed strength.
Camp has--and will continue to--save my life.