Things I Wish People Knew About (My) Depression

It's been almost a full month since I last wrote. Wow. I would say that is hard for me to believe, but it's really not--not when I look back at how difficult and sometimes excruciating this past month has been for me. I knew returning to Gettysburg this fall was going to have its ups and downs, good days and bad days. Realistically, staying at home would have also had ups and downs because that is what the reality of living with any mental illness. I was prepared for this. But what I wasn't prepared for was bad days turning into bad weeks turning into a bad month.

I wasn't prepared for this level of depression. I thought I was stable depression-wise, after I changed medications this past spring. I was feeling okay at home, and when I came back to school, I wrote off my symptoms the first few weeks as needing an adjustment period to being back on campus. But now, its past the period of newness and I'm finding myself having a depressive episode at a time when I can't really afford to have one.

I wish people knew how frustrating depression is for me. It comes suddenly, without much warning, and I don't really know what triggers it in me. But the most frustrating part is when there's nothing I can do to make it better--the times when showering, getting up and getting dressed, going to class, doing my homework, being social, going for walks, taking my meds--the times when none of that works. Those are times when I just want to pull my hair out and scream because there's absolutely nothing I can do because I have a freaking chemical imbalance in my brain and I am not in control of that.

I wish people knew everything is 400 times harder to do because I have depression. Going to class? I spent two hours this morning convincing myself to get off the couch and actually go. Doing my homework? That's difficult even on a good day. On a bad day, it just isn't in the realm of possibilities. The mental effort it takes to make my body go through the most basic motions is enough to tire me out for the rest of the day. Often after class, I feel the need to go home and sleep for hours because everything is so difficult. Lately all I've been able to do is the bare minimum to be functional here--class, meetings, immediate graded homework. Studying or working ahead is near impossible.

I wish people knew how difficult it is to not isolate all the time, whether my depression is bad or not. One of the most crucial pieces of my depression recovery is not isolating. Isolating just feeds my depression more and more, but the same time, going anywhere and seeing anyone is the last thing I want to do. Initiating contact with a friend is not an easy task when my depression is bad. Accepting an invitation to hang out is almost as difficult.

I wish people knew I am a bad friend when I am depressed. This means I might snap at you over a tiny thing. It means I might ignore what you are saying to me because I don't care at the time. It means I might not be able to help you when you are struggling. It means I might say mean things. It means I'll forget to text you or text you too much or cancel plans. I am always sorry, even if I do not say so.

I wish people knew I hate using my depression as an excuse. Any mental illness makes functioning hard. I try not to let it impact my every day life--my schoolwork, my commitments, my relationships. But sometimes I really cannot fulfill an obligation because my brain literally will not function properly. Sometimes I need extra time to finish an assignment because showing up to class over-exhausts me to the point where I cannot do anything else. I have depression and it impacts my life. It is an illness and has similar impacts as any other illness, so sometimes I need to be accommodated, which I hate. So don't make me feel bad about asking for an extra to turn in an assignment or to be excused from a meeting--it is always my last resort.

I wish people knew my depression is not about being sad or feeling bad, although it sometimes is. But mostly, its a feeling of nothingness, emptiness. It feels like drowning slowly. Sometimes I am sad, but mostly, its a heaviness and a darkness that overwhelms all of me.

I wish people knew medication does not cure depression (and needing medication does not make me crazy). Medication helps. Ditto therapy. Ditto walks. Ditto food and friends and support. Nothing fixes it. Depression, as I experience it, is not a problem to be solved, not something over and done with. When I first started taking medication four years ago, I was hesitant about needing a drug to feel normal. Don't only crazy people need meds? Now that I understand more about depression and how the brain works, I understand how biological this illness is and how it needs to be treated like any other condition, like asthma for example. My brother has asthma and he has to take his inhaler every day in order to keep his lungs healthy. Its the same with depression--I have to take my meds every day to keep my brain healthy.

I wish people knew my depression is also physical. I get tired, really tired. Sometimes all I can do is sleep because I am so tired. I lose my appetite completely, and as someone who has a history of an eating disorder as well, this is a very difficult thing.

I wish people knew depression causes a disconnect between my mind and body. Part of this involves not being fully "present" in class or in a conversation. My body will be there and my mind won't necessarily be somewhere else, but it will not focus or concentrate. I've sat through many classes this semester where I took extensive notes and walked out having no idea what we covered. Another disconnect is when I struggle to organize my muscles to do what I need. Mostly this involves getting out of bed or getting up to go somewhere.

I wish people knew I struggle to reconcile my faith and my depression. I often feel like less of a Christian when I cannot feel joy during worship. Or when I'm just going through the motions in church or in my devotions and I feel nothing. When my heart just isn't there. These things make me feel guilty and like less of a Christian because Christians are "supposed" to feel joyful. I struggle to reconcile why God is allow me to suffer like this and why he doesn't heal me. I struggle when someone tells me my depression is a result of something I am doing or not doing spiritually. I struggle when people tell me I need Jesus and not medication or therapy.

I wish people knew its okay to ask me questions about my depression and any of my other mental illnesses. I am not ashamed of them because I know they are partially because of biology and how my brain is wired. I like questions. I like helping people to understand what I am going through because it reduces stigma in our society about mental illness, something that is all too prevalent and damaging.

I wish people knew I just want to know I'm not alone in fighting my depression. Most people ask what they can do or they offer to listen if I need to talk, which are nice gestures. But what I need is someone to snuggle and watch movies with, someone to send me encouraging things in the morning or before class, someone to just give me hugs. Someone to eat with. Someone to reassure me. Someone to tell me it really will be okay and I can get through this. Someone to remind me I am stronger than my depression. Someone to tell me they are proud of me for fighting this hard.

Thank you, Jordie, for this reminder and encouragement.

Sometimes I forget I have depression...

Sometimes I forget I have depression.

Not because I've suddenly recovered from it or it's miraculously gone away, but because most of the time, I am so focused on the fact that I have and eating disorder and I need to recover from my eating disorder. I never really, truly think about recovering from my depression. 

When I think about recovery, I always think about it in terms of eating disorder recovery. I guess that's because it's so easily tangible, whereas depression recovery is not. With eating disorder recovery, I can see the recovery by seeing records of my following my meal plan, by being told by my doctor that I am in my weight range, by no longer being orthostatic or bradycardic. But with depression recovery, it seems like the only thing defining recovery is the ambiguous 'feeing better.' 

I guess depression recovery can be measured by how much more I am leaving my house, how much less I am isolating, how many times I reach out to friends, but none of that seems to signify recovery to me. My depression is this all-consuming feeling of drowning, of being suffocated in this endless pool of hopelessness and pain. It is like being in a cave full of only darkness, where there are absolutely no exits anywhere. It's continual grieving for something that you never knew existed. 

Depression is not so much behavioral as an eating disorder--more mental and emotional, but it is so much more complicated than that. All that depression is becomes so mangled and tangled up inside of my head and interwoven into my life that operationally defining it is not something I can do. I know people have done it--professionals--but defining and explaining it for me, as someone who experiences its intricacies and quirks day in and day out, nothing seems adequate. 

It wasn't until recently I actually noticed I've been completely forgetting about my depression. I obviously know it exists... It crosses my mind every night when I take my antidepressants that, "Hey, Sarah, you have depression and if you stop taking these drugs, you'll soon feel like shit." But other than that, it's hardly ever a thought. 

A little over a week ago, I spent my part of my night/early morning in the emergency room because for the first time in months, I had selfharmed and I was worried I may have gone a little too far. A friend decided I needed to go to the hospital, whether I wanted to or not--I was definitely on the side of not, and so we went. I spent that early morning and the days following trying to figure out exactly what had happened, what had triggered me to do what I did that night. And no matter how much I thought about it, I was not able to quite discern what happened (usually it is fairly simple to see a causal relationship with my behaviors). 

It's slowly come to me that I used selfharm as a way to cope with the overwhemingness of the depression that I was feeling inside of myself that night. Nothing happened to trigger it, just like nothing ever happens to trigger it. It just is, sudden and suffocating. 

I guess lately that I've just been tuning out my depression, focusing on the tangible aspects of my eating disorder recovery, seeing everything I was feeling as an effect of no longer using eating disorder behaviors, and ignoring the fact I have a dual diagnosis of an eating disorder AND depression. 

I've realized I can't treat one and just ignore the other. Recovery does not happen on it's own, and although eating disorders and depression can share similar symptomology, they are not the same illness. I have to work on recovering from both. So now it's time to focus on both maintaining the progress I've made in my ED recovery and learning how to manage and live with my depression. 

Because even though I sometimes forget about it, I do have depression and it does highly impact the qualitiy of my life. 

Willfulness vs. Willingness

Lately I've been doing a lot of thinking about willingness and willfulness, probably something to do with the fact that it seems like every time I have a conversation about my ED, it comes back to those two words. In DBT, there is a lot of talk about willingness vs. willfulness. Marsha Linehan describes willingness and willfulness like this: 

Willfulness is... 

Sitting on your hands when action is needed, refusing to make changes that are needed. 

Giving up. 

The opposite of "doing what works," being effective.

Trying to fix every situation. 

Refusing to tolerate the moment. 

Willingness is...

Doing just what is needed in each situation, in an unpretentious way. It is focusing on effectiveness. 

Listening very carefully to your wise mind, acting from your inner self. 

Allowing into awareness your connection to the universe--to the earth, to the floor you are standing on, to the chair you are sitting on, to the person you are talking to. 

In skills group, we've talked about how willfulness tends to create more black and white thinking and, willfulness usually ends up hurting you in the long run. We also discussed how you have to decide whether you want to work on being willing, but your motivation has to come from yourself. 

I  don't feel like being willing at all right now. I don't feel like being effective, listening to my wise mind, acting from my inner self, or allowing into awareness my connection to the universe. I feel like sitting on my hands and not making changes. I feel like giving up. I don't feel like tolerating the moment. I don't feel like doing what works. 

I feel really willful. 

I've been working with my therapist a lot about how to be more willing, and the last time I saw her, we talked about how even though I am doing things as if I was willing to do them, but I'm not feeling willing at all. And she said that willingness does not equal feeling willing, but that willingness means doing the next right thing, even if I don't feel like it and I hate it. Willingness is a behavior, not an emotion! 

I don't have to feel the least bit willing to be engaging in willingness. I just need to be doing the next right thing in that moment. Which means eating my next meal or my next snack. It means taking my meds every day. It means getting up, taking a shower, and leaving my house every day. It means doing all of these things, even when I'm having a bad depressive day, even when I'm overwhelmed with anxiety, even when I'm having a bad body image day. 

And maybe, just maybe, doing these things will seem less robotic and feelingless. Maybe one day, I will actually feel willing, instead of just behaving willingly. Maybe one day things will get better.

But for now, I guess I'm just stuck going through the motions. As the saying goes, "You don't have to want to... Just be WILLING." 

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.

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Resources and References:
http://www.nimh.nih.gov/health/topics/depression/index.shtml
http://psychcentral.com/lib/an-introduction-to-depression/000650
http://www.nami.org/Template.cfm?Section=depression
http://www.nytimes.com/health/guides/disease/major-depression/overview.html
http://www.huffingtonpost.ca/2013/11/13/depression-myths-_n_4268047.html
http://psychcentral.com/lib/what-is-depression-if-not-a-mental-illness/000896?all=1
http://www.psychologytoday.com/blog/evil-deeds/200809/is-depression-disease
http://psychcentral.com/blog/archives/2009/10/18/7-myths-of-depression/
http://www.psychologytoday.com/blog/the-first-impression/201302/5-myths-about-depression
http://www.healthcentral.com/depression/just-diagnosed-822-143_3.html
http://psychcentral.com/blog/archives/2009/10/18/7-myths-of-depression/
http://www.healthline.com/health-slideshow/9-myths-depression#1
http://www.hpb.gov.sg/HOPPortal/health-article/10202

Christmas Eve.

I keep thinking back to last year, after the candlelight service at church, I was sitting downstairs watching some Christmas special with my family, writing a post reflecting on all of the growth that had taken place in my life that year.  I wrote about being recovered, feeling valued and beautiful and loved and worthy.  I wrote about being more than my past, about never being alone, about hope and healing.  I wrote about my complete faith in an all-powerful, healing, restoring God.

Christmas 2012 I was in a very different place than I was Christmas 2011.

And Christmas 2013 is no different. 

Tonight, I sit alone in my room, thinking.

Thinking about how my life has changed in the past year and has put me in a position that I never once thought that I would be in.  I dropped out of my first semester of my second year at college because I had a major relapse with my eating disorder, depression, and anxiety.  I took medical withdrawals from all but one course, in which I’m taking an incomplete and hope to finish up soon.  I’m taking the entire spring semester off from school.  I’m spending at least four hours a day in different kinds of therapy groups, with different psychologists and psychiatrists and doctors and nutritionists, trying to learn how to completely accept and manage life with an eating disorder, with depression, and with anxiety, trying to learn how to manage my life with this illness.

I never once thought that my life would go back to this, not even all those days I spent in treatment in high school, when I was so excited to go to college so that I could fully engage in my disorder and no one would notice.  I never once thought that things could get this bad again. I never once thought I would be in very intensive treatment again.

I never once thought that my life would do a complete 180 on me. But it has and that’s something that I’m just going to have to accept because even though I think that I've convinced myself that I've accepted this situation, I reach a moment where I get really pissed off about having been given these genes with this temperament and these personality traits and having been dealt this environment.  And then I’m back at square one, trying to accept it all just one more time.

But it’s never just one more time.

Looking back on my post from last Christmas, I can’t help but be a bit judgmental about where I am now and thinking that I’m in a worse place now than I was then.

This Christmas Eve, I’m not thankful. I’m not filled with joy and hope and strength.  I’m not feeling encouraged or blessed.  This Christmas Eve, I am filled with anger and bitterness and resentment.  I’m filled with depression and loneliness and insecurity. I’m filled with anxiety and distress and worry.  I’m filled with shame and guilt and regret.  

I’m filled with questions like “Why me?” and “Will this ever be over?” and “Will I ever feel and live a ‘normal’ life?” I’m questioning what my next steps are, where I stand with my relationships with everyone in my life, and how my faith fits into this.  I’m filled with questions about what my life will look like next Christmas and the one after that.

And something that I've learned in the past five weeks of treatment is that all of this is okay. Having questions and doubts and emotions—it’s all okay. Even during Christmas, when the expectation is joy and peace and contentment. My emotions are real and I am allowed to feel them, even now. Even at Christmas.

I guess what I’m trying to get at is that things change. People change. Lives change. And things don’t always go how you expect them to go. You don’t always end up where you want to in life. Sometimes the unexpected is exactly what happens and sometimes you take a giant leap backwards.

All of that is okay.

It’s life. And life doesn't stop for anyone.

Not even at Christmas. 

I Feel Alone.

A few days ago, I watched a video about how even though we are the most connected to others than we have ever been--thanks to social media like Facebook, Twitter, Foursquare, YouTube, Tumblr, Pintrest, etc and things like smartphones and texting that make anyone easily accessible--we are more lonely than we have ever been. I've linked the video here: 

After watching it a third time, it still makes my head spin when I watch it, but it also makes so much sense if you really think about the message it contains. 

Today, I was sitting in church next to my dad and he had his arm around me, like he usually does every Sunday we're in church together.  I was surrounded by a sea of people, most of whom had watched me grow from a first grader into a college sophomore.  I was surrounded, essentially, entirely by my family. 

And I felt completely alone. 

Right before the service began, I had a conversation with a lifelong friend about all that has been happening in my life, if being home was being helpful, how I was feeling, and it ended, like all of these conversations do, with her saying something to the effect of 'Let me know if you ever need anything. I'm here for you, and I love you.' 

So many people have told me that recently. And I very well know that I am not, in fact, alone. I have friends here who have tried to get together with me, but I've just been too tired or just not wanted to be social. I've received letters and care packages from school friends. I've gotten daily texts from some of my closest friends. And on the rare occasions that I have ventured out into the real world, one that is not my house or treatment, I've spent a couple quality hours with people who have been in similar situations. 

But I still feel alone. 

I don't know if I would say that I feel 'lonely,' because I don't think that's what I'm feeling. Lonely to me means missing people you care about, and although I do miss Gettysburg friends and home friends and extended family, that's not what is consuming me. It's the feeling of isolation, of not being understood, of not being fully known or heard, of people just not 'getting' me. The feeling of being alone. 

I know this has to do with my depression and my eating disorder. The two of them are not mutually exclusive from each other--experts still cannot determine a causal relationship between the two things, just that they tend to be highly correlated. But both add to this feeling of alone-ness, or isolation if you will. 

So even in those moments where I am not physically isolating myself, in the moments where I am not letting my social anxiety win, in the moments where I am not actually alone, the feeling of isolation and alone-ness is still there and it feels more present than it does when I am physically alone. 

Maybe this feeling of isolation and alone-ness has to do with my lack of vulnerability in these social situations.  All morning I was answering questions of 'How's school?' 'Are you glad to have had some time off?' 'Are you looking forward to winter break?' as if nothing were wrong. As if, in fact, I was making the five hour trek back to Gettysburg to have one more week of classes, a week of finals, and then over a month off for winter break. Maybe I need to be more vulnerable. 

Or maybe it has to do with the idea that I'm not constantly surrounded by my friends or that I can walk to class and pass four of my closest friends along the way. Maybe it is actual loneliness because some of those who know me best are not present, here, with me. 

Maybe it has to do with my being an introvert and not feeling fulfilled and cared for in large group settings, like church or like family Thanksgiving. But even in the one-on-one contact that I've had with people where I've been vulnerable and open, I have still felt alone. 

But mostly, my feeling alone has to do with the illness. The fact that I suffer from anorexia and depression and anxiety and that person sitting next to me does not. Or that person sitting across the room, although he or she may also suffer from depression, he or she does not also have an eating disorder and anxiety. The fact that I, alone, am being attacked by this specific illness and this specific combination of comorbid conditions makes me feel alone. 

Our culture puts such an emphasis on individuality, and I've been reading about it all semester in social psychology and how different psychological phenomena are experienced differently in collectivist cultures. If I lived in such a culture, would I feel any less alone right now? Probably not. 

Eating disorders are very individualized. Every person who suffers from any type of eating disorder suffers differently. That's why treatment must be individualized to the person in order for it to be effective. My eating disorder is not the same as any of the other people sitting in DTP with me or anyone else who has gone through CCED or suffered with an ED. 

I feel alone because psychologically, I am alone right now. 

This is one of those posts that isn't going to be wrapped up all nice and pretty and topped with a bow. This feeling of alone-ness is not going to go away just by placing myself in a room full of people, or a small group of people that know me well, or even in a room full of people who 'get it.' Because I will still feel alone. No matter how many letters I receive, texts and emails I get, words of encouragement I am told--the feeling of being alone remains.

And in this moment, sitting with this alone-ness and the discomfort it brings is just going to be something that I have to do. 

And maybe, one day, it won't be here anymore. 

Why I Write & Why I Share

Sometimes people ask me why I blog--why I would choose to chronicle my journey and recovery in such a public manner.  Actually, the majority of people in my life don't even know that I keep a blog.  Which is strange, considering that I've lately taken to sharing my blog posts on Facebook.  

But one of the most common questions I get is something along the lines of, "Why are you so open about your struggles?" Or the stated variation of that question, "It's really brave of you to talk about this so openly and honestly." 

Why do I talk about it? And why do I blog about it? 

I write because one post takes a lot less time to write than it does to explain what I'm going through to all of my friends and family. I write, sometimes, to simply give out information.

I write because writing is therapy for me. I shared one of my latest blog posts with a professor at school, who responded, "Your post, while written almost like you are educating others, seems like you're trying to convince yourself of everything you're typing." I write to understand. To understand myself, my life, and the world around me better. I write because it helps--getting it all down on paper. It helps to take all the facts and information and articles that have been bouncing around in my head and combine them into an imperfect masterpiece that helps me to understand myself. 

I write because I want to remember. No, I take that back. I don't want to remember these days.  These days are pure hell.  They are miserable and I don't want to remember them.  I NEED to remember them.  I need to remember them because according to statistics (and the fact that I am a psychology major hoping to specialize in eating disorders), I am one day going to be sitting across the table from a young woman who is in a similar position to what I am in today and I need to be able to look her in the eyes and say, "I know what you are going through because I lived through it, and I promise you, it will get better." I need to remember because it will make me a better therapist, a better empathizer, and a better human being. 

I write because there are approximately 24 million men and women in the United States suffer from a clinically significant eating disorder. Let me point out that clinically significant in the statistic only includes binge eating disorder, bulimia, and anorexia. There are other types of eating disorders out there with the most common being Eating Disorder Not Otherwise Specified (EDNOS), which is what I was originally diagnosed with in 2011. 

I write because there are hundreds of thousands of people suffering in silence from an eating disorder, anxiety, and/or depression and who feel like they are completely alone in their struggle. Since I've been more open and vulnerable with my struggles and my past, many of my friends, family, and acquaintances have reached out to me and said, 'Me too.' They can't always relate to all of it, but they can relate to some of it. And each and every one of them have told me about their fears of speaking out about their struggles or about how brave I am to speak openly about mine.

I write because there is still stigma around mental disorders.

I write because people are still afraid to seek professional help for psychological disorders because society still thinks that having a mental disorder makes you crazy, insane. Because our society looks down on any type of weakness, even if that weakness or struggle is no fault of that person.

I write because there are still people who think that eating disorders and depression and anxiety are just choices that a person makes.  That someone with an eating disorder can just 'start eating normally' again, or that someone with depression can just 'stop being sad and be happy,' or that someone with anxiety can just 'get over it.'  

I write because there are still people who don't believe that eating disorders have biological, environmental, psychological, social, and genetic causes. There are people who still think that eating disorders are just diets or just a phase. There are people who still think that, as Carrie Arnold says in Decoding Anorexia, "Bad parenting caused eating disorders. Our thin-is-in culture caused eating disorders. A need for control caused eating disorders. Low self-esteem caused eating disorders," even though recent research has proved them wrong. 

I write because when someone finds out that you are diagnosed with cancer, they bring you casseroles, ask how you're doing, and offer to help in any way that they can. But no one wants to know if you have been diagnosed with a mental illness for what? Some irrational fear that they might catch it? The author of this Slate article talks about the ignorance of mental illnesses in this way: 

"Friends talk about cancer and other physical maladies more easily than about psychological afflictions. Breasts might draw blushes, but brains are unmentionable. These questions are rarely heard: 'How’s your depression these days?' 'What improvements do you notice now that you have treatment for your ADD?' 'Do you find your manic episodes are less intense now that you are on medication?' 'What does depression feel like?' 'Is the counseling helpful?'"

I write because stigma around mental health issues not only exists, but is very present in our society. And maybe by telling my story, it can help to lessen that stigma just the tiniest bit. 

Maybe it will help some random person out there to feel less alone. 

Or maybe it just helps me to understand it all. 

Today, I thought about making a grocery list

I have discovered exactly what people-who-don't-know-what-else-to-say say to you when you take the rest of the semester off in order to recover from your eating disorder: 

"So what did you do today?"

It seems to be the only thing that anyone, anywhere wants to know.  And I've struggled to come up with a good answer to that question.  Here's what I've got so far: 

1. I slept. 

2. I became re-addicted to Bejeweled Blitz

3. I did some blogging. 

4. I read some blogs. 

5. I caught up on my emails.

6. I got out of bed and washed my face/brushed my teeth/etc. 

7. I put on clothes that I had not previously slept in! 

8. I watched Kevin Costner in For the Love of the Game

9. I technologically interacted with friends. 

10. I thought about going to the grocery store. 

11. I got angry about having to take a semester off of college, live at home, and go to treatment, which by the way, might not start for the next two weeks or so because the program is full. 

12. I thought about maybe making a grocery list and that maybe then I would actually go to the grocery store. 

Given, the majority of these are things that 'normal' people do every day.  The word normal has been thrown around all over Facebook and blogs quite a lot recently in reference to mental illness and recovery--from this post by Kelsi to this post here, and honestly, it's been something that's been on my mind quite a bit, as well.  I kind of touched on it earlier today when thinking about failure and re-framing my perspective to make it relevant to me and what my normal is.  

See what's normal for me right now, was written about very eloquently in this post here, which was about a completely different topic, but is on my mind right as I write this: 

"You see, people without an understanding of eating disorders don’t realize that they can have a devastating impact upon every facet of an individual’s life. That their life is dictated by rules, their day can revolve completely around exercise or eating or not eating. That their nights can be completely sleepless or spent in the bathroom or spent in the kitchen. They don’t see the urges that arise when the individual is experiencing guilt for 'only exercising three hours that day' or for 'eating extra sultanas out of the Sultana Bran' at brekky time. People don’t see the exhaustion, or the fears, or the thoughts that harangue the individual every single moment of every single day. They don’t understand the outbursts or the tears at mealtimes. They don’t get the rules or the rigidity; the desperate need to feel safe, and if that need can be fulfilled by eating out of the same bowl every day, then so be it. They don’t see the 4am walks; the exercise in the pouring rain for hours on end which leads to extreme hypothermia. They can’t understand the inability to work or study because of a malnourished brain – caused by deprivation of carbohydrates, leading to incapacity to function adequately. They don’t think about the dry skin, the falling out of hair, the bruises that appear the hell out of nowhere, the endless injuries caused by overexercise, and the excruciating leg cramps that awake the individual in the middle of the night. The low blood pressure. The low blood sugar. The osteoporosis. People don’t see the guilt and grief that is felt when the individual 'can’t' go to their friend’s birthday parties or be social ever, due to having to be exercising instead or out of fear of the food that may be present at said event. And they don’t see that they eventually lose their friends, because those friends will only put up with so much shit before they crack. I could go on for ages, but we’d be here all day."

You see what I mean?  Life is vastly different for an individual with any form of an eating disorder.  Vastly different.  And when you are just beginning an initial period of recovery, the seemingly little things are huge victories.  Little things like putting any form of nourishment into your body.  Little things like admitting that life is not always rainbows and sunshine and that yeah, sometimes it can be really, really crappy.  Life is also vastly different for any individual suffering from depression or anxiety, both of which are linked to all types of eating disorders.  The little victories there are getting out of bed in the morning, getting dressed, any form of communication with anyone.  

The little victories when facing mental illness in the beginning stages of recovery are all about survival.  

Today I found out that, best case scenario, I can start the DTP program at CCED the week over November 25th.  That's in 11 days.  11 days of being at home and being miserable and struggling to win the smallest of battles.  I was frustrated and angry and feeling really, really defeated because look at what I've done over the course of 24 hours--things most normal people do in a couple hours in morning or that they do without even having to think about them at all!  All of those things took me an entire day! 

One of my recovery buddies and a good friend put it this way when I was freaking out about making it to the point where I am actually in the DTP program and getting through the next 11 (or more!) days: 

"Recovery is going to be a lot of hanging around and surviving."

She did not say that recovery is going to be a lot of progress and accomplishment.  She did not say it's going to be a lot of jumping out of bed in the morning being excited about life and the future, or that it's going to be a lot of instantaneous progress.  She said that it's going to be a lot of surviving.

Surviving to me means winning the tiny battles and racking up the small victories.  Things like, getting out of bed at some point during the day. Brushing my teeth. Putting on clothes that had not previously been slept in. Responding to emails. Things that seem 'normal' to everyone else. 

Even things like thinking about going to the grocery store, or even thinking about making a grocery list.  

That right there is a small victory.  Because on most days, I would not even consider making a grocery list, much less, a trip to the grocery store to buy 'normal' food.  But let's think about what my normal is right now--I'm in the survival stages of recovery.  I am waiting to get into a program, where they will give me a meal plan and I will learn, at 19, how to eat.  I have been living with a very restrictive diet for quite some time and am still getting used to the idea of doing the hard work that recovery entails.  In my normal, a trip to the grocery store causes a lot of anxiety.  Thinking about buying 'normal,' not 'ED food' (it's a thing...), causes a lot of anxiety because it is outside my routine.  Thinking about what I need to have in order to nourish my body, even if it is 'ED food,' causes a lot of anxiety because I do not know how to eat.  Even the simplest task of making a grocery list, fills me with cognitive dissonance that is not present in the world of 'normal' people.

So yes, even though I only thought about making a grocery list and did not actually succeed in making one, that in and of itself is a huge victory.  Yes, when most people have asked me what I have done today, I list all of the other things that I've done, because in the 'normal' world, those seem more productive.  

But in my normal world, where people understand the understand the unique challenges that come with living with anorexia, I am able to respond to 'What did you do today?' with 'I thought about making a grocery list,' and feel like I actually accomplished something worthwhile. What I see as my accomplishments are just going to seem less 'normal' and more trivial because I do not live in the 'normal' world.

And my world is all about survival.  

Hello darkness, my old friend

I don't think that I've had a night this bad in a long, long time.  I'm assuming that it's some sort of combination of low blood sugar, depression, exhaustion, and stress.  I don't know.  All I know is that I am spiraling into depression.  Not the suicidal, I want to die depression.  But the I literally cannot move off of my bed and function kind of depression.

Which kind of really, really stinks because I have an exam tomorrow.  For which I have not reviewed my notes, read the chapters, or prepared in any way, shape, or form.  So that's how my night is going. And literally at this point, I am considering keeping my butt in my bed all day tomorrow because functioning is not a thing that is going to happen any time soon.

I don't know why it is all so hard.  It shouldn't be.  I mean, I logically know that depression is a chemical imbalance in your brain.  I know that there's really nothing that I can do to help myself get through it.  Well, other than take my medication (which I'm scared to start doing without seeing a psychiatrist), exercise (which is triggering for my eating disorder), eat right (which is not going to happen right now), get enough sleep (I'm in college...), and talk to a therapist (which won't help, yay chemical imbalances!).  But knowing what I have to do and doing it are two completely different things...

And even just looking at the irrationality of my thoughts and emotions right now... it's rather frustrating.  The fact that it's starting to impact, at a very drastic level, things that I fought so hard to keep, is not okay.  My schoolwork, my job, my friendships... I don't know.

Normally I would nurse my depression by staying in bed all day and watching Netflix or television and not eating.  I would spend the day sleeping and not caring that I wasn't getting anything done.  But I actually have responsibilities tomorrow.  Like my exam.  And the prospie.  And Big/Little APO Revs.

So I cannot avoid it all.  My desire to please people is going to overcome my depression once again.  Well.  At least my desire to fulfill my immediate obligations is going to.  I'm not sure about things like class or lunch/dinner dates or my exam.  Because right now, I don't think I could even attempt to manage it.

Everything just seems really hard right now.

And I know that I really need to go talk to someone about this.  I know that I'm not doing okay and that I need to sit down and be real with someone, but there's two obstacles to this that I am experiencing.

The first one is relatively common with people with depression.  I don't know how to explain what I'm feeling to anyone.  Not even psychology people.  My friends will not understand it.  My roommates, my family... None of them will really get it unless they've been there.  Or they'll be like my mom was and continually ask me how I'm feeling or if I'm doing any better today than I was yesterday.  And even those who know that I'm struggling with things right now, I feel like I can't tell them because I don't know how to explain what I am feeling in words to anyone.  I just feel it.

I did, however, read an article the other day that very accurately captured what depression feels like.  You can read it here.

There is also a very accurate Buzzfeed post that captures depression very well.

Then there's the fact that I am definitely still in denial about how bad things are getting.  I mean, what logical reasoning did I have behind not wanting to talk to my parents about all of this or about not wanting to leave school to take care of my health?  I don't know.  But if I'm at the point where I am counting calories, taking pills, obsessing over weight, not being able to concentrate on my academics, forgetting that I have things to do, not moving out of my bed for long periods of time, and all of the other symptoms that existed during my senior year and still do not care, then I am not well enough to be here.

But I also think that a lot of it has to do with the depression that I'm struggling with right now.  Depression causes apathy.  And it also causes a lot of other things, as well.  Like the urge to want to cry to someone and be held and loved and taken care of because I am at my breaking point, but the simultaneous need to isolate and remain silent and not talk about it because social interaction is really just too much.

But then, even if I spoke about how I'm feeling, people would not understand.  Or they would walk away.

Keeping friends right now is very, very difficult.  Mainly because social interaction is difficult.  Getting out of bed is difficult.  Breathing is difficult.  All of those autonomic functions that are supposed to be normal and natural--they're about five hundred thousand times more difficult when you are experiencing severe depression like I am right now.  People don't want to be friends with you or try to help you when you can't even get out of bed.

Then there's the fact that people don't understand how the connection between eating disorders and depression works.  Did the eating disorder cause the depression?  In which case, just start eating again and the depression will get better.  Did the depression cause the eating disorder?  Well, that sucks, but you have to get up and eat.  Sadness isn't an excuse for not eating.  I don't even understand how it works.  My psychiatrist doesn't either.

What people can do, however, is be there for support.  Here are a couple of links on how to help friend who is struggling with depression.  Keep in mind that these may not work with everyone, but from what I've read, they seem relatively okay.  Some of these things have worked in the past for me and my friends, while some haven't.  But check these out:

How to Help a Depressed Friend (And When to Stop Trying)
Five Ways to Help a Depressed Friend

I'm going to be struggling with this for a very, very long time.  It may or may not ever get better. Right now, I'm leaning more toward the not part of that.  I'm probably always going to have depressive episodes.  And every time, they are going to suck.  They are going to be miserable and make me want to pull my hair out and push people away and cry and stay in bed and not move ever.

Just like right now.

And right now, I don't know how I'm going to deal with it.  Because I feel too overwhelmed and depressed and stressed out and too much nothingness and loneliness and emptiness and exhaustion to deal with this in any sort of relatively healthy manner.  Maybe tomorrow things will be better... But I really doubt it.