Holiday depression is common and perhaps up to 10% of the population suffers from it to some degree or another. It is usually related to the holiday season because it brings back memories of a happier time in our lives. We may remember spending past holidays with a loved one who is no longer with us. Or we may get depressed by seeing so many others who have someone special in their lives — whether it be their family, close friends, or a significant other — to share the season with. Or it may be a combination of these things and others, such as dealing with an ongoing mental disorder.

Whatever the reason for suffering the holiday blues, there are some things you can do to try and ward them off, or at least minimize their impact in your life. The holidays are first and foremost a time of spirituality and a recognition of special religious events. Often this may be a good time to renew your spiritual beliefs and spend more time in contemplation of religion and spirituality. If you haven’t been to church or synagogue in years, for instance, now may be a good time to think about going again. I don’t think spirituality alone has all the answers to any of the world’s problems or people’s personal problems. But it can be an important aspect to understanding your life, your motivations, and your relationships with others.

Beyond spirituality, you can consider turning to those activities and hobbies which have often helped you in the past. This may mean volunteering more time at a local hospital or nursing home. Or devoting more time to writing, sewing, woodworking, fixing up things around the house, going to the library, reading, or any of a number of other activities. The point here is to try and keep your mind focused on those things which bring you pleasure and which you enjoy doing. This is certainly no “cure-all,” but it can be a helpful thing to try and do more of. If public places remind you of sad feelings or memories, you may just want to avoid them as much as possible this holiday season.

Many times a person experiences these sad feelings and memories as a natural part of the loss or grieving process. Sometimes this process can be unresolved, and therefore you can become more upset by triggering events or times of the year. Like the holidays. This may be a sign that you need to find acceptance of the loss, which is the final step in the grieving process. This can often be done on your own, and might be helped along by a book on grief.

Besides keeping busy and accepting loss, there are other things a person can do to keep away from the holiday blues. Hanging out with friends or family members which don’t have sad or negative emotions attached to them may be helpful. If not in the real world, then you may also consider spending more time online in a support group or chat area which is to your liking. Spending more time with friends can also keep your mind off of your depression and negative emotions. Some people avoid doing this, though, for fear of bringing the group of friends down with their mood. This is unlikely to happen in most groups and more likely than not, they will bring your mood up by the togetherness.

Obviously if you are suffering from a mental disorder which is worsened by the stress or additional emotions brought about by the holidays, you should look into increasing your coping skills. This can be done on your own, or you can ask your therapist to talk more about these and find ones which work best for you. The key here is to let your therapist know what you need to work on at this time of the year, and then proceed to work on it. If you’re not currently in psychotherapy and your problems are beginning to pile up on you, you may want to seriously consider participating in psychotherapy to help you at this time of the year.

Eating right and exercising is always an important part of living, and the holidays are no different. While it’s fine to stuff ourselves with turkey and ham during Thanksgiving and the December holidays, we should also be careful not to overdo it. It’s very easy to do so and it can contribute to a poor self-image and lowered self-esteem. Exercising regularly helps a person feel good about themselves as well as giving your body a helpful workout. We tend to isolate ourselves and close ourselves up in our homes and apartments during the winter months because of the weather. This isolation can easily lead to bodily feelings of laziness, sluggishness, and difficulty concentrating. Some of these are actually symptoms of depression as well. So exercise and eating right (most of the time!) are important.

There is no quick cure here, or easy method you can use to ward off holiday blues which is guaranteed. However, I hope that some of these things may be helpful to you during this stressful and possibly upsetting time of the year. Good luck trying them out and I hope you make it through okay. Take care this holiday season & best wishes from all of the people here at Psych Central.

This article was originally published in 1996.

The difference is really quite simple, though. Manic depression — or bipolar disorder — includes clinical depression as a part of its diagnosis. You can’t have bipolar disorder without also having had an episode of clinical depression. That’s why the two disorders shared similar names for many years, because they both include the component of clinical depression.

Such a depressive episode is characterized by the common signs and symptoms of depression:

• Feeling sad and unhappy for an uninterrupted period of at least 2 weeks
• Crying for no reason
• Feeling worthless
• Having very little energy
• Losing interest in pleasurable activities

Because both depression and bipolar disorder share this commonality, somewhere between 10 to 25 percent of people with bipolar disorder are first mistakenly diagnosed with only depression. It’s only when the professional learns more about the person and their history do they later discover episodes of either mania or hypomania.

Mania Distinguishes Manic Depression from Depression

Mania is the distinguishing symptom of bipolar disorder and what differentiates it from clinical depression. A person with bipolar disorder has experienced one or more manic episodes (or a lesser form of mania known as hypomania). What’s a manic episode?

• Feeling overly happy, excited or confident
• Feeling extremely irritable, aggressive and “wired”
• Having uncontrollable racing thoughts or speech
• Thinking of yourself as overly important, gifted or special
• Making poor judgments, such as with money, relationships or gambling
• Engaging in risky behavior or taking more risks than you ordinarily would

A person with is experiencing the lesser form of mania — hypomania — may only experience a few of these symptoms, or their symptoms are far less severe and life-impairing. A person with clinical depression experiences none of these symptoms.

Depression isn’t the only disorder that is confused with bipolar disorder. Especially in children and teens, sometimes other disorders — such as attention deficit disorder (ADHD) — may be misdiagnosed, when the teen may instead be suffering from a form of bipolar disorder. That’s because children and teens with bipolar disorder may display hyperactive behavior — a common symptom of ADHD. Teens with bipolar disorder are especially more likely to engage in antisocial or risky behaviors, such as those involving sex, alcohol, or drugs.

People who are diagnosed with the more severe form of bipolar disorder are said to have Type I Bipolar Disorder. Those diagnosed with the less severe form — those who have hypomanic instead of full blown manic episodes — are said to have Type II. Learn more about the different types of bipolar disorder here.

Bipolar disorder, like all mental disorders, is treatable through a combination of psychotherapy and medications. You can learn more about the treatment options available for bipolar disorder here.

Drawing on personal experience with bipolar disorder, the lives of the saints, and feedback received through workshops he has led, Wootton suggests a new paradigm for understanding and coping with mood disorders.

The book is directed primarily at mental health consumers, while professionals may become frustrated with the easygoing style and lack of conclusive evidence to support Wootton’s theories. It was worth a read, but I can’t see myself recommending it to any of the clients I work with as a counselor.

Tom Wootton is the author of Bipolar Advantage as well as the founder of Bipolar Advantage, a consumer-run organization working to change the paradigm for mood disorders for both professionals and consumers.

Wootton traces the start of his unstable and fluctuating moods to when he was nine years old; however, it was not until his forties that he was diagnosed with bipolar disorder. Much of Wootton’s life was spent seeking spiritual fulfillment and he spent many years in a monastery seeking growth and guidance.

After a brief introduction to himself and his journey, Wootton begins to explain how he understands depression, which is not simply as an emotional illness:

“For me, and so many others I have met in talks and workshops, depression has four components: physical, mental, emotional and spiritual” (p. 33).

He then outlines each of these areas and describes how the combination creates what is referred to as clinical depression.

Next, Wootton discusses the concept of “functionality.” After discussing specifics of functioning while both manic and depressed, he proposes a new definition of functionality—that it should be looked at in terms of personal growth and insight.

“Every great change in my life was precipitated by insights gained during depression. Depression has served the function of changing my life for the better” (p. 47).

After wrapping up his discussion of functionality, Wootton moves on to discuss the scale people use to evaluate mood disorders. Without pictures it’s a little hard to explain, but basically he shows that we generally use a linear, one-dimensional scale to try to understand a very nonlinear illness. A frequently used scale goes from one to ten, with one being practically dead and ten being amazing.

Of course, people with bipolar disorder must be evaluated on both depression and mania scales; however, a linear scale is still often used. Wootton proposes a new, three-dimensional scale, consisting of two pyramids, point to point, which cover physical, mental, emotional and spiritual components.

In the next, and largest section of the book, Wootton presents the lives of five saints (four Christian, one Buddhist) and their journeys with depression. Using the examples of Teresa of Avila, Anthony, Milarepa, John of the Cross and Francis of Assisi, he shows how some of the largest influences in spirituality and monasticism grappled with mental illness. He then discusses the advantages that today’s mental health consumers have over the saints, reminding readers that they have shown the way by going before us. Those dealing with depression have advantages such as therapy, medication, research and advocacy that the saints did not have.

Finally, drawing on workshops he has led, Wootton discusses how a person can come to see depression as an advantage:

• acceptance
• introspection
• focus
• creating a business plan for success
• getting
• your own hard work

He places great emphasis on looking inward, learning about yourself and coming to terms with your illness. He is also a vocal proponent of medication and meditation. It is important to note the author’s understanding and acceptance of the fact that this is a process that takes time. When creating a business plan for success, Wootton encourages people to set both short- and long-term goals, acknowledging that change does not completely happen overnight.

I was not convinced of Wootton’s hypothesis that depression is an advantage. While I agreed with his holistic emphasis, he almost made it sound too easy. Proponents of Wootton’s work might argue that he was in fact very realistic in his thinking, but I just didn’t see it.

The book’s biggest strength is its emphasis on depression as a multifaceted illness. Though consumer groups and social workers seem to have begun to embrace this, many physicians still work from a medical model of mental illness. This comes across both directly and indirectly throughout the book as Wootton discusses his new ideas for measuring mental illness.

The part of the book I found most frustrating was the section on the lives of saints. This portion took up the largest percentage of the book, but did not seem entirely relevant. While Wootton’s purpose in including it was clear, to help people understand that the saints came before us and grew through their journeys with mental illness, less detail into their lives might have been more effective. Further, in describing their lives, Wootton uses websites such as Wikipedia to gather his facts, which makes his retelling far less credible.

As a person who has struggled with anxiety and depression for quite some time, as well as a mental health social worker, I really didn’t find this book presented anything radically new and different.

The Depression Advantage
By Tom Wootton
Bipolar Advantage, 2007
196 pages
$18.95 (paperback)

Fortunately PTSD has been thoroughly studied and evidence-based treatments developed to help people heal from the impact of severe trauma. In Conquering Post-Traumatic Stress Disorder, Victoria Lemle Beckner, Ph.D. and John B. Arden, Ph.D., present many of the most current treatment tools in a self-help format. They organize their book in a sequence as outlined in one of their concluding sections:

Conquering Post-Traumatic Stress Disorder offers “a journey from trauma toward growth,” starting “with learning about the struggles that emerge following trauma – the symptoms of anxiety, avoidance, and depression, the harmful ways people sometimes cope with drugs and alcohol, the relationship difficulties.” It teaches about “the nature of these problems” and gives “strategies for overcoming them. Next, it helps people confront “the trauma itself – the memories, the meaning of the event and how it’s challenged” their beliefs and revealed important things about themselves and their lives. Finally, it teaches “how to draw on your trauma experience to transform your life in important ways.”

Brief summaries of each chapter follow:

• Chapter 1 begins with portraits of six different trauma survivors and develops these stories to illustrate healing techniques.
• Chapter 2 educates readers about the body’s stress alarm system and the symptoms this activates. It differentiates normal stress responses from the difficulties that occur when the alarm system doesn’t turn off. Next it details the symptoms of PTSD, including re-experiencing and hyperarousal, numbing and avoidance, and depression. It describes coping strategies that don’t work and tells readers where these are addressed in the book.
• Chapter 3 introduces anxiety-reducing techniques and methods for modifying stress responses. It provides a subjective scale for determining one’s level of anxiety, skills for recognizing false alarms, instructions for riding out the anxiety until it dissipates, grounding exercises to get reoriented in the present, and introduces relaxation techniques.
• Chapter 4 offers more detail about overcoming avoidance, helping readers recognize avoidance triggers and how avoidance expands beyond trauma cues. Readers will learn about conditioning and how to overcome it, as well as how to do exposure therapy for themselves. It concludes with a warning that trauma memories may surface as readers practice exposing themselves to anxiety-provoking situations. I would have liked to see that warning at the beginning of the chapter.
• Chapter 5 helps readers recognize depression symptoms and heal dysfunctional thoughts in a graduated way. It also teaches activity scheduling, counsels those who aren’t helped immediately to persist in activities that prime the pump of positive feelings, and recommends exercise and exposure to light. The authors offer guidelines on when to seek professional help, emphasizing that anyone with recent suicidal thoughts should seek an appointment with a mental health resource and seek emergency help if they are actively considering suicide.
• Chapter 6 discusses ways to promote a healthy brain, including sleep practices, better eating, and medication if needed. The sleep section reviews things that both promote and interfere with sleeping well. A section on medication offers recommendations, cautions, and pointers for being an informed consumer.
• Chapter 7 asks readers who may be substance abusers to list reasons they want to use, reasons they want to quit, and to consider whether they are ready to quit completely or cut back. It’s written simply, without jargon, but follows such best practices as motivational interviewing, proven theories of change, and harm reduction.
• Chapter 8 helps survivors who have withdrawn from relationships to re-engage with friends and family and rekindle romance.
• Chapter 9 teaches how to understand and turn angry responses into more effective communications. This chapter is sufficiently well-written that I would recommend it to non-trauma patients with anger management issues.
• Chapter 10 tells readers how the experience of trauma and the apparent indifference of the perpetrator or nature itself can threaten anyone’s sense of meaning. The authors counsel readers in healing altered beliefs about safety, power and control, self-esteem, relationships, world, faith, and life purpose. Self-esteem, for instance, can deteriorate badly if a person feels guilty about involuntarily freezing under extreme threat, and it is important to heal this with understanding and forgiveness.
• Chapter 11 directly addresses processing the trauma memories themselves by putting them into words through journaling or psychotherapy. It includes a warning that more properly belonged at the beginning of the book—cautioning people not to begin processing trauma through journaling if they are suffering from severe depression; thoughts of hurting themselves or others; overwhelming anxiety; excessive alcohol or drug use; psychotic or severe dissociative symptoms; significant difficulty functioning at home, work or school; being in a potentially traumatic situation like an abusive relationship; or simply not feeling emotionally ready right now. This should be recommended to any trauma survivor who wonders whether to try a self-help approach vs. seeking professional help.
• Chapter 12 offers suggestions on talking about trauma and PTSD with others. It suggests that survivors discuss the impact of the trauma instead of its details. It also has a section for friends and family members, teaching them how to listen and provide emotional support without advice-giving or problem-solving.
• Chapter 13 suggests methods for using the healing process itself to grow and find meaning. It has a moving section on grieving the people, abilities or other things that were lost and offers reassurance on how doing so truly heals instead of opening up a bottomless well of grief. They point out that although survivors may suffer shame from having their courage tested through trauma, re-engagement in life and healing are courageous acts themselves.

No single text offers a complete healing path for all people, and the authors do suggest that readers ideally should work with a psychotherapist for healing trauma. They encourage survivors to start their healing process and comment that some therapists “shy away” from working on trauma memories “because it is a frightening and painful process.” I believe this statement minimizes a more complex issue instead of offering a needed explanation. Consider the difference between an emotionally mature adult who survived an industrial accident vs. a child who was repeatedly molested from ages 2 to 10. The accident survivor had a fully formed identity and coping skills, but the child failed to develop a stable core identity. Thus the accident survivor is far more likely to understand and cope than the abused child.

Conquering PTSD does have some shortcomings:

• It doesn’t give clear instructions upfront to help readers assess whether they should try this self-help approach instead of seeking professional counseling before proceeding.
• Although the authors mention the availability of resources, they don’t provide lists that readers might pursue.
• Consistent single-page formatting of exercises and skills summaries would make photocopying easier.
• Chapter numbers at the bottom of every other page would help readers flip through the book without referring to the table of contents.

Overall, however, the book’s clear, simple language, its logical sequencing of material, the simplicity of exercises, and its evidence-based methods are appealing. The authors try to alleviate readers’ fears and convey optimism that many PTSD symptoms can be overcome. Survivors of simple, identifiable traumas who are not a danger to themselves or others; don’t suffer from active addictions or a major mental illness; and can keep up with essential responsibilities even if facing and overcoming distressing trauma symptoms probably will benefit most from it. However, it is also a valuable tool for survivors who do not meet these criteria but are guided in its use by a psychotherapist who specializes in trauma.

Conquering Post-Traumatic Stress Disorder
By Victoria Lemle Beckner and John Arden
Fair Winds: Quayside, 2008
304 pages
$16.99 (paperback)

But the Saturday before Mother’s Day is also Mother’s Day. It’s just the one nobody wants to admit a need for.

Birth Mothers Day began in Seattle in 1990 to recognize the women everyone else forgets, those who chose to give their children both life and a stable future by relinquishing them for adoption. It’s usually a pretty quiet affair, at least in terms of media coverage. And I’ve yet to see a greeting card for it.

There are organizations – church groups, counseling centers and the like – that host annual get-togethers for birthmoms on the day before the Mothers Day most recognize. The one and only I’ve been able to get to so far helped me achieve a tremendous amount of healing in a single afternoon. When it was over and we were saying our goodbyes, I hugged one of the organizers and said, “I think you’re the only person who cried more than I did.” She replied, “That’s why I told them to be sure to have two big boxes of Kleenex on every table!”

Yep, I’m a birthmom. For years and years it was a source of shame and grief and guilt. Some of that was self-imposed; much of it wasn’t. Out-of-wedlock pregnancies have been viewed poorly for decades, if not centuries. Often birthmoms are afraid to let themselves be known because of that. The damage silence causes is lasting.

Various and sundry rotten things have happened to me in my life. That’s just part of the deal for all human beings. My particular biggies: Assorted types of abuse, job struggles (currently on my third layoff in 15 years), financial trouble because of underemployment and outrageous medical bills for both acute and chronic physical issues.

In spite of all that, I consider the relinquishment of my son almost 21 years ago the source of most of my myriad psychological difficulties. (My diagnosis list is long as your arm; I won’t divulge them all.) The post-traumatic stress disorder came along as soon as I left the hospital empty-armed after giving birth. It took a long, long time to abate, and it only did so because my son’s adoptive mom did some sleuthing and found me a few years ago. Now that I know where he is, and how well he’s doing, and that he’s happy and healthy and cute and talented and smart and altogether wonderful, well, it’s made a huge difference. But I dealt with overwhelming grief for nearly 16 years before we made contact. Time lessens all wounds, but it certainly doesn’t heal them.

Things have changed since 1988. Mine was a closed adoption, meaning no identifying information was allowed. The more recent trend has been toward open adoptions, where a potential birthmom can meet and choose beforehand the couple she feels will be best for her child. Often there’s an agreement that the birthmom will be allowed to be part of the child’s life in some fashion, or at least have an occasional visit.

I would think that’d have to help. Moms worry; it’s what we do. I worried outrageously for 16 years about my son and how he was faring and if he’d hate me for my decision. (As it turns out: No. In fact, he told me he couldn’t imagine the selflessness it took and thanked me for it. Did I mention he’s a great kid?) Every time I heard about an adopted kid being abused to the point of death or near it, I worried. Every time I heard about a new mom who tossed her baby in a dumpster – or, in one case I vividly remember from several years ago, in a plastic grocery bag stashed in a portable toilet – I worried. It turned out to be baseless, but since I didn’t have any information, and no way of obtaining any, who knew?

There’s not as much literature as there should be on the effects of adoption on birthmoms. I can tell you from my own experience, though, that even your own family often doesn’t get it. Friends frequently say stupid, if well-intentioned things; sometimes, mental health professionals say even worse ones. I once had a psychiatrist tell me I “wasn’t really a parent.” (Male, of course. And I’m not man-bashing, simply stating the obvious, that men aren’t going to get it because they can’t experience it. I assure you, nine months of co-existence with another being inhabiting your body, then enduring unendurable pain for hour after hour to help the mini-human out into the world, qualifies you as a parent.)

Another medical professional examining me a few months after the birth said, when I told her about it, “Oh, you’re young, you can have more.” I was 23, and technically that was correct. There was nothing wrong with the plumbing. But you can’t just swap out one child for another. I didn’t have more partly because I was convinced I would be a terrible parent, but largely because I knew that even if I had 12 more, they would never fill the hole in my heart and I would never be able to give all of myself to them.

I love my son to the moon and the stars and back – always have, always will. Love prompted the decision I made for him, as it did for most women in the same situation. Some had their children taken by the courts, some were teens and forced into the decision by their parents, but none of us ever stopped loving our kids. Maybe someday people will think enough of us that there’ll only be a need for one Mother’s Day.

Further reading

I wrote another piece about my birthmom experiences several years ago for Psych Central. If you are a birthmom who needs to talk, my inbox is always open.

Birth Mother’s Day Eases Adoption Grief

www.adoption.org

A birthmom’s diary of the first year post-adoption

Psychotherapist birthmom tells her story

Psychological disability in women who relinquish a baby for adoption

The Girls Who Went Away: The Hidden History of Women Who Surrendered Children for Adoption in the Decades Before Roe v. Wade (Full disclosure: I am acquainted with one of the women interviewed for this book.)

Candy Czernicki is managing editor of Psych Central.

While I can see some truth in this viewpoint, I offer a different opinion: In nearly every case, a person with mental illness experiences some form of extreme thinking, a black-and-white viewpoint. Let’s profile bipolar disorder and depression right now to see what I’m talking about.

Bipolar disorder is characterized by mood swings, sleep disruption, and extreme behaviors. These mood swings can include irritability, energetic happiness, impulsive and erratic behavior, deep depression, anger, or even agitated confusion. None of these states is healthy over the long term, yet this is the world of a person with bipolar disorder.

Bipolar I is the most extreme and dangerous form. A person with Bipolar I behaves in life-threatening ways—driving dangerously, abusing illegal drugs, and performing other acts of self-harm—spends recklessly, shows dramatic behavior changes, has disrupted sleep, and has strong mood swings. Bipolar II is similar except the level of danger and risk to self and others is generally lower. Cyclothymia is even one step milder with little risk of anything truly dangerous, but is still disruptive to the person’s life.

Many people with bipolar say that they really like their unmedicated manic state. They feel so alive, energetic, and creative. They have endless ideas and the motivation to keep them flowing. They feel there’s nothing they can’t do. While a person in a manic state may feel full of life, this is absolutely unsustainable. Nobody truly can have endless energy with little sleep and random eating habits.

In a manic state, a person may forgo or limit most other necessities aside from their passion of the moment. This could include family time, work, exercise, relaxation, hobbies, housekeeping, grocery shopping or shopping for other necessities, cooking, etc. The ideas may be flowing strongly, but what good are they if the person becomes too exhausted to act on them?

Major depressive disorder has hallmark symptoms including strong feelings of sadness, despair, emptiness, and sometimes anger. This burden is so heavy, a depressed person’s pain shows in his or her behavior and thinking patterns. Nothing ever seems to go right; they don’t feel happy enough to be social; they sleep too much so they miss out on exercise. While they may have periods or moments of happiness, the bulk of their emotion is marked by depression.

Several famous painters, authors, and actors have done their most memorable work while living through depressive episodes. But their bodies and minds were burdened with a smothering blanket of despair and loneliness. The depressed mind is often so scrambled that thoughts and feelings don’t come out clearly. How can true creativity flourish in this environment?

Many of these talented people have died younger than necessary or developed addictions. Their greater creativity was effectively strangled because it shortened or greatly impaired their lives. The imbalanced nature of their lives knocked them down many times, and some did not survive their fall.

• Musician Kurt Cobain of the rock group Nirvana reportedly was diagnosed with bipolar disorder. He was also addicted to heroin and survived at least one drug overdose. Cobain died in 1994 from a self-inflicted gunshot wound.

• Wolfgang Mozart was a prolific composer, but also was prone to drinking, depression, hyperactivity, and working excessively with little rest. He died of an unknown illness at age 35.
• Actor Heath Ledger suffered from depression and drug addiction. In 2008, he died of an accidental overdose of prescription medication. Six months before his death, he began to go through dramatic mood swings with deep depression.
• Ernest Hemingway wrote several novels that went on to become world literature classics. He struggled with depression and excessive drinking throughout his adult life. He shot himself to death in 1961.

Depression and bipolar often play a cruel joke. Both disorders both produce an excess of thoughts and overflowing emotions. They can prompt the flow of ideas, but they also create mental confusion and overload. Thoughts and ideas can be easily lost before they are expressed. Creativity is both stimulated and stunted by the same force.

The artists, actors, poets, and authors who have managed to express themselves in spite of their mental illness deserve our respect and appreciation. They have managed to push their ideas out in to the world, past the jagged edges and barbed wire inside their souls. They have given us a glimpse into the mind and heart of someone with significant emotional imbalance and pain. Most are not so lucky.

I started taking Celexa a few weeks ago. I had previously been on Remeron, but it didn’t seem to be doing much. At the suggestion of my psychologist, I asked my psychiatrist about switching to Celexa.

My psychiatrist explained that Celexa is part of a class of drugs called selective serotonin reuptake inhibitors (SSRIs). While I can’t honestly say I understand the precise differences between an SSRI and any other type of antidepressants, I know that SSRIs work on different neurotransmitters and are widely prescribed. They do great things for a lot of people.

My psychiatrist also explained that Celexa can have some bad side effects. She asked me if I was prone to an upset stomach. I said I was. Because of this, she told me to start my dosage at 10mg, go to 20mg the next week, then 30mg the following week. This sounded like a rational plan, so I agreed to give it a try.

If I had done more research before switching to Celexa, I would have found out that Prozac is also an SSRI. Prozac was the first antidepressant I ever took and I had a terrible experience with it. It plunged me into a constant fog, disrupted my sleep, made me cry a lot, and gave me a persistent feeling of strangeness. If I had realized that Celexa was in the same class of drugs, I may not have been so willing to take it.

From the first pill I took, the Celexa made me feel sick to my stomach. Because there are various stomach flus going around right now, it took me a few days to decide if I felt sick from the Celexa or because I had the flu. As the nausea did not abate, I started to pin its source as the Celexa.

I have consistent problems with sleep. The Celexa seemed to make these issues worse. Even with taking Ambien or Trazodone at night, I either could not fall asleep or would wake up a few hours into the night. When I would wake up in the middle of the night, I would lay there for hours trying to fall back to sleep.

The combination of nausea and constant sleep deprivation made me disinterested in food. It also made me disinterested in exercise, which is a huge problem for me. I basically exercise for a living and I felt my job was suffering. Not feeling up to doing the physical activities I usually do made me feel less like myself. I became hugely concerned about this.

With the Celexa, I also noticed a change in my sexuality. My libido was definitely being killed. As this is something that is highly important to me, it freaked me out.

I started to feel that the Celexa was robbing me of who I was. I couldn’t exercise properly, couldn’t sleep, and felt almost completely nonsensual. I was not sure what to do and was becoming increasingly upset about it.

I started to do some research into Celexa and found that 10 percent of people who take it experience side effects. I found a list of the common ones and had almost all of them except hallucinations, dry mouth, cardiac arrhythmia, and blood pressure changes. This upset me even further.

All these factors came to a head yesterday. Because I was feeling sick to my stomach, I had another terrible day of exercise. As exercise gives me a great sense of self-esteem, I found this greatly demoralizing. I also developed a pounding headache in the back of my head. At this point, I decided the Celexa had to go. It was heavily getting in the way of my life.

At my therapy appointment yesterday afternoon, I addressed with my psychologist what was going on with the Celexa. My therapist agreed that I had to go off of it. He knew that I had to be weaned off the drug rather than immediately stop taking it, but he was not sure of the best way to do this. I needed a doctor’s input.

I called my psychiatrist’s office as soon as I got home. It was explained to me that a nurse would call me back as soon as possible. Due to some missed calls, I did not get to speak with the nurse until today. She was incredibly helpful and told me that what I was experiencing with the Celexa is extremely common. As I suggested that I was not sure I wanted to take antidepressants at all anymore, she asked me if I would answer some questions.

The nurse led me through a standard list of questions about my current state of mind. She determined that I was okay, but still wanted me to come in and meet with my psychiatrist to talk about the best way to get me off the Celexa. I explained that I have a new health insurance plan with a $50 co-pay and asked if I may be able to speak with the psychiatrist on the phone, rather than come into the office. She said that was not a problem.

My psychiatrist called me within an hour. We addressed in detail what was going on with my side effects. She explained that even if I adjusted to the Celexa and my sleep, nausea, and headaches improved, the sexual side effects would not go away. She agreed that I needed to get off the drug. We decided on a plan to wean me off.

This left the big question of if I wanted to continue with antidepressants at all. I simply wasn’t sure if they were for me. The psychiatrist pointed out that we had not done a full test of Remeron, the antidepressant I was on previous to Celexa. Remeron is a drug that had an initial positive effect on me without any side effects. After a couple months however, the Remeron did not seem to be doing anything. The psychiatrist reminded me that instead of increasing my dose of Remeron, we had opted to go to Celexa. She asked if I would try a full course of Remeron and see what happened. I agreed.

Tomorrow I will start to wean myself off the Celexa. I will be incredibly glad to see it go. I can’t say I have huge hopes for going back to the Remeron, but it is worth a try. While I am still not convinced that antidepressants are best for me, it’s worth seeing what happens with a full course of Remeron. We shall see!

So rather than lean toward the warm, seductive, siren-like pull of identification and immersion with the dead poet and her writing, I try to spend my time reading books that make me feel happy while at the same time not denying that unhappiness exists.

Someone very dear to my heart gave me a book called Good Poems edited by Garrison Keillor. Every so often when I am feeling particularly melancholic, I find myself flicking through and selecting a poem at random; rather like someone who looks toward a passage in the Bible for inspiration. It’s never far off.

My love for literature and writing has led me through the valley of the shadow of death and down the path of salvation, the same way some people find solace from grief through volunteer work, flower arranging, painting, music or just being with their children and family.

Spending time doing what I love doing the most gives me enough time to slowly turn these overwhelming, innate, visceral body-centered feelings of despair and anxiety into hope, mindfulness, peace and goodwill. I need to trust that while my insides may be temporarily heaving and churning and my nerves are piano-wire taut, the rest of my world hasn’t changed; and when I recover it will still be there, with its somewhat normal constancy, reliability and stability.

My crushed spirit can then start to unfold and flutter its diaphanous wings, rising gently toward heaven and I can sit still knowing that once again I’ve won the battle, but not the war of depression - if only for a short time.

In this, Sylvia is my greatest teacher.

Since the 1970s, meditation and other stress-reduction techniques have been studied as possible treatments for depression and anxiety. One such practice, yoga, has received less attention in the medical literature, though it has become increasingly popular in recent decades. One national survey estimated, for example, that about 7.5% of U.S. adults had tried yoga at least once, and that nearly 4% practiced yoga in the previous year.

Yoga classes can vary from gentle and accommodating to strenuous and challenging; the choice of style tends to be based on physical ability and personal preference. Hatha yoga, the most common type of yoga practiced in the United States, combines three elements: physical poses, called asanas; controlled breathing practiced in conjunction with asanas; and a short period of deep relaxation or meditation.

Many of the studies evaluating yoga’s therapeutic benefits have been small and poorly designed. However, a 2004 analysis found that, in recent decades, an increasing number have been randomized controlled trials — the most rigorous standard for proving efficacy.

Available reviews of a wide range of yoga practices suggest they can reduce the impact of exaggerated stress responses and may be helpful for both anxiety and depression. In this respect, yoga functions like other self-soothing techniques, such as meditation, relaxation, exercise, or even socializing with friends.

Taming the stress response

By reducing perceived stress and anxiety, yoga appears to modulate stress response systems. This, in turn, decreases physiological arousal — for example, reducing the heart rate, lowering blood pressure, and easing respiration. There is also evidence that yoga practices help increase heart rate variability, an indicator of the body’s ability to respond to stress more flexibly.

A small but intriguing study further characterizes the effect of yoga on the stress response. In 2008, researchers at the University of Utah presented preliminary results from a study of varied participants’ responses to pain. They note that people who have a poorly regulated response to stress are also more sensitive to pain. Their subjects were 12 experienced yoga practitioners, 14 people with fibromyalgia (a condition many researchers consider a stress-related illness that is characterized by hypersensitivity to pain), and 16 healthy volunteers.

When the three groups were subjected to more or less painful thumbnail pressure, the participants with fibromyalgia — as expected — perceived pain at lower pressure levels compared with the other subjects. Functional MRIs showed they also had the greatest activity in areas of the brain associated with the pain response. In contrast, the yoga practitioners had the highest pain tolerance and lowest pain-related brain activity during the MRI. The study underscores the value of techniques, such as yoga, that can help a person regulate their stress and, therefore, pain responses.

Improved mood and functioning

Questions remain about exactly how yoga works to improve mood, but preliminary evidence suggests its benefit is similar to that of exercise and relaxation techniques.

In a German study published in 2005, 24 women who described themselves as “emotionally distressed” took two 90-minute yoga classes a week for three months. Women in a control group maintained their normal activities and were asked not to begin an exercise or stress-reduction program during the study period.

Though not formally diagnosed with depression, all participants had experienced emotional distress for at least half of the previous 90 days. They were also one standard deviation above the population norm in scores for perceived stress (measured by the Cohen Perceived Stress Scale), anxiety (measured using the Spielberger State-Trait Anxiety Inventory), and depression (scored with the Profile of Mood States and the Center for Epidemiological Studies Depression Scale, or CES-D).

At the end of three months, women in the yoga group reported improvements in perceived stress, depression, anxiety, energy, fatigue, and well-being. Depression scores improved by 50%, anxiety scores by 30%, and overall well-being scores by 65%. Initial complaints of headaches, back pain, and poor sleep quality also resolved much more often in the yoga group than in the control group.

One uncontrolled, descriptive 2005 study examined the effects of a single yoga class for inpatients at a New Hampshire psychiatric hospital. The 113 participants included patients with bipolar disorder, major depression, and schizophrenia. After the class, average levels of tension, anxiety, depression, anger, hostility, and fatigue dropped significantly, as measured by the Profile of Mood States, a standard 65-item questionnaire that participants answered on their own before and after the class. Patients who chose to participate in additional classes experienced similar short-term positive effects.

Further controlled trials of yoga practice have demonstrated improvements in mood and quality of life for the elderly, people caring for patients with dementia, breast cancer survivors, and patients with epilepsy.

Immersion journalism, as it’s called, can be kind of fun on a limited basis. In my days as a reporter, in pursuit of stories I volunteered to get Tasered and learned how to snowshoe. (The Tasering was fun for the cops who got to watch a journalist get nailed; the snowshoeing – a 5K race my first time on the things – was fun mostly in retrospect.)

Then there are immersion journalists who do it up big. Stefan Fatsis, a former Wall Street Journal reporter, became a professional Scrabble player, then a placekicker for the Denver Broncos. AJ Jacobs, an Esquire magazine editor, read the Encyclopedia Brittanica all the way through from A to Z. He followed that by spending a year obeying as many of the 613 rules of the Torah as he reasonably could, given the limitations of 21st-century life. And Norah Vincent, a former print journalist and syndicated columnist, spent 18 months dressing, living and dating as a man. It led to three stays in psychiatric hospitals – one voluntary, as she dealt with her own severe depression following her first book, and two where she felt more or less well, but played the part in the name of research.

The three hospitals Vincent admits herself to are located along the economic spectrum — a ward in an urban hospital with largely indigent, largely heavily-medicated patients; a private substance abuse rehabilitation clinic in the rural Midwest with a small psychiatric component; and an ultra-expensive “alternative therapy” private clinic that goes against most currently accepted psychiatric treatment protocols.

Of the urban hospital experience, where a nurse confiscated the pen Vincent was using to take notes, she said:

Madness is a disease of the will, of judgment. That is what is impaired. And so, in there, along with so much else, your will was taken away, like a pen, because you could not be trusted with it. Yet your will is the thing that makes you feel human. Without it you cannot be well, which is why no one in there really got well, or, arguably, much better.

This is the paradox of asylums, and their fatal flaw. Put a person in a cage and you cannot help him. But leave him to his devices and he cannot help himself, or will not. Freedom is a prerequisite for healing a broken mind. It cannot be fixed against its will. Yet a broken mind is a broken will, a freedom that does harm, even potentially serious physical harm to itself and possibly others, a freedom that can attack or maim. So, how else to heal but by force? (p. 24)

Along the way, Vincent meets a cast of characters who would be comical if they weren’t so – depressing, actually. The pseudonyms she gives them are wonderfully evocative: “Mr. Clean” is a 6-foot-3 psychotic diabetic perpetually begging Vincent to ask her visitors to bring candy. “Mother T,” a delusional 42-year-old Puerto Rican woman, had seen Jesus flying to the part of the city the hospital was in and claimed Jesus had asked her to follow. Twenty-nine-year-old alcoholic “Bunny Wags (…)looked like a hundred and fifty pounds of chewed suet, sitting there pasty, slumped, defeated. … (p.123)”

At the “alternative therapy” clinic, where clients were housed in upscale apartments, did their own grocery shopping and had nearly unlimited access to therapists, Vincent finally was able to recognize life events she’d been repressing and deal with them. But before she gets that far, she still is accurately able to describe life with debilitating depression:

People say that depression is tears and lassitude and fears and self-loathing. But they do not say it is a brain made of tacks, that it is a relentless passing of sentence.

Guilty. I am guilty.

And an equally relentless rumination and breaking down in response to it. Perhaps like autism, depression is a protective reaction to too much information. Too many thoughts.

In this context, it’s interesting to ask: Why can’t a depressive get out of bed? Because if the minute you woke up, you thought of all the ways you could die or be injured or fail or cause death or failure or harm to others in any given day, you wouldn’t get out of bed either. If you thought too long and hard about all the people who die in crosswalks, you would never cross the street. If you thought of all the people who die in car accidents, you would never get in a car. And those are only the simplest considerations.

Life is lived on ignorance, on not thinking about all the possibilities, about ignoring the most basic fact, that you are mortal and that it is unreasonable to expect a sentient, self-conscious creature to live with the idea that she is going to die. (p. 122)

Once opposed to medication, Vincent eventually decides she will take it in the lowest possible dose to help herself stay out of the abyss. But it’s not just the combination of medication and self-care that the therapists always prescribe that is the biggest takeaway from this book:

It’s all of a piece. Together, the pieces bring about the whole, and the sense of wholeness that is essential to staving off depression. … It is up to me to tend to my wholeness. I do it or I don’t. That’s it. … The success or failure is my own.

…as for cure, that’s a fantasy. You don’t finish. You continue. And you don’t do it – you are not forced to do it – because you are mentally ill. You do it because that’s how living works. Maybe depressives like me have to work a little harder at happiness. Maybe psychotics … have to work a lot harder. But everyone has to work at it.

I’m not saying that eating right and exercising, nurturing your heart and challenging your brain, will save you. It won’t. There is no saving, of course. You never “arrive.” You move. You get on with it. That’s the prescription. (pp. 282-283)

I heartily recommend this book for families, friends and caregivers of the mentally ill. It provides an unflinching look at reality. While the subject matter can be difficult, Vincent’s combination of spare language and detailed description keep the reader engaged from start to finish.

The precursor of the mirror is the mother’s face. —D.W. Winnicott, Playing and Reality, 1971

Thirteen years ago I gave birth to my very much wanted third child. Eight months later I ended up in the psychiatric ward of a public hospital for exhaustion and post natal depression. That was when I met my therapist.

For a long time in therapy I did not have a coherent narrative. My stories were long, rambling, confused and disordered. I did not have the discretionary powers to summarize a situation in a succinct, global and philosophical sense. This gave my therapist a pretty clear idea what sort of upbringing I had experienced with my biological mother.

Finally, here was someone who intuitively understood my battered and tenuous relationship with my mother and managed to approve of and validate my feelings without denigrating her. Only I was allowed to whine irritably and incessantly about my mother — no one else was. Blood is thicker than therapy and my very clued-in and astute therapist knew this.

I thought she was amazingly wonderful even if she did wear Ice Queen pin-striped skirt-suits to work and called herself Ms. I have watched her wardrobe change over the years from power dressing to casual clothes that don’t require ironing, from polished high heels to comfortable flats, from black stockings to polka-dotted, multi-colored, frilly-topped socks and from crisp business shirts to sleeveless polyester vests.

I have watched the many years etch lines of wisdom onto her face. We have both grown older and wiser in the same space and time. Because we are very similar in height, hair color, eye color and complexion I sometimes think she could be my real mother. It’s like looking into a mirror and seeing your own reflection. But I find it overwhelming and intimidating if she stares at me for too long.

Heinz Kohut believes that empathic mirroring is an essential part of the mother-child/therapist-client bonding experience. One day it dawned on me that my therapist was mirroring my movements. I leaned forward and rested my hand on my chin and so did she. My foot would jerk upward when I mentioned my mother and it was very enlightening to watch her foot jerk up occasionally as well. When she involuntarily took a sharp intake of breath I knew I had said something of significant value. When she scratched her neck I reveled in perverse delight knowing I’d said something that highly irritated her.

Having a good belly laugh in therapy is most important. My therapist, my Winnicottian good-enough therapist, had a great self-deprecating sense of humor. When I arrived one day she was wearing crooked orange (orange!) lipstick. I finally mentioned it to her about a year later and she hooted with laughter and has told the story to other people, although not mentioning it was from a client. I once, on a very rare occasion, caught my mother without makeup on and grimaced. I was severely punished with a long, penetrating, icy glare that made my armpits itch ferociously.

Psychologist John Bowlby believes that attachment and bonding between mothers and children is socially significant and a powerful force in human nature. My therapist, to all intents and purposes, at that stage, was my mother and the little girl within me suffered separation anxiety every moment of the day I was without her. Especially when she went away on overseas holidays. Although she always let me know where she was going, and with whom, the pain of knowing she was in another country was sometimes horribly indescribable.

When I got too frightened and lonely I could contact my therapist either by phone, fax, post, text message or email. If all those forms of communication ever failed I would have been willing to give smoke signals or carrier pigeons a go. Although she was very busy at times, if need be she would fit in an extra appointment slot to see me. Knowledge of almost immediate contact soothed me considerably and I was able to cope with whatever demon was confronting me at that particular moment. And there were a lot of devils dancing on my front door step.

Depression is an illness and you need support to help fight it. Treatments can involve a variety of different approaches including antidepressants and psychological therapies. But there are also many self-help techniques you can use to complement professional treatment.

Options include attending a self-help group, making changes to your diet, improving your sleep habits and learning relaxation techniques. Research on acupuncture, herbal medicines (including St. John’s Wort), and aromatherapy suggests that these treatments can help to reduce anxiety and to alleviate mild depression.

Don’t expect too much of yourself, as depression makes it difficult to do what you need to feel better, but you do have some control. Make small changes, persist with them, and you will begin to notice a benefit.

Of course, it’s not that easy. Even small changes may seem impossible, so it’s crucial not to pressure yourself to take action. Imagine yourself completing a few small goals to start with. Consider the resources available to you: friends, loved ones, doctors, information, support from an employer, health facilities, outdoors areas to relax in. Gathering information can help reduce the misconceptions, guilt and fear which are often associated with depression. Look out for books and websites on depression.

Ideas for action include taking a short walk, calling a trusted friend, sending a few emails. If you feel up to it, think about communicating with other people in a similar situation. Sharing experiences within supportive relationships can help alleviate your depression and provide new coping strategies. It can be hard to maintain perspective on your own so, although it can be a challenge, it is worth breaking out of the isolation and reaching out for help.

Once they know how you are feeling, trusted friends and family members will want to help you through this tough time. If you’ve had some bad news or a major upset, tell someone how you feel. You may need to talk (and maybe cry) about it more than once, but a good friend will understand.

Make plans to have lunch or coffee with a friend and explain the situation. You could ask them to check in with you regularly, and set regular events for the two of you such as going to the movies, a concert, a museum, to dinner, or to a small gathering.

Depression can increase your tension, stress and anxiety, so relaxation is an important element of recovery. There are many ways to relax - yoga, reading, listening to a relaxation tape, or getting away for a short holiday. On the other hand, some people unwind best through a more physical activity. Perhaps there is a form of gentle exercise that appeals to you and will make you feel more positive. Taking a walk in the sunshine provides exercise, fresh air, vitamin D, and removes you from your comfort zone if you tend to stay at home.

Dietary changes are a sensible idea to support your recovery from depression. Often people find that their appetite decreases or increases significantly, so try to make sure that you eat regular, appropriate amounts of food, ideally including fresh fruit and vegetables. Certain nutrients, like Omega 3 (found in oily fish, flax/linseed and olive oil) are thought to be especially beneficial. If you’re really struggling to eat well, invest in vitamin or fish oil supplements.

Aim to maintain any hobbies or interests you normally have, if only just a few minutes each day. Routine is essential. These activities will help you to feel better, despite being more difficult and perhaps not giving you the pleasure they usually would. If your interests involve being sociable, try to fight the urge to retreat into your shell. Being around other people will give you a lift.

Make time for things you enjoy, while limiting your working pressures and commitments as far as possible. This may open up an opportunity to begin expressing yourself creatively through a new medium: music, art, or writing. Inspiration could come from spending some time in nature or revisiting favorite books or films to get back in touch with your happier self. Look back over journals or photos to get a fresh viewpoint on your current feelings—you may gain strength from recalling your achievements and obstacles you have previously overcome.

Relaxation techniques are worth investigating. Try deep breathing, progressive muscle relaxation, or meditation. Identify what is adding to your stress load (work? unsupportive relationships? substance abuse? health problems?). See if any of these can be reduced or eliminated.

Most of all, go easy on yourself and don’t set impossibly high standards. Recognize this tendency if you have it, and step back. Challenge your negative thinking by treating yourself as you would a good friend. Sometimes the thought patterns in depression can make you feel helpless, but it is a disease that can be treated. Take gradual steps day by day and be proud of yourself for doing so.

References

Depression Tips

Depression Alliance

Depression Information

If treatment for your depression has not yet worked, don’t give up! Virtually all clinical depression is treatable, but it’s often a matter of finding the right type of treatment for each person. What this usually means is that it’s a matter of trial and error, working with a mental health professional to try different medications at different doses, or different types of psychotherapy strategies.

Traditional Treatments for Treatment Resistant Depression

Medications. Most antidepressants can take 6 to 8 weeks before a person will begin to feel their beneficial effects. This means that you may feel the side effects of the medication long before the clinical benefits of it. Hang in there, but if after 6 to 8 weeks, you still feel no less depression, it’s time to talk to your doctor again.

Doctors will typically try a strategy of increasing your dose, adding another medication, or changing your antidepressant medication altogether. Different doctors will implement different strategies. Research has shown that only 33 percent of people will respond to the initial medication they are prescribed. So hang in there, as you’re likely to be in that majority and need your doctor to look at adjusting your dose or medication.

In early 2009, Symbax (olanzapine and fluoxetine HCl capsules) was the first (and currently only) medication approved by the FDA for the acute treatment of treatment-resistant depression. Symbyax is a medication that combines long-acting Prozac with Zyprexa. Weight gain is one of the most common side effects of Symbyax.

Psychotherapy. Psychotherapy can also take time to work, although some people might feel the benefits of psychotherapy more immediately as it can work to address immediate life stressors or other problems.

Most psychotherapy for depression focuses on helping a person understand how their thoughts can impact their emotions and feelings of depression. It also seeks to help a person improve their interpersonal relationships and communication with others. If one form of psychotherapy seems unhelpful, you may need to work with your therapist on trying a different form.

Be careful when you wrestle with monsters, lest you thereby become one. For, if you stare long enough into the abyss, the abyss also stares into you.
— Friedrich Nietszche

Now I want to tell you about the symptoms that schizoaffective disorder shares with schizophrenia - the disorders in thought.

I find this difficult. It seems I haven’t ever written much, publicly anyway, about what it’s like to be schizoid. I think right now will be the first time I have written about it at any length. I have found it difficult to communicate my experience as compellingly as I had set out to do. It’s taken some time to understand why.

The problem I have is that it is dangerous for me to have the kind of experience that would allow me to write vividly about my illness. I have found in the past that to experience memories of my symptoms with too much clarity causes me to experience the actual symptoms again. It can happen that simply reflecting on my past in a deep way can bring about the insanity. This happened once during a time when I was corresponding regularly with a bipolar friend, and when I told her what it was like to really remember, she very anxiously pleaded with me to stop, let go and forget lest I be drawn into the darkness again.

After some reflection I realize that the danger is in remembering the feelings I have had when I’ve been symptomatic. There is no problem with recalling the events, looking at old photos from the time, or reading what I wrote when I was wigging. What is dangerous is remembering the feelings by actually feeling them again. Remembering that I felt afraid is OK, what is not is to actually feel the same fear I once felt. To write the best I could hope to I would have to recall the actual feelings again, and I think it is best I not do that.

For that reason I have found it necessary to approach this topic with a certain protective detachment that has resulted in the clinical tone my article has so far. I hope you can forgive me for it. I’m finding it a little more difficult to stay so detached as I write about being schizoid. Maybe I will be able to write more effectively here but just between you and me I find the experience more than a little frightening.

For a long time I have found it easy to admit to being manic depressive. I do it casually sometimes, even flippantly. Even before I decided to go public with my illness I was comfortable telling trusted friends that I was manic depressive. But I have always been much more reluctant to own up to actually being schizoaffective. What I said before, that I describe my illness as I do because no one understands schizoaffective disorder, is only part of the truth. The full truth is that even now, after so many years, I still find it hard to face the part of myself that is schizophrenic.

Many manic depressives will tell you that despite the pain it causes that there is something romantic about being manic depressive. As I said manic depressives are known to be intelligent and creative people.

However, despite its extremes, the symptoms of manic depression are mostly familiar human experiences. It is not hard to find completely healthy people who act just like I do when I’m either hypomanic or moderately depressed. It’s just the way they are. Psychotic mania and psychotic depression are not so familiar, but they are different in degree, not in kind.

The schizoid symptoms I experience are just plain… different.

This really gives me a serious case of the creeps.

Hearing Voices

Yet it is in place to appeal to the fact that madness was accounted no shame nor disgrace by men of old who gave things their names; otherwise they would not have connected that greatest of arts, whereby the future is discerned, with this very word ‘madness’, and named it accordingly.
— Plato Phaedrus

Auditory hallucinations are the key sign of schizophrenia. After the summer I was diagnosed, when I related my experience to a fellow UCSC student who studied psychology, he said that the fact that I heard voices by itself made some psychologists consider me schizophrenic.

Everyone has an inner voice that they talk to themselves with in their thoughts. Hearing voices is not like that. You can tell that your inner voice is your own thinking, that it’s not something you’re actually hearing someone saying. Auditory hallucinations sound like they’re coming from “outside your head”. Until you come to understand what they are, you cannot distinguish them from someone actually talking to you.

I haven’t heard voices very much, but the few times I have is quite enough for me. While I was in the Intensive Care Unit at the Alhambra Community Psychiatric Center that summer of ‘85, I heard a woman shout my name - simply “Mike!” It was distant and echoey, so I thought she was shouting my name from down the hall, and I would go look for her and find no one.

Other people hear voices whose words express much more disturbing things. It is common for hallucinations to be harshly critical, to say that one is worthless, or deserves to die. Sometimes their voices keep up a running commentary about what’s going on. Sometimes the voices discuss the inner thoughts of the person who hears them, so they think everyone around can hear their private thoughts discussed aloud.

(One might or might not have a visual hallucination of someone actually doing the speaking - the voices are often disembodied, but for some reason that doesn’t make them any less real to those who hear them. Usually those who hear voices find some way to rationalize why the speech does not have a speaker, for example by believing that the sound is being projected to them over a distance via some kind of radio.)

The words I heard weren’t disturbing in themselves. For the most part, all my voice ever said was “Mike!” But that was enough - it wasn’t what the voice said, it was the intention that I knew to be behind it. I knew that the woman shouting my name was coming to kill me, and I feared her like nothing I’ve ever feared.

When I was brought to Alhambra CPC, I was on a “72 hour hold”. Basically I was in for three days of observation, to allow myself to be studied by the staff to determine whether lengthier treatment was warranted. I had the understanding that if I just stayed cool for three days I would be out with no questions asked, and so although I was profoundly manic I stayed calm and behaved myself. Mostly I either watched TV with the other patients or tried to soothe myself by pacing up and down the hall.

But when my hold was up and I asked to leave, my psychiatrist came to me to tell me he wanted to stay longer. When I protested that I’d met my obligation, he replied that if I didn’t stay voluntarily he would commit me involuntarily. He said something was seriously wrong with me and we needed to deal with it.

He told me I’d been hallucinating. When I denied it, his response was to ask “Do you ever hear someone call your name, and you turn, and no one is there?” And yes, I realized he was right, and I didn’t want that happening, so I agreed to stay voluntarily.

Hallucinations aren’t always menacing. I understand some people find what they have to say familiar and comforting, even sweet. And in fact another voice I think I heard (I can’t be sure) came when I was hanging out by the nurse’s station in the ICU. I heard one of the nurses ask me an inconsequential question, and I answered her only to be surprised to find her looking down at her desk, ignoring me. I think now she hadn’t addressed me at all, that the question I heard was one of my voices speaking to me.

I became very determined that the voices were going to stop. They really bothered me. I worked hard to determine the difference between real people talking and my voices. After a while I was able to find a difference, although a disturbing one - the voices were more convincing to me than what real people actually said. The concreteness of my hallucinations’ apparent reality always struck me immediately, before I ever heard what they said.

Some of my other experiences are this way too: the conviction of their reality always strikes me before the actual experiences do. People have often told me I should just ignore them, but I haven’t had that choice, by the time I can make the decision to ignore something I have already been frightened by it.

After a while I decided I just wouldn’t listen anymore. And after a short time the voices stopped. It only took a few days. When I reported this to the hospital staff, they seemed quite surprised. They didn’t seem to think I should be able to do that, to just make my hallucinations go away.

Still the voices bothered me enough that for years afterwards it startled me to hear anyone call my name when I didn’t expect it, especially if someone I didn’t know was calling someone else who happened to be named “Mike”. For example, there was someone named Mike who worked on the night shift at the Safeway grocery store in Santa Cruz when I lived there, and it would frighten me when they would call his name on the public address system, asking him to come help at the cash register.

Dissociation

At times, particularly that summer of ‘85, I would have the experience that I was not participating in my own life anymore, that I was an detached observer of, rather than a participant in my life.

The experience was like watching a particularly detailed movie with really high-fidelity sound and a wraparound screen. I could see and hear everything going on. I guess I was still in control of my actions in the sense that some guy who everyone else referred to as “Mike” seemed to be speaking and doing stuff from the same point of view as I was watching from - but that person was definitely somebody else. I didn’t have the feeling that the part of me who was called I had anything to do with it.

At times this was frightening, but somehow it was hard to get worked up about it. The person who was feeling and exhibiting the emotions wasn’t the one called I. Instead, I just sat back and passively observed the goings-on of the summer.

There was a philosophical theory that I had long been interested in, that I think I first encountered in a science fiction story I read when I was young. Although I was originally fascinated with it in a conceptual and academic sort of way, solipsism took on a terrible new importance to me that summer - I didn’t believe anything was real.

Solipsism is the notion that you are the only being that exists in the Universe, and that no one else really exists, instead it is a figment of your imagination. A related concept is the idea that history never happened, that one has just this instant sprung into being with one’s lifetime of memories readymade without the events in them ever having actually occurred.

At first I found this interesting to experience. I had always found ideas like this fascinating to discuss and debate with my schoolmates, and now I would talk about it with the other patients. But I found that it was no longer an interesting concept that I held at a distance, that instead I was experiencing it, and I found that reality terrible indeed.

Also related to solipsism is the fear that everything one experiences is a hallucination, that there is some other objective reality that really is happening but which one is not experiencing. Instead one fears that one is living in a fantasy. And in fact that is not far off from what many of the most ill psychiatric patients face. The concern I had is that (despite my experience of actually being in a psychiatric hospital) I wasn’t really free to move around the ward and talk with the doctors and the other patients, but that I was actually strapped in a straightjacket in a padded cell somewhere, screaming incoherently with no idea of where I really was.

There. I told you this was creepy. Don’t say I didn’t warn you.

I once read somewhere that solipsism had been disproved. The book that claimed this didn’t provide the proof though, so I didn’t know what it was, and this bothered me tremendously. So I explained what solipsism was to my therapist and told him that I was upset to be experiencing it and asked him to prove to me that it was false. I was hoping he might give me a proof of reality in much the same way as we worked proofs in Calculus class at Caltech.

I was appalled at his response. He simply refused. He wasn’t going to give me a proof at all. He didn’t even try to argue with me that I was wrong. Now that scared me.

I had to find my own way out. But how, when I knew that I could not trust the things I heard, saw, thought or felt? When in fact my hallucinations and delusions felt much more real to me than the things that I believe now were really happening?

It took me quite a while to figure it out. I spent a lot of time thinking really hard about what to do. It was like being lost in a maze of twisty passages all alike, only where the walls were invisible and presented a barrier only to me, not to other people. There on the ward we all lived in the same place, and (for the most part) saw and experienced the same things, but I was trapped in a world I could find no escape from, that despite its invisibility was a prison as confining as Alcatraz Island.

Here is what I discovered. I’m not sure how I realized it, it must have been by accident, and as I came across it accidentally a few times the lesson began to stick. The things I felt, not with my emotions, but by touching them, by feeling them with my fingers, were convincingly real to me. I could offer no objective proof that they were any more real than the things I saw and heard, but they felt real to me. I had confidence in what I touched.

And so I would go around touching things, everything in the ward. I would suspend judgement on things that I saw or heard until I could touch them with my own hands. After a few weeks the feeling that I was just watching a movie without acting in it, and the concern that I might be the only being in the Universe subsided and the everyday world took on a concrete experience of reality that I had not felt for some time.

I wasn’t able to think my way out of my prison. Thinking was what kept me imprisoned. What saved me was that I found a chink in the wall. What saved me was not thought but feeling. The simple feeling that there was one small experience left in my world that I could trust.

For years afterwards I had the habit of dragging my fingers along walls as I would walk down halls, or rapping my knuckles on signposts as I passed them on the street. Even now the way I shop for clothes is to run my fingers over the racks in the store, searching by touch for material that feels particularly inviting. I prefer coarse, robust and warm material, rough cotton and wool, dressing in long-sleeve shirts even when it is hot out.

If left to my own devices I would (and used to) buy clothes without any regard to their appearance. If my wife didn’t help choose my clothes they would always be hopelessly mismatched. Fortunately my wife appreciates my need for tactilely appealing clothes and buys me clothes that I find pleasant to wear and that she finds pleasant to look at.

The importance of touch comes out even in my art. A friend of mine remarked once about my pencil drawing - pencil is my favorite medium - that I “have a love of texture”.

It is typical of schizoid thought that a simple but disturbing philosophical idea can overwhelm one. No wonder Nietzsche went mad! But I will explain later how studying philosophy can be comforting too. I will tell you how I found salvation in the ideas of Immanuel Kant.

Paranoia

Just because you’re paranoid it doesn’t mean they’re not out to get you.

Paranoia is the one of my schizoid symptoms that bothers me the most. While I’ve only heard voices a few times, if I weren’t taking an antipsychotic drug called Risperdal the paranoia would happen frequently. As I’m sure you could imagine, being paranoid is distressing and so I’m very careful to always take my Risperdal. Visual hallucinations happen quite a bit too (when I’m not taking my medicine anyway) but except for startling me they happen suddenly, I don’t find them as upsetting.

Paranoia is commonly thought to be the delusion that others are plotting against oneself, but it is a little more complicated than that. And you may be surprised to hear that even if one is self-aware enough to know that one is experiencing paranoia, to understand clearly that what one thinks is a delusion, it doesn’t make the delusions go away.

The paranoid are commonly thought to be deadly dangerous. While there have been cases of the paranoid attacking those they thought had it in for them, most paranoids are perfectly safe to be around and in fact are commonly found living among you in society where they lead more or less normal lives. You don’t have to be schizophrenic to be paranoid - it can arise as a neurosis, for example in response to early child abuse, and exist in a pure form without other schizoid symptoms like hallucinations.

I was interviewed in the March 30, 2000 edition of the Metro San Jose, in an article called Friends in High Places. I answered an ad seeking bipolar Silicon Valley engineers for anonymous interviews, but I told them they could feel free to use my name and even my photo. If you click the link, down towards the bottom of the page you will see me sitting on the driveway of the house I used to live in in Santa Cruz.

The article quotes me as saying “I can work effectively even when I’m wigging, even when I’m hallucinating, even when I’m severely depressed.” And by wigging, I meant that I could develop software while severely paranoid. I’ve spent a lot of productive hours at the office, laboring at my computer, while trying to avoid thinking of the fact that a Nazi armoured division was holding maneuvers in the parking lot.

The article goes on to say:

“Programming is more tolerant of eccentric activity,” Crawford says. “Even though I might have been weird, I was a good worker.”

The essence of paranoia is that one’s interpretation of events is deluded, not the perception of the events themselves. In the absence of hallucinations, everything a paranoid experiences is really happening. What the paranoid is mistaken about is why they’re happening. Even inconsequential events take on a significance that is personally threatening. This makes it hard to know what is real. Although one can test one’s sensory perceptions by, for example, asking other people, it is much harder to objectively test one’s beliefs about why something is happening, especially when you don’t feel you can trust what other people say.

For example, a stylishly dressed, attractive young woman approached me on the street one day in downtown Santa Cruz and bluntly said “it’s all been a plot”. It seems that there had been a conspiracy to rob her of her money. She explained it at some length while I listened in awestruck fascination:

She had a book checked out of the library, and meant to return it on time, but a diversion created by the conspirators delayed her. When she finally returned the book, she was assessed a fine. As evidence of the plot she cited the helicopter that flew overhead, spying on her as the left the library.

Anyone can have an unexpected delay and be charged a fine when they return a library book late. Helicopters fly over Santa Cruz all the time - I have no doubt that she really saw a helicopter. But what was special in her circumstances was why she was delayed: she did tell me what happened (I’m sorry I don’t remember) but was convinced that the delay had been caused by those who plotted against her. Many people see helicopters fly overhead; what was special for her is the reason she felt the helicopter to be there.

I don’t actually have such a hard time distinguishing most of my paranoid delusions from reality. It’s because they’re all so ridiculous - I really have spent a lot of time worried about the military coming to attack me. It’s not that I hallucinate my attackers. If I look I can see they’re not there. But when I turn away I feel their presence again. I know very well I experience paranoia and I try to tell myself it’s not real, but I’m afraid that simply knowing it’s a delusion is no comfort at all.

As I said I often feel the fear from my experiences before I have the experiences themselves. People try to tell me to ignore the paranoia but that doesn’t help - first I feel panic, and only then do I think the men with guns are out there waiting for me.

The only comfort I can find is to face my fear. If a Nazi Panzer division is tearing up my front yard, the only recourse I have is to steel my courage and go outside to look for them until I’m satisfied they’re not there (I have to search carefully - perhaps they’re hiding in the bushes). Only then does the paranoia subside.

Walking around Pasadena late in the evening I was discharged from Alhambra CPC, I came across a large white stone, about three feet across and fairly round. There were some wrinkles in its surface. It looked just like an ordinary stone, but I knew it wasn’t - it was someone waiting for me, crouching on the ground, and I feared him. It didn’t look like a real person at all - it looked like someone wearing a very clever stone-like disguise.

I stood there paralyzed for some minutes, unsure of what to do, until I summoned all the courage I could muster - and kicked the stone as hard as I could. After that, it was just a stone.

Now about the little joke with which I introduced this section. Everyone, even perfectly sane people, have challenges they struggle against. You don’t have to be paranoid to have enemies. Perfectly sane people get robbed, beaten and even murdered all the time. Probably the worst part of all about being paranoid is when the paranoid has a real enemy, and that enemy uses the paranoid’s illness against them. You might beg others for help, but the person who is trying to hurt you is easily able to convince them that your complaints are just delusions, and so your pleas fall on deaf ears.

There is a very real stigma against mental illness in our society. Stigma can kill - I once received word from the wife of a European diplomat that his doctors refused to treat his heart condition because he was manic. He died in the hospital of a very real, unimagined heart attack.

There are people who harbour a deep seated hatred for the mentally ill for the simple fact that we are different. And these people do grievous harm to those who suffer, in large part by using the symptoms we exhibit to convince others not to support our cause, to convince them that the hatred we sense from them is all in our heads.

I have been at the receiving end of some of the worst of this stigma. That is why I write web pages such as this, to promote understanding in our society so that in a hopeful future day the stigma will be gone and we can live among you as ordinary members of society.

Geometric Visions

One evening as I was walking across a parking lot at the California Institute of Technology, I looked up to see a Yin-Yang symbol in the sky stretching from horizon to horizon. Shimmers of energy radiated from Mt. Wilson to the North. I felt a deep chord resonating through my body, the vibration of the Universe penetrating deep into my bones. I was as tall as giant striding across that parking lot that evening.

At that instant I Knew. I knew my Purpose.

I had been walking to my weekly appointment with my therapist in downtown Pasadena. I hurried on to our meeting, and when I arrived I excitedly explained my revelation to her.

“Mike,” she replied, “you’re not making any sense”.

For a while after I cracked up at Caltech, and every now and then after that, I would see things like Yin-Yang symbols in the clouds. I would see other things too, like the energy waves from Mt. Wilson, which at the time was a powerful symbol for me. Sometimes the Yin-Yang symbols were animated, and would spin. The might be recursive, with smaller Yin-Yangs in each of the spots, and so on ad infinitum. I found that I could see them if I stared into the snow on a television set that wasn’t tuned to a station.

After I dropped out of Caltech, I started pursuing various artistic endeavours. I learned to draw from Betty Edwards’ Drawing on the Right Side of the Brain, and would construct crystalline latticeworks from painted wooden dowels.

I started to teach myself to play piano. I had a friend show me a few basic chords, and then I would just bang on the keyboard randomly until something that sounded like music came out. All the pieces I can play now I composed myself through improvisation - I still can’t read music. Much later in Santa Cruz I took lessons from a wonderful teacher named Velzoe Brown, and learned to play quite a bit better, but still find interpreting musical notation difficult and tedious.

And I first got into photography in a serious way that Fall at Caltech. A housemate lent me a nice SLR camera, a Canon A-1, and I would walk around campus and Pasadena taking pictures. My sense of sight was vivid in those days and I found that photography came naturally. The expensive Canon could accurately meter a 30-second night exposure, so a great deal of my photos were ghostly shots in the dark. I still enjoy night photography.

I would photograph my hallucinations too. I would try to anyway, only to be disappointed that they didn’t turn out when I got the prints back from the developer. However I can see even now where the seeds of my visions lay in the photographs. For example I would commonly see Yin-Yang symbols graphically floating in the sky, but in the photographs now I can see the hint of shapes in the clouds where one could easily imagine a real Yin-Yang.

Imagining what they see in clouds is a common game among children. But I would take it an extra step, as the shape would take on a stark reality that didn’t look like a cloud at all.

Eventually the visions in the sky went away, but for much longer I was bothered by illusions that I would see out of the corner of my eye. Lots of people catch glances of things that aren’t really there, that go away when you look straight on. But in my case they were rather more distinct than I think most people experience.

My illusions also are based on real objects. The most common (and bothersome) illusion I have is to see flashing police car lights where a real car has a luggage or ski rack. This would combine with my paranoia to give me the urge to dive into the bushes when such cars would drive by.

Risperdal is effective for me at eliminating the hallucinations. I found it very helpful in bringing me back down to Earth during my graduate school manic episode, but it is expensive and I resented taking it at the time, so I stopped for a few months. I finally decided to go back on Risperdal and take it faithfully one night while dining in a restaurant with a friend, only to be bothered by flashing blue police car lights and billowing red flames out the window to my left. Each time I turned to look, I would see only the headlights of cars driving up the street towards the restaurant.

In many ways I miss the visions. Not the squad car lights, but the many beautiful and inspiring things I saw. While living without visions is certainly more placid, it’s not nearly so interesting.

The psychologist who did my intake at Dominican Hospital in 1994 told me that in many more traditional cultures, the schizoaffective people are the shamans. If you wonder why there are no more miracles as in the Biblical days, it’s because we lock our prophets up in mental hospitals.

And my purpose? Very simple: my purpose is to unify Art and Science. In high school I had been active in the theater and the chorus, and also enjoyed literature and writing, but stopped all my artistic pursuits at Caltech because I had to study so hard. I felt the need to restore balance to my life, and I felt the need to bring that balance to Caltech itself, where I felt the lack of right-brain stimulation was damaging and depressing to both the students and the faculty.

I don’t know why that didn’t make sense to my therapist. It made perfect sense to a different therapist I saw a half a year later, just as I was about to get myself in a position to be diagnosed. I don’t think it’s such a bad thing to want to be a well-rounded person, or to want to restore balance to a society suffering from a fetishistic obsession with technology.

In the end, I don’t think it’s such a bad thing at all that I changed my major to literature.

Next: How To Deal with Mental Illness

In Part III, I will discuss what to do if you think you might be mentally ill: the importance of getting treatment as well as an accurate diagnosis, what else might be causing mental and emotional disturbances, seeking psychotherapy and how to build a livable new world for yourself.

I will explain why I am so bold as to write such things in such a public way, and finally I will cite some websites and books you can read to learn in greater depth what mental illness is and how to recover from it.

Manic depression is characterized by a cycle of one’s mood between the opposite extremes of depression and a euphoric state called mania. Schizophrenia is characterized by such disturbances in thought as visual and auditory hallucinations, delusions and paranoia. Schizoaffectives get to experience the best of both worlds, with disturbances in both thought and mood. (Mood is referred to clinically as “affect”, the clinical name for manic depression is “bipolar affective disorder”.)

People who are manic tend to make a lot of bad decisions. It is common to spend money irresponsibly, make bold sexual advances or to have affairs, quit one’s job or get fired, or drive cars recklessly.

The excitement that manic people feel can be deceptively attractive to others who are then often conned into the belief that one is doing just fine — in fact they are often quite happy to see one “doing so well”. Their enthusiasm then reinforces one’s disturbed behaviour.

I decided that I wanted to be a scientist when I was very young, and throughout my childhood and teenage years worked steadily towards that goal. That sort of early ambition is what enables students to get accepted into a competitive school like Caltech and enables them to survive it. I think the reason I was accepted there even though my high school grades weren’t as good as the other students was in part because of my hobby of grinding telescope mirrors and in part because I studied Calculus and Computer Programming at Solano Community College and U.C. Davis during the evenings and summers since I was 16.

During my first manic episode I changed my major at Caltech from Physics to Literature. (Yes, you really can get a literature degree from Caltech!)

The day I declared my new major I came across the Nobel Prize-winning Physicist Richard Feynman walking across campus and told him that I’d learned everything I wanted to know about physics and had just switched to literature. He thought this was a great idea. This after I’d spent my entire life working towards becoming a scientist.

When Did it Happen?

I have experienced various symptoms of mental illness for most of my life. Even as a young child I had depression. I had my first manic episode when I was twenty, and at first thought it was a wonderful recovery after a year of severe depression. I was diagnosed as schizoaffective when I was 21. I’m 38 now, so I have lived with the diagnosis for 17 years. I expect (and have been emphatically told by my doctors) that I’m going to have to take medication for it for the rest of my life.

I have also had disturbed sleeping patterns as long as I can remember - one reason I’m a software consultant is that I can keep irregular hours. That’s a primary reason why I went into software engineering at all when I left school - I did not think my sleeping habits would allow me to hold a real job for any length of time. Even with the flexibility most programmers have, I don’t think the hours I keep now would be tolerated by many employers.

I left Caltech when my illness got really bad at the age of 20. I eventually transferred to U.C. Santa Cruz and finally managed to get my physics degree, but it took a long time and a great deal of difficulty to graduate. I had done well in my two years at Caltech, but to complete the last two years of classes at UCSC took me eight years. I had very mixed results, with my grades depending on my mood each quarter. While I did well in some classes (I successfully petitioned for credit in Optics) I received many poor grades, and even failed a few classes.

A Poorly Understood Condition

I’ve been writing online about my illness for a number of years. In most of what I have written, I referred to my illness as manic depression, also known as bipolar depression.

But that’s not quite the right name for it. The reason I say I’m manic depressive is that very few people have any idea what schizoaffective disorder is — not even many mental health professionals. Most people have at least heard of manic depression, and many have a pretty good idea of what it is. Bipolar depression is very well known to both psychologists and psychiatrists, and can often be effectively treated.

I tried to research schizoaffective disorder online a few years ago, and also pressed my doctors for details so I could understand my condition better. The best anyone could say to me is that it is “poorly understood”. Schizoaffective disorder is one of the rarer forms of mental illness, and has not been the subject of much clinical study. To my knowledge there are no medications that are specifically meant to treat it - instead one uses a combination of the drugs used for manic depression and schizophrenia. (As I will explain later, while some might disagree with me, I feel it is also critically important to undergo psychotherapy.)

The doctors at the hospital where I was diagnosed seemed to be quite confused by the symptoms I was exhibiting. I had expected to stay only a few days, but they wanted to keep me much longer because they told me that they did not understand what was going on with me and wanted to observe me for an extended time so they could figure it out.

Although schizophrenia is a very familiar illness to any psychiatrist, my psychiatrist seemed to find it very disturbing that I was hearing voices. If I had not been hallucinating he would have been very comfortable diagnosing and treating me as bipolar. While they seemed certain of my eventual diagnosis, the impression I got from my stay at the hospital was that none of the staff had ever seen anyone with schizoaffective disorder before.

There is some controversy as to whether it is a real illness at all. Is schizoaffective disorder a distinct condition, or is it the unlucky coincidence of two different diseases? When “The Quiet Room” author Lori Schiller was diagnosed with schizoaffective disorder, her parents protested that the doctors really didn’t know what was wrong with their daughter, saying that schizoaffective disorder was just a catch-all diagnosis that the doctors used because they had no real understanding of her condition.

Probably the best argument I’ve heard that schizoaffective disorder is a distinct illness is the observation that schizoaffectives tend to do better in their lives than schizophrenics tend to do.

But that is not a very satisfying argument. I for one would like to understand my illness better and I would like those from whom I seek treatment to understand it better. That can only be possible if schizoaffective disorder were to get more attention from the clinical research community.