Category Archives: Mental Health Monday

Mental Health Monday: Thin Skin

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I feel the concept of having “thin skin” is on the border of metaphor and simile.

I’ve been running a lot lately (not metaphorically, very actually) and the skin on the back of my ankles/heels is legitimately thin at present. Any time anything at all touches them — a sock, the sheets, my other foot — it hurts like crazy and even bandaids and copious amounts of neosporin (the kind with pain relief) isn’t helping. The only things that seems to help is toughing it out until the nerve endings go numb and from there, I’m good until I stop moving again.

Perhaps not an ideal strategy, but as with metaphorical thin skin, we can’t always (in fact, usually can’t) just stop whatever we’re doing for a good cry. Such is life.

This past week was like the for me, all over. Not just my heels. I just felt so raw and every little thing stung. Words in emails and off-the-cuff remarks, whether intended to be sharp or not, felt painful. And I struggled mightily to get through a couple of those days. Admittedly, in the dark before bed, at least one did end in tears. I couldn’t help them from coming.

By Thursday evening, I wasn’t sure I could handle one more (perceived) insult, and when Friday morning rolled around, only the promise of a weekend in eight hours got me out of bed. By 11:00 am, I was in the thick of self-pity when my weekly meeting with a close colleague came around.

It had been a stressful week, with work and otherwise, and I shared that with Tammy. In response, she shared with me the wisdom of another mutual friend. She said that long ago, when she said something similar, this friend would, without sympathy, look at her and ask, “And where exactly are you in your cycle?”

BINGO.

I had to laugh at myself then. I was feeling especially raw, but in reality, this past week wasn’t actually different than any other.

Sometimes I fall into this myth of mental health that if I’m doing ok, then everything should always feel ok. That true mental health is 100% happy 100% of the time.

If only!!

Some weeks will be up and some weeks will be down. Sometimes I will feel raw and sometimes I will feel invincible. Good mental health, perhaps, is being able to feel both the ups and the downs and knowing that it’s all temporary. No one feeling lasts forever, nor does it exist in isolation.

In fact, in the absence of any down, would any up really feel as good? And to be able to feel sadness, grief, hurt and pain, only makes us human.

Diagnosis: human? I’ll take that.

Mental Health Monday: Dangerous Neighborhoods

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A few weeks ago, an email went out to everyone in my building at work with an important warning.

SUBJECT: Bear Near McMillian and Oak

MESSAGE: We were just informed that there is a bear near the corner of McMillian and Oak.  Please refrain from walking near that area today as the city ordinance is trying to capture the bear and potential cubs.

 

Right. Avoid the corner with the bears, a block from our building. I smiled to myself — how is this my life? How did I end up in a corner of the world in which Betsy DeVos might actually have a point?

I didn’t feel unsafe, just avoided the area for a few days… limited my runs to the other side of McMillian.

Until a few days later when the Marshfield Police Department made an important announcement on Facebook.

The 1500 block of N Hume Ave… in the field about a block from our house. Runs re-routed once again. No letting Curls out alone after dark. Empty pizza boxes left in the garage until garbage day. Again, I did not feel particularly unsafe.

 

It’s interesting, though, that a real live bear, a hungry, just-woken-up-from-hibernation-only-to-find-its-not-really-Spring-yet-in-Wisconsin bear, really did not concern me. Bears are kind of a fact of life around here. And waking up hungry in early Spring is what bears do. It’s not terribly hard to avoid being its food. Avoid the general vicinity, don’t fill your outdoor bird feeders or garbage cans with tasty treats, and you’ll be fine.

It’s so simple… when it’s a real live bear.

But when it’s metaphorical? When the beast lives only in your mind? Then what? Then it seems far less simple.

 

The work email, the Facebook post, they  reminded me of a walk with my aunt through a seedy area of Minneapolis back in October of 2015, shortly after I miscarried and she arranged a weekend getaway for us, saved my life.

We ventured out on foot from our lofty Airbnb in search of good food, unique shops, and a place to get a pedicure. We walked and walked and walked, ending up in a place that didn’t feel quite right. A dangerous neighborhood, perhaps. We certainly didn’t belong. We walked quickly, eyes straight ahead, and took a left into a safer neighborhood as quickly as possible.

We did stop for a pedicure, best described as unforgettable, right on the border between the two neighborhoods, safe and unsafe… and then walked on, leaving the dangerous space behind us in favor of Mexican food and more wine in the loft apartment. At some point along the way, maybe on the walk, perhaps over the wine, my aunt shared with me her own experiences with dangerous neighborhoods — dangerous neighborhoods of the mind.

I loved the metaphor. It was instantly familiar. Dark streets that suck you in, horrific thoughts lurking in shadowed doorways. Roads that lead to dead ends, that feel inescapable. Twists and turns in which a person can lose their way, lose their self.

How often have I ended up in a dark space like that? Unable to stop the thoughts, to prevent further escalation, to prevent the snowball from growing as it rolls down a very steep hill.

The mind as a city with unique neighborhoods, characterized by the nature of our thoughts. Yes.

 

I often spend time meandering carelessly through my mind, failing to use past experiences and mental maps to avoid the dangerous areas. I find myself in those places over and over again, let them suck me in, and get lost. Self-pity, body negativity, grief, jealousy — if I don’t turn back immediately, it can take a long while to get back to safety.

While I’ve always found comfort in metaphor, perhaps this would be a good time to find solution in reality. The neighborhoods in my mind, after all, can’t be all that different from the city of Marshfield. An unpredictable bear wandering the town on occasion — easily avoided, all things considered.

I can heed the warnings, the sightings of potential danger. I can keep the garbage inside until it’s safe to take it out, to get rid of it once and for all. And, if it’s not a bear, something more vaguely unsettling, I can call my aunt and ask her to walk beside me until I’m in a safe space again. A pedicure and bottle of wine to relax on the other side.

Mental Health Monday: The BEDO.

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As a military-naive civilian, I’m generally opposed to the concept of carpet bombing. Too much potential for collateral damage. Though I suppose that’s the point — to throw everything you’ve got at the problem, unintended consequences be damned.

Again, generally speaking, I’d prefer a more targeted solution. Something focused on the problem at hand and, most importantly, guaranteed to work. But not every problem can be solved that way. In fact, many can’t. And I’m growing a bit fonder of carpet bombing as the best solution to one particularly big problem.

 

I’ve struggled with binge eating disorder (BED) for a very, very long time. Some years are better than others, but one thing is for certain: the older I get the worse it gets. Worse and worse and worse. Every period of binge eating so much more difficult to squelch than the last. When I spoke recently of wanting to give up, accepting that this is who I am, it was the binge eating in particular that I meant. I have fought for so long — 20 years at least. Probably closer to 25. I have tried a million different solutions. Books, diets, courses, websites, psychotherapy, psychiatric care. And I’m tired.

I told Celeste, my lovely Celeste, so at my last appointment. That I was done. That I was giving up.

She told me no. One more solution… one single thing left to try: medication.

Celeste and I have gone round and round about the idea of medication for several years. Incompatibility of the medication with a potential pregnancy has always been a concern though, and I wasn’t willing to put the brakes on that for any amount of time to give meds a shot.

So a few years later — pregnancy’s a no-go and the binge eating is at full force, so we’re doing it. I’m going to try the medication.

 

When I think back on all the years of wishing for a magic bullet, a quick cure, it’s remarkable to think how reluctant I’ve been to try what may very well be just that. However, in the interim, I’ve learned a whole lot about the treatment of substance use disorders (substance abuse, addiction) and, in particular, a lot about the concept of medication assisted treatment (MAT). What I’ve learned has been exceptionally pertinent to the way I think about medication for myself in the context of BED now.

MAT itself is somewhat controversial, for a number of reasons not worth discussing here… but what the group I work with has essentially settled on as a guiding principle is that MAT is somewhat of a misnomer as it implies that medication alone can solve what is a very complex problem. We prefer the idea of TAM — treatment assisted with medication. In the case of addiction, it’s using medication to beat back the cravings to such a point that the mind can get to a place capable of recovery. And what that entails, in addition to taking the medication carefully and as prescribed, is a LOT of work, a lot of different kinds of work, and a desperate hope that some bit of that work sticks. Carpet bombing.

 

Perhaps my situation is not so different. I don’t mean to suggest that BED is on par with or the same as addiction in the traditional sense (although arguments can be made for crossover of elements of BED with elements of substance use disorders as well as obsessive compulsive disorder), but perhaps the treatment paradigm ought to be similar. I don’t want to hang all my hopes on medication and forget about the rest of it. I feel so close to giving up, so tired of trying, if this is to be it — it needs to be it. All in.

Since Celeste wrote my prescription, I’ve spent a lot of time thinking about (and researching) what it would mean for me to be all in. Outcomes for BED treatment are variable and relatively poor — so what to choose? Medication is now on the table, but what else? What else is there that I haven’t tried? The answer, as far as I can tell, is nothing… at least on its own.

So: carpet bombing.

I’m pulling out all the stops and trying it all at once, hoping against hope that something… anything… sticks. My medication finally arrived at noon today and I took my first dose at 12:01, right on time. I’ve ordered an UpToDate-recommended cognitive behavioral therapy (CBT) workbook that I’ll use in conjunction with my routine psychotherapy appointments. And I joined a healthy lifestyles coaching program to focus on the intensive behavioral therapy (IBT) principles espoused by the US Preventive Services Task Force…

The Binge Eating Disorder Offensive (BEDO).

If you drop enough bombs, you’re bound to hit something.

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If you’re new around here… or just don’t remember clearly every word I’ve ever written (gasp!) and you’re interested in learning a little bit more about my historical battle with BED and body image, you might consider reading these:

October 17, 2013: Gratitude for a Gentle Reminder

November 5, 2013: Mind, Body, Prison

Mental Health Monday: Who cares which came first when you’re sitting on a dozen eggs?

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The age old question: which came first, the chicken or the egg?

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A cause and effect deal.

Technically speaking, it was the egg. But I’m trying to make a point — so we’re going to focus on the long time philosophical conundrum for the sake of today’s discussion.

 

I struggle with a lot of different mental health concerns. Perfectionism came first and came early. I was young when my parents started a daily routine — hands on shoulders, looking me in the eye, “Rachel… relax” as I stepped out the door to school.

Binge eating came next. I don’t remember my first binge, but I do remember the first time I got caught. I was maybe 9 years old and had a jar of chocolate frosting and spoon tucked away in the filing cabinet I kept in my bedroom.

Legit depression took root in high school and it’s been off and on and off an on ever since. More consistently on than off the older I get. And always a bodily focus – dissatisfaction, disgust, hate.

Anxiety became a problem only very recently — panic attacks post-miscarriage. An entirely new phenomenon, though relatively easy to tamp down in the worst moments with medication and sometimes a well-timed phone call to the just-right person.

A veritable laundry list of interwoven mental health concerns.

 

Since I started seeing a therapist in college some 15+ years ago, I’ve spent a lot of time trying to unravel the knotted mess. The perfectionism obviously led to the binge eating — but did the depression contribute as well? Or was the depression a result? And while anxiety really became a problem only in the last two years, was there always some of it there? I mean, I’m definitely an introvert and social anxiety has been a constant since I was very young — how did that factor into all of it?

The age old question.

Which came first, the chicken or the egg?

 

Round and round and round… for years on end. Exhausting. And more importantly, stupid.

Who cares whether it was the chicken or the egg that came first when you’re sitting on a dozen that can hatch at any given time — running and pecking and clucking and so on?! No one. That should be the answer. And when did I realize that? Last week… maybe this weekend. Either way, it wasn’t soon enough.

 

I struggle with an embarrassingly long list of things. (Honestly, I’ve never felt so embarrassed before talking about these things one egg at a time — the whole carton on display at once? Yikes. Please don’t hate me.) But it doesn’t really matter why. Why doesn’t help. The only thing that matters is what I do, how I deal, the actions I take for the purpose of self care and mental health in the now.

Looking for a cause and solving the root problem is a great plan if you’re dealing with a plumbing issue. Or even trying to do some evolutionary mapping (a la chicken and egg). But it seems that lately, with respect to my mental health, getting stuck in that which-came-first, why-why-why mentality really prevents me from moving forward at all. I get stuck in a place that’s not solution-based, but problem-focused, and I can’t get out. In other areas of my life, I despise that attitude — in work, in personal relationships, when dealing with my physical health. Solutions are where its at. It’s time I took the same tack with my mental health. Enough with the why, the psychoanalysis, the which came first. Freud and the chickens can suck it. I’ve got eggs to deal with by the dozens and I don’t have time for the rest.

 

Mental Health Monday: The monkey in my mind has thumbs.

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From an evolutionary perspective, monkeys are very nearly people. Our genomes know it. And so do our brains.

For as long as I’ve been crazy (always), I’ve thought of what the Buddhists and Evolutionary Psychologists call the “monkey mind” as my second track.

My second track is that source of unceasing, never ending criticism; second guesses; should, would, and could haves. It doesn’t matter how concentrated I am on something else, something completely unrelated. The second track is always running.

Maybe I’m working on a manuscript about a community-based underage drinking prevention program. Yet my second track is likely stuck on some other common refrain – “you’re fat, so fat, gross and ugly and disgusting, get it under control, fat fat fat.” It’s unstoppable. Distracting. Painful. Damaging.

 

I first came across the monkey concept when I read Thank God for Evolution by the Revered Michael Dowd, a once-upon-a-time strict evangelical and biblical literalist who fought vehemently against evolutionary principles, but later came to embrace and even promote evolution as part of what he calls the Great Story. Although Dowd’s discussion of the  evolution of the human brain is somewhat simplistic and over-emphatic, he puts it into a really interesting perspective by diagramming it out using the different animals that have brains as evolved as the different sections of our own… including that monkey.

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Several years later, Dr. C explained it to me in the more zen sense — the Buddhist monkey mind being responsible for the incessant chatter many, most, probably all, of us experience. For over 5 years, Dr. C and I have worked and worked and worked on strategies to calm the monkey… quiet down the second track.

We’ve tried modifying or replacing the message. We’ve tried mindfulness practices, dissociating/separating from the chatter. We’ve tried finding and addressing the root issues (the perfectionism, weight concerns, anxiety, and so on). We’ve tried and tried and tried.

But seriously. The monkey in my mind seems to be a bit more advanced. I honestly think it might have thumbs. And it’s using those thumbs to hang on for dear life — refuses to be ejected, refuses to be quieted, refuses to leave me be.

It exhausts me and after so many years of incessant trying and failing to put the second track, the thumb-y monkey, to rest, I’ve reached a point where maybe I’ll have to accept that this is just how I am.

I said so to my psychiatric nurse practitioner a week or two ago – she tends to disagree. I suspect Dr. C will as well. And I guess that’s the best I can do for now; trust in my team of professionals. That’s got to be better than giving into the monkey, no matter how highly evolved he is.