The U.S. Preventative Services Task Force is recommending anxiety screenings for kids as talked about here: Why a US task force is recommending anxiety screening in kids 8 and older (theconversation.com). I think this is a wonderful idea. I have one hesitation which I’ll get to, but this is mostly a huge step towards acknowledging that mental health is simply health. Kids are screened for things like lice and scoliosis in school. It’s just too bad that it took this long for an official recommendation to add some mental health issues to the list.
The article says that anxiety is one of the most common disorders in children. Also, it is treatable and failure to treat it in childhood leads to many more problems as the children grow up. That makes it sound like a no brainer. Plus, early detection and treatment saves money because treatment becomes harder the longer the condition lasts. Basically, teachers, children, and caregivers would work together and use evidence-based screening tools. The screening would not result in a diagnosis but would identify kids that need to be referred to a specialist for diagnosis and treatment.
This is where my one hesitation comes in. Given our nation’s severe problems with discrimination, school funding, insurance, and wealth inequality that leads to stark differences in parental involvement, there is the risk that the screening program would be a boon to the already well off and do very little for the already marginalized. The screening by itself doesn’t amount to much if the family can’t afford treatment and it’s not covered by their insurance. So, it could widen the achievement gap if not implemented well.
That’s definitely not a reason to ignore the recommendation, though. It just means we have to be careful when we set up screening and monitor it. It has the potential to directly help so many kids. And it has the potential to help reduce the stigma around mental health. As far as I’m concerned, they can’t start screenings soon enough.
This isn’t the kind of thing I’m normally inclined to write about. I’m not a crier. I’ll cry at funerals. The occasional book will get me. But I don’t cry at movies or weddings or any of the other places where people typically cry. Especially at work. There are lots of things that I steadfastly refuse to do at work, but crying may be the biggest. Yet, I cried at work today and it seems worth talking about.
First, it makes sense to explain why I cried. If you’ve been reading my stuff lately, you know I’ve been struggling with depression for at least the last month (I say “at least” because it’s remarkably hard to pinpoint when these things actually start and stop. I suspect this really started around the new year.). That’s not exactly the immediate cause, though. Even depressed Gene isn’t prone to crying. But, thanks to the depression, I’m not sleeping well. I’m exhausted. Work is not going well. At all. Money is incredibly tight right now. I’m not able to spend enough time with my daughter. My stress levels are off the charts. And it all just caught up with me and I started crying. At work.
The thing that might make this interesting, if it is interesting (it’s probably not interesting), is why I so steadfastly refuse to cry at work (or really any public place that’s not a funeral). See, I’m a man (which sounds really weird to say for some reason) and men are not supposed to cry. Period. At least that’s what they tell me. And I’ve certainly internalized that particular lesson. It’s almost impossibly stupid that men aren’t supposed to cry. I don’t know who the they are who told me I can’t cry, either. It definitely wasn’t my parents or anyone I actually care about. But the message came through loud and clear. That’s the really frustrating thing about all of this. I know how stupid the no-crying rule is, but I still firmly believe I can’t cry.
Sadly, it’s probably too late for me. I’ll be stuck believing this nonsense for the rest of my life. I guess what I’m hoping is that by talking about it, I might make a small dent in the messaging. And if enough other people talk about it, maybe we can break through. Maybe the current crop of boys won’t grow up into men who can’t cry. It’s worth a shot, right?
Apparently, it’s Mental Health Awareness Week which happens during Mental Health Awareness Month. I must be a bad advocate. I had no idea. I found out through the morning announcements. And, get this, green is the Mental Health awareness color. At least that’s what I’m guessing since they asked us to wear green to support mental health awareness. I’ve always been a little skeptical about all these awareness weeks and months. It seems like every month is something now. That makes them all blend together, so I’m not sure how much awareness they’re creating.
Still, the worst-case scenario is that these weeks aren’t as successful as they hope to be. They certainly don’t do any harm. So, I’m writing a post to help raise awareness of Mental Health Awareness Week. We have the same goal after all. I think I have enough green to wear something green for the rest of the week. If anyone asks me, “Hey, what’s with all the green?” I can tell them all about it. Otherwise, I can try to write a couple or a few more posts.
Are you doing anything for Mental Health Awareness Week? Can you think of anything else I can do? I’m always happy to get feedback.
Given how hard it is to talk about, and write about, mental health, it seems like fiction, stories, might be the best way to get people to understand. So much of the way we talk about it is metaphorical and impressionistic after all. But I’ve noticed a dearth of good fiction that centers mental health. Actually, that’s being too harsh. The lack that I’ve found is fiction about mental health that resonates with me. The question is, why is that? Am I weird? Some kind of mental health outlier?
Part of why so little of it resonates with me might be because my particular ailment, depression, is a quiet kind of disorder. There’s just not a lot of drama in it, at least not visible drama. Authors and audiences like drama, understandably. That means they are more likely to focus on the manic kinds of illnesses.
Another reason is my teetotalling ways do make me weird. Addiction is probably one of the most common mental disorders and also the most commonly portrayed disorder in fiction. But I’ve never even had a single drink. All those substance abuse stories probably resonate with others, just not really with me.
Hemingway, surprisingly, of all the authors who write about mental illness, resonates with me the most. It’s not surprising because of the quality of his writing. He was a master craftsman. I think it’s surprising because, from what I gather, he and I couldn’t be more different as people. When he talks about mental health, though, he nails it. The Sun Also Rises is probably the most famous. But “Soldier’s Home” is just wow. The restlessness of Krebs. The way he’s desperately lonely until he’s around other people and then he wants to be by himself. I feel seen, as they say.
Mental illness does find its way into some of my fiction. It’s only explicit in one piece that I’ve published (this one), but it lurks in some of the others. This one speaks to the loneliness and isolation. This one is actually patterned after a Hemingway story, The Big Two-Hearted River. Not that anyone would see the connection, or the mental health aspects. I’ve always looked at that Hemingway story as about someone processing and trying to deal with his issues. That’s why I picked it as a model. My story features the unwarranted sense of dread and hopelessness that come with depression.
So, what did I miss? What other fiction is out there that might resonate? I want recommendations. Not that I have the attention span to read them right now, but I’ll get to them. And, out of curiosity, do any of my stories resonate with anyone. That might be another path I could take in this quest.
One of the many frustrating things about mental health issues is that it is a lot harder than it ought to be to get help. This difficulty can be thought of as hurdles that need to be jumped. Unfortunately, the hurdles appear at nearly every point in the process of seeking help. They can be broken into three categories: the confusion surrounding mental illness, the healthcare system, and the insurance system.
I don’t think the confusion needs a lot of explanation. It’s the main reason I feel compelled to write about these things. But there is one specific aspect of that confusion that is a huge barrier for people who need help. People who have never experienced a mental health condition don’t necessarily recognize what is happening to them. There are rarely cut and dry measures for mental health. It’s not like with a fever where you can check and see that your body temperature is over 100 so there’s something to be concerned about. Mental illness is usually a cluster of related symptoms. Unlike nausea or pain, it’s really hard to describe what the conditions feel like. Unfortunately, that means many people are suffering without even recognizing that they are sick.
I know before I was first diagnosed with depression, I didn’t know what was going on. I knew I didn’t feel right. I felt downright lousy. For the longest time, though, I figured I was having a bad day. Even though it was dozens of bad days in a row, it didn’t occur to me that there was more to it than that. When I finally called my doctor, all I could tell him was that, “I don’t feel like myself.” I struggled for a lot longer than I had to, all because of the confusion surrounding mental health.
That leads nicely to the next hurdle to jump, the healthcare system. When I did tell my doctor that I wasn’t feeling good, it still took a long time to get diagnosed. Mental health, psychology and psychiatry, is a specialty. Even if I had known what was happening, I can’t just call a specialist. Everything starts with either your PCP, a walk-in clinic, or the emergency room. Understandably, they all try to treat you in the best way they know how, by trying to treat your physical symptoms. I was complaining of sleep issues, changes in appetite, sluggishness, low mood and things like that. So, my PCP checked my thyroid and tested me for mono and on and on. It was only after he ruled out everything he could think of that he recommended a psychiatrist.
Now, that leads to the next hurdle, finding a psychiatrist that is accepting new patients and takes your insurance (which I’ll come back to in a bit). Mental health is the only area of healthcare I’m aware of where this happens. You don’t get a cancer diagnosis and then have to spend weeks or months searching for an oncologist willing to help. Can you even imagine that? But when a PCP decides you may have major depressive disorder, you get a bunch of phone numbers or websites and have to start making calls. It’s crazy.
A similar, but worse, thing happens with therapists. Many mental illnesses are best treated with talk therapy or a combination of medication and talk therapy. Most psychiatrists only deal with the medication, so you have to find a separate therapist. There are the same problems of finding someone taking new patients and taking your insurance, but, with a therapist, it’s also important that your therapist is the right fit. I’ve often said that finding a therapist is like dating. You go to a few sessions, decide it’s not working, try someone else for a few sessions, and keep going until you find one that works for you. It’s the “works for you” part that’s important. Just because it doesn’t work out with a therapist doesn’t mean they’re a bad therapist. Mental health is intensely personal. If you can’t open up in the right way to your therapist, there’s nothing the therapist can do for you. But it’s an exhausting, frustrating process finding that fit.
Finally, we get to insurance. What I’ve already mentioned, the fact that not all doctors accept all medical insurance is completely ridiculous. It’s amazing to me that this wasn’t a provision of the Affordable Care Act, but an insured patient should be able to seek treatment from any licensed provider in good standing. It’s more than hard enough finding a psychiatrist and therapist to have the insurance company say no when you find someone you like. And it doesn’t stop there. The insurance companies dictate treatment. I just ran into a scenario where I was prescribed 60 mg of a medication. It comes in 60 mg pills, but the insurance won’t cover the 60 mg pills. So, my doctor had to prescribe me 20 mg pills and 40 mg pills instead. It’s hard to imagine anything stupider than that. The insurance companies will also dictate how many therapy sessions you can have per year, how often prescriptions can be refilled, and things like that. And god forbid your doctor prescribes something for an off-label use.
This is just scratching the surface. When you are suffering from a mental health issue, the last thing you want is to navigate a byzantine system. I’m lucky in that I’ve found a psychiatrist and therapist that I like and both of them accept my insurance. If you are in the beginning of this process, you have my deep sympathy. And if you know anyone at the beginning of this process, please give them all the support you can.
It’s Saturday evening, around 7:30. This was the first week in a few weeks that was supposedly normal. I worked both jobs, had my kid for half the week, and had my classes. No spring break. No sick days. Just my life as it’s been for the past nine months or so. Except I’m still having trouble getting my head on straight. And right now (Do you want to know how I’m feeling right now? I probably should have started with that.) I am almost unspeakably tired. It’s not really tired, though. I couldn’t sleep if I tried. But it is exhausted. I’m almost unspeakably exhausted.
Why log in to tell you how exhausted I am? I feel compelled to. A couple weeks ago, I said I was going to talk about this. I’ve been feeling mostly useless the past few weeks, but I’ve gotten some encouraging comments as I’ve tried to articulate some mental health things, so I’ve gotta keep trying. But, again, why talk about being tired? Everyone gets tired. Basically because I don’t think everyone gets tired like this. It’s hard to explain, but I need to try.
One thing I talk about with my therapist is spoons. Neither of us know why spoons, but spoons is the common term. Imagine you start every day with a set of spoons and everything you do throughout the day costs a spoon or two. The busier you are, the more spoons you use. Most of the time, people have enough spoons to cover the whole day. But, some days are particularly busy and some days you have a smaller spoon supply. The spoons thing is a little strange, but I think that’s a concept most people can understand.
Now, lately, I’ve been waking up each morning with no spoons at all. Literally just getting out of bed costs more spoons than I have. On top of that, someone or something seems to have imposed a spoon tax on everyday activities. Things that used to cost one spoon now cost three or four. And things that used to be less than a spoon now take at least one or two. That’s probably as far as I can go with spoons.
What I’m trying to say, though, is that the easiest of daily tasks are not only difficult, they’re draining. If I brush my teeth, I need to collect myself for a few minutes before I can make my lunch which has become a full ten minute task to make a peanut butter sandwich. Any break I get during the day can’t be spent trying to catch up or get ahead. It’s spent trying to rally myself for the next seemingly impossible task. I do that for five and a half days and I’m shot for the next two at least. Then, it starts all over again and the spoon deficit is only getting worse.
It’s not just the tasks, either. Being around most other people takes so much energy it’s crazy. People require so much focus and attention. There are a few that give energy back, but those relationships are rare. So, there’s that too.
I don’t know if this gives an inkling of what I feel like right now, but I’m a few hours removed from the five and a half days. I’m going to collect as many spoons as I can over the next day and a half and see if I can muddle through next week.
One of the odd things about depression, for me at least, is the way it robs me of any kind of attention span. I’ve always had a very long attention span. Even as a little kid I would get absorbed in things and spend hours and hours on them. I can’t even count how many times I’ve watched three Star Wars movies in a row or read a whole book in one sitting. Right now, though, I can’t sit through a half-hour TV show. When I try to read, I’m lucky to get through a page or two without losing track of what’s going on. It sucks.
The worst part about it is that right now I can easily spend hours doing absolutely nothing. I’ll wake up in the middle of the night and all I can do is lie there. If I try to read or watch TV or do some work, I can’t. Frustrating barely describes it. I wonder if this is what it’s like to be a rodent.
I don’t know how long this will last. It’s one of the big reasons I just don’t feel like myself lately. We’ll see.
I use prescription medication to help treat my depression. I find medication may be the most poorly understood subtopic in the mental health conversation. On some level, that’s totally natural. Most of us don’t know enough chemistry and biology to understand even the basics of what the drugs do and how they work. We are completely reliant on doctors and trust. But that’s not really what I mean when I say they are misunderstood. In my experience, at least, most of the stigma around mental health is tied to its “medicalization” and that often centers around the medication we take.
I know I really didn’t want to take any medication when my PCP first referred me to a psychiatrist. The psychiatrist had to talk me into it. I was the patient, but the stigma was alive and well within me. I was judging myself. I felt like it was a sign of weakness. I should have been able to push through, suck it up, all that garbage. I was also worried about what the drugs would do to me. “Comfortably Numb” is a good song, but not how I want to live my life.
The psychiatrist explained to me that these are some of the most well-researched medications there are. Many of them have been on the market for 30 to 40 years. In reality, there is no difference between mental health medication and blood pressure medication. It’s just that people have a skewed perception of mental health. She explained the process to me in detail. I would start on something, and she would monitor me. It takes time for the drugs to become effective and there is always the possibility of side effects. We would then make adjustments as needed. And, this was huge for me, I’m the patient. At any time, if I didn’t like how I felt, we could make changes. I didn’t have to worry about feeling numb.
The first week to ten days were some of the strangest of my life. I was still very nervous about the treatment plan. Every thought and feeling I had made me think, “Is this me or is this the drugs?” I didn’t trust anything. And I just felt weird. Extremely, unpleasantly weird. My doctor explained that that was normal as my body adjusted to the medication. It was a slow process, but after that first ten days, not horrible. And, after a few months, we found a regimen that worked for me. My mood stabilized. I was still able to feel highs and lows. Plus, I didn’t experience any side effects. Taking medication, under a doctor’s supervision, was as successful for me as I could have hoped.
Still, I mostly kept my medication to myself. I know part of that is just standard privacy. I don’t make public announcements every time I get a prescription. But, when someone did find out, I never liked their reaction. I’m supposed to take the pills with food. So, I normally take them with a meal. There were times when I was eating with someone and when they saw me swallow a pill, they’d ask about it. When I told them, it was like an invitation to tell me some horror story of someone else’s medication. Or how we can’t trust the pharmaceutical industry. Or how natural remedies are better. I heard about how rich psychiatrists are. None of those things made me feel any better about taking my medication. And I was surprised by how passionate some of the people were about not taking mental health medication.
I guess that’s why I’m writing this. I don’t know where the anti-medication bias comes from (although one possibility is the excessive warnings attached to drug ads), but it was a big barrier to my getting better. Also, it has made me quite frequently doubt whether I really am better while I’m taking medication. I want to help lower, or even erase, that barrier for others. So, when someone tells you we can’t trust pharmaceutical companies, remember that has nothing to do with pharmaceuticals. We can’t trust any large corporations. And natural remedies are untested. And psychiatrist’s relative wealth is, at best, a non-sequitur. It’s probably an ad hominum. As for the horror stories, that’s why it’s important to work with a doctor that gives you control.
I’m not encouraging anyone to go out and demand medication. I’m just trying to say that your friends and neighbors probably don’t really know what they’re talking about. If you’re having any kind of mental health issue, talk to a trusted medical professional. Work with them until you find a treatment that works for you. It’s not easy to ignore the stigma. I couldn’t. But I’m glad I got past it. Hopefully, telling my story can help someone else get past it, too.
U2 has a song called “Stuck in a Moment”. It’s a pretty great song (this version and this version, too). I’d say it’s a top 3 U2 song. But I’m writing this because I’ve long thought that the line, “Don’t say that later will be better/Now you’re stuck in a moment/And you can’t get out of it,” was a great description of a variety of mental health issues. I know I’ve been stuck in a moment. It’s one of the most frustrating things I’ve ever experienced. You can see the rest of the world moving along, but you’re stuck. The whole vibe of the song actually captures the feeling really well.
Of course, as I’ve said many times, mental health isn’t one thing. This week, “Stuck in a Moment” has been running through my head on loop, but for a different reason. I find I’m trying to stick myself. That may not be the healthiest thing to do but let me explain. Since Sunday night, every time I start to think ahead at all, my anxiety is spiking, and I start spiraling. A thousand worst-case-scenarios come at me faster than I can reason my way out of them. So, I’m trying to avoid thoughts of the future. The healthy way to say it is I’m trying to live in the present. I’m not that healthy right now, though, so I’m trying to stick in the moment.
It’s remarkably hard. I’m an adult with work and a kid and school and such. I’ve never been a big planner. I prefer winging it whenever possible, but planning is an integral part of my life. Unfortunately, planning means thinking about the future and that doesn’t feel good right now. Hopefully this won’t last long, and I don’t get so stuck that I don’t recognize when it’s over.
Have you ever been stuck in a moment or wanted to be?
Recent research is showing that it may be possible to diagnose mental health conditions through blood tests. It’s intriguing work. One of the most frustrating parts for patients with mental health issues is the process of diagnosing the condition. It’s a lot of trial and error and it takes a long time. Like with any illness, when you don’t feel right, you want answers, and you want them quickly. Mental health has always stubbornly refused. It would be great if that were to change.
I was doubtful when I first read headlines about the blood tests. As I talked about recently, there are often no pathogens involved in mental illness. What would they be looking for in the blood? It turns out, instead of looking for infection, or the cause of an illness, they look for traces of the way your body reacts to the condition. For example, in the article linked above, they say that checking levels of BDNF, a protein, was 82% effective in diagnosing depression. There’s still a lot of work to be done, but I’ve moved from doubtful to hopeful.
It’s a bit hard to describe how great it would be to have a quick and easy diagnostic tool. When I first got my depression diagnosis, it took months. I kept going to my PCP because nothing felt right. He did test after test. It wasn’t mono or nutrient deficiency or a thyroid issue and on and on and on. He referred me to a psychologist. There were weeks of sessions and questionnaires and journaling. She did diagnose it, but then there was more time determining the severity. She then referred me to a psychiatrist, and we started medication. It took even more months to find the right combination of medications and the appropriate levels. That’s a ton of effort to put out while going through an active depressive episode.
I have no idea how good the blood tests will get. They may still have to rule out other conditions. They may still have to use trial and error for medications. But speeding up the process, even a little, would be huge. It would cut back on so much suffering. And that’s all we really want.
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