Putting on Pants, and Other Accomplishments of the Chronically Ill

I've been feeling pretty chronic lately. That probably only makes sense to people who live chronic lives, but I don't know how else to explain it. I've been in a depressed and anxious state for going on a month now. No matter what I do, I can't seem to quell it. I go to therapy, I take my meds, I exercise. I (try to) eat healthy (most of the time). I do yoga. I meditate, though I could admittedly do more than that. I read, I write, I color in my coloring books. I've even been... wait for it... asking for help with things to try to ease the anxiety (gasp!) And yet nothing works. I've been battling a lot of gray areas, that I don't do well with. I'm supposed to say "I generally don't prefer gray areas but I think I could improve", because one of my therapists' goals for me is to stop being so absolute and more "flexible". Which believe me, I get.  But nobody understands the nature of a mood cycler and mental health battler like a mood cycler and mental health battler. Nobody. And I know how my brain reacts to gray areas.  In addition to all of this, I have been having a CFS flare up. I don't talk about my CFS much, but as you may imagine, it leaves me ....well... chronically fatigued. And then there's the fact that I've been battling what I'm pretty sure is almost nonstop sinusitis and I can't remember the last time I didn't have a headache. I'm serious. I think I must have been in my teens or early 20s. I almost don't notice them until they flare up and turn into migraines, but they're always there making me feel a little more shitty.

What I think people who don't have an invisible illness have trouble realizing are all the things that we do daily that we have to try so hard to, when to them they come naturally. They may sound minute to you, but to us, they are not. These are all of the things that use up our "spoons", the way extensive workouts and 12 hour works days may use up yours.

• We get out of bed. I know, sounds easy enough. And it is, when depression isn't weighing on us to the point where doing so feels hopeless and worthless. When opening our eyes doesn't mean they're flooding with tears or worse, hollow with seemingly no light behind them. But even when we feel this way, we crawl out of the covers, put two feet on the floor, throw on some pants, and start our day. 

• We pretend we're not sick, at least in public. All day, every day, we smile and nod and say how "Good!" we are when people ask, because neither our colleagues or clients or anyone else we interact with during the general day wants to hear how horribly depressed and anxious we are. This isn't acceptable to most people, especially not at work or in public settings, so we put on a mask and fake it. Every damn day. 

• We run errands, cook dinner, grocery shop, walk the dog, pick the kids up from school if we have them (I don't, unfortunately), despite the fact that all of our energy was drained hours ago. Despite the fact that it feels like our feet are made of cement and that all of the blood that nourishes us has been drawn from our bodies. 

• We put others before ourselves, because we'd hope someone would do this for us. Some days we may sacrifice every last ounce of energy, of mental strength we may have left, for someone else, only to go home and collapse in tears and exhaustion, or without the ability to feel anything at all. 

• We get shit done. Not only do we push through the day despite how awful we feel, but we actually manage to be productive. 

• We battle stigma. We hear the comments people make, the put downs, the generalizations. We hear words like "bipolar", "depressed" "ADD" "OCD" thrown around carelessly.  Things like "I'm so depressed, I have nothing good to wear to the party." And we cringe, wondering if we should educate these people or just move on. 

• We openly struggle in public when our disorder overrides everything else, and nobody helps. We sit on a bench in the park, quietly crying, and not one person stops and asks if we're OK. We are openly anxious, struggling to breathe, holding our head from the dizziness, and not one person offers assistance. We try to hold it together as much as we can, even when it seems impossible, and somehow, we get through those horrible moments.

• We go to therapy, we take meds, we do whatever other techniques we know to try to feel better. We spend precious time and money on these things because we want to stop feeling so ill, even when it feels like absolutely nothing is working. 

• We think, a lot. We think how we can improve, adjust, change. We worry how we're affecting our friends and loved ones. Worried that they will desert us because we are too difficult, worthless, don't offer enough positive. We think desperately how to make things better. We try, even if you don't notice, even if it's not apparent, to do everything we're asked, every technique suggested to feel more in control over our feelings. We may say, "I can't do that" but it doesn't mean we're not trying. It means 'I keep trying and keep being unsuccessful at it. It isn't working the way you think it should."

• We make it through the day.  We go to bed, and we set our alarm because we plan to wake up tomorrow. We are still alive, and we plan to live another day. Some days, that's the best we can do.

We battle this every single day. I realize that for those who haven't battled chronic illness and mental health, it's very difficult to understand. But please, try to respect all the we do manage during a day. All of the ways in which we are fighting and trying to get better, even if we keep saying we can't. For those of us who already feel awful enough about ourselves, maybe our brain doesn't like to say, "I keep trying and failing miserably". The fact that we're continuing to want to beat our illnesses and that we plan to wake up the following day is a success.

Why I Stopped Giving a Sh*t About What People Think

I want to clarify the title here. It's not that I don't give a shit what anybody thinks. I care very much what my loved ones and my close circle of friends think. Those people who I value, who I know value me - all of me. I also value my job and respect my boss and coworkers and therefore, I care that they feel I'm doing a good job, that I'm a good employee/coworker/etc. It's that I don't give a shit what everyone thinks. There's a distinct difference.

I used to. I have had continually low self-esteem and low self confidence from the age of about 13 on.  Depression makes me feel even worse about myself. Like I'm nothing, worthless, hopeless, a failure and always will be. Anxiety tells me that even those people I'm closest to don't really like me and are just putting up with me and being nice.  I border on being an HSP (highly sensitive person) and an empath, so I feel everything, including what others feel about me. In addition to my actual internal feelings, there's the mental health stigma. There are people who think I could be better if I tried harder, looked on the bright side. There are people who don't understand that my illness is a physical illness. There are people who think those with mental health conditions are crazy, violent, should be locked up. We and are illnesses are easy scapegoats when something goes wrong.  When something tragic happens in society, nobody says "Well, you know Bob over there has a heart condition, we'd better heavily investigate him." But if he had a mental health disorder,  you can bet your life savings that they would.   I've been categorized in numerous types of situations as a "trouble maker", denied things I worked hard for and deserved, for being open and honest, for not "fitting the mold", for being different than everyone else.  I've had so many people try to drag me down, blame me, make me feel awful about myself over the years.

I say all this not for any type of pity, from myself or my reader. What I'm trying to say is this: If I cared what everyone thought about me, my illness, what I said, my actions, I'd never come out of my bedroom. I'd lie in bed in despair, my depression, anxiety, low confidence and self esteem, every time I've been stigmatized or made to feel bad about myself, all feeding on each other until I truly don't feel I deserve even life, let alone happiness, success, or anything else. I have been in that place, caring what everyone else said, physically feeling what they feel about me, and letting it pull me into a deep black hole that was barely possible to climb out of.  It is not a good place to be at all.

So I stopped giving a sh*t about what the collective everyone said.  I focus on those who I love, those closest to me, and quite frankly those who keep clothes on my back and food in my kitchen.  And even within those people, I've learned to no longer blindly care what they think. I have found my voice, some strength, some confidence and self-esteem. Not as much as I'd like to, but enough to fight for myself. Enough to not simply say "I care about what they say at all costs, and I'll do whatever it takes to make them happy." I've learned to fight for me, who I am at the core, for my morals and values and beliefs. For my illness, and all that it encompasses. I've learned to keep my head up proudly as I defend myself.

I've also learned through this process that I do not want those in my life who want me to massively change. I'm happy to work on my faults - the faults that I see as my faults, not those that others pin on me because it takes blame and responsibility off of them, or simply because it happens to not be their preference - but I will not change me at the core. Nor do I want people around me who want me to. Because what those people are ultimately telling me is, "we almost like/love you just as you are, but not quite. We'd fully like/love you if you fit into this mold that we've created for you." And I refuse to do that any more. I tried for years. It landed me once in the hospital and many times almost back in the hospital. Not because I was truly sick enough of my own accord to go. Because trying so hard to be who people wanted, caring so much what they thought about me, caused me to lose myself. And that, losing myself, not recognizing who I was when I woke up, looked in the mirror, went about my day, and the confusion that it brought, the feeling of complete loss of identity, made me sick enough to be hospitalized. And I will not go through that again just to please someone else.

And perhaps people think me selfish, or harsh, or uncaring for this. But it helps me stay as mentally healthy as possible. And while I actually barely have a selfish bone in my body (that's always been one of my downfalls, giving of myself for others to the extreme), I cannot give away my mental health to make other people happy any longer. It is, for the first time in possibly my life, a decision I feel 100 percent confident is the right one, and I am proud to live by it. 

In the Year Since I Lost My Old Dog

A year ago today, I lost my best friend, my beloved dog Cinn, who'd I'd had since she was 12 weeks old. Cinn and I had grown up together, her literally, and me through life experiences. We went through my divorce together, my engagement and un-engagement, for two years we lived as part of a family of 5 (two adults, one pre-schooler and our other dog) with a yard and everything. We went through my starting my own business, my being diagnosed with cyclothymia. We moved to Philly and then back to NJ. And then, she fell ill for several months. And just as she seemed to be rallying, she was gone, physically at least, because I know she's still with me.

In the year since, my life has changed drastically. I bought a condo in Philly. I have a new dog, Gracie, who's adorable and smart and intelligent, and 100 percent her own dog. I would never expect her, or anyone, to replace Cinn. She's a completely different dog, and I like it that way. I have been in a serious relationship for the past eight plus months. In some ways, my life with Cinn seems lifetimes ago. In others, it hurts like a fresh wound. I won't lie, I cried all morning, played "our" song on the way to work. Yes, my dog and I had a song. It's "Leaving on a Jet Plane", which I used to sing to her before I traveled each time. It makes me ball like a baby every time. I'm not going to pretend to be strong and say "Well everything happens for a reason, I have a great life now." No, losing Cinn sucked. It will always suck, even though I know she couldn't live forever. August 18th will forever be tough. And that's ok. It's ok because she was wonderful and deserves to have her own special day (days, her birthday is Nov 18th) of memorium.

Cinn taught me so much about life. She taught me that you don't need a lot to have a good one. All she needed was love from me, food, water, and an occasional walk. She taught me what it's like to have someone (dogs count as a "someone", right) offer you unconditional, undivided love. I doubt I will ever experience that again. Gracie loves me, but she's a daddy's girl. She smiles and wags her tail when she sees me. She jumps around like she's just won the lottery of dog treats when she seems him, even if he's been gone for 10 minutes. Which is great - I'm just glad she feels doubly loved, because she's a wonderful dog. Cinn taught me that you often don't have as much time as you want or need together, and that you never know when you'll lose the opportunity for that time completely.

As humans, we so often divide our love an attention between a multitude of things. Our spouses/significant others and our kids of course, but also our work, our hobbies, our friends, the rest of our family (parents, siblings, aunts, uncles, etc), our tasks and chores. How often have you spent a Monday through Friday buried by work and tasks, only to spend the weekend cleaning, running errands, and racing around? How often have you divided your attentions, your love, your efforts so thin, not realizing that the things that matter most, the people that matter most, are not getting the time and attention and effort that they deserve? How often do you assume you'll talk to or see someone later or another time, taking for granted that they'll be there?

I think this last point is the most critical. Now don't get me wrong - I know we need to work to pay bills, support our families, have fun experiences together, etc. I'm not saying we should all quit our jobs and devote ourselves 24/7 to our loved ones. Nor would I want a human that was 100 percent always focused on me and with me every minute. There are words for that kind of thing, like obsession and stalking. But I think we take people and our situations for granted. How often do we really go through our day thinking "What if this person isn't here tomorrow? What if something happens to them? What if they leave me?" (situation dependent, based on the relationship of course).

Perhaps having a chronic illness gives me a different perspective. I, along with others who struggle with chronic illness, have a lot of days with zero to few spoons. In other words, they're shitty days where we are in the worst of our illness and unable to live life as we want because we are incapacitated by our illness. So in those days where we have more spoons, when can enjoy life a bit normally, we don't want to waste them. We want to focus on our top priorities, the people we love, the things pieces of life most dear to us. We don't want to take them for granted because we know, unequivocally, that those days will not last. We know that we don't know when we'll feel this way again, and that it can change quickly, often without much warning.

I have been thinking about this a lot lately. About what we would do if pieces of our life were really on the line, if we really had to actively work on creating our life and our future as we wanted it. Because after all, we do. I've been working on organizing my life and focusing on my future - what and where I want to be, and when. In doing so, I've learned how important it is to focus on your priorities, and do the best you can with your health. And most importantly never, ever, take life or anyone in it for granted.

Cinn and I, circa 2009.

What To Do If A Friend Posts Suicidal Thoughts

We've all seen it. Those of us who battle a mental health condition on a daily basis cringe at it.  The post or tweet or whatever it is these days that goes something like this: "Oh my god, so and so showed up to this party and was wearing the same dress. It was SO embarrassing.  I just wanted to die." Personally, I want to smack this person. Not because of the old stigmatization "people with mental illness are violent", because we aren't, but because this poster, probably without even thinking, trivializes what it feels like to truly want to die. Usually, we get annoyed or scroll past or in some way don't give it much merit because my guess is that this person does not genuinely want to die.  But there are people who do want their lives to end. Not over a slightly embarrassing moment at a party but because they suffer from depression or a mood cycling disorder or numerous other mental health conditions. They actually feel that they, or those in their life, would be better off if they were no longer alive. So what do you do if a friend posts something that indicates severe depression or thoughts of suicide? Of course, everyone is different, and what helps one person may not be best for another. But here are some general guidelines:

• First and foremost, and I can't stress this enough, take it seriously and reach out. I often find a direct, personal reach out is best  - PM, direct reply, text, call.  A "like" or "favorite" doesn't count (even the new sad emoji on Facebook).  All it shows is that you saw it, but didn't care enough to actually contact them. That's honestly worse than no reply/interaction at all. 

• Don't just take their word for it once and figure you've done your duty. If someone truly is suicidal, truly wants to die, they may well not tell you. Because if they do, you'll (presumably, I hope) try to stop them in some way. And in that moment, they may not want you to. 

• That does not mean you shouldn't help them. You should always help them. Their life matters more than they realize in that moment, so you need to realize it for them. This doesn't mean push them. It means don't give up on them as a lost cause. 

• Never, ever assume "they're just saying that" or "they'll get over it" or "it'll pass". You know the saying about assuming. But in this case, assuming could be even worse - it could cost someone their life. 

• Do not figure someone else will handle it. I don't care if you met them yesterday. I don't care if they're a twitter follower who you've never met and never interacted with. If you were having a heart attack, would you want everyone to assume someone else would help you or would call 911? Depression can be just as deadly as a heart attack. 

• When you reach out, do not, under any circumstances, bully them or make them feel bad about how they feel. This is a no-brainer, right? Your friend is contemplating ending their life. Don't make them feel worse about themselves. You'd be surprised. Don't get me wrong, I think people do it with the best of intentions - saying or doing anything that they think will make their friend reconsider. But often, it has the reverse effect, or no effect at all. Some examples: 

• Do not use religion against them. Telling them that they'll go to hell does nothing but hurt them. If by any chance it stops them, they feel horrible about themselves; if it doesn't, now they have lost their lives feeling like they're soul won't be saved. Or they may not be religious, or hold your same religious beliefs, so the only effect it may have is them distancing themselves from you. 

• Do not make them feel bad for YOU. This includes things like how lonely you'll be if they leave you, or how upset you are to see them like this.  Let's get one thing straight. This is NOT about you. It is all about THEM. Yes, it will be awful for you. Yes, you may never be the same again. But they will never BE again. Period. They are so depressed that they do not want to live. It is them and only them that need to be focused on, not you. Don't make them feel like they're failing you because of their illness, like even in death they will fail you. 

• Don't threaten them. It's possible they may need to go to the hospital, or to get an emergency appointment with their therapist (if they have one). But don't use it as a threat. They're not a bunch of rowdy teenagers throwing a loud party who may quiet down if you say you're going to call the police. They are a severely depressed person whose life is at risk. Threatening them will push them further away, and they won't trust you. 

• Do not tell them you know how they feel unless you do. If you have never been horrendously depressed, or had such severe anxiety you feel you cannot function, or cycled between depression and mania to the point of feeling defeat, or gone through one of the numerous other mental health struggles with such intensity that you feel you and your loved ones would be better off if you were dead, you do not know how they feel. So don't pretend you do. This only minimizes what they're going through. Tell them instead the truth - that you cannot imagine what it's like for them, but that you are there for whatever they need. And mean it. Back it up with actions. 

• Follow up. Not for a day or two. Continue to. One post that says they're feeling better doesn't mean they're 'fine'. It means in that moment, maybe only in that moment, they aren't quite as despaired. And it may mean the opposite. Survivors of suicide often say their loved one seemed to be improving just before the suicide. They may have appeared better, but in no way were.

• Never, ever, think that someone is sharing their depression, their illness, their thoughts of suicide for attention. They are not. It is true, they may be asking for help. But they are not asking for attention. There is a world of difference. To use the heart attack analogy again, because I feel that people seem to understand these concepts better with "physical" illnesses, if your friend, or anyone, posted that they were having severe chest pains and having trouble breathing, would you think they were just looking for attention? It is the same with mental health. 

As I mentioned in the beginning, everyone is different. No two people are going to need exactly the same thing. What's most important is that you take your friend's mental health seriously. Understand that you may never understand exactly what it's like, and that it's ok to admit that. Be there for them, as often and as long as they need. The recovery from severe depression or a suicide attempt is a long road with many ups and downs along the way. Those who suffer, who have have experienced suicidal thoughts, who have attempted, are always at risk because there is no cure for depression or mood cycling. Be prepared to support them and be there for them in the long haul. Never give up on them. It's when they are giving up on themselves that they need you most.