Precision in the art of asking for help

One of the things I am absolutely bad at is asking for help.  My life has often gone flaming down around my ears before it occurs to me to let other people know that I’m having trouble.  I’ve therefore spent a lot of time trying to puzzle out the art of seeking assistance, using intellect when the intuition is digging its heels in with full force.  It’s one of those irritating things about mental illness that never really goes away–a lot of my energy is spent working against myself, dodging or moving the barriers inside my own head before I ever encounter external resistance.

The hardest and most essential thing for me to do was get help with my mental illness, because while I knew that how I was feeling was somehow “wrong”, I didn’t have much experience feeling any other way and didn’t know how to articulate what was going on.  As a teenager I spent years circling the issue with my family doctor, a brisk woman who, while not uncaring, was also no-nonsense.  The whole time I was in high school, appointments with her went like this:

Doctor: Any concerns?
Me: I feel bad all the time.
Doctor: How so?
Me: I just feel like crap and I never want to do anything
Doctor: Do you exercise at all?
Me: Not really, I feel too tired.
Doctor: Exercise every other day, get sunshine, and make sure you’re eating enough fruits and vegetables. That’ll make you feel better.
Me: …’Kay?

Having received what seemed like the limit of aid she was willing to extend me  I’d go back home, too fatigued and apathetic to get off the couch, until it was time for another checkup and another lecture about exercise, sunshine, and nutrition.  My problems may have been exacerbated by acting like a couch potato, but being a couch potato was not my root problem; my root problem was that I was living with unmedicated depression and ADHD.   But I didn’t learn to phrase myself in a way my doctor understood until I was nearly finished my bachelor’s degree in psychology, because I didn’t know what information she was looking for.

I used to think that the details were boring and irrelevant to medical professionals, but as it turns out, a few information-laden sentences are as precious gold and silver to a good doctor.  This is partly because mental symptoms are totally subjective, so when one person says “sad”, they might mean “kind of bummed out”, and another means “utterly hopeless and lost.”

1. What am I thinking/feeling?

Am I sad?  Worried?  Scared?  Numb?  Confused?  Absentminded?  (A lot of my clients come in and only talk about feeling “good”, “bad”, or “stressed”.  Everyone means something different with those words.  It’s important for me to find out what those actually mean.)

Do I think, “Boy, I’m a doof” or “I am a worthless piece of shit”?  Do I think, “Oh, now I won’t get asked to the dance”, or “No one will ever love me again?”  Magnitude counts.  I will repeat these lines, verbatim, when reporting my symptoms.

2.  When am I thinking/feeling it?

In what situations do I notice these feelings?  Am I sitting in front of my favourite cake with all my friends singing “Happy Birthday” and feeling totally empty and alone?  Does seeing that the vending machine has sold out of salt and vinegar chips reduce me to tears?  If I fumble the change when getting it out of my purse, am I suddenly convinced that the clerk thinks I’m awful?  These days, my emotions are a lot more “proportionate” or “normal”, and I report that too: “I got really upset and cried for half an hour when I had a fight with my friend, but I don’t think that’s a symptom of anything but the fight.”

3.  How does that manifest in my behaviour?

This one is really hard for me.  I actually have a journal tag (“disability:river in egypt”) which I use to retroactively label the entries where I discuss a problem that is clearly (but not to me at the time) the symptom of an underlying problem.  So sometimes I get friends and family to help me with this, because they can say, “Hon, you’ve been dragging around the place looking like your dog just died for months now.”

It’s especially hard with anxiety, because symptoms of anxiety for me are all the things I don’t do.  When I’m anxious, I don’t return calls or emails, I don’t go to the bank, I don’t start projects, I don’t leave the house, and I try really hard not to remember all the things I’m not doing.  It takes some searching to realize “I haven’t started research on my paper because I lost a library book last year and I’m afraid if I ask a librarian for help they’ll… know.” is also a symptom.

But if you just want to tick your way down a list, general categories for this are:  Sleep; diet; exercise; energy levels; social life; work/school; hobbies.

So for example, this is me when I’m depressed:  I sleep a lot, sleep past my alarm, have trouble getting out of bed, and always feel sleepy or tired; I’m only hungry for really sweet or salty foods and eat a lot of junk; forcing myself to exercise is nearly impossible; I feel too tired and crappy to do anything, and am simultaneously agitated and seek stimulation, usually by playing clicky games on my computer; I skip out on parties, cancel coffee dates, and stop going to group social events; I procrastinate from schoolwork, fall behind on my papers, and miss class; I sometimes start sewing or knitting projects, but lack the will to work on them for more than 20 minutes at a time or finish them when it’s tedious.

4.  How long has this been happening and how often does this happen?

Numbers can be glorious.  The first time my doctor took my depression really seriously was when I said, “I didn’t get out of bed and skipped my 11am class all three days I had it this week.”  It’s like I was suddenly talking a language she understood.

This means you can say, “Once or twice a month, I get so anxious it feels like I’m going to have a heart attack,” or “The last day I didn’t think about what a worthless person I am was in 1998.”   Or, you know, more complicated things:  “Most of the time I’m okay, but a couple times a week…”  “Whenever we visit friends.”  “Ever since the car accident in April.”

Conclusion

This all does rely, sadly, on having a sense of what is or isn’t “normal”.  (I used to be kind of incredulous at the thought that the vast majority of the population did not feel sad and worried all the time.  I couldn’t imagine what it would be like to live like that.)  But if you get a sense of what’s bugging you, you can clearly articulate it in terms that the doctor can easily parse.  Many doctors are busy people, who haven’t scheduled a whole hour to gently pry apart the meaning of “I feel bad”.

So what a younger me might have said to my doctor was:  “I feel sad all the time and really worthless.  I have to force myself to do schoolwork, even when I really love it.  My homework is always late.  I feel so tired and crappy I don’t even go out and ride the horses or hang out with my friends; I sit alone most days at lunch by choice.  When I went to a dance last week I spent the whole time standing against the wall thinking, ‘This is useless, no one will ever love me.’  I’ve felt this way for years.  The last time I remember not feeling this way, I was six.”

And, spoiler:

I don’t feel that way anymore.

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Talking about racism in therapy

The course I hated most in grad school was taught by a professor who said, “If your clients talk about the outside circumstances that keep them down and make their lives horrible, about how they’re so hard done by, they can’t ever take responsibility for their own lives.”  It was supposed to be a course on marriage and family therapy, which is a topic I love a lot on its own; but most of what I learned was about the use of institutional power, from a rich moderate liberal white guy who thought that talking about inequality of any kind was actively harmful to therapy.

I try to remember him even now because he was respected in his field and by his colleagues.  He’d run programs in schools and military bases, taught therapists-to-be, received all the marks of approval from his profession, and thought that if a therapist let their client talk about experiencing racism or sexism, they were sabotaging the therapy.  I try to remember him because I have to remember that when I meet a new client, that client has no outside indicators that I’m not exactly like him. Continue reading Talking about racism in therapy

Guest post: The woman who heard God

And I’m back to the blog after another hiatus. Real life can stop sucking at any time now. Back, with the second guest post from med school! This is the story I asked ladystardust19 if I could repost in the first place, because I think it’s a beautiful example of cultural competency in mental health practice.

A lot of people assume these days that if they hear someone is “Christian”, they know what that entails. That they have a reasonable idea of what practices the religion involves. However, Christianity is not a single monolithic religion—I know I’m blaspheming against ecumenism here, but I’m not sure if I’d call it a single religion at all anymore, so much as a spectrum of many religions with a shared set of core texts, from a practical standpoint if not a theological one.  Christianity is so diverse these days that two Christians who have both been immersed in their faith for decades can meet and scarcely recognize each other’s lived experiences. If you want to be culturally competent where religion comes, you cannot assume that “Christian” is the free square on your bingo card. You have to your research.

There’s a lot more I could say about why it’s important for us to be culturally competent around Christianity—whether about the domination of social services in many areas by Christian groups, Christian thought’s effects on psychological theories and practices, or Christianity’s messy struggle to combine religion and childrearing, and its aftermath. At some point, I probably will. But today, let’s go on to the story. Continue reading Guest post: The woman who heard God

Guest post: Killing Stalin

Since my last post, I have been absolutely snowed under with work; last week, I pulled double the number of usual full-time shifts at my job. My free time has largely been devoted to cuddling the crap out of the new cat I adopted from a shelter in July, and neglecting this blog. Good for me! Bad for you!

In light of this, I’ve solicited some guest content from a friend of mine. If you’ve been reading the comments, you may have seen ladystardust19 chime in with tales from her own work. She and I met in the nerdy teenage girl regions of the internet lo these many years ago; now she attends medical school in the US with an eye to rural general practice when she graduates. This is the first of two guest posts she’s written for the Book of Jubilation. Continue reading Guest post: Killing Stalin

Anatomy of a Scar

So a while back I mentioned offhand that, due to my occasional tendency to blurt things out thoughtlessly, I self-sequester from Nice Guys™.  (If you’re like, “Why does this chick hate decent men?” go read that link.  I don’t.  I’m referring to a specific social phenomenon.)  This is not because I dislike and despise Nice Guys™.  It’s actually based out of empathy and compassion because I don’t know how to keep from hurting them right now.  I see a guy self-loathingly talk about how girls never choose him even after all he does for them, and I’m like, “Me = Bull.  You = China shop.  Me = LEAVING before I break you.”

It’s because I used to be one.  (As a girl.  A Nice Girl™.  Gender socialization makes Nice Guydom different than Nice Girldom in many ways, but they both share a common emotional core.  For the purposes of this post I’m reviving the archaic custom of having the masculine pronoun encompass both male and female perspectives of Niceness, unless a specific example is female.) As a Nice Girl, I trailed in the wake of the people I liked.  I gave gifts, attention, and energy, desperately hoping they would love me back.  I never said a word until far too late.  And then when I was turned down, I was devastated.

I used to be one, but then I dedicated myself to years of beating back the darkness in my soul.  Over the course of this quest I have learned secrets of Nice Guyism that no Nice Guy can hear without pain  They are a very potent medicine; they can cure, but it is not a kind cure or an easy one.  They stripped me down to my very darkest place and left me there for a long time.

Continue reading Anatomy of a Scar

Field report

Being a counsellor with no clients sucks.  I’ve been working at the foster home for five months now, making sandwiches and sitting through meltdowns for little more than minimum wage.  It’s wearying and dispiriting and making me question my decision to live in this beautiful city, which I love, and which is positively oversaturated with mental health professionals.  I even had one afternoon where I was positively convinced I wanted to move home to my rural, frozen, politically conservative city of origin, which unfortunately has rather more job openings (and better licensing laws).  It passed, but still: it happened.

I miss being a therapist.  I miss not worrying every two weeks about whether my bank account will go into overdraft.  I miss being able to go home at the end of eight hours and pet my cat.

(Cat is a separate-but-related concern.  My beloved cat died in March, at fifteen years old.  I decided not to get another cat until I knew I could afford it and whatever veterinary expenses it might incur, since not being able to afford treatment for a sick pet is a special hell with which I’ve become well acquainted.  Time has gone on, my money situation hasn’t gotten better, and two weeks ago I bought myself a teddy bear because I so desperately needed something to cuddle and I couldn’t keep telling myself a cat would happen “soon”.)

I keep forgetting that it’s July, the height of summer, despite how taxing the heat is.  It feels like some harder, drier season.

So it’s times like this I revisit my favourite stories, the ones about people who do the right and necessary thing despite the cost.  I watch Call the Midwife and Oranges and Sunshine (which magnify heartbreak between them, as the stories echo back and forth), and Short Term 12 and Citizen X.  I try to find something deeper to draw from.

I go back to the poem I discovered in undergraduate, when I chafed at years of classes and no meaningful work to do, and try to drink my fill again when I have work, but it’s not my own.

To Be of Use
by Marge Piercy

The people I love the best
jump into work head first
without dallying in the shallows
and swim off with sure strokes almost out of sight.
They seem to become natives of that element,
the black sleek heads of seals
bouncing like half submerged balls.

I love people who harness themselves, an ox to a heavy cart,
who pull like water buffalo, with massive patience,
who strain in the mud and the muck to move things forward,
who do what has to be done, again and again.

I want to be with people who submerge
in the task, who go into the fields to harvest
and work in a row and pass the bags along,
who stand in the line and haul in their places,
who are not parlor generals and field deserters
but move in a common rhythm
when the food must come in or the fire be put out.

The work of the world is common as mud.
Botched, it smears the hands, crumbles to dust.
But the thing worth doing well done
has a shape that satisfies, clean and evident.
Greek amphoras for wine or oil,
Hopi vases that held corn, are put in museums
but you know they were made to be used.
The pitcher cries for water to carry
and a person for work that is real.

I try to burn on, and shine on, and go on; and not to go out.

It’s all in the perspective

Talking with a friend on being pressured to “make peace” with her hugely toxic parents, I found myself saying something I want to remember for future use.

You ARE making peace with them. The kind of peace that comes from having a border fenced with barbed wire and patrolled by armed peacekeeping troops from a neutral third party.

For some of us, “making peace” means coming together into emotional closeness.  For others, it means a lifelong process of negotiating an end to the hostilities.

(In other news, I’ll be at one foster home or another for 72 hours straight this week, and then I have a six-hour training on nonviolent conflict intervention, which is like the martial art of the helping professions because the goal is to cause the least amount of harm possible.  I’m considering laying in a stock of meat pies and chocolate chip cookie dough for myself when I get off work on Thursday, because that level of stress and exaustion demands easy-to-procure carbs.)