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.
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.”
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.”
I don’t feel that way anymore.