Measuring Recovery: Part 2 – More Burns Depression Checklist

I reviewed my overall daily and weekly scores on the Burns Depression Checklist in my previous post, Measuring Recovery: Part 1. I’ll be taking a look at daily scores for subcategories of the Checklist today.

Subcategories

Thoughts and Feelings

The first category consists of 10 items describing one’s subjective experience, including: “feeling unhappy or blue,” “feeling hopeless,” “criticizing yourself or blaming yourself,” and “difficulty making decisions.” Criticizing/blaming and other items related to self-perception seem to be causing me the most difficulty. On a scale from 0 to 4, I tend to rank criticizing/blaming from a 2 to 4 – moderate to extreme.

Activities and Personal Relationships

The second category consists of 7 items that describe behavior and subjective experience related to work/hobbies and social life. Although I do seem to feel worse on days when I withdraw from my social network, the items I see myself struggling the most with are “motivation” and “loss of interest in work or other activities.”

Physical Symptoms

There are 5 items related to sleep, appetite, sex, and “worrying about your health.” This is the category I seem to consistently score the highest in. Even on really good days when my thoughts, feelings, and behavior would suggest otherwise, my body seems to be depressed. I guess this is why it’s so important to exercise.

Suicidal Urges

The final category asks 3 questions: thoughts? desire? plan? Fortunately this is the category I score the lowest in – usually a 1 in thoughts and 0s in desire and plan.

My Scores

Scores for the Burns Depression Checklist are determined by ranking each item from 0 to 4, where 0 means you didn’t experience the symptom at all during the given time frame (1 day to 1 week) and 4 means it was “extreme.”

Instead of tracking each item separately, I decided to look at my scores for overall categories. To standardize the scores, I divided the total score for each category by the number of items in said category. As a result, all the scores represented on the chart/graph below are between 0 and 4.

My (standardized) scores on the subcategories of the Burns Depression Checklist from July 29, 2013 through August 24th, 2013. The gap represents 2 days when I did not complete the Checklist.

What a Mess!

Although at first glance the graph/chart above appears to be chaotic, there are a few noticeable trends.

* First, with rare exceptions, all 4 lines tend to move in the same direction. If one line is going up, the other three most likely are as well, though the angle might be different. (One or more scores may stay the same.) Same is true if they’re going down. In other words, on good days (low score) I feel better and perceive myself in a better light and am more active and have less suicidal urges than on bad days (high score).

* The blue line (thoughts and feelings) starts out with a noticeably different shape from the other 3. By the end of the 4 weeks, however, it is moving in better unison with them. The “thoughts and feelings” subcategory seems to be more internal, while the other categories relate self to body and self to outside world – if such a dichotomy is truly relevant. I’m inclined to say there was a disconnect between these two aspects of my experience that has been (at least temporarily) resolved.

Another way of looking at it is that the biggest disconnect between the blue line and the others is around August 11-14, when I was grieving the death of my undergraduate mentor. It makes sense that I would experience increased sadness, crying, even guilt during such a time, without necessarily having a comparable increase in other depression symptoms.

* Whereas near the beginning of the 4 weeks there are noticeable vertical gaps between the lines, by the end of the 4 weeks the lines tend to overlap. This is especially true of the blue line and the red line, representing thoughts/feelings and activities/personal relationships respectively. How I think and feel is very closely related to my engagement with the world; I’m not sure whether the closeness of that relationship has actually increased or I’ve just become more aware of it. (This is, after all, a self-report measure.)

The Valley and the Peak

There are 2 days in particular that I think deserve some special attention.

The first is Friday, August 16th, when we went to visit the bed & breakfast / potential wedding venue. It was a wonderful vacation; I felt energized, socially and otherwise engaged, I was active, and there was little room for self-criticism, sadness, and so on. I swam until I was completely physically exhausted – but felt amazing – and then enjoyed s’mores with my loved ones and friendly new acquaintances. Fox and I got to spend some time in a beautiful secluded outdoor area and be romantic. I felt so much more alive than I had for so long …

And yet, while I was swimming, I couldn’t help but think about drowning. For one day I was relatively free from depression, but a nagging voice remained, reminding me that all is not right in my brain. Is this a common thing, for someone who loves swimming but only does so when on vacation to think about how easy it would be to drown? I seem to remember a time when all I cared about was the feeling of the water rushing past my skin, the exhilaration as I propelled myself forward using my own energy, bursting through the surface of the water to fill my lungs with life-giving air, and the glorious feeling of weightlessness. Sure, it’s important to take safety precautions. But I always trusted myself to take them. This time I was less sure.

I should also point out that I completed my checklist for the 16th a day later, from memory. I like focusing on the positive aspects of that day, but there was some frustration and anxiety related to getting there, waiting for Fox’s parents (who hit traffic), and learning it was more expensive than we’d expected. I can’t know for sure whether or how my scores might have been different if I’d completed the checklist that night. I can say with certainty that, even with the frustration and anxiety, it was a much better day than I’ve come to consider “normal.” I woke the next morning feeling alert and refreshed – how wonderful!

The second day I want to focus on is Monday, August 19th. I’ve noticed a tendency for my symptoms to oscillate, bad days (high scores) followed by good days (low scores) and vice-versa. It makes sense that, not long after such a good day (such low scores) I was bound to have a bad one (high scores). This turned out to be the worst day since I started my self-assessment.

I don’t really want to repeat what I’ve already said about this day, so I invite anyone interested to read No Space for Me (the post I wrote that day) and the paragraphs near the fourth picture under “Context is Everything” in Measuring Recovery: Part 1.

Suffice it to say – perhaps combining with the “natural” oscillation that would have occurred anyway – my experiences that day contributed to a very dangerous mental and emotional state, which is reflected neatly in that day’s Checklist scores. My scores on Thoughts and Feelings and Activities and Social Relationships both averaged a 3 (“severe”); my senses of agency, social belonging, and satisfaction in life were shattered. I was exhausted and slept during waking hours because that was the only relief I could find from my pain (Physical Symptoms average score 2.8). Not only did I think about taking my own life, but I wanted it to end and I even began contemplating a plan (Suicidal Urges average score 2). I think my fears were what kept me from going any further with it – particularly because I would have had to make noise, which increased my chances of getting caught doing something that definitely was not allowed.

While I’d much rather never feel like that again, I’m grateful for that fear.

Especially since all 4 scores dropped pretty dramatically after that day, and have been staying in the 0-2 range (for the most part) since. I have concerns about my lifestyle, things I want to change or do differently; those kind of require me to be alive. So do my long-term goals.

And the people I love … sometimes I need space from them, sometimes they drive me batty, and yes sometimes I forget they are here … but they’re way too important to just abandon so suddenly. I can’t live for them – I’ll be miserable – but I want to live because I want to spend time with them. I want to share joy with them; to be connected to something bigger than myself. I don’t know what comes after death, but I know what can happen in life because I’ve already experienced a decent chunk of it. And yeah, there are not-so-good moments, but there are also moments that can be wonderful.

The days when I lose sight of this are the worst days, the ones when I score the worst (highest) in all 4 subcategories. I don’t know how realistic it is to try and keep believing in it, blindly, when everything I’m experiencing (through that horrible depression filter) says otherwise. But I can look at this chart/graph and see how the scores oscillate. A bad day will be followed by a good – or at least not-so-bad – day. I just need to give myself a chance to wake up to it.

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