No Stigma, No Shame, More Happiness

I saw this on Facebook and wanted to share it. As someone who both wears glasses and takes medication to keep my brain from trying to kill me, I feel it is an excellent analogy:

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The text reads:

“I wear glasses. Can I manage without glasses? Well, yes, probably. I could squint a lot, constantly move up close to anything I want to see, take the bus or a taxi if I want to go anywhere. I could just accept that I’ll never be able to see eagles flying in the sky or whales jumping out of the ocean.

But why? Why try so hard to manage life when I could just put on a pair of glasses? No one would ever suggest a near-sighted person should just work harder. No one would say ‘Maybe that’s just your normal’ to someone who needs glasses. They would say ‘Let’s go to the eye doctor and get you a prescription so you’re able to see again.’ You shouldn’t have to try so hard.”

– My doctor (paraphrased), when I expressed doubts about going back on an anti-depressant. (via webreakthenwebuild)

(via squidilydink)

This is such a good analogy because nobody thinks about it like this. If you wear glasses, you literally need constant use of a medical aid to experience the world like most people do. If it were anything besides glasses, that would be considered a disability. But needing glasses is an extremely common, visible, and accepted form of disability to the point that we don’t even consider it one, we just accept that some people need glasses and that’s perfectly normal and there’s nothing wrong with needing to rely on them.

That is how all disabilities and illnesses should be seen, and how we should look at treatment for them. You have a problem, and you need help dealing with it, and there’s nothing wrong with either of those things. That’s perfectly normal and that’s okay.

(via ninjarobotclone)

And there are a couple more lines but forgive me I don’t feel like typing them out. The important parts are quoted above.

Putting aside the issues of for-profit pharmaceutical companies, our limited understanding of how certain drugs affect the brain, abuses in the mental illness management system, and that our society is so fucked up at least a quarter of us meet the criteria for mental health diagnoses while the rest are just plain miserable …

While we work on fixing that stuff: some of us need medication (and/or therapy) to function, just like some of us need glasses to see, and that’s okay. There should be no stigma associated with it, no shame in engaging in treatment, etc. When I finally get around to acquiring my next pair of glasses, I look forward to picking out frames I like and feel confident wearing. Similarly, it feels really good to own the work I’m doing in therapy and the medications I take: to be honest and unapologetic about what I need to not only live but (dare I say it?) thrive. It’s part of who I am, similar to how my glasses are part of my style (or look, hehe).

Of course I’m fortunate in that I have access to the care I need and communities where talking about one’s therapist, medication, and/or mental health is … if not normal, at least accepted. It’s understood that we’re all people and we all have our issues, we all struggle sometimes and we all need support. That shouldn’t be a matter of me being fortunate, though, it should be normal – like how acceptance of people wearing glasses is normal now, where once wearing glasses was stigmatized.

Learn more about being stigma free, and take the pledge.

Solidarity.

The Power of Music and Metaphor

I had one of my most intense and effective sessions ever with Wakana last week. She supported me by alternating between A Major and A minor chords on the piano, adjusting her style & chords to complement the emotions I was expressing. I sang, nonverbal melodies at first and words as they came to me – statements and images and raw expressions of anger, grief, triumph… She sang too, reflecting and supporting and occasionally making suggestions. It was very intense; we peeled back most of my defenses as I became more and more relaxed.

It’s one thing to know, cognitively, that one’s self-judgment is the result of early, most likely pre-verbal, experiences of being judged and found lacking. Of not having one’s emotional needs meet sufficiently, and so on. It’s relatively easy (now, after studying psychology for over a decade) for me to connect my current emotional difficulties and insecurities to past experiences. (And yet I’m still surprised how often certain ones come up in therapy.) I’ve built this narrative about my life that organizes the chaos, giving it purpose and meaning; I can reflect on it and pat myself on the back for all the things I’ve overcome.

Yet, time and time again, Wakana tells me the same thing: “You’re too hard on yourself.” She asks what it is I dislike so much about myself. And other than this nonverbal sense of being Wrong, I can’t really answer her. Not in straightforward prose, anyway.

It’s another thing entirely to go through the process of seeking the cause of my self-judgment as it exists deep within my psyche, much as one might search a room for an item one has lost. Several years ago I moved into the other apartment in my mom’s 2-family house; she had been using its closet and cabinets for storage but was happy to have me move back in with her. As Banji helped me clean and re-organize, we identified items that were not mine. Then we moved the items to a space where Mom could sort through them without entering my apartment. We called the items “someone else’s problem,” which made it easier to remove them from my space.

I felt like I was doing that again as I searched for what could possibly be so “wrong” about me. What did I find? The Single Thing I most want to change about myself is this feeling like there’s something inherently wrong with me, which makes me depressed and anxious and keeps me from fully living my life. It keeps me from loving myself. I judge myself for judging myself for judging myself.

… Or so I thought during the session last week. The judgment is definitely what I want and need to change, but I’m still judging something about myself… Perhaps something that doesn’t need to change after all. As I wrote and re-read the above, I realized that I judge myself for having intense emotions – especially when they come up at inconvenient times. The sadness, grief, anger, fear, anxiety, etc. take over my body all too often, usually at times when my “rational side” considers them to be utterly inappropriate.

Today I tried to acknowledge and accept how I was feeling without judging or fighting it. I felt anxious while getting ready to leave the house and considered taking the medication my nurse practitioner prescribed, but decided instead to accept that I felt anxious and continue getting ready. I felt tears welling up in my eyes during conversations and let them flow, inwardly acknowledging why they were there while continuing to share my ideas and experiences.

The problem isn’t my emotions. The problem is that it is risky to allow one’s emotions to show in most social situations. It’s that I have been judged and punished from a young age whenever I expressed strong emotions – especially if my doing so inconvenienced the adults in my life. It’s that, until recently, I haven’t had the support and tools I need to express and manage my emotions in healthy ways, instead of suppressing them.

My emotions are inextricable parts of me that serve vital functions, even if they’re often not what I want or (think I) need at the time. The judgment isn’t mine. It belongs to cultural norms that should be obsolete and caregivers who internalized those norms. As humans we both create and adapt to our environment (society)… and we have an uncanny knack for creating unhealthy environments for ourselves and our children. Self-judgement and internalized stigma are two related ways in which we adapt to some of the most toxic elements in our environment.

(I feel the need to include that not everything in Western society is toxic; some aspects are actually quite awesome. Also, just as we create our environment, we can change it for the better.)

The thing is, it’s one thing to know that cognitively, to think it and talk about it with other people. It’s something else entirely to, as in the movie Inception, delve deep into one’s own mind and find something that was placed there by someone else. Wakana helped me do that last week; now I’m looking for the “someone else’s problem” box.

How Social Anxiety Fuels My Depression

I haven’t just been “out of sorts” the past couple of weeks. I’ve been moderately depressed. Tired, sad, unfocused; I spent an entire day watching The Legend of Korra on KissCartoon because I couldn’t get myself to do anything else (and I wanted to know what would happen next; it’s a great story). I’ve also been isolating, having self-harm urges, and occasionally thinking I don’t deserve to live. The abusive voice is back; when he’s feeling kind he just tells me I’m worthless.

I feel like I’m right back where I started: feeling depressed and overwhelmed by the prospect of applying for internships. (And jobs, but if I have to choose between a job and a music therapy internship, I’ll pick the internship. It’s the last major obstacle to starting my career.) There’s nothing else for me to do, nowhere else to run, no excuses. But everything feels wrong. I haven’t been practicing my instruments, it’s been over 4 years since I last worked with real clients, and I don’t have appropriate attire for an interview. I know there are relatively easy ways to fix at least two of those issues, but I’m finding it hard to get myself to do even something as simple as stepping outside for a few minutes to enjoy the sunshine.

It doesn’t help that I’ve been fighting with my health insurance since mid-June. This is a huge trigger for me; I feel like they’re threatening my very existence. We were a couple days late re-applying for our program, so there was actually a temporary lapse in coverage while our information was being processed. Fox was taking half his dosage to make his medication last for as long as possible while we waited to regain our benefits; that made it harder for him to cope with stress and he came home from work even more exhausted than usual. When we finally got our letter confirming eligibility, I rushed to the pharmacy to refill his prescription – only to discover that our HMO wouldn’t resume prescription benefits until August 1st. I didn’t know we could have our medication paid for directly by our state’s program, and I didn’t have his card with me anyway. I got ridiculously angry, started yelling, and had to use all my willpower not to become violent.

The eligibility letter was followed closely by a letter requesting proof of my citizenship and identity. I was furious – for two reasons. First of all, they required Fox to certify my identity and used the term “child” on the form; I found this exceptionally insulting because I’m the one who’s been doing everything to get and keep health insurance for us both. More importantly, the only reason I could think of why they would have trouble confirming my identity (but not Fox’s) is because I changed my last name when we got married. I updated Social Security and got a new driver’s license over a year ago, but for some reason they couldn’t make the connection themselves. It really wasn’t much of an inconvenience to send them copies of my certificates and IDs, but I felt threatened by it anyway. I was born here, I’ve lived here my whole life, we clearly marked that I am Fox’s spouse, and it’s a long-standing tradition for one partner to take the other’s last name when a couple gets married. They should have no trouble connecting my current name to my pre-marriage identity, it should be a normal part of their procedure.

I did nothing wrong, why should anyone question my right to be here?

That’s my problem: I question my right to be here. Bullying; physical and emotional abuse; living in a world that doesn’t want to admit non-binary pansexual people exist; having a body that is hyper-sexualized, censored, stigmatized, and discriminated against; persistent invasive media promoting impossible beauty standards… It’s hard to avoid internalizing messages that I don’t have a right to be here – or, at least, that if I want to exist I must do everything both inside and outside my power to conform. I feel like simply existing day to day (and being honest about who I am) is a radical act of defiance.

Radical acts of defiance take a lot of energy.

I’m tired.

This latest return of my depression – especially so soon after I thought I’d overcome it – proves to me that I must do something to directly address my anxiety. No matter how well I feel in terms of the depression, as soon as I try to start doing things again, my anxiety fairs up. It’s so bad I can’t do anything, so I don’t do anything; the depression sets in again.

It isn’t part of my official diagnosis (yet), but I’m pretty sure I have social anxiety disorder – which is described as “extreme fear of being scrutinized and judged by others in social or performance situations.” It explains most of my functional difficulties that lead to some of my worst depressive symptoms, particularly being late for class and the couple of times I’ve chosen not to show up for job interviews. Even just going for a walk outside is difficult: I don’t want to be seen by anyone because I expect them to judge me harshly.

Fortunately, I have an appointment with my prescriber on Tuesday. She has offered to refer me for individual therapy – I think within the clinic where I meet with her. I can will ask her to refer me to someone who specializes in cognitive-behavioral therapy (CBT) for social anxiety disorder. (CBT is more effective than medication for treating social anxiety.) Hopefully I’ll be able to start with that person right away and gain the confidence I need to finally move forward with my life.

A New Normal?

According to the current clinical depression screening tool on MoodNetwork.org, I am not depressed. I was so surprised by this result when I first got it, I answered all the questions again to make sure I hadn’t lied on any of them: Sad most of the time, check. Trouble falling asleep and waking early, check. Feeling tired, check. All these other questions… no, my appetite hasn’t changed, I’m actually more motivated and active than usual, and I DON’T FEEL WORTHLESS!!! (or suicidal). I feel… okay.

a checkmark in a green circle next to the words, "You are not depressed."

screenshot of my result from the depression screening: a checkmark in a green circle next to the words, “You are not depressed.”

I’ve been re-taking the screening for the past few days now, and I keep getting the same result. I’m not depressed. I’m not depressed. I’m not depressed. I’M NOT DEPRESSED!!!

Oh my GOD!!!

I know, I know, it’s just an online screening. It’s not a substitute for a mental health professional’s evaluation. Well, I met with two mental health professionals this week. My prescriber told me, “It seems like your antidote to feeling sad is keeping busy.” She agreed with my decision to stay at my current dose of lamotrigine (50 mg 2x/day) because I don’t want to try to medicate away my feelings. Wakana congratulated me, said that clearly the therapy and medication are working, and told me I’ve been making good progress.

I am not depressed. Part of me wants to scream “I’m cured!!!” – but I think that might be a little bit premature. (or complete bullshit.) I’m… better. I’m okay.

I’m standing at the edge of a cliff with a brand new glider on my back, watching everyone else glide around, and wondering, “Is this thing really safe?”

Wakana said, “baby steps.” She used the metaphor of easing oneself slowly into a pool – which I find ironic because to me that’s torture. I’d rather just jump in, get the “it’s cold!” shock over with all at once, and start swimming oh my god swimming it’s the best thing ever!!! I want to go right now! But, umm, I don’t have a pool. So, yeah, this isn’t swimming it’s life. Baby steps. (I have friends who have a pool, and they’ve invited me to come swim in the past. I should ask them if the offer still stands.)

I guess I’m taking baby steps. I’m (literally) taking thousands of steps (that is, walking) on the days when I meet with her… and I want to take more on the days when I don’t. I’ve been having great conversations with loved ones, including Mom. Composing, making art for the fun of it, spoiling our pet rats… being intimate with Fox…  (I love having my sex drive back – and it takes some… navigating…) In the next few weeks I plan to acquire clothes I feel good about wearing, start practicing music instruments regularly, declutter, meet with my adviser about internship possibilities, and start applying for internships and part-time jobs. I had to re-write this paragraph to sound positive and not “being hard on myself” for the things I “should” be doing; now I’m worried about trying to do too much and burning out before I even get started! But at least I can re-write it.

In the past, times when I’ve temporarily clawed my way out of the bottomless pit that is being clinically depressed have been the best days of my life. For example, my wedding: at that time I was still using the Burns Depression Checklist to keep track of my symptoms; on my wedding day my score was 6. That’s “normal but unhappy” (granted, only 1 point off from “no depression”). The best I ever felt – EVER – the best days of my life were what most people would (ostensibly) consider “unhappy.”

These are not the best days of my life. I’m tired. I’m sad. I’m achy. I miss my friends, especially Banji. Last night I had a nightmare (in which my husband died). I’m going to go crazy (and spend way too much time playing The Sims 3) if I don’t find some way to structure my time (besides playing The Sims 3). For a while I was starting blog posts, then deleting them. … I think you get the idea.

Today I scored a 10 on the Burns Depression Checklist, which is the highest score in the “normal but unhappy” range. (a score of 11 would indicate mild depression.) I think I answered honestly, despite the temptation to lower my score to fit with the previous assertion that “I’m not depressed.” It seems accurate to say that I’m unhappy.

But something’s changed. Like someone lifted a blanket off me and I can see the sun and feel the breeze and stand up tall and breathe. I feel more confident. Hopeful. Maybe… even… whole?

The End of the Semester (and other boundaries)

I’m very happy to report that I got a B on my Piano Improvisation final. More importantly, I worked very hard to master the skills I needed, went into the final feeling confident, and felt good about what I’d accomplished. That class was the most difficult music therapy course I’ve ever taken; it’s in the top 5 most difficult courses I’ve taken in my lifetime. Now I’m done with it (including the paper)! I gained a lot of useful techniques and insights, and the inspirations for my two compositions-in-progress. I call that a win!

On Wednesday, I confronted Wakana about her growing tendency to either not be fully present with me, or to interact with me in ways I’d expect of a friend or a parent, during our sessions. I told her, “I’m your client and I’m here so let’s work; I like you and would love to be friends with you, but you’re my therapist.” She apologized and explained that she’s been trying to do too much; now that it’s the end of the semester she can be a better therapist to me (she teaches at a different university from the one I attend). It took us a while to find an appropriate focus for the rest of the session, but with her support and guidance I was able to do some good work:

I’d been feeling guilty about needing to ask for an “incomplete” in Group Music Therapy (I still haven’t finished that paper). Talking to Wakana helped me realize why: I was projecting my childhood relationship with my parents onto the instructor of that course, who is also my academic adviser (and a generally awesome person). I’ve known him for almost six years(!), taken several courses taught by him, been honest with him about my mood disorder, crushed on, admired, and respected him. I’ll admit, I tend to subconsciously(?) blur the boundaries necessary to maintain an appropriate, professional, student-teacher relationship with him; I want us to have a more personal relationship. (I think I’ve managed to keep that from slipping noticeably into our real-life interactions…)

Anyway, the point is, I felt like I needed to be a model student to help him feel good – kind of like how, as a child, I felt like I needed to be a straight-A student to keep my family from falling apart. Handing in my paper before the end of the semester was “the least I could do” to “repay” him for being so supportive all these years.

Then I realized that (I’m an adult now and) my instructor/adviser/mentor’s self-esteem is his business. Also, it’s his job to work with students to help us succeed in school – including being supportive in times of difficulty. Asking for the “incomplete” was the most appropriate, responsible thing for me to do: I clearly communicated my intent to complete the paper, as well as my inability to do so before he was required to submit grades for the course. That’s where my interpersonal responsibility ends. I have an academic responsibility to complete and submit the paper as soon as possible. This responsibility is ultimately to myself: I need to complete the paper so I can earn credit for the course so I can be one step closer to graduating and beginning my career of choice.

Wednesday was also the last meeting of my Group Music Therapy class. I role-played clients for my classmates’ skill demonstrations, then did my own despite feeling anxious. I was able to ground myself, be present in the moment with my “clients,” tune in to what they were feeling, and adapt my intervention to meet their needs.

At one point during verbal processing I felt uncomfortable and wanted to stop. The instructor asked what I noticed going on in the group at that time. I said, “I feel tense and I don’t know what to say.” He replied, “that’s a great intervention! Sometimes, the best thing you can do is just be honest about your uncertainty.” After receiving some additional feedback and suggestions, I asked, “Can I try that now?” That was a huge change for me; in the past I would make mental notes of suggestions with the intention of “using them later,” not applying them to my current situation.

We re-entered the role play and I used my “great intervention.” The “clients” started talking about how they were feeling and expressing dissatisfaction with the music we’d been creating. I remembered what we’d discussed in class about giving the group room to find its own solutions and asked, “What can we do to make it sound better?” Some more discussion led to a “client” explaining that she was rocking back and forth because she was nervous; I asked “What does that nervousness sound like?” She played rapid, intense 8th notes on her drum; after giving her some time to play I invited the group to play with her. This intervention used the suggestion to bring our verbal discussion back into the music; it also incorporated what I’d learned from research for my paper: drumming the same rhythms causes people to move the same way, thus feeling the same sensations. This improves empathy and feelings of group cohesiveness – my main goal.

The next thing I knew, the whole group was playing loudly together. The tension had dissipated. I was so focused on the group, I completely forgot there were people observing us… until the instructor said, “We need to end the role-play.” If I could change one thing, I would have been less concerned with following the plan I’d had for the demonstration and more in tune with what was going on – in other words, better able to just sit back and feel good about what I had accomplished.

More positive feedback and useful suggestions, an opportunity to let my inner child dance around with a shaker – I mean, “role play” for one last classmate – and I was done. I had dreaded this class, but I stuck with it and grew so much from it. The end was bittersweet. I’ll miss spending time with my classmates and especially my small group… and I’m very proud of what I accomplished! I look forward to putting what I’ve learned into practice.

Since then, I’ve been taking some time to feel good about the end of the semester, relax, and compose. I love being able to focus on something I find intrinsically rewarding, not having to worry about deadlines or grades. Fox and I have been spending quality time with each other and our pet rats; it’s really satisfying to feel like we’ve created a family together. I’m happy and optimistic about the future.

… except that early this morning, after Fox’s alarm had gone off, I had a nightmare:

It’s the middle of the night. I’m cleaning the liners for the rats’ cage in a large plastic bin full of water. The rats are in the bin. At first the water is shallow enough for them to stand in it comfortably, but suddenly it is far over their heads.

I’m aware of them, but focused on my work. Periodically I notice that they’re staying under the water; one of them seems to be struggling and the other hasn’t been moving much. Finally, I catch the one that has been struggling and pull him out of the water. He clings to me, dripping and terrified. I worry that, since it still gets cold at night, he might get sick.

Then I remember that the other rat is underwater and not moving. I pull him out, but too late – his body is cold. I feel between his arms/front legs but there is no heartbeat. I try to do CPR (yes, on a rat!) but it’s actually one of the rat stuffed animals Fox got me before we adopted our current pets; the mouth is embroidered onto fabric. I’m aware of this, too, but I try anyway.

After struggling for some indeterminate amount of time, I realize the painful truth: I drowned my rats, and I was only able to save one of them. The other is dead, gone forever. His brother might not live long, and the time he does have will be very lonely…

I woke, devastated, then dragged myself out of bed in hopes that seeing my real, live rats would help me feel better. One was resting – clearly alive – and the other was standing near the door, climbing the wall of the cage, sniffing toward me, and otherwise being adorable in an attempt to attract my attention treats. That cheered me up, but I still can’t shake the guilt from the nightmare.

After reassuring myself that the rats were okay, I saw that Fox was still asleep. I helped him wake up just in time to avoid being late for work! I’m trying to convince myself that’s why I had the nightmare: my unconscious needed something that would force me to wake up enough to help my husband. But somehow I don’t think it’s that.

The vet gave the rats a clean bill of health, but they seem to cough (or hiccup?) and sneeze fairly frequently. Last night their cage was overdue for a cleaning; we replaced their litter, wiped everything down, and today I put the liners (sans rats) in the washing machine. But still. We suck at keeping our space clean, so there’s dust that can affect their lungs; trying to get Fox to help me clean – including their cage – is like pulling teeth. (Getting myself to clean is also like pulling teeth…) I feel like it’s completely on me to keep them healthy – including being vigilant for signs that they might be getting sick. If rats do get sick, their condition can deteriorate rapidly.

Mom’s also been putting pressure on me… in a variety of areas, but particularly regarding the decision of whether to go to my cousin’s wedding. If it were within a couple hours’ drive we would go, but it’s not – and the airfare for 3 people is ridiculous. It’s an 11-hour drive without traffic and/or rest stops. We have to factor in gas, tolls, multiple nights in different hotels, food, Fox taking time off from work, and who’s going to care for the rats? They need human contact and supervised playtime outside the cage at least once per day. My cousin and her immediate family are the only people we’ll know at the wedding (or in the area), and we have no idea whether we’ll get to spend any time with them besides the event itself. It seems unlikely we’ll even have the opportunity to sight-see, use the hotels’ amenities, or otherwise make a vacation out of it.

Fox left the decision in my hands. The three of us talked about it, I thought about it, and I decided that, given the circumstances, the only reason why I’d go to my cousin’s wedding is because she came to mine, so I want to reciprocate. Honestly, I think a better way to reciprocate would be to send her a particularly useful gift. I told Mom my decision and it seems we all assumed that if I’m not going, then she isn’t either.

She seemed happy to be free from the stress of figuring out travel logistics, but expressed concern about how this will affect her friendship with my cousin’s grandmother. (She said she “might” be going.) We conspired for a while to come up with an explanation she thinks her friend – and, likely, their larger group of friends – will find acceptable. Finally, she said she would think about it and asked us to give her until Monday to decide.

Now I’m hoping she’s not going to try to force me to change my mind because she’s that concerned about what her friends – not my cousin whose wedding it is – will think of her. I’m trying to relieve myself of being responsible for my mother’s emotions. I don’t need to be responsible for her relationships, too.

What it all comes down to is: things are going well for me. I’m happy with my life. I just took a huge step toward completing my master’s degree. I’ve been focusing on what’s important, working hard, emphasizing the positive, and asserting myself. I love asserting myself; it feels wonderful to just say what I want or need! Most of the time, people seem willing to help; if they don’t want to – or can’t – they just say so and I can focus on other possibilities. It’s so freeing!

But it all feels so fragile; one wrong move and my whole life will shatter and I’ll be too depressed to get out of bed (or worse). I just want to know things will be okay, and that it’s not entirely on me to keep them from falling apart. Is that so much to ask?

Transgender Tuesday: Links and Spoons

Last week I shared some of the uncertainty I’ve been feeling about my transgender, non-binary gender identity. I’ve read a couple of articles since then that I think everyone should read. They’ve helped me feel more confident that I am what I say I am, regardless of how others treat me or what they might want me to do.

I’ve experienced some harmful effects of the 10 Myths About Non-Binary People It’s Time to Unlearn, especially the myth that we don’t exist. People have taken my gender less seriously or come up with their own explanations of it under the false belief (#2) that I’m “just” confused: for me it’s not so much confusion as that gender is complicated and I’m still working things out; even if I were confused that doesn’t justify disrespect.

Mom hits me with #3 “You are a new concept” and #7 “Your pronouns are ridiculous” all the effin time. She’d try and convince me that her generation is completely incapable of learning new things or adapting to new social realities. That seems highly unlikely to me, considering how much has changed in the past 60 years. The last time she told me using my pronouns is difficult, I told her I understand and just need her to try. Things seemed to be going well… until much later when she made a scathing remark about me spending money on therapy. (You know, the thing that’s slowly freeing me from generations of emotional neglect and abuse.) She’s since apologized but… It’s a process. I just keep telling myself it’s a process.

Sam Dylan Finch’s piece, 8 Things Non-Binary People Need to Know, was exactly what I needed to read; I could swear he wrote it in response to my post from last week! I wanted to quote and/or expand on specific parts that I can relate to strongly, really needed to hear, or find particularly meaningful… but if I did that I’d end up re-posting the whole thing!

I think it’s important that he included #4 “Don’t be afraid to ask for help.” Mental health is a very important issue for everyone and especially non-binary people. Talking to Wakana about my gender identity can be difficult (and frustrating) but I think, in time, it will help me benefit so much more from therapy.

Speaking of mental health, I’m learning to have much better respect for and adapt to my need to budget emotional energy, or spoons. I’ve been feeling very anxious about my piano midterm on Thursday (2 days! AAAAHHHH!!!). I have plans to meet with a classmate today and practice interventions, I have to pick Mom up from the airport this evening, and there are the 2 LGBTQ+ groups I’ve been meaning to join… Long before I went to bed last night, I was already feeling the all-too-familiar dread.

This morning I realized it’s going to be a very busy day and I probably shouldn’t try to do everything I had planned. I practiced some self management: I wrote down everything I have planned for today and prioritized. The meeting with my classmate and picking Mom up have to happen. I should try to catch my instructor during office hours and practice piano some more tonight.

The LGBTQ+ groups are technically optional. I was feeling very anxious about the one I haven’t been to at all yet because it’s brand new and it would be the first thing in my day. In the past I’ve found myself unable to get ready on time for such things, getting extremely stressed out, and not going after all. I just can’t afford to drop that many spoons. So, today, I decided to skip the stress and anxiety and wait to join that new group next week, when (hopefully) I’ll have less important and emotionally-charged things to worry about.

I really hate having to make that decision, especially since it interferes with my goals of being part of the LGBTQ+ community, getting support, and practicing being part of a group. But today it’s the best decision for me. I can use the anger it generates as energy to help myself get through this busy day.

The second group meets at a much better time for me and I feel more comfortable going to it. I’ve already had awkward one-on-one meetings with the facilitator; if there are other people there, it will probably be much better. Knowing that’s a possibility – I’m still free to make the choice that’s best for me when the time comes – feels good.

Healer, Heal Thyself

I came up with a music therapy intervention that not only meets the criteria for at least one part of my piano improvisation midterm, but is also useful for me in my everyday life! I was playing an ostinato (repeated musical pattern) in Mixolydian and kept thinking: “this wants to be a movement intervention, but it’s so tranquil.” I kept imagining myself slowly raising my arms above my head and inhaling, then lowering them and exhaling – like one might do as part of a warm-up for yoga.

Everything I’ve been learning about improvisation, psychotherapy, music therapy, and improvisation points to the same essential guideline: Work with what the client is giving you. My mind was giving me a movement, so I decided to go with it. I played the ostinato in my left hand, used my right arm to do the movement, and sang instructions with the melody that felt most natural. I added turning to one side, back to the center, to the other side, and then back to the center again.

Then I changed up my playing and added my right hand. Initially the music (including my vocal melody) had been very flowy and tranquil, “holding.” I changed it to be more like playing a drum, with shorter sharper notes and pauses between chords, “driving.” It also became slightly faster.

I sang instructions to step side to side and clap, similar to what one might expect in step aerobics. There is an option to increase the tempo (speed), depending on the client’s response and how much time there is for repetition (I need to keep it short for the midterm). I suppose other directions, such as forward and back, and possibly even turning one’s body as one steps, can be added.

After a short time, I returned to the original “holding” music (including vocal melody). I sang instructions to turn to one side and then the other first, then ended with the instructions to raise and lower arms. This gives the exercise a nice symmetry and is intended to help the client remain calm and focused. The whole thing takes about 2 minutes.

Music therapy students are encouraged to be specific regarding which clients would benefit from an intervention, what needs it addresses, and how it meets those needs. It didn’t take me long at all to realize that a simple movement activity like this would be very helpful for me: an able-bodied individual with anxiety and depression, who can follow verbal directions and typically lacks the energy and motivation to exercise.

Everyone (including scientific research) says that physical activity is a highly effective “treatment” for depression, possibly the most effective. I’ve experienced its benefits firsthand, when my symptoms have been mild enough to allow me to do it. The problem is, an intervention doesn’t work if it’s inaccessible to the client (for example, I’d need to modify my instructions – or even come up with a whole new activity – for someone who uses a wheelchair). So, even if exercise could cure depression it doesn’t, because the symptoms of depression prevent exercise.

Which is where my intervention comes in. I could totally see Wakana doing something like this, particularly on a day when my energy and motivation are so low I ask to meet via Skype. I can hear her voice saying, “Stand up, we’re going to do something about this;” I can feel myself groaning as I drag myself out of my chair and scowl at her – annoyed, but secretly hoping that whatever she “makes” me do will provide some relief.

It starts out holding, comforting, with very simple movements that don’t take a lot of energy and can feel good as soon as I start doing them. It’s meeting me where I am: in need of emotional support. The amount of movement, energy, and coordination required increases gradually. When used as a live intervention, the therapist can adjust the level of challenge to meet what the client is capable of at that time. It can be recorded and used by the client (e.g. me) as a daily movement activity that is a million times easier than going to the gym, taking a walk, or even playing Wii Fit. Hopefully it will provide enough energy to encourage additional exercise.

Physical movement aside, I believe listening to the musical intervals (the specific sound created by playing two particular notes simultaneously or consecutively) in my intervention can be intrinsically healing. The Anthroposophical Concept of Intervals describes them in terms of 1) inner or outer focus, 2) movement or stillness, and 3) balance or tension. I find that my musical self-expression, especially when my symptoms are at their worst, tends to involve mostly intervals that are associated with inner focus and tension. There is definitely a place for these elements – in life and in music – but sometimes we need a break from them!

When I was creating this intervention I intentionally chose intervals that are associated with 1) both inner and outer balance as well as 2) active movement outward. Whether I move my physical body or not, use of these intervals reassures me that I am safe and I can direct my energy outward. In other words, these intervals directly contradict the distortion at the core of my mental illness. They free me to be the healthy Self I always am.

All that, in two minutes! I love music therapy.

Progress

Last night’s class was great! Whereas in the past I’ve been terrified to show imperfection and extremely critical of myself, last night I was eager to receive feedback. I was uncomfortable about the class watching last week’s video of me acting as therapist in my small group, but the instructor pointed out something I’d facilitated without being aware of it. This element had been very effective in supporting the goals for the group: free expression and interaction among members.

Then we broke up into groups for hands-on experience, with the task of dealing with “problem group members.” The instructor recommended lyric analysis; for once(!) I immediately knew which song I wanted to use. Another group member was a bit better prepared and group consensus seemed to be for her to go first, so she did. I’m kind of wishing I’d gone first because the instructor came in while she was leading and gave a lot of useful feedback. The whole thing got video recorded, which meant (unbeknownst to us) that there was not enough memory left on the device to record a second mini-session. (Spoiler: So there’s no video of me leading.)

I left plenty of room for one of the other group members to go next, but there was an awkward silence as we all looked at each other. So, I volunteered. Perhaps I could have been a bit more direct about my desire to take a turn leading, but that’s working against an entire childhood, much of my adolescence, and even some of my (young) adulthood spent learning to step back and “give the other kids a chance.” (Including teachers refusing to call on me unless I tricked them into thinking I wasn’t paying attention.) I may have taken it to a bit of an unhealthy extreme, but I’m working to correct that…

I felt so good to go because I wanted to go, not because I had to. I felt ready. I presented the song in the way I felt comfortable with and that left me free to focus on connecting with the group members as we sang. I facilitated a verbal discussion that helped one of the group members come to her own conclusions that were supportive of her therapeutic goals, despite initial rejection of the primary imagery in the song. I tried several strategies to engage a silent group member without losing the ones who were participating. Even though she was quite successful in remaining disengaged, I felt good about the creativity I’d employed and eager to keep working. She later told me that it had been very difficult for her to resist engaging with the group, and that the only way she’d managed was by diligently avoiding eye contact with everyone.

Best of all, I felt accepted by and connected with my small group-mates, and comfortable in the class as a whole. I feel like I’m back on track and more alive than ever!

Reframing

many picture frames of different shapes and sizes, painted a variety of colors, standing up and leaning against each other. from magpieweekend.com

many picture frames of different shapes and sizes, painted a variety of colors, standing up and leaning against each other.
image credit: Becca at magpieweekend.com

Lately I’ve found myself reframing stressful experiences by highlighting the positive aspects, seeing them as learning experiences, or considering the new opportunities they provide. A prime example of this occurred while I was walking to class last Wednesday, feeling absolutely horrible about myself for being late. I thought about how I felt (almost suicidal), what had triggered it (fear that I would never belong in a group), how I would have responded in the past (stayed home, possibly hurt myself), and how I was behaving at the time (going to class!).

I wasn’t exactly in the best frame of mind to think positive thoughts about myself, but I imagined the instructor saying, “Wow, you were feeling that insecure and you still came to class? That shows a lot of dedication! This must be very important to you.” In other words, I imagined someone else saying something positive about me – the thoughts were my own and they contained positive self-talk, even though I couldn’t express and experience it directly as such. That’s… actually quite healthy.

Since then I’ve taken some time to put the whole incident in perspective. There were a lot of factors that made doing my schoolwork and showing up on time for class on Wednesday very difficult for me. I’d spent most of the weekend decluttering, a task that – while necessary and healing – I found very stressful. Fox had offered to join me in continuing that task on Monday, but instead we ended up shoveling snow. I stayed up all night in preparation for a daytime sleep study on Tuesday… during which I did not sleep. Lack of sleep alone probably would have been enough to undermine my ability to function on Wednesday, and I was already painfully aware of the 17th anniversary of my father‘s death on Thursday. I believe it may have predisposed me to cognitive distortions like only viewing the negative aspects of things, generalizing, and catastrophizing.

As much as I’d like to be functional at this time of year, it seems most adaptive to accept that I will need to take “mental health” days on and around February 5th – and to plan accordingly. At the very least, I need to do my best to avoid making extra appointments around this time, especially since I never know how the weather might impact my plans. It’s not a weakness, it’s making an informed decision and engaging in self-care.

Considering everything that was going on, I handled myself quite well on Wednesday. I actually got up, got dressed, and tried to go to class. I traveled all the way to the classroom door before my anxiety got the best of me. The class has a strict attendance policy, so I’d be lying if I said I wasn’t concerned about the consequences. But all I did was miss one class. That’s a very minor mess up in the grander scheme of things.

More importantly, when I got home I wrote a blog post about my thoughts and feelings. I expressed what was going on instead of allowing it to consume me; this kept me safe until Fox came home, hugged, and comforted me. Even though I couldn’t reach out to anyone directly, the public post let Banji know what was going on. She reached out to me and we had an awesome, healing conversation. The written record has also made it easier for me to talk about and reflect upon what happened. This blog is an awesome resource that I’ve created for myself and that you, my readers, have helped maintain as a safe space. Thank you.

The imagined conversation in my most recent post is a reframing of my Wednesday class as an opportunity for growth and healing. This is a big deal for me. Yalom (the author of our primary textbook) recommends understanding mental illnesses in terms of how they affect our relationships – both with other individuals and our ability to function within groups. He instructs (group) therapists to treat these difficulties, for they are the true pathologies clients face. In this class, not only do I have to function in a group where the expectation is that we’re all “normal” (to be honest, I have a hunch that at least 20% of us have mental illnesses – probably more considering we’re all studying to be therapists)… but I’m also studying myself as the “other” as I read and listen to class discussions about people with mental illnesses, “their” problems, and how to treat “them.” It’s all about what I need and often feel I can’t have, what I simultaneously strive for and run away from.

This class is the embodiment of my psychopathology, including (especially!) the internalized stigma. I’ve already had to drop it once; on Wednesday I thought that history would repeat itself. But in reality I have a choice, and that choice is mine alone. I can decide I’m not ready to face it so directly; far from “another failure,” this option opens all sorts of opportunities to me. I could focus more on activism, composing, write a book, find a job, volunteer, hang out at Fox’s workplace all day, read every book in the library … there are too many possibilities. I spend my life playing Skyrim because I’m overwhelmed by all the possibilities. But they’re there! And each one comes with its own challenges. Each one will probably cause me similar problems, all linked back to some aspect of my psychopathology. Each one holds some potential for personal growth.

Or I can keep going to class on Wednesdays and be in that group, whatever that means. I’m increasingly convinced that it needs to include coming out as having mental illness, even if the conditions are not ideal. I could be so vague as to say “I have a mood disorder” or explain that “I live with depression, anxiety, and occasional hypomanic symptoms.” I’m leaning toward the latter because it paints a more interesting, complex, and accurate picture.

I really hope that whatever I say will encourage the other students in that class who have mental health issues to speak up, because there’s no way I’m the only one. One of the readings for this week (by Yalom) was all about how the therapist needs the courage and confidence to be human in the therapy group – fallible, affected by group members, and in the process of learning about zirself through zir experiences in the group. Part of being human is having mental health issues – by Yalom’s definition, difficulty relating with others and functioning in groups, and even doing things that aren’t necessarily healthy in an attempt to be accepted by a group. Group therapy is therapeutic because it provides a safe place to stop doing those unhealthy things and try out new ways of being with individuals and groups – a space that is created and maintained first and foremost by the therapist. How can we create such a space for our clients, if we can’t do it for ourselves?

Before I can do it for my (future) clients, I need to do it for myself. I’m already a member of a group of student therapists who are learning to do group therapy and (probably) feel just as uncomfortable as I do. As much as I want to claim that I’m coming out to help and/or teach the other students in my class, what it ultimately comes down to is that I can’t struggle to pass as “sane” anymore. It hurts too much and requires too much energy. I need to be in the world and I need to be fully myself, including my mad self. Why not here and now?

Links:

Everyday Health: Cognitive Restructuring

Mind Tools: Cognitive Restructuring – with free downloadable worksheet

Sometimes the Answer Lies Within

I’ve been rehearsing the conversation I need to have with the instructor of my group therapy course, preferably before our next class. I’ve told “him” about my desire need to experience group therapy as a client, my difficulty dealing with groups, how I’m impacted by existential issues – which would make for an excellent post – even spoon theory.

In my imagination “he” patiently listened while I explained all this stuff and why I couldn’t join the class on Wednesday, even though I’d gotten dressed and traveled to campus and was standing right outside the fucking door. Then “he” took a deep breath, looked me in the eye, and said:

“This class isn’t therapy, it’s an academic class. But maybe it can provide the experience you need. Think about it: you like your small group mates – that suggests some sense of safety in that group and desire to belong to it, yes? They’re also trying new things in front of a group; it’s a common experience you can support each other through.

“Trying to be in this group – the small group and the whole class – is relatively low-risk. If you see these people again, it will be in maybe one or two more classes, or perhaps as colleagues… they’re not going to make or break your entire life. You have plenty of experience losing relationships and forging new ones. You have survived, even thrived. You’ll continue to do so regardless of what happens here.

“So take a risk. Be yourself with them. If you can also find group therapy, great, I’m sure it will help you a great deal. But don’t walk away from the group you’ve already joined. Use the resource you’re holding in your hands.”

I have no idea what the actual, separate person who is the instructor of this course – and happens to also be my academic adviser – will say when I talk to him in real life. I hope he’ll be willing to work with me to make the course a bit more accessible. But it almost doesn’t matter anymore.

What matters is that I have this voice inside me. These are my thoughts. I have this resource I can tap into whenever I need. I can see the world more complexly than my mental illness would allow.

I find it interesting that I’ve chosen my academic adviser – someone I trust and admire, but whose pedestal has been cut shorter as I’ve observed his limitations over the years – to represent this guiding voice. He’s already told me that my mental illness need not prevent me from entering this field – actually, it might make me a better therapist. He is not only a professional therapist but a trainer of professional therapists; this can’t be the first time he’s dealt with someone like me. If anyone can help me right now, I think – I hope – he can.

And if not the actual person, my internalized version of him can. That means I can. It’s I’m taking an extremely challenging experience and turning it into an opportunity for growth, and more importantly trusting that I already have what I need to get through it in one piece. I just need to trust myself – and I guess I already do.

I just need to believe that I am worth the struggle, the pain, the uncertainty. Not that life is worth living – honestly, that’s up for debate. That Imy dreams, my creativity, the ways I want to influence the world, the relationships I hold dear – that I am worth living. That I – whatever unique meaning or purpose I create for myself in this meaningless void called Earth in the 21st Century – I am worth the pain of existing every second of every day.

It doesn’t “get” better. I will make it better, or die trying.