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.

Dr. Jekyll Experiments with Whole Tones

I’m taking a course in piano improvisation for music therapy, which is both really cool and nerve-wracking. We get to go far beyond the conventions of traditional Western music, to explore musical expression more broadly. We’re simultaneously learning to appreciate the emotional effects of intervals (the specific sound created by playing two particular notes simultaneously or consecutively) and developing a working knowledge of “alternative” modes and scales. It’s nerve-wracking because one never knows when one will be called upon to do this brand-new thing in front of the entire class, and I tend to lack confidence in my piano skills.

The solution is, of course, to practice – both to improve my skills and confidence, and to play with all the new toys that are being handed to me each week! I was feeling rather bored yesterday, alone in my messy apartment without Fox to help me focus my energy. I’d already played The Sims 3 for a few hours and wanted to do something different, so I decided to improvise on piano for a while.

I practiced the whole tone scale, which does not have any half-steps and creates a very dream-like feeling. On the piano it can be played by choosing a key to start on (e.g. middle C), then skipping a key between each one you play. There are two basic whole tone scales; you can start and end on any pitch in either of them.

Whole tone scales for piano starting on C-natural and D-flat. Together they use every key within a minor 9th on the piano.

Whole tone scales for piano starting on C-natural and D-flat. Together they use every key  on the piano within a minor 9th.

I started out by just playing the scale that starts on C-natural, first in the right hand and then in the left. My right hand began to try making more creative melodies, while my left searched for some kind of accompaniment (which in my mind means playing at least two notes simultaneously, preferably with a rhythmic pattern). I made the conscious choice to avoid intervals that are considered consonant (peaceful) in Western music, prioritizing dissonance (tension) and sounds that were unfamiliar.

That led my music to become quite harsh, expressing a mix of anxiety and anger that was almost completely nonverbal. I abandoned the whole tone scale and other ways of organizing pitches (specific audible frequencies) into what is conventionally considered music, relying more and more heavily on tone clusters. There were rhythmic elements and patterns in my playing, but no real meter (a way of organizing rhythm). In other words, I was literally banging on the piano with open hands and had very little intentional control over individual fingers. As time went on, the improvisation became increasingly chaotic.

Themes emerged in the music such as a “rumbling” in the lowest register that I sometimes played with both hands, sometimes with the left hand only. The right hand would flee from this dark ominous rumbling and scramble “up” the piano into the high register, where the sequences of pitches I played were rather frantic. I had the mental image of struggling to climb a slippery rocky incline where I couldn’t find a secure grip. The abyss and/or some horrible monster waited below. At times there was a call-and-response structure to the music, in which one hand would play something (while the other hand was silent), then the other would respond with similar rhythmic patterns (while the first hand was silent).

I quickly interpreted the dark ominous rumbling to be the voice I hear when my depression symptoms are at their worst, telling me I’m worthless, alone, etc. The self-destructive urges that at best undermine my short-term goals and at worst tempt me toward suicide. My inner demon, my true mental illness, my internalization of the abuse I’ve experienced, etc. etc. etc. It has no redeeming qualities, yet I allow it to seduce me.

The right hand could only scramble so far up the keyboard before it had nowhere else to go, so it would come back down toward the rumbling, sometimes joining it. There was no rest, no slowing down and organizing, no creating intentional patterns, no stability. I think my attempt to explore beyond Western music became an excuse for avoiding it, thus depriving myself of most if not all of techniques I currently have in my repertoire for restoring stability, calm, and a sense of wholeness (which I should be using music to promote). I was “up the creek without a paddle” – because I’d intentionally left both my paddles at home.

There was a part of my mind that urged caution, reminding me that I was alone with no one to pull me out of the abyss if I needed them to. I was not with Wakana in therapy, where an exploration like this might prove useful – and could be done safely. It urged me not to go too deep, to come back, to be careful and compassionate toward myself.

But another part was fascinated. It wanted to sit back and observe and analyze everything that was happening. It assured my cautious mind that I could handle this, that it would pull me back when necessary. This is the part that’s enabling me to write about my experience like an objective researcher writing a case study. I think it’s the part of the human psyche that finds serial killers so fascinating. – and, admittedly, part of why I study psychology.

I found the whole experience so interesting, I decided to intentionally cause it to happen again so I’d have an audio recording. If only I hadn’t deleted the file when I hit my first obstacle to transferring it from my phone to my computer. I’d really love to hear what I played, and to analyze it…

The title of this post is a reference to the musical Jekyll & Hyde, which is based on the novella The Strange Case of Dr. Jekyll and Mr. Hyde by Robert Louis Stevenson. In the musical, Dr. Jekyll begins experimenting on himself in order to find a way to remove the evil in his father’s soul. He instead creates Mr. Hyde, an alter-ego who embodies and acts upon all of Jekyll’s “evil” urges – unchecked by morals or concern about his standing in society.

A double exposure image featuring Richard Mansfield as both Dr. Jekyll and Mr. Hyde, taken by Henry Van der Weyde circa 1895. Public domain image downloaded from the Wikipedia Commons.

A double exposure image featuring Richard Mansfield as both Dr. Jekyll and Mr. Hyde, taken by Henry Van der Weyde circa 1895. Public domain image from the Wikipedia Commons.

I’d be tempted to say I write about my “Mr. Hyde” on this blog all the time, but I only disclose part of it. I can admit to suicidal thoughts, habits I know are unhealthy, the temptation to give up on everything, frustration in relationships, anger, guilt, etc. I don’t use this blog to share my thoughts that are racist, wish dishonorable death upon certain politicians, objectify others for my own sexual gratification, devalue other people’s perspectives, etc. To do so would be inappropriate and harmful. I only mention these things now because I believe they are some of the human tendencies Mr. Hyde represents – and we each have our own version of him. We can’t separate him from the “good” part of our psyche, but we can limit his influence on our behavior. Perhaps we can even help him change to be less “evil.”

I think the more important character to examine is Dr. Jekyll, the one who unleashes Mr. Hyde. In the musical his stated intention is to cure his father, who is comatose. He isn’t allowed to experiment on other humans due to the risks involved, so he experiments on himself instead. The song “This is the Moment” reveals that his motivations aren’t really all that altruistic; he’s motivated by pride. He wants to prove himself, to prove “them” wrong. He’s not really being heroic. He’s being reckless.

Watch Robert Cuccioli perform “This is the Moment” on YouTube

Okay, so maybe the first time he transforms into Mr. Hyde it’s an accident. He had no way of knowing that would happen, right? Fine. The problem is that he keeps doing it, over and over, until he loses control. He prioritizes his research over his Self – and the safety of others.

You’re probably wondering what all this has to do with whole tones. Well I started out by practicing whole tone scales, then trying to improvise with them, but I was reckless. I didn’t do anything to ground myself, like going ahead and using a consonant interval (C and E) or playing one of the ostinati we’d practiced in class. (“Ostinati” is the plural of “ostinato,” a short musical phrase played over and over.) Without a predictable pattern, comforting intervals, something to keep me calm and ordered, I had no protection from the chaos.

Okay, so I banged on the piano for a while and made a lot of noise. It was during the day. Anyone who heard it was probably just a bit annoyed by it, then went on with their lives. I might have been the only one who heard it.

The problem is that I knew it was risky to allow my musical improvisation to become so chaotic, but I did it anyway. I felt unsafe – otherwise I wouldn’t have had thoughts urging caution; it wouldn’t have mattered that I was alone. I knew I was unleashing powerful forces I wasn’t prepared to deal with on my own. But instead of stopping the improvisation and moving on to something safer, I decided to go back, to go deeper into the abyss.

I’ll admit, it was kind of fun to romp around. When I needed to come back, I moved myself more and more toward consonant intervals. I played a G-major chord, regained conscious intentional control over my fingers, and explored tonal music for a while. I don’t remember exactly how I felt when I ended the improvisation, but I thought I was okay.

I wasn’t okay. My mind was in utter chaos. The light was too bright. There were too many colors and sounds. The clutter in my apartment that I can usually block out (or even find comforting) was overwhelming. Every thought splintered into several more. Each word brought on an association: an image or a song. That association would lead to another and another and another… it was all going too fast! I couldn’t focus my energy. I could barely move. All I could do was sit and put my head down and try to find something that wasn’t stimulating.

I texted Banji and told her: “I feel like I’m in the middle of a crowded room with hundreds of conversations going on around me, ten TVs set to different channels and blasting, ten radios also set to different stations and blasting, and there’s no escape!” She replied, “hugs,” and I sent her more texts describing how it had happened. I felt the tension melting away as I did so. Eventually I decided to take a shower, which provided sensations I find comforting (and pleasurable) and that brought me back into my body: in a word, grounding. My mind picked one (or maybe two?) thing(s) to focus on. I was even able to read a chapter of Yalom (The Theory and Practice of Group Psychotherapy) during a Skype homework session with Banji.

I’m going to take it as a learning experience. At first I thought maybe whole tone improvisation was contraindicated (not a good idea) for me, but I think the more important lesson is the importance of grounding. There needs to be some kind of home base that can be referenced at any time and provides the foundation for the music experience.

More importantly, I can’t experiment on myself – no matter how much what I learn might benefit my future clients, or how “fascinating” it is. My safety has to come first; I need to recognize and respect my own boundaries.

No, seriously, become ethereal.

TW: suicidal thoughts

In Skyrim you learn Dragon Shouts that let you do awesome things like breathe fire, cross a distance in the blink of an eye, and even force a flying dragon to the ground. The Become Ethereal shout temporarily suspends you between the physical and spiritual worlds. You cannot harm anyone, and more importantly, you cannot be harmed.

Combine that with invisibility, and you basically have the only way I feel I can safely exist right now.

One of my classes is about group therapy, intended to train students to be good group therapists. We’re reading The Theory and Practice of Group Therapy by Irvin Yalom. Before today I would have said that the more I read it, the more I want(ed) to participate in group therapy as a client. I think I need to have that experience for my own healing and before I can responsibly become a therapist.

The feeling was coming up as I read before class today, so I decided to call and see about joining the psych counseling group I mentioned in my previous post. The receptionist asked if I’d ever worked with campus psych services before. I said I’d tried but been unsuccessful. Then she said she didn’t know if the group was still open and transferred me to the person in charge of it. No answer, so I left a voicemail. No response (yet).

I tried joining a group by this organization once before. The person I’d spoken with had said she didn’t think short-term therapy would be good for me given my psych issues. Even though she offered to refer me elsewhere, I felt rejected. My experience today brought up the expectation that this is likely to happen again; they probably don’t want to deal with anyone who has severe – or even moderate – mental health issues.

The clinic Fox and I have been going to doesn’t offer groups that would be appropriate and won’t give me a referral. Even Wakana hasn’t been helpful in this department. I doubt I could find an appropriate group covered by my insurance, and Mom already seems to resent paying for my individual music therapy. I feel like there is no place for me.

I kept reading and what I read confirmed my fears. The very issues driving me to pursue group therapy would probably make me incompatible with the group they’ve created (to address a separate issue that’s just as important to me as any of the members they’ve deemed worthy of it). If I’m not a good fit, then I won’t benefit and may be harmful to the group.

And even if I were granted the privilege of joining a group, the early stages might be toxic for me. They consist of people measuring each other up and jockeying for position in the group. Initial attempts at unity and mutual support degrade as members become very critical of each other. I fear that in such an environment I would at best be ignored and at worst become a scapegoat… or just be outright rejected!

I wondered if this might be happening in class and felt unsafe with it. I thought that if it’s already bringing up all these issues, maybe I should drop the class. But if I do that, it will definitely take me much, much longer than the allowed time to graduate. I already need to request an additional year – that still might not give me enough time.

Then I read Yalom’s thoughts about tardiness and absenteeism and started to feel guilty about all the (non-therapeutic) groups I’ve left. I’d be running late for some reason, then embarrassed about being late so I wouldn’t go, and finally feeling weird about missing meetings so I’d drop out. I’ve done this more times than I can count. Any group leader would be wise to exclude me. The more I read about how harmful this behavior is, the worse I felt.

All the while the clock was ticking. I couldn’t even finish the chapter before it was time to go to class. I took too long in the bathroom. I felt anxious about my inevitable tardiness, but resolved to go to class because there’s a very strict attendance policy.

I arrived almost half an hour late. I looked through the window in the closed door to the classroom, but didn’t see a seat I could slip into easily. I hid in the bathroom to sort out my thoughts. Maybe I could join my small group when the class split up for the hands-on component? But my fellow group members are very nice and likely to ask friendly questions that are my worst nightmare – and even if they didn’t I’d have to explain myself at some point. (Maybe in front of the whole class! – they’d definitely be wondering…)

If I made up an excuse for being late I’d probably end up caught in a lie. When I’m feeling so vulnerable that I want to hide under a rock is not the time (I want) to come out as mentally ill (by admitting that the reading triggered me). I’d feel so much safer doing it so I could share things I’ve learned about therapy by experiencing it as a client. (How very academic of me!)

I looked at the time and realized that even though I was quite late, there was still the majority of the scheduled class time. I could still get quite a bit out of it. I tried to muster up the courage and looked in the room again… but still didn’t see any easily-accessible open seats. Anxiety got the best of me and I left, feeling defeated. I’m not sure how I got home in one piece. I crept back into my apartment and hid.

My own thoughts are my worst enemy. They have been battering me this entire fucking time: I’m worthless. I’ll never be able to support myself financially. I’m a burden and I’ll always be a burden. I should kill myself…

But the worst and most painful thought was this:
(I should contact [name] about this!)
No. Everyone who could help is probably busy, unavailable, or has more important things to do. They would be upset. You shouldn’t bother them.

I’m alone. I feel like my voice is gone. I thought about going to the ER but I don’t think they could help me. I think I’d be mistreated and that would make it worse. I feel like there’s nothing I can do… except maybe play Skyrim. It’s better than cutting myself…

Right?