D is for Dreams

DisforDreams

Waking up completely exhausted is common among people with depression. I usually have more trouble getting up when I sleep during the night than when I am battling insomnia. It’s because I dream. I dream a lot. They aren’t good dreams either. I wouldn’t call them nightmares, but they are realistic and stressful. Sometimes they are repetitive dreams. I often think in the dream oh no, it isn’t a dream this time, it is happening for real! I often can’t tell that I am dreaming. Even upon waking, I am not sure what was real and what wasn’t. I wake up feeling like I’ve had a long stressful day at work and now, I have to get up and do it all again in waking life. Ugh.

Do you dream a lot? Do you have repetitive dreams? Have you ever had trouble telling the difference between your dream and reality?

tired

It sucks, but I just accepted it. I figured everyone has these dreams. Most people do, but not every night, and not to the same intensity. Sleep studies have shown that people with depression dream up to three times more than the average person. Dreams contain more intense emotions and negative themes than average. Dream sleep occurs during the Rapid Eye Movements (REM) phase of the sleep cycle. It is often referred to as Paradoxical Sleep because although you are asleep, it is not the kind that leaves you rested and restored. During REM, all kind of stress hormones are released into your system. Dreams are usually thought of as good things. They tend to be exaggerations of the truth, but dreams tend to be metaphors for your life. Unaddressed concerns get played out in your dreams, leaving your brain free for dealing with the events of the next day. Too much of a good thing though, is always bad. Over-dreaming leaves you stressed and deprives you from the “deep sleep” that you really need. Waking too early is common among those with depression. This is actually the brain’s survival mechanism to prevent the stress from over-dreaming. Why do depressed people dream more? Apparently it is because we have more worries and emotional arousal that has to be worked through.

I don’t know if a completely dreamless sleep is possible, but you can at least find sleep where you don’t remember your dreams. I have come across a few tips I am going to try to see if I can mute these stressful dreams of mine.

  1. Don’t go to sleep stressed. Give yourself time to cool down
  2. Keep regular sleep times, even on weekends
  3. Don’t eat right before bed. Meats and cheeses can increase the likelihood of having nightmares
  4. Decrease alcohol and caffeine consumption
  5. Keep a dream journal or join a dream-sharing group in your community
  6. Research has shown that good smells can affect dreams positively…aromatic oils, lotion, flowers.
  7. Have some sort of moderate exercise during the day and not right before bed.
  8. Don’t sleep on your back. That can induce sleep paralysis which causes you to feel like you are awake and alert, but cannot move. People often complain of a heavy feeling on their chest.
  9. Read something not too thrilling, but not work or school related stuff either.
  10. Don’t stress about not being able to sleep. Worrying about it, will just make it less likely to happen.

Some of these I already do (#3, 4 and 7). Some, I’ll be honest, I’m just not going to do (#5). The others, I’ll give a try.

C is for Cognitive Behaviour Therapy (CBT)

Cognition is so important in terms of mental health. It is the whole basis of cognitive behaviour therapy (CBT). The belief in CBT is that your life experiences consist of five components; environment (past and present), thoughts, moods, behaviours and physical reactions. These components are all interconnected and a change in one can influence the others. Although adjustments in all five areas are probably needed to improve mental health, CBT puts the emphasis on your thoughts. Thinking patterns are thought to be most important when trying to make lasting positive changes in your life. A change in thought patterns from the usual negative to more positive and constructive can cause similar changes in the other components.

must stay positive

Of course, it isn’t as easy as it sounds. Your negative thoughts are automatic. You have to actively identify them and then use a strategy to combat them. I like to use logic. What are the facts? What information do I have to support my thoughts? What is the proof? I use previous experiences too. What has happened in similar situation? How did I cope? What have I learned that will help me this time? You have to work at it before it becomes natural. CBT has really helped me manage anxiety and perfectionism.

Then, there is depression. My issue is self-loathing. I hate the way I look, I’m not successful, I am inadequate. These are my thoughts. I know they are negative and I know I need to combat them. There is nothing wrong with the way I look. I get compliments, no one calls me ugly. I am successful. I am a Ph.D. candidate, that can’t be a failure. I am adequate. I am a good person, I work hard, I try to lead a balanced life. That is adequate. I have re-framed my negative thoughts into more positive ones. I realize my self-loathing is irrational and there are no flaws in my logic, so why do I feel worse?

The whole thing creates a conflict in my head. I know my thoughts are irrational, but logic is not enough to change the way I feel. It seems like I am lying to myself. Not only that, but I am a failure because I can’t get CBT to work for me. I gave up on therapy for a while because of this. Only after doing my own research and talking to the mental health community online did I figure out there were other forms of therapy I hadn’t tried. I guess CBT is either the front line in terms of talk therapy or it was for my specific case. All the clinicians I worked with wanted to go in that direction.

Here is a list of some of the other options.

  • Psychoanalysis – This was developed by everyone’s favourite psychologist, Freud (note the sarcasm here) and is where the whole lying on the couch thing came from. It is intense, several sessions a week are required. It focuses on bring unconscious thoughts and behaviours to the surface.
  • Interpersonal Therapy (IPT) – This one examines the relationships in your life. There is a focus on communication and may involve role playing with the therapist.
  • Dialectical Behaviour Therapy (DBT) – This is centered around the discussion of opposing views and work on how to balance the two extremes. There are usually individual and group sessions. This form of therapy is often recommended for Borderline Personality Disorder.
  • Mindfulness-based Therapy – It is focused on talking and mediation. Its purpose is to reduce stress and prevent a relapse in depression
  • Eye Movement Desensitization and Reprocessing (EMDR) – This method stimulates the brain through eye movements intending to make distressing memories less intense.
  • Life Coaching – The focus is on hopes and ambitions. It uses empowering and motivational methods to reach goals and make changes in life.
  • Arts-based Therapies – Involves expression through various art forms, visual arts being the most common. The aim is to help you release emotions and understand yourself better.
  • Bibliotherapy – The use of self-help books.
  • Acceptance and Commitment Therapy (ACT) – Uses acceptance and mindfulness strategies to increase psychological flexibility.
  • Hypnotherapy – Uses hypnosis to modify behaviour, emotional content and attitude.
  • Somatic Psychology – Focuses on the link between mind and body. It teaches you to become more aware of the physical body and how the mind interacts with it.
  • Humanistic Therapy – The focus is on the person as a whole. It explores your relationship with different parts of yourself (emotions, behaviours, mind, body, etc.).
  • Existential Therapy – It is a holistic therapy that considers depression the result of how you make sense of yourself and the world around you.
  • Compassion Focused Therapy (CFT) – This is usually recommended for those that have high levels of shame and self-criticism. It has Buddhist and evolutionary elements.

My psychiatrist recommended I try DBT next. I was supposed to start in January. In the mean time I have been art journaling and I have a couple self-help books on ACT and mindfulness.

Did you know there were so many different types of talk therapy? Do you have experience with any of these therapies? What do you think is the best approach? Is medication the more important element?

help quote

B is for Biological Basis

Mental health problems are frustrating because it is hard to classify them as having a biological or psychological basis. I know there has to be some psychological component, mental illnesses are diagnosed based on behaviour after all. I am hoping for some solid research showing depression and other mental health issues have a biological basis though. If the cause is in my biology, there isn’t much I could have done to have prevented it. It is not in my control. I am not to blame. A psychological basis would imply that my behaviour is the problem. I am responsible for my behaviour and so I am to blame, or so society dictates. Calling depression a brain malfunction would minimize the shame I feel when I have to explain myself. I don’t want people to feel sorry for me, but I don’t want them to always wonder why I don’t just snap out of it either.

There is support for both the biological and psychological sides. Since mental processes are carried out by the brain, all disorders of mental function are biological. Just like the lungs are the organs for breathing, the brain is the organ for the mind. Where else could mental illness be if not the brain? Not so long ago, we didn’t know that much about how the lungs worked. All doctors could do for respiratory disease were observe physiological presentation and listen to patient complaints. Today, there are all sorts of tests to measure lung function. The same principles apply to the brain, we just don’t know enough about it yet.

On the flip side, some go to extremes, arguing that everything from mental illness, to criminality and sexual orientation are seen less as a matter of choice than a genetic destiny. Mental health problems could be the result of normal personality traits coming together in such a way to make functioning in today’s world difficult. One scientist compared the brain to a computer and mental processing to the software. There can be a bug in the software that prevents things from running smoothly, but the hardware is still fine.

What do you think? Do mental illnesses fall into one of two distinct categories (psychological vs. biological), or do they exist on a continuum having different percentages of biological and psychological contributions?

Recent research posed similar questions to clinicians (psychiatrists, psychologists and social workers) to determine their beliefs on the causes of mental illness. I would like to know what my psychiatrist thinks. After all, his beliefs would probably have an effect on my therapy and may determine whether or not he prescribes medication and which medication it would be. The study showed that clinicians tend to look at mental health problems across a spectrum of biological to psychological rather than categorical. They believe disorders with a larger biological component would respond best to medication, while those with a larger psychological component would respond better to therapy.

They didn’t show all 445 identified mental illnesses on this spectrum, but they did show 9 familiar ones. I looked up my primary diagnosis, depression, on the graph and it was right smack in the middle. Clinicians viewed depression as having biological and psychological contributions that were almost even. Darn. Other diagnoses like bipolar and bulimia were more clear cut in clinician minds, showing larger biological and psychological components respectively.

It turns out the biological basis I was hoping would explain my depression is a double-edged sword. Although the average person would probably be more compassionate about a brain malfunction, clinicians would be less so. This study showed clinicians felt more compassion towards those with mental health problems thought to be caused by psychological factors. Researchers thought perhaps the emphasis on biology was dehumanizing, causing the patient to be viewed as more of a biological mechanism than a person.

Regardless of the beliefs of clinicians or those of society in general, I think we can all agree, the more we understand about all components of mental illness, the better.

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Resources: Ahn, Proctor and Flanagan, 2009

A is for Anger

Happy April Fool’s Day! Today kicks off the A to Z Challenge and the first of my posts on mental health. I’m no good with introductions, so let’s just jump right in.

A is for…

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Anger is a basic, healthy human emotion. It is a signal telling you there is a situation that needs your attention. It is meant to motivate you into action. As with any emotion, there is an element of perception, but generally anger is a response to being treated unfairly, hurt or not having our expectations met. Anger exists on a spectrum from irritation all the way to rage. Frustration is probably the most common point people experience on the spectrum. A lot of people deal with their anger by talking about it, writing about it or exercising it out. These are all healthy ways to deal with anger. Other ways to discharge anger that are also common, but more destructive include shouting, fighting, breaking things or dumping on whoever is near by.

How do you express your anger?

When I am angry, I don’t do any of the things I just mentioned. I wouldn’t describe myself as an angry person. “Angry” is probably the last word most would use to describe me. I just recently discovered that I do in fact, have a lot of anger. So how do I express it? I don’t. Most of the time, I don’t even know I am angry. I suppress my anger and I have been doing it for so long that I no longer recognize the emotion.

Depression and anger have a long history together. Studies have shown that the degree of anger correlates with the severity of depression. Those suffering from depression often have trouble experiencing and expressing anger. It creates inner conflict, triggering guilt, self-criticism and fear of disrupting relationships. Freud even described depression as anger towards the self. I agree with Freud, that is definitely part of it.

In retrospect, I have come up with two reasons for why I started repressing my anger in the first place. One being I am a “people pleaser”. I want to be a good person and I want others to see me that way too. “Good” and “anger” aren’t usually thought of together. That leaves little room for getting angry, let alone expressing it. The second reason is my need for control. If I am in control of my emotions, I am safe. No one can hurt me because they don’t know what affects me. This probably had something to do with those stereotypical mean girls while growing up. Being older and wiser, I know this is unhealthy thinking and it was only a means of self-preservation, but the damage is already done. Suppressing my anger has become a reflex that needs to be undone.

If I don’t get angry, what happens when I am being treated unfairly or my expectations are not met? I blame myself. If I am being treated unfairly it is because I must have done something to make people think they can treat me that way. If my expectations are not met, it is because of my own inadequacy. I don’t go through this reasoning like this in my head. It is automatic. This anger towards myself is turned into hatred. I think What is wrong with you? Everyone else can manage that, why can’t you?

When angry with other people, there is a fear of compromising the relationship or guilt of hurting their feelings. This is enough reason for many to hold back. There is nothing to keep my attacks on myself in check. There are no parallel restraints. Anger turned inwards is vicious. Self-loathing can get so intense that it becomes paralyzing. This paralysis makes you more angry at yourself causing more self-loathing, perpetuating depression. It’s a cycle…… Lovely.

The first step towards breaking a cycle is being aware of it. I can check that off my list.

J52: Just Write

Journal52, Week 11

Prompt: Just Write

I tried multitasking with this one. It is an art journal page for Journal52 and it is my psych homework. I had an appointment with my psychiatrist last Friday. I didn’t mention my declining mood but maybe I should have since it has only gotten worse. I thought it was just the usual up and down at the time. What we did discuss was work. I am having trouble dragging myself through it. I’m not sure if it is work itself, or me being depressed that is the problem. As I was leaving the appointment, Psych said he felt he should give me homework. He asked me to write about work. He wanted me to write what I like about it without thinking about it too much. He didn’t say I had to write it out in my neatest handwriting or anything and considering I hadn’t used this art journal prompt, I figured why not make it into a page.

I’m not really sure what this exercise is supposed to achieve. I don’t deny that there are things I like about my Ph.D., there are just a lot of “but”s. I enjoy learning. If you aren’t learning, you aren’t evolving and if you aren’t evolving, well, you are pretty much dead. I know there are lots of different ways to learn. I just know the academic way of learning and I was good at it, so that’s the route I took.

I also like information. I like to gather it, break it down into small digestible pieces and then build it back up in my own words with my own perspective. I like to share this information with others too. Teaching those that want to learn is always a great experience. I have a bit of stage fright, maybe a lot of stage fright, but giving a talk at a conference can make you feel like a rock star.

I also get to help people, improve their quality of life. Right now, there is no solution for age-related vision loss. There are treatments to help slow the progression, but no cures. The doctors spend as much time with their patients as they can, but some ophthalmologists have to pack 90 patients into one day. They don’t have the time to explain everything. I can do that. I can answer questions and explain how to use various visual aids. We even have training programs that teach people how to use what sight they have left. Most importantly, I can listen. Sometimes, that is all my patients want, someone to listen to them. I can do that.

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The reason I started down this path in the first place was because I was interested in vision, aging vision in particular. I was close to my Gran growing up, I even lived with her the first year my family moved to Montreal. Gran had Macular Degeneration (AMD). It got so bad that she was considered legally blind. This meant she wasn’t completely blind, she could still see light and movement, but no details. She walked around with the white cane, listened to audiobooks and was a member of the Canadian National Institute for the Blind (CNIB).

Now, just stop for a second, imagine what it must be like to be a senior citizen, someone who has been depending on their vision for 65+ years and now cannot rely on it at all. You can’t drive, you can’t read, you can’t recognize people, you can’t shop without help because labels, prices and colours are hard to figure out and you can’t do most of your hobbies anymore because trying to see what you’re doing is too frustrating. Just imagine. It is worse when it happens quickly and there is no time to adapt. That is what happened to Gran. Most of the folks I work with get pretty depressed, but not Gran.

Gran was resilient. She had a great attitude. She was determined to stay independent and wasn’t going to let AMD stop her. She still went out on her own. She used her memory to get around the area she lived in. Once, she slipped on some ice and fell, broke her arm. She was out and about, cast and all a few days later. Her love of reading turned into an audiobook subscription. She used tools given to her by the CNIB to continue playing cards and doing cryptic crosswords. Gran even continued knitting! Of course, she could only do the patterns she knew by heart, but added her own little twist to them. These are two of the elephants Gran knitted. An angel and another one with a pink sweater, scarf and beret.

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All in all, she lived 15 years with AMD. Gran was a remarkable woman. Her attitude was inspiring. Sadly, I know it’s not like this in all cases. That is what prompted me into this field. I wanted to help in any way that I could. I still do.

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By the time I finished my writing, I was in tears. Gran has been gone for 11 years now, but sometimes it feels like it was just yesterday. I guess there are just some losses you never really recover from. I am pretty sure this is not the conclusion Psych wanted me to come to when he assigned me this writing exercise. Perhaps he wanted to determine if I was doing a Ph.D. for the right reasons? I don’t know.

Anyway, this is the page.

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For those of you interested in the art part…..I started by drawing a few eyes here and there. I wrote around them with different shades of blue Sharpie. You can see the Sharpie through the back of the page, so make sure you plan to gesso over the back or something. I wrote in different directions with a combination of printing and cursive. I spread a thin layer of gesso over the writing when I finished. I used my old Blockbuster membership card to spread the gesso. I find you can get a thinner layer with the gesso than with a paint brush. I wanted the writing to still be visible. The eyes were coloured with watercolour pencil crayons and Signo Uniball pens. I went over the background with some pastel gelatos. You can see kinda read the writing. It’s a bit tough in some places. I then went through with a Sharpie paint pen and highlighted some key words.

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