Theory strikes a little too close to home

As I spend my birthday weekend studying for this week's upcoming exams, I am struck by how much of the content in my psych class mirrors my life...especially in this set of lectures.  Two of the main exam areas this week are Major Depressive Disorder and Care of the Chemically Impaired.  Its no secret that I suffer from depression and have for many years.  I am finally coming to terms with the fact that I will likely always have relapses and that perhaps I should just resign myself to a lifetime of anti-depressants.

It has also been an interesting process in looking at my familial history.  I won't go into too much detail out of respect for my family members' privacy, but it is quite evident to me that part of my depression has a genetic component.  I have had discussions with some in my family about the shame and stigma that is still attached to depression, despite the fact that the lifetime risk for men developing it is 5-12% and 10-25% in women.  It was certainly not something talked about in my childhood...that I recall anyway.  Part of that I believe was due to a lack of information, but part of it I believe was the stigma of shame that was attached to any acknowledgment of mental illness.

I am hoping that by being open and honest about my journey, that perhaps my son and nieces will grow up with a different perception of the disorder.  I know in many ways it has become a freeing process for me to be open about it.  Much like my journey in coming out as lesbian, transgender, and queer, each step towards full honesty and acknowledgment of all of me is another step towards personal freedom.

Much of the same could be said about chemical dependency and addiction.  I feel like I have been very aware of issues of addiction from a very young age.  I think it really shaped by adolescence and early adulthood.  I guess my personal response was to go in the opposite direction.  I didn't drink or do drugs in high school.  I was most likely to be found at work or at school working on an upcoming choir or theater production.  On the rare occasion that I did go to a party, I always chose to be the designated driver.

When I left home at 18 for boot camp and then military college (New Mexico Military Institute), things changed a little.  On our few weekends off, cadets would often drive down to El Paso, TX and cross the border into Jaurez, Mexico to drink.  We always made sure someone stayed sober to get us back across the border safely.  I think it is safe to say that I was somewhat of a binge drinker.  I discovered that I had a very high tolerance to alcohol and as a then 18-20 year old female who weighed about 125 pounds, it was always good fun to drink the guys under the table.  By the end of my two years at NMMI, I realized that wasn't how I wanted to live my life and I gave up drinking the day after I graduated.

I stayed a teetotaler until well after my 21st birthday, but eventually began drinking socially from time to time.  I soon found myself married with a kid on the way and quickly realized my then husband was an alcoholic and addict.  I tried to change him, fix him, threaten him...finally I realized he didn't think he had a problem and therefore wasn't going to change.  So I left.

To make a long story short, I was 23, a single mom and on disability (I had fractured a vertebrae falling down some stairs at work while 8 weeks pregnant).  I moved back to Michigan for a few years, began my coming out process, was diagnosed with clinical depression for the first time, and began to face the reality of raising a kid alone.  Thankfully during all of that turmoil and struggle, I never once looked to alcohol or illicit drugs as an escape.  To this day I am still not sure how I managed it.  Even though I was quite suicidal at times back then, a part of me was fearful that if I began drinking I might not ever stop.  I didn't want that for my kid...I had already seen what it had done to my step son.

It is strange to now be 41 and the parent of a 17 year old, who despite all my best efforts, educating him on his genetic risk factors, etc, has himself become an addict.  While I know all the intellectual and scientific causes for his disease, and am able to call it a disease, there are still times when I wish I could just shake some sense into him.  I think in some ways going through Psych Nursing this semester has been good for me.  It helps me to refocus on the big picture.  I still have sadness for the damage alcohol and drugs has caused in my life and my son's life.  I will have a social drink or two on occasion, but I have a healthy amount of respect for it.  And, now that I am back on anti-depressants I will once again refrain.

The last thing I will say tonight is how fascinating I find the teaching methods for this course.  Given that there are 44 people in the class, the reality that a certain percentage of us either have ourselves or have experienced in our family a great many of the diseases and disorders we discuss, I am surprised that there isn't more opportunity to talk about how this affects us personally and professionally.  There has been little to no discussion about how to cope with your own issues that may come up in the course of treating a patient.  I would think that this would be an incredibly important topic, specifically in the field of Psych nursing.  I guess that's why I have a blog.  :)  Thanks for reading.

Peace and compassion...

Better living through pharmacueticals

Although Detroit has been nothing but gray and rainy today, I am reminded of the old Johnny Nash lyrics:

     I can see clearly now, the rain is gone,
     I can see all obstacles in my way
     Gone are the dark clouds that had me blind
     It's gonna be a bright (bright), bright (bright)
     Sun-Shiny day.

I realized over Spring Break that I was feeling a sense of happiness that I hadn't felt in months (and not just because I was back in my beloved Colorado!).  Over the years I've gotten pretty adept at recognizing when clinical depression was creeping back into my life and could take steps (seeing my doctor or therapist, going back on meds, etc.) to mitigate it, but somehow it just crept up on me this time and laid me out in ways that hadn't happened in years.

Thankfully, I did finally realize there was a problem, reached out for help and got it.  While my life is still very stressful and full of anxiety and chronic pain, the oppressiveness of my depression has lifted making life and school feel more manageable again.  In the 3 weeks since I began taking Cymbalta, my depression has almost completely dissipated.  This week I have also felt a decrease in my daily anxiety levels, which is hugely helpful.  I'm still not noticing much, if any affect on my pain levels, but I know it could take 6 to 8 weeks to achieve full affect.  As the song lyrics indicate, I am seeing much more clearly now and it is easier to tackle the challenges that still lie ahead.

It really is true what they say...you need to take care of yourself before you can take care of others.  Or perhaps it is more true to say it is way easier to take care of others if you take care of your self first.  The patients I see every week on the Med/Surg floor, in the Psych unit, and now in Rehab remind me that I want to lead a full, healthy, and sane life, while also helping others and being the best nurse I can.  My current life lesson seems to be about retaining balance.  I think its gonna be a bright, bright, bright, sunshiny day.

Thank you to all my cheerleaders and supporters, both near and far who helped me get through these very challenging few months.  All of your comments on Facebook, here on the blog, via email and snail mail make me feel very loved and grateful.  Love and gratitude.

Peace and compassion...

Mental Health

Mental health...seems like it should be such an easy thing, especially if you are intelligent, have access to good resources, and are not completely isolated.  I find that even at age 40, after countless years of therapy, psych classes, support groups, reading, meditating, you name it, I still have fear and shame around my struggles.  I somehow feel, admitting that I have some mental health "issues" makes me somehow weak or less capable.  Intellectually I know this is not true, it’s just the feelings I fight within myself.

So in my continuing quest to live an open and honest life I thought it might be good to do some more in depth writing on the topic that I started in my last post.  In some recent moments of clarity, I have come to accept that I struggle with depression.  Not a huge revelation to those who know me well I am sure.  However, I think the shift I have come to accept recently is that it is a part of my chemical makeup and I need to find a way to be ok with that.  I have always looked at my depression as situational, even if all evidence indicated otherwise.  I would cycle on and off antidepressants because I did not want to be on them unless I was absolutely miserable.  In a recent conversation with my therapist, she suggested that I may need to just accept that I need to be on a med consistently and perhaps up the dose as seasonal or situational events require.  It some ways it feels like a betrayal of my body.  Why can't it just work "right," without chemical intervention?  Then I look at the patients I am working with, both on the psych unit and on the med-surg unit and realize, they likely have the same thoughts on occasion and comparatively, I am in pretty good shape.  So yes, my name is Nick and I suffer from depression.

The other mental health issue I struggle with is anxiety.  As I briefly mentioned in my last post, I was gay-bashed and sexually assaulted in April of 2007.  The anniversary of that incident is fast approaching and I think because I am so far away from the people who lived through that incident with me and because I am under an incredible amount of stress with my school program and what not, my PTSD anxiety is rearing its ugly head.  Its not an easy thing to admit, but when I passed out during clinical last week it was due in large part to a full-blown panic attack.  Part of my attack involved me being choked from behind.  I have never done well with thoughts or experiences that make me feel as my airway is being cut off.  That anxiety has multiplied at least tenfold since the assault.  

Last week's clinical experience for me was to observe a surgery in an OR suite.  I was scheduled to watch a knee arthroscopy and ligament repair.  After much in and out, following the RN who was prepping the suite, it was time for the procedure to begin.  I took up my spot, out of the way to observe.  I was in scrubs, a cap and a mask.  I found the procedure interesting, but quickly realized that I was having difficulty breathing with the mask on.  I did my best for about 30 minutes to move around, adjust the mask, and distract myself from the ever-growing anxiety.  Finally, as waves of nausea began to wash over me I walked to the other side of the suite and tried to ask some questions of the OR nurse.  Ultimately I realized I had to get to a rest room.  As I left the OR suite and headed to the rest room, I felt myself get slightly dizzy, but kept walking ahead.  I only made it one doorway down before I passed out cold.  I don't even recall going down and when I came to, I thought I was just leaning against a shelving unit.  It took me a full minute to realize I was lying full out on the floor.  

It also took me a little bit to realize that I had been experiencing a full-blown anxiety attack.  As soon as I came to, it was all I could do to stop myself from tearing the mask off my face.  A nurse saw me go down and got another nurse to get me a wheelchair.  I felt embarrassed and ashamed.  On the one hand, I didn't want them to think I couldn't handle watching some surgery, but on the other hand I also didn't want to admit I was having an anxiety attack.  They made me go to the Emergency Department and I did have the courage to tell the doctor that I was having an anxiety attack.  That was anxiety inducing in and of itself.  After my assault, I went to an Emergency Department and felt like I wasn't treated as well as I could have been.  My transgender status makes many people uncomfortable.  To be recovering from a major anxiety attack and then to have to tell medical personnel that I am not familiar with that not only am I a nursing student having a panic attack, but that I am also transgender, not a fun experience.

The upside to all of this is that it made me reach out.  It made me realize that I still have residual affects of PTSD.  It made me decide to go back on medication.  I hope that it is also the turning point of what has been several very dark weeks.  I am working to accept that I may never be "cured" from my depression or my anxiety, but I can continue to manage it in healthy ways that allow me to live a full and vibrant life.  In addition, perhaps if I share my experiences it will help reduce the internalized stigma I feel.

Peace and compassion...