Assessing the Depression Assessment

it's always dark
Forever raining

Ed. Note: I have a tendency to edit a post endlessly as a way to prevent myself from actually publishing said post. I’m making the conscious decision to publish posts even if I don’t think they are good enough to publish just so I can have something up every day. Therefore, some of these daily posts may not be as polished as I would like them to be. Fair warning. 

I went to the doctor on Monday*, and it was one I hadn’t seen before because my PA was on vacation, presumably for the holidays. Part of the visit is a depression assessment survey because I was dumb enough to be honest with my PA about my depression. I’m being facetious, of course, but there’s a limit to what my doctor can do when I see her once a month. I also don’t like that the answers are on a numeric scale which was something like (per week), 0 (not at all), 1 (a few days), 2 (several days), 3 (more than half the days), 4 (all the time). i don’t like not being able to explain my responses,** especially when the questions are like, “I worry too much about things.” My thought process: “Yes, I worry about things too much, but I worry less about them than I did before. So, while I may still worry too much about things several days a week, I worry much less about those things on those days.” I understand that the assessment is supposed to be a starting point for the doctor to discuss these issues with me, but that’s not how it usually works. If you only see your doctor once a year for twenty minutes, an in-depth conversation about your depression probably isn’t going to happen.

But I digress. I do that often. My mind takes me down one path, and I am more than happy to wander off the main track it’s because I have so many different thoughts all the time and because many of them are interconnected, That’s one reason I have soured on Twitter as well. Too many people harp on one topic, insisting that it’s the be-all, end-all. I won’t go down that road right now, either, though.*** I will say that Twitter lends itself to oversimplifying thoughts and reducing complex issues to fit into 140 characters.

Anyway, after I took the assessment and only fudged a little bit,**** I looked at the answers and was pleased with how much lower the numbers were in general. All those years of therapy and working on myself had paid off! So it was jarring when the doctor glanced at the numbers and said, “You scored high on most of the questions.” Since she wasn’t my regular doctor, I didn’t say anything, but if she had been, I would have protested.

Twenty years ago, I was almost catatonic and rarely left the house. I considered it a good day if I got off the couch and brushed my teeth. Twenty years ago, I would have scored off the charts on all the questions. Ten years ago, I was clawing my way out of the hole, but I still hated life with a passion. I would have scored threes and fours across the board if I were to be honest with the doctor–which I probably wouldn’t have been. Five years ago, I had started taiji (tai chi) and at least left the house on a regular basis. I wasn’t thinking about suicide every day, and I was writing almost daily. I would have scored mostly threes, anyways, with a few twos sprinkled in. This time, I had mostly ones and twos with a few threes  I don’t think about suicide every day or even every week, and I attend taiji several times a week now. In the words of an old Virginia Slims ad, I have come a long way, baby!

The doctor’s comment brought me down to earth, but it also made me annoyed. I think it’s a good thing in general to have a depression assessment when you go to the doctor, but it’s meaningless if the doctor doesn’t know you well enough to explore what your answers actually mean. For me, the two biggest things I learned from the assessment were, one, that anxiety is my main issue, not depression. This is surprising to me because I’ve been struggling with depression all my life. I first wanted to kill myself when I was eleven, and I’ve been in and out of therapy for it ever since. My last therapist  diagnosed my anxiety issues fairly late into our tenure together, and she even mentioned it was probably more prominent than my depression, but I wasn’t ready to hear that because depression has been such so ever-present in my life.

Depression is my oldest friend, and as much as it wears me down, it’s a comfort in some ways. I don’t like being depressed, obviously, but I know it so well, it has no surprises for me. Anxiety is something different. It’s like the new person in your life who is magnetic and compelling, but also wildly erratic. I don’t know what to expect from anxiety as it can be provoked in a variety of ways. I mentioned earlier that my mind is constantly churning out thoughts, but what I didn’t mention is that they’re often anxiety-ridden and focused on not committing what I perceive to be social faux pas. Any interaction, no matter how minute, I scrutinize and pick apart to a ridiculous degree, and I berate myself for the stupidest things.

Recognizing that my anxiety isn’t rational doesn’t help, by the way. In some ways, it makes it worse. I pride myself on being able to think myself out of anything, and it’s just not possible with mental health issues. But, I persist in believing that I can think my way out of my depression and anxiety issues, which makes me feel even worse about myself. On the other hand, knowing that my brain is full of shit helps when I can actually acknowledge that what it’s saying is bullshit. In the old days, I had no counter for the constant stream of, “You’re a piece of shit,” “You’re gross and fat,” “No one will ever love you,” etc. not because I didn’t have friends who loved me–I did–but because I refused to believe the love was real.

Now, I have something inside me that can say once in a while, “Hey, you know that’s not true.” It’s not that I have more outside evidence that I’m loved (again, to be clear, I’ve always had friends who love me. I’ve been very lucky in that way), but I’ve done enough work to actually be able to acknowledge it from time to time. More importantly, I rarely have those times when I feel like I’m so grotesque, I will never be loved, and when they do occur, they don’t last very long.

Back to my point that it’s my anxiety that is the major issue, not my depression. I think it’s the crippling effect of the anxiety that causes me to be depressed as well. It’s a strange adjustment to have to make after being defined by my depression for so long. Don’t get me wrong. I still have a low-level depression that stays with me from day to day, but it’s so minimal compared to the chronic, deep depression that I used to experience on a daily basis. I can handle my depression, though I don’t love it, obviously. It’s my anxiety that gets the better of me from time it time.

i will give you an example of how stupid my anxiety is. I have a really good memory for names, and I rarely have to be told a name more than than once before I can remember it. That’s not a problem, obviously, but it can create an anxiety issue when i meet the person again if it’s someone I’m going to interact with on a regular basis. Follow my thought process with me: “Oh. This is the person I met last week. I know her name is Matilda.***** I should use her name to let her know that I remember her.” Me out loud: “Hello, Matilda. How’re you doing?” Matilda, “Um, OK. How about you?” Me (in my head): “Oh, shit. She doesn’t remember my name. Now, I’ve made her feel bad because I used her name. I’m a stupid shit.” Depending on the day, I can feel bad about it for a second or for several minutes. It’s still better than in the old days when it used to be hours.

As I’m writing this out, I’m cringing because I know it’s stupid. I also marvel at how much anxiety stems from being self-absorbed. I know you’re saying, “That’s not true, Minna! My anxiety stems from not wanting to make others feel bad.” I agree that’s the purported force behind anxiety, but if I’m honest with myself, underneath that is the feeling that I don’t want them to think badly of me. I don’t want them to think I’m a terrible person for doing something I perceive as mean or hurtful. In addition, my perception of my affect on them is blown way out of proportion. In my example above, if I didn’t remember Matilda’s name or didn’t use it, I’m sure she wouldn’t have even noticed or cared. It’s the anxiety that makes me think each encounter is a life-or-death situation.

The second realization I had from the depression assessment****** was how much I’ve limited my life because of my anxiety/depression. Again, I want to emphasize how pleased I was that my self-assessment was so much lower than it ever has been.However, as my doctor so helpfully pointed out, it’s still high for the gen pop. I’ve found ways to work around some of my issues, but it takes a toll on me every damn day. I have to constantly refute the bullshit my brain is telling me without getting drawn into it. Even though the voices are muted from where they used to be, they’re still constant. In addition, I have a hard time trying new things because I can think of a million reasons why I should maintain the status quo instead. It’s frustrating because I’m not happy with where I am right now, but any change suggested to me (either by me or by someone else), I immediately shoot it down. I may not do so out loud to the person who’s suggesting it to me, but in my head, I’m thinking, “There’s no way in hell I’m going to do that.”

In addition, I am currently not doing therapy or taking medication for my mental health issues because I’m fucking tired of working on them. As I mentioned above, I have been in and out of therapy for most of my life, starting when I was fourteen. I have had good therapists, and I’ve had fucking awful ones. I’ve been on antidepressants, mostly SSRI, that have worked the first time around for the first year or so, but then stopped working and what’s worse, made me suicidal the second time I tried them. I haven’t tried medication that is tailored more for anxiety yet, so that might be next. I’ve tried several home remedies for depression, and none of them have worked. The only thing other than therapy that has helped is taiji, and the benefits from that are slow and incremental.

I don’t want to undercut the benefits I’ve gotten from studying taiji for six or seven years, however. I am more comfortable moving through crowds, finding seams that are almost impossible to spot, even if I still prefer being alone. In addition, I’m as clumsy as I’ve ever been, but I don’t hurt myself as much or as badly as I used to. I’ve fallen off ladders twice and walked away with only a bruise each time. I’m more comfortable in my body, though I still don’t love it (another post, another time), and I’m becoming more confident that I can take care of myself physically. Taiji has also helped me discover things about myself such as I’m not a pacifist, I love weapons, and I can make progress even though I’m a lazy motherfucker.

Still, something my last therapist said to me has stuck with me ever since she said it. I’m paraphrasing, but the gist of it was that I shrinking my world ever smaller as a way to deal with my anxieties and fears. Her point was that I can only shrink it so much and that if I don’t address the core issues, my world will never be small enough to make me feel safe. My world is bigger today than it has been for twenty years, but I’m still far from where I want to be. The depression assessment I took at the doctor’s was shit, but I’m glad I took it, anyway, because it made me realize that I’m both further along than I’ve ever been and that I still have a long road ahead of me. This is valuable knowledge to have.

 

 

*Routine thyroid check, no biggie.

**This is why I hated multiple choice tests in school. They were often poorly-written, and I could see situations in which several of the answers could apply.

***I have to stop hyping my future blog post about my issues with social media because I don’t want to raise expectations too high.

****I’m not going to expose my vulnerabilities to someone I’ve never met before. Also, I am very fond of footnotes for my newer readers. Get used to seeing the asterisks as you read because there will be several of them per post.

*****Not a real life scenario, but a representative one.

******You thought I forgot, didn’t you?

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