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Feeling Overwhelmed

It has been awhile since I’ve updated my blog. I haven’t been able to do much of anything since my last post. I’ve since stopped working and have been given sick leave from my psychiatrist since mid September. My follow up appointment is mid Oct, and I feel that I am no better than when my sick leave began. I no longer feel that I can go back to working as a mental health nurse at this point. I am unsure if I ever will be able to doing this work.

While running today, I finally decided to listen to a podcast by Tim Ferriss that was aired on September 15th, 2020 with Debbie Millman, the host of a very popular podcast called Design Matters. It was a difficult listen because both of them shared their experiences of childhood sexual abuse, their experiences of realising that they needed help to cope with mental health issues, and what strategies they have used and are still using to assist with their recovery.

What struck me most is what Debbie Millman said earlier on in the podcast, and I quote:

And when I got older, talking 15, 16, 17 years old, at that point, I thought, “Well, I’m not going to let this impact me. I’m not going to let him win my life. I’m going to try to have the best life that I could have.” Not realizing at that young age, as you’ve mentioned, the body keeps the score. You cannot outrun your own psyche. It is not possible. It is just not possible.

Your psyche is too strong to just take those experiences and sweep them under a rug and never ever look at them again.

– Debbie Millman

This has been my default thinking to minimise what has happened to me throughout my early teenage years to early last year when I first was officially diagnosed with clinical depression. I was working in a locked mental health ward and has just started my job there for only 4 weeks before I got unwell. This was definitely not the first time I have had a mental breakdown. I have remembered numerous depressive episode throughout my teens, young adulthood, and throughout my 30’s but I did not think of seeking professional help at that point because it was just unthinkable. It just was not something that I would have done because of the stigma surrounding my culture and where I was brought up (All I can say is that I grew up in a Asian family in Southeast Asia). Even if I did seek out help, I would not have known where to begin, as the health care system where I grew up did not have a robust mental health service due to the stigma attached to it. Somehow, my coping mechanism through believing that what happened to me was nothing and it was in the past and how I would not let it affect my life, kept me going. But, as Dr Bessel Van Der Kolk’s book “The Body Keeps the Score”, my body has found a way to finally show signs of the abuse and everything started crashing down on me.

I will be turning 41 this November and listening to Debbie Millman and Tim Ferriss talk about their lifelong struggle with mental illness and how Debbie talks about being in therapy for the past 30 years, somehow, made me feel that this is going to be my reality as well, and I feel defeated mostly, but, at the same time, there is a glimmer of hope for me as others have gone through similar journeys. The feeling of defeat mainly comes from the hopeless that I feel and how this cycle of depression will come and go, and come back again, and there is nothing much I can do about it apart from learning new coping strategies to help manage and hopefully prevent another depressive episode by being more mindful of when my mood is starting to dip. I also feel that, does it mean that I need 3o years of therapy to be able to finally have some semblance of actually living life, and not just going through the motions as what I have been doing the past 34 years? This is something that I will only know as my journey continues towards seeing the light at the end of the tunnel.

Here is the link of the podcast transcript from the podcast I mentioned in my blog, if you’re interested:

Realisation

Repressed pain may reveal itself more privately, as in a woman, sexually exploited as a child, who has denied her childhood reality and in order not to feel the pain is perpetually fleeing her past with the help of men, alcohol, drugs or achievement. She needs a constant thrill to keep boredom at bay; not even one moment of quiet can be permitted during which the burning loneliness of her childhood experience might be felt, for she fears that feeling more than death. She will continue in her flight unless she learns that the awareness of old feelings is not deadly but liberating.

Alice Miller, The Drama of the Gifted Child

Waking up this morning at 0530 hours, while lying awake in bed, I realised that I have never lived…my years of existence on this planet from the age of 6 years old, when the abuse started, I have merely gone through the motions and have done everything that was expected of me, from my parents, teachers, peers and bosses. I STILL am doing this. A big part of me knows that the right thing to do is to tell my psychiatrist that I am fit enough mentally to go back to being a mental health nurse, but, at the same time, I also know, deep down in my psyche that I need to stop DOING and stop AVOIDING, every anger, hurt, disappointment, guilt, shame and self-loath that I have kept hidden and locked away for decades.

The quote from above from the book ‘The Drama of the Gifted Child’, by Alice Miller, encapsulates what life has been for me all this while. My method of avoidance has never been alcohol or drugs, but bad sexual decisions with men and always striving for accolades; be it in term of academic excellence, winning races in sporting events or running a successful business. I wish I had come across this book sooner in my teens.. maybe then, how my life is now, would be different. But, then again, this is the exact thought process that plagues those who have been abused as a child or even as an adult. We get stuck in this loop of wishing that the abuse had never happened and what our lives would have been if there was no abuse. Would our lives be better? Would be in a better state of being? I have so much work that needs to be done, that when I think about it, I am utterly overwhelmed and waiting to be seen by a Clinical Psychologist that is funded by the health system, seems like a far away place. I only hope that by then, I would have the strength to work through all the pain.

The part where the quote said that one has to realise that old feelings are not deadly, but liberating, is one that I think I will have a hard time ever coming to terms with. The concept of this is taken from the teachings of Buddhism, where suffering is inevitable and if we understand that everything is impermanent, then we know that suffering will end and we become wiser from it. At this point in time, I don’t feel this. I am still stuck in the cycle of numbness, helplessness, extreme sadness and not wanting to be alive. It all sounds very dramatic, but to me, it is my reality at this moment.

Letting Others Care for You

Since my first episode of depression mid of last year, I have continued to remain stoic as that was how I know how to cope with difficult times. I grew up learning to be indifferent and strong whenever faced with difficulties and just push through. This coping method has worked well for me the past 34 years but it is no longer working well for me anymore. I am learning to allow others to care for me instead of pushing everyone away because I do not know how to be vulnerable. My experiences throughout childhood, adolescent and adulthood has been to minimise my experience of sexual, emotional and physical abuse and stay strong by minimising what has happened to me.

It is difficult to let the advise of the psychiatrist sink in when she said that I need to let others care for me. I find it extremely difficult to do. I have no idea how to let my guard down. Despite not being able to let my guard down, I am no longer able to pull myself together and push through this current depressive episode. It feels like this is never going to end and when it does, it will haunt me again sometime later.

I have been going to work daily for the past 3 weeks but really, it is not helping with my recovery. Talking to the psychiatrist yesterday made me realise that I need to accept her recommendation of taking time off work until my mental health is better. My mental distress is manifesting physically in a variety of ways, from headaches, to dizziness, aches and pain, joint pain and extreme fatigue. Yet, I still pushed through the days at work a day at a time, feeling totally drained when I get home. I am finally at home starting today to go on medical leave. I am unsure how long I would be on medical leave for and this time around, I am letting my treating team decide what is best for me as I no longer know what is best for myself.

Feeling Unloveable

Have you ever felt that you’re not worth being loved by anyone because your depression has become overwhelming to those around you? I do feel like this most of my life due to my past trauma of neglect and sexual abuse that started when I was 6 years old. My rational brain tells me that this is not true, but no matter how rational I am, this feeling is unshakeable and some days are stronger than others. Today is one of those days where this feeling is overwhelming. I continue to push my partner away and isolate myself from friends and work has become a place for me to pass time.

Running When Depressed

When depressed, everything becomes difficult and there is no motivation to get anything done. However, it is important to focus on one activity that you enjoy the most prior to the depressive episode and stick to that routine. This would not be easy to do, but it is pertinent to keep to the plan.

For my recovery, I focused on running regularly as I normally would. It takes a lot of mental energy to tell myself to get out the door on my running days. Some days, I am able to get out of the house to run, while some others, I just could not get out the door, and this is alright. There is no point in feeling like a failure when you are unable to stick to the plan. Just think ahead and work towards the next time you are to do a particular activity.

I don’t run as much when I am out running on my own. The usual 6km run that I do twice weekly, at times, only reaches 3km. It took me awhile to feel ok about not doing the distance as I have always run with a set distance in mind. The weekend runs that I do with a friend are more fruitful. Running with someone else motivates and pushes me to do the distance.

The Paradox of Medications

When it comes to psychiatric medications, it does not always work as how it is intended to. Unlike medications to treat physical health issues, psychiatric medications are confounded by various factors such as gender, age, and genetic make up to name a few.

I started on escitalopram 15 months ago and it worked really well 4 days after I started it back then. I could feel my mood lift tremendously only after 4 days on it. However, this current depressive episode is a sticky one and escitalopram did not make a dent into my mood. I was then prescribed Bupropion and I am starting to see some improvement only recently after being on it for 3 weeks. This definitely has brought some relief for me. I am still not quite there yet and I am still not doing much clinical duties at work just yet. It would not be safe practice on my side if I pushed myself when I am not well and ready.

I was on mirtazapine to help with insomnia that is caused by bupropion but have since put on 2 kgs in a week’s time. Mirtazapine causes cravings for carbohydrates and sugary foods, and for me, these cravings only starts at 9pm in the evenings. I have since stopped taking it and have zopiclone to help with sleep. I still only manage to get about 4 hours of sleep a night with that as that is how zopiclone works. It isn’t ideal but it is definitely better than not sleeping at all during the night.

Living with Depression and Anxiety as a Mental Health Nurse

The past three months have been extremely challenging as I am in another depressive episode. I was off work for almost 7 weeks and it took a lot out of me to drag myself to work as my anxiety to return to work was overwhelming. As a mental health nurse, everything I have learned and my experience in supporting clients with mental health challenges does not mean anything in my own recovery.

Feelings of confusion and utter helplessness for not being able to use the various tools that I preach daily to my clients to use to help get them through the darkest hours does not even closely describe what my experience with depression is like. Depression is a word that is ubiquitous, heard by many, but understood only by those who have touched the blackness of it that threatens to engulf and shallow you whole.

The past four weeks I have been struggling to maintain my work plan and I have missed work days here and there. As I haven’t been working full time for the past 3 months, I am struggling to pay my debt and my partner isn’t able to cover everything for the both of us. My account has been seeing red for three months now. It has definitely ruined my credit standing. It will be difficult for me to get a loan after this.

This week is when I start working full time again. Still, I missed work yesterday because I had a cold. I was relieved that I had a cold because I have a reason apart from my depression to not go to work. Work today was slow and dreadful. I felt drained just being there. I am not even doing anything much at work apart from administrative stuff. Despite all the struggles, I am truly blessed to have colleagues who have been kind and supportive. This is what makes the days seem easier.