Featured

Hope is not an emotion

This past year has taught me a precious lesson. I have, for many years, grossly misunderstood the nature of hope. And the more I longed for my imaginary version of hope, the more elusive hope became.

Hope, as it turns out, is as misunderstood as love. Like love, hope isn’t an emotion. In fact, hope doesn’t have to feel good in the least. Like love, hope is a choice and a commitment. A commitment to what? A commitment to keep choosing the path of life — in spite of feeling hopeless.

Child002
Ink

When I first started dealing with periods of severe depression in 2013, I came to believe that one does not simply choose to have hope. Those seasons of unspeakable, impenetrable internal darkness convinced me that sometimes, one is completely robbed of the capacity to have any hope at all. As such, I began taking for granted this notion that the only way to get out of those psychoemotional abysses was to hang in there and “wait it out”.

I don’t mean to say it doesn’t work. Sometimes, staying alive in itself can get so difficult that that’s all the work you can do. With your loved ones standing by your side and giving you just enough to not quit on life, and you dutifully taking your prescribed medication, the storm eventually dissipates, and you start to see the light again, and you find reason to get back on your feet.

But over the course of my last depressive episode, I noticed something rather peculiar. It started when my therapist told me, “You know, at some point, you’re going to get tired of despairing, and you’re going to want to do something.” This was after many sessions of me walking in simply because it gave me something to do, while remaining unreceptive and unwilling to acknowledge that things could get better. My first reaction to her remark was of annoyance and anger. Get TIRED of despairing? You make it sound like I’m choosing to despair. You make it sound like I know some kind of alternative to this terrible existence. But deep beneath all that maudlin angst, I knew she was on to something.

I was noticing that there comes a time when despair becomes your comfort zone. Yes, a very uncomfortable comfort zone, but a comfort zone nonetheless. It’s that zone where you’re no longer thrashing, kicking, writhing, screaming — but you’re floating in that murky, slushy, stinky cesspool of despair. Despairing, loathing, and bemoaning your existence has be come second nature, and the thought of recovery is actually scary. Despair is familiar; recovery is foreign. Not wanting to live has been your default state of being for so long that learning how to live again is intimidating.

Pablo_Picasso,_1902-03,_Femme_accroupie,_Crouching_Woman_(Woman_Sitting,_with_Hood),_oil_on_canvas,_90_x_71_cm,_Staatsgalerie,_Stuttgart
Detail of ‘Crouching Woman’ (1902) by Pablo Picasso

I reflected on this further, and then I went back to my therapist and admitted to her that I was afraid of recovering. I was afraid that if I should start making some changes to my mental and physical routines, I would start to feel better, but still find myself loathing my lot and my existence, and I would have no more excuse to be less than functional. I would have to accept the terribleness of my existence, and simply deal with it.

This admission to my therapist, but mostly to myself, was an important turning point. Of course, I didn’t make an instant 180 to start making tangible progress — I continued hemming and hawing for a while — the bad cognitive and behavioral habits that develop over months of despairing are so difficult to shake off. But there came a day when I decided I would find a way to start moving again. No, not because I felt better, not because I received a sign from heaven that all issues would be resolved. Simply because I realized I had nothing to lose.

It’s funny how that works. The flip-side of despairing about virtually everything is realizing that you have nothing to lose. And suddenly, you find there’s this untapped reservoir of boldness welling up within you. Call it tragic optimism, or a just darn clever biological mechanism that kicks you in the direction of recovery, but you can choose to ride that wave, or choose to continue thrashing.

FHuX5L
Detail of ‘Drowning Girl’ (1963) by Roy Lichtenstein

It became a psychological discipline to bat away negative thoughts, especially about myself. It doesn’t mean all of a sudden knowing what’s true and what’s false. Instead, the inner dialogue sounded a lot more like this: I know, I know, I’m useless and stupid… But I’m gonna be radically okay with it, and see how far I can go. And so I go about my my day having shelved that particular thought. I read a book, I go for the job interview, I enter into a conversation I would typically have avoided. Oh, yes, and I’m a cruel, heartless, wretched human being undeserving of love… But you know what? People seem okay with it. Let’s see how long I can go before I’m exposed. And again, I go about my day, agreeing to meet a friend, or attending a get-together instead of making excuses to stay home. Oh wait — how about the fact that I’m doomed to a lifetime of lonely misery and will never find happiness? Soon enough, I started being able to say, oh just shut up already. 

Perhaps it all boils down to putting aside your pride. We despair because we are unable to accept ourselves and our lives, or we believe the world cannot accept us, or both. It’s not an easy decision to make, but when we choose radical acceptance, magic happens. Slowly but surely, I started experiencing improvements in my mood. The more I put myself out there in spite of the forces threatening to engulf me, the more the clouds began to clear. My thoughts became more realistic, my emotions more stable, and my social anxiety markedly reduced. I became less inward-focused and could start loving and caring for other people again. At the very core of it, I came to recognize the inherent good of being alive once more.

And that was how I learned that you don’t sit around waiting to feel hopeful. Often, we imagine hope to mean seeing the light at the end of the tunnel, when it’s more like digging, grasping, and clawing your way through the dirt until you see the light. Hope is hard work. To decide that you are willing to try is a huge victory over despair, a huge cause for celebration for the people who have been rooting for you, and the beginning of a scary but empowering journey.

christinas-world-andrew-wyeth
‘Christina’s World’ (1948) by Andrew Wyeth

Hope is courageous: it is letting go of the dogged notion that you need X, Y, and Z to live, and being willing to attempt forging a new path. Hope is humble: it is admitting that you don’t know everything, and that your forecast of doom and gloom is fallible. Hope is radical: it is a commitment to stop comparing yourself to others (you know, the “happy, productive, and functional” folks), and focusing on doing what you can do in a given moment.

And finally, you may or may not agree, but I believe that true, lasting hope requires faith. I know that any of my efforts to reject the voices of my inner demons would have been unsustainable without faith in a loving and merciful God. What made those psychological disciplines possible was a deeply spiritual discipline: to begin each day offering up my fears, anxieties, and regrets to God, and trusting like a child that He is already paving for me a new path my eyes cannot yet see. For hope that is seen is not hope at all. And faith is confidence in what we hope for, and assurance of what we do not see. This hope will not put us to shame.

I thank God for the gift of faith, and for loved ones who, having exhausted creative means to motivate me, beseech me to turn to God.

We are not the sum of our weaknesses and failures. We are the sum of the Father’s love for us, and our real capacity to become the image of His Son.

–St John Paul II

Thank you for continuing to accompany me on this journey. 🙂

With a little help from antidepressants

unnamed

This month, The American Recall Center is encouraging conversations online and offline about medication safety (check out their post on the newly-discovered side effects of Xarelto). Judy, their Outreach Coordinator, got in touch recently asking if I’d be willing to write about my own experience with medication. I realized I’ve hardly (publicly) talked about the role of antidepressants in my road to recovery, and so I thought this could be a good place to start.

For 3 months or so, I’ve been getting by with a little help from Lexapro (or escitalopram). Owing to my own stubbornness, compounded by my ignorance about the nature and effects of antidepressants, I waited almost 6 months into this current cycle of depression before agreeing to be medicated. There are a few things I wish I’d known earlier, which I hope could be helpful to you or someone you know:

Antidepressants are not magic pills that will “make us forget all our pains” a la Helen’s drug in The Odyssey, as many people might assume. People looking for a “quick fix” would be disappointed, and it is unfortunate and irresponsible that antidepressants are overprescribed to people who don’t necessarily need them. On the flip side, they are underprescribed to those who actually need them, but are wary and skeptical of antidepressants. I belonged to the second camp.

I was under the impression that antidepressants were mood-altering drugs that would do no more that make me numb to my problems. So to me, to take antidepressants would be to live in denial. And since living with integrity is of paramount importance, this was a huge no-no. For half a year I resisted my parents’ and then-boyfriend’s persistent efforts to get me to see a psychiatrist, until eventually caving in only because I felt guilty for making them so anxious. “Oh, you’re definitely depressed,” the doctor told me as I tried to argue incoherently that I was simply seeing the true terribleness of my existence. She prescribed Lexapro. I brazenly told her, “This is not what I need. What use would it be to feel better and still be this despicable person that I am?” She asked matter-of-factly if I had anything to lose. I guess I didn’t. Perhaps at the very least I would stop embarrassing myself by sitting on road curbs or hugging lamp posts while sobbing about being alive.

Most antidepressants take about 4-6 weeks before they start taking effect. (There’s also a very real possibility that a particular antidepressant may have no effect, or none that is substantial, even after that period. In that case, your doctor would put you on a different antidepressant.) I first noticed it when I began moving around a lot more than usual while in the shower. Considering that I’d recently found myself curled up in a fetal position under running water, that was a big deal. On the same day, I also found myself having enough energy and motivation to finally clean up my bedroom from corner to corner. Overall, I began feeling generally “lighter”, while remaining acutely aware that I was still struggling with negative thoughts and a low self-esteem.

That leads me to the next point: the first symptoms to improve will be energy level, concentration, and motivation. And the last to improve will be your low mood and feelings of hopelessness. I was experiencing improvements in my ability to think, read, articulate myself, and perform basic, everyday tasks. And yet I continued to hate myself and have a bleak outlook on life. I mistakenly thought this was a confirmation of my initial understanding of antidepressants.

IMG_6987

That period before your mood begins to improve can be dangerous. While my suicidal thoughts used to be purely fantastical, during this period, I began to think they were actually quite reasonable and doable (it scares me to admit this now). This is a very real danger for anyone starting out on antidepressants: you might begin to have energy and cognitive ability to actually execute suicide plans. If a loved one is relatively new on antidepressants, please be more attentive and vigilant than usual. It is also important that they are taking these antidepressants under regular consultation with their doctor. He/she will be able to assess how well the patient is reacting to it, if there’s a need to adjust the dosage or switch to a different kind, etc.

I have come to a point where my mood has improved remarkably, and where I’m starting to have much healthier and more realistic thoughts. There is still one more thing I or anyone in my position should remember: do not stop taking your antidepressants at this point. During this cycle of depression, I was informed by my doctor that at whichever point I start feeling “fine”, I will actually need to stay on my medication, and at that optimal dosage, for an additional 9 months to maintain the balance within my body.

I’m also seeing a counselor regularly, even though I didn’t think I needed it anymore. When I found out what a long wait list there was, I told her, “You know, you should just give my slot to someone who needs it more than I do. I’m honestly quite okay nowadays.” However, she told me that given my history of recurrent major depression, it’s important that I continued to see someone to process what’s happened, and also so that the symptoms can be caught much earlier when depression returns. Experience with previous episodes confirm this: inadequate treatment can lead to relapse and recurrence. We should also note that it’s been well documented that the risk of recurrence increases with each subsequent episode. It’s not something we want to gamble with.

Lexapro is an SSRI, or selective serotonin reuptake inhibitor, one of the main classes of newer antidepressants. SSRIs act on a chemical in the brain called serotonin (a neurotransmitter), which helps relay signals from one area of the brain to another. Its many functions in the brain include the regulation of our moods, and many researchers believe that a serotonin deficit leads to depression. SSRIs elevate the level of serotonin in the brain by inhibiting its reuptake. They do not alter our personalities. I also strongly recommend talking to a counselor to complement the medication, and your doctor will most likely say the same. The medication will help us be better receptive to adjustments to our thought processes achieved through counseling, so these go hand in hand!

While depression distorts our perceptions, there are very real hurts in our lives that need to be healed, and real problems to be solved. We need to be in the right frame of mind and have adequate energy to be able to deal with them, and that’s where antidepressants come in. We are “dependent” on them only in the sense that someone with a broken foot has to depend on crutches until he recovers.

My final concern, and this will be pertinent to fellow Christians, is where psychiatric medication falls in our theological framework. We recognize the limitations (and dangers) of psychiatry when taken to reductionist, materialistic directions. It is preposterous to oversimplify mental illness as “chemical imbalance in the brain”, though I have definitely been guilty of that. The Church teaches that the human being is a union of body and soul — what affects physically will also affect us spiritually. We need a physician for our body, and we most certainly and desperately need a physician for our soul, and that is Christ. Seeking medical treatment is not to turn our backs on God — all truth is one; the wisdom amassed in the field of psychiatry, when rightly applied, is part of God’s gift to us. (Highly recommended reading: The Catholic Guide to Depression by Aaron Kheriaty, MD with Fr. John Cihak.) At the same time, we also don’t want to come to view antidepressants as a guarantor against suffering, for we know that in this lifetime there will always be suffering. But we take comfort in that with God we can offer our suffering for something greater than ourselves (I will save this another time — I know it’s not an easy thought to swallow — I will admit it is also rather difficult for me at this moment and I have much to learn from the saints who so lovingly carried their crosses).

I’ll end here for now. Unsure about anything? Talk to a medical professional. All I can share is based on my own experiences, plus some information from trusted sources — I am in no way qualified to dole out expert advice!

Who do you live for?

I share a particularly close relationship with one of my students. Today, I asked him: “Do you think your life is valuable?” He answered, “Sometimes.” I proceeded to steal 10 minutes from my Geometry lesson plan to discuss this further. We arrived at a common realization we’ve both experienced: you can’t always live for other people. It’s not sustainable.

We have both been at rock bottom for different reasons. In the deepest throes of clinical depression, I’d found myself absolutely abhorring myself, to the point of emotionally abusing myself as long as I’m awake, and being unable to look at myself in the mirror. I tried to keep myself going for the sake of the people who love me: my family, my then-boyfriend, and my close friends. But as my condition got worse, I would often think to myself: “Sure they’d be devastated if I were to take my own life. But realistically, they’d move on at some point. They’re not going to grieve forever.”

My doctor once told me, “You’re right, you can’t live for others. You have to find it within yourself.” But that, too, isn’t a foolproof mentality. Like I said earlier, it was it was impossible to live for myself while severely depressed. I simply wasn’t a fan of me. While I often tell this student about all the ways he is amazing, about the importance of loving himself and seeing his own potential, at the back of my mind I do know he needs more than that. And I hope he finds it someday.

So who am I living for?

Well, I live for my God. The God who breathes meaning and purpose into my existence, my relationships, my career, my joys, and even my suffering. In Christ the solid rock I stand, all other ground is sinking sand. I could crack or crumble, but the mighty hands that hold me never will. May I allow the recognition of His unfathomable love to fuel my every breath, thought, word, and deed. I pray the same for you, my brothers and sisters.

I know I have readers who don’t share my Christian convictions. Regardless, I would love to hear your answer to the same question I had to ask myself: “Who do you live for?”

(Addendum: I know I wrote about the importance of pouring ourselves out for others in my previous post. I am not negating any of it. But all the reasons I have any desire to serve others are rooted in God: He created us all and He created us all to love Him and love one another. Without God in the picture, living for others eventually became exhausting and “hollow”. But the moment God becomes the source, His goodness animates everything it touches.)

Screen Shot 2014-11-04 at 7.49.38 PM

Related post: My students are helping me recover from depressionHow do you find your “passion”?