Friday, November 28, 2008
Yesterday I woke up thinking I may not stay really depressed. I wasn't sure at first, because I never know what the day will bring, but it turned out to be an average day for me, and so did today. This is starkly different from earlier in the week when I felt like I was going into a real crisis, going to give up for good. I was angry at the world for giving up on me, angry at anyone I know with money for not recognizing how horrible my life is on my meager income and for not helping me. I was angry at my doctors for ceasing to investigate my condition once I had a 'descriptive' diagnosis. Those things have not been resolved, but I don't feel the anger intensely anymore. I am back to living in the present, enjoying my small victories and third-world luxuries.
I was thinking about this today, because this is the first time I've ever gone so far into feeling really depressed and just walked right back out of it. All my life I had episodes similar to this and could never stop sinking even when I tried, and I tried everything to fight sliding into the dark hell. I had no control over my thoughts, no control over my mood. I would just keep sinking deeper, it was just like quicksand. I could feel it coming on and it scared me to death. This time I was so angry, I actually wanted to be depressed. I said to myself, that's it, I'm giving up. Why should I bother if no one else cares? I can't do this by myself, but no one will help me, so why keep fighting when it's a losing battle? and so on. But here I am, two days later, feeling back to my normal, feeling okay again. Nothing has changed since earlier in the week. So what stopped me from sinking into the quicksand?
Today I was thinking about it, and the difference is this: I am not beating myself up anymore. All this bad stuff is happening to me, but I'm no longer telling myself that it's my fault. Somewhere along the line, in the course of my therapy, I 'snapped out' of it. I snapped out of the blaming-myself mindset, and it has made all the difference in the world. It seems more than just a turning point for me. It's like I went from black and white to colour, or walked through a door and locked it behind me. All those years I was struggling to forgive myself for being imperfect, I was asking the wrong question. Now I can see that question made no sense, because there was nothing to forgive. Once my therapist and I had teased out the thread, identified and discussed the cause and effect of the situation, I let go of the hatred I had for myself - for myself as a little girl, and myself as an adult. Once I really saw that being unloved as a child created all these wounds and the wounds made me think wrong. It's like I had my legs broken and they were never put in a cast, and I just grew that way, and my walking was mangled and lurching and every step hurt. And all along thinking it was my fault for getting my legs broke, and trying to hide my lurching, because if people saw my real walk, they'd know I'd done something so bad. I was ashamed of my broken legs, and I thought I should be. But then, with my therapist's help, I realized that someone else was responsible - someone else broke my legs, and that same someone else failed to get them fixed. That person was responsible for this, because she was responsible for me - I was a child, and she was my parent. She neglected to do the right thing, day after day, as I hobbled on my warped legs. (Interestingly to this extended metaphor, I was actually born with bowed legs. They were put in casts when I was a newborn.)
How to explain how this changed everything? My mind, which had been spewing forth indictments and criticism my whole life, stopped doing those things. I no longer needed to punish myself, because I had done nothing wrong. For awhile I was very angry about all the years of unfair treatment, locked in a torture chamber for so many years when all along I was innocent. It was a huge loss. And I was angry that she let me go on believing I was to blame, even after I'd grown up and was trying to live my own life. I went through a period of greiving what might have been. Don't get me wrong, I'd been thinking about what might have been for a very long time, but because I'd done it to myself (so I thought), it had an element of determinism to it, an element of 'it couldn't have been otherwise'. When I learned I wasn't responsible, that determinism element changed. Philosophically, when I think about it now, it is still there, for could she really have done differently? But it is easier to believe someone else could have chosen a different course of action than to believe that about yourself, especially since I know what was going on in my head. I was told once by a psychic that all my suffering in this life was not my fault, that it was karma from a previous life. I think my mother may have been the embodiment of that karma, for she is who has set me on this unusual path. And most of the time I don't begrudge this path, and I can be very grateful for it at times, because I feel like I have a real chance in this life to spiritually evolve an enormous amount. Attain the stream maybe. But the days when I feel so overwhelmed by my obstacles I am angry that she took away my potential for a normal life. On those days I ask that some of my suffering be more unconscious, not so in my face, ignorable. Or however 'normal' people have it.
Back to the point. I want to say that I don't think it is possible for me to be depressed now that the demon of my inner critic has become so muted. I can almost see her becoming a friend, though I'm not there yet. I still need to have some check and balance going on in order to keep my place, but that can be a friendly voice, helping me to stay on the path. It doesn't have to be malicious, just a "yoohoo" now and then. No, in order to be depressed, I need to have those 'tapes', that endless string of self-recrimination, self-doubt, self-criticism going on. I have to be telling myself that I should have done better, that I'll never measure up, anything less than perfect should make you ashamed, unless you are the best you are worthless etc. And most of all, everything bad is your fault. That demon makes me paranoid - a friend's bad mood is my doing. And catastrophizes - your mistake ruined everything. If you screw up once they'll leave you. And mind-reads - everybody thinks you are annoying. And all those other cognitive distortions. They stopped at the same time, too. All that extra commentary that 'regular' people don't do, I stopped doing also. Now I can take things as they are and move on, without analyzing my part in it, unless it's appropriate. The contents of my mind have altered, like someone flipped a switch and 'depressive thinking' was gone. The switch may as well be called "It's not your fault." The scene in Good Will Hunting where the counsellor kept telling Will "It's not your fault, it's not your fault" made me laugh, though I thought I understood how it worked, in its simple, cinematic way. Now I really get it. Because realizing "it's not my fault" changed my life too.
There may still be some remnants, some stragglers of abusive self-criticism, maybe that's what creates the guilt I feel for procrastinating (but I think this guilt is mostly about some other issue I haven't worked on yet). Maybe I'm still "shoulding" myself too much. JK has told me that in her perspective I am doing a lot of activity, when I complain that I haven't done much. I don't know if I can believe her entirely, because I'm here, and she's in another city, and so she doesn't see the hours I spend playing cards on the computer and farting around on Facebook. But maybe I can give myself more of a break. In fact, my therapist has said something about this too, that maybe I'm not procrastinating, maybe I'm resting because I need to rest. Or something like that, it was quite a few months ago. I've been thinking about my rest/activity balance lately...but that is a topic for later.
So, unless I bring that demon critic back by somehow re-convincing myself that as a child I should've known what was wrong and what to do about it, should have known that I was being neglected and not getting enough love and attention and sought out a way to compensate so I wouldn't be damaged by it. If I could somehow take back the compassion I've come to have for her, and start hating her again (I see I hated her because that was what was modelled for me - mom hates me so I should hate myself, because she must be right), if I could re-convince myself that I am utterly worthless and should be ashamed of myself and my life, well then the demon critic could reassert itself and I could really get and stay depressed. I could re-create the quicksand, hypothetically. But of course that is absurd. I do not want to give up the measure of inner peace this revelation has given me. I do not want to be under the thumb and out of control again. I don't want to hear all that negative stuff in my head.
I was thinking about all this, and wondering how I could effect a similar insight in my depressed friends. How to make them see that none of what they are suffering is their fault? I wanted to suss out what it took for me to get there, to get to that point, what finally flipped the switch. In truth, I think it was not only understanding the thread of cause and effect and seeing that a) I was not the cause, so b) could not be blamed for the effects, but also the space that was created for me by my therapist. Her acceptance, understanding, and above all, validation, opened up a safe space, and also a safety net, for me to be able to explore my being, past and present, and to see what came up with enough clarity. There was no lightbulb, no *ding*, no overwhelming sense of insight at the time. As I've said, the first thing I felt when I grasped this fact was not relief but anger and then, grief. Nevertheless, I'm placing a monument in my personal history by that memory, as the day that it was made possible for me to love myself, the day that my demon inner critic started to disappear. Maybe it was also the beginning of healing.
I don't know how to recreate this situation for my depressed friends. I don't even know if this is what is driving their self-hatred, their negative self-talk, their depression, but I suspect it might be, at least for one. This one had a childhood full of abuse, and is still abusing herself in her parent's place, just like I was. She is very hard on herself, perfectionistic and does a lot of self-harming. She has very real inner critics. The other seems to be stuck in a place where she thinks she should have been better yesterday, preventing her from starting where she is. I don't really know who she blames for her illnesses, but she also has perfectionistic tendencies. I know we are all different, and what works for me may not apply to them. But recovery seems to be a process with steps (not necessarily the famous twelve), and I've already heard one friend echo the first step - true willingness to take responsibility for making recovery happen, because nobody else is going to do it for us. So is it really so far-fetched to think I might be able to help her gain this one? But it is one thing to know intellectually that "it's not your fault", and another to internalize it and really believe it. To let it replace the core belief that you are to blame. To get to a place where your mind shifts from self-hatred to self-compassion, from self-abusing to self-accepting, self-helping. To literally just stop beating yourself up, and instead think about what will do you good, what will make you feel good, and be better, happier, more peaceful. Because despite all my recent complaints and pain and ongoing suffering, I've never been so emotionally well, so accepting of who I am.
I decided tonight to treat myself to lemon chicken dinner from the Lotus Leaf. Guess what my fortune-cookie said? "Good thoughts make life better." I couldn't agree more.
During exposure to a stressor, the brain initiates a cascade of responses. Glucocorticoids are released to mobilize energy, increase cardiovascular activity, and slow down unnecessary physiological processes. Chronic exposure to extremely high levels of glucocorticoids can seriously damage neurons; this is most evident in the hippocampus which contains a high concentration of glucocorticoid receptors. Various animal studies have shown permanent loss of glucocorticoid receptors in the hippocampus as well as significant damage to the hippocampal neurons, with resulting hippocampal degeneration.
Studies using magnetic resonance imaging (MRI) found reduced hippocampal volume in adults with PTSD. In their combat veteran research, Bremner et al. (1995) compared 26 Vietnam veterans with PTSD to 22 normal veterans, similar in age, sex, race, years of education, socioeconomic status, body size, and years of alcohol abuse. Combat veterans with PTSD had a statistically significant 8% smaller right hippocampal volume and a statistically insignificant 4% smaller left hippocampal volume.
In a similar study with adult survivors of childhood abuse, Bremner et al. (1996) found that those survivors with PTSD had a 12% smaller left hippocampal volume and a statistically insignificant 5% smaller right hippocampal volume. It is not known why persons traumatized as adults had smaller right hippocampal volume and those traumatized as children had smaller left hippocampal volume. The researchers suggest that larger sample sizes, with increased power, might find smaller volumes for both right and left hippocampal volumes. Another possibility is that there is a true difference in patients with early trauma, and that early trauma may interfere with brain development.
Diminished hippocampal size may be either a consequence of trauma exposure or a risk factor for the development of psychiatric complications following trauma exposure. Dysfunction of the hippocampus may be related to the fragmentation of memory that occurs with PTSD and to dissociation.
Similar findings were found by Stein, Koverola, Hanna, Torchia, & McClarty (1997) who measured hippocampal volume using the MRI in 21 women who reported being severely sexually abused in childhood. They compared these subjects to a control group of 21 socio-demographically similar women without abuse histories. A statistically significantly 5% smaller left hippocampal volume was found in the women who reported sexual victimization in childhood, as well as a statistically insignificant smaller right hippocampal volume. Left-sided hippocampal volume correlated highly (r = -0.73) with dissociative symptom severity. Stein et al. suggest that the relationship between symptom severity and hippocampal volume indicates that mesial temporal lobe dysfunction may directly mediate certain aspects of PTSD and dissociative disorder symptomatology.
Possible hippocampal degeneration is only one aspect of the complex picture. Studies on the physiological effects of trauma have found profound and substantial effects within multiple interconnected neurobiologic systems. Exposure to extreme or chronic trauma related stressors can result in abnormal patterns of neurotransmitter and hormonal activity, and in permanent changes in neuronal differentiation and organization. Neurobiological effects are evident in brain stem dysregulation, alterations within the central nervous system, irregularities in cortical function, alterations within catecholamine systems, and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and the hypothalamic-pituitary-thyroid axis.
Since these effects are pervasive, powerful, and occasionally permanent even for adults, it is apparent that childhood trauma can have a massive impact on the developing brain, with its high levels of plasticity. The child's brain is structured and neuronally organized by experience. There are substantial implications for all aspects of children's development, with potential deficits and impairment in emotional, behavioral, cognitive, and social functioning.
end of article
I have heard before that people suffering from depression, chronic abuse, or stress have a smaller hippocampus. In some cases, antidepressants can reverse at least part of the damage. I did not know that chronic or severe abuse could affect all those other systems, as highlighted in the article above. It mentions the brainstem, which I have been researching, and the HPA axis, which regulates the stress response. If the latter is malfunctioning, it could mean it is not getting the feedback necessary to 'turn off'. I studied this axis in university, so I know how it works. If it is always on, you are under constant stress, constant 'fight or flight'. You will have high levels of cortisol and other chemicals that are meant for short, emergency use. They are damaging if they are in the body for too long. All this could lead to adrenal exhaustion. Of course, I'm purely speculating, but somebody has to if I'm ever going to figure out what is going on with my body, and nobody else seems to be interested in doing it. Anyway, pain and fatigue - my body breaking down - could certainly be associated with a chronic stress response. So could an exaggerated startle response.
Obviously, I have never been to war, nor was I physically or sexually abused as a child. I don't have an official diagnosis of PTSD, but I do experience almost all the symptoms. Doesn't a nervous breakdown or suicidal episode qualify as a traumatic experience? What about living chronically with the fears of 'losing it', being 'discovered', and subconsciously threatened with losing food and shelter? How about twenty odd years of feeling worthless, unwanted, abnormal, and ashamed? Twenty odd years of a voice in your head saying you have to be perfect or else, saying you are so horrible you have to pretend to be someone else, saying you are a burden and in the way, and that it is your fault? Aren't those years full of chronic abuse? I have re-lived intrusively my own "humiliations" over and over again without being able to control or stop it. I jump out of my skin at least once a day. I never feel safe, even behind my locked door in my one-room apartment. Experience shapes your brain, this is a proven fact. What mangled and warped gray matter lays beneath my skull?
In my previous entry on sleeping, I didn’t discuss how my chronic pain affects my sleep. Nor did I mention the noise factor. So I should mention these things, just to have the full picture.
My apartment is situated on the second-floor, above an often used alleyway. My bed is situated so that my head is directly beside the window, which I have to keep open a crack for air circulation. From early morning on, and sometimes all times of the day and night, there are trucks bombing down the alley. In the relative silence of ‘sleep time’, these trucks sound like 747s taking off a run way. My neighbour has also described the sound like this. In addition, there seem to always be loud drunk people walking and hanging out below my window. This is especially bad on weekends. This makes it difficult to fall asleep and stay asleep, and I often get woken up in fright of these noises. Often the drunks are screaming and swearing at each other, whether in conflict or rowdiness. I can’t move my bed – my apartment is so tiny, the current arrangement is the only one that gives me enough space. I can’t sleep with my head at the other end of the bed – my floor slopes downwards at enough of an angle that beads roll to the far wall if I drop them. I don’t want to be sleeping with all my blood rushing to my head.
The pain. My whole life I slept on my side. Since I have had the back pain, I have no choice but to sleep on my back. It is always more difficult to fall asleep on my back, and difficult to remain on my back while asleep. I have support pillows that I use under my knees. Last night while I was trying to fall asleep, I could feel pain in my back despite lying in the proper position. I don’t know what else I can do, I can’t afford a new mattress. Last night my legs were killing me as well, and I had to take extra pain medication, 2 melatonin, and a zyprexa in order to get to sleep. I woke up today at 7 a.m., worrying.
Then there is my feet. On a good day, the pressure from my heels on the mattress creates a burning pain. On a bad day, my feet are ice cold and extremely painful. That alone can keep me awake all night. Sometimes putting my moccasins on doesn’t even make them warm, because there seems to be absolutely no circulation, and massaging my feet doesn’t create any. I have to put an electric heating pad directly over my feet. So going to bed requires all sorts of props, drugs and rituals. And still I don’t get quality sleep.
Taken together, these two entries detailing the problems that affect my sleep are overwhelming. Enough to go to my doctor with. It is ridiculous, when I think that most people just get into bed and sleep. Writing out these entries earlier in the week made me feel very hopeless and depressed. I wanted to give up, but how can I? I can’t even lie in bed all day like a depressed person, it becomes so uncomfortable. It’s getting to the point that no position can relieve my pain, and that is a frightening place to be.
I may be calling the pot black here as I sit here analyzing some stranger in a somewhat public place. My own ego is asserting its superiority in a 'backdoor' kind of way. Is ignorance any less of a pet peeve for me as nail-biting is for this woman? At least I am not claiming to be a saint. Whatever. I may be making an ass out of myself and being intolerant by writing this, but so be it.
After re-reading this post, I can see there is a bit of projection going on. This woman was being very judgemental, and I hate how judgemental I can be. Am I trying to disown it? I don't know. I have done a lot of work to loosen up the critical voice inside me. It doesn't attack me anymore, but I don't know if it continues to attack others. I have this intuition that I'm not really judging this woman, just writing about something that bugs me. Maybe I'm judging the behaviour I see, maybe I am judging ignorance. That's probably just as unenlightened. It is still difficult for me to switch to a compassionate mind-set when dealing with this kind of thing. There's always the question of what this woman is suffering that makes her act this way. Then again, pitying someone because of their ignorance probably isn't really compassion either. I readily admit I need a whole lot more work on compassion. When it comes to getting the "nothingness/suchness", I'm there, but compassion is very difficult for me. Which makes sense, considering the way I was treated without compassion when I was a child. I think that's one thing my mother still doesn't have either. However 'nice lady-ish' she is, I have never heard her say anything truly compassionate. She doesn't give one thought to anything outside her little monkeysphere, not the environment, not the starving and wretched around the world, nothing. Hell she doesn't even care about the suffering of her own daughter. When it comes to suffering, her head is fully in the sand. *sigh* Why does everything always come back to her. Well I know the answer to that. When am I ever going to be free of the effects of Mother?