mental health mondays :: when to say when, part one

i'm glad to see that it's getting easier for people to admit when there's something that's not right in the old attic. personally, i try to encourage people to engage in these sorts of conversations, not so that we can have a group "woe is me" session, but because it tears the lid off how common it is to have periods of moderate to severe depression or anxiety and how increasingly common it is to take medications for a period of time to help alleviate the symptoms. it is easier to admit, but there does still seem to be a stigma that mental disorders are the domain of the weak or the hopelessly insane and that to admit that one has problems is to cast oneself into one of those categories. Not exactly something you want written on your c.v., for sure.

the great thing about open communication on the issue is that it allows people to better put their own depression and anxiety in context, which is the first step to understanding what can be done. because once you're able to admit that you're having difficulties, it opens up a whole other set of questions about how you're going to deal with them.

the disordered brain, actual image

first, let's dispense with the "weak or crazy" myths. these generally date from a time when there was comparatively little known about the brain, so it was largely assumed that everyone's noggin worked pretty much the same way (the sane way) as everybody else's. the only people who's brains worked differently were easily distinguishable by a mongoloid appearance, or by the fact that they were talking to god and refusing to wash for long periods of time. psychotherapy was highly theoretical and drew from the conjecture of a few influential figures who were able to do a lot of qualitative field testing.

over the course of the twentieth century and the first part of this one (over a decade in and it still feels weird to say that), scientists have been able to gather plenty of quantitative information about the brain. the fact that it still resists detailed poking and prodding while still in use means that it remains difficult to fully understand, but we're way ahead of wear we were when people came up with the idea that all brains were created equal.




brains are almost unimaginably complex (now there's a paradox for you) and we're not close to fully understanding all the factors that can make one work more efficiently than another, but we know enough to say without doubt that the movement of various chemicals has a tremendous effect on the functions of the body, including the so-called "pleasure centres" which are (no matter what you may be thinking) those areas of the brain that tell us whether something makes us feel good or bad. lots of things affect those chemicals- sleep, diet, exercise, injuries, virtually everything your body can do feeds back into the brain and the brain, in turn, tells your body how it feels about it.

so the next time someone starts with the talk about how mental illness is imaginary, remind them that that's what people thought of electricity, but somehow we have light in our houses.

so now that we've established that there are such things as mental disorders, it becomes a question of determining where to draw the line between a regular "up" or "down" cycle and a problem area. for this, i like to use the example of the stock market and point to duration as an indicator of severity. there are always spikes and "corrections", where things slow down, sometimes quite sharply. let's deal with the "down" cycles first. [i'll be dealing with the "up" cycles next week.]

1. a drop in the stock market, as any financial adviser will tell you, is a natural thing and the fact is that markets ride them out every year. without any interference, they come back on their own and things continue as usual. think of this as those periods of time when you feel down because you were turned down for publication or promotion, or when you're going through a break-up, or when you're recovering from an injury.

this is your brain on depression

2. after a certain period of down time, economists start referring to a "recession". this means that you've had a few bad indicators over a period of time. there aren't hard and fast rules, but personally, i favour simply looking at the symptoms, how much it's interfering with your life, whether it shows signs of getting worse, etc. and monitoring for a couple of months to see how it goes. you may or may not want to seek outside assistance, but at least look at some basic things you could be doing in order to ease your pain. [note: if your symptoms include thinking seriously and repeatedly about killing yourself, go directly to step 3 and get help.]

3. if a recession continues, economists determine that the market has entered a depression. a depression is not merely defined by its length, although that is a factor. depressions are severe systemic failures characterised by a lack of resources that would allow improvement. depressions are long in duration and require outside (in financial terms, government) assistance in order to maintain stability while they last and to build up confidence to the point where the economy (or the individual) can start to recover.

if you've been feeling low for months on end, if you're not sure what you could do to make things better, or if you've tried all that you know and nothing is working, this is when you need to move outside your own head and ask for help. help doesn't mean a doctor- it can mean anyone with a reasonably objective point of view and some understanding of how moods, emotions and brains actually work (i.e., recognise that mental problems are real as a start). that can mean a psychiatric professional, but you can just as easily start with a family doctor, a spiritual leader (if you're religious), or even friends. if you're wondering why i say "and even friends", it's because i actually don't think talking to friends about these sorts of things generally accomplishes very much, if for know other reason than that your friends aren't objective. that's not to say you shouldn't talk to them, it's just that they don't tend to make the best therapists.

the only way to monitor how much issues like depression and anxiety in its various forms are weighing on you is to observe your symptoms. and don't trust yourself to remember: write 'em down. there are a lot of perfectly valid sources of information on line about what the symptoms of these problems are. look for ones that are reputable- ones that site outside sources, that have a variety of identified contributors whose qualifications you can verify, ones that present facts rather than theories. as with many things, wikipedia makes a decent starting point. at the same time, find out things you can do that might help with these issues. if you're depressed, try being more active or following better sleeping patterns. if you're stressed, consider cutting down the caffeine intake. these may not solve your problems, but they aren't going to hurt.

if you've tried making adjustments and things still aren't working for you, you've probably reached that point we all dread: the decision on whether or not to medicate.

as far as non-medicinal methods of coping, there are an increasing number of studies on the effectiveness of exercise and diet (i would always recommend those as "first line" therapy anyway), on certain dietary supplements (be careful to look at how much is actually needed to produce a result- it's not as simple as eating salmon more often, although any excuse to eat salmon works for me) and on practices like cognitive behavioural therapy (which can often be a key to addressing the underlying causes of problem depression and anxiety).

if you do want to try medications, then know your options. you'll want to investigate for yourself and talk to your medical professional about the pros and cons of each one. i'll be giving a brief rundown of what your most popular choices will be in part two of this post.