Most of the composition of the original essay happened in August, when I gave the essay over for editing and publication. It’s obviously not August anymore.
In the midst of the fits and starts of our lives, that essay went through heavier editing than anything I’ve ever written in my life. I’m not a professional writer, and I’m bad to compose what I publish on the fly and just give it out to the world – sort of what I’m making myself do now with this blogpost, so I can get this done and get to working on other things that need to be written and graded. But I had a very strong sense from the onset that this story of my depression – both the past and the present of the story – needed to be told much more deliberately. I constructed a deliberate pitch for the essay before I wrote the draft, and I allowed myself to take time with the initial round of edits rather than just brushing the lot of them off and saying “this is my voice, take it or leave it.”
Part of the real benefit of this process was the editing of my words by Kelly Baker, who – along with Katie Rose Guest Pryal – has created this space online for a host of us to talk about our experience with all kinds of disability, and contribute narratives that don’t fit the expectation that popular media seems to want about disease and recovery and ongoing success in the face of adversity. I don’t have that kind of story to share, and it’s more than a bit of relief to find that there are a lot of folk who don’t have that kind of story to share either. Mental illness is a day-in, day-out lived experience, one that is very difficult for those who live “normal” to understand.
Kelly edited this thing with the greatest respect for my words but with questions that were pointed challenges. I leaned into the metaphor of running hard – after all, when I was younger, I literally ran from the problem. Kelly didn’t just let me toss the metaphor out there and leave it unanswered, though. What was I running from? Where did the compulsion to run come from, and what concrete fears was I dealing with as I grew to the point where I am now? They were questions I needed, not just in the moment, but to sit with and to answer as definitively as I could – not just for an essay, but for myself.
Going through the process of producing my essay with someone who understands the territory well and recognized the impulses I was feeling, even as she was provoking me to define them more carefully and more specifically, was a blessing that it’s hard to put into words. I’m grateful for all she gave into my work, and for the space that Kelly and Katie have created to receive it.
But time has passed between August and February, and I’ve had more time to sit with the proposed diagnosis of persistent depressive disorder and the medication I’m on to counter it.
The simple fact that I’m typing out these words on the same day I’ve worked on letters of recommendation and when I still have to plan for an upcoming conference is evidence that the medication is doing one of the most important things I need for it to, and that’s provide the focus to produce concrete results. One of the most frustrating symptoms of my depression was the inability to take initiative to perform a task and have the persistence to see that task through; I’d start a lot of different things, but my focus would badly fade. The antipsychotic medication I’m taking has provided a lot of defense against that.
It is a mild antipsychotic, however, and one of the side effects that comes with the antipsychotic is restlessness. I’ve learned a new word in this new time of medication – akathisia, the innate inability to sit still. Akathisia is a core side-effect of antipsychotic medication, and in its extreme expressions, it’s the effect that leads to the aggression or suicidal ideation that has been associated with antipsychotics.
I figured out very quickly that I couldn’t take even the smallest dose of the antipsychotic every day; the restlessness that resulted was simply overwhelming. I had to take it only on days when I needed the effect and I was going to be doing persistently anyway. When you’re teaching a lab, the restlessness and the instinct to move around quickly isn’t a side effect, it’s a positive feature. I settled into my own pattern of taking the medication, and the PA I was seeing supported it.
Even with both a traditional antidepressant and the augmenting antipsychotic, there are still days when the depression breaks through the gaps. My mood is extremely well-regulated, and emotional highs and lows are genuinely something in my past and not in my present – the antidepressant I take manages that spectacularly, also on the lowest possible dose. But just because the mood is managed doesn’t mean that the physical crashes associated with depression don’t appear – the fatigue, the loss of focus. That, I’m starting to believe, are features of the “double depression” that is a characteristic of persistent depressive disorder – and my suspicion, albeit one that I’m not going to be able to prove, is that the treatment arrests some features of a major depressive episode but not others.
When that happens, I have to forgive myself. It’s okay to take an extra couple of hours of sleep. It’s okay to take an evening off from work or commitments and recover. I do a lot, and I don’t acknowledge that I do a lot enough – or that other people find that lot of what what I do worthwhile.
Early in my professional life I only cared about what I did in the academic environment, and lived in that constant fear that I wasn’t doing enough. That’s the fear that tenure-track faculty are supposed to have, after all, and if you have to ask if you’re doing enough you’re obviously not. I’m much more satisfied now that having that sort of outlook on your professional life is toxic, and it leads you to miss the human element of life – family, friendship, kindness to strangers. I’m hopeful that I’m better at all of that now.
There’s one other element that’s been surprising in this process. I’ve been assuming the need for therapy with new medication or new life circumstance ever since I first allowed myself to admit depression was a reality. Through a comedy of errors and circumstance, I haven’t been able to see a single therapist since my arrival in Greeneville, and all the providers I have seen have told me that I don’t need therapy right now. It’s been very different going through the process of the strongest and most persistent bout I’ve had with depression without a mental health professional to dialogue with, but the trust I have in the medication is pretty strong and I’ve drawn on past dialogues and past experience to make the present moment work for me – and, as I mentioned in the essay, having a physician’s assistant who was willing to listen and respond patiently has been everything I genuinely needed.
That PA is leaving the region, however, and I’m going to need a new primary care provider within the next year. There will be a decision-making process ahead, and the story that the essay left unfinished has turns ahead.
But that’s the importance of the essay – that this story doesn’t get tied up in a neat bow. There are new realizations and new obstacles as life moves forward.
Two other things. One, I had believing friends express their appreciation for my honesty in the aftermath of the essay’s publication, which I appreciate a great deal – there’s a lot in spiritual experience that teaches incorrectly that dependence on God is more important than dependence on medicine, that assumes that mental illness isn’t actual mental illness at all. I didn’t really give that reality time in the essay, because I intended it for a much wider audience than us Jesus-freaks. But if you live in a spiritual existence while experiencing any mental dysfunction at all, Brant Hansen’s essay “Is Jesus Enough?” is an essential read – it’s over twelve years old at this point, but it still gets at the basic conflict I experience over being someone who believes that the Divine is all-powerful and entirely sufficient and yet here I am, on these mind-altering drugs.
The second thing applies to everyone, and it’s the standard exhortation – the reminder that, if you’re struggling with any kind of mental dysfunction, you are truly not alone, and there is somebody out there who shares your experience. I got told I was brave a whole lot for sharing all of this in that essay. I have a very hard time seeing this as bravery anymore; what’s become my therapy is the freedom to talk about my mental health in the reality of how I experience it. I’m happy to have this conversation anymore, as difficult as the conversation can be.
If you’re struggling, let the willingness to have the conversation about what you’re struggling with be your freedom too. There’s an old Margaret Becker song with the central lyric “God’s not afraid of your honesty/He can heal your heart if you speak honestly.” Again, I’m not interested in overspiritualizing this process; the outcome isn’t neat. But even in the messy imperfection of my own progress through mental illness, I hope the healing of my heart is evident in how freely I talk about the process of my treatment and in the welcome I extend to others.
So here’s a bench. Stop running. Rest a while.
And here’s to building other things.