I’m going to get a little extra-personal in this post, in the belief that the more honest and vulnerable I can be, the more my readers can understand the many nuances of life with mental illness.
I want to be a mother.
Of course I do. If you know me, I doubt you think any different. I have always loved children and I think I’m a pretty nurturing person. I like to take care of others. I really like holding babies. There has never been a time at which I have not thought that I would grow up to be a mom, that I would throw all my love and energy and joy and sanity into raising a family, that my husband and I would have cute babies who would grow into happy kids who would turn into sullen teenagers who, hopefully, would become the kind of adults who will love us and take care of us when we are old and creaky and grouchy. It’s always been our plan.
Ah, the plan -- that silly thing we occupy ourselves with making, and remaking, and pretending we have control over, until one day we realize that here we are, that carefully curated plan cast to the side, as we have busied ourselves with the actual, beautiful grind of just living our lives.
Before we got married, my husband told me (less than halfway joking) that he wanted to be “done having kids” by the time he was 30. Well -- almost six years later -- I am on the last legs of 29, he’s not far behind me, and there are no kids on the horizon.
I’ve grown accustomed to the questions, whether they are nosy or curious or needling or serious. “When are you thinking about having kids?” “Are you guys thinking about trying soon?” “You know if you wait until you’re ready, you’ll never actually have them.”
Please (and especially if you are a person who has asked me this yourself) don’t get me wrong. I’m not offended by the questions. We’ve been married for almost six years, and I’ve never been secretive about my desire to have kids. I’ve even offered a [very vague] time frame in the past (“oh, maybe in a year or two…”) so it seems pretty normal that as I round the base toward 30 I’d have to be at least thinking about it.
I know that I don’t need to own a home before I start a family. I know that I don’t need my finances to be in impeccable order before I think about getting pregnant. I know that nothing will actually prepare me for motherhood, because motherhood is unto itself one of the most breathtakingly difficult and wondrous things this life has to offer. I know that. Don’t tell me I shouldn’t wait to be ready; “ready” is a highly relative term.
There’s a lot of good awareness rising up lately about why it can be insensitive to ask a woman whether and when she is going to have children. She may be struggling with infertility. She may have grown up with parents who didn’t show her how love and family should be. She may have miscarried once, or twice, or so many times she can hardly count.
But did you ever think that she just might not feel that she is well enough, mentally, to responsibly bring a child into this world and care for it the way she knows she can, and longs to, and someday, hopefully, will?
Of course that’s not to say that people with mental illnesses can’t, or don’t, have happy, nurtured, cared-for children. They do! All the time! My point is simply that, just as with any other medical condition, some of us must work harder or think more carefully or wait longer to get to a healthy enough place to have kids.
On the surface, some days, I have my act together. I work full time, my house is reasonably organized and clean, I have a plan for dinner that doesn’t involve using an app on my phone to order it, I get all my errands done. I am acting like any regular adult who does these things all the time, and I think, “I’m so ready to add kids to this picture.”
Then soon, maybe the next day or the next hour even, the dark, vicious shadow starts to swirl in the air around me, encroaching on my mind, my space, my heart until it settles inside me, cloaking all of the light of my optimism, my hopes and goals in impenetrable darkness. “Of course you can’t be a mom,” the shadow tells me. “Look at you. You didn’t even shower or make your bed today. What makes you think you can be responsible for growing tiny lives and hearts and dreams when you can’t even make yourself a cup of coffee?”
Thankfully, the darkness doesn’t come as often or stay as long these days, especially compared to several months or a year ago, but it does still come. The doubts and insecurities that a healthy person might have about parenthood multiply tenfold, or more. How can someone who worries about being five minutes late for a dinner reservation possibly handle the concerns and anxieties of being a mother? How can someone who has had days of being unable to get out of bed, much less face the obligations and duties of everyday life, possibly bring a healthy child into this world and not mess it up?
Not to mention what the shadow tells me about the genetics of all of this. “Depression runs in your family. Do you really want to bring a person into the world who will experience this kind of pain and sickness? Do you think that’s a responsible thing to do? Do you think that’s fair?” No, I tell it. It sounds awful. Why would I ever knowingly give someone life when this is how they could feel once they get here? What kind of a mother would I be if I did that? What if my child had it worse than I ever have? It will be my fault. It is, in fact, desperately unfair.
Again, I beg you not to misunderstand; I don’t take these thoughts as truth. Depression lies, as we know, and it lies well, making us feel uninspired, unimportant, incapable, unworthy. I know that I will be a good mother, if I am ever blessed with that opportunity. I know that my husband will be an outstanding father. Any child we have will be showered with an absurd amount of love not only from us, but from grandparents, aunts and uncles, family, and friends. We will care for those kids, and love ‘em, and raise ‘em to the best of our ability, and no level of depression will change that. And I’m well aware that I can no more control passing on mental illness genes than I can the genes that may (or may not) pass along blonde hair and blue eyes, or near-sightedness, or the wide Finnish feet my husband’s side of the family always jokes about.
So the reason my husband and I are choosing to wait, to not have children at this exact moment of our lives and in our marriage, is not the fear that these thoughts are true. It’s the reality of the illness that causes them, the truth about where I am in my slog through the swamp of depression. I’m learning about myself, about my illness, about ways to treat myself better and cope with my emotions and change my behavior to allow for improvement in how I feel and think and live. In this way, no, I am not yet ready to become a mother. And yes, someday, hopefully soon, I will be more ready -- at least psychologically -- to step up to the task. And I need to be more ready, because there’s also the idea of what my hormones will do when I become pregnant, the need to taper off of medications I’ve come to rely on for the duration of my pregnancy, and, of course, my super-increased risk for serious postpartum depression. It’s a lot to think about, so yes, I want to be more ready than I am right now. I want that baby to grow inside a happy, healthy mama, and come out to be mothered by a woman who is strong, and graceful, and resilient, and rational, and self-loving. There are ways I can work on becoming those things for that baby now, so that I am more ready to evolve healthfully as a mother when the time comes.
But one of the biggest lies we learn from our culture, from social media, from the entertainment industry, is that life is a race -- that we must keep up with the neighbors -- that we must meet all of life’s milestones at the same time and in the same way that everyone else does.
A dear friend once shared with me the quote, “Comparison is the thief of joy.” (Google tells me that Theodore Roosevelt actually said it.) But I’m learning to live it. My children, whoever they will be and whenever they will come, will benefit far more from a mother who learned to live and grow and breathe and cope within her mental illness, rather than one who rushed into parenthood because she felt like it was supposed to be the right time. I will content myself with the knowledge that as I wait, and work on myself, my health, my recovery, my soul, I am becoming the mother that I will someday, Lord willing, actually need to be.
I’d love to be ready now. It’s hard to watch cousins and friends and former classmates announce pregnancies and start to grow their sweet families. Some days it actually really sucks. But most days it’s just another day to cherish being married to my best friend, have the chance to sleep in on weekends, be overly affectionate to my cat and focus on becoming well. “Ready” means different things to different people. Maybe these words can add a new layer of context, an extra tinge of compassion, the next time you wonder why that happily married, baby-loving couple hasn’t made their own just yet.
A few days ago, I had to go to the doctor. I was long overdue for my annual physical exam and it was time, but dread and apprehension coursed through my entire body at the thought of the whole thing. The appointment was absolutely one of those things that had me feeling like I wanted to throw a toddler-style, full-blown, kicking-and-screaming tantrum.
This anxiety and fear I was feeling, which had caused me to reschedule the appointment at least twice, had a lot more to do with my depression than it did with the actual appointment. I love my nurse practitioner and trust her implicitly. She saw me through rounds upon rounds of tests when we thought something physical was wrong before I was diagnosed with depression. She takes me seriously and is proactive, yet reassuring. I’ve never had a negative experience with her or with the aides or receptionists in the office. And while I often think that the physical symptoms of my depression could be markers of a more serious disease (you know, like the classic anxious person anthem: could these headaches be a brain tumor?), I really don’t fear some kind of awful, life-threatening diagnosis.
No, what I fear and dread, and even convince myself of, is that something will be wrong with my health that is my fault.
In the interest of transparency: over the past few years, as I have battled depression and put my body through a good number of different medications, I have gained a lot of weight. That’s not what I’m here to talk about, but I will say that I am decidedly an emotional eater, and when I’m depressed it’s my (unhealthy) habit to turn to food. It’s something I’m working on.
Anyway, between the weight gain and the knowledge that type two diabetes runs in my family on both sides, I had convinced myself that I had given myself the disease. This became an enormous source of anxiety for me. I would drink down a glass of water quickly and wonder, “Do I have excessive thirst?” At night if my eyes blurred for a second I would wonder if my vision was changing. I was sure that the junk food I had been turning to was going to catch up with me in a terrible new way, and that everyone I knew -- my doctor, my family, my friends, and most of all myself -- would blame and judge me for being sick. (They wouldn’t, nor do I blame anyone else for having medical problems. People get sick. It happens. They deserve love and care, not presumptions and judgment.)
I also have high blood pressure, another medical issue that runs in my family, and had used my remarkable skills of negative self-talk to force myself into believing that this is something I should feel guilty about and that is entirely my fault.
Cue the anxiety and dread about my visit to the doctor.
But the day came, and I found myself past the awful weigh-in (does anyone like that part?) and nodding to the aide who took my blood pressure that yes, I knew it was high. As I waited for the nurse practitioner to come in, my heart was pounding from anxiety and I felt the negative voices start to creep in. You’re so fat. You deserve health problems. They’re your fault. You’re not worthy of kind, adequate medical care. What do you think you’re doing here?
I realized that I needed to get this under control before the appointment started up again. I began taking deep breaths, trying to slow my pulse. “You are okay,” I started to think to myself. I’ve never been one for mantras, but this one was starting to form in my head almost independently of my own mind. I needed to back up. Before even thinking that I was okay, I needed to acknowledge that I was here, to ground myself, to congratulate myself on getting this far. “You are here,” I said to myself a few times. “You are okay.” The next part just came. “You are worthy.”
I spent the next several minutes breathing deeply, repeating over and over in my mind, “You are here. You are okay. You are worthy.”
I am worthy of quality medical care. I do deserve to be treated with respect, to take care of my body as it is right this second, to take the medication I need to control my blood pressure, to make sure the rest of me is healthy and to allow this wonderful nurse practitioner to take care of me. I am worthy.
The rest of the appointment went fine. I found out that my antidepressant could be causing the high blood pressure. My bloodwork came back, and I don’t have diabetes, or any other illness, now matter how hard my depression and anxiety had tried to convince me that I did and that it would be my own damn fault for gaining weight.
And you know what? If I did learn that I had a newfound health problem, I would still be worthy of respect, deserving of kindness, valuable enough to treat the disease and work to get healthier. It wouldn’t be the end of the world. I have decided that self-blame has no place in how I care for and treat my body.
I am worthy.
Medication for mental illness can be a touchy subject, and everyone is entitled to their own opinion. But I do honestly believe that some of us need psychotropic medication the way a diabetic needs insulin, the way short-sighted people need glasses, the way anyone else takes medication for a migraine or high blood pressure. Understanding that my brain is chemically imbalanced, and that I need medical help to balance it, has been a critical part of my illness and treatment. I refuse to be ashamed of that, and I’m happy to share my thoughts on it here.
You may recall from a previous post that I was started on Celexa by a college health center doctor who knew little about my personal depressive symptoms, and that I later learned that Celexa in particular can increase tiredness and fatigue (my primary, and most debilitating, symptoms). From there, I sought treatment from a psychopharmacologist who journeyed with me from Celexa to Wellbutrin, Prozac, and eventually Cymbalta, which I take now. At each visit she would ask how my mood that day was on a scale from one to ten. I’d answer as honestly as I could, tell her how the past couple of months had been, and we would discuss whether I felt good on the medication I was currently taking or if I was looking to make a change. As a person with depression, it’s always hard to know -- is this as good as it gets for me? Is there something that can help me feel even more like myself, with energy and passion and positivity?
But tinkering with medication is no joke. Each time we made a switch I would have to taper down slowly, sometimes adding in the new medication gradually, and take note of how I was feeling and what side effects I might be experiencing. I remember that Wellbutrin gave me a lot of energy, which was great, but when we bumped up my dosage I started to feel crabby and anxious, irritable and unable to tolerate even the slightest frustration. So we tapered back down. Some of the medications cause weight gain, or dry mouth, or hot flashes, so anything new that starts happening with your body sends up a red flag -- is this a side effect? My current medication (Cymbalta) causes hot flashes and excessive sweating, which is a lovely thing to deal with as a woman in her twenties. There’s nothing like being asked at a toddler’s birthday party if you’re crying, and having to wipe your cheeks and answer “no, I’m just sweating.” It’s a real self-esteem booster. But hey, at least I can smile while I answer. Cost-benefit analysis.
Other than that, I will sing Cymbalta’s praises (for me, and only me, as I’m not making ANY medical recommendations for anyone here). It has been a complete game changer for me. I was on a lower dose of it when I began to see my new therapist (who also now prescribes my medications), and she suggested going with the maximum dose to see how much it could help. And, you guys, IT HELPS! I went from feeling sort of okay some days to having REALLY GOOD days. My husband would come home from work in the evenings to find me having worked a full day, showered, dressed (these are bigger feats than I know how to explain) and cheerfully making dinner after doing several loads of laundry and cleaning some of the house. He said, on more than one occasion, “I haven’t seen this Lauren for at least five years.” I remember walking through my house one day, on my way to wash a dish or switch the laundry, and thinking to myself, “I’m just really freaking happy.” (Full disclosure: maybe my brain didn’t think the word freaking, exactly.)
Some people may argue that it’s unfair to simply take a pill and be happy, and to them I will say: this is not a permanent condition. There is no guarantee. I am not happy every day. I might not even be 50-50 on good vs. bad days. But my good days are so much better than the supposedly “good” days I have experienced in the past couple of years. More often, I am able to say that the highs of life feel as high as they should, instead of just moderately okay. More often, I am able to face the day without a mounting sense of dread or complete apathy. More often, I do what I need to do during any given day or week without missing work or canceling plans six different times.
Those who are against the use of medication to treat mental illness will say that the drugs are shortcut, a way of putting a bandaid on a wound that really needs stitches and professional attention to heal properly. They clamor that “putting in the work” (i.e., working through issues in therapy) is the only way to truly treat the disease. I will answer that while therapy may be the stitches and attention my wound needs to heal, the antidepressants are the ointment and dressing around the wound that keep it from getting infected, that make it livable, that make it tolerable and keep it safe while the healing occurs. I’m not choosing one or the other, but I will say that the meds help make this “wound” of depression tolerable while I’m working on healing myself in therapy -- and on some days, they’re the reason I can even get myself to therapy in the first place.
By July after my college graduation, I had a job and an apartment about an hour and a half away from my parents in one direction and my now-husband in the other. I met good people and enjoyed my work in a residential facility for teenage survivors of complex trauma. Most of all, I liked having the freedom of my own space. I found a psychopharmacologist who could continue to manage my medication, but I did not feel I needed a therapist. I was managing my fatigue and wasn’t, to the best of my memory, really experiencing other symptoms of depression at that time.
During my first meeting with the psychopharmacologist, she asked what my biggest depression symptom was and I answered promptly, “fatigue and exhaustion.” She looked at her notes and shook her head. I looked at her curiously, and she asked, “You were fatigued and they put you on Celexa?” I nodded. “Well, that’s interesting, because Celexa makes you tired.”
I remember raising my eyebrows and saying simply, “oh.” It hadn’t occurred to me to do any research on all the different medications available to me and their side effects, benefits or disadvantages. I took what I was given and went on my way. Looking back, I realized I had continued to feel tired, but my frame of mind had improved to the extent that I was able to manage the fatigue better. Lauren-on-Celexa was better than Lauren-on-nothing, but not as good as I could be on something else.
I don’t think I realized at the time how daunting it would be to spend months, and ultimately years, trying new medications on varying dosages (this continues to be part of my story, and I imagine it always will be -- more on that to come in a future post). However, I think this conversation did help me begin to realize that something better could be out there. If the wrong medication helped me feel a little better, how much could the right medication improve my condition? My condition -- there it was. After meeting with the psychopharm once every couple of months for awhile I began to see my situation for what it really was: an illness that required me to manage and attend to it in order to keep myself healthy.
I remained optimistic; this was a good time in my life. I really did love my job, and met one or two lifelong friends there, as well as several people who would shape my understanding of the social work field and of mental health in general. I was learning and growing, planning to become engaged soon, and aside from frequent bouts of fatigue, I felt well. But at the same time, I made frequent trips back to see my parents and visit the psychopharmacologist near their home; I took my new pills and contemplated the implications of living as a person with depression. I began to use my newfound understanding of the disease as a way to relate to the world around me. I no longer counted my depression as a passing phase of life; I planned to treat it with medication and self-care for the foreseeable future. This is not to say I had any clue what would come in later years (hint: it’s not pretty) but I at least was becoming aware of the need to adjust my expectations, however slightly, to include depression in my plans.
I want to make sure to note that I did not immediately come away from my first therapy appointment with a diagnosis and prescription. This is important! It took a several visits and lots of talking, as well as a couple of inventory-style tests, to determine that I was, indeed, depressed, and not just sickly and feeling down in the dumps.
After a couple of visits, my therapist had me describe the past year or so to her. I recounted the sudden ending of a serious relationship; a back injury that had caused me to drop a magazine internship and left me more or less lying in bed for a month; the recent theft of my laptop (and, as a result, the loss of the digital copies of all of my pictures from my semester in Madrid). I’m sure there was more. When I had finished, she said kindly, “I’m hearing about a lot of loss.”
I sat back and said, “Huh.”
I was happily in a new relationship (hello, husband!), my back had healed after some physical therapy, and I had a better, new computer -- and with most of my pictures on Facebook, I hadn’t really lost them all. In my mind, all of these losses had been resolved. Plus, they weren’t earth-shattering things -- they were normal life things that happen to everyone. But this wise woman explained how sometimes our minds and bodies can catalogue these losses, absorb the shock and sadness of them, and hold on to them, creating a kind of “circumstantial” depression. In her opinion, I was trying to recover from all these “life” things and just needed some help getting over the hump, as it were. She suggested medication to help with that, which I was open to, but I made her aware that I did not want to be on antidepressants for the long-term. “Am I on these for the rest of my life?” I asked nervously. She assured me that she didn’t see that being necessary in my case. I had every reason to believe that this was a temporary state of being for me, and I would come away healthier, happier, and ready to live my life again (without wanting to nap for an hour, every hour, on the hour).
I made an appointment with the doctor at the adjoining health center and she, without asking the specifics of my symptoms or what I hoped to gain from the medication, prescribed a smallish dose of Celexa to be taken daily. She told me it was a “middle of the road antidepressant” and I assumed she had conferred with my therapist (as I had given her permission to do), so I didn’t worry. I filled the prescription and began to take it.
The next few months are a blur, not because of depression but because I was entering the last two months of my college career. I think I did better. I took my medication and continued therapy. I finished and defended my thesis, which ended up being long enough and, I was told, good enough to have been an honors thesis as I had originally intended (too late). I attended all of the senior events -- my eating house formal, myriad college-sponsored celebrations, senior week at Folly Beach -- and had a fantastic time. I graduated cum laude and felt excited to see what was next. Saying goodbye to my friends and professors was hard, but I was content to move back home to Massachusetts with my family and figure out my next steps. By all appearances, I had made it over the hump of whatever circumstances were dragging me down, and in my mind, I was done with this “depression” thing.
I wasn’t done, or maybe it’s better said that depression wasn’t done with me. Now I understand that it likely never will be. I don’t say this with pessimism or hopelessness; just with the comprehension that depression, like most mental illnesses and many physical ones, is a chronic condition. With treatment, self-care and lots of attention, I can help it recede to the outskirts of my life on occasion (and hopefully, eventually, for longer chunks of time). But I’m learning to accept that my depression and I will never be done. Learning to live with that fact is another step toward a healthier life -- and so is cutting myself a break when the disease forges its way back into the center of my existence and takes hold. Depression may not be done with me, but I am most certainly not done with it.
Seven years ago this month, I found myself trudging up the hill and across the campus of my beloved, small-town Southern college to the local CVS. After browsing listlessly, feeling so exhausted I could hardly think straight, I rudely dropped a bag of peanut butter M&M’s down on the pharmacy counter and told the pharmacist I was picking up a prescription. She avoided eye contact and said, typing into her computer, “Celexa?” I nodded and wondered, vaguely amused, how many customers came in and wound up buying chocolate along with their antidepressants. Surely, I thought, I couldn’t be the only one.
As I dragged my aching body back across campus toward my apartment, I called my mother and my boyfriend (now my husband), tears in my eyes, to tell them that I had been diagnosed with depression and was starting medication, per the recommendations of the warm and reassuring counselor at the student health center. I felt simultaneously relieved and anxious; matter-of-fact and embarrassed; hopeless and yet at the same time, considering whether that might be a tiny blink of optimism I felt somewhere inside.
The diagnosis came after months of physical fatigue and malaise, vague aches and pains, a mind-numbing inability to concentrate, low-grade fevers, migraines. I thought everyone was tired all the time until, when I tired after about 30 minutes of shopping over winter break, my oldest childhood friend said to me: “Lauren, I don't think I ever feel tired like you do. Have you gone to a doctor for this?” This was a novel idea to me (Not everyone feels tired all the time?), and so I did as she suggested. My nurse practitioner tested me for lyme disease, mono, and the like -- nothing popped. She sent me to a rheumatologist to rule out fibromyalgia and an infectious disease doctor to eliminate the possibility of anything, well, infectious, and still: I got no answers.
Word of my mysterious ailment spread across our small senior class as I dropped my Spanish honors thesis, after several tearful sessions with my dear advisor, down to a regular one. “Tú tranquila,” he said to me. Calm down. “Sometimes life is more important than school.” I missed classes and passed on social events I would normally have looked forward to. Facebook recently dug up a post in my “Memories” in which a pre-med acquaintance who had heard I was sick asked if I had been tested for typhoid fever: “your symptoms seem to fit.” I was so very, very tired, and starting to be convinced I would never know why.
My roommates, friends and family did all they could to help. They organized a group of everyone I knew to write me encouraging letters (this was thoughtful and kind, and yet as I read them, my eyes stung with tears and my face burned with humiliation as I grew aware of how public my illness had become). They signed up for a farm share so we could enjoy healthy meals together. They encouraged me to exercise, to volunteer, to not just “sit around,” to which I said, fighting off tears, “I just can’t.” My mom came to visit, making the trek from Massachusetts to North Carolina just to be with me. Finally, two friends who had previously been helped by sessions with a counselor suggested I make an appointment so I could get help “dealing with not knowing what was wrong.”
That first visit marks the beginning of my journey with depression, in the sense that I was slowly becoming aware of what was really happening in my mind and body. I’m incredibly grateful (not to mention blessed!) to have had family and friends who supported me through such a stressful, frightening time; without each of them and their love, care, compassion and guidance, I may not have been diagnosed when I was. Seven years later, the struggle is realer than ever, harder than ever, and more painful than ever, but I have begun to learn that my personal moments of transparency and honesty -- with friends, with family members, with people in my social media network -- have allowed me a measure of peace, feeling that I am doing what I can to help my little corner of the world understand what it’s like to live with mental illness. That’s what I’m doing here. I’m going where it hurts, so that you can too, so that maybe one or two of you will better know how to approach mental illness when it touches someone you love. Because if it hasn’t yet, it will -- and they need you.