Ten Years Later

This is another work in progress, although I don’t expect it to take as long to finish as my State of Faith essay (which still isn’t done). I’ve been thinking a lot about my mental health crash at the end of 2014, and this is how I’m documenting that. While it felt like the end of my world at the time, the changes I had to make in order to recover were the end of a lot of unhealthy thoughts and habits and the beginning of living a much healthier and happier life. Not perfect, but . . . I’m getting ahead of myself. Buckle in folks, it’s gonna be a bumpy ride.

The Crash

Ten years ago, on the Saturday before Christmas, 2014¹ I woke in a state of intense fear. I wasn’t afraid of something; I was afraid of everything and of nothing. Fear choked my lungs and sweated from my pores; I labored for every breath. I couldn’t run; I couldn’t hide; there was nothing to run or hide from. This was neither how I expected nor how I wanted to celebrate the birth of Jesus. It was going to define my life for the next two years.

I had gone to bed the night before finally feeling some calm after a long autumn of debilitating anxiety, recovering from a med change gone bad. I was exhausted and relieved that that awful season was finally over. My mind had other plans. At some point during the night, my brain decompensated, and my mind screamed, “tilt!” You know that twilight period when you aren’t quite asleep anymore, but neither are you awake, and the world is a warm and peaceful place, wrapped in the comfort of soft blankets and still dreaming wonderful dreams? Did. Not. Happen. I jolted awake, in what should have been the comfort of my own bed, instead into a state of hyper-alert terror. Sometimes you can pretend bad things aren’t happening by curling up in a ball and squeezing your eyes shut. No such luck. My body had betrayed me, and no amount of pretending could hide that.

I remember very little of the next few days—a chilly walk at Mendon Ponds Park with Chris, dragging myself to church and breaking down, sobbing, as I asked for prayer, a psychologist friend telling me it would eventually get better, an emergency visit to my psychiatrist, who prescribed an atypical antipsychotic and told me it should start to take effect in about three days. Then, Christmas with friends at their parents’, sharing a festive meal in a fog.

The antipsychotic worked and brought my anxiety down to a tolerable level within a week or so, but then the insomnia started. I staggered through work each day, then collapsed on the couch, wrapped in blankets, trying to make up for the sleep that refused to come at night. I was exhausted, barely able to move, dragging myself along until I collapsed at a med check. As I struggled to describe my suicidal thoughts through heaving sobs, my psychiatrist asked me if I could safely drive myself to the hospital.

I spent that night in the observation unit of the psychiatric ED at the hospital where I worked, then spent the next nine days on a locked inpatient unit. Concerned medical professionals asked me lots and lots of questions and devised a new cocktail of meds that would relieve my anxiety while letting me sleep. Thirty minutes after my first dose, I couldn’t keep my eyes open. I was encouraged to attend daily group therapy sessions and carefully filled geometric patterns with brightly colored pencils during arts & crafts time. It wasn’t basket weaving, but it kept my mind focused on something other than how hopelessly shitty my life had become, while the meds gradually did their work. After a week, I was able to put on my civvies and attend a day treatment program a mile or so away. Coming back to the hospital felt like reentering prison, and I was both relieved and disoriented when I was finally discharged to the care of my wife to finish out my two weeks in partial hospitalization. And then, it was back to work and normal life, or as normal as I could manage.

Recovery 1.0

I have few clear memories of that time, although pictures I took tell me that I was at least partially functional.² I lasted a few months, until a social worker colleague found me, unable to form a coherent sentence, sitting in the staff elevator lobby of the children’s hospital.³ She fetched my wife, who brought me back to the Psych ED. My psychiatrist was on service and admitted me to the partial hospitalization program again, after which he put me on three months of disability.

I don’t remember this period either, except that it was sometime during my disability that I started riding my bike nearly every day. I started with five or ten mile rides, then worked up to 25 or 30 miles per day, six or seven days per week. I rode from home to the Erie Canal trail, then to Fairport or Genesee Valley Park, or I rode up to Lake Ontario and over to the Genesee River where it flowed into the lake. I lost weight and gained endurance, and you could break rocks on my thighs. I returned to work for another several months, then, exhausted, went on another three months of disability and even longer bike rides. Two years after my crash, I was weaned off all my crisis meds but one (at a low dose) and finally felt stable in a new normal. Along with meds, therapy, and rest, I had literally ridden myself out of severe clinical anxiety and depression.

I was functional and stable; now I needed to build a new way of doing life that wouldn’t drag me back down into exhaustion and depression.

The Lead Up

This didn’t come from nowhere. I’ve struggled with depression most of my life, and over four decades of work on my emotional health have given me a clearer perspective as to where it came from and the ability to analyze it more objectively. I now believe the root causes were anxiety, which has a genetic component, persistent bullying, and weak inherited social skills. These produced anger, depression, and shame. I used to think my anger and depression were the causes, but I believe now those were only symptoms. Fearing my anger and trying to shut it down simply caused depression and more anger that erupted unpredictably.

While my problems developed over many years, I can trace their origins to childhood:

• Starting in third grade, I was persistently bullied in ways that wouldn’t be tolerated now. This was triggered by social changes at school and carried through to church, since many of the same families were part of both. Adults saw this happening, yet failed to protect me.⁴ To the contrary, they saw my justifiable anger and blamed me, labelling it as a temper that I had to learn to control.
• I was raised by geeks, which is a bit like being raised by wolves, except that wolves are pack animals and probably have better social skills. Dad loved us, but he was clueless as to how to express that, having come from a dysfunctional family. Mom was more demonstrative but could be passive—her NYC attitude was constrained by the religious and social mores around her.
• Our family suffered from a version of midwest nice—blend in, don’t complain, take what you’re given, you’re not so great after all, don’t ask for anything, don’t rise above your station, don’t expect much.
• I don’t remember our church itself being abusive, but there were kids from particular families who bullied me without consequences from their parents or church. I never much enjoyed Cadets (the church version of Scouts) or youth group. The one place I felt at home was the (adult) church choir.
• Anxiety . . . where do I start? I obsessed on perceived failures and embarrassments and had no hope of reaching the impossibly high bar I set for myself.
  • Failures were always my fault, due to my glaring defects.
  • Trying to fit in made my mind spin and heart ache.
  • I felt powerless against bullies.
  • Anxiety hurts. My shoulders and gut clenched ever tighter with no relief.
• I was smart, but smart wasn’t cool. Professor was an insult flung at weenies and wimps. I looked down on stupid kids to keep my self respect.
• It was clear to me that I was the problem—I was a defective human.

Graduating from a small Christian grade school and and moving to a large public high school was a shock to my system initially but longer term gave me room to be much more myself. My anger abated, but this is when I remember starting to feel intensely lonely at times and obsessing on unattainable girls. I remember less about anxiety, which presented as loneliness and lack of confidence—this led to me thinking that depression was my OG issue rather than anxiety.

In college, I mostly remember intense anxiety about keeping up with classwork. I had learned zero study skills in high school, and I spent most of my free time at the radio station during my freshman and sophomore years. Writing paralyzed me, and I got through German class by the grace of a very forgiving (if disappointed) professor. My junior year, I finally learned how to study, having failed a course taught by a professor I really liked. I think I buckled down as much to please him as to get better grades—I aced every course of his that I took from then on. Fear of writing almost prevented me from graduating, and I never mastered homework skills in other classes, although I improved. I’ve only learned in my 60s how to write without fear and that I could actually learn another language. Oddly enough, I worked obsessively on learning lines for plays—a skill that could have taken me far in other classes. I still procrastinated and worried, but I got the job done.

In my junior year, I had a brief, intense romance with a lovely young woman who suddenly and unceremoniously dumped me after I met her parents. I spent an awful semester or two pining after her and finally resolved to stop letting it make me miserable after a summer away. I was still struggling enough to seek out help from the college counseling center, and that was the first time I was ever diagnosed formally with depression. Because of a miscommunication about my graduation date, that work ended prematurely.

After college, I saw a few different therapists and took self help classes. I finally settled on a therapist who has remained a friend and counselor for nearly 40 years, through periods of intense work and interludes of emotional calm. I check in with him now as prophylaxis and to work through any issues I’m struggling with.

Prior to my crash, I’d gone through a long period of under- and unemployment and had finally landed a job as a vendor representative at URMC. I had difficulty navigating the sometimes conflicting priorities of my employer and my client and finally resolved that by becoming a medical center employee, but at only half time. The system I supported went though a series of changes in sponsorship, and I was largely sidelined. I felt useless and isolated, working in a tiny office with no real colleagues, and my mood sank lower and lower. My psychiatrist tried several medications to help my energy level, and the last of these med changes resulted in me essentially going off my primary antidepressant cold turkey (the new med was supposed to have the same effect but didn’t). Learning this at my med check, my psychiatrist immediately put me back on the old med, but I still had to wait six weeks for it to build back up to full effect. I was exhausted after suffering through months of mostly untreated anxiety, but it seemed I was finally back to a functional state and could move forward again. I had no idea how mistaken I was.

Recovery 2.0

Mental illness had destroyed the shaky equilibrium I’d patched together with meds and avoidant behavior, and now I was able to confront and solve problems instead of painfully limping through impossible conditions. Conflict was still scary but far better than going back to where I’d been. I had finally learned in my bones that my deep and abiding shame was a damned lie–I deserved to be loved and treated with respect, and taking care of myself was living well, not self indulgence.

So, what changed?

First, like any good patient in cognitive-behavioral therapy, I changed my unhealthy and self-defeating cognitive distortions. Five points for counseling-speak, but what does that really mean?

At age 52, I’d already made a lot of corrections to the cognitive bits. I’d been in counseling on and off since college, and I didn’t think I was worthless; however, I still felt worthless. Much as my Reformed upbringing might have tried to teach me that feelings were not to be trusted (partly true) and that they could be changed simply by thinking right thoughts (a tiny bit true), it turns out that feelings mostly lead thoughts, not the other way around. Both thoughts and feelings drive behavior, but feelings are the elephant, and thoughts are the rider.⁵ It’s possible for thoughts to change feelings, but it takes a lot of time and a lot of effort.

It also turns out that changing behavior can change feelings. If we act like a thing is true, our emotions will eventually follow. When I started acting like I was worth something and could accomplish goals, I started to believe those. I actually was accomplishing my goals, which made it a lot harder to feel, much less believe, that I couldn’t. This helped develop the confidence that had long evaded me. You might hope for a more intrinsic sense of worth, but even transactional self worth was a big improvement. It certainly was better than thinking I was better off dead.

I was acting like I was capable and worthy, and that changed my emotions and thoughts. So, what enabled me to change my actions? Simply put, I was pissed off. I had hit bottom, and didn’t care what anyone else thought—they couldn’t put me through anything worse than what I’d just been through. While out on disability, my only responsibilities were eating, sleeping, and occasional bathing. Getting out of bed was a life goal, and I could manage that.

I had time enough to do whatever I wanted, and my go-to activity was one I’d loved since I was a kid—riding my bike. I don’t mean riding around the block or to the grocery store. I mean riding hard for two hours, up and down steep hills and along the Erie Canal. I mean 30 mile rides to towns I rarely visited in a car, then riding 30 miles back. Rides that turned my legs to jelly and made me fall asleep as soon as my head hit the pillow—a welcome side effect, given that I was still anxious about my ability to sleep. If you’ve been so exhausted from insomnia that suicide seemed like a reasonable alternative, trust me, you worry about sleeping, and every night of good sleep put that fear further behind me.

Being pissed off, I decided, screw it, I’m going to do the things I’ve wanted to for decades but was afraid to try. I started taking cello lessons for the first time since college. I actually practiced. I took pictures on walks around my neighborhood and entered them in shows. Eventually, I bought a better camera and started volunteering as a photographer at the zoo. I bought a better photo editor, and my technique improved by leaps and bounds. I started setting boundaries and asserting them, which was a bit of a shock to people around me. I wasn’t obnoxious (for the most part), but I wouldn’t let people walk on me.

I repaired stuff at home, and I hired contractors to do the stuff I couldn’t, didn’t have the energy to do, or just plain disliked. Stuff was getting done, and I liked it. I was a better dad because I liked myself and could be patient with my children. I was happier at work because I wasn’t always hoping to be delivered from a job I disliked. I found ways to enjoy the work I was doing. My supervisor recognized I’d been underutilized (aka, bored out of my mind) and gave me more to do. I moved from an office where I was isolated and alone to a cube farm where I was surrounded by other people. Yep, you read right, a cube farm improved my mental health.

Ken 2.0

Chris now calls me Ken 2.0, and it’s a mostly positive assessment of the changes in my personality and behavior since my crash and recovery. Because she doesn’t live in my head, she notices changes in my behavior most—a few examples:

• The first thing she noticed was that I set boundaries. If I felt she was being unfair or mistreating me, I’d tell her, and I wouldn’t let her blame me for things that weren’t my fault. I tried not to to be unfair myself, but I called out behavior that made me say, “ouch”.
• I stopped apologizing for asking her to do things for me. I used to cringe when I asked her to scratch my back (my all-time favorite form of affection) because I had been conditioned to expect an annoyed response. Now I just ask, and if she can’t or doesn’t have enough energy, that’s fine.
• I’ve become much better at managing and regulating my emotions. Because I’ve grown more assertive, I address problems and annoyances before they can grow into huge issues in my mind and trigger disproportionate responses.
• Recently, due to a series of unforeseen events, we needed to purchase two cars in the space of three weeks. While that was stressful and tiring, I was able to respond and be helpful rather than becoming overwhelmed.
• I’m taking better care of myself. I eat better (although I still have a weakness for sweets), and biking has become an integral part of my life.
• My network of friends has grown, and I talk to them more often.
• As witnessed by this essay, I often process my thoughts and experiences in writing, which is a massively helpful relief valve.

Chris has noticed growth in her life in many of the same areas, I think, perhaps, inspired some by my growth. This is an educated guess, but I believe my newfound ability to work through problems more matter-of-factly and without so much defensiveness and anxiety has both reduced her defensiveness toward me and provided a positive example. We’re both mature and emotionally intelligent adults, but those qualities have been inhibited in the past by unhelpful ingrained/learned responses to each other. We were stuck in bad habits and needed to be forced out of our ingrained ways of being in order to break those habits. Hitting rock bottom emotionally and physically was the big stick for me.

So, have I arrived? Sort of. It’s axiomatic in mental healthcare that depression doesn’t just go away but requires lifelong management. I’m functional and I enjoy life, mostly, but I know I can’t just stay there—I need to proactively protect my mental and physical health. That means I get enough sleep and nap if I need to. I have become a bicycle commuter and get plenty of physical exercise. I talk to friends. I exercise my brain. I recognize when I’m anxious, but I don’t become anxious about it—that leads to a downward spiral and crash if you let it. I confront problems before they can become unmanageable. I work through problems instead of suffering in silence.