Tuesday, December 31, 2019

Is This Mic on?

Why I went an entire year without posting to my blog

Well, I mean, no one reads your blog anyway, right?
A year ago today in 2018, I was fidgeting on the examination table at my ob/gyn’s office, a paper drape wrapped awkwardly around my legs. I take these women ‘s health things pretty seriously; in 2012, I was diagnosed with Stage 0 cervical cancer (or carcinoma in situ), which really isn’t as serious as it sounds, but when you’ve just lost your job and your health insurance like I had, anything with the word “cancer” can seem pretty darn scary. I had avoided the dreaded pap smear for six years, too busy trying to balance work and four young children as a single mother, and who had time for self-care, let alone self-health-care?

(Planned Parenthood saved my life. The outpatient surgery was a fraction of the cost at their non-abortion performing clinic compared with other local providers, and they told me to pay “whatever you can, whenever you can.” Just a few weeks later, I had another, better job and health insurance).

Back to 2018. The perky medical assistant wheeled up the EMR cart and said, “I’m going to ask you a few questions about your health.” Sure. Standard stuff.

Then she asked, “Have you noticed a reduced interest in doing things that you normally enjoy?”

The question took me aback. This was a gynecological exam. The etymological history of the word hysteria aside, what did my mood have to do with my uterus?

“Yes,” I responded honestly.

“Are you feeling down, depressed, or hopeless? Have you felt that way for more than two weeks?”

“Yes,” I replied, “But it’s situational.”

And that situational depression—its causes and effects—is the reason I haven’t posted to my blog for a year. The situation involves a loved one, and that loved one has a medical condition for which the main treatment method involves the word “anonymous.” We don’t talk about it. We certainly don’t write about it.

After I continued to respond “yes” to each question on a nine-item depression screening instrument, the medical assistant stepped out to consult with my nurse practitioner who came into the room with a concerned smile.

“It’s situational,” I told her.

“I get that,” she said. “How long has this situation been affecting you?”

When did I stop hearing birdsong?

Was it in October, as the leaves changed colors and fell to the earth, as I grieved my dead father?

Certainly, the “situation” was serious by November, when I was a keynote speaker for the National Federation of Families for Children’s Mental Health annual conference. It took everything I had to pull on nylons, slip into my red power dress and navy blue jacket, step on a stage in Houston in front of hundreds of passionate, powerful mental health advocates, and share my family’s story. All I wanted to do then was to sleep—permanently. I felt like a fraud.

Everywhere I went in Houston during that trip, I saw ghosts. In the tunnels, my father, who worked at One Shell Plaza. In the public library, my teenage self, poring over microfiche news clippings about T.E. Lawrence’s death (my first published article, in Brigham Young University’s Insight Magazine, was about Lawrence of Arabia and the problem of modern heroism). In the theater district, my first love, turning to me with bright eyes at the fountains beside the Wortham Center after we saw Prokofiev’s Cinderella on my 18th birthday.

No, if I was being honest, the “situation” and my inability to function at normal levels was probably earlier than that—September 2018, the start of a new term, when I was eligible to apply for promotion but simply could not see how I deserved it. What was the point of gathering student evaluations? How could I possibly write a narrative highlighting my accomplishments in the classroom when I myself could not see them? Wasn’t I just a burden to everyone?

In hindsight, I think that at least subconsciously, I sensed some of the warning signs that summer, and I tried to take proactive measures. I stopped drinking in early 2018 and will never go back. I resumed my regular yoga practice, lying in corpse pose after a strenuous daily vinyasa flow.

In hindsight, it wasn’t enough.

I was first diagnosed with depression in my senior year of college, and the illness nearly derailed me. With medication, therapy, and incredibly supportive friends and family, I was able to persevere and recover, graduating on time.

When depression struck again during my third pregnancy, I was forced to confront the fact that my mental health condition might be chronic. Once again, medication—a risk during pregnancy but a necessary one—stabilized me.

Before my divorce in 2008, as my marriage was ending, I reached a crisis point (I talked about this turning point and stepping away from suicidal ideation in a 2018 Story Story Night performance about semicolons). Yet once I was on my own, despite the challenges, I felt tremendous gratitude for my life, for second chances, for my beautiful children. During the years that my son was sick, I focused my energy on caring for him, and I am so proud of the man he is becoming today. I was grateful for the opportunities that both Eric and I had to share our stories of hope and recovery. Eric's awesome TEDx Boise talk has way more views than mine (I call that a definite mom win!).

But as a mental health advocate, I hate to admit that I grew complacent during that ten-year reprieve about my own mental health.

When did I stop hearing birdsong? All that I know is this: by the time I took the stage in Houston, I was moving slowly through muffled, suffocating silence. The air pressed on my skin, creeping, crawling. I could not escape. What if the worst thing happens? I thought. What is the worst thing?

I survived. Then December 2018 came. The second week of December, when I lost hope, again, forever.

I have to be vague because if there’s one thing I’ve learned in my years of advocacy, it’s that our stories have boundaries. Where does my story end and where does yours begin? If you want to remain anonymous, do I need to remain silent too? What am I allowed to say? 

I’ve decided after a year of silence that I can talk about myself—my own experiences. I can say that in the second week of December 2018, I felt numb, grey, beyond hopeless, because being hopeless would require a knowledge of its opposite, hope, and those were just four letters on a page to me, like love, like self. These words had lost their meaning. In my experience with depression, everything is spoken and heard through thick cotton. Colors fade. Sleep disappears. Food has no taste. If there are birds, they do not sing.

I can say that this depressive episode was situational, but I cannot talk about the situation because stories have boundaries, and words have consequences. I know this more than most people.

I hate December. In my case, the consequences of sharing stories have involved my worst fears: the loss of my children.

In the second week of December 2018, I had 48 hours to find a new place to live. Thanks to white privilege and a good credit score, I was able to do this. And so there I was in my ob-gyn’s office on the last day of December, flunking a nine-question depression screening.

In 2014, after my book The Price of Silence: A Mom’sPerspective on Mental Illness was published, I had the extraordinary opportunity to meet with David Pate, then CEO of St. Luke’s, the largest healthcare provider in Idaho. He asked me, “If you could make one change to our current healthcare model that would promote mental health, what would you do?” 

I answered without hesitation. “Work mental health screenings into all physical wellness check-ups, from pediatrics on up,” I said. Of course, there are numerous other things we can do—more hospital beds for psychiatric care, integrated models of mental and physical health care, etc. But access to care all starts with knowledge and normalization.

And here I was, four years later, at a St. Luke’s women’s health clinic, experiencing the integration of a mental health screening in my own physical wellness check-up.

“It’s situational,” I told my nurse practitioner. “It will pass.”

“But you don’t have to live like this right now,” she replied. She touched my arm gently and I burst into tears. Not because I was sad—my depression is not sadness. Touch—any touch—was painfully intrusive.

She prescribed antidepressant medication, the same one I had taken during my two previous episodes. The medication worked—I could function again—but I didn’t feel like myself. I was productive but still emotionless, an automaton. I could sleep and eat again, but I still couldn’t hear the songs of birds.

“Let’s try something different,” she said.

We did. And the second medication worked. Everywhere I went, I felt like I was discovering a new language—the language of the birds. They were singing to me, warbling the forgotten words: hope, love, self, okay. I was okay.

I have become acutely attenuated to birdsong.

I have almost completed my promotion packet. Reflecting on my Fall 2018 semester has instilled me with a sense of humility and gratitude that makes me a better teacher.

I have accepted that the nameless heartbreak of December 2018 has become a part of me. 
The past can’t be fixed, but the future is interesting to me again. I want to try.

The "situation" is still a major part of my life, and it’s still anonymous, but I am trying to find ways to reclaim my own voice. And I’m trying to appreciate this opportunity to practice radical compassion. I’ve realized that these efforts will be the work of a lifetime and that as long as some mental health conditions continue to require silence and shame, our work as advocates must continue.

Mental health is physical health. In 2020, we have work to do.  

To be fair, I did write a lot in 2019, just not for my personal blog. I continue to blog regularly for One in Five Minds.org, an amazing organization dedicated to children's mental health, and I still write occasionally for Eagle Magazine and  Greenbelt Magazine. I also had my first short story, "Jesus, Take the Wheel," accepted for publication in the 2019 Writers in the Attic "Fuel" anthology from the Cabin.