Tuesday, July 20, 2010

Should I Still Be in Therapy: Window Into a Depressed Mind

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For the past three and a half years I've been seeing a great therapist. I get a lot out of our sessions. When I've gone too long without regular appointments with Dr. O I have consistently relapsed into my worst depressive episodes. Without fail I stop doing the things that help keep me mentally healthy enough to function. So why do I keep wondering if I should continue going when it sometimes feels like I don't have much to talk about? Each time that thought has crept into my head and I've listened to it the same thing happens. The pattern is clear. Yet I'm at that point again where I'm questioning my need to continue therapy.

I like to think of my brain as having two parts: (1) Healthy Brain, the caretaking, good for me part; and (2) Sick Brain, the self-sabotaging part.

Healthy Brain says, "Good morning! Get out of bed and start your day, lovely Diana." "You should do your stretches today." "Don't forget to take your morning meds." "Let's jump on Twitter and see what people are saying."

Sick Brain says, "Sigh. Roll over and go back to sleep. Nothing happening today to make it worthwhile to get up." "Let that call go to voice mail. If they really need something they'll leave a message." "I'll do it tomorrow." "If I'm up by the time Cliff gets home he won't even know I slept all day."

Sick Brain doesn't tend to win the contest over Healthy Brain if I've been consistently doing the things that help me manage my depression. Sick Brain wins every time if I haven't and continues to win until I break the cycle by hitting the reset button and going back to therapy.

But what is it that tricks Healthy Brain into believing I might not need therapy anymore. Let's see:
  • Guilt: I don't want my family to have to pay for my treatment.
  • Denial: When I started behavioral pain management I realized I was in total denial about the severity of my depression. Now that I'm aware of my tendency toward denial I fight against it, but if I'm not vigilant I fall back into it. Especially because it's what the sick part of my brain wants. Sick Brain says, "Ignore your plan and come back to bed where it's nice and warm." Which is how Sick Brain gets a foothold and takes over.
  • Shame: I might not be worth helping. I'm a lost cause, so why bother?
  • Too much free time: Not having many things in my life that require me to function at a high level allows me to get away with cutting corners on my depression-bashing behaviors. I haven't been able to work because of the frequency of my chronic migraines, which in turn makes it hard for me to stay a step ahead of my depression. I don't have the kind of structure in my life that I once did. Despite doing the behavioral pain management program I struggle with trying to establish some of kind of artificial structure for myself. It definitely helped, but I'm still struggling to put the things I learned into practice.
  • I'm not worth it: This comes last on my list, but it's probably one of the ideas Sick Brain most easily conjures up when it's trying to get me to believe I don't need therapy. It's the belief I can't be worth anyone's investment of time or energy in me and my silly problems. As Sick Brain puts it, "I don't want to waste the therapist's time." This sounds ridiculous to me when I write it out, but it's what really goes through my mind. I don't want to be a burden to anyone, including my therapist. Yet another example of why I need to be in therapy, right? But sometimes Sick Brain sounds so convincing.

So let's recap. I know I need to continue therapy. But the sick part of my brain keeps trying to get me to sabotage myself. How do I keep the correct voice loud and prominent? How do we manage our mental illnesses when the mental illnesses themselves try to derail our efforts to do the things that help us manage them? Mental illnesses like depression are insidious, sneaky creatures unlike anything else I have ever encountered. I've got some ideas to share, which I will bring to you in another article. But I want to hear your thoughts: How do you stay ahead of depression when it wants to bring you down?

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DISCLAIMER: Nothing on this site constitutes medical or legal advice. I am a patient who is engaged and educated and enjoys sharing my experiences and news about migraines, pain and depression. Please consult your own health care providers for advice on your unique situation.