Friday, August 16, 2013

Guest Post: This is Not a Suicide Note

Written by the other half of me, the better half, who turns 40 tomorrow, Valentine

“Every generation wants to be the last. Every generation hates the next trend in music they can’t understand. We hate to give up those reins of our culture. To find our own music playing in elevators. The ballad for our revolution, turned into background music for a television commercial. To find our generation’s clothes and hair suddenly retro.” ― Chuck Palahniuk, Lullaby

I read that today and thought that it echoed my sentiments up until about a month ago. A lot has changed in the past month as I have had some breakthroughs in my therapy and improvements from my meds. Over the past year before this I had been journaling a lot to help get through some of my depressing (and darker) times. Sometimes I would put some of my thoughts on the internet – sometimes I would not.

My thoughts returned to the theme of getting older over and over again. I started continually working on one of my journal entries turning it into an essay of sorts. I think I am done with it now. Here it is, along with a couple of other things I wrote/worked on while being depressed.

This Is Not A Suicide Note

As much as you would like them to be, neither your mind nor your body are, or ever have been, lean, efficient machines. Mental illness has plagued you all of your life, and you have constantly had issues with your stomach throughout the years. You have never been naturally coordinated. In your twenties you managed to get a workout plan down that made you seem almost athletic. Years pass though. Time moves on and after 30 everything starts getting harder.

You start moving at a progressively slower and slower pace. If it took you five minutes to walk down the block last year, it takes seven minutes now – but you feel like you’re exerting the same amount of effort. You don’t make any changes to your diet or exercise but you start gaining weight. Muscle groups that don’t get used on a regular basis hurt the next time you use them. Playing a pickup game of basketball leaves you aching and sore.

You try to run a little farther, and eat a little bit better. Things don’t work right anymore and a pain shows up in your knee that was never there before. You give up.

Having a mortgage and family requires more ambition at work.

Kids need stuff.

Kids get hurt.

Kids get sick.

You find yourself at a desk in a cubicle staring at spreadsheets and numbers. Career moves happen. One workplace is traded for another. Income increases but the cubicle walls stay the same. You are stilling staring at spreadsheets and numbers. This was never the way you imagined your life - this was not a part of “the dream.” But here you are, helping support your family. You love them and this is what you are told you must do by the people around you. Stable job equals stability.

Time keeps moving. Now that you are pretty sedentary and don’t really watch what you eat, it shows. People make comments about your belly. You start riding you bike to work because you’re self-conscious and you’re insecure about your body.

The mid-thirties arrive and things are still harder and harder. You’ve made some strides here and there but your body doesn’t always cooperate. Playing basketball hurts more. You take up running again, and you start running farther and farther but then injuries happen. You buy special shoes and take other precautions. You workout more than you ever did before in your life. Even though it is harder than it ever was before, it makes you feel better about yourself. You actually lose the belly.

When you were younger you could eat whatever you wanted at any hour of the day. Now you eat before bed and you wake up with a burning feeling in your chest. Now you’re taking medicine to keep your stomach acid under control. It turns out other things bother your stomach too, and you start cutting those out. No more alcohol, no more peppermint, no more gluten. People tell you to quit drinking coffee… But you ignore them. It’s your only vice anymore.

Work is stressful, but…

You want to have cable and high-speed internet.

You want to have those special shoes for running.

You want your iPhone.

The harder you work at work, the more stress you have. Buying more things helps – momentarily. But then you need a little more money. You work a little harder, you climb up the ladder a bit, get a little more money to pay for stuff, you buy more stuff and then you need a little more money.

You have had anxiety attacks all your life. They got worse and worse, and you taught yourself to deal with them. But now they are happening all the time. You are having them so much the muscles in your chest start getting sore. There are knots in your shoulders and back. It becomes another pain you learn to deal with. Lying in bed at night your wife puts her hand on your chest and asks in alarm why your heart is beating so fast. It’s just another anxiety attack. You have a presentation tomorrow, or you ate too many cookies, or that one person in the office that you can’t deal with is in your head and you can’t think about anything else.

Mental illness is taking its toll - depression, OCD, anxiety disorder. It was always there, you just didn’t recognize it for what it was. After your first child was born you started having suicide fantasies more often. You weren’t sure how you could be so sad when you should be so happy with your life.

Different therapists have had different solutions. Some fell asleep while you were talking to them. You quit some of them. Eventually, you find one you like that helps you deal with these things in productive ways.

Therapy helps, but it is apparent there are chemical issues. There is a family history of mental illness. You’ve started different meds in the past, and quit different meds in the past. You worried about their effect on your creativity. You worried about society’s perception of you. You don’t worry anymore –they are a necessity. They are your new normal. You still don’t tell people though. You try to keep it a secret at work and amongst acquaintances. Only your friends ever get told the truth – if you tell them. You don’t want it to be a secret, but it isn’t exactly a conversation starter. Writing about it on the internet helps.

Depression is the hardest to deal with. The broad spectrum light on your desk isn’t helping as much as you hoped it would. The meds you’re on don’t seem to be effective anymore. Melancholy comes in waves, lasting weeks. Sadness doesn’t even seem to have a reason any more – it is just your state of being. Paxil, Neurontin, Zoloft, Sertraline… 50 milligrams, 100 milligrams, 150 milligrams, 200 milligrams… None of it keeps the suicide fantasies away.

You imagine getting a gun – you know plenty of people that have them – putting the barrel in your mouth or under your chin and pulling the trigger. You heard that if you wrap a towel around your head it keeps the brains from making a big mess everywhere; a courtesy to those that will find you.

You imagine slitting your wrists. To do it right you have to make a horizontal cut, and then a cut perpendicular along the vein to really let it bleed out. If you do it in the bathtub they can just pull the plug and let it all drain away.

You imagine jumping from the Hawthorne Bridge into the Willamette River. The current is strong and supposedly un-swimmable. It’s supposed to drown you. Turns out the Willamette River is pretty swimmable though. That won’t really work. Maybe walking out into the surf at the beach and letting a riptide get you?

You imagine filling the bath, getting one of the radio cassette decks and an extension cord and dropping it into the tub after you’re in it. That might be easier than slitting the wrists - easier to follow through with at least. Once you let go of the radio that’s it.

You imagine running the car in the garage and letting the carbon-monoxide build-up. Someone down the street from you did that in high-school so you know it works.

People keep jumping from the Vista Bridge. That seems to be a sure fire way to get it done. A long drop onto concrete. You haven’t heard of anyone surviving. It disrupts traffic and MAX though – depending on where you land. That makes it hard to keep the suicide low profile. Some people want to put up barriers to stop the jumpers.

When you were young you were idyllic. You thought the world could be changed. Now that you’re older, you’ve seen more of the world. You’ve become jaded to try and protect yourself from the disappointment. Change might be able to happen but it takes time. Nothing much will be different when you die. People will still hate each other and treat each other like crap. Humanity will keep destroying the planet we live on, bringing everyone closer to an inescapable apocalypse that no one can survive because the planet won’t be able to sustain life. Everyone only cares about right now and pays no regard to next year, next month, tomorrow or even later today.

You can’t watch or listen to the news anymore. Even the least biased seeming reports can set you off. Certain music can take you back to another time and place in your mind and some songs can almost make you cry. Like your diet, you have to be careful about what media you consume and when you consume it.

You’re tired of trying to ignore the problems in the world that have no direct effect on you.

You’re tired of pretending the ones that have a direct effect on you don’t.

You’re tired of the extremes on either side of an issue being the loudest and getting all the attention.

You want to be able to yell at all the selfish destructive people in the world, but you’re one of them, doing the same things in a slightly different way.

Even if you do yell, no one will change.

Not overnight.
You turn 40 this year. You have a marathon under your belt – running helps relieve the stress. You want to run another one. In fact, you want to run an ultra if you can. 40 miles on your 40th birthday. You track your mileage and speed and weight and calories. It’s better than obsessing over real problems. 40mg of Citalopram seem to be making you less anxiety prone, but it’s not doing anything for the OCD.

As 40 approaches, you’re getting better at being crazy. (No one else likes you calling it that but you don’t care.) If you make an effort you can catch negative thoughts and challenge them. You can redirect them and avoid the spins and spirals of the past. It is harder then you thought it would be though. It takes a lot of effort and is mentally exhausting. It is harder to wake up in the morning. Once you do get out of bed it is hard to get moving. Some mornings you miss your run. Some mornings you don’t even manage to walk the dog. That dog is your baby and this is the only thing she needs from you and you can’t make it happen. But you don’t spin on it – you challenge. The dog will be okay – she has her pills too. She will get a walk tonight or tomorrow. She is not neglected.

That right there – that was hard for you. That took effort and it made you feel a little more tired. Just writing this makes you tired. Writing this is a way of processing these feelings. You journal to help challenge and redirect the negative thoughts. It works – but sometimes you journal like this. You pull out this document and edit and rework things. This document is a good representation of how you feel, and how you have felt.

This document is not your suicide note – this document is the turning point. You turn 40 in three days. You may have convinced yourself that it is just a number. Yes you are slower. Yes, things are harder. Everyone else goes through the same things. You know this.

On Sunday, when you are 40 years and one day old, things will not be different. You will be the same as you are today, when you are 39 years and 362 days old.

Things will be fine.

Something Else I Wrote About Depression – sort of in conjunction with the last thing, but not exactly
The imbalance of chemicals in my head and the bad things in the world make me feel like I’m under a heavy blanket. It’s early in the morning and the alarm is going off. I know I need to wake up and get out of bed but I’m so tired and the blanket is so heavy.

Instead of pushing the blanket off, getting out of bed and turning off the alarm, I let the blanket muffle the noise. Maybe someone else will turn off the alarm… eventually. The blanket is so heavy.

A part of me thinks I should get out of bed and face the day. The heavy blanket makes it so hard though. I know that by staying in bed I’m messing things up but the other part of me knows how much more I would mess things up if I got out of bed. I’m too tired to be effective to anyone so I might as well stay in bed and spare everyone my inadequacies. Maybe it would be easier to just stay in bed forever.

But there are people in my life that care about me. They coax me out of bed. They try to convince me that I won’t screw everything up. They are supportive and loving and caring.

That heavy blanket still covers me though – they can’t make the blanket go away, try as they might. Sometimes, I just have to make my way through the day under the blanket. Things are muffled. It is hot and hard to breath. The blanket can trip me when I’m not careful. I just don’t know how to get out from under the blanket.

My wife can help. My therapist can help. My children can help. My canine companions help. I wish that my faith in God could help, but it doesn’t present the same relief it once did. I ask God why I have this blanket over me all the time and it seems like I don’t get a response. It makes me feel neglected - unwanted. I end up talking to God less and less.

It feels like I have been under the blanket for months now. I’ve been weighed down. It has been stuffy and the air is stale. I keep getting tripped up. The relief provided by those around me gets shorter and shorter. They can’t all be there all the time.

But now I have new chemicals to combat the ones in my head. It may not go well at first – I have had bad reactions in the past. I will need the help of loved ones and those I confide in to help me with the blanket. It may wrap itself more tightly, it may grow in size, and it may become thicker and more stifling. Hopefully the blanket will become thinner though. Hopefully the blanket will become smaller in size. Hopefully, the blanket will eventually go away.

Please God, take the blanket away.

Sertraline hydrochloride – according to Wikipedia with commentary by me

Mechanism of action for sertraline hydrochloride:

Sertraline is primarily a serotonin reuptake inhibitor, with a binding affinity of 3.3 nanomolars. Therapeutic doses of sertraline (50–200 mg/day) taken by patients for four weeks resulted in 80–90% inhibition of serotonin transporter in striatum as measured by positron emission tomography. A daily 9 mg dose was sufficient to inhibit 50% of serotonin transporter.

Sertraline is also a dopamine reuptake inhibitor, with an affinity of 315 nanomolars, a Sigma-1 receptor agonist with 5% of its serotonin reuptake inhibitor potency, and an Alpha-1 adrenoreceptor antagonist with 1–10% of its serotonin reuptake inhibitor potency. However, though confirming sertraline’s high affinity for Sigma-1 receptors, different studies suggest that the drug actually behaves as an antagonist at those.

Sertraline demonstrated anti-fungal activity against Candida species in vivo.

I hate mushrooms.

1 comment:

  1. You inspire me Val. I hope your blanket feels lighter as your days pass slowly. I care about you and your family and will be praying your blanket is removed. - Julia Most