Fix It and Forget It? Re-evaluating Mood Disorder and Coping Behavior
In my article titled “Thinking Out Loud: Emotional Stress or Brain Damage?” I explored the possible causes of my daily compulsion to deliver angry rants to an empty room. The article received several responses from people who engage in similar behavior and who see it as a healthy way of venting their pent up frustrations. These public affirmations made me examine more deeply my attitude about what is normal and what needs to be fixed.
After I had MS for a while, I learned better when to contact my doctors and what things I should tell them about what has changed. Disease maintenance is a daily, necessary part of managing multiple sclerosis. Harder to manage are the emotions that surface from time to time that may or may not be directly related to MS. For example, depression is one of the most talked about, written about, and researched symptoms, not only of MS but of many illnesses both acute and chronic—as well as being a condition prevalent among the population at large. Although medication and talk therapy can be of tremendous help to those who have been diagnosed with clinical depression, there is a troubled gray area in which I dwell that does not respond to these recommended treatments. I suspect this gray area shouldn’t even be categorized as depression. It is a zone of discomfort that I have probably distorted by thinking of it as a state of mind that needs its own DRG code. It’s no wonder; whenever I’ve sought out counseling with a professional, my initial consult would end with the therapist telling me that in order for insurance to pay for my sessions, we’ve got to call it something so s/he can give it a diagnostic code. How about depression? I agree to that for practical purposes--and from that point on I am labeled as a depressive. But am I?
Let’s stray a bit from the diagnosis of mood disorder. In an Oct 22 2015 interview on NPR’s “Here and Now,” mindfulness concept guru Jon Kabat-Zinn described part of his stress-reduction program as “putting out a welcome mat for the pain” instead of escaping it. His general audience is largely made up of those who seek distraction by using electronics, music, and various other means to keep oneself outside one’s body. Kabat-Zinn characterizes this kind of person as not ever paying attention to how their feet are feeling or who eat without looking at their food. A life lived on auto-pilot, as Kabat-Zinn describes it. Although that doesn’t characterize a typical MS patient and most certainly doesn’t describe me, mindfulness is nevertheless a helpful tool for chronically ill people as well. Kabat-Zinn remarked that so many of us go to mindfulness when conventional treatments have failed, when prescription meds and physical therapy just aren’t cutting it.
It is Kabat-Zinn’s concept of embracing discomfort that resonates and gave me a jumping off point to explore further--not to go forward to possible remedies, but to back pedal a bit and look at the value judgments I’ve made about how I feel and act--and which very much determines what I do next.
Take the subject of my article “Thinking Out Loud.” The behavior was incessant vocalizing of my every thought and feeling whenever I was alone. Since the behavior wasn’t something I’d ever done before, I thought of it as something being wrong. A problem. Months after the behavior started, I mentioned it to my neurologist and identified it as anxiety. I asked her to prescribe citalopram to see if it would quiet my mind. I was given a low dose. It quieted my mind all right; I couldn’t function at all, and ten days into the therapy, couldn’t even get out of bed, sleeping for 22 out of 24 hours until I decided to stop the drug all together. I immediately bounced back to baseline and started up with the chatter once more.
Why did I feel the need to pigeon-hole mood/behavior changes as anxiety or depression? We can certainly attribute these judgments in part to the structures—and strictures—of the medical insurance industry. But that’s only a piece of it. Let’s go farther back in time.
Sometime during elementary school, a new kind of pressure started up inside me. School had begun to be harder and there were subjects I had some trouble grasping. Back then—during the mid-1960s—feelings were not a subject that adults discussed with each other, let alone with children. I internalized my fears about being called on to answer a question and freezing in terror as I searched my brain for an answer that wasn’t there. During that era, kids were routinely scolded in class for not knowing an answer. The fear of imminent humiliation trumped my fear of failing a subject, riveting me to my chair in mortified silence during class discussions. I developed recurring stomach aches. After going to the nurse’s office several times, I was summoned to the principal’s office. I was in trouble. The principal delivered a chronology of my trips to the nurse—then more or less ordered me to knock it off. The stomach aches stopped. Then I developed migraines. I don’t think I even heard the term “stress” until my late teens. Faker, slacker, and emotional cripple were bandied about from time to time. We as a culture simply had no other language for it. Pop psychology wasn’t being covered in the mainstream media yet. To this day I become instantly withdrawn whenever I participate in a panel discussion where there is the risk of being called on to think on my feet. It still petrifies me. And it seems that somewhere along the line, stress behavior became a synonym for anxiety and depression.
Considering that we still live in a patriarchal culture, talking about emotions that arise from stress is not entirely acceptable yet. Feelings talk largely remains a fixture in the female domain, where women mainly talk to each other, be it sister, friend or mother. They are also more likely to use a hotline or online forum and talk to strangers than their male counterparts. Women intuitively understand the need to talk out their stress in an effort to purge it and feel better. Recent personal experience has reminded me that men still retain the mindset that if you tell them about something then you must want them to fix it. No wonder we have a medical establishment that is compelled to approach complex reporting of emotions as needing a fix. Seeing a counselor for talk therapy alone without drug therapy can be highly beneficial to many--and yet I've heard some of those satisfied customers express embarrassment about having these sessions, feeling that they are so pathetic that they need to "buy a friend" to listen to their woes.
Although we’ve come a long way towards naming, accepting, understanding, and embracing how we feel our lives, we still have a long way to go. Natural reactions to grief, stress and pain need a non-judgmental sympathetic audience, not a diagnostic code. We can’t control the behavior of others, nor should we shame them for their lack of awareness and compassion. That non-judgmental, sympathetic audience must start within us.
I still engage in strident chatter, but I no longer think of it as anxiety or a problem; it is, as some of my fellow MS patients have said, a coping tool. I no longer use the words depression and anxiety to describe anybody’s behavior. I’m boycotting those terms in protest against the uninformed glibness that these labels represent.
A coping tool is different from a mental illness or mood disorder. And if a couple of sessions with a therapist helped me identify which one it is, perhaps the bogus diagnostic code for depression I used for insurance coverage was worth the misdiagnosis if it moved me closer to embracing and giving a voice to my peculiar, unique, flawed, frustrated, shy, angry, wondering, wandering, inner self.
How do you feel before getting an MRI done?