Heart of Darkness

When I recently wrote my extended family to tell them I was too fatigued to celebrate our 50th Wedding Anniversary, many assumed I was fatigued because cancer had returned.

This is not so.

The fatigue is from almost overwhelming depression and anxiety.

The surgery and radiation treatment I had for cancer in 2018 was easier to bear. Recovery was smooth and linear. Support from family was heart-warming and helpful.  The pain was manageable.

My struggles with a recurrent major depression have been ongoing now for six months, with no improvement. (I am under the care of a good psychiatrist and recently started another new antidepressant.) The symptoms are more severe than I have experienced in thirty years.

Anxiety compounds the picture as it amplifies all my senses. My skin is super-sensitive to touch, sounds are all noisy (even running water from a faucet), reflections from mirrors and windows are distracting, and little pains convert to bigger pain.

What helps? We are attempting to solve the puzzle.

Quietness, completing little tasks, coloring, and listening to Jim reading to me (a 50 year tradition!), and sometimes reading on my own.

A quiet companion holding my hand is very soothing. Conversation and questions are agonizing.

Hope springs eternal? By God, let it be true.

Judith: Mentor and Friend

Many women have been important to my life, starting with my mother, who passed away about ten years ago. I miss her and think of her daily.

Isabel B., a neighbor and 4-H leader when I was growing up, was my second role model. I remember Mrs. B. was also active in the Farm Bureau Federation in Wisconsin. The Farm Bureau was, and perhaps still is, the largest organization serving as an advocate’s voice for farmers. My parents were dairy farmers. They also operated a small hybrid seed business (corn and oats), along with raising six children. It was a very, very busy life. So was Isabel’s.

As I look back, Isabel was ahead of her time. She would have been recognized as a career woman today. She was smart, perceptive, bold and energetic, and she made a big impression on me. I wish I would have told her so years ago, before she died.  My memory also reminds me that although Isabel had many talents and accomplishments, in speaking of her the community always appended their judgement:  That they saw her as a poor housekeeper!

I didn’t meet Judith until the late 1970’s. She was a full professor at the University Of Wisconsin-Madison’s college of Agriculture, in the department of Nutritional Sciences. I was employed as clinical instructor in dietetics serving the upperclassmen working on their practicums.  Judith taught the senior class on therapeutic nutrition – that plus her research, of course! – While I located, planned, and coordinated these student dietitians in various hospitals across the county. I supervised the students and Judith supervised me, as dietetics program director.

She also mentored me through the early months, cluing me into departmental politics, advising me when I had various problems with students (or they had problems with me), and critiquing my work.

Several years later, I told her about my past depression.  When work was done that day, we had a heart to heart talk and she invited me to her home for dinner. I was speechless but grateful and moved. Judith made us each a filet mignon, a real Caesar salad, and American fried potatoes. I can still picture our working in her kitchen together. That same night Judith told me that the recurrent depression I had inherited was a disability and only that. She said I could certainly not only survive with the illness, but thrive in spite of it, just as her grandmother had adapted to life with serious arthritis. It was my first encounter with someone who considered mental illness a disability, just as other illnesses and conditions can be disabilities. Her message stuck with me and fortified me.

Years and life have passed by since.

In the 1980’s, my depression reoccurred in a major way. It was interfering with every aspect of my life, work, home, parenting, etc. My psychiatrist and I tried many medications and found none of them effective. He then recommended that I be hospitalized for a work-up in the psych ward to determine if electric convulsive therapy (called ECT; and referred to as shock therapy by many) would be safe for me. I agreed.

I was granted leave from my work. Judith went to bat for me with the University, pulled strings, and saved my job for me. Unfortunately the ECT treatments didn’t relieve my depression. A few months later I was hospitalized again: I was suicidal. Again I was granted leave.

What was most meaningful to me was all the additional support Judith gave. She visited me regularly during both hospitalizations. She made food for my family (oddly, no one else did). I recall the meals were prepared in an electric skillet, already cooked, so that all my husband had to do was plug in the skillet and slowly reheat the food. Throughout this period Jim dealt with long commutes and the normal pressures of work, took care of our children, laundry and everything else, including a visit each night during my hospitalizations.  It was going to be difficult for him to get me to out-patient ECT treatments as well. So Judith arranged for my colleagues to drive me from our home to the out-patient clinic for each treatment, and then return me home as well!

Slowly I recovered and we picked up our lives again.

Time passes. Judith retired and moved to Arizona. We kept in touch via mail and email.

And time has continued: Last year, 2018, I developed cancer in my right jaw and gums. My husband alerted all our families and close friends, including Judith, of my upcoming surgery. Thankfully the surgery went well.  But after recovering from the neck resection, I began six weeks of radiation therapy. While the radiation was aimed at my right neck, rays necessarily passed through my lips and mouth. My mouth erupted in radiation sores; eating and drinking was difficult.

During all these months I had been receiving cards from Judith. The cards were delightful! But one message was different. When I read it I was thunderstruck.  My friend had been dealing with cancer for years. Several surgeries. She had never revealed or even mentioned these illnesses to me!

Judith now told me that she had been through radiation therapy to many parts of her digestive tract. She knew the misery. I received weekly cards from her during treatment, sending me tips for easier eating and swallowing. And, via mail, she laughed and cursed with me about radiation therapy and these damned illnesses. Her favorite repeatable admonishment was “Keep Plodding Along (KPA)”.

The last time I heard from my mentor and friend was the end of October last year: Judith was having another surgery, this time a mastectomy. I continued to correspond, but have not received any replies.

Some people we encounter in our lives are kind, thoughtful and go out of their way to make a difference in our life. Judith is and was that person for me.

Ellie

She was my maid-of-honor.

She was present at the birth of my son; years later she was present at his graduation from high school.

My favorite photograph of her is when she held my son at his baptism celebration; lovingly, tenderly, carefully, and as a mother would do.

I got to know her best when we were both adults, after her move to The Windy City. Ellie loved the bigness and sophistication of Chicago. It was a good fit.

We would have great long phone conversations, very fun, amusing and encouraging of one another. We planned one day to open a small restaurant together. The menu would be simple: Homemade soups, sandwiches, and salads – our favorite foods.

Several times Ellie, and her then partner, arranged for my husband and I to stay at luxurious hotels when we celebrated our wedding anniversary or visited Chicago’s Art Institute. They also hosted us at their apartment which she had beautifully and tastefully decorated. I remember her loving to add color and texture to furnishings through the use of throw pillows. I regaled in the gorgeous works of art mounted on the apartment walls.

Once she arranged an elaborate spread of food for a colleague and myself when the two of us attended a conference nearby. Ellie gave up her bed to my colleague and I that evening, while she slept on the sofa. My colleague, not easily impressed, was impressed!

Perhaps my fondest memory involves my daughter, then 16, coming to Chicago to find the right accessories for her prom dress. Ellie took us to her favorite downtown department store and helped  purchase jewelry and shoes.

Ellie was my sister. She passed away two years ago this month. I miss her and will never forget her.


 

The past few weeks have been a hard time and a difficult holiday season. Depression took firm grasp of my mind and darkly colored the days since I last wrote.

This blog today is dedicated to my deceased Great Aunt Lydia. My mother told me that Aunt Lydia was the only relative kind and gutsy enough to accompany mother to the state mental hospital in the 1950’s, visiting my father when he was committed to that facility. I’m impressed by Lydia’s support and I regret I hadn’t leaned this fact while Aunt Lydia was still living.

Love also goes out to those who helped me through these days: My husband, Children, Son-in-Law, and grandchildren, and for the encouragement and support from my brothers.

“It’s Looking A Lot Like Christmas”

Jim and I have fond memories of and admiration for the many, many special holidays that our parents provided all the years they were healthy. Christmases were joyous whether or not the preceding months had been difficult or pleasant for them. What an enduring gift!

This season we’re enjoying many Christmas traditions:  The festive wreath and evergreen trees – three this year (Yes, three trees!), decorated with old and new ornaments.  Outdoor lights glowing in the night for all; especially our lighted “Peace on Earth” sign. This proclamation a family tradition and prayer.  The many beautiful, rich and inspiring recorded melodies. Christmas services – this year we’ll attend Gail’s paternal grandparent’s church.  Holly.  Mistletoe.  Colorful poinsettias and flowering cyclamens.  The wonderful challenge of finding just the right gifts for our two fine children, terrific son–in-law and beloved grandchildren.  Grandmother’s ceramic Christmas tree (Alright, four trees).  All of us together preparing and serving delicious holiday meals.  Jim’s hot cocoa, and if I’m patient and persevering, my homemade large German Gingerbread House – this I’ll bake and frost featuring delightful Christmas candies and home-baked cookies!

Our blessings are too many to name; good health to be sure, but always beginning with loving family and friends.

Our wish for you is peace in the Christmas spirit; hope and joy in the new year. Hallelujah!

The Subtleties of an Illness: Depression

This past month and a half has been pretty darn difficult for me. Depression descended and stole all the beauty of the lovely fall season.  It terrorized me and made me feel helpless and without hope. I was close to losing my compass in life.

Depression does this by altering my thoughts, behaviors and feelings. It is powerful, life altering; so  sadly and tragically that it can kill by suicide. During depression my feelings are mistaken and flawed. Instead of knowing that I am capable of meeting life’s daily challenges, I feel overwhelmed by them. Getting dressed, for example, is an achievement. What? Why? With depression all little decisions are magnified and threatening. Choosing what to wear on a ordinary day is fueled by anxiety that whatever I choose, I will choose wrong. The negative thoughts that occur with depression are very real. Frequently, those  negative thoughts whisper that all is wrong with my life and my family’s life.  The thoughts and feelings attack my fundamental beliefs and values.

With beliefs and values shaken, depression is left to achieve a stranglehold on my mind.

Sadness pervades.

And I feel especially saddened for those who lived with depression before effective medications were realized and discovered. It was harder to live with depression back in the decades of the 50’s, 60’s and 70’s.  People with depression, or those who had had a nervous breakdown, were thought of as weak, or lazy or both. Lacking in character. Deficient.

Today we have become more open-minded. We know depression is an illness. Before long scientists will uncover exactly what gets tangled in the suffers brain. And luckily, we’ve found new medications that can be life saving.

My new medication will become active in about 3 weeks. Please understand that 3 weeks to me sounds like an eternity.

Understanding families and friends do ease the experience of depression, but In the meantime, I will endure and live through a bit of hell.

Fall. Tears.

October 4th, a Thursday, was a truly beautiful fall day. Crisp, clear, with a big blue sky. My husband and I went for a long afternoon drive in the rolling hills that characterize the driftless country that we live in and around.

I was taken by surprise when the tears started falling. Around every bend the tears fell. My old nemesis, depression was gaining a hold. It didn’t make any sense to be crying on this glorious day. But  I knew depression well enough by now to realize that depression doesn’t necessarily make sense.  It can literally appear out of the blue.

I got through the day by practicing mindful, close attention to my surroundings and my companion.  These kept me anchored.

But the depression has returned and is trying to take a permanent position in my daily life.  If I don’t work very hard to fight it, the depression will take a serious hold for many months. Shorter fall days of sunlight are a trigger to the seasonal disorder.

Clearly I can’t change the seasons nor would I want to change fall into summer, etc. Autumn is my favorite time of year. So what do I do? The depression is misleading. It tells me all things are bad, negative, and deeply darkly foreboding.

So what do I do?

I have two strategies to help me out of depression’s trap.  One is to revisit my list of things and people for which I am grateful. And the other is to create list of all the things and events I am looking forward to in the next 3 to 4 months. Some of those things and events bring a smile, even now.

I’ll name a few: homemade applesauce, baked squash and chili; college football and basketball games; celebrating Thanksgiving and Christmas with family and friends. Two pastimes, coloring and writing.  And , of course, discourse with my family. As I make this list I brighten up. The world is more inviting and rewarding with each minute.

I truly wish and hope for a fall that is fun and fulfilling and a winter with many sunny days for all of us. And that any depression that occurs can be cut down to size.

Thank you kindly.

Note On Preventing Suicide

Suicide is preventable. Truth is: most suicidal individuals want to live; they are just unable to see alternatives to their problems.

Truth so true: When I was 32, I was severely suicidal. I could see no end to my problems. The pain was all consuming and unbearable. My anxiety level was very high. I could hardly hold my hand still. Death seemed the only way out……..Yet, I really wanted to live.

My husband was a fierce and loving support. He asked how I was feeling. He was there for me, helping me connect with professional treatment. He kept me safe and supported. That someone who knew my worst thoughts about myself accepted me, warts and all, was invaluable. Most of all he taught me to have hope in life again.

The experience of being suicidal at that time and at others times in my life has created in me an empathy for all those who attempt or commit suicide.

Here are some principles of suicide prevention, principles that are used by prevention specialists across America. Please learn them and commit to suicide prevention.

# BeThe1To

If you think someone might be considering suicide, be the one to help them by taking these 5 steps:

  • ASK
  • KEEP THEM SAFE
  • BE THERE
  • HELP THEM CONNECT
  • FOLLOW UP

Be Aware of the Warning Signs

Hopelessness

Rage, uncontrolled anger, seeking revenge

Acting reckless or engaging in risky activities, seemingly without thinking

Feeling trapped – like there’s no way out

Increase in alcohol or drug use

Withdrawing from friends, family and society

Anxiety, agitation, unable to sleep or sleeping all the time

Dramatic mood changes

No reason for living; no sense of purpose in life

Here is some advice for responding to someone in despair and considering ending their life:

(From Mental Health America of Wisconsin)

Do:

  • Be aware. Learn the warning signs.
  • Get involved. Be available. Show interest  and support.
  • Ask if he/she is thinking about suicide.
  • Be direct. Talk openly and freely about suicide.
  • Be willing to listen. Allow for expression of feelings. Accept the feelings.
  • Be non-judgmental.

Don’t:

  • Debate whether suicide is right or wrong, or feelings good or bad.
  • Lecture on the value of life.
  • Dare him/her to do it.
  • Ask why, as this encourages defensiveness.
  • Act shocked. This creates distance.
  • Be sworn to secrecy. Seek support.
  • Offer glib reassurance; it only shows you don’t understand.

Offer:

  • Empathy, not sympathy
  • Hope that alternatives are available

Take action:

  • Remove means!
  • Get help from individuals or agencies specializing in crisis intervention and suicide prevention.

NATIONAL SUICIDE PREVENTION LIFELINE

               1-800-273 talk (8255)

               suicidepreventionlifeline.org

 

 

 

 

 

 

 

 

 

How about Our Rural Neighbor’s Mental Health?

Those of us who live and work in cities often forget there is a whole other way of living alongside our own metropolitan or suburban way of life: A large part of the US is still rural. According to US census bureau director John H Thompson, rural areas cover 97% of our land area and contain 20 percent of our people (60 million people).

Rural America is facing a health crisis.  Although the prevalence of mental illness is similar between rural and urban residents, rates of suicide are not.  Suicide rates (Reference – See chart attached) have been growing in the US as a whole since 2000; increasing by nearly 30 percent for both adults and children. That alone is cause for concern.  But the suicide rate in rural areas has increased by more than 40 percent in the same period.  Data from:  Trends in Suicide by level of Urbanization – United States, 1999 – 2015

Growing up in the country and on a farm in the 50’s and 60’s gave me some firsthand appreciation of rural health concerns, including mental health. My father became ill with was what then called a “nervous breakdown”. It was something shameful and no one talked it. It was all a personal failing.  Besides, the work never stops, how could one take “time off” to recover lost mental health?

I think about this issue every time I drive on our nearest rural county highway. I wonder about the health of my rural neighbors. Most of the farms are family farms and their appearance suggests times are tough.

A report entitled The Stigma of Mental Illness in Small Towns notes another of the barriers contributing to the rise in rural mental health problems is that many residents believe that that “I should not need help.”  Or simply don’t know where to go for assistance. Many times there is no mental health professional near and it is a significant burden of time and distance to travel for help.   

A study published in the journal JAMA Pediatrics in 2015 analyzed data on US youth suicide rates from 1996 to 2010. It found that the rates of suicides for rural Americans aged 10 to 24 was almost double the rate compared to their urban counterparts. This was attributed to social isolation, greater availability of guns and difficulty accessing healthcare

It seems that the stigma – that mental illness is shameful – may be felt more acutely in small rural communities. And there is a lack of anonymity there.

Again from The Stigma of Mental Illness in Small Towns:
“We as a society have a hard time asking for help, so it’s hard enough to ask for help without feeling that everybody’s going to know it,”……”Your neighbors don’t have a clue in a city if you’re to get some help. But everybody in a small town will know if your pick-up is parked outside the mental health provider’s office.”(same reference; quote by Dennis Mohatt, VP of the behavioral health at Western Interstate Commission for Higher Education (WICHE) and director of the WICHE Center for Rural Mental Health Research.

The upshot is that rural citizens with mental health needs enter care later in the course of their disease than do their urban peers; enter care with more serious, persistent and disabling symptoms and require more expensive and intensive treatment response.

A policy brief by the National Rural Health Association, The Future of Rural Behavioral Health, February, 2015, makes the case that rural needs can be met by behavioral health reforms addressing the availability, accessibility, affordability and acceptability of services. (new reference). “ Three-fourths of counties with populations of 2,500 to 20,000 lack a psychiatrist and  95 percent lack a child psychiatrist.” Primarily due to this shortage of mental health professionals, primary care caregivers provide a large proportion of mental health care in rural America and may lack the training and experience to handle serious mental health issues.

What would help the situation?

  • Increased emphasis on rural practice during professional training
  • Rural community residents, such as school counselors and members of the clergy, should receive educational material and information from Medicare, Medicaid, and private insurance companies concerning available resources for mental health issues.
  • Programs like Mental Health First Aid (MHA) may be useful in providing basic training to providers and other community resource people and reducing the stigma in the community.
  • Paraprofessionals and emerging professions can also augment the mental health workforce. One example is the emerging field of Peer Support Specialists. Peer Support Specialists themselves have personal experiences with mental illness and can offer invaluable perspective to patients in acute care settings.

And we all need to be more supportive of our rural neighbors.

Mass Shootings and the Myths that Arise

The recent mass shooting has lead me to serious consideration of the relationship between mental illness and violence. I’ll share what I have learned from my studies with you.

Four Myths Arise After Mass Shootings

One: Mental Illness Causes Gun Violence

Two: Psychiatric diagnosis can predict gun crime before it happens

Three: Because of the complex psychiatric histories of mass-shooters, gun control “won’t prevent” mass shootings

Four: US mass shootings “prove” that we should fear mentally ill loners

All four of these assumptions are incorrect, though understandable. Research by Dr. Jonathan Metzl and Kenneth T. MacLeisch finds that an isolated focus on mental illness is misguided.

In their article [1]“ Mental Illness, Mass Shootings and the Politics of American Firearms”, the two researchers analyzed data and literature linking guns and mental illness over the past 40 years.  The result of the research: most people with mental illness are not violent.

Fewer than 5 percent of the 120,000 gun-related killings in the US between 2001 and 2010 were perpetrated by people diagnosed with mental illness.

Misdirected Blame

“There are 32,000 gun deaths in the United States on average every year. People are far more likely to be shot by relatives, friends or acquaintances that they are by lone violent psychopaths.” Metzl and MacLeisch stated “We should set our attention and gun policies on the everyday shootings, not on the sensational shootings because there we will get much more traction in preventing gun crime.”

Mental Health Screenings Cannot Predict Gun Crime

Psychiatric diagnosis is in and of itself not predictive of violence. In fact, the vast majority of persons with serious mental illness do not engage in violent acts [2]. Those with mental illness are far more likely to harm themselves and frequently find themselves victims of violent crimes. [3].

Signs to Predict Gun Violence

If we focus on mental illness, we ignore those other factors that do predict gun violence more broadly:

  • Drug and alcohol use
  • History of violence
  • Access to firearms
  • Personal relationship stress

“People are far more likely to be shot by relatives, friends, enemies or acquaintances than they are by lone violent psychopaths“ [2].

What we can pay more attention to, as a nation, and as local governments, is the quality and availability of mental health care, medication, and health insurance.

“In a way it is a failure of the system often that becomes represented as a failure of the individual“ [1].

Sources cited:

[1] Mental Illness, Mass Shootings and the Politics of American Firearms
[2] Mental Illness is the wrong scapegoat after mass shootings, experts say
[3]  Gun Violence and mental illness: Study addresses perception vs. reality

– Gail Louise

Facts and Misdirection: Gun Violence and Mental Illness

I wanted to write an introduction on the criminalization of mental illness in my February posting. But there has been so much misinformation about the relationship of mental illness and gun violence in mass shootings that I am compelled to write to set the record straight. Here are the highlights of the true story on gun violence by people with mental illness.

The truth is that guns kill people and like it or not, we need effective gun control here in the US.  Focusing on people with mental illness as villains keeps us from tackling that fact, which is unpopular. Those for gun control know that we are up against the NRA and the politicians who kowtow to them.

According to research and experts on mental illness, as gathered and reported in the New York Times February 16th:

While gun violence experts have said that barring sales to people who are deemed dangerous by mental health providers could help prevent mass shootings, several more measures —including banning assault weapons and barring sales to convicted violent criminals—are more effective.

The Times also reported that Americans do not appear to have more mental health problems than other developed nations of comparable size, nations which experience far fewer mass shootings.

A 2016 study estimated that just 4 percent of violence is associated with serious mental illness alone. (National Institutes of Mental Health, National Institute of Health.)  Here is the conclusion of the study: ”Evidence is clear that the large majority of people with mental disorders do not engage in violence against others, and that most violent behavior is due to factors other than mental illness.”

A 2015 study found that less than 5 percent of gun-related killings in the US between 2001 and 2010 were committed by people with a diagnosis of mental illness.

So let’s stop being side-tracked by mental illness. Focus on the tough issue of gun control. Take on the protectors of the NRA!

Amen.