“What’s going on?” I wonder to myself--somewhat incredulous about my buoyant mood. “I mean, this is unexpected--in a glorious, life is 72 degrees outside type of way.” You see, my mood vacillates between uneasy and depressive. When my anxiety/depressive symptoms tighten their grip, my stomach churns itself into an all-consuming knot. My face reddens; I feel like I am concealing (and not very well) a bubbling inferno of emotions. For many mental health sufferers--myself included, our mental illness ravages like a snarling tiger. It distracts and depletes, consuming every reservoir of energy. To function--to preserve through the day, we have to muster every ounce of strength and willpower. Overly dramatic? Perhaps--but as any mental health consumer in the throes of a depressive episode and/or panic attack will tell you, life--at least at times--can feel like cleaning the bathroom toilet. Something to be done--marked by a grim determination. Borrowing from a well-known college basketball maxim, we are just trying to survive and advance (to the next day). So when those anxious/depressive thoughts suddenly don’t seem so suffocating, it is important to celebrate those days (weeks--if we are lucky). Today--bless its heart--is one of those days. I woke up and felt reinvigorated; there was a joyfulness in my step. When I interacted socially, I relaxed--reveling in my newfound serenity. When I sat down and wrote, the words flowed. It was strange--borderline disquieting--to feel so (knock on wood) calm. Where are my anxious/depressive thoughts--those ever-faithful accomplices? It felt like they took an all-expense holiday to Puerto Vallarta. The respite, more likely than not, will be short-lived. I am sure the anxious/depressive thoughts will return with a snarling vengeance--seeking to exact revenge on my mental equanimity. But before they invariably return, this mind vacation (can we just extend it for a couple more weeks?) provides much-needed clarity.
“Do you bowl alone?” “What?” you respond. “What do you mean--do I bowl alone?” More than you ability to pick up the two pin, I am interested in your social support network. In his seminal book Bowling Alone, Robert Putnam describes the social ties that bind communities. Insert the beer frame at your local bowling alley (or the weekly Rotary luncheon). While Putnam doesn’t directly implicate mental health in his seminal book (instead, he focuses on the steady deterioration of once thriving American communities), Putnam’s book prompts an urgent--and uncomfortable--question: What does Bowling Alone--and, more specifically, the loss of civic institutions mean for our collective mental health? My answer: With “significant correlation” between social support and mental health, the loss of these community institutions represents a significant blow to our collective psyche. In 2019, we live in a world of hundreds of Facebook friends, Twitter followers, and LinkedIn contacts yet, paradoxically, few close friends. We are more interconnected than ever before yet somehow more alone. The statistics speak to our collective isolation. According to this Psychology Today article, 25% of Americans have no meaningful social support at all--not a single person they confide in. Half of Americans report having no close confidants outside their family. Bowling alone? Try working alone, commuting alone, watching TV alone, and, sadly, dying alone. Anyone nodding solemnly? I know I am.
The language is insensitive--even incendiary: crazy, sicko, repeatedly pressing for more mental institutions like “the old days.” The comments--and their innuendos--divide--and, in the process, further stigmatize mental health. But, sadly, this isn’t the commentary of your crazy uncle at those dreaded family reunions; instead, these are the comments of Donald J. Trump. That would be President Trump. For the Donald, mental health is a plague--something that needs to be confined. Even quarantined. He routinely conflates mental illness and violence--perpetuating the false narrative that violence and mental illness are intertwined. When he isn’t peddling this false narrative, he is advocating for the return of mental health institutions. “You know, in the old days we had mental institutions. We had a lot of them. And you could nab someone like this, because they...knew something was off. You had to know that. People were calling all over the place,” the Donald informed/lectured. Donald--a little history lesson. Mental health institutions were closed in the 1960s because of safety concerns and deplorable conditions. They were routinely likened to prisons; this New York Times article hints at their despair and cruelty (“the smell of caged humans”). More than just lamenting mental health institutions, I find Donald’s disparagement of the mentally ill deeply disturbing. The President has the world’s most powerful bully pulpit--the ability to seize the day’s narrative with an opinion, quote, or tweet (however ill-advised). But instead of providing factual information about mental health, the President has used his bully pulpit to reinforce demeaning, damaging stereotypes. In the immediate aftermath of the Parkland, Florida shooting, the President referred to the alleged shooter as a “savage sicko.” At Trump’s urging, his then attorney general, Jeff Sessions, vowed to examine the “intersection of mental health and criminality.”
Note: This post may get me in trouble at home (notwithstanding that possibility, the post needs to be written). My girlfriend’s father is a thoughtful, generous guy. I have celebrated countless holiday with him, exchanging gifts and laughs. I genuinely enjoy his company--even when he shakes his head in disbelief at my fervent Democratic positions. Not surprisingly, Bob is active in his community; he has specifically volunteered for the Salvation Army. Serving meals to the indigent, Bob interacts with the less fortunate during his weekly volunteers shifts. When asked to describe his Salvation Army clients, Bob will, on occasion, reference their mental health. Or lack thereof. “They are mentally ill,” he has stated to me unequivocally. In his tone, there is no disparagement or condescension--just a factual acknowledgment of his clients’ mental health. Underlying his seemingly innocuous comment, there is an implicit assumption: mental health looks a certain way. It is the disheveled panhandler dependent on social services (and, incidentally, not the writer/lawyer dating his daughter). And, at some level, Bob’s assumption may be accurate. Among the Salvation Army clientele, it is reasonable to assume that a percentage of food pantry recipients battle mental health issues. Bob’s presumption is fair--even valid.
Life is tough. Our schedules are jam packed; we have work obligations, child care commitments, and -- Junior, stop that shrieking --hardly a moment to unwind from the inexorable daily grind. For parents (thankfully, which I am not), the grind must seem particularly indefatigable. I can hear the weariness --bordering on utter exhaustion -- when I chat with my parent friends. With life coming in hot, how many of us consistently attend to our mental health needs? I suspect that many of us don’t feel we have enough time (or money) to engage in mental health maintenance. The result: we put mental health on the back burner -- somewhere between cleaning out the garage and repairing that malfunctioning lawn mower. I was the same way -- until, that is, my mental health issues floored me. From adolescence to adulthood, I have battled mental health issues. During my freshman year of college, I was officially diagnosed with OCD -- although there were telltale signs during my teen years. Following my diagnosis, I met with a counselor every week in college. And, in part, because of the counselor’s direction/friendship, I thrived -- steadying myself after OCD threatened my equilibrium. When I attended (and stumbled) my way through law school, I had a weekly appointment with a trusted counselor. Law school provides enough mental anguish; I didn’t need my OCD and depression compounding matters. With a giant assist to Dr. Gullickson, I survived and, with a begrudging admittance, even semi-enjoyed law school’s tribalistic rituals. I can do without the Socratic method though.
For many of us, the New Year represents a rebirth--an opportunity to reflect on the previous year’s disappointments and, in some case, repair lingering hurt. In my case, my estranged relationship with my immediate family has been a perpetual source of consternation (and, at times, unending frustration). For those that struggle with family conflict, I am sure you can relate and, I hope, empathize with my broiling family turmoil. Dear Family, I want to wish you a belated Happy New Year. Our relationship is undeniably strained; we haven’t communicated since 2014. Most of our conversations are accusatory--armed with icy threats and recriminations. There have been belligerent phone calls and taunting emails--and that’s when we do communicate. Your lawsuit against me, of course, generated ill will (the property dispute, I believe, could have been resolved with a couple of phone conversations). That said, a reservoir of discontent has long stained our relationship. And, truthfully, I am not exactly sure why. Since Mom’s passing, we should be on the same page--working together to collectively heal our wounds (instead of brooding over slights--real or perceived). More than revisiting past hurts, I would like to take a moment to address the elephant in the room: my mental health. For you, mental health has been a perpetual source of tension and unease. You don’t know how to talk about mental health--and I suspect there has been confusion--even bewilderment--about my mental health diagnoses. This confusion has manifested itself in pejorative labels. These labels are hurtful--verbal grenades designed to demean.
“Damn it--this feels worse than my initial diagnosis,” I groaned before composing my latest email to Dr. Neumaier. “I feel off--like something is really wrong with me.” As I composed the latest email, I wondered what was going on. I understand depressive thoughts--and their, at times, permagrip on my psyche. I am all too familiar with OCD--and its, at times, stranglehold on my mind. But this felt different--a medley of panic, smoldering anxiety, and darkness threatening to torpedo my harried mind. As the sense of helplessness cresconded, I pulled over on the side of the interstate and clicked send on the panicked email. “Here’s hoping I can finally find some relief,” I lamented--before cursing Abilify’s name. Again. For years (strike that--decades), I have played medication roulette--shuffling from one medication to another. The overwhelming majority of medications have had potent--even debilitating---side effects (dry mouth, insomnia, marathon-like fatigue). But more than the aforementioned side effects, weaning myself off a particular medication has been the most difficult--and, at times, crippling side effect. Insert image of me hunched over the steering wheel wordsmithing the latest missive to Dr. Neumaier (We need to schedule that appointment ASAP!) The back story: Taking 1 mg of Abilify for the preceding month, I quickly tired of the medication’s corresponding lethargy. Fumbling over words, my mind felt like it was in verbal quicksand. I felt off--a strange mixture of passivity and detachment. While I had hoped Abilify would dull Wellbutrin’s sharp edges, my hope was descending into concern--even despair.
“How do you decide?” I probe my close friend. “Well, I just listen to my gut,” she responds matter of factly. I slowly nod--borderline incredulous. Who knew that making a decision could be so, well, easy? For OCD sufferers, decision making is an exercise in agony, indecisiveness, and self-doubt. If you don’t want to take my word for it, take the esteemed authors of Decision-Making Under Certainty in Obsessive-Compulsive Disorder. These authors chronicle--in painstaking detail--the chronic indecisiveness characterizing OCD sufferers. Referring to OCD as “the madness of doubt,” the authors state that “individuals with OCD often exhibit indecisiveness, pathological doubt, and avoidance of uncertainty.” Sorry---you may have just heard me grimace in that knowing, half smirk way. As any OCD sufferer knows, doubt--and the attendant anxiety--are willful, ravenous creatures. If the smoldering doubt doesn’t consume you, the swirling pit of anxiety will. In my case, I have watched indecision nearly paralyze me. In school, I would agonize over every last word of a a homework assignment. The writing process, painful during the best of days, would become agonizing. A 30 minute homework assignment would devolve into a three hour torture session--replete with frustrated sighs and guttural groans. Careers and relationships have also stagnated, if not suffered, because of indecision. Opting for law school (of course, on the last possible day of enrollment), my career has meandered from one unfulfilling career path to another. It has been a continual and, at times, fruitless search for something more meaningful than typical law firm tedium. Family and friends have expressed frustration--even exasperation--with my chronic indecisiveness. “Matt, just pick something,” they bellow. I suspect they view my indecisiveness as manipulative--something straight out of the passive-aggressive playbook. But as I mull over my options, there is an overriding concern: What if I make the wrong decision? In some cases--most notably when the OCD is at its shrieking histrionic worst, it seems easier to delegate than make an all-important decision.
Two parent family? Check. Highly regarded public school? Check. Excellent student? Check. Involved in extracurricular activities? Check. Mentally ill? Check (nods sheepishly). I grew up in Des Moines, Iowa--more Americana than apple pie. We had our own basketball court and a sprawling yard in a quiet, tree-lined neighborhood. There were family vacations to Colorado; Spring Break trips to Mexico. There was the the annual Thanksgiving extravaganza, where my aunts and uncles would descend on our cozy, brick home. In short, I had every advantage--involved parents (most notably, a caring mother), supportive aunts and uncles, and a rigorous academic environment. But OCD or, quite frankly, any mental illness doesn’t give a damn about your family pedigree, upscale neighborhood, or academic credentials. It just doesn’t. OCD first emerged during my teenage years. I remember the agony of turning in a seventh grade assignment--as I tossed one aborted draft after another into the wastepaper basket. The content, I am sure, was fine but I was obsessed about my handwriting. “It has to be perfect,” my mind implored. And it had to be; I remember my neverending frustration when I couldn’t meet my insatiable handwriting demands. Yes, handwriting. Insert head shake. My obsessional handwriting thoughts would soon metastasize into obsessional everything. On a family vacation to Florida in ninth grade, my OCD flared its ugly nostrils. The horrific thoughts besieged me; I felt defenseless as my mind staged a bloodless coup.
Did I commit that horrible crime? Did I hit that innocent pedestrian? Did I cheat on that exam? The answer, of course, is no. But as OCD sufferers, our minds are equal parts creative and callous. As my OCD mind churns out the latest falsehood, that nagging sense of doubt remains. In reality, OCD stands for obsessive compulsive doubt. The doubt--that second guessing--fuels our disorder. At times--and in a somewhat amusing twist, I have even doubted my OCD diagnosis (somehow that feels appropriate). For decades, I have struggled with doubt. As the latest OCD thought gurgles in my overtaxed mind, my OCD mind goads, “Matt--maybe, just maybe this thought is real.” And as any OCD sufferer knows, the thoughts feel real--often painfully so. And so the vicious cycle begins. As OCD tickles my mind, it pulls me back into its ether. With a furrowed brow and an array of legal pads, I would endlessly debate the latest distressing thought. The goal: to “figure out” OCD and, in turn, extinguish the all consuming doubt. A hard-learned lesson: a furrowed brow and army of legal pads cannot extinguish doubt and those accompanying pangs of anxiety (trust me, I have tried). Here’s the thing: Intellectually, I understand that certainty is an illusion. Doubt is a fundamental part of everyday existence. From our biggest philosophical questions (Does God exist?) to everyday minutiae (Did I lock the garage door?), doubt pervades our lives. And, truthfully, doubt can even be a positive, prompting us to be more careful when completing tasks. Case in point: Doubting my math abilities, I am much more careful when completing any task involving numbers. Carry the one, Matt.