The Best We Can Do

***This post took me 2 hours to write. It takes about 10 minutes to read. I posted it and then deleted it last night, but then reposted it today because I really do want to share even though it feels vulnerable.***
I’ve spoken with a lot of people in the past year who are struggling with depression. I work with a lot of therapists whose practices are overflowing with people seeking therapy over the last 12 months. I’ve heard many times from friends that they want to reach out but are worried about being a downer.
I know I’m not always great at reaching out because I often assume that other people are very busy. I’m almost always very happy, even sometimes relieved, to listen when someone reaches out to speak what’s on their heart. It doesn’t bring me down. I feel seen in their expression of their struggle and challenges. Hearing the truth of another’s life when they are real, vulnerable, and authentic is riveting and healing for me. I feel honored that they chose me to share with.
A boundary I sometimes have is that I won’t be available if I think that I am enabling someone to stay in an unsafe or toxic situation/relationship by continually listening and providing support. Then sometimes I must disengage to honor myself and them. It’s not my place to judge, but I can only do what I can do. I’m not always able to stay on top of my codependent tendencies in certain situations so I may walk away to prevent myself from needing to seek my own support to keep being that person’s support person.
I really, truly understand feeling and being depressed. I’ve had many long, intense battles with depression starting in my teens and lasting into my 40’s. I’m very lucky that the pandemic situation has not created depression for me. I’ve been very blessed in my health, work, spirit life, and friendship connections. I’ve been on a rollercoaster of sorts just being blown away by paradigm shifts of the past year on many levels, but I have mostly been very fortunate to be only slightly inconvenienced/affected by the coronavirus. But I understand depression deeply, even when I’m not experiencing it like a boot on my neck.
Here are some things that have really helped me in the past. I have a list of people that I can call who I know understand and are good listeners. I have a list of specific ways to ask for help. I have a list of actions that I know are helpful. I have a list of symptoms and thoughts that I know are dangerous. I have a list of medications and medicines I’ve taken and how they made me feel. The lists are important for me to have easily accessible. It’s my healthy self creating strategies to help my depressed self. Depression has a way of affecting my memory and motivation. Reading the lists is a reality check that I’ve developed over the years because of all the people that have helped me pull through at different times, I’m the one who has helped me the most.
I think it’s smart to be cautious about who you reach out to in speaking about your depression. Mental Health Awareness continues to grow all the time, but still, I’ve had many conversations that I made a note to not ever have again. Some people have been so uncomfortable with hearing about my pain that they said really intense, sometimes cruel, and unhelpful things. I believe that there are so many people with beautiful hearts that truly mean well, but just don’t get it. It can be hard to understand.
If possible, it’s better to find a therapist with whom you feel comfortable working with before it becomes a crisis. Trying to find one when you are already in crisis is rough. They sometimes don’t call back, don’t answer emails, have a full practice but don’t mention that on their website, or can’t fit you in for 2 months. Also, a huge percentage of people cannot afford therapy and/or aren’t able to find the right helpful therapeutic relationship or even become open enough and available to be helped by therapy. I encourage people lucky enough to be able to afford therapy or have good insurance to take the time to interview several therapists before choosing one. You want to feel comfortable, seen, and heard.
Another thing I’ve learned after seeing many different therapists over the years is that it is MY time. In some instances, I’ve paid up to $4 per minute, which lit a fire under my butt to quickly end those weird, long pauses at the beginning of the session where they usually wait for you to talk first. I tend to be very compliant and to want therapists to like me, so I will find myself being nice, considering what I say, and hoping to make the session interesting and engaging for my therapist. Eventually, I learned to keep a list of the topics that I really wanted to cover and get help with. I learned to bring those up each time and to address any issues that came up between me and the therapist right away. Having the harder, more awkward conversations, allowing myself to feel unlikeable, ugly, petty, and showing them the parts of me that I hide from everyone else, that’s all part of the deal of healing and growing. I was avoiding that for years by thinking that I could heal while still being nice, compliant, friendly, agreeable, and having no idea how to have agency and help myself to define and go after what I truly wanted in my life (different from what I thought I was supposed to want.) A few times quitting therapy when I felt like it was a breakthrough. Sometimes you are just done and you don’t want to pay $180 for a “closure session.”
It’s also helpful to know that usually a psychiatrist only handles the psychopharmacology part, monitoring your medication/anti-depressants. In my experience, several psychiatrists I’ve seen have been very cold, almost anti-social. Not even looking at me during the session, only typing rapidly into their computers. This might be only because I’ve used Kaiser…they historically/chronically have an abysmal track record for having enough available practitioners for the number of people that need help. I’ve waited 2-3 months to get an appointment before.
Someone once recommended that I see a psychiatric nurse practitioner and that was an amazing and very helpful experience, though very expensive as it was out of pocket. Over the years, I’ve been glad to know not to expect compassion or kindness from my MD or from a psychiatrist. I guess it’s not an important or efficient part of their business model. I truly hope that others have much better experiences than I have, but it was very shocking to me the way I was treated. AND I acknowledge that when I’m depressed, I easily perceive others as being cold, not liking me, or being disinterested in me. So there’s that.
I’ve tried 5 different antidepressant medications over the last 23 years. Prozac, Paxil, Wellbutrin, Zoloft, and Lamictal. In college, my campus doctor gave me an antidepressant and didn’t tell me not to drink alcohol. A few times I got very drunk and blacked out after only a few drinks. The negligence of that doctor is inexcusable in my opinion. He started me at too high a dose and didn’t check in with me or follow up. I felt very tense in my jaw, had intense stomach pains, and experienced weird facial fatigue like when you’ve been over-smiling all day and your face vibrates from exhaustion. I felt like I was buzzing all the time like a halogen light bulb noise in my brain. I didn’t know that I should report these symptoms or ask for my medication to be altered. I was 19. I think I hoped that it might help me lose weight, so I was okay to experience all those terrible side effects and didn’t know that it might be better with some tweaking.
Another antidepressant made me gain a lot of weight very quickly, one caused my hair to fall out, one caused violent intrusive thoughts and a very dark desire to end my life, much worse than the original depression. And 1 medication, Wellbutrin, worked really well almost instantly. That was the last one I tried.
I’ve been very against antidepressants for myself and I’ve also felt very grateful they exist. I’ve been outraged at the side effects my doctors did not tell me about and I’ve been shocked to learn about horror stories from some people taking the same antidepressant that worked well for me. It’s different for everyone.
I’ve felt people judge me for taking antidepressants and I’ve felt people judge me and be frustrated that I didn’t take them. It’s a very personal choice that I always feel an immense amount of inner conflict about. Two psychiatrists I’ve seen recommended for “someone like me” who has had several major depressive episodes, that I should be taking an antidepressant every day for the rest of my life. I disagree. I usually go off them, with or without my doctor’s consent, after about a year, sometimes sooner. For me, they are a tool I’ll accept to get me out of a very dark place, but the side effects are not tolerable in the long run.
I would never judge a person for making a decision to take or not take medication. It’s personal, judgement is never helpful. Listening is helpful. Curiosity is helpful. Reflecting and asking questions is helpful. One strategy I’ve found is to join several Facebook groups themed around people taking that medication to read lots of success stories and disappointment/horror stories. This helps me to know what to look out for. Even though there are extreme stories, I see patterns/commonalities and I trust those real people’s experiences over the 2-minute blurb my psychiatrist gives about how it’s going to “work really well and lots of patients really thrive on this.” It feels like a Jedi mind-trick like if they mention nothing bad, nothing bad will happen.
Several years ago, after being extremely depressed for over a year, my therapist recommended me for an intensive outpatient program that was 4 hours a day, 4 days a week, for a month. It included regular check-ins with my therapist, psychiatrist, and clinical staff support team. It was very interesting being around a group of others also struggling with severe depression. We each checked in daily about what our treatment plan was, who was on our support team, what we had planned for caring for ourselves that day, and how we were feeling. There were also a couple hours of instruction/education about different types of coping methods, meditation practices, CBT, and other behavior modification theories/models. It was actually very helpful.
I looked around the room at all the people there with me and I could see by their body postures who was going to get better and who was going to remain depressed. The people that were getting better were on board with their care plan and taking to heart the advice of the people they had entrusted to help them. They took the recommended steps, filled out the worksheets, and had open receptive body postures. They expressed their emotions rather than stuffing them down or denying them. They had more innocence than skepticism.
Others sat scowling, like they were being forced to be there, arms crossed over their chest, distracted, disengaged, and resistant. I’ve been both types of people, but I consciously chose to get all the healing I could from that experience…take the medication, answer the questions, show up each day, and participate as if my life depended on it. It was so humbling and it helped me so much.
The day I made that decision was a day I had sat on the floor crying uncontrollably for several hours because I was not able to write down a single name of someone I could call if I felt suicidal. The piece of paper had spaces for 5 names. These are some of the lies of depression. That no one wants to hear from you, that no one can help you, that you’ll always be alone, that you’re a terrible person, you’ll never be forgiven, that people would be better off without you, and that you don’t deserve love. It’s not ever true no matter how real it feels.
I’ve described that place as being lost and forgotten at the bottom of a deep well under a huge pile of bricks. I’m so lucky to have received so much support and care at that time. I know that I do not ever want to be back in that place. I also know that anything is possible, and overconfidence or thinking I could never become depressed again isn’t helpful. That knowing inspires me to take the best care of myself that I possibly can because it was such a terrible, horrible experience being that depressed.
When someone I love and care about is depressed, I may feel desperate to try to help them and that may include offering suggestions of things that worked for me or trying to think of something that might make them feel better, and if often reminds me of the helplessness I have felt in the past and how truly uncomfortable that can be.
What I know is that listening in a loving, patient way is helpful. Expressing my care for them and my availability to listen and spend time together is helpful. Making a plan to be together (and then following through) is helpful. One friend invited me over for pancakes and tea and listened to me. That was so heartwarming. I am in awe of the power of listening. It’s okay to have pauses and silences, letting those spaces be there may open up the courage for the other person to share even deeper. Allowing for crying to happen instead of trying to solve anything is helpful. I deeply respect a person’s ability to move through their pain at their own pace when being witnessed by a loved one. It’s such an intimate moment. People sometimes do not want to be touched when they are in pain. Other times they do want a hug, but it’s a good idea to check in and ask first. “I’m available to give you a hug anytime including now.” Someone said that to me. That’s more helpful than “Tell me what you need” or “Let me know if you need anything?” Sometimes I don’t know what I need.
I’m grateful that there are several plant medicines that have helped me on so many levels over the last 10-12 years. Through creating a sacred relationship with these plant medicines in a ceremonial context, I’ve slowly cultivated a deepening awareness of listening to the unique voices of my heart, my body and learning the language of my spirit and how to treat myself in a sacred way. My prayer is to treat myself so sacredly that I inspire others around me to treat themselves sacredly. If we made more time and space to honor ourselves and listened deeply, we would know/remember in our bones that we are not separate from the earth, from each other, from the magic of creation. This knowledge and understanding feel very far away and flimsy when I’m deeply depressed though. So I create lists and reminders for myself about the ways and medicines that help me and how they work.
For me, deeply knowing and staying in that place takes consistent practice, strength, resilience, wisdom, and inspiration. So few external messages in our culture support following our inner wisdom and knowing ourselves deeply. I believe that a lot of my depression has stemmed from seeing the world as a cold, sterile, cruel, uncaring place and feeling powerless, insignificant, and tiny in my prayer to both find and embody warmth, connection, love, and healing.
So much of my healing has involved understanding the constantly evolving force of life that we are never disconnected from while we are breathing or being breathed. Being willing to see and be shown where I’ve been wrong, misinformed, or misunderstood has helped me so profoundly. I’m grateful for all of it. I take nothing for granted. I understand so intricately the absolute miracle of my life and existence. It’s the opposite of depression and it’s nothing like what psychopharmacology provides. It’s a different pathway that’s so incredibly helpful. I also know that it is sometimes not enough or not right for different people at different times.
There are many factors that need to align to allow any type of healing and it’s incredibly personal. Listening to and tending my relationship with myself has never led me astray. Witnessing other people pray about and heal their lives is very powerful. Wherever a person is at, wherever I am at, I honor all of us for doing our best in every moment. I honor us for course-correcting, hopefully without much shame or self-flagellation, when we know or become aware that we did not do our best.
As my mom says, “We do the best we can, that’s all we can do.”
Painting: Untitled by Aboriginal Australian artist Emily Kame Kngwarreye

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