Sunday, 28 December 2014

Guest Post: Depression and anger

Depression and anger

This guest post is written by a fellow medical student who was brave enough to share her story with me, and now wants to share it with you. It is very honest and deeply personal, and made me understand more about anger - I am honoured to feature it on my blog as I know how difficult mental health can be to write about. Thank you very much for writing this for me, you are amazing!

Imagine you’ve fallen accidentally into a deep well, you’re in shock but then it hits you that you’re drowning, you know you are actually going to die and you have been overcome by panic, you fear losing your life and not being able to say goodbye to the people you love, this is it. The best and worst moments of your life flash across your mind in an intense disorganised slideshow and you think of them half wondering the meaning of it all and what could have been different as you desperately gasp for air, with your mind racing looking for a solution, thrashing like a mad animal searching for something to hold onto but its black and there is no life jacket.

Do you give up or don’t you?

I often feel I am being ‘drowned’ like this by my thoughts, the control and intensity they have over me that I can’t seem to shake. Some days are better than others but my low mood is out of control at the moment. I had studied this condition from textbooks a few years ago and although it seemed bad I could never comprehend what it actually was to not enjoy life, I didn’t understand how it was possible for someone to feel that way.

Sadness is a normal part of life, we’ve all experienced it at some point, but it doesn’t last forever in most cases. When that mechanism becomes jammed the result becomes problematic, depending on the intensity some people can function although struggling internally and I often wonder about the statistics, more than often when I’ve opened up to someone about how I’ve felt I have been surprised to know they feel the same or know someone close that does. It is comforting in a strange sense to you are not alone, there is a bond in knowing you are understood.

Why can’t we talk about it or why don’t we. I used to feel abnormal (I still do at times which causes me to self loathe), I didn’t think the thoughts I was having were right so I felt I shouldn’t tell anyone in case they would worry or think I was a weirdo. How do you tell someone you’ve wondered how it would feel to die by being hit by a speeding train, or to splatter to death off the top of a high building, I could kill myself now, grab the nearest knife and cut my throat, I think of the pain, would it be successful? I feel so much internal shame at these thoughts (though I know I shouldn’t be so hard on myself) and death scares me still, It makes me sick that these things even enter my mind. It’s very isolating to feel like this which feeds into the negative cycle of low self esteem. I often wonder what makes some of us more ‘resilient’ than others, we know that some people are more likely to develop depression due to genetics, so is the rest is environment? How much of that do we actually have a control over? We can’t undo the past and it’s hard to accurately predict the future. Life is full of pleasant and unpleasant surprises. There are so many factors that determine our personality, again the nature Vs nurture but who controls our thoughts?

My counsellor said something that I found very interesting, (I had told her I get many unwanted thoughts, often degrading and negative which have violently ripped my self esteem to shreads), but we don’t choose our thoughts they just sort of come into our minds, and actually the majority of people get unwanted thoughts, but the ability of their progression is how much attention we give to them. This means we have the power to change how we feel which is really cool (but can obviously be quite difficult if you have spent a number of years feeling powerless). I try extremely hard to challenge my thoughts everyday but do find it very difficult and more so now that my mood has dropped.

I found myself in the local AnE department last week, I asked my dad to take me as I was having very intrusive thoughts of harming my GP. I WAS SO ANGRY, my referral had been messed up and I was in uncontrollable rage, I am not an aggressive person at all but I have been struggling badly with intense outbursts of anger over the past year, they have been getting bad and as my depression gets worse so does the ability to rationalise and control my mood. It gets to the point that I wish a painful death on people in my mind, but I know this is wrong and It makes me feel very aware that I am having an extreme response. And although I know I have the ability to ‘not pay attention’ to my thoughts I am often left feeling powerless and overwhelmed. When my observations were measured my heart rate was 144 beats per minute (norm is 50-80) and BP 145/90 which is quite high, this is how mad I had become, and I was ‘sick’ with rage and anxiety. Externally I looked controlled but felt as if this was bubbling inside me. I was trying so hard to calm myself, so I practiced some techniques, such as deep breathing, mindfulness and picturing a calming scene, I was also given a benzodiazepine hahah! (It didn’t help too much, I laugh now but it wasn’t as funny at the time). Imagine how hard it is to calm yourself when you are having such a strong physical reaction. I was seen by a nurse and then a psychiatrist (and they assessed my risk of harming myself or others) and determined that I could go home but did need referral into some services to help with my current mood and anger problems which is what I have been waiting for, for a while now hence the anger.

Out of all the emotions anger is one of the most bitter and dark, it rips through rationality and sense. It destroys anything that comes in its way, relationships, friendships, any sense of calm that was present. It is so consuming and deadly. I never realised how lucky I was before that I never used to become angry, but now the smallest thing sets off an atom bomb response in me. The adrenaline gets me ready for fight or flight, my hands shake and then the anxiety comes in which heightens the physical side. At this point I am raging, but mostly I do not have an outburst, yet this is all happening in me, I want to kill someone, forget seeing red, I am all red now and this feels like it won’t end so I breathe deeply and imagine a serene beach. It doesn’t bring the comfort I expect it to. This is what I live with and it becomes more and more unhealthy each time and I need help. There are former issues to resolve which will be a big job, but I’m willing to do anything to put this beast to rest for good before it kills me.

It does upset me very much sometimes that I have depression and anger, because at worst I imagine death is easier than life, yet I’m told life is so precious. I have felt dead inside, the girl from a few years ago is dead and in her place is me- this nothingness. When I think of myself I picture the weeds that have grown around a derelict building, rotting. I knew I was alive but had to pinch myself to validate this and feel real, it was like watching the world on a movie, a world I didn’t feel part of or ‘exist’ in and at this moment everything is bland and dull, I am only experiencing either anger or sadness which is difficult to cope with daily and waiting for a medication review seems like endless torture messing with my emotional endurance. I am lucky that my family is very supportive (I often feel like a burden on them) but hope that soon with some more time and help I can address these problems which are having a heavy impact on me. I feel like a different person completely to the happy, bubby outgoing girl that ‘had everything going for her’ a few years ago.

However these same feelings and experiences have changed my general outlook on life, after going through a trauma and accompanying bout of intense emotional pain I feel more free to live life without restrictions and am aware not to get stuck so deeply into achieving my goals that I miss out on the small things. I can fully feel the pleasure and happiness with simple things when I am good, when I am good I am in natural ecstasy with the world we live in. I don’t think this is completely possible until you have found yourself at the edge of and beyond sanity. I find myself even more accepting than before and have deep empathy and compassion towards human suffering (ironic as I cannot feel it for myself) without a scale of questioning of why people feel upset or down, no matter ‘how big or small’ a problem seems, I had very negative experiences of what seemed as people deciding whether I had a right to be down or not. Often hearing phrases like “you’re not starving, think of poor orphans” or “but you have so much going for you” is not helpful although I appreciate that people meant well.

Coming back to resilience, I think that people with depression and other conditions that affect mentality are exceptional. Considering this is a 24/7 problem that constantly attacks your core of self worth and has large effects on motivation, creating a negative mind-set it is a great achievement to accomplish what may seem like small things to people who have never had a problem with them, tasks like getting out of bed, showering, eating, cooking- the things that people take for granted can become such a strenuous and difficult chore. I have times where I lie in bed continuously for 18hours and more, there is just no ounce of energy left. Completely mentally and physically drained, I will eventually move, it will take a lot from me. Yet we beat ourselves up no matter what the achievement is, invalidating everything. But we still try despite the constant battles and tainting of good. When it gets to a point where these becomes impossible, I can only say that it must be unimaginably difficult, no-one would choose something like that.

I have no idea what the meaning of all this is, I don’t know if there is one, I have a brain that constantly searches for answers, always inquisitive always switched on. I don’t necessarily need an answer anymore, I have accepted that this is how it is but I want some solutions for my current difficulties, this is a lot more practical. I’d like to spend more time into engaging with something that will help rather than endlessly ponder the mysteries of the world, and the human brain, but alas I find it so interesting.

When I go on to become a doctor I know that I will come across numerous people who feel the same as I do today, and I hope that I can make them feel understood and cared for, because the little things count so much. I hope to make a difference which they will remember fondly and can help in some way towards uplifting them.
“If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather.

Try to understand the blackness, lethargy, hopelessness, and loneliness they’re going through. Be there for them when they come through the other side. It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.” 
                            - Stephen Fry

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