compassion {12/11/12}

The front yard of the house where I grew up was shaded by two large trees. In spring they were home to dozens of twittering birds, and of course, the nests of their young. Inevitably some of the newly hatched fell (or were pushed) out of the nests. Every year my brother and I would find their small pink bodies on the driveway, the sidewalk, or in the grass. Once in a while we would discover a baby bird that had survived the fall, wriggling blindly, chirping in fear. We would scoop it up and run to the house, begging our mother to help us save it. On the advice of a local veterinarian, she would procure an eyedropper and some dog food. My brother and I would fashion a makeshift nest from a shoebox, which we'd place under a lamp for warmth.  

My heart is not a baby bird, but sometimes it feels like one. And, nowadays, I try to care for it like one. 

Self-compassion is a relatively new concept for me. For years I excoriated myself for having depression and anxiety. Why do you have to be so weak? I asked myself. Why can't you be like everyone else? I told myself that I was a burden on the ones I loved. I told myself that I was worthless, a failure as a human being. And the harder I was on myself the more depressed and anxious I became, and the more depressed and anxious I became the harder I was on myself.  

It seems sort of obvious, now, that my response to my illness started a vicious cycle. But it took over a decade for me to realize what I was doing, and half a decade to stop doing it. In fact, I'm not even sure I can say that I've stopped--but I'm trying. There are days and weeks when my heart feels naked, vulnerable, and bruised. During those times I try to nurse it like a baby bird.

I'm not calling this a cure and I am definitely not saying this is easy. For some reason (I tend to blame the Puritans), many of us feel that we are unworthy of compassion, though we tend to give it to others. "Treat yourself the way you would treat your best friend," is the first mantra that got to me, and it's one I return to again and again. "Treat yourself the way you would treat an abandoned baby bird" works just as well.

I am not naive. There will always be suffering in the world. The baby birds of my youth, despite our best efforts and my mother's round-the-clock care, never survived. But we never stopped trying to save them. I can't stop myself from experiencing difficult feelings, but I don't have to add anger and self-hatred on top of them. I can hold myself gently.  And I've found that when I do, I recover more quickly than ever before, with less scars.

Besides, my heart is not a baby bird. It beats, it bounces back, it lives.

grief versus depression {12/4/12}

As you may or may not know, the DSM-5 (the American Psychiatric Association's latest diagnostic manual) has been finalized and will be released this spring. It's been about twenty years since the last DSM was released, and obviously there have been a lot of changes in the psychiatric community. Antidepressants have become as abundant as vitamins. Autism diagnoses have skyrocketed. Treatment of children for a variety of psychiatric disorders has become commonplace (though controversial). As someone who has experienced a significant range of psychiatric treatment--both as a teen and adult, both as a patient and a family member/friend--I am naturally interested in all the changes in the latest DSM. But as a survivor of suicide, I am especially concerned about one: the Bereavement Exclusion.  

The Bereavement Exclusion is a sort of clause in the Major Depressive Disorder entry of the current DSM. It basically exists because grief can have symptoms similar to those of MDD, and should not be treated as though it were depression. While drawing a distinction between grief and depression, the current DSM does recognize that grief can trigger a major depressive episode, and that grief that does not improve over time or that exhibits extremes (such as suicidal ideation) may need treatment. 

The Bereavement Exclusion has been removed from the DSM-5. Why? "The “rationale” section on the DSM-5 website’s major depressive episode page explains that the reason for eliminating the BE is that “evidence does not support separation of loss of loved one from other stressors”. The website cites only one reference as the basis for this proposal, a review paper by Zisook and Kendler that claims that bereavement-related depressions are generally similar to standard depression."

What does this mean? One could say it suggests that if you are still feeling sad two and a half weeks after the death of your mother, or spouse, or child, a psychiatrist could chuck some pills at you and send you on your way.

Am I suggesting that?

Yeah, I guess I am.

I have some conflicting opinions when it comes to the differences between grief and depression. Some days I'm not sure there are any. As life is a constant exercise in loss, in a broad sense, grief could be seen as the root of all depressive disorders. My first major depression occurred after my family moved from Detroit to Alabama, and was a result of grieving the home, friends, and family we left behind. 

Here's the tricky part: there are different kinds of grief and different kinds of loss. Grieving my brother's suicide was nothing like grieving my grandparents. Grieving my brother took somewhere between four and six years, and it completely changed my life. Those changes hurt while they were happening--they tore my heart wide open. But now, I am thankful for them. What if they hadn't been allowed to occur? What if they had been chemically suppressed? What if I'd gone on with my life thinking I was supposed to feel "better," "normal," "happy," and "ok"?

Something else, perhaps an even more compelling argument for keeping the Bereavement Exclusion: I was on antidepressants at the time of my brother's death. I continued taking them for two years, and I continued fighting against my grief. I tried to do all the things the DSM would have considered "healthy" and "normal": hold down a job, spend time with friends, get on with my life. I struggled and I failed. It wasn't until after I stopped taking medication that I was able to feel the full force of my grief and move through it. Dampening my feelings only prolonged the process.

I'm not an expert. I haven't conducted any research studies. Maybe I'm the .001% weirdo that doesn't fit the mold. But I tend to doubt it. I certainly think that suicidal ideation in ANY context needs to be treated. But lumping grief in with depression, treating loss with pills...I'm not convinced it doesn't do more harm than good.

Guess we'll see in twenty years?

handling the holidays {11/28/12}

Last week my husband and I headed to Michigan to spend Thanksgiving with family. This necessitated coaxing our thirteen year old cocker spaniel, Sandy, into the car. 

Sandy hates the car. She has always hated the car--ever since I made the mistake of placing her in the backseat alone when she was a puppy. She acts now much the way she did then: hyperventilation and convulsive shivering that stop only when we hit the interstate and she passes out. 

Yes, we have tried drugs. We have tried a crate. Neither made a bit of difference. This year was the first year we tried a Thundershirt. We followed the directions, getting her used to it gradually and offering treats so she could build positive associations. I wasn't expecting a miracle--she's thirteen, after all, and that's a lifetime of fear--but I was hoping it would at least help. 

Shockingly, it did. There was no hyperventilation, and only a bit of shivering that stopped after a few minutes. She didn't quite look like Thundershirt's calm, comforted cartoon mascot, but she also didn't look like she was about to spontaneously combust. I deemed it a success.

And I felt more than a little jealous. I remembered the first Christmas after my brother died--how my eyes were animal-wide in every picture, my face swollen with the extra weight I'd gained trying to eat away my grief. My parents were the opposite: gaunt and grimacing, eyelids so heavy they were scarcely open. We could have used Thundershirts. 

I could still use a Thundershirt.

The landscape of our family has changed, as the landscape of families does. After my brother passed we lost my grandparents, the family dog. My cousins have had more children, I've become an aunt three times over and lost a pregnancy of my own. These are changes easily buried during my daily life, but when the family gathers everything surfaces: the new, the old, the missing, the never will be. It isn't all bad, but it's still a lot to bear. Lacking a Thundershirt I wrap myself in other things: love, first and foremost. Quiet moments when I can catch my breath. Laughter and stories. Pie.   

It isn't perfect. There is still some shivering. But I don't feel like I'm about to spontaneously combust, and I call that success.

at the end of the day {10/19/12}

Last night I turned out the lights one by one, until the world shrunk down to the puddle of reading lamp next to the bed--a circle too small to hold back the fears and desires I'd managed to ignore during the day. They spread like the dark, settled like the dark, and I was reminded of nights after my brother's death.

There were no easy moments in my grief. There were, however, easier moments. Those were most often the middle of the day, when thoughts about my brother could be buried by distractions: work, errands, exercise, television, books, chores. Evenings were a shaky sigh of relief, a weight dropped the moment before muscles quit. Mornings were harder: the fact of his death the first thought in my conscious mind; the realization that I'd have to do it all over again, figure out how to live another day without him.

But nights were the worst. All my day distractions stripped, the thoughts I'd been fleeing reared up in retribution. I'd lay down, close my eyes, and wonder about his last conscious moments. I'd press my hands to my throat, to see if I could feel what he felt. I'd catalogue all the ways I had failed him. I'd strain my ears in the quiet, sure I could hear death coming next for me.

Eventually, thankfully, the sleeping pills would kick in and wash my mind to a blank.

I can't remember when this changed. The first night that something else--an argument with my husband, work nerves, or even excitement--kept me awake. The first morning that, instead of Matt, I thought of breakfast or how much I had to pee. There wasn't a day when the grief magically disappeared.

There was, however, the day when I realized the grief was gone--and had been so for some time. I was sitting on a beach in the sun in northern California, alone, watching the Pacific crash against the earth. I was thinking about how my brother had never seen the Pacific. The thought didn't stab me, it was just there. Just a thought. I asked him to come and sit with me, to watch the waves and feel the sand and the sun and the expansiveness of sky, air, wind. 

On the drive back to the apartment where I was staying, I rolled down the windows of the car and let everything in. I felt so alive, so free, that my heart swelled enough to stretch its seams. It was a different kind of ache, but I knew that somehow it came from the same place.

what to say {9/26/12}

Yet another friend of mine has lost someone to suicide.

First off, let me say for the record that I hate this. In addition to that: I am genuinely surprised when it happens, as if the fact that I don't want anyone to ever have to go through that kind of grief is enough to have eradicated suicide from the planet. Clearly it isn't. The latest statistics (from 2009) show that the suicide rate is at an all time high.

This breaks my heart. Every time someone I know becomes a survivor of suicide, I want to scream NO! and push them back over to the other side of the line. You know that line--the one that cuts across your life like a canyon, dividing it into Before and After. But I can't. The most I can do is apologize, offer an ear and a shoulder, and wander around in a state of shock for a few days.

I still have a hard time believing how bad I am when it comes to dealing with loss. I want to be that person who knows exactly what to say to make someone feel supported and comforted. I want to be that person who knows that they are supposed to drop off a casserole or clean a bathroom, send a card once a month or take someone out to the movies. Instead I open and close my mouth a lot, like a fish, and say things like "I wish I knew what to say."

Here's the thing: when I hear that a person I care about has lost someone to suicide, I try to remember what it was like in those first days. I try to think specifically about the things people said or did that were helpful. And that's how I end up with a fish face. I don't remember anything anyone said or did. I was so blown apart, so broke down, that nothing touched me. I remember wishing many months later that there had been more cards, more care, more people asking me how I was doing (how I was really doing).

But the truth is, there are no magic words. The closest I can find, the ones I say the most and the ones I really want to believe, are: "you are not alone." And then there are the ones I save for later, which I know unequivocally to be true: "it gets better. So so so much better."

letters {9/22/12}

The other day I came across this website, and I instantly fell in love. Like most writers, I am intrigued by other people's private lives. (We can't help it--it's an occupational hazard.) And for centuries the best way to get into the brains of very smart, very interesting people was through their diaries. The second best way was through their letters. 

I actually prefer reading the letters of authors (or other people of note) to reading diaries. Letters, after all, are meant to be read. They are written as a two-way conversation. They are intimate enough to engage, but not so intimate as to overwhelm. They show you something important about a person that a diary can't: they show you how the author interacts with other people. 

Reading this letter from F. Scott Fitzgerald to his daughter Scottie, I was struck by the fact that the letter as window-to-the-soul no longer exists. My favorite contemporary authors will not have email collections published after their deaths. And who would want them to? Emails pale in comparison to letters. Ninety-nine out of a hundred emails require little to no thought, and reveal almost nothing about our innermost thoughts, fears, and desires. 

Does the transitory nature of modern communication help or hinder us? Will the people of future generations wonder who we were and how we interacted with each other, or have we reached an evolutionary point where backward gazes taper to glances?

I guess time will tell.