Note: This is a serial blog. To start at the beginning, click on Chapter One– The Meltdown under “Categories” and start at the bottom.
Depression has been a part of my life on and off since childhood. I didn’t know what it was called as a child, I just knew that I would become very unhappy for periods of time and isolate in my room. It wasn’t until I took a high school psychology class that I had a name for how I felt and realized that others felt that way too. I’ve always been a pessimistic person by nature, expecting the worst out of life. I’m a “glass is half empty” kind of person. If I were a Winnie the Pooh character, I would definitely be Eeyore. Part of recovering from my Meltdown has been tempering this personality trait and trying to become a more positive person.
I think depression is an individual thing, feeling different to different people. There are common themes like the obvious sadness and hopelessness, and also different degrees of depression. When I was in therapy with Sharon, she would always have me rate my depression on a scale of 1 to 10. I think everyone gets depressed at a low level sometime, usually for situational reasons, but I’m going to focus on how it has felt for me to be a 10 on the depression scale.
What I call straight depression, without the mixed mania component, has not happened to me at a 10 on the scale in quite a few years. When it did happen, the sadness and hopelessness that are characteristic of depression were completely overwhelming. There was no light at the end of the tunnel, just a train waiting to run me over. I felt really sad, but I couldn’t usually cry unless I’d had a lot to drink. It sounds contradictory, but while I felt crushing psychic pain, I also felt numbness. This is often when self-harm behaviors occurred. I would cut or punch something to counteract the numbness. It would reassure me to see the blood or the swelling. It didn’t hurt at the time I cut or bruised myself, but it helped me ground myself. When the depression was especially bad, my tendency to dissociate would surface. Hurting myself physically helped bring me back to the present, even though I didn’t want to be there. I didn’t want to be anywhere.
When depressed at a 10, I would feel self-hatred. I loathed myself and felt like I needed to punish myself in some way. I hated my life and wanted to be dead. If I could’ve just willed myself to stop breathing, I would have. This is when the obsessive suicidal thoughts would enter the picture. All I could think about was the pain and hopelessness, and how I wished I was dead to escape it. Being depressed at a 10 was a selfish time. I would not think about my friends and family, or how they would be affected by my suicide. I was not thinking rationally. Thoughts of death and suicide would run through my head over and over.
If I was having a full-blown mixed bipolar episode, I would feel all of the above and then some. This is when I truly felt “crazy.” During mixed episodes I continued to obsess about death and suicide, but the thoughts would race quickly through my mind. It was impossible to distract myself from them. I’d be completely unable to sleep, which means I had no way to escape the overwhelming feeling of despair. Insomnia happened to me during straight depression too, but was worse during a mixed episode. I’d be impulsive during these times, which made the possibility of suicide higher. I felt unable to control myself. I’d become irritable, which isn’t normally my personality. I’d be very agitated and would often just pace around. I still experience mixed bipolar episodes, but the early signs are now unmistakable to me. I know that when it starts happening, I need to get help before it gets worse.
I have to say I don’t care for the personality disorders portion of the DSM. I don’t like describing someone’s personality as a “disorder.” As a mental health patient who has been diagnosed with two personality disorders, I find it rather insulting. However, I understand that labeling a cluster of symptoms makes it easier for treatment providers to communicate with each other about patients.
I’ve been diagnosed with both Avoidant Personality Disorder and Obsessive-Compulsive Personality Disorder. The fact that I was not open about my symptoms with anyone was the most obvious sign of Avoidant Personality Disorder in 2003. I faked “normalcy” to hide my symptoms from friends and family, not wanting to be negatively evaluated by them if they knew the truth about how I felt. Being at all vulnerable with people caused severe anxiety, so I avoided it. Even while I was in the hospital the first time, and immediately afterward when my people knew I wasn’t doing well, I continued to fake it. I don’t think I consciously made a decision to fake it, I think it was just natural for me to do so. I was obviously very aware of the stigma associated with chronic mental illness. This may have unconsciously influenced my behavior. My family dynamic of minimizing difficulties also contributed. But, I don’t remember thinking to myself “Ok, I have to act normal now so people don’t think I’m crazy.”
Sharon being more open with me during my Meltdown year in 2003 caused a great deal of anxiety and discomfort for me. I’m not a touchy feely person who talks a lot about my feelings in general. I have low self-esteem, and get uncomfortable when anyone compliments me. For someone to say they care about me (other than a family member) causes a lot of anxiety. I’d always observed strict boundaries with Sharon before my Meltdown. As a worker in the mental health field, I knew the importance of boundaries and had always kept clear boundaries with my clients. For Sharon to suddenly become more open and to call me after work hours was totally foreign. I was afraid of becoming too dependent on her, with the increased openness and contact between us. I knew the increased contact was temporary, just until I was doing better, and I didn’t want to depend upon it. I needed to keep my defenses intact for the time when things went back to normal between us. The whole openness thing made me feel vulnerable and uncomfortable.
I’ve come a long way in resolving the issues described as Avoidant Personality Disorder. I’m much more open now with everyone about my symptoms and my situation. I’m much more comfortable with feeling close to people. I continue to have some social anxiety, but I don’t think it’s enough to get me diagnosed with Avoidant Personality Disorder any more. Obviously broadcasting my story to the world, in detail, is evidence of the progress I’ve made.
My other personality disorder diagnosis, OCPD, is sometimes helpful. It makes me more organized and efficient. I’m a responsible person. I’m very reliable and predictable. My OCPD symptoms generally revolve around the way in which I organize my life, in what I call my routines or rituals and the rules in my head that I follow. I do certain things either in a certain way or on certain days. For instance, I do laundry and tan in the tanning bed every Sunday and Wednesday. I tan, then take a shower, then start my laundry. My morning and evening routines do not vary at all either. I make a lot of lists and like to cross things off the list when I complete them. An example of a typical rule relates to shaving my legs. For about a fifteen year period, it was a rule that I had to shave my legs every day. Never mind that they didn’t need it, I had to do it.
Not following a rule or a routine causes anxiety for me. I can consciously change some rules, but it’s not easy. It takes a lot of self-talk and reassurance from myself. When I’m depressed the rules become self-destructive, for example not eating while I was in the hospital in 2003, or needing to kill myself if I didn’t move out of my parents’ house in 1995. When I’m depressed it becomes much harder for me to change the rules for myself.
A rule that causes a great deal of anxiety, which I have never been able to change, is the rule about not being late. I show up everywhere at least ten minutes early as a result. I just sit in my car until it’s appropriate to go in to the appointment. Everyone now knows this about me, and it is a source of much good-natured teasing and joking.
Having OCPD means I’m a fairly rigid person. An example of this is my refusal to journal for years during therapy with Sharon. She would often encourage it, and I regularly said “No, I don’t journal” in response. Any type of change causes enormous stress and anxiety for me, even good changes. I like things to stay the same, which feels safe and comfortable. I don’t even change my furniture around, for God’s sake! I realize that change is a necessary and natural part of life, but it remains very stressful for me. OCPD contributes to my stress tolerance being low in general.
Obessive-Compulsive Disorder (OCD) means feeling compelled to do something irrational, not functional. In my case, my OCD symptoms are also dangerous. My OCD revolves around tanning. I’ve been laying in the sun since high school in the 80’s, before the push for sunscreen started. I was more likely to slather on baby oil than sunscreen, but often used neither. I got my first severe sunburn when I was thirteen and on a trip with my aunt and uncle to Key Largo, Florida. We went out on a large fishing boat into the water, and I layed out all day without sunscreen. I got sun poisoning and was pretty sick. I didn’t enjoy Disney World at all over the next few days.
I didn’t get burned badly again until Spring Break of my senior year in high school. I went with a group of friends to Daytona Beach, Florida for a week. I again layed in the sun too long, and again, I got sun poisoning. I fainted in front of a line full of people at a Western Union while I was waiting for my parents to wire money. It rained a couple of days while we were there, so my friends and I decided we weren’t tan enough when we returned home. This is when I first experienced indoor tanning. I went to a tanning booth at a place called Tan Hawaiian. I then continued to use the tanning booths weekly in the winter for about five years, when I switched to tanning beds.
Once I was in college, the tanning only increased. I spent my freshman year at the University of Arizona, in Tucson, Arizona. Needless to say, the outdoor tanning season was longer in Tucson than it is in the Midwest, where I live. My dorm was a nine story building. There was an area on the roof which was used for laying in the sun by the residents. I scheduled my classes around tanning hours so that I could get a good spot on the roof and lay in the sun during prime tanning time. I was only in Arizona for one year, but this may be the time during which tanning started becoming obsessive.
During college, I worked in a bakery in the summers. I worked second shift, so this allowed me to lay out every day before going to work. Tanning was becoming a part of my every day routine in the summer. In order to maintain my color during the winter I went to Tan Hawaiian and used the tanning booth at least once a week. The more I tanned, the more it was becoming part of my identity.
By the time I graduated from college, my mom had purchased a tanning bed. She liked to be tan too, and had no idea it was becoming dangerous for me. I was able to tan for free in the winter by going to my parents’ house. This made it even easier (and cheaper) to tan in the winter. I first started noticing the anxiety associated with not tanning while I was a houseparent at a group home. I worked twenty-four hours a day on a rotating four days on/two days off schedule. So I was not able to lay in the sun in the summer for four days in a row. I noticed I would become anxious on sunny days and obsess about the weather. This is a pattern that repeated itself at other jobs that I had later, in which I worked during the day. Conveniently enough, I worked second shift for four years as a mental health tech, so I was able to lay out every day prior to work. The obsession was reinforced during that time.
In the eleven years since I stopped working full-time the obsession has become stronger, probably because I have more time to lay out. I worked with Sharon in therapy on decreasing the time I spend laying in the sun, with minimal success. Part of the issue is that I enjoy tanning (except on those really hot and humid days), and I like the way I look when I have a tan. Whether it is healthy or not, being tan is part of my identity. I receive positive attention from others when I’m tan which reinforces my tanning habit. Unfortunately, these factors only make it harder to address the obsessive-compulsive issue.
Tanning is more than a hobby or a habit for me, it is OCD. It is not rational or functional. If I’m unable to lay in the sun on a sunny day, I obsess about it and become anxious. I obsessively check weather forecasts so that I can plan my tanning time. I check the UV index daily on a weather website to track how much sun I’m getting. If I have control over appointments or social engagements, I plan them in the morning or evening so as to leave prime tanning time open. I have re-scheduled appointments on sunny days, just so I could lay in the sun.
There is a large grassy area at my parents’ house where I lay out, that I call the Beach. I go out at five minutes to the hour to lay in the sun. There is a power outlet on the shed near the Beach where I plug in my radio/CD player. I usually lay out from 10:00 a.m. to 3:00 p.m., except early in the season when it’s still cold in the morning. Then, I don’t go out until 11:00 a.m. When it’s hot out, I take a five minute break every thirty minutes. If it isn’t hot, I take a ten minute break every hour. I have a specific beach towel I use, along with my tanning chair. It is all very regimented. One concession I have made since I worked with Sharon on my tanning OCD in therapy is that I now put sunscreen on my nose and eyelids. These are the areas that burn the quickest.
This is the routine I follow from April until September. I use my mom’s tanning bed the rest of the year, at least once per week. I understand that tanning is dangerous. It damages my skin and causes skin cancer. I’ve had basal cell carcinoma removed four times since June of 2007. I now have three scars on my face and one on my chest. I undoubtedly will continue to have to have cancer removed in the future. I go to my dermatologist every six months to get checked. I’ve been lucky enough not to have melanoma, the skin cancer which can kill me. People ask me what it’s going to take to get me to stop tanning. It would probably take a diagnosis of melanoma before my brain would be able to stop compelling me to do this. I just hope it doesn’t come to that.
Coming Next: Chapter Three–Things Get Worse