Annals of a therapist during COVID-19: Day 1

3/26/2020

I’d intended, since I went into social isolation about twelve days ago, to write a few blog posts. Funny, uplifting stories and perspectives was the goal, because I think now more than ever, we need the ability to find joy and laughter.

And I might still do that. All bets are off.

But I haven’t yet been able to access that part of me that can pop off a funny anecdote like it’s nothing. The inside of my head is usually a ticker tape parade, colorful and chaotic and overwhelming, and often joyous. Now, though, it’s more like a funeral procession. My brain mechanics feel rusty and worn, slow and heavy, like maybe one of the gears fell out altogether and the others are having to compensate, but aren’t quite up to snuff. Like maybe the whole machine is about to go kaput.

The era of COVID-19 isn’t easy for anyone, so I’m not trying to say my mental distress is special. It’s not. I’m floundering in a completely foreign situation just like everyone around me is. Problem is, I’ve got people looking to me for help, too. I’m still a therapist, even if the world is upside down and inside out. Especially because the world is upside down and inside out.

It’s been a weird road, these past two weeks. The week leading up to Friday the 13^th of March, I was still in a state of heavy denial. The virus was just another flu. I was going to Jamaica on March 21, as planned for over a year. Over that week, I started the process of acknowledging and grieving what my losses were shaping up to be. And on Saturday the 14^th, I woke up and was like “waiiiit holy shit, hold the phone, what are you doing?” It was a strange experience, like all of these new and very real thoughts had infiltrated me and I couldn’t understand why they hadn’t been there all along. I accepted the reality and gravity of Coronavirus in a new way, and grasped my responsibility in flattening the curve. I cancelled my vacation. I got a telehealth platform set up for my practice. I emailed every client to tell them there would be changes in my service delivery. I created consent documentation and consulted consulted consulted. Between Saturday and Monday, I transformed my practice completely. It was exhausting, but exhilarating. I love learning, and I had to—and fast.

Fueled by caffeine, novelty, and optimism, I marched into last week. I saw twenty clients over telehealth, and the process went beautifully. No tech issues, and the whole videoconferencing thing felt a lot less interpersonally weird than I thought it might be. It felt empowering to be able to offer hope and guidance in bleak times. I ended the week with a sense of relief that I could still be a steady presence for my clients, put some good into the world, and also bring in some income for my family.

Enter this week. Now, I was supposed to be on vacation this week, so I opted to keep my caseload light. I scheduled nine people. I had hoped for a restorative week, filled with mostly reading and junk TV and personal stay-at-home projects. It has turned out to be a week of battling with insurance companies, intense client stress, and coming to grips with the mortality of my world. It has turned out to be a week of increasingly horrifying news, a week where I had conflict with family and friends about what “social distance” means in terms of how to enact it successfully, a week of fear and frustration and almost constant anger and anxiety. I’m trudging into Friday feeling like I’ve been steamrolled.

Today I held the sadness of a senior who will likely not celebrate the end of her high school career elbow-to-elbow with her friends. I held the desperation of a refugee who is running out of food with no apparent means of getting more, and whose children have fallen ill, possibly with Coronavirus. I held the anxiety of a pregnant mother who is unsure her partner will get to be in the delivery room with her when she labors. I witnessed the fear of my colleagues as we wonder if and how we will be reimbursed fairly for the important services we provide to others, in the age of telehealth, and I went to bat with and for them in the ways that I could.

Today I had my first panic attack in years.

Because the trauma of my clients is different than mine, but the same. I hold for them the very things I fear myself. Scarcity, financial ruin, loss, and death.

I assume tomorrow, if operating on a better night’s sleep, I will wake with a sunnier disposition. Optimism is my default, to the extent to which clients have described sessions with me as “hope infusions.”

But euthymic mood notwithstanding, I have no delusions of the next few weeks being easy. On me, on anyone. I think we’re in for some real shit, people.

And I guess until my funny bone kicks back in, I’m going to document it.

The face of high-functioning depression

So I struggle with depression. And I’m a therapist.

This whole arrangement is craptastic.

I help people with depression. It’s sort of (not sort of—it really is) my job. As in, people pay me actual money to help them claw their way out of this stuff.  So, it's pretty demoralizing to be grappling with one of the things that I went to school for umpteen years to learn how to treat. It feels shameful. It feels like I’m not supposed to have these kinds of difficulties, because I’m supposed to have this stuff all figured out.

Ha. As if being a therapist somehow makes me immune to human difficulties.  (Spoiler alert, therapists-in-training: You’re still going to be messed up when you’re done with school. Just sayin’.)

So I’m not a superhuman. I can accept that. And my training didn’t save me from this bullshit. I can (mostly) accept that, too. What would be unacceptable to me would be not using the insight I have gained from this bleak period to maybe help someone else. Possibly, by virtue of being trained as a therapist and HIGHLY experienced as a depressed person, I can shed some light on the subject for y’all. Here goes:

Depression isn’t all sadness and crying and moping and couch potato-ing, even your mental image of “depression” might look sort of like that.  True, sometimes depression looks like this:

But sometimes, it looks like this:

I hope you guys like my face in that top one. Also, my hair.
(Long story. Actually short story: the Mai Tais did it.)

Yeah! That cheerful, silly face is the face of depression, kids! These pictures were taken at the height of my misery. Many of us who are depressed are quite good at masking it. Especially those of us who have high-functioning depression.

What’s high-functioning depression? It’s the kind of depression that isn’t completely disabling—which means I can work and parent and play volleyball and other life things— but the tasks often feel harder, sometimes take longer, and they wear me out more than usual. I've had bouts of this stuff since college-- it comes and goes in waves, some keeping me underwater longer than others. The current wave has had a wicked undertow. 

For me being depressed is a lot about heaviness. Everyday tasks can seem impossible. For example, I’m someone who feels at home in the kitchen. Baked goods= love, in my book. In September, I had a friend who had a baby, and what better way to say “I’m happy for you” than chocolate revel bars?

These things are delicious. I’ve made them a million times before. Yet, making them this time was so hard. The reaching down into a lower cupboard for the mixing bowls, the measurement of dry goods, the having to go to the basement pantry to retrieve a bag of chocolate chips…every step took monumental effort. And this is so not me. On a non-depressed Saturday afternoon at home, I can bake two or three things, and maybe also rearrange the Tupperware cabinet and do some gardening and go on a 3-mile walk, and then whip up supper, and it’s no big deal. I like being energetic. I like getting things done. So this feeling that my body is perpetually moving through water? No Bueno. 

Even worse than the heaviness, though, is the thought parade….oh, the thought parade. If you’ve ever had depression, you know what I’m talking about. This is a rather soul-sucking phenomenon: when my brain decides to say really cruel things to me in a really convincing way. It’s like having Cersei Lannister living in my head. After that, my brain takes me down the Memory Lane of Failure. (With my clients, I call this part The Shitshow.) A sampling of Cersei + The Shitshow: You’re worthless. You’re never going to get your life together. You fail at everything you do. And the worst one, the absolute nail in the coffin: You are a terrible mother. And then I relive all of the moments that I have failed, all the ways I don’t have my life together, and all of the times I was a less-than-stellar parent. This is the part that makes me want to stay in bed and stare at the wall for hours at a time.

Art by Claire Jarvis

Here’s a weird thing I’ve noticed about me and depression, though— I’m a pendulum swinger. And what I mean by this is: depression will say to me you’re worthless and everyone hates you. And, in trying to shake this off, I’ll seek out my friends. Put on some pretty clothes and red lipstick, plaster on my most winning smile, and gravitate to wherever the fun is happening. Swing the pendulum. Try to find evidence that I am indeed worthwhile and that people don’t hate having me around. Also, alcohol provides a temporary reprieve from the crippling Cersei thoughts. And then they come back, ten-fold, the next day—because that’s how alcohol works. It depresses you the next day. #themoreyouknow  #friendlyneighborhoodpsychologist

Now, let me issue the caveat that I enjoy going out with friends when not depressed. That’s just me—I like people, and I like laughing—and, for the record, I like singing and dancing and not taking life very seriously sometimes. But when depressed, these times out of the house feel like lifelines in a way that they probably shouldn’t.  

Because of my pendulum-swinging means of trying to cope, it isn’t always obvious to myself (and others) that I even am depressed. That’s the thing: depression can be a sneaky, insidious little beast. It comes for me in camouflage, lays in wait, sniping, throwing grenades—full on guerrilla warfare—and I can’t see it until it’s bad.

It doesn’t help that I’m pretty good at denial and avoidance, i.e., “I’m not depressed, nosiree, I just suddenly hate myself and feel like my life is going down the shitter.” I either couldn’t or wouldn’t look at the evidence: I sucked way more than usual at making decisions—and this is bad, because I always suck at decisions. I hated all of the music that I usually love. Food sounded gross and made my stomach hurt, so I didn’t eat much. I couldn’t fall asleep at night. (Very uncharacteristic. I usually sleep like a boss.) If a client reported these experiences to me, I’d know right away what was going on. But despite the astounding, staggering amount of evidence of depression, I couldn’t see it. Its camouflage was too good, too complete. It blended in with the colors of my life, and I just assumed that the lies of depression were true. (i.e., I really was a terrible person, and people really did hate me, etc.).

Here's the thought that blew my depression’s cover:

“Wouldn’t it be easier on everyone if you weren’t here?”

Whoa. I’d never had that kind of thought before. 

Thankfully, I stopped and self-reflected. For one blessed moment, my internal voice had my back, and she said, “Hold up, sister. What did you just say to yourself?”

Then I knew what was going on. And to therapy I went and to the doctor I went and to the gym I went. Yep, the gym. Because honestly, I’ve never found anything as effective for my own personal mood management as good old fashioned gym torment. 

I’m slowly getting better. I wish recovery was as easy as a few grueling hours at the YMCA or a few weeks of therapy or a few months’ worth of pills. It’s not, though. Healing from depression is like slogging through a field of deep mud. One foot held up and striving forward, one foot sinking down into the goo. Repeat, repeat, repeat. 

So I cope. I read a lot. I do the gym thing. I go on walks. I watch The Office and The West Wing, two shows that comfort me. I attempt to be emotionally present with friends and family. I try to remember that the Cersei Shitshow thought parade isn’t the truth, even though it feels like The Truth when it’s happening, but rather, that these thoughts are depression being a little bitch.

And I write like I need it to survive. This too is a coping skill. When I write I attempt to understand myself, to be understood by others. It’s mightily gratifying to have some thoughts out of my head and on paper instead of rattling around on the inside. If I get to make myself or someone else laugh, that’s a bonus.

I want y'all to know: I’ll get through this. I already am. And I always have. 

I’ll keep putting one muddy foot in front of the other until the ground underneath me dries up again. And it will. It always has. 

And for my functionally depressed comrades-in-arms out there: I’m with you. I’m here for you. We’re all gonna make it. Take care of yourselves, do all the things that help, and the ground will dry. Just you wait. 

***

Author's note: Suicidal thoughts are serious and should be treated as such. If you're having thoughts of ending your life, get yourself to help. Call a parent. Text a friend. 
Call this hotline: 1--800-273-8255. Go to this website: The Hopeline.
Find a therapist. 

You matter. Trust me.