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Yet Another Essay About Chronic Fatigue

September 17, 2014 Leave a comment

So, here’s the thing about living on the margins of disability with chronic fatigue and brain fog of uncertain etiology (i.e., unexplained symptoms).

Have you ever had a bad cold or hay-fever and you had to take a big honkin’ dose of Benadryl or Nyquil one of those other medicines that makes you all spacey and dopey? If you have, start with that (if you haven’t, I have no idea how to even begin explaining this to you. We might as well come from different planets).

Assuming you’ve had such an experience, think back on it. Think on the grogginess, the lethargy, the difficulty concentrating, the intense desire to just lie on the couch all day and not do anything that requires any physical or mental effort. You don’t feel up for much besides munching snacks and watching soap operas. Yeah, you can get up when you have to– you can, in fact, walk, talk, answer the phone, slouch your way into the kitchen for more snacks, check your email… but just barely, and not for any length of time. It’s not so much that it’s physically difficult to do any of these things, although you feel achy and clumsy and slow and would rather just lie still. It’s more that it takes serious and deliberate effort to remember what you’re doing, even while you’re doing it, and almost immediately afterwards the memory sinks away again into the soft mental blurriness of not-really-thinking about anything. It’s so very much easier not to do anything at all.

Imagine feeling that way most of the time. For at least part of every day, if not all day. Imagine fighting that feeling in order to get up every morning. Feeling that way as you try to make appointments, pay your bills, answer your emails, fix and eat meals and clean up afterwards, drive to work, do work, run errands, come up with the list of errands that need running in the first place… And on and on and on. Everything you can think of, you do while feeling this way, at least some of the time. Phone conversations with Mom. Putting away groceries. Deciding what to wear. Choosing whether or not to accept a friend’s invitation to dinner.

Imagine this. And then forget it, because what I’ve described so far only just touches lightly on what it is like to actually LIVE this way.

It says nothing about the guilt and dismay and despair you still have, 15 years after the fact, over losing yet another good friendship because, for the better part of a year, you just plain couldn’t muster whatever it takes to pick up the phone and call someone, anyone. Or answer a simple email. You tried to explain what depression means, how it eats away entire chunks of yourself and everything in your life, but few people can understand this unless they’ve experienced it themselves. It sounds unreal, even to you, even now. You wonder why you couldn’t have been a better person, why you couldn’t remember or focus or make the effort or drag yourself out of moping or whatever it was to spend a stupid five minutes making sure that someone else knew you valued them as a person. How can you explain, even to yourself, that even when you thought of doing so, the thought faded away mere moments later? That in some strange way you were barely aware of your own existence, let alone theirs?

And how do you square that with fact that, since no one stuck you in a hospital or an institution during that time, you must have been maintaining some semblance of a normal life all those months? You ate, you bathed, you dressed, you laughed, you went for walks, you went to work even! You appeared to be a fully functional person. Perhaps a somewhat lazy and irresponsible person, sure, but a real person all the same. You even felt normal most of the time, or at least normal for you. When huge chunks of your own life and self are missing from your awareness, you don’t really notice their absence most of the time.

You go about your daily business until something brushes a spider-web thread that jostles a memory, and then the bottom drops out of your world. The bill comes in the mail that says “3 months overdue!” or you get another phone message from the friend you can’t seem to keep in touch with, or a photograph slips from between the pages of a book and reminds you of an entire crucial section of your childhood that has somehow gone un-thought-of for ages. Or worse yet, that photograph has been sitting on your desk all along, and your eyes have passed over it time and again without registering the meaning behind what they were seeing. It’s a dizzying, jarring feeling when you realize these kinds of things, when you suddenly notice that time has been passing without your being aware of it. It doesn’t seem quite possible, no matter how many times you experience it.

But you suffer from a curious sort of out-of-sight-out-of-mind syndrome taken to the extreme, as though your mind were a pool of murky water and the vast majority of its contents visible to you only when they bubble up to the surface seemingly of their own will and very nearly at random. You can hold something at the surface to look at for a while, but the moment you let it out of your grasp it may sink again.

Enough stuff stays on the surface about your current life that you can pass for very competent in certain areas– work, school, a given hobby, a particular social group. The problem is that you can turn your attention from one of these things for what seems like mere moments, and an entire continent’s worth of material can sink, Atlantis-like, out of sight, so that you are horrified to rediscover, some weeks or months or even years later, that a major section of your life has simply vanished from your view, and all the important structures you had so carefully built and maintained have crumbled to driftwood. You’ve forgotten to follow up with that colleague you were so excited to meet, and surely that project you wanted to work on with them is long since finished. You’ve forgotten the name of the manager you worked with at the time, or even when you worked there, and most of the other details you’d need to put that job on a resume. And it’s probably too late to ask. No one you know even works there anymore, or if they do, they’ll be baffled to hear from you after such a long silence. How could you have lost track of something that once meant so much to you? You began to focus on a different area of your life, and in doing so, lost an entire other world.

Or it can be as simple as putting that bill down on your desk to go find your checkbook so you can pay it. Along the way something distracts you, and by the time you come back to the desk (without your checkbook, I might add), you’ve forgotten the bill’s existence, even though it’s sitting Right There, and eventually you’ll casually set another paper on top of it, or move it into the top drawer “momentarily” so you can use the space for something else, or even stick it to the fridge door with a magnet, where you will cease to see it because your mind glosses over unnecessary details most of the time, and when you go to get something out of a fridge, papers stuck to the door are surely unnecessary details. And then you get a notice that the bill is “3 months overdue!!” (how did that happen?!) and you feel like a lousy and useless person.

Or take the fridge itself. You bought a bag of peaches because you were excited to try a new recipe for some dessert. By the time you got home from the market, it was too late to cook, or you were tired, and you set the peaches in the fridge telling yourself you’ll cook them tomorrow. Only somehow tomorrow came and went, and you forgot about the peaches. And the next day you find a bag of peaches in the fridge, what a surprise! Oh yeah, that recipe! Let’s cook. But you look closer and the peaches have rotted and wilted away and you realize that somehow the “two days” since you bought them must have been closer to two weeks. You’ll have to throw them away and start over.

And after the fourth, or fifth, or is the fifteenth time that something like this happens, you wonder if you should just stop wasting food and money and eat nothing but canned soup and frozen microwaveable dinners for the rest of your life, despite hating the unhealthiness and the waste and all the packaging. You’ve tried all the little life-hacks. You left the recipe book on the kitchen table, where you’d be sure to see it, open to the page you needed. You stuck a note on the fridge saying “We have: PEACHES!!!” Sometimes these measures do work. Often they do not.

Why bother with anything? You can’t even invite someone over to share the peach dessert you finally cooked, because now your kitchen looks like it was hit by a tornado and smells like something died in it. Sure, you’re a normal, sane, responsible, decent adult person… who just happens to leave the dishes sitting in the sink for an entire week before washing them? Yeah, like anyone is really going to believe that. Would you? And it’s going to take three times as long to clean now as it would have if you’d scrubbed up right after cooking, and you know that, so why didn’t you just…?

Your life is a constant litany of “Why couldn’t you just…?” and “Why didn’t you just…?” and “Have you tried…?” and “Maybe you can…” Some from yourself, some from other people. The ones from yourself make you feel guilty and depressed. The ones from other people make you angry, defensive, and bitter. Sometimes you have tried. Sometimes you can’t muster the energy to try. Sometimes you mean to try, and forget. Either way, the fault always seems to lie, somehow, with you.

And inevitably, the vast majority of people in your life will come to the conclusion that you are lazy, or inconsiderate, or both. Never mind having friends over, do you have any idea how hard it is to find someone who is willing to LIVE with someone who regularly forgets to do the dishes? Who sits down to rest for a few minutes after eating and doesn’t even realize that she didn’t clear the table until it’s time for the next meal? Assuming you remember that there is a next meal to be had.

There are, of course, those days when you wake up with a bit of bounce in your step and do All The Dishes! and scrub out the sink and even mop the floor, and then suddenly it’s gotten to be 4 PM and you haven’t yet eaten anything or made any of the phone calls you needed to make and now you feel woozy because you didn’t eat and you have to go lie down for the rest of the day and probably won’t feel well tomorrow, either.

Then there are those rare days, or even weeks, where you’ve somehow gotten into a nice little groove– waking up, late breakfast, clean up after, run an errand or two, nap, check email, get an evening meal, relax with something fun to do, and you think “Oh, this isn’t all that bad after all. Sure I’m tired a lot and have to take things relatively easy, but it’s not unmanageable if I just keep myself on track. What a baby I was being all along! Why am I such a complainer?” and so on. And you start feeling marginally guilty about considering yourself disabled at all.

(After all, if there were something really, properly wrong with you, they’d have found it by now, wouldn’t they? All those specialists and blood tests and brain scans. And you probably wouldn’t have these periods of near-normality. Maybe you really are just lazy after all. At other times, of course, you feel even more crippled than your peers who have diagnostic labels. You know wheelchair users and cancer patients and people with severe epilepsy who do more in a day than you do. Lots more. How do they manage? Are they just stronger, better, more determined people than you? Or is there really and truly something wrong with you? There must be. But for now, you’re doing well, so why worry about it?)

Eventually, of course, there will be a scratch in the CD, a nail in the road, a missing step, and the whole thing will come crashing down around you, and you may not even notice it happening at the time. A skipped meal, a forgotten errand, staying up too late one night chatting with friends so that you oversleep the next morning, a change in work schedule, just doing a little too much in one day and not being able to do quite enough the next… and the whole system simply unravels around you.

And then one day you’re looking through the 27 million unread messages in your inbox and you spy the email from a friend you meant to respond to right away, only that email was from… six months ago. And there’s a tab open in your browser for an event you wanted to go to, and you looked at it every day for a few days and then it got lost in the shuffle and now when you find it again the event was… also six months ago. How did you come to this point yet again? What happened? Where did the time go? How did these thoughts spend so long underwater?

I can make to-do lists and charts and calendars and set my bills to pay automatically (yay technology!), but there’s no way to write down everything that needs to be remembered on a regular basis, and if I did manage to write it all down, I’d never have time to read it. How can I know what things I’ll forget, and when? I can’t. So what should I do? Maintain an immense spreadsheet of every friend, relative, and acquaintance, and when I last spoke to them? Not a bad idea, actually. I’ll get around to trying it soon, or at least starting it. I’ll lose track a quarter of the way into making it, I’m sure. Or make it and use it for a while before I miss logging one call and slowly stop using it all together, and it will become one more forgotten file taking up space in my google account, until by the time I ever find it again it will be so hopelessly out of date that I’ll have to start all over.

Do I sound defeatist? I hope not. I don’t feel defeatist or defeated, actually. Over the years, tips and tricks and practicing mindfulness have gotten me to the point where I can usually manage the most important stuff most of the time, and that’s a darn good start, really. And I have friends who understand, and/or struggle with similar issues themselves, and that makes a world of difference to my ability to accept myself. I still lose a lot, but not everything. I may not be able to do much, or do things very often, compared to most people, but I do greatly enjoy the things I can do, whenever I can do them.

I have my moments. Writing this was one of them. More of an hour and a half than a moment, really. And here it’s 2:30 PM and I washed half the dishes and scrubbed the sink but I still haven’t had breakfast… I think I’ll go do that now. Writing this helped. It got the words out of my head and into something that will remember them for me, something that can reach out and touch other people’s lives. I don’t think I said everything I meant to say, but I came pretty close. It makes me feel more real when I can do this kind of thing. More worthwhile as a person. And more hopeful, too, because it’s a reminder that I CAN do things, sometimes even amazing things, and do them well. Just not very often.

Personal Interlude: Black Dog on a Leash (Living with Chronic Depression)

I am a disability-positive person. I see beauty in human diversity, and believe there is great value in the varieties of body and mind and the great wealth of experiences that ensue from those differences. That being said, I don’t always see disability through rose-colored glasses.

Depression, like chronic pain, like most chronic illness, is one of those disabilities that’s hard to live with no matter how well it is accommodated. In fact, depression is not only a chronic illness, but also a form of chronic pain. The weight that sits in my chest may be metaphorical, but the pain is real, and at times even physical.

Yes, it would be nice if I didn’t face stigma and misunderstanding, but in my own life, those problems have been relatively minor. At best, I might have been diagnosed and started medication a few years earlier. No one has ever really been cruel to me on account of my mental illness, and no one has ever taken my freedom or any other of my rights away because of it. In this, I know I am lucky.My battles are not the same ones that many disabled people face.

Depression makes it hard for me to accomplish things, have ambition, follow my dreams. It means I’m often years behind on things like routine doctor’s visits, and other things that adults are supposed to do regularly. It’s the reason I only have a B.S. at this point, not a PhD. It’s why I work part time for barely above minimum wage, and have always worked for far less than I am worth. I am lucky– very lucky!– that I have always had other resources to fall back on, and am not living in poverty. I am lucky I have not had to file for disability status– many of us with mental illness and chronic fatigue fall into the cracks in the system because we lack the energy to even do things like file the paperwork for the help we need.

But even if money arrived on a silver platter and doctor’s visits came right to my door, at least to some extent I would still be suffering, and not in a way that anyone could do anything to change. I do suffer– SUFFER– from depression. I use that terminology very deliberately. Depression hurts. Chronic fatigue hurts. They hurt most of the time. Sometimes they hurt almost unbearably. They grind me down, hold me down, wear me down. They make it a struggle to get up in the morning, to eat, to breathe– never mind things like keeping friends and finishing college. There are times– so many times– when all I can do is curl myself into a little ball around the pain and whimper. I lose a lot of time that way.

***

What to do? More medication? Different medication? Maybe. Each comes with its own side effects and risks, and not always obvious ones, either. A myriad of other suggestions– from polite to aggressive– beseige me constantly. They range from utter nonsense to pure common sense, from free and easy to massively expensive in money or time/energy. The one thing most of them have in common is that I lack the energy to even attempt them. At least here I’m in a holding pattern, treading water– maybe not doing well, but functioning at a level I can survive with. And that’s no small thing. I do fear losing that balance. As hard as I find life right now, I am living and breathing and moving forward. I may not be doing well, but I don’t think I could stand to be doing any worse.

***

All this being said, I live well with depression– really! A lot of it is luck– like I mentioned, I’ve never truly struggled financially, I have plenty of good friends, my life has been remarkably free of major tragedies and other situational causes for depression– and (believe it or not), my personality is a pretty happy one. It’s an odd combination, actually– I’m a fairly cheerful, optimistic, fun-loving, easy-laughing, moderately-positive-thinking, stop-and-smell-the-roses kind of person… who just happens to spend a lot of time in intense emotional pain over absolutely nothing at all. Depression is a really weird thing when you get right down to it. It made far more sense when I was an angsty teenager with no romantic prospects– being miserable, cynical, and bitter meshes well with clinical depression. At that point, I had no way to know I was suffering from an illness; it made sense to be unhappy. But having trouble getting up in the morning when you have a pretty awesome life is harder to understand, even when you’re the one experiencing it.

A doctor recently gave me one of those depression rating scales to fill out. Then, after talking to me, she said “You know, you have a pretty great attitude for someone who scored this high on the depression scale!” I laughed and told her “I’ve had a lot of practice.” And it’s true that the mental tools I’ve developed to help me cope make a huge difference. They don’t lessen the pain, but they allow me to keep going in spite of it. Many of them are simple practical tips– get enough sleep, eat every day, don’t make any major decision while feeling depressed– and others are more like mantras, things I wouldn’t accept anyone else saying to me but I need to hear– like “remember, your brain lies to you,” and “it’s only pain– it can’t actually kill you,” and “it won’t hurt any less if you give up and collapse, so just grit your teeth and keep going.” I suspect everyone’s the little phrases are different. Some of mine are pretty weird, too. But you tell yourself whatever you have to in order to keep going.

***

My body hurts. I’m tired, and tired of being in pain. I didn’t get nearly as much done today as I wanted to, although I did accomplish a fair amount. I’m not looking forward to going to bed because I know I’ll be even more tired in the morning. And I meant to spend this time catching up on writing book reviews, but oh well, I suppose I needed to write this too. I wish I had more time– no, more energy– energy in a day: the time is there, but I can’t use it.

And I can’t think of how to end this, so….

My Brain Is Not An Assault Rifle

February 19, 2013 Leave a comment

Yes, this needed saying. Thank you Kyriolexy for saying it so well.

Kyriolexy

I didn’t want to write this post. I didn’t want to write about the Sandy Hook massacre of 27 people, 20 of them children. I don’t typically write about strong emotions, and what is the aftermath of the death of children but strong emotion? I didn’t want to. But here I am.

When I heard of the shooting at Sandy Hook Elementary School in Connecticut, I was horrified and viscerally sickened. I imagine that most people felt similarly, especially those of us who are parents. I thought about my friends and acquaintances in Connecticut and worried for their safety. I thought about my children–my nine-year-old son, who at that moment was in an elementary school classroom exactly like that of the Sandy Hook children. My seven-year-old son and my not-quite-six-year old daughter, so close in age to the young victims. My firstborn daughter, who follows current events and could not…

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You Are Not Adam Lanza’s Mother

December 16, 2012 Leave a comment

A better come-back than I could have come up with.

An Open Letter to the Internet

December 15, 2012 Leave a comment

On the topic of the latest, tragic shooting. I’m hearing a lot of speculation about why and how such a thing could happen, as always. None of us can imagine what would make a person do something so horrific, and so we speculate. And with that speculation, sadly, comes scapegoating.

People speculate about what type of person might be able to do such a thing: Not someone like us, but maybe people with mental illness, autistic people, goths, atheists, people who play violent video games, people who listen to heavy metal, children of single parents…

The terrifying truth is: we have no idea what pushes a person to the edge of humanity and beyond. If we did, we’d go around finding all those people and locking them up for good.

We know some factors that can contribute — we know that people who are raised in violence, abused, traumatized by war, and otherwise treated badly throughout their lives are more likely to snap and revisit that violence on the world… but if we went around preemptively locking up everyone who’d had it rough, we’d run out of jails in the first 5 minutes and most of them full of the innocent besides.

We know that drugs are more likely to make people do things that are desperate and rash. We know that desperation and despair can rob formerly decent people of their humanity. But these things primarily lead to crimes that we can understand, even as we abhor them– robberies, muggings, individual acts of violence. What could push a person to the point of causing destruction on such a massive scale is simply beyond explanation, and all the more frightening for being so impossible to understand.

All I can say is: let us not allow our fear to turn us against each other. If there is one thing we can do to reduce the risk of violence in this world it is, I believe, to treat each other with decency and respect. To reach out every day and remind one another of our own and each other’s humanity. To treat each other with compassion and concern, to encourage our empathy to strengthen and flourish. To mourn when tragedy occurs, but not to let it kindle hate in our own hearts.

Thank you.

On Living with Chronic Clinical Depression

August 3, 2012 2 comments

I am suddenly struck, once again, by the intense desire to try to explain the experience of clinical depression to those who have never endured it.

The word “depression,” to so many people, conjures up mere sadness, and makes them shake their heads in bafflement at how such a thing can entirely derail a person’s life. Those who have lived through intense sorrow or intimate grief understand better how all-consuming such emotions can be. But depression, at least for me, has very little to do with being sad, or even being anhedonic (devoid of feelings).

To me, depression means a bone-deep fatigue, an exhaustion that is physical, mental, and emotional all at once, as though I have just spent a week pushing myself through such stress and hard work that I’ve reached the very limits of what my body and mind can stand. Maybe those of you who have gone through military training or getting a PhD or working backstage during a Broadway production any other form of intensive hazing may have a sense of what this is like…. except that depression, at least as I experience it, has no discrete and perceptable cause, is not limited to a short span of time, and does not include any sense of accomplishment to mitigate the pain.

For the rest of you, I ask you to remember a time when you were ill with a particularly unpleasant bout of flu or cold. There was probably at least a day, at the beginning or end of this sickness, or when you were recovering from a major injury, where you felt neither distinctly sick — in the sense that you had no fever, were not vomiting, were not in actual pain, etc. — nor explicitly well. You were stuck, at least temporarily, in an unsettling in-between state whose existence you had probably never even considered before.

Everything seemed to require more effort than usual — walking, talking, even thinking, as though you were half asleep and wearing weighted clothing. Your mind and body were clumsy, and easily pushed off balance. You were capable of doing most things, and maybe even capable of doing them well if you concentrated very hard, but there was no such thing, that day, as an easy task.

You could lie on the couch and watch TV or perhaps read, but any other activity, no matter how fun, or chore, no matter how light, seemed overwhelming and, frankly, not worth the effort. Going to the grocery store, fixing yourself a meal, studying, balancing a checkbook, making a phone call, having lunch with a friend, seemed to require not only more physical energy than you possessed, but more ability to concentrate, and more emotional fortitude as well. Ultimately, you wanted more than anything else to rest, to recharge, to be free for the moment of the obligation to do anything more complicated than breathe.

I hope you can recall an experience like this one. Now imagine, if you can begin to do so, spending at least 50% of your time feeling more or less this way. Having to struggle every morning to drag yourself out of bed as though you haven’t slept in days. Clinging by your fingernails to moments of clarity, energy, momentum, or motivation, because you don’t know how long they will last or when they will come again. Slogging through the basics of what has to be done — cleaning and feeding yourself, keeping up with the bills, walking the dog, going to work or school — always struggling to do more than the bare minimum required but oh so rarely able to do as much as you want.

I live like this. With a near-constant weight inside my chest dragging me down, a ball and chain around my mind and will. Every day I push through it, fighting just to keep moving. Like a wind blowing against me, it is a constant force, but the force of it is not constant. It lightens for a few hours or days at a time to the point where I barely notice it. Sometimes it vanishes altogether, briefly, and I realize with shock how much affected me even on the “light” days.

Then it sneaks up on me again so subtly I nearly grind to halt before I notice it has returned. Or else it hits me out of nowhere with the full force of a line-backer’s tackle. Sometimes I freeze, mid-moment, suddenly unable to lift my fork to take another bite, or write the next line of text, even holding my breath as the wave crashes into me and I suddenly have to re-evaluate my plans for the rest of the day, even the next hour…. and wonder, each time, if I must re-evaluate the rest of my life as well. If I can even bear to continue.

Every time, I say yes. I have no desire to die — none at all. Perhaps this is because I am on medication for my depression, and as bad as everything I’ve described sounds, I know it really isn’t that bad at all in the grander scheme of depressive disorders. I also know that my life is a relatively easy and greatly privileged one, and I sure as hell don’t want to give it up.

All the same, I live almost every day on an internal battlefield, and some days it takes everything in my power to hold the line, let alone feel victorious. The word “depression”? It doesn’t even scratch the surface.

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