It started with crying.
The tears kept coming and they wouldn’t stop. Then her energy sapped. She didn’t have motivation to do anything, not even leave the house. Finally, she started feeling overwhelmingly anxious and one day she experienced a vicious panic attack.
“That’s when I finally went to the doctor.”
Her doctor diagnosed her with depression. That was decades ago. Years of medication and off-and-on therapy later, she is still coping with the disease.
“It’s not a bad thing,” she says. “It’s no different than a heart problem. It’s an illness.”
This is a real story, from a real woman—a mother of two, grandmother of three—living right here in Fargo. Although she is normally happy to share her story of dealing with depression to anyone who may also be struggling with the disease, she wishes to remain anonymous to protect her immediate and extended families’ identities.
Part of her reasoning circles around her protecting her parents, both of whom suffered from depression. She says she first became aware of their depressive states while in high school in the 1950s.
“My mom would wake up one morning and she’d be depressed,” she says. “It would be a year sometimes before she’d come out of it. But it was very hush-hush back then. You didn’t talk about it.”
One in Ten Adults Have Depression
Times have changed. Medications for depression (Cymbalta, Wellbutrin, Pristiq) are featured nightly in prime-time television advertisements. Newspapers, magazines, and broadcast news regularly feature stories about mental health. In early October, The Forum ran a front-page story of a woman who jumped to her death in Fargo after struggling with mental health issues since age 19. And questions about stress and anxiety are now routine during many patients’ annual physicals.
“A lot of times what we see is people beginning to experience an episode with depression or anxiety slowly,” states Dr. Danial Sturgill, a psychologist with Sanford Health in Fargo. “It doesn’t necessarily start off dramatically.”
That was precisely the case for Patrick S. from Chicago, who recently graduated with his master’s degree in computer science. Patrick says he first started struggling with depression as a teenager. “I think some of it had to with the fact that I was gay,” he explains. “That was a challenge that I had to internalize, especially back then.”
Patrick’s constant quest to figure out why he was gay and if that meant something was wrong with him was draining. And it got worse when he entered into his first long-term relationship. “When I was 23, I got into a relationship and he didn’t love me,” states Patrick. “I was in a crappy relationship and I was young and I didn’t have the skills to cope. I became more and more depressed until I ended up having a suicide attempt.”
He was hospitalized in a psychiatric unit for a month before beginning a year and a half of rigorous therapy.
One hypothesis of why we’re suddenly more comfortable talking and hearing and learning about mental illness is a lot of us suffer from it. The latest report from the Centers for Disease Control and Prevention (CDC) shows an estimated one in 10 U.S. adults report depression. The same study finds that several groups are more likely to suffer from major depression: people between 45 and 64 years old; women; blacks and Hispanics; people with less than a high school education; people who were previously married; the unemployed; and people without health insurance coverage.
On its website, The National Alliance on Mental Illness (NAMI) states, “Depression occurs 70 percent more frequently in women than in men for reasons that are not fully understood. Without treatment, the frequency and severity of these symptoms tend to increase over time.”
Therapists interviewed for this article agree the most common mental health issues for which they counsel people in Fargo-Moorhead are depression and anxiety. Beyond the CDC’s criteria, therapists say economic stressors, issues with aspects of a rural life, and life adjustments like the birth of a child or death of a loved one are the biggest reasons why people in our region suffer from depression or anxiety. Many people also experience Seasonal Affective Disorder (SAD) which is a kind of depression that can occur during long winter months.
“It’s important to note that there are many varieties of depression and anxiety,” explains Sturgill. “Depression can range from low-grade, chronic depression to bipolar disorder where there are major changes in a person’s mood states. Anxiety can include everything from generalized anxiety, panic disorder, Obsessive-Compulsive Disorder, and Post Traumatic Stress Disorder.”
John Lyon, a therapist with The Village Family Service Center, also says depression and anxiety can co-mingle in people, which can complicate a diagnosis and course of treatment. “You can be anxious and depressed,” he says, adding, “and sometimes you can experience generalized or catastrophizing worry, and depression, where you’re evaluating things in a negative or unpleasant way.”
What is Depression?
But what, exactly, does depression feel like? And why is it happening?
For Samantha Smith, a happily married mom of two young girls from Fargo who also wishes to use a pseudonym to protect her family’s identities, depression manifested in three ways: anger, compulsive eating, and isolation.
“I’ve probably been dealing with depression since high school,” she says, “but of course, like many people I never sought help. I was always able to push through it.”
A series of traumatic life changes that included an abrupt marriage, childbirth, and her husband’s erratic work schedule catapulted Samantha into a depressive state from which she could not self-soothe.
“I’d get angry, extremely angry about everything,” she explains. “I wasn’t necessarily mad at anyone but I was angry at life.”
Sometimes Samantha wouldn’t eat for days, like her mind and body forgot to tell her it needed nourishment. Then she would binge, unaware of how many calories she was consuming while sitting in front of the television.
And then, she started pulling away from extended family and friends. A social butterfly who loved to talk and go to parties or other public events, Samantha holed herself up inside her home every night.
“Normally I loved talking on the phone, but I would only talk to my husband, my parents, or his parents,” she remembers.
Samantha’s experience is not unlike millions of others who are suffering from depression. The National Alliance on Mental Illness says, “Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.”
Mental health issues in general, and certainly depression and anxiety, are physiological conditions that are happening inside your body, often to your brain. You didn’t cause it. You didn’t do anything wrong. It can be hereditary. Often, you can’t fix it without a course of treatment like medication, therapy, exercise, meditation, or some combination of clinical and holistic approaches.
“I think that people don’t recognize that depression is something physical that’s happening to them,” says Sanford’s Sturgill. “They tell themselves, ‘I just need to buck up and deal with this,’ instead of seeing the depression as an illness that is largely beyond their control.”
Perception—or how you view the world around you and your place in it—is something that skews when experiencing a mental health issue, says Barbara Werre, a Board Certified Professional Counselor and Licensed Marriage and Family Therapist and owner of Essentials of Life in Moorhead. She says perception is the common denominator in nearly all of the cases of mental health she’s counseled.
“Each of us has a unique way to make sense of our ‘own world’ which then explains ‘our reality,’” says Werre, adding that a person’s perception is built, in part, on personal beliefs, morals, family history, environment, etc. These combined beliefs and experiences become the filter through which a person reacts to the world around them.
During an episode of a mood disorder like depression, your perception of where you fit into your world can dramatically change, says The Village’s Lyon. “You’ve heard the expression rose-colored glasses? Well, it’s like depression-colored glasses. Everything looks bad or feels sad,” Lyon says. “And so many people, because of that, feel like it’s a sign of personal failing. They think, ‘I’m a bad person because I can’t handle this or manage that.’”
However, with additional research into the brain and increased awareness about mental health, Lyon says more and more people are beginning to understand that depression is a physiological disorder and they are willing to seek help.
For example, Samantha reached out to her family practitioner who immediately saw her distress and referred her to a psychiatrist. Today, with the help of medication and psychotherapy, she is in a much better place.
“I was in such a cloud before getting help that I couldn’t even see how bad off I was,” explains Samantha. “I was a little nervous before my first therapy session. I didn’t know what it was going to be like. But he was very nice and straightforward. He explained what a therapy session with him would be like and asked if I was okay with that.”
It’s important to clarify that Samantha isn’t cured. The National Alliance on Mental Illness states that, for most people, depression will be a lifelong battle where periods of wellness will alternate with periods of illness.
Fight or Flight
Sometimes a mental health disorder can appear after experiencing a traumatic event. Post Traumatic Stress Disorder, or PTSD, is often associated with veterans of war, but the National Institute of Mental Health (NIMH) reports about one in 30 adults in the U.S. suffer from the anxiety disorder.
A person often shows symptoms of PTSD after seeing or living through something dangerous. According to the NIMH website, “This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This ‘fight-or-flight’ response is a healthy reaction meant to protect a person from harm. But in PTSD, this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they’re no longer in danger.”
Angela Bartsh, a married mother of two from Fargo, is recovering from PTSD following the birth of her second child. She was forced to deliver him in a car with only the help of her sister after her labor progressed during a surprisingly short span of 20 minutes. Compounding Angela’s anxiety over the birth was a moment after paramedics arrived and she asked them if everything was okay with her child. She says they paused and asked her to give them a moment before assuring her he was, in fact, healthy.
It was in those precious seconds that Angela believes her trauma reached a critical point. She began experiencing severe nightmares and anxiety attacks. After waking up sweating and crying, she’d rush into his room at night to make sure he was breathing. Angela says she would “freak out” if she had to leave his side for more than a couple of minutes. Convinced she had postpartum depression, she sought advice from her doctor. But after discussing her symptoms, doctors determined Angela was actually suffering from PTSD.
“I felt alone. When I tried talking about it with other people, they thought it was a cool experience. I delivered my son in a car,” she says. “What they didn’t understand was the not knowing if he was alive or okay. The paramedics did everything right that day; I just didn’t know.”
Medication has eased Angela’s nightmares and keeps her anxiety levels manageable. For many people though, psychotherapy or other treatment methods may also be needed. At Essentials of Life, Werre incorporates a nontraditional psychotherapy called Eye Movement Desensitization Reprocessing (EMDR). It’s just one of the modalities she uses to help patients. Lyon, one of several therapists at The Village trained in EMDR, explains it in more detail. “EMDR uses alternating bi-lateral stimulation, usually eye movements, to help the client process traumatic memories and experiences. Theory suggests that this bi-lateral stimulation helps the client’s own brain reprocess the trauma into a less hurtful and emotionally powerful memory.”
A Major Concern
Unfortunately, mental health issues like depression, anxiety, and PTSD still carry a heavy amount of stigma. For a variety of reasons, people don’t feel comfortable admitting they are not functioning well.
It took Angela almost a year to tell her parents about her PTSD diagnosis; her husband’s parents still don’t know. “I was embarrassed. I am supposed to be this strong mom who can handle anything,” she says. “I felt stupid that I had this problem; I felt and thought that people who actually experienced an event had PTSD, people in war and police officers. I still feel uncomfortable talking about it.”
Kama Jensen, a licensed Clinical Counselor who owns Conscious Living Counseling and Education Center in Fargo, says stigma against people with mental health issues is still a major concern—and it often comes from the patients themselves.
“People will find a way to get by, and this can create habitual patterns which worsen conditions like depression and anxiety,” explains Jensen. “Our brain is designed to be efficient and find the quickest answer. Without a healthier solution, the mind can convince itself that the way to cope with anxiety and depression is to avoid social events, people, or even life.”
This can result in suffering in isolation which, according to Sanford’s Sturgill, is one of the worst things that can happen to a person suffering from depression or anxiety.
“That’s when things get really bad,” he says. “When they don’t talk, they become isolated. They start to feel that it’s not okay for them to talk about their problems to others.”
Werre believes much of the stigma that forces people to keep quiet about their mental health concerns is a cultural phenomenon called the “myth of naturalism.”
The myth implies several key factors: 1) A person should know how to manage anything and everything in life, 2) It is a weakness to seek help from others, 3) Being independent is a strength.
“It is pervasive and destructive,” Werre states. “This myth has helped create the stigma that still exists today. Humans are meant to be connected to trust others, and we are meant to learn from each other.”
In other words, suffering in silence doesn’t do anyone—least of all you—any good.
There is a shift, albeit slight, happening. The Village’s Lyon explains that as more research is funded and completed, and more media outlets report those findings, more people are viewing therapy as self-improvement instead of a psychological sentencing.
“I see a lot of self-referrals now,” says Lyon. “So many people come in wanting to work on themselves in hopes of becoming a better person. They are taking pride in wanting to be their best selves. There is definitely a self-improvement culture that’s been growing.”
Actors like “Mad Men’s” Jon Hamm, musicians like “The X Factor’s” Demi Lovato, and well-known journalists like “60 Minutes’” Mike Wallace disclosing their brushes with mental health issues have also bolstered people’s understanding that it can affect anyone, regardless of their status in life.
However, there is still a long way to go. All you have to do is look at the two women and one man who chose to remain anonymous in this article. Although they’re happy to share their story to help other people recognize symptoms and seek help, they’re not so comfortable with the reactions they get (or their family would get) that they want to make their identities public.
You know the warning signs. The symptoms. The most common types of mental health issues. You think you need help. Now what?
The simple answer is to find someone to talk to. Although a licensed therapist is best, Sturgill says reaching out to a family member, friend, member of clergy, or your personal physician is also good.
“The idea is that you find somebody who you can bounce ideas off of,” he advises. “You tell them what you’re experiencing and together figure out when you need additional help.”
Locating and using a support system of family and friends is what ultimately helped Patrick S. cope.
Patrick was able to manage his depression by turning to family and friends and a regular, rigorous exercise routine. “Those things really helped me,” he says.
If and when you’re ready to take that next step, there are plenty of resources available to you in our region, and nationally, over the phone or through the internet via web therapy (although you may want to check with your insurance to find out what is covered under your mental health plan option).
Determining which method of therapy is best for you may take trial and error, something Conscious Living’s Jensen says any clinician should welcome. If they don’t, it’s a red flag.
“I always tell people to shop around for the best fit,” advises Jensen. “A quality clinician should never feel threatened by questions like: Tell me about your background. What training do you have in treating depression or anxiety? How long will the therapy process last? These are important questions. Go to the person who feels right for you.”
For Ashley Kingsley, a mom of two from Denver, Colorado, that meant finding therapists who were willing to explore alternative methods of treatment. “I tried hypnosis. I tried yoga, meditation, quitting caffeine and alcohol, nicotine. I was willing to do anything that would help. I then went to medications.”
According to The National Institute of Mental Health, choosing the right medication, medication dose, and treatment plan should be based on a person’s individual needs and medical situation, and under a doctor’s care. Dosage may need to be adjusted from time to time. For example, Samantha’s psychiatrist upped her dosage when she experienced postpartum depression following both her children’s births.
The Other Side
When you’re in the throes of depression or an anxiety disorder, it can feel like you’re trapped in your own mind.
“Focusing on anything was extremely difficult,” says the grandmother we met first whose parents both struggled with depression. “The more I’d try to think or concentrate on something, the more I couldn’t. I started to feel so trapped I didn’t want to leave the house.”
But when the cloud clears (following whatever forms of treatment you’ve sought), she says it can turn your whole existence around.
“For me, medication was really the breakthrough. I remember when I started feeling better, it was like, ‘Wow! I didn’t know I could feel so good!’” she says. “Once I experienced that, it was so phenomenal I knew I’d be willing to take charge of my mental health whatever it threw at me.”
That’s a self-improvement strategy everyone should try.
Patricia Carlson is a freelance writer and media coach from Dilworth, Minn. View more of her work at www.patriciacarlsonfreelance.com.
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