Too Much and Not Enough

     When someone finds out that I have a mental health condition, especially some strange type of OCD called Primarily Obsessional Obsessive-Compulsive Disorder, they tend to have a lot questions. One of the questions I get frequently is something like, "What sort of medication do you take for it?" That seems to be the thing that people are most worried about asking. I'm not bothered by it. I just think it's odd that people tend to focus on the medication aspect of treatment instead of something more practical like the cost and frequency of therapy, or maybe even the other stuff I'm doing, like lifestyle changes, that are helping me on my journey to recovery.
     I feel weird about that question. I don't take any medication every day for my OCD, but I was prescribed Ativan. I only take it if my anxiety has been too high for a set number of days that I give myself in spite of everything I do to get the anxiety to go back down, or if I feel a panic attack looming and I can't fight it off. I take it sparingly. I have told this to people, and I've encountered people on both ends of the judgement spectrum.
     Some people think it's a big deal that I don't take something like Lexapro or Anafranil or even Valium every day, and they have recommended self-medicating with pot since I don't want a prescription. Some people also seem very negative about the fact that I take an Ativan occasionally. I've also encountered people that view medication for mental health conditions as un-Christian. It seems like I'm either too medicated or not medicated enough, depending on who you ask.
     In our society, we have a huge stigma around taking medication for mental health conditions. In America, it seems like taking medication for your mind is a sign of weakness, or that someone is using it as a Band-Aid or crutch. It also seems that, at least in my area where ADHD medication as well as things like Prozac and Paxil are handed out like candy by doctors who shouldn't really be prescribing such things without sending patients for a psychological evaluation, that being diagnosed with an actual condition but not taking any medications for that condition is just as frowned upon and puzzled over by a great number of people. (Like, I have a free pass to take the happy pills so I should take advantage of that.)
     I'm most definitely not anti-medication. I think that if you need medication to help your brain get well and to help you function at a higher level, then you should definitely talk to your therapist about a medication action plan that would work for you. The medication is there to help you, and when coupled with therapy it can be very effective for a lot of people.
      I don't even have a profound reason for not trying Anafranil or any other medications. I just don't want to try them yet. I tried Lexapro for 5 days, and it was the worst 5 days of my life. The Lexapro just didn't get along with my brain chemistry. So, I'm trying therapy on its own, and that is currently what works best for me. Although, if my therapist thought I needed medication, I would listen to her.
     I'll end with this: Mental health conditions are so very different for everyone that lives with them every day, and so are the effects of the medications used to treat them. Whether or not you choose to use medication in your treatment plan is the business of you and your therapist, and maybe your parents if you're under age. Don't let anyone make you feel weird about your decisions regarding medication because they aren't you. They have no idea how your brain works, and they have no idea what you live with every day.
    

Life Unmuted

     We all, at least once in our lives, have felt like life has piled up on us and everything going on is just too much. Sometimes, try as we might, to manage our time and our stress and to balance our lives, too many things can happen at once, out of our control. Some people are better at dealing with these moments in life, but me, well...I like control a little too much to be okay with it when things like that happen. (Okay, maybe a I like control a whole lot.)
     This past week, I had a lot going on that was outside of my control. I had what seemed to be a health crisis, but it turned out to be something that wasn't a huge deal. I had an issue with my feelings that I had to take the time to sort out. I was worried about the safety of some people I knew with dangerous occupations. Then, I also had my very first photo session, and it was family portraits. I loved that part, but it was very stressful since it was my first time photographing people. I felt anxiety, intense fear, disappointment, sadness, excitement, and other things in quick succession all week, all as jumbled in my mind as the issues that were causing the feelings. I had no idea what to do with so many feelings going on at one time. I really didn't have control over any of these things, and that just added to my problem because I tried to have control over all of them.
     While I was in elementary school, high school, and even in college, life would pile up on me, much the same way as last week. My way of dealing with it was sort of to not deal with it. I would throw myself into school work, and I would ignore the problems. It almost felt like I could shut my emotions down or at least press the mute button until I was ready to feel them (which would have been never if I had my way). Then, at night, when I would try to go to sleep, I would let myself think about the things that were bothering me. I would be so overwhelmed by all the problems. I ended up crying myself to sleep more times than I can count. Then I would wake up, hit the mute button on my feelings, and repeat the same routine as the day before.
     This week, while I tried unsuccessfully to take back my control with the same methods I had used all my life, I realized that I could no longer press the mute button on my feelings. I had feelings, and I still didn't like it. This stress and my worry over the fact that my feelings mute button was missing made me feel so out of control. I didn't even know if my feelings were normal feelings, but I couldn't stop them from rolling in like a giant tank. Due to the stress, I felt like someone had cranked up the volume on my OCD, which I had finally turned down to almost background noise.
     I had to resort to the new methods I'd learned in therapy. I tried Mindfulness, and I had to just sit with my feelings and observe them. I just had to feel stuff until the stuff was processed and resolved. I also had to accept the fact that I couldn't actually control everything, including my own feelings. That's a pretty scary thing when you're not used letting yourself feel things. (Shocking discovery: I'm noticing that I'm a pretty emotional person, and it doesn't take much to make me tear up.)
     I still have the habit of trying to shove my feelings down and ignore them because, even with therapy, old habits take time to break. I am trying to embrace my feelings, but it's also scary because I'm terrified something will set my anxiety off and send me into a panic. I just have to remind myself that living a life unmuted is healthier than pretending I don't have any feelings.
     I'll end with this: Our feelings exist for a reason, and it's completely okay to feel whatever we feel. We can't really control our feelings all the time, and that is also okay, as long we don't act in any way that harms us or anyone else because of those feelings. The sooner you can embrace your feelings and just feel them, the quicker the feeling will process and resolve in most cases, according to my therapist. Life with feelings is much more interesting than life with your feelings on mute.

How Do You Do It?

     I was talking to a friend the other day, and we were chatting, like usual. The person knows that I have OCD, and the topic of mental health came up. Then the person asked me a question that surprised me. "How do you do it?" the person asked me. Meaning a number of things: how was I handling my OCD, how was I functioning so well, how did I still seem to be at least okay while I was dealing with OCD.
     The question surprised me because they thought I was doing well enough to ask such a question. I've only heard this question applied to parents that are super-parents or college students that go to class full-time while they work full-time and maintain a 4.0 GPA, people that seemed to do exceptional things. So, it wasn't a question I expected to hear. So, this got me thinking. I started thinking about the way I appear to other people.
     While I was secretly living with OCD I remained high functioning because I had to be high functioning in order to hide the fact that I was dealing with the possibility that I was losing my mind. No one could know that I was dealing with intrusive thoughts that I didn't understand and mental compulsions that I didn't even know were compulsions. I hid it so well that not even my mother knew what was going on until this past year when I literally couldn't deal with it on my own any more.
     Then I started therapy. I assumed that when I came forward with an OCD diagnosis and my decision to seek treatment that the way people had viewed me would change. I had assumed that everyone would suddenly view me as some lower functioning weakling that couldn't manage on her own. I viewed myself that way in the beginning, like the OCD made me weaker. It didn't occur to me that some people, maybe those struggling with some mental health condition, or maybe just those people that understood OCD or mental health in general might view me as stronger for having more on my plate to deal with. I also hadn't thought that I would be viewed the exact same as before my diagnosis, but that has also been the case (with a couple of exceptions).
     I still have bad days, and to me those bad days are so terrible that I know they have to be obvious to everyone around me. I'm even a little bit afraid that, if I go out when I'm having a bad OCD day, that people will be able to read it all over my face. It feels like I have OCD stamped on my forehead. That has never been the case. When I have bad days, no one even notices. I appear normal to everyone that doesn't know me on a personal level. I still appear to be a very high functioning, well adjusted person instead of the anxiety-riddled, OCD-labeled person that I see when I look in the mirror some days.
     So, I've been thinking. How do I do it? I have no idea how to answer that question. I just take life with my OCD one day at a time, and I hope and pray that I have more good days than bad days. I also think the answer depends on the person that asked the question. I would probably give a different answer to every person that asked. If a fellow OCD sufferer asked, I would give a technical, therapeutic answer. If another friend asked, I might list off the lifestyle changes I've made since October. If a stranger asked, I might just say that I sought out the help of a therapist, and that I've used a workbook.
     I'll end with this: Be aware of how you see yourself versus how other people see you. You're worst days might look like just an average day to the casual observer, so don't stress about how you appear to everyone else so much. You never know, someone might look up to you for the fight you don't even realize you're winning against a mental health condition.

Dealing with Anxiety in Public

     I'm just sitting at a table waiting for the dinner that I ordered. A door slams. I hear yelling in the kitchen. A toddler over at the next table is screaming. People are talking loudly to be heard over all the other noise. Maybe I'm already trying to manage my anxiety that day because I've been having a particularly bad day due to my OCD intrusive thoughts. My anxiety is quickly climbing to the level that usually means the tears are going to start flowing. I'm in public, and realizing that only adds to my anxiety. I feel a panic attack looming. What will everyone think? I CANNOT have a panic attack in public, in front of all these strange people.
     The scenario I depicted above is one that I still find myself in at least once a month. I go somewhere, and I'm perfectly fine the whole time I'm in the car. Then I get inside (movie theater, restaurant, shopping mall, store crammed with people, or the grocery store around a holiday when people frantically hurry from one aisle to the next), and something makes my anxiety skyrocket. Suddenly, I feel like I can't breathe, the tears come, and I'm about to be in full-on panic. This sort of thing happens at home sometimes, too, but it always seems so much worse when I'm out in public.
     I used to just suck it up as best I could while I was in public. I vowed that I would behave as normally as possible no matter what. This just made the anxiety worse, and I would usually push myself right into a panic attack because I was so aware of my body and the anxiety symptoms.
     I showed up for a therapy appointment not too long ago in a state of heightened anxiety, trying to force myself not to have a panic attack. I had been trying the deep breathing exercises like I was supposed to. I had even tried the grounding technique that I was familiar with. I was still on the verge of panic. Then my therapist taught me a new grounding technique that worked. She called it Being Like a Dog, but in my mind I refer to it as Zoning In because that makes more sense to me. I use it all the time now because it doesn't require movement or any objects that I would have to carry around. It also doesn't require the deep breathing, but you can do that, too, if you want. I also chew gum when I get very anxious, but you don't have to do that.

Being Like a Dog (AKA Zoning In):
     You're basically zoning in on each of your senses, one at a time. It gets you to focus on things outside of yourself and your anxiety symptoms. It also makes you focus on the present moment, what's around you right now. It's unnoticeable to everyone around me, so I like it especially for when I feel panicked in public. You can say these things to yourself or a friend, or you can type them in your phone notepad, or write them down. (I usually silently say them to myself.)
     1. What do you hear? Ex. right now I hear my fan humming and the TV in the next room.
     2. What do you see? Ex. I see my orange blanket, coffee cup, and the sun in my window.
     3. What do you feel? Ex. I feel the breeze from my fan, and my warm coffee cup in my hand.
     4. What do you smell? Ex. I smell coffee and lavender.
     5. What do you taste? Ex. I taste the coffee I'm drinking. (Gum, your food at the restaurant, ect.)

     I may have to repeat this a few times, depending on how much anxiety I'm dealing with. You can repeat as many times as you need to. It's okay if you don't have something going on for all five of your senses. Maybe it's quiet wherever you are or you don't smell or taste anything, but you should still include all 5 senses in your list each time.
     I'll end with this: Experiencing an anxiety attack in public can feel worse than the ones you experience at home. Holding it all in and pretending to be perfectly fine can make it worse. Just remember: odds are in your favor that no one is watching you at all (let alone to see if you're normal or anything like that). The grounding technique I mentioned above is a wonderful thing, but I'm definitely not saying that is the ONLY tool to manage your anxiety in public.

Talking to Myself

     "Don't be ridiculous, Megan. Come on, you know you're not actually going to suffocate. Just stop it! This is stupid. You were fine. What did you do? Why can't you just...?" This was the conversation I had with myself (in my head, of course) the other night, during and after an anxiety spike. This is the conversation that I have internally pretty much every time I experience an anxiety spike. I sound harsh, right?
     I basically say everything to myself that I wouldn't want anyone else to say to me. I'd be angry with someone if they talked to me the way I talk to myself about my anxiety. I would never say these things to anyone else struggling with any kind of mental health condition. I would be understanding, kind, and (hopefully) helpful if I stumbled upon a friend in the middle of an anxiety attack. Yet, I wasn't extending the same understanding and kindness to myself.
     I didn't even realize how negative I was when I talked to myself about my OCD until my therapist pointed it out. At my last session, she asked me what I would think or say to myself while I was experiencing an anxiety spike. I gave her the rundown of my usual internal conversation. She was quick to point out that I could definitely turn my internal dialogue in a more positive direction.
     Negative self talk can have damaging consequences. I was putting more pressure on myself than I should have been to continue improvements instead of just being grateful that I've improved at all. I was saying some pretty harsh things to myself, and that was keeping my confidence on the low end when I was dealing with my OCD, which in turn was making my spikes last longer and be worse in general than they should have been.
     My negative self talk was also keeping me focused on the physical symptoms of my anxiety. I felt like I couldn't breathe, so I was reminding myself over and over that I wasn't actually going to suffocate, which wasn't helpful. My chest hurt, so I was reminding myself that a panic attack wasn't actually going to cause a heart attack. I was scanning my thoughts and even the events of the day to see what I had done to cause my own spike, which just kept me locked in rumination and made me blame myself. Then I was getting frustrated because I couldn't just shut down the anxiety, which just added to the anxiety. I had anxiety about my anxiety, and the way I was talking to myself about it was only making things worse.
     I was doing the breathing exercises. I was distracting myself. I was trying mindfulness. I was burning lavender oil. I was even trying out yoga. My therapist even said I was doing a lot of the right things to deal with the sudden spikes. The problem was the fact that I was being so negative in the way that I was thinking about my anxiety and talking to myself about it that it that it just kept feeding the anxiety monster.
     I've been more careful with the way I talk to myself lately. When I catch myself engaging in negative self talk, I've started to try to correct it. Instead of saying, "You know you're not going to suffocate," I say instead, "My body is getting enough air." Then instead of blaming myself for having the spike in the first place, I remind myself that maybe it wasn't my fault because my brain may have picked up something in my environment that I wasn't even aware of and associated it with something else that sent off the alarm signals that caused the spike in my anxiety. I've started to notice a significant decrease in my free-floating anxiety as I've tried to engage in more positive self talk. Once again, it feels like I might actually be able to get my anxiety under control.
     I'll end with this: Be kind to yourself. Be patient with yourself. If you wouldn't say it to your friend or someone else you love, why would you say it to yourself? Be careful with the words and the tone you choose when you talk to yourself about anything, but especially when you talk to yourself about something, like a mental health condition, that isn't even your fault.

The Small Victories

     I had a conversation with my therapist a few weeks ago, and we were talking about some changes that I had started to notice. An example is that when I wake up these days, my mind is quiet or filled with thoughts that fall into the neutral category, like whether or not it's a workout day, instead of the intrusive thoughts that I've been waking up with for years. Yes, I still experience anxiety, but it's more of a free-floating anxiety instead of the anxiety brought on by my intrusive thoughts.
     I was sort of beating myself up for still having anxiety, even the random free-floating anxiety, more days of the week than I was being calm. I was trying to be patient, but after being in therapy for 3 months, I wondered if I should be seeing bigger improvements. I was still making small improvements, but I was worried that they weren't enough, like maybe I wasn't trying hard enough.
     My therapist thought I was being too hard on myself, and I was. She told me something like, "It's really the small victories...they're important because they give you the confidence you need in yourself to be able to continue to improve." She had a point.
     It's like this: When you learn to drive a car, you don't just get in it and go right for the main roads with all the traffic and things like that. You start off slow. You learn where the gas and the break are. You learn how all the knobs and buttons in the car work and what they're for. Then maybe you back up and drive down your driveway a few times. Then you might take the car though your neighborhood (and hopefully you don't cry behind the wheel like me). The point: You learned to drive in small pieces. You couldn't just get in it and drive yourself to school on the first day. All those small pieces you learned were important pieces, and when you got the hang of them, you were confident and proud of yourself for accomplishing something.
     Mental health, especially recovery from and even the day-to-day management of some mental health condition that grabs hold and throws your life out of whack, can be thought of in the same way. You recover in little, but still very important, pieces. Those small victories you have, like going a whole day without a panic attack when you have panic attacks everyday, or managing to get up and shower when you're depressed, are super important. Those small victories give you more confidence to think that maybe you can get better. Those small victories give you hope. They get you thinking about the big victories you could see in the future, or they may even spur you into more wellness-oriented changes you could make, like trying out yoga or whatever your idea of wellness practice includes.
     I was thinking about this the other day, and I realized that because of the little pieces and the little changes I've made, I haven't had a panic attack in just over two months. I started off thinking that if I could go 24 hours without a panic attack, I was alright. Then I started thinking that if I could go 48 hours without a panic attack, I was alright. My small victories added up. Now, I'm just working on managing the anxiety instead of being terrified that a panic attack is going to hit me at any second.
     I'll end with this: Even the small victories are important when you're getting your life back after or during a struggle with a mental health condition. Those small victories add up. Remember to stop for a second and recognize your victories no matter how small because you worked to achieve them.

If You Can't Afford a Therapist

     I saw this link someone shared on Facebook the other day mentioning free and very cheap resources for people when they can't afford to see a therapist, and I got pretty excited about it. I didn't know about a bunch of the stuff on the website's list, and I hadn't been aware that things for mental health services were free (aside from crisis hotlines). So, I did some digging, too, and I found a couple of other free resources to add to that list. (I'll post all the websites I used at the end of this blog post.)

1. Crisis Hotlines or Call Centers:
     I saw numbers listed for all sorts of call centers for everything from suicide prevention, OCD PTSD, domestic violence, to LGBT-related issues.
 The National Suicide Prevention Hotline: 1-800-273-8255
 GLBT National Helpline: 1-888-843-4564
 GLBT National Helpline for Youth: 1-800-246-7743
 National Domestic Violence Helpline: 1-800-799-7223/LGBT: 1-800-832-1901
 National Eating Disorder Association Helpline: 1-800-931-2237
 Veterans Crisis Line (for veterans and their families): 1-800-237-8255
*This isn't the full list, so check out the website for more.

2. Mental Health Apps:
     I've really been looking at these apps for your smartphone, but I don't have personal experience with them. Most of them are free in Google or Play Stores (whatever is on your phone). Just click where it tells you to download or install and then you'll have your mental health app at your fingertips.
 Operation Reach Out: This app was designed to aid suicide prevention (free iOS and Android)
 PTSD Coach: This app is linked directly to support services and helps deal with specific issues  (free for iOS and Android, also available on the web to download)
 Stop! Breathe! Think!: This app helps cultivate mindfulness to reduce stress (free iOS & Android)
 Mindshift: This app is for anxiety management (free iOS and Android)
*This isn't a full list, so check the websites and maybe Google some additional things if interested.

3. Support Groups:
     I have seen postings around my small town for support groups for Alcoholics Anonymous, Narcotics Anonymous, and general substance abuse, but I haven't seen any for mental health conditions. You can Google services like that in your area, or check with your local community health organization. Support groups are free, usually informal, usually with a non-therapist (just a regular person) leading discussions about whatever the specified issue is for the group.

4. Workbooks:
     Workbooks aren't free, but you can get them for pretty cheap prices on websites like Amazon. On Kindle or tablets some books are as cheap as $0.99. Others that come in hardcopy format are under $30, and used for $10 and under. They have workbooks for OCD, Anxiety, Depression (including teen and Bipolar depression), eating disorders, ADHD, personality disorders, and PTSD. All you have to do is search Amazon and pick the right workbook for you.
     I used a workbook to help with my OCD (a practice outside of therapy sort of thing), and it helped me more than I thought it would. I read the workbook, did some of the thought-centered exercises, and it changed the way I thought about my OCD completely. It wasn't a fast or easy process, but I still recommend trying a workbook if you can't afford a therapist.

5. Websites:
     Websites can also be a good resource if you can't afford a therapist. Some have an online forum or chat for mental health-related topics, and some are just to help you gain information.
 OK2TALK: For teens and young adults dealing with mental illness, an online forum to share personal stories and provide support.
 Trevor Space: For members of the LGBT community to share stories and support.
 IMAlive: An online crisis chat staffed by trained and supervised volunteers across the country.

If you just want information check out these resources:
 International OCD Foundation
 National Alliance on Mental Illness AKA NAMI (can provide you with a list of resources. They  also have Pinterest boards!)
 MentalHealth.gov
 National Institute of Mental Health
 National Eating Disorders Association of America
 Substance Abuse and Mental Health Services Administration

     I'll end with this: If you can't afford a therapist, and you're struggling, please, don't think that it'll never get better. Check out some other resources like workbooks, help lines, mobile phone apps, and online chats. Help is out there, and it's very cheap or free, if you look in the right places. If you don't know how to look, ask someone. You can even ask me.

The websites I used:
1.http://greatist.com/grow/resources-when-you-can-not-afford-therapy
2. http://rumpfcounseling.com/blog/2015/6/8/apps-for-mental-health
3. https://www.veteranscrisisline.net/