The Medication Game: Trial and Error

Despite progress in Mental health treatments in the past few decades, we still rely on a fair bit of trial and error to find the right treatments for each individual. Even when we know something does work, we don’t necessarily understand why or how. And symptoms, both in what causes them and what alleviates them, can vary widely from person to person.

Gone are the days when society would just shut people away in asylums (looking at you, Arkham), sedate the shit out of them, or force them to undergo painful, cruel procedures. Some of those procedures still exist, like Electroconvulsive Therapy (ECT), but are carefully considered, performed with informed consent (looking at you, One Flew Over the Cuckoo’s Nest), and conducted in a manner that is far more sensitive to patient needs.

We have developed a greatly expanded array of medications as we’ve improved our understanding of how our brains work and what physiological factors can be at play with challenges to mental health. Rather than just sedate the shit out of people, we can use medications targeting specific neurotransmitters, like serotonin, to help our brains use them more fully.

In this post, I will share my experiences with the medication game: the trial and error of finding the right treatments for my mental health challenges. I will discuss various medications I have taken for my mental health challenges, discuss gaps in our understanding of what works for some but not for others, and point to some exciting research that is aimed at taking guesswork out of the process for finding the right treatments for each person.

The Imitation Game (film)

The Imitation Game is a terrific film about Alan Turing and his team’s work during World War II to crack the cyphers that German Navy used for their communications. By easily changing settings on their Enigma machine, the Germans were able to create a new cypher scheme every day. Turing and team needed to start over every day. This work included a massive machine designed to churn through mathematical probabilities to quickly land on the most likely solution. The machine and the process behind it laid the early foundation for the computers we know and love and hate today.

Enigma machine

That daily reset necessary for Turing and his team parallels with the trial and error that is often a key component of finding the mental health treatments that will work well for any one person.

Note: The The Imitation Game – Wikipedia entry notes some historical inaccuracies between the film and what actually occurred, beyond some amount of dramatization that often accompanies films like this.

The Current Process: Fuck Around & Find Out

Despite how much we understand about our brains, there is still a tremendous amount we just don’t know. The human brain is massively complex and hard to study, particularly when it comes to disorders or injuries. We can’t just go around giving people tumors or concussions just to study what happens. It’s even worse for mental health challenges that can behave differently for each person, both in terms of symptoms and in the therapies that are likely to work for them.

The treatments for mental health rely heavily on the highly scientific process of Fuck Around & Find Out (FAFO):

Fuck Around: Let’s try X.
- Find Out: Hm. OK. That didn’t work…
Fuck Around: Let’s try more X.
- Find Out: Hm. OK. That didn’t work…
Fuck Around: Let’s try Y.
- Find Out: Hm. OK. That helped some but the side effects were unmanageable…
Fuck Around: How about X and Y together?
- Find Out: Shit. OK.
Fuck Around: Z?

Not only is this a terrible experience for the patient, but it can take a long time. Some medications take four to six weeks before they reach their therapeutic efficacy. And then, it takes time to assess how it is working. As a result, the “Let’s try X” can last months, during which the patient can still be in a bad way.

Some interventions, like Transcranial Magnetic Stimulation (TMS) (see Transcranial Magnetic Stimulation (TMS) » Can’t Juggle) take place over several weeks and involve an investment of time (heading into the TMS clinic every weekday). Eye Movement Desensitization and Reprocessing (EMDR) (see Trauma, EMDR, and the Kobayashi Maru Test » Can’t Juggle), can take weeks and be absolutely grueling. EMDR kicked my ass so profoundly that each weekly session was followed by three to four days just to recover.

Even when we find a treatment that works pretty well, there is no guarantee that it will continue to work well over time. Sometimes a medication, for example, will be helpful for a few years and then stop being helpful for no apparent reason. This really sucks as it means starting the Fuck Around process over again (albeit with one less option since we now know something that is ineffective).

Some medications must be ramped down over time, rather than just stopped altogether, to avoid nasty effects, some of which can be just as awful as the symptoms they seek to alleviate. This can add even more to the process of changing medications.

To Thine Own Self Be True

One big factor in the challenge of managing mental health is that it relies heavily on the subjective reporting of symptoms by the patient. There is not an objective scan or test like there is for things like broken bones or strep throat. Progress requires that the patient both notice symptoms and communicate them effectively.

Even just noticing symptoms when they occur can be challenging, particularly when someone is in crisis and their processing centers of their brain are being circumvented. Stigma can also make it harder for someone to share symptoms due to feelings of embarrassment, shame, or fear of backlash.

Communicating symptoms clearly can also pose challenges. Sometimes we just can’t find the words to express ourselves. There have been times where my therapist has asked me questions about how I am feeling and there has just been a long pause followed by me saying, “I don’t know.” That’s not a good time. Nor does it actually help move forward.

My Own FAFO

I am going to focus on medications here. Over the years, I have been through several rounds of medication FAFO for my Depression and/or Anxiety. I will share some of them along with relevant experiences. It is really important to stress here that these are MY experiences. What worked or didn’t work for me does not provide a roadmap for someone else that is guaranteed to be effective or ineffective. Total shit-show, yeah?

Medications:

With medications, I work closely with my provider. This is an important partnership and is part of the challenge. If you and your provider are not able to work together well, then the results are likely to be poor. I have a great relationship with my provider, and it makes a huge difference.

Meds I no longer take and why:

Sertraline (Zoloft)
- This provided me with no benefit.
Bupropion (Welbutrin)
- This helped a little but gave me tremors in my hands something fierce as well as profound dizziness so we left it behind
Aripiprazole (Abilify)
- This one made me way short of breath (I actually almost passed out just standing in my dining room) so we stopped it very quickly
Venlafaxine (Effexor)
- This one took a bit of work to find the right dose but worked great once we got there
- A major downside of Venlafaxine is that it is VERY sensitive to missed doses. Most meds are OK if you miss a dose here and there. Not this one. Miss one day and the next day SUUUUUUCKS
- This one stopped working after a few years so we had to say goodbye to it
Alprazolam (Xanax)
- This one was super helpful with my Anxiety and helped me profoundly with sleep
- It’s also a really powerful med so careful management is vital; It can be both habit-forming AND dangerous
- I did really well managing it… except this one time (see Almost There and Back Again: A Fat Man’s Tale » Can’t Juggle)
- Needless to say, I don’t have this one anymore
- I experienced very un-fun withdrawal symptoms after we removed it from my regimen

Meds I currently take:

I am currently on a mix of medications that took some FAFO to land on. I meet with my provider every few months (more often if we are Fucking Around on something new) so we sometimes make small adjustments here and there. It is not uncommon for folks to take more than one medication. For some, like me, there is no one medication that has all the right effects.

Escitalopram (Lexapro)
- This one took a bit to find the right dose, but it works well for me so I still take it daily
Lamotrigine (Lamictal)
- This one works well in concert with my Lexapro and I still take it every night
Mirtazapine (Remeron)
- I take this one every night as it helps with my sleep
Quetiapine (Seroquel)
- This one works well in concert with my other nighttime meds

A New Hope

The podcast Depresh Mode with John Moe | Maximum Fun is a wonderful part of my weekly listening. John Moe, author of The Hilarious World of Depression, interviewing a wide range of guests, from artists to comedians to musicians to actors to professionals working in the world of mental health.

Listening to John interview guests, many of whom have some of the same symptoms I have, makes me feel less alone. John does a wonderful job of guiding the experience with sensitivity, care, and humor. I highly recommend adding Depresh Mode with John Moe to you podcast feed.

The Depresh Mode episode from October 21, 2024, The Promising World of Precision Treatment for Depression | Maximum Fun, features a Stanford University researcher, Dr. Leanne Williams, who is working to develop a methodology using a Functional MRI (like a video instead of just a still shot) to help categorize how an individual’s brain is impacted by their symptoms. She then uses the results of this categorization to identify treatments that are likely to work well for that individual. The episode does a great job at describing the current FAFO process and why it is so challenging before diving deeper into the research.

Dr. Williams’s work has the potential to profoundly improve the treatment landscape for those, like me, who experience mental health challenges. Reducing the FAFO process and landing in a more direct manner to likely beneficial treatments sounds like a major step forward for us.

Wrapping Up

There is a lot of misunderstanding of medications for mental health. Some people see loved ones taking medication and expect it to make their loved one 100%; like the meds should “fix” everything. Others may see medications as weakness or failure on the part of the person who takes them. For many of us, our mental health challenges involve chemistry, our brains not properly using resources the rest of our body provides. Medications are a key part of helping us manage our symptoms.

I have said it before, and I will say it again: Medication doesn’t juggle for me, but it does allow me to use both hands.

Concrete, Water Buffalo, and a Black Hole

Several years ago (I don’t know how many, but it was more than ten), my oldest brother’s garage had a void under the concrete pad (floor) of his garage. We could see it as a black, empty space when looking through the 3/4 inch gap between the edge of driveway and the garage pad itself.

Our Dad was out visiting from NH and together we all took on the project of using ready-mix concrete (just add water) to fill in the gap and thereby shore up the pad itself to reduce the risk of it collapsing and swallowing cars or water buffalo.

Note: My brother did not have any water buffalo at this time. But it just seems like water buffalo would not benefit from falling through a collapsing concrete garage pad. Although he has since moved to Florida, and I cannot visually confirm, I am confident that my brother continues not to have any water buffalo in his care.

Also note: No water buffalo were harmed in the creation of this post.

Also also note: While this post will discuss some very challenging emotions, I am safe right now.

The Plan

Our plan was to mix the concrete and pour it through the 3/4 inch gap between the driveway and the garage pad to fill in that black hole underneath. We went to Home Depot and picked up a couple 50-lb bags of concrete mix. We mixed in water from a garden hose and proceeded to pour/push it into that 3/4 gap. Getting the mixed concrete through that gap was way more of a pain in the ass than it sounds. You see, properly mixed concrete doesn’t flow as freely as water, so it took effort to make sure the concrete went into that gap rather than just gathering in a blob on the driveway.

After the first bag, there was no visible change to the hole. That concrete was just swallowed without having any effect we could detect. So, we mixed another bag and repeated the process. The result was the same: nothing. After another trip to Home Depot to get several more bags of concrete mix, we repeated the process again, several times. The result was the same: nothing.

Home Depot. More concrete. Mix. Pour/push. Still no change. We had been at it for hours at this point.

The Understatement

My Dad just peered into the gap, which, other than concrete residue around the gap, looked just like it had when we started: a black hole. He calmly took his cigarette out of his mouth and just said, calmly, “Oh my good word…” We all just started laughing at the ridiculousness of the situation and the spot-on, highly technical assessment of the situation my Dad had provided.

When the project was done, we had ended up using 1150 pounds of dry concrete mix in filling that hole, all of it pushed through that 3/4 inch gap over the course of several hours and several trips to Home Depot. According to some basic searching online, an adult water buffalo can weigh up to about 1200 pounds, although some larger ones have been seen. That means, we used approximately 1 water buffalo of dry concrete mix in the completion of this project.

When I mentioned water buffalo in the intro of this post, it was just an attempt at fun (see below). The fact that the amount of dry concrete we used here aligns with the weight of 1 water buffalo is purely accidental. That said, I’ll take it as a much-needed win.

The Black Hole

From a mental health perspective, I am dealing with two major issues right now:

Anhedonia: An inability to experience pleasure; having little interest or enjoyment in doing things
Dysphoria: An overall mood state of unease, dissatisfaction, or hopelessness.

It is not uncommon for folks like me that struggle with Depression or other mental health challenges to experience anhedonia and/or dysphoria as symptoms. I am experiencing both at the moment.

These two assholes prevent me from getting any joy out of things that usually make me happy AND make me feel certain that this state will continue forever.

My brain is currently a black hole, sucking in and destroying anything that gets near it. Like the void under my brother’s garage pad, it feels like no amount of enjoyment will ever have an effect to make me feel better. I can pour in as many Water Buffalo of concrete I can get my hands on, and it won’t matter.

I am going through each day doing things more out of habit than because they make me feel good. I enjoy coffee. I am having coffee, but not enjoying it. I am eating (although less than usual), but not enjoying what I eat. I love my family and am spending time with them. But I am getting no enjoyment out of it (despite some laughter). My family is not doing anything wrong and my feelings for them have not changed, I just can’t capture the light they provide to me.

Both Sides, Now

I have Joni Mitchell’s beautiful song, Both Sides, Now, in my head as I write this. I think it is because I have both tried to help someone who is experiencing these symptoms (and struggled to understand why I couldn’t help) AND experienced these symptoms myself. In the past, I have been the concrete; currently I am the void.

Whether you are the concrete, the void, or even a water buffalo, please know that you are NOT alone. There are people that understand. I am one. There is no guarantee that tomorrow will be better than today. But it CAN be. It’s worth making another trip to get more concrete. And if that isn’t enough, it’s worth it to make another.

Almost There and Back Again: A Fat Man’s Tale

Content Warning: This post contains discussion of suicide.

In this post, I want to share my thoughts and feelings leading up to, during, and after my attempted suicide on March 8, 2024. I am not going to go into a lot of detail in some areas, but I will share some pretty raw stuff. So, buckle up, yeah?

Note: the fact that I refer to myself here as “Fat Man” is not self-deprecating humor or meant to apply any judgement to myself or others on being heavier than other folks. Weight stigma is a real and insidious problem. This post will not focus on my weight at all, so I feel no CONTENT WARNING is necessary. If you or a loved one struggle with weight stigma, I highly recommend the Maintenance Phase podcast.

Other Note: Fans of J.R.R. Tolkien’s The Hobbit and The Lord of the Rings trilogy will likely find some fun easter eggs in this post. I hope you enjoy them as much as I do.

The last 16 months or so have been a bit of a roller coaster for me. I know that metaphor is overused and a bit lazy. I wanted to come up with another one but the best I can land on is The Great Space Coaster which doesn’t really fit. Where my Gary Gnu fans at?

This ride included the following (not necessarily in chronological order):

(dammit) Several mental health crises with my family at home that took a massive amount of my energy to deal with in order to support those I love
(dammit) Two medical leaves from my dream job at Microsoft due to my Depression/Anxiety
(woohoo!) Completing Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) for my Depression/Anxiety
(SUPER woohoo!) Purchase of a super powerful gaming PC for the first time ever in my life
(dammit) Terrible performance reviews at Microsoft as I tried (and failed) to meet the increased demands of my role. The things I was really good at, and that had gotten me promoted a few years ago, just weren’t enough anymore.
(SUPER dammit) Termination from my dream job at Microsoft due to my inability to meet expectations of my role despite my best efforts to do so
(SUPER dammit) Feelings of betrayal and abandonment as family members expressed how I was failing to meet their expectations of me despite my best efforts to do so
(SUPER DUPER dammit) Suicide attempt on March 8
(woohoo!) Surviving said attempt
(Super dammit, but necessary) Hospitalization
(woohoo!) Discharge from the hospital (followed by pepperoni pizza) on March 14
(woohoo!) Did I mention pizza? Mmmm

Note: While I am going to share that my suicide attempt involved an overdose of one of my medications, I am not going to refer to it by name. Instead, I will call it Lembas (the magical “waybread” that the Elves in the Lord of the Rings series use to sustain them when travelling long distances).

Concerning Failure

In a hole in the ground (my basement office) in Minnesota, there lived a Fat Man. Not a nasty, dingy, dirty hole with nowhere to sit down or play computer games, but nice hole with a gaming PC and comfy chair.

One of the things I tend to do when I am struggling with my mental health is to isolate in my basement office. When I am having a hard time “being” then “being around other people” is SO MUCH harder. I also worked from home for the past several years in that same office. I also also have hobbies that I either must do in my office (computer games) or that are just easier to do in my office (so I can watch or listen to what I want without needing to coordinate with anyone else).

The bottom line is that I’m in my office a lot.

Venn Diagram of Me in my Office

From my perspective, I take part in several different activities and happen to be in my office (by necessity or by choice) when I do them. I see the smaller circles inside the diagram, not just the outer one. I almost always (not when I need to isolate) welcome my family to come in and talk with me if they need or want to. So, from my perspective, I was not failing anyone, I was just using my office.

From my family’s perspective, I am in my office almost all the time and therefore not available. They tend to only see the outer circle in the diagram: “Me in my office,” which I fully acknowledge is understandable. This generates feelings on their part that I am not there for them or that I just don’t want to be around them and am therefore failing as a father and/or husband.

As noted above, I had failed in my dream job at Microsoft. So, I was failing at work AND at home despite my best efforts in both places.

Meme showing two buttons, and a man sweating over which one to press. They are both labelled FAIL

The Unexpected Journey

After struggling for a month with the loss of my dream job, and an absolutely brutal (from my perspective at the time) family therapy session the night before, I decided that everyone would be better off without me.

I had just gotten a refill (30-day supply) for my Lembas prescription, and I had not yet insisted that the bottle be stored in the lockbox that only my wife has the combination for. Thus, I had access to all of it. That proved suboptimal.

Around 11:30am Central on Friday, March 8th, 2024, I locked my office door and downed the entire bottle of Lembas along with my nighttime meds for the day (which includes a bit more Lembas) that I take to help me sleep. Thus, I had like a shit ton of Lembas in my body.

I sent a text to my family indicating how I felt and that if they ever loved me they should let me be and let me go. I wanted to say goodbye in a way that wouldn’t leave them wondering why I had gone but also would not generate immediate red flags that would make them rush to intervene. Thoughtful, yeah? #FacePalm

I turned off my computer and sat back in my chair and closed my eyes. After what seemed like less than 5 minutes to me, I woke up Saturday evening (according to my wife, since I had no idea) in a little room at the Acute Psychiatry Services (APS) unit of a local hospital feeling dizzy as fuck and only barely aware of myself or my surroundings. I will share more about APS later in this post.

My first thought was utter disappointment that my attempt to take my own life had failed; yet another fucking failure. I knew at that moment that I had just made EVERYTHING worse than it already was. AND, I was more trapped than I had ever been in my life.

Riddles in the Family Text Chat

My text to my family ruined my planned exit. My text had a similar to feel to ones my youngest daughter had seen before from friends who were having thoughts of self-harm. She ended up texting my wife and my oldest about what I had sent. One of them came to check on me, found the office door locked (which I pretty much NEVER do), and knew there was a problem.

I kind of want to make a “what does it got in its pill bottleses, precious?” joke here but it seems like too much. Is it too much? Yeah. It’s too much. Never mind.

The bottom line is that my youngest played a key role in saving my life.

In the Houses of Healing

Hospitalization for mental health is most decidedly NOT FUN or enjoyable in ANY way. The wards for the most acute needs, like the APS I mentioned above, are essentially “people storage” designed to prevent patients from self-harm. There is medication management but no other therapies. It’s just to get patients stabilized and safe enough to move to a more tradition in-patient setting.

In APS, the unit itself is locked down and the rooms and environment are designed to deny any means of self-harm. Solid beds bolted to the floor, padded corners everywhere, nothing sharp or even dull and hard. And individual rooms that disallowed turning the lights all the way off so that the staff can observe you at all times via video. APS is essentially human storage. Or at least that is how it felt to me.

I was on a mandated 72-hour hold in the APS unit. Those were the longest 3 days of my life. I didn’t have the brain power for reading or much else, so I mostly just had my thoughts which were filled with disappointment, darkness, and doom.

The very firm foam mattress of my bed triggered really bad muscle spasm in my back. That added a lot of physical pain to my experience and made every moment feel so much longer. I have bulging discs in my lower back that make the way my pelvis shifts when I lay on firm surfaces super painful.

The few bright spots were a visit from my wife and two visits from my oldest daughter. My daughter and I discussed the fantasy series I have been ruminating on for decades. I had told parts of it to my girls as bedtime stories and they both LOVED that. I shared more of the ideas I had put together over the past several years and we had such a great time. She got so excited she started (when she got home) drawing up some possible designs for character clothing and key locations. It was pretty amazing. Because of those conversations and how excited we both got over it, I am actually starting to write the damned thing.

Eventually I was moved to a more general psychiatric ward for those struggling with mental health and/or addiction issues. It is a more relaxed environment for more freedom and a bit more independence. It is still locked down and designed to prevent self-harm but there are showers, various therapy activities, social interaction, and easier communication with the outside world.

My time in the general ward was certainly better than in APS. I was able to read again, socialize with other patients, and even play some chess with another patient that loved the game and was starving for someone to play with that knew the game well enough to play with strategy and not just the basics of how the pieces move. That was fun. I only beat him once (gotta love a Knight fork). We both really enjoyed our games.

I only spent a few days in the general ward. After my first meeting with the in-patient psychiatrist, it was clear that I had been very thoroughly “doing the work” of managing my mental health via consistently taking my medications, actively participating in psychotherapy, and had a great ability to advocate for myself in insightful and healthy ways. She concluded quickly that getting me home as soon as possible was the best course of action.

As we were planning for my discharge, the psychiatrist asked if I needed refills on any of my medications. I mentioned in a very deadpan way that “I seem to be out of Lembas for some reason…” and she guffawed with delight at the joke. That felt really good.

I want to say that the people that work in mental health facilities are heroes. They are understaffed, overworked, often poorly treated by patients, and seldom get appreciated for their efforts. The health systems in place in the United States, designed to prioritize making money rather than actually providing care, are a total shitshow. But healthcare workers are not at fault for that in any way. They do the best they can with what resources they are allowed and very much deserve respect and gratitude. They certainly have mine.

Well… I’m back.

Now that I am out of the hospital, I will be doing another round of PHP and resuming care with my own psychiatrist and therapist. I am also respecting the needs to my family in order to help them feel that I am safe. We are being far stricter about what medications are locked up and I am being very patient with my wife needing to periodically ask me how I am feeling. My actions had a massive impact on all of them. It is heartbreaking to me to know what I put them through.

If you have dealt with self-harm/suicide as part of your own mental health challenges, please know that you are not alone. There are people out there who understand. I am one of them.

If you have a loved one who tries to harm themselves, please don’t blame yourself or them. There are too many factors in play to pin judgement on anyone. The best path forward is to show up for them with compassion and empathy.

I hope this post helps someone. It certainly helped me to write it.

Thanks.

PS for Saint Patrick’s Day: The nurse that brought me from the APS unit to the regular ward is named Patrick. I had the joy of telling him, “I didn’t see a single snake the entire time I was in here. Thanks for all you do.” Who’s got two thumbs and makes jokes with the hospital staff after a suicide attempt? #ThisGuy

Abassynia, 2022

I’m not gonna lie. 2022 has been a tough year for me. I really struggled with my Depression and Anxiety for most of it. I’m glad to put 2022 behind me. At the same time, I feel like I am more resilient at the end of the year than I was at the beginning. There were parts of 2022 that I do/did appreciate.

Note: see “M*A*S*H” Abyssinia, Henry (TV Episode 1975) – IMDb for context on the title of this post. The sentiment doesn’t fit super well, but the reference was just too much for me to pass up.

What doesn’t kill you makes you stronger?

While I think this phrase is a gross oversimplification, and is sometimes outright bullshit, I do think it holds SOME truth. We ARE undeniably shaped and impacted by our experiences. Sometimes the result is some kind of growth (I’m not referring to some random protuberance that appears on someone’s face here) and we end up better for it. But sometimes experiences just suck and that’s all there is to it.

Everything happens for a reason?

This is a phrase that I find to be a common one people of faith use when someone they know is going through some shit. The reason is usually that God has placed this challenge in their life to help them grow or to test them in some way. While their intentions may be good, I find this phrase/idea to be decidedly unhelpful drivel.

Let me explain.

I’m a recovering Catholic. I still consider myself a Christian; though I don’t use my Christianity as a weapon or a stamp to mark people as “other” or “less than” like so many Christians do nowadays. That shit infuriates me. I place more blame for this on leaders in organized religious groups than on the individuals, though. While religious faith (not just Christianity, but all of them) can help people find meaning and even some peace in their lives, I firmly believe that religious faith is also an amazingly convenient means for people with power to manipulate people without power. Way too often, faith is the hilt people offer to religious leaders to allow themselves to be turned into instruments of harm.

No. there is too much. Let me sum up.

I believe, when you boil things down to the most basic level, EVERYTHING happens for some combination of four reasons:

Physics
Chemistry
Biology
Human decisions

There are undeniably folks who will take issue with my excluding “the will of God or some other deity/deities” in this list. That’s fine. I’m not attacking anyone here. Just sharing what I believe. To me, the idea of a god taking discrete manual actions to affect each and every person’s life is to label that god as a moron.

Even a junior-level database administrator knows that relying on manual tasks to maintain even a hundred databases (let alone billions) is a guaranteed path to failure. So they use automation and scripts to allow their efforts to scale. Even if one’s response is that an all-knowing god IS capable of doing all this manually, why would they do their work in the least efficient way possible? Are junior-level database administrators smarter than an all-knowing god? Really?

I jumped up on my soapbox a bit here, huh? I hadn’t intended to when I started this post. But I’m keeping it in so that this post is an accurate reflection of what’s going through my head right now. Again, not meant to attack anyone.

A look back at 2022

I feel like some sort of retrospective of accomplishments from 2022 would be valuable for me, so here goes.

While I did not post often, I did continue to blog about my experiences with mental health challenges. Since this is a personal blog, I don’t pressure myself to post with any particular schedule. I post when I am able. I don’t post when I am not. And either is OK.
I had a fantastic year at work. I’m in my dream job at Microsoft where I help the folks who produce Power BI and related products and services understand the goals, priorities, and challenges of some of the world’s largest organizations. Feedback from all sides was that I went above and beyond even though I was just doing the job the way I felt it should be done. That feels great and keeps Impostor Syndrome on the sidelines way more often than not.
I had the courage to take a leave of absence/medical leave from work when I realized that I just COULD NOT get myself well AND do my job at the same time. I am fortunate to have this as an option, both from a benefits/financial perspective, as well as from the standpoint of a compassionate and supportive manager and team.
Back in July, I started sharing daily check-ins on how I am feeling/doing each day. See #MentalHealthDailyCheckin » Can’t Juggle (cantjuggle.com) for more on this effort. I started just posting on Twitter and eventually added LinkedIn and Instagram as well. I’ve only missed a couple of days, which greatly exceeds my own expectations. Since I have never had the discipline for keeping a journal, this has been a very low-effort way to reap some of the benefits that others get from journaling. Also, the feedback from this effort has been amazing. The outpouring of support and appreciation for my openness has overwhelmed me with joy and love from friends, family, coworkers, even total strangers.
It took a bit longer than expected, but I did finally get my youngest daughter to say, “tits.” See There are no “bad” words » Can’t Juggle (cantjuggle.com) for more on this noble pursuit.
I managed to make it through my first ever experience in which suicide felt like a really good option. See Cat Pee, Suicide, and Bananagrams » Can’t Juggle (cantjuggle.com) for more on this.
I made the incredibly difficult decision to surrender 3 of our cats in order to do what I needed for my own mental health even though it was a very unpopular choice for my family. See Surrendering Cats: Pre-game Show » Can’t Juggle (cantjuggle.com) and Surrendering Cats: Post-game Show » Can’t Juggle (cantjuggle.com) for more on this.
For the first time, I shared that I am the child of a sex offender, around which a lot of my childhood trauma revolved. See John Cazale and Inmate 19250 » Can’t Juggle (cantjuggle.com) and Overcoming Victimpostor Syndrome » Can’t Juggle (cantjuggle.com) for more on this.

Wrapping up

I made some really difficult choices this year. On the whole, I feel like I made the right ones. I’m still here. That’s a big one. I’m hoping 2023 is less… interesting for me. I can’t imagine having another year so jammed up with strife, tribulations, bullshit, drama, and so forth right after this one. I made it through 2022, and I’m proud of that, but 2023, take it a little easier on me, yeah?

Remember the Can’t

I’m having a hard time today. I mentioned it on Twitter but that seems too transient a platform to rely on for helping others feel less alone when they need it. So, this very brief post will just have a list of thoughts going through my head right now.

It is not a character flaw to be unable to function due to a mental illness/disorder, to “can’t” as I sometimes refer to this.
It is OK to can’t.
There are probably people you care about that are can’ting right now.
I am can’ting right now.
Despite how it may feel, can’ters are not alone.
I am safe.

If you can’t, please know that you are still worthy of love and compassion and that the world is better with you in it.

Meet Dave: My Anxiety Vampire

Personification and Externalization

I have found great value in personifying and externalizing my mental illnesses and other aspects of the wild ride my brain treats me to. But what the hell does this even mean? Well, dear reader, I shall explain using some very concise and easy definitions adapted from Reid Wilson, Ph.D., Director of the Anxiety Disorders Treatment Center in Chapel Hill, NC, and contributor to Psychology Today. He is also that author of several books, including Stopping the Noise in Your Head.

I adapted the definitions below from Dr. Wilson’s article Wrestling With Anxiety in the Canadian Wilderness from May of 2020. It’s a brief, easy read and I recommend it. Anxiety, hiking, and bears! Oh, my!

Personification is the attribution of human-like identity to something, the subject, that is not a human. It is related to anthropomorphism in that it allows for treating the subject as a person you can address directly.

Externalization is perceiving of a part of yourself as being outside of yourself instead. Rather than being a part of you, it is something in a relationship with you.

Meet Dave

Face of Nosferatu from the 1922 film — Nosferatu

Since my Anxiety burst through the wall of my mind like the Kool-Aid Man a few years ago, I have been personifying and externalizing it in an effort to make it a bit easier to deal with. For me, my anxiety is a ferocious vampire (no stupid sparkling; #TeamAlice) named Dave that stands about 1 inch behind me almost all the time. Because he is so close, if he decides to get me, there is no possible way I would be able to prevent it. I am completely at his mercy.

When I look back at my childhood, and really throughout my entire life, I can see that Dave has been with me almost since day 1. I have always been leery and uncomfortable with my back to open doorways, darkness, or any other place where Dave or other creatures could be laying in wait for me.

What are you afraid of?

I was actually afraid A LOT as a kid. My parents even tried the practice of checking my room for monsters when they put me to bed. But, it didn’t work. You see, MY monsters were wily, persistent little shits; they would just come back as soon as my parents left the room or turned off the light. Nightlights were a huge deal for me; although I never had a blue canary nightlight until adulthood.

To this day, I seldom enjoy horror movies and tend to avoid them altogether. It still takes some effort, sometimes, to walk through a dark room in my house. Being outside alone after dark, even just to bring the trash and recycling bins to the curb, is often a nerve-wracking experience for me. I am able to push through and do what I need to do, but it takes more effort than it does for most people, I think.

Anxiety is not my enemy

Beavis kicking Butthead in the junk — Ouch

As humans evolved over the millennia, we developed fear and anxiety. These feelings helped to inspire caution, and ultimately helped us to survive as a species. It is easy for us to understand, today, that walking up a mountain lion and kicking it in the junk is not a scenario that is likely to end in our favor. But on a more primitive level, before we developed the brains we have today, it was the fear and caution that would have urged early humans to avoid junk-kicking exploits like this. Junk-kickers, those that didn’t exercise this caution, were less likely to be around long enough to procreate, making the junk-kicking trait less likely to pass on to future generations.

Thus, Anxiety, in a very real sense, was a vital asset to our success as a species. It exists as a means of trying to keep us safe. I find it helpful to keep this in mind and take it even a step further: Anxiety is not my enemy. It is a healthy part of me. It is not the fact that I experience anxiety that is a problem; it is the fact that I have an anxiety disorder that is the problem. My brain triggers anxiety far more frequently and forcefully than it needs to in its attempts to keep me safe. It sees more danger in more places or even just DANGER in all the places. Which brings us back to Dave.

Dave is my hero

Dave, as the personification and externalization of my anxiety, just wants to ensure my safety. He wants to keep me from being eaten. So, rather than standing 1 inch behind me to try and get me, he stands there to guard me. He has my back. My Generalized Anxiety Disorder makes Dave way more active than he needs to be. He needs to spend less time crying wolf and more time sitting in a corner with his coloring books and crayons. But he’s on my team (#TeamDave). He, like my Paladin, is my hero.