An Image Problem

One of the biggest challenges facing those of us who struggle with depression is a complete lack of understanding from our friends, family, and the public at large. Depression is not seen as an illness, it’s seen as a mood. We try to explain, we cite facts and figures, but most people just don’t get it. When all is said and done, they assume we could snap out of it if we would just try a little harder or look at a rainbow.

A big part of the problem is the name: depression. In addition to being the name of a clinical diagnosis, it’s the name of an emotional state (as well as a dent, a weather phenomenon, and an economic issue). Most dictionaries list the emotional definition ahead of the medical one.

Even when depression is seen as a clinical diagnosis, often it is still tied to an emotional state: a condition triggered by a major event. This incorrectly makes it seem temporary, like a mourning period, and something that will go away as soon as the sufferer moves on or cheers up. While this is true in some circumstances, it’s not the standard.

Depression has an image problem. Imagine the reaction you’d get if you told someone you needed medication to regulate Non-binding Seratonin? Or that you were just diagnosed with Neurogenesis Deficiency Syndrome? That sounds like a disease anyone could get behind without passing judgment.

Another problem is the treatment.

The primary treatment for depression is therapy. Yes, medication can be involved, but it is almost always recommended along with therapy. Therapy carries all kinds of negative implications and social stigma. (This stigma is probably worse for men. We expect women to be a little crazy—“hysterical” even—but men are supposed to be tougher than that.) It’s open-ended. There is no cure, no finish line. Rarely is a patient considered done with therapy. Visits may become less frequent or even suspended, but it’s expected that visits could resume at any time. Progress is difficult to measure, and it’s nearly impossible to compare results between patients or providers.

It would be great if medication or surgery could provide a definite solution, or if depression could be quantified easily and tracked. We could tell our families that our checkup went well, and our blood depression level was down to 8.4%. Instead, we come home from therapy, shrug and say, “It was OK today. The new dosage seems to maybe be a little better. It’ll be hard to say for another couple of months.”

Depression is vague and fuzzy. Despite treatment, it can still come and go quickly. Our ability to discuss it with friends and family is limited by their understanding and our ability to articulate ourselves. Yet we must discuss it, or we run the risk of isolating ourselves even further. It’s a problem.

How I Got Here

First an introduction, then a little of the back story that led me to start writing Daddy Is OK. Hi, I’m Lyle. I’m 42, married, with two kids: a 4-year-old daughter and a 2-year-old son. I am primarily a stay-at-home father, although I pick up the odd job here and there to bring in a few dollars. After many years of struggling with obesity, my weight now qualifies me as “only” overweight. (I was almost 100 pounds over my target weight at one point; I made it down as low as 15 pounds over; I am currently about 35 pounds over.) My knees and hands are showing the early signs of arthritis and I have a couple of damaged discs in my back. I’m also clinically depressed.

That may seem an odd collection of details about me, but they are the most relevant to this blog. As time goes by and this blog grows, more about me should emerge. It’s hard to say at this stage how much this blog will be about me, how much it will be about my roles, and how much it will be about my illnesses. All three are so intertwined in my head, separating them may be impossible.

For many years, the title of “writer” has nagged me. Very little of my writing has ever seen the light of day. Outlines and random chapters of a couple books are tucked away on my hard drive, waiting for me to get back to them in my free time. The demands of fatherhood have stripped away many of my pursuits and hobbies, effectively changing who I am.

I—like many—always tended to define myself through my job (or occasionally through my hobbies). Life wasn’t perfect, but I was chasing my dreams and making decent money, occasionally at the same time. My marriage was good and we had just bought a house. My back pain was pretty severe, but after seeing many, many doctors, I finally had a diagnosis and a treatment plan. The depression had been nipping at my heels for a while, probably most of my life, but it was manageable. It generally took the form of increased irritability during times of stress. (This is something I recognize now in hindsight; at the time, I just called it “stress.”)

My wife and I kicked around the idea of having kids, or maybe adopting, or maybe being foster parents. We definitely wanted children in our life, but we hadn’t decided in what way. Then mother nature stepped in and made the decision for us.

We were both taken a little off-guard by the pregnancy, but processed the surprise pretty quickly and started getting ready to be parents. As the due date got closer, I got nervous and excited and worried—pretty typical new parent stuff. My stress levels began to increase, and so did my “stress” levels.

I got irritable; sleep became elusive. My wife and I weren’t really fighting, but we weren’t getting along our best, either. This was not the way to enter into fatherhood, and it was time to seek out some help.

Getting mental health care while trying to work within the guidelines of an insurance policy isn’t always easy. Many private practitioners choose to remain outside the insurance system, which leaves large clinics. While many of the individuals in the large clinics are well-educated, well-meaning, and hard-working, the system creates an assembly line style of treatment: see Dr. A for a prescription every 90 days, see Dr. B every two weeks for therapy. Fill out this form at every visit, and this other form twice a year. In short, they try to measure and quantify an inherently unquantifiable condition.

Still, it helped. The medication (60mg duloxetine daily) seemed to smooth the rough edges a bit and the therapy helped me identify and label some of what was happening. I didn’t really connect with my therapist, but it was OK. Once again, things weren’t perfect, but they were generally under control.

After a while, the effectiveness of this approach was fading. It became routine, and I found myself sharing less with my therapist. It was easier just to give the answers I thought she wanted, continue through the system, and keep getting the medication. My depression got worse, but my ability to mask it improved greatly.

We were debating whether or not to have a second child, and once again, mother nature stepped in to make the decision for us. With a second child on the way (and the first child learning to talk back a little) the “stress” began to increase.

Once again, it was time to seek help. My current therapist was fine, but there was no strong connection there. After digging through reviews, recommendations, and insurance requirements, I found a new therapist who seemed a likely choice. His focus was more behavioral, which would put more pressure on me to help myself. He was not licensed to prescribe medication, but that wasn’t a concern for now, as the pharmacy continued to refill my prescription.

Once again, some improvement came pretty quickly. My new therapist was very down-to-Earth, and helped me focus a little on taking care of myself. My priority had always been others first, myself last. On the surface, that seems very altruistic of me, but the cumulative, negative impact on my life was significant. My health, my sleep, my diet, my needs, my desires were all ignored. As difficult as it was for me to process, my complete disregard for myself was destroying me. Intellectually, it was pretty simple, but emotionally, it seemed selfish and wrong to even consider changing.

My son was born, and things were looking better. Yes, a second child added some stress (and some “stress”) but things were manageable. We agreed that two children was enough, and we hoped a vasectomy would discourage mother nature from interfering with our decision-making process again. My new role as a slightly less unselfish father of two in regular therapy became the new norm.

Unfortunately, with routine comes complacency. A second child kept me busier than ever, and my focus on myself drifted. Therapy became routine, and putting my happy face on became easier. The system caught up with me, and my prescription was not renewed. The insurance jungle was more than I could face, so I just stopped taking my medication.

This more or less brings us up to now.

Things are slipping for me. My temper is getting shorter and my opinion of myself getting lower. My job prospects are lousy, and my life is losing direction. For now, being a father is my primary role, but my kids will be spending more and more time at school over the next couple of years. The new year is upon us, and that seems like a good time for change.

Next week, I’m seeing a new psychiatrist. I think I need to be on medication again, and I probably could use a more aggressive approach to therapy. I’m trying desperately to regain control over myself and my life. I don’t like the person I’m becoming, and I want to do better for my kids, my wife, and myself.

This is why I chose to start writing about my experiences. This is my opportunity to focus on myself while sharing with others. I can’t be the only one dealing with these things.