This Could Be the Day

My weight has always been a problem. Only twice in my life have I ever felt like my weight was easy to control: once with pneumonia, and once with altitude sickness. In both cases, my weight dropped quickly without any effort. At every other time in my life, my weight has been a struggle.

About five years ago, I got REALLY aggressive with trying to control my weight. My wife was pregnant with our first child, and my weight was as high as it’s ever been (close to 300 pounds). It was time to change.

My doctor wouldn’t even discuss other health issues with me as long as my weight was in the “obese” range. The mentality seems to be that fat people can’t have any non-weight-related health issues. Everything that could possibly be wrong would be fixed instantly with a BMI of 24.9.

I tried to lose weight on my own, measuring and recording every bite. Then came Weight Watchers, My Fitness Pal, and FitBit. Along the way there was near-starvation, regular exercise, low-carb, gluten-free, dairy-free, and vegetarian. I saw several doctors and a dietitian. My weight went down, my weight went up; nothing seemed to work for any length of time. Despite my best efforts, my average weight loss was around four ounces a week.

Weight loss can be a brutal struggle for anyone, and even more so when clinically depressed. Feelings of failure, guilt, hopelessness, frustration, and despair come naturally to both the dieting and the depressed.

After a while, I was essentially starving myself. At my lowest point, my intake was around 700 calories a day. Exhaustion and hunger were my constant companions, but the weight just kept coming. My weight became something of an obsession, and all my precious free time was dedicated to researching causes and solutions.

It turns out, gaining weight on an extremely low-calorie diet is actually pretty common. The solution seems to be “re-training” the body to burn calories instead of trying to cling to every morsel of food. It would mean gaining some weight in the short term, but starting to eat a reasonable amount of food again and losing weight over time.

So, I gave it a shot. Vowing to avoid the scale for a few weeks, I re-committed myself to eating a healthy, well-rounded diet in line with my basal metabolic rate. My pants got a little tighter, then they started getting a little looser again. I felt pretty good; this seemed to be working.

Well, it wasn’t. Combined with the weight gain from a couple weeks before the re-training, I was up thirteen pounds. At four ounces a week, that’s an entire year of torture negated in about six weeks.

I completely lost my mind. This could be the day. I seriously started considering the best way to die. A huge breakfast, a couple cigarettes, and a jump into the icy river ought to do it. I did not want to live anymore.

Pain. I hated myself so much it physically hurt. My stomach clenched; my chest was tight. I tried to cry, but I couldn’t, so I screamed instead. My daughter was terrified, so I hid in the basement.

After a while, my wife came down to check on me. She tries so hard to be supportive, but she just doesn’t know what to do with me anymore. She’s currently helping me navigate our insurance so I can try to get on medication again, but that’s its own form of torture.

Something set me off. In hindsight, I don’t know what it was, but I’m sure it was irrelevant. For whatever reason, it seemed like a good time to pick a fight with my wife. I remember screaming “Every day I wake up and pray to god that this could be the day that I just die!” and storming out of the house.

Now I hated myself even more. On top of everything else, I had just screamed at the one person trying to help me. Thoughts of dying started running through my head. Not suicide, but just dying. I ended up buying a cup of coffee and my first pack of cigarettes in a decade. I went to the park and stood on the dock, looking out at the frozen lake, sipping my coffee and smoking.

The ice was pretty thin. Probably wouldn’t hold my weight. I wonder if I could pull myself out? Probably not. Probably wouldn’t matter after a minute or two. God, I missed cigarettes. Nobody else out here; probably wouldn’t get any help. Maybe. Maybe not. I don’t know.

Then came thoughts of my children. They love me, most of the time. They’re still young enough, they don’t really know what that means, but they love me with complete abandon. I have to do what’s right for them, even if that means not being around anymore.

Then came thoughts of my wife. She loves me, most of the time. She’s intelligent, she knows what that means, and she loves me anyway. She’s an amazing mother, and I have to do whatever I can to support her, even if that means not being around anymore.

I know what I think, but I can’t make that decision for them.

[Note: I started writing this piece right after the new year. Since that time, I started seeing a new psychiatrist, got back on medication, leveled out a little, had to stop seeing the new psychiatrist thanks to an insurance screw-up, and am now looking for another new therapist. I spent (and continue to spend) a lot of time processing the feelings and emotions of this period, and felt it was important to finish telling the story. This was most definitely a low point for me, possibly my lowest, and I am glad to say I have stepped back from the edge at this point.]

My Mask Is Stuck

Choosing a therapist is tricky. There are so many considerations: gender, age, style, location, insurance network, availability, and would you like drugs with that? Then, you need to have a session or two before you can even begin to decide whether or not you made the right choice. If so, great, but if not, then it’s back to square one.

But, there’s another side to therapy: the person receiving the treatment. More specifically, I mean me.

Therapy depends as much on the person receiving the treatment as it does on the one giving it. A patient’s ability to share information honestly will have a huge impact on the results. Yes, an observant therapist can read between the lines and ask the right questions, but ultimately, what the patient shares is up to that patient.

I started seeing a new therapist a few weeks ago, my third since starting therapy about four years ago. So far, it’s very promising. She managed to cut through a lot of garbage pretty quickly and give me some completely new insights. It is my sincere hope that I can be honest and share the right information with her.

In the past, that hasn’t always happened, and it doesn’t come naturally to me. For one thing, there’s a lot more that happens in a week than can possibly be shared in 45 minutes. Most of it is irrelevant (I made a sandwich. I put mustard on it. The bread was a little dry. I added bread to the grocery list.) But what about the rest? It can be very difficult to choose what to share, which stories are most important, and what relates to the topic we last discussed.

Even more limiting, there’s my own personal editing. After years of carefully selecting what I tell (and don’t tell) my friends and family, of pretending to be “fine, just tired,” I’m not always sure who or what I am. Am I feeling pretty good, or just less terrible? I’m not as well-adjusted and content as I want everyone to believe, but am I really as screwed up as I think I am? How much of this is me and how much is the mask I wear and how much is there even a separation?

Then of course there’s the big question: if I actually tell my therapist everything, am I going to be tossed in the loony bin forever? Or, perhaps even worse, will she come to the conclusion that there’s nothing wrong with me at all?

I want my therapist to think well of me. I care what this complete stranger getting paid to listen me thinks about me personally and professionally, so I try to put a positive spin on everything. I’m so desperate for adult conversation that I want to keep it fun and light. I want my individual struggles to be meaningful, so I try to choose my deepest thoughts to share. I want to get better, so I try to include what I think is important, but I also want to edit out my most embarrassing thoughts.

It would be so much easier if I could just be myself all the time, but I can’t. I’ve already alienated so many important people in my life that I can’t stand the thought of losing any more. So, I wear my happy mask.

Generally, this is harmless, at least to others: small talk with the cashier or a friendly chat with a neighbor. These times are enjoyable and a chance to give normality a try. When a stranger asks, “How are you today?” they rarely are looking for an in-depth answer, so it’s an opportunity to not give one.

With friends and family, it can be more insidious. It starts innocently enough: glossing over a few details, not mentioning a new medication. But, the more you don’t talk about it, the easier it becomes to not talk about it. After a while, you never talk about it, except in therapy.

But what happens when these habits creep into therapy sessions? That’s what happened to me. I grew so accustomed to not talking about it that I started not talking about it in therapy. Oh, I still talked about my depression, but I polished it first. At that point, therapy—arguably the most important tool for treating depression—became essentially useless to me.

Now I have a chance to start fresh again, and I hope I don’t blow it.

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.