3 days ago
Thursday, June 30, 2011
Right now I am waiting for my car, which is in for routine servicing. I have a great shop, which is where we bought the car. (Pic is not my car - I have a Honda. One can dream.) They have a nice waiting area at the shop with tables, free internet, and plenty of light. And lots of people who have no idea that you are terrified.
I call them 'normals' sometimes. This is so unfair to them, and to me. I know perfectly well there are no normal people, only people pretending to be normal, or people who don't even realize that 'normal' is an issue. Still, I can't help it, looking around and watching how they touch things without thinking, use water fountains with impunity, and eat their lunches on tables that have vague grease stains. How do they do this?
It's been an hour and a half, so far, and nearby is a dad and his little girl. I heard him say, "You've been so good! It's been more than three hours, and you've been so patient." He has a computer for her to play games, and she's been playing and listening to music. He's been a great dad, watching her and commenting and giving her praise. Bored or not, she obviously loves the attention. It is so very cute, and I should be filled with thoughts about how d@mn cute she is.
And yet. She is sick. With something respiratory. She has been coughing the entire time I've been here. Every cough makes me jump inside. I have to mentally try to calm down, and fight the urge to run away. If she was at the same table, I would have moved - making some excuse about giving her and her dad more space. But they are a dozen feet away in a large, well ventilated room. She's sitting and playing happily, if getting a bit tired. She isn't running around coughing on everyone and touching all the doorknobs and flat surfaces. But I am still half stuck to the ceiling. And I feel so bad about it, trapped between (1) wanting to feel sorry for her being sick and bored and/or smile at her cuteness, and (2) running away from her in fear.
More coughing. Lots of coughing. It has been two solid hours, now. They must have been here for four. I am still fighting the urge to run. To find another table. I don't want to. I'm reading blogs and working on my writing and am in a nice, quiet spot without a lot of foot traffic. I want to stay. I know perfectly well there is no "safe" table. No matter where I go, there will be something that will make me cringe.
My car is finished - two hours and fifteen minutes of cognitive dissonance. I'm sure you know exactly what I mean. I am so relieved to go. I stand, collect my things, and my courage. I walk over to the little girl and her dad and I say, "Wow, you are so patient!" She's surprised, and sort of blinks and half-smiles at the stranger. Her dad smiles broadly and replies, "A lot more patient than I am. She's a good girl." He is pleased with what I said.
So this is my win for the day. Going home and wondering if I am going to get sick isn't anything new. That's every day. But making someone smile in spite of terror, that was bonus. So what's your latest win? How'd you make it happen?
Your Hostess With Neuroses
Image credit/info: cool car from donaldmctim on flikr via Creative Commons, CC 2.0
Thursday, June 2, 2011
The scientific literature for anxiety and depression continues to amuse, entertain, and on rare occasion actually enlighten. I'm not even sure why I read the journals, since for the most part my only comment is "no duh." But my psychologist continues to remind me that there is a difference between something being obvious to me as a sufferer of mental illnesses, and having actual metrics and research to back it up. At least we have more and better ways to explain how crappy we feel.
But I don't want to actually get too down on it. As a scientist I love research and data, I just wish these papers I read would say something really surprising. I wish they would offer a jolt of realization, a truly new idea or approach. Instead they say things like, "The people with GAD in this study felt bad, and the people with GAD as well as other diagnoses felt really bad." In spite of everything, I keep hoping to spot that magic formula, that golden key that will unlock the mess that is my mind and make everything come together.
One advantage of reading over and over things you could have told the researcher yourself is validation. There is now a lot of research backing up what many of us have been saying for years. It gives me more faith in myself and my perception of my own situation. And in spite of my belly-aching, the fact that I do keep reading the journals must mean I am enjoying it to some extent. It's hardly required reading.
Anyway, here is something that caught my eye in the April 2011 issue of Depression and Anxiety. (Yes, I'm behind in my reading.) Hollon wrote a report entitled "Cognitive and Behavior Therapy in the Treatment and Prevention of Depression." Here is an interesting quote about ADMs (Antidepressant Medication) "A recent reanalysis of the FDA database for all registered trials for a dozen of the more recently approved medications (including the bulk of the SSRIs) found evidence of substantial publication bias. Trials that produced positive findings almost invariably found their way into the literature, whereas trials that did not either were never published or were published in a manner that made the target medication appear to be efficacious when it was not."
This is sad, but not unexpected. Null results are always harder to publish, and large drug companies that fund many studies are not going to promote a paper that shows their drug is mediocre. The reason I honed in on this is because I am a strong advocate for multiple kinds of therapy being used together - an integrated, holistic approach to treating people as whole people. In my case, that means both meds and talk therapy, as well as other things. I've known too many people who chose to treat depression with meds, and nothing else. Hollon goes on to say, "Finally, there is no evidence that having taken ADM does anything to reduce risk for subsequent symptom return and standard practice has evolved over the last several decades to keep most patients who respond on medication indefinitely."
And, well, some of us may need that. I'm not sure I'll ever be in a position to go off the meds completely. I had four major depressive episodes that were completely untreated, and that carves quite a biochemical path through the brain. Still, I do not think this means everyone needs the meds forever, as is the current trend. I also think that concentrating on just meds means that a lot of people who need deeper intervention never get it. There are people who would improve and take control of their lives in a whole new way if they had the right combination of treatment. Some talk/cognitive/acceptance type therapies DO have evidence to show a reduced risk for subsequent symptom return. And that is certainly some data that shouldn't be ignored.
I think as patients we need to be sure we advocate for the treatments we need - what we know works for us as individuals and complete people - rather than what is the trend of the moment. Research is great stuff, but in the end, bias shows up in the literature the same as it does in any human endeavor.
The literature can point us all over the place. I advocate that the investment we need to make in ourselves is to treat ourselves as whole people, who need a host of things like good food, sleep, and social interaction. Our minds and bodies are working with the same chemistry, and are the same electrical system. We need all kinds of options, like meds, CBT, ERT, talk therapy, DBT, yoga, meditation, acupucture, and more, to create a therapy program that really moves us forward in our healing.
Your Hostess With Neuroses
Image credit/info: [F]oxymoron, The Chemistry of Inversion, Creative Commons via Flickr CC 2.0
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