It’s been three weeks and a day since my last post. A lot has changed since then, which is a convenient excuse for why I’ve been slacking on this newsletter. But the truth is, I’ve just been overwhelmed. I made my last post one day after I turned in a resignation letter at my job where I’d worked since October 2021. With no backup plan, besides another four weeks of short-term disability and a handful of upcoming freelance assignments.
There was once a time I couldn’t imagine not working. But, once I stopped, I realized I had been running on fumes and in survival mode 24/7 for, well, always. My C-PTSD was constantly in the driver’s seat, and it’s a miracle I accomplished all that I did.
My therapist has told me she believes I use work to avoid feeling, and I think there’s some truth to that, but not intentionally. I think it has more to do with growing up working in the family restaurant, and my family dynamics, where I learned that work comes first. You never let work down, you always show up. You do what you have to do to keep the ship afloat.
I’ve always struggled with guilt for taking time off, even when I am very sick. I tend to
feel like I have to be “productive” even on my days off, finding some project to do at home so that I don’t have to feel the shame of being “lazy.” It’s not just that, but also there is a sense that I am somehow undeserving of this self-care, or perhaps any care. I’ve been fighting that feeling for years.
This intense “work ethic” has repeatedly led to me putting in much more time, effort, worry and energy than I was being paid for. In addition to all that, I’ve never had just one job. I tend to have several, and though I have dialed back on that I also have to watch out for overcommitting and being involved in too many volunteer or other activities.
When my therapist and psychiatrist convinced me it was not just OK, but essential to the success of my treatment to go on medical leave, I had been long since burned out. At first, it was just for a month, with a promise to return at least part-time as soon as I could.
But a month in, when I was just starting to feel a little better, I knew I wasn’t ready to return, even in a limited capacity. My therapist helped me to permit myself to take another month, and the fact that my doctor had already filled out short-term disability paperwork with the same return date allowed me to feel it was justified, even though I anxiously checked my email for days after, expecting some kind of indication that my boss was angry with me.
By the time another couple of weeks had passed, and I was looking at my looming return date, so much had changed within me that I knew I simply could not return to that pace or environment, especially while still focusing on my healing and treatment. I asked my doctor for one more month of disability as I finished out the last three of my round of 15 treatments. Rather than give yet another hopeful return date to my boss, I resigned, and it was one of the best things I’ve done for my health in a long time. It was not easy to quit, but I’m proud of myself for prioritizing my care and my needs in a way I have never done or felt safe to do before.
Even though I felt proud, I was also more than a little nervous about what the future would hold when I finished treatment. The next day, I had my 13th treatment. The medicine was strong, and I dissociated a little at first. I remember looking at my arm and thinking it belonged to my sister or my mom. Then I felt immense joy at being connected with my distant family members in this way, wearing the same freckles and Irish skin.
Later that night I wrote that I was having a lot of anxiety about “work stuff” and that despite the wave of joy I’d felt earlier, “sadness and overwhelm are creeping in.”
Then I clarified that if it wasn’t sadness, maybe it was just alone-ness, directionlessness. Fear.
During the next two weeks before my next treatment, I vacillated between joy and fear. The first week I was mostly happy and managed to land two interviews for cool part-time jobs, which felt like a good sign. But by the 10th day, I was feeling paralyzed by anxiety and suffering from major executive dysfunction and overwhelm.
On the day before my 14th treatment, I wrote: “ This week a lot of things were different. I didn’t track or journal as much. I missed most of my meetings. … I also didn’t connect much with friends or family. Not sure if all the things were because of the wearing off of the esketamine or if not doing all these made me less happy. I also struggled with negative thoughts, felt like I was in an emotional flashback … I felt very negative toward myself. And very fearful.”
During my next session, I tried to connect with joy and positive feelings. I blew bubbles and ate Skittles and colored. I had a moment where I felt I was “in a spiritual realm” and I decided to visit briefly with my deceased miniature pinscher, Eve, whom I consider to be one of my life’s great loves.
Later in the session, I realized some limiting beliefs I’d been holding around money and success since the second grade when my Catholic school teacher, Mrs. Krejci, introduced me to the idea of holy martyrdom and the idea that “blessed are the poor.” I remember declaring that I wanted to be poor when I grew up, genuinely believing that meant I would be a good person.
Despite connecting to some inner wisdom and joy, I spent most of the week after that triggered and paralyzed by insecurity around the assignments I had to turn in and the job application process. I watched multiple true crime series (not the best for mental health) and struggled with avoidance and procrastination while beating myself up for knowing better and yet, still getting stuck in a downward spiral.
Today, a week after my last treatment, I had my first suicidal thought in over a month. I was feeling bad for feeling bad, and had a false negative thought that I will never get better. I cried a little, realized I was feeling incredibly lonely, and then reached out to my online support community to say I was struggling. After that, I went for a walk, ate food, sat in the sun and had a popsicle and then went to my regular Wednesday night meeting. After an hour and a half of listening to my fellow travelers share their experiences, hopes, fears and thoughts I felt so much more connected and could see how I had been isolating because of my negative beliefs about myself and not wanting to be a “downer” or admit that I was struggling.
.
I also had realized that I was having classic depression symptoms, which surprised me because I thought my depression had been lifted. “I have anxiety and ADHD, those are my problems right now,” I thought. I googled suicidal thoughts and ADHD and found out there is a connection, but these feelings were familiar. Not wanting to do things I enjoy. Isolating. Trouble focusing and sleeping. Not wanting to get out of bed. Fatigue. Feeling hopeless, guilty, worthless. Upset stomach. Loss of appetite. I had gotten so used to not being depressed I couldn’t recognize it, or maybe didn’t want to.
Oddly, after I faced all of this, I felt relieved.
My therapist often talks about “extinction bursts,” which is a phenomenon in which a problem gets worse before it gets better. I think of it like a game of tug of war. In order for anyone to win, someone has to let go. And when they do, the winner, who was pulling so hard with all of their might, inevitably falls to the ground too before they can claim their victory.
I’ve had many of these one-step-forward-two-steps-back moments throughout my recovery journey, but I think it is most obvious with this treatment. What I don’t know is whether it is something I am causing out of fear (self-sabotage??) or a natural response to change, but it doesn’t really matter.
Through this latest extinction burst, I learned that esketamine probably isn’t going to fix my depression long-term, at least not without reinforcements. I also realized the power of healthy habits and routine. My meetings, journaling, self care and even this space are crucial to keeping myself connected with my emotions. Without that, I easily spiral into a depressive state. It’s been coded in my brain and body for 39 years, so it makes sense that as the esketamine wears off it becomes easier to return to that space.
I’ll have to be more diligent about my mental health practice. Because that’s what it is. I’m learning how to work with the muscle that is my brain, I’m practicing healthier thoughts and hopefully reinforcing better habits, while trying to also understand my nervous system and retrain it to trust that I am safe, even when I take a tumble or realize that I need to let go of the rope altogether.
Once again, your writing touches me. I'm rooting for you over here in cyberspace, and look forward to seeing you in meetings. Also, I can relate to the need/drive/unconscious obsession to work hard and accomplish, even in retirement, although retirement has helped my stress level immensely.
Your toolbox is also way more equipped now….because of your treatment, your breakthroughs, and this newsletter. Even if you experience depression again, it won’t be the same because you aren’t the same, you are more equipped and I hope you find pride in that!