I must be in a really good place or a really awful place to begin talking about my depression publicly, again. My talky therapist cautioned me. “There might be some future complications.” As in, health insurance! Or looking for a job.

In depression we want to constantly collapse. We hope for constant rescue. But the truth is we’ve got to be self-rescuing knights and princesses.

If you’ve ever had to seek services for a mental illness you’ll begin to understand what he was hinting at. 90% of the therapists I’ve seen are private pay only. What that means is your health insurance that appears to cover mental health, really covers some consulting by your family PA. Or at the maximum, a beginning therapist who’s willing to see patients for $35 – $45 per hour. And I can tell you, that’s not many.

And here I am, freaking out my family (no my fiancé however) by coming out as a sufferer. Why would I do this? Fame? Hardly. Fortune? Um, yeah, from what, an Oprah appearance? No.

I started this new blog (my 5th) to capture all of the writing I’ve done in the last 6 years about depression, creativity and depression, and divorce and how it triggered my worst depression ever. I’m coming out. Much in the same way sexual orientation used to be the stigma, I think today we’re more afraid of someone with a mental illness than we are of a gay or transgender person.

The media, and the congress majority party like to point to mental illness every time there is a mass shooting. But what they are doing is deflecting the bullets that should be going right for their main financial contributor, the NRA. Yes, mental illness is a huge problem in the US. And yes, many of the people who commit horrendous crimes are suffering from mental illness either temporary or clinical, I mean, how else could you shoot someone outside of a war zone?

Mental illness is very poorly understood. And, in fact, the doctors are only slightly more informed than those of use who suffer. See, we tend to do a lot of research, seeking out relief from this invisible and debilitating disease. And the pharma industry is working hard to replicate the success of Prozac, but even the drugs are a shot in the dark.

In my case, a cocktail of some of the old drugs, the cheaper ones now in generic form, tends to work the best. I tried some of the fancy new drugs, atypical they are called, and they flattened me out like road kill. So I go with the tried and true, and cheap, Wellbutrin-generic. (The same drug sold as a smoking cessation med.) And this drug serves like a persistent cup of coffee during the day, more than a feel-good drug. And I occasionally need to add in some Lexapro-generic when I’m starting to have obsessive thoughts. Between these two drugs I have successfully recovered over and over. It’s exhausting. But it’s better than the alternative.

Now I’ve just admitted to my illness and given you my prescription. But there’s a lot more to my strategy and care team. The drugs can help, but believe me, they are not a cure. The only cure is in my actions. I must take action to feel better. The Welbutrin tends to help me get out of bed in the morning. But it’s what I do with those 12 – 18 hours before I get back in bed, that really matters. The actions are up to me.

If your therapist agrees with you about what you can’t do, they are giving you the permission to not do stuff that you need to do for your recovery.
I believe in talk therapy as well. And I have learned over my 30+ years in therapy, that there are huge differences in the quality of care provided by the different schools of psychology and the different levels of training a therapist has. But the main thing in finding a talky doctor is to feel and empathetic bond with them. This is not transference. I don’t want my therapist to be my mom or my dad. I want them to FEEL into me, and understand and be articulate about FEELINGS. And then help me to take ACTION.

I’ve had men and women therapists and both have provided great care in my past. I have noticed a tendency that’s worth noting. Women therapists, in my experience, tend to be more empathetic and nurturing. But in the same vein, they tend to coddle me a little bit too much. They give me support where they should give me a harsh talking to. Sometimes, a therapist will collude with my depression. This is a role they must never have. None of your care team should ever agree with your diagnosis or symptoms of depression. Let me explain.

When I’m in my happy place I can laugh at and examine my depressive episodes from all angles. This is often where some of the good work around coping strategies gets done. BUT… When I’m in a depressive state it is easy, when talking with me, to want to give me encouragement and hope. Some of that can veer into collusion. Here’s what I’ve learned about that.

• I want you to accept and nurture me.
• When I’m depressed I need acceptance and warmth.
• When I’m depressed I will say very convincing things about what I can and can’t do when I’m depressed.
• You should never agree with me about what I can’t do. That is collusion.
• If your therapist agrees with you about what you can’t do, they are giving you the permission to not do stuff that you need to do for your recovery.

Dear loved ones and therapists, please do not give me permission to stay in bed all day. Please do not excuse my missed appointments, or missed dinner dates, for any reason. They are a symptom of my depression and an example of how I am NOT DOING WHAT I MUST DO.

The recovery from depression always comes from forward momentum in action. Taking action is a contradiction to the depression that is telling you to close-it-all-down, stay in bed, isolate yourself to protect others. But those are lies.

In my childhood (between 4 – 7 years old) I would often take to the hills when my father would hit a rage-filled moment in his alcoholism. We lived in a neighborhood that had huge lots. So I would climb the hill behind my house and build stick and stone forts. I would go there to be alone, to be safe. I would gather rocks and sticks nearby for weapons. But who was I defending against? My mom and dad? How was I ever going to win or even survive that battle?

As an adult I exhibit some of the same behaviors in response to high stress and depression. I isolate. I think that I will feel better by curling up in bed and closing the blinds. But it’s a lie.

I did not get better up in my stick and stone fort. I only got better when I returned to the house and found my mom. I only got better by taking action against what I really wanted to do. I really wanted to stay up in that fort until they sent out a search party. I desperately wanted someone to come find me, pick me up, and tell me it was going to be okay. As a kid that is a perfectly acceptable request. It’s what parents should do with kids. As an adult this type of behavior and desired response from others is likely to cause you a lot of pain. It might even get you in trouble with your job, or put your relationship into jeopardy. You cannot wait for someone to come rescue you from your stick and stone fort.

I cannot call in sick, I cannot opt-out of activities I used to love just because I am depressed.
The only way out of the fort is by your own action. The only way out of your depressive moments is by making contact with others in the world. You might call your care team. You might call a friend who understands. You might have a loving spouse who can give you warmth and cuddle without the coddle. That’s what you need. You need peace, love, and understanding, and then you need action.

Only you can take the action. Your therapist and family can all make suggestions, can all think they have a handle on what’s best for you, but only you can do it. Only you have the ability stand up in your mess of a fort/life/situation and ask for help. You have to tell those around you what’s happening and what you need. And you must ask them NEVER TO COLLUDE WITH YOUR DEPRESSION.

Telling me he understands my stick and stone fort is a therapist’s job. Telling me it’s okay for me to call in sick is colluding. I cannot call in sick, I cannot opt-out of activities I used to love just because I am depressed. Sure, I don’t need to add a lot of stressful activities, but I cannot isolate. Only through massive action, action forward, action back towards engagements and people and tasks, can we find the grip on the slipper slope back to wellness. We must fight to climb back up the hill ourselves. We can have a team of people around us cheering us on, but it’s an individual sporting event.

Today, back at the top of the hill, reengaged with my family, with work, with my creative process, it is easy for me to shout about ideas and strategies for doing what I’ve just outlined. But only two months ago, I was in my own stick and stone fort hiding from everyone. The holidays are typically hard for me. But this past holiday I “took a digger.” And my lovely companion didn’t collude with me or my isolation. She constantly showed up, cooked healthy meals, asked me what I needed, and demanded we go for a walk. It is through those laborious trips up the neighborhood hills that I got my strength back. More than the meds and more than the talky doctor, it was the daily living experience that I had to heal within. And walking, staying close to someone else (even if you don’t talk much) is the key to getting better.

I may never be 100% free of this terrible disease, but I can do better each time. I can show my care team where I hide and ask them to call me out every. single. time. There are no exceptions to this rule. Anytime I was let off the hook, “Okay, you can stay home, I can see how tired you are,” was a time when I ultimately felt worse not better for the release. In depression we want to constantly collapse. We hope for constant rescue. But the truth is we’ve got to be self-rescuing knights and princesses. The truth is we can only do it for ourselves. Our friends, family, and support team can cheer us along, but it’s our legs and our lungs that have to propel us back up the hill.

… let’s continue tomorrow …