Abstract

Keywords: Mental health, depression, self-care, collaborative decision making, patient engagement.
Citation: Elder JA. Another mental health professional shares her “self-care” story. J Participat Med. 2012 Apr 11; 4:e9.
Published: April 4, 2012.
Competing Interests: The author has declared that no competing interests exist.

To the Editors:

I enjoyed reading Sana Johnson-Quijada’s article about her patient, Patricia. I often find that the internet, along with word of mouth from friends who have been diagnosed with ADHD and other disorders, has its good and not so good sides.

The internet has so much information that folks (including myself) can easily find symptoms that fit some of what the self-diagnosis is. It reminds me of astrology, where each person reading his or her “sign” will find some parts to be fitting for them and ignore the others. Fortune cookie messages remind me of this same experience.

There is so much information out there and we all get overwhelmed to the point that when we go to our health care providers, we seem like hypochondriacs.

Even Clinicians Can Have Depression

I myself, a psychologist, recently experienced an episode of major depression and was clueless about what was going on with me, and it took my psychiatrist and primary care physician to convince me that the stressors affecting me had left me agitated, exhausted, sad, and angry. It was the anger part that I had not connected to depression as I have found that practitioners and the public alike are looking for the very sad, lethargic figure that we see on the ads for antidepressants.

Along with my health care providers, I had to search out my own remedies. They ended up being: fresh air and sunshine, taking walks with friends, cognitive-behavioral therapy, sitting meditation, an antidepressant, and avoiding folks that would not believe that I (a psychologist!) was experiencing major depressive disorder. Because this was new territory for me, the people around me had difficulty seeing me struggle in a way they had not seen before. How could this competent, successful woman being taking such a nose dive? The facts were quite clear: I had lost a full time job (and thus a career) for reasons that had nothing to do with my performance; my husband of 12 years decided he wanted a divorce three months after the job loss; I worked three days a week as the caregiver of a dear friend with ALS who died four months after my job loss and one month after my ex-husband told me he wanted out of the marriage. I wish I could tell you that my recovery took a short period of time.

Yet it did not. I am getting better finally after two years from the onset of the depression, and 10 weeks ago, I had a total left hip replacement. It was easy getting better from that. Initially, I had a walker and I was stunned by the kindness I received from strangers because of that equipment. Even the cane I used soon afterwards alerted people to my disability.

Yet mental health problems do not show up on the outside. There are no crutches, canes, wheelchairs, or walkers for ADHD, depression, bi-polar, OCD, or schizophrenia, and you do not get to use a handicapped parking permit. Because people cannot see the inner turmoil on the outside and because our society has a “pick yourself up by your bootstraps” attitude, the person with internal suffering looks OK and is not.

Dr. Johnson-Quijada, I am so glad that you were able to listen to your patient, and not confront her about what she thought was wrong, and that you incorporated what might be wrong with your differential diagnosis and engage her enough that she came back to you. My guess would be that had you not been kind and respectful enough to do that, she would not have returned for another visit.

My own personal fight with depression has given me compassion about the “sameness” I have with all folks in this world, rather than the differences. I have come to understand that many people I work with are healthier than myself, and that their “pearls of wisdom” are gems they share with me. If any of my “gems” are useful for them, I do the Happy Dance. At the same time, I am well aware that they did all the hard work to get better. Just as I had to do my physical therapy for my hip (and I am walking like a normal person now! Whee!), there is a lot of footwork involved, besides taking medications, in getting better from internal pain.

Getting better from internal suffering requires, for me, learning to do the exercise (such as Dr. Johnson-Quijada’s patient did with her sleep hygiene) and unlearning some distorted thinking that began more than two years ago. Along the way, as my emotional and spiritual health grew stronger, I began to make connections between certain themes and piece together what allowed this to happen. Yet this was possible only when my spirit and brain were ready to handle the light-bulb moments. Those constructive insights come only when we are strong enough to handle them, and to learn from them in order to get better is a gift in itself.

The Hard Part: Self-Care Outside the Clinician’s Office

While my health care team was very valuable to me because they could see things that I could not and most importantly because they believed me when others did not, it was following their suggestions once out of their offices that forced me to become a “cooperative patient.” Most of this work had nothing to do with meds. It was largely common sense and asking myself, “What brought me joy when I was 7 years old?” Playing. Hanging with friends. Not worrying about stuff that I could not control anyway. I wish I had my mom around as well, because she was a great mom and resource when I was 7 years old.

At age 56, I know there is no mommy, daddy, or babysitter for me, though we humans all reach and grasp out for that caregiver when we are in pain, whether physical or mental. Finding those few folks who will come when you call them, hang with you when you are a mental mess, and take you out to socialize when every fiber of your being screams to stay under the covers of your bed — that kind of love and compassion is very therapeutic.

I have come to think that the development of mental health care teams like this might be helpful. I once had a client tell me, “You are my paid best friend.” How true that was, though I loved her anyway. If home health care includes nurses and physical therapists, perhaps it should include caregivers who are just kind and tolerant people. What is wrong with paid best friends or paid friends when the person who is suffering is feeling alone and without anyone?

Self-Care for Both Clinician and Patients

Dr. Johnson-Quijada, self-care is so important. I know that on an intellectual level and have to force myself to do it. I am a mom with two grown sons, so I know the experience of being a brand new mom — raising them brought the term “multitasking” to a new level, and a not such a good one. I learned to be a wonderful caretaker and now am learning how to be a healthy care receiver. I love how you came alongside Patricia, did not collude while doing so, and let her “internal treatment plan” evolve so that you could run your ideas by her. I find myself going for walks with my clients now, getting us out of my office, while we both benefit from the fresh air, sunshine, and exercise. Gosh darn, clients sure like it, and they talk more and come up with these fab ideas! They are our experts and I feel blessed to be with them for their journeys, as like yourself, I learn and benefit more from them than they could imagine.

Thank you so much for your article. You go, woman.

Copyright: © 2012 Jacqueline A. Elder. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.