An anxious introvert calls her Congresspeople

Before November, I had never called an elected official.  Way back in high school, I wrote a letter to my town council, about something tiny—the safety of a local intersection, I think it was.  It was for a class assignment and not something I felt super-strongly about.  My councilperson delivered a written response in person to my house, which was both awesome and terrifying.   A few years later, I emailed my representatives at all levels, local through federal, asking for pins to trade at an international event.  (Is this still a thing one can do?  I don’t know.)  All were quite responsive; I got several bags of nice pins.

But calling?  I hate making phone calls.  The social anxiety I have about talking to people in person is an order of magnitude worse on the phone, where I have no visual cues and it’s hard to hear what people are saying half the time.  This phone-hate is not uncommon, I gather, among anxious folk and among introverts more broadly.

People in the know, however, say that calling is the most effective way to get your point across to an elected official, short of showing up at an in-person event when they’re in town.  So now, I call.

It’s still a lot of work for me.  I have to write out what I’m going to say (or find a script I can use), with adjustments for leaving a voicemail versus talking to a live person.  I have to spend a solid ten minutes just sitting in silent isolation with my phone and my script, mentally preparing.  And then I have to decompress afterward, for however long that takes.

At the same time, I have to combat the thoughts that tell me I’m not doing enough.  There are so many things I could be doing, so many calls I could be making.  There are activism messages saying I ought to be making longer, more confrontational phone calls.  The amount of input that I have to sort through to figure out what I should do and say is overwhelming.

To combat all the different directions of anxiety, I try to remember a few things:

1.  Doing something is better than doing nothing.  The perfect is the enemy of the good, and all that.  Right now, my choice isn’t between “make a long, involved call” and “make a short, here’s-my-message call.”  It’s between “make a short, here’s-my-message call” and “don’t call.”  So I do the thing that I can do, which is less than some people can do, but still a thing done.  Similarly, when I put in a solid effort to call about something and get only busy signals and full voicemails, I’ve given myself permission to not feel bad about emailing instead.  A message in a less-noticed medium is better than no message at all.

2.  Focus is good.  Basically another take on point #1.  I can’t make calls every day—I would be a constant nervous wreck.  And I don’t have the mental space to keep track of every single issue.  So I don’t: instead, I pick the issues I’m going to follow in-depth.  (For the curious, these are health care / women’s health / reproductive rights, and LGBTQ+ equality.  These may not be your personal top-priority issues, and that’s OK.  Point 2 in this piece has a good explanation of why.)  Regardless of issue, I also call my Congresspeople on the rare occasions when they do something I approve of, because positive feedback is good, too.

3.  Those people answering the phone?  That’s their job.  They are specifically supposed to be listening to me and passing on my message in some appropriate fashion.  I am not imposing on their lives.

4.  I’m not the weirdest person who’s ever called.  Even when I’m nervous, even if I trip over my words, I figure the person answering the phone has heard worse.  I’m polite, and I’m calling about something that’s reasonably connected to reality.  (Note that by “polite,” I don’t mean “agreeable,” I mean “recognizes that the staffer on the phone is another human being.”)

5.  I’m not alone.  This is relevant for both external impact (my call doesn’t mean much on its own, but as part of a hundred calls, it matters) and internal turmoil (loads of people have varying degrees of phone anxiety).  When I’m freaking out, I review the helpful “How to call your reps when you have social anxiety“—it reminds me of my strategy, and reassures me that others are dealing with this too.

I tell myself these things, and I keep going.

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Brain chemistry in the age of anxiety

I’ve had plenty of opportunities over the last 12 days to observe how my body and mind respond to stress, and I’ve learned something really interesting.  Specifically, my “mental illness anxiety” is quite different from my “fear/rage/stress anxiety.”  This is a useful thing for me to know personally, but it also relates to the way society has trouble understanding that mental illness is an illness and not just a bad day.

The mental illness is irrational.  It can be triggered by anything or nothing.  I’ve written before about what this anxiety feels like.  It is paralysis.  It is wanting to make my brain just stop it, accompanied by a frantic search for what is bothering me so I can make it go away.  Except there isn’t any particular thing causing it, and so my brain just keeps searching and panicking and pulling up every possible thing that could be a problem and making them seem worse and awful.

The fear-anxiety is rational, and so it manifests in my brain in a very different way.  Sometimes it’s overwhelming, and I cry in grief and terror and collapse for a while.  Often, though, it’s motivating.  Instead of freezing up and freaking out, my fight-or-flight mechanism actually kicks in correctly and I make plans to fight or flee.

Oddly, my physical reactions to these two anxieties are distinct, too.  In my post about anxiety, I wrote that it’s “a tightness in your chest, your arms, your jaw.”  If it’s really bad, it almost feels hard to breathe.  This is the reaction to the irrational malfunctionings of my brain.  The rational fear?  It leaves my chest alone but knots my stomach to the point where I cannot eat.  It twists my guts in knots—the same kind of knots that show up before the starting gun of a race.

In one case, my brain is reacting the way it has evolved to do.  It senses a threat, and it responds.  This is normal.  This is correct.

In the other, my neurochemicals are just totally out of control.  This is the illness.

They are different.

Psych meds and mutant genes

A little while back, I mentioned that I was having a pharmacogenomic test done, i.e., a genetic test to suss out how my body might respond to different medications.  In my case, the test was looking at antidepressants and other psych meds.  The results are in; they’re nothing dramatic, but they’ve validated my experiences with certain medications.

For example, I had been taking aripiprazole (Abilify) as a sort of helper drug to complement my primary antidepressant.  I started out taking the very lowest available dose, and when that seemed to be going well, my psychiatrist recommended increasing it.  I tried that for three weeks, went “NOPE, not OK,” and dropped back to the lower dose.  Even though my psychiatrist had given me permission to do this, she seemed disappointed and continued suggesting the higher dose.

Well, guess what?  It turns out that I have genetic markers for processing aripiprazole very efficiently; the test results note that I should “use with caution” and “lower doses may be required.”

I was right.  I was right that the higher dose was wrong for my body, even though it’s a “normal” dose for other people.

The test also looked at a gene called MTHFR, which produces the gloriously long-named enzyme methylenetetrahydrofolate reductase.  It converts folic acid to a form called L-methylfolate, which is the form used by the body and brain.  (Moms, remember how important it was to take folic acid while you were pregnant?  It’s because L-methylfolate is super important for brain and nervous system development.)

Long story short, it turns out one of my MTHFR genes is a mutant version, meaning my body might not be processing folic acid as well as it ought.  There’s some preliminary research that this is associated with depression and maybe with low energy levels.  [Cautionary note: If you’re curious about this for yourself and decide to start Googling about MTHFR, put your critical thinking hat on tight.  Those search results are going to pull up a lot of BS.  Real medical research about MTHFR seems to be fairly scarce.]

In an odd sort of way, it’s exciting to finally have a test actually find something wrong with me.  I’m depressed and I’m anxious and I’m tired, and yet all the normal tests (iron levels, thyroid hormones, etc.) are always, well, normal.  I now have a new and different thing to try: taking L-methylfolate supplements.  I’m not incredibly optimistic that they’ll make much of a difference, but one can dream.

Going public with my decision to leave academia

Today I officially announced my plans to leave academia after the PhD.

By “officially announced,” I mean “told my thesis committee as a group and not in a wishy-washy I’m thinking of leaving academia way but a definitive I’m never applying for postdocs way.”

“Academia is not a healthy place for me to be,” I told them.  “And I’ve learned that I’d much rather mess about with code than come up with big-picture science questions.”

So I’m kind of freaking out a bit about that now.  Not as much as I was freaking out about it last year, when I was afraid to tell anyone that I was even thinking about exiting academia.  But a little.  Because it feels kind of permanent now, you know?

Still, I’ve made my decision, and academia is not for me.

Last year, I was worried that I might fall back in love with my field of study if I somehow figured out how to overcome the depression and anxiety that had become closely linked with it.  This year, I know I won’t.  Maybe someday, from a distance, I will learn to be excited again about cool related science in the news.  Here, though, in the daily grind of writing and stressing and making plots—no, I won’t love it.  This year I was fortunate enough to produce some really interesting results, and it helped, but it didn’t help enough.

I’ve come to properly realize that although anxiety and depression are parts of me that will follow me everywhere, they are made enormously worse by the environment of academia.  Isolation, lack of help, intense career pressure, an almost total lack of positive feedback: those things all feed the brain monsters and send me into places I cannot control.  I don’t expect that another career path will be all sunshine and roses, but it will be different and it will be outside the cult-like insularity of the ivory tower.

Of course, I still have to finish my PhD, which is freaking me out A LOT on a daily basis.  My thesis committee was divided between those who thought I was making good progress and those who didn’t believe I could do it in a year.  Not exactly the most encouraging of situations.  Still, I think if I can force myself to bang out the text of another paper by the end of the month, I might be able to convince myself that I can do it.  So that’s the current goal.  Expect to hear lots of complaints about writing.

I forgot how to have a relaxing Sunday morning

It’s been a rough weekend.  Little Boy brought home a stomach bug, which he then generously gave to me, who passed it on to his dad.  (At least there was some stagger so we had one semi-functioning adult at a time.)  There has been a lot of ugh, turn the TV on and just try to distract ourselves while we get through this.  Even feeling somewhat better, my appetite has been too low to give me any real energy, mental or physical.

Needless to say, I did not go for my usual Sunday run this morning.  I sat and ate breakfast, and drank a cup of tea, and tried to gather myself for the day.  I felt so tense, as though there was something I ought to be doing—but there wasn’t.  Little Boy was puttering around the kitchen mostly not getting into trouble.  There was no hurry, nothing planned.  There were chores to do—there are always chores to do—but they didn’t need doing right away.  So why was it so hard to relax?

Maybe running on both my weekend mornings is getting to me.  Maybe I need more breaks like this, so that I know how to deal with them when they arise.

Referring PhD students to counseling is treating the symptoms, not the disease

I went off on a bit of rant on Twitter yesterday, starting with the sentence above.  Around about the 7th or 8th tweet, I realized that I needed to work this up into a full-fledged blog post.  So here we go.

Two things set off this rant.  The first was reading the latest in a long line of articles about the mental health problem in grad school.  Don’t get me wrong, it’s a fine article, and the more people talk about this, the better.  However, like many of its predecessors, it focuses on access to counseling and other mental health care as the solution.  That’s absolutely important, and so is emphasizing the message that it’s OK to seek treatment.

But offering counseling and antidepressants is just treating the symptoms.  If my toddler woke up with a dangerously high fever, I would give him Tylenol to bring it down, but I’d also take him to the doctor, where the cause of his fever would be evaluated and treated.  If all the kids at his daycare came down with the same serious illness, the staff would give us all information about how to get them treatment, but they’d also clean the heck out of everything and assess whether their hygiene policies needed changing.

Along those same lines, we need to talk about why anxiety and depression are so prevalent among PhD students.  As the links above describe, graduate school causes mental health issues in many students, and exacerbates existing issues in others.  We need to make sure that those students who are suffering feel comfortable asking for help, but we also need to fix the system that’s causing this psychological epidemic in the first place.

I’m sure there are people out there who think that this is just how a PhD has to be, and sure, pushing yourself to your intellectual limits is always going to be hard.  But don’t you think people would do better—be more productive, produce better work—if the system didn’t function in a way that made them miserable?

The second trigger to my rant was a discussion that took place at a gathering of female postdocs and PhD students in my department.  It was a meeting to chat with last week’s (female) colloquium speaker.  Based on who organized this particular meeting, I suspected that any advice might tend toward the useless kind, but I went anyway.  (There were donuts, what can I say?)

The organizer and the guest of honor were both the kind of postdoc that the department likes to bring in to tell all us PhD students “how to succeed:” people who’ve won an especially prestigious postdoctoral fellowship, the kind that will get their resumes placed at the top of the pile in faculty searches.  These people tend to be extroverted, assertive, even cocky; in grad school, they did “groundbreaking research” and somehow managed to publish a half-dozen first-author papers.  Be like these people, goes the message, and you too can be successful and awesome.

This is the mold.  This is the person the system says you have to be.  There’s an underlying assumption that it’s possible, if you just work hard enough, for everyone to become this person—and that if you don’t, it’s because you didn’t try hard enough.

Which brings me back to why I’m not OK with “make counseling more available and less stigmatized” being presented as the full solution for poor mental health among PhD students.  It relieves the system of the burden of change and puts it on the individual students.  There is something wrong with you, says the system.  Go get that taken care of, and when you’re all fixed up, come back and fit yourself into our mold.  

Let me end with a personal example, in hopes of further clarifying my point.  One of the pieces of advice we always get is to talk to lots of faculty who aren’t your research advisor.  Make yourself seem more awesome.  Cultivate people who can write letters of reference for you in the future.

The problem with this advice isn’t its content.  Networking is an important skill that will serve you well in just about any occupation, and fundamentally, people won’t learn about your research unless you tell them about it.  No, the problem with this advice is that it’s universally delivered from the perspective of a confident, gregarious extrovert: “Just go talk to professors!”

I’m a shy introvert with major social anxiety—it’s incredibly difficult for me to “just go talk” to anyone, much less someone who’s presented as an evaluator and an important part of my career.  Talking to someone—taking up their time—makes me feel like I’m being a huge imposition.  These are my issues to overcome, and they do require real mental health care.

But you know what else would really help?  A system that acknowledges that this is hard for me.  A system that is just the tiniest little bit more encouraging of these kinds of interactions.  That reassured me that I’m not doing something dramatically wrong and weird and awkward when I knock on a professor’s door and ask to chat.  That doesn’t treat every discussion about research as an evaluation of me, designed to make the questioner look good.  And above all, a system that doesn’t assume that I’m a bad researcher just because I don’t fit the mold.

Post-apartment stress syndrome

When we first moved to the house, more than half a year ago, every noise set me on edge.  Cars revving.  Dogs barking.  Children shouting.  Leaf blowers blowing.  Even the steps of pigeons on the roof reverberated in my ears like the clanging of gongs.

And when there was no sound, my mind invented some.  I have stood in my silent closet, looking around for the source of the music that played faintly around the corners of my hearing, only to realize that there was no music at all.

I never used to be sensitive to noise, at least not outside the range of normal.  As a child, I found the echo of late-night train whistles to be soothing, not disturbing.  I have lived in a variety of dorm rooms with a variety of roommates, and while not all of those experiences were necessarily pleasant, noise levels were never a major issue.  Heck, for three semesters in college, my window looked directly across an alley to a popular fraternity.  I slept fine.  Getting homework done was never a problem.

Life in the apartment began as a death by a thousand cuts.  There were the neighbors who left their TV on talk shows all day, the sound of not-quite-understood words spilling over into our workspace / dining room.  There were the other neighbors who watched TV while going to bed, apparently clueless of the fact that they shared a wall with our bedroom and that we might, perhaps, also be trying to go to sleep.  There was the fact the slam of any door reverberated through the whole building.

There were occasional barking dogs, and sometimes there were dogs who would bark for hours, left alone on patios.  There was the woman who would let her toddler grandchild yell and shriek outside our windows with only the barest attempt at redirection.  There were the pre-teens who bounced basketballs off the walls, who stomped up and down the stairs, and whose preferred gathering spot was a few feet from our front door.  And then there were the neighbors who bought fancy new bass speakers because it somehow never occurred to them that enjoying loud bass on a nightly basis might not be the best idea in an apartment setting.  (Those were the same neighbors who, upon moving out, decided that the best time to move their bed was at 11 p.m.—and that the best way to do it was by dropping the mattress off the balcony immediately above our bedroom.)

You can’t really complain about these things, because then you’re That Neighbor Who Complains.  TV noise carries through walls; it just does.  Dogs bark.  Children play.  The neighbors with the fancy new speaker system turned it down when the apartment manager finally bothered to pass on our message about it.  The kid bouncing the basketball moved on when asked politely.

It got into my head, though.  Instead of getting used to the noise and tuning it out, my brain began to expect it and go looking for it.  It hoarded and guarded its quiet time, never knowing when it would next be interrupted by a bang or a bark or the irregular mumble of a TV.  It grew protective and angry and paranoid.

It would’ve just been another fact of life, something I would have had to learn to cope with, if it hadn’t been for the last set of upstairs neighbors.  I’ve written about them before—they were one of the major factors contributing to my postpartum depression, and to my husband’s.  Their thuds and bangs and bumps and stomps never stopped, not even at night.  It sounded like they were rearranging furniture on a daily basis.  Even earplugs couldn’t keep out the sound.  We woke when they woke, which was somewhere around 5:30 in the morning.

We left that apartment, at the cost of a buy-out fee of two months’ rent, with two months left on the lease.  The manager was puzzled—why not just keep living there for those two months, since we had to pay the rent anyway?  We couldn’t.  It was driving us literally insane.

I no longer hear phantom music.  Loud music, though—real music, thumping and bumping with bass—still triggers a fight-or-flight reaction.  Blood pressure rises.  Anxiety spikes.  Make it stop make it stop make it stop.  The memory of when the noises never stopped brings on the fear that they never will again.

It does stop, though.

And every day that goes by in a house with solid walls and normal, pleasant neighbors, I get a little bit more normal again.

Taming social anxiety with the Golden Rule

Do unto others as you would have them do unto you is a principle that all of us, including me, could use to implement more in our lives.  It wouldn’t make human interaction perfect—it can fail when people don’t notice differences of privilege and perspective—but it’s a good start.

Lately, I’ve been trying to apply the Golden Rule in a roundabout sort of way inside my own head.  I struggle with a significant level of social anxiety.  I find talking to other people, both in person and online, to be a scary thing.  I’m afraid that they’ll judge me and I’ll be embarrassed.  It’s not debilitating, but it is mentally exhausting.  The anxious scared part of my brain (Captain Awkward dubs this the Jerkbrain, which I think is a perfect name for it) is always overanalyzing everything I do and say and coming up with reasons why I did it wrong.

That’s where the Golden Rule comes in.  When my Jerkbrain starts freaking me out, I ask myself, “If someone did this to me, would it be OK?  Would I judge them?”  Usually the answers are “Yup, it’d be fine,” and “Nope, they’d be good,” and I can calm down for a bit.

Example 1:  I start getting paranoid about leaving a comment on a stranger’s blog.  My Jerkbrain starts in with an ongoing sequence of “This person is going to think you’re so weird.  A crazy online stalker or something.  Clearly you are not part of this blogger’s community.  And what makes you think you have something to contribute anyway?” etc. etc. etc.

Pause.  Breathe.  Do I like it when new people comment on my blog?

Yes, of course.  I love new readers.  As long as they’re not leaving eight-paragraph screeds about how feminism hurts men or spamming me with links to their “Make $150,000 now!” site, we’re good.

Is my comment rude or totally out of line for the site?

Nope.  [On the occasions that I leave an angry/argument comment someplace, I’ve already decided that I’m not being nice and this whole mental discussion is bypassed.]

Then why do I think it would be a problem?

Huh.  OK.  I guess I can stop freaking out about it.

Example 2:  Thinking about who to invite to a party.  There’s an obvious list of friends, plus a number of acquaintances in the same social group.  It’s a large-ish event; my instinct is to invite the acquaintances too, so they don’t feel left out.  But my Jerkbrain starts in: “These people don’t know you that well, why would they want to come to your event?  They’re going to think you’re extra-strange now.  How could you think they’re your friends?”  If it’s a gift-giving sort of event (e.g., baby shower), add a big dose of “They are just going to think that you’re out for more gifts.”

Pause.  BreatheDo I mind being invited to events by people I know a little but not well?

Nope.  It’s nice to be invited to things.

If someone invited me to something, and I decided that I didn’t feel like going because I didn’t know them that well, would I judge them for it?

Nope.  I’d just politely decline the invitation and then forget about it.

If someone didn’t invite me to something, but did invite a lot of people that I knew, how would I feel?

Bad.  Sad.  Lonely.  I wouldn’t want to err on the side of leaving someone out.

Then it’s OK to invite them.  Proceed.

It’s not 100% foolproof, of course.  There’s no way to guarantee that the person on the other side won’t react in a completely different way than I would.  But it’s a better starting place than “Never talk to anyone because AAAAAAAA!”

This is what anxiety feels like

I definitely wouldn’t say that I suffer from severe anxiety.  I don’t have panic attacks, my fears rarely rise to the level of phobias, and I’m generally capable of functioning as an adult when necessary.  In fact, I tend to think of my anxiety as a secondary issue, a little demon friend that tags along with my depression.  But it’s still there.  A lot.

It strikes most often out of the blue, usually in the morning.  I’ll get shot through with a burst of it while brushing my teeth or washing my face.  I’ll want to hide, curl up, claw out the feeling.  Sometimes my brain will seize on some past imperfection, like that time I said something dumb while teaching three years ago, or one of my blog posts that I don’t love, and I’ll be wracked with embarrassment all over again.

Most days, the feeling passes.  Life is a good distractor.  But on some days, it sticks around.

Today was one of those days.  I couldn’t really tell you why—I think the thought of navigating Twitter as an introvert might be freaking me out a bit, but there aren’t any specific worries running through my head, and while progress on my thesis feels achingly slow, that’s not anything new.  Nevertheless, the anxiety was strong all day.

Anxiety is a tightness in your chest, your arms, your jaw.  It’s an electric current in your limbs, a perpetual coursing of adrenaline.  It’s like being in constant flight-or-fight mode, except you don’t quite know what it is that you should be fighting or fleeing from, because if you did, you’d do one of those things and maybe it would go away.

Anxiety is feeling like you want to poke out segments of your memory so that they won’t bother you any more.  It’s wanting to delete the things you’ve written, erase yourself and hide from the world so there’s no chance of ever being judged.  It’s a persistent urge to punish yourself for the ways that you have failed, accompanied by the sure knowledge that you will fail again in the future.

It’s also the fear that the tenseness is all that’s keeping the real terrors at bay.  That if you try to relax or mediate and let down your guard, all the things you hate about yourself will come tumbling into your head and you’ll collapse under their weight.  And so you try to find things to keep your mind busy instead.  Keep it full of the words of others so it doesn’t have time to come up with its own.

And it’s not knowing how to end this blog post, and then wondering if you should apologize for being so serious, and then thinking, who cares, it’s my blog, and then finally deciding that it’s OK to stop right here.

Mental health care access is a joke

We’ve been trying to find my husband a psychiatrist.  It hasn’t been going very well.

The first place we tried was a local community health center with several psychiatric nurse practitioners.  A referral and some phone calls later, he was told to come in at 8 a.m. on a specific day for a walk-in appointment.  It turns out “walk-in appointment” is an oxymoron, because, when he arrived, he was told that the earliest available time slot that day was 10 a.m., and that wasn’t with any of the people he’d been told he would see.  For one of them, he’d have to wait until at least 3 p.m.

Well, my husband is a man with a job and a tight schedule, so he left.  Further calls revealed that the center has no non-walk-in options for the initial evaluation appointment.  That wasn’t going to work.

So we tried a different place.  The friendly assistant on the phone informed us that yes, Dr. M. was taking new patients, but the earliest available appointment was in January 2016.  What?!

Health care in the U.S. always tends to be a maze of referrals and insurance verifications, but mental health care seems to be the worst of all.  You see, to see a psychiatrist (or a psychologist, or a therapist or counselor), you have to do go through the following steps:

1.  Find a practitioner who sounds like a good fit for you.

You would think that you could just get a recommendation from your regular doctor.  You would think.  That’s how other specialties seem to work.  When I was referred to a physical therapist for some long-term hip problems, the referring doctor sent me to a specific person.  Someone they thought might be appropriate.

Mental health?  Nope.  When I talked to my OB-GYN about postpartum depression, I got some vague hand-waving about how they couldn’t recommend anyone in particular because they didn’t know who took my insurance.  When I walked into my university’s student counseling center – the people who handle all student insurance referrals for mental health – and asked to be referred to a therapist for postpartum depression, they had no idea to whom they should send me.  After a long while of awkward searching, I asked if they could just give me a blank referral and let me find someone.  They did.

2.  Check that the practitioner in question accepts your health insurance and is taking new patients.

The health insurance question seems to be particularly problematic with therapists, who often practice alone and may only contract with a handful of insurance companies.  And the only way to get a solid answer is to call the practitioner’s office and ask.  I’ve yet to encounter a health-insurance-created online “provider search” that is user-friendly in any way.

3.  Get the official, insurance-approved referral from your primary care physician.  [May be optional depending on how your health insurance works.]

That’s right, you have to make a completely separate appointment with your primary care physician, just to get the piece of paper / electronic signature saying that your mental health care is medically necessary.  Or in my case, you have to go through triage at the student health center again and re-answer a bunch of irrelevant questions about your drinking habits.

4.  Call to make an appointment.

Theoretically straightforward.  Often frustratingly not.  Sometimes, like The Mort Mommy, you face a bureaucracy so unorganized that you never get through.

5.  Wait for the appointment.

Maybe the soonest they could get you in was a few weeks from now.  Maybe it was eight months away.  It’s not like mental health issues are ever urgent, right?

6.  Attend appointment.  Decide if you feel comfortable enough to make another.  If not, rinse and repeat the entire cycle.

Comfort level is important with any medical professional, but especially when it comes to mental health.  If you don’t mesh with your therapist, it’s not going to work very well.  My latest attempt at therapy ended after just five sessions because it became clear that he didn’t have a frame of reference for my issues and so we were going over and over and over the same things with no forward progress.

This whole process is hard enough when you’re sane and have your life together.  It gets exponentially harder when you’re depressed.  When it feels like every little task takes an overwhelming amount of energy and it all seems hopeless anyway.  Or when you’re so anxious that every phone call to a stranger leaves you panicking that you’ve said something wrong.

It’s ridiculous.  My husband and I have decent health insurance.  We can afford the $25-a-visit co-pays.  We live in a moderately-sized city, and we have the job flexibility to make appointments during the work day.  Even at our worst, we have each other for support and the presence of mind to say to a doctor, “I am depressed and need help.”  And we still struggle to access mental health care.  Imagine how much harder it must be for those who don’t have the same level of support and privilege.