Inside of Depression and Out, or: a Question I’ve Been Curious About for a Long Time

“What is it like to be sad when you’re not depressed?”

Have I ever known what it’s like to be just sad? There was a time before I even thought of myself as depressed where I looked back over my life and realized that I couldn’t ever remember a time when I’d been consistently happy. I don’t exactly think I’ve always been depressed, but I think I’ve always been too obsessed with doing exactly, perfectly right by everyone that I didn’t leave room to ever be satisfied with myself, which is a recipe, at the very least, for constant anxiety.

I know a little bit what it’s like, now. Because for a week or three after I started taking Wellbutrin, my brain changed. I had some days where I was anxious about stuff, but the anxiety was different. It was different and it wasn’t. It was exactly the same feeling that I’ve become rather intimately familiar with over the last quarter-century, give or take.

The feeling was just the same, but the difference, for me, was that suddenly it wasn’t attached to a narrative. It was still rather unpleasant, in the sense of, “Oh dear, this is quite unpleasant, I am not very much enjoying this at all!”

But that was it. It was just there, with me, and unpleasant.

On depression it’s different. It’s the same feeling, but is attached to this dark cloud of “This is the only way things have ever been or ever will be, and it will never get better, it’s all futile, and nothing will ever get better, but there is every possible chance it will get much worse.”. On depression, my brain forgets about the time between episodes. Thinking about the experience reminds me of the idea of state dependent memory, except that instead of being able to remember certain things when I’m depressed, I stop being able to remember anything but the other times I have been depressed. All the episodes and bad moments and hopelessness connect to each other and I can’t remember anything that happened in between. I can’t remember that anything has ever happened in between.

The difference between being sad or anxious or exhausted when I’m depressed and when I’m not is this. The feelings are just the same, but the narrative isn’t. Rather, outside of depression, there just isn’t a narrative. It’s just a feeling. Pleasant or unpleasant, it’s just it’s own thing. Inside of depression, it’s all connected in this tapestry of “This is how everything always has been and always will be.”.

So now I know.

As I get an opportunity to return ambient stress levels to within manageable parameters, I’m hoping I’ll get back to that place and have some time to get used to it. Fingers crossed.

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Antidepressants Update

So. Antidepressants.

My new psychiatrist has me ramping up on a relatively new drug called Viibryd. It is supposed to have fewer sexual side effects than most of the others on the market. This past weekend, an “um-friend” of mine visited from out of town, on account of which I got very little sleep. Yesterday I switched from 10 mg to 20 mg on the ramp up, and presumably either on account of that or the incredible lack of sleep or both ended up pretty sick and threw up a few times.

I told my psychiatrist and he recommended I stick with 10 mg for longer and see how that goes. In addition to being generally sick the last few days, I’ve had the worst flareup in my chronic pain symptoms I’ve experienced in a long time. It has been a generally miserable couple of days.

I’m not sure what the next go-to strategy will be if the Viibryd doesn’t work. Most other drugs I’ve tried have had little impact and annoying side effects. In particular, my recollection is that most of them, rather than lowering my interest in sex like I was warned about, tend to lower my ability to get hard, but do absolutely nothing to my interest in sex. Wellbutrin, when I tried it, had the opposite effect, but it also led to my feeling jittery throughout the day, and is apparently not effective against anxiety, which is one of my issues.

So we’ll see. Right now I’m just clenching my teeth through all the chronic pain stuff, which I’m anticipating will die down after I’ve caught up more on sleep.

Trying Antidepressants

I think I am going to try antidepressants again.

I’ve been mulling this over for a good while now. The last time I tried antidepressants was about six years ago; I tried Pristiq, Paxil, Zoloft, and Wellbutrin, and stopped trying after none of them seemed to have any effect outside of side effects. Looking back, however, I’m not sure if I gave all of them enough of a shot, time-wise, and I’ve been thinking it might be a good idea to try again, with one or two of those or with different ones.

I’ve talked to the therapist I’ve been seeing a few times about medication, and she has generally taken the position that meds are an option that wouldn’t be a bad idea for me to try, but has left the decision about whether or not to try them up to me.

There are a few different things that have led to my decision to take a stab at meds again. The first one was reading Greta Christina’s post about being on antidepressants indefinitely, and, in particular, learning this bit:

“Apparently, if someone’s had three or more serious depressive episodes in their life, the current standard of care (as my psychiatrist understands and interprets them, anyway) is for them to stay on anti-depressants. If someone has had three or more serious depressive episodes, the chances are very high that they’re going to have another one — and when that happens, it’s better, for a zillion reasons, to already be on medication.”

Second, also via Greta Christina, was this analogy she quoted in a subsequent post:

“Maybe instead of diabetes as your go-to simile, try using asthma.

I’ve had asthma for as long as I can remember. I’ve been on maintenance medication for it since I was in junior high. When I’m on the meds, I can run, exercise, do all the things that normal people do. When I’m not on the meds, running might put me in the hospital.

When I was diagnosed with chronic depression, I was thrilled. I was doing something about the thing that was holding me back from being the me I wanted to be. As far as I am concerned, it is just like getting on asthma meds. I fully expect to be on them the rest of my life, and I’m happy to do so.

I think the “chronic” part of “chronic depression” might be what is throwing you for a loop. It doesn’t mean you’re constantly depressed. It just means that you’re at an elevated *risk* of having an attack of depression. I.e., it isn’t the episodes of depression itself that the “chronic” is referring to. It is the elevated risk. In that way it’s a lot more like asthma. And just like my asthma medications help me be the person I want to be who can run and exercise and stay in shape, the medication for depression helps me be the version of me who has motivation, loves a challenge, loves to learn new things, and has decently high creative output.”

I love this analogy for depression. I think it is spot on, and it has changed the perspective that I take on my own depression symptoms. More than anything else, it is the effect that this analogy has had on how I perceive my depression symptoms that has pushed me over the edge into considering medication again. I have had a few moments lately where I felt either socially overwhelmed or incredibly lonely and ended up feeling immensely, viscerally awful about myself as a result. Having the experience that I have and the perspective I have on that experience, I am able to look at those and say “This is not a normal or useful response to what is going on right now.”.

It doesn’t necessarily make me feel better at the time, but it does make me want to do something about it.  The last few times this has happened, I have looked at it and said “This is the emotional equivalent of an asthma attack; there is no good reason to be experiencing this, and I might be able to avoid experiencing it by being on medication.”.

In certain ways, my life is also not in a state of significant change at the moment, which means it is not a bad time to experiment with medication again.

This is a thing I think I’m going to try.

Having Dynamic Emotional States Feels Weird

I’ve been thinking a lot about this post lately.

I’ve been going through some depression. It’s a combination of circumstances that I don’t particularly feel like going into on the blog right now, but suffice to say I’ve had some pretty bad days. I’ve had some days of feeling intensely lonely, and some days of feeling just generalized awfulness with no apparent source.

Yesterday, I made myself go to a beginner waltz class.

I love dance. For me, dance is the ultimate social introvert activity. I don’t like groups, and dance is a perfect way to be social while operating entirely in serial with people. No group interaction, just a series of individual interactions that are too brief to get particularly awkward even if it turns out you don’t click very well. When I know what I’m doing, dance-wise, people enjoy dancing with me, and when I don’t, I find that dancing somehow supercharges my ability to be a charming conversationalist, and I can have a lot of fun with people just riding on that.

Dancing yesterday was incredibly fun, and I even found myself being really socially flirtatious with the woman I had the best chemistry with.

And then I came home, and I went to sleep, and I woke up, and the depressive exhaustion was back. I may go dancing again tonight, and it may be just as fun, and I may feel just as good, and then I may come home and feel the same swing back to the other end of the scale tomorrow morning.

It feels so strange to talk about how good going out dancing feels at the same time as I’m going through this depression stuff, because somehow I still haven’t intuitively grasped the idea that I can feel so good about things and so bad about things in the same span of time. I feel like I should just have some STATE that is relatively consistent, and not this ludicrously context-dependent existence.

STATE: PRETTY GOOD.

STATE: TERRIBLY BAD.

I don’t know. I’m just saying it’s weird, is all.

How to Be Skeptical of Your Own Brain, Part Three: Ideas

 Introduction | Part 1: Chronic Pain | Part 2: Depression | Part 3: Ideas

I manned an Ask an Atheist table regularly when I was in college. A lot of good discussions were had at that table, and the ones I most enjoyed tended to be the ones that focused on a particular point. Someone would say they didn’t believe in evolution, and I would go over the genetic evidence for it (which was and is my favorite); someone would argue that without religion you can’t have morals, and I would explain why their morals had no more objective basis than ours; etc.

Every now and then, though, there would be one of those discussions where every time I made a few points against one of their arguments, the religious person would change subjects. The whole argument would be a game of religious apologist bingo, jumping from “The Bible says God exists” to “You can’t prove God doesn’t exist” to “But you can’t have morality without God” to “But you can’t explain the universe without God” to Pascal’s Wager, etc., etc. No matter how many arguments for a god failed to stand up to scrutiny, the person would just jump to another one.

The strange thing about this pattern, which you see in all kinds of debates all the time, is that people don’t seem to recognize the pattern. When five arguments have been knocked down, the person jumps immediately to the sixth argument, apparently without pausing to consider the possibility that maybe there is a reason the first five “foolproof” arguments have failed. That maybe the problem  is that the premise they’re defending is wrong, rather than that they just haven’t found the one argument that really will be foolproof.

To my mind, the reality in the argument with the Christian at the Ask an Atheist table is that the first five arguments failed for the same reason the next five arguments are bound to fail: because the premise they’re defending is false. Gods don’t exist.

Why doesn’t this occur to more people in these arguments? Why, after the umpteenth argument in a row has failed, don’t people think to ask themselves if maybe the problem is with their premise? Why do they keep searching for reasons why they are correct instead of asking if they are correct?

Well, why did I keep searching for a physical problem with my back when I started experiencing chronic back pain? Why did I keep searching for a problem with me all those times I experienced the emotional pain resulting from depression?

I know the answers to those questions: I kept searching for a physical problem with my back because physical pain begs for a physical explanation. Physical pain instinctively prompts you to ask the question “How am I damaged?”. By the same token, I kept searching for a problem with me when I felt bad about myself because that kind of emotional pain begs the question “What is wrong with me?”.

I think the reason why people search for reasons why they are correct instead of asking if they are correct is because cognitive bias begs the question “Why am I correct?”, not “Am I correct?” in the same way that pain begs the question “How am I damaged?”, and not “Am I damaged?”.

Our instinct is to trust our lived experience. Our instinct is to trust what we perceive — to trust that when we feel hurt, it is because we are hurt, that when we feel bad it is because of something bad, and that when we feel conviction it is because something is true.

I spent years uselessly searching for a problem with my back to explain my back pain, and I spent years uselessly searching for problems with myself to explain why I felt bad about myself, and everywhere you look, all the time, in arguments, people spend tremendous amounts of time asking “Why am I correct?” in response to their bias without even realizing that that is what they are doing. To me, these all look like different versions of the same story, and I think that the same type of skeptical thinking can be applied in each case.

What would it mean to think of bias as an analog of pain? It would mean thinking of bias as an experience produced by my brain based on taking in all of the available contextual data I have about an idea and turning it into a conscious experience of conviction about that idea. In the same sense that my brain will take in an enormous amount of subconscious context before creating a conscious pain experience, I imagine that it takes in context in a similar way before producing a conscious experience of conviction. Also, in the same sense that I can skeptically evaluate an experience of pain and make a conscious decision about whether or not it indicates damage, I can skeptically evaluate an experience of bias and make a conscious decision about whether or not it accurately suggests the validity of an idea.

Let’s do one more analogy:

Imagine that you have a motion-activated security system in your house. If someone tries to break in, it goes off, and you call the police. However, if you have a dog, sometimes your dog might set it off, too. You don’t want your reaction to the alarm sounding to automatically be “Someone is breaking in.”, you want your reaction to the alarm sounding to be “The alarm is going off.”, so that you can then ask “Is it sufficiently likely that someone is breaking in that I should call the police, or did I forget to close the gate to keep the dog upstairs?”. The alarm going off doesn’t mean “burglar”, it means “alarm”, and it’s up to you to decide whether or not that alarm is a sign that your house is being broken into or not.

In the same way that it is better to think “alarm” instead of jumping to the conclusion of “burglar”, I endeavor to think “pain” instead of “physical damage”, “emotional pain” instead of “something wrong with me”, and “I feel conviction about this idea” instead of “this idea is true”.

It is incredibly valuable to identify the experiences, the “alarms”, that cause us to act in certain ways or beg us to make certain assumptions. I wasn’t aware that it made sense to question my experience of pain, physical or emotional, until I realized that pain was a constructed experience that might not be accurate, and therefore deserved to be examined critically. By the same token, we are not able to question our biases unless we are able to separate ourselves from them, look at them, and critically question the conscious experience of them.

If you don’t realize that you are experiencing a product of your fallible subconscious brain when you experience, say, a conviction that a particular deity must exist, then you may end up searching for ways to justify it instead of asking if it is justified. You cannot effectively question the bias “alarm” unless you are aware of it. Similarly, if I didn’t understand that pain is a product of my fallible subconscious brain, then I would still be fruitlessly searching for ways to treat my low back. If I didn’t realize the same thing about emotional pain, then I might still be wasting time trying to find things to fix about myself in response to it.

I want to take a moment here to make sure that I emphasize that when I say we should question these experiences, I don’t mean to say we should dismiss them. Sometimes the alarm going off means there is a burglar in your house. Sometimes your ankle hurts because you sprained your ankle. Sometimes you feel bad about yourself because you really shouldn’t have taken that candy from that baby, or that job at Fox News. Sometimes you feel conviction that George W. Bush was a terrible president because he was, in fact, a really terrible president. The point of all of this is not to say you should instinctively doubt your experiences, but that you should practice instinctively being able to spot them and hold them out in front of you for examination.

In almost exactly the same way that I skeptically examine my experiences of physical or emotional pain, when I experience a conviction that a particular truth claim is correct, I try to figure out why my brain thinks that conviction is appropriate (“Why is the ‘conviction alarm’ going off?”). If I can’t recall the experiences or context that led to the conviction, but I have confidence in it, then, usually, instead of sifting around for justifications, I will simply say that it is my strong impression that a particular truth claim is correct. On the other hand, if I decide I don’t have confidence in the conviction, then I have an opportunity to reevaluate my position.

In light of this process, I have become incredibly fond of the phrase “It has been my impression that [assertion].”. In discussions, this is my way of saying “I have a bias about [assertion] that I trust, but I can’t remember the specifics of how I formed that bias at the moment.”. We so often think of bias as a negative thing, but for the most part I think of it as a useful form of data compression. Deciding to trust a bias isn’t necessarily bad, but it is a decision that should be made consciously instead of automatically wherever possible.

Be skeptical of your brain. See the process. See the “alarms” that prompt you to jump to certain conclusions before jumping to those conclusions. In the same way that I have to routinely ask “Why do I think I am physically damaged?” instead of “How am I physically damaged?” in response to pain, never ask “Why am I correct?” without first asking “Why do I think I am correct?”.

 The phrase "Deity X is real." being put under a magnifying glass, revealing the words "I am having an experience of conviction about an idea. This conviction may or may not indicate that this idea is correct. Do I have any other info to suggest that this conviction is or isn't the result of this idea being correct?".

The phrase “Deity X is real.” being put under a magnifying glass, revealing the words “I am having an experience of conviction about an idea. This conviction may or may not indicate that this idea is correct. Do I have any other info to suggest that this conviction is or isn’t the result of this idea being correct?”.

 

How to Be Skeptical of Your Own Brain, Part Two: Depression

 Introduction | Part 1: Chronic Pain | Part 2: Depression | Part 3: Ideas

I wasn’t officially diagnosed with depression until 2008, but when I look back on my life, I can see the beginnings of it started much earlier. Whatever part of my brain is responsible for producing the sensation of guilt has been working overtime for as long as I can remember.

When I was in high school, I tended to respond to the experience of feeling bad about myself by trying to fix things about me. I figured that if I just managed to figure out how to be an ethically flawless human being, I would be happy. I spent a lot of high school and college trying to manage being 100% perfect at honesty or pop-culture-Buddhist emotional detachment. I figured that was the key — I figured people felt bad because they were doing things wrong, and so when I felt bad it was because I was doing something wrong.

So every time I felt bad, it was because I wasn’t being as honest as I could be about this thing or that thing, or because I was attached to people in ways that prevented me from being able to see them clearly. It was because I needed to fix something. In the end, though, no matter how much effort I put into becoming ethically flawless, it didn’t ever seem to make me much happier. In point of fact, it tended to do the opposite.

It took me a very long time, even after I was diagnosed with depression, to understand the size of the mistake I had been making. It’s only in the last few years that I’ve been able to fully articulate the bait-and-switch that happens when I’m depressed — the fact that all of the flaws that I find with myself when I’m feeling bad aren’t the cause of my depression, but a symptom of it. It was more recently, still, that I finally made the connection between depression and chronic pain.

The thing that it took me so long to realize is that the emotional pain that comes from depression is just as unreliable as the physical pain that I experience in my back. I needed to realize that the emotional pain doesn’t necessarily mean I need to fix something about myself in the same way that physical pain doesn’t necessarily mean I have physically damaged myself.

As I discussed in the last section, the process that I have learned to go through when I experience chronic pain symptoms goes roughly like this: when I notice pain, I try to think if anything has happened recently that is likely to have produced an actual injury. If I can think of something, then I treat it like an injury. If I can’t, then I assume that the pain is a mistake.

I almost never ignore pain entirely, but if I suspect it’s not actually due to physical damage, I treat it like a paranoid delusion, rather than something physically wrong. Much like you might try to calm down a paranoid person who is convinced “everyone is after them” by talking to them about why that’s probably not true and trying to calm their nerves, when I judge my pain to be the product of a paranoid brain, I focus on all of the evidence that nothing is actually wrong, I try to reduce stress, and while I don’t completely avoid physical exertion, I do try to keep it relatively mild so as not to further scare my brain. The interesting thing is this: what I have learned to do with respect to depression is almost exactly the same.

When I notice emotional pain, I try to think if there is any actual good reason for it. If I can think of something, then I try to address that. If not, then I treat my brain like it’s being paranoid. The only difference is that where in the case of physical pain the paranoia is resulting in an inaccurate picture of what is going on with me physically, in the case of emotional pain the paranoia is resulting in an inaccurate picture of what is going on with me, shall we say, existentially. I think of emotional pain as my brain’s potentially flawed artistic rendering of the state of my existential self in the same sense that physical pain is my brain’s potentially flawed artistic rendering of the state of my physical self.

The impact of this model on my mental state can be quite powerful. I have had the experience of waking up in a state of pretty severe depression, and thinking “I can’t think of any reason for these feelings to be happening, therefore they probably aren’t accurate, and there is probably no good reason for me to be having them.” and having the depressive feelings dissipate. It isn’t always that easy, but it is, at times, a powerful tool to have in my toolbox.

Even when it doesn’t have an immediate effect on depressive feelings, this model of thinking is an incredibly useful tool for critically examining depressive thoughts. Nowadays, when I feel bad about myself, I understand the problem to be the fact that my brain produces this emotional pain without good reason to do so, and instead of assuming it is a sign that I need to fix something about myself, I assume it’s a sign that I need to do some maintenance on my brain.

Now, when I experience physical pain that begs for a physical explanation or emotional pain that begs for a problem-with-me explanation, I am able, when it is appropriate, to deny them that — I’m able to say “No, this is not a problem with me, it is a problem with you, Brain.”

In the next post: how this same model applies to ideas and arguments.

 The phrase "I am worthless." being put under a magnifying glass, revealing the words "I am having an experience of intense emotional pain. This pain may or may not indicate that something about me is not okay. Do I have any other info to suggest that this pain is or isn't the result of something about me not being okay?".

The phrase “I am worthless.” being put under a magnifying glass, revealing the words “I am having an experience of intense emotional pain. This pain may or may not indicate that something about me is not okay. Do I have any other info to suggest that this pain is or isn’t the result of something about me not being okay?”.

How to Be Skeptical of Your Own Brain, Part One: Chronic Pain

 Introduction | Part 1: Chronic Pain | Part 2: Depression | Part 3: Ideas

Note: for the purposes of this discussion, when I use the phrase “physical injury”, I am generally referring to an injury for which the physical point of origin is not my brain. This is bad terminology, given that the brain is just as physical as the rest, but I haven’t yet been able to come up with a better shorthand.


My back pain became chronic about 10 years ago. I had occasional experiences with back pain before 2004, but none of it was ever the sort of all-the-time pain that I started experiencing after a particularly intense sparring test in kung fu that summer. I experienced what a few doctors would later refer to as a “spasm” of the muscles in my back, and, after the pain didn’t go away quickly, decided to take some time off from kung fu to heal.

I waited, and waited, and waited, but every time I experimented with practicing kung fu again, the pain got worse. Even when I wasn’t experimenting with kung fu, I was in pain. Eventually, I started seeing doctors to try to get some decent diagnosis and treatment for the injury.

One doctor said it was that my vertebrae and my sacrum were out of alignment, and I should do some PT and some exercises and wear an SI belt. That didn’t work. Another doctor said it was a muscle tension thing and recommended muscle relaxants and anti-inflammatories. That didn’t work, either. Another doctor said it was core weakness and I should do some strengthening exercises for my core. That didn’t work, either. Another said it was that my leg lengths were different, another said it was a muscle in an ongoing state of spasm, another that it was networks of muscle knots…

No matter how many different doctors I went to and treatments I tried, none of them ever seemed to consistently help.

After about seven years of trying different doctors and treatments, I started going to a physical therapist who was more up on chronic pain research than most of the others I had been to. He would talk amiably through our PT sessions, and one day in the course of conversation, he said something that completely changed my perspective. He told me that there was almost certainly nothing wrong in the tissues of my back; he told me that the pain I was experiencing was almost certainly not a response to a physical injury.

I hadn’t considered that possibility before, because I didn’t know that this sort of pain could happen without being a response to a physical injury. Up to that point I had been convinced, without even consciously being aware that I was making an assumption at all, that the pain I was experiencing had to be a result of a problem with the tissues in my back.

Physical pain begs for a physical explanation, and because of that I searched for a diagnosis and treatment for a problem with the tissues in my back for years longer than I should have.

The thing I needed to understand about pain is that it is an artificial construct, not a direct feed of information. Pain in your foot doesn’t happen because of tissue damage in your foot, it happens because tissue damage in your foot sends danger signals to your brain, and your brain decides, based on those signals and historical context, that pain is an appropriate response*. Danger signals from the tissues are neither necessary nor sufficient for pain – they are one piece of context out of many that your brain uses to make a decision about whether or not to create a pain experience. Your brain can get danger signals and decide not to cause pain, and it can also decide to create pain in the absence of any danger signals whatsoever.

Metaphorically speaking, there’s an artist in my brain who looks at all of the physical inputs from all over my body, and all of the historical context from my life, and paints a picture that becomes my conscious experience. My pain isn’t a photograph of the state of my tissues, it is an artistic rendering  of the state of my tissues based on what the artist thinks is exciting or important. The same physical input will produce different sensations for me versus for anyone else, and for me now versus for me a year from now**, in much the same way you might expect different artists to paint the same scene with different styles and emphasis.

If I’m going to really take this metaphor all the way, then we could say that the problem with my body is that sometimes the artist gets drunk, and for some reason, when he’s drunk, he gets obsessed with my low back. The pictures he paints, and the pain I experience, do not correlate with what is actually going on in my tissues in any useful way whatsoever, they’re just a bunch of renderings of my lower back in violent red and orange.

For the last year or so of my life, my back pain has been better than at any other time in the last ten years, and I attribute that entirely to the fact that I learned these things about pain and have been able to apply them in useful ways. I may always have some difficulty with back pain, but for me, personally, no doctor or treatment has been as useful as learning about the process of how pain is produced.

My education about pain has enabled me to view my lived experience of pain through a skeptical lens. When I experience pain, I don’t assume that it is because of an injury. In the same way that a person with phantom limb pain isn’t going to worry that they’ve injured a phantom limb, I have learned not to worry that I have injured a part of myself when I experience “phantom pain” in a body part that just so happens to still exist.

In my day-to-day, this means that instead of responding to pain by not doing the thing that “caused” the pain, I respond to it by asking myself if it is likely that the pain is a response to actual damage, or a response to my brain making a mistake. If I think it’s the former, then I treat the pain like it’s an actual injury. If I think it’s the latter, then I use various strategies I’ve developed to accomplish the basic goal of telling my brain that it’s getting things wrong, and slowly increasing my exposure to the things that it mistakenly thinks are causing me damage.

In short, the single most useful tool for me, personally, in managing my chronic pain has been developing the ability to be skeptical of my experiences of pain***.

In the next post: the story of how I came to apply this same type of skepticism to my experiences with depression.

The phrase "Ouch! I hurt my back!" being put under a magnifying glass, revealing the words "I'm having an experience of pain in my back. This pain may or may not indicate physical damage. Do I have any other info to suggest that this pain is or isn't the result of physical damage?".

The phrase “Ouch! I hurt my back!” being put under a magnifying glass, revealing the words “I’m having an experience of pain in my back. This pain may or may not indicate physical damage. Do I have any other info to suggest that this pain is or isn’t the result of physical damage?”.

 


* In reality, the process is significantly more complicated than this — there are, for example, many different forms of modulation that can happen between the tissues and the brain — but I have made this simplified explanation as true to the actual process as I can without going into the less necessary fiddly details.

** Those of you who remember when you got your first cell phone may recall your first experiences with “phantom” cell phone vibrations. “Phantom” cell phone vibrations did not occur for any of us before we owned cell phones — not because our pant legs rubbed against our legs differently, but because our brains had not learned to interpret that type of input as possibly indicating the vibration of a cell phone. Same input, different context, different output.

*** I should note, here, that the strategies I use are not a cure for my chronic pain, but a major help, and that they are generally not easy or quick fixes, but take a lot of work, and that they will not, of course, work the same, or necessarily at all, for everyone. Not all chronic pain works like mine, not all of it stems from a purely neurological source. All pain does come from the brain, not the tissues, whether it’s phantom limb pain, actual limb pain, or pain resulting from the fact that you’ve just lost a limb, and as such I think education about these aspects of pain is probably always useful for chronic pain sufferers, but it will not always work as well as it has for me.

How to Be Skeptical of Your Own Brain

Introduction | Part 1: Chronic Pain | Part 2: Depression | Part 3: Ideas

 

From one thing, know ten thousand things.

— Miyamoto Musashi

 
I was going to try and write an introductory anecdote for these posts, myself, when I realized that another fantastic blogger had already written one perfectly. Before you continue reading, check out this post by Ferrett Steinmetz.

I think about the only other time I hallucinated, having dropped acid on a very hot summer’s night… and I found it disappointing.  Yes, my vision was flexing and distorting, and I witnessed all sorts of curious artifacts as my brain’s visual processing center went into overload – but I quietly dissected each illusion, breaking it down into its interesting components, and in such a way I reduced what could have been a wild trip down into a series of interesting quirks.

I don’t really hallucinate, I don’t think.  I know what my brain is up to.  And today, I realized why:

It’s because I’m a depressive.  I don’t trust my brain.

So when my brain starts providing false visual information, I do the same thing: I question it.  I compare it to reality.  And if it doesn’t make sense, I ignore it.

This post and those that follow it will be a series of anecdotes from my own life illustrating my personal journey from (1) learning to skeptically examine my chronic pain symptoms to (2) applying that same pattern of skeptical thought to my depression symptoms to (3) applying that pattern of skeptical thought to my reactions to ideas and arguments. In telling the story, I’m hoping to outline a generalizable model for thinking skeptically about all of our conscious lived experiences as human beings — a model for how to be skeptical of our brains.

It starts, naturally, with Part 1: Chronic Pain.

“What Happens After?”, the Anti-Catastrophizing Game

One of the strategies that a therapist of mine once recommended to me to stop catastrophizing is a game I call “What Happens After?”.

The thing about catastrophizing is that catastrophe narratives almost always end with the catastrophe. If you’re worried about failing a test, then catastrophizing means imagining that you’ll fail the test, and failing the test is the horrible Worst Thing in the World end of the story. If you’re worried about a breakup, then the relationship being over is the horrible Worst Thing in the World end of the story. I’ve borrowed the “worst thing in the world” phrasing from Cliff at The Pervocracy blog, who writes eloquently about this kind of thinking:

I remember when my first “I love you” relationship ended.  I couldn’t abide the thought.  I screamed.  I cried.  I tried to seduce him.  (While still crying. Sexxxay.)  I threatened to harm myself if he didn’t come back.  I called him until he stopped taking my calls.   The ridiculous thing is, I didn’t even like him that much.  It wasn’t about getting the joy of the relationship back.  It was about avoiding TWTITW [The Worst Thing in the World].

At some point I bawled myself to sleep, and the next morning I woke up and had to pee.  Because even in the wake of The Worst Thing In The World, you still have to pee.   I peed and went to work. It was the day after the end of eeeeeverything, but the bus still picked me up at 7:08 and I still got a half-hour and a chicken sandwich for lunch.  I was in pain, I was in bad pain, but I had thought it would be infinite pain, and it was finite.  It was only a six-foot cockroach.

I can’t say “and then I never believed in TWTITW again,” but it was the start of a journey.  Failing a class helped too, as did getting fired from a job, as did very messily breaking up with a very close friend.  Not because these things weren’t bad.  All of them sucked, all of them cost me opportunities I would never get back, all of them caused real and irreparable harm, yet the morning after… I still had to pee.

The “What Happens After” game is a pretty simple idea: if I’m ever worried about a particular worst-case scenario, I try to imagine what will happen after it. It doesn’t have to be a “plan” for what I will do after the thing happens (although making plans against worst-case scenarios can sometimes also be a helpful tactic) so much as the creation of a narrative, any narrative, that doesn’t stop with the catastrophe.

If I go through a breakup, then the day after that I’m going to have to make myself breakfast, and then I’m going to have to call that friend I haven’t been in touch with, and then I’m going to have to get some writing done or some coding done. The week after that I will have that swing dance thing to go to, and the week after that there is a conference…

The idea is that you just keep writing the story out until you realize that no matter how horrible it might be, the catastrophe that you’re worrying about will not be the end of the story. Somehow, moving catastrophes to the middle of their narratives from the end of the narratives has an ameliorating effect on the anxiety associated with them, at least for me.

Sometimes it happens that I forget to do the “What Happens After” thing, and then situations come up that prove the truth of the exercise to me. That is, something that I’ve worried a lot about happens, and then a bunch of stuff happens afterward, and I realize that the narrative doesn’t end at the disaster’s edge. This happened to me in a relatively minor way just recently.

One of the things I tend to worry about a lot is whether or not I have sufficiently established consent for the things I do with people. My pattern is pretty much to always explicitly ask for things, but it’s not uncommon, even in those cases, for me to worry like this: “I can ask, but this is a thing I really want to do, what if she isn’t interested, but she can tell that I really want to do it and feels pressured and then OH GOD I HAVE PRESSURED SOMEONE INTO A THING?!”

Recently, I had the experience of making out with two friends of mine for the first time. With the first friend, it went very well. I asked if she wanted to make out, she said yes, and then we enthusiastically did just that. With the second, I asked, and she said yes, but when it came to actually making out, I didn’t get a very strong sense that she was into what we were doing.

With the first friend, we made out for a while, and it was awesome, and I felt really good about it afterward. With the second friend, I got an uncertain impression, and decided to hold off on asking or initiating again. This may seem like the obvious way things like this would go, but in my brain it was a bit of an epiphany: “Oh! If I get the impression that maybe someone isn’t as into doing something as I thought, then instead of “OH GOD, DISASTER HAS HAPPENED AND THE WORLD EXPLODES”, what actually happens is I gather some data and use that data to inform how I initiate or don’t initiate things in the future.

Where before, the narrative ended in disaster, it now ends in my having more information and using that information to better understand the situation. Now, with that new narrative, the whole situation is a little less scary. This is how the What Happens After game is supposed to work, and I have found it to be very helpful at times for getting my head out of the “What if the world explodes?!” headspace, and into the “Well, then it will explode, and tomorrow I will still have to pee.” headspace.

Things Are Pretty Bad

It always seems to be worst in the mornings and just before going to sleep.

It helps to think of depression and pain problems as puzzles to solve. It gives you a path to follow to feel like you’re making progress. Try this thing, then if that doesn’t work try this thing, then if that doesn’t work try this thing, etc.

What’s supposed to happen when you do that is that you eventually try hard enough and find the right thing to try and things get better. That’s how the story is supposed to go. It isn’t how mine is going. If I had actually chronicled all the different things I’ve tried for the physical and mental stuff I’m going through on this blog, there would have been a lot more posts over the last year or two. There have been the different daily routines to minimize physical activity that aggravates my physical conditions, the different strategies for communicating and engineering interactions with people that make me feel satisfied and cared about, all those times some new thing I was trying felt like it was working for a few days before everything went back to feeling like last time.

Somehow, in spite of all the things I’ve tried, I’m still here, feeling physically broken and lonely and exhausted and like I don’t know what options are left to try.

Every now and then I think of a new direction to turn in, and I turn to face that direction and walk forward and bang headfirst into a wall I didn’t know was there. It’s like living in a tiny room, and every time you try to get out the walls press in a little closer.

I am in a dangerous place right now. I experimented with yoga a week or so ago, which seems to have turned out to have been a very bad idea — my tendonitis symptoms have changed in an alarming way is making me wonder if I might not have any time left to put off taking some time off from work, and hoping that will be enough.

In consequence, I’m making an effort to locate friends to crash with in the interim, because although there is a decent chance my savings would last a few months of my being unemployed, I think there is a good chance that my mood would plummet further down than it already has. My bad moments are already dipping into a frequency and extremity of suicidal ideation that I am scared by — a few months with nothing to do but brood would be a brilliant recipe for making those moments more frequent and more dangerous than they already are. I think crashing with friends for a while might be the best way to avoid that escalation.

I am seeing a therapist. I am making an effort to talk to people. I am doing the things that you do, and doing them as well as I can. And I am writing about this because it’s as good a way I know as any to make sure I’m letting people know where I am, and because I think that providing a window into what this looks like and feels like it is as important as providing windows into any of the other aspects of the experience of depression or chronic pain.

A while ago I had a conversation with a friend where I talked about how one of the most frightening things, to me, about the idea of committing suicide was that people might be mad at me for doing so. She told me that the people she knew who had friends who had committed suicide were usually not so much angry about the suicide itself as that the friend hadn’t told them that they had needed help. I have tried, since then, to always make sure that I communicate with people when things are going badly, even when I don’t want to, so that if I ever do end up committing suicide, I won’t have left people feeling that way.

But at this point I don’t know what to ask for. Usually I ask for talking, but right now my voice still isn’t doing that well, so I’m having to carefully manage the amount of talking I do. I guess really what I need right now is to find a way to feel financially and emotionally secure for long enough that I feel like I have the time to rest my body for as long as is needed for it to actually get better.

It still boggles my mind how situational so much of this is. I definitely have depression, and it definitely contributes to how this all feels in major ways, but without the physical shit I’m dealing with, there would be so many additional options for self-care for me. There would be ways of socializing and meeting people, there would be less management of the amount of time I spend talking or exercising or just… existing in certain positions that make certain physical symptoms worse.

If I just hadn’t worn out my voice to the point that it got this way. If I hadn’t gotten so excited about being able to type and code faster at the beginning of this year that it resulted in tendonitis. If I hadn’t gotten so excited about finally finding a form of exercise that I could do and found fun that I overdid that and ended up with these symptoms in my legs as well. If I hadn’t, in the effort to get better, tried yoga, which seems to have ended up making things worse.

If it didn’t feel like just this long process of me trying as hard as I can to get better, and my body responding by finding new ways to get worse.

Truthfully, sometimes I get frustrated that there even are the stigmas that there are against suicide. Shouldn’t I have the right to throw in the towel? Shouldn’t I have the right to say, “You know, this is just too much to expect any person to reasonably handle, and I quit.”

The line between where I am and a set of circumstances in which I could be happy feels so thin. Is so thin. If my body were a little different, a little more resilient. If things had gone slightly different way. If things have gotten better after one of the things I’ve tried. If the yoga had worked.

I went on steroids briefly for my throat. Steroids are a pretty effective short-term treatment for the symptoms of tendonitis, although long-term a terrible idea, because they actually eat away at connective tissue. At the same time, I had been experimenting with friction massage for the tendonitis, and for a few days it felt like that was working well. For a few days I caught a glimpse of just how thin the line is between where I am and the set of life circumstances where I think I could be happy.

With the tendonitis gone, and my voice better, I could work more and stop having to worry about money, and I could meet people, and I could teach coding, and I could write.

But none of those things is simple right now. Some of them are complicated and others are impossible. And I’ve spent a decade always having to wonder if it’s a good idea or a bad idea, physically, for me to go for a walk. For most people that’s the simplest thing. You want to go for a walk, so you get up, and you walk out your front door, and you go.

This isn’t really going anywhere anymore, I’m just talking through thoughts as they come. And I guess this is about the end of them for now. I am doing my best, because I know it will be worth it if I somehow manage to get through this. I know it will, but right now I don’t know how to get there, or if I can.