A new season, a new diagnosis

If you’re a frequent reader, you may have noticed that I’ve been posting at a markedly reduced rate. The arrival of spring has, for me, coincided with a new season in life.

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Frankly, ideas no longer come to me as readily as they did over the last few months. Or if they still still do, then perhaps it’s the words I need to convey them that are no longer at my beck and call. I’m aware of how my fingers no longer chase after words that once spontaneously spilled onto the keyboard.

Does it bother me that it now takes a more deliberate, concerted effort to condense my thoughts into the written word? That socializing is no longer as easy breezy? That I now get tired more easily and sometimes struggle to stay alert at work? That I now need afternoon naps and more snooze hours? A little bit, yes, but while all this might sound like a melodramatic lament, I’m actually surprisingly okay with these developments.

It’s not the most pleasant feeling, but at least I’m not terrified. Two years ago, I had no idea what was happening to me, so best guess was that I was losing my mind. I vividly remember having a horrifying existential breakdown in front of my computer while struggling to comprehend some class-assigned readings. In retrospect, I probably over-exaggerated the problem. It probably wasn’t quite that I understood NOTHING, as I ran around exclaiming in despair to me helpless roommate. More likely, I simply could no longer read, comprehend, and process at the super-speed I’d come to regard as “normal”.

And when it happened a year ago, I assumed it was the onset of another bout of depression. It happened to be crunch time for my B.A. thesis, the pinnacle of my undergraduate career, and also the dreaded job hunt season. I grappled and clamored and clawed to keep my head and my “sanity” above the quicksand, only to get sucked right under. Before I knew it, I found myself on the floor of The Stacks, spilling tears and snot all over musky old books (I apologize to everyone who had to touch those books after me), freaking out about being “the most pathetic human being to ever exist” and begging my hapless boyfriend not to make me get on the plane to Pittsburgh for a final interview.

In this space I’ve freely written about my travails in “recurrent major depression”, but never once mentioned my brewing suspicions of a misdiagnosis. Over the last few months, I’d begun to suspect that my “condition” should rightfully be termed and treated as bipolar II. With each article read, each forum scoured, and conversation had (with friends who have had similar experiences, friends in med school, helpful folks on Quora…), I grew increasingly certain. But it was only about a week ago that I received affirmatives from my general physician, as well as a psychiatrist.

I don’t simply drift in and out of depression — I ebb between a few months of depression, and a few months “hypomania“, a lesser known term. You can easily find descriptors of the common symptoms of hypomania, but generally, I would classify them all as basically being a Super version of yourself: quicker, more creative, more productive, more sociable, more adventurous, more energetic (but on the flip side, often more impulsive, which can lead to poor judgment and bad decisions). A word they often use is grandiosity. But me being naturally more reserved, the grandiose, less inhibited version of myself often just seemed healthy, confident, and fun.

Doesn’t sound bad, does it? In fact, you’d find many people with bipolar II asking questions like, “How can I extend my hypomanic episodes and shorten my depressive episodes?” Unfortunately, it doesn’t quite work that way because your brain is essentially on over drive during hypomanic episodes, so to indulge in it would likely result in a harder crash. And I can only imagine how drastic spikes and falls, left uncalibrated, would mess up one’s brain in the long run.

I now wonder: How was it humanly possible that I churned out an average of 4 full-length blog posts and 2 original drawings per week? And all without sacrificing my full-time job, volunteer commitments, self-directed study plan, occasional Netflix binges, and a healthy social life? No, now it doesn’t quite seem humanly possible. And I am accepting that it’s not supposed to be.

My “superpowers” have been taken from me. And that’s more than okay. When I speak of a “new season” in life, I don’t mean a new season marked with reduced activity and inspiration, because that wouldn’t exactly be the first time. It is a new season in that I am now aware of what’s going on in me. I know what body of knowledge I should be tapping into. I know when and where to get help if needed. I know what to encourage, and what not to. I know what feelings can be indulged, and what shouldn’t. I have a good relationship with my psychiatrist and therapist, and I am actively involved in making decisions about going on/off medication, making plans to learn to self-regulate where possible, and so on.

Why did it take me so long to consult health experts about my brewing suspicions? I was afraid. I didn’t like the idea that the periods in my life where I actually liked myself and liked being me, I was in fact just “hypomanic”. I yearned for those to be “normal”, not things that might potentially need to be repressed, regulated, corrected, or even medicated. Basically, I was afraid to acknowledge that I might not really be me when I’m at my best. But over the last few months, I’ve come to realize that there’s no such thing as a “real” you. The depressed me is still me, the hypomanic me is still me, and same goes for everything in between.

Perhaps I’m not as “consistent” as I would ideally be, but who is? We’re at times lazy, at times driven. At times selfless, at times self-indulgent. At times insecure, at times self-assured. At times fearless, at times cowardly. And at times we are lost in the fog, at times we find a good vantage point to see past the fog, and at times we even find our footing in the midst of it all.

I am learning to be okay with uncertainty, and with a lack of control. And it helps to realize we can only ever have perceived certainty and control. When we think we know what tomorrow will bring, it’s really just an illusion, isn’t it?

Thank you for accompanying me on this journey. Peace be with you. 🙂

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More than we desire peace, we desire meaning

[I]t can be seen that mental health is based on a certain degree of tension, the tension between what one has already achieved and what one still ought to accomplish, or the gap between what one is and what one should become. Such a tension is inherent in the human being and therefore is indispensable to mental well-being. We should not, then, be hesitant about challenging man with a potential meaning for him to fulfill. It is only thus that we evoke his will to meaning from its state of latency. I consider it a dangerous misconception of mental hygiene to assume that what man needs in the first place is equilibrium or, as it is called in biology “homeostasis”, i.e., a tensionless state. What man actually needs is not a tensionless state but rather the striving and struggling for a worthwhile goal, a freely chosen task. What he needs is not the discharge of tension at any cost but the call of a potential meaning waiting to be fulfilled by him.

–Viktor Frankl (neurologist, psychiatrist, and Holocaust survivor)

When you know your “good days” are numbered

The first time I tasted a depressive episode in 2011, I didn’t think it was anything more a one-time glitch in an otherwise emotionally healthy life. And then in the winter of 2012, it returned, and this time worse in manifold ways. Eight months later, I emerged stronger than before, declaring to myself and the world that I wouldn’t fear a relapse. But the truth was, I didn’t really believe it would come back. It was a vague possibility in my head, but nothing more.

No prizes for guessing this one, but it did return the following spring. Again, and this is highly likely due to inadequate treatment and self-care, this one was also worse than its predecessor. I hadn’t even had a chance to attempt to conceptualize what that might even look like. Before I knew it, I was reduced to a human ball of invisible, destructive thoughts — sometimes sobbing, sometimes suicidal, other times both.

I am now well, and am beginning to grasp what it means that this is going to be a recurring theme in my life. As I pour my refreshed energy and extended wake time into the passions God has placed on my heart, I am also aware that I cannot lay claim to my present capacities indefinitely.

What do I do with this awareness? I don’t know what the “best practices” are (feel free to share any advice with me), but I’ll probably have many tries to figure this out anyway. But typically, my approach these days have been to “seize every moment”. I try not to sleep beyond what’s necessary for my health, I try not to say no to an invitation to a meal/coffee/conversation/adventure, I try not to reject the appeal of someone in need. I also assess the gifts and talents God has bestowed on me (for example, my voice, my writing, and then those drawing skills that seemingly came out of nowhere) and consider how I can use them to bless others. I reflect on the special passions He has planted in me, such as my love for children, the youth, and the developmentally disabled, and consider how they ought to inform my vocational decisions.

On a more proactive, self-protection side, I’ve been making good on this hypothesis: that if I took advantage of the times when I’m not depressed to learn more about depression (from reading books and articles, and talking to experts including my own healthcare providers), I will eventually become better at handling depressive episodes when they do return. These on top of responsibly staying on medication and being disciplined about self-care, of course.

Now, and you’re probably already thinking this: though I write this from the perspective of someone diagnosed with “recurrent major depressive disorder”, these musings are relevant to any living human.  Our good days are numbered, our days in general are numbered. We don’t know what tragedy might befall us, and when it might. We don’t know what we might lose tomorrow. And then there are also the things we can reasonably expect: the changes that will come with old age, and of course, the fact that we will all die.

Maybe these aren’t things we often think about, and I might even be coming off as if I were still in the thick of depression. It’s also often said that to think about the end of life prevents us from living our lives, but I patently disagree. I believe there are few things more important to how we live our lives than contemplating the temporality, and fragility, of life on this side of eternity. Accepting the vanity of our present pursuits is the beginning of discovering our true purpose, and the true meaning of our lives.

It’s getting easier, these days, to acknowledge our mortality on a mere theoretical level, without really allowing it to sink in in our daily deeds and interactions. Perhaps because modern society has gotten so good at marginalizing death and suffering. Those things are hidden away in hospitals and hospices. Even the things that aren’t hidden from plain sight — like the plight of the homeless, and our brothers and sisters languishing daily under systemic injustice and oppression — we’ve somehow been trained to phase them out of our interior lives. Because it’s more convenient (not to mention more lucrative for corporations) that we are kept distracted by illusions of invincibility and the pursuits of temporary pleasures.

But fight that. I invite you think reflect on these realities more often than you might be used to. I speak not from a preacher’s podium, but from someone who’s been brought so low she had no choice but contemplate these unpleasant reality checks. This is not to rain on anybody’s parade, because the contemplation of “unpleasant” truths is necessary bitter medicine to a pride that needs humbling, a temper that needs taming, a coldness that needs thawing, an indifference that needs shattering, and a soul that needs healing.

I have come to trust in the Great Physician who administers this medicine, and I trust Him with my entire life and being.

Swallow the bitterness in faith, and then we can begin to taste the goodness of life in its fullness. I’m still catching new glimpses of it each day. A life where I am not the center, where I can delight in giving more than I do receiving, where I can truly delight in the joys of others without envy (for the most part), where I rejoice simply in knowing that I am a beloved child of God, where I look forward to an eternity in my final destination.

If I can help somebody as I pass along,
If I can cheer somebody with a word or song,
If I can show somebody he is travelling wrong,
Then my living shall not be in vain.

If I can do my duty as a Christian really ought,
If I can bring back beauty to a world up wrought,
If I can spread love’s message as the Master taught,
Then my living shall not be in vain.

(From “If I Can Help Somebody”, arranged by Ray Liebau.)

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Congratulations on making it to the end of the “heaviest” post I have written in a while. Leave a comment with your thoughts — I would love to hear from any perspective! 🙂

One thing I’ve learned about friendships and difficult times

“Often love is offered to you, but you do not recognize it. You discard it because you’re fixed on the same person to whom you gave it.”

–Henri Nouwen

Doodled by Karen Zainal
Doodled by Karen Zainal

I thank God for the troll, the coconut trees, and the sludge monsters in my life. 🙂

P.S. I’ll start writing proper, full-length posts again soon…

Dear Chiara Natasha

Update: Chiara has gotten in touch with me, thank you for your help in spreading the word!

Dear Chiara,

My name is Karen, and I’m a 23-year-old Indonesian girl. I read about you in stories covering the recent AirAsia tragedy. My heart grew heavy as I learned that you have so suddenly lost the people I imagine had been closest to you. I was filled with an overwhelming urge to get in touch with you, but I didn’t know how, so I started emailing the editors of Singaporean newspapers. But I realized I didn’t want to waste any time. To people who aren’t in deep pain, another day is just another few hours that invariably tick by. But for those in agony, time stalls and you find yourself in an abyss where past, present, and future meld together. And so I’m writing to you here, and I hope you see this. I don’t have magic words or any big promises. To be honest, I don’t know how I can help you, except to tell you that you are not alone. Maybe you have many strangers trying to reach you with a word of comfort right now, or maybe they, like me, don’t know how. Maybe you will read this and you wouldn’t be able to take me too seriously because I don’t know your pain, but I just need to do something and I pray I can help in some way.

Before I say anything else, I want you to know that I am and will continue to pray for your father, your mother, as well as your brothers, Nico and Justin. I believe in a God whose love and mercy is unparalleled, and I pray that He, with the intercessions of the saints and angels, will lead your family members’ souls to heaven. And I know I’m not the only one praying for them.

I don’t know much about you other than the few details I could find in those articles. If I gather correctly, you are an Indonesian studying in Singapore. If so, we have at least one thing in common. I was also born and raised in Indonesia. In 1998, my parents sent me and my older sister to Singapore to get a better education. We lived apart from the rest of our family for quite a while, before they were able to join us more regularly when our youngest sister got older. Between then and now, we’ve relied on airplanes to take either our parents to Singapore, or us to Indonesia. Once or twice I’ve imagined the possibility of a disaster, but never too seriously. Words cannot express how sorry I am that this has happened to you. As I thought about you, I couldn’t imagine anyone feeling more alone than you must have felt when you received the news. But at the same time, I also thought, wow, that this girl is somewhere out there right now, wow, she is strong.

Dear Chiara, I don’t know your pain, and I don’t know your fears. All I can offer is any empathy or insight that could come from having been clinically depressed a few times in my life. Each time, reality and facts would become so distorted in my mind that I believed with every fiber of my being that I was alone, and that I had nothing left. I pulled through with the unsolicited help of some very unexpected people in my life. For example, a friend of my ex-boyfriend’s parents reached out to me and became a listening ear and a constant source of support. Who would have thought? Well, God intervenes in our lives in very unexpected ways. Dear Chiara, I hope during this time you will be open to even the most unexpected sources of support. Dear Chiara, this must sound most contrived, but how I wish I could give you a hug.

I am and will continue to pray for you, my sister. Many things may not make sense right now, but have hope in a God who knows and sees more than we do. Where we see no open doors, He sees one that we don’t even know exists. You are very strong, and you are very loved.

Chiara, please feel free to contact me anytime at all. You can email me at: karen.zainal@gmail.com. If you’re not Chiara, feel free to share this with her, or anyone who might potentially know her.

With love,

Karen

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Learning to love my name again

Since day 1 I’ve observed how students love doodling their own names. That’s the first thing many of them do given any downtime, boys and girls alike. Along the margins of their notebooks you’ll find their names in cursive, block letters, graffiti-style…

More recently, my colleague had the brilliant idea of creating an “Honor Roll” board to put up the names of students who are getting the target minimum B in their regular Math class. Everyone got busy writing their names on individual notecards. Boy did that activity take much longer than expected. For the first time, some were meticulously using their best penmanship, even decorating the borders and background, and asking to start over on a fresh card when they messed up. A far cry from the pages of their Math notebooks (you’d think they’re deliberately trying to veer as far from the margins as possible…).

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I mentioned this “phenomenon” to my RCIA instructor, who pointed out that name-writing is a powerful form of self-identity and self-expression . It makes sense that this impetus would be particularly strong during formative and experimental teenage years.

Your name represents you. It’s how you represent yourself to others, as well as to yourself, and is something people associate with you. While deep in depression, I developed a profound shame of my own name.

I wasn’t too surprised by how I hated seeing myself in the mirror — that happened the previous two time I was depressed and was a natural consequence of an unhealthy self-esteem. What was new this time round was how I hated seeing my name, hearing my name, and worst of all having to say my name.

While deep in depression, I had neither the mental energy nor agility to understand why this was happening. It’s clear to me now. I had come to attach my name to everything I have done, but most of all my failures and mistakes.

I had come to despise my own existence. And your name, after all, is like footprints of your existence — it’s attached to virtually everything you’ve done: essays, standardized tests, consent forms, report cards, college applications, job applications, diplomas, awards, text correspondences, email correspondences, credit card purchases…

Since I was so plagued by overwhelming shame for everything I have ever said and done, I naturally began to be ashamed of my name. It is nothing less than soul-crushing to come face-to-face with your own name, one with which you’ve lived for more than two decades, and find that you’ve done nothing but sabotage and tarnish your own legacy.

Meeting new people was torture because it meant having to introduce myself. I’d reached a point where I’d begun to feel alienated from my own name. Saying my name had become like saying the name of an enemy! I hated having to wear my name tag at work. I squirmed in the inside whenever I had to introduce myself to colleagues and students. It made it hard to be fully present in any situation when you’re subconsciously trying to dissociate yourself from your name, your identity.

But as I make my journey toward full recovery, I am learning to be kind to myself. I am learning that there’s a depressed Karen, a non-depressed Karen. A proud Karen, a humble Karen. An insecure Karen, a confident Karen. A selfish Karen, a selfless Karen. A Karen who makes mistakes, a Karen who does things right. A hypocritical Karen, a genuine Karen. A Karen who wasted many opportunities, and a Karen who is learning from her mistakes. A Karen crippled by doubt, a Karen who walks by faith.

I am not perfect. I don’t mean to say that to suggest that I’ll just have to live with that. Instead, I am saying this: every up and down, every failure and success, is an important part of my journey toward becoming the Karen that God created and ultimately desires me to be.

Hear me, coastlands, listen, distant peoples. Before birth the LORD called me, from my mother’s womb he gave me my name.” (Isaiah 49:1)

I will end with this beautiful passage taken from The Inner Voice of Love, the “secret journal” of Henri Nouwen, a Catholic priest who went through a debilitating cycle of depression:

There are two ways of telling your story. One is to tell it compulsively and urgent, to keep returning to it because you see your present suffering as the result of your past experiences. But there is another way. You can tell your story from the place where it no longer dominates you. You can speak about it with a certain distance and see it as the way to your present freedom. The compulsion to tell your story is gone. From the perspective of the life you now live and the distance you now have, your past does not loom over you. It has lost its weight and can be remembered as God’s way of making you more compassionate and understanding toward others.

Can you identify with any of this? Have you ever attached shame to your own name? What’s the story?

Related post: Being depressed did not make me “an innocent in hell”

My students knew I was depressed before my colleagues did

During our training, we were told that students are far more perceptive than we’d expect. Students can tell if you don’t care, students can tell if you’re fake, students can tell if you’re pretending to be someone you’re not. These are all true, but who knew they’d also sniff out my depression?

They didn’t exactly read it from my face, but there are plenty of other signs they could pick up.

I was in the hospital visiting a student who’s recovering from a traumatic injury (and overall near-death experience), when I decided to tell him about my history with depression. It thought it would be a good way to start a conversation about how we can commit to learn and grow from life’s tragedies.

But before I could elaborate, he cut me off: “Oh, I knew that. I saw that book you were reading.” He’s referring to The Catholic Guide to Depression (How many times have I referred to this book on my blog? You’d think I was getting paid to plug it…). I have a rather messy workspace in the classroom, and would leave my non-class-related things at random corners. Now I wonder how many students saw my little orange bottle of antidepressants.

On a separate occasion, I was letting my students know ahead of time that I wouldn’t be in school the following day. I didn’t expect anyone to bat an eyelid, but one of them began “badgering” me.

“Why?”
“I need to see my doctor tomorrow.”
“Oh, during the day? What’s wrong with you?”
“We can talk about this after class.”
“No, just whisper it to me.”

While his desk mate was paying no attention, I casually explained, “I will be seeing a therapist tomorrow. The first appointment has to be during the daytime. Don’t worry, I won’t have to miss school for this in the future.”

Of course, he wanted to know more, this time with a hushed voice and a look of concern in his eyes.

“Wait, so what’s wrong with you?”
“Just finish your work, and we can talk more after class, okay?”

The sweet boy just wouldn’t have it, so finally I whispered, probably against protocols of appropriacy, “I was diagnosed with depression. But don’t worry, it’s under control.” I did not expect him to whisper back, “Oh, I think I have that too.” But I’m thankful he did — otherwise, I wouldn’t be able to support him as comprehensively as I now can.

Sensing that there is much potential for this “secret” to be “used” for good in the classroom, I told another student. This particular student wasn’t struggling with anything particularly atypical of a high-schooler, but he struggled a lot with motivation. He found it hard to want to do anything that was difficult or unfamiliar, which you unfortunately encounter a lot in Math. I was getting a lot of “I don’t want to do this anymore” and “I’m calling my mom” from this boy.

One day, I sat him down and told him about how hard it was for me to go through college while depressed. I shared this not to guilt-trip or shame him, but to explain how things would have turned out much different had I lived according to the mantra of doing only things that are easy or comfortable. I also shared how my deepest regrets from my younger days are exactly that: forgoing many opportunities for growth simply because they weren’t within my comfort zone. “You know, that’s why I still can’t ride a bike today.” That drew a chuckle, but I knew I finally had him in a way that would last a longer than my previous ‘life lectures’. The message was clear: we won’t grow if we’re never uncomfortable.

I believe there is room for vulnerability (in appropriate doses and at appropriate times) in the classroom. It makes you more human, a concept many students find difficult to grasp.

And it helps establish genuine relationships. Some believe it’s better to keep things “professional”, but I doubt that’s universally applicable. These relationships, in turn, will help you teach. Not just classroom material, but lessons in life and virtue.

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A candid shot taken by my colleague

Related post: My students are helping me recover from depression, “It all started with tea.”