Thursday, July 12, 2012

Things Run in Threes

Three quick stories, the types of things that roll around in this therapist's head during the course of a day.

Jesse Jackson Jr.
The Legend, the Dad, Jesse Jackson Sr.
 (1) Jesse Jackson Jr's Mood Disorder  

Our biggest local news is that Illinois Congressman Jesse Jackson, Jr., son of the legendary political figure and civil rights leader, Jesse Jackson, Sr., is in Arizona receiving intensive medical treatment in a residential facility.  Rumors are flying that the congressman is there for alcohol or drug addiction, but the official word is much less exciting.  He's suffering from a mood disorder.

It was really annoying yesterday, if you listened to the news on radio.  Every third sentence had to be about this story.  Forget privacy, forget respect.  He's suffering from depression, and he can't work and why can't it be left at that? This shouldn't be the most catastrophic or interesting story of the day!  Hasn't some terrorist been stopped mid-air in China?

Then today it comes up in therapy not once, but twice, patient's versions of:  I knew, he had it!  I could just tell.  One week gaunt, the next week perky.  Then listless, then . . .nothing about Jesse in the news for months!  And now, THIS! 

And I realized that it is a good thing.   It is a good thing that psychiatric illness is normalized on the news, that we can talk about it, that people recognize depression, especially, as a fairly common illness, not something that can be helped if only we (a) just worked out! (b) ate right, (c) married into the right family, etc., etc.  It happens to everyone, depression, which is what these broadcasts recognize.  Or more importantly, to me, a cutting edge population, the clinical population, feels less alone.  They are the people in the know, and they are telling us, what's what.  Delicious.

(2)  Adult Asperger's and Depression

This one explains so much!
Years ago I had a patient with Adult Asperger's, and have seen many since then.  Once you know what to look for, it isn't hard to pick it up.  Not that this is a common diagnosis, but 1 in 250 isn't exactly one in a million. Ever since Baron-Cohen came out with a better test for Adult Asperger's, more and more people with this compelling disorder are coming to therapy.

Tony Atwood
I found a list of affirmations in Tony Atwood's book, The Complete Guide to Asperger's Syndrome,  and brought it to work with me one day.  The patient read through it and told me that it didn't matter. The depression people like him have (depression is often associated with Asperger's) is born of deficiencies that might improve, but will never be overcome (we shall overcome): misunderstanding social norms, not knowing the intentions of others, cluelessness about people's expectations, a sense of isolation ingrained over a lifetime.  No amount of affirmation, I deserve respect for being different! can change this.

And yet, like other AAA patients, his sense of humor has me on the floor.

He shows me a link to a tee shirt he found online that says,  I'm not rude. . .I have Asperger's, and he tells me he could never wear it.  Too embarrassing.  We talk at length about his sense of despair, his inability to hit the mark, socially. his inability to put words on feelings his whole life. He hasn't got feelings so much as rationale.  His rationale, and only his, since empathy he tells me, for someone like him, is like Greek to a Jew.

(3) The Runaway Train of Depression

We talk a lot about how depression can feel like a runaway train.  Women in particular can't stop the crying, especially if they are suffering before menses, PMS.  It's like, sure, we're depressed.  But our bodies have to cope with our hormones, too?  Or is it all, hormonal.  Feels like that, sometimes.

It doesn't matter, really.  What matters is the feeling that this is unstoppable, that the tears will never dry, a feeling of loss of control, a feeling of serious crazy.  Insanity. What is crazy if not lack of control?  Nothing.  A person feels as close to insane with these feelings.  It is not unlike the insanity people with Asperger's feel, like they are aliens, can't speak this unintelligible language, the language of social cues.

Segue to Asperger's just a moment, because it can be so depressing (my last referral had no idea he had the diagnosis, came in with suicidal ideation).  Why do they want to be together in groups! What's with these get-togethers?  Ridiculous.  This is how it feels to have Asperger's, and this is how it feels under depression.)

Even imitating the natives, it is hard to be one of them-- both conditions.  But merely having Asperger's, being unable to read what is expected, not knowing what anyone wants from you if it is not spelled out, a person does feel out of control, a mistake will happen at any moment in a social situation.

And it does.  Insanity, not unlike the insanity we feel when we can't "manage" our emotions, especially sadness.  We're supposed to be able to do that, right?  Manage them!  And guess what?  Sometimes, that's impossible.

So what is the cure for this craziness?  For both crazinesses.  For the runaway train, those tears that don't stop?  People who are in a relationship can, and often do, ask a partner to hold them.  Holding therapy is nothing new.  We use it for kids all the time.  Kid has a tantrum?  Hold him.  Kid is sad?  Hold him.  And let the child determine when it is time to let go.

Same for a woman, or a man, weeping, thinking depression is insanity, off the charts, unstoppable.  If she can get someone to hold her, if he can get someone to hold him, it helps.

There's usually a problem with that, however, which is that sometimes the trigger for the tears is something that this partner said, or something not done.  So asking for a hug puts a vulnerable individual in a position of potential rejection.  They just argued.  Timing is bad.

This is where I say, Own the craziness.  Just like with Asperger's.  Own that you feel out of touch, insane, that you are in a crazy place and it is nobody's fault, least of all that partner's.  Even if it is, you don't say that, not if you want to neutralize the fight and start over, get the drug, the feeling of human arms around you.

That's the cure.  It really is.  One of them, at least.



Critically Observant Jew said...

"People who are in a relationship can, and often do, ask a partner to hold them. Holding therapy is nothing new. We use it for kids all the time. Kid has a tantrum? Hold him. Kid is sad? Hold him. And let the child determine when it is time to let go."

Except that kids (up to a certain age - or maybe not) are cute, and even when they're not, you're holding them to contain the tantrum. Adults (with their tantrums) - not so much. Hence it's more like asking someone to hug a porcupine.

therapydoc said...

Ya, but she's your porcupine.

therapydoc said...

Or he, whatever the case may be.

Dr. G. H. Ellis said...

With more people than ever getting diagnosed with these illnesses and that including celebrities whose every moves are documented by paparazzi, depression and other mental illnesses can't help but become normalized in society. Another step, though, is for individuals to accept and create a new normal for themselves.

Critically Observant Jew said...

What I meant to say was to comment on "People who are in a relationship can, and often do, ask a partner to hold them" - how can a person in a relationship ask another one to hold him if he is the porcupine in question?

Unknown said...

If you mean what internal steps you have to take to ask for a hug from someone you've hurt - you need to get to a point where you feel okay with being just a little vulnerable to your partner. (I'm assuming there are no massive burnt bridges etc.)

If you mean what do you say specifically then -
1. Apologize: "I'm sorry for what I said/did"
2. Acknowledge the prickly-ness: "I know that [what I said - be specific here] was hurtful"
3. Acknowledge/validate your partner's response: "You have every right to be hurt/angry/not want to talk to me"
4. Apologize again: "and I'm really sorry"
5. Explain yourself: "I don't want to abdicate responsibility for what I said, but I said it because I felt awful"
6. Then ask for some cuddles: "and I would really like a hug from you to help with the awfulness"

I hope that helps some :) The hug will be worth it.

(hey, therapydoc! I'm a lurker - awesome blog!)

kg said...

My young adult aspie gifted son has chonsen to study economic behaviour theory (who knew such a thing existed?!)---so while he doesn't get people, he can study their economic behaviours and make inferences....what a nitch! Of course, he would like it if people would follow a pattern or rules!

therapydoc said...

GREAT comments, thanks Unknown and Dr. G.H. and kg.

And Critical, it probably bears repeating, what Jonathan Sacks (chief rabbi of the UK) (quoting Schopenhauer) said about the porcupine:

What do porcupines do in winter? asked Schopenhauer. If they come too close to one another, they injure each other. If they stay too far apart, they freeze. Life, for porcupines is a delicate balance between closeness and distance. It is hard to get it right and dangerous to get it wrong. And so it is for us.

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