When burnout obscures major depression: a #LISMentalHealth week post

 

After finding a good psychiatrist and starting a new antidepressant, I tracked my symptoms for several days thereafter.
After finding a good psychiatrist and starting a new antidepressant, I tracked my symptoms for several days thereafter.

I am very grateful to Cecily and Kelly for organizing LIS Mental Health Week, and the blog post that follows is my contribution to these conversations.

I have written elsewhere recently about how I have a double-depression diagnosis–that I have recurrent major depression on top of dysthymia. (The etymology-nerd in me is amused by the fact that “dysthymia” is Greek for “bad state of mind.” TELL ME ABOUT IT.) I’ve often wondered if the fact that I am prone to depression also makes me more prone to experiencing burnout. As I’ve been reflecting on these two conditions and how they overlap (and they do overlap, according to my quick scan of PSYCArticles), I had an important realization: I think that my professional burnout masked a recent episode of depression until the depression had significantly progressed to something more severe and more terrible.

In February of 2014, I began to experience a new episode of major depression, but it felt different. It felt so utterly unlike my previous recurrent episodes that I did not recognize it as depression. I just thought I was burned out. I had been promoted and awarded tenure the year before, and my book had come out the year before, and I was looking forward to a Fall 2014 semester sabbatical. The fact that I was suddenly completely unable to concentrate at work seemed like just another burnout symptom. I would go to my office, close the door, and literally stare off into space for hours. I would look at the clock and say, okay, it’s 11:30 am. I can space out for 20 minutes and then I really have to buckle down and get to work. And so I’d space out, and the next thing I knew, a whole hour would go by.

To be candid, I found this state of mind terrifying. I’ve been depressed a lot in my life with the low energy and lack of motivation that goes along with it, but I’d never before felt this complete disengagement with reality, this compulsion to stare at a wall for hours and do nothing. Since this severe concentration problem was utterly unlike anything I’d ever experienced, I attributed it to boredom and burnout. I did not recognize it as depression.

This severe lack of concentration started to improve a little bit, but then it would worsen again, over the next few months–there were lots of ups and downs. When I was up, I was very productive and engaged. I wrote a ton of blog posts on my getting-ready-for-sabbatical blog. But then when I was down, I was down. I felt really scared about these symptoms and it finally started to occur to me: maybe this is more than burnout. Maybe this is depression. Maybe you should do something about before it gets out of hand.

At my med check visit early that year, my psychiatrist said that she was leaving her practice to work for the VA, so it wasn’t like I could just follow her to her next practice. She mentioned some names of other people in her soon-to-be-former practice that I could see, and then gave me a bunch of refills, maybe enough for six months.  At the time of that visit in January, I felt fine, and thought I’d worry about finding a new psychiatrist later.

This was a mistake.

By the time I recognized it was time to see a psychiatrist to assess my medication situation, there were no new patient appointments available in that practice for several weeks out. I called other psychiatric practices in the city, and either no one was taking new patients, and if they were accepting new patients, the first available appointment for a new patient was maybe two months away. This was not helpful, not at all. It’s hard to explain the desperation I felt, how lost, how hopeless on top of hopeless, how completely unworthy of help.

It was also at around this time that I made a very poor choice: I started messing with my medication myself. One particular drug was super expensive, even with my insurance paying 80 percent, and so I stopped taking it as regularly. I would skip doses, or go long stretches without, and then I would start taking it again. I cannot emphasize what a terrible idea this was, but in my defense, I was not really in my right mind.

Things reached a crisis in early June 2014. I wasn’t actively suicidal; it was more passive than that. I wasn’t making plans to kill myself, but I was imagining how death might happen to me without my intervention, if that makes any sense. On my regular evening walks with my wife, I had to constantly fight the urge to not dart out into the busy street. I became very afraid of knives, because I didn’t feel safe around them. I had disturbing, intrusive mental images involving knives. I finally confessed to my wife what was going on, because another poor choice I made during this time was to conceal all of this from her because I didn’t want to worry her. She made me call my therapist, who referred me to a psychiatric urgent care clinic because I did not want to be hospitalized. I went to this place and they gave me a new medicine to try. But it was too late. I didn’t have time to wait for a new medicine to work. Three days later I saw my therapist, and she told me to go the hospital to get evaluated.

Someday, when I have more intestinal fortitude, I might write about the hospitalization experience, but I can’t right now. It’s too traumatic. Suffice it to say that it was a nightmarish, dehumanizing 48 hours, and I couldn’t get out fast enough, once I fully understood what a terrible mistake it was to go there. The hospital was called Our Lady of Peace*, but never has anything been more inaptly named. It was more like Our Lady of the Disturbance of the Peace.  Or if we’re sticking with real names the Virgin Mary is known by, Our Lady of Sorrows would be more appropriate.

I’ve not yet mentioned what was going on with my work situation during this time, primarily because I wasn’t really doing a whole lot of work. I was going to work, but it was mostly going through motions. It was more important to me to hide my distress and give the impression of competence than it was to acknowledge that I needed help, and that staring off into space for hours in my office with the door closed was maybe not the best use of my time. I dropped the ball on lots of things in ways I would never, ever do ordinarily, which was mortifying and exceedingly distressing.

When I had to go to this urgent care place, I finally confessed to my library director that I was having a bad time and needed some time off to get my medication–and mind–straightened out. I really, really did not want to tell him any of this, because, again, I cannot bear for anyone to think I’m not competent, not smart, not capable of handling my business. I need not have worried, however, because he was supportive and completely non-judgmental. “It’s just like if you had a broken leg,” he said. And then when I updated him to say that I was being hospitalized, he was deeply concerned for me and my health. Deep down I knew that he would respond in this way, that he would be kind and concerned and compassionate, because that’s the kind of person he is, but when you’re in the kind of mindset where all you can think about how worthless you are, where you are continually assailed by troubling, intrusive thoughts of self-harm, where you feel like you are drowning in waves of despair and hopelessness, it’s really hard to have a grip on reality. During this time, a co-worker was dealing with what turned out to be terminal cancer, and I told my director that I felt like a malingerer when my colleague J. had a real illness. He shut that line of thinking down very quickly, but compassionately.

During all of my conversations with him about needing to be away, needing time off to get my head together, I asked him to please not disclose the nature of my illness or hospitalization. He respected my wishes and kept this information private, but when I was discharged from the hospital, I was so grateful to be free that I did not give a fuck who know where I was and why. Fuck stigma. The stigma around mental illness is terrible, and it only makes me feel worse about myself, and I don’t want to participate in the perpetuation of stigma.

This Fuck Stigma perspective is a form of bravery that is not always easy to summon up. Sometimes it’s more empty bravado than anything–if I say this enough, maybe I’ll feel it through and through and it will feel real and genuine. Right now, right at this very minute as I write this, I confess to having niggling doubts about publishing this, about any professional ramifications it might have, but then, as I think about it, I get angry. If anyone thinks any less of me because I am speaking openly about my experience with depression then FUCK THEM.

FUCK STIGMA.

And also, while I’m issuing commands: please pay careful attention to your moods and emotional state if you are dealing with professional burnout. I really honestly think that I could have at least tried to arrest my terrible depression episode of 2014 if I hadn’t confused my symptoms with burnout. There was a clusterfuck of other stuff going on there at the same time–the difficulty in finding a psychiatrist, for example–but if I had paid closer attention to how I was feeling in February, I can’t help but think that things would have turned out differently.

So, this is my story, or at least one chapter of my story. My struggles to deal with mental health is one of the primary narrative threads of how I understand my life. It is helpful to remember that while in the depths of depression, the soul-crushing loneliness I feel is just another depression lie–I am not alone. I know you are out there, because you’ve told me that you know this story, too. I hate that I know it, and I hate that you know it, too, but when we tell the story together, we’re shutting down one of the many lies of that very unreliable narrator: depression. I hate liars, don’t you?

*If anyone finds this post while googling for information about Our Lady of Peace psychiatric hospital in Louisville, Kentucky, DO NOT GO. Do anything in your power to stay safe and seriously: DO NOT GO. PLEASE.