I’ve debated about what I planned to write for this post for weeks. And the irony? It’s been a bit of a rough summer and some of the things I want to talk about are the very things that have made it difficult to do so.
As my website says, I am a doctor by day and a novelist by night. My evening vocation is what qualifies me to be part of this collection of 100 writers who are reaching out to people who are going through tough times and showing them they are not alone, but as I write this, I will attempt to wear both my hats at once, as I’ve taken care of people having trouble and have been one of those people at different times in my life.
Many of the posts have been about major depression, anxiety, suicide, PTSD. I want to talk about grief and adjustment disorder. Both conditions mimic a lot of the signs and symptoms of major depression and, in fact, adjustment disorder is also known as exogenous, reactive, or situational depression. Both grief and adjustment disorder represent symptoms in relation to a particular stressor. In grief it’s often the loss of a family member or loved one, but we can also grieve relationships, jobs, and financial setbacks. Both of these are considered temporary and definitely related to the preceding stressor.
In my time, I’ve experienced both.
Just like with depression, people who are grieving or going through an adjustment reaction can experience very real, very debilitating symptoms: overwhelming sadness, loss of hope, anhedonia (loss of enjoyment of normal activities), crying spells, nervousness, anxiety, worry, desperation, difficulty initiating or maintaining sleep, poor concentration, reckless driving, putting off important tasks like bills or chores, avoiding family or friends, poor performance at school or work, and even suicidal ideation and beyond.
The diagnosis of major depressive disorder requires that these symptoms be present for several months without relenting. Does that mean the person who is grieving or the person experiencing adjustment reaction/disorder aren’t going through something very real or serious? Absolutely not.
As I wrote my first draft of this post, it was 1 a.m. on a Friday night, a night where I didn’t get to sleep till a little after 4:30 a.m. Sure, I’d had a bit too much caffeine in a 24-hour period, but that wasn’t the only issue. My brain just wouldn’t shut off. My thoughts that evening revolved around a pretty specific situation, but that doesn’t change the fact that despite being dead tired, my body just wouldn’t go to sleep. If that had been a one-night issue, it wouldn’t have been a big deal, but in a summer filled with heartbreak, identity theft X 3 (all resolved, thank God), and three surgical procedures in a row to get a particularly large kidney stone out of my left ureter (along with being put under anesthesia three times in a row for said procedures), there have been a lot of sleepless nights. Not to mention a ten pound weight loss, mostly because I haven’t felt much like eating. Also, a lot of anxiety, some focused and some not as much. Bouts of sadness, and yes, crying. Times where it seemed all hope was gone. I even got a bit behind on bills, mowing, cleaning the house, etc. which for anyone who knows me well would agree is a pretty big deal. My job as a family physician suffered, as patients require your energy, your positivity, even your love, but if you are using those things to heal yourself from a psychic wound, it’s difficult to spare any juice for anyone else. To be clear, through all of this, I never considered suicide, but I did develop a better understanding of people who just want to make the pain go away.
And while we’re talking about pain… I’ve had patients with depression, anxiety, etc. tell me about chest pain, headaches, stiff muscles, etc. For me, it’s a cold ache that starts in my shoulders and radiates down my deltoids and biceps and into my forearms. It’s a feeling of dread, of doom, and when anxiety or depressive whatever keeps me up at night, this is the tool it uses.
One of the biggest hits this summer was my writing. Over June and the first week of July, I wrote 26,000 words, an all time high for me. Basically one fourth of a book in just under 6 weeks. I was cooking with gas and was so proud.
The rest of July, August, and September? None. Nada. Zip. This thing that had brought me such joy for so many years had become another chore. Another thing I had to do. Another task I had to complete. And I just avoided it, like a lot of other things in my life, not because I wanted to, but because I simply didn’t have the energy to put into it.
And that sucked.
In the last few weeks, I’ve been doing a lot better. Sleeping through the night, eating well, feeling hopeful and even happy again, enjoying work, and basically getting back to being myself. Even wrote about 2,500 words in the last week. It’s been nice to feel good again. And I knew I would. This wasn’t my first bout with feeling low.
Med school knocked the wind out of my sails off and on for the better part of two years, but I got better. Being stuck in Iraq for 11 months left its mark on me, but I feel like I’ve recovered from that as well. And this summer’s heartbreak was not my first. I’m coming out of the tunnel, and it’s good to see the sun again.
And there it is. The tunnel analogy. So many times, when my patients have been going through a tough time or a dark period in their life, I’ve told them that they are simply going through a tunnel. Tunnels may be dark while you’re in them, but there was light before you went into the tunnel and there will be light when you are out again. All one has to do while in the tunnel is hang on and know that whatever is happening to you, be it internal, external, or both, the pain is temporary and will pass.
Funny. In a way, I’ve been telling people to hold onto the light for years, and didn’t even realize it until I wrote this paragraph tonight.
And now we get to the important part. First, and MOST IMPORTANT, the tunnel thing is NOT Darin telling you that when things get bad, just pick yourself up and brush yourself off. If you are going through anything like what I’m describing, and I don’t care if you call it depression, adjustment, grieving, the blues, a bad day, or whatever, get help. If you are hurting, tell someone. Tell a family member. Tell a friend. Tell your doctor. Talk to a counselor or a clergy person or anyone who will listen. Get the help you need.
I will leave you with three thoughts.
First, tunnels have beginnings, middles, and ends. Keep driving. Second, even if you are not okay at the moment, you will be. And third, you are not alone. If you need help, get help. If you need to talk, talk. If the person won’t listen, keep talking till you find someone who will.