Mental Health

MENTAL HEALTH

1. For some time, I have been feeling: I may have had issues with depression all my life

A problem with reaction to loss and criticism. Sources. “Loving Mother” d. 1999, tyrannical father – also loving in a way but infrequently demonstrated, boarding school, mother in England, racial difference between myself and my peers in India [and here] and some consequent isolation.

[Growing up] in my family affection was expressed physically. This was India. In middle class India, then, especially compared to America now, sex is not open and that includes displays of romantic affection. But other kinds of love and closeness are expressed more openly than in the US. Of course reality is more complex than any generalization but I am simplifying to make a point. In some parts of India men can walk hand in hand in public without drawing attention and without it being thought that there is necessarily anything more than friendship. Families are more private in India, have their own variations on tradition that live and die with the family. In my family it was ok to cuddle and massage. My dad, mom, brother, and I – anyone could cuddle anyone. But, mostly my brother was close to my dad and me to my mom. I loved my brother. We fought a lot. I apologized to him some years ago – I was the older brother and I bullied him. I did not see it as bullying. My dad set a tone of anger and either ignored the interaction between my brother and me or came down hard on me. Physical punishment, yelling, humiliation [all by my dad] were part of general discipline – I think of it as constant harassment. I got the brunt of it. Yes older siblings tend to face that but my dad said and my brother believes that I could [and did] stand up to my dad more and that I could handle it better. My brother, apparently, could not handle it and responded better to a “kinder” approach. Could I handle it better – in terms of my inner life? But on the surface I know that even when I’m feeling intimidated other people do not know it. Back to physical affection. I would also cuddle my brother. I do not recall my feeling, or there being, anything sexual about any of the family way of expressing affection. One day when my brother was 17 and I was 22 he said “I do not want to cuddle anymore.” I said “fine”; we never did that again. He has said that he has homosexual tendencies but I do not think he has been in homosexual relationships. He is married to a British woman, live in London. Many years later I would hug my brother when we met – he would tolerate it. I like to hug people that I like but I am doing less of it than I used to. I do not initiate hugs with people that I do not feel affection for. But I will hug some who initiates a hug – even people that I dislike; and, then, I can feel affection during the hug itself: it is a warm thing and I enjoy warmth toward others even [sometimes] when I do not like them. It makes me feel good and feel good about myself. It seems to me, sometimes, that my American acquaintances express affection without feeling it. Part of that is the cultural difference in the affect-emotion equation. Still, I sense expression without feeling and this gives me a sense of loss. Sometimes, especially when there are no women around as in high school in India or “experimentally”, I have found myself fantasizing about romantic love with males – with occasional action. But, most of the time its women that I want and want to be with in an intimate relationship. When I think of being in a relationship with a man – that is not at all appealing but why? My gut reaction is this: firstly I just plain find most male bodies “yucky” if I think of those bodies in a sexual way; and, secondly, even apart from explicit sex, there is a loveliness factor in being and sharing with a woman. Why am I rambling? [In the first version there was more about sex that was rambling.] I am not having an identity crisis – I’m a writer and writing comes easy. But there is purpose here. First, I want to put stuff down on paper. Secondly, I am having a relationship crisis [the crisis is internal, the relationship itself is and has been declared to be “over”] – and so anything may be a clue. I’m wondering what my life is going to be like and what I want to do. Begin with a [mental] systems inventory.

[But some challenges are energizing]

Other reasons I may have been depressed or have had a depressive tendency for a long time.

% enjoyment of my life? Intimacy?

Some inner strength and perseverance – occasionally/often overdone… but why do I need to persevere? Its not all perseverance; I have had lots of enjoyment.

Why am I where I am? Relationship; career/work

True, I see this as positive in some ways – not all rationalizing, but the question is still valid. In some ways I have had life-long problems with work and love and I see this as related to the depression issue. But, probably, the “depression complex” and the “abandonment complex” interact. Begin somewhere.

“Abandonment” is sheer terror. I am better, now, here – but still not good and there is a corresponding loss in openness and enjoyment. And I do not feel clear headed enough or hopeful enough to want to “fix” things. Some of the “terror” is situational but it begins, now, with “me”. Probably has some origin in development and some in my “natural constitution”.

Factors in my being “better” with abandonment: experience, exposure, cultivation [allowing myself to feel pain, exploring it, I need more of this], slowing down of endocrine factors – adrenaline, testosterone, thyroid. My 86 year old father is on thyroid replacement but the deficiency may be due to chemotherapy.

… tendency to feel put down, abused; and some tendency to allow abuse. I sometimes act as though others know what I’m feeling – and this impacts my feeling and behavior adversely.

Socially – I am a mixture of reserved and outgoing. Scored midway between extravert and introvert on a Jungian scale [perception – judging, sensing – intuitive, thinking – feeling, extravert – introvert]. In some ways I’m more outgoing with Americans – I don’t think they know what I’m feeling as much as I think Indians know… but there’s a problem. It’s that affective expression of given feeling is culturally determined and Americans are, typically, more demonstrative and more public. The result is that someone from India would know when I’m feeling a certain way or feel my warmth but an American does not and requires an overt demonstration … and, without that, feels I’m aloof or unfeeling. Seems like I’m contradicting things said above but I don’t think so, as I said reality is complex. I guess the following is true: out here in California some people think I’m aloof; this was not so when I lived in Texas and the East. It’s heightened by my natural reserve [50:50] and by the fact that public demonstration of feeling is not as much the norm in India. Its more complicated than just, its also that what kinds of feeling and what constitutes ok feelings and ways of expressing feeling are, to a degree, culturally determined. A few of my Indian friends, the extraverted ones, have cultivated the new culture, others hang out mainly with other Indians and I’m somewhat in between. The result, combined with my own “stuff”, is that my life [work, love] is affected.

I drink, sometimes, as social lubricant and sometimes thrill seeking. The effect is less now. I have learned that drinking during times of loss robs me of emotional strength to cope, of “ego integrity.” I do not and do not need to drink everyday. I enjoy having a clear head and its easy for me to not drink. I use coffee as an “upper” – two cups in the morning, occasionally more at other times.

I do not dislike all authority. But I have an issue with what I think of as pompous, rigid, rule oriented, undemocratic, borderline competent authority. This itself has not gotten in the way of doing well in and keeping and performing in jobs. There is a certain independence which blurs into the authority issue but that is also appreciated as a positive contribution to the environment and in performance and initiative. I tend to be a little late with everything even commitments to myself. In my own life I hate deadlines. I remember vacations when I’d get into something really interesting and then have to give it up when school began. I wanted a time when I would not have to live with deadlines. That is how I live my life outside of work. I wonder what will happen as I approach 60, 70 and the inevitable decline. I am not looking forward to the final deadline. Death and fear of death are not an overt preoccupation. I’m unrealistic with my time organization/perception. When I am this way with others, is it passive-aggressive? And if so, is that always inappropriate?

The sum total of psychiatric medications I have taken is < 5mg valium in 1976. The prescription was for .5mg, I cannot remember the schedule, for my complaint of “tightness” in the head. That tightness is still with me but is, mostly not a problem. When I am not coping well it seems like it is part of the poor coping.

I sometimes think I am the tiger that has not yet roared.

2. Now

In 1992 I faced life with great confidence, felt I could handle anything. Not so now.

Diminishing enjoyment of a variety of things since 1996. Things that were beautiful have lost their luster. Hiking and backpacking are still energizing. My “energizing” but not as much. Some of that is its being “old” and, perhaps, some because of lack of recognition. I come from a number of environments in which recognition is important. It is not unimportant to me but not as driving as might be expected. The process itself and the place that it takes me are more important. It started, ostensibly, as academic even though spiritually driven. The spiritual component is more evident and explicit, now. But truth is essential. My “project” is a problem for some relationships.

This is the first of two somewhat rambling paragraphs on my love life. Only one real love relationship since 1996. The best ever in many ways. It seems to be over – she says it is. Its not unilateral. Beyond a point I did not give. That is not the same as withheld; there are three problems – not being able to give what she wanted; her rejection of what I could and tried to give; being on different wavelengths. I know I cannot completely bring unconscious depths to light but, definitely, a large part of what I did not give [passion fizzled, she thinks its me and has taken it personally, I’m sure it wasn’t all me or all passion fizzling] was the pressures of my own internal commitments that I stated up front – which makes me feel somewhat relieved but not justified. I know its not that simple. When the relationship went well I thought I could handle the pressures. And I recognize that there are implied commitments when one says “I love you.” That was not said lightly. I had loved her [it was reciprocated] for a long time. Then she was ill and everyone was thankful when she was well. We [common friends and I] missed her when she was in the hospital. I called her – she was drugged up with pain meds. She asked a male friend to ask me to come and see her – turns out the friend had a romantic interest in her and did not tell me. But then she was well again and we spent time together at work. The relationship has never felt like a soap opera. Everyone loves her, likes me. So, we went into this [that] thing with trepidation [“What have I gotten myself into now”, I asked after we agreed to go home to my house.] but also with joy and hope. But, now, its over. I am largely ok with the “love” part of the relationship being over. But she’s still in there in my vision of the future and what the world is and it sometimes hurts in the mornings and other times of the day – I have a partial handle on the anxiety but I think fear of more anxiety is stopping me from doing what I need to do. I will feel a lot better when I know that she will be ok. If I knew she would be ok I’d have only my own issues and I could handle that well – and am doing so. We still say we love each other and I believe that it is true. It is not 100% over since we have neither completely shut and locked the door but its close – at least for now. I need to be careful and constructive about what it would take. Openness, the closeness-space issue, mutual concern – we each care for the other but the caring could mesh better, external guidance… I need to do a little more pinpointing so that I can have a little more clarity; some thoughts in the next paragraph.

What to do? Accept and experience sadness, pain – it will hurt. Cultivate my life. Establish something for the future: friendship. Possibilities and limits. Antidepressants give you strength – to leave or heal. Consider. What will it take for me? Freedom to work and journey. 1/x time together and good; not all the time together and 1/x good; live apart? For S [S: She]: you are wow sensitive to other people – this is one of your qualities and strengths; but its not always accurate – it’s a way you are at times and especially when there is a potential for loss; and the inaccurate side is the tendency to assume the worst and be convinced that you absolutely know what you “assume” – your strength is your weakness; one way out would be low doses of anti-psychotics to supplement the anti-depressants; isn’t this a classical treatment for “abandonment trauma”; the flip-side to management of paranoia might be the loss of sensitivity; also, the paranoia is only a problem in close relationships – perhaps only in this close relationship; and my analysis may be inaccurate. A new thought while running, 5/30/01, that, of course, S [for she] likes sex but also has some issues with it: push, pull; I will not analyze because I cannot – at least not without ongoing 1:1. For S [for She], I think but do not know, sex in itself is push-pull, and this is complicated by the fact that sex is affirmation of some aspects of worth. I hesitate to analyze because I could be wrong, because it could hurt. I remind myself that I do it for positive reasons. No doubt I have said enough above that anyone could deduce that I likely have issues. But this is not meant to be a tit-for-tat thing. Anyway, combined with the paranoia thing perhaps what would be good for S when she is with someone whose libido could overcome the gradient [hump] and cross over into ecstasy… My ailing libido did not – I did not give up – but I do know that it has been plenty strong to overcome conflict – to not even have a problem with conflict except when the conflict is over sex. That probably means that my self-worth or something is linked with sex. Lets just say that we came together, we tried. If its better to love and lose… then losing with S is better than winning with many a ~S. My strength is my weakness; my emotional strength is my strength when it sustains me and my emotional strength is my weakness when it makes me distant – even though that distance is not intended as such but as self-protection and that not at an explicit level. I think, generally, that my depression issue would, if resolved, give me a better outlook on life and better handling of normal problems.

The relationship is/was an acute issue, but the depression complex is not new. I have been thinking of seeing someone for a number of years. The steady decline in enjoyment and coping since 1996 is key but its insidious and I have to remember and compare to be aware of it.

Less energy. Less exercise.

Mild alteration in sleep… usually wake up 1 – 3 times, less refreshing. I wonder if this is related to some generalized low level issues. The recent week: more anxiety due to the end of the relationship and more early morning sleep disturbance especially.

No problem eating except sometimes “excess” but I think it would have to be more and more often to be binge eating. The excess eating is due to “boredom”. I have learned to moderate it since it causes me to put on weight. In my family, eating a lot was something to be proud of. My father, mother, brother were/are overweight. My weight problem is not as severe. It is partly due to self-image, partly due to health concerns. I enjoy the use of my body. I like feeling healthy. I do not like being sedentary all the time.

Less in the area of sex. Virility, pleasure, passion, maintaining erections. I enjoy good sex, but sex has gone downhill in 50% of my relationships. It tends to do that when sex itself is a focus of conflict. Much as I want to I have never yet overcome the “downhill thing”. Do I have a tendency to be attracted to certain kinds of women… and certain kinds of women to me. Sex has remained good in relationships where it was good to begin with and there were conflicts about other issues. I think, now, I can enjoy and be in a relationship in which the sex is not great provided there are other things. Touching, caring, cuddling, videos, cooking together, … , ideas and nature. I like what someone said about love, “Its important to gaze out onto the world together” … in addition to gazing into each others eyes.

My coping is currently poor. It is poor in what I want/need to do for my life, my ambition, work, my “project” http://www.horizons-2000.org, how am I going to face relationships. No I am not having a mid-life crisis. While the coping has been poor for a while it has been especially bad this last week. Poor coping does not mean indulging in self-destructive acts and so on but difficulty focusing on what I need to and want to do. Some of that is due to the need to wrap up the relationship, accept the end but some is due to loss of emotional reserve which I think/hope is temporary. I see signs of it getting better.

Some floundering in my life. I might be floundering even more than I think I am.

Summary. I think there has been an insidious process going on since 1996. It is complicated and exacerbated due to dealing with recent loss. But I have been thinking of seeking help for at least a year and aware that I have been “depressed” for longer. When I set up this appointment I was not feeling acutely over the loss.