I just want to remind everybody that I am not a psychologist, psychiatrist, therapist, or any kind of professional with an –ist at the end of their title. I am just a guy who has been there.
How do you approach mental health treatment? I, well, approach it wrong. Even right now, I am just applying two sides of the triangle.
The mental health triangle is based upon a conversation I had with a friend at a business conference. Lance and I were discussing business models. He was telling me about a book he had read a long time ago, sometime in the 80’s, about a production triangle. If you google “Production Triangle,” you’ll find hundreds. We can’t find this particular one.
Lance is a very successful businessman. He found that this model can be applied to any business. Each side has to be equal or else the triangle collapses. For a visual, think of taking away one side of a triangle. It collapses in on itself, flatlines. The business doesn’t go under necessarily, but it is operating in an unhealthy manor. It can’t reach its full potential and struggles more than grows. The sides of the triangle need to be equal, with equal attention given to them.
The sides of the production triangle are products or goods, marketing, and finance. I won’t get into that but I will remind everybody that there is a reward to anybody that might recall the book from a business class they may have taken in the late 80’s? Anyway…
Our conversation turned to other things, but the triangle stayed in my head. Lance had mentioned he could apply it to almost anything, and does. He even applies it to sex when teaching about love and intimacy in his church classes.
I went back to my hotel room that night and continued thinking about the triangle. I was already in the midst of my depressive episode and the production triangle began to merge with it. It gave me a lot to think about.
I had thought I had gotten past the depression. I was taking my meds regularly and things seemed to be going well. I was living a fantastic life. I had a good job, a beautiful home, a wonderful wife. Then, I hit a wall. I was still in the early stages of the episode and wondering what the hell had happened. What triggered it?
Professional burnout was definitely a part of it–or maybe professional burnout was a symptom of it?
Then, while lying in bed in a hotel room in Chicago, the mental health triangle began to form.
On one side of the triangle is meds, or psychiatry. It had taken me a few years to find the right one, but the Zoloft had been helping a lot.
Wait. Halt. Pause.
I really need to repeat myself here. I am not a doctor or specialist, so all of the following is conjecture and based upon personal experience.
Back to the Zoloft.
I had been through a few different meds and only later realized that you need patience. There is no such thing as a magic pill. I think I read that each med has only a 40% chance of working well and you need to give it a couple months to see if it will work.
I swore by my Zoloft though. I had been on it for a long time, and it helped. Until it wasn’t helping so much anymore. –I would later discuss it with my psychiatrist and she felt that I had been on it for so long that my body had become resistant. She switched me to a fairly new drug on the market, Viibryd.
There was still something very wrong though. Another side of the triangle came into focus: psychology, or therapy. Talk therapy. For me, that side of the triangle was weak at best.
Though I knew I needed it and had known I needed it for decades to work through past issues and current ones, I had only toyed with therapy. A couple sessions here and a couple sessions there.
I grew up during what I consider the dark ages of mental health care. Due to cutbacks and insurance issues, talk therapy had been regulated to pure crisis intervention–unless you had the cash to pay for it.
But that was one of my problems. I had the cash. I was doing well. I knew I should be in therapy. As a student of systems theory, one of my soap box issues (so I won’t get started into it for now), I knew that just taking meds was not the entire solution. It was a part of it, but?
That has always been one of my problems. I take the path of least resistance. The easiest path. I had been doing well, the pills were helping, I was feeling good, so why spend the extra time and money for therapy?
Therapy, for me, is like meds. You need to experiment to find the right one. It takes time and patience. You need to have a healthy, therapeutic relationship with your therapist and connect in the right way. The only times I had even attempted that particular journey was when I was in crisis mode and forced to react to a situation instead of acting on my own behalf.
Then, it hit me. The third leg of the triangle. The flatline. My business was doing well but according to Lance–though he never said it out loud–it was flatlining.
The third leg of the Mental Health Triangle is personal care. I had completely ignored it all my life. I tell people that I did worse than burn the candle at both ends. I took a flamethrower to the entire candle. I burned myself out, poured out all of myself, without doing anything to replenish myself.
Oh, I lied to myself. I’m pretty good at that. I told myself the vacations, the meets with friends, and my cat were enough. It wasn’t. I had developed unhealthy coping mechanisms at a young age.
I knew the answers, but I never pursued them.
A part of me, the petulant child, wants to scream and throw a tantrum. “It’s not fair! I shouldn’t have to do this crap. Other people don’t and they are perfectly fine!” (they are not, but that is another story).
But isn’t that the lesson we all learn at a very young age? Life isn’t fair. Ignoring the unfairness, ignoring the things we should be doing, doesn’t help.
My mental health triangle came into focus and I fell asleep. It gave me a lot to think about over the coming months as the depression got worse and my life fell apart.
Crisis intervention versus personal care.
Acting versus reacting.
The deeper I got into the depressive episode, the worse the depression got, the harder it was to do anything. I think about all of the things I should be doing, all of the things I know will help, but that, for me, is the nature of depression.
This is where friends and loved ones really pissed me off. I would get all of the normal advice. It was all of the normal, simple things. The things I knew. They can all be summed up in the sentence, “stop being depressed.”
I can’t!
It might seem simple from the outside looking in, but from the inside looking out, it is a much different perspective. It is like trying to function with layers of blankets wrapped around me. The deeper into the depression I get, the more layers that get added.
I remember one incident when I was in tears because I couldn’t put on my socks. I have been in situations before when I couldn’t put on socks and needed help, but they were because I had thrown out my back or had surgery. This wasn’t that. Physically, I felt perfectly fine.
I could get reach for the sock. After struggling, I could get it on a few toes, but I couldn’t get the one sock on my foot. I gave up and went barefoot that day. Which made me feel like an even bigger piece of shit.
How did I get there? How did a very accomplished man get to the point where he couldn’t put on his sock? It goes back to the triangle. And where I screwed up. So let’s go back and take a look at the triangle from a personal perspective.
Psychiatry. Meds.
I didn’t like them. I hear that repeated a lot. The first med I was put on was when I was in college. Prozac, I think. They got tossed all over my apartment one night. I didn’t like the way they made me feel. –that’s something else I hear a lot.
I still don’t like them. Without insurance these days, my choices are limited. Very limited. I don’t have access to the new drugs that are coming to market so I am sticking with a tried and true one: Lexapro. With the med comes the tried and true side effects. I really don’t like those.
TMI? Too much information? Is there such a thing in this podcast? One of the reasons why my doctor switched me to Viibryd was she felt I had become resistant to the Zoloft. The other reason was it was known to have less of a particular side effect. Sexual dysfunction.
Nope, it doesn’t work. I am unmanned. I’m becalmed on the sea of manhood, without even a breeze to stir my sail. The desire has even gone away as well for the most part. I tell myself this is a good thing as my penis has gotten me into almost as much trouble as my mouth.
But I am lying to myself.
Not that I get many opportunities, but it would be nice to have dirty thoughts once in a while. I remember the feelings of sexual attraction, I remember the sexual fantasies, I remember the feeling of waking up with…well, you know. But they are all just memories, distant ones. And getting more distant.
At first, I thought it was just a natural part of me getting older. Then, I was talking about it with a nurse, my aunt.
“No,” she said.
I think I was 48 at the time? She said maybe, maybe, after a couple more decades, but now it definitely was not natural. So, I went to a specialist and went through all of the tests. Some were very uncomfortable. From testing my testosterone levels to some poking and prodding withy needles in very sensitive areas. There was nothing physically wrong with me. It was all in my head, and in my meds.
I know a lot of people struggle with the side effects. I’ve reached a point in my life where I am like, “what else can I do? What’s the alternative?”
At one point in early 2021, with the depression hitting me harder, I thought the meds–the Viibryd at the time–wasn’t working anymore. So, I said the hell with it. I did do it the smart way: I weaned myself off the Viibryd and the anxiety med I was taking, taking smaller doses until I was off them completely. I was in such a bad depression, in such a funk, I really didn’t they were working anyway.
That turned into a complete and utter disaster.
It took a few weeks, but I realized that the meds had been working. They had been helping. I went from being depressed into falling into an abyss that took me months to get out of.
But what can you do, I do, about dealing better with that first side of the pyramid?
Well, first, don’t be stupid like me and stop taking your meds.
You really need to talk to a psychiatrist and have some patience. Remember what I said about the meds: each one has a 40% chance of being effective and takes time to see if it will be effective. Now, there is even a genetic test that they can see what type of drug should be most effective.
Also, there are new drugs coming to market, the first in decades. Viibryd is fairly new. If you have not spoken with a doctor about meds in a while, it might be time to stop in and have a discussion.
Finally, there are also new therapies getting a lot of exposure. If you are like me, and Google is keeping track of your every move, you are seeing a lot of ads on Instagram and Facebook about new kinds of therapy. Psychedelics, ketamine, and magnetic resonance therapy (MRT) are a few. I am working on an article now about these new treatments that I have heard offer good outcomes, especially for those who have become resistant to traditional meds.
The second side of the pyramid, psychology or talk therapy, is an entire other article.
There is now unprecedented access with the new technology being integrated. A great example is Better Help, at http://www.betterhelp.com. It offers consumers a way to find a therapist and connect with them for online or phone sessions. The website matches you with a therapist based upon criteria you input.
I am excited about things like this. In my opinion, therapy devolved into a “triage” type mindset. If a person is in crisis, you would get help to get you get past the crisis.
It can be much more than just a crisis though. With me, it has been a lifelong struggle. It is not whether or not I would have another crisis, it was when I would have another crisis.
Talk therapy can, and should be, getting to the roots of the problems. I don’t think anything magically disappears. Trauma, depression, PTSD, Anxiety Disorder and everything else has roots somewhere. Now maybe I will have depression for the rest of my life, along with the PTSD and Anxiety Disorder, but that doesn’t mean I can’t do anything about it. There are healthier coping mechanisms to learn and even sometimes learning the causes of what is happening to us can lead to better paths to recovery.
It was like one time I was tested for ADHD. I was excited! I had taken the online tests, matched up perfectly, answered everything to have the ADHD diagnosis, and then went to a specialist for their diagnosis. Finally! I would get the directed help I needed to at least work on one aspect of what was wrong with me.
While waiting for the diagnosis, it was like a cross between the Maury Povich Show, waiting for the DNA test results, and the NFL draft, waiting to put on that coveted professional jersey.
Then, Maury made the big reveal. “I am sorry, but you do not have ADHD.”
Wait. What? I was crushed. I answered all of the questions! I had taken the online test and it said I had ADHD. I wanted to have ADHD! It was an answer. A path.
There was no ADHD professional jersey for me. I was not part of the team.
The doctor offered to put me on a medication just to see if it would have any effect but explained that it wouldn’t. I didn’t bother. I just went back to searching for answers.
About a month or two later, I was talking to a friend of mine, a psychiatrist that specializes in PTSD. I mentioned the test and the results.
“Didn’t anybody mention to you,” he replied, “that PTSD can present itself as ADHD?”
I was about 48 at the time. My initial PTSD diagnosis came when I was 30.
Talking to a professional can help.
And as I mentioned in other episodes, just talking can help. Which leads to the third side of the triangle, for me, the base. This is the one that should have been the strongest to support the other two sides, but it was the one I failed at miserably my entire life.
Self-care.
A part of the reason why I am doing this podcast is it is a journey along my path to healing and recovery. Another page on my website is Friends of GInA, Gentler Insanities Anonymous. I would eventually like to see meetings for people who suffer from my I call the “Gentler Insanities.” Friends of GInA is taken directly from the 12-step program and modified for people like me.
It is a pretty simple idea. I believe that talking about our problems with people who understand is a healthy step. It gets us away from the isolation, makes us feel not so alone.
Another recent discovery I have made, this year, was through a friend of mine whose life was saved by Alcoholics Anonymous. I won’t get into his story as that is his to share, but we discussed it. We were talking about AA and my idea. He liked it.
The 12-step program is an awesome support system. You can find meetings at multiple places and multiple times any day of the week. My friend shared with me something interesting that I didn’t know: anybody can go to open meetings.
There are closed meetings, just for those suffering from an addiction, but there are open meetings available to anybody that walks in the door. My friend suggested that I try out a few of the open meetings until I can get my own program up and running.
I had thought about it a bunch of times. Hundreds. Maybe thousands. When the depression hits, especially at night, I withdraw into a tight ball. It can become a battle. In Philly, I would heave a sigh of relief at 2 am, when I knew the strip clubs closed, one of my unhealthy coping mechanisms. Or I would be there being chased out by the lights.
But what if there was someplace I could go, just to listen, and maybe talk, grab a cup of coffee, and be there with people who might not understand my particular issues–but “issues” can be a very big boat. I don’t have to isolate myself. I don’t have to battle this alone.
Another step I have taken is yoga. I have been hearing about it for years and they offer classes at night, during my witching hours. I had always thought of yoga as just stretching and exercise. There is a lot more to it.
I finally started going a few years back when the professional burnout and the depressive episode was really starting to kick in. I was looking for a lifeline so grabbed one, a yoga studio not too far from where I worked.
It was transformative.
At first, it was exactly what I assumed it to be: 45 minutes of stretching and exercise followed by a cool down period. That alone was helpful. I found that after the sessions, I was invigorated and feeling better. I had more energy. Then, I got deeper into yoga, into mindfulness.
To me, yoga is a “fake it till you make it” activity. Some of the benefits are there immediately. The stretching, poses, and exercise can help with all manner of issues. The real benefit of yoga, to me, is on a deeper level, a mental level.
I would say a “spiritual level” here, but I don’t want to scare anybody away that might be considering it. Get all mystical. So, let’s stick with mental.
After a couple months of practice, I was in the middle of a session, assuming the half pigeon pose. I couldn’t do it right. One leg is supposed to be stretched out behind you with the other leg tucked up under you perpendicular to your body. I could do the stretched-out leg, but my body just wouldn’t do the perpendicular part.
“That’s perfectly fine,” my instructor encouraged me after a previous class when I asked her about it. She would always talk about how this was our practice, our yoga, and to just allow our bodies to do what it was comfortable doing.
So, I reached into the pose. My one leg was stretched out fully behind me and the other mostly just tucked underneath me. But that was perfectly fine. I leaned more into it, with my head finally touching the ground and my arms outstretched in front of me. I found…something. A quiet, a peacefulness, a stillness of my mind where the depression and other issues could not touch.
“You got it now,” my yogi whispered to me, and then walked on to the next student.
And it was about then that the pandemic shut down everything, including yoga studios. I still can’t seem to do yoga from home. I just can’t get into it. Maybe if I had had a few more months of practice?
And then there is the gym about 15 steps from the door of my apartment that I stare at each day. And the two mile walk I was doing until I threw out my back.
I know, I know: it is hard. Remember: this is the guy who couldn’t put on a sock. The differences in me then and now, however, make me wonder. What would my life have been like if I had started some of these healthier habits before, years ago, built them into my life?
…I hear a rustle of whips being unleashed me, the steel heads of the cat of nine tails going scritchity sckritch. The three big no no’s of therapy: should have, could have and would have. I mentally turn around.
Oh, c’mon guys. Put away the whips and let’s sit down and chat. Have some coffee. C’mon. Take a seat. Get comfortable. Cream and sugar?
I do agree that “should have, could have and would have” are useless. For the most part. We can beat ourselves all day with regrets. But I also believe they are useful in learning from the past to create a better tomorrow for us.
I really don’t know. I’ve never been here before. A lot of this all came together for me a few years ago, while the depression was starting to hit. There were also a lot of other things occurring in my life. I’m guessing, though, that a strong pyramid may have insulated me more, protected me more from the effects of the depression.
I’ve heard of a bunch of different things. One person I know makes it a point to go to the animal shelter once a week to play with puppies. Puppy therapy?
And with the thought of diving into a room full of puppies, that is a wrap.
Aloha
