Depression Update
It’s been a bit over three years since I was officially diagnosed with depression and started with therapy and medication. I can say without hesitation that overall, my life is much improved over 3+ years ago.
I can say with equal certainty that I haven’t been “cured” of depression, any more than insulin and regular visits to the endocrinologist cured my diabetes.
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I mentioned Christine Miserandino’s spoon theory over on Twitter earlier today. Spoon theory is an analogy about living with chronic sickness or disability. I know the analogy doesn’t work for everyone, but I’ve found it helpful in understanding and talking about and explaining some things.
What I’ve been finding in recent months is that I don’t actually know how many spoons I’ve got when I wake up in the morning. On any given day, I might be able to deal with the pressure of a looming book deadline, a crisis at work, a puppy destroying something important, an unexpected bill, a family argument, and whatever else comes my way. On another day with similar troubles, I could end up burning out like Biggs Darklighter over the Death Star.
I’ve gotten a bit better at recognizing when it’s happening. Just like I can generally feel when my blood sugar starts to drop too low, I can feel when I’m all out of cope.
It’s not a pleasant feeling, mind you. It’s a cold, congealed soup of anger and despair and exhaustion and shame. And recognizing it doesn’t necessarily mean I can do anything to fix it.
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My wife took me out for dinner and Jurassic World on Sunday. This was a good thing. I needed to get away, to relax and recharge and just enjoy myself for a few hours. It’s self-care, and as such, it’s something I wouldn’t necessarily have done on my own.
Medication is one thing. I’m pretty good at remembering to pop a pill every night, checking my blood sugar regularly and doing the math to match insulin to carb counts. But self-care is a murkier kind of medicine, one that takes more time and effort than programming an insulin pump. It’s also one I’m more likely to assume I can blow off.
Oh sure, I haven’t been getting enough sleep, but I’ll catch up on the weekend. I’ve missed some exercise, but I had other important things to do. I haven’t socialized much, but I’ll get to that as soon as the book is turned in.
How do you quantify self-care? How do you prescribe a given dose to be taken daily? (Those questions are rhetorical, by the way — I’m not asking for advice right now.)
And of course, there’s that other voice arguing that your self-care isn’t as important as those other people’s needs. It’s not as important as Doing All the Things.
I know self-care is important. As Morpheus said, there’s a difference between knowing the path and walking the path. But here comes Red Riding Hood to remind you that walking the path is all well and good, but it’s even harder to stay on that path once you’ve started.
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I remember growing up without email. I think email is an amazing tool, one that’s made my life so much better and simpler in so many ways. I remember getting my first email account as a college student, and how amazing it was to reconnect with a friend who’d moved to MIT.
I also hate email. I hate the neverending inbox, and that nibbling sense of failure that comes with every message that sits there waiting too long for a response. I hate that it takes spoons to answer some fucking emails, and knowing if I don’t, people will feel disappointed or hurt, or will wonder why I answered one email but not the next, and will start to second-guess whether they did something wrong when it’s just me trying to juggle a bunch of damn spoons without dropping any.
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We’re going on vacation soon. That will be a good thing. It won’t be 100% stress-free, but the stresses will be different, and hopefully fewer.
I’m also looking at some potentially big changes later this year. Stressful and anxiety-making, but potentially very good in the long term.
In the meantime, I was Guest of Honor at a convention last weekend, did a radio interview last night, was part of a Baen podcast recording today, and am getting ready for my 11th novel to come out in just over a month. All wonderful, amazing things I only dreamed about when I was younger.
Good things can use up spoons too.
#
It’s easy to take progress for granted.
I’m not fine. I am, however, doing a hell of a lot better than I was three years ago.
I just need to remember that it took a lot of work to get here, and that if I want to stay here — which I do — I need to keep doing the work.
Jeri Lynn
June 30, 2015 @ 7:44 pm
I can empathize, as many, many of these feels are things I fight. Mine is generally anxiety rather than depression, but they sometimes feel like opposite sides of a really similar coin. My friends & I have started posting some of the self care things we do & cheering each other on. Have fun on your vacation & I look forward to the new book!
Dave
June 30, 2015 @ 7:48 pm
Thank you for posting this. I have struggled with depression for a lot of years but only recently admitted it and sought help.
kimber
June 30, 2015 @ 7:56 pm
I get the whole thing about blowing off self care and never really knowing how many spoons you’re going to have. I got an instagram account, and among other things, i use it to track when i make art or write, which is part of my self care. I like jeri’s comment above, maybe I’ll start using it to track some of the things i do for self care. *big hugs*
By the way, one of the things i do for self care is reading, and right now libromancer is one of the books on my reading pile. I’m really enjoying it. Thank you for bringing that story and those characters into this world! 🙂
pixlaw
June 30, 2015 @ 8:07 pm
One of the things it took me, literally, 40 years to realize was the way that the depression and the Type I are inter-related. Once my BG drops too far, the odds are 4 out of 5 that I’m going to get depressed. Even if my life is otherwise fine. And depression effects the BG, if for no other reason than it makes it harder to exercise, harder to care about what the BG is.
The only time I ever seriously contemplated suicide was once in college when my BG had dropped precipitously and I didn’t realize it (this was back in the days before BG tests, and all we had to rely on were urine glucose sticks which were woefully inadequate). It’s no surprise that Type I and depression are so connected; I’m just sorry it took me so long to recognize it.
mjkl
June 30, 2015 @ 8:17 pm
I live by the Spoon Theory. No, I don’t know when I wake up how many spoons I’ll have (unless it’s reallly few); I’ve learned to go on the assumption that I have a medium level each day and then enjoy it if I have more than expected later on.
I’ve also learned not to push myself when I’m running out of spoons (or if it’s a good day, not to go all out 100%), because I’ll pay for it later and for the next couple of days. An article I read used a great analogy – most people who overdo things have overdrawn at the bank and need to pay off the debt; those of us with conditions that use up spoons will have overdrawn at a bank that has penalties and fees, so we have to pay off the debt plus another 30% or 50% or more. Makes it really important not to overdraw spoons.
Take care – with best wishes from another person chronically low on spoons.
Adrian
June 30, 2015 @ 8:23 pm
What you call spoons my therapist referred to as emotional energy. It worked for me as an analogy, because I could liken it to physical energy. Sometimes you are too physically tired for certain activities and need to rest and recharge. Same with emotional energy – you run out of it too. Some people have more than others, some can recharge easier and faster than others, but we all start each day with a finite amount, just as with your spoons.
I had to learn to tell myself “I don’t have the emotional energy for this right now.” Once I did, it helped me get through tough times. Everyone needs to find what works for them, and develop their own ways to cope.
By the way, I loved how skillfully and thoughtfully you portrayed Isaac’s depression – and I always look forward to your books. 🙂
jocelyn
June 30, 2015 @ 8:28 pm
“Good things can use up spoons too.”
THIS. I’ve often found that my depression can be triggered by happy things, like my body is trying to overcompensate for the unfamiliar feeling of joy. Learning to recognize early signals is a key part of coping with depression.
May you get your Spoonometer calibrated spoon… er, soon.
Cynthia Price
June 30, 2015 @ 8:30 pm
I understand and empathize, Jim. I had, in fact, wondered if you’d been hit by some big stress or something, since I hadn’t seen you on Words, and hadn’t seen much in the way of posting.
I’m currently experiencing what my body does in reaction to me getting manic and overdoing it (I have anxiety and manic depression/bipolar), which is to say, being in massive pain. I woke up almost unable to move for the anger of the nerves in my lower back (specifically my sciatic) the other morning. I’m now only able to move by the grace of oxycodone and Ibuprofen 600 every few hours. That and having received an IM injection of dillaudid in the emergency room at o’dark-thirty the other morning. I left the house for the first time since Saturday (other than the ER visit) today. I hope to see you back on Words soon, as that will likely mean you’ve made it through the valley floor, and are on your way back up the other side.
fr4ct4l
June 30, 2015 @ 8:32 pm
“And of course, there’s that other voice arguing that your self-care isn’t as important as those other people’s needs. It’s not as important as Doing All the Things.”
This made me cry, so there’s my sign that I’m overdue for my own self-care. I thank you deeply for posting your thoughts and experiences.
Jim C. Hines
June 30, 2015 @ 8:39 pm
Wait, do we even have a game going right now? I haven’t been playing as much, but I think I’m mostly caught up on most of my current games…
And ugh. I hate dealing with hospitals and emergency rooms. I’m glad they were able to help though, and that you’re recovering some mobility.
Jim C. Hines
June 30, 2015 @ 8:40 pm
It’s weird. I’ve almost learned that if something really cool happens, I should expect a kind of bounce-back period, like my mood has to swing back like a pendulum before it stabilizes again. What the heck, brain???
Jim C. Hines
June 30, 2015 @ 8:41 pm
Thanks, Adrian. As you can probably guess, that aspect of UNBOUND was pretty important to me, and it means a lot to hear that it worked for people.
Jim C. Hines
June 30, 2015 @ 8:44 pm
Thanks.
And oh, great. Now we need to worry about compounding spoon interest? Damn spoons are as bad as the credit card companies!
Jim C. Hines
June 30, 2015 @ 8:46 pm
I’ve definitely noticed that any low blood sugar episode leaves me exhausted, and makes it that much harder to deal with anything else that happens.
It’s something my therapist brought up pretty early on, saying that even if I’ve got the diabetes under good control, it’s still One More Thing we’re constantly having to deal with and worry about.
Jim C. Hines
June 30, 2015 @ 8:46 pm
I’m glad, and I hope it’s been helpful.
Jim C. Hines
June 30, 2015 @ 8:53 pm
You’re very welcome. And please do take care of yourself.
(See? It’s so much easier for me to tell other people to take care of themselves than to do it myself…)
Becky Raine
June 30, 2015 @ 9:03 pm
I count my spoons every day. Christine hit the nail on the head, with that one. It is used by so many people, to explain what it is like to suffer with chronic pain, and other autoimmune disorders. Thank you for sharing it with your fans.
Becky in Elko
mjkl
June 30, 2015 @ 9:04 pm
The good news is that you can learn how to manage them most of the time, as long as you keep those damned penalties in mind. It does require cutting oneself soem slack and not listening to the voice in the back of one’s head saying “You SHOULD be able to do all those things. You’re a bad parent/employee/spouse for not being able to do everything people with no health challenges can do.” And of course the depression feeds those voices. BTDT. The good news is that when you learn to listen to your body instead of those voices, life becomes more manageable and pleasant.
Here’s some cute for you: http://i.imgur.com/NQA8jCT.gifv
Suzanne Church
June 30, 2015 @ 9:10 pm
I’ve always found “self-care” to be a simple concept in theory but a very difficult one in practice.
As a kid, the idea of “self-care” was often characterized as “self-indulgence” and I must admit, that nagging voice is really hard to shut up, even decades later. I have to consciously schedule self-care and sometimes FORCE myself into it.
Seems ridiculous, right? But for those of us with a “depressive affect” it’s always a tough road.
Since I injured my knee and good portion of my time and energy is used up with knee-related activities — exercises, physiotherapy, doctors’ appointments,etc. I have way fewer spoons for everything else and self-care is always the first casualty.
Keep “doing the personal work” Jim, and I will too. I truly hope your vacation re-fills the well with a huge load of spoons.
Erica Wagner
June 30, 2015 @ 9:49 pm
Glad things are better than they were three years ago, but I do relate about its being easier to deal with crises on some days than others. I remember learning about the spoons analogy, and it speaks to me too. Hope your vacation is fun and more energizing than tiring.
Sally
June 30, 2015 @ 10:48 pm
Predatory payday spoon lenders!
Loan sharks of spoons!
Yeah. Perfect metaphor. I’ll remember that next time I’m sitting around the house recovering (Probably tomorrow afternoon, the way things are looking).
Laura
June 30, 2015 @ 11:54 pm
Your piece from last year, “Writing with Depression,” really touched me. It made me want to go back and revisit a lot of the things I’d dealt with but since buried because memories are terrifying. I wrote about them. And wrote and wrote and wrote. And suddenly I was looking at a 4,000 word behemoth–on how my depression intertwined with my becoming a teacher. It was painful and beautiful, and wonderful, and hard, but I am so proud of it. It took months to write, and is currently being edited. Perhaps I’ll get it published. And then I can thank you properly.
Cea
July 1, 2015 @ 12:22 am
I have been married for 26 years to an incredibly brilliant, creative man who is bipolar (chronic) and diabetic. Reading your blog was like looking at our life. His illness was well controlled when we met. He was on lithium and it worked well. Unfortunately his doctors didn’t do a very good job of monitoring his meds until finally we found a responsible MD. This doctor actually ran drug panels, then called him and took him off the lithium. It was too late. It has destroyed his kidneys. He was never able to come back fom the depression that ensued when his meds were changed. He’s on the transplant list and just got the surgery to prep him for dialysis. And he counts spoons too. Some days he’s on, some not, but we constantly work on mindfulness. He tries to keep the idea that there are good days and times even when the black dog is stalking his days. It helps. He doesn’t give up, he’s strong and it amazes me. We’ve stored up some spoons, hopefully enough, and before he starts dialysis I am taking him on a tour of Tony Hillerman’s Navajo Country. (This week!)
Sorry for the novel here. I guess I just want you to know that you can face this all and come through it. I enjoy your writing very much and quite selfishly want you to keep on keeping on. I hope your summer is sweet and vacation relaxing.
Megpie71
July 1, 2015 @ 12:38 am
You are me, and I claim my five UKP. Or to put it another way, I empathise very much with what you’re saying.
I went to visit my psychologist yesterday. It was a good visit, mostly positive, mostly touching base about how I’ve been the last couple of months (ten visits per year on Medicare, and this was number eight for the year… the Australian mental health system is severely dysfunctional). But I still come out of the blasted things feeling as though I’ve had a dredger go through the bottom of the mental harbour, and stir up all the muck there (and now I have the job of calming down Cthulhu and getting that back to sleep again). Today, I’m supposed to head off and return a library book, and quite frankly, all I really want to do is curl up on my bed and go back to sleep (doesn’t help that it’s a grey, overcast day outside, and it’s a bit on the cold side as well). I was originally planning to go shopping for new jeans, but that’s landed on the mental “nope, not happening” list, because shopping for clothes for me requires copious spoons, which today I really don’t have. Particularly since I know this weekend I’m going to need some “social interaction” spoons to spare (which means I have to stockpile during the week) in order to handle dinner with the in-laws on Saturday night (to celebrate my partner’s birthday).
Well, time to get up and return the library book, whether I particularly want to or not.
Heather
July 1, 2015 @ 7:04 am
> I hate that it takes spoons to answer some fucking emails
YES. I have a page online where I tell people how to contact me to request a book review. I also make it very clear that due to bipolar/etc. I don’t have the energy/wherewithal to reply to most emails, so they should simply not email if that bothers them. Unfortunately it’s harder to explain that to friends/colleagues.
I hope those positive changes you’re going to be making help! Something one of my first psychiatrists told me is: even *good* big changes still cause a lot of stress and upset in your life. I have to remind myself of that every so often, and I sometimes have to remind a friend or two that it’s okay to freak out even when things are changing for the better.
I wish you all the best. Balancing life is an act that never ends. But it can sure be worth it.
Jim C. Hines
July 1, 2015 @ 8:22 am
Woke up to a bunch of comments and emails about this post. Thank you all. I kind of wish there weren’t so many people who could relate, but it definitely helps and means a lot to know you’re not alone…
Christy
July 1, 2015 @ 8:29 am
Thank you for your post. My own self-care has eluded me lately, and your post has reminded me how important it is, even if it means not Doing All the Things that try to crop up as more important. I am happy for your progress, and hope that it continues. Likewise for all the others (including myself) who are dealing with depression, and benefit from hearing that we are not alone in it.
D. D. Webb
July 1, 2015 @ 9:20 am
Thanks for this, Jim. I’ve been going through a particularly bad depressive episode myself the last couple of days. The thing that really irks me is I can power through most parts of my life while depressed, but when it comes to writing, everything gets 500% harder. I struggled all day yesterday to make a deadline and my final result was less than satisfactory to me, but it was all I could force out. I feel like I could make peace with the depression if it wasn’t so hostile to my creativity, y’know?
Jim C. Hines
July 1, 2015 @ 10:38 am
And at least for me, if I’m having trouble with the writing, it can have a huge impact on the depression. It’s an ugly, nasty cycle, designed by a particularly cruel brain-weasel.
sistercoyote
July 1, 2015 @ 11:01 am
This is my experience as well; I’m very lucky in that I have a good friend who, when I start behaving oddly or flat-out tell her “my depression is winning” starts running through basic self-care questions with me: have I eaten, am I thirsty, etc. Because depression lies and tells me I don’t need that stuff.
But other people do.
Martin
July 1, 2015 @ 11:07 am
Being mostly healthy, I nevertheless like the explanation model of the spoon theory for my own life.
E.g. age attacks your spoons too. Max Spoon is reduced and spoon generation is slowed down, spoon costs may be increased (in my case: stairs are really expensive now) ;-).
At 18, you may generate 5 spoons per hour. So pulling an all-nighter (which reduces your spoon spawn by 3/h) is not so bad. At 50 with just 2 spoons per hour, an all-nighter puts the spawn rate into the negative. That’s why I avoid it now ;-).
Now I am thinking how to create a web service that cross-breeds the spoon theory and HabitRPG. Probably a stupid idea, because using it regularly would also cost spoons….
Jim C. Hines
July 1, 2015 @ 11:11 am
I’ve actually got at least two self-care type items in my HabitRPG set up. I could see that working…
Martin
July 1, 2015 @ 11:22 am
Hmmm…. I will spend some time thinking on it. It is probably a typical game design balancing problem. Lack of details prevents immersion, abundance of details kills fun through micromanagement.
Lisa Pendragyn
July 1, 2015 @ 2:16 pm
Yes! It’s like crap, now something bad has to happen because how dare I be happy about something. I hate that I’m more comfortable not trusting happiness than not worrying over all the things I can’t control or fix.
Rin
July 1, 2015 @ 5:34 pm
Thank you for sharing this–it means a lot, and I’m hoping it’ll help my partner. 🙂 A number of the comment exchanges on here might, too. We are well familiar with the spoon theory in my house, for a number of reasons. “Good things can use up spoons too.” They do, and that doesn’t make you a bad person or horribly defective! This one is so hard to remember.
Also, thank you for clarifying that your questions were rhetorical! I like to be helpful, and sometimes find myself three sentences (>.> or paragraphs, it’s something I’ve been working on) into a reply before checking on whether someone actually WANTS my notions on an answer to a question. You mentioning it right there kept my brain from shifting gears.
I hope you’re able to bring your self care back up to a happier Jim level soon. I love your work, but the tortured artist motif is overrated–I’d much rather have my favorite art and stories on a lower basis than have that speedy delivery cost their creators too much.
sistercoyote
July 1, 2015 @ 7:34 pm
I need a like button.
Brendan
July 2, 2015 @ 10:07 pm
Hey Jim!
I think it’s so amazing and awe-inspiring that you’re so honest about posting it and I’m glad you’re getting better for yourself. I think the world needs to do better in how it sees and understands mental health and to remove that stigma from it. It’s happens and it’s a part of our lives whether we’re directly affected or indirectly affected.
Cynthia Price
July 2, 2015 @ 10:42 pm
I have/had a request in, I believe, to which you had not yet responded. You’re usually pretty quick to reciprocate after a game ends, so I figured you were super busy. Then I read this, and realized your brain was busy blocking your fun. 😉
DawnD
July 3, 2015 @ 12:58 am
This is brilliant. I have noticed the deficit (the next few days being even harder), but I’ve never actually put this together before. I just go ahead and do what I need to do without really thinking about what that means for the next few days… I need to re-assess this. Thank you for the thought.
Pat Munson-Siter
July 4, 2015 @ 4:09 pm
I am mildly bipolar. My husband at 62 was diagnosed with early onset Alzheimer’s at the end of last year. I have discovered that as a care giver I now HAVE to make sure to take care of self-care items. If I put myself into the hospital due to stress, not eating properly (I’m one of those folks who lose their appetite when depressed rather than binge eating), lack of sleep, etc then there really isn’t anyone available to take care of my husband (he is in early stages so does not need assisted living or nursing home care yet.) and I’ve already been told to expect the demands on time and energy to get worse, at least until he gets to the point where he needs to be admitted to a nursing home. So while not quite your situation, the need to keep an eye on self care and making sure it happens
Pat Munson-Siter
July 4, 2015 @ 4:12 pm
Sorry! To continue – has been impressed on me. Especially as when I’m in the depressive part of my cycle, it’s so easy to keep slipping down that slope of I don’t take care of myself.
Cynthia Price
July 5, 2015 @ 6:53 pm
Oh, man. My BG has a TON of impact in my emotions. I know, for instance, that if I want to rip someone’s face off for the offense of breathing too loudly, I should probably check my sugars. 😉
Cynthia Price
July 5, 2015 @ 6:56 pm
Your blog needs a ‘thumbs up’ option. For serious.
Miriam
July 7, 2015 @ 9:24 pm
I’ve personally always loved the weather analogy. The ups and downs of depression and anxiety are like bad weather. Wait awhile, and it will change. Is it your fault that the weather sucks? Nope. Can you stop it? Nope. Is it that much more exhausting to run errands during a torrential downpour or with giant balls of hail falling on your head? Yup. You can still do it, but the cost will be greater.
Anyway, thanks for the great fiction, and for being so open about your mood disorder. I think it makes a real difference for public figures to talk about mood disorders without attaching any stigma. After all, the last thing a depressed person needs is to feel ashamed about being depressed.
I’m Back | Oakheart by Liz Danforth
August 9, 2015 @ 9:13 pm
[…] (and I don’t argue with that) but all life is change, and transitions are always stressful. Even good changes take spoons, as Jim Hines wisely pointed out. (If you are one of the seventeen remaining webwise people who […]