My big furry SSRI

Meet Bear. He’s cute, I guess

Two years ago, I got my first dog. Before that day, I went through all the typical doggo-loving phases: Getting to know my friend’s dogs and agreeing to dogsit every once and a while, which quickly became begging to dogsit, learning every detail about every breed, checking out the dogs on Kijiji far too often, and expressing an “awwwww” at every dog I passed.  

I eventually clued in to the fact that—as a 28-year-old adult who is married with a grown-up job—I could actually have my own dog, if I wanted one. One week later, this 20-lb monster of a doggo, Gerrard Kyle Lowry Drake Mueldoon (aka Bear), joined our family. I imagined us spending every minute together, becoming the best of friends and passing long afternoons lazing around in the park. There would be lots of walks, cuddles, and secrets shared. Despite not being able to speak the same language, we would always be able to understand one another. Our love would transcend language, obvi.

And yet—despite these ridiculously high expectations for this dog and our relationship—I completely underestimated the role Bear would come to play in my life.

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When we got Bear, I wasn’t doing a good job of treating my agoraphobia. I had been taking an SSRI for about six months, and while it was keeping my anxiety relatively low, I wasn’t exposing myself to new situations. I had committed to starting cognitive behavioural therapy that year, but I still hadn’t bothered to do it. All I wanted to do was enjoy the feeling of not having to think about my anxiety for once.

That said, I knew I needed to start CBT and exposure therapy, because despite feeling better anxiety-wise, I hated the way medication made me feel. Although this was only the second SSRI I had ever tried—and it had only been six months—I didn’t see myself staying on medication much longer. I hated the side effects, especially how exhausted it made me; I was sleeping 9–12 hours every night. It also made me feel less like me: I am a person of extremes, and I always have many ideas and lots of excitement over them. But SSRIs end up dulling these key features of who I am. I needed to get off them.

It wasn’t intentional, but becoming a dog owner was a catalyst for my transition off medication. I no longer had any choice but to get out of the house and experience new situations, places, and people. In the early days, my husband and I took that dog everywhere. We would walk him around the block or take him to a close-by coffee shop or dog park. Eventually we would take him on longer walks, or we would drive him to a new neighbourhood for an adventure. We took him to regular vet appointments, along for the seven-hour drive to my hometown, or to visit friends. He would even join us for patio beers in the summer.  

Out and about: Bear, my husband, and me at the pride parade last summer

This gradual and consistent exposure to new situations that were increasingly farther away from our home—and my comfort zone—was accidental CBT. Situations that would normally cause me anxiety or that I had been avoiding were now unavoidable. They became a part of my daily routine. And it was exactly what I needed: I went from spending a lot of time being isolated in my apartment to wandering around the city with Bear, exploring new places and meeting new people.

Being forced to engage with others also helped treat another component of my mental health: the depression that would inevitably accompany long periods of isolation. When you’re anxious and depressed, the last thing you want to do is talk to people, especially complete strangers. Before Bear, I couldn’t even be bothered to leave the house amidst a deep depression. After Bear, I really didn’t have a choice. He needed to be walked every day, and this involved constantly stopping for complete strangers who wanted to meet him.

Because who wouldn’t want to meet this doggo?

When I was out with Bear—even amidst the darkest of moods—each encounter would improve my state of mind, bit by bit. I’d see someone’s face light up when they set eyes on him, and the questions would start: “OMG he’s so big!/How old is he?/What kind of breed is he?/How much does he weigh?!” I’d semi-enthusiastically reply with the answers I’d given nearly one thousand times before: “Yes, he’s a monster/Six months/Saint Bernard Mix/Almost as much as I do.” But like any proud parent, once I got talking about my baby it was hard to stop. I’d start talking about his funny habits, how much my husband adores him, the way he plays with our kitten. The more I’d talk, the further from my solitude and sadness I felt.

And sometimes, I would be pulled into someone else’s sadness. I would routinely chat with a woman down the street about anxiety, depression, and addiction—sometimes for hours at a time while our dogs played in her yard. There was a man who told me about how he had kept his dog while he was homeless, but was now struggling with the decision to part with his pup because of the chaos in his life. Another woman in a wheelchair stopped to show me pictures of her dog while petting mine, telling me how her dog helps combat her depression. And I’ll never the broken heart of my neighbour after her two goldens—fixtures in our neighbourhood—passed away. 

Not only would those conversations pull me from the depths of my own depression, but they forced me into the present and allowed me to connect with the person in front of me. I felt a bit less alone. I stopped wondering whether anyone would notice if I disappeared. I remembered that a world exists beyond my problems, and that everyone has darkness in their lives—darkness that is made a bit more light by the kindness of a stranger (and the love of a good dog).

I don’t think it’s a coincidence that I started CBT and fully transitioned off my meds within the first eight months of getting Bear. It’s also not a coincidence that my world opened up to new people, new places, and new experiences after he entered my life. Bear helped me build the confidence to exist in the world again, and he was by my side every step of the way.

Here’s to two years on my big furry SSRI.     

<3

Check your privilege—then use it to make shit happen

Lately, I’m trying to lean into the role of being an advocate for mental health. My primary motivation for starting this blog is because I think it’s important for people dealing with mental illness to speak out about their experiences. This not only helps others to understand or feel less alone, but we are the people who are best positioned to advocate for the changes we need to see in the world.

Last week, I committed to doing that on a new, more visible level. I decided to participate in the Centre for Addiction and Mental Health’s One Brave Night for Mental Health challenge. The challenge is twofold: raise money for CAMH and commit to doing a challenge, which could be staying up all night or hosting an event. For my challenge, I’m choosing to take on something that is an actual challenge for me, but something I have wanted to do for a long time: speak to my colleagues about my experiences managing an anxiety disorder in the workplace.

Launching this campaign, not unlike launching this blog, put me in a state of high anxiety last week. I’m not sure how confident I come across when I write or speak about these issues, but inside, I am constantly doubting myself. I wonder if all of my friends are secretly thinking, OMG SHUT UP no one cares about your anxiety. I wonder if doing this can actually make the difference I think it can, or whether it’s going to cause future damage, particularly to my career. I wonder if there are other things I should be devoting my time and energy to.

The first five times I’ve thought about speaking in front of my colleagues about my anxiety, I’ve felt so anxious that it’s made me physically sick. My body has responded as if I were about to do it. I’m terrified. What if no one comes because I suck? What if everyone comes and I suck? What if some people think of me differently afterwards—or worse, treat me differently? Is this worth the risk?

All that said, I’m unequivocally taking on this challenge. For one, those doubts and fears are largely just my anxiety talking. But also, I strongly believe that the impact of speaking out is greater than the accompanying anxiety, self-doubt, and potential risk. It educates people who have limited experience with mental illness, which fosters understanding and changes attitudes, beliefs, and actions. It supports people with mental health conditions who are reminded that they aren’t alone and their struggles are real, which can empower people to seek treatment, advocate for themselves, and keep going during tough times.     

And I feel a responsibility to speak out, because I’m in a position to be able to do so. I have a lot of privilege in this world: I’m white, I’m well-educated, and I live in a high-income household in which both my partner and I have secure, permanent jobs. That last part really matters: I can afford, literally, to be open about my mental health issues with little fear of losing my job—and even if I did, my family and I would be okay.  

That’s not to say there aren’t risks, or that this work doesn’t have an impact on me—it does, and in these early days, it’s uncomfortable to feel so vulnerable all of the time. But when you have privilege, you have a responsibility to acknowledge that privilege, and then think about how you can use it to help advantage someone other than yourself. This is where social change begins.

If you want to check out (or support!) my One Brave Night campaign, click here. I’ll be raising money until Friday, April 6.    

the life-changing magic of CBT

two weeks ago, i explained the important role that cognitive behavioural therapy plays in treating agoraphobia. people suffering from agoraphobia may spend months or years avoiding certain situations that trigger panic attacks, and reintroducing oneself to those situations requires a gradual, structured approach.

this is where an exposure (or anxiety) hierarchy comes in. an exposure hierarchy is just a list of situations that cause anxiety, ranked by level of difficulty. some people will break each situation down into a series of progressively more challenging tasks. for example, tackling a fear of riding an elevator might begin with simply looking at elevators or imagining oneself in an elevator, then travelling up one floor on an elevator, and then two, and so on.

breaking situations down into a series of tasks isn’t how i approach exposure therapy, but i do take a two-phased approach to each situation by first trying coping exposure and working toward full exposure. coping exposure involves using coping strategies throughout the situation. for me, this includes taking an ativan before the event (ativan is an anti-anxiety medication that, unlike commonly prescribed SSRIs, is used on an as-needed basis, having an immediate but short-term effect) or doing the event on my own. this is somewhat unusual for an agoraphobic, many of whom rely on a support person when they go places, but i actually feel safest handling situations on my own, because it would feel less embarrassing if i were to have a panic attack.

full exposure entails entering these situations without relying on those coping strategies. for me, that means without medication, with others, and without meticulously planning potential escape strategies beforehand (i.e., knowing where all bathrooms and exits are in a building, sitting close to exits, and creating excuses in case i need to leave).

so what exactly are the situations that i am so afraid of? well, here’s my current exposure hierarchy.

my current anxiety hierarchy, drawn by a person who failed grade 8 art class

i realize these events probably make for an exciting saturday night for most of you (minus the whole dentist appointment situation, obvi). but, for me, these situations are… hell. at least, the lead up is total hell. knowing i have to endure one of these events will put me in a low mood a few days in advance. i’ll feel severe anxiety the day of, and i will spend a lot of time trying to decide if i should just bail.

if i bail, i’ll feel momentary relief that is quickly drowned out by guilt over bailing (especially if i’ve bailed on someone) and frustration with myself for not keeping my plans. this can quickly spiral into a period of depression where i question the value of living a life so restricted by my anxiety. these periods are scary and can be so tough to pull myself out of.

if i decide to go through with my plans, my body and mind will torture me until about five minutes into being there—i’m usually okay once i get where i need to go. and i usually end up having a great time and i’m really happy that i went, but it’s an excruciating mental and physical process to get there. here’s a bit of insight into that mental process and why i find them so challenging:

dinner with a friend (45% of max anxiety levels): i honestly love food, fancy cocktails, and good conversation with a friend, but being locked into a meal with just one other person is stressful. like, what if i need to leave the restaurant? i can’t leave without paying, but what if i am in the middle of a panic attack and need to leave? how would i explain this to my friend? i am very selective about who i will go to dinner with and it takes a lot for me to mentally prepare  

having a friend over (50%): i love hosting people, and yet, i’ve had only a handful of people over to my place with whom i don’t share DNA. i really struggle to let people into my space, because i fear having a panic attack and wanting them to leave, which would be awkward. i tend to rely on my husband—or even my dog—being around to help me cope when we have guests 

event, by which i mean seeing a speaker or panel (60%): i got through some pretty big events this year, including seeing hillary clinton (alone, which was easy) and rupi kaur (with my sister, which was much harder and i needed to take an ativan). these types of events are the kind of thing you want to do with a friend (yikes!) or in a small, intimate venue (double yikes!), and i’m just not there yet 

hair appointment (70%): i didn’t get my hair coloured for four years until this past summer, because i was afraid that i would have a panic attack during the hair appointment. when i went last summer, i asked my husband to check in on me a couple times. these situations are actually the worst, because you really can’t just leave with your hair in foils or only cut on one side 

hosting a party (75%): same deal as having a friend over. it’s tough for me to let people into my space, because, like, what if i want them all to leave RIGHT NOW—then what? #awkward 

movies (80%): i’m not into movies, but my husband is. this is something keegan constantly asks me to do, but we have not gone to a single movie in our four years together. i haven’t actually seen a movie in theatres in seven years. i have no desire to sit in a dark theatre surrounded by strangers for hours—that sounds like hell to me, aisle seat or not 

ballet (90%): i had a panic attack at the ballet years ago—before i understood that’s what was happening—and it was just a fucking miserable experience. it happened like five minutes in, and i left, tried to return, and ended up needing to go home. unlike the movies, this one bothers me, because i love live performances. keegan and i managed to go to cirque du soleil this summer and we often go to basketball games, but this is an ordeal because i have to carefully select our seats and i won’t go anywhere unless i can have an aisle seat. sigh, who needs the theatre when you have so much drama going on inside your little head? 

dentist (100%): can i just say that this fear elicits the most annoying responses from other people? so many people reassure me that they too dislike the dentist or that they are afraid of the dentist, but that’s not my issue with going. the dentist combines two extreme fears for me: being stuck somewhere from which it would be difficult to escape and an intense phobia of medical things, specifically hearing medical things described, which causes me to get sweaty, trembly, and dizzy without fail. i have not been to the dentist in over five years, and i’ve been putting it off because i know i need a procedure done and i don’t want to deal with hearing it be described to me 

so, that’s me. that’s what my anxiety disorder looks like right now, and those are the situations i’m tackling with CBT.

that might seem pretty overwhelming, and you might be wondering whether CBT/exposure therapy alone could really help me overcome such intense fear and anxiety over so many situations. i want to end this post by sharing my exposure hierarchy from the summer of 2016, when i first started CBT.

anxiety hierarchy from summer 2016. ended up doing 11/15 of these things

a number of those things—including things i described as “impossible” a year and a half ago—are now a part of my weekly routine. i read at a coffee shop once a week after work. I recently went back to gymnastics and started taking a class at university. le nordik, which i put off visiting for one year after we received gift certificates as wedding gifts, is now considered one of my happy places. my life would look completely different today without CBT.

i didn’t conquer everything on that list not because CBT doesn’t work, but because i stopped working CBT once my world got just big enough to let me do the things i needed—or really wanted—to do. i’ve been able to enjoy that world for a while, but i’m starting to outgrow it again. as i work to expand it, i’ll check in from time to time, hopefully with cute purple hair and perfectly polished teeth.

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i’ll be taking a couple weeks off from writing, but i’ll see you on the gram. thanks for reading!

call it like it is: mental health, disability, and the workplace

i had coffee with a friend the other day, someone that i work with. we were talking about how he needed someone to backfill for his job for a few weeks. it’s not that i particularly want to do this job, but i was curious why he hadn’t thought of me as a potential replacement. he said that while he had no doubts i could do the job, it required being in the office every day for long hours.

i understood that he was subtly referring to the fact that every so often i need to take a day off. but what i don’t think he understood was that, in that moment, he was revealing some serious biases about what he thinks people with mental health disorders can and can’t do in the workplace.

i want to say this was just a chat between friends and the only outcome was frustration and hurt feelings on my part. i want to say it stops there, but the more i think about it, the more i realize this is hella problematic.

let’s say a few years later, this guy becomes my boss—or the boss of someone he doesn’t know, and this person discloses a mental health condition. what if he begins to redistribute their workload, or overlook them for assignments or promotion opportunities, all because he assumes that they can’t handle it?

the fact of the matter is, lots of people have conscious and unconscious biases about what people with mental health disorders can and can’t do. but when these biases manifest in actions in the workplace, we have to label them what they are: discrimination against someone with a disability.

you might be questioning the last part of that statement, wondering whether you believe that a mental health disorder is truly on par with other, more commonly recognized forms of disability. i get your instinct, but let’s recall what a disability is: a long-term physical, mental, intellectual, or sensory impairment which, in interaction with various barriers, may hinder an individual’s full and effective participation in society on an equal basis with others.

not everyone with a mental health disorder will experience symptoms to the extent that meets that definition, but it’s important to understand that, for some people, a mental health disorder is a legitimate disability that affects the way they move through the world—and we need to label it as such.

i get that people are sick of labels and classifying everything and everyone. there’s a perception that cuts across many spheres of our lives that people are too obsessed with language—and too obsessed with using it correctly. but language matters. classifying a mental health disorder as a disability if it meets the definition of one matters.

because labels mean that people with mental health disorders can safely disclose their conditions to their employer. they entitle that person to seek reasonable accommodation in the workplace and to challenge decisions that appear discriminatory. a label means that these actions are not just allowed, but are legally protected rights.   

mental health in the workplace is a topic i will return to many times. probably because work is where i feel the impact of having a mental health disorder most acutely. it is the place in which i feel the most challenged by my disorder. it is where i am constantly reminded that i am not “normal”. and it is where i will push myself the hardest to minimize, ignore, or conceal the reality of my condition in order to maintain the appearance of normal and continue to advance in my career.

coming to understand my anxiety disorder as a disability has helped me realize that i don’t have to minimize, ignore, or conceal my condition to adapt to the workplace—it’s the workplace that has to adapt to me. the sooner we reach a consensus on that, the sooner we can make real progress on building workplaces that let people with mental health conditions thrive.

agoraphobia: also known as my brain is a total dick

before delving into a bunch of topics that stem from my experience with anxiety, it seems only polite that i first introduce my anxiety. rather than giving you a clinical diagnosis, i thought it might be more interesting to show you my “exposure hierarchy”. i’ve been meaning to create a new one anyways #multitaskingwins

but as i started drafting this post, i quickly realized that i can’t show you an anxiety hierarchy without first introducing you to cognitive behavioural therapy, and to understand why cognitive behavioural therapy is key to the treatment of my anxiety, i kind of need to introduce you to my particular anxiety disorder—and we’re back where we started!

if i could choose one word to describe anxiety, it would probably be circular.

let’s get these requisite introductions and small talk out of the way.

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i struggle with elements of a few anxiety disorders, as well as periods of severe depression, but my primary diagnosis is agoraphobia with panic attacks. agoraphobia translates into “fear of open spaces”, but what it means for me—and approximately 0.5–1% of the adult population—is “fear of places from which it would be difficult or embarrassing to escape if i were to have a panic attack”. in my next post, i’ll get more specific about the particular places that cause me the most anxiety, but for now it will suffice to know that the only place in the world in which i feel completely at ease is when i am alone in my own home.

a fear that all-encompassing does not develop overnight. how did i get here? that’s where the panic attacks come in: at some point in my life, i experienced a panic attack. after this occurred a couple of times, i became aware that these episodes were happening in similar situations and i started to avoid them because panic attacks are hella unpleasant.

so that sucks, right? it definitely gets worse: once my brain started to associate panic attacks with these situations, it would trigger a panic attack every time i entered them in order to show me how dangerous they were. eventually, my brain took to initiating the panic attack sequence before i even entered these situations, just to reeeaaallllllyyy get its point across.

so that sucks, right? yea, no, definitely gets worse: because my brain is diligent as fuck, it has adopted this approach for a wide range of situations that share common features with the first ones—features like “this place would be difficult or embarrassing to escape”. do that for, like, a decade or so without treatment and that is how i developed a pretty severe case of agoraphobia.

you’re probably thinking that my brain sounds like a total dick. agree, but it means well. it’s actually trying—trying really, really hard—to protect me from what it is interpreting as dangerous situations. it’s just gone a bit overboard, because, lol, do you know how many places could be potentially difficult or embarrassing to get out of? basically every situation ever.

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so where do you go when you feel like you can’t go anywhere? treatment for agoraphobia is different for everyone, but from what i understand, you essentially can’t recover from it without some form of cognitive behavioural therapy.

for the uninitiated, cognitive behavioural therapy, or CBT, is a type of therapy focused on helping people with mental health disorders identify the thought processes (cognitive) that influence their actions (behaviour), which may be contributing to their issues. once you become more aware of your thought processes, you can begin to pick out potential distortions and challenge their validity. you learn how to rewrite the script your brain has been playing for you and—often with some coping strategies to help you along at first—you begin rehearsing it while you take on the situations that terrify you.

that last step is where people, myself included, really get stuck. placing yourself in situations that cause you extreme physical and emotional distress sucks. think of the most stressful exam you’ve ever written or interview you’ve ever had. imagine the stomach cramps or nausea you felt while you waited for it to begin. remember how your hands were sweating, your heart racing, that lump in your throat growing by the second. you’re trying to play it cool, but you are FREAKING OUT.

would you voluntarily put yourself in that situation over and over again? probably not, even if i wrote down some phrases for you to repeat or taught you some deep breathing techniques to try in the moment. you’d be like, um, no thanks. that sounds weird and awful. i don’t write exams very often anyways, so take your weird mantras and awful breathing exercises and be gone.

i so wish i could take that approach, but here’s the thing: agoraphobics don’t have the luxury of taking that approach—at least for any extended period of time. while i can pretty easily avoid movie theatres or concerts for eternity with little consequence, i can’t avoid meetings, medical appointments, and public transit without incurring damage to my career, my health, my relationships, and, most importantly, my quality of life.

that’s why CBT is critical to recovery from agoraphobia: it provides a structured, gradual approach to facing the situations that cause fear and severe anxiety, or those that have perhaps been avoided altogether for years. and it truly is weird and awful at first, but the more exposure you have to these situations, the easier they become to endure. and then, one day, you don’t feel like you are “enduring” anything anymore. you have managed to reframe the situation for your brain as safe and non-threatening. yay! your brain stops being an overzealous dick and your world gets a little bigger.

right now, i would say that my world is big enough that i can do most of the things i need to do: ride public transit, go to work, go to class, and even the odd social event. but there’s a lot missing from that list that i want to do. more on what those things are next timeImage result for smiley face emoji

redefining strong

While today may be the only day of the year that some people talk, think, and learn about mental health, for myself—and many people like me—these activities are ingrained in my daily life. I’m not actually sure if I could imagine an alternative reality in which mental health issues were not a constant presence in my life.

I’m always taking in new information on mental health issues, be it through self-help books, blogs, social media, podcasts, and presentations. And likely due to the very personal nature of these issues, this information is typically framed in the context of the author’s own experiences.

Lately I’ve noticed that these stories often share a common, somewhat linear narrative: The author struggles, receives a diagnosis, seeks treatment, faces a few setbacks, but ultimately perseveres. They are usually living “symptom-free” at the time of sharing their stories, writing from a position of strength, hindsight, and wisdom.

Perhaps it isn’t surprising that these are the stories about mental health that we are often told, and that these are the people who often tell them. Most obviously, people love a good redemption narrative, and people want to take advice from others who have been successful in overcoming the challenges that they themselves are currently facing. It’s also easier to write from a position of strength—it’s easier to craft a narrative when you know that all the loose ends will eventually become tied.

That said, another explanation comes to mind: People with mental health disorders often don’t give themselves permission to do things until they are “better”.

I relate so strongly to that statement. I constantly define my current state as “mentally unwell” or “not normal”, and then make judgements on what I can or cannot do in my current state—and what I will do once I’m better. I’m not even sure I know exactly what better means, but I have made myself dozens of promises that hinge on me being just that. Once you get better, you can take that class. Once you’re anxiety-free, you can book that trip. Once you’re normal, you can start that writing project.  

I can’t even count the number of times I have snatched an idea out of Mentally Unwell Mercedes’ hands and said, “You don’t deserve this. This is for Mentally Well Mercedes”.  

It’s taken me a while to come to this conclusion, but fuck that shit.

And so, here I am, handing over that writing project I was saving for another version of myself for two reasons: Because I am capable of creating the content I want to see and because I believe that doing so could make the world a better place in a small way. Because even though I struggle with severe anxiety every day, I can still write about my experiences from a position of strength. And by doing so, I believe that people with or without mental health conditions will begin to understand that we are strong—no matter where we are on that so-called pathway to recovery and no matter where we end up