Energy Crisis: Depression Episode (Depressi-sode (di-ˈpre-she-ˌsōd))
In which I read some trauma books and visited a psychedelic therapy clinic
It’s been a moment. Been in a depressive episode, so I’m glad to be back at it.
The Great Downregulation is finally happening. These past two months have been the most secure and quiet that my spotty memory can recall. Plus I went to a psychedelic clinic this week, so I wanted to take an inventory of how I’ve been faring.
Still don’t seem to have that much energy. I cleared most of my social calendar in August so that I could get some rest. After months of practising sleep restriction in the evenings, I’m now allowing myself to either nap or just close my eyes after work. Been changing my substance use to enhance sleep.
Bought nicotine vape juice with half the concentration. Brewed mostly decaf lattés in the last month. Spread out my ADHD meds throughout the day. Stopped using my sleep mask in the mornings, so now my circadian rhythm is back in line with the sun, waking me up at 7 consistently. Sleep debt still bouncing between 15 hours and 8, so need to keep working on that. I’m starting to use Benadryl as a temporary sleep aid.
I stopped going to trauma therapists some years ago in favour of working on more present day issues, so it’s nice to be back in the general vicinity. I still talked and wrote about it a lot throughout that time in an indirect way as I explored other topics like Attachment Theory and ADHD, so it may not seem like I’ve been that removed.
Finished reading “What Happened To You?” a couple weeks back.
One of the most important lessons I learned was the concept of therapeutic moments, directly engaging with the pain in short spurts. The key point that spoke to me was that therapeutic moments should be rather short in duration, on the order of a few seconds. It’s the individual brick used to rebuild boundaries, and it takes a ton of therapeutic moments to heal from the emotional wound. Healing day by day, slow and steady. Damn. The alternative is retraumatizing by diving in too deep, so yeah.
Dr. Perry illustrated the concept of therapeutic moments with the story of a thirteen-year-old boy who had a severely painful childhood. Mom was depressed, father abandoned them, foster father was so abusive he trafficked him and gave Jesse a head injury that landed him in the hospital with a coma.
When all of the conventional means of treatment failed to produce results, someone on Jesse’s treatment team suggested placing him in a retirement community, where he would eventually work as a transportation aide. He helped the senior residents around the facility, and they could use the camaraderie. After years of providing support, he eventually earned a promotion, which included room and board. He even enrolled in a vocational school after he graduated from high school. With the many interactions throughout the day from solving technological problems, taking people for walks, listening to their stories, etc., he was able to form dozens of supportive relationships with a diversity of community members. Over the years, he experience thousands of therapeutic moments, and his functioning returned to average for his age in a shorter time than anyone expected. Quite the turnaround for such a bleak start.
Therapeutic moments taught me to not engage too deeply in emotional processing for too long; wish I heard that years ago when my ADHD time blindness tangled with my complex trauma. If the pain is massive, you can’t rush it. Like healing from a physical wound, it’s a rather slow process with no option to accelerate or bypass it, and you need weeks or months to fully heal from even a minor surgery. Jumping in too deeply is like picking at a scab or some stitches, causing the body to restart the healing process.
Great book with valuable learnings and a format that’s easy to follow. Highly recommended.
Picked up “The Body Keeps the Score” again. Keeping a pretty good pace by reading it right before bedtime, which has improved my sleep.
Sometimes it feels like Bessel van der Kolk is speaking to me directly. Don’t tell my high school English teacher, but I’m going to quote a bunch of passages that jumped out without much commentary.
Recovery from trauma involves the restoration of executive functioning and, with it, self-confidence and the capacity for playfulness and creativity.
Traumatized people are often afraid of feeling. It is not so much the perpetrators (who, hopefully, are no longer around to hurt them) but their own physical sensations that now are the enemy. Apprehension about being hijacked by uncomfortable sensations keeps the body frozen and the mind shut. Even though the trauma is a thing of the past, the emotional brain keeps generating sensations that make the sufferer feel scared and helpless. It’s not surprising that so many trauma survivors are compulsive eaters and drinkers, fear making love, and avoid many social activities: Their sensory world is largely off limits.
After trauma the world is experienced with a different nervous system. The survivor’s energy now becomes focused on suppressing inner chaos, at the expense of spontaneous involvement in their lives. These attempts to maintain control over unbearable physiological reactions can result in a whole range of physical symptoms, including fibromyalgia, chronic fatigue, and other autoimmune diseases. This explains why it is critical for trauma treatment to engage the entire organism, body, mind, and brain.
If you feel safe and loved, your brain becomes specialized in exploration, play, and cooperation; if you are frightened and unwanted, it specializes in managing feelings of fear and abandonment.
However, processing by the thalamus can break down. Sights, sounds, smells, and touch are encoded as isolated, dissociated fragments, and normal memory processing disintegrates. Time freezes, so that the present danger feels like it will last forever.
Constantly fighting unseen dangers is exhausting and leaves them fatigued, depressed, and weary.
People with PTSD have their floodgates wide open. Lacking a filter, they are on constant sensory overload. In order to cope, they try to shut themselves down and develop tunnel vision and hyperfocus. If they can’t shut down naturally, they may enlist drugs or alcohol to block out the world. The tragedy is that the price of closing down includes filtering out sources of pleasure and joy, as well.
People who cannot comfortably notice what is going on inside become vulnerable to respond to any sensory shift either by shutting down or by going into a panic—they develop a fear of fear itself.
Because traumatized people often have trouble sensing what is going on in their bodies, they lack a nuanced response to frustration. They either react to stress by becoming “spaced out” or with excessive anger. Whatever their response, they often can’t tell what is upsetting them. This failure to be in touch with their bodies contributes to their well-documented lack of self-protection and high rates of revictimization and also to their remarkable difficulties feeling pleasure, sensuality, and having a sense of meaning.
Numerous studies of disaster response around the globe have shown that social support is the most powerful protection against becoming overwhelmed by stress and trauma.
Sounds a lot like me in my mid-20’s. Proud to say that these excerpts don’t describe me completely anymore, but they do show up a lot. My self-confidence has grown significantly. I’m playful, creative, inventive. I still enlist substances and activities to numb my senses, but I’ve decreased my alcohol and binge eating by a lot. I can tolerate uncomfortable emotional sensations for longer. And now I lean more readily on social support rather than solo alternatives to regulate my mood.
Still have another third of the book to go, but it has been an enlightening read. Refreshingly takes a lot of burden off of me and back onto what happened to me.
Reading on complex trauma recently has gotten me thinking about my overall recovery, and it feels like I’ve only just been able to achieve stability, which has felt quite brief. They talk about healing and post-traumatic wisdom. lolwut. Is that even a thing?
The complex trauma books have expanded the amount of the grace I need to give myself. Looking back over the few months, it’s discouraging how drained I’ve been, but on the brighter side, each day where I don’t encounter toxic stress is a massive victory. So struggling through fatigue is far preferable even if it feels awful. For all the things that happened to me, including the things I did to myself in trying to deal with it all, I think I’m managing pretty well.
That’s the reason I started vaping, as an acknowledgement that I don’t have enough willpower to get myself out of this mess. I’ve had a lot of fun this summer, and now I just want to wind down and sleep. I did straight talk therapy for a long time, and now I’m a couple years into my drug era. Without a more supportive tribe with which to co-regulate, this is how it has to be.
Mindfulness and meditation always seem to be the answer to how to self-regulate, which is annoying. It feels like it takes so many deep breaths to really calm down. Alas, I’m giving in and finally doing the thing that’s supposed to help me the most. Humbug. After putting it off, I’ve finally found a place to fit it in to my everyday experiences, so that’s more progress.
Despite my energy being lower than it was when I was powered mostly by fear and anxiety, it’s also grown from where it once was since starting therapy. I’ve taken two weeks off from all kinds of physical exercise, so starting slow again with 10-minute yoga sessions. I must harness the power of saying no, which was dangerous for Young Jon. Have a book picked out for that too.
Silence is one of my triggers. Yeah, it’s wonderful. That’s what happens when you grow up in a dysfunctional home with constant fights that never resolved but were simply replaced by the next argument. Fear of silence has made me a great employee and roommate. 🙄 I’m learning to turn silence from an enemy into a friend, microdosing it in the Therapeutic Moments tradition to get closer to autonomy and restore executive functioning. Fuck, this is gonna take forever, if it even happens before I hit the dirt. Thinking about healing feels foreign and distant because I’ve been in the process of stabilizing for so long. Healing would be great, but damn, it feels far away.
Down the K Hole
Met with a psychiatrist at the psychedelic clinic. They guide trauma victims through exposure therapy while using ketamine to prevent emotional arousal. It’s considered an off-label use, but many studies have shown it can produce long-term improvements if followed up by other treatments. That is, psychedelic therapy isn’t a magic bullet. The benefits drop off beyond six sessions, so that’s the max that this clinic offers.
After submitting an application form last month, they called to evaluate whether I’d be a good candidate. Then they set up an appointment with a psychiatrist for a deeper assessment of how I’m doing, what I’m looking for, and if my overall health or medications would conflict with the ketamine.
The appointment involved me recounting my story, which is always enjoyable. At a high level, the general state of medicine means that people who suffer with mental health issues have to put on a performance of their disability for people to believe them. Psychiatrists sit somewhere in between the realms of physical and mental health, closer to the former than the latter, a doctor/pharmacist hybrid.
The last time I saw a psychiatrist, they said I seemed fine and didn’t need what they could offer, which was in the midst of one of my lower periods during The Struggle. I’ve typically favoured psychologists, who fall more on the mental health side, but my current condition requires something stronger than what I’ve been doing. I don’t know exactly what I might need, so this is just one guess.
In the end, I was approved to proceed with the ketamine-assisted therapy whenever I was ready. Could start as early as Monday. If and when I proceed, they recommended not taking my ADHD meds beforehand because ketamine, which is a horse tranquilizer, mixed with stimulants could interact in undesirable ways.
I originally thought I didn’t want to proceed because of the cost, but now I’m thinking that I should at least try one session. Maybe in the new year when my insurance refills. What else in everyday life costs more than $1000? Rent, cars, bikes, phones, tablets, laptops, vacation getaways, winter jackets. Seems like an easy comparison for the long-term benefits of treating trauma, even if it’s about five times the cost of an hour with a psychologist. Feels like a problem for Future Jon to worry about. At the very least, I need to get back to a trauma therapist in the meantime.
I’m so tired. Resting finally. Simultaneously reducing and increasing drug use. Sleeping better but still room to improve.
Trauma books be hitting the spot and helping me to fall asleep. Incorporating therapeutic moments to microdose silence and emotional pain.
Considering trying out ketamine-assisted therapy at some point. Gonna start looking again for a psychologist that treats trauma.
Now I’m gonna go lie down.