Understanding How My Mind Works

Having a chronic illness of any type generally kinda sucks. And when it’s a mental illness, there can be the added complexity of people misunderstanding what it even is.

For example: Some people may hear “depression” and think “sad all the time.” Or, they might hear “anxiety” and think “worried all the time.” And while these people aren’t totally off the mark, they’re kind of erasing all the nuance that’s actually pretty important. Because if the average person can’t recognize a mental illness when it’s affecting themselves or someone they love, there can be a lot of unnecessary suffering before treatment is finally pursued. Not to mention there can be a lot of misunderstandings when, say, a friend with depression turns down all your invites to hang out.

So, part of my hope with this post is that it helps others understand:

1. What it actually takes to be diagnosed with a mental illness.
2. What it’s like to live with (multiple) mental illness(es).

What I’m Dealing With

It’s really, really hard to recognize you have a mental illness when you’ve lived with it for most of your life. You kind of just assume that everyone else thinks and feels the same way you do. And that, well, they’re all somehow learning how to manage these hurdles and so can you.

Until one day…you realize that it’s not normal to think and feel this way. And that you can get help, and should get help. Because when you have a physical illness, the best way to take care of it is to go see a professional. So why on earth do we pretend mental illness should be handled any other way?

Besides, I think therapy is awesome. I genuinely recommend everyone try it out. Even if you don’t have a mental illness, it’s a great way to let out your thoughts and feelings to someone who isn’t a friend or family member. And then you can get some relatively unbiased feedback. It’s super cathartic when you find a therapist you gel with. And if you’re like me, you might finally get some insight into why your mind does what it does.

Which brings me to my diagnoses. Until I went to therapy, I could only suspect that I might have had depression at some point in my life. Otherwise, I was just there to process my realization that I was transgender. But as I continued going to therapy, it became clear that I was dealing with a lot more than I initially thought. And in hindsight, I can’t even believe I suffered for so long without recognizing that it wasn’t normal and I could get help.

In fairness, I do have several mental illnesses that kind of intertwine. To help you understand what it takes to be diagnosed with these conditions, I’ll be providing the diagnostic criteria used by mental health professionals (as listed in the DSM-5). Sorry for the walls of text coming up…

Major Depressive Disorder

Five (or more) of these symptoms should be present during the same 2-week period (with #1 and/or #2 being required for a diagnosis):

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation [pacing, fidgeting, or wringing of hands] or retardation [slow movement or speech] nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day.
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

These symptoms need to cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Generalized Anxiety Disorder

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

1. Restlessness or feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Obsessive-Compulsive Personality Disorder

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental or interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships.
4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values.
5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
8. Shows rigidity and stubbornness.

Some additional detail the DSM provides that seem very applicable to me:
“They may force themselves and others to follow rigid moral principles and very strict standards of performance. They may also be mercilessly self-critical about their own mistakes.”
“Individuals with this disorder are so concerned about having things done the one ‘correct’ way that they have trouble going along with anyone else’s ideas. These individuals plan ahead in meticulous detail and are unwilling to consider changes.”
“When rules and established procedures do not dictate the correct answer, decision making may become a time-consuming, often painful process. Individuals with obsessive-compulsive personality disorder may have such difficulty deciding which tasks take priority or what is the best way of doing some particular task that they may never get started on anything. They are prone to become upset or angry in situations in which they are not able to maintain control of their physical or interpersonal environment, although the anger is typically not expressed directly. […] Anger may be expressed with righteous indignation over a seemingly minor matter.”

And I hate to keep quoting directly from the book, but this whole paragraph is super me:
“Individuals with this disorder usually express affection in a highly controlled or stilted fashion and may be very uncomfortable in the presence of others who are emotionally expressive. Their everyday relationships have a formal and serious quality, and they may be stiff in situations in which others would smile and be happy. They carefully hold themselves back until they are sure that whatever they say will be perfect. They may be preoccupied with logic and intellect, and intolerant of affective behavior in others. They often have difficulty expressing tender feelings, rarely paying compliments. Individuals with this disorder may experience occupational difficulties and distress, particularly when confronted with new situations that demand flexibility and compromise.”

I also have Gender Dysphoria, but that’s pretty much summed up by me being transgender (and I explained it in one of my J.K. Rowling posts). My therapist and I have also suspected some other conditions, but I don’t seem to totally fit the criteria for them.

What Does It All Mean?

I have been regularly seeing a psychologist, have gone to Dialectical Behavioral Therapy, and have a psychiatrist. So all the talking, medications, and learning of coping techniques have helped me overcome a lot of the hurdles set by my mental illnesses.

But I still have plenty of bad moments and bad days, and during those times, my life can be a living hell. Not to mention, anyone I interact with can also feel hurt. Which makes me feel even worse, since I try my best to be a good and caring person, but it doesn’t always come out that way.

Here are some ways my conditions manifest in real life:

• My depression can make me tired and have no drive to do things, which means I might not keep up with household chores or might skip hanging out with friends.
• My anxiety (and OCPD) can make decisions difficult, even when it’s something simple like choosing a meal from a menu or picking an outfit to wear. Hell, this happened when I was child asked to pick out a Little Golden Book at the store. I couldn’t decide which I wanted, so we left without getting any of them.
• The perfectionism of my OCPD can mean I tend to follow the mindset of “do it right or don’t do it at all.” So I might hesitate to wish someone happy birthday if I didn’t do it on the day of their actual birthday. Or I give up on learning a new skill because I’m not immediately good at it.
• I remember my adherence to rules coming up when I’d play Yu-Gi-Oh! games with my friends. I became notorious for how often I pulled out the rulebook to ensure we did everything by the book.
• I also remember regularly getting into arguments with my friends about the most trivial bullshit you can imagine. I suspect it’s part of my OCPD and adherence to there being one right way of doing things.
• Because I have recurring feelings of worthlessness from depression and can be mercilessly self-critical from OCPD, I can go down spirals of self-hate that erode my confidence in myself and make me feel like nobody could possibly like me.
• In general, I feel like a very stiff person full of tension, both mentally and physically, thanks to a combination of my conditions. It makes me feel very awkward around others and like I can’t let loose.
• Sometimes it’s just hard for me to think. It’s a real problem when I’m trying to get work done and there’s nothing. It’s part of the problem with being in a job that requires creativity and critical thinking. If my mind goes blank or has trouble concentrating thanks to anxiety, then I’m kind of screwed until it passes.

I could go on, but I think you get the idea. Taking one of these examples by itself might not sound too bad, but when these types of things happen all the time, it can be terrible. It’s hard to feel like a normal, functioning person who can be a good friend and partner when this is all working against me.

I’m not trying to sound all “woe is me” or anything, but I just want to make it clear that it takes a lot of effort to combat all this each and every day. It can be exhausting to fight against the way I’ve automatically behaved for most of my life. Fortunately, even if therapy and medication haven’t “cured” me, they’ve definitely helped ease the load.

I guess my point is, keep this all in mind as you go about your life. There are many people like me who live with mental illness. According to the CDC, 1 in 5 Americans experience a mental illness in a given year. We’re all dealing with invisible conditions that can make us a little less pleasant to be around. So please be patient and understanding. You never know what someone might be going through.