depression – Pamela Helberg

Each quarter, as I take new classes and learn new material, I analyze and diagnose myself accordingly. I generally text a friend of mine who is a marriage and family therapist (MFT) during class. Our exchange goes something like this:

Me: OMG, I so have this.
MFT: what?
Me: I wasn’t properly attuned to as a baby. That’s why I’m so fucked up.
MFT: gawd
Me: well, it could be that or it could be that I experienced a trauma as an infant.
MFT: maybe
Me: I was dropped on my head once.
MFT: well, that explains it.
Me: I know, right?
MFT: it’s just one lens, Pam. A theory.
Me: oh. Sorry for being so narcissistic.
MFT: You’re not a narcissist.
Me: borderline?
MFT: ugh.

And so it goes. Each quarter I learn new and fascinating ways to make sense of human behavior.

A few years ago, when I began working on my memoir, I asked my (by then former) psychologist if I could have access to my records. I wanted to reconstruct a timeline of events and double-check my memories. Since she had seen me through some of my darkest hours I figured I would find a good record of events that I had been too depressed and distraught to remember. And I did. But I also discovered how I had been diagnosed, and I found it all a bit unsettling to see the DSM codes next to the list of my symptoms.

If you read yesterday’s blog, Dear Reader, you know that I was depressed. So it came as no surprise when I decoded the DSM codes to find variations on that theme: major depressive disorder, recurrent episode; major depressive disorder, recurrent episode in partial remission; major depressive disorder, severe. And so on. I was fine with these diagnoses and also with the occasional Adjustment Disorder diagnosis that I found. I knew enough by then to know that when a mental health provider doesn’t know what else to use, when a client just needs to chat a bit to clear things up, they use the somewhat ambiguous 309.9 (Adjustment Disorder, Unspecified).

Diagnosing someone with an illness or disorder that appears in the DSM 5 is an art, not a hard science. This latest version of the Diagnostic and Statistical Manual is arranged quite differently from its predecessors with disorders arranged according to lifespan. So, disorders that affect children come first—neurodevelopmental disorders, followed by illnesses that appear in adolescence and early adulthood: schizophrenia and psychosis, depression, anxiety, OCD. These are followed by trauma related disorders, dissociative disorders, somatic (body disorders), feeding and eating disorders, elimination disorders, sexual dysfunctions, substance abuse issues, personality disorders, and paraphilia.

Gone are Axis I, II, III, IV, and V. Used to be that the most acute and familiar disorders—those requiring immediate attention fell under Axis I: schizophrenia, major depressive disorder, panic attacks; ongoing personality issues—narcissism, borderline personality disorder, intellectual disabilities, obsessive/compulsive disorder—fell under Axis II. Axis III was reserved for related medical conditions such as terminal cancer, which might contribute to a client’s depression. Axis IV diagnoses included life events: marriage, job loss, promotions, divorce, death of a parent or child, and Axis V is used for the Global Assessment of Functioning Scale, a 100 point questionnaire evaluating the client’s ability to function in daily life.

What we CMHC (clinical mental health counseling) students all learn early on in our clinical program is that diagnosis is a necessary evil if a mental health care provider wants to take insurance. Insurance companies will not pay if we don’t attach a diagnosis to our clients. At the same time we learn that our clients are much more than walking bundles of diagnoses.

The bottom line is that when a person presents in my office and tells me what’s going on in their life, how they are coping day-to-day, and want to pay for their sessions with insurance, I have to give them a diagnosis. One counselor I’ve talked to diagnoses everyone with PTSD. After all, she says, we have all had trauma in our lives. Others consult the DSM and match the client’s presentation with the best diagnosis.

Failure to attend to details? Difficulty sustaining attention with tasks? Often lose things? Easily distracted? Often forgetful? ADHD 314.

Heart palpitations? Sweating? Trembling and/or shaking? Shortness of breath? Nausea? Choking feelings? Fear of losing control? Fear of dying? Panic Disorder 300.01

Marked distress? Significant impairment in social, occupational or other areas but doesn’t meet the criteria for another mental disorder? Adjustment Disorder 309

When I left the psychologist and started seeing the counselor, I stopped feeling like a hopelessly troubled person and more like a person with some troubles that could be resolved. Instead of being treated for my “mental illness,” I was treated like a person and we looked together at why I might be feeling depressed or anxious or sad or worried. I began to see that my inability to come off my meds for depression had more to do with the fact that in my case, I had been treating the symptoms, but not the root of the issue.

Over time, I came to understand that my behaviors, moods, and thought patterns had more to do with how I had learned, over the course of the last few decades, to deal with the world. Starting in infancy we all learn how to get our needs met. Some of us learn to trust that we will be taken care of, that our needs are important, that our voices are valued. Others not so much.

There are many lenses through which to evaluate human behavior: family systems, attachment theory, behaviorism, post-modernism, Jungian. There are many schools of thought on how to best help people: cognitive behavior therapy, exposure therapy, psychoanalysis, narrative therapy, play therapy, art therapy, drama therapy.

There are a multitude of diagnoses I could apply to my future clients, but my clients deserve more than a label and to be compared against a checklist of criteria.

I must to remember Carl Rogers and not ask, ”How can I treat, or cure, or change this person?” But instead,“How can I provide a relationship which this person may use for [her] own personal growth?”

Fifteen years ago this week, I picked my eldest up from school. She arrived at my car sobbing, clutching what could only be a Mother’s Day art project, a gift wrapped with lots of construction paper, held together with even more scotch tape. When I asked her what was wrong, she explained between tears and hiccups that she only had time to make the one present. “But I have two mommies!” She whimpered. My heart broke into a million pieces. Gently, I took the gift from her hands and unwrapped it. It was a book. This was a problem easily solved. When I explained we could make a color copy, the relief on her face broke my heart all over again. We drove directly to Kinko’s. “See,” I said, holding up an exact replica, “One for me. One for Mommy M.”

Mommy Pam's Hair and Necklace; Mommy M's Eyes and Earmuffs — Mommy Pam’s Hair and Necklace; Mommy M’s Eyes and Earmuffs

Seventeen years ago, I sat weeping in my therapist’s office, terrified that I had made the biggest mistake of my life, certain that my life as a mother was over. I had just left my children, my partner and co-parent—my children’s other mother—had just moved out of our family home and into a tiny apartment, taking only my clothes, a CD player, and my 1964 Dodge pickup truck with its rusted out floorboards and no seatbelts. In a fit of youthful optimism I’d taken a job that would allow me to spend more time with our girls, keeping them out of daycare, a move that did not go over well with my co-parent. Long story short, she asked me to move out of the house, her house, launching us all into a long and painful custody battle. A war in which there would be no winners.

As I wept in that office, overwhelmed with despair, I could not visualize a way forward. I could not imagine life without my daughters, then six and two years old. We’d adopted both the girls as infants, first as single parents, then as a couple. We stood before the judge in the King County courthouse among family and friends and promised to be a forever family. Our names graced the birth certificates. Our little family seemed solid. I thought my decision to take job with more flexibility was the right one. My diminished salary would be made up in what we saved on daycare for our youngest and after school care for the oldest. We had worked so long and so hard to adopt the girls, had spent so many years dreaming this family into existence, it made no sense to me that we both worked full time and put the girls in daycare.

Full of bravado, and in spite of stern warnings from my partner, I had to follow my instincts as a mother. I had to do what I saw as the Right Thing. What did it get me? No house. No relationship. No kids. I thought, naively it turns out, that being a legal mother of both girls would grant me the right to be a parent, at least half time. Not so. While heterosexual divorced couples with children automatically get kicked into a custody process, “divorced” lesbian mothers, at least in 1996, got nothing. There was no divorce because there had been no marriage. Our commitment ceremony, while a fun little ritual, had no legal ramifications. Really, all that seemed relevant at the time was the fact that I did not have my name on that house title. I had to move out. Having no legal access to the house meant I had no access to my kids. I had no idea when I left that my soon-to-be ex would bar me from seeing our kids, that once I was gone, she would attempt to erase me from their lives.

mothers day 5 — My mom works at Village Books. Her favorite food is spagetti and meatballs. She is very fun to be around. she’s tall and her hair is maroon color. She is very nice because she buys me ice cream.

My days suddenly silent, my nights stretched out empty, I spiraled into a deep depression. My identity as a mother slipped away. No diapers to change. No breakfast to make. No lunches to pack. What was I, if I wasn’t a mother? Everything I had been, I’d given up in our pursuit to adopt our girls, to be in this relationship, to become a family. One social worker along the way even commended me for giving up on being a writer and getting a real job. I’d sold my bookstore. I had become a Mother, and I loved being a Mother so much that I wanted to spend more time with the girls. That love had led me to here. To nothing, it seemed. If I couldn’t be a mother, then maybe I shouldn’t be at all. I thought about moving away, just leaving town. I flirted with razor blades and alcohol. My therapist reminded me regularly and forcefully of the damage done to those left behind.

I decided to stay. In town and on the planet. I upped my antidepressants. I got a lawyer. I worked three jobs and went back to school. I found two housemates, asked my grandmother for an advance on my inheritance, and bought a house. I made a home. I fought to remain relevant in my daughters’ lives. Not one part of this journey was easy. Co-parenting with someone who would rather I just disappear, with someone who had to be court-ordered to share custody sucked, but it sucked so much less than not parenting at all. My legal and therapy bills grew enormous. When I cried and railed against the unfairness of my situation, my therapist told me how fortunate my children were to have me in their lives. When I couldn’t breathe because the initial child support payments I had to make were more than half my meager monthly salary, she helped me strategize a solution. When I despaired that I would have no meaning in, no impact on my daughters’ lives, she reminded me that they would come back to me, they would be in my life, maybe not the next week or the next month, but in a few years, when they were out of school, in their late teens and early twenties. Mothering meant showing up and reaching out, even when I didn’t think it would matter, even when no one reached back. Even when the next week, let alone the next decade, seemed impossibly far away.

But I did it. I showed up. At games. At concerts. At parent teacher conferences. Doctor’s appointments. Most of the time, I felt awkward because the teachers, the doctors, the other parents didn’t know I even existed. I had to show up at the school with the Parenting Plan in hand to get my name on my kids’ emergency contact list. I had to request I be added to the PTA’s little booklet with the kids’ and parents’ names, phone numbers, and addresses. Every year. I had to introduce myself to coaches, principals, other parents. Sometimes, I missed events because I found out about them too late or was too embarrassed to call other parents to ask. The last time I called the pediatrician’s office to get information about my daughter’s medications they hung up on me, refusing to give me information even though my youngest was still a minor, even though I had the paperwork granting me joint medical custody. I had to take the parenting plan to the pharmacy to find out what medicine my child was taking. Often, I felt like a fraud, an imposter. So many times I wanted to give up, to crawl away in shame. The depression and suicidal thoughts stayed with me for years.

Still, I pressed through the fog and darkness. Even when I had to take a job 80 miles from home—I drove back three days a week, arriving in time to pick the kids up from school. I finagled time off. I found a way to be there. I got a MySpace Page. I got a Facebook page. I texted. I emailed. I called. I found a way. I made Easter baskets and bought Halloween treats, Valentines Day cards, swallowed my pride and left them on their front porch if I had to. And if my ex made other plans for Christmas Eve or Christmas Day, I had presents and stockings and dinner with the girls on December 23^rd. Because what day we spent together didn’t matter. First day of school? I showed up. The day my eldest left for college, I packed my mother in the car with me and we went along too. I refused to be erased.

And you know what? That decade passed and my girls are in my life. They finished high school. My eldest finished college. The youngest just started this year. These are the days my therapist promised. These are the days I couldn’t even imagine.

Happy Mothers’ Day.