Image from: socialworkftw.com, designed by Eve S. Parker and adapted from Linehan, M.M. (1993), Cognitive Behavioral Treatment of Borderline Personality Disorder.

A “Depression Chain Analysis” – in other words, my attempt to dissect the latest depressive episode

You’re so negative about yourself. It disturbs me… If you’re positive you will feel/act, BE positive…and that will affect your life in positive ways.”

This is what a very wonderful, well-meaning cousin wrote me a week or so ago, trying to boost me up after reading one of the darker articles posted here. Now admittedly, my cousin qualified this with some very kind sentences and attempts to impart wisdom. But what my cousin and many others who haven’t experienced “mental illness” don’t seem to understand is that I can’t simply turn my negative thoughts off with the flip of a switch. It doesn’t matter how many times either myself nor others attempt to tell me I have value, am a good writer, have something to offer this world, etcetera, when I’m entering a dark period. Instead my mind will hone in on the cold hard facts of what I am increasingly coming to view as a rather pathetic existence. [Don’t get me wrong – external validation helps me immensely – keep it coming 🙂 !]. But unfortunately when I’m in a bad place, my mind forgets the affirming things people have said and hones in on the negative parts of my life;  I interpret and magnify what would likely be minor events or circumstances, for others, in weird warped ways. Ways that can, in certain circumstances, culminate to the point where all of sudden I’m sitting at the bottom of a deep depressive well, trapped in the dark, with no rescuer in sight.I mention the not-gettingness of the above quote because it seemed a fitting preamble to a piece I’m going to write now on how a relatively good week mysteriously – or so it appeared at the time – turned into a very bad weekend, all in the blink of the eye.I’ve been more stable lately – well, relatively speaking – in regards to my mental health. Last Friday, however, I was felled by a major depressive episode. The swiftness and sniper-like precision with which this depression struck both surprised and put me down-for-the-count for two solid days. It also sent me into another wave of suicidal ideation and thoughts of the like of “Why do I even try?…. Clearly my life is purposeless…” etcetera…

When I take the time to think about things after such episodes, I can sort of generally and vaguely pinpoint a couple of triggers. This time around, I could immediately identify the final trigger but it was minor and didn’t seem to explain the gargantuan force and weight of this particular mood.

And so later, when I started breathing air again and could think more clearly, I thought it might be helpful if I once and for all started identifying precursors to my episodes, and then set down in ink the types of circumstances, events, behaviors and circular reasoning that slowly build and culminate into tsunamis of depression that have me sleeping on my couch for two days. Maybe, I thought, if I wrote this type of thing down here, on this forum, it might also help others understand the very subtle events as well as bizarre interpretations which can cause someone like me to go from a week of ok-ness -and even nascent hope – to a total white-out of those fleeting lights.

Anyone who’s participated in a DBT (Dialectical Behavior Therapy) program, or a treatment center that employs this modality (and most of them do these days), has likely been asked to perform what’s called a “Behavior Chain Analysis.” This is an exercise, developed by DBT founder Marsha Linehan, intended to help clients gain more awareness into the string of events, thoughts and emotions that lead up to one’s acting out on a “problem behavior” – such as substance abuse or an eating disorder – as the professionals so empathetically [read: sarcasm] like to call such actions. (A more apt and less shame-inducing label for these behaviors, I believe, might be “coping behavior.”) I realized this “Behavior Chain Analysis” exercise could be just as easily translated to dissecting depression – and hopefully therefore help me ward off that Black Hole which seems to always lurk around the corner, ready to swallow me up. Particularly since such episodes do, for me, sometimes end in a “problem behavior” – such as not eating, or having three drinks instead of one (enough to get me drunk), or – worst of all –me sending off a nasty email to a loved one which attacks and hurts them in ways they least deserve.

Above you see a diagram summarizing the main components of a Behavior Chain Analysis. Normally, when performing this exercise, clients are instructed to describe each component in painstaking detail. For the sake of time, space and your attention span (which is probably already waning), however, I will attempt to provide a briefer dissection for you, saving the more detailed version for myself.

THE LINKS THAT FORMED THE CHAIN

It was a Friday, and I think first and foremost, the fact that I was physically exhausted and completely run-down from sleep-deprivation, dehydration, working late into the night (because that’s when my mind is at it its quietest, self-hate-wise), and probably not eating enough the two days prior put me in a high state of both physical and emotional vulnerability.

There were also a variety of emotional stressors – some recognized, some not – that had been accumulating that week, including a few days of extremely high anxiety induced by a literal $0.00 bank account balance as I waited my SSDI check. While my family eventually helped me out a bit so I could get by until Friday, that stress took its toll – including the shame that came with taking additional money from my family, who are already helping pay part of my rent. Then there were the sort of vague, suppressed, unnamed emotions that had been circulating around in my mind – the links, so to speak: humiliation and rejection prompted by few visitors to my Web site last week – nor anybody’s efforts (save my mother’s) to share the site with others. There was also nearly no response to an email I sent out to about 70 people about a subscription option for notifications related to this Web site. Then there were the three close friends – or so I thought – who had failed to even acknowledge, “like” or comment on the Web site that I’d been subconsciously fretting about for weeks. This all just exacerbated the lurking suspicion I had that only a few, kind-hearted friends and family members were visiting the site out of pity, posting comments merely to make me feel better, but that nobody really took it seriously.

And I want it taken seriously. It’s not just a “blog” to me, you see; it’s my attempt – however unlikely – to reclaim some journalistic or at least writerly legitimacy.

When I finally got home from all the errands I had to run Friday (because my SSDI money finally came in), it was about 7 p.m., and I simply didn’t have the energy to make dinner, since dinner – and it’s clean-up – takes me forever (the eating disorder thing). And so I had a drink – ok, actually, I had two, because I was unusually anxious and demoralized – and I had the drinks on an empty stomach as well. I did make some coffee and snack a little here and there, but I didn’t consume the actual meal I usually do to prevent my buzz from lasting more than an hour or so.

In short, both my physical and emotional vulnerability – the first realm diagrammed above –was, as you can see, rather high Friday night.

As I was putting away food and household essentials I’d gone days without, making coffee, and “snacking,” I also had Bill Maher on in the background. All of a sudden I see Ben Affleck getting into a heated debate with Maher and some other guy about the portrayal of Muslims. I was interested in the debate but what moved me was Affleck’s passion – and the fact that he had a huge audience of cable viewers before which he could express that passion. I started stewing a little – not too much, but a little – over the fact that I’ll never have that kind of platform, much less an audience beyond my tiny circle of friends and family, because I’m “mentally ill,” poor, and not famous. I started internally muttering about how unfair it was that simply money, celebrity or sociopolitical power gives someone a voice in today’s world, regardless of their intelligence or credentials (don’t get me wrong, I think Affleck deserves his platform – but a lot of others who have a Voice our society don’t.) I started remembering how powerless and voiceless I am, in this world, and those feelings as well as some anger about this blended in with all the others that had been floating in my brain the past few days.

And then came the final trigger, or “prompting event,” as DBT lingo puts it: A dear friend – and the only person to do so, on top of it – purposely unsucbscribed from the site’s email list – even though no one I’d sent the aforementioned email to was subscribed in the first place, as I had explained in the note. I happened upon this discovery by mistake. I was simply checking MailChimp (the free, online subscription platform) – which I was still familiarizing myself with – clicked some button, and saw a newsfeed of sorts. Which is where I saw my friend listed as the only unscriber, and since she has a photo linked to her email address, her face was there staring out at me as well. To me, at the time, the message was loud and clear. My friend was looking me in the eye and screaming, “Stop bothering me with your silly, amateur (not to mention pathetically sad) Web site already!!!” And she was screaming this as a representative for all the 70 people I’d sent the notification to. Thus confirming, without a doubt, that my Web site was widely seen as a joke.

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14 comments

  1. LaDonna says:

    Love this! so insightful and practical. I want to remind you that you are ALREADY a voice to contend with. As for income streams: dog walking- babysitting- house cleaning- house sitting- offering to help an elderly person with household tasks- english tutor – writing tutor- check out CL under gigs, often people post those kind of things there.

    keep writing friend, the world needs your voice. : )

  2. Debbie Wilson says:

    Hi Jeanene, it’s your aunt, Debbie. The articles you’ve written so far on this blog, have been anything but boring. I look forward to reading everything you have to write. I know my manageable deppression, can not compare to your struggles. But I can relate to much of what you feel. The only thing about your writing that
    is hard, is hearing you put yourself down so much. I have held back on making any comments because first of all, I can not write and am embarrassed by it. But, because of my concern and love for you, I am writing this now. I also hesitate to say anything because you will not take my compliments without feeling that they are only trying to serve the purpose of cheering you up. You have absolutely no idea what a gift you have. I am an avid reader, and you surpass many writers. I may not be able to write, but I can tell bad from good. I know though, that It wouldn’t matter who praised you, you would still not feel good about yourself. You have always been a lovely person. Uncle Craig has a very special place for you in is heart, and always has. Mental illness is worse than any other disease, and ones that have never felt it, can not possibly understand, even though we so desperately want them to. It is not there fault and the best we can hope for is that they will just be there for us, and realize that parts of our personality is the disorder and not who we really are.

    • Jeanene Harlick says:

      Thank you Aunt Debbie :-). Your comments touched me so much that I am going to respond to you separately via email — so a note will be coming to your inbox soon! I truly appreciate you reading my stuff and everything you said above — you have no idea — but want to convey my thoughts more effectively when I’m not rushed, and respond to some of your comments as well, so hence a coming email…

  3. Debbie Wilson says:

    Oops, I hit send too soon. Keep up the good work. I think that you will help many with your website and am so hopeful that you too can find help. It is never too late! Don’t forget that we are always here for you. Looking forward to seeing more of your writing

  4. Sarah says:

    Jeanene: I read this over the weekend and was amazed. You are doing one of the hardest things in life: telling the truth. I think it will help you and many others too. It definitely helps me! The only advice I have is to try not to look at your traffic/subscribers/comments/social networks– just do your work and let go of the rest. Go Jeanene!

  5. Eileen says:

    Jeanene, Wow! It is hard to put my reaction to this article into words. The bold honesty and helpful DBT information touch my heart and encourage me. BCA is something I have found helpful. (I am just beginning to apply DBT into my life) Please continue your blog regardless of the feedback. It is voice for many who don’t have your descriptive skill.

    Your blog is interesting, informative and brave. Congratulations on achieving so many things in one place.

    Your article impressed me in several way but mainly because it included many twofers – two things at the same time. This is rare and I respect your ability and effort!! These are just a couple of examples of what I am talking about: You are self-aware and honest. Those 2 things are difficult to put in the same sentence, let alone into one person. Especially when mood issues are involved. You are doing research and applying it to yourself. ( in your article and the blog itself) Also 2 things that I rarely see together. You are acknowledging your challenges and doing everything you can to overcome them. YAY!! (For your perseverance) You are sharing in a place where others, who have no idea of what you are dealing with will give you feedback about your situation – not all of it will come across as sympathetic because of their lack of experience. This is a very brave thing to do! I am so proud of you! You are rare and special.

    • Jeanene Harlick says:

      Eileen — meant to reply to this comment sooner! Thank you thank you thank you! You make me see myself in a different way. Thank you for taking the time to express such insightful things in such eloquent words — and to be so generous in your kind words for me. I think you give me too much credit — but your words give me strength nonetheless. I’m glad you’ve discovered DBT yourself too. It is quite a popular therapy nowadays, at least in “treatment world.” There is also a similar modality called Acceptance and Commitment Therapy that is gaining more of a following — have you heard of it? It draws on some DBT philosophy but adds new things as well. At any rate thanks so much for everything. Everyone’s comments here mean a great deal to me.

  6. Kay says:

    Jeanne,

    Your article has given me a lot of insight into the problems
    a dear friend of mine is experiencing. Please keep writing.
    It is so very informative.

    Thank you,
    Kay

    • Jeanene Harlick says:

      So glad it helped Kay. Thank you for visiting, and reading. You can always email me personally too if you think I might have additional thoughts about what your friend is experiencing… It’s good to hear from you and I hope you’re well.

  7. Renee says:

    Hi Jeanene,

    Your article was excellent. You have a wonderful way of being honest about all that you are going through. I’ve also had family members that have struggled with mental illness and it is so important to forgive yourself and as you said “do no further harm”. I know how hard it is to get to an OK place when we are feeling sad and self destructive. Try to remember that suicide is a permanent solution to what may seem like permanent problems (but they do pass), and although I’m sure when you are in the dark places it’s hard to remember that. It sounds like you are doing much self reflection and making many strides to help yourself when the little triggers start piling up. I truly think that will help you. Also, reach out and try to build on making contacts to have a support system. LOVE yourself one day at a time, sometimes one second at a time is necessary. All the little steps you’re making will string together as the days go by. As you said, people are busy and sometimes people just do not know what to say or do when their loved one is struggling so much. Try to realize their limitations are not all about you…we all have our issues we are dealing with on a daily basis too. Hang in there and continue your writing as it has a very therapeutic effect on most of us.

    Love and Hugs to you,

    Renee

  8. Char says:

    Jeanene, Thanks again for writing. I see myself in your words so much. I’m a bit older than you, so that might be the reason that for the most part, that I stopped caring what people think of me. I’ve spent far too much time feeling badly about what people (who do not matter to me in the grander scheme of my life) have said and think about me. They are people who are decent human beings, but who have failed miserably as friends. I think that’s a big deal. Being a good friend is priceless and matters to us when our abject despair arrives to drive the wedge of self-loathing and disappointment at life into our hearts and make us wish we were instead dead. Also don’t give up on love. I didn’t find it until I was 55 years old, but it has been worth the wait. The man I love and who loves me, gets me, especially in my dark hours. In fact he reaches for me then, when even I cannot pull myself forward. One of my boyfriends told me to call him when I felt better. You deserve love and you have love to give. I know this, because I read your blog. There is love for life in every line. I don’t always respond because I’m dealing with my own shit and I bet this is the case with others too. I just had another episode like yours as well. My prompting event would seem so minute to most people that they have judged me to be “too sensitive” and “take things too personally”. For one “friend” this was a personal affront to her. All I can say about that is that the people who most detest me for being “too sensitive” or “so angry” are completely insensitive and (I’m pretty sure) wish they felt more, and/or are so afraid of their own anger that looking at mine scares the shit out of them. So it’s easier to just reject me. I also think in time, you will have fewer episodes of saying hurtful things to others, as you will start to see you do it when your own pain threshold is too great to restrain yourself. We are suicidal because we turn all of this inward and want our selves to end. I lay awake nights beating the hell out of myself for everything I’ve said that even almost touches being hurtful. What I finally recognize in myself is that being hurtful is not the intent. Being heard is. People like to be right and they don’t like to listen. Finally, I want to say that yoga has helped me to, instead of internalizing my feelings or raging outwardly to some hapless family member or the meter maid, let it go. I know it sounds clique but it really does, and I’m not even that good at it. But, I do see a change in myself when I practice for even 10 minutes. I set the timer on the oven and stretch for five and breathe for 5. Sometimes it’s all I can do, but if I do it when I’m feeling okay, I’ve noticed I can calm down faster when I’m in the center of an episode.

    I don’t know you, but you feel like a sister. Keep writing the Microscopic Truth. It can be a lifeline for us who don’t have the guts, yet.

    Much love,
    Char

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