A Good Skill Set For Depressives (With or Without Drugs)

I’ve been living with clinical depression for a couple of decades now.  It can be challenging terrain…lots of sheer cliffs and deep canyons that are way too easy to get lost in, especially in the beginning when they can feel inescapable..but after twenty years I’ve learned how to get around.  Mapped out the local territory, made friends with the natives, and built a beautiful life there that I really love and am deeply grateful for.

I’ve done it without antidepressants.  And before anyone gets their panties all in a bunch, I’m not opposed to pharmaceutical treatment. (I so dislike that whole battle.  It’s divisive, distracting, and a waste of precious resources.)  It’s just that, back when I slipped into my first severe episode, I didn’t know what was happening to me.  Depression wasn’t the by-word it is today.  It took a while just to figure out what I was dealing with and, once that became clear, I still couldn’t afford long-term, continued access to drugs.

So it was fortunate I’d already pieced together an alternate treatment plan that was working for me.  It’s complex, eclectic, and tailored specifically to my life and strengths, so there’s no point in going into detail here.  But there were a handful of important skills I had to develop in order to make the whole thing work and I suspect they might be helpful no matter what treatment plan a person turns to.  So just in case that’s true, here they are:


1)  Develop emotional endurance.  A lot of it.  Do exercises.

2)  Trust your instincts, you’re not crazy.  Some studies have suggested that depressives actually have a more realistic view of the world than non-depressives.

3)  Question your conclusions.  Depressives can take that aforementioned realistic view (especially in a severe episode) and translate it to mean everything is futile and unbearable when it’s not.

4)  Develop emotional endurance.  Really.

5)  Depression annihilates confidence so cultivate stubbornness instead.  (Desperation is also a surprisingly effective motivation for short hauls but it’s tough on the adrenals.)

6)  Did I mention develop emotional endurance?

And 7)  Look for light.  It’s a discipline that can save you.  If you can’t find any immediately, then hang on to memories of old light until you can.  Living with depression is a lot like living at night.  Colors fade out and disappear during a descent, and the whole world falls into shades of gray.  But once you figure out where to look and start to see them, the stars in there will knock your socks off.

The Pillars of Creation

copyright Dia Osborn 2011

Potential For-Profit Hospice Abuses

I just found this article on Bloomberg: Preparing Americans for Death Lets For-Profit Hospices Neglect End of Life

It talks about a disturbing possibility of abuse by some for-profit national hospice chains in their attempts to maximize profits at the expense of dying patients.  I don’t have time to comment on this right now (since I just finished my last post) but suffice it to say I’m glad this is being investigated.  Big Money realized there was a profit bonanza coming in end-of-life care back in the early 2000’s and positioned themselves by snapping up all the small hospices they could buy.  I felt deeply uneasy at the time because I worried they might start “streamlining” in order to maximize profits.

While things are never as simple as they appear, this seems to bear out at least some of my fears.  I hope this doesn’t turn anyone away from seeking hospice care.

One possible answer to the problem is a move to “concurrent care” where a person can receive both curative treatment and end-of-life care simultaneously.  I realize that might seem contradictory, but in two studies done by Aetna insurance where terminally ill patients were allowed both ongoing treatment and palliative and hospice care, it turned out access to both programs actually cut emergency room visits by half, and hospital and ICU visits by two thirds.  Overall costs dropped by almost 25%.  And most importantly, the people in the studies reported much higher levels of satisfaction with their care.

copyright Dia Osborn 2011

Going Light

John Grey, a thoughtful and entertaining blogger/smallholder over at Going Gently, mentioned in a recent post that “going light” is a Welsh phrase for the accelerated wasting process that happens during the last days and hours of dying.  During this time it often looks like they’re starting to disappear right before your eyes.

The phrase really struck me, not just because it’s the loveliest way of describing this transition I’ve ever heard, but because it’s also the most accurate.  That’s exactly what the rapid changes look and feel like with both the body and spirit of someone who’s dying.

I’m going light now, Ma.  I’m going light.


(Image: dan / FreeDigitalPhotos.net)

copyright Dia Osborn 2011

“The Good Short Life”

The New York Times ran a great opinion article by Dudley Clendinen last Sunday called The Good Short Life.  Great title.  It’s about just what it sounds like.

Mr. Clendinen has A.L.S., the best known of the motor neuron diseases which are generally held to be one of the most difficult ways to die.  It involves a gradual shutting down of the involuntary nervous system which, when left to its own devices, leads to a very, very slow suffocation.  The disease takes years to play out and is beyond horrible.

In the article he talks freely, openly, and gracefully about the good and bad involved with dying…and I love him for it.  He’s refusing to disappear into that cloud of gray mist where we so often relegate our dying–that place where we don’t have to see them or deal with them or think about what they’re going through.  Instead he’s speaking up (or writing up in this case), doing his part to maintain a normal, ongoing, comfortable chat about the whole thing.  About dying, that one other universal reality besides being born and drawing breath that we all have in common.

The article is two pages and worth a read.

He broaches a number of controversial topics including the overwhelming costs involved with long term medical care for a condition such as his and the moral question of who’s going to pay for those costs (…the respirator and the staff and support system necessary to maintain me will easily cost half a million dollars a year. Whose half a million, I don’t know…)  He also talks about the choice he’ll have to make about when he’ll die because that’s something those with a motor neuron disease always face; when to fight it, when to manage it, and finally how to either surrender or escape it, whether through the blessing of pneumonia or other infectious disease or a method more proactive.

Of course these are extremely loaded subjects to address, ones which tend to invoke some very strong emotions in people, but that doesn’t mean we don’t still need to talk about them.  Our medical system has advanced to the point where most of us are eventually going to have to face the same kind of choice as Mr. Clendinen.  A lot of people don’t understand this yet but most of us won’t just die anymore.  Medical advances have made it possible to sustain the barest physical functioning for indefinite lengths of time, usually far, far longer than anyone desires.  This means that sooner or later someone has to actively, consciously decide that we’re going to die.  Either we decide to forgo further treatments, our loved ones decide to withdraw life sustaining measures, or somebody else decides they’re not going to pay for it or provide us care anymore.

This is the darker underbelly–the turbulent, terrifying, whitewater rapids–we’ve created with our brilliant, modern, technological capabilities.  For better or worse, these are the kinds of choices that now go with the territory and we are all going to have to learn how to navigate them.  There’s no such thing as a gift–however miraculous, however blessed–that isn’t also accompanied by a burden of responsibility.  In this case we now need to learn how to bear the burden of miraculous choices.

Not everyone will agree with the particular choices Mr. Clarinden eventually makes–which is fine, everyone doesn’t have to–but we can all benefit from studying the way he’s willing to talk about them.  Each of us, when faced with the unique circumstances of our own dying time, is going to have equally difficult choices to make, and simply knowing how to talk about them with our doctors and loved ones will make them far easier for everyone to navigate.

copyright Dia Osborn 2011

Crisis in Paris: How Modern Telecommunication Technologies Saved The Day

Remember this?  Anyone?  Anyone?

(image by Stromcarlson)

Our daughter is in Europe as part of her post-college graduation celebration.  Should be wonderful, no?  Well, we all thought so during the six months of planning involved, but unfortunately the trip hit the rocks on the three-stage plane ride to Spain.

Beautiful Child of our Hearts planned all along to travel with a good friend who has a mild anxiety disorder.  This didn’t seem to pose a problem because, up until boarding the plane, Friend had always managed it successfully with meds.  However, all that changed with the prospect of hurtling approximately 12,000 miles through the sky in a giant toothpaste tube.  In spite of everything her pharmaceutical interventions had to offer, Friend still collapsed and wound up crying for the almost seventeen hours it took to get to Madrid.  Things were somewhat better on land, but by the time the two of them limped into Paris, Friend was experiencing a full-blown meltdown.  It was at this point we received the phone call alerting us to the fact that we now had a mental health/medical crisis on our hands.

Enter:  The godsend of modern telecommunication technologies.

I don’t remember now the exact sequence involved, but at the crescendo of the next three hours of crisis management we had myself in Boise, my sister in Seville, my wife-in-law in southern California, my nephew in southern France, Friend’s (frantic) father somewhere else here in Idaho, an airline phone representative who was God only knows where in the world, and of course our two, inexperienced travelers in a tiny, internet cafe/closet in Paris, all tied together by an intricate web of technology, working on the common goal of getting this fragile, at-risk, woman-child safely home.

Even in the midst of the major stress involved I was struck by how amazing it was; the bewildering complexity of communication taking place.  This was so not the world I grew up in.

We utilized telecommunications capabilities provided by Skype, Sprint, AT&T, Verizon, Telefónica, France Telecom, a couple of land-line phone providers, and whoever the telecommunications company is in Estonia.  There was a staggering array of computer and hand-held device makers involved as we all furiously worked online; talking to the girls, researching various train schedules and flight options, and firing notes and links off to one another through email and instant messaging capabilities.

Now, I’ve seen all the commercials.  I know that what we were doing barely scratched the surface of the mind-boggling communication possibilities available in today’s world.  But it was still amazing and miraculous and wonder-filled to me.  Twenty-seven years ago when I made my first trip to Europe, the only way to communicate en-route was with collect calls on an ancient system of randomly placed pay phones. Today’s situation would have been far more difficult (and terrifying) to negotiate back then.

My father-in-law regularly bemoans the way technology is taking over the world.  He feels that it’s gobbling up increasingly large chunks of our lives, smothering so many of the old pleasures that used to nourish our hearts and minds.  He thinks people should spend less time in front of a screen and instead get out in nature more, talk to each other more, read and attend lectures and go dancing more.  And he’s not wrong.  One of the modern disciplines we all need to develop is getting up out of the chair and walking away of our own volition.

That said, my daughter and her friend would have been in a lot more trouble than they were without all the advantages that have also come to us through technological developments.  There’s an old proverb that says something like Everything is both a blessing and a curse.  I think it’s always our job to reap the blessings while keeping an eagle eye out for the curses.

Long story short, together we found a way to get Friend onto a plane, out of Paris and…a mere twenty hours or so later…safely back home again.  Beautiful Child stayed behind in Paris, a little scared but stubbornly determined to see the city of her dreams anyway.  But finally, a bad case of bed bugs drove her out of the hostel in France and down to her aunt’s house in Seville for help with the infestation.  (A whole ‘nother episode of fiasco that deserves it’s own post.)  C’est la vie, no?

copyright Dia Osborn 2011