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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by fallsfall on February 28, 2005, at 17:32:59
I have been severely depressed for 10 years (at least that's how long I've been diagnosed), and disabled from working for 8 of those 10 years. I've been hospitalized twice. I did manage to go back to work for 2 years in the middle, but I would say that I was still depressed when I was working.
My therapist and I have been talking about going back to work. I would like to go back to work, but I'm terrified to do so.
We talked today about what I'm afraid would happen if I did go back to work: I'm afraid I would crash again.
I quoted statistics: If you have had one episode of depression you have a 50% chance of having a second one. If you have two episodes, the chance rises to 70%. With three, it is up to 90%. [Take these numbers with a grain of salt, I don't remember what the real numbers are, but it is clear to me that I have a much better chance of having another episode of depression than I have of not having another]
I do believe that I will crash again. I think that I will crash sooner and harder if my life is more stressful (i.e. if I am working), but I think that I would crash again even if I never went back to work. So, for me, the question about going back to work seems to boil down to whether I can find a work environment that will be less likely to speed up and deepen the crash, and whether I can have a support structure in place to keep the crash from being worse than it absolutely has to.
My therapist wasn't thrilled with this thinking. He thinks (and he is probably right) that if I go into this expecting to crash that it will be a self-fullfilling prophesy. My argument is that I need to have contingencies for the real risks I would be taking.
He said that if he thought there was even a 50% chance of working triggering another crash that he wouldn't accept those odds. And here I am thinking it is more like 90% (How many "episodes" is 10 years? At least 2, but I would think more, since most "episodes" are more like 6 months).
That was validating in that I interpret what he said to mean that my fear about going back is valid (because I think there is a very good chance that working will trigger another depression).
So he is thinking that less than 50% chance of success (I believe he is defining success as no future crashes - I would be happy with having a period of working that is longer than my periods of depression) - he thinks that less than 50% chance of success is not good odds. I'm feeling very optimistic because I think there is a 10% chance that I won't crash again. This is an improvement from the 0% chance that I felt 1 1/2 ago.
But what kind of choice do I have? I only have one life. I can spend it being depressed because I'm not working/can't work/are afraid to work. Or I can hope for some good years and prepare for the inevitable crash.
Trying to believe that I will ever be "well" seems a lot like lying to myself.
I do understand that "90%" doesn't mean that I will get 10% better. It means that if you took 10 people just like me, 9 would stay sick and one would get better. Statistics are black and white: better, not better. I do know that there are shades of grey in getting better (hey, this is progress for me - I just typed the word "grey"... or is it "gray"?). So it really isn't as simple as 9 stay sick, one gets better. But the bottom line is that the prognosis isn't very good. But the prognisis for me being happy on disability for the rest of my life isn't good either.
I don't know what I'm asking here. But comments would be appreciated.
Posted by pinkeye on February 28, 2005, at 17:55:57
In reply to Prognosis, posted by fallsfall on February 28, 2005, at 17:32:59
I wouldn't be able to honestly predict your chances of getting depressed again.
But here is a line of thinking which might help you - supposing you have a huge tendency to put on fat - then it is almost sure you will become fat again even if you work your way and become very slim.But, chances does not mean you can overcome it. If you put in a monitoring scale in your house and keep watching your weight at a regular pace and go on a diet everytime you put on 2 lbs, then there is an extremely good chance, that you will not become fat again. and if you do become a little fat, you will be able to catch yourself and go back to becoming slim. That is what I do - I was heavily overweight 10 years back, and I slimmed down and have maintained my weight fairly stable for the past 9 years.
Same thing goes to getting depressed. As long as you keep working on it with your therapist and develop awareness of yourself and know how to prevent a major crash, you should be fine. Knowing that you have a tendency to become depressed, learn to recognize the first signs of depression in yourself and promise to yourself to act on it as soon as it starts.
The statistics are probably indicative of the factor, that most people when they become depressed, don't go on to develop a full fledged coping strategy for themselves and don't have an external guidance as much as they need. Depressed people are more likely to give up and not seek assistance when they need it. But if you want, you can beat the statistics.
Posted by pinkeye on February 28, 2005, at 18:06:12
In reply to Re: Prognosis » fallsfall, posted by pinkeye on February 28, 2005, at 17:55:57
You should see the movie Forrest Gump. Nobody would have even thought a guy with an IQ of 75 could lead a successful life. Draw inspirations from movies like that.
Posted by littleone on February 28, 2005, at 20:14:48
In reply to Prognosis, posted by fallsfall on February 28, 2005, at 17:32:59
Here are some very quick thoughts falls.
> My therapist and I have been talking about going back to work. I would like to go back to work, but I'm terrified to do so.
I don't think you've really clarified anywhere in this post whether you are thinking of full time work or part time. I've never worked part time myself, but I would think they would feel very different. Is it possible that your goal could be to work x hours per week rather than aiming for a full time job? I'm not sure if that would be feasible if you're getting some sort of disability benefits.
> So, for me, the question about going back to work seems to boil down to whether I can find a work environment that will be less likely to speed up and deepen the crash, and whether I can have a support structure in place to keep the crash from being worse than it absolutely has to.
>
> My therapist wasn't thrilled with this thinking. He thinks (and he is probably right) that if I go into this expecting to crash that it will be a self-fullfilling prophesy. My argument is that I need to have contingencies for the real risks I would be taking.I think you're being very smart and careful. It would be unwise to work towards these targets without a safety net/backup plan of some sort. But by the same token, your T does make a valid point.
I think it would be important to ensure that your safety net/backup plan isn't something that you will unconsciously aim for. That all parts of you realise that working is a more attractive option than the backup. I think that would take quite some work with your T. I would tend to think that then you won't be as likely to expect a crash. You will be more focussed on attaining your goals.
>
> But what kind of choice do I have? I only have one life. I can spend it being depressed because I'm not working/can't work/are afraid to work. Or I can hope for some good years and prepare for the inevitable crash.There are other options to working you know. Volunteering is one that springs to mind. And there are more informal work environments, eg tutoring kids, etc. Sorry, I'm not trying to invalidate you, just trying to broaden your options if you feel backed into a corner.
>
> Trying to believe that I will ever be "well" seems a lot like lying to myself.I must admit I did get a little lost with your %'s. So I'm a little confused as to what your T thinks your prognosis is like. But I hope he disputes this idea of yours. How can you continue therapy without hope?
Posted by Dinah on March 1, 2005, at 2:23:35
In reply to Prognosis, posted by fallsfall on February 28, 2005, at 17:32:59
In spite of all the percentages, you either will or won't have another depressive episode. But if you do, don't you think you have more coping skills and a better support network in place now than you did before you had this therapist?
I fully expect to have ups and downs (and some really low downs at that). But I'm less scared knowing that my therapist is willing to stick with me through the lows, and that I don't have to strike out blindly.
Actually, that's probably how I feel in my more cheerful moments, but I prefer my more cheerful thoughts for others, if not myself. :)
You know, I have this discussion with my annoyingly optimistic therapist from time to time. He sees planning and safety nets as negative thinking. I see them as sensible. We generally come to some sort of compromise where he manages to get from me that I'm merely making contingency plans, while I manage to get from him that flying without a net isn't something I'm comfortable with.
Can both of you be a bit right? (Although I must say I think you're more right. While it doesn't help to be paralyzed with fear, it helps a lot to figure out what you'll do in various possible scenarios.)
Posted by Daisym on March 1, 2005, at 10:55:35
In reply to Re: Prognosis » fallsfall, posted by Dinah on March 1, 2005, at 2:23:35
Falls,
I can tell you are in a terrifying place. If you define a successful recovery as going back to work, and you are afraid to go back to work, you begin to tell yourself that you don't want to recover and you are "choosing" to be depressed.
I know you have written about this before. But I think you are choosing "safety" and trying to prepare yourself for the bumps and curves that life always throws. That is not a "bad" thing. This is one of those situations in which there is no one right answer. I know you hate hearing that. Choosing to go slow, to make easy choices first, to give yourself lots of time...those are all wise things to do. Not giving up therapy, or your other supports is a wise thing to do.
We've talked about other options besides working -- that you can define successful recovery as feeling good about what you are doing with your time and who you are. Someone else suggested a few options. But the practical realities of being a grown-up mean looking at self-sufficiency at some point -- how do you meet your basic human needs for food, shelter and clothing. Again, there are a variety of ways to do this, you have to get to a place where you are comfortable with your choice, among the options.
The scariest part, at least for me, are those old expectations. I think sometimes I still think that eventually therapy will help me get back to who I was before I crashed, before depression was a part of my life. I have to stop and think, "no, I'm not going back. I'm going forward into a new reality where my old ways of doing things no longer work. I might not be a superstar anymore, but maybe, just maybe, I'll be truly happy with myself. Content instead of driven." Sounds very far away for me right now. But I know I don't have to be "all better" right away or all at once. I think Dinah is right -- you are both right.
Remember, baby steps.
(((Falls)))
Posted by fallsfall on March 1, 2005, at 11:04:04
In reply to Re: Prognosis » fallsfall, posted by pinkeye on February 28, 2005, at 17:55:57
Yes, I agree that being vigilant, and recognizing the first signs and taking action etc. are important. And I am convinced that it is easier to keep yourself from getting depressed than it is to work out of a depression. And this is what I'm banking on - that I can forestall the inevitable long enough to have some kind of a life in between crashes.
But you said "know how to prevent a major crash". I don't know how to prevent a major crash. I know that my current therapist is more "powerful" in this regard than my previous therapist. But I guess I really don't expect him (or me) to be able to prevent a crash.
Maybe I just think that there is to much work to be done still before I'm "strong" enough, or "skilled" enough, or "unbroken" enough to prevent a crash.
Posted by fallsfall on March 1, 2005, at 11:05:49
In reply to Re: Prognosis, posted by pinkeye on February 28, 2005, at 18:06:12
I do have a big enough ego to think that if anyone can beat this, it is me. And I have not given up. I'm just scared to death.
Posted by fallsfall on March 1, 2005, at 11:14:23
In reply to Re: Prognosis » fallsfall, posted by littleone on February 28, 2005, at 20:14:48
> I don't think you've really clarified anywhere in this post whether you are thinking of full time work or part time. I've never worked part time myself, but I would think they would feel very different. Is it possible that your goal could be to work x hours per week rather than aiming for a full time job? I'm not sure if that would be feasible if you're getting some sort of disability benefits.
>
*** I currently work 10 hours a week. I am on SSDI, so there is a limit to what I can earn without losing my benefits. There are programs (Trail Work Periods, and Ticket to Work) which help with narrowing the gap. But the bottom line is that there is only so much "easing into work" that can be done, and still be able to eat. I have an appointment with a Vocational Rehabilitation counselor next week (which is what has prompted this current panic).
>
> I think it would be important to ensure that your safety net/backup plan isn't something that you will unconsciously aim for. That all parts of you realise that working is a more attractive option than the backup. I think that would take quite some work with your T. I would tend to think that then you won't be as likely to expect a crash. You will be more focussed on attaining your goals.
>
*** You are pretty smart! This is what we have been working on. I believe that the depth of my depression is an unconscious mechanism for keeping me from the danger of working. We are working on "making the unconscious conscious" - which right now means becoming aware that I am convinced that I *will* crash again at some point.
> There are other options to working you know. Volunteering is one that springs to mind. And there are more informal work environments, eg tutoring kids, etc. Sorry, I'm not trying to invalidate you, just trying to broaden your options if you feel backed into a corner.
> >
*** I volunteered before I took my 10 hour a week job. But I feel that if I am *capable* of working that it is irresponsible of me to *not* be supporting myself.> I must admit I did get a little lost with your %'s. So I'm a little confused as to what your T thinks your prognosis is like. But I hope he disputes this idea of yours. How can you continue therapy without hope?
*** My specialty is confusing people with numbers... My hope currently is that I will have some good years before the next crash - that eventually my "good" periods will be longer than my "bad" periods. At this point, this is as good as it gets.
Posted by fallsfall on March 1, 2005, at 11:17:58
In reply to Re: Prognosis » fallsfall, posted by Dinah on March 1, 2005, at 2:23:35
> In spite of all the percentages, you either will or won't have another depressive episode. But if you do, don't you think you have more coping skills and a better support network in place now than you did before you had this therapist?
>
*** Absolutely. And this is the reason that I am even entertaining the idea of working again.> I fully expect to have ups and downs (and some really low downs at that). But I'm less scared knowing that my therapist is willing to stick with me through the lows, and that I don't have to strike out blindly.
>
*** I'm still working on this. My previous therapist rewarded independence with fewer sessions. The better I got, the less available she was. It is taking my current therapist a lot of work to convince me that he works under a different model.> Actually, that's probably how I feel in my more cheerful moments, but I prefer my more cheerful thoughts for others, if not myself. :)
>
> You know, I have this discussion with my annoyingly optimistic therapist from time to time. He sees planning and safety nets as negative thinking. I see them as sensible. We generally come to some sort of compromise where he manages to get from me that I'm merely making contingency plans, while I manage to get from him that flying without a net isn't something I'm comfortable with.*** Yes. And I think that we will get to such a compromise. But at this point, we're still pretty far apart...
>
> Can both of you be a bit right? (Although I must say I think you're more right. While it doesn't help to be paralyzed with fear, it helps a lot to figure out what you'll do in various possible scenarios.)
Posted by fallsfall on March 1, 2005, at 11:29:39
In reply to Re: Prognosis, posted by Daisym on March 1, 2005, at 10:55:35
> Falls,
>
> I can tell you are in a terrifying place. If you define a successful recovery as going back to work, and you are afraid to go back to work, you begin to tell yourself that you don't want to recover and you are "choosing" to be depressed.
>
> I know you have written about this before. But I think you are choosing "safety" and trying to prepare yourself for the bumps and curves that life always throws. That is not a "bad" thing. This is one of those situations in which there is no one right answer. I know you hate hearing that. Choosing to go slow, to make easy choices first, to give yourself lots of time...those are all wise things to do. Not giving up therapy, or your other supports is a wise thing to do.
>
*** I hate going slow. I try to equate it to being physically in shape. That there is only so much that you can do at first - that it is all cumulative and that you have to build the base first. But then I feel like a complete idiot that after 48 years I still don't have the skills to go to work.> We've talked about other options besides working -- that you can define successful recovery as feeling good about what you are doing with your time and who you are. Someone else suggested a few options. But the practical realities of being a grown-up mean looking at self-sufficiency at some point -- how do you meet your basic human needs for food, shelter and clothing. Again, there are a variety of ways to do this, you have to get to a place where you are comfortable with your choice, among the options.
>
*** I honestly don't see that there are options. Either I am "better" (working), or I am working on getting "better" (working). Some of this may be because my dad was very successful (so my definition of success is very high). Some of it may be because my mother never worked (but she has a very successful volunteer "career"), and my father puts her down all the time. I know I have a lot of work to do in this area.> The scariest part, at least for me, are those old expectations. I think sometimes I still think that eventually therapy will help me get back to who I was before I crashed, before depression was a part of my life. I have to stop and think, "no, I'm not going back. I'm going forward into a new reality where my old ways of doing things no longer work. I might not be a superstar anymore, but maybe, just maybe, I'll be truly happy with myself. Content instead of driven." Sounds very far away for me right now. But I know I don't have to be "all better" right away or all at once. I think Dinah is right -- you are both right.
>
*** But giving up on being who I was is part of what has deposited me here. And how do you work towards something if you don't know what the something is? So I'm working towards a goal of being "better" some (most?) of the time - but now my therapist doesn't like that goal... sigh.> Remember, baby steps.
>
> (((Falls)))*** Right. Baby steps for the 48 year old. (sorry... guess I'm still pretty upset about this whole thing...) I know you are right. But that is yet another thing I have to learn to do.
*** Hugs are always appreciated.
Posted by Aphrodite on March 1, 2005, at 13:37:51
In reply to Prognosis, posted by fallsfall on February 28, 2005, at 17:32:59
I was so struck by your post. The challenges ahead must be very daunting as our careers seem to be so wrapped up in how we see and define ourselves. Forgive me if I am remembering incorrectly, but didn't you once have a demanding, high-stress career? You've spoken vaguely about "work," but is there a particular kind of work you are looking for? Is the trepidation that you are planning to return to the kind of work environment in which you've crashed before?
Maybe this is an opportunity to do something different, a new path, a less stressful work environment with a supportive therapist to lean on.
I also want to mention that in my career, I work closely with Voc Rehab, and in my area at least, they are wonderful and very resourceful. You mentioned your worry in that regard. I've known many people who have been turned around by the Voc Rehab services, so I hope they are just as wonderful in your neck of the woods.
Further, you were quite eloquent about the fear of being self-sufficient and "well" and what that might mean for the support you get from your T. Could he promise you in writing or otherwise that you would be rewarded differently by him? Maybe that could ease that very real anxiety.
I hope your meeting goes well. It sounds like a very trying time for you. (((Falls)))
Posted by fallsfall on March 1, 2005, at 17:31:47
In reply to Re: Prognosis » fallsfall, posted by Aphrodite on March 1, 2005, at 13:37:51
> I was so struck by your post. The challenges ahead must be very daunting as our careers seem to be so wrapped up in how we see and define ourselves. Forgive me if I am remembering incorrectly, but didn't you once have a demanding, high-stress career? You've spoken vaguely about "work," but is there a particular kind of work you are looking for? Is the trepidation that you are planning to return to the kind of work environment in which you've crashed before?
>
*** I am/was a software engineer (plus I've done management of software engineers) - my specialty is bug fixing. Not exactly low stress... The industry is high stress, and bugs are higher stress. I loved it, but when I went back 4 years ago I dropped the management part in hopes of reducing the stress, but that wasn't enough.> Maybe this is an opportunity to do something different, a new path, a less stressful work environment with a supportive therapist to lean on.
>
*** I currently work in the local library. The stress level is much lower. My current thinking has me going back to get a Masters in Library Science. Then I could be a librarian. You can do library work with out the degree, but they don't pay you as much. Plus the time in school would give me a chance to get used to feeling better without the stress of working. Hopefully, by the time I finished my degree I would have enough confidence in my abilities to get a job.> I also want to mention that in my career, I work closely with Voc Rehab, and in my area at least, they are wonderful and very resourceful. You mentioned your worry in that regard. I've known many people who have been turned around by the Voc Rehab services, so I hope they are just as wonderful in your neck of the woods.
>
Since I am on SSDI, I can get the Voc Rehab services through their "Ticket to Work" program. When I set up the appointment the guy sounded really nice and knowlegable - and his wife is a librarian! Thanks for the encouragement, though. Success stories are always helpful.> Further, you were quite eloquent about the fear of being self-sufficient and "well" and what that might mean for the support you get from your T. Could he promise you in writing or otherwise that you would be rewarded differently by him? Maybe that could ease that very real anxiety.
>
*** We have done a lot of work trying to convince me that I won't lose therapy/him if I get better. I'll have to read my post again, I thought I was over that... Guess not?> I hope your meeting goes well. It sounds like a very trying time for you. (((Falls)))
Thanks for your support.
Posted by antigua on March 4, 2005, at 14:05:39
In reply to Re: Prognosis » Aphrodite, posted by fallsfall on March 1, 2005, at 17:31:47
You even have a plan! I'm really impressed. Give yourself a little more credit fallsfall--the master's in library science sounds great and well thought out.
My pdoc says the same thing, about chances of recurring depression. I don't like his numbers. My odds are way over 100% by now, but I'm NOT going to let that stop me. (My depression hits big time about every 8 years, w/smaller bouts in between; I don't want to live watching the clock, though). My T doesn't agree w/him. If and when I resolve my major issue (csa) I will be better prepared to deal w/the next bout (which always comes back to the csa in one form or another). So, like you, I will be better prepared but I can't predict how it hard the depression will hit me.
I know I'm kind of rambling, but what about living our lives? I can't not do something just because I might get depressed in a few years (talking about me, here).
For me, I'm not ready to go back to work FT yet. I work PT from home and as much as my SO hounds me, I'm not going back until I get through this. Otherwise, I will definitely crash hard(er) and still be facing the same demons. I have to get well first. (I was out of town a while ago and looked in the mirror at the hotel. I had the strangest feeling--where had I been for the last 16 years? I felt like Rip Van Winkle, that when I had kids, the world as I knew it crashed and i've never been the same. I haven't been the same of course, but I see new possibilities before me now!)
Geez, does this make any sense? I just wanted to offer some support.
antigua
Posted by fallsfall on March 5, 2005, at 21:55:13
In reply to Re: Prognosis/MLS, posted by antigua on March 4, 2005, at 14:05:39
Thanks. Support is always appreciated.
I have the plan, but I am terrified to follow it.
I believe that I'm not ready to do so. I can almost think about going to school. But I can't think about working. It completely terrifies me. I think that I may have been pushed into things most of my life when I wasn't ready. So much so that I have no way of deciding if I'm ready or not - I just *do* the things and somehow hold it all together. But this one I'm sure I couldn't hold together.
Fortunately, my therapist doesn't push me (I am pushed by something/someone but I don't quite know who). I see the Voc Rehab guy on Thursday and I am completely stressed out about it. My therapist said "The meeting on Thursday will just be a consultation. That's all. Just a consultation.". I take from that that it is OK if there are no actions following the meeting. That it can be just for information. That going to the meeting isn't a commitment that I'll go back to work. Thank heavens he isn't pushing, I couldn't take that.
I wish I could say that "I can't not do something just because I might get depressed in a few years". But the thought of doing better and then crashing again... I don't know if I could take it. I think I need more skills - to understand healthier ways of looking at things. And I need to organize my environment so that it won't trigger me so much. Otherwise it feels like running a marathon after the doctor has looked at my broken leg, but before he has even put the cast on.
I'm really hoping that if I can take some more time, and learn some more skills that I will be able to contemplate a future. I would really like to be able to do that.
This is the end of the thread.
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