“Art washes away from the soul, the dust of everyday life.” Picasso

As I was rising out of an episode, when the struggle to get out of bed and get dressed became a bit easier, I participated in an 8 week art therapy group. Getting dressed, eating, and driving myself there still required substantial mental and physical energy, but upon arriving in the studio, my brain seemed to slightly shft its focus. Instead of attending to the nonstop, negative messages wearing a groove in my consciousness, I was able to concentrate on the physical act of putting a paintbrush in a cool, serene puddle of green paint. In the beginning, I had no idea of what I wanted to paint, no image in mind. But, once my brush swept across a pristine, white canvas, at least for a couple of hours, my mood seemed to benefit from attending to and completing a task.

Image: Molly Canfield
"when I feel good"
Image: Molly Canfield
“When I’m feeling good”

Art therapy is” the use of creative techniques to help people express themselves visually and examine the psychological and emotional undertones within their art.” Goals of art therapy include: exploring emotions, improving self esteem, managing addictions, relieving stress/anxiety/ depression, and coping with physical illnesses or disabililties. The act of creating, no matter the end result, can also benefit those under psychiatric stress. Sometimes the act itself (of creating art) is of benefit to the individual while other times painful, difficult feelings may be expressed through direcct or indirect symbolism within the piece.

Who benefits from art therapy?

Children often have limited vocabulary as do some geriatric patients or those with traumatic brain injury. Regardless of the cause of mental suffering, art provides a safe, supportive space for the expression of scary, difficult to express emotions. Those whose primary language is different from their current environment (English as a second language) and those suffering from post traumatic stress disorder may also find the creation of art to be a nonthreatening way of conveying painful emotions or past trauma. Those living with chronic illness, terminal illness or physical diabilities can “escape” from the stress of their daily lives.

Teens…Use art as an avenue

What group of people can be: irritable, confused, “closed off”, resistant to therapy, easily bored? If you answered ME!, I would add my name to that list. The many positive attributes of art theapy make it especially suitable for teens. The troubled teen may be super difficult to engage, resistant to forming close relationshps to authority figures, and threatened by the loss of control in a traditional therapy session. And, itsn’t a table full of various art materials more interesting to the multifaceted, creative teen mind? Many find the act of creating to be of such benefit that they will share it with the world in the hope that it will inspire, comfort, and/or support other sufferers.

Art Activities for anxiety, autism, learning disabled, teens, adults, pets (not really)

The past several years have seen a plethora of coloring books for adults. The popularity of adult and teen coloring books is testament to the healing, stress relieving power of art. Just the physical act of putting colored pen/pencil to paper fits in well with the CBT concept of mindfulness. In case you’ve missed it or just haven’t caught up yet, mindfulness is the psychological process of bringing one’s attention to experiences occuring in the present moment, Meditation which incorporates mindfulness training is thought to relieve stress and anxiety. In focusing on the current moment, becoming mindful of it, “one can reduce stress, enhance performance, gain insight and awareness through observing our own mind, and increase our attention to others’ well-being. ”

Calm your mind

What does mindfulness have to do with art therapy? By focusing on the current moment, for example the singular act of putting pen/pencil to paper, filling in those blank spaces with color, one’s attention is focused on the task at hand and not on punishing ourselves with worry, grief, anger and so on. The act of drawing, painting, coloring, creating allows our mind to remain present, return our breathing to a more even pace, and allow our physical body to take a break. Art therapy engages nonverbal areas in the brain an provides an outlet when talking about painful, diffficult memories is too overwhelming. Our “undigested memories” can find a place to “live” until we feel able and ready to process them. The adult coloring book business is booming. A search on Amazon for adult coloring books yielded over 50,000 results. Try meditating on that!

Images: Molly Canfield
“When I’m feeling depressed”

Safe Place activity

Finally, I will close with an example of an art therapy activity, suitable for almost any age and functioning level: Safe Place Activity – Teens and children often do not have control over their environments or feel like they don’t. The desire and stuggle to have a safe place is a universal concept, but for teens and children the safe place is often physical as well as mental in nature. Materials such as colored pencils/ markers, old magazines, popsicle sticks, yarn, glue, acrylic paint, poster board, colored paper, fabric will appeal to many age groups.

In a group, talk about the meaning of “safe” for the individual. As clients feel comfortable, ask them to describe what their ideal safe place might be like. As this may be difficult to discuss out loud, in a group setting, they can be asked to silently thnk about this. Provide the above materials to clients and ask them to create/draw/assemble materials for their safe place. At the end of session time, allow clients to talk about what they’ve made. What makes this a safe place for you? For more art therapy activities like this one click here.

Down, down, down

Do you ever feel like you’re living inside a dark, locked closet with no way out and no help in sight? Do you ever feel like your life is one big mistake, that you’ve always been a failure? All of these thoughts churned round and round inside my head during the fall of 1984. I was in graduate school at the University of Georgia. My internship at XXX Elementary School found me working in a resource class for children with emotional and behavior concerns. How perfectly ironic that my first significant, extended depressive episode developed while I was supposed to be learning how to work with children who had emotional and behavioral issues

I did not know what had been happening to me over the course of approximately a year. Things that I had enjoyed – going out dancing with friends, painting, reading and even completing coursework I’d once been so excited about became nearly impossible to finish or enjoy. My emotions consisted of crushing despair and hopelessness, with no future that I cold imagine, good or bad. (But, in this instance, always bad.) Professionals call this “foreshortened future”. Physical sensations, “brain fog”, leaden legs and arms, migraines, took the place of energy I’d once kept up with by working out and eating fairly well. My concentration plummeted. My ability to maintain focus on anything, pleasurable or not, ground to a near halt while my motivation completely disappeared. I often felt like an automaton, walking, breathing, eating, sleeping and repeat, repeat, repeat. I didn’t know it then, but I was walking on a tight rope, while the rope and I were coming unraveled. Somehow, I found the energy to drag myself to class, complete assignments, and keep myself “physically together”. By that I mean eat, sleep, shower, and get some exercise. All along I tried my utmost to mask my sense of drowning in a bottomless black hole of clinical depression. Sleep became the only activity I looked forward to as it was the only time I wasn’t crying, staring at the ceiling for hours or imagining that I had some malignant, undiscovered disease.

My recall of the exact time that I finally called my parents and told them how I felt has faded from my memory. But, I still remember the phone call home. I sobbed throughout and described what was going on with me. I could find no particular reason which prompted this episode, no death in the family, loss of a boyfriend or failing a class. So, I decided that there was something wrong with me. It had to be my way of thinking, my thought patterns. If I could just change the way I thought, (my perspective) then things would look better again, my life would “go back to normal.” All I knew of therapy was what I’d seen on television. The patient lies on a couch, face up, while an omnipotent, mental sort of Sherlock Holmes interprets the patient’s words. The patient then accepted the therapist’s analysis and his thinking magically reverted to a positive outlook on life. I realize that this is a compressed description, but television didn’t go into an in-depth version of psychoanalysis.

Back to the phone call with my parents – First, I talked with my mom. As I described what was happening to me, how thoroughly miserable I felt, I could hear the mounting concern in her voice. It was as if I had called and described a cancer that was growing inside of me. For reasons I did not fully understand at the time, I “pulled some punches” when talking to my mom. I guess I thought at the time, that I did not want to hurt her further when describing my symptoms. Was it guilt? Shame? Not wanting to disappoint her? Next my dad took the phone. He listened as I choked out my description again. (I guess we didn’t have multiple phones at the time??) My dad was hit with the full force of my nightmare which, at that time, included suicidal thoughts. When I was done and drained of words, my father spoke the words that would change my life, “Molly, you are depressed. You have to make an appointment with a doctor.”

“You have depression?!”

Bill White, owner of http://www.chipur.com and fellow blogger extrodinaire, has allowed me to write this article as a guest post on his blog. I am honored to work with a seasoned blogger, experienced mental health provider and one who has “walked the walk” , seen depression from the patient’s point of view.

I had been seeing my pain management doctor for almost two years when I decided to bring up my mental health issues at my next appointment. To be more accurate, I’d talked with the previous doctor in the practice about my depression and anxiety. I had been up front with him about my antidepressant medications. Dr. XXX, however, transferred to another practice. So, it was time to educate the next physician who would treat me for chronic pain.

Me: “I’m going to take a big leap of faith and trust you with what I’m about to tell you.” Dr. XXX.: “Alright. Go ahead.” Me: “I’m also being treated for depression and anxiety. Both are at manageable levels right now. In remisson.” Dr. XXX.: “You?! Depressed?!!” Me: “No. In remission. I’m doing pretty good these days.”

This was an exerpt from one of my most recent doctor visits. “Why??” you ask, was it a leap of faith, a matter of trust for me to bring up my mental health issues? Well, to begin with, I wanted to be up front and remind her that I still took antidepressants. All of my doctors need to know about all medications that I take and how these may interact with each other. That’s pretty much standard fare for me at the doctor’s office. It is also a matter of trust. If I tell my general practitioner about my diagnoses (major depressive disorder, generalized anxiety disorder), whether they are in remission or not, will he/she continue to treat me with a consistent perspective? Or, will my symptoms (and me) been seen through a mental health filter? “She says she’s still having pain, but it might be the depression/anxiety/etcetera talking.” This is what I imagine may be going through the doctor’s mind after being made privy to my mental health issues.

The National Institute of Mental health (NIMH) recently reported results of a phone survey with over 1000 adults in the state of California regarding whether or not they would share their depression symptoms with their family doctor or not. All participants were asked to choose among 11 possible reasons for not sharing this information with their doctors. 43% of the participants said that they would not share this information during a “normal office visit.” The majority of respondants reported not being comfortable with receiving a prescription for antidepressants. These respondants endorsed an anti-medicine stance that depression was not something many felt a general practitioner was able to address. This is unsettling, as the general practitioner is the healthcare professional who most often takes note of his patients mental health. This may well be the initial contact for the patient to share troubling mental health symptoms. He or she should be able to recognize symptoms which may prompt a referral to specialists, such as a psychiatrist, psychologist, or counselor. Next on the list of reasons for not being forthcoming was stigma. Many people believe, and perhaps with a valid reason given the current data breach debacles, that their mental health information would become a permanent part of their medical record. Furthermore, what if their employer might able to see this information? Would it effect the employee’s position in the company? Would their co-workers find out? Would it effect a possible promotion?

Patients who fear the stigma of disclosing to their doctor mental health concerns may unknowingly risk worsening symptoms due to a missed opportunity and a chance for early intervention. Research is currently focused on neural pathways, or how a “train of thought” or belief set may become entrenched within the brain itself. Well worn pathways of neural circuits, some experts theorize, may become more difficult to interrupt (treat) over time. The path of least resistance could become the road to a more embedded perspective. (This theory hits very close to home for me. If you read my initial post, before I was formally diagnosed, I spent many hours/days trying to imagine a way that I could change the way I thought. The more time I thought about this dilemna, the more my brain may have chosen to remain on that path. (Thinking about thoughts gave me headaches.) Recent theories focus on how our brain as an organ may become “damaged” or “stuck” , forming if you will, well-worn neural pathways. Much has been theorized that, like other chronic conditions, the longer depression is left untreated, the more difficult it becomes to effectively treat. I can readily affirm this sentiment. After being pulled out of my first significant depressive episode, my psychiatrist shared the following with me: “We (medical professionals) are beginning to find support that some patients may need to continue taking antidepressants to prevent a relapse. ” I recall feeling a mix of emotions to that idea. The medication had certainly worked well for me in pullng me out of a very dark, difficult episode and it was with relief that I did not feel ready to have that support removed. Remaining on an antidepressant “for at least 9 months” seemed reasonable. That was paraphrasing as the actual conversation took place almost 30 years ago.

courtesy: Filip Kominik

* It is of note that I was treated initially with a tricyclic antidepresseant and I remember when Prozac hit the market. Here we are many, many years later and multiple antidepressant combinations are not uncommon for those of us who continue to grapple with treatment resistant depression. Perhaps it is telling that, for me to share my diagnoses with my pain management physician, felt like a leap of faith. 30 years after that initial clinical depression diagnosis I’ve encountered a range of physician perspectives; some biased, others more open-minded. My migraine headaches were diagnosed before the depression diagnosis by a neurologist in the town where I attended graduate school. This is not notable, except for the response I received during one of my early office visits . I waited for what seemed like an eternity as the migraine pounded and pulsed through the side of my head. After a brief neurological examination, my newfound neurologist let me know that he “did not prescribe pain medicine” and that “Pain never killed anybody.” What?!?! He really did say that and, me being a relatively naive patient in my early 20’s, did not challenge his “wisdom.” Perhaps it was statements like his and less than compassionate care by other physicians, which may have caused me to see doctors from a somewhat biased viewpoint. It may be that I, too, must make a leap of faith.

(W, hy people with depression hide their symptoms from doctors. http://www.recoveryranch.com/articles, Last modified: 4/22/19, Posted: 10/7/11)

To tell, or not to tell…reasons why employees hide mental illness

As I was typing the above title, it struck me that “hide” could sound quite negative. “Hide” seems to have nefarious, dishonest connotations. As children, we hide when we’re in trouble. As adults, we hide if the I.R.S. notices us. If an employee needs accommodations at work for a condition/disability such as deafness or diabetes , I feel like “hide” would not be used in relation to those conditions. We might say “disclose” or “share” when describing the manner in which an employee chooses to inform his employer of a health condition which may warrant accommodations necessary for optimal work performance. OR, I could be reading too much into the use of that one word? OR, I am being “too sensitive” and should just get over it….? Regardless of your stance on the word hide related to mental health, it is likely that you have definite opinions on how much, when, and why an employee should, would, could, want or need to share his/her mental health challenges.

Stigma. Loss of status. Cost. Fear. All are reasons many employees do not inform their employers of their mental health issues. We are painfully aware of the consequences of undisclosed and undertreated mental health problems in the workplace. From poor job performance, absenteism to serious outcomes such as erratic behavior and violent acts of which we have become all too familiar in our news cycles. Mass shootings by armed teenagers to even more extremes such as the Germanwings Airbus tragedy in which a co-pilot hid his mental illness from his employer. As a result, Andreas Lubitz, hid his mental illness from his employer and deliberately caused the crash which killed all 144 passengers on board the flight as well as 6 crew members. It was learned after the crash that Andreas had not disclosed his mental health treatment for recurring episodes of depression accompaned by psychotic features. However, the genesis of Lubitz’ final episode was likely a combination of mitigating factors and could not readily be explained by a single cause. Would it have been possible for employers to have created an environment in which employees would feel safe enough to have disclosed their mental health challenges?

What factors could have made Lubitz keep his mental health difficulties so well protected? Stigma and discrimination may continue for the employee’s lifetime even when acute symptoms have resolved and the condition is in remission. Who among us has not heard the not-so-subtle threat that one’s abberant behavior or transgression would be made a part of one’s “permanent record.” What a shame it is when those of us struggling to overcome/manage mental health conditions are seen as burdens or liabilities in the workplace while this harsh standard would hardly be applied to a cancer survivor. Fear and anxiety frequently accompany a mental health diagnosis. Five major mental illnesses – mood disorders, anxiety disorders, dementia, eating disorders, and schizophrenia/psychotic disorder – may become chronic resulting in more pain on top of the lifechanging diagnosis. Loss of status after working hard and long can disappear in a flash. Isolation, shame and even harassment are often the result of an employee’s mental health disclosure. Despite the Americans with Disabilities Act (ADA) accommodations, mentally disabled workers are often put in lower profile projects/positions and lose their jobs when employers fire them for erratic behavior which becomes pervasive. It’s my theory that employers may let go their own employees for mental health concerns but document or promote an unrelated reason for the dismissal. Of course, in right to hire/right to fire states, the employer’s “bottom line” must be taken into account. Denial of insurance coverage, higher insurance premiums to the monetary cost of treatment accompany the actual cost of mental illness in the workplace. Despite the elimination of pre-existing conditions as a reason for insurance denial, the reality for employees in small businesses remain riddled with cost. Before the elimination of pre-existing conidtions as grounds for insurance denial or higher premiums, I witnessed the charged stress as my father attempted to negotiate with the insurer in finding the best rates for his family. The ever present threat of insurance denial resulted in anxiety, poor sleep and mood swings for him. He carried the weight of our family’s world on his shoulders. My father’s mental health challenges compounded the very real task of securing appropriate coverage as well as treatment for such struggles. I did not learn until after his death that he had aughtored a book (The Far Side of Despair, Russell K. Hampton, 1975) documenting his clinical depression from the time when I was too young to remotely comprehend the stress of carrying our familiy’s financial situation.

In the era of an “opioid crisis”, political correctness and the efforts to blame medications for society’s ills, it seems quite logical to conceal our reliance on anything except for our “wllpower”. It is unfortunate that medications are blamed for negative outcomes when several factor are often at play when mental health problems effect an employee’s work performance. The invisible stuggles associated with mental health diagnoses may make it seem as if attention is not warranted in comparison with visible health problems, for example diabetes or an arthritic knee. I do not have the solution for mental health accommodation in the workplace. It seems we must cautiously approach our employer when a mental health diagnosis lands on our doorstep. Go into business for ourselves or try to elininate stigma and educate a broader audience on the struggles as well as accomplishments of mental health survivors.

(The real reasons employees hide mental illness, http://www.inc.com/indigo.triplet, Pub.: 3-31-19)



Reluctant “expert”

33 years of fending off the black dog (Winston Churchill’s term) using a multitude of medications, therapies, hospitalizations, and novel approaches yet to be FDA approved has resulted in my becoming a de facto “expert.” Albeit, not a title I have aspired to or dreamt that would fall on my shoulders. After towels filled with tears, hours isolated under the covers and trying dutifully all that the professional, psychiatric world has to offer, I’d finally heard the answer to my most often lament, “Why me?? Why is this happening to me (again)” Neither God nor the universe answered. Until this year.

My current therapist often listened intently but sometimes open-mouthed, to the lengthy descriptions of my trials and successes. One afternoon session I heard the answer to my lament. “Would you be willing to come speak at my church?” Don’t run away yet! My site will not dwell upon or be focused toward religion, spirituality or higher powers. You believe in what you believe in and so will I. How does that sound? I was thrilled to hear her ask me and immediately blurted, “YES! I would love to!” There was the answer to the infinite number of times, in the midst of my darkest days, when I’d cried, “Why me?!”

Now, I knew that instead of being looked at as a problem to be solved/treated or a cluster of symptoms, here was someone seeing the positive way in which I could help someone else. Someone who is also hurting, frightened, sad but still hopeful for an end to their torment. Or at least a reprieve. My journey will be shared from the beginning until now in the hope that others who are suffering will find a supportive place, a listening ear, and a source of helpful information as well as hope. You will find all of these and more on my site. The distinct difference from many other depression blogs/sites, will be that I am a patient with a history of clinical depression andgeneralized anxiety but also a trained, experienced psychologist. Toomanydiagnoses (my username) encompasses not onldepression and anxiety, but also borderline pesonality disorder, and trauma survivor (rape). I am ready to share what I know of the mental health milieu (neighborhood) as well as learn from my followers. I am very much looking forward to hearing from my people! A cure is a wonderful ideal and more than anything, I dream of that happening, but until then, you have a home here at depression2perspectiveshealth.blog.