Coping emotionally until I get professional help
August 13, 2007 7:55 PM   Subscribe

I know I need therapy, and I intend to get it as soon as my health insurance comes through in a few weeks. I'm under a lot of strain from a pending divorce and various related financial issues. I'm not just depressed, but I have the attention span of a gnat and I get caught in horrible, tormenting chains of obsessive thoughts. This is really crippling my ability to work and bill my customers, leading to more financial stress, leading to more emotional stress, etc. What solid things can I do in the short term to focus, work and get things done without pacing, obsessing and crying a lot?

You might insist that I get professional help NOW, but even if I get treatment that doesn't require medication, this will count as a pre-existing condition and could either jack up my rates or be the last straw that gets my application rejected completely. I've had other health issues this year that may already be turning the underwriters against me.

Here's how I'm behaving:

* I met some friends this weekend and had a great time, but I started tormenting myself today with thoughts of how I had behaved awkwardly or stupidly. (They're not terribly close friends, so I can't burden them with a request for help right now.)
* I haven't been able to focus on my cluttered office and prioritize and make decisions. Some days I manage fewer than 2 billable hours. Deadlines are whooshing past.
* I can't stop thinking about how unutterably, achingly lonely I am.

My disposable address is askmemedical@gmail.com. Thanks!
posted by anonymous to Health & Fitness (24 answers total) 8 users marked this as a favorite
 
I don't have a clue as to help your mental state, but you might consider hiring a bookkeeper to collect your receivables and pay your bills. It will take a lot of pressure off.

I would also break tasks up into smaller tasks and make short lists that you can check off thus boosting your confidence. You will see the bigger tasks get done that way.

Good luck.
posted by JohnnyGunn at 8:31 PM on August 13, 2007


Get some exercise and some sleep (but don't overdo it), break everything down into small tasks, write out a plan for getting them done and be a little anal about it all. Talk to family and friends, a lot, it's time to call in some chips here.
posted by caddis at 8:32 PM on August 13, 2007


Oh....I certainly do know exactly how you feel. I can offer you my perspective as someone who has lived through a divorce and the breakup of a relationship I thought was "the one". Please take good care of your physical health. Your are probably feeling unlovable, undesirable, and generally out of sync with your surroundings. These, in my experience, are perfectly natural feelings and I promise you they will pass.

*Get the sleep you need. Do not eat poorly (fast food, and tons of coffee, etc.).
*Exercise can work wonders to improve your mood and your ability to concentrate (I rode my bicycle for at least 30 minutes everyday).
*Write in a journal every day for at least 20 minutes to get all of the jumbled thoughts and emotions out of your head (don't worry about spelling, handwriting, punctuation, or anything else). You never have to read it again, just get it all down and out of your head.
*Call friends you haven't talked to in a while (you don't have to tell them how horrible you feel, just ask them what is going on in their lives--it really helps to concentrate on people and things other than yourself).
*Tackle your office for 45 minutes at a time. Use the other 15 minutes to take a lap around your building. If nosy people wonder what you are doing, just tell them that you like to get up and stretch during the day....it helps clear the mind.

Please remember, you are a worthy, lovable, valuable person and this too shall pass. Take good care. WS
posted by Womanscientist at 8:42 PM on August 13, 2007 [1 favorite]


A couple of my friends have had good success using an herbal supplement called 5-HTP to treat depresssion and anxiety, one of them while he was waiting to qualify for low-income health care that would cover "real" anti-depressants. Both of the people I have known who have used it have been very happy with it. I think it runs about $10 for a three week supply, you should be able to find it at most health food stores. Good Luck!
posted by ezrainch at 8:45 PM on August 13, 2007


Isn't there some way you could get help without the insurance companies knowing? Pay cash at a community health clinic or something like that and then, you know, lie on the insurance application. I only mention it because the one thing you could do that would be most likely to help you (at least if you believe the medical literature) is to start on a med. Many of these are generic, inexpensive, and effective.

I am not in favor of drugging all your problems away, you obviously have a lot of things to work out, but I am concerned that you are having a lot of problems functioning and you really need to start getting your life in order before things spiral further out of control. I am not sure that telling you to meditate or read this or that book is really going to do that.

At any rate, whether you decide to take the above advice or not, I think it's really important that you take care of your physical health. The connection between your physical well being and your emotional well being is real and important. This means eating healthy, limiting alcohol, drugs, caffeine, and tobacco, getting plenty of sleep and some light exercise. All of these things will actually make you feel better, improve your self esteem and give you something positive to focus on.

Good luck to you, seriously.
posted by Slarty Bartfast at 8:47 PM on August 13, 2007


You've gotten some good advice which I will echo:

+ Make lists. Identify Specific, Measurable, Achievable, and Realistic Tasks. (Think: SMART.)

That means that your goal today isn't "To clean out my office and get my professional life in order," but instead, "Eliminate a third of the pending items from my inbox. Identify those items that are really urgent. Do them today, or communicate with somebody to set expectations of when they *will* be done."

Make small goals, and celebrate achieving them. Repeat.
posted by deCadmus at 9:06 PM on August 13, 2007


I'd suggest hiring a professional organizer to help you with the office. I know the feeling of getting swallowed by your work or personal space - it's suffocating. You will feel sooooooooooo much better once your space is uncluttered. It's well worth the time and money.

Also something that could help you relax is yoga. Particularly the practice of pranayama, which is a type of breathing. When I used to take yoga we'd do a lot of breathing and it helped with my anxiety a lot. I used to breathe really shalowly when I felt anxious, and then I felt more anxious because of the poor breathing! Yoga isn't going to cure your life, but it can help calm your mind and body down so you can focus a little more.

And yes, I think you should seek out a professional to talk to. Look in the yellow pages for sliding-scale clinics or the like. You will feel better talking to a counselor about your anxiety and depression. You are not the first person to feel like this, and you have the power to help yourself get better. A professional can help you sort out what's going on and help you figure out how to reorganize your life and feel better.
posted by radioamy at 9:18 PM on August 13, 2007


While getting professional mental health help is important, lying on a health insurance application is a bad, bad idea. They can use any lie you tell as an excuse to cancel your coverage later. If you get cancer or need a heart transplant down the line, they will scrutinize your claim, and if they find out that you lied on your application, they can cancel your coverage on the grounds that you committed fraud, leaving you without insurance. Do not lie on your insurance application.
posted by decathecting at 9:49 PM on August 13, 2007


You might want to go ahead and start seeing a mental health professional (a therapist or psychiatrist or both) in the meantime to get you through until your insurance kicks in. Many providers understand that clients sometimes have difficult financial circumstances and will allow you to carry a balance and/or work out a payment plan so that you can get the help you need.

Make sure you let the professional you choose know of your financial and life situations in advance of your meeting. They will probably ask anyway so that there are no misunderstandings.

If you are still not comfortable with the idea of seeking therapy without insurance, you might start to think of alternative sources of relief. Here are a few to get you started:

1. Lean on your family or support system (friends, religious group members, etc.)

2. If you have a spiritual system, consider investing yourself in that system--pray, meditate, get involved in an activity, etc.

3. Look outward--think charity or something that helps you focus your energies on other people. Habitat for Humanity, work at a food shelter, or participate in political or social activism.


I wish all hope for your well-being. Be in peace.
posted by mynameismandab at 9:55 PM on August 13, 2007


God damn, insurance is evil. I have to admit that decathecting is probably right but you gotta do what you gotta do.
posted by Slarty Bartfast at 10:00 PM on August 13, 2007


i second alot of the advice about excercise, eating right and sleep. journaling is a good outlet until you have a therapist. after extremely trying points in my life i found writing to help a great deal and i don't normally journal.

one time i found myself horribly scatterbrained, like to the point of possibly looking into checking myself into some form of intreatment, life had blown up in my face worse then i had ever imagined possible. i didn't journal in the traditional sense, i just wrote down all of the shit and random bits flying around. it was pretty crazy looking (i wish i had a copy of it to reflect on) and really random, without really thinking about it i began to cross out the extraneous bits. it helped enormously in narrowing down my thoughts to the part that really mattered. after i crossed off some crazy idea i could forget about it, it was like brainstorming in a way.

setting up some kind of simple framework for your life, say a foundation. like the exercise, diet, etc. forming a recognizable routine could help. in my reading about working out it's recommended people eat smaller portions more regularly, about every two hours. so you do cardio for half an hour when you get up and carry healthy snack and powerbars with you. set your watch for every two hours to go off, snack. that way you eliminate little things from your mind.

something i read recently that might help in setting up a routine for the important bits to move forward (like working out for 1/2 an hour a day), is to get a big year long calendar. the kind that has every day of the year. each day you do your short work out and eat right (for example). you put a big X on that day. after a few days you have a chain of X's and then it's a matter of not breaking that. good reinforcement for setting new routines.

good luck and in the times that are really bleak find some little short mantra, like "this will end". and repeat it over and over and over and over. you just need to get thru that little bit. i don't know you from adam, but i really hope you aren't making plans for anything drastic. the cliche of "life does get better" is totally true.

call a good friend.
posted by andywolf at 10:00 PM on August 13, 2007


[I apologize for the length of my response...I hope something I've said will help you get through this.]

I'm not just depressed, but I have the attention span of a gnat and I get caught in horrible, tormenting chains of obsessive thoughts.

This is part of depression. Really.

I can't tell by your post whether you've been treated for depression in the past. Either way, wouldn't your health insurance cover your treatment given that the current episode of depression began (ahem) 2 weeks after your policy began? In the worst case, you could go for a checkup with a GP and tell them what's going on; I would be surprised if you weren't able to get a prescription for antidepressants that way once a doctor is able to diagnose you.

Rumination: this one can be really hard to overcome (in my experience, anyway). Someone else has suggested writing your thoughts down - that may or may not work for you. Whenever I did that when I was depressed, I'd go on and on for pages, and I'm not sure it helped much. It may work for you; try it, but be careful not to let your thoughts drag you down as you're "getting them out." If this seems to be the case, stop and do something else.

I know you're feeling really lazy, unproductive, and generally horrible about yourself right now. You're trying to keep up the facade, and barely hanging on. I'm not sure about the requirements of your job (or other responsibilities that you have). As much as you can, though, ratchet down your expectations of yourself. Not permanently, mind you, but until you're through this.

My therapist used to suggest (I was in grad school, taking classes at the time) that I do only the work I absolutely needed to do to get by during an episode. Being a perfectionist, this was so hard to do...but it always ended up that doing a half-way okay job of something was better than fixating on it but doing nothing at all. If at all possible, find ways to take shortcuts, get extensions on deadlines, eliminate things that don't absolutely have to be done now, etc.

Focus: this is another tough one. Eventually, I found that the best thing to do was just admit to myself that I was having serious problems focusing. It helped, honestly. It's basically telling yourself that "yes, I am sick right now, and I'm going to get better. In order to get through this, though, I have to scale back my expectations and accept that things will be different for a while." Roll with it as much as you can. Read only what you have to read - don't spend your energy reading newspapers, websites, or other extraneous stuff (I know, usually it's fun...but save your attention for the stuff you need to get done right now).

When I know I'm going through a serious episode (as you seem to be right now), I have learned to acknowledge this and then I go into "coping mode." Expectations are lowered, I plead sickness (really, this level of depression is a serious disability), and I refuse to feel guilty for sleeping too much, watching too much tv/movies, or reading nothing but graphic novels. It's almost like I turn back into a kid - not that I was ever a carefree kid, but you get the point.

Some may say that this is "giving in" to depression, or letting it win, or something like that. If you did this for the long-term, that would be true. However, consciously going into "coping mode" does help me when I'm going through an episode of severe depression. Keep in mind that when many people talk about depression, it has little resemblance to this sort of depression; be aware that there are HUGE differences between mild/moderate and severe depression.

None of this is very practical advice. As far as that goes, I find that when I'm like this, writing down EVERYTHING is critical. If you're having that 5-minute memory thing going on, writing things down as soon as they come out of someone's mouth (or into your mind), alleviates a surprising amount of stress. I agree with others about the old break-tasks-down-into-small-steps technique. Just make sure that you don't waste energy/time/focus on anything that can wait, and be aware that "small steps" may be too big right now - if that is the case, try microscopic steps.

Another tactic that helps me is to think in terms of having a limited (REALLY limited) reservoir of energy/focus available to me each day. This helps me remember to save those resources for the things I really need to address; everything else will have to wait.

Most of all, don't beat yourself up. Commit to making an appointment with someone as soon as you possibly can. In the meantime, find those coping strategies that work best for you. If you have a hard time being patient with yourself, it might help to think about how you'd treat a close family member/friend who was going through something similar.

Take care of yourself.
posted by splendid animal at 10:03 PM on August 13, 2007 [5 favorites]


I have been in your situation (going through divorce with attendant stress while trying to work as a contractor) and experienced the same feelings and symptoms.

My advice:
- if you have a sympathetic boss or customers, let them know. It is better to be a flake with an excuse than a flake with no excuse. People you have relationships with understand that you are a human being with human problems.
- go for a walk at lunchtime every day, outside, preferably into a park or other semi-natural space.
- in addition to the walk, get some kind of exercise three times a week. (The walk is for contemplation and de-stressing in nature, not for exercise).
- reach out to friends who ARE close.
- do not drink, drinking every day makes these problems worse, even if you think you're not drinking to excess.
- take notes on everything. Partly this will help you remember what you were doing 5 minutes ago, and partly this helps you focus your thoughts.
- not all useful counsel comes from medical people. If there is someone, anyone in your life whom you trust to talk to, maybe some older person who's been around the block, talk to them.
posted by i_am_joe's_spleen at 10:42 PM on August 13, 2007


Along the lines of what deCadmus said at the beginning about setting small goals: I've suffered from depression for many years, and I've found that when it is especially severe, setting up some kind of external system that forces me to get going on tasks helps a lot.

This may have been posted about before (I can't remember where I picked up this technique), but here's what I do to focus on work I need to get done -- and feel better about myself in the process -- on days when I have unstructured time: I set the timer on my kitchen stove for 15 minutes, and then do something relaxing, like surfing the Internet, or lying outside in the sun. When the timer goes off, I have to stop what I'm doing (unless I want to listen to annoying beeping forever), walk into the kitchen, and attend to it. It's easy to reset it for 15 more minutes, in which I do something "productive" (vacuum, start a load of laundry, file papers in my office, etc.) It's also easy to convince myself to do something that feels like work for only 15 minutes, especially when I know I get to do something fun afterwards.

Then I repeat the cycle: 15 minutes fun, 15 minutes work, etc. It's vital that the timer be in a different room than the one I'm doing the "fun" thing in, or I'll backslide. And I'm only doing "work" half the time, of course, but it sure beats none of the time, and in a 4-hour period, I'll get 2 solid hours of highly focused, productive work done.

A side benefit is that my mood usually improves because I'm actually accomplishing things. I've used this method on and off over the years when I'm feeling especially stuck, and it seems to be a reliable way to short circuit the overwhelming inertia that often accompanies depression.
posted by I love to count at 11:22 PM on August 13, 2007


I would seriously consider a few minutes a day of meditation. Not transcendental mediation or anything, but just some basic beginner Buddhist meditation. It can really help calm you. If you live somewhere where there is a local zen center or meditation group, it's even better to start out doing it with others. If you live in a place with a university, they will probably have a student group that welcomes non-students to come and sit with them. This really helps me get out of my head for a few minutes and get me off the track of obsessive unhealthy thoughts. Good luck.
posted by sneakin at 3:38 AM on August 14, 2007


i like all the previous advice. sleep as well as you can, get exercise, eat well, avoid alcohol and drugs. keep your goals small and manageable. ride out the loneliness by using your spare time well--spend an hour or two at the beginning or end of the work day to get your office organized. break it down into doable pieces: today i'm going to get my files in order. tomorrow i'm going to take care of my desktop, etc. lists will help keep you focused.

it's a cliche but it's true: take it one day at a time. you'll get through this.
posted by thinkingwoman at 4:52 AM on August 14, 2007


When I was going through a very stressful breakup with my business partner, I found doing yoga helped a lot with the obsessive thoughts...it helped me just focus on what my body was doing rather than what it was thinking, if that makes any sense. I really recommend it!
posted by miss tea at 5:15 AM on August 14, 2007


Echoing what everyone else is saying, but with specifics:

- Sleep. Do not drink alcohol to sleep. Take diphenhydramine HCL (Benadryl, one version of Unisom) or doxylamine sulfate (the other kind of Unisom, I prefer this one because it doesn't make my mouth so dry). Pick a bedtime that will allow you about a 9-hour window before you need to be upright and breakfasted and working. Use fresh clean sheets and make your bed neatly before you get in it. It's probably better to do 4 nights on and 3 nights off, but do what you need to do for now. Start with getting 3-4 nights of relatively good sleep and worry about the rest later.

- Eat at least 3 evenly-spaced meals a day. Try to eat things resembling real food, even if it's just a peanut butter sandwich or a can of soup. Do not jack with your blood sugar right now by skipping meals or living on frozen pizzas. Have some yogurt, it's good for your stomach and immune system. Drink water.

- Go to Target or the library or the used video store and see if you can find a simple yoga workout. Living Arts has a number of them - the AM/Stress/PM DVD is a winner, as are most of the Rodney Yee sessions (avoid the intermediate and advanced if you're not already quite flexible - get his Beginner, AM/PM, Back Care, or I see he's got a Relaxation and Breathing for Meditation disc now). You don't need to be good at it, and you don't have to push yourself; even your first time through you will feel the benefits. Give it a try, and if you don't like it just go for a walk and do some gentle stretching.

These things really will help with the obsessive thoughts. Even at my mentally fittest, a bad deficit in any of these will result in the bad tape loop in my head. This will at least help stabilize you until you've got more resources. It's what they mean when people say "take care of yourself."

The 15-minute thing is a lifesaver, as well. My actual paying work is quite difficult to do in 15 minutes because it needs concentration, but I can get some things done if I do 15/45, and as the sleep and food catch up with me I can then do 30/90 and 15/90. It's the old Flylady thing: you can do anything for 15 minutes. And it's true - you can sort a bunch of laundry in 15 minutes, or pick up a lot of trash, or file, or answer business email or pay bills. No matter how much you don't want to do it, it'll be over in 15 minutes. If you need to get through the next few days in 15 minute increments until the sleep and food start working, that's okay.
posted by Lyn Never at 6:33 AM on August 14, 2007


reversing this spiral starts with generating that first invoice.

If you think of it as only one invoice, it might not feel so daunting.

"My name is _____ and today the only thing I need to do is make one invoice. I may make others in the future, but today I'm only going to make one. That's all."
posted by Wild_Eep at 6:48 AM on August 14, 2007


A basic Buddhist idea about depressing is that it results from focusing inwardly too much, and that by focusing outwardly (volunteering at the retirement home, soup kitchen, calling a lonely relative more often, baking for coworkers), you make yourself feel needed and useful. It's hard to get up the motivation to start doing this, but worth it once you do.

In terms of the breathing, Andrew Weil's Breathing CD is good and easy as cake.
posted by letahl at 6:55 AM on August 14, 2007


Take it easy on yourself. It's natural that you'd be feeling more insecure now (your first example) -- so many sources of your security have been ripped away. And since that anxiety is just a natural outgrowth of what's happening, rather than seeing it as a problem to be solved, I'd just consider it one of many feelings that are going to pass through you these days.

Then, I'd accept that you're probably not going to be able to get much done. You are going through a really hard time. You might as well relax into this fact, rather than railing against it.

Then, realistically prioritize what you'll do. In a similar situation, I hit a moment when I realized I was going to get almost nothing done and that I had much bigger issues to focus on, and then I went into survival mode. What is the minimum you really need to do to get through these next few weeks? Subcontract out the work? Email your clients explaining that you'll be unable to complete the project due to a personal emergency? Apply for a job at Starbucks? Write up a quick outline?

You're in a tough situation. It will be better the more you can get on your own side and honestly ask yourself "this is really hard. how am i going to get through it?"

This is a good comment. I also highly recommend the book When Things Fall Apart by Pema Chodron. She wrote it partially about how she got through her own divorce. She talks about how to live in the presence of the loneliness and other feelings, and really knows how hard it is, but she also has good advice on how to accept what's going on without letting it overwhelm you (or how to let it overwhelm you, without considering that a huge problem or screwup).

Best of luck. I'm sorry you're going through this.
posted by salvia at 10:02 AM on August 14, 2007


5-HTP was mentioned earlier -- I've found it helpful, but read about it before you start taking it. It's not appropriate for everyone. Fish oil is helpful for some people, so are walnuts. If you are able to eat fish and walnuts, these shouldn't have any adverse side effects.

If you need someone to talk to:
I heard a story from a man who had spent some time living homeless. One day, a counselor/psychologist of some sort came up to him in a park. She offered him five dollars (you might need to adjust this for inflation) if he would listen to her for an hour. Evidently, this is what she did for therapy.

No guarantee of confidentiality, but really unlikely to show up when you are applying for health insurance.
posted by yohko at 7:56 AM on August 15, 2007


You know, It is so hard to go through a Divorce, and on top of it trying to cope with financial situation, I have seen people go through it, as well as myself. One thing I always tell them, and I told myselft too is that when it looks the darkest, hang in there because you are close to getting out of that situation.
Think positive, these situations don't last forever, concentrate on what you want to be, where you want to be and who you want to be with.

Good luck, try to get in a mental health website like www.nami.org


take care
posted by punkmex at 11:10 AM on August 16, 2007


...thoughts of how I had behaved awkwardly or stupidly.

One cognitive behavioral therapy tactic is to try to see how depression may be distorting your view of reality and to try reflect more rationally on your experiences using a chart like this. It may or may not be helpful but is one thing to try for the short-term. Feeling Good by D.D. Burns is an easy-to-skim intro to this kind of CBT-style self-help.

CBT doesn't work for everyone though, and a book I've found more helpful is Stephen Hayes' Get Out of Your Mind and Into Your Life which teaches a more meditative way of defusing negative thoughts rather than trying to debate them.

However when really depressed, being motivated and focused enough to read a book on depression is not something I'm always capable of, so therapy is really the best, but it also takes time to shop around for a therapist you feel compaitble with.

In the meantime, a lot of the suggestions here are great, my favorite being the ones where you blow off a lot of time at the movies or read for fun. I actually picked up jewelry-making too the last time I was depressed. But anything tactile that you've ever had an inkling to try out is great, for example try to find a pottery class at your local adult ed. center or community college. Treat it as a necessary sanity pill if you feel guilty about taking the time or the cost. It'll get you out of the house and in the space of other people, but you don't necessarily have to interact with them much.

Your office also sounds like a negative space right now so try to find some other place to try to work where there's other stuff going on, like borrow a laptop and go to the library or a local coffee shop. If your work requires you to be at home alone then one funny thing to try might be to get a few webcams and enlist some of your friends to watch you work while you watch them. Being aware of other people around might make you self-conscious enough to focus on work, or at least sit at your desk and look the part, which is still a huge step.
posted by beluga8 at 1:53 PM on September 20, 2007


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