Update: It’s May 2017 and among other things, it’s Mental Health Awareness Month.
Approximately 1 in 5 adults in the United States (43.8 million, or 18.5%) experiences mental illness in a given year and more than 20 million Americans suffer specifically with depression every year. It is reported that psychological distress among patients with breast cancer is common and is linked to worse clinical outcomes. Depressive and anxiety symptoms affect up to 40% of breast cancer patients, and depression is associated with a higher relative risk of mortality in individuals with breast cancer.
So, I wanted to share again my experience at the intersection of depression and breast cancer. I hope by doing so, that I can be part of the wrecking ball that is so necessary to break down the walls and barriers that keep mental illness in the shadows, coiled in shame and stigma. I’d like to offer up my story in the hope that a reader might feel less alone and perhaps provide a tiny but powerful light to help keep them holding on. It can get better. xo Melissa
If you or someone you know needs helps now, you should immediately call the National Suicide Prevention Lifeline at 1-800-273-8255 or call 911.
Where Are All The Silver Linings?
Even before cancer, I was intimately acquainted with depression and anxiety. We shared more than one dance together. We fight. We makeup. We fight. We breakup. That’s just the way it’s always been. On and Off. I managed this relationship with an assortment of tricks. There are the therapists I would purge all my thoughts and feelings onto weekly. There is the pharmacy where I routinely picked up the latest antidepressant and anti anxiety pills I was prescribed. Sometimes they even tossed in a mood stabilizer or an antipsychotic for good measure. And then there was the doctor who I checked in with on a regular basis to make certain all was going as planned.
As a person so prone to depression and anxiety, believe me when I tell you – keeping that many appointments and having that many interactions in order to procure those tiny little things that are going to hopefully help you feel better is fucking hard to do. If you suffer from depression and/or anxiety, you know exactly what I mean. But I managed, mostly.
Depression Is An Asshole
Mental illness and mental health are nothing to be quiet about, yet it remains one of those issues people still sweep under the rug and avoid talking openly about. I understand the desire to keep that secret, to not want to be labeled or judged or abandoned. I know the dark struggle it can be and I’m confident many of you out there reading this know it too.
Depression is an asshole. It’s the sort of asshole that makes you think you’re all good one minute, and then the next, you’re flat on your face and don’t know which way is up. That happened to me in 2009. I thought I was coping fairly well. I thought I could deal. But what I didn’t see at the time because I was so entrenched in it was that I was actually in the throes of my deepest, darkest, depressive episode ever.
The flat on my face moment, when I couldn’t tell which way was up or which way was out, was a pivotal chapter in my life. I wanted to die. It’s an indescribable thing – to want to die – to want the pain to stop – to want to give up. I’ll never forget those feelings of despair. And at the apex of that pain, I made a choice. A choice, today, I regret deeply. I chose death. I attempted to take my own life. It was the only way out that I could see, and that is – just one – of the reasons why depression is an asshole.
I survived that darkest moment and I am so grateful that I did. For the next year, after the attempt, I needed a lot of help and it took a lot of work on my part to find my way back – to the other me – the happy me. But eventually I got there and I never wanted to go back to that place – that space – in my head. Not ever again.
Joke’s On Me
Then 2013 came along and brought with it – breast cancer. I am not a particularly religious person, but when the news of cancer was dealt my way, my first thoughts were “Really, God?” I have come this far, and I finally feel good and hopeful and just full. Now I get cancer? Now? Fuck you.
Fast forward a year. My surgeries are done but I no longer look or feel the same. My real breasts are gone. I’ve gained weight I don’t want. I suffer chronic pain and neuropathy and I live in a constant state of fear of my cancer coming back. The physical healing is underway and largely complete. As far as anyone can tell, I’m okay. Or at least they want me to be. Heck, I want to be. But what they can’t see and what I’ve been afraid of is that my old dance partner has come back. That asshole, depression, is making another appearance and – I am terrified.
I’m terrified that cancer has reduced me to a pile of ashes and depression is the gust of wind that’s going to blow me away. The truth is, life after a cancer diagnosis can be a lonely place. It’s a place (even a space) I wasn’t in any way prepared to occupy. When you face your mortality, like you do when for instance you purposely try to die like I did or when you’ve been told you have cancer like I was, you begin to assess everything. You pare life down and toss all the nonsense and clutter. What used to be important no longer is. You begin focusing on the things that truly matter to you, the pulp of life.
The trouble is, even with all this new insight into life and what mattered to me – I was simultaneously feeling like nothing really mattered. It’s true. I felt like nothing mattered. Why had I survived my suicide attempt only to be given a cancer diagnosis? The truth is, cancer is just bad luck. There is no rhyme or reason why this happened to me. I have no family history, no genetic predisposition. I just happen to be one of the 1 in 8 women who get breast cancer in their lifetime. Now I didn’t expect it at age 37, but there I was. I had cancer.
My cancer diagnosis was found at an early stage. Stage 1 in fact. And despite all the time this diagnosis would supposedly afford me, I could not find much gratitude. I could not find those silver fucking linings. Only a vast, empty space lay before me. A barren wasteland.
I thought I would feel grateful. I thought I would feel a giant sense of relief. But instead, I was full of nothingness. There were no bright sides to be looked upon. My glass was most definitely half empty and even among the most supportive family and friends – I couldn’t see the “gift” everyone had told me cancer was supposed to be.
So there I was, feeling as though no one could possibly understand my feelings of isolation, my lack of interest, my tremendous fear and anxiety and I judged myself for it. My thoughts told me how ungrateful I was being and how people with a terminal diagnosis would switch places with me in a heartbeat, and how wasteful I was being with all this time I’d been afforded.
Tamoxifen was supposed to increase my odds of living a long cancer-free life. It would block the hormones receptors from allowing estrogen and progesterone in. This way, since my cancer fed off from my hormones, it would essentially be starved to death. Sounds good right?
Despite my hesitations, I went ahead and tried it. I tried so hard to stay on that hormone blocker, but after six months of swallowing that tiny little 20 mg cancer-fighting-drug, I faced the reality that this “life saving” drug was instead killing me. If depression needs a partner in crime to get the job done, Tamoxifen is it’s guy. There was just no way around it for me. I had to stop. I was more willing to risk recurrence by ending the hormone therapy than I was willing to accept certain death by staying on it.
Pain and Doubt
It’s been four years since my diagnosis and I’m still living IN and OUT of that place and space of nothingness. More OUT in recent months, but I still wind up back IN it every once in awhile. When I’m in that place and space I have to fight really, really, hard to fend off the darkness that is my depression. Often I succeed. But when I’m unsuccessful, the lights disappear and inevitably I fall. Hard.
Falling always returns me to a place and space of quiet pain, trauma and doubt. I waver between thoughts like “what if I die on the way to the grocery store?” or “fuck it, give me another drink” and “maybe it would be better if I just wasn’t here.”
While I ponder dying, I inevitably slip into guilt. Guilt says things like “who am I to worry about death when my friends who have run out of treatment options are putting on brave faces, showing up, and getting shit done?” Guilt calls me selfish and ungrateful. These thoughts only led to more retreating, more isolation and more loneliness. And then there’s the sadness and the self-medicating which only creates an inability to accomplish anything. Even when I want to leave this place and space of quiet pain and doubt, my feelings and thoughts are just too heavy to carry. They weigh me down like a ton of bricks and I cannot move.
Given my predisposition and familiarity with all these negative thoughts and feelings, I recognize them enough to call them what they are. I recollect on that time in 2009 when I gave my depression the keys, the car and the gas to drive me over the edge and I don’t ever want to wind up back there. But the centrifugal force of these thoughts makes it almost impossible to find my way back. Back to the middle – to the eye of my psychological and emotional storm- where it’s calm, and my thoughts can be still. Hormone blockers (like Tamoxifen) only worsened my feelings of desperation and giving up.
Don’t Let Go
My familiars for almost two years after my diagnosis consisted of pajamas, bedhead, occasionally brushed teeth, lots of unexplainable tears, huge amounts of anger, and pills. All the pills. I went to therapy weekly for a year. My ability to contribute financially to my family had been greatly reduced and my desire and stamina to work was zilch. Did I mention the 30 extra pounds that found their way to my middle? I had a Buddha belly but I did not in any way feel like the Buddha. Moving hurt. The water in the shower hurt my skin. Getting dressed hurt. And my brain hurt. My brain literally felt broken. Everything was a big blurrrr. Nothing seemed clear. I felt myself losing mental faculties and acuity. I hated it, but I was not going to let go. I held on for dear life.
By now, walking the dog was a monumental feat. Doing the the laundry spent more energy than I cared to surrender on such a task. Feeding myself was a half-hearted act. Most days I didn’t eat. Planning dinner – nevermind cooking dinner – became way too big of a task to take on or even wrap my head around. My family lived on frozen food and take out. I just . . . couldn’t . . . do it. Leaving the house was out of the question. The only place or space that could hold my body or my pain, was my bed. I spent endless hours in that bed.
I began canceling get togethers, coffee dates and anything that involved leaving the house. It started with excuses that I was just too busy. Eventually the excuses weren’t even necessary because I simply stopped making plans altogether. And then, then I really felt alone. This was a place and space I didn’t want to occupy, but for the life of me, I couldn’t find my way out.
What happened to the “this is going to be the toughest year of your life AND THEN you’ll go back to normal,” spiel that my doctors all gave me and every other breast cancer patient I’ve ever spoken to? It’s been four years and I’m still not back to normal. There’s no such place. I’m better than I was at year 1, 2 and 3, but still. I’d like to strangle whoever started that ridiculous impossible notion.
The truth is, you don’t get to go back. You don’t get to step away from cancer and climb back into your old self. That person is gone in a lot of ways. So you have choices. You can try to pretend cancer didn’t happen and try to go on as if it didn’t – but I promise you at some point you’ll fall flat on your face and have to deal with the fact that cancer did happen to you and it did change you. You can also choose to stay stuck. To be stunted by cancer’s arrival, never going beyond the person you were in that time period, caging yourself forever as a cancer patient.
I’ve attempted both. Neither worked. In fact, they are quite harmful really. Going forward is so much easier than going back. You have less energy after cancer, so rather than fighting the current trying to return to the old you, relax and let yourself ride the current into the only you that exists anymore. She might be a totally different version of yourself. You might not even recognize her. But introduce yourself. Say hello. Become her friend.
To my early stage sisters, my advice to you is to avoid at all costs the very real inclination to get stuck as a cancer patient. Too many women don’t even have the luxury of making that choice. But for now, you do. I’m not saying forget you had cancer and I’m certainly not overlooking the very real fact that cancer – even when survived – continues to have an impact on our bodies, minds and spirits. But let the current take you. Let it take you further and further away from it as time goes by.
The only way out is FORWARD. Remember that.
There is no straight line in the cancer world. No two patients take the same course. And when we start judging ourselves against unreasonable standards set by the medical community and the false narrative about what it looks like to survive breast cancer, nothing but disappointment and feelings of failure will surface.
I couldn’t begin to tell you what exact steps to take in order for you to feel right, and good again. But I can tell you what has helped me.
In the tiniest of ways I began to let light in. I desperately needed light. Not just light at the end of the tunnel sort of light. No, I especially needed physical light. Sunlight. Good old Vitamin D. I started small, by opening the blinds. I’d find a place on the floor where the sun was shining and like a cat I would curl up and lay there, letting the sun warm my face and tickle my skin.
Saying Thank You
I could feel it helping. And so I thanked the sun. I began thanking every little thing that felt good. I thanked music for helping me feel again. I thanked nature for helping me breathe again. I thanked Prozac and Neurontin and Clonazepam. I thanked the cat and the dog and my husband and my food. I thanked the color turquoise for coiling around my soul, and healing me with it’s blue-green beauty. Over and over I thanked these wonderful little things.
Caring For Someone Else
Eventually I began walking the dog – something I had been pawning off on everyone else. As overwhelming as that was, it soon became something I looked forward to. It was helpful to remind myself that someone else relied on and needed me.
I took all the medicine. Good – Consistent – Medicine. It helped. It still helps.
Art of any kind was good for me. Art was capable of telling stories when the words were lost. Art has saved me more than once. Art helped me see color again. Just look at that jar of turquoise water. Art provides many gifts. Healing is probably the biggest one.
Loving, Kind, I’m-Not-Leaving-You sorts of touch were incredibly humanizing and important. A lot can melt away in the arms of someone who cares about you. Trust can be built in the warmth of a doctors hand when placed upon your shoulder. Touch is a net that has the capacity to catch us when we fall.
Good food. I began to feed myself again, to really nourish my body. I was suffering in so many ways and food was kind and healing – in a way that, for the first time, I truly appreciated.
I read books so that I could fill myself with words instead of pain. And sometimes, when I was too exhausted to read, I then listened to all the words. Other times I let the words spill onto paper in case one day, I needed them to save me. I dove into tales of falling and rising by some of my most beloved authors and women. Brene, Liz, Glennon, Elizabeth, Cheryl, Lidia, Martha, Jen and Rupi just to name a few. They were buoys when I would begin to dip below the surface. I would underline and highlight and scribble in the margins, dog ear the pages I needed to go back to, read over and over the same four lines because it was the salve my spirit needed. And they nested on my nightstand, just a reach away from the place I felt most safe.
Good friends – the sort that understood this kind of darkness – were hard to find. But I had a few and that’s all I needed. I keep those friends closest to my heart. They have earned the right to hear my story, as Brene Brown says. They are life preservers when I am deep in the dark waters of sadness and fear. I can reach out my hand and one is always there to grab ahold of me and pull me back to safety, and provide an emotional sort of CPR.
I engaged in talk therapy for about a year and when it stopped serving me I parted ways with it. I’ve sought out therapy time and again in my life. When I feel well enough to cope without it, I take a break. Sometimes that break last months, sometimes years.
I stopped looking toward the far-away-future. The future was too scary for me. I wanted to control it but I couldn’t. So instead, I began focusing on the here and now. Tomorrow, perhaps. If I was daring, maybe the next week. Living in the present made an overwhelming situation seem far more manageable.
Ohhhh the walking. The act of walking has been everything to me. Mostly I keep that to myself. That became MY time. MY space. That’s where I grow and heal. That’s where my spirit stretches and the earth grounds me. I slow down and take time to really see what’s around me. Incredible colors abound outside. Even turquoise skies. The outdoors is one giant metaphor for everything in life.
Little by little. Step by step. I found a way – my way – back to a place close to what I needed. A place that felt safe, comforting, and even happy. These simple little things have helped breathe life back into me. They didn’t return me to my old self, but I did find someone a lot like her.
You Have To Save Yourself
It takes a long time to heal. I’m still healing. Did you know that for every hour you are under anesthesia, it takes the body 30 days to recover? So, that means if you’re under for a 5 hour surgery, you’re looking at around 5 months before your body fully recovers from that. The physical damage takes months, years, even lifetimes to mend. This isn’t a cake walk and don’t let anyone tell you otherwise. It wasn’t and still isn’t easy. But I’m here.
I still find myself in the throes of depression now and then. Anxiety and fear still try to take the keys to the car and I still duck around corners so they don’t sink their teeth into me. But I’m here. I’m not letting fear win. I’m not letting depression win.
In all of my cancer experience, I wanted desperately to find a single silver lining. You know, that gift everyone tells you that cancer is? I have come to realize and I hope this doesn’t disappoint you, but there aren’t any. Cancer doesn’t possess or create anything positive. It isn’t silver and certainly doesn’t come wrapped in a bow as a gift.
Instead, I found my friends, incredible teachers, all my perfect imperfections, my voice and my walks. These are my safe spaces and those are the places where I find endless silver linings . . . and some of them are turquoise.
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