How does it all start?

I have been getting my life in order of late. In extremely exciting and very adult news, I have paid off my HECS debt! I now actually own my two degrees. I have consolidated my fifteen superannuation accounts. This week I got my car serviced and after a very assertive talking to from the mechanic, I have two brand new tyres. And I am going through the process of having a ‘proper’ General Practitioner. Like, a GP who actually knows me. Not just the one who is available when I've got myself an ear infection from washing my hair too frequently in the bath.

I haven’t had a regular GP since I was a very young person. So new GP – let’s call him Dr Nick, because that is his name – had a bit to catch up on. And we’ve spent time together looking over and listening to different parts of my body. And I’ve attempted to succinctly summarise my mental health history for him. This has not been as easy as I’d hoped. Turns out I’m not the eloquent historian I envisioned. And also, answering personal psychological questions short and sharp, is tough. It’s not like sitting on the couch with psychiatrist Dr Matt and being able to babble on for a forever until you think you might just nearly maybe have it sort of figured out.

Take this, question for example. Dr Nick asks – ‘Have your episodes been triggered by anything?’ (Except he didn’t ask it like this. Because he is a doctor. And sometimes doctors prefer to use really complicated language to remind us that they’re really smart. Technically he asked – ‘Have your episodes of mental illness had an etiological cause or event?’)

It’s a warranted question to ask. There is immense scientific literature on this topic. People who have a severe depressive episode are most likely to have experienced a stressful life event within the past year (like divorce, moving, job loss, death of a loved one, medical illness etc.) compared to people without mental illnesses.

But I found it a tricky question to answer. In a short GP consult.

Probably, my episodes were brought about by a complex interaction of biological, cognitive, social and psychological factors all conspiring together in wonderful ways.

What I reckon probably happens to me is that there may be a build-up of life events (yes, we could call these social factors, or environmental causes or triggers), and when these events are of a particular kind that holds an inherent threat to my sense of who I am (the psychological part) then my mood is more likely to shift. Probably downwards.

So, there’s been times in my life where there has been a lot of life events or stressors and because of the nature of these events, they’ve affected me in a particular way. There’s been periods where I have been working full time, feeling a bit anxious, but keeping my head above water, to quite a different state of mind. When I am there I feel quite different. I don’t only feel sad, I feel physically ‘changed’; heavy of limb, tired, unable to sleep yet also very agitated and restless. I ruminate about things that at other times I would be able to cope with easily and I can be full of fear and panic. When I look in the mirror I am quite sure I can see it in my eyes. There are times when my fear can shift into obsessive and paranoid thoughts and feelings of wanting to end my life. It’s terrifying and yet oddly familiar at the same time.

And there’s other times where there’s been life events or stressors that have occurred, but an episode of mental illness hasn’t followed. Why? Probably because these stressors didn’t play into my vulnerability so much. They didn’t attack my sense of self or my psychological state in the same way. Or my psychological state was stronger or more resilient at the time.

I reckon the most toxic kind of life event that can trigger depression is one that resonates with a particular aspect of the person’s underlying vulnerability. Life almost seems to conspire to match the event to the person. Eventually anyway.  

And as I’ve mentioned before that vulnerability for me is the big Ps. Please. Perform. Perfect. The belief that if I do things perfectly I can minimise or avoid the pain of blame, judgment and shame. This comes with the nasty and debilitating belief ‘I am what I accomplish and how well I accomplish it’. So when events or stressors come along that target this belief system (which happen reasonably regularly), I become more susceptible to depression and anxiety.

So why do I experience depression when others experience far worse life events then me, yet don’t become diagnosed with mental illnesses? The only way I can explain why only some of us seem to become depressed in response to life events is by drawing on the concept of vulnerability. A combination of genetic factors, early life experiences and life stresses can cumulatively add to our vulnerability. Such that, when a torrent of life events come along, those of us who have the greatest vulnerability and lowest threshold for becoming depressed, can get washed away by the waves while those who are fortunately more resilient seem to remain standing.

So, how did I respond to Dr Nick. Unfortunately not with a neat and succinct hypothesis regarding predisposing factors, psychological vulnerabilities and precicipating events. Instead I said something along the lines of “Yeah, sort of.”

Because that’s maybe nearly about right.

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