Put on your oxygen mask first

Getting through the next few months

I busted out the SADD lamp yesterday. Winter in Chicago can often extend through April, even early May, the hallmark of which is a low oppressive lid of clouds. That’s just a regular year without a pandemic, without post-election deflation and worry. So this week I’m running two free-to-all issues on mental health. Today’s addresses the grownups and later this week is for kids. If you find this helpful, please forward to any friends who might need it but please encourage them to subscribe, or share on social, to help support this independent work.

I consulted four experts on some questions that I had and that readers sent in:

Kristen M. Granchalek, LCSW is a therapist (and mom of three) in Chicago who specializes in women’s issues, grief and loss, and anxiety.

Carlin Barnes, MD is a double Board certified and licensed child, adolescent and adult psychiatrist in Houston (and mom of one) whose 20-year career is spurred by a passion for delivering care to special populations.

Marketa Wills, MD, the CMO of Johns Hopkins Healthcare, is a board-certified psychiatrist in Florida who serves as a physician leader in a provider-led managed care organization. She and Barnes are the co-founders of Healthy Mind MDs, LLC, a wellness enterprise whose mission is to improve the emotional and mental well-being of all Americans.  

Emily W. King, PhD, PLLC, is a licensed psychologist and health services provider in private practice in Raleigh, North Carolina. A mom of two boys, she has nearly 20 years of experience working with children and adolescents with anxiety, depression, ADHD, and autism spectrum disorders.

“What are the best ways for me to connect with a therapist remotely - or finding/connecting with a therapist for the first time? Zoom might not be best for everyone, and being able to talk openly in your home when kids/spouses are nearby can be challenging.”

Kristen Granchalek (K.G.): Therapists are more comfortable with it now if you need to talk while taking a walk or you need to sit in your car, if you can communicate with yours about why things have to be a certain kind of way. A lot of the rules are lessened as far as licensure and insurance requirements when it comes to seeing people out of state. Find someone in a different time zone so you can do therapy when the kids are asleep. We tend to say “Unless I can do X activity in this circumscribed place where it doesn’t impact anyone in my life, I’m not allowed to do it.” This is one of those things where we have to be more demanding and it has to happen. Zoom babysitting is a thing—put the kids on with Grandma and Grandpa while you and dad have a conversation with the therapist once a week. I know someone who is working at home with her husband: they do their therapy over lunch one day a week.

Drs. Barnes and Wills (B&W): Some suggestions for connecting with a therapist include online resources such as Psychology Today, contacting your health insurance plan, or asking your medical provider for referrals. Trusted family, friends, and colleagues can also be good resources for therapist referrals.

“What advice do you have for women whose partners struggle with (non-severe/life-threatening) depression, in terms of how much is realistic to ask another partner to accommodate before getting professional help?"

B&W: Dealing with a depressed partner who is not willing to get help is not easy. But by not addressing the issue head on, your partner’s depression could become more advanced to the point that he or she withdraws further, becomes suicidal or perhaps even turns to alcohol and/or drugs. Waiting to get help is not the answer and it only increases the chances that your relationship won’t last. A concerned partner has the duty to put his or her foot down – albeit in a supportive, gentle, non-accusatory way – and insist that their loved one demonstrate actions that support good health for the entire family. While it’s important that you show that you care, it is also fair to empathically point out how the depression is impacting you and your children. Suggesting that your partner discuss the issue with his or her trusted primary care physician or family doctor is a good place to start. You can also be in the examining room to share your perspectives about the symptoms and changes that you have witnessed and observed. 

Remember, stay empathic and non-judgmental as you approach your loved one. Here’s what that may sound like: “I’m concerned about you being so tired lately and about your spirits being down these past few weeks/months. It’s so unlike you. It’s impacting you and it’s impacting our family. I care so deeply about you and I firmly believe that you deserve to feel better. I think Dr. Doe will be able to help. Next Monday or Tuesday works for me – which works better for you? I can call and make an appointment.”

Also remember to take care of YOU. It’s all too common for spouses to pour themselves emotionally into taking care of the person who is depressed – and by doing so they lose themselves.

K.G.: Mental health issues have been normalized in our society to great benefit to many of us, but I think there’s some tendency to say “My depression or my anxiety or my ADHD requires accommodation,”  and that can become problematic in a relational system when it becomes accommodated by the other and not managed by the person having the experience. Having empathy for a condition doesn’t preclude someone for being accountable for what they can be. When we talk about “self care,” I don’t like when it connotes bubble baths and a glass of wine. It’s about self knowledge and knowing what are my assets, my liabilities, how I manage. It has a lot to do with discipline. That’s a dirty word, but it’s how we take care of ourselves. I call it “SEEDS”, sleep, eating, exercise, doctors orders. If we’re depressed or anxious, we can ask for help, but our job is to say “I’m doing the following, and here's how you can help support me.” That’s not carte blanche to not help out around the house or avoid doing things that stress you out. It has to be a negotiation. When the pandemic first happened, it was, “Whatever it takes to make do, we’ll make do,” and that worked for four weeks, but you can't do that for 18 months. 

Every partnership has gone through some implicit or explicit negotiation about what we owe one another. When something changes in our lives, whether it’s a new baby, a job, or a pandemic, that thing needs to be negotiated. You may think, “My husband’s depressed, what can I ask of him?” You can ask whatever you want! He might not be able to give it to you, but one person’s needs don’t trump everybody else’s. Too often our families are configured such that one person’s needs matter more than anybody else’s and whether that’s the kids, the partner or the wife, whoever that is, that’s an inherently unstable and unsatisfying dynamic. 

“What advice do you have for people who lost someone last year or this year and have to grieve in solitude? What about grieving the end of the pre-COVID world as we knew it, how do we do that?”

B&W: The grief associated with death is familiar to most people, but dealing with grief has been particularly challenging during the pandemic period. Under non-pandemic circumstances it is customary for families to be able to visit their sick and/or dying loved ones in the hospital to say their final words. Unfortunately, due to social distancing measures imposed to slow the transmission of the illness in-person hospital visitation is not possible and many individuals are dying alone with medical personnel taking on the role of family during the period of transition. And once the person has died, many of the customary traditions that allow us to process the grief such as funerals, burials, repasts and family gatherings have been down-sized or curtailed to adhere to social distancing expectations. This makes it particularly challenging to process the death of a loved one. 

Here are some strategies that one can employ to effectively manage grief during the pandemic:

1) Mark your loved one’s death with a special symbolic ritual that you create.

2) Write a special prayer or poem as an ode to your loved one and get it framed.

3) Hold a Zoom or teleconference with family and friends and tell positive or funny stories about your loved one that passed. 

4) Seek out support from your priest or pastor.

5) Seek out professional help if you are having thoughts that life is not worth living. 

Grief generally gets easier to cope with over time as we adjust to a new normal – i.e. begin to accept life without our loved one. A prolonged grief (>6 months) where the feelings of sadness deepen and intensify over time are consistent with what is known as a “complicated grief”. If you are experiencing feelings of complicated grief, professional help is highly recommended. 

It is natural to grieve in connection with the various losses that have occurred during the pandemic – for example, loss of ability to walk around mask-free, loss of being able to spend quality time with family and friends, loss of many recreational activities, just to name a few. Recognizing these losses and coming to peace with them are an important aspect of building resilience. Practicing mindfulness and developing a mindset of gratitude will help you move to acceptance, preparing yourself for the next phase of the pandemic. 

“I’m worried about a general depression setting in now that the drama of the election is over and things are moving slowly with COVID recovery. What, if anything, can I proactively do to counteract this?”

Emily King: I like to think of it as seasons. There was a season of campaigning and then waiting for the inauguration and there will be a season, I hope, of empowerment or advocacy or whatever we feel is our thing to put our energy into after this. That letdown we feel is that someone let the air out. You release a pressure valve. It’s like the day after your wedding or after Christmas. Notice that, and be reflective—what are you missing in that moment, what did you enjoy about that process, what’s your next thing? What’s your next season? You were involved in politics and campaigning for a reason. Now, how can you put your energy into something similar? Maybe it’s policy change—choosing a policy you’re passionate about—and modeling for our kids, too. At least for me, I grew up feeling like everything was safe until Desert Storm. Our kids are experiencing four huge things to focus on. This is their generation’s opportunity to put their energy into what they want their future to look like. I didn’t get that until I was in college. I knew I should vote; was I as passionate about it as I am now? Probably not. Our kids are passionate out of the gate, so let’s arm them. You have this passion. This is where we can put that energy.

How should I handle anger? I have so much anger over the gross incompetence that got us to where we are with the pandemic and e-learning. But there's no real way to act on it. So we have to accept it. But that makes me depressed.”

B&W
: Anger, sadness, and depression (along with other negative emotions such as anxiety, irritability, frustration, and helplessness) are valid reactions to the unprecedented challenges many of us have faced this year. Studies show that rates of anxiety and depression have increased by 30-40% during this pandemic.  Some people find that channeling their negative emotions into positive actions (for example, exercising, practicing mindfulness, journaling, volunteering) can be very helpful and help them manage their feelings and improve their coping. If you are having a particularly hard time managing your feelings and emotions, we suggest that you seek the help of a qualified therapist or your healthcare provider. 

K.G. Anger out is anger, anger in is depression. Those of us who can’t express anger tend to be more depressive. Instead of getting angry and demanding change on behalf of someone else we say, “If I were different, I wouldn't be so mad.” I think there’s a lot to be gained from feeling anger and expressing it and allowing it to be verbalized and move through your body. That’s what’s so infuriating, that we feel like we’re screaming into a void. We have this urge to make someone feel and be impacted by our rage.  Trump was the perfect boogeyman. He was so impervious to any of our feedback. 

Sometimes it helps to make big movements and press against a wall. Feeling pressure against you, when you're feeling that angry, to lean on a wall or exercise ball, it can have an ameliorating effect, like, “I’m not floating in space.” Get it out, feel it, yell, scream, say whatever ridiculous thing you have to say. Whether we’re overcome by fear, anger, grief, feel it, take a deep breath and say “Enough for now. Not forever.” Just move it along. I think we get so caught up in leaning into that feeling that we create a lot more pain and suffering instead of letting it moving through us. 


End credits

I hope you are doing okay overall. If you are struggling with thoughts of self-harm, call 800-273-8255 or chat with the lifeline.

Thank you for reading Evil Witches, a newsletter for people who happen to be mothers. If you have any questions, ideas, suggested topics or questions about submissions, you can reply right to this email. You can follow Evil Witches via Instagram or Twitter. Some future upcoming (lighter) topics include how to pull off an actually fun Zoom party/shower and tips from a thrifty, clever friend of mine who can put any random outlier pantry/freezer ingredient to good use. Got something in your kitchen that you can’t figure out what to do with but don’t want to throw away? Let me know and I’ll try to stump her!

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One witchy thing

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