While everyone pretty much has heard about the big financial bailout bill that President Bush signed into law the other day, few people know that there was a little-discussed amendment to the bill that requires parity for mental health coverage from the big insurance companies. Simply put, this means that in a year’s time insurance companies must treat mental illness the same as physical illness. They cannot limit the amount of covered sessions you have with your therapist, nor determine that mental health treatment is “medically unnecessary” without specific, concrete proof of how and why they came to this determination. This was a great victory for mental health advocates, but will no doubt open the door to some sticky conversations between insurance companies and psychiatric patients. For instance:

Insurer: We are denying you coverage because you only had one foot on the ledge; the

other foot was clearly inside your apartment.

Patient: But I felt like jumping.

Insurer: If you had jumped, we would have approved you for more therapy sessions.

Patient: If I had jumped, I would be dead.

Insurer: Exactly. But you would have been covered for as many visits as you deemed

necessary, nonetheless.

Or:

Patient: My therapist says we working on some pretty complex issues that could take

months to resolve.

Insurer: What specifically are these issues?

Patient: It has to do with my mother taking my favorite teddy bear away from me when I

was six.

Insurer: We’ll give you another teddy bear.

Patient: That’s not good enough.

Insurer: Then we’ll give you another mother.

I suppose in time the insurance companies and psychiatric patients will learn to speak the same language, but until then, there will certainly be some growing pains.

I’ve always been allergic to ragweed and pollen and pretty much accepted the fact that I would be coughing sporadically through much of last spring and summer. Then came the news on PsychCentral.com of an experiment that showed that stress and anxiety can exacerbate reactions to routine allergens. Hence, if you are an anxious type person your allergies will be worse than if you are the calm and at peace sort. Being in the former category, I immediately started coughing uncontrollably. It got worse when I went into the room where one of our cats spent her life and where I sometimes slept when my husband’s snoring kept me up.

I tried to make an appointment to see my internist but he was away on vacation and had to see his partner, an Iranian who I had as much confidence in as a thoroughbred going off at 99-1. “My husband thinks it’s a post nasal back drip” I told Dr. Farheed, when I saw him. “What do I have?”

“That’s what you have,” said Farheed, but it was more of a question than a diagnosis. I had taken a chest x-ray which was clear except for “perhaps, maybe a little trouble spot,” he said, and he had given me a prescription for prednisone but said, “I’m not sure if you should use it.”

I went home with more questions in my mind than I had left with and called my brother in California, a good internist, and told him what was going on. He told me to fill the prescription for prednisone and get rid of our cat. I complied with the latter and after taking the mediation for a week, my cough had gone away and my face had become as round as Charlie Brown’s, haven eating everything in the house except for our refrigerator.

The cough stayed away for a week and then came back. By this time my regular internist was back and he referred me to a pulmonary doctor to get a pulmonary function test (something my brother had also recommended). After I took the test, my pulmonary doctor said they were almost normal. “Are you under a lot of stress?” he asked me.

“Stress?” I squeaked. “Why yes, I have a book coming out and I’m pretty nervous about it because I’m supposed to be blogging, but I’m not and I don’t think my publisher likes me too much and I have this publicist who….”

Dr. Nason raised his hand. “I get it,” he said.

And now that I had read the PsychCentral article, I got it, too.

My comic memoir, Hide & Seek, recently got a very interesting review in Martha Stewart’s magazine, body + soul:

The Laughing Cure

A woman's offbeat solution to escaping her own malaise

Reading Wendy Aron's Hide & Seek (Kunati) is like spending time with an exasperating friend who discloses way too much but also makes you laugh like crazy. In recounting her journey to conquer her depression, Aron includes childhood grievances, adult embarrassments, and self-criticisms galore, all spike with witty observations and a keen eye for life's absurdities. Surprisingly for its genre, the book avoids a touchy-feely "aha" moment in the end; instead, Aron's epiphany involves realizing that she enjoys making jokes out of the sometimes awfulness of life. The result is a book less an instructive guide to surviving depression than a colorful character study of someone who did just that. It's the outcome, not the advice, that inspires.

--David Valdes Greenwood

This review made me stop and think how exasperating I actually am to my friends. I queried my best friend, Marie about it. “Am I exasperating?” I asked her.

“Well, sometimes you do have a tendency to whine,” she said.

Marie is right. I do whine a lot and I am a big, draining pain in the ass to the people who know me best. But apparently I keep them laughing, so they cut me some slack. The problem is, I don’t know how to be any other way. Having never had my emotional needs met as a child, I have been emotionally bleeding on my friends for a lifetime. In fact, I can’t remember when I haven’t heard, “Well, I have to go now…” after an extended bout on the telephone with Marie.

After reading this review, however, I have become determined to turn over a new leaf. I am going to ask friends how they are doing before I launch into my own travails. I am going to try to cut down on the number of complaints I have about my family. I am going to become a new person…as soon as I speak to Marie about a few things that are really bothering me.

As depressives, we all suffer from low self-esteem and we all know what a killer it is. Therese Borchard, in her blog Beyond Blue, described having no sense of self-worth this way:

“Three years ago I walked into my therapist's office feeling like a Krispy Kreme donut: I had no center. Everything I attempted, both professionally and personally, seemed to flop. I had no sense of self, no confidence, and no faith in myself. I found nothing of value in my DNA.”

Borchard went on to say that she has battled back by putting together something known as a self-esteem file. To make your own self-esteem file, she advised, you begin by trying to identify 10 of your strengths--10 positive qualities about yourself--and write them down on a piece of paper. If you are unable to identify ten things you like about yourself, Borchard recommended that you find four other people that can. If you don’t have a lot of friends, she says, think of other people like “coworkers, or siblings, or teachers, or pastors, or mail carriers.” If still don’t have four people, Borchard advised making new friends by taking a class, getting a dog (pet owners stick together) or going to a support group. To get the cooperation of the four people you’ve selected, she said, you can tell them it’s for an online project you’re doing and offer to write down a list of the positive qualities that you have found in them. When you’re done with the project, you were to actually take the paper the lists are written on and stuff them into a physical folder in your filing cabinet for referral every time you are feeling low about yourself.

Borchard’s recommendations all sounded well and fine, except I have a few problems with the self-esteem file. First of all, what if  you were stymied by the fear that you didn’t even have ten positive qualities that your friends could list? Wouldn’t that just put an end to your self-esteem all together if you gave the assignment to your best friend and she was unable to come up with ten good things about you? The suggestion to go outside your circle of close friends is also problematic. Listing ten great things about me is not something I would ask a new friend to do for fear she would run for the hills. New friends, when they are first getting to know you, don’t need the pressure of having to list why they like you. They may not even know, yet, if they do like you. As for my mail carrier, I’m reasonably certain the only good thing he knows about me is that I tip him at Christmas time. Furthermore, even if I have found four people who could come up with ten positive qualities each, what if I couldn’t think of ten things I liked about them and couldn’t reciprocate?

Don’t get me wrong, I’m all for high self-esteem, but Therese, there must be an easier way to go about getting it.

I admit it. I fell of the wagon. The exercise wagon. When I was in my twenties and thirties, I exercised like a fiend. I lived in Los Angeles where the weather was accommodating and found myself playing tennis two to three times per week and taking long walks in between. I felt great.

When I moved back to New York in my thirties I joined an indoor tennis league. It was expensive and I hated the other ladies in the league. (In LA, I had made individual games on the spur of the moment with friends and acquaintances, not people who were foisted on me.) The ladies in the league were focused on one thing—winning a plastic trophy at the end of the season. Their viciousness sickened me. My brother, who is a podiatrist, wrote me a note that said I had broken my foot and had to withdraw from the league (I wrote a comic play about the whole experience.) After the tennis league, I joined a gym, but I found exercising on recumbent bikes and the like to be quite boring. So I stopped working out there, too. By now I was forty and parts of my body were in active revolt against movement of any sort. I relented and stopped exercising altogether.

You may wonder why I’m so guilt-ridden about this, but if, like me, you suffer from depression you’ll know why—exercise is one of the most powerful ways to stave off depression. It releases endorphins which give us a natural high and a sense of well-being. I need that. While ruminating about it, here's what was suggested to me by Lisa, a reader of the depression blog, Walking the Black Dog:

“There are little things you can do that don’t have to be a huge effort, but add up after a while. You can walk more by parking further away from stores and take the stairs instead of the elevator. Sometimes I just like to walk briskly up and down the rows in a department store. There is also dancing. It can be fun going out and doing it or staying at home in your living room and shaking it where no one can see you. I enjoy gardening and there is nothing like a good round of leaf raking in the fall for your arms. Doing housework and laundry and carrying groceries from the car are all good for you. I think if people just did more things themselves, they would get more exercise.”

For now, I’ve adopted Lisa as my savior. I am going to follow her advice and try to make some progress on getting back into exercise. If only my back didn’t hurt so much!

"'[Y]ou may just be one of those people that have to stay on Paxil the remainder of your life. It is like insulin for diabetics. Many people take SSRIs for their whole life. Plus, because of the length that you have been on Paxil, you may never be able to get off it.'"

Of course this psychiatrist or any psychiatrist who tries to make patients afraid to get off their antidepressants is acting very unprofessionally and is probably doing so because he has a vested interest in keeping his patients addicted. Why? The insurance companies pay psychiatrists very well for medication management (not so with therapy, and that is why so many psychiatrists are getting out of it).

The writer of another blog, The Splintered Mind, related how he was able to overcome his depression without the help of antidepressants and how much damage taking medication had done to him. He argued, too, that antidepressants simply don’t work and holistic methods of treatment are far superior.

I’m not saying that many psychiatrists aren’t drug pushers or that more natural methods of healing aren’t better than meds. But in my own personal experience, I have stabilized on the same antidepressant—Elavil--for over ten years and have had minimal side effects. My psychiatrist thought I was doing well and wanted to get me off the medication, so I tried it and quickly started to get depressed all over again. Sure, I think that the less pills you have to take, the better off you are. But there should be no shame in acknowledging that you need medication to remain stable. The simple truth is that some people need to be on antidepressants and others don't. The only wrong side in this debate is the side  that insists their point of view is correct.

“Can time spent with an animal truly translate into a meaningful, healing experience? That’s the goal of equine-assisted psychotherapy (EAP), an increasingly popular experiential treatment where individuals interact with horses in a variety of activities, including grooming, feeding, walking and equine games, for improving their psychological health…”

The author of the article was skeptical about EAP, but I’m here to tell you that it works. The summer after my first hospitalization for major depression I had the chance to spend time with some thoroughbred fillies and colts at a farm next to a vacation home my parents owned. Some twenty-five years later, I have fond memories of how it helped me transition back into “the real world” by giving me a place to cast aside worries that I was going to be judged, criticized or rejected for being mentally ill. Horses didn’t do those things. Only people did. I eventually overcame my fears of interacting with people on the “outside,” but being around those beautiful animals that summer made the path that much easier to travel.

As someone who was first diagnosed with major depression while attending an out-of -town college, this survey disturbed me. When I was at the beginning of my depressive episode, my parents urged me to go to the counseling center on campus. Up to that point, I did not even know that a counseling center existed. My college made no efforts to publicize that it was available to students who might feel troubled, nor, as far as I knew, were faculty and staff advised to look out for students who might be having emotional difficulties and urge them to seek counseling. This all happened almost thirty years ago, and I had hoped that things on campus would have changed in the intervening years, but I see from this survey that they haven’t.

Often times, particularly when a child is at out-of-town college, parents have no idea what is going on with her/him. (If school shootings are any indication, they have no idea what’s going on with the kids who live under the same roof!) It’s therefore incumbent upon colleges to find ways to invest in the emotional well-being of their students. Some may say that that is not the college’s responsibility, but I disagree. If someone had a physical problem, you can be sure that a college would assist with her treatment. It should be the same for conditions that are emotional in nature. Parents should be alerted that their child is having difficulties and the school should work with the parents and the child toward a course of treatment that satisfies all parties. It’s simply a matter of life or death.

“Can you have a beer?” I asked.

My friend snorted.

After I hung up the phone I started to castigate myself in a way that should be recognizable to any depressive. We continually look for ways to beat ourselves up and feel “less than” the next person. But this time I felt like I really deserved the self-hatred. My friend, who is not a depressive, was facing several horrible things—her beloved feline had to undergo an exploratory biopsy for cancer, her brother was heading back to a mental hospital, her niece had just been diagnosed with a rare cardiac illness that could cause sudden death and she was working twelve hour days under tense conditions with no let up in site—and all I could say was, “Have a beer!!!?”

I have never been good at giving advice and comfort. I am a comfort seeker, not a comfort-giver; I am a drain on others, and it irks me. It has even cost me some friends. I know that the only reason I can’t comfort the people in my life is because I have no capacity to comfort myself. Most depressives can't.

I called my friend back the following evening and apologized for my deficiencies. Like a good a friend, she understood. I understood, too. It was something I promised myself I’d work on. In the meantime, I asked her: “Do you still feel so bad?”

“Sort of,” she said.

“Well, it’s only natural to feel a little overwhelmed right now,” I responded. “Tell me if there’s anything I can do to help.” It was a small start.

Reading this article brought back a flood of unpleasant memories for me. While I wasn’t diagnosed with anxiety and depression until college, I distinctly remember that many of my symptoms were present when I was going to sleep away camp as a tween. I hated sleep away camp. I begged my parents not to send me, but they did because it was “what everyone else was doing.” When I got to camp I was terrified of all of the “new” children. I made one friend and clung to her like a life preserver. I cried incessantly for my parents to come take me home. As I was a great athlete, they were flabbergasted by my refusal to fall in love with my surroundings. It got so bad, I fantasized about running away from camp and almost did on one or two occasions.

So parents, beware. If your child is having a difficult time at camp, it is not something to be ignored. Clinical depression manifests itself in many ways and intense worry and sadness at the thought of being away from home is one of them. My own parents were clueless and I did not get the treatment I so desperately needed. Don’t make the same mistake with your kids.