A Flare-up of a Chronic Illness

[Content note: depression]

This is a personal post, not an advice post or a big societal problems post. But past experience has shown that some people appreciate and benefit from it when I describe how I try to think about things.

“Reframing” is a term we sometimes use in mental healthcare (and elsewhere) to basically refer to changing the way you think about something. While therapists sometimes suggest ways to reframe things to clients, it’s ultimately up to the individual to decide whether or not they want to reframe, and if so, how.

For some people this concept can hit a nerve because it can sound a lot like the well-meaning but ultimately useless (and even hurtful) advice we get to “look on the bright side” and “think about the positives.” But that’s not what reframing means to me. Here’s an example.

In one of my classes, we are required to meet in pairs for ten weeks to administer and receive counseling. Not as a roleplay exercise, but as an actual attempt to disclose one’s struggles or work with someone else on those struggles. Many students in the class expressed strong discomfort with being one of the “clients” in this exercise, but I’m already accustomed to sharing very personal and intimate details with thousands of strangers online, so I had no qualms about signing up to be counseled.

During our first session, my student-counselor asked me a question: “What, to you, would be an ideal or perfect day?”

It didn’t take me long to think about my answer, which turned out to be sort of a non-answer.

“There isn’t one,” I said. I explained that after eleven years of depression, there is no longer such a thing as an ideal or perfect day and it feels like there never was. That sort of thing is so far out of the realm of possibility for me that, in my view, there’s no point in sitting around hypothesizing about it*.

The reason is that hypothesizing won’t bring me any closer to experiencing it. The things that stop me from being able to have perfect days, those days you spend the rest of your life wishing you could relive, are not surmountable things.

As an example, I told them about the previous weekend, when my roommate and I had gone to visit friends in the suburbs of Philly and then went to a steampunk-themed dance in the city proper. I’d been looking forward to it for a while. It was supposed to be one of those awesome nights. We got all dressed up, and I was wearing my friend’s spectacular dress that I felt amazing and sexy in, and I was with my friends, and it was going to be awesome.

Until, of course, it wasn’t. Not long after we got there, I experienced one of the things I refer to as a depressive trigger, for lack of a better term. It’s whatever the depression version of getting triggered is–specifically, it brings on acute depression symptoms–and it happens to me periodically. I heard it and I felt every metaphorical gear that keeps my brain working properly grind to a halt. It was like driving down a beautiful country road in the sunshine and suddenly finding yourself in a thunderstorm.

After that I couldn’t make myself function. I felt an uncomfortable combination of numb and sad in a very “deep” sort of way. I was constantly on the verge of crying, and knew I would if I let myself think about the thing that had triggered me. I couldn’t talk to anyone, at least not in any socially appropriate way, and I couldn’t dance or pretend to be happy or do much of anything else.

So I left my friends, sat in a corner, and spent most of the rest of the night writing in my notebook (good thing I carry it everywhere) and messaging with one of my partners on my phone. (Situations like this, by the way, are one of the reasons I’m so adamant that it should be socially acceptable to be on your phone at social events. Because my options at this point were: cry in front of my friends, be on my phone, or leave and somehow find my own ride back from Philadelphia to New York at 10 PM on a Saturday night.) I was eventually more or less okay, but it took a long time, and I spent most of the night on the effort to make myself feel more or less okay.

This is not atypical for me; it’s been happening for almost as long as I can remember, and while the triggers have changed a little over the years–as has my ability to manage them–the fact that they happen in the first place has not.

I used to hate myself for it. I’d berate myself endlessly for “ruining” everything or “wasting” good times away, especially since the triggers were as predictable as they were unavoidable. Surely I could learn to stop doing this? (But I see nothing about “acute depression triggers” in any of the scholarly material I read and I don’t even know if this is a typical aspect of the experience of depression or if anyone has ever reported it at all. I just know that that’s how depression works for me.)

Now, I told my student-counselor, I think about it differently. Of this specific incident, I think: I had a flare-up of a chronic illness, but I was able to manage it.

And because I’ve learned to think about it that way, a lot of other things start standing out–the things that went right. I had a great, relaxing day with my friends before it happened. I got dressed up and felt good about how I looked. At the event itself, during the times when I was feeling more or less okay, I met some interesting new people and took some great photos that I’ll have to look at and reminisce. While I was feeling triggery, my friends noticed and checked in on me in ways that demonstrated their concern and care but did not step over any of my emotional or physical boundaries. (Most significantly, I don’t like to talk about the things that cause me to feel bad, and nobody asked or expected me to.) While I was feeling triggery, I managed to disclose a little bit of it to my partner online–not something I am often able to do–and my partner was supportive. I was able to stop it from getting any worse.

Reframing is not the same as its distant cousins, “looking on the bright side” and “finding the silver lining.” I didn’t choose to look on the bright side or find the silver lining. The silver lining found me, after I had reframed the situation in a way that didn’t make me look like a horrible wretched failure of a person. And when I reframe, I don’t attempt to dilute or ignore the reality of the situation. It is not preferable that things like this happen when I’m trying to have a good time with my friends. There is no “silver lining” to getting triggered. I’m not going to wax poetic about what this teaches me about myself or about the human condition. I’m not going to gush about how situations like this really bring out the wonderfulness of my friends and partners, because my friends and partners are wonderful a lot of the time, whether or not I’m currently feeling like crap.

When I think back to that night now, I don’t feel sad, because I’m remembering the good things along with the bad. Previously, the distortion that my brain engages in would’ve made that impossible. I’ve tried to somehow force myself to think about the good things before and failed. It could only happen once I found a way to look at the situation realistically.

I didn’t fail. I didn’t ruin anything. I didn’t choose for this to happen. I had a flare-up of a chronic illness, but I was able to manage it–with the help of some of my friends, but also by drawing on my own strengths and resources.


*That said, the question the student-counselor asked is typically a pretty good one to ask, as it helps the therapist understand what their client hopes to change about their life. But I already know that I want something impossible. I want to be cured. I won’t be, and that’s okay.

A Flare-up of a Chronic Illness

12 thoughts on “A Flare-up of a Chronic Illness

  1. 1

    That might be the best depression-related thing I’ve ever read, Miri. Seriously. That helped, a lot, in ways I can’t articulate yet, but I’ll TTY later when I’m not on my phone, for a start.

    Sincerely. If not the best, no worse than third, EVER, and honestly that’s just me hedging my bets because I’m old and my memory formation isn’t ideal. Thank you.

  2. 3

    Thanks, this also seems to explain to us (mostly) non-depressive people how to interact with people suffering from your kind of chronic condition. Reframing things this way makes a lot of previous experiences I’ve had with my depressive ex and with occasionally depressed friends more understandable.

    Hope you enjoy your next steam-punky concert better, while for me spending a night out just listening and reading/writing/drawing in my notebook is pretty much the definition of having a good time.


  3. 4

    My own therapist asked me a variation on that question: what is my ultimate goal, what would life look like if I felt better, that sort of thing. (I forget his exact words.) He mentioned, as examples, career, educational and life “milestones” as a means of indicating that I was doing okay, and my answer was that I wanted a reason to want to get out of bed every day.

    Learning how to reframe things is, I think, one of the things I’ll be working on with my therapist, because I don’t feel like this is a skill I have, especially where my mental illness is concerned.

      1. The whole thing where you shut down in the middle of big social situations. It’s happened to me; it used to happen a lot more often when I was younger. Eventually I just had to learn to deal with it, because I knew that if I didn’t I would, depending on the particulars of the situation, get shit on by (a) my family, or (b) my friends (“friends”).

        1. queequack, this isn’t a competition. I don’t know who has it “worse,” men or women, and I think that women of color in particular experience a lot of constraints on their ability to display this sort of vulnerability.

          In any case, I can guarantee you that I’ve faced pretty serious social consequences throughout my life for this sort of thing. The reason I didn’t this time is because my friends are amazing, not because I’m female. But again, I don’t want to get into a competition about it. Mental illness sucks for everyone.

    1. 5.2

      i have done what Miri describes back when i was pretending to be a man, and had people react in a good way. i have also had negative reactions to me being unable to cope in social situations.

      i think you need to talk to your friends and family, and try to help them be able to react in more useful ways. hopefully they will listen to you and want to help once they understand what is happening.

      1. My family has gotten better ever since I got an Official Diagnosis and an Official Prescription. My friends, well, in fairness most of them are not aware of my mental issues because I don’t want it to define me, and also, when people do find out their reactions are generally negative. One of my housemates last year knew, and he mostly responded with assorted drunken “jokes” throughout the semester, like calling me a basket case and stuff. So no, I’m not going to talk to my friends about it.

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