The Difference of Emotions: Our Biases and Depression

Depression is an isolating pain. A pain affecting the soul, a pain that consumes all hope and leaks away pleasure and ambition. Individuals impacted by it have described the experience as: "Most closely connected to drowning or suffocating- but those images are off mark"- Styron and "The word depression is a wimp of a word for such a beastly experience."

First let's define some terms! Emotions are short lived, intense and triggered experiences whereas mood is a global feeling that colours an individual's perception. Mood can influence emotions. It is vital to know that there is a stark difference between a person who is depressed about something and a person who is globally depressed!

So why is it that the word "depression" in mainstream media and common conversation is overused to describe "just feeling low" and what is the harm of this? 

We express our emotions through a wide variety of words. The statement "I am sad" was not an uncommon way to speak about such emotions; but with the evolving years the term "sad", similar to "happy", has begun to lose its true place. It has become a common word, a word that doesn't seem to encompass the entire experience of sadness. And rightfully so, our experiences are all different. But here, we start incorporating stronger phrases, phrases such as "I am depressed". Following the flow of things, it hasn't taken long for the phrase and everything associated with it to become more and more status quo. Feeling depressed is all of a sudden a normal, transient feeling. One that anyone can "get over". This way of thinking is harmful because it washes away the experience of a person feeling truly depressed and invalidates their mental health condition. This stigma hinders the ability to seek help and effectively recover. 

Depression disorders are real, organic conditions of the psyche of a person. There are many things that can hinder with the levels of the neurotransmitter serotonin in the brain. Thus depression mood disorder is beyond the expression of the emotion sadness as a reasonable reaction to an event in life. The inflicted persons are truly in pain and suffering. This is not a mood that one can just "get over". The cause is complex and the path to recovery is not straightforward. If anything, the path is full of painful hurdles that need to be overcome and at any point the person can stagnate or start reverting if not closely monitored.

https://www.boredpanda.com/depression-through-art/?utm_source=google&utm_medium=organic&utm_campaign=organic

Illustration by Robert Carter, depicting what depression feels like. Many patients have described a feeling of entrapment and inability to ignore the internal cues. These internal cues can become so distressing that they become a risk factor for life. 

Depression disorders in medicine are diagnosed using the DSM-V criteria. This criteria tries to capture the experience of depression outside of stressors, substance use and medical conditions. The term used is "Major Depressive Episode" to describe a two week incident of non-stop symptoms and "Major Depressive Disorder"  if continuous episodes and the doctors have ruled out other psychiatric illnesses. So as you can see, there is a process to diagnosing depression disorder. It is not as simple as labeling a low emotion especially one secondary to life stressors as depressed. 

Opening our eyes to our own biases and perspectives is even more important today, where mental health is a true crisis. We can only empathize with individuals struggling with mental health by taking a moment to recognize the importance of individual experiences and stopping ourselves from labeling emotions as "nothing to worry about" or transient. Every emotion matters and being reflective of your own or others' accounts of emotion can truly go a long way in today's day. 

                                                                                        ~ D & R

Army Activate, the Battle of Allergens: Eosinophilic Esophagitis

This week we bring you a story from another strong and resilient individual. The condition brought to the spotlight is one that is barely covered in medical school lectures, but it has one of the most complex management plans. 

Eosinophilic Esophagitis (EoE) is a chronic inflammatory condition in which the esophagus becomes sensitive to a wide variety of allergens. When in contact with such allergens the eosinophils, a type of white blood cell (the immune system's first-line army), begin to infiltrate the esophagus resulting in an immune response and inflammation. Eosinophils are normally not present in the esophagus so the presence of these cells on endoscopy almost guarantees this diagnosis. When the esophagus is inflamed it is highly irritable and leads to significant narrowing, making it difficult to swallow food, causing reflux, and possibly spreading the irritation to the surrounding structures.  

.......

"I was a picky eater as a child. There seemed to be something about the taste or texture of certain foods that didn't sit quite right with me. It was always the same story. We would sit down for dinner and my mom would be determined to make sure I ate. Being a picky eater was just not an option. Five-year-old me would have never imagined how events would unfold years later. By the time I was in high school, I had lost 60 pounds and could hardly eat a slice of bread without choking on it. They said I had a swollen thyroid and bad gut health, but no one could answer my question; WHY? I thought perhaps I was sensitive to certain foods and slowly home cooked meals became my go-to. 

But things were in for another twist. Moving away for university brought with it many challenges, including more cafeteria food and less home food. The processed foods and cross-contamination of ingredients took a toll on me every time. I found myself drifting to coffee, salads, or unhealthy alternatives for comfort. And once again, I was searching for a reason for my symptoms. Could it be the braces this time?

Not too long after, I had my first episode of vomiting, hyperventilating, and passing out. And after that, the trips to the ER became regular. It was becoming difficult to explain the situation to my family without worrying them. I continued to try to find answers, and while there were many answers I didn't know which one was correct. Was it allergies, was it the stress of being a student (a diagnosis I was usually given in the ER), or something else?

I am thankful for my family doctor who got the ball rolling by ordering my first endoscopy. The procedure was unexpectedly awful. Both the adult and pediatric endoscopes were unable to go down my inflamed esophagus, an otherwise highly unlikely complication. From what was visible, they told me I had close to 200 eosinophils in my esophagus. Thus the diagnosis was made, eosinophilic esophagitis, a diagnosis that is rarely seen in my age group. Endoscopies became more frequent, I was given medications with several side effects, and I started an elimination diet with not much relief of symptoms. Allergy tests indicated that I had allergies to a lot of environmental agents, but often these tests can be indeterminant for many with EOE. And so, I was let go without further follow-up and referred to an allergist. 

Several months in with recurrent symptoms, I came across a research article by a professor at my university. She advocated for me to receive an endoscopy to confirm the diagnosis for targeted management. If I had not seen her that day my esophagus would have been so swollen I would have needed an NG tube. The very thought of being unable to eat was terrifying. I was started on esophageal dilatations every 8 weeks with the goal of bringing my esophagus from 5mm to 15-20mm. My roommate became a big part of my recovery during a mentally tasking 1.5 years of dilatation procedures. 

Two weeks ago I swallowed a pill for the first time in 8 years. I CRIED. The idea of swallowing something without having to chew it and not having reflux was life-changing. It may be a little thing for others, but for me, this was the biggest accomplishment and a much-needed reassurance. 

Being followed by the doctor I have now, who does research on EOE, was a boon. You can see when someone has a passion for something and hers was to help people not just by managing symptoms but by stopping them altogether. I have never had a doctor meet me after every procedure and explain how the events unfolded. She took what I wanted to do in life, where I was living, and made it all work miraculously. 

Since my diagnosis, I have seen the support of my family, friends, and physicians grow. I have been able to join focus groups and read up on EOE to be my own health advocate. It means the world to me to have such supportive and understanding people who have been there through each stage of this journey. I am proud of myself for surpassing the mental challenges that I constantly encountered over the last few years. It was not an easy or predictable journey, and neither will it be going forward, but I feel strong knowing how I had risen above the challenges and knowing that I am surrounded by so many people who care."

.......

                                                                                    - Anonymous

The Circuit of Strength

When we take a look around everything seems to work in networks, in groups, in pairs. The light bulb has a long circuit behind its brightness. The trees have many roots that help nourish and keep the trunk standing strong. Similarly in humans, nothing strengthens us more than the presence of supportive loved and cherished people. As a human with a search for social interaction, this network can be an asset and the pillar for strength at times of need. 

Living with chronic illness is difficult, especially because there is rarely an end in sight. The diagnosis is usually something that must be lived with and "endured". Now in such a situation you can endure it with pain and torment or take the wheel and guide yourself to a path that you would like to see yourself on. Here we talk about some methods in developing a "circuit of strength" that have shown to be helpful. 

Disclaimer: the advice provided here is not a replacement for professional help/ advice from physicians, nurses, counsellors or allied health care providers.  

Engaged coping: Building your team!

Erin Skinner, a psychologist from the USA defines coping as a collection of purposeful, volitional efforts that are directed at the regulation of aspects of the self and the environment under stress" (1). In simple terms, coping is how an individual reacts to stress. There are both good and bad coping habits. We will focus on the good coping method of seeking help and taking lead of your health. Countless research articles and even personal experiences have shown time and again  the importance of a support system in dealing with stressors. If anything research has shown that disengaging or passive coping (i.e. avoiding or denying the stressors) leads to poor outcomes (2). 

This entails:

Reaching out to family or friends that you trust. For example, with a diagnosis of diabetes including family and friends may help with controlling diet and improving exercise to manage blood sugar levels. Why walk the path alone, when there is someone willing to walk it with you in a supportive way!!

Creating dialogue with your doctors to lay out expectations and hopes. This way realistic goals can be set and placement of a safety net accomplished. The latter will create a better watch on medications and changes to health.  This is an example of where being proactive is better than reactive!

Vulnerability and determining the nature of stressors

Chronic illness presents a wide array of threats and emotional demand. So a key step is to determine what stressors are present and of them which are the most distressing (3). This can help specialists such as counsellors create a specific plan to address these stressors. Remember stressors can be from physical symptoms of diagnosis but also the emotional aspect of prognosis, how to fit in society with an illness and fear of recurrence. Here vulnerability is not synonymous with "weakness" but rather a state of openness to our illness/situation such that ability is formed to accept help!

Invest in yourself!

A significant part of managing most chronic illness involves lifestyle and behavior changes in diet, exercise, sleep and mindfulness (4). At times these modifications can feel taxing, but investing this time for your holistic wellbeing will help you gain the sense you are in control and reduce anxiety. The time spent on yourself will also improve physical well being. This large payout of improved quality of life is worth the time and energy!

These are just a few ways to help create a well tuned circuit of support and thus strength in facing chronic illness. 

***Feel free to share methods that have worked for you in the comments!***

💮💮💮💮💮💮💮💮💮💮

For all those families, friends, colleagues, and mentors who have stood by us with a supportive shoulder; We cannot thank you enough for your contributions that  turned a negative thought process into a positive one. In reflecting on our experiences, we wanted to share a poem dedicated to all the people that play a supportive role:

Far too many times I have felt alone

But you have been there for me

Far too many times I stood below

But you pulled me up from within

Never too far, never too slow

A network is what you have been

A network of strength, courage, and joy

One that brings a new perspective in

Alone I am not, for this network I have

Nothing can take it away

The strength, courage, joy, and love

I hope to share with another one day

-DB

                                                                                                            -InvincibleWeAre

References:

1. Skinner EA, Zimmer-Gembeck MJ. The development of coping. Annu Rev Psychol.

    2007;58:119-44. doi: 10.1146/annurev.psych.58.110405.085705. PMID: 16903804.

2. Compas BE, Jaser SS, Dunn MJ, Rodriguez EM. Coping with chronic illness in

    childhood and adolescence. Annu Rev Clin Psychol. 2012;8:455-80. doi:

    10.1146/annurev-clinpsy-032511-143108. Epub 2011 Dec 20. PMID: 22224836;

    PMCID: PMC3319320.

3. Tobin, D.L., Holroyd, K.A., Reynolds, R.V. et al. The hierarchical factor structure of the

    coping strategies inventory. Cogn Ther Res 13, 343–361 (1989).

    https://doi.org/10.1007/BF01173478

4. https://www.health.harvard.edu/staying-healthy/10-steps-for-coping-with-a-chronic

    condition

Bardet Biedl Syndrome, I don't think you have heard of me: Rare genetic disorders

In the 1920s, most of UK was recovering from the World War I but two doctors were occupied studying two families with unique features and persisting obesity. Those doctors were Bardet and Beidl. They noted that these two respective families had members with obesity, polydactyly (more than 5 digits per hand or feet), and retinitis pigmentosa (this isn't a spell but rather an unfortunate cluster of processes that lead to loss of the cells that "see" light and color and thus lead to vision loss slowly). 

.......

"I am grateful for this opportunity to voice my experience as a person with Bardet Biedl syndrome. Let me start from the beginning. My parents were new immigrants to Canada when they were expecting me. I have heard from my parents and siblings how doctors would say "I'm sorry your baby has a genetic disorder" or "Your child will not live to see past the age of 16 years." At some point I am sure my family felt hopeless especially when they saw their 6 year old child unable to speak or walk and by this age having already experienced numerous seizures and countless hospitalizations.  

To my geneticist, I was a child born with a ciliopathic rare genetic disorder and all they could offer were stats and reassurance. My presentation was so rare that even resources were scarce. However, from the support I got from my school teachers, language and speech specialist, neurologist, plastic surgeon and pediatrician, I felt invincible! Living in the amazing country that Canada is, I was provided with "shields" to protect me and help me face the world. 

Today, I am in a life skills program at high school and I have lived past the expiration date of 16 years that the doctors recited. I am able to do most normal functions even though it took me a lot longer to gain those skills. I do have the unfortunate barrier of "night blindness" and living in a province where it gets dark after 5pm for 6-7 months this can be challenging. Sometimes I do get sad seeing my siblings and peers getting drivers licenses and I am not allowed to drive. However, the Canadian Blind Society not only took me for training session but also equipped me with the resources I need when out after dark. 

I love mountains. Usually I feel like a mountain, standing strong against the violent of winds. Of course mountains signify the ups and downs that everyone faces in their lives!

I have felt alone, I have felt scared and I have in painful tears asked my creator why he made me like this. Honestly, it is hard but I have come to terms with my disease and I know I am unique. I bring a perspective to this fast paced world that we all fit in and life isn't a race. I am not broken nor am I last. 

Reflecting back on my life, my sister thought of a poem that I wanted to share with you.

I am rare, not less.

I stand out from the crowd,

Sometimes it hurts when people stare, I must confess

I shine through the layers of struggle even if it appears like a mess

It's a lonely journey but I am proud

Proud that I created an address.

An identity of being rare, resilient and no less

I am grateful for this life and I say this loud,

I am rare, not less. 

I am hopeful this short read was informative and hope you learned something new about a rare genetic disorder that has no cure or treatment. If you would like to learn more about Bardet Biedl and rare genetic disorders, please see the links below."

.......

Helpful Resources From the Anonymous StoryTeller: 

https://www.frontiersin.org/articles/10.3389/fped.2018.00023/full

https://rarediseases.org/for-patients-and-families/information-resources/rare-disease-information/

                                                                                              - Anonymous