Episode 35: The Winter Blues

Written By Kayla Crum

Mental health is vital to our overall well-being. We know this. But what are you supposed to do in a prolonged season of isolation or recovery when you can’t reach for your usual mental health boosts? Today on the podcast we discuss Ella and Kayla’s different experiences with mental health and the help they each sought. If you’re wondering if you should reach out to someone, this episode is for you.

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TRANSCRIPT

 Kayla 0:09

 You're listening to the My Sister’s Cancer podcast. I'm Kayla Crum, registered nurse and writer.

 Ella 0:15

 And I'm Ella Beckett, social worker and cancer survivor.

 Kayla 0:20

 We're sisters on a mission to care for the cancer community through the sharing of real life stories, a sprinkle of sass, and lots of support. 

Ella 0:28

Join us in a new kind of pity party. It's a pity so many of us carry the heavy burden of cancer alone. So let's make it a party and carry it together.  

—-------------------

Kayla 0:42

 Welcome back to the My Sister's Cancer podcast. I'm your co-host, Kayla Crum, here with my sister, Ella Beckett. Before we jump into today's episode about the importance of mental health, I just wanted to remind everyone that we do have a Patreon where you can support our work. You can go to Patreon.com, that's P-A-T-R-E-O-N, or there's links on our website or our Instagram and you can check that out. It's an option to pay $5 a month to support the work that we do. And we really appreciate all of you who are already supporting us. We've obviously woven concepts of mental health throughout this whole podcast, but we wanted to take some time during this winter season when a lot of people often feel down, at least here in Michigan, when we don't see blue sky for about 2 or 3 months, to really hone in on mental health and give it its own episode. Talk a little bit about both of our own experiences with therapy or with, you know, our own ups and downs, and as always, to empathize and educate anybody who might be listening. So, like I just mentioned a minute ago, some people get the literal winter blues called Seasonal Affective Disorder. So that is a true, real condition where people get depressed during the winter months when they don't see the sun, they don't see the blue sky. It's cold. This generally happens in colder climates. So here in Michigan we get a lot of snow. We get a lot of clouds and gray sky. February often feels like the longest month, even though we all know it's the shortest month. So that's a very real condition and that can affect people, um, seasonally. And then the other thing I wanted to mention is that, you know, I think we sometimes think of people as, well, “so-and-so has depression” or “so-and-so has anxiety,” and we think of it sort of like saying “so-and-so has diabetes” or “so-and-so has, you know, MS.” Like something that doesn't go away. That can be true. But there is also situational anxiety and situational depression. So you can go through periods of depression and or anxiety based on something that's happening to you in your life. And I think to a lot of our audience members in the cancer world, that's probably what we’ll mostly be talking about today or what you'll relate to. That doesn't mean that it's just temporary and no big deal. That doesn't mean that it goes away quickly and that doesn't necessarily mean it goes away forever after, say, you're in remission or whatever. But, you know, situational anxiety or depression is just as real as ongoing anxiety, depression. And it can last months or years, you know, as cancer can or whatever your situation is. So I just wanted to normalize that and sort of define those terms up front, that even if you haven't been diagnosed with depression, with anxiety, you know, from a doctor as just like a lifelong thing you're going to deal with, you can still have very real anxiety or depression for a season. And, you know, in this podcast we talk all about seasons. And so in this season of isolation, a period when active cancer treatment is done but you're still recovering, I think this is a really crucial window when situational depression and anxiety can rear its head. So depression and anxiety are mostly what we're going to focus on today. Obviously, there's a whole host of other mental health needs that we could touch on, but in relation to the cancer world, I think those are the two, the two biggies that we're going to focus on today. So, Ella, I guess I wanted to ask you… It's such a huge question, but, like, what was your mental health journey like throughout your cancer experience? If you had to sort of give the five minute overview?

Ella 5:00

 Yeah, that's a really hard question to answer, but I'll - I'll give it a whirl. I think what you were just saying really resonates a lot with me about the fact that anxiety and depression can be situational and that it's dependent sometimes on the season that you're in, quite literally like outside the season that we're in. But I think in terms of this podcast and in terms of my journey and our journey, you know, I think mental health, it just widely varies during the different cancer seasons. When you're first diagnosed, when I was first diagnosed, that definitely takes a toll on your mental health. And I definitely experienced a pretty significant period of time where I was at a - at a pretty low point mentally, I would say, in that diagnosis season and then moving into treatment, I mean, because it brings so many physical and bodily changes and it's so exhausting physically. I think it really does a number on your mental health too. And so I think I kind of picture my mental health as like a hills and valleys, in many ways, in each different season that I experienced cancer and that we've talked about on this podcast, there were certainly peaks where I was like, okay, I feel like I my mental health is on the upward climb, like it's feeling more secure and stable, and then something, you know, happens or you get a setback or you get that relapse diagnosis and it just kind of tanks again, in some ways, in the isolation season in particular. I think this is part of the reason we wanted to talk about this in this season, is I think it can be one of the hardest seasons and the longest seasons. And then there's science to prove that being isolated from other people is also really bad for your mental health and your physical health. So I think it's, you know, it's hard to say, oh, well, my mental health took this trajectory. I definitely think like the visual that's coming to mind though, is like little hills and valleys, if that makes sense.

 

Kayla 7:25

 It's a roller coaster.

 

Ella 7:28

 Yeah. Kind of. 

Kayla 7:29

Thanks for sharing that. And then obviously we're not in the survivorship season yet. But would you say that - was it like a slow upward climb back to normal for you, or… I mean I hate using that word, but like stable mental health, uh, in your survivorship season or was it still some hills and valleys?

Ella  7:51

 Yeah, I think that's a really important clarification to make. I do think there were still hills and valleys. And I think one of the things that I really personally wrestled with, and I think we'll probably talk more about in the survivorship season, is the notion of survivor's guilt and the hardship of, you know, once you have survived cancer and you make all these friends that also have cancer, unfortunately, the reality is that you do lose some of those friends. And so I think that was something that was really hard for me to navigate as I moved into my own survivorship, that that wasn't the reality for all of the people that I was meeting and kind of gaining along the way, if that makes sense.

Kayla 8:44

 Yeah. It does. I guess one thing that we want to really talk about today is not just normalizing the experience of anxiety and depression, but also seeking help for that. So I remember you did, when you were inpatient, have opportunities to speak to social workers. I don't think they had a psychologist, that was sort of like, they call that person in as needed, am I right?

Ella 9:15

I think there was a psychologist, but I think - I don't think I was very open to talking to people when I was inpatient. [chuckles]

Kayla 9:23

[laughter] Well, I'm glad you said that because that was my memory, too. You were kind of like, “I'm fine, leave me alone.” And I get that. I guess I'm specifically talking about during your transplant, when you were there for, like, a month, you were kind of like, “Mmhmm, I'm good. Okay. Have a nice day.” [laughter from both] So looking back at that time, I mean, I'm not trying to, like, say you did or did not do the right thing. Do you wish you had talked to somebody, or for you at that time, were you kind of like, put your head down and get through it? Obviously this is more treatment season, but I'm just curious.

Ella 10:01

 Yeah. Unfortunately, I think one of my coping mechanisms is just like, I don't even know the words for it, but mostly -

Kayla 10:09

Withdrawal?

Ella 10:10

Withdrawal, shutting things down. “I'm fine.” Even if I'm like internally not okay. Like I think it's in some ways it's just like, nope. Like I'm not even - I don't even want to go there. Um, I think withdrawal is a good way to put it, obviously. Now I'm like, yes, I do think talking to someone in the thick of it, in the midst of that inpatient stay, would have greatly benefited my mental health in the long run. But I could also understand where I just like, wasn't really feeling it and how it in some ways, it can feel like another thing to do, another thing on your plate or a burden that you have to bear is like to walk through and even, I mean, working through your feelings and sitting with those feelings is really hard work. So I think in that moment I just maybe didn't have the capacity or just didn't want to go there. But to answer your question, I do think talking to someone would have definitely been beneficial for me.

Kayla 11:11

 Yeah, and I bet though, like you were saying, it is a lot of work. And when you're physically at your limit, like they literally bring you to the brink of death and back to transplant you, you don't have a lot left to give a therapist or, you know, a psychologist. So… I get that. And I mean, you were like 19 or whatever. Like, I don't think - that age didn’t help either. You know, that's a tough age. 

Ella 11:38

I was a little angsty overall. 

Kayla 11:41

Yeah. [laughter] Mhm. Uh, but you did seek therapy later. Right? So what were those experiences like?

 

Ella 11:50

 Yeah. So I had two different times that I went to see a therapist for a set period of time, and I really can't even bring back how long either of the experiences were. But I know for sure, once was when I got back to college that first semester, which was actually second semester, and everyone had been there for a full semester that I was home trying to get better. Overall, I think that was a decent experience, but I think what's really interesting in both of the therapy experiences that I had is that when I reflect back on kind of what the focus was or what we spent most of our time talking about, it was largely relational-focused. And I just think that's so interesting because like, yes, obviously cancer took a toll on my relationships. And I think when you're a young adult, like, so much of your identity is wrapped up in your relationships with other people. So I think maybe I was just like, trying to sort through these bigger relationships in my life and how they had changed and wanting them to be different or whatever. But now I think back to that and I'm like, I had so much to unpack about my cancer experience. Like maybe my time would have been better spent working through some of that. And like actually giving me the tools to cope with everything that I'd been through, you know? 

 

Kayla 13:19

Mm, yeah. And this is probably a good time to suss out the different types of therapy available. Really, there's a wide variety of different therapists, counselors, whatever you want to call it. I think you and I both had experiences with licensed master level social workers, so they obviously have their master's degree and then have done a ton of clinical hours to earn that license level designation, the L in the LMSW. And they can own, like, a private practice, or they can do it in like, a hospital setting. Then there's also psychologists who have gone to school and studied psychology, and then there are psychiatrists. Those are the people that can give you medication. So neither of us have had experiences with mental health medication. So I do want to just name our deficit here that we can't speak to that. And we are totally in support of that and have people in our life who have used medication or are still using medication. And we think that's great. That's just neither of our experience. So I don't want to say too much about that, but if you are looking for someone who can prescribe medication, that would be a psychiatrist. So that's important to note. And Ella, even regardless of which type of person you find for a therapist, there's different approaches they can take, right, that you've learned about as you're going to grad school for your social work degree?

 

Ella 14:55

 Pretty much every therapist that you're going to see is probably working from a different theoretical approach or a combination of some of the approaches. So you might have heard of like, psychoanalytic therapy or cognitive behavioral therapy. There's a lot of different theoretical approaches that therapists use. And then there's different clinical skills within those that they often will use, too. There's like a strengths-based approach to therapy where you're really just focused on the client's strengths and kind of working from those rather than focusing on the deficit. So there's a lot of different approaches too, that can be taken.

Kayla 15:39

 So I think the big takeaway from that is A) if you seek counseling for the first time ever and don't feel like it works, or you don't vibe well with the therapist or their approach, there's so many other options out there. So don't give up and feel like, well, counseling wasn't for me. Listen, I also want to caution against, I guess, what I would call fake therapists. That's not the word. But like, there are people - and I find this or I've heard of this especially in the Christian space. Um, you can get a Christian counselor who is a licensed therapist. That's what I had when I got therapy. But I, I think that sometimes church-adjacent people will offer therapy services but they don't really have any higher education in those approaches Ella was just talking about or scientific backing of what they're helping you to overcome. So I'm not saying that can't be helpful. I've done counseling with a pastor, like premarital counseling when me and my husband were engaged, I've done spiritual direction, which was meeting with a former pastor who now just sort of helps people on their spiritual path as they're questioning things. But neither of those are like therapy in the sense of: I have a mental health condition, such as anxiety or depression that I need help with. So I would just be careful when you're looking for assistance, to be clear-eyed about what the person you're looking for is offering. There can be benefit from a church person, like, giving you some counsel, especially if, like you were saying, like you focused a lot on relationships. I think often like pastors or like other people in the church will counsel families on family dynamics or like marriage dynamics, and that's all great. But like, if you're trying to treat like, anxiety or depression, you probably want somebody who has some sort of degree and follows like a scientific approach to help with that. So my experience was for anxiety. I think I've talked about it before on the podcast that like, cancer sort of brought to life sort of a latent anxiety. I have memories of certain points in my childhood and adolescence where now, looking back, I can see like, that was a season of anxiety for me. But again, like we mentioned at the beginning of the episode, anxiety kind of comes up just situationally for me. So it's not like every day I'm dealing with symptoms. But if I go through a tough season or something traumatic like Ella’s diagnosis, then I can kind of get catapulted back into that space. And for me, I was having physical symptoms as well as mental symptoms. So obviously the things you think of as like tight muscles and headaches and upset stomach, but then also like chest pain and sometimes dizziness and you know, you can even feel like hot or cold, like all these things can happen to you as part of anxiety. I didn't seek help until 2020, and Ella had her transplant in late 2017. So like three years after, um, for me to finally be like, okay, this problem is not going away, I need help. Um, I'm sure the pandemic didn't help with that, but it hadn't - it had been there the whole time since Ella’s first diagnosis. Um, and then I just think it didn't get better. Like, I think I thought once Ella was in remission, it would fade away again, as it had at other points in my life. But I needed, like, professional assistance to overcome that. And I think the most surprising thing I learned was how much for me that involved learning to calm my body. I mean, I've been to nursing school, like I understood the basics of different like, mental health approaches, but I was really taught how to calm my body. Even in situations where you're interacting with other people and they don't even know you're doing it on the inside. A lot of it is breathing, and I know we all get sick of being told to take a deep breath, but there's like a lot of research behind how you breathe and how that affects your experience of stress and your stress hormones being secreted, and even something like relaxing your pelvic floor. Which sounds crazy to say, but a lot of us are tense on the inside and places you would never think of, like your abdomen. A lot of us tense our stomachs all day. Your glutes, a lot of us tense those. Or your pelvic floor, which is like yes, those muscles you use to release and stop peeing. And you can learn how to just relax that. And it's crazy how much that can send a signal from your brain to the rest of your body. Like, okay, like I'm not in danger. Like calm down. I feel like the first several months of my counseling was like, trying to weed through all of my body's stress signals that had built up over the years. And then I spent more months, like, unpacking my childhood, which is like a stereotype of counseling, but that helps in relation to my younger sister having cancer. So like learning about family dynamics and healthy and unhealthy habits that I had fallen into and like, why I felt weirdly responsible for her cancer or like capable of preventing it returning. Like, I unpacked a lot of that. And from the beginning, though, she helped me identify that I was experiencing anxiety through, like scientific assessments. I took like different little surveys that are validated and used in the mental health world. And then we made a plan together to like, okay, here's what you're experiencing symptom-wise, and we're going to try to tackle that. So - and she was a Christian counselor and she was an LMSW. So it's like, again, you can find a different mixture of whatever you're looking for. Um, sometimes it just takes a few tries to find the right person. That was sort of an overview of my experience in counseling. And I guess one thing I wanted to emphasize is that it was so different than talking about my struggles with a friend or a family member. So I've mentioned before this friend that let me vent to her once a week when Ella was in treatment, and that was amazing. I really needed that outlet. My husband is super supportive, like I have a lot of people I can talk to, but they're not therapists. Like, they couldn't teach me to relax my pelvic floor or like to breathe in these different ways that literally tell your brain to calm down. Um, and even if they were a therapist, it muddies the waters when you're in a personal relationship with somebody. So if you've always thought like, well, I don't need a therapist, like I have a really good person or people I can talk to, I would just say like, it's not the same. So if you are experiencing symptoms of anxiety and depression, it's amazing to have a supportive network around you. But that's not the same thing as getting therapy.

 

Ella 22:47

 I also want to add to that, like if you are seeking out help and you're, you know, trying to find a therapist that's a good fit. And, you know, if they aren't doing assessments of any kind upfront or it does just begin to feel like venting and there's not really like a treatment plan or something like guiding your time together. Like I would just be wary of that too, and kind of remind yourself that you're not seeking out just venting to a friend, right? You have friends, hopefully to do that to, or people in your life that you can vent to, but you need someone who's actually like a licensed mental health professional to help you, like work through what you're navigating and actually, like, reduce your symptoms, like you were saying, or, you know, get back to doing the things that you really enjoy doing in life. I think a lot of people get to a point where they're no longer even able to function on a day to day basis, or do the things that they really enjoy doing. And that can be due to depression and anxiety. And so I think one of the main goals is not only to reduce those symptoms, but then to get you back to the things that you really want to be doing. So. All that to say, I just want to put out a little warning bell that if a therapist does begin to feel just like venting to a friend, it might not be the best fit for you.

Kayla 24:13

You just mentioned, you know, getting back to the things you want to do. I think that can be true. But I also think a lot of times people are doing everything they do and just not enjoying it or like, not feeling present. So what finally pushed me to get therapy and admit it to myself was sitting on the beach on my birthday with my family. Like literally that’s my idea of a perfect day. And I just had a crushing weight on my chest that I still couldn't get rid of. And I was like, okay, if you're in your happy place with your best people and you still can't relax, like, you need some professional assistance. So sometimes I think that we're like, well, I get out of bed every day and I do everything, so I can't be that bad. And it's like, yeah, what's your internal experience? And I don't think I even realized what was available to me, even just in my normal life now, like the skills that I built with my therapist allow me to deal with life's little frustrations or let-downs, big and small, in a way that's just so much more tolerable in my own body than I ever even thought was possible. That's not to say I don't feel things, I feel things deeply, but it's like not getting stuck there and not putting your body on that high alert mode all the time. Or like pumping out those stress hormones. You can truly train your body to feel the sadness or feel the anger, but not turn it into a prolonged physical reaction. So like I was saying, clearly you need someone who is working on those types of things with you, not just letting you vent at them. When you were talking about people to be wary of, another thing that came to mind was a life coach. Uh, those are great. I think they have their place, and I think some therapists also have like, a life coaching service. So I'm not, like, opposed to life coaches or business coaches or whatever. But again, like if you're seeking help for something like anxiety or depression, a life coach is probably not a good fit. A life coach is great if you're just like, I don't know, like, what do I want to do in my career? Or like, I have trouble getting organized, or I have trouble sticking to a workout plan. Like they can help you with those things and help you do some reframing and make some different life goals and decisions. But they're not the same as getting mental health help from an expert. So just know what you need. Or at least, as you try different things out, be like, “Hmm, okay, what - what isn't serving me and what do I need instead?”

 

Ella 27:05

 So if there's people listening to this episode, Kayla, and they are experiencing some of these symptoms, or they really do think that they could benefit from talking to someone, where would you suggest that they seek that out or start looking?

Kayla 27:19

 Yeah. So we'll link to, first of all, a description of anxiety and depression. And that might sound silly, but I think that we can talk ourselves into thinking we're okay or that we're - it's not really depression or it's not really anxiety. So I'll link to a site that sort of describes it, or sort of has you go through a little bit of a quiz type thing to determine if what you're experiencing is anxiety and or depression. You can have both or either one. And along with that, you know, if you need immediate help, like if you have thoughts of harming yourself or others, there is now a national mental health hotline. It's 988. So just like we have 911 for physical emergencies, we have 988 for mental health emergencies. And that's free. That's for everyone, just like 911. That's a pretty recent adaptation of that number and expansion of that service. So that's a huge recent improvement to our system here in the United States. I do want to talk about the elephant in the room, which is money, because it's all good and fine to talk about therapy, but we all know it costs money and it is expensive. That's unfortunately the case here in the United States. Just like anything related to the health care system. And mental health care is health care. So it is tied up with our health insurance system that's not the greatest. But think outside the box a little bit if you can. If your insurance plan does not cover mental health services, you might be better served by virtual counseling. There's places like Better Help; I've heard that advertised on different podcasts, and we'll link to that, that pair you with a therapist basically over like Zoom or whatever program they use and are a little bit more affordable than seeing someone in person. I also think it's worthwhile if you're in college, most colleges have some sort of free mental health service on campus for all students, and I wish I had used that more when I was in college. Like you mentioned, you used it for one semester. Um, now I'm like, dang, I should have just gone the whole four years because it was there. So for sure, in college access the free counseling. And then workplaces often will have, like, a third party contracted virtual counselor as well. So I know that, like, when I worked for a large hospital system, they had some sort of service that you could use, and I never used it, but, where they paid for like twelve sessions or something. And that was part of your benefits package with a virtual counselor. So again, all of those avenues might not lead you to exactly the person or situation you need, but it's a place to start. And there's also services - nonprofits locally that will let you pay what you can afford. So, you know, find a - seek out different community centers or organizations in your - in your city to see if there's anything like that. Because often if you can prove your income needs, then you can access, you know, professional mental health help at a discount. If you have an HSA or an FSA, one of those health savings accounts as part of your insurance plan, that can be a great way to pay for mental health as well.

 

Ella 31:22

 Well, thanks for hanging with us today. We just wanted to hold space for the importance of mental health, especially in the winter season when it can really be difficult to keep your spirits high and your mental health stable. And we just want to acknowledge that and hold space for the way that cancer can really take a toll on your mental health. Just a friendly reminder to take care of yourself in whatever way you can today, and to do something that will benefit your mental health. Next week, we will be talking about how to show up for people virtually in this season of isolation, ways that maybe we found helpful or what we have learned, maybe even through COVID, of some different ways to get creative and show up for other people when you can't physically be there for them. So that's what we'll be talking about next week, and we hope that you have a great week in the meantime.

Kayla Crum
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