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Robin Williams

When I saw that Robin Williams had died, I was sad for the death of someone whose work had touched my life, but I did not cry. Then I saw it was suicide and — as twisted as this may sound — hoped it was to avoid the painful decline of a chronic illness. When I saw he’d been severely depressed, I stood in my kitchen and sobbed. Depression was that illness and he’d already experienced its painful decline.

I remember what it felt like when death seemed like my best option and am crying for everyone who feels the same way. That the world has lost someone who brought great joy to so many lives, that a woman lost her beloved husband, that children have lost their father to a cruel yet (usually) treatable illness is tremendously sad. That he is only one of the thousands of people who took their own lives today… I cannot find the words.

1-800-273-TALK. Put that number for the National Suicide Prevention Lifeline in your phone right now. Whether you need it for yourself someday or for someone you love, have it available and, more importantly, use it. If you have had suicidal thoughts in the past, please put together a suicide safety plan. (The link is to guidance in the context of migraine, but it is best to put a plan together with the help of a mental health professional. The National Suicide Prevention Lifeline can also help with a suicide safety plan.) I hope you’ll never need to use it, but planning ahead could literally save your life.

Take care of yourselves.

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Migraine and Depression: Disturbing Research Findings

The link between migraine and depression is pretty well established, but some research findings are still disturbing. Such is the case for a large-scale study published in the journal Depression Treatment and Researcher in November 2013. The study, which included 67,000 Canadians, more than 6,000 of whom have migraine, found that depression and suicidal ideation were much higher among migraineurs than non-migraineurs.

A glance at the findings:

  • 8.4% of men with migraine were depressed at the time of the study, while only 3.4% of those without migraine were.
  • 12.4% of women with migraine were depressed, while 5.7% without migraine were.
  • Both men and women with migraine were more likely to have ever considered suicide seriously than those without migraine.
  • 15.6% of men with migraine had considered suicide serious versus 7.9% of men without migraine.
  • 17.6% of women with migraine had considered suicide serious versus 9.1% of women without migraine.
  • Migraineurs, male and female, younger than 30 had a six times higher risk of depression and four times higher odds of suicidal ideation than those 65 and older.
  • Suicidal ideation among those with migraine was also higher in those who were unmarried, had lower household income and/or greater physical limitations.

Reference: Fuller-Thomson, E., Schrumm, M., & Brennenstuhl, S. (2013). Migraine and despair: factors associated with depression and suicidal ideation among Canadian migraineurs in a population-based study. Depression research and treatment, 2013. (The full text of the article is available for free.)

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I Relocated for Migraine & Found My Home

I moved for migraine and found my home in Phoenix.When I was in Seattle last summer, I wrote about my grief that migraine kept me from living in the city that felt like home to me. A few months later, when friends were visiting for Thanksgiving, I was hit with the realization that Phoenix had become my home. I continue to be surprised by just how much I like living here now.

Returning to Phoenix wasn’t in my plan until I made the connection between weather and the severity of my migraine attacks.* I only agreed to come back after Hart and I decided I would try to spend summers in Seattle. That’s not just because summer is hot and stormy in Phoenix, but because I felt like I needed that time in Seattle. Not anymore.

I often describe my relationship with Seattle as troubled romance. Despite how much I love her, we’re not compatible. In fact, with her cloudy skies and rain, Seattle can be downright cruel to someone with weather-triggered migraines. I’m pretty sure I loved her more than she loved me. We broke up years ago, but I always thought we’d get back together. I’ve officially moved on. (Though I wouldn’t be opposed to summer flings.)

I’m no longer angry that migraine forced me to give up my favorite city; I’m thrilled that it has led me to discover Phoenix anew. I don’t wish I lived anywhere else, though I’m still eager to travel and explore the world. I miss my friends elsewhere, but adore my loved ones here. Pine trees and lakes, which I definitely still need, are only a couple hours away (and Ponderosa bark smells like vanilla).

My emotional “home” in Seattle was on the sofa in front of the fireplace. I don’t have a special place like that in Phoenix. That bothered me until I realized I don’t need one. My entire house is my center, the whole city is my home. I no longer think “I want to go home” during a bad migraine; I’m already here.

*Moving didn’t reduce my migraines as much as I’d hoped when I first returned. See Relocating to Reduce Weather Triggers, on Migraine.com, for the full update.

(photo by John Stavely)

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Coping With the Guilt of Illness

Guilt surfaces in my writing frequently and, when I publish anything that mentions it, I’m deluged with comments and emails from readers who are also plagued by guilt because about everything they’re unable to do due to illness. I also get comments from healthy readers who tell me I have no reason to feel guilty because I’ve done nothing wrong. But the guilt of illness is not rational.

On a Good Day is the most recent post to prompt a lot of readers to say they feel guilty. Reading those comments broke my heart in a way that had never happened before. It was so clear to me that these readers had done nothing wrong, but were punishing themselves for being sick. I was saddened both by their distress and how much it echoed how I used to feel.

That’s right, I said how I USED to feel. As I read other people’s responses to On a Good Day, I wanted to offer a balm or a strategy to move away from feeling guilty about letting people down because of illness. Only then did I see how much guilt I’ve let go of in the last year. It took days of reflection to figure out what had made the difference in my life. Self-compassion was the answer.

As an extraordinarily harsh self-critic, developing self-compassion seemed like the last thing I’d ever be able to do. And yet, I’m doing it. I’ve made enough progress to release the massive guilt that used to overwhelm me. I still have a LONG way to go, but this little bit has turned my life upside down — in a wonderful way.

I’m sure working with my therapist has made a huge difference in my self-compassion, but I’ve also learned a lot from books, podcasts and audiobooks. I’ve recently discovered the amazing resources from researcher Kristin Neff. Her audiobook Self-Compassion Step by Step is essentially a self-compassion workshop on CD. I’m listening it now and wish I’d found it years ago. Her website, self-compassion.org, also has great free resources, including videos, blog posts, self-compassion exercises, Q&A and even a self-compassion quiz.

I took that self-compassion quiz yesterday. I scored 2.19 out of 5. Anything below a 2.5 is considered low self-compassion and 2.5 to 3.5 is considered moderate. I was thrilled to be that close to moderate. I have no doubt that if I’d taken the quiz a year ago, my score would have been well below 1.

Even a small shift in self-compassion can make a huge difference in how we treat ourselves. If you’re weighed down by guilt, please take a look at Dr. Neff’s website and maybe look at some books about it. It isn’t a quick fix, but the psychological weight that has been lifted from my life has been so worth the work.

Writing this got me curious about what I’ve written about guilt over the years. Here are a few samples, including my first written attempt at self-compassion:

And a very similar post, published on Migraine.com last week: Letting Go of Guilt.

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Mindfulness for Depression

Mindfulness as a tool for coping with depression is often distilled into “thinking your way out” of depression — which angers pretty much anyone who has ever struggled with depression. Mindfulness is more about becoming aware of how negative thoughts build on each other and cause additional emotional pain, then learning how to attend to such thoughts in a way that limits their damage. At least, that’s how it works for me.

Zindel Segal, who wrote The Mindful Way Through Depression and developed the technique of mindfulness-based cognitive therapy, explained in a TEDx Talk how mindfulness can be an effective tool for coping with depression and preventing relapse. He also talks about the science behind the approach and research about its application. Here’s his basic description of how it works:

What we’re trying to get people to do is to anchor themselves in their experience so that when a negative emotion comes up in the mind, it can wash over them; it doesn’t…bring to mind all of the negative associations that for some people can happen very automatically. Instead they can find a different place for standing and working with these feelings, and as a result have much more of an option for selecting a response and influencing what happens next.

Segal’s TEDx Talk is good, but If you’re looking for help with depression and guidance on how to apply mindfulness to cope with it, start with the book. It’s tone is less academic than the TEDx talk and it provides concrete hands-on guidance.

You’re probably tired of hearing me say that I’ve found mindfulness to be an invaluable tool for coping with depression, chronic illness and even migraine attacks.