Anger, violence and mental health: a response to Deborah Orr

I’d noticed some outrage on twitter about a comment piece by Deborah Orr, published on Friday afternoon, but had avoiding reading it until this morning. The headline is incendiary enough, but it was a sentence in her final paragraph that made me really furious:

It seems to me that lack of mental health, not gender, is the defining motivation of all violence.

At its most basic level, this statement is unsupported by evidence. Women are 40% more likely than men to have mental health problems, and yet over 85% of perpetrators of violent crime are men. If there really was a causal relationship between poor mental health and violence, we would expect women to be the majority of perpetrators of violent crime.

It’s in attempting to make such simplistic causal links that Orr’s analysis falls down. Fifteen years ago, Lori Heise proposed the now widely used ecological framework for explaining violence against women. Heise’s model recognises that men’s use of violence cannot be explained by identifying a single causal factor, but that it is the interplay of personal, situational and socio-cultural factors that result in violence.

Ecological model | Image from Centers for Disease Control and Prevention, 2004. Sexual violence prevention: beginning the dialogue. Atlanta, GA: CDC.

The ecological framework doesn’t discount poor mental health as a factor, but it makes it one tiny piece of the puzzle. And like any puzzle, one piece can’t operate on its own. When a person – usually a man – makes the choice to use violence, that decision is a product of factors at the individual, relational, community and societal level. In a country where the state is sanctioned to use violence to resolve conflict through overwhelmingly male military and police forces, where perpetrators of violence against women are rarely convicted for their crimes, and where sex and relationships education isn’t mandatory on the curriculum (let alone education about consent), identifying poor mental health as the primary causal factor for men’s use of violence seems absurd.

So Orr’s argument frustrated me in its absurdity. But it made me furious because it’s personal.

I was diagnosed with Borderline Personality Disorder in 2004. The first time I’d ever heard of it was when my male psychiatrist gifted me with the label. The diagnostic criteria for BPD is changing, with the publication of the DSM-5 last month, but in the previous version (DSM-IV) there were nine criteria. One in particular stood out and made me believe the diagnosis was incorrect: “inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).” I was being told that not only was I angry, I was potentially violent. That I was a danger to others.

Earlier this year, I requested my patient file from all those years ago. It shows that we discussed the diagnosis over three sessions and although I strongly resisted the diagnosis, after three sessions the psychiatrist’s notes still recorded that I met 6 of 9 criteria for diagnosis and a letter was sent to my GP informing her of the diagnosis. The barely legible scribblings over the many following sessions contain notes like “gets angry – self harm”, “holds anger in onto self”, “showing anger by rebellion, appearance; passive aggressively; repressed.”

And this leads me back to Orr. The pathologising of my anger and being told that I was potentially dangerous to others was about the least helpful thing anyone could have done for me. While my psychiatrist interpreted my anger in his notes, I did my best to avoid addressing my anger in therapy, because I didn’t want to meet the diagnosis I’d been given. I dropped out of psychiatric treatment after 18 months and got on with my life. But I never dealt with my anger.

Nearly ten years later, I’m back in therapy again. I have another diagnosis: moderate depression – an improvement on the BPD, major depression, alcohol dependence and anorexia nervosa I was labelled with last time. Hopefully older and wiser, I’ve found a female counselling psychologist through Mind who I know doesn’t do diagnosis. And what have we been working through over the past several sessions? Finally, after all these years, my anger.

So guess what, Deborah Orr? I’ve got a mental health problem and I’m angry: but I’m not violent. I choose not to be. And that choice has nothing to do with my mental health and everything to do with hundreds of overlapping personal, situational and socio-cultural factors in my life.

Nearly halfway.

It’s been weeks between posts and I’m now nearly halfway through my 12 counselling sessions. They’ve not been easy, and every Thursday afternoon I decide not to turn up that evening. But I haven’t missed a session yet. And I’ve been on time for every one. Moira, my counsellor, interprets this as me being strong and caring for myself. I think it’s probably got more to do with needing to be ‘good’ and not get in trouble.

I’ve had talking therapy before, and yet still I’d forgotten just how hard it is. How much I hate it. How I always feel more miserable leaving the room than I did when I stepped through the door. After my first session, I felt completely drained. After the second, full of rage. After this week, session five, I was overwhelmed. I knew I was depressed, that I’ve been feeling low for a long time. What I didn’t know is how deep those feelings go.

Moira is a good counsellor. Probably the best I’ve had. And I like her. But trusting her is another thing completely. I haven’t trusted myself enough to be honest about how I feel. Alone, with no chance of anyone hearing me, I can’t say out loud the things that are in my head. So trusting her enough to put those words in the space between us is a big project. I’ve spent five hours of my life with her. Or rather, just over four hours, since we have 50 minute session together. I’ve spent more time with acquaintances on a night out. Why should I trust her?

She’s an expert at building that trust, or ‘rapport‘ as it’s probably better described. And yes, there’s a lot more trust between us after four hours than I would have with an acquaintance on a night out. But it still takes longer than that. And sometimes, the empathy that builds rapport can also create a barrier to opening up.

Yesterday, Moira verbalised that she was feeling an overwhelming feeling of guilt and suggested that if those feelings were being transferred to her, it demonstrated the strength of my experience of that guilt. I was glad she told me, and I understood what she meant. Body-centred countertransference is a concept I know well from my own work. When she said it, it helped me acknowledge the strength of my feelings and accept that they were real. But here’s the thing about guilt: it also made me feel guilty. Guilty for transferring that to her, and scared that I had no control over that transference.

I have another six sessions with Moira. In that time, I want to work towards being able to open up to the people closest to me – and specifically my partner, P – in a healthy way. But what if meeting those needs for myself, what if that process of opening up, actually hurts someone I love? What if I pass on my guilt, my anger, my rage? And if I transferred those feelings to Moira, without me having really opened up, what will happen to her if I let it all out?

So I find myself nearly halfway through my allotted 12 sessions and I’ve barely started saying anything that’s really real. I worry that I’m setting myself up to fail. I’m opening the floodgates, and I’m going to leave myself stranded.

And the most perverse thing? I don’t want more than 12 sessions. I want it to be over as soon as possible. I hate doing it. But I believe it’s helping.

Blog for mental health 2013.

I commit to the Blog For Mental Health 2013 Project.  I will blog about mental health topics not only for myself, but for others.  By displaying this badge, I show my pride, dedication, and acceptance for mental health.  I use this to promote mental health education in the struggle to erase discrimination.

I’ve been meaning to do this post for a while, but hadn’t ever quite got around to it. At latest count, there’s over 60 bloggers on the blogroll of this important project.

I’ve changed a word in the ‘pledge’ that I’ve copied here: the last word of my pledge is not ‘stigma’, it’s ‘discrimination.’ I’ve been thinking about this a lot, following a twitter conversation started by @stfumisogynists about a month ago.

I believe that the use of the word ‘stigma’ rather than the term ‘discrimination’ may actually serve to perpetuate discrimination. Stigma is essentially an individualising word. It makes it about our problems as individuals with mental health problems and places the burden of responsibility on us as individuals to “come out” and challenge stigma. I’d rather talk about the discrimination that we face on the basis of our mental health status, that has nothing to do with us as individuals and everything to do with the society and culture that we live in.

Choosing to approach this through the lens of discrimination shifts the focus from us as individuals and places responsibility squarely back on the shoulders of those it belongs to: individual people, institutions and cultures that discriminate against us.

Here’s to blogging for mental health in 2013.

[An update: there’s another bit to this thing, where you’re supposed to write a bio of your mental health and ‘pledge’ other people. I’m reluctant to write a bio of my mental health, because my mental health is not me and it doesn’t deserve it’s own bio. I’m lots of things: a feminist, a writer, a cyclist, a researcher, a music lover, a beer drinker, a traveller, a tourist, an atheist, an immigrant, an activist, a cook etc etc. My mental health is part of me, but it’s not me. Secondly, I’m not a fan of the word ‘pledge’ either, but that’s a story for another day. If I have to recommend someone, I’ll go with Zedkat by the fab @stfumisogynists. Click that link, it will make you laugh.]

This is a new day.

This time last week, I felt pretty rubbish. The counselling I’d been waiting for for five months had fallen through after I found out that my counsellor and I knew each other professionally. That evening, I told my partner (P) that I was thinking of giving up on counselling. I felt that that even if they found me a new counsellor who I don’t know, I may run into them professionally at some point in the future. I would find uncomfortable and compromising.

Our conversation went badly, to say the least. Given that I’d admitted that I’d also stopped my medication, P was anxious about me abandoning treatment altogether. He tried to engage me in a ‘rational’ discussion about pros and cons, and challenged me on whether it’s really such an issue if I know my counsellor professionally. I clammed up and the conversation ended when I burst into tears. I felt like he thought I was overreacting and that he was making no effort to understand how difficult the experience that afternoon had been. I felt isolated and alone. The discussion may have been helpful in a few days time, but a few hours after the abandoned appointment, I needed someone to listen to how upset I was.

The following day was a friend’s wedding, which was lovely, but socialising with lots of people I barely know is draining and at weddings I always drink far too much free wine, leaving me feeling even lower for the next couple of days.

I started the week with a plan to call Mind and take myself off the waitlist. I figured it would be weeks before another evening slot came up anyway and I didn’t want to risk the blurring of my personal and professional life again. But before I got around to it, the counselling coordinator called me with an offer for a slot with a different female counsellor, starting next week. It caught me by surprised that this felt like good news, and I accepted the appointment. I start my 12 weeks of counselling with Moira* on Thursday, and I’ve been feeling more positive since then.

And I got some more good news: a job interview. It’s a dream job and I’d submitted an application with the attitude of ‘you’ve got to be in it to win it’, but not expecting to ever hear from them. But I’ve got an interview. And if I was successful, I would be much less likely to run into my counsellor in that role. I know it’s still a long shot, but it reminded me that there are other jobs out there and that abandoning counselling because of my job is probably not the most rational solution to my problems.

I walked out of work on Friday evening, the sky was blue and the sun was shining. I was listening to Sally Seltmann, and with this song, I felt like things might just get better.**

 

* Still not her real name

** On the borderline is a pretty problematic song. Seltmann says that she wrote it as an ode to Princess Diana, who apparently had BPD. Whether Diana had BPD or not, the lyrics suggest Seltmann’s complete misunderstanding of what it feels like to have problems with low mood, seeming to prescribe to the notion of ‘drag yourself out of bed by thinking happy thoughts.’ Nevertheless, for some reason, it worked for me on Friday so I’m putting it here anyway.

That time when my counsellor was a work colleague.

I had my first Mind counselling session scheduled for a couple of days ago. I had taken the day off work and had a nice day with family, going to see an art exhibition and chatting over a late lunch in a lovely cafe before heading over. I wasn’t feeling anxious, but I did feel empty and not sure what I would talk about.

I arrived a few minutes early for my 5pm appointment with the counsellor I’d been allocated, Karen*. Reception was closed, and despite buzzing several times no one opened the gate to let me in. I waited until someone came out and sneaked in behind them, and hung around the locked reception door wondering what I should do. The courtyard was crowded with people, but no one paid any attention to me. A few minutes later a familiar-looking woman let herself in through the gate and came over: “Are you here for counselling?” I introduced myself; she was clearly having the same thought process. “I think we’ve met before, haven’t we?”, Karen asked. Yes, I think so. She apologised for being late and excused herself to go and prepare the room, leaving me outside.

I write a note to myself: Shit. I recognise her. From work I think. I search my  work emails, trying to make the connection. But I don’t know her last name and I meet at least a hundred new people through work every month. The point is though, we recognise each other. Which means it’s likely that our paths have crossed professionally and that they will again. I contemplate making a run for it before she comes back, but that wouldn’t be very professional.

Karen reappears: Come on up. So have you worked it out yet, how do we know each other?

Me: I’m not sure, I think it’s probably work.

Karen: Probably. Come through and we can talk about it.

In the warmth of the counselling room, I explain where I work. Karen’s face lights up: “Oh right, that’s it.” She asks me how I feel about it. What I feel is compromised, and angry. But I don’t say that. I explain as politely as I can that although I’m confident she would be professional, I wouldn’t feel comfortable receiving counselling from someone who I might then bump into into at work. She was understanding, and left the room to explain the situation to her manager. She returns, and says that the counselling coordinator will get back in touch with me as soon as another counsellor is available.

So I leave.

On the way home, I write another note to myself: All I want to do is cry. But I’m at the tube station. I’ve been waiting for so long, and this has confirmed all my fears about seeking help.

 

*Obviously not her real name.

Today is the day.

Today is the day: my first counselling session. I would like to write about how I feel, but truthfully, I don’t feel anything. It’s been nearly five months coming, and today, I feel much like I did five months ago. Numb. Empty. And exhausted. Exhausted by the daily grind of depression, the heaviness of trying to get out of bed, the dissonance of putting on an enthusiastic face for the outside world, and the pressure of wanting to be ‘getting better’ for the people in my life who were so relieved to see me getting professional help.

I ran out of citalopram a week ago and can’t find the prescription slip to order a repeat. I could go back to my GP to get a new prescription,  but I’ve explained to myself that since I didn’t want to be on medication anyway, this is a good opportunity to see whether psychological treatment alone is enough. That’s the rational explanation. The truth is, the thought of seeing him again makes my heart beat through my chest, so I’m avoiding it.

Now today, I have to talk. But what to say? My life is good. I have a well paid, interesting job; a partner who I love deeply and have fun with; a nice flat in an area lots of people wish they could live in; good relationships with family; and lots of friends who I love and who care about me. There is no good reason for me to be unhappy. I could dig out supposedly traumatic events from throughout my life, but in my experience, that’s true of pretty much everyone. So that leaves me back where I started: what to talk about? In my last go at psychological treatment, I remember endless silences because I didn’t know what I was meant to talk about.

A couple of months ago, I requested a copy of my patient file from the psychiatrist I saw in 2004-5. It was hard seeing things written down about myself, things that I didn’t recall being spoken in the room. Words like “anorexia nervosa: partial remission”, “drunk today”, “borderline personality traits: see for further assessment”. There were also the letters between my psychiatrist and my GP, which I’d not seen before.

I feel she is suffering from a mild to moderate Borderline Personality Disorder. She describes a long history of labile mood, and has been self lacerating for the 2 years. She also bites her fingers to cause pain, and can also be reckless with spending and sex.

And a year later:

If she remains engaged in therapy she should continue to make slow but steady progress.

I dropped out of treatment a month after that last letter was written.

I feel reassured that this time I am seeing a counsellor without an official referral from my GP, so they won’t share information about me. But I know I suggested in an earlier post that it would be useful for them to share information. The point is, I want information shared in a way that includes me. I want professionals who are collaborating in my treatment with me. If they communicate, I should be copied in. Instead, I get a choice between uncoordinated treatment from two separate professionals who don’t know what the other is doing, or coordinated treatment in which I have no voice.

Waiting times.

It’s a month since my counselling assessment and I’m still waiting for my first session. I expect to wait another month, until the first week of March, but I haven’t had a letter yet to confirm when that appointment will be. It’s two months since I first went to the GP about my mental health (or 21 months, if I count it from the actual first time I went, but was too anxious to disclose).

Before that first GP appointment, I wrote:

I expect that I will either not be offered any help, or if I am, it will be either antidepressants or a referral for a few sessions of CBT that I may have to wait months for.

The reality hasn’t been that far off my low expectations and I’m starting to wonder why I even bothered. I’m pleased that I’ve been offered integrative counselling, not CBT, but the wait for it to start is draining and I’m ambivalent about the antidepressants after taking them for two months.

At my last appointment, the GP told me to come back in three months, but that I could come back earlier if I needed to. I don’t know what that means though. How bad does it need to be for me to come back? I’m feeling worse again, but then depression does go up and down anyway, and I’m not sure whether I should expect that pattern to be different on medication? And what will the GP have to offer anyway, besides an increased dosage?

I’m also concerned that the Citalopram is now making things worse. I’ve been having night sweats; I get them anyway, but now they’re almost every night. I wake up between 3 and 4am, throwing off soaking bedsheets, slippery with sweat, my heart pounding and feeling terrified. It’s not easy to get back to sleep after that. This leaves me exhausted during the day, exacerbating the feeling of concrete in my limbs.

In seeking professional help, I was under no illusions that I would receive high quality treatment. What I’m surprised to realise now though, is that despite that, I didn’t really have a plan for what I would do when my low expectations were realised. I think I still thought that after trying unsuccessfully to treat myself for so long, professional help would be the answer. I would get help, and although it might take time, I would be moving towards recovery.

Now I’m not so sure. My suicidal ideation has pretty much stopped, which is good, but beyond that I can’t see any real gains. I’m sure that eventually I will get to see a counsellor, but right now I feel isolated and more lost than before seeking help. At least then, I still had my psychological ‘last resort’ of seeking treatment.

Silver Action.

Last week was tough. After feeling better for a few weeks, my mood dropped for no obvious reason. Someone mentioned to me a GP surgery that prescribed volunteering for depression, resulting in reduced antidepressant prescribing. I haven’t been able to verify it, but I said to them, “If I went to my GP for treatment for depression and was prescribed volunteering, I’d scream.”

They don’t know I’m depressed, nor that I’m on antidepressants. And I wouldn’t actually scream at my GP. When I visit the GP I’m pretty much polite and compliant to a fault. And the last time I had depression, volunteering was actually an important part of my recovery. So much so that volunteering, and specifically activism, have become a central part of my life and identity.

This time though, the stress of group dynamics within activism was a partial trigger  for my depression, and feelings of responsibility towards my volunteering commitments increase my anxiety. So I’ve reduced these commitments to give myself time to heal. That doesn’t mean switching off completely though, and last Sunday, I did volunteer. There was a commitment to attend two meetings last week and then all day Sunday and I felt I could manage that.

I volunteered at Silver Action, a performance by artist Suzanne Lacy at the Tate Modern Tanks. Over five hours, 400 women over 60 years old gathered in the performance space to talk ageing, activism and feminism. They sat at tables draped with yellow tablecloths, in groups of four, sharing stories of their lives as activists and reflecting on the challenges of ageing as women. I listened in to their conversations at various points during the afternoon, and what I heard was transformative. Not in a “my depression is now cured” sort of way, but it did transform some of my negative thoughts.

Conflicts within activism have left me feeling that I have nothing to contribute and that all I’m doing is fighting others within the movement. One woman completely flipped those thoughts for me though, without us ever actually interacting. She said that at the start of second wave feminism, they all thought they were part of a sisterhood, that they all wanted the same things and they’d fight together. But they weren’t all the same, they had disagreements and the movement fractured. In her view, this was exactly what needed to happen. They did fragment, they moved into smaller groups, all starting different campaigns on the issues that were important to them, and she felt that the movement was stronger and more powerful because of it. When she said that, with the benefit of 40+ years experience in the movement, for the first time it didn’t feel like someone just putting a positive spin on conflict, but actually made me believe that conflict and disagreement is integral to change.

Across all the conversations I heard, women talked about the sexism they experienced as young women. In my most negative moments, I feel like nothing will ever change. But these women changed their lives, and they changed mine too, before I was even born. I heard lesbians talk about having their children removed when they came out, a woman talk about not being able to open a bank account, another not being able to list her partner’s name on her child’s birth certificate because they weren’t married, and another remembering being asked to leave the room so the men could drink port. Things have changed and that didn’t happen by chance, it happened because of these women.

One woman said something that I found hard to hear. She felt that younger women have taken their gains and are sitting back and theorising about it. While most of these older women are still active in different ways, they also spoke of not having the same energy for campaigning that they did in the past. Right now, my depression means I don’t have the energy for it either. I know that I need to care for myself and focus on recovery, and this means scaling back. But it will only be for a little while: I’ll be back, because there’s still so much left to do.

You can catch up on what happened at Silver Action on twitter #silveraction

#TimetoTalk

I few days ago, I posted a tweet that got quite positive feedback, using the hashtag for the Time to Change campaign #TimetoTalk.

Over the past couple of months, the process of talking to my partner, seeking professional help and starting this blog has increased my confidence about talking to my friends.

The friend from my tweet, C, was aware I was experiencing low mood from a brief conversation we had back in August. She’d said that she’d also been feeling low, but neither of us had spoken about it since. Even though she’d disclosed, to me she always seems strong and able to cope and I felt embarrassed to tell her that I wasn’t coping.

C has been away for a few weeks and during that time I’d finally disclosed my mental health problems to a mutual friend, S. I didn’t ask her to, but I knew S would probably tell C.

On Wednesday evening, I’d just left my last meeting and was heading back to the office. C rang my mobile and I ignored the call. In the office, a colleague mentioned that C had popped by to say hi. Again, I ignored it. I was supposed to be going to an event but decided I couldn’t face seeing people and headed home. Halfway home, C texted that she had another commitment but would be coming for the end of the event and did I want to go for a cup of tea after? I started typing that I wasn’t going, but then told myself that I need my friends, forced myself to change my mind and texted back to say that would be perfect.

The event was inspiring, but most of all, a cup of tea with C afterwards was exactly what I needed. She gave me the space to talk, but left it open for me to make the decision as to whether I wanted to.

C: So how have you been?

Me: I’ve been okay. Have you spoken to S?

C: Yes.

And then she just waited and let me speak. And when I eventually moved onto another topic, she didn’t press it, but moved on with me and we had a laugh and a chat like we normally do.

C had sent me two emails earlier in the week that I’d ignored, and I later realised she’d messaged me on Skype too. I also found out that she wasn’t planning to go to the event at all, but my colleague had said I’d be there, so she went specifically to see me. I’d ignored her several times and yet she persisted. I feel lucky to have a friend who is secure enough in herself to not take it personally, and who cares enough about me to push the issue.

Which brings me back to #TimetoTalk. There’s a similar campaign in Australia, called R U OK?, which I’ve always disliked. People have asked whether I’m okay before and it always makes me defensive. It makes me feel that it’s obvious that I’m not coping. When someone asks, “Are you okay?”, what I hear is, “What’s wrong?”, and that’s never a helpful question.

Time to Change have created some films for the #TimetoTalk campaign. I particularly like this one, Isaac and Aronda. Aronda says, “I’d say, get the kettle on. Create a space where you can just focus on that person and ask how they’re feeling.” That’s exactly what C did for me, and it worked.

Six weeks on Citalopram.

It’s six weeks since I started taking Citalopram. As I’ve mentioned, I track my mood on Mappiness. The graph below shows how happy, relaxed and awake I’ve felt between the end of November and mid January. Overall, I think there’s been a slight improvement, although it’s not particularly clear.

A comparison to the same period last year provides even less clarity (there’s more data here, as I was tracking twice a day): I had a more pronounced upward trajectory this time last year, when I wasn’t on medication.

I saw the GP for a second follow-up on Thursday and mentioned that although I felt a bit better, I had noticed a similar pattern last year so wasn’t confident the change was due to medication. He didn’t really accept that explanation:

GP: I mean it can be a combination of things. Normally around the winter months, there’s less sunshine of-course, it affects people’s moods. And if you are pre-disposed to developing low moods anyway, probably it can make it a bit, exaggerate its effect. Now, ah, the other thing about the tablets is that ah, sometimes you don’t see the effect because it’s so gradual and what tends to happen is the only time that people realise it’s working is when they come off, and then they realise that it was working. So I think, you know, they’re actually working.

It’s winter now and I was telling him that I’m feeling a bit better, so his explanation made me feel that he wasn’t listening. From our previous conversations, I feel like he is very confident in the efficacy of SSRIs and that it would be very difficult to change that belief.

I’ve also felt in my two follow-up appointments that he’s not really interested in psychological treatments, and has only offered it as a complementary treatment because I wanted it. This time, I don’t think he would have even checked in about the counselling he’d referred me for, except that I brought it up.

GP: You still feel bad about yourself, self esteem?

Me: Yeah, that’s, yeah that’s still there. I’m gonna start counselling with Mind, but that’s not for a few weeks.

GP: Okay, okay. You managed to get hold of them.

Me: Yeah, yeah. So I had my assessment but I’ve just got to wait for them to allocate me a counsellor.

GP: Right. Great. Concentration?

He didn’t change my Citalopram dose, but gave me a repeat prescription and told me to come back in 3 months. I left my third appointment feeling frustrated. In my own line of work (a different health field), we talk constantly of “partnership-working”. In my first appointment, the GP gave me the phone number for Mind, but he drastically under-estimated how long I’d really have to wait to access counselling, didn’t know they offered evening appointments nor the actual cost, and he couldn’t tell me what type of counselling they offered. Now, he knows I’ve accessed the service but he’s not interested in knowing anything more.

It strikes me that once I start counselling, my counsellor will probably have the best insight into how my mood is changing. But there will be no discussions between my counsellor, my GP and I about these changes and my medication. This leaves me stuck in the middle, responsible for coordinating my treatment, and trying to communicate with a GP who believes that antidepressants are the best answer.