Rare long, rambling, stream-of-consciousness post

Update: I decided to republish this for two reasons:
1) It’s a great point of reference for me to reread when these issues rear their ugly heads again (reading a draft is hellannoying) and 2) Ana reminded me that it’s good to know others feel the same and know they’re not alone.

If you’ve stumbled upon this post for the first time, I hope it can help you in some small way.


It’s another one of those days. I’m at work, struggling with social anxiety yet again. I don’t normally ramble on my blog but I think everyone needs a vent post now and then. It’s not just about social anxiety but sort of a thought dump. It’ll likely be a long stream-of-consciousness vent post and may not make sense. I’m not editing it and it won’t have the best grammar. Expect run-on sentences. I don’t expect you to read it all; I have no attention span to reread it myself. It’ll just make me feel better. Deal.

WARNING: There is cussing in this post. If you are offended by that kind of language, I suggest you stop reading.

Continue reading “Rare long, rambling, stream-of-consciousness post”

This Girl's Biblical View

A little late in posting this but better late than never.


“Therefore I say to you, do not worry about your life, what you will eat or what you will drink; nor about your body, what you will put on. Is not life more than food and the body more than clothing? Look at the birds of the air, for they neither sow nor reap nor gather into barns; yet your heavenly Father feeds them. Are you not of more value than they?  Which of you by worrying can add one cubit to his stature? “So why do you worry about clothing? Consider the lilies of the field, how they grow: they neither toil nor spin; and yet I say to you that even Solomon in all his glory was not arrayed like one of these. Now if God so clothes the grass of the field, which today is, and tomorrow is thrown into the oven, will He not much more clothe you, O you of little faith?

“Therefore do not worry, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ For after all these things the Gentiles seek. For your heavenly Father knows that you need all these things. But seek first the kingdom of God and His righteousness, and all these things shall be added to you. Therefore do not worry about tomorrow, for tomorrow will worry about its own things. Sufficient for the day is its own trouble.
Matthew 6:25-34
(NKJV)

Personal interpretation
This passage piggybacks off of last week’s verse (Philippians 4:6-7) about not being anxious. Here, Jesus says not to be concerned about God providing for our needs because He takes care of all the little details such as feeding birds to allowing flowers to grow and bloom. Plus, he adds, worrying doesn’t solve anything. (Know anyone who’s been able to fix an issue while experiencing a panic attack?) His listeners are told to first seek God’s will for their lives. Jesus also admonishes them to focus on getting through that day and not worrying about the next day because there are enough issues to deal with at that present moment.

Personal meaning
In this economy, it is so easy to worry about losing a job or if that happens, what would happen to paying the rent or putting food on the table. God says He’ll provide for our needs. Not our wants but our needs. Something to keep in mind is our finite human minds cannot comprehend what an infinite God deems as our needs.

Jesus also tells the listening crowd to seek after “the kingdom of God and His righteousness.” The primary need Jesus emphasizes here is God. Everything else that we consider our needs (food, water, shelter, clothing, etc.) is considered extemporaneous, hence, why they are “added to” us. Our needs are first spiritual then physical. (And spiritual often ties into the emotional.)

Personal application
worryWorry. Anxiety. How can I apply this so it’ll affect my life?

The answer is simple: “Seek first the kingdom of God and His righteousness.”

A personal application of this verse would be to do everything with God in mind and emulate His characteristics: holiness, truth, justice, love, care, compassion, and forgiveness among others. I am encouraged to “seek” those things — look for them, strive for them — they are goals to shoot for.

Recently, I’ve been learning the Westminster Catechisms. A catechism is a statement of doctrinal belief often made in a series of questions and answers. The first question of the Westminster Shorter Catechism is “What is the chief end of man?” The answer: “Man’s chief end is to glorify God, and to enjoy him forever.

My chief end in life is to glorify God. Seeking after that could prevent so much worry because I’d know that God would take care of me no matter what happens.

For example, if my husband has shown evidence of his faithfulness to me, I won’t live in fear that he’s banging another woman every time he works late.

God has been in my life a heckuva lot longer than my husband has. He has proven Himself faithful to me time and time again. I’ve seen evidence of his goodness to me: how He brought me and my husband together, how He’s saved me from killing myself, and how He’s blessed me monetarily (we’re not poor). God, like my husband, has never given me any reason to worry about whether He’ll look after me.

My counselor suggested that I write a list of all the things God has done for me in my life so whenever I wonder about His passivity, I can look at it and see how active He really is. Something akin to a list of things I’m grateful for. Otherwise, I tend to have a short memory. The future scares me because I don’t know what to expect. It causes me anxiety and worry. Often it’s because I’m not seeking after Him.

Although I said the answer was simple, I never said putting it into action was easy.

Mood rating: 6

Song of the Week: It's Going To Be Alright by Sara Groves

Another regular feature that I’ll try to do is post songs each week that really mean something to me and apply to my life during this week. One of my favorite artists is Sara Groves who writes so many songs that have helped me through different periods in my life.

This past week, I suffered from severe social anxiety on Tuesday and ended up having a panic attack. (I thought I was going to die; I couldn’t breathe!) My husband and I were on our way to counseling that night and Sara’s song “It’s Going To Be Alright” came on. I sang along with the song, fighting back tears the entire time. Finally my husband asks, “What does that song mean to you?” Immediately I burst into tears and told him I was fighting back tears, especially toward the end of the song where she urges the listener to “cast your cares.” That specific line is based on I Peter 5:7 where Peter writes, “Casting all your care upon Him, for He cares for you.” I’ve been really struggling with trusting God in the midst of all this, freaking out about what my coworkers think of me. I’ve been going through a “Are You There God? It’s Me, Margaret” phase. Where is God in the midst of my social anxiety? Where is he when I’m feeling alone and abandoned because my coworkers go out to lunch and don’t invite me? Where is God when I’m on the outskirts of forming close bonds with my coworkers just like they’ve formed close bonds with each other? Why am I the weirdo and the freak? What makes me so socially repulsive?

Then I hear Sara sing to me (it felt like it anyway), “I believe you’ll outlive this pain in you heart, and you’ll gain such a strength from what is tearing you apart” and those lyrics just GOT to me. It was as if God was speaking to me through the song and said, “Hey, it’ll be okay. I’m here for you and you’ll only get stronger from this situation. Marissa, you’ll be fine. It’ll be alright. Just talk to me. Tell me what you’re feeling. Tell me all about your pain. I’m here to listen and give you strength each day.” After feeling like God’s been like my dad for the past few years—not alive but up in the heavens somewhere, it’s like the silence was broken and He finally just communicated to me to turn to Him instead of running straight to my husband first. Talking to God is easier (and cheaper!) than talking to my husband.

Enough of the backstory. But now you know why I’ve chosen this particular song for Song of the Week. It seems like a good way to end the week on a good note. You can listen to the full song here. The lyrics are included below the cut.

Continue reading “Song of the Week: It's Going To Be Alright by Sara Groves”

FDA: No link between Singulair and suicidal behavior

On Tuesday, the FDA announced that an investigation into Merck’s clinical trial data did not discover a link between Singulair (montelukast) and suicidal behavior. The investigation, which began 9 months ago, was prompted by a number of reported suicides, especially that of 15-year-old Cody Miller who took the drug and appeared to have no history of mood or behavioral problems. (It is worth noting here that Singulair “is the top-selling drug for people under 17 years old” and Merck’s biggest seller with annual sales of close to $4.5 billion.)

In attempt to assess Merck’s data better, the FDA also investigated AstraZeneca’s Accolate (zafirlukast) and Cornerstone Therapeutics’s Zyflo (zileuton). Although the FDA did imply that “the data were inadequate to draw a firm conclusion” and said that the clinical trials were not set up to observe any psychiatric behavior. Here are the data the FDA discovered during their review of these trials:

SingulairSingulair: 41 placebo-controlled trials that included 9,929 patients

  • Reports of suicidal thoughts: 1 (treated with Singulair)
  • Attempted suicides: None reported
  • Completed suicides: None reported

AccolateAccolate: 45 placebo-controlled trials that included 7,540 patients

  • Reports of suicidal thoughts: 1 (placebo group)
  • Attempted suicides: 1 (placebo group)
  • Completed suicides: None reported

ZyfloZyflo: 11 placebo-controlled trials (number of patients unknown)

  • Reports of suicidal thoughts: None reported
  • Attempted suicides: None reported
  • Completed suicides: None reported

Forgive me for being cynical but the data sounds fishy. I can’t pinpoint why but it does. The suicide numbers and patient involvement data seem to deviate some from the numbers listed in Merck’s PR issued last March. (I’m seeing 11,000+ patients vs. 9,929 patients.) Regardless of the clinical trial data, it appears that the FDA as of yet have not reviewed post-marketing data.

Scott Korn, a senior safety surveillance executive for Merck said in an article for Reuters:

“‘At the time we did not believe, and we still don’t think a link has been established’ between Singulair and the suicides.”

In the same article, Sanford Berstein analyst Tim Anderson had this to say about the possibility of the FDA finding a link:

“If the… safety review leads to a stern warning about behavioral changes in the Singulair label, this could frighten users of the drug or their parents and give Merck’s competitors ammunition to attack the brand.”

The Washington Post has Dr. David Weldon, director of the Allergy and Pulmonary Lab Services at Scott & White in College Station, Texas, on record saying that he had not “seen any increase in psychiatric problems with the drug but that some patients had complained of nightmares after starting on Singulair.” (Note: It appears that the closest conflict of interest Weldon would have here is that he served as a consultant and is honoraria for AstraZeneca.)

Dr. Rauno Joks, head of the SUNY Downstate division of allergy and immunology, made an interesting point in the Washington Post article:

“The physician really needs to review whether there are symptoms that have developed since patients started taking the medication, if there’s an underlying depression that was there before medication started.

Also, seasonal allergies in and of themselves can cause fatigue and lethargy, which makes it harder to assess, because those are some of the symptoms you have with depression.”

The FDA says they’ve completed analyses of submitted clinical trial data but their “safety review will continue” for several more months before they come to a concrete conclusion. For customer testimonials, check out medications.com that has over 2,300 people reporting side effects and askapatient.com that has an average 2.3 rating from 524 reviewers. The most commonly reported mood-related side effect on both of the sites is irritability.

This Girl's Biblical View

Be anxious for nothing, but in everything by prayer and supplication, with thanksgiving, let your requests be made known to God; and the peace of God, which surpasses all understanding, will guard your hearts and minds through Christ Jesus.
Philippians 4:6-7
(NKJV)

Personal interpretation
Don't worry about anything. Pray and ask God for your needs and desires, thanking Him for everything He's already given to you, and God will provide you with assurance—a kind of heavenly, unfathomable assurance—that will protect your heart and mind from constant worry and anxiety.

Personal meaning
While I know I shouldn't worry about anything, I still freak out over things and usually they're the littlest things. (See Don't Sweat the Small Stuff.) The verse encourages me to pray and beseech the Lord for help but I've got to admit, I often forget and try to do things on my own.

Personal application
The verse encourages me to really talk to God—to make God real in my life as though He were standing face to face with me. Just like I would talk to my mom and go, "Hey, Mom, I'm a little short on cash. Can you help me out today?" Well, not that irreverent but that's the idea. If I have a good relationship with my mom, I wouldn't sit in my bedroom, fretting and worrying about whether I should ask her for money or not—especially if I know she has the money she can spare me.

God wants to hear me talk to Him. And instead of opening my big mouth to Him, I start complaining about my worries and fears to other people. Voicing my concerns isn't so much a problem as ignoring that God can handle it is. And God's word promises that if I give my burdens over to Him (with faith in Jesus Christ), He will provide me with comfort and reassurance that He's got everything under control.

As I am wont to say: It sounds nice in theory. Maybe I should try testing it.

Mood rating: 5.7

Social Anxiety and Social Awkwardness

AnxietyIf you met me in person, you’d never know that I struggled with social anxiety or what I’ve deemed social awkwardness.

I’m a pretty quiet and shy person at first but the more you get to know me, the more you get to love me! (Just kidding about the latter.) In all seriousness, the more I become comfortable in certain social situations or a group of people, I can be loud, outgoing, silly (zany if you’d like!), bubbly, and full of energy.

After close to a year of being at my current place of employment, I have yet to be fully comfortable. My personality comes out in short bursts but then I get quiet, withdraw, and “shut down,” keeping to myself and avoiding interaction with my coworkers if I can help it.

I assume—I don’t know for sure—that they have judged me negatively and for whatever reason don’t like me. In a previous post, I tossed around a couple of social situations where I felt like this before. I invent all sorts of reasons in my head:

  • I’m a freak
  • I’m a weirdo
  • I don’t interact much with them
  • I don’t have an immediate warm, outgoing personality
  • I don’t dress very fashionably
  • I have nervous habits that they probably don’t like
  • I am all-around irritating, grating, and annoying in some manner that I don’t know of

Most people struggle with this kind of thing without any real basis. My fear used to be completely unfounded and after the incident at my previous job, I am plagued by thoughts of social anxiety and awkwardness tenfold. I don’t know what I did at my last job to rub my coworkers the wrong way but I wish I knew so I could try to work on it and cut it out. Vague references of “immature” and “annoying” don’t help me much.

So here I throw out the detailed descriptions of social anxiety and social awkwardness. The first one was developed by the NIMH; the second is my own invention built off of the social anxiety description.

Continue reading “Social Anxiety and Social Awkwardness”

Christian counseling: Nouthetic vs. Biblical

Last night, I spent some time on the phone with my husband’s friend’s sister (aka my former pastor’s sister). We’ll call her Natalie.

Natalie was very sweet and kind, really encouraging and strengthening me by sharing her testimony of faith in God. She suffers from anxiety and panic attacks, which has led her to take Paxil (on and off) for the past 7 years. She says the drug has helped her tremendously and who am I to knock the drug (knowing what I know about Paxil/Seroxat) when she has seen the wonders that it has worked in her life?

I briefly explained my story of depression, history of suicide, and diagnosis of bipolar disorder. Although she couldn’t fully relate, she was very sympathetic and understanding. In fact, our conversation was so fruitful, I ended up taking notes!

Jay AdamsWe briefly touched on the issue of Nouthetic counseling (NC). She has undergone the course and simply needs to be certified. The counselor I currently see is associated with the Christian Counseling Education Foundation (CCEF), which has roots in NC and was founded by the man—Jay Adams—who developed the method. However, CCEF is now known for what is called biblical counseling. The organization has since moved away from pure Nouthetic methods and become more a bit more varied, taking bits and pieces of psychology (and perhaps psychiatry) that line up with the Bible. Adams, disagreeing with the organization’s approach, founded the Institute for Nouthetic Studies and uses the Bible as the sole counseling textbook. According to the wiki entry on Nouthetic counseling, Adams developed the word Nouthetic based on the “New Testament Greek word noutheteō (νουθετέω), which can be variously translated as ‘admonish,’ ‘warn,’ ‘correct,’ ‘exhort,’ or ‘instruct.'”

NC was developed back in the ’70s as a response to the popularity of psychology/psychiatry. Many Christians reject some of the teachings of such popular psychologists as Freud, Jung, Adler, Maslow, etc. Adams’ highly successful book, Competent to Counsel, criticizes the psychology industry and counters its teaching with a Nouthetic approach.

But NC has its Christian critics.

Continue reading “Christian counseling: Nouthetic vs. Biblical”

Generic Lamictal (lamotrigine)

I'm on "Day I-don't-know" of lamotrigine (generic Lamictal). It's been at least 2 weeks. I haven't had any significant side effects except for extreme fatigue. I am often tired. Some days, I can give myself a boost of energy by playing the Wii Fit (which I snagged Saturday afternoon) and other days, exercising just wears me to out to the point where I head to the shower and then to bed. I can have 3 cups of coffee, never become fully awake, and still go to sleep at a decent time.

I'm still not sleeping well. Haven't slept well since before I went into the hospital in October 2006. I can't remember the last time I had truly restful sleep.

My symptoms remain at bay. I haven't had many suicidal thoughts or impulses. In fact, some days, I can go without thinking about suicide at all. I can't say it's all the medicine — my counseling and faith play a much bigger role — but I'm sure the medicine helps.

I've recently noticed that I'm not suffering from as much social anxiety. Again, I don't know if this is due so much to the medication as it is to the resurgence of my spiritual life. I ventured out on Sunday to a meetup writers workshop group that I'd never been to before. It was extremely weird. Not the situation, but the fact that I walked into a room full of strangers, made myself comfortable on the couch at the coffeehouse and offered input quite freely without worrying about what the others thought of me. I even had the audacity to network with a woman who works at a trade magazine in the area. How strange. I don't have balls. This is not me.

What the heck has happened to me?

Loose Screws Mental Health News

The mastermind behind Stavzor is Noven Pharmaceuticals (in conjunction with Banner Pharmacaps Inc.). The new “small, easy-to-swallow soft gel capsule” is available in three strengths: 125, 250, and 500 mgs. The pills are are “up to 40% smaller than han Depakote® and Depakote ER® tablets at the 500 mg dosage strength.” From Noven’s PR:

Stavzor is approved for the treatment of manic episodes associated with bipolar disorder, as monotherapy and adjunctive therapy in the treatment of patients with complex partial seizures that occur either in isolation or in association with other types of seizures, and for prophylaxis of migraine headaches.

The drug will hit the market in mid to late August.

The hotline receives an average 250 calls each day from veterans that have fought in Iraq, Vietnam, and Afghanistan.

The issue of soldiers with mental illness has recently come to light with studies showing that 1 in 5 soldiers returning from Iraq and Afghanistan have shown symptoms of post-traumatic stress disorder. The issue of the high suicides rate has been a high priority of the VA since mental health director Ira Katz tried to hide the significant number of suicides committed by veterans.

The National Suicide Prevention Lifeline is available 24 hours a day by calling 800-273-TALK (8255); veterans should press “1” after being connected.

“We have seen a 60 per cent increase in demand for our child anxiety classes in the past six months,” said [Dr. Kimberley O’Brien, of the Quirky Kids Clinic at Woollahra in Sydney].

It sounds more like the article is speaking of children who are exposed to constant physical and emotional abuse. If that’s the case, shouldn’t there rather be an increase in parenting properly classes?

Social Awkwardness revisited

I’m attempting to overcome social awkwardness but it’s something that I’m still dealing with. I’ve renamed it “social anxiety.” I mentioned it to my diagnosis to my doctor — OK, I admit — hoping for medication. You know what he prescribed?

CBT. (sigh) I was hoping for dulled emotions.

When I took Lexapro, my emotions were so dulled that I didn’t care much about anything. It was frustrating but within my fogginess, it was freeing to not worry about what people thought of me. Unfortunately, Lamictal doesn’t have that effect on me. So while my mixed-mood, manic, and depressive episodes are under control, my anxieties about social situations persist. I’m still paralyzed by what occurred at my last job.

I struggle with a variety of things:

  1. If others are speaking in hushed voices, I worry that they’re talking about me.
  2. When I don’t get invited to events, I think they’re purposely excluding me.
  3. If I respond to mass emails at work, I wonder whether they start shooting emails to each other behind my back, talking about how much of a loser I am.
  4. In the midst of a conversation, I wonder if my thoughts are coherent and if they understood what I was trying to say in the midst of my stutter. (I only have mild stuttering around people I don’t know or am not comfortable with. Selective stutterism?)
  5. If I’m in a conversation with acquaintances and mention something that I have heard or know of, I worry that they think I’m a “know-it-all.”
  6. Because I often walk with my head down and a serious look on my face, people probably think I’m weird.
  7. Because I have occasional bursts of talkativeness but seem mostly quiet, my coworkers probably think I’m odd. (I’m only gregarious with people I know or am comfortable with.)
  8. If I say something, I immediately wonder if it was a stupid thing to say.
  9. I’m not that interesting so there’s no point in talking to other people. (How egocentric.)
  10. There’s no sense in inviting people to lunch  because that would give me the potential to humiliate myself and get them to dislike me. (Once again, narcissistic.)

I’m likely no different than the majority of people. The difference between those who struggle with social awkwardness and other people is how these situations are handled.

I came across a post from The Simple Dollar on Seven Ways to Overcome Social Awkwardness. Fear holds me back from actually employing these things (something else I need to work on), but let me know if any of those principles actually work for you.