March Mindfulness is Mashable’s series that examines the intersection of meditation practice, technology, and culture. Because even in the time of coronavirus, March doesn’t have to be madness.
I couldn’t practice mindfulness until I started taking medication to treat my anxiety.
I never had the patience for meditation, and while I enjoyed yoga as an exercise, I usually ended practice frustrated that I couldn’t effectively clear my head.
The only habit I’ve ever been able to maintain is nightly journaling. For the past decade, I’ve diligently ended my day by dumping my thoughts into a journal. Before seeking treatment for anxiety, I used it as an outlet to vent my stress from day-to-day existence. Now, I’ve learned to incorporate mindfulness techniques before, during, and after sitting down to write — and I wouldn’t have been able to do so without pharmaceutical help.
There’s a misconception that mindfulness can only be practiced by sitting quietly with your eyes closed. You can incorporate the skills you learn while doing mindfulness exercises into daily activities, like walking, journaling, and even eating. Meditation researcher and mindfulness pioneer Jon Kabat-Zinn defines mindfulness as “the awareness that arises from paying attention, on purpose, in the present moment and non-judgmentally.” His stress reduction exercises built on linking those concepts with various types of meditation have been found to be promising treatments for anxiety and depression.
But managing to incorporate these practices into daily life is especially challenging when you’re experiencing mental health shortcomings. For many living with anxiety and other mental health disorders, mindfulness or medication alone aren’t enough to manage a healthy lifestyle. When both are incorporated into a treatment plan, they can work together.
Generalized Anxiety Disorder (GAD) affects 6.8 million adults in the United States, according to the Anxiety and Depression Association of America. I’ve been anxious for as long as I can remember, but didn’t begin treating it until earlier this year. When I finally sought therapy, I thought I was just having trouble dealing with what seemed like pretty manageable stress. But the symptoms I had — constant fatigue, restlessness, insomnia, muscle tension, and an overwhelming feeling of being, well, overwhelmed — pointed to a case of severe GAD. A psychiatrist prescribed a daily dose of Escitalopram, better known as Lexapro.
The adjustment process was a trip. I experienced appetite fluctuations, drowsiness, and a dull, persistent headache that pulsed in the base of my skull. For about a week while I increased my dose, I felt so stupid; no matter how hard I tried to, I couldn’t focus or write coherently. As I pass the six-to-eight week threshold of time for the medication to fully take effect, most of those symptoms have subsided. I don’t feel particularly changed or better, but I don’t feel the panicked, overwhelming dread that I used to. I sleep through the night now. I think more quietly — in a recent call with my therapist, I compared it to having only six trains of thought running at once, instead of 18.
Before, my diligent journaling often spiraled into a self-pitying “brain dump,” and while I felt lighter after writing, I didn’t necessarily feel better. Journaling provided an outlet, but it also fed into my anxiety. Since starting Lexapro and regularly working with a therapist, I’ve begun using mindfulness techniques while journaling.
I practice breath work before my nightly vent, and end entries with three observations about my body. I write about how my fingers feel holding a pen and the pressure I’m applying to the page. I write about the way I’m craning my neck and curving my back to balance my notebook on my knees. I write about the way my breathing changes when I record something that irritated me that day. I still vent, but regulating my breathing and incorporating body scanning — bringing awareness to parts of your body individually and the discomfort you may be feeling — into my nightly routine, helps release tension I didn’t even realize I was holding.
There’s another sign of Lexapro working in my journal entries. Now that I’m relatively adjusted to it, I use more punctuation.
“They’re called anti-depressants and not pro-happy pills.”
Dr. Ashley Covington, a holistic psychiatrist based in Los Angeles, incorporates both mindfulness and medication in treating her patients. In her practice, encouraging patients to do breath work every morning or take daily walks observing their surroundings can better their quality of life in a way that just medication can’t. In using mindfulness, “one size doesn’t fit all,” so she has her patients do “grounding exercises” that involve observing their surroundings to practice being present. Medication alone isn’t always enough for that.
“They’re called anti-depressants and not pro-happy pills because they truly do prevent people from getting into the trenches of depression or having panic attacks, but they don’t necessarily create positive opportunities in your life,” Covington said. “That’s what you’re responsible for.”
She told me that I probably used journaling originally as a coping mechanism to discharge anxiety. A lot of people with anxiety, including myself, tend to have a constant sense of urgency because anxiety is caused by an overactive nervous system response. When you suppress that response with medication, there’s more “space” in your head, Covington reasoned.
“And then there’s more space to think about punctuation,” she added.
Mindfulness and medication work together
Like me, comic and animation writer Carrie Tupper saw her quality of life improve when she began using both medication and mindfulness to manage her mental health. Before medicating, practicing mindfulness just pulled her deeper into her depressive episode.
“The journaling just made me feel like I was whining into the void, so I felt awful doing [it.] Meditation left a quiet space to realize how empty and numb I felt,” she said in a Twitter DM. “Writing lists was another opportunity to feel like I wasn’t deserving, worthy, or thankful of the blessings I had.”
People with trauma and other mental health disorders have trouble practicing mindfulness because of an especially strong fight-or-flight response. Covington called it a struggle between two parts of the nervous system: one that controls the body’s response to dangerous situations and another that reduces heart rate and regulates digestion. Those struggling with their mental health need to “train” their bodies to default to the latter, where both mindfulness and medication step in.
Tupper sought professional help for her depression after a suicide attempt. In the five years since she began taking medication, she’s learned to incorporate mindfulness techniques into her own life that force her to be present, rather than default to stress.
“The door was jammed…And try as I might to knock the damned thing down I was trapped with this slow moving ghost.”
Tupper compares her brain to a house: During the worst of her depression, she felt like she was “locked inside one room.”
“The door was jammed, it wouldn’t budge,” Tupper said. “And try as I might to knock the damned thing down I was trapped with this slow moving ghost.”
Medication was like the “key to open the door,” but when she managed to leave the metaphorical room, she realized the rest of her house was a mess. The “ghost” — her depression — still follows her and creates mess, so she needs to be consistent about cleaning. Her mindfulness techniques give her the tools to clean.
“It’s like finding a new door and opening it to a new mess to clean up, and you’re just like, ‘OMG, seriously? You messed this one up too?” Tupper explained. “And when your ghost starts acting out, the cards also help find ways to chill it out.”
Engaging in mindful activities — like meditation — has been proven to improve executive function like memory, self control, and focus. A 2012 study published in Social Cognitive and Affective Neuroscience found that participants who meditated performed better in executive functioning tasks than those who didn’t. For those with disorders that affect executive functions, like anxiety or ADHD, Covington notes that mindfulness can be especially helpful to turn off the “busy chatter” that takes up your brain.
“Even one minute of mindfulness like that can still help ground you, creating a little bit of presence, so that you know that when you do need to go back into work mode again you’re giving your brain that little break,” Covington said.
There’s still a stigma around medication
While self care is wildly popular, treating mental illness with medication is still stigmatized. Practices like luxuriating in bath bombs and treating yourself to a well-deserved snack are common, so why isn’t taking care of your brain culturally accepted as well?
Writer and teacher Noah Cho agreed that if medicating came with less baggage, he probably would’ve started treatment for anxiety and depression earlier. Although he tries not to “give into” toxic masculinity, being the oldest son in a single parent household swayed him away from taking care of his mental health.
“I grew up as the ‘man of the house’ and people expected me to be a bit more flawless.”
“I grew up as the ‘man of the house’ since my father died and people expected me to be a bit more flawless and not break down,” he said in a Twitter DM. “I was able to shed a lot of that over the years through therapy but some of it still lingered way into adulthood.”
Cho practices mindful eating, which helps him manage body dysmorphia disorder. It helps him slow down and reassures him that he’ll have enough to eat. He’s also more patient with himself, centering himself by using apps like Headspace or going on runs.
“But I never would have even been able to get to that point without therapy and Lexapro,” Cho said. “Which gave me the ability to actually ‘see’ what my anxiety and depression was, rather than existing as angst that I joked about or used as my personality.”
Covington, the psychiatrist, dismisses preconceived notions that only “weak” minded people need medication. Like any other health issue, mental health should be treated, too.
“Why make it harder on yourself if you don’t need to?” Covington said. “What are you trying to prove by resisting medication? If it’s truly going to improve your quality of life, and if it’s going to create a platform to help set you up for success, then who’s missing out?”
It’s important, however, to note that medication may not always be the answer. The United States is facing a concerning rise in overmedication, which can, at times, be harmful.
It may not be forever, but meditation and medication work together
The longer I take Lexapro, the better I am at mindfulness. I recently began practicing yoga more regularly, and in a time as uncertain as this coronavirus pandemic, it’s been a lifesaver. I finally understand what it’s like to let myself feel present at the end of my practice.
I’m not sure if I’ll take Lexapro for my entire life. It’s possible that I can wean myself off and live healthily without it. It’s also possible that I’ll need it forever. Regardless of whether it’s a long-term solution for treating my anxiety, it can’t be the only solution. Similarly, practicing mindfulness alone isn’t enough to manage the cluttered house that is my brain.
Covington compares taking medication to lifting yourself out of a “crisis mode.” It’ll get you back on your feet, but it may not be sustainable on its own. For that, you need mindfulness tools to stay aware of your mental state. Meditating, taking walks, and journaling can all work in conjunction.
Cleaning up a messy house can take work, but it’s less daunting when you have the tools to check in with yourself.
If you want to talk to someone or are experiencing suicidal thoughts, text the Crisis Text Line at 741-741 or call the National Suicide Prevention Lifeline at 1-800-273-8255. For international resources, this list is a good place to start.