Winning the fight over depression
It has been a more than 40-year battle, but Peggy Koan believes she is finally controlling her battle with depression and anxiety.
“I think my depression has turned out to be a gift. I say that because the compassion that I have developed, the empathy that I have developed for people in pain, I have been able to find purpose and meaning in living with depression by helping other people,” she said “I think it has been the way I have learned to set healthy boundaries. We are our own worst critics.”
As Thanksgiving approaches, Koan says she is thankful for the relationships in her life. “I have love and support from my husband (Todd), daughters (Sarah and Natalie), family and friends,” she states. “I’m thankful for the experiences of my life. It doesn’t matter if they were joyful, painful or just ordinary. They have shaped me into who I am.”
She is thankful for an opportunity to share her story. “Depression and anxiety are real aspects of my life and I am finding a way to live with this fact,” she explains. “I hope this offers hope to others who live with any emotional pain.”
Koan is a wife and a mother. She is a creative, artistic person who just happens to live with depression and anxiety. It has greatly impacted her life.
She started working as a speech therapist in Tyndall, South Dakota, in 1985. Later, she moved to Jamestown, North Dakota, where she worked as a speech therapist in a private practice clinic and later for the school district.
Her first major bout with depression came in the 1970s at the age of 14. “Depression wasn’t talked about, recognized or supported and I hid it very well,” she recalls. “It took every ounce of me and my strength. I had to take time off from school because I couldn’t get out of bed. The pressure of school work, responsibilities around the house, socializing, activities; it all became too much.”
She continued on trying to find ways to deal with the depression and anxiety. At that time there was no help for her. The episodes persisted in college. Then she became involved with the masters program for speech therapy.
“At that time I decided this was not normal to feel like some days I can’t get out of bed to brush my teeth,” she remembers.
At that time, Koan went to the psychology department to talk to master’s level students who were doing internships. It was the first time she received help with her depression.
Fast forward to 1984
Koan got married in 1984, thinking that the life change would make a difference with her depression. It didn’t.
“I think it was the first time my husband had come into contact with depression,” she says. “His family is very emotionally stable.”
The Koans moved to Bemidji, Minnesota. She didn’t know anyone. She was pregnant. The family had one car.
“I was pretty isolated at home,” she recalls. “When my daughter was born, I experienced post-partum depression that really impacted my ability to enjoy this time with my child.”
It lasted about a year; but she was also getting irrational thoughts like ‘I can’t take care of this child. What if I am never able to take care of her?’
“It was really irrational thinking, but I gradually worked my way out of that through some supportive friends who recognized what it was,” she said.
Her husband was there for her. “He was stressed because he was in a new job, he had a new baby and he had a wife who was not functioning at full capacity,” Koan states. “He did what he could to do things around the house to take care of the baby and try to just be supportive of me.”
Koan suffered her first hospitalization for depression and anxiety in 1991 while living in Jamestown, North Dakota. “I was afraid I was going to hurt myself,” she recalls. “I had a five-year-old daughter and I didn’t want to do that to her.”
She sought help through a local mental health center. She found a counselor who put her on anti-depressants. “I would say that was the beginning of a long process of working toward wholeness,” she states.
The Koans moved to Owatonna in 1998. Koan was hospitalized another four times and had to take leaves of absence from work. Two of those hospitalizations were at St. Mary’s Hospital in Rochester, where she received electric convulsion therapy because the depression level had gotten so severe.
Her last hospitalization was in November 2014. “I didn’t want to go on anymore and I was afraid I was going to hurt myself. The quality of my living had been greatly impacted,” she recalls.
The road to recovery
The road to recovery started in 2010. The help came through specific counseling, trial and error with medication, plus no longer working. “I had to quit my job because the depression and anxiety just didn’t allow me to handle the stress, deadlines and pressures,” she says. “The depression would flare up and many days it was so painful just to make the choice to open my eyes. There were also days where I could get up and say, ‘I’m not going to pull the covers back over my head and lay in bed the rest of the day to escape the pain.’ That was a victory.”
During that last hospitalization, Koan was referred to a therapist in the South Central Human Relations Center and into a specialized therapy called dialectical behavioral therapy.
That is when Koan met Cati Johanneck, a licensed independent clinical social worker with the South Central Human Relations Center. Johanneck was the person who helped her through the year-long therapy program for people who have significant long-term health issues.
DBT includes individual therapy one hour each week, group skills training sessions 2 ½ hours each week, 24/7 coaching context where the patient can call anytime, team consultation 1 ½ hours each week and community support.
“People have to have at least one year treatment of therapy and psychiatry, have been hospitalized and because of their mental health issues have had severe problems,” Johanneck said. “We want to treat the sickest of the sick.”
In 2012, South Central’s program became a Minnesota state certified DBT program. Since then an estimated 75-100 people in Dodge, Steele and Waseca counties have gone through the program.
“There is a big problem. There are a lot of people in high need of the intensity of the program,” Johanneck states. “I think one of the major differences is the skills training. It is very intense. One of the strengths is that we generate a lot of hope. We believe in the clients. We believe in the program.”
One of the most difficult parts is for a person to learn and understand emotions. “A lot of people think emotions just happen,” Johanneck says. She adds that there is usually a meaning behind the event and the interpretation of that event has a lot to do with what comes next. “Once a person understands the different pieces of emotional experiences, we can teach them to change them anywhere along the way.”
Koan says the program is set up to provide very specific skills to deal with depression and anxiety. One area that causes Koan discomfort and anxiety is conflict. “This has taught me how to clarify my goals and enter into a conversation, so that I am able to get my needs met. I have self respect when I’m done because I did not allow the fear to keep my having a conversation that was needed.”
She graduated from the program in early November.
Johanneck says it is phenomenal that Koan has finished the program. “It has meant the world to her. It has been life-giving,” she adds. “It has helped her tolerate the emotion as opposed to avoid it or run away from it. There was a point she wanted to drop out.”
A big part of DBT is accepting that a person lives with depression and that it can always come back.
In Koans case, she says, “I feel freedom now. Rather than fight that I live with depression and anxiety, now I have skills to manage it.”
Her husband and two daughters have stuck with Koan through the ordeal. At one point, her youngest daughter was the parent when Koan came home from the hospital. “My family is probably my best support system,” she says. “They have watched me struggle, but they’ve also watched me courageously meeting obstacles and pain.”
Koan states she has always been upfront with her daughters about depression explaining to them what depression looks like, what the symptoms and signs are and letting them know that it is okay to find someone you trust to talk to if you should ever feel any of the symptoms.
“They are both very compassionate,” she says. “I also think that they were able to appreciate the courage it took for me to live with depression. They developed ways to be emotionally strong.”
And the family was there for her. For example, during Koan’s bad days the girls would let her experience what she was experiencing. “They didn’t try to trivialize it or use trite sayings like, ‘You’ll get over this,’” Koan recalls. “They would pitch in around the house with whatever needed to be done. Often my girls would write a little note saying that they love me. Most of all, what I needed to see was that their lives were continuing on in a normal way. And they did.”
It was about six months ago, six months into her DBT therapy, when she started to notice the skills helping with her depression and anxiety. “Once that happened I didn’t want to stop,” Koan says.
Now, most days she is level. However, there is the occasional, maybe once every three weeks, where she will wake up and feel down. “I know how to handle that,” she says. “I recognize it for what it is and that it will pass. I use the skills I need to use or contact people who support me.”
Talking about depression
Koan understands the stigma about depression is still there and she is very guarded on whom she tells her story to. “When I was younger I absolutely didn’t mention it to anybody,” she remembers. “One of the turning points for me, as an adult, was when I was asked to go to the high school and speak in the women’s health class about depression. That was when I really felt I could be honest about this and open.”
She remembers looking around the room, knowing that there were girls in the room that need to hear her story because they are experiencing depression. “It is very common in adolescence,” Koan states. “I thought if I want to give some purpose and some meaning to this pain that I have lived with then I want to share my story with other people.”
Her family was excited about Koan’s willingness to step outside of her boundaries. “They encouraged me,” she says, adding that her youngest daughter, Natalie, was in that class. In fact, it was her daughter that asked if her mother would come in and speak to the class. “She was very supportive of what I had to say. I do not believe either of my girls have been embarrassed or ashamed.”
Another reason she decided to step out of the box and talk was that Koan was getting tired of keeping her depression and anxiety a secret. “I was tired of the depression ruling me,” she says. “I really believe it would be part of my healing process to share this with others.”
In addition, she tries to point out that if a person is feeling down for longer than two or three weeks, that is not normal sadness. “At that point you need to seek help whether it is talking to a trusted friend, a pastor, a teacher, family member or getting professional help. This is a disease that is invisible, but it is every bit as impacting as a disease that is visible such as cancer.”
It disappoints her that mental health is like the orphan of the medical world. “It is not given the same amount of respect,” she states. “I live with diabetes. There is nobody judging me because I’m a diabetic. People don’t see me as less because I’m diabetic.”
However, because of my depression, people see me not capable of controlling my emotions, she adds.
“When will she have her next bout of depression?” she says. “I am most angry there is not enough help available, especially for the adolescents. I believe there is a real shortage of mental health professionals and facilities available for people to receive the help they need.”
Despite all the sad times, Koan is proud of how courageous she has been in facing her demons and continuing to seek out help for herself. “I have cared enough for myself and love myself enough to do that,” she says.
She believes that it is important for a young person to get help early on, just so they can manage their mental illness. “That would be my hope that they can learn at a young age how valuable they are no matter what the depression tells them,” she states.
For Koan, over the next 3-5 years, she has a vision of being a loving grandmother and getting on the floor playing with her grandchildren. She would also like to become a spiritual director. And then there is just spending quality time with her husband and daughters going camping or hiking and doing the things they enjoy doing together.
“Most of all to just say ‘I’ve built a life worth living.’”