I'm a clinical psychologist, and I struggle with my mental health too.

I’m writing this with my aragonite crystal and blue apatite stone in my hand, my tranquility sea salt and rosemary candle glistening nearby, and a coffee that is 85% decaf and 15% regular because…anxiety.

I have been struggling. And I think it's okay to say so out loud.

I have not been as “publicly present” for awhile, and it comes down to needing space to process, heal, and survive. As you may know, I live every month with Premenstrual Dysphoric Disorder. This long term chronic condition has its way of evolving with age, stress, and just the complexity that can occur over the lifetime of a reproductive cycle. It has this curious not-so-fun tendency to show up in a new way or level of intensity time and again. This time around, it happened over the 2021 holiday season.



[Image: Single flower bud not yet open, under the rays of the sun at golden hour.]

I want to preface with these points:

• I share my story with no desire for an extension of sympathies or quick solutions. This stuff is hard, messy, complicated, and always in flux. It's uncomfy and tough to ‘be with’. And it’s the present reality of my journey. Of course, I welcome all rays of care, empathy, understanding, compassion. I sincerely though share this with the primary intention of creating authentic space to show up in the sacred messy. The ‘Hey I’m here flowing with this, in case you are too. Let’s support each other, because we are divinely worthy of being seen and held.’
   
• Today I feel like opening up about it. Next week/month might feel different. Today, I have one approach to my PMDD management. Next year I may feel very different about it. We’re allowed to pivot and transform.
  
  
• This is not a comprehensive review of my experience. There are details I do not feel up to writing about, and that's ok. We each have permission to share what feels aligned at the time.
  
  
• Gentle content warning: There will be some mention of distressing PMDD symptoms and mental health crisis. If your mind and heart are not in the space to receive and absorb this, please please take care of you first.
  
  
• I’m a clinical psychologist, but first I am very much a human living, breathing everyday with a nuanced chronic illness. What I write here comes from my heart. This is not medical advice. I have some ideas for managing all this because of my training and lived experience; however, by no means does it translate to me having it all figured out. Nor am I suggesting that what works for me will work for you. Take the pieces that resonate, talk with your own trusted healthcare providers, and let’s stay in touch to lift each other up. 

Okay, deep breath.

In December, I was severely anxious and depressed. It had started with increasing panic attacks around ovulation, to the point where I felt like I was losing touch (detachment) with reality. I was experiencing what is called dissociation. It can come in different forms, and can happen on a spectrum of intensity. Dissociation is one of the brain’s defense mechanisms when it feels under threat or overwhelmed. The brain registers an urgent need to keep the person safe (e.g. in a panic state or recovering from trauma). Through the process of dissociation, the nervous system disconnects or pulls the person from reality to ‘keep them safe’. It is not necessarily a listed PMDD symptom in itself, though it can occur when one is experiencing excess anxiety. For me, it was like I was either not in my body, delayed in my sense of time, floating above ground, significantly disconnected from the loved ones and environment around me, or having an unsettling sense that things around me were not real. This unfortunately also was exacerbated by paranoia. I was experiencing episodes when I would have a significant and scary level of distrust in my environment and others around me. It was terrifying. If you know, you know. These clinical experiences can happen for folks living with anxiety, traumatic stress, postpartum mental health issues, and mood disorders like PMDD. 

Then, like clockwork, in the days approaching my period, I felt the PMDD fatigue and depression coming ashore. However, this time around, I did not feel safe. It was one of the worst depressive episodes I have moved through in a long while. I had thoughts of unaliving myself and that was my cue to immediately call in for my partner/family support and to initiate a mental health plan. I was able to flow through that and feel safer with myself, but it was highly uncomfortable. Days later, my panic and paranoia came back with a vengeance and I went to the Emergency.    

I am now seeing a psychiatrist, restarting SSRI medication (I had trialed SSRIs awhile back at the start of my PMDD journey), and beginning individual therapy again.

[Image: Single red orange flower in bloom, in a field under the rays of sun at golden hour.]

Why did I ask for help?

• The symptoms and distress exceeded my capacity to manage at the time. I was not able to function at my normal level. My usual coping skills were not sufficient. I felt afraid and unsafe. These are all signals that I needed more support.
  
  
• I am not a superhuman. Yes, I have a doctorate in clinical psychology. But a degree is not a protective shield from struggling with mental health challenges. It’s okay to ask for help. If you are a health professional reading this and having a hard time too – I see you. You are allowed to take care of yourself, to lean on others, to be vulnerable, to need support, to be courageous enough to be wholly yourself in all your sacred messy. Mental health shame and stigma in our helping professions is grossly ironic and awful and we’re working on dismantling that.
  
  
• I am worthy of nourishing my healing. I am worthy of tending to my own garden of needs. I give a lot. Historically, I have held space for others often. I also do not like being a ‘burden’, or being the one who is needing more support than I am able to give. However, I am redefining what ‘needy’ means to me. I am unlearning the societal programming that says we have to do and be all the things all by ourselves. I am practicing how to receive.

Why did I decide on medication and therapy?

• Many living with anxiety, depression, and chronic health disorders such as PMDD benefit from therapy or psychiatric medication or both. To learn more about evidence based treatment options specifically for PMDD, you can visit IAPMD.org https://iapmd.org/treatment-options Each person is wonderfully unique so please honor the treatment or management approaches that fit for you.
  
  
• I want to feel more ease, more peace, more myself. If these treatment approaches are stepping stones in the direction of feeling more grounded, I am open to investing in that and giving it a go. When our nervous system is in crisis mode - as mine has been - it 1) first and foremost needs to feel safe, and 2) may need external supports in order to access baseline functioning where it feels safer. For me, at the present time, this includes medication and psychotherapy. In general, when we are more regularly at baseline, we can then more consistently proactively practice our regular coping skills. It’s slowly and intentionally progressing from ‘putting out fires’ (crisis) to thoughtful maintenance (sustainable management).
  
  
• I personally and professionally believe in a multi pronged approach to managing PMDD. I always have. I’m still engaging my mindfulness practice everyday (a life saver in itself). I’m taking my supplements. I’m drinking my lemon water while in my yoga practice. I’m cooking my plant-based meals. I’m resting. I’m cuddling with my support doggie. I’m saying ‘no’ when I need to. I’m replacing regular coffee with matcha or decaf, choosing the tea instead of wine. I’m journaling, tarot-ing, dancing, nature-ing. I’m doing all the things. PMDD warriors know this well. PMDD can notably shift or worsen with age and stress. I am in my mid-30s, and I am experiencing substantially more stress right now for a multitude of reasons. Makes a whole lot of sense that my nervous system has been feeling overwhelmed and needing extra tender loving care. I know that meds + therapy can be additional supportive elements to better flow with what I am navigating right now in this specific chapter of my healing process.
  
  
  [Image: Field of many red orange wildflowers in bloom, together in a field, under a bright blue sky with clouds.]

  ---

Why am I sharing this now?

It felt right. I could say something 100x more profound I am sure if I had the brain capacity to do so. The truth is I am still sorting through it all. I am still very much actively healing, unraveling, expanding, hurting, yearning, and figuring out-ing. I needed time to be in my hermit survival mode for a while there. And if you are in that spot right now – you do you. Know that it’s entirely okay to take the time you need to love yourself in the ways your being is asking for. Many people are feeling exhausted and extra stressed right now. Whether you live with PMDD or not, this is a time of holding multitudes -- hope and sadness, awe and fear, uncertainty and trust. It can feel like a whole lot to carry and process everyday. This can feel extra tough for those of us living with chronic health issues. I personally am still in the haze of my meds trial and my anxious ‘how is this all going to turn out’ phase, so I still need time. My being is saying fairly loud and clear that it needs spaciousness to slow down, tend inwardly, and create room to feel the feels.

I am a clinical psychologist and a trained therapist – and I struggle with my mental health. I am practicing saying that out loud to honor this is my genuine truth *and* just in case there’s a lovely soul reading this and whispering, ‘thank goodness I’m not the only one.’ You are indeed not the only one out here in that field of unknown, blooming in the context of not-quite-there-yet. There was a time when I was managing my anxiety and depression well without medication and therapy. Then that changed. And. That’s. Okay. These paths of ours are not perfect linear healing trajectories. Grief, depression, stress, anxiety, lack of clarity, pain – it all comes when it does. It’s scary and feels wildly unfair sometimes. And you are so so right in wanting to feel more ease, more peace, more okayness. I hope this part of my story is a gentle comforting reminder in those moments when it feels really hard. You are not any less of a spectacular human when you need help, when you need to be cared for, when you need to do things differently than you have for a long time. Choosing to love on yourself – truly love yourself enough to take meaningful care of yourself – is such a gift.

I am practicing what I teach here. At the time of this writing (end of Jan 2022), I will be taking time away from my typical offerings to tend to my healing process and upcoming life transitions. I will likely not be as active on social media and newsletters. I am putting a pause on the ‘PMDD Grounding Circle’ gatherings for now. I have every intention to return with more creative loving community supports. My online PMDD mindfulness course is still available, as it’s an ‘evergreen’ course and can be accessed at any time. More of my energy will be saved for folks who are signing up for or moving through that course. (If you're interested in learning more, feel free to message me so we can chat about it.) I am hopeful that this mini break of 'tending to my garden' will permit me to show up with more supportive presence for the community.

In the meantime, if you’re finding any pieces of this story helpful to your heart, please do send me an email to let me know how it lands with you. I might be quieter these days, but would still absolutely *love* to hear from you. As always, feel free to share with others who may appreciate the read. Also, you're welcomed to join my newsletter (if you aren't on there already) and are interested in staying connected and knowing when I have new offerings in the future.

Sending gentle fierce waves of love, compassion, and reverence to your being.
💛 Dr. Mo

If you or someone you love is experiencing depression, anxiety, or suicidal ideation please do reach out to your healthcare providers, such as your primary doctor, a psychiatrist, psychologist, or therapist. If you are seeking a therapist, there are multiple directories and suggested considerations listed on my Resources page. Additionally, IAPMD.org has resources for PMDD peer support groups and a clinician directory as well. In the event of a mental health crisis, there is help available.

~ Go to your local emergency room.
~ Contact your health provider's psychiatry hotline. 
~ Call the National Suicide Prevention Lifeline 1-800-273-8255
~ Call 1-800-950-NAMI (6264)
~ Text HOME to 741741 (Crisis Text Line, USA)
~ Text SHOUT to 85258 (Crisis Text Line, United Kingdom)
~ Connect with another crisis helpline local to your region.