Talking is the best therapy, and talking is something I practice and enjoy quite a lot. My significant other and I have been talking about my recent feelings, so far drawing a few key conclusions. I’ve dubbed this emotional state post-surgical depression or post-operative depression. At first it seemed it could be similar to post-partum depression, but after some initial research it seems depression and anxiety are not uncommon after surgeries, especially after plastic surgery. We haven’t found any concrete resources yet. (But she is looking, she points out now, nudging me gently in the ribs. Sorry not the ribs, the arm, she wants to be accurate.)

Initial Research

As a general gist, we’ve found articles that relate to post-operative depression as caused or influenced by anesthesia. Being under general anesthesia is an interesting concept – you’re not quite asleep, not quite unconscious, yet your body undergoes one of the most radical changes imaginable. And you don’t feel a thing. Moreover, some articles state how surgery makes you reevaluate your mortality, it leaves you feeling powerless and vulernable (although I’d make the distinction of elective vs obligatory surgery). Still, that’s sort of how I felt afterwards – in pain, mildly drugged and semi-conscious, not self-sufficient, weak, and very very vulnerable.

Curiously enough the few articles we’ve found about this are related to plastic surgery post operative depression following a breast enhancement (and breast reduction). Women experience depression because their appreance is not what they thought it would be – it’s a horrible ugly mess of scars and swollenness and bruises and stitches and blood and pain. The same can be said for breast deduction / double mastectomy / top surgery.

Fun Facts

[Update: the girlfriend found some interesting facts]. Some quotes:

• Women are more prone to post-surgery nausea than men (and I’m more prone to post-or-pre-anything nausea)
• When we’re healthy, we tend to think of our bodies as somehow intact, both inviolable and homogeneous. Major surgery can shatter that image, and with it the concept of self-sustaining health. The feelings of mortality, of loss, and of vulnerability can be profound, and recognizing depression in surgery’s aftermath becomes very important. [This echoes my thoughts in a way. Before, my body was perfect - I never ever imagined that I'd be one with a deformity, an embarrasment, a prominent scar. For over twenty years I never went to sleep picturing myself with two hugely noticeable red lines across my mid torso, not until very very recently.]
• Post surgery depression can result from the after effects of anesthesia (which seems to bring out our sensitive side and our anxiety)

With a History of…

It’s no surprise that I experienced a surge of anxiety, as I have a history of anxiety and depression. This also fits into the puzzle, as I am already pre-disposed by personality to take in situations and have them turn into a cognitive mess. My significant other has forever called me her “little bundle of nerves.” Moreover, any kind of big stressor is likely to trigger this worrisome thought cycle again. The good thing about all this is that I know this side of myself, so I immediately recognized it as anxiety. I wouldn’t say I know how to fix it, except to hope and wait for things to get better (and ask my girlfriend to repeat to me a million times that things will get better).

More Ideas

I had realistic expectations coming in. Although I had come to terms with the idea of having scars, and had reconciled my current body with my potential future body in my mind, it’s not reality. And reality is just that, much more real. It hit me so hard I didn’t see it coming.

In addition, I would qualify this experience as a trauma, both physical and psychological: “an often serious and body-altering physical injury” and “an emotional or psychological injury, usually resulting from an extremely stressful or life-threatening situation.”

Again though, I’d like to emphasize the difference between voluntary and forced surgery, but only to recognize that neither is more or less stressful than the other, just a different kind of stress. In voluntary surgery, as was my case, you grapple with issues such as second guessing your decision, question the necessity of the operation, the validity of your right to do it, and only you are to blame for the final outcome, whether good or bad. Doubt, guilt, remorse, uncertainty of the future, holding onto the past – those are just some of the emotions flowing through me.

Catching Up

My body just underwent a very radical, and very quick, change. In comparison to other bodily changes, this one was lightning fast. Think about it – how long did it take me to grow to my current height? (yes, I was growing at some point) About a decade and three quarters, I’d estimate. What about my breasts, how long did those take to grow to their full potential? About 5 years probably. And I’ve only had them for 10. Then they were gone in the opening and closing of my eyes, literally. My reverse puberty happened overnight.

Consequently, my brain is racing to catch up. Due to the mind’s resilience, it will catch up. One day I will wake up, just like any other day, and feel the familiarity of my chest, and my scars, and all that remains there, as if nothing was ever different. And this day will not come suddenly, each day will build up on the last one, as I slowly familiarize myself with a new and strange part of my body.

Science Lesson Intermission

As an evolutionary psychologist, this sudden shock I experienced makes a lot of sense. The body always experiences slow and gradual changes, too small to notice in the present moment, and only with a retrospective mind does one realize the changes that have actually taken place over the long run. Thus our brain is used to processing bodily changes only at this crawlingly slow pace. Except in extreme cases, of course, such as accidents. Accidents are bad, therefore our brains should be shocked in the case of something that looks like an accident. They need to trigger the stress response, the fight or flight response. Increased alertness, which morphs to anxiety and nervousness, is the result. [Note, these are merely my deductions, not actual scientific research.]

Not Regret

I don’t regret it. I can’t regret it. When you do something wrong, you go through all the what-if’s. Scrolling down this list, we concluded it was impossible for me to have NOT made this decision.

If I had waited more, a few months, even two, five years, the itch would have still been there, top surgery would have remained on my mind. You can’t unknow something you already know, and this was one of those things. The minute I learned this was a very real possibility, I clasped on to this idea.

If I had researched more, I probably would not have come across counts of post surgical depression. I’m already actively researching this with almost no luck. In all the forums, list serves, conferences, blogs, etc, I never once read how people sometimes feel so crappy after their surgery. Or maybe I read it, glossed over it, made nothing of it, since nobody seemed to make a big deal out of it.

If I had been in therapy or counseling, I would have still wanted top surgery. Had the therapist tried to talk me out of it, I would’ve been resistant, doubly stubborn and doubly resolved. Had the therapist not tried to talk me out of it, I’d be, well… here.

If this was just “an idea I bought into,” like a cool fad or trend (as my mother has expressed), then why should I “buy into the opposite idea” or fad or trend (like my father has expressed)?

If this was for the worst, then what could have been for the better? Nothing has come to mind yet.

Time Heals

The old adage proves true, or will, hopefully. At least that’s what I’m betting on. With time, my body will heal, and my mind will heal. And the old adage about talking is also true. I only hope others would talk about this more, so it won’t hit you like a truck when it comes.

And now, I leave you with a quote from my most intelligent significant other:

Is it so bad that we have to rationalize everything? My honey is depressed, and what do we do? We go and look for medical journals that will tell us why.

And here’s today’s picture.

*Clean* purple underwear right after a nice "shower"

Resources

I have yet to read these in their entirety, but here are some resources I’ve seen, found, or am looking for:

• “Psychological Complications in 281 Plastic Surgery Practices” by Gregory Borah, et al. In Plastic & Reconstructive Surgery 104(5):1241-1246, October 1999.
• “The Effect of General Anesthesia on Postoperative Depression”, Scher C., Faw S, Anwar M. Abstract Presented at International Anesthesia Research Society, Anesthesia & Analgesia 88(2S) 27S. February 1999.
• Anesthesia and how to prepare for it
• An Understandable Complication
• http://www.breastlift4you.com/depression.htm
• http://www.med.umich.edu/depression/condition.htm