“Twitter Psychosis”? I’m Skeptical

[Content note: mental illness & delusions]

Over at the Daily Dot, I did some mythbusting about this alleged “Twitter Psychosis.” For whatever reason, it’s hard for me to pick out an excerpt, so I’ll just go with what I think is the most relevant part of this story, but you should go read the full thing to get the background:

Unlike most other published psychological research, the study about Mrs. C and “Twitter psychosis” is a case study— a type of research in which researchers study one particular person, or case. Something you should know about case studies is that they’re the least scientifically rigorous experimental design possible. There’s obviously only one subject or participant, and a particular person’s psychology is so idiosyncratic and impacted by so many factors that we may or may not even notice that it’s difficult to draw any firm conclusions. Unlike other studies, that compare some group to some other group, case studies don’t allow us to see what happens if certain conditions are different.

This study was further an observational case study, not an experimental one. In experiments, researchers change something or do something to the participants and see what happens. In observational studies, they can only observe what’s already going on. This means that it’s impossible to tell what causes the observed phenomena to occur.

That said, case studies are useful sometimes. When researchers are first discovering a new phenomenon, or when people with a particular condition are very rare, there might be no choice but to study a single individual. Observational studies in particular are useful when it’s unethical or impossible to tweak some variables to see what happens. Twitter psychosis, if it’s a real thing, is probably quite rare. We would have to study thousands of participants to find cases of it. And if Twitter really can cause psychosis in certain people, it’s clearly unethical to purposefully expose them to it to see what happens. So, case studies, including observational ones, are often the first step of studying something new.

My main concern with this type of research—and with other recent warnings by mental health professionals that the Internet (and social media in particular) can cause or aggravate mental illnesses—is that people dealing with mental health problems may be pressured by friends, family, or doctors to stay offline. Of course, sometimes staying off the Internet (or off social media specifically) can be a wise choice for someone for any number of reasons. However, the general trend of anti-tech alarmism makes it likely that “stay off the internet” will be a piece of advice too often and too easily given.

People with mental illnesses can be vulnerable to persuasion and even coercion by those with authority over them, including therapists and psychiatrists. If a person with a Ph.D. says, “I think you need to stay off Twitter,” they may take their advice without any grains of salt.

You might ask why this matters. It matters because the Internet can also be an incredible source of support and information for people with mental illnesses. Tumblr, in particular, is known for its supportive community, but it’s not the only one. Reddit has subreddits dedicated to every major mental illness where users can post stories, ask for advice, and support each other. Twitter’s hashtags make it easy to find tweets about your illness, and mental health organizations and professionals are very active there, posting supportive messages, advice, and news about clinical research.

And Facebook is where many people “come out” about their mental illnesses for the first time, finding it easier to share with many people at once rather than with individuals—but without having to show it to the whole world. (Incidentally, Facebook is also where I run a support group for atheists dealing with mental health problems, which many of the participants have told me has been really helpful.)

It’s possible that Twitter can trigger psychosis in some people with other risk factors, and researchers should conduct more studies to find how whether, how, and why this happens, and how it can be prevented. But we should be careful not to cut suffering people off from a potentially vital source of support.

Read the rest here.

 

Overapologizing and the Myth of Closure

Something that happens to me sometimes with guys* is they do something I find hurtful, I calmly tell them so, they apologize, I thank them and accept, and then…they keep apologizing. And apologizing. And talking about how they feel like “such a jerk now” and how they really are a nice person who doesn’t usually do things like this and they’re really so sorry and I keep saying that it’s fine, they apologized already and I accepted and it’s okay as long as it doesn’t happen again and…they just. keep. apologizing.

And then it occurs to me that, even if they don’t realize it, they’re asking for something from me. They want reassurance. Fucking up feels bad, and I’m the one with the supposed power to make them feel like good people again. So the endless apologizing is meant to extract those sorts of caring behaviors from me–”No, really, I really like you as a person, I know you didn’t mean it”–and perhaps, eventually, capitulation–”It’s okay, really, it wasn’t even that big a deal, I probably shouldn’t have even said anything about it.”

As I said, this is probably unintentional/subconscious; people who do this probably think that they’re just making sure the other person really has forgiven them. But since it’s based around a temporary loss of self-esteem, the only thing that can end the cycle of apologizing is to be convinced that they really are a good person–perhaps because the thing they did wrong wasn’t even that bad of a thing to do.

And there’s plausible deniability there, too. But they feel so bad! But they’re just showing you how much they care that they messed up! But…maybe it was juuust a little bit kinda really mean of you to make them feel so bad! And on it goes. It feels wrong to ask that someone stop apologizing, even if it’s making you feel bad. I think we’re meant to take over-apologizing as a sign of extra concern, or perhaps as a compliment. But, as with surprisingly many social interactions, over-apologizing may be more about the apologizer’s needs and wants rather than those of the person being apologized to.

We all have probably had times when we fucked up and apologized and just really needed to have that apology accepted immediately and to be reassured that we’re good people immediately. Some of this may tie into something that I’ve noticed before and that advice columnists like Captain Awkward and Doctor Nerdlove have discussed: the myth of closure.

Usually discussed in the context of breakups, the myth of closure is the idea that there’s something called “closure” that would really, really help us get over breakups, and that may even be owed us by the person who broke off the relationship. Sometimes it’s helpful to know why things ended, sometimes not, but regardless, nobody owes you that explanation. Sometimes, being an adult means sitting with the uncomfortable feelings and learning to overcome them by yourself, without the help of the person who caused or triggered them (but with, of course, the help of friends).

A similar thing happens in the context of fuckups and apologies. You fuck up, you feel bad, you apologize, and then you (may) think that you need to be absolved by guilt by the person you hurt. But sometimes people aren’t willing to accept your apology, and that’s okay. Sometimes they accept it, but they’re not interested in discussing the issue any longer. That’s okay too. They don’t owe you any closure. You may need to process your feelings about your fuckup without their help.

And then it occurs to me that it’s mainly women who are consistently asked and expected to do this–this emotional work. This soothing of hurt feelings, this rebuilding of lost self-esteem. Not only that, but it’s usually the woman who was hurt in the interaction who is expected to do it–at a time when she deserves the space to deal with what she experienced, she is drafted into your Feeling Okay Again Army.

In her wonderful piece which I linked to in my last roundup, Sarah writes about the conversations that often happen between men and women about sexism and sexual violence, and how they go wrong. In it, she links to an article by Susan Silk and Barry Goldman about how to get support when bad things happen to someone you know:

Draw a circle. This is the center ring. In it, put the name of the person at the center of the current trauma. For Katie’s aneurysm, that’s Katie. Now draw a larger circle around the first one. In that ring put the name of the person next closest to the trauma. In the case of Katie’s aneurysm, that was Katie’s husband, Pat. Repeat the process as many times as you need to. In each larger ring put the next closest people. Parents and children before more distant relatives. Intimate friends in smaller rings, less intimate friends in larger ones. When you are done you have a Kvetching Order.

[...]Here are the rules. The person in the center ring can say anything she wants to anyone, anywhere. She can kvetch and complain and whine and moan and curse the heavens and say, “Life is unfair” and “Why me?” That’s the one payoff for being in the center ring.

Everyone else can say those things too, but only to people in larger rings.

When you are talking to a person in a ring smaller than yours, someone closer to the center of the crisis, the goal is to help. Listening is often more helpful than talking. But if you’re going to open your mouth, ask yourself if what you are about to say is likely to provide comfort and support. If it isn’t, don’t say it. Don’t, for example, give advice. People who are suffering from trauma don’t need advice. They need comfort and support. So say, “I’m sorry” or “This must really be hard for you” or “Can I bring you a pot roast?” Don’t say, “You should hear what happened to me” or “Here’s what I would do if I were you.” And don’t say, “This is really bringing me down.”

If you want to scream or cry or complain, if you want to tell someone how shocked you are or how icky you feel, or whine about how it reminds you of all the terrible things that have happened to you lately, that’s fine. It’s a perfectly normal response. Just do it to someone in a bigger ring.

Comfort IN, dump OUT.

Of course, the situations we’re talking about are not at all comparable to traumas like these in terms of their emotional salience and difficulty. But, as Sarah points out in her piece, having a Kvetching Order is still important for more minor situations, so that you’re not overburdening a person who is already burdened. In this case, if you’ve hurt someone and that’s hurting you, you need to go to an outer ring to kvetch about it. So, not the person you hurt (or their best friend or significant other), but a friend of yours who isn’t as close to the situation.

Sarah then brilliantly connects this back to gender: women sometimes discuss the shit they have to deal with, and men can feel frustrated, angry, or even vicariously traumatized as a result. But because of our crappy gender roles, men are less likely to have close friends that they can confide in than women are, and when they do have such friends, they’re most commonly women. This means that if men want to confide in someone about how crappy they feel in response to women’s stories of sexism, they may have nobody to share that with besides women. And women are in a smaller ring than men when it comes to the issue of sexism and sexual violence. Sarah writes:

If you are a man who is becoming upset/depressed/overwhelmed/hopeless/defensive when you listen to the women in the world/your life talk about their experiences, you need to talk about it.  With another man.

I really, really mean this.  Not to complain about how crazy or uptight women are, please.  (I mean, personally, I don’t think that would help you or me very much at all).  But you absolutely need to talk to another guy.  A guy you are friends with and who you trust is ideal.  And if you don’t have that kind of guy in your life- and, seriously, you are not alone in that area- then you have the very hard, critical work of figuring out how to make that kind of friendship ahead of you.  If you are feeling a restless helplessness over all of this, that can be your challenge.  Because I think as women we really, really need you to form those relationships.  We really, really need you to have an emotional connection to each other.  And we need to know you guys can turn and talk each other through these hard things and support each other while you support us.

To bring it back to the over-apologizing thing, if a guy hurts his female friend and then feels bad about it, he’s not as likely to have other close friends–especially close male friends–to talk about it with. So the temptation is especially strong to talk to the friend that he hurt.

Fucking up feels bad, and it’s legitimate to want support when you feel bad, even if it’s because you did something wrong. That’s why it’s important to have other people or places you can go to get support when you feel bad. And when you do this, by the way, honor the person who you hurt and who helped you be better by retelling the story accurately. “I said something that I really shouldn’t have and hurt my friend. I apologized and she accepted, but I still feel really bad. I guess I’m just looking for some reassurance I’m not a terrible person even though I did this wrong thing.”

You deserve to be supported and reassured when you’ve done something wrong and taken the right steps to fix it. But please don’t manipulate the person you hurt into doing this for you.

~~~

*Obligatory note that this can happen between people of any gender, but I notice it especially with men, and have spoken to several women who have noticed the same thing. So, while it probably happens with everyone, it probably happens more–or more intensely–with men apologizing to women. And, therefore:

DISCLAIMER: The Author in no sense intends to imply that All Men are responsible for the aforementioned Conflict(s) or Issue(s) as described in this Text. The Author reiterates that Not All Men commit the Offense(s) detailed in the Text, and that the Text is not intended to apply to or be addressed to All Men. The Author hereby disclaims any binding responsibility for the emotional well-being of such Men who erroneously apply the Entreaty(ies) contained within this Text to their own selves. The Reader hereby agrees to accept all responsibility for any emotional turbulence that arises as a result of the perusal of this Text.

Camping Trip Mornings

My favorite moment of any camping trip is the first morning.

I wake up in my tent having finally made it through a spooky and often uncomfortable night–air mattresses and sleeping bags are not my thing–and feel relieved. I can hear dry leaves and twigs crunching beneath footsteps, the thud of hiking boots on dirt and gravel. Water pours from a spigot nearby as someone fills a kettle or washes their hands. There are sleepy conversations, debates about breakfast and pleas for the kids to brush their teeth. Having never been camping with anyone besides my family and their boisterous, colorful friends, I’ve only ever heard these discussions in Russian. Camping, like baking, knitting, and skiing, happens in my native language.

Outside the smoke curls lazily from campfires that finally collapsed shortly before dawn. Pale morning sunlight filters through the canopies of the trees, catches the drifting smoke, stumbles over the tops of the tents, and finally lands in my little sister’s hair, glowing golden, as she pulls me over for breakfast.

The picnic tables almost sag with the weight of the food and drink. Last night’s empty bottles line the tables, but so do this morning’s omelets, sausages, bread, cheese, hardboiled eggs, bagels, fruit, and tea. People shove food into my hands. Water from last night’s apparent rain runs off the blue tarp that hangs over the tables, and I find a dry spot to sit with my paper plate.

And as I look out from my perch at this small piece of the world, the things that seemed so treacherous in the dark just last night–the things you trip over, the things you step into, the things that cast creepy shadows in the firelight–now look boringly normal. The perilous trek to the campground toilets now reveals itself as a short and simple path. The black water of unfathomable depth that I saw at the edge of the flashlight’s beam is just a pond. Dragonflies flit over it, and a frog croaks at its edge.

In the morning, everything suddenly feels safe and familiar again.

When I feel scared, uncomfortable, and alone, I sometimes think about those camping trip mornings, and about how the exact same things can seem so much safer in the sunlight. This visualization that is also a memory calms me down. I think about the transformation that happens at sunrise that first day, of threatening to friendly, strange to familiar.

That transformation is mirrored in my own life to a frustrating degree. People I once held my tongue around and felt anxious with become my closest friends. Streets I explored cautiously, my eyes darting around as though searching for threats, become streets I walk down proudly, yet casually. Things that seemed burdensome and inconvenient to do become routines: ignorable at worst, comfortable at best.

It may not sound like something you’d describe as “frustrating,” but I do, because I can’t seem give myself permission to not be okay with everything immediately. Why couldn’t I have immediately recognized that person as the lovely friend that they are? Why didn’t I see these streets as my home? Why couldn’t I always do these things easily and automatically?

It’s just not how my brain works. I’d venture to guess it’s not how most people’s brains work.

I wish I were someone who craved novelty, who relished the unfamiliar, who reveled in uncertainty. Someone who could cherish their memories without feeling desperate to relive them. But I am not that person. I want it to feel like the camping trip morning all the time. I want to wake up and realize that I know exactly where I am, mentally and physically. I want to stumble outside, rubbing the dreams from my eyes, and see the people I love there waiting for me.

And most of all, I want to feel that these are acceptable things to want.

Debunking Four Myths About Polyamory

I just went through a frankly hellish transition of ending my Midwest trip, saying goodbye to my family yet again, coming back to New York, and moving into my new apartment in Brooklyn. Predictably, all this led to an inordinate amount of emotional turmoil, but I somehow managed to write this piece for Friendly Atheist about some polyamory tropes.

Polyamory — the practice of having multiple sexual/romantic relationships with the knowledge and consent of everyone involved — is currently going through that stage that all “alternative” lifestyle practices must go through: the one where journalists discover their existence and have a field day.

Luckily for them, more and more people are willing to openly talk about their open relationships as the stigma of being non-monogamous diminishes. Journalist Olga Khazan interviewed quite a few of them in this article for The Atlantic. While the article is well-researched, balanced, and accurate overall, it (probably unintentionally) repeats and propagates a few tropes about polyamory that aren’t always accurate.

Note that I said “not always”; tropes are tropes for a reason. There are plenty of people whose polyamorous lives resemble them, and I mean it when I say that there’s nothing wrong with that (as long as it’s all consensual!). But I think that the (presumably non-poly) audience these articles are aimed at might benefit from seeing a wider variety of poly experiences and opinions, so I wanted to add my own voice.

With that in mind, here are a few dominant narratives about polyamory that aren’t always true, but that crop up very often in articles about polyamory.

1. Polyamorous people don’t feel jealousy.

It’s right there in the title, “Multiple Lovers, Without Jealousy.” Although the article does later go more in-depth about the ways some poly couples experience and manage jealousy, the headline perpetuates the common myth that polyamory is for a special breed of human (or superhuman, perhaps) who just “doesn’t do” jealousy.

Some do, some don’t. For some poly folks, jealousy is a non-issue. For others, it’s an annoyance to be ignored as much as possible. For still others, it’s a normal, natural emotion to be worked through and shared with one’s partners. There are as many ways to deal with jealousy as there are to be polyamorous — and there are many.

The reason this matters is because framing jealousy as a thing poly people just don’t experience drastically reduces the number of people who think they could ever be poly. I’ve had lots of people say to me, “Oh, polyamory sounds cool, but can’t do it because I’d be jealous.” Of course, dealing with jealousy isn’t worth it for everyone, so I completely respect anyone’s decision to stick with monogamy because of that. But I think it’s important to let people know that you can experience jealousy — even strong and painful jealousy — and still find polyamory fulfilling and completely worthwhile.

Read the rest here.

“I’m a strong woman and I don’t need help.”

A common argument against interventions that aim to decrease harassment and violence against women–conference harassment policies, stronger anti-bullying measures on social media, and so on–is made by women and goes something like this: “I’m a strong woman and I don’t need to have my hand held.” Sometimes this is served with a side of “You’re the real sexist if you think that women are weak enough to need this.”

There are a lot of false assumptions layered in these statements. Namely:

1. That not needing certain protective measures makes you “strong” relative to others.

According to the fundamental attribution error, people tend to overemphasize the role of others’ internal characteristics and underemphasize the role of the situation they are in when trying to explain others’ behavior. In this case, many people observe others asking for harassment policies, trigger warnings, and the like, and attribute this to those individuals’ supposed “weakness” rather than to situational factors.

This discourse of “strength” when it comes to harassment and bullying troubles me. What I’ve generally found is that an individual’s ability to “deal with” harassment and abuse has less to do with how “strong” they are and more to do with other factors: social support, personal history of victimization, and feeling otherwise safe in the current environment, for instance.

Further, one’s likelihood of experiencing harassment and abuse in the first place has less to do with how “strong” they actually are, and more to do with how they are perceived by others. While individual factors have some impact on that, so do social categories that people use to think about others. Women with disabilities are extremely likely to be sexually abused because others perceive them as unable to speak up or get help, and because they perceive everyone else as unwilling to believe the testimony of a woman with a disability. Sadly, the latter is often true.

Therefore, feeling able to handle contingencies like sexual assault and harassment on your own, without help, is often more an indicator of privilege than superior personal traits. It certainly is for me. Part of having privilege is having difficulty seeing how other people may not have the same opportunities or experiences as you, for reasons that are not their fault.

2. That recognizing that some people(/women) need protective measures is bigoted(/sexist).

This is the gender version of another of my favorite bad arguments, If You Notice Race Then You’re The Real Racist. No, Real Racists (insofar as there is such a thing) are people who have managed to convince themselves that they “don’t see race” while continuing to judge and discriminate on the basis of it.

In the real world, there is sexual harassment and assault. In the contexts that we’re discussing, such as conferences and college campuses, sexual harassment and assault are most commonly perpetrated by men against women. Although harassment policies, anti-bullying measures on social media, and other initiatives of that sort have the potential to help anyone regardless of gender, most people correctly note that the initiatives are being created with female victims in mind–because that’s the majority, and because the loudest voices in anti-sexual violence advocacy tend to be women.

Noticing reality is not bigoted in and of itself. (But it’s possible to discuss reality in a bigoted way, obviously. For instance: “Women are the majority of sexual assault victims because men are slavering beasts” or “There tends to be more violence in neighborhoods where the residents are predominantly Black because Black people are more violent.”) If it is true that women are the majority of sexual harassment victims–and, according to current research, it seems to be–then it makes sense to be concerned with reducing sexual harassment against women.

But as I mentioned, such protective measures are useful to anyone who experiences harassment or assault, regardless of gender. When you say that such measures are by default sexist against women, you are assuming that all potential victims are female, and ignoring all the ones who are not. Although I do so hate to play “You’re The Real _____,” it is actually quite sexist to assume that men cannot be victims of sexual harassment or assault, and quite cissexist to assume that non-female, non-male people don’t even exist, as victims or otherwise.

3. That “strength,” whatever that is, is a quality that everyone ought to have, regardless of personal circumstance, and having it makes you clearly superior to those who don’t.

This is probably the main reason this response arises. A lot of people feel good about themselves when they position themselves as strong and independent and maybe a little bit better than those who can’t “take care of themselves.” In this way, the “I’m a strong woman” narrative is actually sort of a reasonable response to sexism. When you’ve been told implicitly and explicitly your entire life that you’re weak because of your gender, why not reimagine yourself as strong? Stronger, perhaps, than other women?

But when you say, “I’m a strong woman and I don’t need this,” what does that say about the women who are not “strong,” who do not consider themselves “strong,” who cannot be “strong” in the ways that you are referring to?

I was originally inspired to write this post after a discussion on my Facebook about an article that I posted about interaction badges. This is a measure implemented at some conferences for Autistic people to help them set boundaries around social interaction. Red badges mean, “Do not initiate interaction with me”; yellow badges mean, “Only initiate interaction with me if we know each other”; and green badges mean, “I would like to talk but have trouble initiating; please initiate with me.” The badges are very useful for people who sometimes have trouble reading subtle social cues from others or sending such cues themselves, which describes many people on the autism spectrum.

I posted about this idea and said that it would be a cool thing to implement at the conferences I go to–not just because plenty of ASD folks attend these conferences too, but because it would be helpful for lots of people neurotypical and otherwise. Predictably, someone said that they’re a “strong woman” and they don’t need this and so on. A friend of mine responded that, well, some of us aren’t strong, and some can’t set boundaries, and why do these people deserve to feel uncomfortable or even unsafe just because they don’t have the capability to be “strong” in this way? How is that fair at all?

There are plenty of legitimate reasons someone might temporarily or permanently lack the ability to assertively set boundaries. People with autism sometimes experience selective mutism, which means they cannot speak. People with social anxiety or similar conditions might panic and be unable to relax and find the words they need. In more extreme situations, sexual assault victims often experience a sort of paralysis that prevents them from being able to speak up and say “no.” This is a documented effect.

Setting boundaries is often exhausting, and different people have different amounts of energy (or spoons, if you prefer that metaphor) to do it. If colored badges make a space more accessible, why not? If you personally don’t need it, who cares?

4. That these protective measures are being implemented with the assumption that everyone needs them.

Actually, most people do not get harassed and assaulted at conferences or elsewhere. Some of the people who do get harassed and assaulted at conferences or elsewhere will have ways to cope and deal with that on their own, without using the resources made available to them by that space. When I was assaulted in college, I decided not to report it or utilize any campus resources for survivors because I didn’t feel that I needed them. When I was harassed at conferences, I decided not to let the organizers know, because I preferred to deal with it in other ways. To the best of my recollection, I have never used any formal procedure for dealing with harassment or assault, for my own personal reasons.

So, for various reasons, you may not need to use a protective measure in a given space. That’s great! Nobody implied that you, personally, need this measure. If you don’t end up experiencing harassment or assault, that’s obviously good. If you do, but you’re comfortable handling harassment or assault on your own, then you don’t need to avail yourself of the measures in place to help survivors. But not everyone is, for more reasons than I’m able to list.

This is why “I’m a strong woman and I don’t need this” ultimately falls so flat for me as an argument for or against anything. Claiming that harassment policies are useless because you don’t personally need them is no more sensible than claiming that a restaurant should not have vegan options because you’re not personally a vegan. And claiming that harassment policies somehow imply that all women (yourself included) are weak and need protecting is no more sensible than claiming that the mere presence of an elevator is accusing you of laziness.

There are people who sometimes need harassment policies and there are people who sometimes (or always) need elevators. If you don’t, ignore it and go about your business.

Or, better yet, understand that others may need help that you do not, and support them in their effort to get it.

~~~

I’ve previously written some other stuff related to this argument:

Also of relevance is the fact that the “strong woman” narrative has particular meaning and significance for women of color.

Depression and Self-Gaslighting

Gaslighting is a term you probably know, but if you don’t, it refers to the act of telling and convincing someone that their feelings or perceptions are not really true. In the context of interpersonal relationships, gaslighting is considered to be an abusive behavior, as it can render people incapable of trusting themselves and their own judgment, instead placing an undeserved trust in the gaslighter.

Cognitive distortion is also a term you probably know. It refers to a set of maladaptive mental habits that people with mental illnesses tend to have. (The Wikipedia list is useful, and I discussed some specific examples in this post.)

A cognitive-behavioral approach to mood disorders involves teaching the client the difference between thoughts and feelings. A lot of people will say things like, “I feel like a failure.” The therapist’s role is to remind them that “I feel like a failure” isn’t actually a feeling, but a thought. “I feel like a failure” is really “I think that I’m a failure.” The therapist may ask, “How do you feel when you have the thought that you are a failure?” The client may say, “I feel hopeless,” or “I feel miserable.” Hopefully, the therapist can help the client see that a lot of their thoughts are actually cognitive distortions, and that there are more helpful and realistic ways to think about the same things.

That’s the standard CBT frame that’s used in all the training videos I watch in school. But the reality, at least for me, is a little less tidy. Sometimes feelings come seemingly out of nowhere, and while I know there is a reason for them (and I usually know what the reason is), there was no proximal cause for the feeling. There was no maladaptive thought.

Sometimes I see a partner with someone else and I just feel awful. I don’t think, “I bet they’re going to leave me now,” or “That person is way cooler than me,” and then feel awful. I just feel awful. Is it because I trained myself to feel awful on cue, as a conditioned response? Maybe. Others would argue that feeling awful is a “natural” response to seeing a partner with someone else, though I disagree. Regardless, the feeling comes immediately and without any stimulus other than seeing the thing.

Sometimes I have to leave my family after a visit and I become extremely depressed. (I will have to do this in a few days. I’ve already had a few breakdowns about it.) I don’t think, “I WILL NEVER SEE MY FAMILY AGAIN” or, slightly more realistically, “It is Terrible and Bad that I have to leave my family.” I just think about the mere concept of leaving and instantly collapse in tears. (To wit: there is nothing less undignified than collapsing in tears while sitting on the toilet, but that just happened to be when I remembered about my flight home. It happens.)

Last year I wrote about some things I had learned from depression, including two slightly/seemingly contradictory maxims: “Not everything your brain tells you is accurate,” and “Your feelings are valid.” You can read that post to see what I meant by these things, but the jist of it is that depression can teach you to be more skeptical about some of the stuff going on in your brain, but also that you get to feel how you feel without passing judgment–or having others pass judgment–on it. Some would say that feelings can’t be “wrong.” They can be crappy, or not useful, or distracting, or whatever, but they cannot be empirically inaccurate or morally wrong.

However, this is where reality gets murkier than these convenient teachings. Feelings aren’t wrong, per se, but they can be premised on exaggerated or inaccurate fears or worries. I feel bad when my partners like people who I think are Better than me. But what is “better”? Can I really accurately say that someone is “better” than me, rather than maybe better at certain things and worse at others? And isn’t the whole point of polyamory that nobody has to leave anyone just because they’ve found someone “better”?

I feel depressed when I have to leave my family and go home to New York. But I know I will be just fine and quite happy when I get there. I know this because I’ve gone through it many, many times now. There is no reason to feel so depressed I can’t get out of bed for two days. Yes, it’s sad to say goodbye to your family. To me, personally, it is slightly tragic, even, that I can’t live close to them the way people usually do in our culture. But it is not that sad. It is not weeping-on-the-toilet-bowl sad. Few things in my life are objectively that sad.

These are far from the only situations like this that I experience; it happens all the time, every day. I get very frustrated. “No feelings about feelings,” a friend of mine says, not as a rule, but as an aspiration. I can’t make it work.

So I start gaslighting myself. “That’s not true.” “That perception is just wrong.” “That’s false and you know it.” “There is no reason to be upset right now.” “Your hypothesis that that person is somehow objectively better than you is premised on nothing but a pile of turds.” “THAT FEELING IS WRONG AND YOU SHOULD IGNORE IT FOREVER.”

Cutesy slang about jerkbrains and badfeels aside, what I’m now doing is very serious. Now I have abandoned a defensive stance and taken up an offensive one, with which I will battle the Wrong Feelings and vanquish them in a burst of light. Gaslight.

What happens when you teach yourself not to trust your own perception? How many toxic people become “just difficult for me to deal with because I’m so insecure and oversensitive”? How many untenable situations become marginally acceptable because “I’m only miserable about it because my brain lies to me”? How many injustices become annoyances to shrug at because “I’m just pessimistic about everything and don’t realize how good life is”?

People tell me that I’m so good at setting boundaries, but sometimes I wonder how much shit I have patiently accepted because I thought my brain was lying to me. In any case, I’m very glad I discovered feminism at the same time I discovered that I have depression.

Somewhere between “Your feelings are bad and you should feel bad” and “Your feelings are an accurate barometer of external reality” lies a vast unexplored land of feelings that are excessive but useful, of feelings that don’t make any sense but that alert you to an issue that needs to be explored, of feelings that can be discussed with a partner to build trust and intimacy, of feelings that have been spot-on many times before but have simply outlived their usefulness in this new and happier life you have built.

I wish I could really believe that feeling things is okay.

A Primer On Atypical Depression

At CONvergence two weeks ago, I and a few other people did a panel on myths about mental illness. It was really great, and I hope that there will be a video of it up eventually. At one point, I tangentially mentioned atypical depression, a type of depression that is sometimes contrasted with melancholic depression, or the “typical” kind.

Atypical depression is the type that I have, and that might be part of the reason it took me something like seven years to realize that I had depression at all. A few people have since told me that they didn’t even realize atypical depression was a thing. So I decided to write a brief overview of it in the hopes that more people who don’t have a name for what they’re going through might find a name for it.

There are some “classic” depression symptoms that most people think of when they think of depression: being numb or sad most of the time, being unable to take joy in things you used to like, insomnia, and loss of appetite and weight. You think of the person lying in bed unable to care about or take pleasure in anything.

Atypical depression has a rather different set of features. Instead of insomnia, you may have hypersomnia (oversleeping). People with atypical depression might regularly need to sleep 10 or 12 or even more hours. Instead of loss of appetite, you may overeat and/or gain weight. Instead of being numb or just uniformly sad, you have high mood reactivity, or mood swings. You may find that you’re able to enjoy things and feel happy when things are going very well, but as soon as things are neutral or even just a little bit bad, you feel horrible again. There are two other symptoms that are sometimes present: leaden paralysis, or the feeling that your limbs are very heavy and difficult to move, and high rejection sensitivity, which means being overly concerned about people not liking you or rejecting you, to the point that it impairs your social functioning.

Unsurprisingly, these different sets of symptoms mean that different types of antidepressants may work best for each type. I will quote Wikipedia here, since it’s sourced and there’s no good reason to rephrase it:

Medication response differs between chronic atypical depression and acute melancholic depression. Some studies[4] suggest that the older class of antidepressants, monoamine oxidase inhibitors (MAOIs), may be more effective at treating atypical depression. While the more modern SSRIs and SNRIs are usually quite effective in this illness, the tricyclic antidepressants typically are not.[1] The wakefulness-promoting agent Modafinil has shown considerable effect in combating atypical depression, maintaining this effect even after discontinuation of treatment. [5]

I don’t know how useful this information is to you if you think you may have atypical depression, but at least now you know that if your symptoms fit this pattern but your psychiatrist prescribes you a tricyclic antidepressant without further explanation, it might be worth bringing up this research. In addition, if SSRIs haven’t been working for you, you might ask your psychiatrist about trying MAOIs rather than a different SSRI or a higher dose of the same one.

In terms of therapy, I can’t seem to find any studies on the effectiveness of different types of therapy on the different types of depression (that may be because Google Scholar is actually a terrible search engine), but my educated guess would be that dialectical behavior therapy (DBT) would be extra helpful for atypical depression as opposed to melancholic depression. DBT is a type of therapy developed specifically to treat borderline personality disorder, which involves lots of mood swings, rejection sensitivity, and general troubles with managing emotions. DBT contains a lot of the same techniques as cognitive-behavioral therapy (CBT; the standard of evidence-based treatment), but it also emphasizes mindfulness and learning to cope with strong emotions. Atypical depression, with its mood swings and interpersonal issues, might be especially amenable to it.

To the extent that psychodynamic therapy is effective (actually, plenty of studies suggest that it might be), it might also be more effective on atypical depression than other approaches. Atypical depression tends to have an earlier onset, and people may experience it as an aspect of their personality that is rooted deeply in their life experiences. When practiced well, psychodynamic therapy may be useful for resolving these issues. But none of this is to say that standard CBT should not be tried.

During my senior year of college, I asked a professor who studies the neuropsychology of mood disorders whether or not he knew of any research on neurological differences between atypical and melancholic depression. After all, there’s been plenty of research on how depression affects the brain–in terms of active brain regions, neurogenesis (growth of new neurons) in various regions, and so on. Were all these studies really done using patients who might’ve had what looks like two nearly-completely different illnesses? Apparently. My professor wasn’t aware of any such studies, and I’ve only found one myself: some research that examined which hemisphere of the brain responds more to a particular face test, and in atypical depression patients, the right hemisphere was much more active than it was in melancholic depression patients and in non-depressed controls. The authors write, “This is further evidence that atypical depression is a biologically distinct subtype and underscores the importance of this diagnostic distinction for neurophysiologic studies.”

There also seems to be some evidence that atypical depression in particular is linked to thyroid dysfunction, which may explain some of the physical symptoms. However, the results seem to be rather complicated and confusing, and it’s definitely not a simple causative link.

Although the diagnostic criteria for depression contain both sets of symptom patterns and there’s even a special indicator for “atypical features,” the popular conception of depression is of the melancholic type, not the atypical type. This means that many people, believing that depression necessarily means “being completely miserable all of the time always,” may not realize that they might have depression and can benefit from treatment.

Atypical depression presents a classic boiling-frog problem. Because you are in fact capable of feeling happy for short or medium stretches of time, it can take a serious increase in symptom severity to realize that there’s anything wrong. Incidentally, as I mentioned, atypical depression also tends to have an earlier onset than melancholic depression, which means that you may spend your entire post-childhood life that way. For some people, certainly for me, it felt like it was “just my personality.” To make things even more confusing, the rejection sensitivity tends to be present even during periods of time when the rest of the symptoms are in remission. But when it comes to mental health, nothing is ever really “just your personality” if you don’t want it to be.

Hopefully, this overview will help people–at least the people who read this blog–broaden their awareness of what depression is. If there’s anything I missed in terms of research, by the way, please let me know. As I mentioned, my Google Scholar-fu is much worse than my Google-fu.

Of Ethics, Feelings, and Skyrim

I’m currently visiting my family in Ohio, which means catching up on all the gaming I’ve been too busy for during the last five years. My 12-year-old brother and I have a nice symbiosis going: he has a Windows machine, which meant I could install Skyrim on it, and I have a purchased copy of Skyrim. So we take turns watching each other play.

Kilkreath Ruins. Creepy, yeah? Well, maybe you just had to be there.

Kilkreath Ruins. Creepy, yeah? Well, maybe you just had to be there. Credit: Ekulylnam

Last night, while I was adventuring through the Kilkreath Ruins on a quest from the Daedric Prince Meridia, my brother remarked that he found the cave scary–the creepy noises, the unidentified black mist near the ground–and that started off a discussion about the emotional effects of games and how we feel about them.

My brother said that he’s actually glad that the game is making him feel things again. He has previously played it on Xbox (claiming, in fact, that he “beat the game”), but he said that after a while, he stopped feeling bad when people died or feeling scared by the parts that were meant to be scary. But he prefers to feel those things even though they don’t feel good, because otherwise he worries that he’s becoming unempathetic, somehow cruel. This, he said, is why people should be careful about letting little kids play games: you need to make sure they don’t get used to not feeling things.

I hadn’t actually thought of it that way before, though it seems obvious now. I had always been frustrated by how deeply I felt things that happened in games, and how much that actually restricted my gameplay. My ethics as a game character are not very different from my ethics as a real-life person: I don’t steal (unless, hypothetically, it’s vitally important), I don’t fight anyone who doesn’t fight me first, I try to avoid injuring innocent people with splash damage unless it’s totally unavoidable, I try to persuade people rather than bribing or threatening them, and I don’t hunt wild animals (except the ones that attack me).

But despite everything my brother said, we soon discovered that our styles of play are actually quite different (besides the fact that I play slowly and deliberately whereas he tries to get through quests as fast as possible, a difference that he had already remarked upon in frustration many times). After the Meridia quest, I ended up doing another quest in which I was falsely accused of multiple murders and ended up in a prison mine with people who had attempted (and failed) to recapture the city from people they thought were oppressing them. Together with them, we escaped from the mine, since they all turned out to be very capable mages.

Outside the mine, the escaped prisoners were confronted by prison guards. I had planned to fight alongside them, but here my brother started insisting that I kill the prisoners instead. Why? Because they have really good armor, I wouldn’t get a bounty, and I could kill them easily now that I had my own armor and weapons back. I said, “But they already gave me a set of that armor as a gift.” My brother said, “But it’s really expensive and you could make 10,000 gold just from selling all of theirs.” I said, “But I have other ways to get gold.” He said, “But it’s so easy! Just kill them!”

I knew one thing for certain: I had absolutely zero desire to make 10,000 gold by killing these men. At that moment, there was nothing I wanted to do less than to kill them. The idea just felt bad.

And so I told my brother, “Remember how you felt so scared of the cave you asked me to turn the sound down, even though you knew it was irrational? That’s how I feel about killing the men. It would make me feel bad. The point of playing a game is to have fun. That would make it very un-fun for me.”

He immediately stopped trying to convince me to kill the men and never brought it up again.

It’s true, refusing to kill the men was an irrational choice. Within the game, there were no disadvantages to killing them, and one huge advantage to killing them. But outside of the game, the advantage seemed so small–what’s 10,000 gold, really?–and there was also one glaring disadvantage–the fact that I would feel crappy and uncomfortable, partially defeating the entire purpose of playing the game to begin with.

Earlier I might’ve found this frustrating. I thought that I let myself get way too affected by virtual things. I’m the sort of person who would treat even a fairly rudimentary robot as I’d treat a human or a non-human animal.

Now, having had the first conversation with my brother and the subsequent moral dilemma with the prisoners and the guards, I started to think differently about it.

After all, we (I include myself in this) are more likely to think of it as a feature, not a bug, when we experience emotional reactions to things like films and shows and novels. (That, in fact, is what I reminded my little brother when he called me crying after finishing The Little Prince, and again when he called me crying several years later after finishing Flowers for Algernon.) Playful teasing outside, feeling terrified or very sad during movies is pretty standard. Why not in games?

Maybe it’s because we assume that the point of film and literature (as a fan, not a scholar) is to be absorbed into a story. The point of games, some might argue, is more tangible: to shoot stuff, to solve puzzles, to build cool things, to become the best. Stories may matter in games, but they don’t matter the way they matter in films and novels.

And there are definitely games I would play purely for those tangible aspects. I don’t get emotionally invested in the story of my SimCity creations (though maybe some do). I care slightly for the plight of Fez’s Gomez, who has literally had his entire world as he knew it torn to bits, but mostly I’m just there for the cool puzzles.

Persuade, intimidate, or bribe: Skyrim's eternal moral dilemma.

Persuade, intimidate, or bribe: Skyrim’s eternal moral dilemma.

But with games like Skyrim, I come for the fighting and stay for the interesting narrative, and that generally means starting to feel immersed enough in that world to feel bad when people die needlessly in it. The experience of considering (and strongly rejecting) the idea of killing the escaped prisoners for their valuable armor reminded me of something I think I already knew: that much of ethics, at least for me, is based on automatic emotional responses. Stealing feels bad. Threatening feels worse. Killing needlessly feels even worse.

There must be ethical systems out there that rely on something besides emotion and that still result in minimal harm to other people, but they feel alien to me. In any case, I doubt that those systems would transfer over to virtual worlds. Why bother?

Sometimes I wonder if other people feel that way, and if other people end up playing about the same way that they live (give or take a few magical abilities and badass warhammer techniques, of course). If there are gamers who feel bad when they kill NPCs, I wouldn’t expect them to ever say so, because nobody seems to talk very much about the emotional experience of gaming in general, and because of the hypermasculine culture of it.

But for me–someone who has no interest in participating in or belonging to any sort of “gaming community” and who wouldn’t even take up the label “gamer”–it doesn’t feel like a big deal to say that games make me feel things. Not just general things like excitement or fear, but specific things, like I feel sorry for that man who died even though he’s just a bunch of 1′s and 0′s. Or I wish I didn’t have to kill that dragon; it would feel much better if we could just be friends. (That one might be influenced by the fact that I recently saw both How To Train Your Dragon movies and really liked them.)

And now I’ve finally decided that I like it that way. It’s more rich and fun that way, even with the bad feelings too. Like my brother, I like myself better when I feel those things. Embracing that irrationality feels more human to me.

On Gender, Misattribution, and Kendall Jones

I’ve been a little preoccupied with travel and conferences lately, but now hopefully I’ll have more time to write. If you donated to my conference fundraiser, look out for a post thanking you and summing up the conferences, as well as any posts you may have requested.

For now, here’s a Daily Dot piece about Kendall Jones, the Texas cheerleader who’s become, by some accounts, “the most hated person on the Internet” for posting photos of herself with animals she killed in Africa. The rest of the piece cites some cool research, so you’ll want to click through to it.

Observing all of these responses that have been pouring in over the past few weeks, pro golfer John Peterson tweeted, “I support Kendall Jones. If it was a 60-year-old overweight dude posing with his African kills, no one would talk.” While Peterson doesn’t sound like he has a problem with hunting (indeed, his Twitter bio says, “If I could get paid to hunt, id be doin that”), he correctly notes that men who hunt don’t seem to garner such a reaction.

In fact, a Virginia Democrat—not on the ballot but seeking Eric Cantor’s House seat—named Mike Dickinson even publicly offered $100,000 to any “ex-boyfriends” who could provide naked photos or “sex stories” about Jones. (There, I hope, go his electoral dreams.)

First of all, using misogyny—or whatever noxious mixture of elements causes our cultural panic about women, sex, and nude photos—to abuse someone who’s done something wrong is not any sort of justice I believe in. Second, I’ve never heard of anyone bribing people for nude photos of a man, at least not as some sort of convoluted punishment. That threat is used against women and those perceived as women exclusively.

At the same time as the Democrat’s nudie pic requests went viral, a Facebook page popped up calling for Kendall Jones’ death.

I don’t want to say that the Internet hates Kendall Jones just because she’s a woman. To say that would be to conveniently ignore the cruel things that she does in order to make a point about sexism.

A more accurate way to interpret this might be that the Internet hates Kendall Jones because she’s done cruel things, but the only reason everyone even took notice of those cruel things is because Kendall Jones does not look or sound like the type of person we expect to hunt animals for sport.

Normally, the idea of trophy hunting isn’t one that most people, even those who generally care about animals, have much of an emotional reaction to. Some find it acceptable or even laudable; others mildly disapprove—but not enough to have strong feelings about the issue. It wouldn’t surprise me if seeing someone unexpected participating proudly in trophy hunting triggers a negative reaction that people then attribute to the person’s actions rather than their identity.

After all, it takes a lot of self-awareness to notice and think, “Huh, I seem to be having a very strong reaction of anger and disgust when I see a young attractive woman posing with animals she killed, but not when an older man does the same thing.” Most people will instead think, “Wow, I’m very angry about this. It’s disgusting to kill animals for fun like that.”

Most people who experience such a reaction would simply assume that it’s being caused by the most obvious thing: the pointlessly killed animals. They forget all the times they encountered the idea of men hunting animals for sport—because those encounters didn’t register on such a high emotional level.

Read the rest here.

Depression Is Not Sadness (Again)

[Content note: mental illness, depression, anxiety, suicide]

When I think about the frequent charge that therapists and psychiatrists and those who work with them are trying to “medicalize” “normal” emotions like sadness and fear, I think that people don’t really understand how emotions like sadness and fear can be distinguished from mental illnesses like depression and anxiety.

I’ve tried to explain this to many people multiple times, in person and through writing, and so have many other people with mental illnesses as well as professionals in the field. Yet people continue to conflate emotions and illnesses, or rather to assume that mental healthcare advocates are conflating them. It’s often difficult to continue engaging patiently with this claim.

Even those who are knowledgeable about illness and disability make this error. In an otherwise-fantastic blog post about the medical model of disabilityValéria M. Souza uncritically cites this very inaccurate view of antidepressants:

In The End of Normal: Identity in a Biocultural Era, Lennard Davis affirms: “A drug would be a prosthesis if it restored or imitated some primary state that appears to be natural and useful” (64). Davis makes this statement in the context of his argument that SSRIs are not “chemical prostheses” for depression, since happiness is not a “primary state” of being and since there is compelling evidence to suggest that SSRIs do not actually work (Davis 55-60).

I’ll address the SSRIs-not-working thing first since I have less to say about that and it’s not as relevant to this post. The reality seems to be more that SSRIs work well for some people but not at all for many other people and we haven’t really figured out why they work for some people but not others, or more specifically, which types of people they work for and which they don’t. And on a personal note, I’m a little tired of being told that SSRIs “don’t work” when they’re part of the reason I didn’t try to off myself four years ago. There is compelling evidence to suggest they do not actually work and there is compelling evidence to suggest that they do actually work, so I’m comfortable saying that the jury’s still out on this one.

More to the point: antidepressants are not meant to cause “happiness” because depression, the illness they are meant to treat, is not defined by a lack of “happiness.” Depression involves a constellation of physical, emotional, and behavioral symptoms that make happiness very difficult or even impossible. These symptoms have a number of other deleterious effects which vary for different people. There are many ways depression can ultimately “look,” such as being unable to get out of bed, being unable to hold down a job, bursting into tears several times a day over tiny inconveniences or in response to nothing at all, losing your sex drive, being unable to sleep, having to sleep over 12 hours a day, having severe memory loss, losing the ability to enjoy any previously enjoyable activity, experiencing complete emotional numbness, obsessing over death and suicide, physically hurting yourself, or attempting suicide.

Maybe being “happy,” whatever that even means, isn’t a “primary state,” but I would argue that being able to live a relatively normal life in which you can go to school or have a job, have relationships with people, and not want to kill yourself is a “primary state.”

Being treated for (and, hopefully, recovering from) depression does not give you extra things that other people don’t have, such as constant happiness and optimism. It gives you what everyone else has had all along, which is a reasonable and age-appropriate amount of control over your emotional state and the ability to create your own happiness if you want to and make the effort.

By the way, you can definitely be miserable and unhappy without having a diagnosable mental illness, but it’s rare to find a person whose unhappiness is truly caused entirely by their own voluntary actions. Depression can also develop as a result of voluntary actions; for instance, if you have a number of career options available to you but you choose an extremely stressful and mind-numbing (but perhaps lucrative?) option, you might end up becoming depressed because of it. At that point, your best bet might be to find a way to make a career change, but it’s likely that you’ll also need therapy to help undo the maladaptive mental habits that the situation has created. (Medication might help too, but in a case like this I’d personally recommend therapy first.)

I think a better way to explain the difference has been that, at least in my experience of mental illness versus mental health, there are things that mentally healthy people can do to significantly increase their level of happiness, whereas people who are going through a bout of mental illness can rarely make a huge difference just by stopping and smelling the roses or making more time to play with their kids or enrolling in a cooking class or whatever. They can maybe make a small difference, but it’s unlikely to reduce the mental illness symptoms themselves. I used to get so frustrated at things like The Happiness Project and other initiatives of that sort, until I finally realized that they weren’t aimed at me because happiness would literally not even be a possibility for me until I treated my damn mental illness.

(That said, things like that can be very useful for someone whose mental illness is in remission or otherwise low-grade. Right now, I’m not fully symptomatic for depression but I’m aware that it can probably come back at any time, so I do a lot of things to keep my mental health strong to try to avoid it coming back.)

It’s difficult to tease out all the complicated interactions between mental illness, mental health, and happiness, and of course it varies for different people. In my experience–which includes my personal experience, my interactions with friends and partners, and my studies and clinical experience, here it is in a nutshell: untreated/unmanaged mental illness makes happiness virtually impossible to achieve. Treating or managing your mental illness, whether through medication, talk therapy, or personal lifehacking, helps make happiness possible to achieve. But the work of achieving it is still yours to do. No drug or therapist can just give you happiness.

And most people with mental illnesses realize this. I haven’t met anyone who was just like “I wanna go to the psychiatrist and get a pill and just be happy always forever.” Most of us just want to stop crying all the time, or stop having panic attacks whenever we need to interact with new people, or stop having intrusive and scary thoughts of killing ourselves, or stop lying awake for hours each night because we can’t stop imagining all the bad things that could happen to us.

“Happiness” is the cherry on the sundae of mental health. You need to put the ice cream and the syrup and the whipped cream in the cup first.

(I’m not sure what it says about me that in reality I actually despise maraschino cherries and always ask for them to be left off my sundae. This is an analogy that was definitely intended for the presumably more normal people who will read this.)

If you still think that what we call “depression” is just an attempt to medicalize “sadness,” then you don’t know what one or either of those things are. So I’ll illustrate with an example of an internal monologue I have had when I was sad, and one I have had when I was depressed. The subject is the same, but the emotional response isn’t. See if you can figure out which is which!

I really wish I had a partner. It’s lonely not having anyone to come home to and it feels crappy seeing all my friends with their partners even though I know I should be happy for them. Sometimes I wonder if I’m just not that attractive or likable as a person. It seems like I’m the only person not dating anyone. I hope I meet someone soon, but I don’t know when or how that will happen and I’m not that optimistic about it right now. 

I really wish I had a partner. I feel like a complete worthless failure because literally everyone else I know is seeing someone and I’m not. I’ll probably never find anyone and I’ll just be lonely for the rest of my life and there won’t be anyone to call 911 if something happens to me and they’ll find my body in my apartment days later because nobody gave enough of a fuck to check on me. Not like I blame them. I’m so ugly and stupid that I don’t know why anyone would even want to hang out with me, let alone go out with me. Everyone’s probably pitying me because I don’t have anyone and everyone can tell that it’s because I’m completely pathetic. I feel like I might as well not even exist because what’s the point of going through life alone and unloved?

One of those is a sensical reaction to lacking something in your life that’s important to you (a romantic relationship); the other is over-the-top. The emotional response in the second example is disproportionate; it doesn’t make sense to leap all the way from “I’m sad because I wish I had a partner” to “I’m a worthless failure and will die alone.”

That second monologue contains a number of characteristic cognitive distortions associated with depression, such as all-or-nothing thinking (I have to have a partner or there’s no point in even living), disqualifying the positive (the good aspects of my life are irrelevant; it’s all bad because I’m single), mind-reading (everyone must be pitying me), fortune telling (because I don’t have a partner now, I will never have one), catastrophizing (something bad will happen to me and I’ll die alone in my home because nobody will help), personalization (it’s completely my fault that I don’t have a partner; none of it comes down to chance or being in the wrong environment or anything else), and emotional reasoning (I feel like a failure because I’m single; therefore I definitely am a failure).

While mentally healthy people do make cognitive distortions too, mental health is a spectrum: the more you’re able to refrain from thinking in these harmful ways, the more mentally healthy you’ll (generally) be. If you look at the first monologue, you’ll see some slight distortions, like the fear that you’re unlikeable or unattractive just because you happen to be single, or the perception that you’re the only person not dating when that’s obviously not true. But only in the second example do these irrational thoughts become all-encompassing. And, importantly, only the second example involves thoughts of death and suicidal ideation.

Note also that in the first example, being single is causing sad feelings, whereas in the second example, the emotional responses are not primarily caused by the singleness. Perhaps being single is the immediate trigger of the extreme sadness and negativity, but what’s really causing it is depression. A depressed person who is miserable about being single will not stop being miserable if they stop being single; they will usually be miserable about other things. That’s exactly what happened to me back when I was having that monologue. I’d inevitably get into a relationship and then be miserable because I didn’t think my partner liked me enough, or because I was worried about school, or because I felt like all my friends hated me, or because I hated myself, or just because.

Depression can trick you into thinking that you’re depressed “about” something. You’re probably not. You’re depressed because you have depression, and luckily, you can treat it.

Sadness, on the other hand, is about things. You can be sad because you’re single or because you got a bad grade or because you hate your job. Sadness is a normal, healthy reaction to experiencing things that you don’t like. It’s a useful and important emotion because it tips us off to situations that we should try to change if we can. Sadness can prompt us to take a step back and think about things and how we would like them to be better.

Medicalizing sadness and medicating it away would probably harm individuals and also our society as a whole. It would make things pretty boring. Isn’t it great that antidepressants and therapy are not actually trying to do that? Isn’t it great that we can help people avoid catastrophic, paralyzing, life-ruining sadness and fear like the ones associated with mental illnesses, while helping them get in touch with healthy and situationally appropriate sadness and fear? That we can help them understand their emotions and use them to change themselves, their lives, or the world, without having their lives completely governed by them?

Indeed. Depression is not sadness. Anxiety is not fear. Nobody is actually trying to eradicate sadness and fear.

~~~

At Skepchick, Olivia has a great take on this, concluding that:

I do think that it’s important to address our societal phobia of sadness, grief, and pain. But the way to do that is not to throw the mentally ill under the bus by implying they are running from their negative emotions when they seek out treatment. It also doesn’t mean casting shade on the few tools for treatment of mental illness that we actually have evidence are effective. A diagnosis of depression does not say “this person is too sad”. It says “this person can’t function the way they would like to because their emotions are consistently out of control”. There is a world of difference between those two statements.