Everyone Should Go to Therapy

Recently I wrote a post about why some people might choose psychiatric medication over seeing a therapist. (Fine, so it wasn’t that recent. >.<) I promised a followup post about a belief that I hold concurrently–everyone should see a therapist.

Now, before everyone freaks out, let it be known that I say “everyone” only in the most theoretical of ways. Meaning that, I recognize that as things are today, what I’m proposing isn’t really possible. But in the Happy Fun Miriam Land of the future, where stigma against mental healthcare is gone, insurance coverage is reasonable and available to the majority of people, and research has identified effective therapeutic interventions for most mental problems, everyone should and would be able to go to therapy.

For now, I’ll qualify what I’m saying with this: if you are able to see a therapist, you should, and if you are able to take your children to see a therapist, you should.

Why?

Well, why do we have regular dental and physical checkups? Why do children receive vaccines? Why do we make an appointment with a doctor when we think we’re coming down with something serious?

Hopefully the answers to those questions are self-evident.

Clearly, it is acceptable–and even expected–that people seek two types of healthcare throughout their lives: preventative and palliative. We should see a doctor regularly to make sure that nothing’s going seriously wrong with our bodies, and we should see a doctor when we suspect that something IS going seriously wrong with our bodies.

This much isn’t in dispute. But what about our minds?

For the most part, people wait until things are really, REALLY wrong with their mental state before they go see a psychologist. (And some don’t go even then, but that’s a different story.) For instance, I didn’t see a psychiatrist for my depression until I wanted to kill myself. People with eating disorders typically don’t receive care until they’re dying, or close to it. People with anxiety issues don’t get help until their anxiety is preventing them from having any semblance of a normal life.

Like most physical maladies, mental illnesses don’t just come out of nowhere. They usually develop from years and years of poor coping strategies and maladaptive beliefs. For instance, I remember being as young as 6 and constantly thinking that everyone secretly hates me, nobody wants to be my friend, and everyone’s talking behind my back. Guess what? When I was 18, I still basically believed that. Except by then, my beliefs had become self-fulfilling prophesies, and they had reinforced themselves until it became nearly impossible to get rid of them. Wouldn’t it have been so much easier if a child psychologist had helped me get over them 15 years ago?

My little brother, age 10, thinks he’s ugly. He has adorable curly hair, itty-bitty freckles on his face, and beautiful blue eyes. He’s thin and athletic, but thinks his stomach is fat and sometimes does crunches in his room. He hasn’t really learned how to make friends yet, and he has nobody to teach him. As a result, he thinks nobody will ever want to be his friend, and he chooses to brag and show off for attention rather than try to make other kids want to be his friends.

My brother does not have depression, an eating disorder, or even–believe it or not–a serious case of narcissism. What he also doesn’t have, however, are effective mental tools for interpreting the world and for being happy. And he’s not going to find these tools on his own.

What if, in addition to physical checkups to make sure that kids’ bodies are developing correctly, that they’re learning good hygiene, and that they’re eating well and exercising, we also had regular mental checkups to make sure they’re developing good mental habits?

Clearly, not everybody is going to need constant mental healthcare like I do, and like everyone else with a serious mental illness does. Most people would be totally fine checking in with a trusted family therapist every once in a while. But others, like my brother, would seriously benefit from catching the problem before it mushrooms into the sort of thing that I went through.

Even if people never do develop diagnosable mental illnesses, unhappy children often grow into unhappy adults. Ever had a boss who made your life miserable by demanding constant ass-kissing to protect her fragile ego? Ever dated a guy whose fear of commitment destroyed the relationship? Ever had a bully in high school whose inability to relate to others in a positive way greatly affected your own life?

These people have psychological issues. I’m not saying that in a degrading way at all; many people have issues. But because most people don’t think that they should see a therapist unless they want to off themselves, people like these usually don’t get help.

Although I strongly despise the mindset that people with mental problems should be treated as personal inconveniences, the fact is that people do affect each other emotionally. Imagine if every time someone got a contagious illness, all they could do was just continue going about their daily lives until it passed, infecting everyone they came into close contact with. Luckily, that’s not how it works; most people go see a doctor when they realize they’ve come down with something. What if people did the same for mental problems?

I think that’d be a much more pleasant world to live in.

And I promise I’m not just saying that because I’m going to be a therapist and want money.

Everyone Should Go to Therapy
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Storytelling

(Or: Massive Annual New Year’s Eve Note, Vol. 5)

[TMI Warning]

Many psychologists believe that it’s not what happens to us that matters, it’s the stories we tell ourselves about what happens.

Some people unfortunately interpret this to mean that we ought to “look on the bright side of life” and “find the silver lining” and all that crap.

I don’t really see things that way. Never have. Life sucks a lot of the time, and anyone who tells you otherwise is either stupid, in denial, or trying to sell you something.

But I have learned, over the past year, how powerful personal storytelling can be. This was the year I took a lot of pain and turned it into a force of energy.

~~~

A year ago, I thought I was done with this whole depression thing forever. That didn’t turn out to be the case. It came back almost as soon as the new year started, worse than ever before, seemingly undefeatable.

This has been a painful year. People hurt me this year. They lied, broke my heart, used me, and took my friendship for granted.

I was alone a lot, more alone than ever before. In fact, I spent most of the summer alone in New York. It was a fantastic experience, but a lonely one nonetheless.

It was hard, a lot of the time, not to think about all the ways depression limits me. If I didn’t have it, everything about my life would be different. I’d be outgoing, I’d go to parties, I could stay up late and take harder classes. I wouldn’t be so tired all the time, I wouldn’t have such a hard time talking to people, and, of course, I wouldn’t be so sad.

But sometime over the course of this year, I stopped thinking about all the things I couldn’t do because of depression, and started thinking instead about all the things I could.

For instance, I would never have started NU Listens, my peer-listening organization, if I hadn’t been depressed. I wouldn’t have the skills that allow me to help people. I wouldn’t write so much, or so well. I wouldn’t be able to fully appreciate my family and the other people I have in my life. I probably wouldn’t know what my calling is.

Some people, knowing that, would assume that I’m “thankful” for the experience of being depressed, or that I consider it “part of God’s plan” for me, or that it was “all for the best.”

Well, sorry to burst your bubble, but no. I don’t think any God would put a person through this, and that’s one of the reasons I don’t believe in God. I’m not thankful and I don’t think it was for the best. I want my adolescence back. I want the first two years of college back.

In our culture, preoccupied as it is with constantly finding the silver lining to everything from rejection to failure to broken hearts, I think it’s bold of me to say that I’m not thankful for what happened. I know I’m expected to offer up some grand lesson to be learned from all this, but I’m sorry to say that there just isn’t one. Sometimes shit happens. It definitely happened to me.

Knowing that, I’ve given up trying to find some sort of grand meaning in my experiences with depression. I sure as hell don’t accept the Judeo-Christian notion that I somehow deserved it, and although it has had some positive consequences, I’d say it did more harm than good. By far.

So how to go on? Well, that’s a complicated question for someone who prefers to see things in complicated ways. The story I’ve decided to tell about my own life isn’t necessarily happy, but it’s empowering for me. It’s about working within my limitations to achieve great things.

After all, the truth is that I’m probably not going to ever fully recover. I live at the mercy of something I can’t fully control, and my entire being–from feelings and moods to thoughts, beliefs, and actions–is tempered by it. Some days it leaves me alone, and some days it barely lets me get out of bed.

It means I have to be on my best behavior all the time. Nine hours of sleep, fruits and veggies, not too much carbs or meat, brisk walking every day, at least. Schoolwork has to be done before 9 PM or so, or else I can’t concentrate on it. I get overwhelmed by information easily, hence all the organization–categorized to-do lists and a calendar, a notebook that I carry everywhere, everything in filing folders in a box under my desk. In class I have to write by hand because it keeps me more alert. Otherwise, I start dozing off after sitting still for five minutes, no matter how much sleep I’ve been getting, because that’s how my body is.

I have to always stay busy, because as soon as I have a moment to myself, my mind starts conjuring up nasty thoughts. You’re such a bitch. Go kill yourself. The reason I take five/six classes, work two jobs, and run two student groups isn’t for my resume. It’s for my health.

~~~

So those are my limitations. Sometimes they seem pretty extreme. Sometimes they seem like a blessing compared to what some people are given.

Regardless, I’m not going to define myself through them anymore.

Instead, I’m going to define myself through the unique gifts that I have, and that I’ve become aware of because of my experience with depression.

When I’m helping someone, my self disappears–and with it, so do all of my fears, insecurities, and dysfunctions. I feel like I’m entering the other person’s being. It’s almost a spiritual experience.

Of course, my ideas about others aren’t always correct, but I start down a path of understanding. I start to see why the love the people they love, why the fear the things they fear, why they do things I would never do, why they believe things that I don’t believe.

I’m not looking for any accolades or sense of moral superiority when I say that my calling is to help people feel better. In a way, I’m just as selfish as anyone else. Some people are happy when they make money, or when they do experiments, or when they play sports; I’m happy when I make others happy.

It’s pretty much that simple.

~~~

It’s been a year since I “came out” as having a mental disorder. Since then, my relationships have only grown stronger and my sense of being valued and respected has only increased. Sometimes people do imply–usually via anonymous comments on my blog, as they know better than to say it to my face–that I’m making people “uncomfortable.” My response to this is always the same: they’ll get over their discomfort. I won’t get over my depression.

The truth is that–and I’m terribly sorry about this–I really don’t give a fuck about your comfort. I just don’t. It’s not my job to make anyone comfortable. I don’t really care about fitting in or being cool or normal. I must be missing that gene, or whatever.

If I sound completely different right now than I did just a few paragraphs before, I wouldn’t blame you for being confused. My life’s work will be to help people find happiness, but never at the expense of my own ability to live and express myself as I see fit. My understanding of psychology is that if you’re so concerned with how I live that you’re made “uncomfortable” by my depression, it’s you who needs to change, not me.

I don’t think most people realize the extent of my lack of fuck-giving because, unlike many other young malcontents, I don’t wear it on my body. My clothes are normal. I talk like a more-or-less average educated person. I don’t have any tattoos or extra piercings and don’t plan on getting any, and my hair is dyed, but only slightly. It’s styled in a mostly average way. I don’t choose to “rebel” by doing lots of drugs or people, and I don’t smoke, drink, or listen to unusual music.

But internally, I feel like an alien in this world. There’s a thick glass wall between me and everyone else. There’s a terrible creature that has its tentacles wrapped around my brain, and every time it squeezes, I want to rip my head off.

That’s what depression is.

~~~

That’s not to say this year has been all bad. It certainly hasn’t. I made many friends this year–not just any friends, but best friends. I started working on two different research projects at school. I found a way to connect with the Jewish community at Northwestern. I made Dean’s List this past quarter, started my own peer listening group, got accepted as a columnist for the Daily Northwestern next quarter, drastically increased my blog’s readership, tried therapy for the first time, successfully navigated my first quarter in my own apartment, went on quite a few dates, learned how to make my own jewelry, was accepted to a quarter-long Jewish education program, and befriended a few professors.

I went to New York three times, growing more and more certain with each time that this is where I want to live someday. I watched my older brother get married and found out that I’ll be an aunt in a couple of weeks. I met distant family members I hadn’t even known about before. I decided to wean myself off antidepressants when the new year starts.

Depression keeps me from being truly happy, but I refuse to let it rewrite the story of my life any longer. What I’ve been able to do despite of (and perhaps because of) my limitations makes me glad to be alive. I hope to recover someday, but even if I don’t, my life is going to be worthwhile.

~~~

A few days ago. I’m walking near Union Square in Manhattan. The sun has nearly set and the wind is chilling. I hear a man begging for money.

“Can you spare some change?” he’s saying, over and over. The passerby walk past him and he says, “That’s okay. Maybe next year.”

I put a dollar bill in his cup and he says, “God bless you, miss. I really mean that.”

He says happy New Year, and I say happy New Year too.

And then I continue on my way.

Maybe next year.

Storytelling

Death to Debbie Downer

Made famous by SNL.

I propose a moratorium on the term “Debbie Downer.”

“But whyyyy?” you might argue. “Those negative people are so annoyinggg!”

Perhaps. But I think we need to stop using that phrase, for several reasons.

The first thing I think of when I hear the phrase “Debbie Downer” in one of the contexts it’s most commonly used (i.e. “Oh, don’t mind him, he’s just a Debbie Downer”; “Why are you being such a Debbie Downer?”; etc.), is that it’s a reflection of our culture’s dismissal of anyone who doesn’t have a smile plastered all over their face at all times.

After all, isn’t that such a dismissive thing to say? When one calls someone a Debbie Downer, they’re implying that this person’s thoughts and opinions aren’t to be taken seriously. It means that rather than taking the time to figure out why someone’s saying all these negative things, they’re just going to write them off with a convenient alliterative term.

Second–and if you read this blog regularly, I’m sure you know where this is going–“Debbie Downer” is often used as a disparaging term that basically means “person with a mental illness.” In that context, it’s not only insulting, but inaccurate. Depression and related disorders don’t simply make people “negative.” They make them hopeless, joyless, and, at times, suicidal. You don’t really know if the frustrating person making pessimistic comments all the time is actually a pessimist, or actually struggling with a debilitating illness. So why assume?

~~~

“But wait!” you might say. “How dare you tell me how to talk? Free speech!”

Absolutely. Unlike certain more Leftist people, I would never argue that one should “ban” words just because they offend people. But look at it this way–if your friend or family member is being negative and you call them a “Debbie Downer,” all you’re doing is shutting them down and making them feel like you don’t really care about how they feel. Is this really what you want them to think? No? Then choose your words more carefully.

As for how I think one should respond to overly negative people, it’s not the way we’re used to doing it. Many people respond by trying to argue with or counteract the negative statements with positive ones, or sarcastically asking “Don’t you have anything nice to say?”, or snapping something like, “Stop complaining.”

(Our culture places a huge stigma on anyone who expresses anything even closely resembling a complaint. What else would explain the proliferation of special purple bracelets given out by various groups that members are required to wear until they have stopped “complaining”? My high school band used them. Rather than feeling free and happy in all this new-found positivity, I felt shut up and silenced, like my opinions–negative or otherwise–don’t matter.)

You’ve by now probably gathered that I think all of this is not only an exercise in futility, but actually quite damaging to relationships. Unsurprisingly, people don’t like to feel belittled and rejected.

Next time, try this simple question: “What makes you say that?”

You may be surprised at the response you receive.

~~~

The last point I wanted to make regarding this phrase is that it reveals something very interesting about our culture. We view others’ negative emotions as some sort of personal insult or attack, and we respond accordingly. Rather than either addressing the person’s issues or ignoring them, we instead allow them to bring us down–hence the term “Debbie Downer.” The response that many a depressive (or simply a sad person) has encountered is, “Why do you have to ruin my mood all the time? Why do you have to bring everyone down all the time?”

My response to that is, why are you letting someone else’s problems ruin your mood?

One might argue that it’s “impossible” to be in a good mood if someone around you is not. This is pure bullshit. In fact, I’m going to propose something radical–what if it’s entirely possible to be in a good mood despite the presence of “Debbie Downers?”

I believe that unless you yourself have a psychological problem that keeps you from being in control of your own emotions, nothing can keep you from being in a good mood if you want to be. So perhaps we should stop blaming our own bad moods on other people and acknowledge that we have control over them instead.

The great irony here is that the people bitching and moaning about “Debbie Downers” are usually those very same people who tell those of us with mental illnesses that we just have to “look on the bright side” and “stop letting the little things bring you down” and all those tropes. Perhaps they should take their own advice.

A sad person isn’t a personal insult to you, nor an insurmountable barrier to your own happiness. Next time you encounter one, try a little compassion instead of sarcastically putting them down with a cliched phrase.

Death to Debbie Downer

Yes, We Need Psychiatric Labels

Recently I stumbled upon a Huffington Post article by one Dr. Peter Breggin, who lists himself on HuffPo as a “reformed psychiatrist.”

This should’ve told me everything I needed to know, but I read on.

The article is titled “Our Psychiatric Civilization” and tries to make the tired point that in this day and age, we are defining ourselves by our psychiatric diagnoses and not by anything else. It’s difficult to fully dissemble this argument because Breggin unceremoniously shoves so many unrelated arguments into the same sad little article, but his main points seem to be:

  • Psychotropic medication is overprescribed.
  • Psychiatric diagnoses (i.e. major depression, bipolar disorder, ADHD, etc.) oversimplify the human condition.
  • Back in the good ol’ days, people apparently did a lot of spiritual soul-searching rather than resorting to all those damn pills.
  • The way people connect in our culture is through their psychiatric diagnoses.

I honestly don’t know which planet Breggin is living on, but it’s certainly not mine. I’ve addressed the overprescription crap elsewhere so I won’t talk about that now.

As for the second point, this is, to a certain extent, true. Psychiatric diagnoses DO oversimplify one’s psychological state, but that’s because you have to have a starting point. If you’re diagnosed with ADHD, you know that, some way–whether it’s through medication, therapy, or some combination of the two–you need to learn how to focus your attention better. If you’re diagnosed with major depression, you know that you need to somehow learn how to fix your cognitive distortions and become more active. If you’re diagnosed with seasonal affective disorder, you know that you need to do things that counteract the shortening of the days–use a full-spectrum lamp, take vitamin D supplements, etc.

Just as knowing that I have, say, asthma or the flu doesn’t describe the full state of my entire body, a psychiatric diagnosis isn’t meant to describe my entire psychological condition. Breggin seems to think that we live in a world where all we know about each other is what pills we’re popping, and nothing else. This is ludicrous. In fact, that’s something we don’t often know, given the stigma that still exists regarding mental illness.

Breggin goes on to claim in a condescending way that there’s no reason for people to connect with each other based on psychiatric diagnoses at all:

Patients ask me, “Should I join a bipolar support group?” If I were flippant, which I never am with patients, I could respond, “Only if you want support in believing you’re bipolar and need to take psychiatric drugs.”

My first thought upon reading this drivel was, Thank G-d he doesn’t say this to patients. My second was more like, What the fuck?

The idea that seeking support from others who face similar issues as you is somehow disempowering and promotes seeing oneself as a victim is quite possibly the most batshit stupid thing I’ve ever heard from someone whose profession is helping the mentally disordered. Shockingly enough, people like to feel like they’re not the only ones with problems. Perhaps this has truly never occurred to Dr. Breggin.

Quite the contrary, I have benefited immensely from connecting to other people who have depression and other mental disorders. Many of my friends have one, and together we’ve formed a sort of support network. All of us can always count on having someone to talk to, and those of us who aren’t as far along in the process of recovery as others can ask friends for advice. I don’t know where I’d be right now without that.

(Maybe in a perfect world, we could just have support groups called “Fucked-up People Support Group,” but somehow this seems counterintuitive.)

Anyway, psychiatric diagnoses can also be immensely helpful in explaining to healthy friends and family what the deal is. While Breggin seems to think that “depressed” is some sort of insulting, disempowering label I ought to reject, let me tell you some of the labels that my close friends and family described me with before they knew I had depression:

  • overdramatic
  • overemotional
  • bitchy
  • attention whore
  • immature
  • insensitive
  • selfish
  • crazy
  • weird
  • fucked up

Yeah um, I’d take “depressed” over that any day.

Not surprisingly, you don’t make a particularly strong case for yourself when you try to insist to people that, no, it’s not that you’re really overdramatic, it’s just that you have this problem with, well, being overdramatic, and you’re trying to work on it, you promise!

Trust me, that doesn’t work. What does work is saying, “I have a disorder called depression that distorts my thinking and sometimes makes me act in a way that seems overdramatic. With therapy and medication, it’ll improve.”

Apparently, though, Dr. Breggin is much too intent on destroying his own profession to allow those with mental illnesses even that small comfort. After all, he makes it pretty obvious that the reason he hates psychiatric labels so much is because they make it possible to prescribe medication, and that, of course, is a big no-no.

If I got a dollar every time some well-meaning fool tried to inform me that the medication that saved my life is unnecessary, I would have enough money to actually afford a therapist.

Yes, We Need Psychiatric Labels

How to "Be There" for a Depressed Person

So. I’ve talked about things not to say to a depressed person before. People have often asked me how, then, one should go about it instead.

One of the nicest things that ever happen to depressed people is when one of our close friends or family members tells us emphatically that they want to “be there” for us. This is great. Depressives aren’t easy to deal with, and anyone who chooses to do so deserves respect.

However.

There are right ways to go about being supportive, and there are wrong ways to go about it. I’m going to try to illuminate some of the right ways here. Don’t worry, it’s not hard.

  • Be honest and specific about the extent to which you are able and willing to help.
  • If you’re not, one out of two things will happen–the depressed person won’t take you seriously and won’t come to you for help anyway, or they will overestimate the extent to which you can help them, and this leads to extreme frustration for both of you.
  • If you’re very busy most of the time, tell them a specific time when you’re free to talk. This is important because depressed people often feel even worse at the thought of there being nobody available to talk to them, or of people being busier than they are.
  • If you’re available to listen but have no idea what to say in response, tell them that. They might be able to suggest ways to respond, or they might tell you that just listening helps.
  • If you don’t really like hearing depressing things for personal reasons but still want to help, explain that, and offer to help them do things to take their mind off of their depression, such as watch movies or cook together. Sometimes, that helps as much or more than just listening to someone.
  • Be a bit kinder than you would normally be.
    • Depressed people are, for lack of a better word, very fragile. They get upset by things that “normal” people don’t get upset by.
    • This is not the time to make “constructive criticism” or point out mistakes that the person has made. For instance, some depressed people have substance abuse problems. Do not say “You need to stop drinking or else you’ll only get worse.” All that does is make the person feel guilty and ashamed. First of all, you’re (I’m assuming) not a therapist, so you’re not an expert on how to cure depression. Second, if you’d like to make suggestions for improvement, frame them them very carefully. Perhaps, “I’ve noticed that you tend to feel worse after you’ve been drinking. Have you thought about trying to stop?”
    • If this sounds like sugarcoating or handling people with kid gloves, maybe it is. Maybe it seems silly to you. But remember that this isn’t about you. It’s about someone else.
    • In relation to the first point I made, be really sensitive about how you tell the person that you’re busy/otherwise unavailable and can’t talk to them or help them. Don’t just be like, “I have to go to bed now. Bye.” Say something like, “I need to go to bed because I’m really tired, but I hope you feel better and I’ll talk to you again soon.” Remember that unless you specify that you’re tired but that you wish you could help, a depressed person is likely to assume that you’re just trying to give them the slip. Try not to be offended by this. It’s not because you haven’t been a good enough friend; it’s just how their brain works.
  • Remember that there are many ways to help.
    • If you’re not comfortable listening to someone talk on and on about really sad things, that’s perfectly understandable and okay. If you still want to help them, there are other ways.
    • As I mentioned earlier, one thing that really helps depressed people is getting them out of bed/off the couch and doing something. Offer a pleasant but engaging activity that doesn’t require too much social interaction or new situations–watching movies, cooking, exercising, going to see a lecture or exhibit, going to a small social gathering (NOT a huge party with lots of drinking), taking a walk, going shopping, etc. If you’re both students and have a lot of homework/studying to do, you can invite the person to do that with you. Even if you’re not actually interacting, it’s nice to be around people.
    • You can also help in very small but practical ways. Get notes for them if they miss class (but encourage them to try to go next time), tell mutual friends that they’re going through a hard time and need extra support, help them search for a therapist or psychiatrist, that type of stuff.
  • Don’t make it about you.
    • I can’t stress this enough. Honestly, the shit that can come out of a depressed person’s mouth is pretty ridiculous at times. I’m obviously not proud to admit this, but I have occasionally been known to scream (electronically or otherwise) things like “FINE GO AHEAD AND HATE ME” and “I GUESS YOU WON’T CARE IF I DIE” at people.
    • This, I’m sorry to say, is just part of the package. Depression really fucks with people’s ability to process things rationally. Although there are things you can do to avoid such a reaction (see “Be a bit kinder than you would normally be,” above), it may still happen, and it’s not your fault. Don’t make this about yourself, don’t react defensively, don’t accuse the person of not appreciating your friendship.
    • If they say something that really does bother you, it’s perfectly fine to bring it up when they’re calmer and less upset. But don’t do it while they’re freaking out about something.
  • Be really careful if you’re communicating via texting or the internet.
    • The reason I say this is because this is where I’ve most often seen things go terribly wrong. Written communication has a way of seeming much more curt, rude, and inconsiderate than it really is. Depressed people are already overly sensitive to things like this, so communicating in writing can make it even worse.
    • That’s not to say that you should rule texting and the internet out entirely. Just take care to make up for the lack of body language. You can’t smile reassuringly, touch someone on the shoulder, or hold their hand over the internet. So if you’re saying something that can be interpreted ambiguously, be very cautious. With depressed people, there’s a certain Murphy’s Law–if it can be interpreted negatively, it will be.
    • Some ways to combat this are to use emoticons to help convey emotion, to express things more clearly, and to ask the person how he or she is interpreting what you’re saying as a way of checking in.
  • Try not to offer advice unless they ask for it.
    • This is a big one. I’ve written before about the tendency of people to want to “fix” others by immediately offering them advice, but this really fails when it comes to depressed people.
    • First of all, depression is different from ordinary sadness in a qualitative, not quantitative, way. In other words, it’s not “more” sadness, it’s a “different” sadness. What works for you when you’re feeling a bit down probably isn’t going to be what works for someone with a clinical disorder. This is why all those entreaties to “just put yourself out there!” and “just smile!” and “just get some sleep!” really, really fall on deaf ears when it comes to depressed people. Trust me, we’ve tried all of that, and much more.
    • Second, advice probably isn’t what they’re looking for (unless they tell you so). When people are upset, not only are they not in the right frame of mind to evaluate your suggestions accordingly, but what they probably really want is for someone to agree that things are hard for them and to sympathize with that. In other words, don’t be like, “Oh, that’s no big deal, you can just try x, y, and z.” Try “Wow, that must be really hard for you, but I believe that you’ll get better.”
  • Never ever make the person feel guilty or indebted for needing your help.
    • This is rarely done maliciously; I think it’s usually by accident. Sometimes people who are close to a depressed person become frustrated or resentful, which is natural. However, just because it’s natural doesn’t mean you should necessarily express it–at least not in the way that most people do.
    • If you find that helping the person is taking up too much of your time and energy, that’s absolutely a fair conclusion to come to. But that doesn’t mean you have the right to blame the depressed person for it. You choose how to spend your time, not they.
    • The correct way to address this, in my opinion, is to explain calmly that you feel like you’ve been putting too much of yourself into helping this person. Explain that, since you’re not a therapist, you can’t devote as much time and energy as the person might need. Clarify that you still care about them, but that you need to focus on yourself more.
    • The reason this is so important is twofold. First of all, depressed people can’t help the fact that they need support. They just do. Making them feel ashamed of that does no good. Second, some depressed people are suicidal, and one of the biggest causes of suicidality is feeling like a burden to others. This is why you should try not to make a depressed person feel like a burden to you.

    So there you go. I’m sure there will be a followup post to this because it’s such a big issue for me. Feel free to ask if you have any questions!

    How to "Be There" for a Depressed Person

    Antidepressants and Strength of Character

    You're not a bad person if you take any of these roads. I promise.

    Spoiler alert: They have nothing whatsoever to do with each other.

    There are different levels of stigma surrounding mental illness. There’s the stigma of having a disorder in itself, the stigma of being in treatment for a disorder, and, perhaps most of all, the stigma of that treatment being pharmacological.

    People love to hate psychopharmacology, especially antidepressants, the efficacy of which is constantly being questioned (often for good reason). However, I’ve noticed that drugs like antidepressants receive a special type of scorn, one that cannot be based solely on the efficacy mystery.

    I’ve found that where mental treatment is concerned, therapy holds some sort of moral superiority over drugs in many people’s eyes. I think many people still feel that mental disorders are spiritual illnesses, not medical ones, and that treating them with a pill is some sort of cop-out. (Imagine the public furor if researchers came up with a pill to, say, erase the feeling of guilt.)

    This would explain why, though therapy is still stigmatized–after all, the Ideal Person works out these issues on his or her own–it is considerably less looked down upon than psychotropic medication. Our culture values struggle and hard work so much that even recovering from an illness should be mentally effortful.

    What people don’t realize is that there are plenty of perfectly legitimate reasons why someone might choose medication over therapy, at least in the short term. Consider, for instance, the situation I found myself in a month before I began my sophomore year of college. Having spent my entire freshman year growing progressively more depressed, I’d thought that coming home for the summer would magically fix everything. It didn’t. With a month to go, I realized that I felt like I’d rather die than go back to school.

    That was when I was first diagnosed with depression, and I think my psychiatrist realized, as did I, that I just didn’t have time to muck around with my feelings–I had to get better quickly, or else going back to school would be more upsetting and stressful than I could handle. So I started taking antidepressants and quickly improved enough to feel like I could deal with being in school. The mucking around with my feelings came later.

    Aside from that, I can think of many other reasons medication can at times make more sense than therapy. For example:

    • Financial concerns. Antidepressants cost me $30 a month, while therapy costs $80 for four weekly sessions. That’s a pretty big difference for many people.
    • Time. Some people are at a point in their lives where they literally can’t spare an hour or more a week for therapy. That might sound ludicrous to you, but if you’re a college student, a new parent, or a low-income worker, it probably doesn’t.
    • Availability. Unfortunately, not everyone lives in an area where good therapists are available and accessible (and bad therapists will do more harm than good). This is especially true for members of marginalized communities, who may have a hard time finding therapists who are sensitive to their issues. Not all therapists are as open and accepting as they should be.
    • Insurance. I’m lucky to have a fantastic insurance policy that covers basically everything I’ve ever needed. However, many policies are very picky with regards to therapy (as opposed to medication, which does require a prescription from a person with an MD). For instance, some policies refuse to cover therapy unless there’s an official diagnosis, and you don’t necessarily need to have a diagnosable mental disorder in order to need help. Besides, you can’t be diagnosed without going to a specialist to begin with.
    • Nature of the disorder. Although most mental illnesses obviously involve a psychological component, some do not. For example, many people in temperate climates get Seasonal Affective Disorder (SAD) during the winter months, which is characterized by a low-grade depression as well as various physical symptoms. It’s usually treated with antidepressants or light therapy, which actually has people sit in front of full-spectrum light.
    • Language. Therapy requires people to talk pretty extensively about themselves and their lives, something that would be very difficult for, say, a new immigrant who’s just learning English. Unless such people are able to find a therapist who speaks their native language, it would be pretty hard for them to get anything out of therapy.
    • Comfort. As a future therapist, I obviously wish that everyone were comfortable with the idea of therapy. But not everyone is. That could be because of cultural factors, family attitudes, personality, or negative experiences with therapy in the past. I think that using medication to improve your quality of life while working up the courage to see a therapist is perfectly okay.

    I hope that this list shows that making decisions about mental health isn’t that different from making decisions about physical health–it has more to do with personal preferences and practical concerns than with the strength (or lack thereof) of one’s character.

    Of course, I do believe that therapy is really important and generally awesome, which is why one of my upcoming posts will be about why I think that everyone (or almost everyone) should see a therapist. Stay tuned.

    Antidepressants and Strength of Character

    Mental Illness Is Not a Punchline

    Damn, I’m certainly on a crusade against humor these days.

    That was sarcasm, by the way. I love humor. I just think it should be deployed carefully.

    A few days ago in my Psychology of Personality class, the following happened:

    Some people were having their own conversations while the professor was trying to give a lecture. The professor cracked a joke–“Hey guys, I have ADD so I can’t focus if other people are talking, so please stop!” followed by “I don’t really have ADD, but still.”

    Now, for the record, I totally get that it sucks for a teacher when people are talking in class. But I also feel that there are other ways to address that situation without making a joke about having a mental illness that you don’t actually have. Especially, you know, if you’re a person who has a PhD in psychology and conducts research on people with actual mental illnesses.

    The sad thing is, before he followed his comment up with that disclaimer, I was actually really touched. I thought it was wonderful that a professor of psychology would take a stand against the stigma of mental illness by stating in class that he has one. But then, you know, it turned out to just be a joke.

    ~~~

    Last spring, I took a class on Cognitive Behavioral Therapy. It was an advanced class, with just around ten students or so, taught by one of the most esteemed professors in the department. We got to the chapter on Borderline Personality Disorder, which, as you may know, is considered one of the most frustrating mental disorders–both for clinicians and for the patient’s friends and family. So naturally, no discussion of it could be complete without my professor’s bombastic explanations about how she tries to avoid treating BPD patients because they’re just SUCH a pain and about how she once had a friend with BPD who was just SO hard to deal with. Everyone gasped and laughed at her descriptions.

    Then, of course, the other students had to start raising their hands and talking about their own friends that they’d taken the liberty of diagnosing with BPD, and how  horrific those people were.

    This was a time in my life when I was seriously wondering if I had BPD myself, so, yeah, that was pretty unpleasant.

    ~~~

    Last fall, I took a class on psychopathology. It was my second psychology course ever, and my first that related specifically to mental disorders–a topic very close to my heart at the time since I’d been diagnosed with major depression only a month before.

    Before the course started, the professor sent out an anonymous survey to the entire class about our experiences with mental illness. On the first day of class, she disclosed the stunning results–more than half of us said we’d been diagnosed with one.

    So we got to the chapter on depression and the professor started talking about depressive cognitive distortions, using specific examples. The professor started listing them off in such a way that the whole class started laughing. And laughing, and laughing.

    Now, I totally get that it sounds funny. Consider this dialogue:

    X: I’m getting a B in calculus. I’m a total failure.

    Y: You’re not a failure at all! You have straight As in the rest of your classes.

    X: Well, those don’t count. They’re easy anyway.

    Y: Yes, and calculus is pretty hard, so it makes sense that you wouldn’t do as well. Besides, a B is a pretty good grade.

    X: No, it’s a shitty grade. Everything I do is shitty and I’m always going to be a failure.

    That is an example of several cognitive distortions, including overgeneralization, disqualifying the positive, magnification, and labeling. And, when read aloud in a particular tone of voice, I can see how it might sound kind of funny.

    But having been through it myself and studied it extensively, I can also hear the pain behind what X is saying. It’s not a punchline. It’s a cry for help from a person trapped inside their malfunctioning mind.

    ~~~

    Here’s the thing. I get it. People with PhDs in psychology have spent years and years reading, writing, and talking about stuff like this. I’m sure that it’s completely normal for two psychologists to crack jokes about mental illness to each other.

    Knowing that many people who pursue degrees in psychology are spurred to do so by their own experiences with mental illness (I’m an example of this), I understand the urge to joke about it because I joke about it myself. It helps alleviate the fear and pain of living with mental illness.

    That doesn’t mean I’d joke about it to a room full of 100 people who don’t know me well and who may be dealing with their own issues, though.

    Case in point–at the time I took the aforementioned psychopathology class, I was still learning how to recognize cognitive distortions in myself, and I was beginning to realize the extent to which they’d ruined all of my previous interactions, friendships, and relationships. To have a room full of 100 people laughing uproariously about something that nearly brought you to suicide just three short months before is, well, no laughing matter.

    ~~~

    I’m not saying there’s no room for humor about mental illness. There definitely is, and humor has been one of several strategies that have helped me process what happened to me. But humor must be used carefully.

    I’ve written before about the complex relationship between humor and mental illness–here, here, here, here, and here. But this time, the situation is very different because the off-color jokes are coming not from comedians, television writers, novelists, or clueless friends of mine, but from people who know more about psychology than 99% of the population.

    Unfortunately, I still haven’t quite worked up the courage to tell a person with a PhD that they’ve offended me.

    But I’m working on it.

    Mental Illness Is Not a Punchline

    How Depression Feels

    I feel like there’s a disease in my head. I want to excise the brain parts that it lives in, the parts responsible for loneliness, worthlessness, apathy, cynicism, seriousness, sensitivity, and all the other ways in which I could be described.

    I feel like a book lying open on the grass. The wind blows the pages around and one can’t help but read them. Nothing that’s written can ever be forgotten.

    I feel like I’ve wound up my body’s pocket watch all wrong. It doesn’t go at the same pace as everyone else’s. Sometimes it ticks when it shouldn’t. Sometimes it doesn’t when it should. Where is that damn watchmaker?

    I feel like a sinking ship. All of my most beautiful parts are underwater now, my framework waterlogged and rotting. Up on the tilting deck, an orchestra plays for anyone who dares to listen.

    I feel like there’s a darkness following me wherever I go. Some call it a black dog, others call it a raincloud, others call it the noonday demon. Sometimes we sit on a bench next to each other, just gazing out into the world through our foggy, listless eyes. When it’s with me, I see in black and white.

    I feel like a piece of driftwood on a beach. Why am I here, and not there? Is this sandy spot any better than that one?

    I feel like there’s another spirit inside me and it’s more compassionate and optimistic and hopeful than I’ve ever been able to be.

    I feel like there’s a flood slamming against the levee walls of my brain.

    I feel like there’s a screeching phoenix beating in my heart, trying to burn a hole in the scarred tissue and escape.

    I feel like I’m moments, or days, or years away from coming alive. It’ll happen, someday.

    How Depression Feels

    I'm Not Sorry

    [TMI Warning]

    As a person with a mental condition that often drastically affects interpersonal relationships, I’m a total pro at apologizing. I do it practically every day. Here’s a sample of depression-related things I’ve apologized for lately:

    • crying
    • being too tired to meet up with a friend
    • being late
    • leaving early
    • getting upset when a friend acted insensitively
    • needing to talk to someone
    • saying something negative
    • needing to go be alone for a bit
    • writing something emotional
    • being unsure of whether a friend really cares about me or not
    • not understanding a joke
    • not being dressed well/not having makeup on
    • taking criticism too harshly
    • not wanting to be in a big group of people
    • not wanting to drink
    • being quiet
    • not having an appetite

    Now, I realize I should be counting my blessings for the fact that I now have friends who understand me and my brain enough to be able to accept those apologies–in high school it was much worse. But at the same time, I’ve become acutely aware of how inauthentic I’m being when I apologize for the various ways in which my depression manifests itself. Sure, I’m sorry if the way I am makes life difficult for people or makes them uncomfortable. But apologizing implies that I could’ve avoided the situation had I been more attentive or considerate, just like when one apologizes for, say, forgetting a friend’s birthday or for spilling hot coffee on someone.

    I can’t avoid being fatigued or upset or sensitive, though, any more than a diabetic can avoid needing insulin shots.

    Of course, most people who don’t know me very well don’t even know that I’m depressed. Thankfully, I’m not required to wear a scarlet letter “D” on my shirt. But even if they do know, I feel compelled to apologize every time my behavior deviates from that of a healthy person, just to remind them that I’m well aware of the fact that the way I am can be an inconvenience for people.

    The truth is, though, that insofar as “I’m sorry” means “I messed up,” “my bad,” “this is on me,” “I should’ve known better,” “I should’ve tried harder,” “I should’ve been a better person,” and the like–I’m not sorry. It’s not my fault. I couldn’t have stopped it. There’s nothing I could’ve done. I’m getting treatment and trying my best to recover, and that’s as much as I should be held responsible for. I’m not even to blame for not getting treatment sooner, because I was a kid and had no idea there was anything wrong with me. I’d been told “that’s just how you are” all my life.

    I wish I could stop apologizing for having an illness. But until people understand it well enough to react to my apologies the way they’d react to an asthma sufferer who apologizes for getting out of breath, I can’t.

    I’m still not sorry, though.

    I'm Not Sorry

    Mental Illness as a Spectator Sport

    Step right up, ladies and gents, see the amazing inhuman hoarders here!

    Our culture seems to have three ways of relating to people with mental illnesses–either they’re pathetic losers who need to “snap out of it”, or they’re crazies who need to be locked away (think schizophrenia in popular culture), or they’re here for our pleasure and entertainment. That last one is a relative newcomer, and that’s the one I want to write about here.

    Just look at our celebrities–specifically, the ones with substance abuse problems. When it comes to them, it’s all fun and games till someone dies. While the late Amy Winehouse was still alive, blogs and magazines loved to publish photos of her visibly drunk, putting her up for public ridicule. Sure, everyone knew she could use some rehab–she sang about it herself–but there was never an ounce of compassion in how we, as a society, related to her.

    And take Charlie Sheen, clearly a troubled individual. I don’t even remember how many days went by that articles making fun of him littered my Google Reader feed. With him, there isn’t even any ambiguity regarding the diagnosis, but he was still treated like a circus animal, and everyone sat back in their seats, made some popcorn, and watched.

    Take TV shows like A&E’s Hoarders, Intervention, and Obsessed. These shows literally turn mental illness–and the treatment thereof–into entertainment. You can laugh as the poor OCD sufferer cries when forced to touch a gas pump nozzle with her bare hands, or gag as that creepy hoarder guy reveals his apartment full of old snack wrappers and rotting food.

    I’m not saying that it’s wrong to inform people about the lives of those with mental disorders. What I’m saying is that this informing should be done in a compassionate, humanizing way, and reality TV isn’t always the best format for that. For instance, the show In Treatment, which describes a (fictional) therapist and his clients, is a far cry from the carnival sideshow-like feel of the reality shows. I’m not exactly a big fan of reality TV in general, but as a medium for educating the public about mental illness, it’s even worse than usual, because it creates an environment in which people view their fellow human beings as freaks to be gawked at, not as peers to be sympathized with. (A counselor quoted on Everyday Health calls it “exploitanment.”) This happens on virtually every reality show–think how much the people on Jersey Shore and American Idol get made fun of. The difference is that the people on Jersey Shore and American Idol (arguably) do not have a serious mental illness.

    Ultimately, all media companies want to provide stuff that sells, and in the case of magazines that publish photos of drunken celebrities (with witty commentary, of course) and TV networks that produce shows putting people with mental disorders up for display, the money’s definitely talking–people love it. But the quality of mental healthcare in the U.S. will never improve while our culture continues to treat people with mental disorders as amusing distractions and not as people.

    Mental Illness as a Spectator Sport