“What do you have to be depressed about?”

If you have experienced depression while living what appears to be a fairly nice life, you’ve probably had someone ask you, “What do you have to be depressed about?”

Sometimes people who ask this question are genuinely curious because they think that depression is necessarily “about” something and they just don’t understand what, in your case, it could be “about.” Sometimes, though, people who perceive your life to be better than theirs feel resentful and jealous and, upon hearing that you are suffering from depression, demand to know what could possibly be wrong with your life that could cause a mental illness.

The origins of depression are complicated and still not very well-understood. One model that’s gained ground lately is called the diathesis-stress model. The term “diathesis” refers to a vulnerability, which could be genetic, biological, environmental, or psychological. “Stress” refers to a catalyzing event, a life stressor that can increase one’s chances of developing a disorder (the diathesis-stress model has been used to describe more than just depression).

One specific type of diathesis that has been researched concerns a specific gene, known as the serotonin transporter gene or 5-HTTLPR. Some studies suggest that people with a particular variant of the gene are more likely to develop depression, but only if they have a significant life stressor. If not, then there’s no difference between people with the different variations of the gene.

The results are mixed so far, but this is just one example of a way in which having “something to be depressed about” can indeed provoke depression. But it’s not the whole story. People without significant life stressors can still get depression, and people who do have life stressors are still much more likely to get depression if they have that genetic predisposition–the diathesis.

Diathesis can come in all sorts of forms. Having learned poor cognitive coping skills as a child could be a diathesis. Having abnormalities in the brain’s neurochemistry could also be a diathesis, although the “chemical imbalance” theory of depression as we’re used to seeing it is more or less bullshit.

Some types of diathesis might be considered to count as “something to be depressed about,” such as living in poverty, having a chronic health condition, or having an unstable or abusive family life. Others, such as having genetic predispositions or brain abnormalities, would not count as such for most people. Asking someone what they have to be depressed about is therefore not very useful.

But moving away from the science of depression’s origins, I’ll state the obvious: no matter how well you know someone, you never know everything that’s going on in their life. Not even if it’s your kid. The person may have a significant life stressor that’s triggering their depression that they just haven’t told you about, and they probably won’t if you sarcastically ask them what they have to be depressed about. If you’re genuinely curious, a better way to phrase that question is, “I’m sorry to hear you have depression. Is there anything that’s triggering it for you?”

The important thing with that is to never ask questions like you already know the answers. The question, “What do you have to be depressed about?” comes along with the implied answer, “Nothing.” Even if you don’t think it does. That’s how many people are going to hear it. So don’t get too caught up on the literal meaning of the words you are saying, and think about how they’re going to be interpreted.

The hypocrisy of the “What do you have to be depressed about?” question becomes blatant when you consider our typical response to those who do, by all accounts, have something to be depressed “about.” What tends to happen is that when we feel that depression is to be expected in a given situation, we also frame it as “okay.” Normal. Natural. It’ll pass on its own and we shouldn’t interfere.

This might explain the controversy over the decision to remove the bereavement exception from the newest edition of the DSM. Previously, people who were grieving had a two-month “window” during which they could not be diagnosed with depression, which often looks very similar to bereavement. With the publication of the DSM-5, this exception was removed. Lots of people were Very Concerned that this means that we’re “medicalizing” a “normal” process such as grieving.

I know I probably over-rely on comparisons to physical health, but that’s because they can be very illuminating. If you’re subjected to a some loud noise and you get a headache, or you work out strenuously and get extremely sore muscles, few people would suggest that you shouldn’t take medication to ease those pains just because they happened “naturally” (whatever that means). Being extremely sad, even “depressed,” as a response to a loved one dying is definitely “natural,” but that doesn’t mean it can’t interfere with your functioning as a person, and that you don’t deserve help dealing with it.

I’m not necessarily saying that high levels of grief should be diagnosed as depression, though. I’m just pointing out the hypocrisy of expecting people to produce compelling “reasons” for being depressed, but then refusing to consider people who do have compelling reasons to be depressed, even if they show all the symptoms.

My final gripe with the “What do you have to be depressed about?” question is that it’s often a way of trying to rank human suffering. What do you have to be depressed about? Some people are abused by their parents. What do you have to be depressed about? Some people are starving. What do you have to be depressed about? Some people have cancer.

Well, if you, personally, were abused by your parents, are starving, or have cancer, I wouldn’t fault you for feeling that the concerns of people with depression aren’t as serious as yours. That’s your right. But there are no measurements with which we can assess how bad someone has it. There is no Standard Life-Shittiness Unit. We need to stop looking for one, and treat every individual’s pain as legitimate.

Why You Shouldn’t Use Mental Illness As A Metaphor

And speaking of the dilution of language, I’m going to talk a little about how the language of mental illness gets co-opted regularly.

Sometimes this is done completely innocently, as metaphor. “The weather’s really bipolar today.” “I’m kinda OCD about this, sorry.” “I’m so depressed about the Blackhawks losing!”

Sometimes it’s a little less innocent, as “humor” that implicitly degrades its target: “She’s, like, totally fucking schizo.” “Clinically Depressed Rob Pattinson Cavorts With Models in New Dior Ad.” (Jezebel has historically been pretty bad about using mental illness as a punchline.)

My usual objection to using mental illness terms in this way is that mentally ill people (who comprise a fourth of American adults) are likely to find them marginalizing and hurtful. It makes us feel like the potentially-fatal conditions we struggle with are just a joke to you. It’s not a nice feeling, and if you are a person who generally cares about your friends’ feelings, you should probably be aware of this.

But the dilution of mental illness terms might have another, more insidious effect, and that is changing our mental schemas of what mental illness looks like such that it’s less and less serious, and treating it accordingly.

As an example, I was recently posting on Facebook about the infuriating phenomenon in which someone discloses a phobia or trigger that they have to warn their friends, and then their friends proceed to try to deliberately trigger them. I literally watched it happen, and then I watched the friend post a new status about how people do this, and someone tried to do it again.

So my friends and I were discussing this and one of them mentioned that a possible factor (aside from the obvious douchebaggery) is the fact that many people now use “phobia” very colloquially, as in, “thing that makes me have a sort of uncomfortable but totally harmless reaction that would probably be amusing for you to see,” as when my little brother wants me to taste something totally gross (but safe and edible) or when my mom is like “ewwww look at all this dust that’s built up on your windowsill!”

I think my friend may be right. These words are used so casually that our conception of their meaning gradually shifts without our even noticing it. It’s like a boy-who-cried-wolf type of situation in that regard. If nine different friends joke to you about how they’re “sooooo OCD” because they like all their books organized just so on their shelf (a situation familiar to just about every bibliophile, honestly), then the tenth friend who comes to you and tells you that they have OCD is probably going to evoke that mental image, rather than one of someone who actually can’t stop obsessing over particular little things and carrying out rituals that interfere with that person’s normal functioning, perhaps to the point of triggering comorbid disorders like depression. This may be a person who washes their hands until they are raw and hurting, someone who has to flick the light switch on and off seven times every time they leave a room, or someone who has recurring, uncontrollable thoughts about hurting someone they love even though they have no actual desire to do that.

Well, that sounds a little different than insisting that your books be categorized by subject and then alphabetized by author, no?

Likewise, if your friends are constantly telling you they’re “depressed” because their team lost or because they got a bad grade, only to return to their normal, cheerful selves within a few hours, the next person who tells you that they are “depressed” might elicit a reaction of, “Come on, get over it! You’ll feel better if you go out with us.”

And so the meanings of words change.

But just because the people around you use mental illness terms in that diluted way doesn’t mean you should accept it. If you want to be an ally to those who struggle with mental illness, you should treat disclosures of mental illness seriously every time unless you’re absolutely certain that that’s not what the person is telling you. Feel free to ask for clarification.

I already shared this story as a comment on another post, but I’ll share it again because it’s applicable here. I once ran into an acquaintance and we chatted for a bit. I asked him what he’d been up to, and he said, “Just, you know, getting sober. I’m an alcoholic.” And I said, “Congratulations, good for you!” And he responded, “Oh, I’m not actually an alcoholic, I just meant that I’ve been drinking less. Haha, I forgot that you’re a psych major.”

The latter comment annoyed me because of its implication that I took his seeming disclosure of alcoholism seriously because I majored in psychology. That’s not why. I took it seriously because it sounded serious, because I want to support people who struggle with mental illnesses, and because I know what a big step it would’ve been for me to tell someone I didn’t know that well that I had started treatment for depression, back when I had it.

But other than my brief chagrin, there weren’t really any drawbacks or negative consequences for me in this situation. I faced no repercussions for taking him seriously. I undoubtedly came out of the situation looking like a decent person who cares about people, and he probably felt a little silly for flinging the term “alcoholic” around, but also reassured that if he ever did get diagnosed with a mental illness, I would take him seriously.

Although it may feel that way sometimes, you do not have a limited number of Real Mental Illness Points that you need to save up for responding to people who have a Real Mental Illness, and that you shouldn’t waste on those who are just using those terms metaphorically. The worst thing that happens if someone tells you that they have a phobia and you decide to refrain from trying to trigger that phobia is…exactly nothing. The worst thing that happens if someone tells you they’ve been feeling depressed lately and you say, “I’m so sorry to hear that, is there anything I can do to help?” is that they say, “Oh, don’t worry, it’s not like, depression or anything. I’ll feel better soon.”

That’s it!

And your taking them at their word sends a message to them that you believe that these words should be reserved for describing the illnesses they indicate, rather than being used as convenient metaphors. You’re helping to set a norm about how these words should be used.

Meanwhile, if you’re someone who uses mental illness terms to describe states of mind that you do not feel are mental illnesses, I’d encourage you to take advantage of the richness of the English language (or whichever language you speak, which I’m sure is also rich) and not do that. (Russian, for example, has some beautiful words for sadness. There’s the general sadness, or grust'; there’s a stronger version, toska; there’s a type of sadness that’s accompanied by an unwillingness or inability to do anything to improve one’s state of mind, unyniye; there’s a type of sadness that isn’t really directed at anything in particular and lies somewhere between grust’ and toska in severity, pechyal’; and there’s a type of sadness that includes grief, but also sadness at the loss of a treasured possession or an important opportunity, skor’b. And that’s a few. And don’t get me started on the Portugese word saudade.)

Note that I’m not including here folks who have diagnosed themselves with mental illnesses because they’re unable (or currently unwilling) to seek help from a professional. If you feel that you have the mental illness known as depression, then that word, I believe, is yours to use.

My point is only that sometimes misusing language has actual harms, and while language does evolve and change over time, we need words to describe mental illnesses. We can’t fight something that we can’t name, and we need to be able to fight depression and OCD without people thinking that we’re fighting feeling sorta down when your team loses or wanting to have all your books organized just so.

~~~

Related: Small Things You Can Do To Improve Mental Health In Your Community

[repost] At The Edge Of The Known World: What It’s Like To Consider Suicide

[Content note: depression and suicide]

Today is World Suicide Prevention Day. I wrote this post for it a year ago, and I decided to repost it today because I still think people should read it and I doubt I could write another one that’s better.

Somebody, somewhere in the world, kills themselves every 40 seconds.

Set a timer on your phone or watch for 40 seconds. When it beeps, another precious, beloved life is gone.

Yesterday, September 10, was World Suicide Prevention Day. Although suicide prevention entails important things like improving mental health screening and treatment, increasing access to mental health services, and decreasing the stigma of admitting and treating mental health problems, I think there’s another part that we usually miss when we talk about prevention. And that part is understanding what being suicidal is really like.

Those who kill themselves (or wish to do so) are not selfish.

They are not weak.

They are not simply having a bad day.

All of these tropes about suicide, and many others, are wrong.

I can only speak for myself, not for any of the other millions of people who have struggled with this most ultimate of dilemmas. But for me, at least, here’s how it was.

 

I don’t think I ever wanted to be dead.

I have, however, wanted not to be alive.

Why? Because living sucked, because I hated myself, because everyone else must surely hate me too, because I was a burden, because I was going to be alone forever, because I was like an alien that was accidentally born on the wrong planet, to the wrong species, in the wrong society. Killing myself would be like correcting a cosmic error.

There were many ways I dreamed about it happening. Pills of some sort would’ve been my first choice, although I was absolutely terrified of what would happen to my body if they failed to kill me. (Go figure, I was terrified not of dying, but of failing to die.)

But I wanted to be able to take the pills and lie down somewhere and just curl up until I stopped feeling forever.

Sometimes I also thought about bleeding to death by slashing my wrists or something. But I despise pain above all else, and also, poetic as it would be, the thought of someone I love finding me that way made my guts churn. Also, could I actually do it? Could I actually take a knife and slice open my own skin?

I doubted it.

Jumping off of a building occurred to me a lot, especially at the very beginning of my love affair with suicidal ideation. That was back when I was studying journalism, panicking constantly, and feeling just about ready to do anything to escape. Was the journalism building high enough? If not, what would be?

And then there were the trains. Living in Chicago, you take them a lot. Every time I stood on the El or Metra platform as a train rolled in, I thought about it. Not seriously, as I’d made no plans and written no note, but the thought did occur. The rails screeched, and gust swept into my coat and rattled my bones. How I hated standing on the platform, forced to imagine my own death graphically every time a train rolled in.

Recently, when I was already better, I was waiting on the platform for the Metra. A train was coming. It turned out to be an express train that barreled through the station without stopping. The blur, the clamor, the sudden slap of wind–I was left shaken for several minutes after it passed, imagining what that could’ve done to my body.

Strangely, I never even considered guns, although that is what a character in my abandoned novel chose to use.

I composed many different suicide notes in my mind. Some were lengthy and elaborate, with separate sections for each person I wanted to reckon with before I died. I used to keep secrets and grudges for years, and I wanted everyone to know the truth in the end. (These days, I try to make sure that if I suddenly die today, little will have been left unsaid.)

Other notes were simple. They contained nothing more than a quote or a song lyric. Often they included an apology to my family. I thought about writing it in Russian, not English, as though that would make it any better for them.

I also thought about not leaving a note, but something about that made me very sad. What if they never knew? But might that not be better?

And I could not stop listening to that OK Go song, “Return“:

You were supposed to grow old.

You were supposed to grow old.  

Reckless, unfrightened, and old,

You were supposed to grow old.

I never made a firm plan to kill myself, I never attempted to kill myself, and, obviously, I never did kill myself. The only reason, I think, was because I cared more about my family’s wants and needs than I did about my own. As much as I thought I needed to stop living, they needed me to continue living, and so I did.

Is this “normal”? Do others talk themselves out of suicide this way? I have no idea. This isn’t really something I talk about over beers with friends.

I was lucky, when it comes down to it. Lucky to have a family I love so fiercely that that love overpowered my hatred for life.

Death and I, we have an awkward but strangely comfortable relationship now. If I don’t bother with her, she doesn’t bother with me. I don’t fear death itself very much, although the idea of just not existing terrifies and baffles me, just like the idea of time travel or parallel universes or the butterfly effect.

Sometimes I feel as though I’ve traveled to the edge of the known world, teetered on that edge, and then shrugged my shoulders and returned. I can’t really tell you exactly what I saw there, but I will say that there is a thick glass wall now between me and those who haven’t made that journey.

I say to a dear friend as I write this, “I’m thoroughly desensitized to the thought of myself dying.”

“I’m not,” she says. “You should stay here and grow crotchety and gray. Perhaps even collect spiderwebs.”

“I love you,” I say.

“I love you, too.”

For better or worse, I will live with what I saw at the edge of the known world until I die what I hope will be a natural death.

The Law is Not on Our Side

[Content note: sexual harassment and assault]

Many brave writers have described what happened to them when they reported gender-based threats and violence to the police. Occasionally the outcome is positive, but often nothing at all happens and often something terrible happens.

Here are two recent examples I’ve read. The first is by Heina of Skepchick:

When the officer called me in, I was shaking a bit, but spoke as clearly and calmly as possible, presenting my evidence and voicing my fears. He responded with laughter.

Taken aback by his trivialization of the situation, I asked him if he could look at my evidence. I knew who the guy was, I pleaded. Couldn’t he, as an officer of the law, do something? Take the guy to task for threatening me somehow? At least take down a report so that if something happened, there was a record? He replied with an incredulous no to all my inquiries.

Out of the blue, he asked me if my picture included my face. I said no. He asked me how I expected to attract responses with a picture that didn’t include my face. Before I could respond, he answered his own question: it was a sexy picture, was it not? Feeling shamed, I was unable to speak and merely nodded.

“Don’t worry about it, then,” he chuckled. “Go home.”

What choice did I have other than to begin to gather up my things and prepare to leave? Before I could make my exit, though, he told me that he often visits women-seeking-women for the pictures, winked at me, and expressed his hope that he would see me on there sometime. Taken aback by the lechery in his tone, I half expected him to take a swat at my ass as I walked out the door.

The second example is even more jarring and painful to read, and deserves a strong trigger warning. It was a comment by EEB on a post of Jason’s, and Stephanie reprinted it with permission:

Two male detectives arrived at my house. I stammered out a request for a female detective; it was denied. (I learned later that they violated procedure by not accommodating the request.) They made me go through what happened. I was in excruciating pain and dripping blood but they didn’t want to take me to the hospital just then, and said the hospital “wasn’t ready” anyway. So I described the rape. Then they asked if I was taking any drugs. Well, just my medication. I thought it was strange that they literally spent more time asking about my mental health history and the types of medication I took, instead of the rape, but at the time, again, I was in shock, and not thinking much.

[...]Over the next few months, I submitted to multiple, horrific “interviews” that really felt like “interrogations” as time went on. I was also dealing with a serious medical condition at the time (I almost died; my intestines ruptured, but was almost certainly not a result of the rape, just bad timing). But I still believed in the system. I still didn’t want the man who raped me on the streets. I did everything they requested, answered every invasive question (the were really focused on my mental health history!), even got on the ground and acted out the rape for them, with the head detective on top of me acting out the part of the rapist. Not only was I absolutely hysterical by the time we were done, I’m positive that aggravated my PTSD for a long time after.

And after all that, I was called in for an “interview” to discuss “a new lead in your case”. They didn’t let my rape counselor in the room–again, against the law, I found out later! For about an hour (I think; my sense of time was not that great) they were no longer even pretending to be supportive. They accused me over and over of making it up. They had very flimsy “evidence” (which I won’t go into because it’s both complicated and ridiculous) but mostly it was their “instinct”.

Because I have a mental illness. Because I was hospitalized after attempting suicide. Because I “claimed” I had been sexually assaulted in the past. Because I was crazy, and he was sure I was just looking for attention. He had a bipolar ex-wife, you see, and she made his life a living hell. He told me how he understood mentally ill women, and how we need to create drama. How we’re liars, and we crave attention.

And over and over they accused me of lying. Alone in this tiny room with two large, angry men, I was doing everything I could to keep from having a panic attack. I couldn’t respond to what they were saying; again, I think I was in shock. And they threatened me with jail time, with a felony on my record, destroying my family, public humiliation (he threatened to call the papers–something he did anyway, because, quote, “the community needs to know there was no threat to public safety”). They said I would be charged with a false report, with terrorizing the public (there was a public awareness campaign initially after my attack, though I didn’t have anything to do with it. After the rape, I did everything I could to maintain anonymity, and only told two people–beyond my family and the cops–hat I was attacked. But…I did it for attention, which was why I didn’t tell anyone? I’m just sneaky like that, I guess!). Accusations, threats, anger, pounding the table, over and over and over.

The detective looked at me. His whole demeanor changed; he tried to seem kind, avuncular. “Tell me you made the whole thing up. This whole thing will disappear. Nothing will happen to you. You can leave, if you just tell me you made it up. Tell me you made it up and you’re sorry for lying, and I’ll let you leave.” I tried to hold out–but I didn’t last long. Honestly, at that point, all I wanted in the entire world was just to get out of that room. There are very few things I wouldn’t have done, if I could only leave. So I looked at him and lied. I said, “I made the whole thing up. I’m sorry.”

Through both of these examples, we see that women who are marginalized along other axes besides gender face additional injustice–cruelty, even–by law enforcement officials. Heina’s sexual orientation was used against her both by the man she reported for threats and by the cop who was supposed to be helping her. EEB’s mental illness was used as an excuse to abuse her, accuse her of lying, and ultimately coerce her into recanting her accusation despite overwhelming physical evidence that it was true.

The more intersecting marginalizations you have, the less likely you are to be treated fairly by the police. This is, sadly, nothing new at all, and it’s not limited to sexual violence (see: Trayvon Martin, stop and frisk, queer people being arrested for being queer). So why do people still insist that 1) survivors of sexual assault have a moral duty to report it to the police, 2) if the police do not prosecute a rapist, that means that no rape occurred, and 3) if a survivor chooses not to report, then they do not deserve any accommodations from their communities, and those communities must pretend that nothing ever happened?

EEB’s story, in particular, suggests that at least some false rape accusations are not actually false rape accusations. More research is urgently needed to determine how common this is, but my fear is that it is not uncommon. This story also shows how ableist ideas about mental illness–that people with mental illnesses are just “crazy” and “delusional” people who make shit up to ruin people’s lives–prevented a survivor from seeking justice and allowed a rapist to go free.

I used to be sympathetic to the idea that people should report sexual assault to the police, but I’m becoming less and less so. While I think we have an imperative to reform this system and make it work, for now, I don’t think it’s at all unreasonable for a survivor to choose not to report. If I were advising a survivor, I’m not even sure that I would feel comfortable encouraging them to do so.

And, dudes, next time you show up demanding to know why so-and-so didn’t report if they were “really raped,” I’m going to link you to this post. Remember that feeling safe around police officers is a sign of privilege, as is the belief that they will treat you fairly.

On Memories Of Former Homes

The market is swarming with people on Friday afternoon. Tables covered with piles of fruits, vegetables, meat, fish, eggs, bread, and household goods beckon as their owners shout their prices into the din. Feral cats dart beneath the tables, dodging people and cars to snatch scraps of food. Shoppers haggle: “Ten shekels for this? No way. I’ll give you eight.”

If you listen closely, you’ll hear Hebrew, Arabic, Russian, English, and probably more. You’ll see men with kippas and black hats. You’ll see women, including young girls, with every inch of skin covered but their hands and faces, and women with miniskirts and crop tops. You’ll see schoolchildren shopping for their families and old men and women dragging bags of groceries on their own. There will always, at any given moment, be an old lady standing at the curb and shouting at a bus driver because the bus route has changed, and the rest of the passengers are shouting to her which bus to take instead.

More than anything, you’ll notice the heat. It beats down from the sky and rises from the pavement, seeps out of buses and cars and into your body like a poison. It’s a dry heat, which may seem like a small comfort, but it makes all the difference.

Past the market stalls and down the mountain, the Mediterranean glimmers. By this time of year it’s nearly impossible to actually swim in thanks to the jellyfish, but if you swim in the bay you’ll be fine.

The hours pass and the market starts to shut down. By the time the sun is setting, the whole city has slowed nearly to a stop: buses don’t run anymore, stores have closed, and the last few stragglers are rushing through the streets to get home. As night falls, the smell of freshly-baked challah flows out of open windows along with the prayers and songs of Shabbat.

To you, this may be unfamiliar and weird and even uncomfortable; to me, it was home.

~~~

When I was 13, I returned to Israel for the first time since my family moved away seven years earlier. That trip, at the time, meant absolutely everything to me. It was a chance to rediscover my history and heritage. It was a vacation from the boredom and bullying that made up my school days. Most of all, it was an escape from the horrible new feeling–not even just a feeling, but a way of being, really–that had seeped into every little corner of my life. Six years later, I would learn to call it depression.

Those two weeks in Israel caused mood swings the likes of which I’d never experienced before (but that would become too familiar over the following nine years). I felt ecstatic to be back in what I then considered my Real Home and full of wonder at the things I was seeing and learning. Being there caused a flood of old memories to resurface and I delighted in them.

But at the same time, I balked with increasing fear and horror at the idea of returning to my miserable American existence, which I was certain I could cure only by returning to Israel after high school. (I did not, obviously, know about antidepressants.)

Although I knew I’d miss the food and the stunning beauty and the beach and all that, what I knew I’d miss the most was just that feeling that I had there, that unmistakeable thereness.

I told my mom in tears that I was terrified of forgetting what it was like to be there, and in response she told me about a trip she took to southern Russia as a teenager, a trip that grew fuzzier in her memory over time, but that she could never truly forget. Maybe the details were gone, but the essence was not and never would be.

Somewhat comforted, I tried to capture the “thereness” in any way I could. I associated it in my mind with certain smells and songs. I kept a detailed diary. I took photos. I recorded it in poems.

Ever since, I’ve been chasing that feeling.

~~~

Summer is probably the best time of the year to be in Ohio. It’s hot and muggy as hell, but everything becomes soft and beautiful in the summer. The fields of ripening corn ripple over hills left by glaciers long ago, and the streams that wind through the woods–assuming they haven’t dried up–are perfect for dipping your feet into.

My mom and I, and later my siblings once they were told enough, would often explore the paths that lead through these woods. Many of them separated different subdivisions from each other, or they were part of school grounds or parks. One such path led to a mysterious mansion far away from any other houses; another was strewn with paintballs that my little brother eagerly collected but that my sister was for some reason terrified of.

Summer in Ohio is anything but quiet. Cicadas can keep you up at night if you’re not used to them, and early in the morning you’ll be woken up by neighbors tending to their lawns more meticulously than my family ever did. Once or twice a week we’d drop whatever we were doing because we’d hear the ice cream truck coming down the street, and that was our favorite summer sound of all. (That, and the lifeguard’s whistle when breaktime ended at the pool.)

For a good twelve years or so, that’s how all my summers felt. Nowadays they’re quite different.

~~~

More wisdom from my mom: the summer before I started college, I was dating my best friend and we were about to go off to different schools. Although I’d spent the previous summer in Israel, away from my then-boyfriend, this was the first time I’d be in an indefinitely long-distance relationship and I wasn’t taking it well. His school started a month before mine did, so he was the first one to leave. My mom told me, explaining that my anguish was perfectly normal: “It’s always harder to be the one who stays.”

Maybe that’s a small part of the reason it’s so much easier now for me to love places than people. With places, I always get to be the one who leaves. Places don’t “grow out” of me and leave me; I grow out of them and leave them. People change suddenly, without warning; places usually change slowly and very predictably, if you know anything about sociology.

That’s not to say that my relationships with places are easy or simple. It took me a long time to understand that I love my town in Ohio in some way. It was painful to realize that I couldn’t stay there and still be myself. It was even more painful to come to Northwestern and realize that what I thought for five years would be a safe haven was actually rather cold and unwelcoming, and not the sort of place I would ever learn to belong in. Yet there were things I loved about it too.

When I was little I played a game with myself. It was very simple. All I did was pay careful attention to my surroundings and pretend that I was seeing them again after having been away for a very long time, perhaps because I’d been transported to a magical alternate universe and had just now found my way back (I liked fantasy novels as a kid; can you tell?). This game made me see ordinary things like my house or my backyard through an entirely new lens. I was able to make myself feel as though my boring white-bread neighborhood was the most amazing place in the world, simply by pretending that I’d been forced to leave it for a while.

Later on, that actually sort of happened. No, I didn’t get transported through a wormhole to an alternate universe; I just went back to Israel for a whole summer (the aforementioned summer). When I returned to Ohio, I instantly fell in love with it in a way I never had before. It was so green. So quiet. So comfortable. I could understand the language strangers spoke to me. How had I ever taken that for granted?

I never really lost that feeling, and I carry it with me now as I move to a place that’s almost as different from Ohio as Israel is.

~~~

Everyone whines that they hate snow, but you can feel the energy pick up on campus as the flurries turn to snowflakes that grow bigger and bigger. Just a few hours ago it was sunny and above freezing, but that’s Chicago weather for you.

As Deering Field turns from green to white, students on break from class (or maybe just skipping) show up to throw snowballs and make snowmen. Past the field, Deering Library towers imperiously like a set from Harry Potter. In fact, we’d often jokingly call it Hogwarts.

If you walk past the library and down to the lake, you’ll see the hundreds of huge rocks that line the coast. Most of them have been painted by students to celebrate friendships, relationships, student groups, or just their lives at Northwestern in general. Sometimes I see marriage proposals, sometimes I see my favorite song lyrics, sometimes I even see Russian words; I’m not sure which of those makes me happier.

Ever since I first saw the painted rocks the summer after my seventh-grade year, I knew I had to get into Northwestern and paint my own rock someday. I managed the first half of that, but, for some reason, not the second.

~~~

You might think that, as a person with depression, I tend to focus and ruminate on the negatives of things. Although I do that sometimes, I also have a remarkable ability to find the positive in just about everything. Usually this ability serves me very well; although I’m fragile during transitional periods and dislike change, once I’ve had some time to process things I’m able to adapt to just about anything. That’s because I find the good in it.

Ironically, though, when I’m depressed this turns into a sort of weakness. Like a lifesaving medicine that becomes a deadly poison in overdose, my happy memories of past homes become so potent during depression that they rob me of my ability to appreciate the present. When I’m depressed, I’m tortured by these memories, which play over and over in my mind like faded old movies that I can’t turn off. I remember the most insignificant little things: the worn-down steps to my grandma’s apartment building in Haifa, the porch swing on the deck back in Ohio, the hard and scratchy couch in my old dorm where I’d watch football games on TV in the fall, the sound of kids jumping off the diving board at the pool my family went to (still goes to; I’m just not there anymore), the snow falling around University Hall, the taste of a sudden mouthful of Mediterranean water, the slam of the door to the garage when my parents came home from work, the music of my high school marching band echoing through the muggy summer night.

I think of these things without wanting to and I hear the same cruel thought over and over: You will never feel these things again.

I have these memories, but the places they come from are lost to me forever.

Oh, sure, I could return, physically at least. I have returned. But the feelings are gone. That thereness is gone.

~~~

Another season, another (very different) campus. It’s a summer night in New York City and I’m sitting in front of Columbia’s Butler Library and crying for too many reasons to explain. Students–my peers, theoretically–walk past me in chattering groups and I wonder for the millionth time what’s wrong with me. I’m finally exactly where I wanted to be and somehow it still feels awful.

After a while I pick myself up and walk somewhat mechanically off of campus onto Broadway. The sun has just set, which in most of my previous homes would mean that things have either died down or will shortly. But here, the city is just coming to life. The restaurants around campus are still full. People are standing around in front of bars and on street corners talking. The 24-hour pharmacies and grocery stores and diners (I’m still amazed at the idea of a 24-hour anything other than Burger King or 7-Eleven) are full of customers.

The night is warm, but not hot, and I feel better.

There are, right now, over 8 million people in this city who are just like me and also not like me at all. All of them have, at some point, been as terrified and lonely as I am right now. All of them have places that they love and miss. All of them have friends that they rarely see, or might never see again. All of them have parts of their pasts that they wish they could relive, and parts of their pasts that they wish they could forget, and maybe even parts of their pasts that they wish they could both relive and forget, if only because forgetting would end that burning need to relive.

It’s hard to feel alone when I think about that.

~~~

People tell me that the new memories I’m making can replace those old ones. That the new home I’ve found makes up for the loss of my previous homes. It doesn’t, just as new friends can’t replace the ones I’ve lost. Love just doesn’t work that way.

For what it’s worth, I’m glad that I’ve moved to a place that I adore so much. I’m glad that I could live here for the rest of my life and still be learning new things about it all the time. I’m glad that I’m a just a subway ride away from sprawling parks you can get lost in and from some of the loudest, most crowded city streets I’ve ever seen, from stores that sell the food I grew up with and stores that sell food I’ve never heard of or tasted before.

But those memories continue to haunt me and I know that I have to live with them somehow.

The best I can do is to try to capture them in writing so that I don’t have to carry their weight on my own, but it seems that I can’t. At best, writing provides a facsimile, a movie-set version of landscapes that were endlessly deep and rich. They didn’t end with a painted backdrop.

Sometimes I feel like I’d give anything for just one more day to inhabit these old places, homes, selves, lives. I want to feel like I felt when I lived there. I want to feel like the person I was, even though I don’t actually want to be that person anymore.

Isn’t there any way I can come back?

Most of all, though, I don’t want to lose yet another home. But it’s too late. I made the decision to move months ago, and even if I’d chosen to stay in Chicago, it wouldn’t have been the same. College is over. Those lazy days in coffee shops and bookstores are over. Running down the hall or down the stairs to see my friends is over. I will never again feel like I felt when I did those things, and I will never again be the person who did them.

I have to keep telling myself this so that it’ll sink in, even though telling myself this feels like shit. Otherwise I’ll keep feeling like any minute now I’ll wake up back in my old apartment and realize that this whole New York thing was just a weird and kind of scary dream, and it’s time to throw on some clothes and get to class.

But the funny thing is that someday this, right now, is what I’ll miss. Someday the memories I’m making right now will have a “thereness” of their own and I will miss them just as terribly as I miss Israel and Ohio and college now. Someday I’ll look back on my first days and weeks in New York and smile and cry about them.

It is probably true that whenever I travel between these four places in the future, I will simultaneously be leaving and coming home. I’m trying to make my peace with it, as awkward as it feels.

It’s weird, isn’t it? Loving more than one person feels completely natural to me.

Loving more than one place, though, feels like betrayal.

Living With Depression: Hope

[Content note: depression and suicide]

This is my series on depression and what it’s actually like beyond the DSM symptoms. It’s not meant to reflect anyone’s experience but my own, although I’m sure plenty of people will identify with it. If things were completely different for you and you feel comfortable sharing, the comments section’s all yours. Previous posts in the series are here.

The title of this post is “Living With Depression: Hope,” but because of the bit before the colon, the part after it is hard to come by.

One of the main ways in which depression differs from sadness or “the blues” is the pervasive loss of hope that its sufferers experience. When you’re depressed, you don’t merely feel bad; you know beyond a doubt that you will always feel bad. You don’t have evidence for this, but the strength of your conviction is so great that you automatically attribute it to accuracy. After all, if it weren’t absolutely true that you will always feel this bad, why else would you be so certain of it?

That’s one of many ways in which the depressed brain tricks you.

Unfortunately, the hopelessness of depression isn’t limited to big-picture questions like whether or not you will eventually feel better. It affects every little thing. You will never make friends. You will never find a partner. You will never have sex again. You will never get a job. You will never get into graduate school. You will never find a place to live that you like. You will never reconcile with your family. You will never get in shape. You will never get these damn errands finished.

(This also means that it’s impossible to tell the difference between what’s actually unattainable and what merely feels that way. I recently told my mother that one of the reasons I chose not to go for a PhD was because there’s absolutely no way I could’ve made it into a doctoral program given my lack of research experience. My mother pointed out that I’d said the same thing about the master’s program to which I will soon be merrily on my way. It’s true. I did say that. I also said that I will never get into Northwestern and never get any summer internships and never find a partner and never find a way to move to New York City. Sometimes I think that I’ll never get married or never be able to get a fulltime job. Which of these are based on a skeptical assessment of the evidence, and which are not? Who knows.)

This is going to sound ridiculous when I say it this way, but imagine knowing for certain that every little bit of your life will always be bad. Imagine if someone traveled back in time from the future and told you that you are going to fail at everything and you will never be happy and nobody will ever like you. Got it? Now try to live out the rest of that life.

That is depression.

When you look at it that way, suicide becomes a little easier to understand. One of the many things healthy people don’t get about suicide is how you could want to end your life for good just because of a “temporary setback” or “when things might get better” or “without knowing how life will turn out.” People call suicide a “permanent solution to a temporary problem.”

Sure, that’s how it looks to a healthy person. But to a depressed person, it’s not a temporary problem. It’s a permanent problem. You do know exactly how life will turn out and it will turn out terribly.

This is why it’s so patently ridiculous to me when people start going on about “Yeah well how can you really know if it’s depression or just sadness I mean aren’t we sort of medicalizing a normal emotion.” This is why it’s so clear that these people have no clue what they’re talking about. I’ve spent a lot of time being depressed and I’ve also spent a lot of time being sad. When I’m sad, my thought process goes like this: “Blah, it’s really fucking sad to be leaving behind my life in Chicago with all these friends I have and all the places I like to go. I will never have these things in my life in this way again. This is really fucking sad. I can’t wait till the move to NYC is over because then I’ll get to acclimate to a new life and it won’t feel as bad to have left this one behind.”

When I’m depressed, my thought process is more like this: “THERE IS ABSOLUTELY NOTHING GOOD ABOUT CHRISTMAS BREAK ENDING AND HAVING TO GO BACK TO CHICAGO. I HATE EVERYTHING THERE. Yeah, I guess I have friends there, but they probably don’t even like me. My classes will probably suck this quarter (yeah I picked them myself but whatever everything I choose for myself always ends up being shitty). The weather fucking sucks and I can’t stand it anymore. I’ll just sit in my apartment alone like a loser. Fuck my life.”

But here’s the thing: when Christmas break ended and I went back to Chicago, it was…fine. I adjusted, as I always do. But in the days leading up to break ending, I was absolutely unable to see that that would happen. It didn’t matter that I’d had the same thoughts at the end of every break. It didn’t matter that I had the same thoughts as I prepared to go home for break, from where I was now so reluctant to leave.

Nothing mattered. I had lost hope. Hopelessness was the default state in which I lived most of the time.

But without hope, there’s no way to be happy or even content. If things are going poorly for you right now, you’re convinced that they will always be that way. If things are going well, you’re convinced that it could all end at any time and your future seems grim.

Without hope, something as mundane as returning to school from Christmas break feels like an insurmountable obstacle. Without hope, my upcoming move to NYC would have me completely paralyzed with dread and anxiety (and I have to say, it’s pretty difficult even with hope).

Without hope, treating your depression feels pointless. Why make the effort when you already “know” it’s not going to help? Without hope, platitudes about “looking on the bright side” are pointless, because depression is an illness that literally prevents you from ever looking on the bright side. Telling a person with depression to try to be hopeful or to try to believe that things will get better is like telling a person with diabetes to consider trying to produce more insulin.

As of a few days ago, my depression has been subclinical for about a year. This means that I don’t fit the diagnostic criteria for it. I do not have major depression. I have recovered.

I do have many of its symptoms, some in mild forms and some a little stronger. So to say that I’m not at all depressed is probably inaccurate. In any case, though, the past year has been an experiment in learning to have hope again–hope that I will adjust just fine to my move in a few weeks (!!!!!!!!), hope that I’ll like my new graduate program, hope that I’ll be able to pay my bills, hope that I’ll get a job when this is all over, hope that my life will slowly start to resemble, however crudely, the vision I have had for it.

This means trying to see clearly through the fog that has hung like a curtain in front of my eyes since childhood, and occasionally getting a peak behind that curtain. We are all, of course, largely ignorant when it comes to predicting our own futures, but the important thing is to have the ability to make predictions that don’t make us want to curl up under the covers and cry.

The Letter I Didn’t Write

[Content note: depression, suicide, self-harm, eating disorders, sexual assault]

This is a long and intensely personal post about college, which I graduated from today. I’m writing it more for myself than for you, so feel free to skip it if you come here mainly for the political rants and psychological babble.

A few weeks ago I got a Facebook invite about a book that some students were compiling. Any current Northwestern senior could contribute a letter, anonymous or not, about their four years at Northwestern, addressed either to themselves four years ago or four years from now. This fall, incoming freshman will receive a copy of the book.

I waffled for a few weeks, finally convinced myself that I had nothing to say, and let the deadline pass.

Of course, that’s not true. I had plenty to say, but I knew that if, four years ago, I had received a letter from my current self about my college experience, I would’ve packed back up and ran the fuck away. Why do that to an innocent freshman?

If you don’t have anything nice to say, don’t say anything at all.

I’ve heard this for my entire life, and it’s the little voice in my head that so often keeps me silent. But usually I can ignore it, which is why this blog exists.

This time it worked. While I won’t say that I have nothing nice to say about my four years at Northwestern, most of it is not very nice. So I stayed silent.

But now it’s my graduation day, and, as with everything else in my life, I can’t fully process or move on from these four years without writing about them. Besides, this is my blog, not anyone’s book meant to provide inspiration and guidance to a new generation of Northwestern students. This space is mine, and this is the letter I didn’t write.

~~~

[Read more...]

Depression and the Lie of the “Real Self”

[Content note: depression and suicide]

Mitchell of Research To Be Done has a fantastic post up about this idea that when you’re on psychiatric medications, you’re not “the real you.” I’ll shamelessly quote about half the post:

This is just a for the record, for everyone, whether you’re talking about antidepressants or any other form of medication or life circumstances: THERE IS NO SUCH THING AS THE “REAL YOU”.

You know why? Because HUMAN BEINGS ARE CONTEXT-DEPENDENT CREATURES.

You are the real you when you’re being flirty and charming and totally hitting it off with someone adorable. You are the real you when you’re crying on the floor of your room and wishing the world would end. You are the real you when you’re living it up on vacation and you are the real you when you’re just getting through the day at a boring job. You’re the real you when you’re on vacation and hate everything about it, and you’re the real you when you’re flying through the day at an amazing job. You are the real you when you’re at a party, and you’re the real you when you’re staying in with your cat. You are the real you when you’re drinking, when you’re high, when you’re reading, when you’re fucking, when you’re lonely, when you’re surrounded by friends, when you feel absolutely worthless, when you’re brimming with confidence, when you wish the universe would leave you alone, and when you love everything about it. You’re the real you when you’re unspeakably angry and hate everyone, and you’re the real you when you’re ecstatically in love and feeling on top of the world.

“THE REAL YOU” IS A MEANINGLESS TERM USED BY PEOPLE WHO DON’T UNDERSTAND HOW HUMAN BEINGS WORK.

I wanted to expand on that idea a bit and talk about why it’s extremely harmful to people who are suffering from mental illness.

When I was depressed, I believed that Depressed Me was The Real Me. Not only that, but I believed that my depressed view of the world was The Most Accurate View Of The World. That when I was depressed and thought that everyone hated me and that I was an alien in this world who should die because I don’t belong here, that was, in my opinion, the most authentic view I could possibly have.

A large part of me feared recovery. Cheerful people grated on me, and of course, in this optimism-fetishizing culture, I thought that the only alternative to miserable depression was peppy, bubbly cheerfulness. That, after all, was what everyone seemed to want me to be, and that felt wrong wrong wrong.

There were a lot of reasons for my belief that depression was “real” and happiness was “fake.” First of all, as I just mentioned, I had a totally skewed image of what happiness actually looked like. Many people make that same mistake, of course, and it’s only now, when I’m healthy and happy but not that outwardly cheerful, that I realize that happiness just doesn’t always look like that. Sometimes it looks like hours spent alone reading. Sometimes it looks like passionate anger at injustice, and doing something about that injustice. Sometimes it looks like writing over 1,000 words in a sudden rush of ideas and creativity. Sometimes it looks like playing footsie with a partner while we do our homework in silence. Sometimes it looks like sitting at the coffee shop with my best friend, just talking about stuff. Sometimes it looks like savoring a meal I cooked myself. Sometimes it looks like waking up early on my first day back in the city, putting money on my metrocard, taking the subway, and walking up the stairs out onto the street, awestruck every time. Sometimes it looks like the moment I received my graduate school acceptance letter. And sometimes it does look like exactly what you’d think–dancing with friends and strangers at a party, knocking back shots and laughing at our own stupidity.

A second reason I believed depression was more “genuine” was that there was definitely a bit of sour grapes going on. No matter what I did, I hadn’t been able to feel happy with myself and my life since early childhood. That’s a lot of failure for a young person. So by late adolescence I was spending a lot of time being like “FUCK YOU HAPPINESS I DIDN’T WANT YOU ANYWAY YOU’RE ALL FAKE AND BORING AND SHIT.” It seems childish, but it was probably one of the only defenses I had. If I’d really known what I was missing, really felt its absence, I’m not sure how I could’ve made it through.

Third, it’s hard to ignore the fact that, even as Western culture promotes optimism and cheerfulness and happiness as mandatory, especially for women, it simultaneously elevates misery and depression to an exalted status. There’s a stereotype of depressed people as writers or artists, people who See Humanity As It Really Is and bring those insights to us through beautiful works of art or literature, and who die alone, unappreciated, perhaps drunk in a gutter or by suicide.

For a pitifully long time, in fact, I wondered if I could ever be a Real Writer if I became happy.

In his book Against Depression, Peter D. Kramer writes:

To oppose depression too directly or completely is to be coarse and reductionistic–to miss the inherent tragedy of the human condition. And here it is not only the minor variants–the psychiatric equivalents of tennis elbow–that bear protecting. Asked about eliminating depression, an audience member may answer with reference to a novel that ends in suicide. Or it may be an artist who is held forth, a self-destructive poet. To be depressed–even quite gravely–is to be in touch with what matters most in life, its finitude and brevity, its absurdity and arbitrariness. To be depressed is to adopt the posture of rebel and social critic. Depression is to our culture what tuberculosis was eighty or a hundred years ago: an illness that signifies refinement. Major depression can be characterized as more than illness, or less–a disease with spiritual overtones, or a necessary phase of a quest whose medical aspects are incidental.

(How can this image of the depressive exist in the same culture that stigmatizes depressives as pathetic, lazy, selfish, whiny losers? Why, you have to be depressed in the right way, of course.)

The final reason, I believe, was a property of the illness itself. The thoughts and emotions conjured by depression are so strong, so urgent, so potent that they felt more real than anything I’d ever felt before. The insights it gave me–they felt so brilliant at the time–could never come to me any other way. There was no other way to just know all these things about Life and Humanity. (This is also why I think that some of the aforementioned artists and writers might not be quite so brilliant as we may think.) When I was depressed I felt like a character in one of the Russian novels I love (where depression, incidentally, often plays a starring role). What could possibly be more genuine than this?

And during those times I’d forget how good it felt not to be depressed. I simply lost access to those memories. I wanted desperately to not be depressed anymore and I was also desperately afraid of who I would become if I were to stop being depressed. Depression skews and poisons everything. All of your memories, all of your identities, every sense you have of who you “really” are.

The result of all of this is that I felt that my depression was authentic. It was The Real Me. Recovering, especially through taking medication, would not be The Real Me.

I can’t know for sure now how that affected my eventual recovery. There are those who say that it must’ve significantly delayed it because I had to Really Want To Get Better and all that, but that’s straight-up victim-blaming bullshit. I DID want to get Better. I was just lost and confused and didn’t know what Better would even look like. And even when I didn’t want to get Better, that was a symptom of the illness itself. Depression is a feedback loop.

I do know that it made the decision to take medication (which brought me back from the brink) a lot more difficult than it needed to be. All that anxiety about potentially losing my ability to write was a waste of time and energy. Those fears that people would only like me if I was Deep and Insightful and Mysterious? They were crap.

And, anyway, here I am, nearly a year post-recovery and still writing, still being moody and weird, still doing my best not to have an overly rosy view of the world. Still ruining your fun.

But it’s deeply unjust to trick people suffering from depression into believing that they won’t be their Real Selves if they recover (especially if they recover using medication). People love to be all like “Yeah well what if anti-depressants had been around in Van Gogh’s time?” Well, maybe we’d still have his amazing art. Maybe it would look a little different. Or maybe Van Gogh would’ve done something totally different with his life and we’d never know the difference.

All I know is, no painting in the world can be so beautiful as to justify that sort of suffering.

Small Things You Can Do To Improve Mental Health In Your Community

[Content note: suicide, mental illness]

A few weeks ago Northwestern lost yet another student to suicide. There’s been pressure building all year for improved mental health services on campus, and I think that pressure will soon culminate in real, helpful changes on campus.

At the same time, some have been saying that what we need is not better mental healthcare services, but changes in campus “culture,” such as a reduction in the stigma of accessing mental healthcare and an increase in our willingness to discuss mental health which each other.

I don’t think that these things are mutually exclusive; I think we need both. People whose troubles are relatively minor will benefit from increased openness about mental health on campus without needing any improvements in mental healthcare, but those who suffer from serious mental illnesses–the kind that can contribute to suicide–need more than just supportive friends and professors. They need treatment. Right now, it’s becoming clear that many of those people are not getting the help they need.

Echoing these debates, a blog run by Northwestern students called Sherman Ave posted a piece called “A Reflection on Death, Privilege, and The College Experience.” (Sherman Ave usually sticks to humor, but this time it poignantly diverged.) The author wrote:

In writing these words and thinking these thoughts, I do not believe that a “call to action” here ends in throwing more money toward psychological services. As much as I believe that funding of psychological services at this university should be increased, I would hesitate to claim that another few thousand dollars would have stopped Alyssa Weaver and potentially Dmitri Teplov from committing suicide. Rather, I encourage everyone reading this article to think carefully about the state of those without the privilege of stable mental health.  We should seek to sympathize with members of our community instead of ignoring them for the sake of convenience. If we have the tremendous power to come together in grievance of a lost classmate, then there’s absolutely no reason we shouldn’t be able to show the same love and solidarity for that classmate before they give up on our community.

And a commenter responded:

I agree with the need to come together to “show the same love and solidarity” to members of our community who need or want support and communication from others, but what does that practically mean? I find myself asking–how can I, as one person, contribute to a positive dialogue that moves our community towards supporting each other in the face of hardship? How do I even “identify” someone who needs my help? Or how do I make myself open to facilitating healing in my peers?

I don’t think there’s any easy answer to this. Practically speaking, changing a culture is like voting–it’s pretty rare that the actions of a single individual make an immediately noticeable difference. Westerners are used to thinking of themselves as individual agents, acting on their own and without any influence from or effect on their surrounding culture, and this is probably one of the many reasons it’s so difficult for people to even conceive of being able to make an actual impact when it comes to something like this.

You don’t have to be an activist, a therapist, or a researcher to make a difference when it comes to mental health. The following are small things almost anyone can do to help build a community where mental illness is taken seriously and where mental health is valued. Although I’m specifically thinking about college campuses here, this is applicable to anything you might call a “community”–an organization, a group of friends, a neighborhood.

1. When people ask you how you’re doing, tell them the truth.

This is something I’ve been really making an effort to do. This doesn’t mean that every time someone asks me “What’s up?” I give them The Unabridged Chronicles of Miri’s Current Woes and Suffering. But I try not to just say “Good!” unless I mean it. Instead I’ll say, “I’ve been going through a rough patch lately, but things are looking up. How about you?” or “Pretty worried about my grad school loans, but hopefully I’ll figure it out.” The point isn’t so much that I desperately need to share these things with people; rather, I’m signaling that 1) I trust them with this information, and 2) they are welcome to open up to me, too. Ending on a positive note and/or by asking them how they are makes it clear that I’m not trying to dump all my problems on them, but I leave it up to them to decide whether or not to ask more questions and try to comfort me, or to just go ahead and tell me how they’re doing.

2. If you see a therapist or have in the past and are comfortable telling people, tell them.

One awesome thing many of my friends do is just casually drop in references to the fact that they see a therapist into conversation. This doesn’t have to be awkward or off-topic, but it does have to be intentional. They’ll say stuff like, “Sorry, I can’t hang out then; I have therapy” or they’ll mention something they learned or talked about in a therapy session where it’s relevant. The point of this is to normalize therapy and to treat it like any other doctor’s appointment or anything else you might do for your health, like going to the gym or buying healthy food. It also suggests to people that you are someone they can go to if they’re considering therapy and have questions about it, because you won’t stigmatize them.

3. Drop casual misuse of mental illness from your language.

Don’t say the weather is “bipolar.” Don’t refer to someone as “totally schizo.” Don’t claim to be “depressed” if you’re actually just feeling sad (unless, of course, you actually are depressed). Don’t call someone’s preference for neatness “so OCD.” These are serious illnesses and it hurts people who have them to see them referenced flippantly and incorrectly. One fourth of adults will have a mental illness at some point in their life, and you might not know if one of them is standing right next to you. Furthermore, the constant misuse of these terms makes it easier for people to dismiss those who (accurately) claim to have a mental illness. If all you know about “being totally ADHD” is when you have a bit of trouble doing the dense reading for your philosophy class, it becomes easier to dismiss someone who tells you that they actually have ADHD.

4. Know the warning signs of mental illness and suicidality, and know where to refer friends who need professional help.

You can find plenty of information about this online or in pamphlets at a local counseling center. If you’re a student, find out what mental health services your campus offers. If you’re not a student, find out about low-cost counseling in your area. If you have the time, see if you can attend a training on suicide prevention (and remember that asking someone if they’re okay or if they’ve been feeling suicidal will not make them not-okay or suicidal). Being aware and informed about mental health can make a huge difference in the life of a friend who needs help. This doesn’t mean you’re responsible for people who need help or that it’s your fault if you don’t succeed in helping them–not at all. It just gives you a toolbox that’ll help you respond if someone in your community is showing signs of mental illness.

Learning about mental illness is also extremely important because it helps you decolonize your mind from the stigma you’ve probably learned. Even those who really want to be supportive and helpful to people with mental illnesses have occasionally had fleeting thoughts of “Why can’t they just try harder” and “Maybe they’re just making this up for attention.” That’s stigma talking. Even if you didn’t learn this from your family, you learned it from the surrounding culture. Studying mental illness helps shut that voice up for good.

5. Understand how social structures–culture, laws, business, politics, the media, etc.–influence mental health.

If you learned what you know about mental  health through psychology classes, your understanding of it is probably very individualistic: poor mental health is caused by a malfunctioning brain, or at most by a difficult childhood or poor coping skills. However, the larger society we live in affects who has mental health problems, who gets treatment, what kind of treatment they get, and how they are treated by others. Learn about the barriers certain groups–the poor, people of color, etc.–face in getting treatment. Learn about how certain groups–women, queer people, etc.–have been mistreated by the mental healthcare system. Find out what laws are being passed concerning mental healthcare, both in your state and in the federal government. Learn how insurance companies influence what kind of treatment people are able to get (medication vs. talk therapy, for instance) and what sorts of problems you must typically have in order for insurance to cover your treatment (diagnosable DSM disorders, usually). Pay attention to how mental illness is portrayed in the media–which problems are considered legitimate, which are made fun of, which get no mention at all.

It’s tempting to view mental health as an individual trait, and mental illness as an individual problem. But in order to help build a community in which mental health matters, you have to learn to think about it structurally. That’s the only way to really understand why things are the way they are and how to make them change.

Self-Diagnosis and Its Discontents

There’s a certain scorn reserved for people who diagnose themselves with mental illnesses–people who, based on their own research or prior knowledge, decide that there’s a decent chance they have a diagnosable disorder, even if they haven’t (yet) seen a professional about it.

I understand why psychologists and psychiatrists might find them troublesome. Nobody likes the idea of someone getting worked up over the possibility that they have a mental illness when they really don’t. Professional mental healthcare workers feel that they know more about mental illness than the general population (and, with some exceptions, they do) and that it’s their “job” to serve as gatekeepers of mental healthcare. This includes deciding who is mentally ill and who is not.

Self-diagnosis also gets a bad rap from people who have been professionally diagnosed with a mental illness. They feel that people who self-diagnose are doing it for attention or because they think that diagnosis is trendy.

This actually bothers me much more than the arguments against self-diagnosis coming from professionals. Why?

Because the claim that people who self-diagnose are just “doing it for attention” or because they think it’s “cool” is the exact same claim frequently made about people who get diagnosed professionally.

To be clear, I’m not saying that people never label themselves as mentally ill for attention. Maybe some do. Maybe a significant proportion of people who self-diagnose don’t really have a mental illness at all. I’d have to see research to know, and from my searches so far I haven’t really found much research on the phenomenon of self-diagnosis. (But I’m taking note of this for my master’s thesis someday.)

However, there’s a difference between someone who’s feeling sad for a few days and refer to themselves as “depressed,” and someone who’s been struggling for weeks, months, or years, and who has read books and articles on the subject and studied the DSM definition of the illness. The former may not even count as “self-diagnosis,” but rather as using a clinical term colloquially–just like everyone who says “oh god this is so OCD of me” or “she’s totally schizo.” (This, by the way, is wrong; please don’t do it.)

(It’s also likely the case that some people self-diagnose because they have hypochondria. However, the problem is not that they are self-diagnosing. The problem is that they have untreated hypochondria. Maybe diagnosing themselves with something else will get them into treatment, where a perceptive psychologist will diagnose them with hypochondria and treat them for it.)

Even if some people who self-diagnose are wrong, I still think that we should refrain from judging people who self-diagnose and take their claims seriously. Here’s why.

1. It gets people into treatment.

I wish we had a system of mental healthcare–and a system of social norms–in which everyone got mental health checkups just as they get physical health checkups. For that, two main things would have to change–mental healthcare would have to become affordable and accessible for everyone, and the stigma of seeing mental health professionals (whether or not one has a mental illness) would have to disappear. (There are other necessary conditions for that, too–the distrust that many marginalized people understandably have for mental healthcare would have to be alleviated, and so on.)

For now, going to see a therapist or psychiatrist is difficult. It requires financial resources, lots of time and determination, and a certain amount of risk–what if your employer finds out? What if your friends and family find out (unless they know and support you)? What will people think?

Because the barriers to seeing a professional are often high, many people need a strong push to go see one. Having a strong suspicion that you have a diagnosable mental illness can provide that push for many people, because nobody wants to go through the hassle of finding a therapist that their insurance covers (or finding a sliding-scale one if they don’t have insurance), coming up with the money to pay the deductible, taking time off work to go to the appointment, dealing with the fear of talking to a total stranger about their feelings, and actually going through with the appointment, only to be told that there’s “nothing wrong” with them.

As much as I wish things were different, the reality right now is that relatively few people go to therapists or psychiatrists unless they believe that they have a mental illness. If self-diagnosing first gets them into treatment, then I don’t want to stigmatize self-diagnosis.

2. It helps them find resources whether or not they see a professional.

In the previous point, I explained that for many people, self-diagnosing can be a necessary first step to getting treatment from a professional. In addition, once people have diagnosed themselves, they are able to seek out their own resources–books, support groups, online forums, etc.–to help them manage their symptoms. This can be extremely helpful whether or not they’re planning on getting treatment professionally.

While psychiatric labels like “depression,” “generalized anxiety,” and “ADHD” have their drawbacks, they are often necessary for finding resources that help people understand what they’re going through and help themselves feel better. If I’m at a library looking for books that might help me, asking the librarian for “books about depression” or “books about ADHD” will be much more useful than asking them for “books about feeling like shit all the time and not wanting to do anything with friends” or “books about getting distracted whenever you start work and not really having the motivation to finish any of it and it has nothing to do with laziness by the way.” Same goes for a Google search.

It’s certainly fair to be worried that people looking on their own will find resources that are unhelpful or even dangerous. But I think this is less of a problem with self-diagnosis per se, and more of a problem with the lack of scientific literacy in our society, and the lack of emphasis on skepticism when evaluating therapeutic claims. For what it’s worth, going to see a mental health professional will not necessarily prevent you from encountering quackery and bullshit of all kinds. And in any case, the blame does not lie with the people who self-diagnose and then fall for pseudoscientific scams, but with the people who perpetrate the scams in the first place.

This point is especially important given that many people will not be able to access professional mental healthcare services for various reasons. Maybe they can’t afford it; maybe they work three jobs and don’t have time; maybe they can’t find a therapist who is willing to accept the fact that they are trans*, kinky, poly, etc. Maybe they are minors whose parents are unwilling to get them into treatment. Maybe they were abused by medical professionals and cannot go back into treatment without worsening their mental health.

There are all kinds of reasons people may be unable to go and get their diagnosis verified by a professional, and most of these are tied up in issues of privilege. If you have never had to worry that a doctor or psychologist will be prejudiced against you, then you have privilege.

3. It can help with symptom management whether you have the “real” disorder or not.

At one point when my depression was particularly bad I noticed that I had some symptoms that were very typical of borderline personality disorder. For instance, I had a huge fear that people would abandon me and I would bounce back and forth between glorifying and demonizing certain people. If someone made the slightest criticism of me or wasn’t available enough for me, I would decide that they hate me and don’t care if I live or die. I had wild mood swings. That sort of thing. It’s not that I thought I actually had BPD; rather, I noticed that I had some of its symptoms and wondered if perhaps certain techniques that help people with BPD might also help me.

Luckily, at this time I was still seeing a therapist. So in my next session, I decided to mention this observation that I had made, and the conversation went like this:

Me: I’ve noticed that I have some BPD-like symptoms.
Her: Oh, you don’t have BPD.
Me: Right, but I seem to have some of its symptoms–
Her: No, trust me, I’ve worked with people with BPD and you do NOT have BPD.

I suppose I could’ve persevered with this line of thinking, but instead I felt shut down and put in my place. I dropped the subject.

So determined was this therapist to make sure that I know which mental illness(es) I do and do not have that she missed out on what could’ve been a really useful discussion. What she could’ve done instead was ask, “What makes you say that?” and allow me to discuss the symptoms I’d noticed, whether or not they are indicative of BPD or anything else other than I am having severe problems relating to people and dealing with normal life circumstances.

The point is that sometimes it’s useful to talk about mental illness not in terms of diagnoses but in terms of symptoms. What triggers these symptoms? Which techniques help alleviate them?

So if a person looks up a mental disorder online and thinks, “Huh, this sounds a lot like me,” that realization can help them find ways to manage their symptoms whether or not those symptoms actually qualify as that mental disorder.

This is especially true because the diagnostic cut-offs for many mental illnesses are rather random. For instance, in order to have clinical depression, you must have been experiencing your symptoms for at least two weeks. What if it’s been a week and a half? In order to have anorexia nervosa, you must be at 85% or less of your expected body weight*. What if you haven’t reached that point yet? What if you don’t have the mood symptoms of depression, but you exhibit the cognitive distortions associated with it? Acknowledging that you may have one of these disorders, even if you don’t (yet) fit the full criteria, can help you find out how to manage the symptoms that you do have.

4. It helps them find solidarity with others who suffer from that mental illness.

I understand why some people with diagnosed mental illnesses feel contempt toward those who self-diagnose. But I don’t believe that sympathy and solidarity are finite resources. If someone is struggling enough that they’re looking up diagnostic criteria, they deserve support from others who have been down that path, even if their problems might not be “as bad” as the ones other people have and/or have not yet been validated by a professional.

Acknowledging that you may have depression (or any other mental illness) can help you find others who have experienced various shades of the same thing and feel like you’re not alone.

My take on self-diagnosis comes from a perspective of harm reduction. The idea is that strategies that help people feel better and prevent themselves from getting worse are something we should support, even if these strategies are not “correct” or “legitimate” and do not take place within the context of established, professional mental healthcare.

We should work to improve professional mental healthcare and increase access to it, especially for people in marginalized communities and populations. However, we should also acknowledge that sometimes people may need to help themselves outside of that framework. These people should not be getting the sort of condescension and eye-rolling they often get.

~~~
*The diagnostic criteria for eating disorders are expected to improve with the release of the new DSM-V, but I’m not sure yet whether or not the 85% body weight requirement will still be there. In any case, this is how it’s been so far.