A Flare-up of a Chronic Illness

[Content note: depression]

This is a personal post, not an advice post or a big societal problems post. But past experience has shown that some people appreciate and benefit from it when I describe how I try to think about things.

“Reframing” is a term we sometimes use in mental healthcare (and elsewhere) to basically refer to changing the way you think about something. While therapists sometimes suggest ways to reframe things to clients, it’s ultimately up to the individual to decide whether or not they want to reframe, and if so, how.

For some people this concept can hit a nerve because it can sound a lot like the well-meaning but ultimately useless (and even hurtful) advice we get to “look on the bright side” and “think about the positives.” But that’s not what reframing means to me. Here’s an example.

In one of my classes, we are required to meet in pairs for ten weeks to administer and receive counseling. Not as a roleplay exercise, but as an actual attempt to disclose one’s struggles or work with someone else on those struggles. Many students in the class expressed strong discomfort with being one of the “clients” in this exercise, but I’m already accustomed to sharing very personal and intimate details with thousands of strangers online, so I had no qualms about signing up to be counseled.

During our first session, my student-counselor asked me a question: “What, to you, would be an ideal or perfect day?”

It didn’t take me long to think about my answer, which turned out to be sort of a non-answer.

“There isn’t one,” I said. I explained that after eleven years of depression, there is no longer such a thing as an ideal or perfect day and it feels like there never was. That sort of thing is so far out of the realm of possibility for me that, in my view, there’s no point in sitting around hypothesizing about it*.

The reason is that hypothesizing won’t bring me any closer to experiencing it. The things that stop me from being able to have perfect days, those days you spend the rest of your life wishing you could relive, are not surmountable things.

As an example, I told them about the previous weekend, when my roommate and I had gone to visit friends in the suburbs of Philly and then went to a steampunk-themed dance in the city proper. I’d been looking forward to it for a while. It was supposed to be one of those awesome nights. We got all dressed up, and I was wearing my friend’s spectacular dress that I felt amazing and sexy in, and I was with my friends, and it was going to be awesome.

Until, of course, it wasn’t. Not long after we got there, I experienced one of the things I refer to as a depressive trigger, for lack of a better term. It’s whatever the depression version of getting triggered is–specifically, it brings on acute depression symptoms–and it happens to me periodically. I heard it and I felt every metaphorical gear that keeps my brain working properly grind to a halt. It was like driving down a beautiful country road in the sunshine and suddenly finding yourself in a thunderstorm.

After that I couldn’t make myself function. I felt an uncomfortable combination of numb and sad in a very “deep” sort of way. I was constantly on the verge of crying, and knew I would if I let myself think about the thing that had triggered me. I couldn’t talk to anyone, at least not in any socially appropriate way, and I couldn’t dance or pretend to be happy or do much of anything else.

So I left my friends, sat in a corner, and spent most of the rest of the night writing in my notebook (good thing I carry it everywhere) and messaging with one of my partners on my phone. (Situations like this, by the way, are one of the reasons I’m so adamant that it should be socially acceptable to be on your phone at social events. Because my options at this point were: cry in front of my friends, be on my phone, or leave and somehow find my own ride back from Philadelphia to New York at 10 PM on a Saturday night.) I was eventually more or less okay, but it took a long time, and I spent most of the night on the effort to make myself feel more or less okay.

This is not atypical for me; it’s been happening for almost as long as I can remember, and while the triggers have changed a little over the years–as has my ability to manage them–the fact that they happen in the first place has not.

I used to hate myself for it. I’d berate myself endlessly for “ruining” everything or “wasting” good times away, especially since the triggers were as predictable as they were unavoidable. Surely I could learn to stop doing this? (But I see nothing about “acute depression triggers” in any of the scholarly material I read and I don’t even know if this is a typical aspect of the experience of depression or if anyone has ever reported it at all. I just know that that’s how depression works for me.)

Now, I told my student-counselor, I think about it differently. Of this specific incident, I think: I had a flare-up of a chronic illness, but I was able to manage it.

And because I’ve learned to think about it that way, a lot of other things start standing out–the things that went right. I had a great, relaxing day with my friends before it happened. I got dressed up and felt good about how I looked. At the event itself, during the times when I was feeling more or less okay, I met some interesting new people and took some great photos that I’ll have to look at and reminisce. While I was feeling triggery, my friends noticed and checked in on me in ways that demonstrated their concern and care but did not step over any of my emotional or physical boundaries. (Most significantly, I don’t like to talk about the things that cause me to feel bad, and nobody asked or expected me to.) While I was feeling triggery, I managed to disclose a little bit of it to my partner online–not something I am often able to do–and my partner was supportive. I was able to stop it from getting any worse.

Reframing is not the same as its distant cousins, “looking on the bright side” and “finding the silver lining.” I didn’t choose to look on the bright side or find the silver lining. The silver lining found me, after I had reframed the situation in a way that didn’t make me look like a horrible wretched failure of a person. And when I reframe, I don’t attempt to dilute or ignore the reality of the situation. It is not preferable that things like this happen when I’m trying to have a good time with my friends. There is no “silver lining” to getting triggered. I’m not going to wax poetic about what this teaches me about myself or about the human condition. I’m not going to gush about how situations like this really bring out the wonderfulness of my friends and partners, because my friends and partners are wonderful a lot of the time, whether or not I’m currently feeling like crap.

When I think back to that night now, I don’t feel sad, because I’m remembering the good things along with the bad. Previously, the distortion that my brain engages in would’ve made that impossible. I’ve tried to somehow force myself to think about the good things before and failed. It could only happen once I found a way to look at the situation realistically.

I didn’t fail. I didn’t ruin anything. I didn’t choose for this to happen. I had a flare-up of a chronic illness, but I was able to manage it–with the help of some of my friends, but also by drawing on my own strengths and resources.

~~~

*That said, the question the student-counselor asked is typically a pretty good one to ask, as it helps the therapist understand what their client hopes to change about their life. But I already know that I want something impossible. I want to be cured. I won’t be, and that’s okay.

The Sad Girls of Tumblr

[Content note: mental illness, depression, self-harm, suicide]

I’ve written before about the potential dangers of presenting depression and other mental illnesses as somehow attractive or appealing or more “real.” In a blog post dealing with the same issue, Spencer writes:

We love to romanticize depression. On Tumblr, browse the “#soft grunge” tag and you’ll find artfully edited photos of scars and Instagram-filtered pictures of cigarette cartons with phrases like “You’re going to die anyway” superimposed. “Soft grunge” treats depression and suicide like beautiful black roses–twisted, painful romantic ideals. We do it off of Tumblr too, like when we associate our favorite comedians’ or authors’ mental illnesses with their genius. Half the time, it seems, “tortured soul” is uttered in awestruck, not empathetic tones.

That post also links to another post, called “On Tumblr’s Romanticization of Depression,” by a blogger named Sarah:

Every time you reblog pictures of a computer screen that says “stupid sad girl” or Marlboro cigarettes with sticky notes pasted on them saying “because you broke my heart,” every time you contribute to a culture that makes depression seem like a quirky thing to add to your “about” section instead of a serious disorder with one of the highest death rates of any illness, you are actively making it okay for people to ignore their health problems and just be sad. That’s enablement.

People need to stop posting pictures of pills and tagging them #death, #suicide, #self hate, #soft grunge, and #pale. Trust me on this one, overdosing on pills: not really a good time. It’s nothing like the pictures of parties that are scattered all over your dashboard. A pretty blue-eyed boy will not come up to you when you’ve been lying in an ER bed for four hours because you can’t walk and tell you how beautiful you and your sadness are. Maybe that’s because you won’t be wearing pants at the time (I wasn’t), or maybe that’s because you’ll barely be able to speak because your mind is so distorted by the drugs. He won’t kiss your fucking scars. In fact it’s likely that nobody ever will, because seeing the mutilated flesh of someone you love is terrifying.

In a general sense, I agree. Spencer and Sarah make the point that seeing depression presented as sexy and alluring may discourage people from viewing it as an issue to work on, and while it should always be an individual’s choice whether or not to consider themselves “mentally ill” or to seek treatment for a mental illness, normalizing such pain and suffering probably doesn’t help.

But then I started thinking–how many of the people posting these things are depressed themselves, and how much moral responsibility should we assign to a person in the depths of mental illness to avoid presenting their own condition in a way that may encourage others to follow suit?

Sarah allows for this possibility, including a caveat:

Which isn’t to say that no girl with a soft grunge blog is actually diagnosed with depression (or any other mental illness), because I’m sure many are. And I think I can kind of understand the appeal. Feeling like you’re a part of something can be comforting, and so can seeing that other people feel the same way you do. When you’re in the healing stages of a mental illness, having support isn’t just important, it’s a necessity. But the soft grunge subculture doesn’t support the “Sad Girls” it idolizes, it enables them.

However, I’m not sure that really answers my question.

First of all, I take issue with the term “enablement” as used here. Professionals and others usually use this term to mean doing things that encourage someone else to behave self-destructively. For instance, someone may “enable” a friend’s problem drinking by constantly offering them alcohol or inviting them out to bars; a parent may “enable” a child’s preoccupation with getting high grades by grilling them about their grades and expressing disappointment at anything less than an “A.”

But I’m not sure what exactly Sarah thinks is being “enabled” here. If it’s depression itself, then that doesn’t make sense, because depression is not a risky or maladaptive behavior that can be enabled. It’s a mental illness. It could also be not getting treatment for depression, but I’m not sure that makes sense as a behavior that can be “enabled,” either. Not getting treatment for depression is, sadly, the default. True, if people’s Tumblr feeds were filled with age-appropriate, compassionate advice about seeking help for emotional distress, they might be more likely to do so. But in that case, the entire way the dominant culture approaches mental illness qualifies as “enablement.” In that case, every time a friend told me to “just cheer up!” or “just come hang out with us!” when I was feeling sad, they were “enabling” my behavior of not seeking treatment, because they were suggesting that depression is something that can be fixed by choosing to “just cheer up” or go to a party.

More to the point, I think that this view somewhat discounts the very realistic possibility that the people posting these “soft grunge” images are themselves depressed, and what this means about “enablement.” Who are they enabling? Themselves? Each other? Others who are more or less depressed than they are? Younger Tumblr users?

It’s complicated to me because I view this type of self-expression–the romanticization, the preoccupation with death, the attention-seeking (which I do not mean pejoratively)–as part of the mental illness itself. As a symptom, even. I haven’t seen any studies about this and have no idea which Google Scholar keywords could possibly help, but anecdotally, my experience with people who suffer from mood disorders is that some of them cope with the illness by viewing themselves and the illness in this way. Not all, obviously, but almost no mental illness symptom is shared by everyone who has that diagnosis, so to call something a symptom is not to imply that it’s a universal symptom.

It is sometimes comforting, especially when you’re scared and don’t know what’s happening to you and lack the knowledge to label it “depression,” to think of it as something special and even positive. This is especially the case when you’ve been steeped in a culture that glorifies a certain type of disaffected sadness, and ties it causally to greatness in art, music, and literature. So, even if the girls of the soft grunge subculture are enabling others, that’s only because they were first enabled themselves.

Some of it is a sort of sour grapes thing, too. You try to be happy, you can’t, everything hurts, and you think, fuck it, who wants that boring shit, anyway?

When I was in high school, I didn’t have a Tumblr (I don’t think it existed yet), but I definitely found these types of images appealing in some way. Maybe if something like Tumblr existed I would’ve even shared them. The reason they appealed to me was because they made me feel like the way I felt was a way of being more alive, not a way of missing things that other people got to have–joy, security, optimism, hope, self-esteem. And even if I didn’t meet the diagnostic criteria for depression at the time, I certainly did just a couple years later when I was diagnosed with it.

I don’t think that any of this necessarily makes promoting such memes and images ethically okay. Most of us have no problem condemning pro-ana/-mia blogs and forums, for instance, and this is really the depression/bipolar disorder version of that. (I suppose, though, you could argue that pro-ana/-mia materials are more dangerous than “pro-depression” materials, if you could even call these Tumblrs that.)

But it does mean that it’s not as simple as telling people to stop doing it.

I think the first step would be to start taking adolescent mental health seriously. It’s a serious issue. Most people know this, I think, on some level. But we still don’t take a preventative approach.

It’s expected that parents start taking their children in for dental checkups as soon as they have teeth. It’s expected to start seeing an ob/gyn for checkups as soon as you become sexually active. Why not taking that sort of proactive approach to mental health in adolescence–or even in childhood?

(Of course, all of that is bound up in issues of privilege and access, but even teenagers whose parents can easily afford and access mental healthcare often fail to receive it until things become very bad.)

So, yeah, in short, I don’t disagree with either of the perspectives I linked to. I just think it’s a little more complicated than I ever realized before. It’s easy to say, “Don’t romanticize depression! It encourages people to view depression as normal and healthy.” It’s harder to say, “Don’t show symptoms of your depression! It encourages people to view depression as normal and healthy.”

Towards A Better Conversation About Mental Illness

This is my latest for the Daily Dot, about how we can discuss mental illness more accurately, productively, and compassionately, particularly in the wake of tragedies like Robin Williams’ suicide.

After comedian Robin Williams committed suicide two weeks ago, fans took to the Internet to express their grief, as well as their admiration for his work. Whenever a beloved celebrity passes away, regardless of the cause, social media temporarily becomes a sort of memorial to that person, a chronicle of the ways in which they changed lives.

However, when the cause is suicide, a celebrity’s death also brings out lots of dismissive, inaccurate, or even hateful statements about people with mental illnesses. According to some, Williams was “cowardly” and “selfish” for committing suicide. Last week, Musician Henry Rollins wrote an op-ed for L.A. Weekly (for which he apologized over the weekend) in which he said that he views people who commit suicide with “disdain,” claiming that Williams traumatized his children. There was plenty of rhetoric about suicide being a “choice,” the implication being that it’s the wrong choice.

Comments like these not only misinform people about the nature of mental illness, but they are also extremely hurtful to those who struggle with it. As the Internet continues to respond to Robin Williams’ death, here are some suggestions for a better conversation about mental illness and suicide.

1) Do your research.

We all have a “folk” understanding of psychology, which means that we experience our own thoughts and feelings, interact with other people, and thus form our opinions on psychology. Obviously, noticing things about ourselves and the people around us can be an important source of knowledge about how humans work.

But it’s not enough. If you haven’t had a mental illness, you can’t really understand what it’s like to have one—unless you do your research. Depression isn’t like feeling really sad. Anxiety isn’t like feeling worried. Eating disorders aren’t like being concerned about how many calories you consume. Your own experiences may not be enough.

Before you form strong opinions about mental illness and suicide, you need to know what mental illnesses are actually like, what their symptoms are, what treatment is like, what sorts of difficulties people may have in accessing treatment or making it work for them. If you can make tweets and Facebook statuses about a celebrity’s suicide, you can also do a Google search. Wikipedia, for all its drawbacks, is a great place to start. So are books like The Noonday Demon and Listening to Prozac.

2) Never engage in armchair diagnosis.

Now that you have a good idea of what different mental illnesses look like, you should try to figure out who has which ones, right?

No, please don’t. Armchair diagnosis, which is when people who are not trained to administer psychiatric diagnoses try to do so anyway, is harmful for all sorts of reasons that Daily Dot contributor s.e. smith describes in a piece for smith’s personal blog:

The thing about armchair diagnosis is that it mutates. First it’s a ‘friend’ deciding that someone must have bipolar disorder because of some event or another. Over time, that’s mutated into an ‘actual’ diagnosis, repeated as fact and accepted. Everyone tiptoes around or gives someone sidelong glances and makes sure to tell other people. Meanwhile, someone is completely puzzled that other people are treating her like she’s, well. Crazy.

Whether the person you’re talking about is a celebrity or not, it is up to them whether or not to make public any information about their health. Mental health is part of health. While having a mental illness should never be stigmatized, unfortunately, it still is. People deserve to decide for themselves whether or not they are willing to disclose any mental illnesses they may have.

Even if someone commits suicide, that doesn’t mean we can come to any conclusions on which mental illness they had or didn’t have. First of all, not everyone who commits suicide could have been diagnosed with any mental illness just prior to it. Second, various mental illnesses may lead to suicide. Many online commentators, including journalists, simply assumed that Williams had depression. However, he may have also had bipolar disorder, in which depressive episodes are interspersed with manic ones. Williams himself never stated which diagnoses he had, so it’s best not to assume. Whatever he had or didn’t have, it is clear that he was suffering.

Read the rest here.

Depression and Self-Gaslighting

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A Primer On Atypical Depression

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Depression Is Not Sadness (Again)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

~~~

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

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

Are Celebrities Responsible for Modeling Good Mental Health?

[Content note: depression, mental illness, suicide]

My newest piece at the Daily Dot is about Lana Del Rey, mental illness, and what we expect from artists and celebrities.

Singer Lana Del Rey has recently reignited an age-old discussion about the glamorization of depression and suicide among (and in) young musicians. In a Guardian interview she has since tried to distance herself from, Del Rey focused on death:

‘I wish I was dead already,’ Lana Del Rey says, catching me off guard. She has been talking about the heroes she and her boyfriend share—Amy Winehouse and Kurt Cobain among them—when I point out that what links them is death and ask if she sees an early death as glamorous. ‘I don’t know. Ummm, yeah.’

[...] It’s unlikely that statements like Del Rey’s actually make anyone go, “Huh, maybe I should try killing myself.” However, they can be harmful because they perpetuate norms that discourage seeking help and prioritizing mental health. Del Rey certainly isn’t single-handedly responsible for this, by the way—mental illness has long been associated with artistic brilliance, glamour, and even sometimes sexual desirability. Some believe that you can’t really be a great artist unless there’s something very wrong with your brain, but I think that’s largely confirmation bias. If you think that artists must be crazy, you’ll pay extra attention to the ones that are and little attention to the ones that aren’t.

We tend to expect that when artists go through difficult times, their way of coping is to make art about it. (Neil Gaiman gave a beautiful speech about this.) Making art can indeed help people deal with all sorts of adverse circumstances, including mental illness, but sometimes it’s not enough. Luckily, some artists, musicians included, have spoken out about seeing therapy and medication when they needed it—not an easy thing to do in a society where mental illness is still stigmatized and being a celebrity means having your private life constantly scrutinized and sold as entertainment.

On the other hand, I’m also leery when celebrities are expected to be “role models” and to demonstrate positive, healthy behavior to the children and teens who look up to them. It would certainly be nice if, when interviewed about her moods, Del Rey said something like, “I’ve been going through a hard time and dealing with lots of sadness, but I’m seeing a great therapist and taking good care of myself.”

But holding her responsible for the mental health of hundreds of thousands of young people is unfair and hypocritical. Del Rey’s young fans would benefit a lot more from seeing their own parents model good self-care, but we don’t encourage that in parents any more than we do in glamorous singers. Instead, we shame people who take poor care of themselves, and we shame people who are open about seeking therapy.

Read the rest here.

On Hating Yourself, And All Of Your Selves

[Content note: depression]

The self, as everyone learns in an introductory psychology class, is not a stable or definable entity. “Self” is not a biography or a fashion style or a set of identity labels–it is something more contextual, more situational, more fluid than that. Selves shift depending on who we’re with and what we’re doing and how our bodies feel at the moment and too many other variables to list, and anyone who decries the supposed “fakeness” of being a different person in different situations or with different people fails to realize that we’re all made up of multiple selves, and it’s not always obvious which (if any) are more “authentic.”

What, then, does it mean to hate yourself? If your self is multifaceted and constantly shifting, hating it is like trying to hold water in your hands.

Yet many people with depression or other mental illnesses will tell you authoritatively that they “hate themselves,” and, at least for me, that expression stems from a deep-seeded emotion that I can’t identify in any other way. It’s not a basic emotion like sadness or anger, but neither is it a concrete, System 2-type of thought, such as, “I am dissatisfied with my current approach to dating and relationships.”

All I know is that I feel the thing and I think that I hate myself, all of myself, the parts that come alive when I’m out in the city alone and the parts that only a few of my partners see and the parts that manage to think my way out of this and the parts that were brave enough to leave everything I knew to move here and the parts that make it possible for me to sit and listen to someone for an hour and the parts that are writing this now.

It doesn’t make sense to hate even the selves that I’m most proud of, but I do it anyway. At that moment I don’t want to pick and choose. At that moment I would happily surrender my entire self in order to receive a new one from some cosmic lottery. At that moment I’m convinced that if that lottery created a new me at random, reset all the sliders and let the chips fall where they may, that would still lead to a more optimal result than the one I’m stuck with now.

I’m convinced that it’s such a terrible hand that I hold that I’d rather discard it, reshuffle the deck, and draw anew, than keep playing with the cards I was dealt.

In reality, this is not a good model for personality or self or character or whatever it is that I hate so much. Selves can be improved; that’s the entire reason we have the whole genre known as “self-improvement,” as useless as many of these offerings are. And my selves were not the product of an unlucky draw, either. They are quite predictable results of my genetics, upbringing, environment(s), experiences, and so on. I’m sure that only a small portion of it is really random. While that doesn’t necessarily make me like the results any more, it does mean that they aren’t meaningless.

And on good days I have plenty of evidence that this self-hatred isn’t rational–that is, it doesn’t follow from the premises. One example is the way that I’ve managed to keep steadily hating myself even as I’ve changed dramatically over the last few years. Self-hatred, along with a few other things like love of writing, has remained a constant in my life when little else has. I remember bursting into tears on the band bus my sophomore year of high school and trying to explain to my first boyfriend that I couldn’t be happy when I hated myself so much. And now, eight years later, I have (for whatever reason) this blog and these readers and all these friends who are listening to me repeat the same tired fucking bullshit that I’ve been telling anyone who would listen since before any of these people even knew who I was. I am, more often than I care to admit, still the broken girl trying to communicate the uncommunicable to someone who had no idea what on earth I was on about.

I used to hate myself for being romantic and preoccupied with relationships. Now I hate myself for being cynical (on a good day I call it “realistic”) and apathetic about the whole thing while everyone around me starts serious relationships and moves in with partners and gets engaged.

I used to hate myself for depending on people just to get through the day without breakdowns. Now I hate myself for being unwilling to ask for the smallest bit of help from anyone outside my immediate family.

I used to hate myself for being weird and nerdy and obsessed with science and technology. Now I hate myself for being not weird enough and not nerdy enough and obsessed with the social sciences, except not in the right “scientific” way like all my friends are where you post articles about statistics and meta analyses and replication. (I’m interested in these things too, yes, but I hate myself for not being interested enough in them.)

I used to hate myself for being passive and never speaking up when people hurt me. Now I hate myself for the meticulous boundary-setting I do on an almost-daily basis.

I used to hate myself for caring so much about things like grades and achievement and being the best. Now I hate myself because I can’t be arsed to care.

I used to hate myself for being so pathetically and childishly insistent on telling my parents everything. Now I hate myself for the way I can’t bring myself to even tell them that I’m getting paid to write now, or that I spoke at a conference, or that I’m dating someone new.

Unless I’m just programmed to hate everything, this doesn’t make sense. Rather, it seems that I hate everything that I label as “myself,” no matter what values that self actually takes on.

And maybe everything I just wrote is wrong because I’ve never really hated myself “for” things; I just hated (and still hate) myself indiscriminately. I could accomplish all of my goals tomorrow and I would still hate myself. I could resolve all the unresolved conflicts in my life and I’d still hate myself. I could conquer all the demons and banish all the ghosts and open all the doors and insert more cliches here and I’d still hate myself, because it has nothing to do with who I actually am or what I actually do.

Maybe that sounds depressing and pessimistic, but to a depressed person–or this depressed person, at least–it’s actually incredibly freeing. There is no reason for the self-hatred, or whatever the proper term for that darkness is. I didn’t do anything to deserve it. It is, for whatever genetic or circumstantial reason, just my darkness to live in. For now.

Can You Be Happy for 100 Days in a Row?

The 100 Happy Days project.

“Can you be happy for 100 days in a row?” the website wants to know, taunting me with its cheery font and yellow color scheme.

No, I can’t.

“You don’t have time for this, right?” the next line asks rhetorically.

I’ll answer anyway. I have time. I, despite my grad program and 3-hour commute, have plenty of time to be happy. What I lack is the capacity.

It goes on:

We live in times when super-busy schedules have become something to boast about. While the speed of life increases, there is less and less time to enjoy the moment that you are in. The ability to appreciate the moment, the environment and yourself in it, is the base for the bridge towards long term happiness of any human being.

But I do enjoy the moment I’m in. I enjoy watching the skyline from the train during my commute. I enjoyed my four-hour trek through Central Park yesterday. I enjoy the moment the shutter snaps. I enjoy the food I put into my body, especially when I’ve cooked it myself. I enjoy the feeling of my muscles straining at the gym, several times a week. I enjoy the early morning sun over the Hudson. I enjoy the relief of jumping into bed with a book or a paper after work. I enjoy the music I listen to for hours a day. I enjoy every minute I spend writing, and I spend many minutes on it every day. I’m enjoying the moment I am in right now, despite the subject that I’m about to discuss.

All of this, and yet.

I can’t be happy for 100 days in a row. I can’t be happy for ten days in a row. I can’t, except for certain very rare instances, be happy for a day.

I can be happy for an hour or a few.

And by “happy,” I don’t mean “entirely free of negative emotions.” That’s a simplistic view of happiness that few people probably subscribe to. By “happy,” I mean that the good definitely outweighs the bad. I mean feeling that your life is, basically, what it should be and that the decisions you’ve made to get to where you are have been generally pretty good. I mean feeling like you’re a good person overall, give or take a few flaws. I mean being able to wake up in the morning and feel glad that another day is starting.

I don’t know what the folks behind the 100 Happy Days project meant by “happiness” exactly, but I’m sure it’s closer to what I just described than to “entirely free of negative emotion.”

Nobody expects to be entirely free of negative emotion, so I hope that strawman is now happily burning out in the field.

I can’t be happy for 100 days in a row because my brain doesn’t work that way. The good feelings don’t “stick.” When they happen, they’re genuine and meaningful, but they wash away like words scratched into the sand. I argue against them without meaning to. That essay was shit. He doesn’t give a fuck about you. Everything about you is ugly. Your parents will die and you won’t even have the money to fly to their funerals. Your siblings barely remember what you look like because you’re never home. Your partners will leave you for real girlfriends, as opposed to the sloppy facsimile of one that you are. Everything good is temporary; everything bad is permanent.

I don’t know what the nice people who made the 100 Days website would say about this, if anything. Maybe they would say that I’m just not making enough of an effort, giving enough time, to the project of Being Happy. Or maybe they would say that they’re sorry, but this is just a fun little experiment that was never meant for People Like Me.

And there it is. It’s not that there’s anything wrong with this idea. It’s a neat idea, for certain people, for whom the biggest obstacle to being happy and satisfied with their lives is failing to stop and smell the roses.

But I can’t tell you how often I come across these things, accidentally or because a friend recommended it, and think, “Oh, right, that’s not for me.” All those self-help books, anything that addresses mood without explicitly trying it to mental health and psychology. (This one especially.) All these little projects. The mere idea of self-care.

While I know many people with mental illnesses get a lot out of self-care, and self-help, and what have you, for me personally, it’s never resonated. I’ll tell my friends that I’m sorry, I can’t go out tonight after all, because I just can’t and I’m sad and I can’t. And they’ll be supportive, they’ll say, “It’s okay, everyone needs some time to recharge and take care of themselves.” And I get frustrated and I want to tell them that NO I’m not going to “recharge” and this isn’t “taking care” of myself this is giving up and it’s NOT going to make me feel better to sit alone in my room looking out the window all night, it’s just that crying in public is inappropriate whereas crying in your room is okay, so that’s what I have to do.

For me, “self-care” and “enjoying the moment” aren’t things I do because they make me happy, since almost nothing makes me happy. They’re things I do because they help me feel like there’s a purpose to my being here. And I need to feel that way to continue to be here, because I’ve been close enough to the edge to know how slippery and ephemeral that belief can be, and what chaos breaks loose without it.

People say, “You should do what makes you happy.” They say, “I’m glad you moved to New York where you could be happier.” They say, “The most important thing is to be happy.”

Well, I have to measure my outcomes in other ways. I don’t care how much money I make (I won’t make much) or how far up on the career ladder I get (I won’t get very high) or how desirable of a person I marry (I might not marry anyone), and I can’t really be happy. What does that leave?

How many interesting and fond memories I collect. How many people I impact positively. How much and how well I write. How much I influence the causes I want to influence. Of course, it’s much harder to get a sense of these things than it is to get a sense of how happy or sad I am at any given moment.

It’s entirely possible that in a few months or years I’ll be taking this post back. Maybe happiness the way I define it is in my future, maybe one day I’ll stop bitterly regretting all the choices I’ve made and scanning communications from my friends and partners for signs of imminent departure. Maybe the view of the skyline, beautiful as it is, won’t be the best part of my day anymore, because there will be something better. Maybe the flowering trees along Broadway will be the nice little extras that push the day from good to great, as long as I remember to stop and smell them.

But if anything, all these years of feeling like my brain is a science experiment gone awry have taught me that happiness isn’t always an accurate or precise measurement of anything. When I’m achieving everything I want to achieve and I’m surrounded by loving friends and family but I still feel miserable, the failure to be happy isn’t a “sign” of anything. For me, mood is mostly decoupled from the things that are actually supposed to create happiness, whether that’s professional success or pretty flowers or whatever.

I can’t be happy for 100 days in a row, but that means nothing other than my brain doesn’t work that way. All things considered, I think I’m doing pretty okay for myself, despite and regardless of and, most importantly, because of the challenges my mind creates for me.

Disrupting Depression’s Negative Feedback Loop

[Content note: depression]

Recently I went through a spot of depression. I’m not sure if I’d call it “An Episode Of Clinical Depression” or not; when you have a personality that already meets several of the diagnostic criteria for depression and you’ve had it since your earliest memories, it can be hard to tell what is or isn’t “An Episode Of Clinical Depression.” So, I don’t really care what I call it.

The whole thing seemed to draw on a few of the recurring themes in my life: I Cannot Date Like A Normal Person; Everything Good In My Life Is Over; I Will Never Have A Real Career Or Any Money; and, my personal favorite, There Is Nothing Redeeming About Me Except My Writing Ability. (Make a note of these; they’ll be on the exam.)

Of course, objectively, everything was going pretty well for me this winter. I have great friends in NYC that I see once a week or more. School stuff was going fine. I love New York. I have a no-longer-very-new partner that I like very much and whose only significant drawback is having the misfortune of not living in New York. (Alas, not everyone can be so lucky as me.) The fact that I managed, in light of all this, to be entirely convinced of my own failure in every conceivable department (while I remained confident of my writing skills, I berated myself endlessly for underutilizing them) was the first sign to me that something was once again significantly off in my brain.

Depression is really nothing but a huge negative feedback loop. The worse I felt, the more I became convinced that I have nothing of value to offer other people as a friend, partner, or anything else. I found that I could barely stand messaging with friends online (something that’s normally my lifeline) because I felt like I had nothing to say. People would ask how my life is or what’s up or how I’m doing or whatever and I had no way to answer that question. My life is bad. Nothing is up. I’m doing shitty. And you?

My various attempts to talk about the depression itself (only when people asked, of course) generally got nowhere. Either they would be like “That really sucks, I’m sorry :(” and the conversation would end there (as it should–I don’t want to force anyone to listen to this) or they would attempt to fix me and that would fail and there would be frustration all around. A few people would listen patiently and then say very little and I had the distinct sense of over-stepping, and so I tried not to ever do it again.

To make matters even worse, I couldn’t stand hearing about their lives, either. Hearing about someone going on a date or otherwise doing romance-/sex-related things became a literal depressive trigger. One time I ended up going back and forth between crying and just being miserable for the rest of the day because someone told me that someone else we know went on a date. Not because I begrudged them their happiness at all, but just because I was entirely convinced that I would never go on a date again because for whatever reason I can’t handle going on dates. (Long story. In sum: introversion.) I also hated hearing about job-related success because I was (and remain) convinced that I will never in my entire life have a job I like OR a job that gives me enough money. I’m not even talking both, mind. Either/or. But that’s also a long story.

So, since I couldn’t talk about my own life and I could only listen to other people talk about their lives as long as they weren’t happier with those lives than me, that left me with…not a lot of conversation topics. (My other mode is RAGE ABOUT SOCIAL JUSTICE!, but I’m only okay with doing that when someone specifically starts a conversation with RAGE ABOUT SOCIAL JUSTICE! Otherwise I assume nobody gives a fuck.) And thus I ended up largely avoiding conversations. And that only made me more and more convinced that I’m broken and wrong and cannot interact with other people like a normal fucking human being, which only exacerbated the depression, which only made me more and more convinced–and so on. There was even a point when I hit rock-bottom and made a list of ways in which I’m a total worthless failure compared to one of my friends and I came up with 21 reasons. That is a lot of ways to fail. And I could’ve probably kept going.

Sometimes there is no rhyme and reason to any of this. I remain hopeful that someday researchers will understand exactly how and why it happens and how to stop it, but for now, the depressive feedback loop continues ad nauseum–until it’s suddenly interrupted. What it takes to interrupt it is something that varies from person to person. For some it’s drugs or therapy (drugs worked that way for me once a long time ago), for some it’s getting out of a situation that’s become intolerable, for some it’s finding a way to make a situation tolerable, for others it’s totally random.

For me, it was reconnection. Everything suddenly flipped around on a random day when a friend saw a sad tweet of mine and offered to listen if I wanted to talk. Knowing this friend is struggling with depression too, I told them a little bit about it and they responded kindly and helpfully, neither trying to fix me nor leaving it at “sorry, that sucks.” We didn’t talk for long, but it was enough to disrupt the depressive feedback loop. (It was also enough to make me realize that one of my major mistakes this entire winter has been attempting to discuss depression with people who do not have it. Of course that’s not going to go anywhere. They can’t possibly have any idea what the fuck I’m prattling on about.)

That day I started talking to more people. People I hadn’t talked to much for a few weeks or months, or that I’d been talking to a little bit not very authentically. I let myself believe that I am the sort of person who actually talks to people long enough to become that person again. And the more I felt like a competent and sociable person who has positive traits, the less I got insecure and anxious when people talked about their own accomplishments, and the more I was able to show genuine happiness for them, and the more I felt like a competent and sociable person who has positive traits.

And that evening, I found out that two of my closest friends are moving to New York this summer. These are the kind of friends that I feel comfortable asking to hang out when I’m feeling down, the kind of friends I’d invite to my shitty little apartment, the kind of friends I don’t need a “reason” to go see. The kind of friends that my other local friends will eventually become, but not yet.

Already the huge city felt less lonely.

Later that night I took a hot shower because why not. I could hear my phone pinging with messages from my friends. The bathroom window was open because the city was finally unfurling from its long frozen sleep, and the steam from the shower was billowing out the window into the darkening sky. I’ve often felt a strange nostalgia and comfort standing at this spot, and that night I finally realized why: my grandma’s apartment in Israel is the only other one I’ve spent lots of time in that has a bathroom window, and for a moment I felt like I could almost be back in my first home again.

The second I realized that, I suddenly knew that everything would be okay again.

To be sure, I knew that there would still be awful nights after this one and that it would probably take a long time to be as happy and hopeful as I was during my senior year of college. But every time in the past that I’ve gotten that unmistakeable “it’ll be okay” feeling, it was the beginning of a long but steady trek up and out of the ditch I’d found myself in.

I recently saw the movie Frozen (yes, just recently). A lot of things resonated with me in that movie, but in particular I liked the theme of connection. In the movie, Elsa tries to hide her magical talent (and, by extension, her entire self) from everyone around her, even the little sister she loves, in order to keep them safe from the magic and to keep it a secret. That to me sounded a lot like a metaphor for depression, whether or not it was intended to be one. I also go to certain lengths to keep people from seeing how miserable I sometimes am*, and I also do this in order to “protect” them from worrying about me, from the frustration of being unable to help, and from whatever mild or severe drop in mood they may experience upon exposure to me. Like Elsa, I ultimately fail at this.

Elsa discovers in the end (spoiler alert) that the only way to prevent her gift from consuming her and everyone around her is through connection with others, through being close to people she loves and experiencing the positive emotions that brings. Likewise for me, there is no relief from depression without connection. Locking myself away in a tower makes for a good fairytale, but not so much for a recovery.

But that’s where my story diverts from the Frozen metaphor. There is no turning my depression into a wonderful force for good that makes a big happy ice skating rink for all the villagers and a cute snowman who talks and a beautiful ice palace. I have always resisted the societal imperative to turn all adversity into a “blessing in disguise.” While I certainly learned useful things from the experience of being depressed, that doesn’t mean that depression itself has positives, at least not for me. If you’d like to view yours that way, you are of course welcome to.

For all the fuss I make about how I can’t do this or that or I totally fail at this or that (I have basically decided that I am never going on a “date” again and I have also given up on trying to find a summer internship because they’re all unpaid and I’m fucking tired of paying for public transit and for lunch every day without being paid for my goddamn work), I’m actually improving in all sorts of ways. My writing’s never been better. I’ve started writing for the Daily Dot, which demands a level of confidence I did not previously have. I’ve been starting more conversations with people online, which I don’t usually do (especially not while depressed).

And, for the first time ever, I’ve written a blog post that’s purely about myself and my life and I don’t even have the slightest urge to put a big disclaimer at the top about how this is a personal post and you probably shouldn’t read it.

That’s right, I actually don’t give a fuck if you read this post and think it’s a waste of your time. Too bad, I guess. :)

Now that I’ve gone all meta, I’ll just say this: this is not an advice post. Please don’t leave me angry comments about how suggesting that you talk to your friends more isn’t going to help. If you’re going through something that may or may not be “An Episode Of Clinical Depression,” please do whatever makes the most sense to you or seek advice from a qualified professional. But what I do think that anyone can glean from this story is that sometimes you have to find a way to disrupt the negative feedback loop somehow. The challenge is figuring out what will disrupt it for you specifically.

What I went through this winter was pretty mild compared to other depressive things I’ve gone through, so it makes sense that the solution to it was also pretty easy and simple. Letting my friends back in felt like opening the curtains and letting the sunlight back into my room after a long, dark winter.

~~~

*By the way, the fact that I write publicly about depression is not at all incompatible with the fact that I hide the worst of it. I do pretty much everything described in this perfect article about how to be a “good depressive citizen.” In fact, I’ve probably done it in this post. But I tried to circumvent that a little by letting you see a little bit if how I actually felt.

Edit: So I got curious and read the Wikipedia entry about “The Snow Queen,” the fairytale that Frozen is loosely based on. It sounds like an even better metaphor for depression than the movie:

An evil troll (“called the devil“)[2] makes a magic mirror that distorts the appearance of everything it reflects. It fails to reflect the good and beautiful aspects of people and things, while magnifying their bad and ugly aspects. The devil teaches a “devil school.” He and his pupils take the mirror throughout the world and delight in distorting everyone and everything; the mirror makes the loveliest landscapes look like “boiled spinach.” They try to carry the mirror into Heaven with the idea of making fools of the angels and God, but the higher they lift it, the more the mirror grins and shakes with delight, and it slips from their grasp and falls back to earth, shattering into millions of pieces. These splinters — some no larger than a grain of sand — are blown around and get into people’s hearts and eyes, freezing their hearts like blocks of ice and making their eyes like the troll-mirror itself, seeing only the bad and ugly in people and things.