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.

What This Depression Survivor Hears When You Call Religion A Mental Illness

[Content note: mental illness, suicide, abuse]

Some atheists love to compare religion to mental illness, or directly call it one. I won’t link to examples; it’s pervasive and has probably happened on this network.

While there may be some useful parallels between mental illness and certain types of religious experiences, calling religion a mental illness in the general sense is a clumsy, inaccurate, alienating thing to say.

This is a list of things that go through my head, things that I hear when I hear atheists calling religion a mental illness. I’m speaking only for myself here. My experience of having depression informs some of these opinions, but so does my knowledge of psychology, my experience working with people who are struggling, and my understanding of what being religious is like and what draws some people to religion.

Some of these may seem contradictory. That’s because they are. Atheists who compare religion to mental illness may do it in various ways and with various meanings. They may do it in a “logical,” intellectualizing sort of way, or they may do it in a spontaneous, ridiculing sort of way. It can be “Religious people are victims of mental illness and need our help” or it can be “LOLOL go see a shrink for your stupid sky daddy delusions.” What I hear when I hear you calling religion a mental illness depends on the context.

“Nobody in their right mind would ever choose to observe a religion.”

Calling religious people mentally ill suggests that they do what they do because they’re “crazy.” I get that religious beliefs and rituals may seem bizarre to atheists who have never had any desire to hold those beliefs or perform those rituals. Sometimes when I’m at religious Jewish functions I sort of look around myself and feel like a bit of an alien. This is so weird, I think. Why would anyone do this?

A major component of mental illness is that it is maladaptive. People with OCD sometimes can’t function because they can’t stop performing their rituals or thinking about their obsessions. People with depression sometimes can’t get out of bed, shower, talk to people, go to work for weeks or months at a time. People with schizophrenia sometimes lose all sense of the distinction between reality and fantasy.

Religion can be maladaptive when taken to extremes, but that’s a problem with the manifestation, not with the core component: believing in a god. In and of itself, believing in a god can actually be very adaptive. When people feel like they have no control over the universe, when they lose someone they love, when a grave injustice happens, it can be comforting to believe that there’s someone up there pulling the strings. It’s not comforting to me, personally, but to many people it is. That doesn’t make their beliefs accurate, but it does make them understandable. You don’t have to be “crazy” to want to believe in a religion.

“Your religious friends may seem happy and well-adjusted, but they’re actually sick just like you are.”

We often hear about people who are restricted, cut off, or even abused by their religion. These cases are tragic and deserve every bit of the attention that they get. But what about all the people living happily with religion?

Atheists who claim that religion is a mental illness seem to be saying that these people are just kidding themselves. Sure, they’re happy, but that happiness can’t be real because it’s the product of a mental illness. Or they think they’re happy, but they’re really not.

If this is what you believe about religious people, ask yourself why you think you know more about their mental state than they themselves do.

“I consider myself qualified to diagnose millions of people I’ve never met with a mental illness.”

Armchair diagnosis is a bad idea. It promotes the idea that mental illness is whatever we feel on a whim that it is, and that random internet commenters are qualified to determine whether or not someone has a mental illness despite never having even spoken to them, let alone spent time with them in person as a diagnosing psychologist would.

“Whether or not I think someone is mentally ill is more important than whether or not they think they’re mentally ill.”

And in addition to that, the fact that probably zero religious believers think that their religion qualifies as a mental illness is a good indication that you should stop saying that it is. Of course, you can and should disagree with them on other things, external things, like whether or not god exists or whether or not religion is a net good in society or whether or not people can be ethical without religion. But what goes on in their own minds is something they know much more about than you ever will.

“People who say their faith helped them deal with their mental illness are just kidding themselves.”

Can’t fix a mental illness with another mental illness, right?

This is a tricky area because I do think it’s very fair to question the presumption that religion helps people with mental illness in general. First of all, people (religious and not) with mental illnesses are often told that they need to pray or “have faith” or repent or whatever, because some religious people believe that mental illness is a sign of insufficient faith or a punishment from god or both. Second, some religious people find that religion actually makes their illness harder to cope with, whether because of these responses or other factors. Some people may even become more vulnerable to mental illness as a result of something their religion taught them, such as shame or a preoccupation with doing things a certain way.

However, there are also many people who say that religion helped them cope with their mental illness, whether it was the faith itself, a supportive religious community, or both. I do not feel comfortable claiming that these people are lying to themselves or to us.

I wish that people didn’t need faith to cope. I wish we had foolproof treatments for mental illness. I wish everyone had access to those treatments. I wish we never had to send patients home saying that we don’t know what else to do for them. I wish we knew exactly what–which genes, which environments, which neurotransmitter deficiencies–caused mental illness, so that nobody ever had to feel like it was either a random accident of chance (terrifying) or an act of god (slightly less terrifying, for some people).

But right now, we don’t have any of that. So it makes sense that some people would cope by telling themselves that it’s part of god’s plan and that they can’t possibly comprehend that plan.

I want people to be happy and alive. That’s my first priority. Once they’re happy and alive, I can think about trying to get them to think more rationally and scientifically. If thinking irrationally and nonscientifically is what keeps someone from suicide (or from a miserable life), I accept that.

And as far as the community aspect goes, having a strong support system can be both a protective factor against mental illness and also a mechanism that helps people cope or recover. Building humanist communities is extremely important for all kinds of reasons and this is one of them. We’re making progress, but humanist communities still don’t have the scope or resources of religious ones. There are also still plenty of atheists publicly decrying these projects and boasting about how they don’t need them and such things are useless and pseudo-religious and for the weak-minded. That’s harmful. If a religious person feels that their church or synagogue is the only source of support they have for their mental illness, they might not necessarily be wrong.

“Religious beliefs are inherently bad and harmful to the individual, just like the distorted thoughts associated with mental illness.”

Some people, such as Greta Christina, have made powerful, compassionate arguments for the idea that religious belief is universally, intrinsically harmful to society, separate from the harmful effects that organized religion can have. I’m not sure yet how I feel about these ideas, but I’m still much more comfortable with the opinion that religious belief does harm to other people and to society as a whole than that necessarily does harm to the individual who holds it.

Most religious people would probably say that their religion helps them be happy, charitable, kind, and strong. I may feel skeptical about this, but they know better than me.

On the contrary, the symptoms of mental illness are very, very clearly harmful in a way that is undeniable. While people with mental illnesses may sometimes deny that there is anything wrong, they are often clearly unhappy, and their denial is often caused by fear of the stigma of mental illness. (All the same, though, if someone tells me they are not mentally ill, I would never argue with them.)

“All mental illness means is having irrational thoughts or believing something without evidence, and it is possible to completely stop having irrational thoughts.”

I hate to break it to you, but irrationality is probably part of the human condition. Everyone is, to some extent, subject to cognitive biases. Almost everyone at one point or another engages in superstitious, fantastical thinking. Clearing your mind of irrational beliefs that aren’t based on evidence is something that can only be accomplished intentionally, with effort. Even then, you will never be perfect. There’s a reason the popular rationality site Less Wrong is called Less Wrong, not Perfectly Right or Not At All Wrong.

So if being irrational is a sign of mental illness, then we are all mentally ill, atheists included. But more likely, (extreme) irrationality is only one component of mental illness. Others might include engaging in behaviors that are harmful to oneself, behaving in ways that are not considered normative in that particular cultural context (a problematic criterion, but a useful one when used in conjunction with others), being unhappy with one’s mental state, and not being able to function properly in one’s daily life.

“My desire to make a point is more important than what the psychological evidence says about religion and mental illness.”

To put it simply, the processes that lead people to be religious are not the same ones that lead them to be mentally ill. As I mentioned above, religious belief is a subset of the sort of irrational thinking to which all humans are prone. Humans look for patterns in the world and easily form superstitions on the basis of those patterns. Humans also generally enjoy the feeling of being part of a group or having a community, and religion is an easy way for a lot of people to experience that feeling. Many people who are religious were born into religious families and were taught that god exists and [insert religious tenets here] from birth, so it sticks.

On the more abusive end of things, people may stay in harmful religious sects or communities for similar reasons as they stay in abusive relationships. They are made to feel by their abusers that they will never be complete without the faith. They are taught that they will go to hell forever if they leave. They are made to feel worthless and powerless. They are told that people outside of the religious communities are bad people.

Being affected by abuse does not mean you’re mentally ill. It means that someone who knows how to take advantage of people took advantage of you. Furthermore, religion is but one of many props people can use to abuse and control each other.

On the contrary, mental illnesses have substantial genetic and biological components to them. Studies on identical twins, including ones reared apart, have demonstrated fairly high concordance rates for some disorders. While the chemical-imbalances-cause-depression theory has now been shown to be drastically oversimplified, mental illnesses clearly do have some sort of neural causes, triggers, and effects. Mental illnesses are often (but not always) triggered by major stressful life events; they can occur when an individual goes through hardship with which they are not psychologically equipped to cope.

Unlike religion, mental illnesses are not taught to people by other people; they tend to occur when genetic/biological susceptibility lines up with stressful environments or adverse life circumstances. Unlike religion, people do not try to remain mentally ill so that they do not lose their support systems or because they are afraid of what would happen if they stopped being mentally ill. They remain mentally ill until they receive proper treatment, or until the illness remits on its own. Unlike (non-abusive) religion, people do not have a choice whether to stay or leave. Those who suffer from eating disorders, substance abuse, or OCD may claim or genuinely feel that they have a choice, but they actually don’t, and that becomes evident as soon as they try to stop. Yet countless people voluntarily leave religion every day. That doesn’t sound like a mental illness to me.

“You chose to have your mental illness, just like people choose to be religious.” 

Some atheists who make this comparison believe that having religious beliefs is a choice (and abandoning them would also be a choice). If having the symptoms of a mental illness is a choice, what does this say about the rest of us?

“Mental illnesses (like religion) can be cured by making fun of people’s irrational beliefs and shaming them on the internet.”

Normally recovering from a mental illness requires therapy, medication, a strong social support system, or some combination of those. I rarely see atheists agitating for better mental healthcare services for religious people to help them deconvert. In fact, providing people with the resources they would actually need to leave religion (as opposed to simply telling them they’re wrong over and over again) is not a major focus of very many atheists. Of course, I would be remiss not to mention the work done by groups like Recovering From Religion and the Clergy Project. But I also haven’t personally witnessed anyone associated with these groups claiming that religion is a mental illness.

“Religious people can’t be held responsible for their beliefs; they’re just victims of an illness.”

If you do agree that mental illness is not a choice, however, that implies that being religious is not a choice either. That implies that religious people do not have agency over any part of their religious belief or observance. Not only is this offensive to religious people, but it actually suggests that we shouldn’t hold them responsible for their beliefs. You wouldn’t blame a person with anxiety for feeling anxious, would you?

“I don’t care about mental illness unless it’s religion.”

Relatedly, better mental healthcare is not a major concern of many atheists (the ones who don’t have mental illnesses, that is). It really should be. Mental healthcare is stymied by both religion and pseudoscience, and advocating for more research, funding, and concern in this area is a project that I think would be of great relevance to the secular movement. But the only time I see most atheists bringing it up is when the “illness” is religion. What about the 25% of American adults who will suffer from an actual mental illness (or more than one) at some point in their lives?

“Mental illness is bad and shameful; that’s why I’m using it to disparage religion.”

Sometimes when I see the religion-mental illness comparison being made, it’s being done in a way that is clearly meant to ridicule and put down. Atheists frequently employ language that stigmatizes mental illness to refer to religious people, such as “crazy,” “insane,” “nutcase,” and so on. Even when you’re not using such clearly hurtful language, though, you can still be perpetuating stigma by saying that such-and-such Islamist “belongs in a mental institution” or that such-and-such fundamentalist Christian “needs to see a shrink.”

If you think religion is horrible and then you compare it to the condition I have, how am I meant to think you see me?

“You are a rhetorical prop for me to use to disparage religion.”

And that’s why I feel like people with mental illnesses are being used as convenient stand-ins when someone wants to diss religion. I feel like our suffering is just a tool for you to pull out of the antitheist toolbox when you need it. “Look how stupid religion is! It’s just like a mental illness!” you say. My depression is not at all like a religion. Unlike a religion, I didn’t choose it. Unlike a religion, it has never provided me with rituals and communities. Unlike a religion, it was not something taught to me by people, not something I could’ve avoided. Unlike a religion, it can’t go away no matter how many times you tell me I’m wrong. Unlike a religion, it has no positive effects, ever. Unlike a religion, my depression didn’t just make me empirically wrong about certain things; it broke my entire life into pieces and took away my ability to enjoy anything. Please stop using that awful legacy to score cheap points against religious believers.

“Attacking religion is more important to me than being inclusive and supportive of atheists with mental illness.”

I tell other atheists over and over again that this is hurtful, inaccurate, and completely pointless. And over and over again, despite the massive support I get in these comment threads from other atheists with mental illnesses, they insist on using this stigmatizing, alienating language. They ignore our knowledge of psychology and mental illness and continue to claim, against the evidence, that religion can be categorized as a form of mental illness. Rather than diving in and learning more about how mental illnesses are defined and which mental processes contribute to religiosity, they refuse to let go of this rhetorical tool.

I don’t think that’s a coincidence. I think that deep down many people think so poorly of people with mental illnesses that they know how effective it can be to compare anything you think is bad to a mental illness. It happens all the time.

But considering how many people I know in this community who are diagnosed with a mental illness, I would cautiously say that maybe you shouldn’t keep alienating us. I’m just one person, but I have serious qualms about working with an atheist leader or organization that holds the view that religion is a mental illness. I doubt I’m the only one.

Find a better argument. Find one that is accurate, first of all, and that stomps on as few already-marginalized people as possible.


Moderation note: I have finals this week and am unlikely to be around to answer every single question and argument I get. I will moderate strictly for comments that stigmatize mental illness, though. If this piece sets off lots of debates in the comment section, hopefully they can flow smoothly and somewhat productively without much input from me.

“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.

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.