“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.

Living With Depression: Hope

[Content note: depression and suicide]

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

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

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

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

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

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

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

That is depression.

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

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

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

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

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

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

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

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

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

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

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

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

The Letter I Didn’t Write

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

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

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

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

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

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

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

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

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

~~~

[Read more...]

Depression and the Lie of the “Real Self”

[Content note: depression and suicide]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Criticizing Psychiatry Without Throwing the Baby Out with the Bathwater

So, I read this article in The Atlantic called “The Real Problems with Psychiatry” and…I’m torn. The article is an interview with this guy Gary Greenberg, a therapist who has previously written a book called Manufacturing Depression: The Secret History of a Modern Disease and has now followed that up with The Book of Woe: The Making of the DSM-5 and the Unmaking of Psychiatry.

Now, to be clear, I haven’t read either of these books. I might, just to see the full depth of his arguments. But I decided to read the interview anyway and assume that he accurately represented his own claims in it.

Parts of the interview, I think, are really on point. Greenberg discusses the history of the DSM (the manual used to diagnose mental disorders) as a way for psychiatry as a discipline to establish credibility alongside other types of medicine. He criticizes the DSM on the grounds that the mental diagnoses that we currently have may not necessary be the best way to conceptualize mental illness, and he thinks that once we gain a better understanding of the brain we will find that they have little to do with the physical reality of mental illness:

Research on the brain is still in its infancy. Do you think we will ever know enough about the brain to prove that certain psychiatric diagnoses have a direct biological cause?

I’d be willing to bet everything that whenever it happens, whatever we find out about the brain and mental suffering is not going to map, at all, onto the DSM categories. Let’s say we can elucidate the entire structure of a given kind of mental suffering. We’re not going to be able to say, “here’s Major Depressive Disorder, and here’s what it looks like in the brain.” If there’s any success, it will involve a whole remapping of the terrain of mental disorders. And psychiatry may very likely take very small findings and trump them up into something they aren’t. But the most honest outcome would be to go back to the old days and just look at symptoms. They might get good at elucidating the circuitry of fear or anxiety or these kinds of things.

I don’t know if he’s right. But I suspect that he might be.

He also makes a great point about the fact that we often assume that anyone who acts against social norms, for instance by committing a terrible crime, must necessarily be mentally ill:

It’s our characteristic way of chalking up what we think is “evil” to what we think of as mental disease. Our gut reaction is always “that was really sick. Those guys in Boston — they were really sick.” But how do we know? Unless you decide in advance that anybody who does anything heinous is sick. This society is very wary of using the term “evil.” But I firmly believe there is such a thing as evil. It’s circular — thinking that anybody who commits suicide is depressed; anybody who goes into a school with a loaded gun and shoots people must have a mental illness.

Greenberg also discusses how mental diagnoses have historically been used to perpetuate injustice, such as the infamous “disorder” of “drapetomania,” which was thought to cause slaves to try to escape their masters, and the fact that homosexuality was once considered a mental illness (and other types of sexual/gender variance still are).

He also talks a lot about how the DSM and its categories are tied in with all sorts of things: scientific research and mental healthcare coverage, for instance:

To get an indication from the FDA, a drug company has to tie its drug to a DSM disorder. You can’t just develop a drug for anxiety. You have to develop the drug for Generalized Anxiety Disorder or Major Depressive Disorder. You can’t just ask for special services for a student who is awkward. You have to get special services for a student with autism. In court, mental illnesses come from the DSM. If you want insurance to pay for your therapy, you have to be diagnosed with a mental illness.

The point about needing a DSM diagnosis in order to receive insurance coverage is really important and cannot be overstated (in fact, I wish he’d given it more than a sentence, but again, he did write books). As someone who plans to eventually practice therapy without necessarily having to formerly diagnose all of my clients, this matters to me a lot, because it may mean that I might have to choose between diagnosing and working only with clients who can afford therapy without insurance coverage (which, at at least $100 per weekly session, would really not be many).

But sometimes Greenberg makes a good point while also making a terrible point:

One of the overlooked ways is that diagnoses can change people’s lives for the better. Asperger’s Syndrome is probably the most successful psychiatric disorder ever in this respect. It created a community. It gave people whose primary symptom was isolation a way to belong and provided resources to those who were diagnosed. It can also have bad effects. A depression diagnosis gives people an identity formed around having a disease that we know doesn’t exist, and how that can divert resources from where they might be needed.

First of all, we don’t “know” that depression “doesn’t exist.” We know–or, more accurately, some of us suspect–that the diagnosis we call “major depression” might not map on very accurately to what’s actually going on in the brains of people who are diagnosed with it. What we call “major depression” is a large cluster of possible symptoms, and since you only have to have some of them in order to be diagnosed, two people with the exact same diagnosis could have almost completely different symptomology. Further, because depression can vary like a spectrum in its severity, the cut-off point for what’s clinical depression and what’s not can be rather arbitrary. It’s not like with other types of illnesses, where either you have a tumor or you don’t, either you have a pathogen in your bloodstream or you don’t.

Second, Greenberg doesn’t seem to extend his analysis of the effects of the Asperger’s diagnosis onto other disorders. There is absolutely a community of people who have (had) depression, eating disorders, anxiety, and so on. Those communities are absolutely valuable. My life would be demonstrably worse without these communities. They haven’t “diverted resources” from anything other than me wallowing in self-pity because I feel like I’m the only person going through these things–which is how I used to feel.

Right after that:

What are the dangers of over-diagnosing a population? Are false positives worse than false negatives?

I believe that false positives, people who are diagnosed because there’s a diagnosis for them and they show up in a doctor’s office, is a much bigger problem. It changes people’s identities, it encourages the use of drugs whose side effects and long-term effects are unknown, and main effects are poorly understood.

Greenberg is correct that false positives are a problem and that diagnosing someone with a mental illness that they do not have can be very harmful. However, his dismissiveness of the problem of false negatives–people who do have mental illnesses but never get diagnosis or treatment–is stunning coming from someone who is a practicing therapist. Untreated mental illnesses are nothing to mess around with. They can lead to death, by suicide or (in the case of eating disorders) otherwise. Even if things never get to that point, they can ruin friendships, relationships, marriages, careers, lives. While I get that Greenberg has an agenda to push here, some acknowledgment of that fact would’ve been very much warranted.

In short, Greenberg seems to make the logical leap that many critics of psychiatry and the DSM do; that is, because there is much to criticize about them and because it’s unclear how valid the DSM diagnoses are, therefore depression is “a disease that we know doesn’t exist” and antidepressants are harmful (that’s a whole other topic, though).

Antidepressants may very well be harmful. Diagnostic labels may also very well be harmful, for some people. But I think the stronger evidence is that untreated mental suffering is harmful, and sometimes therapy just isn’t enough and cannot work quickly enough–for instance, for someone who is severely depressed to the point that they can’t possibly use any of the insights they may gain in therapy, or to the point that they are about to commit suicide.

I hope that one day we’ll have all the answers we need to minimize both false negatives and false positives. But for now, we don’t, and I worry that attitudes like Greenberg’s may prevent people from getting the help they urgently need, as much as they may simultaneously promote vital criticism and analysis of psychiatry and the DSM.

~~~

Note: I didn’t fact-check everything Greenberg said in the interview because I’m hoping that The Atlantic employs fact-checkers. But if you have counter-evidence for anything in that article, even parts I didn’t quote here, please let me know.

Living With Depression: Strength

[Content note: depression]

Half a year ago I started a series of posts about living with depression in order to help people understand what it’s like to have it beyond just the DSM symptoms that you always hear about. Then I moved to FtB and got super intimidated and didn’t want to write it anymore. But now I have writer’s block and I’m feeling too overwhelmed by everything going on in the world so I’m going to write about myself.

It’s not meant to reflect anyone’s experience but my own, although I’m sure plenty of people will identify with it. If things were completely different for you and you feel comfortable sharing, the comments section’s all yours.

The two previous posts, if you’re curious, were about trust and openness.

For many people, both sufferers and non-, depression is primarily a lack of strength.

Emotional strength, that is. When you hear people call depression a “weakness,” consider the fact that the opposite of “weakness” is “strength,” and you’ll see exactly what they think is lacking in those who suffer from it. Of course, enlightened as depression sufferers supposedly are about their own illness, most of us fall into the same trap at some point.

Because on the surface, depression really can look like a lack of strength. For many years, at the slightest sign of misfortune or difficulty–a bad grade, a rude remark from someone–my entire mental composure would crumple like a dry leaf you crush in your hand. Imagine going to the gym and trying to lift one of the lightest weights they have, but you drop it and collapse in a heap on the floor. That’s approximately the physical equivalent of how it feels, with all the humiliation and self-blame involved.

In reality, of course, it has nothing to do with weakness or strength. It’s an illness. It’s not your fault. (It’s not a “chemical imbalance,” by the way, as someone would usually say right about now, but it’s not a weakness either.)

But, honestly, most days I can’t internalize that knowledge, no matter how many courses I take and articles I read. I feel weak.

Anyway, my solution to this for a while was to try to present a false persona that is strong, competent, and detached. I spent a lot of time furiously pretending not to care about things, because that’s what I thought strength was. It never worked. I’m sure people saw through it, and besides, the thing with depression is that often you can’t fake your way out of it. The pain and emotions it causes are too powerful to hide. It’s like the difference between not letting it show on your face when you’ve stubbed your toe, and not letting it show on your face when you’ve fractured your leg in three places. People are gonna be able to tell. No matter what.

And that inability to hide what I felt was private, shameful, and weak was probably the worst way I’d ever felt like I failed myself. Worse than not liking college, worse than having to drop journalism, worse than not getting (or having to decline) a slew of coveted internships and other opportunities. In the endless parade of personal failures to which I am a constant, unwilling spectator, failing to be “mentally strong” is the absolute worst.

So what about physical strength, then?

It’ll probably come as no surprise (as I’m sure I’m far from the only person who does this) that I use physical strength and competence as a way to distract from and make up for the emotional strength that, despite everything I know about depression, I still feel I do not have.

I’ve been doing that for as long as I can remember. I used ballet that way when I used to dance, from when I was 6 years old until I was 15. Then I switched to marching band, which you may think isn’t hard until you’ve done it. During the off-season I’d bike or walk pretty long distances or go to the gym or exercise at home. Of course, all that was irrevocably tainted by the fact that I had massive body image issues and eating habits that at times were very unhealthy, but I do remember the difference between wanting to lose weight and wanting to be strong. I haven’t always wanted to lose weight, but I’ve always, always wanted to be strong.

(Of course, physical strength is a gendered trait, and the gender that we usually associate it with is male. That means that we think of physical strength as being able to lift a whole lot of pounds–with your arms, that is–and it means that my male friends scoff at how pathetically I compare to them in that department. Of course, I just smile and roll my eyes, because I’d love to see them sit calmly in the splits for 15 minutes while reading a book, or twirl on the toes of one foot. Whatever.)

Partially, I like being strong for the same reasons anyone else does–it feels good, it’s useful, it keeps you healthier. But also, it allows me to shape my body in the way I’ve never managed to shape my mind. Getting physically strong requires a lot of effort, sure, but everyone knows exactly how it’s done. I don’t know how to stop being so emotionally nonresilient. I only know that sometimes I go months without any problems, and then suddenly, for no reason, I start crumpling again.

Muscles don’t work that way. You work them out, and they get stronger. You don’t work them out, and they eventually get weaker. You know which exercises work out which muscles. You know that if muscles are sore, you gave them a good workout. (I say this as I can barely walk for the third day in a row because of this thing I did with my calves, so there ya go).

If I were able to afford a therapist who could actually help (as opposed to the ones that I’ve had, who did not), maybe I’d eventually become emotionally strong. But for now I’ve mostly given up. The only thing that works when I feel weak is simple distraction, but the more tired and overwhelmed I am and the more mental effort I’ve already exerted on other things, the harder distraction gets.

But when I feel strong physically, it makes up for not feeling strong emotionally. Just a little bit.

Lessons I Learned From Depression

[Content note: depression]

People struggling with mental illness (or any sort of illness, or anything crappy, really) are constantly exhorted by well-meaning people to find the “silver lining” in their experience. This often takes the form of tropes about “learning who your real friends are” or “learning how to fully appreciate life” or “understanding what’s really important in life” and on and on.

For a long time I resisted the entire notion of finding “lessons” or “learning opportunities” in my decade-long struggle with depression. (Yes, decade-long. Yes, I’m 22.) Part of this was because the people who demanded that I do so were just so damn annoying, frankly. No, I will not spin you a convenient story about What Depression Has Taught Me to make you feel better when you see my tears or my scars.

But mostly I resisted because I felt that admitting that I’ve learned things from this experience requires intentionally forgetting the fact that most of it had no meaning. There is no meaning to losing half of your life to something you can’t even see or prove to people or sometimes even describe in words. There is no meaning to having most of the memories of your life discolored, blurred, and tainted by a misery and terror that had no name. This is not the stuff of inspirational memoirs or films. While some people suffer for political causes or for their children or in order to produce a great work of art, I suffered for absolutely no reason at all.

But, of course, I did learn some things. Maybe I would’ve learned them even if I’d had a more normative emotional experience, but right now it really seems like I learned them as a result of being so miserable a lot of the time. And while I reserve a very special fury for those who implore us to create meaning out of meaningless suffering and produce “lessons” and “silver linings” and “bright sides” carefully repackaged for their consumption, I think these are lessons that are worthwhile to share.

I am not my GPA, weight, debt, scars.Lesson 1: Not everything your brain tells you is accurate.

Most people, I think, go through life without giving much thought to whether or not their perceptions are providing them with the most accurate possible picture of reality. But sometimes our brains are pretty crappy at this. Of course, I would’ve learned that without the help of depression, because I study psychology. So I’ve known for a while about stuff like the fundamental attribution error, the halo effect, anchoring, confirmation bias, the Dunning-Kruger effect, the false-consensus effect, the just-world hypothesis, in-group favoritism, the hot-hand fallacy, the Lake Wobegon effect, status quo bias, and all sorts of other biases, fallacies, and errors.

But what really brought it home was depression. While the cognitive errors I’ve listed are generally adaptive and keep people happier, depression was the opposite. Instead of telling me that people like me despite evidence to the contrary, my cognitive distortions told me that everyone hates me despite evidence to the contrary. Rather than telling me that I’m above-average in most things, they told me that I’m below-average in most things. On any given day I would invariably feel like the stupidest, ugliest, least likable, most worthless person alive. True story.

At some point it occurred to me that I would never recover if I didn’t learn how to treat what my brain said with a healthy amount of skepticism. So I started to. (Perhaps not coincidentally, this was the time in my life when my political views evolved the most, because I also started challenging my knee-jerk reactions to various issues in our society.) Of course, this is a lesson that is not limited to folks with mental illnesses, because everyone’s brain does this to them at some point. For many people, including some of those who proudly label themselves “skeptics,” thinking critically about what happens inside one’s brain does not come nearly as easily as thinking critically about what happens out there in the world.

So, for me, this meant a lot of time spent repeating to myself, “Yes, I feel like Best Friend hates my guts, but that’s just a feeling and it’s not necessarily true” and “Yes, not getting that internship makes me feel like I’m a complete failure who will never amount to anything in her chosen field, but that’s just my brain lying to me again” and “Yes, Partner wants to see their friends rather than me tonight, but this doesn’t mean that Partner doesn’t care about me and doesn’t want to keep seeing me anymore.”

Pause, rewind, repeat, and there you have my recovery.

Lesson 2: Your feelings are valid.

Does this seem like a contradiction to the previous lesson? It’s not. Unfortunately, when confronted with the apparently irrational emotions of others, many people immediately jump to the conclusion that those emotions are WRONG. (These people should never try to be therapists.)

However, just because someone’s emotions do not seem like a “rational” response to what they’re going through, that doesn’t mean there’s no reason for them. That reason can be whichever complicated and still-misunderstood brain processes cause depression. It can be that those are the emotions they saw expressed in their families growing up, and learned to mimic at an early age. It can be that last time this sort of thing happened, it ended terribly and now they’re freaking out over this seemingly minor thing because it could end that badly again. It can be that what’s currently happening to them is reminding them of something else entirely.

Or it could be for any number of other reasons that you do not know, and that the person having the “irrational” feelings might not know either. So why assume?

It’s important to remember, too, that there tends to be a pattern to the emotions we decide are “irrational” and “inappropriate” in others. Anger from a woman or a person of color is perceived differently than anger from a white man. Sadness from a woman is perceived differently than sadness from a man. Archetypes like the Angry Black Man and the Hysterical Woman are sometimes so deeply ingrained that we don’t even notice ourselves applying them.

But all emotions are valid. Some are less adaptive than others, some we want to change, some can contribute to unacceptable behavior if we don’t address them, yes. But they’re all valid, and telling others (or ourselves) that some emotions are not okay to have doesn’t help in changing them.

Lesson 3: Sometimes you have to keep your mental health in mind when making decisions.

This is the one I’ve resisted the most. I had to quit studying journalism because it was giving me panic attacks, and I chose not to pursue a PhD in part because I didn’t think I could handle it emotionally (well, and because the thought of it just bored me). When it comes to my personal life, my mental health is a big part of the reason I gave up monogamy, although I’m now glad I did for many other reasons. It’s also part of the reason I never studied abroad, gave up many other opportunities, and chose to move to NYC.

When I first started to realize that mental health is a factor that I need to consider when making decisions about my academic, professional, and personal life, I felt abandoned and betrayed by my own brain. I understood intuitively that sometimes you can’t do things because they require physical traits or abilities that you lack or because you don’t have the cognitive skills or because you just lack access to those opportunities. But to have all those things and still give something up just because my brain doesn’t like it? That seemed ridiculous.

In fact, that way of thinking is just an extension of the stigma of mental illness. Just as we think that mental illness isn’t really “real,” we think that mental health isn’t really important. It’s reasonable, we think, to choose not to live in Florida because you can’t deal with the weather or to choose not to go running because it’s too hard on your knees or to choose not to be a physicist because you can’t do math worth a shit, but not getting a PhD because grad school would make your depression relapse? Not being a journalist because interviewing people gives you panic attacks? Not studying abroad because being away from people you love makes you suicidal? What the hell is up with that. Just deal with it.

So for a long time I did stuff that made me miserable because I was fighting so hard against the notion that mental health is something you need to take care of and cultivate, just as you would with your physical health. But one of the most important things I’ve learned how to do in college is knowing when to say “no” to things that sound fantastic but might break down the levees I’ve built up to keep the depression from flooding in.

Of course, sometimes it still makes me furious. I recently gave up a great opportunity for that reason; I badly wanted to do it but every time I thought about actually doing it, and the sacrifices it would entail, I broke down, sobbing, paralyzed, unable to say yes or no to it. Eventually I finally turned it down, full of resentment at myself and my useless brain, but trying to understand that my reason was a good one and that I deserve permission to make this choice.

Now, naturally, there are those who would tell me to Just Do It! and Get Out Of Your Comfort Zone! and blabbityblahblah, but those people will just have to trust me when I say that I know the potential dangers much better than they do. Mental illness is a whole ‘nother ballgame. When I want to Get Out Of My Comfort Zone! I try getting to know someone new or reading something I disagree with that makes me a bit uncomfortable. When I move to NYC, I can Get Out Of My Comfort Zone! by joining new groups or going to events where I don’t know people and seeing what happens.

That’s getting out of my comfort zone. Ignoring the fact that I have important needs when it comes to my mental health, though, is not “brave” or “spontaneous” or “gutsy.” It’s just irresponsible, just as it would be irresponsible go ride a motorcycle without a helmet or to not wash my hands during flu season.

So give yourself permission to treat your mental health with the care and concern it deserves. Of course, you might be aware that doing something could make your mental health worse and choose to do it anyway for any number of reasons, and that’s completely fine, too.

But so many of us struggle merely to accept the idea that it’s okay not to do things for the sole reason that they might worsen our mental health, and that’s something we have to overcome.

It's okay not to be okay.