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.

Yes, We Need Psychiatric Labels

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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