mental illness

Everyone Should Go to Therapy

Miri, , , , , , 10 Comments

Recently I wrote a post about why some people might choose psychiatric medication over seeing a therapist. (Fine, so it wasn’t that recent. >.<) I promised a followup post about a belief that I hold concurrently–everyone should see a therapist.

Now, before everyone freaks out, let it be known that I say “everyone” only in the most theoretical of ways. Meaning that, I recognize that as things are today, what I’m proposing isn’t really possible. But in the Happy Fun Miriam Land of the future, where stigma against mental healthcare is gone, insurance coverage is reasonable and available to the majority of people, and research has identified effective therapeutic interventions for most mental problems, everyone should and would be able to go to therapy.

For now, I’ll qualify what I’m saying with this: if you are able to see a therapist, you should, and if you are able to take your children to see a therapist, you should.

Why?

Well, why do we have regular dental and physical checkups? Why do children receive vaccines? Why do we make an appointment with a doctor when we think we’re coming down with something serious?

Hopefully the answers to those questions are self-evident.

Clearly, it is acceptable–and even expected–that people seek two types of healthcare throughout their lives: preventative and palliative. We should see a doctor regularly to make sure that nothing’s going seriously wrong with our bodies, and we should see a doctor when we suspect that something IS going seriously wrong with our bodies.

This much isn’t in dispute. But what about our minds?

For the most part, people wait until things are really, REALLY wrong with their mental state before they go see a psychologist. (And some don’t go even then, but that’s a different story.) For instance, I didn’t see a psychiatrist for my depression until I wanted to kill myself. People with eating disorders typically don’t receive care until they’re dying, or close to it. People with anxiety issues don’t get help until their anxiety is preventing them from having any semblance of a normal life.

Like most physical maladies, mental illnesses don’t just come out of nowhere. They usually develop from years and years of poor coping strategies and maladaptive beliefs. For instance, I remember being as young as 6 and constantly thinking that everyone secretly hates me, nobody wants to be my friend, and everyone’s talking behind my back. Guess what? When I was 18, I still basically believed that. Except by then, my beliefs had become self-fulfilling prophesies, and they had reinforced themselves until it became nearly impossible to get rid of them. Wouldn’t it have been so much easier if a child psychologist had helped me get over them 15 years ago?

My little brother, age 10, thinks he’s ugly. He has adorable curly hair, itty-bitty freckles on his face, and beautiful blue eyes. He’s thin and athletic, but thinks his stomach is fat and sometimes does crunches in his room. He hasn’t really learned how to make friends yet, and he has nobody to teach him. As a result, he thinks nobody will ever want to be his friend, and he chooses to brag and show off for attention rather than try to make other kids want to be his friends.

My brother does not have depression, an eating disorder, or even–believe it or not–a serious case of narcissism. What he also doesn’t have, however, are effective mental tools for interpreting the world and for being happy. And he’s not going to find these tools on his own.

What if, in addition to physical checkups to make sure that kids’ bodies are developing correctly, that they’re learning good hygiene, and that they’re eating well and exercising, we also had regular mental checkups to make sure they’re developing good mental habits?

Clearly, not everybody is going to need constant mental healthcare like I do, and like everyone else with a serious mental illness does. Most people would be totally fine checking in with a trusted family therapist every once in a while. But others, like my brother, would seriously benefit from catching the problem before it mushrooms into the sort of thing that I went through.

Even if people never do develop diagnosable mental illnesses, unhappy children often grow into unhappy adults. Ever had a boss who made your life miserable by demanding constant ass-kissing to protect her fragile ego? Ever dated a guy whose fear of commitment destroyed the relationship? Ever had a bully in high school whose inability to relate to others in a positive way greatly affected your own life?

These people have psychological issues. I’m not saying that in a degrading way at all; many people have issues. But because most people don’t think that they should see a therapist unless they want to off themselves, people like these usually don’t get help.

Although I strongly despise the mindset that people with mental problems should be treated as personal inconveniences, the fact is that people do affect each other emotionally. Imagine if every time someone got a contagious illness, all they could do was just continue going about their daily lives until it passed, infecting everyone they came into close contact with. Luckily, that’s not how it works; most people go see a doctor when they realize they’ve come down with something. What if people did the same for mental problems?

I think that’d be a much more pleasant world to live in.

And I promise I’m not just saying that because I’m going to be a therapist and want money.

Everyone Should Go to Therapy
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Storytelling

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(Or: Massive Annual New Year’s Eve Note, Vol. 5)

[TMI Warning]

Many psychologists believe that it’s not what happens to us that matters, it’s the stories we tell ourselves about what happens.

Some people unfortunately interpret this to mean that we ought to “look on the bright side of life” and “find the silver lining” and all that crap.

I don’t really see things that way. Never have. Life sucks a lot of the time, and anyone who tells you otherwise is either stupid, in denial, or trying to sell you something.

But I have learned, over the past year, how powerful personal storytelling can be. This was the year I took a lot of pain and turned it into a force of energy.

~~~

A year ago, I thought I was done with this whole depression thing forever. That didn’t turn out to be the case. It came back almost as soon as the new year started, worse than ever before, seemingly undefeatable.

This has been a painful year. People hurt me this year. They lied, broke my heart, used me, and took my friendship for granted.

I was alone a lot, more alone than ever before. In fact, I spent most of the summer alone in New York. It was a fantastic experience, but a lonely one nonetheless.

It was hard, a lot of the time, not to think about all the ways depression limits me. If I didn’t have it, everything about my life would be different. I’d be outgoing, I’d go to parties, I could stay up late and take harder classes. I wouldn’t be so tired all the time, I wouldn’t have such a hard time talking to people, and, of course, I wouldn’t be so sad.

But sometime over the course of this year, I stopped thinking about all the things I couldn’t do because of depression, and started thinking instead about all the things I could.

For instance, I would never have started NU Listens, my peer-listening organization, if I hadn’t been depressed. I wouldn’t have the skills that allow me to help people. I wouldn’t write so much, or so well. I wouldn’t be able to fully appreciate my family and the other people I have in my life. I probably wouldn’t know what my calling is.

Some people, knowing that, would assume that I’m “thankful” for the experience of being depressed, or that I consider it “part of God’s plan” for me, or that it was “all for the best.”

Well, sorry to burst your bubble, but no. I don’t think any God would put a person through this, and that’s one of the reasons I don’t believe in God. I’m not thankful and I don’t think it was for the best. I want my adolescence back. I want the first two years of college back.

In our culture, preoccupied as it is with constantly finding the silver lining to everything from rejection to failure to broken hearts, I think it’s bold of me to say that I’m not thankful for what happened. I know I’m expected to offer up some grand lesson to be learned from all this, but I’m sorry to say that there just isn’t one. Sometimes shit happens. It definitely happened to me.

Knowing that, I’ve given up trying to find some sort of grand meaning in my experiences with depression. I sure as hell don’t accept the Judeo-Christian notion that I somehow deserved it, and although it has had some positive consequences, I’d say it did more harm than good. By far.

So how to go on? Well, that’s a complicated question for someone who prefers to see things in complicated ways. The story I’ve decided to tell about my own life isn’t necessarily happy, but it’s empowering for me. It’s about working within my limitations to achieve great things.

After all, the truth is that I’m probably not going to ever fully recover. I live at the mercy of something I can’t fully control, and my entire being–from feelings and moods to thoughts, beliefs, and actions–is tempered by it. Some days it leaves me alone, and some days it barely lets me get out of bed.

It means I have to be on my best behavior all the time. Nine hours of sleep, fruits and veggies, not too much carbs or meat, brisk walking every day, at least. Schoolwork has to be done before 9 PM or so, or else I can’t concentrate on it. I get overwhelmed by information easily, hence all the organization–categorized to-do lists and a calendar, a notebook that I carry everywhere, everything in filing folders in a box under my desk. In class I have to write by hand because it keeps me more alert. Otherwise, I start dozing off after sitting still for five minutes, no matter how much sleep I’ve been getting, because that’s how my body is.

I have to always stay busy, because as soon as I have a moment to myself, my mind starts conjuring up nasty thoughts. You’re such a bitch. Go kill yourself. The reason I take five/six classes, work two jobs, and run two student groups isn’t for my resume. It’s for my health.

~~~

So those are my limitations. Sometimes they seem pretty extreme. Sometimes they seem like a blessing compared to what some people are given.

Regardless, I’m not going to define myself through them anymore.

Instead, I’m going to define myself through the unique gifts that I have, and that I’ve become aware of because of my experience with depression.

When I’m helping someone, my self disappears–and with it, so do all of my fears, insecurities, and dysfunctions. I feel like I’m entering the other person’s being. It’s almost a spiritual experience.

Of course, my ideas about others aren’t always correct, but I start down a path of understanding. I start to see why the love the people they love, why the fear the things they fear, why they do things I would never do, why they believe things that I don’t believe.

I’m not looking for any accolades or sense of moral superiority when I say that my calling is to help people feel better. In a way, I’m just as selfish as anyone else. Some people are happy when they make money, or when they do experiments, or when they play sports; I’m happy when I make others happy.

It’s pretty much that simple.

~~~

It’s been a year since I “came out” as having a mental disorder. Since then, my relationships have only grown stronger and my sense of being valued and respected has only increased. Sometimes people do imply–usually via anonymous comments on my blog, as they know better than to say it to my face–that I’m making people “uncomfortable.” My response to this is always the same: they’ll get over their discomfort. I won’t get over my depression.

The truth is that–and I’m terribly sorry about this–I really don’t give a fuck about your comfort. I just don’t. It’s not my job to make anyone comfortable. I don’t really care about fitting in or being cool or normal. I must be missing that gene, or whatever.

If I sound completely different right now than I did just a few paragraphs before, I wouldn’t blame you for being confused. My life’s work will be to help people find happiness, but never at the expense of my own ability to live and express myself as I see fit. My understanding of psychology is that if you’re so concerned with how I live that you’re made “uncomfortable” by my depression, it’s you who needs to change, not me.

I don’t think most people realize the extent of my lack of fuck-giving because, unlike many other young malcontents, I don’t wear it on my body. My clothes are normal. I talk like a more-or-less average educated person. I don’t have any tattoos or extra piercings and don’t plan on getting any, and my hair is dyed, but only slightly. It’s styled in a mostly average way. I don’t choose to “rebel” by doing lots of drugs or people, and I don’t smoke, drink, or listen to unusual music.

But internally, I feel like an alien in this world. There’s a thick glass wall between me and everyone else. There’s a terrible creature that has its tentacles wrapped around my brain, and every time it squeezes, I want to rip my head off.

That’s what depression is.

~~~

That’s not to say this year has been all bad. It certainly hasn’t. I made many friends this year–not just any friends, but best friends. I started working on two different research projects at school. I found a way to connect with the Jewish community at Northwestern. I made Dean’s List this past quarter, started my own peer listening group, got accepted as a columnist for the Daily Northwestern next quarter, drastically increased my blog’s readership, tried therapy for the first time, successfully navigated my first quarter in my own apartment, went on quite a few dates, learned how to make my own jewelry, was accepted to a quarter-long Jewish education program, and befriended a few professors.

I went to New York three times, growing more and more certain with each time that this is where I want to live someday. I watched my older brother get married and found out that I’ll be an aunt in a couple of weeks. I met distant family members I hadn’t even known about before. I decided to wean myself off antidepressants when the new year starts.

Depression keeps me from being truly happy, but I refuse to let it rewrite the story of my life any longer. What I’ve been able to do despite of (and perhaps because of) my limitations makes me glad to be alive. I hope to recover someday, but even if I don’t, my life is going to be worthwhile.

~~~

A few days ago. I’m walking near Union Square in Manhattan. The sun has nearly set and the wind is chilling. I hear a man begging for money.

“Can you spare some change?” he’s saying, over and over. The passerby walk past him and he says, “That’s okay. Maybe next year.”

I put a dollar bill in his cup and he says, “God bless you, miss. I really mean that.”

He says happy New Year, and I say happy New Year too.

And then I continue on my way.

Maybe next year.

Storytelling

Yes, We Need Psychiatric Labels

Miri, , , , , , , 28 Comments

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.

Yes, We Need Psychiatric Labels

Antidepressants and Strength of Character

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You're not a bad person if you take any of these roads. I promise.

Spoiler alert: They have nothing whatsoever to do with each other.

There are different levels of stigma surrounding mental illness. There’s the stigma of having a disorder in itself, the stigma of being in treatment for a disorder, and, perhaps most of all, the stigma of that treatment being pharmacological.

People love to hate psychopharmacology, especially antidepressants, the efficacy of which is constantly being questioned (often for good reason). However, I’ve noticed that drugs like antidepressants receive a special type of scorn, one that cannot be based solely on the efficacy mystery.

I’ve found that where mental treatment is concerned, therapy holds some sort of moral superiority over drugs in many people’s eyes. I think many people still feel that mental disorders are spiritual illnesses, not medical ones, and that treating them with a pill is some sort of cop-out. (Imagine the public furor if researchers came up with a pill to, say, erase the feeling of guilt.)

This would explain why, though therapy is still stigmatized–after all, the Ideal Person works out these issues on his or her own–it is considerably less looked down upon than psychotropic medication. Our culture values struggle and hard work so much that even recovering from an illness should be mentally effortful.

What people don’t realize is that there are plenty of perfectly legitimate reasons why someone might choose medication over therapy, at least in the short term. Consider, for instance, the situation I found myself in a month before I began my sophomore year of college. Having spent my entire freshman year growing progressively more depressed, I’d thought that coming home for the summer would magically fix everything. It didn’t. With a month to go, I realized that I felt like I’d rather die than go back to school.

That was when I was first diagnosed with depression, and I think my psychiatrist realized, as did I, that I just didn’t have time to muck around with my feelings–I had to get better quickly, or else going back to school would be more upsetting and stressful than I could handle. So I started taking antidepressants and quickly improved enough to feel like I could deal with being in school. The mucking around with my feelings came later.

Aside from that, I can think of many other reasons medication can at times make more sense than therapy. For example:

  • Financial concerns. Antidepressants cost me $30 a month, while therapy costs $80 for four weekly sessions. That’s a pretty big difference for many people.
  • Time. Some people are at a point in their lives where they literally can’t spare an hour or more a week for therapy. That might sound ludicrous to you, but if you’re a college student, a new parent, or a low-income worker, it probably doesn’t.
  • Availability. Unfortunately, not everyone lives in an area where good therapists are available and accessible (and bad therapists will do more harm than good). This is especially true for members of marginalized communities, who may have a hard time finding therapists who are sensitive to their issues. Not all therapists are as open and accepting as they should be.
  • Insurance. I’m lucky to have a fantastic insurance policy that covers basically everything I’ve ever needed. However, many policies are very picky with regards to therapy (as opposed to medication, which does require a prescription from a person with an MD). For instance, some policies refuse to cover therapy unless there’s an official diagnosis, and you don’t necessarily need to have a diagnosable mental disorder in order to need help. Besides, you can’t be diagnosed without going to a specialist to begin with.
  • Nature of the disorder. Although most mental illnesses obviously involve a psychological component, some do not. For example, many people in temperate climates get Seasonal Affective Disorder (SAD) during the winter months, which is characterized by a low-grade depression as well as various physical symptoms. It’s usually treated with antidepressants or light therapy, which actually has people sit in front of full-spectrum light.
  • Language. Therapy requires people to talk pretty extensively about themselves and their lives, something that would be very difficult for, say, a new immigrant who’s just learning English. Unless such people are able to find a therapist who speaks their native language, it would be pretty hard for them to get anything out of therapy.
  • Comfort. As a future therapist, I obviously wish that everyone were comfortable with the idea of therapy. But not everyone is. That could be because of cultural factors, family attitudes, personality, or negative experiences with therapy in the past. I think that using medication to improve your quality of life while working up the courage to see a therapist is perfectly okay.

I hope that this list shows that making decisions about mental health isn’t that different from making decisions about physical health–it has more to do with personal preferences and practical concerns than with the strength (or lack thereof) of one’s character.

Of course, I do believe that therapy is really important and generally awesome, which is why one of my upcoming posts will be about why I think that everyone (or almost everyone) should see a therapist. Stay tuned.

Antidepressants and Strength of Character

Mental Illness Is Not a Punchline

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Damn, I’m certainly on a crusade against humor these days.

That was sarcasm, by the way. I love humor. I just think it should be deployed carefully.

A few days ago in my Psychology of Personality class, the following happened:

Some people were having their own conversations while the professor was trying to give a lecture. The professor cracked a joke–“Hey guys, I have ADD so I can’t focus if other people are talking, so please stop!” followed by “I don’t really have ADD, but still.”

Now, for the record, I totally get that it sucks for a teacher when people are talking in class. But I also feel that there are other ways to address that situation without making a joke about having a mental illness that you don’t actually have. Especially, you know, if you’re a person who has a PhD in psychology and conducts research on people with actual mental illnesses.

The sad thing is, before he followed his comment up with that disclaimer, I was actually really touched. I thought it was wonderful that a professor of psychology would take a stand against the stigma of mental illness by stating in class that he has one. But then, you know, it turned out to just be a joke.

~~~

Last spring, I took a class on Cognitive Behavioral Therapy. It was an advanced class, with just around ten students or so, taught by one of the most esteemed professors in the department. We got to the chapter on Borderline Personality Disorder, which, as you may know, is considered one of the most frustrating mental disorders–both for clinicians and for the patient’s friends and family. So naturally, no discussion of it could be complete without my professor’s bombastic explanations about how she tries to avoid treating BPD patients because they’re just SUCH a pain and about how she once had a friend with BPD who was just SO hard to deal with. Everyone gasped and laughed at her descriptions.

Then, of course, the other students had to start raising their hands and talking about their own friends that they’d taken the liberty of diagnosing with BPD, and how  horrific those people were.

This was a time in my life when I was seriously wondering if I had BPD myself, so, yeah, that was pretty unpleasant.

~~~

Last fall, I took a class on psychopathology. It was my second psychology course ever, and my first that related specifically to mental disorders–a topic very close to my heart at the time since I’d been diagnosed with major depression only a month before.

Before the course started, the professor sent out an anonymous survey to the entire class about our experiences with mental illness. On the first day of class, she disclosed the stunning results–more than half of us said we’d been diagnosed with one.

So we got to the chapter on depression and the professor started talking about depressive cognitive distortions, using specific examples. The professor started listing them off in such a way that the whole class started laughing. And laughing, and laughing.

Now, I totally get that it sounds funny. Consider this dialogue:

X: I’m getting a B in calculus. I’m a total failure.

Y: You’re not a failure at all! You have straight As in the rest of your classes.

X: Well, those don’t count. They’re easy anyway.

Y: Yes, and calculus is pretty hard, so it makes sense that you wouldn’t do as well. Besides, a B is a pretty good grade.

X: No, it’s a shitty grade. Everything I do is shitty and I’m always going to be a failure.

That is an example of several cognitive distortions, including overgeneralization, disqualifying the positive, magnification, and labeling. And, when read aloud in a particular tone of voice, I can see how it might sound kind of funny.

But having been through it myself and studied it extensively, I can also hear the pain behind what X is saying. It’s not a punchline. It’s a cry for help from a person trapped inside their malfunctioning mind.

~~~

Here’s the thing. I get it. People with PhDs in psychology have spent years and years reading, writing, and talking about stuff like this. I’m sure that it’s completely normal for two psychologists to crack jokes about mental illness to each other.

Knowing that many people who pursue degrees in psychology are spurred to do so by their own experiences with mental illness (I’m an example of this), I understand the urge to joke about it because I joke about it myself. It helps alleviate the fear and pain of living with mental illness.

That doesn’t mean I’d joke about it to a room full of 100 people who don’t know me well and who may be dealing with their own issues, though.

Case in point–at the time I took the aforementioned psychopathology class, I was still learning how to recognize cognitive distortions in myself, and I was beginning to realize the extent to which they’d ruined all of my previous interactions, friendships, and relationships. To have a room full of 100 people laughing uproariously about something that nearly brought you to suicide just three short months before is, well, no laughing matter.

~~~

I’m not saying there’s no room for humor about mental illness. There definitely is, and humor has been one of several strategies that have helped me process what happened to me. But humor must be used carefully.

I’ve written before about the complex relationship between humor and mental illness–here, here, here, here, and here. But this time, the situation is very different because the off-color jokes are coming not from comedians, television writers, novelists, or clueless friends of mine, but from people who know more about psychology than 99% of the population.

Unfortunately, I still haven’t quite worked up the courage to tell a person with a PhD that they’ve offended me.

But I’m working on it.

Mental Illness Is Not a Punchline

How Depression Feels

Miri, , , 8 Comments

I feel like there’s a disease in my head. I want to excise the brain parts that it lives in, the parts responsible for loneliness, worthlessness, apathy, cynicism, seriousness, sensitivity, and all the other ways in which I could be described.

I feel like a book lying open on the grass. The wind blows the pages around and one can’t help but read them. Nothing that’s written can ever be forgotten.

I feel like I’ve wound up my body’s pocket watch all wrong. It doesn’t go at the same pace as everyone else’s. Sometimes it ticks when it shouldn’t. Sometimes it doesn’t when it should. Where is that damn watchmaker?

I feel like a sinking ship. All of my most beautiful parts are underwater now, my framework waterlogged and rotting. Up on the tilting deck, an orchestra plays for anyone who dares to listen.

I feel like there’s a darkness following me wherever I go. Some call it a black dog, others call it a raincloud, others call it the noonday demon. Sometimes we sit on a bench next to each other, just gazing out into the world through our foggy, listless eyes. When it’s with me, I see in black and white.

I feel like a piece of driftwood on a beach. Why am I here, and not there? Is this sandy spot any better than that one?

I feel like there’s another spirit inside me and it’s more compassionate and optimistic and hopeful than I’ve ever been able to be.

I feel like there’s a flood slamming against the levee walls of my brain.

I feel like there’s a screeching phoenix beating in my heart, trying to burn a hole in the scarred tissue and escape.

I feel like I’m moments, or days, or years away from coming alive. It’ll happen, someday.

How Depression Feels

The Trivialization of Mental Illness

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I’m reading a very interesting novel called The Four Fingers of Death. It’s somewhat science-fiction, with a distinctly Vonnegut-esque tone to it–very sarcastic and cynical. The story takes place in the 2020s, and the author, Rick Moody, gives several hints as to the general milieu of the future. Few people have cars as gas is very hard to come by, India and China are dominating the world, and paper books are mostly a thing of the past. One little detail that the narrator mentions several times–a detail that most readers would skim over, but that the author undoubtedly meant to make a point with–was the 8th version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Currently the DSM is in its fourth version–DSM-IV–but the DSM-V is in the works. However, in the world in which Four Fingers takes place, the DSM-VIII has medicalized all sorts of everyday issues, such as a disdain for hygiene (“aggravated hydrophobia with hygiene avoidance”), opening a game of chess in an unusual way, being rude to waitstaff, and speaking unusually (“conversational pseudo-uremia”). What completely got me, though, was when the narrator diagnosed a new friend with “mixed caffeine obsession with chronic caffeine dependence” when–get this–the friend suggested that they meet up at a coffee shop!

The author’s point, of course, is easy to see. It’s a satire of the supposed overdiagnosis of mental disorders even today, and of the presence of useless and non-clinical “disorders” in the DSM. As in, hahaha, at the way things are going, soon we’ll call not showering a mental disorder! To this point, the narrator of the story mentions that everyone has been diagnosed with a mental disorder these days. The way he talked about the DSM–“I flip through it looking for symptoms I have yet to contract”–makes this attitude even clearer. Through his satire, Moody implies that mental illnesses are not something to be taken seriously.

Forgive me for making a big deal out of a (probably insignificant) novel, but this mindset right here–that mental disorders are just some sort of farce invented by people yearning for attention for their minuscule problems–this is what’s responsible for one of the biggest threats to adequate mental healthcare in America. I’ll attack this mindset point-by-point.

First of all, contrary to popular opinion, “everyone” does not have a mental disorder these days. I’m sure you’ve heard someone comment, perhaps after hearing of another person’s diagnosis with a disorder, something to the effect of, “Oh, lord, everyone’s popping pills for something these days!” No. Everyone is not popping pills for something these days. Many people do, at some point in their lives, take medication for a mental issue. But most psychotropic medications are meant as temporary solutions while the person works on their problems in therapy or on his/her own. People aren’t meant to take them for their whole lives.

And even if every single person in this country does, at one point or another, take psychotropic medication, that doesn’t mean much on its own. Almost everyone takes drugs for colds or headaches at some point, but nobody seriously advocates against this. I use the word “seriously” carefully here–a radical diet book I came across recently, Skinny Bitch, claims that we should basically never take medication for anything. It says, “Yeah, getting cramps totally sucks. It’s supposed to. Every month you endure cramps (without medication), you are preparing for the physical pain of childbirth. So suck it up. Stop interfering with Mother Nature.” Pardon my coarseness, but I actually nearly crapped myself when I read this. What?!

Most of us are glad that with things like modern surgical techniques, dentistry, drugs, and diagnostic tools (like x-rays and blood tests), we now live happier, healthier lives. Before these things were developed, people had 40-year lifespans and got all kinds of gruesome illnesses. Similarly, back in the good ol’ days, people with mental disorders either spent their lives in misery, got committed to mental asylums, or simply offed themselves, depending on the nature of the disorder. If we can prevent that by having “everyone pop pills,” so be it–at least until we can find a better solution.

Second, the fact that some mental disorders may be overdiagnosed does not mean that every diagnosis is illegitimate. Some parents, for instance, push for their children to be prescribed medication for ADHD in order to help them get ahead in school, even if they do not actually have ADHD. It should be noted that there are standard screening procedures for this disorder that ensure that people are diagnosed correctly. If a parent gets their child to somehow cheat the screening tests, or if an unscrupulous doctor prescribes medication even though the child doesn’t fit the diagnostic criteria, well, guess what–these people are being unethical. That does not mean that ADHD isn’t a legitimate disorder that many people–adults included–legitimately suffer from.

Furthermore, although some people probably do “imagine” their disorders and seek treatment in order to get attention, I should point out that this can only be a minority. There is nothing at all pleasant or fulfilling about spending hundreds of dollars, taking medications that give you really crappy side effects, and telling a complete stranger about the most shameful aspects of your life. This is not fun. Anyone who invents a mental illness and seeks treatment for it as a way to entertain themselves is an idiot.

I should also point out that even though some people do falsify their problems and some psychiatrists do overprescribe, this is a general trend that you can’t really apply to individual people. Unless you are a psychiatrist, you are simply not qualified to judge whether or not a particular person’s problem is “real” enough to merit treatment. Everyone told me there was “nothing wrong” with me and that I should stop being a crybaby, until it got so bad that my daydreams changed from imagining that cute guy from class asking me out to imagining which method of suicide is most effective. Don’t be the person who trivializes someone else’s illness. Just don’t do it.

Third, Moody suffers from the mistaken assumption–shared by many people–that the trend in the field of mental health is for increasingly insignificant and non-clinical problems to be classified as mental disorders. With this view in mind, it’s easy to see how the author could come up with the hypothesis that in 20 years, a disinclination to take showers could be considered a clinical disorder.

However, if there’s any trend here at all, it’s in the opposite direction. For instance, premenstrual dysphoric disorder–more commonly known as PMS–was in the DSM until the revision of the DSM-III in 1987. Much earlier, in the 19th century, women who suddenly showed a strong desire to have sex were labeled with the diagnosis of “hysteria.” The cure? An orgasm. (This diagnosis was also a catch-all term for any medical complaint made by a woman. Obviously, it’s not longer considered a disorder.)

Finally, I’m pretty sure that nobody who has this author’s opinion of the DSM has actually looked at one. I’m no DSM expert, but I’ve looked through it a number of times, and I can tell you that very few of the disorders listed in it seem trivial to me. (There are disorders that shouldn’t be there, perhaps, but for different reasons. For instance, gender identity disorder, which refers to a very strong feeling that one has been born into the wrong sex, is probably in the DSM because psychologists have assumed that it leads to a lot of distress and problems for the person who has it. Before it was possible to change one’s biological sex, that was probably true. But today, it has become clear that if a person who’s “suffering from GID” is able to change their sex, things get better. The remaining problems are caused more by society’s lack of acceptance for trans* people than by their psychological makeup.)

However, Moody is echoing the prevailing cultural sentiment that mental disorders are nothing but insignificant little problems that people have in their daily lives. If this were true, popping pills to solve these problems would indeed seem pretty silly. However, it’s not true, and unfortunately for those of us who have to struggle to find adequate mental healthcare and to get friends and family to accept and understand that struggle, people like Moody are busy spreading this misconception around through various media–in this case, a satirical novel.

Contrary to what Moody seems to think, recognized mental disorders cause significant problems in daily living, relationships, and work. Some involve hallucinations or delusional beliefs. Some involve uncontrollable episodes of panic, which are said to feel somewhat like heart attacks. Some cause people to be unable to experience pleasure from anything they do (this is called anhedonia). Some cause people to become so preoccupied with cleanliness, order, and performing particular rituals that they are literally unable to go through the day without taking care of these things. Some keep people from getting a good night’s sleep–ever. Some cause people to try to throw up every bit of food they eat, or stop eating altogether. Some cause people to want to kill themselves.

Do you see anything trivial here? I don’t.

The Trivialization of Mental Illness

Some Thoughts on Depression

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[TMI Warning]

About five months ago, I wrote a post on Facebook (and on this blog) about my experience with depression and how I came to receive treatment for it. I remember feeling very triumphant as I wrote it, because I felt like my difficulties were finally over.

This turned out to not exactly be the case.

In January, perhaps precipitated by some unfortunate personal circumstances, I relapsed and have been trying, mostly unsuccessfully, to recover ever since. The months since then have been filled with a lot of self-loathing, many random bouts of crying (daily at times), and much speculation on my part as to whether or not I really belong in this world.

This is when I realized that my problems, whatever they may be, don’t simply go away when I’m not depressed. I don’t “invent” the issues that I’m unhappy about. But being healthy makes it easier to ignore the pain in the back of my mind–all the wasted opportunities, lost friends, and scarring memories that have built up over the years like dust on a windowpane. When I’m healthy, I simply don’t think about it, and consequently I’m happier. But the mockery that I’ve made of my life isn’t a figment of my imagination; it’s quite real.

~~~

I also started to realize, perhaps even more than I did when I wrote that post, how little the healthy world knows about depression. Mental illness is truly the last taboo; many people refuse to even consider dating someone who has it. Kinda makes me reconsider being so open about my experience…

Even people who would otherwise be supportive just don’t know enough. For instance, if you know your friend is a diabetic, would you offer her a piece of cake? Probably not. But would you casually make fun of your depressed friend? Unfortunately, many people would, even though teasing and jokes are things that many depressives have a lot of trouble with. (This is because depression often causes a cognitive deficit that makes people take everything–a snappy tone of voice, an odd glance, a sarcastic remark–very personally. Here’s a great guide to cognitive distortions.) I am always analyzing and picking apart things that people say to me to try to figure out if they were just teasing or not. I am terrified of the threat of rejection that these casual utterances may carry, so I am always alert, always on my best behavior.

~~~

Another thing I’m never sure of is which parts of me are depression and which are simply me. I’m a skeptic, a cynic, and generally not too big a fan of things that most people seem to really like (Exhibit A: this). I don’t fit in with my surroundings in many ways. I’m more complex, polite, caring, respectful, quiet, conscientious, serious, passionate, emotional, and sensitive than most. I’m less assertive, flaky, impulsive, cheerful, “chill,” and casual than most. This makes for a great number of personality differences between myself and most people I know. When I’m not feeling depressed, these differences fade into the back of my mind. But when I am, they come right to the front, putting up a wall between me and the rest of the world, making me feel like I’ll be an outcast for life.

~~~

One more realization–Northwestern might be the worst place in the world to be depressed. (Not that there’s really a good place for that, except perhaps the psychiatric ward of a hospital.) It’s isolating, stressful, and miserably cold from October till May. Your peers churn industriously around you like a hive of North Face-clad bumblebees while you vegetate listlessly in your shitty shoebox room and email professors, friends, student group leaders one by one and tell them that you’ve been ill and cannot come to whatever crap you’re supposed to be at that day. You eat Nutella from the jar and wonder why none of your friends care. You wonder why you expect them to care. You sleep, a lot.

Northwestern also happens to have entirely inadequate mental health services, but that’s a topic for another post. My friends and I are working to change that. But for now, this is a really, really unfortunate place to be depressed.

~~~

And that’s it, really. I’m not entirely sure where I’m going now, but hopefully it’s somewhere good.

Some Thoughts on Depression

A Point-by-Point Assessment of "10 Reasons to Date a Depressive"

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[TMI Warning]

Thought Catalog had an interesting post yesterday called “10 Reasons to Date a Depressive.” It’s sardonic and irreverent but actually brings up a few good points about depressives (and dating them). I’m going to analyze the piece point-by-point and add my own (as usual, very serious and scholarly) commentary.

1. Anything you leave with them will be right where you left it, no matter how long you leave it. Pending suicide, hospitalization or just deciding to go somewhere else while in a melancholic haze, the depressive avoids doing, well, things.

Yeah, this is pretty true. I think I’m unusual in that I force myself to clean even when I’m feeling awful (because it helps), but many depressives don’t.

2. Borrowing money has two advantages. Depressives do not expect you to pay them back. It’s probable they don’t even remember lending it to you, after a while of nothing mattering.

Partially true. We do often feel like people are always going to take advantage of us (i.e. by not paying us back), but we never forget. We hold it in the back of our minds and feel resentful.

3. Cheap date. Most depressives who want to live at least a little are on some sort of antidepressant. The chemicals in most antidepressants increase the potency of alcohol. You may end up with vomit on you while they tell you stories of their missed opportunities. But then again, you may not. It’s good to stay optimistic around depressives, for obvious reasons. Also, most depressives don’t eat much.

Since I don’t really drink, I wouldn’t know about this. However, it’s worth pointing out that not only are some antidepressants potentially fatal if taken with alcohol, but it’s also a really bad idea to drink if you’re depressed (alcohol itself is a depressant, and so on and so forth). If you’re dating a depressive, please don’t encourage them to drink.

4. Avoiding the meet the family situation. Depressives usually hate their family. And depressives don’t want to meet your weirdo brood. That would interrupt days-long, pensive thought-loops. These are necessary for doing nothing.

Not true for me, but definitely true for some.

5. Sex. As with most things it’s a double-edge sword with the depressed. They may get wasted (easily, see above) and fuck some of that anger out on you or they may get wasted and spend the night in the emergency room. It is worth the risk, though, if only to do it once. Intoxicated sex with a highly-medicated depressive is liken swimming with dolphins.

Actually, many depressives lose interest in sex as a result of their condition, and many antidepressants can lower sex drive or inhibit orgasms as a side effect. Also, from what I’ve heard (but thankfully never experienced), drunk people in general are TERRIBLE at sex.

6. Drugs. Depressed people love to self-medicate. This often means unlimited beer and usually pills and pot. If you’re into speedy drugs though, you’re out of luck. Depressives are terribly uncomfortable with bouts of increased energy.

I wouldn’t know.

7. Poor memory and attention. Lucky for you, poor cognitive skills are a sign of depression! Depressed partners won’t remember things, like cruel words or mysterious sheet stains, and there’s less of a chance they’ll notice when you do stupid shit.

Only partially true. We definitely have poor memory and attention, but we will ALWAYS notice when you do stupid shit, ALWAYS freak out about it, and ALWAYS remember it.

8. A lot of quiet time. If you’re into quiet (though not usually the peaceful kind), depressives are for you. If they aren’t quiet due to overwhelming internal existential dread, you’re getting the silent treatment for whatever you most recently said or did that crushed their identity.

Haha. This is completely true. If you’re going to date a depressive, make sure you’re not one of those people who needs to be talking or doing something all the time. We like to sit around and think.

9. Sensitivity. Depressives are very sensitive people. This will work well for you when you are sick or lose your job or any time you need someone to feel sorry for you. Or maybe you saw a squirrel outside and then looked away and when you looked back it was gone and for a second you were slightly glum. Anything. Just don’t expect any actual help. Depressives are already too weighed down with pain to do physical activities.

So so so so true. Whenever one of my friends or family members is upset, I literally feel it in my heart. I would drop anything to help someone. Even if it’s not something that I personally would be upset about (for instance, one of my friends gets very upset about bad grades and I don’t really), it’s like my feet instantly go in their shoes. Most depressives I know are the same way. Of course, though, sensitivity also has the flip side of making people very easily hurt, which is one of the hallmarks of depression.

10.You are now awesome! When with depressives, usually a mess of bodily and foreign clothing stains, bloodshot eyes and plenty of hopelessness to share, you are truly a joy to all of the senses. So, even if you don’t want to invest in dating a depressive, just spending a little time with one can go a long way to making you feel better about yourself.

Honestly, from what I’ve heard, spending time with depressives makes you feel much more shitty than good. So don’t do it for that reason.

A Point-by-Point Assessment of "10 Reasons to Date a Depressive"

Preventing Depression

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I love it when people who actually know what they’re talking about confirm something I’ve believed for ages.

In this case, a study at the Feinberg School of Medicine (that’s Northwestern’s med school) showed that one out of every four or five college students who come to their school’s health center may be suffering from depression. The study also recommended that colleges should start screening students for depression. This way, they might even be able to pinpoint students with minor depression and help them get treatment before their depression worsens.

Ever since I’ve started seriously reading about psychology and depression, I’ve felt that we should start taking a preventative approach to it–not just in colleges, but everywhere. Depression tends to worsen with time, and even when it does remit on its own, it usually comes back later, with more intensity. Furthermore, distorted thinking patterns seem to precede the development of a full-blown depressive episode, so why not address those earlier rather than later?

For instance, parents take their kids to the doctor to make sure that they’re growing at a normal rate and developing the cognitive abilities they’re supposed to develop–why not also check to make sure that kids aren’t developing negative and maladaptive thinking patterns that could increase their risk for becoming depressed later?

You might think that kids are too young to show definitive patterns, but I think that’s false. My own little brother, who’s eight years old, constantly complains that he’s fat and needs to exercise, despite being underweight for his age. He also says that everyone at school hates him (they don’t) and that his school is awful and should be burned to the ground (and various other sentiments that have gotten him sent to the principal’s office before). Perhaps most importantly, he also has a pervasive family history of depression.

The unfortunate truth is that society views mental illnesses as fundamentally different from physical illnesses. One is a straightforward matter–you go to a doctor for checkups, and if something is wrong, you receive treatment. The other is for some reason shrouded in mystery, and people generally don’t go seek help for it until they’re already barely functioning.

As recent scientific developments are beginning to show, however, it may be that all mental illnesses actually have a physical basis. More and more psychologists and psychiatrists (notably, Peter D. Kramer of Listening to Prozac fame) are starting to take this view. If they’re right, it follows that we should try to take a preventative approach in treating mental illness, not a palliative one.

However, many people still have negative attitudes about the idea of psychological screening. One of the students quoted in the article linked to above said that these screenings are a bad idea because someone could just “be having a bad day” and–oh, the horrors–get recommended for counseling. First of all, however, counseling isn’t exactly the same as taking antibiotics or getting a spinal tab. Second, that just means that we need to develop better depression screening tools, not that we shouldn’t screen for it at all.

In college especially, conditions like depression can take a turn for the worse rather quickly, as evidenced by the several suicides we’ve had on campus while I’ve been a student here. Every time a tragedy like that occurs, friends and family are often quoted as saying that they “never saw it coming.” Maybe a professional psychologist would’ve.

Preventing Depression