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

[Content note: mental illness, suicide, abuse]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

~~~

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

“What do you have to be depressed about?”

If you have experienced depression while living what appears to be a fairly nice life, you’ve probably had someone ask you, “What do you have to be depressed about?”

Sometimes people who ask this question are genuinely curious because they think that depression is necessarily “about” something and they just don’t understand what, in your case, it could be “about.” Sometimes, though, people who perceive your life to be better than theirs feel resentful and jealous and, upon hearing that you are suffering from depression, demand to know what could possibly be wrong with your life that could cause a mental illness.

The origins of depression are complicated and still not very well-understood. One model that’s gained ground lately is called the diathesis-stress model. The term “diathesis” refers to a vulnerability, which could be genetic, biological, environmental, or psychological. “Stress” refers to a catalyzing event, a life stressor that can increase one’s chances of developing a disorder (the diathesis-stress model has been used to describe more than just depression).

One specific type of diathesis that has been researched concerns a specific gene, known as the serotonin transporter gene or 5-HTTLPR. Some studies suggest that people with a particular variant of the gene are more likely to develop depression, but only if they have a significant life stressor. If not, then there’s no difference between people with the different variations of the gene.

The results are mixed so far, but this is just one example of a way in which having “something to be depressed about” can indeed provoke depression. But it’s not the whole story. People without significant life stressors can still get depression, and people who do have life stressors are still much more likely to get depression if they have that genetic predisposition–the diathesis.

Diathesis can come in all sorts of forms. Having learned poor cognitive coping skills as a child could be a diathesis. Having abnormalities in the brain’s neurochemistry could also be a diathesis, although the “chemical imbalance” theory of depression as we’re used to seeing it is more or less bullshit.

Some types of diathesis might be considered to count as “something to be depressed about,” such as living in poverty, having a chronic health condition, or having an unstable or abusive family life. Others, such as having genetic predispositions or brain abnormalities, would not count as such for most people. Asking someone what they have to be depressed about is therefore not very useful.

But moving away from the science of depression’s origins, I’ll state the obvious: no matter how well you know someone, you never know everything that’s going on in their life. Not even if it’s your kid. The person may have a significant life stressor that’s triggering their depression that they just haven’t told you about, and they probably won’t if you sarcastically ask them what they have to be depressed about. If you’re genuinely curious, a better way to phrase that question is, “I’m sorry to hear you have depression. Is there anything that’s triggering it for you?”

The important thing with that is to never ask questions like you already know the answers. The question, “What do you have to be depressed about?” comes along with the implied answer, “Nothing.” Even if you don’t think it does. That’s how many people are going to hear it. So don’t get too caught up on the literal meaning of the words you are saying, and think about how they’re going to be interpreted.

The hypocrisy of the “What do you have to be depressed about?” question becomes blatant when you consider our typical response to those who do, by all accounts, have something to be depressed “about.” What tends to happen is that when we feel that depression is to be expected in a given situation, we also frame it as “okay.” Normal. Natural. It’ll pass on its own and we shouldn’t interfere.

This might explain the controversy over the decision to remove the bereavement exception from the newest edition of the DSM. Previously, people who were grieving had a two-month “window” during which they could not be diagnosed with depression, which often looks very similar to bereavement. With the publication of the DSM-5, this exception was removed. Lots of people were Very Concerned that this means that we’re “medicalizing” a “normal” process such as grieving.

I know I probably over-rely on comparisons to physical health, but that’s because they can be very illuminating. If you’re subjected to a some loud noise and you get a headache, or you work out strenuously and get extremely sore muscles, few people would suggest that you shouldn’t take medication to ease those pains just because they happened “naturally” (whatever that means). Being extremely sad, even “depressed,” as a response to a loved one dying is definitely “natural,” but that doesn’t mean it can’t interfere with your functioning as a person, and that you don’t deserve help dealing with it.

I’m not necessarily saying that high levels of grief should be diagnosed as depression, though. I’m just pointing out the hypocrisy of expecting people to produce compelling “reasons” for being depressed, but then refusing to consider people who do have compelling reasons to be depressed, even if they show all the symptoms.

My final gripe with the “What do you have to be depressed about?” question is that it’s often a way of trying to rank human suffering. What do you have to be depressed about? Some people are abused by their parents. What do you have to be depressed about? Some people are starving. What do you have to be depressed about? Some people have cancer.

Well, if you, personally, were abused by your parents, are starving, or have cancer, I wouldn’t fault you for feeling that the concerns of people with depression aren’t as serious as yours. That’s your right. But there are no measurements with which we can assess how bad someone has it. There is no Standard Life-Shittiness Unit. We need to stop looking for one, and treat every individual’s pain as legitimate.

Why You Shouldn’t Use Mental Illness As A Metaphor

And speaking of the dilution of language, I’m going to talk a little about how the language of mental illness gets co-opted regularly.

Sometimes this is done completely innocently, as metaphor. “The weather’s really bipolar today.” “I’m kinda OCD about this, sorry.” “I’m so depressed about the Blackhawks losing!”

Sometimes it’s a little less innocent, as “humor” that implicitly degrades its target: “She’s, like, totally fucking schizo.” “Clinically Depressed Rob Pattinson Cavorts With Models in New Dior Ad.” (Jezebel has historically been pretty bad about using mental illness as a punchline.)

My usual objection to using mental illness terms in this way is that mentally ill people (who comprise a fourth of American adults) are likely to find them marginalizing and hurtful. It makes us feel like the potentially-fatal conditions we struggle with are just a joke to you. It’s not a nice feeling, and if you are a person who generally cares about your friends’ feelings, you should probably be aware of this.

But the dilution of mental illness terms might have another, more insidious effect, and that is changing our mental schemas of what mental illness looks like such that it’s less and less serious, and treating it accordingly.

As an example, I was recently posting on Facebook about the infuriating phenomenon in which someone discloses a phobia or trigger that they have to warn their friends, and then their friends proceed to try to deliberately trigger them. I literally watched it happen, and then I watched the friend post a new status about how people do this, and someone tried to do it again.

So my friends and I were discussing this and one of them mentioned that a possible factor (aside from the obvious douchebaggery) is the fact that many people now use “phobia” very colloquially, as in, “thing that makes me have a sort of uncomfortable but totally harmless reaction that would probably be amusing for you to see,” as when my little brother wants me to taste something totally gross (but safe and edible) or when my mom is like “ewwww look at all this dust that’s built up on your windowsill!”

I think my friend may be right. These words are used so casually that our conception of their meaning gradually shifts without our even noticing it. It’s like a boy-who-cried-wolf type of situation in that regard. If nine different friends joke to you about how they’re “sooooo OCD” because they like all their books organized just so on their shelf (a situation familiar to just about every bibliophile, honestly), then the tenth friend who comes to you and tells you that they have OCD is probably going to evoke that mental image, rather than one of someone who actually can’t stop obsessing over particular little things and carrying out rituals that interfere with that person’s normal functioning, perhaps to the point of triggering comorbid disorders like depression. This may be a person who washes their hands until they are raw and hurting, someone who has to flick the light switch on and off seven times every time they leave a room, or someone who has recurring, uncontrollable thoughts about hurting someone they love even though they have no actual desire to do that.

Well, that sounds a little different than insisting that your books be categorized by subject and then alphabetized by author, no?

Likewise, if your friends are constantly telling you they’re “depressed” because their team lost or because they got a bad grade, only to return to their normal, cheerful selves within a few hours, the next person who tells you that they are “depressed” might elicit a reaction of, “Come on, get over it! You’ll feel better if you go out with us.”

And so the meanings of words change.

But just because the people around you use mental illness terms in that diluted way doesn’t mean you should accept it. If you want to be an ally to those who struggle with mental illness, you should treat disclosures of mental illness seriously every time unless you’re absolutely certain that that’s not what the person is telling you. Feel free to ask for clarification.

I already shared this story as a comment on another post, but I’ll share it again because it’s applicable here. I once ran into an acquaintance and we chatted for a bit. I asked him what he’d been up to, and he said, “Just, you know, getting sober. I’m an alcoholic.” And I said, “Congratulations, good for you!” And he responded, “Oh, I’m not actually an alcoholic, I just meant that I’ve been drinking less. Haha, I forgot that you’re a psych major.”

The latter comment annoyed me because of its implication that I took his seeming disclosure of alcoholism seriously because I majored in psychology. That’s not why. I took it seriously because it sounded serious, because I want to support people who struggle with mental illnesses, and because I know what a big step it would’ve been for me to tell someone I didn’t know that well that I had started treatment for depression, back when I had it.

But other than my brief chagrin, there weren’t really any drawbacks or negative consequences for me in this situation. I faced no repercussions for taking him seriously. I undoubtedly came out of the situation looking like a decent person who cares about people, and he probably felt a little silly for flinging the term “alcoholic” around, but also reassured that if he ever did get diagnosed with a mental illness, I would take him seriously.

Although it may feel that way sometimes, you do not have a limited number of Real Mental Illness Points that you need to save up for responding to people who have a Real Mental Illness, and that you shouldn’t waste on those who are just using those terms metaphorically. The worst thing that happens if someone tells you that they have a phobia and you decide to refrain from trying to trigger that phobia is…exactly nothing. The worst thing that happens if someone tells you they’ve been feeling depressed lately and you say, “I’m so sorry to hear that, is there anything I can do to help?” is that they say, “Oh, don’t worry, it’s not like, depression or anything. I’ll feel better soon.”

That’s it!

And your taking them at their word sends a message to them that you believe that these words should be reserved for describing the illnesses they indicate, rather than being used as convenient metaphors. You’re helping to set a norm about how these words should be used.

Meanwhile, if you’re someone who uses mental illness terms to describe states of mind that you do not feel are mental illnesses, I’d encourage you to take advantage of the richness of the English language (or whichever language you speak, which I’m sure is also rich) and not do that. (Russian, for example, has some beautiful words for sadness. There’s the general sadness, or grust'; there’s a stronger version, toska; there’s a type of sadness that’s accompanied by an unwillingness or inability to do anything to improve one’s state of mind, unyniye; there’s a type of sadness that isn’t really directed at anything in particular and lies somewhere between grust’ and toska in severity, pechyal’; and there’s a type of sadness that includes grief, but also sadness at the loss of a treasured possession or an important opportunity, skor’b. And that’s a few. And don’t get me started on the Portugese word saudade.)

Note that I’m not including here folks who have diagnosed themselves with mental illnesses because they’re unable (or currently unwilling) to seek help from a professional. If you feel that you have the mental illness known as depression, then that word, I believe, is yours to use.

My point is only that sometimes misusing language has actual harms, and while language does evolve and change over time, we need words to describe mental illnesses. We can’t fight something that we can’t name, and we need to be able to fight depression and OCD without people thinking that we’re fighting feeling sorta down when your team loses or wanting to have all your books organized just so.

~~~

Related: Small Things You Can Do To Improve Mental Health In Your Community

[repost] At The Edge Of The Known World: What It’s Like To Consider Suicide

[Content note: depression and suicide]

Today is World Suicide Prevention Day. I wrote this post for it a year ago, and I decided to repost it today because I still think people should read it and I doubt I could write another one that’s better.

Somebody, somewhere in the world, kills themselves every 40 seconds.

Set a timer on your phone or watch for 40 seconds. When it beeps, another precious, beloved life is gone.

Yesterday, September 10, was World Suicide Prevention Day. Although suicide prevention entails important things like improving mental health screening and treatment, increasing access to mental health services, and decreasing the stigma of admitting and treating mental health problems, I think there’s another part that we usually miss when we talk about prevention. And that part is understanding what being suicidal is really like.

Those who kill themselves (or wish to do so) are not selfish.

They are not weak.

They are not simply having a bad day.

All of these tropes about suicide, and many others, are wrong.

I can only speak for myself, not for any of the other millions of people who have struggled with this most ultimate of dilemmas. But for me, at least, here’s how it was.

 

I don’t think I ever wanted to be dead.

I have, however, wanted not to be alive.

Why? Because living sucked, because I hated myself, because everyone else must surely hate me too, because I was a burden, because I was going to be alone forever, because I was like an alien that was accidentally born on the wrong planet, to the wrong species, in the wrong society. Killing myself would be like correcting a cosmic error.

There were many ways I dreamed about it happening. Pills of some sort would’ve been my first choice, although I was absolutely terrified of what would happen to my body if they failed to kill me. (Go figure, I was terrified not of dying, but of failing to die.)

But I wanted to be able to take the pills and lie down somewhere and just curl up until I stopped feeling forever.

Sometimes I also thought about bleeding to death by slashing my wrists or something. But I despise pain above all else, and also, poetic as it would be, the thought of someone I love finding me that way made my guts churn. Also, could I actually do it? Could I actually take a knife and slice open my own skin?

I doubted it.

Jumping off of a building occurred to me a lot, especially at the very beginning of my love affair with suicidal ideation. That was back when I was studying journalism, panicking constantly, and feeling just about ready to do anything to escape. Was the journalism building high enough? If not, what would be?

And then there were the trains. Living in Chicago, you take them a lot. Every time I stood on the El or Metra platform as a train rolled in, I thought about it. Not seriously, as I’d made no plans and written no note, but the thought did occur. The rails screeched, and gust swept into my coat and rattled my bones. How I hated standing on the platform, forced to imagine my own death graphically every time a train rolled in.

Recently, when I was already better, I was waiting on the platform for the Metra. A train was coming. It turned out to be an express train that barreled through the station without stopping. The blur, the clamor, the sudden slap of wind–I was left shaken for several minutes after it passed, imagining what that could’ve done to my body.

Strangely, I never even considered guns, although that is what a character in my abandoned novel chose to use.

I composed many different suicide notes in my mind. Some were lengthy and elaborate, with separate sections for each person I wanted to reckon with before I died. I used to keep secrets and grudges for years, and I wanted everyone to know the truth in the end. (These days, I try to make sure that if I suddenly die today, little will have been left unsaid.)

Other notes were simple. They contained nothing more than a quote or a song lyric. Often they included an apology to my family. I thought about writing it in Russian, not English, as though that would make it any better for them.

I also thought about not leaving a note, but something about that made me very sad. What if they never knew? But might that not be better?

And I could not stop listening to that OK Go song, “Return“:

You were supposed to grow old.

You were supposed to grow old.  

Reckless, unfrightened, and old,

You were supposed to grow old.

I never made a firm plan to kill myself, I never attempted to kill myself, and, obviously, I never did kill myself. The only reason, I think, was because I cared more about my family’s wants and needs than I did about my own. As much as I thought I needed to stop living, they needed me to continue living, and so I did.

Is this “normal”? Do others talk themselves out of suicide this way? I have no idea. This isn’t really something I talk about over beers with friends.

I was lucky, when it comes down to it. Lucky to have a family I love so fiercely that that love overpowered my hatred for life.

Death and I, we have an awkward but strangely comfortable relationship now. If I don’t bother with her, she doesn’t bother with me. I don’t fear death itself very much, although the idea of just not existing terrifies and baffles me, just like the idea of time travel or parallel universes or the butterfly effect.

Sometimes I feel as though I’ve traveled to the edge of the known world, teetered on that edge, and then shrugged my shoulders and returned. I can’t really tell you exactly what I saw there, but I will say that there is a thick glass wall now between me and those who haven’t made that journey.

I say to a dear friend as I write this, “I’m thoroughly desensitized to the thought of myself dying.”

“I’m not,” she says. “You should stay here and grow crotchety and gray. Perhaps even collect spiderwebs.”

“I love you,” I say.

“I love you, too.”

For better or worse, I will live with what I saw at the edge of the known world until I die what I hope will be a natural death.

The Law is Not on Our Side

[Content note: sexual harassment and assault]

Many brave writers have described what happened to them when they reported gender-based threats and violence to the police. Occasionally the outcome is positive, but often nothing at all happens and often something terrible happens.

Here are two recent examples I’ve read. The first is by Heina of Skepchick:

When the officer called me in, I was shaking a bit, but spoke as clearly and calmly as possible, presenting my evidence and voicing my fears. He responded with laughter.

Taken aback by his trivialization of the situation, I asked him if he could look at my evidence. I knew who the guy was, I pleaded. Couldn’t he, as an officer of the law, do something? Take the guy to task for threatening me somehow? At least take down a report so that if something happened, there was a record? He replied with an incredulous no to all my inquiries.

Out of the blue, he asked me if my picture included my face. I said no. He asked me how I expected to attract responses with a picture that didn’t include my face. Before I could respond, he answered his own question: it was a sexy picture, was it not? Feeling shamed, I was unable to speak and merely nodded.

“Don’t worry about it, then,” he chuckled. “Go home.”

What choice did I have other than to begin to gather up my things and prepare to leave? Before I could make my exit, though, he told me that he often visits women-seeking-women for the pictures, winked at me, and expressed his hope that he would see me on there sometime. Taken aback by the lechery in his tone, I half expected him to take a swat at my ass as I walked out the door.

The second example is even more jarring and painful to read, and deserves a strong trigger warning. It was a comment by EEB on a post of Jason’s, and Stephanie reprinted it with permission:

Two male detectives arrived at my house. I stammered out a request for a female detective; it was denied. (I learned later that they violated procedure by not accommodating the request.) They made me go through what happened. I was in excruciating pain and dripping blood but they didn’t want to take me to the hospital just then, and said the hospital “wasn’t ready” anyway. So I described the rape. Then they asked if I was taking any drugs. Well, just my medication. I thought it was strange that they literally spent more time asking about my mental health history and the types of medication I took, instead of the rape, but at the time, again, I was in shock, and not thinking much.

[...]Over the next few months, I submitted to multiple, horrific “interviews” that really felt like “interrogations” as time went on. I was also dealing with a serious medical condition at the time (I almost died; my intestines ruptured, but was almost certainly not a result of the rape, just bad timing). But I still believed in the system. I still didn’t want the man who raped me on the streets. I did everything they requested, answered every invasive question (the were really focused on my mental health history!), even got on the ground and acted out the rape for them, with the head detective on top of me acting out the part of the rapist. Not only was I absolutely hysterical by the time we were done, I’m positive that aggravated my PTSD for a long time after.

And after all that, I was called in for an “interview” to discuss “a new lead in your case”. They didn’t let my rape counselor in the room–again, against the law, I found out later! For about an hour (I think; my sense of time was not that great) they were no longer even pretending to be supportive. They accused me over and over of making it up. They had very flimsy “evidence” (which I won’t go into because it’s both complicated and ridiculous) but mostly it was their “instinct”.

Because I have a mental illness. Because I was hospitalized after attempting suicide. Because I “claimed” I had been sexually assaulted in the past. Because I was crazy, and he was sure I was just looking for attention. He had a bipolar ex-wife, you see, and she made his life a living hell. He told me how he understood mentally ill women, and how we need to create drama. How we’re liars, and we crave attention.

And over and over they accused me of lying. Alone in this tiny room with two large, angry men, I was doing everything I could to keep from having a panic attack. I couldn’t respond to what they were saying; again, I think I was in shock. And they threatened me with jail time, with a felony on my record, destroying my family, public humiliation (he threatened to call the papers–something he did anyway, because, quote, “the community needs to know there was no threat to public safety”). They said I would be charged with a false report, with terrorizing the public (there was a public awareness campaign initially after my attack, though I didn’t have anything to do with it. After the rape, I did everything I could to maintain anonymity, and only told two people–beyond my family and the cops–hat I was attacked. But…I did it for attention, which was why I didn’t tell anyone? I’m just sneaky like that, I guess!). Accusations, threats, anger, pounding the table, over and over and over.

The detective looked at me. His whole demeanor changed; he tried to seem kind, avuncular. “Tell me you made the whole thing up. This whole thing will disappear. Nothing will happen to you. You can leave, if you just tell me you made it up. Tell me you made it up and you’re sorry for lying, and I’ll let you leave.” I tried to hold out–but I didn’t last long. Honestly, at that point, all I wanted in the entire world was just to get out of that room. There are very few things I wouldn’t have done, if I could only leave. So I looked at him and lied. I said, “I made the whole thing up. I’m sorry.”

Through both of these examples, we see that women who are marginalized along other axes besides gender face additional injustice–cruelty, even–by law enforcement officials. Heina’s sexual orientation was used against her both by the man she reported for threats and by the cop who was supposed to be helping her. EEB’s mental illness was used as an excuse to abuse her, accuse her of lying, and ultimately coerce her into recanting her accusation despite overwhelming physical evidence that it was true.

The more intersecting marginalizations you have, the less likely you are to be treated fairly by the police. This is, sadly, nothing new at all, and it’s not limited to sexual violence (see: Trayvon Martin, stop and frisk, queer people being arrested for being queer). So why do people still insist that 1) survivors of sexual assault have a moral duty to report it to the police, 2) if the police do not prosecute a rapist, that means that no rape occurred, and 3) if a survivor chooses not to report, then they do not deserve any accommodations from their communities, and those communities must pretend that nothing ever happened?

EEB’s story, in particular, suggests that at least some false rape accusations are not actually false rape accusations. More research is urgently needed to determine how common this is, but my fear is that it is not uncommon. This story also shows how ableist ideas about mental illness–that people with mental illnesses are just “crazy” and “delusional” people who make shit up to ruin people’s lives–prevented a survivor from seeking justice and allowed a rapist to go free.

I used to be sympathetic to the idea that people should report sexual assault to the police, but I’m becoming less and less so. While I think we have an imperative to reform this system and make it work, for now, I don’t think it’s at all unreasonable for a survivor to choose not to report. If I were advising a survivor, I’m not even sure that I would feel comfortable encouraging them to do so.

And, dudes, next time you show up demanding to know why so-and-so didn’t report if they were “really raped,” I’m going to link you to this post. Remember that feeling safe around police officers is a sign of privilege, as is the belief that they will treat you fairly.

#FtBCon Wrap-up and Thank Yous

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Hopefully you caught at least part of our first-ever FtBCon this weekend; if not, here’s a convenient playlist of all of the things. I had a blast with it despite being chained to my computer for two and a half days; I met a bunch of people, learned a lot, and got to talk about some important stuff. Not that different from a meatspace conference, actually!

The best part were all the comments I saw from people who said that they never have the option to go to meatspace cons. Many said this was their first atheist/skeptical conference. Many said that physical/mental disabilities, money, work, children, and so on kept them from traveling to cons.

Of course, FtBCon isn’t anywhere near a perfect simulation of a meatspace conference. It can’t be. Nothing can replace that feeling of walking into a huge room full of likeminded people milling about, vendors selling books and jewelry and clothing, friends you rarely get to see in person. Nothing beats taking photos with your heroes and having people recognize you from the Internet. We have to keep doing our best to make conferences accessible in every possible way.

But FtBCon came damn close. The chat room was always full of great conversation, just like the hotel lobby after the day’s talks have wrapped up. Many of the panels would keep going after they went off air, with the panelists telling each other everything they didn’t get to say during the panel and then dissolving into conversation about family or books or life. People found new bloggers and speakers to follow, people made friends, people made plans for the future.

For instance, the folks from the amazing chronic pain panel mentioned wanting to create some sort of group for skeptics with chronic pain, and my mental illness panelists and I want to do a series of private and public hangouts about mental health from a skeptical perspective. And throughout the conference, many of us were already busy thinking up ideas for the next one (in fact, there’s a lively conversation going on in the FtB backchannel about that already).

Some of the highlights for me, aside from my own panels, were listening to Shelley Segal perform a beautiful song called “My Morality,” listening to Kate (check out her brand-new FtB blog!) give a great solo talk about the DSM, giving the folks from the Pathfinders Project the chance to promote their amazing work, hearing Ashley and Kelley talk about representation in some of my favorite YA novels, and, of course, drinking with everyone at the end and dissolving into laughter every 10 seconds.

It’s hard to believe that I’ve only been a part of this community for about a year. I never could’ve guessed, a year ago, that this summer I’d be helping organize such an awesome event–and one with so much potential to be even better next time.

Here are the panels I organized, by the way. On Friday night we did Sex & Skepticism, which I’ve been hearing is many attendees’ favorite panel:

The last panel of the night was Supporting Freethinkers with Mental Illness:

And on Sunday afternoon, we did another one on mental illness: “What’s the Harm? Religion, Pseudoscience, and Mental Health”:

In conclusion, I had a fucking fantastic time. I want to thank the rest of the organizers–Jason, Ian, Stephanie, Brianne, Russell, Ed, and especially PZ, who basically put this whole thing together before we got off our asses to help. (We promise to do better next time, PZ.) I also want to thank everyone who submitted proposals for panels, including the ones we weren’t able to accommodate (sorry about that! There were only a few of us and very many of you). And I especially want to thank my panel participants–Kate, Brendan, Drama, Olivia, Ed, Greta, Benny, Sophie, Franklin, Ginny, Nicole, Courtney, Ania, Niki, and Allegra. It’s gotta take guts to go on streaming video in front of hundreds of people to talk about sex and mental illness, but you all did it and it was great.

And, of course, thanks to everyone who was so excited–everyone who shared the event on Facebook, everyone who kept the chatroom hopping with discussions, everyone who tweeted, everyone who told us that this is important and necessary.

If you attended, please fill out this survey to tell us how we did. The next FtBCon will be much better, and it may be sooner than you think…

What I’m Doing This Weekend! #ftbcon

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FtBCon is almost upon us! Here’s a handy guide to everything I’m doing this weekend, aside from ALL OF THE SOCIAL MEDIA. All times are CDT (UTC – 5). The rest of the schedule, with links to where all the sessions will be, can be found here.

I’m hosting three panels for others (not speaking, just setting up and relaying audience questions):

Promoting Social Justice in Small Atheist Groups: Friday 10pm to 10:50pm with Paul Wright, Daniel Midgley, Madge Carew-Hopkins (they’re all from Australia!)

A lot has been said about promoting social justice in large groups of atheists, like forums, blogs and conventions. It’s not always easy to keep out the trolls and harassers and to say what needs to be said, but it can be done. But what do you do in a small university atheist club, or a local skeptic meetup group? Paul Wright, Madge Carew-Hopkins and Daniel Midgley talk about atheist groups in Perth, Australia and how the arguments that rage in the wider community have parallels in local atheist groups.

Reproductive Rights: Saturday 2pm to 3pm (with Brianne Bilyeu, Greg Laden, Bree Pearsall, Fausta Luchini, Aoife O’Riordan, Robin Marty and Nicole Harris)

A panel of reproductive rights activists come together to discuss access to abortion in current events , clinic escorting and some common religious and non-religious arguments against abortion. Our panel consists of clinic escorts – including one panelist who volunteered before FACE laws went into effect (Freedom of Access to Clinic Entrances), health care professionals, an author and several bloggers who write about reproductive rights. Our panelists hail from Minnesota, Kentucky, Virginia and Ireland.

Meet the Pathfinders: Sunday 11am to 12pm (with Ben Blanchard, Conor Robinson, and Wendy Webber)

Three of the volunteers of the Pathfinders Project, a yearlong international service and research trip sponsored by Foundation Beyond Belief, will be discussing the project, themselves, why they are involved, and why humanist service is so important.

I’m also moderating three more:

Sex & Skepticism: Friday 6pm to 8pm (with Greta Christina, Ginny Brown, Franklin Veaux, Benny, and Sophie Hirschfeld)

Sexuality is an area of human experience where pseudoscience and woo frequently prevail. How can skepticism and atheism enhance sex? What are the harms of allowing quackery and unexamined biases into the bedroom? Our panelists have a wide range of experiences with sexuality and skepticism, and their views on these questions will be diverse and thought-provoking.

Supporting Freethinkers with Mental Illness: Friday 11pm to 12am (with Kate Donovan, Brendan Murphy, Olivia James, and Drama)

“Have you tried yoga?” “You just need to pray harder.” “You should try this herbal supplement.” People with mental illnesses get advice like this all the time. Although it’s not particularly helpful to anyone, with skeptics and atheists it’s especially misguided. What should we say to freethinkers dealing with mental illness? How do we support them in an evidence-based way? How can we use skepticism and critical thinking to reduce the stigma of mental illness? How can we improve access to treatment that actually works?

What’s the Harm? Religion, Pseudoscience, and Mental Health: Sunday 1pm to 2pm (with Ania Bula, Nicole Harris, Niki M., Allegra Selzer, Courtney Caldwell, and Rachel Maccabee)

Religious and pseudoscientific communities often claim to promote mental health, whether through treatment or social support. Our panelists will discuss their experiences with mental illness and how religion and pseudoscience have influenced them. They will talk about the religious and pseudoscientific treatments they have gone through and how friends and family from those communities have responded to their mental illness.

And I’m speaking in this one, moderated by Crommunist:

God is Love? Relationships in a Godless World: Saturday 4pm to 6pm (with Ania Bula, James Croft, Jamila Bey, Beth Presswood, and Anti-Intellect)

Despite the popular assertion, one does not need to believe in a god to have love in their lives; however, disbelief surely shapes the kinds of loving relationships atheists can have. What effect does lack of a god belief have on things like sexual desire, shame, and the types of relationships we feel comfortable with? A panel of people with different experiences and perspectives discusses some of the issues and takes your questions!

I hope to see lots of you online this weekend! Don’t forget that you can talk to other attendees in the Pharyngula chat room.

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.

Small Things You Can Do To Improve Mental Health In Your Community

[Content note: suicide, mental illness]

A few weeks ago Northwestern lost yet another student to suicide. There’s been pressure building all year for improved mental health services on campus, and I think that pressure will soon culminate in real, helpful changes on campus.

At the same time, some have been saying that what we need is not better mental healthcare services, but changes in campus “culture,” such as a reduction in the stigma of accessing mental healthcare and an increase in our willingness to discuss mental health which each other.

I don’t think that these things are mutually exclusive; I think we need both. People whose troubles are relatively minor will benefit from increased openness about mental health on campus without needing any improvements in mental healthcare, but those who suffer from serious mental illnesses–the kind that can contribute to suicide–need more than just supportive friends and professors. They need treatment. Right now, it’s becoming clear that many of those people are not getting the help they need.

Echoing these debates, a blog run by Northwestern students called Sherman Ave posted a piece called “A Reflection on Death, Privilege, and The College Experience.” (Sherman Ave usually sticks to humor, but this time it poignantly diverged.) The author wrote:

In writing these words and thinking these thoughts, I do not believe that a “call to action” here ends in throwing more money toward psychological services. As much as I believe that funding of psychological services at this university should be increased, I would hesitate to claim that another few thousand dollars would have stopped Alyssa Weaver and potentially Dmitri Teplov from committing suicide. Rather, I encourage everyone reading this article to think carefully about the state of those without the privilege of stable mental health.  We should seek to sympathize with members of our community instead of ignoring them for the sake of convenience. If we have the tremendous power to come together in grievance of a lost classmate, then there’s absolutely no reason we shouldn’t be able to show the same love and solidarity for that classmate before they give up on our community.

And a commenter responded:

I agree with the need to come together to “show the same love and solidarity” to members of our community who need or want support and communication from others, but what does that practically mean? I find myself asking–how can I, as one person, contribute to a positive dialogue that moves our community towards supporting each other in the face of hardship? How do I even “identify” someone who needs my help? Or how do I make myself open to facilitating healing in my peers?

I don’t think there’s any easy answer to this. Practically speaking, changing a culture is like voting–it’s pretty rare that the actions of a single individual make an immediately noticeable difference. Westerners are used to thinking of themselves as individual agents, acting on their own and without any influence from or effect on their surrounding culture, and this is probably one of the many reasons it’s so difficult for people to even conceive of being able to make an actual impact when it comes to something like this.

You don’t have to be an activist, a therapist, or a researcher to make a difference when it comes to mental health. The following are small things almost anyone can do to help build a community where mental illness is taken seriously and where mental health is valued. Although I’m specifically thinking about college campuses here, this is applicable to anything you might call a “community”–an organization, a group of friends, a neighborhood.

1. When people ask you how you’re doing, tell them the truth.

This is something I’ve been really making an effort to do. This doesn’t mean that every time someone asks me “What’s up?” I give them The Unabridged Chronicles of Miri’s Current Woes and Suffering. But I try not to just say “Good!” unless I mean it. Instead I’ll say, “I’ve been going through a rough patch lately, but things are looking up. How about you?” or “Pretty worried about my grad school loans, but hopefully I’ll figure it out.” The point isn’t so much that I desperately need to share these things with people; rather, I’m signaling that 1) I trust them with this information, and 2) they are welcome to open up to me, too. Ending on a positive note and/or by asking them how they are makes it clear that I’m not trying to dump all my problems on them, but I leave it up to them to decide whether or not to ask more questions and try to comfort me, or to just go ahead and tell me how they’re doing.

2. If you see a therapist or have in the past and are comfortable telling people, tell them.

One awesome thing many of my friends do is just casually drop in references to the fact that they see a therapist into conversation. This doesn’t have to be awkward or off-topic, but it does have to be intentional. They’ll say stuff like, “Sorry, I can’t hang out then; I have therapy” or they’ll mention something they learned or talked about in a therapy session where it’s relevant. The point of this is to normalize therapy and to treat it like any other doctor’s appointment or anything else you might do for your health, like going to the gym or buying healthy food. It also suggests to people that you are someone they can go to if they’re considering therapy and have questions about it, because you won’t stigmatize them.

3. Drop casual misuse of mental illness from your language.

Don’t say the weather is “bipolar.” Don’t refer to someone as “totally schizo.” Don’t claim to be “depressed” if you’re actually just feeling sad (unless, of course, you actually are depressed). Don’t call someone’s preference for neatness “so OCD.” These are serious illnesses and it hurts people who have them to see them referenced flippantly and incorrectly. One fourth of adults will have a mental illness at some point in their life, and you might not know if one of them is standing right next to you. Furthermore, the constant misuse of these terms makes it easier for people to dismiss those who (accurately) claim to have a mental illness. If all you know about “being totally ADHD” is when you have a bit of trouble doing the dense reading for your philosophy class, it becomes easier to dismiss someone who tells you that they actually have ADHD.

4. Know the warning signs of mental illness and suicidality, and know where to refer friends who need professional help.

You can find plenty of information about this online or in pamphlets at a local counseling center. If you’re a student, find out what mental health services your campus offers. If you’re not a student, find out about low-cost counseling in your area. If you have the time, see if you can attend a training on suicide prevention (and remember that asking someone if they’re okay or if they’ve been feeling suicidal will not make them not-okay or suicidal). Being aware and informed about mental health can make a huge difference in the life of a friend who needs help. This doesn’t mean you’re responsible for people who need help or that it’s your fault if you don’t succeed in helping them–not at all. It just gives you a toolbox that’ll help you respond if someone in your community is showing signs of mental illness.

Learning about mental illness is also extremely important because it helps you decolonize your mind from the stigma you’ve probably learned. Even those who really want to be supportive and helpful to people with mental illnesses have occasionally had fleeting thoughts of “Why can’t they just try harder” and “Maybe they’re just making this up for attention.” That’s stigma talking. Even if you didn’t learn this from your family, you learned it from the surrounding culture. Studying mental illness helps shut that voice up for good.

5. Understand how social structures–culture, laws, business, politics, the media, etc.–influence mental health.

If you learned what you know about mental  health through psychology classes, your understanding of it is probably very individualistic: poor mental health is caused by a malfunctioning brain, or at most by a difficult childhood or poor coping skills. However, the larger society we live in affects who has mental health problems, who gets treatment, what kind of treatment they get, and how they are treated by others. Learn about the barriers certain groups–the poor, people of color, etc.–face in getting treatment. Learn about how certain groups–women, queer people, etc.–have been mistreated by the mental healthcare system. Find out what laws are being passed concerning mental healthcare, both in your state and in the federal government. Learn how insurance companies influence what kind of treatment people are able to get (medication vs. talk therapy, for instance) and what sorts of problems you must typically have in order for insurance to cover your treatment (diagnosable DSM disorders, usually). Pay attention to how mental illness is portrayed in the media–which problems are considered legitimate, which are made fun of, which get no mention at all.

It’s tempting to view mental health as an individual trait, and mental illness as an individual problem. But in order to help build a community in which mental health matters, you have to learn to think about it structurally. That’s the only way to really understand why things are the way they are and how to make them change.

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.

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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.