Depression is Not Sadness

[Content note: depression, suicide]

Yesterday I came across the story of Junior Seau, an NFL linebacker who committed suicide on May 2. He shot himself in the chest and was found in his home by his girlfriend. Although little is known of Seau’s mental health leading up to his death, he had apparently suffered from insomnia for the last seven years of his life.

Sportswriter Chris McCosky wrote a beautiful column in the Detroit News about Seau’s death and continuing ignorance about depression and suicide. In the column, McCosky shares his own experiences with depression and suicidal thoughts and laments how difficult it is to explain them to people. He notes, as I’ve noted before, that one common reaction that non-depressed people have is to wonder what the hell we have to be so sad about. He writes, “It’s almost impossible to talk about it to regular people (bosses, spouses, friends). They can’t fathom how somebody in good physical health, with a good job, with kids who love them, who seems relatively normal on the outside, can be terminally unhappy.”

The unbearable frequency at which McCosky and I and probably everyone else who tries to talk about depression get this response could be a testament to the fact the most visible symptom of depression is usually sadness. So that’s the one people latch on to: “What do you have to be so sad about?” “Cheer up!” “You have to decide to be happy!”

Because of the sheer obviousness of our sadness, we’re often forced to try to use it to describe depression. We say that we’re just extremely sad, or unhealthily sad, or a different kind of sad. It’s sadness that never goes away like sadness is supposed to. It’s sadness that’s out of proportion to the troubles that we face in our lives. It’s sadness that we can’t stop thinking about. For those of us with bipolar or cyclothymic disorder, it’s sadness that comes and goes much too quickly.

And it is. But the truth is that sadness actually has very little to do with depression, except that it is one of its many possible symptoms.

Based on the diagnostic criteria for depression, you don’t even need to be chronically sad to be considered “depressed.” Anhedonia, which means losing the ability to feel pleasure from things that you used to enjoy, could be present instead. Under the formal DSM-IV definition, you must have at least five of nine possible symptoms to have major depression–and one of the five must be either depressed mood or anhedonia–and only one of those symptoms involves sadness. (If you so some very basic math, you will notice that this means that two people, both of whom officially have major depression, might only have one symptom in common. Weird, huh?)

So, even if your particular depression does include sadness, it’ll only be one of many other symptoms. The others might be much more painful and salient for you than the sadness is. Some people can’t sleep, others gain weight, some think constantly about death, others can’t concentrate or remember anything. Many lose interest in sex, or food, or both. Almost everyone, it seems, experiences a crushing fatigue in which your limbs feel like stone and no amount of sleep ever helps. Then there are headaches, stomachaches, and so on.

So, depression doesn’t necessarily mean sadness to us. (And, a gentle reminder to non-depressed folks: being sad doesn’t mean you’re “depressed,” either.)

Depression is not sadness; it’s an illness that often, though not always, involves sadness. No amount of happy things will make a depressed person spontaneously recover, and, usually, no amount of sad things will make a well-adjusted person with good mental health suddenly develop depression. (Grief, of course, is another matter.) And sadness, on its own, does not cause suicide.

We need to start talking about mood disorders as disorders, not as emotional states. McCosky writes:

Junior Seau wasn’t sad when he pointed that gun to his chest. He wasn’t being a coward. He wasn’t being selfish. He was sick. I wasn’t sad when I thought about swerving into on-coming traffic on Pontiac Trail some 20 years ago. I was sick.

What he’s saying is that people don’t kill themselves because they’re sad. They kill themselves because they have an illness that, among other things, makes them feel sad. It also makes them feel like their life is worthless, like they’re a burden to others, like death would be easier, and all the other beliefs that lead people down the path to suicide.

There is a tendency, I think, to assume that people are depressed because they are sad. A better way to look at it is that people are sad because they are depressed. That’s why, even if we could “turn that frown upside down!” and “just look on the sunny side!” for your benefit, it would do absolutely no good. The depression would still be there, but in a different form.

Junior Seau did not leave a suicide note, so nobody will ever know what he was thinking when he died. I would guess, though, that he was thinking about much more than just being sad.

Depression is Not Sadness
{advertisement}

Anonymity and Mental Illness

The stigma of mental illness has many negative consequences, such as decreased access to employment and housing, barriers to seeking treatment, and many broken friendships and relationships.

What it also does, unfortunately, is make it much harder for people who’ve suffered from mental illness to speak about it publicly, using their real names.

I’ve been thinking about this because North by Northwestern, our campus magazine, ran a feature in its spring issue about mental illness at Northwestern. Overall, the piece was great and discussed how our academic system may be contributing to unhealthy levels of stress. The author of the piece interviewed two students who spoke about their experiences with depression and anxiety.

But both of the students’ names were changed for the article, and it bothered me.

For the record, I would never begrudge an individual for choosing to speak about his or her mental illness under a pseudonym. We all have different priorities, and not everyone has decided to spend their life advocating for those with mental illnesses (as, for instance, I have). Even those who do may decide that using a pseudonym is in their best interest–for instance, this blogger whom I greatly respect.

The magazine, however, could have chosen to find sources who would be willing to let their real names be printed. I know it could’ve, because those people exist on our campus. I’m one of them. Many of my friends are, too.

This is important for several reasons, some short-term and some long-term.

The short-term reason is that seeing fellow students speak publicly about their experiences with mental illness can make a huge difference in the life of someone who’s just starting to acknowledge and deal with their own illness. It lets them know they’re not alone and gives them hope for the future.

It can also give them a specific person to reach out to. After I started writing about depression, friends, acquaintances, and even strangers started writing to me, sharing their stories, and asking for advice. I heard from friends that I knew were struggling and friends who seemed to have everything together. I heard from a guy who’d told me once that he’d had depression briefly but pulled himself out of it on his own. I felt humbled to know the truth.

A friend of mine who spoke in a panel about her eating disorder once told me that she had the same experience. She was quoted in an article about the panel, and afterwards people reached out to her about it.

There’s a bigger picture, though, as well. Every time someone “goes public” about a mental illness, they chip away at the culture of secrecy that surrounds it. And the more of us do it, the harder it’ll be to deny us jobs, cut off friendships with us, continue believing that we’re weak and lazy, and be ashamed of us.

I’m glad those two students spoke to NBN, and I know it was hard for them to do even knowing that their names would not be in print. But NBN had a chance to do something really important, and they missed that chance.

As I was writing this post, I found out that there’s someone pretty powerful who recently took that chance. During his speech for people who have lost family members in the military, Vice President Biden talked about the deaths of his wife and daughter in 1972. Then, he said, “I probably shouldn’t say this with the press here, but it’s more important–you’re more important.” Then he went on:

For the first time in my life, I understood how someone could consciously decide to commit suicide. Not because they were deranged, not because they were nuts, but because they had been to the top of the mountain and they just knew in their heart they’d never get there again.

Biden’s not the only one, of course. Plenty of well-known people have spoken about mental illness, such as Rachel Maddow, William Styron, and Demi Lovato.

In his seminal book on depression, The Noonday Demon (which I have coincidentally just finished reading), Andrew Solomon intentionally avoids using pseudonyms whenever possible. On the first page of the book, he writes,

I asked my subjects to allow me to use their actual names, because real names lend authority to real stories. In a book one of the aims of which is to remove the burden of stigma from mental illness, it is important not to play to that stigma by hiding the identities of depressed people.

I believe that when writing about mental illness, one must be cautious of the status quo. With regards to mental illness, as with regards to just about everything else, the status quo can be a dangerous thing. You cannot think and write about the tragedy of mental illness without also acknowledging the tragedy of stigma, which pushes so many of us to stay silent for too long. In my case, it was eight years. For others, it’s a lifetime.

Accepting the use of pseudonyms in one’s work just because that’s what’s always been done, or because finding interview subjects who are willing to use their real names might be difficult, does an injustice to everyone who suffers from the continuing presence of stigma.

Anonymity and Mental Illness

Sunday Link Roundup

So I’ve decided to dedicate one post each week to sharing all the awesome things I read elsewhere on the Internet. Hopefully I actually remember to do this each week. 🙂

1. On the benefits of psychiatric labels. I’ve written about this before, but this blogger says it beautifully: “My labels have freed me to live in better harmony with the person I wish to be.”

2. On sexual harassment as an exercise of power.

3. On casual sex and how, for some people, it’s just not that great. I can really relate to this.

4. On “Straight White Male” is the lowest difficulty setting in life. This super-controversial post uses video games as a metaphor for privilege. It’s been accused of ignoring issues like class, but I think we can all agree that Metaphors Are Imperfect.

5. On the (in)visibility of bisexuality. Also, everything else on this blog is fantastic.

6. On Mitt Romney as a bully. I wrote about this too, but this post explores more facets of the story. “The fact that so many responses to Romney’s abuse categorise it as pranking or fun rather than bullying says a lot about why this country has such a big bullying problem. The refusal to identify what he did as wrong, and to connect the dots on what it means politically, speaks to dangerous social attitudes.”

7. Last but not least, this blogger dedicated an entire post to why my blog is awesome. Needless to say, I feel really really special. 😀

Sunday Link Roundup

What You're Really Saying When You Say that Suicide is "Selfish"

I’m still thinking about the Chet Hanks suicide thing from last week and the various responses to it that I saw online. Specifically, I cited two comments that referred to suicide as “selfish.”

“Selfish” has to be one of the most common adjectives people think of when thinking about suicide. Those of us who are involved in mental health advocacy could probably rant at you for hours about how this word perpetuates the stigma that mental illness and suicide carry in our society, how useless and counterproductive it is to accuse a suicidal person of being “selfish,” and so on. In fact, if you get nothing else out of this post, I hope you reconsider using that word to describe suicide if you’ve done so before.

But I can understand where this sentiment comes from. While everyone loses loved ones at some point in their lives, relatively few people experience suicidality first-hand. For this reason, people understand the latter situation much less than the former. Faced with the thought that someone you love might kill themselves and put you through all the resulting grief just because of some inner turmoil that you can’t see or understand, it makes sense that you might feel that suicide is selfish.

At the same time, though, conceptualizing suicide as a “selfish act” sends the message that people somehow “owe it” to their loved ones to stay alive despite immense emotional pain. When you say that suicide is “selfish,” you’re implying–even if you don’t mean to–that the individual’s pain, as well as their potential to improve, isn’t what matters. What matters is how they’ll make the people around them feel.

I don’t mean to discount the grief that people feel when someone they love commits suicide–that’s real, valid, and deserves attention. And, obviously, I believe that people should not commit suicide. But I believe that because I also believe that people can recover from the pain that’s causing them to consider suicide, not because they owe it to others to live.

What all of this comes down to is that most people do not (and perhaps cannot) understand what actually goes through a suicidal person’s mind. Maybe they assume that suicidal people are just sad the way all of us sometimes get sad, except maybe a bit more so. (I honestly don’t know how mentally healthy people think about suicide because I haven’t been one for a while.) It would indeed be rather selfish to put your friends and family through so much pain just because you felt sad one day.

But that’s not how suicide works.

The way I see it, the tragedy of suicide is not (or is not only) the fact that an individual’s suicide also hurts others. Rather, it’s that the individual could have found a way to heal, be happy, and live out the rest of his or her life. Calling suicide a “selfish” thing to do erases that latter tragedy and implies that our primary purpose in life is not to create a meaningful and worthwhile life for ourselves, but to keep our friends and family happy at all costs.

Our first priority should be to convince those who want to take their own lives that those lives are intrinsically valuable and should be preserved for their own sake. Only when they’ve accepted that premise can they even begin to think clearly about their obligations and interactions with other people.

Telling a suicidal person that suicide is “selfish” only reinforces the guilt they already feel. People should choose to live because their lives feel worth living to them, not out of a sense of obligation towards others.

Note: Since this is quite a sensitive topic both for me and probably for many readers, please try to be especially careful with your comments. I reserve the right to delete any comments that I feel may trigger people, even if they’re completely on-topic.

What You're Really Saying When You Say that Suicide is "Selfish"

Chet Hanks, Victim Blaming, and the "Weakness" of Suicide

Chet Hanks, son of Tom Hanks and a student here at Northwestern, has this to say about victims of bullying:

Chet's tweet: "Ayo I don't condone bullying but anyone who offs themselves cuz they got picked on is weak."
Credit: Gawker

And then, perhaps in response to people who responded to him (including yours truly), Chet tweeted these followups:

“I say real shit and I always speak my mind if you don’t like it I could give a fuck less.”

“Lol…Haters: I am sorry I do not cater to your demographic: shlubby dudes that don’t get laid enough it’s ok go back to your Internet porn”

“G’head check my feed, all the people hatin are mediocre Lames and cute girls show me love #whatdoesthattellyou

How mature.

Sometimes I wish someone would invent a technology that allows you to connect to someone else’s brain and actually feel what they feel. Because language is a poor substitute.

Maybe if we had such a technology, people would finally understand that mental illness and suicide do not happen to people because they are “weak.”

However, since we don’t have such a technology, the best we can do is educate ourselves about other people, something that college provides a great opportunity to do. It’s too bad that Chet Hanks seems not to be taking advantage of it.

Some of the comments on the Gawker piece I linked to, while generally dismissive of Chet Hanks, are hardly any better:

His expression of emotion is misguided and a bit douche-y, but I second the sentiment. Suicide is a horrible option to exercise as a bullying deterrent. It’s a permanent solution to a potentially temporary problem. It exchanges the pain you feel for the pain of those around you who love you and is essentially a selfish act.
Suicide is selfish and hurts people who care about you, but calling people who are potentially thinking about doing it weak is only going to make things worse. He could have expressed this sentiment in a way that was constructive and helped people, instead of highlighting what an asshat he is.

It’s probably true that some people are psychologically more susceptible to suicide than others, but that difference has nothing to do with “strength” or “weakness.” It also has nothing to do with “willpower” and “selfishness.” To put it broadly, suicide is what happens when a person no longer wants to live–which isn’t necessarily the same thing as wanting to die.

Tragically, most people who commit suicide do so at least in part because they don’t feel like anyone will miss them, and contrary to what the self-righteous commenters above seem to think, not everyone does have friends or family who care about them. It’s also worth noting that, with the exception of people like me who were bullied for being nerdy, kids who get bullied tend to already be marginalized by society in numerous ways–because of fatness or ugliness, mental or physical disability, perceived or real homosexuality, noncompliance with gender roles, and so on. Sometimes, these are the very children who are least likely to have supportive parents, siblings, teachers, and friends cheering them on through their trials.

What Chet seems to miss is that the causal relationship between bullying and suicide isn’t just that a kid goes to school one day and gets called a fag and comes home and tries to kill himself. Bullying is almost never a one-time thing; it can continue over months or years. It’s a constant wearing down of an individual’s self-worth and belief that he/she belongs in this world. Bullies don’t simply call you names and beat you up–they convince you that nobody wants you here.

While supportive friends and family can alleviate these tragic effects somewhat, as I mentioned, not everyone has supportive friends and family. And even if they do, that may not be enough. Children don’t have the freedom that adults have–they’re completely powerless to escape the situation by moving or dropping out of school. The only recourse they generally have is telling an authority figure at school, and that tends to do nothing at best or backfire at worst.

But of course, pretty much everyone reading this blog probably already knows all that. What they probably don’t know is how it actually feels to seriously consider suicide, and how little it has to do with concepts like “weakness” and “selfishness.” If you’d like to hear about it from someone who knows of what she speaks, feel free to ask me personally. Otherwise, I’d recommend this amazing book.

After we read about Chet’s tweet, some of my friends and I started talking about the whole concept of victim blaming and how pervasive it is in our society. Although it’s usually talked about in the context of sexual assault, there really isn’t a single shitty human experience that doesn’t routinely get blamed on its victims: mental illness, bullying, poverty, racism, sexual harassment, you name it. If you have depression, it’s because you’re just not looking on the bright side of life. If you’re getting bullied, it’s because you stick out too much or “react” too much. If you’re poor, it’s because you’re too lazy to get a job. If you’re fat, it’s because you eat crap and don’t exercise. If you feel discriminated against, it’s because you’re “too sensitive.” If you’re getting harassed on the street, your skirt’s too short. And so on and so forth.

(In fact, as Barbara Ehrenreich notes in her brilliant book Bright-sided, even cancer, that ultimate of tragedies, is increasingly getting blamed on its victims. Why? Because they didn’t “think positively” enough.)

Sometimes, it’s really difficult and unpleasant to acknowledge the fact that, even in our pull-yourself-up-by-the-bootstraps, when-there’s-a-will-there’s-a-way sort of culture, sometimes life just screws people. Sometimes it just does.

It’s easier to blame the victim than to make the sort of cultural changes we would need to make sure that people get screwed over as little as possible. Much easier than to figure out how to teach compassion to kids, how to eradicate racism, how to get people to realize that there’s never an excuse for raping people.

But just because we may not yet know how to do those things does not mean we should just throw up our hands and say, “Yeah well, if they off themselves, it’s just cuz they’re weak.”

The more I study psychology, bullying, and the many challenges faced by people that society continually marginalizes, the more I think: If only it were that simple.

*edit* Also, here’s an awesome blog post about this from my friend Derrick.

Chet Hanks, Victim Blaming, and the "Weakness" of Suicide

The "Right" Way to Be Depressed

CNN did a great thing today. They published a first-person account by one of their editors, Stephanie Gallman, about her experience of being diagnosed with depression, and of telling her friends and family about it.

Initially when I saw this article, I was overjoyed. It’s good to see mainstream media outlets publishing articles about depression that are personal rather than scientific in nature, and I’m relieved that more people are willing to publicly state the fact that they have depression.

But then I actually started reading it:

In August, after several months of seeing a therapist and a psychiatrist, I was diagnosed with depression.

The news came as a shock.

“I’m not depressed,” I said defiantly, shaking my head when the doctor deducted that must be what was ailing me.

“I hate depressed people.”

She laughed at my strange reaction, but I was serious. I don’t want to be in that category of people. Everything they take in and spew out just breathes negativity, and they are difficult to be around. I despise these people.

Gee, thanks, Stephanie. We despise you too.

She goes on to describe how, at her doctor’s urging, she finally realized that the symptoms of depression really did describe her experience. When her doctor suggests antidepressants, she’s not too excited about the idea but seems to at least consider it.

Then she discusses dropping the “D-bomb” to friends and family. Her favorite response from them, apparently, is surprise:

A lot of the people reacted to the D-bomb the same way I did — “You’re depressed?! You?  Stephanie Gallman? But you’re one of the happiest people that I know! You Hula-Hoop in Walmart!” (I really do Hula-Hoop in Walmart — every time I go.)

These are the people I wanted to reach out and hug; they made me feel like I hadn’t turned into Debbie Downer.

It’s true, to the outside world, I do appear happy. And I realize this is hard to grasp, even for me, but I am happy most of the time. I am fully aware of how blessed my life is and express gratitude for it daily. I have worked hard not to let what’s going on with me on the inside affect the way I present myself on the outside.

It’s hard not to notice how much this smacks of a certain self-congratulatory relief, of “doing” depression the right way. This woman is clearly such a considerate person, for not letting her depression affect how she presents herself!

Gallman’s gratitude for her blessed life strikes a chord with me, as it will with many other people with depression, because of how damn often we’re told to “count our blessings” and “be grateful for what we have.” There’s nothing worse, apparently, then being ungrateful.

That said, there are definitely some great things about the article. Gallman talks about her anger at being told to “do more of the things that you enjoy” rather than taking antidepressants. “Bite me,” she writes. “These patronizing (“The Secret”? Are you serious?) prescriptions infuriated me, as if the reason I wasn’t happy is because I hadn’t tried hard enough.”

She also makes a great point about the need for more openness surrounding mental illness. One of the responses she often received when she dropped the “D-bomb” was stories about friends and family members who had also suffered from depression:

I was dumbfounded. I wanted to scream like Adam Sandler in “The Wedding Singer”: “Gee, you know that information … really would’ve been more useful to me yesterday!” Why isn’t anyone talking about these illnesses that affect our most important body part — our brain?

Indeed, why aren’t more people taking about these common, devastating illnesses?

Unfortunately for Gallman, one answer is that it’s because of people like her.

Specifically, it’s because of the people who call us “Debbie Downers,” who tell us that we’re “spewing negativity,” who blame us for our own illness just like Gallman (tragically) blamed herself.

The problem with Gallman’s narrative is that we’re not all as “blessed” as she is. Her theory that she may be to blame for her own depression because she withdrew from friends may be applicable to her own life (though I doubt it), but it’s not very applicable to those depression sufferers who may not have a strong support network like she does. She writes, “No surprise, the wonderful people in my life have all been very kind and sympathetic, offering words of comfort and support.” Well…good for her. Not everybody has that.

Furthermore, not everybody is an accomplished adult who has a dream job as an editor at CNN. Gallman’s habits of eating well and exercising healthfully, which she is proud enough of to mention in this article, are not available as options to everybody. It’s clear that she has a full enough life that she’s able to throw herself into other things and avoid that terrible label of “unhappy.” Her optimistic personality, another trait of which she is very proud, is something that psychologists generally agree is inborn and possibly genetic–not something that all of us are so lucky to have.

After reading this article, I was struck by the pervasiveness of the message hidden between its lines–that there is a “right” way to be depressed. Gallman plays this role well. She does not embrace her diagnosis, nor her doctor’s suggested treatment; after all, doing so would imply that she “wants” to be a victim. She steadfastedly counts her blessings every day and reaches out to her supportive friends and family. She eats well and exercises. She is absolutely not to blame for her depression because she does everything “right.”

And most of all, she sees her depressive side as something shameful and ugly, just a foil to her sunny personality.

What about those of us who don’t have a sunny personality?

I feel for Gallman, not just because of her struggle with depression, but because of how indelibly she has internalized the idea of depression and unhappiness in general as something Wrong and Bad. There’s no room in this article for the scandalous idea that depression, while being difficult and unpleasant, is something that a person can make peace with–the way they might make peace with having asthma or diabetes.

There’s also no room in this article for sympathy for those who don’t play the role of Optimistic Depression Sufferer as well as Gallman does. No sympathy for those who don’t identify themselves as happy people at all.

I’m glad that Gallman has shared her story, and I wish more people would do the same–with their real name attached. But I hope that readers who don’t have experience with depression do not assume that Gallman speaks for all of us.

Edit 4/2/12: If you want to see a brilliant, prominent person discuss her experiences with depression without being judgmental and promoting stigma like Gallman does, read this.

The "Right" Way to Be Depressed

Liking Yourself and Being a Good Person–Is There a Connection?

Read this quote:

“I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth. Whether I shall ever be better I can not tell; I awfully forebode I shall not. To remain as I am is impossible; I must die or be better, it appears to me.”

If you were to take a wild guess, would you say that the person who wrote this was a productive member of society? Do you think that he or she was the type of person who helped others, who contributed meaningfully to his or her community? Was he or she a good person?

If you’re like most people (which, if you read this blog, you’re probably not, but bear with me), you’d probably answer “no” to those questions.

And you’d be dead wrong, because the author of those dismal thoughts was Abraham Lincoln.

This past weekend, my Jewish education group had its second retreat of the quarter. (I wrote about the first one here.)

One of our many discussions during the retreat was on which qualities are necessary for someone to be a good person (however one defines “good”). Some of my group’s suggestions, such as empathy, seemed completely accurate.

Some, however, did not. One student mentioned that she thinks that liking yourself is a prerequisite to being a good person, and everyone enthusiastically agreed.

I waited for her to explain. She said that you have to be fine with yourself before you can focus on being a good person to other people. She said that not liking yourself is unhealthy. (And unhealthy, by extension, must mean bad.)

I said, “What if the person you are right now just isn’t likable to you?”

She said, “Well, then you would just be bitter.”

I said, “I don’t like myself and I’m not bitter.”

She stammered, said sorry, and left the subject alone.

Here’s the thing. I would agree that genuinely liking yourself is a pretty good goal to have in terms of your own psychological development. However, I completely oppose the moralization of this quality. That is, I oppose the idea that liking yourself makes you a “good” person and that not liking yourself makes you a “bad” person. I also oppose the idea that you can’t be a “good” person unless you like yourself.

I have several reasons for opposing this concept. One is that I truly don’t believe that your opinion of yourself is strongly correlated with your treatment of others and your ability to contribute positively to society. There’s a stereotype of people who have low self-worth as selfish, miserable, and–as the girl in my group said–bitter. While it’s quite possible that not liking yourself would lead some people to be this way, it can also push people to turn outwards and do incredible things for others. Abraham Lincoln, for instance, may have been one such person.

Second, while the argument that you must like yourself in order to be a good person does not necessarily imply that liking yourself automatically makes you a good person, I think that’s something that should be examined. Once you do that, you’ll hopefully realize that there’s simply no connection. Some people who like themselves are great people. Some are horrible people. Some like themselves so much that they don’t give a crap about anyone else.

Third, there is an illness that up to a quarter of adults will experience at some point during their lives that has as one of its symptoms feeling worthless and hating yourself. That, of course, is depression. I hope I don’t have to explain why I find the suggestion that depressed people can’t be “good” people to be inaccurate, superficial, and downright offensive.

Fourth, all of this hinges on one’s personal definition of a “good person,” which was never elaborated on during our discussion. (I find that in conversations of a religious nature, these things tend to just be left undefined.) To me, a person who isn’t good is a person who has the opportunity to help others but chooses not to. A person who cannot help others due to circumstances beyond his or her control should not be labeled as “bad.” So if disliking yourself really is keeping you from helping others, that doesn’t mean you’re not a good person. It just means you have to work on your issues before you can put your goodness into action.

As I told the girl in my group, I dislike myself. There are two main reasons for that. One is that I have depression, and as I mentioned, that’s one of its symptoms. The other is that the culture I live in rejects many of my most defining traits, and it’s really, really hard to like yourself when you’re bombarded with cultural messages that tell you that you’re unlikeable.

With time, I’ll probably learn how to ignore those messages. But to suggest that I can’t be a good person right now because of them (and because of my depression) is extremely condescending. I do my best to be a good friend, daughter, sister, and leader in the Northwestern community. I have found causes that I support and advocate for them tirelessly. Because of my openness about my own experiences with mental illness, I have been able to serve as a source of information and support for many other people that I’ve met over the past few years.

Now, that’s hardly on the level of, say, Abraham Lincoln. But it’s more than a lot of other people my age do. A lot of the ones, I might add, who insist that this time of our lives is a time to “just focus on me” and “just do what I want.”

Liking yourself is great. It feels nice. But we shouldn’t confuse it with having the ability and the desire to do good.

Liking Yourself and Being a Good Person–Is There a Connection?

Goodbye Lexapro

[TMI Warning]

Today marks the end of an era of my life.

Today I took my last dose of antidepressants, and tomorrow, for the first time in a year and a half, I will get up in the morning and (purposefully) not take that pill again.

I went on Lexapro as a last resort in July 2010. I won’t go into all those details here since I’ve written about it before, but I’ll say that, at the time, I had no other choice. When a body has been critically injured, it enters a coma. I was in the mental version of that.

Lexapro did a lot of things to me, some expected, some not so much. I stopped crying every day and wanting to kill myself, at least for a while. I also became, according to my friends, more lively, more social, and visibly happier.

But then, there was the other stuff. Lexapro broke up the one meaningful romantic relationship I’ve had in my life. (Was it destined to break up anyway? Now I’ll never know.) It altered my values and beliefs for some time and turned me into the sort of person I would’ve hated a few months before. Now I’m back to my normal self, thankfully.

It was also a cruel helper at times. If I missed just a day of it, I’d be a wreck by nightfall. If I missed two days, the withdrawal symptoms kicked in, and they were horrible. I’d be dizzy, nauseous, barely able to walk, completely unable to explain to people why I was suddenly sick when I’d been fine just that morning. (“Sorry, I’m going through drug withdrawal” isn’t really an effective explanation for most people.) The worst symptom of antidepressant withdrawal has no official name, but depressives refer to it as “brain zaps.” They’re momentary sensations of being shocked or stunned in the head and they happen every few minutes or so, or even more often.

Theoretically, of course, there’s no need to ever miss a day of a prescribed medication, but when you factor in insurance issues, CVS’s constant fuckups, weird sleeping schedules, and other crap, it happens pretty often. I remember one awful time when I forgot to bring my medication back to school from break with me and I had to get my parents to ship it. Those were an unpleasant few days. Another time, my psychiatrist refused to renew my prescription unless I came in to see her, but I’d already be back at school by the time she had her first available appointment slot, and there was no way I could skip classes to drive six hours home to Ohio. She wouldn’t budge.

I’m not going to go into a whole condemnation of psychiatry or the pharmaceutical industry because they gave me back my life. However, I will say this: there is so, so much work to be done.

My psychiatrist prescribed me Lexapro after a nurse practitioner talked to me for ten minutes, and she for about five. She said that “academic stress” was causing my depression and that antidepressants would help me deal with it. She must’ve missed the part where I said that my depression started when I was 12 years old. She also apparently missed the glaring cognitive distortions and emotional issues I was having, and had been having for years and years. She oversimplified my problems and thus prescribed a simple remedy.

It took a while to even begin to sort out what the problem really was, and I’m still not there yet.

Some other things my psychiatrist didn’t tell me: the personality changes. The withdrawal symptoms. The fact that I was more likely than not to have a relapse (which I did). And, of course, the fact that you don’t really recover from depression. You only learn how to avoid it for bursts of time.

That was stuff I shouldn’t have had to learn through experience.

Now I look at that almost-empty bottle and I just can’t look at it with a sense of gratitude. I will never be an enthusiastic advocate of psychiatry, though I will continue fighting for the rights of patients to obtain complete information about medication and to make their own decisions.

I look forward to the end of that daily reminder of what I’ve lost. For the past year and a half, I have started every day by taking Lexapro and remembering that I’m not okay. Now I won’t have that anymore. Now I’ll be able to go half the day, maybe even an entire day, without thinking about that part of myself.

I’m not nearly naive enough to think that this is the end. For all I know, I’ll be back on the medication in a month. I’m almost certain that I’ll be back on it within the next few years.

But for now, at least, I’m done with it.

For now, the only things I’ll be taking in the morning are a multivitamin and a shower.

Normal, just like everybody else.

Goodbye Lexapro

Depressed on Shabbos

[TMI Warning]

This past weekend, I participated in an overnight retreat with a Jewish education program I’m involved in called the Maimonides Leaders Fellowship. In Jewish parlance, the trip is called a shabbaton as it takes place over the weekly holiday of Shabbat (“Shabbos” is the Ashkenazi variant of the word, in case you’re confused).

On shabbatons, the custom is generally to observe Shabbat in accordance with Jewish law. Although this is commonly interpreted as not doing any “work,” our rabbi pointed out that the actual rule is that you cannot “act” on the physical world. For observant Jews, sundown on Friday to sundown on Saturday is a time when writing, using electricity, driving a car, tearing paper, cooking, exchanging money, and tons of other activities are all forbidden.

Anyway, I won’t go too far into the religious significance of Shabbat, since I’m sure you can read about that elsewhere and I’m not really the best authority on it anyway. But from the discussions we had as a group, I gathered this much about Shabbat, which I didn’t know before: it’s not only a time of rest, but of reflection. The idea is that you don’t do much of anything except be with your friends and family, eat good food, and think about how your life is going.

All of this sounds awesome in theory. Everyone could probably use some time to just think.

However, for people who struggle with depression, as I do, there is literally nothing worse than to have to spend a day doing nothing but eating, socializing, and thinking.

In fact, Shabbat is tragically full of the very things that depressives should generally try to avoid. For instance, like most Jewish holidays, it revolves around eating and drinking. The amount of food that it’s customary to consume at a Shabbat lunch or dinner could probably feed a family for a week. While this does theoretically sound awesome, overeating takes a huge toll on my mental state.

A similar issue is the compulsory socializing. Although not all depressives are introverts, many are, and the disorder sort of turns everyone into a bit of a loner. I wish I could spend hours with people and feel good about that, but I just can’t. After an hour or two, I start to sink into a funk and desperately want to escape. Unfortunately for me, Shabbat meals last for hours.

The prohibition on writing hits me hard, too, because writing is the main outlet I have for channeling my emotions in a positive way. It’s one of the few things that helps when I’m very upset. Reading is an okay substitute, but it’s just not the same.

Thinking, however, is the worst. Depressives can’t really “think,” they can only ruminate–which means endless, circular thoughts about why they’re terrible people unworthy of love. If I had to sit down for a while and think about how my life is going, I would probably become very, very miserable, and that’s exactly why I vastly prefer doing things to sitting around and thinking about them.

And indeed, on Saturday night when Shabbat was over, I didn’t feel refreshed and at ease like I was told I would feel. I didn’t feel stressed, either, but then I rarely do. Rather, I felt vaguely overwhelmed, like my mental capacity had been drained. Later that evening, I burst into tears for literally no discernible reason, and that’s not something that happens to me often anymore.

Unlike certain other religions, Judaism does not want its adherents to suffer or put their health at risk. That’s why, for instance, those who are sick or pregnant are not obligated to fast on the Jewish fast days. That’s why Jews are not only allowed, but obligated to break Shabbat in order to save a life.

However, the entire concept of mental health has only really been around for the past century, whereas the laws of Judaism were written thousands of years ago. I can no more expect Judaism to make allowances for people with clinical depression than I can expect it to, say, condone same-sex marriage.

Religion in general isn’t particularly kind to the mentally ill. When it’s not telling us that we’ve brought this upon ourselves and it’s God’s punishment, it’s telling us that we ought to be able to drag ourselves out of it on our own by praying, repenting, being good wives and husbands, or just sheer willpower. One of my favorite bloggers refers to depression as “spiritually incorrect,” capturing perfectly the way I feel about the intersection between my faith and my mental disorder.

I hope that as I learn more about Judaism, I’ll discover ways to make it work with the person that I am. That person will probably never be able to enjoy a full day of eating and being with people; I’m just not built that way. But I know that Judaism does have much to tell me about living well.

However, I doubt that I will ever be willing to observe Shabbat the “right” way. Spending one-seventh of my life without the ability to do the one thing that always makes me feel good seems like a waste. Ultimately, I don’t believe in God and I don’t believe in an afterlife, so this is the only one I’ve got.

Depressed on Shabbos

"If You're Fat, Then What Am I?"

There are a lot of misconceptions out there about body image and eating disorders. I can’t even begin to address all of them here. But there’s one I’ve been thinking about lately–that problems with body image are caused solely by comparing yourself to unrealistic standards, and can be solved by simply comparing yourself to the “real” bodies around you instead.

First, a disclaimer–I’ve never had anorexia or bulimia. However, I’m not entirely out of my depth here. Had I gone to see a psychiatrist at some point prior to this year, he or she would probably have taken note of my obsessive calorie-counting, severe dietary restrictions, compulsive weight-checking and fat-pinching, and general conviction that I was “fat,” and diagnosed me with something called “eating disorder not otherwise specified,” or “EDNOS.” This means that one doesn’t meet the diagnostic criteria for any of the eating disorders, but is definitely disordered nonetheless.

(For the record, I’m much better now.)

Anyway, one thing I remember very vividly from my years of thinking I’m fat was one particular response that I often encountered. Some people (mostly other girls), upon learning how I felt, would respond with this: “If you’re fat, then what am I?”

Now, I understand exactly where this comes from. Many of my peers were probably insecure, too, and it makes sense that they would be reminded of their own insecurity once I mentioned mine. Since I was indeed thinner than many other people, that response makes sense on some level. If I’m fat, they must be obese!

But it doesn’t really work that way. It would certainly be convenient if people’s self-concepts were always rational and based on reality. But the very definition of mental problems is that they’re distortions of reality–they’re unrealistic. That’s why grief after the death of a loved one isn’t considered a mental disorder, but depression is.

And that’s exactly why “If you’re fat then what am I” is not an effective response. At the time, I didn’t give two shits what other people were. It didn’t enter my thought process. In my case, my conviction that I was fat was mostly caused by cultural factors; namely, the fact that Russians are fucking preoccupied with beauty and weight. Absolutely preoccupied. It was also caused by years of ballet lessons, my depressive personality (which magnifies personal flaws), the belief that I could lose 10-20 pounds and still be healthy, fear that guys wouldn’t find me attractive if I had folds on my stomach, and many other causes.

For other people with body image and eating issues, the causes may be different. Some people develop the feeling that they’re unable to control their environment, so they control the only thing they can–their body. Others may start out actually overweight, start to diet and lose weight, and find that they’re addicted to the feeling of getting thinner. Others develop an overwhelming guilt whenever they eat, especially when they eat unhealthily, and they start to purge after eating. Some may have friends who constantly talk about their bodies’ flaws (remember Mean Girls?) and start to think the same way.

Whatever the causes are, these issues are much too complicated to be defeated by a simple glance at someone who weighs more than you.

Of course, “If you’re fat then what am I” also fails one of the most basic requirements of being a good listener–don’t change the subject to yourself. If your friend feels crappy and needs to talk to you, don’t make it about you. If your own issues are making it difficult for you to listen, tell your friend that. Sure, they might be disappointed that you can’t listen to them, but that’s much better than how they’re going to feel when you take their pain and turn it into a conversation about you and your weight.

It’s easy to resent people who, according to you, “should” be perfectly happy with their weight but are not. I can’t say I don’t get a twinge of annoyance whenever I witness a girl much smaller than me freaking out about her weight. But then I remind myself that she’s not me. Poor body image seems almost like a cliche among young women these days, but it’s so much more complex than you might think.

"If You're Fat, Then What Am I?"