Treating Depression Is Not Medicalizing Sadness

One of the criticisms I often see leveled at therapy and medication is that it’s turning basic human emotion into an illness. There was a huge outcry of this when the DSM V took out the grief clause from the diagnosis of depression (previously one could not be diagnosed with depression 6 months after a major loss), people often throw this at ADD, and in this otherwise lovely article about chronic depression, one psychiatrist refers to diagnoses like dysthymia as follows: “The ‘thymias’ which the DSMs discover – cyclothymia, dysthymia – are helpful for private practitioners in the States. They provide another disorder to be diagnosed, treated and billed for.” The author follows this up with “We’ve reached a point where if you are not actively experiencing ‘happiness’ then you feel you are ill. And if your friends and family think you aren’t happy enough or making them happy enough, they advise a trip to the doctor. “

Now don’t get me wrong, I do think there are many ways that our society fetishizes happiness. Many people find ways to run away from any negative emotions, and those who do act down or angry or sad are generally encouraged to do whatever they can to change that. Those of us with fairly pessimistic temperaments are accused of self-sabotage, of choosing a bad attitude, of being debbie downers. No one really much wants to be around us and we are informed in no uncertain terms of that fact.

But where I do want to differ from these criticisms is that they seem to equate the treatment of depression, even low level depression, with our society’s inability to handle negative emotions. These are two very different things. There’s an odd perception from those who haven’t actually experienced therapy that it’s about getting rid of all the bad feelings and that the end goal is to create someone who is happy clappy skippy doo. At the very least, people who go to therapy are supposed to come out “well adjusted” which for some reason is often associated with a Stepfordish oddness or calmness. We imagine Chris Traeger bouncing around like a hyperactive puppy when we think of those who have overcome depression.

 (not me)

In reality, this is exactly the opposite of the experience that I have had with therapy, and I suspect that many other people have had to delve into some extremely unpleasant emotions as a result of therapy. One of the main elements of therapy for me has been learning that negative emotions are necessary, provide information, and can be tolerated. I have learned tools to be able to feel bad and not immediately spring to fix whatever is wrong (which oftentimes is nothing).  My therapists have repeatedly told me that they want to find the appropriate place for all of the elements that make me up, including such winners as ennui, existential angst, and an overactive sense of guilt.

Here’s the clear and defining line between depression and normal, healthy sadness: depression affects your ability to function in your life. Whether that’s because it’s major depressive disorder and you have reached a point where you can’t shower in the mornings or whether that’s because it’s pervasive depressive disorder and you’ve felt low level emptiness your entire life and you just can’t handle it anymore, what makes something a problem is when it starts to interfere with someone’s life in a negative way. Now this isn’t as clear and defining of a line as we would like, but there it is and most individuals would be able to tell you if they feel like their emotions are getting in the way of their life.

Treating depression, whether with medication or with therapy, is about allowing an individual to function again. A functional human being feels painful feelings sometimes. One of the most obvious examples of the ways in which treatment of depression is actually antithetical to happiness obsessions is in mindfulness practices, particularly DBT. These ask an individual to simply notice their feelings without judgment, letting them happen without trying to change them.

One of the many reasons that people often end up in therapy or on medication is because they have been too afraid to honestly look at their negative emotions, feel them, and let them go. Of course there are some therapists and clinics that may go too far and end up treating any negative emotions as problematic, but overall the profession’s aim is to help people who are struggling.

The other piece of the puzzle is medication, which many people view as a “quick fix” for those who refuse to deal with their problems and just want to be happy all the time. Now I haven’t been on every medication ever so I can’t speak to all experiences, but that really is not how medication works most of the time. I have never had medication actually lift my mood, it simply has held back some of the negative so that I have space to work towards positive for myself. It allows me to go about my daily life in a relatively normal manner so that I can find ways to be effective long term. Again, it’s about keeping depression from drastically impacting my life.

Perhaps the reason that so many people point towards the prevalence of therapy and medication in our society as evidence that we refuse to be happy is because of a basic misunderstanding of what those treatments do. If someone’s emotions are keeping them from achieving their goals in life, from having relationships, from effectively doing their jobs, then the aim of treating those emotions is to help that person live their life. That doesn’t require happiness, but it does require the ability to cope with negative emotions.

I do think that it’s important to address our societal phobia of sadness, grief, and pain. But the way to do that is not to throw the mentally ill under the bus by implying they are running from their negative emotions when they seek out treatment. A diagnosis of depression does not say “this person is too sad”. It says “this person can’t function the way they would like to because their emotions are consistently out of control”. There is a world of difference between those two statements.

Ok, maybe I’m a little bit Chris Traeger.

Assorted Poetry (TW: Self Harm, Eating Disorders, Ennui)

Note: No one freak out about mentions of symptom use. These are all just capturing feelings, not literal.

 

 

Last night I took a blade to my skin

Blood letting for the soul

The foul humors escape.

There is more life within me than the flimsy walls of my body can contain

Bursting and breaking through in fits

A quick slice so much easier

Draining an abscess

 

Have you ever felt a nostalgia so melancholy your breath flees?

Or fallen in love with the golden caricatures of humanity?

Do you walk the streets in the twilight, breathing in the scents of rain and promise

And wonder if you could live forever?

Have you ever run your hands over your body and wondered

How easy it would be to rip it open

off

just for the freedom?

 

Sometimes when I love too hard, I refuse food

A quiet prayer that my body disappear

To give me more space to stretch and love you more deeply.

Did you know that a body can burst if you fill it with enough loves?

 

Some girls bend their bodies into contortions, hoping to confuse the fire within

into fading out

Their skin paper thin

They glow as lanterns

Until they concoct an emptiness to kill the flames.

Their insides were yearning for people, for places

So they replaced passion with need

for size 2, for vodka, for death

And now their skin simply crinkles, hollow

 

I let the heat bleed out of me when I can’t carry the weight

But I can breathe flames on days I am strong enough to stand.

 

 

 

 

 

 

A single face, glimpsed

A face that might be the face of one I once loved

is enough to leave me shaking with nostalgia

 

At night my feet know that it’s time to leave

but my mind has no destination.

My heart supplies the names of everyone I have every shown myself to

truly

and my feet anxiously trip through memory and longing

 

I can’t escape the way that feeling so much is always pain

And the flood of insecurities that returns with each face

I am sitting alone in the dark

The razor blades of my eyes cutting over each ounce of fat

And everyone I’ve ever loved is not here

Object permanence has escaped me, and they are lost

 

I am more, I am more than ennui

I could be more, and perhaps I could collect each face for good.

But I am already too much

And they cannot fit into my long list of labels.

I cannot chase lost souls.

Sensations and Confusion

Most people would not describe me as a sensual person. I think I come across as fairly cold, definitely stand-0ffish, and distinctly touch repulsed. I’m not a hugger, I’m pretty lukewarm on cuddling, and I really like having a large personal bubble (which no one gets to be in unless I explicitly invite them in). I’m a picky eater, like soft and comfortable clothes, and am uncomfortable with looking and acting sexy.

But oddly enough, this stand-offishness is actually because I am incredibly sensual. I’m ridiculously sensitive (if you try to tickle me I will likely elbow you in the groin. Unintentionally). Sometimes I feel sensuality so hard that it hurts. When my cats are being particularly adorable I get the desire to cuddle them so hard that my jaw starts aching and I get shakey shivers through my spine. Sometimes I have to grind my teeth or bite down on something to keep myself from pulling a Lennie. (Don’t worry my kitties aren’t in danger, I just love them a lot and sometimes have to restrain myself).

Scents can change my mood completely. Petrichor will immediately make me nostalgic and full of feelings I can’t quite put my finger on: infinity I suppose. Some scents are home, and others are fear. The smell of a certain deodorant will always be my first boyfriend and will always be violation. Lilacs are childhood, and spaghetti is safety.

And sounds. Sounds are amazing. The sound of someone chewing will make me more violent than anything else in the world. But music can make me feel things I can’t explain, powerful, sexy, beautiful, deep, broken, joyful, empty…music and dance and rhythm speak to me on a level that nothing else does. I will remember the words to a song after just a few repetitions, I will learn the muscle memory of movement better than anyone I’ve met.

Touch is too much for me. I get shivers from someone brushing against my ankle or my wrist. Soft socks can change a whole day for me. Anything less than a slap is a tickle. I can feel your breath on my neck and it makes me wriggle and squirm. I once got off just from the feeling of someone touching my back.

Don’t even get me started on food. I can’t put anything with the slightest hint of bitter into my mouth and I crave sugar like no one I’ve ever met. Once a taste is in my mind I can’t shake it until I eat, and eat, and eat. I once wanted cream cheese wantons for a full year. No matter how many times I ate them, the need never left. Textures can ruin any meal for me. Trying to eat tofu is a practice in attempting not to vomit. I would rather not eat than eat something mushy or gooey or gelatinous.

I crave sensations. Perhaps self harm is an attempt to get a high, a thrill, a sensation. Sometimes when I see a picture of a beautiful person I feel a longing so hard it hurts. Perhaps that’s why I thought I was a sexual being for so long. I WANT so much. But when I stop and think about it, I don’t WANT kisses or sex or anything of that nature. I want to stare for longer, I want to possess the spark of beauty that’s in the face, I want to rub my face on the soft skin just like I do with my cat’s fur. I want to grab ahold of things and squeeze and contain. I crave beauty, I crave speed, I crave movement. I feel the same thrill on a roller coaster as I do whirling on the dance floor as I do looking at the face of that gorgeous movie star.

And it’s confusing. It’s confusing how much I want. I have so much, but sometimes the spaces that I have close in and I feel like I need to run outside and rub my face all that the world is. Sometimes I am afraid that because of what I have chosen today I won’t be able to fall in love over and over with all the things I can experience. The fear makes me nauseous.

How can I contain the feelings, how can I identify, how do I have any grounding when each new experience gives me a whirling high that confounds me? My own emotions are too much to keep me in one place, one person, one body. I can’t contain myself. I wonder sometimes if I love too much because my body refuses to cut out the excess, colors are too bright and tastes are too sharp. People think that minds are separate from bodies, but how can I keep my emotions stable when my body feels so much? How can I not feel so much when the world is full and intense and soft and more than my senses can process?

The longing I feel will always confuse me. I don’t know if I will ever be content.

Why I Need Mindfulness

Recently my mood has been fairly low. I’m still trying to figure out why and how to make it better, but for the moment things are pretty stagnant and I’m really not sure what steps I can take to improve my mood. This is a place of intense frustration, and I know that many people can get to be in this situation: you may not be able to change your work or family situation, you may feel like your external situation is actually fairly positive overall, or you may have no idea what has triggered a depressive episode. There are often times when you can’t take positive actions to improve your depression.

Of course when that happens it tends to snowball on itself. If you don’t know how you’re going to improve your situation, there is an intense hopelessness that it will get better. You think about the future and you don’t know how or if it will ever change, and all you can imagine is the whole size of your whole future feeling the way you do now. That is an intensely icky feeling.

You start to feel bad, you think about feeling bad forever, and how you feel now gets worse. Then you think about feeling even worse forever and it gets even WORSE. Imagine this on loop for days and weeks at a time. This is what it’s like when you don’t know how to fix your depression.

Of course the whole crux of the problem is that you don’t know what to do to make yourself feel better. Here’s the secret though: I know what you have to do. A warning: this will not necessarily make right now feel better, but it will give you some relief from the circling, spiraling pain and might just give you enough time and space to breathe and figure out a good solution. So what is the solution? Mindfulness.

Are you all done giving me dirty looks now? Good. This seems trite. It seems woo woo. It seems ridiculous and not practical. When I was first introduced into mindfulness, I would fart in its general direction too. But that was before I heard this explanation of why mindfulness is useful. Mindfulness cannot make you feel better right now: that’s not its purpose. Mindfulness is about only letting your mind be in the present. While depression can often involve angst and anxiety about the past or the future, mindfulness is just existing and doing what you are doing.

So remember all of that angst about the future that crops up when you cycle in your depression? Those things are not hurting you right now. They’re not even happening right now. If you can stop thinking about them and only exist in this moment, you’ll stop feeling all the crappy feelings of the past and all the potential crappy feelings of the future. That is a lot of crappy feelings that you don’t have to worry about until they actually happen. And the whole point of mindfulness is that if you can train your mind to exist in the present, you don’t have to take on all the suffering that is not really affecting you right now.

If you’re like me, that all sounds lovely except that you have no idea how to do it. Half of your problem is that you’re really bad at being mentally present, you can’t focus, you’re too tired. Never fear. There are concrete steps that you can take to be mindful. They aren’t easy, but they do at least give you a clear path forward.

The most important thing to remember about mindfulness is that it’s about being aware: observing, describing, and being present. That’s what it means to be present-to focus on your surroundings, your emotions, your thoughts, and your senses. Here are some basic steps you can start with. Initially, try one simple, small thing and do it mindfully. Try washing the dishes or driving home from work. While you’re doing it, just notice things: how the water feels, the song playing in your head, the smell of the soap. Once you’ve started to notice it, you can add words: describe it. It might be good to just start with these two steps, and you don’t need to go overboard: 10 minutes might be the most you can handle. Once you’ve started to get the hang of those steps, try participating. If you notice your thoughts or your concentration wandering while you do an activity, just take note and then gently bring your focus back to what you’re doing.

This is probably the hardest part of mindfulness: the idea is not to get annoyed or frustrated with yourself, but just to notice what you’re doing and change it. If you can approach mindfulness with the intent of being gentle with yourself, of recognizing that you’re a little fragile right now, it generally will go better.

If you don’t want to do this while you’re trying to get something done, or if you just want to have some time to seriously practice mindfulness, some good practices are focusing on breathing and body scans. Instead of focusing on a task you can just pay attention to your breathing, or you can start at your toes and focus on each part of your body individually. This is a little more concrete and a good place to start when you’re beginning mindfulness.

Of course throughout your day you can also take time to pull your thoughts back to what you’re doing, to notice your surroundings, to pay attention to your breath, or to stimulate your senses in some way. I particularly find that being aware of my body and being aware of being in my body are good ways to be mindful. As much as 15 minutes of these little things each day can really help to reset that spinning wheel of anxiety and fear that starts going in the midst of depression.

Obviously this needs to be done in conjunction with some problem solving and reflection about what’s really making things bad for you. You might need a change in meds, an adjustment at work, changes in relationships, or a variety of other problem-solving things to improve the situation. But a good way to wait things out when you can’t figure out what to change or to get through your day to day tasks without ruminating is to work on mindfulness.