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.

What Someone With Depression is Like

Tonight at dinner someone mentioned Silver Linings Playbook, a movie about people with mental illness. My uncle chimed in “It did a very good job of portraying what someone with depression and anxiety is like”.

I felt the hurt of it before I realized why. Something bubbled up inside of me with the need to yell “Here’s what someone with depression and anxiety is like. Your niece!”

Sometimes people with depression can make it through a whole dinner conversation, but sometimes they need to escape to the basement with the kids.

Sometimes people with depression are willing to chime in and talk, and sometimes they’re quiet.

Sometimes people with depression are manipulative and self-centered, and sometimes they are selfless and kind.

Sometimes people with depression eat pie. Sometimes they eat steak. Sometimes they eat ramen noodles from a package.

People with depression graduate college. Or not. They hold down jobs, except sometimes when they can’t.

They might be a dog person or a cat person, a people person, or not so much.

Sometimes they die of a drug overdose and sometimes they fly through school with straight A’s and land their dream job.

Someone with depression might be bounding with energy or they might take naps every day just to make it to the evening.

Some people with depression will let you know about it and others won’t.

Some people with depression have kids, others never will.

Some are chatty, chatty, chatty, others introverted.

Sometimes they make it through incredibly difficult times. You might not know they’re hurting so bad inside. Sometimes they crash and burn (but even when they do, they usually don’t want you to know).

A person with depression could be scrappy or smart or artsy or average or generous or really any adjective you might be able to think of to describe a human being.

Sometimes they hate themselves for having depression but sometimes they just hate you for using phrases like “people with depression” as if they’re a monolithic and foreign species.

Someone with depression might just be like that person sitting right next to you. Your niece, your cousin, your daughter. And they might just never open up to you about their depression if you say things like that.

Because let’s be up front here: people with depression are pretty much like other people. Some things are just a little harder for them. And it pretty much is horrible to be considered a foreign people that your family members need to watch movies about in order to get an inkling of how you work and who you are, or to be completely erased for a fictional portrayal of mental illness.

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.

Anhedonia 101

One of the more common symptoms of depression is what is known in psychology circles as “anhedonia”. Most people see this word and go “huh?” then continue their lives. However for those people who experience anhedonia, it’s an incredibly debilitating aspect of depression and is one that more people need to understand. Without that understanding, others can make suggestions that seem like impossibilities, or simply say things that are cruel without realizing it.

You can read the rest of this post at Aut of Spoons.

 

I’m Worse Than I Used To Be

In my recent internet browsings, I ran across a Facebook status from a friend who suffers from depression. The status was fairly simple. It basically said: “I’m so much worse than I used to be.” This language is in a lot of places. “My depression has gotten worse”, “this is the worst she’s ever been” and so on. But there is an important distinction between saying “my depression is worse” and saying “I am worse”. One of these is helpful and is an assessment of the seriousness and difficulty of a situation. One of them reflects back upon yourself, and can have some negative consequences.

Here’s the thing: when you are in the midst of depression you are not “worse” than you were a year ago or five years ago. Your situation is worse. You however are exhibiting great courage and strength by continuing to get yourself out of bed each morning and struggle through each day. YOU are amazing in the moments that your struggle is the worst.

Let’s imagine a situation in which it is not your brain or your body that is making things difficult for you. Let’s imagine that you’re navigating a wilderness. Things keep trying to kill you, it’s desolate and dark, you don’t know how to get out, and you have little hope of it getting better. You struggle to keep going. You find tricks to make light, to find food, to keep yourself putting one foot in front of the other, moving in the hope that something might change. If someone were to look at you, they would certainly judge your situation as bad, but I seriously doubt they would say that you were doing worse than you had in a cushier circumstance. YOU as a human being are surviving, growing. You may not be flourishing, but you are learning tools to flourish.

Depression is just as difficult a mental landscape as this imagined world. You are navigating. You may not realize how much skill you are navigating with, but you are still alive, you are still moving, you have created your tiny lights to bring you through the day.

But why does it matter? What’s so bad about using this colloquialism?

We all know language is important. We all know that people already feel enough shame around mental illness. Many people struggle to succeed in day to day tasks when they’re in a difficult time with their mental health. It’s easy to feel like you’re “bad” or you used to be “better”. There is no reason to continue to reinforce that message to people, and in fact reminding people of their own power and strength is highly important to recovery. Especially when someone is talking about themselves, they need to remember that their own judgments can cut down their self-esteem and make it even harder for them to recover. Saying ‘things suck right now’ is a way to keep your own value out of it: you’re still kick-ass, but depression sucks.

Each time we reinforce the idea that mentally ill is equivalent to broken, wrong, bad, or inept, we are harming those who suffer from mental illness. It is far too easy to be sloppy about our language when we’re referring to mental health, and too many people already do this. Especially when there are so many fantastic ways of describing how frustrating it is to deal with depression (jerkbrain is laying siege! Release the hounds!), why would we fall back on words that repeat to us that we are not good enough for the world or that we were better when we weren’t sick? Why would we reinforce to ourselves that we have an obligation to get better because we suck so bad now?

Repeat after me fellow sufferers from all forms of jerkbrain: I am not bad. I am no worse than I was before jerkbrain struck. I am striking out into a wilderness that no one before me has braved and I am STILL ALIVE. It is dark and it sucks and I am afraid, but I am STILL ALIVE. I have survived things that the neurotypical cannot imagine, I woke up this morning and I got out of bed and no one can imagine how brave that was. I am a kickass jerkbrain warrior. I am the best I can be.

I’m a Duck

It’s been a rough few weeks for me. I’ve had a lot of stress happening, and some close friends have had bad things happen to them, and I’ve been left feeling like the best I can do on any given day is make it to work, sit my butt in the chair, and not cry. I have a lot of friends who have been trying to help, giving me advice, telling me what works for them. Unfortunately, these tend to be people who are not suffering from mental illness or who have never suffered from mental illness. And so I’ve spent a lot of this week staring people’s privilege in the face while they tell me I should just “be more social” or “stop watching TV”, and I have to explain how that’s not possible for me right now.

People don’t understand why I can’t make certain changes in my life. That makes sense. I don’t look sick or injured. I am not mentally incapable in any way, and sometimes I can get a great deal done in a short period of time. I sleep enough, I don’t have an excess of things going on. What is it about my life that makes it so impossible for me to adjust my priorities and work on things like socializing or reading more often or cutting TV out of my life or exercising?

The difference between your life and mine is made up of spoons. For you, getting out of bed, eating your breakfast, and going to work might not take much out of you. For me, it’s a difficult process that requires a lot of high level thinking and a lot of emotional regulation skills. The best metaphor that I know of is that my dad once described me as a duck: people watching me on the surface of a lake might think that I’m placidly swimming along without putting much effort in, but if you look just below the surface I’m paddling my little heart out. That’s what having a mental illness is. Now you might ask what am I doing under the surface just to get out of bed and make it to work in the morning. Well, I’m fighting my own brain.

Let’s just take today as an example. Last night I had a meltdown about socializing, which means that today I woke up tired. I spent a good ten minutes convincing myself that yes, I did have to go to work today and face people again (typically it takes me ten minutes between waking up and getting to work, so that’s a lot of time for me). I then spent the next ten minutes trying to decide whether to buy coffee now or later. To you this is no big deal. To me, this is an important choice. Coffee is an appetite suppressant. If I drink my coffee first thing in the morning, I’m more likely to get hungry for lunch. Drinking coffee first thing in the morning rather than later is a conscious choice to try to set myself up to eat. However leaving my office to go get coffee halfway through the day can be an important act of self care. I spend half my morning trying to decide whether I want to prioritize eating or breaking up the boredom and anxiety of my day.

After I get to work, I look at my to-do list. I have about enough actual work to last me an hour, then the rest of my day is spent killing time. Boredom triggers anxiety for me. Huge anxiety. I try to think of as many possible things to distract myself as I can, and then I write them down. Now I have to decide how to start my day. Generally if I go until 10:00 without accomplishing any work, I begin to wallow in self-judgment, however if I usually don’t have much energy first thing in the morning and if I finish all my work first thing I fall back into boredom by the end of the day (see: anxiety). Over and over I renumber the things on my list to try to find the perfect combination of real work and social media work to keep myself engaged and not feeling like a failure.

Currently, my phone has a single message. I know who it’s from. I can see the little red light blinking at me. It’s from someone who doesn’t speak English, who’s called me repeatedly. I tried to send him to intake where they have interpreters, but thus far I haven’t been able to get him the help he needs. I’m afraid to listen to the message and be reminded that I couldn’t help this person, so instead every time I glance over at my phone I have a flashing red reminder of it. This means more mindfulness and emotion regulation work to keep my anxiety and self-hatred in check.

After I finally get my list in order and start doing work, I have a hard time concentrating on one thing because I always think I should be completing everything at once. Periodically my work will devolve into rabid clicking between tabs, typing two words before jumping to something else. When this happens I have to take five minutes to close my eyes and breathe slowly, reminding myself of one-mindfulness. Finally I make it to writing this blog. Some of you might say this is a waste of my time or that I could be spending the time saving my energy for something more beneficial later today. The reason I’m choosing to do this is because it’s a distraction, and when I don’t distract at work I start to get extremely anxious (see again, boredom). Anxiety takes more energy, and leaves me potentially incapable of staying at work for the rest of the day. In the back of my mind there’s the ever present knowledge that my to-do list is not long enough for eight hours. I am always playing out little arguments with that fear, trying to keep myself in the here and now.

It’s now about 1 PM and I haven’t eaten lunch yet. I’ve been thinking about lunch since I got to work though. I’ve imagined what I could eat, how long it would take. I know that eating is a nice break from staring at the computer for me, and that it leaves me feeling a little bit refreshed. However it also leaves me with a lot of judgments and depression about myself that distract me and require a good deal of work to leave behind. Thinking about food is stressful, so the past five hours have been rough, thinking of how good it would taste before immediately jumping to the fat on my stomach or my thighs and the jeans that I didn’t fit into this morning. Back and forth, back and forth I go, my brain constantly ping-ponging between the arguments for and against food. By the time I actually get around to eating I’m almost out of the ability to manage stress, and so eating leaves me very vulnerable. Simply making it to the end of my work day might take all the rest of my energy.

But I also have therapy today, and as anyone who’s been to therapy knows that’s emotionally draining. So by the time I get to the end of the day I will be fairly worn out. I’m planning to cook dinner, because one of my goals is to be able to cook instead of eating out so that I can afford to feed myself in the future. This has also been a balancing act of anxiety about money and anxiety about food. I have to go to the grocery store, which at times has left me bawling in the fetal position, so I’m already steeling myself against that experience. This all will take a great deal of my emotional energy because food makes me worried and afraid, and I will need to use a lot of calming strategies to deal with it. Every one of these stressors not only takes up some of my attention and my energy, but then asks me to engage a complementary skill or coping strategy so that I can make it through the day, keep my job, and not have a melt down.

Add in to all of this that if I don’t eat, I’ll be dizzy and tired by the time I leave work, and the fact that I spend all day at my office freezing cold and trying to warm myself up, and it leaves me fairly exhausted by the end of my day. If I were to go out and try to socialize, it would be all I could do to smile and nod. I have no energy left to read instead of watching TV because my eyes would fall out of focus and I’d read the same paragraph over and over and over. I have spent all day reviewing the DBT skills options and trying desperately to engage skills that I’m still learning and which are incredibly difficult for me. This is a light day for me. Every day of my life I spend constantly calculating how much I can handle and how to manage my emotions.

Some people might say that we always get to choose how we act or what our attitude is, however the fact that I have to deal with all this anxiety is not a choice of mine. I can make choices about how to react to it, and about how to use the small amounts of energy I have. I can make choices about where to spend my time and focus when I have the energy to calm myself. And yes, I do get some choice about what to do with my spare time. However I don’t get to make a choice about the fact that my brain is nearly always screaming at me with something it wants to take up my full attention. I’m left with a very limited number of choices: listen and freak out. Engage skills. Or stuff it all down and pretend it’s not there. I don’t really get to prioritize other things over these because these are always immediate, strong emotions that demand attention. Survival is always my priority.

With all this going on just below the surface simply to keep myself a functioning member of society, is it any surprise that it sounds ridiculous to me to suggest that I should just change my lifestyle up, or face my social fears? Is it any surprise that I simply CAN’T strike up more conversations or spend a lot of time emotionally prepping myself for social encounters? Is it any surprise that I’m hurt and upset when people suggest these things because they invalidate all of the work that I’m doing and then tell me that I should take responsibility for being lonely and frustrated with my life?

I realize that for the most part all of this work is invisible, and so no one means ill when they suggest things to me. But from the perspective of anyone with an invisible illness, you all need to know that it hurts when you say that.

It’s hard enough to validate myself and the work that I’m doing as it is. Society is hardly patting me on the back for giving myself permission to take a nap last night instead of calling my loan company. I already feel useless and incompetent at many things because I don’t have the energy to figure them out right now and because the work that I am doing hardly looks like work (right now my to do list includes things like “cook”,  “Hot bath”, “make it to the end of the work day”, and “eat lunch”. I feel like I should probably just add “breathe” on there with how basic most of this stuff is). Being reminded that I have so much more I could be doing, or that I supposedly have the ability to change my situation if I just tried hard enough feels horrible. It makes me feel like everything is my fault, and it tells me that if I want to have a better life I should just change.

Remember that having extra energy or the choice of how to prioritize things in your life is a privilege. Survival is my priority and it has to be right now. Whenever it looks like someone isn’t doing very much but is worn down and complaining, contemplate how much they might be doing under the surface.

13 Reasons Why: Having Sympathy

ALERT: this post will have spoilers.

 

Last week I read the book 13 Reasons Why, which is a book that is made up of 13 tapes recorded by a girl who commits suicide and leaves these tapes to explain why she did. Each tape is a person, and she sends the tapes to the people on them so that they can understand what happened. After finishing this book I found myself frustrated at the portrayal of Hannah, the suicidal girl the story centers around. She was portrayed as selfish, dramatic and bratty. She blamed her suicide on others. She never asked for help or accepted help when it was offered. And some of her reasons for committing suicide seemed a little ridiculous, like being teased about having a nice ass. I found this frustrating because it seemed to infantilize how serious many people’s problems are, and how hard they fight to get help and are often denied it.

 

At the same time, I did find the book powerful in that Hannah clearly pointed out how other people’s actions affected her and particularly pointed to the sexual harassment that was heaped on her. I thought that it was powerful that the effects of this were taken seriously in the book, and that it was made clear that it was not ok for someone to smack her ass or try to cop a feel. So I was conflicted. I didn’t want a book to circulate that treated people who are suicidal like they’re attention seekers or stupid or selfish. But I also felt that there were some good messages.

 

And then I read this review. This shitty, shitty review.  It basically straight out said some of the things that I was thinking. And when I saw them baldly there before me I realize how much of a shitface I was for my reaction. Because here’s the thing: even if Hannah’s reasons WERE trite or overdramatic or whatever, there are people out there who feel suicidal for those same reasons. There are people out there who do feel that their suicidal impulses were at least in part created by others. And those people have EVERY RIGHT to EVERY SINGLE ONE of their feelings. There is no right or wrong way to be depressed. There is no justified depression and unjustified depression. If someone feels so desperate that they will take their own life, you don’t get to judge whether or not the reasons were good enough. You sit your ass down and you feel sorry and you listen if they left you some way to make sense of it. They had no obligation to explain their feelings to you, and they had no obligation to have feelings that you felt were acceptable. People get to feel depressed in whatever fucking way it happens to them.

 

This is one of the reasons that I get frustrated with the concept of “tumblr depression” or “tumblr eating disorder”. You know the person. The blog that posts all black and white pictures and melancholy quotes. The girl that seems to take everything personally and dramatizes everything and sort of passive aggressively refuses help while asking everyone to pay attention to her. And a lot of people get pissed at these sorts of blogs and individuals, because they say that’s not real depression. That’s just someone looking for attention. That gives people with real mental illness a bad name. She just cuts for attention. She just starves herself because she thinks anorexia is cool. Now on some level this is understandable: it can be really frickin’ hard to talk to someone when they’re acting like this. But I hate to break it to you, it can be hard to talk to someone with mental illness. And if someone is cutting themselves in order to get attention, THEN YOU SHOULD GIVE THEM SOME FUCKING ATTENTION BECAUSE HUMAN BEINGS DESERVE AND NEED ATTENTION.

 

I went through this kind of phase, and while it may look trite and stupid from the outside, it hurts just as much as “real” depression when you’re on the inside. You don’t get to judge someone else’s feelings and tell them that they’re not actually depressed or unhappy, or that the reasons they’re hurting themselves aren’t valid. If someone says they’re hurting then you damn well better believe them. Even if they are using passive aggressive techniques to try to get attention, that means that they’re hurting. They’re lonely. They feel pointless or useless or unwanted. Asking for attention is not a crime and being sad about stupid things is not a crime. If someone is unhappy it’s not our place to judge why. It’s our place to offer sympathy and try to help. Because no matter how silly something might seem to us, it’s real to the individual, and blowing off someone’s unhappiness as trivial is simply being inhumane and unfeeling.

In Defense of the Suicidal

Before I begin this post I want to say that I am all in favor of psych treatment, mental health accommodations and more care and attention given to those who appear to be in a bad place. ABSOLUTELY 100% I ADVOCATE THESE THINGS. I want better access to care, better quality of care, and more quantity of care. ALSO: TRIGGER WARNING TRIGGER WARNING: self harm, suicide

All of that being said, this article in defense of psych treatment for attempted suicide pissed me off. I do support having resources for those who are coming out of a suicide attempt, to help them stabilize and get medication and have mental health care (of course I think all of those things should be available before the person gets to the point of suicide), but the idea that it should be mandatory and the whole tone of the piece rubbed me entirely the wrong way. Now most of this piece is going to using personal and anecdotal evidence, but I think that that was WHY the article pissed me off so much: mental illness and suicide are about very personal and internal experiences, and this article reduced it all to statistics, as if that could explain how someone with mental illness is feeling. That’s upsetting.

Most of the evidence that he uses in the post revolves around the idea that those who are suicidal are not thinking clearly and thus are not in any position to make decisions about whether or not they want life or death. Wow. WOW. Let’s try applying this argument to any situation that does not involve mentally ill individuals. Say for example someone had a heart attack. I’m guessing we would all say they’re not exactly thinking clearly at that point in time or directly afterwards. Doctors would likely stabilize the patient, and then recommend certain changes the individual should make to protect themselves from future problems. Now we may look with confusion at people who don’t implement these changes, but we don’t suggest that we should stick them in a mandatory “healthy eating and exercise” facility for a few weeks afterwards to “stabilize” their mental health and get them to a place where they’re “thinking straight”. That’s because we assume that what these individuals do with their life is up to them and if they want to put their life in jeopardy it’s their own damn business.

To look at it from an opposite perspective, say a mentally ill person was being threatened by another individual. They’re being held at gunpoint. We 100% believe that this mentally ill person has the right to choose whether to be alive or dead in this situation and that another person does not. We would NEVER EVER say “well because you’re mentally ill you’re not thinking straight, maybe you do actually want to be dead you never know”. We have a prejudice towards life. We have no idea whether being dead is better or worse than being alive, but we continually assume that if someone has a choice, they SHOULD choose life. That seems just as unfair to me as telling someone else that they should be dead. It’s nobody’s else’s concern what an individual does with their own life or death (with the exception of family members and close friends and other individuals who will be emotionally impacted, but this article was talking about legal and medical procedures to be enacted by perfect strangers).

At other points in this article, the individual states that the average person suffering from MDD has only about 4 episodes of depression in their lifetime and that these episodes last only 6 months, so the pain is temporary. They also state that with medication most people get better, and that with CBT statistics are even better. Ok, so the first statistic is an AVERAGE. There are many individuals who have situational depression and are diagnosed with depression for a single episode. This brings the average way, way down. For those people suffering from major clinical depression, it’s often an ongoing struggle. Even when you’re not in the midst of a full on episode, it still makes everyday life harder. As someone who has MDD (and who is only 22) I can vouch that I have already been through 5 episodes (probably more, that’s just a basic estimate from the last 5 years), and that each of these has been on the high end of six months. That’s almost half my life for the last 5 years. So telling me that it’s “temporary” and that I’m overreacting to a temporary problem is extremely condescending. It’s telling me that a statistic knows my life better than I do.

He also doesn’t address the fact that co-morbid diagnoses exist and complicate these issues severely. Eating disorders have the highest mortality rates of any mental illness, and they are NOT temporary, nor are they easy to solve with medication or therapy. They are often comorbid with depression, and many of those deaths come from suicide. As he mentioned, BPD is also a high cause of suicide, and this also does is not something that is “cured” but is more likely something that is “managed”. He also states that it often goes away by itself in “a few years to a decade”. A DECADE? I have BPD symptoms, and I can promise you that waiting it out for a decade is NOT an option. Making light of how difficult that is for individuals is again, extremely condescending and doesn’t bother to listen to how difficult life can be when you’re in the midst of BPD for years and years on end, in what feels like a state of unrelenting crisis. It makes perfect sense to want to be done with it.

In addition, his comments about medication seem to ignore the fact that many individuals who try to commit suicide are on medication or have been on medication and have been in therapy before or currently are in therapy. Meds don’t work for everyone and therapy doesn’t work for everyone. OBVIOUSLY we should try to give everyone the best options possible by allowing them access to therapy or meds, but if they don’t want it it’s their choice to decide that their life isn’t worth living and that those things aren’t for them. No one should be forced into doing things they don’t want to do simply because we view life as better than death and think that this will change their mind.

As someone who has been pushed into therapy and meds, life doesn’t suddenly magically get better. Your suicidal tendencies don’t suddenly disappear. You don’t suddenly gain a new appreciation for life that makes you clear of mind. And even now when I’ve been on meds for months and in therapy for years, I still don’t want them. Many people feel this way. If someone chooses to be unhappy then that is their business and if that choice leads to them desiring death, then again that is their business. Only in the case of mental illness do we feel it’s ok to tell people that they HAVE to do what we feel would make them happier. It is incredibly condescending that we are treated as children who don’t know what’s best for us because of our mental illness.

I’m not even going to touch the ageism in the first section of the post except to say that teenagers have the right to bodily autonomy too.

The final element that I want to address is the seeming underlying assertion that a 72 hour lockup doesn’t hurt anyone, and we might as well do it in case it can help. Now as someone who has been taken to the ER without my consent for mental health reasons, I can promise you that it IS NOT HARMLESS. I was not admitted, I was simply asked some questions and when I convinced them that I had no intentions of killing myself they let me on my merry way. But I had to sit and explain myself in a cold, sterile room at 2 in the morning for hours to people that I didn’t know who didn’t know my mental health history and who diagnosed me with “adjustment disorder” (which is bullshit since I told them that I have diagnosed depression and an eating disorder which is why I had been self-harming). I was terrified, I was traumatized, and I was angry. I spent a week after that having a difficult time trusting the person who called, and I proceeded to bottle up my emotions even worse than before because I was terrified of having another similar experience. It was absolutely horrible in every way. Let me reiterate: I was not even admitted. It was still humiliating, exhausting, terrifying, and traumatizing.

From the people that I know who have been in residential or in-patient treatments, they treat you like a child: they take away your possessions, they watch you nearly constantly. I have never heard about someone having a positive experience in a psych ward. I have heard about individuals being restrained against their will, not being allowed visitors, feeling bored and lonely. These things do not help an individual suffering from depression. They are extremely harmful, and suggesting that just because a psych ward is not equivalent to One Flew Over the Cuckoo’s Nest means it’s a great place is ridiculous. There IS discrimination against mentally ill individuals and it DOES take place in psych wards and mental hospitals across the country. So when we consider mandatory psych treatment for suicidal individuals we sure as hell better weigh the negatives against the positives. We have to weigh that these treatments often are traumatizing or scary or discriminatory.

To close, I am in no way advocating for suicide. I do agree that it’s a fairly permanent solution and that exploring the problem from all angles before taking any action is the most prudent route to go, and that this should involve therapy and meds. However the idea that suicidal individuals don’t do this or that they enact a huge decision based on a spur of the moment feeling is ridiculous and infantilizing. From personal experience I have been struggling with the problem of why to stay alive for four years now. If I were to commit suicide in the future (this is not a suicide note. Nobody call the cops. Please dear God I do not want to have to go to the ER and explain that I’m not suicidal. Again.) I would not want my death to be held up as a moment of weakness or a single bad decision. If I were to commit suicide it would be after years of struggling and writing and considering and deliberating. If you look at the lives of individuals who do commit suicide, I think you’ll find more often than not that they have thought about it long and hard. At least give them that much credit. Do their memories that favor. If we’re going to do anything, we should provide everyone with the tools and knowledge to make informed decisions, and then we should give people the freedom of life or death, without the prejudice of saying that life is always and inherently better than death and if you believe otherwise you’re deranged.