What It’s Like: Major Depressive Disorder

Hello and welcome to the final installment of the What It’s Like series! Previous posts 1, 2, 3, and 4. Today I’ll be trying to talk about the most amorphous of my diagnoses, Major Depressive Disorder. Once again, the disclaimer that these are my experiences. I am not a mental health professional, I don’t speak for all people with depression, and depression can look vastly different for different people. If you know someone who has depression and want to know what it’s like for them or how to help, I strongly suggest talking to them.

Onwards, to depression!

I cry a lot. I mean a lot a lot. I cry more than any other human being I’ve ever met. Sometimes out of absolutely nowhere a wall of just straight out pain hits me and my eyes get all watery and even if I hate it I can’t stop myself from crying. Depression is like having enough sad/bad/scared/aaah feelings that they start leaking out of your face at random times.

I can always tell when my brain is falling into depression or anxiety based on my sleep patterns. Anxiety means insomnia, which in turn comes with day after exhaustion. Depression means just being tired all the time, sleeping for 12 or 13 hours at a time, never feeling rested, never having energy. It’s the times when it’s sheer struggle just to stay awake through the day and my eyes start going out of focus every few minutes. Depression is down, anxiety is up.

Depression for me also tends to be whole world focused. Anxiety usually revolves around me and how horrible I am and what I’ve done wrong. It’s all the nasty little voices at the back of your head that tear you down. Depression is more along the lines of despairing hopelessness. I’m pretty far into nihilist territory in terms of my philosophical beliefs, and it’s also easy for me to fall into solipsism. These are the kinds of things that will trigger a deep depression for me. There’s a lot of evidence that the world is fairly purposeless, that most of our lives will be spent doing basically the same things, and that if you’re not satisfied with that you’re going to be miserable. Those are the sorts of thoughts that are quick to send me into a depressive spiral.

So what does it actually look like when I’m depressed? I get quiet. The whole world starts to feel overwhelming, too loud, too big, too bright. Basic tasks feel insurmountable, possibly because I just don’t care. Things feel heavy or thick, and it takes too much effort to remember or focus or smile. I feel tender and broken, and I curl into myself, physically and emotionally, to try to keep myself safe. My appetite goes wonky: sometimes I feel empty inside and just want to eat all the time, sometimes food sounds terrifying. More often than not depression is a feeling of having no idea what your emotions and your body are going to do next (but a strong conviction that it won’t be good).

The thing that I dislike the most about depression is anhedonia. I get anhedonia like nobody’s business. For those who don’t know, anhedonia is a loss of interest or enjoyment of things that used to be fun or engaging. I’m typically someone who enjoys a lot of things. I’m a joiner, and most of the time I’m trying new hobbies or filling every second of every day with things that make my brain feel engaged. So when those things stop holding any interest, it impacts me in a big way. I’ll try to go do something fun to pull up my mood, but it will feel pointless and joyless, which pushes my mood down even further. There is nothing that will make me smile, never ever ever again, everything will always feel like a struggle, and I’ve become utterly broken because the things that used to be awesome aren’t anymore.

It’s really easy for my brain to turn everything into the worst thing in the world when I’m in a down period. Something goes wrong and I’m inconsolable for days. It’s not a plea for attention or an attempt at drama. My feelings just won’t turn off, they won’t stop hurting. It feels like someone’s ripping my throat out through my stomach. I’ll cry so hard my whole body starts spasming. I feel it in my body. I get aches and pains, I can’t make it through a work out. I get sick.

And I get mean. When I’m depressed the whole world revolves around me. I want to make some allowances to myself and others for the fact that you get to be a little self absorbed when everything hurts, but it’s true that I ask for a lot and can’t give much back when I’m down. Being alone feels impossible because my brain won’t stop telling me bad things, but I don’t know how to do anything but complain since my brain also won’t let me see anything interesting or happy. So I end up compulsively texting and chatting, going on and on about how much I hate myself and my life and the world. I can see myself doing it and I can’t stop myself. It hurts to feel so dependent.

Depression for me also tends to come in long, ridiculous bouts. The worst was probably during my sophomore year of college, fall semester. I spent the entire semester so hopeless, lonely, and bored that I had to talk myself through each hour, promise myself that I could get to the next one. I spent a lot of time trying to numb myself to everything through starvation, mindless games, or any form of escapism I could use. Most seconds were spent wondering why I was still alive, what it was doing for me or for anyone, why it had to hurt so much. Sometimes it felt like nothing and sometimes it felt like everything packed into me all at once.

It’s hard to make any sense of depression or put it into a neat narrative. That’s probably why this description seems so disjointed: depression doesn’t make sense. It’s a lot of really unpleasant feelings and horrible thoughts mashed together in no discernible order. It’s assuming the worst, losing the good, and feeling like no one cares. And unfortunately, since my depression is chronic, it’s always lurking, waiting for a bad day that it can take advantage of.

Living Up to Expectations

Human beings take on the traits that are ascribed to them, or at least they often do. In studies about minorities and oppressed groups, people did worse on tests after being reminded about negative stereotypes of them. Sometimes we hear of studies like this and don’t really see how they apply to our lives, so I want to give some anecdotal evidence from my own life of this phenomenon. It’s amazing how powerful our perceptions of ourselves can be.

 

A few weeks ago my office all took the Strengths Finders test. You answer a bunch of questions and it tells you what your innate talents are, where you can excel the most. I got input, learning, intellection, competition, and achievement. Basically the first three mean that I really really love to think and learn lots and lots oh my god, and the second two mean that I’m ridiculously driven. Now I already basically knew these things, however in the last few weeks, I’ve noticed myself making choices that conform to these skills more and more, and doing so while thinking of the labels.

 

As an example, today I chose to go to academia.edu for the first time and look up some papers that I found interesting to expand my knowledge base, as well as to prep for some writing I wanted to do. Now I had decided long ago that I wanted to do this writing, and so I may have gotten around to taking this step eventually, but I literally went through the thought process of “I need to feed my intellectual brain. I should look up research”. I specifically volunteered for a project at work that involved research even though I’m not particularly interested in relational databases because I realized I could be more knowledgeable about something.

 

In addition, I’ve also noticed that I’m giving myself more and more permission to be competitive. I’m noticing that when I do well at something, I say to myself “Yeah, I’m competitive and I just won something! VICTORY IS MINE!” I’ve also found myself choosing not to engage in things that will absolutely completely definitely lead to me losing because I know my competitive side will be incredibly unhappy. Finally, I’ve been paying more attention to my conceptions of fairness, and labeling things as “unfair” when I feel that I’m on an unequal playing field with someone so that I can those things in a less competitive light. All of this because of a label for something that I already knew I was.

 

It’s incredibly interesting to see how I’m reinterpreting a variety of my actions in light of this new label, and how I’m working to mold myself closer to these things, owning them as opposed to seeing them as negatives or weaknesses. It’s interesting to think of how differently I might have acted had some of my other strengths been at the forefront of my mind the day I took the test. I’m sure there are other ways that I have molded my behavior to fit these expectations that are less conscious, but I found this an interesting and insightful example of some commonly known psychology in action.

What You Know: Reading Fiction and Nonfiction

I was talking with a colleague the other day about loving to learn and about what kinds of things I like to learn. He mentioned that he can’t read novels because there are simply so many nonfiction topics to learn about that he can’t imagine wasting time on fiction. While I can understand the drive to learn as much about our world as possible, I can’t understand cutting fiction out of my life. Most of us understand what we learn or gain from nonfiction: straight facts or insight into phenomena or incidents in the world. However there’s a lot of people who appear to miss the real learning we can do when we read novels.

As a novel junkie, I’d like to take this opportunity to explain how I view fiction as a source of knowledge.

Many people see the arts as beneficial because they allow us to connect to each other, or to feel emotions. These are good things, but they aren’t direct lessons or sources of knowledge. In addition to catharsis or other emotional and/or spiritual (in the sense of connective) elements, there is a little more to fiction. In my mind, the most important thing we can learn from fiction is empathy. When we allow ourselves to enter into someone else’s mind and story, we learn about what it’s like to be another person. We learn about other experiences. We learn how to imagine what things might be like for someone else. This skill provides us with a great deal of straight information, and as we partake in this process in each novel, we gain facts about what it’s like to be each character in the novel. While no two people are exactly the same, these insights can help us connect with real human beings and understand their motivations, histories, and experiences.

In addition, we can also understand a bit of the human psyche by reading fiction. A good author will create characters who react realistically to their surroundings, who have understandable and realistic emotions and motivations, and who make sense as human beings. Spending time in someone else’s head can help you not just to understand a specific type of person, but to understand some basic human psychology. Again, this provides you with some additional empathy.

Depending upon the genre, you may also learn something about history, a certain place, a particular incident or phenomenon, or a group of people because of the setting. Again, many fiction authors spend a good deal of time researching and understanding the setting of their novels so that they can create something that is realistic and will teach you through the story.

But there are more difficult things you can learn by reading novels. Novels are made up of characters facing difficult situations. This means you as the reader are asked to contemplate those difficult situations, and you are left with a deeper understanding of ethics, as well as your own character. You can find new roles models (I learned feminist ideals from many of my childhood and teenage reading), learn what sort of person you don’t want to be, or imagine ideals in things like friendship and family. Literature often tackles deep philosophical questions, and while you may not directly discuss them while reading, you do still find yourself thinking about them and wondering what your own reactions might be.

Examples of these issues from books I’ve read:

1.What does it mean to lie?

2.When should you trust someone?

3.Should men and women be treated the same?

4.How should you treat a friend?

5.Are adults trustworthy?

6.What makes life worth living?

I also have read fiction books that tackled everything from mental retardation to pregnancy to life in poverty to being a rich socialite. You get insight into each of these worlds, you get to inhabit each of these worlds for a time and hopefully understand better the perspectives of individuals in these situations.

In addition, the conversations that arise out of novels and fiction are hugely important to informing our sense of self and our knowledge of the world around us. We see which things we react to and we can begin to understand why when we discuss novels and fiction with those around us. We may gain empathy for one of our friends or colleagues by hearing their interpretation or perspective on a book or movie. All of these things are real and true forms of knowledge: they’re knowledge about what it’s like to experience things, and that is something that you can’t gain from nonfiction.

On Feeling Past My Prime

This morning I was reading an article about how age affects women more harshly than it affects men because of societal expectations of a woman’s “prime”. It’s interesting, because I never think about my age in terms of when I’ll be past my prime, or when I’ll stop being able to have babies, or when I’ll not be able to get a man anymore. Those things are not in the least bit important to me. The concept that at some point I will stop being relevant or sexy or loved or wanted because I’m old seems like the stupidest thing ever and I just don’t think about it.

 

But still, as a 22 year old, I often feel past my prime. I feel like I have lost the opportunities that I had and squandered what potential people told me was there. I’m certain I’m not the only one who feels like this, because I’ve been told by others that they feel like they’re behind or they’ve missed out or they haven’t done enough and they’ll never be perfect enough to achieve their dreams.

 

This cuts across genders, although I’ve personally seen it more in females. What has this generation been told that they somehow feel if they haven’t won a Nobel Prize by the time they get out of college then they’re useless? Because that’s the overwhelming sense I get from my friends and peers: no matter what I accomplish it will never be enough and I should have done it sooner anyway because I was supposed to be a prodigy.

 

Let’s try to put this into perspective through a few choice anecdotes. I have a friend who’s brilliant. She retains facts like nobody’s business and will excitedly tell you EVERYTHING about her subject of choice. She knows what she likes and is passionate about it. She’s on her way to getting a degree in that subject, and ready for grad schools following. And yet. And yet. She hasn’t gotten straight As. She’s in a difficult program and sometimes she struggles. She has a hard time balancing school and friends and family and mental health. Just like any other normal human being on this planet, she isn’t perfect. And whenever these things face her, I can see her melt. It’s the saddest thing in the world. I can see the voices talking to her and telling her that despite her plans and her dreams, and the fact that she is ON TRACK to live out those dreams, she’s useless and she hasn’t accomplished anything.

 

I have another friend who graduated from a small liberal arts college with good grades, played in the orchestra, held a job the whole time, is fit and talented and intelligent, got a well-paying job out of college, and now feels that his life is going nowhere. He didn’t get an engineering job straight out of school and isn’t sure what he wants to do in grad school. And so his degree suddenly becomes useless, his grades suddenly aren’t good enough, and nothing he does is worth anything. Even though he spends his time doing things like building cars and making a bike for his girlfriend, and doing things that he clearly loves, he feels his life is not good enough and HE is not good enough because there is some unspoken expectation of greatness for him.

 

And finally (not to brag, but to illustrate that I know what I’m talking about): I graduated in 3 years from a small liberal arts school after being admitted to every school I applied to. I graduated magna cum laude with honors in both of my departments (I was a double major). I held multiple jobs all three years and participated in a wide variety of extracurriculars. I now have a job, and I’m biding my time trying to decide what to do next. But when I think about where I am in life, I feel as though I have already wasted the best years of my life. In high school, I was told so often that I was smart, that I would do great things, that I would accomplish. I didn’t do that in college. I didn’t get published in major journals, I was never recognized for any sort of brilliance. I didn’t come to any great discoveries. I was just a regular student who got through. I’m not working at an amazing job, thinking Big Thoughts or moving towards a Bright Future. I don’t know what I want to do in grad school, and when I think about it I’m fairly certain that when I go, I won’t be held up as the best of the best. I’ll probably do well, but I won’t be richly rewarded. I’m trying to do what I love through writing and editing, but a piece of me still holds on to the dream that someday a publisher will stumble upon my writing and hand me a contract and I’ll suddenly be the next J.K. Rowling.

 

Now I know that in each of these examples, none of us are brilliant shining stars. None of us are about to cure cancer or write the next great American novel. But each of us are doing pretty well for ourselves. We’re smart, we’re relatively accomplished, we haven’t screwed up majorly in any way, and we’re all kind of following the appropriate path for our age group: going to college and then kind of trying to figure things out for a while. For those of us who are out of college, we’ve got steady jobs that allow us the freedom to figure out what we want to do in the future.

 

So why is it that we’re all convinced we’ve failed? Why is it that we feel we have not lived up to expectations, or that we could have been so much more? Why is it that in my mind when people told me “you have a lot of potential” I heard “if you don’t achieve fame and success by the end of college you suck”? Why is it that for all of my generation I get the feeling that we expected ourselves to be child prodigies who would excel at something from the time of birth and blow past every other person in that field by the time we were 18?

 

I can’t answer these questions entirely on my own. I don’t have sociological research to back any of this up, but I do have suggestions and possibilities. When I was young, I was told over and over of my own potential. I grew up in an era when telling a kid they could do anything was the norm. Dreaming big was expected and encouraged. I was told that if I work hard, I can accomplish whatever I set my mind to. Now I have no problem with parents encouraging their kids to dream, but telling me over and over that I can accomplish anything is simply a lie. Things are out of our hands sometimes, and wishing and trying and working doesn’t change that. I was propped up all my life: told by teachers that I was so smart, told by parents that I was special and amazing. I don’t regret for a second the support that I had from these people, but I wish that I had a piece of reality thrown in there: that as talented as I am, as smart as I am, as loved and supported as I am, things will still not always go my way.

 

I think of Dr Seuss’ book The Places You’ll Go. For a kids’ book this fucker is remarkably insightful. Because despite being full of support and love and excitement, it acknowledges that even someone as brainsy and footsy as you can get in trouble sometimes. I don’t feel like I had that. Somewhere along the way, my generation go the message that we could control our futures if we just worked hard enough and did things right enough. Which means that if things didn’t go our way, we must have done something wrong. We must have failed.

 

I see this in the way that we talk about college (always about getting into a top school, not getting into a school you like), the way we talk about jobs (how much are you making out of college), the way we talk about degrees (how many things did you major in? what’s your GPA? How many jobs did you have?), the way we talk about grad school (can you get funding for it? How much more will it make you?)…we don’t ask people questions like “are you enjoying yourself? Do you have good friends? Are you doing something you love?” So despite the fact that I spent 3 years studying something that I find absolutely fascinating, I’m a failure because I have not gone on to start a Ph.D at Berkeley, or because I have not published, or because I have not…xyz.

 

I wish we could stop feeling like we’ve failed. I wish we could change the dialogue from “what are you accomplishing” to “what are you enjoying”. I wish we could stop feeling we need to be the best. If I have any hope for the next generation, it’s that they’re empowered to know they have opportunities and abilities unlike anyone else in the world, but that they also learn to accept. Change always comes first from acceptance.

Frustrations with the DSM

I live in a very psych oriented world. I work for a nonprofit that provides services to kids with autism and developmental disabilities and general mental health problems. I spent at least five hours a week in therapy. I talk a lot about mental health, I care a lot about mental health, and a few of my friends and I just started throwing around the idea of creating a skepticism and psychology conference (SO EXCITED). So I’m thinking (as per usual) about mental health.

One of the talks at SkepTech (by the fabulous Stephanie Zvan) was about psychometrics, which is “The science of measuring mental capacities and processes.” She talked a fair amount about how we often define certain disorders based on our stereotypes: we view autism as a boy’s disorder, so the diagnostic criteria are slanted towards how autism presents in boys. I think this is a very important thing to address (especially in terms of race. UGH), and I think the place to start is with the DSM (the psychology diagnostic manual). The DSM is very much a quantitative measure. For eating disorders for example, it lists particular weights, numbers of binges and purges per week, and length of the persistence of the disorder as diagnostic criteria. In many ways, these concrete diagnostic tools are incredibly helpful: they allow insurance to see who to treat or not and they allow clinicians to have something more solid than personal judgment to use in their diagnoses. That’s important. We do need some element of consistency, we need some science in our diagnostic tools.

The problem shows up in the fact that many of these diagnoses are written around what is considered the typical case and doesn’t necessarily allow for any variation. It also doesn’t address the fact that many people have lots of symptoms that don’t quite fit into a neat diagnostic category. In many ways it’s far too rigid. Diagnoses that involve NOS (not otherwise specified) often aren’t covered by insurance, aren’t included in research, and aren’t afforded as much respect as serious problems by clinicians or the individuals diagnosed.

This is a really big deal because it limits who can access mental health care based upon demographic or personal variation. Males with depression generally exhibit it in very different ways from females, and they are not diagnosed as often because they aren’t viewed as the typical depression sufferers. People of color are not diagnosed with eating disorders nearly as often as white girls (particularly teens).

So how can we both create helpful categories AND capture the wild diversity of mental illness? How can we approach mental illness not as a checklist of symptoms that we address and move the individual back to the neurotypical end of the spectrum? First and foremost, insurance needs to NOT be tied to strict diagnosis. That is not fair to individuals who might need preventative therapy or interventions, or those who want to catch a disorder before it becomes so serious that it interferes with their life. It is also not fair to those individuals who have a serious mental illness that is wreaking havoc on them, but who don’t fall neatly into a category. But it’s also unfair to those who DO fall into the category, because it might ignore any other symptoms or problems that could be contributing to their diagnosis. OF COURSE labeling some patterns and similarities can be helpful because it allows us to conduct research and to develop treatments that work for people with similar issues. But these labels should not be considered so strict, should not be the only guide we have in treatment, should not have such harsh boundaries, and should allow more movement between diagnoses. They should be guidelines (the code is more like guidelines than actual rules).

There should also simply be more cross-cultural research. Right now we have very Western-centric views of psychology as well as very white, male views of psychology (thanks Freud). We need to focus on evidence based treatments, and we also need to simply be willing to have MANY types of treatment available for people who are exhibiting different symptoms because of their demographic. We need to have psychologists who are social justice aware: personally I think that sociology, women’s studies, and race studies classes should be required of every psychology major. It is SO important to improve our mental healthcare system, and the first place we need to turn is how we determine who needs mental healthcare.

If we’re being honest? EVERYONE. Mental healthcare isn’t about turning people into the neurotypical. It is about improving functioning. Everyone could use a mental health checkup, just like they have a physical health checkup to make sure they’re functioning like they should and to catch any worries or glitches before they turn into something serious. We need a paradigm shift that no longer sees diagnoses as identifying problematic difference to seeing diagnoses as identifying problems with functioning that require help.

NOTE: they are trying to adjust some of these problems in the latest update of the DSM, the DSM-V which is coming out in May.