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.

Preemptive Nostalgia

I am leaving the country in about three and a half months. I’ll be gone for a year. I really don’t know if I’ll live in the same state again when I come back, or whether I’ll come back after my master’s program is done. I’ve never lived outside of the state of my birth. The longest I’ve ever been gone for is a month. I’ve lived in the same city for all of that time except the three years I spent at college (only 45 minutes away).

What I’m saying is that it finally feels like I’m leaving home for the first time.

What’s odd is that it has become highly apparent to me that we only begin to value things when we’re about to lose them (ok not always but oftentimes). Part of this is that we don’t always take advantage of opportunities right in front of us until we’re about to lose those opportunities. I’ve been noticing that I’ve started to feel a tenderness towards places that seemed mundane and boring for most of my life, and even more than that I’ve felt a deep desire to explore the city I’ve lived in for 23 years. I suddenly feel as if I’ve been missing out on all the amazing things that are right in front of me (and that I knew were there), but really just didn’t feel motivated to get up and do.

It feels like a kind of preemptive nostalgia. I know that I will miss all of this when I’m gone. I know that there are so many things of comfort to me here, places I’ve known my whole life. I know that there’s a level of “home”ness to this city that I doubt I will ever find elsewhere: I have memories from my every year of my life here, I know the city itself extremely well, I know nearly every free activity that is available, I know the theaters and the bars and the restaurants and the music venues. While I may come to know another city quite well, it’s doubtful that I’ll ever have the same innate knowledge of another place again, the knowledge that comes from living here, having a mother that lived here, and grandparents that lived here, and learning the stories that they tell of the city and its history.

There are few situations where I will ever be able to take advantage of a feeling like this. I’ve very intentionally been looking for ways to get out and engage with the things that make my home what it is. I’m going to plays, festivals, parades. I’m looking for new ways to see the city by biking around lakes (once it warms up I hope), leaving the apartment, getting outside. Because I know ahead of time that I will leave and I am starting to feel the fear of change, I get to savor the time that I have left here. I get to make the effort to see things positively before I go.

I wonder if there is ever a way to have this kind of preemptive nostalgia in other situations? When we’re feeling frustrated with a partner or a friend, what would it be like to imagine not having them around anymore? When we’re frustrated with school or a job, what would happen if we think of it ending? Especially when relationships are going sour, we rarely see the end of it as a time to reflect on the things we loved about it. But what if we did? It’s hard to break up with someone, and we often agonize over it because we don’t want to hurt the other person, there are things we still love. But what if we could look at the relationship with the kind of nostalgia we have when high school ends or when we leave a place we love? Perhaps it would hurt less, and remind us more of what was good.

Or maybe this is just a way of letting myself be sad for longer, of not really existing in the moment and enjoying what I’m doing. Maybe it’s a way of only appreciating things once I don’t have to experience them anymore. For now I will simply see it as an opportunity to appreciate in the moment.

Adulthood: Mourning The Past

I’ve been having a lot of ennui about being an adult lately. This is not uncommon. Twenty somethings excel at ennui and not wanting to be adult. But there appears to be more to this ennui than simply being overwhelmed or not really wanting to take responsibility.

Accepting adulthood doesn’t just mean taking on new responsibilities and learning how to do practical things. All of those are difficult and stressful, but what might be the most difficult part about growing up is the changing relationships and the loss of the world that existed when you were a child. When you begin to take responsibility for yourself, it shifts every relationship you have been in with an adult it shifts how the world looks, it shifts what consequences look like and how you handle them.

One of the most difficult of these for me is relationships. I’ve had an extremely close relationship with my mother since I was young. When I was a kid, this meant that she took care of me, she protected me, she made the world an easier place for me while teaching me about all the awesome stuff I could do in it. She was amazing at making things happen that I deeply wanted to happen (e.g. going to that really cool summer camp).

Now that I’m an adult, that person that my mother was no longer exists. In childhood, parents can become a bit godlike. Sometimes they’re kind, benevolent, awesome gods (like my parents), and sometimes they’re shitty gods, but they do hold all the power in the relationship. Sometimes this means they can come across as faultless. No matter how you view your parents when you’re a child, you’re not seeing them as real, complex human beings (because that’s not the relationship parents and children have).

As you grow up and the power dynamics in your relationship even out, you see your parents in more and more realistic ways, as human beings with faults and fears. The god that protected you as a child dies. This hurts. A lot. It’s a little bit terrifying too. The relationship you had with the adults in your life will change drastically, and that is also scary and painful. You’ve replaced your parents with these new, odd people who are very much like your parents but suddenly can’t fix things for you and screw things up sometimes and have a history and want to do things other than cook you dinner.

This may sound very selfish, but at its root its about losing someone you love. Of course I still love my parents, but they’re not the people that I saw as a kid. I’m never going to get back the feeling of Mama Bear Who Will Fix All My Problems And Make Everything Ok. That’s a good thing, but I miss her. Part of growing up is mourning. Oddly though, we never talk about the fact that it’s a good and healthy thing to stop and feel sad for the things that are gone. Generally the attitude is “well you knew you had to grow up, everyone has to do it, move on”. That’s unhealthy and callous. Setting aside some time to feel sad that things have changed makes perfect sense and makes it easier to go on and do the difficult work of paying your bills and organizing your own damn vacations and building a new relationship with these people who are your parents.

There are other things to mourn though, and other places to notice that as your perspective changes, you may have to learn to be in relation to new things. A big part of this is consequences. As a kid, consequences are often arbitrary and usually limited by the adults around you: in all likelihood nothing you do will have the consequence of you ending up homeless, getting fired, going hungry (there are circumstances in which these things happen, but for the most part you aren’t going to cause them). As an adult, these things are possible, and your actions could cause them: you can get fired, you can lose your apartment, you can not have enough money for food! AH! Your relationship to the world has expanded into a much bigger and much scarier territory.

While it’s quite likely that you won’t end up making any of these huge mistakes and you probably know that, the fact that they now exist is something that’s scary and new. The world has changed in an irrevocable way. This is another thing that you get to mourn. Every couple of months if you need to, you can sit down and have a good old worry fest about the fact that it’s now up to you to make sure you have a roof over your head and food in your tummy and no deadly molds growing on your bathtub. And once you’ve felt that worry you can stand back up and remind yourself that you’re capable and not going to make any deadly mistakes, then go about your day.

The natural emotions that are part of growing up aren’t a bad thing, but for some reason it’s become normal and acceptable to tell young people that they should just get over it and ignore those emotions because hey, it’s just being an adult and everyone has to do it. Newsflash: there’s lots of things that everyone has to do that are unpleasant and terrifying and that deserve some time to respect that. A great example of this is that everyone’s parents dies and it’s absolutely understood that you get time to grieve. Similarly, growing up is a time of flux and change and confusion. All of these come with natural emotions and it makes sense to feel those emotions.

Let’s stop with the shame and start accepting that a part of adulthood is mourning what you lost when you put childhood aside. Sometimes you do get to sigh deeply and miss having Mom tuck you into bed when you’re sick, or having long afternoons of playing outside in the dirt. You get to mourn the things you miss, and hopefully you can figure out how to reincorporate some of those things into your life in appropriate, adult ways.