I’m seeing a lot of well-intentioned posts and comments this week, in the wake of the suicides of both Kate Spade and Anthony Bourdain. People are posting about hugging your loved ones a bit tighter, or telling someone you love them, or giving a hug to a friend. And it’s lovely. But it ignores the fact that depression is a mental illness, not a bad day you can fix with a hug and a cup of hot cocoa.
If telling someone you loved them or giving them a hug would pull them back from the brink of suicide or cure depression, maybe we’d have hugging centers. We don’t. Hugs don’t cure depression. Love doesn’t cure depression. Or any other mental illness.
Is that harsh? Maybe. But let’s focus on facts. Depression is not a case of being really sad. It’s a disease. It’s a mental illness. Before I get into my lengthy and potentially self-indulgent post (this concern has me debating this post), here are a few things I don’t want to bury:
- OF COURSE you should tell people you love them and you’re here for them. You should give hugs if they are requested or needed. You should listen and talk and support. This is baseline humanity. But it might not make a difference to the depressed brain.
- Depression is a disease. Choose your metaphor: it’s like diabetes, it’s like hepatitis, whatever. But it’s particularly insidious. It’s not impacting an organ you can easily dissociate from. This post from Emily McDowell nailed it: “Depression… affects our brain— the organ we use to make decisions. This is one reason mental illness is so deadly: the part of our body that’s affected is the same part that’s responsible for our behavior. It’s like if you broke your leg and then had to use that leg to walk to the hospital.”
- It’s a disease that medicine doesn’t fully understand yet. This is what makes it — much like many forms of cancer — tricky to treat. We don’t know the exact cause(s), so it’s hard to find a cure. We know things about depression. We know depressive brains are different. Just this February, we learned that brain imaging can identify different types of depression, and that might help us figure out how to identify and treat them.
- We know that some drugs help the depressed or anxious brain (for example, by keeping more serotonin up in there), but they don’t work for everyone. We know that some people become totally drug resistant and nothing helps. We know that talk therapy helps. Cognitive behavioral therapy helps. We know that therapy + drugs can help more than either one alone. We know that electro-convulsive therapy helps some people by basically “resetting” the brain, like you would reset a blown fuse. Again, we don’t know exactly why yet. It just does. We know that depression and anxiety are comorbid conditions; that means if you have one, there’s a good chance you’ll be dancing with the other at some point. Not always, but it’s not unlikely.
- Depression isn’t the same for everyone. We know there are different types, but symptoms vary. Some people stop eating, some people binge, some people’s eating habits don’t change. Some people have insomnia, some people have hypersomnia, some don’t change. You might experience memory loss (I did); you might not. You might experience logorrhea (where you can’t stop talking/writing — odd, do we have any prolific writers with depression?) but this also happens with bipolar disorder.
- Fucking anhedonia. This is a big one, and I hate this one. It’s one that most people with major depressive disorder experience. This is why reaching out to them might not help. Their pleasure/happiness response is fucked. Hedonist = someone who lives for the pursuit of pleasure. Anhedonia = the inability to experience pleasure. Again, experiences vary, but for me, I couldn’t find enjoyment in anything. Food lost its flavor. I didn’t enjoy shopping. Or reading. Or cooking. Or photography. Or time with friends. Or anything creative. It was like the color and taste and scent had been drained from the world, and I was trudging through a cardboard diorama. Imagine any little thing that gives you joy. Now imagine that it’s there, but it elicits no emotional response. It’s no wonder that Depressed Eva was often criticized for being cold and distant.
- It doesn’t just go away. This post from Chris Hardwick also resonated: “[depression] isn’t a dragon you just slay once and you’re done. You wouldn’t exercise for a little while and go, ‘Ok done! I’m fit for life now!’ It’s an ongoing process, and that’s okay, because everything needs maintenance.” 100% true. It waxes and wanes, ebbs and flows, but depression tends to be cyclical. Again, there are variations, but for those of us who have struggled for a while, you learn to recognize your triggers and the signs that you are slipping and need to get support.
- More than hugs, we need access to mental health care. We need it to be covered in the same way as any other medical need (I know that’s another issue entirely, but you get the point.) We need it to be accessible and affordable, for everyone. We need to make it easy to FIND. We need to make it easy to ACCESS. We need to pull it out from under the hidden parts of insurance websites, where I’ve had to get linked to three different websites before I got to the mental health services page, and then it was buried under “Drug Abuse and Mental Health.” Thanks, guys. We need to train other medical professions to recognize the signs and learn how to make a recommendation that goes beyond a script for pills. We need to make it something we can talk about openly. We need to stop telling people to cheer up, or smile, or calm down when they need medical attention.
- I think it’s worth deepening your understanding. Whether you suffer from it or just want to learn more (and read a great book), I would highly recommend Andrew Solomon’s The Noonday Demon: An Atlas of Depression. On the surface, it’s a memoir – but it goes so much further with interviews of scientists, doctors, and Solomon’s personal experiences seeking alternate therapies. His words are powerful — and true:
“You are constantly told in depression that your judgment is compromised, but a part of depression is that it touches cognition. That you are having a breakdown does not mean that your life isn’t a mess. If there are issues you have successfully skirted or avoided for years, they come cropping back up and stare you full in the face, and one aspect of depression is a deep knowledge that the comforting doctors who assure you that your judgment is bad are wrong. You are in touch with the real terribleness of your life. You can accept rationally that later, after the medication sets in, you will be better able to deal with the terribleness, but you will not be free of it. When you are depressed, the past and future are absorbed entirely by the present moment, as in the world of a three-year-old. You cannot remember a time when you felt better, at least not clearly; and you certainly cannot imagine a future time when you will feel better.”
You can stop reading here. What follows is my history. I worry about posting this. Why? Because there’s so much “I” — but I can only speak from “I.” I can’t tell you about someone else’s experience. These are the stories I can tell, so here they are.
As Mr. Solomon notes above, depressed time is a conflation of past and present. I am an unreliable narrator. Depression steals memory; I’ve pieced it together in a sort of “meh, approximately” kind of way, and by recalling other things happening in the world.
I have experience with major depressive disorder, some mild anxiety, and obsessive-compulsive personality disorder. I have about 30 years experience, actually, starting when I was about 10:
I am 10. I sit in the cafeteria with my head on the table and my arms around my head, trying to drown out the sounds around me because I feel so alone and so sad and I don’t know why.
I am 13. I lash out at my family. I’m angry and moody and resentful. I don’t remember much about why or what was going on, other than my parents were not talking to one another and I was the messenger between them for many, many years. I’ve learned since that one of the effects of major depressive episodes is memory loss; it can wipe out vast swathes of your life from your memory. My brother or mother or sister will say, “Don’t you remember when…?” and I don’t. I truly don’t.
I’m 16ish. My English teacher and I are talking after school. I’m in honors English. I’m a perfectionist; I’m an academic over-achiever. I’m better with words on paper than talking. As we’re talking about an essay, the conversation moves to other things. She asks me, out of the blue, “Do you think you might be depressed?” I say I don’t think so because that word means something very dramatic and “crazy” to me. I don’t understand it, so I ignore it.
I’m probably still 16. I’m often sad and crying for no reason. I’m often frustrated at life and people. I feel unworthy and imperfect. A friend tells me, “You’d better cheer up, Eva. If you lose us, you have no friends left!”
I’m 18. I am waking up every morning, dry-heaving, queasy. Can’t sleep. I got to the doctor. “Any chance you’re pregnant?” Nope. “Are you feeling stressed?” A bit. “Do you think you might be depressed?” I start weeping in the office. The doctor writes me a prescription for Prozac. I never fill it because how will that help?
I’m 19. I’m attending NYU as a commuter student, taking 16 credits, and working full-time five days a week at a bookstore in NJ. My life is crazy busy and full. I have trouble sleeping. I have trouble getting to class on time. When I get to campus, I sometimes go to the Bobst Library between classes, sit down at a table and read. I am so overwhelmed with exhaustion that I often fall asleep and miss class. My grades are slumping — so I talk to an academic advisor who suggests I take a leave of absence for a semester and maybe look into counseling. I take the leave of absence; I don’t see a counselor, because how can they help me if I don’t even know what’s wrong?
What can they tell me about myself that I don’t already know? They can’t help me feel like I’m worthy or valuable. Therapy is bullshit, I think to myself. I say this out loud in a creative writing workshop class; it does not go over well. I am naive and in denial.
I’m 20. I went back to NYU, got back on the dean’s list after my semester break. I’m doing well, GPA is high, I’m kicking ass, and things are good.
I’m 22/23? I graduate (a semester late.) I get my first apartment and job. September 11th happens (but I don’t feel anything – I’m disconnected.) Our company goes bankrupt. I lose my job. I have to move back home. I get in a car accident and total my car, but no one is hurt. I’m unemployed. My school bills and credit card bills from a trip to England come due. I don’t have the money. I almost default on those loans, but find a way to pay minimums.
Same age. I feel hopeless and worthless. I’m spending money I don’t have because I’ve thought it through and decided I’m not going to be around much longer, so I won’t have to pay those bills. I’m not sure what I’ll do to follow through, but I can’t do this. I’m a burden to my family. I’m a fuck-up. I’ve lost friends because when they call me, I don’t answer the phone. I bail on plans because I can’t bear to go through the motions and put on a face around them, and no one wants to be around this miserable, pathetic person. When friends ring the doorbell, I pretend I’m not home. I can’t blame them for saying “fuck you.” If they hate me, they won’t miss me when I’m gone. It makes perfect sense. If I’m always fighting with my family, it will make it easier on them when I finally free them of the burden of having to deal with me. Somewhere in here, my mother tells me that I’m difficult to love, and that she doesn’t understand how I have friends. I can’t argue. I think of it as a kind of Irish goodbye – drop off of people’s radar, and they won’t notice that you’re gone. Poof!
A year later? Maybe? I have a crappy job, but at least I can pay some bills. I am driving on a four-lane highway in my parents’ minivan – a maroon Toyota Previa. There is no divider on this road. I think to myself, “If I just veered into the opposing lane of traffic, it would be a terrible accident. My family wouldn’t be mad at me, and it would be over and done.” I imagine this. I visualize this. I think of all the benefits of this approach. I break; I start crying hysterically. I pull over to the shoulder and cry and cry and cry because I realize, for the first time, that this is NOT normal.
I get home. I have health insurance, so I call them and navigate the craziness of the phone tree to get to their mental health services. It takes a while. They finally go through the questionnaire to see if I’m in immediate danger of harming myself or others. I assure them, I am not, but I need help. They give me the names of doctors. I call a few. I make an appointment. I start seeing one.
I am diagnosed with major depressive disorder. I am also told I have obsessive compulsive personality disorder. This means, partially, that I need to be perfect. This plays very nicely with depression — because if I’m not perfect, I’m not worthy of love or care or respect or kindness. The doctor tells me I’m in an abusive relationship with myself. I can’t argue. He recommends medication; I refuse. I don’t want to be on meds.
Somewhere in here, I am sleepless and still living at home. I decide to do laundry at 3 a.m. because I can’t sleep anyway. My little brother wakes up because he hears me doing laundry. He comes into the laundry room and asks me, “what’s wrong?” I break down, physically and emotionally, and collapse onto laundry weeping because I have no words. The answer to “what’s wrong” is everything and nothing. He holds me, my 17-year-old little brother, and doesn’t know what to do, so he just tells me, “It’s OK. I’m sorry. It’s going to be OK.”
I try to explain depression to my parents. They tell me to exercise. To go for a walk. They don’t want me to be taking meds because that’s for crazy people and I’m not crazy. Just moody. Or artistic. Or melodramatic. I’m just doing this for attention, maybe.
I’m 27ish. I have a new job. Things are good. But I am feeling the dark cloud again. Crying frequently, for no reason. Everything is wrong, but nothing is wrong. Maybe it was a family issue. Maybe it was a boy issue. I don’t remember. But the doctor, again, recommends medication. He says I need a buffer between all the external stimuli coming at me from all directions, since I have enough coming at me from within.
This time, I say OK.
The next 5-6 years, I am seeing a therapist and talking about my feelings and family and history. I am taking medication, until it stops working and then I switch to another one. They keep me level, but the dark thoughts don’t ever go away; they just take a bit longer to penetrate. I go from Prozac to Wellbutrin to something else that works OK, but I gain a ton of weight in a very short time. I feel worse. To lose that weight, the doc gives me an anti-spasmodic which has an off-book use of aiding weight loss. I have a bad reaction; within hours of taking it, I am unable to read or speak, break out into a cold sweat, and go home from work, leaving an incoherent note for my boss, followed by 18 hours of solid sleep. I am convinced I will be fired, and begin to freak out because my mental illness is going to ruin my life.
I am not fired. I never take that pill again. Things are OK for a few years.
I have a friend. She is pregnant. I am there for the birth of her child. But I don’t know how to be a friend to her when she is going through the most difficult time of her life because my depression drains me. I don’t know how to support her through her experience. I feel it’s better to step away and release her from the burden that is me. Just in case.
I’m 30? 32? I have a friend. I maybe want more, but do nothing about it because I don’t deserve happiness or love. So things float along. He doesn’t know how to deal with someone who has depression. I’m “moody” and “overly emotional” or “unstable”. Because I have feelings. Because I cry. Because I feel sad. He says he hates it when I make self-deprecating comments. I try to explain depression. I try to explain mental illness. He tells me that he has to keep reminding himself that I have no control over this, and that it’s like diabetes. He tells me he puts up with a lot to be my friend. I can’t argue, because everyone does. I’m difficult to love. I’m difficult to be around. This is a highly toxic situation for both of us. I end the friendship.
I am 34 or 35. At a new job that pays me 50% more than the previous one. I’ve been promoted; I’m doing really well with my career. BUT. The dark cloud is back. Now I cannot function at work, and that terrifies me because that’s the one part of my life I feel I am competent in – and now I am doubting myself. I talk to the doctor. He says I should take FMLA because he’s worried about me. The meds aren’t helping anymore and even he isn’t sure what the next step is. A woman at work tells me that she’s struggled, and that I should start smiling because smiling tricks your brain into thinking you’re happy, and that’s what cured her depression. I curb the desire to tell her to go fuck herself, because if curing depression was as easy as walking around with a smile on your face, we’d be in a society of creepy smiling “Black Hole Sun” people. By this point, I’ve perfected the appearance of someone who has her shit together. I can smile and be cheerfully efficient and get a promotion at work, because I am currently a high-functioning depressive. We can do that, too.
(Aside: if you’re always busy and working and creating and doing, you never slow down enough to think and feel and fall into the pit that’s waiting for you. It’s not like bipolar disorder; this is just keeping yourself and your brain occupied and distracted with so many other things that the dark thoughts don’t get a chance to get a foot in the door, because it’s a revolving door that’s going really fucking fast.)
I decide that yes, I will take FMLA. While I have the energy and strength and my brain is willing, I will spend that time making my mental health a priority, and will make getting appropriate treatment my mission. I talk to my boss. I cry. I stress about crying to my boss. My boss is supportive. She helps me navigate the paperwork and HR stuff. She tells me she understands. She even gives me the names of some therapists.
My co-workers throw me a little “happy FMLA” party because we are a small group and we are close. I am deeply touched, but don’t show it because it doesn’t feel real. I take 6 weeks off from work to see CBTs like it’s my fucking job. I have a notebook for this purpose. I have a script that I will recite with each therapist so they’re getting the same story from me. I tell them I’ve spent years on meds, and in talk therapy, but I don’t feel much change – the dark still envelopes me. I still feel unworthy of this life. I still feel like a mess. I tell them I need a toolkit for the future — if I’m going to have one — to help me untwist this tangled mess in my brain.
I find a CBT who is close by. I start seeing him. I like this approach. I feel different.
I reconnect with some friends. I begin to say “yes” to friends who want to make plans and try to believe that they actually do want to spend time with me and are not inviting me to hang out because they pity me, or are doing it out of mercy for this sad, worthless person who is clearly so undeserving of love. Those thoughts become less frequent.
I see this doc for about a year, and I am a changed woman. Then his office closes abruptly due to an emergency. I don’t have the time to restart the search, so I decide I will be OK for a while. I’ve got some tools in my toolkit, right?
I’m 37. Our company lays off 500 people. I am one of them. I am OK with this, because I’d been starting to look for a new job anyway. I am surprisingly chill with all of this, and I have a new job offer within a couple of weeks of getting laid off. The dark thoughts are kept at bay.
My beloved cat, Joe, is sick. He’s been my companion for 3 years and my reason to get out of bed in the morning, even if I didn’t want to do it for myself (the dark cloud is there, just floating a bit higher). My grandmother has died. We fly to Poland for her funeral. I didn’t grow up with her, so I am sad, but not devastated. We get back. My cat is diagnosed with kidney disease. I take him to the vet every day for 18 months to get him his subcutaneous fluids. When he finally lets me know it’s time to let him go, it’s my birthday. I am gutted. My reason to wake up in the morning is gone. I can’t function. I can’t sleep. I can’t eat. I scramble to find another doctor because I know I am missing some critical pieces from my toolkit, and I am NOT equipped to rebuild after this.
I find a new CBT. He’s out of network. He costs $175 per visit, and I see him weekly.
It is worth it. He is worth it. I come to realize that I am worth it, and that I can go on.
He questions me. He makes me battle my twisted brain. He doesn’t let me hide behind humor or deflection. He asks tough questions and pushes me to answer. He asks why I’m sad or scared, or why I’m worried, and we unpack and dismantle those thoughts so I can see exactly where and how my brain has been lying to me for almost 30 years. I don’t need to understand why my brain has been lying. Depression is why my brain has been lying to me. It’s a mental illness. That’s why. I just need to understand how to say, “hold on a minute. You’re a fucking liar. Let’s look at the fucking evidence around you.”
In some ways, CBT is teaching you to cross-examine your own brain. You know it’s lying on the stand. You know it’s twisting the facts. You have to recognize the way it’s lying, and then shove that evidence in its face and keep asking questions until it breaks down in the witness box, like a bad actor on an episode of Law & Order. At first I hate it, but within two weeks, I am a fan. The doctor tells me that I’ve really embraced this approach very quickly; I tell him it’s about fucking time.
My second homework assignment is to adopt a cat. I tell the doctor all the reasons I cannot. But he pushes. So I adopt a cat. I bring him home and cry because I don’t think I’m ready. What if I’m not able to provide a good home? What if I don’t bond with him? What if he never bonds with me? I struggle, but this is part of the process. The doctor and I talk. I bond with the new kitty. His name is Jasper, and he actually makes me laugh.
After about four months of intense, weekly Cognitive Behavioral Therapy, I am so much better. I am able to take these skills I’ve learned and battle these thoughts. I know that thoughts are not feelings. They are not truth. They are not facts. I can’t feel worthless. I can feel sad or angry. “Worthless” isn’t an emotion I can feel. I am not worthless. I can change my thoughts because I’m putting in the work to change my mind.
It’s now. The thoughts haven’t gone away entirely. This is the nature of the disease. They are intrusive. They penetrate my mind. But I have been trained. I know what to do. These thoughts have been with me for 30 years, but now I know how to take them apart, and look at them as if under a microscope, and use my rational brain to say, “No. That’s false. Let’s not give that thought any more attention.” I have to talk myself through it sometimes since stress is a trigger. When I’m at work, I will take a moment and say to myself, “Your rational brain knows better. Let’s make a list of what you’re thinking, and let’s go through and challenge these assumptions. No, you can’t read your boss’s mind, so you cannot assume that she is thinking you are incompetent. Perhaps she is wondering if you’re overwhelmed, and maybe you should talk to her about getting help prioritizing your work.” This happens often, at work and in life.
And right now, June 9, 2018, I am OK. I have a pottery class tomorrow. Yoga on Thursday. I have tickets to events in August. I am leaving the house and seeing friends tonight. My cat is asleep next to me, and I have no desire to cry at the moment.
I may not remember many events from the last 30 years, but that’s depression for you. And no, it’s not self-medication. I am too much of a control freak, and don’t want to mess with chemicals that can fuck up my depressed brain.
But I remember going days without washing my hair and wearing a scarf to work to cover the greasiness and customers asking me if I was in some kind of religious group because my head was always covered. I remember sleepless nights, crying because I wanted nothing more than for someone hit me in the head with a blunt object to knock me unconscious because I wanted to stop feeling and stop thinking… and I stopped short of that, because the logical next step was scary.
I remember thinking so many times that if I was gone from this world, deleted from all the equations that I was part of, it would be so much easier on everyone. My family might be sad for a bit, but they’d be unburdened. They wouldn’t have to put up with me anymore. I’d already lost my friends, so they were spared because they didn’t know me or care about me anymore already. After all, people told me I was difficult, and that they put up with a lot to know me; I had evidence. It wasn’t just in my head. I was unloved by the people who were supposed to be my friends, and the people who did love me – my family – were only doing so out of obligation. It is known. The biggest favor I could do them, the most selfless gift I could give, would be to find a way to kill myself and spare them the pain and trouble of knowing me, and to spare myself the pain and trouble of this existence, that didn’t seem to be worth anything to anyone, least of all me.
To the friends I’ve lost over the years, I am sorry. I’m sorry I was an asshole. You deserved better, but I didn’t have anything better to give.
To the friends and family who have stuck by, thank you. You may not have known all the shitty details, but I appreciate you hanging on. I appreciate you seeing some little spark that was maybe worthy of your time, so that I had people to come back to.
To anyone else, you’re alone, but you’re not alone. You can be both at the same time. You’re alone in your specific experience, but you’re not alone in your suffering, and you’re not alone in the fight. You may not have the energy to fight. I know. It’s hard. You don’t think it’s worth it. You can’t envision a future where things will be better. You can’t muster the energy to get out of bed. It’s too much. Please hang on. If you can muster an ounce of energy, reach out to someone. Family. Friend. Acquaintance. Trusted co-worker. Teacher. Doctor. Your church.
You’re not broken. You’re sick. This disease is trying to take you down. But the disease is what needs to go; not you. You are not the disease. You can separate from this mental parasite. It takes time. It takes work. But it’s worth it.
If you don’t think you have a kind ear anywhere, call the National Suicide Prevention Lifeline at 1-800-273-8255. They are there 24/7.
Thanks for reading.