Depression and Identity Politics

I was talking with a friend the other night about self-identification, and the way diagnoses can become a huge part of how we view ourselves.  I got to thinking about how I define myself in relationship to my depression, which is an illness.

I do define myself by a number of identity traits that are or are not inherent.

So, for examples, I consider myself a Jewish person.  Jewish first, person second, not because my personhood is necessarily subordinate to my Judaism, but because my Judaism informs such a huge part of my life that it's only reasonable the adjective should come before the noun.

I am a woman, or, following on the prior paragraph, a female person.  For that matter, I'm a cisgendered female person.  Again, the vast majority of my outlook on life, the decisions I make, are based from a cisgendered female perspective.

To make certain I'm not leaving those parts of myself that are privileged unmarked, I am a white person.  At the same time, I am a person of Russian and Polish descent.  And here we see where the "person" comes first.  My whiteness defines me because it inherently defines my experience in relation to others.  My heritage does not.  It is a part of me, it does not encompass me.

I am a writer, because I am driven to write, because I write in my head, because writing is something I could not live without.  I am a person who plays bridge, a person who swing dances, because I do those things, but the world would go on turning for me were they to disappear from my life.

Which begs the question: am I a depressive, or am I person with depression?  I like to think it's the latter.  I like to think that the illness does not control so much of me that it comes before my rational, even normative--to a degree--thought process.

People with cancer are not cancerous, or "cancer people."  People with asthma generally do not define themselves as asthmatic in terms of personality, in terms of what drives them as people.  Obviously, these are not direct parallels, since, outside of brain cancer, neither of these illnesses affects the mind, and how our mind works is so often how we define ourselves as human beings.  Still, the fact remains, it is not considered healthy to define ourselves by our physical maladies, and yet it seems to be no surprise to people when persons with mental illnesses see that as a driving force for our personalities.

I argue that they are certainly part of us.  Perhaps even a significant part.  But I also argue that we, like people with MS or Lupus or Crohns, are doing our best to get along despite the presence of the disease.  It informs our personalities, it should not define them.

To wit: we are not mentally ill persons; we are people suffering from mental illnesses.

Reach Out and Touch Someone: the Effects of (In)Visibility on a Community

For the most part, response to the article I shared in lastweek's blog was positive.  Those who were upset by it mostly kept quiet, which I consider to be the high road, and appreciate.  I had some people disagree with me, which was also fine, in that I could listen to them and then move on.  I don't need the world to agree with me on my personal opinions.

I chose to write that article for a couple of reasons.  Right now, Jewish Family Services ("JFS") has paired with National Alliance for Mental Illnesses (NAMI) to do a mental health awareness campaign.  So far as I can tell, this largely involves sending out fliers that proclaim, "It's okay to talk about it."  Not that I don't appreciate the funds spent on the fliers, but visibility, especially for something with this much stigma attached, takes a little more effort than that.

The other, connected-but-not-identical reason, is that I think visibility is important in and of itself.  Regardless of my community's "push" for it, just standing up and saying, "Hey, I have this problem," allows other people with the problem to feel less alone.  More than that, it allows them to feel less broken.

So, why did I write the article?  I've talked about visibility before in this blog, and I will probably talk about it again.  As far as I'm concerned, particularly for persons with mental illness who are out in the day-to-day world, visibility is the number one issue facing mental health awareness.  As such:

I did it for the mom who contacted me and said, "Thank you," because her daughter suffers from mental illness.

I did it for the wife who called me, and thanked me, because after reading it, her husband finally opened up and talked a little bit about his depression.

I did it for the aunt who talked to me about her nephew's struggles.

I did it because mental illness, by definition, is invisible.  If I get up in the morning, and do what I am supposed to do, be that work, or chores, or my volunteer positions, I must not be depressed because depressed people don't get out of bed.  Complete, disabling depression is really the only "visible" kind.  And even there, the problem is still invisible, which is why persons who are entirely disabled by it get comments like, "You just need to try harder," or "Staying in bed isn't working for you, why don't you try something else?"

I recently read about a friend of mine's mother asking her why she was so depressed when her life was going so well.  She had no "reason" to be depressed.

My friend's nephew, who's in his teens, said, "Saying you don't understand why a person is depressed because their life is going well is like saying 'I don't know why you have asthma, there's plenty of air in here.'"

Asthma is visible.  Nobody doubts somebody is asphyxiating, or thinks someone is doing it for attention, or because they're just not thinking positively about it.  This is the same with every virus, bacterial infection or disease we can "see" in some way.

Depression, particularly depression in functional depressives, is invisible, which heightens the isolation that the disease already causes.  If you are able, if it is safe, and you are comfortable, standing up and saying, "Hey, I have this disease," takes just that little tiny bit of stigma away.  It might let one person know she is not alone.  It might let another person say aloud, "I have that, too," which might affect yet another person.  You never know.  But it might.

Oh G-d: the Intersection of Depression and Religion

Sorry about my absence last week.  This week I am acually posting something I wrote for my synagogue's newsletter.  I intend to discuss why I chose to write this and the aftermath of it in my next post.

Caveat: this post is not meant to imply in any way, shape or form that having a relationship with a higher power is necessary to better the lives of those who are depressed.  There are significant periods of time when I find it much more comforting to believe there's nothing out there, because at least then there's a reason nothing CARES that I feel like this so much of the time.

That said, to the article:

I am mentally ill.  I suffer from severe clinical depression.  Let me be clear about this: this does not mean I am sad.  This means that, when not properly medicated, I spend most if not all of my time thinking how much I would like to kill myself.  This means the desire to be dead is all I feel in those periods of time.  This means that, I can be on medication that works, but isn't quite right, and think the best I am going to feel—ever—is simply not-suicidal.  For most persons who suffer from mental illness, medication is helpful, if not an absolute necessity.  In many cases, it is the latter.

Medication for mental illness has almost as much stigma attached to it as the illnesses themselves.  People who take psychotropic drugs are weak, we "just want to feel good all the time," we "are not strong enough in our connection to G-d."  That last one is something I learned about from a friend.  Evidently, in certain sects of Christianity, taking medications for mental illness is frowned upon because if the ill person "just believed in Christ enough," they would feel the joy they do not feel.

Judaism, to its credit, does not approach treatment for mental illnesses in precisely this way.  The torah has examples of depression in figures like Saul.  Saul has periods of extreme dejection, jealousy-fueled rage at David, and otherwise irrational melancholy.  The torah tells us that David playing the harp for him helped somewhat with these emotional periods.  In the torah, David's music is the "therapy" Saul needs.  Obviously, in biblical times, the type of drugs we have today weren't even a thought.  There might have been homeopathic remedies for cuts and burns, bruises and infections, and alcohol or the like for self-medication, which is a far different thing than being properly medicated and seen to by a physician. Saul, though, didn't have the option of taking Prozac or Celexa and remembering that, oh, yeah, he was king, and things were pretty good.

From the outside looking in, it's hard not to see Saul's depression, his illness, as the reason David takes the throne instead of Jonathan.  Jonathan essentially comes from tainted blood.  Saul cannot trust in G-d enough, cannot connect to the divine enough, and therefore, David, who can, succeeds to the throne, and leads our nation, becoming a legend.  Saul's legacy is far less brilliant.  Although he is a byword for wisdom, his time as monarch is deeply overshadowed by David.  It is really no wonder persons who suffer from mental illness feel turned away by Judeo-Christian religious communities.

To make more comprehensive what I am trying to get across, telling a person who is depressed to trust in G-d, or be grateful for what G-d has given him or her, is much like telling a deaf person to just listen harder.  Helping a person who has depression (or is manic, or having a panic attack, or in crisis in any other way) to get help, however, is a way to bring him or her back to a place where s/he has the basic ability to trust in G-d, to appreciate what G-d has given to him or her, to do things with what s/he has been given in life.

I am not saying medication is right for everyone.  I am saying that a general reliance on religion has healed absolutely nobody I know who struggles with mental illness, and in many cases has made the illness worse.  I am saying that therapy of some type, or a mix of therapies, be it animal, music, art, physical, talk, medicine, or otherwise, is absolutely necessary for alleviating the worst of the symptoms of mental illness. 

We as Jews pride ourselves on taking care of our own, on tikkun olam, on our compassion.  Let us be leaders in showing compassion to those with mental illness, in helping them to get what they need, instead of judging them for their inability to be who we expect or want them to be.  Let us be leaders in caring enough to help people like me reach a place where a positive relationship with the divine is a possibility, rather than an ever out-of reach desire, another failure on our part, one more reason to leave the community.   

"It's like...": Talking About Depression Through Similes and Metaphors

As someone who was on Prozac for two years, the thing I still think of immediately upon hearing the word is the commercials they used to have, with a cartoon person under a cloud that followed her around.  I remember thinking, "Yeah...no, it's not like that."

It's not that the single-person-rain cloud is a terrible metaphor, but it's really not a great one, either.  For one thing, we use that particular metaphor to refer to people who bring drama or other things we don't like to a situation, regardless of whether that person is actually mentally ill.  It's specificity, therefore, leaves much to be desired, and  more than that, it lumps those of us who are actively fighting against that "cloud" with persons who embrace it.  Another thing is, while we all might find Pigpen from "Peanuts" cute, we also all think he could go and find himself a bar of soap and some water.  In other words, when we see artistic representations where only one person is being affected by something, we tend to put the onus of dealing with it on that person without much consideration for what that means.

Obviously, metaphors and similes are contextual.  Not every one is going to apply in every situation.  But, here are a few solid and decently transferable ones.

1.  The broken arm:  I cannot take credit for this one, it comes from a friend whose brother is on the Autism spectrum.  Hir mom once told hir that if hir brother had a broken arm, nobody would expect him to pitch a baseball game with that arm.  But because nobody could SEE the Autism out front, people often expected life skills of him that were the equivalent of asking a kid in a cast to pitch that ball.

Depression is the same way.  No, you can't see it.  That doesn't make it less real than a broken arm and it certainly does not make it less debilitating or limiting.  Some people with depression CAN do everything persons without can.  Others cannot, plain and simple.  And even the ones who can?  Are struggling at least ten times as much as a person with normal brain chemistry to complete the same exact task.

2:  The minefield:  Also not mine.  I wish I could remember who I picked this up from.  Living with depression is like walking through a minefield every day, except that only the person with depression knows there are mines.  She spends all day avoiding them, and if she gets to the other side of the field, everybody acts like it's not a big deal, no accomplishment, nothing to give her a shoulder squeeze about and say, "Hey, well done."

HOWEVER, if she accidentally trigger one of those mines, it's huge and ugly, there's a good chance others get hurt and everyone blames her.  She didn't actually SET the mines, she just couldn't avoid one.  Whether she couldn't see it, or it wasn't possible to jump over, or whatever, the triggering was not intentional.  But she gets in trouble for it, all the same, when every other day, hurtling and running and desperately trying to cross that damn field, everyone takes her actions for granted.

3.  The monster:  This one is mine.  Every day I get up and I'm being attacked--think of this in physical terms.  The attacker is up to the person creating the metaphor.  Mine is amorphous and monstrous.

But I'm being attacked.  And I'm struggling against my attacker, throwing kicks and punches, screaming for help, trying all kinds of things, waving my hands.  It's not just that nobody hears me--although many people don't--it's that people hear and walk by anyway.  In my head, I'm always on a busy street, and people know what's happening, but they still walk on by.

The thing is, at the end of every day, the monster resolves itself into me.  Because, as one of my friend with depression once said, "The problem is, my brain is trying to kill me."

I agree, to a certain extent.  But really, my brain is trying to do the maximum amount of harm UNTIL it can kill me.  Which means that, yes, the monster I'm fighting?  Me, and only me.

This is a short post, because I don't want to muddle this issue, it's too important.  Verbal and visual representation of mental illness in a positive way is sorely lacking, and if I can inject just a little bit of it into the common rhetoric, I will be pleased.

To sum up: things to avoid are more broad metaphors and similes--pick something specific, like a broken arm, like a physical attack, a minefield.  Avoid metaphors and similes that are used for sadness, because sadness is different.  Use descriptive terms and EXPLAIN why the two are good comparisons.

And please, if anyone has other good metaphors/similes, leave them in the comments.

ETA:  A comment was left with the World Health Organization's video on depression.  This metaphor did not work for me, because it needed a LOT of narrative explanation, which I try to avoid, and because it's based on a dog, which is something I have positive associations with.  That said, it might work for others, so I am glad to have the resource.  Thanks, Jay!

The Honey-Do List: or, some basic DOs

I apologize for this being a week late.  My sister was doing her first half-Iron distance triathalon last week, and for those of you who aren't familiar, spectating that kind of event is an endurance test in and of itself.

In any case, as promised, the flip-side of my last blog post: or, what TO do as the friend/family member of someone suffering from severe clinical depression.  Sticking to the five number format, since it worked well last time and I like symmetry.

5.  Take care of yourself.  I'm willing to bet this seems self-evident, but only from the outside looking in.  It is incredibly easy to lose sight of self-care when being a support system for someone who is spiraling.  Self-care is a lot of things.  It is eating right, it is sleeping enough, it is physical activity, but most significantly, in this situation, it is the ability to say no, to look to others for help.

I had two friends once, and one was a depressive.  She was a self-harmer, and I'm pretty sure she had borderline personality disorder.  The other friend was someone who had never really dealt with self-harm and the threatened potential of something worse.  Both women were young at the time, and the support-friend got to the point where she was the ONLY support for the self-harming friend.

Support-friend wasn't sleeping enough, was very worn down and at one point, I asked, "When Other Friend asks you to come over or if she can stay with you, do you feel like you can say no?"

And after a long moment, she shook her head, "No."

Trying to get help while depressed is hard.  It sucks.  It often doesn't work quickly, so it seems like all the effort was pointless.  If you allow yourself to become the sole support system for someone who is depressed, that person may very well take advantage (knowingly or unknowingly) and use your support until YOU are the one whose health is suffering.

Learn to say, "No, I cannot help you right now," and to put yourself first.  Realistically, unless you are taking care of yourself, making sure that you are steady and grounded, you're not able to help us anyway, you're just creating an enabling loop.

4.  Encourage us to get help and to KEEP AT the things that are helpful.  This, obviously, ties in with the last one.  Here's the thing about depression: when we're in a depression cycle, we have neither the energy nor the mental strength to seek out aid on our own.  We don't believe it will help.  Many of us have been and been and been to professionals to no real advancement or change.

We still need it.  Not only because professionals are the best suited to know when we need to be put in a hospital and make that choice dispassionately, but because they are paid to take care of us, and therefore are an essential part of the support system.

When we're doing well, we often tell ourselves (and others), "Oh, I don't need that right now."

When we're doing well is EXACTLY when we need to be working on it.  It's when we have the best ability to do so.  Chances are, though, that we won't unless encouraged.

What's more is, we probably won't stick with it unless we see support from our friends and family.  Asking a person who is depressed what she's getting out of her therapy sessions?  An absolute no.  Saying, "Hey, I really think you're doing better at __________ since you've been in therapy,"?  Go for it.

This is the same (maybe even more so) for meds.  A lot of people seem to think psych meds are the same as say, cold meds, where once you start feeling better, you can get off of them and your body will take care of the rest.  That's not how it works.  These meds are more like something you would take for an auto-immune condition, or something else chronic.

A lot of people DO get off their meds when they start feeling better and then spiral back because the improvement stemmed from the meds fixing the problem.  Psych meds are often a lifelong deal for people with depression.  Being meds positive is a HUGE help, since there's already a stigma on mental illness and using meds for them.  Not to mention, every one of these meds comes with a barrel of possible side effects and the probability of long-term liver or kidney damage.

I avoided meds for SEVEN YEARS for lots of reasons, but definitely among them was the idea that taking them made me weak, that "now we just prescribe a pill for everything" and I didn't really need them.  I needed them.  I still need them.  And I still hate that I need them.  The last thing I need is people making me feel like I'm weak/stupid/bad for taking them.

Finally, we also need to be encouraged to build up community.  Whether this is through support groups, or hobbies where we meet other people, the more community we have, the more help YOU have when things get bad.  Community is essential.  If there's a way to help us create some, even if it's just having a few dinner parties and trying to introduce us to people you think might make good friends?  In the long run, that's going to be better for everyone involved.  You will have people to turn to for support and support for us can be diffused among a larger group of persons.

3.  Aid in good habits.  This is a little like four, but slightly different in that this is talking day-to-day behaviors.  So, for example, depression tends to breed a lot of "side effect" conditions, such as eating disorders, insomnia, agoraphobia, etc.

For example, let's say your friend's problem is agoraphobia, in the sense that she refuses to leave her hosue.  Create a standing "date night." This is important: be the one to drive, to pick the place and be ready to have to do the work of basically dragging her with you over protests. But do it.  Make sure she gets out of the house, even if it's only for an hour.

If the problem is compulsive overeating?  Do activities that don't involve food or at least involve healthy foods.

Help us to live in clean and safe environments.  Maybe this means coming over on a Saturday and making us sort out our closets with you, if you're good at that kind of thing.  Maybe this means helping us to find a cleaning company, if financially viable.

Get us to exercise.  Physical movement helps with the depression, even if we don't want to do it.  If the weather's nice, get us to take a walk around our neighborhood.  Or maybe find a yoga workout online that can be done inside, together.  Just something to get our blood flowing.

Like I said last week, do not do these things FOR us, do them WITH us.  And if you cannot get us to leave our house/help with tiny things/etc.?  Call our doctor.  Let a professional handle the situation.

2.  Listen.  Listening is hard.  It's hard to just take in a flood of "I hate my life," and not try to help, not try to make us see where there's a flaw in our "logic," but here's the thing: you can't help, not in the big picture of actually clearing up the depression, and our logic is flawed because our brain is misfiring.  No amount of arguing is going to change that.  Chances are we KNOW our logic is flawed and it doesn't matter, because we cannot emotionally feel that.

There's a comic of one person having a panic attack, and another person says, "Calm down," and then the person panicking says, "It worked!"  When put into stark relief that way, we can all see how ridiculous a comment like that is, when someone's brain is telling her to panic.  It's the same with depression.  You can tell us to "cheer up," or "think positively," or that the "past does not define the future," or that "hope exists," and you're basically just talking to yourself.  And probably making us feel like you weren't listening or you are dismissing the way we feel.

But listening to us, listening and just saying, "man, that sucks," or, "can I hug you?" or "I'm here," any of those things, it may not make it BETTER for us, but it doesn't make it worse and it does remind us that there is someone out there who cares enough to just let us be who we are, mental illness and all.

It's not fun for the person listening, believe me, I get it, I've been that person more than once.  And it feels helpless and sometimes really eye-rolly.  But to the person to whom you're listening?  It feels like, for once, someone is actually HEARING us, and we don't get a lot of that.

1.  Be persistent/annoying.  My best friend texts me every day.  Every single one.  Without fail.   And most of the time I'm kind of like "yeah, I'm here, yeah."  But on those days where I'm holding onto things with broken fingernails and the skin of my teeth?  That grounding moment is huge.  It says, "Hey, there's someone out there who would be really upset if you did what you want to do right now."

Bug us.  Sometimes, we're probably going to be dicks about it, wanting to be left alone to ruminate, let the depression marinate.  It is very seductive in that manner.  Be that third wheel.  Disrupt our date, bring pizza we didn't ask for, and a board game.

Try to do it in a way the person in question handles well.  I'm best at text and email, so that's what most of my friends do.  They'll call in a pinch, but I don't like being on the phone, so they try and avoid that.  Other people like that voice connection, or, if you're near, maybe they'd sometimes prefer actual face to face.  You have to determine what works best for you and your loved one.

I recently saw an article about how people disappear in times of grieving to "give the mourner space."  Except that, in most cases, what the mourner needs most is a community of support, rather than "space."  Depressives are the same way.  We put off vibes that we want to be left alone, and maybe some of us even really do, but we shouldn't be.  We need to have people showing they care, making sure we're responsive, and generally just pecking at us until our brain lets up and we settle into a remission phase.

What You See Might Be What You Get, But It's Not Who I Am

In the past two weeks, I have finished writing two stories, each over ten thousand words long, and edited them in order to send on to outside editors.

I have walked ten miles in two-and-a-half hours, and I have swum a mile in a flat fifty minutes.  I've biked fifteen miles.

I've taken the ice bucket challenge, donated to two charities, and volunteered for another two.  I've also been to a meeting as part of the executive board of my synagogue.

I have been on time to both my jobs every day and taken care of every piece of business that has come up, including a surprise clusterfuck with the courts that occurred twice last week.

These are some of the things I've done in the past two weeks.  In that time, I've also spent almost every waking moment reminding myself that if I kill myself, nobody is going to take care and love my two rabbits.

Hi.  My name is Leslee.  I am thirty-four.  I have a Masters and a JD.  I am licensed to practice law in two states.  I have been published three times in academic books and trade journals.  I have a black belt in taekwondo.  I finished an Olympic-length triathalon in 2013 and will be walking a half-marathon in about a month.  I have had people respond to my fiction stories, posted under a nom de plum, and tell me that those stories have helped them to deal with serious emotional traumas within their lives.  I have a dog and two rabbits.  I love to lindy hop, and have been swing dancing for fifteen years.  I played bridge against my grandparents twenty years ago, and now I play it in bridge studios.  I'm part of a Toastmasters group full of crazy-awesome people.  I love to read.  I like to bake and I like eating what I bake even more.  I've been to China and Israel and a number of other places and I want nothing more than to go to a new and different places around the world.

And I am seriously, clinically depressed.

I have been in talk therapy on and off since 1992.  I have been going consistently since 2006.  In 2007, I finally consented to being put on meds.  They worked for about six years.  I had to change them four times in that span of years.  They have not been working, despite new changes, for about six months now.

I exercise, I watch what I eat, I get the sleep I am supposed to get.  I have been trying neuro-feedback for six months.  If it was going to help, I probably would have seen a change by now.

I would like to try electro-convulsive therapy (ECT), and my therapist agrees it's probably my best option at this point, but it is $300 - $800 a treatment, and you start at two treatments a week.  I could MAYBE afford one a month.

Lately, I've talked a few times on Facebook or at a Toastmasters meeting about how I "pass" as mentally healthy.  About how that means most people do not understand what I am telling them when I say I'm depressed.  And about how that makes it almost impossible to get real help or support outside of mental professionals paid to provide aid.

About how I taught myself early on--out of fear of the consequences of doing anything else--to believe that nothing in life except things that are pleasureful for me is optional.  In other words: going to work?  Not optional.  Getting writing done?  Optional unless I owe someone else a story.  Then non-optional.  Going to a board meeting?  Non-optional.  Reading a book?  Optional, with a side of only-if-you-have-finished-everything-else.

This means I am insanely efficient, and if I tell you something is going to get done, it will either get done, or, on rare occasions, I will let you know well in advance that it is not going to be possible.  This means people see me as put together, as "fine."

This means that in the eyes of the world, I am not depressed.  I am maybe, perhaps, sad.  Sadness is an emotion.  It is an important emotion.  It is not an emotion that makes death the only thing a person wants out of life.  Depression does that.

Because my depression is even more invisible than that of the person who won't get out of bed, or who cuts herself, or who can afford, time and money-wise to go to the hospital, I spend a lot of time pushing back against people's misconceptions about depression, and how it functions.  Those misconceptions have been rife in the media and popular discussion in the wake of Robin William's suicide, and I've felt more and more that I have some responsibility, because I have the ability to do so, to talk about what depression, and particularly functional depression looks like.  And how functional depression requires as much support as the kind that keeps sufferers in bed.

Since I am working on being kind to myself--an uphill process--I am setting the goal of updating this blog once a week to talk about something related to functional depression, anything.  And maybe people will read, and maybe they won't.  Maybe someone will see this, and feel less alone, and maybe nobody will.  But words are one of the few things I've always had control over, in a world where I have very little control over anything.  They are the way I have met most of the people I am closest to in the world.  So I am going to try this.  Try and see if it helps me, if it helps others, if it helps.