The Head Shrinker: Finding the Right Therapist, When and How

This may be the most true thing I say in this blog, ever: finding the right therapist is a gigantic pain in the ass, and it sucks.  However, while I've known a few remitting-relapsing depressives who are ridiculously high-functioning and who didn't feel the need for therapy, most depressives need it.

Truly, I feel like MOST people could use at least a little therapy.  It helps with self-awareness, which in turn aids how we treat and deal with other people.  But depressives?  Definitely.

As such, a few rules for finding the right therapist:

1. Do it when you're not depressed.  This is huge.  And not always possible.  But IF it is, if you can start looking at a time when you have the mental resources and the drive to do so, do it.  When you're depressed there's almost no way you will find the energy to try different therapists out, find one who actually clicks.  Not to mention, figuring out sliding scales, insurance, and other such issues when depressed can be near to/completely impossible.

A sub-rule to this is: Don't quit because you're "feeling better."  You're not going to magically decide you feel up to going back when you hit another depressive episode and don't want to get out of bed in the morning.  Therapy needs to be established as a regular thing in good periods, so that it carries out through bad periods.

2.  Look for professionalism.  Yes, this seems obvious, but let me tell you: not so much.  For one thing, the top two reasons therapists of all ilk lose their licenses are either breaking confidences or, yup, that oldie but goodie, sleeping with their patients.  Get recommendations, find out what reputation the doctor you are looking at has.  If you have the slightest inkling something is wrong, get out.

Small story:  I once had a therapist who fell asleep in a session.  I gave him the benefit of the doubt.  Everyone has a bad day, right?  Then he did it a second time.  I never returned.  Professionalism in therapy means that person is paying complete attention to you.  Make sure you feel that way.  If you don't, move on.

3.  Your therapist should be friendly, but not your friend.  Yes, you should be able to call your therapist in an emergency.  She should not, however, be the first person you think about calling no matter what happens.  What is more, she's not there to just support your feelings.  If you're being out of line or doing something stupid?  You want her to call you on that.  You WANT her to be that objective third-person view on your life, because without that, there's no way for YOU to learn things from her, and in turn, from yourself.

A corollary to this: your therapist should be able to say, "Hey, you need to put yourself in the hospital," and to press the issue if she feels it is necessary.

4.  There are a billion and five kinds of therapy, find the one that's going to work for you.  Talk therapy not working?  Have you tried art therapy?  Music therapy?  Cognitive behavioral therapy?  Those are the three that pop up right off the top of my head.  Any quality therapist, if you say, "Hey, I don't feel like I'm getting anywhere," will either, a) suggest a different tack to take, or b) suggest a different kind of therapy.  Listen and try new things.  You never know when you're going to hit that right one.

5.  If you feel like there are things you can't tell your therapist, you've got the wrong therapist.  I'm dead serious.  If you can't talk about that sex dream you had that's freaking you out, or something traumatic from your past, or your "guilty pleasures" with your therapist?  Find a new one.  A therapist can't help without seeing the things nobody else gets to.  That's the whole POINT of a therapist.  Feeling like you've got to hold back means you're holding yourself back from whatever your therapy goals are.  (And any decent therapist will create goals with you at the outset.  They don't have to be quantifiable, but they will be present.)

And this is huge: if at ANY point, you tell your therapist something and feel judged?  Run, don't walk.  A therapist's job is to take you as you are and help you to be the happiest and most comfortable you can be.  Tell your therapist you look at members of the same gender in a sexy way and they suggest religion?  Get the hell out.  Tell your therapist all you can do when you're at your worst is cry and watch football and they tell you you need more productive hobbies?  Pedal to the metal, my friend.  Yes, as I said above, it is a therapist's job to tell you when you might need to look at something differently, or interact with someone in a different fashion, etc.  It is NEVER their right to judge you, and if that happens?  Guess what?  You've got the wrong therapist.  Get thee a new one, anon.

Sparkle Motion, or, Just Keep Swimming: Exercise and Depression

With the exception of exercise addicts, nobody gets up in the morning and thinks, "Man, I can't wait to hit the gym."  Depressives even less so than the average person.  Which is why movement, any kind of movement, is pretty vital when it comes to handling depression.  Well, at least for me, and for a significant number of the other persons who suffer from depression I know.

Personally, I have three days to not do any kind of movement before I turn into a raging nutball.  Hormonal imbalance has nothing on three days of absolutely no working out for me.

That said, I'm too impatient and fidgety personality-wise to always do the same kind of workout.  In general, I think a lot of people need variety in their workout schedule.  If you're someone with depression, and you live in a cold place, if you can afford it, joining a gym with a wide variety of options is probably the best investment you can make in your mental health, aside from a therapist and possibly medication.

My personal workout schedule goes something like this:

Monday:  Usually swimming.  Aside from being a lot more gentle on a body that's seen its fair share of damage, swimming forces my mind to count.  Counting helps my brain slow down.  Swimming is generally a good alternative to meditation for people like me, who aren't great at consciously working to shut our brains down.  As such, swimming has a number of benefits: it's strengthening, it builds breath capacity, it's meditative, and it's exhausting, and almost always guarantees a good night's sleep for me.

Tuesday:  This usually becomes my abs-day.  Having some workout equipment at home, even if it's just a jump rope, or an exercise ball, is, in general, a good plan.  I keep both of those things, as well as an ab roller, and a hula hoop.  The hula hoop is great, because it works my abs while I zone out to an episode of Agents of Shield, or something like that, most weeks.  It allows my brain some free time, while my body works off some of the worst of my tension.

Wednesday:  I usually go walk with my sister in the winter.  In the warm months, my walks are outside, and I much prefer that, but since I can't walk outside for a significant portion of the year here, having my sister available to go pass the time on the treadmill is super helpful.  In general, if you can find a gym-buddy, it will help you to get to the gym, not only as a way to hang out, but because you're not the only person who knows you're supposed to go.  Sometimes peer pressure is a great thing.

Thursday:  Again, in the warm months, this is usually my bike ride day.  The bike KILLS me, but it's also pretty sweet, having that wind in my face, and it's a great all-over workout.  In the cold months, this might be another gym day.  About a year ago, when I was in taekwondo full time, Thursday was a tkd day.  If something programmatic like that appeals to you, that's another great option, because a) you're paying for it, and want to get the service, and b) people expect you to show up.  Also, forms are very meditative, it's a great way to slow down your brain.

Friday:  In the evenings, I go swing dancing.  Dance lessons/social dances provide fantastic cardio and when you're following, there's the plus of just letting go, of going where your lead takes you, which is meditative in its own way, as is following the beat of the music.  If you have a dance studio near you, the money to take a class, and any interest, I highly recommend this.  Not only is it good for you on several levels, it gets you out among people, which is another helpful aspect of it.

Saturday:  In the warm months I do long walks or bike rides early in the morning with Team & Training, which is an outfit that trains for endurance events.  I try to do one endurance event per year, at least.  Long-term goals, and just a little bit of that peer pressure I mentioned, help me to get through the every-day types of trainings, it might or not for you.   But any of the above options are good ones for Saturdays.

Sunday is my rest day.  You SHOULD have a rest day.  Two isn't the worst idea, either.  Your body needs the down time.  It's just that it really, really needs the activity as well.  Trust me, at first it might suck, but sooner or later you will start to realize that the irritability that comes along with depression is worse when you haven't done something in a while.  And it can be as little as jump roping for ten minutes, taking your dog for a walk around the block, or doing some yoga stretches.  Everyone's needs are different.

Our bodies, though, especially the bodies of depressed persons, need that activity.  And for the most part, our minds are perfectly willing to enact revenge when it's not engaged in.  Do your best to get up, and disallow at least that much of your mind's trickery.  Or, if it's a friend or family member struggling, be that friend who goes to the gym with her, comes over to do a workout, takes a walk, takes a dance class with her, whatever gets your loved one moving, be the person to make sure that happens.

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.   

Fur and feathers: animals and depression therapy

Today's post is going to be short.  I missed last week because things have been crazy, and this week, to be honest, I'm having a really hard week.  My meds are working, but I'm deep in circumstantial depression and while it's not as bad as the chemical, it's a very close call.

As such, I want to talk about the import of animals to the overwhelming majority of people who suffer from depression.

I am actually not one of those people who believes that animals in general have high levels of recognition that "their human" is feeling badly, and therefore they need to provide comfort.  Nor is this a highly scientific article on the benefits of pet ownership for the mentally ill.  All I want to talk about here is how I, personally, am one hundred percent certain that the positive benefits from animal ownership are often lifesavers in the case of depression and anxiety.

To be clear: I am not speaking of trained therapy animals.  I am speaking of your every day rescue.

I am alive because of my rabbits.  I am alive because they are high-maintenance, and they might not even necessarily love me, but they need me.  And that's the core issue.  Animals need us.  And for people who suffer with not feeling worthwhile or necessary, having that one being who absolutely thinks you are?  Essential.

And yes, there are other benefits.  For most people, pets make them laugh.  Laughter is hard to come by when depressed, but pets are one of the few things that can generally cause it.  If the pet is a dog, it tends to force the depressed person out of her house and to physically move, both of which are beneficial to working one's way toward a semblance of functionality.

Pets will not make everything better.  But they will, almost always, provide significant aid in a number of areas and be something to focus on at the worst of times.

The person you know who has depression--or yourself--not a dog or cat person?  Okay.  Some other options are: guinea pigs, rabbits, hamsters, rats, mice, iguanas, geckos, frogs/toads, fish, snakes, birds, even farm animals, like pigs, horses, or goats.  Obviously those last three require the ability and space to care for them, but my point is, not even this is an exhaustive list.  There is an animal for just about anyone, it's simply a matter of finding that animal.

Whether the animal works as a calming device--fish often work this way-- a comfort source, something to laugh at, something to make a person more active, or just a reason why the person has to get out of bed, pets aren't magic, but they really do come very very close.

It's Not a Happy Pill, It's an Anti-Depressant

In 2007, I went on anti-depressants.  This is notable, because I was diagnosed as needing to be on medication in 1999.

Why the eight-year hesitation?  A few things:

1.  Anti-depressants have a HUGE stigma to them.  The term "happy pills" in an of itself is an issue, it suggests that people who need--not want, NEED--to be on these kinds of medications are in fact just looking for an easy out.  It's as if we're somehow just going to our doctor instead of down the street to score some illegal substance that makes us feel better for a few hours.

To illustrate, here is a comment once directed at me by a family member.  A family member, who, by the way, is nominally in the health industry:  "Yeah, anti-depressants are great in the wake of, say, a tragedy.  I took some [when my father died] and they helped me to get through it.  But you can't live your life on a pill just to make everything easier."

In other words: stop being weak.  The rest of us are just fine without pills to help us get through the day.

2.  Anti-depressants come with side-effects.  One of the most common is significant weight gain, which isn't fun for anyone, but for a woman--and, in my case, a woman who already has societally-induced body dysmorphia--that can be devastating.

On one of them, I stopped sleeping.  On another, I was so nauseated that even basic toast wanted to come back up.

Additionally, they can have counter-indications.  I was on Prozac long enough that it started CAUSING suicidal ideation, rather than alleviating it.  They also cause long-term liver damage, which means they essentially shorten the lifespan of almost anyone on them.

To sum up: they are not fun and are terrible on your body.

3.  For me, I was terrified.  What if I went on them and they didn't work, and this was what life was like for the rest of it, a very possible seventy or more years?  More importantly, what if I went on them and they didn't work because there was nothing wrong with me other than being lazy and pessimistic and a bad person?

In the end, though, I had to try.  Because, honestly, things couldn't get worse, and the hope, however small, that they might get better was impossible to turn away from.  My medication history has been full of ups and downs.  It took several tries to find the right medication the first time, but I will never, not if I live to one million and three, forget the feeling I had when the right one--Lexapro, at that time--kicked in.

It wasn't sudden, it was slow, but there was one day when I got home from work and the gym, and wanted to do something that wasn't sleep.  I had the feeling tomorrow might be a pretty good day.  I felt like ticking a few things off my to-do list.  And I thought, "Huh, look at that.  There's a person in there."

And then I cried.  Because for the first time since I could remember, I could feel something that wasn't soul-numbing hopelessness.  Even if it was sadness that I'd waited so long to go on the meds, it was real, an emotion, not just a blanket of brain chemical malfunction.  And, as it turned out, when on meds that work, I'm actually pretty chill about a lot of things, even things that objectively suck.

Now, let me be clear: when I am on anti-depressants that work, not everything is easy.  Life is still life.  It is still stressful, and I still have to accept that I am not going to get a lot of things I want or wish for.  People can still be hurtful, and loss still occurs.

The difference is, my brain's default reaction to all of this is not, "What's the point?  Why should I bother with this anymore?" or, at the worst, "Everything and everyone would be so much better off if I just sat down with a bottle of pills and disappeared."

That's not a happy pill.  I've never taken any hardcore street drugs, but from what I have been told by people who have, it's a COMPLETELY different sensation.  What's more, it's ephemeral.  You come down from it.

Anti-depressants don't cause happiness.  They cause the brain to work the way it's supposed to.

Here's the truth: being on anti-depressants is a pain in the ass.  Forget all the stuff I mentioned above, okay?  Your body gets used to them.  And you slip back into depression.  And sometimes the best they can manage is to keep you from living in a haze of suicidal ideation.  Sometimes it takes years to find the right combo, because just having that much help makes it feel like they're working.  And, to some extent they are.

I have changed meds seven times since 2007.  Every time is a gamble.  And for years at a time, I have been willing to accept, "not actively suicidal" as "meds are working."

I'm lucky right now.  I'm on the one-two-three punch of Welbutrin, Lexapro, and Abilify and it WORKS.  It works in the way where, when I have free time, I actually want to read or write or watch some television, instead of sleep.  It works where I can do things like plan ahead: go to the grocery store with an actual list, and come home and make meals for the week.  It sounds simple.  It's not.  It's the difference between a life that is just made up of days of forcing myself out of bed and to do every little thing that has to be done until I can get back in bed, and days where my life is actually happening, and I'm an active participant in it.  And because they actually work, instead of just providing base-stabilization, it's the first time since 2011, which was the last time I was on a combo that fully worked, that I can remember who I'm like as a person underneath the depression.

Right now, my insurance is refusing to support the Abilify, which means I'm going to have to appeal and try and figure out another way if they still refuse, since it is $830/month, which is, you know, outside my ability to afford.  I'm still underemployed, and still have been for over two years.  My rabbit has an ear infection that will not go away, and my dog vomited directly where I sleep on my bed while I was dancing Friday night.  And you know what?  It's all okay.  I'll find a way to afford the drug, because I need it, and I have always figured out ways before.  My rabbit is almost nine years old and this is her first ear infection, which is a near miracle.  The puking forced me to clean my mattress, which really needed it.  And I'm in the process of interviewing for a job I might get.  If I don't, well, back to the drawing board.

I cannot emphasize enough: these drugs aren't happy pills.  They do not blind me to the things that I'd rather NOT happen in my life.  They don't give me moments of ecstasy.  They allow me to COPE and to live my life without the constant specter of suicide.

If you or someone you know is avoiding medication because of stigma or fear, I cannot stress enough that neither of those are good enough reasons to continue being miserable.  Please, please try, or get them to try, talking to a prescribing doctor.  Maybe meds aren't for you.  But maybe they are.  And maybe underneath how terrible everything is, there's a person, screaming that zie just needs a little help, just a shove in the right direction.  Get yourself, or try to help the person you love get that shove.

"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!