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(Mental Health) My Depression

Myth 150Back when I was 14 or 15, my sister ran away from home for a month and it straight-up wrecked me. We had no idea where she was or if I would ever see her again, and it was the first time we had been apart for that length of time. Growing up, we were pretty close; she protected me from the neighborhood bullies because she was a little spitfire and I told her stories and made our meals when Mom was occupied. We had often made a game of running away together, planning our escape route and the best time to steal away; but this time, she left without me and I had never seen it coming. She was one of the only people I felt I could rely on.

During that month I was in a haze. I remember being even more quiet than usual, and it felt like I was moving and thinking through cotton — slow, muffled, distant. When I got home from school, I didn’t know what to do or what I had the energy for, so I would sit on the floor and stare at the back of the couch until it was time to go to bed. Looking back through decades of experience, I can say that was the first time I ever had an episode of major depression.

Major Depressive Disorder is a mental illness that affects over 200 million people worldwide; it can strike anyone at any time, but it tends to affect women more than men and first diagnosis frequently happens between 20 – 35 years old. Common symptoms include a persistent, inescapble low mood; anhedonia, or an inability to experience pleasure — even with things that you used to love; feelings of guilt and worthlessness; insomnia; fatigue; loss of appetite. There are a number of depression disorders, besides. Atypical Depression, for example, tends to manifest earlier and sufferers will respond to good news with an increased mood, but also eat more with low moods and tend to sleep more during episodes. People with atypical depression also have a very high sensitivity to social rejection.

There’s Persistent Depressive Disorder or dysthmia, a less-severe but chronic state of depression lasting for over two years. There’s Bipolar Disorder, where a depressive state “swings” into a normal mood or manic state. There’s Post-Partum Depression, in which a woman experiences a disabling episode of low mood after giving birth. There’s Seasonal Affective Disorder, where bouts of depression happen during a particular season. All of these conditions can cause real difficulties in the lives of people who are coping with them. They affect our ability to be consistent with our work, attentive in our relationships, resilient with our setbacks, content with our lives. These mood disorders make it hard for us to maintain an even perspective about ourselves and the world around us, even with treatment.

That’s because depression is a disease that affects the brain, the one organ we rely on to interpret all the stimuli we get everywhere else. Because the brain is so complicated we’re not entirely sure how depression is caused, but we do know there are several areas of the brain that tend to be affected. Neurotransmitters — the chemicals that stimulate brain activity and give us the ability to think, feel, and make connections — tend to have a harder time working in depressed people, and some areas of the brain are different. The hippocampus, the part of the brain responsible for long-term memory and recollection, tends to be smaller in depressed people; the amygdala, a group of structures associated with base emotions like fear, sadness, and arousal, tends to be more active as well. This combination, especially in depressed people, could explain why it’s easier for us to remember past events that are associated with intensely negative emotions while we tend to forget the things that counteract the internal narrative that preserves our low self-esteem.

Because depression can be caused by either having too few neurotransmitters, or having receptors that are too sensitive or not sensitive enough to them, or an overly-aggressive reuptake system that sweeps them our of our synapses, it’s difficult to say with any clarity which treatment works best; every one of us who deals with depression has a distinct mix of physical, neurological, genetic and environmental factors. Some of us that respond well to medication might have a lot of trouble with talk therapy, while some of us who can manage quite well with lifestyle changes and behavioral therapy might suffer intense side effects with medication. For most of us, some combination of therapy and medication often does the trick — though it can be a process finding the right therapist and/or medication. No one treatment is better than any other; the best treatment for your depression is the one that makes it more manageable for you.

Depression can manifest differently depending on your age, gender, environment and cultural background, but there are no hard and fast rules. Men tend to be more irritable or have trouble controlling anger; women might become more withdrawn; young people might become more reckless or less able to concentrate. It can be really difficult for Black Americans with depression to receive proper treatment for a host of reasons — we are often expected to “fight through” emotional pain, and the cultural stigma about mental illness is still fairly strong. There is a distrust of doctors, especially psychiatrists, and there is too little value placed on openly discussing our feelings. Beyond that, the dominant culture often misreads the expression of a mental illness and either misdiagnoses it or misses the diagnosis completely. While the field is just starting to take a culturally competent approach to mental health care, it still has a long way to go.

It can be easy to dismiss depression as an “imaginary” disease simply because the factors that determine its causes, diagnosis, and treatment are so complicated and can often feel subjective. I understand how it can look from the outside that those of us within the mental health space are just stumbling around in the dark, guessing at definitions and such. But just because something isn’t well-understood doesn’t mean it isn’t real; just because our understanding about something is fuzzy doesn’t mean that thing can’t be pinpointed exactly.

I’ve been dealing with depression for my entire life, and I’ve only recently been fortunate enough to have the ability for treatment. I’ve attempted suicide twice due to my depression, and I still fight through it every day in order to live the best life I can. I know that I’m more likely to have depression because I’m the child of a schizophrenic, and the hereditary link between that mental illness and offspring is well-established. I’ve seen every one of my siblings suffer with their own issues; I know one of my nephews will need to learn how to cope with it. These are facts.
My personal experience with depression has taught me a few things about how to relate to it. All the stuff they tell you about sleep, diet and exercise? Absolutely true, with perhaps sleep being the most important. Being active really does help, especially if it gets you outdoors and in the sun for some time. I can often feel when an ’emotional trough’ is coming on, because it becomes harder to concentrate and I find myself unable to be interested in things; when this happens, I can ‘prepare’ for what’s coming by making sure I focus more on self-care than productivity. It doesn’t stop it from happening, but it becomes easier to ride out.

Depression, for me, is intensely associated with self-worth. I become paralyzed by the idea that I have nothing worthwhile to say or that I can’t say anything in a way that engages or affects other people. I feel stupid and boring and permanently, unfixably broken. It becomes too much effort to do more and more basic things, and my world shrinks steadily because so much becomes unreachable. Cooking something to eat feels like an ordeal; talking to someone to explain how you feel is impossible; doing something for the joy of it feels pointless, and doing something productive feels inconceivable.

My worst spells have all heavily featured unchecked emotional eating (candy and salty chips in alternating waves), being unable to leave my bed or couch, and an overwhelming desire to just sleep forever. Being active, sticking to my routine, finding something to stimulate different parts of my brain — that’s something other people can do. I can’t. Sometimes, even breathing feels painful and exhausting. I need some kind of stimulation, like a TV show or music, but the stimulation doesn’t bring pleasure — just a reprieve from my own thoughts.

Thankfully, I haven’t had a really bad spell in about ten years thanks to Prozac and cognitive behavioral therapy. But I know that it’s unlikely I’ll be off medication at any point in the future, and I’ll need to constantly work on myself to develop better habits and coping strategies. For many others, depression can be a more-intense but less-chronic condition. Some of us have very long cycles that enable us to be fine for years before something knocks us back into that headspace. Some of us will have to wander in the wilderness for a very long time before we find a treatment that works for us.

No matter what, it’s important to remember that depression is a real illness and those of us who cope with it must do so with significant complications. We might not be able to put energy into practices and routines that would help our brain chemistry. We might not be able to afford proper treatment or medication. We might not have a support network to rely on for the things we need. We might have cultural barriers that prevent us from seeking the help we need or getting the proper treatment. It’s a hard enough illness on its own; combined with social, economic and environmental factors it can be that much harder to deal with.

So please, if you can, be easy with the people who are dealing with depression. Recognition and encouragement are vital to shift not only our perspectives, but the perspectives of those around us as well. People with depression aren’t hopeless or crazy; more likely, we’ve just never been given the chance to get the knowledge and help we need.

This is part of a series of post for Mental Health Awareness Month. For more information about what you can do to help build awareness for this often-neglected aspect of our personal health, go to this website: http://www.mentalhealthamerica.net/may.

 
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Posted by on May 7, 2018 in mental-health, Self-Reflection

 

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(Personal) My Sister, One Year Later

Myth 150

One year ago today, my sister died. My mother, my two nephews and their father were gathered in the conference room down the hall from her room in the hospital when we got the news — even though her heart was beating and she was breathing (with help), her brain hadn’t registered any activity for long enough that the presiding physician called time of death. Everyone cried. It was the first time I had hugged my Mom since I had come out to her. It was the first time I had ever hugged either of my nephews.

I rushed to Baltimore with the small hope that I would get to see my little sister alive one more time. It had been eighteen years; we spoke on the phone sporadically, but we hadn’t seen each other since I left home. The worst thing for me, at the time, was knowing that the last time I saw my sister was when I was being disowned. Between then and last year, she gave birth to four children, tried to take care of my difficult and increasingly frail mother, had a nervous breakdown. For the longest time she had been self-medicating for mental health issues, and in the end that’s what had brought us here.

I think about Teneka every day. I think about how hard it must have been to struggle against your own brain without a support network of people who understood and accepted what she was going through, who were committed to helping her find what she needed to get better. It could have been talk therapy, or cognitive behavioral techniques, or medication. It could have been changing her lifestyle so that she had room to take the time she needed to cope with everything on her plate. It could have been a community of people willing to give her help when she needed it without asking or judgement.

Instead, she was under a system that punished her for finding any way she could to ease her pain without giving her access to the tools she needed to do so in a healthy and sustainable way. The people around her dismissed very real issues she was having and encouraged her to do the very things that would make them worse. Her own mother took whatever help she offered and said it wasn’t good enough, accused her of being selfish and lazy and untrustworthy. My sister was a good woman who needed help, someone to orient her. But there was no way she could get that.

It breaks my heart, because my sister is part of a narrative that’s been used to blame black Americans for our problems since the end of slavery. The truth is, however, much more complicated. The immediate cause of her passing — what’s on her death certificate — is not the reason she died. The real reason is that we, as a civilization, are far more interested in judgement and punishment than compassion and assistance. Instead of recognizing the very real problems Teneka suffered under, we made her feel broken for not being able to cope with them.

Her experience isn’t uncommon. There are so many black women who have to shoulder extraordinary burdens — motherhood and everything that comes with it, often totally by themselves — while being told that they are wrong in every way. Our sisters don’t look the way they should; they don’t talk the way they should; they don’t act the way they should. Their names are wrong, their hair is wrong, their clothes and makeup are wrong. They’re hoes, or they’re stuck-up; they’re too angry and too loud, too ignorant, too dark, too ugly.

Misogynoir took my sister away from me. The stigma around mental health took my sister away from me. Our social inability to address the pain felt by our most vulnerable citizens while placing them under impossible stress took my sister away from me. I’m still grieving about that, because I’m reminded of it every day.

Remember this story about two women being racially profiled at an Applebee’s?

Or this story about a black woman detained by police on the tarmac because the police were called on her for no reason?

Or this story about a black woman being mistreated at a Waffle House and the police receiving no repercussions?

What about the responses Kelis received when she detailed the abuse she received at the hands of Nas?

What about what our sisters have suffered at the hands of powerful men like Bill Cosby and R. Kelly?

These are all stories that have been in the news for the past two weeks. If I started going into the recent and not-so-recent history of mistreatment of black women, we’d be here all day. If I started going into the institutional problems that prevent our sisters from getting the mental health treatment they needed, we’d be here all week.

I don’t want anyone else to feel trapped in a private and invisible hell the way my sister was. It’s so important for me to speak up about mental health because I know first-hand that not doing so literally kills people. We have to be better about this. The lives of our women depend on it.

Dr. Amber Thornton is a licensed black American psychologist who has devoted so much of her time to addressing the stigma of mental health in our communities while also advocating for better cultural competency within the professional psychological community. Her podcast, “A Different Perspective”, has invaluable information about depression, anxiety, and the black experience.

Journalist Imade Nibokun heads up the Depressed While Black Twitter and Tumblr pages, creating an online community of folks across the diaspora who have to deal with the personal struggle of depression and the social struggle of institutional racism at the same time.

The Black Mental Health Alliance is an organization of licensed black American mental health practitioners, activists and organizers dedicated to dealing with mental health issues on a personal, professional, and institutional level.

All of these people are doing much-needed work, helping our community see the problems we face clearly while adapting perspective and solutions built by institutions with little to no insight into how these problems manifest through our shared culture and history. On the anniversary of my sister’s death, I vow to support them and their work and I ask that you please do the same. I want my sister’s legacy to be one that spurred us into action, to finally address this blind spot within our own community.

I love you so much, Teneka. I’m so sorry that we failed you; I will work hard so that we fail far fewer people like you.

 
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Posted by on April 30, 2018 in mental-health, Politics, Self-Reflection

 

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(Personal) Cracking Myself Open

Myth 150One of the earliest memories I have about my mental illness is breaking down in the middle of lunch in sixth or seventh grade. Things were not going well for me. I was a shy and awkward kid who loved reading fantasy books. I was really sensitive, so I didn’t hold up to bullying very well. And I had gotten into trouble enough that in addition to homework and everything else, I had to write a sentence “I will not…something something something.” 1000 times.

I was sitting alone, trying to think of what impossible task I should do over lunch and how I could justify putting off the others, when I just needed to put my head down. It didn’t help. Tears welled up and I let them fall. My entire body locked up. All I wanted to do was curl up tighter. Someone found me, stood me up, and asked me if I had eaten anything. Then they marched me up to the lunch line.

It felt like my entire body had fallen asleep. I didn’t have full control over the way I moved, so I just lurched around like Frankenstein’s monster. I couldn’t stop crying. There was no way I could eat, or speak, or open my mouth. When the lunch lady asked if I needed anything, all I could do was sob and shake my head and lurch back to my seat.

To this day I have no idea what to call that episode. A panic attack? A nervous breakdown? Who knows. But it happened again when my sister ran away from home, and again shortly after I dropped out of college and moved to Arkansas.

I’ve been dealing with depression and anxiety for my entire life. Most of the memories I have of my childhood are unhappy ones, where something in my brain just snapped and a response rose from within me that I still don’t understand. What’s more, I can remember similar things happening to the people around me; my father’s mind going after his divorce, retreating further into himself; my mother disappearing for hours to sleep off depression; my sister’s mood swings; the strange rumors that dogged certain neighbors. When I was growing up, our understanding of mental illness was little more than being able to identify “crazy” behavior; if someone did something “crazy” once too often, then they were branded. And there wasn’t anything they could do to shake that off.

Even now, knowing what I know about my family history and the struggles that my siblings and I face, I see that for the most part that understanding hasn’t deepened much. My sister is on medication that makes her incoherent or sleepy. My brothers still do things they don’t understand. And, now that she’s reaching the end of her life, my mother is beginning to forget things and become confused.

It’s taken me a long time to come to grips with my mental illness, to accept it and learn how to incorporate it into my self-image. But there are so many black Americans and others in the diaspora who either can’t or won’t for a constellation of reasons. Most of us simply can’t afford treatment for mental health issues, and wouldn’t know where to begin even if we could. There is a stigma, even now, around therapy and medication that makes it difficult to encourage folks to seek out. There is still this narrative that those of us with mental illnesses are just “weak” or “whining” and only need to “get your mind right” to overcome them. We know so little, but we have such strong opinions.

Talking about my personal struggle with these things is still frightening to me, even though I do it so much. But it’s important that I do. Within black circles, and geek circles, and even Buddhist circles, there is so much misinformation about mental illness and what people who deal with them are like. If being open about them can help to dispel that, then that’s what I have to do. For my family, for my friends, and for my community.

If you are dealing with a mental health issue, please know that you’re not alone. There are more of us than you know, willing and able to lend a hand. If at all possible, do what you can to lessen the stigma around these issues — especially in minority groups. There is no shame at all in having a chronic mental illness, or in seeking treatment for it. There is no shame in doing what you need to do in order to be the best person you can.

 

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(Mental Health) When Depression Strikes You

Myth 150Chronic depression is one of those things that can be very difficult to deal with, mostly because those of us who suffer from it exist in two states. When things are fine, we might think that we’ve rounded the bend and things will never be as bad as our last valley again. And then, when we find ourselves descending towards another crash, we have no idea how to stop it or make the cliff feel any less steep. I think most of us have an “out of sight, out of mind” attitude towards things that are big problems; when we’re not actively battling our depression, we prefer to forget we have it.

But the fact is that chronic depression is a disease; an invisible one, one whose symptoms might not show up for days or weeks or months, but a disease that most of us will have to cope with for a major part of our lives. When a diabetic has his glucose levels under control, the diabetes isn’t cured — it’s just managed so that the symptoms aren’t making it difficult to function.

I think it’s useful for those of us with mental health issues to think of our illnesses like that. The symptoms might not be bad enough to prevent us from functioning most of the time, but it’s still doing its thing under the surface. There are things that we can do to help ourselves manage it; taking care of ourselves can make depressive episodes less frequent and less severe. I can’t guarantee that we’ll ever be completely free of it, but we can develop a number of coping mechanisms to help.

Learning how to live with depression is a process. Sometimes it might feel like we’re making no progress at all; sometimes it can feel like we’re sliding backwards into our worst places. But it’s important to have patience with the process and with ourselves. There is nothing fundamentally broken about us; there is nothing that we can’t handle. There are just a lot of considerations we must make that most others might take for granted. This can be a gift of practice; learning how to appreciate many aspects of our life that we wouldn’t even notice otherwise.

Here are some of the things I’ve learned to do over the course of several years. You might find that different habits work better for you, and that’s fine. It’s not important to do every single thing that people recommend for you. It’s important to find your own way of managing your mood and getting to a place where you feel comfortable and capable within your own skin. Take my advice, or discard it and forge your own path. But please try. It’s worth it, I promise.

Sleep. This is single biggest piece of advice I would recommend for people dealing with mental illness: sleep well. I can’t overstate the importance of rest in helping yourself to get on a more even keel. If you don’t have a sleep routine, or you’re having issues with getting regular or quality sleep, I really do think this should be a top priority. Sleep allows us to settle our emotions and builds our ability to cope with fluctuations in mood or changes in our environment that would cause anxiety. It is one of the best things we can do to care for ourselves.

Building a good sleep habit takes time and practice. The chemical imbalance that can lead to depression also impairs sleep function, so we end up sleeping too little or too much. However, keeping a regular sleep practice is a great foundation for routine that we can use to help us weather those times. Listen to your body; notice when you start to feel tired or your brain tells you it’s time to get to bed. Notice when you’re most likely to wake up without an alarm clock. If at all possible, build your sleep time around your own circadian rhythm. If it’s not possible, determine when you need to get up and count back nine hours — start getting ready for bed at that time.

It’s not easy, and it’s not quick, but it is effective. Once you’re sleeping regularly, your body can begin the work of stabilizing itself.

Eat well. I know in a lot of situations this can be exceedingly difficult. Even for those of us in the United States, we might live in a food desert where fresh produce or lean meat might be hard to come by. Many of us simply don’t have the money or time to make our own meals. I get it. But making sure we at least eat food that gives us a good balance of proteins, fats, carbohydrates and fiber will give our body its best shot at managing itself.

If possible, eat three squares a day that includes lean protein, unsaturated fat and complex carbohydrates. Think a turkey sandwich on whole wheat bread, multigrain chips and fruit. Try to limit caffeine intake after 2 PM; we all know that caffeine plays havoc with the ability to sleep and too much of it will definitely exacerbate anxiety issues. Drink more water, and cut back on sodas and sugary drinks.

You hear this kind of advice all the time, and I know how much of a drag it can be to try and follow through. But it’s definitely important. The better fuel you give your body, the better it will be able to function. That’s the simple fact. And I know that the instant you begin to control your diet it feels like you’re swimming upstream, and we just can’t put in the effort all the time. But try. And keep trying. Notice how you feel — how you really feel — after you eat. Does the food sit heavy in your stomach? Do you feel gassy or bloated? Greasy? Light? Satisfied? Focus on the foods that make you feel good — not just emotionally, but biologically. The more you listen to your body, the more it will tell you what it needs. To be a god-damn hippie about it.

Exercise. I know, I can hear the groaning from here, but trust me — being active when you can really helps. Just going outside or getting the blood flowing helps just about every part of your body, including your brain. When you find the activity that works best for you, your brain learns how to release endorphins that tell you that you’re doing a good job. And again, pushing yourself to pay attention to your body will help you recognize how it speaks to you — how it tells you that it’s in pain, or needs food or water, or what kind of shape or mood it’s in. Learning your body is the first step to being comfortable with it, realizing and accepting its limitation, and appreciating the things you like about it.

Most people think of exercise as a slog; huffing on the street during a grueling run, or sweating through some terrible routine that you can’t begin to keep up with. But it really doesn’t have to be; it can be any activity that gets you moving and makes you happy. For me, it actually IS running. I get a wonderful high and a sense of accomplishment after putting in my miles. But for you, it might be anything from playing tennis, basketball or football to playing Dance Dance Revolution or Rock Band on your XBox. If it gets your heart rate up and your body moving, it’s fair game. Do it as regularly as you can without hurting yourself.

Therapy. This is another suggestion that takes on almost limitless forms. For you, it might be therapeutic to write your feelings down in a journal or talk to the spiritual leader of your congregation. It might be reading, walking in nature, talking to a therapist or taking medication. Whatever works for you, seek it out and do it; develop a self-care routine, arm yourself with coping mechanisms, engage with the world and community around you however you see fit.

Again, I understand how difficult this might be for some of us. We might live in places where mental health professionals are hard to find or prohibitively expensive; we might not have access to an understanding or capable support network; we might not know where to begin to develop a framework of self-care. But if you’re reading this, you probably have access to the Internet and that gives you a leg up. Research things that might help you and try them out; describe the results when you use them, and determine if it would be useful to keep doing them. Seek out communities online if you can — there are a number of websites and forums for those of us dealing with depression and anxiety. Don’t be afraid to ask for help if you need it. Try.

Sleeping regularly, eating as well as you can, doing active things you find enjoyable and engaging in a therapeutic practice are all basic things we could all do to help stabilize our mood as much as possible. Again, these are a lot easier said than done for many of us, but please — do what you can when you can. Seek out help and support where you can find it. And keep trying. What helped me most with my depression is seeing it for what it is. It allowed me to engage with it, really understand it. And by doing that, I understood myself a lot better. Self-awareness is perhaps the most powerful tool we have against our mental illness. It helps us learn how to cope with it and to live happy, full lives even while we struggle.

If you have depression, anxiety or another mental illness difficult to endure and tough to make people understand, I see you. I’m with you. I want to help. And I’m not the only one.

But the best way to get help is to help yourself. We can support you, but we can’t “fix” you. There’s nothing to be fixed. You’re a human being, wonderful and complete just as you are. You deserve to live, to be happy, to be loved. For people like you and me, it takes more work and care. But it makes the results of that work so much sweeter.

 

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(Mental Health) When Depression Strikes a Friend

Myth 150Last Monday, I posted a quick primer on what happens physically and chemically to the brain when depression strikes. On Wednesday, I talked a little bit about what that feels like for me. I wanted to state (again) that depression and other mental illnesses are incredibly varied and complex; there’s not a single cause or expression of it, and everyone’s experience and struggle with it will be different. However, I’m hoping that talking about it will give people a better idea of what it’s like to live with it.

Today I want to talk about how we can help loved ones who are depressed, especially when they’re in the middle of an episode. It’s fairly common for people living with depression to have periods where they’re managing OK and things are at some kind of baseline, then fall into an abyss when chemicals or external factors shift. Even when they’re doing everything possible to manage themselves, this can happen. It’s no one’s fault when it does — that’s just the nature of this illness.

It can be exceedingly difficult to watch someone you’re close to go through that. You can see them start to think horrible things about themselves and the world around them; to sink down into a hopelessness that causes a complete negation of who they are; to watch them say or do things to make the situation actively worse. Because we’re a social species, and because we genuinely care about these people, their despair can frequently become our own. And because most of us don’t know exactly what’s wrong, any attempts to fix it at best do nothing and at worst only pushes the person further down that pit. Helplessness becomes frustration, and frustration can become anger.

As someone with depression who’ve also dealt with a number of loved ones going through the same thing, I get it. I’ve been on both sides of this equation. I know what it’s like to be in the mental space that says I’m a terrible person living in a terrible world and nothing will ever get better. And I know what it’s like to speak with someone like that, to try to make them feel better, to feel the panic and maddening frustration when everything in my bag of tricks simply doesn’t work.

So this is as much for myself as it is for anyone else in these situations. It can be hard to remember a few things that may help us relate to someone in the grips of depression a little better. If you have your own recommendations, or would like to share your experiences, or would like to offer feedback on mine, please feel free.

First, please remember that your friend is in the grips of an illness. This is an actual disease that affects the way your loved one thinks; those thoughts can lead to words and actions that are difficult to deal with. Most of the time, all we’re going to see is what our loved ones say or do. As with most invisible diseases, that’s just the tip of the iceberg. There are a host of interrelated thoughts, experiences and body processes that lead to that result that we’re not aware of. It’s important to keep that in mind — your loved one is having trouble coping with what is happening with them, and that often leads to behavior that doesn’t make sense or can be outwardly intensely aggravating.

In times like these, I’ve found it helpful to try my best to keep in mind that this person is effectively disabled and treat them as such. We wouldn’t expect someone in a wheelchair to just grab something off the top shelf, and we wouldn’t expect someone who’s diabetic to just eat something that would send their glucose through the roof. During episodes where our coping mechanisms fail or we enter the depths of our illness, please don’t expect us to just behave normally or think differently or be something else. It’s exceedingly difficult, if not impossible.

When we talk about everything that’s gone wrong in our lives, it’s often not that we have no idea how to solve these problems (though that may certainly be the case). It’s that depression or anxiety looking for a reason to exist, latching onto anything it can find to take root and become more permanent. I don’t want to say that a depressed person complaining about their lot in life has nothing to complain about; what I am saying is that what’s going wrong feels insurmountable and unsolvable when we’re at our worst, whether it’s true or not. For us, that perception is reality. Life is fundamentally broken, and it can’t be fixed.

I think this is what lies at the fundamental disconnect between a depressed person and a loved one. There is that seemingly unbridgeable gulf between our perception and theirs. To someone in a depression, no one understands just how awful things are, how wretched and permanent. To someone watching depression from the outside, this loved one doesn’t understand just how much they are loved and have people willing to help them if they would just get up and try.

I believe the best thing we can do for our depressed brothers and sisters is to accept them as they are, in that moment. When I’m in that valley and I talk about how terrible things are, I’m not necessarily looking for a fix; I’m looking for understanding, for the comfort that comes with connection, for someone to take my hand and say “I hear you, and I know that you are suffering.”

That can require an extraordinary amount of empathy. So many of us don’t like sitting with difficult emotions, even if we’re the ones feeling them. We look for ways to stop being angry or sad or uncomfortable as quickly as possible, and because we’ve never developed the patience or compassion for ourselves to allow these emotions to exist within us when it appears in others we simply cannot tolerate it. We want THEM to stop it as quickly as possible, too.

So when a depressed loved one comes to us with their difficulty, we treat the situation like we would treat it in ourselves. How can we fix this? How can we distract from this? How do we stop this? The short answer is that we can’t. We must simply accept it, be in that difficult space, find a way to bear it, however we can.

That load is lessened so much when there is someone willing to be with us in those moments. Just hearing someone say “I know this is awful. I am here for you.” can make an unbearable, permanent situation feel like something that is “only” difficult. Hearing someone try to offer solutions to my problems can have a paradoxical alienating effect; I know that they’re only trying to help, but the attempts to offer solutions only underscores the fact that they don’t understand me. Sometimes, it forces me to admit that I don’t understand myself at those times.

Like a cold, or a bad flare-up of arthritis, or some other chronic disease, depression is not necessarily something that can be fixed. When it happens, we can only manage it as well as we can. Because it affects the way we think, speak and act, those of us in the thick of it are often unable to do what we need in order to manage it. As part of the support network, sometimes it falls to us to find ways to make that happen.

Empathy, patience and understanding are necessary for this. I understand that so many of us have that in limited supply, mainly because we’re dealing with our own issues. Taking on the suffering of someone else is not easy, even in the best of times. But whatever we can offer to someone else has a tremendous effect.

Finally, please be sure to take care of yourself. I know how difficult I was on the people around me during my worst depressions, and I know that a lot of these people burned themselves out giving and giving and giving without making sure they were OK as well. Do what you need in order to be OK; get good sleep, eat well, talk to someone about your experiences and difficulties, if you can. It’s impossible to care for someone else if you don’t care for yourself first.

Wednesday, I’ll offer advice on what we can do, as depressed people, to care for ourselves. All of this is first drafty, but I hope it’s helpful anyway. It’s important that we at least begin these types of conversations.

 
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Posted by on June 6, 2016 in mental-health, Self-Reflection

 

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(Mental Health) What The Chemicals Feel Like

Myth 150I have dealt with depression for my entire life. I suffered from it before I even knew what it was; some of my earliest memories are staring at the ground, feeling empty and sad for no reason. My first suicidal ideation happened when I was in 6th or 7th grade and before that I imagined running away from home or beating people up with such vicious and satisfying fervor that thinking back on it makes me cringe. If I wasn’t sad, I was angry, and if I wasn’t either of those I was wishing that I could be someone I wasn’t or some place that didn’t exist. Up until I was 13 or so, schoolwork was my one refuge.

The reason I say this is to give a sense of how long I’ve been living with this. Knowing what I know now, I can look back at moments that have always stuck with me and determine exactly what was going on. When bad things happened, the emotional response I had to them was borne out of a persistent and deep depression. I would either feel a knowing, exhausted acceptance (Of course this bad thing happened to me, what else would?) or a sudden and intense anger at the world. There were times where I felt too depressed to move or think, so I would simply sit and stare at the back of a couch for a few hours. Anything to pass the time without having to exist.

Over time, through high school, college and afterward, I learned to develop a vocabulary for my experience. Learning more about other people’s experiences helped me to shape my own in a more solid way. Even still, depression is as difficult to talk about as any other emotional state, perhaps more so. Everyone experiences joy in a slightly different way, but everyone has experienced joy. Trying to explain depression to someone who has never been depressed is trying to communicate something with no common frame of reference.

But here, I’ll try anyway.

For me, depressive states are marked by three things — a lack of energy; a sad and hollow feeling; and an irrational anxiety about consequences, especially social ones. I become hyper-aware of small facial expressions and vocal inflections that might indicate someone feeling negative towards me, and discard anything that might offer a counter-narrative. If someone has anything good to say about me, they’re either lying because they’re nice people who want to spare my feelings or they don’t truly know me yet.

Depression shrinks my world until I’m the only thing in it. Everything that happens contributes to the story I tell myself about how I’m a terrible and broken person, or how the world is cruel and unfair, or how the burden of being alive is simply too great to bear. I recognize that when I’m really depressed I get really narcissistic. I can’t stop thinking about myself or my lot in life. Even when I realize it’s an irrational line of thinking, I can’t help it — everything is about me.

The lack of energy is maybe the worst part. It’s like you have this bank of willpower or ability, and for most people the basic stuff doesn’t cost much of anything. Getting out of bed? That’s like, one energy point. Taking a shower? Three, maybe five, depending on how sleepy I am. Getting dressed and going outside? Well, anywhere from two to ten energy points. If you have a bank of 100 every day that you need to use until you sleep, your day is generally filled with activities that maybe use 75 of them.

But when I’m depressed, everything is so much more expensive. Waking up and having a thought costs energy, so going down the list of things I have to do is enough to drain me. Getting out of bed can cost 75 energy points; it’s all I can do at that point to shuffle to a couch, turn on the television, and lie back down. That’s it. That’s all I’ve got.

The neurotransmitters in your brain are the chemicals that help regulate your internal cycles, and when they’re unbalanced it can throw your whole energy system out of whack. Depression severely limits your energy budget, so you just don’t have a lot to spend. It can seem like a mystifying thing to most people if someone spends a week in bed, or can’t actually make a can of soup for themselves. But in those instances, just interacting with someone — telling them I’m hungry — is a Herculean effort that exhausts me enough to bring me to tears.

For a while, I went through this cycle where I would dip into a mild depression for a few days to a couple of weeks, then come out of it. When I came out of it, I felt like I could do anything. I’d make plans and set goals because I didn’t want to waste any more time, but that level of energy is not permanent. It’s like winning $500 in the lottery. You’re flush for a while, but you’re back where you started a lot sooner than you would think.

The lack of energy is often accompanied by a worsening sadness that bottoms out into this numbness where feeling anything happens at a distance. Anything that tries to shake me out of that is met with anger. I think a lot of depressed people have this reaction, too; when you try to work with me on solving the things that are wrong I am really not interested in hearing it. Anything I could do would be way too much work (because I have no energy) and probably not yield results anyway (because my brain will chemically not let me be optimistic). I’ve been in a room full of people trying to cheer me up or offer a way out of what’s going on, and I’ve batted down every platitude or piece of advice. And I’ve been part of that concerned group of friends, getting increasingly desperate, confused or angry about why my friend just won’t TRY to make things better. It’s easy to forget in that situation that just having this conversation might be taking all the energy this friend has. It’s difficult for everyone involved.

As I grew up, I knew that the way I feel sometimes is not “normal”, and that the people who stuck out their necks for me would eventually run out of patience and understanding. That made me feel worse. No one wants to be the person who drains the emotional energy out of everyone they meet, and there are a lot of times where it feels like social interactions are this out-of-body experience. The sane part of me is watching the rest simply stand there like an immovable wall while friends, family, colleagues and acquaintances try to chip away at the fog that surrounds me. Knowing that I make other people sad and worried is an awful feeling, and it burdens me further during those times when I’m least capable of carrying that weight.

I don’t mean to make this sound like being concerned or trying to help a depressed friend is something that never helps and shouldn’t be done. I am trying to explain why I’ve responded (and will respond) to those attempts in a particular way. In the depths of depression, everything gets twisted through a filter into its worst possible shape. Worse, we can see it happening in real time, but can be powerless to stop the process.

So in really bad depressions, I would vacillate between reaching out to people and pushing them away. I would have to express the way I felt to someone, anyone who would listen, but I resented any attempts to make me feel better. In those terrible days and nights, what I wanted more than anything is someone to just let me be understood, but would let me know that they loved and cared for me. At the same time, I fully understand how hard it is to sit with someone who is suffering deeply and intensely. The people who are often best equipped to help someone out of their depression are often the same people who are devastated by being in its proximity.

Symptoms of depression vary widely. Some people have physical aches or pains; others get irritable or agitated. Some withdraw into silence or isolation, and others cry, scream and throw things. We each suffer in our own ways, and each of us have learned to deal with these senseless feelings in various helpful and not-so-helpful ways. To those of us on the outside, the actions make little sense. We know, and chances are they’ll make little sense to us when we’re through that rough patch. But in the moment, it’s an inarticulate, clumsy reach for something to get us through the next hour, or minute, or several seconds. Those moments when our brain chemistry goes wrong can feel like an eternity, and the crushing weight of that can make it impossible to regain any sense of perspective.

I know this was a little rambling, but I hope it was at least a little helpful. If you would like to share your personal experience of depression, or have questions about the behaviors or feelings of others, please do so in the comments. And if you’d like to know more about what it’s like to live with depression, here are a few links:

Depression Quest — This is an interactive story game by Zoe Quinn (yes, that Zoe Quinn), and it struck me as one of the absolute truest expressions of depression ever. I…can’t play that game for long.

Depression Comix — This is a series of comics that illustrate the weird rabbit-trails of thought depressed people stumble down all the time. It can come across as a little pithy, but I can relate so much to so many of these.

Adventures in Depression — Allie Brosh of Hyperbole and a Half fame penned this two-part comic essay about her bout of severe depression, and it’s really illuminating, funny and heartbreaking.

I’ll try to have fiction posted on Friday; next week, I’ll talk about a few things that have helped me cope with my own depression and a few more things that might help friends and loved ones who want to care for a depressed person in their lives.

 
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Posted by on June 1, 2016 in mental-health, Self-Reflection

 

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(Mental Health) What Is Depression, Anyway?

Self Improvement 150On the weekend before last, I walked all night to raise money and promote visibility for suicide prevention and related issues. There were more than a thousand people with me, all dedicated to this cause because they had been touched by mental illness and the havoc it can wreak over the lives of people who cope with it and the people who form their support network. It was a sobering thing, knowing just how many people were directly affected.

Walkers wore honor beads to show their connection to suicide. Green meant you had a personal struggle or attempt. Gold meant you lost a parent; white meant you lost a child; orange meant you lost a brother or sister. Red is for losing a spouse, purple is for losing a friend or other loved one. There was a rainbow of colors over a sea of blue shirts that day, and the sheer variety of people wearing green beads really blew me back. There were old hippies, young video game nerds, intellectuals and business-people, homemakers, people of color, couples and whole packs of others. I could look at someone, see their green beads, and know that I’m not alone in what I survived. So many people from so many different walks of life also deal with depression and the suicidal ideation that can be a part of it. It was inspiring, but also surprising.

We don’t talk much about suicide or the conditions that lead to it — namely, deep depression and anxiety. I can understand why. Mental illness is something that can be very hard to wrap your brain around; one can understand it logically, or have an idea of what it’s like through metaphor. But when you’re dealing with a loved one who feels like they’re only burrowing deeper into a hole you’re trying to pull them out of, it can be exasperating, confusing and make you feel hopeless.

Why do we do that when we’re depressed? What’s actually going on when people like me are in the worst of those troughs? I wanted mainly to try and explain things on a few different levels — what physically or chemically happens to the brain; what it feels like to me personally when it does; how it looks to our support networks; and what the depressed and their loved ones can do to help manage their condition before, during and after episodes. This might take me a little while to do, and it’ll most certainly take multiple posts. I want to make sure that my information is correct and any recommendations made are helpful, but also please keep in mind that I’m not a mental health professional. I have intimate knowledge about this, but I’m not trained to deal with it any way.

Depression (or major depressive disorder, or chronic depression) is a mood disorder often characterized by deep feelings of sadness, hopelessness, numbness, loss of interest and lethargy. People within a depressive episode can appear sad or empty to the point of near-catatonia; angry or irritable; entertain irrational thoughts or worries that leads to catastrophic imaginings; be unable to sleep, or sleep too much; appear tired or “slowed down”, so that thinking and speaking are noticeably delayed; appear distant, aloof and/or unable to explain what’s going on. There are a lot of other symptoms, of course — depression isn’t a “monolith” illness, and everyone’s relationship with it will differ depending on physiological and environmental factors.

So what’s going on in the brain that depression manifests with such different symptoms? Why do some of us get really sad and still while others get agitated, angry or paranoid? Why is it so difficult to treat depression with medicine or lifestyle changes, like so many other illnesses?

That’s a difficult question to answer, simply because so little is known about the physiology of the brain and how it relates to mood. The brain is a frighteningly complex organ that is really a bundle of inter-related systems working together to do amazing things — if any one of them runs into a problem, it can cause changes that are hidden through some dependencies and rise in others. The simple fact of the matter is we can’t pinpoint to one part of the brain and say with certainty that this is the part that causes mood disorders.

What we do know is that there does seem to be a genetic component, and parents can pass depression and other mental illnesses to their children. For example, my biological mother was schizophrenic and the children of schizophrenic people are at a higher risk for chronic depression. There is also a physiological component that might take a bit to explain.

So, our moods are actually electrical and chemical messages that travel through our brain. What happens is an electrical message is sent from a neuron, travelling down the long trails called dendrites to the end of the branch. Think of it like a rural family walking down a long dirt road to put a message in a mailbox. That message can be anything from “This thing you’re touching is very hot.” to “You are getting sleepy.” That message changes from an electrical stimulus to a chemical when it reaches the mailbox, and that chemical is called a neurotransmitter.

Receptors at the end of dendrites for other neurons are specially formatted for any of the 30 (identified) neurotransmitters; when those receptors pick up the neurotransmitter, it converts the chemical message back into an electrical impulse which races along the dendrite (that dirt path), into the cell body, and then to the axon — which changes the electric impulse back into a chemical — and the whole process starts all over again. We have anywhere from 10-100 billion neurons in our brains, and they can communicate with each other in less than 1/5000 of a second. It’s amazing stuff; our brains are processing incredible amounts of information at astonishing speeds, converting electricity to chemicals and back again.

So what happens to the message once it’s been received by a neuron? Well, it’s released from the neuron that started it and floats in the synapse — the space between neurons in our brain. It’s then either taken back by the neuron that started it (that’s called reuptake) or broken down into another chemical called monoamine oxidase (MAO).

There are three neurotransmitters that have typically been focused on when it comes to depression — serotonin, dopamine and norepinephrine. Any one (or more) of the three have been shown to have unbalanced levels in people who are depressed. Basically, the chemicals that tell our brains to regulate our mood, sleep, appetite, stress and sexuality are in short supply or the brain has trouble actually knowing what to do with them.

While at first we believed that it was the level of these chemicals that were the main cause of the problem, there has been research that indicates it might be the connection between neurons in certain parts of the brain — like the amygdala, thalamus and hippocampus, all of which have been shown to be physically different in people who deal with depression. Anti-depressants target certain processes in our brains to elevate the level of these neurotransmitters and to improve the number and quality of connections in the areas of the brain associated with them. SSRIs, or selective serotonin reuptake inhibitors, basically prevent one of these neurotransmitters from being called back to its parent neuron. So there are more of them floating in the synapse, waiting to be picked up by other ones and pass along the appropriate messages. MAOIs, or monoamine oxidase inhibitors, are drugs that prevent these neurotransmitters from being broken down if they’re not doing the reuptake thing.

So, to sum up, depression can be caused by an imbalance of three neurotransmitters — serotonin, dopamine or norepinephrine. This imbalance could be caused by an overly efficient reuptake process that calls back these chemicals before the job is done; it could be caused by bad connections between synapses in certain parts of the brain; it could be caused by the brain’s inability to form these chemicals properly to begin with. Each possible medication treatment targets one aspect of this problem, and possibly only one neurotransmitter. That is why it can take some time for medication to work in the first place (because physical and chemical changes to the brain don’t happen overnight) and some time for your psychiatrist to find the right medication (because the problem might not be that your serotonin is too low, it’s that your dopamine can’t attach properly to synapse receptors).

Even though our brains have a “post office” that passes along literally billions and billions of messages between neurons every single minute, sometimes something goes wrong with the system and we lose the ability to send and receive postcards that say “Having a great time, I hope you’re doing well!” Sometimes, it’s not even something in the brain — it could be hormones that are causing different physiological responses in the body that ultimately end up affecting the brain. There are no quick or inexpensive tests to pinpoint exactly what’s going on with the chemicals in the brains and bodies of us depressive people, so medication is often our most educated guess.

There are, of course, different kinds of depression. Major Depressive Disorder is what most of us think of when we talk about depression, but there is also Persistent Depressive Disorder (where depression lasts more than two years), Bipolar Disorder, Seasonal Affective Disorder, Postpartum Depression, Psychotic Depression (which is accompanied by hallucinations, delusions and paranoia) and others. A proper diagnosis can lead a psychiatrist towards one or more medications, but most often treatment will happen on multiple fronts; while looking for a chemical solution, cognitive behavioral therapy can help us identify and manage thoughts and emotions that come from depression.

What’s important to realize is that depression is a distinct physical illness — as real as diabetes, AIDS or Parkinson’s Disease. There is a real chemical and/or physiological disorder in our brains that affect how and what we think, our levels of energy, our ability to manage conflict and stress in our lives.

During depressive episodes, our brains are going through changes that make it much more difficult to manage our moods, sleeping patterns, appetites and other things. When we’re depressed, we may literally be physically incapable of being happy, maintaining a balanced perspective, sleeping or eating as we should, or even getting out of bed. The chemicals that allow us to do that are simply not present or active within our brain.

That is what those of us who manage depression have to face. While many of us are lucky enough to have access to mental health care and responsive treatment, many more of us are unable to visit a therapist or psychologist; have no means to seek help; or are in an environment where mental illness is poorly understood, stigmatized or completely ignored. Those of us trapped within those situations often have no recourse but to suffer alone and helpless.

So many of us who have this illness recognize that there’s something wrong with us; that we can’t feel happy or motivated or interested the way most people can, or that we feel empty and hopeless even though we have no reason to. We know that our inability to do everything that might be expected of us can be a real burden on those around us, and that it can be difficult or impossible to explain just what’s happening to us. When we’re in a place where getting out of bed and just taking a shower is all that we can do today, it can be extraordinarily alienating for even the most well-meaning advice to miss the mark of our experience, to offer ideas or solutions that the depressed person is simply incapable of imagining.

It’s an awful thing to be in that place. We can often be unable to think of times when we didn’t feel this way, or imagine a future in which we won’t feel this way. This is going to sound lame, but U2’s song “Stuck in a Moment That You Can’t Get Out Of” was a revelation for me; it really captured the major problem of depression for me, that idea that this is something ugly and permanent that I will have to bear for the rest of my life.

For those of us with this illness, there are a number of things that make our manifest symptoms and internal experience unique. Specific brain chemistry, personality traits, environmental and social factors, hormonal imbalances, life experience and so many other factors contribute to how we express, cope and view depression. And I know how difficult that is to help with, but trust me — it’s not any easier for those of us trapped inside of our own heads.

On Wednesday, I’ll talk more about my personal experience with depression. But for now, here are a few links that offer further information.

All About Depression — A website that offers information and resources about what depression is, how it works and manifests, and treatment options.

What Causes Depression? — A page from the Harvard Medical School that talks about what we know (and still need to learn) about the physical and chemical roots of depression.

Antidepressants (Wikipedia) — Wikipedia, of course, has an extensive article on antidepressants and how they work chemically. What’s interesting is we still don’t know exactly WHY they work; but the data gathered over the decades prove that they do.

National Alliance on Mental Illness — NAMI is the leading organization in the United States dedicated to mental illness and improving the conversation about it within our country. They also have tremendous resources, information, and outreach.

See you folks on Wednesday. If there are any questions about depression or comments about information I’ve presented here, please let me know!

 
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Posted by on May 30, 2016 in mental-health, Self-Reflection

 

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