Alaina Mabaso's Blog

Fiction Need Not Apply.

A little perspective for all the freaks of nature known as “morning people.”

There are times in your life when you just want to listen to music all day, because oh my God, those lyrics or that tune are your life. Like when you’re in the crazy, fluttering swoop of a new love. Or when you’ve got a migraine so bad that even looking at the computer screen makes you feel about two microns from vomiting and you can’t handle anything but turning on a very, very quiet Pandora station and lying there like road kill that somehow managed to crawl inside your apartment. My mind never goes as deep into a song as when I’m in blinding pain and will do anything to escape it.

I need music when I write, but also when I do things like clean the fish tank or grill hamburgers. The constant tunes are a dinghy for my depressive brains. And sometimes my mind pauses its perpetual tangle of words thrashing across the screen, to grab onto some song lyric like an overtired toddler hoarding a Tonka: MINE.

For example, I’ve been listening nostalgically to Sublime since high school, but the song “Garden Grove” was playing yesterday, and suddenly I thought: yes. YES.

Bradley Nowell sings “there’s a reason why my soul’s unsound,” and boy does he have the definitive list, including “that smell inside the van,” “my bedsheet covered with sand,” “sitting through a shitty band,” “getting hassled by the man,” “waking up to an alarm,” “sticking needles up your arm,” “feeling depressed ev-ER-ee day,” “getting yelled at by my dad,” “saying I’m happy when I’m not,” and other grungy complaints.

Without trivializing his tragedy, I want to point out that Nowell knew what he was talking about, before he died of a heroin overdose when I was still in junior high. What strikes me this week about this litany of 90’s misery preserved forever in song? Nowell lines up depression, parental disapproval, drug use, shitty bands, and ultimately fatal lies about your overall well-being right alongside the total injustice of waking up to an alarm clock.

And I get it.

Who needs Satan when we've got alarm clocks? Image via Wikimedia Commons.

Who needs Satan when we’ve got alarm clocks? Image via Wikimedia Commons.

For every person who is waiting for me to give in, be sensible, buy a bunch of tasteful sweaters and blouses, and find a full-time job in someone else’s office, I can give you a reason why being a freelance writer is best for me. But I need to be honest. It’s not all about the writing.

After years upon years of waking up to alarm clocks, from junior high through my last “day job” in 2010, there is nothing — NOTHING —like the bliss of telling almost everyone that I’m not available for  any meetings until after 10am, going to sleep, and waking up the next morning when I’m damn well ready to.

Does that mean work goes til midnight? Fine. I will tap away at my keyboard in flagrant nightly disregard of every lecture on “sleep hygiene” I ever got from psychiatric nurses and my more well-adjusted friends.

Because no matter how many hours of sleep I get, my body feels like a badly-glued model plane in the morning, and there are gremlins in my apartment who inject my joints with sand overnight. It scrapes my insides from toes to trochanters when I get out of bed, while invisible pinpricks flare across the soles of my feet. I realize all this may be the purview of my “fibromyalgia,” that dastardly, desultory diagnosis, and that it’s not normal to feel like the twelve feet between my side of the bed and the bathroom is my own daily constitutional in Hades. I’m just trying to give all you “morning people” a little perspective.

Most importantly, if I have to stand up before 9am, I realize beyond a shadow of a doubt that absolutely everything in the world except keeping my head on the pillow is a terrible, terrible idea. It does not matter how much money I have spent or stand to earn. An early-morning trip to Norristown, New York City, or Johannesburg, a perfectly reasonable scheme the day before, is revealed for what it truly is under the horrible peachy-pink streamers of dawn: the mistake of the century compared to the utterly sensible pleasure of closing my eyes again and rolling over.

My husband seems to have an easier time of it, routinely leaving the house for work before 7am, as I did for years, without any sign of violently resenting his lot in life. I am sometimes aware of his departure, and behind my eyelids, abject sympathy bubbles alongside the relief of lying here in the dark for another hour or two.

Maybe my problems are compounded by my inability to consume the world’s morning drug of choice. Just when I need the most help, caffeine will do nothing but make my heart race, nausea churning my stomach as if the poor organ is lashed to a raft in a stormy sea. The next morning, my bladder will feel like it’s full of NASA ignition fire instead of pee.

No thanks.

So I do my best to carve out an alarm-clock free life, but there’s only so much a girl can do. A couple times each month, with a heavy heart, I set my alarm for an ungodly hour like 7:30am. This usually results in a solid spate of anxiety dreams, beginning around 5am, that the alarm has failed to go off and I have missed my meeting. I wake up at 6:30, heart pounding, and seize my phone. Slowly, slowly, I sink back into unconsciousness, and just as I re-achieve that true blessed blackness, the alarm rips it away.

All I can do is hit snooze three times at minimum, forcing my eyes to stay open for that last nine- minute stretch, and then feel on the nightstand for my glasses, and stagger to the bathroom for a cool shower with the treacly twang of Mumford and Sons turned almost migraine-low and the bathroom light OFF. Oops, can’t shampoo with my glasses still on. One wet shaky hand puts them where I know the sink is.

By the time I dry off, it’s still hard to remember why I would ever consider eating anything again. But when I have an early meeting, I choke down an egg or a piece of wheat toast, almost gagging with the effort while I wait for a train full of other people’s stingingly fresh cologne and coffee breath.

I face the world dressed nicely enough but without a trace of eye shadow or lipstick, hair pulled into a damp ponytail because giving me a choice between two extra slams of the snooze button and a stint with the hairdryer is like asking whether I’d rather eat a caramel sundae, or be bitten by a recluse spider.

After more than three years of freelancing full-time, I don’t know how the good employees of the world do it. Mornings are meant for at least an hour in bed between regaining consciousness and regaining your feet, with plenty of stretching and enough meditative diaphragmatic breaths to make a college theater professor weep.

How much can you really get done before 10am anyway, provided writers and editors who shall remain nameless haven’t been e-mailing you at 6am with pitches and questions that need attention? By the time I get to a massive homemade smoothie with yogurt and frozen blueberries, the thing might as well be lunch.

But my pitches are rolling. My deadlines are on track. My edits are smooth. The afternoon flashes by. And when illness and the umpteen pitfalls of my life flare up, I find one seed of utter contentment besides old Sublime songs or Yo-Yo Ma playing Bach yesterday, today, and tomorrow: no alarm clock.

 

Why do we eliminate cancer cells, but not depression symptoms? Talking with author Jonathan Rottenberg (part III)

Welcome to the last installment of our chat with author and psychology expert Jonathan Rottenberg. (Here are part I and part II if you missed them, or want to learn more about The Depths: The Evolutionary Origins of the Depression Epidemic, and the writer.)

Today, we look towards recovery from depression: what do we know? What don’t we know? And how can ordinary folks help? Here are excerpts of our conversation.

Adenocarcinoma cells. If you had them, wouldn't your doctor try to get rid of them all?

Adenocarcinoma cells. If you had them, wouldn’t your doctor try to get rid of them all?

Alaina Mabaso: Psychiatrists are doing a really hard job obviously, and I’m interested in the practical application of what you say in The Depths about “wellness.”

You write “the vast enterprise of depression treatment research inspired by defect models has virtually nothing to say about wellness or thriving.” So does that mean that most therapists and doctors are kind of only doing half of what their job should be, or does it mean we need a different kind of practitioner or coach to oversee the latter stages of someone’s recovery into that actual stage of well-being?

Jonathan Rottenberg: There certainly are psychotherapists…who would be interested in broader visions of wellness.

It isn’t really studied very much in any formal sense, that’s one problem, and definitely, when we’re talking about treatment and evaluating treatment, the only outcomes are whether or not the symptoms decrease, which is great, but I challenge you to find any treatment studies that look at broader measures of human functioning, let alone the squishy things like “purpose” and “meaning in life,” even just things like interpersonal functioning or the broader measures of psychosocial functioning.

Ninety-nine or 100 percent of the time, they’re just measuring how much do the symptoms go down, which I think is a good place to start; but there can be two people who have low symptoms who are very very different, and til recently, there hasn’t been a lot of interest in differentiating between low symptoms and total extirpation of [an episode of] depression. Turns out it really is very important, because people who have residual symptoms tend to have depression that comes back a lot sooner, and the longer that someone can be in an asymptomatic state, that is going to predict that the recovery is going to take, it’s going to last; [the depression] may not even come back ever.

Certainly in other branches of medicine…they’re very interested in those residual cancer cells, you know, we can’t have those; but with depression, basically the standard [in recovery] is when they say someone has responded with greater than 50 percent symptom reduction. If you were spectacularly depressed, you’re still pretty depressed… That [outcome is] not good enough.

I’m not doing psychotherapy, but I do know of psychotherapists, and there are not a lot of people who can afford to pay for psychotherapy on an ongoing basis, so that it would be useful… Insurers [are] not convinced that people should have treatment once their symptoms have substantially improved; there’s limits to how long you can see a therapist and so forth.

To me, [wellbeing] is just a far more logical goal than simply “my goal in life is to not be depressed.” That’s not going to be enough.

AM: It’s a negative statement. It’s not what you want; it’s what you don’t want.

JR: Right.

AM: I want to come back to what you said about the importance of speaking to people who are in that struggle, instead of clamming up. Some writers or filmmakers or whoever, they might address the topic of depression as you have, in this hindsight model: I was depressed; I came through it, now I’m better, and I’m going to stand up and talk about it. What about doing that in the public forum when you’re still in the mess of treating it and trying to figure it out? Not coming at it from the perspective of “I battled this, and here’s my wisdom,” but “I’m in this right now.” [I was first inspired in this line of thought by Terry Gross’s excellent Fresh Air interview with author and blogger Allie Brosh.]

JR: Well, that takes even more courage, I think, and it’s beyond a lot of people’s capabilities in the sense that when someone feels really depressed, they feel that they have nothing of value to say and…usually retreat from other people rather than approaching other people. There aren’t a lot of forums for these kinds of things.

AM: That’s what I’m finding.

JR: In my own case, I would say that I certainly have a tremendous amount of shame, and felt that I didn’t have anything to say during the depression…I think that one thing that would be terribly therapeutic is if we could change how other people typically react to depressed people.

A person thinks, “I’m socially toxic because I’m depressed,” and if just enough people in the environment affirm that by acting weird and unable to cope with the fact that their friend or acquaintance is depressed, that reinforces this view that “I’m defective, I’m not worthy,” and makes the person even less willing and able to share this part of their experience. I think that the solution to depression in the US is going to involve social change a lot more than it’s going to involve a new drug, and part of that is changing the social field around the depressed person. Not to say, hey, it’s great, join the land of depressed people, but just acknowledge that this is a part of life that almost anyone might have.

If everyone in the person’s social field said, “look, I know this is really hard…I know a lot of people with depression,”… it would make the burden of having depression a lot [lighter]. I feel like part of why people don’t get better is they get socially isolated, and they end up 100 percent in their own head.

If someone had the strength to talk about their depression while they’re still depressed, that can be great, but that’s going to be more than a lot of people can do, and enough people are going to experience really bad reactions [from] other people.

But I agree with you that often the dialogue is that the [former sufferer] is in a really safe place and they have a narrative of having overcome: that’s kind of more easily assimilated by other people [than the question of] whether or not the treatment was important.

AM: Like getting over the flu or something.

JR: Yeah… I have deep respect for severe depression, and think that it is quite scary…and I don’t think that just talking about it makes these states evaporate…but there’s a whole bunch of things that are sustaining these states, and the social environment in our culture is definitely one of the substrates for why there’s such a ridiculous amount of depression now in our country.

AM: My experience, and the experience of some people whom I know who have struggled with this, is a sort of cut-off, like, “you’re in this state, obviously I can’t talk to you, and I’m just going to let you alone until you come out of this,” which is just devastating to the person who’s already in a fragile place.

JR: I think [this topic has] a lot of potential, in spite of all the negative things that I would say about the current state of play… I’m hoping that there’ll be other things besides my book that will shake things up… I think that we haven’t yet had the kind of mobilization that the problem deserves, but I think that there will be more. I’m just not sure what it’s going to take.

AM: I’ve struggled with these problems for many years, and I think if people can see someone else talking honestly about how rotten this place really is, that really does help everyone.

JR: I admire what you’re doing, and I think it really does have good effects, so keep it up.

Thanks for reading this special interview series with The Depths author Jonathan Rottenberg, and thanks to Jon for chatting with us. You can find out more about his book at www.thedepthsbook.com, and follow him on Twitter and Facebook.

If you missed them, here are part I and part II of the interview.

Also of interest:

I apologize for this outbreak of the total jerk who lives inside my head.

It’s not always interviews, and it’s not always depression, but the conversation from readers is always interesting. Scroll down to the bottom to subscribe to the blog, or keep up on Twitter

 

Is psychiatry intellectual fraud? Talking about depression with author Jonathan Rottenberg (part II)

Welcome to part II of our chat with The Depths author Jonathan Rottenberg. (If you missed part I and want to catch up, and learn more about the book and writer, click here.)

Lock the doors: Today, we’re taking on the psychiatry establishment. Here are excerpts of our conversation.

Author Jon Rottenberg. Don't let the smile fool you. He was a psych patient. (Photo by Robert Rottenberg, via www.thedepthsbook.com.)

Author Jon Rottenberg. Don’t let the smile fool you. He was a psych patient. (Photo by Robert Rottenberg, via http://www.thedepthsbook.com.)

Alaina Mabaso: I wanted to ask you about something in your book that you touch on a little bit. I was just interested because of some of the crossover with my own experience. You mentioned your own sojourn in inpatient care at Johns Hopkins Hospital. I also was a patient at Johns Hopkins earlier this year for depression. It was not a good experience. Given your view of depression as an evolutionary mood system that we should try listening to and approaching in interdisciplinary ways, what do you think about inpatient or hospital stays for people who are depressed?

The blogger, another psych patient! Where will it end??

The blogger, another psych patient! Where will it end??

Jonathan Rottenberg: No-one normally hospitalizes anyone these days because of the difficulty of paying for it, so it really is, in our current system, an absolute last resort, and I think in my case [several years ago], it was still pretty hard to get admitted.

It was sort of an admission of defeat that all these other therapies hadn’t helped me…and the hospital offered a break… It didn’t really make a big difference for me, but was really very frightening: the idea of going to a hospital for a psychiatric problem. I think in certain cases it can be helpful; if someone’s environment is really chaotic and is interfering with any hope of stabilizing the person.

I’m just saying more generally that I would agree that mainstream psychiatry and even pretty good psychiatry isn’t that good. I just don’t think depression is like having diabetes, which is one of the main metaphors that’s typically used in really any sense, but really even in a treatment sense, where you can find out to what extent your therapy for diabetes is making a difference on the targets that you’re interested in; you can draw blood, you get different measures of people’s reactions to sugar, but you can’t do that with depression. There’s no biological test that would tell you whether or not your treatment is working, and so that’s pretty horrible [as an analogy that] breaks down as soon as you look at it.

It’s true that insults to the body can cause depression. It’s really not a shock from the evolutionary perspective either, that if you sustain a head trauma, or are sick with cancer, that that can have profound effects on your mood…but fundamentally I don’t think that’s the right approach for most people.

AM: My experience with many psychiatrists is a refusal to look at my underlying physical issues. The thing that landed me in inpatient care is I have an extremely painful chronic illness that nobody can cure; I grew very, very depressed and expressed that I wanted to die, because I was in so much pain, and I was locked up. There was this disconnect: the idea that my body being extremely painful and debilitated was not a valid reason to be feeling bad, and I needed to be locked up and put under guard.

JR: Did they address what your reactions were to the pain? Were they simply saying that having depression in this context was maladaptive and we were going to treat the depression? Did they give you any tools for thinking about the pain and reacting to it differently or anything like that?

AM: No, it was a short stay. They forced me onto a couple different drugs, and after my release, required me to see an outpatient psychiatrist who specializes in pain management. He essentially ignored the chronic pain history, and diagnosed me with a personality disorder, based partly on the fact that in his opinion, I write too much: my devotion to writing is pathological, therefore I have a mental illness. And for me, that connects with what you write in your book about part of what you think the key to overcoming depression is: a sense of purpose in your life, a sense of passion about something that you like to do. What happens when there’s this disconnect in a medical scenario, and your doctor sees something that’s your passion, and calls it a symptom of a disease?

JR: In any field, there are people who don’t know what they’re doing…psychiatry maybe more than some other fields of medicine where it’s a lot easier to quantify the outcomes… If someone’s replacing knees, I think they can grade difficult and easy cases, and look at success rates, but I think in psychiatry that’s a lot harder to do.

There are people who were trained a long time ago and didn’t keep up [or] people who are just intellectually not very strong, and they’re left in a position of incredible power. [Patients] are trained to defer to [psychiatrists’] expertise. I think that in addition to purpose, I’d argue it’s really important for people to take control of their treatment, if they’re in treatment (which I don’t think is a bad thing).

We’re better consumers of things like toasters and what airline to fly on than something as important as mental health. There’s amazingly poor data for the consumer. It’s a huge issue. If you want to buy a toaster, you can go to underwriters’ laboratories and consumer reports and find out about all these toasters you can buy, and all their features… With psychiatry or other areas of mental health, there’s very little reputational information you can get, and people can do things that are borderline unethical, and it’s very difficult to sue. But if your toaster doesn’t toast the toast, you can take it back and get your money back.

AM: When I was at Hopkins, part of the problem that landed me there was my physical illness. I have to stick to a very strict diet because of it, but the doctors and practitioners on the ward would not accommodate my diet… To me, it seemed like this extremely basic disconnect from care and human dignity, like here you’re claiming to cure my psychiatric illness, and you’re failing to even give me food that I can eat. And this is supposedly one of the top hospitals in the country, so how does this reflect on psychiatric care in general? It’s scary to me.

JR: I want my book to be more than just anti-psychiatry — I feel like that’s kind of too easy. I agree with everything you’re saying, and that a lot of that is pretty shameful and we need to do better. There are some good psychiatrists out there. There are even a lot of psychiatrists who share these same kinds of critiques.

Psychiatrists have a tough job in the sense that [they’re dealing] with the most difficult patients that haven’t gotten better on their own, or with the help of their families…I think the thing that would kill me if I were doing that job is just that there’s a certain intellectual fraudulence to it, especially when prescribing the drugs.

Therapy’s another matter; that’s a real art form. Some people are probably magicians and can have some pretty remarkable results (of course a lot of terrible ones too), but [with] drug treatment, I just think you have to tell the patient a series of white lies about what’s going on…the whole thing is shrouded in mystery: how you’ll get better and when you’ll know that there’s any benefit.

AM: When I was in Hopkins, and I was in a conference with my psychiatrists, forced onto a [psychotropic] medication that I didn’t want to take and that had disastrous consequences for me, I asked the doctor, “Why are you putting me on this medication versus another one?” And she said, “it’s more anti-cholinergic.” And I’m like, here I am, a psych patient, a layperson, and you’re just going to tell me that as the answer for why you’re making me swallow this pill?

JR: Well, they don’t know. There’s no rational basis for…prescribing a drug [based on its side-effects]… If someone is potentially dying of cancer, you would not prescribe medicine based on whether it’s more sedating or less sedating. [But psychiatrists] prescribe medicine to people who are wanting to kill themselves, [a] life-threatening problem, on the basis of things like side-effects.

It’s all just completely seat-of-the-pants type decisions, and that’s why I’m saying that I would find it hard if I were in psychiatry; that it’s kind of an intellectual fraud. It’s intellectually weak.

[There may be more progress in other types of medicine like imaging and diagnostics]…but in psychiatry it seems like it’s been pretty much a steady state, no progress, and yet more and more market share and mind share. That’s really ugly.

I had a similar experience in the system, that I was a smart person being told a bunch of stupid things by smart people who should have known better. I just felt that they weren’t sufficiently humble.

AM: that’s one way to put it.

JR: A critique of where we are now has got to be the place to start…the current dominant approach is really part of why we’re in such a bad place.

AM: I remember being on the ward, and they’re serving dinner to the patients, and my attending psychiatrist comes up, and begins to talk to me about my medication dosage, in the middle of the kitchen, in earshot of all the other patients and guards and nurses. How dehumanizing is this? You would not do that in any other field of medicine: discuss someone’s most intimate problems and medication regime in front of thirty other people you don’t know.

JR: Yeah, that’s a good point. I think that on some level, there is a view that if you’re having these sorts of problems, you’re a very compromised human being. If you’re in a psychiatric hospital, even if you’ve consented…I think it is hard to accord the same status, the same respect, that you would [otherwise get].

I think that again, in terms of really changing things, a first position is to say that people who have problems with depression are people who are just about as flawed as people who don’t have depression, and just say, ok, they’re not fundamentally flawed, they’re flawed like everyone else is flawed.

I don’t think it means that you’re superior or that you’re inferior, it means that your mood is not within bounds that you would like, and that’s important to know, and could be a real challenge to get in better bounds, but the thing is, when people are overtaken by these moods, the moods themselves cry out these kind of judgments, so it’s very easy for the culture to act on and say, well, [the patients] say that they’re no good, so they must be no good.

In part III of our interview with Jonathan Rottenberg, we discuss treating depression versus learning to thrive, and society’s role in ending the epidemic. Comment below, scroll down to the bottom of the page to subscribe, and stay tuned. Miss part I? Read it here.

Also of interest:

 It would be better if I’d never been born: Depression and parenthood

Depression and the self-help book disaster: talking with ‘The Depths’ author Jonathan Rottenberg (part I)

Look out. We’ve both seen the inside of the psych ward, we survived, and now we’re talking about it in public.

This is the start of a special three-part conversation with psychology professor Jonathan Rottenberg, Ph.D., author of The Depths: the Evolutionary Origins of the Depression Epidemic, published in 2014 by Basic Books. It’s been reviewed in outlets including The Daily Beast and The Economist, excerpted in Salon, and will appear in the New York Times Book Review next month.

Jon takes a fresh approach, arguing that the prevailing “defect model” of studying and treating depression is all wrong. We should not be trying to find and fix some fatal personal or biological flaw that leads to depression, but trying to understand the deep evolutionary roots of depression, and how low mood can be a natural signal to stop throwing ourselves against goals we can’t achieve.

He brings a lot to light, from how depression may have evolved in our animal forebears, to how people overcome depression (that’s right, you can recover, he should know), to how deep its stigma actually goes. Here are excerpts of our conversation.

I told Jon that I knew his book was good because I had a lot of questions as soon as I’d finished it.

Jonathan Rottenberg: I’m glad you had that reaction, and I’m hoping that other people will, because I think we need to shake up our ideas and our whole approach to depression, because we’re not making a whole lot of progress as far as I can tell.

Alaina Mabaso: Can you tell me a bit about the reception of your book? You’re coming out with some pretty fresh ideas, so what has been the response?

JR: I’ve been waiting for someone somewhere to throw rocks at me or call me horrible because [of] the implications of [the idea] that a lot of people are wasting their time, and are misguided with respect to depression, and I’m still waiting for [Listening to Prozac author] Peter Kramer to firebomb my house or something.

I get nice messages from people who read the book, who are like, “wow, this really changed how I think about depression, and thanks.”

AM: You mention a lot of lab studies about human moods in your book. Can studies which artificially and temporarily affect participants’ mood really tell us about the true-life experience of low mood and depression?

JR: I think that the lab literature is helpful. I think the whole discussion about the effects of low mood [has] gotten kind of silly in the sense that people seem to want or argue that low moods are unhelpful and destructive. [But] they’re fine; evolutionarily selected for, when it really does seem to be the case that there are all kinds of benefits, but also costs to these [low mood] situations. You don’t have to decide whether they’re bad or good to see that they have potential. I would submit to you that any negative emotion that you could think of, it’s sort of absurd to say that it’s bad. Is anger bad?

AM: Well, it depends on the context.

JR: Right. It’s certainly useful if you’re trying to rally people against a perceived injustice. Is it good to be chronically angry? Does it help your chances of mating and winning status? Maybe not. But for some reason, people have a much more nuanced appreciation for things like fear or anxiety: people can understand that without a capability for anxiety, you’re not going to make it out for very long, but that too much anxiety or anxiety in the wrong context can be destructive. We don’t apply that same kind of thinking to depression and sadness. That’s one thing that I was trying to do in the book.

AM: This really jives with my personal experience, and I think it also has to do with being a woman, too. If I write passionately about something that I’m angry about, some people say, why are you angry? Don’t be angry! And I say there are reasons to be angry in the world.

JR: Is the goal for there to be no depression, or no sadness? That seems like a pretty absurd goal.

I agree…that there’s too much depression, and that a lot of people who have depression have bad outcomes: not just that they’re unhappy, but [because their] health can be impaired [or they’re at risk for suicide], and I think that the goal can be to better manage these states and see where they come from…They do have some value, but that doesn’t mean that we shouldn’t encourage people to learn how to cope with these effects. And paradoxically, that being better able to accept some degree of depression or sadness is increasingly thought of as a way in the long run to be less tormented and ruled by these kinds of states. [But] it’s not the typical position. You see a lot of how-to books which are often about –

AM: “How to be happy!” “Live your best life!”

JR: Banish depression from your vocabulary; don’t think negatively, things like that.

AM: “Think positive.”

JR: A lot of those books, I think, are really misguided, and I think do a lot of harm. I think I was diplomatic in [The Depths], but my true feeling is that most of self-help is a disaster, and really it doesn’t help people much at all. Some of the problem is that most of these programs are such cartoons: they’re not a valid representation of science, they’re oversimplified. It’s not that it’s bad in principle; most of the execution of these things is disastrous and it’s really driven by commercial interests more than anything else.

AM: I want to get to what was one of my favorite lines in your book, and ask you to expand a little bit on it. I was really interested in your point about the relative silence around the reality that people do recover from depression, and they don’t go on to a life of being debilitated and broken. You write, there’s this unspoken view that depressed people “should not bother to aim so high,” as if they’re never going to climb out of these depths.

So we do hear a lot about the stigma against depression, but in my experience, it’s framed as a social stigma or a public stigma, and you seem to be saying that there is a deep stigma in the medical field as well, that doctors are actually applying to their patients. Do you want to say more about that?

JR: You mean in the sense [of] recommendations that you’re going to need therapy for the rest of your life; you’ll need medication for the rest of your life?

AM: “It’s chronic, you’re just never going to get better.”

JR: It’s clearly not true. We really don’t know very much about the 40% of [depression sufferers] who have one episode of depression… Whether it’s because these people learn things, whether it’s because these people have other countervailing strengths that become more important than whatever liability they had to depression…I think we should be studying these people a lot more, and also I think that these people have a lot to offer the 60% of [depression sufferers] who have repeated [episodes of] depression, not just for raw inspiration (although that’s nice), but [because] their experience is helpful and we don’t hear from them that often.

I think there’s a difference [between our approaches to addiction and depression], where there’s this [idea of addiction relapse] as a big issue. People who have overcome addictions are often very public in reaching out to people who are still struggling, and for whatever reason, that doesn’t seem to happen as much with depression… Maybe [sufferers] are afraid of depression returning; they’re embarrassed about it; they have a fear that they won’t get a job [or] friends.

We are still dominated by this defect model, so it’s all about, “let’s find the defect; when we find the defect, the problem is solved.” [We should be looking at it differently]: why some people, even if they have a supposed defect, have these really good outcomes. It’s not a small number. What is that about? I think that would be a good book.

In part II of our chat with Jonathan Rottenberg, we get real about the morass of modern psychiatry. In Part III, we look at the truth about recovery. Scroll down to the bottom of the page to subscribe, find Jon on Twitter or Facebook, and stay tuned.

Also of interest:

Four pearls of “wisdom” we should outlaw TODAY

Why I hate it when you say, “That’s just the depression talking.”

I apologize for this outbreak of the total jerk who lives inside my head.

That article’s finally done. What should I make for dinner?

If you call that an article.

What’s that supposed to mean?

Oh, nothing. I just thought you were a professional.

Well I am. Aren’t I?

Sure you are. If you didn’t want to read through that mess one more time before filing, that’s your business.

What do you mean, mess? That’s 800 words of solid journalism.

Sure, just like that article from last week when you forgot a preposition in one of the sentences and your editor at NewsWorks had to ask to you fix the sentence before the story could run.

That was totally not a big deal. I’m pretty sure it wasn’t a big deal. He literally said it was a great article.

Maybe when you can remember all your prepositions you could write a great article before robots start doing it for us anyway.

Screw you.

Hey if you don’t want to listen to the voice of reason that’s fine.

Yeah, it is.

So you admit I’m the voice of reason.

That’s not what I meant.

You’re not on TV or the radio.

What the fuck does that have to do with anything?

I’m just saying that your colleagues are getting great regional media exposure while you’re writing essays and local news. It’s not like they’re older or better educated than you are. YOU’RE not breaking stories on NPR. What’s wrong with you?

Just because I like writing better than other kinds of media-gathering doesn’t make me a failure.

So you like listening to the radio and hearing your friends?

Yeah. They’re good reporters and I admire them.

And there’s NO part of you that wonders why you’re constantly stuck in hyper-local coverage?

Shut up.

Geez! Touchy, touchy. I’m sure you’re really good. In your own little way.

Dammit, I’ve done a lot of HuffPost Live segments, a G-Town Radio show, and in August I’m doing a WHYY radio interview about a story I wrote.

Other freelance writers are regularly working for national outlets.

So what? It’s not like they pay any better than local outlets anymore.

Sure, settle for steady pay over a shot at being Zerlina Maxwell.

I could be like Zerlina Maxwell.

How many blog subscribers do you even have? Like, less than two thousand, after FIVE YEARS of weekly toil? Whoop de doo. If you were any good you’d have a book deal by now and you’d be on Fresh Air with Terry Gross making people laugh and cry. You know who’s never, ever calling you? The producers of The Daily Show.

I don’t care that I’m not famous. I like my regular readers and I have fun.

Your friends are publishing novels and memoirs and writing for the New York Times. They’re smarter and harder-working than you are.

Good for them.

Yeah, tell it to all 270 of your Twitter followers. Way to win the internet.

Why can’t I ever just finish a single goddamn story in peace?

Oh come on, you know you’d be nothing without me. I keep you SHARP.

Do you realize I have an illness that hurts so stinkin’ bad it drives people to suicide? And I keep working anyway?

You’re weak.

How am I weak?

You have to take rests during the day.

Oh so lying down for an hour is a crime. This is why I freelance, so I can set my own hours. For my health.

I thought you were ambitious.

Just because I have an illness doesn’t mean I’m not ambitious. If anything, I’m MORE ambitious because I have a lot to overcome.

Ok so do you want ten “Congratulations!” balloons, or 50?

Fuck you. My friends would never talk to me that way.

Good thing I’m already inside your head then.

I don’t have time for your crap.

Yeah, you need to do the dishes and the laundry and mop the kitchen floor.

I WILL as soon as the Advil kicks in.

The sink needs scrubbing.

Yeah, it does.

You’re a rotten wife.

What?

Hm? Sorry, what?

Shut up. I am not.

You’re not what?

I am not a rotten wife.

Tell it to your best friend. Oh wait, you don’t HAVE one, you’re a wary, emotionally withdrawn workaholic.

I wonder how that happened.

You know it’s better not to trust anyone anyway.

I guess.

Oh what are we eating now? A spoon of ice cream without even closing the freezer door?

Look, I really have a lot to do tonight.

No problem. I can wait. When are you doing your meditation and PT exercises?  I’ll come back then.

Like hell you will. I need to do my diaphragmatic breaths.

Yeah, breeeeaathe into that fat tummy of yours.

Newsflash: A writer isn’t an athlete.

It’s pathetic how much time you spend writing.

You JUST said I don’t work hard enough.

When did I say that?

Like two minutes ago!

I’m trying to help you.

Oh yeah?

Yeah. I AM you, you NSAID-popping mental sloth. With a dirty sink.

Oh for God’s sake I am just going to go watch The X Files on Netflix until you shut the fuck up.

Why don’t you just admit the two of us are better together?

There is no ‘us.’

That’s what you told the psychiatrists.

Are you telling me you LIKE antidepressants?

Because I can call outpatient psych right now.

Hello?

That’s what I thought.

It fucking sucks when we can’t eat anything or get out of bed or write.

So let’s stay off the tricyclics, shall we?

And the SSRI’s.

And the SSRI’s.

Mid-90’s David Duchovny is so handsome.

Mmm-hm.

Hey. You’re married, Don Draper.

Do we need to discuss Hugh Jackman’s campfire scene in Australia? The one where he takes the water bucket –

You know you have another deadline in the morning. If you go over your notes now —

Lay off, bitch. I know.

Geez. Sorry.

No you’re not.

No I’m not.

I know.

Then shut up.

Fine.

Fine.

You are gonna write the piece, though?

 

Three things you shouldn’t say to someone with chronic illness

This is a recent MRI of my lumbar spine. Can you spot the two bad discs?

This is a recent MRI of my lumbar spine. Can you spot the two bad discs? OUCH.

When I read the story about a Danish woman with multiple sclerosis who ran 366 marathons in one year — yes, one marathon every day for 364 days, and then two marathons on the 365th day — I wanted to hurl my computer against the wall, and not just because I’m jealous of her amazing feat.

“I can choose to be, ‘Oh, tell everybody I’m not feeling so well,’ or I can tell myself, ‘No, I want to feel good and tell everybody I’m feeling good.’ It’s my choice. That’s kind of a freedom,” the runner says on CNN.

Negative Nelly alert

I think this case is an extremely unusual one. Most of the time, it’s just not true that wanting to feel good and telling others you feel good when you don’t feel good will free you from your illness.

I understand the need to deny or conceal your medical condition(s). I do it every day.  Some of my doctors are surprised that I work instead of claiming disability for a slew of major health problems. But I love my work, and on most days, I find that You can do it is a better internal mantra than damn I need to get in bed and rest until someone brings me dinner.

But I also need days when it’s safe to acknowledge how tough things are — the days when it’s hard to walk, or when tears hotter than the water pour down my cheeks in the shower, because it’s the only time when nobody else can see me or call me on the phone, and something just slips.

Unfortunately, that safe space can be hard to come by, because it means finding people who are willing to see the pain when they see me, without retreating into fear, pity, contempt, platitudes, or unsolicited advice. In other words, just like cutting the high fructose corn syrup is as important to your diet as eating vegetables, pinpointing the things we don’t need is as necessary as focusing on what we do need.

My unsolicited advice for you

So this is a short and potentially painful, inflammatory list of things not to say to me, a person with a chronic illness.

  • “How do you think this makes me feel?”

This should be saved for when someone healthy is behaving in a cruel, disrespectful, or irresponsible way. It should not be used when a sick person is struggling. A truly debilitating illness, including a mood or mental disorder, causes stress to everyone who loves the sufferer, and the sufferer is very aware of that, even though he or she is no saint.

There may be other people in your life who can be an appropriate ear for the legitimate stress and pain you feel when someone you love is sick, especially when that illness is a lifelong slog, not the flu or appendicitis.

The plain truth is that sometimes, I just can’t handle your stress about my illness on top of my own stress about my illness. I apologize. But it effing sucks to feel sick all the time, and I’m not the emotional reincarnation of Hercules.

  • “Have you tried the [nutritional fad] diet?”

Most of the time, I’m willing to give you a pass on this one, because you have the best intentions. But here’s the thing. If I have been diagnosed with a life-altering and lifelong illness, I’m probably under the care of medical specialists, and a proper diet is already a component of the plan to manage that illness. I appreciate your desire to help, but don’t need diet tips from every corner.

My own diet, to manage problems like migraines, fibromyalgia, and interstitial cystitis, is already restrictive enough to affect every meal. I have spent over a decade on my own mission to track what foods and beverages work for my body.

Plus, I bet you a million dollars that Häagen-Dazs isn’t in whatever diet you saw featured on the raw/gluten-free/paleo/macrobiotic/probiotic/vegan recipe book table at Whole Foods this month. And if you wanna take away my ice cream on a rock-bottom shitty day, what’s left?

So remember, I’m already on a strict diet; stick to your own diet, and zip it, unless you are very, very familiar with my illness, and I ask for your advice.

  • “You’re too young for this!”

This one is the real topper, because I hear it all the time, from friends, family, colleagues, and even doctors.

KNOCK IT OFF.

It’s hard to even list all the reasons this comment makes me feel like crap, but I’ll try.

Yes, I do have some problems that are more common in elderly people than in people just shy of their 31st birthday. But remember — just because something is true does not mean it is appropriate to blurt it out over lunch.

I understand that you’re trying to say something sympathetic and I appreciate that, but really, how is this comment helpful? All it does is remind me of how debilitated I am. Part of the struggle of chronic illness for young people is that our bodies are indeed failing us in ways they ordinarily wouldn’t at this age. (If you dread aging in a healthy body, how do you think it feels when serious pain or limited mobility sets in before age 30, when everyone else is hiking and biking and birthing one cherub after another?)

Also, you may be dead wrong when you say “you’re too young for this.” Yes, pain and debility are usually associated with aging, but in many cases, a chronic illness is a matter of our genes, not our age. If I have the illness, I have the illness, and it doesn’t wait politely to strike until after I’m eligible for Medicare.

Think of adults with attention deficit disorder, something often associated with children. When the adult ADD sufferer has trouble focusing, would you exclaim, “You’re too old for this”? No? Then don’t pass audible judgment on how an illness relates to someone’s age. It’s not comforting and it’s not a compliment.

Beyond positive thinking

This blog post may just be one long example of why I am not as good a person as the Danish marathon runner. But it’s my truth. And it’s ok if you officially do not want to hang out with me, or read my essays.

I can understand the kind of positive thinking that allows a person with multiple sclerosis to run over 26 miles a day. It’s probably similar to what drives me to meet my deadlines and satisfy clients week after week. But positive thinking without an honest assessment of what really hurts — in our bodies and in what other people say — is like a hot air balloon without a basket. It floats uselessly away with nothing to let you get onboard and no way to ground yourself when necessary.

Do you have a chronic illness, or does someone in your life struggle with this? What are the comments that help or hurt you?

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Human health vs Hobby Lobby: Keep those lady-parts in the dark where they belong

I was feeling really sick recently, but I didn’t tell anyone because it wasn’t a human health problem. It was a women’s health problem.

Many of my Christian school teachers wouldn’t have touched sex education with a ten-foot speculum. It was the perfect prelude to entering an entire society which thinks separating reproductive concerns from health care is as easy as removing Mrs. Potato Head’s plastic nose.

Pregnancy: just don’t think about it

When I was nineteen, my middle-aged male urologist answered my questions about my recently diagnosed interstitial cystitis —until I wanted to know whether the condition would complicate pregnancy or childbirth.

He chuckled and said there was really no point in asking about that right now, is there?

Maybe he brushed me off because I was young and unmarried and, in his opinion, not ready for children. Maybe he didn’t care that urinary problems and chronic pelvic pain could impact a future pregnancy — or even the choice to start a family.

Now, I know these are ludicrous reasons to ignore a patient’s concerns. But at the time, I didn’t question my doctors. Cheeks burning, I hastily ended the appointment.

The wormhole to my uterus

I remembered that doctor because the question of corporations’ right to exclude their employees’ birth control from health insurance coverage is in the news again, now that the Supreme Court has ruled that corporations can opt out of the Affordable Care Act’s contraceptives mandate on religious grounds.

A lot of responses to this controversy have popped up, including reports that Hobby Lobby, a Christian family-owned craft store involved in the suit, objects to some types of birth control but invests in companies that make abortion drugs and IUDs, the latter being one of the very contraceptive devices Hobby Lobby healthcare plans deny its employees. Another writer veers into a rant about China and its human rights abuses, the point being Hobby Lobby’s hypocrisy, buying many of its products from a country where forced abortions are rampant, while the company opposes abortion and even some kinds of birth control in the US.

Judging from the level of anger about what we’ve dubbed the “Hobby Lobby decision,” I’m guessing that a lot of people don’t realize Hobby Lobby isn’t refusing to cover all contraceptives: just the ones it believes, based on faulty knowledge of medical science, to cause the demise of embryos, rather than preventing fertilization itself. Hobby Lobby insurance policies will cover your vasectomy — and your tubal ligation.

That doesn’t make this decision any better, though.

I suspect politicians, CEOs, and bishops who want to thwart people’s access to some kinds of birth control are operating with the same mindset as my former urologist.

To them, reproductive care isn’t like pulmonary, cardiac, neurological, digestive, dermatological, or orthopedic care. It’s as if female reproductive organs exist in some kind of separate dark universe subject to others’ practical and ideological whims.

Git ‘er dead

Catholic hospitals which will let a woman die from a miscarriage gone septic rather than treat her by removing the doomed fetus are one of the most extreme examples of the toxic refusal to integrate female reproductive health with overall human health.

Corporations now trumpeting “religious freedom” to oppose Affordable Care Act provisions requiring comprehensive contraceptive coverage for employee health plans are mired in the same fallacy. Even if you ignore the fact that the decision of whether or not to become pregnant has enormous full-body health implications, these objectors are conveniently forgetting that some contraceptives, particularly the IUDs in question, treat debilitating conditions like endometriosis, Polycystic Ovarian Syndrome, or premenstrual dysphoric disorder. In other words, “birth control” isn’t always about family planning.  Welcome to modern medicine!

But because we’re talking about girl-organs, a fellow human being’s health is your “biblical” corporate objection. And just because the practical outcome at hand is the access to some forms of birth control over others (touted as a minor issue by some commentators in the why-can’t-we-just-all-get-along vein) doesn’t make this decision any less poisonous.

As many other writers have pointed out, I would like to see the courts defend a Jehovah’s Witness who denied his employees coverage for blood transfusions, or a Scientologist CEO who objects to coverage for antidepressants.

Let infants take their chances

When I tried to shop for health insurance before Obamacare, many affordable policies explicitly excluded coverage for pregnancy or maternity-related costs. As a married thirty-year-old woman in a country where a healthy birth routinely costs tens of thousands of dollars, I knew this was a preposterous excuse for insurance. These insurers probably don’t realize it’s an illusion when magicians saw women in half on stage. In real life, you can’t manage your overall health while ignoring your reproductive health.

Take the folks who are angry because the new law requires many insurance policies to cover contraceptives and maternity care. They think a system providing adequate health care for women and their babies places an unfair burden on people with penises, who should be able to buy policies from a pool that excludes women’s care. Is it worth mentioning that woman don’t become pregnant on their own? Or that adequate pre- and post-natal care prevents a host of tragic, expensive medical problems that weigh on the entire system?

Please, show me someone who doesn’t owe his life to Mom’s oh-so-problematic parts. And then continue insisting that “women’s care” is an unfair use of your resources.

Viagra ≠ the Pill

Even people on the liberal side fall into the Magical Segmented Lady trap when they point out the moral and intellectual outrage of denying women some forms of reproductive care by calling for the same insurance policies to drop coverage for the treatment of erectile dysfunction. If you don’t want your female employees to access all birth control options, the argument goes, by gum, you should prevent access to medicine for erectile dysfunction, too.

But men paying out of pocket for better, longer-lasting erections aren’t in the same boat as women who face the risks of pregnancy and motherhood without a budget or support system for proper care. This is a false equivalence that only serves to further compartmentalize human health care, instead of accepting the reality of the whole body, male or female.

Cover your eyes, this is gross

So, back to my recent sickness. My hellacious periods, suffered in silence, remind me twelve times a year that my reproductive organs don’t have the same status as the rest of my body. It feels subversive, tacky, and risky to mention that my periods make me think that God, if God exists, really doesn’t like women.

(Turns out some of the troubles are complications of interstitial cystitis. Coulda mentioned that, oh crappy urologist of my youth.)

After several days of widespread pain and what could at best be called a virulent passive death wish, the real fun starts, usually at dawn on the 28th day. Even with multiple medications and attention to physical and dietary triggers, I am often immobilized for several hours by the pain. Hours of crushing nausea are an occasional bonus, but the eight-hour migraine, more defiant and immovable than Bashar al-Assad, is unavoidable.

This is the first time I’ve ever publicly mentioned this, because one of the only ways we’re allowed to talk about menstruation is memes of female psychopaths demanding chocolate. I don’t know who these people are. I don’t eat chocolate before or during my period because caffeine increases the agony.

(All this is also worth saying here because some of the birth control options corporate insurance policies can now withhold from their employees on religious grounds include devices or medications that can treat symptoms like mine.)

So be ashamed, embarrassed, and misinformed. Mock your period as some kind of alien invasion and don’t reveal that you’re hurting. On the same principle, let your teachers and your doctors ignore your questions about sex and pregnancy. Let your culture and health care system rope those ovaries off from the rest of you. Let clerics, corporate owners, and judges you’ll never meet determine your healthcare options.

Because this is a modern free society.

And reproductive organs don’t deserve the same roster of options as all the other parts of your body.

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I have seen the price of evil, and it’s $7.99

Sometimes, you have to give something the benefit of the doubt. And sometimes, you just know.

With a parent devoted to an extremely eclectic and successful eBay store built on hundreds of items purchased at auctions and garage sales, I see a lot of odd things come and go in my parents’ house.

Antique campaign buttons. Collectible perfume bottles. Unspeakably ugly poodle figurines. A fuzzy brooch in the shape of a skunk.

Internet dating sites (that endless, insufferable pool of encounters that is fodder for every wannabe comic and essayist in America) are trying to prove that there is someone for everyone, and eBay proves that no matter what the item is, somebody somewhere in the world will pay to have it shipped to their door.

You remember that doll from The Conjuring? Of course you do, that shit was creepy as all get out. Some people say there’s a true story behind “Annabelle” in the movie, a frizzled, dirty, glassy-eyed toy that begins to walk around an apartment by itself, write cryptic messages, and eventually trash the place.

There are websites that claim to reveal the real Annabelle, an absurdly large and smiley Raggedy Ann doll from the 70’s, which “demonologists” Ed and Lorraine Warren (of Amityville Horror fame) eventually subdued after making off with it in their car.

As the august publication badassdigest.com notes, “Ed agreed to stay off the highway because there was a concern that the demon [in the Raggedy Ann] might fuck with the car.” Good thing, too, because their brakes kept failing, so Ed “sprinkled the doll with holy water” and the car starting working again.

See? Even demon Raggedy Ann knows Jesus, so why don’t you read that Jehovah’s Witness pamphlet on the bus already? Also, I went on a ski trip once, and I shit you not, the host had an entire room full of Raggedy Ann and Andy dolls, just lining the shelves and bureaus, grinning. Like Alfred Hitchcock’s birds but with red yarn hair instead of feathers.

You can bet I pitched my sleeping bag elsewhere.

The point is, clown dolls are bad news, but does my mom care? No. She goes to the auction one night, and she brings this home.

Somebody owned this.

Somebody owned this.

As faithful readers already know, I’ve been staying with my parents more than usual lately because some serious health problems have been getting me down: I have lumbar degenerative disc disease in this mad storm of interstitial cystitis and clinical depression, and last week a psychiatrist told me I have a borderline personality disorder because, in his opinion, I write too much (the note-taking, this writing-for-a-living, it’s obsessive, you see) so I’m in delicate shape overall.

But does my mother, the woman who drives me to the orthopedist and makes me blueberry smoothies and rubs my back and otherwise loves me beyond reason, try to protect me from the clear influence of evil?

No, she does not.

She buys this antique wind-up clown doll with fleshy plastic feet-hands and keeps it in the living room while she lists it on eBay, and I work a mere two or three rooms away, vulnerable and impaired by various physical and psychiatric diseases.

And yes, someone bought the doll on eBay.

Somebody saw this doll online, thought, “I need to bring that thing into my home,” paid my mom the full asking price of $7.99, plus shipping, and had that cloth-and-plastic horror mailed to their house. In (I kid you not) Salem, Massachusetts.

I don’t know whether to be overjoyed that the thing is out of the house, or to whisper a prayer for the clown’s new owner.

Because really.

I know evil when I see it.

bad clown face crop

Sleep well!

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Is this the ugliest painting in the world?

I hate to be unkind. I know what it’s like to make your way as a creative professional in this world.

But I simply have to ask.

Is this the ugliest painting in the world?

While I do not know who painted it, I have more than a cursory acquaintance with this painting. I lead a group of professional writers in Philadelphia, and we meet for lunch once a month at the food court at the Bellevue shopping center, where the painting hangs.

This shopping center is what I should call aspirational. The gilded glass doors are so heavy that they’re probably trying to weed out the weak and the sick. There’s Tiffany & Co., Ralph Lauren, and, for people who need $90 marble rolling pins, Williams Sonoma. (Alas, Richard Gere will never give me a credit card so I can go in and show them all.)

The food court is downstairs. This painting adorns the dining area, and I have been both fascinated and repelled by it for months.

I’ve been writing about the arts professionally for years. (That’s why I can’t afford to shop at Ralph Lauren.) I’ve pored over Elaine Kurtz’s absorbing, gritty, otherworldly landscapes, yawned through watercolors of daisies on chairs, fallen into lithographs by Benton Spruance, communed for hours with Violet Oakley murals, and interviewed an artist who finds trash on the street, spray-paints it gold, and then puts it back.

I am not without taste.

I don’t know if the Bellevue painting has a title, but I call it “The Pig.”

A lot of worthwhile art challenges our minds rather than simply appealing to our eyes. But “The Pig” leaves me with too many troubling questions.

The painting cries out with the artist’s incongruity. Look at the smooth, meticulous brushstrokes on the vase, evoking the dimensional play of light and shadow on its burnished coppery curve.

And then look at the crude black outline on the pig’s flattened body parts. The skinny gray sticks the pig has for legs.

What is with this flower with sharp red ribs for petals?

Why is the pig standing next to it? Is the vase on the floor or, as I infer, on a tabletop? How did the pig get onto the table? And why is it standing there, defiantly alive? Is it reflecting on the fate of its delicious brethren under the canopy of this blood-red alien flower? Why does the Bellevue want me to look into the inscrutable yet accusing eyes of a skew-snouted hairy gray pig while I eat my grilled cheese with tomato and bacon?

Did you look at this pig’s face? Its nose appears to be mounted directly on its shoulders and chest. And its flattened black eyes are practically migrating into its ears.

My God, those eyes.

Can anyone lunch comfortably under this sinister gaze?

Somewhere, an artist faced a blank canvas. And this is what that canvas became. Now, beneath Tiffany’s, Ralph Lauren, and Williams Sonoma, it waits.

It watches.

It haunts my lunches.

If you agree with me about “The Pig,” then let me know in the comments, so I can find comfort in the fact that I’m not a total philistine. And if you think I’ve been overtly cruel in writing this blog post, or you think “The Pig” is beautiful, feel free to tell me exactly what you think of me.

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Why I hate it when you say, “That’s just the depression talking.”

When you are depressed, your entire life can feel like this.

When you are depressed, your life can feel like this. No, spring is never coming. Really, it never is. Never ever ever.

“That’s just the depression talking.”

If I had a dime for every time someone has said that to me this year, I might be able to pay my out-of-pocket hospital bills off by next week.

Blog readers know that the last several months have been a little rough. A back injury keeps putting my opioid-intolerant, claustrophobic ass in the MRI tube. I did a month of physical therapy and then ended up in the ER, and then a surgical center. I’ve been knocked out twice with propofol, and treated with steroids, fentanyl, liver-sizzling doses of ibuprofen, diazepam, ketamine, gabapentin, and who knows what else the nurses shot into my IV’s when I was groggy and/or out of my mind with pain. I also tried a chiropractor and massage, and politely declined offers of marijuana, acupuncture, Reiki, and homeopathy. Just as I was realizing that my back was still in serious trouble, all the hospital bills started to arrive.

“Just hang in there.”

I’ve been depressed as long as I can remember. So, especially since my intrepid pain specialist reduced my treatment to a bottle of Valium and the statement, “you just have to hang in there,” an agonizing, expensive, months-long medical ordeal doesn’t seem like a temporary annoyance. It seems like the latest good reason to die.

According to the website of the American Foundation for Suicide Prevention‘s (AFSP) Out of Darkness Overnight campaign, over 38,000 people die by suicide every year — the fourth leading cause of death for people ages 18 – 65 in the US. Over 100 people kill themselves every day, though the number of people attempting suicide is much higher.  More men die by suicide, but more women attempt it. Over 60 percent of people who succeed in killing themselves have major depression, AFSP goes on. Depression is more common than cancer and coronary heart disease: about 15 percent of the population will suffer clinical depression at some point in their lives.

Though AFSP says depression is an extremely treatable psychiatric illness, with up to 90 percent of people who get treatment feeling better, the really scary thing is that, by AFSP’s count, 30 percent of depressed people attempt suicide, and half of those die.

That’s part of why I hate it when people say, “that’s just the depression talking.” To me, this common phrase, probably intended to help depressed people halt their pathological thought patterns, trivializes the seriousness of clinical depression.

Image via Wikimedia Commons

Image via Wikimedia Commons

Depression is an illness

Take meningococcal disease. It’s much less common than depression, with about 800-1200 Americans getting it every year, according to the National Meningococcal Association, but it can be dangerous, with a mortality rate of 10-15 percent. When a person with meningitis says his neck hurts, would you tell him, “That’s just the meningitis talking”? No? Well, the AFSP estimates that depression is fatal in 15 percent of cases, and if those patients are anything like me, they often hear, “that’s just the depression talking.”

A lot of people know what depression is really like, and a lot of people don’t. Clinical depression can make your eyeballs feel like the Hoover Dam, as you fight back tears all day. It’s a long, black, consuming, sour-molasses conviction that you’re worthless, no-one can help you with anything that matters, and that things will never change. It’s the certain knowledge that people love you because they’re deluded. The simplest choices swamp you with confusion or indifference. It’s dull headaches and a silent static roar that, if you forget to concentrate, can block out what other people are saying.

Depression is a different experience for different people. Some people lash out, some people seem sunny and social but sob every time they’re alone, some people have physical pain, and some people are immobilized by the misery. For me, depression manifests with an obsessive achievement drive, and that’s probably why no-one, not even me, had a clue anything was wrong until I was almost done high school. Who would be concerned about the straight-A student buried in extracurriculars? Today, my depression still doesn’t fit the stereotype of the person who can’t bathe or go to work. Rather, it drives me to keep working at all costs, and in that sense, it might fuel my career rather than hinder it.

Being depression’s dummy

Despite its treatability, depression is one of the most insidious conditions there is. If you have plantar fasciitis, you don’t mistake the pain in your feet for your personality. But depression affects how you feel, think, and speak. When you’re depressed, others can be annoyed or alarmed by the sad or hopeless things you say, or your apparent refusal to take their advice or turn your thinking around. They try to bust you out of your mental funk by saying, “That’s the depression talking,” as if the illness has turned you into its own ventriloquist dummy, and you can shake off that nasty puppeteer just by recognizing the problem.

Congratulations if you can face this image of depression without being immediately scared to death. Image via Wikimedia Commons.

Congratulations if you can face this image of depression without being immediately scared to death. Picture via Wikimedia Commons.

But in my experience, telling someone, “that’s just the depression talking” doesn’t work any better than saying, “that’s just the appendicitis talking” when your friend has a really, really bad stomachache. This phrase implies that the sufferer can control her symptoms, or, in other words, that she’s choosing to be sick, or choosing to let her illness “speak” when she could and should be silencing and overcoming it.

Choosing depression?

“I think you are just used to the depression and want to hold on to it,” a friend concluded recently. “Do you really want to stay depressed? Why?”

It’s hard enough to cope with depression, but when others suggest that you brought it on yourself, or chose a bad mindset, it’s devastating, and can prevent people from seeking help, for fear of being judged.

And if you’re gearing up for the comments section to tell me that getting treatment IS my responsibility, just as it would be with any other illness, you’re right, it is. I am in treatment — the treatment that is best for me right now, after years of experience with many psychologists, psychiatrists, medications, and alternative strategies.

Your voice

My therapist asked me a very perceptive question recently when I mentioned interacting with readers whose opinions are different than mine, or who insult me, or tell me I should keep quiet because they don’t like my arguments.

Deftly looking past an inherent morass of emotions, she simply asked, “How does it feel to have a voice?”

Later, it occurred to me that my writing career might not be the love affair with language that I always assumed it was. It might be something deeper that my early years often denied me: the opportunity to recognize and speak up honestly about the sad, unfair, painful, infuriating, bizarre, and hilarious things in our lives.

However I’m feeling, I have a voice.

So that may be the worst thing about opening up to someone else about how sad or hopeless or worthless I often feel, and having them answer, “That’s just the depression talking.”

Depressive feelings are still feelings

There are feelings under the ice of my heart. Bad, bad feelings. But they are still feelings.

There are feelings under the ice of my heart. Bad, bad feelings.  So bad you’re justified in leaving the room. Or the state. But they are still feelings.

I understand the value of separating your sense of yourself from the symptoms of the illness. When you’ve been depressed for a long, long time, you wonder if being miserable on the inside is simply part of your personality. People who love you want you to realize that it isn’t.

But if all people can do is point out that “the depression is talking,” they’re simultaneously personifying the illness and downplaying the feelings it causes. Just because a feeling is a clear symptom of depression doesn’t mean it isn’t real to the person experiencing it.

Depression do’s?

So how do you cope with a depressed person? After writing all this about depression don’ts, you’d think I’d have a clear answer about what works, but I haven’t found it yet. It’s probably different for everyone. And I’m starting to suspect it’s almost as hard to live with a seriously depressed person as it is to be depressed yourself.

I would say that there is an immense courage in being able to really hear what other people say, even if their state of mind is frightening. Many of my family members are good at this. “Think about how I can help and then let me know. There is no feeling you have that scares me. I can hear it all,” one wrote on a very dark night. That kind of openness, without judging or personifying the illness, is a lifeline.

Others succeed simply by saying they care about me and that they’re concerned, and asking if I have a doctor or psychologist to talk to. They don’t judge. They don’t deflect or minimize. They just tell the truth: I could use help and there’s no shame in getting it.

Anytime I admit my fight with depression in public, I worry it will cost me in a competitive field, but I also think that many others are silently struggling and would benefit from an open conversation (and sometimes I feel like career writers who have never been depressed are few and far between). I appreciate this essay by a journalist who decided to make his journey with mental illness public. He says that if every newsroom had a “mental patient,” maybe the media as a whole could help reduce the stigma of mental illness.

For anyone who has ever been depressed or loved someone who was depressed, Allie Brosh’s “Adventures in Depression” and “Depression Part Two,” from her “Hyperbole and a Half” blog (now a book) are a raw, funny, and soul-soothing read.  You can also listen to Brosh’s Fresh Air interview with Terry Gross, which helped me with the idea that it’s ok to talk about depression while you’re still in the mess of treating it.

Have you ever been depressed? What are the things that hurt or helped you?

This blog is for depressed and non-depressed readers alike. Hit the bottom of the page to subscribe. 

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