The Law is Not on Our Side

August 29, 2013 Miriableism, criminal justice, criminal justice system, intersectionality, law, mental illness, police, sexual assault, sexual harassment22 Comments

[Content note: sexual harassment and assault]

Many brave writers have described what happened to them when they reported gender-based threats and violence to the police. Occasionally the outcome is positive, but often nothing at all happens and often something terrible happens.

Here are two recent examples I’ve read. The first is by Heina of Skepchick:

When the officer called me in, I was shaking a bit, but spoke as clearly and calmly as possible, presenting my evidence and voicing my fears. He responded with laughter.

Taken aback by his trivialization of the situation, I asked him if he could look at my evidence. I knew who the guy was, I pleaded. Couldn’t he, as an officer of the law, do something? Take the guy to task for threatening me somehow? At least take down a report so that if something happened, there was a record? He replied with an incredulous no to all my inquiries.

Out of the blue, he asked me if my picture included my face. I said no. He asked me how I expected to attract responses with a picture that didn’t include my face. Before I could respond, he answered his own question: it was a sexy picture, was it not? Feeling shamed, I was unable to speak and merely nodded.

“Don’t worry about it, then,” he chuckled. “Go home.”

What choice did I have other than to begin to gather up my things and prepare to leave? Before I could make my exit, though, he told me that he often visits women-seeking-women for the pictures, winked at me, and expressed his hope that he would see me on there sometime. Taken aback by the lechery in his tone, I half expected him to take a swat at my ass as I walked out the door.

The second example is even more jarring and painful to read, and deserves a strong trigger warning. It was a comment by EEB on a post of Jason’s, and Stephanie reprinted it with permission:

Two male detectives arrived at my house. I stammered out a request for a female detective; it was denied. (I learned later that they violated procedure by not accommodating the request.) They made me go through what happened. I was in excruciating pain and dripping blood but they didn’t want to take me to the hospital just then, and said the hospital “wasn’t ready” anyway. So I described the rape. Then they asked if I was taking any drugs. Well, just my medication. I thought it was strange that they literally spent more time asking about my mental health history and the types of medication I took, instead of the rape, but at the time, again, I was in shock, and not thinking much.

[…]Over the next few months, I submitted to multiple, horrific “interviews” that really felt like “interrogations” as time went on. I was also dealing with a serious medical condition at the time (I almost died; my intestines ruptured, but was almost certainly not a result of the rape, just bad timing). But I still believed in the system. I still didn’t want the man who raped me on the streets. I did everything they requested, answered every invasive question (the were really focused on my mental health history!), even got on the ground and acted out the rape for them, with the head detective on top of me acting out the part of the rapist. Not only was I absolutely hysterical by the time we were done, I’m positive that aggravated my PTSD for a long time after.

And after all that, I was called in for an “interview” to discuss “a new lead in your case”. They didn’t let my rape counselor in the room–again, against the law, I found out later! For about an hour (I think; my sense of time was not that great) they were no longer even pretending to be supportive. They accused me over and over of making it up. They had very flimsy “evidence” (which I won’t go into because it’s both complicated and ridiculous) but mostly it was their “instinct”.

Because I have a mental illness. Because I was hospitalized after attempting suicide. Because I “claimed” I had been sexually assaulted in the past. Because I was crazy, and he was sure I was just looking for attention. He had a bipolar ex-wife, you see, and she made his life a living hell. He told me how he understood mentally ill women, and how we need to create drama. How we’re liars, and we crave attention.

And over and over they accused me of lying. Alone in this tiny room with two large, angry men, I was doing everything I could to keep from having a panic attack. I couldn’t respond to what they were saying; again, I think I was in shock. And they threatened me with jail time, with a felony on my record, destroying my family, public humiliation (he threatened to call the papers–something he did anyway, because, quote, “the community needs to know there was no threat to public safety”). They said I would be charged with a false report, with terrorizing the public (there was a public awareness campaign initially after my attack, though I didn’t have anything to do with it. After the rape, I did everything I could to maintain anonymity, and only told two people–beyond my family and the cops–hat I was attacked. But…I did it for attention, which was why I didn’t tell anyone? I’m just sneaky like that, I guess!). Accusations, threats, anger, pounding the table, over and over and over.

The detective looked at me. His whole demeanor changed; he tried to seem kind, avuncular. “Tell me you made the whole thing up. This whole thing will disappear. Nothing will happen to you. You can leave, if you just tell me you made it up. Tell me you made it up and you’re sorry for lying, and I’ll let you leave.” I tried to hold out–but I didn’t last long. Honestly, at that point, all I wanted in the entire world was just to get out of that room. There are very few things I wouldn’t have done, if I could only leave. So I looked at him and lied. I said, “I made the whole thing up. I’m sorry.”

Through both of these examples, we see that women who are marginalized along other axes besides gender face additional injustice–cruelty, even–by law enforcement officials. Heina’s sexual orientation was used against her both by the man she reported for threats and by the cop who was supposed to be helping her. EEB’s mental illness was used as an excuse to abuse her, accuse her of lying, and ultimately coerce her into recanting her accusation despite overwhelming physical evidence that it was true.

The more intersecting marginalizations you have, the less likely you are to be treated fairly by the police. This is, sadly, nothing new at all, and it’s not limited to sexual violence (see: Trayvon Martin, stop and frisk, queer people being arrested for being queer). So why do people still insist that 1) survivors of sexual assault have a moral duty to report it to the police, 2) if the police do not prosecute a rapist, that means that no rape occurred, and 3) if a survivor chooses not to report, then they do not deserve any accommodations from their communities, and those communities must pretend that nothing ever happened?

EEB’s story, in particular, suggests that at least some false rape accusations are not actually false rape accusations. More research is urgently needed to determine how common this is, but my fear is that it is not uncommon. This story also shows how ableist ideas about mental illness–that people with mental illnesses are just “crazy” and “delusional” people who make shit up to ruin people’s lives–prevented a survivor from seeking justice and allowed a rapist to go free.

I used to be sympathetic to the idea that people should report sexual assault to the police, but I’m becoming less and less so. While I think we have an imperative to reform this system and make it work, for now, I don’t think it’s at all unreasonable for a survivor to choose not to report. If I were advising a survivor, I’m not even sure that I would feel comfortable encouraging them to do so.

And, dudes, next time you show up demanding to know why so-and-so didn’t report if they were “really raped,” I’m going to link you to this post. Remember that feeling safe around police officers is a sign of privilege, as is the belief that they will treat you fairly.

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On Memories Of Former Homes

August 16, 2013 Miricollege, depression, home, israel, life, memory, moving, new york, northwestern, ohio, personal, travel7 Comments

The market is swarming with people on Friday afternoon. Tables covered with piles of fruits, vegetables, meat, fish, eggs, bread, and household goods beckon as their owners shout their prices into the din. Feral cats dart beneath the tables, dodging people and cars to snatch scraps of food. Shoppers haggle: “Ten shekels for this? No way. I’ll give you eight.”

If you listen closely, you’ll hear Hebrew, Arabic, Russian, English, and probably more. You’ll see men with kippas and black hats. You’ll see women, including young girls, with every inch of skin covered but their hands and faces, and women with miniskirts and crop tops. You’ll see schoolchildren shopping for their families and old men and women dragging bags of groceries on their own. There will always, at any given moment, be an old lady standing at the curb and shouting at a bus driver because the bus route has changed, and the rest of the passengers are shouting to her which bus to take instead.

More than anything, you’ll notice the heat. It beats down from the sky and rises from the pavement, seeps out of buses and cars and into your body like a poison. It’s a dry heat, which may seem like a small comfort, but it makes all the difference.

Past the market stalls and down the mountain, the Mediterranean glimmers. By this time of year it’s nearly impossible to actually swim in thanks to the jellyfish, but if you swim in the bay you’ll be fine.

The hours pass and the market starts to shut down. By the time the sun is setting, the whole city has slowed nearly to a stop: buses don’t run anymore, stores have closed, and the last few stragglers are rushing through the streets to get home. As night falls, the smell of freshly-baked challah flows out of open windows along with the prayers and songs of Shabbat.

To you, this may be unfamiliar and weird and even uncomfortable; to me, it was home.

~~~

When I was 13, I returned to Israel for the first time since my family moved away seven years earlier. That trip, at the time, meant absolutely everything to me. It was a chance to rediscover my history and heritage. It was a vacation from the boredom and bullying that made up my school days. Most of all, it was an escape from the horrible new feeling–not even just a feeling, but a way of being, really–that had seeped into every little corner of my life. Six years later, I would learn to call it depression.

Those two weeks in Israel caused mood swings the likes of which I’d never experienced before (but that would become too familiar over the following nine years). I felt ecstatic to be back in what I then considered my Real Home and full of wonder at the things I was seeing and learning. Being there caused a flood of old memories to resurface and I delighted in them.

But at the same time, I balked with increasing fear and horror at the idea of returning to my miserable American existence, which I was certain I could cure only by returning to Israel after high school. (I did not, obviously, know about antidepressants.)

Although I knew I’d miss the food and the stunning beauty and the beach and all that, what I knew I’d miss the most was just that feeling that I had there, that unmistakeable thereness.

I told my mom in tears that I was terrified of forgetting what it was like to be there, and in response she told me about a trip she took to southern Russia as a teenager, a trip that grew fuzzier in her memory over time, but that she could never truly forget. Maybe the details were gone, but the essence was not and never would be.

Somewhat comforted, I tried to capture the “thereness” in any way I could. I associated it in my mind with certain smells and songs. I kept a detailed diary. I took photos. I recorded it in poems.

Ever since, I’ve been chasing that feeling.

~~~

Summer is probably the best time of the year to be in Ohio. It’s hot and muggy as hell, but everything becomes soft and beautiful in the summer. The fields of ripening corn ripple over hills left by glaciers long ago, and the streams that wind through the woods–assuming they haven’t dried up–are perfect for dipping your feet into.

My mom and I, and later my siblings once they were told enough, would often explore the paths that lead through these woods. Many of them separated different subdivisions from each other, or they were part of school grounds or parks. One such path led to a mysterious mansion far away from any other houses; another was strewn with paintballs that my little brother eagerly collected but that my sister was for some reason terrified of.

Summer in Ohio is anything but quiet. Cicadas can keep you up at night if you’re not used to them, and early in the morning you’ll be woken up by neighbors tending to their lawns more meticulously than my family ever did. Once or twice a week we’d drop whatever we were doing because we’d hear the ice cream truck coming down the street, and that was our favorite summer sound of all. (That, and the lifeguard’s whistle when breaktime ended at the pool.)

For a good twelve years or so, that’s how all my summers felt. Nowadays they’re quite different.

~~~

More wisdom from my mom: the summer before I started college, I was dating my best friend and we were about to go off to different schools. Although I’d spent the previous summer in Israel, away from my then-boyfriend, this was the first time I’d be in an indefinitely long-distance relationship and I wasn’t taking it well. His school started a month before mine did, so he was the first one to leave. My mom told me, explaining that my anguish was perfectly normal: “It’s always harder to be the one who stays.”

Maybe that’s a small part of the reason it’s so much easier now for me to love places than people. With places, I always get to be the one who leaves. Places don’t “grow out” of me and leave me; I grow out of them and leave them. People change suddenly, without warning; places usually change slowly and very predictably, if you know anything about sociology.

That’s not to say that my relationships with places are easy or simple. It took me a long time to understand that I love my town in Ohio in some way. It was painful to realize that I couldn’t stay there and still be myself. It was even more painful to come to Northwestern and realize that what I thought for five years would be a safe haven was actually rather cold and unwelcoming, and not the sort of place I would ever learn to belong in. Yet there were things I loved about it too.

When I was little I played a game with myself. It was very simple. All I did was pay careful attention to my surroundings and pretend that I was seeing them again after having been away for a very long time, perhaps because I’d been transported to a magical alternate universe and had just now found my way back (I liked fantasy novels as a kid; can you tell?). This game made me see ordinary things like my house or my backyard through an entirely new lens. I was able to make myself feel as though my boring white-bread neighborhood was the most amazing place in the world, simply by pretending that I’d been forced to leave it for a while.

Later on, that actually sort of happened. No, I didn’t get transported through a wormhole to an alternate universe; I just went back to Israel for a whole summer (the aforementioned summer). When I returned to Ohio, I instantly fell in love with it in a way I never had before. It was so green. So quiet. So comfortable. I could understand the language strangers spoke to me. How had I ever taken that for granted?

I never really lost that feeling, and I carry it with me now as I move to a place that’s almost as different from Ohio as Israel is.

~~~

Everyone whines that they hate snow, but you can feel the energy pick up on campus as the flurries turn to snowflakes that grow bigger and bigger. Just a few hours ago it was sunny and above freezing, but that’s Chicago weather for you.

As Deering Field turns from green to white, students on break from class (or maybe just skipping) show up to throw snowballs and make snowmen. Past the field, Deering Library towers imperiously like a set from Harry Potter. In fact, we’d often jokingly call it Hogwarts.

If you walk past the library and down to the lake, you’ll see the hundreds of huge rocks that line the coast. Most of them have been painted by students to celebrate friendships, relationships, student groups, or just their lives at Northwestern in general. Sometimes I see marriage proposals, sometimes I see my favorite song lyrics, sometimes I even see Russian words; I’m not sure which of those makes me happier.

Ever since I first saw the painted rocks the summer after my seventh-grade year, I knew I had to get into Northwestern and paint my own rock someday. I managed the first half of that, but, for some reason, not the second.

~~~

You might think that, as a person with depression, I tend to focus and ruminate on the negatives of things. Although I do that sometimes, I also have a remarkable ability to find the positive in just about everything. Usually this ability serves me very well; although I’m fragile during transitional periods and dislike change, once I’ve had some time to process things I’m able to adapt to just about anything. That’s because I find the good in it.

Ironically, though, when I’m depressed this turns into a sort of weakness. Like a lifesaving medicine that becomes a deadly poison in overdose, my happy memories of past homes become so potent during depression that they rob me of my ability to appreciate the present. When I’m depressed, I’m tortured by these memories, which play over and over in my mind like faded old movies that I can’t turn off. I remember the most insignificant little things: the worn-down steps to my grandma’s apartment building in Haifa, the porch swing on the deck back in Ohio, the hard and scratchy couch in my old dorm where I’d watch football games on TV in the fall, the sound of kids jumping off the diving board at the pool my family went to (still goes to; I’m just not there anymore), the snow falling around University Hall, the taste of a sudden mouthful of Mediterranean water, the slam of the door to the garage when my parents came home from work, the music of my high school marching band echoing through the muggy summer night.

I think of these things without wanting to and I hear the same cruel thought over and over: You will never feel these things again.

I have these memories, but the places they come from are lost to me forever.

Oh, sure, I could return, physically at least. I have returned. But the feelings are gone. That thereness is gone.

~~~

Another season, another (very different) campus. It’s a summer night in New York City and I’m sitting in front of Columbia’s Butler Library and crying for too many reasons to explain. Students–my peers, theoretically–walk past me in chattering groups and I wonder for the millionth time what’s wrong with me. I’m finally exactly where I wanted to be and somehow it still feels awful.

After a while I pick myself up and walk somewhat mechanically off of campus onto Broadway. The sun has just set, which in most of my previous homes would mean that things have either died down or will shortly. But here, the city is just coming to life. The restaurants around campus are still full. People are standing around in front of bars and on street corners talking. The 24-hour pharmacies and grocery stores and diners (I’m still amazed at the idea of a 24-hour anything other than Burger King or 7-Eleven) are full of customers.

The night is warm, but not hot, and I feel better.

There are, right now, over 8 million people in this city who are just like me and also not like me at all. All of them have, at some point, been as terrified and lonely as I am right now. All of them have places that they love and miss. All of them have friends that they rarely see, or might never see again. All of them have parts of their pasts that they wish they could relive, and parts of their pasts that they wish they could forget, and maybe even parts of their pasts that they wish they could both relive and forget, if only because forgetting would end that burning need to relive.

It’s hard to feel alone when I think about that.

~~~

People tell me that the new memories I’m making can replace those old ones. That the new home I’ve found makes up for the loss of my previous homes. It doesn’t, just as new friends can’t replace the ones I’ve lost. Love just doesn’t work that way.

For what it’s worth, I’m glad that I’ve moved to a place that I adore so much. I’m glad that I could live here for the rest of my life and still be learning new things about it all the time. I’m glad that I’m a just a subway ride away from sprawling parks you can get lost in and from some of the loudest, most crowded city streets I’ve ever seen, from stores that sell the food I grew up with and stores that sell food I’ve never heard of or tasted before.

But those memories continue to haunt me and I know that I have to live with them somehow.

The best I can do is to try to capture them in writing so that I don’t have to carry their weight on my own, but it seems that I can’t. At best, writing provides a facsimile, a movie-set version of landscapes that were endlessly deep and rich. They didn’t end with a painted backdrop.

Sometimes I feel like I’d give anything for just one more day to inhabit these old places, homes, selves, lives. I want to feel like I felt when I lived there. I want to feel like the person I was, even though I don’t actually want to be that person anymore.

Isn’t there any way I can come back?

Most of all, though, I don’t want to lose yet another home. But it’s too late. I made the decision to move months ago, and even if I’d chosen to stay in Chicago, it wouldn’t have been the same. College is over. Those lazy days in coffee shops and bookstores are over. Running down the hall or down the stairs to see my friends is over. I will never again feel like I felt when I did those things, and I will never again be the person who did them.

I have to keep telling myself this so that it’ll sink in, even though telling myself this feels like shit. Otherwise I’ll keep feeling like any minute now I’ll wake up back in my old apartment and realize that this whole New York thing was just a weird and kind of scary dream, and it’s time to throw on some clothes and get to class.

But the funny thing is that someday this, right now, is what I’ll miss. Someday the memories I’m making right now will have a “thereness” of their own and I will miss them just as terribly as I miss Israel and Ohio and college now. Someday I’ll look back on my first days and weeks in New York and smile and cry about them.

It is probably true that whenever I travel between these four places in the future, I will simultaneously be leaving and coming home. I’m trying to make my peace with it, as awkward as it feels.

It’s weird, isn’t it? Loving more than one person feels completely natural to me.

Loving more than one place, though, feels like betrayal.

Living With Depression: Hope

July 4, 2013 Miricognitive distortions, depression, hope, living with depression, personal, suicide19 Comments

[Content note: depression and suicide]

This is my series on depression and what it’s actually like beyond the DSM symptoms. It’s not meant to reflect anyone’s experience but my own, although I’m sure plenty of people will identify with it. If things were completely different for you and you feel comfortable sharing, the comments section’s all yours. Previous posts in the series are here.

The title of this post is “Living With Depression: Hope,” but because of the bit before the colon, the part after it is hard to come by.

One of the main ways in which depression differs from sadness or “the blues” is the pervasive loss of hope that its sufferers experience. When you’re depressed, you don’t merely feel bad; you know beyond a doubt that you will always feel bad. You don’t have evidence for this, but the strength of your conviction is so great that you automatically attribute it to accuracy. After all, if it weren’t absolutely true that you will always feel this bad, why else would you be so certain of it?

That’s one of many ways in which the depressed brain tricks you.

Unfortunately, the hopelessness of depression isn’t limited to big-picture questions like whether or not you will eventually feel better. It affects every little thing. You will never make friends. You will never find a partner. You will never have sex again. You will never get a job. You will never get into graduate school. You will never find a place to live that you like. You will never reconcile with your family. You will never get in shape. You will never get these damn errands finished.

(This also means that it’s impossible to tell the difference between what’s actually unattainable and what merely feels that way. I recently told my mother that one of the reasons I chose not to go for a PhD was because there’s absolutely no way I could’ve made it into a doctoral program given my lack of research experience. My mother pointed out that I’d said the same thing about the master’s program to which I will soon be merrily on my way. It’s true. I did say that. I also said that I will never get into Northwestern and never get any summer internships and never find a partner and never find a way to move to New York City. Sometimes I think that I’ll never get married or never be able to get a fulltime job. Which of these are based on a skeptical assessment of the evidence, and which are not? Who knows.)

This is going to sound ridiculous when I say it this way, but imagine knowing for certain that every little bit of your life will always be bad. Imagine if someone traveled back in time from the future and told you that you are going to fail at everything and you will never be happy and nobody will ever like you. Got it? Now try to live out the rest of that life.

That is depression.

When you look at it that way, suicide becomes a little easier to understand. One of the many things healthy people don’t get about suicide is how you could want to end your life for good just because of a “temporary setback” or “when things might get better” or “without knowing how life will turn out.” People call suicide a “permanent solution to a temporary problem.”

Sure, that’s how it looks to a healthy person. But to a depressed person, it’s not a temporary problem. It’s a permanent problem. You do know exactly how life will turn out and it will turn out terribly.

This is why it’s so patently ridiculous to me when people start going on about “Yeah well how can you really know if it’s depression or just sadness I mean aren’t we sort of medicalizing a normal emotion.” This is why it’s so clear that these people have no clue what they’re talking about. I’ve spent a lot of time being depressed and I’ve also spent a lot of time being sad. When I’m sad, my thought process goes like this: “Blah, it’s really fucking sad to be leaving behind my life in Chicago with all these friends I have and all the places I like to go. I will never have these things in my life in this way again. This is really fucking sad. I can’t wait till the move to NYC is over because then I’ll get to acclimate to a new life and it won’t feel as bad to have left this one behind.”

When I’m depressed, my thought process is more like this: “THERE IS ABSOLUTELY NOTHING GOOD ABOUT CHRISTMAS BREAK ENDING AND HAVING TO GO BACK TO CHICAGO. I HATE EVERYTHING THERE. Yeah, I guess I have friends there, but they probably don’t even like me. My classes will probably suck this quarter (yeah I picked them myself but whatever everything I choose for myself always ends up being shitty). The weather fucking sucks and I can’t stand it anymore. I’ll just sit in my apartment alone like a loser. Fuck my life.”

But here’s the thing: when Christmas break ended and I went back to Chicago, it was…fine. I adjusted, as I always do. But in the days leading up to break ending, I was absolutely unable to see that that would happen. It didn’t matter that I’d had the same thoughts at the end of every break. It didn’t matter that I had the same thoughts as I prepared to go home for break, from where I was now so reluctant to leave.

Nothing mattered. I had lost hope. Hopelessness was the default state in which I lived most of the time.

But without hope, there’s no way to be happy or even content. If things are going poorly for you right now, you’re convinced that they will always be that way. If things are going well, you’re convinced that it could all end at any time and your future seems grim.

Without hope, something as mundane as returning to school from Christmas break feels like an insurmountable obstacle. Without hope, my upcoming move to NYC would have me completely paralyzed with dread and anxiety (and I have to say, it’s pretty difficult even with hope).

Without hope, treating your depression feels pointless. Why make the effort when you already “know” it’s not going to help? Without hope, platitudes about “looking on the bright side” are pointless, because depression is an illness that literally prevents you from ever looking on the bright side. Telling a person with depression to try to be hopeful or to try to believe that things will get better is like telling a person with diabetes to consider trying to produce more insulin.

As of a few days ago, my depression has been subclinical for about a year. This means that I don’t fit the diagnostic criteria for it. I do not have major depression. I have recovered.

I do have many of its symptoms, some in mild forms and some a little stronger. So to say that I’m not at all depressed is probably inaccurate. In any case, though, the past year has been an experiment in learning to have hope again–hope that I will adjust just fine to my move in a few weeks (!!!!!!!!), hope that I’ll like my new graduate program, hope that I’ll be able to pay my bills, hope that I’ll get a job when this is all over, hope that my life will slowly start to resemble, however crudely, the vision I have had for it.

This means trying to see clearly through the fog that has hung like a curtain in front of my eyes since childhood, and occasionally getting a peak behind that curtain. We are all, of course, largely ignorant when it comes to predicting our own futures, but the important thing is to have the ability to make predictions that don’t make us want to curl up under the covers and cry.

The Letter I Didn't Write

June 22, 2013 Miricollege, depression, life, northwestern, personal13 Comments

[Content note: depression, suicide, self-harm, eating disorders, sexual assault]

This is a long and intensely personal post about college, which I graduated from today. I’m writing it more for myself than for you, so feel free to skip it if you come here mainly for the political rants and psychological babble.

A few weeks ago I got a Facebook invite about a book that some students were compiling. Any current Northwestern senior could contribute a letter, anonymous or not, about their four years at Northwestern, addressed either to themselves four years ago or four years from now. This fall, incoming freshman will receive a copy of the book.

I waffled for a few weeks, finally convinced myself that I had nothing to say, and let the deadline pass.

Of course, that’s not true. I had plenty to say, but I knew that if, four years ago, I had received a letter from my current self about my college experience, I would’ve packed back up and ran the fuck away. Why do that to an innocent freshman?

If you don’t have anything nice to say, don’t say anything at all.

I’ve heard this for my entire life, and it’s the little voice in my head that so often keeps me silent. But usually I can ignore it, which is why this blog exists.

This time it worked. While I won’t say that I have nothing nice to say about my four years at Northwestern, most of it is not very nice. So I stayed silent.

But now it’s my graduation day, and, as with everything else in my life, I can’t fully process or move on from these four years without writing about them. Besides, this is my blog, not anyone’s book meant to provide inspiration and guidance to a new generation of Northwestern students. This space is mine, and this is the letter I didn’t write.

~~~

Continue reading “The Letter I Didn't Write” →

Depression and the Lie of the "Real Self"

June 12, 2013 Miriantidepressants, art, authenticity, depression, literature, medication, mental illness, personal27 Comments

[Content note: depression and suicide]

Mitchell of Research To Be Done has a fantastic post up about this idea that when you’re on psychiatric medications, you’re not “the real you.” I’ll shamelessly quote about half the post:

This is just a for the record, for everyone, whether you’re talking about antidepressants or any other form of medication or life circumstances: THERE IS NO SUCH THING AS THE “REAL YOU”.

You know why? Because HUMAN BEINGS ARE CONTEXT-DEPENDENT CREATURES.

You are the real you when you’re being flirty and charming and totally hitting it off with someone adorable. You are the real you when you’re crying on the floor of your room and wishing the world would end. You are the real you when you’re living it up on vacation and you are the real you when you’re just getting through the day at a boring job. You’re the real you when you’re on vacation and hate everything about it, and you’re the real you when you’re flying through the day at an amazing job. You are the real you when you’re at a party, and you’re the real you when you’re staying in with your cat. You are the real you when you’re drinking, when you’re high, when you’re reading, when you’re fucking, when you’re lonely, when you’re surrounded by friends, when you feel absolutely worthless, when you’re brimming with confidence, when you wish the universe would leave you alone, and when you love everything about it. You’re the real you when you’re unspeakably angry and hate everyone, and you’re the real you when you’re ecstatically in love and feeling on top of the world.

“THE REAL YOU” IS A MEANINGLESS TERM USED BY PEOPLE WHO DON’T UNDERSTAND HOW HUMAN BEINGS WORK.

I wanted to expand on that idea a bit and talk about why it’s extremely harmful to people who are suffering from mental illness.

When I was depressed, I believed that Depressed Me was The Real Me. Not only that, but I believed that my depressed view of the world was The Most Accurate View Of The World. That when I was depressed and thought that everyone hated me and that I was an alien in this world who should die because I don’t belong here, that was, in my opinion, the most authentic view I could possibly have.

A large part of me feared recovery. Cheerful people grated on me, and of course, in this optimism-fetishizing culture, I thought that the only alternative to miserable depression was peppy, bubbly cheerfulness. That, after all, was what everyone seemed to want me to be, and that felt wrong wrong wrong.

There were a lot of reasons for my belief that depression was “real” and happiness was “fake.” First of all, as I just mentioned, I had a totally skewed image of what happiness actually looked like. Many people make that same mistake, of course, and it’s only now, when I’m healthy and happy but not that outwardly cheerful, that I realize that happiness just doesn’t always look like that. Sometimes it looks like hours spent alone reading. Sometimes it looks like passionate anger at injustice, and doing something about that injustice. Sometimes it looks like writing over 1,000 words in a sudden rush of ideas and creativity. Sometimes it looks like playing footsie with a partner while we do our homework in silence. Sometimes it looks like sitting at the coffee shop with my best friend, just talking about stuff. Sometimes it looks like savoring a meal I cooked myself. Sometimes it looks like waking up early on my first day back in the city, putting money on my metrocard, taking the subway, and walking up the stairs out onto the street, awestruck every time. Sometimes it looks like the moment I received my graduate school acceptance letter. And sometimes it does look like exactly what you’d think–dancing with friends and strangers at a party, knocking back shots and laughing at our own stupidity.

A second reason I believed depression was more “genuine” was that there was definitely a bit of sour grapes going on. No matter what I did, I hadn’t been able to feel happy with myself and my life since early childhood. That’s a lot of failure for a young person. So by late adolescence I was spending a lot of time being like “FUCK YOU HAPPINESS I DIDN’T WANT YOU ANYWAY YOU’RE ALL FAKE AND BORING AND SHIT.” It seems childish, but it was probably one of the only defenses I had. If I’d really known what I was missing, really felt its absence, I’m not sure how I could’ve made it through.

Third, it’s hard to ignore the fact that, even as Western culture promotes optimism and cheerfulness and happiness as mandatory, especially for women, it simultaneously elevates misery and depression to an exalted status. There’s a stereotype of depressed people as writers or artists, people who See Humanity As It Really Is and bring those insights to us through beautiful works of art or literature, and who die alone, unappreciated, perhaps drunk in a gutter or by suicide.

For a pitifully long time, in fact, I wondered if I could ever be a Real Writer if I became happy.

In his book Against Depression, Peter D. Kramer writes:

To oppose depression too directly or completely is to be coarse and reductionistic–to miss the inherent tragedy of the human condition. And here it is not only the minor variants–the psychiatric equivalents of tennis elbow–that bear protecting. Asked about eliminating depression, an audience member may answer with reference to a novel that ends in suicide. Or it may be an artist who is held forth, a self-destructive poet. To be depressed–even quite gravely–is to be in touch with what matters most in life, its finitude and brevity, its absurdity and arbitrariness. To be depressed is to adopt the posture of rebel and social critic. Depression is to our culture what tuberculosis was eighty or a hundred years ago: an illness that signifies refinement. Major depression can be characterized as more than illness, or less–a disease with spiritual overtones, or a necessary phase of a quest whose medical aspects are incidental.

(How can this image of the depressive exist in the same culture that stigmatizes depressives as pathetic, lazy, selfish, whiny losers? Why, you have to be depressed in the right way, of course.)

The final reason, I believe, was a property of the illness itself. The thoughts and emotions conjured by depression are so strong, so urgent, so potent that they felt more real than anything I’d ever felt before. The insights it gave me–they felt so brilliant at the time–could never come to me any other way. There was no other way to just know all these things about Life and Humanity. (This is also why I think that some of the aforementioned artists and writers might not be quite so brilliant as we may think.) When I was depressed I felt like a character in one of the Russian novels I love (where depression, incidentally, often plays a starring role). What could possibly be more genuine than this?

And during those times I’d forget how good it felt not to be depressed. I simply lost access to those memories. I wanted desperately to not be depressed anymore and I was also desperately afraid of who I would become if I were to stop being depressed. Depression skews and poisons everything. All of your memories, all of your identities, every sense you have of who you “really” are.

The result of all of this is that I felt that my depression was authentic. It was The Real Me. Recovering, especially through taking medication, would not be The Real Me.

I can’t know for sure now how that affected my eventual recovery. There are those who say that it must’ve significantly delayed it because I had to Really Want To Get Better and all that, but that’s straight-up victim-blaming bullshit. I DID want to get Better. I was just lost and confused and didn’t know what Better would even look like. And even when I didn’t want to get Better, that was a symptom of the illness itself. Depression is a feedback loop.

I do know that it made the decision to take medication (which brought me back from the brink) a lot more difficult than it needed to be. All that anxiety about potentially losing my ability to write was a waste of time and energy. Those fears that people would only like me if I was Deep and Insightful and Mysterious? They were crap.

And, anyway, here I am, nearly a year post-recovery and still writing, still being moody and weird, still doing my best not to have an overly rosy view of the world. Still ruining your fun.

But it’s deeply unjust to trick people suffering from depression into believing that they won’t be their Real Selves if they recover (especially if they recover using medication). People love to be all like “Yeah well what if anti-depressants had been around in Van Gogh’s time?” Well, maybe we’d still have his amazing art. Maybe it would look a little different. Or maybe Van Gogh would’ve done something totally different with his life and we’d never know the difference.

All I know is, no painting in the world can be so beautiful as to justify that sort of suffering.

Small Things You Can Do To Improve Mental Health In Your Community

May 26, 2013 Miricollege, culture, mental health, mental illness, northwestern, stigma, suicide26 Comments

[Content note: suicide, mental illness]

A few weeks ago Northwestern lost yet another student to suicide. There’s been pressure building all year for improved mental health services on campus, and I think that pressure will soon culminate in real, helpful changes on campus.

At the same time, some have been saying that what we need is not better mental healthcare services, but changes in campus “culture,” such as a reduction in the stigma of accessing mental healthcare and an increase in our willingness to discuss mental health which each other.

I don’t think that these things are mutually exclusive; I think we need both. People whose troubles are relatively minor will benefit from increased openness about mental health on campus without needing any improvements in mental healthcare, but those who suffer from serious mental illnesses–the kind that can contribute to suicide–need more than just supportive friends and professors. They need treatment. Right now, it’s becoming clear that many of those people are not getting the help they need.

Echoing these debates, a blog run by Northwestern students called Sherman Ave posted a piece called “A Reflection on Death, Privilege, and The College Experience.” (Sherman Ave usually sticks to humor, but this time it poignantly diverged.) The author wrote:

In writing these words and thinking these thoughts, I do not believe that a “call to action” here ends in throwing more money toward psychological services. As much as I believe that funding of psychological services at this university should be increased, I would hesitate to claim that another few thousand dollars would have stopped Alyssa Weaver and potentially Dmitri Teplov from committing suicide. Rather, I encourage everyone reading this article to think carefully about the state of those without the privilege of stable mental health. We should seek to sympathize with members of our community instead of ignoring them for the sake of convenience. If we have the tremendous power to come together in grievance of a lost classmate, then there’s absolutely no reason we shouldn’t be able to show the same love and solidarity for that classmate before they give up on our community.

And a commenter responded:

I agree with the need to come together to “show the same love and solidarity” to members of our community who need or want support and communication from others, but what does that practically mean? I find myself asking–how can I, as one person, contribute to a positive dialogue that moves our community towards supporting each other in the face of hardship? How do I even “identify” someone who needs my help? Or how do I make myself open to facilitating healing in my peers?

I don’t think there’s any easy answer to this. Practically speaking, changing a culture is like voting–it’s pretty rare that the actions of a single individual make an immediately noticeable difference. Westerners are used to thinking of themselves as individual agents, acting on their own and without any influence from or effect on their surrounding culture, and this is probably one of the many reasons it’s so difficult for people to even conceive of being able to make an actual impact when it comes to something like this.

You don’t have to be an activist, a therapist, or a researcher to make a difference when it comes to mental health. The following are small things almost anyone can do to help build a community where mental illness is taken seriously and where mental health is valued. Although I’m specifically thinking about college campuses here, this is applicable to anything you might call a “community”–an organization, a group of friends, a neighborhood.

1. When people ask you how you’re doing, tell them the truth.

This is something I’ve been really making an effort to do. This doesn’t mean that every time someone asks me “What’s up?” I give them The Unabridged Chronicles of Miri’s Current Woes and Suffering. But I try not to just say “Good!” unless I mean it. Instead I’ll say, “I’ve been going through a rough patch lately, but things are looking up. How about you?” or “Pretty worried about my grad school loans, but hopefully I’ll figure it out.” The point isn’t so much that I desperately need to share these things with people; rather, I’m signaling that 1) I trust them with this information, and 2) they are welcome to open up to me, too. Ending on a positive note and/or by asking them how they are makes it clear that I’m not trying to dump all my problems on them, but I leave it up to them to decide whether or not to ask more questions and try to comfort me, or to just go ahead and tell me how they’re doing.

2. If you see a therapist or have in the past and are comfortable telling people, tell them.

One awesome thing many of my friends do is just casually drop in references to the fact that they see a therapist into conversation. This doesn’t have to be awkward or off-topic, but it does have to be intentional. They’ll say stuff like, “Sorry, I can’t hang out then; I have therapy” or they’ll mention something they learned or talked about in a therapy session where it’s relevant. The point of this is to normalize therapy and to treat it like any other doctor’s appointment or anything else you might do for your health, like going to the gym or buying healthy food. It also suggests to people that you are someone they can go to if they’re considering therapy and have questions about it, because you won’t stigmatize them.

3. Drop casual misuse of mental illness from your language.

Don’t say the weather is “bipolar.” Don’t refer to someone as “totally schizo.” Don’t claim to be “depressed” if you’re actually just feeling sad (unless, of course, you actually are depressed). Don’t call someone’s preference for neatness “so OCD.” These are serious illnesses and it hurts people who have them to see them referenced flippantly and incorrectly. One fourth of adults will have a mental illness at some point in their life, and you might not know if one of them is standing right next to you. Furthermore, the constant misuse of these terms makes it easier for people to dismiss those who (accurately) claim to have a mental illness. If all you know about “being totally ADHD” is when you have a bit of trouble doing the dense reading for your philosophy class, it becomes easier to dismiss someone who tells you that they actually have ADHD.

4. Know the warning signs of mental illness and suicidality, and know where to refer friends who need professional help.

You can find plenty of information about this online or in pamphlets at a local counseling center. If you’re a student, find out what mental health services your campus offers. If you’re not a student, find out about low-cost counseling in your area. If you have the time, see if you can attend a training on suicide prevention (and remember that asking someone if they’re okay or if they’ve been feeling suicidal will not make them not-okay or suicidal). Being aware and informed about mental health can make a huge difference in the life of a friend who needs help. This doesn’t mean you’re responsible for people who need help or that it’s your fault if you don’t succeed in helping them–not at all. It just gives you a toolbox that’ll help you respond if someone in your community is showing signs of mental illness.

Learning about mental illness is also extremely important because it helps you decolonize your mind from the stigma you’ve probably learned. Even those who really want to be supportive and helpful to people with mental illnesses have occasionally had fleeting thoughts of “Why can’t they just try harder” and “Maybe they’re just making this up for attention.” That’s stigma talking. Even if you didn’t learn this from your family, you learned it from the surrounding culture. Studying mental illness helps shut that voice up for good.

5. Understand how social structures–culture, laws, business, politics, the media, etc.–influence mental health.

If you learned what you know about mental health through psychology classes, your understanding of it is probably very individualistic: poor mental health is caused by a malfunctioning brain, or at most by a difficult childhood or poor coping skills. However, the larger society we live in affects who has mental health problems, who gets treatment, what kind of treatment they get, and how they are treated by others. Learn about the barriers certain groups–the poor, people of color, etc.–face in getting treatment. Learn about how certain groups–women, queer people, etc.–have been mistreated by the mental healthcare system. Find out what laws are being passed concerning mental healthcare, both in your state and in the federal government. Learn how insurance companies influence what kind of treatment people are able to get (medication vs. talk therapy, for instance) and what sorts of problems you must typically have in order for insurance to cover your treatment (diagnosable DSM disorders, usually). Pay attention to how mental illness is portrayed in the media–which problems are considered legitimate, which are made fun of, which get no mention at all.

It’s tempting to view mental health as an individual trait, and mental illness as an individual problem. But in order to help build a community in which mental health matters, you have to learn to think about it structurally. That’s the only way to really understand why things are the way they are and how to make them change.

Self-Diagnosis and Its Discontents

May 10, 2013 Miriharm reduction, healthcare, internet, mental health, psychiatry, psychology, self-diagnosis, therapy37 Comments

There’s a certain scorn reserved for people who diagnose themselves with mental illnesses–people who, based on their own research or prior knowledge, decide that there’s a decent chance they have a diagnosable disorder, even if they haven’t (yet) seen a professional about it.

I understand why psychologists and psychiatrists might find them troublesome. Nobody likes the idea of someone getting worked up over the possibility that they have a mental illness when they really don’t. Professional mental healthcare workers feel that they know more about mental illness than the general population (and, with some exceptions, they do) and that it’s their “job” to serve as gatekeepers of mental healthcare. This includes deciding who is mentally ill and who is not.

Self-diagnosis also gets a bad rap from people who have been professionally diagnosed with a mental illness. They feel that people who self-diagnose are doing it for attention or because they think that diagnosis is trendy.

This actually bothers me much more than the arguments against self-diagnosis coming from professionals. Why?

Because the claim that people who self-diagnose are just “doing it for attention” or because they think it’s “cool” is the exact same claim frequently made about people who get diagnosed professionally.

To be clear, I’m not saying that people never label themselves as mentally ill for attention. Maybe some do. Maybe a significant proportion of people who self-diagnose don’t really have a mental illness at all. I’d have to see research to know, and from my searches so far I haven’t really found much research on the phenomenon of self-diagnosis. (But I’m taking note of this for my master’s thesis someday.)

However, there’s a difference between someone who’s feeling sad for a few days and refer to themselves as “depressed,” and someone who’s been struggling for weeks, months, or years, and who has read books and articles on the subject and studied the DSM definition of the illness. The former may not even count as “self-diagnosis,” but rather as using a clinical term colloquially–just like everyone who says “oh god this is so OCD of me” or “she’s totally schizo.” (This, by the way, is wrong; please don’t do it.)

(It’s also likely the case that some people self-diagnose because they have hypochondria. However, the problem is not that they are self-diagnosing. The problem is that they have untreated hypochondria. Maybe diagnosing themselves with something else will get them into treatment, where a perceptive psychologist will diagnose them with hypochondria and treat them for it.)

Even if some people who self-diagnose are wrong, I still think that we should refrain from judging people who self-diagnose and take their claims seriously. Here’s why.

1. It gets people into treatment.

I wish we had a system of mental healthcare–and a system of social norms–in which everyone got mental health checkups just as they get physical health checkups. For that, two main things would have to change–mental healthcare would have to become affordable and accessible for everyone, and the stigma of seeing mental health professionals (whether or not one has a mental illness) would have to disappear. (There are other necessary conditions for that, too–the distrust that many marginalized people understandably have for mental healthcare would have to be alleviated, and so on.)

For now, going to see a therapist or psychiatrist is difficult. It requires financial resources, lots of time and determination, and a certain amount of risk–what if your employer finds out? What if your friends and family find out (unless they know and support you)? What will people think?

Because the barriers to seeing a professional are often high, many people need a strong push to go see one. Having a strong suspicion that you have a diagnosable mental illness can provide that push for many people, because nobody wants to go through the hassle of finding a therapist that their insurance covers (or finding a sliding-scale one if they don’t have insurance), coming up with the money to pay the deductible, taking time off work to go to the appointment, dealing with the fear of talking to a total stranger about their feelings, and actually going through with the appointment, only to be told that there’s “nothing wrong” with them.

As much as I wish things were different, the reality right now is that relatively few people go to therapists or psychiatrists unless they believe that they have a mental illness. If self-diagnosing first gets them into treatment, then I don’t want to stigmatize self-diagnosis.

2. It helps them find resources whether or not they see a professional.

In the previous point, I explained that for many people, self-diagnosing can be a necessary first step to getting treatment from a professional. In addition, once people have diagnosed themselves, they are able to seek out their own resources–books, support groups, online forums, etc.–to help them manage their symptoms. This can be extremely helpful whether or not they’re planning on getting treatment professionally.

While psychiatric labels like “depression,” “generalized anxiety,” and “ADHD” have their drawbacks, they are often necessary for finding resources that help people understand what they’re going through and help themselves feel better. If I’m at a library looking for books that might help me, asking the librarian for “books about depression” or “books about ADHD” will be much more useful than asking them for “books about feeling like shit all the time and not wanting to do anything with friends” or “books about getting distracted whenever you start work and not really having the motivation to finish any of it and it has nothing to do with laziness by the way.” Same goes for a Google search.

It’s certainly fair to be worried that people looking on their own will find resources that are unhelpful or even dangerous. But I think this is less of a problem with self-diagnosis per se, and more of a problem with the lack of scientific literacy in our society, and the lack of emphasis on skepticism when evaluating therapeutic claims. For what it’s worth, going to see a mental health professional will not necessarily prevent you from encountering quackery and bullshit of all kinds. And in any case, the blame does not lie with the people who self-diagnose and then fall for pseudoscientific scams, but with the people who perpetrate the scams in the first place.

This point is especially important given that many people will not be able to access professional mental healthcare services for various reasons. Maybe they can’t afford it; maybe they work three jobs and don’t have time; maybe they can’t find a therapist who is willing to accept the fact that they are trans*, kinky, poly, etc. Maybe they are minors whose parents are unwilling to get them into treatment. Maybe they were abused by medical professionals and cannot go back into treatment without worsening their mental health.

There are all kinds of reasons people may be unable to go and get their diagnosis verified by a professional, and most of these are tied up in issues of privilege. If you have never had to worry that a doctor or psychologist will be prejudiced against you, then you have privilege.

3. It can help with symptom management whether you have the “real” disorder or not.

At one point when my depression was particularly bad I noticed that I had some symptoms that were very typical of borderline personality disorder. For instance, I had a huge fear that people would abandon me and I would bounce back and forth between glorifying and demonizing certain people. If someone made the slightest criticism of me or wasn’t available enough for me, I would decide that they hate me and don’t care if I live or die. I had wild mood swings. That sort of thing. It’s not that I thought I actually had BPD; rather, I noticed that I had some of its symptoms and wondered if perhaps certain techniques that help people with BPD might also help me.

Luckily, at this time I was still seeing a therapist. So in my next session, I decided to mention this observation that I had made, and the conversation went like this:

Me: I’ve noticed that I have some BPD-like symptoms.
Her: Oh, you don’t have BPD.
Me: Right, but I seem to have some of its symptoms–
Her: No, trust me, I’ve worked with people with BPD and you do NOT have BPD.

I suppose I could’ve persevered with this line of thinking, but instead I felt shut down and put in my place. I dropped the subject.

So determined was this therapist to make sure that I know which mental illness(es) I do and do not have that she missed out on what could’ve been a really useful discussion. What she could’ve done instead was ask, “What makes you say that?” and allow me to discuss the symptoms I’d noticed, whether or not they are indicative of BPD or anything else other than I am having severe problems relating to people and dealing with normal life circumstances.

The point is that sometimes it’s useful to talk about mental illness not in terms of diagnoses but in terms of symptoms. What triggers these symptoms? Which techniques help alleviate them?

So if a person looks up a mental disorder online and thinks, “Huh, this sounds a lot like me,” that realization can help them find ways to manage their symptoms whether or not those symptoms actually qualify as that mental disorder.

This is especially true because the diagnostic cut-offs for many mental illnesses are rather random. For instance, in order to have clinical depression, you must have been experiencing your symptoms for at least two weeks. What if it’s been a week and a half? In order to have anorexia nervosa, you must be at 85% or less of your expected body weight*. What if you haven’t reached that point yet? What if you don’t have the mood symptoms of depression, but you exhibit the cognitive distortions associated with it? Acknowledging that you may have one of these disorders, even if you don’t (yet) fit the full criteria, can help you find out how to manage the symptoms that you do have.

4. It helps them find solidarity with others who suffer from that mental illness.

I understand why some people with diagnosed mental illnesses feel contempt toward those who self-diagnose. But I don’t believe that sympathy and solidarity are finite resources. If someone is struggling enough that they’re looking up diagnostic criteria, they deserve support from others who have been down that path, even if their problems might not be “as bad” as the ones other people have and/or have not yet been validated by a professional.

Acknowledging that you may have depression (or any other mental illness) can help you find others who have experienced various shades of the same thing and feel like you’re not alone.

My take on self-diagnosis comes from a perspective of harm reduction. The idea is that strategies that help people feel better and prevent themselves from getting worse are something we should support, even if these strategies are not “correct” or “legitimate” and do not take place within the context of established, professional mental healthcare.

We should work to improve professional mental healthcare and increase access to it, especially for people in marginalized communities and populations. However, we should also acknowledge that sometimes people may need to help themselves outside of that framework. These people should not be getting the sort of condescension and eye-rolling they often get.

~~~
*The diagnostic criteria for eating disorders are expected to improve with the release of the new DSM-V, but I’m not sure yet whether or not the 85% body weight requirement will still be there. In any case, this is how it’s been so far.

Criticizing Psychiatry Without Throwing the Baby Out with the Bathwater

May 4, 2013 Miriantidepressants, depression, dsm, insurance, mental health, mental illness, psychiatry9 Comments

So, I read this article in The Atlantic called “The Real Problems with Psychiatry” and…I’m torn. The article is an interview with this guy Gary Greenberg, a therapist who has previously written a book called Manufacturing Depression: The Secret History of a Modern Disease and has now followed that up with The Book of Woe: The Making of the DSM-5 and the Unmaking of Psychiatry.

Now, to be clear, I haven’t read either of these books. I might, just to see the full depth of his arguments. But I decided to read the interview anyway and assume that he accurately represented his own claims in it.

Parts of the interview, I think, are really on point. Greenberg discusses the history of the DSM (the manual used to diagnose mental disorders) as a way for psychiatry as a discipline to establish credibility alongside other types of medicine. He criticizes the DSM on the grounds that the mental diagnoses that we currently have may not necessary be the best way to conceptualize mental illness, and he thinks that once we gain a better understanding of the brain we will find that they have little to do with the physical reality of mental illness:

Research on the brain is still in its infancy. Do you think we will ever know enough about the brain to prove that certain psychiatric diagnoses have a direct biological cause?

I’d be willing to bet everything that whenever it happens, whatever we find out about the brain and mental suffering is not going to map, at all, onto the DSM categories. Let’s say we can elucidate the entire structure of a given kind of mental suffering. We’re not going to be able to say, “here’s Major Depressive Disorder, and here’s what it looks like in the brain.” If there’s any success, it will involve a whole remapping of the terrain of mental disorders. And psychiatry may very likely take very small findings and trump them up into something they aren’t. But the most honest outcome would be to go back to the old days and just look at symptoms. They might get good at elucidating the circuitry of fear or anxiety or these kinds of things.

I don’t know if he’s right. But I suspect that he might be.

He also makes a great point about the fact that we often assume that anyone who acts against social norms, for instance by committing a terrible crime, must necessarily be mentally ill:

It’s our characteristic way of chalking up what we think is “evil” to what we think of as mental disease. Our gut reaction is always “that was really sick. Those guys in Boston — they were really sick.” But how do we know? Unless you decide in advance that anybody who does anything heinous is sick. This society is very wary of using the term “evil.” But I firmly believe there is such a thing as evil. It’s circular — thinking that anybody who commits suicide is depressed; anybody who goes into a school with a loaded gun and shoots people must have a mental illness.

Greenberg also discusses how mental diagnoses have historically been used to perpetuate injustice, such as the infamous “disorder” of “drapetomania,” which was thought to cause slaves to try to escape their masters, and the fact that homosexuality was once considered a mental illness (and other types of sexual/gender variance still are).

He also talks a lot about how the DSM and its categories are tied in with all sorts of things: scientific research and mental healthcare coverage, for instance:

To get an indication from the FDA, a drug company has to tie its drug to a DSM disorder. You can’t just develop a drug for anxiety. You have to develop the drug for Generalized Anxiety Disorder or Major Depressive Disorder. You can’t just ask for special services for a student who is awkward. You have to get special services for a student with autism. In court, mental illnesses come from the DSM. If you want insurance to pay for your therapy, you have to be diagnosed with a mental illness.

The point about needing a DSM diagnosis in order to receive insurance coverage is really important and cannot be overstated (in fact, I wish he’d given it more than a sentence, but again, he did write books). As someone who plans to eventually practice therapy without necessarily having to formerly diagnose all of my clients, this matters to me a lot, because it may mean that I might have to choose between diagnosing and working only with clients who can afford therapy without insurance coverage (which, at at least $100 per weekly session, would really not be many).

But sometimes Greenberg makes a good point while also making a terrible point:

One of the overlooked ways is that diagnoses can change people’s lives for the better. Asperger’s Syndrome is probably the most successful psychiatric disorder ever in this respect. It created a community. It gave people whose primary symptom was isolation a way to belong and provided resources to those who were diagnosed. It can also have bad effects. A depression diagnosis gives people an identity formed around having a disease that we know doesn’t exist, and how that can divert resources from where they might be needed.

First of all, we don’t “know” that depression “doesn’t exist.” We know–or, more accurately, some of us suspect–that the diagnosis we call “major depression” might not map on very accurately to what’s actually going on in the brains of people who are diagnosed with it. What we call “major depression” is a large cluster of possible symptoms, and since you only have to have some of them in order to be diagnosed, two people with the exact same diagnosis could have almost completely different symptomology. Further, because depression can vary like a spectrum in its severity, the cut-off point for what’s clinical depression and what’s not can be rather arbitrary. It’s not like with other types of illnesses, where either you have a tumor or you don’t, either you have a pathogen in your bloodstream or you don’t.

Second, Greenberg doesn’t seem to extend his analysis of the effects of the Asperger’s diagnosis onto other disorders. There is absolutely a community of people who have (had) depression, eating disorders, anxiety, and so on. Those communities are absolutely valuable. My life would be demonstrably worse without these communities. They haven’t “diverted resources” from anything other than me wallowing in self-pity because I feel like I’m the only person going through these things–which is how I used to feel.

Right after that:

What are the dangers of over-diagnosing a population? Are false positives worse than false negatives?

I believe that false positives, people who are diagnosed because there’s a diagnosis for them and they show up in a doctor’s office, is a much bigger problem. It changes people’s identities, it encourages the use of drugs whose side effects and long-term effects are unknown, and main effects are poorly understood.

Greenberg is correct that false positives are a problem and that diagnosing someone with a mental illness that they do not have can be very harmful. However, his dismissiveness of the problem of false negatives–people who do have mental illnesses but never get diagnosis or treatment–is stunning coming from someone who is a practicing therapist. Untreated mental illnesses are nothing to mess around with. They can lead to death, by suicide or (in the case of eating disorders) otherwise. Even if things never get to that point, they can ruin friendships, relationships, marriages, careers, lives. While I get that Greenberg has an agenda to push here, some acknowledgment of that fact would’ve been very much warranted.

In short, Greenberg seems to make the logical leap that many critics of psychiatry and the DSM do; that is, because there is much to criticize about them and because it’s unclear how valid the DSM diagnoses are, therefore depression is “a disease that we know doesn’t exist” and antidepressants are harmful (that’s a whole other topic, though).

Antidepressants may very well be harmful. Diagnostic labels may also very well be harmful, for some people. But I think the stronger evidence is that untreated mental suffering is harmful, and sometimes therapy just isn’t enough and cannot work quickly enough–for instance, for someone who is severely depressed to the point that they can’t possibly use any of the insights they may gain in therapy, or to the point that they are about to commit suicide.

I hope that one day we’ll have all the answers we need to minimize both false negatives and false positives. But for now, we don’t, and I worry that attitudes like Greenberg’s may prevent people from getting the help they urgently need, as much as they may simultaneously promote vital criticism and analysis of psychiatry and the DSM.

~~~

Note: I didn’t fact-check everything Greenberg said in the interview because I’m hoping that The Atlantic employs fact-checkers. But if you have counter-evidence for anything in that article, even parts I didn’t quote here, please let me know.

Living With Depression: Strength

April 27, 2013 Miridepression, exercise, fitness, living with depression, mental illness, personal, strength8 Comments

[Content note: depression]

Half a year ago I started a series of posts about living with depression in order to help people understand what it’s like to have it beyond just the DSM symptoms that you always hear about. Then I moved to FtB and got super intimidated and didn’t want to write it anymore. But now I have writer’s block and I’m feeling too overwhelmed by everything going on in the world so I’m going to write about myself.

It’s not meant to reflect anyone’s experience but my own, although I’m sure plenty of people will identify with it. If things were completely different for you and you feel comfortable sharing, the comments section’s all yours.

The two previous posts, if you’re curious, were about trust and openness.

For many people, both sufferers and non-, depression is primarily a lack of strength.

Emotional strength, that is. When you hear people call depression a “weakness,” consider the fact that the opposite of “weakness” is “strength,” and you’ll see exactly what they think is lacking in those who suffer from it. Of course, enlightened as depression sufferers supposedly are about their own illness, most of us fall into the same trap at some point.

Because on the surface, depression really can look like a lack of strength. For many years, at the slightest sign of misfortune or difficulty–a bad grade, a rude remark from someone–my entire mental composure would crumple like a dry leaf you crush in your hand. Imagine going to the gym and trying to lift one of the lightest weights they have, but you drop it and collapse in a heap on the floor. That’s approximately the physical equivalent of how it feels, with all the humiliation and self-blame involved.

In reality, of course, it has nothing to do with weakness or strength. It’s an illness. It’s not your fault. (It’s not a “chemical imbalance,” by the way, as someone would usually say right about now, but it’s not a weakness either.)

But, honestly, most days I can’t internalize that knowledge, no matter how many courses I take and articles I read. I feel weak.

Anyway, my solution to this for a while was to try to present a false persona that is strong, competent, and detached. I spent a lot of time furiously pretending not to care about things, because that’s what I thought strength was. It never worked. I’m sure people saw through it, and besides, the thing with depression is that often you can’t fake your way out of it. The pain and emotions it causes are too powerful to hide. It’s like the difference between not letting it show on your face when you’ve stubbed your toe, and not letting it show on your face when you’ve fractured your leg in three places. People are gonna be able to tell. No matter what.

And that inability to hide what I felt was private, shameful, and weak was probably the worst way I’d ever felt like I failed myself. Worse than not liking college, worse than having to drop journalism, worse than not getting (or having to decline) a slew of coveted internships and other opportunities. In the endless parade of personal failures to which I am a constant, unwilling spectator, failing to be “mentally strong” is the absolute worst.

So what about physical strength, then?

It’ll probably come as no surprise (as I’m sure I’m far from the only person who does this) that I use physical strength and competence as a way to distract from and make up for the emotional strength that, despite everything I know about depression, I still feel I do not have.

I’ve been doing that for as long as I can remember. I used ballet that way when I used to dance, from when I was 6 years old until I was 15. Then I switched to marching band, which you may think isn’t hard until you’ve done it. During the off-season I’d bike or walk pretty long distances or go to the gym or exercise at home. Of course, all that was irrevocably tainted by the fact that I had massive body image issues and eating habits that at times were very unhealthy, but I do remember the difference between wanting to lose weight and wanting to be strong. I haven’t always wanted to lose weight, but I’ve always, always wanted to be strong.

(Of course, physical strength is a gendered trait, and the gender that we usually associate it with is male. That means that we think of physical strength as being able to lift a whole lot of pounds–with your arms, that is–and it means that my male friends scoff at how pathetically I compare to them in that department. Of course, I just smile and roll my eyes, because I’d love to see them sit calmly in the splits for 15 minutes while reading a book, or twirl on the toes of one foot. Whatever.)

Partially, I like being strong for the same reasons anyone else does–it feels good, it’s useful, it keeps you healthier. But also, it allows me to shape my body in the way I’ve never managed to shape my mind. Getting physically strong requires a lot of effort, sure, but everyone knows exactly how it’s done. I don’t know how to stop being so emotionally nonresilient. I only know that sometimes I go months without any problems, and then suddenly, for no reason, I start crumpling again.

Muscles don’t work that way. You work them out, and they get stronger. You don’t work them out, and they eventually get weaker. You know which exercises work out which muscles. You know that if muscles are sore, you gave them a good workout. (I say this as I can barely walk for the third day in a row because of this thing I did with my calves, so there ya go).

If I were able to afford a therapist who could actually help (as opposed to the ones that I’ve had, who did not), maybe I’d eventually become emotionally strong. But for now I’ve mostly given up. The only thing that works when I feel weak is simple distraction, but the more tired and overwhelmed I am and the more mental effort I’ve already exerted on other things, the harder distraction gets.

But when I feel strong physically, it makes up for not feeling strong emotionally. Just a little bit.

Lessons I Learned From Depression

April 14, 2013 Miribias, depression, emotion, life, mental health, mental illness, personal, psychology, skepticism23 Comments

[Content note: depression]

People struggling with mental illness (or any sort of illness, or anything crappy, really) are constantly exhorted by well-meaning people to find the “silver lining” in their experience. This often takes the form of tropes about “learning who your real friends are” or “learning how to fully appreciate life” or “understanding what’s really important in life” and on and on.

For a long time I resisted the entire notion of finding “lessons” or “learning opportunities” in my decade-long struggle with depression. (Yes, decade-long. Yes, I’m 22.) Part of this was because the people who demanded that I do so were just so damn annoying, frankly. No, I will not spin you a convenient story about What Depression Has Taught Me to make you feel better when you see my tears or my scars.

But mostly I resisted because I felt that admitting that I’ve learned things from this experience requires intentionally forgetting the fact that most of it had no meaning. There is no meaning to losing half of your life to something you can’t even see or prove to people or sometimes even describe in words. There is no meaning to having most of the memories of your life discolored, blurred, and tainted by a misery and terror that had no name. This is not the stuff of inspirational memoirs or films. While some people suffer for political causes or for their children or in order to produce a great work of art, I suffered for absolutely no reason at all.

But, of course, I did learn some things. Maybe I would’ve learned them even if I’d had a more normative emotional experience, but right now it really seems like I learned them as a result of being so miserable a lot of the time. And while I reserve a very special fury for those who implore us to create meaning out of meaningless suffering and produce “lessons” and “silver linings” and “bright sides” carefully repackaged for their consumption, I think these are lessons that are worthwhile to share.

Lesson 1: Not everything your brain tells you is accurate.

Most people, I think, go through life without giving much thought to whether or not their perceptions are providing them with the most accurate possible picture of reality. But sometimes our brains are pretty crappy at this. Of course, I would’ve learned that without the help of depression, because I study psychology. So I’ve known for a while about stuff like the fundamental attribution error, the halo effect, anchoring, confirmation bias, the Dunning-Kruger effect, the false-consensus effect, the just-world hypothesis, in-group favoritism, the hot-hand fallacy, the Lake Wobegon effect, status quo bias, and all sorts of other biases, fallacies, and errors.

But what really brought it home was depression. While the cognitive errors I’ve listed are generally adaptive and keep people happier, depression was the opposite. Instead of telling me that people like me despite evidence to the contrary, my cognitive distortions told me that everyone hates me despite evidence to the contrary. Rather than telling me that I’m above-average in most things, they told me that I’m below-average in most things. On any given day I would invariably feel like the stupidest, ugliest, least likable, most worthless person alive. True story.

At some point it occurred to me that I would never recover if I didn’t learn how to treat what my brain said with a healthy amount of skepticism. So I started to. (Perhaps not coincidentally, this was the time in my life when my political views evolved the most, because I also started challenging my knee-jerk reactions to various issues in our society.) Of course, this is a lesson that is not limited to folks with mental illnesses, because everyone’s brain does this to them at some point. For many people, including some of those who proudly label themselves “skeptics,” thinking critically about what happens inside one’s brain does not come nearly as easily as thinking critically about what happens out there in the world.

So, for me, this meant a lot of time spent repeating to myself, “Yes, I feel like Best Friend hates my guts, but that’s just a feeling and it’s not necessarily true” and “Yes, not getting that internship makes me feel like I’m a complete failure who will never amount to anything in her chosen field, but that’s just my brain lying to me again” and “Yes, Partner wants to see their friends rather than me tonight, but this doesn’t mean that Partner doesn’t care about me and doesn’t want to keep seeing me anymore.”

Pause, rewind, repeat, and there you have my recovery.

Lesson 2: Your feelings are valid.

Does this seem like a contradiction to the previous lesson? It’s not. Unfortunately, when confronted with the apparently irrational emotions of others, many people immediately jump to the conclusion that those emotions are WRONG. (These people should never try to be therapists.)

However, just because someone’s emotions do not seem like a “rational” response to what they’re going through, that doesn’t mean there’s no reason for them. That reason can be whichever complicated and still-misunderstood brain processes cause depression. It can be that those are the emotions they saw expressed in their families growing up, and learned to mimic at an early age. It can be that last time this sort of thing happened, it ended terribly and now they’re freaking out over this seemingly minor thing because it could end that badly again. It can be that what’s currently happening to them is reminding them of something else entirely.

Or it could be for any number of other reasons that you do not know, and that the person having the “irrational” feelings might not know either. So why assume?

It’s important to remember, too, that there tends to be a pattern to the emotions we decide are “irrational” and “inappropriate” in others. Anger from a woman or a person of color is perceived differently than anger from a white man. Sadness from a woman is perceived differently than sadness from a man. Archetypes like the Angry Black Man and the Hysterical Woman are sometimes so deeply ingrained that we don’t even notice ourselves applying them.

But all emotions are valid. Some are less adaptive than others, some we want to change, some can contribute to unacceptable behavior if we don’t address them, yes. But they’re all valid, and telling others (or ourselves) that some emotions are not okay to have doesn’t help in changing them.

Lesson 3: Sometimes you have to keep your mental health in mind when making decisions.

This is the one I’ve resisted the most. I had to quit studying journalism because it was giving me panic attacks, and I chose not to pursue a PhD in part because I didn’t think I could handle it emotionally (well, and because the thought of it just bored me). When it comes to my personal life, my mental health is a big part of the reason I gave up monogamy, although I’m now glad I did for many other reasons. It’s also part of the reason I never studied abroad, gave up many other opportunities, and chose to move to NYC.

When I first started to realize that mental health is a factor that I need to consider when making decisions about my academic, professional, and personal life, I felt abandoned and betrayed by my own brain. I understood intuitively that sometimes you can’t do things because they require physical traits or abilities that you lack or because you don’t have the cognitive skills or because you just lack access to those opportunities. But to have all those things and still give something up just because my brain doesn’t like it? That seemed ridiculous.

In fact, that way of thinking is just an extension of the stigma of mental illness. Just as we think that mental illness isn’t really “real,” we think that mental health isn’t really important. It’s reasonable, we think, to choose not to live in Florida because you can’t deal with the weather or to choose not to go running because it’s too hard on your knees or to choose not to be a physicist because you can’t do math worth a shit, but not getting a PhD because grad school would make your depression relapse? Not being a journalist because interviewing people gives you panic attacks? Not studying abroad because being away from people you love makes you suicidal? What the hell is up with that. Just deal with it.

So for a long time I did stuff that made me miserable because I was fighting so hard against the notion that mental health is something you need to take care of and cultivate, just as you would with your physical health. But one of the most important things I’ve learned how to do in college is knowing when to say “no” to things that sound fantastic but might break down the levees I’ve built up to keep the depression from flooding in.

Of course, sometimes it still makes me furious. I recently gave up a great opportunity for that reason; I badly wanted to do it but every time I thought about actually doing it, and the sacrifices it would entail, I broke down, sobbing, paralyzed, unable to say yes or no to it. Eventually I finally turned it down, full of resentment at myself and my useless brain, but trying to understand that my reason was a good one and that I deserve permission to make this choice.

Now, naturally, there are those who would tell me to Just Do It! and Get Out Of Your Comfort Zone! and blabbityblahblah, but those people will just have to trust me when I say that I know the potential dangers much better than they do. Mental illness is a whole ‘nother ballgame. When I want to Get Out Of My Comfort Zone! I try getting to know someone new or reading something I disagree with that makes me a bit uncomfortable. When I move to NYC, I can Get Out Of My Comfort Zone! by joining new groups or going to events where I don’t know people and seeing what happens.

That’s getting out of my comfort zone. Ignoring the fact that I have important needs when it comes to my mental health, though, is not “brave” or “spontaneous” or “gutsy.” It’s just irresponsible, just as it would be irresponsible go ride a motorcycle without a helmet or to not wash my hands during flu season.

So give yourself permission to treat your mental health with the care and concern it deserves. Of course, you might be aware that doing something could make your mental health worse and choose to do it anyway for any number of reasons, and that’s completely fine, too.

But so many of us struggle merely to accept the idea that it’s okay not to do things for the sole reason that they might worsen our mental health, and that’s something we have to overcome.

Brute Reason

Care and responsibility.

mental illness