suicide

Reaching Out for Support When You Have a Mental Illness

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[Content note: mental illness]

After having written tons of posts about supporting people with mental illness, I realized that there was a gap–I’ve seen few articles about how to reach out for support when you’re the one with the mental illness. Specifically, how to do so in a way that’s respectful of people’s boundaries.

This is a difficult topic, for reasons that I think are obvious. I don’t want to discourage anyone from reaching out for help, ever. I also want to encourage people to be mindful of others’ needs and boundaries, even when everything hurts so much that that feels impossible to do. Especially then.

Why do these two goals feel like they stand opposed to each other? They shouldn’t. Getting affirmative consent before sharing difficult and potentially-triggering things with people isn’t just good for them, it’s also good for you. Most of us who struggle with mental illness have our moments of panic about imposing on others or being a burden on them. Making sure that we’re actually getting their consent before leaning on them for support can help us with those feelings.

I’ve been on both sides of this. I’ve been the depressed and suicidal person who had to reach out for help, sometimes in ways that didn’t really allow people to say no. I’ve also had people reach out to me in ways that made me feel trapped and coerced. So I think I have a lot of empathy for everyone in both of these situations.

This is a huge topic and this post is very long, but it still doesn’t cover all the nuances. This post is focused on the issue of consent and boundaries specifically, so please don’t be too disappointed if it doesn’t cover everything you thought it would. Suggestions for future posts are welcome as always.

Consent, Consent, Consent

The most important thing about reaching out to someone for support with a mental health issue is to explicitly ask for their consent to have this conversation. This means that, rather than sending them a sudden wall ‘o’ text on Facebook, you might first say, “Hey, can I vent to you about depression for a bit? You can respond whenever you have a moment.” Or in person, if the topic hasn’t come up organically in a way that suggests that they’re ready to hear about it, you might say, “Can we talk about some ED stuff I’m going through right now?”

If you want to talk to someone about things that are fairly likely to be triggering–examples include self-harm, suicidal ideation, eating disorders, homicidal ideation, and so on–it’s a good idea to include a content note. In a message or text, that can just look like “TW: anorexia”; in person, you might say, “Can I talk to you about some eating disorder issues I’m having. I might get into detail.” This is important because 1) the person you’re talking to might have their own issues, which you may not necessarily know about; 2) they may be in a space right now where seeing a sudden wall of text about a very serious topic might really stress them out; and 3) regardless, people can often help you better if they have some idea of what you’re going to talk to them about, especially when it’s something pretty serious like that. When I see “Hey, can I talk to you about anorexia?”, I put myself in a different headspace than when I just see “Hey, can I talk to you about some stuff?”.

When you message someone to talk to them about Heavy Stuff and do not give them a warning about the content or an opportunity to politely bow out, understand that you are making it very difficult for them to say no to you, especially if they’re not someone who feels comfortable asserting boundaries (and most people aren’t). You may not intend to make them feel this way, but that’s the effect it often has when you don’t check in to see if it’s okay first.

I’ve gotten sudden walls ‘o’ text while in class, while on dates, when I was just about to fall asleep in bed, while finishing an assignment on deadline, and all sorts of other inopportune times. It put me in a serious bind, because on the one hand I had a really serious message demanding my attention, and on the other hand, I had things that I needed to be doing. When someone suddenly sends me five paragraphs about having an eating disorder and being suicidal, it feels incredibly wrong to say, “I’m really sorry, but I’m busy right now and can’t talk.” I usually do it, but that’s only because I’ve developed very strong boundaries over the years. Most people haven’t.

Another way that you may unintentionally make it difficult for people to set boundaries is by getting their consent for a certain type of conversation (“Hey, got a minute to chat?”) and then, once they agree, making it clearly way more than a minute and more than just a “chat” (“So I’m really really depressed and I think I’m about to lose my job and I just don’t know what to do, I’m almost out of savings and–“). Phrases like “got a minute to chat” and “hey what’s up” are vague, sometimes intentionally so. Once someone gets into a conversation with you, it’s almost impossible to then be like, “Um, actually, I thought this would just be a casual chat; I’m not really available for a conversation like this right now.”

If someone tells you that no, they cannot talk/listen right now, respect that answer, even if it feels unfair or unreasonable. They may in fact be lazy. They may in fact be selfish and callous. They may in fact completely not understand what you’re going through and if they did then they’d listen. They may in fact just be shallow people who want everything to be sunshine and daisies all the time. They may be all of those things, but they still deserve to have their boundaries respected.

The Importance of Being Specific

Consent is one reason why, when you’re reaching out to someone for support, it can be helpful to be as specific and clear as possible about what you need from them. (I say “as possible” because that can be really difficult when you’re in a moment of crisis.) If they know what they’re being asked to do, then they can actually consent to it. But taking a moment to think about what you need from others right now will help you, too–it’s easier to get what you need if you know what that is and ask for it:

“Hey, I need to just vent at someone about some depression stuff. Would you be able to listen for a bit?”

“I’m feeling down and it would be helpful to distract myself. Could you come over and play video games with me?”

“I’m feeling unsafe tonight. Is it ok if I spend the night at your place and just do my own thing with someone else in the room?”

You may, like me, be concerned that if you let people know you’re having a hard time, they’ll try to offer you types of help that you don’t need. In that case, it can be a good idea to be clear about what you’re not looking for, too:

“I’m going through a really rough time. I don’t really want to talk about it, but could we just chat for a while about something else?”

“I’m having a really bad day. I’m not really up for talking to anyone, but could you send me some cute animal videos?”

What if you want support but have no idea what would help? In that case, being specific is clearly impossible. I think it’s better to be transparent and say something like, “I’m feeling really bad and to be honest I don’t know what would help right now. I just wanted to reach out to someone.” Hopefully, your support person might have some ideas about how to help or what to say.

The reason this sort of transparency is helpful is because otherwise, the person might assume that you do need something specific and you know what that is, but that they need to somehow intuit it. Or they may ask you what they should do, which can be stressful for you to have to respond to.

As a more long-term strategy, though, it might be helpful to try to figure out what other people can do that would help you feel better, so that you know what specifically to ask for from them. If you have a therapist, they can help with that project. If not, you can ask others who struggle with similar issues (maybe on a support forum if you don’t know anyone personally) what works for them. Just because you have similar issues doesn’t necessarily mean the same things will work for you, but there’s a good chance you’ll find something.

Why This Can Be So Hard

Back to the issue of boundaries. For many of us, the pain of mental illness is so strong that it’s hard to empathize with someone who says it’s too much for them to hear about. Resentment can build. You think: “They can walk away from this conversation, but I have to live with this my whole life.” When someone is unable to listen to us talk about how awful we’re feeling, that can kick up those feelings of resentment.

But just as we ask our friends, partners, and family members not to take it personally that we have a mental illness, we should try not to take it personally when they have their own feelings and limits. There’s a reason psychologists have a concept called “vicarious traumatization,” and a reason why therapists and social workers have such high burn-out rates. Of course, you may not be asking them to do anything close to what a therapist does, and they may not experience it as “traumatization,” but the point is that being very close to someone’s pain can have an impact. In addition, your support people may be dealing with their own mental health issues, which you may or may not know about. They may want to listen to you, but may be unable to because of what it brings up for them.

One last thing I want to say about this is that for me personally, depression made it really difficult to see how my own pain was hurting others. I don’t mean in that awful way that we talk about, where people take our pain as a personal insult or expect us to be happy all the time. I mean that seeing someone you love in pain hurts. Legitimately. But when I’m depressed, I think I’m so awful that I don’t understand how anyone could possibly care that I’m hurting–even though I reach out to them with the hope that they’ll listen. (Mental illness causes many such contradictions.) And when they say that they care so much that it’s really difficult for them to hear about it, it sounds like they’re insulting and patronizing me, presumably to “get out” of having to listen to me. That this perception is often wrong is something that I had to recover from the worst of it before I could understand.

Self-Forgiveness

Reading this, you may realize that you have overstepped boundaries in the past. (Or maybe you already knew this.) Mental illness can make people feel like they’re horrible and deserve to die, and realizing that you have overstepped boundaries may exacerbate this.

Try to be gentle with yourself. Mental illness can provoke boundary-crossing behavior, and while it’s important not to use this as an excuse not to work on it, it also means that you’re not a terrible person, and you can get better–both in terms of boundaries and in terms of your symptoms themselves.

Talking about this issues presents what The Unit of Caring refers to as a competing access needs problem. Some people will really benefit from this advice. Some people may already be so terrified of violating boundaries that they almost never ask for the help they need. (This may be surprising given that I wrote this post, but I’m squarely in the latter group.) Mental illness also complicates matters in that people may simultaneously be excessively terrified of crossing boundaries, while also sometimes crossing boundaries!

If you feel that implementing this advice will do harm to you, then don’t implement it. However, I would posit that it would actually be helpful for most people, because my core message here isn’t “You should be Very Very Careful about not violating anyone’s boundaries,” but rather “Hey, here’s how to reach out for help in a way that respects people’s boundaries.”

Supportive People Who Aren’t Really

One reason you may be terrified of crossing boundaries is because you may have done your due diligence and followed all this advice and then still had people tell you that you’ve overwhelmed and burdened them and they never wanted to help you this much but felt obligated to. There’s a lot going on here, such as:

  • Poor boundaries on the part of those people
  • People being used to passive communication and reading unspoken messages into your words that you never put there (such as, “If you don’t help me I will hate you/hurt myself/etc”)
  • A duty-centered view of relationships (believing that being your friend/partner/family member obligates them to help you whether or not they want to or can safely do so)
  • Simple ableism: believing, however implicitly, that your mental illness makes you so weak and helpless that they are ethically obligated to help you, no matter at what cost to them

The plentiful existence of people who act in these ways makes it difficult to talk about boundaries and mental illness. If we’re constantly accused of being burdensome and asking for too much no matter how careful we are, that can easily obscure the fact that sometimes we really do reach out to people in ways that make them feel like they can’t say no. But remember: both of these things can be true, and are true. They sound contradictory but are not.

There’s no simple way to fix this problem. If you’re not sure whether or not you’re being mindful of boundaries, it might be worthwhile to consult a friend that you trust to be honest and ask them for feedback. And if you notice that there are people in your life who keep telling you that it’s okay to vent about your feelings or to ask them to take you out for ice cream but then it turns out that they never wanted to help you and only did it out of a sense of obligation, it might be time to downgrade these people from “friend that I ask for mental health support” to “acquaintance that I talk about Marvel films with.”

Whatever their reasoning for not being honest (or not being aware enough of their own needs to be able to be honest), it’s not a healthy dynamic. It’s the sort of dynamic that leads many of us to feel like such awful burdens all the time. It’s the sort of dynamic that can make it really difficult to take this blog post seriously, because if people are constantly calling you a burden when you’re not, you may not be able to recognize the ways in which you might actually be crossing boundaries.

Of course, supportive people are difficult to come by and it can feel counterintuitive to stop going to these people for support when they seem to be acquiescing. (And if you ever feel like it’s a matter of life or death, please, do whatever you need to do to keep yourself safe.) But they’re not, in fact, supportive people. If they were, they would properly set boundaries with you in a way that’s compassionate but still assertive. Pretending to consent and then blaming you for believing them is an unkind and unsupportive thing to do.

~~~

If you are in crisis and do not feel safe, and none of your support people are available to talk to, please call 911, go to the ER, or call one of these hotlines if you don’t feel safe doing the first two things:

  • National Suicide Prevention Lifeline
  • The Trevor Project (for LGBTQ youth)
  • Trans Lifeline
Reaching Out for Support When You Have a Mental Illness
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Why We Should Ban Conversion Therapy

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[Content note: suicide, transphobia, abuse]

I wrote this article for the Daily Dot about conversion therapy. Please note that I did not write and do not endorse its headline as it appears at the Daily Dot.

At the close of a year that saw both incredible gains for transgender people and a number of tragic acts of transphobic violence, 17-year-old Leelah Alcorn, a trans teen from Ohio,committed suicide on Sunday. In a note that she had preemptively scheduled to post on her Tumblr, she described the bigotry she had faced from her parents, who tried to isolate her from her friends and the Internet as punishment. They also sent her to Christian therapists who shamed her for her gender identity.

In response, the Transgender Human Rights Institute created a Change.org petition on December 31. The petition asksPresident Obama, Senator Harry Reid, and Representative Nancy Pelosi to enact Leelah’s Law to ban transgender conversion therapy. Less than two days later, the petition has already gained 160,000 signatures and made the rounds online. It may be the most attention that conversion therapy has gotten outside of activist circles for some time.

Aside from LGBTQ activists, secular activists, and mental healthcare professionals seeking to promote evidence-based practice, not many people seem to speak up about conversion therapy, or understand much about it. Most discussions of it that I come across deal with therapies that attempt to “reverse” sexual orientation from gay to straight or to eradicate same-sex attraction. However, conversion therapy also includes practices aimed at transgender people with the goal of forcing them to identify as the gender they were assigned at birth.

In her suicide note, Alcorn wrote, “My mom started taking me to a therapist, but would only take me to Christian therapists (who were all very biased), so I never actually got the therapy I needed to cure me of my depression. I only got more Christians telling me that I was selfish and wrong and that I should look to God for help.” Although she did not elaborate further about her experience in therapy, it’s clear that the treatment goal was not to help Alcorn reduce her risk of suicide, accept herself, recover from depression, or develop healthy coping skills that would help her stay safe in such an oppressive environment. The treatment goal was to force Leelah Alcorn to identify as a boy and to fulfill her parents’ and therapists’ ideas about what being a Christian means.

This is not mental healthcare. This is abuse.

Read the rest here.

Why We Should Ban Conversion Therapy

Towards A Better Conversation About Mental Illness

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This is my latest for the Daily Dot, about how we can discuss mental illness more accurately, productively, and compassionately, particularly in the wake of tragedies like Robin Williams’ suicide.

After comedian Robin Williams committed suicide two weeks ago, fans took to the Internet to express their grief, as well as their admiration for his work. Whenever a beloved celebrity passes away, regardless of the cause, social media temporarily becomes a sort of memorial to that person, a chronicle of the ways in which they changed lives.

However, when the cause is suicide, a celebrity’s death also brings out lots of dismissive, inaccurate, or even hateful statements about people with mental illnesses. According to some, Williams was “cowardly” and “selfish” for committing suicide. Last week, Musician Henry Rollins wrote an op-ed for L.A. Weekly (for which he apologized over the weekend) in which he said that he views people who commit suicide with “disdain,” claiming that Williams traumatized his children. There was plenty of rhetoric about suicide being a “choice,” the implication being that it’s the wrong choice.

Comments like these not only misinform people about the nature of mental illness, but they are also extremely hurtful to those who struggle with it. As the Internet continues to respond to Robin Williams’ death, here are some suggestions for a better conversation about mental illness and suicide.

1) Do your research.

We all have a “folk” understanding of psychology, which means that we experience our own thoughts and feelings, interact with other people, and thus form our opinions on psychology. Obviously, noticing things about ourselves and the people around us can be an important source of knowledge about how humans work.

But it’s not enough. If you haven’t had a mental illness, you can’t really understand what it’s like to have one—unless you do your research. Depression isn’t like feeling really sad. Anxiety isn’t like feeling worried. Eating disorders aren’t like being concerned about how many calories you consume. Your own experiences may not be enough.

Before you form strong opinions about mental illness and suicide, you need to know what mental illnesses are actually like, what their symptoms are, what treatment is like, what sorts of difficulties people may have in accessing treatment or making it work for them. If you can make tweets and Facebook statuses about a celebrity’s suicide, you can also do a Google search. Wikipedia, for all its drawbacks, is a great place to start. So are books like The Noonday Demon and Listening to Prozac.

2) Never engage in armchair diagnosis.

Now that you have a good idea of what different mental illnesses look like, you should try to figure out who has which ones, right?

No, please don’t. Armchair diagnosis, which is when people who are not trained to administer psychiatric diagnoses try to do so anyway, is harmful for all sorts of reasons that Daily Dot contributor s.e. smith describes in a piece for smith’s personal blog:

The thing about armchair diagnosis is that it mutates. First it’s a ‘friend’ deciding that someone must have bipolar disorder because of some event or another. Over time, that’s mutated into an ‘actual’ diagnosis, repeated as fact and accepted. Everyone tiptoes around or gives someone sidelong glances and makes sure to tell other people. Meanwhile, someone is completely puzzled that other people are treating her like she’s, well. Crazy.

Whether the person you’re talking about is a celebrity or not, it is up to them whether or not to make public any information about their health. Mental health is part of health. While having a mental illness should never be stigmatized, unfortunately, it still is. People deserve to decide for themselves whether or not they are willing to disclose any mental illnesses they may have.

Even if someone commits suicide, that doesn’t mean we can come to any conclusions on which mental illness they had or didn’t have. First of all, not everyone who commits suicide could have been diagnosed with any mental illness just prior to it. Second, various mental illnesses may lead to suicide. Many online commentators, including journalists, simply assumed that Williams had depression. However, he may have also had bipolar disorder, in which depressive episodes are interspersed with manic ones. Williams himself never stated which diagnoses he had, so it’s best not to assume. Whatever he had or didn’t have, it is clear that he was suffering.

Read the rest here.

Towards A Better Conversation About Mental Illness

Are Celebrities Responsible for Modeling Good Mental Health?

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[Content note: depression, mental illness, suicide]

My newest piece at the Daily Dot is about Lana Del Rey, mental illness, and what we expect from artists and celebrities.

Singer Lana Del Rey has recently reignited an age-old discussion about the glamorization of depression and suicide among (and in) young musicians. In a Guardian interview she has since tried to distance herself from, Del Rey focused on death:

‘I wish I was dead already,’ Lana Del Rey says, catching me off guard. She has been talking about the heroes she and her boyfriend share—Amy Winehouse and Kurt Cobain among them—when I point out that what links them is death and ask if she sees an early death as glamorous. ‘I don’t know. Ummm, yeah.’

[…] It’s unlikely that statements like Del Rey’s actually make anyone go, “Huh, maybe I should try killing myself.” However, they can be harmful because they perpetuate norms that discourage seeking help and prioritizing mental health. Del Rey certainly isn’t single-handedly responsible for this, by the way—mental illness has long been associated with artistic brilliance, glamour, and even sometimes sexual desirability. Some believe that you can’t really be a great artist unless there’s something very wrong with your brain, but I think that’s largely confirmation bias. If you think that artists must be crazy, you’ll pay extra attention to the ones that are and little attention to the ones that aren’t.

We tend to expect that when artists go through difficult times, their way of coping is to make art about it. (Neil Gaiman gave a beautiful speech about this.) Making art can indeed help people deal with all sorts of adverse circumstances, including mental illness, but sometimes it’s not enough. Luckily, some artists, musicians included, have spoken out about seeing therapy and medication when they needed it—not an easy thing to do in a society where mental illness is still stigmatized and being a celebrity means having your private life constantly scrutinized and sold as entertainment.

On the other hand, I’m also leery when celebrities are expected to be “role models” and to demonstrate positive, healthy behavior to the children and teens who look up to them. It would certainly be nice if, when interviewed about her moods, Del Rey said something like, “I’ve been going through a hard time and dealing with lots of sadness, but I’m seeing a great therapist and taking good care of myself.”

But holding her responsible for the mental health of hundreds of thousands of young people is unfair and hypocritical. Del Rey’s young fans would benefit a lot more from seeing their own parents model good self-care, but we don’t encourage that in parents any more than we do in glamorous singers. Instead, we shame people who take poor care of themselves, and we shame people who are open about seeking therapy.

Read the rest here.

Are Celebrities Responsible for Modeling Good Mental Health?

[repost] At The Edge Of The Known World: What It's Like To Consider Suicide

Miri, , , , 13 Comments

[Content note: depression and suicide]

Today is World Suicide Prevention Day. I wrote this post for it a year ago, and I decided to repost it today because I still think people should read it and I doubt I could write another one that’s better.

Somebody, somewhere in the world, kills themselves every 40 seconds.

Set a timer on your phone or watch for 40 seconds. When it beeps, another precious, beloved life is gone.

Yesterday, September 10, was World Suicide Prevention Day. Although suicide prevention entails important things like improving mental health screening and treatment, increasing access to mental health services, and decreasing the stigma of admitting and treating mental health problems, I think there’s another part that we usually miss when we talk about prevention. And that part is understanding what being suicidal is really like.

Those who kill themselves (or wish to do so) are not selfish.

They are not weak.

They are not simply having a bad day.

All of these tropes about suicide, and many others, are wrong.

I can only speak for myself, not for any of the other millions of people who have struggled with this most ultimate of dilemmas. But for me, at least, here’s how it was.

 

I don’t think I ever wanted to be dead.

I have, however, wanted not to be alive.

Why? Because living sucked, because I hated myself, because everyone else must surely hate me too, because I was a burden, because I was going to be alone forever, because I was like an alien that was accidentally born on the wrong planet, to the wrong species, in the wrong society. Killing myself would be like correcting a cosmic error.

There were many ways I dreamed about it happening. Pills of some sort would’ve been my first choice, although I was absolutely terrified of what would happen to my body if they failed to kill me. (Go figure, I was terrified not of dying, but of failing to die.)

But I wanted to be able to take the pills and lie down somewhere and just curl up until I stopped feeling forever.

Sometimes I also thought about bleeding to death by slashing my wrists or something. But I despise pain above all else, and also, poetic as it would be, the thought of someone I love finding me that way made my guts churn. Also, could I actually do it? Could I actually take a knife and slice open my own skin?

I doubted it.

Jumping off of a building occurred to me a lot, especially at the very beginning of my love affair with suicidal ideation. That was back when I was studying journalism, panicking constantly, and feeling just about ready to do anything to escape. Was the journalism building high enough? If not, what would be?

And then there were the trains. Living in Chicago, you take them a lot. Every time I stood on the El or Metra platform as a train rolled in, I thought about it. Not seriously, as I’d made no plans and written no note, but the thought did occur. The rails screeched, and gust swept into my coat and rattled my bones. How I hated standing on the platform, forced to imagine my own death graphically every time a train rolled in.

Recently, when I was already better, I was waiting on the platform for the Metra. A train was coming. It turned out to be an express train that barreled through the station without stopping. The blur, the clamor, the sudden slap of wind–I was left shaken for several minutes after it passed, imagining what that could’ve done to my body.

Strangely, I never even considered guns, although that is what a character in my abandoned novel chose to use.

I composed many different suicide notes in my mind. Some were lengthy and elaborate, with separate sections for each person I wanted to reckon with before I died. I used to keep secrets and grudges for years, and I wanted everyone to know the truth in the end. (These days, I try to make sure that if I suddenly die today, little will have been left unsaid.)

Other notes were simple. They contained nothing more than a quote or a song lyric. Often they included an apology to my family. I thought about writing it in Russian, not English, as though that would make it any better for them.

I also thought about not leaving a note, but something about that made me very sad. What if they never knew? But might that not be better?

And I could not stop listening to that OK Go song, “Return“:

You were supposed to grow old.

You were supposed to grow old.  

Reckless, unfrightened, and old,

You were supposed to grow old.

I never made a firm plan to kill myself, I never attempted to kill myself, and, obviously, I never did kill myself. The only reason, I think, was because I cared more about my family’s wants and needs than I did about my own. As much as I thought I needed to stop living, they needed me to continue living, and so I did.

Is this “normal”? Do others talk themselves out of suicide this way? I have no idea. This isn’t really something I talk about over beers with friends.

I was lucky, when it comes down to it. Lucky to have a family I love so fiercely that that love overpowered my hatred for life.

Death and I, we have an awkward but strangely comfortable relationship now. If I don’t bother with her, she doesn’t bother with me. I don’t fear death itself very much, although the idea of just not existing terrifies and baffles me, just like the idea of time travel or parallel universes or the butterfly effect.

Sometimes I feel as though I’ve traveled to the edge of the known world, teetered on that edge, and then shrugged my shoulders and returned. I can’t really tell you exactly what I saw there, but I will say that there is a thick glass wall now between me and those who haven’t made that journey.

I say to a dear friend as I write this, “I’m thoroughly desensitized to the thought of myself dying.”

“I’m not,” she says. “You should stay here and grow crotchety and gray. Perhaps even collect spiderwebs.”

“I love you,” I say.

“I love you, too.”

For better or worse, I will live with what I saw at the edge of the known world until I die what I hope will be a natural death.

[repost] At The Edge Of The Known World: What It's Like To Consider Suicide

Living With Depression: Hope

Miri, , , , , 19 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.

Living With Depression: Hope

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

Miri, , , , , , 26 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.

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

Who Is To Blame For A Suicide?

Miri, , , , , , , , , , , , , , 18 Comments

Yesterday I was driving around in my hometown and listening to the radio. The DJs did a segment on the suicide of Jacintha Saldanha, a nurse in a hospital where Kate Middleton was being treated, who was pranked by some radio DJs and tricked into giving out Middleton’s medical information.

The DJs on my hometown station put a caller through and asked for her opinion. She said that it’s not at all the DJs’ fault that Saldhana clearly had issues and that they shouldn’t have lost their jobs because of what happened. Furthermore, it was “irresponsible” of Saldhana to kill herself and leave this whole mess behind.

Lesson one: never listen to the radio in Dayton, Ohio.

Lesson two: people have a lot of trouble with grey areas and blurry lines.

(Of course, I mostly knew both of these things already.)

It seems to be very difficult for people to form an opinion on this tragedy that isn’t extreme. Some say that the DJs were just doing their jobs, the prank was completely harmless, just a bit of fun, and Saldanha was messed up and crazy. Others say that the DJs are terrible people and should be blamed for Saldanha’s suicide. The latter seems to be the minority opinion.

I don’t think that the truth always lies between two extremes. In this case, though, I feel that it does.

Suicide is a complex phenomenon and the suffering that causes it–and that is caused by it–makes it even more difficult to comprehend. A particularly painful fact that the friends and families of people who kill themselves sometimes have to face is the fact that suicide often has a trigger. Sometimes, that trigger is other people.

I remember reading a young adult novel called Thirteen Reasons Why a few years ago. The novel is very serious for a YA book, and the premise of it is that a teenage girl, Hannah, has killed herself and left behind a set of audio recordings in which she explains to every person who was implicated in her mental troubles what it was that they did.

One was addressed to a guy who found a poem she wrote and spread it all over the school. Another was to a guy who took photos of her through her bedroom window. By the end of the book you get a picture of a girl who was just completely used and marginalized by almost everyone she interacted with.

And yet–this is the part that some readers, judging from the reviews, didn’t get–Hannah is not supposed to be a wholly sympathetic character. You’re meant to feel sorry for her, but her actions are meant to make you uncomfortable. The tapes she leaves behind seem a bit vindictive. And at the end you learn that two of the major triggers for her suicide were that she failed to stop a rape at a party and that she allowed her friend to drive drunk–and hit and kill someone.

So, who’s to blame for Hannah’s suicide? Her classmates were cruel, yes. But they didn’t know what she was going through. And she could’ve saved herself a lot of guilt had she intervened and stopped the rape and the car accident, but can you really expect a terrified teenage girl to do that?

The point of the book, to me, is this: you can’t blame anyone. It’s comforting to think that you can, but you just can’t.

Similarly, the Australian DJs who pranked Saldanha could not have known what would happen. In fact, even now we don’t really understand. Although she reportedly left a suicide note, we don’t know what it says, and we don’t know what kinds of personal struggles she might’ve had leading up to her death. To their credit, the DJs have said that they’re heartbroken and sorry.

But blaming Saldanha is sick and cruel.

And while I don’t blame the DJs for her death, I still think they shouldn’t have done it.

The thing is, we live in a world that presumes that everyone is “strong” and mentally healthy and capable of dealing with whatever life throws at them without falling apart. This is why people like Saldanha are blamed and exhorted to “just work on their issues,” even after they’ve died.

We assume that people are always capable, for instance, of refusing repeated sexual advances, ignoring social coercion and proselytism, dealing with mental health issues without ever being taught how, overcoming pervasive racial inequality, facing the humiliation (and, sometimes, terror) of street harassment, suffering through targeted online hate campaigns, refusing to believe it when magazines tell them they must be thin, and so much more. We expect them to do all this without anger, because anger is “counterproductive.” So, of course, is mental illness.

We expect people to conform to an ideal that includes emotional strength, confidence, and resilience, and we refuse to concede that few people are able to live up to this ideal all of the time. How much do we expect a person to bravely, stoically handle? I’m not sure there is a limit.

The DJs assumed, whether consciously or not, that Saldanha would either see through the prank or be able to deal with the international attention she would receive for falling victim to it. As it turned out, she was not.

At The Daily Beast, Kent Sepkowitz writes:

With the recent focus on bullying sparked by suicides of young people who were hectored as outcasts, a new or newly articulated risk factor for suicide has gained currency: humiliation. Though certainly related to hopelessness and to real or threatened financial embarrassment, humiliation is its own very private experience, with its own equally private triggers. How and why certain events might brutally transgress honor and dignity in one person yet the same events barely touch the next, remains inscrutable. In this particular tragedy, it seems a sense that she was being publicly ridiculed—humiliated—somehow pushed Ms. Saldanha over the edge, an edge previously defined and maintained by her tremendous pride in her work.

Why do we expect people to deal with public humiliation for our own entertainment?

I would hope that rather than limiting the discussion to what these particular DJs should or should not have done, we expand it to talk about the exploitation and degradation that modern media thrives on. That these DJs would even think to go through such trouble to obtain someone’s private medical information is ridiculous. That there is a market for that information is ridiculous. I’ve long believed that celebrity gossip is unethical, but when it sets off a chain of events that ends in a suicide, that becomes even more apparent to me.

Not only is it impossible to blame any individual person in this awful story, but to do so would be to miss the point. Something in our culture–in the ways we relate to each other and in the ways we expect each other to be strong–is broken.

If I absolutely had to lay blame on something, it would be that.

Who Is To Blame For A Suicide?

Please Sign My Petition to Remove the "No Respect For Suicidal Teens" Facebook Page

Miri, , , , , , 23 Comments

[Content note: suicide]
Yup, I’m using my blog to promote something. But it’s a very important something.

In my blog post earlier today I mentioned this atrocious Facebook page, which cruelly mocks suicidal teenagers by calling them “selfish” and “ignorant” and inciting them to kill themselves. I had reported it to Facebook, and I just received this email in response:

“Thanks for your recent report of a potential violation on Facebook. After reviewing your report, we were not able to confirm that the specific page you reported violates Facebook’s Statement of Rights and Responsibilities.”

Now, clearly, this is some bullshit, because Facebook’s terms include the following:

“6. You will not bully, intimidate, or harass any user.
7. You will not post content that: is hate speech, threatening, or pornographic; incites violence; or contains nudity or graphic or gratuitous violence.”

This Facebook page is violating these terms by bullying, intimidating, and harassing teens who are suffering from mental illness and are considering taking their own lives. Furthermore, it certainly qualifies as hate speech against people with mental illnesses. The page also attempts to incite suicidal teens to kill themselves with posts that say things like “go drink some bleach,” and, unsurprisingly, it also contains racist material.

So I started a petition to get Facebook to take the page down. Please sign it here and share it.

The thought of a struggling teen stumbling across this page makes my stomach churn. I don’t care if it’s a “joke” or not; it should be taken down.

This is a small thing, but change begins by refusing to allow hatred and ignorance like this in our society, including on the websites we use.

Update: Thanks so much to everyone who signed the petition! The page is now gone. However, its creator left some comments over on Greg Laden’s blog and has made it clear that they intend to bring it back. Pretty unfortunate how vested in their hatred some people are.

Please Sign My Petition to Remove the "No Respect For Suicidal Teens" Facebook Page

The Problem With "Teen Angst" and Why You Should Take Teens' Mental Health Seriously

Miri, , , , , , , , 30 Comments

[Content note: depression and suicide]

There’s a disturbing and pervasive idea out there that the psychological troubles of teenagers are inconsequential and unworthy of attention because they’re just a part of “teen angst” or “growing up” or whatever.

I’m thinking about this now because last night I ran across this Facebook page. It’s called “No Respect For Suicidal Teens,” and please don’t click on it unless you’re prepared for the hateful victim-blaming that it promotes. (If you can, though, you should go and report it.)

First of all, it’s completely false that teens can’t “really” be depressed and suicidal. Although the age of onset for depression and bipolar disorder is most commonly in the late teens and 20s, many people report that their chronic mood disorder began when they were teens. (Count me among them.) Left untreated, mood disorders often get progressively worse, or they remit on their own but then keep recurring.

Painting all teenage mood problems in a single shade of “teen angst” can prevent teens with diagnosable mood disorders from seeking help, because they either second-guess themselves and conclude that what they’re experiencing is “normal” (read: healthy) or they try to get help but are rebuffed by well-meaning adults who tell them that this is just what adolescence is and that they’ll grow out of it.

And then, of course, they find that it doesn’t get better after adolescence, and sometimes they tragically conclude that they must simply not have “grown up” yet. (Again, count me among them.)

Second, mental issues do not need to have reached clinical levels to be unpleasant, troubling, and inconvenient. Any time you’re unhappy with some aspect of your emotions, moods, thoughts, or behaviors, that’s a good enough reason to seek help from a therapist. Seriously. Either the therapist will help you accept aspects of yourself that you’d been bothered by, or they will help you change those aspects. Whether or not those aspects have a fancy name in the DSM isn’t really relevant.

So a teenager whose emotional experience is characterized by “angst” can benefit from seeking help even if they don’t have a “Real Problem.” All problems are real; the fact that they can vary dramatically in scope and magnitude doesn’t make them any more or less so.

And what if every teenager needs help managing their mental health during adolescence? Doesn’t that mean we’re making mountains out of molehills and inventing problems where none exist?

Nope. Nobody thinks it’s weird that virtually every teenager (who can afford it) goes to a dentist and has their wisdom teeth checked and probably removed. Nobody thinks it’s weird that virtually every female-bodied teenager (who can afford it) starts seeing a gynecologist when they become sexually active. Nobody thinks it’s weird that people of all ages regularly get physicals and get their eyesight and hearing checked.

It is expected that everyone will need (and, hopefully, receive) treatment for some sort of physical ailment over the course of their lives. Yet the idea that even a sizable minority of people will need treatment for a mental problem still gets many people ranting about how we ought to just “snap out of it.”

Are some teenagers actually “over-dramatic” (whatever that even means)? Probably. But it’s hard to tell who’s being over-dramatic and who isn’t, which is why that’s a decision best left to a professional. I was constantly accused of being “over-dramatic” when I was a teenager. Not to put too fine a point on it, but everyone changed their minds very quickly once I became so depressed I could barely function and thought about suicide constantly. Perhaps that could’ve been prevented had I gotten help earlier rather than taking everyone’s analysis of my “over-dramatic” personality to heart.

If a teenager mentions or threatens suicide, take them seriously and help them get treatment. If they turn out to have been “over-dramatic,” a therapist can help them figure out why they threaten suicide hyperbolically and find a way to stop. That’s a therapist’s job, not a friend’s, teacher’s, or parent’s.

The belief that the thoughts and feelings of children and teenagers are not to be taken seriously is widespread and dangerous, and goes far beyond just mental health. It is far better to take someone seriously and get them help when they didn’t really need it than to ignore someone’s call for help and attention when they do need it.

The Problem With "Teen Angst" and Why You Should Take Teens' Mental Health Seriously