Wednesday, May 15, 2013

Understanding Depression: A Guide


In celebration of the triumphant return of Allie Brosh, I want to talk a little bit about my own experience with depression.

When I met my best friend in college, she had been dealing with depression for a long time. She was diagnosed during high school and had been taking anti-depressants for years; she is likely going to need medication for the rest of her life. Despite growing up around people who viewed mental health problems in general (and depression in particular) as a weakness of character and anti-depressants as a cop-out, my friend’s brilliant example of a rational approach to depression easily overwhelmed my inclination toward skepticism of the diagnosis and treatment. Even as I watched her cope with side effects (shaky hands, dehydration, dry mouth, odd sleep patterns, and so on), I learned to feel as comfortable with “mind drugs” as I did with “body drugs.”

I also observed what living with depression means. It means sleeping – a lot. It means having far less energy than those around you. It means making difficult, frustrating choices to take fewer classes or work fewer hours than you would otherwise be able to handle. As a friend of a depressed person, it means accepting many last-minute cancellations of plans. It means working around sudden, inexplicable fatigue or despondency. It means not taking it personally when your depressed friend doesn’t want you around.

I wish I could say I had a perfect record as a “friend of depression,” or at least a very good record, but that wasn’t the case. A canceled lunch would plant a seed of annoyance that would sprout a weed of frustration the next time a phone call went unreturned. If I wasn’t careful, the weeds could turn into a briar patch in which I’d lose both my patience and my sympathy. It was so inconvenient!

I can honestly say that I never doubted my friend. I absolutely believed her when she said she was tired, that it was too hard to wash a single spoon, that she needed time alone. But at the same time that I believed *her*, I couldn’t accept the *reality*. *Why* does it have to be this way? *Why* can’t she just push through it? *Why* does this huge inconvenience just drop into our lives with no visible cause, explanation, or ceremony? I rebelled against the idea the way an innocent mind rebels against the organized mass slaughter of the Holocaust – it didn’t fit with my personal experience of the human psyche.

I’ve heard that humans can’t actually form memories of pain. You can remember the circumstances of the pain, but as for the pain itself, that is lost. Perhaps this is why you can’t really understand a type of pain you haven’t experienced. I’ve heard many people describe the experience of breaking a bone, but having never done so myself, I simply cannot relate to it the way I can relate to being hospitalized for a sunburn or getting pepper-sprayed in the face. Depression – in a way, a type of pain – is similar. For all my exposure to it, my attempts to understand it, and my textbook knowledge about it, I just did not “get it” until I got it.

A little less than a year ago, I was diagnosed with depression. Now I get it.

Having been on both sides of the relationship, I want to try and give some guidance to those who are trying to support a friend with depression. I will do my best to explain what it feels like, including ways you can try to imagine it for yourself, and I’ll suggest ways you can help your friend and yourself. You won’t “get it,” but hopefully you will accept and understand it as best you can.

1. Yes, I really am *that* tired – It is impossible to overstate how tired depression makes you. At one point, I slept for an entire weekend. Not “staying in bed, but actually watching TV/playing on the computer/daydreaming” sleep, but actual, deep, African Sleeping Sickness-type sleep. It’s not a sleepiness that results from sleeping too much or too little. It’s not tied to what you did during the previous day or week or month. It’s just a constant fact of life.

Imagine: Start with the way you feel at the end of a long day, when you’re mentally exhausted. Only instead of night, it’s morning. Now feel that inside your neck, toward the back, beneath your ears, and forward into your skull, toward your brow-bone, are lead weights. The weights are pulling your head down, and you have to constantly work to keep it up. Then someone puts one of those lead bibs over your shoulders, the kind they use at the dentist when they X-ray your teeth. You wear this all day, every day. Just staying upright is a struggle. You wish more than anything that you could curl up wherever you are: on a couch, on the carpet, on the lawn, on the concrete floor of the parking garage. Maybe you actually do, when no one’s looking.

That’s what I would call a “good day;” on a bad day, I wouldn’t even sit up in bed.

2. Simple tasks become epic quests – This, I think, is the hardest to understand. We’ve all been tired, and we’ve all been sad, but only people with depression or tetraplegia know how difficult basic tasks can be. And I do mean basic. Here are just a few of the things that caused me to burst into tears, totally break down, or give up and go back to bed:
-Putting on a sock
-Combing my hair
-Discovering a missing button on a shirt
-Brushing my teeth
-Retrieving my cell phone from a table five feet away
-Spilling coffee (more on that later)

I don’t know why, but at one point or another, all of these tasks just required too much effort to even consider. For a person who defines “success” as “doing a lot of things in a day,” this is a bitter pill, indeed. But the real kick in the tits, to me, was the bizarre combination of being unable to feed yourself while still gaining tons of weight. After I was diagnosed, I did my best to set the bar low for myself. When dinner time came around, I was prepared to pat myself on the back for the simple act of eating food from a can. But at times I couldn’t even do that. If it wasn’t a one-step process, it was out of the question. I could handle taking something out of the pantry, but to take it out of the pantry *then* open a drawer *then* use the can opener *then* figure out how to heat the food (requiring either a microwave-safe container or a pot, either way having yet another cabinet to open), that just couldn’t be fathomed. With how hard all of that was, you can imagine how likely I was to go grocery shopping. Eventually I just didn’t eat, but I *still* gained weight.

Imagine: You need to fill a bucket with water from a river. Some of the people around you are just carrying their buckets to the river and dipping them in, but your bucket is nailed to the ground. Others have smaller buckets or big ladles, and they’re making a few trips back-and-forth to fill their buckets. You have a teaspoon. Yes, *technically* it’s possible for you to complete the task but the combination of the inherent difficulty and the comparison to those around you having a much easier time of it overwhelms and paralyzes you.

That’s basically the experience of a depressed person changing out of pajamas.

3. You don’t want anyone to know – Once I spilled a little coffee on my shirt while sitting in my office. I absolutely lost it. This was an insurmountable obstacle, this tiny spot on my sweater. After it took *so* much effort to get up that morning and *so* much more effort to actually put on clothes and get myself to work, now *this*?! Why did I bother? Why do I bother with anything? I can’t possibly deal with this situation. I could try to wash it off, but then my shirt will be wet and besides, washing the shirt will be at least a million times harder than putting it on was. To get another shirt, I’d either have to go home (impossibly hard!) or to the store (even more impossible and hard!). I could put on my spare shirt, but it’s ugly and doesn’t match everything else I’m wearing and I’m not really sure where it is anyway and also people saw me in the shirt I have on and if I change shirts now they will know that I’m such a fuck-up I can’t even drink a cup of coffee properly! And then they’ll know – oh god, they’ll know! They’ll know something’s wrong. Somehow I got away with staring at my screen all day, doing nothing at all between bouts of uncontrollable crying, but once this coffee stain becomes public, I’ll be outted as the pathetic loser that I am.

This is an absolutely real, word-for-word thought process that I went through. I wasn’t even clear on why I cared if people knew. I wasn’t afraid of being fired or of any particular consequences. It was simply the fact that people might know that paralyzed me. I can’t explain it, I can’t even understand it myself, but I have seen this phenomenon universally among depressed people. Ms. Brosh’s post aptly illustrates one facet of this: the attempt to interact with people in a normal, expressive way when your emotions are essentially turned off. You try to make yourself into an emotional Turing machine (input: sad story, output: frowny face), but like the T2000, it’s not quite right. All to perpetuate the fraud that you’re fine and everything’s normal.

If your friend trusts you enough to admit to being depressed, please respect that trust. Let him know that he doesn’t have to hide it from you. Tell him he doesn’t have to try to fake normalcy – and don’t freak out when he complies. It’s invaluable to have even one person around whom you can stop the charade.

4. You might not even know – My best guess is I was depressed for at least 8 months, possibly as long as a year, before I was diagnosed. Despite my familiarity with the condition (ha), I didn’t even consider the possibility. Constant fatigue and rapid weight gain eventually drove me to seek a medical opinion. What I got was Prozac.

It was shocking, to say the least, in large part because I felt (and still feel) that I had gone through much worse times in my life without becoming depressed. In fact the proximate cause of my depression seems to have been one bad manager at an otherwise enjoyable job. How pussy is that?

People seem to go through this strange process with depression. You’re sad, but then you look around and see that things are great. Since there’s no reason for it, you dismiss your sadness, assuming that it will go away. As you continue to be unhappy, you continue to reassess. Every time you find that things are great (My marriage is great! My job is great! I have money! I have legs!), you invalidate your negative emotions more. Eventually you cut your emotions out of the assessment altogether. You stop even considering how you feel and go straight to evaluating your circumstances. Then one day, a doctor or an old friend or a relative you haven’t seen for a long time asks you the big, bad question:

Are you happy?

No.

You answer without thinking, without evaluating – you answer honestly. Then the whole house of cards collapses. Maybe you cry, maybe you go dead inside, maybe you hate yourself or the person who forced you to see it, but no matter what, the jig is up. No more ignoring, no more avoiding, no more hoping it goes away. You stare into the abyss, and the abyss stares back.

What you need to know, friends of depression, is that this is the absolute hardest time. This is when the lone, fragile defense against the overwhelming despondency inside is broken. Your friend is going to feel like he’s failed. He should be happy, dammit! If you’re very close to him (a parent or lover, for instance), you’ll likely agree. You gave him everything, and he just threw it away by being unhappy! How could he be so unappreciative?

What you need to do – right in this moment – is make a decision: is the relationship important to you? If it is, then the *only* thing that matters is getting your friend healthy again. That’s it. Whatever got him to this point, whether his own mistakes or uncontrollable factors, is neither relevant going forward nor something you can accurately assess. Get him into therapy, and on meds, if necessary, and let the professional do the work.

The same goes for the treatment, or as friends like to call it “advice.” You wouldn’t try to set a friend’s broken leg, so why would you try to fix his depression? Your tips and tricks (“Go socialize! Get more exercise! Eat healthier!”) are not helpful, even if they happen to be valid, which frankly they probably aren’t. There’s a reason why you need a PhD before you can dole out such “tips” in a way that actually produces results.

What is helpful is to create a supportive environment. If you’re heading to the gym, invite your friend. Don’t pressure him, and don’t berate him if he says no, but make the offer consistently and casually. Do the same thing with social events or chores like grocery shopping. You should expect to be turned down more often than not, but eventually he’ll be ready, and when he is, it will help enormously to have the opportunity ready and waiting for him. He’ll be ready to attend a party long before he’s ready to throw one. Talk to those people with the fancy letters after their names and learn everything you can about depression, but use that knowledge to support your friend and help yourself, not to lecture or as leverage for your demands. Focus on going through the process with him rather than pitting yourself against him (or against his depression.) If you find yourself struggling to do all of this, consider seeing a therapist yourself. A point may come when it’s too much for you, and you have to end the relationship. If that happens, I recommend seeking a professional opinion on how to go about it.

This has been a bummer of a post, so let me leave with an update on the bat-eating centipede:
1. These centipedes are the largest in the world, growing up to a foot long. 
2. They live in Peru, so NEVER GO TO PERU. 
3. They have fully embraced the bat diet and have regularly been observed SNATCHING BATS OUT OF THE AIR.
Oh fuck.

God help us all,

S. Misanthrope

3 comments:

  1. Glad you are getting back on the right track!

    ReplyDelete
  2. Esters have a pleasant fruity smell

    ReplyDelete