On Depression (mine)

Hey! Thanks for reading! Just a reminder that I wrote this some years ago, and may have much more complicated feelings about this topic than I did when I wrote it. Happy to elaborate, feel free to reach out to me! 😄

Part of getting better about managing my depression is being open about it. Contrary to what I frequently told myself, it turned out friends and family do appreciate you going into details about this. I'll describe some topics about my depression, since you almost certainly have someone in your life who might like it if you knew more about it (like me!).

[Note that I'm only speaking from my own experience, and this doesn't apply to all depressed people. Depression affects everybody differently. None of this is properly medical or anything, just observations from my experience and conversations with others. I'll often speak in the collective ("we often...") but I only speak from what I know.

Also, trigger warnings for suicide, and depression.]

What is depression and what does it feel like?

• Hyperbole and a Half has a wonderful two-part comic (1, 2) describing it.
• Ken White at Popehat describes depression, from a first-person perspective, in this article (from "The Third Thing" onwards).
• [Edited -- 19-10-2013] Shriram Krishnamurthi pointed me out to Dick Cavett's two shares on the NYT, which I found pretty fantastic.

Some main points to take away:

Depression is not necessarily sadness. When someone is in the midsts of a depressive attack, they aren't mopey, or even sad, really. In my experience, it's a mix of hopelessness, anxiety, lonliness, and desperation.

I sometimes compare its persistent and chronic nature to Mono. I'd always heard that people who have Mono are just very tired, and I understood that at an intellectual level. Tired: got it. Super tired, all the time. Sounds sucky.

But then I got Mono six months ago, and suddenly, after spending all day in bed, literally having done nothing else but lay in bed, I still felt my body ache for rest from whatever I was doing. Which is impossible: it's like being hungry even if you spent all day eating. There was a feeling of need and want from my body but no amount of doing the right thing could even approach making me feel tolerable; I would spend all day resting and still feel painfully exhausted.

Depression is like that. You feel self-hatred, alone, hopeless, and that merely existing is painful on its own, and nothing alleviates it. This is why it frequently leads to suicide: your mind is always telling you "you know, there is a way to make this pain go away, in fact, you'll never feel it again!" Sure, you won't feel anything else either, but the pain is so persistent and overwhelming that you really don't care. Most of managing depression, for me, has been learning how to tell that voice "no" well enough to survive the night, night after night, while still trying to maintain an externally reasonable life.

Most depressed people won't present depressed to you. This is something that's a little harder to explain, but many depressed people won't tell you that they are depressed, will hide out during attacks, and never let themselves show their vulnerability to you. They'd rather be caught dead (literally!) than let you know what they're fighting against.

There are a few reasons for this: It's often more socially advantageous that people only know your best self rather than your most vulnerable self, especially since your most vulnerable self is vulnerable in a way and to a degree that neurotypical people just can't fathom. You also don't want it to define you (preferring "It's Pablo, the actor/engineer with fun tweets!" rather than "It's Pablo, he's the guy who sucks, plus he's got depression!"). Finally, illness or not, it's never easy to be vulnerable.

The biggest reason, ultimately, is that there's still a ton of misunderstanding and stigma about mental illnesses and depression ("suck it up!" they say, like telling a diabetic if they really wanted to they could just produce their own insulin). Many people's more hurtful suggestions don't come from a position of malice or spite, but that doesn't make their misunderstanding hurt any less. This is partially what this post hopes to correct.

I often justified the choice to keep it away from people as "[my friends and family] don't need this in their lives" and "I wouldn't want to worry them," and while that's true to an extent, it was mostly about my own self-protection and control. Like coming out as gay, once you've opened the door to this aspect of your personality to the world, you really can't take it back. While it's unlikely your friends and family will immediately phase you out of their lives or cast you as a radically different character in their story after telling them you're depressed, they can still be hurtful and destructive pricks to you out of ignorance in a time of need, thinking they're helping you. They will also frame every choice you make or every setback you have in terms of your depression, which isn't often what you want.

So most of the time, we just keep it to ourselves, and maintain our social relationships like a nice garden.

While people have seen me perform and know me to be pretty capable, confident, and headstrong, there are many people in your life who also present as happy, successful people for much of the time, but frequently feel, as I do, as helpless and pathetic as Voldemort in Harry's Limbo.

I lied though, when I said stigma and discomfort is the biggest reason. The actual biggest reason for not telling others about depression is that telling others might lead you to taking steps to feel better.

On reluctance to get better, or, losing your logic

A funny thing about depression (and another thing I feel is not entirely well-understood by neurotypicals) is that it's exceptionally good at defending itself, especially from the rational part of the brain that you'd normally use to get over it.

As an example, every time I ask a depressed friend what another depressed friend should do if they're feeling suicidal, or suffering from violent attacks, they always say

"I would suggest they get therapy, if it's really bad, consider antidepressants."

"But what if they don't want to? It would make them feel weak. Do you think they would be acting weak?"

"Of course not! There's no shame in needing help."

Then ask them if they apply these ideas to themselves, and the answer is almost always no. For the record, that's been my response for years, too.

The depressed people I know are smart enough to know that there are proactive, obvious things they can do to feel better. Most are also smart enough to know that it makes no logical sense for them to ignore them. But part of the disease is resistance to these things, resistance to thinking you deserve it, or that it could truly be a net win; that the benefits are "worth it."

An example of that line of thinking, taken straight from how I approached it for years:

Even if I could just wipe it away, swallow a pill, and be "cured," I don't think I would. Depression has been a part of my life for so long, such a critical part of the way that I understand and consume the world, I don't even think I'd recognize myself if I were to take it away. So much of how I contextualize life events, my place in the world, and the actions of others takes place in the context of a mind that's able to battle itself, and I think that's valuable. It's like the "Mutant Cure" in the third X-Men movie -- I know most of society would think it's just "better," but it's really more complicated than that.

(This is how I approach the situation when I'm lucid, and not in an attack. When I am in an attack, it's more like FUUUUUCK FUUUUUCK STOP IT I WANT TO DIE I WANT TO DIE MAKE IT STOP AAAAAAAAHHHH FUUUUUUCK between violent sobs for hours or days, and I'm not so sweet on being depressed anymore)

Now there's a lot wrong with the approach above: most obviously, I could try therapy/medication and if I don't like the result, I could stop. But altering your brain is scary no matter how you do it, and for some reason I and others tend to resist it, at least when it applies to our depression.

When neurotypicals try to help depressed people, one of the most frustrating things they can do (for both sides) is try a logical approach. "Just think of how good your life is!" or "Think of how beautiful things can be!" It's frustrating for the depressee, since it can be taken as condescending ("you think I haven't thought of that?!") or their brain can spin it around on themselves ("given all that, and I'm still sad? What the hell's the matter with me!?"). For the person trying to help, it can be frustrating when you say objectively, obviously true things and they seem to backfire, or get met with active resistance ("don't you want to feel better? why are you shutting down everything I say?!").

This isn't to say never help, just to please be patient -- you aren't really dealing with your friend, you're dealing with the worst and most petulant their brain can produce, and it's lashing out at you for threatening it.

It's all chemicals

When I say "you aren't dealing with your friend," what I mean to say is that it's all just chemicals. Your brain is a sack of neurons in soup, and if you change the balance of that soup, it changes the person. I know we all like to believe in Self and Souls and things, but I firmly believe and understand that all that Self is derived by whatever matter it's ensconsed in.

Consider that we've developed anti-depressants that help a great number of people. The most common type is the SSRI, or selective serotonin reuptake inhibitors. One of the chemicals your brain swims in is called serotonin, and many depressed people's brains "gobble" it up in a process called "reuptake" too quickly. These drugs supress that reuptake stage, leaving behind more serotonin, and viola!, for some people, this greatly reduces their suicidal thoughts.

I find it helpful, personally, to model my feelings and thoughts as "me" and "my depression," separately. That there is a Pablo, who you all know and love, but he's always at odds with that other thing that I don't really have a choice in, that makes me a sad, cruel, useless mess (look at that picture of Limbo Voldemort again). I'm not the only one to do this: Matthew Inman has his Blerch, and Seth Rogen uses it in Knocked Up to justify yelling profanities at his girlfriend during a fight:

I've found for myself and the people who support me, remembering that the difference between a depressed person and a neurotypical is often just some chemicals, probably seratonin, not some Great Truth you're too ungrateful or stupid to understand, or some massive personality flaw. It's chemicals in a very weird brain.

A favorite illustration of this is in Parkinson's. Neuroscientists learned if you pulse the hippocampus with electricity at regular intervals, the motor system symptoms of many who have Parkinson's more or less vanish:

Why? Neuroscientists don't really know. They literally just tried stuff on rats and it seems to help. So remember your brain is just a big dumb organ made of stuff, and much of the suffering from Depression is just a chemical process that's not going how it should, like diabetics with insulin in their bloodstream.

A few more links, final thoughts.

• Wil Wheaton wrote about his depression very sincerely, and did so again to remind everyone that you aren't alone in this.
• Matt Fraction writes about his close calls with suicide, and what kept him from doing it.
• Andrew Sullivan did a series on suicide and published some reader reactions. He posted other articles on the topic.

In Wil's first post, he mentions a friend Steve who committed suicide, who he thinks about often. My "Steve" is Sunil Tripathi.

I only met him briefly, as he was a friend of my roommate's girlfriend. His brother Ravi was in my freshman dorm, and one of the friendliest, down-to-earth people I met at Brown. Sunil's birthday is a day after mine, and he's the second son of a family with two sons and a daughter, like me. And I know what it is to be in a family like his and feel the sudden loss of one of their children.

Mostly, I think of the times on Brown's campus when I was there, like him, suffering. How 'fine' he seemed in my brief interactions with him, and how I must seem to most. How I got through by the skin of my teeth, not because I had something he lacked: it was just luck of how and where we were caught with our attacks.

I also think of Aaron Swartz. I think of Ilya Zhitomirskiy. I think of Michael Ly. I think of Reteah Parsons, whose suicide was provoked by trauma. I sometimes make a mental collage of all my friends I know who fight depression, and wonder how many of us will still be around in 1, 5, or 10 years.

I think about what a tragic loss it is to all of us that they're gone, and even when I feel like there's not a whole lot I can do myself to feel better, I can talk about it, and hopefully remove some of the mystery to those who don't have to or get to think about it too often.