This is somewhat off-topic for the blog, but pretty damned on-topic for my life.
I’ve talked about this before, but it’s the kind of thing that just keeps coming up.
I’ve got a bunch of different medical conditions.
I’m a post-surgical GERD sufferer – for all intents and purposes, I was born without a sphincter at the top of my stomach. That means that acid could easily get out of my stomach, into my esophagus, my vocal chords, and my lungs. Without surgery, I would probably be dead of esophageal cancer as a result. Since the surgery, I’ve had lingering problems with my swallowing reflex being fouled up, being unable to burp or vomit, and suffering from pretty severe chest pain from muscle spasms. I take a variety of medication as a result, to keep it all under control. For over ten years, I took benzodiazapenes every day as part of the treatment regimen for that: benzos are an addictive drug.
I’ve also got some of the worst allergies of anyone I know. When I first got tested for allergies, based on my symptoms, the allergist selected a set of 45 possible allergens to test me with. Most people with bad allergies would show a significant reaction to 15 or so. I came up positive for 42. I needed to get allergy shots for 25 years, and I continue to take antihistamines and inhaled steroids on a daily basis to treat it.
I also have clinical depression, and very severe social anxiety. I take an SSRI every day for the depression, but I’ve yet to find anything that works for the social anxiety.
No one ever gives me any grief about my stomach troubles. I mean, what could I do? The muscle at the top of my stomach didn’t work. There was a huge amount of acid getting into my throat and even my lungs every day! Of course I had to do something about it!
And allergies? Man, that sucks. Everyone feels bad when they see me sniffling, or when I have to pull out an inhaler because I can’t breathe. But you know, luck of the draw, some people get stuck with allergies. No fun, but it’s manageable with medication, right?
But depression? Whoa, baby. Whole different story. Instead of the benign sympathy or indifference that I get from people who hear about my other troubles, I get shit like this:
A cool thing to do for your mom would be to stop
worshipping your own depression and make strides to improve yourself and your life
— MattyTalks (@mattytalks) May 13, 2013
To be clear, that wasn’t directed at me in particular. No, it was directed at everyone who’s suffering with depression. See, depression isn’t a real illness. People who are living with depression aren’t suffering from a real illness. No, we’re worshipping our depression. All we need to do is stop being such pathetic assholes, and get up and “make strides to improve our life”.
Before I started taking my SSRIs, I didn’t worship my depression. I didn’t even realize that I was depressed. I just felt like the world had gone flat. It’s hard to describe it better than that. I didn’t really feel much of anything. I wasn’t sad. I wasn’t happy. I wasn’t anything. The world was all grays, no colors. Good things happened, and I couldn’t feel good. Bad things happened, and I couldn’t feel bad. My wife was pregnant with our second child, and I wasn’t happy, I wasn’t nervous, I wasn’t anything. I was just flat.
When I finally realized that there was something wrong with me, I got a referral from my doctor, and I saw a psychiatrist, who prescribed medication for me. About two weeks later, I realized that stuff was different, because I was noticing colors. I never stopped seeing them, but they stopped registering – they didn’t mean anything. I literally felt as if I weighed less – like someone had laid an invisible lead blanket on me, and now it had been removed. Something bad happened at work – the project that I’d been working on for the previous two years had not gotten its funding – and I was upset about it!
It was an amazing thing, a total change of the world. The pills didn’t make me happy. With the stuff at work, and the stress of a new child coming, I was probably more unhappy than I was before I started taking them. But the unhappiness was real, it was mine, and I felt it.
After about a year of taking the pills, on the advice of my doctor, I tried stopping it. For people with symptoms like mine, he said that about 40% would relapse pretty quickly, but 60% would be fine without any medication. After about three months without it, the world went back to that flat drab nothingness – I was part of that 40%. So I restarted the medication, and I haven’t stopped since.
I won’t even get into the social anxiety stuff here. That’s even worse that the depression. Depression is commonly viewed more as a personal weakness than an illness; but SA isn’t even seen as that: it’s just a joke.
Contrary to what the assholes out there say, depression isn’t a personal weakness. It’s not the pathetic obsession of weak-souled losers who just need to get off their couch and stop being such a schlub. It’s a real illness. It’s difficult, and it’s painful.
My depression is just as real as my GERD was, or as my allergies and asthma are. It needed to be treated just as seriously as they did. Getting stomach surgery probably saved my life. Getting treated for depression probably did too.
The assholes who try to portray depression as weakness, who mock people for suffering from depression, who make cracks about being nice to our moms and getting off of our butts: they’re not helping. But really, they don’t want to help. They want to feel smug and superior. But they’re doing worse than just not helping. They’re actively making things worse. By reinforcing the stigma against mental illness, they’re making it less likely that people who desperately need help will be able to get it.
So, as I responded to the tweet I quoted above:
.@mattytalks @lolgop An even cooler thing to do would be to learn to shut up about shit you don't understand.
— MarkCC (@MarkCC) May 11, 2014
Completely agree, while I think it’s getting better (or possibly I’m just doing a better job of filtering and ignoring people) there’s still a huge stigma in society with mental health.
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I just wanted to say that the main way to change this particular attitude is for lots of people on a regular basis to speak up about it. And while your tweet doesn’t help much (140 characters is not enough), your essay here does. Thank you. Slowly, with stories like this one we will change the culture.
Is it not true that SSRIs aren’t really effective at curing depression? I’ve read that CBT is a much for effective method to cure the issue.
Depression is an extremely difficult thing to treat.
For people who suffer from *mild* depression, the apparent rate of effectiveness is around 33%, which is not statistically significantly better than placebo.
For that same pool of people, CBT’s effectiveness is *slightly* better. Still under 50%.
For people with moderate to severe depression, you can divide into groups in many different ways based on symptoms, and effectiveness varies enormously between groups. Most of the time, CBT, traditionally psychotherapy, and SSRIs have roughly equivalent success rates, with different subgroups having different response rates for different treatments. My reading is that it’s not yet clear whether there is a real effectiveness difference by group, or whether that’s just a statistical artifact. (Divide into enough different groups, and you’ll find any correlation you want; and diagnosis of depression subtype is so uncertain and idiosyncratic that it’s almost arbitrary.)
Anyway, what it comes down to is: some people will respond extremely well to SSRIs, some will not. Some people will respond extremely well to CBT, some will not. Some will respond to talk therapy extremely well, some will not. We have no good way of predicting which will work best for any particular patient.
So the best approach, at the moment, is to find a decent doctor that you trust, and try different treatments until you find something that seems to work for you. Given the screwed up american insurance system, it’s usually medication first, not because it’s got the greatest chance of success, but because it’s got no worse chance of success, and it’s the easiest to get an insurance company to cover.
One issue with “depression” as a label is that it covers a wide range of underlying conditions.
There’s “social” depression; it’s not a clinically diagnosed condition, it’s what the everyday joe is thinking of when they say “I’m depressed” meaning “I’m feeling a bit unhappy today, and can’t work out why”.
Then there are several illnesses with the same symptoms, which we lump together as “clinical” depression; they all present the same way, but different illnesses need different treatments. CBT is great for one form of depression; SSRIs work on another; yet other forms need other treatments.
For an analogy to physical illness, consider “flu-like symptoms”. There is a huge list of diseases with flu-like symptoms. If we didn’t have a modern understanding of disease, we wouldn’t be able to tell the difference between early stage tuberculosis (responds to antibiotics), smallpox (viral, hard to treat) and histoplasmosis (fungal, can be treated with antifungals if necessary).
Right now, we’re at the stage where we recognise a set of symptoms as “clinical depression”; we don’t yet understand the illness well enough to distinguish various causes of depression (just as we used to have a set of symptoms now known as “flu-like symptoms”, but not enough understanding to distinguish the causes and thus identify sensible treatments).
So, for some causes of depression, you’re right – SSRIs are ineffective, CBT works. For others, it’s the other way round – CBT is ineffective, SSRIs work. When we have a way to distinguish the various causes of depression, we’ll be able to say to people like Mark, “oh, you have xyz depression – SSRIs for life”, to people like me, “oh, you have qrs depression – SSRIs when you need them”, and to a third group “oh, you have hij depression – CBT for you”.
Very well said.
I think a big part of the problem is that clinical depression is not a good description, because a lot of people confuse it with emotional depression. The Twitter guy might have just been referring to the latter (e.g. the “emo” high school clique).
Maybe think of a better name? Emotional anesthesia?
For me, calling it emotional anesthesia might make sense. (That doesn’t really capture the experience; I just don’t know how to explain it better.) But peoples subjective experience of what depression is vary widely. Not everyone, not even a majority of people, have an experience with depression that matches my description. There is no one description that works. The experience of it is very subjective and personal, and there’s not really any particular term that’s generally accurate.
“Depression” is a sort of catch-all diagnosis for a wide range of conditions with emotional symptoms. It’s almost a diagnoses created by the treatment: anyone who responds to a treatment for “depression” is retroactively “depressed”, and then people with similar symptoms are swept into the same basket.
No matter what you call it, the problem is the same. It’s a serious problem, which needs a serious response to identify a treatment that will help. The problem isn’t what we call it – it’s the social stigma that we attach to it.
Not to belabour the point I want to make, but often what something is called affects how people perceive it. “Impotence” was the official medical term before “erectile disfunction” was invented, and that also changed attitudes (and helped Pfizer market Viagara, of course – they came up with the new term).
Of course, it doesn’t always work. The stigma of “person who doesn’t bother to think” has followed several new terms for “person with congenital mental imparement who tries hard”.
In addition, the word “depression” does have more than one meaning, including a trivial one (as well as a lowland, or a dip in measurements), and that can lead to misperceptions. It’s legitimate to be “depressed” over the death of a relative, even though that’s not the same thing as what you’re referring to. It’s normal to grieve and get over the first on your own. Someone who experienced that and not the second might not even know there’s a difference, assuming the second is just as trivial. If they were called different names, it would be obvious that there is a difference, avoiding 1) the incorrect assumption, and 2) the need to explain.
Thank you for writing about this, and especially pushing back against the zombie Victorian sensibility that equates mental illness to a character flaw.
For those who have not run across it, I’ve always found Wil Wheaton’s post does a pretty good job explaining it for those that don’t get it at all: http://wilwheaton.net/2012/09/depression-lies/
And for those that can’t wrap their head around what happens when your mind starts betraying you, I can only share my one brush with this sort of depression. It was induced as a side-effect of a pain med I was taking. Everything was going along swimmingly, and one day, I woke up and started planning how to kill myself. The fact that I was rationally aware something was wrong and that there was no “real” cause for me to be suicidal mattered not one jot. There was a large part of my consciousness that stopped functioning the way it had done for all of the rest of my life because my brain chemistry was well and truly screwed up (I believe the literature for the painkiller put the mental side-effects at about 3% of users). Mercifully, it stopped almost as soon as I went off the meds and has stayed that way (except once when I was truly desperate for pain relief and went on the OTC version for more than a day).
All that you think and feel and are is a couple of pounds of goo shooting electricity through a cloud of neurochemicals, and it’s really rather remarkable that more doesn’t go wrong more regularly considering how delicate the blasted thing is.
Drug-induced depression is crazy scary!
I get that way if I take benadryl. It doesn’t make me drowsy – it makes me crazy depressed, in the sad hopeless suicidal way. I stay far, far away from it.
The best I can explain it to someone who does not suffer: Imagine you’re full. You’ve eaten a large meal. Your friend then takes you to the most fabulous all you can eat buffet. Everything you could want is on that buffet: great sushi, lobster, smoked salmon, all manner of french pastries. You tell your friend you’re not hungry. Your friend says you should just try to be hungry. Come on. Look at all the wonderful food. Why can’t you enjoy it? Your friend can. He eats plates of lobster right in front of you, chiding you for not enjoying this and suggesting trite strategies for eating more than you’re physiologically capable of. “Here comes the choo choo open the gate!”
Him telling you what you’re missing, him showing you the joy you’re missing does not change the fact you’re physiologically incapable of seeing food as enjoyable at this point. The brain is just not wired to find the smells and sights of food as enjoyable after you’ve satiated yourself previously. And all his efforts just make you feel worse. This buffet may never come around again. Why did he even take you there in the first place?
No one would seriously do that because we all understand your enjoyment of food and how your brain responds to food, even the best food, is wired to your physiological state. People need to grasp depressed people just can’t be happy. You’re not a dumb person. You get it. Try to be happy. Telling you the patently obvious just tends to make people feel worse.
i hope you get better my friend
I can relate to your description of depression: the grayness.
I’ve tried CBT for several years. It helped, and I felt better for 10 years. Then, something new triggered the depression again. I don’t feel like going through therapy again.
I’ve always resisted medication, because I fear I’d need it for the rest of my life.
Just because you’re mad at the world for having an abnormal digestive system and feel alone and like you don’t fit in, doesn’t mean you can judge how other people are feeling. Depression is not just a feeling, it’s a chemical imbalance in the brain. Like the acid imbalance in your stomach. Do some research before you make yourself look like an arrogant “emotional expert.”
Did you even bother to *read* the post before you started flaming?
My entire argument was that I suffer from two different ailments: depression, and the digestive thing.
One of them, the digestive issue, I take drugs for, and pretty much everyone agrees that there’s absolutely nothing wrong with taking drugs – even very strong, potentially addictive drugs! – to treat it.
The other, the depression, I take drugs for. And a very large number of people throw all sorts of tantrums, claiming that there’s something horribly wrong with me for taking the drugs.
There’s no real difference between these two. Both are functional problems with a part of my body. Both are treatable by taking medication that affects the dis-function of a part of my body.
But because in depression, the part of me that’s malfunctioning is a piece of my brain, people have a dramatically different reaction to it. The person who this whole post was originally aimed at was a jackass who argued, essentially, that people with depression need to get over themselves and stop worshipping their depression.
It’s a sadly common attitude. Depression is viewed, by too many people, as a weakness instead of a disease. It is a disease. People who are living with depression don’t need to be insulted, or told that they’re weak, or that they just need to stop moping. It’s a legitimate illness, and people who suffer from it need to find a treatment that works.
For some lucky people like me, it’s easy: the medication just works, and within a month or two, it’s pretty much gone.
For others, talk therapy works.
For still others, cognitive/behavioral therapy works.
For still others, some combination works.
And horribly, for some small group, nothing that we’ve found so far seems to work.
There is, sadly, no single solution. But for most of us, there is some solution that will help. What’s important is getting rid of that damned stigma that says that depression is somehow different from digestive trouble, or heart trouble, or diabetes, or allergies, or liver disease, or psoriasis, or and other ailment. For all of those others, everyone agrees that if you’re ill, you should see a doctor and find out how to treat your illness. But for mental illness, we put it in a different category, and say that you shouldn’t get it treated – that you’re weak for having the illness, and you don’t need to get treated, you just need to man up.
That’s bullshit, and I’ll fight it to my dying breath.
I agree, for the most part, but how does this square with that old post about mental illness and personal responsibility? What criteria do you use to determine when it is acceptable to mock someone?
They say you should get up and start talking to people to get out of depression. Many others will try motivational speech but that’s not working most of the time. Countries like india, where depression is often associated with a trivial behavioural stage having no affiliation as even as an abnormality of your brain. Most of them think of people undergoing depression as a lethargic, unmindful towards their social responsibility and unworthy. This widespread tendency and lack of awareness has unprecedented effect over depressed people. Many of them loose their jobs, get isolated of their friends and families. That’s enough for anyone can undergo so worst circumstances in their lives. People or society as a whole must understand that depression and SA are simple illness which need proper counselling and medication. A lack of chemical in your brain need to be fulfilled which can be done by prescribed medicines by a medical practitioner . Apart from this motivational speeches, exercises, going for picnic, camping , other outdoor activities and other things may work for short span of time but in long run its just go ineffective.