Friday, August 5, 2011

A head cold.

I have what I will freely admit is very mild and very occasional depression. But it had been hitting me kinda bad the last couple weeks. I started taking antidepressants and now the fog's finally starting to lift.

What helps me the most--both as a person with rather unreliable neurology and as someone who works with psychiatric patients in the ER--is to think of it as a cold. Or if it's chronic and bad, something more like pneumonia. An ordinary physical disease. You can't make a cold go away by recontexualizing it, but if you've been thinking "ugh, it's so gross and inconsiderate of me to cough all the time; why can't I just use a little willpower and decide to not cough?" it helps to know the coughing is a reflex. Likewise, knowing I'm depressed won't make me stop feeling sludgy and miserable, but it'll stop making me thinking that feeling is justified. It'll stop me trying to "snap out of it" and getting frustrated when I can't just decide to be perky. My brain isn't being an asshole; it's coughing.

When I was about 11, I got a wicked case of pertussis. I'd had the shot, but I got it anyway--the vaccine is 85% effective and I was in the lucky 15%. I spent a good six weeks on the couch hacking and wheezing. My sister couldn't stand it. The coughing grossed her out, it kept her up at night, it made her worry she was going to get sick. So she'd scream at me, "Stop coughing! God, just stop it!"

This is what I aspire not to do to the psych patients in the ER, or to the people I know with mental illness. It's not necessarily that I accept their illness; but I accept that it is an illness. When they annoy me or offend me or confuse me, it's not about me. It's not even about them. It's about the fact that telling someone with mania to settle down, or someone with schizophrenia to stop being so weird, is like saying "just stop coughing." It's not just insensitive but totally ineffective to treat a symptom like a choice.

(I also think it's important to never lose sight of the magic phrases "significant distress or impairment" and "danger to self and others." Because these are the things we treat in mental health--when someone is suffering, when they're unable to do their daily tasks of living, or when they are harming or likely to harm themselves or someone else. What we don't treat is being wrong. Someone can be wrong all day long--can think they have five arms and the CIA has put a chip up their butt--and as long as they're okay with their life and getting enough to eat and not hurting anyone, it's really none of our business. The point of mental health care is to promote wellness, not enforce the correct reality. Nobody has the job title Clinical Philosopher.)

The person is separate from the illness--and this doesn't mean that the person is blameless or without agency. Mentally ill people come in all flavors, including being really nice or really rotten people. Their disease has changed their brain, not replaced it. They're able to make choices. But whether to be mentally ill isn't one of those choices.


  1. After a long time of beating myself up for having deep downs, I've tried to think of how I'd treat myself if I'd been in a car crash. I wouldn't say "Get out of that bed, so what if your leg is broken, just suck it up and dance on out of here."

  2. I hope you feel better soon!

  3. Can someone without mania have moments when they freak out? If so, can we tell them to calm down? Or do they temporarily have no control over their actions?

    Likewise, if so, is it possible that someone with mania can have moments of that same kind of not-attributable-to-their-mania freak out? Or will all their freak outs automatically be manic?

    Or, if not, can we ever tell anyone to change their behaviors?

    1. In the general case, if you're trying to get someone to change their behavior without trying to understand the reasons for it, you're gonna have a bad time.

  4. With one important distinction: Mental illnesses are not contagions you can pass on to others!

  5. Anon - Really, saying "calm down" rarely works on anyone who's really spun up, regardless of the reason.

    Addressing the specific thing that's agitating them is more likely to work on someone who's not manic, though.

  6. I especially like your last paragraph. I think one of the hardest things about learning about mental illnesses is learning to not judge the person by their condition, but not letting it be the explanation for their every action either. I have know someone with several diagnosises. Many of his mood swings and so on are entirely out of his control, but as I've gotten to know him better I've realized that not everything that looks like a symptom is one. He's been known to exaggerate or underplay how he feels depending on what he wants to get out of a situation. He's a bit like someone who really has a cold, but decides how bad it is based on whether you're asking him to go to the movies or to a dentist's appointment. After a while you pick up some tells for when he's not being entirely honest about what's going on with him. Many people with the exact same conditions behave completely differently, as some of my other friends have proven. You can hold people responsible for how they deal with their conditions, but you shouldn't stigmatize someone simply for having one, or judge everyone by bad experiences with one individual with the same diagnosis.

    Anonymous at 8:19; it sounds like those questions are coming from personal experiences with someone. Between that and not having an actual degree in anything psychology related, I'm reluctant to answer any questions, and I'll bet other people are too. But maybe some of what I've said sheds light on the situation? Maybe?

  7. I work as a CNA at a local nursing home and pull the night shift. A lot of this is really easy to forget at times when we're understaffed and over stressed and it's all to easy to forget that the dementia and Alzheimer's isn't something they do to annoy us or hurt us in the short time we spend with them, but something they live with every day.

    Thank you for reminding me of that vital part of my job.


  8. "Nobody has the job title Clinical Philosopher."

    That is a fantastic line.

    But there are people who would like to be Head Clinical Philosopher - there is a huge literature out there basically asking "wtf does it mean to be mentally healthy/unhealthy." And a lot of it is really interesting and brings up good questions.

    But as you said, at the end of the day it does come down to promoting wellness.

  9. In a whole creative writing class in college (last year) I was the only person who voted that, if a prompt instructed us to not make any of our characters sick, then no character could have a mental illness. I thought that was obvious, and it was insulting to even ask. The instructor agreed with the class, and she said that the "illness like any other" idea was only encouraged by the pharmaceutical companies. I'm not even an amateur medical expert, and I've had a clean bill of mental health up to this point in my life, so I didn't really have anything coherent to argue. (Also, I am a scientist in another field, so I sometimes get overly careful about being able to cite my scientific facts.)

  10. As a mental health case worker, this brings me warmth :) I am constantly dismayed at the stigma and misunderstanding.

    It was really awkward this past Independence day when a whole table of ignorant extended family members were gawking at me and asking embarrassing questions (in the sense of ignorance - especially about schizophrenia), but at least they were ASKING to figure out what's real and what's not. I've worked in mental health the last 5 years, and it's so normal for me. I sometimes forget that I live in my mental illness bubble (not too unlike your kink bubble) and there's still a lot of shit to work through.

  11. FC - I used to have that exact job! It's hard.

    They showed us a video in our training that stuck with me. It showed a thirtyish young woman going to bed at night, in her nice homey bedroom with her husband by her side... then waking up abruptly in a hospital bed next to a stranger and with a grouchy CNA snapping at her to get up and roughly pulling her clothes off.

    I don't know if that's exactly what dementia feels like, but I suspect it's not far off, and the image always made me appreciate how well most of our demented residents actually took it. I can hardly blame the few that did freak out.

  12. @Anon (8:19)

    I do not have manic episodes (or any mental illness), but I'm a highly emotional person. If I'm upset or worked up about something and someone tells me to calm down, I'm very likely to tell them to shut the fuck up and either listen to what is upsetting me or just leave. Luckily, I have the self control not to punch people who say insensitive things. Telling upset people to calm down sends the message that their feelings are invalid. That is not how you speak to someone who is worked up about something. Period.

    Also, yes, people who get manic episodes can get worked up about things outside of the mania. It can be hard to parse out what is coming from where, but not everything a person with a mental illness does is about or attributable to the illness.

  13. I just finished translating this one :D I actually have a list of entries I'm working on, because I'd like to publish all of them at once on a separate blog since mine is full of cake recipes and musings about k-pop, but this particular entry hit too close to home to not translate it right away.

    Here's the link!

  14. @Lisette - that is exactly how I feel. I'm a very sensitive person and being told to calm down or that it's not a big deal is plain and simply the WORST thing anyone can say to me. Unfortunately, I don't yet have the self control to NOT get upset and start crying harder, burrowing further inside my feelings.

  15. My biggest problem with the mental health care is when people start saying "oh, you're depressed, just go take some drugs" (or similar, probably not that blatent). I think that's loosing sight of the "wellness" thing. Trying to force people to be the people-you-want-them-to-be by deploying mind altering chemicals is really nasty; wheras helping people to be the people THEY want themselves to be is fantastic. I feel this difference is key.

  16. Naath - Yes and no. A lot of those "mind altering chemicals" are godsends when someone isn't comfortable with the way their mind works. I don't think someone should be forced to take antipsychotics if they don't want or need them, but medications are extremely useful in mental illness.

    Antidepressants in particular (and almost no one is happy being depressed, obviously) are godsends. I think they've gotten bad press as "happy pills" and "quick fixes" when in fact for most people they're "capable pills" and "appropriate fixes."

  17. This is an awesome post. I hope you feel better soon.

  18. Untoward Lady--

    True, but most people wouldn't tell someone to "just snap out of" noncontagious physical diseases like diabetes or MS, or to "pull themselves together" and stop being disabled after a stroke or a car crash. (Some people will recommend all sorts of useless or worse things like expensive homeopathic nostrums or a trip to Lourdes, but even those involve some form of outside intervention.)

  19. Yes. This post is amazing.

    When I was dealing with depression this past Winter, it was the first time I really understood how much it was like being really physically sick--it reminded me of when I had really bad viral bronchitis years ago. Both times I kept trying to just push through and do things "normally," but my body and emotions just didn't have the resources.

    And when I had bronchitis, my coworkers at the time kept treating me like I was coughing so hard just to be dramatic. I coughed so hard I fell over a few times. I'd also coughed so hard that I cracked two ribs. I'll try to remember that when I'm tempted to treat someone else's mental illness (like my close friend's BPD) like they're just being a drama queen.

  20. When people talk about mental illnesses like they're not normal illnesses, I wonder how they forget that most normal illnesses are also mental illnesses.

    How many times have you gotten a disease with "irritability" as a symptom? I'd guess at least once.

    Plus I've rarely been sick without mentally feeling different from normal. In fact being mentally able to get out of bed and do stuff I generally take as a sign I'm getting better; it's not like a stuffy nose can make me lie in bed all day no matter how bad it is.

  21. Thank you.

    Also, there are people who essentially have the job "Clinical Philosopher" - if not the title. Many medical anthropologist are studying how illness is constructed, with a particular focus on chronic, mental, or otherwise 'defining' disease. Sue Estroff'sn essay "Identity, Disability, and Schizophrenia: The Problem of Chronicity" is a really good look at how mental illness and the mentally ill are defined.


  22. Yes, mild-altering-drugs are absolutely the answer to some people's problems. I wish those people every luck with getting access to the drugs that help them the best and I'm sorry that so many people have to fight so hard to get access to treatment they desperately want.

    But I'm sick of people claiming that the mentally ill don't have the ability to withhold consent (obviously not wanting treatment is just a symptom of your illness!). I find laws that allow people to be subject to treatment they don't want simply disgusting (and yes, in the UK we have these laws).

  23. As a very anxious person who recently spent two months cut from the world in her room, thanks.

  24. "think of it as a cold. Or if it's chronic and bad, something more like pneumonia. An ordinary physical disease."

    With my chronic depression, I finally came to terms with using medication by re-contextualizing it as analogous to taking acetaminophen for my chronic back pain. I didn't choose to have the back pain or the depression, but they exist, so the best plan of action is to treat them the most effective available options for me: medication, meditation, yoga, acupuncture, exercise, eating healthier, or a combination of all.

    @naath: "I find laws that allow people to be subject to treatment they don't want simply disgusting (and yes, in the UK we have these laws)." That sort of law is frightening. Recently I read a proposal for living wills, where people could specify whether or not they would want treatment in certain situations. I think that's a much better alternative than having a law decide for everyone.

  25. Psychiatric medication is and should be an option, but it isn't the only option and it isn't always the best one. The choice is individual.
    I took antidepressants for a few years and they really helped me realize what it's like to NOT be depressed. I feel like I had been depressed for the majority of my life and didn't even understand what it felt like to have a stable, even mental state. The pills saved my life. They pulled me out of despair and allowed my brain to practice being happy. Taking them was the best decision I've ever made.

    Stopping them was also the best decision I've ever made. I don't need them right now, I'm able to prevent my symptoms from returning with other coping strategies - FOR FIRST TIME IN MY LIFE. I still say I am "depressed" in the sense that I know I have to live with and manage this condition, just like I have to live with and manage my asthma. I have long symptom free periods where I do not have trouble breathing, and right now I am not having depression symptoms - but the depression and the asthma are always there and I always have to manage them to prevent symptoms from returning.

    I did not like feeling like my mental state was dependent on a pill, and I got really scared by the withdrawal effects. For this reason I hope I never have to take an SSRI again, but if it's a choice between a pill and depression I will obviously choose the pill. When it comes to mental illness you really have to do "whatever works."

    @Naath - I agree with you, except for one thing: If someone is causing a large amount of tangible harm to themselves or other as a result of mental illness that illness should be treated. The treatment should be as minimal as possible to get the person into a state where they have a better idea of what is going on and are more capable of giving or withholding consent.

  26. I am delurking to, like many of the people commenting here, say thank you.

    My husband has suffered three bouts of serious depression, two while we have been together. The first time he was depressed while with me it took him a long time to admit it to himself and to the people that care about him that he was ill. He did get on the drugs eventually and between us we pulled him back up. By the time the more recent bout hit he had changed his outlook on the depression. We refer to it as 'brain-flu' and taking the anti-depressants are like taking anti-virals. He is also asthmatic and now anti-depressants, at the right time (he isn't on them permanently) are just the same as the asthma meds - he wishes he didn't have to take them, but they are necessary.

    My husband has a certain way with words and I would like to share something he said about taking meds for his depression. Imagine that depression is a very deep swimming pool. The only way out is the ladder at the side of the pool. When you are really down the bottom rung of that ladder is consistently out of reach. To my husband the meds gave him a extra rung, extended the ladder just far enough so that he could grab hold. It was then CBT, support from family, exercise, relaxation that got him back up the ladder and out of the pool entirely, but the meds were the thing that put him back on it. Interestingly, during his most recent bout he said that the meds had stopped him falling off the bottom of the ladder instead.

    I don't think that taking medication for depression is a fix-all, but is another method to help that person reach what they consider to be 'well', even if that means that they are on medication permanently.

  27. I have a family member who is mentally ill. For years, I was a firm believer in this disease theory. Perhaps I still am. But at this point I am just tired. He's hostile, cruel, threatening, he hates women, and frankly I don't think that's the disease - I think that's who he really is. All that sanity would do, would help him understand that it's inappropriate to frighten everyone around you by demanding they look into your seething pit of hostility.

    I'll make allowances for the hallucinations and the elliptical conversations. But I'm no longer willing to tolerate the raw hatred.

  28. Awesomely, awesomely, awesome post. Both as a person who has had mental colds and as a person married to someone who has had/has such illnesses.

    As to anon right above me: first a big hug. (()) It is VERY difficult to be with someone who is chronically ill in any way. I'm currently on both ends of it as a spouse who is chronically ill and with a spouse who is chronically ill.

    It is not cruelty or bigotry or anything at all to protect yourself. You shouldn't feel guilty or ashamed of it. We, as a society, regard words as meaningless and downplay emotional/verbal abuse. This is stupid. Emotional/verbal abuse is abuse. Full stop. It's abuse.

    So ask yourself this: suppose that family member were hitting you, would you feel bad about removing yourself from that situation? Would you apologize for refusing to allow them to hit you again? What if they hit you because they have dementia and totally can't help it? Would you then allow them to break your nose?

    Of course not. And no one would expect you to. Well, raw hatred is the same thing. It doesn't matter if the hatred is caused by illness or not, you don't have to absorb it. You can accept that your family member is blameless without holding yourself out as a mental punching bag. It's okay.

  29. Wow, but do I wish my husband had had ER nurses and doctors like you when he landed in the hospital for his first manic episode (when we had no idea what was going on, mind).

  30. I'm watching something on cults, and I was reminded of this post. The Shakers seem weird to me (Jewish-raised atheist). No less weird than, say, Heaven's Gate. But we regard Heaven's Gate as dangerous and the Shakers as not dangerous.

    (And like mental illness, it's culturally bound: Falun Gong is hardly more notable in the U.S. than any other religion that isn't mainstream Protestantism, while in China it's officially subject to persecution.)

  31. i love all of your blog, but, oh, thank you for this post.

  32. I agree that the its-like-a-cold-thing can be a good strategy, and I dont want to question anyones selfdefinition, but I think the comparison is problematic in this generality. It makes it easy to attribute the problems someone has to them individually, without taking a look at e.g. society. At least that is my experience with psychotherapy and psychiatry: When I criticize the institution or the way society is organized, it is often turned into my individual problem.

    Needless to say: The all-time-classic is: "Society is sexist" - "Ahh, you have a problem with being a woman." Gnnnnnnrrrrrrrr!

  33. Just came across the blog this morning, really enjoying what i've seen so far!!
    I wanted to comment on this particular post though, i'm prone to depression sometimes and usually it doesn't last too long but the last month and a half or maybe even two and a half months i've not been able to shake it.
    It's the kind of situation where i identify that there's nothing seriously wrong in my life and that other people have to go through worse than i do so i ought to just snap out of it. This makes it worse because i feel bad for feeling bad!
    But yeah, i wanted to say thanks for this post. Thinking of this like a cold or flu makes it easier to approach.
    Keep up the great work with the blog!