Sad-face: Depression and Anxiety in Perspective

“Just snap out of it”

“At least you don’t have a ‘real’ disease”

“The medicine you’re taking is probably keeping you from getting better”

“You’re just using it as an excuse so you don’t have to work as hard as everyone else”

“Just another person with a ‘victim’ mentality”

“You didn’t even experience that much trauma, just get over it already”

“You should just smile and you’ll feel better”

It may be surprising to some people that all of these thoughts (and worse) come from my own autocannibalistic brain. Occasionally I read/hear disparaging statements about mental health issues from other sources, but the most damaging and destructive opinions are self-generated.

And the denial! I am constantly amazed that after 10 years of this shit I can still convince myself that nothing is wrong (while absolutely disintegrating mentally and withdrawing from any and all social contact).

Go ahead, ask me what’s wrong.

My answer: Nothing. Everything is great! (Raise eyebrows, keep eye contact, smile).

Lists seem to be a popular thing on the internet so I came up with one, and in order to make it more universally appealing I will work from the assumption that more than one person experiences the things I experience!* Plus I came up with a super catchy name for my list:

A list of things you might not know about depression and anxiety that your friend, partner, or family member may be dealing with on their own:

1. Depression is not “sadness.” Depression is all the negative emotions you can possibly imagine (sorrow, grief, anger, frustration, desolation, loneliness, incompetence, hopelessness, and despair) all morphed into a giant sucking void that drowns out all other thoughts and feelings and has an overall effect of creating an EMPTY shell of tired useless human husk.

This shit is no joke. When my husband asks me, “What’s wrong?” (so he can try to fix whatever is making me curl up in a ball on the floor) what can I say? “I am sad” doesn’t really convey the black hole of agonizing misery residing in the center of my chest.

Your brain literally feels like it doesn’t want to have anything to do with you, that no one wants anything to do with you, and why (really) WHY haven’t you driven off a bridge already?

2. Taking anti-depressants doesn’t always cure depression. Managing clinical depression is often an on-going process. Depression that stems from other mental health issues (such as post-traumatic stress or traumatic brain injury) can be more difficult to treat when it’s compounded by anxiety, insomnia, loss of short-term memory, or other cognitive issues. 

According to my very smart doctor, many people (myself included) will reach what is referred to as the “max therapeutic dose” of their current anti-depressant/anti-anxiety medicine and will start experiencing “breakthrough” symptoms of depression. These symptoms can be treated with additional medication, but reestablishing that equilibrium takes some dosage adjustments and while that’s taking place your brain can get all wonked out.

Break-through” symptoms are aptly named; they are the unanticipated feelings of “just give it up,” that materialize out of thin air (or “break through”) precisely when you think you’ve finally kicked this bullshit to the curb. Break-through symptoms muffle the words of love and encouragement uttered by your friends and family even when, by all accounts, you should be filled with joy, pride, and happiness (like, say, when your team wins the Super Bowl, or when your child writes an exceptionally adorable story for school). Instead, you are blanketed with the familiar and oppressive hopelessness, sadness, and weariness that insistently repeats ever louder and louder, “Why even bother? Nothing matters anyway.”

“WHY NOW?!” you ask.

“WHY NOT!?” your brain replies.

3. That angry, pissed-off person you know – the one everyone thinks is an asshole – they might just be depressed. Depression and anxiety can manifest as irritation (or in my case HULK RAGE). I didn’t know anything was wrong with me for a long time because I wasn’t sad, I was angry. It was everyone else’s problem, too. (You know – cranky old man syndrome: “DAMN KIDS. DAMN WEEKEND DRIVERS. STOP SMILING AT ME.” And yes, “GET OFF MY LAWN.”) I was unable to see any of the good, and was blinded by what I considered to be the “bad.” It was the anger that finally prompted me to get the help I needed, months after I figured out something was wrong.

I felt like I was a failure for not dealing with my issues, I felt guilty for feeling so shitty (how’s that for a vicious cycle?) and I believed I was a terrible mother and spouse. When I started actively imagining my own death on a near-daily basis, I didn’t even want to try to get help because I didn’t think I deserved it. And that made me angrier.

I didn’t initially get help for myself, but for the well-being of my children – I was afraid that their exposure to all this rage would warp them for life, or worse, that I would hurt them. Fortunately, the first time I reached out for help I met with an extremely compassionate person at the VA who was able to guide me through one of the most difficult times of my life and help me feel more like myself again.

4. You may know someone who thought about killing themselves before they got to work today, and yesterday, and the day before that… You know how there are functional alcoholics? Well, I think most people operate on some sort of “functional” scale; some are just more functional than others. And there may be a couple people you know who are “functionally” depressed.

When I worked as a corrections officer, I used to sit in on suicide evaluations for inmates who expressed suicidal thoughts or demonstrated self-harming behavior. The facility psychologist would ask the inmate a set of questions from a questionnaire that was designed to measure the risk of suicide. Based on the answers, the person would be classified as either no risk, or low, medium, or high risk, and the inmate’s environment would be adjusted accordingly. All inmates classified as low, medium, or high risk were isolated in the Close Watch unit, where an officer would literally watch them 24/7 though plexiglass cell walls.

What always gave me pause during these evaluations was that my own classification, had I been in the ‘hot seat,’ would have consistently been low or medium. I suppose that made me a “functional” suicidal person.

And if I was showing up to work, day in and day out, making it to my dental appointments, suffering through my commute, interacting with my kids, and all the other stuff we have to do as human beings, all while enduring a low-level, persistent nudge to just give it all up without anyone at work having any idea what was going on, I imagine there are others going through the same shit.

I never told anyone at work I thought about killing myself (I didn’t even talk about it with my family) and I’m very fortunate I got help before I did anything horrible. I did have friends and family who could tell something was off and they were insistent (and persistent) that I go to the VA, calling frequently and suggesting ways I could get childcare to get to my appointments. Because of their insistence, I was able to get treatment before I did anything to hurt myself.

5. Your friend or loved one doesn’t want to go anywhere fun? It’s not because they hate you. Anxiety is a depression multiplier. For people who suffer from anxiety and depression, anxiety tends to be that constant companion, looming over their shoulder, just waiting to strike.

For me, it’s sort of like that feeling you have when you’re watching a horror or suspense movie, and you know that some scary fucking monster or serial killer is going to attack the main character, and you’re just bracing yourself so you don’t scream or jump and spill your popcorn and embarrass yourself.

But where depression can often be managed or mitigated through a daily medication that adjusts serotonin levels in your brain, anxiety is a little trickier to treat because it tends to be situational.

There are sounds, smells, environments, or scenarios that a person will identify as anxiety triggers, and after they confirm that “yes, crowded places do make my heart feel like it’s in a vise, and my palms start sweating, my face goes numb, and my vision starts to tunnel, and I can’t breathe. Oh. My. God. I CAN’T BREATHE” they will commonly adjust their schedules and activities (and their entire life) in order to completely avoid, if possible, any situation that could induce an anxiety response.  Because, seriously, you feel like you’re going to die. And then after you feel like that (from something stupid like going to the grocery store) you get super upset and down on yourself for being such a fucking loser that you can’t even buy eggs or talk to the cashier at the checkout without freaking out. And then you get depressed.

It took me a long time to sort out the things that trigger panic attacks and anxiety responses. Fortunately some (like urban driving) have become less intense over time. Others (like loud, crowded places) are sort of okay if I have someone with me who understands my limits and is supportive if I need to leave right away. If you are trying to find something cool to do with your friend and they keep turning you down, think about the activities you are proposing and see if you can find a lower key event. For example, if you keep asking your friend to go to sporting events or concerts, and they consistently turn you down, maybe invite them to lunch at a quiet café or diner, or plan a weekday afternoon trip to a museum. Or ask them what they are interested in doing. If they still turn you down, then you were right in the first place, and they probably don’t like you (I’m sorry for getting your hopes up).

I often still feel immensely guilty and embarrassed about my depression and anxiety. But I do not feel the same way about other people who face similar challenges (because, dude, this stuff suuuuucks). There are some pretty rad cartoons that address the stubborn preconceptions that exist around mental health, and there are some excellent resources out there, both for people dealing with depression and anxiety, and for their friends and loved ones. I think the more we talk about it, the easier it will be for people to reach out and get the help they need.

If you have suicidal thoughts, or if you know someone who is talking about suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

From www.mentalhealth.va.gov/suicide_prevention/:

“Veterans can chat online at www.veteranscrisisline.net, or send a text message to 838255 to receive confidential support 24 hours a day, 7 days a week, 365 days a year, even if they are not registered with VA or enrolled in VA health care.

*Obviously, everyone has a different brain and a different experience. I am not speaking for all people who live with mental illness, only of my own challenges and observations.

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