Imagine you wake up one morning to an incessant knocking on your front door. You peel yourself out of bed in a groggy stupor, wondering what kind of surprise awaits you on the other side of the door. As you pull open the door, your heart sinks.
There on the doorstep stands your old friend, Mr. Depression. He came without warning. No letter. No phonecall. No email. Not a single little heads up. Even though you are very familiar with Mr. Depression and knew that he could be deciding to visit you again at any moment, you weren't expecting him. Not today. Not now. Yet, here he is, standing on your doorstep with his suitcase in his hand.
In an instant, everything changes.
Mr. Depression breezes by you and barges into your house, bringing with him a dark, heavy cloud that he places directly above your head. That old familiar feeling of self-loathing, hopelessness and dread starts to fill your mind. A heaviness grows in the pit of your stomach while a tightness creeps across your chest. That negative soundtrack in your mind kicks in and you can feel yourself sinking into a dark area.
In a panic, you start to ramble off a few questions for Mr. Depression:
Mr. Depression stays silent and simply stares back at you. He knows that you already know the answers to your questions. As you reflect back on the weeks leading up to this unexpected visit, you might be able to identify some triggers or warning signs; some clues that Mr. Depression was on his way for a visit. Maybe you were overworked. Maybe there was some additional financial stress in your life. Maybe there were some relationship conflicts. Maybe the weather was lousy. Maybe your nutrition and exercise patterns were off. Or, maybe there were no signs.
Sometimes the reasons for Mr. Depression's visits are rooted in our childhood experiences or are the result of trauma. Sometimes Mr. Depression visits us because of life adjustments and losses. Sometimes Mr. Depression is an old family acquaintance who has been passed from generation to generation. Sometimes Mr. Depression shows up for no reason at all. Yet, there he is, in your life. In your house.
Regardless of his origins, Mr. Depression has visited you many times before today. Sometimes he stays for just a day or so but sometimes his stays can be lengthier. When he arrives, he never tells you how long he is going to stick around. Mr. Depression is a terrible houseguest. He is demanding, consuming and completely attached to your hip. He follows you around everywhere you go: to work, places with your children, out with your friends, to the grocery store, in the car. Everywhere. He saps your energy and leaves you feeling completely empty. The longer he is here, the more effort it takes for you to do previously simple tasks like answering texts, getting out of bed, exercising, eating, even brushing your teeth or putting on a bra. Mr. Depression makes everything significantly more challenging and the whole time he is here, he is whispering awful things into your ear - he thinks you are a terrible person; he thinks you are ugly; he thinks you are a bad parent and an awful friend; he thinks you are a failure. The longer he sticks around, the more you start to believe his words.
Often when Mr. Depression comes to visit, you try your best to keep his visit a secret. You don't want your friends to know about your new house guest. Afterall, they might think you are crazy. They might think you are just looking for attention. They might not understand why you can't just grab Mr. Depression's suitcase, toss it out into your front yard and give Mr. Depression a good shove out the front door. They might ask why you can't simply choose to have a visit from Mr. Happy or Mr. Grateful instead. And while you know that your friends will mean well, their questions and advice will probably only tighten Mr. Depression's grip on your life right now.
So, you settle in and try to do the things that have made Mr. Depression leave in the past. Perhaps you adjust some medications, take some trips back to psychotherapy, focus on increasing your coping strategies, increase your self-care efforts and lean on people who are supportive and won't judge you. Over time, like always, Mr. Depression eventually starts to loosen his grip on your life. He stops following you everywhere and eventually one morning you wake up and find that he has left your house in the middle of the night. Of course, he always leaves things behind; little reminders that he was there and that he could be back at any moment.
But what is this visit from Mr. Depression like for the people on the outside, the people unaware of his arrival? For them, they often witness significant changes in their friend; perhaps overnight or perhaps gradually. Their once cheerful, outgoing friend now appears grumpy, irritable and sometimes non-responsive. Texts and phone calls to the friend go unanswered. They begin declining or canceling plans to get together. On the rare occasion that they do engage in social activities, they are a bit of a drag as they talk badly about themselves and focus on the negative. Even their physical appearance seems different. Their social media account activity changes. Friends might think they are being iced out of relationships, that their friend has suddenly become bitchy and uninterested or that it takes too much energy to be around their friend now. All of this means that by the time Mr. Depression finally leaves, he may have already caused some significant damage to relationships.
So, how can we minimize that chances of Mr. Depression destroying our relationships? One good start is to be honest.
For those of you dealing with the unexpected visits from Mr. Depression, consider being honest with those people closest to you. They will notice the changes in you anyways- help them to see what is at the root of these changes. Educate them about your experiences with depression and teach them about what you need in terms of support. If you are struggling with depression and would like additional support, please review The Depression Toolkit.
For friends of someone who might be struggling, be supportive and resist the urge to pass judgement. Remember that the vast majority of individuals would much rather Mr. Depression not be a part of our lives. It's not a choice they make for attention or sympathy or medication prescriptions; It's just part of them. Holding space and providing support for someone with depression can be emotionally exhausting so remember to take care of yourself during those times as well. For additional resources for family and friends, please visit the University of Michigan Depression Center.
For more articles on mental health, depression and self-care, click on the following links:
If you have ever been on social media, you surely have seen those bright and cheerful memes reminding you that "Happiness is a Choice," instructing you to "Be Happy" or "Choose Happy" and sharing insights such as "Mind Over Matter." Often these memes are helpful, serving as a way for us to reframe our outlook and view our lives through a more positive lens. We've all had those days (or weeks) where nothing seems to be going our way and it becomes very easy to focus on the negative. A bright and simple meme may catch our eye as we scroll through our Facebook feed and somewhere deep inside our brain the message resonates with us. Suddenly we begin to consider the things that are going right. Sometimes we can "Choose Happy." Thanks, Facebook!
But what about those times when happiness isn't a choice? Are there times when we simply can't "Choose Happy"? According to the National Institute of Mental Health, nearly 10% of the US population suffers from a mood disorder such as Major Depressive Disorder, Dysthymic Disorder or Bipolar Disorder. Nearly half of those cases are classified as severe (National Institute of Mental Health, 2016). Think about that statistic. 10%. 1 in 10. Let's look at it in terms of raw numbers: the National Alliance on Mental Illness reports that there are over 20 million Americans living with Major Depressive Disorder or Bipolar Disorder (National Alliance on Mental Illness, 2016). 20 Million. For these individuals, happiness isn't always as simple as making a choice. Anyone that has ever battled a mood disorder or known someone with such a diagnosis knows that even when everything in someone's life is going right, happiness for them can be fleeting. Sometimes it can feel completely impossible. For many individuals, happiness is often just out of reach and the weight of depression can be deeply debilitating.
For these individuals it isn't as simple as choosing happiness. For many, depression is something that will follow them for many years; always lurking just around the corner. Treatment and symptom management options include medication, psychotherapy, support groups, lifestyle changes and diet changes. In other words, it takes work and lots of support to manage a mood disorder and just when it finally seems to be under control - boom! The bottom drops out and suddenly everything feels overwhelming and hopeless...again.
What is it like for these individuals when they see the bright and cheerful memes on social media reminding them to choose happiness? Wouldn't it be nice to think the memes have magical powers that can rewire the chemical imbalances in some people's brains? Wouldn't it be wonderful if these catchy phrases could do away with the need for anti-depressants, psychotherapy and help to eliminate the need for mental health reform? Wouldn't it be amazing if memes could make those suffering from depression finally break free of the black cloud that is often swirling around inside their head? Sure it would. But, this is the real world. I would wager a bet that for many of these individuals the calls to "Choose Happiness" do far more harm than good and often contribute to the negative stigma surrounding mental illness. In other words, they alienate individuals and reinforce the isolation often experienced with a mood disorder.
For an individual with depression, likely the one thing they want more than anything in the world is to wake up and feel normal. Based on my experiences, very few people enjoy opening their eyes each morning only to be greeted by the heaviness and isolation of depression. There are constant reminders to these individuals that they are different, they are not normal and that it is not ok to feel depressed. Mental illness, such as depression, carries a deeply negative stigma and being diagnosed with a mood disorder is not something most people share with others. Instead, once someone receives such a diagnosis, they often keep it a secret and carry it with them in shame. Yet diagnoses such as diabetes, heart disease, cancer or respiratory disease don't carry that same level of negative stigma and shame. Maybe that's just because things like diabetes, heart disease, cancer and respiratory disease are more common and more dangerous than mental illnesses such as depression, right? Wrong. According to the Centers for Disease Control and Prevention, Suicide is the 2nd leading cause of death for individuals ages 10-34 and the 4th leading cause of death for those aged 35-54 (Centers for Disease Control and Prevention, 2016). The National Alliance on Mental Illness reports that 90% of those who die by suicide have an underlying mental illness (National Alliance on Mental Illness, 2016).
Let those numbers and statistics sink in. We are talking about individuals with a diagnosis that is very prevalent, very debilitating and can also be deadly. Yet, the message our society often sends these individuals is that THEY are the problem, they are not normal and they simply need to "Choose Happy." Being reminded to "Choose Happiness" over and over again seems to be akin to telling the depressed person to "Get Over it" or "Just be Normal." Maybe, for some people, those bright and cheerful memes are actually quite painful.
Do I think everyone should stop sharing the memes in question? No. Of course not. For many people, they provide a bright spot and a useful reminder to change their perspective. But, maybe before sharing such a meme, take a moment and reflect on the people in your life who may be suffering silently from a mood disorder. Remember that the statistics I have shared are only based on those individuals who have sought treatment for a mood disorder. There are likely far more individuals suffering in complete silence, afraid or unsure of how to access support. Chances are that you personally know at least one of the more than 20 million people in the country who have such a diagnosis. How can you best support them? How can you help to break down some of the barriers for them? How can you help to get rid of the negative stigma associated with mental illness? What if your message to them conveyed that it was ok for them to be themselves? What if your message conveyed total acceptance and unconditional support and didn't put pressure on them to "Choose Happiness?" What if your message conveyed that you still choose them, no matter how they are feeling?
Centers for Disease Control and Prevention. 10 leading causes of death by age group, United States - 2014. (n.d.) Retrieved July 25, 2016 from http://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2014_1050w760h.gif
National Alliance on Mental Illness. Mental health facts in america. (n.d). Retrieved July 25, 2016 from http://www.nami.org/NAMI/media/NAMI-Media/Infographics/GeneralMHFacts.pdf
National Institute of Mental Health. Any mood disorder among adults. (n.d) Retrieved July 25, 2016 from http://www.nimh.nih.gov/health/statistics/prevalence/any-mood-disorder-among-adults.shtml
About Changing perspectives...
I often find myself encouraging people to consider changing their perspective or reframe the way in which they view things. This blog is an extension of that practice and is also an opportunity for me to write from a number of different perspectives including clinician, educator, mother, friend and supervisor. Blog topics are also quite varied and changeable. Topics explored include, but are certainly not limited to, grief, parenting, health and wellness and relationships. Join me and explore a number of changing perspectives!