Depression---an online discussion

Major depressive disorder (hereafter referred to as "depression") is a prevalent and disabling illness. According to the National Institute of Mental Health:

Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44...[and]...affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.

There's been some terrific writing on depression around ScienceBlogs this year. I've written a few pieces touching on mental illness in the past, but never anything explicitly about depression. Given the frequency and impact of this disease, it's time to have a frank discussion. This was spurred in part by an acquaintance who reads my blog and has struggled with depression herself. She happens to be a pretty good writer and was willing to share some of her experiences with us.

I'd like to use her story to start off a discussion about many of the problems surrounding depression, some of which aren't so obvious, including impact on work and friendships. And since I want a frank and open discussion, I'm asking my commenters to think twice before hitting "post". In an unprecedented act of censorship, I'm asking you to censor yourself when it comes to derogatory comments about each other. If you can't properly censor yourself, I'm likely to do it for you.

I'm rendering the voice of "graustesinnever" in "thesis" font to set her writing apart from mine.

Depression and my advisor

from graduatesinnever

I saw a lot of posts around the blogsphere lately with questions about depression. There was one in particular at Dr. Isis', a question about whether or not the student should tell her advisor. I was so heartened to hear so many people say Yes, tell your advisor. They will understand, they will help you. One of the commenters even talked about her advisor coming to pick her up in the morning when she was too sick to get out of bed. I was so heartened, and but I was also so sad. That experience is entirely foreign to me. Since I don't have a blog where I can write about stuff like this, Dr. Pal, when I asked, gave me generous permission to post here. Knowing the audience I bet I'm in for a bit of bashing.

I have clinical depression. I have had depressive episodes, I think, since I was a teenager, but I was only diagnosed in grad school. I only found out later how strongly it runs in the family. But hindsight is 20/20, and I can remember times when I should have been beyond excited and happy, surrounded by wonderful people and doing wonderful things, and all I could do was stare in the middle distance, and try not to cry all day long, over and over for weeks, months. I spent an entire summer in Western Europe. At one point, I spent days doing nothing but riding the 95 bus line around Lyons, never getting off, just sitting and staring out the window. I would cry and beg silently in my mind for people to notice. But of course, all those things people do when they are depressed, which they think are going to make people pay attention, are exactly the sort of thing that drive people further away.

But by senior year of college, all was right with the world, grad school applications were in, and life looked ok.

And then I went to grad school. I entered a punishing routine of classes and labwork. And the grad school I picked, was not what I thought it was. It was one of the best programs in the country for my discipline. But it was more competitive than anything I had ever experienced. No one was a friend. I was immediately ostracized for being geeky and weird, and treated in a way I hadn't seen since middle school. I was a good student, and decent in the lab, but I was incredibly lonely. I never learned how to meet people, and my fellow students made no effort to join together. We might be colleagues for the rest of our lives, but it will be jealous competition at best.

Nothing triggers depression like feeling so alone. Finally, in my second year, several things happened, I got increasingly desperate, and when I started to look at kitchen knives the wrong way I went to see a counselor. I thought I hated grad school. I thought it was biomedical science. I needed to GET OUT. But I could barely get out of bed.

counseling helped a little, antidepressants helped more. My counselor, my parents, and my close friends who knew (most of them still don't) asked me repeatedly whether I had told my advisor. I had not. I will not. Several years later, my advisor still doesn't know. My committee doesn't know. Even my mentor will not know. Maybe, in a few years, in a post-doc, I will tell someone. But I am too afraid.

My program is very hard. It has a high drop-out rate. I remember one girl dropped out, it was whispered for months that it was because she was bipolar. She went crazy, people said. A boy dropped out, and everyone said how he was an alcoholic and crazy, they said he had schizophrenia. Or maybe, they said, it was just the drugs. Another boy dropped out. Everyone knew about his anxiety, his depression, his ADHD. Every bad grade he made was the same. His drugs weren't working that day. He wasn't in a good place. If he could just try again... The members of his class grumbled when he got an extra four hours to take an exam. The second time he failed the quals, he was gone. Most people in the department just said he clearly couldn't take it.

So when I got a diagnosis, and I knew I wasn't just being emo and stupid and a child, I felt nothing but fear and shame. I couldn't tell people. I can't tell people. There is a stigma in mental illness, and nowhere does it show up more than among the high-achieving. You might HAVE mental illness or an addiction. But you're supposed to keep working through it. You're smart and promising, you are better than depression or alcoholism or anxiety. Amazing how biomedical scientists can think that willpower will overcome brain chemicals.

Where did I get these opinions? From my fellow students, but also from my professors. I heard them scoff at the students who came in to talk about their depression. Often they were given second chances, but no one expected them to make it. The program is supposed to weed out those who can't make it. Most professors didn't even believe them. They thought ADHD was an excuse, depression was laziness. It's not that you can't get out of bed, it's that you won't. Obviously.

I used to daydream a lot about telling my advisor. Maybe I would get a nod of understanding. Maybe they would ask me what they could do to help. But I had seen them scoff at the other students, too. I got reproved the one time I cried in their office, for being unprofessional. Crying is not something a scientist does in public. In fact, it's not something a scientist does at all. They would think I couldn't handle it. From then on, their eyes would be watching me, seeing if I was going to fail. At the best, they might treat me delicately, like I was made of glass. I didn't want that. I'm sick, in a way, but I'm not dying.

So I never told anyone. I went with the stereotypes. I worked through it. I raced out of offices before they could see me cry. I spent hours in the bathroom, leaning against the door of one of the stalls, desperately hoping no one would come in. Or hoping even more desperately that someone would come in, and ask me what was wrong. I learned how to pretend I was angry. I got angry instead.

Two years later, the depression receded. For a little while. I know now that it will always come back. I wonder if my advisor thought I was just unproductive because I was stupid. Or because I was lazy. Probably. But I am still too scared to tell them the truth. Then it might be stupid, lazy, AND depressed. Great. Someone get that hot potato out of my lap.

I hope someday I can find a mentor I can trust enough to tell them. I hope I won't be scoffed at. I hope someone cares enough to call when I don't come to work, rather than send some mildly reproving emails a few days later, when they notice I am gone. I hope they won't start to avoid me, to make excuses. I hope they won't give me a lukewarm reference, because they don't want to recommend damaged goods. If I fail, it reflects badly on them.

Depression isn't weakness. It isn't a lack of willpower. It is scary and deadly in a way that only being trapped in your own mind can be. It spins your thoughts in more negative circles, til you can't think your way out. And it doesn't make it better to know, even in moments of clarity, that this is affecting your career, but those who can help your career will not help you. Everyone understands other chronic conditions. Help will be given for diabetes, for cancer, for autoimmune diseases. Those are visible, we can see them. Depression is constantly asking to be seen, and pushing people away at the same time.

So what is the point? There is still a stigma, even among the most educated in the nation. There is still no understanding of mental illness. Since there is no understanding, there is little sympathy and less help. Think about those students who you thought just couldn't make it. Were they really just lazy and unmotivated? Did they just like to party too much? Or did you never think to ask if it was something else, if something was wrong. Do you, like many professors, not really like seeing emotion in your students, unless it's science related. Maybe you think you've been down too, and you did just fine. These people aren't strong enough, that's it. Kids these days.

Points of discussion are whatever you wish, but among them:

  • The somewhat false dichotomy of "mental" vs. "physical" illness
  • The stigma of brain illnesses
  • Career considerations
  • Our current health care system as it relates to mental health

Thanks in advance for participating and doing so politely.

Resources, including crisis help: here.


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Fantastic post, Pal, and my hats off to the reader who wrote to you. I think this shows how multi-faceted these discussions need to be. Although one person may not experience stigma, that experience may not be universal.


As someone with bipolar (affective) disorder (BAD) and a history of severe depressive episodes, I identify with graduatesinnever's fear of telling her advisor or mentor about her problem. (Loneliness is also a trigger for me.) The stigma and misunderstanding exist, and it is very difficult to teach people about the reality of mental illnesses. Depression (and BAD) are often hit because we imagine these mood illnesses as mood swings. They're not mood swings; these moods that are very difficult shake off (especially without medication). The misunderstanding of these illnesses creates the stigma, and fuels the fear that people with mental illnesses won't get compensation. Over the years, I have only told one instructor about my problem. I have gave other reasons for my poor and inconsistent performance: stress, but it is stress that exacerbates the moods.

For many years, I have been told that I have too much self-pity (during my depressive episodes), and that I must kick myself and pay attention to other people. Maybe that works for some people, but it is difficult when one only sees pain and horror and isolation. Maybe self-pity is a symptom; instead of mocking or accusing people of self-indulgence, we need to recognize the problem behind that behavior.

I agree with Isis that this experience may not be universal. I don't know. Maybe someone here will represent that experience.

graduateinnever, have faith. There are people in science and academia who will understand (and have similar conditions). If I had told even just one person, who turned out to be a very sympathetic professor, then someday, you can find some help, too.

Andrew Solomon's "The Noonday Demon" is the best one-volume treatise of depression I've read -- rational, explicit, unflinching. Graustesinnever, please read the book. I've struggled with depression for decades, and only after reading "The Noonday Demon" was I convinced that someone else not only knew the torment but had found a way to master it.

By mediajackal (not verified) on 30 Jun 2009 #permalink

(My graduate degrees are in psychology;I've done various types of counseling/related work;currently I work with international students).Dear "Grad Student": first of all, you're very brave to write so honestly about your life (forgive my brevity, I'm just off a plane). I think that first of all, you need to dis-entangle a few things.1.Graduate school can be nightmarish for anyone, *and* mental illness can complicate *whatever* you do.Also,2. separate what *you* think from what others think,(similarly,speculating about others' thoughts recursively *ad infinitum*- hey, take it easy on yourself!).I would suggest that you see a counselor *totally* unrelated to the university you attend, with whom you can discuss *anything* including( but not limited to) school/work.

By Denice Walter (not verified) on 30 Jun 2009 #permalink

Depression isn't weakness.

Of course it's weakness. So what? I'm most likely twice your size and can pick up things that you can't budge. I probably have better eyesight even at twice your age. I'll also bet that you are much better at walking (I can't run, at all) than I am. Does that make you bad? Does that make me bad? Rhetorical questions.

We all have weaknesses. Pretending otherwise just sets us up for failure, and worse than failure it sets us up to blame ourselves for things that we can't -- and shouldn't expect to -- control.

Context: Looking at my childhood and early adulthood, I'm probably mildly ADHD and borderline autistic spectrum [1]. I lived for 25 years with my ex-wife, who's diagnosed ADHD and depressive. My current mistress has a serious tendency towards depression, and responds very badly to the usual antidepressants. Two of my children are ADHD, one pretty seriously.

Them's the cards we're dealt.

The question is, what to do to make the best of life?

Step one: don't join games you can't win. I can't comment on the program you're in, but from here on out it's essential to pick your environment (social, physical [2]) to be as supportive as possible.

Step two: The old prayer about "change the things I cannot accept, accept the things I cannot change, and the wisdom to know the difference" applies. Find your realistic boundaries. Take chances near them, but don't set yourself up for failure by going far past those limits. Get help checking your answers, because human judgment is fallible and checking each others' work catches a lot of errors.

Step three: You too can be your own maze-running rat. We're all subject to behavior modification, which is just as much a part of our brain wiring as mood (if limited.) Define the problem, set up realistic goals for modifying your own behavior, and enlist the resources to execute the plan.

Do I put a lot of emphasis on others helping you? Damn straight. People are good (if remarkably thick sometimes.) Once they get it hammered through all that bone that you're as much in need of assistance as the lady with the red-tipped cane [3] they will want to help, even if they're clueless to the point of "more harm than good" -- at first.

People deserve a chance to do good. Give them that chance, and you'll be amazed.

PS: PAL can give you my contact info, or I'm easy to look up.

[1] Hard to tell now with all the acquired behavioral adaptations.
[2] Probably best to avoid high latitudes. Consult an expert.
[3] Or more. Mark Probert has two sons: one confined to a wheelchair by a serious congenital neurological problem, the other with ADHD. The whole family agrees that the son with ADHD has the worst of the deal.

By D. C. Sessions (not verified) on 30 Jun 2009 #permalink

There --is still-- a stigma, even among the most educated in the nation.

Well, close but no cigar, there are people who continue to practice this prejudice, and teach it, but in dwindling numbers.

By Harold A. Maio (not verified) on 30 Jun 2009 #permalink

"It's not that you can't get out of bed, it's that you won't."

This got me thinking: how can you tell the difference between "can't" and "won't"? Is the difference even important? It's hard enough for me to distinguish between the two inside of my own head, much less with someone else, so I think that's a factor hindering acceptance.

Also, I wonder if some of the shame that people pile on mentally ill people (particularly depression) is really just projection of their own guilt when they act lazy, sad, avoidant, etc. themselves. "I feel guilty when *I* do it, and so should you!"

That's a very moving email and a reminder of a good point, thank you for sharing it with us.

What I'm curious about, if you don't mind the tangent, is depression as a symptom rather than the primary condition. I know depression is a symptom of diabetes, and a side effect of some medications. With such safe and varied antidepressants these days, I kind of wonder how many people out there are being treated for only part of the problem (not that I'd in any way suggest the depression should not be treated!).

The poster (whom I'd like to congratulate for being courageous and providing such a moving description of depression) mentioned having symptoms as early as high school. I've heard that 1 in 8 high schoolers has some form of clinical depression at some point during those four years. I'm curious as to what people think of efforts to screen all high schoolers.
Obviously there are confidentiality issues, but can they be overcome? It's awfully darned easy for a kid to slip in and out of classes every 47 minutes without a teacher picking up on any signs that something is wrong - as a teacher (and now parent), it definitely concerns me. If there were an easy & ethical way to identify and help kids, I'd be all for it.

I wonder if some of the shame that people pile on mentally ill people (particularly depression) is really just projection of their own guilt when they act lazy, sad, avoidant, etc. themselves. "I feel guilty when *I* do it, and so should you!"

In part it's a matter of Job's comforters.

In part it's the fallacy of linearity, that you observe. In everyday life for most of us, a nudge can take us from not-doing and doing (whether getting out of bed, mowing the lawn, or whatever.)

Extrapolating that, though, gets us to "The Little Engine Who Could" and the pernicious song "High Hopes" -- which teach the lesson that not doing the physically impossible is a moral failure.

That way lies madness. Literally.

By D. C. Sessions (not verified) on 30 Jun 2009 #permalink

Thank you! I can't even begin to tell you how relieved I was reading your story - it follows my own very closely. No one, not even my husband, believed I was depressed and having anxiety attacks even when I was continually breaking down in my office and sleeping until 5pm. I was so lucky when a friend recognized the behaviors and talked me into counseling. Most of my counseling sessions were on this very topic - I was so afraid to let anyone know what was wrong with me because I was/am terrified of the stigma. In the end I worked myself up to talking to my advisor about it, but even then I loaded the conversation up with all the things I was doing to get myself on the right track. I still don't know if it was the right decision to make, but only time will tell that.

I have learned, since my breakdown, that a VERY large percentage of students passing through my department have been through counseling or are on meds, etc. I've made it a point to tell new students coming in about my experience so that they don't have to go through it alone if it happens to them.

But the stigma is still prevalent. I still haven't told my mother that I am on anti-anxiety/depressants, even though they have made my life amazingly more livable. The conviction on her end is that she couldn't possibly have raised me so horribly that I would have a mental illness, and besides, how the hell did I get into graduate school if I was depressed to begin with? Didn't I go wandering through Europe by myself? I suppose some of it should be flattering, but in reality these kinds of thoughts prevented me from getting treatment for a long time, and I lost a sizeable chunk of my life to it. Denial, well-intentioned or not- is never helpful.

By Callicebus (not verified) on 30 Jun 2009 #permalink

I get this "you can work through it if you want to" crap from my father if I bring anything up to him, so I mostly don't. I love him, he loves me, and he thinks he's giving me good advice.

His experience for 86 years has been that hard physical labor can overcome any "bad" feelings, both physical and mental. For him it does. Endorphins maybe?

Or maybe he experiences pain differently from most everyone else. I've tried to explain this to him -- that the same pain might feel different to different people and get nowhere with him.

Anyway, while I can take this attitude from my father, it annoys me considerably from other people. I know I'm depressed because when I'm on antidepressants I feel so much better. It's not like there's a blood test for it. But no days of endless crying for what seems even to me for no good reason are worth stupid remarks from others.

I am not a grad student though, and I do have people around me who understand, so I doubt I can truly relate.

Graduatesinnever - I wish you the best in finding your way through this. People who have the brains to understand what you are studying are too few and too precious to have this disease stand in your way.

Part of the problem with depression, serious, debilitating recurrent depression, is that when you are not in it's death grip you are "ok", as in you can act "ok" better than you would ordinarily. Thus when you are doing "ok" you want to function as normally as anyone else, and can function as normally as anyone else, given that everyone has some issue or other to deal with daily..
This gets tricky when you are also smart or talented or ambitious, for several reasons. First, if you are normally gregarious, outgoing, accomplished, motivated then people don't believe you have a problem, even when you do manifest symptoms. "What do you mean you're depressed? You do more than most people I know, etc etc". Keeping exceptionally busy is one way to keep moving, albeit zombielike, without collapsing into bed forever.
Also, when you are feeling well you do want to work at your maximum, like anyone else. This is where I disagree with D.C. Sessions- that you don't need to "dumb down" your work in order to accommodate the depression. Maybe cut out some obvious negative stressors like abusive workplaces, long commutes, crappy pay, but beyond that you still should keep the goals you had. When you do feel good you'll be happy you have a challenging and interesting job. Feeling shitty & also having a shitty job/downgraded schooling/less $ spirals into some real negativity real fast, I tell ya.
Thirdly, if you are adept at appearing to cope and still making it through the day in a competitive environment, it has been my experience that people then think you are using your claims of depression as some kind of excuse to garner sympathy (see point 1- they don't believe you in the first place), and think you are expecting some sort of accommodation, when in reality you may just be trying to explain your situation and foster some understanding.

I also know depression does some serious thought process rewiring when left untreated (or even treated, really), and you need to step back before doing anything drastic. By drastic I mean shaving your head, skipping town, dropping out of school, overdosing, having unprotected sex, firing people, whatever- you name it. Patience and some outside support is crucial. I could kick myself 10 times over for some of the dumb ass decisions I made- opportunities I passed up, scenarios I left, beliefs I held, because I let the depression sicken my brain & didn't get enough help from the outside.
Outside help- can't get enough. Shrink, counselor, friend, family, blog, book, group, therapist, whatever- get some & use it. Don't be afraid to try meds, therapies, check yourself in if necessary. I eventually did ECT, and while I'm not convinced it fixed much, the act of attending full time to my illness was important. It validated that this really was as big a deal as people say it is. Job on hold, pets being taken care of, someone digs you out from under the rubble of your "life". $40K later, mostly paid by insurance, thankfully, I knew that this had been a lifetime thing, 10 yrs of meds hadn't prevented this, but I needed to learn to fight & stay alive long enough to do what I knew I was capable of.
So stay in school, get help- lots of it- and enjoy your work on the days you can. It's worth it.

This is where I disagree with D.C. Sessions- that you don't need to "dumb down" your work in order to accommodate the depression.

I suspect I did it again: putting the idea poorly.

I'm not suggesting "dumbing down" expectations, except to the extent that having an elephant in the living room forces you to pay more attention to your route across it than otherwise.

We all have to consider capabilities and limitations in our lives. Just as a for-instance, those of us with children can't reasonably do some things that we could if we didn't have them. So be it. Those of us with physical limitations (e.g. my totally shot legs) are wise to avoid doing things where those limitations are a threat (no marathons for me, nor rim-to-rim-to-rims.)

Don't "dumb down" -- but do think very, very carefully about your plans. A destination with a supportive environment might beat out one with other benefits but lacking support, for instance.

By D. C. Sessions (not verified) on 30 Jun 2009 #permalink

Anna, I think your point is relevant to a lot of graduate students/high achievers in general. I know for me, I've become so adept at putting on the "I am productive ambitious happy and fine" act that that's usually the last thing to go-I stop sleeping well first, then I stop eating and start losing weight, then I become a little socially withdrawn because being around people and keeping up the act is so exhausting, especially on no sleep and no food; but through all of this my work barely suffers. People start to notice things are off because I get disheveled-messy hair, no makeup, wrinkled clothes. The time my productivity drops is usually at about the stage I start stockpiling sleeping pills and antihistamines, and that's when I know the bottom's fallen out and get help.
It's a strange trade off. I've excelled in grad school, despite two serious depressive episodes. But that success has come at a pretty heavy cost to the rest of my well being.

Graduatesinnever, thank you for this important post. I can totally grok your experience, except for one difference: My illness has been so severe that I have failed to live up to my intellectual and creative potential. I am stuck, for the rest of my life, in a job that I hate. There is no chance of returning to school because I have to support my family (including dear husband).

What you say about the times when we most need to connect with people corresponding exactly to times when we are behaving badly -- pushing people further away -- is so true. I believe only people who have experienced the prison of the mind can truly understand how devastating, how completely debilitating this experience is. People say "get help." Jesus, people love to say that! I have seen a psychiatrist and a psychologist RELIGIOUSLY for thirteen consecutive years (I am not going to count the "help" I got as a teenager and college student). I have obediently swallowed all kinds of pills every single day which led to an 80 lb weight gain, but no significant (sustained) relief of symptoms. What is wrong with me? Why are the every day tasks of living impossible, insurmountable hurdles? Why, when I try to connect with others, do I end up feeling such intense shame? Why am I such a freak? I think about death A LOT. I pour the giant bottle of Tylenol (yes, I know how to do it right) into my hands. I lust for those little pills. I tell my husband I'm going to kill myself and he answers, "You're crazy." No shit. I keep telling myself that I can change, be better, but I know it's a lie. One day I will kill myself. Maybe when the kids are older, but one day. And I look forward to it. I don't even care if my death, like my life, is slow and painful.

The only times that I have felt that life is worth living are times when I have experienced love, especially when my children were small (although the truth is I probably shouldn't have reproduced). But depression is like being under anesthesia -- you lose the ability to feel love, even if it is there for you. I wish I could tell you it's going to be OK (it's not). But I will give you one piece of advice: Finish graduate school even if you have to crawl on your hands and knees to get through it. Give yourself a shot at a meaningful life. You may even find some people who give a damn and will see you through the worst times. I give a damn.

By anonymous (not verified) on 30 Jun 2009 #permalink

I'm going to try. Please excuse me for any rambling. Much editing would mean not contributing at all.

I have, in the past, been diagnosed with a number of different mental illnesses, most of which I on the point of whether I fit the criteria. (The greatest point of my doubt is that two diagnoses I held at the same time were mutually exclusive.) I suppose this is a good place to jump off on the question of the heath-care system as relates to mental health... I don't think counselors, psychologists and/or psychiatrists work anywhere near closely enough together (though I understand this is likely to vary by region). Neither do I think doctors who don't consider themselves to be in the mental health field work closely enough with these people. As has been said, there are conditions which may cause or contribute to depression or other mental illnesses.. so doctors outside of mental health ought to be involved and I do wish that, if mental health programs really aren't working out, then perhaps other, less likely causes would be investigated.

I know that there is a notion of a database of medical records going around. I must admit, that scares me. All my MH diagnoses stem from within a few years of my leaving home, some before and some after. That home was abusive and, frankly, I simply didn't know what was what.. but those diagnoses followed me. Even now, when there's something going on with me, if I've been honest with my records or they otherwise know, it seems many clinicians first thought is that my problem is related to mental illness. At one point, I got a twitch in my arm which only stopped when I was quite asleep. A friend's mom was a nurse and told her I should see someone about that, pronto. For lack of anything else in town our insurance covered that was open, someone took me to the ER... where they saw my records, gave me a Benadryl, and sent me to psych intake (who couldn't understand why they'd do such a thing). It seems that everything that went wrong with me was tainted by those diagnoses all before I was 19. I know doctors really don't like people lying about things, withholding things.. but I do hope there can be some understanding here.

The stigma of brain illness... Yes, I know some of that. Brain illnesses such that affect cognition, especially. (Or maybe that's just my bias.) I think some of it is just because it's so far out of the mythical "normal" experience. People can't really understand something for which they have no comparison. I'm told it's even common for there to be prejudice in disability-circles toward the mentally/cognitively disabled. I suppose the reasoning starts you're different from me in ways I can't see and don't understand... but ends somewhere significantly worse than therefore I will try my best to learn, minding my own ignorance. It's a pity.

In response to the quoted bit, (and if I'm off here, I'm sorry.. I admittedly can have trouble understanding,) I don't think that there is necessarily more understanding where "physical" problems are concerned. I have MS.. and uncommon disease but common enough that it seems everyone knows someone within four or so degrees of separation. But there's trouble with that, too.. because then it seems that everyone thinks it goes exactly how it has for the person they know or how it has for some celebrity. But alas, it doesn't work that way. I happen to have some very uncommon symptoms of this significantly uncommon condition (and uncommonly severe manifestations of some more common symptoms). I am alone and not understood. More than that, if anyone just hears I have MS, they will almost certainly have a very wrong idea about how I am. Worse, while there are medicines to limit the disease progression and some to ameliorate certain symptoms, treatment and even screening for cognitive problems is controversial (and, as far as I've been able to find, unproven). I get people thinking I'm stupid, rude, uncaring, being obstinate.. even people who are close to me thinking such things.. because I might fail to answer a question on demand or be unable to "read between the lines" or choose among options. I get judged over such things though I can often do no better. As far as I understand, in medicine it's even controversial whether anxiety is a symptom of cognitive problems in MS or if anxiety causes those problems. (For my part, I think people think I'm anxious or upset when I'm merely frustrated or just overwhelmed due to, eh, buffer overflow or the information or question being such that I can't understand it.) People certainly don't understand those things.

I suppose that goes to show there aren't so much barriers between "mental" and "physical". Though I suppose "so much" is giving too much. They're aren't barriers, not unless you're holding some mind/body dualism. But then, our brains change more often that most of us probably realize. (At this point, I'd be surprised if they didn't all the time.) Living changes your brain physically. The mental is physical, though I make no claims that I understand it. Kind of blows my mind. Or brain. ;)

I can very much relate to the poster of #17.

I've had many people describe me as one of the smartest people they know. Apparently I'm very talented and have so much potential. Where has it gone? So much of it has been eaten by depression. It's a hard thing to realise that I will never live up to my potential. That I'll have to sit on the sidelines and watch others enjoy the success that might have been mine, if I had only been able to DO something.

I also think about killing myself on a regular basis, though I'm not anywhere near the point of acting on such thoughts. It's more that I can very much imagine killing myself at some point, eventually. Mostly, I just wish I had never been born.

I spent a lot of years refusing to admit that I had depression and refusing to seek help. Eventually I had to, or I really would have killed myself. When I finally had to start explaining what was wrong, I was surprised to find how understanding most people were. It was also a little horrifying to discover just how many people I knew were also struggling with depression.

Now I'm far more open with my illness. I don't broadcast it to everyone I meet, but if it comes up somehow I don't try to hide it. If someone needs to know, I tell them. So far, so good. The worst reaction I had was from someone who lectured me about not trusting in god. If only I truly trusted god, I wouldn't feel so depressed! Ha! I was at my most depressed when I was a Christian.

The most common reaction I get is, "But you're always so cheerful!" Yeah, I'm good at hiding how I feel when I'm around people. But if you could witness my insomnia alternating with bouts of "epic sleeping", the crying jags and the inability to deal with certain aspects of my life, you'd realise I'm not that cheerful personality I project in your presence. If you could hear the dark spiral of my thoughts, you'd know better than to fall for my confident, poised exterior.

I really, sincerely hope that any of you who are advisers or colleagues of someone suffering with depression make your best effort to help that someone overcome their illness and succeed. Help them to reach their potential. Don't let them end up like me, stuck in a dead end job, reading about the science they should be doing.

By AlsoAnonymous (not verified) on 30 Jun 2009 #permalink

A close friend of mine, a masters student in psychology, hung himself some 5 years ago. Didn't see it coming. His professors at his funeral, did not see it coming.

And I battle depression, on and off, for years. I tried anti depressants but they quieted my mind too much, and I found it unsettling, and the rather violent onset nausea upon taking them, meant drugs were not going to work.

I've learned to manage the things that trigger depression, to keep from slipping into that negative spiral of thinking.

And sometimes, I just resort to keeping physically busy so I don't have to think. It sometimes works.

I struggled with the worst depression in years, at a university where I knew no one, and my profs were...indifferent at best, and I was struggling in a class. Went to an academic advisor who suggested that perhaps I just didn't belong, and if I couldn't afford it, maybe it wasn't for me, what made me think I deserved to be there, she said.

And promptly, my mood hit the deck, I contemplated awful things, and walked over to the student counselling services, in tears and suicidal thoughts.

It's gotten better. I have decided to switch to a more...supportive university ( or at least one less like a tank of piranhas) and go from there.

I don't like the depression, and the best thing I found was to find what triggered it, and what alleviated it, in healthy ways, and manage it.

It isn't always going to work, but the black moods don't last as long as they used to, at least.

I sometimes wish the drugs had worked, but the short while I was on them gave me some insight on how non-depressed brains work: they don't go chasing negative thoughts like a crack addled hamster on a wheel.

@#9 above

There is a difference between a depressed mood and an episode of major depression. Other physical states, like stroke, heart attack, etc, and lead to depressed mood, but also to a full-blown episode of major depression. Of course there are connections between the brain and other parts of the body, so that illness in one affects the others, but it's not a one-to-one correspondence.

A few random thoughts: There is strong evidence that exercise is at least as effective as anti-depressants (maybe more). The problem is it's hard to get physical when you can hardly get out of bed. But if one can make herself do it, make it a habit, apparently it works. (I don't follow my own advice. I'm too depressed to exercise.)

Second, we are all aware of the problem of scientific illiteracy in this country. But I think we have an even bigger problem with health/medical illiteracy. At least science is taught in schools. I think high school students should be forced to study human health, which would include the study of mental illnesses and hopefully reduce the stigma in the process. Human health/disease should be taught as a science course, not just the P.E. teacher spending a week preaching about using condoms and a week preaching about nutrition and exercise (which is better than nothing). The kind of course that I have in mind would cover all kinds of diseases/conditions, pathophysiology, some pharmacology (not just "crack is bad" but also Tylenol can be deadly - and why/how), biochemistry, microbiology and so forth, all in the context of human health and disease. I bet the average American has no idea what the liver does and why it's important. I'm fairly certain that the same average person lumps all mental illnesses under the unfortunate label of "crazy." And that is a shame.

By Catharine (not verified) on 01 Jul 2009 #permalink

My mind boggles and I get very, very angry at this notion that in this day and age people still need to be concerned about the stigma of neurological issues. I am extremely grateful to have been raised with a very firm "fuck 'em if they don't like it" sort of attitude. Makes it really easy for me to be open and unashamed of most aspects of who I am (though not so useful when it comes to being ashamed of myself in my own eyes). So when it comes to dealing with my depression, bipolar and ADHD, it is easy enough for me to just not worry about what others might think.

It's amazing to me the reactions I get when I talk about it with instructors. Especially given that I am not seeking accommodations for it, I just want them to understand why, for example, I might make huge contributions to the class discussion one day and be silent and sullen the next - sometimes in the same session. I understand why a lot of people are horrified at the thought of other people knowing, when I have instructors look at me like I have an extra nose growing out of my forehead because I mentioned that I am bipolar and that the meds only manage so much.

And it was only that much worse when, in the course of some classroom discussions I mention dealing with addiction and substance abuse problems. Because if there happens to be guilt on the part of those judging/moralizing about most neurological issues, everybody knows it's perfectly ok to moralize about fucking addicts. We deserve what we get, because we made the choices that put us wherever we happen to have ended up.

And that is how it becomes so very shameful to have atypical brain chemistry. That's why I can sit with someone in a coffee shop, who turns red at the thought of admitting he's on psych meds. That's why it is so fucking easy for people on psych meds to decide that they can quit - that they're - better.

For what? It's hard for a lot of people to grasp that people with neurological issues can actually have something to contribute. It's hard for them to understand these issues in the first place - they aren't obvious and easily quantified, like cancer, diabetes or viral infections. You can't see them or test for them in blood or urine.

It's all in their head, many people seem to think. Right behind the thoughts of psychopaths and schizos losing it and falling into a violent rampage.

Motherfuckers, we're the ones with issues, not you. Why the fuck is it our responsibility to make you feel better about our problems? But that is all too often exactly what is demanded. As if we don't have enough problems to deal with as a baseline. Or perversely, admitting what's going on in our heads just makes it easier to dismiss us - a ready made excuse, justified by the thought that "this person is never going to make it, so why don't I make sure they learn that now?"

I am very grateful that many of the folks in these parts are as understanding and accepting as they are - I really am. But the bottom line is that you are not everyone and, for example, Graduatesinnever is in a highly competitive program that is as likely to push her out, as it is to do anything else. One of the important lessons I have learned in my 1.5 semesters back in school, is that I am either going to have to shut up about who and what I am, or deal with potentially egregious consequences. For those who are familiar with me, I think my own decision is obvious - I am not keen on shutting the fuck up. But I am choosing not to shut up, knowing that it could and likely will impact my educational career.

As a final thought, I would like to point out to those of us dealing with these issues, there is a great deal of support and comfort to be had from people who understand. On the sidebar of my blog there are links to forums and if you don't see a link that would be appropriate, feel free to email me and I will see about remedying that. Therapy is important - meds are often times also very important. But talking to people who have neurological issues much like one's own can really make a huge difference. Simply knowing that you're not alone is wonderful...

@ anna, eela, anonymous, Beth, AlsoAnonymous,& Nico:your ideas contribute immensely to the discussion. I only have a few minor points to add:1.sometimes wanting to kill "yourself" really means "killing" your *life*- translation: getting rid of the environment, the situations, the problems, the illness, the pain, the hopelessness,*not* your actual self (problem is, they're kind of *hard to separate*!); some young potential suicides have been quoted as expecting a "rebirth"of sorts after the event(kind of a risky hope).So maybe begin contemplating the idea of suicide as "symbolic"- ending one so-called *life* and starting another better *life*(I promise not to go all Jungian on you,it's not my style.)2.some of the "help" you might seek can also be yourself.DC noted accurately how you can "work" on yourself behaviorally and set reasonable limits.I propose a much more modest program: it is very possible to learn to manage stress better- there are relaxation techniques,exercise,recreational activities,etc.;however,in addition to those techniques, simple time management can make your life a lot easier.I mean the "nuts and bolts" of daily living- set your clothes out in advance,leave the house a little earlier if there's likely to be traffic,find simpler ways to eat- whatever makes your life easier.Do some research on this.Years ago,I taught some of these methods to people who had a very serious illness, as well as using them myself.

By Denice Walter (not verified) on 01 Jul 2009 #permalink

@ Catherine and Du Wayne:I did not mean to leave you out, I didn't see you when I pushed the button- I enjoyed your comments.

By Denice Walter (not verified) on 01 Jul 2009 #permalink

@14 This is where I disagree with D.C. Sessions - that you don't need to "dumb down" your work in order to accommodate the depression. Maybe cut out some obvious negative stressors like abusive workplaces, long commutes, crappy pay, but beyond that you still should keep the goals you had.

And if the goals are tied, inextricably, to the abusive workplace/university, at the end of a long commute, and the crappy pay isn't going to improve until you get out of grad school and maybe not then, what do you do?

I come from a long line of clinically depressed people. When the counselor asked me if there was a anyone in the family with a history of depression, even she was impressed by the number of relatives who had been diagnosed and treated. If you allow for the undiagnosed ones who lived as if they were depressed, or were self-medicating with alcohol, over half the family tree is/has been living in burrows.

I get stress-induced depression, but the problem with getting depressed, like the problem with getting drunk, is that the first thing that goes is your ability to recognize that you are sliding into an altered state.

It depends on what aspect of your life the depression hits first ... it may be sleep, food, or work.

By Tsu Dho Nimh (not verified) on 01 Jul 2009 #permalink

@ Tsu Dho:"the first thing that goes.....".Exactly.All the more need to plan in advance;when you're feeling ok, set some habits in motion that will assist you when the "rougher time" comes.Simplify activities of daily life. Find enjoyable semi-passive activities(looking at art galleries, nature,reading, listening to music).Focus your plans around whichever aspect gets "hit first".Try to figure out what the "early warning signs" are.Oh, and it's good to have people around who understand your situation.

By Denice Walter (not verified) on 01 Jul 2009 #permalink

Take care all.Peace out.

By Denice Walter (not verified) on 01 Jul 2009 #permalink

So maybe begin contemplating the idea of suicide as "symbolic"- ending one so-called *life* and starting another better *life*

I think this is excellent advice. If you ever decide that you are going to kill yourself, how is withdrawing all of your money and getting on a random plane somewhere going to make things worse? Sure, the people you leave behind (especially family members) are going to be sad if you leave a note telling them not to expect to see you again, but they would be even more sad if they saw your body in a coffin.

And if your new life isn't working out, move on somewhere else. Suicide will always remain an option, but it's the 'nuclear option'; so extreme that all others are preferable.

That said, I do think that one should only run away when one has tried every practical way of fixing the problems that are driving the depression. You may have to try lots of things, and it's quite possible that none will work completely. Hopefully you will find a combination that results in a sustainable recovery, however slow.

I've just finished a course of CBT which has given me some useful skills with which to deal with anxiety (itself a symptom of my long-term depression). They will help postpone the day that I will feel that I have to 'run away'.

For the record, my depression developed during grad-school, too. I think, in retrospect, that I have always been susceptible; it was a combination of factors which triggered it. My colleagues were sympathetic, but not particularly supportive. Now, I don't believe that I will ever have a career in science. Actually, one of the things that makes me most angry is that I saw many students go on to get PhDs who were not at all bright; they were spoon-fed by their avisors, and their theses were prosaic. Some even decided to not use their qualification after they graduated. One is even into fucking homoeopathy.

It doesn't matter how intelligent you are, depression can slay you.

"Amazing how biomedical scientists can think that willpower will overcome brain chemicals."
I hear ya. One of the more bitter disappointments of grad school has been figuring out some of the attitudes about mental illness that are prevalent among biomedical scientists.
Still, I'm really appreciative that I'm doing biomedical research. There are a lot of smart people in this area, and while that's intimidating as all get out when it comes to thinking about making it work as a career, it also means that I have some faith that research can solve medical problems. There have been times when I've been depressed and it's seemed like absolutely nothing at all helps. At least during those phases the fact that they are coming out with new treatments provides a glimmer of hope.
Control over our lives may be an illusion, but it's a pretty necessary one. When you are just convinced nothing can change your mood, it's a pretty scary feeling.
Actually, I think that's one reason there are so many judgmental attitudes toward depression- if people admit someone else's mood is outside their control, they might realize how fragile their own mental wellbeing is.

"One of the important lessons I have learned in my 1.5 semesters back in school, is that I am either going to have to shut up about who and what I am, or deal with potentially egregious consequences."
+1. I chose to shut up though. I didn't have to in undergrad, where I could sometimes blend in due to the sheer number of people. But in grad school, it became necessary.

Denise Walter- I think the hardest part is telling whether you hate your life because you're in the wrong situation or whether any life with your brain chemistry is not worth living.

Catharine- exercise is generally awesome, but I think it's important to remember that when "studies show" an effect, it relates to a population.
Exercise being more effective than antidepressant medication could mean it improves mood in the average depressed individual more, or it improves mood in a greater number of people. Either way, I've never seen a study that implies exercise will work for everyone (even among those that can make themselves do it).

During one of the worst depressive episodes of my life (I have chronic depression, though have not had a clinical episode in the past decade), I decided to tell my professor. She wanted to know why I'd been skipping class, so I told her. There's more to the story than you all need to know, but the short version is that I was feeling very depressed, having just been quite thoroughly wronged by a very close friend who happened to be in the same class. I couldn't face seeing her, so I wasn't always able to get up the courage to attend.

Result? The professor told me she was on to me. That she didn't want to play my little game. I asked her what she meant, but she got angry. It was clear she thought I was making the whole thing up in order to get special treatment. But I wasn't intending to ask for any special treatment at all. I just thought, in my youthful naivety, that when she asked why I hadn't attended, she actually cared what the answer was.

Evidently, she thought I was lazy.

My depression spiraled out of control at that point. The one person who had noticed something amiss with me, and asked after my well-being, thought I was lazy, not depressed, and a liar trying to become a cheater. I would get no help from the establishment, I believed. No one cared, I thought. So I told no one else. I retreated further into myself. My grades plummeted, and very shortly, I was dismissed from the college for having a shockingly low GPA. I went home to my parents, fought viciously with my mother, who clearly believed I was a failure and thought it would be helpful to berate me and laugh at me. But I did finally get psychiatric help, and a year later, was able to return to school, raise my GPA back up to a respectable level, and graduate on a normal schedule. (Four actual years of study, though it was five calendar years if you include the year I took off.)

You do need to tell somebody if you are depressed, so that you can help. But although I'd hope your advisor would be able to help you, my experience makes me wary of recommending honesty. It would depend on the advisor. I told my professor, and got it thrown right back at me. She hated me from that day forwards, convinced I was a lying, cheating, lazy, slob. I never expected that; I thought she was a sympathetic sort of person. And maybe she was, but she obviously did not believe that I had depression.

Amber, #3:

For many years, I have been told that I have too much self-pity (during my depressive episodes), and that I must kick myself and pay attention to other people. Maybe that works for some people, but it is difficult when one only sees pain and horror and isolation. Maybe self-pity is a symptom; instead of mocking or accusing people of self-indulgence, we need to recognize the problem behind that behavior.

That is so well said.

My mother often remarks how suicide is the ultimate selfish act, and has tsked about how uselessly self-absorbed certain depressed people are. She thinks this is helpful, but it isn't. I know when I'm depressed, I can't kick myself out of it. Usually. I have found one rather strange trick -- putting on headphones and listening to "The Downward Spiral" (Nine Inch Nails) does something. It's like it exorcises the depression, burning it out by indulging it heavily for a short time. I wind up viewing my depression from the outside and seeing the errors in logic. I also have found that my husband has a remarkable gift for pulling me out of the spiral before it gets really bad, which I think is why I haven't had a clinical episode in ten years (roughly the amount of time I've known him).

By Calli Arcale (not verified) on 01 Jul 2009 #permalink

Calli (and others who haven't seen it), I recommend Ed's post at Not Rocket Science about how pressure to think positively can hurt us. I suspect it relates to your experience with music. There's so much pressure to be happy that being depressed in itself becomes just one more failure--and when we're depressed, we're so sensitive to failure.

I remember getting grief in high school for listening to music that was about things being wrong. Other kids could only see that there were bad things in the music. They couldn't see what a relief it was to acknowledge the bad things instead of denying or fighting or hiding them. It was so restful, and at a time when I desperately needed some rest. It wasn't happy music, but it was one of the few things telling me it was okay not to be happy.

Aside from that really bad day with the bad academic advisor, I have not had a major depressive episode in years.

Unsurprisingly, she'd just told me I'd wasted my time and didn't belong or deserve to be there.

The difference is, instead of letting it eat at me for weeks, I went and basically vented my head with a counsellor.

I agree, though, it isn't so much "i wanted to die" but I wanted the situation to end. while the former played in to it, it wasn't the sole thought in my head.

And I agree again, keep moving. I had an ex roomate with depression issues who'd take to her bed for weeks on end, where I admit, I try to drown it by working, and walking or some other physical activity.

But it's been 8 months since that day and there's been some ups and downs, but nothing like that crashing mood again. Previous to that, it had been years.

I never really told people, not out of shame, but because I didn't want special accomodations, or misguided attempts at it that only felt like coddling, or worse, pity, or told to "pull yourself out of it." Because people tend not to understand the whole depression issue, it was easier to say nothing. So I guess it's stigma, but often people's attempts at making me feel better ONLY made me feel worse.

Nico, I really hear you on other people making you feel worse. The only people I feel comfortable talking to during a really bad episode are people who I know have the same issues I do. I really do appreciate people without anxiety trying to help me out, I really do, but because a) they don't know what I'm going through and b) most people haven't had to or haven't realized that they've dealt with mentally ill people before that a lot of time what's meant to come across as comforting comes across as "oh poor baby, did you get a boo boo?" I can't blame people for trying though, as usually its such a nice change from "if you tried harder, you wouldn't feel this way."

By Callicebus (not verified) on 01 Jul 2009 #permalink

From the other side of the advising table. I'm a prof, and advise students at different levels, including MA students.

I've been told by a couple students that they've got depression (or other illness problems), and I have to admit I'm sort of at a loss. Imagine, for a moment, that I'm trying to be a decent person: now what do I do beyond mumble that I'm sorry they're having problems and do they need my help getting in touch with counseling services of the office for students with disabilities, etc.?

What would you suggest would be helpful from your academic advisor(s)? (And keep in mind that I'm overworked and underpaid, and totally NOT interested in psychology or counseling or brain chemistry. I'm not qualified to counsel someone or do therapy or whatever, and for good reason.) (I teach literature.)


Bardiac, I don't know. I know that a few instructors saw me completely stressing out and melting down, and gave me some extensions on work deadlines ( which were extremely rare where I was taking classes).

I didn't need help finding services from profs, I needed in some cases, simple help with assignments or such, but in my case, the university didn't really have them, or they were inadequate for demand, so I wasn't the only student suffering.

I'd have to think on it, really. The best help came from the faculty who didn't give all the answers, but a nudge in the right direction or positive feedback on my work, even if it's just a casual comment. In the depressive mindset, those negatives wind up being over amplified by my head.

I learned quick which TA's and Profs wouldn't piss on anyone if they were on fire, and those who genuinely took an interest in their students and their subject matter, and would throw you a rope if you looked like you were drowning despite your efforts.

#33 Benjamin Geiger - I'm sorry to hear that the inside of your head is so similar to the inside of mine. I mean, it's nice to know that I'm not alone, but I wouldn't wish how I feel on anyone.

#25 Denice Walter - I don't know that changing the situation would necessarily help. My life is actually going pretty well at the moment. I know this objectively, but I still feel worthless and undeserving of what I have. Just think - if I didn't exist then someone else could have my job, and my house, and the food I eat, and all the other things that I'm not deserving of. By continuing to exist I'm depriving someone else of the resources I consume! Since I'm not contributing much of anything, and there are only maybe two people who would truly miss me, wouldn't it be better for everyone if I weren't here taking up space? What makes me think that I deserve a better situation? I should be trading down, not trading up! Etc.

People say that suicide is a selfish act, but I think that many people who commit suicide are thinking along the same lines. If they think everyone will be better off without them, then they are trying to act selflessly. I know this is a skewed perspective, because I've seen the effect of suicide and attempted suicide on the friends and family of the suicidal person. But it's difficult to turn off the thoughts, and even more difficult not to believe them a little.

By AlsoAnonymous (not verified) on 01 Jul 2009 #permalink

Another resource: National Alliance on Mental Illness

Acknowledging your depression is perhaps the most difficult step -- and the most important.

By mediajackal (not verified) on 01 Jul 2009 #permalink

Some of those comments describe exactly my thoughts. One of the smartest people folks know, and yet stuck in a dead-end job where my brains are more of a hindrance then they are a help. Reading about the stuff I could be contributing if I were less of a failure. I feel stifled by my current environment, yet powerless to escape the situation. And would a change even do anything? Previous experience says no. And where does that leave me?

What I find odd are the suicidal thoughts. I just feel like a complete failure and don't want to face the world - yet I (fortunately!) still recognize that they are unhealthy and I damned well should not follow through with them. Yet the cascade of self-hatred continues, and I can't help but mime a gun blowing my head off periodically.

Perhaps it's time finally I sought help for this.

By Anonymous (not verified) on 01 Jul 2009 #permalink

Bardiac- this isn't specific to depression, but keep in mind that fear of failure can produce horrible writer's block. Sometimes an experienced writer can help troubleshoot people through that just because they've learned a trick or two that works for them.
I also had one or two profs sit down with me for a relatively short time (half an hour or an hour) and have a conversation about an assignment. They took notes, assured me I had something to say, and handed me the notes at the end. I had a sketch of an outline, which got me over some activation-energy barrier so I could write.

Telling students you aren't interested in psychology/medicine/whatever is not particularly useful. Advising students is part of your job. I once told a friend I needed to tell my advisor about something (pregnancy, not depression) and I was dreading the conversation. The next week my friend asked me how things had gone with my counselor. I was perplexed- I had actually been seeing an OBY/GYN who co-specialized in psychiatry, but I hadn't told my friend about that. Then I realized- he heard "advisor" and, not being familiar with academia, substituted the near-synonym "counselor" (think about it, "to advise" and "to offer counsel" are very similar).
You can, and generally should, avoid advising on someone's 'personal life'. But there is going to be some bleed over between the personal and the professional. You won't be perfect, but in general if you try to be sympathetic and don't think of it as something to be squeamish about, you will be able to help somewhat.

I was very careful who I told about my depression. I'm still careful who I tell that I was depressed. (Depression is like an addiction, the potential is always there, but with effort and help, it doesn't have to win.) Too many people don't know how to handle someone else's neurological illness, and don't want to. It's too scary. If it can happen to you, it can happen to them, the same way some people can't handle being told you have cancer, or your're gay. Their eyes glaze, they look away, they get hostile, they stop speaking to you, they blame you. (I like the use of the term, neurological disease, instead of mental illness. Less loaded.)

The body and mind are the same thing. One of the best things I learned from my therapist is that it is useless and self-destructive to think about my depression or try to analyze it. Because when I am depressed or sliding into it, by brain chemistry is not working right. I work very hard at doing physical things and noticing my body and saying out loud how it feels. Thinking does not work. It's astonishing how getting enough sleep does.

I have no idea of the difference between can't and won't. Nobody knows, and don't let anyone convince you they do. Some people find it easier to be active than to sit quietly. Some find it easier to be sociable than to be alone. Some people get crazy busy under stress, some drink, some eat, some can't eat. Some of us withdraw into this anhedonic depression that isn't exactly fun, but it's a familiar place. We all have out weaknesses and strengths. Some weaknesses show more than others. Depression is no more a moral flaw then Multiple Sclerosis or Dissociative Identity Disorder or seizures, but there are way too many people who don't get it and don't want to learn.

So I'm careful. I don't tell the boss, but I tell my Tai Chi group. I don't tell my professor, but I tell my trusted friends. My therapist saved me. Asking for help was terrifically hard. But we don't have to struggle alone.

Hi Bardiac -

I've had a couple of my students tell me this too, and before I really started having bad episodes, I was definately at a loss as well. I now realize that they were attempting to explain what they saw as unexcusable behavior (missing class, crying during class, etc.), not trying to look for help or comfort - most of them were already seeing someone.

You certainly shouldn't feel like it's your job to have to sort out your students' lives and be responsible for their well being. I would liken the appropriate reaction to someone telling you they have a permanent physical illnes. Acknowledge they have it, and be sure that they know about the campus clinic. If it's something that's affecting their schoolwork, you might want to ask them if they have a plan for dealing with the depression while they're continuing to work (I'm not talking specifics, most people won't want to discuss which meds they're on, etc.). Becca's advice above was great - I've done the same for some of my students, but I understand it is a matter of time on your end. Really, something along these lines is enough, and it really is appreciated. The reason most of us are afraid to tell our depts. is because we're afraid they'll look down on us, not that they won't help or make exceptions for us.

John: #8

This got me thinking: how can you tell the difference between "can't" and "won't"? Is the difference even important?

This is something I still worry about quite a lot: how do I tell whether I'm really ill, or just malingering? One of the things I often crave is for someone to tell me that I am actually unwell and I'm not simply a bad person. But if I explain that to someone then anything they may tell me in response doesn't count.

I'm English, so I have the "wonders" of the NHS to care for me rather than your own (non-)system but perhaps my experiences will still be interesting.

I still struggle with depression. One of the things that I think might have helped me in the past, and even now, is a more paternalistic approach to my health care.

When I'm in bad shape, I feel incapable of making decisions or taking action. I don't want to be offerred options, in case I make the wrong choice. I want someone to come out and tell me what to do.

My first lengthy period of depression was about 20 years ago. I think that the man cause was loneliness/issolation. After a while, with pressure from my employer after missing a lot of work, I sought help from my GP. He sent me to see a clinical psychologist for a few sessions of CBT, which helped considerably.

As a result of the depression and therapy I changed job and moved to a more congenial location, closer to my family and friends. Apart from a short episode early in, I was content in my new home for quite a while and did very well in my career.

However, a few years ago things changed. My job became much less satisfying and I became seriously depressed agin.

This time when I sought help with my new GP I was offerred choices. In some cases I'm pretty sure I made the wrong decision - like putting off anti-depressents for a long time: they've proved quite beneficial but by the time I made the decision to try them things had got really bad and my career was in very bad shape.

I tried to find a local CBT practitioner, but again was offerred choices. I wanted someone to say, "Here: make an appointment with this person". Instead I was given web sites for professional bodies and told how important it was that I pick a therapist I was comfortable with. How the hell could I figure that out? Just give me a damn name!

I saw a counselor and whilst it was good to have someone to talk to she wasn't prepared to tell me what to do, or even suggest what I should do. I never did understand what the counseling process was supposed to be about.

A lot of emphasis seems to be placed on empowering the patient these days; putting the reins of their treatment in their own hands. But that's not necessarily appropriate for all patients. Maybe a more old-fashioned approach would be better at times.

Graduatesinnever, thank you for posting your story, and Pal, thanks for hosting it. We all need to be more cognizant that depression and mental illness are more wide-spread than they appear. Premature judgment before knowing someone's whole story is what really gets us in trouble.

To the individuals suffering depression:

As a bystander friend or relative, what would a helpful way to act be? Or something helpful to do?

Calli, what does your husband do to help with the depression?

What should an employer do?

My mom is depressed and I don't have the foggiest about what to do about it.

By Ren fruoken (not verified) on 01 Jul 2009 #permalink

"I have found one rather strange trick -- putting on headphones and listening to "The Downward Spiral" (Nine Inch Nails) does something. It's like it exorcises the depression, burning it out by indulging it heavily for a short time. I wind up viewing my depression from the outside and seeing the errors in logic."

That reminds me of what one of my creative writing teachers from high school said, that if you're depressed those silly platitudes are very often meaningless, that one wants to immerse in them, and that's why good poetry tends to be about suffering and despair rather than fluffy bunnies and sunshine (though certainly "emo" stuff can turn that darker side of poetry into something hideous). If people keep shoving "oh, well you'll just get over it anyway" into your face that does nothing, worse than nothing often enough, because then, at that moment, it DOES seem like all the world, whether it is a depressed mood or something more serious that needs another therapy to resolve.

Reminds me also of when I was in French class and thinking "I am so depressed. I am so depressed." I kept repeating it in my head while doodling in my workbook as I corrected the homework until it just seemed absurd and then I wasn't feeling depressed anymore. While most depressed moods of mine haven't resolved that easily, it did seem interesting.

I work in a medical setting, but I'm not an MD, I'm an information professional. I work with MDs all the time both professionally and personally. Several MDs and many friends have asked over the years why I never went to medical school. My sister who is a physician calls me when her kids are sick to ask me what to do.
Why didn't I go to medical school? Primarily because I knew my depression would prevent me from succeeding. There was no way I was going to get through the major stress of medical school without major depressive episodes and I couldn't survive that.

#17, 19, & 31 -- I empathize with your posts. I have suffered with MDD since grade school. I've been on most of the anti-depressants on the market with mixed results. A few years ago I had ECT, which helped a little. When I told my advisor about my depression, he did what #31's professor did. He said I was "lazy," "want[ed] people to feel sorry for me," "waste[d] his grant money," and then kicked me out of the lab. I thought I knew this person and could trust him. he then told the entire department, and I heard talk about the "psycho" student. As a result, I would NEVER recommend telling a thesis advisor about any psychiatric illness or addiction. There's too much risk. And now I am returning to a different school and have no intention of telling anyone there. That supposedly educated professionals can have attitudes like that of my ex-advisor is appalling. Then again, maybe it's not me. A friend still in my old program was diagnosed with breast cancer and the department kicked her out, too.

@ Catherine, #23
I've read that some docs are starting to give a short dose of Provigil (Modafinil) to help people with depression "get physical", as you say. I take that for MS fatigue and yes, it makes it such that I'm able to do things. For me, a small dose can mean I go from hardly being able to lift my head in the morning.. to being able to get up and get breakfast. I can well-imagine a little bit of energy/wakefulness drug helping. Just getting out of bed and doing stuff might make people feel better.. and that push to get out of bed might not need to last long because of getting in the habit and such.

@ DuWayne, #24
On support, I actually go to a traumatic brain injury group once in a while.. I don't have that.. but I seem to fit there better than anywhere else and they don't mind. We have the same kinds of problems. (Including getting upset when it doesn't make sense.) It works.

@ Denice Walter, # 25
I wish I could do time-management.. really. I told my neurologist about the trouble I have. Choosing can be extremely difficult and planning is full of choices. I get so frustrated, so overwhelmed sometimes. And then it seems docs think I have these problems because I'm anxious, but really it's the other way around -- I don't feel anxious or anything like that until I'm trying to make a decision and utterly failing at the task. (It makes me angry and frustrated to be told this is an anxiety problem. I need to learn how to choose and plan, not just not care about it so much.) I need help, sometimes I can't even decide what to eat and so I just eat peanut butter and crackers.. It's bad. My neuro wants me to have a neuropsych eval.. but neuropsychs are hard to find and it's even worse on Medicaid. I kind of wonder why he can't just presume I do, in fact, have the problems I say I do.. and give me a referral to whoever can help me with this planning, choosing and such.
Still, I get what you're saying about the simple things.. For example, I get overwhelmed if I have too much stimuli, so I try to keep a hat with me and sometimes sunglasses, too. That way if I feel like I might get overwhelmed, I can put something on to limit the visual input. It can help me a lot though it's just a little thing.

@ AlsoAnonymous, #38
On suicide.. I don't know if this is what you're talking about, but I can understand that it's hard to turn off suicidal thoughts. I've thought such things for years.. the answer for every problem was "I should kill myself." Even for stupid little things! Now... now I haven't been suicidal for a good while, but sometimes the words come to my mouth unbidden. Sometimes I want to.. only I don't really want to. More of that I have an impulse to do something but don't really want to. I know what you're talking about can be/is terrible, but this ghost still haunts me. I don't understand why and I do wish it goes away. Of course, now the urges are usually to hit my head -- I know that's bad, but it can't be as bad as killing myself.

@cucl2, #44
A couple things.
One, I don't think "can't" and "won't" are the right terms. I like more of a spectrum from "easy" through "difficult" to "impossible". Sometimes (rarely) it's easy for me to get up. Other times it can be very, very difficult. There have been times when it was impossible. (For a couple of days, I couldn't even lift my legs, an arm, my head. Yes, I was in the hospital for a bit.) For this way of thinking about it, none of the answers mean malingering. Just because I have a good day doesn't mean I'm any less ill.

Fwiw, I even worry about malingering sometimes. Probably seems ridiculous because I can see my disease on MRI films.. but there are only a few places where one could say that a certain plaque is causing a certain cognitive dysfunction.. so I might wonder if I'm making something up. Eventually I convince myself that's stupid and that I'm only making things harder for myself by thinking such things. Certainly we want other people to give us the benefit of the doubt regarding our problems.. so maybe we can make a start by doing that for ourselves.

Two, choices about practitioners, don't I know it! And how are you supposed to be able to know you'll be comfortable with a therapist until you've been with them a bit? And I also so get what you're saying about lack of suggestions. I went to one a couple of times a while back. I don't remember much about it but that I didn't go back because the ending made me cry. Whatever she'd said, I didn't understand.. like, I totally didn't get what she meant, not at all. But it was getting near the end of time and though I said I didn't understand, she didn't try to explain, she didn't say we could talk about it next time, no, she told me, "Just think about that and we'll talk about it next time." That was saying I could understand something that was beyond me and how ever I protested, she insisted only that. Not a person for me and hadn't really helped anyway. (Not that I'm saying therapists are bad, just she wasn't for me and I'm not sure therapy is for me because other cognitive issues make it very hard.) Ugh.

Perhaps you're right about empowerment.. though I think patient empowerment + suggestions would be good. I don't think it would be good for patients to get stuck in treatments that are wrong for them. (I've been there before.. and I was too young to understand I really did have a choice. I kept getting worse though I was told I was doing better. I only found out much of the problem was rare side-effects because I was looking things up in a nurses' drug book that I'd just prepared for library shelves.) Basically.. bad to have little direction, bad to have forced direction (as in, do this, period).

Otherwise.. I don't think I said.. misdiagnosis scares me.. and with mental illness, it seems as if it never goes away. That combined with the way many professionals seem to take it that having been diagnosed with a mental illness means everything wrong with you ever is mental-illness related or part of mental illness, etc.. that scares me. I mean, given my history of PTSD, an endocrinologist I saw told me that there was nothing to do for my hyperthyroidism.. that I just needed to go back on anti-anxiety pills. Forget about my thyroid hormones, my 130 bpm pulse, my extreme weight-loss, my temperature, my fatigue.. I'd been or was mentally ill, obviously that was my real problem. Oy. (The specialist made the diagnosis that eluded my GP, but I went back to my GP, who, with the diagnosis, gave me some beta-blockers until my thyroid was spent.) It really scares me what some docs do upon seeing a diagnosis of a mental illness. If misdiagnoses are in there, too.. that would have to be even worse. Can come to doctors not even listening to you, you know, because you're crazy. (Though dismissing medical signs, ones which cannot be changed by thought, I can't imagine why anyone would do that.) Of course, these things are inexcusable... but they happen. They've happened to me personally quite a bit.

I don't really understand the difference between depression that manifests itself in people independent of circumstances and people who will become ill in certain types of situation. I took my daughter out of school because it was clearly a very toxic situation for her and was making her ill - really ill. Homeschooling was all she needed to be very healthy indeed, though I suppose many people would have chosen a drugs and counseling route. Or left the child ill for years?

Anyway, that is the kind of depression I am most used to dealing with - the kind you fix by changing the circumstances. Things might be easier for everyone if we were clearer on the distinction between that kind of depression and the biochemical kind.

Things might be easier for everyone if we were clearer on the distinction between that kind of depression and the biochemical kind.

There is no clear distinction. In treating and preventing depressive episodes, medication, counseling, and attention to life circumstances can all be important.

The mind is a brain-dependent phenomenon and there is no clear way to un-tether mind from body, or to clearly deliniate "intrinsic" from "extrinsic" depression (although attempts have certainly been made).

Pen -

Actually, there isn't necessarily a difference neurologically - at least not a significant one. Our brain chemistry is far from static and our understanding of depression and other neurological issues is basically in it's infancy. It could well be that people who suffer extreme situational depression are Depressed, but will only manifest symptoms in the face of certain stimuli. It could also be that everyone has the same capacity for depression and those of us who are diagnosed with unipolar depression are simply unable to moderate it without medication.

Then there are those who might well stop exhibiting symptoms, if only they could change their situation in life - but who can't change their situation in life without making truly egregious sacrifices or because they simply can't figure out what changes need to be made.

I agree that it would be nice to be able to make that distinction, but it just isn't that simple. It could well be there simply isn't a distinction to be made and if there is, it could take a whole lot of slogging through the brain and parsing the fine distinctions.

@ Beth: sometimes you can start planning and choosing by *mimicking* others' plans/choices; go to a local bookstore or library,look at "time manager" type books, menu plans, etc., and follow their suggestions. A useful way to prevent over-scheduling yourself to is limit the number of activities you take on for a given day: e.g.,if you have to see a doctor on Tuesday, don't *also* make that "food shopping" day.Sometimes if the choices seem too difficult to make (for something that is *not* of earth-shattering importance)just pick the first one (or whatever number you like... "Oh no!not *another* choice!"). If they *are* important, list "pro's" and "con's".As people who need to remember something accurately often create mnemonics and lists, you can similarly make a physical planner(on a sheet of paper,it doesn't have to be anything elaborate).Just a few ideas for you.Good luck(BTW, I am the queen of lists, notes,and flow charts).

By Denice Walter (not verified) on 03 Jul 2009 #permalink

Anonymous #40:

I completely relate to this. In fact, I often feel like my supervisor is purposefully trying to prevent me from advancing because he can "use" me for all of the areas in which I exhibit superior work skills (especially in the form of intellectual contributions) while taking credit for my ideas/interest/knowledge/work. At the same time, the areas in which I've experienced significant difficulties due to medical and psychiatric problems (which he knows about) are exploited as "evidence" of my incompetence and my inability to advance in academia or even to find employment elsewhere. Ironically, these areas of difficulty are in the menial everyday tasks and not in all of the other work I do that has expanded my job description dramatically: higher-level functioning - the kind of functioning that once had me headed to medical school - has been entirely preserved.

So I have been put in a position of having to feel eternally grateful to this person for "permitting" me to stay employed even though the accommodations that have been made for me are ones that I would have been granted through the Americans With Disabilities Act if I had gone to my union or to Human Resources. Consequently, my supervisor gets to berate me for my medical/psychiatric problems that prevent me from doing certain tasks and to conveniently forget the fact that no one else in my job classification does the amount of work that I'm forced to do. On the other hand, I get to constantly worry about losing my job - and my health insurance - despite doing substantial intellectual work that should have doubled my salary.

I had been feeling hopeless and suicidal for a long time. I thought that death was the only way out of this unbearable situation. Instead, I went back on an antidepressant medication that has worked for me in the past. It is already helping. My supervisor has less power over me because I have regained the confidence I had lost by working with this person. And now I am actively looking for another job or considering transferring to another department. I'm not afraid anymore. I'm far more afraid of the idea of remaining his undervalued indentured servant for the rest of my life.

By Anonymous (not verified) on 03 Jul 2009 #permalink

Delurking to say @Bardiac - I am a literature student, and I'm depressed. I haven't told my professors/advisor, but I can tell you what response I would hope for if I did. For me, my depression makes it extremely difficult for me to speak in class or speak to my professors privately -- mostly because I have no self-confidence and feel like I'd just be wasting their time and/or making a fool of myself. I think one very important thing to do for a student who tells you they have depression is just to make sure that they know you think they have something to offer -- that their ideas are good, and they're smart and capable of succeeding, regardless of any difficulties they might have. Just an extra bit of praise, saying out loud something you're already thinking is good about the student's work, can do a lot of good. A depressed student may not be doing the things that would normally trigger you to praise them or even to speak with them often, but they need that praise and interaction with you even more. So I'd suggest going a little out of your way to give them that, if you're comfortable with it. I wish professors would, say, ask/encourage me (not the class in general, but me specifically) to come to their office hours so I wouldn't feel like I was imposing when I did. Or take the lead in a conversation, ask me questions until I could overcome my insecurity and get into the discussion. Even just writing a little more detail than you normally would when grading a paper can do some good for a student who feels isolated and unable to get feedback on their work.

I hope this helps. It's great that you want to assist your students. I wish more professors did!

By thedrymock (not verified) on 03 Jul 2009 #permalink

@ Pen and PalMD

I recognize that there is no clear distinction, that mind is a function of brain.. but I do agree that reliance on the biomedical model can be a bad thing. As I said, I grew up in an abusive household, but when I had problems I was told it was something wrong with me. My parents had made it clear that I was the problem.. and now they had someone with credentials to back them up. For me, this only made things worse. The social part shouldn't be forgotten.

@ Denice Walter

Your suggestions are probably good... for someone more capable with such things than I am. I hardly have any schedule at all other than medical appointments, so over-scheduling isn't currently a problem. But I have trouble choosing, trouble starting things, trouble stopping things. Somehow, I doubt the books are made for people who have trouble like this. I know most rely on ability to prioritize and I have trouble with that, too. I do keep a couple of little notebooks to help me remember things, but that's all, really.

Then again, maybe it's not me. A friend still in my old program was diagnosed with breast cancer and the department kicked her out, too.

Mine kicked out two pregnant women and stopped paying me when I got sick from hypothyroidism-linked depression (which, like my newly developped asthma, I'm suspecting had something to do with the stuff I used to handle in the lab). He still, of course, expected me to continue working (asshat).

My theory is that most PIs are crazy, some more than others. I don't know if it attracts the crazy, or if the job makes them crazy. Maybe a little of both.

That's why I left. I've seen PIs do things so mean it makes me ashamed of being the same species as them. And I've seen post-docs go crazy (and being incredibly, childishly mean) and waste their lives trying to reach that position. And lately I've seen people who had a position lose everything after struggling so hard to get so little, while others stepped on their backs trying to keep theirs. And I've worked stupid minimum wage jobs, where I was treated like a retard, just to keep afloat.

Now I've decided that's enough. I'm never going to do anyhting for free ever again. If I'm coming in on week-ends or evenings, the bastards will pay me overtime. So, good riddance research, hello pharmacy.

Someday I have to thank that PI of mine for that final push to leave the whole shebang while I'm still (mostly) sane, if somewhat bitter.


I was revisiting this post, found your "I was told it was something wrong with me," had a massive flashback, and am now exploring ways of getting off Prozac because, hell, I've been operating under a false premise for decades. Thank you.

By mediajackal (not verified) on 04 Aug 2009 #permalink