More people are talking openly about their depression, but is public perception changing?
am always encouraged when people publicly share their personal experiences with depression. Many who suffer from chronic, clinical depression are speaking out, trying to start a conversation, hoping to lift the stigma that surrounds a misunderstood mental illness.
According to the World Health Organization, depression is common worldwide, with an estimated 350 million people of all ages affected. That’s a lot of depression, and people talking openly about their struggles is a fantastic start. I see fellow sufferers rallying behind them and expressing gratitude that they no longer feel alone. What I don’t always see is a noticeable shift in perceptions of those personally unaffected by depression. In fact, I sometimes wonder if non-depressed people are even listening to the conversation.
A couple of years ago I read an essay in which the author confessed to feeling that she was losing herself in her first year of motherhood. While the piece resonated with many readers, a quick glance at the comments showed how easily people jumped to the conclusion that the new mother was mentally ill. That was disturbing, but one comment stood out:
“Depression is massively narcissistic.”
I still haven’t stopped thinking about the ignorance of that statement. Only someone who has never experienced a major depressive episode would say something so cruel, especially to the mother of a ten-month-old baby. And even if the author was mentally ill, depression is not even a symptom of narcissism. I’m sure some narcissists suffer from depression, but not all depressed people are narcissists. Depressives may behave in ways that appear selfish, but selfish behavior in the face of illness is not narcissistic. In fact, narcissism is categorized by the DSM-5 as a “personality disorder,” while depression is considered a “chronic illness.”
I’d like to explain what depression is like based on my experience. This is not for the benefit of fellow depressives, but for people who have never been depressed. This is for people who believe that depression implies narcissism, weakness, or laziness. This is for people who think that depressed people can simply “snap out of it.” If you’re one of those people, please stay with me. I’m going to put you in my (sometimes) sad shoes, walk you through it, and ask you to try — really, really try — to imagine what the slow, dark spiral feels like.
• • •
One day you start feeling a little sad but don’t understand why. Your life is great! You have all the stuff that’s supposed to make you happy, but you don’t feel happy. You might feel a little guilty because of the starving children in Africa. Maybe you tell yourself that you’re coming down with something, that Mercury is in retrograde, or that it’s just a phase.
But it isn’t a phase. After a couple weeks you don’t feel just a little sad anymore. You’re crying over your morning coffee or in a bathroom stall at work. Now you feel sad, guilty, and embarrassed because you can’t hide your sadness anymore, and you don’t like crying in front of your coffee. You love your coffee. It makes you happy and you don’t want it to think less of you.
At this point, you can still pretend to be normal when you’re at work or out with friends or yelling at spending time with your kids. These things probably even make you feel better for a while. They’re exhausting and you might need to curl into the fetal position and nap more often than you care to admit, but you can still fake it when you have to. You can still function.
A couple weeks later you stop going out with friends and yelling at your kids because you don’t have the energy to fake it. Nothing brings you joy or makes you feel better for even a little while. You still go to work, but you can’t focus and your boss is starting to look at you funny. Now you’re sad, guilty, embarrassed, and scared, because you don’t want to lose your friends or your kids or your job.
You finally tell your partner that you’re in a funk, that you might be depressed or something. Your partner nods and makes comforting noises and for a few minutes you think they get it. Then they say, “Are you gonna go grocery shopping this week?” You realize they don’t get it. Now you feel sad, guilty, embarrassed, scared, and alone. And that seems perfectly rational because you’re the one who can’t get your shit together. You are alone in your depression.
One morning you wake up and can’t get out of bed because you can’t imagine going through another day with all those feelings crashing around in your head. You call your boss and say you don’t feel well. You tell your partner that, too. And then you stay in bed and feel relieved that you don’t have to fake it. You tell yourself you just need sleep, lots of sleep, and then you’ll be okay again.
But you don’t magically become okay again. The longer you stay in bed, the more you want to stay in bed. Bed is a safe place because you’ve surrendered. You’ve stopped faking it and you no longer have to deal with anyone. Between dozing and staring at your arm hair (because you’re too fucked up to watch TV or read a book), all that sadness, guilt, embarrassment, fear, and aloneness start to seem less defined.
Those feelings don’t go away, though. Instead, they morph into one big feeling: despair. You realize that something is really, really wrong with you. You wonder if you’ll ever be okay again. You wonder if you even want to be okay again. Life seems like so much work, more work than you can imagine doing, ever.
Finally, after a time, even the despair goes away and you feel nothing. You look back with morbid nostalgia on the sadness, guilt, embarrassment, fear, aloneness, and despair. You crave sleep because in dreams you feel something.
This is the heart of depression: a shitload of nothingness.
You can’t sleep, so you root around in the medicine cabinet and find some old Ambien. You take one and you finally sleep, for a while. When you wake up you take another, and later, another. You start counting the pills left in the bottle and wondering if you should just take them all and sleep forever. You tell yourself that your partner, your kids, your friends, and your coworkers would be better off without you.
If you’re lucky, this line of thinking starts to scare you. You pick one thing in your life that makes you feel like an asshole for even considering suicide. Maybe it’s your family, or your work, or your cat. But it’s something.
You ask for help, which feels like the hardest thing you’ve ever done. Talking to your partner, finding a doctor, even picking up the phone and dialing a number, seem impossible. Everything seems impossible. But you do it anyway because the alternatives are either more nothingness, or real and permanent nothingness, and you’ve decided you don’t want that.
If your luck continues, you get the help you need: a good doctor, a proper diagnosis, a plan of action that works for you. Maybe medication, talk therapy, or a combination of the two.
You begin doing all the work, the hard-as-fuck work that will let you feel something, anything, that makes you want to live. If your doctor prescribes medication, it may take weeks to kick in. Talking to a therapist brings back all the sadness, guilt, embarrassment, fear, aloneness, and despair, and that feels counterproductive.
You have some good days but mostly bad. If you keep working, the good days come more frequently. Your meds start working. Therapy becomes easier. You keep doing the work no matter how hard it is. You learn a bunch of stuff about depression that you never wanted to know.
Eventually, you feel like yourself again, or close enough. If you’re smart, you keep working because you don’t want to end up back in bed. And then you know what happens? You live the rest of your life knowing that depression is an illness, and while you might be in remission, it could sneak up on you again. Or not.
You never know if the nothingness will take over again.
• • •
I was lucky, but I wasn’t very smart. When I felt like myself for a year or so after my first depressive episode, I stopped taking my meds without telling anyone. I felt fine. I was doing everything right: eating healthy, exercising like crazy, exploring Buddhism, practicing mindfulness. For a while, I was okay.
Then I spiraled again, but I didn’t recognize the signs. Finally, when I wanted nothing more than to stay in bed forever, I went to my therapist, sat in his office, and cried for the whole forty-five minute hour. I started the work all over again: medication, talk therapy, waiting for the good days to outnumber the bad.
That’s what depression looks like for many people. We are not depressed because we are narcissistic, lazy, or weak. We know we are difficult — even infuriating — to be close to or to live with. So we often cling to denial as tightly as people who don’t understand that depression is a life-threatening illness, or people who believe that depression is a behavioral issue. It’s not a behavior at all. You cannot choose how to behave when you feel nothing inside.
For me, the cycle repeats itself even though I’ve never again gone off my medication. Every three or four years, my antidepressant/anti-anxiety cocktail loses its punch. I catch it as quickly as possible and I start new medication.
I am so grateful that the people closest to me are understanding and empathetic instead of ignorant and judgmental, because this is me for the rest of my life. But not all people who suffer from depression are as lucky as I am.
So, mentally healthy people, please remember this: Empathy from those who live with depression is wonderful, but sympathy from those who can’t really know how it feels? That’s a gift of selflessness and compassion.