Tag Archives: mental health

Mental Illness Is Not a Punchline

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Damn, I’m certainly on a crusade against humor these days.

That was sarcasm, by the way. I love humor. I just think it should be deployed carefully.

A few days ago in my Psychology of Personality class, the following happened:

Some people were having their own conversations while the professor was trying to give a lecture. The professor cracked a joke–“Hey guys, I have ADD so I can’t focus if other people are talking, so please stop!” followed by “I don’t really have ADD, but still.”

Now, for the record, I totally get that it sucks for a teacher when people are talking in class. But I also feel that there are other ways to address that situation without making a joke about having a mental illness that you don’t actually have. Especially, you know, if you’re a person who has a PhD in psychology and conducts research on people with actual mental illnesses.

The sad thing is, before he followed his comment up with that disclaimer, I was actually really touched. I thought it was wonderful that a professor of psychology would take a stand against the stigma of mental illness by stating in class that he has one. But then, you know, it turned out to just be a joke.

~~~

Last spring, I took a class on Cognitive Behavioral Therapy. It was an advanced class, with just around ten students or so, taught by one of the most esteemed professors in the department. We got to the chapter on Borderline Personality Disorder, which, as you may know, is considered one of the most frustrating mental disorders–both for clinicians and for the patient’s friends and family. So naturally, no discussion of it could be complete without my professor’s bombastic explanations about how she tries to avoid treating BPD patients because they’re just SUCH a pain and about how she once had a friend with BPD who was just SO hard to deal with. Everyone gasped and laughed at her descriptions.

Then, of course, the other students had to start raising their hands and talking about their own friends that they’d taken the liberty of diagnosing with BPD, and how  horrific those people were.

This was a time in my life when I was seriously wondering if I had BPD myself, so, yeah, that was pretty unpleasant.

~~~

Last fall, I took a class on psychopathology. It was my second psychology course ever, and my first that related specifically to mental disorders–a topic very close to my heart at the time since I’d been diagnosed with major depression only a month before.

Before the course started, the professor sent out an anonymous survey to the entire class about our experiences with mental illness. On the first day of class, she disclosed the stunning results–more than half of us said we’d been diagnosed with one.

So we got to the chapter on depression and the professor started talking about depressive cognitive distortions, using specific examples. The professor started listing them off in such a way that the whole class started laughing. And laughing, and laughing.

Now, I totally get that it sounds funny. Consider this dialogue:

X: I’m getting a B in calculus. I’m a total failure.

Y: You’re not a failure at all! You have straight As in the rest of your classes.

X: Well, those don’t count. They’re easy anyway.

Y: Yes, and calculus is pretty hard, so it makes sense that you wouldn’t do as well. Besides, a B is a pretty good grade.

X: No, it’s a shitty grade. Everything I do is shitty and I’m always going to be a failure.

That is an example of several cognitive distortions, including overgeneralization, disqualifying the positive, magnification, and labeling. And, when read aloud in a particular tone of voice, I can see how it might sound kind of funny.

But having been through it myself and studied it extensively, I can also hear the pain behind what X is saying. It’s not a punchline. It’s a cry for help from a person trapped inside their malfunctioning mind.

~~~

Here’s the thing. I get it. People with PhDs in psychology have spent years and years reading, writing, and talking about stuff like this. I’m sure that it’s completely normal for two psychologists to crack jokes about mental illness to each other.

Knowing that many people who pursue degrees in psychology are spurred to do so by their own experiences with mental illness (I’m an example of this), I understand the urge to joke about it because I joke about it myself. It helps alleviate the fear and pain of living with mental illness.

That doesn’t mean I’d joke about it to a room full of 100 people who don’t know me well and who may be dealing with their own issues, though.

Case in point–at the time I took the aforementioned psychopathology class, I was still learning how to recognize cognitive distortions in myself, and I was beginning to realize the extent to which they’d ruined all of my previous interactions, friendships, and relationships. To have a room full of 100 people laughing uproariously about something that nearly brought you to suicide just three short months before is, well, no laughing matter.

~~~

I’m not saying there’s no room for humor about mental illness. There definitely is, and humor has been one of several strategies that have helped me process what happened to me. But humor must be used carefully.

I’ve written before about the complex relationship between humor and mental illness–here, here, here, here, and here. But this time, the situation is very different because the off-color jokes are coming not from comedians, television writers, novelists, or clueless friends of mine, but from people who know more about psychology than 99% of the population.

Unfortunately, I still haven’t quite worked up the courage to tell a person with a PhD that they’ve offended me.

But I’m working on it.

Got a Job? No Fun For You

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[Snark Warning]

I read one of the advice columns in this month’s Cosmo. A woman was writing in and asking if it would be okay to wear a top that reveals her tan lines to work, provided the top was modest and work-appropriate. The response was, no, it wouldn’t. Why? Because you wouldn’t want your boss to think that you spend your free time lying around at the beach:

Even though the best of us can fall victim to zebra skin by accident, exposing your sun stripes at work would be flaunting your bad judgement (baking does lead to skin cancer, after all). Perhaps worse, as far as your boss is concerned, it suggests you spend lots of your free time being at one with your beach towel–not exactly impressive.

“Not exactly impressive?” What does that even mean? Apparently, you shouldn’t let your boss know that you actually have fun on your days off. Oh, heavens no! You ought to be at home, catching up on emails.

(As for the skin cancer thing, I’d just like to point out that even if you wear sunscreen, you’re eventually going to get a tan if you spent a lot of time outside. Trust me, my mom slathers my little brother and sister with sunscreen obsessively, yet at the end of the summer they still have those cute little freckles and tan lines.)

Naturally, I immediately thought back to an earlier post I wrote about why adults are always so miserable and try to make me as miserable as they are. Now I’m not surprised. Apparently, once you’re all grown up and have a job, you’re not even allowed to have a good time when you’re off work. No wonder adults are always in such a crappy mood, and no wonder they want to warn me that in a few years I’ll be in a crappy mood too.

What shocks me is that Cosmo isn’t exactly a serious, business-y magazine. It’s mostly read by people who like to enjoy themselves every now and then (or every day/night, as the case may be). If even Cosmo is saying that you can’t have fun once you’re a grown-up (or, at the very least, that you have to do it in secret), what’s the world coming to?

This doesn’t even make sense to me, because I would hope that my boss would want me to come to work refreshed and in a good mood. I would want him/her to know that I’m not going to be asking for time off to go see a therapist about how miserable I am because I never have fun.

(I’m hoping, perhaps in vain, that since I’m going into the mental healthcare field, things will be different for me. After all, if there’s anyone who knows that relaxing and having fun is absolutely necessary, it’s a therapist. In my opinion, therapists should be able to model healthy behavior for their clients. If a client casually asks me what I did over the weekend and I’m forced to either lie or confess that I spent the entire time huddling over my laptop in a corner, crying, and biting my nails off while my husband played with the kids, that’s not good.)

Where did we go wrong? Why is it that in other countries and cultures, it’s perfectly normal to take a nap after lunch before coming back to work? Why is it that the United States is the only country I could find that does not mandate a minimum amount of paid vacation time for all employees? Why is the United States one of the only developed countries that does not offer paid maternity leave (to say nothing of paternity leave)?

One thing that never fails to surprise me about American culture is how fixated it is on work.  Russians, for instance, seem to view work mostly as a means to an end (money, security, providing for one’s family), whereas for Americans, it’s an end in itself. I rarely hear my parents talking about work when they’re home, and the only time I’ve seen them doing work-related things at home is when my dad starts maniacally writing some sort of equations on a napkin. My parents don’t have smartphones or tablets. If you send an email to their work address on Friday evening, you won’t receive a response till Monday. And yes, they go to the pool on weekends, and evenings, and any other time they fucking feel like it. That, in my opinion, is how it should be.

The Trivialization of Mental Illness

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I’m reading a very interesting novel called The Four Fingers of Death. It’s somewhat science-fiction, with a distinctly Vonnegut-esque tone to it–very sarcastic and cynical. The story takes place in the 2020s, and the author, Rick Moody, gives several hints as to the general milieu of the future. Few people have cars as gas is very hard to come by, India and China are dominating the world, and paper books are mostly a thing of the past. One little detail that the narrator mentions several times–a detail that most readers would skim over, but that the author undoubtedly meant to make a point with–was the 8th version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Currently the DSM is in its fourth version–DSM-IV–but the DSM-V is in the works. However, in the world in which Four Fingers takes place, the DSM-VIII has medicalized all sorts of everyday issues, such as a disdain for hygiene (“aggravated hydrophobia with hygiene avoidance”), opening a game of chess in an unusual way, being rude to waitstaff, and speaking unusually (“conversational pseudo-uremia”). What completely got me, though, was when the narrator diagnosed a new friend with “mixed caffeine obsession with chronic caffeine dependence” when–get this–the friend suggested that they meet up at a coffee shop!

The author’s point, of course, is easy to see. It’s a satire of the supposed overdiagnosis of mental disorders even today, and of the presence of useless and non-clinical “disorders” in the DSM. As in, hahaha, at the way things are going, soon we’ll call not showering a mental disorder! To this point, the narrator of the story mentions that everyone has been diagnosed with a mental disorder these days. The way he talked about the DSM–“I flip through it looking for symptoms I have yet to contract”–makes this attitude even clearer. Through his satire, Moody implies that mental illnesses are not something to be taken seriously.

Forgive me for making a big deal out of a (probably insignificant) novel, but this mindset right here–that mental disorders are just some sort of farce invented by people yearning for attention for their minuscule problems–this is what’s responsible for one of the biggest threats to adequate mental healthcare in America. I’ll attack this mindset point-by-point.

First of all, contrary to popular opinion, “everyone” does not have a mental disorder these days. I’m sure you’ve heard someone comment, perhaps after hearing of another person’s diagnosis with a disorder, something to the effect of, “Oh, lord, everyone’s popping pills for something these days!” No. Everyone is not popping pills for something these days. Many people do, at some point in their lives, take medication for a mental issue. But most psychotropic medications are meant as temporary solutions while the person works on their problems in therapy or on his/her own. People aren’t meant to take them for their whole lives.

And even if every single person in this country does, at one point or another, take psychotropic medication, that doesn’t mean much on its own. Almost everyone takes drugs for colds or headaches at some point, but nobody seriously advocates against this. I use the word “seriously” carefully here–a radical diet book I came across recently, Skinny Bitch, claims that we should basically never take medication for anything. It says, “Yeah, getting cramps totally sucks. It’s supposed to. Every month you endure cramps (without medication), you are preparing for the physical pain of childbirth. So suck it up. Stop interfering with Mother Nature.” Pardon my coarseness, but I actually nearly crapped myself when I read this. What?!

Most of us are glad that with things like modern surgical techniques, dentistry, drugs, and diagnostic tools (like x-rays and blood tests), we now live happier, healthier lives. Before these things were developed, people had 40-year lifespans and got all kinds of gruesome illnesses. Similarly, back in the good ol’ days, people with mental disorders either spent their lives in misery, got committed to mental asylums, or simply offed themselves, depending on the nature of the disorder. If we can prevent that by having “everyone pop pills,” so be it–at least until we can find a better solution.

Second, the fact that some mental disorders may be overdiagnosed does not mean that every diagnosis is illegitimate. Some parents, for instance, push for their children to be prescribed medication for ADHD in order to help them get ahead in school, even if they do not actually have ADHD. It should be noted that there are standard screening procedures for this disorder that ensure that people are diagnosed correctly. If a parent gets their child to somehow cheat the screening tests, or if an unscrupulous doctor prescribes medication even though the child doesn’t fit the diagnostic criteria, well, guess what–these people are being unethical. That does not mean that ADHD isn’t a legitimate disorder that many people–adults included–legitimately suffer from.

Furthermore, although some people probably do “imagine” their disorders and seek treatment in order to get attention, I should point out that this can only be a minority. There is nothing at all pleasant or fulfilling about spending hundreds of dollars, taking medications that give you really crappy side effects, and telling a complete stranger about the most shameful aspects of your life. This is not fun. Anyone who invents a mental illness and seeks treatment for it as a way to entertain themselves is an idiot.

I should also point out that even though some people do falsify their problems and some psychiatrists do overprescribe, this is a general trend that you can’t really apply to individual people. Unless you are a psychiatrist, you are simply not qualified to judge whether or not a particular person’s problem is “real” enough to merit treatment. Everyone told me there was “nothing wrong” with me and that I should stop being a crybaby, until it got so bad that my daydreams changed from imagining that cute guy from class asking me out to imagining which method of suicide is most effective. Don’t be the person who trivializes someone else’s illness. Just don’t do it.

Third, Moody suffers from the mistaken assumption–shared by many people–that the trend in the field of mental health is for increasingly insignificant and non-clinical problems to be classified as mental disorders. With this view in mind, it’s easy to see how the author could come up with the hypothesis that in 20 years, a disinclination to take showers could be considered a clinical disorder.

However, if there’s any trend here at all, it’s in the opposite direction. For instance, premenstrual dysphoric disorder–more commonly known as PMS–was in the DSM until the revision of the DSM-III in 1987. Much earlier, in the 19th century, women who suddenly showed a strong desire to have sex were labeled with the diagnosis of “hysteria.” The cure? An orgasm. (This diagnosis was also a catch-all term for any medical complaint made by a woman. Obviously, it’s not longer considered a disorder.)

Finally, I’m pretty sure that nobody who has this author’s opinion of the DSM has actually looked at one. I’m no DSM expert, but I’ve looked through it a number of times, and I can tell you that very few of the disorders listed in it seem trivial to me. (There are disorders that shouldn’t be there, perhaps, but for different reasons. For instance, gender identity disorder, which refers to a very strong feeling that one has been born into the wrong sex, is probably in the DSM because psychologists have assumed that it leads to a lot of distress and problems for the person who has it. Before it was possible to change one’s biological sex, that was probably true. But today, it has become clear that if a person who’s “suffering from GID” is able to change their sex, things get better. The remaining problems are caused more by society’s lack of acceptance for trans* people than by their psychological makeup.)

However, Moody is echoing the prevailing cultural sentiment that mental disorders are nothing but insignificant little problems that people have in their daily lives. If this were true, popping pills to solve these problems would indeed seem pretty silly. However, it’s not true, and unfortunately for those of us who have to struggle to find adequate mental healthcare and to get friends and family to accept and understand that struggle, people like Moody are busy spreading this misconception around through various media–in this case, a satirical novel.

Contrary to what Moody seems to think, recognized mental disorders cause significant problems in daily living, relationships, and work. Some involve hallucinations or delusional beliefs. Some involve uncontrollable episodes of panic, which are said to feel somewhat like heart attacks. Some cause people to be unable to experience pleasure from anything they do (this is called anhedonia). Some cause people to become so preoccupied with cleanliness, order, and performing particular rituals that they are literally unable to go through the day without taking care of these things. Some keep people from getting a good night’s sleep–ever. Some cause people to try to throw up every bit of food they eat, or stop eating altogether. Some cause people to want to kill themselves.

Do you see anything trivial here? I don’t.

Some Thoughts on Depression

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[TMI Warning]

About five months ago, I wrote a post on Facebook (and on this blog) about my experience with depression and how I came to receive treatment for it. I remember feeling very triumphant as I wrote it, because I felt like my difficulties were finally over.

This turned out to not exactly be the case.

In January, perhaps precipitated by some unfortunate personal circumstances, I relapsed and have been trying, mostly unsuccessfully, to recover ever since. The months since then have been filled with a lot of self-loathing, many random bouts of crying (daily at times), and much speculation on my part as to whether or not I really belong in this world.

This is when I realized that my problems, whatever they may be, don’t simply go away when I’m not depressed. I don’t “invent” the issues that I’m unhappy about. But being healthy makes it easier to ignore the pain in the back of my mind–all the wasted opportunities, lost friends, and scarring memories that have built up over the years like dust on a windowpane. When I’m healthy, I simply don’t think about it, and consequently I’m happier. But the mockery that I’ve made of my life isn’t a figment of my imagination; it’s quite real.

~~~

I also started to realize, perhaps even more than I did when I wrote that post, how little the healthy world knows about depression. Mental illness is truly the last taboo; many people refuse to even consider dating someone who has it. Kinda makes me reconsider being so open about my experience…

Even people who would otherwise be supportive just don’t know enough. For instance, if you know your friend is a diabetic, would you offer her a piece of cake? Probably not. But would you casually make fun of your depressed friend? Unfortunately, many people would, even though teasing and jokes are things that many depressives have a lot of trouble with. (This is because depression often causes a cognitive deficit that makes people take everything–a snappy tone of voice, an odd glance, a sarcastic remark–very personally. Here’s a great guide to cognitive distortions.) I am always analyzing and picking apart things that people say to me to try to figure out if they were just teasing or not. I am terrified of the threat of rejection that these casual utterances may carry, so I am always alert, always on my best behavior.

~~~

Another thing I’m never sure of is which parts of me are depression and which are simply me. I’m a skeptic, a cynic, and generally not too big a fan of things that most people seem to really like (Exhibit A: this). I don’t fit in with my surroundings in many ways. I’m more complex, polite, caring, respectful, quiet, conscientious, serious, passionate, emotional, and sensitive than most. I’m less assertive, flaky, impulsive, cheerful, “chill,” and casual than most. This makes for a great number of personality differences between myself and most people I know. When I’m not feeling depressed, these differences fade into the back of my mind. But when I am, they come right to the front, putting up a wall between me and the rest of the world, making me feel like I’ll be an outcast for life.

~~~

One more realization–Northwestern might be the worst place in the world to be depressed. (Not that there’s really a good place for that, except perhaps the psychiatric ward of a hospital.) It’s isolating, stressful, and miserably cold from October till May. Your peers churn industriously around you like a hive of North Face-clad bumblebees while you vegetate listlessly in your shitty shoebox room and email professors, friends, student group leaders one by one and tell them that you’ve been ill and cannot come to whatever crap you’re supposed to be at that day. You eat Nutella from the jar and wonder why none of your friends care. You wonder why you expect them to care. You sleep, a lot.

Northwestern also happens to have entirely inadequate mental health services, but that’s a topic for another post. My friends and I are working to change that. But for now, this is a really, really unfortunate place to be depressed.

~~~

And that’s it, really. I’m not entirely sure where I’m going now, but hopefully it’s somewhere good.

Learning How to be Happy

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I’m going to go out on a limb and criticize something even more popular than the things I usually criticize–my school’s Happiness Club.

The Happiness Club is a prominent student organization at Northwestern that aims to increase happiness by planning all sorts of activities for the campus, such as kite-flying, free hot chocolate, water balloon fights, “silent” dance parties, and so on. In other words, all fun and exciting activities.

So what’s the problem?

The problem is that it’s not “happiness” that these activities are promoting; it’s momentary joy. Momentary joy is an important component of a happy life, but it’s not even close to all you need.

Let me explain. Most Northwestern students have been fed on a steady diet of stress, sleep deprivation, and SAT prep classes since before we hit puberty. The kinds of effects that such a diet inevitably has–for instance, perfectionism, fatigue, anxiety, and depression–are things that no amount of kite-flying will cure.

To put it bluntly, most people I know here (myself included) are simply not capable of living our lives in a way that’s conducive to long-term happiness and well-being. We suck at prioritizing–academics and extracurriculars come before friends and family, every time. We demand perfect grades from ourselves. We apply to only the most prestigious internships and burst into tears when we inevitably fail to get those positions. We fill our schedules to the point that we have to schedule in shower time. We don’t pause to relax, think, or meditate.

In other words, the skills that we lack–balance, mindfulness, perspective, and a healthy amount of compassion for ourselves–are exactly the things that are not being taught to us here. These are the skills that lay the foundation for a happy and meaningful life.

Of course, there are resources. CAPS (our psychological service) offers workshops, and RAs are encouraged to emphasize the need for balance and stress relief to their residents. But the people we look to and trust the  most–our peers–are often more of a negative influence than a positive one. (For instance, how do you think I feel about my own study  habits when my friend tells me she stayed up till 4 AM studying, slept for two hours, and got up at 6 to keep going?)

That’s where a group like the Happiness Club should, theoretically, come in. In addition to the undoubtedly fun activities that they already plan, why don’t they offer workshops on stress relief, meditation, or yoga? Why don’t they bring in speakers who talk about how one can be both productive and happy in college? Why don’t they encourage greater awareness of things like perfectionism, anxiety, and depression?

We need to start up a campus dialogue about these things, because there isn’t one right now. Occasionally, late at night, one of us will admit to a friend that we’re just not living the right way. But this conversation needs to happen on a larger scale. There is too much misery here. I don’t doubt that many Northwestern students are happy in some sense of the word, but they’re not as happy as they could be, because while all the adults in our lives have taught us how to live a successful life, nobody’s taught us how to live a happy one. Maybe it’s time to teach ourselves.