Tag Archives: mental illness

[In Brief] How to Talk About Mental Illness Recovery Without Shaming

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Lucy Hale covers this month’s Cosmo.

Remember that post about celebrity gossip I just wrote? Well, here’s an example of how reading that stuff can be useful and enlightening.

I’m reading an interview in the September issue of Cosmo with Lucy Hale, a 23-year-old actress most known for her role on Pretty Little Liars, a guilty pleasure of mine. In the interview, Hale opens up (apparently for the first time) about the eating disorder she struggled with as a teenager:

But behind the scenes, Lucy developed a dangerous habit all too common among young starlets. ‘I’ve never really talked about this, but I would go days without eating. Or maybe I’d have some fruit and then go to the gym for three hours. I knew I had a problem,’ Lucy says of the issue that plagued her for two years. Luckily, unlike some actresses who have been unable to escape the downward slide, Lucy had the strength to turn herself around. ‘It was a gradual process, but I changed myself,’ she says.

Except for the following paragraph, in which Hale talks about cutting damaging friendships out of her life, no other details are given about how she recovered from her eating disorder, and I won’t assume. However she did it, it’s awesome and she deserves to feel great about having accomplished that.

However, the Cosmo writer takes it a bit further with this sentence: “Luckily, unlike some actresses who have been unable to escape the downward slide, Lucy had the strength to turn herself around.”

Wait…what? So people who succumb to the “downward slide” of eating disorders, or who need professional help to recover, just lack the “strength” that Hale has?

Obviously, I disagree.

If Hale really did recover without any professional help–which, again, she does not make that clear–there are many potential reasons for that. Perhaps she had a great support system of friends and family. Maybe she’s not genetically predisposed to eating disorders. Maybe her parents have healthy eating habits that they were able to model for her. She might’ve not had as serious a case as others do. Or perhaps she just got lucky.

None of this means that actresses who are “unable to escape the downward slide” have any less “strength” than Hale did. It means, probably, that they had different circumstances. Different lives.

So, how does one talk about people who have recovered from mental illness on their own without putting down those who cannot? My answer would be, by not comparing them to each other. Hale recovered? That’s awesome. Another actress didn’t? That’s a tragedy, and she deserves help and support. Their illnesses are not comparable, even if they happen to share the same name.

As Leo Tolstoy said, unhappy families are all unhappy in their own way. Similarly, people who suffer from mental illness all do so in their own way. Just because one recovers and another does not doesn’t mean that one has more “strength” than the other.

P.S. Before anybody goes all “but it’s just Cosmo, who cares!”, Cosmo has a circulation of over 3 million in the United States and is also distributed in over 100 other countries in 32 languages. Readers of this blog probably think Cosmo is silly and not something to be taken seriously (which it’s not), but the truth is that many people around the world probably get most of their information about things like mental illness from media like this. So it’s definitely worth examining and critiquing.

Abortion and Suicide: A Spurious Link

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In South Dakota, it is now legal to require doctors to tell women seeking abortions that they are putting themselves at risk for suicide.

This move is brilliant from a PR standpoint. Unlike banning certain types of abortions entirely or, say, forcing women to undergo invasive screenings that are medically unnecessary, this seems completely apolitical when you first look at it. Don’t people deserve to be informed if they may be increasing their risk for suicide? Don’t we all agree that suicide is a Bad Thing?

However, something tells me that this is actually another attempt to scare women out of (what should be) a normal, socially acceptable medical procedure.

First of all, the inconvenient truth here is that credible research consistently shows little or no link between abortion and poor mental health. One 2008 study reviewed the literature and found that the only studies that seemed to show such a link had very flawed methodology, whereas the studies that were well-designed showed no links. (Damn liberal academics!) And here’s another study that showed no such links. And here’s a thorough debunking of a study that did claim such links:

Most egregiously, the study, by Priscilla Coleman and colleagues, did not distinguish between mental health outcomes that occurred before abortions and those that occurred afterward, but still claimed to show a causal link between abortion and mental disorders.

In other words, that study actually tried to use mental health pre-abortion to confirm a hypothesis about mental health post-abortion. This is simply not how you do science. And it’s especially bad here, because according to the American Psychological Association, guess what the best predictor of mental health post-abortion is?

Across studies, prior mental health emerged as the strongest predictor of postabortion mental health. Many of these same factors also predict negative psychological reactions to other types of stressful life events, including childbirth, and, hence, are not uniquely predictive of psychological responses following abortion.

That’s right. Shockingly enough, the best predictor of mental health is, well, past mental health. And poor mental health predicts poor response to all sorts of stressful events, of which abortion is only one example. Another one being, for instance, childbirth!

Compounding the bad science here is that, unlike physical side effects,suicide isn’t something that just happens to you suddenly and without warning. People don’t just suddenly wake up one morning and decide to kill themselves. Suicidality is a complex process that involves factors like genetics, family history, environment, social support, mental illness, and life circumstances. For instance, here are some things that, according to research, actually increase one’s statistical risk for suicide:

As you can probably surmise, not all of these correlations are also causations. While mental illness and drug addiction can actually cause suicidal behavior, being intelligent and being LGBT probably cannot. In the latter case, the causative culprit seems to be (surprise surprise) institutionalized discrimination and homophobia. Before I get too off-topic, let me point out the irony in the fact that, despite this well-known risk faced by LGBT youth, I don’t see any of these pro-lifers advocating for an end to homophobia.

That’s why something tells me that nothing about this court ruling actually has anything to do with suicide prevention.

Although the court’s ruling does at least acknowledge that abortion probably doesn’t cause suicide, it nevertheless states that “conclusive proof of causation is not required in order for the identification of a medical risk.” This is probably true, but it only makes sense from a physical health standpoint. If studies show that people who get a certain elective medical procedure are much more likely to, say, experience headaches or nausea or numbness, you don’t necessarily need a causative study to conclude that there’s a reasonable chance that these symptoms were caused by the procedure (assuming, of course, that there was no illness present that might be causing them). Furthermore, there’s a difference between saying “This procedure may cause you to experience cramps and headaches” and saying “This procedure may cause you to kill yourself.”

The truth is, mental health doesn’t work that way. A person who gets an abortion might experience mental side effects because of the stress of having gotten pregnant accidentally and been forced to decide what to do, perhaps without the support of a partner or family. Furthermore, any invasive medical procedure can be stressful and worrying for many people–especially one like abortion, which is consistently portrayed as more painful and dangerous than it really is.

And this is all made even more complicated by the fact that the faulty studies in question were actually studying mental health before the abortion. Perhaps a person with poor mental health is more likely to seek an abortion in the first place–say, if they feel that they aren’t mentally capable of raising a child at the moment.

Ultimately, decisions about what to tell a patient should be left up to the people who know most: doctors (with, of course, a reasonable amount of regulation to prevent malpractice). If a doctor can tell that a person seeking an abortion is going through a lot of mental distress, then that doctor may want to gently recommend counseling and perhaps give out some hotline numbers–and training doctors to recognize signs of mental health troubles is always a good thing.

But doctors should not be mandated to fearmonger to their patients. They should especially not be mandated to serve a pro-life agenda.

[Guest Post] An open letter to the woman who said I wasn’t skinny enough to have an eating disorder

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Another guest post, this time by my friend Kate.

You are the mother of my greatest friend. Your house was my refuge in high school. I wanted to surprise you and share my happiness with you when I got into my dream college. By my senior year, I spent almost every day after school at your house. You offered to cover for me, to be a hiding place when I simply could not deal with my family…and you became someone I trusted. You knew me in the worst throes of my starvation. I was skinny then. I was too skinny, and faint and malnourished and mentally ill. You didn’t know it then, but your son guessed, and for that, he has my eternal gratitude. Without him, I do not know that I would have survived to this point. That is not hyperbole.

You saw me this summer, back home for the worst summer I’ve had. I have gone off therapy for these three months, because you see, my parents don’t use modern medicine, and I cannot trust them to care for me. I am dependent on the kindness of my university to have treatment in the first place. This summer, all I have are friends, and my own will to do anything to keep from slipping back into a hell of calorie counting and obsessive thoughts and the nightmare of reflective surfaces. I used to hate myself, you know. It still creeps up on me and strangles and pulls at loose skin, until all I can do is hold off from screaming and curl up in bed.

You don’t know this. I would have told you, had you asked. I speak about my cesspit of destructive behavior, because you can’t tell when you look at me. That is true of most eating disorders, and someone has to talk about it. I will be that person.

You can’t tell that some days I realize all I’ve had is a cup of coffee in twenty-four hours, and I am blisteringly happy. You can’t tell because I force myself to hold a normal weight. I have for four years, and on especially good days, that is a source of pride.

That number on the scale isn’t the weight I want, but it is healthy. It is perfectly in the range for my height, a muscular build that runs and leaps and cartwheels, but it isn’t skinny. It isn’t skinny, and that is all you see. I am not starving, and so I cannot possibly suffer. I should get over it.

I’d like to, but if the past six years are any lesson, I won’t. I will always depend on alarms to remind me when to eat. I will plan my workouts ahead of time, because when I don’t, I become obsessive, and exercise until I cannot see straight. I will never eat with abandon. Meals will be planned for. Eating out will be stressful. I will have an uneasy truce with food.

And there will be people like you. I hate saying that because, until yesterday, when I said that I meant people who would care, and make me laugh, and be one of the solid ones. There will be people like you, who think I’m making a fuss, playing victim. You were one of the good ones, once, so I’d like to set the record straight.

I am recovering from an eating disorder. For two years, I averaged less than 800 calories per day. I danced intensively, as much as four hours a day. I lost too much weight. I was starving and bony. I did permanent harm to my body.

I have bradycardia. That means my heart beats too slowly; it doesn’t speed up enough when I exercise. If I push too far? I’ll faint. I do not trust myself to exercise outside of a gym. I cannot know when my vision will narrow, but in a building, I at least know that if I stay unconscious, someone will be there. I want you to consider that my safety net is the kindness of strangers to notice if I do not wake up.

The rate for attempted suicide in those with eating disorders is as high as three times that of the general population. Everyone quotes statistics, but I want you to take a hard look at that one. If you combine the neurotypical people out there with those who have PTSD, with those who have major depression, with everyone else who has considered their life not worth living, they attempt suicide at one third the rate of those with eating disorders. You know what makes me hurt so badly I want nothing more than to make it stop any way I can? When people I trust decide some number on a scale measures the weight of my claims, when they reinforce the horrible things I believe about myself. I just never thought one of them would be you.

I want you to know something important about your son. Your son cared for me without knowing any of those facts or statistics or numbers. He just thought I was worth time. He thought I was too skinny, that I was maybe hurting myself, and so he did what he could. He held me and took me to dinner and made sure I ate. He never demanded justification—he waited until I told him I had an eating disorder—the first person I ever confessed to. He smiled, and said he knew, and then we went back to life as normal. We talk every day, because we take care of each other.

I want you to understand something, more than anything else in this letter. You
said I didn’t really have an eating disorder. But that wasn’t the worst thing. You also told my greatest friend, your son, that he should back away from me. You said he shouldn’t ‘have’ to take care of me. You wanted him to back off, because I was being whiny. I cannot forgive that.

I can forgive your careless misunderstanding of my eating disorder. You won’t be the last. You hurt me badly, but it’s ignorance like the words you spoke that keep me speaking up. I cannot forgive your wish to destroy my support.

You spoke selfishly. It is the selfless spirit of your son, and his love that quite literally, saved my life. I’m sorry you can’t see that. I’m sorry I don’t want to see any more of you.

Relevant citations: here and here.

Kate Donovan is a junior studying psychology and human development at Northwestern University. She is the president of Northwestern’s Secular Student Alliance and a writer at Teen Skepchick and the Friendly Atheist blog.

Depression is Not Sadness

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Yesterday I came across the story of Junior Seau, an NFL linebacker who committed suicide on May 2. He shot himself in the chest and was found in his home by his girlfriend. Although little is known of Seau’s mental health leading up to his death, he had apparently suffered from insomnia for the last seven years of his life.

Sportswriter Chris McCosky wrote a beautiful column in the Detroit News about Seau’s death and continuing ignorance about depression and suicide. In the column, McCosky shares his own experiences with depression and suicidal thoughts and laments how difficult it is to explain them to people. He notes, as I’ve noted before, that one common reaction that non-depressed people have is to wonder what the hell we have to be so sad about. He writes, “It’s almost impossible to talk about it to regular people (bosses, spouses, friends). They can’t fathom how somebody in good physical health, with a good job, with kids who love them, who seems relatively normal on the outside, can be terminally unhappy.”

The unbearable frequency at which McCosky and I and probably everyone else who tries to talk about depression get this response could be a testament to the fact the most visible symptom of depression is usually sadness. So that’s the one people latch on to: “What do you have to be so sad about?” “Cheer up!” “You have to decide to be happy!”

Because of the sheer obviousness of our sadness, we’re often forced to try to use it to describe depression. We say that we’re just extremely sad, or unhealthily sad, or a different kind of sad. It’s sadness that never goes away like sadness is supposed to. It’s sadness that’s out of proportion to the troubles that we face in our lives. It’s sadness that we can’t stop thinking about. For those of us with bipolar or cyclothymic disorder, it’s sadness that comes and goes much too quickly.

And it is. But the truth is that sadness actually has very little to do with depression, except that it is one of its many possible symptoms.

Based on the diagnostic criteria for depression, you don’t even need to be chronically sad to be considered “depressed.” Anhedonia, which means losing the ability to feel pleasure from things that you used to enjoy, could be present instead. Under the formal DSM-IV definition, you must have at least five of nine possible symptoms to have major depression–and one of the five must be either depressed mood or anhedonia–and only one of those symptoms involves sadness. (If you so some very basic math, you will notice that this means that two people, both of whom officially have major depression, might only have one symptom in common. Weird, huh?)

So, even if your particular depression does include sadness, it’ll only be one of many other symptoms. The others might be much more painful and salient for you than the sadness is. Some people can’t sleep, others gain weight, some think constantly about death, others can’t concentrate or remember anything. Many lose interest in sex, or food, or both. Almost everyone, it seems, experiences a crushing fatigue in which your limbs feel like stone and no amount of sleep ever helps. Then there are headaches, stomachaches, and so on.

So, depression doesn’t necessarily mean sadness to us. (And, a gentle reminder to non-depressed folks: being sad doesn’t mean you’re “depressed,” either.)

Depression is not sadness; it’s an illness that often, though not always, involves sadness. No amount of happy things will make a depressed person spontaneously recover, and, usually, no amount of sad things will make a well-adjusted person with good mental health suddenly develop depression. (Grief, of course, is another matter.) And sadness, on its own, does not cause suicide.

We need to start talking about mood disorders as disorders, not as emotional states. McCosky writes:

Junior Seau wasn’t sad when he pointed that gun to his chest. He wasn’t being a coward. He wasn’t being selfish. He was sick. I wasn’t sad when I thought about swerving into on-coming traffic on Pontiac Trail some 20 years ago. I was sick.

What he’s saying is that people don’t kill themselves because they’re sad. They kill themselves because they have an illness that, among other things, makes them feel sad. It also makes them feel like their life is worthless, like they’re a burden to others, like death would be easier, and all the other beliefs that lead people down the path to suicide.

There is a tendency, I think, to assume that people are depressed because they are sad. A better way to look at it is that people are sad because they are depressed. That’s why, even if we could “turn that frown upside down!” and “just look on the sunny side!” for your benefit, it would do absolutely no good. The depression would still be there, but in a different form.

Junior Seau did not leave a suicide note, so only God knows what he was thinking when he died. I would guess, though, that he was thinking about much more than just being sad.

Anonymity and Mental Illness

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The stigma of mental illness has many negative consequences, such as decreased access to employment and housing, barriers to seeking treatment, and many broken friendships and relationships.

What it also does, unfortunately, is make it much harder for people who’ve suffered from mental illness to speak about it publicly, using their real names.

I’ve been thinking about this because North by Northwestern, our campus magazine, ran a feature in its spring issue about mental illness at Northwestern. Overall, the piece was great and discussed how our academic system may be contributing to unhealthy levels of stress. The author of the piece interviewed two students who spoke about their experiences with depression and anxiety.

But both of the students’ names were changed for the article, and it bothered me.

For the record, I would never begrudge an individual for choosing to speak about his or her mental illness under a pseudonym. We all have different priorities, and not everyone has decided to spend their life advocating for those with mental illnesses (as, for instance, I have). Even those who do may decide that using a pseudonym is in their best interest–for instance, this blogger whom I greatly respect.

The magazine, however, could have chosen to find sources who would be willing to let their real names be printed. I know it could’ve, because those people exist on our campus. I’m one of them. Many of my friends are, too.

This is important for several reasons, some short-term and some long-term.

The short-term reason is that seeing fellow students speak publicly about their experiences with mental illness can make a huge difference in the life of someone who’s just starting to acknowledge and deal with their own illness. It lets them know they’re not alone and gives them hope for the future.

It can also give them a specific person to reach out to. After I started writing about depression, friends, acquaintances, and even strangers started writing to me, sharing their stories, and asking for advice. I heard from friends that I knew were struggling and friends who seemed to have everything together. I heard from a guy who’d told me once that he’d had depression briefly but pulled himself out of it on his own. I felt humbled to know the truth.

A friend of mine who spoke in a panel about her eating disorder once told me that she had the same experience. She was quoted in an article about the panel, and afterwards people reached out to her about it.

There’s a bigger picture, though, as well. Every time someone “goes public” about a mental illness, they chip away at the culture of secrecy that surrounds it. And the more of us do it, the harder it’ll be to deny us jobs, cut off friendships with us, continue believing that we’re weak and lazy, and be ashamed of us.

I’m glad those two students spoke to NBN, and I know it was hard for them to do even knowing that their names would not be in print. But NBN had a chance to do something really important, and they missed that chance.

As I was writing this post, I found out that there’s someone pretty powerful who recently took that chance. During his speech for people who have lost family members in the military, Vice President Biden talked about the deaths of his wife and daughter in 1972. Then, he said, “I probably shouldn’t say this with the press here, but it’s more important–you’re more important.” Then he went on:

For the first time in my life, I understood how someone could consciously decide to commit suicide. Not because they were deranged, not because they were nuts, but because they had been to the top of the mountain and they just knew in their heart they’d never get there again.

Biden’s not the only one, of course. Plenty of well-known people have spoken about mental illness, such as Rachel Maddow, William Styron, and Demi Lovato.

In his seminal book on depression, The Noonday Demon (which I have coincidentally just finished reading), Andrew Solomon intentionally avoids using pseudonyms whenever possible. On the first page of the book, he writes,

I asked my subjects to allow me to use their actual names, because real names lend authority to real stories. In a book one of the aims of which is to remove the burden of stigma from mental illness, it is important not to play to that stigma by hiding the identities of depressed people.

I believe that when writing about mental illness, one must be cautious of the status quo. With regards to mental illness, as with regards to just about everything else, the status quo can be a dangerous thing. You cannot think and write about the tragedy of mental illness without also acknowledging the tragedy of stigma, which pushes so many of us to stay silent for too long. In my case, it was eight years. For others, it’s a lifetime.

Accepting the use of pseudonyms in one’s work just because that’s what’s always been done, or because finding interview subjects who are willing to use their real names might be difficult, does an injustice to everyone who suffers from the continuing presence of stigma.