By the time I had graduated high school, I'd known four people who committed suicide and many more who attempted. These were siblings of friends, parents of friends, and friends. At funerals, the talk was always "But they were so loved" or "Didn't they think about their family?" or "But they were so successful" or "Couldn't they see everything they had?" I never remember hearing anyone talk about depression, the very real illness that it is, and the very intense way it distorts your thinking. No one was talking about the way depression makes you want to crawl out of your skin to get some relief from the incessant pain.
So, not only does depression create an incredible amount of pain, people are often told that they have no right to feel that pain.
For someone who hasn't experienced depression, it can be really hard to understand. This creates a cycle where those who experience depression are afraid to talk about it due to misunderstanding which makes it even harder for those who don't understand, to learn. But learning is crucial because depression can be deadly if left untreated. According to the National Institute of Mental Health (NIMH), in 2015, suicide was "the second leading cause of death among individuals between the ages of 15 and 34." This is a serious health crisis that we are afraid to talk about.
A combination of what depression does to you and how our society views it, has turned depression into this confusing, misunderstood, pile of shame. Let's change the way we talk about depression by starting with a little more understanding.
1. Depression distorts your thinking.
Depression is an asshole. It will sit there and tell you that you're alone, you're worthless, and you'll never feel better. Depression tells you not to ask for help and to feel ashamed. And the worst part is, our society reinforces that message. It's hard to challenge that distorted thinking when society tells you to just get over it because there are people out there with "real" problems. So for those of you experiencing depression, your problems are real and valid.
And for those of you who want to support someone with depression, start with listening. Real listening. We all want to feel heard and understood. That doesn't happen if we share our deepest pain and then someone says "Oh well my Uncle Jerry started running and that cleared his depression right up." You don't need to try and fix it and make it better, sometimes you just need to get down there in the trenches and listen. Also, watch this amazing video on empathy by the amazing Brené Brown.
2. Suicidal thoughts are pretty common and don't always mean someone wants to die.
I understand that "I thought about blowing my brains out three times yesterday" isn't necessarily the best conversation starter. But I dream of a world where someone can talk about suicidal thoughts and get recommendations for help the same way you would when talking about back pain. I get so many clients struggling with depression that initially say they need help with their anxiety (it has much better PR). There is so much shame and fear of other's reactions that surrounds depression and suicidal thinking, that it's hard to admit to even me, their therapist, that they feel that way. There is a fear that if they admit what they are feeling, they'll get labeled as crazy and locked away forever. In some cases, hospitalization can be important, but it isn't the answer most of the time. If a therapist wants to hospitalize you every time you mention a suicidal thought, find a new therapist. You should be able to discuss those thoughts without fear and the right therapist will be able to do that with you.
And if you are supporting someone with suicidal thoughts, don't be afraid to ask them, calmly, about it. You aren't going to put suicidal thoughts in their head. Offer to help them find a good therapist or psychiatrist, drive them to an appointment, check in. Make It Ok is an amazing organization with resources on reducing the stigma of mental illness and helping you find the right words to say. If someone needs more immediate support, encourage them to call the National Suicide Prevention Lifeline at 1-800-273-8255 or text the Crisis Text Line at 741741. And of course, if someone is ever a serious, immediate threat to themselves, call 911 or, if it's safe to do so, take them to the hospital.
3. We don't always understand what depression looks like or when it will hit.
I think we get this picture in our heads that people who are depressed are sitting in their rooms with all the curtains closed. And maybe sometimes that's true. But oftentimes, when someone is depressed, they can still seem okay because they don't want to seem like a burden. Again, that combination of depression being an asshole and telling you that you're worthless, and society misunderstanding it often leads you to get really good at hiding it.
Also, depression, like any other disease, doesn't give a damn who you are or what's going on. You can have some amazing things going on in your life, and depression can decide it's a good time to visit. In fact, it is often when those good things are happening that depression can be even more likely to show up. In those moments we tell ourselves "I should feel happy..." and we beat ourselves up for not feeling that way. This leads down a terrible spiral of increased self-loathing and frustration. If you find yourself there, be kind to yourself. Practice separating your thoughts from who you are. For example, instead of thinking repeatedly "I'm broken because I can't feel happy right now," say to yourself "I notice the depression is telling me I'm broken." If you are supporting someone struggling, remind them it's okay to not feel happy even when you feel like you should. Sometimes just taking away that pressure to feel happy can be a huge relief.
4. We don't know when or how to get help.
Going to the doctor for anything is hard (I'm guilty of that myself.) Getting help when you're in the middle of depression can feel impossible. And of course, when you feel a little bit better and up to finding a therapist, it feels like maybe things aren't serious enough to get help. Unfortunately, depression often comes in waves and it's important to get help even if you feel like things are going okay, kind of like going to a doctor for a check up.
Once you do decide to get help, it can hard to know where to begin. Do you need a psychiatrist (MD), a psychologist (PhD or PsyD), a social worker (LCSW), or a professional counselor (LPC or LMHC), and what the hell do all of those things even mean? In short, all of those people are trained to provide psychotherapy but might have a different background or approach. My best advice is find someone you connect with and feel comfortable talking to; this might take a few tries. Psychiatrists are the only ones in that group that can prescribe medication. Although your primary care doctor can prescribe you meds, I definitely suggest also seeking support from a psychiatrist if you feel you need medication and a good one will tell you if you don't need it.
Here are some online directories to help you or someone you care about find a therapist:
Check out my resources page for books, podcasts, and apps that can also be helpful.
Depression is a very serious health concern and is not something to deal with on your own. I hope as a society we can continue to talk more openly about it so more people can get the help they need.
For more information on therapy for depression, head here.