Mental Health: The Invisible Stigma

The Invisible Stigma

Recently I read an article, frankly it was a rather superficial piece, on mental health, published originally in a Mommy Magazine, but it got enough interest that it was republished online via CNN. The interesting thing about it, is that my first immediate reaction upon reading it the first time was outrage. I reposted the article along with a diatribe. This isn't anything new, I have some of the most interesting discussions when I get irate about something, but this time something unique happened.

Over the course of the day when different people saw the link, I got two very polarized responses. The first, irate agreement with my annoyance, the second was polite confusion trying to pinpoint what exactly had struck me so wrong. It was the second response that made me think. I reread the article, trying to pinpoint the exact phrases that set me off, and they were there, but it was a subtle game. The article never directly said anything pointed, in fact it was the very calm, nonspecific nature of the piece that made it all the more frustrating, and all the more difficult to combat.

I'll bring back a link to the article, and discuss my arguments about it at length further on, but first a little background on me, and the experiences that have affected my perception.

I was diagnosed 'depressed' at seventeen. This didn't come as a surprise to anyone, I'd known I was unhappy, and frankly sick of fighting an endless battle with my sadness, apathy, and loneliness. It was back in 02, and even though more and more people were learning about depression, aware that it existed, and the TV and magazine ads for prozac had already started making the rounds, it was still something no one really wanted to admit happened to them.

I had a lot of reasons to be depressed. In addition to the dramas of adolescence I'd been fighting a long hard battle with another invisible disease, Ulcerative Colitis, that left me dangerously underweight, exhausted, wary of everything I ate, and frequently in the hospital. The thing is, depression doesn't care if you have a reason to be depressed, reasons just make it all the more difficult to fight it. Getting diagnosed with depression was a relief, it gave my problem a name and a description of ways to combat it. Like my other disease, not knowing what was killing me was far worse than giving it a name.

The irony in my struggle is that if I told people I was depressed and taking antidepressants as a teenager, they had no argument with that. For most it was something so indefinable, that they didn't bother to question it, they just accepted it. No, the irony was in the way people reacted to my actual physical disease. I had UC. I was diagnosed by doctors through many, many tests. I went through many courses of medication. I had a doctors note requiring teachers to forgive my absences because sometimes I was in the hospital, sometimes I just couldn't get out of bed. But when I did go to school, it was such a relief to see my friends, I preferred to act like nothing was wrong. I joked with friends, goofed around, and tried to have a normal school experience.

Some people couldn't accept that. Teachers, especially, couldn't grasp the idea that I could be deeply ill, and yet joke with my friends during class. They assumed I wasn't trying hard enough to do their coursework, some seemed to assume I was outright 'faking' a disease to get attention. I was deliberately failed by one teacher, despite my A on the final exam. Another teacher refused to give me a letter grade, and only supplied a 'course completed' stamp that got me out of her class without contributing to my GPA. Passive aggressive punishment for having a legitimate disease.

I am far more bitter about the experiences I had at the hands of adults, I admit. There were other incidents with students, more petty and cruel, but I don't expect better from teenagers. Stupidity at sixteen is almost required. It was the people that should have known better. Those that should have been past such petty judgments, those are the wounds that I remember.

It was situations like this that made me all the more sensitive to meta-messages. All the things you read between the lines, all the cruelty and subtle emphasis you make clear without ever saying a word. I think many people who become depressed are more sensitive to the opinions of others. Many of these people are highly intelligent, artistically inclined, and clever enough to see through the fronts others put up.

This might make them too sensitive, maybe even paranoid at our most insecure, seeing daggers in every sigh, and judgment in every silence. But we aren't stupid, and when we say people judge us for our 'mental disorders' we aren't wrong.

I was fortunate to know, quite acutely, that I was depressed, and I needed help when I first sought it. It made it easier to accept the diagnosis, but it didn't mean it was easy to stay there. Depression is like a cancer, you can beat it back, and sometimes go for a long time free of it, but there's no guarantee that it will stay gone, and all too often it comes back. To make matters worse, it might not be just depression. It might be anxiety caused by stress factors that you can predict, or panic attacks that come on violently for no reason. You could be diagnosed depressed, but actually suffer from a manic depression where half the time your unable to sleep, sit still, or stop chasing a dream, then you crash and fall into a pit of despair and lethargy. Mental disorders are tricky to face, hard to diagnose, and even harder to treat long term without difficulty.

Yet, if given half the chance, I'm sure almost everyone you know can tell you a 'solution' to your problems. Everyone has been sad, or unhappy at some point, but not everyone has been depressed. The fact that so many people believe sadness, mourning, or normal unhappiness is equal to clinical depression is one of the hardest logical fallacies for both depressed and 'normal' people to overcome.

If I have an ugly infected boil on my toe, it takes a special kind of person to give me advice on how to cure it, let alone someone who'll want to talk about it at all. Yet if you say you're "depressed" for most people they assume it's your way of asking them to 'fix it', and they'll try. (Sometimes I wish Depression had a fancier name. I think I'll start calling mine 'Johnson's Apathy'. If I tell people I'm on medication to cure my Johnson's Apathy maybe they'll stop telling me how I can quit my pills and just take a vacation instead.)

People who have fought the battle for their mental health, especially people who are willing to talk about it openly, have all dealt with the oftimes crushing advice on how to get better. "Just try to cheer up." "Maybe you need more sunlight." "Maybe you need more vitamins." "When I'm sad I just…" "If your so stressed, you should take some time off." "You need to get out more." "You need to relax more." "Get a hobby." And the far worst one, the one that so few actually say, but we can read it loud and clear between the lines. "Maybe it's all in your head." "Just stop being that way."

Passive aggressive, condescending, sometimes well meant, but all the more painful, the advice from people who've never truly understood mental disorders all carries the same stigma, "I'm fine. So what is so wrong with you?"

People with depression aren't seen as 'sick', they're seen as weak, unmotivated, not 'really trying' to get better. The burden of the judgment can be a weight that crushes you, especially when you're already deeply convinced that you cannot escape your flaws. Someone who is depressed, but afraid to be labeled 'mentally ill', will run from that stigma. Sometimes until it kills them.

I am fortunate. I know that my depression is a physical chemical imbalance that I need medical help to manage. I know my depression is not a sin, a personal flaw, a choice or a weakness. I know that I cannot always help the sadness that swallows me whole, and that when that happens, my job is to get support, see my Doctor, and remind myself that it will get better. You know what, even though I know all that with the same certainty that I know the sun will rise… When I am depressed, it doesn't stop me from hating how I feel, hating who I become, and feeling like a burden and a failure to my family.

Knowing that depression is a disease I can fight, with proper medication, therapy, and support of friends and family is the rope I need to climb out of the pit that depression throws me into. Having the certainty that I will keep fighting, and this is not my fault is all the difference in the world sometimes.

This is why a fluff piece in amagazine offended me so much. (Specifically titled, "Xanax Makes Me a Better Mom") The article began with a 'depressed' mother who went off her medication and 'cured' her depression with moments of solitary meditation, the article ended with a 'depressed' mother who's daughter said 'she feels sad' (An early sign of depression, though in a child it's contingent on a LOT of factors, like duration, severity, frequency, before deciding it's an actual concern.) so the Mother's conclusion from her daughter's sadness was to go off her medication and try to deal with her disease (and her potentially depressed 6yo) unmedicated.

Basically looking at the structure of the article, if you begin a news piece with a statement about using alternative (to medication) methods to combat depression, then end that piece with a similar statement about getting off the pills and reconnecting with life, the position of those two pieces make them your strongest 'argument'. Thus, the article is saying "American parents are over-medicated and need to stop taking pills in order to better experience life".

This is why I found the article a bit offensive. If you also look at the statements they included in the article statistics from the CDC stating one in ten people are on antidepressants, include a therapist who thinks people just want a pill to deal with normal feelings in life, and a snippet from a psychologist who says taking pills without seeing a therapist is never going to fix the problem. Even though they couched all this language in fuzzy anecdotes about parenting and interviews with parents on medication, their implication is clear. "You don't need a pill. You just need to get over it."

The stigma is right there, wrapped in statistics, and couched in anecdotes. "They fixed their depression. Why can't you?" "You don't need medication." "People just want a pill to deal with normal sadness." The words are there, "It's just easier to take a pill." along with the implication, you are weak for needing a pill to survive your illness. You are a failure for 'not facing' your depression and getting over it. You are broken.

If someone is depressed an already hating themselves then all they see from these words is not an offer of help, or an observance of the medical possibilities for getting better, instead they just see how they can't fall into the fallacy of the over-medicated society.

The thing is, there are probably a great many people who are not clinically depressed, but have had a rough time, get on a dose of pills to get through it, and never think to stop. There are probably many people who would benefit from therapy to deal with traumas and triggers in their life that still effect them today. There are even people who are depressed, but choose to face it without medication because they feel they know what they're doing and they know the risks.

The problem isn't if people are taking too much medication, or if it's the wrong medication. The problem is that we don't bother to learn what depression is, how to help, and what to do to support those who have it. Instead we assume the media is to blame, that people are taking pills they don't need, and no one has a legitimate illness.

Doing that just takes us backward, and leaves us marginalizing mental illness, reducing it to 'an illusion' and stranding the legitimately sick people without aid, and without the understanding they desperately need. Depression is a captor, it takes your mind, it tears down your confidence, it divides you from your ability to judge rationally who you are, and if what you’re feeling is normal. If everyone who isn't depressed learns to think it's all a lie… then who will be there to help the person who can't help herself?

Every article that boosts the stigma that mental illness isn't 'really a disease' does damage to the way people perceive mental illness, and each other. My biggest fear is that too many people will believe that lie, and those of us who need help will be left to die by inches, imprisoned in our own minds.

The Myth of the "Alternative Lifestyle"

 
As a writer, I've come to know that words are very powerful things. The right words will resonate with people, bringing people to empathize with a character or to sympathize with a viewpoint. The right words make people stop, they make people listen, and they make them think.
Similarly, the wrong words at the very least will cease to make sense or resonate with readers, at their very worst they wind up angering people, exposing flaws in the speaker, and bringing people to the opposite opinion of what the speaker wanted them to see.

Which brings me to focus on the word "alternative". The dictionary posits that an alternative is a secondary choice, an additional option. The word by itself doesn't have a negative connotation, yet when we tie in the word "lifestyle" it suddenly takes on the nature of a label. A code people use, when for whatever reason they are afraid to say "gay".

The obvious fallacy in this term should be clear. Basically it furthers the "us vs them" in the debate of what relationships are real and valid. We call homosexuality an "alternative" to heterosexuality as though it was a choice these poor souls made just to make their conservative neighbors uncomfortable.

Avoiding the potential bear trap of making this about politics, I'll stick to the wording here. The other flaw in this reasoning, is it implies by its very nature that there are in fact only two ways to live, two ways to parent, a normal way, and an alternative. This is absurd.

The "nuclear" two parent model is as alternative these days as a homosexual household. We have homes with step parents, half siblings, and split custody, we have single parent households, we have family's where multiple generations live together, or children share a home with aunts, uncles, and cousins. We have families of blended race and multiple languages, families of devout religion, and families who don't express their faith.
There is no one way to build a family, and as such, there is no inverse alternative. Instead there's a plethora of options for how families live and come together, and trying to label one, just one, choice in a sea of options as "alternative" is what really shines a focus of hypocrisy on this phrasing.

Ultimately, I hate labels. They seem to be a way of oversimplifying issues and people into mere terms that can be cataloged and set aside. When I look at a family, my ideal isn't based around one man one woman, it isn't even based around the number of parents a child has. In my ideal, a family is a group of people who live together, love each other, and work hard to provide the very best they can for each other. If people are happy together, if they care for each other and provide for each other, I don't see how that is an "alternative" to family.

Writing Character: The Lies that You Believe

I've spent a lot of time reading in the past few months. I've gotten back into the Game of Thrones Series, and I re-read Agatha Christie's "And Then There Were None". Between them and watching Downton Abbey, I wound up thinking a lot about character in writing.

Building believable characters means they have to be more than just props to fuel a plot, even side characters have to be more than a two dimensional trope filling space around the hero. I'm not saying they have to be perfect, but quite the opposite, they have to be imperfect in a way that sets them apart from a casually contrived paper doll. They have to have motivations that fuel their actions, and believable reactions to their situations.

One thought that I've been focused on a lot in the past few weeks as I look at the characters I want to write, and characters others have written, is that deep down, almost everyone lies to themselves. It's a perfectly human coping mechanism.

Some lies are altruistic, "I know I can save the princess!" He cannot possibly KNOW that, and if your reading something like Game of Thrones he'll more likely die, horribly, than succeed. He's lying to himself to build confidence and faith in himself and his mission.

Other lies are more destructive, "I had to kill him! There was no other way! I'm not a cold blooded murderer!" This clearly paints a character desperate to reconcile their actions with their own guilt, or the judgment they know they'll face from another. Even the character himself doesn't really believe his words, and that insecurity and desperation can easily creep into their actions causing them to be reckless or unnecessarily judgmental.

As a reader, we have the unique perspective to look at a characters entire path, from beginning to end. Even as the character chooses not to believe a gristly truth, or they convince themselves of a more optimistic future, we as the reader can see. Sometimes the imminent danger is so obvious to us, from our view, that we can't help be shout, "Can't you see he's lying to you!" or "Don't! It's a trap!". Yet within the narrative, the character instead embraces those comfortable lies and falls headlong into peril.

A truly good book keeps you reading even if you've become furious at the character for what they've chosen. Even if you hate the character for becoming the opposite of what you hoped or expected, you may still find yourself reading, turning the page, and going even further. Ultimately we find it hard to walk away from characters that are real, characters who believe in certain truths, and believe in certain lies because we want to know how they evolve from what they are.

The worst thing you can do is create a character that is flat, boring and without depth. That character might not anger anyone with their choices, but they won't win any devotion either. Two dimensional characters are not real, so we don't care if they get thrown away. If you want anyone to care about your characters plight, they need to have a depth that is relatable. They have to think, they have to feel, they have to lie.

So what lies does your favorite character believe?