World Suicide Prevention Day 2015: Stop Saying, “I Don’t Understand.”

September 10th is World Suicide Prevention Day.

Whenever someone commits suicide, whenever the news gets wind of it or it goes viral on Facebook, the first thing people say is,

“I can’t understand why someone would want to do that.”

“I can’t understand why someone would do that to their family.”

“I can’t understand.”

“I don’t understand.”

On behalf of mental illness sufferers everywhere, I’d like to say:

Stop.

Enough.

Don’t.

It doesn’t help.

We get it.  You don’t understand.  It’s unfathomable to you that someone would take their own life.  But when your response to illness is simply “I don’t understand,” you stigmatize us all.

People with mental illness have a condition.  When someone dies of cancer, it’s obvious what killed them.  No one says that they don’t understand why someone would let their cancer cells grow like that.  It would be like saying, “I can’t understand why your blood sugar is so low,” or “I don’t understand why anyone would want to have a ruptured appendix.”

Mental illness is not a choice.

When you say, “He should have fought harder for his family,” you’re showing that you don’t understand the fight against mental illness.  It’s not the final knockout match between Rocky and Apollo Creed, where everyone’s itching for a fight.  It’s not a boss battle, when you’ve practiced and leveled-up until your guns shoot atomic sparkles and you fart fire.  It’s not even the Death Star run, although the odds are definitely not stacked in your favor.

No, mental illness is not a battle we walk into because we want to, sixshooters blazing.  Mental illness isn’t even a battle, per se, because battles have beginnings and endings and monuments in city parks.  It’s a creeping war of attrition against the demon riding shotgun.  You’re not entirely sure when he jumped on, until you look in your rearview mirror and there he is, smiling like rot in your backseat, and before you know it, he’s next to you, messing with the stereo with his cold hand on the nape of your neck.  You don’t ever toss him all the way off – not really.  The most you can do is to keep him – it – at bay, nipping at your heels instead of looped around your throat.

That’s what kind of a fight mental illness is.  

I’ve been fighting to shake that demon off my entire life.  That’s 27 years of war.  That’s basically Vietnam.  You give up some territory because you just can’t keep it, win it back later when you’re feeling stronger and you want to go to that party or get that drivers’ license. Some days you get out of bed, and some days you don’t.  It’s a back-and-forth struggle with no demilitarized zone and no United Nations intervention.  Sometimes you survive that war with your body and soul intact.

And sometimes you don’t. 

I have never felt the need to harm myself.  It’s one of the few blessings of my condition – I’ve always been too terrified of death to even think about it in the abstract, let alone the specific. I turn off documentaries about cancer and avoid clickbaity titles about terminal illness and tragedy because the feeling of my own mortality is just too much most days.  But I have been afraid of wanting to hurt myself.   I have woken up in the middle of the night, terrified that one day I might just step off the curb and wouldn’t that be terrible? 

You might be thinking, “That sounds insane.  How can you be afraid of thinking something?”  

That’s what mental illness is, kids.  That’s what it does.  Diabetes robs your body of the ability to regulate its blood sugar. Cancer robs your body of the ability to regulate cell growth.  Mental illness robs your mind of the ability to regulate its thoughts – to push them aside in order to go about living.  When I first told my therapist that I had thoughts – powerful, frightening and compelling thoughts, thoughts so intense that they made me physically ill – she called them “intrusive thoughts.”  Everyone gets signals from their brain. They tell us not to touch a hot stove or that puppies make us feel happy.  They can keep us safe and healthy…when they’re working right.  When you have mental illness, your brain is wired in a way that it sends you mixed-up signals. Can you imagine trying to fight your perceptions, your emotions, your sensations for years on end?  Decades?

When I don’t take my medication, it takes me all the energy I have to filter through the sensory information coming in to my brain.  Every single touch, taste, smell and sight spikes another anxiety flare.  That’s what mental illness is.  Mental illness is not just “sadness” or “stress,” any more than diabetes is just “indigestion.”  I can eat a cake and feel a little sick in the morning.  My diabetic friends can’t shake that off.

So don’t say, “I don’t understand.”  Suicide happens because of mental illness.  When someone commits suicide, they have died because mental illness took their life.  And if you want to help, if you really want to help, then you need to acknowledge that suicide is not “a coward’s way out.”  You need to acknowledge that mental illness is a disease.  You need to stop saying, “I don’t understand,” and start saying, “What can I do?”  You need to vote for candidates who will expand, not cut, mental health resources in the United States. You need to talk to your kids about mental illness – take the stigma away so that they can talk to you if they feel their mind is out of control.  You need to support teachers and counselors because they are the front line of defense for our kids’ mental health.  You need to support men, and tear down the outdated notion that men who struggle with their emotional health are weak.  You need to support women, whose bodies and minds are under legislation. You need to support your LGBTQA* brothers and sisters, who are at a higher risk for mental illness and who often lack the resources they need.

You need to be aware.

You need to understand.

Forgiving Ourselves, Snarls and All

I’m backsliding this weekend.

Backstepping, falling off, backsliding, riding the Struggle Bus – however you’d like to put it, I am sitting a few steps back on my journey this weekend.  I can see the footprints in front of me, marking how far I was a few weeks ago, when I decided to pursue my passions and leave a steady job because I could.  Last week, I submitted a piece of fiction to an online publication – my first attempt at publication, I’ll have you know.  That’s probably a few steps ahead of where I’m sitting, plopped down on the road and rocking back and forth.  It’s a comfort thing.  Don’t worry.  I’ve had three panic attacks in two days, and right now there feels like there’s a river of clamor running just under my skin.  Everything feels noisy. I’ve changed my shirt three times today because everything itches.  I’ve been letting the noise leech out of my skin slowly: yoga and classical music helps tremendously.  I’m beginning to feel a little bit more like myself as I write this, exhausted and finally sedate.

My wonderful boyfriend picked up on it before I did, and it took him suggesting a walk for me to realize that I’d been grinding my teeth for the last half-hour while trying to read.  I’ve always found physical activity the most effective treatment for my episodes, and if I’m lucky, they happen on a Sunday, so I can dedicate two hours of yoga to resetting my brain.

I’m not always sure why these episodes happen.  Sometimes, I can pinpoint an obvious trigger – hunger, impending sickness, poor sleep, or stress.  It’s easier to forgive myself when I can detect the cause of the panic.   Isn’t that the case for all of us, though?  Isn’t it easier to forgive behavior when there are mitigating circumstances?

I’m beginning to realize, though, that looking for an excuse – a mitigating circumstance, a trigger – to explain and justify my panic just encourages me to keep blaming myself.  Yes, it’s important to understand our triggers, so that we can understand our reactions to them, but we don’t need to understand our triggers to forgive ourselves. When we make reasonable cause a prerequisite for forgiveness, we punish ourselves more harshly when we feel ways we don’t understand. That way of thinking makes a panic attack more acceptable in certain circumstances than in others. It validates people who ask us, “What have you got to be depressed about?”

The unfair truth is sometimes we don’t have anything to be depressed about, or afraid of, or anxious about.  We just are.

It’s that knowledge – that my brain is often setting off smokebombs and flares in response to no threat – that makes me feel prickly.  It makes me feel tired.  More than anything, though, it makes me feel guilty.  I feel guilty because I worry obsessively about showing that side of me to the outside world – letting the snarls and thorns grow on the outside and prick the people I love.  I can’t count the number of times I’ve apologized to my sweet, understanding boyfriend for the way I am this weekend.  Of course, it was always unnecessary and he always made sure I knew that, but I wasn’t really apologizing for his sake.  I was apologizing for me, to soothe myself, to reassure myself that I was controlling whatever damage my snarls were wreaking on the world around me.  I wasn’t sure what justified my episode this weekend – I’m still not entirely sure – and so it seemed to me that I didn’t deserve to be afraid. I was mad at myself for messing up the progress I thought I’d made. I couldn’t forgive myself for feeling this way and let myself ride it out.

But here’s the thing: it’s never about whether you deserve to feel sad or anxious or mad or terrified.  The feelings exist because they exist.  You didn’t cause them, and it’s not your fault.  

I’m slowly learning to trust the people I love to tell me if I hurt them, instead of assuming that my anxiety will seep out of my skin and infect them.  They are strong, and they are capable of taking care of themselves.  They love me, and they realize that my mind sometimes goes too fast, like a broken carnival ride.  Sometimes I have to write those things down, so that when my mind’s a maelstrom of white noise and I feel like if I open my mouth I’ll just scream, I can look and remember that I’m loved.   People with mental illness aren’t stupid, but sometimes when our minds short-circuit, we need reminding.

I’m also learning that recovery isn’t a road.  I’ve always liked checklists and recipes, because if you follow the directions exactly, nothing bad can happen to you.  People with anxiety try to make their lives into checklists, and in true fashion, I’m guilty of doing that to the recovery process.  I find myself assuming that if I do everything I’m supposed to do (medication, exercise, diet, meditation) that I’ll just keep getting better and better and someday I won’t have any problems anymore.

The truth – as always – is more complicated than that.  Living with anxiety means living with it.  There’s no cure for mental illness, only treatments.  I’m never going to not be prone to anxiety, and some days I’ll have episodes.  Some days, I’ll have episodes for no reason other than the way my brain is wired.  The measure of my recovery won’t be the total absence of symptoms, but the fullness of life I’m able to achieve given the brain I have.  In that respect, I’m doing fabulously.  I’ve done brave things not without fear, but in spite of it. I have built relationships, full knowing that they will cause me emotional stress.  I’m slowly learning to let go.

And I’m slowly – oh so slowly – learning how to forgive myself, regardless of the reason for my fear.  It’s a difficult process, but a necessary one, if I’m ever going to love myself the way I need to – snarls and all.

Snarls and all.

Why I Love My Pills

I love my pills, yes I do…I love my pills, so why can’t youuuuu?

Anyway. Serious writing time.  Let me put on my Serious Writing Hat.

Upon occasion, I’ll share bits of my journey with people I know. I’ll tell them that I live with anxiety, and they’ll get stars in their eyes and tell me how incredible I am, and how they couldn’t possibly do what I’ve done, and how strong I must be to manage this…without medicating myself into a stupor.

Huh.

I suppose I should start leading with, “So, I take fantastic pills every day that keep me from getting too crazy all up in here.  How about you?”

Apparently the fact that I’m not a drooling, spaced-out wreck popping pills every five minutes means that I can’t possibly be one of those people.  You know, those people who take dangerous chemicals that mess with their brains until they stop being people and start craving human flesh.

First of all, that’s offensive to Undead Americans everywhere.  Also, that’s not how antidepressants work.  We have a dangerously inaccurate popular understanding of this kind of medication and of the people who take them, and it has grown tiresome.  I’ve got enough in life that causes me anxiety; I don’t feel like dealing with people who think I’m taking “the easy way out.”

According to this article in the Scientific American, more Americans are taking prescription antidepressants than ever before. The estimate is somewhere in the realm of 8-10% of adults.  This rise was characterized by an editorial in the New York Times as – wait for it – “a glut of antidepressants.”

If you’re like me, you’re now imagining Jabba the Hutt sitting on his throne on Tattooine, surrounded by piles of pills.  “Eee choota, Solo!  Conda Wookiee chibiti ootaskoota Proooozac!  HO HO HO HOOO!”

If one were to believe the opinions expressed by the popular media, antidepressants are dangerous, mind-numbing chemicals handed out like Halloween candy to criminals and psychopaths by shady, uncaring doctors in Big Pharma’s pocket.  It’s the last line before the first-quarter commercial break in an episode of Law and Order: Special Victims Unit.  The hardworking but oh-so-broken detectives find an unlikely suspect for a rash of human dismemberments, only to discover, to their horror, that the all-star college valedictorian has an open prescription for Prozac!  He must have a lair filled with human toes.

That doesn’t even touch on the world of internet comment boards and opinion pieces.  You shouldn’t touch on it, either.  It’s a dangerous place, and you’ll need to take a shower and cuddle a puppy right afterwards.  Because I care for each and every one of you, my lovely readers, I’ve already taken a long, sewage-y swim in its waters, and collected some of the choicest bits of poo just for you!

“Anti-depressants are pushed as a ‘magic pill’ by Big Pharma to make money off of you.”

“The side-effects are enough to make anyone depressed!”

“Doctors and Big Pharma are over-medicating the population. It’s a conspiracy to keep us in their pockets!”

“It’s just a placebo effect.”

“The real danger is in the side effects – it’s dangerous to just put chemicals in your brain!  A natural life is the only way to live!”

According to the internet, antidepressants are either the biggest joke being played on us by Big Pharma, or they’re going to give you radioactive super-powers and sparkly farts.

Where does that leave us?  It leaves us squarely in the middle of a culture in which one out of ten people take medicine meant to make them feel better, all the while being vilified for deciding to feel better.

If you’ll allow me to roll up my sleeves, I’m going to lay down some Truth.

Ready?

1. Psychiatrists don’t just “hand out” drugs as a whole.  Yes, there are bad apples in every profession, but most psychiatrists – and doctors – want their patients to feel better.  Dr. Evil is the exception, as is Dr. Strangelove. Just use your judgment! If your doctor doesn’t seem to listen to you, find one who does.  Feeling better is good, and trained psychiatrists will not simply stuff pills down your throat like you’re a reverse Pez-dispenser.  When I first started seeing a psychiatrist for my anxiety at age 24, she required that I make lifestyle changes to alleviate my anxiety and continue seeing the counselor at the Student Center who had referred me to her in the first place.  She also prescribed me medication.  I needed every aspect of my treatment.  I made huge dietary changes and began working out every single day.  I haven’t kept up the every-day exercise to the rigor that I initially did, but I remain active.  I continued talk therapy.  But you know what?  The medication made it possible for me to do all of those things.

Let me explain.  As soon as I began taking Zoloft, I saw results.  Not in my anxiety and intrusive thoughts – those took weeks of retraining to reduce – but in other, purely physical symptoms of anxiety.  My insomnia lessened, so I could get sleep and have the energy to leave the apartment in the morning, to go to the gym, to walk across campus to go to counseling.  My constant nausea – what I’d always thought of as my ‘fussy tummy’ was gone. I was hungry, for possibly the first time in my life.  I gained weight. This may not seem like a positive – we live in a world where thinner is better – but I’d spent years as a 115-pound, 5 ft. 10 beanpole. I used to get sick constantly.  I was frail, y’all.

The best part of getting the right medication was that it got rid of symptoms that I didn’t realize weren’t normal.  People with anxiety often suffer from something called depersonalization: the feeling that your body doesn’t belong to you. You feel like your face is made out of rubber, and when you do move, it feels like you’re starting out of a dream.  It’s irritating.  And I thought everyone had to deal with it.

Yes, therapy is vital.  Yes, reworking the mental pathways that allow anxious thoughts to spiral is important.  Exercise and diet and forming positive relationships are all integral parts of living with mental illness.  Medication can be life-changing as a part of that process.

2. Big Pharma is real, but it’s not a reason to deny yourself or anyone else the care they need. Yeah, the pharmaceutical industry is full of all kinds of nastiness.  And yeah, its goal is to make money.  These are reasons for reform, not rejection of all medications.  The oil industry is one of the dirtiest in the world (in more ways than one).  Are we rejecting automobiles?  No.  No we are not.  Automobiles make our lives easier and better.  What we are doing is breaking the monopoly through alternate-fuel and electric cars.  We have to reform the pharmaceutical industry, but that’s not the point here.  They may be the Evil Empire, but you’ve got to occasionally admit that they make really quality stuff.

Most doctors, as a matter of fact, will do whatever they can to keep their patients from being under the thumb of insurance companies and the pharmaceutical industry. This includes using samples to try different kinds of medications and making the referral process as easy as possible.

3. Side effects are nothing to sneeze at. They’re real, and they can be scary.  However, every drug is different, and it takes time to find the right one for your brain.

When I first started taking SSRIs, my psychiatrist prescribed Prozac.  It was the most commonly-prescribed SSRI, and it had shown success in helping some people with anxiety.  She told me that I was to keep in contact with the Health Center and to call the 24-hour emergency line if I had any side effects that alarmed me.

I did end up calling the emergency line, at 2:00 in the morning, when it felt like bugs were crawling all over my skin.  I couldn’t sleep.  My panic had gone through the roof.  If my brain had been the Oval Office, the inside would have looked very much like that scene in Independence Day after Jeff Goldblum showed President Bill Pullman that the aliens were using our satellites against us.  My sense of self-preservation was on the first Air Force One ride out of that mother. Somewhere in the midst of DEFCON 3, I was able to dial the emergency line. After the on-call psychiatrist calmed me down, I made an appointment online for the very next morning.  I told the psychiatrist about the side effects and said, “I know that there are adjustment periods for medicines – I get that.  I just don’t think I can make it through this one.”

She listened to me.

She listened to me and prescribed me a different drug.  Prozac just wasn’t a good fit for me, she explained.  Everyone’s brain works differently, but the goal is to make me feel like I can function.  Zoloft might be a better choice for me, and just to be on the safe side, she put me on Valium temporarily.  SSRIs change one’s brain chemistry, so sometimes you have to grease the wheels with a mild sedative.  She also gave me the choice: I could try another SSRI, or we could keep working without medication.

I’ll admit it: the side effects of Prozac had been so horrific that I was hesitant to try something else. It was like I’d taken an acid trip with Lord Sauron.  I wanted to get better so badly, though, that I went for it.  It was the best decision I have ever made.

4. Yes, drugs are chemicals that you’re putting in your bodies.  You know what else is a chemical? Absolutely everything.

I hate to break it to you, but you’re made of chemicals.  So am I.  So is the Pope.  So is Beyonce.  We are all made of chemicals. Even Moby is made of chemicals, because we are all made of stars…which are all made of chemicals.

Every single thing you put in your body, from water to potato chips to plutonium to the fresh blood of your enemies, is a chemical.  Some chemicals are good – like water.  Some chemicals are bad – like heroin.  The “naturallness” of a substance is no measure of its goodness, by the way.  I’m all in favor of making natural food, like vegetables and fruits, available as a healthy alternative to chips for people who are not me.  However, let’s not pretend that Nature hasn’t been doing her damndest to kill us over the last few million years.   Hemlock is totally organic and it will totally kill you. Yes, I choose to put a chemical in my brain because that chemical makes my life better.

I know that there are people who manage their mood disorders without medication. They use exercise, diet, neurotherapy, and essential oils.  For them, I have nothing but love.  Respect.  But what I don’t have is admiration because I don’t consider them to be any stronger than someone like me, who uses medication as a part of my treatment.  If you’re healthy, then that’s fantastic, and it doesn’t matter to me how you got there.  What I do object to, however, is the “helpful” advice on how to “kick” my “chemical habit.”  These well-meaning people only contribute to the stigma surrounding antidepressants that causes people to quit their regimens without consulting their doctors.

The fact remains that many people who take prescription medication to help them with depression, anxiety, schizophrenia, or any other mental illness feel like they have to hide that fact from others – even the people they love the most.  How many people feel like they have to lie about their Lipitor?  How many people feel that they have to hide their Prednisone in their sock drawer? Would you ever tell someone that they didn’t “need” their chemo?

I remember having to take a deep breath before telling my boyfriend about my nervous breakdown two years ago and the resulting regimen of diet, exercise, and, yes, Zoloft that keeps me healthy in mind and body.  I trusted him – of course I did – but I’ve spent a quarter of a century in this culture.  He didn’t bat an eye, of course, because he’s sensible and compassionate, but my own internalization of our cultural norms did surprise me.

So here I am.  I take pills.  They keep me sane.

It’s awesome.

The Riotous Courage of Being: Bravery and Mental Illness

I have never understood people who sleep easy. For as long as I can remember, I have struggled with falling asleep. Don’t get me wrong: I adore dreamland, once I’m there. The passage over, however, tends to be rough. I have the most difficult time turning off my mind. As an example: I’m writing my first draft of this piece at approximately 12:34 AM on my iPhone, after several solid attempts at slumber. Insomnia hasn’t been as bad of an issue lately, but my old friend visits from time to time. When I was a child, though, it was unbearable. I spent the first 45 minutes to two hours every night trying to stop the day from wheeling about in my head.  It was in those moments that my constant companion, Fear, would crawl into bed next to me like the worst housecat ever.  Every shadow was a monster, and even the air was suffocating and foreign, as if my lungs belonged to someone else.

When I got older, those first few hours would play like a blooper reel of my most embarrassing moments from the day, paired with contingency plans for every horrible event that could possibly happen.  What would happen if my parents suddenly vanished?  Who would take care of us? These questions were punctuated by mental calculations: if it was 1:03 right now, and I have to wake up at 5:15 to catch the bus at 6:00, how much sleep can I get tonight? And what if I don’t get enough sleep and something terrible happens?

My mind is a busy place.

And so I developed a method for helping myself to sleep, which worked about half of the time.  I would make up stories.  If I didn’t think about my own life, I could usually lull myself to sleep.  I usually made up stories about my favorite cartoon characters and put myself into them.  That’s right: I was writing fanfiction before I could actually write. If I’m being honest, I made some vast improvements to the canon of The Cowboys of Moo Mesa.

I still put that technique to work when I can’t sleep.  Some of my best stories have come from those pre-slumber moments. When I was trying my hardest to fall asleep, I used to tell myself stories about bravery.  When I was a child, I knew what bravery looked like. Bravery meant women warriors in fantasy lands, starship captains, queens and princesses and sacrifice. I knew that I wanted very much to be brave. I used to imagine what would happen if an adventure were to appear at my window. I used to dream that I would be brave enough to take it, but as I couldn’t recall reading about any heroes who had to sleep in their own bed with exactly three pillows and a stuffed animal on each side for symmetry, I felt that I would be ill suited for bravery. I didn’t think that brave people spent most of their time being wary of the toaster or checking the under-the-bed every half-hour or telling themselves stories so they could get to sleep every night. Brave people, I reasoned, could do things I couldn’t.

Later in my life, bravery came to mean different things. Bravery meant going on dates with boys, driving on the highway, and studying abroad in France.  Bravery meant throwing parties, going to parties, and deciding to road-trip at the last minute.

I did none of those things.

Because I had such conscripted ideas of what courage was, I felt as if I were a coward. A coward with an advanced degree and a stellar work history, but a coward nonetheless.  I felt that I spent so much time managing my anxiety that it took me twice the effort to maintain what other people thought was a “normal” life.  Constant policing of my mind left no chance for valor. I was afraid of spontaneity because I thought it would break the brittle ice standing between my outside composure and the maelstrom of tics, compulsions and noise that threatened to spill out of my mind. I saw other people my age dropping everything to travel abroad, to pursue a calling in New York or Los Angeles, to fall topsy-turvy in love and embark on a romance for the ages.  I didn’t understand how I was supposed to go out and chase my dreams when it took all I had to hold myself together, and I was ashamed of my fear.

I’ve learned, however, to both forgive myself for my perceived shortcomings and to redefine courage in the face of all I have undergone.  I’ve learned to weather life in a world that I find often overwhelming and frightening.  I’ve overcome the clamor in my head and the roaring in my ears enough to engage with the life all around me.  I’ve moved through the panic to form attachments – which, if we are honest, are messy, entropic things by their very nature.  Love is complex, intuitive, and absolutely terrifying. People are unpredictable. If courage is defined as moving outside of one’s comfort zone, then I may be the bravest of people.  Do I take medicine to help me do this?  Yes. Yes, I do.  But the fact that I take medicine to keep myself healthy in mind doesn’t undermine the strength I have at my very core.  The courage.

Mental illness has a pronounced, devastating effect on one’s sense of self.  I don’t mean “self-esteem” in the fabricated, superficial way we so often encounter.  I mean, rather, the connection between our minds and our inner selves – our personality, if you will. As a person of faith, I think of that transcendent part of myself as my soul. Mental illness kills your ability to recognize the value of your own soul, because your perception of reality is skewed and sick.  I know that from first-hand experience, and having people pat you on the back and tell you “You’re all right,” does very little good.  It feels like charity.  And you know for a fact that it’s a lie. You’re not “all right.”  I certainly wasn’t.

Instead, let me reassure everyone who suffers from mental illness that you may not be “all right,” but you are brave.  When you feel as if every breath will collapse your lungs, breathing is brave. When you are frightened of the Outside World, going to work is brave. Holding conversations is brave when you feel yourself drifting away inside yourself whenever you start to speak. You may never travel abroad. You may never “find your calling.” For some of us, life itself will be the greatest battle.

Simply being is act of riotous courage.

Yes, mental illness is “all in your head.” By it’s very definition, it is in your mind.  But that doesn’t make it any less real.  This is something that is happening to you, and it is real, and you are brave – however you choose to weather this storm.  And once I realized that – once I realized that forgiving yourself is wonderful, but not as wonderful as not punishing yourself to begin with – I started living my life, not in spite of my anxiety, but with it.

I decided what I wanted and threw out the list of “Things You Have to Do Before You Die,” because life cannot be a checklist governed by the fear of Death. I accepted that my fear will always be with me, but that I am powerful because I stand in the face of Fear and know it by its name.

I did drive on the highway – at age 24, on my own terms.  I never lived abroad – but I learned to treasure the close relationship I gained with my parents in its place.  I did quit a job to pursue my passions – though I still have to manage the panic caused by jumping out without a safety net.

I’ve even fallen in love.

All of that seems pretty courageous to me.

We Didn’t Start the Fire: “Just Get Over It” Has Never Been Sufficient

“Everyone ‘these days’ has got depression.”

“We used to just call it being sad – I didn’t need to pop pills after [insert traumatic event].”

“People in America only think they’re depressed. Try being in a third-world country. I went to Africa on a mission trip and everyone was so much happier. Maybe it’s because everything is simpler there, or people are more grateful.”

“Americans eat too much fast-food and spend all their time on their phones. Want to be happy? Go outside and get some exercise!”

“People would rather take medicine than deal with their problems, and that’s really sad.”

Have you ever heard any of these lines?

Have you ever said any of these lines?

The number of people being treated for mental illness is on the rise.  Now, science tells us that we can’t confuse incidence with diagnosis: just because a disease is being diagnosed more, it doesn’t mean it is actually happening more.  We might just be more aware of it than we were.  Our standard of living is better than it has been, and maybe we’re just less willing to put up with debilitating fear and depression than our forefathers were.

But if you read the comments on any article about anxiety, depression, or any other mental disorder, you get the sense that there’s a large group of people who just want you to get over it.  They think that depression and anxiety and schizophrenia are modern conditions, caused by a society of smart-phones and easy answers and divorced parents and gay marriages. They think that doctors give out drugs like candy and that there is a cabal of psychiatrists and psychologists who profit from this new “American hypochondria.”  They will tell you that people weren’t depressed during the Great Depression, that no one had anxiety during Vietnam, and that the cure for all ills is taking walks in the sunshine, turning your phone off, and being grateful for what you have. People who are not doctors will tell you that you don’t need medication.  People who are not psychiatrists or psychologists will tell you that you don’t need therapy.  In short, if you can’t manage your life, then it is your fault, and America is riddled by people who can’t manage their lives.

Let’s get one thing straight: mental illness is not new.

The Ancient Greek physician Hippocrates hypothesized that mental illness was a biological, not spiritual, condition in 400 BC.  If the name Hippocrates sounds familiar to you, it’s because doctors to this day take the Hippocratic Oath.  Hippocrates is possibly the most influential figure in Western medicine.

Anyone versed in medieval literature is familiar with the humors.  I don’t mean Eddie Izzard. For those of you who aren’t gigantic nerds, the humors are bodily fluids that ancient and medieval doctors and scientists theorized were responsible for various aspects of personality.  The big four are black bile, yellow bile, phlegm, and blood – they represent the four major temperaments, or moods.  If a person is healthy, then Hippocrates theorized that all four humors are balanced. An imbalance in the humors caused any number of personality issues – what we now think of as mental disorders.

Melancholy or melancholia was one such condition.  A person suffering from melancholia (comparable, though not completely, with modern-day depression) was thought to have an excess of black bile. They were often despondent and prone to uncontrollable mood swings.  Now, modern medicine has punctured the theory that the body is made up of four fluids.  We also no longer believe that blood causes anger or phlegm causes apathy. I think the hypothesized cause of mental illness is a lot less important than the fact that doctors were asking questions in the first place.

What does this mean? It means that even though ancient and medieval doctors weren’t able to see inside the body and the brain – like we can now – they accepted that there is a distinct link between our mental health and our physical one.  The ancient Greeks also tried to treat mental illness using herbs and therapeutic activities.

The smartest people in the world have been treating mental illness as a biological condition for thousands of years.

Let that sink in.

Not only did ancient and medieval doctors try to treat mental illness, but authors also featured people with mental illness in some of the most famous works in the Western canon.  You can’t read Hamlet without thinking the Prince of Denmark’s life would be better if Elsinore had a grief counselor on hand. Poets like Goethe explored the “melancholic” temperament that led young men to commit suicide for love or grief.  People with mental illness are everywhere in literature and history.  Abraham Lincoln wrote often of his depression and suicidal thoughts.  Winston Churchill called his recurring depression his “Black Dog.” Leo Tolstoy suffered from “hypochondriasis,” a constant fear of illness.  And there are more.

We live in a linked-up society, in which we know far more people than ever before. Our social networks are a web that stretches wider than the village or city block of our grandparent’s day. Of course we’re going to know more people who suffer from mental illness.  Not only that, but we are privy to a host of information – constantly streaming – that makes it seem like we’re in the endtimes when it comes to mental health.  But it’s simply not so.  Go through any Southern family album with a grandparent. Do it. I dare you.  You’ll hear all about Cousin Louis, the recluse (agoraphobia or social anxiety); Grandpappy Turner, who burned hot and cold all his life (bipolar disorder); Aunt Millie, the hypochondriac (acute anxiety). We have always been here.

And there have always been names for our diseases.  In the 19th century, a person suffering from what we now call clinical anxiety would be called a “neurotic.”  A person suffering from depression might be called “melancholic” or “depressive.” “Nervous illnesses” were considered to be a phenomenon of wealthy women, but now we know that biological factors – particularly childbirth – wreaked havoc on the physical and psychological wellbeing of women, particularly those without proper support.  “Rest cures” were prescribed for the wealthy, but if you were of the working class, you were out of luck.  We don’t know how many people in the pre-NIH era suffered from these ailments because people didn’t talk about them.

Well, now we do.

We talk about our breakthroughs and our breakdowns, but we didn’t invent them.

We’re just unwilling to simply live with them.

Why “24 Steps?”

You may have noticed that my little corner of the internet has gone through a name-change recently.  “A View from the Geek Seats” is no more, but that doesn’t mean that I’m going to stop writing about geek culture.  Of course not – I’ve been steeped in science fiction, fantasy, and comic books too long to give that up entirely.  However, I’ve realized that I want – I need – to tell another story: my story.

I have clinical anxiety.

There’s something vaguely liberating about seeing those words in black and white, a phantom notion given concrete substance as I write.  At the same time, it seems so much smaller than it really is.  A four-word sentence seems hardly adequate to describe an emotion that has been at the core of my being for as long as I can remember.

Some of you may not understand or know what clinical anxiety is or how it works. When I say “I have anxiety,” I don’t mean that I get nervous giving speeches, or panic when the nurse gives me a tetanus booster.  I don’t mean that I get scared watching scary movies or stressed when my workload is high. All of these situations are normal incidences in which human beings may feel anxiety.  I have these reactions, and I bet you have at least some of them.  Who wouldn’t feel nervous when a cop pulls them over for speeding?  Who wouldn’t feel fear waiting for the results of recent medical tests?  Fear and stress are normal human reactions – and they serve a purpose.  Fear keeps us from engaging in risky behavior that might endanger themselves. Stress motivates us to accomplish our goals.

No, friends.  When I say “I have anxiety,” what I mean is that I lived in the house of fear, with few windows into the outside world.  My earliest memories are of waking up and dreading the day ahead because even as a child, I knew – I just knew – that there was some great, unfathomable Bad Thing that could happen to me that day.  Have you ever met a fearful child? They go through life knowing in every fiber of their tiny beings that the world is a terrifying place and that they are very, very small.  When I say “I have anxiety,” what I mean is that there is a demon on my shoulder and that demon is fear. Imagine falling asleep after a long day.  As soon as you begin to drift off, you feel as if you aren’t breathing and you start awake.  That’s what it feels like to live with anxiety. All day, every day.

When I tell people that I struggle with anxiety, it usually surprises them.  I don’t “look like” someone who is mentally ill.  I don’t “talk like” someone who is mentally ill.  I was a straight-A student. I have an advanced degree. I have always been a stellar employee and an academic and social leader. I don’t seem like society’s picture of a “crazy person.”  But I was good at school. I was good at work.  These were controlled environments where if I put in effort, I would receive stability.  I got a remarkable amount of work done because I felt like if I stopped or slowed down, then everything would cave in and that omnipresent Bad Thing, the one I had been holding off since childhood, would happen.  Can you imagine being on guard your whole life? Feeling the fight-or-flight instinct from the moment you wake up until the moment you fall asleep?   It’s exhausting. And about 3/4th of the way through my graduate school career, it became too much.  I had what could only be described as a nervous breakdown.

So what did I do?  I got help.  I got counseling. I got medication.  I went home to stay with my parents and to start over.  This war can be fought, and it must be fought to live a full life – one not shaped by fear. I manage my life now, and I’m in the best mental health I have ever been in.  However, I can’t overstate the struggle it has been – and continues to be. I’m not “cured.”  I never will be.  My anxiety is a part of my life.  But it’s not the only part of my life.

I have not been eager to share this part of my life with the people around me.  I didn’t want to be judged. I didn’t want to be second-guessed in work situations by people who might tag me as “crazy” or “insecure.”  I have labored like Sisyphus to control my reactions to the world around me. My reticence hasn’t helped anyone, least of all me. People – good people, kind people, brave people – lose the battle against their demons every day.

They die, thinking they are alone.

It’s time to open up a conversation about mental health, one that doesn’t go away a few weeks after a publicized suicide fades from the media circus.

Why “24 Steps?” When I was at my worst – jumping at every car horn, compulsively checking the door locks – I would pace in my tiny apartment to calm myself. It took me 24 steps to make the circuit through my kitchen.  I will never forget that circuit, pacing like it was the only thing keeping me alive.  No one needs to feel as small as I did then.

Let’s change the story.