depression

October 10 is Mental Health Awareness Day. If you’re a regular reader, you probably already know I’ve been dealing with depression for a while now. Got the official diagnosis back in April of 2012. Started on antidepressants the next month. Began seeing a counselor shortly after that.

The depression had been there a lot longer. I remember feeling suicidal as a kid, and getting close enough to scare myself at least twice. Looking back, I can see stretches where the brain weasels got the best of me in college too, and they had a good old time messing with my head the year I spent living in Nevada.

The pills helped to stabilize my mood and get me back to a healthier baseline. The counselor helped me make some changes with my life. Neither of these things actually fixed or cured the depression. Like my diabetes, it’s still there — I’m just doing a better job of managing it.

Unlike the diabetes, I can’t take a drop of blood and measure how Depressed I am today. Wouldn’t that be nice? “My Depression Level is 193. Better watch a half hour of kitten videos.”

A big difference in my pre- and post-diagnosis life is that I now know the brain weasels are there. I’m better at recognizing when I’m just having a lousy day vs. when the Depression is getting the upper hand. Being able to identify the problem, knowing it’s real, helps a lot.

But it doesn’t make the problem go away. I know it’s there, and I know there are cracks in my mental health the brain weasels can sneak through. To choose a totally hypothetical example, say a book I’m working on is going a lot more slowly than I want…

One of the best things I’ve learned over the past six years is that I’m not alone. Since I started talking about the depression, I’ve spoken with a lot of people who are fighting the same disease. Others are battling different mental illnesses. And none of us are alone in that fight, even though the brain weasels will totally lie and try to make you think you are.

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Lesson One: Depression lies. It says you’re alone, you’re unworthy of love, your failures are deserved and your successes are flukes, your happiness is fleeting but sadness is eternal, your problems are inescapable, and things will never get better. It’s all lies.

Lesson Two: Mental illness is real. You know, I had zero problem going to the hospital for my diabetes back when I was diagnosed. My blood sugar was over 600 at one point. It didn’t matter how strong or determined or optimistic I was if my pancreas was taking early retirement.

Mental illness is just as real and valid as any other. Willpower won’t make my pancreas start working. Willpower also won’t rebalance the chemical makeup of my brain. There are things I can do to help — exercise can be a useful tool for both diseases — but it won’t cure the problems.

People get sick. That doesn’t make you a failure, and it’s not your fault.

Lesson Three: Getting help is … helpful. Going to the doctor and the counselor was hard. Really hard. But it made a huge difference. It may have saved my marriage. It helped my relationship with my kids, and with the other people in my life. It helped my writing.

It may take time to find a doctor and/or therapist who’s the right fit. If you go on medication, it may take time to find the right dosage and the right med or combination of meds. And some health insurance plans can be a nightmare.

But if you can, it’s worth reaching out for help.

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For those in the U.S., Mental Health America has what looks like a good set of tools for getting started, including screening tools and steps to find help. MentalHealth.gov has some resources as well.

Be kind to yourself. You deserve health and happiness.

I’ve talked before about dealing with depression. Last week’s trip to Buenos Aires, combined with next week’s trip to France, got me paying attention to the ways depression impacts and is impacted by travel, especially bigger trips like these.

It hit me the most on my first day in Buenos Aires, after I’d been dropped off at the hotel. I was exhausted from the flight. I’d missed my pills the night before during all of the travel chaos. I had nothing scheduled that first day, and I was alone in a new city where I didn’t know the language.

This blend of exhaustion and anxiety is just the type of situation my brain-weasels love, and as I settled into my room, I could feel them digging in. I knew intellectually that once I was out interacting with my publisher and doing the press interviews they’d lined up for me, my brain would snap into Performing Writer mode, and I’d be okay. But for now, all I really felt like doing was locking the door, turning out the lights, and waiting for tomorrow to arrive.

Intellectually, I had a pretty good idea what was going on in my brain. I knew I was tired and jet-lagged and overwhelmed, and I’ve gotten better at recognizing when depression is getting the upper hand. Unfortunately, recognizing the problem doesn’t make it go away. In at least one way, it made things worse, because it fed right into the self-recriminations.

• “Think about all the people who were so envious of you getting to come to Buenos Aires, and now that you’re here, you’re depressed? What’s wrong with you?”
• “Here you are in a brand new country, and all you want to do is hide in your hotel room? Sad.”
• “Maybe you should stop accepting these invitations. Let someone who’d appreciate them go instead of wasting these opportunities on you.”
• “Coward.”

Knowing it’s the depression talking doesn’t make it stop. Knowing the self-recriminations are a trap doesn’t stop them from pulling you down.

Eventually, I made myself leave the hotel and go for a walk. Just a few blocks to look around and get my bearings. (And yes, to catch a few Magikarp.)

It helped. The brain weasels didn’t vanish, but they quieted down significantly as we wandered and looked around, absorbing the new sights and sounds. I knew I needed food, so I wandered into a McDonald’s.

• “What kind of loser goes to another continent and eats at McDonald’s?”
• “Pathetic.”

I needed that dose of familiarity, and after staring at the menu for a few minutes, I went up and asked, “Habla Inglés?”

She had just enough English to tell me she didn’t speak English. Pretty much the equivalent of my Spanish. But I managed to order anyway. She asked a question. I had no clue. But after a few rounds and some hand gestures, I realized she was asking for a size. I pantomimed small, medium, and large, saying them in English without thinking, then asked for a medium.

She got a big grin on her face and repeated “Medium,” adding, “I spoke English!” She was so excited she forgot to charge me. (Yes, I reminded her.) The whole exchange left me smiling.

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This is such an odd post to try to write. I had a wonderful time in Buenos Aires. I’m so happy and honored that I got to go. I was also depressed about the trip, especially that first day or two. Both of these things are true.

I’m going to France next week for Les Imaginales. I’m feeling anxious. I suspect the depression will hit me in much the same way, especially that first day when I’m exhausted and have nothing scheduled. I’m mentally berating myself about feeling stressed instead of excited. I know, intellectually, that this will be another wonderful experience.

But brain weasels don’t give a shit.

• “Now you’re depressed about going to France? You are such a disappointment.”

It’s just over five years since I got my diagnosis. Since I started taking antidepressants and talking to a therapist. It’s frustrating to be reminded that, like the diabetes, this isn’t something we’ve been able to “cure.” Instead, it’s something I try to manage. Like the diabetes, some days I do better than others, and some situations make it harder to manage.

To everyone I met and talked to in Buenos Aires: It’s not you; it’s me. You were amazing, and I had a genuinely great time, despite this chemical imbalance in my brain.

And to the brain weasels, I’m sure I’ll see you again next week. Hopefully I’ve learned enough to get you back into your cages. But just in case, maybe I should Google the McDonald’s closest to my hotel in Paris…

I blogged a week ago about mental illness and antidepressants, prompted by an exchange I had with a troll on the #imnotashamed hashtag on Twitter.

I like and support the stated mission of Team Notashamed: “to spread the message that mental heath conditions are nothing to be ashamed of … [and] helping end the harmful stigma associated with mental heath conditions and advocating for better and more accessible healthcare.”

But good intentions don’t mean you never screw up. Rose Lemberg pointed out the following post on the I’m Not Ashamed Twitter feed.

And…no. Just, no.

I have no problem with some of the comments here. Mental illness is not a character flaw. It can be incredibly helpful to know you’re not alone. But some of the others are a mess, and problematic as hell.

I am creative and smart. I am, in all modesty, both creative and smart, yes. But this has nothing to do with my mental illness. Depression doesn’t make me creative or smart. My creativity, my work as a writer, these things happen in spite of my depression, not because of it. Depression is an obstacle I’ve had to overcome in order to be productive and creative. Please stop spreading the bullshit myth that creativity and intelligence are in some way enhanced by mental illness.

I’m so strong because of it. Maybe you are. Great! Maybe you’re not. That’s okay too. I do believe it takes strength to survive any sort of chronic illness, but does that mean the illness makes you strong? Because to be honest, there are times I wish I could put that strength toward other things instead of spending so much of it coping with depression. I don’t see my mental illness as some sort of gift, one I should be grateful for because it makes me stronger. If you choose to believe that for yourself, fine. Don’t push that on everyone else.

I help others now. This one didn’t fishhook my attention as much as the previous two until I saw a few Tweets by Corey Alexander, talking about the imagined trajectory of “graduating” from trauma to helping others, and the pressure on helpers to focus their energies on others to the exclusion of themselves. It got me thinking back to working with sexual assault counselors, and how many of those wonderful, kind, dedicated people had been through their own traumas. Some were still suffering from PTSD. But the emphasis was always on helping others. I think it’s great if you’re able to help others, and being able to draw on your own experiences can make you a more effective helper. But as Rose Lemberg pointed out, the word “now” makes it seem like you didn’t/couldn’t help people before? Or that this is the trajectory everyone should be on. There’s just so much to unpack here.

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I’m not going to go through everything. But all right, I get it. Someone wanted to post something feel-good and inspirational. So they Tweeted something problematic, and various folks on Twitter called them out about it.

At which point it sounds like I’m Not Ashamed began blocking people who had a problem with the Tweet. As far as I can tell, they never responded or addressed people’s concerns; they just went straight to blocking.

ETA: They blocked me less than an hour after this blog post was published.

I asked them about this, but haven’t yet gotten an answer. The Tweet that started it all is currently pinned as their top Tweet. We know they’ve seen the criticism, since they were blocking people, so this feels like a pretty clear message that they’re choosing to ignore that criticism.

And that’s the bigger problem here. This is a group that’s set themselves up as advocates for people with mental illness…while ignoring feedback from the very group they claim to support. I don’t know the individuals behind Team Notashamed or their situation, but this feels like symptoms of Toxic Ally Syndrome, where you’re so determined to be an “ally” of Group X that you ignore or argue with members of Group X because you know best. This is often followed by choruses of, “Why are you getting angry at me? I’m your ally! Fine, if you’re gonna be so ungrateful, I’ll just take my allyship and leave!”

I hope it doesn’t go that route. I hope they read and respond to the critiques from the people they’re claiming to want to support, rather than ignoring and blocking.

ETA2: One of the members of that group Twitter account informed me that “All leaders of team not ashamed personally deal with mental illness.” This doesn’t change my sense that it feels like Toxic Ally Syndrome, but I don’t want to erase that these people also either have or deal with mental illness themselves. Hopefully that makes sense?

I’ll wrap this up with a Storification of Rose Lemberg’s Tweets last night about mental illness and identity and the pressure to feel or act certain ways, generally for the comfort of others.

Last month, Rachel Griffin started the #imnotashamed hashtag on Twitter for people to talk about and try to destigmatize mental illness. Naturally, there were a handful of people who took this as an invitation to try to undermine that message.

Low libido, erectile dysfunction, decreased genital sensitivity, inorgasmia, blunted emotions. Antidepressants destroy Love. #imnotashamed

— Jayla (@jailina_) January 17, 2016

This is the example I ended up arguing with, which led to me designating a brand new subspecies of internet troll: a genital sensitivity concern troll. She asked if I was still in that relationship, what meds I was on, talked to me about how my medication usually causes emotional numbness and sexual dysfunction, and so on. Gosh, it’s nice to know that whatever else happens, some random stranger is Very Worried about whether or not my genitals are fully functional.

Well, I’ve been on Zoloft for more than three years now, and I’m happy to say that not only has it helped my life immensely, everything (with the exception of my pancreas — and that’s a totally separate issue) remains fully functional.

Too much information? Maybe. But @jailina was just so worried about all of us people on antidepressants, and whether or not our various bits still worked. She also seemed convinced that antidepressants were just a conspiracy by Big Pharma to sell drugs, and we all get depressed sometimes, and so on.

Now, she wasn’t entirely off-base. Mostly, but not entirely.

Most medications have potential side effects. For Zoloft, those side effects can include sexual problems, as well as sleepiness, nervousness, insomnia, dizziness, nausea, skin rash, headache, diarrhea, constipation, upset stomach, stomach pain, changes in appetite, dry mouth, and weight loss.

Sounds intimidating, eh? But so far, the only side effect I’ve run into was some dry mouth in the beginning.

Shall we compare that to the “side effects” of my untreated depression? Because those effects included oversleeping, impaired relationships with my children, impaired relationships with my wife, reduced productivity as a writer, and oh yes, a major reduction in my sex life. When I was younger, there were also effects like suicidal tendencies.

Side note: suicide also has a negative effect on your sex life.

I get the fears. What if medication turns me into an emotionally numb zombie? What if it takes away my creativity and spirit as a writer/artist?

Let’s start by busting that last myth: Depression does not make you a better writer!

The myth of the tortured artist is bullshit. Not only do you not have to be tormented and miserable to be creative, you’ll almost always be far more productive if you’re mentally and emotionally stable. I almost doubled my writing output the year after I started getting my depression under control. Every writer I’ve talked to who has a mental illness has told me they do better when that illness is managed.

As for the side effects? Tell your doctor what you’re worried about. Talk about the potential side effects and what to watch for. The first medication you try might not be the right one for you, or the dosage might need to be adjusted. It can take time to find the right treatment. If you encounter side effects, you and your doctor can adjust your medication. You’re not damned to an eternity of dizziness, dry mouth, and numb genitals.

Depression is not just a bad mood. Mental illness is not something you can overcome through stubbornness. I liken it to my diabetes. I can’t tough my way through having a nonfunctional pancreas. Trying to do so would quickly put me into a coma, and then into a grave. Likewise, stubbornness isn’t going to straighten out neurochemical imbalances in your brain.

Don’t let the genital sensitivity concern trolls scare you out of asking for help if you need it. Educate yourself, yes. Ask about side effects and treatment options. In my case, the combination of medication and talking to a therapist is what worked best.

“Antidepressants destroy love?” That’s some Jenny McCarthy-level ignorance there. 100% pure, uneducated ass-talking.

Without exception, my relationships are stronger, healthier, and more loving today than they were before I started antidepressants. (They’re not perfect, mind you. No pill can do that. But they’re so much better than before.)

Mental illness isn’t something to be ashamed of. And getting help isn’t something to be afraid of.

It’s been a bit over three years since I was officially diagnosed with depression and started with therapy and medication. I can say without hesitation that overall, my life is much improved over 3+ years ago.

I can say with equal certainty that I haven’t been “cured” of depression, any more than insulin and regular visits to the endocrinologist cured my diabetes.

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I mentioned Christine Miserandino’s spoon theory over on Twitter earlier today. Spoon theory is an analogy about living with chronic sickness or disability. I know the analogy doesn’t work for everyone, but I’ve found it helpful in understanding and talking about and explaining some things.

What I’ve been finding in recent months is that I don’t actually know how many spoons I’ve got when I wake up in the morning. On any given day, I might be able to deal with the pressure of a looming book deadline, a crisis at work, a puppy destroying something important, an unexpected bill, a family argument, and whatever else comes my way. On another day with similar troubles, I could end up burning out like Biggs Darklighter over the Death Star.

I’ve gotten a bit better at recognizing when it’s happening. Just like I can generally feel when my blood sugar starts to drop too low, I can feel when I’m all out of cope.

It’s not a pleasant feeling, mind you. It’s a cold, congealed soup of anger and despair and exhaustion and shame. And recognizing it doesn’t necessarily mean I can do anything to fix it.

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My wife took me out for dinner and Jurassic World on Sunday. This was a good thing. I needed to get away, to relax and recharge and just enjoy myself for a few hours. It’s self-care, and as such, it’s something I wouldn’t necessarily have done on my own.

Medication is one thing. I’m pretty good at remembering to pop a pill every night, checking my blood sugar regularly and doing the math to match insulin to carb counts. But self-care is a murkier kind of medicine, one that takes more time and effort than programming an insulin pump. It’s also one I’m more likely to assume I can blow off.

Oh sure, I haven’t been getting enough sleep, but I’ll catch up on the weekend. I’ve missed some exercise, but I had other important things to do. I haven’t socialized much, but I’ll get to that as soon as the book is turned in.

How do you quantify self-care? How do you prescribe a given dose to be taken daily? (Those questions are rhetorical, by the way — I’m not asking for advice right now.)

And of course, there’s that other voice arguing that your self-care isn’t as important as those other people’s needs. It’s not as important as Doing All the Things.

I know self-care is important. As Morpheus said, there’s a difference between knowing the path and walking the path. But here comes Red Riding Hood to remind you that walking the path is all well and good, but it’s even harder to stay on that path once you’ve started.

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I remember growing up without email. I think email is an amazing tool, one that’s made my life so much better and simpler in so many ways. I remember getting my first email account as a college student, and how amazing it was to reconnect with a friend who’d moved to MIT.

I also hate email. I hate the neverending inbox, and that nibbling sense of failure that comes with every message that sits there waiting too long for a response. I hate that it takes spoons to answer some fucking emails, and knowing if I don’t, people will feel disappointed or hurt, or will wonder why I answered one email but not the next, and will start to second-guess whether they did something wrong when it’s just me trying to juggle a bunch of damn spoons without dropping any.

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We’re going on vacation soon. That will be a good thing. It won’t be 100% stress-free, but the stresses will be different, and hopefully fewer.

I’m also looking at some potentially big changes later this year. Stressful and anxiety-making, but potentially very good in the long term.

In the meantime, I was Guest of Honor at a convention last weekend, did a radio interview last night, was part of a Baen podcast recording today, and am getting ready for my 11th novel to come out in just over a month. All wonderful, amazing things I only dreamed about when I was younger.

Good things can use up spoons too.

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It’s easy to take progress for granted.

I’m not fine. I am, however, doing a hell of a lot better than I was three years ago.

I just need to remember that it took a lot of work to get here, and that if I want to stay here — which I do — I need to keep doing the work.

• Depression lurks in the corner.
• Depression waits for an opening.
• Depression is exhausting.
• Depression has little patience for others, and even less for you.
• Depression remembers every mistake, real and imagined.
• Depression is afraid of change.
• Depression is “fine.”
• Depression teaches you to lie.
• Depression is ashamed of you.
• Depression is forgetful.
• Depression doesn’t want you to go out tonight.
• Depression thinks you deserve it.
• Depression tells you not to talk about it.
• Depression is abusive.
• Depression is seductive.
• Depression disguises itself.
• Depression is always tired.
• Depression thinks you’re weak.
• Depression wants you to read the comments.
• Depression doesn’t care about the good things that happened yesterday.
• Depression expects you to fail.
• Depression doesn’t believe things will get better.
• Depression is overwhelmed.
• Depression wants you to think you’re the only one.
• Depression knows you more intimately than any lover.
• Depression is a glutton, and depression can’t stand the thought of food.
• Depression demands perfection.
• Depression undermines success, and magnifies failure.
• Depression is comfortable.
• Depression is a bully.
• Depression lies.

I have a guest post at Sarah Chorn’s Special Needs in Strange Worlds feature over at SF Signal today: Writing with Depression:

I get anxious every time one of my books comes out. Will this one sell as well as the last? Will people like it? Will Spielberg finally call me up and offer me an obscene amount of money to turn my books into blockbusters? Will this be the book that tanks and destroys my career, forcing me to live on the streets and hunt rats for food?

From what I’ve seen, that anxiety is pretty typical for most novelists. But I’m particularly nervous about my next book, Unbound. This is the third book in my current series, and will probably be out in very early 2015, give or take a few months. I’ve put my protagonist Isaac through an awful lot in the first two books. As a result of those events, when we see Isaac again in Unbound, he’s struggling with clinical depression.

Thanks to Sarah and SF Signal for running these essays!

My therapist shared something interesting earlier this week. With the caveat that this is all a bit simplified, and human brains don’t fit into neat lines and graphs, it still helped me to think a little differently about depression and anxiety and stress, and to understand both myself and certain other people in my life a little better.

She started by drawing the following graph:

This fits pretty well with my experience. There’s a relatively straightforward relationship here. The more depressed you are, the less productive you are. (Giving lie to the myth of the tortured artist who’s most productive when they’re depressed.)

Next, she drew a graph of anxiety.

This one also made sense, once we talked about it a bit. If you have absolutely no anxiety, you end up with a lot less motivation to produce anything. Take away all of my deadlines, and I’m definitely less productive and more likely to spend an evening bumming around on the couch watching Doctor Who. Not that there’s anything wrong with that.

On the other hand, too much anxiety can be crippling, with the far extreme being someone who can’t even leave their room or home.

So basically, we want to minimize depression and find a healthy and moderate level of productive anxiety. Got it. So far, so good.

What gets interesting, at least for me, is looking at the implications of the two models. If depression is more of a linear thing, it means you have that straightforward goal of getting as far to the left as possible. This also means small steps to fight the depression are more likely to have small steps in improving your productivity. It tends to be a long, slow battle.

I’ve been in therapy and on medication for depression for about two years now. This has had a pretty large impact on the depression, and when you look at my productivity these days … well, I’m doing two books in 12 months instead of my usual one. Smaller improvements have led to smaller changes in productivity, like being able to keep up with washing the dishes. Again, it’s not a perfect graph, but it makes sense to me.

I sketched in two sample changes in mood. If the depression improves by X, productivity also improves by X. That tends to hold true whether you’re really depressed or in a generally good space. (Yes, I’m simplifying the math and assuming a 1:1 slope.)

Anxiety, on the other hand, resembles a bell curve. That means any given change in your anxiety can have drastically different results, depending on where you happen to be on that curve.

Look at this next graph. Both of the horizontal lines, indicating a change in anxiety, are the same. The vertical lines, showing change in productivity, are not.

For someone near that ideal middle-ground, a small increase in anxiety of amount X could have a relatively small impact on productivity, perhaps X or even X/2. On the other hand, if you’re more anxious, the same increase of X in your anxiety could have a much larger impact, hurting productivity by a factor of 2X, 3X, or more.

Likewise, for someone who’s struggling with anxiety, removing just a small stressor could have a very large impact, and help exponentially.

And the exact same increase in anxiety can actually boost productivity for someone to the left of the curve as much as it hurts someone to the right.

This was an AHA moment for me. I spend a fair amount of time working with people and trying to motivate them, whether it’s my employees at the day job or my children at home, and looking at that Anxiety graph helped to crystallize why the same tactic can have very different results for different people … or even for the same people at different times.

Someone on the left side, who seems to be slacking because they don’t really care? Maybe their anxiety needs to be turned up a bit, by talking about potential consequences. On the other hand, for someone on the right side of the graph who’s already close to a panic attack, potential consequences are likely to push them even further, making things that much harder for them. In that case, trying to take a little of that anxiety off their shoulders can help tremendously.

I see some of the same effects with the way stress and anxiety intertwine in my life. There’s a certain middle ground where I can add or remove things I need to get done, and it doesn’t have much of an impact. But once I hit that tipping point, just a small increase in stress can drag me down hard.

Like I said at the beginning, this is a bit of an oversimplification. Human beings tend to be pretty complicated and messy. But seeing depression and anxiety drawn out like this was really helpful for me, so I figured I’d share it in the hope that it might help a few of you as well.