Let’s talk about feelings, okay?
My mom has always told me that I “feel things very intensely.” Beginning in the fifth or sixth grade I began to fill notebooks with angsty, pained, (and painful to read) poems about love and loss (in all the wisdom I could muster from my 12-year-old heart). I have a distinct memory of my high school self becoming so consumed with a book on a family camping trip that I talked to no one until I finished it, and cried inconsolably for hours after I was done (in my defense, though, it was a really sad book). But I couldn’t put the book down, rejoin the real world, and walk away from how deeply it made me feel.
Then, when I began counseling in college and we had started exploring a diagnosis of depression, my therapist asked if I had always “tended toward the melancholy.” While that’s not a particularly flattering way to think of oneself (“why yes, I do identify closely with Eeyore, thank you for asking!”), I thought back on my notebooks and on my general outlook and had to admit that, at times, I did.
This tendency to see things with a bit of an overcast tone, on top of a propensity for feeling any kind of emotion intensely, means that I easily become sad -- and then, quickly, very sad. In a person with healthy coping skills and emotional regulation, this kind of sadness, whether from a book or a movie, or from a personal disappointment, or a tragic current event on the other side of the world, can be a passing feeling that might be remedied by a long walk, a talk with a friend, or a journaling session. But in my own experience with with depression, that kind of sadness -- the kind that should be faced and handled as a part of a healthy emotional life -- can trigger a deeper, more disturbing emotional response. For me, at least, the regular everyday sadness of life’s normal events can be like giving my depression a foothold in my soul, a place for it to grab on and take root.
So as I sank deeply into my depression over the past year or two, I began to avoid certain things that I knew would make me sad. I’ll read a crime thriller at the drop of a hat, but pushing myself to read something that had more emotional depth became off-limits. I can only see this in retrospect -- but I spent a good couple of years reading more far-fetched mysteries and police procedurals than I can count, while ignoring books I’d long wanted to read by favorites like Toni Morrison or John Updike because I was scared of what those beloved writers might make me feel. Likewise, I turned away from movies or TV shows that skew toward the tragic and opted either for sitcoms or, again, crime dramas. I passed by articles in the news that looked interesting and thought-provoking because they were about current events or social conditions that would make me feel sad about the state of the world.
I feared that if I allowed myself to feel unhappy in response to an appropriately sad stimulus, my depressive symptoms would take hold, that I would allow the weight of my illness to pull me further down into the spiral of despair that I experience when I am having an episode of major depression. (This spiral will be the sole subject of a future post, I promise. It will be fun.) I couldn’t let myself do it. It felt like too big a risk to give my depression even a fleeting chance to worm its way deeper into me.
I must state here that this is an observation I am making about myself only, and in retrospect only. I know that many people with depression seek out sad music or other media or news to validate their feelings and to feel less alone in their sadness. Personally, I avoided it at all costs. There’s no right way to experience mental illness (again, more on this another time).
But as I am growing and learning about self-care and becoming well, I’m working on learning the appropriate ways of dealing with normal emotional responses to sad things. I recently watched a speech that made me cry. I knew it would make me cry, and feel sad, and I was tempted to go to bed before it came on, but my husband encouraged me not to miss it and so we watched it together. (Coping skill #1: have someone with you for moral support.) I did cry, and I did feel sad, but then afterwards it felt okay. I did not feel the long, spindly fingers of depression reaching up from the depths of the spiral to grab at me. My husband showed me cat videos that made me smile. (Coping skill #2: laugh at things that are funny.)
And tonight, as I’m writing, we’ve decided to go see “Manchester-by-the-Sea,” a film set in my hometown (woot!) that is supposed to be excellent and also incredibly sad. I have asked myself, and my ever-patient husband, several times this week: “Why do we want to go see something so sad?” And also, “How am I supposed to choose to go do something for ‘fun’ that I know is going to make me cry?” Again, I imagined that after watching it I would come home in tears, emotionally wrecked and feeling devastated about fictional characters to whom fictitious sad things happened. (Coping skill #3: remember that sometimes sad things are not real.)
But I have decided, in a slow but clearly evolving way, that I am not going to be someone who misses out on life experiences like weeping at the end of an outstanding novel, or crying through a touching, phenomenally-acted film, or mourning with the people of another country who have just survived a terrible earthquake, just because it will make me have feelings. Feelings are okay. Feelings are real and raw and sometimes they hurt, and if you are mentally ill then a lot of the time they hurt, but part of life is learning to feel things as they come over you, and deciding what to do with them, and absorbing them into your human experience so that they make you a better, more insightful, more compassionate person. (Coping skill #4: remind yourself that feelings are allowed as part of your human experience.)
On hard days, or in the midst of a depressive episode, there can be wisdom in choosing to filter out some of the things that cause sadness and despair. But on healthy days, through the ins and outs of life, finding my footing as an emotionally healthy person, capable of feeling and gauging and processing my response to life, is one of the best ways to learn self-care and to grow in my understanding and capacity to care for others.
So, in that spirit, I’m headed to the movies -- with a pack of tissues.
A few months back, I was reading a few pieces on The Mighty, one of my favorite websites. It’s a platform for first-hand posts about mental illness, disability, and chronic and rare illnesses (some of my blog posts also appear on there). As I clicked on various links related to mental illness, I came across a post about something called “double depression.” I had never heard the term before, and as I read, the tiny lightbulb in my brain began to flicker and glow, until it became so bright that I wanted to shout, “Eureka!” (or something equally melodramatic). I felt like I had finally figured out why I could sometimes live in the day-to-day of my depression, while other times the illness was knocking me on my rear end so hard that I couldn’t get back up for days.
Double depression occurs when a person who has dysthymia also experiences a major depressive episode. To help us all understand what the heck this means, I’m going to explain these two different types of depression. Then I’m going to give you a ridiculous metaphor for each of them. Then we can talk about how fun it is when they join forces.
Major depressive disorder (MDD), which is what I’ve always been told I have, is characterized by all the things I’ve covered in previous blog posts. It can be emotional: sadness, hopelessness, loneliness, wanting to die. It can be physical: aches and pains, stomach problems, headaches, weight gain or loss. There can be irritability, fatigue, loss of interest in previously-loved activities. Sleeping too much or too little. Typically, those who suffer from MDD experience episodes of acute depression, during which they may feel suicidal or not, may self-harm or not, may function in their daily lives or not. But the key to MDD is that the episodes do end. They may last days, weeks, months or even years, but at some point they stop, and the depression lifts.
The type of depression I did not know about, dysthymia, I would best describe as the mellower cousin of MDD. The symptoms are similar, but while episodes of major depression are likely to come to a more tangible end, the hopelessness, low self-esteem, and disinterest that characterize dysthymia do not. That’s right -- although dysthymia is considered a milder form of depression than MDD, it is chronic. As in, it does not go away. I think one of the best popular culture examples of dysthymia is probably Eeyore -- always plodding along, always pessimistic, every adventure met with a sigh. Eeyore never seems able to pull himself entirely out of the gloom that surrounds him. That’s kind of what it's like to live with dysthymia.
Now, as promised, an absurd metaphor.
Imagine, if you will, a 600-pound gorilla (yes, Wikipedia told me that they can weigh that much) who is determined to beat the living daylight out of you. He sees you as a threat and he is going to attack you with all the weight and strength he’s got. He’ll shake you and kick you and push you around and maybe even bite you. You’re getting the crap beat out of you, but hey -- it won’t last forever. Eventually the gorilla will get bored or feel satisfied that you are no longer a threat, and he will leave you alone. You’re left to lick your wounds and eventually get back on your feet. You’ll have a few scars, but the gorilla will be gone. That’s major depression.
In contrast, dysthymia is the much smaller, cuter-by-comparison monkey that sits on your shoulder. He won’t mortally wound you, but he won’t ever go away either -- he’s always picking at your hair, screeching in your ear, smelling up your house, making your life inconvenient and chaotic and unpredictable. It’s not pretty and it’s not fun. Sometimes it’s painful, but it’s not like you’ll end up in the hospital with any broken bones. The thing is, you will never be rid of the discomfort and exhaustion you feel from dealing with him every single day. That’s dysthymia.
So, what’s double depression? Double depression is when the monkey on your back wraps its arms tight around your neck to hold on, and the gorilla comes at you swinging. You might have learned to live with the little guy -- annoying though he is, he’s your monkey, and most of the time he’s not all that bad -- but now you have to carry his weight and fend off the gorilla who is trying with all his might to kick your ass. You’re less able to defend yourself because the stupid monkey won’t let go, and you’re tired from carrying him around all the time, so the gorilla has an easier shot at you than ever. And then, guess what? When the gorilla finally decides he’s done with you, the monkey doesn’t follow after him and leave you be. He clings on, just like always, so it’s just a little harder to heal and recover. You’re perpetually swatting at the monkey, who won’t leave you alone, and meanwhile, you never know when the gorilla might come back for round two (or three, or four…).
To get back to the real world for a moment: double depression is when a major depressive episode occurs in a person with existing dysthymia. The depressive symptoms you thought you were doing pretty well living with are suddenly compounded, and you are thrown into a deeper, darker place than any you’ve been to before. Your fatigue is no longer nagging, but all-consuming. The minor aches that fade with sleep start to keep you up all night. The passing thought that maybe not much in life really matters is replaced by an unrelenting thought pattern of pervasive hopelessness.
Once I realized that I may have been living all this time with dysthymia, and that my hardest times were the ones punctuated with major depressive episodes, I spoke with my therapist and my nurse practitioner, both of whom agreed that this was the most likely scenario. I can’t say I feel relief at the diagnosis -- it feels pretty awful to be told that my light at the end of the tunnel is likely a hazier, dimmer one than I’d like it to be -- but having a label helps me better understand what I need to do to take care of myself. On the very best days, the monkey on my back lets me put him down on the couch for awhile so I can take a break. I’m learning to love those moments and use them to enjoy life, all the while preparing to pick the monkey back up, and even to face the gorilla once in awhile -- hopefully mustering up more a little spunk and optimism than Eeyore.