When Depression hides in plain sight

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    • When Depression hides in plain sight

      “Be kind, for everyone you meet is fighting a battle you know nothing about.” ~ Wendy Mass

      /Kurt Cobain. Alexander McQueen. Junior Seau. L’Wren Scott. David Foster Wallace. Chris Cornell. Robin Williams. Kate Spade. Anthony Bourdain .../

      Depression clearly doesn’t care if you are a celebrity. It doesn’t care who you are, how much money you have, or what you do. It doesn’t care about your accomplishments or whether you have “everything to live for.” It doesn’t care if you have kids.

      It doesn’t care if you are homeless or if you live in a mansion. It doesn’t care about the love of your family, your friends, or your fans.
      Depression smirks when good, kindhearted people say things like “just snap out of it,” or “stop being so sad, what do you have to be sad about?” Depression scoffs when people say it’s simply “mind over matter,” and it should “be easy to chase it away if you just try to look at the bright side.”
      The only easy thing about depression is that it’s easy to hide. We can pretend that all is well for the world outside, when deep down within ourselves we are struggling with feelings we don’t understand or communicate. We can fake being happy and connected, even when we know that pieces of our puzzle are missing. We can hide our depression in plain sight, because we don’t want others to worry.

      For those of us who suffer, the different abuses we employ tell the same story of our shared human condition, which is a constant craving for those “hits” of dopamine and serotonin and the aftereffects of being “high” that are wonderful, but far too short-lived and mean nothing later when our darkest, lowest thoughts return and we are left needing more.
      Our abuses are about chasing a feeling. We turn to food, to alcohol, to drugs. We turn to shopping, gambling, and sex. Many of us develop addictions, and many of us mask our need for relief by outwardly pretending to be fine. Or we simply become disengaged, and we don’t care about the effect our disengagement has on those we love. We always think we have things under control, but chasing and masking are reckless, ruthless behaviors that only propagate our disease.
      Celebrities who take their own lives reveal a startling truth. Their deaths stun us because they seem to have everything they could possibly want and everything they’ve worked so hard for. Their suicides shine a glaring “reality check” spotlight on the fact that depression doesn’t care about what we have or what we show the world. It doesn’t care about our fronts, our captivating personalities, our intellect, or our success. It doesn’t care about our talent, artistry, or expression. It doesn’t care who we know, or where we’ve been, or what we look like, or how old we are.
      Chronic depression just wants relief. It wants to take us under with it. It wants to drown. It wants a bullet. It wants a rope. It wants to bleed. It wants us to end the masking, the chasing, and the need.

      It just wants relief from endless suffering at the hands of a monster who hides in plain sight.

      Stay soft. It looks beautiful on you.
    • I remember walking down the street with Neil one evening and pondering out loud if maybe I was having issues with depression again.
      This was sometime in late summer and the thought had crossed my mind because things were taking me just a little too long to get done. I asked him if he had noticed anything out of the ordinary and, upon reflection, he said not really. I rhetorically questioned if it would be harder for me to recognize a new wave of depression because my baseline for discomfort was SO high. My equilibrium was so askew because of what I had endured years before. Living with depression (minus the compounded problems of addiction) took me a LONG time to get treated because even that was somehow manageable…until it wasn’t.
      So I wondered if a mild depressive episode would even register with me because I was used to living under difficult circumstances. I took that thought and filed it away in the back of my mind and continued our walk home.

      Although my depression wasn’t officially diagnosed until a couple years ago, I’m quite sure it’s something that I’ve struggled with for many, many years before that. During those times, I was able to escape it by pouring alcohol on it or flooding it with drugs and neurotransmitters that mimicked happiness. When those coping mechanisms stopped, I was able to realize that something more was going on. I shared about it in several posts on this blog, and the contrast as I came out out of that thick, wet sand was so sharp that I never considered that I might go through it again.
      Antidepressant medication made a huge difference in bringing me to a manageable baseline of functioning. I didn’t feel as heavy and the incessant, worrying thoughts I lived with on a daily basis were gone. I felt confident and capable. This lasted a good two years until the end of last summer.
      Slowly, over a period of about six months, I began finding it harder to get things done. My mind felt more cluttered and I would get overwhelmed much easier. Just looking at my personal training schedule would make me tired. Again, I found myself putting off laundry — one of the hallmarks of my first struggle two years prior.

      I wasn’t able to put each piece together since it happened so slowly over those months. It wasn’t that one day I woke up and all of these things happened at once; I would be fine one day and then the next have trouble getting things done, telling myself that tomorrow was a new day.
      Around the end of November, I realized that “tomorrow is a new day” had become my new mantra. I was barely getting anything done and when I did manage a full day of work, I would feel mentally exhausted. I was getting dangerously close to missing deadlines and would fail to do things which then required me to backtrack in order to get paid for the work I had done.
      As these parts of my life began to get more unmanageable, I sought out the therapist I had worked with previously. I made an appointment and told her that I felt similarly to when I had first seen her — lost and needing someone to help me along. At first, I thought that I just needed someone to kick my butt into gear, but one of her first questions was “how long have you been on the medication?”
      Slowly, I started putting two and two together and realized that many of my current issues were the same as two years ago, although not quite as severe. She told me I might need to adjust my medication because my brain simply may have acclimated to it.
      I was so happy with the way I responded to medication initially that for some reason I felt like I had been cured and that it would keep me feeling like I could endlessly function on a day-to-day basis. I didn’t consider that things may need to be tweaked or I might experience more depressive episodes over the duration of my life. I immediately started a new dosage and continued to meet with her over the next month or two.
      Those first couple sessions were literally me telling her what I needed to get done (but couldn’t) and her making a list of things I needed to do before coming back to her. She was my accountability because I had lost any sense of my own. My first list was literally “email accountant, finish Google Doc, schedule week, and work one day on my book.”

      My first experience starting medication was intense, sometimes unpleasant, but relatively short before I felt a difference. My second experience was more subtle. Around two weeks, I started to feel slightly worse than I had initially, almost paralyzed in my ability to do anything. Two weeks was how long it took me the first time, so when I didn’t notice a shift towards the positive, I became frustrated and discouraged. That feeling eventually went away, but I still wasn’t feeling much better.

      Suddenly, more than four weeks later, I felt confident. I felt organized. My mind was functioning faster and the things I was having trouble with were getting done. My therapist reminded me that each person is different and it can take anywhere from 4-8 weeks for a medication to fully take effect. I no longer went into her office looking for her to hold my hand through the things I needed to do; I went in with a plan and we worked on it together.

      As I began to feel more like myself, I told her how frustrated I was with this entire process. I felt like living with depression (and its resurgence) slowed me down. It made me less productive. I didn’t want to lose months of productivity again — especially in a career where you need to be proactive and take care of many things yourself.

      One of the suggestions she gave me was to make a list. She told me to think about what signs I noticed as this latest episode crept up and record those so that in case one came up in the future I could refer to it and notice any similarities. Nothing can prevent it outright, but at least I will be able to seek help earlier and stop wasting time denying what is actually going on. I felt like I was either trying to continuously paddle upstream or my boat was caught in a whirlpool that spun in circles without moving anywhere.

      Although I’m feeling more like my old self, I still have sessions booked with her because I want to make sure that I stay on this path for a bit before heading out on my own. I feel more prepared to take on work and life and am grateful for the experience, even though it’s a frustrating one. I believe the strongest people are the ones who face their challenges, learn, and grow from them.
      If you’re someone who struggles with depression, I suggest making your own list. The sooner you catch it, the sooner you can prepare and be ready to ride the wave.

      Stay soft. It looks beautiful on you.
    • В памет на Anthony Bourdain

      Депресията е демон, с когото се раждаш и който винаги надделява впоследствие. Независимо какво правиш, как действаш или противодействаш. Не трябва да се бърка с неудовлетворението от живеенето като такова в определен социум, нито със самосъжалението - това е обяснение за елементаристи психолози, за които естествената среда на човешкото същество, е нахилената и удобна поза на щастливия кретен. На полезния идиот.
      Нито с ниската самооценка - смешното е, че всеки има такава "ниска" самооценка. Не защото се подценява, а защото твърде много очаква и защото се мисли за уникален субект. Защото се надценява. И после плаче как не е оценен.
      Да имаш реална самооценка, не означава да се надценяваш, влизайки удобно в ролята на жертва. Означава, да не очакваш невъзможни неща. Дори да не си ги помисляш, да не се сравняваш. Да не искаш парцалената кукла на съседа ...

      Един страхливец може и да скочи с парашут, за да опонира на фобията си от високото. Един страхливец, който се ужасява да лети със самолет, може и да преодолее страха си от високото, прелитайки над океана за около 8 часа. Това действие обаче е твърде семпло като контрапункт на ужаса да се проумее, че не можеш да контролираш. Не си господар на съдбата си, не можеш да станеш победител, ако ще и 1000 осемхилядници да изкачиш. Депресията често се маскира като зов на сърцето, като желание за велика победа или преодоляване на страха от смъртта. Като месианство.

      Досега изредих все синоними на бягството, бягство и втурване в далечния коридор на големите постижения, където героите преодоляват депресията ... Не, няма нищо по-страшно от герой, постигнал геройството си.

      "Чувствам се като Квазимодо. Ако той отсядаше в скъпи хотели, то това щях да съм аз. Чувствам се изключително изолиран. Комуникирам, за да оцелявам, но всъщност съм ужасен в комуникацията си с хората, които обичам." (А. Б.)

      Депресията е втората природа на човека, втората глътка въздух след първата. Депресията е като гладна косатка, която дебне тюлен в плитичните. Харпия, която улавя само с един скок, дремещ на дървото ленивец. Млада лъвица, която издебва млад бивол и смъртоносно го захапва за опашката. Депресията е вечна борба за оцеляване. Кодът на Битието. Тя е черната антиматерия, която изпълва всяко пространство във вселената. Древен квазар, бълващ смъртоносна радиация.

      Само в красивите митове и приказки, Белрог си намира майстора в лицето на Гандалф.
      В реалността, спасителните брегове обикновено се оказват миражни пристани, пропити от алкохолни изпарения и хероинови видения. Конфликти, изтощение, пътувания, изолация, неспособност за общуване, но и нежелание да се общува.
      Накрая Всичко се оказва Нищо.

      Нямам финална фраза. Депресията продължава.
      Stay soft. It looks beautiful on you.
    • People with depression use language differently – here's how to spot it

      From the way you move and sleep, to how you interact with people around you, depression changes just about everything.
      It is even noticeable in the way you speak and express yourself in writing. Sometimes this “language of depression” can have a powerful effect on others. Just consider the impact of the poetry and song lyrics of Sylvia Plath and Kurt Cobain, who both killed themselves after suffering from depression.
      Scientists have long tried to pin down the exact relationship between depression and language, and technology is helping us get closer to a full picture. Our new study, published in Clinical Psychological Science, has now unveiled a class of words that can help accurately predict whether someone is suffering from depression.
      Traditionally, linguistic analyses in this field have been carried out by researchers reading and taking notes. Nowadays, computerised text analysis methods allow the processing of extremely large data banks in minutes. This can help spot linguistic features which humans may miss, calculating the percentage prevalence of words and classes of words, lexical diversity, average sentence length, grammatical patterns and many other metrics.
      So far, personal essays and diary entries by depressed people have been useful, as has the work of well-known artists such as Cobain and Plath. For the spoken word, snippets of natural language of people with depression have also provided insight. Taken together, the findings from such research reveal clear and consistent differences in language between those with and without symptoms of depression.
      Language can be separated into two components: content and style. The content relates to what we express – that is, the meaning or subject matter of statements. It will surprise no one to learn that those with symptoms of depression use an excessive amount of words conveying negative emotions, specifically negative adjectives and adverbs – such as “lonely”, “sad” or “miserable”.
      More interesting is the use of pronouns. Those with symptoms of depression use significantly more first person singular pronouns – such as “me”, “myself” and “I” – and significantly fewer second and third person pronouns – such as “they”, “them” or “she”. This pattern of pronoun use suggests people with depression are more focused on themselves, and less connected with others. Researchers have reported that pronouns are actually more reliable in identifying depression than negative emotion words.
      We know that rumination (dwelling on personal problems) and social isolation are common features of depression. However, we don’t know whether these findings reflect differences in attention or thinking style. Does depression cause people to focus on themselves, or do people who focus on themselves get symptoms of depression?
      The style of language relates to how we express ourselves, rather than the content we express. Our lab recently conducted a big data text analysis of 64 different online mental health forums, examining over 6,400 members. “Absolutist words” – which convey absolute magnitudes or probabilities, such as “always”, “nothing” or “completely” – were found to be better markers for mental health forums than either pronouns or negative emotion words.
      From the outset, we predicted that those with depression will have a more black and white view of the world, and that this would manifest in their style of language. Compared to 19 different control forums (for example, Mumsnet and StudentRoom), the prevalence of absolutist words is approximately 50% greater in anxiety and depression forums, and approximately 80% greater for suicidal ideation forums.
      Pronouns produced a similar distributional pattern as absolutist words across the forums, but the effect was smaller. By contrast, negative emotion words were paradoxically less prevalent in suicidal ideation forums than in anxiety and depression forums.
      Our research also included recovery forums, where members who feel they have recovered from a depressive episode write positive and encouraging posts about their recovery. Here we found that negative emotion words were used at comparable levels to control forums, while positive emotion words were elevated by approximately 70%. Nevertheless, the prevalence of absolutist words remained significantly greater than that of controls, but slightly lower than in anxiety and depression forums.
      Crucially, those who have previously had depressive symptoms are more likely to have them again. Therefore, their greater tendency for absolutist thinking, even when there are currently no symptoms of depression, is a sign that it may play a role in causing depressive episodes. The same effect is seen in use of pronouns, but not for negative emotion words.
      Practical implications
      Understanding the language of depression can help us understand the way those with symptoms of depression think, but it also has practical implications. Researchers are combining automated text analysis with machine learning (computers that can learn from experience without being programmed) to classify a variety of mental health conditionsfrom natural language text samples such as blog posts.
      Such classification is already outperforming that made by trained therapists. Importantly, machine learning classification will only improve as more data is provided and more sophisticated algorithms are developed. This goes beyond looking at the broad patterns of absolutism, negativity and pronouns already discussed. Work has begun on using computers to accurately identify increasingly specific subcategories of mental health problems – such as perfectionism, self-esteem problems and social anxiety.
      That said, it is of course possible to use a language associated with depression without actually being depressed. Ultimately, it is how you feel over time that determines whether you are suffering. But as the World Health Organisation estimates that more than 300m people worldwide are now living with depression, an increase of more than 18% since 2005, having more tools available to spot the condition is certainly important to improve health and prevent tragic suicides such as those of Plath and Cobain.
      Mohammed Al-Mosaiwi, PhD Candidate in Psychology, University of Reading

      Stay soft. It looks beautiful on you.