The first thing you need to know about secure psychiatric facilities is that their bathrooms smell strongly of pee.
That may not seem remarkable to you. Many bathrooms smell of pee. But the facility in which I was a guest this time last year was notably immaculate in every other way. A lot of time and attention went towards making it clean and welcoming. Yet the private bathrooms — one to a two-person dorm room, no lock — always smelled of pee. That's because there's an elaborate metal cage built around the workings of the toilet, like one of those Hannibal Lecter masks. This makes the toilets very difficult to clean. Hence, the constant smell of pee.
The people who run the facility protect the toilets like that so that you won't disassemble them and use the pieces to hurt yourself. My wife would tell them that this concern dramatically overestimates my home improvement skills, but I guess they want to be careful. It seems to me that if you take the time and effort to disassemble a toilet with your bare hands, you're committed enough to be allowed to do to yourself as you see fit. To date my view has not prevailed in the psychiatric community.
I found this out exactly a year ago, when I had a particularly bad day. My family and friends had a worse one.1 I'll spare you the particulars; they aren't the point. I had the sort of day that illuminates the distinction between "I've fought depression for sixteen years" and "I've successfully fought depression for sixteen years." It turns out the difference matters.
I'm still here. That's a consequence of the grace, and love, and generosity, and decency of others, and my own ridiculously good luck. I'm here, I feel good — not just okay, but good — and I'm very happy to still be here. Not only that, I feel hope. If you haven't been depressed, that may seem like just a little thing, but it's not. I don't feel the hope that I'll never have a low point of anxiety and depression again. It's going to happen again; that's the deal. No: I feel hope that when it happens again, I have the tools to face it.
Every time I write about depression, I feel like I'm having the naked-at-school dream, exposed and poised for incoming ridicule. No matter how often I say that depression is nothing to be ashamed of, and how sincerely I believe it in my head, my gut tells me otherwise. But every time I write about depression, I get emails from people thanking me for talking openly about the subject and for describing what it's like. And, as I said, I'm only here because of the decency of others. I owe back. I owe back more than I can possibly repay. A little squeamishness doesn't weigh much in the balance.
So here we are. I'm Ken, and though I live an outwardly "normal," high-functioning and successful life, I suffer from grave anxiety and depression, and last year it got bad enough that I was hospitalized "voluntarily" for it.2 Maybe you suffer, or maybe you love somebody who suffers, or maybe you want to understand depression and anxiety more so you can support people who suffer. I want to share some things I've learned in the course of a harrowing experience, in hope that it might help someone, even a little.
Ask For Help. You Can't Go It Alone.
I'm not an addict. But dealing with depression and anxiety has resembled what I've read about addiction treatment. I've had to reach bottom and concede my own powerlessness to get better. I'm not still here because of strength of character. I didn't survive because I found it in myself to hope that things could improve. In fact I didn't have that hope a year ago today. I survived because at my worst moment I knew that, however hopeless I was, I could put myself in the hands of the people who care about me. I'm here because, at my lowest, I admitted that I was powerless to help myself, admitted that I needed help from others, admitted that I had to rely on other people. That wasn't easy; I'm stubborn and fully invested in the classic American self-image of independence and grit. But it was necessary.
I bring this up because even mentally ill people are bombarded with the message of self-reliance. Learn how to eliminate negative thoughts! Take control of your depression! Fix yourself with these four methods! Overcome your problems! Be strong! There's something appealing about these messages — even as they fail to produce results — because social interaction can be unpleasant and painful when you're depressed and anxious. An elaborate excuse to withdraw and self-rely is welcome, like a doctor telling you to drink more milkshakes.
Part of my improvement was about taking personal responsibility and achieving some mastery of my condition, as I'll discuss below. But the core of it was admitting that I had to trust and rely on people, and that I needed them to help me, and that I could not just stoic it out all by myself. I had to be okay admitting to other people that I was broken — admitting to colleagues that I needed help at work to get some time to get better, admitting to family that I needed help, admitting to various medicos the extent to which I'm fucked up. Instead of being the guy who can always offer a solution or a plan or a strategy, the one people can count on, the one always ready to take responsibility for results, I had to say "I don't know what to do, and I need help." You can be pressed firmly to the vast bosom of your loving family and friends and still be all alone if you're not ready to say that.
I am incredibly lucky in my family and friends. Not everyone has that support network. Maybe you think you don't. But if you are in pain, your family and friends and coworkers may surprise you. Even if you're on your own, there are dedicated professionals out there whose purpose is helping you. Seek that help. I don't mean "go someplace for an hour to talk, and then go back to work and back to carrying the weight on your shoulders." I mean bring yourself to admitting you can't do it without other people.
If you have a loved one in pain, from my perspective the best thing to do is to say "I don't know what I can do, but whatever it is, I'll do it. I'll help you, and I'll take you to others who can help. Let me help you carry the weight." You can help by eliminating the excuses we use not to get help. "I'll miss work!" I'll cover your shifts. "The kids need me!" The kids can stay with us for a month. "I'll lose my job!" No you won't — I'll go to bat for you. "I don't know who to call!" I'll call for you.
Don't Rule Anything Out.
If you asked me a few years ago, I would have been horrified at the concept of a stay in the looney bin.3 I know people who have spent time in psychiatric facilities; it doesn't diminish my respect for them. I admire people who have spoken openly about such hospitalization, like David Weigel or Annmarie Timmins, and think that their stories prove how being hospitalized doesn't make you less of a responsible adult, or professional, or trustworthy person. I knew that intellectually. But down in my lizard brain, where I whisper my failings to myself, I told myself if you go to a mental hospital, that's it. You're not a parent and a law firm partner and a citizen any more. You're a Crazy Person.
It took a crisis to get me past that — it took reaching bottom and thinking, hey, it can't possibly get worse, so why the hell not? Acute ward, here I come!4 Letting go of that arbitrary line and opening myself to the possibilities was a huge relief. Thank God I did it. It was what I needed — time unconnected, away from the sources of crippling anxiety and accompanying depression, so that people could help me figure out how to deal with it, instead of just suffering through it. When you're depressed and anxious to the point of crisis your daily life is like drowning; you're too focused on surviving to figure out how to change.
Hospitalization may not be right for you or your loved one. I'm not saying to go check yourself in. I'm telling you to be open to the array of possibilities. Be open to medication. Be open to therapy. You may be surprised to discover what works for you once you give it a try. I had rejected talk therapy for years; I always found that it provoked more anxiety than it prevented. (I'm the sort to have a panic attack trying to figure out what to say when I cancel my therapy appointment because of a work conflict.) But, having admitted that I needed to listen to other people, I tried a new doctor and a new modality — cognitive behavioral theory, specifically — and found it effective and liberating.
Just consider what you've previously ruled out, is all I'm saying. Question your disqualifying assumptions, or help your loved ones do so. I assumed without reflection that hospitalization meant the end of my career; I went on to have one of my most successful years ever. I was better as a spouse and parent and lawyer and boss because I wasn't miserable.
I was diagnosed 16 years ago with major depression. I've been cruising along, in good times and bad, with medicines working or not working, assuming that was the case. Doctors didn't seriously re-evaluate that diagnosis until this crisis, nor did I. Careful evaluation led me to understand that I've got both depression and what we'll charitably call an "anxiety problem." This combination is apparently common in annoying Type As like me — and with it comes the ability to mask pain, to remain very high-functioning so nobody sees how you feel until you snap. The way it works for me is this: during a bad cycle, the anxiety begins, and feeds on itself until it becomes omnipresent and all-consuming, in a way I've tried to describe before:
Think of the most stressed and worried you have ever been in your life, and then imagine that your stomach feels like that all the time.
Imagine that you are constantly gripped with overwhelming feelings of dread and crushing hopelessness — irrational, not governed by real risks or challenges, but still inexorable.
Imagine that you are often fatigued to the point of weakness and irritability because you can't get to sleep until late at night, or because your mind consistently shakes you awake at four in the morning, racing with worry about the day's activities as your stomach roils and knots.
Imagine that most social interactions become painful, the cause of nameless dread. Imagine that when the phone rings or your computer dings with a new email you get a short, hot, foul shot of adrenaline, sizzling in your fingertips and bitter in your mouth.
Imagine that, however much you understand the causes of these symptoms intellectually, no matter how well you know that you are fully capable of meeting the challenges you face and surviving them, no matter how well you grasp that these feelings are a symptom of a disease, you can't stop feeling this way.
Imagine that you have moments — maybe even minutes — where you forget how you feel, but those moments are almost worse, because when they end and you remember the feelings rush back in like a dark tide that much more painfully.
Then, once I'm in anxiety's grip, depression kicks in. And, as the Bloggess says, depression lies. Depression tells me that it's never going to change. Depression tells me that there's no hope, that I'm going to feel this way forever. Depression tells me I've tried everything to get better and it doesn't work. Depression tells me that I'm a failure as a husband, a father, a friend. Depression tells me that I suck at my job — that if clients are happy with my work it's only because they are deluded.
You can see how this one-two punch can put you down.
Not surprisingly, treatment that focused only on depression — or that saw anxiety as a mere part of depression, instead of a separate phenomenon magnified by depression — wasn't effective. But, sixteen years down the path, trying a new approach was remarkably effective. Treating the anxiety and depression as distinct problems with distinct causes and solutions worked better than anything ever has. Perversely, admitting defeat and giving up control led to getting much more command over my disease and my response to it.
So, if what you've tried hasn't worked so far, never stop questioning your premises. Maybe you're not solving the right problem.
Think About Your Body Along With Your Head.
One of the things I learned after my crisis was that I had never seriously thought about how my body contributed to the state of my mind. As a long-time out-of-shape unathletic geek, my body was never a focus. I heard that exercise and diet could impact my mental health, but I didn't grasp why.
Starting from scratch let me re-evaluate this and think about how I could address mental symptoms by addressing physical symptoms. An example: when I was anxious and depressed it was common for me not to eat anything until dinner. What I figured out is that my stomach would start churning and rumbling from hunger. That feeling is remarkably close to the unquiet stomach of anxiety, and my mind would tell me you're really anxious, which would make me more anxious and less likely to eat, and so on, in a vicious cycle. What I figured out was that if I addressed the physical symptom reasonably — for instance, by taking pains to have a bit of protein for breakfast and mid-morning — the mental symptom followed. I also discovered that calling out and naming physical symptoms helped prevent them from making the mental symptoms worse. When I am in the grip of anxiety I get nasty hot shots of adrenaline, like an electrical charge through my chest, when the phone rings or an email comes in or I read something concerning or anything else happens. The physical symptom makes me more anxious. But I learned to say that's not anxiety — that's a symptom of anxiety. That's an adrenaline surge, and it will pass. I'll work it off by taking a walk around the office. The anxiety's still there, but the vicious body-mind cycle of escalation stops.
I found the book ""Why Zebras Don't Get Ulcers" to be extremely helpful in understanding the biology of how my body impacts my mood, and vice-versa. Before I had been very skeptical of any body-focus as sort of crystal-thumping woo. But not surprisingly, there's actual science to the concept that our bodies impact our minds.
This particular approach may not be as helpful for anyone. Consider it, then, in the category of keeping an open mind to new approaches.
Talk To People; You're Not Alone.
I mask extremely well. I'm told this is typical of people with both anxiety and depression. I'm very adept at keeping people — even those close to me — from detecting how badly I feel. A lot of us are.
The problem with this, of course, is that people can't help us if they don't know we need help. Plus, even when we know on some level we're hiding our pain, on some level the failure to detect it increases feelings of alienation and loneliness. There's nothing lonelier than nobody around you knowing you're in pain.
Just as you have to ask for help, you've got to reach out. This can be terribly painful until it starts to work. Human contact is intolerable when I'm very anxious and depressed. But human contact helps me see that I'm not as apart as my disease tells me.
In the hospital my roommate was roughly my age, but could not have been more different if a sitcom casting crew had chosen us for an Odd Couple remake. He was an adventurer, a long-haired aspiring rocker, a dude who was used to wearing leather pants the way I wear Dockers. I have a conservative haircut; he had tattoos on the palms of his hands. Our upbringing, our education, our tastes, our relationship history, our ambitions were worlds apart. But when we talked, we got each other. We spoke the same language. I could describe exactly how one of his surges of anxiety would take hold; he could describe exactly how hopelessness would set in with me after a few days of worry. Our good days are nothing alike, but our bad days are eerily similar.
The more I talk to other people with this disease the more I get that I'm not alone. The more I read brave people opening up in public about anxiety and depression — like Wil Wheaton or Jenny Lawson or Larry Sanders — the less alone I feel. I live in hope that if I open up some other people may feel less alone. My disease tells me I'll never feel better; the existence of other people who have survived and thrived tells me that my disease lies.
I couldn't get through this if I couldn't laugh at myself and at the absurdity of it all.
I first recognized this because of golf pencils. You're encouraged to write to loved ones when you're hospitalized. But pens are potential weapons, so they give you the short, stubby pencils that you'd use to score miniature golf. These induce hand cramps but are highly ineffective for suicide. Once a day they'd ask me to sign a promise not to hurt myself, or others. When they asked that they gave me a pen. An oath written with a golf pencil is of mickle might; nobody expects your word to be binding unless it's written with, at a minimum, a Bic. After you sign the no-harm promise they take the pen back, and give you back the golf pencil. One day the cosmic ridiculousness of this struck me so hard that I started to laugh until tears rolled down my face. I do not recommend this as a strategy to get out of a mental institution more promptly.
Human frailty is the root of comedy. My disease is a flaw, a brokenness, and I'll be damned if it doesn't help to laugh at it. This can be disconcerting to others. A dear friend called after I got out of the hospital and asked, very worried, what I was up to that day. "Just hanging around," I said. Beat. "Maybe that's a poor choice of words." The resulting horrified silence was painful. For him. Sorry/not sorry. "The soft-serve machine in the looney bin was broken," I took to saying when people commented on my weight loss. Rather than become socially anxious about whether or not people knew what had happened, I cheerfully probed. If you run into a neighbor in the grocery store, ask them if they know where they knife aisle is. If they twitch, then they know.
We're ridiculous, all of us, grunting and squinting and snorting our way from one end of life to the other. Laughing's the best way to go. It's hard to worry what people are going to think about your disease when you're laughing at it. Laughter is defiance, it's power, it's hope. A thing I can laugh at does not fully control me.
So laugh at it all. Forgive your loved ones their black humor about their condition; it's an effective coping mechanism.
I won't ask you to be fine. Nobody's fine. Be better. Reach out.
The National Suicide Prevention Lifeline at 1-800-273-TALK (8255) is available 24/7. The National Institute of Mental Health has links to many other resources for people in pain and their loved ones. So does the Suicide Prevention Resource Center.
- Today I sent my wife a very nice "thanks for sticking with me even though I'm nutty" bouquet. ▲
- I mean "voluntarily" in the sense of "you can check yourself in voluntarily, or we will check you in involuntarily." ▲
- That's the correct psychological term, unless you have an HMO, in which case it's "nuthatch." ▲
- I only spent a day and a half in the acute ward of the facility. I did not enjoy it. That's a story for another time. ▲