A couple weeks ago, I crowdsourced some questions for some potential mental health experts and this week, one of those questions gets answered by clinical psychologist/advice columnist Dr. Andrea Bonior, who also does about a million other things (see more in the full article). Thanks for all the questions, and I plan to keep getting them answered as long as I'm able!
In the last few weeks, I've been interested in expanding things beyond compiling Depression Stories. There's a great deal of value in these stories, and I'm more than proud to tell them, but I don't want the good they're doing to end once there are no more stories in my inbox.
To that end, I've started up a blog here called The Couch, where we will focus on mental health issues. The goal is that it can be a place where people talk about mental health, be it their own struggles, those of loved ones, stories about mental health, or anything related.
In addition, I want to include expert insights* into mental health, whether it be in the form of articles, essays, or questions and answers. That begins this week.
Andrea Bonior, Ph.D. is a licensed clinical psychologist and the author of "The Friendship Fix." For nearly ten years, she's written the quirky mental health advice column "Baggage Check" for the Washington Post Express. She blogs for Psychology Today and the Huffington Post and teaches at Georgetown, making frequent television and radio appearances. She can often be found arguing for empathy and connection, and against sexual objectification, the commercialization of childhood, and that one type of pen that clearly still has ink in it but craps out on you anyway.
How can I help the therapist help me? I've seen various therapists over the years, and I've always thought it would be useful to have some sort of guide as to the best ways to explain what I want/need from them. So, I guess, a guide as to prepping for therapy so that I get the most out of it that I can - because it's expensive and time-consuming and emotionally trying.
Thanks so much to the reader who pointed us toward this guide (h/t reader Dazzle Me - Ed.); it goes a very long way toward helping you prepare to get your therapy needs met in the most proactive way, and has lots of specific things to think about. The bigger picture, though, is also important, and you have a wealth of history to guide you. Think about your past therapy experiences, and whether there were specific ways that your needs weren't getting met, and what that seemed to stem from. Are there patterns that you can detect? For many, it's feeling stagnant in therapy but not speaking up about it (and ask yourself why: awkwardness? Not wanting to hurt the therapist's feelings? Not having a model for how to be assertive?). For others, it's not knowing exactly what their goals are. And still for others, it's feeling like they're not being as active within the sessions themselves, leaving things unsaid or brushed over, not being able to be completely open. Or perhaps not being able to work out frustrations with therapy going longer than they expected, or costing more than they expected— they feel ambushed, like they didn't know what they were getting into. All this can be made significantly better by specific parameters and goals being quantified in the beginning. On the more positive side, think about the therapy and therapist that worked best for you. If you do better with someone active within the session, spell that out. If you'd rather have more space to talk freely and meander, ask that of a potential therapist. Would you want homework, or would the idea of that be a stressor in and of itself? Do you want to decide when to end, or would you expect a therapist to dictate that? Would you rather work on goals one at a time, or instead dig deep into the soupy mess of how they're all related? Do you want tangible markers of your progress, or is subjective emotional experience and insight enough? The bottom line should be to communicate— to yourself in terms of what you're really looking for, and to your therapist— not only at the outset, but throughout the process. In fact, this very question would be a great one to pose to them as well, so that you can really formulate exactly what working together would look like (and whether they're worthy of what you're looking for.) Good luck!
Thanks so very much to Dr. Bonior for taking the time to answer this question. If you have a question to ask a mental health professional in a future piece, tweet it or e-mail with the subject line, "Question," and it may be used in a future volume.
As always, I have linked to each contributor's full story. Clicking on each name will take you to their full story. I will be continuing to publish Depression Stories volumes until I have no more stories in my inbox; e-mail me your story with the subject line "Depression" if you would like it included in a future volume, and remember to indicate whether you would like your story to be anonymous.
The full archive of Depression Stories can be found here.
*some names changed
I am 34. I have always been over weight and loud and very outgoing. I was just the type of person that probably lived themselves too much and enjoyed talking to EVERYONE. I enjoyed working and dancing and just being constantly active. That is until I started having severe back and neck pains also hip pains. So I started going from Dr. To Dr. Trying to figure out what was causing all of the pain. This was back in 2004. So years went by and my current doctor's still had not pin pointed a specific cause for the pain. But of course they went through all the stages of calling me a liar, saying I was doing it for the attention. They even said I was just too fat and I'd I lost the weight I would be just fine. Well I want ready to really lose weight so I just keep going to the doctors, pretty much harassing them to help me. This went on until 2006 still not really knowing. One doctor said I had bursitisin my hips and a year or two later the same Dr said that it was fibromyalgia. Which was part correct. I did have fibromyalgia in my shoulder blades. The doctors prescribed many different medications. And pain pills. Gradually I was not able to go or and dance anymore. My husband and I started noticing that I was slightly starting to slouch over and depending on if I was trying to be active that day, depended on how much of a slouch I had. Not being able to do all the things I enjoyed doing, even sex was too painful to attempt, depression began to set in. It took away the Casa everyone knew and loved and replaced her with someone who made up excuses not to go out because she was afraid that people would stare at her and laugh because she couldn't stand up straight. She now had anxiety about going to crowded place because she had the fear that she would trip, or that jet legs would give out or even just that because most people don't pay attention to where they are bound and might run into me. Every day in the real world was frightening.
I have survived depression for as long as I can remember. Several times, just barely. I've been medicated, "shocked" with electroconvulsive therapy, and "stimulated" with a vagus nerve stimulator implant – and have a blog that talks about not only my struggles, it also talks about my raising a bipolar son.
I haven't posted to my blog much for awhile as I have been so overwhelmed with so many things to write about – things I recently learned about family members that finally make pieces of my puzzling life make sense – and on so many different emotional levels – that I don't know where to start.
As most of my friends and family know, I have moderate to severe chronic depression.
With therapy and proper medication it can be, to a certain extent, controlled.
It is a disease like any other, and it can kill. If you have any doubts about how crippling mental illness can be (Oh just get over it! Stop feeling sorry for yourself!) the facts leading up to the death of one of our time's finest writers, David Foster Wallace, should change your opinion.
Note I do not claim to have the value in this world that Wallace did. I simply point to his death as one that illustrates what depression is capable of.
The best analogy I have to explain depression, and when I start to slip into what I call 'The Dark Time', is the following:
Your life is a book in your lap. You are curled up on a couch in the late afternoon, next to a sunny window and each day is a page. As you read, though, the passages slowly become harder to see; you cannot focus and the words melt into the pages. The passages you do make out are filled with your faults, failings, and long lists of how you are just not.... Not enough.
Not kind enough, not thoughtful enough, not sensitive enough, not thick-skinned enough, not choose-your-happy-adjective-here.
At first you don't notice. You just keep trying to read, because you know - you have to. It's your life.
But the slow struggle of reading - of living your life - grows and creeps over you, quietly draining you.
You cannot, cannot find a job; even an interview.
You love but the love is not returned.
Your friends want to see you, but you have nothing to offer.
Even the 'Lost Dog' flyer at the corner shop brings you to tears. Time has no meaning, weeks bleed into each other.
To keep reading your book seems fruitless enough that...
a whisper starts telling you,
Just put the book down, Elle.
I was in this place - this very dark place - when I moved from DC back home to Seattle. And I am there again.
I am the life of the party. I make everyone laugh, people enjoy being around me. What they don't know is how I can't stand being around myself. It's odd for me to think of myself as depressed. I have only recently come to terms with how deeply sad I am. How I think nothing good will ever happen to me, how I am completely and utterly worthless. I've engaged in high risk behavior, anonymous sex, cocaine, drinking. Anything to make distract me from how I feel. Anything to make me feel wanted. Anything to make me forget. I'm in therapy now I'm just starting to understand how depression has effected my life, my relationships my choices, it's all a bit overwhelming. I don't have much of a support system, i've alienated my closest friends and I don't feel comfortable in telling my family. I feel so overwhelmingly alone. I have a few other friends but I feel bad about burdening them with what's going on, I feel a large amount of shame. It's hard to explain that the fun loving girl that everyone seemingly adores hates herself and think the world would be better off without her. So I keep it to myself, and my therapist. I understand I have to make changes to my life, eat better, sleep better drink less. Start to take care of myself. But it's really difficult for me to do that when I don't care about myself. I'm tired of feeling this way. I'm tired of hating myself. I really want to be happy but I can't get over that initial hurdle.
I have reached a milestone. I am ofﬁcially working as a full-time artist. This is a dream come true for me. I don't know if it will last forever, but for now, it is just really incredible. I think it is a good time for me to sit down and reﬂect on this new achievement. I feel incredibly lucky to be living the life and working the career that I have dreamed of since I started making art about 12 years ago. In just 12 years I have achieved what I thought was actually impossible, what my teachers in undergraduate school told me was statistically limited to a small percentage of students. Something like, only 5% of art students continue making art after they graduate, and only 5% of that 5% continue making art for the rest of their lives, and only 5% of that 5% make a living off it. Ok, I don't remember if those numbers are accurate, but it was something ridiculous along those lines and I felt my chances of being a full-time artist were pretty slim to none. I even felt silly telling my family members at our annual family party what "I wanted to do" with my life. So, I kept it to myself and secretly hoped it would happen, and just kept working at it.
I'm so lucky and so completely shocked that it has happened. I can live off of my work and it feels incredible. It might not last forever or sustain itself, but I'm having a pretty fun time with it for now. So, how did this happen? I could be completely selﬁsh and say something generic like "I worked really hard and never gave up." Sure that's partially true. Another huge help is from the support from the community I am a part of. My mentors challenged me to be a better person and a better artist. My colleagues have given me amazing opportunities, showed my work in their apartment galleries, wrote reviews of my work, and have been in general amazingly supportive. My parents have always supported me even though they know how hard it is to make a living in the arts and just wished I was an engineer already.
But really, none of this is what I ended up thinking about when I sat down today to reﬂect on this. A much bigger obstacle that I have only recently started to overcome, which I have struggled with for as long as I can remember but rarely if ever talk about, is depression. I want to talk about this because I think it's something that people silently struggle with, and it seriously gets in the way of living out the life you want to live. It also can go completely unnoticed and effect people who seem otherwise happy, who have supportive communities, families who love them, and friends who care about them.
I don't think it's any small coincidence that I started to seriously make strides in my art practice at the exact same time I began to manage and overcome my depression. Many people who know me are very aware that I have struggled on and off with anxiety for most of my adult life. This was something I was always relatively comfortable talking about. It also showed in very physical ways. There was a time many years ago that I lost a ton of weight, dropping down to a mere 115lbs (my normal weight is 135lbs). I looked and felt awful, and my family and friends were worried for me. It was after that episode that I started talking about my anxiety more freely, and tried therapy and other options for managing it.
What I didn't ever talk about was the depression that went hand in hand with my anxiety. I never told anyone that I would spend entire days in bed because I couldn't bear the thought of starting the day. Or that I spent a whole three nights in a row ruminating over a full bottle of pain killers. I never told anyone that I stood over a bridge of deep water imagining what it would be like to blissfully jump and be swallowed by the blue depths. I never told anyone that I would stay up into the early hours of the morning planning and researching ways to gracefully exit the world without inconveniencing my friends or family, or think of kind ways for the person who would ﬁnd me to be less disturbed. Never told anyone about the suicide hotline I tried calling but hung up before anyone answered because I was too afraid to say out loud to the person on the other line that I probably need help.
My depression is my most frustrating flaw, and I can't seem to shake it. It sucks out all my motivation and enthusiasm for anything, so I feel like I'm in a constant state of boredom and apathy, even when I know I have something important to do, like my degree. I'm going to graduate soon and I have my dissertation and exams but I can't force myself to work because I feel like I don't care, but then I lie awake at night worrying about it and internally screaming at myself for being so lazy and useless. I go in and out of therapy, but in this country you can only get access if you're a danger to yourself or others, and it never really seems to work for me.
I often blame my depression on the sexual abuse I went through as a teenager, but if I am honest to myself I have to admit that it was always there before that. I was preyed on because I was vulnerable and I was vulnerable because I was depressed. I felt worthless, so I agreed to do things I didn't want to do. I have it easier than a lot of people; I've never seriously attempted suicide, although there were a few close calls, and my low pain tolerance that during my attention-seeking teenage years I never quite managed to get the full 'identity' of self-harming emo. I didn't really have any identity at all really, I could never put the effort in to cultivate a style or a passion for anything, and I went in and out of different friendship groups often, and dramatically.
What I do have is a lot of self-hatred, and doubt. I have always doubted myself, and since puberty it has developed into actual dislike for who I am. Sometimes I can't help lying to people to cover up things I have done, to make me look like more of a victim, even though it's unnecessary because it's not like I've done anything bad in my life anyway, I just feel like I have to justify why I feel sad. People don't understand and they get frustrated and think I'm ungrateful if we're trying to do a nice thing or whatever and I just sit there looking blank, so I feel like I have to convince them that it's because of this horrible traumatic sexual abuse I went through when I was a teenager, when actually I just can't summon up any kind of emotion.
I don't think people realize what it's like to have both depression and anxiety. Imagine feeling a nagging worry about your life: you don't have enough friends, you don't work out enough, you don't have enough to do outside of work, you hate your job, you feel like you need to escape your current situation into something better. Then when you try to remedy it, the depression kicks in: listlessness, apathy, fatigue. This cycle continues until you break through at least one of them.
The meds don't seem to fix the real issue, but mask them with their own problems attached. My last experience with an SSRI left me with two emotional options at any given time: frustrated or not frustrated. It's scary because this is how someone with an anti-social personality feels. I know I'm more human than that, yet I can't function well with all the emotions I have when not medicated.
However, I will say that I have been in much worse places in my life. I never tried suicide or even thought about it seriously, except almost once in college during a rough period in my winter SAD depression. I was able to logically break through that moment in time, and I am grateful for that. My freshman year of high school I was diagnosed with OCD and became crippled by it. I went to cognitive therapy and it helped very much by giving me tools I use today. My junior year, I developed agoraphobia and was on home leave from school for a few months. However, in the end I was able to go back to school by gently pushing myself to face my fears. I was lucky in college to not have any anxiety issues, really, but that seemed to leave a void that depression felt welcome to fill. Now, my post-graduate life has a mix of both. In my experiences with these horrible, horrible times, I learned that a combination of medicine and therapy can be helpful. It's definitely never easy: there is not an easy way out. And suicide is never an easy way out, although it may appear so at times. I find strength in knowing that I've been able to challenge my disease and that I can do it again. I know I will struggle another day, but I also know I will rise about it once again. Through it all, I am an optimist at heart: some days it's just harder to see.
Please help me. I am 37 and have suffered with depression for years. A little over a year ago I had a major depressive episode that landed me in the ER, unable to form words. I couldn't remember how to do simple tasks.
After therapy and medication changes, I found out I was unexpectedly pregnant with our third child. I chose to go off of medication because of potential harm to the fetus and we welcomed with joy our beautiful baby. In the midst of the depression and pregnancy I left my job to care for our older children and spend time with the new baby. This went extraordinarily well. I lost weight, I felt good about myself, my marriage and sex life improved tremendously. But we were financially strapped and facing possible foreclosure of our house. I returned to work at the beginning of the year, making very good money in a job where I am doing well and am respected.
But I have very recently felt the depression creeping up and I think I am losing my mind. I am convinced that because my children are happy, healthy and beautiful that something terrible is going to happen to them. I am convinced that because I love them so much and can't live without them that I will lose them. I also know- not think, I KNOW- that I am an awful mother and they deserve better than me. The smallest setback at work makes me feel like a colossal failure. Worst of all my second child is extremely similar to me in temperament, and I can see in her already that I may have passed this awful disease to her to live with.
What do I do? I can still function fine for a week or so at a time but I then unravel completely, crying hysterically, rocking back and forth and talking to myself. That seems to act as an outlet for whatever is brewing inside of me and then I can go on until it starts to boil over again a little later. I have managed thus far to keep it hidden from my wonderful, loving and understanding husband. He deserves a normal wife and my kids a normal mother. Not this mess.
I feel like I am hanging from a cliff and some days I am able to pull myself up and other days I am clawing to hold on, but the pit is always there, looming. No end in sight. Even the pit is bottomless. No way to get fully back on solid ground. I don't know what to do. I don't want to and I have no intention of killing myself. But I want to disappear. I want to run and never be found again.
What is wrong with me? This isn't "normal" depression. I don't hear voices or have delusions, but during the episodes I am not what I would consider lucid. It is like I have to descend into the pit of madness for an hour or two to emerge sane enough to manage the rest of my life for another week or two.
I can't lose this job. Should I leave my family to move on without me? My daughters are young and don't know what's wrong and if I leave know they may not ever know how sick I am. I can't expose them to this. I'm it. I'm the bad thing that is going to happen to them. To watch their mother descend into madness. That is what is going to happen. I would never hurt them, never ever hurt them but isn't letting them see this hurtful enough? If I leave now they won't understand and someone will tell them I died or was dying and they will understand it wasn't something I could fix and I spared them the agony.
When I was a kid, my big brother had to go to therapy once a month to help him with what I eventually learned was an eating disorder, as well as depression. A decade later, and he's my favorite person in the world. He's also the main reason why I've never seriously considered killing myself.
My entire family, my mom, dad, and brother, all have anxiety issues or have clinical depression. I don't want to tell them that I'm having the same problems, because a. treatment is money, and b. I don't want to make them feel like its their fault, or give them more to be anxious about.
I started self harming after my abusive boyfriend of about a year finally broke up with me and stayed away. I didn't realize he was abusive until my mom pointed out that he should NOT be making me feel like I'm not good enough. It took me until a month afterwards, after I already started cutting, that when someone says to you "if you really loved me, you would do (thing that makes you uncomfortable. I could find another girl that would be willing to do that if you don't want to." he made me feel like I was worthless, and that paired with a whole host of other things happening in my life just made me feel like I wanted to go to sleep and never wake up.
I started cutting instead, and most of the people that caught glimpses of the cuts told me that they were there for me, they would help me out. They kept their word, and I wish I could thank them all in this post, because I know it'll be a while until I see some of them again.
I stopped cutting because my brother almost caught me one day. I always wear long sleeves around him, but I don't think he knows that's why, because I'm a generally chilly person. I don't want to hurt anymore, but the only thing I want more than that is to not hurt my favorite person in the world.
My depression started when I finally acknowledged that I was sexually abused as a child. After completely blocking it out for 6 years, when I turned 16 I realized the truth. The realization sent me spiraling fairly quickly. Sleeping is nearly impossible. I'll go almost an entire week on 13 hours of sleep. My nights are spent desperately trying to occupy my mind with Disney movies. It takes serious effort to stop myself from overeating. Getting out of my bed for school is a fight. On the weekends, getting out of bed rarely happens. I hide my depression from most of my family, from my track coach, from my friends. One of my oldest friends is slipping away because I can't even make myself reply to her text messages.
I go to practice and school and act like everything is fine. But inside I'm empty. There's absolutely nothing. I can't handle life, I can't handle my emotions. I spend countless hours in my room trying to sob quietly so my family won't hear, punching a pillow over and over. I can't tell you the last time I got a good night's sleep. I can't make decisions. Everywhere I look people are enjoying high school saying how this is the "time of their life." Most nights, I just wish mine would end.
I recently started seeing a therapist to cope with the abuse. I told my mom about what happened when I was a child, and she's been extremely supportive. But she just doesn't understand my depression. She tells me I don't sleep at night because I choose not to go to bed. She tells me I eat too much because I don't have will power. She yells at me for not doing simple chores like the laundry because she thinks I'm being lazy. I know my mom loves me and only says these things because she doesn't understand, but it makes me feel like an over dramatic fool. There are times when I feel like I have no right to be dwelling in this awful emotional state because I've convinced myself the abuse I endured wasn't that bad. When my mom offers over simplified explanations for why I can't function, she legitimizes my feelings that I'm not allowed to be depressed.
I never imagined I would be battling depression in high school. My family has the belief that medication is rarely necessary and is for the weak, but each day I feel myself slipping further away. Every day, dragging myself from bed becomes more difficult. If I don't get this under control, I'm not sure what shadow of myself I'll become. I'm not even sure I'll be able to keep living.
Joshua David can be found on Twitter at @joshuaadavidd.
Image via Jesús León.
*while our experts are knowledgeable, this is not intended to be advice for any individual or a replacement for individual treatment. Contact someone at one of the above resources for individual treatment.