Amy Winehouse

So another celebrity (by social standards) dies, and everybody has an opinion. People who didn't even know this woman are saying things like "she was an addict and was asking for it", "she was sick and died of her disease", "celebrity got the best of her"....

Who are we to decide this?

There probably is truth to all of those, but the real question is this, WHERE WERE YOU?

A lot of the same people who criticize and even those who sympathize with Winehouse's plight are the same people who openly take enjoyment in the shenanigans of Charlie Sheen, Paris Hilton, and Lindsay Lohan.

It's all fun and games until some dies isn't it.

Where are you when someone close to you has those same issues?

When someone close to you succumbs to substance abuse or mental illness, do you have the absolute reason why it happened, or is it "different"?

Do you ask yourself "Where was I?", or do you victimize yourself by thinking "why did this happen to me?", and justifying yourself with "I just didn't know".

"IT" did not happen to you but to them, and you "should have known".

As a society we all know that Amy Winehouse dug her own grave, but as individuals we excuse ourselves as "not knowing".

Why do we "not know" when it hits close to home?

Humble recognition

Sometimes recognizing a person's depression can suffice to help them, even if temporarily.

Some of the reading I'm currently doing makes me feel better as it acknowledges depression as a disease we know very little about, in fact we know A LOT LESS THAN WE LIKE TO THINK WE DO.

That last part is the most important part; the recognition must be done with the modesty that we do not know.

The all too common patronizing "recognition" which goes something like "I haven't had it so I don't know" (IE. "We're not interested, just get back to functionality and we can all forget about it.") is hollow at best, disingenuous at worse.

To recognize that someone else is suffering something we do not know and that our concern is two-fold:
A) That the person is suffering.
B) That we are ignorant about that suffering, and that that ignorance is a faultof ours.

Pretending we know what depression entails and how to "treat" it in order to make the sufferer feel better can often have the opposite effect, because the simple "go see your doctor - take some meds - do some CBT - get more active - socialize more" is just that, overly simplistic. The simplicity of it can make the depressed person feel even more depressed.

Taking meds, doing therapy, getting active, and socializing doesn't take away that a person may genuinely feel depressed about things like the dysfunctional world we live in, about how their life (as active and social as it may be) does not make them content.

So yes, depression is a disease with biological components, but it is much more than that, and that much more is what we don't know.

Manufacturing Depression - By Gary Greenberg

Is a fascinating book which looks at the history of the disease we know as depression.

Greenberg details how the "scientific" community (in)directly with pharmaceutical companies purposely strayed away from Freudian-style analysis in diagnosing depression because of it's "unreliability". (IE. One man's self-criticism is another man's self-awareness.)

In order to give psychiatry it's proper place in "scientific" medicine (and pharmas to make profit), they came up with "Reliable criteria" which defines (and diagnoses) a person who is truly depressed.

One of my biggest beefs has long been the simplicity with which depression is diagnosed and treated. It is commonly held by medical professionals (who consider this "scientific") that the best treatment for Major Depressive Disorder is for the patient to regularly take their prescribed medication and goes through Cognitive Therapy.

My beef with this is the over-simplification. Taking anti-depressants and "changing my way of thinking" does not address philosophical questions like what consists contentment and "happiness".

A person may not feel "happy" despite having a "normal life". Many a lay person does not (or chooses not to) comprehend this (IE. "There are lots of people "worse off" than you, therefore you SHOULD be happy).

As for modern "scientific" psychiatry and psychology, the person is clinically depressed if they have 2 or more of these symptoms for 2 or more consecutive weeks:
- depressed mood (such as feelings of sadness or emptiness).
- reduced interest in activities that used to be enjoyed, sleep disturbances (either not being able to sleep well or sleeping to much).
- loss of energy or a significant reduction in energy level.
- difficulty concentrating, holding a conversation, paying attention, or making decisions that used to be made fairly easily.
- suicidal thoughts or intentions.

Listening to a list of symptoms and diagnosing is relatively easy, listening to what TRULY MAKES A PERSON UN-HAPPY is a little more difficult, so by calling it "un-reliable", the "scientists" wiggle their way out of the tough part.

In the book, Greenberg elaborates on the rise of psychiatric medicine in the past 100 or so years as well as an entire chapter on Cognitive Behavioural Therapy (CBT) which he doesn't dismiss, but makes it clear that the "scientifically proven" tag it attaches to itself is not quite accurate.

Acceptance

Acceptance is often presented as an easy catch-phrase answer when we don't know what to do.
"You lost your job?, just accept it and move on."
"Someone lied / stole / hurt you, just accept."

Of course dwelling on past events is not healthy, but neither is just "accepting" without dissecting said event and resolving it (as much as possible) in our hearts and minds.

For the depressive person, "accepting" negative outcomes often turns out to be unwarranted self-criticism.

Sometimes losing a job, getting lied to, getting robbed, or hurt is NOT the victim's fault, and "simple acceptance" that "nothing can be done about it" becomes "it must be my fault / I must have done something wrong..."

As much as the situation can not be modified, how we see it and judge those involved can make all the difference between truly moving on and simply "accepting".

Using the Internet (and social media) in a healthy manner

Below is a link to a recent interesting article on how social media may exasperate depressive symptoms in those who are already prone to depression.

The gist of the article is that social media's (mostly Facebook) "skewed view of reality" may make an already depressed person even more depressed.

Seeing others have more "friends", posting positive (whether true or not) status updates, posting pictures of having fun (as if it's a constant) (can) make a depressive's symptoms worse.

Have you experienced "Social Media Depression"?

Felt the need to have your life be better due to others' Facebook profiles / statuses / pics?

How would you suggest a person deal positively with depression while at the same time using Social Media in a healthy matter?

http://ca.news.yahoo.com/facebook-depression-among-harms-linked-social-media-sites-20110327-211050-004.html

Who knows best?

If you want advice on bringing up children, ask someone who's never had any they'll tell you everything you're doing wrong.

The same applies to depression, if you suffer just ask those who haven't had it, they have all the answers. The best one is still "I haven't had it so I don't know" (IE. "I don't believe you".)

Of course I'm being facetious. People always want to appear knowledgeable, but when we don't know (or believe) something it doesn't mean it doesn't exist or isn't true.

Having an opinion is absolutely acceptable, but with it comes responsibility (a word very popular with "know it alls"). True responsibility includes respect; respect for others opinions, feelings, and realities (which are different than ours).

This entails (on a deeper level) that responsibility requires humility which is (unfortunately) not a very common trait.

The person who has never experienced depression has the responsibility (although rarely the behaviour) to accept their ignorance without dismissing the reality of depression.

Am I whining? In the eyes of many, absolutely.
Do I care? No, because their ignorance is bound to show elsewhere.
Am I better than anyone? Definitely not because I don't know half of what I think I do.
Am I worse than others? Of course not, we all have our failures.

When I'm tired

Depression brings people down and when you’re down, you’re tired.

One of the most common (yet misunderstood) symptoms of depression is fatigue. In my depressive episodes I was often extremely tired and people around me did not seem to understand that.

Although most non-depressives say the right things about depression (IE. “We know it is real”, “you are suffering”), the acknowledgement, and proper understanding of symptoms is extremely rare.

When I was (it still does occur) tired, I knew it was not “normal” to be that tired, but also that this fatigue was not just a simple case of short night’s sleep, change in schedule, or any other common reason. Depression was (coming) back, and getting (extra) rest would make me stronger to face it (depression) the next day.

I have tried “toughing it out” and ended up unable to leave the house for three days.

Unfortunately our society’s over-preoccupation with getting things done “yesterday”, the person who takes a day off from work, school, or any other activities is seen as weak or low-functioning. Of course when said person does make the effort to get up and go to work / school, the effort is not recognized, but if they indeed over-exert themselves and end up with another serious sickness, they are practically made out to be guilty of “not taking care of themselves”.

I have read articles about how taking time off work can be beneficial for both a person’s mental and physical health. Unfortunately, most employers (that I have known) treat absenteeism like it was the plague. Openly criticising an employee’s absenteeism rate by comparing them to others, and holding it against them in performance reviews even when they (the employer) have been made aware of the employee’s condition.

Luckily (or not), this is not (usually) the case for employees with organic illnesses, but when it comes to depression and other mental illnesses, the prejudice is still very prevalent.

What have you done for me lately?

People are often “proud” of those who suffer from Depression when they (the sufferers) are doing something for these others or at least not being a nuisance.

The number of people (employers, family members, friends, and others) who say they “understand depression” and “do what they can for people who suffer from it”, yet where are they when the person is suffering?

It’s easy to “understand” and “help” someone when they are doing what we consider “normal”.

What about when the person is sick? Only helping people “when they help themselves” is weak. True “help” occurs when it is needed.

It is common knowledge (and if it’s not, educate yourselves) that depression sufferers know themselves better than anyone else. If that is true (or at least believed), how come people are so quick to criticize when a depressive passes up on an invitation, or takes a day off work?

Would we be as critical of the cancer patient or AIDS sufferer who had the same behaviour?

Medication

In Canada, antidepressant medication is the most prescribed medication, and for good reason....People are depressed.

The question I'd like to raise is whether antidepressant medications (SSRI's being the most common) truly help people live happier lives or if they help people be happy "enough".
My experience with SSRI's has been so-so, and not because of the medication itself (IE. It never made me exuberant, but I've also never had significant negative side effects).

The first time I was prescribed an antidepressant, I had no clue I was depressed, went to a walk in clinic and the doctor (seeing me for the first time and I was in the office maybe 10 minutes) prescribed "Fluoxetine". It sounded good that a medication good be prescribed, but when I got home (and yes, I should have done this at the doctor's office which I now diligently do) I looked up "Fluoxetine". It's Prozac.

The fact a doctor (who knew nothing about me or my previous history (medical or otherwise)) prescribed Prozac truly through me off. How dare he medicate me for depression when he knows nothing about me. Would he have sent me to chemo if I'd said I'd smoked for 10 years?

After a couple more prescriptions (Paxil and Effexor) which I took A) Reluctantly and B) With false hopes, I didn't get much better.

Back on Effexor I am much better, but I also had some talk therapy, group therapy, a better understanding of depression, and solid relationships in which I'm comfortable discussion my issues.

I believe I will be depressive my whole life, but not necessarily depressed.

Medication helps stabilize my mood and my functioning, but it's talking about it with therapists, family and friends, blogging, looking inwardly, and understanding myself that makes me happy.

Where were you?

Have you ever felt the urge to tell people they were not "there" for you? Did you feel they were actively present when you really needed them?

Worse, did they become present when you were better and somehow take credit or make you feel inadequate?

In our society which calls itself open and accepting are people genuinely available when needed?

Do people just "not know" or do they choose to "not know"?

What makes you depressed?

Do you get bored, angry, and eventually depressed by repetition? I know I am.

I recall going to the doctor's (same doctor!!), and I would be asked the same questions I had the last 10 visits ("Do you want to harm yourself or others?", "Do you find enjoyment in things you used to?", "On a scale from 1-10 where would you put your happiness?")

If this is the criteria for "treating" depression, why aren't sufferers simply given a set of questions they can review every four weeks?

How can anyone claim medically "treating" someone if all they do is ask the same questions and interpret the answers?

Freud has been dismissed because he was not "scientific", how is today's psychiatric medicine "scientific"?

Just don't be a nuisance

This morning at a neighbourhood coffee shop I overheard an interesting conversation between 2 scruffy looking men. One asked the other "are you still clean?", the second answered "yup, going on 7 months", the first congratulated him. They went on to talk about work, the first man saying he was working construction 7 days a week, when the second man said he was looking for work, the first said he would see with his employer if they need extra help and hopefully they would have work for his friend.

As ordinary and common as this conversation probably, it lead me to think about social expectations.

What first hit me is the hypocrisy of our society which would appreciate how these 2 men have straightened out their lives, yet where were we (society) when they needed help?

At a deeper level, I recognized that socially, we don't care that these 2 men might still be going through difficulties financially, work wise. That they don't really have choice about what they do for a living, they have to take the first thing which comes along. When they do, they will be expected to be grateful. As if "doing something", regardless of what it is, how (un)important, or boring it may be, is all that's important.

What matters to us a society is not that people have happy, fulfilling, and complete lives; we only don't want others to be a nuisance.

So in order to function in our society, one must simply "not be a nuisance". Not very mtivating is it?

How to think is not What you think

I touched on this on a previous thread, but How one thinks is different than What they think.

Cognitive Behavioral Therapy (CBT) is extremely beneficial in how it teaches a person to change their "way" of thinking, but it doesn't changes their thoughts themselves.

For example, when I began therapy I was extremely angry and told the counsellor "I'm angry because people don't do enough to genuinely help people with depression".

I learned through therapy that my way of thinking was flawed in that I let my anger prevent me from moving forward. That doesn't mean that WHAT I thought was wrong;people do not do enough.

What is important is that what we think is not wrong, it may only need to be re-framed.

How adapting and functioning are not enough

I recently completed reading a book which I purposely am not posting the title of since it can be interpreted as controversial and that in itself may influence people's opinion (positively or negatively). On practically every page I would go "that's exactly what I've always believed". I never sought a public platform per se, but even getting people to just listen (never mind understand or agree!!) has been excruciatingly difficult (IE. Impossible).

This reluctancy of others to listen has partially lead to a long-standing bout of chronic depression. I refer to this as my "existential depression".

Perhaps people don't want to hear me because it's not very "positive", maybe it's "too deep" for them, or maybe the truth of their own fallibility makes them uncomfortable.

Regardless, my pre-existing depressive condition has been magnified with this (perceived by me) lack of understanding / caring by others.

I control my condition through various ways such as medication, counselling, and educating myself about it, but there still seemed to be something missing.

Reading this book has helped me understand that I'm not "wrong" in my beliefs, just that they are not commonplace, and that most people are uncomfortable hearing such truths.

Reading is therapeutic. I have done hours of Cognitive Behavioral Therapy (CBT), which basically helps a person change their throught process. CBT has been extremely beneficial, but it strictly targets "How you think", not "What you think (and truly believe)".

It's very easy for me to think "I live in an industrialized country where corporations and money influence / decide how people (ought to) behave; therefore I simply need to adapt to that and I'll be "happy"".

My "problem", has been that I go further and say "but that is wrong, and if I "adapt" to (what I believe is) a wrong, that doesn't make me happy, it actually makes me feel worse".

The therapeutic part of reading (this particualr book) is that it confirms that I'm not "wrong" (nor alone) in my beliefs; that other people belief very similarly, in fact (some) get published and have public forums (IE. They fucntion).

So what do we talk about?

The previous post may have left some of you wondering what I suggest can be done in order to make mental illness a less touchy subject of conversation.

Let me begin by saying that it will always be a very delicate topic, and needs to be addressed as such. Just like talking about cancer and other serious illnesses is not pleasant, it is still important to discuss these matters without feeling like we're an alien.

So if we don't talk about mental illness as being "stigmatized", what do we call it or how do we approach the topic?

Very simply by talking about it for what it IS, not what it isn't!!!

I will use the example of depression since it is so close to me.

Depression will affect 1 out of 5 Canadians in 2010 with varying degrees of severity. Some won't be able to leave their house for days on end, while others will be able to function normally despite it. The vast majority are somewhere in the middle.

Depression can not be diagnosed the same way as organic diseases (IE. You can't take a blood test or urine sample for diagnosis), but several physical and emotional symptoms occur in most depression sufferers, and through these we can establish diagnosis.

Since diagnosis is based on "experienced" symptoms, and patient recognition of these symptoms, diagnosis can often be off the mark. This explains in part why some patients may have medication and dosage changes. For other mental illnesses, correct diagnosis is even more difficult.

Many people suffering depression will often concurrently suffer one or more other mental illnesses, most commonly anxiety (under it's various forms), and/or substance abuse.

Which came first, the depression, anxiety, or substance abuse is not important, what is important is proper diagnosis of what ails the person and follow treatment accordingly.

Some form of depression is also very common in most other mental illnesses (IE. The average bipolar person will be depressed 70% of the time as opposed to 30% of the time in manic phase). Schizophrenics also have periods of severe depression, but theirs is part of schizophrenia.

Now most people suffering from unipolar depression do manage to function normally in society, some with the help of medication, counselling, some not. Each case is different.

Depression is a very common ailment, it affects people of both genders, all races, and all age groups. Some symptoms will be more prevalent in certain groups of people, but again these need to be taken as one (potential) piece of a very large puzzle.

That, in an extremely brief summary is what depression is.

Was that so difficult?

Ask the right question

I've often been amused by the statement (often used by "Positive Psychologists") "You're just not asking the right questions".

what I find amusing is not the idea of searching for the source of a problem, but rather that there's discrimination in how a person goes about it.

A prime example is a depressed person; in positive psych, the question they would see fit is "what can I (depressed person) do about it?". As well intentioned as that is, it omits to ask "Am I depressed (or is it something else)?", "Why am I depressed?", "Have I felt this way before?"...

To the "positive" crowd, these questions may seem irrelevant, redundant, and a waste of time, but how can one truly access the root of the problem without asking those questions?

Simply asking "What can I do about it?" doesn't get to the root of the problem, it actually promotes avoidance (IE. I'll occupy myself and pretend "it" isn't there).

Asking the tougher questions such as "am I depressed?", or "Why am I depressed?" are precisely that, tougher, but also truer.

I thought of this topic not specifically in regards to depression, but more social issues. One issue which is close to me is homelessness since it is often related with mental illness.

When you see a homeless person what question do you ask yourself? Do you ask "How can a person bring themselves to that?" or the tougher "How does the society that I belong to accept this for it's own citizens?"

I'm sure there's tons of other questions, some tougher than others, but next time you start asking questions, maybe the first one should be "Is this the TOUGH question?"

Selfishness

A difficulty I have encountered which has contributed to my depression is the mixed message in our society about selfishness and altruism.

As a general rule, selfishness is defined and portrayed as being negative and not something that one wants to be (or be known as), yet when someone is going through difficulties, it is often said that they need to "help themselves" (IE. Be selfish).

In fact, the entire industry of popular "psychology" is based not on generosity and altruism, but rather on selfishness; it's even called "Self-Help".

I've often heard people say "So-&-So, he's just TOO NICE a guy". How can someone be "too nice"? None of us will ever be half as nice as we can!!!

The difficulty I've had is when at times I've be nice, or generous (perhaps naively), I was actually criticized. That just did not make sense to me. In my mind, I was doing it in good faith, and for a good reason. Whether the (hoped for) result was reached or not was not the goal, I just wanted to help.

It would make me depressed to realize that I couldn't even be nice!! I did what I thought was right, and still got shit, how useless am I!!!!

After this happened a few times, I got less enthusiastic about being nice or helpful, and then I was accused of "selfishness". This in turn also made me depressed.

The most depressing part was the contridiction which (in my mind) was "whether I do something nice or whether I don't, the result is the same (criticism)". That left me depressed that I didn't do the right thing either way, and more importantly, that there was no "right thing" I could do.

What are we waiting for? Continued...

Below is an article explaining the recent suicide of singer Marie Osmond's 18-year old son who was suffering from depression.

What kind of society are we that we just accept such tragedies, and even comfort (IE. Bury our heads in the sand) ourselves by thinking "it can't happen to us"?

Is it more/less important because it happened to a celebrity, of course not. The celebrity aspect is strictly because that's what we, as a society, want to hear about.

What is important is that depression kills, but it also treatable (as long as it's not made out to be something to be ashamed of!!). We ALL need to educate ourselves on what depression is, and how to cope with it.

Whether a sufferer or not, it is EACH AND EVERY ONE OF US' responsibility to be courageous enough to overcome our misconceptions about depression and mental illness, and finally be cognizant of what it really is,, and what we can do to combat it and prevent future events like this one from occuring.

http://ca.news.yahoo.com/s/reuters/100228/entertainment/centertainment_us_osmond

What are we waiting for?

Below is an article on the recent passing of Andrew Koenig, actor and son of Star Trek actor Walter Koenig.

The story explains how Andrew was suffering depression, and it is what eventually got the best of him.

The Koenig family did what they could, but the limited available services made it impossible for Andrew and his family to make the seriousness of the situation known.

This must not become another "sad story" and be left for not.

Depression is real, it kills people, and does not discriminate; men, women, young, old, rich , poor.....And we are all victims, whether as sufferers or friends / family of sufferers.




http://ca.news.yahoo.com/s/capress/100225/entertainment/koenig_disappearance

Stigma (continued)

Back on December 7th 2009 I wrote about the use of the term "stigma" in relation to mental illness (specifically depression), and how it's a euphemism for "shame", but sounds much better.

Today I would like to further the topic of the use of the term "stigma", and how it relates to other facets of depression.

Numerous articles and publications suggest that depression manifests itself differently in men and women adding that "Male Depression contains an extra stigma" (IE. Cultural gender bias). Once again, the word "stigma" sounds better to the ear. Synonyms of "stigma" in this context can include: "gender bias", "unfair disadvantage", and "inequality". Use of these terms (for male depression) would never be accepted.

Another part of mental illness and depression which is stigmatized is compliance (The word adherence can also be used). Compliance is defined as "The degree to which patients follow the medical recommendations of practitioners."

Compliance of mental illness and depression medications is judged much more severely than any other conditions. The person with lung cancer or emphysema who continues smoking, the person with high blood pressure who continues to drink heavily, not get regular exercise, continue eating a high fat diet, even not take their medication will likely get reprimanded, but they will not be portrayed as "weak-willed", or "just not wanting to help themselves".

Also, the idea that psychiatric medications are "more important" than medications for other conditions is false. The diabetic who misses his insulin is at much higher risk than the depressive who misses his anti-depressive medication or even the schizophrenic who misses his lithium.