You don’t need empathy to support a depressed person

When a friend was hospitalized for appendicitis, people flocked to visit him at the hospital. When I was clinically depressed, some who knew it avoided me like the plague. But I completely understand — it’s natural for us to be afraid of the unfamiliar, including unfamiliar illnesses. And when it comes to depression, people are wary not because they are afraid it might be contagious (hey, many don’t even recognize it as an illness!), but because they are afraid of saying the “wrong” thing.

A friend once apologized to me, “I’m sorry I haven’t been reaching out to you or being there for you. I’m not like J — I wish I were, but I’m not. But know that I’ve been praying for you, okay?”

At the time, I smiled and told him not to worry about it. I read between the lines and I read his facial expressions — I knew what he was saying was that he wasn’t good at empathizing and didn’t want to do or say things that might end up aggravating matters. We exchanged hugs and parted ways for the remainder of the academic year. But that night I wept in my room. I wasn’t sure why at the time; I cried over the silliest things after all.

I know why now. I felt abandoned by a friend. Sure, he wasn’t my best friend, and I did have other close friends who were walking the journey with me, but when an individual walks out on your life, his/her absence can’t be compensated by quantity. The next time I saw him, it would be the beginning of a new academic year, and I’d have already recovered over the summer. We hung out again and were friends once more. This was no isolated case. It happened again, and again, with different people.

ozzy

But my friends are not bad people. They are wonderful people. They did not stop being my friend during depressive episodes because they were tired of me. In fact, I don’t think they even intended to stop being my friend. And I’m sure they believe they were doing what was best for me. From their point of view, they were temporarily stepping out of my life so someone more “qualified” could step in to take better care of me. Someone who would have the right things to say, someone who perhaps have gone through the same thing I was going through, someone who could give good advice. Basically, someone who could empathize.

And yes, I wished I had people in my life who fit the above descriptions, and I was indeed blessed with at least one such individual, but it didn’t erase the deep pain of being “left behind”. And one thing I’ve come to realize over a few cycles of depression is this: depressed people don’t need you to empathize; they just need you. A depressed person would rather have you say all the worst possible things, rather than not have you at all.

It is very difficult to understand what a depressed person is going through. That is an inescapable fact. But even a fellow depression fighter/survivor would not be able to understand completely, since disorders of the mind affect each individual as uniquely as his mind is unique.

But a general common theme is that the depressed individual experiences and perceives a reality different from that of the non-depressed individual. I remember despairing not because I didn’t know if I would ever recover, but because I came to believe there was nothing from which to recover. I didn’t believe I had a negative cognitive bias, but believed that it’s others who had a positive cognitive bias, while I saw my existence for what it truly was.

Loved ones of those who are depressed, you have a very tricky and very important task of holding their hand and walking together, even though you are walking in different realities, until you are once more reunited at the end of the tunnel. This is very important because they need to be walking with someone who can see the light at the end of that tunnel. If you choose to wait to greet them on the other side, what if they never make it there?

Someone very dear to me had no experience whatsoever with depression. He bought himself a book on the topic (The Catholic Guide to Depression, which I’ve recommended multiple times in previous posts) in an attempt to understand what I was going through. It’s safe to say that even after a year, he never came close to understanding, but what mattered was that he never stopped walking with me. He never got tired of me even when I got tired of myself. And he never stopped believing that God would deliver me even when I’d lost all hope. You have my eternal gratitude.

How do you maintain your grip on reality?

About a year ago, I wrote a letter to my future self. It was barely three months after what had been my debilitating bout of depression to date, and I was a little nervous. To realize that for eight out of twelve months I could have been so wrong about so many things, so blind to so many truths, so caught up in the half-lies of my distorted reality — it was a world-shattering realization. (In my previous post, I write in greater detail about the distorted thought patterns of a depressed person.)

I say world-shattering because most of us grew up being told to believe in ourselves, that if we believed something about ourselves then that’s true. Or at least, that what we see in ourselves is supposed to be more valid than what others see in us. Never let anyone else have the final say. They are but naysayers. Trust your heart. 

I was finding that that wasn’t so great of a mantra to live by. In my depression, I believed that what I had was not a treatable illness, regardless of what anyone told me. I also believed God had either abandoned me, or He simply hated me, regardless of what anyone told me. Because it sure seemed that way to me.

I remember being 15 or 16 and watching supermodel-turned-talk-show-host Tyra Banks instruct the teenage girl on her show to “go home, take a post-it, write I am beautiful, stick it on your mirror and recite it to yourself every day until you believe it.” The live audience promptly rose to their feet for a watery-eyed standing ovation. I remember grimacing at my laptop screen, not because I disagreed that this girl looked perfectly pleasant, but because all these women were essentially telling her to completely disregard her own conviction. And they expected it to work? I won’t pretend to know how one overcomes Body Dysmorphia Disorder, but I doubt that was it. I don’t think they let the poor girl say anything, but I knew that if I were her, I would have thought supermodel Tyra Banks was just patronizing me by telling me I was beautiful when I really wasn’t. It’s not going to work. Not unless our culture stopped worshipping self-belief and self-determination above all else. Because sometimes, many times and for many reasons, we are going to be misguided and we are going to be wrong.

Who, then, can we trust to tell us truths that can be so counter-intuitive?

Back to the letter I wrote to myself. I hoped for this letter to protect me against depression’s most powerful trick: the distortion of perceived reality. This is part of what I wrote to a future self who might be caught in another raging mental storm: If that’s what’s happening now, hold on to this golden nugget of truth: Many things in life have failed you, but God will not fail you. If you’re going to succumb to the lies of depression, fine, but this is one thing you can vouch with all your mind, heart and soul is true. Otherwise, strive to know more of Him and His plan for your life, his role for you in His kingdom. Go into storms confident that you are standing on solid rock. . . . You are a daughter of God and He loves you more than You could ever know.

zoomed in

This was written solely to myself, and no one else has seen it till this moment. I thought this would be foolproof. It’s in my handwriting, and it’s sincere — how could future me distrust it?

But I did. About six months later, I opened this letter again and I wanted so badly to rip it to shreds. I read my own words and chastised myself for being so delusional at the time of writing. For the second time, I became obsessed with the theory of depressive realism: depressed individuals make more realistic inferences than non-depressed individuals. While everyone around me insisted that my depression gave me a negative cognitive bias, I believed in myself so much that I thought it was them who had a cognitive bias — a positive cognitive bias. And I, being supposedly depressed, had the more accurate appraisal of myself and the world.

What arrogance, Karen.

I remember my then-boyfriend trying to tell me I was being arrogant. It made no sense to me at the time. How could I possibly be arrogant when my self-esteem is at rock bottom?

It turned out that while depressed, I lost many things — self-esteem, self-love, empathy, love for others — all but my idolatry of my own intellect. I suppose it didn’t help that I’d been immersed in an academic environment that worshipped the intellect as the harbinger of Truth.

Recently, I talked to my RCIA instructor about my struggle to retain my faith during depressive episodes. He said that we consider the human person, we often don’t look beyond the intellect, the emotions, and the body. Our free will, he says, is a very sacred gift God has given us. It operates outside of intellect, emotions, and body. He has given us our will so we can know Him, and choose whether or not to love and follow Him.

I see now that as a Christian, I must, using my free will, submit my intellect to God. While this must sound like blasphemy to any post-Enlightenment atheist, I declare this unashamed because there is no better option.

To people for whom religion is but a tool of rationalization, I say the same of secularism. It comes down to the question of which is the more reliable tool. Well, my religion is not quite a tool, but a relationship with the true and living God. He gave me my capacity to think and capacity to rationalize. When my brain is “broken” and doesn’t perceive things quite accurately, I can turn to its manufacturer to tell me what I ought to be perceiving. Thank God for the Church that has been entrusted to guard and dispense God’s truths, so we will never be left as orphans (John 14:18) flailing around trying to make sense of everything given our limitations.

I repent of my life-long arrogance and self-idolatry. I will end this post with one of the most-cited verse of the Bible: Trust in the Lord with all your heart, and lean not on your own understanding. (Proverbs 3:5). I used to think this applied mostly to those who “aren’t smart enough to come to their own understanding of things”. I take that back, and I would even add that this is particularly relevant to those we consider to be highly intelligent.

What I needed was not a letter from me. What I needed was God’s Word and the teachings of His Church, and the humility to trust Him over myself.

I know not all my readers share my convictions, so I’ll open this up to you: how do you maintain your grip on reality? Or more broadly speaking, how do you know what’s true?

Related post: Being depressed did not make me an “innocent in hell”

Recommended reading: In Miracles, C.S. Lewis demonstrates how the fact that we can even reason and rationalize is a great argument for the existence of a transcendent Creator. Or go to Wikipedia for a summary of the argument from reason.

With a little help from antidepressants

unnamed

This month, The American Recall Center is encouraging conversations online and offline about medication safety (check out their post on the newly-discovered side effects of Xarelto). Judy, their Outreach Coordinator, got in touch recently asking if I’d be willing to write about my own experience with medication. I realized I’ve hardly (publicly) talked about the role of antidepressants in my road to recovery, and so I thought this could be a good place to start.

For 3 months or so, I’ve been getting by with a little help from Lexapro (or escitalopram). Owing to my own stubbornness, compounded by my ignorance about the nature and effects of antidepressants, I waited almost 6 months into this current cycle of depression before agreeing to be medicated. There are a few things I wish I’d known earlier, which I hope could be helpful to you or someone you know:

Antidepressants are not magic pills that will “make us forget all our pains” a la Helen’s drug in The Odyssey, as many people might assume. People looking for a “quick fix” would be disappointed, and it is unfortunate and irresponsible that antidepressants are overprescribed to people who don’t necessarily need them. On the flip side, they are underprescribed to those who actually need them, but are wary and skeptical of antidepressants. I belonged to the second camp.

I was under the impression that antidepressants were mood-altering drugs that would do no more that make me numb to my problems. So to me, to take antidepressants would be to live in denial. And since living with integrity is of paramount importance, this was a huge no-no. For half a year I resisted my parents’ and then-boyfriend’s persistent efforts to get me to see a psychiatrist, until eventually caving in only because I felt guilty for making them so anxious. “Oh, you’re definitely depressed,” the doctor told me as I tried to argue incoherently that I was simply seeing the true terribleness of my existence. She prescribed Lexapro. I brazenly told her, “This is not what I need. What use would it be to feel better and still be this despicable person that I am?” She asked matter-of-factly if I had anything to lose. I guess I didn’t. Perhaps at the very least I would stop embarrassing myself by sitting on road curbs or hugging lamp posts while sobbing about being alive.

Most antidepressants take about 4-6 weeks before they start taking effect. (There’s also a very real possibility that a particular antidepressant may have no effect, or none that is substantial, even after that period. In that case, your doctor would put you on a different antidepressant.) I first noticed it when I began moving around a lot more than usual while in the shower. Considering that I’d recently found myself curled up in a fetal position under running water, that was a big deal. On the same day, I also found myself having enough energy and motivation to finally clean up my bedroom from corner to corner. Overall, I began feeling generally “lighter”, while remaining acutely aware that I was still struggling with negative thoughts and a low self-esteem.

That leads me to the next point: the first symptoms to improve will be energy level, concentration, and motivation. And the last to improve will be your low mood and feelings of hopelessness. I was experiencing improvements in my ability to think, read, articulate myself, and perform basic, everyday tasks. And yet I continued to hate myself and have a bleak outlook on life. I mistakenly thought this was a confirmation of my initial understanding of antidepressants.

IMG_6987

That period before your mood begins to improve can be dangerous. While my suicidal thoughts used to be purely fantastical, during this period, I began to think they were actually quite reasonable and doable (it scares me to admit this now). This is a very real danger for anyone starting out on antidepressants: you might begin to have energy and cognitive ability to actually execute suicide plans. If a loved one is relatively new on antidepressants, please be more attentive and vigilant than usual. It is also important that they are taking these antidepressants under regular consultation with their doctor. He/she will be able to assess how well the patient is reacting to it, if there’s a need to adjust the dosage or switch to a different kind, etc.

I have come to a point where my mood has improved remarkably, and where I’m starting to have much healthier and more realistic thoughts. There is still one more thing I or anyone in my position should remember: do not stop taking your antidepressants at this point. During this cycle of depression, I was informed by my doctor that at whichever point I start feeling “fine”, I will actually need to stay on my medication, and at that optimal dosage, for an additional 9 months to maintain the balance within my body.

I’m also seeing a counselor regularly, even though I didn’t think I needed it anymore. When I found out what a long wait list there was, I told her, “You know, you should just give my slot to someone who needs it more than I do. I’m honestly quite okay nowadays.” However, she told me that given my history of recurrent major depression, it’s important that I continued to see someone to process what’s happened, and also so that the symptoms can be caught much earlier when depression returns. Experience with previous episodes confirm this: inadequate treatment can lead to relapse and recurrence. We should also note that it’s been well documented that the risk of recurrence increases with each subsequent episode. It’s not something we want to gamble with.

Lexapro is an SSRI, or selective serotonin reuptake inhibitor, one of the main classes of newer antidepressants. SSRIs act on a chemical in the brain called serotonin (a neurotransmitter), which helps relay signals from one area of the brain to another. Its many functions in the brain include the regulation of our moods, and many researchers believe that a serotonin deficit leads to depression. SSRIs elevate the level of serotonin in the brain by inhibiting its reuptake. They do not alter our personalities. I also strongly recommend talking to a counselor to complement the medication, and your doctor will most likely say the same. The medication will help us be better receptive to adjustments to our thought processes achieved through counseling, so these go hand in hand!

While depression distorts our perceptions, there are very real hurts in our lives that need to be healed, and real problems to be solved. We need to be in the right frame of mind and have adequate energy to be able to deal with them, and that’s where antidepressants come in. We are “dependent” on them only in the sense that someone with a broken foot has to depend on crutches until he recovers.

My final concern, and this will be pertinent to fellow Christians, is where psychiatric medication falls in our theological framework. We recognize the limitations (and dangers) of psychiatry when taken to reductionist, materialistic directions. It is preposterous to oversimplify mental illness as “chemical imbalance in the brain”, though I have definitely been guilty of that. The Church teaches that the human being is a union of body and soul — what affects physically will also affect us spiritually. We need a physician for our body, and we most certainly and desperately need a physician for our soul, and that is Christ. Seeking medical treatment is not to turn our backs on God — all truth is one; the wisdom amassed in the field of psychiatry, when rightly applied, is part of God’s gift to us. (Highly recommended reading: The Catholic Guide to Depression by Aaron Kheriaty, MD with Fr. John Cihak.) At the same time, we also don’t want to come to view antidepressants as a guarantor against suffering, for we know that in this lifetime there will always be suffering. But we take comfort in that with God we can offer our suffering for something greater than ourselves (I will save this another time — I know it’s not an easy thought to swallow — I will admit it is also rather difficult for me at this moment and I have much to learn from the saints who so lovingly carried their crosses).

I’ll end here for now. Unsure about anything? Talk to a medical professional. All I can share is based on my own experiences, plus some information from trusted sources — I am in no way qualified to dole out expert advice!