Disability: Depression Diaries and Puritan Work Ethics

[Content Note: Depression, Surgery]

One of the really frustrating things about depression is how well it succeeds in camouflaging itself as a "nothing" disease, the mental equivalent of having a touch of sinus drainage in the morning, or of needing your joints to warm up for a few minutes before you can really hit the ground running.

Part of this is social, I think. As a society, we really don't take mental diseases seriously at all. When I left the hospital after my surgery this year, I was given an entire notebook of instructions on how to take care of myself, what activities I can and cannot do (as well as an honest-to-god timeline on when those activities magically become available to me!), what dangers are posed to the hardware in my back and to the bone grafting process in general, and who I can call for help if I experience any serious issues during recovery. But no one, at any point in this process, said to me, And oh-by-the-way, the meds you're on might make you severely depressed, in which case you should call this number.

I'm ridiculously fortunate in my fate. I have a loving and supportive family with the privilege and finances and kindness to carry me through this. I have a mother who researches medications on a regular basis and who was able to warn me at the first sign of serious trouble that my emotions were no longer under my control. I have a number of social networks that have kept me afloat. And I have a definitive cause for my depression (medications) and a multi-step plan for getting off that cause and hopefully away from the depression. Having a concrete "reason" for depression and a set exit strategy from it is helpful beyond belief. In all these ways, I'm one of the lucky ones -- but it doesn't mean I was taken seriously by society at large or by my own dedicated health professionals.

Beyond the social notion that depression is really nothing to get all het up about, there's a lot of personal minimizing that comes along with depression. Depression can by its very nature be utterly self-loathing and terribly minimizing. There's an internal voice that has come along with my depression that has consistently minimized the effect of depression ("It's just a bit of sadness. Perk up and deal with it.") while constantly criticizing myself for not accomplishing more, and for not accomplishing the "correct" things.

I was raised with a Puritan work ethic. I was raised to believe that work came first, and then you played. If you didn't have enough time to do all your work, then you didn't get to play. You played "catch up" until the work was done, whether that took a day or a year. Bootstraps!

Depression has, for me, magnified that work ethic into a terrible impetus that has several times driven me into a dark spiral of helplessness and self-loathing. The depression would keep me in bed a little later, watching TV just a little longer. That "play time" then cut into my self-assigned "work time", and I would end up blogging a little less, answering fewer emails, addressing my medical bills a little slower than I felt that I should. When the depression buckled down on the loathing because why are you not getting you work done, Ana, then the cycle just got worse: more bed, less work, more self-hatred. Lather, rinse, repeat.

And depression is able to get away with this vicious cycle because it pretends that you're not really sick.

So you don't get a break from your "work time" because you're not really sick. You're a little sad, yeah, but who isn't and doesn't practically everyone grapple with depression from time to time and aren't they all doing pretty well, so you don't get an excuse. No slackers around here! And this is completely bullshit for a number of reasons, but because you genuinely do care about getting your work done and being a useful person, you either buckle down and work yourself into the ground, or you fail to do your work because your body simply can't or won't cooperate and you end up loathing yourself even more. What successes you do have get chalked up as nothing more than the bare minimum anyone could do; your inevitable failures are magnified into full-blown character flaws.

(And I say "inevitable" there quite consciously, because you will fail at times. For years now, I have kept a daily To-Do list. I almost never finish every item on that list because I always underestimate how long it will take to complete tasks. It was only after my depression, however, that my daily failure to complete all my tasks became a serious source of anxiety for me. Suddenly I was a terrible person -- not because I estimate tasking time badly, but because a good person would be able to complete all her tasks in time, regardless.)

Also, you don't get more "play time" when you're suffering from depression because you're not really sick. So anything that could reasonably be chalked up to a healing process or a coping mechanism -- sleeping more, playing video games, looking at bright colors, re-organizing discrete items -- is really just you playing around when you should be doing real work. And every moment you spend on this "play time" is a moment wasted, which just goes to show that you really are a terrible person for wasting all this time and potential productivity.

These are all things that the depression has led me to think in the past few weeks. They're also garbage.

If you are suffering from depression, then you are really sick. Yes, you really are. Depression is a real illness, it's not 'just' something that you can banish on demand. Whether you suffer from it daily or weekly or a couple of times a year, when it's on you, you are really sick, just as my mother is really sick with allergies even if they only flare up at certain times of the year (spring) or in certain places (theaters) or in conjunction with certain stressors (other illnesses).

When you are really sick, there's still unavoidable work to be done. But you have an official pass from me to prioritize. To decide what really, really needs to be done and what would simply be nice to be done. You have the right to let low priority things slip as needed. You have the right to ask for help to complete your work. You have every right to be proud of the things you manage to accomplish while sick, rather than feeling upset with yourself that you didn't do more. You are really sick; everything you manage to do while sick is something to pat yourself on the back for.

When you are really sick, there's all the more need for rest and play and self-medication. You have every right and reason to rest when your body requires it, to play games that will perk you up, to look at soothing things or spend time completing small, concrete tasks that bring you pleasure. Seeking pleasure and distraction and calm isn't a character flaw -- it's a sign that you are unconsciously aware of your illness and you are taking steps to treat it. You are really sick; any change in your routine that helps you to feel better is a change that acknowledges that. Intuitively treating your disease is something that you should be proud of, not something that you should criticize yourself for as one more piece of evidence that you are lazy or procrastinating or slothful. 

It's not always easy to remember all this. Society doesn't take depression seriously as an illness, and depression itself isn't conducive to that kind of self-diagnosis. It's hard to think of ourselves as being ill, because it would be so much easier if the depression were just a spot of sadness that a few more tugs on the bootstraps could clear up. But if you believe that you struggle with depression, then it's alright to believe that you are really sick. It's alright to play a little more and work a little less, just as it would be if your arm were in a sling or if you'd just been through major back surgery. It's alright to ask for help.

If you are really sick, please don't beat yourself up for being sick. Sicknesses can't be healed by willpower alone, or even necessarily by time or medicine. My surgical incision heals on its own time, scoffing at medications and topical ointments. My back will never be fully straight. The fact that I can't change these things -- the fact that they affect what I can and can't do, and what kind of work/play balance is healthy for me -- does not make me a bad person. It makes me a person struggling with a serious illness.

The same is true for depression.


St. Jebus said...

TW: depression, religious experiences
(I don't know if a TW would be needed on a post that already has the same one, but I figured better safe than sorry.)

This is so right, Ana. My mother struggled with depression while I was in middle school/high school, and then I struggled with it a bit during high school/college. I would be going to school full time, working full time, and then I would beat myself up for not already being a minister/having a better job/getting higher grades/having a girlfriend/etc. Fortunately, I ended up with people around me that didn't let me drop into too much of a spiral.

My mother ended up going a different direction than I did, in that she dealt/deals with her depression religiously - by which I mean she is a born-again Christian. Completely different than what I did, but it seems to work for her.

Wow, I started to ramble a bit there.
Summing up: Definitely agree with the post. Depression is absolutely an illness, and has to be treated as such. Unfortunately, it appears that unlike many diseases, the same treatment doesn't work on everyone the same way. (Ah, there's my point again. Lost it for a minute.)

jhasan said...

Thank you. Verbalizing how I have felt but couldn't explain to myself or anyone else makes me feel less alone.

Will Wildman said...

This post resonates with me maybe more than any other in the series so far.

Gonna have to think about this more.

Mmarple26 said...

Wow. where were you ten years ago when I was crippled with depression, anxiety and panic attacks? mental illness is invisible, as I learned all too well. I lost my close friends because of it- because they got tired of 'putting up with my depression shit' and the burden of a mentally ill person became too much for them to deal with. Which in turn burned into my mind that I was such a worthless piece of crap even my own friends couldn't put up with me.

My God, what a horrible period of time that was. All the advice I got from my parents was 'get over it' and because there was nothing physically wrong with me, no obvious disability like a cast or an eyepatch, people thought I was either faking it or doing it to get out of responsiblity. 22 years old and I wanted to die. What a long way I've come since then and what amazing people I've met along the way who understand what its like to be on the other side of fence of being Other.

Ain't blogging grand? Finding a behaviorial counselor saved my life and years of therapy got me back to limping. Still have trouble with agoraphobia but nothing like it was.

If you need support, someone to talk to, someone to complain to talk to me :) one of those people who has personal experience with depression and self-loathing and self guilting for not being 'normal'. and in return I think I will print this out and tape to my wall

Naomi said...

TW: Pregnancy/Birth

I will note that the failure to include "evaluate for depression" as part of the standard of care can be remedied.

It's part of the standard of care for obstetricians, midwives, and pediatricians to evaluate new mothers for PPD. This was probably motivated more by concern for the babies than concern for the mothers, but I was warned of the possibility while pregnant and briefly screened at the followups after birth.

It absolutely SHOULD be part of the standard of care after major surgery. My grandfather almost died of despair after his open-heart surgery in his 70s, although people didn't realize what was going on right away. His sons rallied to give him some extra nurturing (the thing I remember hearing about -- this was along time ago, and I was very young at the time -- was bringing him homemade chicken soup.) The surgery was a rough recovery, but it was the depression that almost finished him off. He did recover fully, and lived to be almost 87 (and he had a good old age: he took great pleasure in his volunteer work, his friends, his children and grandchildren, and his live-in ladyfriend.)

Kirala said...

It absolutely SHOULD be part of the standard of care after major surgery. My grandfather almost died of despair after his open-heart surgery in his 70s, although people didn't realize what was going on right away. Hear hear! My grandfather had heart surgery in January and already had depressive issues. Did anyone warn us that major depression was a frequent result of major surgery? No. And given that my grandfather lives alone with my grandmother, out of the way of the rest of the family, friends of only limited closeness... this has not been At All Good for either of them. The surgery might have been necessary, but fair warning, preparation, and a treatment action plan would have been incredibly useful.

Regarding what Ana said about depression being illness: how dare you contradict the depressive voices in my head? (Not experiencing it now, but wow, familiar.) I thought about allowing the depressive voices to speak for themselves - you know, sarcasm/irony - but I find that even when I know it's sarcastic, the sarcasm doesn't register when I'm sick. It feels like dogpiling. So. I'll just say the depressive voices in my head are NOT HAPPY, Ana. Not happy at all.

St. Jebus said...

@ Kirala I remember that, too. I remember people telling me that I wasn't unloveable, I wasn't hated, etc., and my internal monologue would get angry with them for lying to me.

chris the cynic said...

The two things I get from other people most are:
1 X had depression, X was able to work.
2 If you got a job you'd have health insurance.


At this point my major goals in life are to stay hydrated and get to sleep on time (my blind broke, I now wake with the dawn so if I don't get to sleep on time I don't get enough sleep) I'm not doing very well with either.

My non major goals suffer similar problems.


Anyway, good post, hope your ability to cope steadily increases from now until such time as it is no longer necessary.

Smilodon said...

That is awful Chris. I don't know how you educate people who've never been depressed, but good luck at dealing with the world.

I get the opposite. Every time I've mentioned to a doctor that I think I suffer from depression, I've been told that, if I'm going to work every day, I can't possibly be _really_ depressed. This is probably true in the clinical sense, since I believe clinical depression would mean that I wasn't functional. But it's not particularly helpful to hear a doctor say "Well, if you manage to sit at a desk for eight hours and not cry, then your problems aren't that bad" without aknowledging that if sitting at your desk thinking about excel makes you so sad that you want to cry, there might be something wrong.

(Memories of your recent .hack post - if someone is depressed, and they have a victory, don't tell them that it doesn't count.)

chris the cynic said...

I'm going to go out on a limb here and say that, whatever their other virtues might be, your doctors have all universally sucked when it came to the topic of depression.

That is, quite simply, bullshit.

Now there are multiple forms of clinical depression (I have the misfortune of having two of them, apparently) and perhaps for some form that's true, but I call serious bullshit on, "If you can put your butt in the seat on a daily basis you're not depressed."

I might not be able to do that with a job, but operating largely on inertia I've managed to show up for university every single day save one week while depressed. I'm not saying I was there in any useful capacity. Many of those days were "be very still and hope no one expects me to be able to think or act" days, but I was physically present. I've done this for long enough to earn the right to graduate with two majors.

And yet I've had multiple psychiatrists and psychologists who have all agreed, "Yup, there's clinical depression here," during that span. (And will likely to continue attending university if for no other reason than right now that they only reason I have access to psychiatric healthcare. Also, attending classes prevents me from simply doing nothing all month.)

So I wouldn't trust your various doctor's flippant anti-diagnosis even in the clinical sense. Trying to make a diagnosis simply on the basis of, "Can show up consistently," ought to have triggered a, "Not enough information," error.

Fenixmagic said...

I have Seasonal Affective Disorder (which has an acronym that makes me want to punch whatever asinine doctor that came up with it in their smug little face.) Such a cutesy term for the horrible struggle it entails. It means every year, in November, I will start to lose myself. I don't get to be me anymore. I get to shore up my defenses, regulate every response to my boss, come into work late because I just couldn't get rest (again!) despite sleeping for 10 hours. It means explaining to others that they can't "cheer me up" or why I know I don't have it so rough, blah blah. Then, at last, in March or May or whenever it decides to let up, I get to be me again.
The reason I know all this is only experience and reading. No doctor has ever diagnosed me properly, and I've seen the fads come and go with medicine patents (fun fact: if you were diagnosed as bi-polar in the last 10 years, it was probably because that's the meds the pharma reps were pushing.) I ended up majoring in psychology to help myself. Doctors don't know what to do with an informed patient. They've never answered my questions about the studies that have recently shown that depression and allergies are related. They haven't been able to test out my theory that my depression is directly related to the quality of sleep that I get, and that if you don't sleep well for weeks and weeks, you'll probably end up how I do each winter. They just want you to shut up and take the meds they give you.
I hope you get to feeling better, and that your plan works. Even if your doctors aren't paying attention, you are, and you're not making anything up. If all you can do is get out of bed, then that is still a victory. When it's time that you can do more, you will. Until then, rest and know that others know what you're going through, and we're rooting for you...not to do anything, but just to get back to being yourself again.

chris the cynic said...

I've heard about allergies as the cause of all sorts of things, is there any test for them?

If you don't have a clear, "This is allergies" reaction but instead it manifested as depression or something else, how would one ever discover it was allergies in the first place? How would one discover they even had allergies?

Gelliebean said...

I just wanted to say thank you so very very much. This resonates so deeply that I was crying by the time I finished reading it. No one should feel like they need 'permission' to take care of themselves, but you're very right that depression is an invisible condition - one doesn't have a cast or a bandage on, can't point to any 'legitimate' physical symptoms (at least, that don't come across as just plain laziness) and in my experience as a female dealing with depression, a lot of people like to diagnose it as moodiness, PMS, over-emotionalism etc. - essentially a passing, temporary mood swing instead of the deeply permeating thing that it really is.

As a slight tangent, I really, really loath those advertisements for anti-depressants; there's one with a cute little storm cloud following a cartoon woman around, and another with a wind-up doll that keeps running down. All the commercials I can remember seeing focus on women only, as if men either don't ever get depressed, or are expected to deal with emotional issues without any assistance - which I find frustrating and troubling. It may be more likely for a woman to have depression than a man - approximately a 2:1 ratio, according to the Mayo Clinic - but that still means about 1/3 of the depressed population is male, so this isn't a strictly gendered issue and I hate to see it treated that way. And I don't like the cutesy-look to them. I can understand that it might be intended as reassuring, maybe? In a sort of "see-it's-not-so-hopeless" way? But it really bugs me.

Lonespark said...

Random info: I have been trying some internet treatment stuff, Mood Gym and... something Couch. Anybody else try these things?

So far they seem good, but what I was really looking for was something like a therapy buddy, a person you could chat with in real time, like you would with a counselor...anyone know of anything like that?

Lonespark said...

E-couch. That's what it's called.

Dan Audy said...

Usually to identify allergies you either need to take an allergy test (which generally they don't want to give you without a compelling suspicion of allergies) or identify a pattern of cause and effect.

When they identified my milk allergy at age 11 it was because my mother noticed a strong correlation between my having crazed, rage filled fits the day after I would go to other kids birthday parties. However it didn't always happen and eventually she narrowed the specific cause down to going to birthday parties that served pizza and ice cream. Since I had never been terribly fond of milk (in retrospect there were good reasons) and my parents were stingy about non-homecooked foods I usually binged on them and then having overloaded my system had a massive explosion as my mental health deteriorated over the next day.

Dan Audy said...

TW: Self-harm, depression

In terms of depression my biggest problem is that I've gotten too damn good at faking being OK so people will just leave me in peace. To them I seem pleasant, cheerful, and better looking (I'm losing weight because I hardly eat - this is not a good thing to compliment me on). It takes a serious effort of will not to put on the happy mask and acknowledge that I'm not OK and no there isn't anything that they can do to fix it and of course the times I need to do so most are the ones I least have the willpower to engage in that struggle. It was so bad that the first time I ended up hospitalized was because I had an emotional break and FORCED myself into a situation where it was going to be so bad that no one could possibly ignore it and even if I wanted to I would be unable to conceal what happened or pass it off as something I was capable of dealing with. That involved what felt like an out of body experience which had me watching as I sat for hours carving every self-hating, loathing thought I had into my flesh with a blade. Now I have this struggle everytime I sink into a deeper depressive state to be proactive (always a challenge when depressed) and tell the people I care about rather than letting it build until I feel a need to show them. I don't like to tell my wife because I don't want to burden her while she is dealing with her own depression and other medical issues and while they are much, much better about mental illness than they used to be my parents tend to believe that the best cure for depression is to 'just get up and do something' *facedesk*. A lot of the time the most effort I can conjure up is to sit at the computer and read or play a game and since that is something normally done for fun I get treated as lazy for not doing something worthwhile rather than applauded for not spending 6 hours staring a wall in bed.

Thanks for validating the struggle.

Laura G said...

When I heard my brother was diagnosed with dysthymia, I told my parents that I had it, too, and had to explain what it was (oversimplification -- low-level, chronic depression).

My parents kind of looked at me and said, "Wow, the way things are today... that's not a disorder, that's just life!"

Which in my mind supports the "it's hereditary" hypothesis, if my brother's diagnosis hadn't already.

*shakes head* "That's just life..." Sure! But it *shouldn't be*!

Silver Adept said...

I read this and fervently wish that I could take time for self care on these kinds of things. But, as everyone has noted, when you have the invisible pain, you can't always convince someone else that you need time to yourself.

My significant other gets physical pain from what should normally be "simple" things, like standing. It's better than it was before, but it it's pretty obvious for me to know (and for anyone else to know) when they're hurting. So I routinely am telling them that they need to take time to be healthy and functional. (They're List People, too, so they're stubborn about self-care when there are Things to be done, but I can usually prevail on them because, y'know, pain.)

Unfortunately, since I suffer from the invisible one, when I was feeling really depressed last year due to work issues, my significant other gave me lists of things to do around the house while I was on vacation from work, because I was home and that meant Projects could be done. I might have had one or two days for self-care in the two week period I took off. (Lest anyone think they're a complete monster, Significant Other was very supportive in helping me talk about my issues and making suggestions on how I could insure myself against further problems. Things are better now, although the scars are still visible, and I think I've become much more cynical than I was before.)

Sometimes you have awesome significant others, like AnaHusband, and sometimes you have a significant other that doesn't really understand why someone might need a day to themselves to recharge or fight away some blahs, even if there's a big list of stuff to be done.

It does not help the Issues when you know, if you took time of from work, you would instead end up doing work at home.

And there's no real way I can think of how to explain this that doesn't sound like (or won't be interpreted as) laziness or discounting all the work that happens while I'm at work and sounding like I take my significant other for granted.

Isabel C. said...

Yeah: the number of people in my family with some variety of anxiety disorder or depression is apparently vast--which I never knew until sometime in the last two or three years. Gotta love WASPs.

Dan Audy said...

That is really rough Silver Adept. I struggle on both sides of the issue when trying to manage my own depression and help and allow my wife to manage hers. Significant Other doesn't sound like a monster but a completely regular person who fails to be perfect. Even experiencing it myself I sometimes catch myself leaving my wife a list of 'things she must do' or freaking out because I was away for a week and every dish in the house is dirty, piled in the sink and on the dishwasher I ran before leaving (still unemptied) and the cat box hasn't been cleaned in that time either.

It definitely isn't laziness to need time to yourself or simply being unable to manage doing that stuff because today all you've got the spoons for is getting through the day.

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