Depression Is Like Diabetes
Depression is probably the one thing in life I have the most experience with. Sixteen years to be exact (I kind of feel like I should list that on my LinkedIn profile). When I was eleven, I was hospitalized for major depression and ever since, I’ve been trying to write something meaningful or profound or at least funny about it.
Since my initial diagnosis, I’ve had two other major episodes (“breakdown” is such a murky word, although I suppose that makes it kind of perfect for depression). But even when I’m not fully immersed in the illness, it affects my everyday life. Pick up my pills, take my night pills, take my morning pills, schedule an appointment with my therapist, pay my therapist, schedule an appointment with my prescribing doctor, wonder if I’m feeling run-of-the-mill sadness or if my melancholy is a precursor to weeks, if not months, of disoriented terror.
You know, the usual.
But after a dozen or so years, it really does become normal to you. But it’s an endless exercise in patience to remember that other people don’t understand your version of normal.
Language is a big part of the problem. The terminology we use to describe mental illness is woefully lacking. Take depression for example, since that’s my area of expertise. We use the word “depression” to describe a debilitating illness that sometimes convinces you to kill yourself. We also use the word “depression” to describe how we feel after watching a sad movie.
No wonder people don’t get it.
But communicating depression to those who haven’t experienced it is something of a rite of passage for those of us in the know. So hell, I’ll give it a shot.
When you use clinical language in an everyday setting, it distorts the meaning. The way our language works, it makes perfect sense to say, “My team got knocked out of the playoffs. I’m so depressed.” But you would never say, “My team got knocked out of the playoffs. I’m so diabetic.”
Do you know how diabetes feels? Probably not. Neither do I, but I have an (admittedly rudimentary) understanding of how it works.
[Side note: Dear people living with diabetes, I understand that your experience is different from my own and this analogy is in no way meant to simplify or minimize your disease. I just think the comparison can be a helpful way to clarify the experience of depression. Have a good day.]
For my purposes, let’s stick with type 1 diabetes, which means the body is not creating insulin and thereby not processing nutrition the way it’s supposed to. A person with type 1 diabetes could eat a nutritious meal, but unless they take their medication (insulin), their body will not process that meal into the energy they need. That’s why one of the symptoms of undiagnosed type 1 diabetes is constant hunger. To an outside observer, this seems bizarre: a person eats but does not feel satiety. They are receiving all the necessary inputs, but because of a problem in the way their body processes them, they are not receiving the expected results — the outputs, if you will. The person appears to have everything they need, yet they can’t function (at least not for long). And there you go: depression. Sort of.
One of the scariest things about depression is that it seems to make no sense. Think about how you go through the day. Good things happen, bad things happen, in-between things happen. And usually, the proportions of those things affect how you feel about your day. Obviously, we all have off days or days when we wake up in an especially good mood, but generally the input of your experiences affects the output of your emotional state. Happy experiences tend to make you feel happy and the same with sad experiences. But when I’m in a period of depression, my brain is not processing these inputs correctly. I can have a perfectly good day and spend all of it just trying not to cry. Everything could unfold as usual, but suddenly normal interactions and experiences overwhelm me with hopelessness and despair. When the depression creeps in, the inputs of my life do not process into the normal outputs.
One of the biggest signs I’m in trouble is that the things I enjoy don’t make me feel good anymore. It’s like you eat a full meal, but your body still feels depleted, deprived. And if you don’t know what’s going on, that’s fucking scary.
So imagine that you have type 1 diabetes. You eat a bunch of food, but your body still feels achingly hungry. And then you say, “God, I’m hungry,” because that’s what people do. And then some jerk looks at you and says, “What do you have to be hungry about? There are lots of people with less food than you.” And they’re right because there are many people without access to nutritious food. BUT THAT’S NOT THE PROBLEM WE’RE DISCUSSING RIGHT NOW, IS IT?
And that’s what it’s like to have someone tell you, “What have you got to be depressed about? There are people with real problems.” The commenter is talking about inputs and inputs are not the problem. The problem is that my body is not processing those inputs into the chemical and emotional outputs that I need to function. So shut up.
If your car kept breaking down, you wouldn’t yell at the car, “You have plenty of oil and gas! What’s wrong with you?!” You would take it to a mechanic (the car equivalent of a doctor) and ask what was wrong with the system. Maybe you’d check the filter or the engine or something. I don’t know much about cars, but my point is still valid.
I remember one afternoon when I was in college. I was hanging out in my favorite professor’s office hours. The guy was smart and funny and wanted you to know he was from the Bronx and wasn’t going to take any shit. He and I had bonded over past conversations about Allen Ginsberg’s poetry and our own experiences with mental illness. But we weren’t alone that day. There were a couple of other students; one was a guy I’d never met, presumably from one of the professor’s other classes. We were just talking about life and graduation and stuff, and somehow we arrived at the topic of depression. He was a professor of German literature, cultural studies, and Nietzsche, so maybe that was inevitable.
But this kid was going on about how people with depression should just exercise, because he’d heard of some study that said thirty minutes of jogging had the same chemical effect on the brain as an antidepressant. He didn’t say which antidepressant or at what dose or whether the experimental group were people who exercised in their everyday lives or people that hated going to the gym. To him, it was so simple: input exercise, output happy.
I tried to give the professor a knowing smile, but he wasn’t having it. He put the kid in his place, “When you can barely summon the energy to get up and take a piss, jogging seems out of the fucking question.”
The kid tried to backtrack and tell us “what he meant,” perhaps realizing that for some of us, it wasn’t just an academic conversation.
“I’ve cried on an elliptical,” I added.
In my mind, I imagined this comment sounding somber and deep. But of course, “I’ve cried on an elliptical” just comes off as weird in most contexts. Another example of inputs not creating the expected outputs.
The conversation waned quickly. I wondered what was going through the professor’s mind when he’d blown up at the kid. Was he trying to defend me? The sadder thought was that he might have felt the need to defend himself — that this brilliant man, much older and wiser than myself, could still be hurt by the insinuation that his depression was a marker of weakness. But that’s what depression does. It plays with your mind and makes you insecure. It bends your perception of reality. It makes you feel weak.
When you’ve lived with depression so long, you get used to people not understanding. Most of the time, I don’t even get angry anymore. On a good day, when someone shoots off their mouth about depression or mental illness, I just try to be happy for them. Sure, I might explain that it’s not as simple as they seem to think, but I know I can’t make them understand. Words can’t communicate it. Maybe to get it, you have to live it. And if that’s the case, I hope they never understand.