May 18

“The Hilarious World of Depression” by John Moe

Public radio personality John Moe, who has a podcast called The Hilarious World of Depression, now has a memoir by the same name. Yes, he’s a funny person; yes, he’s been depressed most of his life. And that’s not all—his brother died by suicide; his father was alcoholic.

From the publisher:

Inspired by the immediate success of the podcast, Moe has written a remarkable investigation of the disease, part memoir of his own journey, part treasure trove of laugh-out-loud stories and insights drawn from years of interviews with some of the most brilliant minds facing similar challenges. Throughout the course of this powerful narrative, depression’s universal themes come to light, among them, struggles with identity, lack of understanding of the symptoms, the challenges of work-life, self-medicating, the fallout of the disease in the lives of our loved ones, the tragedy of suicide, and the hereditary aspects of the disease.

Moe likes being able to put mental health issues out in the open, easing stigma for “saddies” while also educating the “normies.” Melissa Broder, New York Times:

The Hilarious World of Depression…could be a particularly useful tool for those who grew up in homes where seeking therapy was seen as weakness, those who don’t have the language for mental illness, and particularly for men age 50 and older. If you’re looking for a Father’s Day book for a depressed dad who is aware of his condition but averse to seeking treatment, this is the one.

An illuminating review of The Hilarious World of Depression by Publishers Weekly:

Despite his suicidal ideation and his struggle to move past his guilt after his brother’s suicide, Moe’s story is not bleak. While he does not come out on the mythical other side, he learns—with the help of medication, dogs, listening to music, and therapy—to break the ‘habit of converting stress into bleak, goth-eyeliner-wearing despair.’ Such side-eye commentary separates Moe’s story from the ‘trite ’70s self-help’ he loathes, as does the inclusion of quotes from podcast guests Maria Bamford, Patton Oswalt, and others. Moe’s edifying, enjoyable take on the realities of living with depression will uplift any reader.

Selected quotes from Moe’s recent interview with Terry Gross, NPR:

I didn’t want to be taken away from my family. I didn’t want to get in trouble. I didn’t want to be institutionalized. So I thought, I better keep it a secret. But it was just this unsourced terror that I had….It led to a lot of kind of hyper-achieving mentality. I joined every activity at school. I was elected to class offices of vice president and president of my class. I tried to be the friendliest, most outgoing kid I could — thinking that that could be medicinal and counteract it.

A big thing I’ve been hearing [during the pandemic] is a fair number of depressed people doing miraculously OK through this, because we’ve been preparing for this for a long time.

Andy Richter was on our show and he’s compared his depression to a bad back. Like, you know, that it’s a thing that you have, and sometimes you’re feeling great, and then when it starts to flare up, then you need to take a hard look at it. You need to go back to your therapies and your treatments. You need to look at what’s the best way to address this flare up: Is that medication? Is it physical therapy (if it’s a bad back) or mental therapy (if it’s your mind)? So, things might go wrong, but you have a toolkit for dealing with it.

Nov 20

“That’s Mental”: Bipolar II in Humorous Essays

Look up author Amanda Rosenberg, author of That’s Mental: Painfully Funny Things That Drive Me Crazy About Being Mentally Ill, and these are the words she uses to describe herself:

Writer. British Chinese. Bipolar II. Love Island. Mental. No worries if not.

Her new book is a series of brief essays divided into BC (Before Crazy) and AD (After Diagnosis), and it’s been called “candidly mental but with jokes” (The Nerd Daily).

A less concise intro to the book (PureWow):

After a mental breakdown, suicide attempt, stay in a psych ward and misdiagnosis of borderline personality disorder, Rosenberg received a later-in-life (but correct) diagnosis of bipolar II, which the National Institute of Mental Health broadly defines as ‘a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes.’ Rosenberg describes her depressive episodes as feeling like her head is ‘clogged up with a toxic sludge,’ while manic episodes mean she’s ‘impulsive and obsessive,’ and finds it difficult to articulate how she’s feeling. ‘Everything [is] CAPS LOCK.’
How was she not diagnosed earlier? Largely because, as a part British, part Chinese woman, she didn’t fit the archetypal ‘mentally ill’ person (either a brooding, misunderstood straight white man or an off-the-handle straight white woman). The thing is, she reminds the reader, mental illness doesn’t discriminate. ‘It’s not just straight, white, ethereal-looking people who get depression. Asian people are depressed. Black people are depressed. Queer people are depressed. Trans people are depressed. People with disabilities are depressed.’

In a pertinent excerpt about mentally ill characters on TV (Salon) Rosenberg further notes: “I have nothing against white people playing characters struggling with their mental health. But when you’re a non-white kid and the only people you see on-screen are white, it seems like they’re the only ones who experience mental illness. Not just that—they’re the only ones allowed to have a mental disorder.”

Mental health stigma, grief and loss, trauma, unhelpful advice offered by others, and the difficulty of taking mental health days are just some of the topics covered in Rosenberg’s book. Also, of course: medication and therapy. Nadia Bey, Affinity, alludes to an interesting facet of the author’s experience with the latter: “With mental illness, there’s a sense of needing to have everything figured out or have the ‘correct’ feelings. Rosenberg touches on this by mentioning how she pretended to be sad in therapy because it seemed to be what was expected of her, which contrasts with her pretending to be fine once her mental health began to decline.”

Among the favorable reviewers is comedian Sara Benincasa, author of Agorafabulous!: Dispatches From My Bedroom (see my previous post): “Amanda Rosenberg writes in a very funny, wonderfully accessible way about her experience with bipolar II. She uses her experience as a jumping off point for advice that feels like it comes from a candid friend. Then, just when she’s got you comfortable, she punches you in the gut with a small snapshot of agonizing grief or a particularly evocative, elegant turn of phrase. Truly, this is my absolute favorite way for a writer to approach a tough subject, and she does it gloriously. May this book serve to make you laugh and to increase your compassion for all who live with mental illness. Perhaps you’ll even be kinder to yourself.”

May 11

“Lost Marbles”: Living with “Depression & Bipolar”

This is the book that medical students should read, not the DSM. Jim Phelps, MD, reviewing Lost Marbles: Insights into My Life with Depression & Bipolar

Part memoir, part self-help, Natasha Tracy‘s Lost Marbles: Insights into My Life with Depression & Bipolar, is a collection of articles she’s written that have previously been posted at Bipolar Burble and Breaking Bipolar over the course of several years.

Quotes excerpted from an interview Leslie Lindsay conducted with the author:

One of my strengths, I feel, is to write about mental illness in a way that is real, honest, gritty and not sugar-coated. I say the things that people with mental illness think but don’t have the words to express. This is why people identify with my work so strongly.

I don’t believe in the concept of “stigma” per se. What I believe in fighting is prejudice and the inevitable discrimination that follows it. I believe that by making people with mental illness three-dimensional people with real emotions and real struggles, we actually start to sound just like everyone else – just amplified.

[If diagnosed with bipolar disorder]…(I)t’s important to know that the world is not ending, there will be a tomorrow and there is an innate you that will not disappear. That said, the world, the tomorrows and even you, will change in response to the illness. Again, this is normal and natural. Most people never get back to a pre-bipolar state.

There are many things a newly-diagnosed person can do. Firstly, it’s important to get the best bipolar specialist psychiatrist and therapist one can find and create a treatment plan that makes sense for the individual. Then the treatment plan must be followed. It’s also important to lean on loved ones during this time as they will connect a person to who he or she really is.

It’s an unfortunate truth that for many in the United States the cost of medication is very high. That said, the drugs, while laden with issues like side effects, save lives every day. Many people would have taken their lives without these medications. Yes, there is no doubt that they are expensive and have other associated issues, but when it comes down to life or death, a functional life or a life spent in psychosis, there is no doubt that they are still worth it.

Some helpful resources suggested by Tracy in the interview:

If you want a sampling of Tracy’s writing before getting Lost Marbles, here are just a few good choices:

Apr 25

Mental Health Stigma Arises from Language

One of the clues to mental health stigma is in our language. Why do many, for example, talk in hushed tones about the “mentally ill” but are not so judgy or secretive when reporting about the “physically ill?”

More specifically, why do we say someone “is” his or her diagnosis, e.g., he or she IS schizophrenic, versus saying that person “HAS schizophrenia”? Do we ever say so and so “IS cancer”? Or “IS a broken leg”?

Mental health stigma is definitely at play. Another language example comes from researchers at Ohio State University. They reported (Science Daily) that when participants heard about “the mentally ill” they showed less tolerance than when they heard about “people with mental illness.”

What is “mental illness” anyway? A couple definitions:

  • American Psychiatric Association: “…health conditions involving changes in thinking, emotion or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities.”
  • National Alliance on Mental Illness: “…a condition that affects a person’s thinking, feeling or mood. Such conditions may affect someone’s ability to relate to others and function each day. Each person will have different experiences, even people with the same diagnosis.”

Psychiatrist Thomas Szasz (1920-2012), on the other hand, famously proclaimed “the myth of mental illness” in his “Manifesto” :

Mental illness is a metaphor (metaphorical disease). The word disease denotes a demonstrable biological process that affects the bodies of living organisms (plants, animals, and humans). The term mental illness refers to the undesirable thoughts, feelings, and behaviors of persons.

Likewise, David Oaks, a “psychiatric survivor” and founder of MindFreedom International, has proposed that “‘mentally ill’ reflects a medical model that’s too narrow. If you’re okay jusing this model about yourself, that’s one thing, he adds, but it shouldn’t be the only way of looking at things. Thus he goes further:

…Let’s stop legitimating the use of words and phrases like ‘patient’ and ‘chemical imbalance’ and ‘biologically-based’ and ‘symptom’ and ‘brain disease’ and ‘relapse’ and all the rest of the medical terminology when we are speaking about those of us who have been labeled with a psychiatric disability.

What kind of language might serve us better?

Are we supposed to go the way of insurance company lingo, I wonder, and try to view issues as “behavioral health” versus “mental health”? Less about your brain or having an illness, more about what you do? Even though they simultaneously require billing codes that label people with mental disorders in order for them to qualify for coverage?

Anne Cooke, PhD, proposes the following to psychiatrist Allen Frances in a Psychology Today post on a related topic: .”..Why not just use people’s own language? That way we enable people to define their own experiences and avoid imposing our own ideas on them.” (This advice would be more applicable to everyday or clinical usage than helping clients use their insurance coverage, I need to add.)

But what about, asks Frances, the more severe issues that actually require proper diagnosis or labeling in order to have an understanding of how to resolve them? Back to an earlier analogy, a broken leg can’t be properly fixed if we don’t diagnose it correctly in the first place.

No easy answers, but a combination of knowledge and sensitivity will at least guide our communication toward some better places.

Dec 21

Asking For Help: Why So Hard For So Many?

Why is asking for help—of any kind, not just the therapy kind—often so hard?

Peggy Collins, author of Help is Not a Four-Letter Word (2006), thinks many of us suffer from “Self-Sufficiency Syndrome,” which is “characterized by an inability and unwillingness to ask for help or delegate because of the belief that no one can do it as well as you can.”

Jeana Lee Tankh (Huffington Post) lists some other aspects of this syndrome: “There are short-term payoffs that self-sufficient people experience such as singular control, approval from others, career enhancement and self-confidence, all of which act as a catalyst for the behavior. Yet, when self-sufficiency is taken to the extreme, the burden of too much responsibility can cause stress, unrealistic expectations, lack of self acceptance and no acknowledgment of personal needs.”

When writer Alina Tugend (The New York Times) also researched this subject, she cited  both M. Nora Klaver‘s May Day! Asking For Help in Times of Need and Garret Keizer‘s Help: The Original Human Dilemma. Some of the various reasons include, said Tugend, “not wanting to seem weak, needy or incompetent,” fear of “surrendering all control,” fear of obligation and indebtedness, and lacking the skills to do it effectively.

Dr. Deborah Serani can remedy that last one. But first she cites (in a blog post) some myths that can prevent us from reaching out:

  • It makes us look vulnerable.
  • Holding things in and keeping personal issues under wraps keeps us secure.
  • It bothers others.
  • Highly successful people never ask for help.
  • I am a giver. I don’t like when others help me.

The truths, in a nutshell, are that aid-seeking is empowering, connects us with others, helps other people feel needed, and aids success. Plus, as with the last one, our resistances are just plain worth getting over.

Seek HELP, Serani says:

  • Have realistic expectations for the kind of help you are seeking
  • Express your needs simply and clearly
  • Let others know you are there to help them as well
  • Praise your pals for their assistance and pat yourself for asking for help

What about reaching out to a therapist—what specific factors hold people back?

Self-sufficiency is one of them. Others include, but are not limited to, mental health stigma, financial barriers, lack of local availability of therapy, being unable to get an appointment soon enough, and prejudice and discrimination.

Some of these are very real for some people, some are untested internalized beliefs. Most can be overcome, partly by researching the various available alternatives—online therapy, for example, versus in-office therapy, just to name one intervention that could be effective for those in certain circumstances. But in order to even look into such things, many people need a bit of assistance.

And now…? Aren’t we back to square one?