Denying Sadness

I am convinced that stoicism is never the answer to anything, being nothing more than a cruel, callous encouragement to people to devour each other, a powerful ally of sadists and tyrants keen to get people to endure things which should be firmly refused as unendurable. Courage, indeed!

--Les Murray, Killing the Black Dog

Through my countless hours of idle contemplation I became aware of one simple fact. We do not talk about sadness. Anyone who talks about it is seen as whiny and unpleasant to be with. We discourage expressions of sadness with nonsense about Getting a Grip on Yourself. “Emo” is used as a derogatory term. Nobody wants to hear about your dead aunt or mother or brother, and you don’t want to bring it up for the fear of burdening your friends. But has this always been the case? Is it our nature to frown upon talking about sadness? Or maybe this is a socially constructed norm that we all just grown accustomed to, like our obsession with individualism? Somewhere in Abraham Lincoln’s biography I read that in his days showing inner angst was the equivalent of getting a six-pack. So what has changed since then that stigmatized sadness?

There are 50 percent more suicides than homicides in the U.S. Most people get these numbers switched. This is partly because of the mis- and underreporting of suicide by the media, mostly due to coverage leading to copycat suicides. This ignorance prevents the society from addressing the problem of mental illness and perpetuates the stigma associated with mental illness. It seems that people are in denial of all the sadness in the world. They consciously, and often even craftily and pertinaciously, refuse to face the reality that surrounds them. The suicide rates, the prevalence of illness, poverty, and inequality are just a few of the plethora of issues that cause people their lives, and, probably even more importantly, the quality of their lives. But if there is so much suffering in the world, why do we often overlook it? In another book I read that the self-conscious mind makes up only about five percent of our thoughts. If that is true, then that means that 95 percent of our decisions, actions, and behaviors are the result of something wholly out of our control, the subconscious mind. So maybe avoiding sadness is a built-in defense mechanism that protects us against overwhelming thoughts of pain. After all, denial is the first stage in the five stages of grief.

I think our society is in denial of sadness. We avoid the subject of suffering at all costs, and thereby make it taboo. This is because we have not developed coping mechanisms, and simply do not know how to address and deal with the reality of death. We even put make up on the dead to make them seem life-like, as if they are only going into a long sleep. Or maybe we can’t yet accept that suicide is a part of our society. Newspapers underreport suicide for fear of rebuke by family members devastated by guilt and shame. Maybe yet it is anger that we are afraid of. We suppress anger for fear of getting labeled as someone with anger-management issues. We escape and reject pain at all cost. We praise those who go through pain without complaining, because pain is seen as weakness. We say things like "just snap out of it" and "pull yourself by the straps", which are cruel and hurtful, especially to somebody suffering from depression who has no control over his illness. And sadness; well, we brush it underneath our beds because we are too busy being preoccupied with being positive and optimistic all the time. If you talk to a random sample of people in our society, or look at a random sample of profile pictures, you would think we are the happiest people on earth. However, the rates of mental illness and suicide in America are bigger than those in any other industrialized country.

We make the topic of sadness taboo, making it impossible for someone to discuss feeling a healthy dose of sadness with anyone else. We perpetuate these fears by social norms, such as everyone telling us that being sad is somehow a weakness and that we should be calling 5150 if someone even mentions the word suicide. We what message are we sending them other than “under no circumstances talk about sadness or people will think you are crazy.” So people never do, and one day they are gone without even saying goodbye, and you wonder how can it be. So talk, talk, talk about sadness, suicide, depression, about your inevitable death, which could come at any moment and under any circumstances, and about feelings of sadness and melancholy. Because by sharing sadness with your friends, you are letting them know that when they are going through hard times they are not alone.

Depressed and at Cal

I never really thought about mental illness until the start of my sophomore year when my psychotherapist diagnosed me with major depression. I saw the Prozac commercials on TV and the posters around campus, titled “Look for the Signs of Depression”, but I never suspected that it would happen to me— much less that it would force me to withdraw from school and admit myself into a hospital.

One day I was disturbed by the eccentricity of my thoughts, so I decided to call and make an appointment to see a counselor at the Tang center. As I found out, I had six free sessions, as all Cal students do even if they do not have insurance, which gave me some comfort. However I was very apprehensive about my first appointment—I am not all too comfortable with spilling all of my personal problems to a complete stranger. So in an attempt to regain some potential loss of control, I wrote a list of all of the questions that I would ask my counselor during our first appointment, such as “What are your religious views?” and “Why did you decide to become a counselor?”

The first counselor I saw at the Tang center was Dr. H, a non-intimidating, energetic man. When I sat at the chair in his office, and after he asked me, “so what brings you here,” my defenses somehow dropped, and thus my treatment began and continues until today, although with a different counselor. While sharing the experience of my first counselor visit with my friend over the phone, he asked me, “so how did it go?” To which I replied, in jest, “he said I was crazy”. He responded, “come on man, this is serious”. It is. As I later found out, one in ten students are treated for depression in the U.S. in any given year and many more are affected by it through knowing somebody who suffers from it.

            Despite seeing a counselor, watching my diet and exercising, I was feeling progressively worse, and even though I was attending my classes, I was failing them. This led me to withdraw from all of my classes by the end of every semester that year. So, Dr. H recommended me to take antidepressants, to which I initially was extremely opposed (“I am not down to take drugs”, I told him during our first meeting. I was against any sort of pharmaceutical intervention because my cultural background taught me that I was the one who should resolve all my difficulties and the belief that such medication is "unnatural"). However, the symptoms kept exacerbating, so I finally gave in and saw a psychiatrist, Dr. M, who prescribed me my first antidepressant, Paxil. I put all of my hope into these pills, and—thanks almost exclusively to the placebo effect—I started feeling better almost immediately. But this amelioration was ephemeral, and my health soon regressed.

When the summer came, and I went home to San Diego, thinking, "if I couldn’t get better at Berkeley, I will get better here". After all, the sun is supposed to be good for people with depression, right? When I stepped into my home in San Diego, I remember crying from relief. But as the end of summer drew nearer, things weren’t looking any better, especially because around that time I was going through withdrawal while trying to wean myself off of Paxil, which was only making me drowsy. So I withdrew from Berkeley and admitted myself into a hospital for “Cognitive Therapy Intensive Outpatient Program”.

This six-week, twenty-day program consisted of lectures and group therapy. The purpose of the lectures was to help us re-learn the rudimentary life skills, such as making decisions and being assertive. Group therapy was where everybody had a chance to talk about his or her issues and receive feedback from the rest of the group. Of course, the issues in these groups revolved around the most familiar topics of conflict, intimacy, and loss.

            Following the hospital, more treatment of meeting with my therapist followed as well as being put on a new antidepressant, Effexor XR, and then on Welbutrin. In addition, I was taking classes at UC San Diego and a community college to satisfy my UC Berkeley requirements, with the full intention of returning as soon as my health allowed. What was I doing in my spare time? Trying to escape my misery through watching TV shows, hanging out with friends, learning to meditate, volunteering, and making some pocket money through tutoring—everything a non-depressed me would do, only without enthusiasm.

            One spring day, I walked outside to go to my car and noticed that something was different, slightly yet distinctly so—that unnameable tide that obliterated any enjoyable response to the living world was gone. For the first time in many months I felt pleasure—I could feel the sun’s warmth on my shoulders, I noticed the greenness of the grass, and I smelled the freshness in the air. That was the day my depression was gone, and tears of relief filled my face. Now it was time to face the life’s responsibilities and return to Berkeley, where I am currently continuing my study and reflecting on these past days.

The Stigma Within Us

During my sophomore year as an undergraduate student at UC Berkeley I was diagnosed with depression. What my therapist meant was that I had clinical depression, or major depressive disorder (MDD)—the mental illness that is characterized by an inability to enjoy life; including eating, exercise, social interaction or sex; feelings of worthlessness, isolation, and hopelessness. That's what I had. I felt hopeless, worthless, and utterly alone—feelings I never had before to that intensity—and I felt ashamed for feeling this way.

My mind brought up feelings from the deep recesses of my mind—the dark, secluded corners that are inaccessible and even dangerous for our conscious minds to see. I had feelings that I never had before—for which there are no names—and I did not even suspect that these feelings were possible. As I said before, I did not enjoy life, had frequent crying spells, and felt guilty about it. Everyone around me seemed so happy, and I did not want to be a burden on my friends and family, so I did not tell anyone that I had depression. This state was wholly alien to me, and I knew I was in uncharted waters, and yet I was afraid to ask for help. I just ignored it and hoped for it to go away. Had mental illness and depression been an open subject, where everyone knew what it is and how to treat it, I might not have felt the way I did and would have reached out for help sooner.

It all started at the end of my freshman year at Cal. I lost my motivation to do homework, I could not pay attention in class, and I stopped attending my classes altogether. Any work just felt so meaningless. Although I remember that I did reach out to two of my friends, who took the time to chat with me. But even though it felt good to relate what I was feeling to another human being, my friends did not suspect that anything was seriously wrong. But how could they, at a time when mental illness is such a sensitive topic that virtually nobody talks about it and the media avoids it? It was hard for me to acknowledge that what I was experiencing was anxiety and depression. I did not even consider that I was in the early stages of depression, but sensing that something was wrong, I scheduled to see a counselor at the Counseling and Psychological Services (CPS) at the University Health Services. But even after I was diagnosed I denied this fact for a very long time.

After I reached my six-session semester limit, my therapist, who also worked at other Universities, told me—explaining the high demand for counseling at the University—that depression is an “epidemic” at Cal. This is no surprise, considering that I led the typical freshman lifestyle: I ate whatever and whenever I pleased, I didn’t exercise, I pulled all-nighters almost weekly, and I was under the stresses of adjusting to new academic demands and a new setting, while being away from home for the first time. Considering that one of my classes was the size of my whole high school, Cal can be an overwhelming, alienating place. Therefore, like many students do when they first come to Cal, I had difficulty adjusting and feeling a sense of belonging.

Although people may feel grief, stress, and sad due to life's changes, not everyone becomes clinically depressed. The lifetime prevalence of major depressive episode is 17% in the US (or 1 in 6), and 1 in 15 have it at any given year, with varying severity. The term "depression" is highly misunderstood because it is ambiguous. When people say they are depressed they usually refer to having low mood or a bad day. However, in a major depressive episode, low mood is but one of dozens debilitating symptoms. Depression may also refer to an umbrella term for any or all of the mood disorders (Major depressive disorder, Dysthymia, Bipolar disorder, and substance induced mood disorders). There is usually no clear cause of MDD—such neat logic and compartmentalization are not how the human mind and depression work. Surely, my genes, poor lifestyle and perpetual stress contributed to me having depression, but the exact pathways remain a mystery in the medical field. Almost one in seven college students nationwide have been diagnosed with depression in their lifetime. Depression is also the leading cause of disability worldwide, and yet the subject remains taboo! A moment's reflection would reveal that this is an outrage. How many people with depression do you know?.. My guess is not many. So if depression is an “epidemic” on campuses across the U.S., and especially at Cal, why do so few people know about it and why did I feel so stigmatized?

To a large extent, the stigma is due to our misunderstanding of mental illness. Partly because its severity is inaccessible to someone who has not experienced it, and partly because this topic is avoided in conversation and the media. Media only mentions mental illness (if at all) when it reaches the extreme, such as in the cases of a school shooting or a suicide. This gives the public an image of the mentally ill as being a threat to society who should be locked away in an asylum. Even mentioning—much less admitting to having—a mental illness leads most people to discomfort and avoidance.

So now, the real question is: how do we get rid of the stigma of mental illness that plagues so many students on our campus? How do we accept that depression is a real illness as reality and stop the deplorable shame and unnecessary suffering? How do we recognize that mental illness necessitates the same care as cancer or diabetes or an injury does? Only through talking openly about depression and mental illness, we've got to take any opportunity to talk about it. So let’s start right away and talk to just one person—friend or stranger—about mental illness today.

Darkness Visible: A Memoir of Madness, by William Styron

A beautiful book... almost plain-spoken, and all the more profound for it. Describes depression very accurately and gives a just account of its innumerable intricacies—all the more impressive, since it’s a short book. Reading this book was the greatest solace in my loneliness, where no one can relate. The focus, the honesty, the disarming lyricism, the sensitivity, that constant rueful sadness, even humor—and, yes, redemption. There isn’t any attempt to glamorize or romanticize depression—Styron even reflects on centuries of artists who seem to be inexplicably blighted by the disease. A mix of personal defeats, friends, the writing life—and how one’s existence is just permeated with the darkness. Oh, there’s just so many things I want to share, to discuss—I want to point to a page and say, “Yes, that’s true,” and then to another, “He’s right.” Depression is sometimes termed "the invisible illness", because it is not apparent—nor is its severity accessible—to an outside observer.

William Styron (1925 – 2006), Darkness Visible: A Memoir of Madness

[A] fascinating aspect of depression’s pathology . . . This concerns not the familiar threshold of pain but a parallel phenomenon, and that is the probable inability of the psyche to absorb pain beyond predictable limits of time. There is a region in the experience of pain where the certainty of alleviation often permits super human endurance. We learn to live with pain in varying degrees daily, or over longer periods of time, and we are more often than not mercifully free of it. When we endure severe discomfort of a physical nature our conditioning has taught us since childhood to make accommodations to the pain’s demands- to accept it, whether pluckily or whimpering and complaining, according to our personal degree of stoicism, but in any case to accept it. Except in intractable terminal pain, there is almost always some form of relief; we look forward to the alleviation, whether it be through sleep or tylenol or self-hypnosis or a change of posture or, most often, through the body’s capacity for healing itself, and we embrace this eventual respite as the natural reward we receive for having been, temporarily, such good sports and doughty sufferers, such optimistic cheerleaders for life at heart.

In depression this faith in deliverance, in ultimate restoration, is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come- not in a day, an hour, a month, or a minute. If there is mild relief, one knows that it is only temporary; more pain will follow. It is hopelessness even more than pain that crushes the soul. So the decision-making of daily life involves not, as in normal affairs, shifting from one annoying situation to another less annoying- or from discomfort to relative comfort, or from boredom to activity- but moving from pain to pain. One does not abandon, even briefly, one’s bed of nails, but is attached to it wherever one goes. And this results in a striking experience- one which I have called, borrowing military terminology, the situation of the walking wounded. For in virtually any other serious sickness, a patient who felt similar devastation would by lying flat in bed, possibly sedated and hooked up to the tubes and wires of life-support systems, but at the very least in a posture of repose and in an isolated setting. His invalidism would be necessary, unquestioned and honorably attained. However, the sufferer from depression has no such option and therefore finds himself, like a walking casualty of war, thrust into the most intolerable social and family situations. There he must, despite the anguish devouring his brain, present a face approximating the one that is associated with ordinary events and companionship. He must try to utter small talk, and be responsive to questions, and knowingly nod and frown and, God help him, even smile. But it is a fierce trial attempting to speak a few simple words.

Thank you, Mr. Styron. You saved my life, and you are deeply missed.

Is Suicide Selfish?

“Suicide is not selfish. Period."

—John Kevin Hines, a suicide prevention advocate and suicide attempt survivor.

Kevin Hines, at the site of his suicide attempt.

It is easy to assign blame. Whenever people are disturbed, their propensity is to assign blame, to get "justice" by holding those responsible for the offense accountable, whether through force, verbal attack, or shunning.

It's curious how the first emotion you feel when you hear about the suicide of somebody you know is fear—the fear that you are somehow responsible for the death. One day, when I was in Berkeley at my volunteer site entering data, I got a call. It was Pierre, my good friend from San Diego. His voice sounded grim, and after an exchange of 'how are you's', he said he had something serious to tell me and asked me to sit down. I was puzzled and asked what happened. He told me that David, our mutual friend—the one with whom we used to hang out and play the board game Risk—had committed suicide. The news sounded unreal to me, and a strange stream of emotions passed through me; one of the strongest ones, thought irrational, was fear—the fear that I was somehow responsible for his death, that there might have been something I said or did that caused him to feel so bad as to come to this end.

David, several months before he committed suicide.

My friend's death came as a surprise and a shock to me. And as I found out later, his family and friends, including Pierre, who brought be this terrible news, were no less stupefied. He left no explanation as to why he did it, and it is up to our imaginations to speculate what might have led him to take his own life. He had a good job, his family is well off, he had friends, and many people knew him at his Church.

Outside you act so tough
But inside you cry
All the pain inside just makes you want to die

—Brian Head Welch, L.O.V.E.

The point that I am making here is obvious—that no matter how much you think you know a person, you really don't. This point is illustrated clearly through the words of Karen Kenyon, author of the book Sunshower who has been married to her husband Dick Kenyon for almost sixteen years. One night, instead of coming home as he always did, Dick, then an administrative worker at UCSD, ended his life on November 3, 1978, by jumping to his death from an eleven-story building on the campus where he worked. "There were no observable clues, no threats of destruction, just a slightly noticeable withdrawal", write Ms. Kenyon; his suicide note to his wife began, "Karen, This job has killed me." This goes on to demonstrate the extreme dichotomy between the inward and outward manifestations of pain. A person may be burning in agony on the inside while showing no outward signs of distress.

"When someone takes his or her life, it is seen as the saddest statement anyone could ever make. At least in our culture, this is so. Suicide is covered up, hidden by family and friends. It is seen as a mark on the lives of those connected with it. But it happens. It is part of our human experience."

—Karen Kenyon, Sunshower

Death is a part of life (there is joke that goes "death is a part of life, namely the last part", which is also true), and so is suicide. In my suicidal ideations I do not blame anybody for my wanting to die. If I ever decide to kill myself, the decision would be deliberate, well-thought out, and my own. I would not take my life by impulse or folly, rather the decision would be rational and carefully thought out. We all sometimes cause suffering and mistreat each other, whether deliberately or unintentionally, but we never wish our loved ones to die. So you see, it is irrational to feel like you're to blame for another's suicide. Friends and especially families of suicide victims often find themselves in deep distress, because they feel responsible for their loved one's suicide, and the society may perpetuate this feeling. But this is never the case. It is never the family's, or anyone's fault. The pain of the tragedy of the sudden loss stings, but it is not because close ones are responsible. It is because a big part of them has died with that individual, and they need time to grieve and accept the death.

Blame is a fatal emotion. Along with shock, sorrow, shame, and sense of failure, guilt is the hardest emotion to get through for the survivors. All of the questions torture those left behind, making them want to punish themselves with things like cancer and death. It is important to support suicide survivors and to let them know that you do not blame them for what happened.

“Nobody realizes that some people expend tremendous energy merely to be normal.”

—Albert Camus (1913 - 1960), French existentialist author and philosopher

...To Be Continued

"We the living are likely to feel accused by this person who 'voted with his feet.' It appears to cast a subversive judgment upon the social polity as a whole that what was supposed to work in life—religion, family, friendship, commerce, and industry—did not."

—Edward Hoagland, "Heavens and Nature"

It is ignorant and arrogant to judge somebody’s decision of taking their own life, because everybody’s life belongs to them, not us, and to judge them is to claim ownership of their life. Furthermore, dismissing suicides as rash decisions is abhorrent because it diminishes the suffering of the suicide victims and prevents the society from recognizing its own role in contributing to suicides as well as addressing the dysfunction within the society that led to the suicide victims' suffering and the eventual death. It prevents others from holding themselves accountable for their lack of effort to prevent that person’s suicide and maybe even their own contribution to that person’s suicide. Life is every person’s inherent right, and so is the right to die.

"I went over everything in Dick’s and my life together. I felt we belonged together. But now I built case after case against myself. Maybe I wasn’t a good enough wife or a friend, I would conclude. And yet all my questioning was self-centered...

"After a long while, I did wonder if he didn’t have that right...

"... I know that if I could have stopped Dick I would have done almost anything within my power. But who would I be doing this for? Really myself. I am the one who didn’t want to suffer the separation—the loss. So now I want to say to Dick—‘I let you go’. Now the only judgment I can make is that it is very hard at the point of separation (Journal excerpt, November 14, 1979).

"So I began to realize it was Dick’s decision. No one else would have wanted that in any way. He did not tell a soul. He kept his secret, and made the choice, for reasons I can only speculate about now, and still the reasons don’t really matter. People have said everything from “He was a saint and martyr” to “He was very sick”. He did what he did, and in a way we have no right to interpret it. He did it for reasons he considered right and necessary—the only thing to do. In a way I feel—Can’t he even have that?

"I do believe we are all responsible for our lives, and so acceptance of our involvement in what happens around us is essential, but I feel we have to also know and respect that others have their own ultimate choices, as we do ours.”

—Karen Kenyon, Sunshower

My friend David died by suicide two years ago, without showing any warning signs. His family and friends are terribly devastated and are still grieving his loss, but it is not up to me to judge his decision; I don’t know what he was going through. Even thought his family and friends deeply miss him, we respect his decision to take his own life. It is ignorant to blame the suicide victim, and it is selfish to call him selfish, because when we do so, it is only our own pain—and not the pain of the deceased—that we care about.