Following a rash of celebrity suicides lately, as there is following any major celebrity suicide, there’s increased talk of mental health through social and national media. What isn’t talked about as much, though mentioned, is that the national suicide rate in the US has increased by 30% since 1999. That’s not just a minor increase — this is a major public health crisis.
The question is — what can or should we do about it? Some quick stats to get the conversation started: the annual age-adjusted suicide rate is 13.42 per 100,000 individuals. There are 123 suicides per day. This is the 10th leading cause of death in the US. Men die by suicide 3.53x more often than women. The rate of suicide is highest in middle-age white men in particular.
When someone makes the decision to end their life, it feels as if there is no other choice. Reasons for suicide (and suicide attempts) vary depending on a person’s psychological makeup. For some, it’s a response to specific traumatic life events. To others, it’s the result of lifelong depression or history of drug abuse. And to many, it’s the build up of feeling like a failure (rationally or irrationally) — whether that be the loss of celebrity status or being incapable of financially taking care of a family (and, often, too afraid or ashamed to seek help.)
When people say depression is an illness like any other, I pause. It is and it isn’t. Research on depression is still in its early days. There are genes that impact our mood, and it’s been proven that the hippocampus in the brain is smaller in depressed people by 9 to 13%. Stress can likely suppress the production of nerve cells in the hippocampus.
There are certainly serious mood disorders such as Bipolar, which switch between depression and mania, and I do not meant to downplay or make light of the seriousness of chemical imbalances that can be and have been successfully treated by medication in certain depressed individuals.
But so much of our language and thoughts on depression is shaped these days by big pharmaceutical companies who try to convince us that taking drugs will fix the problem. No one, even Ivy League-trained psychiatrists, understand exactly how these drugs work. They seem to increase the production of nerve cells as well as nerve cell connections in the hippocampus, as well as increase neurotransmitters in the brain. After enough studies, they figure out depressed people can feel better over time when this all happens.
Yet the part of depression that isn’t talked about is what I believe is its place as a personality disorder.
You can’t treat personality disorders with medicine, thus less research is spent on solving for the aspects of personality that impact a person’s mental state. Personality disorders are characterized by fundamental differences between the individual and most other people. As such, if we are to accept that “most other people” are not depressed (outside of short-term, life event-response depression), then a depression should be a personality disorder.
There are three basic types of personality disorders, which are characterized by clusters of symptoms. Type A personality disorders are related to the individual’s ability to relate to other people, leading that person to behave in a way that other people regard as odd. An example of this is paranoid personality disorder, where the individual is unusually distrustful and suspicious of others.
In type B personality disorders, the sufferer struggles to regulate his or her moods, often switching rapidly between feeling very down and very happy, and exhibiting similar variations in his or her view of others. An example is borderline personality disorder, which is characterized by erratic relationships, unstable moods and often self-harm.
The final type of personality disorder is type C, in which feelings of fear and anxiety dominate the individual’s existence. This leads them to become socially withdrawn, with an example being avoidant personality disorder. These individuals are often misunderstood, because it’s easy to mistake their crippling fear of rejection as a disinterest in social interaction.
How can we have the conversation about depression without discussing and understanding personality disorders (which I prefer to call “personality traits” or “personality types”?) If you think of why anyone would decide to take their own life, with the exception of in cases of terminal illness, chances are their personality fits into one or more of the above buckets.
Psychologists say you can’t change a person’s personality, but you can help them learn to better manage “irrational” thoughts through Cognitive Behavioral Therapy (CBT) and Dialetical Behavior Therapy (DBT). This is somewhat true. Many people are capable of escaping black-and-white thinking with proper exploration of irrational thought patterns (i.e.: I made one mistake, everyone hates me and I don’t deserve to live) and coping skills (splash cold water on your face and go for a run when you feel you are in crisis mode, regardless of your reasoning for experiencing panic or a crisis.) Even those who have personality disorders which turn such thoughts against others (blaming one or multiple people for all of the bad things in their lives / the world) can be helped if they’re open to breaking down a thought process into rational thought patterns and increasing levels of empathy, even if this empathy is obtained through more intellectual vs emotional means.
Some personality disorders are so extreme (sociopathy, for instance) they may be untreatable. But in the cases of personality disorders/traits/types which increase the likelihood of suicide, it is imperative that we bring these to light as part of our conversations about depression. Because, whenever we talk about depression, we say “reach out to a friend and tell them you’re there for them,” but ultimately this is meaningless if you do not want to open the can of worms that is supporting someone with what you may see as irrational thoughts (and, you must also ask yourself, are you capable of being there for a person who is paranoid or avoidant or has extreme trouble regulating their moods.)
Sure, everyone can relate to a person feeling down because they lost a job or they can’t pay the bills. But, how about a person who is succeeding in life on the outside, but inside they feel as if no matter how great their accomplishments, they are still a failure? What about a man (or woman — but often a man) who only knows how to be a breadwinner, who has a job that pays the bills, but who is paranoid that he will lose his job and be unable to provide for his family? Or a woman (or man) who was raised in an unstable environment and has extreme fear of being abandoned to the point of only knowing how to push people away time and again to prove that those people will actually not abandon them?
Beyond suicide, there are many, many means of self harm, from drug and alcohol abuse to cutting to binge eating. All of these tie to our desire as human beings to feel in control. As children, we cry when we are hungry or scared — but typically our needs are met by parents who ensure we are fed and protected. Then adulthood happens. We are on our own. We have to interact with other humans who are also trying to figure it out as they go. And, because we’re humans, we can’t show our animalistic sides at all. We have to have our shit together so to speak. As hard as it is to be a depressed woman in our society, it’s even harder to be a depressed man, as men are especially told that they should be strong and not emotional or “weak.”
When one thinks about death as an option, even if they’d never commit suicide, and especially if it’s a recurring thought (and not a one-time reaction to a specific life event), then the important thing to understand is that the thoughts have bubbled up to the point where death seems like the right and in some cases only option to escape the pain. But this pain is often caused by recurring thought loops tied to personality types, not necessarily chemical imbalances that can be cured by antidepressants.
So, back to the question of how to support a depressed friend, it seems we must be better at being open about (and not judging) those who have what “healthy” people would see as irrational thoughts that one should just stop thinking. This would be akin to telling an anorexic person that has a low BMI that s/he is not fat and looks beautiful.
In the same vein, we must be open to discussing the cause of personality disorders/traits/types. For many, these are caused by abuse or neglect in childhood. Some are clearly more sensitive to certain early occurrences in life than others, which may be genetic or something that we’re individually born with. As life goes on, we acquire many scripts which dictate how we process our interactions with others, and how we value ourselves.
At the same time, we live in a society that puts a premium on “happiness” and being happy all the time. Social media only makes this worse, as we see only the best of other’s lives in snapshots of everyone smiling. For adolescents this can be especially harmful. But we’re all at risk as it’s easy to forget that behind the smiling pictures of families and friends is a host of “what we don’t talk about” that everyone is dealing with and they wouldn’t share on a Facebook wall or Instagram pic.
This obsession with happiness — especially in America — is not good for us. As this brilliant headline from Inc. last year puts it — “Experts: American’s Obsession with Happiness is Backfiring Badly. :: We’re bombarded by happiness advice all the time, so why are we getting objectively more miserable?”
There is nothing wrong with wanting to be happy, but happiness, much like sadness, should be appreciated as temporary states of the human psyche, not something we must strive to achieve at all times and at all costs.
At the same time, our society more than ever values individual responsibility over the wellness of its population for the greater good. It’s an “every man in it for himself” mentality that, even for those who believe it (and perhaps especially for those who believe it), hurts us immensely.
Another book (which I haven’t read yet but has a great title and which is now on my reading list) America the Anxious: How Our Pursuit of Happiness Is Creating a Nation of Nervous Wrecks notes that our obsession with happiness is making us miserable. The general premise is that our focus on helping ourselves and not helping others makes us miserable.
“The more happiness research I read, the more it starts to look as though we might all get a better happiness return from sitting in the pub with our friends, bitching about meditation, rather than by actually practicing it. Quite” ― Ruth Whippman, America the Anxious: How Our Pursuit of Happiness Is Creating a Nation of Nervous Wrecks
The messages we receive as Americans are mixed: you are responsible for yourself and your family. Asking for help from others is something to be ashamed of, in most cases (especially as a male but increasingly as a female.) Providing help to others is acceptable within limits, but only if that person is worthy of receiving help. Oh, and be happy all the time. Go to a zen retreat or something. Do some yoga. You’ll be blissed out.
But we have gotten to a point in our culture where we expect to much — of ourselves. Of others. Of what life should be. The greatness of living in modern-day America is that the possibilities are vast. Although being born wealthy certainly helps, it’s still possible, through hard work and a bit of luck, to build a stable life for oneself (*harder for people of color, but still possible compared to other societies and especially times in history.) We live in a time when you can do anything. And maybe that’s part of the problem.
We kill ourselves because we create a mental model of who we should be and often we can never be that person. We are depressed because we believe fundamentally we should be happy and in control and if we’re not, we’re broken and unfixable. A stressful life event can tip a depressed person — already convinced he or she is fundamentally broken or that life itself cannot improve— over the edge.
Many, many people with depression and/or personality “disorders” will never commit suicide. But they may drink too much or eat too much or do any number of harmful things that don’t get media attention in the same way but are nonetheless extremely problematic.
So, when we say “reach out to a friend and let them know you’re there” — what does that really mean? Certainly if someone feels alone and like no one cares, a friend reaching out may indeed save their life. But, at a higher level, I think it’s more important to be open to discussing how miserable we all are and how misery is an equally important and acceptable state of being human. We discuss misery in the arts and culture — but in real life, it’s not acceptable to share the shit that is going on in our lives with others. It feels selfish, in a way, to share said shit. But, in reality, this helps us all — to admit openly to our fears, our challenges, our weaknesses, our “I’m not happy and this is why and that’s ok.”
Because — I always come back to — life is pretty f’d up, when you think about it. We’re born, we live 100-some healthy years if we’re lucky, and along the way our loved ones disappear. At the same time we’re biologically designed to make more people (not that everyone does or has to, but many people do), and those who do have the pressures of raising and feeding offspring and those who don’t have the pressures of finding meaning in life in other ways.
But, life shouldn’t be taken so seriously. It’s practically a long-running joke, on us. Yet, if we can step away from that and look around at the wonder of it all — just sit back and always try to find that part of us from our childhood when we experienced something for the first time… when we genuinely said and felt “wow” — then maybe we still have a fighting chance to be ok. We still need to feed and clothe ourselves and our families, but beyond this, what we really need is human connection. We need to be willing to be publicly vulnerable and embrace that vulnerability as the ultimate character of strength.
life with interest 