Major depressive disorder (hereafter referred to as "depression") is a prevalent and disabling illness. According to the National Institute of Mental Health:
Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44...[and]...affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.
There's been some terrific writing on depression around ScienceBlogs this year. I've written a few pieces touching on mental illness in the past, but never anything explicitly about depression. Given the frequency and impact of this disease, it's time to have a frank discussion. This was spurred in part by an acquaintance who reads my blog and has struggled with depression herself. She happens to be a pretty good writer and was willing to share some of her experiences with us.
I'd like to use her story to start off a discussion about many of the problems surrounding depression, some of which aren't so obvious, including impact on work and friendships. And since I want a frank and open discussion, I'm asking my commenters to think twice before hitting "post". In an unprecedented act of censorship, I'm asking you to censor yourself when it comes to derogatory comments about each other. If you can't properly censor yourself, I'm likely to do it for you.
I'm rendering the voice of "graustesinnever" in "thesis" font to set her writing apart from mine.
Depression and my advisor
I saw a lot of posts around the blogsphere lately with questions about depression. There was one in particular at Dr. Isis', a question about whether or not the student should tell her advisor. I was so heartened to hear so many people say Yes, tell your advisor. They will understand, they will help you. One of the commenters even talked about her advisor coming to pick her up in the morning when she was too sick to get out of bed. I was so heartened, and but I was also so sad. That experience is entirely foreign to me. Since I don't have a blog where I can write about stuff like this, Dr. Pal, when I asked, gave me generous permission to post here. Knowing the audience I bet I'm in for a bit of bashing.
I have clinical depression. I have had depressive episodes, I think, since I was a teenager, but I was only diagnosed in grad school. I only found out later how strongly it runs in the family. But hindsight is 20/20, and I can remember times when I should have been beyond excited and happy, surrounded by wonderful people and doing wonderful things, and all I could do was stare in the middle distance, and try not to cry all day long, over and over for weeks, months. I spent an entire summer in Western Europe. At one point, I spent days doing nothing but riding the 95 bus line around Lyons, never getting off, just sitting and staring out the window. I would cry and beg silently in my mind for people to notice. But of course, all those things people do when they are depressed, which they think are going to make people pay attention, are exactly the sort of thing that drive people further away.
But by senior year of college, all was right with the world, grad school applications were in, and life looked ok.
And then I went to grad school. I entered a punishing routine of classes and labwork. And the grad school I picked, was not what I thought it was. It was one of the best programs in the country for my discipline. But it was more competitive than anything I had ever experienced. No one was a friend. I was immediately ostracized for being geeky and weird, and treated in a way I hadn't seen since middle school. I was a good student, and decent in the lab, but I was incredibly lonely. I never learned how to meet people, and my fellow students made no effort to join together. We might be colleagues for the rest of our lives, but it will be jealous competition at best.
Nothing triggers depression like feeling so alone. Finally, in my second year, several things happened, I got increasingly desperate, and when I started to look at kitchen knives the wrong way I went to see a counselor. I thought I hated grad school. I thought it was biomedical science. I needed to GET OUT. But I could barely get out of bed.
counseling helped a little, antidepressants helped more. My counselor, my parents, and my close friends who knew (most of them still don't) asked me repeatedly whether I had told my advisor. I had not. I will not. Several years later, my advisor still doesn't know. My committee doesn't know. Even my mentor will not know. Maybe, in a few years, in a post-doc, I will tell someone. But I am too afraid.
My program is very hard. It has a high drop-out rate. I remember one girl dropped out, it was whispered for months that it was because she was bipolar. She went crazy, people said. A boy dropped out, and everyone said how he was an alcoholic and crazy, they said he had schizophrenia. Or maybe, they said, it was just the drugs. Another boy dropped out. Everyone knew about his anxiety, his depression, his ADHD. Every bad grade he made was the same. His drugs weren't working that day. He wasn't in a good place. If he could just try again... The members of his class grumbled when he got an extra four hours to take an exam. The second time he failed the quals, he was gone. Most people in the department just said he clearly couldn't take it.
So when I got a diagnosis, and I knew I wasn't just being emo and stupid and a child, I felt nothing but fear and shame. I couldn't tell people. I can't tell people. There is a stigma in mental illness, and nowhere does it show up more than among the high-achieving. You might HAVE mental illness or an addiction. But you're supposed to keep working through it. You're smart and promising, you are better than depression or alcoholism or anxiety. Amazing how biomedical scientists can think that willpower will overcome brain chemicals.
Where did I get these opinions? From my fellow students, but also from my professors. I heard them scoff at the students who came in to talk about their depression. Often they were given second chances, but no one expected them to make it. The program is supposed to weed out those who can't make it. Most professors didn't even believe them. They thought ADHD was an excuse, depression was laziness. It's not that you can't get out of bed, it's that you won't. Obviously.
I used to daydream a lot about telling my advisor. Maybe I would get a nod of understanding. Maybe they would ask me what they could do to help. But I had seen them scoff at the other students, too. I got reproved the one time I cried in their office, for being unprofessional. Crying is not something a scientist does in public. In fact, it's not something a scientist does at all. They would think I couldn't handle it. From then on, their eyes would be watching me, seeing if I was going to fail. At the best, they might treat me delicately, like I was made of glass. I didn't want that. I'm sick, in a way, but I'm not dying.
So I never told anyone. I went with the stereotypes. I worked through it. I raced out of offices before they could see me cry. I spent hours in the bathroom, leaning against the door of one of the stalls, desperately hoping no one would come in. Or hoping even more desperately that someone would come in, and ask me what was wrong. I learned how to pretend I was angry. I got angry instead.
Two years later, the depression receded. For a little while. I know now that it will always come back. I wonder if my advisor thought I was just unproductive because I was stupid. Or because I was lazy. Probably. But I am still too scared to tell them the truth. Then it might be stupid, lazy, AND depressed. Great. Someone get that hot potato out of my lap.
I hope someday I can find a mentor I can trust enough to tell them. I hope I won't be scoffed at. I hope someone cares enough to call when I don't come to work, rather than send some mildly reproving emails a few days later, when they notice I am gone. I hope they won't start to avoid me, to make excuses. I hope they won't give me a lukewarm reference, because they don't want to recommend damaged goods. If I fail, it reflects badly on them.
Depression isn't weakness. It isn't a lack of willpower. It is scary and deadly in a way that only being trapped in your own mind can be. It spins your thoughts in more negative circles, til you can't think your way out. And it doesn't make it better to know, even in moments of clarity, that this is affecting your career, but those who can help your career will not help you. Everyone understands other chronic conditions. Help will be given for diabetes, for cancer, for autoimmune diseases. Those are visible, we can see them. Depression is constantly asking to be seen, and pushing people away at the same time.
So what is the point? There is still a stigma, even among the most educated in the nation. There is still no understanding of mental illness. Since there is no understanding, there is little sympathy and less help. Think about those students who you thought just couldn't make it. Were they really just lazy and unmotivated? Did they just like to party too much? Or did you never think to ask if it was something else, if something was wrong. Do you, like many professors, not really like seeing emotion in your students, unless it's science related. Maybe you think you've been down too, and you did just fine. These people aren't strong enough, that's it. Kids these days.
Points of discussion are whatever you wish, but among them:
- The somewhat false dichotomy of "mental" vs. "physical" illness
- The stigma of brain illnesses
- Career considerations
- Our current health care system as it relates to mental health
Thanks in advance for participating and doing so politely.
Resources, including crisis help: here.