Out of My Mind
About my experience with clinical depression
Originally posted on Medium.
I ♥︎ NY
In January 2012, I quit a job that I had become too comfortable with, and moved to New York to study at Columbia University. I was proud of the way I had wrapped up my previous chapter in Pune, thankful that I wouldn’t need to worry about student loans, and excited about the project I was joining in the Software Systems Lab. I took the mild winter as a good omen, and eased into a new routine within a few days. Course work was light and easy. Project work was challenging but something I couldn’t be dragged away from. My advisor was the most brilliant person I ever worked with, and my labmates were all smarter and nicer than me. I didn’t know many things, but I had never been more prepared, more motivated, or more engaged with my work.
Outside the lab too I was exploring. It was my fourth city, and its restlessness injected into me a new jolt of energy. I loved spending time in Columbia’s libraries, especially relaxing in one of Butler’s reading rooms with a story by Alice Munro. I ran occasionally along the Riverside Park, thrilled to discover that I was able to run for the first time four years after a severe knee injury. I collected new experiences and tastes through classical music concerts, museums, and the many restaurants.
Soon it was spring. Towards the end of March I started crying in the shower.
I was baffled. I had never cried as an adult before. Back in January 2008, when a resident twisted and jerked my fractured leg to realign a dislocated knee, my eyes involuntarily filled with tears. That didn’t count. Now I had no reason to cry. The project was more challenging than I had expected, and I had to cut down on my weekend jaunts just to keep up, but I was neither losing sleep nor appetite over it. This wasn’t the first time in my life when I didn’t know everything I was expected to. I was not out of ideas. I was getting sufficient help from my brother and everyone in the lab. And I didn’t like my project any less. I couldn’t extrapolate any of that to sorrow.
Adjusting this into my routine was strange but simple. Most mornings, as I reviewed the previous day’s progress and that day’s plans, I also cried. Crying in the shower didn’t interfere with my schedule.
Are you talking to me?
In April 2012, a controversy about a few professors of my alma mater made news among the Indian dailies, and got forwarded to the email group of my classmates. As alumni we wanted to say something about it, take a position perhaps. We discussed heatedly. I took an unpopular side and made loud and dramatic pleas, even while I knew that I was offending some of my friends. I was obsessed with that email thread, reading and re-reading what each person said. I referred books in the library, PDFs on the IITM website, talked to one of the professors involved, and searched for connections and precedents. I watched Boston Legal episodes with a desire to channel Alan Shore, even though I mostly related to Jerry Espenson. In my mind I was trying to put together a strong legal case for a fair trial with everybody on the email thread acting as the jury. But on text I was out of my mind. What I wrote was more emotional than rational. It was insensitive. I cried several times while composing my replies, and many more times re-reading them. The summary was to appeal to their kindness, and in my warped reality it was more for my sake than for anyone else’s. I was convinced that I was going to do something terrible, and while there was no saving me from that, I needed them to understand in the aftermath, not just that I could do wrong but that “humans are fallible and we are all hurtling towards gigantic mistakes that make us unforgivable in the eyes of our future generations”. My own emails were the guilty pleas. I didn’t win the argument. I wore the others down.
It was an exercise during which my tears finally spilled out of the shower. Now I could cry with ease, and I was crying regularly in my room. Two more changes began that I had yet to notice. I started fixating on some weighty quote or the other, often my own, imagining it to be profound, and reciting it over and over. When I got bored, I either polished the quote or tried a different modulation. Later it expanded from a quote to a series of paragraphs. Depending on how I feel about that behavior at any given time, it was either like Travis Bickle in Taxi Driver, or Subba Rao in Money. Such short-lived obsessions also started becoming enormous time sinks, which I started referring to as “getting stuck”.
By May 2012, I realized that whatever was happening to me was strange enough for others to possibly notice it. I had to think carefully before every move. I began reviewing all communication from my recent past. Emails, chats, messages, and call logs. I counted the number of times I emailed my family and friends, and the number of times they did. The amount of time I took to respond, and the amount they did. The number of times I suggested to my friends that we meet, and the number of times they did. Paranoia. I interpreted the findings as me being overly eager, the way I had been in that April email thread, and decided that I would have to control that, by restricting all communication to what was strictly necessary. It shrunk my world to a radius of one person. My comfort in solitude slipped into a need for reclusion.
I found this in my diary, dated 30th June, 2012:
Over the last 6-months, I became very thin-skinned. I lost the ability to laugh at jokes. I easily got upset, if not offended, by everyone and everything.
In July 2012, a friend from London and another from Austin visited NY. For a week, my reclusion was stripped away. I was saved from my thoughts. I was glad to meet them, and on their pretext my other friends whom I had been avoiding. The most important thing was that nobody seemed to suspect anything. I had it under control. Towards the end of their trip, at a relatively large reunion, one of the people who had been on the April thread remarked about my participation in it. Fresh fodder for a fried brain.
All the things!
Today it is possible to piece together an accurate picture of our pasts. For someone who isn’t active on social networks, and who deleted several of his accounts, blogs, and private notes from back then, even I have the email threads, call logs, credit card bills, Netflix and Goodreads histories, etc. to get a medium resolution picture of my life in 2012 and 2013. Maybe I am holding out for that memoir contract with Random House, or don’t yet dare to stare into that darkness, but I haven’t dug into my data deeply to write this piece. I also don’t have a ready recollection of that time, and I know my mind too well to not trust it from making up smooth narratives from a handful of misremembered memories. So not a lot of show and tell here.
My mind continued to deteriorate for the rest of 2012. It did not stop with crying, getting stuck, losing self-control, and being paranoid.
I indulged in mildly compulsive behavior. I regularly took a used A4 sheet, tore it down into smaller and smaller pieces, and at the end counted them. If I was alone while taking stairs, along with counting the steps, I climbed farther than my destination or went back and retraced the steps, so I could count again or more. I continued to count the emails I had received from friends and family, and that result continued to fuel my desire for reclusion. I cleaned parts of the apartment like the hall that I never entered, parts like the bathroom that would have been a shared responsibility, and parts like the long corridor inside the apartment that people rarely cleaned. I cleaned my room and the kitchen, which was mostly only used by me, more regularly and more thoroughly. Instead of cleaning the dishes once a day, I cleaned them after every use. Very rarely, especially if I sensed that my roommate had used them, I cleaned them twice.
My grip on self-control seemed to slip. I worried that my emails were getting more verbose, though I managed to keep their frequency low. During the few times I met with friends, I became self-conscious mid-sentence that I must have been talking too much and listening too little. During some of the daily meetings with my advisor, I wondered whether my face was becoming transparent. The lack of control was most apparent in how easily I got stuck. There were many triggers for this. Something I read, something I did, something someone else did, something I imagined. What made it worse was that a part of my mind was aware of it getting stuck. I sensed it most strongly as a noise that I couldn’t keep out of my ears.
My sensitivity to noise increased. Whether it was labmates chatting, roommate calling his girlfriend, or people partying. Once, at the end of Spring 2012, students across the street were partying past midnight in East Campus. The noise bothered me so severely that I called 911, who routed me to Public Safety, who took my complaint and within minutes broke up the party. Ironically, I at times also sought external noise to quieten the noise in my head. I threw stress balls and super balls against the walls of my room, aware that I could be disturbing my roommate. The noise in my head also made it difficult to sleep. I never suffered a fully sleepless night, but on many nights I found it difficult to fall asleep on my usual hour. The act of lying on the bed waiting for sleep involved the act of doing nothing, an environment most conducive for the noise in my head to get louder. On some nights, I pushed headphones deep into my ears and listened to MP3 tracks from AcousticSheep at max volume. It didn’t help. I figured out that the way to fall asleep was to work or watch Netflix until my eyes were too strained to stay open for the rest of that night. Both worked for me.
In the summer of 2012, I attended a rooftop party where people passed around joints and looked like they were having the time of their lives. I realized how rarely I could unwind, especially in the presence of others, and regretted some of my conservative choices. A few days later I tried smoking for the first time, hoping that nicotine might fix me. After five cigarettes over a week, the obnoxious taste and texture they left in my mouth forced me to give up. But the attempt expanded into a desire to take risks. I walked along Morningside Park on some nights, knowing that it wasn’t safe for solitary walks. I pushed myself harder and harder in the gym, until I almost fainted one morning on the way back to my apartment. I walked in the cold without warm clothing. On one evening, a tourist getting off a CitySights bus said to me, “Why, yes, cold is for other people,” and I felt pride.
I longed to do something risky, to be reckless with my life.
Living became difficult. I had no self-worth, and I felt strongly that others shouldn’t depend on me for anything because I was not good enough and getting worse. To make things easier, I had no dependents in any sense of the word. I frequently thought of suicide. I occasionally planned for it, and once scouted locations for it. Though I never attempted it, once the thought took shape in my mind, death was always lurking, regardless of whether I wanted it or not. It multiplied my fears and made some ordinary things difficult. I had to become more careful and deliberate while crossing roads and walking along subway platforms. On a handful of occasions I dreaded cutting vegetables. With some experience I learnt to recognize such hours early on, and it was easy enough to work from home a little longer, or cross footbridges instead of roads, or cook using pre-cut vegetables. I gained a deeper understanding of Michael Cunningham’s The Hours and its movie adaptation.
I was not doing nothing about my problems. I indulged in chocolate, which filled me with momentary content that couldn’t last. I sometimes looked into the bathroom mirror and demanded that I get over it, which never worked and always ended with me bawling. I read things online. Google’s auto-completion and millions of results when I searched for “why am I always” sad or crying or crying for no reason, gave me a sense of solidarity, though I never clicked on any of the results. My greatest comfort was the Q&As on Go Ask Alice. Alice was the wisest and kindest person I knew back then, and she often encouraged Columbia students to check out our Counseling and Psychological Services (CPS). I combed through their website, determined to never use it.
By November 2012, I lost all hope and could no longer pretend I could handle this alone. After a few events, I was afraid of what I might do to myself, and on 7th November finally called CPS seeking an appointment. I cried a lot that day, not the way I had for the past few months without reason, but because it was the first admission of my failure to cope with the blues, something so ordinary, and the first gesture I made to another person seeking help. Despite my attempt to congratulate myself for finally being honest, I was engulfed by disappointment, guilt, shame, and fear.
The next day I had a phone call with a psychologist at CPS. She asked me a few questions to get a sense of my situation and its urgency. It was about ten minutes long, during which my voice cracked and I took a few pauses to be able to speak without breaking down. I don’t remember much else. She asked me to come in the next day for a session with Dr. Dee*.
The next day, on the 8th floor of Alfred Lerner Hall, I filled a number of forms sitting with several other people. There I was, confident of being the saddest person on the planet, surrounded by many others auditioning for the same role. We all looked passably normal, like everyone else in the world who weren’t on that floor. As I filled the forms, I realized that the number of people who would know about my situation was steadily increasing. The psychologist I had spoken to a day ago already knew, though we would never meet in person. The one I was to meet that day would in a few minutes. The reception staff might recognize me, if this ever became a more regular thing. My file on the Columbia medical records would have new pages about mental health. My insurance company would have something, probably everything. I didn’t care that third parties would know. I would just be a statistic, personally identifiable, but still no more or no less than the rest of the people on the floor. Someone in my family or friends knowing about it, on the other hand, was something I was unwilling to consider. But the forms also needed details of an emergency contact — my brother — and I started having second thoughts about the whole getting well program.
Soon Dr. Dee came looking for me, and escorted me into his office. It was small, with no place for a couch that I was hoping to take a selfie on. I sat on the edge of the chair closest to the door, with a better exit strategy than he had. He sat on the opposite corner, behind a desk on one side and a monitor on the other. He seemed relaxed, and it relaxed me. He was my dad’s age, which I appreciated. At once I asked him about my privacy and convenience. Why emergency contacts and under what circumstances will they be contacted? Will my case be discussed with others? Will anybody else be informed about my situation? Will I ever have to be an in-patient? Will I have to meet other people as part of group counseling? Will this interfere with my work? What aspects of my case do I have no say on? etc. He patiently answered all my questions, and they were satisfactorily clear and detailed. I was not looking for the fine print*, and I started trusting him.
He asked me some questions too. Trying to know me, my background, the state of my life and my mind. He went through the forms I had filled, which included a medical history of mine and briefly that of my immediate family, and asked some questions based on them. Slowly we began talking about why exactly I was there. During that conversation, I cried in front of him in what was becoming my signature greeting. First I was embarrassed, and tried to control it as well as I could. Then while crying I wondered whether he would be so moved that he would join me in my misery. Thankfully he didn’t. He waited patiently. Then I cried openly. Articulating my difficulties, and expressing them even if mostly in the form of tears, to a rational third person provided immediate relief.
During that session I felt that Dr. Dee genuinely cared for my well-being and was concerned about my current state, and that he wanted to help. Not being acquainted, knowing that I had the choice to step out of the office and never come back, knowing that even if I were to return for another session and another after that, there would be a day when I wouldn’t have to face him again, knowing that he wasn’t a family member or a friend or a colleague, it made it easier for me to not try to act normal, because as far as the two of us were concerned this was my normal.
We decided to meet the next week for my second session. This went on for ten sessions over six months. Three in November, two in December, three in January, one in February, and the last in April. The 9th one in February 2013 was my last regular session, at the end of which we decided that I was well enough to handle things on my own and that any sessions after that would be only if I felt the need.
The doctor-patient relationship was never as challenging or dramatic or tense as any of the ones I’ve seen on TV, including the realistic ones in In Treatment. I felt like we were a good team. He took notes and referred to them, but he mostly did it before and after my appointment, so it felt more like a casual conversation. I did the same thing. Having swallowed the shame from the failure of not being able to handle myself independently, I was determined to keep my treatment as effective and short as possible. I never missed my sessions. I reviewed each session by the end of that day, taking notes including assignments to be completed before the next session. I prepared for the earlier sessions by trying to enumerate all my current symptoms, especially other non-obvious ones that I couldn’t readily recognize, tracking their progress, brainstorming about things we might discuss the next time, and trying to do my assignments. It helped.
All we did during these sessions was talk. We mainly focused on my day to day life since the previous session, what was better and what was worse and why. On occasion these threads got me talking about my past experiences and feelings. To a small extent we also talked about my assignments from the previous session, and those for the next session. During each session of 50 minutes, I was capable of being rational, as if we were dissecting the life of someone I cared about, but whose pain was not mine.
The assignments were simple. Meeting friends one weekend. Asking out someone I had met at a party. Going out with that person. Telling my roommate to start taking the trash out on his turn. Asking my advisor for more time to complete my work. Most normal people would find these trivial. I didn’t. I needed rehearsals, planning, postponing, and an anxious interaction with another human being that never went as planned.
Apart from these I also kept track of other things, with realistic targets to bring them down. Like not counting email, not tearing paper into pieces and counting them, not getting stuck, not having difficulty sleeping during my regular hours, not getting frustrated by noise, not becoming acutely anxious before and after meetings with my advisor.
But my life during these six months of treatment continued outside that tiny office, with things other than the ten 50-minute sessions. My work and most day-to-day activities outside of these sessions went on the same way as they had. And so the things I kept track of didn’t always improve. My symptoms didn’t vanish after a session. In fact the worst night of my life was towards the middle, between my 5th and 6th sessions. On that night I cried more than on any other, I was scared shitless of what I would do to myself, called the National Suicide Prevention Lifeline and hung up, and snapped rubber bands against both my wrists over and over till some of them broke and the pain was too sharp to feel my wrists. I don’t remember what happened that night, and I don’t think it’s important, though back then it must’ve seemed so. The important thing is, the day after was sunny, and I was relieved to realize that I was alright.
There were times when I didn’t want to keep my appointment. Sometimes I didn’t want to talk because I felt like I was betraying my closest ones when their topics came up, or because I was disappointed with myself, or because I was afraid Dr. Dee would tell me we weren’t making progress, or because I was afraid he would tell me my problems were imaginary and not significant enough to take his time, or because I couldn’t muster the energy to keep going and waiting for it all to be over one day and much preferred it all to end now right now. Thankfully it was important for me to be professional, and when nothing else worked, that still remained.
Even on days that I was willing to talk openly, it wasn’t always easy. Apart from just crying, there were things that I found difficult to articulate, and at times things I wasn’t willing to say aloud. Most of the times, I swallowed such difficulties, with Dr. Dee’s support and encouragement. He and I talked about suicide at length. In general, and in particular about my own thoughts. Why I longed for death, how I changed from not just waiting for it to come but sometimes to take a step towards it. Some of the ways I had considered it, and the reasons why I had ruled some of them out. About the one time when I almost cut myself. About self-harm that is not suicidal.
During one session he explained to me the limitations of the treatment he could give as a psychologist. That we could also consult a psychiatrist who would be able to prescribe anti-depressants, most probably belonging to a category called SSRIs, that might help cope with my moods, and especially to drag past any social situations. He provided a rough idea of what various courses of medication look like, how they work, and how I was expected to wean off that course once I got better. I was tempted, but I decided not to seek that line of treatment. I personally knew only a couple of people who had taken anti-depressants, and they had both complained that medication made them drowsy, and they had both discontinued midway. I feared that drowsiness would interfere with my lab work. Fighting solo, I also feared that any side-effects, especially if I fail to strictly follow the course, might make things more difficult or physically visible (weight gain, e.g.). Both sleepiness and physical side-effects had the danger of drawing attention from people around me, which I was keen to avoid. I felt that anti-depressants might be more useful for social situations, whereas I had the luxury of limiting them as much as possible. I felt that despite ups and downs I was making steady progress through counseling, and that even if it might take longer I could get better without any medication and more importantly without involving anybody other than Dr. Dee. On hindsight the irony of turning down medication is not lost on me.
I got better, didn’t I?
I couldn’t have recovered without Dr. Dee. But I also can’t explain how he helped me. He told me during my first session that I had a lot of stress in my life, something we revisited often. I didn’t believe him because compared to all my labmates and my advisor I wasn’t working hard, though it was true that it was the hardest I had ever worked. I used to write regularly, mostly in the name of catharsis, when I was much younger. Upon discovering great literature, I was embarrassed with my own writing and I had cut down and gradually stopped. Dr. Dee encouraged me to get back to it, that catharsis was not a bad reason to write. I didn’t follow that either. He repeatedly pointed out to me, through various examples, that I was being too hard on myself. I agreed with him, but it took me a while for the relevance of it to sink in.
I waited until my last session to ask Dr. Dee what the diagnosis was. It was as if I was afraid of finding out that it was a boo-boo. For some reason he never brought it up either. We concentrated on getting better from whatever it was, than on solving the mystery of what it was. Major depression.
Hindsight, not 20/20
Even months after my last session with Dr. Dee I wasn’t fully healed. Any conscious reviews of that time or even unconscious reminders through something I read or watched could fill me with sadness and fear. It took me many months before I could safely remember that time without reliving the worst parts of it.
I have had a few years since then to reflect on that period. Today I am capable of reviewing those memories, poking them, probing them, cautiously. Whereas back when I was in the thick of things, all my experiences were being filtered through an unhealthy brain, today I have a better picture. I realize that it was not one of those single character Greek tragedies, despite my monologues. Besides everything I have mentioned so far, I had other things going on in life. Mostly good things. My first research project made a small contribution to an OSDI paper. The second one was more or less a paid vacation, though it ended my funding. The third was a most interesting one, and while I contributed nothing, I earned back my funding, and our experience paved the way to better ideas in the minds of smarter people who continued to work on it. My fourth project made another small contribution to a second OSDI paper. I ended with a healthy GPA even after ignoring the final semester in the name of actively de-stressing. Outside of my lab, I worked with even more students, few of whom became friends. I still met old friends sometimes. I kept in touch with my family as regularly as always. The interactions I had with of all of them benefited the quality of my life. I remained in good physical health, and continued to have an appetite. I continued to run and developed a fondness for it. I watched Twin Peaks and The West Wing for the first time. I visited various Columbia libraries, primarily Butler and Barnard, at least every week and read almost everything that Alice Munro published, and read few other books about her writing. I learnt a lot.
During treatment and later, I also realized that some of my symptoms were personalized extensions. I have always enjoyed counting and cleaning and organizing things, have found those relaxing, and today I can see that as a reason why I have been drawn to software projects that involve measurement or reformatting. I have always been mildly anxious about most social interactions, including on occasion with my closest family and friends. I have always had a problem with noise. The big difference was that, my thoughts and actions that involved counting, cleaning, and meeting people during depression, the very habits that signified being in control, became compulsions. I fought for that control, and when I failed to regain it, I declared it as a more general loss than it probably was.
My most vivid memories are of snapping rubber bands against my wrists, of attempting self-harm, and of contemplating suicide. As I understand them today, those instances were not about giving up or out of a desire for a fatal outcome. They were almost always an effort to relieve unbearable pain, pain that did not have an origin outside of my brain, pain for which the only defense my brain could think of was distraction in the form of another more immediate source of pain. My judgment was not the only thing that was impaired. The remembrance and readjustment of memories, the generation of imaginary scenarios, the interpretation of them all were devoted to darkness. On one hand I was too exhausted for positive thoughts, and on another I had endless energy for negativity.
For the last three months I have been trying to remember the past. Not just about what it was like, but also about what I was like at that time. As the puzzle fills in, the picture I see is of a secretive egomaniac incapable of empathy. I was capable of reacting to every sad thing in the world, but those reactions were always about me. I was intensely sensitive, but with major calibration issues. In some ways, probably with the knowledge that things turned out for the better, I regret the mistakes in interactions with other people than any riskier thing I might have considered or done in solitude. Perhaps because of that, and partly with a desire to erase the public view of that past, I have since closed down several of my accounts I had back then, deleted many things I had written. Most likely an over reaction.
A few months ago, when I first told my family and friends about my depression, the question on most of their minds, and to some extent the question most asked or discussed was, “Why?”. Why was I depressed? It was a question that haunted me throughout the period of my depression. I felt that if I could figure that out, then I could fix myself. Root cause analysis is not the only problem-solving strategy, but it was the only one that I could think of, and wrongly believed for a while that it was the only way here. I couldn’t figure out the cause, and that scared me from sharing my agony with a second person. I feared that the cause would come up in any conversation with a second person, and not having any, the only option would be to point a finger at me or someone close to me. For how much fiction have we consumed that all explain mental illness as a consequence of an abused or an abusive past. Dr. Dee never probed for a root cause, and that immensely helped me in confronting this illness one day at a time, not in what may have happened, but in what I could do next.
During the time of my recovery, I decided that it was too early, raw, and futile for me to poke around the wounds and see what oozes out. By the time I got better, I made my peace and moved on. At times when I get curious, I could look back and wonder about a few different things as possible suspects, but my memory has become too stale and patchy for an investigation, even if someone had the means and methods to make a scientific inquiry. Over the past few years I have also formed a strong opinion that trying to find out why in cases like these is unimportant and an unnecessary distraction for individuals. It is useful for medical researchers and sociologists to have large data sets of approximate causes*, but that knowledge at an individual level may be insufficient and unnecessary for recovery.
Personally, why is a part of a larger question: why didn’t I tell anyone? Until now. One reason was because I didn’t want my loved ones to blame me or themselves or each other. That fear, at least at an insignificant level, turned out to be true when I told them and saw them wrestle with this new revelation and the way some of them tried to make sense of it by mapping it against a forced and flawed recollection of their own words and actions. Another reason was because I was afraid people would just shrug or deny that I was depressed. Though inapplicable to my close friends and family, this was also not entirely imaginary for I had one conversation where a person called my depression imaginary, and it had devastated me back then. Another was my unwillingness to relinquish control, and my irrational fear that the people whose help I might have sought would in their own zealousness for my well-being choose to decide what is best for me, and that I would then relinquish my right to voice a difference of opinion out of guilt about having put them in a position where their own lives revolved around mine.
I was not thinking straight.
I have thought and said those five words many times in the past few months. I have blamed my depression for many of my thoughts, words and actions back then. How convenient to blame a disease for everything that went wrong while padding my resume and reaping the benefits of the good experiences from back then? What was I and wasn’t I responsible for? Thankfully, the only one asking me that question is myself, and it is for me to figure out in my own time. These thoughts along with the sudden need to explain this to other people has given me a more nuanced, if not clearer, understanding of depression and mental illness, which continues to evolve.
Every part of the human body gets sick, in different ways and with different severities. Brain included. What we call “mind” is the main part, subsystem rather, of the body that interprets the inputs received and generates outputs. When that subsystem has bugs in it, depending on the nature and severity of the bugs, the pipeline between the reception of inputs to the generation of outputs is impaired to some degree. The existence of bugs is not equivalent to a shutdown of the subsystem. The bugs may disable some features of the subsystem, may affect some features partially, and may have no affect on the functioning of the rest. The centrality of the brain has led us to associate it with the person, an association that is convenient for social interactions. Hiding the complexity of the human body, reducing it to the identity of a human being, has also made it more difficult to appreciate the complexity of it, and made it impossible to have a rational analysis of disease.*
Apart from all the reasons I have already mentioned for being secretive about my depression, the one that has most haunted me is the fact that mental illness is a stigma. A stigma that I, a modern educated rational somewhat open-minded man, have given in to. I have the luxury of financial and social stability and support to cope with it, but I was irrationally fearful of how the world might react to the knowledge of my depression. What would my family and friends think? Would they abandon me? Would they wear kid gloves to handle me? Would they protect me by restricting me to a cage? Would my advisor declare me incompetent and ask me to hand over my work to others? Would prospective employers use it as grounds for rejection if they come across it during background checks? Would new acquaintances have cause to keep distance? How would people interpret my illness and in what ways would I be discriminated? Would anybody believe me at least after I get better? I fail to articulate what I mean by stigma, for beyond all these questions and a foreboding of fear, there is a sense of shame and guilt. That my illness is a reflection of me and my way of life, and suddenly the defining element of my life. Most of these questions sound irrational to me today, but I worried about them even after I got better, even after I knew that I needn’t.
I recognize that I had it easy compared to others. I have been trying to recall the names of young Indian acquaintances who were mentally ill at some point in their lives before their 30th birthday. Three committed suicide. One attempted it, but has been doing well. Four others had varying degrees of success in coping with it. Acquaintances who are long dead fall out of memory, and very few struggling with mental illness are open about it, which is to say the numbers in my immediate circles may be higher. Among my circles in India, I have never been part of conversations about mental illness as a medical condition, but I have heard many expressions of pity and of well-meaning disapproval and of weakness and of misfortune in reaction to news about suicides, mostly of celebrities. I have heard expressions of mild to pure contempt on knowledge of a person or an unhappy couple among relatives visiting psychiatrists. I have heard these from educated urban people who consider themselves, and whom I mostly consider, open-minded. I have never heard about cases of people I knew who were mentally ill, sought and received help, and got better. Redrawing the circle larger, I cannot recall Indian movies where a main character was mentally ill and was neither a psychopath nor a victim who doesn’t die at the end.
I do not mean this as an indictment. This is not isolated to certain people or societies or states, though it may be in the mainstream of some cultures more than others. None of this mattered to me before I was depressed, but it did soon after. Human beings have evolved collectively, by learning from each other, thought at different paces, and this is no different. I think awareness about mental health, illness, knowing success stories about people who were sick and then got better, etc. might have helped me, and given me hope when I had none. In fact, when one of my brother’s classmates wrote about his struggle with mental illness, I had read it at a time when I was depressed, and I believe it in turn nudged me towards seeking help. I wish to pay it forward.
Dr. Dee is not his real name.
Refer HIPAA or its equivalent in your region for the fine print.
Refer Wikipedia and its references for a holistic overview of the causes of the disease in general.
I have no medical opinions. This is only the current simplistic way I’m trying to make sense of the questions I have.