I can't, I'm in a Depression

When I was a kid, my parents would occassionally let us take mental health days from school. In the eyes of a fourth grader, that often meant that we weren't feeling sick, but were taking a day off to recharge.  (I was not diagnosed at the time.)  As an adult, I still often hear people say that they need a mental health day, but it seems to be a ubiquitous term, thrown around without a whole lot of actual meaning other than "I need a break".  Nobody becomes concerned, unless they know the person and their health history on a deeper level perhaps, that someone taking a mental health day is actually struggling with their mental health. Because that's not something society does.

We are a society that's afraid of illness. We are so afraid of catching something that if someone so much as has a cold, we tell them to stay home from work/social obligations/etc. If a child has even a mild fever, they have to stay home for 24 to 48 hours as to not infect someone else in the class. And I understand all that. I'd like to avoid the stomach flu as much as the next person, trust me.

But the problem isn't what we allow, it's what we don't. Actual mental health days are not "OK".  Most of us can't call out of work and say, "I'm sorry, my anxiety is horrible today. I need a sick day," Everyone at work is stressed out and they're all there. Can't we just get over it? Nobody stops to consider that diagnosed anxiety and stress from a busy schedule or deadline are not the same thing.  If a friend invites us to a gathering, we can't say, "I'm really sorry, I know I promised to come but my depression is just awful right now." If we do, we're a downer, boring, a party pooper. People start saying things like, "You've changed, you used to be so much more fun!"  Yet people in those same situations would treat us like we had the plague if we felt sick to our stomach.

The bottom line is, society as a whole doesn't accept that mental health conditions are physical illnesses that have incredibly real symptoms and cannot just be pushed through. Just as you don't want to wake up with a stomach virus or the chicken pox, I don't want to wake up in a severe depressive episode. And it's no easier for me to work during my depression as it is for you to work with the flu. But we've not come to accept this. And even if we're given a small reprieve (one sick day, one missed outing with a friend), it's not allowed to continue. Despite the fact that you wouldn't expect someone to  be completely recovered from the flu in 24 hours, people quickly lose patience and understanding when my anxiety or depression are bad for three, four, five days straight. They may feel bad at first, but by the fifth day I often need to "pull myself together". And if you do need to take this extended time away, people become suddenly quiet and avoidant when you return to whatever it is.... work, social life, etc. Despite the fact that I find it downright rude to not ask how someone is feeling when they have been ill for a week or more, people don't. If they do, it's a pleasantry and they don't actually want an in depth answer. Nobody actually wants to hear about your depressive episode or your crippling anxiety. And while they probably don't want to hear the nitty gritty about your stomach flu, they'll probably at least be empathetic to the fact that you were ill.

My hope is that one day I'll be able to say, "I'm sorry, I can't... (do whatever it is).... my depression is bad," just the way I would say, "I'm sorry, I can't, I have a stomach virus," and people will understand. Unfortunately, we have a long way to go. 

What It Really Feels Like To Have Chronic Fatigue

Virtually every human above the age of about 10 (and possibly younger) has experienced fatigue. Fatigue is different than simply being tired as a result of every day activity.  It's defined as: 

"Extreme tiredness, typically resulting from mental or physical exertion or illness."

Chronic Fatigue, put simply, is chronically feeling this way. But it's not that simple. It's not that you don't get enough sleep so you're often tired. It's not that you just need to take a nap and you'll perk up. It's that you are physically, emotionally, and mentally drained, to the point of not being able to think, or sometimes see, straight.  My chronic fatigue can exhaust me to the point of actual weakness.  There are times I think things like, "I don't physically think I have the energy to put on pants", or "I'm so exhausted that I don't know that I can make it to my bed to sleep." I have literally almost fallen asleep walking. I get weak to the point where I don't feel like I can hold myself up. I'm so exhausted that my vision starts to blur. 

In addition to the physical symptoms of exhaustion, I often have difficulty concentrating or putting thoughts together, my brain feeling "fuzzy", for lack of a more technical term. In my case, also having cyclothymia, these confound the already troubling symptoms of depression, hypomania, or anxiety. The two intertwine, making the symptoms of each multiply. I know others with chronic illness who battle chronic fatigue as well, it exacerbating their symptoms equally as badly. 

Chronic fatigue comes in "episodes" for lack of a better word. Sometimes, I'm not particularly fatigued. Other times, I can feel it start to creep up, first as a feeling of tiredness, and lingering as it increases in intensity to severe exhaustion. Other than a feeling of being tired, something most of us feel from time to time in our busy lives, I don't have much of a warning. I'll have a day or two where I feel like I just can't manage to wake up fully, and then fatigue will set in. 

Now, I'm sure there are going to be plenty of "welcome to my life" people out there (this phrase, by the way, makes me want to slap you, so please don't ever say it to me). These people are going to say something like "That's what it's like to be a new parent; that's how I feel because I'm a busy executive that barely has a chance to sit down; Now you know how I feel... ."  But here's the difference: you chose that, and it won't go on forever. Your kid won't be screaming for feedings in the middle of the night for the rest of their lives. You could choose to not be a high powered busy executive. And nobody calls you lazy or unmotivated when you can't manage to get basic tasks done because it's too much effort for your exhausted and weakened body. They get that your exclusive job makes you so busy you have no free time.  But for those of us with chronic fatigue, either in the form of CFS (Chronic Fatigue Syndrome) or as a symptom of another illness, we do deal with that stigma. People think it's an excuse, that we could do it if we tried harder, made more of an effort. People think that if we just got a little more sleep, we'd be ok. People think we could make it go away if we wanted to. People think we're just tired, like them, and we should suck it up. But we're not, and we can't. 

But You Don't Feel Sick

Virtually everyone with an invisible chronic illness has dealt with "but you don't look sick", and the stigma and discrimination that goes along with it. People assume that you have to look perpetually ill if you have a chronic illness, and it's frustrating as hell - not every illness has obviously visible symptoms 24/7.  But it's not the only "invisible" part of a chronic illness. What those who don't battle chronic illness don't often understand is this: you don't have to always feel sick either. Not every single minute of every day for the rest of your life, at least. Take my condition, for example. I go through  mood cycles. Which by definition means I'm likely to feel differently from day to day, or at least week to week or month to month. Some days, cyclothymia kicks my butt, and I'm slogging through a depressive episode, or trying to reign in a hypomanic episode. Some days my anxiety and panic are pretty horrendous. Some days, I don't feel much of this at all, as long as I stick to my meds and general routine. That's right, there are times when I don't feel sick.  But let me clarify one crucial point:  this is NOT because I am free from illness on those days. Chronic doesn't go away - hence the reason that it's chronic. And just because I have a good day, or even good week or month, doesn't mean it's in "remission" (quotes for the fact that I'm not a fan of this term as applied to cycling, since obviously, it goes in cycles).  It's simply what it sounds like - a good day.

It may not even be a good day. It may be a good half a day, or a good couple of hours. It may simply not be a bad day, and those with chronic illness know you have to grab those opportunities because you never know when it may taken a turn for the worse.  I might have woken up this morning, or yesterday morning, with in a terrifying depressive episode. But as I'm rapid cycling, I've cycled out of it. Or I might wake up feeling perfectly fine, and cycle into hypomania by the end of the day. Something could trigger my anxiety at any moment. With a chronic illness, you are never not ill. You just don't have to feel it every living, breathing moment, thank goodness. Yet the general public seems to think that you do. They seem to think that if you were fine yesterday, how can you be unable to get out of bed today. Or if you were horribly ill last week, how can you manage to be out having a cup of coffee with a friend this week like a ... gasp... normal person. Aren't you sick? Surely you must not be that bad if you can manage to get out of the house. But this is ridiculous. It's like saying that a dedicated employee must work every holiday, even if the company is closed for the day, because otherwise they're clearly not dedicated enough. Battling a chronic illness takes a tremendous amount of strength, effort, and perseverance. If our illness gives us a "day off", why should we not be allowed to enjoy it?

Chronic and invisible illnesses deal with enough stigma. We already have to explain why we can't just "get better" or "push through it". We already have to explain that mental health conditions aren't just a bad attitude, that we're not just lazy or not trying hard enough, but that they're an actual medical conditions that respond to treatment. So if we have a day where we don't feel or look sick, let us have it without judgement We spend enough time battling illness. Don't make us battle your stigmatization and lack of understanding as well. 

How Would You Respond To Someone In a Mental Health Crisis?

If you saw a stranger standing alone suddenly stop and clutch their heart and look to be in pain or alarm, would you stop and help? Would you at least ask if they were OK or call 911 or look for the nearest person who may be able to offer more assistance? My guess is, you would be likely to. You'd want to take some action. Surely, you, a good, caring, kind person, wouldn't leave someone, even a total stranger, who looked to be suffering a heart attack. Same if you saw someone fall in agony with what looked to be a broken bone. But what if you saw someone having a mental health crisis? If you saw someone sitting against a wall or sitting on a bench, standing on a corner sobbing, completely alone, in obvious emotional pain. Would you stop? What if they were in the midst of an anxiety or panic attack, asking for help, or saying something that didn't make sense to you through their tears, struggling to breathe? What if they tried to pretend they weren't there, so depressed and withdrawn they wished to be invisible?

I can tell you from personal experience, the answer is no. Strangers do not stop. They do not ask if you are OK. It doesn't matter to them that you're crying, gasping for breath, quietly asking for someone to please help. To them, that's "crazy", and they're not going to touch "crazy" with a ten foot pole. They don't want to be associated with it. Or, to give them the benefit of the doubt, maybe they think, at least for us women, that we're just being dramatic, hormonal, emotional. That they have bigger problems than to help some woman that can't pull herself together and help herself (I can't speak from the man's point of view, as  I've never been a man suffering from an anxiety attack or depressive episode in public). But I can tell you that I can count on one finger the number of times someone has stopped for me. And that person was in an elevator with me, so perhaps it was simply the proximity, or the fact that I was wearing a shirt that said "Out of Darkness Walk for Suicide Prevention" at the time that made her think that something more substantial was wrong. But let me tell you, that one person, she made me feel like I mattered when I thought I didn't. But that happens so seldom.

Let me tell you instead what happens: You have a panic attack, or anxiety attack, or (hypo)manic episode or are so depressed you can barely lift your head. Someone you don't know, or don't know well, sees or hears this. They get concerned, but not for you, for themselves.  Because you're acting "weird" at best and "crazy" at worst. Maybe you're dangerous, they think. I better not let them near me, let alone help. Then, without speaking to you at all to find out what happened, to make sure you're OK they "take some action". Some cowardly, inappropriate action. Maybe they post something about it on social media "I just saw this crazy lady crying on the corner for no reason and begging for help. What a freak." Or maybe, if it's someone somehow associated with you - someone in your industry, or in your housing complex, they write something to you about your "behavior", or worse, write something to someone else and complain about you without any knowledge of what actually happened. Maybe you're then stigmatized and possibly discriminated against in the group or community, or whatever it is. Not overtly, of course - that's illegal. Nobody wants the ADA on their tail. But maybe you're glanced at sideways, or written off as less capable, or considered a "problem" that people talk about behind closed doors. All without anyone speaking to you to find out about your medical condition. And if it's someone you have no contact with - well, you just become that crazy lady that cries on the street randomly. Or you're nobody at all. Nobody deserving of help, of asking if they're OK. And that, to be honest, is worse. I've been an outsider my whole life. I get it. I've grown to accept it. But to be nobody, to be invisible? In avoiding asking if that person was OK, it might be the last thing that nobody said to that person. Because all they needed in that moment was someone to reach out and notice kindly, and nobody did. That person, in their eyes, is nobody.

So please before you judge, before you label, and before you pass someone by that looks to be in any kind of pain, stop and think - how would you feel if all you needed was someone to understand what you were going through, or at least to try to, and everyone refused, as if you and your pain didn't exist And maybe, next time, stop to ask. Or offer a tissue to someone crying. Or offer to listen to them. But treat them like a human being. The way you would if they were having a "physical" attack, because it's no different. You might think it is. You might a heart attack is an emergency because you think it can kill and mental illness cannot.  And you'd be horribly mistaken.

I hope others have a better experience. I'd like to hear them, if you have. I'm sure the world is full of good and caring people who would stop and help a stranger in any kind of need. So please, if you've been in such a situation, please share if so inclined. It can, of course, be anonymous, as always.