Stress is Not a Synonym for Depression

dark portraitA recent suggestion by a reporter, following President Obama’s speech at the National Conference on Mental Health, that depression is just another word for stress, and that stress that can be dealt with hard work, stoicism and prayer, was a serious reminder about how we, as a society, view mental health issues less seriously than ones involving our physical health. Reporters, like the one at The Daily Caller, need to be reminded of stories like this one:

We knew there was trouble. There were plenty of signs: angry outbursts, slamming doors, sullen answers to ordinary questions, operatic drama over things like misplaced bathing suits and project deadlines. For years, she had refused to take any ADHD medication, and we had agreed, provided her grades held up, and she’d kept that bargain. But now her grades were in the tank, and she wouldn’t even admit there was a problem, much less talk about solutions. She met our offers to help with angry accusations that we were nagging her. We had teacher conferences. We dragged her to therapy, where she sullenly refused to talk. “I. Can. Take. Care. Of. This. Myself,” she would say, through clenched teeth. Anyone who has ever lived with a teenager will not be surprised to hear that when she came into my office that Sunday afternoon, I was exhausted, worried and pissed off in roughly equal measure.

“Mom,” she said, “I do not feel safe.”

More drama, I thought wearily, but out loud, I said, “Why is that?”

“I don’t know what I’m doing. I don’t know what to do.” As she sat there, tears began to run down her face that she did not bother to wipe off. “I just don’t feel safe.”

It’s funny, how you can stay up nights imagining all the catastrophes that could befall your child, and yet not recognize one when it’s staring you in the face. I got my car keys, thinking, “She doesn’t mean this; I’m going to call her bluff.”

It’s two miles from our house to the freeway, and the whole way there I kept expecting her to say, “Mom, I’m sorry, I was exaggerating, turn the car around,” but she didn’t. And the longer the silence lasted, the more my body seemed to detach from my mind and I started to feel a slow but growing sense of dread. This is real, I thought. She’s really in trouble. She spoke only once during the 25-minute drive. “Do we have to go?” she asked, in a small voice, and I heard myself say firmly, “Yes, we do.” It was my inner Crisis Manager speaking, and memory.

I’d been in that passenger seat once, years ago, being driven to a psychiatric ward against my will. Depression is encoded in my DNA, and it’s been a lifelong battle to learn how to manage it—decades of just learning how to take care of myself, and then, once I became a mother, trying like hell to minimize the collateral damage to my husband and children, with what I can tell you is decidedly mixed success. But in recent years, things have been good—better than good, actually, almost to the point where I could fantasize about the possibility of never being sick again. Maybe I’m cured, I found myself thinking. Maybe it’ll leave me alone now. I’ve dealt with this illness for too long to really believe that, but somehow I was counting on the idea that if it came for anybody, it would come for me.

I knew, of course, that depression is in part a genetic issue. But genes are not destiny, environment plays a powerful role, and I had done everything I knew, everything humanly possible, to protect my daughters. I talked about my own struggles. We talked about body image; we talked about the pressure to become some walking, talking American Girl doll with perfect grades and perfect hair. We talked about academic pressures. Parents of smart kids with ADHD learn quickly that a fourth grader who knows more than her teacher about the Holocaust can still get a ‘C’ in social studies because she will inevitably forget to turn in some paperwork, and schools these days are all about paperwork. I tried to impress on our kids that we were not interested in paperwork. We expect great things from you, I would tell my daughters, but we care more about what you learn than about what your grades are. That’s how the real world will judge you, too. You will be fine. You are beautiful. You are smart. You are loved.

It wasn’t enough. If whatever bad genes she inherited from me weren’t enough, ADHD almost always presents with some other glitch in the brain wiring—dyslexia, maybe, or an auditory processing disorder. Rebecca’s co-morbid condition was anxiety. As everybody who has ever suffered from depression knows, anxiety is to depression what gasoline is to a fire. And then came junior year, with an overload of AP courses—nobody told us three was too many, and she was so eager—and a boyfriend, and concerns about her weight, and looming in the distance like some impossibly rugged mountain range she was supposed to know how to navigate this thing called COLLEGE.

It’s a hell of a lot of pressure our kids are under, and a lot of them are just white-knuckling it through. Bemoaning the sad state of the younger generation is a thousand-year-old sport, but I would argue that never before in the history of the human race have there been as many pressures on kids, young women especially—the insane competition for college, a stumbling economy, growing wealth inequality, environmental degradation, our society’s obsession with body image, the rape culture, cyber bullying, just for starters—and so little access to the kind of sanity-saving activities that previous generations took for granted: time spent in nature, quiet solitude, face-to-face connections, spiritual nourishment.

According to the National Institute for Mental Health, roughly 11 percent of adolescents have developed a major depressive disorder by the time they are 18. Most of them are girls. It’s an illness that, once kindled in the brain, tends to recur—all the more so when it goes untreated, which may explain why according to the World Health Organization, major depressive disorder is the leading cause of disability among Americans between the ages of 15 and 44. Depression underlies many if not most of the problems that teenagers are famous for getting into—drugs, binge drinking, promiscuous sex—and cutting. God, the number of kids whose psychic pain is expressed by taking a knife to their own skin is just incredible, and now my child is one of that number.

“It’s the cutting season,” one therapist sighed when I confided in her about Rebecca’s crisis. “Spring is notorious for it, and spring of junior year especially.” There is a season for this?

So we went to the emergency room, where we spent two and a half days—yes, days—before the hospital could find a bed for Rebecca, and then the closest one was at an adolescent facility 60 miles away. You think hospitals are easy to get into, that all you have to do is show up and demonstrate you have an emergency, right? Not for mental illness. The average wait for a psychiatric bed in this area these days is between two and five days, according to a recent story in the Washington Post. That’s significantly longer than even a few years ago, mostly a result of cutbacks in government funding for mental health treatment—and this is an affluent area with more than its share of doctors. Imagine having a kid in crisis and living on, say, an Indian reservation in North Dakota, or in a small town in the Mississippi delta. And even when you get access to treatment, it’s basically a revolving door. The months-long psychiatric sojourns depicted in movies like Girl, Interrupted or The Bell Jar are either decades out of date, or affordable only for people who are so rich they don’t bother with things like health insurance.

Rebecca was at the treatment facility for five days. I can’t say she underwent any actual treatment there; thanks to insurance reimbursement limitations, their job was limited to making sure she didn’t hurt herself and that the pills they gave her didn’t actually make her sicker. Luckily, that was all she absolutely needed. She’s home now, seeing a therapist—who she’s actually talking to—and she takes her meds, and they seem to be working. She’s back in school, making up missed assignments, hanging out with her friends (who are, thank God, light-years more enlightened about psychiatric issues than my generation was). We are not out of the woods yet by any means, but she is slowly getting better.

So why am I writing about this? Because a personal account packs an emotional punch that dry statistics never do, and because this is so important, especially for you mothers of daughters. People hear the phrase “teenage depression” and think it’s just “normal” adolescent angst, as opposed to what it is: an illness inextricably linked to suicide, the third leading cause of death for young people between the ages of 15 and 24. The fight against stigma and ignorance has made great advances since I was a teenager, but it is far from won. There are still idiots out there like the secretary at Rebecca’s school, who Rebecca once overheard saying—in what seemed to be a remark she was meant to overhear—that “depression is a choice.” This was a person working in a high school counselor’s office.

So please: be on the lookout. It’s so easy, when we think our teenagers are being a pain in the ass, to miss the signals they are sending. It’s so easy for them to shut down, to retreat into silence and barricade themselves behind closed doors when things get tough; they are, after all, on the cusp of adulthood, and they want so badly to handle things all by themselves. But this is a problem that nobody can handle alone. Believe me, I tried—for a lot of years—and it’s a small miracle I’m here to tell you it can’t be done.

I hope that this warning will be unnecessary. But if you ever do encounter this crisis, I hope your kid will be as brave as mine. As we walked into the hospital emergency room that day, she said, “Every instinct in my body says I should turn around and run.” But she didn’t. She kept taking one step after another, toward an outcome she could not possibly imagine. I have never admired her more than I did at that moment—unless maybe it was the moment a few days ago when I asked her if it was okay if I wrote about this, and she said, “Of course.”

You can find guest contributor Tracy Thompson at her website, www.tracythompson.com, and at her blog, The Blockhead Chronicles. Her most recent book is The New Mind of the South.

Image via iStockPhoto

  • If depression was a choice, I certainly wouldn’t have made it. I’d choose to be happy. Hell, who wouldn’t choose to be happy? I certainly wouldn’t choose to be on all this medication, to spend hours and hours in therapy talking about things that make me feel worse before I can ever feel better. Self-righteous people who don’t have a clue make ignorant remarks about mental illness that cut right to the bone for a person whose brain is already filling her with self-doubt, telling her she’s useless, worthless, trapped in a darkness from which she’ll never emerge.

    I’ve always called depression and anxiety two sides of the same coin for me, but I like your gasoline to the fire analogy.

    I’m glad your daughter is getting the help she needs, and that her friends are supportive. Maybe by the time their generation has kids they’ll be able to do away with the stigma so everyone is able to reach out for help without being made to feel ashamed.

  • K Hunt

    Your daughter is my hero. I hope that my own kid will be so brave, whether facing this particular demon or any of countless others that we all encounter in life. Heck, I hope *I* will be!

  • Kristie Madden

    Someone said this to me, that it was a “choice”. I also have anxiety and ADD that didn’t get diagnosed until my early 30’s. Great article.

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