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Everyone Can Fall Down the Rabbit Hole

A few months ago my 3 year old son uttered the words, "I hate you, mommy."  It was after I yelled at him for doing something wrong, which I've long forgotten what exactly the source of our exchange was. But I certainly can remember those words. I can hear them in my head if my brain decides, at random moments, to replay them.

My intellectual, clinical psychologist brain can explain this for days. He's 3, he doesn't know what he's saying, he learned the word hate somewhere else, presumably at preschool, as I discourage its free use in our house. He's using it to express his anger not his true feelings toward me because once he self-regulates (psychobabble for calms the F down) he tells me he loves me.  Blah blah blah.

Regardless of all that knowledge and shit I have from too much education, those words destroy me emotionally.  Maybe they hit me harder because of my profession because my head goes to all the subsequent pathology he'll surely go on to develop due to my shit parenting. And if my brain decides to mess with me and replay them, usually in a convenient scenario like on the bus, it's impossible not to cry.

My training in cognitive behavioral therapy (CBT) tells me to reframe my thoughts, examine the evidence, accept the reality that my 3 year old doesn't hate me.  Things I teach people almost every day to help manage their anxiety or depression. I'm a fucking expert at CBT.

Yet I can't "CBT" my way out of that one.

In the past week, 2 celebrity personas opted to take their own lives. It's brought mental health and its treatment back into the national discourse.  Why it takes a mass shooting or celebrity suicide to make this happen is beyond me.  Unfortunately, none of these events change the fact that we have an abysmal mental health system that continues to be gutted of resources at every opportunity.  And this, at least in my home state of Illinois, is one trend that is truly bipartisan.

The suicides of Kate Spade and Anthony Bourdain also have spurred reminders of the existence of crisis hotlines. I don't know how many tweets and retweets I've seen, and it's all well and good to remind us there are dedicated people out there just a phone call away. But, like the inevitable "Thoughts and Prayers" that come after a major tragedy, this really doesn't open up the conversation in the way it needs to be.

This blog post would be nauseatingly long if I got into all of the nuance of this topic, so I want to try to get my thoughts into some bullet points, because who doesn't like bullet points?
  • Instead of saying "mental health" use the actual language of the diagnoses we're talking about. And not just saying depression or anxiety or bipolar or PTSD, as these are somewhat arbitrary labels we like to slap onto people's lived experience. If you've never experienced depression, ask someone who lives with it what it feels like. What their asshole brain likes to tell them at 2 am after 2 straight weeks of insomnia. How everything you once enjoyed has a shadow cast over it making these things seem like the biggest waste of time, or pain in the ass. We're too clinical about "mental health" in our conversations, so those not living with depression or anxiety or schizophrenia don't know what it feels like, making it easy to dismiss or judge because "there's no way I'd ever get depressed." But when you break it down, we've all had some symptoms of depression at one point or another.

  • If a loved one is depressed or anxious, try not to say stupid shit. And realize even the most well-intended things you say, that you think are on point and would totally help you, might make your loved one feel worse. Before you offer advice, simply listen and reflect on what they're saying. Ask them what helps them feel better, and if they say "nothing," that may very well be true at that given moment. Check back with them often but give them some room to breathe, too.

  • Don't be afraid to talk about suicide with someone feeling suicidal. You're not going to convince them to actually go through with it. Ask them why they feel hopeless (this is the number one predictor of someone getting to a suicidal state). Ask them for reasons why they wouldn't go through with it (this is a huge predictor of why someone would not commit suicide). Don't freak out on them and call the police or haul them off to the ER, unless it's REALLY clear they're in imminent danger to themselves. While we want to keep people safe, depending on the ER, it could make things worse.

  • Understand that even people with in depth training on how to treat depression or anxiety can fall down the same rabbit hole, and all that training won't always pull them out of it. So if you've tried CBT or DBT or CPT or ACT or any other acronym we've come up with in psychology and it's been really really hard, or didn't work, or maybe kinda worked - you're not broken, you're not a failure, the treatment isn't bullshit. It's just really hard and kinda imperfect.

  • Even if your loved ones aren't depressed, check in on them. Invite them out for a cup of coffee or to come over and watch The Matrix trilogy, fully recognizing that the third installment will be a couple of hours of your life you'll never get back. Send them a random card in the mail or some flowers with a funny note. These gestures will do much more for us as a society, and our mental well being, than retweeting a suicide helpline after a celebrity death.  But absolutely do that, too.

--Dr. T2

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