Depression Doesn't Lie
Jun. 10th, 2018 12:33 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
tim[CW: discussion of suicide, major depression, child abuse, and trauma]
I've been hearing the trope "Depressed people's brains lie to them" a lot in light of a couple well-known people having recently killed themselves. It's comforting, mostly to people who don't experience major depression. It's also mostly wrong, in my opinion.
Against exorcism
The demonic-possession model of depression, for lack of better words, says that depression is a foreign presence, an invader in an otherwise healthy body. That there is some pure version of you that is not depressed, and depression is unnatural, disordered, a disease process. Like bacteria or a virus that shouldn't be present in your body. You are not depressed, you "have depression", not in the sense that depression is a condition you live with whether or not you're currently having a depressive episode -- but rather, in the sense that depression isn't a fundamental part of who you are.
If depression is a demon and all you need to do to get your real, true, normal, neurotypical self back is to exorcise the demon, then if you seek medication and/or therapy, you're going to have some pretty unrealistic expectations for what it can do for you. Medication and therapy are useful for a lot of people, but they don't turn a depressed person into a non-depressed person the way that antibiotics kill bacteria. (Again, I'm talking about the kind of depression that recurs and doesn't have a clear and immediate situational trigger, not the kind that a person might experience after the death of someone close to them.) I don't know of any evidence to suggest a treatment like that will ever be possible.
We are often told to give others the benefit of the doubt, to not assume the worst possible interpretation of others' actions without more information. Why not apply that principle to yourself? Instead of an unwelcome invader to fight off, can you treat your depression as a friend, albeit one who it's difficult to relate to or communicate with?
Depression as coping mechanism
"Depressed people's brains lie to them" is so much more comforting of a take than "people who have been abused over and over expect to be abused again, and that's reasonable", isn't it? Isn't it easier to call depressed people defective than to acknowledge we live in an abuse culture and that literally damages people's brains? Easier, that is, for people who don't live with depression.
If you get hurt every time you get close to another person, but you are a social animal who requires social contact to be healthy, depression is a logical and normal response. The Hobson's choice between enduring isolation or enduring abuse can be resolved, but doing so requires access to significant skills and resources. Not having those resources isn't the same as having a brain that lies to you.
Isolating yourself is a defense against being hurt by other people, and that defense mechanism can last long after the situation that precipitated it is gone. For example, if you're an adult who was abused as a child. Maybe everybody else in your life since you moved out of your parents' house has been great, but you wouldn't know because your body is convinced that if you get close to people, they'll hurt you the way your parents did. This kind of trauma doesn't generally heal spontaneously like a paper cut. It's not impossible to become happier and more comfortable if you have it, but doing it requires being taught skills and having significant privilege that makes it possible to apply those skills. Your brain isn't defective or deceptive because you don't know things that you haven't learned yet.
Depressed brains tell you the truth: that you're in a situation where the best survival mechanism that you know is to withdraw from social engagement. Your brain has powerful ways to warn you about danger. That you are alive in the world today means that you are descended from a long line of organisms that were great at surviving, at least long enough to reproduce. What your brain can't do on its own is teach itself new ways to handle danger. That's the part that requires help from others. However, your brain isn't lying to you just because it can't solve any problem with no external input. Needing social interaction to cope with serious problems that themselves cause inability to connect socially doesn't make your brain a liar. It makes it human.
So what if your brain is telling you "you should kill yourself"? What if it tells you that all the time and the difference between a good day and a bad one is just how well you can distract yourself from hearing the message? A brain that's telling you to die is a brain in a situation where you subconsciously believe that the danger you face exceeds your energy and ability to respond to that danger. It means you need help, but if you believed that help was available, your brain wouldn't be telling you to die. If you're living in 2018 under late capitalism and you're not extremely privileged -- then it's not incorrect to perceive danger all the time. What is likely incorrect is the belief that no help is available. But if you hold that belief, it doesn't mean your brain is lying to you. We all have incorrect beliefs, because no one has perfect access to information and we don't know the things we haven't learned yet.
What neurotypical people don't want to hear
Many people who have never felt hopeless, who have always had people they can rely on, don't want to hear that in a lot of cases, the belief that no help is available is more accurate than not. The just-world fallacy is one reason why you might believe that if somebody isn't getting the help they need, it's their fault for not trying harder. Telling people to just get help, that help is always available, may seem benevolent, but it's actually the other side of the coin from the attitude that blames people who complete suicide for not having tried harder to live. In both cases, believing that the suffering depressed people experience is their own fault is a defense mechanism that protects a neurotypical person from confronting the reality that people suffer who don't deserve it.
If you have friends who care about you, but can only tell you to do yoga and drink more water, and can't pay for trauma-informed therapy for you, then effectively, no help is available. If the only therapists where you live aren't familiar with trauma, and you can't afford to see them anyway, then effectively, no help is available. Telling people to "just get help" ignores that getting help, itself, can be dangerous, and the perception of that danger escalates your brain's depressive response.
I don't like the "your brain lies to you" framing because despising yourself and disowning parts of yourself aren't exactly things that depressed people need to be doing more of. The distinction between "I am broken" and "I don't know how to do this yet" is important for anyone who's still learning new things, whether that's kids in school or adults figuring out how to navigate a hostile world. If you conclude, instead of "I am broken", "it's not worth learning" in the face of things you don't understand, that sets off a different, but also unhelpful feedback loop.
You can think of depression as like a fire alarm. If your fire alarm goes off, then that's telling you something. The alarm doesn't tell you how to put out the fire, but blaming the alarm because it doesn't help you figure out what to do about the fire isn't likely to help. If your fire alarm malfunctions and goes off all the time even when there's no fire, on the other hand -- which might be a good analogy to a lot of people's experience with depression -- then it means you need to repair or replace the alarm, rather than conclude that it's never useful to pay attention to fire alarms.
None of this is meant as advice for people who are currently in a depressive episode. Metacognition -- the skill that lets you examine your internal responses and distinguish between the feeling of wanting to die, the belief that you should die, the awareness of having a reaction, and the identification of the reaction's root cause -- is not something you can develop while acutely struggling to survive, except maybe with professional help. I'm attempting to summarize lessons that can only be learned through experience, and reading this isn't a substitute for having those experiences. I'm also not trying to say that my way of coping with depression is better than yours.
In fact, I'm mostly writing for neurotypical people here, people who, if they experience depression at all, experience it as a passing mood rather than a constant presence. With that in mind, I recommend that neurotypical people who are not mental health professionals follow a couple rules of thumb if they need to talk about depression (and maybe you don't need to talk about it at all, aside from helping people find adequate professional help):
When neurotypical people say "depression lies", they mean "depressed people tell me things I don't want to hear": primarily, that we're all failing at building communities that make people want to live.
FAQ
But aren't you assuming all depression is caused by trauma?
It's true that I'm writing here mostly about depression that's rooted in past trauma and/or ongoing difficult circumstances. That's the kind I'm familiar with, but maybe there are people out there who have never had anything bad happen to them but, nonetheless, are depressed because of a chemical balance. These people can still be compassionate to themselves. It's like having a malfunctioning fire alarm: the system that's alerting you of a problem exists in the first place to protect you from real threats. It might be that some depression is actually a chemical imbalance that originates totally randomly (though I don't think the evidence to conclude that exists at this point) and can exist in a person who is getting all their needs met, but I think being compassionate towards the parts of yourself that aren't working, and looking to the ways in which those parts are doing the best for you that they can do, is still helpful.
Your experience of depression doesn't sound like mine. I don't think this way of thinking would work for me.
The only way I can think of to answer this is with an analogy, which isn't perfect, but I think gets at the point. Imagine the following conversation:
ALICE: "People say you shouldn't hit kids, but hitting my Bobby is the only way I can keep him in line."
CAROL: "Dealing with kids is very hard, but there are other ways you can deal with difficult behavior from them, and it's worth learning those ways."
ALICE: "You just don't know my Bobby, maybe your kid doesn't need to be hit, but mine does."
Is little Bobby such a demon from hell that physically assaulting him is the only way any parent can manage him? I would say probably not. All children are different, because all people are different, but that doesn't mean things that are harmful to all of them don't exist. If you believe you can only care for your child by physically abusing them, that doesn't mean your child is different from mine; it might just mean you haven't learned how to do things differently. I don't think comparing children to misbehaving parts of your brain is so far off, because just as children don't know how to act because they haven't learned yet, and blaming them for what they don't know isn't useful, it's the same with parts of yourself that you may not like.
Are you saying if I'm depressed, I can't think of my depression as lying to me?
No, if it's useful for you, there's nothing wrong with you doing that. I'm offering an alternative, which no one has to take if it's not useful to them. Just as I wouldn't tell you to stop getting blackout drunk every day if that's the only thing keeping you alive, I wouldn't tell you to stop hating yourself or seeing yourself as demonically possessed. I can say that there are risks in both cases, but if you're doing it, it has a function to you, and the only person who can legitimately tell you to stop doing it is someone who is prepared to work with you on finding a replacement coping mechanism (i.e. a therapist).
Are you saying people with chronic depression can never recover?
No. I don't think that "depression lies" particularly helps with recovery, though.
What if your brain mistakes a situation that's not dangerous for one that actually is? Isn't it still useful, then, to think "depression lies?"
Again, if you're depressed and this works for you, okay. I still think it's not useful to attribute malice to your brain. Being aware of the reaction you're having without forming a judgment about it (like "It's lying!") is different from taking any particular action based on the reaction you're having.
Isn't depression "the only illness that convinces you that you don't need treatment for it?"
I don't find that a useful framing either, because I think it's more useful to look at why a person might not feel it's safe to seek help, a feeling that is usually based on reality to some extent.
Isn't it reductive to say that you can learn your way out of depression, especially the kind that really comes from your brain not working right, not your current or past environment?
This is why I'm being careful to say that this isn't actionable advice. Telling you that it's possible to learn something isn't the same as teaching it to you, but you have to believe that it's possible to learn before you can be taught. As with any chronic condition, learning to live with it doesn't make it go away. If I didn't think it was possible to live with a chronic condition, I would have to conclude that I and many of my friends shouldn't be here, and then we would all disappear in a puff of logic.
If depression doesn't lie, does that mean a person experiencing suicidal ideation should believe their suicidal feelings, and kill themselves?
No. When I say that the part of your brain telling you to die isn't lying, I mean it's drawing the best conclusion it can draw based on the information available to it. To acknowledge that you are feeling like dying would be a good idea doesn't mean you have to act on that feeling, any more than validating your friend who hates themselves doesn't mean saying, "Yes, I agree, I totally hate you!" Asking "what is this trying to tell me?" is an alternative to either believing "my brain is lying to me", or believing that what it's telling you is true and that you need to act on it. Feelings don't dictate actions.
I think that suicide can be a valid last resort, but that doesn't mean it's the first resort or that everyone who experiences suicidal ideation ought to act on it. Some situations might truly be beyond hope, but I think those are pretty rare compared to the ones where help can be unearthed. I don't have advice to offer here for depressed or suicidal people, because there's already plenty of that out there. I do have advice for people who don't experience these difficulties: do what you can to make the world a place where more people feel that life is worth living. I'm inspired here by Valerie Aurora's essay "Suicide and society: Where does responsibility for preventing suicide lie?".
I've been hearing the trope "Depressed people's brains lie to them" a lot in light of a couple well-known people having recently killed themselves. It's comforting, mostly to people who don't experience major depression. It's also mostly wrong, in my opinion.
Against exorcism
The demonic-possession model of depression, for lack of better words, says that depression is a foreign presence, an invader in an otherwise healthy body. That there is some pure version of you that is not depressed, and depression is unnatural, disordered, a disease process. Like bacteria or a virus that shouldn't be present in your body. You are not depressed, you "have depression", not in the sense that depression is a condition you live with whether or not you're currently having a depressive episode -- but rather, in the sense that depression isn't a fundamental part of who you are.
If depression is a demon and all you need to do to get your real, true, normal, neurotypical self back is to exorcise the demon, then if you seek medication and/or therapy, you're going to have some pretty unrealistic expectations for what it can do for you. Medication and therapy are useful for a lot of people, but they don't turn a depressed person into a non-depressed person the way that antibiotics kill bacteria. (Again, I'm talking about the kind of depression that recurs and doesn't have a clear and immediate situational trigger, not the kind that a person might experience after the death of someone close to them.) I don't know of any evidence to suggest a treatment like that will ever be possible.
We are often told to give others the benefit of the doubt, to not assume the worst possible interpretation of others' actions without more information. Why not apply that principle to yourself? Instead of an unwelcome invader to fight off, can you treat your depression as a friend, albeit one who it's difficult to relate to or communicate with?
Depression as coping mechanism
"Depressed people's brains lie to them" is so much more comforting of a take than "people who have been abused over and over expect to be abused again, and that's reasonable", isn't it? Isn't it easier to call depressed people defective than to acknowledge we live in an abuse culture and that literally damages people's brains? Easier, that is, for people who don't live with depression.
If you get hurt every time you get close to another person, but you are a social animal who requires social contact to be healthy, depression is a logical and normal response. The Hobson's choice between enduring isolation or enduring abuse can be resolved, but doing so requires access to significant skills and resources. Not having those resources isn't the same as having a brain that lies to you.
Isolating yourself is a defense against being hurt by other people, and that defense mechanism can last long after the situation that precipitated it is gone. For example, if you're an adult who was abused as a child. Maybe everybody else in your life since you moved out of your parents' house has been great, but you wouldn't know because your body is convinced that if you get close to people, they'll hurt you the way your parents did. This kind of trauma doesn't generally heal spontaneously like a paper cut. It's not impossible to become happier and more comfortable if you have it, but doing it requires being taught skills and having significant privilege that makes it possible to apply those skills. Your brain isn't defective or deceptive because you don't know things that you haven't learned yet.
Depressed brains tell you the truth: that you're in a situation where the best survival mechanism that you know is to withdraw from social engagement. Your brain has powerful ways to warn you about danger. That you are alive in the world today means that you are descended from a long line of organisms that were great at surviving, at least long enough to reproduce. What your brain can't do on its own is teach itself new ways to handle danger. That's the part that requires help from others. However, your brain isn't lying to you just because it can't solve any problem with no external input. Needing social interaction to cope with serious problems that themselves cause inability to connect socially doesn't make your brain a liar. It makes it human.
So what if your brain is telling you "you should kill yourself"? What if it tells you that all the time and the difference between a good day and a bad one is just how well you can distract yourself from hearing the message? A brain that's telling you to die is a brain in a situation where you subconsciously believe that the danger you face exceeds your energy and ability to respond to that danger. It means you need help, but if you believed that help was available, your brain wouldn't be telling you to die. If you're living in 2018 under late capitalism and you're not extremely privileged -- then it's not incorrect to perceive danger all the time. What is likely incorrect is the belief that no help is available. But if you hold that belief, it doesn't mean your brain is lying to you. We all have incorrect beliefs, because no one has perfect access to information and we don't know the things we haven't learned yet.
What neurotypical people don't want to hear
Many people who have never felt hopeless, who have always had people they can rely on, don't want to hear that in a lot of cases, the belief that no help is available is more accurate than not. The just-world fallacy is one reason why you might believe that if somebody isn't getting the help they need, it's their fault for not trying harder. Telling people to just get help, that help is always available, may seem benevolent, but it's actually the other side of the coin from the attitude that blames people who complete suicide for not having tried harder to live. In both cases, believing that the suffering depressed people experience is their own fault is a defense mechanism that protects a neurotypical person from confronting the reality that people suffer who don't deserve it.
If you have friends who care about you, but can only tell you to do yoga and drink more water, and can't pay for trauma-informed therapy for you, then effectively, no help is available. If the only therapists where you live aren't familiar with trauma, and you can't afford to see them anyway, then effectively, no help is available. Telling people to "just get help" ignores that getting help, itself, can be dangerous, and the perception of that danger escalates your brain's depressive response.
I don't like the "your brain lies to you" framing because despising yourself and disowning parts of yourself aren't exactly things that depressed people need to be doing more of. The distinction between "I am broken" and "I don't know how to do this yet" is important for anyone who's still learning new things, whether that's kids in school or adults figuring out how to navigate a hostile world. If you conclude, instead of "I am broken", "it's not worth learning" in the face of things you don't understand, that sets off a different, but also unhelpful feedback loop.
You can think of depression as like a fire alarm. If your fire alarm goes off, then that's telling you something. The alarm doesn't tell you how to put out the fire, but blaming the alarm because it doesn't help you figure out what to do about the fire isn't likely to help. If your fire alarm malfunctions and goes off all the time even when there's no fire, on the other hand -- which might be a good analogy to a lot of people's experience with depression -- then it means you need to repair or replace the alarm, rather than conclude that it's never useful to pay attention to fire alarms.
None of this is meant as advice for people who are currently in a depressive episode. Metacognition -- the skill that lets you examine your internal responses and distinguish between the feeling of wanting to die, the belief that you should die, the awareness of having a reaction, and the identification of the reaction's root cause -- is not something you can develop while acutely struggling to survive, except maybe with professional help. I'm attempting to summarize lessons that can only be learned through experience, and reading this isn't a substitute for having those experiences. I'm also not trying to say that my way of coping with depression is better than yours.
In fact, I'm mostly writing for neurotypical people here, people who, if they experience depression at all, experience it as a passing mood rather than a constant presence. With that in mind, I recommend that neurotypical people who are not mental health professionals follow a couple rules of thumb if they need to talk about depression (and maybe you don't need to talk about it at all, aside from helping people find adequate professional help):
- Be specific instead of universal. For example, "My friend Bob realized that it was easier for him to cope with his suicidal thoughts when he started saying to himself, 'depression lies'"; not, "Depression lies to you."
- Respect and strengthen depressed and otherwise mentally ill people's autonomy. Honor the ways in which our brains keep us alive, even if it doesn't look like how your brain works. It's patronizing to tell somebody else that their brain isn't working, but it's affirming to say instead, "Wow, you must be going through something really hard if your brain is protecting you by encouraging you to hide and retreat. I know it's hard for you to reach out and I don't expect you to do it, but I'm here if you want to hang out or even just share in each other's company without talking."
- Avoid prescriptivism. Just because your friend Bob said that the "depression lies" framing worked for him doesn't mean you need to recommend it to anybody else, or tell them they're doing it wrong if they don't view their depression as lying to them.
- Validate instead of undermining. This doesn't mean agreeing: if your friend says, "I hate myself, I'm such a terrible person," there's no reason for you to say "Yes, you are a terrible person!" It means acknowledging that their feeling is real and being comfortable in its presence, rather than expressing discomfort with it (which gives your friend a job to do: hiding their feelings so you can feel more comfortable) or trying to fix it.
When neurotypical people say "depression lies", they mean "depressed people tell me things I don't want to hear": primarily, that we're all failing at building communities that make people want to live.
FAQ
But aren't you assuming all depression is caused by trauma?
It's true that I'm writing here mostly about depression that's rooted in past trauma and/or ongoing difficult circumstances. That's the kind I'm familiar with, but maybe there are people out there who have never had anything bad happen to them but, nonetheless, are depressed because of a chemical balance. These people can still be compassionate to themselves. It's like having a malfunctioning fire alarm: the system that's alerting you of a problem exists in the first place to protect you from real threats. It might be that some depression is actually a chemical imbalance that originates totally randomly (though I don't think the evidence to conclude that exists at this point) and can exist in a person who is getting all their needs met, but I think being compassionate towards the parts of yourself that aren't working, and looking to the ways in which those parts are doing the best for you that they can do, is still helpful.
Your experience of depression doesn't sound like mine. I don't think this way of thinking would work for me.
The only way I can think of to answer this is with an analogy, which isn't perfect, but I think gets at the point. Imagine the following conversation:
ALICE: "People say you shouldn't hit kids, but hitting my Bobby is the only way I can keep him in line."
CAROL: "Dealing with kids is very hard, but there are other ways you can deal with difficult behavior from them, and it's worth learning those ways."
ALICE: "You just don't know my Bobby, maybe your kid doesn't need to be hit, but mine does."
Is little Bobby such a demon from hell that physically assaulting him is the only way any parent can manage him? I would say probably not. All children are different, because all people are different, but that doesn't mean things that are harmful to all of them don't exist. If you believe you can only care for your child by physically abusing them, that doesn't mean your child is different from mine; it might just mean you haven't learned how to do things differently. I don't think comparing children to misbehaving parts of your brain is so far off, because just as children don't know how to act because they haven't learned yet, and blaming them for what they don't know isn't useful, it's the same with parts of yourself that you may not like.
Are you saying if I'm depressed, I can't think of my depression as lying to me?
No, if it's useful for you, there's nothing wrong with you doing that. I'm offering an alternative, which no one has to take if it's not useful to them. Just as I wouldn't tell you to stop getting blackout drunk every day if that's the only thing keeping you alive, I wouldn't tell you to stop hating yourself or seeing yourself as demonically possessed. I can say that there are risks in both cases, but if you're doing it, it has a function to you, and the only person who can legitimately tell you to stop doing it is someone who is prepared to work with you on finding a replacement coping mechanism (i.e. a therapist).
Are you saying people with chronic depression can never recover?
No. I don't think that "depression lies" particularly helps with recovery, though.
What if your brain mistakes a situation that's not dangerous for one that actually is? Isn't it still useful, then, to think "depression lies?"
Again, if you're depressed and this works for you, okay. I still think it's not useful to attribute malice to your brain. Being aware of the reaction you're having without forming a judgment about it (like "It's lying!") is different from taking any particular action based on the reaction you're having.
Isn't depression "the only illness that convinces you that you don't need treatment for it?"
I don't find that a useful framing either, because I think it's more useful to look at why a person might not feel it's safe to seek help, a feeling that is usually based on reality to some extent.
Isn't it reductive to say that you can learn your way out of depression, especially the kind that really comes from your brain not working right, not your current or past environment?
This is why I'm being careful to say that this isn't actionable advice. Telling you that it's possible to learn something isn't the same as teaching it to you, but you have to believe that it's possible to learn before you can be taught. As with any chronic condition, learning to live with it doesn't make it go away. If I didn't think it was possible to live with a chronic condition, I would have to conclude that I and many of my friends shouldn't be here, and then we would all disappear in a puff of logic.
If depression doesn't lie, does that mean a person experiencing suicidal ideation should believe their suicidal feelings, and kill themselves?
No. When I say that the part of your brain telling you to die isn't lying, I mean it's drawing the best conclusion it can draw based on the information available to it. To acknowledge that you are feeling like dying would be a good idea doesn't mean you have to act on that feeling, any more than validating your friend who hates themselves doesn't mean saying, "Yes, I agree, I totally hate you!" Asking "what is this trying to tell me?" is an alternative to either believing "my brain is lying to me", or believing that what it's telling you is true and that you need to act on it. Feelings don't dictate actions.
I think that suicide can be a valid last resort, but that doesn't mean it's the first resort or that everyone who experiences suicidal ideation ought to act on it. Some situations might truly be beyond hope, but I think those are pretty rare compared to the ones where help can be unearthed. I don't have advice to offer here for depressed or suicidal people, because there's already plenty of that out there. I do have advice for people who don't experience these difficulties: do what you can to make the world a place where more people feel that life is worth living. I'm inspired here by Valerie Aurora's essay "Suicide and society: Where does responsibility for preventing suicide lie?".