An overview & critique: Depression in fiction books

For reasons that I will inevitably wind up discussing more in-depth later, this is a topic that I am very interested in.  After all, there is no doubt about it: So much of our world is informed by our media, including fiction books.  Major pop culture phenomenons – books like Harry Potter and The Hunger Games, for instance – wind up having a major impact on a whole slew of societal attitudes, everything from the names of our children to the hobbies we play.

Of course this extends to serious issues, like mental health.  As I sat, thinking about this entry, I came to the realization that I cannot think of too many books I’ve read that explicitly feature stories about characters who feature mental illness – even when the book is potentially about something other than mental illness.  This is important from a stigma perspective: I think it is vital that readers hear stories about people with mental illness living a successful life, despite their challenges.

Now, please don’t misunderstand: Just because I haven’t read them doesn’t mean they aren’t out there.  A very quick Google search reveals no shortage of books that discuss exactly this topic.  And, indeed, many of these books touch of mental illness in a more tangential way.

Two young adult books that I’ve read immediately come to mind.  One is Fangirl by Rainbow Rowell, which discusses a young woman moving to college and dealing with a slew of pressures, then finding therapy in her writing.  Another, Anthem of a Reluctant Prophet by Joanne Proulx, features a character who clearly is struggling with depression and anxiety, even though it goes unspoken throughout the novel.

I’m coming at this from the perspective of Young Adult novels, which I must confess, I still enjoy (a quick look at my Goodreads page will confirm this!).  But, from the perspective of mental illness, there is an important reason for discussing this genre in particular: 50% of all mental illness starts at age 14, and 75% by age 24.  If this issue can be addressed early enough – particularly during it’s onset – it can make a big difference.

I suppose my point is this: As best I can tell – and, again, admittedly, I could be wrong, please correct me if I am – it seems like mental illness in fiction is addressed in one of two ways:

  1. It is completely undiagnosed, leaving readers guessing or playing armchair psychiatrists, and that’s never a good idea.
  2. It is the centerpiece of the book.

Don’t get me wrong, neither of these things are necessarily bad in and of themselves.  I’m just having this conversation from a stigma perspective.  The first option listed above can be problematic and fail to fully address a characters illness, which can lead to misguided perceptions about the way that mental illness works.  The second option can be good, but it, too, can make people think that mental illness is somehow more debilitating than it truly is.

Also, please understand, I’m not criticizing any author or book.  Many of the ones that deal with mental illness – directly or indirectly – are powerful, and it’s not possible or fair to be critical of an author simply because they don’t address a particular issue in a way I want to see it done.

That being said, from a stigma perspective, that’s what I’d love to see more of.

Any thoughts to add, or books I am missing?  I’d really love to know – if only to read them!  Please let us know in the comments.

Depression is more than feeling sad

One of the things I have certainly struggled with in my personal life – and I think one of the things that many people don’t realize – is what depression truly is.  I saw this image ages ago in my Facebook feed, and I think it sums it up personally:

depression is more than sad

This is so, so accurate (except for the Mario Kart part – I got nothing there) and I say this based on more than just a viral image.  According to the DSM (Diagnosis & Statistical Manual, the official way in which mental illnesses are diagnosed), the following five symptoms are indicative of a Major Depressive Disorder:

  • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad, blue, “down in the dumps,” or empty) or observation made by others (e.g., appears tearful or about to cry). (In children and adolescents, this may present as an irritable or cranky, rather than sad, mood.)
  • Markedly diminished interest or pleasure in all, or almost all, activities every day, such as no interest in hobbies, sports, or other things the person used to enjoy doing.
  • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or decrease or increase in appetite nearly every day.
  • Insomnia (inability to get to sleep or difficulty staying asleep) or hypersomnia (sleeping too much) nearly every day
  • Psychomotor agitation (e.g., restlessness, inability to sit still, pacing, pulling at clothes or clothes) or retardation (e.g., slowed speech, movements, quiet talking) nearly every day
  • Fatigue, tiredness, or loss of energy nearly every day (e.g., even the smallest tasks, like dressing or washing, seem difficult to do and take longer than usual).
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day (e.g., ruminating over minor past failings).
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day (e.g. appears easily distracted, complains of memory difficulties).
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideas without a specific plan, or a suicide attempt or a specific plan for committing suicide

The first item is specifically about depression and feeling sad.  The rest are most definitely not.  And it’s important to note that everyone experiences depression differently, and at different times.  For some, sadness is the overwhelming emotion.  For others, it’s complete anhedonia.  These emotions are felt in different ways, at different times.

I write about this based on my own experiences.  I’ve found that, when I am going through a rough patch, it isn’t often led off by sadness – usually, I start with insomnia and a loss of appetite – I always lose weight when I am depressed.  Things usually go downhill from there.  Not for nothing, but those two symptoms are often the canaries in the coal mine.  I work out a lot so I’m almost always hungry, and if I don’t want to eat, I almost always wonder if something is wrong.  It’s amazing, the way depression sneaks up on you like that…it comes out of nowhere and starts to nibble at your mind, before you are even aware of it….

My point is this: It would be foolish to assume that depression is just depression.  It can be experienced as an entire series of symptoms, many of which have nothing to do with feeling sad, and all of which can easily be confused with something else.  I draw some comfort from this – there is nothing “wrong” with me – well, besides the obvious, haha.

I’m really curious to hear from others.  Have you experienced depression in some other way, including those not listed here?  Let us know in the comments!

You are not alone: A quick – and personal – review of depression statistics

On my drive home today, I was listening to a podcast called Everybody’s Fucked Up, a podcast by two video game developers who have both struggled with mental illness.  One of them, Tessa Vanderhart, discussed how one of the best things she discovered in therapy was that it helped teach her that no one who suffers from mental illness is truly alone.

That reminded me of a story from when I first got to college, and when my own depression really exploded.  It was the 2nd or 3rd day of school, and I am completely freaking out.  I still remember everything about it: It was a gorgeous, late August day.  I was sitting on the steps just outside of my dorm, on my oversized cell phone, talking with my Dad.  A group of girls walked by, and they were laughing and smiling.  I knew one of them from high school, and she waved at me.  I sheepishly waved back – my face was obviously tear-stained.  I had been balling, homesick, can’t adjust, I am convinced I had no friends, it’s never gonna get any easier, I want to go home, all that good stuff.  Anyway, I’m on the phone with my Dad, telling him how I was sure I was the only one who felt this miserable, because, after all, I didn’t see anyone else who was as upset as me. Exasperated, he responded, “Of course you don’t!  That’s because they are all in their rooms, crying like you!”

He was right, of course. I later found out that .5% of the kids in my class actually dropped out the first weekend because they just couldn’t handle being away from home, and that says nothing of the kids who were just struggling like me.  But, that story actually illuminated a bias that I’ve found still remains when it comes to mental illness: Far too many people think that they are truly the only ones suffering, because they don’t see anyone else.

Nothing, of course, could be further from the truth.

I want to give you two statistics on mental illness and try to personalize them as much as possible.  A quick look at the literature shows:

  • 43.8 million American adults – about 18.5% – experience mental illness at some point in a year.  So, dear reader, let’s assume for a moment that you are one of the unlucky 18.5% of Americans who suffer from mental illness, and you think you are the only one.  Okay.  Let’s say you are sitting in class, and say there are 25 people in that class.  Odds are pretty good that you and four others have mental illness.
  • 18.1% of Americans will experience some sort of anxiety-related disorder over their lifetimes.  You work in an office of 50 people, and you are in the bathroom,  heart accelerating, stomach churning and bawling your eyes out, but trying to do so quietly so no one wonders what is wrong.  You think you are the only one?  Odds are that nine other people are in a different bathroom, panicking for no reason or reliving some highly traumatic event.

One of the bad things that researchers and politicians have a tendency to do is to talk in the abstract, to talk in big, global numbers, and not give those numbers any context.  Sure, 43.8 million Americans sounds like a lot, right?  What makes even more of an impact is a personal one – a friend, a colleague, a classmate, a coworker.  This is even more important for people who suffer from mental illness – we are more than just a number, and it’s important that we be seen as such.

When you think of mental illness, or when you think of your own mental illness, one of the hardest things to remember, sometimes, is that you aren’t alone. As you sit in your bed crying, or at your desk, wondering how you are going to get through the day, or scrolling through your Facebook newsfeed in a desperate effort to take away your pain, you have to try to remember that you aren’t the one suffering.  There are millions upon millions of you – of us – that share your pain at any given moment.

Try to remember that, and try to let that thought give you some comfort – you aren’t the only one.

Things you CAN do to fight depression and anxiety

I think that one of the worst things that I’ve found in dealing with depression is the hopelessness that comes with it.  One minute you’re fine, and the next, you’re…not.  Medication and therapy help, but depression is a chronic condition.  It comes back.  And while you can limit it, manage it…it still comes back, and sometimes worse than others.

I’ve said it a million times and I’ll say it again: Professional guidance, and a controlled regimen of therapy and medication, can make all the difference in the world.  When it comes to chronic mental illness, the evidence is clear: Treatment works.

But, treatment doesn’t just mean that you rely on medication and/or therapy to get better.  To some extent, and I’ve certainly found this in my own life, you have to take control of your own illness.  Yes, you may be a victim of a bad roll of the dice, but no one need be depression’s victim.  There are things you can do, on your own, to help keep depression away (again, please note, NOT advocating any of the below in place of therapy, medication or any other professional advice that a licensed medical professional gives you…can’t emphasize that enough).  Here are a few tips that worked for me, and can hopefully work for you.

Exercise

Here’s a good one with a ton of benefits: Exercise can make a huge, positive difference when it comes to depression.  According to the Mayo Clinic, it does so by releasing “feel-good” chemicals, reducing immune system chemicals that can make depression worse and by increasing your body temperature.  Better yet, any physical activity can be helpful, so fear not!  You don’t have to launch yourself into a massive weight lifting program.

On a personal level, I’ve found the gym to be a savior.  Not only does it help you get in shape, feel better and look better, but it makes you feel like you are accomplishing something.  All too often, when you are depressed, you want to just lie around and Netflix & Sad.  You become depression’s bitch, and that is exactly the time to get up and force yourself to move around.  It takes a lot of hard work to overcome this natural inclination to slug-out on the couch, but it is well, well worth it.

Meditation

The evidence is clear: Meditation can help to ease the symptoms of depression, anxiety and stress.  It doesn’t have to be long – the article I link to says 2.5 hours a week – but, a bit of meditation goes a long way.  What I found somewhat interesting here was that most articles relating to depression and meditation don’t just discuss meditation, but a specific type of meditation – mindfullness meditation.  This specific type of meditation is defined as “a technique of meditation in which distracting thoughts and feelings are not ignored but are rather acknowledged and observed nonjudgmentally as they arise to create a detachment from them and gain insight and awareness.”

What is remarkable is that at least one study found that meditation “helped prevent depression recurrence as effectively as maintenance antidepressant medication did.”

Okay, I’ve resisted this all my life.  Not “resisted,” really…just, haven’t allowed myself to do it. I’ve come up with excuses, I’ve done it for a few days, I’ve stopped and started and just haven’t been able to sit down and meditate.  This blog entry has convinced me…again…of how important meditation can be for depression!  Must.  Do.  It.

Also, try the app Headspace.  I’ve used it a couple of times and it seems interesting.

Practice good sleep hygiene

Sleep hygiene?  It’s exactly what it sounds like – using healthy practices to help you get some real rest.  Sleep and depression have a complex relationship – a lack of sleep can lead to depression, and depression can lead to a lack of sleep, which makes getting a good night’s sleep all the more important.  Good sleep hygiene includes:

  • Limiting naps.
  • Not drinking caffeine too close to bed.
  • Limiting screen time too close to bed.
  • Having enough exposure to natural light (huh, didn’t know that).
  • Having a set sleep and wake-up routine.

During some of the particularly rough periods of my depression, I had a REAL hard time sleeping.  It was the canary in the coal mine of my symptoms – I couldn’t sleep, and suddenly, there I was again.  Sleep hygiene – particularly the routine and screen time part (which I still really need to work on!) – is vitally important, at least to me.

Video Games

I discussed this the other day, but felt it was worth repeating: Video games can help with depression.  First, the basics: There are studies which show that MMORPG and other social games can help reduce social anxiety, while puzzlers can reduce stress and anxiety levels.  Other apps and video games have also been found to reduce levels of depression.

Of course, video games can have serious negative drawbacks.  There is, unfortunately, ample evidence that some are not working and are instead playing video games, and there are real fears that mental health plays a role in this.  Video games provide an immersive escape, where there is no judgement, no consequences, and no real failure that cannot be eradicated by reloading the last save file.  This, of course, is dangerous when it comes to entering and remaining in the real world.

As I said earlier in the week, I’m a believer that video games can be great – if used in moderation.  They provide a nice retreat when necessary and can recharge your batteries – getting you ready to relaunch into the real world.

Anything you want to add?  What works best for you?  Let us know in the comments!

Video games and depression

One way I cope with depression is video games, which some studies have noted can help improve social anxiety, depression and stress levels.  I wanted to elaborate on this one a bit.

First: I love video games.  And I mean I loooooove video games.  I can tie most major periods of my life to some sort of video game.  I still remember playing Halo 3 on Xbox live before I went out on my first date with my wife (the guys I was playing with wished me luck when I said why I was leaving for the night).  I remember Final Fantasy X before college graduation.  Skyrim when my son was first born, too little to move and would curl up on my chest while I slayed dragons.  My kids are named Auron and Ayla…bonus points if you can figure out what games those names came from.

I still remember being almost five, coming home from Heather Cohen’s birthday party, and my Dad leading me into our basement, where he gave me the most magical birthday present every: A Nintendo Entertainment System.

Video games have a special place in my heart.  As I grew older and began my journey with depression and anxiety, they offered a safe place and a retreat from reality.  I can see myself playing Grand Theft Auto 3 when I was going through a rough patch with my girlfriend at the time.  During the worst of my anxiety in college, again, it was Final Fantasy X. I still remember being a lonely, awkward middle schooler and just being obsessed with Tie Fighter, because it made me feel good at something.  In the Star Wars universe, no one cared that your hair wasn’t stylish, or that your forehead resembled a pepperoni pizza more than any normal persons should.  You just shot at the bad guys.  End of story.

That being said – that concept of escaping into a video game – is it a good thing?

Personally, I’ve had some experience with MMORPGs, but not a ton.  As much as I love video games, I don’t have enough time to truly enjoy them.  I’ve played my share of them – Warcraft in particular – but, as a newcomer, always found them to be too intimidating to really get into.  However, there’s no question about it – some people get into video games at the expense of real life.

On one hand, there is research with shows that video games can be helpful in reducing stress, anxiety and depressive symptoms.  They provide a creative outlet and a safe place to retreat to when the real world can get overwhelming.  Of course, that retreat can be toxic, which leads to the concept of video game addiction.

Now, to be clear, though there is no shortage of media reports about video game addiction, it is not yet an officially recognized disorder by any major medical governing body.  On an anecdotal level, I suspect that many of us know people who are way, way too into fantasy worlds, but that doesn’t mean they are “addicted,” per se.

I also think it’s worth noting that video games have never been an area free of controversy, and the conversation about whether or not games are addictive have been going on since Space Invaders.  So, clearly, this is a conversation that has gone on for quite sometime.

Are video games good or bad for mental health?
Like the answers to most perplexing questions, this one is evolving.  Video games have positive benefits on depression and anxiety, as far as I am concerned.  I’ve found them to be a safe retreat and a chance to temporarily escape the pressures of the real world.  In my opinion…again, just my opinion, not any medical advice…they can be great, but no different than any other hobby.  You use them briefly to recharge and recalibrate before launching yourself back into the real world.  The challenge, of course, is acknowledging when enough is enough.  For some people, that can be more difficult than others.