#humor and play and activism are so necessary to process heavy shit

[areyoudoingthis]

i had an even better theater class today i love doing things that move me and inspire me

[sheathandshear]

But Why Doesn’t the Depressed Person Do the Thing?

Any non-depressed person who’s interacted with a depressed person for a while may find themselves puzzled by a lot of the less well-known aspects of depression. Feeling sad? Okay, we get that. Feeling suicidal? Well, that’s a lot more complicated, but we kind of get that? But one of the things I’ve heard the most from other non-depressed people/people in my life is:

But why don’t you do the thing?!

And they’re not asking me to learn how to ride a unicycle. They’re not asking me to run for office. They’re not asking me to clean my house from top to bottom, even though my house is disgusting and really could use a good clean. No. They’re asking me: Why don’t you do the dishes? Why don’t you answer emails? Why don’t you refill your meds before you run out? How is it that with 95% of the responsibilities you take on, you drop the ball and then just watch it roll down the hill?

So here, in part, is a short explanation of why it’s not that I don’t do the thing, it’s that often, I can’t.

What the world is like for a depressed person:

The future does not exist. Literally. Depression is a plodding series of single days. It’s not that we don’t get calls from creditors, or recognize that we really need to finish that project at work, or even do laundry -- it just doesn’t matter, because we’re continually stuck in in the now, with no energy or imagination left to contemplate a future beyond “can I get out of bed tomorrow”. We are running on 10% battery, always, and that energy gets relegated to the most basic tasks of survival.

If there’s suicidal ideation in the mix, this gets even more pronounced, this basic inability to give a shit about things even with long-lasting, even dangerous consequences. Bad credit score piling up? I don’t care. Thousands of dollars of medical bills and student loans? I don’t care. Not BPA-free? I don’t care. Start smoking? I don’t care. Self-harming? I don’t care. Go to school for another two years? For what? Put together a career path? Why? Even if you’re not actively seeking out death, there’s an underlying feeling that death is right around the corner, so you’re not going to live long enough to see the bad consequences of your actions.

We see the laundry on the floor. We see the dishes in the sink, and the roaches on the counter. We see the trash piling up. We see the unread emails and the unopened bills. We see that there’s nothing left in the cabinets but half a box of instant oatmeal. It’s not that we’re lazy. We want these things to be solved. But there’s this very useful word called avolition:

“A symptom of various forms of psychopathology; the decrease in the motivation to initiate and perform self-directed purposeful activities. People with avolition often want to complete certain tasks but lack the ability to initiate behaviors necessary to complete them. It has been related disorders of diminished motivation, [such as] schizophrenia, bipolar disorder, and trauma disorders.” (Wikipedia)

To give an example: I have problems with laundry. A lot of problems with laundry. The combination of physical chronic illness (doing laundry requires repetitive lifting arm motions and carrying heavy loads up and down two flights of stairs) and depression means that I do laundry maybe once a month, and only with outside help (namely, my sister to actually do the laundry and bring it up to my room), where I fold it -- or not. For the last few weeks, it’s just been sorted in various laundry bins strewn across my room instead of put in my drawers. 

I want to do laundry. I know, intellectually, I need to do laundry. But the last time I managed to do laundry independently was during a hypomanic episode when I brought all four giant bags of my laundry to a 24/7 laundromat in the middle of the night, because even then I couldn’t manage the process of waiting load by load at home, and it cost me a good $40. Mental illness: it’s expensive, and not just meds and therapy.

Well, yeah, but you’re not one of those “low functioning” severely depressed people. You look fine. I know what real depression looks like.

I truly hate the words “high functioning” and “low functioning”, because they don’t accurately portray the subjective experience of depression, and they give this idea that you can just look at someone and tell that they’re depressed.

Let’s play a game! Can you tell which one of these people is severely depressed?

Unwashed hair and clothes, flat affect, stays in bed, avoidance of social situations, can’t verbalize their experiences or emotions, cries all the time.

Seemingly chipper and upbeat and work, starts projects but never finishes any of them, increasingly “unreliable”, chainsmoker, late or absent all the time, politely dodges their coworkers’ offers of social events, apartment is an utter, disgusting mess, only eats cereal and yogurt because everything else requires too much energy, never answers the phone because their creditors are the only people who call anymore.

Informed, calm patient at the psychiatrist’s office. Dresses well (because their entire wardrobe is nice clothing), highly articulate and clever, may even use diagnostic language themselves, has a sense of humor about their condition, subtly reaction testing the psychiatrist the entire time, leaves the psychiatrist feeling like the patient is stable and only “slightly” depressed. Patient doesn’t mention daily, vivid daydreams of suicide, because at one point the psychiatrist talked about institutionalization as a joke about one of his other patients.

Unemployed but actively searching for a job, doing odd jobs for family in the meantime. Has a sense of humor, affectionate with friends and animals and children, but never seems to complete all the tasks on their list, just the most basic ones, and the job hunt isn’t going well. They lost their previous job because of poor memory and concentration problems. They never cry, but they’re prone to random outbursts of rage disproportionate to the situation. They used to have a number of hobbies, but those hobbies seem to be dropping off; when asked about it, the person shrugs and says that they don’t have time, even though you can’t figure out how, because it seems like they never do anything.

Surprise! These people are all severely depressed!

If you take away a single thing from this post, it’s that people who are depressed (even severely depressed) often don’t look or act like the stereotypical image of depression. Moreover, many people who are depressed but don’t fit the stereotypical image of depression think they’re lazy or unmotivated when in fact, they are experiencing severe symptoms of their depression, such as avolition or an inability to plan and act for the future.

So the next time you ask yourself “Why isn’t this depressed person doing the thing they need to do?”, ask instead, “How might their depression affect their ability to do the thing that they need to do?”, and “How can I help them find ways to work with their symptoms to improve quality of life?”

*Standard disclaimer: Many of the things I describe come from my experience as someone on the heavily depression-skewed side of the bipolar spectrum. YMMV.