Labeling my Life , my self, and depression: Stick and Stones and the DSM-V

This is the third in my series of posts discussing my reading of Monica A. Coleman’s book Not Alone.
I’ve always been ambivalent about my depression.  I think it’s because, like Coleman, I have a slightly suspicious attitude about having the way I am labeled. As if the sum and total of who I am as a person and how I see and experience the world can be reduced to a diagnosis.  I agree with Coleman that “a reduced life doesn’t work for me.” She elaborates:

“A reduced life doesn’t work for me. My diagnosis is just shorthand and not my fully developed story. It’s only a very brief way of explaining some of what I live with. It’s probably most helpful for psychiatrists. Mental health conditions are as unique as the people who live with them. I have two good friends with the same diagnosis, and we have pretty different experiences of depression and hypomania. More importantly, my diagnosis is just one part of what can be said about me. There’s a lot more to me than this name. This name was given to me by people who write manuals.”
Coleman, Monica A. (2012-08-24). Not Alone: Reflections on Faith and Depression (pp. 13-14). Inner Prizes, Inc.. Kindle Edition.

 

The Diagnostic and Statistical Manual (DSM) is the doctor’s and therapist’s field guide to collections of mental health symptoms. “It clusters symptoms and names them, thereby indicating who is normal and who is not. And I’m not sure if this is a good or a bad thing” (p 12).

I agree. I’m not sure it’s a good thing either.  One of the terrible things about depression is that once you get diagnosed or labeled, it does seem easier to get help and at the same time, you are not always sure the help (therapy or medication) is helping.  It’s like a prison sentence, you will always be held captive in some way to the medicine and the diagnosis.

Another of my favorite books on depression is Where the Roots Reach for Water: A Personal and Natural History of Melancholia by Jeffrey Smith. Smith interweaves his own experiences of depression with historical accounts of how depression and depressives have been explained and thought about in the west since the time of ancient Greece.  I love his account for both its personal and historical stories, but especially because he discusses his ambivalence about being labeled and his need medication along with his struggle to find and use medication as part of his life, but never seeing it as an “answer” or a “cure.”

I know that both therapy and medication have helped me.  I also know I have not really changed much since I was diagnosed and first “treated” decades ago.  Sometimes I feel that the only thing that’s really changed is my awareness that I am not the only one. Before I was able to explain how I felt and felt heard and recognized as a person in pain, I felt like I was more than depressed and was losing my mind. It was scary and that fear was more debilitating than the depression has ever been.  I am still not sure what this thing called depression is because sometimes it is a mood, sometimes lack of energy, sometimes just the way I experience and reflect on the world.

Whatever “depression” is, it unnerves me that my life and experience is, or even can be reduced to a collection of symptoms and categorized so easily.  And yet, at the same time. I have to admit that at times, it has been easier to explain myself because of this same list of symptoms.  Physicians and therapists are only human like me and I can give lengthy existential descriptions of how I am experiencing life, but there is no help or understanding until I can name feelings or describe lack of sleep. It’s just the way it is. It’s important, however that people have a broader awareness that

“medicine is a practice. It’s the experts’ best estimation, given the evidence in front of them. Sometimes they get it wrong, and the effects can be disastrous. But they try again, to get as close to right as possible. And when they get it right, they can save lives.Coleman, Monica A. (2012-08-24). Not Alone: Reflections on Faith and Depression (p. 15). Inner Prizes, Inc.. Kindle Edition.

My responses to the reflection questions from Not Alone:

Exploration What do you call your experience?

I’ll be honest. I still don’t know what to call my experience.  I use “depression” because it’s the term people understand when I say it.  It’s like using the term God.  My religious tradition of Unitarian Universalism is full of people who will do all kinds of verbal, theological, and philosophical gymnastics to avoid using the word “God.” They will use Spirit of Life, Source, Goddess, Source of Grace, All that is Glorious and Good, Web of Life, Human Potential, Spirit, Infinite Intelligence, All That Is, Energy, Love, and the Divine.  I find it easier  to just use the word “God.”   It’s similar with how I am.  I read a book such as this one by Monica A. Coleman and I see myself reflected in her experience of what is referred to in general terms, depression.

 Reflection What are some of the names that help describe who you are?

There’s an exercise you may have experienced as it is used in educational, pastoral, business, leadership, and diversity trainings of various types.  A group of people are given the task: Describe yourself without using any of the usual labels, such as what you do to make a living, any of your relationships, especially family relationships, or religious, racial, ethnic or cultural identifications of any kind.  It’s very difficult.  Yet this is what it gets down to, really, when we’re asked or when we ponder the question “Who are you?”

I can describe myself using all the usual labels such as father, partner,  minister, writer, Native American, Portuguese, white, Unitarian Universalist, musician, chess player, geek.  All of these give people some indication of who I am or some information about me. Yet, none of these tells anyone what is really in my heart, what my dreams are, what I FEEL like, or really how I most authentically experience myself as a living being.

I feel the same way about depression.  It’s an understandable term. Many people will have some grasp of who I am in part and how I feel when I use it, yet like the term “God” it is convenience because really describing what I am talking about takes a lot of words, a lot time, and a lot of getting to know me.

Depression is an easier term to use, but it doesn’t tell you that I hate being classified or labeled. That I hate needing anti-depressants and I that I am sometimes skeptical of how well they work or how much they are really helping.

I used to want to be different. I used to not want to be depressed, but now I realize there is no being me, who I really am without it.  I don’t think I’ve ever actually been any different.  I feel joy like sunbeams bursting through clouds and I feel anguish and pain like tortures invented just for me in order to brutalize my heart in the strongest way imaginable.  I also wander in the woods and swear the world is alive with things unseen and that we’ve forgotten how to talk to. I also sit on a beach and stare at the ocean and look up that stars and can get lost in my connection to universe so that it seems like I’ve already reached Nirvana.  It’s been almost 50 years and I have to believe at this point that these things and “depression” go together and although I don’t like the depression, I wouldn’t trade the way those things speak to my soul for anything. Anything.

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2 thoughts on “Labeling my Life , my self, and depression: Stick and Stones and the DSM-V

  1. I had a depressive episode as a young person. I am sympathetic to the idea of problems surrounding “labeling” and the various stigmas and challenges that may arise around that. There is a challenge in trying to find and define various clinical problems or “dis-eases” that occur and not allow it to become reductionist in the wrong hands. The DSM is a controversial document, and will continue to be so. It is inherently important AND difficult to get consensus on psychological disorders and categorize them meaningfully so that persons can be eased in their challenges.

    From my experience in the social work world, most mental health clinicians seem to be trying to change the language around to descriptors like “she has schizophrenia” or “is struggling with managing her bipolar disorder” rather than “She is schizophrenic, bipolar, etc.” I honestly don’t believe that any of the people that I have met are attempting to reduce a person’s life to one catchy diagnostic word, but in health and health-related fields it is important that we have words that we can broadly agree on as having particular meanings. If we had to go through UU-style gymnastics to agree on what “cancer” was, we’d have a lot of dead patients. 😉 Clinicians understand that words matter, and are trying to move towards using language that reflects that a particular clinical diagnosis is clinical and not speaking to the totality of the person.

    I am sympathetic to the issue, but admit to being ambivalent about it. I never considered the phrase “He is a diabetic” as being descriptive of anything other than the presence of diabetes, why would I consider “bipolar” differently? But I understand that for some this language matters a lot and I try to be intentional in my words.

    Just as there is much “physical illness”, there is a considerable prevalence of mental illness in the world. We would do much better in the world if we would continue to have frank conversations about the fact that it DOES affect so many people and that it IS just a normal (and sometimes challenging) part of the human experience. We drag too much ancient and puritanical baggage that wants to project weakness of will or character defects where there are none.

    Peace to you brother.

  2. I appreciate how you say that the fear of losing your mind was greater then the depression. That is EXACTLY how I felt, too. People can’t really understand until they have been there. The word depression just doesn’t fully capture the experience. Thank you for sharing.

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