I take a journey through the mental health system.

Author’s note: What follows is a lengthy and personal post about my experiences with depression and anxiety. While I do hope it helps to inform, none of this is a substitute for professional help. If you think you may have depression, give your doctor a call.

Depression: a primer.

In the past, when I’ve told people that I have depression, many of them have immediately asked “what’re you depressed about?” Maybe they wanted the chance to point out that things aren’t so bad, or they might have wanted to try their hand at a little armchair psychology, go a bit deeper. In any case, for the most part, their intentions were probably good, and they can’t help being misinformed.

First off, maybe I can help a bit with the “misinformed” part.

Let’s start with some terminology. Some people feel sad sometimes, usually as a result of something bad happening. Death in the family, bad breakup, loss of a job, accidentally taking a mint-condition action figure out of the package. They may say something like “I’m so depressed,” and they may genuinely need someone to talk to to feel better. These people are entitled to whatever help they think they need, but they don’t really have depression.

When we’re talking about depression, we’re talking about an illness. The American Psychiatric Association puts out a book called the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short, that mental health providers use as a reference for diagnosing mental illness. They just released a new edition, the DSM-5, and if you really want to learn all the criteria for diagnosing depression, then by all means pick up a copy and get reading. But you really are better off leaving that for the professionals.

For us lay-people, all we really need to know is that depression is a sickness, something that should be treated by a trained professional. Sometimes, treatment involves talking with a therapist, often a psychologist or clinical social worker (or they may carry other titles). Treatment may also require pharmaceutical intervention, by which I mean medication. Needing medication is NOT a sign of weakness. It’s like having diabetes; some people can treat their particular form of diabetes with diet and exercise, but other people have to take insulin. You’re sick, you take medicine. This doesn’t make you any less of a person. Medication for mental disorders can be prescribed by a general practitioner, but a psychiatrist is specially trained to dispense these sorts of drugs.

How do you know if you have depression? If you’re feeling sad a lot of the time, or if you EVER have thoughts of harming yourself, call someone. If you’re not sure it’s serious, you should still call someone; it won’t hurt to be sure, and it may help just to talk to someone. Who should you call? If you trust your doctor, call their office. If you don’t really have a doctor, I would suggest trying a therapist’s office directly. They can help assess you and put you in touch with other resources in the community, including psychiatry, if you need them. Most take insurance, some charge on a sliding scale based on income. It’s possible there’s no-cost help in your area; check with the health department in your city or county. The important thing is to remember that depression is an illness, and it only gets better if you treat it.

So now we know. Depression is an illness. I cannot stress this enough. Depression does not care how successful you are or how many friends you have, any more than the common cold does. And although heredity seems to play a part, having a family history of mental illness doesn’t guarantee you’ll have depression, and the lack of a family history doesn’t mean you’re immune. Depression, by the way, is just one example of the many mental illnesses a person may be living with.

Getting help is the key. It’s important to realize that if you think you may have depression or anxiety, help is available. Sometimes it takes a while to get in to see someone (more on that later), and sometimes things have to get really, really uncomfortable for you early on in the proceedings, but it can and does get better. Trust me. Here’s how I know.

My time on the patients’ side of the desk.

My experience with the mental health system should have begun much earlier than it did. I was a troubled kid; I don’t really know if the sadness I felt every day as a little kid and a teenager was depression, but it was certainly not a happy time for me. I thought about death a lot. I didn’t sleep much. By age thirteen I was actively contemplating suicide on a near-daily basis. In those days, I still believed in God and the Bible, and part of that was believing I would go to hell if I killed myself. This was probably the only thing that stopped me.

My parents were aware of the problem. Sadly, their response was the same as it always was in difficult times: they shut themselves in their room and got high. They did that a lot, actually, whether times were tough or not. You can imagine the effect that had on their decision-making faculties.

It would appear, by the way, that mental illness runs in my family. My dad’s dad committed suicide; he apparently shot himself in front of his kids when my dad was ten or so (this is not the story my dad told me; his dad’s method of suicide involved a train, according to him. The end result is the same, I suppose). My mom, who had her own issues, says my dad once attempted suicide himself, but I don’t know if that’s true. My dad served in the Navy during the Vietnam war, and that really seemed to mess him up. He’d been out of the Navy for over twenty years before he finally decided to seek help.

So I didn’t get the help I needed. Believe it or not, I never really thought of myself as being sick. How could I? I’d lived with it for so long, it just felt normal. And things stayed like that for years. The summer of 2001 began the darkest year of my life. I was twenty-one. I had problems with my job, problems with money, problems with girls, and my parents had split up. It’s important to note that all of these are problems that people usually have no trouble dealing with. And even though these things all happened within a relatively short span of time, I didn’t consider myself cursed or unlucky. Instead, I started to realize that there was something wrong with me, that I was missing the necessary skills to deal with these things, emotionally-speaking. I took it out on friends, on my brother, on coworkers and strangers. I was alienating absolutely everyone, all because I was so miserable.

It came to head in August of 2002. I was spending quite a bit of time alone, in bed or sitting in my living room, unwilling to do anything or see anyone. I’d quit my job at the movie theater, a good job. I’d broken up with my girlfriend (she dumped me, actually). My car was taken by the police for not being inspected or registered. Phone was shut off. Things were grim. It’s hard, now, to even think about just how poorly I felt. And what happened next is even harder to think about.

My brother, while away with the Marines, had left some of his stuff in my apartment. Among the boxes of clothes and CDs and DVDs was a plastic case that contained an AK-47 rifle, complete with clips and ammo. I knew how to use it; we’d once gone out to the woods and shot it. So I knew how to load it, how to chamber a round. And, sitting in my bedroom, in an apartment with no downstairs or upstairs neighbor, in a neighborhood where I never saw any other residents, I put the barrel of that rifle against my forehead and my thumb on the trigger. I was ready. I knew no one would find me for a while. I was convinced no one would miss me. I knew this was the only way out.

For some reason, I didn’t do it. To this day, I have no idea what stopped me, don’t know why I uncocked and unloaded the rifle and put it back in the case. But I did. And I had a friend drive me to the Emergency Room at Forbes Regional Hospital in Monroeville, PA.

While sitting with the triage nurse in the ER, I told her that “I just felt like dying.” So they took all my clothes, gave me a gown, and had security escort me upstairs to the 7th floor, the hospital’s Psychiatric department.

ForbesI was only there for a few days, but the place still gave me nightmares for years after leaving. I spent the whole time trying to convince them I wasn’t suicidal. Yes, I was lying. Of course I was suicidal. But I didn’t like it there. It was freezing cold (in spite of it being 80 degrees outside), the food was awful (I couldn’t eat any of it, and only had terrible coffee for my entire stay), and the people scared me. I’ve since learned that it’s not a good idea to lie to people who are trying to help you. And they took good care of me, the horrible food notwithstanding.

They let me go with a few sample packs of Celexa and gave me bus fare. They’d also given me the name of a clinic in the community where I could see a therapist and a psychiatrist for free (my stay at the hospital had been taken care of through some assistance program). The place was close to my house, or it would’ve been if I’d had a car, which I didn’t. I had to walk or take the bus, and since I couldn’t afford the bus, I walked.

The therapist (I wish I could remember her name) was nice, but getting to the appointments was problematic. After missing a couple, they told me I couldn’t come back. And since they were providing my medication, once I ran out of the sample packs they gave me, that was it. I needed another way to get the help I needed, so I came up with a plan. I’d move in with my dad up in western New York (he moved back up there from the Pittsburgh area after they split) with the hope I could take advantage of the healthcare provided to the Native American population who lived on the reservation (see this post for a bit of background on my screwed-up heritage. Look for the question about my dark hair). This plan was doomed from the beginning, since I likely wasn’t eligible for services. And I hated that area of the world. Still do. I’ll never go back.

But I never ended up executing that plan. In what turned out to be an incredibly fortunate turn of events, I met a girl. Actually, I already knew her from my job at the movie theater, but it had taken a while for me to muster up the courage to ask her out. And considering I didn’t have a job or a car or any money, I needed a lot of courage.

That relationship turned out to be a good one. A really good one. So good that I completely forgot about my plan to move back to New York and instead got a job, now hoping to put my life back together. Things were going so well that I also forgot about my mental health needs. This girl, who I would end up marrying, came from a good family who took me in and accepted me and treated me well.

Things were improving, but another problem had come up. It would be years before I could put a name to it. It’s possible, I guess, that my time with the free-clinic therapist hadn’t been as beneficial as I thought. It had left me exposed, raw, like opening a wound we didn’t have time to close. This is why it’s always important to keep your appointments.

I started having panic attacks. Unable to take full breaths, shaking, hands gone numb, my brain playing the “what if?” game on an endless loop. It’s thoroughly unpleasant. And although I’d always been a bit of a shy person, my reticence was getting worse. I was becoming scared to talk to people, to speak my mind at all. I started having trouble leaving the house. My mind had become my enemy, and a horrible enemy it was. I was now suffering from anxiety disorder.

I thought I could get by on my own, and since I didn’t have insurance, there wasn’t much choice. Things went on like that for another few years before I set foot in a doctor’s office. At twenty-six, I finally had health insurance. My primary care doctor tried me on some antidepressants and referred me to a therapist. I saw her for a few sessions, but our schedules didn’t match up, so I switched to someone else who could see me in the evenings. Luckily, in our town, there are plenty of therapists who don’t keep bankers’ hours. Some are even available on Saturdays.

I’ve tried several different medications. I’ve tried them on their own, or with therapy. Most recently, I’ve tried therapy alone. Yes, I’m still working at it. It appears, at this point, I’ll need to get back on medication, because my anxiety is getting worse. It happens. They tell me that anxiety and depression often appear together, and that they can be caused by improper brain chemistry. To treat that, you need medication. Therapy helps with thought patterns, helping to break old habits and form more healthy ways of thinking about yourself and your problems. I am someone who needs both therapy and medication. This is just fine.

Which brings us to the present. That’s not the entire story, though. There’s another side of the desk.

My time on the other side of the desk.

Author’s note: the following is entirely based on my own experiences and observations. I consulted with no one while writing this, and all opinions are entirely my own.

My first job with the University of Illinois at Urbana-Champaign was at the bookstore. It was run by the University’s Student Union, and I didn’t really like it. But it was a job, and it came with health insurance and dental insurance and retirement and vacation time. Not bad, as jobs go. I worked there for about a year and a half before transferring to the student health center.

MHC_01At McKinley Health Center, I was employed as a clerk in the Medical Records department. This, in some ways, was worse than the bookstore, but it paid better and I liked most of my coworkers. I didn’t really get along with my supervisor, which didn’t help. I actively tried to transfer out of Medical Records, and after four years I finally got out.

My new job was as a front-desk clerk in McKinley’s Mental Health department. I was a bit nervous going in. I had no idea how my previous experience in the mental health system would translate. As it happened, it proved to be invaluable.

A few months in, I started a realize a couple things. The people I worked with were all pretty damn amazing. It’s not hard to have respect for people who go into the mental health profession; it isn’t an easy job. Their job was made even less easy by the fact that, in my opinion, there simply wasn’t enough of them, not for a student population of that size.

Students have other mental health options off-campus, including therapists in the community, some of whom accept the health insurance issued to students for at least a part of their fee. But on campus, it was either McKinley or the Counseling Center (another University-run group of counselors), and both are only open during regular hours on weekdays, when students have most of their classes. One student told me this was “neglectful” of the University. I think I agree with that.

MHC_02The lack of providers at McKinley meant that appointments were at a premium. First-time visits, during which the therapist or psychiatrist would assess the student and get them going with medication or regular therapy visits, were sometimes booked for up to two months. This may not sound like a long time, but to someone struggling with anxiety or depression, it can be an eternity. Forget about classes and studying; if you can’t even get out of bed, two months is too long. I’ve been there. It’s hell.

I ran into similar problems with scheduling appointments for myself. For a first-time appointment with Psychiatry at Carle, the area’s biggest hospital and clinic organization, I had to wait around three months. For therapists, things were a little better, and I didn’t have to wait as long. But I’m not a student. I have good insurance and can call around for appointments. Services at McKinley and the Counseling Center are available at no cost to students (they pay a health fee with their tuition; this is separate from the student health insurance, which apparently doesn’t cover very many off-campus therapists).

I should mention that McKinley, like many mental health offices, has protocols for patients who call or walk in and are in crisis, meaning they are on the verge of harming themselves or others. This “emergency triage” procedure works well enough, but not without problems, especially with such a small staff.

Why there’s not enough providers is a mystery to me (and again, it’s just my opinion). I know that McKinley has placed numerous ads for a psychologist in the local paper, but they still only have one on staff. Why has that job search, which is handled by a committee, repeatedly failed? I personally believe that part of the problem may be the administration at McKinley.

There’s evidence to suggest that medical doctors (most of McKinley’s administration are MDs, RNs, and such) are not immune to the stigma behind mental health treatment, as explained in this article written by Jean E. Wallace, Department of Sociology, The University of Calgary (I’ve linked to just the abstract here, I’m afraid). And here’s another by John M. Grohol, Psy.D, published on psychcentral.com about why doctors avoid mental health treatment for themselves. The article is based on a survey of UK doctors, but I think it has merit for US doctors as well, especially the part about stigma. He says:

“I guess doctors don’t realize they are only perpetuating the cycle of stigma, by avoiding such treatment themselves. And whether they admit it or not, such thinking can’t help but influence the way they portray behavioral health treatments to their patients.”

Is that McKinley’s problem? It’s just one theory. And I’ll admit, I’m pretty bitter. That same administration did a nasty thing to me recently, and their actions seem to dovetail nicely with my theory. See, I’d missed some work due to insomnia. For months, I didn’t sleep. It was awful. I couldn’t function properly, at work or at home. At one point, I had no less than four healthcare providers working with me on this: a therapist, a psychiatrist, my primary care doctor, and a bona fide sleep specialist. Nothing was working. I got FMLA protection, so I at least wouldn’t lose my job.

I lost it anyway. The administration figured out a way to move me out of Mental Health and back down to Medical Records, citing “operational necessity” and neatly skirting the rules and laws behind FMLA and our workers’ union. Moving me down to Medical Records, a position I fought like mad to get out of, was punishment for missing work, pure and simple.

Yes, this was, I believe, a group of healthcare professionals punishing me for a mental health-related illness. My insomnia was indeed deemed a mental health issue, and they knew that, because I told them. I told them the whole story. They put me through what they called a “pre-disciplinary hearing,” during which I explained that I was getting treatment, and that my attendance would improve. I felt like I had no choice but to voluntarily disclose private health information, which I did in order to avoid losing my job.  In the end, it didn’t help, and I’d shared my personal problems with my bosses for nothing.

The sad thing is that I really thought I was good at my job. My previous experience with anxiety and depression gave me an instinct that I used to help students get to where they needed to be. I really thought I was helping. There were even times I went above and beyond (as we all did, providers and support staff alike) to help students.

Here’s a fun example. Last winter, a pipe that fed our sprinklers burst, effectively destroying the mental health unit. We were moved down to another part of the clinic so our providers could keep seeing patients. Everyone scrambled to get things up and running. Our IT people had said they’d taken care of transferring the mental health phones down to our temporary space, but the phones weren’t working. The lines couldn’t be forwarded to our new location for some reason. No one was particularly concerned about this (among administration and IT, I mean). So I took care of it myself. I forwarded the mental health phones to my personal cell phone. I just couldn’t stomach the thought of someone calling and getting nothing but endless ringing. What if they were in crisis? What if they’d just spent the entire night working up the courage to finally call us and get some help, and all they got was ringing? It was important to me that they were able to get through to someone. No one except my immediate supervisor knew that I did this, and I doubt she told anyone.

But now everyone knows. I was good at my job, and they got rid of me anyway. And they had to have known that there was no way I’d just happily accept the involuntary transfer and move on.

So now I don’t work at McKinley. I would much rather be unemployed than work another day in Medical Records, so I quit. It may sound foolish, but I still have health insurance, the bills are still getting paid, and I spend my days writing, which is what I’ve always wanted to do. So I’m fine. Getting forced out turned out to be a gift, however unintentionally given, but it still stinks that it happened. Especially if I’m right about the administration and the reasons behind their indifference towards my mental health issues and the frankly disgusting way they treated me (and their attitude toward the mental health practice at McKinley in general). The director of McKinley, to whom I personally pleaded to put me back in the Mental Health department, is a respected practicing physician. The other administrators involved are nurses. These are the people in charge, and if they truly view mental health treatment as I think they might, that’s pretty scary.

But there’s still hope for a positive outcome. The picture I’ve painted, based on my short time on the provider’s side of the desk, is hopefully not a typical scenario. It’s just something that people should be aware of. A person’s journey towards good mental health may not be an easy one. It may not be particularly expedient. But it’s worth it. If you need help, don’t give up.

It would certainly help matters greatly if the general population were better informed about mental illness, as this might start to erode some of that stigma that exists against mental health treatment.

As I write this, the death of actor Robin Williams is still fresh in my mind. He committed suicide, leading some people to call him a “coward,” and others to wonder how in the world he could’ve been so depressed, being so successful and rich and famous. One of my friends commented on Twitter that suicide is “selfish,” and that people always have other people in their lives they can turn to for help. I do agree with that. Suicide, by definition, is pretty damn selfish. And yes, help is out there for just about everyone, in the form of family or friends or even anonymous suicide prevention hotline operators. All would certainly be willing to help, and the people left behind when someone takes their own life are left wondering, sometimes frustratingly, why they never asked for help. They had to have known it was available, right?

But depression doesn’t work that way. Depression isn’t rational. Depression tells you that you are alone, that no one cares, that no one will miss you when you’re gone, and that suicide is the only way out of the pain you feel. I don’t think any less of my friend for making that statement; it’s sadly part of a commonly-held sentiment. Most people think depression is something you just “get over.” It isn’t. And peoples’ ignorance on the subject is anything but harmless. It only feeds that stigma. It’s an awful cycle.

As for me, my journey continues. I am not free from mental illness. I am not healed. I am much better than I was, but it will take time. And that’s okay.

Here’s a few things that, if you’re in need of help, and you’re going to make that phone call, you should keep in mind:

  • Be as open as possible, right from the start, even with the people who answer the phones. It’s likely everyone at the office is sworn to secrecy under HIPAA.
  • Never lie to your therapist or psychiatrist.
  • Things might suck at first, but stick with it. It gets better, so keep your appointments.
  • If you ever have thoughts of harming yourself or others, call someone. Your provider will likely have given you a phone number to use in an emergency. There’s also a few at the bottom of this post.

And while it’s important to tell those in need that help is available and that things will get better, I think it’s also important to tell the rest of the world the key facts about mental illness:

  • There’s a reason it’s called an illness.
  • Mental illness is a serious problem that requires treatment.
  • There’s nothing wrong with seeking treatment, and needing treatment is not a sign of weakness.

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