Depression takes practice. Now, some of you may hear that and say: “Jessica, that’s preposterous. Do you know my boss? Have you met my ex? Don’t you know that mental illness runs in my family? I don’t have to try to be depressed. It just happens.”
What I’m saying is that living well with depression takes practice. Being productive every day, despite depression, takes practice. Being a student or an employee with depression takes practice.
I’ve had experience with depression both personally and professionally, but before I go there, I want to share with you a few numbers that illustrate how depression impacts all of us, as a society.
According to the World Health Organization by the year 2020, depression will be the second-greatest disability in the world, second only to blindness. The National Institute of Mental Health tells us that depression is the number one disability among Americans ages 15-24, preventing millions of people from being able to finish school or hold down a job. Psychology today calls it ‘presenteeism’, the phenomenon by which companies lose billions of dollars every year in lost productivity to depressed employees who come to work but don’t actually work. All of this means that depression can be as debilitating as a physical obstacle.
For instance, carrying a cane. But, with a visible disability, we assume it will take practice to cope, including things like physical therapy. Yet when it comes to depression, we think that a label and medication are enough to cope. Now, I’ve worked in mental health non-profit for years. And while I’m thankful for the great strides we’ve made with anti-stigma campaigns, it’s time to go beyond getting a diagnosis, into giving people actual coping mechanisms.
Because without coping mechanisms, we’re trapped in a downward spiral. Being depressed leads to falling behind, falling behind leads to more depression. So let me tell you why I care so deeply about this cause. I had a happy childhood, I was the youngest of 15 grandchildren, and we were very close. And yet, in spite of faith, family, friends, I had these moments of darkness and the only way I could describe it would be to call them flashes of grey, in an otherwise cotton candy childhood.
I remember my first episode, I was 8 years old, and we were going to school, and all of a sudden I thought, gosh, all this feels meaningless. Like, I don’t know, I just feel like I’m going to live seventy years, and die, and go to Heaven. So, I don’t know why we go to school, I don’t know why we go to work, I just feel — I just feel really empty. And thankfully those moments were very fast.
However, when I became a teenager, those moments of darkness, they stretched into hours, and hours became weeks, and sometimes hours and weeks became months. And during these depressive episodes, I would have crying spells, I found it difficult to concentrate on anything, sometimes I did have suicidal thoughts.
But just as bizarrely as these depressive episodes came, they left. And they were replaced with episodes of genuine stability and happiness, and sometimes highs where it would take me 5 to 6 hours to fall asleep, and I would have extreme outbursts of artistic creativity, where I could finish a painting that takes 4 weeks to make in 4 hours. And so, the roller-coaster of mood swings continued until I had an epiphany when I was 18 years old.
I was a freshman in college and a friend with bipolar disorder committed suicide. This prompted me to research the illness. And everything started to click – I realized I had half the symptoms of bipolar disorder; it explained the inexplicable episodes of depression, the highs due to what we now know as hypomania, where I couldn’t sleep and I had racing thoughts.
So I saw the campus psychiatrist, who diagnosed me with bipolar II, and I got a second opinion, which confirmed the diagnosis. Now, with therapy and medication, things were much better. But something was missing. What nobody taught me was how to get stuff done when I was depressed.
So, on my own I developed creative strategies. I graduated from Northwestern University cum laude with two majors, I competed for Northwestern speech team, I was a state champion, a national quarter-finalist, a national semifinalist. I also co-founded an organization to help depressed students on campus. But bipolar disorder was not my only foe.
When I was 19, I was diagnosed with a very painful polycystic ovarian syndrome. And then when I was 24 years old, an autoimmune neuromuscular hurricane by the name Myasthenia Gravis invaded my life. I’ll never forget my first episode. I was climbing up this long flight of stairs at work, this beautiful sunny day, when all of a sudden I couldn’t feel anything below my waist. And so I kept falling, and falling, and I could hear my high heels tumbling down the stairs. At first I thought, you know, where are my quadriceps? I know I brought them with me when I left the house this morning.
But then, my thoughts turned somber as students stepped over my limp body, in a rush to get to class. And my mind was screaming ‘Get up!’ But my body couldn’t move. And I couldn’t speak. A few weeks after that, I was diagnosed and hospitalized in critical condition with Myasthenia Gravis. The doctor gave me a 50/50 shot of living. And that was 7 years ago.
So today, I carry a cane for the Myasthenia Gravis. People often ask me: ‘Hey, what’s it like to live with 5 diseases?’ And I tell them the truth, I say: ‘Well, I see myself as Rocky and my 5 diseases as Rocky’s different opponents’.
So, bipolar disorder is Apollo Creed, the polycystic ovarian syndrome is definitely Ivan Drago, Myasthenia Gravis is Mason Dixon, asthma is Clubber Lang, and psoriasis is Tommy Gunn. The odds of getting the first 3 of these 5 diseases are 1 in 50 million.
And after that I stopped counting because I just didn’t think there was a point. So, every day I wake up in pain and what I do when I wake up is I play ‘Eye of the Tiger’, and I put on my Rocky boxing gloves, and I pray to God for strength to get through another day. Today, I’m a health activist, a writer, and a speaker, I have my own award-winning blog, ‘Fashionably ill’, which is about surviving pain with style and humor, and I’m a contributor to several other websites, including The Huffington Post, MSNBC did a documentary on my life, Psych Central named me a mental health hero.
And right now, I’m really excited about a project I’m working on; I’m consulting on a project with Rutgers University and University of Massachusetts medical school. We’re developing a program that will help young adults with severe mental illness finish school and find meaningful employment. And that’s the thing I want to talk about today, it’s how to get stuff done when you’re depressed.
The three themes we’re going to address are proactiveness, urgency and difficulty. So, proactiveness. What does it mean to be proactive? Do you have a plan for the next time you get depressed? So, let me give you an analogy: Over the years, my Myasthenia Gravis has gotten better with medication, physical therapy, nutritional supplements, practice. But there are still times when, all of a sudden, I can’t feel my legs, or I’ll lose feeling in one half of my body, either the left or the right side. The other day, I was talking to one of my students, I coach high school debate, and I could sense that I was losing feeling in my legs.
So immediately, I sprang into action. I clutched my cane harder because I knew what was coming. In the same way, when I sense that I’m getting depressed, I spring into action. I call my therapist right away, schedule an appointment, I start exercising more than usual. Because exercise releases endorphins, the feel-good hormones, that help us fight stress and depression.
But, in order to make a plan, you need to know two things: Your symptoms of depression and the strategies that work for you. When we usually talk about the symptoms of depression, it’s a generic list. You’ve probably seen it in a pamphlet or read it somewhere on the Internet. But the truth is, no two people are exactly alike.
So what are your symptoms of depression? Some people, when they’re depressed, they lose their appetite. Other people tend to overeat when they’re depressed. Some people have insomnia. For others, they sleep too much. Some people have outbursts of anger; and still, many people with depression have no temper at all. Know yourself.
In addition to knowing your symptoms, you need to identify now what strategies work for you. So, what do you need when you get depressed? Is it faith, is it family, is it friends, is it exercise, is it reading, is it listening to music? Identify these strategies now so that when you see your symptoms, you can spring into action.
The other day, my niece gave me a pleasant surprise visit, and I was really happy to see her. When she hugged me, she said: ‘Tita Jessica, did you know you have toothpaste in your hair?’ And so I’ve learned that toothpaste in hair equals depression. For me, anyway. Know yourself, plan now, don’t wait, be proactive. The best defense is a good offence. In addition to being proactive, we need to understand the concept of urgency.
Urgency is about drowning out wild noise and focusing on what’s the most important. So, let me give you an example of what not to do. In college I had this class called ‘The sociology of crime’. And once in a while, the professor would show us clips from classic mafia movies, like ‘The Godfather’ and ‘Goodfellas’. And so I had this brilliant plan for the midterm. I mean, I thought it was a great plan. And I was going to finish reading the whole textbook, I was going to review all the lecture notes, and I was going to watch all of those mafia movies.
So, the test was on a Tuesday. I reserved Sunday for watching all those mafia movies: ‘Godfather’, ‘Goodfellas’, ‘Casino’ And Sunday came and went, watched all those movies, I reserved Monday for reading the textbook. Monday came, and I woke up depressed. And then I stayed depressed.
So, Tuesday morning came, and I hadn’t read a thing. I went into the exam, and for every question on the test, I kid you not, my answers were: ‘Well, in Goodfellas, Henry Hill, played by Ray Liotta, he did this,’ or, ‘Lorraine Bracco did that,’ or, ‘According to Vito Corleone’ Wouldn’t it be great if my professor rewarded me for temerity of my answers? He didn’t.
He said while it was great that I had mastered mafia cinema, he would appreciate it if I read the textbook next time. So, obviously, if I had to do it all over again, studying the textbook was a 100, no, maybe a million times more important than watching ‘The Godfather’. Urgency is about being able to understand what is most important and what is most pressing. So, I keep a daily to-do list. If something’s due today, it gets 4 stars, if it’s due tomorrow, 3 stars, sometime this week, 2 stars, next week, 1 star.
And when I’m depressed, I ignore anything that has less than 3 stars. Urgency is also about being able to say no to non-essential tasks. So, meeting your work deadline is essential. The church bake sale is non-essential. When we say yes to everything, we amplify our stress.
One of my friends’ mom, a pastor, says: ‘If you can’t say no, then your yeses mean nothing.’
Third and finally, getting stuff done when you’re depressed is about understanding difficulty. So, when I’m depressed, I label all tasks as a 1, 2 or a 3. If it’s an easy task, it’s a 1. Examples include eating breakfast or taking a shower.
If it’s a moderately difficult task, it’s a 2, and a 3 is reserved for difficult tasks. For example, finishing a paper in college or scheduling an appointment with your child’s teacher, or meeting a difficult work deadline. And when I’m depressed, I focus on finishing all the 1 level tasks first. And every time I cross something off my list, even if it’s taking a shower, I feel empowered and I think: ‘Bipolar, watch out, I’m coming, I got this!’ And as I finish off all the 1 and 2 level tasks, I build the confidence to tackle the 3 level tasks. And you can also help yourself by turning a 3 level task into a 1 level task.
So, I remember a time when I was in my therapist’s office and I told her: You know, I want to exercise because experience has told me that when I exercise, I feel better about my bipolar disorder. But I’m just too depressed to do 30 mins of exercise right now. And she said to me: If you don’t have 30 minutes, can you just give me 10 minutes? That was life-changing advice. So now I aim for 10 minutes. And 10 becomes 20. And 20 minutes becomes 30 minutes.
Today we’ve talked about 3 themes in getting stuff done when you’re depressed. They’re proactiveness, urgency and difficulty. Almost always when I use these strategies, they work. But there are days when the bipolar disorder or the ovarian disease, or the Myasthenia Gravis, or all of the above win. And when that happens, I remind myself of something that I want to share with all of you. I want to share this with anyone listening, who fights depression, or who loves someone that does.
Yes, depression is real. But hope is real. Courage is real. Resilience is real.