The Column of Disquiet – What We Talk About When We Don’t Talk About Mental Health

Celebrities—they’re just like us! Despite their seemingly charmed existence, they too may be, often silently, grappling with mental illness; and, occasionally, may take their own life.

Two well-known individuals died by suicide1 recently—fashion designer Kate Spade2 on June 5th, and on June 8th, celebrity chef Anthony Bourdain.3 In the wake of both deaths, outside of the sentiments and outpouring of memorials on social media, and thinkpieces circulating the internet, there have been a lot of people who have shared the telephone number for the Suicide Prevention Hotline in a tweet or a Facebook status update, or, have said something to the effect of how they are ‘here’ for anyone who is struggling.

Spade and Bourdain

And while these individuals certainly meant well, the truth is that sharing a 1-800 number isn’t going to suddenly solve the world’s mental health problems, let alone the problems of the, like, one person who sees it in their social media feed. Stating that you are ‘here’ to listen to someone having a difficult time isn’t magically going to take away the stigma that some who are living with debilitating depression or anxiety, or worse, feel every day.

Both of those actions4 are about as helpful as thoughts and prayers.

Anytime something like this happens—a well-known individual dies by suicide, or there’s some kind of awful tragedy involving somebody who wasn’t, for whatever reason, getting the help they needed, the outcry is that we, as a society, need to ‘talk about mental health.’

But tragedies continue to happen, and people—both famous people from seemingly charmed existences and boring, regular-ass people like you and me—continue to struggle in silence, and sometimes, make the choice that you cannot take back.

I’m left wondering when this ‘talk’ about mental health is going to begin—where is it going to be held? And who is going to be at the table?

An emergency room doctor asked a friend of mine, who had a pretty serious mental health crisis a little over a year ago, if he had just tried thinking ‘happy thoughts’ instead. That is, quite literally, the worst question you can ask to anybody, let alone someone who is in such a state and is simply trying to get help.

So, what I’m saying is let’s not invite that doctor to this discussion.

I’ve been waiting for this ‘talk’ to arrive for so long now, and I’m wondering how this discussion is even supposed to begin; so, fuck it. I’ll start—

For roughly the last five years, outside of the regular, usually once a month appointments I have with a therapist—something I’ve been doing for over a decade5 now—I had been working with a psychiatrist for medication management.

The psychiatric health clinic I had been referred to was in a suburb of Minneapolis—like a half hour or so away, but I didn’t really mind the drive. It went by quickly, and when I was still employed at the newspaper, the appointments meant I got to delay going in to the newsroom6; after quitting the paper, it just meant I tried to schedule the appointments for my day off, and could do errands in suburbia after it was over if I was feeling up to it.

The clinic in question—there are a number them, with locations across the Twin Cities area. They aren’t like a franchise, or a chain—but it’s close (a ‘brand’ maybe?) and the whole thing reminded me a little bit of an assembly line. I’d check in, fill out a short form about how I was feeling (I’m not quite sure if anyone ever actually looked at these), wait my turn, and then I’d go in to my appointment—usually lasting around 15 minutes or so, before I was sent on my way.

For the first year, I worked with a woman with blonde hair—I don’t remember her name. I would sit in a chair across from her desk, and I’d talk; I’d talk about my anxiety, and my depression. I’d talk about the ‘sad days’ that I would have. She would listen, or at least feign that she was, all while typing away, her nimble fingers clicking and clacking across the keyboard of her computer.

We’d try different prescription antidepressants—sometimes she’d give me a white paper sack full of samples before saddling me with an actual prescription that needed filling. And I would try. I’d give them time, but maybe not enough? I’d try to live with the side effects7. Eventually, I would lose my patience or I wouldn’t see any difference, and during my next appointment, we’d start all over with something else.

Eventually, this woman I worked with left, and I was placed with another woman with blonde hair—Samantha. One of the two, I don’t recall who, put me on Pristiq. Early on, it was a ‘designer’ prescription antidepressant—relatively new, unavailable as a generic drug8, and expensive as shit.

That was a number of years ago—probably four, maybe less; truthfully it all kind of runs together in one blur of medication names. I’ve managed to ride it out on Pristiq for a while, hoping that it’s doing something—that it’s helping me in some way. Every evening, when I pop the brownish, reddish square into my mouth, I tell myself that it must be doing something, and that life would be much, much worse without this.

Over time, the check-ins about medication management became less frequent, and the prescription refills were set up to last for three months at a time. Somewhere, in between my last appointment with Samantha—in July of 2017, and a few months after that, I received a letter in the mail stating that she had relocated to another suburb of the Twin Cities, but was still practicing with this ‘brand’ of clinics. The letter implied I was supposed to keep my appointments with her, but did not expect me to drive to wherever she was based out of now.

Instead, I was to still drive the half hour out of town, to her old office, and I would contact her, using what amounts to a video phone, at her new office—the concept of which was not very appealing. The idea of sitting in a room—probably a broom closet, or something very close to one, and using a video phone, or some kind of similar contraption, seemed incredibly cold and uninviting—like some dystopian, Blade Runner-level shit.

But the idea of continuing to commute the half hour, and starting all over again with another psychiatrist, just to check in so I could have my prescription refill approved, did not seem very appealing either.

In Northfield, there are two ‘health networks,’ or clinics, or whatever you want to call them. One of them offers psychiatric care; the other—the one where my primary care physician is—does not. And I learned, after a lengthy phone conversation, that it would be a nearly Herculean task of getting an appointment with someone in psychiatric care at this other clinic. It, unfortunately, is not as easy as scheduling something and then adding it to your Google Calendar; this clinic requires a referral—from either someone working with you who is within9 their ‘health network,’ or if I was unable to secure that, it meant scheduling an appointment with a general practitioner from their clinic, who I would then need to speak with about a referral.

It meant making a doctor’s appointment to get another appointment.

At that point, it seemed easier to concoct and pull off some kind of elaborate heist than it is to get mental health services there, and just imagine if I had been someone on the verge of an actual crisis—not just somebody who is, like, a mostly functioning adult and only really needed a prescription refill every couple of months?

There are people who need help and aren’t getting it; and then there’s a situation like this—I am trying to continue with the help I’ve already been getting, and I’m not so much turned away at the door, but it’s like I’m pounding on the door, and I can see people on the other side, but no one is coming to answer it. And I don’t see why I, or anyone else, should have to jump through so many hoops in order to receive this kind of care.

In the end, I made an appointment with my regular, ‘primary care’ doctor10, and when I told him what I needed, he didn’t even bat an eyelash—the prescription refill was already sent over to the pharmacy before the appointment was finished.

* * *

There are a few different ways I could describe living with depression.

If I want laughs, I could say that it’s like living with a really shitty roommate—they are always around, but don’t contribute anything to the household. My depression doesn’t pay rent, buy groceries, make dinner, do the dishes, fold the laundry, et. al. But it’s always there—using all the bandwidth, eating all of my cookies, and forgetting to put a coaster down.

The truth is that, for me, I liken living with depression to two things—drowning, and being strangled.

I say this only because these are both terrible events, but they are both situations where the act of which takes time—your mind has time to take stock of what is happening; maybe you can try to see a way out, or maybe you just succumb to the growing panic. They are also both situations where, because they take time, there are moments when the grip may not be as tight, or you may not feel yourself being pulled under.

There are, then, of course the moments when the constricting around your throat grows tighter and tighter, or, you begin wildly flailing around again, trying to keep your head above water.

The most harrowing and accurate depiction of depression I’ve ever come across is from Darkness Visible, by William Styron11—a slim memoir that, in somewhat graphic detail, documents his unexpected and rapid descent into a debilitating depression—

In depression this faith in deliverance, in ultimate restoration, is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come—not in a day, an hour, a month, or a minute. If there is mild relief, one knows that it is only temporary; more pain will follow. It is hopelessness even more than pain that crushes the soul. So the decision-making of daily life involves not, as in normal affairs, shifting from one annoying situation to another less annoying—or from discomfort to relative comfort, or from boredom to activity—but moving from pain to pain. One does not abandon, even briefly, one’s bed of nails, but is attached to it wherever one goes. And this results in a striking experience—one which I have called, borrowing military terminology, the situation of the walking wounded. For in virtually any other serious sickness, a patient who felt similar devastation would by lying flat in bed, possibly sedated and hooked up to the tubes and wires of life-support systems, but at the very least in a posture of repose and in an isolated setting. His invalidism would be necessary, unquestioned and honorably attained. However, the sufferer from depression has no such option and therefore finds himself, like a walking casualty of war, thrust into the most intolerable social and family situations. There he must, despite the anguish devouring his brain, present a face approximating the one that is associated with ordinary events and companionship. He must try to utter small talk, and be responsive to questions, and knowingly nod and frown and, God help him, even smile. But it is a fierce trial attempting to speak a few simple words.

This may seem exaggerated, or like hyperbole, but I assure you that it isn’t, because I’ve been there. There are times when I am still there. Sometimes the very idea of have to respond to a question asked of me is almost too much—there are times when it takes all the energy I can possibly muster to have a short, banal conversation.

* * *

20 years ago, my paternal grandfather, James, died by suicide. He was 67.

James

From what I can recall, there were whispers about this that I heard as a teenager, though at that time, I didn’t give it a lot of thought. I don’t even have very many memories of him, or my paternal grandmother—maybe just one or two out of context fragments, when I was young, at a get together an uncle’s house near McHenry, Illinois, where both of my parents grew up.

Around four years ago, my father contacted me through email and told me his oldest sister was putting together a family history and asked if I was interested in receiving any of the information. I think to everybody’s surprise, including my own, I said sure, why not.

What I ended up getting was entirely more than I anticipated.

Thick manila envelopes began showing up in our mailbox, and at this point, near the end of 2014 and beginning of 2015, one of our rabbits, Sophie, was starting to have some serious health issues, and I was struggling with the stress I was under writing for the newspaper. Sophie passed away in February, and when this sister of my father’s—my aunt, I suppose—contacted me to ask if I looked through the information she was sending, I explained that there had been a death in the family, I was having a hard time with it, and now was not a good time for me to go over the information she had provided.

For a while, envelopes continued to arrive; then they eventually stopped. Truthfully, I don’t think I was ever really that interested in sitting down and pouring through all of the information she was providing to me; maybe I was just being too nice and that’s why I agreed to it in the first place. After enough emails back and forth about how I still hadn’t had a chance to go through the envelopes she sent, she got the hint.

Recently, I was cleaning out the drawer where I had stashed all of the envelopes she sent. I opened them, briefly looking at the documents and photograph reprints included in each. One of them included an individual report on my paternal grandfather—‘Cause of Death: Suicide’ it states at the top before listing other information, like the names of his children and wife

The document, a product of my aunt’s faulty home printer, is marred by streaks where there are no letters in certain places, as well as her clunky, frustrating use of language. In the notes on my grandfather, James, it states he was a carpenter by trade, and that he loved stock car racing—building two cars during the 1970s.

Other races weren’t so fond of James,” my aunt writes. “And three of them rammed James into a cement wall, destroying the car and trapping James inside. (unintelligible due to the ink streaking) helped get him out of the burning car. In his later years, injuries from being in the carpentry trade and other jobs he had took a terrible toll on his body. He was in constant pain to the point where no medical treatment helped anymore.

Depression set in, and sadly, he took his own life.”

* * *

I’m not sure how long I’ve been using the expression ‘sad day,’ but it almost immediately cemented itself into my lexicon.

Today was a sad day,” I will say to my wife, when she asks how I’m doing; “I’ve been having a lot of sad days,” I will explain to my therapist as she balances my enormous case file on her lap. It means that there is nothing in particular that the day sad—nothing extraordinarily bad or traumatic happened to me. I am just plagued by a sadness that is almost impossible to shake.

It’s just always there—like a conversation you can’t seem to find a way to politely end. It’s what’s muted any kind of enthusiasm or energy I may have once had; it’s what keeps my affect incredibly low.

Of course there are moments when you can get around it—you feel good about something, or you find yourself laughing and possibly having what could resemble ‘a good time.’

But there is a voice—the voice that tells you not to get too far ahead of yourself. You feel the grip begin tightening again; you feel yourself slowly getting pulled under.

There are times when the physical manifestation of a ‘sad day’ actually takes my breath away, and there is a constriction somewhere deep within my chest that causes me to stop what I’m doing and take a moment.

When you’ve been living, or at least trying to live, through depression and anxiety for as long as I have, and when it’s done enough damage to relationships the way it has for me, you become incredibly self-aware—I’m aware enough of it now to understand what is happening, and sometimes why it’s happening, but I am unable to intervene.

And when you become this self-aware, you are able to recognize it in others, even if they haven’t recognized it in themselves.

It’s become common place that when greeting someone, instead of simply saying ‘hi’ or ‘hello,’ you also include, ‘how’s it going?’ or ‘how are you doing?’ People do this as a means of, not stimulating an actual conversation, but of just meaningless small talk—something to fill the void and silence of our existence.

More often than not, the person who has asked you ‘how’s it going?’ doesn’t want to know the real answer to the question. They want you say, ‘It’s fine. How are you?,’ or ‘Great. Things are great.’

Rarely am I great, and ‘fine’ has become a bit of a loaded response—it could actually mean you are fine, or, in the right context and with the right person, they could understand that, coming from you, things are, in fact, not fine at all.

I find myself responding by simply saying, ‘okay,’ when these pleasantries are asked of me. How’s it going? It’s going okay. How am I doing? I am doing okay. Those are both lies, but the person at the coffee shop, filling my travel mug, who has just asked me ‘how my day is going’ is not expecting me to bark back with, ‘Fucking terribly. The fuck do you care?’

The co-worker passing me in the hallway who has asked me how I’m doing does not want me to answer with, ‘On the verge of tears yet unable to cry—how are you doing?

They want fine. They want okay.

Things are fine. Things are okay.

But nobody is fine. And nobody is okay.

Everybody is struggling, but outside of the closed door of a therapist’s office, nobody wants to talk about the seemingly endless struggle, and this is why there is still, after all this time, a stigma, or embarrassment, or fear, of mental illness or asking for help.

In my aunt’s awkward notes about my grandfather’s life, she writes that after he was in too much physical pain, ‘depression set in, and sadly, he took his own life.’ I look at photos of him she sent along with this information—an undated, black and white photo, presumed to be from the 1940s. In it, he has a full head of coiffed hair, a pencil thin moustache above his lips, and an intense stare aimed right at the camera; a color photo, from 1976—the same intense eyes, the hair almost all gone now, though, a precisely trimmed chin strap beard making his jawbone pronounced, and his smile almost a sneer.

She said that depression set in, but I look at these and wonder if it was there all along.

In knowing about my grandfather’s suicide, I won’t go so far as to say that it ‘haunts’ me now, but it certainly casts additional darkness on an already long, black shadow that trails me.

* * *

It takes a lot for me to actually follow through and read a news article I see shared on social media—sometimes I try, but I’m stopped by a pay wall, but most of the time, I just don’t care enough to click the link.

The other day, while eating lunch, a Twitter acquaintance of mine shared a MinnPost link that truncated a Star Tribune story regarding Blue Cross Blue Shield’s decision to cut mental health reimbursement rates for mental health clinics—the story, written by Glenn Howatt, said the move “has left thousands of mental health clinics scrambling to pay salaries and overhead costs with lower revenue.”

Howatt continued by saying the impact of this is felt by smaller clinics without the market power to negotiate payment rates and other contract terms. “Some are concerned that the clinics will shut their doors or stop taking insurance all together,” he writes. “Making it harder or more costly for those needing help for trauma, depression, anxiety, substance abuse, and other issues.”

Blue Cross, as an organization, stated this move was to control what it said were ‘unusually high claims trends.’

Tell me again when we’re going to have that talk about mental health.

 

 

1– When I still wrote for the paper, I learned that this phrase, ‘died by suicide,’ which sounds pretty heartless, is what the Associated Press demands you use.

2– I knew very little about Kate Spade, aside from the fact that she made very expensive purses and handbags. In my very limited research while writing this, it turns out she is David Spade’s sister-in-law. 

3– The outpouring of grief over Anthony Bourdain’s death makes me feel kind of like a prick for having such a low opinion of him; not that I was ever, like, ‘I wish he were dead.’ But he’s said some pretty inflammatory things about vegans and vegetarians in the past, and despite how beloved he apparently was, these things never sat very well with me.

4– Both of these are outstanding examples of ‘hashtag activism,’ because it’s easier to say something on the internet that makes it look like you care, than actually caring.

5– You’d think I’d be fixed after 11 years; maybe I’m doing it wrong.

6– I remember a very specific occasion where I had an appointment in the morning, and a co-worker—he was also out of the newsroom, at a meeting elsewhere in the city—texted me to ask me if I had heard on the police scanner what all the sirens he was hearing were about. I gently reminded him I was in a different zip code, at a ‘doctor’s appointment’ as I often called them.

7– They’re almost always sexual side effects, which is super neat; as if you aren’t sad enough as it is, here, take a pill that either makes it so you can’t get a boner, or you can’t ‘finish.’

8– It is since, thankfully, available in a generic and much more affordable form.

9– It seems worth mentioning, though confusing to explain, that I actually do see a doctor (a specialist) that works out of this clinic, though as, more or less, a contractor, and only two days a week. Though I was unable to speak with him directly, a nurse in his office was 100% certain he would not give me a referral.

10– So, like, the whole reason I had started seeing a legit psychiatrist for medication management was because I wanted to work with someone who, I thought, would take the time to listen to me before throwing prescription after prescription at me. I guess I was expecting, or anticipating, a different experience with my assembly line, ‘branded’ psychiatric care.

11– Please read this book.

Kevin Krein has been operating the award winning music blog Anhedonic Headphones, since 2013, and he contributed the back page column to the Southern Minn Scene magazine for roughly three years. He occasionally contributes to Bearded Gentlemen Music, and his writing has appeared in River Valley Woman and The Wagazine. He tweets about his ‘sad days’ regularly: @KevEFly.

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