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Got depressed for a week or so just recently. Doing better now. No reason motivating the episode, just came out of nowhere— like the last time, a couple months back. Having lived with depression my whole life, there’s usually a reason; I mean, not an actual reason necessarily, but my mind will always find something to fixate on and call the reason. So the fact that it hasn’t these last couple times is strange in the extreme. As is the fact that the episodes have ended just as abruptly as they began. The first time around I was thinking the differences may be because of transitioning; depression is biochemical and changes as we age, so of course things’ll be different after upending your hormones.

But now I’m almost 100% certain it’s “because of transitioning” for a different reason. A while back I switched to a form of estradiol where you get a pellet implanted every few months (as opposed to taking pills twice a day or patches/injections every few days). You’ll notice this “couplefew months” bit sounds familiar… How long the pellets last varies per person, with a prior expectation of three months. The first time around I went that three months; and was depressed for a bit over a month at the end (which is absurdly short for my depressive spells). The second time around, this time around, I went 10 weeks; and was depressed for “two” weeks. I put the two in scarequotes because a week into it L suggested it may be hormonal, so I started taking some of my leftover pills. And began feeling profoundly better after a day or two. Got the new pellet today and can already feel its effect above and beyond the irregularities of pills. Next time I’m aiming for 8 weeks.

So, yeah. I’ve known T / lack of E is a major component of my depression. When I first started HRT I almost immediately started feeling happier than I’d ever been. I often joke how HRT is the best antidepressant I’ve ever tried. (Which is a lot funnier when talking to my psychiatrist, who knows how many I’ve tried and saw how quickly & effectively HRT worked.) But yeah, apparently it’s far more integral than I ever realized. The effects are just so immediate and drastic. They set in long before the hotflashes, headaches, and other symptoms of hormonal imbalance.

So for any other ladies out there on pellets —whether trans or on HRT for other reasons (and I’m sure this applies to men too)— if your depression returns in the vicinity of when you’re due for a new pellet, do be sure to consider that as a possible cause and adjust your schedule as appropriate.

winterkoninkje: shadowcrane (clean) (Default)

It's a new year, and the new semester starts next week. To be honest, the last semester ended on a down note: the week of Thanksgiving, depression hit again. It'd been about five years since the last major episode, so better than usual if by just a bit. The last week or so thing's've started looking up again, but who knows how long that'll last or how long till it really clears up.

A bunch of friends, fellow academics with mental illness, have given newyears posts on how they're dealing with their MI; posts I've found somehow more uplifting than I would've expected. And so, thus inspired, I'm hoping to return to blogging regularly. The plan is to post regularly on tuesdays and (prolly irregularly) thursdays. (Edit 2016.01.13) Let's make that regularly on thursdays and irregularly on tuesdays.

So, with that said, I'll see y'all again on tuesday.

winterkoninkje: shadowcrane (clean) (Default)

I talk about a number of sensitive topics: depression, cPTSD, child abuse, sexism. Every one of these are topics where you risk damaging or ruining your career simply by bringing them up. And, believe it or not, I'm actually a rather private person; I do not discuss my personal life as part of casual chit-chat, I do not "accidentally" share personal details, and even mundane goings-on I prefer not to mention except among friends. So why, then, do I speak about these topics? Why make myself uncomfortable and risk devastating financial repercussions? The reasons I speak haven't changed much over the years (though the way I think about those reasons has). And yet, I don't think I've ever given a clear explication of these reasons and what I hope to achieve by my words. It's time to correct that.

I speak as a form of active political resistance against the silence culture that pervades the US (and surely the rest of the world). I do not discuss my history as a form of confession, nor as a form of exhibitionism; I talk about my past in order to perform my politics. I've talked about silence culture before, and today I want to unpack that a bit more by distinguishing between two different forms that silence culture takes.

A Note on Terminology

Complex Post Traumatic Stress Disorder (cPTSD) is a variant of PTSD that arises from long-term exposure to trauma. Simple PTSD results from acute trauma —e.g., a single violent encounter, or short-term exposure to warfare—, whereas complex PTSD results from repeated exposure to trauma over an extended period —e.g., childhood abuse where the child lives with the abuser, or living in a war-torn region. The complexity of cPTSD stems both from the extended/repeated nature of the trauma, and from the pervasive/inescapable nature of the traumatic environment. Together these undermine any sense of self-worth, personal safety, or ability to trust others. (cf., cPTSD Light, Out of the Fog, EMDR-web)

In the past I've always talked about "PTSD", because "cPTSD" did not exist when I was diagnosed. However, I'm a text-book example for cPTSD— both symptomatically and etiologically. Consequently, henceforth I will refer to my experiences as cPTSD, both for clarity/specificity and to raise awareness of the distinction. As if it needed stating: I still stand with those who live with "simple" PTSD, and will continue to advocate for awareness of and sensitivity to their experiences.

Internal Silence Culture

The internal culture of silence is a specific form of psychological violence used to sustain abusive environments. This is the kind of culture that says, "what happens in the family, stays in the family." This apophthegm shows up in alcoholic families, in families with mental illness1, in sexually abusive families, in intimate partner violence, in sexist and racist work environments, in acquaintance rape, in fraternity gang rape, and countless other abusive social groups. In all these situations, enculturated victims teach the new generation of victims that the outside world is dangerous, that they cannot trust it because it will betray them ("unlike the family"), that talking about the physical, sexual, and psychological violence will delegitimize and harm the one who speaks out, that talking about this violence will "embarrass" the family or other social unit, and that the damage of this loss of face will be greater than the damage from the violence itself. Sometimes abusers also teach this message, either by presenting themselves as "the real victim" or by threatening increased violence should the victim go public. But the culture of silence cannot be maintained without the complicity of enculturated victims.

The discussions and disclosures in my youth had the goal of disrupting this internal silence. By speaking out about the specifics of my own trauma, disclosing who enacted which forms of violence, and how they were themselves victims of violence, I took control of my life away from my abusive family. By speaking openly, I ensure that others in similar situations know they are not alone, and know that they too can break their silence. By naming the demon, we can tame it. By disclosing generations of abuse we make ourselves open to the possibility of breaking that chain instead of repeating the cycle once more with our own children.

Most of these discussions of my personal history happened years ago. I don't know how much they can be traced back to me now, since the bulk of them happened in the mid- and late 1990s when anonymity and pseudonymity were de rigueur. But I don't care. The only thing I regret is my youthful naivete and whatever ways I hurt people along the way— including my previous inability to see my abusers as fully human, as simply reenacting the abuse they themselves were raised with2. Though I do not give the specific details anymore, I am fine with these details being part of the public record. I am not —and will not be— embarrassed by my history. The past is a mere collection of facts; it cannot compel my silence. By neutralizing my own embarrassment, I know that at least on a personal level my politics have been successful. The more I can help others to neutralize their embarrassment and guilt about speaking out, the better. And I am not above enumerating the details once more if that is what's required.

External Silence Culture

More recently I've switched away from talking about my history with abuse, and towards talking about how living with depression and cPTSD affects my daily life. This is a shift in focus, not intent. I used to only be aware of internal silence, and tailored my activism accordingly; but now I realize there is another form of silence, one which is much less discussed and therefore more in need of awareness.

The external culture of silence is the systemic means by which a community fails to recognize (or refuses to admit) that it has a problem. It is the silence which allows each compagnie to realize and internally discuss the problem, while the community at large remains ignorant. It is how failure of communication prevents local/specific knowledge from becoming global/universal knowledge.

External silence culture often takes the form of superficial acknowledgement of a problem while perpetuating it via ignorance or misunderstanding of its root causes. A prime example is the way certain men acknowledge that sexism is a problem, but then turn around and enact the same sexist culture they decry in their blog posts. Another is how we can admit that, in the US, one-in-11 people are affected by some form of depression and one-in-24 people live with major depressive disorder (CDC), but then on an individual level most americans refuse to believe they know anyone with depression. Or how we can admit that depression costs US employers 44 billion dollars per annum in lost productive time, but then we turn around and stigmatize people for seeking treatment.

I do not believe this failure to recognize how our communities perpetuate the problems they nominally oppose can be brushed off as "mere" hypocrisy. There's a deeper issue than logical inconsistency going on here. Systemic failures can never be explained by idiosyncratic failures. This failure of communication is due to enculturated systems of silence and to a failure to appreciate how global interactions are constructed through local, personal interactions. As a species, we do not understand how to interpret facts like "one-in-N people"; we can believe these facts to be true without recognizing how that truth must be immanent in the personal microcosm of our daily surroundings.2.5 This mode of cognitive failure is perfectly natural, which is why we must take explicit steps to disrupt and forestall it.

This is why I talk about the fact that I live with depression and cPTSD. By making this public knowledge, in refuting the sanist assumption, I deny people the ability to believe they don't know anyone with these conditions. I don't say "there are lots of people with depression", I say "I am a person with depression", I say "you know someone who has attempted suicide". I make it personal. The logic here is the same as the logic behind Out & Proud. By making it personal, by going on with our daily lives and yet not allowing these lives to be masked over by normative assumptions, we help those around us to realize that we are everywhere, that we have always been here, and that we are already part of that thing they call "normal".

One of the ways silence is encultured is in all the things we don't feel the need to say when among "our own kind". With people like ourselves there is less need to discuss certain details; they already know, and so we can speak in analogies, allusions, and assumptions. But when we take this dialect of implicit communication into larger communities, our words are misunderstood and misconstrued because the audience fails to hear the content in what we do not-say and presumes the content of what they expect us to not-say. The problem here is not that we communicate meaning through the not-saying of particular things— the use of implicit communication typically increases the efficiency of communication, and it's an essential component of how groups foster intimacy. The problem is being unaware of the fact that there are many dialects of subtle communication, and being uncritical of our assumption that the audience knows which dialect we are using and understands how it should be interpreted. Subtle communication is why satire is such an effective shibboleth (Arthur Chu), and why George W. Bush can give speeches which are interpreted radically differently by evangelical Christians and the rest of the country (Craig Unger, William Safire, inter alia).

This is why I talk about what it is like to live with depression and cPTSD. By discussing their specific, ongoing influence on the ways I interact with the world, I'm explaining one of those dialects of assumed experience. Just knowing that I have depression is not enough to understand what it means, how it affects who I am and what I do. We need explanations like the spoon theory, depression quest, mainichi. Before the spoon theory was vocalized in 2003 people with chronic conditions would try to explain how our lives are just plain harder, but non-spoonies misinterpreted our words as "laziness" or "whininess". That references to spoons are so ubiquitous now, is because of the specific ways that explanation serves to make this aspect of life real to those who do not live it.

Beyond "illness", "cures", and the eventive mythology of trauma

In cognitive science there's the concept of umwelt3: an organism's lived experience of their surroundings. To understand why animals behave in certain ways it is not sufficient to know about their environment: the animal does not make decisions based on our perception of their environment, they make decisions based on their own observations and internal conceptions of these surroundings. The senses at our disposal are not like tools in a drawer that we can pick up or discard at a whim. Our senses are fundamentally ingrained in the fabric of reality: reality cannot exist to us without our perceiving it, and we cannot perceive any aspects of reality which lay outside our sensory capabilities. There is no unified "reality", at least not in any way that's helpful to daily life. Each of us inhabits different worlds, and each of these worlds is structured by our personal and specific perceptive, physical, cognitive, and social capabilities.

When people hear "PTSD" they think of veterans waking from nightmares, as if the condition is a punctual event with the effects of rewatching a scary movie. People don't realize that when we say we are "haunted" by our pasts, we mean it in the full gothic sense of the word. Our pasts, our memories are a demonic possession. They cast a pall over interactions, corrode friendships, corrupt vision with spectral intruder-attackers, poison socialization with projected phantasmagoric intentions. The haunting leeches into every waking moment, draining their color —except for harsh glaring garish splotches—, and when all those waking moments have been polluted it seeps into the dreamworld, hungry for more. The severity of the haunting varies, of course. And the possession sometimes goes into remission, hiding away to strike again later. And some of us aren't plagued by revenants or sluagh, we have poltergeists: spiritual agents that move things when we aren't looking, that are mostly quiet but always directing us down their crooked paths, with loud bangs and broken furniture if need be.

PTSD —like depression, and like anxiety— is not an event, it's a mode of living. Although we must talk about the events which gave rise to these conditions (to end our internalized silence), doing so allows our society to continue believing in and perpetuating the mythology that trauma causes an event of suffering rather than causing a state of suffering. This mythology includes the belief that mental "illness" can be "cured", that it is a transient condition without long-term repercussions. While acute depression4 is short-term, I'm not so sure it should be considered transient: 80% of people who've had a depressive episode go on to have another (Fava, Park, & Sonino). Contrarily, major depressive disorder —aka "depression"— is, by definition, an ongoing condition. Similarly, while simple PTSD can also be short-term5, the existence of complex PTSD suggests that simple PTSD is not transient. Conditions like cPTSD, depression, and anxiety are not something that goes away. We need to accept that fact and talk about them accordingly. We need to teach people how to live productive and fulfilling lives, not teach them to pin hopes on a "cure". Pretending it will go away causes disappointment, guilt, and embarrassment about not having "gotten over" it yet. And pretending it'll go away contributes to the continued marginalization of people who live with these chronic conditions. Pretending that depression, anxiety, and cPTSD are "illnesses" that will "go away" causes real and lasting psychological damage; and it does so in the exact same way as pretending child abuse will "go away" if we don't talk about it, and that pretending one's sexual orientation is an "illness" or that it might "go away" if ignored.

By refocusing my speech on what it's like to live with depression and cPTSD, one goal is to combat this mythology of a "disease" with a "cure", but the bigger goal is to inject some humanity into the public conception of people with these conditions. The spoon theory works because snatching spoons out of someone's hand creates a visceral reaction, which induces a personal experience of the claim that "life is harder", and thus causes one to view people with chronic conditions as expressing authentic human responses to living in a particular kind of world— even when that world isn't the one the snatchee is used to inhabiting. When I speak of my paranoia about releasing writings into the world, or the fear that masculinized cultures induce in women, or the panic I experience whenever I have the presumption to share deep personal opinions, or the rage I feel at people dismissing the monumental pain of living, my goal in all these disclosures is to help people see —for once— that I am human. That my responses are authentic, that they are responses shared by countless others who live in worlds like the one I inhabit. We are not diagnoses, we are not labels, we are not identities; we are human. We do not feel the need to describe our umwelt to one another, but you know not how to read the meaning we utter in the gaps between words. And this is why I speak, if you can but hear.

Afterword

While editing the above post, I became aware of an abusive campaign against Zoë Quinn (the creator of Depression Quest) orchestrated by a malicious ex. This sort of invasive, dehumanizing, personalized attack is not at all uncommon— for women. If you are a man, you cannot comprehend what this is like because it is a form of gendered violence tailored exclusively to women. This is part of our umwelt. As women, our realities are shaped by the ever-present threat that our sexualities will be weaponized against us.

This highlights a very different reason I am open about my past. By being open about these things, I ensure that they cannot be used against me in the sort of "revelatory" smear campaign Quinn is facing. Make no mistake, my sexuality and psychology will be used against me. Openly handing men the ammunition only prevents them from engaging in this one specific form of violence. While I prefer to think of my openness as active political resistance, the fact is my openness is also a form of triage. A way of defending against the worst of the misogyny I must face for daring to exist. Perhaps I will unpack this motivation a bit more in another post.


[1] I really hate the term "mental illness". It's medicalizing and pathologizing. When people find out I wear glasses they barely even notice; why should finding out whether I take meds be any different? My height also has significant health repercussions, but noone talks about my "vertical illness". My brain is no more magical than my eyes or my spine. Unfortunately, I don't know of a suitable alternative to using the term MI. If you know of one, please do drop me a line.

[2] The surviving members of my family have matured significantly since my childhood, and it is not my intention to malign the people they have become by discussing the harm they inflicted on me throughout my childhood.

[2.5] Even without getting into cognitive issues, linguistic issues already forestall our ability to comprehend what statistics like these mean. Mark Liberman has written a number of excellent articles at Language Log about how, at present, natural language fails to adequately capture or convey probabilistic information and how this causes undue confusion between frequencies, rates, risk, odds, likelihoods, ratios of any of these, and various other probabilistic and statistical measurements. Here's one on how it's misleading to report odds ratios, counterbalanced by this piece on why (log) odds ratios are useful and have a cognitive basis.

[3] I refer here to the variation that occurs in embodied cognitive science and ecological psychology, rather than the variation that occurs in semiotics per se. So more like Gibson and less like Uexküll.

[4] The form of depression brought on by a novel traumatic event, like the loss of a loved one.

[5] EMDR-web reports being able to relieve 9/11 survivors of their simple PTSD using Eye Movement Desensitization and Reprocessing (EMDR). Prior to writing this article I was unaware of any reliable treatment for successfully treating PTSD, and I'm still not familiar with all the literature here.

Tori

28 Jan 2011 02:03 am
winterkoninkje: shadowcrane (clean) (Default)

It's funny how things can come back out at you after so long. I was just sitting there, wrapping things up to go play some games, when my randomizer throws over a decade away. Tori Amos, Indigo Girls, all these beautiful haunting women who filled those early years at college. The stupid years. Finally done with highschool, finally done with the drama (before realizing it isn't done with you), fleeing three thousand miles from an abusive family to find finally that life may be worth the living of it, and those three thousand miles sundering that first longest term relationship, the one when you somehow suddenly silently move from the weeks and months of teenage romance to years, but when years seem still unthinkable, before they've become the expected of adult romance.

"Gods, how did we survive being so young?" I want to ask, an incantation to break the spell, to separate again those memories from the living now and drive them back into "so long ago". I drown myself in reading up on Tori's latest work, a return to the personal, a return to the California of Little Earthquakes and to those two-decade old memories of earlier joys mixed with pains at CTY. As I listen to Plath, Tori intimates, insinuates, her recent moments of brushing up against that all-too-appropriate theme. And something about sitting at home now, alone but not lonely, comfortable against the winter's cold, reminds me of other dark moments, of christmas alone in a cheerful shared home. Our lives are bounded by the great movements, the segues from one phase of being into another, and that odd christmas happened to fall on just such a movement.

Right now, even as these old thoughts come back to me across the years, I am not at all depressed. Usually these scenes only return to me when that whirling deepness settles in again. We spend so much time trying to forget the bad parts of living, it's hard to express exactly what that feeling is when you can look on them clearly and yet not have them drag you down. It's been far less than that decade since I've been gripped in depression, but I do think that was the last time suicide crossed my path. It seems so strange, from here, from now, to think of all that's happened since then. As I get older I keep fearing that the time will slip away, that I'll wake up one day and wonder where it all went. And yet, when I break free from the illusion of the present, this last decade held so much more than the decade that came before. But I also know it's funny the way things can come back out at you after so long. When the boogey man comes he doesn't care about all the things you've learned, all the secrets of the universe unlocked, the identity unearthed from the ashes of childhood, the sexuality wrested from bigotry and hatred, the degrees earned or papers published, the friendships known, the people helped, or the stable happy home with that goddess who makes you smile every day.

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