Death by Depression, Not Suicide

Death by Depression, Not Suicide

It can be difficult to explain mental illness to those who might have little or no experience with it. Part of my goal as an advocate is to help society to understand the gravity of mental illness and abate the stigma, especially when it comes to depression and suicide. There’s still so much stigma and mystery around both topics that when the following email landed in my inbox after last week’s tragedies of Kate Spade and Anthony Bourdain, I felt I should pass it along. It’s by two members of and it not only hit home with its title “Death by Depression, Not Suicide”, but it does a great job of helping to unravel the difference between the two in accessible terms. Suicide is an unthinkable act to most, and this email helps explain death via depression, with compassion, rather than propagate the stigma by labeling it as suicide…

“Recent shocking news has reported on the deaths of celebrities Kate Spade and Anthony Bourdain. Many have speculated about how such successful, beloved people can “kill themselves.” While the news is horrible, the story line misses critical points. First and tragically, Spade and Bourdain join a growing number of more than 100, mostly less famous, Americans having similar deaths “by suicide,” each and every day.  More importantly, the notion that Spade, Bourdain, and the others, decided to end their own lives is, in a deep sense, not true. These individuals are the victims of the pernicious illness of the brain, Depression.

Depression is a horrific illness that affects as many as 10% of Americans at any one time. Depression is a brain disease that can cause confusion and distortions in thinking, as well as interference with basic physiologic functions, including:  sleep, energy, appetite, motor function and more. It is neither self-inflicted nor a moral failure. Depression interferes with cognition (or thinking), making it impossible for the individual to perceive and accurately interpret the environment with a consequent inability to experience pleasure and anticipate the future. The brain’s failure to undertake accurate self-assessment of risks is intrinsic to Depression, with a disruption in sense of self and loss of the basic evolutionary drive for survival; this leads to dangerous behaviors and even death. Death during Depression is not a “self-inflicted” death (suicide) because the sense of self is gone; it is Death by Depression.

In the face of overwhelming evidence that Depression and other psychiatric disorders are serious illnesses that can disrupt brain function, including the will to survive, why do we still use the term “suicide?” “Suicide” is associated with the stigmatizing concept that those with psychiatric illness are intrinsically flawed or weak and want to die. Stigma and antiquated understandings about Depression and brain disease foster ignorance about the fact that Depression is just as life threatening an illness as are cancer and heart disease.

It important to accurately understand Depression and Death by Depression. Depression is a treatable brain disease and, Death by Depression is preventable. Depression is a medical emergency! It requires the immediate attention of medical professionals, friends, and family. The victim of Depression should not be left unattended any more than should someone bleeding profusely or having a heart attack – even if they insist that they are “OK.” Along with the immediate protection of the person with Depression, it is essential to rapidly apply evidence-based treatments. This will not only prevent death and debility but it will also help those with Depression save their lives so they can have much wanted, productive futures to share with friends and family.

Protection and prevention of complications (including injury and death) are the important first steps in treating Depression. But, this can’t be done if Depression is not identified early. Look for depression! When you find it, act promptly. If you are the victim of Depression, immediately tell someone (friend, family member, and / or professional) and let them help you get treatment. If you know someone with Depression, ask how you can help and make sure that they receive urgently needed professional care.

No one wants to die from Depression, or any other illness. To suggest otherwise is diminishing the value of life and the individual affected by Depression. Unfortunately, the concept of “suicide” interferes with our shared responsibility and opportunity to effectively prevent Death by Depression.”

Bennett L. Leventhal, MD
BC2M Scientific Advisory Council + BC2M HS Research Co-Lead
Professor of Psychiatry, University of California San Francisco

Neal D. Ryan, MD
Professor of Psychiatry, University of Pittsburgh


❤️National Suicide Prevention Lifeline: 1.800.273.8255

❤️National Alliance on Mental Illness: 1.800.950.6264

❤️Text: HOME to 741741

❤️Text: ANSWER to 839863

Peace, love, and wellness.

Update: I Missed Mental Health Awareness Month…Oops

Update: I Missed Mental Health Awareness Month…Oops

Hi there, how have you been?

It would only make sense that I would do at least one post last month given that it was Mental Health Awareness Month. I had every intention of doing so, I was just a bit too consumed by life and my own mental health awareness, so I thought I’d catch up with an update. The big news, I was accepted last month to the bachelors of social work program at SFSU, I’m over the moon!! But I was also rejected at first. Ok, I was wait-listed. I was devastated, so I let myself feel sorry for myself for a day or two and then I moved immediately into figuring out a backup plan. While I was in the midst of my self-pity an old poem from my childhood popped into my head called Harlem, by Langston Hughes. It graphically challenges your answer the question, “What happens to a dream deferred?”, and then suggests that maybe the dream just explodes. Well, my answer to that was a resounding– hell no my dream does not explode, it absolutely lives, albeit deferred. And so I began planning what I would do should I not make it off the wait list this year and have to wait another year to reapply.

Given that I want to go into mental health in the LGBT community, I began looking at a minor curriculum in LGBT studies, I was actually pretty excited about the idea of it. While I was busy making these alternative plans, and being a total pain in the ass squeaky wheel to the entire social work department, I was notified that I’d been moved from the wait list into the program. There’s 25 seats, about 50 people applied, I’m happy as a clam on my new path! But it was hard earned. This whole process of totally uprooting my life in my mid-thirties, working only part time and going back to school has launched a serious platform for forced growth, and it seems in my years of experience that when it comes to growth and healing, it gets worse before it gets better.

I’m immensely grateful to be able to say that after a lifetime of depression symptoms and about 12 years of actively battling clinical depression, I feel I’m finally free of its daily grips (that’s not to say I don’t still get down from time to time, and I can’t say at this point in time that I or anyone can fully be cured of depression from a clinical standpoint. I am hopeful though). But what has come along in full effect in its place, and is the topic of many of my posts this year, anxiety. More specifically morning anxiety.

It’s a horrible way to wake up (often after a night of minimal sleep) and start off the day with that wad of tension in my chest, my mind racing, extremities tingling. Feeling out of control and scared my heart starts racing, my breath gets hyper, the noise in my head gets louder and louder and before I’ve reached 30 minutes into my day I’m broken down mentally, physically and emotionally, and in tears. There’s so much nervous energy in my body combined with the cacophony in my head, it creates so much resistance toward the whole day, and I’ve lost control before I even had the chance to try and hold onto it. It disrupts my sleep, it steals my cognitive ability, it makes me sad. And I can’t say it’s because I’m forever stuck in the future, I just wake up this way first thing with a full mind/body effect. I’ve done loads of research on morning anxiety and the only real biological factor that plays into it is that the stress hormone cortisol is highest in the morning. Otherwise everything else steadfast suggested a good morning routine.

The good thing about anxiety is that with all this nervous energy, it’s become a great motivator. I took the advice of a morning routine despite wanting to hide under my blankets in bed from the world where it used to feel so safe during depression. Now with anxiety, I genuinely fear that if I stop moving I’m going to self destruct. So the first thing I do is wake up early. It works out because usually now once I wake up I can’t go back to sleep anyway, and it allows me the time to 1. engage in my morning routine, and 2. not feel rushed to get ready and out the door for the day. Both have proven to be quite helpful in maintaining my morning chill vibe. What’s also helped is not just the morning routine, but self-care throughout the day. If I’m feeling tense or worked up by nervous energy or stuck in my head, I do something about it instead of resisting it and allowing it to fester.

Here’s what I’ve been doing and the general frequency, in any combination throughout the morning, afternoon, or evening:

  • Morning pages, most days. I do 1-2 pages
  • Meditation 1-2 x a day or as needed, no less than 10 minutes
  • Yoga 1-2 x a day, 10-20 mins
  • Stretching throughout the day
  • Walking 4-8 x a week, whether its 10 mins around the block or meandering 3 miles through the city
  • Jogging 3-5 x a week for at least 15 mins. I was never a jogger but for whatever reason the higher impact seems to help clear the nervous energy better
  • Smaller interval exercises like crunches, pushups, squats, wall sits 1-2 x a day
  • Breath work as needed throughout the day
  • No alcohol during the week
  • No caffeine (I get my jollies from a cup of decaf a few days a week)
  • Cleaner diet– I’m mostly vegetarian but I default to carbs. I’ve tried replacing  more of those with fruits and veggies, seriously limiting sugar, and avoiding anything that will make me feel heavy
  • Ashwaganda and CBD oil to help calm my nervous system
  • Acupuncture 1 x a week
  • Reaching out to my community and loved ones for support as needed

One other thing I’ve learned to do that’s been really helpful is to not resist the anxiety. I know that sounds totally counter-intuitive– like um, ok I’ll just let the anxiety have me until it grinds me down into a panic attack and they my whole day is shot? Yes and no.  This took a bit for me to understand, too. I realize it’s fully instinctual for us to resist that which causes us harm, but maybe anxiety isn’t there to try and harm us. Maybe its trying to tell us something, like a child crying out for help but who has no words to express himself. Maybe whatever it is that’s in us that crying out for help just needs to be loved and cared for instead of turning a cold shoulder to it, so that it may ultimately heal and release on it’s own. It’s almost like Murphy’s Law in that the more you resist something, the more you’re feeding it your power through the resistance, giving it reason to stick around, and therefore it’s going to be further destructive. If it can go wrong, it will go wrong.

So when I feel it start to rise up, or when I’m fully in the throes of it, I try and remind myself to not be upset over the way I’m feeling because it’s more than likely a part of me that needs healing, and it’s going to be a process. If tears need to flow I let them, if I need to let off nervous energy then I move, if I need to quiet my mind and calm my body I meditate and breathe and allow myself to be present with my feelings, no intellectualization needed. Not only that but it all helps to keep things in perspective and it helps me keep the faith in myself that I can and will make it to the other side of the daily struggle with anxiety, just as I have with depression.

I’m sorry I missed you last month. Things in life are falling into place, and anxiety has been actively trying to displace all these things I’m working so hard to maintain. But with love and compassion for myself and my challenges, I will keep a place for everything and everything in its place.

Peace, love, and wellness.


Against Stigma

Against Stigma

I’ve been listening to a lot of podcasts lately. It’s something new for me, it seems to help keep me focused, in my body and out of my head. They’ve generally been on topics like emotions, communication, philosophy, love, mental health, social work, and stigma. The latter is a massively burgeoning topic right now, thankfully, as it absolutely needs to be discussed everywhere possible all the time if we’re going to have any chance at cracking down on it and getting it the hell out of the mental health community where it does nothing but harm. The dictionary definition of stigma: “A mark of disgrace associated with a particular circumstance, quality, or person.” Living with mental illness is tough enough as it is, no one who is suffering needs or deserves that shit.

If there’s been one overarching theme I’ve noticed behind a majority of the topics I’ve been listening to, it’s bringing forth real measurable change and progress through banding together, talking, loving our fellow man, being open and equanimous; what can best be described as community: “A feeling of fellowship with others, as a result of having a particular characteristic in common, sharing common attitudes, interests, and goals.” Everyone needs this in one way or another. To be human is to commune. People need other people, more specifically people with whom we share common ground. Especially when it’s a highly stigmatized ground we stand on. I say let’s stand together!

I’m probably going to wind up hyping up the value of community in future posts til I’m blue in the face. To be honest I could always sense that something integral was missing from the fight against stigma but couldn’t articulate exactly what it was so perfectly summed up in one encompassing word. All the podcasts I’ve let into my head lately have done a wonderful job of really cementing upstairs for me how fundamental community is as a huge catalyst for change and progress on any facet of life. Good thing is that it’s a pretty simple notion; it’s all about coming together, loving, celebrating and accepting each other as we are, lending a hand or an ear or a resource, letting go of the pretense. Rather than an individualistic, shame-ridden silent suffering, it’s about a collectively proud, boisterous effort to bring forth change for the better.

I personally take pride in my ability to stand up in front of 1 or 100 people and say I have depression, anxiety and ADHD because the fact is, I’m still standing. I’m a survivor, I beat the odds. I’m proof positive people can live with mental illness and actually thrive under the right care and support. But those are exactly what’s missing from the fight against stigma– proper care and support. As well as community, acceptance, and the freedom from stigma. Love is missing. Let’s call mental health stigma what it really is: discrimination. When was the last time you saw a person who felt too stigmatized to admit they are afflicted with something like cancer or diabetes? Why is it any different for those battling mental illness? How do we change that landscape? We build community around it; there’s power, strength, and resolve in numbers!

We not only need to rally together around the topic of mental illness, need to talk about it. Your actions could make someone’s day and your story could save someone’s life. Having feelings is not wrong, it’s not a sign of weakness. Just as the need to commune is human, so is the need to emote. I don’t care who you are, what you come from, or how hard you’ve become, you’re still human. Shining a light on the topic is the entry to the path of healing. It creates much needed hope that there is a solution to a problem that’s been rampant yet stifled for too long. Untreated mental illness kills people. I’d be willing to bet you know someone who’s been adversely affected by it, or you at least know someone who knows someone who has. 1 in 4 Americans deals with some form of mental illness, it’s all around us every day. Yet 56% of those people go untreated. It’s time to get real about this and stop treating it like the black sheep of the litany of illnesses that humans endure.

It’s time to officially throw out the old ideals of “it can’t happen to me, mentally ill are those on the street corner talking to themselves, just get over it, it’s only the blues, not in my family, not in my culture, what about my pride, my image, no no no not me”. It can happen to you, it quite frequently happens to those around you as well, and there’s no shame in it. Simply stated– we want to stay in good physical health so we regularly see the doctor for checkups and as needed for symptoms. Why wouldn’t you treat your mental and emotional bodies with the same respect? That’s really all it should boil down to but we’ve baked it into this monster of a thing that people are too afraid to cop to and continue to treat it as such.

Mental disorders are not adjectives. The stigmatizing words need to go, their heyday is over. “Crazy”, “mental”, “insane”, “psycho”, “nuts”, etc., they’re all total pejoratives when applied to those facing mental health issues and wholeheartedly perpetuate the stigma. We need a shift in the context of the language we use. Instead of appropriating these words and casually throwing them around when referring to those with mental illness, much like we don’t use the word “retard” anymore (beside the fact that it’s totally inappropriate and offensive), we need to be more aware of and sensitive toward the words we use. The best, most instantaneous thing you can do right now is to lead by example.

Years ago when I was unknowingly a little too forthcoming about my challenges with people who weren’t ready, willing or able to be kindly receptive, I remember telling a guy I’d been seeing for a while that I dealt with depression. His response “oh, does that mean you’re going to lose it and go crazy on me?”. Whether he meant it as a joke or was genuinely curious what that meant for him, to me it was rife with ignorance and stigma and I quietly released him from my social life. Comments like his made me realize exactly how much work there was and still is to be done in the effort to overcome stigma. I’ll never forget that instance though, and who knows where he was coming from, maybe he’d previously had a bad experience with a girl in regards to mental health. However, just because he judged me didn’t mean I was going to return it.

I’ve been called all sorts of things along my path to wellness. When you’re too afraid to open up about what you’re facing, people are free to draw their own conclusions and as such I’ve been labeled lazy or self-involved or maladjusted. Even when I did come out to those I thought I could trust, for example when I fessed up to my boss at work many years ago I was called a burden, or admitted my struggles to people who I thought were friends I was deemed as misguided or flaky. Surely I’ve been called crazy behind my back plenty of times over the years I struggled the most. But these are all views that are again, riddled with ignorance and stigma. When we watch how we speak about and regard one another, each individual choice of words can be a drop in the bucket of breaking down the stigma on mental health.

When I look at someone who is visibly struggling with any sort of mental illness in any sense, I don’t see “crazy” or “nuts”. I see pain, or PTSD, or what has probably been a really rough and harrowing ride in life for them trying to work its way out. I see an intense, acute need for healing, care, love, acceptance and safety. We all want and need those things. I personally think the only reason behind someone stigmatizing another is because they’re simply unfamiliar with the other person’s experience and it makes them feel safer to distance themselves from that person by stigmatizing them. If only we could reprogram society to think and act oppositely of that, it would by default create more cohesiveness and community, one non-judgmental, kind action at a time.

We need to make this a priority, everyone needs to be an advocate. If you hear someone saying something crass or stigmatizing, or acting out of judgement or ignorance toward someone with mental health challenges, say something. If you see someone acting out of character, or strange, instead of viewing them through the lens of judgement and shame and casting them off, try and see through their behavior to what is more than likely underlying pain, trauma and a need for healing. If you saw someone trip and fall on the street you wouldn’t automatically assume they were drunk, in fact you’d probably try and help them up and make sure they’re ok. Don’t assume that because someone’s behavior doesn’t fall within the spectrum of what’s perceived as “normal”, that they deserve to be judged. More often than not it’s a cry for help.

If you’re curious as to how you can do your part, check out this article from the National Alliance on Mental Illness on 9 ways to fight mental health stigma, and keep on fighting the good fight one word, action, or thought at a time. We’ve got a long way to go.

Peace, love, and wellness.