What made you depressed?

A few months ago, I moved from Chicago to my hometown of Pittsburgh, which necessitated finding a new primary care doctor. In Chicago, I used Yelp to find my amazing PCP. But now that I live in a smaller city and I have an HMO, I had a tough time finding reviews on doctors. I chose my new PCP from a listing from my insurance because 1) she was fairly closeby, 2) she was a woman, and 3) she had a few decent ratings on Healthgrades.

When I arrived for my appointment, I filled out the standard new patient paperwork. I ticked off the boxes for depression and anxiety, and listed the medication that I take for these conditions.

I’ve dealt with anxiety and depression for my entire life, though I wasn’t formally diagnosed until college. I talk about it. A lot. People are probably sick of hearing me talk about it. But I talk about my experiences so much because a lot of people don’t. I strongly believe that a lot of the problems with mental healthcare and treatment in this country start with people refusing to talk about it. Our puritanical society has decided that we can talk openly about all sorts of things that I’d rather not discuss, but someone saying that they’re depressed or have a diagnosed personality disorder is just too taboo.

So I was more than prepared to talk about my medical history in this regard. But then my new PCP asked a really stupid question that did not bode well for our discussion:

“How long have you been depressed?”

This is a really stupid question. It betrays a fundamental misunderstanding of how depression works. It indicates that depression and anxiety have a starting point and an ending point. That one day you woke up and felt sad and/or anxious, and you measure your feelings from that day. “How long have you been depressed?” looks like this:

In reality, depression and anxiety look like this:

 

 

Depression is a two year-old’s scribble. It’s not a straight line. It’s up and down and diagonal and all over. Good luck finding a starting point and an ending point. And anxiety hangs out over your shoulder telling you that everyone thinks your scribble is stupid and ugly.

But fine, whatever. It was a stupid question, but I gave her the benefit of the doubt — maybe it was just bad phrasing. “Well,” I said, “I’ve been depressed all my life, but I was formally diagnosed about ten years ago.”

Then it got worse.

“What made you depressed?”

Again, this line of questioning says when your depression started on [insert date here], what was it that started it? There is such a thing as situational depression, where a particular event directly leads to depression. But most people I know who are depressed have “clinical depression,” which means there is no inciting incident for their feelings. In fact, they may go through a rough time at work and home without any depressive episodes, and they may be doing extremely well at work and have a great new relationship and be depressed.

Sensing an opportunity to educate, I very kindly told my doctor that, “Nothing in particular made me depressed. I just get depressed sometimes.”

“And have you always been on medication?”

“No, I started that more recently. Maybe five years ago.”

And then came the kicker.

“Well, it must be working because you seem pretty chipper.”

Okay. First of all, my medication has absolutely no bearing on my personality. I am a chipper person. I am very nice to strangers and people regularly tell me that I am friendly and outgoing. Which is funny, because I am none of those things. I am an introvert and talking to strangers for too long makes me need a nap. But I know how to turn the friendly part of myself on when I need to.

And even in my most ugly depressive and anxious state, I would still say “thank you” to the bus driver and ask the grocery store cashier how they were doing today. Because my condition has no impact on my ability to be friendly and kind. I try really hard to make sure of that.

And just for the record, my chipper self had a whole slew of anxious thoughts on the way to that appointment, ranging from you’re going to be late to you’re too fat and she’s going to yell at you to what if my insurance doesn’t work? to what if she makes fun of me, so my chipper disposition with my doctor, essentially a stranger, has nothing to do with the anxiety and thoughts that are roiling in my head.

Well-meaning but completely wrongheaded questions and comments like this are why I talk about my mental health. I shouldn’t have to teach my doctor what depression is and is not. I shouldn’t have to educate a physician on what antidepressants do. The more people speak openly about their mental health, the more everyone will understand it better.