Two days ago, Nana learned from a friend that singer Li Min left because of depression, and she used the words "shocking the soul" to describe it. As a post-80s generation, Nana was surrounded by Li Min's rhythmic singing throughout adolescence, and she would perform on stage with her songs and dances in college. "I even thought about being a bright person like her." She recalled.
Nana forwarded the Weibo content of Li Min's second sister mourning her sister in the circle of friends, and there were still messages in the comment area: "Really fake, she looks so cheerful?" ”
As a depressed person with a history of 25 years, Nana realized that behind this statement, the public's prejudice against depression still exists: many people are still accustomed to excluding cheerful and outgoing people from the "susceptible group" for depression.
Guo Xiaoyun is the chief physician of the Shanghai Mental Health Center. In her many years of outpatient experience, she has indeed encountered a similar situation of "smile depression". They are sunny and positive on the outside, but their inner suffering is not exposed to people. A family member of a depressed patient told her during the consultation that the patient seemed to be in a good mood outside, but when he got home, he cried in his room.
Dr. Tina Silverman, a psychologist at Cooper University Hospital in the United States, once pointed out that ordinary patients with severe depression may be unable to get out of bed due to severe physical strength and mental decline; In contrast, patients with smiling depressions tend to have more energy, and once they have desperate suicidal thoughts, they are more likely to act and succeed.
However, Guo Xiaoyun also explained that there is no diagnosis type of "sunshine depression" in medicine.
Depression is one of the broad categories of mood disorders "mood disorders". "The factors that really affect depression may involve many aspects: genetics, social environment, physical diseases, endocrine system, major stimuli and other factors..." Guo Xiaoyun explained. In 2019, China's first national epidemiological survey of adult mental disorders showed that the lifetime prevalence of depressive disorders in Chinese adults was 6.8%.
On the morning of the second day after Li Min left, Nana's WeChat group bombarded various analyses of Li Min's state before her death: some people thought that Li Min's laughter in front of the camera in the last two years was a cover up and a final help, while others thought that she was cheerful by nature and just "didn't think about it for a while, didn't hold on."
As a senior patient and licensed psychological counselor, Nana is reluctant to make such speculation and analysis. "I understand the state of mind she left when she left, it was really a relief. Most of the depressed patients who carry out the act of death are not momentarily unthinkable, but have struggled for a long time, and they are really overdrawn and unsustainable, and the cheerful and optimistic character is completely unable to help these people go out at this time. ”
The following is Nana's self-statement.
Narrator: Nana Age: 43 Occupation: Company employee, community counselor
A patient with "sunshine" depression who has attempted suicide twice
At the age of 17, one day after taking a break from school due to "school boredom", I did not have the strength to get out of bed. I declared to my parents, "I don't want to live, I'm going to die, you guys have a good life." ”
Before declaring suicide, I never expressed depression to them. When I said this, I didn't even know what had changed qualitatively in me. I used to be a cheerful daughter that my parents were proud of. One of the main motivations of my previous life was to make my parents happy. But at the time, I said everything from the bottom of my heart.
In my understanding at the time, I couldn't go to school normally. I have become a burden and waste of my family, and my life is worthless.
This outbreak came violently, with the threat of death. It was also the first time my mom realized it was time to take me to the doctor...
For a long time when I was diagnosed with major depressive disorder in my sophomore year of high school, I was thinking about a question: It was very unreasonable for this to happen to me.
Like Li Min, I am a person with a particularly sunny and cheerful personality in the eyes of the outside world. As a teenager, I was excellent, moral, intellectual, physical, aesthetic, and I was particularly keen to participate in various group activities.
Until one day, I found that I became easily tired in class and my thinking slowly dulled. This was an early symptom of depression, but at the time I didn't realize that something was wrong with me, and I always felt that I could overcome it with effort. Just like when I used to have a cold and fever, I would also hold a hanging bottle with one hand and do homework with the other.
Contrary to expectations, after about 3 months, my symptoms became more severe. I slowly lost my mobility and lay in bed all day without wanting to go to school.
I try to ask for help from people around me and talk to the teacher I trust the most. The teacher encouraged me in her way, but it hit me. She said at the time: "People are dependent on themselves..."
The teacher's reaction could not be blamed on her. After all, more than 20 years ago, our school education had very limited awareness of adolescent depression.
But I was completely desperate. I sent a signal for help because my self-regulation system was failing, but the teacher meant that I didn't try to get through.
Then I got more and more depressed. My mom took me to the local psychiatrist. We do not have a local psychiatric hospital in Leshan. At that time, the doctor at this general hospital gave me the diagnosis: "This child is over this life." "The doctor prescribed me a handful of medicine, but it didn't work, and the side effects were very big. Later, the whole person was in a state of dizziness and not very awake.
During that time, the only thought I had was to die. Although I haven't acted yet, I'm already planning for it. For example, I will think that I can't get sleeping pills, and I am hesitating whether to jump off the building or jump into the river. At the same time, I thought about my parents' despair and collapse when they saw my corpse, and I was hesitant, and I thought that it would be a day if I could hold on for one more day.
What is it like to be depressed and courting death? For me, who fell ill at the age of seventeen or eighteen, death meant relief and the end of everything.
This torture is twofold, psychologically and physically, I will panic, headache, nausea, trembling and trembling every day, and when it hurts, I want to hit the wall and pull my hair. Every minute and every second is like someone cutting your flesh with a sharp knife. But I went for a physical examination and found no problems.
At that time, I was not living for myself, I was holding on for my parents. I even thought that if a devastating earthquake buried me or a fire could free me from the guilt of suicide for those around me, it would be the most suitable for me.
As an adult, I have come into contact with many depressed patients, and I have found that many patients experience similar physical and mental pain when they have suicidal thoughts.
Seeing that I was deteriorating, my parents decided to take me to the Mental Health Center of West China Hospital, the best psychiatric hospital in our province. It was a bumpy road, four or five doctors were changed, and the dressing was constantly changing.
In fact, before I went to Huaxi to seek medical treatment, my suicidal thoughts never stopped. My thought was: let me take any medicine, I will take it with my eyes closed, let me be filial to you one last time. If I have taken all the medicine that I was asked to take, and it still has no effect, then I should have been filial to all my filial piety, and I will leave when I should go...
But miraculously, with my final "performative persistence", the effect slowly appeared. My thinking has changed, and the thought of dying is slowly decreasing.
The time of wanting to commit suicide in a day changed from 100% to 90%, slowly only 50% or even 20%, and then only occasionally had thoughts of death... I returned to school half a year later. In order to ease my anxiety, my parents decided to let me downgrade to a new class. At that time, the teachers and classmates were really tolerant of me, and I used to run home crying after only one or two classes a day, but no one saw me as an outlier for this. After about another semester, my social functions slowly recovered and I was able to study normally as before. I returned to that cheerful state, even the shining focus of everyone's eyes. Although my grades dropped from the top three in the class to more than ten, my parents did not complain or demand anything from me.
Later, I went to school, worked, and married like a normal person, and everything was so smooth that I almost forgot my experience of depression. But the clouds swept in again a few years after I got married.
In 2012, because I was sick several times, coupled with the big problems with my lover and my way of getting along, the thought of "wanting to die" gradually appeared in my mind. At the same time, my sense of responsibility for my parents reappeared, holding me back again. I know that depression is knocking again. But this time, I have confidence in my heart. I even comforted myself: "You want to die now, but this is only the result of changes in neurotransmitters in your brain under the control of the disease, as long as you take medicine and seek medical treatment, everything will be fine if the problem in front of you is solved." "I started asking for medicine again. At the same time, I opted for divorce, which was the uncontrollable factor I could think of for my illness. If I don't divorce but seek death for such a man, my reason tells me that it is very unworthy.
After the divorce, my ex-husband realized that he lacked awareness of my illness. The reason is also that I left him with the inherent impression of "sunny and cheerful". When I mentioned that I wanted to jump off the building, he encouraged me: "Then you can jump." "In his consciousness, I am an optimistic person, and I can't really seek death. He even told me an example: when he was a child, he cried, his parents beat him, and he stopped. He was treating me and his cathartic moments with the same attitude. I was amazed that he could be indifferent to life to this extent.
In fact, these are all dangerous temptations. Replace it with another "cheerful" person who may not be able to survive.
Nana's plant in a corner of her home. Photo courtesy of interviewee
In the face of depression, "sunny and cheerful" is perhaps the most lethal evaluation
Many people will summarize the depression of cheerful people as "smiling depression", and I think this formulation is also problematic.
Many patients smile when they are depressed, in fact, it is a fake smile out of social etiquette, not a smile in the heart. But cheerful people before suffering from depression, in fact, it is easy to get joy and satisfaction from the heart, and it is easier to establish a connection with other people, which is not a concept at all with the so-called "fake smile".
Before I transitioned to major depression, I was still aware of positive emotions such as joy. Even during my first depression, I would still try to participate in some group activities and get some happiness from them, but this happiness was slowly dispelled by the shadows, and there were fewer and fewer moments of happiness.
But some cheerful people may no longer have their former energy in public after illness, but they may deliberately hide their weakness, which is possible.
I found a common denominator, many sunny and cheerful depressed people end up on a dead end, in fact, because of the superimposed pursuit of perfectionism. They hope to maintain a sunny and positive image in front of everyone, but many times they are already unable to do so, or even after taking their last breath, they cannot return to the original ideal state, and this sense of gap will make people desperate.
I want to express this feeling with "resilience of life". If a depressed patient still fights with the determination of "rather than broken jade" during the acute attack, the spring of life is pulled to the tightest, and it is likely to break instantly. At this time, if you can be more relaxed with yourself, you have to get by, but you will have more life and tenacity, but you can come over more.
The word "strong" is a positive character when a person is physically and mentally healthy, but it can be fatal for people with depression. So you must not use "be strong" to comfort friends with depression around you.
It is precisely because I have seen too many such cases that I am also making adjustments, and my standards for myself have changed from "excellent and thoughtful to friendly" to "casual and happy".
At the same time, I found that during the illness, my lively and cheerful personality did not help me get out of the disease better. Because in the time of extreme depression, the personality of an optimistic and cheerful person has actually been suppressed, he is no longer under his control, and he is even more unable to be optimistic about the things around him, does not want to see people, does not want to talk. Therefore, we should not have higher expectations for the self-healing ability of outgoing, cheerful and depressed patients, which often harms them.
In the past, I saw unscientific evaluations of depression in outward personality people on the Internet, and I always couldn't help but go back, but then I found that such prejudices can be seen almost everywhere, and I didn't bother to fight back one by one. But on certain occasions, such as doing interviews or doing popular science in the live broadcast room, I still have to say.
The public's cognitive bias often exacerbates the stigma of people with sunny and cheerful personalities, and deepens their doubts about themselves. If the relatives and friends around you also think about the problem in this way, thinking that an optimistic person has an abnormality, but he can't think about it for a while, he is shocked, and he is relaxed, which is likely to delay their diagnosis and treatment.
Nana's plants and ornaments in the corner of her home. Photo courtesy of interviewee
Since my second relapse and recovery from depression, I have embarked on a path of inner self-exploration in the past ten years. I began to buy psychology books of various genres, and in 2015, in order to make me better "self-help", I obtained a professional certificate of psychological counselor level three. At that time, I did not take this certificate to help others or professional needs, but to have more methodology to explore myself and explore why depression chose me. In 2018, I also joined the mutual support community of people with depression to "get by" and became a "companion" who helps other patients.
At the same time, I started to really become a counselor. And from the hundreds of depressed patients I actually contacted, it is really difficult to classify in terms of personality, occupation, and age. Some of them are introverted and less talkative, and many are good at socializing, cheerful and lively. To use an analogy, would we think that a fat person is more likely to catch a cold than a thin person? In fact, depression is also true for people with different personalities, all of whom have the probability of getting sick.
The causes of depression are very complex and comprehensive, and even if the medical field has studied for so many years, there is still no standard answer. But to be sure, there is no saying which personality people are more likely to get depression. Such a generalization is disrespectful to every sick individual and is very rude.
What can I do in the face of a life that is ready to leave at any time?
Not long ago, we got together for the 20th anniversary of high school. At that party, many of us thought of a female classmate who had left this world. She was my classmate after returning from school from depression, the top child in the class, and she was also very outgoing. But in her junior year of high school, she developed depressive symptoms similar to mine.
The year I went to college, she returned to her hometown to repeat her studies, and soon after heard the news that she had jumped into the river to kill herself. I also heard that since she had depression, her family has been very incomprehensible. Until she left this world, her parents still blamed her for her choice. This makes me embarrassed.
I used to analyze my own medical history. I can persist to this day, in fact, there are many inevitable factors in it.
Every time I have an illness, my home environment and work environment are helpful to me. For example, during my first episode of adolescence, my mother took me to live in a large house with a yard at the house of a good friend of hers, to avoid being disturbed by visiting classmates. Here, I don't have a panic attack in front of a crowd, everything is very loose and free. She was right to do this, because many depressed people don't want to socialize when they get sick, and even feel suffocated.
During the time when I was most suicidal, my mother held my hand every day when she slept. As soon as I woke up, she woke up with her. When she realized I was really sick, she never questioned why I got sick. Instead, she would record my illness every day to see if there were signs of improvement.
When I was sick, my father's anxiety was also severe. My mother realized that his emotions could have a negative impact on me, so she left him alone, taking care of me closely.
Environmental factors can help depressed people dispel suicidal thoughts, and they can also become a driving force for them to go to a dead end. Because people are extremely sensitive at that time, many things will be magnified in their hearts.
I understand this feeling, so now when I do counseling, or when a patient confides in me that he wants to kill himself, I think how can I give them the support and companionship they need?
This is the time to listen to what they need, not what beliefs and values I want to give them. When many people persuade people with depression, the common phrase is "want to open up." This sentence is very unempathetic for the patient community. If a person really has the ability to open it himself, will he still get sick?
If we don't know how to comfort him, we can actually quietly accompany him and tell him: I know you are very uncomfortable. But don't say things like "It's not a thing" or "It's okay after it."
Some adolescent depressed patients suddenly contacted me and said, "Sister Nana, I swallowed my medicine and am on my way to the hospital to wash my stomach." "At this point, I will understand that she is signaling me for help, that she is scared and needs company. I wouldn't make any further comments about her suicide, but would say to her, "I've always been there, and you can contact me whenever you need it." ”
Many times, when a depressed person expresses "I want to die" to you, you should understand that being able to actively express "I want to die" is actually hoping to come out with the help of external forces. People who really die tend to silently plan these things and will not tell others about them anymore.
Not all patients who want to kill themselves can be retained by me. In the past ten years, my mentality towards this matter has also changed greatly. In the past, when a patient gave birth to a suicide, I would be very sad, and I would ask myself to make sure that they could no longer have death-seeking behavior, otherwise I would keep worrying about it and make myself uncomfortable. But now, after I find that my patient has suicidal thoughts, on the one hand, I must contact the emergency contact around me as much as possible, and on the other hand, I will not repeatedly confirm whether he no longer commits suicide after persuading him. All I can do is show up from time to time and let him sense that someone who understands him is by his side and can find me at any time.
If he leaves after I try my best, all I can say is that it's out of my control. I will also try to separate myself from this thing emotionally.
Recently, I found that a depressed netizen who had been in contact with me suddenly ran out of news. I went to greet me, and she told me, "Attempted suicide, lying in the hospital." ”
I was very touched in my heart, her personality is similar to me, a very lively and cheerful girl. Every time she had suicidal thoughts during an acute attack, she would come to talk to me, but why didn't she come to me this time to talk to me?
Her answer was: "I don't think there's much to say." ”
I instantly understood her state and told her, "I know you're in pain and want to give up, and there's no feeling of remaining." But I just want to tell you, I think about you, you are such a good person, can you try to keep more beautiful people like you in the world? I hope that the next time you are so difficult again, you will remember what I said, even if you can leave me a note. If I have this situation in the future, I will remember to leave a message with you. ”
After hearing my words, she burst into tears and promised me. At that time, we touched each other, and I had to tell her that there were still people in the world who remembered her, and that this might become a stumbling block for her survival.
It is easy to be "fettered" by these beautiful things to the pace of death, which may be a gap that was easy for people who were optimistic and cheerful to open, because we tend to pay more attention to the value of social relationships in our hearts. Because we have benefited so much from the warmth of human interaction, this will also become a kind of attachment to life.
Looking back on the 25 years of fighting depression, I am also amazed by one thing, my optimistic and cheerful personality has not been changed by depression until now, as long as the acute attack period has passed, I am still the Nana who can bring energy and laughter to the people around me. Perhaps, positive sunshine is the background color of my life. And the invasion of depression is a dark cloud that occasionally descends in my life. When the wind comes, there is always a time when it blows away.
Editor-in-chief: Wang Xiao Text editor: Wang Xiao
Source: Author: Yang Shuyuan, Zhang Lingyun, Wu Yuqing