The Demons of Emmanuel Osagie

(depression and anxiety as told by someone who knows what the fuck he’s talking about)

Edvard Munch. Self Portrait with Cigarette. 1895.

When I ran into Emmanuel in the dining hall, he was already in the middle of an animated conversation with Katarina about how he had spent the last two days in a psychiatric ward. Apparently a friend of his had sent him there in a panic, thinking his life was in danger. (“I know what I’m doing,” he said, over and over again.) Emmanuel — a pre-med psychology major molded by depression and anxiety— spun a tale of hospital mismanagement and excruciating boredom, where he manipulated staff to get what he needed and finally get out. “Playing the game,” as he put it.

I sat down with Emmanuel and Katarina, intrigued. I heard only about half the story, but I was still hooked, for Emmanuel is the sort of person who sprinkles his words with that perfect amount of salt — not enough to be annoying, but enough to bring flavor to everything he says.

Katarina looked at Emmanuel in awe. She said, “Wow, I’ve never known what it’s really like to have a mental illness.”

I nodded in agreement, and said, “Like, the only reason I know anything about depression is because I talked to a friend with depression — while she was at a low point.”

Emmanuel turned to me and asked, “So what did you learn?”

“Um, that depression is kinda this general inability to feel feelings,” I floundered, “That it’s often related to panic attacks, and, like, it often makes getting out of bed really hard.” I shrugged. “I mean, I won’t claim I know a whole lot.”

“Good, ’cause you don’t,” Emmanuel said.

I sighed. “At some point, I need to learn more about depression and anxiety, from someone who actually knows what they’re talking about.”

“Want to start now?” Emmanuel asked.

“Sure.”

As Emmanuel started speaking, I pulled out my phone and began typing away, my carpal tunnel be damned.

“Oh, you’re taking notes?” he said, amused, “Well, then, let’s get serious.”

What is Depression?

So first things first, depression is not just sitting around and crying. Folks with depression are smart. They still do things. But emotions do become less of a thing. Everything’s all blah and grayness, nothing is fun, that sort of thing.

Like, you physically cannot feel happy. You know everyone else is happy, you know you should be happy, and you try to be happy, but nothing works.

Now, people can compensate (or even overcompensate) for a good while. But trying to feel happy when you literally can’t feel happy gets tiring, and when nothing works, that gets really frustrating. So you stop trying to be happy. You stop trying to do things. And you stop telling people you’re not happy, because you know that their advice will be total bullshit. People without a mental illness, they mean well, but they’re just going to say, “Oh, all you need to do is get out more!” or “How about you just eat more chocolate?” That shit doesn’t help.

Remember: This isn’t normal sadness. This is advanced sadness. Don’t try to tell people with depression what to do to feel happy again. They probably tried it, and it didn’t work. Listen, instead. Try to figure out what’s going on in their heads, because that’s as important for the depressed person as it is for you.

Now, depression has some friends: suicide, self-harm, and anxiety. Let’s talk about anxiety first.

Anxiety

There are a lot of reasons that people with depression also have anxiety. For example, maybe the brain is under stimulated, so the anxiety pops up to fill the gap.

You feel tense, hypervigilant, jumpy. You feel like something horrible is about to happen to you, but you don't know what or why. Like, one time in class, a girl just put her phone down on her desk. It made no sound, but I freaked the fuck out. Like, even now, if I wasn't putting a lot of cognitive control on myself, I would be shaking and crying.

Unchecked, anxiety leads to things like self-harm and risky behavior.

Now, you can feel depressed and anxious at the same time. They work independently of each other. But they're both really tiring. Anxiety, obviously — it takes a lot of effort to scan every little thing in the room for danger. And with depression, it's tiring because you have to keep doing things, no matter how hard it is to just get up. Example: I haven't brushed my teeth in, what, a week now? Even that is hard with depression.

How To Know When There’s a Problem

Katarina interrupted, “But how can I help?”

Emmanuel rolled his eyes. “Well, first you need to know whether there’s a problem — and how much you can actually do.”

One thing to check for is a lack of self-care. Are they dressed up today, do they have makeup on, or are they in sweatpants and a hoodie and looking like they didn’t shower in three days?

Another warning sign is if they’re not doing what they usually do for fun, or if they don’t go out anymore. Again, when you’re depressed, the things that once made you happy don’t make you happy anymore.

Also, if you ask them how they’re doing, and they say they’re fine all the time, take note. Depressed people generally don’t say they’re sad because they know that telling the average person that they’re sad won’t improve things.

Anyway, on to self-harm…

Self-Harm

Self harm is different for everyone. I'll give my story, but take it with a grain of salt. It won’t apply to everyone. Oh, but first…

Emmanuel rolled up his sleeves, revealing an array of partially healed cuts, old and new. He pointed at scars one at a time. “This one was when I was freaking out about a test two days ago, this one was because people were nice to me and I was still depressed, these two happened the day before I was sent to the psych ward…”

He noticed Katarina cringe. “Oh, I encourage you to touch it. It's a good learning experience.”

As I ran my finger across the cuts, Emmanuel said, “See? Ajey has the right idea. Now let's take a closer look at my right arm.”

There were three cuts across his right forearm, and one running down. They were at various levels of healing, but they were all eerily straight.

Emmanuel asked, “Do these look natural, like I had fallen?”

“N-no,” Katarina stammered.

“Why not?”

“If you had just fallen, t-the cuts would look much messier.”

“Good,” Emmanuel said. He shifted his arms. “Now let’s look at my left arm.”

Two smaller cuts were crossed together near his wrist. “Do these look natural, either?” Emmanuel asked.

I shook my head.

“Why not?”

“Because if they were natural,” I said, “then the cuts would be all over your arm, not just at your wrist.”

Emmanuel smiled. “Now you're learning,” he said.

Here's the deal. I do self-harm because it feels good. It offers pleasure and control. It helps me think clearly. Sometimes I use it as punishment because I think I deserve it, but most of the time, it’s just nice. Besides, it's hard to fight urges to hurt yourself. Often, fighting those urges hurts more than actually cutting. Self-harm is also usually related to a lack of self-value — it's easier to hurt yourself if you don't like yourself very much.

Me? I started self-harm with my fingernails, but that wasn't enough. I went to teeth, but that wasn't enough. Then I want to keys. They didn't cut the skin, but they left a mark for six hours or so. I liked seeing the marks. I’ve also used knives, screwdrivers — whatever gets the job done.

I usually self-harm in isolation, but sometimes I do it in front of other people. Hell, I could do it in front of you right now.

Now, let me be clear here: self-harm is not for attention. That is probably the worst thing you could say to someone with depression. But it‘s often a cry for help. How do you know? Well, 1) did they tell you, and 2) was it visible?

If someone wears weird Band-Aids, or has lots of small cuts, or says they fell, notice where the cuts are. Notice what direction they go. Look for designs: personally, I like doing hashtags.

For me, I cut my arms because it's visible there. It becomes that cry for help I mentioned. (Also, it's pretty easy to cut there.) Other folks cut on their upper thighs. It's easy to cut there, too, but it's also easy to hide, if you’re into that.

My therapist puts it pretty well: self-harm is like cigarettes. Sure, it's addictive and unhealthy, but it won't kill you (immediately), and in a pinch, it's a way of coping — especially when your drugs aren't working. Remember, folks: pain is free.

If someone you know is hurting themselves, there’s no point in taking things away (except maybe personal knives or bare razor blades). They’ll find something, and that something might be even more dangerous. Instead, your first step should be to ask them why. Understand why they hurt themselves, and go from there. Now, some folks want self-harm. It's a part of their life. They're much harder to deal with. Tell them to get help — there’s little you can do unless you’re professional.

Treatment: Drugs, Psychiatrists, and Psychotherapists.

Emmanuel reached into his jacket pocket and pulled out a small pill bottle with a white cap. Shaking it in his hand, he asked, “Why do depressed people take drugs?”

Katarina shrugged and mumbled something I couldn’t hear. I said, half to myself, “To stay alive.”

Emmanuel smiled to me. “Correct.”

He uncapped the pill bottle, laid the cap on the table like it was a bowl, and poured thirteen circular white capsules into the cap.

“This is lorazepam,” Emmanuel said, “It’s an anti-anxiety medication. I use it on an as-needed basis.”

He looked at the label on the bottle, which said to take one dose every other day. “Yeah, the label’s wrong. I’d better talk to my psychiatrist about that. Anyway, it starts to kick in within 20 minutes, it hits max concentration in about 2 hours, and it decays to half concentration — after which it loses therapeutic value — within 12–14 hours. This is good shit. Lemme tell you, when I got to call my psychiatrist after I got locked in that psych ward, this was the first thing I asked for.”

He smirked, an evil glint in his eye, and said, “You want one?”

Folks with mild or moderate depression can often get by with without medication, but if you have severe depression, you’re either medicated or dead. Drugs — when used correctly — are good, and people who take drugs are not weak or doing the wrong thing. Don’t you dare say that to someone.

A lot of these drugs can be prescribed by a primary care physician. Does that mean they know what they’re doing? No.

Psychiatrists, however, do know what they’re doing. They’re the ones people talk to when it comes to medications for mental illness.

Psychotherapists — therapists — are the ones who talk to you. The whole sit-on-a-couch thing. Long term healing happens here.

People with depression need both psychiatrists and psychotherapists — but sometimes, they can find one person who can do both jobs.

Your job, as someone who has friends with depression: know what medications your friends are on. And don’t let them overdose. I’m not talking downing an entire pill bottle at once, I’m talking four pills a day when the max is three. Those limits are there for a reason.

Another thing to remember: if your friend’s drugs aren’t working, they should be looking into other drugs. There are lots of options, and if one isn’t working, that’s no excuse to stop entirely.

Emmanuel had taken out his ID card and was running it up and down his arm in a sawing motion. Katarina motioned to the card and stammered, “A-aren’t you supposed to not do that?”

Emmanuel looked up and said, “No, I’m fine.” He put away his ID card. “But that was smart.”

How to Help

Again, this is not normal sadness. Your job as someone who is trying to help is simply to understand. Ask for specifics, let them talk, let them process their own emotions.

Don't just suggest ways to make them happier. Don't tell them they're being irrational. Don't get frustrated by what they say, even if it makes no sense at first. You cannot change their perspective until you understand their perspective. What you think will work might not work, and no matter how arbitrary the triggers for depression may seem, it's real for that person.

Of course, among depressed people, some people know what they’re doing and others don’t. I’m depressed, but I know what I’m doing. When I’m sad, I know why. But many folks don’t know how to dig into their own emotions as well as I do. Check for specifics. There’s a huge difference between “Hey, can we talk?” and “I need help, because X, Y, and Z.” And always be suspicious, even if that person knows what they’re doing. Reality for a person with depression can get kinda wonky. If they tell you not to be worried, be worried. Again, always ask for specifics. You have no idea how important the details are.

Don’t Offer 100%

Oh, and know your own limits, too. If you’re going to promise to always be there for that person, you had better always be there. I would rather know when I can’t ask you for help than ask for your help and have you flake on me. Think before you speak. For that matter, think before you speak in general. Good life advice.

Don’t offer help, and don’t ask what’s wrong, unless you’re prepared for what’s coming. Sometimes the triggers for depression aren’t sexy. It might just be a greeting card they took the wrong way. And sometimes it’s not just the mental illness — there are legitimate reasons to freak out, after all.

You don’t have to be the only person helping. In fact, you shouldn’t be the only person helping. It takes a village, folks.

And improvement is not a straight line up — it’s more like a sine wave. Ups and downs. Just because they’re getting help doesn’t mean they’ll be okay all of the sudden. Depression never goes away: it can only be managed.

Panic Attacks

Calm yourself first. Speak softly, speak in monotone. Never raise your voice. If they're comfortable with touch, touch. If they're not comfortable, well, you'll know pretty quickly.

Tell them to breathe. In for five seconds, out for six seconds. They will not want to do this. They will be bad at this. Make them do it anyway. Leave them down on the ground or on a bed, if they're comfortable. No shame in that. Give the drugs necessary to calm them down. ZzzQuil and Benadryl work, usually.

Panic attacks last anywhere from a few minutes to an hour, and they usually turn out okay. If they're not calm after an hour, and you're concerned they might die or get seriously injured, a hospital can sedate them. But that is a last resort. When in doubt, ask them if they think it's a good idea to go to the ER. Make sure they're in the loop, or else you may send someone into a psych ward that will actually do more harm than good.

“If you want to see a panic attack, ask. I'm holding one back right now,” Emmanuel said with an evil grin, “I usually hold myself under tremendous mental control. But I could drop all of that…right now. I could start crying without end, convince you I'm going to kill myself. Hell, I could go back to the psych ward right now.”

Katarina had pushed herself to the back of her seat, as if trying in vain to take cover from a lobbed grenade.

“I might just do it,” Emmanuel said, “It would be great practice for you two. At the very least, it would be pretty fun to watch you squirm.”

Emmanuel sounded like a man with a demon — a demon snarling, lunging at bystanders, but held back by an iron chain that Emmanuel might just…let go of.

“I think I should take some time to take in what I have learned so far,” I said, fumbling over my words, “Thanks for teaching me all of this.” I smiled nervously. I felt my heart beating near my collarbone, at a rate demanding fight or flight.

“Sure,” Emmanuel said, “Sometime soon, we’ll chat again. Better you learn from me than from some idiot who doesn’t know what they’re talking about.”