Own your own crazy, or risk losing it all

September 1, 2017

We know crazy in America. There are good forms of crazy, crazy like a fox (shrewd and crafty), and bad forms of crazy, bat shit crazy (histoplasmosis infection). You can be crazy as a loon (odd sounding bird), or a coot (another odd sounding bird), or cuckoo (what is it about birds?). One can be mad as a hatter (mercury poisoning), or a March hare (weird behavior during breeding season). People are sometimes crazy as hell, or crazy in love. I can certainly go “crazy on you”. A person can be a loco, mental, meshuga, or just plain nuts. They could also go around the bend and be better off in the bughouse, especially if they have bats in their belfry (because they are bat shit crazy). However, not all crackpots are certifiable; some are just cranky. In the end, It’s a Mad, Mad, Mad, Mad World.

With all due respect to Captain Jack (and really, just how much respect is he due?), self-recognition of craziness may not be a true marker of sanity. Sure, you can be depressed (or manic, or psychotic) and know it, at least at some level of awareness. It is more common however, to be oblivious to your own mental health problems. This is a serious question for my family, my friends and me. Perhaps 25 % of all Americans suffer from mental health problems distinct from addiction1. In my business, many disability claimants make mention of depression, anxiety and drug and alcohol abuse (DAA in Social Security parlance), and it seems like every one is treated for chronic pain. Across the United States, much of healthcare is devoted to, or complicated by, mental health problems and addiction. We know crazy: Are there any functional people left in America?

I worry about my own mental health. Craziness of all types runs rampant through our family tree (like squirrels looking for nuts). Depression can be genetic; some people are just not wired correctly2. I could be depressed: God knows I deserve to be depressed. However, depression can also develop in response to stress, or trauma, or illness. There has been a bit of stress in my life over the last few years. I am at risk for depression, but how do I sort out that diagnosis from a general, normal state of miserableness? Depression can develop slowly, over time, in response to a never-ending stream of crap3. Symptoms of depression can be subtle and variable, but your friends will often know that you have a problem. People with true mental illness make those around them uncomfortable.

People with active mental illness often have troubled relationships with family and friends. Loved ones may avoid them, or limit their response to disturbing behaviors. A string of failed or lost relationships may be a clue to the central individual’s illness. Occam’s razor, the choice based on the fewest assumptions is usually correct. Sure, your entire family could be unredeemable jerks not worth the time of day. It is much more likely though, that you are the problem. It’s you baby, not them; own your own crazy.

Still, the signs and symptoms of depression can be contradictory4. Escapist behavior can be a sign of depression. However, you do not have to be depressed to want to run away from your lousy life. Someone with depression may unwittingly try to self-treat through excess work, drink, socializing, and sex. Really? Extreme behavior is a sign depression if it deviates from normal habit. Otherwise, everyone in my Medical School class was depressed. On the other hand, brittleness of emotion is the one sign of depression that we all can recognize. Discussions become fights, happiness is dulled, self-esteem is lost, and you may laugh and cry regularly, or at the wrong time (inappropriate affect). I see some of that every day in my family and myself. I cry during sappy commercials, and movies, and songs, and I have a penchant for gallows humor. Maybe I am (at least a little) depressed.

Now you know, and knowing is half the battle (thanks GI Joe). Unrecognized problems cannot be corrected. We are all in denial. In the end, you need to talk about your problems, about your behavior, about your failures, about the odd course of your life. I am willing to talk, and write, about my hateful, unexpected circumstances. I may even accept a modicum of responsibility for who and where I am in life. I will undoubtedly continue to self-medicate. My equally depressed wife wants to run away. We can do better. Depression can be treated with counseling, cognitive behavioral therapy5, and medication. Anxiety6 also responds well to treatment7, just in case I am anxious about my depression. No matter what, I will take ownership of my disease, for my health, and for the health and well being of my loved ones.

1. Prevalence of mental illness in the United States: Data sources and estimates (Bagalman and Cornell, 2016). https://fas.org/sgp/crs/misc/R43047.pdf

2. Causes of depression (2017).

http://www.webmd.com/depression/guide/causes-depression — 1

3. Can you be depressed without knowing it? I was (Gillihan, 2017)

https://www.psychologytoday.com/blog/think-act-be/201705/can-you-be-depressed-without-knowing-it-i-was

4. 10 signs you’re depressed but don’t know it (Berglas, 2011). Forbes.

5. The empirical status of cognitive-behavioral therapy: A review of meta-analysis (Buller, et. al., 2006). http://www.sciencedirect.com/science/article/pii/S0272735805001005

6. What is generalized anxiety disorder (Richards, 2017). http://anxietynetwork.com/content/what-is-generalized-anxiety

7. Cognitive behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials (Hofmann and Smits, 2008).