My Mask Is Stuck

Choosing a therapist is tricky. There are so many considerations: gender, age, style, location, insurance network, availability, and would you like drugs with that? Then, you need to have a session or two before you can even begin to decide whether or not you made the right choice. If so, great, but if not, then it’s back to square one.

But, there’s another side to therapy: the person receiving the treatment. More specifically, I mean me.

Therapy depends as much on the person receiving the treatment as it does on the one giving it. A patient’s ability to share information honestly will have a huge impact on the results. Yes, an observant therapist can read between the lines and ask the right questions, but ultimately, what the patient shares is up to that patient.

I started seeing a new therapist a few weeks ago, my third since starting therapy about four years ago. So far, it’s very promising. She managed to cut through a lot of garbage pretty quickly and give me some completely new insights. It is my sincere hope that I can be honest and share the right information with her.

In the past, that hasn’t always happened, and it doesn’t come naturally to me. For one thing, there’s a lot more that happens in a week than can possibly be shared in 45 minutes. Most of it is irrelevant (I made a sandwich. I put mustard on it. The bread was a little dry. I added bread to the grocery list.) But what about the rest? It can be very difficult to choose what to share, which stories are most important, and what relates to the topic we last discussed.

Even more limiting, there’s my own personal editing. After years of carefully selecting what I tell (and don’t tell) my friends and family, of pretending to be “fine, just tired,” I’m not always sure who or what I am. Am I feeling pretty good, or just less terrible? I’m not as well-adjusted and content as I want everyone to believe, but am I really as screwed up as I think I am? How much of this is me and how much is the mask I wear and how much is there even a separation?

Then of course there’s the big question: if I actually tell my therapist everything, am I going to be tossed in the loony bin forever? Or, perhaps even worse, will she come to the conclusion that there’s nothing wrong with me at all?

I want my therapist to think well of me. I care what this complete stranger getting paid to listen me thinks about me personally and professionally, so I try to put a positive spin on everything. I’m so desperate for adult conversation that I want to keep it fun and light. I want my individual struggles to be meaningful, so I try to choose my deepest thoughts to share. I want to get better, so I try to include what I think is important, but I also want to edit out my most embarrassing thoughts.

It would be so much easier if I could just be myself all the time, but I can’t. I’ve already alienated so many important people in my life that I can’t stand the thought of losing any more. So, I wear my happy mask.

Generally, this is harmless, at least to others: small talk with the cashier or a friendly chat with a neighbor. These times are enjoyable and a chance to give normality a try. When a stranger asks, “How are you today?” they rarely are looking for an in-depth answer, so it’s an opportunity to not give one.

With friends and family, it can be more insidious. It starts innocently enough: glossing over a few details, not mentioning a new medication. But, the more you don’t talk about it, the easier it becomes to not talk about it. After a while, you never talk about it, except in therapy.

But what happens when these habits creep into therapy sessions? That’s what happened to me. I grew so accustomed to not talking about it that I started not talking about it in therapy. Oh, I still talked about my depression, but I polished it first. At that point, therapy—arguably the most important tool for treating depression—became essentially useless to me.

Now I have a chance to start fresh again, and I hope I don’t blow it.

An Image Problem

One of the biggest challenges facing those of us who struggle with depression is a complete lack of understanding from our friends, family, and the public at large. Depression is not seen as an illness, it’s seen as a mood. We try to explain, we cite facts and figures, but most people just don’t get it. When all is said and done, they assume we could snap out of it if we would just try a little harder or look at a rainbow.

A big part of the problem is the name: depression. In addition to being the name of a clinical diagnosis, it’s the name of an emotional state (as well as a dent, a weather phenomenon, and an economic issue). Most dictionaries list the emotional definition ahead of the medical one.

Even when depression is seen as a clinical diagnosis, often it is still tied to an emotional state: a condition triggered by a major event. This incorrectly makes it seem temporary, like a mourning period, and something that will go away as soon as the sufferer moves on or cheers up. While this is true in some circumstances, it’s not the standard.

Depression has an image problem. Imagine the reaction you’d get if you told someone you needed medication to regulate Non-binding Seratonin? Or that you were just diagnosed with Neurogenesis Deficiency Syndrome? That sounds like a disease anyone could get behind without passing judgment.

Another problem is the treatment.

The primary treatment for depression is therapy. Yes, medication can be involved, but it is almost always recommended along with therapy. Therapy carries all kinds of negative implications and social stigma. (This stigma is probably worse for men. We expect women to be a little crazy—“hysterical” even—but men are supposed to be tougher than that.) It’s open-ended. There is no cure, no finish line. Rarely is a patient considered done with therapy. Visits may become less frequent or even suspended, but it’s expected that visits could resume at any time. Progress is difficult to measure, and it’s nearly impossible to compare results between patients or providers.

It would be great if medication or surgery could provide a definite solution, or if depression could be quantified easily and tracked. We could tell our families that our checkup went well, and our blood depression level was down to 8.4%. Instead, we come home from therapy, shrug and say, “It was OK today. The new dosage seems to maybe be a little better. It’ll be hard to say for another couple of months.”

Depression is vague and fuzzy. Despite treatment, it can still come and go quickly. Our ability to discuss it with friends and family is limited by their understanding and our ability to articulate ourselves. Yet we must discuss it, or we run the risk of isolating ourselves even further. It’s a problem.