There is a crack in everything, that's how the light gets in

Content note: this post deals with suicide and suicidal ideation. If you’re not up for that today, I totally understand and take good care of yourself. I also swear a lot in this post, because depression and suicidal thoughts deserve all the curse words, so maybe don’t read it aloud in front of young children.

This afternoon, I got out of a more intense telehealth therapy session than usual, where I opened up to my new CT-based therapist about the intrusive thoughts I’ve been dealing with and some past experiences related to them (and received excellent care), and opened Twitter for a brief mental break before diving back into work. I then saw the news that a beloved New York Times reporter “suddenly died this morning after a long and courageous battle with depression.”

You know what that means. So do I. And it stirred up some feelings.

These days I feel pretty good. I am, as ever, a work in progress (aren’t we all?), and perhaps someday before I die I will work up the courage to go on dates with amazing women, tell my savior complex to chill out, and cook dinner for myself more often than I get Uber Eats or fast food, but these are relatively small potatoes. I manage my depression and anxiety with Lexapro, weekly therapy, support from people I love beyond measure (both biological and chosen family), and a toolkit of coping strategies I’ve developed with help from therapists and others over the years.

But I know what it’s like to feel a lot worse. What it’s like to feel so horrible I’ve contemplated taking my own life. And I know what it’s like to lose friends and family to this goddamn fucking horror show of a disease.

I wanted to write a little about this from a couple of angles. One of them, which I’ll start with, is what kind of support from other people helped me in my lowest moments. Then, in case anyone reading could use it, I’ll share what helped me get through the dark nights.

Extremely important note: I am not a mental health professional. These are things that helped me, and I share them in the hopes that they may help someone else, but I cannot tell you what will or won’t work for you. (But if you need someone to call mental health professionals for you and get you in to see someone and find a treatment plan that works for you, I will absolutely help you with that.)

How to help someone else

One of the most well-intentioned but absolutely useless phrases you can say to someone like me is “Let me know if there’s anything I can do to help!”

I don’t mean this as an insult. It’s a wonderfully kind gesture to want to help someone who is struggling, and I fully understand wanting to help but not knowing what to do. (Been there!) But here’s the problem: a combination of my own neuroses from some suboptimal life experiences and the absolute asshole that is depression brain make it very hard for me to follow up on such an offer by asking for something. I feel like I’m being a burden by asking for something that they can’t or don’t want to give - and even if it is something the person would be delighted to do for me, I have a hard time believing it is when I’m going through it. So I’m not going to ask.

I’m working on trusting others and asking for help (see: therapy), and making bits of progress, but it’s slow. There is one thing my loved ones have done that helps break down that wall of resistance, though: offering something specific.

Specificity helps ease the guilt of needing to rely on others. (Yes, I know we all need each other and there should be no guilt or shame involved, but I will again refer you to depression being a total fucking asshole.) I feel a little better knowing that the help I’m taking is something that whoever offered it feels capable of doing and wants to do.

So what can you offer? Glad you asked! Here’s a definitely non-exhaustive list of things that might help a person in a mental health crisis. Think about what your person/people are most likely to need and what you can realistically offer, and pick your favorite or favorites. (And feel free to drop a comment if you have other suggestions!)

Then we get to the other part: when it’s been a little while since the crisis moment, check in with your loved one and see how they’re feeling.

One of the best articles I’ve ever read, from several years ago, is this excellent (very long, but 100% worth it) Huffington Post piece detailing an unconventional but effective method suicide prevention researchers have found. Jerome Motto and his team simply sent form letters to patients who had previously attempted suicide, reading “It has been some time since you were here at the hospital, and we hope things are going well for you. If you wish to drop us a note we would be glad to hear from you.” with space to write a response and an addressed envelope. They sent 24 letters over 5 years, with slight wording variations but following the same basic structure.

It worked. Motto’s experiment cut suicide rates in half compared to a control group of attempt survivors who didn’t receive the letters.

One of the participants, discussed in the article, wrote back “You are the most persistent son-of-a-bitch I’ve ever encountered, so you must really be sincere in your interest in me.” Motto and his research team called that the “bingo letter” - encapsulating exactly why the experiment worked. The letter, as plain as it was, provided proof that someone cared about these people.

I’ve gotten “Hey, I know you were struggling (a couple weeks/a month/whatever amount of time) ago, how are you doing now?” messages and I am not exaggerating when I say they mean the world to me.

Getting better is really hard. I now count the time since I’ve been suicidal in years, and I’m still working on it. And one of the darkest thoughts that can pop up, one that depression brain loves, is that no one really cares about me or loves me. A simple “hey, I’m thinking about you, hope you’re doing okay” message, no matter if it’s from a close friend or someone I barely know, is tangible evidence that depression brain is full of shit, that I am cared for and loved.

If I ever win the lottery, one of the things I will do is fund researchers and professionals trying to replicate this approach, trying to find a way to do it at scale. In the meantime, I’m just going to tell everyone I can about it in the hopes it helps someone. You don’t have to have the perfect words to reach out. You just have to care.

How I got myself through the worst of it

I am alive today in part because of a swing and a cigarette and in part because of busy season at work. I will explain.

Senior year of college, I was really stressed out. I’d spread myself very thin with jobs and an internship, I was skipping my classes and doing poorly in them, I wasn’t eating particularly well since I’d gone off the campus meal plan, I didn’t have a full-time job lined up, and my driving anxiety meant I didn’t yet have a license and therefore wasn’t eligible for many jobs. I was increasingly anxious as graduation neared, and one early spring night I decided I was going to go to the convenience store where I usually got Diet Coke and snacks for late-night essay writing, get some sleeping pills, and take them with a bottle of wine.

I had to walk by Mirror Lake on UConn’s campus to get to the convenience store. There are a couple of swings hanging from a tree overlooking the lake. Usually in nice weather, people will be sitting out there and using the swings, but I was going around 1 or 2 AM and it was deserted. I don’t know exactly why, but for whatever reason, I decided I was going to sit on that swing before I went to the convenience store.

I swang for a few minutes and felt like a little kid, in a surprisingly good way. After that, I had a pack of cigarettes in my purse (I know, I know, I don’t smoke anymore) and lit one while looking out at the lake. I took a few more swings after I finished my cigarette and decided that I didn’t really want to get the pills and I should probably go back to my dorm and try to sleep, so I did.

I graduated with a 3.0, even with the thoroughly mediocre senior year grades. I got my license, and a job, and another job in DC. It was okay in the end. I had no idea how any of this would turn out while I was on that swing, but it didn’t matter. I needed a moment to do something I liked and remember that, even if I didn’t know how to get all the way out right then, there were still good things. That’s what it took to stick around and figure out the rest.

So let’s fast-forward to 2018. I’d been prescribed Qsymia, a weight-loss drug that includes a stimulant and appetite suppressant. Problem is, stimulants are actually really terrible for people with anxiety. At first, I was thrilled at how easily I could wake up in the morning, but I quickly found I had trouble sleeping at night. I no longer had a therapist and was struggling to find one that would accept my health insurance. Work was ramping up - this was June of an even year and my biggest clients were all keeping me busy. My impostor syndrome kicked into overdrive. I was 100% convinced that my bosses would find out I didn’t know what I was doing and fire me. On a couple occasions, I would start crying at work and go hide in the bathroom, praying no one would notice. I made plans to go to Asheville for my birthday on a whim, not really out of wanting to go explore a new place but just feeling like I needed to escape.

One Thursday night, I was staring at a memo for an important client that I’d promised my boss that day, so he could approve it and we could get it proofed and out the door before the quasi-holiday weekend. I’d made myself an outline and it only needed to be a couple pages, but the words just weren’t coming. Around 8 PM, I admitted defeat and left the office to catch the bus home, dwelling on how awful I was during the 45-minute ride home. At the time, my bus stop was across the street from my apartment, and as I waited at the crosswalk I started wishing a car would run the red light and hit me.

I was scared of that thought. I knew then that something had to change, but I didn’t know what to do. I spent a couple hours crying and worrying, knowing I needed help but not knowing how to ask for it or who to turn to. And then I had the thought: “If I don’t get help, if I end up killing myself, I’ll leave all this work to my coworkers and that’s just not fair.”

I mean, really. That has got to be the dumbest fucking reason anyone has ever decided not to die. Like work matters at all when a life is in the balance.

But it worked. I put out the bat signal on social media and was greeted with love, support, and offers of help. I told a coworker I needed the next day off and we talked for a while, some practical things about how it would go at work but also distraction. My friend and I figured out how I could get in to see a doctor quickly and get stabilized. I stopped taking the weight-loss meds and got on Lexapro, and later left the doctor who prescribed them to me, and found a therapist I worked with for over three years.

I don’t know what it is for you that motivates you to stay alive. But here’s the thing - it doesn’t have to be something big or something that solves all your problems. Suicidal thoughts are sometimes described as what happens when your issues exceed your ability to cope. I didn’t, and you don’t, need to fix all those issues to make it worthwhile to stay alive. I needed to increase my ability to cope just a little bit, just enough to make it through the night and find the help I needed to make long-term improvements. And I’m not the only one - of all things, there’s a Cracked article that I revisit once in awhile about tiny things that stopped suicides.

I’ve found a few things help when the depression and anxiety spiral hits, and these days I can recognize the spiral for what it is before it reaches “I wish a car would hit me” levels of darkness and break into the toolkit a little earlier. This is for me, everyone is different, but maybe something in here will help you.

I try to remember the last time I ate something, and if it’s been a while, I do my best to have a snack. It does not have to be healthy. It does not have to be any particular type of snack, just something I can eat when I feel horrible.

I splash cold water on my face. I have no fucking idea why this works, but it does for me. One of the techniques Ursula Whiteside suggests on her suicide prevention site Now Matters Now (I have it bookmarked, just in case) is to plunge your face into a bowl of ice water. I’ve tried this and found it to be too much for me, but the cold water does the trick.

I curl up with my dog. She’s snuggly and warm and will take extra care to lick my face if I’ve been crying. I know the latter is probably a natural impulse, but it makes me feel loved and reminds me that I need to care for myself so I can stick around for her.

I have a playlist I listen to. I can’t do happy songs when I’m feeling that low, the mismatch just makes me feel even worse, but it’s also not necessarily great to wallow in the really sad stuff. So I’ve picked out gentle songs that are soothing and maybe a little melancholy, but also optimistic. Mine is very specific to my taste, but you might enjoy making your own.

I try to get myself to go to bed, even if sleep won’t come for awhile. A lack of sleep is perhaps my greatest enemy when it comes to mental health. I can’t think clearly on insufficient sleep, making it harder to work through intrusive or anxious thoughts, and it makes it harder to do other things to take care of myself because I feel tired. So I take melatonin and my meds, get into bed with Molly, cocoon myself in my huge comforter until I feel warm and cozy, and watch something on YouTube that I could fall asleep to but will be a little bit of a distraction if I’m still awake and struggling for awhile. (I know it sounds weird, but Fall of Civilizations is really great for this.)

I tell a friend or post on social media that I’m struggling. It helps to be honest. Sometimes those friends can provide something tangible to help or hear me out as I work through something I’m struggling with. Sometimes I just need to hear that they love me. I know they do, but depression can make it so easy to forget.

I hope that if you need it, any of the above helps you even a little, or that you’re able to find the little things that do work for you. I don’t know who you are reading this, but whether you’re someone I’ve known all my life, an acquaintance I don’t know that well, or a stranger who found one of my salty tweets about politics or Formula One and decided to investigate, I care about you and I want you to be okay. You deserve good things. And if you need help to get through a tough day, I hope you reach out - to me, to someone you love, to a professional, to anyone. You are loved, you are deserving of that love, and we need you on this side.