Two attempts to relieve myself: I am most afraid of hearing others say I am "smiling depressed". I have been suffering from depression for 25 years | Depression | Evaluation

Two days ago, Nana learned from a friend that singer Li Wen had left due to depression, and she used the words "awe inspiring" to describe it. As a post-80s generation, Nana was surrounded by the rhythmic singing of Coco Lee throughout her adolescence, and even performed on stage with her songs and dances in college. "I even thought about being someone as bright as her," she recalled.

Nana shared the Weibo content of Li Wen's second sister mourning her sister on her social circle, but there were still constant comments in the comment section, saying, "Really or not, does she look so cheerful?"

As a depression patient with a medical history of 25 years, Nana realized that behind this statement, the public's prejudice against depression still exists: many people still tend to exclude outgoing and cheerful individuals from the "susceptible population" of depression.

Guo Xiaoyun is the chief physician of Shanghai Mental Health Center. In her many years of outpatient experience, she has indeed encountered situations similar to "smiling depression". Their outward manifestations of sunshine and positivity, while their inner pains of illness are not exposed to people. A family member of a depression patient told her during diagnosis and treatment that the patient appeared to be in a good mood outside, but as soon as she returned home, she confined herself in the room and cried.

Dr. Tina Silverman, a psychologist at Cooper University Hospital in the United States, once pointed out that ordinary patients with severe depression may not be able to get out of bed due to severe physical and mental decline; In contrast, patients with symptoms of smiling depression tend to have more energy, and once they have thoughts of despair and suicide, they are more likely to take action and achieve success.

However, Guo Xiaoyun also explained that there is no diagnostic type of "sunshine depression" in medicine.

Depression is one of the major emotional disorders known as mood disorders. "The factors that truly affect depression may involve many aspects, such as genetics, social environment, physical diseases, endocrine system, major stimuli, etc." Guo Xiaoyun explained. In 2019, the first national epidemiological survey of adult mental disorders in China showed that the lifetime prevalence of depression in Chinese adults was 6.8%.

The morning after Li Wen left, Nana's WeChat group bombarded with various analyses of Li Wen's state before her death: some believed that Li Wen's hearty laughter in front of the camera in the last two years was a cover up and last resort, while others believed that she, who was naturally outgoing, was just "not thinking about it for a while and didn't hold on.".

As a senior patient and licensed psychological counselor, Nana is unwilling to make such speculations and analyses. "I understand her state of mind when she left, it was really a kind of liberation. A depression patient who commits the act of death is mostly not a momentary thought, but has been struggling and working hard for a long time, which is really energy exhaustion and unsustainable. At this time, an outgoing and optimistic personality can no longer help these people go out."

Here is Nana's self narration.

Narrator: Nana Age: 43 Occupation: Company employee, community psychologist

Sunshine type depression patients with two attempted suicides

At the age of 17, one day after taking a break from school due to my aversion to learning, I had no strength to get up from bed. I declared to my parents, "I don't want to live anymore. I'm going to die. You guys should live well."

Before announcing my intention to commit suicide, I never expressed my depression to them. When I said this sentence, I didn't even know what qualitative change had happened to myself. I used to be a cheerful daughter that my parents were proud of. One of my biggest motivators in my past life was to make my parents happy. But at that time, all the words I said came from my heart.

In my understanding at the time, I couldn't live a normal school life anymore. I have become a burden and waste to my family, and my life is of no value.

This outbreak came very violently, with a threat of death. This is also the first time my mother realized that it was time to take me to see a doctor

For a long time during my sophomore year of high school, when I was diagnosed with severe depression, I kept thinking about a question: it was unreasonable for this to happen to me.

Like Li Wen, I am a person with a particularly sunny and outgoing personality in the eyes of the outside world. During my teenage years, I was excellent, with a strong sense of morality, intelligence, physical fitness, aesthetics, and labor skills. I was also particularly enthusiastic about participating in various group activities.

Until one day, I found that I became easily fatigued during class and my thinking slowly became sluggish. This is an early symptom of depression, but at that time I was completely unaware that it was my own problem. I always felt that with hard work, I could overcome it. Just like before when I had a cold and fever, I would hold a bottle in one hand and do homework in the other.

Contrary to my wishes, my symptoms worsened after about three months. I slowly lost my mobility and lay in bed all day without wanting to go to school.

I try to seek help from people around me and confide in my most trusted teacher. That teacher encouraged me in her way at the time, but it hit me hard. She said at the time, "People have to rely on themselves..."

The teacher's reaction cannot be blamed on her. After all, more than 20 years ago, our school education had very limited understanding of adolescent depression.

But I was completely hopeless at that time. I sent out a signal for help because my self-regulation system malfunctioned, but the teacher's message was that I didn't make an effort to persevere.

Later on, I became even more depressed. My mother took me to the local psychiatric department for treatment. There is no specialized hospital for mental illness in our local area of Leshan. At that time, the doctor at this comprehensive hospital gave me the diagnosis: "This child's life is over." The doctor prescribed a bunch of medicine for me, but it didn't work and the side effects were particularly severe. Later on, the whole person was in a state of dizziness and lack of clarity.

During that time, the only thought I had was wanting to die. Although I haven't taken action yet, I have already started planning this matter. For example, I would think that I cannot get sleeping pills, and I am hesitating whether to jump off a building or jump into a river. At the same time, I thought of the despair and collapse my parents felt when they saw my body, and also hesitated. I thought I could hold on for an extra day.

What is the feeling of seeking death due to depression? For me, who fell ill at the age of seventeen or eighteen, death meant liberation and the end of everything.

This kind of torture is dual, both psychologically and physiologically. Every day, I feel flustered, headache, nausea, trembling and trembling. When it hurts, I feel like hitting walls and pulling my hair. Every minute and every second, it feels like someone is cutting your flesh with a sharp knife. But I went for a physical examination and didn't find any problems.

At that time, I was not living for myself, I was persevering for my parents. I would even think that if there were a devastating earthquake that buried me or a fire that could free me from the guilt that suicide brings to those around me, it would be the most in line with my wishes.

As an adult, I have come into contact with many patients with depression, and I have found that many patients experience similar physical and mental pain when they have suicidal thoughts.

Seeing me deteriorating, my parents decided to take me to the mental health center of West China Hospital, the best psychiatric specialty hospital in our province, for medical treatment. The journey was bumpy, with four or five different doctors constantly changing their dressing.

Actually, before seeking medical treatment in West China, my suicidal thoughts never stopped. My idea at the time was: whatever medicine I was supposed to take, I would close my eyes and take it, so that I could finally show filial piety to you. If I have taken all the medicine that I was asked to take and it still doesn't work, then I have fulfilled all the filial piety I should have. I will leave one day when I should

But miraculously, as I persisted in my final performance, the efficacy gradually emerged. My thinking has changed, and my desire to die is slowly decreasing.

The time I wanted to commit suicide in a day increased from 100% to 90%, gradually only 50% or even 20%. Later, I only occasionally had suicidal thoughts... Half a year later, I returned to school. In order to alleviate my anxiety, my parents decided to demote me to a new class. At that time, my teachers and classmates were really tolerant of me. I often could only sit for one or two classes a day and would run home crying, but no one regarded me as an outsider for this. After about another semester, my social function gradually recovered and I was able to study normally as before. I have returned to that enthusiastic and cheerful state, even shining in the eyes of everyone. Although my grades dropped from the top three in the class to over ten, my parents had no complaints or demands from me.

Later on, I went on to study, work, and get married like an ordinary person, and everything went smoothly. I almost forgot about my experience of suffering from depression. But the dark clouds swept through me again after a few years of marriage.

In 2012, due to several illnesses and significant issues with the way my loved one interacts with me, the thought of wanting to die gradually reappeared in my mind. At the same time, my sense of responsibility towards my parents has reappeared, once again holding me back. I know, depression is knocking on the door again. But this time, I have confidence in my heart. I even comforted myself, "You really want to die now, but this is just the result of a change in neurotransmitters in your brain under disease control. As long as you take medicine and seek medical attention, everything will be fine." I began to seek medical attention again. At the same time, I chose divorce, which is one of the uncontrollable factors that I can think of for my illness. If I don't divorce but rather die for such a man, my rationality tells me it's not worth it.

After the divorce, my ex husband realized that he lacked awareness of my illness. The reason is also my inherent impression of him being sunny and cheerful. When I mentioned that I wanted to jump off a building, he actually encouraged me: "Then you go jump." In his consciousness, as an optimistic person, I couldn't really seek death. He even gave me an example: when he was a child, he cried and his parents would beat him up, and he would calm down. He is also using the same attitude towards me and his moments of venting emotions. I am surprised that he can be so indifferent to life.

Actually, these are all dangerous temptations. Changing to another cheerful person may not necessarily make it through.

The plant that Nana planted in a corner of her home. Respondents provide pictures

Facing depression, "sunny and cheerful" may be the most destructive evaluation

Many people tend to categorize outgoing individuals with depression as "smiling depression," and I think this term is also problematic.

Many patients smile when they are in a depressed state, but it is actually a fake smile from social etiquette, not a heartfelt smile. However, before suffering from depression, outgoing individuals are actually more likely to feel joy and satisfaction from the bottom of their hearts, and are more likely to establish connections with others, which is completely different from the concept of "fake laughter".

Before transitioning to severe depression, I still had the ability to perceive positive emotions such as joy. Even during my first time suffering from depression, I still worked hard to participate in group activities and gained some happiness from them. However, this happiness gradually dissipated by the shadows, and the moments of happiness became less and less.

But some outgoing individuals may no longer have their previous energy in public after falling ill, but they may deliberately conceal their weakness, which is possible.

I have found a commonality that many sunny and cheerful depression patients end up on the brink of extinction, which is actually due to the pursuit of perfectionism. They hope to maintain a sunny, positive and energetic image in front of everyone, but often times they are already overwhelmed, and even after taking their last breath, they cannot return to their original ideal state. This sense of gap can be very disappointing.

I want to express this feeling with the resilience of life. If a patient with depression continues to struggle with the determination of "it's better to break the jade than to ruin it" during an acute episode, the spring of life is likely to break instantly when pulled to its fullest. At this point, if one can be more lenient towards oneself and muddle through a bit, it will actually have more vitality and resilience, but it will be even more able to come through.

The word "strong" is a positive and positive character when a person is physically and mentally healthy, but for patients with depression, it may be fatal. So you should never use "being stronger" to comfort your friends who are suffering from depression.

It is precisely because I have seen so many such cases that I am also making adjustments myself, and my standards for myself have changed from "excellent, thoughtful, and friendly" to "casual and happy".

At the same time, I found that during my illness, a lively and outgoing personality did not help me better get out of the disease. Because during times of extreme depression, an optimistic and outgoing person's personality is actually suppressed. He is no longer under his control and cannot approach things around him optimistically. He does not want to see people or speak. So, we should not have higher expectations for the self-healing ability of depressed patients with outgoing and cheerful personalities, as this often harms them.

I used to see unscientific evaluations of depression among people with outward facing personalities online, and I couldn't help but argue back. Later, I found that such biases were almost everywhere, and I was too lazy to fight back one by one. But in specific occasions, such as conducting interviews or conducting science popularization in live streaming rooms, I still have to say.

The public's cognitive bias often exacerbates the shame and suspicion of sunny and cheerful individuals towards themselves. If family and friends around them also think this way and think that an optimistic person is experiencing abnormalities, it is just that they can't bear to think about it for a while and have been hit. Relax your mind, which is likely to delay their diagnosis and treatment time.

The plants and ornaments placed in a corner of Nana's home. Respondents provide pictures

Since the second relapse of depression and recovery, in the past decade, I have embarked on the path of inner self exploration. I started buying psychology books from various schools to read. In 2015, in order to help me better save myself, I obtained a Level 3 professional certificate as a psychological counselor. At that time, I was not taking this certificate to help others or meet professional needs, but to have more methodology to explore myself and why depression chose me. In 2018, I also joined the mutual aid community for depression patients and became a companion to help other patients.

At the same time, I began to truly become a psychological counselor. And from the hundreds of depression patients I have actually encountered, it is really difficult to classify them in terms of personality, occupation, and age. Some of them are introverted and reserved, while others are good at socializing, outgoing and lively. For example, would we assume that a fat person is more likely to catch a cold than a thin person? In fact, depression is the same for people with different personalities, and there is a probability of getting sick.

The causes of depression are very complex and comprehensive, and even after years of research in the medical field, there is still no standard answer. But what can be certain is that there is no mention of which personality traits make people more prone to depression. This kind of induction is disrespectful to every individual with illness and is very rude and impolite.

What can I do when facing a life that is ready to leave at any time?

Not long ago, it was our 20 year reunion after graduating from high school. At that party, many of us thought of a female classmate who had already left this world. She is my classmate who returned from school due to depression. She is at the top of the class and has a very outgoing personality. But in her third year of high school, she experienced depression symptoms similar to mine.

When I went to college, she returned to her hometown to study again, and soon after I heard the news of her jumping into the river and committing suicide. I also heard that since she suffered from depression, her family has been very puzzled. Until she left this world, her parents still blamed her choices a lot. This makes me very sad.

I have analyzed my medical history before. I have been able to persist until today, but there are actually many inevitable factors involved.

Every time I get sick, my family and work environment are always helpful to me. For example, when I first fell ill during my adolescence, my mother took me to a big house with a yard at a good friend's house to avoid being disturbed by classmates who came to visit me. Here, I won't experience panic attacks when facing a crowd, everything is very relaxed and free. She is doing this very correctly, because many depression patients do not want to socialize when they are sick, and may even feel suffocated.

During the time when I wanted to commit suicide the most, my mother held my hand every day while sleeping. As soon as I woke up, she followed suit. When she realized that I was really sick, she never questioned why I got sick. On the contrary, she will record my illness every day to see if there are any signs of improvement.

When I was sick, my father's anxiety was also very severe. My mother realized that his emotions could have a negative impact on me, so she set him aside and kept her alone to take care of me.

Environmental factors can help depression patients dispel suicidal thoughts and also serve as a driving force for them to reach a dead end. Because people are extremely sensitive at that time, many things are magnified in their hearts.

I understand this feeling, so now when I do psychological counseling or when a patient confides in me that they want to have a suicide, I always think about how I can provide them with the support and companionship they need?

At this point, it should be listening to what they need, rather than what kind of beliefs and values I want to give them. Many people often use the phrase "think big" to persuade patients with depression, which is very lacking in empathy for the patient group. If a person really has the ability to think on their own, will they still fall ill?

If you don't know how to comfort him, we can actually quietly accompany him and tell him: I know you feel uncomfortable. But don't say things like "it's not a big deal" or "it'll be okay after it's over" to him.

Some teenage depression patients suddenly contacted me and said, "Nana sister, I swallowed medicine and am on my way to the hospital for gastric lavage." At this point, I would understand that she was sending me a signal for help. She was afraid and needed companionship. I won't make any further evaluation of her suicidal behavior, I will say to her, "I've been there all along, you can contact me anytime you need me."

Many times, when a depression patient expresses "I want to die" to you, you should understand that being able to actively express "I want to die" is actually hoping to use external forces to come out. Those who truly face death often silently plan these things and will no longer confide in others.

Not all patients who want to commit suicide can be saved by me. In the past decade or so, my attitude towards this matter has also undergone significant changes. In the past, when a patient committed suicide, I would be very sad and would demand that I make sure they no longer engage in suicidal behavior, otherwise I would keep thinking about it and make myself uneasy. But now, when I find that a patient has suicidal thoughts, on the one hand, I need to try to contact the emergency contact person around me as much as possible, and on the other hand, I will not repeatedly confirm whether he will no longer commit suicide after comforting him. All I can do is appear from time to time, making him feel that someone who understands him is by his side and can always find me.

If he still leaves after I have tried my best, I can only say that it is not within my control. I will also try to separate myself emotionally from this matter.

Recently, I found out that a depression netizen who had been in contact with me suddenly had no news. I went to greet her and she told me, "Suicide attempt, lying in the hospital."

I am deeply touched by her personality, which is very similar to mine. She is a very lively and outgoing girl. Every time she has suicidal thoughts during an acute attack, she always comes to me to confide in me, but why didn't she come to me to confide this time?

Her answer is: "I don't think there's anything I want to say anymore."

I instantly understood her state and told her, "I know you are in pain and want to give up. There is no sense of retention left. But I just want to tell you that I miss you. You are such a good person, can you work hard to leave more beauty like you in the world? I hope you will remember the words I said the next time it's so difficult, even if you can leave a message for me. If I have this situation in the future, I will remember to leave a message with you."

After listening to my words, she cried uncontrollably and agreed to me. At that time, we were touched by each other, and I had to tell her that there were still people in this world who cared about her, which might become a bond for her to survive.

It is easy to be bound by these beautiful things and walk towards death, which may be a gap that once optimistic and cheerful people easily opened up, because we often pay more attention to the value of social relationships in our hearts. Because we have benefited so much from the warmth of human interaction, it can also become a kind of attachment to life.

Looking back at the 25 years of fighting against depression, I was also amazed by one thing. My optimistic and cheerful personality has not been changed by depression until now. As long as the acute phase is over, I am still the Nana who can bring energy and laughter to people around me. Perhaps, positive sunshine is the foundation of my life. The invasion of depression is an occasional dark cloud in my life. When the wind comes, there will always be times when it blows away.