Content warning: This piece discusses depression and suicidal ideation.

They say drowning doesn’t look the way we might expect. There’s no flailing or splashing or crying out for help. It’s a quiet, gentle slipping under, dangerously imperceptible to most of us.

Sink, surface, gasp. Sink, surface, gasp. Sink, surface, gasp until you just — sink.

It can be so subtle, in fact, that it’s not uncommon for children to drown within 25 yards of a parent or adult, simply because the violent warning signs we expect to see aren’t how the struggle really manifests. By the time we realize what’s happening, it’s too late.

How could we miss it? How could someone fighting for their life look so calm?

—

Depression feels something like drowning on dry land and I’ve been going under undetected for years.

People who consume a curated idea of me online may not know that I float in a much darker, murkier space inside my head. It challenges my relationships, hinders my work, wreaks havoc on my body, and, I’ve realized, intends to swallow me. And it has for a long time.

You wouldn’t know it. I look fine. Act fine. Say I’m fine. I help run a successful business. I travel frequently. I get invited to flashy events. I have money. I crack jokes. I drip privilege. I get it. By any external measure, I am thriving.

But drowning doesn’t always look the way we might expect, and this is a quiet, gentle slipping under. I’m fine. I’m fine. I’m fine. Until I’m not.

—

I’m not alone. One in five American adults will experience a mental illness this year.

Anxiety disorders are most prevalent, affecting an estimated 48 million people, followed by major depression, which drags more than 17 million of us under. Here in Mecklenburg County, 138,000 adults reported being diagnosed with depression in 2016.

The tricky thing about a sickness we can’t see that carries a stigma we can’t seem to shake is that it’s just so damn hard for us to talk about it. We bury it under the highlight reel of our social feeds, and behind the veil of put-togetherness at work, and we don’t even notice each other gasping for air.

Only 43 percent of U.S. adults with a mental illness received treatment last year, and many struggled for a long time before reaching for the life raft. The average delay between the onset of mental illness and treatment is 11 years.

Not surprisingly, the lack of access to mental health treatment disproportionately affects minority groups.

The surgeon general’s office released its first-ever report on mental health in 1999, and it concluded that racial and ethnic minorities have less access to mental health services and, when treated, are more likely to receive poor care than are white Americans. The disparity persists 20 years later.

LGBTQ individuals are more than twice as likely as heterosexual men and women to experience a mental health disorder. But according to the American Psychiatric Association, many of those affected will delay or avoid treatment because they’re worried about stigma and discrimination when accessing services.

And a severe shortage of mental health professionals in rural communities makes access to care difficult to impossible in some areas. In 65 percent of non-metropolitan American counties there is not a single psychiatrist.

Mine is the experience of an upperclass straight white woman in an urban metro, and it matters to place it within the context of the lived experiences of people who balance this kind of struggle with additional burdens I don’t have to face for reasons that are unjust.

—

The first time someone told me I was depressed I asked her to repeat it.

It was the summer of 2017 in the second session with my first-ever therapist. She said it so casually and with such certainty I had to stop her.

“You think I’m depressed?”

She explained that the things I was saying and the way I was feeling qualified as symptoms of major depression if they persisted for two weeks or more.

I laughed. I had felt this way on a measure of years.

I recently found a journal in my desk from April of that year. All it contains are four pitiful entries where I tracked my bedtime, waking hour, ability to get dressed, and mental energy. I had sunk deep, cutting off social ties and almost never leaving the house except to feed some stray cats.

I remember sitting with Ted at Joe & Nosh one day while he gently, patiently made the reasonable request that I please show up to the office every once in a while. Through tears that were a mix of shame, frustration, and confusion, I choked out, “I just… can’t.” And I didn’t know why.

The journal was probably a desperate attempt to figure out why these simple things were impossible for me, but I couldn’t even keep up with that.

Depression makes easy things hard to do. You fumble around your living room like you’ve never been there before. Tasks you once mastered feel new and difficult and at times insurmountable.

After the therapist finally put a label on my struggles, I felt an enormous sense of relief. It gave me permission to detach my sluggish behavior from who I am, and instead say it’s something I have.

It’s innately complicated to separate problems of the mind from the essence of the self. You aren’t cancer; you have cancer. Allowing for the same distinction in mental health is encouraging.

But it also made me a bit too cocky. Believing I had it all figured out after two sessions, I never went back to see the therapist. And I tanked. I isolated further, cut off all my friends, destroyed my relationships, and essentially torched my life. When the smoke lifted, there was nothing left.

Depression isn’t a scapegoat for my decisions. I accept responsibility for that. But it provided a soft, familiar landing at rock bottom. And that is where I found myself in 2019, in a hell of my own making with a monster that feeds off my misery.

Sink, surface, gasp. Sink, surface, gasp. Sink, surface, gasp.

—

Isolation is my drug of choice, and I’ve overdosed this past year.

Much of what I thought was self care to treat my depression ended up exacerbating symptoms of a disorder that thrives in my solitude.

Depression hates you. When it tells you to cancel those plans, ignore those texts, avoid human contact, stay in bed all day — it’s not helping you recharge to face another day. It’s bleeding you dry so you won’t even bother.

I can go days without seeing anyone except the concierge staff in my building, usually only leaving to walk my dog or run errands or show face at work. I’m active on social because I can do it alone and still feel like I’m making human connection. It really just pushes me away.

But like any drug, isolation feels good. It’s safe and familiar and I’m in control of everything. No one will ask me hard questions here. I can’t fuck up here. I won’t have to fall in love again here. And like any drug in excess, isolation can kill you.

I’ve never had a clear plan to end my life but I often wish I were dead.

That’s how I explained it to the first therapist I saw in the summer of 2017. It’s called passive suicidality, less an active desire to die and more a passive detachment from the will to live. It’s a symptom of major depression.

Passive suicidality might present itself as fantasizing about a car crash or simply hoping that you won’t wake up. You can allude to it lots of ways, all of them dangerous. Last month I told my psychiatrist, “I just don’t get the point.”

“Of life?” he asked.

Yes, of life. I don’t get the point of being alive.

We doubled the dosage on my antidepressant and he double checked to make sure I had his cell phone number.

—

When I was at my lowest earlier this year, a total stranger sent me a message on Instagram to let me know I deserved to be suffering.

I don’t disagree with her but I’ve got it under control. No one hates me more than I do.

I snapped back at her that it was a pretty careless thing to say to someone who in that moment wanted to die.

She told me I should have announced to everyone that I was suicidal. How else was she to know? After all, they say drowning doesn’t look the way we might expect, right?

So now it’s been said. Am I more or less worthy of a space to heal as a result?

Could we be gentler with each other without demand for a doctor’s note?

—

This past summer I enrolled in an intensive outpatient program at HopeWay, a nonprofit mental health treatment facility in south Charlotte.

Therapy essentially became my part-time job — three days a week, three hours a day, for a little over a month.

The campus is pretty with a trickling waterscape out front and a locked door that buzzes when you walk in. The building smells like cafeteria food for the inpatient clients and it made me feel sick the first day.

They gave me a binder filled with worksheets and my schedule — process group every morning, a rotating lineup of recreation therapy, art therapy and music therapy in the second block, and cognitive or behavioral therapy for the final hour. I wore a new shirt like it was the first day of school.

HopeWay was my life raft. Group therapy cracked me open. Pouring out the worst of me in front of strangers who met it all with empathy humbled me. Bearing witness to their struggles softened me. I got a psychiatrist. I got on antidepressants. I learned all kinds of techniques to help keep my head above water.

But it’s not an instant fix, and discharge wasn’t the end of the work. I see my psychiatrist monthly and my therapist every week. It’s a process but I am better equipped to work through it now.

—

The closest I ever came to drowning in water was my first and last sprint triathlon.

I’d never done an open water swim and was unprepared for the thrashing mayhem as real racers entered Cane Creek Lake around me. I don’t know if I was having a panic attack or if this is what drowning feels like, but within seconds I couldn’t catch my breath or move myself out of the pack or signal any of the rescue kayaks.

I was sinking and no one would notice.

The only thing I knew to do was to flip over and float it out on my back. The chaos cleared until it was just me and the sky and a rescue kayaker asking if I needed help. I waved her off and trudged along, alternating between a painfully slow surface level frog swim and frequent breaks to float.

I felt like I might die out there but I knew I wouldn’t. And although I was the last one out of the water, I wasn’t the last to finish the race. I gained momentum on the bike and run and was proud of my overall performance, pathetic swim and all.

I’m in the water right now, floating at best, and my therapist is hovering around in the rescue kayak letting me figure it out. I really feel like I might die out here but I know I won’t. If I can get to the other side of this there will be hills to coast down and dry pavement to pound. I’ll catch up again. It gets easier. It gets better.

I know that when we’re drowning we don’t make waves, but I intend to swim.