“I could break my ankle walking out of here and I wouldn’t be covered. I could get cancer. I could get influenza. I could get all kinds of things but I get no coverage. Because I have depression. And that was the sole reason. There is no question that is the only reason I got refused.”3 At one job after another in both the public and private sector, Mary hesitates over the paperwork query asking whether she has depression. “I’ve struggled, really, with the thought of, ‘Jeez, do I really write that down?’ [But] I can’t bear the thought of not being honest. And if they find out you haven’t been honest they can void all of your coverage. And because I’m a single parent, I need some of it.”
The purpose of life insurance is peace of mind so the denial of coverage because you’re crazy is its opposite. Knowing you can’t afford to take time to heal if you need it makes for a state of perpetual insecurity.
So I sought out some of the voices representing Canada’s insurers (US giant Kaiser Permanente declined my request) and they emphasized that every case is unique. But the representatives I spoke with said it’s unusual for someone to be denied all coverage, for anything, because of one condition.
Insurance companies are not charities. They’re in the business of shielding themselves from financial risk. Life, health, disability or income-loss coverage can be denied if the potential cost is seen as being too high.
And often mental illness is too big a risk to stomach.
Insurers call it anti-selection—“a policy taken with the intent to benefit from it to the detriment of the insurer,” as Claude Di Stasio, former vice-president of Quebec affairs and holder of the mental health file at the Canadian Life and Health Insurers Association, puts it. Classic example: you buy home insurance, then set the place on fire. But what about when the harm you do is to yourself? Let’s say you apply for health or life insurance and you get it—either you’ve never been diagnosed with depression or you tell them about your diagnosis and they’re cool with it. Don’t even think about killing yourself for the next two years: your beneficiaries will get zero dollars. Insurers worry that people kill themselves as a ruse to bilk their carrier and get money for their family. (This is all, incidentally, a great way to ensure people never talk about the illness eating them up inside.)
“We’re trying to be clean and not discriminate, but we don’t want mental health people benefiting from claims they should not to the detriment of other people,” Di Stasio says.4
Trying to die or harming yourself without dying is also financially unwise. Many policies exclude self-inflicted injuries, so if you need income replacement or care that isn’t covered by the public system, you’re out of luck. If you want to try to get it covered, you’d have to prove not only that the self-inflicted injury is the product of mental illness but that there wasn’t really intent—that you didn’t know what you were doing.
Karen Cutler, the chief underwriter at Manulife, Canada’s multinational insurance company, tells me by phone that the company offers coverage to the vast majority of people who are mired in or have gone through depression. They’re looking for signs that you’re coping and stable—for upwards of two years, ideally—sussing this out through phone interviews, cover letters, questionnaires. “It’s no different than if we’re looking at someone with diabetes or high blood pressure. How much time has passed, are you taking your medication, are you controlling your symptoms?”5 Every plan and every situation is unique. As I write these words I am eyeing the little pill bottles paid for (thank the chronic illness gods) by my employer’s insurer. But if you have a history of being prescribed antidepressants, Cutler says, chances are you won’t get coverage for those antidepressants. If you have a history of missing work, changing jobs, or needing time off work as a result of your depression, you probably won’t get disability coverage or, if you do, it will be limited.
“And that’s just common sense. From a business perspective, it makes sense,” Cutler says. Being hospitalized for depression, even if it was multiple years ago, won’t count in your favour. But, she adds, “when we underwrite people we underwrite with the lens of, you know, ‘There but for the grace of God go I.’ Our goal is to try to offer coverage, not to try to find reasons not to offer coverage.”
DEANNA
Deanna Cole-Benjamin, who’d shared her story with me in the Kingston café, recounted how her suicidal ideation and her psychiatric hospitalization jeopardized not only her own health insurance, but her kids’—even after she received treatment that pushed her years-long grapple with depression into remission. “I was ‘too high-risk.’ They just said, ‘If we are not going to insure you, we cannot insure anyone in your family.’”6 She might have been tempted not to disclose her mental illness, Deanna says. But her employer already knew, because her crippling disorder rendered her unable to work for years, long after short- and long-term disability payments expired. She lost all her benefits and when she reapplied, her prior illness was already known.
That refusal played a role in prompting Deanna to seek work elsewhere. “It’s terrible. And you’re just contributing to that whole stigma: you don’t want to talk to your friend because you don’t know who your friend knows who might say something to somebody. That’s not right.”
MARY
Insurers aside, Mary’s gotten better at assessing how someone in her personal or professional life will respond to her disclosure. She’s had to. “There are always some people where, you know, ‘Maybe I’m not going to share this particular aspect of my existence with you,’” she said. “You pick up certain vibes around people” in how they react to difference and craziness in others—in the news, on the street, in the office. Even people who think they can deal with it, who say the right words, sometimes freak out just a bit.” I’ve had that happen. Friends, employers who make empathic noises, who convince me and themselves that they’re cool with crazy lady, suddenly ghost on me, or turn wary. “They don’t know how it manifests and they don’t know what they’re going to do. And I think that’s the more difficult piece….Like, ‘Are you going to turn into a serial killer?’”
Mary’s had depression used against her by romantic partners, “with the suggestion that ‘well, you’re weak. You’re the weak one, here. You’re crazy. You’re the one that’s the problem….It’s because you’re like this that everything is wrong.’ Which your brain is also telling you.”
She’s had co-workers who say she’s just too sensitive to handle the challenges and setbacks of everyday life. “That you don’t have the gumption for whatever’s going on. You can’t stand up for the tough fights….I can hear one particular voice, and it’s twenty years ago. And it’s such an affront.” The worst is the way comments like these reinforce your own self-loathing. “Depression is extremely isolating. And it’s self-isolating. Your brain starts to tell you nobody will understand.”
Then there’s the flip side. People still approach Mary for advice or just to talk to someone who knows what it’s like. “They want recognition that, you know, they’re in the same boat. It’s really an important touchstone to know ‘You understand my situation. I know you can’t solve it, but you understand it.’ They may not have anyone else who does.”
In her decades wrestling with depression, Mary amassed “an exceptional support network. I have more than a few people who are totally open to being there if I need it.” But she’s never tested that openness. She says she’s paralytically afraid of being seen as weak, afraid they will think differently of her.
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THE FEAR OF REJECTION, the sense that your very presence damages those you care about most, propagates emotional isolation. And the loneliness makes you crazy. You don’t notice till someone mentions your vice-like bear hugs. Then you realize you’ve been sending meaningless weightless messages to random people in the hopes of striking up an escapist exchange about nothing. You’ve been atomizing human contact: tightly interwoven fingers in clasped hands; the feeling of leaning sideways agains
t someone on a couch. You start weirdly wishing for time spent with dogs and babies—their social expectations are simpler, it seems; their methods of communicating affection more straightforward. How dumb is it that I, so priding myself on my independence and so prizing my solitude, can so graspingly need someone to talk to?
When I was a kid our family had a dog named Charlie. Gorgeous chocolate Lab. Shameless droopy begging eyes. Extreme affection. Unbelievable stupidity. He made a point of devouring the grossest things he’d find on walks—decomposing fauna, mostly; and seaweed, for some reason. He’d expel it hours later, one way or another, like clockwork. And on our next walk he’d do the exact same thing. Whatever synaptic connections are supposed to be formed to create memories and then retrieve them to inform future decision-making, that wasn’t happening.
Same thing happens to me when it comes to discussing pathological misery. I try it. It’s horrible. I vow never to do it again. Time passes. And inevitably the desire to vent is so great, the prospect of some measure of comfort so alluring, that sandy dead crab so tasty, I spill. I break the brittle shell holding everything together.
It’s not supposed to work that way. People say, “Tell me if I can help with anything”; “You know you can call me any time, right?” And don’t get me wrong: there are times I would reach out and feel truly heard, feel like I was grasping something solid for the first time in forever. And, believe me, I understand how soul-crushing it is to deal with severe, chronic illness in someone close to you. But just as many impulsive confessions I regretted. Usually because they led to unwanted consequences—a loss of liberty or the initiation of an intervention I wasn’t seeking, or a sudden social or professional distancing, the way you’d shrink from someone snuffling on a bus. But also because in my most selfish moments I didn’t consider what the confession that brought me relief would do to the person on the receiving end. Even if they didn’t shun me or call the cops, I caused them distress and made them feel obliged to fix something that wasn’t theirs to fix. (My psychiatrist would tell me to chill, that helping someone at an excruciatingly shitty point in their life can itself feel empowering, can be “egosyntonic”—reinforcing the person you want to be. But my god I quail at the thought of burdening people with my misery. Maybe I shouldn’t.)
People bemoan the paucity of people coming forward about their mental illness. But have you ever tried talking frankly with a friend, colleague, relative about your endless despondency, your pit of despair, your incessant desire for oblivion? The disincentive from talking to anyone but your psychiatrist about your mental state is enormous. I’m the first to admit I isolated myself preventatively. Because fuck if that wasn’t a trillion times better than having people ghost on me—grow irritable or terse or silent in conversation; leave calls, texts, emails unanswered.
In fairness, much or all of this was probably in my head. That’s how a negative cognitive bias works. But imagined or not, it is misery-making.
The result is threefold:
You learn to interact with others as little as possible.
When you do interact, you disclose as little as possible about your affective state.
When you do disclose, whether out of trust or obligation, you learn to couch despair in something safer—pithy pissiness works well.
So the ice stays unbroken. Thickens, if anything. And the conviction you’re actually horrible for other people makes an even greater case for self-annihilation.
I have more photos shot from inside my apartment than anyone living alone in a five-hundred-square-foot space with one window should ever have. I talk to the radio and to podcasts. Apologize when dropping or knocking over household objects. Chide contumacious hard drives, internet connections, appliances. A crazy cat lady with no cats. This makes being in places with other people even worse because I can’t shake the habit of talking to myself, my computer, my phone. I laugh it off when colleagues murmur, “Anna, sitting beside you is so entertaining,” inwardly thinking I shouldn’t be around human beings.
Being a shut-in also gives you convenient access to a demarcated pacing area. If I don’t develop a cardiovascular illness brought on by a fatally sedentary lifestyle it’ll be thanks to pacing. That, and hand-wringing—both major medals in the Neurotic Olympics.
* * *
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IT’S STRIKING HOW POWERFUL a factor shame was—is—in worsening my worst moments, making pits of despair inescapable traps. If self-loathing or insides made of lead kept me immoveable in bed in the morning, shame kept me from reaching for my phone when I reached consciousness to email my boss and call in sick, shame made me dread my workplace. Shame kept me at work later to make up for these absences, which further messed up my nights and doomed my mornings. Shame and fear of appearing a slacker stopped me from telling my boss I would have to dash out to an afternoon medical appointment, so I was late or cancelled altogether (in my defence, the latter only ever happened once). Shame stopped me from bugging my doctor or my friends when I was at home steeped in misery. Shame, horror at the prospect of ever having to face the world again, let alone having to face it and to face up to myself again and again for what could be the better part of a century, propelled me closer to death than anything else ever did.
Pro-tip: Don’t sob on things you can’t machine wash. Learn how to fucking blow your nose and wipe your eyes without getting mucous everywhere.
MICHELLE
Some people are better at harnessing the support of those closest to them to get through periods of shit. But it was easier for Michelle Yan to tell her cousins she was gay than it was to tell them she was depressed. “For the longest time, I wouldn’t be able to say it….It was difficult to admit to them what was happening,” she tells me in the café of a north Toronto mall. And when she worked up the courage to tell them she discovered psychic pain among just about everyone else in her family. “But it was never talked about.” 7
Not in her family. Not to strangers, not to friends, not to those with whom you shared a gene pool and a home. You kept face by keeping silent. Michelle got good at keeping silent. She had realized in university that what seemed a questioning sexual uncertainty in high school was a sexual orientation, but she didn’t tell her family, and it wasn’t until weeks before she and her long-term girlfriend planned to move in together that Michelle told her mom she was gay.
“I very clearly remember where I was when I told her—in her bedroom. And at first she didn’t really understand what I was talking about. And then when it kicked in she was like, ‘That’s not possible.’…She was devastated.”
Coming out and moving out didn’t make Michelle feel any less torn between the family she loved and the woman she was in love with. She agonized over her mom’s response to her sexuality and struggled to explain to her girlfriend why she couldn’t just tell her parents to accept her or fuck off. “She’s like, ‘You told her. She needs to deal with it on her own now.’ And I’m like, ‘I understand, but in my culture I’m very respectful toward my parents.’”
Michelle blamed herself for her mom’s pain, for her girlfriend’s frustration, for her own mercurial emotions that now flew out of her control, sent her bawling or yelling without warning. Even though Michelle was the primary breadwinner and caregiver while her girlfriend searched for a better job, she felt she was failing everyone she cared about most.
“We would have fights. I would threaten myself….Did I want to hurt myself? I think I had serious thoughts of doing it.”
She and her girlfriend broke up. Michelle moved back in with her mother. “I just completely fell apart….We’d gone through so much in order for us to be together, and it had taken so long to come out to my parents, her parents. So I just thought, ‘This is it, this is the be-all and end-all, for ever and ever,’” Michelle said. “And I was just like, I don’t know what my life is now: my life was with her. There was no direction….I couldn’t see a future.”
She saw a therapist, who suggested Michelle was going thr
ough depression. “I didn’t want to admit it at first. I was like, what does that say about me?…Who would want to deal with somebody who has these types of issues? Just stacking guilt on pressure on self-blame.” But ultimately, a friend going through similar angst made her see her own suffering for what it was. “He forced me to actually talk about what was going on in my head.” And they’d rely on each other, each reality-checking the other’s self-recrimination. “And that helped me, tremendously, in terms of being able to pull out of depression.”
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ON TOP OF EVERYTHING ELSE, depression has had a gender problem. When psychiatrists were delineating it as a mood disorder they reverse-engineered a reification—recruited people they thought were depressed and decided their symptoms were the symptoms of depression. But the people they thought were depressed were predominantly women. In part because they excluded people with addictions (which many men have), and in part because they just associated what they thought of as depression with women more than men. Vicious circle: because the people they included in their studies defining depression were overwhelmingly women, they then decided depression was an illness that overwhelmingly affected women. They created a set of symptoms in line with what they saw in women, and identified it using emotional language that women were socialized to use more readily.8
Creating a disease that pathologizes women, ignores men and adheres to cookie-cutter gender norms reverberates today: women still comprise the majority of the people diagnosed with depression and we still don’t know how much of this disparity is due to the skewed way we started off defining depression or the self-reported way we diagnose it or the divergent ways mood disorders attack different people. Either women are more vulnerable to the maw of despair than men or we’re doing something wrong in identifying those in its grip. Disproportionately pathologizing women bodes ill, and we’ve sure as hell seen it as a method of subjugation before.
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