All in My Head

CW: mental health, pain, depression, suicidal ideation, & suicidal contemplation

I wish I could explain the pain; the actual and very real physical pain that takes my breath away when I am least expecting it. My bones ache as though I have been outside on a frigid day. Starting at the center of my back between my shoulder blades and moving down my arms, it slowly dissipates as it reaches my fingertips. The pain slides down my spine and into my pelvis, settling in with a slight “hrmph” like a dog ready for a nap. There is a strange cynical irony that the pain is the most concentrated in my core; because, at this point, it feels truly inextricable from who I am at my most base level.  

I am physically healthy, and there is no external cause or reasoning for the pain. It is, quite literally, all in my head. For better or for worse, depression is all in my head.

I have had a string of tough days lately, and earlier this week, I had an especially hard one. I could not focus on anything. I spent an embarrassing amount of time sitting on my couch disassociating and staring across the room into nothing. I refrained from talking, listening to music, and scrolling social media (which, that was probably for the best, to be honest.) Late into the evening, the pain took over, and I cried. I sobbed. My tears were both the culmination of pain and a release of overwhelming thoughts. More than once, I had to remind myself to breathe, because my brain would forget how to do it. I want to say that my tears washed away my pain, but all it really did was bring it back down to a more “manageable” level. A careful balance was restored once again.

Depression is all in my head, yes, but that does not make my pain any less real. It does, however, make it impossible to justify it to others who do not understand. So often, society uses “depression” as a throwaway substitution for “sad,” but all that does is minimize the very real experiences we carry with shame – so much shame. It just does not seem “big enough” to say, “Oh, I have been depressed,” when someone asks about how I am doing and where I have been. It comes across as “oh, I have been a bit unhappy, so let me whine about it” and not as the miserable truth. It is seen as a sign of weakness – something to keep hidden – instead of a demonstration of strength. When, really, it takes nothing *but* strength to carry on day-in, day-out, despite the pain.

I believe that the only expert on someone’s pain is that person themselves. Yes, we can empathize, sympathize, commiserate, connect with, show compassion for, and hold space for as long as someone needs, but only they are the expert. Pain, in all forms, is exhausting, so it is only logical that our tolerance level wanes over time. The desperation for relief can be agonizing. I grew up hearing that suicide was a “permanent solution to a temporary problem,” but now I can see how, sometimes, a permanent solution to end pain and suffering, regardless of the cost, can be the ultimate goal.

Let me be perfectly clear: It has been a long time since I have seriously considered such a permanent solution. I cannot promise that I will never go there again, but I am not there now. Passive SI still takes my breath away on tough days, but it is just that: passive and fleeting. It is the thought equivalent of a sentence that starts fully formed but trails off halfway through. My chosen family, therapist, and psychiatric nurse practitioner all check in with me often. They remind me that while I may be lonely, I am not facing my pain alone.   

My internal voice has gaslit me for years that I deserve the pain that depression ushers into my life. It also thrives on degradation and toxicity. There is an idea that a person can only hear negative comments for so long before the message is internalized and believed. But what if the constant bombardment of harsh criticism, acrid insults, and endless doubts stems from the person themselves? It creates a storm that feeds on the never-ending pain, and it is impossible to stop. A friend told me recently that I deserve to be half as good to myself as I am to those I show up for in my life. The honest truth? It is easy to be kind to those around me because I love them all. I do not even like myself most days, let alone love myself. I am working on it, but I feel useless most of the time.

A few years ago, at the height of COVID, a friend chose to have a private birthday celebration at a tattoo shop. It was just our tiny group and the artist, all masked, of course, and we all selected different things that were small but meaningful. I chose the chemical symbol for serotonin, which is one of the main hormones connected to clinical depression, to go behind my left ear, right along my hairline. I placed it on my head as a very obscure reference to the Harry Potter series. At the end of the series, Harry turns to his mentor with one final question.

“Tell me one last thing,” said Harry. “Is this real? Or has this been happening inside my head?”

Dumbledore beamed at him, and his voice sounded loud and strong in Harry’s ears even though the bright mist was descending again, obscuring his figure.

“Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?”

Of course. Of course, depression is happening inside of my head, and that means it – and the pain -- is just as real as anything. And, honestly, there is never a day that I am not reminded of it somehow, and, damn, I wish that that was not the case.