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Masking The Exam

What's hiding behind the disguise?

In medicine we had to examine patients for important signs of disease. These signs could point us in the right direction of a diagnosis, or more importantly warn us of impending disasters. Pain is one obvious sign, but not just “Ow it hurts” pain. We needed to find out when did the pain start, where it was exactly, what kind, how bad, and so on. So when your doctor constantly asks you more and more questions about your pain, this is why. When you want to respond “Who the hell cares, doc, it just HURTS!?” well this is why.

This is also the reason why doctors might subject you to a lengthy interrogation before giving you pain medication. It’s not that we like watching you suffer…mostly. (Believe it or not, watching how you squirm is an actual sign that can tell us what might be wrong with you). It’s not as crazy as it sounds. Even in this age of Ultrasound and MRI we still need to observe signs like pain to know which steps to take. If you come to the ER in pain what do we do with you? Do we send you home? Do we operate? Do we run more tests? And if a slug of morphine has you feeling groovy but unable to tell us about your pain, we call that masking the exam.


Phew! All of this medical explication to stretch a metaphor! You see I was missing the truth of my own diagnosis, my own depression; something was masking the exam. Sure, things seemed to be improving on the surface. One very good sign was my energy level. Rather than watching hours of daytime TV in my pajamas, I was growing active again. Some exercise here, some website work there. Art classes, improv classes, tennis classes. Doing things put me in a much better state of mind.

Most of all was the writing. It gave me purpose. It gave me motivation. It gave me an outlet. I knew it wasn’t always great. I knew the blog only had a handful of readers. (Yeah, I check. Don’t judge me). All I wanted was something raw and honest, and maybe something that started conversations. Regardless of the quality, the reach, or the result, the writing was helping me. I started writing as a therapeutic. It was my catharsis. It made me feel noticeably better. I saw improvements and for six months enjoyed what seemed to be a pathway to recovery.

Yet somehow untreated depression remained. I called it residual depression – depression in remission. It was worse than that, though. I just couldn’t recognize it. The writing was my painkiller, masking my exam. It was hiding my untouched depression. At my center was still the self-loathing. Who cares if others congratulated me for being “brave” or “insightful”. Depression could only see failure. Much more acute was my guilt and shame for not yet finding a way to contribute to society, or at least to our household finances. With every bit of praise or encouragement I received from friends, my inner voice would just yell “Get a job, loser!”

But wait! I had started writing. I could respond, “I do have a job! I’m a BLOGGER!” (said in earnest without a hint of irony). It gave me relief from the pain of this mental abscess deep inside me. I had a website. I printed business cards (fifty cards are really cheap at your local copy store). I even had a Linked-In page. It all felt official. Meanwhile the untreated mental infection festered inside me, masked by this mental morphine known as writing. Until finally it burst, the pain from my inner demon breaking through my figurative narcotic. It unveiled my continued self-hate, untouched by the good vibes my writing was giving me.

Great! So with this epiphany I knew what I had to do. Lay off the painkillers (AKA my writing) so I could really examine my innermost mental illness without anything “masking the exam”. It should have been so easy to start moving forward. Tackle my depression unimpaired, thereby finding the conviction towards a new career. Just moderate how much writing I did. Easy-Peasey!


(A couple of therapy sessions later…still depressed)

Naturally I couldn’t let anything be simple. My writing wasn’t just a painkiller making me feel better. My mind had transformed it into the cure. My primitive lizard brain had grown infatuated with this shiny new object. It couldn’t just be a hobby. It couldn’t just be an exercise. It couldn’t just be something I did on the side. It had to go viral. It had to lead to the next NY Times Bestseller, book tours, interviews with Oprah. That’s how my brain works. Everything needed a purpose, a goal, an end-zone. Anything short of that was a failure. Writing just for the sake of writing didn’t cut it. Writing as a new career? Now that was finally my ticket out. As with anything for my simplistic mind, it had to be all or nothing.

Ah, but of course it wasn’t just my mind being simplistic. It was the same demon warping something good into yet another fault. My guilt grew with every word tapped out on the keyboard. “Psssh! Only a self-indulgent pratt blogs while his household implodes around him!” Basically my inner voice convinced me that if I hadn’t published a book in, oh, six months then what the hell was the point. To go back to my already over-stretched medical metaphor, instead of a painkiller masking my exam, my writing was now at best a placebo. More likely it was snake oil masquerading as a cure. The more I took, hoping to treat this disease, the worse it got.

So I stopped writing. Cold turkey. I violated the Blogger’s Cardinal Rule: No matter how good or bad, keep posting Content, Content, Content! For the fifteen to twenty of you who follow this, you might have noticed the conspicuous absence of activity. In a melodramatic overreaction I even put a “Sorry We’re Closed” graphic over this website.

Then something unexpected happened. During my hiatus a college classmate messaged me asking why the blog was down. She knew of someone going through a rough patch and thought my writing would help. This was not the first time I’d received such a message about my blog. Was I inspired to write again? Armed with knowledge that my writing did indeed help if not me then somebody else? Of course not, because Depression.

I told all of this to my therapist (whom I’m convinced now drinks an extra RedBull and slams some TUMS whenever she sees my name on her schedule). She was actually able to use my own (tired) metaphor to help me see what I had done: If a medication had unequivocal evidence of benefit would you feel guilty for taking it? Would you ever just stop it cold turkey out of spite? Even if you noticed some adverse side effects you might try to modulate the dose or maybe try something to help the symptoms, especially if this medication were the only known cure for this disease. Even chemotherapy, some of our most toxic medications, can be adjusted, tailored, or modified if it has a chance of curing a cancer. Had I considered trying to modify my outlook on writing to help my depression? Of course not. Depression twists good things into bad, helpful into harmful, medicine into poison.


In medicine sometimes we experience failures, especially when facing a challenging diagnosis. Sometimes it can be because some signs obscure others; they mask the exam. Other times we mistake subjectivity for fact. We elevate what may be no more than a gut feeling to the level of “truth”. It becomes the foundation for all of our subsequent thinking; it creates its own logic.

I did all of the above. I let my writing mask my depression. But worse than that I created an entire allegory to explain my ongoing depression, and thus found a way to blame my writing. The metaphor became more important than the actual symptoms, more real than the actual disease. I had found a way to blame my metaphorical cure and even the metaphor itself, rather than blaming the disease.

My signs are all still there. Not all of them are outwardly detectable. I did a great job of convincing everyone, my therapist, my family, even myself that I was getting better. But now I see that the self-hatred, the inner voice, my demon have always been there.

I remain depressed today, and depression is still a big asshole. I remain unemployed. I remain unable to move forward towards changing that fact, but I take steps. Some so very small, but they are forward discernible steps. Independent of that, I have found writing again. It’s not a metaphor anymore. I know it has it’s own benefits, benefits to others, and definitely some undesired side effects. But I also know it is not a drug. It is not masking my exam. It is not snake oil, labeled as a panacea. It is not chemo with side effects. It’s just writing, and my disease is depression. Not cancer, not an infection, not appendicitis, but nonetheless a real disease. It has medications, therapies, and failing those, real consequences. It warps our own thinking, turning us against ourselves. It is exhausting just figuring it out, let alone writing it down. But I work to figure it out.

So I’m writing it down. Unmasked.

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