Mental Health Mixtape #2: Songs About Diagnoses
In the tradition of fairytales and folklore, to learn your enemy’s true name is to gain power over them. Think of the story of Rumpelstiltskin: the princess pronounces the goblin’s moniker and he is brought to his knees. I see a consonant relief in the face of my clients when they receive a new diagnosis. A sense of power has been gained. If nothing else, they now know their goblin’s name.
I so enjoyed writing the first “Mental Health Mixtape” playlist and it continues to be the post people tell me that they connect with the most. This time I chose to write about a playlist centered around songs that more or less name a diagnosis explicitly. What interested me about this is the counterpoint that these songs provide to the flatness of the clinical language of diagnosis.
While diagnosis may be a useful tool for communicating sets of traits, art stands as an opposing force to remind us that human experience is not something so easily sorted and classified. After all, I might see four different people in a day with Major Depressive Disorder who show up completely differently, and the diagnosis tells me very little about the genesis and best treatment for these individuals.
Diagnoses have utility in their social reality and to dismiss them risks missing and minimizing the value and relief they offer. But the most they can provide is a sketched outline to be filled in with shading and color. If diagnosis is the rational categorical form of understanding that point us in a conceptual direction, then art and especially music are its expansive counterparts that plunge us back into the full complexity of human experience.
Ok, get to the songs!
Manic Depression, Jimi Hendrix
Before going into private practice I worked in community mental health, where I worked with clients dealing with profoundly destabilizing mental health issues who frequently had little other support. My clients with Bipolar I Disorder diagnoses would sometimes miss a series of sessions without contact or response. When they abruptly showed back up, the looks on their faces prefaced the cyclical story that over time became all too predictable.
Imagine your worst night of drinking complete with blackouts and flashbulb memories of things you shouldn’t have done: people you’d kissed, fights you’d gotten into, money you shouldn’t have spent, dumb harebrained stunts. Except it came out of nowhere, the whole thing had lasted a week or so, and you hadn’t slept at all. And then at some point you started to get tired, and when you woke up the wreckage of the last week is staring you in the face and you wish it was a bad dream but it’s not. This is the aftermath of a manic episode that I imagine Jimi singing this song from.
Jimi sings with a world-weary frankness that underscores the chaos that bipolar disorder creates. Even the way the song begins, with its sardonic rolling guitar and drums rhythm, reminisces of peeling oneself off the floor to try to understand what the hell just happened. This song could be a soundtrack to the many sessions I’ve had with clients reeling in the hazy aftermath of mania.
“Manic depression/is a frustrating mess,” Jimi sings with exhausted punch and wail. Of course Hendrix himself died of a heroin overdose at the age of 27 after a long history of drug use which was probably exacerbated by his own Bipolar Disorder. Underneath the final guitar solo he can be heard repeatedly chanting “Music sweet music”, a homage to the hope and meaning he himself in art, and to his own inspired expression of a chaotically gifted mind.
Runs In the Family, Amanda Palmer
This song is about depression and coping. Its protagonist recounts in a frenzy her friends who struggle with their own mental health, insinuating her desperation to understand her own dysfunction.
“My friend has problems with winter and autumn
They give him prescriptions, they shine bright lights on him
They say it's genetic, they say he can't help it
They say you can catch it, but sometimes you're born with it”
Palmer’s terse delivery swells into a desperate wail for the chorus as her tone of helplessness boils into anger:
“All day I've been wondering what is inside of me
Who can I blame for it? I say it runs in the family”
Good news, Amanda, you can absolutely do that! The medical consensus is that about 50% of the risk of depression is heritable, although the amount of genetic influence can vary widely from person to person. To someone with depression wondering what is wrong with themselves, why they can’t just get on with the business of living but instead feel trapped in their own personal bedlam, it is a natural progression to stab a petulant finger at genetic fate.
In both her solo work and her work with the Dresden Dolls Amanda Palmer has pretty much perfected a subgenre I affectionately refer to as “Crazy Bitch Songs.” I say this with gratitude. Women in particular need to know that despite historic contempt for the “hysterical woman”, feeling “irrationally” infuriated and completely out-of-control are normal parts of depression. Songs like this help us understand ourselves by reflecting back the roiling mix of ferocity and the banal frustration of living with depression: trying to crack the code and figure out an escape, only to end up chasing your own tail time and time again.
Panic Attack, Atmosphere
Hip-hop as a genre contains some of the most candid writing that I know in lyrics about living with a mental health condition. This makes sense. After all hip-hop began as music of resistance, with its earliest luminaries like Grandmaster Flash in “the Message” describing the social realities of Black Americans in ghettoized neighborhoods. One feature of oppression is the toll it takes on individuals who are exposed to ongoing stressors of poverty and marginalization, which exacerbate the likelihood of developing a mental health condition like panic disorder.
This song is characterized by an erratic throbbing rhythm that evokes the heart rate of a panic attack. Frontman Slug’s rapping is aggressively deadpan, with the showmanship of his delivery underscoring his characteristically superb songwriting.
“Panic attack, so what's the plan of attack?
You had to be had, you cut in half, you had to react
You battle with your shadow from front to back
Stack up the stats, handle the math and that'll be that”
This song also addresses the role of both legal prescription and illegal street drugs in dealing with panic attacks, and draws a direct link between them. What are they, Slug asks, but different ways of coping?
“Look honey, everybody needs a helper buddy
Nobody's drug-free, the streets would be hella bloody
Do you call yourself a patient or a junkie?
The only thing that separates is who takes your money”
While I respect the validity of challenging the medical establishment and its norms, I do think painting prescription and street drugs with the same broad brush ignores some big differences. The primary difference between street drugs and prescription drugs is control and predictability of dose and ingredients. The second difference is less absolute and more philosophical, but perhaps more important.
Generally (and I will acknowledge there are a lot of exceptions in actual use) prescription drugs are designed to help a person control their mental health symptoms so that they can do the things that make up a full life in our society: work at a job or go to school, maintain relationships, parent their kids, etc. Street drugs, however, are more likely to alter consciousness in such a way that one is pushed further away from the ability to function in society and fulfill these various roles, sometimes relegating people to a subculture of only other people who use drugs.
There are complicated questions with even more complicated answers surrounding the legal prohibition of street drugs and the role they play in people’s lives, including those with mental health disorders who often use them to self-medicate in the face of social neglect and desperation.
Schizophrenia, Sonic Youth
While mental health issues have become much more socially accepted in the last several decades, not all are treated equally. Schizophrenia remains a deeply feared and stigmatized diagnosis, with implications of being truly “crazy” and having “lost one’s mind.” This song was inspired by the brother of Kim Gordon, bassist and vocalist for Sonic Youth. Growing up, Gordon idolized her older brother Keller, who was eventually diagnosed with paranoid schizophrenia.
The song is dreamy and wistful, while evoking the uneasy feeling many of us get around people in the midst of a schizophrenic episode.
“I went away to see an old friend of mine
His sister came over, she was out of her mind
She said Jesus had a twin who knew nothing about sin
She was laughing like crazy at the trouble I'm in”
Ethereal, high-pitched fingerpicking bridges us from the first half of the song into the second. Gordon’s vocals on the next verse come in like the voice that wakes you up from a dream, or perhaps ushers you into one.
Although it seems to be more biologically based than most other mental health conditions, schizophrenia’s expression is highly influenced by culture. The contents of hallucinations and delusions vary markedly, as do the broader themes. For example, the sister in the Sonic Youth song expresses Christian religious content with what seems to be a “metaphysical truth, revealed!” theme, which is fairly common in the history of schizophrenia in Western culture. Also common in modern Western culture is a theme of persecution, which includes culture-bound content like fears of being monitored such as by bugs or cameras in the wall; or the conviction that one is being pursued by organizations like the FBI or the CIA.
Several of my clients at the clinic fixated on aspects of the Star Wars story. I like to think of this as a reflection of how successful Lucas was in penning a “Hero’s Journey” myth that uniquely suits 21st century Western culture. These clients frequently expressed identification with one of the main characters, or saw the story as a sort of ur-myth of the universe which they sometimes conflated with reality. In other cultures, though, intrusive or bizarre thoughts are interpreted as more culturally relevant content such as the influence of spirits or having been bewitched.
Interestingly, people with schizophrenia in more traditional societies often have better long-term outcomes than those living in the US. This is thought to be an effect of the role that family and community integration play in preventing the progression of the illness. More traditional societies generally assume that people with schizophrenia still can and should have social roles to play in their community, with corresponding expectation that they contribute to the family or collective wellbeing albeit in a modified way. But in the US our more fragmented social structures and more formal culture of work means that people with schizophrenia are often limited to impoverished environments that allow for little stimulation, meaning, or social connection.
I am hopeful about better treatment improving outcomes in this country as well. The first generation of medications for schizophrenia came with side effects so intense that patients existed in physical misery and mental vacancy. Common practice was to institutionalize patients where they frequently had little access to social or other stimulation, and unfortunately were also vulnerable to abuse.
New medications do not have the horrendous side effects of the first generation of antipsychotics. Perhaps more importantly, the role of community integration and family and social support is being recognized, as well as how radically improved a prognosis is when the disorder is diagnosed and treated early. This has resulted in a host of community programs and funding streams directed at early diagnosis, education for families, wrap-around care, and the creation of social living and support programs. I was amazed at how much better my clients did when they came to our center and found a way to be involved in the community programming, and when something interfered with that at how rapidly they deteriorated.
ADHD, Mae Stephens
At once upbeat, sultry, and sarcastic, Mae Stephens’ “ADHD” is easily the most danceable song on this playlist. This song is fun, and fun is both essentially therapeutic and politically radical in the case of living publicly with a mental health diagnosis. Stephens’ wry self-acceptance trumpets into a sense of joy in being who you are, warts and all.
In the first verse Stephens sings about the frustration she has with her quintessentially ADHD patterns:
“I don't remember what I said two minutes ago
Have alarms every minute on my goddamn phone
Spent my entire day, lazy, just sat at home
Bingin' shows I've seen fifty times before, like
What the fuck was I singin' about?
Got a hundred different riddles I can't figure out”
Frequently, ADHD treatment involves two prongs: a) coaching around how to better manage symptoms of executive dysfunction and b) processing and learning how to deal with shame, guilt, depression, anxiety etc. related to being neurodivergent, which frequently means addressing the part of the brain that has internalized societal messaging about being incompetent, incapable, hopelessly screwed up, and a total mess. While Stephens acknowledges to these latter struggles in the first verse, by the second verse there is a sense of acceptance and even pushing back.
”A is for attention that I try to take the lead
And the D is for the deficit of functionality
Then the H is hyperactive, which is absolutely me
And disorder is the wrong term, it's just my normality”
Points for awareness of the social construction aspect of diagnosis in that last line! Over the last few decades there has been a shift towards recognizing ADHD as a set of characteristics to be placed in a spectrum of neurodiversity, rather than pathologized. Some evolutionary psychologists hypothesize that ADHD traits remain with us as a useful variation on normal functioning. This tracks for me. I’ve seen clients of mine do incredible things when they can find ways to work with their brain.
I also really, really like the aesthetic that Mae Stephens leans into with not only the song but also video and album art. It all expresses a cute, kooky style that is reminiscent of high school locker decorations and girls’ college dorm rooms. Bold prints. Shaggy pillows and bright flowers. Kaleidoscopic backgrounds reminiscent of those tapestries everyone had. Mae’s eyebrows are even dyed different colors!
Both in the song and through this visual sensibility, Mae Stephens says “this is me” even while singing about a diagnosis that can be incredibly frustrating. I saw a Facebook post of a quote some time ago that I haven’t been able to find attributed to anyone in particular, but managed to grow roots in my brain. It said, “The secret to happiness is to live imperfectly with great delight.” Way to do it, Mae!
Days Move Slow, Bully
Starting with a sparse drum beat and a long guttural moan, “Days Move Slow” sounds exactly like depression feels when the fever starts to break. With the above Amanda Palmer song “Runs In the Family,” you’re still in the thrashing thick of it. But “Days Move Slow” sounds to me like the day you wake up and you know you’re ready to find a way out of the hole, even if everything still looks shitty and stupid–if only because you’re sick and tired and bored with depression itself. You might still be exhausted and desperate, but there’s a shift when the absolute bleakness turns into a kind of absurd shrugging what-else-can-I-do moment. This is the point where you say to yourself, “okay, I guess this bullshit is what I have to work with, and I'm going to find some way to work with it.”
So yeah, it’s kind of a depression banger! The chorus goes:
“And days move slow
I'm living in the same black hole
But there's flowers on your grave that grow
Something's gotta change, I know”
I always associated this song with depression, but grief is apparent in some lines, like the one about “flowers on your grave”. In the course of writing this I learned that the song was written to commemorate the loss of Bully lead singer/songwriter/guitarist (she pretty much is the band) Alicia Bognanno’s dog, Mezzo. She speaks to the profundity of this loss in the following interview:
“As someone who has spent the majority of my life feeling agonizingly misunderstood, there is no greater gift than experiencing true unconditional love and acceptance. I waited my whole life for the bond and irreplaceable companionship I had with Mezzi…I was a stranger to the level of love I now know exists because of Mezzi.”
While most people recover from grief by giving it the honor, time, and attention it deserves; there is a relationship between grief and longer standing depression. In his iconic lecture on the biology and psychology of depression, Robert Sapolsky describes the correlation between losing a parent before the age of 10 and developing clinical depression. As he puts it, “This makes perfect sense. What is a lot of what’s going on during your first 10 years of life? You are learning about cause and effect…And you have just learned in the most big-time, awful way, there are things you can’t control.”
In conclusion…
The songs on this playlist offer a lush, 3-D reality that clinical language never could. And while they surely don’t describe everyone’s experience, they extend to us an emotional depth and breadth that offers solace to some and empathy to others. These realities of the mind become examined and charted in song, helping us to not only understand but allow them to become part of the bigger maps of human possibilities we all share.