My twitter and facebook feeds are lighting up: if you need help, call 1-800-273-8255 (The National Suicide Prevention Lifeline). Reach out—you’d be amazed how many people have struggled too. And, in time, get (professional) help—it helps.

That last bit should come with an asterix.

I’ve been struck lately by the narratives I’ve read—from this piece in Vox written in response to today’s events to a very thoughtful recent blog post by a fellow Berkeley graduate student—that describe the trajectory from crippling emptiness or sadness, to labeling it depression, to overcoming all of the external barriers to treatment, and to recovery. The pieces I’m thinking of are thoughtful and nuanced; they understand recovery as a work-in-progress, and a getting help as a hand-up but not a panacea. But getting help is always the climax of the story.

Reading these, I feel like my own narrative is scrambled. If you read much of this blog, you’ll know that for more than a decade, I’ve either overcome or ignored (I’m not quite sure which) the stigma around accessing treatment. Yet of my two worst episode of the last decade, I was already medicated for one and, for the other, had abandoned my meds on the downslide because they, for whatever reason, were not arresting the aforementioned downslide. I had a regular—and great!—therapist (hit me up if you want a recommendation in Berkeley) before, during, and after both episodes.

I still fell low enough to wind up in the hospital.

Sometimes these narratives make me feel even more like a loser. If getting help is supposed to make me feel better, to allow me to become a famous author or star or whatever, are the residual failures lingering after treatment only my own? Hearing about the wonders of getting help today made me think so.

In truth, I have a foot in one world, and a toe in a second. One is of (sometimes high) functioning depression, kept at a distance by a triumvirate of medications, regular therapy, supportive friends and family, and a raft of helpful privileges, and another where none of that means shit because I’m depressed anyway. We only really hear about the second world from crackpots who want to use its inhabitants to lambast psychiatry as mind-control or convince us that it’s really all capitalism’s fault. Maybe we’ll put those unfortunate denizens with “treatment-resistant depression” on the agenda when we start talking about legalizing magic mushrooms.

It is people in this second world—who might be getting help, who might be helped some by getting help, and who are still not helped enough to meet our standard of well—that I’m thinking of when I express my frustration with that refrain, “get help.” I remember an event in our department where we talked about the mental health of our students, and the admonition from someone from Counseling and Psychological Services to, essentially, send anyone who seemed in trouble to the student health center. Everyone nodded along.

“Do you know what actually happens when they reach there?” I asked, noting the limited number of sessions, the sometimes-complicated intakes, and the difficult referrals. I insisted that treatment can only complement, rather than replace, creating a supportive social environment. I insisted that Afterwards, another graduate student told me, “There could have been someone who was thinking about getting help, and you just discouraged them.”

I would never willingly do that. I wouldn’t be writing this blog post without professional help. But I don’t want us to abandon the treatment failures.

So my asterix is this: before you tell someone to get help, start by asking them if they have gotten help before. Ask them what their experience was, and how it could be better. Learn about how hard it is playing phone tag with psychotherapists until you find a “match.” Recognize how few psychiatrists take insurance (and maybe help them track one down!). Realize that medications have side effects. And know that even culturally-competent, evidence-based, compassionate treatment doesn’t work for everyone. Have a back up plan.

Not everyone is going to get better right away. It sucks, and it’s also okay.