Well, dang, people. I just learned that it is Mental Health Awareness Week. Which means it wouldn’t be appropriate to write the post I was going to write today, because although it was on the topic of mental health, it was irreverent and ironic and not especially hopeful or enlightening. (I’ll write that one next week–I promise it’ll be more fun!)
This, from NAMI:
There are not many impersonal “calls to action” that I feel a need to heed. In fact my knee-jerk reaction to those quasi-political words, in any context, is to “go lie down,” let the activist types take the lead, and to offer assistance only if asked directly (or if told “there will be treats and/or prizes for the volunteers!” ) However, timing is everything, and it seems like a good time to do my part.
My two cents (This turned out to be longer than I thought. More like a buck fifty’s worth. You’d better go get a beer. Or come back next week.)
I don’t have a lot to say about depression, because mostly, I don’t understand it. It’s nothing like you think it is, if you’ve never experienced it. For me, It is not a mere sad mood (and being the melancholic type to begin with, I will say sadness is not such a terrible thing, in fact, it often feels like it is closer to beauty and to joy than are many of the other “negative”emotions). Where sadness is an emotion, depression is a loss of all emotional responsiveness. It is an emptiness, a profound nothingness. It might sound like a big case of the “blahs,” which we all succumb to from time to time, and that is certainly a component of it, but it is so much more.
Along side of the emptiness is a sharp, painful awareness of the fact (I should say perception, or misperception, but such is the cognitive distortion that it feels like a fact) that one is cut off from life itself –a life everyone around you seems to effortlessly inhabit. It is a feeling of such supreme isolation and alienation that being around normal pleasant conversation, innocuous recounts of a typical weekend, or other ordinary exchanges can feel like physical blows, like being deliberately excluded, separated from that which matters most deeply to you.
Notice that I say “being around” these ordinary exchanges rather than “being in” them–and it is that distinction, that separateness, that makes all the difference. And the inability to be “in” them is not for lack of trying! Often times, most of the time, a person with depression is trying, has to try, for more hours of the day than not, just to go through the motions. (It’s exhausting.)
Most of the time, I can hold it together, I can “look” and “act” normal, and can participate quite convincingly in these ordinary exchanges. A couple of close friends who know my struggles will sometimes say “Well, for what it’s worth, you seem better today. If I didn’t know, I’d never guess you are depressed.” And sometimes, ironically, that is the most alienating thing of all to hear. I am trapped behind a large pane of glass watching everyone else–I desperately want to rejoin the land of feeling, of living, and being, but I can’t break through. And nobody even knows I’m gone.(1)
This is the double bind of the isolation of depression–sometimes it is too painful to be around others, to be both unfeeling and unseen, and yet to cut oneself off from others provides little solace, and often worsens the condition.
As Joseph Campbell said, “I don’t believe people are looking for the meaning of life as much as they are looking for the experience of being alive“–and (my words now) it is this experience, of being alive, that is so profoundly missing in depression. The kindest thing a friend said to me recently was simply, “I give you a lot of credit for just keeping on going.” He himself has never been depressed, but somehow he just “gets it”– how hard it is to just keep showing up. (Thanks, Boonie.)
Why Can’t You Just Snap Out Of It?!?
Probably the most damaging part of depression for me, when I’m in the throes of it, is the self-blame. Other people have bad things happen, very bad, unimaginably hard things, and yet they are not depressed. Allie Brosh’s tragicomedy “Adventures in Depression,” paints a painfully accurate description of this self-berating. In essence, “Get over yourself! Quit your whining! You are pathetic.”
She writes “When I couldn’t will myself to not be sad, I became frustrated and angry. In a final, desperate attempt to regain power over myself, I turned to shame as a sort of motivational tool.” (No one would recommend this strategy, by the way.)
(So why can’t you just snap out of it?)
“Why can’t you just snap out of it?” Despite the self-condemning and self-defeating nature of the question, the question remains (and so too the negative spiral downward that so often follows). Without going into a long medical model diatribe attempting to explain, the short (oversimplified) answer is this: dysfunction in several regions of the brain that regulate mood. Real live measurable observable impairment in areas including the pre-frontal cortex that contribute to an inability to “think positively.” (2)
Depression is not a normal behavioral variant or personality style; it is a clear abnormality of brain and behavior.
I found these passages so oddly reassuring when I first came upon them, in Peter Kramer’s Against Depression:
“I consider myself reasonably depressive, in terms of my personality style. I am easily upset. I brood over failures. I require solitude. I have a keen sense of injustice. In the face of bad fortune, I suspect that I might well succumb to mood disorder. In medieval or renaissance terms, I am melancholic as regards my preponderant humor, and yet, I have never qualified for a diagnosis of low-level depression [much less major depression.]”
So, yeah. I have a depressive personality, it’s true. But experiencing clinical depression is a different beast entirely. As he puts it, “Depression across a broad spectrum remains a distinct disease, separate from the various personality states it sometimes accompanies.” For whatever reason, this helped me a lot with the self-blame. It’s an actual disease of the body. Those of us that are living with depression should all get huge medals for how decently we do function, a lot of the time.
And then the fog lifts. . .
When the depression lifts, which often is surprisingly all of a sudden, out of nowhere, I literally can’t even recall how bad I felt. When it’s back, I can’t recall what it feels like to feel normal. There is an amnesia that permeates the entire experience, such that I frequently have to ask my husband, “How long have I been feeling this bad?” (It’s been awhile . . .) Did I feel like this all last week? (You had some good stretches in there . . .) Or, has it really been since January? Did I have any good weeks? And so on.
I sometimes look at a photograph and think, wow I look so normal (read: happy) there, but I remember that day vividly, how I was just going through the motions, how I did not feel at all like myself, how I was counting the hours until bedtime, so I could escape into sleep.
Or conversely, when the fog lifts, as it has, today, I will think, Wow, I remember saying that I felt worthless, but I cannot even conjure up what that actually even means. (And hence the difficulty in writing about it at all–even now as I describe it, I think surely I must be exaggerating. And yet if, when, it returns, I will think: that doesn’t even begin to touch it.)
Well, I started out by saying I don’t have a lot to say about depression, which apparently is not the case. What I should have said is there is not a lot I can say I understand about depression. How it comes on, or how it lifts. But just going through the exercise of trying to describe it, my experience of it, makes me feel less alone with it. More connected to the world. It’s a first step, and at the same time, a coming full circle, back into myself, back into being, experiencing, connecting, feeling. Living.
The kindest thing you can do for someone who is suffering is to simply listen, and try to understand. So thank you.
Footnotes (which you should just skip because, seriously, this isn’t graduate school. No one will check.)
(1) And since figuring out how to live authentically is a huge driver for me, writing with transparency, and vulnerability, with a desire to connect, to remind myself and others “we’re all in this together,” you can imagine that this is especially painful, to feel alienated.
(2) Kramer’s conclusions come from ” a wealth of recent research on the disease in the last decade, including work in genetics, biochemistry, brain imaging, the biology of stress, studies of identical twins, etc. . . . Kramer presents a sustained case that depression essentially pokes holes in the brain, killing neurons and causing key regions of the prefrontal cortex — the advanced part of the brain, located just behind the forehead — to shrink measurably in size. . . He compares the brain damage from depression with that caused by strokes. (I did read the entire book, but here I am sort of crappily citing from this NYTimes Book Review)