Sunday, October 05, 2014

One too many mornings

A big part of me doesn’t believe, still, that “depression” exists.  According to the New Yorker:
There is little agreement about what causes depression and no consensus about what cures it…  There is suspicion that the pharmaceutical industry is cooking the studies that prove that antidepressant drugs are safe and effective, and that the industry’s direct-to-consumer advertising is encouraging people to demand pills to cure conditions that are not diseases (like shyness) or to get through ordinary life problems (like being laid off).
Louis Menand’s article, a review of Gary Greenberg’s book, “Manufacturing Depression,” continues:
Greenberg basically regards the pathologizing of melancholy and despair, and the invention of pills designed to relieve people of those feelings, as a vast capitalist conspiracy to paste a big smiley face over a world that we have good reason to feel sick about. The aim of the conspiracy is to convince us that it’s all in our heads, or, specifically, in our brains—that our unhappiness is a chemical problem, not an existential one. Greenberg is critical of psychopharmacology, but he is even more critical of cognitive-behavioral therapy, or C.B.T., a form of talk therapy that helps patients build coping strategies, and does not rely on medication. He calls C.B.T. “a method of indoctrination into the pieties of American optimism, an ideology as much as a medical treatment."
In other words, “depression is not a mental illness. It’s a sane response to a crazy world.”

According to Wikipedia:
The term "depression" is used in a number of different ways. It is often used to mean major depressive disorder but may refer to other mood disorders or simply to a low mood…  The diagnosis of major depressive disorder is based on the patient's self-reported experiences, behavior reported by relatives or friends, and a mental status examination. There is no laboratory test for major depression.
Essentially, it doesn’t exist, right?  But then there are days I wake up when I am unable to move.  Not literally, of course—I can roll over in bed, wiggle my fingers—but I don’t.  I lie there and I don’t move.  I think of all of the reasons I should move, or the things I could do that’d make me feel better, but I don’t do them.  I can’t bring myself to.  I rehearse a list of things I know to do, things I know help—heat, light, reading, baking, sitting in the sun, yoga, taking a long hot bath or a shower, going to a cafe or a library—but all of them, even the thought of them, even the first step towards them, feels like dust in my mouth.  I can’t move.  I don’t even pee when I need to pee because it requires too much energy to move to the bathroom.

In an earlier New Yorker article, “The Anatomy of Melancholy,” Andrew Solomon writes about his experience with his depression:  “My vision began to close.  It was like trying to watch TV through terrible static, where you can’t distinguish faces, where nothing has edges.  The air, too, seemed thick and resistant, as though it were full of mushed-up bread.”

I know that feeling.  For me the air feels resistant like mud, or like trying to swim against a current.  Motivation is a central problem.  I can think of a lot of things that make me feel better (writing, sunlight, a walk) but it is impossible to motivate myself to do them.  Or it’s possible but I can never do it.  Or I can do it sometimes, just not when I’m in the darkness.  In the hole, the bottomless pit, that Townes Van Zandt sings about above, so effortlessly.  The old lady catches me.

“Why, my soul, are you downcast? Why so disturbed within me?” asks the Psalmist.

When I’m in the pit, pulling myself out is like trying to find pull myself from quicksand, use my own body as leverage.  It’s impossible to find any purchase.

Of course I can get out of bed.  It is possible.  It is not impossible.  And yet I don’t.  I lie in bed for hours—literally—not moving, thinking about doing something and not doing it.  Some days I can.  Some days I get up and take arms against the sea of troubles, even when it feels like moving through molasses.  Like swimming while drowning in a sea of mud.  Other days it is impossible.

In the wake of Robin Williams’s death, everyone is talking about depression, but not many people are saying anything useful.  Several times I’ve heard commentators say:  “just so we’re clear, ‘depression’ is a mental illness, not ordinary sadness or ‘feeling blue.’”  And I think:  oh, so what I have is just ordinary sadness.  Even when I’m not feeling sad at all.  Even when I’m feeling nothing inside but darkness, and heat and pain inside my head without actually experiencing heat or pain.

I’m sure Robin Williams and David Foster Wallace and everyone all thought they had ordinary sadness right up till the end.  How can we tell the difference when we’re in the middle of it?

Even Solomon writes, as he recovers, with the help of a vast pharmacopeia:  “I have felt blue sometimes, and on some days I have chosen not to work on this difficult subject…”  But how does he tell the difference?

I find it challenging to talk about, not because I feel guilty or ashamed, but because I don’t believe it exists.  I do feel guilty about my coping mechanisms—computer games and television and food—all things that other people assist me in feeling guilty about.  I feel guilty about my presence on the planet, about myself as a waste of space.  I feel “all the typical symptoms—hatred, anguish, guilt, self-loathing.”  But I don’t feel ashamed of the presence of the miasma itself because I don’t believe in it.

It’s also difficult to talk about because there’s nothing anyone can do to help.  Antidepressants don’t work.  Talking to other people just spreads the disease, if it exists.  Depression is contagious.  Why should I drag anyone down inside the pit with me?  I hate reaching out for help because then I have to admit that the only thing inside is an echo because all that exists in there is a big black hole and I can’t tell anyone without dragging them down too.

I’ve been feeling this way for twenty years, if not longer.  I wept the night before I turned ten because I realized my childhood was over.  Oh, wait—I was just feeling blue, right?  Even as a child, I felt something like nostalgia, a deep eternal grief at the passage of time.  I remember learning the word “melancholy,” and the idea that someone could be a “melancholic.”  I remember thinking, oh, so that’s what I am.  I developed obsessions that I treasured close to my chest, and when I shared them, carefully, and was rejected, I plunged into despair.  I lay in bed crying, before the age of eleven, telling my mother and sister that I had people who loved me, but no one who liked me.  How could they?  I remember listening to Puff the Magic Dragon and weeping:  Jackie Paper came no more!  Therein lay the essence of life’s tragedy!

Some days I wake up okay.  Other days I wake up unable to move.  Everyone blames negative thoughts, as proponents of CBT, and the power of positive thinking, believers in the pieties of American optimism, do:  change your thinking, change your life.

Andrew Solomon writes:
Once upon a time, depression was generally seen as a purely psychological disturbance;  these days, people are likely to think of it as a tidy biological syndrome.  In fact, it’s hard to make sense of the distinction.  Most depressive disorders are now thought to involve a mixture of reactive and internal factors;  depression is seldom a simple genetic disease or a simple response to external troubles.  Resolving the biological and psychological understanding of depression is as difficult as reconciling predestination and free will.  If you remember the beginning of this paragraph well enough to make sense of the end of it, that is a chemical process;  love, faith, and despair all have chemical manifestations, and chemistry can make you feel things.  Treatments have to accommodate this binary structure—the interplay between vulnerability and external events.

Vulnerability need not be genetic.  Ellen Frank says, "Experiences in childhood can scar the brain and leave on vulnerable to depression."  As with asthma, predisposition and environment conspire.  Syndrome and symptom cause each other:  loneliness is depressing, but depression causes loneliness.
For me, negative thinking is merely a symptom.  If I feel like things are hopeless I find a reason for why things are hopeless and I can find plenty.  But the hopeless feeling comes before the negative thoughts.  Sometimes the negative thinking catches me in a cycle and drags me deeper into the hole, but it’s almost worse when I feel nothing but emptiness and just like there’s nothing inside, not even negative thoughts.  And I can’t convince myself to do anything.

Since I was a child I’ve felt like suicide is a brave move, a way of using actual physical weapons against the sea of troubles, as Hamlet is the first to suggest.  “The ultimate hallmark of depression,” an “obsession with suicide.”  I think of those who have—Kurt Cobain, Elliott Smith, David Foster Wallace, Aaron Swartz, Vincent Van Gogh, Sylvia Plath, Virginia Woolf—as secret brothers and sisters.  On bad days I pore over their Wikipedia pages.  Those who had the courage to tell the truth to an empty, hopeless world.

…the particular kind of depression I had undergone has a higher morbidity rate than heart disease or any cancer.  According to a recent study by researchers at Harvard and the World Health Organization, only respiratory infections, diarrhea, and newborn infections cost more years of useful life than major depression.  It is projected that by the year 2020 depression could claim more years than war and AIDS put together.  Ant its incidence is rising fast.  Between six and ten per cent of all Americans now living are battling some form of this illness;  one study indicates that nearly fifty per cent have experienced at least one psychiatric disorder in their lifetime.  Treatments are proliferating, but only twenty-eight per cent of all people who have a major depression seek help from a specialist;  fifteen per cent of hospitalized patients succeed in killing themselves.
Watching Robin Williams movies helps.  It’s odd to me how many of them deal intimately and sensitively with depression and suicide. My favorite movie as a teenager, and maybe still, is "Dead Poets Society," and I was powerfully affected by two of his other movies, not as well known:  "What Dreams May Come" and "World’s Greatest Dad."

In “World’s Greatest Dad” Robin’s character writes a suicide note and then gets to see what happens afterward—in some ways, it’s a suicide’s watching of his own funeral, a fantasy wish fulfillment.  He says, presciently and half-sarcastic:  “Suicide is a permanent solution to a temporary problem.”  But what if the problem’s not so temporary? 

In “What Dreams May Come” we get to see what happens after a suicide, too.  But this time from the other perspective.  From below the ground.

“What Dreams May Come” was horribly reviewed when it came out and still has a 44% rating on Metacritic.  I beg to differ with the reviewers.  Many parts of it terrified and entranced me when I originally saw it—joyful jumps through big messy wet swaths of color in heaven, walking on the disembodied faces of those in purgatory who don’t realize they’re there.  Since Robin’s suicide, I can’t stop thinking about the part when he dives down from heaven into hell, through an increasingly creepy and macabre dreamscape, where finally, at its very bottom, he finds his wife, who committed suicide.  She’s been sent to hell not because of her suicide but because of her own tendency to create “nightmare” worlds, the same tendency that led her to suicide to begin with.  She’s all alone, in darkness, living in a twisted version of their house, visibly tortured by her surroundings.

That part stays with me.  Because it’s what depression is.  When I’m there, I’m all alone, and nothing anyone could say could help or change anything.  Suicide and depression are really the same thing, because depression is already hell.

Jane Kenyon, a depressive and a poet, writes:  “Unholy ghost, you are certain to come again… and turn me into someone who can’t take the trouble to speak;  someone who can’t sleep, or who does nothing but sleep;  can’t read, or call for an appointment for help.  There is nothing I can do against your coming.”

In “Brothers Karamazov” Dostoevsky posits that heaven and hell are now, determined only by our frame of reference.  We are not condemned to hell in some future time;  if we are condemned to hell, we live there now.  The same with heaven.  Christ Jesus said:  “The kingdom of heaven is at hand.”  Here, now.

“That life is heaven,” he said to me suddenly, “that I have long been thinking about;” and all at once he added, “I think of nothing else indeed…  Heaven,” he went on, “lies hidden within all of us—here it lies hidden in me now… we are all responsible to all for all, apart from our own sins, you were quite right in thinking that, and it is wonderful how you could comprehend it in all its significance at once. And in very truth, so soon as men understand that, the Kingdom of Heaven will be for them not a dream, but a living reality.”
Spoken by a character who committed murder, a murder he’s been hiding:  “I know it will be heaven for me, heaven, the moment I confess. Fourteen years I've been in hell.”

And here are words spoken by Father Zosima a prophet, a poet, a priest—someone who echoes both Christ and Buddha for me:
My brother asked the birds to forgive him; that sounds senseless, but it is right; for all is like an ocean, all is flowing and blending…  I ponder, “What is hell?” I maintain that it is the suffering of being unable to love...  there are some fearful ones who have given themselves over to Satan and his proud spirit entirely. For such, hell is voluntary and ever consuming; they are tortured by their own choice. For they have cursed themselves, cursing God and life.
Those "fearful ones" stay with me. “For God has not given us a spirit of fear, but a Spirit of love, of power, and of a strong mind.”  2 Timothy 1:7

I love that trinity.  Love, power, and a strong mind.  If I can have love and power and a strong mind, then I live already in the kingdom of heaven.  If I fear, then I live in an ever-consuming and voluntary hell.

But I fear so much, all of the time.  As Solomon writes:  "It’s possible to distinguish between anxiety and depression, but according to... a leading expert on anxiety, 'they’re fraternal twins.'"
A quote from Tina Berger:
I often explain it this way. If you go and visit a Western-trained psychologist for seemingly inexplicable anxiety, he or she will most likely ask you about your life and your job and your family of origin. You may receive a diagnosis and plan of treatment. The treatment will likely involve relaxation and stress reduction, perhaps some additional talk therapy to address past emotional wounding, and you may be referred to a psychiatrist for medical treatment with anti-anxiety medication. You may or may not find the source of your anxiety. Whatever the recommended course of treatment, unexplained anxiety is generally seen as a pathology here in the West. If you have anxiety and you can’t source it to an immediate and direct problem in your life, the general assumption is: something is wrong with you.

An ecopsychology-based perspective takes a much bigger picture view of anxiety, considering questions like, “How sane is it, to have no anxiety as such beautiful species of plants and animals disappear from the planet one by one?” “How sane is it to have no anxiety when we know children are dying unnecessarily from starvation in many parts of the world?” “How sane is it that we work such long hours to continue acquiring so many things that we will throw away in less than a year?”
How sane am I?  Not very.

One last Solomon quote:
At a cocktail party in London, I saw an acquaintance and mentioned to her that I was writing this article. 
"I had terrible depression,’ she said. 
I asked her what she had done about it.  
"I didn’t like the idea of medication,’ she said.  "My problem was stress-related.  So I decided to eliminate all the stresses in my life."  She counted off on her fingers.  "I quit my job," she said.  "I broke up with my boyfriend and never really looked for another one.  I gave up my roommate and moved to a smaller place.  I stopped going to parties that run late.  I dropped most of my friends.  I gave up, pretty much, on makeup and clothes."  I was looking at her in bewilderment.  "It may sound bad, but I’m much less afraid than before," she went on, and she looked proud.  "I’m in perfect health, really, and I did it without pills."
Someone who was standing in our group grabbed her by the arm. 
"That’s completely crazy.  That’s the craziest thing I’ve ever heard.  You must be crazy to be doing that to your life," he said. 
Is it crazy to avoid the behaviors that make you crazy?
Jane Kenyon writes, of emerging from a devastating depression:  “With the wonder and bitterness of someone pardoned for a crime she did not commit I come back to marriage and friends…  to my desk, books, and chair.”  She writes, of ordinary contentment:  “What hurt me so terribly all my life until this moment?  How I love the small, swiftly beating heart of the bird singing in the great maples;  its bright, unequivocal eye.”

So I make plans for a half-suicidal foray across the Atlantic.  Or I make sense of the world through art, as Townes van Zandt, the patron singer of depressives, did.  He also drank himself to death aged 53. Ernest Hemingway, with his shotgun, beat him by nine years.  Robin Williams beat him by ten.


Anonymous said...

I appreciate your honesty. I wish no one had to struggle this way. I often feel a slave to my emotions. The ability to "buck up" or "fly right" is not within my control most days. I want to be consistent, "a rock", but some days are good and others are not. I have found two things that help me get out it, 1. anger 2. waking up the next day. When I consider suicide, I think the only truly brave way to do it is to starve yourself to death. If your resolve is high enough to be depressed for the length of time it would take to starve yourself, then maybe things are really that bad. There are a few old people I have heard about and/or seen who have accomplished starving themselves. Obviously, if your coping mechanism is eating, that might not work as well to stave off suicide, but I would urge to remember the phrase you used "a permanent solution to a temporary problem". Also, the anger that helps pop me out of it mid-day is often related to the people who are in my life. If, when you are not down, you can get C. to agree to call 911 "out of love" when he sees you in that state, it is greatly motivating. At the time it feels like a betrayal, but the anger you will feel toward him, might just work like magic. It sure does me. Anger is the "fight" part of "fight or flight". It pops me out of the flight response of suicide or avoidance by laying in bed. It may not be a popular solution, but who cares about popularity. It works.

Melissa Jenks said...

Thanks, in turn, for your honesty. I do feel like the notion of "bucking up, li'l camper" is very much the attitude of most people, something which is generally not in my control. Starving oneself is a legitimate method of committing suicide, as many anorexics could tell you. I have known many anorexics and bulimics and other disordered eaters (I would call myself one of them--in bad times I'd say I'm just a bad anorexic) and maybe it is a brave solution for them, if just as dysfunctional as any other method of suicide.

"A permanent solution to a temporary problem" comes from Robin Williams's movie, "World Greatest Dad." When he says it he's arch and half-sarcastic, and it's almost a suicide sound byte. Anger, on the other hand, is not something I've often tried, but it does seem like something that might get me out of bed on bad days. One of the articles I read about depression said that most people's success in dealing with depression has to do with the people in their lives, so I definitely think that having someone respond "out of love" in whatever way is crucial.

Thanks again.

Red Sonia said...

Hmm. I want to stop time for a second so I can stand in a hot shower where no on else is waiting or watching or wondering.

I live in fear of losing you and what I can't do to to make the pain or the feelings go away. I will say again and again and and again, so read this out loud, I want you to always and often tell me how you feel. I want you to call me anytime. I would so much rather be dragged down into your state with a chance to be next to you, then be avoided. In the book Cutting for Stone, Thomas Stone rejoices at TB, because he knows he will get to suffer with his mother in the cold high altitude treatment facility. I'm all in and I love you and I am devastated by all that you and I and others must endure as we seek out the light.

Thank you for sharing something so personal and exposing. You are brave, loving and strong!