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.
Solomon:
…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.
Dostoevsky:
“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.'"
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.