08/07/2014 10:47 pm ET | Updated Oct 07, 2014

Depression, Psychosis and Psychopathy

What is worse? Depression? Or psychosis?

That was a question posed to me by a friend some years ago.

It is a bit difficult to separate the two in my case because I have been diagnosed for many years now with major depression with psychotic features, known in the parlance as psychotic depression (back in the late 1990s, I was diagnosed with schizophrenia and, later, schizoaffective disorder).

While an estimated one-quarter of people in this country suffer from some form of mental illness, it is a much smaller percentage of Americans who battle the most severe disorders.

According to the web site of the National Institute of Mental Health, 16 million U.S. adults had a major depressive episode in 2012. That represents about 6.9% of adults aged 18 and over in this country.

Schizophrenia afflicts an even smaller percentage of Americans, roughly 1.1% of U.S. adults in any 12-month period.

My first psychotic break, which occurred in 1997, was more depressive in nature than the relapse in 1999. I did have some delusions in 1997, but more than anything I was waylaid by a lifelong depression that had become so severe that I was not only suicidal, I could barely walk, could not sleep, had no appetite and had no interest in anything, including baseball and movies, two of my passions since childhood.

Depression has been with me perhaps since I was in the womb. There is clearly a genetic problem that has targeted some members of my family, including my grandfather, who took his life within a few days of my birth, though many years before I was born. I was probably named after him in Hebrew because of that connection.

Thankfully, I have been able to transmute what seemed like a curse into a blessing. But I cannot remember a time when I was not depressed.

It crippled me for years, undermining my concentration level. That hindered me in so many ways but perhaps most notably as a reader.

My lack of concentration was most acute in March 1997.

So what did I do after my first break and after recuperating for two and one-half months in Connecticut?

I came back to L.A. and became a proofreader.

That line always gets a few laughs, which are needed in any discussion of major depression. Since major depression is so severe and long-lasting, I have to conclude that, in my case, it has been worse than psychosis.

I say this, even though in 1999 I was so acutely psychotic and delusional that I received a 20 on the GAF (Global Assessment of Function) score. I learned of that score from reading my admission form to the UCLA Neuropsychiatric Institute, where I was put on an involuntary 72-hour hold in late January of that year.

My delusions at that time were horrific and terrifying. As I have written before at length, I thought that I was going to be assassinated and framed for a series of crimes sweeping the nation.

In spite of those harrowing delusions, I would reiterate that depression has been worse for me, primarily because my psychosis has been finite and contained, whereas my depression, while muted, has never gone away.

And for those two and one-half months in 1997, when I was deeply depressed, suicide was always on my mind. It was not on my mind as much when I was psychotic in 1999.

Psychosis is like living a nightmare, living in a parallel universe, where warped metaphor, not reality, rules. In my case, because I had felt like a pariah my whole life, my brain conjured a world where I was the consummate pariah, a disgraced criminal on the lam.

Depression is not like living a nightmare. Depression is like not living at all. Depression takes away all hope, all desire to participate in life.

It is no wonder that I could barely move in March 1997. After getting out of the USC psych ward, I shuffled from my bedroom to the bathroom in my bathrobe, even though I had run the L.A. Marathon only a few weeks earlier.

And no wonder I had no appetite and no interest in anything, a condition that clinicians refer to as anhedonia.

I would not wish depression on anyone. As for psychosis, it may be more finite for some people, like me, but it can leave you irreparably damaged to the point that you become severely depressed and suicidal.

In the end, both illnesses are devastating. I know that I am lucky that I have recovered, that I found an angel, my wife Barbara, who loves me, and that I found a rewarding and fulfilling career as a writer.

Most people, who have had a 20 on the GAF score and a onetime diagnosis of schizophrenia, are not so lucky.

Yet I know that I am not the only one. I know many people with severe mental illness, who are functioning, who are working in diverse fields such as law, medicine and business.

We should all be grateful that President Obama's Affordable Care Act provides coverage for people with preexisting conditions. Mental illness, by its very nature, tends to be preexisting and chronic.

I hope that there will come a time when those with schizophrenia, bipolar disorder, major depression and other severe mental illnesses will feel comfortable enough not to worry if anyone sees them leaving a therapy session out of a back door. I hope there will come a time when those who do not suffer from mental illness will have more compassion for those of us who do. And I hope there will come a time when the papers of record, however well-intentioned, will stop reinforcing stigma by writing about how the prisons are stocked with the mentally ill.

Yes, there are people with mental illness in jail. But, as I have written before, forensic psychiatrists will tell you that the vast majority of the criminals who show up on surveys as "having a mental-health problem" are in fact psychopaths or have anti-social personality disorder.

These criminals, whom many psychiatrists do not even consider to be mentally ill, often plan violent crimes for which they show no remorse.

Most of them commit acts of violence not because they are depressed or psychotic. They do so because they are psychopathic, angry and hateful.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

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