Listening to Depression

How many times have I been fired? What would I do if my wife left me? How could someone have helped me ten years ago, during my second psychotic break, when I trampled for six hours across Los Angeles, convinced that I was going to be assassinated?

Ranging from the comical and the tone-deaf to the compassionate, these questions have been posed to me over the years at talks I have given to clinicians and patients at self-help clinics, day hospitals, medical schools and prisons for the criminally insane.

Recently, I was invited to be a panelist at Loyola Marymount University, which on October 16 will be holding a conference on recovery from addiction and mental illness. In anticipation of this event, I will answer one question, which surprisingly has never been asked, and that is: What is depression actually like?

It seems a fitting coda to Mental Illness Awareness Week, which is designed to educate the public about disorders of the mind. During this week, which was inaugurated by Congress in 1990, the National Alliance on Mental Illness organizes walks, workshops and other events to fight the stigma associated with illnesses such as schizophrenia, bipolar disorder and depression.

Depression is such a mystery to so many people, including the mentally ill, that it often defies description, but it strikes me that it is important to try to describe it to other people so that they can get an appreciation for the deadliness of the beast.

As I have written at length, some people view the mentally ill as being violent and rageful. One might think of the opening image of Yeats' "The Song of Wandering Aengus," in which a man deems his brain to be charred by fire.

That may be a good metaphor for someone with anger-management problems, but it doesn't convey what severe depression is like, at least not what it was like for me.

Back in 1997, at the time of my first psychotic break, I lost my appetite, couldn't sleep though I lay in bed all day with my clothes on, couldn't read because of a lack of concentration, smelled differently, the mephitic, sweaty odor of fear, and lost interest in just about everything: a state clinicians refer to as anhedonia.

If I had to compare that deep sense of hopelessness to anything, it would be to low tide at twilight. It is as if your brain is the shore, and it's getting very little nurture from the rays of light or the waves of water, which, like your neurotransmitters, are dormant, fading, near extinction. It's not midnight at low tide; there is still a glimmer of light on the horizon, though, as Bob Dylan once wrote, it's "sinking like a ship."

For those who are mathematically inclined, another way of thinking about depression is to picture a Cartesian plane, with your life fixed beneath the X axis. When you are severely depressed, you are not at zero; you are below zero.

When you start recovering, you do not automatically soar above the X axis. First, you have to heal sufficiently just to get to zero.

Imagine what it's like to be drowning, under water. First you have to get to sea level. But once you reach it, you will still be flailing until you swim to shore.

Andrew Solomon, in his National Book Award-winning tome, The Noonday Demon, used another metaphor for this prolonged two-stage process. If memory serves, he wrote that depression is like a branch on a tree that has a disease, such as a fungus. It is rotting and dying.

In order for the tree to recover, you first have to get rid of the disease itself. But that is not the end of the process, for the branch still has no green on it, no leaves, no fruit. After ridding the branch of the disease, you then have to water the roots and give it sunlight for the branch and the tree to grow again.

So, now that you know more about depression, what can you do about it? That is easy. You can contribute to organizations like NAMI.

You can attend conferences like the Recovery Summit at Loyola Marymount, which will be held on Friday, October 16. Those in the Los Angeles area who need more information can go to www.soberhousing.net/summit.

But perhaps most of all you can think twice before assuming that the mentally ill are violent or simply lazy. Most of us are no threat to you, and many of us work very hard in spite of our condition. We have to in order to get above zero.

 

 

Comments

[JoanneRM]

Depression has many causes. Many people are prone to it genetically, and through a traumatic event or events, suffer a trigger to depression, or more often, bouts of depression. Many people suffer an hormonal trigger to depression. There are other triggers, and people fall into different groups. Most will benefit from medication and talk therapy. Many from just one or the other. It depends. A number of people with the most severe depression, respond well to modern methods of ECT, which run counter to the old methods.

I think modern psychology, post-1980'a psychology, has rambled around our problems long enough, that I can trust them to discuss the condition of my psyche, and take their prescriptions to try. I read the package insert and looked it up on the Internet. I took the polio vaccine on faith when it first came out, and didn't get polio.

To me, depression is like sitting on the floor of an empty swimming pool, just before the bottom. The temperature is not cold, but not warm either. There is no sound, and no movement of air.

[Giada]

It is difficult to explain to those who have never experienced severe depression. The inclination from others is to fix it, or problem solve, rather than attempt to fully understand.

Depression is not on a list of choices for the day = )

[SaigonHappened]

Suffered it for 20 years. Medicated and fully functional for about 6. Cost me my marriage. That's what depression is, kids. I call it "the green man" after a character from that old TV show, "Northern Exposure." I 'm looking for him every day and, if I ever catch that little green b*st*rd, I'm gonna kill him and get on with my life.
I hope you find peace.

[mamacat]

In my opinion, being human means learning to live with our insecurities, our craziness, our depressions, and even our insanities. Thank goodness we can't be prosecuted for our thoughts!

Meeting, talking, and listening with people, one quickly learns that everyone carries around a lot of unwelcome baggage. While we pretend that we live in a rational world, each of us has to cope with our own irrational emotions and preconceptions.

The author intends to discuss clinical psychiatric problems, but in a very real sense, human thought and language processes carry with them their own built-in limitations and problems.

[khanti]

A moment of feeling hollow?

[MerrieWay]

Thank you so much for your brilliant visual analysis. There are so many questions I have for you that 250 words here...are just not enough. When someone is in the psychotic break mode, and heavily medicated, how can one which is causing the isolation from the outside world. I watched someone grow more despondent on meds... the higher the dose the symptoms worsened. Manic...wa­s replaced by sleeping most of the time.
So sad. What happened to mental health why is it illness connotation? Why aren't tests routinely given to determine underlying cause, (diabetes rare form, hormone imbalance, etc)? How can a psyche doctor give a diagnosis without those tests? It's appalling from the most common-seneschal standpoint­....and disturbing from an ethical standpoint.

[Robert David Jaffee - Huffpost Blogger]

Thank you for your kind words. When I was having my second psychotic break in 1999, I forgot to take my meds for probably 5 to 6 days. The meds definitely did not cause my break. To the contrary, my absentmindedness in forgetting to take them exacerbated my condition. As for underlying causes, what I can tell you is that suicide and severe mental illness both run in families. That was and is the most salient of the underlying causes in my case.

[Corofine]

Most people believe depression is mainly a psychological disease. But isn't that also logical?: if you suffer from a trauma, an infection, too much stress: all these go with malnutrition over a greater period of time, emptying the body's reserves of important substances. Most are not aware that our mood depends on the serotonin level in the brain (most might know that they are treated with serotonin reuptake inhibitors or similar "heavy" drugs that are interfering with our neurotransmitter systems). It is a shame, that nobody tells you, that this shortage is influenced by what you eat and drink and by what you take as drugs.
The amino acid Tryptophan (precursor of serotonin) has to enter the brain, and it is then used to form serotonin. Tryptophan transport into the brain is only possible in the morning or after exercise, when other amino acids are absorbed by the energy-hungry muscles and cells. Only then they are not competing for the transporter into the brain (Tryptophan being the only amino acid that is not "consumed" as energy source). And the transporter must not be occupied by drugs or Aspartam-derived Aspartic acid and Phenylalanin! both neurotoxic! as is excess Glutamate. they will hold the serotonin levels low! So avoid these by all means! (Humphries et al., 2008; Direct and indirect cellular effects of aspartame on the brain; Eur. J of Clin. Nutr. 62:451-462)
.... continue in the second posting...

[Corofine]

... second posting: I think it is a good message, that depression may be cured by eating the right food, preferably not industrially processed!, preferably LOGI, and by filling the shortages of Antioxidants, Vitamins, Minerals, Coenzyme Q10 or Ubiquinol and Omega-3-Fatty acids.... Once, your body is "refilled" with what it needs, you are much stronger to cope with psychological issues. It is so important that good feelings come back , bit by bit (and it's serotonin that is required for feeling). So recover from deficiencies!! A way that I discovered as a quick aid: 1 Spoon of pulverised raw cost (from whole plants! vegetables, fruits, amaranth..­) in a drink in the morning provides the brain with sufficient tryptophan in the brain for the whole day. or you prepare it from fresh plants... or ask a holistic therapeut about it! There are more solutions than drugs!