THE BLOG
09/08/2014 01:55 pm ET Updated Nov 06, 2014

Suffering at the Hand of The Black Dog

"A light seen suddenly in the storm, snow
Coming from all sides, like flakes
Of sleep, and myself
On the road to the dark barn
Halfway there, a black dog is near me."
-- Robert Bly, Melancholia, in The Light Around the Body, 1967

The bite of the black dog can be worse than its bark. To some, the black dog is man's best friend, a faithful companion in the rear of a pickup truck. To others it is a metaphor for the shadows of depression. Depends, as always, on ones perspective. I was bitten early in life, and though the scars have diminished, the hurt never goes away. Roman lyric poet Horace in 40 BC associated the opaque canine of hopelessness and despair -- a reference resonated in the first century in the writings of Greek orator and philosopher Apollonius of Tyana.

All I know is that I can't sleep at night, haunted by demons of depression that keep me captive in the early hours of the morning.

Robert Lewis Stevenson in Treasure Island, perhaps one of the finest works in English literature, cast the black dog as a pillaging pirate, a harbinger of violence, with two fingers missing on his left hand. Eighty-four years later, putting the best face on imagery, master sailor Robert Douglas on Martha's Vineyard befriended a black lab, boxer mix aboard his schooner the Shenandoah, calling his mate the "Black Dog" after Stevenson's swashbuckler. For 16 years, Douglas and his companion were inseparable, ultimately the inspiration of a celebrated tavern and accessory chain, anchored in Vineyard Haven, which bears the name, The Black Dog.

Still, the black dog is haunting for me. In 16th-century English myth, it was associated with the devil or a hellhound, a nocturnal apparition whose appearance was regarded as a presage of death, a guardian of the underworld. There is no hyperbole in this for those who live with depression, the fear of melancholy. Actor Robin Williams, who courageously fought these monsters, knew it all too well. While Williams' suicide shocked the world with piercing questions of "How can this happen?" his death cut deep for the 19 million who suffer at the hands of the black dog. Reading the spate of stories and accolades about Williams, I initially wanted to comment, but needed space to reflect on this deeply personal struggle against depression. Williams' death is testimony to his fight to live. He buried himself in his work, as do many of us in this battle to keep the monsters caged. "Impossibly high functioning," as it has been said of Williams.

Never let them see you sweat!

Yet, I ooze over a wholesale misunderstanding, in lay terms, of what depression means. It is not a mood swing, a lack of coping skills, character flaws, or simply a sucky day, a month or a year; it's a horrific, often deadly, disease. Many, like Williams, choose to deflect the relentless in-your-face assault of these demons, hoping to stare them down for as long as possible. It's a lonely, numbing gaze, a confrontation that sometimes one cannot win. Losing is not failure; it is evidence of the fight. Williams, just a year younger than I, fought valiantly. He is a hero in his defiance of a disease that roams boldly at will, often taking no prisoners.

In depression, there is no off button. No Hollywood scenes the likes of Moonstruck, a Norman Jewison classic where Loretta Castorini, played by Cher, slaps Ronny Cammareri, a beguiled Nicholas Cage, then slaps him hard again, commanding, "Snap out of it!"

You can't snap out of depression. Even Winston Churchill, who used the ever-present "black dog" as his daily symbol of despair. Reflecting on his depression he wrote: "I don't like standing near the edge of a platform when an express train is passing through. I like to stand back and, if possible, get a pillar between me and the train. I don't like to stand by the side of a ship and look down into the water. A second's action would end everything. A few drops of desperation."

Yet, like Williams, Churchill used his affliction for good, in his case, as a battering ram against Hitler in World War II. Psychiatrist Anthony Storr noted how Churchill marshaled his depression to enlighten political judgments. Observed Storr:

Only a man who knew what it was to discern a gleam of hope in a hopeless situation, whose courage was beyond reason and whose aggressive spirit burned at its fiercest when he was hemmed in and surrounded by enemies, could have given emotional reality to the words of defiance, which rallied and sustained us in the menacing summer of 1940.

Churchill's depression, observers have suggested, allowed him to assess fully the Nazi menace and recognize in the process that conciliatory gestures -- the policy of England as the time -- would only embolden Hitler. Thus, as prime minister, he altered the course of history, attacking Hitler head on, using his black dog to his advantage. Sic him!

From the start of recorded history, many leaders and creative types, artists and writers, given to mood and anxiety disorders, have used The Black Dog as a lens to the soul. Eugene O'Neill, Tennessee Williams and Charles Dickens all appeared to have suffered from clinical depression, as did Ernest Hemingway, Leo Tolstoy and Virginia Woolf, to note a few.

Comprehending depression is as confounding as the question comedian George Carlin posed many years ago: "If God is so powerful, can He make a rock so big that He can't pick it up?"

Depression is heavy, it is complicated, the cause of a range of factors.

"It is often said depression results from a chemical imbalance, but that figure of speech doesn't capture how complex the disease is," according to a special health report from Harvard Medical School, titled, "Understanding Depression."

Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals. Rather, depression has many possible causes, including faulty mood regulations by the brain, genetic vulnerability, stressful life events, medications, and medical problems. It is believed that several of these factors interact to bring on depression.

My depression was brought on as a young man. Looking back, I felt at times lonely, worthless, desperate, and confused. I was an "A" student, a jock, a good-looking kid, the funny man at family gatherings and parties. Still, I felt useless. I spoke to my parents about it, and they told me that I'd get over it. Years later, I found out my father was on depression medication, and my mother had succumbed to it as well. Earlier, her brother had taken his life in a depressive state. Finally, I saw a doctor and was diagnosed with clinical depression -- again not code for a bad day, but a frightful state of mind.

The black dog can be provoked by other diseases, doctors advise. In the case of Robin Williams, there was much commentary about the impact of Parkinson's disease on accelerated depression. Such is the case with Alzheimer's. The black dog stews in the defective tangles and amyloids of the disease. Five years ago, I was diagnosed with early onset Alzheimer's. Since that time, the depression has heightened to a point where not long ago, I considered leaving this planet. Exsanguination, as my doctor calls it, or bleeding to death, the result of a prostate cancer biopsy that went horribly wrong, resulting in horrific internal bleeding. For three days I refused to tell anyone of the hemorrhaging, considering in hopelessness it might be the time to punch my ticket.

In all, I lost eight pints of blood. The body holds 10. I was on the threshold, but in a come-to-Jesus moment, I sought help, sensing in my gut this wasn't my time. Later in the hospital, after a transfusion of six pints, a nurse told me, "Do you realize you're supposed to be dead?"

"Yes," I replied, "But no one had the courtesy to tell me."

The cancer now is my exit strategy to this other insidious disease, eating away at my brain, piece by piece, until one day, I won't recognize my own name.

Today, The black dog still roams within me as I look for its leash to try and reign in the beast and, in a way, make good from evil.

Greg O'Brien's latest book, On Pluto: Inside the Mind of Alzheimer's, will be published in September. He is also the subject of the short film, "A Place Called Pluto," directed by award-winning filmmaker Steve James, online at livingwithalz.org. In 2009, he was diagnosed with Early Onset Alzheimer's. His maternal grandfather and his mother died of the disease. O'Brien also carries a marker gene for Alzheimer's.