THE BLOG
03/18/2010 05:12 am ET Updated Nov 17, 2011

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.