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Sunday, March 25, 2012

My Dives Into the Gulf of Depression

"The worst way to have chronic depression
is to have it unconsciously,
to be in a burning rage
and not know you are angry."

 –Les Murray, Killing the Black Dog:
A Memoir of Depression

I feel the need to define something I have experienced many times. To do this definition any justice, I must confess that words typically fall short when a writer tries to convey accurately anything so intimately entwined with emotion. To tell the truth, when I am in the deepest throes of my illness, I try so hard to climb back that I don't dwell on dissecting the problem or understanding the pain that paints my world black. Therefore, I can, at best, offer some personal experience and trust people will more clearly comprehend a condition that I am still battling as a veteran with 30 years of direct contact.

First of all,  I believe the standard medical definition of depression is largely inadequate for expressing the term. Everyone knows that a depressed person is sad for a prolonged period of time. A depressed individual may exhibit many of the same symptoms of clinical depression. The distinction between simply being normally depressed and being clinically depressed is best understood in terms of reactive mechanisms.

Normal (reactive) depression is psychological because a person is emotionally “reacting” to something that has happened. A person suffering normal depression can usually make adjustments and avoid debilitation. But, someone suffering clinical depression experiences symptoms that are triggered by a chemical imbalance in the brain. It is a biological disorder, but it usually has psychological symptoms very similar to reactive depression. In clinical depression, however, the  individual has little, if any, control over emotions and moods.

The clinically depressed person suffers a medical condition so severe that it is considered abnormal. Clinical depression can be caused by a reaction to unfortunate life circumstances, or it can be caused by no obvious reason. The mental disease is often described by its symptoms --these usually consist of feelings of sadness, guilt, or unworthiness; crying spells; disturbance in appetite and weight changes; and disturbance in sleep. And, of course, these symptoms are determined by medical professionals to be more intense or prolonged than would generally be expected in normal, reactive depression.

The major differences between reactive depression and clinical depression are (1) the inability of the person suffering from clinical depression to exercise rational control of emotions, and (2) the permanent toll that suffering with clinical depression exacts.

Dysthymic disorder, or dysthymia, is characterized by long-term (2 years or longer) symptoms that may not be severe enough to disable a person but can prevent normal functioning or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.

I believe the public generally misunderstands clinical depression because of the wide range in its period of incubation and the relatively unimpaired appearance of its symptoms. Typically, diseases are accurately diagnosed by a medical doctor or specialist through thorough physical examination. People are very familiar with the meaning of these diagnoses and the severity of debilitating physical illnesses.

In the case of most "physical" diseases, the public doesn't question the onset of the malady, the severity of the symptoms, or the need for prompt, thorough, professional treatment. Unlike cancer, diabetes, or any other of a host of these physical maladies, a diagnosis of clinical depression is often viewed with skepticism and disbelief.

After all, most people have a connotation of sadness, crying, sleep deprivation, etc. as reactions to common emotions that a human experiences in the natural course of a life. Everybody expects these things to occur as normal repercussions of regretful situations such as breaking up with a companion, being laid off from a job, or losing a loved one.

"And then, over and over, I would say I was sick—sick with any documented ailment I could think of except 'depression,' which no one, no matter what the brochures with grainy girls’ pictures and the word 'reuptake' say, will ever believe is a real sickness." –Virginia Heffernan, “A Delicious Placebo”

I remember the complete desperation I felt in 1984 as I decided to make my first trip to a psychiatrist. I had experienced a couple of bouts with "nerves" before then -- one during my college days of the early '70s when I realized that changing my major from journalism to English would mean I had to take many extra classes and another during the time of my divorce from my first wife in 1977 -- but I had never felt so hopeless or so unable to experience even the slightest joy as in 1984.

Before I committed to treatment, I had tried to ride out what I thought was a bad case of the blues for at least a month. At first, I thought that I was just a little depressed in the sense of a lingering attitude that I had, in some way, perpetuated myself. So, I tried to rationalize the causes and apply the usual cures -- talking it out with friends, walking outdoors in the sunlight, getting some extra rest from daily stress. Although these activities would ease some pain, nothing I did would exorcise the intense dark spirit that had taken over my entire demeanor.

I was like a hiker on the edge of a dizzying cliff, who had felt a strong push and the loose shale shift beneath his feet. I was sliding toward a certain fall but desperately trying to stop my momentum. The normal lifesaving procedures I had always relied upon were failing. I didn't understand why I couldn't just "buck up" and stop my descent. I realized this beast was aiming to shove me below and kill me.

"I yearned to get better; I told myself I was getting better. In fact, the depression was still there, like a powerful undertow. Sometimes it grabbed me, yanked me under; other times, I swam free." –Tracy Thompson, The Beast: A Reckoning with Depression

Naturally, during that time, everyone who cared for me (including my wife and children, my parents, my brother, my coworkers, and my friends) wanted to know what was causing my sad behavior. I really didn't know, and, I was sure they thought my ignorance was just a lie to cover some awful situation. As time went on and I began looking and acting even worse, many of those around me felt I must be hiding the news that I had some terminal disease.

Yet, in truth, I wasn't grieving over a loved one or suffering from some terrible trauma. I did understand that the pressures of teaching (especially grading for some unknown reason) had triggered my recent panic attacks and deep dysphoria. I actually wished I had been the victim of some awful catastrophe because then, my state would have been justified as originating from a "worthy event." And, guess what? Every time I thought about people who had monumental reasons to be depressed, I felt guilty, and this guilt made me feel even worse. I remember thinking, "I would love to beat myself up."

When people told me to "cheer up" and "come out of it," I was certain they did not understand my inability to climb out of the deep hole I was in. I got so tired of hearing these attempts to force me to function in a world "filled with happiness and good thoughts" that I actually began to avoid all contact with others.

Something in my mind, something unknown to me, had made me a cripple -- a person who was mentally handicapped and who was becoming more and more physically handicapped from exhaustion, worry and lack of sleep and appetite. I tried and failed so many times to accept and practice the sage advice of "just think good thoughts" that my stomach turned at the mention of the words. Even good thoughts produced melancholy as anything "good" seemed to be a relic of a healthy past personality capable of feeling happiness.

"All their 'helpful' comments imply that if I’d only do _____, my problems would be solved. Like it’s all within my grasp, able to be managed and mastered, if only I would try harder, longer, better. As I nod my head in polite and pathetic appreciation for their input, I scream inside, 'Shut up! Shut up! Unless you’ve been lost in this particular section of hell yourself, don’t you dare try to give me directions.'"  –Martha Manning, Undercurrents: A Life Beneath the Surface

Frankly, I decided to make the trip to the doctor because I couldn't control any important parts of my daily existence. I knew I had experienced a nervous breakdown of some sort, but I was extremely embarrassed to be a mental patient. Before I had my first meeting with the psychiatrist, I had visions of media stereotypes that related to head "shrinking: I thought I was going to lie down on a couch and spill my innards about every bump and bruise that had occurred in my life.

Accepting the reality that you're "crazy" is not easy, especially after you have functioned so well for so long. I saw myself as a "nut" on the doorstep of the Cuckoo's Nest.

"It’s strange, the line you cross when you move from calm and satisfied with the rightness and safety of things to the sudden panic that the world has turned angry and dangerous." –Martha Manning, Undercurrents: A Life Beneath the Surface 

Nevertheless, I had run out of options. I had already been to my family M.D. and he had made the referral upon examining my skin full of frayed nerves. I was beginning to feel quite sure an "end" would be better than enduring much more unrelenting pain. I was close to suicide and even closer to wandering off somewhere on my own.

Instead, I took my first tentative steps to the psychiatrist's office. Arriving there and sitting in the waiting room, I felt like a goldfish in a fish bowl staring out at a hungry cat. I actually wondered if the doctor would devour me quicker than my illness. I thought, "This place is the beginning of the end of the world as I had once known it." I was totally petrified -- afraid of others, afraid of myself, afraid of what I had become, and afraid of my future as a lunatic.

"My world falls apart, crumbles, 'The center cannot hold.' There is no integrating force, only the naked fear, the urge of self-preservation. I am afraid. I am not solid, but hollow. I feel behind my eyes a numb, paralyzed cavern, a pit of hell, a mimicking nothingness. I never thought. I never wrote, I never suffered. I want to kill myself, to escape from responsibility, to crawl back abjectly into the womb. I do not know who I am, where I am going—and I am the one who has to decide the answers to these hideous questions. I long for a noble escape from freedom—I am weak, tired, in revolt from the strong constructive humanitarian faith which presupposes a healthy, active intellect and will. There is nowhere to go …"  –Sylvia Plath, journal, November 3, 1952

I waited there in shock for probably fifteen minutes before I met the psychiatrist. I will never forget the first words he said to me. He took one look at whatever transformation I had become and said, in a matter of fact voice, "You are probably the most depressed person I have ever seen."

At this point I would like to describe my feelings as a person who experiences bouts of OCD and clinical depression. For me, the onslaught begins as a simple worry about nothing in particular; I become fixated about a problem, an action, or a concern more than I should. Often, I feel I have made a mistake or I have caused some irreparable harm to others.

As my OCD takes hold, I honestly believe I have done something that could cause "the end the world" or, at the very least, could cost someone their life. I begin thinking, calculating, backtracking, double and triple checking, and doing any and everything to ease my mind. My panic and obsession build until I become mentally and physically exhausted.

Occasionally I reach some temporary but insufficient justification for my feelings. But then, almost immediately, I believe I have done something worse that supersedes the first injustice I had committed. I wonder,"Oh, hell, how do I fix this one?" The cycle starts again and continues to escalate until I begin to resist all  human contact and restrict all physical motivation.

As you might guess, this irrational OCD behavior makes me feel pretty depressed because its power over me is unrelenting. At this point, I begin my rapid free fall into the darkness of clinical depression -- a depression that grows ever blacker with each new day.

My nerves, which never were too steady, start feeling naked and exposed on every inch of my body. Sounds, sights, even touches become sources of irritation until they eventually peak and I am forced to withdraw completely -- to solitude, to silence, to bed in hopes of sleep. Sleep is the only comfort I find, but, even as I ready myself to sleep, I know waking will force upon me other worries and return me to the reality of my worst fear -- my mentally disturbed conscious self. So, I always spend as much time in bed as possible, and I begin to think, "Maybe I can sleep forever."

"... I feel tired to death, paralyzed by this mysteriously wasted life’s stubborn concentration on hopelessness and dissolution. It occurs to me that if I lie still like this for long enough, then I’ll be dead when I finally wake again, and nothing can ever again torment me, beset me, or present me with evidence of my baseness and decay. That thought is the only one that can comfort me." –Christer Kihlman, The Blue Mother

Soon, every time someone mentions I need to leave the house or get busy doing something, I feel dread and painful panic attacks that, much like cramps, spasmodically roll through my gut. I know the world outside is now a foreign landscape. I don't want to think about driving or even walking outside. I know I will mess something else up if I exit the house, and, besides, no one wants to be around a frowning, haggard, emotional mess.

"It’s enough just to speak when spoken to, to give some minimal reaction to a stimulus. But to actually be the stimulus doesn’t even occur to me." –Martha Manning, Undercurrents: A Life Beneath the Surface

Sometimes panic becomes more cerebral than physical, and, at that point, my mind recollects all the discretion of my past -- recent and distant -- the entire guilt-glutted load. Then, I feel I have to make up, in some manner, for all of my transgressions. As I realize it is impossible to correct all of these things, I feel worthless. My lack of sufficient means for atonement begins pangs of familiar guilty emotions that cycle over and over. I feel sorry... for anything and everything... for ever believing I had the right to interject in the affairs of others.

Thereupon, I withdraw to live completely within my mind, a brain now racing with emotions I know I can't express. It feels like limbo -- I find I purposely immobilize myself, but then, I feel guilty because I definitely understand my need to conquer my self-imposed isolation and deal with reality.

But, if I attempt to touch the real, functional world, I withdraw when anything becomes remotely "touchy." I avoid all possible confrontations: harmless visits are even out of the question. Besides, people know it is not "me" who is stumbling around like a zombie but instead the product of my disease. They have seen me act crazy before so if I do venture around them, they put on their "toleration faces" -- a mix of pity, distrust, and anxiety.

"I should come with a consumer warning, like the labels that say 'Handle with care' or 'May be hazardous to your health.' I am unfit for human consumption. I struggle to articulate how awful and isolating this feels, but I can’t find the words.  –Martha Manning, Undercurrents: A Life Beneath the Surface

In full-blown depression, I feel paralyzing fear towards anything that might evoke my emotions. Music, television, telephone calls -- I avoid them all. Having to experience emotion -- good or bad --makes me extremely overwrought. Joy and happiness do not exist when I am in this state. I become very self-centered, and I feel incapable of performing any task that requires judgment or cooperation.

At last, I get to the point where loneliness feels natural and I believe solitude is my designated state. As those around me eventually tire of my irrational, unchanging, "dark" demeanor, they avoid me until I can, once again "become myself."

After that, I find myself at the bottom of a deep, lonely grave that I have dug for myself. Ashamed of "doing it again," I live underground until my doctor finds the right mix of chemicals to balance the sensible workings of my brain. Gradually, I return to the surface and, eventually, I gladly feel "right" again. But, even then, I do not understand exactly how I became depressed. The only thing I do know is that I have been out of control, a "brainless man" again.

"That’s the thing I want to make clear about depression: It’s got nothing at all to do with life. In the course of life, there is sadness and pain and sorrow, all of which, in their right time and season, are normal—unpleasant, but normal. Depression is an altogether different zone because it involves a complete absence: absence of affect, absence of feeling, absence of response, absence of interest. The pain you feel in the course of a major clinical depression is an attempt on nature’s part (nature, after all, abhors a vacuum) to fill up the empty space. But for all intents and purposes, the deeply depressed are just the walking, waking dead." –Elizabeth Wurtzel, Prozac Nation

To close this entry, I want to stress a couple of my understandings. I believe once you first take the fall of clinical depression, you must always safeguard yourself with professional treatment. Two separate times since 1984 I decided to go without my medication. Why? I thought I was cured, and I wanted to be drug free and re-experience a life of independence. The first time I logged three years before I crashed. The second time I barely made one year before I bottomed out. Each time the fall was a little steeper, and I found it more difficult to mend. Now, at age 61, I have resigned myself to taking medication for the rest of my life. I still have some ups and downs but (as of yet) no major freefalls.

The other point I want to stress is this: Don't wait to find professional medical help. Despite feelings of shame or pride, you will benefit from fighting your illness with a doctor by your side. We tell ourselves "we can handle it" or "it's a sign of weakness to ask for help" but the truth is depression, ODC, and any major mental disorder can destroy the strongest individual. You are not defective or "nuts" if you are mentally handicapped. You can live a normal, happy life with the proper treatment. The smaller the fall you take, the better. Let the doctor diagnose your illness at the first sign of a problem. I hope this helps someone avoid the anguish of clinical depression.

"I hated being depressed,
but it was also in depression
that I learned my own acreage,
the full extent of my soul.
 –Andrew Solomon, The Noonday Demon

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