9/12/2006

May thy heart sing

My favorite season is Autumn. There is something about a day when the air is clean and crisp with the bluest of skys that makes my heart sing.

Ironically, fall is the time of year that things are the hardest for my mental health. Its been about a year since I got the courage to begin treating my depression. I had always had a fear of going into public...but when I began crying and hyperventilating at a bank, I decided I coundn't continue like this anymore. What I found the hardest was learning that being happy is ok. That I really do deserve to go through life with all the negetivity in my head muted to a dull roar...I actually have the ability now to see that all that noise is just noise. I don't come from a background where therapy is an option...just pull yourself together and get through it, no one has it easy, quit your whining. Or better yet, never under any circumstances admit that your bad moods, which include sitting in a dark room drinking after work are a problem, much less depression--aren't midwesterners great!

My best friend from college has a history of clinical depression. Its been a really hard year for her. Things have gotten worse of late. I asked her if she wanted me there, she said no. I had urged her a few months ago to talk with her social support network in the city she lives in. I have met them, they are good people. It took time but she has let them in and they are standing with her in her time of need. I have been talking to her two or three times a day for the last week, but its not the same as being physically with her. I am so grateful that she is surrounded in a loving community. Really that is all a person can hope for in a lot of ways.

I know she hears the strain in my voice when she talks to me. Its one part worry and one part trying to decern what is appropriate to say. She has always been the one I go to when I am unwell...but I can't burden her right now. It is important that she get to a good place and learn ways to maintain it. She has just discovered the fact (that through proper medications) life can be wonderful, that it is possible for people like us to live in ways other people do. It is a joyful revelation and one of the most terrifying I have ever experienced. And everyday is not perfect, but the weight of it all is so much lighter. I can now navigate through life easier. I pray that what she is experiencing right now will continue, that finally she can actualize her potential without being weighted down with depression.

10 comments:

forrest said...

I've known quite a few people who were "depressive" or "bi-polar;" partly it's because these have been the popular diagnoses lately. Maybe that's been because there really is a lot of "that" going around, just the peculiar flavor of the spirit of this time. Like Freudian Vienna was full of classical hysterics, who have virtually disappeared since then. And where have all the "multiple personalities" gone lately?...

Maybe it's because these diagnoses come with a "treatment" that can be prescribed, and a no-fault theory of their origin.

"No-fault" is good, and true. It's an improvement on "Snap out of it!" But I'd be wary of certain side effects. Side effects of the "medicines", for one; there's been a long history of "safe," "effective" "treatments" turning out other than advertised. And side effects of accepting a label, a distinction from "normal people."

There are chemical states of the brain--a large dose of amphetamines, for example--that can render anyone misfunctional. But there's a wide range of different modes in which "normal" people think and experience life. My best friend in high school tried LSD, said the effects were interesting but not essentially different from his usual, highly visual way of thinking. Other people, like me, found it overwhelming- "More energy than one human being can handle," as Stephen Gaskin put it.

If you need to take a pill to help bring your suffering under control, restore your sense that life is a good thing, get yourself in condition to live without the pill--That can be useful. Accepting the pill as a permanent way of life--I'd be wary.

One of my friends had worked hard to qualify for a new career. She was an extremely competent woman but totally tempermentally unsuited for that career, and she had her heart set on it. She crashed and burned, spent several weeks raging and raving until a group of concerned friends, having received many desperate midnight calls, formed a posse to come tell her she needed to be committed. She wouldn't go.

When she finally got her appointment with a shrink, she told him: "Look, all I need is one good night's sleep." Whatever he gave her, she says it put her out in the midst of a raging anxiety attack--and when we talked with her the next morning, we could see that she was on her way back to herself.

My personal guess--for all it is, and isn't worth--is that the cognitive end of both conditions is a person's feeling that his worth depends on him being someone different from who he naturally is. In a manic state--He can shut off everything that might undermine his belief in his own perfection. In a depressed state--He becomes helpless against the impossible demands and unwarranted accusations he lays on himself.

And why so many people now? Again a guess: Success in conventional terms has become very very elusive for a great many people, while the outlook for the "unsuccessful" has become terrifying--and our cultural expectations are still based on a denial that our way of life has become unviable. An insane social myth, potentially quite crazy-making.

James Naylor said...

I wish it were that easy, that we could "get in a condition to live without the pill." In all honesty, I sincerely believe we over-medicate in this society. That depression has become a sweeping catagory used to diagnose and medicate people, not all of whom need it. For some talk-therapy and exercise might be enough. For others a good diet and a sun-lamp.

I was very leary about taking medication. Not only was there the guilt and shame of admitting a weakness or that there was something potentially "wrong" with me but that the side-effects are vast and ridiculous.

Most of the people I know are depressed, and not in a pop-psychology way, a serious I-am-constantly-holding-them-in-the-light-kinda-way. Depression eats at us all from time to time and for some of us it is a daily battle to get through another day alive. It is hard for the caretaker part of me to feel like I have ever done enough for others. I can be with them physically or emotionally, but I can't take away the pain and sorrow.

My therapist and I look at the underlying factors causing my depression...but the drugs allow me to actually examine them. The drugs allow me to get through a day without crying. The drugs make it possible for me to realize I can't control everything and not freak out when someone moves something without asking or doesn't understand my instructions...and does something that does not follow my strict logic for the world.

Have you ever had to bandage up someone's arm after they have inflicted self-harm? Have you tried to have the conversation with them about that? It doesn't really work to say, love yourself more or stop undermining yourself.

I had a conversation with the friend i wrote this post for. She was telling me how terrified she felt because she could now see herself living a functional and happy life...it was possible. She had just started a new medication. Our experiences were the same...the dark weight was lifted...the sensations of anger, fear, and self-loathing were so muted in our minds...we were free of something we didn't know had been that bad till it was gone...why, because we had lived our whole lives with it. But please don't trivalize our experiences of a "re-birth" even if it is through medication. Do I want to be on a medication for my moods for my whole life no, but if it will keep me from living like I used to...I want it. I wish I was as fixable as you think. I wish it was a popular fancy of physicians or that I feel inadequate about my place in the world and ability to achieve under the current hegemonic paradigm of the US. But even if our society has constructed norms that are an "insane social myth" the depression I am talking about is not.

Blessed be.

Marshall Massey (Iowa YM [C]) said...

Dear heart, I have seen this widespread depression too. It seems to me it is much more widespread in U.S. society than in some that are much poorer -- but much more socially secure -- than our own. I wonder if much of it is not due, not to chemical imbalances, but to finding oneself in a world where there is no security, where the loss of employment can kill you and the ruling powers believe that five or six per cent of the populace must be kept in unemployment at all times in order to keep wages down. (Yes, they really do believe this, and say so.) Where families are broken up by economic forces that compel both parents to find employment, often on different schedules, sometimes in different towns. Where one's house is mortgaged and can be taken away if one can't pay the installments. A world like that eats away at the soul every hour of every day. It instills not only irrational depression but also irrational violence.

This is not to say, take no drugs. Sometimes drugs are the only way back up from the pit. But I wish to support your intuition that the drugs should not be necessary.

RichardM said...

Depression is probably more common in the United States than it is in Sumatra and the reason may very well be cultural. But other diseases flow the same patterns. You will find particular cancers rampant in one society and rare in another. Cultural factors probably play a role in cancer too. But if I got a particular cancer and it was caused by some defect in my society I would still seek chemotherapy if I thought it would give me a chance of survival. And I would do it despite knowing the sideeffects.

I agree that we ought to take a good hard look at our society and see why it is making so many people depressed. The quantity and depth of the depression we are seeing in people is appalling. It is also much more prevalent among young people and in those among the best and the brightest. But actually being depressed doesn't help solve the problems on either an individual or on a corporate level. If the society that is making people sick is also able to invent drugs that can get people healthy enough to be productive, then those of us who are sick should take the drugs and regain the strength to get back to doing something productive about those deeper underlying problems.

Marshall Massey said...

Your posting, friend Richard, reads as if you believe you are disagreeing with me. I don't think you actually are, though. Did you fail to notice my statement, "This is not to say, take no drugs"?

forrest said...

I don't say I know for a fact what's going on with this contemporary epidemic of madness... but it doesn't sound like anyone's seriously disagreeing with me.

Life right now is this incredible mix of horror and hope--with many people seeing no credible justification for the crazy hope I do feel.

I'm not saying that anyone can somehow learn to live "a normal life" without the pills, because I don't know that any of us humans will ever get to live "a normal life" ever again. (Suppose one were a proper ancient Roman, living a normal life, and all of a sudden he sees this scrungy guy with a spear, his mustache groomed and polished with rancid butter--and our Roman may not know it, but his life is simply not going to be the same hereafter.)

I really don't like theories that label some people as intrinsically "defective" and thereby doomed to a life on psych meds. I'm not recommending "no meds": and your regimen of "meds plus talk" sounds like exactly what I do favor (only not as a permanent way of life.)

An acquaintance of mine deals with a lot of Tibetan lamas. He was telling me about one, who'd lived several years in Mongolia practicing accupuncture. The point was, there was a weird condition of the pulses this guy found typical of his American patients, and he'd never felt it in anyone in Mongolia. His guess was that it had to do with our pervasive insecurity; a Mongolian might have all sorts of worries but he did know, for example, there would always be someplace he'd be entitled to sleep at night.

I did meantion "pill-pushing doctors" as one possible explanation for the sheer number of people getting diagnosed, but that isn't really the one I find most plausible. It is part of why people diagnose themselves "depressed" rather than "unhappy." Unhappiness is not a disease, not a character flaw, just a fact of human life. Depression is more like unhappiness plus kicking oneself while one is down, and people don't need a doctor to do it to themselves. That has to be from situational factors.

I've been so worried in times of personal poverty--that it wasn't until much later, months after returning to a secure life, that I would suddenly find myself unexpectedly happy, astonished that I could be happy. "I had the blues/ so bad one time/ put my face in a permanent frown./ Now I'm feeling so much better/ I could cakewalk into town." (Taj Mahal.)I gather that depression is like that, with a strong component of self-blame, and no expectation of ever coming back out into the sunlight. Bleh!!!

Another thing about some of the depressed people I know... one friend won't let me talk about this to her, she's so afraid that I might think her condition was somehow "unreal", just because I'm skeptical of the mythology surrounding it. That I might want to take away her pills, or the disability check she truly needs. Fact is, I'm glad she's still around after the course of shock treatments that nearly zombied her out a few years ago. And still sometimes worried she may end up using medical help to destroy herself.

I'm not really against the pills, but I think it's important not to buy the whole package that comes with them...

David Parsons said...

There are certainly more diagnoses of depression than previously, but whether that reflects a greater disease incidence is unclear. I see three factors that may be driving the rise in diagnoses.

The first factor is that there is less stigma attached to mental illness. Mental illness is now believed to be the result of brain chemistry, rather than a character defect or demon possession, and so people are more willing to seek treatment and admit a diagnosis than they were even 30 years ago.

A second factor is the discovery of treatments that actaully work a decent percentage of the time(the tri-cyclics and the MAO Inibiters), followed by the discovery of treatments that work with reduced side-effects (the SRIs and the newest MAOIs coupled with talk therapy of some type). "Less" is not the same as "no," whether we are talking about stigma or side effects, but for a person who is genuinely depressed the stigma and side effects are usually perceived to be less onerous than the symptoms of the disease.

No one doubts that the best solution is not to be depressed in the first place, but the modern treatments are better than the old way. The old way of dealing with depression was alcohol, which provided immediate short-term relief of symptoms, but had some unfortunate side effects, including death by liver disease or vehicular incident or other causes.

Even after the discovery of tri-cyclics, women were diagnosed with depression, while men were diagnosed with alcohoism; I suspect that is because in the 1950's and 1960's men didn't go to doctors, and women didn't go to bars.

A third factor is medical insurance, espcially in combination with low wages. Many people have access to a General Practitioner, but not to a Psyciatrist or mental health specialist. So GP's are put in the position of trying to diagnose who is depressed and who is just bummed out, without proper training, and under much time pressure; given the relatively benign effects of the medications, and the severe consequences of the disease, they may err on the side of caution and diagnose depression a little too easily.

I don't know how to sort out the problem of "disease diagnosis" vs. "disease incidence." The third world comparison raises another interesting complication: Is the lower incidence in some third world nations due to fewer doctors to provide diagnoses, and/or a higher death rate due to lack of treatment? Or is it actually a mentally healthier environment? And what exactly is the role of environment in depression?

I'm with Marshall Massey and Richard M on this; if the diagnosis is accurate, and the medications help, one should thank God for effective medications and take them with great joy.

RichardM said...

Marshall,

I did not mean to sound as though I were disagreeing with you. As my daughter has suffered greatly from depression and the medical treatments have seemed to help I react like a protective father.

I actually agree with you that insecurity is one of the causes of depression. I would also identify the glorification of selfishness as another factor. Thinking only of oneself is soul-killing. People have most often lived in societies which encouraged and praised thinking of the good of others. We live in a society which praises narrow self-interest and ridicules those who place the interests of others above their own. We are inundated by propaganda for selfishness and that is both different and depressing. Being told by the media in a thousand ways that you are a fool for not wanting to "maximize your earning potential" and soft-minded for caring about animals, trees or poor people has got to be depressing to anyone with finer feelings.

Marshall Massey (Iowa YM [C]) said...

Hi, Richard!

-- I appreciate your reply to my reply. I understand how dads can get overprotective, and I'm grateful to have your reassurance that you're actually feeling friendly.

Since I have your attention here, let me add that actually I'd converse with you on your own web site -- you've posted some interesting stuff! -- but your own web site accepts comments only from people who are registered with Blogger, and I feel a stop in my mind against supporting a conversations-for-registered-guests-only arrangement.

RichardM said...

Marshall,

Well, I didn't realize that. I'm still pretty new to this blogging thing. I'll see if I can change the settings to allow you to participate without registering.