I felt a funeral in my brain and
mourners to and fro kept treading
treading till I felt that sense was
breaking through and when they all were
seated a service like a drum kept
beating beating till I felt my mind was
going numb and then I heard them lift a
box and creak across my soul with those
same boots of lead again then space
began to toll as if the heavens were a
bell and being were an ear and eye and
silence some strange race wrecked
solitary here just then a plank in
reason broke and I fell down and down
and hit a world at every plunge and
finished knowing then we know depression
through metaphors Emily Dickinson was
able to convey it in language Oya in an
image half the purpose of art is to
describe such iconic States as for me
I had always thought myself tough one of
the people who could survive if I'd been
sent to a concentration camp in 1991 I
had a series of losses my mother died a
relationship I'd been in ended I moved
back to the United States from some
years abroad and I got through all of
those experiences intact but in 1994
three years later I found myself losing
interest in almost everything I didn't
want to do any of the things I had
previously wanted to do and I didn't
know why the opposite of depression is
not happiness but vitality and it was
vitality that seemed to seep away from
me in that moment everything there was
to do
seemed like too much work I would come
home and I would see the red light fly
on my answering machine and instead of
being thrilled to hear from my friends I
would think what a lot of people that is
to have to call back or I would decide I
should have lunch and then I would think
but I'd have to get the food out and put
it on a plate and cut it up and chew it
and swallow it and it felt to me like
the Stations of the Cross and one of the
things that often gets lost in
discussions of depression is that you
know it's ridiculous you know it's
ridiculous while you're experiencing it
you know that most people manage to
listen to their messages and eat lunch
and organize themselves to take a shower
and go out the front door and that it's
not a big deal and yet you are
nonetheless in its grip and you are
unable to figure out any way around it
and so I began to feel myself doing less
and thinking less and feeling less it
was a kind of nullity and then the
anxiety set in if you told me that I
have to be depressed for the next month
I would say as long as I know it'll be
over in November I can do it but if you
said to me you have to have acute
anxiety for the next month
I would rather slit my wrists than go
through it it was the feeling all the
time like that feeling you have if
you're walking and you slip or trip and
the ground is rushing up at you but
instead of lasting half a second the way
that does it lasted for six months it's
a sensation of being afraid all the time
but not even knowing what it is that
you're afraid of and it was at that
point that I began to think that it was
just too painful to be alive and that
the only reason not to kill oneself was
so as not to hurt other people and
finally one day I woke up and I thought
perhaps I'd had a stroke because I lay
in bed completely frozen looking at the
telephone thinking something is wrong
and I should call for help and I
couldn't reach out my arm and pick up
the phone and dial and finally after
four full hours of my lying and staring
at it the phone rang and somehow I
managed to pick it up
and it was my father and I said I'm in
serious trouble we need to do something
the next day I started with the
medications and the therapy and I also
started reckoning with this terrible
question if I'm not the tough person who
could have made it through a
concentration camp then Who am I and if
I have to take medication is that
medication making me more fully myself
or is it making me someone else and how
do I feel about it
if it's making me someone else I had two
advantages as I went into the fight the
first is that I knew that objectively
speaking I had a nice life and that if I
could only get well there was something
at the other end that was worth living
for and the other was that I had access
to good treatment but I nonetheless
emerged and relapsed and emerged and
relapsed and emerged and relapsed and
finally understood I would have to be on
medication and in therapy forever and I
thought but is it a chemical problem or
a psychological problem and doesn't need
a chemical cure or a philosophical cure
and I couldn't figure out which it was
and then I understood that actually we
aren't advanced enough in either area
for it to explain things fully the
chemical cure and the psychological cure
both have a role to play and I also
figured out the depression was something
that was braided so deep into us that
there was no separating it for our
character and personality I want to say
that the treatments we have for
depression are appalling they're not
very effective they're extremely costly
they come with innumerable side-effects
they're a disaster
but I am so grateful that I live now and
not fifty years ago
when there would have been almost
nothing to be done I hope that fifty
years hence people will hear about my
treatments and be appalled that anyone
endured such primitive science
depression is the flaw in love
if you were married to someone and
thought well if my wife dies I'll find
another one it wouldn't be love as we
know it there's no such thing as love
without the anticipation of loss and
that specter of despair can be the
engine of intimacy there are three
things people tend to confuse depression
grief and sadness grief is explicitly
reactive if you have a loss and you feel
incredibly unhappy and then six months
later you're still deeply sad but you're
functioning a little better it's
probably grief and it will probably
ultimately resolve itself in some
measure if you experience a catastrophic
loss and you feel terrible and six
months later you can barely function at
all then it's probably a depression that
was triggered by the catastrophic
circumstances the trajectory tells us a
great deal people think of depression as
being just sadness it's much much too
much sadness much too much grief at far
too slight a cause as I set out to
understand depression and to interview
people who had experienced it I found
that there were people who seemed on the
surface to have what sounded like
relatively mild depression who were
nonetheless utterly disabled by it and
there were other people who had what
sounded as they described it like
terribly severe depression who
nonetheless had good lives in the
interstices between their depressive
episodes and I set out to find out what
it is that causes some people to be more
resilient than other people what are the
mechanisms that allow people to survive
and I went out and I interviewed person
after person who was suffering with
depression one of the first people I
interviewed described depression as a
slower way of being dead and that was a
good thing for me to hear early on
because it reminded me that that slow
way of being dead can lead to actual
deadness that this is a serious business
it's the leading disability worldwide
and people die of it every day
one of the people I talked to when I was
trying to understand this was a beloved
friend who I had known for many years
and who had had a psychotic episode in
her freshman year of college and then
plummeted into a horrific depression she
had bipolar illness or manic depression
as it was then known and then she did
very well for many years on lithium and
then eventually she was taken off her
lithium to see how she would do without
it and she had another psychosis and
then plunged into the worst depression
that I had ever seen in which she sat in
her parents apartment more or less
catatonic essentially without moving day
after day after day and when I
interviewed her about that experience
some years later she's a poet in
psychotherapists named Maggie Robbins
when I interviewed her she said I was
singing where have all the flowers gone
over and over to occupy my mind I was
singing to blot out the things my mind
was saying which were you are you are
nothing you're nobody you don't even
deserve to live and that was when I
really started thinking about killing
myself you don't think in depression
that you've put on a grey veil and
they're seeing the world through the
haze of a bad mood you think that the
veil has been taken away the veil of
happiness and that now you're seeing
truly it's easier to help schizophrenic
who perceived that there's something
foreign inside of them that needs to be
exorcised but it's difficult with
depressives because we believe we are
seeing the truth but the truth lies I
became obsessed with that sentence but
the truth lies and I discovered as I
talk to depressive people that they have
many delusional perceptions people will
say no one loves me and you say I love
you your wife loves you your mother
loves you you can answer that one pretty
readily at least for those people but
people who are depressed will also say
no matter what we do we're all just
going to die in the end or they'll say
there can be no true communion
between two human beings each of us is
trapped in his own body to which you
have to say that's true but I think we
should focus right now on what to have
for breakfast a lot of the time what
they are expressing is not illness but
insight and one comes to think what's
really extraordinary is that most of us
know about those existential questions
and they don't distract us very much
there was a study I particularly liked
in which a group of depressed and a
group of non-depressed people were asked
to play a video game for an hour and at
the end of the hour they were asked how
many little monsters they thought they
had killed the depressive group was
usually accurate to within about 10
percent and the non-depressed people
guessed between 15 and 20 times as many
little monsters as they had actually
killed a lot of people said when I chose
to write about my depression that it
must be very difficult to be out of that
closet to have people know they said do
people talk to you differently and I
said yes people talk to me differently
they talked to me differently and so far
as they start telling me about their
experience or their sisters experience
or their friends experience things are
different because now I know the
depression is the family secret that
everyone has I went a few years ago to a
conference and on Friday of the
three-day conference one of the
participants took me aside and she said
I I suffer from depression and I'm I'm a
little embarrassed about it but I've
been taking this medication and I just
wanted to ask you what you think and so
I did my best to give her such advice as
I could and then she said you know my
husband would never understand this he's
really the kind of guy doing this
wouldn't make any sense so I just you
know it's just between us and I said yes
that's fine on Sunday at the same
conference her husband took me aside
and he said my wife wouldn't think that
I was really much of a guy if she knew
this but I've been dealing with this
depression and I'm taking some
medication and I wondered what you think
they were hiding the same medication in
two different places in the same bedroom
and I said that I thought communication
within the marriage might be triggering
some of their problems but I was also
struck by the burdensome nature of such
mutual secrecy depression is so
exhausting it takes up so much of your
time and energy and silence about it it
really does make the depression worse
and then I think I'm thinking about all
the ways people make themselves better
I'd started off as a medical
conservative I thought there were a few
kinds of therapy that worked it was
clear what they were there was
medication there were certain
psychotherapy there is possibly
electroconvulsive treatment and that
everything else was nonsense but then I
discovered something if you have brain
cancer and you say that standing on your
head for 20 minutes every morning makes
you feel better it may make you feel
better but you still have brain cancer
and you'll still probably die from it
but if you say that you have depression
and standing on your head for 20 minutes
every day makes you feel better then
it's worked because depression is an
illness of how you feel and if you feel
better then you are effectively not
depressed anymore
so I became much more tolerant of the
vast world of alternative treatments and
I get letters I get hundreds of letters
from people writing to tell me about
what's worked for them someone was
asking me backstage today about
meditation my favorite of the letters
that I got was the one that came from a
woman who wrote and said that she had
tried therapy she had tried medication
she had tried pretty much everything and
she had found a solution and hoped I
would tell the world and that was making
little things from yarn
she sent me some of them and I'm not
wearing them right now I suggested to
her that she also should look up
obsessive-compulsive disorder in the DSM
and yet when I went to look at
alternative treatments I also gained
perspective on other treatments I went
through a tribal exorcism in Senegal
that involved a great deal of rams blood
and that I'm not going to detail right
now but a few years afterwards I was in
Rwanda working on a different project
and I happened to describe my experience
to someone and he said well you know
that's West Africa and we're in East
Africa and our rituals are in some ways
very different but we do have some
rituals that have something in common
with what you're describing and I said
oh and he said yes he said but we've had
a lot of trouble with Western mental
health workers especially the ones who
came right after the genocide and I said
what kind of trouble did you have and he
said well he said they would they would
do this bizarre thing he said they
didn't take people out in the sunshine
where you begin to feel better they
didn't include drumming or music to get
people's blood going they didn't involve
the whole community they didn't
externalize the depression as an
invasive spirit instead what they did
was they took people one at a time into
dingy little rooms and had them talk for
an hour about bad things that had
happened to them
he said we had to ask them to leave the
country now at the other end of
alternative treatments let me tell you
about Frank Russakoff Frank Russakoff
had the worst depression perhaps that
I've ever seen in a man he was
constantly depressed he was when I met
him at a point at which every month he
would have electroshock treatment then
he would feel sort of disoriented for a
week then he would feel okay for a week
then he would have a week of going
downhill and then he would have another
electroshock treatment and he said to me
when I met him it's unbearable to go
through my weeks this way I can't go on
this way and I figured out how I'm going
to end it if I don't get better but he
said to me I heard about a protocol at
Mass General for a procedure called a
cingulotomy which is a brain surgery and
I'm think I'm going to give that a try
and I remember being amazed at that
point to think that someone who clearly
had so many bad experiences with so many
different treatments still had buried in
him somewhere enough optimism to reach
out for one more and he had the
cingulotomy and it was incredibly
successful he's now a friend of mine he
has a lovely wife and two beautiful
children he wrote me a letter the
Christmas after the surgery and he said
my father sent me two presents this year
first a motorized CD rack from the
sharper image that I didn't really need
but I knew he was giving it to me to
celebrate the fact that I'm living on my
own and have a job I seemed to love and
the other present was a photo of my
grandmother who committed suicide as I
unwrapped it I began to cry and my
mother came over and said are you crying
because of the relatives you never knew
and I said she had the same disease I
have I'm crying now as I write to you
it's not that I'm so sad but I get
overwhelmed I think because I could have
killed myself but my parents kept me
going and so did the doctors and I had
the surgery
I'm alive and grateful we live in the
right time even if it doesn't always
feel like it I was struck by the fact
that depression
is broadly perceived to be a modern
Western middle-class thing and I went to
look at how it operated in a variety of
other contexts and one of the things I
was most interested in was depression
among the indigent and so I went out to
try to look at what was being done for
poor people with depression and what I
discovered is that poor people are
mostly not being treated for depression
depression is the result of a genetic
vulnerability which is presumably evenly
distributed in the population and
triggering circumstances which are
likely to be more severe for people who
are impoverished and yet it turns out
that if you have a really lovely life
but feel miserable all the time you
think why do I feel like this
I must have depression and you set out
to find treatment for it but if you have
a perfectly awful life and you feel
miserable all the time the way you feel
is commensurate with your life and it
doesn't occur to you to think maybe this
is treatable and so we have an epidemic
in this country of depression among
impoverished people that's not being
picked up and that's not being treated
and it's not being addressed and it's a
tragedy of a grand order and so I found
an academic who was doing a research
project in slums outside of DC where she
picked up women who had come in for
other health problems and diagnosed them
with depression and then provided 6
months of the experimental protocol one
of them lolly
came in and this is what she said the
day she came in she said and she was a
woman by the way who had seven children
she said I used to have a job that I had
to give it up because I couldn't go out
of the house I have nothing to say to my
children in the morning I can't wait for
them to leave and then I climb in bed
and pull the covers over my head and 3
o'clock when they come home it just
comes so fast she said I've been taking
a lot of Tylenol anything I can take so
that I can sleep more my husband has
been telling me I'm stupid I'm ugly I
wish I could stop the pain well she was
brought into this experimental protocol
and when I interviewed her six months
later she had taken a job working in
childcare for the US Navy she had left
the abusive husband and she said to me
my kids are so much happier now she said
there's one room in my new place for the
boys and one room for the girls but at
night they're just all up on my bed and
we're doing homework all together and
everything one of them wants to be a
preacher one of them wants to be a
firefighter and what if the girl says
she's going to be a lawyer
they don't cry like they used to and
they don't fight like they did that's
all I need now is my kids things keep on
changing the way I dress the way I feel
the way I act I can go outside not being
afraid anymore and I don't think those
bad feelings are coming back and if it
weren't for dr. Miranda and that I would
still be at home with the covers pulled
over my head if I were still alive at
all I asked the Lord to send me an angel
and he heard my prayers I was really
moved by these experiences and I decided
that I wanted to write about them not
only in a book I was working on but also
in an article and so I got a commission
from the New York Times Magazine to
write about depression among the
indigent and I turned in my story and my
editor called me and said we really
can't publish this and I said why not
and she said it just is too far-fetched
these people who are sort of at the very
bottom rung of society and then they get
a few months of treatment and they're
virtually ready to run Morgan Stanley
it's just too implausible she said I've
never even heard it anything like it and
I said the fact that you've never heard
of it is an indication that it is news
and you are in news magazine so after a
certain amount of negotiation they
agreed to it but I think a lot of what
they said was connected in some strange
way to this distaste that people still
have for the idea of treatment the
notion that somehow if we went out and
treated a lot of people in indigent
communities that would be an
exploitative thing to do because we
would be changing them there's this
false moral imperative that seems to be
all around us that treatment of
depression the medications and so on are
an artifice and that it's not natural
and I think that's very misguided it
would be natural for people's teeth to
fall out but there is nobody militating
against toothpaste at least not in my
circles and people then say well but
isn't depression part of what people are
supposed to experience didn't we evolved
to have depression isn't it part of your
personality which I would say mood is
adaptive being able to have sadness and
fear and joy and pleasure and all of the
other moods that we have that's
incredibly valuable and major depression
is something that happens when that
system gets broken its maladaptive
people will come to me and say I think
though if I just stick it out for
another year I think I can just get
through this and I always say to them
you may get through it but you'll never
be 37 again life is short and that's a
whole year you're talking about giving
up
think it through it's a strange poverty
of the English language and indeed of
many other languages that we use the
same word depression to describe how a
kid feels when it rains on his birthday
and to describe how somebody feels the
minute before they commit suicide people
say to me well is it continuous with
normal sadness and I think in a way it's
continuous with normal sadness there is
a certain amount of continuity but it's
the same way there's continuity between
having an iron fence outside your house
that gets a little rough spot that you
have to sort of sand off and maybe do a
little repainting and what happens if
you leave the house for a hundred years
and it rusts through until it's only a
pile of orange dust and it's that orange
dust spot that
orange dust problem that's the one we're
setting out to address so now people say
you take these happy pills and do you
feel happy and I don't but I don't feel
sad about having to eat lunch and I
don't feel sad about my answering
machine and I don't feel sad about
taking a shower I feel more in fact I
think because I can feel sadness without
nullity I feel sad about professional
disappointments about damaged
relationships about global warming those
are the things that I feel sad about now
and I said to myself well what is the
conclusion how did those people who have
better lives even with bigger depression
managed to get through what is the
mechanism of resilience and what I came
up with over time was that the people
who deny their experience the ones who
say I was depressed a long time ago and
I never want to think about it again and
I'm not going to look at it and I'm just
going to get on with my life ironically
those are the people who are most
enslaved by what they have shutting out
the depression strengthens it while you
hide from it it grows and the people who
do better are the ones who are able to
tolerate the fact that they have this
condition those who can tolerate their
depression are the ones who achieve
resilience so Frank Russakoff said to me
if I had it to do over I suppose I
wouldn't do it this way but in a strange
way I'm grateful for what I've
experienced I'm glad to have been in the
hospital 40 times it taught me so much
about love and my relationship with my
parents and my doctors has been so
precious to me and will be always
and Maggie Robin said I used to
volunteer in an AIDS clinic and I would
just talk and talk and talk and the
people I was dealing with weren't very
responsive and I thought that's not very
friendly or helpful of them and then I
realized I realized that they weren't
going to do more than make those first
two minutes of small talk
it was simply going to be an occasion
where I didn't have AIDS and I wasn't
dying but could tolerate the fact that
they did
and they were our needs are our greatest
assets it turns out I've learned to give
all the things I need valuing ones
depression does not prevent a relapse
but it may make the prospect of relapse
and even relapse itself easier to
tolerate the question is not so much of
finding great meaning and deciding your
depression has been very meaningful it's
of seeking that meaning I'm thinking
when it comes again this will be hellish
but I will learn something from it I had
learned in my own depression how big an
emotion can be how it can be more real
than facts and I have found that that
experience has allowed me to experience
positive emotion in a more intense and
more focused way the opposite of
depression is not happiness but vitality
and these days my life is vital even on
the days when I'm sad I felt that
funeral in my brain and I sat next to
the Colossus at the edge of the world
and I have discovered something inside
of myself that I would have to call a
soul that I had never formulated until
that day 20 years ago when he'll came to
pay me a surprise visit I think that
while I hated being depressed and would
hate to be depressed again I found a way
to love my depression I love it because
it has forced me to find and cling to
joy I love it because each day I decide
sometimes gamling and sometimes against
the moments reason to cleave to the
reasons for living and that I think is a
highly privileged rapture thank you
you