Depressions
By Galen Tinder
I awoke one morning two weeks away from completing my last year of graduate school, the morning after spending a pleasant Saturday day researching in the library, and it was there. I could tell before I raised my head from the pillow. I didn’t know what “it” was exactly—some combination of hyper-anxiety and primal dread.
When I stood up, the room—a small dorm habitat—wheeled around me ominously, like an out-of-balance carousel trying to spill me onto the ground. I sat back down. When I glanced tentatively at yesterday’s newspaper sitting at the foot of my bed, images pulsed and swirled themselves into a chaotic panorama of headlines, photos, and text. I was suddenly aware that my heart was beating fast and loud. Several minutes later, anxiety pushed me out the door into the hallway. It was a Sunday, so few other students were around. I paced up and down the hall, back and forth, passing the day in frightened perambulation. I did the same thing the next day, and the next—it seemed the only way to keep panic from engulfing me.
I eked out my last days of school, but despite my effort to act and appear normal, and my evasions of human interaction, my friends caught on that something was amiss and asked what was going on. For the first of many times over the next nearly four decades, I was confronted with one of the isolating curses of severe depression—its inexplicability to the uninitiated. It is so outside the realm of ordinary human experience as to be indescribable. Acute depression is not like being sad in the ways nearly all of us are at times, nor is it like feeling out of sorts. If sadness looks like a harmless gecko, severe depression looms like an all-devouring Tyrannosaurus rex.
After four months, the “it” left as mysteriously as it had come. I was so relieved that I chalked up the whole ghastly business to an idiopathic anomaly. I moved on with my life, giving it no more thought.
But six years later it came back. This time, I was prevailed on by people and circumstances to get medical help. My primary care physician referred me to a local psychiatrist of his acquaintance, one of a number I would consult over the coming decades. It was from this first psychiatrist that I first heard words that, when strung together, went like this: severe clinical, recurrent, treatment resistant, unipolar depression of the anxious (in distinction from enervating) type. Eventually I also heard the term “endogenous,” meaning that in my case the depression’s etiology was my inner chemistry rather than problematic external circumstances.
When my second episode struck, I was several years into my first “real” job, meaning the one for which I had been educated and trained. Eventually, I could not keep up with my work and took a couple weeks off to fine-tune my medications—I stopped two and started two others. This episode also ended abruptly after several months. My psychiatrist at the time warned me that a person who has two bouts of clinical depression has a 50% chance or better of further episodes. Sure enough, after the second attack, I had six or seven more episodes over the next 28 years. Most lasted four or five months, limited, perhaps, by my ever-rotating amalgam of medications.
During my career with depression, I have taken more medications and combinations of medications than I can remember. I began with SSRIs and later SNRIs like Effexor, atypicals like Wellbutrin, and an MAO inhibitor, Parnate. My current doctor has tested my genes in the hope of identifying chemical matches with particular medications, but in my case, none turned up.
I have been hospitalized four times, once for suicidal ideation. People say, in a macabre joke, that a hospital is no fit place for sick people, and this was true for me. Though “safe,” I always felt worse institutionalized than at home. Ten years ago, I had electroconvulsive therapy (ECT), to no avail.
My inability to describe to others what acute depression feels like has been frustrating and magnified by aloneness. I often saw in the expressions of others their wondering about the characterological weaknesses that underlay my paralysis. I sometimes wondered this myself, and felt shame at being undone by this invisible ailment that was so hard to treat and seemingly impossible to prevent. Today, I can in some measure empathize with people afflicted with auto-immune disorders that are so hard to diagnose and treat and impossible to see.
Occasionally people ask me what it feels like to be depressed. I respond that depression, at least for me, doesn’t have feelings. It crushes them. I can’t, for example, say that depression makes me feel sad or frustrated. Severe depression crushes ordinary human emotions, the ones necessary to our sense of humanity, beneath the fist of terror and despair. It is not even that depression leads to despair. It is itself despair. Desperate for an image, I once suggested to an inquisitive friend that he imagine himself jumping off a ten story building, and landing feet and legs first on the concrete below. I asked him to conjure the agony of his feet and legs fracturing into uncountable shards of bone and shreds of sinew. This is how, I said, my brain hurts.
In one of the most eloquent books about depression ever written, the autobiographical Darkness Visible: A Memoir of Madness, 20th century novelist William Styron brings his literary gifts to a description of his own depression. He calls the term “depression” a “slug” of a word that has slithered its way into our language to describe a devastating cataclysm. Styron acknowledges the limitations of language to describe an experience incommunicable to those not possessed. He suggests the term “brainstorm.” My own meteorological conjuring is an F-5 tornado laying waste a home, a neighborhood, and a town, leaving no signs of life on the horizons.
Sometimes called a slim tour-de-force, Styron’s book first appeared as a long essay in a 1983 issue of Vanity Fair before it was issued as a book. Soon after it came out, I bought a copy for my wife and in years since have referred people to both the essay, which can be accessed online, and the book. In either rendition, it can be read in a couple hours. Styron writes that “the pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne.” I first read this passage 20 years ago, when I was in between episodes. I began to weep because for the first time I knew that there was another human being who knew what I felt like when in the grip.
Severe depression scares people and even those closest to it don’t know how to help their loved one to feel better. They sense that there is nothing they can say, but out of their own pain and the frustration of helplessness may remark, “Just hang in there…”; “Eventually it will get better…”; “Have you tried positive affirmations?” These efforts at comfort and exhortation at best make me feel misunderstood and more isolated. The distinguished educator Parker Palmer relates that when he was depressed people tried to comfort him with assurance of his eventual recovery. But the person who brought him solace was an old friend who came over every day to massage his feet. Most days, nothing was said between the two men.
After my second episode of depression, I began to research the nature, causes, and available treatments. After 30 years, I have kept at it but no longer anticipate making any dramatic discoveries. For decades we have thought that an insufficiency of neurotransmitters causes depression; nowadays we are not so sure. A diminishment of brain chemicals often accompanies depression, but correlation is not causation. In recent research a significant percentage of those helped by the medication they were given turned out to be ingesting a placebo. These days most specialists acknowledge that we don’t know what causes depression for a given person, though genetics and early childhood abuse (I qualify for the first, but not the second) can play a role.
For decades I got depressed, then got better, got depressed, got better, and so on without gaining any wisdom about my condition or myself. I was convinced I was a case of defective biology and messed up brain chemicals. My worst episode began nine years ago and lasted eleven months. For much of the time I was confined to bed. I came up with a coping mechanism that sounds odd, but kept me alive. Every morning around 11:00am I decided not to kill myself that day. I then immediately reassured myself that tomorrow was another day on which I could choose differently. Then the next morning around 11:00 I made the same decision followed by the same reassurance. In this manner I kept myself alive day by day, for months. Oddly, every morning I would feel girded by Camus’ statement that the only serious philosophical question is that of suicide.
After seven months, the psychiatrist I was seeing, who was the kindest of them all, told me regretfully that she didn’t know what more she could do for me. For some reason, her acknowledgement energized me enough so that I drove home and opened Google. In a few days I turned up the name of a physician who practices what is sometimes called biopsychiatry. This means, in part, that the doctor is skilled in the efficacious mixing of medications and supplements. A cocktail, as it is called.
After taking my history the psychiatrist said that while I had gone through a rough time, she was confident that she could help me get better. I was surprised how much her statement lifted my morale. After two months under her care, I recovered. Aside from a minor blip now and again, I have been well for the last eight years.
What does this all mean, this episodic career in depression? Perhaps there are two questions here, the first being what does it mean for me, for who I have been and who I am today. The broader question is that of what suffering means for all of us, for those who have walked a far harder road than have I. Is it all meaningless? Does it have a purpose, if not always then sometimes?
For most of my life, my episodes of depression, lasting, until the final one, an average of five months, have seemed unrelated to my non-depressed life. They came spontaneously and left the same way, unconnected with life events, my pre and post psychological condition, never caused, so far as I could tell, by emotional stress. So they struck me as biochemical eruptions over which I had no control. They were attacks disembodied from my “normal” life. When they left, I resumed this life until the next time.
Today I doubt it is so simple. I mentioned earlier that depression crushes feelings like happiness, sadness, empathy, and vulnerability. Recently I have realized that when I emerged from a depression, these emotions stayed crushed. Perhaps I thought I could avoid further misery by not feeling, by retracting into myself, taking my right brain off line, never developing a capacity for authentic self-reflection and vulnerability with myself. Tongue not entirely in cheek, a friend once diagnosed me as suffering from habitual and excessive analyticity. I now think that this quality may have been both a consequence of my depressions and a maladroit defense against more of them in the future.
In any event, it has struck me over the last several years that a life of self-retracted feelings has not served me well as either a depression dampener or a way to live. I have gradually taken hold of a different kind of living marked by feelings of sorrow, happiness, regret, reformation, vulnerability, empathy. I don’t know how this has happened, but a different way of living has laid firm hold of me and blessed me, at the age of nearly 70, with new vistas of rich experience. Is this in some way a mysterious gift of depression? I would sure like to figure it out, but doubt I will.
I was recently trying to characterize to a friend the changes I have experienced and my desire to understand their etiology. When I finally stopped talking, she smiled, cocked her head, and said “Who would have thunk?” Perhaps this says enough, at least for now.
Galen Tinder is retired from a career in counseling and now spends much of his time in the field of narrative studies and practice.