The mass of men lead lives of quiet desperation. – Henry David Thoreau, Walden
According to the Diagnostic and Statistical Manual of Mental Disorders, the preeminent authority on psychiatric diagnoses, major depressive disorder is characterized by the following symptoms: either a depressed mood or a loss of interest or pleasure in daily activities consistently for over two weeks, marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms (i.e., perceiving things not as they really are), psychomotor retardation, hypersomnia nearly every day, or fatigue or loss of energy nearly every day.
Check. Check. Check.
Before I was born, symptoms of depression would sometimes rear their ugly heads in my family. I have a great aunt who committed suicide, as did her daughter. I have closer relatives with many symptoms of depression, often left untreated. Some of my earliest memories include staying up all night terrified of an otherwise uneventful day at school, throwing up because I forgot to return a nickel to a classmate, or becoming feverish and hallucinating after being exposed to swimming pools or lakes, of which I was somewhat phobic. I grew up with fear and trepidation and a generally negative view of the world, despite a loving home environment and the best of parents.
Over time, my illness became more subtle and more pernicious. Less vomiting, more perfectionism, fewer hallucinations, more internally negative thoughts. Going to college in the late eighties taught me much more than pure academia, including positive ways of thinking, and the fact that I was loved by others beyond my family. I still remember the day it happened. A friend took me to his parents’ house on the way to an activity, and they couldn’t stop talking about how neat I was because he had been talking about me. For someone with depression, this was amazing – that people thought about me, positively, when I wasn’t there. They even talked about me! At times like this I actually felt joy. But the stress to perform was tremendous. It wasn’t good enough to simply pass a class, I needed to make at least a B. I needed to have more than acquaintances; I needed a legion of best friends. It wasn’t enough to simply be involved in activities outside of school, I had to be involved with everything. It wasn’t long before I, like Shakespeare’s Danish prince, wondered,
To die: to sleep;
No more; and by a sleep to say we end
The heart-ache and the thousand natural shocks
That flesh is heir to, 'tis a consummation
Devoutly to be wish'd. To die, to sleep;
To sleep: perchance to dream: ay, there's the rub;
For in that sleep of death what dreams may come
When we have shuffled off this mortal coil,
Must give us pause: there's the respect
That makes calamity of so long life
Those thoughts were a profound warning sign. Friends and church leaders persuaded me to be evaluated, and the questionnaire testing came back positive for depression. But I didn’t have the money or the foresight to seek help beyond the evaluation yet.
It’s hard to seek help for depression. It takes admitting that you can’t function well on your own. It takes a humility and meekness I did not yet have. It takes good insurance, since not all insurance covers psychiatric care. And it generally takes a support system that sees the problem for what it is – an illness, like cancer, the flu or MS -- rather than as a personal failing.
Still, I fought the illness, the dark thoughts. I surrounded myself with positive things and worked hard to stay on top of events – work, school, social life, service. In fighting, I grew stronger, at least I thought. However, the dopamine and serotonin receptors in my brain were determined to malfunction. See, in depression the brain doesn’t function normally. Generally there are problems with certain neurotransmitters, like dopamine or serotonin (things which I like to call “happy juice”), where either the brain doesn’t produce enough of them or receptors reabsorb them too quickly, before they can take proper effect. There are many reasons why these receptors malfunction, some temporary, some permanent. There are also many effects from the malfunction – the negative or psychotic thoughts, hypersomnia, all the symptoms I listed before. The brain is a still a mysterious thing.
After I moved to Idaho, my ability to cope grew progressively worse until I lost my job and found myself as though dead, a cipher scarcely able to function, unable to create. I was unable to function in the areas I considered necessary, and I found myself withdrawing socially, failing to do service as I had, unable to read or write or enjoy or even do the daily maintenance around the house that had once seemed so simple and basic. I had reached the point where I felt I had nothing. In truth, by then I still had a loving husband and friends and family, a nice home, and many blessings, but I was seeing through the glass, darkly.
Depression is like drowning. You’re in the middle of the ocean with nothing in sight but water and more water. You’ve been treading water for so long that every muscle aches and fatigue is swamping you. Sometimes you feel like you can keep your head above water, but other times you can’t. You just can’t. It affects every aspect of your life. A typical day consists of sleeping, eating, and more sleeping when it’s at its worst. Even television is overwhelming and unsatisfying to the depressed, leading my sister to state, “Depression is when even TV isn’t fun anymore.” Dishes go unwashed because they are just too overwhelming. You don’t talk to people because what’s the point, or even worse, you feel stupid and useless and unloved. There were times when I would come home from a social event in tears, sure that I didn’t fit in and that everyone hated me. Every setback is a deal-breaker and every good thing is swallowed up in the sea of despair. Even your closest relationships suffer as you feel too ugly and stupid to be loved; every show of love to you seems like a lie or a trick. Everything is irritating, you are snappish and sullen. And no matter how often logic and evidence tells you that things can’t possibly be this bad, your brain just isn’t working right and warps everything to fit its dark manifesto, like a twisted lens.
There is a scripture passage in the Book of Mormon that states that there must be opposition in all things. If not, we couldn’t tell the difference between good and bad, happiness and misery. I had known the misery. I had lived that cold, empty side and I had had enough of it. I had known, briefly in college, happiness. I had known what it was like to hope, to love, to enjoy. I knew there was something besides that which I was feeling. I knew it existed. I needed to find it again. Find it and grab a hold of it and run with it.
I began to realize that I had to make choices. I believe it was Corrie Ten Boom, a holocaust survivor, who told us that happiness is a choice. Horrible things happening to you are not usually a choice. Depression was not a choice. But how I dealt with it was a choice. I was miserable. But there had to be things I could do about it. If there were no cure, then at least something must exist to take the edge off. Would it be worth it? Was it possible to be happy even while depressed? I had to formulate a hypothesis and test it, the hypothesis being that there was a way to fight the depression. If this hypothesis was correct, I could find a way to fight the depression and feel better. But depression is a fickle master. Under the delusions it fills your mind with, there is no way to fight it. No hope. Again I found myself turning to scripture, this time the eleventh chapter of Hebrews in the New Testament. “Faith is the substance of things hoped for, the evidence of things unseen.” I didn’t hope – I didn’t dare – but I wanted to. Whether that desire could be enough I didn’t know, but I had to try it. I had to have faith that something really could help me, and act on that faith.
There is an old adage that says “good help is hard to find,” and nowhere is that more evident than in seeking competent mental help. I tried half a dozen counselors, one of whom told me I was sinning because I was feeling bad about myself, and half as many psychiatrists. Even with good people helping me, psychiatry is an inexact science. There is a lot of trial and error with the medications, some doing nothing, others making it worse, each trial being plagued with questions: is it helping? Is it helping enough? Is it worth the side effects? Is there something better out there than this? But as John Lubbock (one of a line of Barons in England) says, “Happiness is a thing to be practiced, like the violin.” Now there are things that help me. After years of trials, I now have medication that’s suddenly like a life preserver in that sea of despair. No longer is every eye focused on me and every person in the room thinking how stupid I am. No longer do I snap at everything my husband has to say. Counseling helps as well, if for nothing else than an authority figure telling me the dark thinking is wrong. Not bad, just not true.
The people around me, my friends and family, have to make adjustments as well. They have to recognize the symptoms that are a call for help. They have to help encourage me, at just the right non-threatening level, to do more. They have to put up with someone who doesn’t function up to the abilities of a “normal” person. But what is “normal” anyway? What does “functioning” mean? Holding a job? Raising good kids? Not blowing up at people? The dictionary simply says that it is “conforming to the usual standard, type or custom” or “physically, mentally, and emotionally healthy.” There isn’t a real definition of “normal” that can be applied consistently to behavior, is there? I mean, for every culture it is going to change, including subcultures, down to individual families. Everything that makes us different, or “abnormal,” isn’t necessarily bad. Every tiny failure in functioning doesn’t make me unhealthy. When it comes to depression even the definition of depression is warped by the illness. I may therefore be better than I think I am.
Bad things happen. They happen to everyone. Just because I’m depressed and I see bad things where they don’t exist doesn’t mean that I am somehow exempt from having bad things really happen. The trick is knowing how to deal with them. I lost jobs – I had to tell myself there were other jobs out there. My husband lost jobs – I had to remind myself that there were things to help us even then and not to panic. We moved, and I had to ask for help, swallow my pride, and ask for more help than I wanted to. We have had to take care of a nephew because his drug-addled mother couldn’t. The depression and inexperience with raising teenagers makes this difficult and I’m not doing as good of a job as I would like, but I have to remind myself that it has to be better than what he had before. It’s really not that much different, dealing with the real problems and the depression-warped ones. So in an odd twist of fate, perhaps according to the will of God, I am becoming stronger than some others in dealing with hardships. I have depression every day, but perhaps this makes the bumps in the road less perceptible to me. Depression, a blessing in disguise? Perhaps. To someone with my religious background and faith, it is.
Every day I have to make choices. What do I believe? I believe I can fight this. What can I do? I can get up; I can function, however minimally. Picking up ten things in the living room isn’t cleaning the house, but it’s better than what the depression tells me I want to do – sleep, sleep, and more sleep. I get up. And I get up in the morning. I exercise. I go out when the depression is bad and I need positive feedback. I find commiseration in with others who suffer as I do. I am going back to school in an effort to revive the creative part of me that was lost. What can I be? I can be happy. No matter how much practice it takes.