Learning about Depression

It’s after five in the morning but I’ve been awake for nearly two hours. I’ve already eaten my breakfast and am now ensconced in my lovely living room/library, listening to the birdies chirp their own way into the morning. For several weeks I have been wakeful in the middle of the night every two or three days. Rather than lying interminably in my bed awaiting more sleep, I give in to the inevitable (after a half hour or so), and get up to eat and then to read. Within a couple of hours I am usually ready for a nap. On mornings when I must be up by 6:30 or 7:00 anyway, that pleasure will be delayed. If my day is filled with events that cannot be changed, I struggle through with tiredness dogging my every step. I know exactly what this is about because I have been here many times before. I am experiencing one of my own classical symptoms of depression.

The syndrome of depression is not well understood in common parlance. It is not synonymous with the feeling of being depressed or sad, though that mood can be one symptom. Anyone can have a “down” day or feel unhappy when grieving a loss or a reversal of fortune, but these ups and downs of life do not constitute a mood disorder. A mood disorder can only be diagnosed by looking at a broad spectrum of symptoms that are present over a prolonged period of time – at least several weeks in duration. What these symptoms indicate is that one of the body’s organs – the brain – is not functioning well. The fear and prejudice about what we call “mental illness” has lessened somewhat over the past decade or so but malfunctions of the brain continue to threaten people in a particular fashion. You rarely find someone hesitant to speak to their friends of their diabetes, kidney stones, heart problems, or their cancer treatment. But it is still common for people to hide their medical diagnosis and form of treatment of a mental disorder. And, it’s not hard to understand why they do so.

Our understanding of brain function is growing exponentially with technologies and research tools now available, but the translation of this knowledge into simple and thorough methods of treatment is a gradual work in process. There are very good medications available now that could only have been dreamed of just a few decades ago, but they do not work for everyone in the same manner. Sometimes trial and error is the difficult path that an individual must follow with his or her physician. Besides, people fear repercussions in their families, communities, or at work if it becomes common knowledge that they suffer from a “mental illness.” No one wants to be seen as “abnormal,” to have their actions, moods, or decisions openly or covertly questioned by others as just symptomatic of their “condition.” But the truth is that most people would be astonished if everyone who currently dwells in this particular “closet” was to come forward with the truth about his or her struggles. “Mental health” issues afflict in some fashion or other every family that I have ever had contact with, showing up in a multitude of forms: alcoholism or drug addiction, anorexia and bulimia, problems with anger management or with stress – leading to somatic illnesses and/or the break-down of relationships. Even more serious troubles like schizophrenia or a severe bipolar condition can cause devastating ruptures in a family and in the personal life of the individual that usually cannot be hidden from public view.

But to return to my own location in all of this: I went into therapy when I was twenty-six, clear about some of the issue with which I struggled but with no real comprehension of others. The group that I was associated with for the next seventeen years as a client, a learner, and a fledgling therapist was firmly rooted in a psychological approach. A medical model that explored genetics, brain functions, and medication was spurned. There were many reasons for this divide, based somewhat on the paucity of available psychiatric treatments, as well as the zeitgeist of the sixties and early seventies, and, the background and education of the lead therapist. I retained the views and approaches of this training into my early fifties as I built my own practice as a newly minted registered psychologist.

Around that time a young woman came to see me who was suffering from a major depression. She was unable to go to work; in fact she spent about 20 of every 24 hours sleeping or lying about in a state of utter inertia. She told me that her doctor had prescribed anti-depressants, in fact, Prozac, which had only recently become available. I did not discourage her from taking the medication but I thought it bad advice, simply another factor that would complicate the tortuous process she would have to endure to climb out of her state of mental and physical exhaustion. I was astonished when a few weeks later she appeared at my office as if another person altogether: bright, energetic, ready to talk about a variety of personal issues that she was facing, particularly in relation to her parents’ opposition to her marriage. We talked about her depression and the changes she had undergone. Her doctor had recommended two books to read while convalescing: “Listening to Prozac” by Peter Kramer, and, “You Mean I don’t Have to Feel This Way” by Charlotte Dowling.” I quickly availed myself of both and settled down to learn something new.

What I learned on practically every page of these books was that troubles that I had struggled with myself over the years, in greater or lesser severity, were symptoms of depression. No one had ever pulled these pieces together for me in a clear-cut diagnosis. I was then able to do this for myself. I was dealing with a low grade, chronic form of depression, often called dysthymia. In cycles when the symptoms were most prevalent, I would experience, as recently, disturbed sleep patterns. I would struggle with low self-esteem, with mood swings from sadness to irritability to anxiety, with a sense of feeling separated from all the other happy people at life’s party, of being overwhelmed by the exigencies of my everyday life, with memory problems and an inability to concentrate, with a periodic feeling that life was just too difficult and I would be better off when it was over. Wasting little time I took myself to a doctor and enumerated my concerns. He concurred with my analysis and prescribed Prozac. Within a month I felt like I had entered into a new state of being. Despite all of the personal therapy that I had done over the years, nothing had freed me from the weight of this chronic condition as did the new and for me, miracle medication. Since, I have learned more about the genetic pre-dispositions and about the nature of depression itself. When recently I experienced the return of some symptoms, I knew enough what was happening to make an early appointment with my GP to discuss options.

So there you have it. I know that the human body constitutes an integrated whole, each and every organ affecting the others. It is only intellectually that we can parse these into distinct and separate entities. A big piece of the healthy life that I live without debilitating, stress-related illnesses comes from the fact that I have been fortunate enough to find help with a chronic condition which, without treatment, would have had grave impacts upon the functioning of my entire body, and perhaps in particular my immune system. I read a long time ago that one way to a long and fruitful life is to have a chronic condition and to take good care of it. It’s a funny perspective but seems to contain some usable wisdom.

Fathers' Day Thoughts

Today is Fathers’ Day. Newspapers have been running stories about dads for several days now – memories of great dads, what great dads are like, how to be a great dad, and etc. One piece that I particularly liked encouraged fathers to mix it up physically with their kids: wrestling with them, playing sports with them, encouraging them to test their own physical boundaries and to take risks. Another advised men to tell their daughters that they are beautiful and generally to take an interest in and support their “hobbies.” I didn’t see any pieces about poor or outrightly bad fathering. Not the time to examine those aspects, I suppose. I did think of a line from one of Leonard Cohen’s songs, “It’s Fathers’ Day, and everybody’s wounded.” Wounds can exist on both sides of the equation: adult children who harbour painful memories, anger, and resentment toward their fathers, and, fathers who suffer lukewarm responses or even overt rejection from their children.

I haven’t been reflecting too much on my own relationship with my father who died over twenty years ago, though I do think about him. In my thoughts and memories he is still very much alive, just as his dad, Charley, he called him, was to him. So often he would say, “Charley would enjoy that.” Probably like most people my relationship with my father was a mix of the good and the not very good. He struggled with his own demons but tried his best to father us and to provide in the way that was expected of the fathers of the 1950s. Undoubtedly there was much about my version of adolescence that grated against his own inner struggles. We were not close. My memories of him during my teen years are of a man some distance away – doing the yard work, off to a movie with my mother, not someone with anything to say to me. I took the brunt of his periodic irritability in sudden slaps across the head, usually for some outspokenness that he found offensive.

Just before I was to leave home the summer I turned 19, he came downstairs from his bed to tell me that he loved me and that if I ever needed anything to let him know. I remained fixed in my chair where I was studying for an exam and he returned upstairs. When he left, I wept. It was so very painful to hear these words from him. Nothing like this had ever passed between us. Many years went by before we were able to speak frankly about those early days. He was 75 and I was in my 40s. He had no memory of the things I was no longer afraid to speak with him about, but he denied nothing. With tears in his eyes he told me that if he had hurt me in any way he was sorry. It was so true and so real. I absolutely forgave him and was able to let go of those painful incidents. Since, my residual feeling about him has been one of affection.

I used to envy people who had what looked to me like loving parents with whom they were close. It’s an easy thing to look into another home, like the little match girl peering in through the window, and to see delights that are denied to oneself. I doubt that few people grew up in a home like that of Little Beaver. For most of us the blessings have been mixed: we were given what we were given and then we have had to deal. I got a lot from my parents (if I might say so without seeming overly boastful): a healthy constitution, good Celtic looks, some intelligence, a feeling for music and literature, as well as many other qualities which, as one says when advertising a garage sale, are too numerous to mention. Other less delicious pieces which have been handed down genetically: freckles, psoriasis, problems with the gall bladder, and, an incipient mood disorder. But more of the latter another time. 

Aside from their genetic contributions to my welfare, I also got lots on the nurture side. My mother was a strong personality in her own fashion. She was the dominant force in our household. As I grow older, I realize how much I am like her, perhaps more than the other kids, though even a decade or two ago I would have stoutly denied that resemblance. She was tough in ways that could be hurtful but she also had an inner strength that could get her through the trials of her life without ever giving in or giving up. My father, when not caught in his own tempestuous moods, exhibited a joy in life and an appreciation for sexuality that unconsciously taught me an alternative to my mother’s more stoic and repressive approach.

I didn’t set out to write about my parents this morning, but as we know, one thing easily leads to another. And so there we are, or, shall I say, here am I, on this lovely almost summer morning, counting my blessings instead of sheep. Happy Fathers’ Day reflections!

Jury Duty, or, My Brush With the Law

Last fall I received a summons, literally a “Come here!” from the Sheriff’s Office, of the Ministry of the Attorney General of Ontario. I was to present myself at a particular date and time for jury duty. As the date given coincided with my up-coming departure for Puerto Vallarta, I was able to demure. Nothing further was said. Two or three weeks ago I received a second summons. In capital letters presumably to emphasize the serious nature of this demand, I was told the following: YOU ARE REQUIRED to attend the Superior Court of Justice at 361 UNIVERSITY AVE .... on the 11^th June, 2014 at 9:00 AM and may be selected to serve on a jury. On the upper right hand corner was noted the following admonition (also in capitals): AS A JUROR, IF YOU DO NOT ATTEND ON THE REQUIRED DATE, YOU WILL BE LIABLE TO THE PENALTIES PROVIDED BY THE JURIES ACT. I had every intention of attending though I did not expect to be chosen. In fact, I carefully filled out the accompanying questionnaire, indicating that I would be out of the country with family members for two of the next five weeks (all true). I offered to be available for jury duty in the late summer or early fall, however. Aside from the fact that this is an ancient and worthy requirement of citizens in democratic/British-system countries which I would be willing to perform, I believe that it would be an interesting experience.

So this morning about 8:25 I set off in the lightly falling rain and legged it down to 361 University, carrying my summons papers, some snacks to ward off low blood sugar, a bottle of water, gum, some Samurai Sudoku games, other assorted necessities, and my transistor radio in case I was still there this afternoon when the Blue Jays are to play Minnesota for what the announcers call “the rubber match.” Others were streaming into the hallowed halls of the Supreme Court of Justice for Ontario when I arrived. First stop: a screening of one’s person and belongings identical to airport procedures. Next, up on the elevator to the sixth floor into a line-up of other summonees (such a word?). 

Our papers checked and our presence noted, we were ushered into a court room nearby. This large, fairly square hall required but a few artefacts for it to morph into a church. The front section, a quarter to a third of the space, held a raised dias whereupon the “celebrants” or the essential actors played their particular roles. Below, behind “the bar,” was a seating arrangement of what could only be called “pews,” long wooden benches segmented by arm rests into individual places. The hushed atmosphere of the hundred or so prospective jurors awaiting instructions completed this sense that we were attending a place of worship.

The room was already quite full when I entered but I found a place in the front row: the better to see you, my dear, I thought. It was 9:00; then it was 9:05, then 9:10. People continued to stream in. The clerks in charge helped them to find the few remaining spaces, even placing a few late-comers on the serious side of the bar in big, comfy chairs available there. The lady to my immediate right asked a passing clerk in a decidedly Teutonic accent if we would be compelled to wait for all of these people who were coming in late. “The paper said 9 o’clock,” she said. “Nine o’clock means nine o’clock; we shouldn’t have to wait for them.” The clerk explained that we were waiting for a representative from the jury office to address us. My neighbour seemed not to understand that this was the cause of delay and continued to complain about late comers. She looked to right and to left to find allies for her position. I studiously kept my face neutral and my eyes facing  the dias, the place from which all instructions would come.

And they did. From behind the dias emerged a jolly fellow who greeted us warmly, asking after our health and comfort. He explained to us that we had not been called for general jury duty but rather for a particular criminal case that was expected to take about three weeks. However, he said, it had been decided that the case would be tried by judge only. We were not needed. A great sound of relief emanated from our assembly. However, he added, I checked to see if your presence could be of value to other cases. He paused for effect: bad news; you are not needed. Another, louder and happier sound erupted; applause even. Moreover, he went on, because you came as required, even though not needed, you are now exempt from calls to the jury for the next three years. More happiness and applause. This fellow was enjoying himself. We rose and began to file out to the escalators.

As I exited the building on a side street, a police officer crossed the road and came up behind me. He was a tall good looking fellow of 40 or so dressed in a bullet-proof vest. From a pocket at the front protruded a weapon of some kind. I read recently about a study which concluded that people who speak randomly to strangers whom they encounter during their day tend to be happier than those who maintain more distance. Endeavouring always to be open to new learning, I have incorporated this hint for happiness into my practices. On this occasion, I turned to the officer and said, “That’s a serious outfit you are wearing. Are you one of those fellows that we see on TV taking people down?” (Or something to that effect.) Luckily the man had a sense of humour. “Oh yes,” he said, “That’s us. Out of sight and out of mind.” “Well,” I said to encourage him, “it’s good to know that there are people out there protecting us.” “I wish more people felt that way,” he replied rather ruefully. “You know how it is,” I said. “It’s like being a kid: you like the boundaries but you just have to fight against them anyway.” “Exactly right,” he said, looking pleased. “Have a good day,” he called out as he took a sharp left and entered the courthouse. So that little encounter made me happier and maybe even did something for him.

Two brushes with the law in one morning: a day full of incident. And now for lunch and the ball game.

Kafka and the Ironies of Fate

Another great find in the one dollar bin around the corner from my “south Annex” dwelling place: Introducing Kafka, text by David Zane Mairowitz, illustrations by the great Robert Crumb. Martha Chase Jackson Pagel and I visited Prague at the end of an overly expensive cruise/tour along the Danube from Budapest to just beyond Linz sometime in the late 1990s. The bus which conveyed us from the Danube to Prague necessarily travelled through the outer districts of that sprawling city, revealing in its passage the blight imposed by Soviet era construction projects. The inner city to which we were transported shone by comparison, preserved as were few European locations from the destruction of WWII. For three days we walked its narrow, labyrinthine streets and vast open squares, along the river dividing its districts, and over the Charles bridge, that iconic monument serving now as one of Prague’s most visible foci of tourism. Mementos of Prague’s famous son, Franz Kafka, were ubiquitous.

Reading Mairowitz text, I see the irony of this posthumous claim. Kafka lived his entire life (1883-1924) in Prague, all but the last several months in the Jewish ghetto. Part of the Hapsburg Empire until the Treaty of Versailles created the new entity of Czechoslovakia in 1919, Prague’s state, Bohemia, was composed of the same mix of nationalities, languages, and religions to be found throughout that and other 19^th century European empires. With the dissolution of these mammoth entities, underlying rivalries newly released found their focus in nationalism, setting the stage for the destruction wrought by the second act of world war initiated in 1939.

Kafka, slight and sensitive, was born to a Jewish kosher butcher, large and powerful, a man of decided opinion and little toleration for his retiring, hypochondriac son and his penchant for “scribbling.” Within the household of such a parent, the surrounding ghetto, and the city of Prague, set for his first 36 years in the Hapsburg Empire, coming to a sense of confident self-identity presented grave difficulties for Kafka. He was born a Czech, spoke German as his first language, and though Jewish, was not religiously inclined. In no sense could he fully find himself as Czech, German, or Jew. Still, Mairowitz stresses the profound influence upon him, revealed in his work, of Yiddish storytellers and of the particular fantasy-ridden sensibility, humour, and stoicism that inhered to the ancient ghetto and its denizens. To these influences he brought a unique quality, sometimes transforming his primary characters into animals and insects, expressing in this manner an understanding of his own condition and by extension, that of others.

By the time Kafka died of tuberculosis at the age of 41, Czech nationalism had already effectively worsened the situation for Jews in Prague. In Germany a similar process eventuated in the rise to power of the National Socialist party by 1933. Several years later Germany successfully annexed much of Czechoslovakia, moving not only to subject and enslave the Czechs, but to isolate and then eradicate their Jewish population. Anti-Semitism in Czechoslovakia allowed little resistance to or compassion for their fate. In the post WWII Soviet-dominated state all religions were suspect and essentially forbidden. Mark and I found in our visit to Prague last fall that though services are now permitted, there is little active presence of Judaism in the city. The nearby town of Theresienstadt, once the sight of incarceration of many thousands of Prague Jews, tarted up to impress visiting Red Cross observers with  Germany’s “exemplary” treatment of the Czech Jewish population, is now a tourist destination. From here most who survived disease and starvation were transported to Auschwitz for their own exemplary “final solution.” Kafka’s dystopian stories capture presciently the fate awaiting his co-religionists in the decades following his death. In Prague itself, to find Kafka “revered,” pushed to the foreground of Czech literary significance, and served up for touristic consumption as a saleable icon seems almost a gigantic, bitter joke, one that perhaps might have been enjoyed by the master himself.