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.