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  • "I felt a Funeral, in my Brain,

  • And Mourners to and fro

  • Kept treading - treading - till it seemed

  • 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 all the Heavens were a Bell, And Being, but an Ear,

  • And I, and Silence, some strange Race,

  • Wrecked, solitary, here -

  • (Just) then a Plank in Reason, broke,

  • And I dropped 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,

  • Goya 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 flashing 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'd have to be depressed for the next month,

  • I would say, "As long 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 wrist 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 does it 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 that depression was something that was braided so deep into us

  • that there was no separating it from 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 50 years ago,

  • when there would have been almost nothing to be done.

  • I hope that 50 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 are 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 and psychotherapist 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 nothing. You are 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 gray veil

  • and are 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 schizophrenics who perceive

  • 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 talked 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 most 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?" I said, "Yes, people talk to me differently."

  • They talk to me differently insofar as they start telling me about their experience,

  • or their sister's experience, or their friend's experience.

  • Things are different because now I know that 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 suffer from depression, and 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 to whom this wouldn't make any sense,

  • so, you know, it's just between us." And I said, "Yes, that's fine."

  • On Sunday of 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 began 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 psychotherapies. There was 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, 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 ram's 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, 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 he said, "But we've had a lot of trouble with Western mental health workers,

  • especially the ones who came right after the genocide."

  • I said, "What kind of trouble did you have?"

  • And he said, "Well, they would do this bizarre thing.

  • 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."