When a depressed celebrity commits suicide, there is always an uptick in society’s compassion for people who suffer from that condition. It never lasts very long. Those are valuable teachable moments, but the lesson never seems to sink in. The proof of this is that the level of people’s patience with individual sufferers never experiences a sustained rise in volume. Parents continue to lose patience with depressed children; people continue to lose patience with depressed co-workers and friends; spouses lose patience with their depressed spouses. This is due, I believe, to the mysterious nature of depression. It cannot be measured objectively. There cannot be any clear, observable evidence, nothing, that is, comparable to an x-ray that displays a broken bone. Depression is invisible.
A broken bone must be a relief for the treating doctor, in a way. Finally, a patient with an obvious medical problem that calls for a clearly defined course of treatment that works in the majority of cases. Doctors don’t always get that kind of clarity, because many of their patients present with maladies that are not immediately obvious. More often than not, however, there are some tests that will assist the doctor. Laboratory tests, or various mechanical imaging tests, which, taken together, can point the doctor to a narrow range of possibilities. With depression, there is no such assistance available. The patient presents with a wide range of more or less ambiguous symptoms that the patient feels, but either cannot or will not express. And that’s if the patient presents at all! Why bother? If you have a broken arm, you go to the doctor, but if you are depressed, you most often just try to shut up about it.
That’s the doctors. Honestly, they are of little assistance when it comes to the treatment of depression, even in the most treatable cases. Those would be the cases of “situational depression,” a condition that arises as a result of a sudden, shocking event, often a terrible loss, like the death of a parent or spouse. Note that, even in those cases, the sufferer may not recover any quicker from the condition because of the treatment; the condition will probably resolve just as fast if no doctor’s care is sought or given. In more serious cases, the depression is the result of events or situations that are lodged deep in the sufferer’s past, things that were serious enough to alter the sufferer’s physical and emotional development. The symptomology may ebb and flow, but the condition remains almost constant over the entire life of such a sufferer. The doctors call this “major depression,” or “clinical depression.” In such cases, there is not much that the doctors can do.
There are two main treatments that they try, or maybe three. One, they reach for their prescription pads and offer the patient anti-depressant drugs. These, in the experience of many sufferers, will have a beneficial effect for between three and five or so years. After that the brain’s chemistry will have adapted itself to the presence of the drugs and returned to the original imbalance. The drugs are seen as a management tool, not a cure. When the worst symptoms return, and they will, the doctor will respond by trying different medications or combinations of medications. It is, finally, a pointless and expensive enterprise, suitable only for bringing a patient back from the brink of committing suicide.
The second popular treatment is “cognitive therapy.” This is where a highly trained counselor, who is probably not a medical doctor, will guide the sufferer in a process of holding a mirror up to their condition, in the hope that by examining it they might come to understand themselves and make the depression more manageable. The sufferer may, it is hoped, achieve some measure of control over his condition. This is, in my experience, the treatment that offers the greatest life-line to the sufferer. Note that it begins with an admission of failure: the attempt will be to make the condition more manageable. In that limited assistance, however, it can be very successful in making life a little easier for the sufferer to tolerate. In the absence of miracles, we must thank God for small favors.
There is no known cure.
The possible third treatment that I alluded to earlier is psychotherapy, the “talking cure,” first suggested by Dr. Sigmund Freud. This is an attempted “cure” administered by medical doctors who receive extensive post-doctoral training in psychotherapy. The goal is to guide the sufferer through a process of remembering and understanding the life-events that gave rise to a particular “neurosis.” In practice, the psychiatrist sits almost silently in the room while the sufferer talks about whatever subject presents itself. The doctor nods his head, grunts meaningfully, and makes notes, occasionally directing the patient to go into more detail. The idea is to cause a breakthrough, or something of the kind. In my experience, and in my opinion, it is a colossal waste of time, and a great expense, with no hope of success.
Here is where things get difficult for the family and friends of a depression sufferer. People who are not depressed seem incapable of understanding what the sufferer is feeling, or why they feel like that, or why they cannot simply recognize the problem and deal with it. They wonder how someone can go on, year after years, and finally decade after decade, without simply “getting over it.” The sufferer hears the same things over and over again. “That’s all in the past!” Or, “just forget about it!” With a lot of, “why are you so negative all the time?” It is also very likely that those with the condition have been affected in their performance of life’s duties. The depression has caused them to underachieve in general, or in their working life in particular. Those around the sufferer are likely to focus on and criticize them for self-medicating, or employing avoidance mechanisms. There is more exacerbation than assistance in this behavior.
But the symptoms, what is it exactly that the depressed individual is feeling on a moment to moment basis? What are the feelings that the family member cannot understand, having never felt anything like that themselves? Allow me to try to be useful.
I am depressed, and mightily so. “How depressed is he, Johnny?” The only effective counsellor that I have ever had asked me in an early session, “how long have you been feeling like this?” I was fifty-years-old at the time. I considered my answer, and said, “since I was about four-years-old.” She laughed out loud, thinking briefly that I was kidding. Immediately seeing that I was not kidding, she regained her composure and asked me if anything in particular had happened at that time. “My sister was born.” After that, I explained, my mother became unpredictable and was more violent with me. After that, my mother, never a warm individual, was never loving or nurturing to me. After that, my life was a constant round of fear and anxiety, with frequent screaming and beatings. My sister, God bless her, is a wonderful woman and completely blameless in all of this, and, luckily, she was not subjected to the same kind of behavior that my mother exhibited regarding me. I, on the other hand, was doom-struck, and I have remained fearful and anxious ever since.
Disclaimer: I am well aware that the world is full to overflow with people who have had it much worse than me in life. Furthermore, I’ve been very lucky in general, and my experience of life has been better than could have been expected. I am not here to complain; I seek only to clarify depression for the reader, partly through an examination of my own experience.
So, symptoms. Rather than go over an endless list of feelings over the course of so many years, I will concentrate on the year between May, 2016, and May, 2017, with a nod to the previous eight years. It was a difficult time throughout. In that time, I had experienced expulsion and exclusion from my marriage and my home, gradually becoming alienated from my children’s affections as well. My marriage ended in divorce in December, 2014. In 2015, I gave away almost all of my possessions, which had been unceremoniously thrown into a storage unit by my family. They had sold my car, without telling me, before the divorce was filed. My oldest son kept my records. Other things remained at the house, or failed to find their way to the storage unit. At $120 per month, long-term storage was an unsustainable expense for me, so I tried to find good homes for things, donated what was appropriate to a favorite charity’s thrift-store, allowed a few friends to take what they wanted, and just said goodbye to the rest. I was not offered any chachkas or family pictures, and I was afraid to ask for anything.
TO BE CONTINUED