Thoughts for a Rainy Tuesday

The most-visited post on this blog, by a huge margin, is this list of Five Practical Reasons Not to Kill Yourself. I closed it to comments a long time ago because I got tired of depressed people trying to convince me to give them permission. The whole point of the blog post was that I don't give myself permission.

I didn't know Robin Williams, and I'm not sure I even know anyone who worked with him (which is a little surprising, because he worked with a lot of people, and I know a lot of people, so those groups might have overlapped). His brand of humor was one I had to take in small doses, because it was so transparently manic, and mania scares me (I feel the same way about Jim Carrey). But he was an extraordinary actor, with an almost unmatched gift for disappearing into a role the way few movie stars can. And the most casual observer could see that he noticed everything, and felt it all deeply.

Last night on social media I had a brief exchange with someone who was trying to argue that depression (or, presumably, bipolar disorder, which was Robin Williams' ailment) had to be seen as an existential disorder, not a medical one. He said you couldn't see depression in an autopsy, therefore it's not an illness, and we do harm by framing it that way.

I don't have enough formal education to be able to dispute that, and I wasn't interested in arguing with a stranger in 140-character chunks. But I will say here what I know to be true about depression, from my own experience and from my observations of friends and family members who struggle with it.

It's not reality-based. That is, depression is not a rational reaction to a chaotic world, as this guy was implying. Sorrow, grief, anxiety, yes — all those things are reasonable reactions to a world in which governments bomb children, police terrorize people in their own American neighborhoods, and people win arguments just by shouting loudest and longest. Depression's something else. Depression is shades of gray and the absence of joy. It's irrational fear, magical thinking, compulsive behavior and the need to punish oneself for daring to exist, much less trouble anybody with some stupid request for help.

It's not really emotional, except when it is. This is the hardest thing to explain to people who haven't been depressed. Depression is not "the blues." Everybody gets sad sometimes, and some people feel really sad, with reason, for a really long time. Depression isn't grief. In the worst bouts of depression, simple sadness would feel like a breakthrough, because then at least I'd be feeling something. Anger is welcome, because anger (at least for me) is a sign that I'm coming out of it, that I care enough about anything to get pissed off. Sometimes I try to make myself angry so I don't get depressed. If you know a rageaholic, that might be their issue, too.

It is not something you can reason your way out of. Pep talks don't help. Everybody who suffers from depression and lives eventually figures out tricks to manage it (and this is why I recommend cognitive behavioral therapy — they teach you this stuff). I make lists and agree to external deadlines: when everything is terrible (when I am terrible), being able to complete even the most basic task is something that helps. The anxiety of knowing that a client is waiting for me to complete a task is usually enough to get me out of bed in the morning, to move me to the computer, to make me leave the apartment and get on a train or a plane. But not always. And that's the last point I want to make:

Depression is not something you can fix on your own. Last week I went to my doctor to ask for help, for the first time in years. I've been treated for depression, on and off, for most of my adult life — but I thought I was better, I thought I could handle it, I didn't have decent insurance, and for all those reasons and more I stopped the treatment. I told my doctor this and she, in the kindest possible way, got a little exasperated. "If someone had told you, when you were 21, that you had Type One diabetes," she said, "you wouldn't stop taking your insulin just because your blood sugar was under control."

Some day, when medical science knows a lot more about the brain, they'll be able to sample brain tissue and say, "See, this person had too much [fill in the blank] and not enough [this other stuff], and that's why —" But until then, the science of brain chemistry is still very much a trial-and-error process. I'm about to start that process again, and I admit it scares me. I've also learned that doing things that scare me is another tool that helps manage my depression.

If you hear I've gone bungee jumping, you'll know why, and I hope you'll come along if you want. In the meantime, I recommend this and this if you want further reading.