Tuesday, February 19, 2008

Beyond Blue: Because of, Not In Spite of

Therese Borchard writes:

Last week's post on the Newsweek happiness article provoked many interesting comments. I especially liked this insightful one from Beyond Blue reader Mia:

Such a great discussion here. And I really love the distinctions being made: "medicine" vs "drugs" and "sadness" vs "depression." And how I love Dr. Kramer's over-and-over-and-over insistence that we're talking about a disease here people -- not simply a deeply felt negative emotion. Is there a tendency to throw pills at things too quickly in this society? Perhaps. But people seem to forget that one of the reasons drugs are prescribed -- and one of the useful applications of drug samples from pharmaceutical reps -- is to help diagnose the problem in the first place. Is it "sadness" or "fatigue" or "depression"? Sometimes I can't even tell, but recently -- in my usual weary dreary battle to slog through the winter -- I added Prozac back into the mix of other meds, vitamins, and alternative-med therapy (had half a bottle left after weaning myself off them early last summer), and dang, I felt so GOOD for the first time in many months. (And I wanted to cry, then, NOT because I was sad but because I was happy and relieved...if I was sad, then it was because I waited so long to think about trying it, all the beating up of myself I was doing and the half-life version of myself that I was giving to my kids.) My point: Sometimes it's the taking of the meds -- and getting (or not getting) the expected/desired response -- that helps pinpoint the malady, even sorting out when "depression" is emotional upheaval vs chemical upheaval.

I don't know about anybody else, but more than once in this whole sadness-vs-illness debate I've found myself wishing for a different word than "depressed." When people say, "How depressing!" or "Man, I'm sure depressed" they're not talking about the same kinds of things that have most of us turning to SSRIs. And maybe that in itself contributes to the confusion and the ignorance, of having my mom, for instance, say to me that she wished my sister could "pull herself together" so that she could "get off all those d*mn pills." Maybe if chemical depression was called something like Peter Kramer Syndrome, like Lou Gehrig's Disease or Tay-Sachs, people would finally "get it"??? Get that ingesting the right chemical, in manufactured pill form -- to address the body's inability to manufacture it on its own (much like insulin for the diabetic) IS IN ITSELF part of "pulling yourself together." They're not mutually exclusive realities!

God bless the people who can do this on their own, with talk-therapy alone or a right mix of alternative therapies -- I applaud you, I envy you, and sometimes for months at a time I can BE you. But sometimes that SSRI is exactly the crutch I need -- and I use the term "crutch" on purpose, because even tho it has a negative connotation, a crutch used properly is an effective and needed tool when you're in danger of falling and hurting yourself, or of causing further damage when a healing part of your body is still vulnerable.

My own problem with depression -- and this is where the people around you are so important, to help you get a reading on what's going on with yourself -- is that I don't always recognize when a new or deeper episode is creeping up on me. Usually, a major depressive episode happens so gradually that I don't notice it. (It's like that adage that if you throw a frog into boiling water, it knows enough to jump out. If you put a frog into cold water and gradually turn up the heat, it will of course stay put and get cooked.) Once major depression settles in and is firmly rooted, I typically lose my ability to be the good and vigilant advocate of myself that I'd be in the case of other health problems.

Instead of thinking "Oh crap, my neurotransmitters are petering out again, better go see the doc" the tendency instead is to do just about everything OTHER than that -- work harder, guzzle more caffeine to work harder, wallow in self-hate, subject myself to overly critical people who feed into that self-hate, more work and more caffeine and less sleep, and voila your chemical imbalance shuts you down just like a washing machine that aborts the the spin cycle whenever its balance is off. (I heard a great quote at a retreat recently that may apply here: "Your mind can play tricks on you, but the body never lies.") After a while, how can you reasonably expect yourself to haul your sorry butt into a doctor's office when you can't even manage the basics like remembering to eat, take a shower, or changing your clothes?

Because our obsessively optimistic society -- control your own destiny, pull yourself up by your bootstraps (assuming you have bootstraps, which the untreated depressive doesn't) -- can't figure out what to do with the likes of us, because our reality simply doesn't "compute," doesn't fit their model and belief system, we need to be removed from the landscape of the American Dream somehow, just as surely as Native Americans who got in the way of land-grabbing westward "progress." And so if our depression becomes too bothersome to be written off as mere emotional travail (trivializing the disease), then we're "put on a pedestal" (romanticizing the disease) like Poe and Van Gogh in the name of great art. To which I respond, like Dr. Kramer: That's not BECAUSE OF depression -- that's DESPITE depression. Kinda makes you wonder what other great works of art Van Gogh might have evolved to, as his techniques matured, had he not killed himself. I mean, duh! Had he survived depression, we might be thinking of "Starry Night" as his early/immature work instead of his crowning glory!

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