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Depression , the secret we share
(part two)


Depression , the secret we share
(part two)

The following is the transcript of his speech at TED in October 2013

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, (Laughter) 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. (Laughter)  And I said that I thought communication within the marriage might be triggering some of their problems.
(Laughter) 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. (Laughter) She sent me some of them. (Laughter) And I’m not wearing them right now. (Laughter) 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.” (Laughter) (Applause) He said, “We had to ask them to leave the country.” (Laughter)

Now at the other end of alternative treatments, let me tell you about Frank Russakoff. Frank Russakoff had the worst depression perhaps that I’ve ever seen in a man. He was constantly depressed. He was, when I met him, at a point at which every month, he would have electroshock treatment. Then he would feel sort of disoriented for a week. Then he would feel okay for a week. Then he would have a week of going downhill. And then he would have another electroshock treatment. And he said to me when I met him, “It’s unbearable to go through my weeks this way. I can’t go on this way, and I’ve figured out how I’m going to end it if I don’t get better.” “But,” he said to me, “I heard about a protocol at Mass General for a procedure called a cingulotomy, which is a brain surgery, and I think I’m going to give that a try.”And I remember being amazed at that point to think that someone who clearly had so many bad experiences with so many different treatments still had buried in him, somewhere, enough optimism to reach out for one more. And he had the cingulotomy, and it was incredibly successful.

He’s now a friend of mine. He has a lovely wife and two beautiful children. He wrote me a letter the Christmas after the surgery, and he said, “My father sent me two presents this year, First, a motorized CD rack from The Sharper Image that I didn’t really need, but I knew he was giving it to me to celebrate the fact that I’m living on my own and have a job I seem to love. And the other present was a photo of my grandmother, who committed suicide. As I unwrapped it, I began to cry, and my mother came over and said, ‘Are you crying because of the relatives you never knew?’ And I said, ‘She had the same disease I have.’ I’m crying now as I write to you. It’s not that I’m so sad, but I get overwhelmed, I think, because I could have killed myself, but my parents kept me going, and so did the doctors, and I had the surgery.I’m alive and grateful. We live in the right time, even if it doesn’t always feel like it.”

I was struck by the fact that depression is broadly perceived to be a modern, Western, middle-class thing, and I went to look at how it operated in a variety of other contexts, and one of the things I was most interested in was depression among the indigent. And so I went out to try to look at what was being done for poor people with depression. And what I discovered is that poor people are mostly not being treated for depression. Depression is the result of a genetic vulnerability, which is presumably evenly distributed in the population, and triggering circumstances, which are likely to be more severe for people who are impoverished. And yet it turns out that if you have a really lovely life but feel miserable all the time, you think, “Why do I feel like this? I must have depression.” And you set out to find treatment for it.But if you have a perfectly awful life, and you feel miserable all the time, the way you feel is commensurate with your life, and it doesn’t occur to you to think, “Maybe this is treatable.”

And so we have an epidemic in this country of depression among impoverished people that’s not being picked up and that’s not being treated and that’s not being addressed, and it’s a tragedy of a grand order. And so I found an academic who was doing a research project in slums outside of D.C., where she picked up women who had come in for other health problems and diagnosed them with depression, and then provided six months of the experimental protocol. One of them, Lolly, came in, and this is what she said the day she came in. She said, and she was a woman, by the way, who had seven children. She said, “I used to have a job but I had to give it up because I couldn’t go out of the house. I have nothing to say to my children. In the morning, I can’t wait for them to leave, and then I climb in bed and pull the covers over my head, and three o’clock when they come home, it just comes so fast.” She said, “I’ve been taking a lot of Tylenol, anything I can take so that I can sleep more. My husband has been telling me I’m stupid, I’m ugly. I wish I could stop the pain.”

Well, she was brought into this experimental protocol, and when I interviewed her six months later, she had taken a job working in childcare for the U.S. Navy, she had left the abusive husband, and she said to me, “My kids are so much happier now.” She said, “There’s one room in my new place for the boys and one room for the girls, but at night, they’re just all up on my bed, and we’re doing homework all together and everything. One of them wants to be a preacher, one of them wants to be a firefighter, and one of the girls says she’s going to be a lawyer. They don’t cry like they used to, and they don’t fight like they did. That’s all I need now, is my kids. Things keep on changing, the way I dress, the way I feel, the way I act. I can go outside not being afraid anymore, and I don’t think those bad feelings are coming back, and if it weren’t for Dr. Miranda and that, I would still be at home with the covers pulled over my head, if I were still alive at all. I asked the Lord to send me an angel, and He heard my prayers.”

I was really moved by these experiences, and I decided that I wanted to write about them not only in a book I was working on, but also in an article, and I got a commission from The New York Times Magazine to write about depression among the indigent.

And I turned in my story, and my editor called me and said, “We really can’t publish this.”

And I said, “Why not?”

And she said, “It just is too far-fetched. These people who are sort of at the very bottom rung of society and then they get a few months of treatment and they’re virtually ready to run Morgan Stanley? It’s just too implausible.” She said, “I’ve never even heard of anything like it.”

And I said, “The fact that you’ve never heard of it is an indication that it is news.”

(Laughter) (Applause) “And you are a news magazine.”

So after a certain amount of negotiation, they agreed to it. But I think a lot of what they said was connected in some strange way to this distaste that people still have for the idea of treatment, the notion that somehow if we went out and treated a lot of people in indigent communities, that would be exploitative, because we would be changing them.

There is this false moral imperative that seems to be all around us, that treatment of depression, the medications and so on, are an artifice, and that it’s not natural.

And I think that’s very misguided. It would be natural for people’s teeth to fall out, but there is nobody militating against toothpaste, at least not in my circles.

People then say, “But isn’t depression part of what people are supposed to experience? Didn’t we evolve to have depression? Isn’t it part of your personality?” To which I would say, mood is adaptive. Being able to have sadness and fear and joy and pleasure and all of the other moods that we have, that’s incredibly valuable. And major depression is something that happens when that system gets broken. It’s maladaptive.

People will come to me and say, “I think, though, if I just stick it out for another year, I think I can just get through this.”

And I always say to them, “You may get through it, but you’ll never be 37 again. Life is short, and that’s a whole year you’re talking about giving up. Think it through.”

It’s a strange poverty of the English language, and indeed of many other languages, that we use this same word, depression, to describe how a kid feels when it rains on his birthday, and to describe how somebody feels the minute before they commit suicide.

People say to me, “Well, is it continuous with normal sadness?” And I say, in a way it’s continuous with normal sadness. There is a certain amount of continuity, but it’s the same way there’s continuity between having an iron fence outside your house that gets a little rust spot that you have to sand off and do a little repainting, and what happens if you leave the house for 100 years and it rusts through until it’s only a pile of orange dust. And it’s that orange dust spot, that orange dust problem, that’s the one we’re setting out to address.

So now people say, “You take these happy pills, and do you feel happy?” And I don’t. But I don’t feel sad about having to eat lunch, and I don’t feel sad about my answering machine, and I don’t feel sad about taking a shower. I feel more, in fact, I think, because I can feel sadness without nullity. I feel sad about professional disappointments, about damaged relationships, about global warming. Those are the things that I feel sad about now. And I said to myself, well, what is the conclusion? How did those people who have better lives even with bigger depression manage to get through? What is the mechanism of resilience

And what I came up with over time was that the people who deny their experience, and say, “I was depressed a long time ago, I never want to think about it again, I’m not going to look at it and I’m just going to get on with my life,” ironically, those are the people who are most enslaved by what they have. Shutting out the depression strengthens it. While you hide from it, it grows. And the people who do better are the ones who are able to tolerate the fact that they have this condition.
Those who can tolerate their depression are the ones who achieve resilience.
So Frank Russakoff said to me, “If I had a do-over, I suppose I wouldn’t do it this way, but in a strange way, I’m grateful for what I’ve experienced. I’m glad to have been in the hospital 40 times. It taught me so much about love, and my relationship with my parents and my doctors has been so precious to me, and will be always.”

And Maggie Robbins said, “I used to volunteer in an AIDS clinic, and I would just talk and talk and talk, and the people I was dealing with weren’t very responsive, and I thought, ‘That’s not very friendly or helpful of them.'” (Laughter) “And then I realized, I realized that they weren’t going to do more than make those first few minutes of small talk. It was simply going to be an occasion where I didn’t have AIDS and I wasn’t dying, but could tolerate the fact that they did and they were. Our needs are our greatest assets. It turns out I’ve learned to give all the things I need.”

Valuing one’s depression does not prevent a relapse, but it may make the prospect of relapse and even relapse itself easier to tolerate. The question is not so much of finding great meaning and deciding your depression has been very meaningful. It’s of seeking that meaning and thinking, when it comes again, “This will be hellish, but I will learn something from it.” I have learned in my own depression how big an emotion can be, how it can be more real than facts, and I have found that that experience has allowed me to experience positive emotion in a more intense and more focused way.
The opposite of depression is not happiness, but vitality, and these days, my life is vital, even on the days when I’m sad.

I felt that funeral in my brain, and I sat next to the colossus at the edge of the world, and I have discovered something inside of myself that I would have to call a soul that I had never formulated until that day 20 years ago when hell came to pay me a surprise visit.

I think that while I hated being depressed and would hate to be depressed again, I’ve found a way to love my depression. I love it because it has forced me to find and cling to joy. I love it because each day I decide, sometimes gamely, and sometimes against the moment’s reason, to cleave to the reasons for living. And that, I think, is a highly privileged rapture.

Thank you.



Depression, the secret we share

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