Depression , the secret we share
The following is the transcript of his speech at TED in October 2013
“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 [thought] 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 — [And] then a Plank in Reason, broke, and I fell 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.
Depression 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.” (Laughter)
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 —
(Laughter) as they had actually killed.