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Thursday, May 29, 2014

I Turn to My Readers for Suggestions

No one seeks out depression, especially in the springtime, when our world seems at last to be coming back to life after its long, cold sleep. But depression doesn’t need to be sought: no, it comes unbidden and unwelcome. And making it go away again can be extremely difficult. I’ve been thinking about this because people important to me struggle with the problem. Maybe you do, too, or someone you know does. Is there anything we can do to help?

One of my natural first thoughts was to survey books on the topic, but that’s not as easy as one might think, either. The authors of one site I found had done the same thing and concluded:
On [sic] the main ... we are disappointed with the majority of books on depression. They fail to distinguish between the different types of depression. They waste valuable space debating whether depression is a "disease" like diabetes or a problem of adaptation and poor coping skills. For us, the answer is that depression is a syndrome, with many different causes and solutions.
Well, fine, but then I looked at their list of books and found myself still disappointed. What I really want to do is throw the question “out there” and ask you
Is there some particular book on depression and/or bipolar disorder that you have found especially informative and/or helpful? 
You needn’t be depressed to weigh in on this question, and you can register your comment as “Anonymous” or even send it to me in e-mail, if you’d like.
Here’s another question: 
If you are sometimes depressed, is there anything you would like friends to ask or say to you during those times?

As for me, here’s what (little) I know from my own experience:

1)  Depression is not “feeling sorry for yourself.” If a depressed person could “snap out of it,” he or she surely would. In fact, the burden of what I think of as meta-depression can exacerbate the problem, as a thoughtful person compares his or her life and problems to those of others and thinks, “I shouldn’t be depressed.” Depression is not a matter of should or shouldn’t.

2)  Neither is it true that “everything is relative” because all personal experience is absolute. We can observe other people living their lives, but the only one any of us lives is our own. The only life any of us knows “from the inside” is our own.

3)  Depression is not “all in your head.” Depression is an overwhelmingly physiological experience, as much as a state of mind. During the winter of my worst and longest depression, I could only sleep two to three hours a night and would awake feeling encased in a suit of dread from head to toe. Every day and every night were draining and exhausting.

4)  There is a lot a depressed person can do to try to push depression away, but no cure is guaranteed to work. Exercise can help. (I forced myself to go to the pool three mornings a week.) A cheery environment can help. (I repainted a dull beige room a light, sunny yellow.) It’s a good idea to see a doctor. (I did.) Prescription medication helps some people. (I tried it for a while.) “Getting out of the house,” yoga, meditation – all are good ideas. Talking can help. But nothing is a guaranteed, instantaneous cure.

5)   You cannot assume that someone who continues to be depressed is “not trying” to feel better. You may have no idea how hard that person is trying or how many things he or she has tried and is continuing to practice. Second-guessing and guilt-tripping a depressed person for being depressed is no help at all.

I’ve numbered these as if they are separate “points,” but it should be clear that they are all interrelated.

A big problem with Internet “research” is that so much of what turns up in search results comes from people with something to sell, whether it’s a book or a pill or a program. When I remembered that NIH is my go-to for general health questions (thus avoiding sites focused on sales), I turned to NIMH to see what they had to say about depression, and right away I found it more helpful:
Most likely, depression is caused by a combination of genetic, biological, environmental, and psychological factors. 
Depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain involved in mood, thinking, sleep, appetite, and behavior appear different. But these images do not reveal why the depression has occurred [emphasis added]. They also cannot be used to diagnose depression.
 To me this is helpful not because it claims to have all the answers but for the clear statement that answers are elusive. The brain of a depressed person looks different, but the difference does not reveal the cause. Is it situational? Chemical? A symptom of some other illness? Brain image can’t show answers to these questions.

Every generation, it seems, has its popular answers, but there is still so much we don’t know. 


Northport muse said...

Pamela, the single best resource I have discovered related to mental illness is NAMI, the National Alliance on Mental Illness, It has good clear diagnostic definitions, discussion of treatment, abundant resource lists, support group connections and up to date research articles.

P. J. Grath said...

Many thanks, Barbara. Here's a quick link to the treatment section of the site B. recommended:

Someone else in an e-mail recommended the following video:

One Facebook friend recommends the book WHY AM I AFRAID TO TELL YOU WHO I AM, by John Joseph Powell, and another Another recommended Sylvia Plath's THE BELL JAR, which would probably be insightful for someone with a depressed loved one but not what I'd recommend to someone already in a depressed state.

More ideas?

Karen Casebeer said...

Pamela...In my years as a licensed psychologist treating many depressed individuals, I found the best treatment was a combination of taking an antidepressant and talking to a licensed therapist experienced in treating depression and bipolar disorder. Current antidepressants are very good, but take a few weeks to reach optimum strength. If the individual isn't willing to see a therapist, medication can still be helpful. Getting outdoors, exercise, and meditation are also self-help adjuncts to medical treatment. The best book for helping men overcome depression is I Don't Want to Talk about It by Terrence Real. I've also successfully used Feeling Good by David Burns and The Mindful Way through Depression by Williams, Teasdale, Segal, and Kabat-Zinn. Karen

P. J. Grath said...

Thanks much for your knowledgeable suggestions, Karen. I do want to reiterate, however, that an individual may do ALL of these things and still not entirely escape. Sometimes coping is the best one can do. I think of it as lousy weather: it comes and goes, occasionally stays a long time, and you do as much as you can not to dwell on it while you're stuck there.

Karen Casebeer said...

Lousy weather is a good metaphor, Pamela, but I wonder if people struggling with depression have expectations that they will feel good all the time. Feeling down is a normal part of life, just as feeling good is. That's why I personally like the meditation approach because it helps us recognize the hills and valleys of normal life. Feeling down becomes a problem when it interferes with life functioning and that's the line that needs to be recognized so treatment can begin.

P. J. Grath said...

Interesting question, Karen, especially (I think) for Americans: do we expect to "feel good" or be "happy" all the time? You make an important point by distinguishing simple "feeling down" from the kind of down that interferes with functioning. In the winter of my worst, near-paralyzing depression, my problem was not plain old dissatisfaction or ennui but downright mental and physiological misery. An hour of sleep would give that much escape, but I would "wake into dread" only too soon. Difficulty and struggle are normal parts of life and probably good for us. Severe depression serves no good that I can see.

Karen Casebeer said...

Yes, you have it correct that severe depression serves no good purpose. It's so difficult to be paralyzed from participating in life by that level of depression. And because depression is such a physiological problem, it's really important to be on the right medication at the right dosage. That is no easy task because there are at least 10 good antidepressants out there of the SSRI type, and it's a bit of a trial and error to work that all out. If the depression is mostly winter-related, this seasonal affective disorder can be helped by using lights. I think this particular winter of the most recent past was difficult for many of us.

Steve Morse said...

Pamela — Thank you for your insightful post on depression. While I personally do not suffer from depression, it’s been in my family for generations. My mother was chronically depressed for most of her adult life, and, in the 40s and 50s about all the “help” she received were the tentative admonitions of my father to “Try looking at it on the bright side, Claire.” More recently, one of my children has been in and out of hospitals and psych wards for the last 20 years, and continues to suffer from bi-polar disorder today.

If I had to select three books on the subject, I’d suggest: An Unquiet Mind (1995) by Kay Redfield Jamison; Darkness Visible: A Memoir of Madness (1990) by William Styron; and The Noonday Demon: An Atlas of Depression (2001) by Andrew Solomon. These are all classics in the genre and are probably not new to anyone versed on the subject.

Jamison is a chaired professor of psychiatry at Johns Hopkins School of Medicine and has also suffered from bi-polar disorder. Her book was the first I read on depression, and it was a revelation. The book by novelist William Styron is a personal memoir of his struggle with depression and is undoubtedly the most literary of all accounts of the disease; it’s poignant, frightening, and beautiful all at once. Solomon, a contributor to The New Yorker, is another personal account, vividly told, and also very informative.

Your post was enlightening, and I admire you for including it in your blog.

Steve Morse

P. J. Grath said...

Steve, while I know of the three books you recommend, I'm not sure I've read any of them, so thanks for jogging my memory and putting those titles out there for other people. Your father and mother remind me of someone I know who had severe low moods for the first time in her life when she was pregnant. She said it gave her the first insight she'd had into how "snapping out of it" or "looking on the bright side" did not constitute helpful advice -- because she just couldn't do it.

Anonymous said...

Hi Pamela, I've always been more prone to cheerfulness than depression, so am pretty clueless as to what a depressed person is actually experiencing.

I found the 1993 movie 'Mr. Jones' (about bi-polar disorder) with Richard Gere quite eye-opening. It made me understand a bit better why someone would go off their medication, or not want to be medicated in the first place. Unfortunately, the movie is not based on a book but is an original screenplay. Like many critics I found the romance part of the story unnecessary and forced, but the rest was quite insightful.

P. J. Grath said...

I would see just about anything with Richard Gere in it but somehow "Mr. Jones" is one I've missed. Thanks for the suggestion, Amy-Lynn. I find Sylvia Plath's analogy of the bell jar a very good fit for the experience of depression. The sun may be shining, birds singing, flowers blooming, but the depressed person can't connect. It's like being inside a glass jar and looking out. And those are not the worst moments, either.