Trigger warning: content discusses suicide.
Little has been said or documented about the fact that depression is ridiculous.
Changing the channel on the TV makes me want to cry. It feel senseless and pointless. Emails pile up, the letter box overflows, the soil in the plant pots dry miserably. I feel that human contact is terrifying whilst knowing at the same time that there is nothing terrifying about human contact. Moving from the sofa to the shower to tend to my body feels insurmountable. The bin fills, the sink fills, the laundry basket fills. They sit untouched. I brood over the simplicity of cleaning a cup, a plate — the effortless action of something so uncomplicated and mundane. Yet clearing the sink seems mammoth and nugatory. How can the thought of rinsing of a cup occasion 40 minutes worth of rumination, guilt and self-hatred?
What used to give life shape, contour and colour has fallen away into some unknown void. My love for yoga, running, reading and writing has experienced sudden death. I am bent with sadness experiencing this psychic and physical draining of vigor and vitality. It is an internal ache that the English language falls short in giving description to.
If it wasn’t so dire, I would laugh at the insane absurdity of it all.
It is unthinkable for depression to arrive against the backdrop of a good life. A life punctuated by beautiful and cherished moments of parenthood, friendship, professional reward and accomplishment.
Just when I thought I was emerging from one dark place; clouds parting and vitality starting to make itself known, I unpredictably slip quietly back into the black hole. Like a mole emerging from under his hill, only to find himself tethered at the neck, to some vexatious anchor deep within the muddy earth.
I ponder what could underlie the current intrusion of this cerebral trespasser. The sorrows of my childhood, the loss of my marriage, the remnant and residual pain of past trauma? No, it is not this. The traumas of old are in my rear view mirror. I am recovering from my losses, I have embraced my imperfections, I am relishing the wisdom and faculty that comes with the slow process of healing and maturing. I accept that others can betray, exploit and annihilate etcetera. I am rarely forlorn about relational disappointments. So all in all, all seems well if you know what I mean. Except that it’s very much not.
When it descends, I want my loved ones to understand, but I don’t have the energy to explain it. I want to reach out to their loving arms but the shame of my affliction causes me to withdraw from humankind. The exhaustion, the apathy and you know — the general fugue that occupies the air space of the depressed.
The air is thick and it resists my existence. Nothing and no one has corners or edges, vision blurs and definition of life absconds, both philosophically and literally. The universe and its inhabitants seems to exist on the other side of a glass pane — normalcy over there, me over here, locked in this dark prison.
Hours pass; hundreds of minutes spent staring into the bleak nothingness for minute on top of minute; an hour becomes hours, hours become days. Just nothingness. No will, no desire, no nothing. My body hollowing — disinterested in consumption of any kind and my brain shriveling from the sharp absence of stimulation. Guilt washes over and through me.
I don’t wish to come into contact with another human being lest they catch my damned disease. Or woe, would they see deep into my eyes and uncover the blackness of my soul.
I find it best not to make eye contact with others at all. A dishonor I think, to such an elementary function of the human condition. I want to look deeply into the eyes of those I love, to see and touch their joy and their pain, hold their hands in it, but truly, the depressive paralysis renders one incapable of this connection.
My psychiatrist reminds me of periods of relative euthymia. She tells me to recall how ‘this too shall pass’. That I will get better. Fond of her I may be, but in this moment I want to laugh at her, and hit her voraciously, all at the same time. I mean really, spouting Lincoln’s infamous adage to someone crippled by depression is a platitude that grossly misses the mark and only leaves one feeling foolish and embarrassed about ones condition. She might just as well have told me that I will soon sail to Hawaii on a banana boat, so sure I am that my real life is definitely, a fait accompli.
Nobody talks about the self-obsession that accompanies depression. But it feels to be that way — self indulgent, self consuming. The past and future are eclipsed by this present — an almost narcissistic focus on the self and now, reminiscent of a toddler’s modus operandi.
An oversensitivity to all and everything pervades. A self-consciousness that gives rise to a malignant self-hatred. Distorted thinking percolates the mind on repeat: I am unlovable, I am a failure, I am meaningless, I am worthless. There is no hope. If in a euthymic state I were to read the transcript of my depressive internal monologue I should think I would find it all rather hilarious and bonkers. But there lies the beastly conundrum of the dark soul — that it makes no sense, no sense at all.
Scared of myself, I will my being into sociability. I see my friends and fail to laugh. I go to parties and want to hide in the bathroom. And I do, sitting on the toilet seat while rivers of aimless tears betray the brave-face that I put on for the outside world. I gingerly embark on conversations only to yearn that I could fold away into invisibility. Thoughts dominated by my social impotence and worthlessness. Cognitive functioning on a sharp decline; unable to absorb or comprehend idle chatter. The guilt of wanting to escape the people I love the most. The shame in wanting to retreat to my self-pitying hovel where I can let my body and mind collapse into itself.
The weight of everything and nothing is intolerable. It strangles all agency, and all seems futile, pointless and barren. The concept of future evaporates into oblivion — the future is inconceivable. 24 hours feels like a torturous week. I want to fill my days with sleep so that I don’t have to face the abject hopelessness.
How can I describe the darkness of my soul to those I love without them running for the hills? I feel alone in this harrowing place.
Loneliness causes depression and depression causes loneliness. Exhaustion exacerbates depression, and depression exacerbates exhaustion.
This affliction is mired in riddles and muddled algebra.
Sleep is evasive. Insomnia affords only 45 minute sleep cycles. It is not unusual for depressed folk to have no deep sleep at all. Fearsome dreams cause panic to awaken me, my bed sheets drenched.
Mornings are grim and psychically painful. After 5 am I finally fall into the deepest sleep and as the alarm sounds, enormous and all-consuming waves of tears rise up from my belly. They fall endlessly without purpose, down the side of my face soaking my pillow. The sense of ominous dread is choking, it is a despair I fail to find words for. I cannot summon the energy to rise yet against the backdrop of my physical inaction my mind races uncontrollably, intrusions of brutal self-chastising thoughts about my functional infertility. I feel under siege by my own self.
Tom Wehr, who heads sleep research at the N.I.M.H., says that “though depressed people seek the oblivion of sleep, it is in sleep that the depression is maintained and intensified.” In particular for bipolar patients, scientific literature points to the criticality of maintaining a regular sleep schedule, as a deviation from a rigid nocturnal regime can propel one into a depressive or manic episode. But what if your biology will not allow you to sleep for fucks sake? The mind boggles.
Freud once described pleasure as the release of tension; there is an urgency in my need to rid myself of this inner agitation. Were this release to occur, would I experience pleasure I wonder? For sure anything would be better than this.
Psychologists and psychiatrists regularly come to fisty-cuffs in debating the cause of major depression — whether it is organic, or it is situational. My old psychotherapist believed that it is the interplay between my traumatic past and the subsequent sensitivity of my brain in response to recurrent emotional and cerebral stress. Whilst acknowledging the role of complex trauma in my plight, my psychiatrist on the other hand, believes my oft-visiting depression to be the genetic, organic manifestation of bipolar disorder.
Emotional vulnerability need not be genetic. Ellen Frank, of the University of Pittsburgh, says that “experiences in childhood can scar the brain and leave one vulnerable to depression.” As with diabetes, predisposition and environment conspire. In my case, it appears the kindling of my childhood traumata and my genetic predisposition to depression are colluding in the most dreadful way.
I have lost track of the concoction of drugs. As is characteristic of bipolar disorder, anti-depressants send me into a hideous and intolerable mixed state where depression and agitation coagulate in an unbearable form. It is well known in the psychiatric community that anti-depressants given to bipolar patients can propel one into an urgent and hell-bent need to suicide — sadly I can verify this phenomenon.
Of the long-list of mood stabilisers I have tried all spare a few. The inventory of side effects run the length of my arm: paralysing sedation, unpaletable weight-gain, akisthisia, tremors, headaches. It goes on. Anti-psychotics are worse, if that’s even possible. Lithium became a good ally, until it was not — the immediacy of its impact was joyful but it lasted all of two weeks before my vision became blurry, I was unable to walk in a straight line and my stoic friend anxiety took a hideous turn for the worse. I was literally a trembling mass of jelly on a dildo.
The journey of medicine trials leave you feeling like a Voodoo Doll — save for the supposed magic that arises from sticking pins in a fabric dolly with buttons for eyes. There is nothing magical about the rollercoaster of side effects, nor the unpredictability of what may work, and what may not.
Benzodiazepines are a loyal companion. They thwart anxiety and greatly reduce agitation and irritability. But effectiveness is short lived; tolerance increasing with each tablet, along with addiction to and reliance on a man-made substance designed to blunt your natural inclinations.
Thankfully I have found a mood stabilizer that four weeks in has no side effects of note. I am storming the skies, hoping with all my might that I may start to see the sun peep out from the weighty clouds.
In the midst of suicidal impulse of late, I reached out to my old psychotherapist whose opinion I value greatly and character even more so. He wrote: “Amelie, my most beloved mentor believed that even organic depression can be overcome without meds. So the question seems moot: you can’t tolerate the meds, so going down the pathway provides no help.”
He is not a great advocate of medication, particularly when he is of the belief that the recurrent dark passenger of mine is a result of my childhood. He went on to say —
“Amelie I think the human condition is very challenging, but it need not be unbearable. The unbearable-ness is the issue entirely. When you are strong and rested, you do appreciate the beauty in your life. When things weigh on you, these ghosts from the nursery rise up like opportunistic soldiers to war against your wisdom and happiness. They don’t like to relinquish control of you and fight to regain it when they can”.
I wish it were so simple to attribute my dark passenger to a traumatic history. If it were I would feel some modicum of control in tackling this beast. I would sink all my reserves — financial and emotional, into psychotherapy to obliterate those opportunistic soldiers. But the patterns of my history tell me otherwise — that the cause and effect between what is past and what is present sometimes has no identifiable relationship — no seemingly apparent trauma related trigger for the revisit of depression.
The matter of suicide is a central and serious one in the domain of major depression and bipolar depression. One that scientific study has given rigorous attention to. It yields terrifying statistics — in clinical samples of treated and untreated, over 50% of bipolar patients have made at least 1 historical suicide attempt. And the lifetime risk of suicide in untreated unipolar major depression is 20%.
What makes one end their life, and another not? I believe, along with my psychotherapist that it is possible for one to survive without 21st century medicine. But the price can be high. Even with chemical support, the fight can be almighty and when depression is layered with comorbidity — traumatic pasts, chronic anxiety, substance abuse etcetera, the vulnerability toward suicide, and success in doing so, is even greater. The role of both psychotherapy and pharmaceuticals can be pivotal in allaying both depression itself, and the desire to end one’s life. But for some, this is not enough. Talk is not cheap, and medication is not cheap; for those without the means to afford such assistance, euthanasia is often a tragic inevitability.
In her 1989 book, Positive Illusions, Shelley Taylor writes that “the mildly depressed appear to have more accurate views of themselves, the world, and the future than normal people. [They] clearly lack the illusions that in normal people promote mental health and buffer them against setbacks.”
In this, I guess I have something to be grateful for. Too optimistic a world-view can result in foolish risk-taking — certainly not something I will ever suffer from given my inclination to vegetivity. Yes, the emergence from depression can give rise to a realistic clarity and perception of the world, its inhabitants and the human condition in general. I do not hold fanciful and delusory desires of continuous, enduring happiness. Rather I would feel blessed and profoundly grateful for the placidity of peace; the stillness of a quiet mind.