Sunday, September 13, 2009

Depression


No, not the economic one - the other kind.  Depression, once an illness that dared not speak its name, is now familiar to most Americans.  It effects men and women, young and old, and plenty of us.  Depression can be minor or major – that is, less or more seriously afflicting.  It can come in a single episode, or it can be recurrent or chronic.

Andrew Solomon , the brilliant author of a comprehensive work on depression entitled “The Noonday Demon,” described it as “the aloneness within us made manifest.” “The only feeling left in this loveless state,” Solomon wrote, “is insignificance.”  Another great poet of depression, William Styron, likened it to “darkness visible.”   

To those who have not known clinical depression, the powerful, poisonous grip of it can be hard to understand.  The depressed person, instead of eliciting our compassion, can seem like someone who just wants pity; who isn’t trying; who wants everyone else to be as miserable as he is.  Those who love a depressed person are deserving of compassion themselves: the depressed person is often very hard to live with.  He cannot feel loved, no matter how sincerely and with how much devotion others try to love him.  He clings to his loved ones, even as he pushes them away.  His self-loathing is often turned on those who love him, who then feel the brunt of his profound disappointment in himself, his discouragement and self-contempt.  The more he hurts those who love him, the more he sinks into shame, guilt and despair.

Depressed people need help but often are too afraid, discouraged or ashamed to seek it.  Those who love them need to push, insist, or demand, if need be, that they get help.  Two things help:  medication and psychotherapy.

The SSRI medications (Selective Serotonin Reuptake Inhibitor), such as Prozac and its many successors, have been the most effective medical treatment to date.  With relatively few side effects for most people, they have helped relieve the worst symptoms of most kinds of minor depression, and they are very often successful in controlling recurrent major depression.  However, these medications do not turn sorrow into joy – an SSRI is not a panacea.  Rather, SSRIs help to diminish obsessive rumination.  For the depressed person, this can mean that the compulsion to obsess over an endless litany of cruel judgments against himself can be controlled and eventually even stopped. 

But these habits of self-loathing run deep and have not sprung out of thin air.  The terrible thoughts and feelings of the depressive have meaning – and therapy is the means by which the traumatic origins of depression can become known.  People typically think of “trauma” as a terrible incident of some kind of violent assault.  But trauma can also be developmental.  Developing as a child in a family led by caregivers who are ill – for example, with alcoholism and other addictions; mental illness; personality disorders and mood disorders  - can be a significantly traumatic experience. 
For those who have grown up under these conditions - where trauma is cumulative, and rooted in childhood dependence on unstable caregivers - the sense of utter, desolate aloneness can become a lifelong, haunting presence, like a curse one is helpless to dispel.  Too often, depressives blame only themselves for their difficulties, not realizing that their upbringing all but guaranteed they would eventually fall prey to depression.   Therapy not only illuminates the origins of depression, but helps to create a path toward healing, growth and change.

If you have healed your depression through exercise, through spirituality, through service to others or meaningful, inspiring work, or through a loving relationship – you are among the lucky.  If you’ve tried it all and still suffer, seek the help of a licensed mental health professional.  It is never too late to get help for depression, and to claim the right to a life of meaning and possibility  - a life in which it is possible to love and be loved.       

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