Monday, December 1, 2014

"Do you WANT to be depressed?" -- redux

Therese Borchard, author of Beyond Blue, recently headed a blog post with this question, "Do you WANT to be depressed?"

Do you, dear reader? Does anyone want to be injured or ill?

I wonder if major depression is the only condition that draws forth such an ignorant question. How often do we hear people ask others, "Do you want to have cancer? ... a broken leg? ... heart disease? ... ALS?' It seems to me that even people labelled with other conditions that we call "mental illness" aren't subject to that question ... "Do you want to have schizophrenia? Do you want to live in a state of panic? Do you want to have been traumatized?"

Of depression, if we were to play with "Do you want to be depressed?", we might also ask, "Do you want to be depleted of vitality? Do you want to live in a state of corrosive loneliness? Do you want to despise your existence? Do you want to stand far outside every circle of relation in the world?"

How would you answer these questions?

Only a person deep in the mire of major depression might answer "Yes" ... but this answer is not a natural one. We are beings, creatures, of relation. We are mammals; we are wired to bond.

To consider the question, and to answer "Yes" to it, is a symptom of depression in itself. A more apropos question, though, would be, "Do you want to be dead?"

The first article I ever read on depression -- the one that opened my eyes and began my journey to understand what I'd lived with since I was born -- was written by a psychologist named John Welwood. It was titled, "Depression as a Loss of Heart." I have no doubt that devastating heartbreak, however it comes, is one of the primary formative factors in major depression. There are as many forms of depression as there are people who suffer it. Many, many other formative factors are at play, but there is something common at the core of this condition that the World Health Organization has ranked the #2 cause of disease-related disability worldwide -- superceded only by (hmm...) heart disease.

I wonder if a primary something is heartbreak -- a devastation of bonded, loving, reciprocal relation. Think of the injuries done by humans to other humans in the infinite number of ways that we can harm one another -- from child abuse to torture and war; from bullying in the playground to callous firings at the workplace and "entertainment" that features murder, rape, and other forms of intentional harm. Think of trauma. Think of the deaths of those we love, of all the ways we leave and are left by others, and how the losses pile up over the years. Whether we know it or not, no matter how hardened to it all we might think we are, our hearts are still battered by each blow ... and our brains, master regulators that they are, resound with the damage done, wiring the rest of our bodies to mutate into klaxons of alarm and fear. We cut ourselves off and away from relation with other people; we retract like crabs; we burrow into isolation. We fend off what we most need: engagement and relation with other human beings. We all have a limit of how much loss, how much existential injury, we can endure.

In major depression, a singular element is added to heartbreak, loss, and the damage done to our brain's capacity for energy regulation: self-despising. We turn against our own goodness, our own being. Here is another core something that seems to be unique to major depression.

Therese Borchard tells a story of how she hid the effects of a burst appendix until she needed to be rushed to a hospital. I did the same, at age ten, with an infected laceration on the top of my right foot. I'd cut it on a jagged, rusting spear of metal that was jutting off the edge of my brother's pedal car. A huge triangle of flesh hung from my foot; the injury bled like a bastard and I snuck up to my bathroom, into the bath, and then I doused the wound with rubbing alcohol and layered it with Band-Aids. I got through the next day ... but the day after that, I was sent home from school on crutches because I couldn't walk. My foot had swollen beyond the bounds of my shoe ... and shot agonizing pain up my leg. Many years later -- I was in my mid-20s -- my mother told me that my blood had been poisoned ... and that if another day had gone by, my leg would have had to be amputated below the knee.

Somehow I believed that I was bad for having been injured; that I needed to hide the injury; that I deserved no help for being so stupid to cut my foot. I was terrified of being punished for having been hurt.

I was already living in a state of major depression. I was a child who, at the age of five, sat at the kitchen table with a bowl of food in front of me (having been told that I had to clean my plate before I could go), thinking this thought over ... and over again: "I want to die."

My soul was injured ... and bleeding. I was already gravely wounded.

Dr. Richard Mollica, in his book Healing Invisible Wounds, calls trauma "the existential injury." The word "trauma" derives from the Greek for "wound" ... so a trauma could be anything from a cut foot to a direct threat on one's life -- thus "the existential injury." It could be said that major depression is an existential illness -- and a life threat -- a trauma? -- in itself. One of the mysteries we grapple with in relation to major depression is how we can threaten our own life, our own existence. We can believe that we want to die, that we are being compelled to die.

But Life does not want to die. The force that fuels and sustains us does not want to die. Andrew Solomon, one of our world's leading experiential and scholarly authorities on depression, has said that "depression is the flaw in love" ... and perhaps depression is also a flaw in our relation with our own life force. Somehow, we believe that we should be dead ...

The flaw in love. Major depression cleaves such a flaw in our capacity to love, to bond, to be in relation, that we not only believe we are cut off from our natural inclination to bond with others, but we also cut ourselves away. Somehow, this double-edged severing of relatedness is one of the central symptoms of depression ... and could depression be a symptom of our species' penchant to do battle, make war, sever our bonds with other people, other beings, and with Life itself? To varying degrees, we all do battle. We argue and fight with our families, friends, colleagues ... and with others whom we call strangers ... others we deem to be a threat. We scrabble to acquire, succeed, gain status; we compete and contest; we engage in countless forms of lording-it-over to arrive at the top of a heap; bloodshed and soul-shred be damned.

Most of all, we tend to hack away at our own souls. Therese writes of what she calls "death thoughts" ... She eats a handful of potato chips, and on rushes the vile voice that taunts her. We all have our death-thought triggers ... and it often happens that for those of us with major depression or in the aftermath of existential trauma, we are triggered by merely being. 

Merely being is my primary trigger. There was a predatory person in my early life who had constant access to me, who told me I was filth, that I was bad to the bone, rotten to the core. By the time I was five and was sitting over that bowl of food, unable to eat, I believed these curses. I was infested, infected, in-formed with death thoughts, with a suicidal imperative. The natural self-centeredness of a five-year-old child guarantees that whatever she's told about her being, she'll believe to be true. If I believed that I was filth, that I was rotten to the core ... what else could I think except that I wanted to die, that I should be dead?

The flaw in love. I once had a husband who was the great love of my life ... and he told me again and again that I was his ... until an unrelenting bout of depression -- brought on by over two years of existential trauma and cemented into place by my history -- ruined my ability to be in relation. I was broken of my ability to bond; I could not reach out to my husband, nor to anyone else ... and I could not, for a long time, be reached. For as long as he could, my beloved remained by my side, tending to all aspects of both of our lives. He was so generous of heart ... until he couldn't be any more. He was tormented by the break in my ability, my capacity, to bond; he'd lost his primary relation. He did what any person would do who is shorn of relation and desperate for it -- he sought elsewhere. He left me. He had to save his own life.

The flaw in love. The flaw in me. Talk about death thoughts.

In the years since my husband left, I gradually came to understand that I left the marriage first. I did not choose to leave; trauma and depression took me. Several years later I was able to forgive  the man who had been my mate ... and I still struggle to forgive myself. Still. I have to forgive myself for merely being, every day. I have to forgive myself, daily, for the flaw, the injury, in my capacity to love. Paradoxically, nothing matters more to me than love, and if my character has a primary virtue that I do my best to act on, it's mercy.

It's been said that depression is selfish. It sure as hell is ... and I believe that this is one of the foundations of our stigma against it. How many of us are told to join this or that, to slap a smile on our face, pull up our socks and just get on with it, pick up the phone and call someone, anyone, to essentially pretend that we are happy, happy, happy? To stop being such a downer, such a drag?

I often wonder if major depression is a symptom of something else. The essence of this condition is still largely a mystery; through history, we've attributed its presence to everything from neurochemical mayhem to inflammation to gluten intolerance to laziness to a lack of faith to a weakness of will. God knows. (Just found: an excellent article in the latest Psychotherapy Networker that questions our general assumption that depression is "largely a problem of the individual." Thank you, Jonathan Rottenberg!)

I do know that depression is, in part, mourning writ huge; that it can wreck our inborn, biologic mechanisms of affinity; that it does its damndest to destroy all our relations. We are wired to cling to our mothers, fathers, and other sustainers from the moment we're born ... and we yearn and pine and reach for love our whole lives long. We live in an overriding culture that teaches us not how to love, but how to compete and fight and do more harm than good. And in major depression, the fatal flaw is that we turn against our own goodness, our own beings, our own natural urge to be in relation.

The flaw in love ... The flow in love. How to we mend this flaw, this injury, and restore our natural capacity, this supreme inborn gift?

For we need love -- both to give and receive it -- like we need air, water, food, warmth, shelter. Love keeps us alive and thriving.

I know that one of the essential medicines in my restoration is love. I would be long dead were it not for the love of people who have sustained the soul in me, who have reminded me of my goodness, who have held and tended me through my life. I know that I'm alive because all along, there has been at least one person who has loved me without fail, and whom I have loved without fail (except during that harrowing time a few years ago when the effects of trauma and depression nailed me to my bed and to the terrible interiority of existential despair and illness).

We reach out. We reach in. Like breath ... in, out, in, out ... and we allow ourselves to be reached. To reach beyond ourselves, into ourselves, and to be reached ... this is essential medicine. It is what we live for, no matter what else we tell ourselves. We're born to blend with those we share love with. I have a saying on my bedroom wall, directly across from my bed, which is the first thing I see in the morning and the last thing I see before I go to sleep at night:

And God said,
love your enemy
so I obeyed Him
and loved myself.
~ Kahlil Gibran

Do we want to be depressed, to live in a state of existential despair and shearing loneliness? My answer is a resounding NO. We may believe at times, as Therese writes, that it's easier to be ill, to contract, to disappear, to hide in the mire of long illness, to give up. Depression and the aftermath of trauma can exhaust our vitality to a point where we feel "that far" from dead -- and it takes a certain amount of base vitality to engage. Sometimes we just don't have it ... the well is dry.

Or is it? Again, I say NO. We're still alive; there's still a drop of fuel in the tank. If we're alive, we're still vital ... even if we can't feel the vitality. It is there. This, we must believe. I apply this belief in the face of all despair; I practice it like a discipline. I am alive, therefore I can love. 

You are alive ... therefore you can love. One drop at a time. Believe it.


  1. Wow, Alexa, this is so moving. You had me in tears,,,You write so poignantly and honestly. Depression is not an easy thing to write about but you cut right to the core of your experiences, your feelings, and your beliefs. Despite all the pain you describe, you still sound hopeful and tenacious. I will remember that image of the 5 year old at the table for a long time....Thank you!