What is Depression?
Exploration of an Altered State
Melancholia I, Albrecht Dürer, 1514.
Two and a half years ago I wrote a piece I titled I Have No Pill For You which documented a "spiritual emergency" or psychotic experience I had in October of 2012. This experience forced me to begin asking the question, What is psychosis? Since that time I had two other psychotic experiences. Approximately one year ago I wrote the following to summarize what I had gone through:
A year later I find these words I wrote to still be accurate, accept for the implied claim that I am not bi-polar. In fact I am. I've come to accept the diagnosis I've been given: bi-polar one disorder. This acceptance has come with a sense of relief, sadness and empowerment. Relief because I finally have an explanation (even if conventional) for what happened to me; because I'm taking medications that actually seem to work; and because countless others suffer from this disorder and so I'm not alone. Sadness because it is sad to have an affliction, a disability, a disorder. Empowerment because I am methodically chewing through the experiences I've had (though not without the help of healers and friends) and can even feel a kind of pride in having familiarized myself with a heretofore unknown to me part of the human experience, a pride because this is now part of the life I'm given to have.
[Note: In the previos paragraph I wrote "I am" bi-polar when, in fact, I should have written, I have bi-polar (disorder). One never says, I am cancer or I am diabetes. Thus one shouldn't say, (nor think of others as) "I am bi-polar," because bi-polar is a disease of the body and not a state of being, like being a man or woman or child. Of course one could argue that it is very much a state of being, but so is suffering from cancer. Out of a commitment to removing the stigmas (forms of prejudice) from mental illness then one should not think of others as "being bi-polar" - or borderline, schizophrenic or ADD.]
. . .
These writings are in the form of a journal, a series of periodically written inquiries into the questions, What is psychosis? and What is depression? I Have No Pill For You was my initial exploration in writing of the altered state of psychosis. In this essay I am writing about depression. I don't think either psychosis or depression is understood, certainly not by the one who experiences them. And if those of us who experience them don't understand them, then who does? By not understanding them I simply mean the mystery of what they are outweighs the understanding. They are more mysterious than understood.
I'd never experienced depression in my life until after my second psychotic experience. Of course I'd had low moods and melancholy, heartbreak and deep blues after the end of a relationship, grief following deaths of friends and my parents, but not clinical depression. This was an altered state entirely new to me. Now that I look back, if my bipolar disorder was truly bipolar then I would inevitably experience the low end of the wave, depression, something I was unprepared for, an initiation I'd never had, a suffering I had no idea could be so bleak, so physically debilitating, so painful, something that takes away life as one has known it with such frightening thoroughness.
Within this mystery I'm certain no two people experience depression in the same way, so my inquiry is my own, informed from my own experience. My conclusions are provisional, even for myself, much less for others and are not necessarily meant to be generalizations.
On March 17th of this year I took an Alaska Airlines flight from San Francisco to Portland Oregon. I was feeling quite normal during the flight and even felt creatively inspired to write about the landscape below me; scenes of snow-capped Mount Shasta but also numerous reservoirs with low water due to California's extended drought. Within two days of being in Portland my inner landscape changed completely, and virtually overnight. I was in tears that third morning trying to describe to my son Devin and his mother Lisa - to visit them is why I'd come to Portland - what was going on with me. Overnight I felt I was in the throes of dementia. Did I have early onset Alzheimer's I asked myself ? Lisa had gone online and found an Alzheimer's site that listed symptom like my own. I could't concentrate, I couldn't remember things, I couldn't make decisions, I couldn't organize or do detail work. I could barely read and it was difficult to participate in conversations. By "couldn't" I mean I had real difficulty; these normal processes of the brain had suddenly become greatly altered and I hardly recognized myself.
On my last day in Portland I lost my Canon point-and-shoot, a camera that, when with me, I'm as aware of and conscious not to loose as my wallet. The next day I somehow managed to get to my next flight, this one to Boulder Colorado. When I arrived in Boulder my cognitive difficulties only got worse. It was then that I began to realize that I had also entered a depression. Only later did I come to understand that the cognitive difficulties I was experiencing are symptoms of depression - which only underscores how inadequate the term depression is for the maladies that occur under its rubric. Might impaired cognitive depression disorder be a more comprehensive term?
. . .
The root of the word anguish is from the Latin angustus, which means "to narrow." Anguish itself means "an excruciating mental or physical suffering." In the midst of my depression the narrowing I experienced was longing for sleep (fortunately I could sleep; many cases of depression are marked by insomnia). One of the few comforts was to get into bed, to be in bed, to wake up in the middle of the night in bed and realize I could sleep some more. Otherwise there was (mostly) a kind of anguish that engulfed me, that I carried choicelessly yet without being able to perceive just where it was and just what it was.
As is typical, my depression-anguish was marked by thoughts of self-accusation and even hatred. As William Styron wrote in his memoir Darkness Visible, "Of the many dreadful manifestations of the disease, both physical and psychological, a sense of self-hatred - or, put less categorically, a failure of self-esteem - is one of the universally experienced symptoms, and I had suffered more and more from a general feeling of worthlessness as the malady had progressed."5 Worthlessness is exactly the right word for the overall sense of myself that would overtake me. Sometimes the feeling of worthlessness and the physical anguish brought imaginings of suicide, ideations. They were passing thoughts, but they were there.
I told a friend about the degree of my self-acusational thoughts and he seemed to recoil, said he was surprised that after all these years of Buddhist practice I had so little maitri (loving kindness) for myself. He didn't understand that my thinking process was altered, that these were the the type of thoughts that just naturally emerge from the mind under depression, that they carried with them a forcefulness that tried to insist they were true, and that in more normal times I did indeed experience maitri.
My mornings were usually mostly free of depression (though not the period of first waking up). This was no doubt because I am a "morning person" and always feel at my best in the early hours of the day. It was also because I meditate in the morning and meditation made a significant difference in the quality of my morning and sometimes my whole day. In meditation the transparency of my thoughts, whatever they were, was easy to experience and the effects of mindfulness-awareness practice influenced my experience after meditation positivily, as always. But when depression would occur - never triggered by some external event, but simply arriving like a hidden tide or weather pattern - the anguish would color my experience almost totally. I tried to be with the anguish, taste its feeling rather than get caught in its accompanying story line. Becoming aware of the felt-sense of the body was the key to avoiding the trap of story-line and subsequent enmeshment in believing my thoughts.
The feeling in my body was often one of fear (although I didn't suffer from anxiety as so many with depression do). Besides the fear, which manifested as a a kind of knot in my belly, the anguish was even more dominant, literally a kind of physical pain, though difficult to localize and difficult to describe. And in the worst stage of my depression, when I was also cognitively impaired, I had no inspiration or motivation (hence the desire for sleep) and little ability to think clearly, make decisions, organize anything (including the organizing it takes to effectively cook a meal) and engage in conversation. I felt quiet, forcefully hunkered down, vaguely fearful, at odds with myself, caught in low-level physical pain, low in energy and often exhausted. In spite of this I led as normal a life as I could; I conjured the warriorship of my spiritual tradition, I visited friends, renewed my driver's licence, found a doctor and a psychiatrist, ate good food, went on walks, attended meditation programs and even talked on the telephone (something I found particularly hard).
Then one day it all shifted. Over the next two weeks I had a couple of days of depression, but overall I was beginning to feel normal, like myself again. In the subsequent weeks I felt no depression at all. Was this turnaround the result of a pill or simply a natural movement in my brain, some kind of chemical shift related to the ebbs and flows of bipolar disorder? Even on the darkest days - it had been raining in Boulder for weeks - my inner sun was bright, my personality was back, including a sense of humor. I could even write again.
The shift corresponded with taking an anti-depressant, recommended by the psychiatrist I'd begun to see. She said it would take a couple of weeks or more before I noticed anything, but in fact I seemed to experience a turnaround overnight. Either that or, as I wrote, I was due for a change anyway. Maybe both? In any case, I've come to believe it is the medicine, Lamotrigene, a six-sided pill the size of a ladybug, that comes with a multipage side-effects warning-label (rash, fever, difficulty breathing, involuntary quivering, double vision, chest pain and severe anxiety, to name just a few). I've had no side-effects and have come to adore the white pill with an indentation through its center. My adoration measures how far my thinking has come over my lifetime, choicelessly, since I never experienced depression until two years ago (at age 59); never imagined myself taking such a drug, and in fact have never taken a pill in my life (save antibiotics) for anything before I began taking Abilfiy (after my third psychotic experience). Now I am taking a two-ingredient cocktail of pills, medicines with a whopping list of side-effects and mysterious consequences for the brain. Sometimes I'll put the Abilify and Lamotrigene on my shrine so they can receive blessings and I can acquiesce in my heart to their seeming necessity in my life.
. . .
I agree that melancholia is a more apt and more beautiful word than depression. For me, it conjures up Albrecht Dürer's famous etching of the same name, created in 1514, and thus the word evokes the Renaissance, the intersection point of the medieval and modern world, a time when melancholia, at least as depicted by Dürer, would be a depression with transcendentally penetrating aspects, a depression that might harbor creativity. Renaissance thought linked melancholia not only with potential madness but also with creative genius.
There was another dimension to my most recent depression, which had lasted from March 10 until April 30, 2015, a period of fifty-one days. This dimension was a creatively insightful one, though also severely painful. But it was accurate (not altered or disordered), useful to me now, even precious. During the fifty-one days, astrologer friends had told me about this or that lunar eclipse, solar eclipse or transit of Uranus, Pluto and Saturn. They stressed this was a powerful, intense and transformative time. Whatever the case, I felt it was, that in the midst of my disordered and distorted thoughts of self-accusation or self-loathing I also received waves and waves of insights, mostly at night. The insights were circumspect, probing, incisive and nearly every one examined my shortcomings: everything from negligible faux paus to life-altering mistakes were revealed to me, cinematically. I was taken back, mostly at two or three in the morning, to reexamine my life.
The insights left me filled with regret. The depression caused me to seek sleep, to lie in bed, for instance, at four in the afternoon. Though I knew seeking sleep was "wrong," not healthy (in Buddhist terms a kind of longing for ignorance, for the "animal realm"), at the same time I had to surrender to it as part of experiencing the depression. It was the same with regret. Regret serves nothing or no one, yet like depression it was rather new to me (I experienced similar periods last year), and something in my psyche insisted that I live for periods of time in regret (insisted I become a "hungry ghost"), insisted that I taste regret in all its bewailing and suffocating dimensions.
The insights took me back to every crossroad in my life: why did I end my relationship with E (and L, E, D, C and T); why did I stop being an accountant; why did I get a masters in creative writing instead of becoming a therapist; why did I give my record collections away; why did I give everything I owned away (even my clothes); why did I drop out of Ngeton School (a program of Buddhist studies); why did I sell my car; why did I travel to Istanbul? In the middle of the night it seemed that every decision I ever made was wrong, some of them like naïve idiocy, some like crimes again humanity. Regret, aligned it seems with the planets and eclipses and fueled by depression, added to my sense of worthlessness.
Just as my cognitive impairments gradually receded (and essentially vanished even before I started to take Lamotrigene), so regret too became something else, something ultimately salubrious. Regret became repentance, humility, humor and irrelevance, pretty much in that order. Maitri won out over self-loathing.
. . .
Maybe I've not yet addressed the question, What is depression? I've provided my experience but not an answer. Perhaps experience is the only answer there is? If I was a chemist or psychaitrist I could talk about brain chemisty and what the pill the size of a ladybug does when it enters my bloodstream (Lamotrigine is generally accepted to be a member of the sodium channel blocking class of antiepileptic drugs, and is effective in the treatment of the depressed phase of bipolar disorder. 7). I've come to accept the chemical explanations of what depression is, though I believe, as my therapist does, that shock and trauma probably lay the ground for clinical (bipolar) depression to manifest. I had lots of shock in the years before my first bipolar psychotic episode; the end of a relationship, the death of both of my parents (and where I was their primarly care giver), the loss of a spiritual comunity and the loss of a place I'd lived for twenty years.
. . .
Depression makes one withdrawn and one recoils from relationships, yet relationships are essential in combating depression. My friends were crucial and generous sources of support during my depression. One friends helped me organize my life, another gave me rides and kept the converstion going when I couldn't, another gave me a lecture on my own goodness, injecting me with confidence. Sometimes I confided in my friends with more candor and emptional nakedness than I'd ever expressed. Yet during my depression I chose only to see the the friends I was closest too; a great many friends I avoided seeing. So depression is something that causes one to withdraw from relationships but can also make one a more honest and intimate friend.
During my depression I felt unmoved, without enthusiasm, often without appreciation and certainly without inspiration. Nature, particularly seemed something I felt strangely indifferent to. I'd look at the sky, a stand of pine trees or magpies foraging the back lawn but I'd feel little or nothing and would turn away, more comforted by a book (though there were times I could barely read) or checking my e-mail. Now nature is beautiful and compelling again. It has been raining in Boulder week after week, but today the sky is clear - for awhile - and the bushes and grasses have exploded with greenery and growth. I'm not depressed, I'm meditating for two hours in the morning and I'm writing again. Perhaps I've never felt better. I am inspired, in particular by life's beauty and the ability to find a passage through our challenges.
1. Darkness Visible, Willam Styron, 1990. Vintage Books, New York. Pg. 82
2. Albrecht Dürer and His Legacy, Guilia Bartrum, 1973. Princeton University Press, Princeton, NJ. Pg. 188.
3. Diary of a Snail, Günter Grass.
4. Darkness Visible, William Styron, pg. 7
5. Ibid., pg. 5
6. Ibid., pg. 37
Self portrait, Albrecht Dürer.
Museo del Prado, Madrid
Since antiquity - in the tortured lament of Job, in the choruses of of Sophocles and Achilles - chroniclers of the human spirt have been wrestling with a vocabulary that might give proper expression to the desolation of melancholia. - William Styron 1
Albrecht Dürer's Melancholia, with its heavily draped winged figure leaning her chin on her hand in a mood of wary despair and a clutter of instruments lying in a disorderly fashion around her, must be the most written-about image in the history of art. - Giulia Bartrum 2
In railroad stations, on foggy waterfronts, in shantytowns, wherever something is meaningless or moribund, she turns up. She sulks, eats her heart out, stews in her juice; she has become a burden to herself, insufferable. Everything is shallow, emtpy, calculable, mechanical; one and the same article passes by in heartbreaking uniformity. - Günter Grass 3