Depression

I’m not a mental health professional, but during my long career consulting on the development of supportive housing, I’ve met many individuals who suffered from severe mental illness, including major depression.  So after my stroke when I began to hear about the possibility of depression, I had some understanding of what might be coming, and I have to say it worried me, because the individuals I had met that truly suffered from major depression were severely disabled, even the ones that were under psychiatric care and taking their medications.  Not only were they quiet and subdued, but the disease affected them physically.  They were stooped and tired, without energy or initiative.  When I was close to them, I could feel the weight of the depression dragging them down, like a heavy, wet, moldy blanket was draped over them, against which they had to constantly struggle to keep from collapsing.

The staff at the inpatient rehab facility seemed to be alert to any sign of its appearance.  In my second week there, before I had made any progress in my ability to walk, or even stand by myself, my physical therapist asked about my children, who were 17 and 21 at that time.  She had met Polly, who had taken an extended leave from teaching, and who spent most of every day with me, observing and sometimes participating in my therapy.  I told her Hannah and Collin had visited me several times at night after she had left, but I did not want them to come during the day and see me taking therapy.  She didn’t understand, so I explained that I didn’t want to alarm them by having them see their father in such a weak, helpless condition.  It made perfect sense to me, and Polly agreed with me, but the day after this conversation, the social worker visited me with questions and concerns about my mental state.  I assured him I wasn’t depressed, but I don’t think he was convinced, but he never mentioned it again.  My children never saw me take physical therapy, but the issue was made moot, since I began to make rapid progress and was soon walking with a cane.

It wasn’t until I came home after four weeks at the inpatient facility that I looked into the medications I was taking and found that one of them as an “anti-anxiety” drug.  I stopped taking it and felt no difference in my attitude or outlook.  Not to say, though, that I had no experience with depression.  During a four-week period in my eighteenth post-stroke month, it paid me a visit.  Luckily, it didn’t come at me full force, I felt it only as a brush of a corner of that oppressive blanket, but it was enough to convince me that it was nothing to take lightly, and if its hold on me had started to strengthen, I would have sought professional help. 

The way I think of depression is in my personal, layman, terms of internal and external.  Internal is major or clinical depression, a serious illness caused by chemical imbalances in the brain that can be alleviated, if not cured, by the correct dosage of the correct combination of psychiatric drugs.  Not by drugs, though, like Valium, that only temporarily mask the symptoms. External depression is situational, brought on by circumstances occurring in our lives.  Internal depression colors our perception of external reality with hues of darkness.  External depression colors our internal thoughts and emotions with the same palette. 

As someone who tries, to the extent that I can, to see the world as it is, without self-delusion, either positive, or negative, I believe there is nothing inherently wrong with external depression.  Sometimes we see our situation in the world exactly as it is, and what we see provides ample reason to be depressed.   The good news, though, is that external depression yields to the introduction of depression-fighting external stimuli:  a sunny day, the smell of baking bread, a loved one’s kiss.   Internal depression, however, can’t be touched by what is external.  It’s hidden inside our brain, seething and festering, insulated from the outside.  The danger it presents results from its ability to prevent us from seeing the world as it is.  It corrupts and distorts our vision of reality, creating delusion to the extent that ending our lives can be perceived to be a better alternative than living with hopelessness.

The depression I experienced was somewhere on the continuum between internal and external.  It yielded to exercise, to nuzzling from Lily, my dog, to my wife coming home at the end of the day, to my children calling to talk.  But for several weeks it came back at night, in the early morning darkness, to try to convince me that the remainder of my life would be short and bleak, and that happiness for me was over and would not be returning. 

I’m not the Pollyanna type, and I know that for some people at some times, not living really is preferable to the pain of living, and I respect that, and support their decision.  I also know that if we are in the grip of depression, we may not be seeing our life as it truly is, but how the depression makes us see it, and before we do something that can’t be taken back, we need to make sure that we are seeing with vision as clear as it can possibly be.  The stakes are too high for anything else.