Solomon

''For the moment, the panic was my only sensation. The Xanax would relieve the panic if I took enough of it, but enough of it was enough to make me collapse completely into a thick, confusing, dream-heavy sleep. The days were like this: I would wake up, knowing that I was experiencing extreme panic. What I wanted was only to take enough panic medication to allow me to go back to sleep, and then I wanted to sleep until I got well. When I would wake up a few hours later, I wanted to take more sleeping pills. Killing myself, like dressing myself, was much too elaborate an agenda to enter my mind; I did not spend hours imagining how I would do such a thing. All I wanted was for “it” to stop; I could not have managed even to be so specific as to say what “it” was. I could not manage to say much; words, with which I have always been intimate, seemed suddenly very elaborate, difficult metaphors the use of which entailed much more energy than I could possibly muster. “Melancholia ends up in loss of meaning...I become silent and I die,” Julia Kristeva once wrote. “Melancholy persons are foreigners in their mother tongue”.

 

"If one imagines a soul of iron that weathers with grief and rusts with mild depression, then major depression is the startling collapse of a whole structure". 

 

"I returned, not long ago, to a wood in which I had played as a child and saw an oak, a hundred years dignified, in whose shade I used to play with my brother. In twenty years, a huge vine had attached itself to this confident tree and had nearly smothered it. It was hard to say where the tree left off and the vine began. The vine had twisted itself so entirely around the scaffolding of tree branches that its leaves seemed from a distance to be the leaves of the tree; only up close could you see how few living oak branches were left, and how a few desperate little budding sticks of oak stuck like a row of thumbs up the massive trunk, their leaves continuing to photosynthesize in the ignorant way of mechanical biology.

Fresh from a major depression in which I had hardly been able to take on board the idea of other people’s problems, I empathized with that tree. My depression had grown on me as that vine had conquered the oak; it had been a sucking thing that had wrapped itself around me, ugly and more alive than I. It had had a life of its own that bit by bit asphyxiated all of my life out of me. At the worst stage of major depression, I had moods that I knew were not my moods: they belonged to the depression, as surely as the leaves on that tree’s high branches belonged to the vine. When I tried to think clearly about this, I felt that my mind was immured, that it couldn’t expand in any direction. I knew that the sun was rising and setting, but little of its light reached me. I felt myself sagging under what was much stronger than I; first I could not use my ankles, and then I could not control my knees, and then my waist began to break under the strain, and then my shoulders turned in, and in the end I was compacted and fetal, depleted by this thing that was crushing me...Its tendrils threatened to pulverize my mind and my courage and my stomach, and crack my bones and desiccate my body. It went on glutting itself on me when there seemed nothing left to feed it''.

"I lay very still and thought about speaking, trying to figure out how to do it. I moved my tongue but there were no sounds. I had forgotten how to talk. Then I began to cry, but there were no tears, only a heaving incoherence. I was on my back. I wanted to turn over, but I couldn’t remember how to do that either. I tried to think about it, but the task seemed colossal. I thought that perhaps I’d had a stroke".

"Being anxious at this extreme level is bizarre. You feel all the time that you want to do something, that there is some affect that is unavailable to you, that there’s a physical need of impossible urgency and discomfort for which there is no relief, as though you were constantly vomiting from your stomach but had no mouth. With the depression, your vision narrows and begins to close down; it is like trying to watch TV through terrible static, where you can sort of see the picture but not really; where you cannot ever see people’s faces, except almost if there is a close-up; where nothing has edges...Becoming depressed is like going blind, the darkness at first gradual, then encompassing; it is like going deaf, hearing less and less until a terrible silence is all around you, until you cannot make any sound of your own to penetrate the quiet".

 

"...only half of Americans who have had major depression have ever sought help of any kind—even from a clergyman or a counselor. About 95 percent of that 50 percent go to primary-care physicians, who often don’t know much about psychiatric complaints. An American adult with depression would have his illness recognized only about 40 percent of the time...Less than half of those whose illness is recognized will get appropriate treatment. More than half of those who do seek help—another 25 percent of the depressed population—receive no treatment. About half of those who do receive treatment—13 percent or so of the depressed population—receive unsuitable treatment, some 6 percent of the depressed population—receive inadequate dosage for an inadequate length of time. So that leaves about 6 percent of the total depressed population who are getting adequate treatment. But many of these ultimately go off their medications, usually because of side effects. “It’s between 1 and 2 percent who get really optimal treatment,” says John Greden, director of the Mental Health Research Institute at the University of Michigan.''

"The truly depressed...had always been largely invisible because their very disease causes them to sever human contacts and allegiances...Those who are not themselves afflicted with the complaint dislike seeing it because the sight fills them with insecurity and provokes anxiety". Society rejects those who are afflicted "...as it had always done insofar as it could".

 

 

"...most of the poor depressed fit several profiles for initial onset of depression. Their economic hardship is only the beginning of their problems. They are often in bad relationships with parents, children, boyfriends, girlfriends, husbands, or wives. They are not well educated. They do not have easy distractions from their sorrow or suffering, such as satisfying jobs or interesting travel. They do not have the fundamental expectation of good feelings. In our rage to medicalize depression, we have tended to suggest that “real” depression occurs without reference to external materiality. This is simply not true''

"Depression cuts across class boundaries, but depression treatments do not. This means that most people who are poor and depressed stay poor and depressed; in fact, the longer they stay poor and depressed, the more poor and depressed they become. Poverty is depressing and depression is impoverishing, leading as it does to dysfunction and isolation. Poverty’s humility is a passive relationship to fate, a condition that in people of greater ostensible empowerment would require immediate treatment. The poor depressed perceive themselves to be supremely helpless, so helpless that they neither seek nor embrace support. The rest of the world dissociates from the poor depressed, and they dissociate themselves: they lose that most human quality of free will. When depression hits someone in the middle classes, it’s relatively easy to recognize. You’re going about your essentially okay life and suddenly you begin feeling bad all the time. You can’t function at a high level; you don’t have the will to get to work; you have no sense of control over your life; it seems to you that you will never accomplish anything and that experience itself is without meaning. As you become increasingly withdrawn, as you approach catatonia, you begin to attract the notice of friends and coworkers and family, who cannot understand why you are giving up on so much of what has always given you pleasure. Your depression is inconsistent with your private reality and inexplicable in your public reality.

If you’re way down at the bottom of the social ladder, however, the signs may be less immediately visible. For the miserable and oppressed poor, life has always been lousy and they’ve never felt great about it; they’ve never been able to get or hold a decent job; they’ve never expected to accomplish anything much; and they’ve certainly never entertained the idea that they have control over what happens to them. The normal condition of such people has a great deal in common with depression, and so there’s an attribution problem with their symptoms. What is symptomatic? What is rational and not symptomatic? There is a vast difference between simply having a difficult life and having a mood disorder, and though it is common to assume that depression is the natural result of such a life, the reality is frequently just the other way around. Afflicted by disabling depression, you fail to make anything of your life and remain stranded at the lowest echelon, overwhelmed by the very thought of helping yourself.''

 

"We have gone from a monolithic and malign mental health system for the depressed to a shattered, limited one...For Stanley, deinstitutionalization was the unfortunate result of civil libertarians’ defending the “wrong” people while the government went wild about cutting costs. Deinstitutionalization was supposed to translate into a diverse range of care in the community, but nothing of the sort has occurred. The consequence of deinstitutionalization has been the disappearance of a multitiered system of treatment in which people are gently shoehorned back into their communities: far too often, patients are in for total incarceration or they’re out on their own".

 

''I am persuaded that some of the broadest figures for depression are based in reality. Though it is a mistake to confuse numbers with truth, these figures tell an alarming story. According to recent research, about 3 percent of Americans—some 19 million—suffer from chronic depression. More than 2 million of those are children. Manic-depressive illness, often called bipolar illness because the mood of its victims varies from mania to depression, afflicts about 2.3 million and is the second-leading killer of young women, the third of young men. Depression as described in DSM-IV is the leading cause of disability in the United States and abroad for persons over the age of five. Worldwide, including the developing world, depression accounts for more of the disease burden, as calculated by premature death plus healthy life-years lost to disability, than anything else but heart disease. Depression claims more years than war, cancer, and AIDS put together. Other illnesses, from alcoholism to heart disease, mask depression when it causes them; if one takes that into consideration, depression may be the biggest killer on earth''.

 

 "At some point, a point we have not quite reached but will, I think, reach soon, the level of damage will begin to be more terrible than the advances we buy with that damage''.

 

"We need to be terrified by the statistics. What is to be done?...Few of us want to, or can, give up modernity of thought any more than we want to give up modernity of material existence. But we must start doing small things now to lower the level of socio-emotional pollution. We must look for faith (in anything: God or the self or other people or politics or beauty or just about anything else) and structure''.

"I believe that words are strong, that they can overwhelm what we fear when fear seems more awful than life is good. I have turned, with an increasingly fine attention, to love...by themselves pills are a weak poison, love a blunt knife, insight a rope that snaps under too much strain. With the lot of them, if you are lucky, you can save the tree from the vine''.

"We must not only avail ourselves of the immediate solutions to our current problems, but also seek to contain those problems and to avoid their purloining all our minds. The climbing rates of depression are without question the consequence of modernity. The pace of life, the technological chaos of it, the alienation of people from one another, the breakdown of traditional family structures, the loneliness that is endemic, the failure of systems of belief (religious, moral, political, social—anything that seemed once to give meaning and direction to life) have been catastrophic''.

 

The Unabomber—whose techniques of communicating his Luddite sensibilities were disastrous but whose insights into the perils of technology are sound—wrote in his manifesto, “Imagine a society that subjects people to conditions that make them terribly unhappy, then gives them the drugs to take away their unhappiness. Science fiction? It is already happening...In effect, antidepressants are a means of modifying an individual’s internal state in such a way as to enable him to tolerate social conditions that he would otherwise find intolerable.”

 

"It would be better for the environment if everyone stopped using cars, but that’s not going to happen unless there’s a tidal wave of utter crisis. Frankly, I think there will be men living on the moon before there will be a society free of automotive transport...There will be no revolution, but there will be the advent, perhaps, of different kinds of schools, different models of family and community, different processes of information. If we are to continue on earth, we will have to do so. We will balance treating illness with changing the circumstances that cause it...we will, I hope, save this earth’s rain forests, the ozone layer, the rivers and streams, the oceans; and we will also save, I hope, the minds and hearts of the people who live here''.

Andrew Solomon