"i felt a funeral, in my brain, and mourners to and fro kept treading -- treading --till [it seemed] that sense was breaking through -- and when they all were seated,
sex education volunteer nyc, a service, like a drum -- kept beating -- beating --till i [thought] my mind was going numb -- and then i heard them lift a boxand creak across my soul
with those same boots of lead, again, then space -- began to toll, as [all] the heavens were a bell,and being, [but] an ear, and i, and silence, some strange race, wrecked, solitary, here -- [and] then a plank in reason, broke, and i fell down and down -- and hit a world, at every plunge, and finished knowing -- then --"
we know depression through metaphors. emily dickinson was ableto convey it in language, goya in an image. half the purpose of artis to describe such iconic states. as for me, i had alwaysthought myself tough, one of the people who could survive if i'd been sent to a concentration camp. in 1991, i had a series of losses. my mother died,
a relationship i'd been in ended, i moved back to the united statesfrom some years abroad, and i got through all of thoseexperiences intact. but in 1994, three years later, i found myself losing interestin almost everything. i didn't want to do any of the thingsi had previously wanted to do, and i didn't know why. the opposite of depressionis not happiness, but vitality. and it was vitality
that seemed to seep awayfrom me in that moment. everything there was to doseemed like too much work. i would come home and i would see the red lightflashing on my answering machine, and instead of being thrilledto hear from my friends, i would think, "what a lot of people that isto have to call back." or i would decide i should have lunch, and then i would think,but i'd have to get the food out
and put it on a plate and cut it up and chew it and swallow it, and it felt to melike the stations of the cross. and one of the things that often gets lostin discussions of depression is that you know it's ridiculous. you know it's ridiculouswhile you're experiencing it. you know that most people manage to listen to their messages and eat lunch and organize themselves to take a shower
and go out the front door and that it's not a big deal, and yet you are nonetheless in its grip and you are unable to figure outany way around it. and so i began to feel myself doing less and thinking less and feeling less. it was a kind of nullity. and then the anxiety set in.
if you told me that i'd have to bedepressed for the next month, i would say, "as long i know it'll be overin november, i can do it." but if you said to me, "you have to have acute anxietyfor the next month," i would rather slit my wristthan go through it. it was the feeling all the time like that feeling you haveif you're walking and you slip or tripand the ground is rushing up at you, but instead of lasting half a second,the way that does,
it lasted for six months. it's a sensationof being afraid all the time but not even knowingwhat it is that you're afraid of. and it was at that pointthat i began to think that it was just too painful to be alive, and that the only reasonnot to kill oneself was so as not to hurt other people. and finally one day, i woke up and i thought perhaps i'd had a stroke,
because i lay in bed completely frozen, looking at the telephone, thinking, "something is wrongand i should call for help," and i couldn't reach out my arm and pick up the phone and dial. and finally, after four full hoursof my lying and staring at it, the phone rang, and somehow i managed to pick it up, and it was my father, and i said,
"i'm in serious trouble.we need to do something." the next day i startedwith the medications and the therapy. and i also started reckoningwith this terrible question: if i'm not the tough person who could have made itthrough a concentration camp, then who am i? and if i have to take medication, is that medication making memore fully myself, or is it making me someone else?
and how do i feel about itif it's making me someone else? i had two advantagesas i went into the fight. the first is that i knew that,objectively speaking, i had a nice life, and that if i could only get well, there was something at the other endthat was worth living for. and the other wasthat i had access to good treatment. but i nonetheless emerged and relapsed, and emerged and relapsed,
and finally understood i would have to be on medicationand in therapy forever. and i thought, "but is it a chemical problemor a psychological problem? and does it need a chemical cureor a philosophical cure?" and i couldn't figure out which it was. and then i understood that actually, we aren't advanced enough in either areafor it to explain things fully. the chemical cureand the psychological cure
both have a role to play, and i also figured outthat depression was something that was braided so deep into us that there was no separating itfrom our character and personality. i want to say that the treatments we havefor depression are appalling. they're not very effective. they're extremely costly. they come with innumerable side effects. they're a disaster.
but i am so grateful that i live nowand not 50 years ago, when there would have beenalmost nothing to be done. i hope that 50 years hence, people will hear about my treatments and be appalled that anyone enduredsuch primitive science. depression is the flaw in love. if you were marriedto someone and thought, "well, if my wife dies,i'll find another one," it wouldn't be love as we know it.
there's no such thing as lovewithout the anticipation of loss, and that specter of despaircan be the engine of intimacy. there are three thingspeople tend to confuse: depression, grief and sadness. grief is explicitly reactive. if you have a lossand you feel incredibly unhappy, and then, six months later, you are still deeply sad,but you're functioning a little better, it's probably grief,
and it will probably ultimatelyresolve itself in some measure. if you experience a catastrophic loss, and you feel terrible, and six months lateryou can barely function at all, then it's probably a depressionthat was triggered by the catastrophic circumstances. the trajectory tells us a great deal. people think of depressionas being just sadness. it's much, much too much sadness,
much too much grief at far too slight a cause. as i set out to understand depression, and to interview peoplewho had experienced it, i found that there were peoplewho seemed, on the surface, to have what sounded likerelatively mild depression who were nonethelessutterly disabled by it. and there were other peoplewho had what sounded as they described itlike terribly severe depression
who nonetheless had good lives in the intersticesbetween their depressive episodes. and i set out to find outwhat it is that causes some people to be more resilient than other people. what are the mechanismsthat allow people to survive? and i went out and i interviewedperson after person who was suffering with depression. one of the first people i interviewed described depressionas a slower way of being dead,
and that was a good thingfor me to hear early on because it reminded methat that slow way of being dead can lead to actual deadness, that this is a serious business. it's the leading disability worldwide, and people die of it every day. one of the people i talked towhen i was trying to understand this was a beloved friendwho i had known for many years, and who had had a psychotic episodein her freshman year of college,
and then plummetedinto a horrific depression. she had bipolar illness, or manic depression, as it was then known. and then she did very wellfor many years on lithium, and then eventually,she was taken off her lithium to see how she would do without it, and she had another psychosis, and then plunged into the worst depressionthat i had ever seen in which she satin her parents' apartment,
more or less catatonic,essentially without moving, day after day after day. and when i interviewed herabout that experience some years later -- she's a poet and psychotherapistnamed maggie robbins -- when i interviewed her, she said, "i was singing 'where haveall the flowers gone,' over and over, to occupy my mind. i was singing to blot outthe things my mind was saying, which were, 'you are nothing.you are nobody.
you don't even deserve to live.' and that waswhen i really started thinking about killing myself." you don't think in depressionthat you've put on a gray veil and are seeing the worldthrough the haze of a bad mood. you think that the veilhas been taken away, the veil of happiness, and that now you're seeing truly. it's easier to helpschizophrenics who perceive
that there's something foreigninside of them that needs to be exorcised, but it's difficult with depressives, because we believewe are seeing the truth. but the truth lies. i became obsessed with that sentence: "but the truth lies." and i discovered,as i talked to depressive people, that they havemany delusional perceptions. people will say, "no one loves me."
and you say, "i love you, your wife loves you,your mother loves you." you can answer that one pretty readily,at least for most people. but people who are depressedwill also say, "no matter what we do,we're all just going to die in the end." or they'll say,"there can be no true communion between two human beings. each of us is trapped in his own body." to which you have to say,
"that's true, but i think we should focus right nowon what to have for breakfast." (laughter) a lot of the time, what they are expressingis not illness, but insight, and one comes to thinkwhat's really extraordinary is that most of us knowabout those existential questions and they don't distract us very much. there was a study i particularly liked
in which a group of depressedand a group of non-depressed people were asked to play a videogame for an hour, and at the end of the hour, they were asked how many little monstersthey thought they had killed. the depressive group was usually accurateto within about 10 percent, and the non-depressed people guessed between 15 and 20 timesas many little monsters -- as they had actually killed. a lot of people said, when i choseto write about my depression,
that it must be very difficultto be out of that closet, to have people know. they said, "do peopletalk to you differently?" i said, "yes, peopletalk to me differently. they talk to me differently insofar as they start telling meabout their experience, or their sister's experience, or their friend's experience. things are different because now i know
that depression is the family secretthat everyone has. i went a few years ago to a conference, and on friday of the three-day conference, one of the participantstook me aside, and she said, "i suffer from depressionand i'm a little embarrassed about it, but i've been taking this medication, and i just wanted to ask youwhat you think?" and so i did my best to give hersuch advice as i could. and then she said, "you know,my husband would never understand this.
he's really the kind of guy to whomthis wouldn't make any sense, so, you know, it's just between us." and i said, "yes, that's fine." on sunday of the same conference, her husband took me aside, and he said, "my wife wouldn't think that i was really muchof a guy if she knew this, but i've been dealing with this depressionand i'm taking some medication, and i wondered what you think?"
they were hiding the same medication in two different placesin the same bedroom. and i said that i thoughtcommunication within the marriage might be triggeringsome of their problems. but i was also struck by the burdensome natureof such mutual secrecy. depression is so exhausting. it takes up so muchof your time and energy, and silence about it,
it really does make the depression worse. and then i began thinking about all the wayspeople make themselves better. i'd started off as a medical conservative. i thought there were a fewkinds of therapy that worked, it was clear what they were -- there was medication, there were certain psychotherapies, there was possiblyelectroconvulsive treatment,
and that everything else was nonsense. but then i discovered something. if you have brain cancer, and you say that standing on your headfor 20 minutes every morning makes you feel better, it may make you feel better,but you still have brain cancer, and you'll still probably die from it. but if you say that you have depression, and standing on your headfor 20 minutes every day
makes you feel better, then it's worked, because depressionis an illness of how you feel, and if you feel better, then you are effectivelynot depressed anymore. so i became much more tolerant of the vast worldof alternative treatments. and i get letters,i get hundreds of letters from people writing to tell meabout what's worked for them. someone was asking mebackstage today about meditation.
my favorite of the letters that i gotwas the one that came from a woman who wrote and saidthat she had tried therapy, medication, she had tried pretty much everything, and she had found a solutionand hoped i would tell the world, and that was makinglittle things from yarn. she sent me some of them. and i'm not wearing them right now. i suggested to herthat she also should look up obsessive compulsive disorder in the dsm.
and yet, when i went to lookat alternative treatments, i also gained perspectiveon other treatments. i went througha tribal exorcism in senegal that involved a great deal of ram's blood and that i'm not goingto detail right now, but a few years afterwardsi was in rwanda, working on a different project, and i happened to describemy experience to someone, and he said,
"well, that's west africa,and we're in east africa, and our rituals arein some ways very different, but we do have some rituals that have something in commonwith what you're describing." and he said, "but we've had a lot of troublewith western mental health workers, especially the ones who cameright after the genocide." i said, "what kindof trouble did you have?" and he said, "well,they would do this bizarre thing.
they didn't take people outin the sunshine where you begin to feel better. they didn't include drummingor music to get people's blood going. they didn't involve the whole community. they didn't externalizethe depression as an invasive spirit. instead what they did was they took peopleone at a time into dingy little rooms and had them talk for an hour about bad thingsthat had happened to them." (applause)
he said, "we had to ask themto leave the country." now at the other endof alternative treatments, let me tell you about frank russakoff. frank russakoff had the worst depressionperhaps that i've ever seen in a man. he was constantly depressed. he was, when i met him, at a point at which every month,he would have electroshock treatment. then he would feelsort of disoriented for a week. then he would feel okay for a week.
then he would have a weekof going downhill. and then he would have anotherelectroshock treatment. and he said to me when i met him, "it's unbearable to gothrough my weeks this way. i can't go on this way, and i've figured outhow i'm going to end it if i don't get better." "but," he said to me,"i heard about a protocol at mass general for a procedure called a cingulotomy,which is a brain surgery,
and i think i'm going to give that a try." and i remember being amazedat that point to think that someone who clearly had so many bad experiences with so many different treatments still had buried in him,somewhere, enough optimism to reach out for one more. and he had the cingulotomy,and it was incredibly successful. he's now a friend of mine. he has a lovely wifeand two beautiful children.
he wrote me a letterthe christmas after the surgery, "my father sent me two presents this year, first, a motorized cd rackfrom the sharper image that i didn't really need, but i knew he was giving itto me to celebrate the fact that i'm living on my ownand have a job i seem to love. and the other presentwas a photo of my grandmother, who committed suicide. as i unwrapped it, i began to cry,
and my mother came over and said, 'are you crying becauseof the relatives you never knew?' and i said, 'she hadthe same disease i have.' i'm crying now as i write to you. it's not that i'm so sad,but i get overwhelmed, i think, because i couldhave killed myself, but my parents kept me going,and so did the doctors, and i had the surgery. i'm alive and grateful.
we live in the right time,even if it doesn't always feel like it." i was struck by the fact that depression is broadly perceived to bea modern, western, middle-class thing, and i went to look at how it operatedin a variety of other contexts, and one of the thingsi was most interested in was depression among the indigent. and so i went out to try to look at what was being donefor poor people with depression. and what i discovered is that poor people
are mostly not beingtreated for depression. depression is the resultof a genetic vulnerability, which is presumablyevenly distributed in the population, and triggering circumstances, which are likely to be more severefor people who are impoverished. and yet it turns out that if you havea really lovely life but feel miserable all the time, you think, "why do i feel like this? i must have depression."
and you set out to find treatment for it. but if you have a perfectly awful life, and you feel miserable all the time, the way you feelis commensurate with your life, and it doesn't occur to you to think, "maybe this is treatable." and so we have an epidemic in this country of depression among impoverished people that's not being picked upand that's not being treated
and that's not being addressed, and it's a tragedy of a grand order. and so i found an academic who was doing a research projectin slums outside of d.c., where she picked up womenwho had come in for other health problems and diagnosed them with depression, and then provided six monthsof the experimental protocol. one of them, lolly, came in, and this is what she saidthe day she came in.
she said, and she was a woman,by the way, who had seven children. she said, "i used to have a jobbut i had to give it up because i couldn't go out of the house. i have nothing to say to my children. in the morning,i can't wait for them to leave, and then i climb in bedand pull the covers over my head, and three o'clock when they come home, it just comes so fast." she said, "i've been takinga lot of tylenol,
anything i can takeso that i can sleep more. my husband has been telling mei'm stupid, i'm ugly. i wish i could stop the pain." well, she was broughtinto this experimental protocol, and when i interviewed hersix months later, she had taken a job working in childcare for the u.s. navy,she had left the abusive husband, and she said to me, "my kids are so much happier now."
she said, "there's one roomin my new place for the boys and one room for the girls, but at night, they're justall up on my bed, and we're doing homeworkall together and everything. one of them wants to be a preacher, one of them wants to be a firefighter, and one of the girls saysshe's going to be a lawyer. they don't cry like they used to, and they don't fight like they did.
that's all i need now, is my kids. things keep on changing, the way i dress,the way i feel, the way i act. i can go outside not being afraid anymore, and i don't thinkthose bad feelings are coming back, and if it weren'tfor dr. miranda and that, i would still be at homewith the covers pulled over my head, if i were still alive at all. i asked the lord to send me an angel,
and he heard my prayers." i was really moved by these experiences, and i decided that i wantedto write about them not only in a book i was working on,but also in an article, and i got a commissionfrom the new york times magazine to write about depressionamong the indigent. and i turned in my story, and my editor called me and said,"we really can't publish this." and i said, "why not?"
and she said, "it just is too far-fetched. these people who are sort ofat the very bottom rung of society and then they geta few months of treatment and they're virtually readyto run morgan stanley? it's just too implausible." she said, "i've never even heardof anything like it." and i said, "the factthat you've never heard of it is an indication that it is news." "and you are a news magazine."
so after a certain amount of negotiation,they agreed to it. but i think a lot of what they saidwas connected in some strange way to this distaste that people still havefor the idea of treatment, the notion that somehow if we went out and treated a lot of peoplein indigent communities, that would be exploitative, because we would be changing them. there is this false moral imperativethat seems to be all around us, that treatment of depression,
the medications and so on,are an artifice, and that it's not natural. and i think that's very misguided. it would be naturalfor people's teeth to fall out, but there is nobody militatingagainst toothpaste, at least not in my circles. people then say, "but isn't depression part of what peopleare supposed to experience? didn't we evolve to have depression?
isn't it part of your personality?" to which i would say, mood is adaptive. being able to have sadness and fear and joy and pleasure and all of the other moods that we have,that's incredibly valuable. and major depression is something that happenswhen that system gets broken. it's maladaptive. people will come to me and say,
"i think, though, if i juststick it out for another year, i think i can just get through this." and i always say to them,"you may get through it, but you'll never be 37 again. life is short, and that's a whole yearyou're talking about giving up. think it through." it's a strange povertyof the english language, and indeed of many other languages, that we use this same word, depression,
to describe how a kid feelswhen it rains on his birthday, and to describe how somebody feelsthe minute before they commit suicide. people say to me, "well, is itcontinuous with normal sadness?" and i say, in a way it's continuouswith normal sadness. there is a certain amount of continuity, but it's the same way there's continuity between having an iron fenceoutside your house that gets a little rust spot that you have to sand offand do a little repainting,
and what happens if you leavethe house for 100 years and it rusts throughuntil it's only a pile of orange dust. and it's that orange dust spot, that orange dust problem, that's the onewe're setting out to address. so now people say, "you take these happy pills,and do you feel happy?" and i don't. but i don't feel sadabout having to eat lunch,
and i don't feel sadabout my answering machine, and i don't feel sadabout taking a shower. i feel more, in fact, i think, because i can feelsadness without nullity. i feel sad about professionaldisappointments, about damaged relationships, about global warming. those are the thingsthat i feel sad about now. and i said to myself, well,what is the conclusion?
how did those people who have better lives even with bigger depressionmanage to get through? what is the mechanism of resilience? and what i came up with over time was that the peoplewho deny their experience, and say, "i was depressed a long time ago, i never want to think about it again, i'm not going to look at it and i'm just goingto get on with my life,"
ironically, those are the peoplewho are most enslaved by what they have. shutting out the depressionstrengthens it. while you hide from it, it grows. and the people who do better are the ones who are able to toleratethe fact that they have this condition. those who can tolerate their depressionare the ones who achieve resilience. so frank russakoff said to me, "if i had a do-over,i suppose i wouldn't do it this way, but in a strange way,i'm grateful for what i've experienced.
i'm glad to have beenin the hospital 40 times. it taught me so much about love, and my relationshipwith my parents and my doctors has been so precious to me,and will be always." and maggie robbins said, "i used to volunteer in an aids clinic, and i would just talk and talk and talk, and the people i was dealing withweren't very responsive, and i thought, 'that's not very friendlyor helpful of them.'"
"and then i realized, i realized thatthey weren't going to do more than make those firstfew minutes of small talk. it was simply going to be an occasion where i didn't have aidsand i wasn't dying, but could tolerate the fact that they did and they were. our needs are our greatest assets. it turns out i've learned to giveall the things i need."
valuing one's depressiondoes not prevent a relapse, but it may make the prospect of relapse and even relapse itselfeasier to tolerate. the question is not so muchof finding great meaning and deciding your depressionhas been very meaningful. it's of seeking that meaningand thinking, when it comes again, "this will be hellish,but i will learn something from it." i have learned in my own depression how big an emotion can be,
how it can be more real than facts, and i have found that that experience has allowed me to experiencepositive emotion in a more intense and more focused way. the opposite of depressionis not happiness, but vitality, and these days, my life is vital, even on the days when i'm sad. i felt that funeral in my brain,
and i sat next to the colossusat the edge of the world, and i have discoveredsomething inside of myself that i would have to call a soul that i had never formulateduntil that day 20 years ago when hell came to pay me a surprise visit. i think that while i hated being depressed and would hate to be depressed again, i've found a way to love my depression. i love it because it has forced meto find and cling to joy.
i love it because each day i decide, sometimes gamely, and sometimes against the moment's reason, to cleave to the reasons for living. and that, i think,is a highly privileged rapture. thank you.