Depression: Looking Up from the Stubborn Darkness (2 page)

Depression ... involves a complete absence: absence of affect, absence of feeling, absence of response, absence of interest. The pain you feel in the course of a major clinical depression is an attempt on nature’s part ... to fill up the empty space. But for all intents and purposes, the deeply depressed are just the walking, waking dead.
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The mental pain seems unbearable. Time stands still. “I can’t go on,” said a twelve-year-old girl. “I could weep by the hour like a child, and yet I knew not what I wept for,” recounted Spurgeon of one of his many episodes.
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“A veritable howling tempest in the brain.”
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“Malignant sadness.”
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“My bones wasted away through my groaning all day long.”
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“The unhappiness was like dust that infiltrated everything.” “I am now a man of despair, rejected, abandoned, shut up in this iron cage from which there is no escape.”
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“The iron bolt ... mysteriously fastens the door of hope and holds our spirits in gloomy prison.”
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Profound melancholia is a day-in day-out, night-in night-out, almost arterial level of agony. It is a pitiless, unrelenting pain that affords no window of hope, no alternative to a grim and brackish existence, and no respite from the cold undercurrents of thought and feeling that dominate the horribly restless nights of despair.
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But it is not just pain. It feels like meaningless pain. “That is all I want in life: for this pain to seem purposeful.”
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If pain leads to childbirth, it is tolerable, but if it just leads to blackness or nothing, then it threatens to destroy.

Abraham Lincoln thought the pain would lead to death; the body couldn’t tolerate it.

I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on earth. Whether I shall ever be better, I cannot tell; I awfully forbode I shall not. To remain as I am is impossible. I must die or be better, it appears to me.
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What tortures many people is the fact that they
don’t
die. “Exhaustion combined with sleeplessness is a rare torture.” “The pain seeps into everything.” The thought that they might remain in this horrible state is too much to consider. “No one knows how badly I want to die.” But death has its own horrors. It feels like a vanishing point where they cease to exist at all. And what about the uncertainty of life after death? Is there annihilation? Will divine judgment crush and destroy? You are without peer in fearing the worst.

“There was no control on my mind—thoughts ravaged me, brutally harsh ideas, thoroughly crushed ideals, incomprehensible feelings.” The mind is stuck. How can people think about anything else when
it
is there? “I’m in a straitjacket.” “I’m completely bound and tied up—there is a gag in my mouth.” Without one’s normal mental resources, the world is frightening. Panic. Left unchecked, hallucinations and delusions can seize the imagination with such force that they are indistinguishable from reality itself. Self-reliance seems impossible. Infantile dependence is the only way to survive. Being alone is terrifying. Abandonment is a constant fear. “I fear everyone and everything.”

I tried to sleep but couldn’t. Part of it was that I was scared to wake up with a feeling of panic in the pit of my stomach. Anxiety was always present, and for no good reason it just got worse. I wanted to be out of the house, but I was scared to be alone. No matter what I did, I couldn’t concentrate except on questions such as “Am I going insane? What have I done to deserve this? What sort of punishment is this?”

You would think that if your circumstances were better, you would be too. But depression has a logic of its own. Once it settles in, it can’t distinguish between a loving embrace, the death of a close friend, and the news that a neighbor’s grass is growing.

Decisions? Impossible. The mind is locked. How can you choose? Nothing is working; the engine of your mind is barely turning over. And aren’t most decisions emotional preferences? How can you decode when you
have
no emotional preferences?

Certainty? The only certainty is that misery will persist. If certainty of any good thing ever existed—and you can’t remember when it did—it is replaced by constant doubt. You doubt that you are loved by anyone. You doubt your spouse’s intentions. You doubt your spouse’s fidelity. If you are a believer in Jesus Christ, you doubt the presence of Christ. You doubt the very foundation of your faith. “God have mercy on the man/Who doubts what he’s sure of.”
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The only thing you know is that you are guilty, shameful, and worthless. It is not that you have made mistakes in your life or sinned or reaped futility. It is that you
are
a mistake; you
are
sin; you
are
futility. “In this regard, depression can be a form of self-punishment, however subconsciously or involuntarily administered.”
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God has turned his back. Why bother going on in such a state? You might as well join God and turn your back on yourself too.

If forced to make distinctions, you might say that there are times that are worse than others, but who is able to measure different degrees of hell? Let’s just say that there can be a rhythm to it. Asleep at 11:00 p.m., up at 2:00 a.m. Anguish, fears, and a torrent of pain lay hold of you while you try to live through the morning. It settles into the normal deep sadness and paralysis until mid-afternoon and is followed by a steady drizzle of fear, pain, guilt, panic, deadness, and fatigue until evening. Sometimes you might even reach the peaks of general malaise. It is true: the body can’t take the pounding pain for too long. So you get some occasional breaks from the worst of it.

It can be quieter for some people. Instead of a bottomless abyss and howling in the brain, life is flat, gray, and cold. Nothing holds any interest. You are a barely walking zombie. Everything is drab, lifeless, and tired. Why work? Why get out of bed? Why do anything? Why commit suicide? Nothing seems to matter. You are afraid that if one of your children died, you
still
wouldn’t feel anything.

Yet pain does break through in this more lifeless, numb state. It comes especially when you remember that you were once alive. Was it another person? Another lifetime? No, it must have been you. You remember that you actually wanted to have a sexual relationship with your spouse. A book on the shelf once kept you up all night; you couldn’t put it down. That music would make you want to get up and dance. But you try to forget those times because the contrast between then and now is almost unbearable. You prefer numbness.

It feels like you are always sick. In past generations or places less psychologically minded, they describe it solely in physical terms. For example, in China they call it
shenjing shuairo,
an alleged physical problem characterized by dizziness, fatigue, and headaches. Your body doesn’t feel right. You are always tired. Doctors are consulted more than pastors or counselors.

In the early 1900s, a businessman reported these symptoms to his doctor.

It’s not just my body that’s tired but my brain. I constantly feel as though an iron vise were tightening on my cranium. My head feels empty. My mind won’t work. My ideas are confused and I can no longer concentrate. My memory is shot. When I read, I can’t remember at the bottom of the page what I’ve read at the top. ... As for my will, my energy is gone. I no longer know what I want, what I’m supposed to do. I doubt, I hesitate, I don’t dare make a decision. Moreover, I’ve no appetite and I sleep badly. I have no sexual desire.
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How could this be all in my mind?
he thinks.

You are waiting for a medical doctor to say that he made a mistake.

“The good news is that it’s not all in your mind after all. I apologize for the misdiagnosis. The bad news is that the cancer will kill you in about a week and a half.”

You are confident that everyone would be better off without you.

Is it any wonder that suicidal thoughts are always close?

These descriptions might not sound hopeful, but they demonstrate that many others have gone through similar experiences. You are not alone.

Also, many of these quotes are excerpts from larger stories of hope and change. They are by people who have gone through depression and are no longer deadened by it. They are telling what
was
rather than what
is.
Most of them even had the energy and clarity to write moving and helpful literature.

What words would you choose? How would you describe the indescribable?

While it is some encouragement to know that you are not alone and that others have experienced what you have, it is more helpful to know the cause and the cure.

Here is a suggestion: don’t commit yourself too quickly to one explanation. Granted, depression begs for an answer, and there are more than enough interpretations from which to choose. But think in terms of various
depressions
rather than depression. Though there is a common experience, there is not a common cause. You can probably nod your head with many of the descriptions of depression, but the way you stumbled upon depression—or were blindsided by it—is unique. Try to be patient. Pause a little longer before you commit to a story that makes sense out of what you are experiencing.

Jackie is forty-five now and has struggled with depression most of her life. She would agree: the experience of depression is shared; the causes are not. When she talks with another depressed person, they speak the same language and even use the same words for their experience, but they have very different stories. Also, she would say that she experiences different depressions. For example, one kind of depression has seasonal fluctuations to it. It feels like everything in her is barely moving. Another tends to be incited by old family tensions. It expresses itself in self-condemnation and hopelessness.

There can be mysteries and complexities in depression. Rather than becoming weary at the thought of more work ahead, join in with people like Jackie and be a student of this experience.

So far you are finding a language for depression. It is important to put your experience into speech. With this in mind, consider just a few more words. The words you have read so far are from those who have gone through depression. The next group of words are, from my perspective, much less gripping. They are the technical and professional descriptions of depression. Yet they are worth reading.

Think of depression not so much as “I have it” or “I don’t have it” but as a continuum of severity. On one end it is bothersome, at the other end debilitating. The less severe depression is technically called Dysthymic Disorder, the more severe, Major Depression. More popularly, the less severe is referred to as situational depression and the more severe as clinical depression (fig. 3.1).

Figure 3.1. Levels of Depression.

The caretaker of the technical language for depression is the American Psychiatric Association (APA) and its diagnostic manual, the
Diagnostic and Statistical Manual of Mental Disorders,
now in its fourth edition (DSM-IV). It has proposed that the building block for “Depressive Disorder” or “Bipolar Disorder” is what the DSM-IV refers to as a “major depressive episode.” It reads like this:

Five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful)

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or decrease or increase in appetite nearly every day

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others ...)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt ... nearly every day ...

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day ...

(9) recurrent thoughts of death ..., recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide ... . The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
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