From The New York Times, a powerful piece by Will Lippincott who writes, “When depressed, the self-esteem I presented to the world belied just how out of control I felt inside.” Read the News
No Longer Wanting to Die
7 Thoughts From a Chronically Unhappy Person
From The New York Times, Diana Spechler writes, “My depression habits include avoiding pain and courting diversion. During every bout of depression, I grasp – at yoga, therapy, medication, romance – and hope that my tiny firefly of pleasure won’t wriggle from the cup of my palms.” Read the News
Depressed, but Not Ashamed
From The New York Times, a brave and inspiring article written by two high school girls who decided to devote an edition of their school’s newpaper to stories about classmates who struggle with depression. Read the News
To Know Suicide: Depression Can Be Treated, But It Takes Competence
From The New York Times, best-selling author and psychiatrist, Kay Redfield Jamison writes, “Certainly, stress is important and often interacts dangerously with depression. But the most important risk factor for suicide is mental illness, especially depression or bipolar disorder.” Read the News
The War In My Father’s Head
What a cruel thing is war; to separate and destroy families and friends, and mar the purest joys and happiness God has granted us in this world; to fill our hearts with hatred instead of love for our neighbors and to devastate the fair face of the earth. – Confederate General Robert E. Lee
Depression has many roots. Several of them anchored in the deep soil of our past.
I dug down into that ground last week. It was the 70th anniversary of D-Day; America’s landing in Normandy and entry into World War II. Watching all the television tributes to these now old and fading veterans, I thought of my dad.
The Great War
My father enlisted in the Navy in 1944. He was 18 years old. He fought on a destroyer ship in the Pacific theater. He saw many of his young buddies meet horrible deaths.
The war not only took a devastating psychological toll on him, but also his family in the years that were to unfold. In a very real sense, my mom, my siblings and I were also casualties of that war that never ceased in my dad’s head.
While he died in 1981, he’s still on my mind some 33 years later. I’ve gone from a young man to middle-aged, from a teenager in college to a lawyer about to mark my twenty-fifth year in the profession. I can’t help but look back at him and our time together as father and son. To the man he was and the man I’ve become.
Looking Back
I read a New York Times’ review of a book out about J.D. Salinger, author of The Catcher in the Rye. The article noted that Salinger, who served in the infantry during WWII in Europe, witnessed a lot of death and mayhem and struggled with depression his whole life:
“Salinger’s experiences during WWII heightened his sense of alienation. The war left him with deep psychological scars, branding ‘every aspect’ of his personality and reverberating through his writings. Salinger had suffered from depression for years, perhaps throughout his entire life, and was at times afflicted by episodes so intense that he could not relate to others.”
Like Salinger, my father came back from the war a broken man. He, too, would also have trouble relating to others. He had frequent nightmares. As children, we heard his screams behind our parent’s bedroom door. When he wasn’t raging, he was usually drunk. When he wasn’t angry and violent, he was depressed.
Dad survived his years of PTSD by drinking. Cheap beer and bottom shelf whiskey. He became a hard-core alcoholic. It gave him a brief respite from the demons shouting in his head. A sort of dying to a day of struggle in the hope that he would wake up the next day and all his pain would be gone.
Writer and hard-core drinker Charles Bukowski wrote about this type of dying,
“Drinking is an emotional thing. It joggles you out of the standardism of everyday life, out of everything being the same. It yanks you out of your body and your mind and throws you against the wall. I have the feeling that drinking is a form of suicide where you’re allowed to return to life and begin all over the next day. It’s like killing yourself, and then you’re reborn. I guess I’ve lived about ten or fifteen thousand lives now.”
A Final “I’m Sorry”
Dad ultimately died from too much drinking. Smoking three packs of Camel unfiltered cigarettes a day couldn’t have helped either. I was 19 when they diagnosed him with cancer. He would spend the last six weeks of his life in the hospital. He seemed unrepentant, never saying he was sorry for anything. Maybe he thought he didn’t deserve forgiveness. Or, maybe it was too frightening to think what our reaction would be.
But I remember one night that I went to visit him in the hospital towards the end. There wasn’t anyone else in the room. It was dim, but the lights near the nurses’ station cast enough light to see in the ill-defined shadows. Dad was awake when I got there. I pulled up a chair and sat next to his bed. I kissed his sweaty brow, but avoided looking into his eyes.
“Dad, just rest,” I said. He gave a weary nod. A little more time passed. It was quiet except for periodic announcements over the P.A. system. I was sure he was asleep.
Then, quite unexpectedly, I felt his hand stroking my back as I hunched over in my chair. I immediately knew it was his way of connecting beyond the words he couldn’t bring himself to say: “I love you and I’m sorry for everything.”
My favorite poet, Mary Oliver, remembers her long-deceased father in this moving poem:
My father, for example,
who was young once
and blue-eyed,
returns
on the darkest of nights
to the porch and knocks
wildly at the door,
and if I answer
I must be prepared
for his waxy face,
for his lower lip
swollen with bitterness.
And so, for a long time,
I did not answer,
but slept fitfully
between his hours of rapping.
But finally there came the night
when I rose out of my sheets
and stumbled down the hall.
The door fell open
and I knew I was saved
and could bear him,
pathetic and hollow,
with even the least of his dreams
frozen inside him,
and the meanness gone.
And I greeted him and asked him
into the house,
and lit the lamp,
and looked into his blank eyes
in which at last
I saw what a child must love,
I saw what love might have done
had we loved in time.
Why You Hate Work
The New York Times reports, “The Way we’re working isn’t working. By the time you get home, you’re pretty much running on empty, and yet still answering emails until you fall asleep. Read the News
Why Is There More Depression in the World?
The unmistakable rise in depression across the globe is unsettling. What explains the it? Read the Blog
Depressed, But Not Ashamed
From The New York Times, a brave article by high school students Madeline Halpert and Eva Rosenfeld. Read the News
The Depression Machine: Why Too Much Stress Cranks It Up
I listened to a NPR segment this week about the connection between playing football in the NFL and brain trauma.
One retired running back said that each collision he suffered during a game “was like being in a car accident.” What a tremendous cost to pay, I thought.
For many of us, daily life is so demanding and stressful, that, like a football player, it’s like being in a series of car accidents. The word “stress” doesn’t even seem to do justice the corrosive experience of so much stress– “trauma” is more like it.
The trauma isn’t the type inflicted by bone jarring hits during a football game — it’s psychological, though no less real.
In his book, The Everyday Trauma of Life, psychiatrist Mark Epstein writes in a recent New York Times article,
“Trauma is not just the result of major disasters. It does not happen to only some people. An undercurrent of trauma runs through ordinary life, shot through as it is with the poignancy of impermanence. I like to say that if we are not suffering from post-traumatic stress disorder, we are suffering from pre-traumatic stress disorder. There is no way to be alive without being conscious of the potential for disaster. One way or another, death (and its cousins: old age, illness, accidents, separation and loss) hangs over all of us. Nobody is immune. Our world is unstable and unpredictable, and operates, to a great degree and despite incredible scientific advancement, outside our ability to control it.”
Such trauma not only impacts our psychological/emotional and spiritual selves, but our physical brains.
In a brilliant article in The Wall Street Journal this week entitled, “Stress Starts Up The Machinery of Major Depression”, Robert Sapolsky, Ph.D., points out that there are many factors that increase our risk of major depression including genes, childhood trauma, and endocrine and immunological abnormalities.
But a frequent trigger is stress.
Sapolsky writes, “The stress angle concerns ‘adhedonia,’ psychiatric jargon for ‘the inability to feel pleasure.’ Adhedonia is at the core of the classic definition of major depression as ‘malignant sadness’”.
As a person who has a genetic history of depression in his family and childhood trauma, I was drawn into Sapolsky’s article. What was the connection between stress and the malignant sadness I’ve experienced off and on since being diagnosed with depression twelve years ago?
Who would have thought that rat brain research would help me understand the link?
Sapolsky gives us a little background about our brain structure by letting us know that our abilities to anticipate, pursue and feel pleasure revolve around a neurotransmitter called dopamine in a region of the brain called the nucleus accumbens. Then he turns to the rats for further illumination:
“Put a novel object – say, a ball – in a mouse’s cage. When the mouse encounters the ball and explores it, the arousing mystery, puzzle and challenge cause the release of a molecule in the nucleus accumbens called CRF, which boost dopamine release. If an unexpected novel object was a cat, that mouse’s brain would work vey differently. But getting the optimal amount of challenge, what we’d call ‘stimulation,’ feels good.”
We humans need just enough challenge and stress to make life interesting.
“CRF mediates this reaction: Block the molecule’s actions with a drug, and you eliminate the dopamine surge and the exploration,” writes Sapolsky. “But exposing a mouse to major, sustained stress for a few days changes everything. CRF no longer enhances dopamine release, and the mouse avoids the novel object. Moreover, the CRF is now aversive: Spritz it into the nucleus accumbens, and the mouse now avoids the place in the cage where that happened. The researchers showed that this is due to the effects of stress hormones called glucocorticoids. A switch has been flipped; stimuli that would normally evoke motivated exploration and a sense of reward now evoke the opposite. Strikingly, those few days of stress caused that anhedonic state to last in those mice for at least three months.”
Sapolsky concludes:
“But meanwhile, these findings have an important implication. Life throws lousy things at us; at times, we all get depressed, with a small letter “d.” And most people—as the clichés say—get back in the saddle; prove that when the going gets tough, the tough get going. What then to make of people who are incapacitated by major depression in the clinical sense? Unfortunately, for many, an easy explanation is that the illness is a problem of insufficient gumption: ‘Come on, pull yourself together.’ There is a vague moral taint.”
The trauma of everyday stress is an important player in major depression. When combined with genetic history and a difficult childhood, it can tip the applecart and result in what Andrew Solomon calls “The Noonday Demon”. The takeaway is that the better we get at managing the “trauma of everyday life”, the better chance we have at preventing depression.
My worry is that the society we’ve created and the hectic lives we lead make the management of stress very difficult, indeed.
Is the World More Depressed?
The New York Times reports that suicide rates have increased 60 percent over the past 50 years, most strikingly in the developing world, and that by 2020 depression will be the second most prevalent medical condition in the world. Read the News
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