Perhaps the most valuable result of all education is the ability to make yourself do the thing you have to do when it ought to be done, whether you like it or not; it is the first lesson that ought to be learned; and however early a man's training begins, it is probably the last lesson that he learns thoroughly.
The word depression is used to describe two distinct maladies. One use is to express disappointment: "They didn't return my phone calls. I'm depressed." "How depressing--the coffee machine is out of cafe ol." We also feel this mild kind of depression in the normal cycle of life's ups and downs.
The other use of the word depression is medical--it describes a physical illness caused by a biological (yes, usually genetic) imbalance in the body.
The simple solution for disappointment depression: Get up and get moving. Physically move. Do. Act. Get going.
Depression is often caused by a sense of not having accomplished enough. We question the usefulness of what we've achieved in the past, and doubt our ability to achieve anything useful in the future. Self-doubt robs us of our energy. We feel depressed.
We look at all we want to do. It seems overwhelming. We tell ourselves, "I can't do all this," and instantly fulfill our own prophecy by not even trying. The energy drops even more, and the depression deepens.
I was once thrown out of a mental hospital for depressing the other patients.
When we eventually feel we must do something, there seems to be so much left undone from our previous inertia that we become confused. The confusion leads to indecision. The indecision leads to, "Oh, what's the use," and more inaction, which leads to you guessed it.
At some point, the cycle must be broken by action. Do something -- anything --physical. If the house is a mess, pick up one thing -- any one thing -- and do something with it: put it away, throw it out, send it to your brother, donate it to charity, something, anything. Pick up one more thing. Continue. Eventually, you will have a clean house. Before "eventually," however, the depression will begin to lift.
Yes, disappointment depression is a Master Teacher. Its message is, "Get moving. The energy is here. Use it." When you start to move, the energy will meet your movement. But first, you must move.
Medical ("clinical") depression is not caused by disappointment or lack of action, but by a biological imbalance in the chemistry of the brain. This form of depression takes a bit more explaining--there are so many misconceptions about it. Here's my story.
Over an almost-thirty-year period, I had attended more personal growth workshops, visited more healers, meditated more hours, taken more vitamins, and not only read but written more self-help books than almost anyone I knew. Nevertheless, I was not happy. I wasn't even satisfied. I wasn't even simply bored.
I was miserable.
By mid-1993, I was ready to try anything--even psychiatry. I called Harold H. Bloomfield, M.D., one of my co-authors on How to Survive the Loss of a Love, told him I wanted to make a professional appointment, and met him at his office. We spoke for an hour. Finally, he said, "Peter, you've been suffering!"
Yeah. That's what I was doing--although I had never applied the word suffering to myself. His official diagnosis: depression.
Like many people, I had some serious misconceptions about depression. I didn't like depression. I didn't want depression. But then, I guess you don't get to pick your disease.
The tricks that work on others count for nothing in that very well-lit back alley where one keeps assignations with oneself: No winning smiles will do here, no prettily drawn lists of good intentions.
To my surprise, I learned that depression was a physical illness, a biochemical imbalance in the brain most likely caused by certain neurotransmitters (the fluid the brain uses to communicate with itself) being pumped away too soon. When there are too few of certain neurotransmitters, brain function becomes inharmonious, and the complex mental, emotional, and physical manifestations of depression result.
These manifestations can include a "down" feeling, fatigue, sleep disorders, physical aches and pains, eating irregularities, listening to Julio Iglesias, irritability, difficulty concentrating, feeling worthless, guilt, addictions (attempts to self-medicate the pain away), suicidal thoughts, and my favorite, anhedonia.
Anhedonia means "the inability to experience pleasure." The original title for Woody Allen's movie Annie Hall was Anne Hedonia--the perfect description of Woody Allen's character. It was also the description of my life. Although I had spikes of happiness, nothing gave me pleasure for any length of time. The concept of "just being" was entirely foreign to me. My intensive self-help seeking since 1965 had been my attempt to obtain the simple enjoyment of living that many people seemed to have naturally.
All my attempts had been unsuccessful--I had a physical illness that prevented even the best-built self-esteem structure from standing very long. In the book Harold and I later wrote, How to Heal Depression, the chapter explaining this phenomenon is entitled, "The Power of Positive Thinking Crashes and Burns in the Face of Depression." You can plant all the personal growth seeds you want, but they become like the seeds that fell on the rock in Jesus' parable (Matthew 13:5-6):
Some [seed] fell on rocky places, where it did not have much soil. It sprang up quickly, because the soil was shallow. But when the sun came up, the plants were scorched, and they withered because they had no root.
That's what depression had wrought inside me: one, vast, barren rock garden--without the garden.
There is surely a piece of divinity in us, something that was before the elements, and owes no homage unto the sun.
SIR THOMAS BROWNE
I also learned that most depression is inherited. I realized that if I looked around my family tree and saw a lot of nuts, there was a very good chance I was not a passion fruit (which is just what I thought I was). Since depression is a genetic biological illness, like diabetes or low thyroid, it wasn't lack of character, laziness, or something I could "snap out of"--it would be like trying to snap out of a toothache.
I was ready to consider what the good Doctor Bloomfield recommended I do about my depression.
He explained several options, which included two short-term "talk" therapies (Cognitive Therapy and Interpersonal Therapy) and antidepressants--as in Prozac. I, who had been programmed by John-Roger to think drugs were the devil's own tool, thought--as many people did--that Prozac was the devil itself.
The Church of Scientology had done a brilliant job programming the media and, hence, the general public, into believing that not only was Prozac unsafe, but astonishingly unsafe. They accomplished this (for whatever reason) by finding a handful of people who had done some aberrant things. Scientology then presented the aberrant behavior of these people as typical side effects of Prozac. It was a thoroughly imbalanced and unscientific presentation. More than five million people take Prozac in this country every day--ten million worldwide. Millions more have used Prozac since its introduction in 1987. It is among the safest of all prescribed medications. (No one has ever died from taking Prozac--although hundreds die each year from allergic reactions to penicillin, or from internal bleeding caused by aspirin.)
Still, I didn't like the idea of taking a pill that would--as Newsweek pointed out on its cover--give me a different personality. I didn't necessarily like the personality I had, but I also didn't want to become a Stepford writer.
A depressed person is someone who, if he is in the bath, will not get out to answer the telephone.
Harold explained that antidepressant medications do not give one a new personality. There is no "high" connected to them. They're not tranquilizers, pep pills, or mood elevators. All antidepressants do is keep the brain from pumping away certain neurotransmitters too quickly. This allows the neurotransmitters to rise to appropriate levels, which lets the brain function harmoniously again.
An analogy might be that antidepressants plug a hole in a rain barrel so the barrel can fill. The depression lifts because the brain's naturally produced neurotransmitters are allowed to rise to natural levels. Antidepressant medications, then, don't add a synthetic chemical to the brain that alters the brain's function; they merely keep the brain from pumping away its own naturally produced neurotransmitters too quickly.
Further, if you take antidepressants and feel better, it's because you are depressed. If you take an antidepressant and are not depressed, you won't feel much of anything. In this, antidepressants are like aspirin: if you have a headache and take an aspirin, your headache goes away and you feel better. If you don't have a headache and take an aspirin, you won't feel much different. The good feelings touted so enthusiastically by people taking antidepressants are not caused by the antidepressant medication, but by the lifting of the depression--when a pain you've grown accustomed to goes away, the feeling of just plain "ordinary" can seem like euphoria.
Okay. I was ready. Lay on the Prozac.
Within a week of beginning the medication, I felt not exactly better, but as though the bottom of my emotional pit had been raised. In the past, small setbacks had caused a toboggan ride all the way down to an emotional state best described as "What's the point of living?" In the choice between life and death, I would reluctantly choose life (with about the same enthusiasm as Michelangelo's Adam on the Sistine Chapel receiving the spark of life from God), and crawl back up to "normal" again.
Normal for me, however, was depression. As it turns out, I've had a long-term, low-grade depression since I was three. This depressed state was my benchmark for "normal." On top of this, I would have, from time to time, major depressive episodes--lasting from six months to more than a year. When the two of these played together (that is, played havoc together on me), I had what is known in psychiatric circles as a double depression (a fate I would not wish upon my worst enemy).
If Quentin Crisp had never existed it is unlikely that anyone would have had the nerve to invent him.
After I'd taken Prozac for two weeks, I felt the floor of my dungeon had risen even higher. By the third week, I felt I had--for the first time--some level ground on which to build my life. I still was concerned how firm it was, so I walked across it lightly, as one does across a piece of land that was once quicksand.
That was the image I had: any good deed, any positive project, any accomplishment, I placed on the quicksand where--like Janet Leigh's car in Psycho--it would slowly, painfully, inexorably sink.
Now I inched a little farther toward the center of my land, seeing how firma the terra really was. It was a great victory when I could jump up and down in what was once my pool of emotional quicksand and know it was finally safe to build there.
What I built, of course, was up to me: if I built depressing things, my life would still be depressing. But now I had a chance to build something stable, something reliable, something good.
I also began feeling spiritual for the first time. I felt connected to God in a solid, unpretentious way. The discovery of this connection was no great "hooray, hooray, I found God," but a slow clarification--like watching a Polaroid picture develop. It all seemed so natural--and simple. It had nothing to do with John-Roger's intricate cosmology I had so carefully memorized.
And--just as so many other great teachers had said--the kingdom of God was within.
I also found myself simply enjoying things: ordinary, everyday, no-big-deal activities were pleasurable. I remember sitting in a chair, waiting for a table at a restaurant, and I was enjoying just sitting there. I felt so contented, all alone, sitting there, it was almost like being in love.
In fact, it seemed that I was falling in love--with myself.
To love oneself is the beginning of a lifelong romance.
Are you depressed? Well, here's a checklist from the National Institutes of Health. On this checklist they also give symptoms of mania, which is the irrational, unpredictable upperswing of manic depression. (I never had mania, but I did overachieve as a compensation for the depression--I was trying to "prove" my worthiness by outward achievement. Doesn't work.)
According to the National Institutes of Health:
A thorough diagnosis is needed if four or more of the symptoms of depression or mania persist for more than two weeks or are interfering with work or family life.
With available treatment, eighty percent of the people with serious depression--even those with the most severe forms--can improve significantly. Symptoms can be relieved, usually in a matter of weeks.
Symptoms of Depression Can Include:
In the Workplace, Symptoms of Depression Often May Be Recognized by:
Symptoms of Mania Can Include:
These symptoms are not "just life." If you've had four or more of them for more than two weeks, or any of them is interfering with your work or relationships (including with yourself), a diagnosis is in order.
Never go to a doctor whose office plants have died.
Even if you checked every box (as I must have--I could have been depression's poster boy), you are not necessarily depressed. This is simply a checklist to see if a diagnosis from a physician (an M.D., D.O., or psychiatrist) is in order. Your physician may say you're not depressed, but you do (for example) have low thyroid (which mimics depression symptoms in about twenty percent of the cases). This is why a physician should be consulted for diagnosis.
On the other hand, emotional support and the administration of short-term "talk" therapies--such as Cognitive or Interpersonal Therapy--is often best given by psychologists (Ph.D.s or MFCCs).
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