Stalking you like a bad disease.
“I am NOT a doctor, though I have played one in real life.” That is one of my favorite disclaimers, but I must also give the more traditional: This article is not intended to diagnoses, treat or cure any medical condition. I have hung out with a bunch of doctors during over two decades of working in psychiatric research. As a database manager and biostatistician I have observed based on prevalence of both assessed symptoms and final diagnosis, depression is like the common cold of psychiatry. However, today I write not from a medical or scientific perspective but from the perspective of someone who has been stalked by depression throughout most of my life. There has been a few times when depression has managed to break into my mental state and threatened to set up camp. Sometimes I just wake up in the morning and there it is invading my thoughts, screwing with my self-concept, smashing my ambition. I turn to ask, “HEY –WHO LET YOU IN HERE?”
Depression can invade your mental state through a number of portals such as acute emotional trauma like the loss of a loved one or a relationship. However, depression will also sneak in the door holding hands with post-traumatic stress, head trauma, thyroid disease and early dementia. Even worst is when depression takes advantage of the structural weaknesses of your own brain and ties into the framework such that it takes weeks to evict it; that is what we call major depressive disorder. Although I have co-authored a couple of publications on depression and suicidality, I have recently gained new insight through my professional activities into why depression has stalked me into adult life: I am currently working on a study at the University of California at Irvine that examines how childhood maltreatment increases the risk for life course depression. I now realize how blessed I have been since childhood to be able to recognize depression creeping up on my mental state and block it from breaking in.
I got the first hint of this ability when I visited a close friend Bill who was hospitalized with severe depression. Bill was in the class behind me at American High School and we connected through our participation in the Student Association for Performing Arts, going on tours and playing in the band together, and we also connected through Young Life with weekly meetings, Bible Study and Woodleaf Camp. Bill was the person in high school that knew my secret shame that my family struggled financially with my mother being challenged to support four children on her own while battling lupus and cardiovascular disease. My mom connected with Bill’s mom because she saw Bill’s mom working at the food pantry where she went to go get food when she could not afford groceries. My connection with Bill continued into college as he was my discipleship partner when I was with Navigators and we met weekly for prayer, reflection and Bible study.
However, there was a divide between us as I sat across from him during my visit to him at the psych ward. I was trying to understand why he was there and I was not. He was one quarter away from graduating from college; he had a 3.95 G.P.A in an honors program at University of California at Davis where we attended. He was engaged to be married to an adorably bubbly intelligent young lady that I previously supervised at the dining commons. He continued to be loved by the many friends he made in college just as he was in high school. Meanwhile, I was the misfit who had left school for two years because I had to sort out all of the emotional junk from my childhood including sexual abuse, physical abuse, witnessing violence and parental abandonment; I was working to close the windows that depression was using to sneak into my mental state. Already I had come to realize that I had leverage over depression. I had developed a resilience that was like my super-power. In that moment I so wanted to give what I had to Bill, but I could not. I did not have the power to simply speak it into him. His depression had exploited the structural deficits of his brain and had become so strongly encamped that even the best medicine of the time could not evict it.
I still desire to transfer my knowledge of staving off depression to others such as the woman I called “Motor Boat.” She was the woman who often swam next to me during noon lap swim at California State University at Long Beach (CSULB). I called her Motor Boat because of the way she moved quickly past me doing kicks with a kickboard even while I was swimming freestyle. I came to accept that she just floated better and was more hydrodynamic. We only had a few conversations over a couple of years but her presence was part of my milieu, and I noticed when she was absent for a couple of weeks. When she returned to lap swim, I asked what happened to her. She said, “I just became really depressed after my qualifying exams. For days I just sat inside my place watching movies and eating cheese...”
As I listened to her describe her experience I thought her response was not as bad as how she felt about it and labeled it. I knew from my first job working in a neurochemistry lab under the direction of Dr. Dorothy Gietzen with joint appointment in Psychiatry and Nutrition, that cheese contained a lot of the building blocks for the happy neurotransmitters in the brain. In addition it contained a substance that acted in the same way as endorphins. I responded by telling her, “Sometimes the only difference between sanity and insanity is how you plan your psychotic breaks . . . If you had anticipated that there would be a huge psychological letdown after your exams, even if you did well, you could have planned for recovery and healing: You could have gone out ahead of time and purchased a really nice cheese platter and rented all of your favorite movies so you had a movie schedule in advance. You could have scheduled time off from work. Then you could have just relaxed at home savoring the cheese and the videos without anxiety or shame. You could have even invited friends to join you, or not. Most importantly you could have just enjoyed healing and recovery without self-condemnation.”
Although 27 percent of people presenting at outpatient clinics for general medicine have depressive symptoms making depression the common cold of psychiatry, people just don’t know how to manage depressive symptoms like they do cold symptoms. When people feel a cold coming on, or have seen it making its rounds about the office or school, they plan to go home, load up on the vitamin C and fluids and get to some rest. However, many people don’t have a plan for when they have been exposed to a common life stress that will leave them emotionally spent and vulnerable to depression. Even worse significance of rituals like funerals, mourning periods, housewarmings and honeymoons have been lost with time without awareness that these were prescriptions for recovery from life stressors beyond being traditions. You should have recovery plans for other anticipated stressors including but not limited to buying a home, moving, having a baby, children leaving home, family vacations and retirement.
Then there are the unexpected losses like losing a job, catastrophic accidents or being victim of a crime where you cannot plan ahead. Experience coping with loss helps. One thing that did surprise me in the couple of studies I co-authored regarding depression, was how the part of the brain that stores memories is unhealthy in those vulnerable to depression. When we get a cold, we draw upon memories of past colds to plan our coping strategy and reassure ourselves that we will get better in a few days. In the same way, we should be able to draw strength from successfully overcoming past losses. The other area of deficit was the part of the brain where we identified self. The picture that comes to mind regarding this is that of my friend and teammate Tim Lajcik after a defeat at a wrestling tournament at California State University at San Francisco. After the match he sunk his hands in his head in a sense of utter defeat. The sweat on his back and the blood dripping from his bandaged wrists indicated that he had fought hard to do everything in his power to win and yet he did not prevail. It was not his first defeat in his career. Instead of labeling himself a loser, he remembered his past wins and that he had the ability to fight back through the consolation bracket to place third in that tournament. In addition he went on to place eighth in the NCAA II national tournament that year.
We also need to recognize when we cannot by force of will and training fight back the symptoms of depression, and have a plan for that. Just as people recognize when cold symptoms progress to severely impaired breathing despite the best home remedies, medical intervention is required, people should recognize that depression symptoms lasting more than a week or accompanied by thoughts of harm to self or others might require medical intervention. Just as there is no shame in going to the emergency room or urgent care to get an exam to rule out pneumonia there is no shame in going to see a physician to check off all your symptoms to rule out or confirm severe depression. Just as your doctor may have medicines to treat when what you first thought was a cold turns out to be influenza or pneumonia, doctors have medicines to treat when your depressive symptoms turn out to be severe depressive disorder.
I have been fortunate that, although depression has stalked me, it has never overtaken me and I have been able to kick it out of my mental state before it has ever had opportunity to set up camp. I am fortunate to have outdoor gear and can escape it with a good wilderness adventure (appropriately planned not like the time I went camping during finals week in college). The stalker known as depression has given me a scare a few times by startling me with dark thoughts and feelings of extreme self-doubt and life-pessimism. So I encourage anyone who confronts this demon stalker to get some professional help if you feel overwhelmed and don’t know how to fend off its attack. The last thing I want to experience is another good friend falling victim to the stalker that is depression.