Martin Sheridan was first treated for depression at 22. Fifteen years later, he puts into words his struggles with the disease
I felt a funeral in my brain And mourners to and fro, Kept threading — threading — till it seemed Sense was breaking through. (Emily Dickinson)
I remember before I felt these things. I remember looking at my sister in her darkened room in the depths of emotional turmoil. I remember looking down that hallway and hearing endless sobs and I remember bewilderment.
What was so wrong? Why was my sister feeling so much pain? I thought everything was kind of OK. But it wouldn’t be long before I felt it too. Like Emily Dickenson and my sister, I would soon come to know the funeral in my brain.
There is a silent disease sweeping the land. The latest figures suggest 300,000 people with medical cards are suffering from it. When you factor in private patients, that figure could be closer to 500,000.
It hospitalises 10,000 and contributes to the deaths of up to 5,500 citizens every year. Don’t panic, it isn’t contagious, and it’s not the dreaded ebola. You are eight times more likely to suffer the disease if your parents suffered from it.
This, of course, places considerable strain on the word ‘contagious’.
Mysteriously, two thirds of the people who suffer from the disease do not seek help for it. Instead, they suffer from its chief weapon, silence. With this in mind, it could be the case that up to 500,000 people in Ireland are afflicted. If these kind of figures are correct, are we not in the midst of an epidemic? Quite possibly we are.
The disease in question is depression.
I have suffered from what we term depression for most of my life. I am 37 and was first treated for depression and severe anxiety at 22.
When I took medication for the first time it provided some relief from what can only be described as a kind of living hell. Panic attacks left me curled in corners afraid to move or woke me in the night like demons. Fear became my permanent state.
When anxiety had wrung me through, and I believed it wasn’t possible to feel any worse, depression came.
Depression feels somewhat like life has been sucked out of your body; as if something alien came in the night and took it from you. Movement becomes akin to death. Even the smallest task seems gargantuan, a monstrous act promising some kind of annihilation.
After depression took hold, I was left swinging pendulum-like between two unbearable states. At one pole, fear and its great force sent waves of fierce energy throughout my body. Eventually that energy sent me back upon myself, back past equilibrium towards collapse and capitulation, and to depression once again.
It’s the kind of awfulness that underpins Sartre’s description of existence.
“I exist,” he bemoaned, “that is all, and I find it nauseating.”
Like Sartre, I began to experience life as some kind of sickening curse. I’d stand on platforms with my back pressed to walls far from steel just in case the urge for an end came too strong. When relief arrived in the form of SSRIs, I realised I had been feeling the edges of depression since I was a child. I can trace its lurking shadow back to my 10th year.
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Within six months, I relapsed into a severe depressive episode. Strangely, I found the relapse more intense, more painful. Usually a second bout of pain is easier, no? Surely experience, objectivity, understanding would contribute to a lessening? With depression, I have found the opposite to be true.
Logic, and all the rational human tools, disappear into the black hole of the depressed mind; the more depressed you get, the more depressed you get, or so it seems. I think the worst thing depression does is it tears at your innate sense of belonging. The one that says: “I am safe here, this is where I am supposed to be.”
The fabric that bonds us to the human form then is stretched, misshapen, and sometimes torn. The world becomes a foreign hurt-filled distant place, and the very ground of our being is confronted. In some cases it obliterates that ground, flattening us in the process.
Depression feels to me like an illness of vitality, an illness of will, rather than solely a mental one, and it challenges that will and that vitality and all the other innate human functions we take for granted to their very limits.
Throughout the last 15 years living with depression, many questions have arisen. Insights and answers have appeared sporadically, often providing illumination to darkened corners of misunderstanding. Many questions, however, remain unanswered.
There is one which has stubbornly refused to leave. It returns through wellness and in the pitch black, and hovers in a constant as if asking to be answered. I believe most people who face serious depression also ask themselves this question: Is depression an emotion or is it a disease?
Is it something that must be treated medically, such as diabetes or asthma? Or is it an emotional precursor for growth; a thing to be faced, passed through, endured? Like the mythological phoenix, a dissolution of self before something new is born.
In attempting to answer this question, I have realised numerous things. One of these is that the modern medical treatment for depression can be effective at alleviating symptoms and bringing function back into our lives, but, long-term, it is not a cure.
Some of the medications used to treat serious depression have addictive qualities, and most have extremely harsh side-effects. In my experience, long-term use of these medications can actually inhibit our ability to recover from depression.
Depression affects both mind and body. Depressed thinking brings about depressed emotions that affect the body. These emotions cause physical responses which in turn fuel depressed thinking, and so on. Like a mouse on a wheel, depression acts as a vicious cycle between body and mind.
Medication can change our mood receptors which has a knock-on effect to thinking which can break the cycle, albeit temporarily. In my experience, and I believe in the experience of many others, when medication is discontinued the depressed thoughts often return to begin the cycle again, along with, invariably, the old thinking, the old patterns of pain. This is perhaps reflected in the recurrent nature of depression. Some 50% of those who recover from an initial depressive episode will have further episodes in their lifetime. This rises to 80% after two episodes; the more depressed we get, the more depressed we get. Or so it seems.
To really cure depression, and not just treat it, we must address our patterns of thinking as well as our physical symptoms. We must do this because the mind is boss, and the body believes what the mind says, acting out the intricacies of our 90,000-a-day thoughts.
Mind over matter is an old adage yet, rather conspicuously, the medical industry refuses to move towards this truth. This is despite such glaring evidence as the placebo effect.
I often wonder could the answer to this denial lie somewhere in the quagmire of the billions and billions of pharmacological profit that arises from the commodity of the sick. In a sweeping investigation into the efficacy of anti-depressants entitled The Emperor’s New Drugs: Exploding the Antidepressant Myth, author and Harvard medical lecturer Irving Kirsch used the Freedom of Information Act to obtain US Food and Drug Administration reviews of all placebo-controlled clinical trials (positive or negative) that were submitted for the initial approval of the six most widely used antidepressant drugs approved between 1987 and 1999 — Prozac, Paxil, Zoloft, Celexa, Serzone, and Effexor.
The results were startling. Altogether, there were 42 trials of the six drugs. Most of them were negative. Overall, placebos were 82% as effective as the drugs. In another recent book investigating the astonishing rise of mental illness in the US, the author Robert Whitaker not only agrees with Kirsch’s contention that antidepressants are about as effective as sugar pills, but contends that they actually cause damage to the neurological structure of the brain.
With long-term use, Whitaker suggests, it becomes almost impossible for the sufferer to discontinue medical treatment as the drugs themselves effectively change the neural pathways of the brain, making the user neurologically dependent upon their effects.
It isn’t in treatment alone that we are failing the depressed, but in diagnosis too. In diagnosing depression, modern medicine relies on a set of abstract symptomology taken from a manual, which is then generally applied to individuals.
The DSM (Diagnostic and Statistical Manual of Mental Disorders) has come in for sharp criticism in the last two decades. There have been many books by journalists and mental health professionals about the lack of science behind the DSM, the overdiagnosis of psychiatric disorders, and the anthologising of normal behaviours.
Aside from what seems like a categorical failure on the part of the medical industry in diagnosing and curing depression and mental illness, cultural attitudes to depression also seem to contribute to both the difficulty in treatment, diagnoses, and cure.
The increasingly problematic modern world and our culture’s seeming emotional intolerance often make clear diagnosis and choice of treatment difficult. For instance, reactive depression can complicate a diagnosis. It is clearly distinct from serious depression and is a natural human reaction to trauma, to grief or loss.
In a culture where there is so little tolerance and wisdom concerning human emotions, often people who should be treated are not, or those who are treated medically could do without the harsh repressive realities of a medical intervention, instead benefiting from a more holistic approach to their treatment.
In this light, it is easy to come to a conclusion that our current social, cultural, and medical model for treating this disease is deeply flawed. This is not to say that some GPs are doing great work in their efforts, but they are unequipped to deal with depression in a way that can allow the sufferer a possibility of overcoming the disease.
I believe our current approach to treating depression is wholly inadequate and ignores the idea of a cure. It condemns sufferers to a life of taking extremely harsh medications, in the process swelling the coffers of pharmaceutical conglomerates.
We are failing to cure depression because we are failing to address depression at the level it exists. Because depression presents as both a physical and mental disease, its symptoms, treatment, and recovery require both a physical and mental approach.
One may argue that the contemporary method to treating depression is certainly an improvement on the barbaric practices of half a century ago and beyond, where people were incarcerated and subjected to treatments that wouldn’t have been amiss at Guantanamo. However, it is my experience that when serious depression is treated through medication alone, we can become somewhat like our ‘insane’ ancestors; except now the prison exists inside. We become cut-off from the very emotions that can be our cure.
When I began to confront the thoughts and emotions associated with depression, true change began. When I faced these seemingly terrible things inside of me, what I found was nothing short of profound.
“And then a Plank in Reason, broke And I dropped down, and down And hit a world at every plunge And finished knowing — then.”When I read this last stanza from Emily Dickenson’s wonderful poem, I imagine her reciting it alone in her room among her hardest days in the cold and bleak Massachusetts winters. For me, it’s a soliloquy for depression. We can read these last lines as the depiction of a final succumbing to depression. The last stand of reason collapsed as the mind falls further down and through the thickened boughs of a psychic hell. But I read differently. I feel these lines to tell of breakthrough.
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They tell of depression leading to the breaking of reason, yes, but through that seeming end of a reasoned reality alone, depth arises. Dickenson speaks of reaching something far greater than knowledge, and that is knowing itself: Wisdom.
I have spent the years since my first encounter with depression fluctuating between states of wellness and states of extreme suffering. If it wasn’t for medication, I wouldn’t be alive now tapping these keys.However, if it wasn’t for my intuition that there was something more to depression, something more than the idea that my illness was a passive force that existed outside of myself, and if it wasn’t for my will to explore, and continue to explore as I do, other possibilities beyond medication, other opportunities for learning, I would never have found, as I suspect Dickenson did, that depression could be my greatest teacher.
Depression has taught me about compassion, something I would have quaffed about in my younger years. Not the kind of token compassion that says ‘Ah sure Jaysus isn’t it terrible about so and so’. Or the kind of compassion that rages against the world for all its apparent inequalities. Rather it’s the sort of compassion that feels the very depths of what it is to be human. It is heartfelt, and asks you to look at other beings without judgment because you understand now that you could never understand what it meant to be them, all their pain, all their glory. Never.
Depression has showed me the very depth of our human story. It has taught me that each and every single human being is like looking out to the vastness of space on a cold clear night, deep beyond comprehension. Yet mostly we never live that, or ever even come to realise it.
It lives in us like the unknown seed. Depression has taught me that the mind must not be believed, that it is conditioned, that it says things constantly like a little child with a tape recorder; over and over and over. Depression has shown me how our mind is predominately negative, how its self-talk is so often self-harm. It has taught me that no peace can be found outside.
No money, no fame, no book, no person, no future event in time and space will ever fill us up the way we hope it can. Depression has taught me that suffering is the ubiquitous human state, but that suffering can be transformed, turned as if by magic into understanding.
Depression has taught me that the purpose of suffering may just be that. When the plank of reason breaks, we come to learn, to grow, to suffer, to sow. The very way the farmer knows that if he wants the seed to be strong he must cover it in soil, take the light away, and then, shrouded in darkness, the seed grows strong.
When we provide tools for people to confront their pain, to deal with it in a real and progressive manner, we are providing them with opportunities to grow and become more compassionate, more caring, more productive citizens; we are, in effect, contributing to our own interests as what we can or can’t do is always bound by the abilities of the group.
When we medicate to eradicate we deny growth. The author Chuck Palahniuk suggests the lack of a world war in our time is significant: “Our generation has had no great war, no great depression. Our war is spiritual. Our depression is our lives.” If we can live through our depression rather than just suppress it, we can come to realise its transformative power, as I’m sure many have. This does not mean medication is not a tool we can use; it may be.
Used alone, particularly over long periods, the evidence is beginning to suggest it might perhaps inhibit our ability to overcome and learn from depression. Every person’s depression requires its own approach, unique to the individual.
There is no one fix-all cure and currently we are failing sufferers of depression by medicalising to the determent of curing. Depression was once the quiet melancholy that left the lady of the house submerged in her quarters, far from the author’s pen and the protagonist’s intentions. It is now, in the age of our great spiritual war, reaching epidemic proportions. Mental illness and depression are on the rise.
The World Health Organisation projects that, by 2020, depression will be the second-leading cause of disease in the western world. It predicts a 50% rise of depression in young people. One is at considerably greater risk of depression the more income one has; depression, it seems, is a disease of ‘development’.
Our generation’s legacy — the world that we will hand to our children — will be a world filled with challenges. It seems probable now that catastrophic climate events are but a matter of when. It seems increasingly likely that we will hand over to our children a defunct, ghastly unequal, and impotent economic system.
However, these things may be surmountable, the human spirit runs the roads of defiance, but not if we fail to provide the tools for our children to navigate the rising storm of their internal world.
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