The black dog

On (my) depression

This is both very long and about my experience of clinical depression, which might make it a hard read for you. I get it.

I was 14 years old the first time I understood myself to be depressed and could articulate it to somebody else. I tried to tell my mother; it did not go well. I remember it very clearly. I had gone to my high school’s graduation ceremony (incidentally, just steps away from where Sojourner Truth delivered her most famous speech, something they never taught us at that high school). My mother picked me up in our car, a white Geo tracker with something like the Jazz Solo Cup pattern on the doors. I was wearing a navy blue dress made from a kind of waffly fabric, blue tights, blue shoes. Maybe I was in the choir?

From the backseat, I said tentatively, “ I think I’m depressed?”

“About what?” she said.¹

This was a question I was not prepared to answer. I wasn’t sure. “About … Dad?” I said. This was true, but not in a way I understood until much later. My father had died suddenly about 18 months before, and my family almost never talked about it, about him, or about how I felt about it. My mother had also told me and my brother before we returned to school not to talk to anyone there about it, either. So I didn’t. I was sad about his death, but I was also depressed and traumatized in no small part because everyone around me was behaving like he had never been there in the first place.

Anyway, I don’t remember what she said to this. Later, at home, I came into the living room where she was watching TV and told her to forget about what I had said. “Okay,” she said, and I knew she was relieved. I left the room.

Until I left home, I was given no help except for a single visit to the therapist who had treated my father² after I expressed para suicidal ideation to a friend at school. I suspect the school told her I had to see someone, because she routinely ridiculed therapy. On the drive home she asked me if I wanted to go again, and I said no. She, again, was relieved.

Found this through Arianna Rebolini (@arianna_rebolini)

The first thing I did when I got to college was start going to therapy—literally like within ten days of getting there—and shortly after that I started Zoloft. My mom had also said not to use our health insurance to pay for it, so I was spending all of my work-study money paying retail for the prescription. I was scared she’d get mad. Unsurprisingly, she did not believe in anti-depressants. Eventually I stopped doing that and just used the insurance, scared every time, but she never said anything about it.

In a lot of ways, it has been the same story ever since. I am depressed most of the time. In fact, I did not experience a significant clinical remission in my depressive symptoms— which is just 12 weeks— until I was 30 years old.³ Now I have had several, precious beads strung on a necklace that is mostly made up of smaller, cheaper ones.

The effect, when one day a treatment suddenly starts working, is stunning, disorienting—Wizard of Oz technicolor. One of my favorite poems is Jane Kenyon’s “Having It Out with Melancholy,” and in one section she describes it this way:

7 PARDON

A piece of burned meat 
wears my clothes, speaks 
in my voice, dispatches obligations 
haltingly, or not at all.
It is tired of trying 
to be stouthearted, tired 
beyond measure.

We move on to the monoamine 
oxidase inhibitors. Day and night 
I feel as if I had drunk six cups 
of coffee, but the pain stops
abruptly. With the wonder 
and bitterness of someone pardoned 
for a crime she did not commit 
I come back to marriage and friends, 
to pink fringed hollyhocks; come back 
to my desk, books, and chair.

After one new drug started working about 10 years ago (I’m now maxed out at the highest dose) I called my psychiatrist because I was worried that I was manic. (Bipolar disorder runs in my family.) she asked me a few questions and said, “I think you are just … happy.” We both laughed.

From 2015. I was very depressed when this photo was taken. The dog is my pal Buster, who belongs to my BBF Amelia.

One of the biggest revelations of those first periods of recovery was that I am a healthier, happier, more productive person than I ever knew— they revealed myself to me. I had spent years sawing away at my problems in therapy and despaired of making progress, and then I found out that many of them just disappear when I’m not depressed. I act like someone who done an enormous amount of very hard work successfully. It turns out I only binge eat sugar when I’m depressed and probably unconsciously trying to fix my brain. My house is only dirty and my refrigerator full of rotten food when I am depressed. It turns out I don’t hate writing, and I don’t forget things, and I have the energy for friendship and hobbies. It is not excruciating to be alone and I am not really lonely. I wish I could explain to you what these times are like, what is radiant and holy about them, but I find that I can’t really remember.

These periods do not last. The medications that work never work very long. I have tried a dozen drugs, and now I take five, but my doctor and I are not sure which ones are still working. It is enormously risky to try to remove any of them. I also receive ketamine treatments and use a light box. I tried transcranial magnetic stimulation and dialectical behavior therapy and more or less taught myself cognitive behavioral therapy; I have gotten advice from psychics and tarot readers and white lady shamans and I put tumbled lithium into my water bottle for whatever positive vibes the lady at the witchy rock store in Oakland told me it could bring. I have gone through lengthy periods of doing hot yoga every day. I tried six weeks of cryotherapy and the other day did a sauna and a cold plunge in Lake Michigan in the hope of getting a big hit of dopamine. (Worked for a couple hours.)

Me, age three, sometimes very happy and sometimes very sad

I take an absurd number of supplements (fish oil, magnesium, zinc, vitamin D, vitamin B, and a special form of folate that I need because I have a genetic mutation that means that I don’t process it properly). All of the supplements help in a way that is hard to articulate, except to say that when I do not take them I noticed a difference. I am in therapy twice a week and have been in therapy at least once a week since I was 18. When I am not physically disabled, and longtime readers will know that over the past few years I have spent long stretches that way, I exercise at least an hour a day, five days a week. Occasionally all of it is nearly enough. Maybe 25% of the time.

In those windows of time, I come alive again, joyously, tenderly. Jane Kenyon again:

9  WOOD THRUSH

High on Nardil and June light 
I wake at four, 
waiting greedily for the first
note of the wood thrush. Easeful air 
presses through the screen 
with the wild, complex song 
of the bird, and I am overcome

by ordinary contentment. 
What hurt me so terribly 
all my life until this moment? 
How I love the small, swiftly 
beating heart of the bird 
singing in the great maples; 
its bright, unequivocal eye.

The richness of these periods makes the rest of my days feel much worse, not only because the fully alive person I am commits to work for other people in ways that become impossible. I have lost so many opportunities. If you wonder, as I know some people do, why I haven’t written a book, why my PhD took so long, why I published almost nothing for five years, why writing a newsletter is so hard for me, why I did not get a full-time academic job: now you know. I am mostly too sick to do the things I want to do. I have a string of stories I managed to commission and could not finish—good ones, too—and file things so late that it consistently closes doors. Writing and teaching might be the worst possible jobs for someone like me, and I do not have the hustle to do them well. I feel guilt and shame about this every single day. I am very, very poor and always have been and, unless something changes, always will be. This is to say nothing of the joy and pleasure I miss out on. Those losses are staggeringly greater.

Sometimes I think about how incredible it would be if I had a full year of health. Just a year. Enough time for it to feel ordinary, enough time to stop worrying if every bad feeling portends its end, enough time to occupy every part of my life, just for a while.

In depressive episodes, time is so long, and I also wake up to find that months have passed.⁴ The world also gets so small. I can’t make plans or keep them. I can’t react to the stuff that happens out there in the world that matters. I forget about music, books. I think more slowly, and I spend a lot of the time I can think feeling guilty and ashamed about the past and afraid of, and sad for, the future. Not too long ago I managed to remember literally 50 terrible childhood memories in the span of about three hours!⁵ I have many therapy sessions where I just don’t talk at all. My house is dirty, my face is dirty, my clothes are dirty, my sheets are dirty, the cat boxes are dirty. I forget to pay bills, forget appointments. I’m so relentlessly bored, but too paralyzed to care. I have full-body aches. My face looks weird when I’m in front of a mirror. In college, my crew coach looked at me one day and said, “Your eyes look gray. They look gray instead of white.” Everything hurts.

I don’t know why I am explaining all of this. Maybe I want people to understand what most of my life looks like. Maybe it’s that I am deeply worried about what will happen to health care and whether I will even have access to my very expensive health insurance. (Who will enforce laws protecting pre-existing conditions if the administrative state barely exists?) Maybe it’s that it’s dark in here all the time. Or maybe I am explaining to myself why it is I can’t be who I am.

I can’t change my medication for another three weeks, but maybe I’ll be back to life after that. I hope you’ll see me then.

I think about this a lot: An old West Wing Christmas episode

1. Since she died, I have realized that she should have understood what I was saying. My family history is ghastly. There are suicides on both sides. My dad was depressed and a drug addict. I have an immediate family member with bipolar disorder. She probably did understand what I was saying. She just didn’t want to.

2. This is weird as hell, right?

3. No, it absolutely does not help that my life is also routinely interrupted by trauma and crisis and more or less always has been, because I think what happens is that I use whatever capacity for resilience I have to meet those moments, and once they’re over there’s nothing left. It does not help that this is all tied up with accumulated trauma. Like in a lot of ways it’s obviously situational, but that doesn’t necessarily explain why nothing works. My psychiatrist agrees with my conclusion that my brain is a dopamine sinkhole—treatments that produce more dopamine typically work and then … stop working pretty quickly.

4. My dissertation advisor once told me to think of all of this as time that was lost, but not wasted. Sometimes I’m convinced of that.

5. Sometimes my shorthand for this kind of thing with some people is pointing at my head and saying “I hate it in here.”