Tuesday, December 22, 2020

A Majority of One (The Scourge of Depression)

No quote today, as I'd like to speak freely on the subject of Depression.

I was recently informed of a friend's (previously unknown) battle with Depression. This is a subject, Mental Health, that is important to me and I am compelled to discuss it at length. I understand this is not necessarily my usual kind of post, but there are not enough words devoted to this topic to suit me. Most of what is said and written about the subject has always impressed me -- in a purely negative way -- with its vacuity, recycled self-help-guru nonsense that mainly serves to sell books and keep therapists in business, and outright misrepresentations (usually made by people with no direct experience), so that I believe I must speak up.

Before I begin I want to pre-empt the "you don't know what you're talking about" crowd and state the following in as clear and concise a manner as possible:

I am not a doctor. I have no psychological training. I have nothing in the way of what might be called "a qualification" to speak authoritatively on this subject. I claim none. 

Then again, most of the people who do have such a nebulous attachment to "authority" regarding this problem can't really speak authoritatively on it, either.

The proof of that accusation is all the people running around on Happy Pills because modern psychotherapy largely turns your psychiatrist and therapist into drug dealers. There are, of course, exceptions, but save yourself time and effort and don't raise much protest about how you aren't, if so inclined. That there are exceptions to every rule is a given, and that doesn't require you to shout it from the rooftops or to protest your personal innocence.

What I can bring to this discussion is experience. A long, often painful, experience. I am not going to recite it all here for the purposes of making myself out to be some sort of martyr, nor am I aiming at clicks: this is about the insidious nature of Depression, the baleful effects it has on one's mental and physical state and is intended as an encouraging message to any and all who may be suffering.

You are not alone. There are people who understand. You can overcome.

My own story begins on what was shaping up to be a lovely morning in September of 2001.

Then came the airplanes. The first one passing directly over my head and crashing into the building I had just left not 30-40 seconds before. To skip the grisly details, I'm alive by a matter of yards, others weren't so lucky, and for the remainder of that day I had a ringside seat for everything that followed. I had just watched some 3,000 people die in the most gruesome of fashions one can imagine.

It was a few months before the horror of what had occurred truly set in. The realization arrived with a variety of issues -- nightmares, unexplained physical pain, insomnia, sensitivity to sounds or to changes in lighting, trembling. There was a curious sensation in which one feels something like a half-euphoria, as if you were no longer inside your own body and had become a mere observer of the events in which you were involved, and a half-terror that had no identifiable source.

Then came the abject sadness. The crying. The self-recriminations.

All sorts of things begin to happen to you, and you have no explanation as to why they happen. Because Depression arrives with handmaidens -- some of her best friends are Anxiety, Fear, Uncertainty and Anger.

Eventually, you find yourself walking into emergency rooms, believing you're having a heart attack. You do this several times in a six-week span. Everyone tells you your heart is fine, there is no physical problem... and you believe they're lying to you. Because two more of Depression's girlfriends have show up: Denial and Paranoia. They MUST be lying to you because if there wasn't a physical problem, you wouldn't be having chest pains, headaches, shortness of breath, dizziness and all the rest.

Soon, you find yourself spending five days in the hospital cardiac ward because the doctors want to ensure they aren't missing something. You get the full workup.  Twice. They haven't missed anything. A pissed- off cardiologist who reminds you of Juliet Mills (only hotter, complete with English accent. To DIE for) takes a "tough love" stance with you, explains that you're taking up space and resources that could be better used on someone who was really ill, and that you should get your fucked-up, hypochondriac ass to a psychiatrist,

And you do. Only to discover that the field is filled to the brim with morons. Literal, knuckle-dragging, sad-sack, mouth-breathing, nose-picking, bedwetting morons.

I would say the only professions with more incompetents in it would be Politics, Law, Big Media, and Public school teachers.

For every Dr. Phil I (who I think is great) there's a thousand Keystone Kops. For every Jordan Peterson (a true giant) there's five thousand make-believers with a certificate who only took up the field, you assume, to explain what's wrong with themselves.

It is difficult to find someone who actually KNOWS what they are doing when it comes to treatment, and this is one of the biggest scandals in the American Health Care System: the mental health system we have is sub-par, mainly because it is full of sub-par practitioners operating mainly by guesswork out of a book (The DSM) that includes (validates and justifies, by taking them seriously) such things as your co-worker with a functioning penis suddenly declaring that you have to call him Loretta while he pretends to menstruate, for example.

You will meet all kinds in your quest to discover what's wrong:

The pill-pushing (literal) swami who will experiment with different pharmaceutical cocktails until, by sheer luck, he finds the "right" combination for you.

The skinny, nasally, unfuckable Olive Oyl type who is fascinated by your sex life (for lack of her own).

The wanna-be Freud or Jung obsessed with your bowel movements and masturbation practices.

The "document-every-minute-of-every-day-because-I-have-no-better-idea" scold.

All of them charging several hundred dollars for the 40-minute hour and none of them getting close to the source of your problem(s).

The problem, from my perspective, is that unlike physical medicine the field of psychology lends itself to trendy or unproven therapies and theories. For example, a broken leg is a straightforward process. You can see it on an x-ray; there is a mechanical process for setting a bone, there are mechanisms like splints and casts, plates and screws, that have long records of verifiable efficacy.

Not so for psychotherapy. Psychologists are dealing with emotional issues that are often the result of a combination of experience and trauma, often years in the making, that can't be detected by an MRI, or a blood test, and which often don't have a "standard" one-size-fits-all treatment protocol.

This is the main reason why most drug-rehab programs don't work (another thread).

Modern psychology (I know, some will quibble. Save it. This is opinion.) appears to operate on one of two theories (in no particular order, and very simply):

1. (Virtually) All mental disorders are a result of chemical imbalances in the brain. The way to treat these imbalances is with drugs. Since the organ in question -- the human brain -- is still largely a mystery to medical science, and the drugs being used are still largely a mystery, as well (sometimes they work, sometimes they don't, who the fuck knows why?) the results of this sort of practice are hit and (mostly) miss. We will take you through an odyssey of the full smorgasbord of pharmacological offerings -- different drugs, different doses, different combinations of same -- according to some study or chart until we get a result (whether positive or negative is usually of secondary importance. The aim is to achieve SOME result and then to continue the guesswork from there).

In the end, this sort of "doctor" has you taking 400mg of Zoloft every day (after you've already tried a course of Prozac and Wellbutrin), accented with doses of Xanax, and you've gone from apathetic, frightened basket case to hyper-aggressive semi-amnesiac with a misfiring urinary system, binge eating junk food, and your head feels like it is "buzzing" 24 hours a day.

I mean, you can feel something like an electric current running inside your head all day and literally hear the hum one usually expects from a piece of electrical equipment.

Needless to say, this approach did not work for me.

2. The patient knows -- sub-consciously -- what his/her problems are. It is just that in their confused state of mind they are unable to focus their attention sufficiently to properly identify the sources, reason out the causes and effects and then undertake a series of logical, rational actions to affect a cure, or at the very least, an acceptable coping mechanism.

In fact, they're here because they don't have a coping mechanism.

This sort of therapy takes various names and associated forms, but it is essentially "Talk Therapy". The idea is to get the patient talking about a variety of targeted subjects -- childhood memories, reflections on traumas (both realized and unrealized in terms of awareness), current state of mind, specific criteria regarding general health and well-being, and the sense of self. Eventually, the patient has an epiphany, the problem is identified, and once this happens the treatment program becomes a simple(r) matter of finding a way to accept, overcome and adapt to the circumstances that caused the disorder, originally.

This, to me, is the most-effective for of therapy. It is also the form that takes the longest to achieve the desired result, turns out to be the most-expensive, and is the one health insurance companies hate the most.

I tell you all of this because I don't want you, who may be suffering right this very minute, to fall into the trap that I did. Just because someone has "Doctor" at the beginning of their name or  "MSW" at the end of it, doesn't mean they know what they're doing. It can take a great deal of time, and trial-and-error, until you can find someone who can offer something beyond "take this pill, fuck me if I know how or why it works/doesn't work" and "tell me about your diet and sexual habits" at $400 an hour.

I warn you about this because this process took seven (7) years of my life away from me, and in many regards, left me worse off than when I had originally showed up for "treatment". In the end, my problems were many years in the making; 9/11 was not the cause of them, it was merely the catalyst for what came after. The final (and correct) diagnosis was Clinical Depression, Post -Traumatic Stress Disorder (PTSD), Panic Disorder, Obsessive-Compulsive Disorder (OCD) and Agoraphobia. I had somehow managed to function (but to not really "live") by a combination of alcoholism, denial and an incredibly decadent and ultimately wasteful self-indulgence financed by a high-paying, extremely-stressful job on Wall Street. It was an unmitigated disaster of destructive behavior.

And it left me hiding in closets, curled up in a ball either drowning in my own cold fear sweat or crying like an infant.

The only saving grace? I hadn't dropped into the sewer of habitual drug use. Somehow, I managed to draw the line there.

So, I speak from hard-won experience here.

I found the right people (really, PERSON: I stopped seeing psychiatrists, stopped taking the drugs and went all-out talk therapy). This decision worked for me; it might not be right for you. Don't immediately discount the psych or the drugs altogether.

But, you didn't come here to hear my story: you came here to get some useful advice (I hope). Here it is:

* There is nothing "wrong with you". In fact, I would go as far as to say that if you're feeling depressed, anxious and the rest of it, there is probably something wrong, somewhere, in some aspect of your life, and your depression and anxiety are actually HEALTHY, in this manner: Your body and your mind are alerting you that something is amiss, this is causing you great harm and distress, and that this is a signal to do something constructive about it.

The problem(s) you're having, at least initially, is/are that you haven't discovered the source(s) of your discomfort. You're most-likely confused, unfocused and unwilling to believe that you might be "crazy". Right now you're trapped in a cycle of self-recrimination, regret, anger, fear, and a whole slew of negative emotions and have no target to unleash them upon...except yourself. What you're feeling right now is probably being trapped in your own brain. You need to unleash a shitstorm of unbridled emotions, but haven't a target to aim at, and so the negative emotions get internalized. You're eating yourself one piece at a time for lack of a constructive outlet for pent-up pain and disappointment.

* Speaking of the cycle of negative emotions, I've been there. I understand how it works: the endless replays of events in your life, the wondering of how things might have been different with another decision, or the lost opportunities. You're dwelling on them. You're becoming obsessed with them. It's keeping you up at night; it causing you to second-, third, and fifteenth-guess yourself. It is calling into question everything you've ever done, might wish to do, and has you yearning for an easy solution to the past that is never going to come. The past is over; all that is left to you is the present and the future.

That sort of thinking (in alcohol recovery we call it "stinkin' thinkin'") is more-harmful than anything else. It saps you of the ability to move forward, it retards your ability to adequately reason, plan and, most-importantly, understand that change is necessary. It will keep you from making the change necessary.

Don't let it. Learn to understand how the cycle works -- negative emotion/negative response or activity/more negative emotion -- and to recognize it at the onset. Then make a conscious effort to stop it. This will require a lot of therapy, because it is not an easy skill to acquire.

* The Stigma. I find it often incomprehensible that in a day-and-age where we will tolerate -- even celebrate -- the worst of humanity's self-destructive impulses and denial-of-reality schemes (rioting as "justice", Socialism as a solution to anything, phony compassion for the asshole who believes X and Y chromosomes have no meaning or consequence, the pathological desire for attention, of any kind, by the completely unworthy of it) that things like Depression are still viewed through a lens of misunderstanding, and sometimes, even disgust. 

The Stigma attached to mental disorders is palpable, it is real, and it can be an obstacle. It is not only that our self-image is being conditioned by an internal, self-produced stigma ("there's something wrong with me!"), but that we're subject to evaluating our self-worth by how others perceive us. or, rather, how we perceive that others perceive us.

My advice: fuck 'em all. This is a serious matter. it is an excuse -- damned near a justification! --  to be selfish and self-centered. This is your LIFE that is at stake, not only in a literal sense (the possibility of suicide) but also in terms of how we live and enjoy what's left to us. In this regard, the opinions of others as to your value or status is irrelevant. People who would judge you on this basis are not helping you, only hurting you. Their opinions do not matter when dealing with Depression: only yours does. And your opinion MUST be that you're not some sort of crippled freak, but rather a valuable person who is currently imprisoned for having committed no crime except to feel. And the truth is, you probably feel "better" and deeper than most people do. It's been my experience that most people are shallow, hollow, they are crowd-followers and trend-emulators, and because they're doing what everyone else is doing and surrounded by people very much like them, they don't -- can't -- realize it for having no objective, internal standard of well-being.

They think they're happy because everyone else around them thinks they're happy, too, and they just haven't had that collision with reality, yet, that causes them to think: Is this all there is? Is this all I am? Where did it all go wrong? How can I fix this?

Never mind the Stigma. Go and be a better you. The better you doesn't require the validation of everyone else.

* This does get better. With the right help and the right attitude, you can overcome this. It will not be easy. You will have good and bad days. You will relapse, as old habits and behaviors -- your previous coping mechanisms, which are comfortable to you -- die hard. 

You will question everything. You will not get answers to all of the questions. You will have to learn to live with that. You will have to learn to make the best use of the answers you do get. You will never be "perfect". Perfect doesn't exist and is the enemy of "Good Enough", in any case. That's all we can ask of ourselves on most days, to simply be good enough.

There are those of us who understand because we've lived it. We've walked the plank.

This time of year is especially hard and often cruel to those who suffer the internal war. The problem is certainly exacerbated by COVID-19 and it's results, especially in terms of isolation. I'd like to take this opportunity to tell you "I'm here for you". I'd also like to link to several online services that over the years I have found to be valuable resources for dealing with Depression (and other maladies). I'll list a few below:

Man Therapy - a website/resource that uses humor and video to address many mental health issues. Starring Kelsey Grammar as "Dr. Richard Mahogany". Also has external links to other mental health resources. Here is their YouTube channel. This is one of my favorites.

National Network of Depression Centers (NNDC) - provides a myriad of links, telephone services and a directory of all related to depression, anxiety, substance abuse and treatment of same.

National Alliance on Mental Illness - a resource-rich website that will explain your issues to you, how to recognize and deal with your symptoms, and connect you with healthcare providers who can help.

Anxiety and Depression Association of America

The Kim Foundation

National Council For Behavioral Health -- this one has a lot of resources for veterans and their families outside of the VA system. Good resource for everyone on a variety of mental health issues.

National Veterans Foundation

Hang in there. As long as you're fighting you can still win!

UPDATE: For some reason, Blogger will not link to the Man Therapy site via hyperlink. Blogger claims the site does not exist, but it does.  Probably banned for some reason (fuckin' Snowflakes or "fact checkers"). You can find it at ManTherapy.Org.


Anonymous said...

A very good read and wonderful links provided. I'm 61 years old and have suffered depression all of my life. As a 2nd grader I left a suicide note and attempted to hang myself. There have been other attempts close but no cigar. As they would day.

I've gone to counseling over the years. I found one this past winter who guided me in the right way. My MD also prescribed Lexapro. Its been a God send.

To those who suffer seek help. Its not an easy adventure. I still have my bad days, but my good days exceed my bad ones.

Matthew Noto said...

"...but my good days exceed my bad ones."

And that's not such a bad thing, is it? Can you really ask for much more?

Hang in there, Friend.

Anonymous said...

No, there isn't much more to ask for.

Thanks for the topic and thanks for your site.

Matthew Noto said...

No problem, Buddy.