Wednesday, May 16, 2018

Insidious Creeping Mental Doom

Readers of this blog (both of them!) may be wondering where I've been, what I've been doing, and why I have not been gracing the internet with my particular brand of thoughtful, well-informed opinion (aka blathering on about stuff). Well, let's get into it ...

The title of this thing should serve as fair warning: this is not going to be a fun post. It is not going to be a jokey, snark-filled rant about current events, or a plea for people to treat each other with civility, or anything like that. There will be no talk of donald trump, or Stormy Daniels, or Michael Cohen, or Israel, or anything to do with politics or current events.

See, right now I, as well as millions of others, are locked in a solitary struggle to function normally, to handle day-to-day obligations, while simultaneously trying not to collapse in on ourselves as a way of retreating from ... well, everything.

Depression is a condition that affects millions, to varying degrees. In many cases people pass it off as "having a bad day," or "feeling a little blue," or something of that nature ... in short, trivializing it and trying to treat it is a momentary aberration instead of the chronic condition that it is. And in some cases, it is merely a fleeting thing. However, in many others it is not.

I'm sure that everyone reading this is familiar with the common symptoms of depression:
  • Feelings of sadness.
  • Feelings of hopelessness and despair.
  • Changes in appetite.
  • Mood swings and irritability.
  • Insomnia.
... and the list goes on. One of the common questions asked during any depression screening -- whether performed by a family doctor, a school counselor, a psychiatrist -- is "Have you or are you now thinking of hurting yourself?" This question is flawed, in my view, because it assumes that self-harm is a specific course of action engendered by the depression.

The question implies that depression will instill an urge to self-harm, that it will create a mindset in the sufferer that injuring yourself is now an acceptable activity. This is not the case. What does happen, and what is rarely addressed, is that depression is painful -- often unbearably so -- and sufferers are simply trying to make the pain stop. This is one reason why people suffering from depression are more likely to become addicted to opioids -- and, in a vicious cycle, opioid addiction can increase the severity of depression symptoms (say what you will about opioids, they are extremely effective and work exactly as advertised: they promise to make pain stop, and they do just that -- no muss, no fuss. The fact that they are addictive is just the cost of doing business).

Depression sufferers who attempt (or achieve) suicide are doing so not because they no longer want to live, they are doing so because they no longer want to live like that, in constant agony, and there do not appear to be any viable alternatives.

There is also the sense that something is missing, something big. The problem is, another hallmark of depressive symptoms is that it makes it almost impossible to identify what that missing thing is, exactly. The usual approach to sussing out this mysterious missing bit is to "try on" various things to see if it makes the feeling go away ... but no matter what they think of as a candidate to fill the void, the depression kicks in to make whatever it is thoroughly unappealing. In my case, creative pursuits are a huge part of my life. I write plays, I pen op-eds that never actually get published, I write and record music. I am currently architecting a new addition for my house using some pretty nifty CAD software.

Of late, however, none of that has done anything for me. I keep feeling like there was something missing -- either I wasn't doing something I should be doing, or I was doing it when I shouldn't, or I was doing it when I should be doing it but doing it wrong, or something. Usually when someone feels that something is lacking, they can fairly quickly identify what it is and take steps to address it.

With depression, this becomes impossible because everything that a person thinks of as a possibility turns out to be about as appealing as rolling down a hill in a barrel full of thumbtacks and landing in a pool of rubbing alcohol. In my case I tried on several different options -- going to an open mic that happens on Thursdays in Blue Bell, working on the model of the house, recording tracks for an album of cover tunes I'm putting together, working on one of the four plays I have in development -- and each of these things was rejected due to a lack of appeal.

And therein lies the fundamental challenge of dealing with this thing. Yes, there are feelings of sadness, hopelessness, and so on, but the real bitch about it is that nothing -- and I mean nothing -- has any appeal. Meals are chores to completed as quickly and painlessly as possible, preferably with little to no conversation. Favorite TV shows, movies, and so on become excruciating slogs of tedium. Books become too much work. Playing music becomes a joyless enterprise. Even writing this blog post, something I can usually knock out in about twenty minutes or so, has taken me, cumulatively, over twenty four hours.

Only sleep -- really deep sleep, the kind that sends the sleeper into oblivion -- holds even a modicum of appeal. For a depressive, the thought of sleeping 24/7 is about the only thing that holds any promise. This is another reason that suicide sometimes becomes an option: no matter how long one sleeps, when they wake up they are still them. Because it is physically impossible for someone to remain asleep for more than eight or nine hours (except in unusual circumstances, of course), there is a skewed perception that death is simply sleep on steroids ... and even thought it's ludicrous, there is a subconscious train of thought that things will be better once you "wake up."

The most disturbing thing about all this, however, is how one's relationship with death changes. Under normal circumstances, death is something that rarely enters one's thoughts, and when it does it is in the context of something to be avoided. People have a healthy fear of death; it is instinctual. Depression is powerful enough to override this instinct and make death seem like just another alternative.

So what to do if you or someone you love is suffering from depression ...
  • Be supportive. Don't coddle them, but also do not get angry with what appears to be stubborn indecisiveness. It's not that they are unwilling to make a decision on anything, it's that they can't. The energy reserves to do this simply do not exist. Asking them to make a decision -- any decision, even if it's "where do you want to go for dinner?" -- will be perceived as being not worth the effort.
  • Do not point out every reason they have to not be depressed. This will only make the situation worse because the depressed person will now also have a layer of guilt because they aren't enjoying the things they are "supposed" to.
  • Try to subtly introduce things you know the depressive enjoys. Make them their favorite meal, for example, or take them to do one of their favorite activities.
  • Above all, do not present anything as "something to help with depression." Paradoxically, acknowledging the depression in this manner only makes it worse.

If you really want to make a positive difference, though, try to get them to laugh. It may sound simple, but laughter really is the best medicine here, for a number of neurochemical reasons I am not qualified to go into here in any depth. Suffice it to say that depression is usually a result of a serotonin deficiency, and laughter -- true gut-busting laughter, not a polite chuckle -- boosts serotonin in a big way. It also has an added benefit of allowing the depressive to forget about their depression ... which also causes the pain and hopelessness associated with it to go elsewhere, even if it is only for a moment. This respite from the pain is probably the best thing that could happen, in the sufferer's view, and it may even allow them a window of clear-headed, rational thought that will allow them to seek help.

Depression is real. It is debilitating. It can be fatal. And if you think it's painful watching a loved one endure this, try to imagine how excruciating it is for them.

I gotta lie down.

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