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Archive for May, 2009

The Atlantic“…depression turned out to be a major drain on physical health: of the men who were diagnosed with depression by age 50, more than 70 percent had died or were chronically ill by 63.”  “What Makes Us Happy?” by Joshua Wolf Shenk / The Atlantic, June 2009 

 

Woody Allen opens the movie, “Annie Hall,” with an old joke:  “Two elderly women are at a Catskill mountain resort and one of them says, ‘Boy, the food at this place is really terrible.’  And the other one says, ‘Yeah, I know.  And such small portions.’” 

That sort of sums up how I feel about the prospect of dying early from depression.  “Life really sucked.  Too bad it was so short.” 

In the late 1930’s researchers at Harvard began a longitudinal study of 268 college students that would go on for 72 years.  Through interviews and questionnaires they were hoping to find the formula for a/the “good life.”  In the June edition of The Atlantic, Joshua Wolf Shenk shares with readers, for the first time, information contained in documents used to support this study. 

I have to admit, this wasn’t the first time I had heard about how depression can shorten a person’s life span.  The first time occurred while I was sitting in the small, grey cubicle of Caesar C., my Farmer’s Insurance agent, trying to purchase a whole life policy.  At the time, Caesar was unable to explain to me in a way that I could understand, why the rates were astronomical.  In fact, I still don’t understand.  Or maybe I just don’t want to.  Maybe I just can’t stomach the concept that my life will end before I’m rid of this damn disease.  That it will end before the day arrives when I can finally greet the alarm clock without suspicion and dread. 

The second time I realized what I might be up against was in the inappropriately tilted book by Peter D. Kramer, “Against Depression.”  While in theory, its title might be appropriate, anyone who suffers from depression is likely to feel even more depressed after reading it: 

Depression leads to poor health behaviors, through apathy.” 

Depression was (being) implicated as a risk factor for stroke and heart disease.” 

In old age, depression becomes a straightforward risk for shortened life, not through suicide but through ordinary ill health.” 

You see, my life has already been shortened by this disease.  This past week alone I spent the major portion of each morning in bed, sometimes not rising until noon or later, partially because I was depressed, and partially because of insomnia (brought on by hypomania) that hasn’t allowed me to sleep more than two hours at a time. And then there are all of those moments and days that I wasn’t really present because I was manic and out of control, shopping, gambling, fornicating, doing everything to excess, being extreme, being some alter-ego, but not myself. 

I’ve already lost a third of my life (a pretty safe estimate) to this disease.  Somehow I don’t think it’s fair that it’s a statistical reality that I might also have to forfeit another couple of decades to it on the back end. 

I for one have no intention of going down without a fight.  If my mental handicaps have taught me anything, it’s to be a fighter, to hang on, to hold out for that break in the blackness.  To be patient for that one spring day of walking barefoot in the sand watching the sun set on Stinson beach.  That (sometimes,) is worth all that I have to endure on those other days when my entire life seems buried in fog. 

But I was encouraged by a few things in the Atlantic article, most of them having to do with the mind’s ability to overcome all of the obstacles put in our way, if we can only learn how: 

What we do…affects how we feel just as much as how we feel affects what we do.” 

[The] central question is not how much or how little trouble these men met, but rather precisely how—and to what effect—they responded to that trouble. [The] main interpretive lens has been the psychoanalytic metaphor of “adaptations,” or unconscious responses to pain, conflict, or uncertainty. Formalized by Anna Freud on the basis of her father’s work, adaptations (also called “defense mechanisms”) are unconscious thoughts and behaviors that you could say either shape or distort—depending on whether you approve or disapprove—a person’s reality.” 

Much of what is labeled mental illness…simply reflects our ‘unwise’ deployment of defense mechanisms.” 

AND: 

“…the key to the good life—not rules to follow, nor problems to avoid, but an engaged humility, an earnest acceptance of life’s pains and promises.” 

I have been off prescription medication (for depression/bipolar disorder) for several months now.  Not one day of it has been easy.  Not one day has been spent without some kind of spike, and usually several, up and then down.  But each day was better than a day spent with my moods chemically altered and the associated side effects.  And each day I get to observe my mind for what it is, for how it works.  And each day holds the promise that tomorrow will be better.  That I might live to celebrate my 83rd birthday sipping coffee in a Paris café.

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NYT Sunday MagOf course, none of the drugs work conclusively, and for now we are stuck with what comes down to a refined form of guesswork — 30-odd pills that operate in not completely understood ways on neural pathways, on serotonin, norepinephrine, dopamine and what have you. No one, not even the psychopharmacologists who dispense them after considering the odds, totally comprehends why they work when they work or why they don’t when they don’t. All the while the repercussions and the possible side effects (which include mild trembling on the one end to tardive dyskinesia, a rare condition that causes uncontrollable grimacing, on the other end) are shunted to the side until such time as they can no longer be ignored.”  “A Journey Through Darkness,” By Daphne Merkin / Sunday May 10, 2009 New York Times Magazine. 

Another quiet Sunday on the sofa, a cup of French roast coffee, George Winston on the piano (on the stereo, not in the living room) and the mandatory perusal of the New York Times.  But again, today, as in recent Sundays, my mind is not allowed to drift and contemplate budget tapas in Barcelona or the latest Denis Johnson novel, “Nobody Move.”  No, today I must once again confront the topic of depression.  Seems there is no getting away from it these days. 

The cover story of The New York Times Magazine is “A Long Journey in the Dark: My Life with Chronic Depression,” by Daphne Merkin.

Ms. Merkin’s experience of a hospital stay at the New York Psychiatric Institute, prescription drugs, and the decision of whether or not to try ECT (electro-convulsive therapy) to manage a particularly bad bout of depression, is beautifully told, heartbreaking, and all too familiar. 

The article is worth reading for many reasons.  For one, she covers a lot of ground: therapy, drugs, suicide, and relationships.  For another, while the story may not be a unique one, her ability to use language to make a point or to describe an emotion, is almost painfully beautiful and right on target. 

In some way, the quiet terror of severe depression never entirely passes once you’ve experienced it. It hovers behind the scenes, placated temporarily by medication and renewed energy, waiting to slither back in, unnoticed by others. It sits in the space behind your eyes, making its presence felt even in those moments when other, lighter matters are at the forefront of your mind. It tugs at you, keeping you from ever being fully at ease. Worst of all, it honors no season and respects no calendar; it arrives precisely when it feels like it.” 

My only issue with the essay is the ending.  For a woman who has “…not been free of psychotropic medication for any substantial period since [her] early 20s,” and admits to gobbling down a “…medley of pills — Lamictal, Risperdal, Wellbutrin and Lexapro,” she seems content with the idea that Abilify is the answer, albeit a temporary one. 

While I am always happy that someone has even momentary relief from the pain of depression, I can’t help but have that feeling overshadowed by disappointment at the fact that these stopgap measures are our only, short-lived, salvation. 

How long will we have to play prescription Russian roulette, wasting precious months, even years, as we wait to see what combination will work for us, all the while knowing that the solution is never permanent?  Never a cure.  While Ms. Merkin’s essay tries to end on a positive note, it is at best, a bittersweet one.

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Lush LifeHe had no particular talent or skill, or what was worse, he had a little talent, some skill: playing the lead in a basement-theater production of “The Dybbuk” sponsored by 88 Forsyth House two years ago, his third small role since college, having a short story published in a now-defunct Alphabet City literary rag last year, his fourth in a decade, neither accomplishment leading to anything; and this unsatisfied yearning for validation was starting to make it near impossible for him to sit through a movie or read a book or even case out a new restaurant, all pulled off increasingly by those his age or younger, without wanting to run face-first into a wall.” “Lush Life” by Richard Price.

Nothing can ruin your day quite like turning on the television and seeing Meredith Vieira interviewing a friend of yours. But there I was, standing in the kitchen, hair still matted from sleep, eyes still waiting for that first cup of coffee before being truly able to focus, and a fresh bowl of Kashi GOLEAN Crunch cereal swimming in two percent milk, when Romi, looking every bit like a celebrity, pauses for a brief moment before answering one of Meredith’s questions.

True Confession: This person is really more of an acquaintance than a friend, but that distinction is further lost on me as I watch her interact with Hoda & Kathie Lee a few days later.

After the segment ends, glutton for punishment that I am, I turn off the TV, turn on the Mac, and Google my friends’ name. The result: page after page, link after link of websites, blogs, newspapers and podcasts, all about said acquaintance and her recent book tour. As I perused the websites, read the blogs and scanned the book reviews, I have to admit that I was genuinely happy for her.

But I know how the mind works. Our subconscious isn’t sub for nothing. While I sensed no obvious feelings of jealousy, never having been a person motivated by fame or fortune, there was, there had to be some underlying feeling of…what?

Can a person observe someone else’s success without being reminded of their own failure?

As a person who struggles with bipolar disorder, I find the concept of success elusive. The “manic” me applies to grad school without giving it a second thought. The “depressed” me is the one who actually has to show up for class and hand in assignments. No matter what I do, it never seems like it’s enough. “Manic” me builds sand castles not far enough from the shore and “depressed” me is left with the impossible task of fending off high tide.

True Mom ConfessionsTrue Confession: While it’s true that I have no desire to be famous, I do have to admit that, even though its not a motivating factor, I wouldn’t mind being rich.

We live in a competitive world where everything is constantly being measured and judged: the top ten…the six most…the world’s best…the biggest…the fastest…the cheapest…and on and on. If we are not the best or the fittest or the smartest, what are we? And while we can celebrate another’s success, congratulate them on a job well done, and really truly be happy for them, isn’t there something, somewhere, in the deepest recesses of our minds that leaves behind a residue that reads, “I’m not worthy,” that makes it just that much more difficult to extend the effort?

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