What it is like to live with clinical depression

Storm cloudsIt’s been a little more than fifteen years now since I was first diagnosed as clinically depressive. I haven’t really talked about it much in that time, here or anywhere else. Partly this is for the same reason that I don’t talk about myself more generally — my assumption is most people would find the day-to-day details of my life to be as dull as dishwater. I mean, I’m a computer programmer, not James Bond, you know?

But it’s also in part because I’m a coward. Depression (and mental illness overall) still carries a stigma. It changes how people look at you, even if they don’t want it to. You can see it in their eyes. And I was afraid of what it would mean if that look was the look I got from everybody. So I kept quiet.

But that stigma will never go away if as those of us who live with this never talk about it, right? Right. So fuck it, let’s talk.

Sorrow vs. despair

Those people I’ve spoken to about it who don’t have it themselves generally assume that depression is analogous to the worst bumming-out they’ve ever had, only worse. They think about some event that made them really sad — the death of a loved one, the end of an important relationship, some major decision they made the wrong way, something like that — and then figure it’s more or less the same thing, only, like, times two.

Maybe for some people it’s like that; I can only speak to my own experience. And in my experience, it’s not like that at all. There’s a distinction, I would argue, between that kind of feeling — let’s call it sorrow — and what the clinical depressive feels, which is closer to something like despair.

The main thing about sorrow is that it’s a temporary condition. No matter how deep it is, eventually it wanes. Like a physical wound, given time, it will heal. It may leave some ugly scars behind, but the skin closes, the bones knit. And while we may not feel that at a conscious level, somewhere, deep down, we know it. We know that the dark tunnel has an end, even if we can’t see any light at the moment. So we have hope, a reason to keep plodding through.

Despair is more existential, because part of it is the fear that it has no end. That this is just the way the world is, now and forever. That nothing will change, because nothing can change. And despair is the depressive’s lot, because we carry our tragedy around with us in our head. You can’t run from it by changing jobs or moving to a new city — though God knows, we try! — because you’re just going to take your head along with you. Try to escape and you just find it stalking you, its teeth bared, its eyes hungry.

Depression is a battle you know you can’t win, an enemy you know you can’t defeat. It’s a war that never ends. All you can do is arm yourself and train so you’re ready whenever it strikes.

The physicality of depression

The other distinction I would make between regular sadness and clinical depression is the sheer physicality of the latter. It’s not just something you feel in your heart, it’s something you feel in the rest of your body too. It engages your senses in a way that regular sadness does not.

The best way I can describe the experience is like this: it’s like a tornado sweeping across the prairie of your mind.

Sometimes it comes out of nowhere, but usually not. Usually it approaches the way a real storm does — slowly, tentatively. Clear skies cloud over, a breeze becomes a gust. It can be triggered by some event in your life, some failure or rejection or snub, but just as frequently it comes for no discernible reason whatsoever.

And then it comes, and when it comes, it comes hard. Your brain fills with noise, with static, like an old broadcast TV would do when lightning crashed around it. The signal of your thoughts distorts, breaks up, until all there is is the noise, roaring like a freight train through your consciousness.

But the experience isn’t just in your mind. It’s tactile, and it’s everywhere. Everything you’ve ever failed at, every mistake you’ve ever made, all of them are suddenly converted into dead weight, and that weight lands on you like a ton of bricks. I mean that literally — it presses down on you, like the hand of an angry god. You feel every ounce. If you’re standing, you want to sit; if you’re sitting, you want to lie down. If you’re lucky, you just sag under the weight of it. You want to lay down and pull a blanket over your head.

Things go along like that for however long they’re going to go this time, and pretty much the only thing you can do in the meantime is ride out the storm. You can still be somewhat productive if you’ve got some simple manual labor to do — take out the trash, walk down the street for lunch, go get the mail — but cognitive labor is difficult or impossible; your brain, for the moment, has problems of its own to deal with.

Eventually, though, it passes. The weight lessens, the noise quiets, the static clears. The storm starts to move off into the distance. You can open your eyes and think a complete thought again. Hooray! It’s over! Until the next time.

Learning to ride a tiger

As the Chinese say, one who rides on the back of a tiger will find it difficult to dismount. So what can we, those of us who are stuck on the back of this tiger, do? We can’t get off, but can we learn to live something like a normal life?

There are ways. The big one is, of course, medication. People like to rage about Big Pharma, and they certainly do plenty of things to justify that rage, but antidepressants work and can be a literal life-saver. With the right meds, the attacks can become both less frequent and less severe. They can dull the pain, limit the weight, turn down the volume on the roaring noise to a point where it becomes an annoyance instead of a debilitating handicap. To a point where you can live and work and do all the things that make a life. To a point where you can live again.

Nothing’s perfect, of course, and antidepressants aren’t exempt. The big problem is that doctors don’t really understand why they work, only that they do. (They have theories, but nobody’s been able to prove one conclusively yet.) So finding the right meds for a particular patient is as much an art as a science; it can take a few tries to find a medication or combination of medications that are actually effective at reducing that person’s suffering. And like most medications, antidepressants can have side effects of varying degrees of severity. It’s therefore possible that the patient will have to wade through whole new types of physical problems as their doctors try different meds on them, which for an already-depressed person is sort of piling insult upon injury. (And even effective meds can have blowback effects: some useful antidepressants cause people to put on weight, for instance, and nobody ever solved their self-image problems by getting fatter.)

All of which probably sounds like it sucks, because it does. But it usually sucks less than the alternative, which is going through all those attacks over and over again for your entire life without anything to blunt their force. So if you’re depressive, and you’ve been avoiding pharmacological treatment out of fear of the meds, I urge you to reconsider. Meds are tough, but living with depression without treatment is much, much tougher. (Not to mention that many people who avoid medication just end up self-medicating themselves with alcohol or drugs, which can bring whole new catgories of suffering on their own.)

Beyond medication, there’s also more traditional psychotherapy — “talk therapy,” where you work through your problems on a doctor’s couch. There’s plenty of debate about how effective this can be, so your mileage may vary. I was fortunate enough to find a very good therapist not long after my diagnosis, though, and over the course of a couple of years she helped me immensely.

Because the root of my depression was biological rather than psychological, there wasn’t much she could do to help me address that. But what she could do was learn to recognize the self-defeating ways I reacted to the depression, and break out of those negative, recurring patterns. She was a cognitive-behavioral therapist, and the central insight of cognitive-behavioral therapy is that over our lives we develop standard reactions to various kinds of internal and external stimuli — reactions seated so deep in our consciousness that we never really even think about them; we just react, the way a child reacts when it touches a hot stove. But because they’re pure impulse, these reactions can be unhelpful, or even actively harmful. So improving your life becomes a matter of recognizing these patterns, and then training yourself to break out of the ones that hurt more than they help.

I found this approach incredibly powerful for dealing with depression, because part of the problem with depression is that depressives frequently do really, really stupid things to try and cope with living with it. We spend money we don’t have buying things we don’t need, because we think the shiny new thing will cheer us up. We drink too much and ingest substances we shouldn’t and have sex with people we really should not be having sex with in a search for something powerful enough to dull the pain. But we don’t do these things consciously; we do them instinctively, following patterns that we learned a long time ago, often as children too young to even understand we were learning something that would echo in our mind for the rest of our lives. So learning to spot these tics, and eventually to free yourself from them, can liberate you from a hamster wheel of self-destruction.

There’s plenty of other consolations in the world besides these — philosophy and art, creation and accomplishment, and friendship and love, to name a few — but while those are all good and can all be helpful in varying degrees, nothing beats meds and talk. Meds and talk are the reason I live a productive life today. Meds and talk are how you learn to ride the tiger.

I don’t really have a snappy ending for this essay. I wish I did; as a writer, few things feel better to me than wrapping up an argument with some really powerful statement, some punch that takes the point I’m trying to make and drives it right between the reader’s eyes. So I’ll just end by saying that hopefully reading about my experiences will help at least one other person out there realize that they’re not alone, and that there is hope. Because the only way we will ever heal the world is by tending to each other, one by one.