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Andrew Solomon 談憂鬱,我們共有的秘密

Andrew Solomon: Depression, the secret we share

 

Photo of three lions hunting on the Serengeti.

講者:Andrew Solomon

2013年10月攝於TEDxMet

 

翻譯:洪曉慧

編輯:朱學恒

簡繁轉換:洪曉慧

後制:洪曉慧

字幕影片後制:謝旻均

 

影片請按此下載

MAC及手持裝置版本請按此下載

閱讀中文字幕純文字版本

 

關於這場演講

「憂鬱的反面並非快樂,而是活力,當時我感到活力似乎逐漸離我遠去。」在這場意義深遠且顛覆性的演講中,作家Andrew Solomon將我們帶入他與憂鬱抗爭期間內心最黑暗的角落。這使他展開世界探索之旅,採訪其他憂鬱症患者-結果驚訝地發現,他分享得越多,越多人願意分享自己的故事。(攝於TEDxMet)

 

關於Andrew Solomon

Andrew Solomon是作家,撰寫政治、文化、心理相關著作。

 

為什麼要聽他演講

Andrew Solomon 2012的著作《背離親緣:父母、孩子與自我探索》(Far From the Tree: Parents, Children, and the Search for Identity),闡述父母不僅學習如何對待特殊兒童,也在過程中發掘其中蘊含的深意。Solomon令人震驚的論點是,多樣性使我們緊密相繫。他撰寫關於因應罹患失聰、侏儒症、唐氏症、自閉症、精神分裂症、多重嚴重殘疾兒童的家庭,以及天才兒童、因強姦而受孕之兒童、成為罪犯之兒童、變性兒童的故事。他在每一個篇章中,紀錄他們在同情與愛中的掙扎-雖然彼此大不相同,但共享深刻聯繫。

 

深入探索這些勇敢而值得肯定的故事是Solomon接受自我的旅程,受到這個研究的影響,導致他決定在中年時扮演父母的角色。Solomon的上一本著作,《正午的惡魔:憂鬱症指南》(The Noonday Demon: An Atlas of Depression),榮獲2001年美國國家圖書非小說類獎。

 

Andrew Solomon的英語網上資料

Home: AndrewSolomon.com

Twitter: @Andrew_Solomon

Book: Far From the Tree

 

[TED科技‧娛樂‧設計]

已有中譯字幕的TED影片目錄(繁體)(簡體)。請注意繁簡目錄是不一樣的。

 

Andrew Solomon 談憂鬱,我們共有的秘密

 

「我腦海裡浮現一場葬禮,悼念者來來去去,不停地踩踏,直到穿透我的意識。當眾人入座,儀式開始,彷彿鳴鼓般不斷地敲擊,直到我的意識逐漸麻木。我聽見他們抬起棺木,同樣地鉛靴聲再次響起,穿透我的靈魂。喪鐘開始迴盪四周,天空彷彿是座大鐘,存在彷彿是隻耳朵。我與寂靜,某種奇特的族類,獨自在此腐朽。就在此時,理性斷了弦,我不斷墜落,墜入一個又一個世界,最後失去知覺。」

 

我們藉由隱喻瞭解憂鬱。愛蜜莉.狄更生(美國女詩人)藉由語言詮釋;哥雅(西班牙畫家)藉由圖像表達,藝術的目的之一就是為了描述這種象徵狀態。

 

對我來說,我總是認為自己非常堅強,是那種即使被送去集中營也能生存的人。

 

1991年,我經歷一連串不幸:母親去世、愛情終結。歷經數年海外生活後,我返回美國。經歷這一切之後,我依然安然無恙。

 

但1994年,也就是三年後,我發現自己幾乎對任何事物都失去興趣,甚至不想做任何之前想做的事,我不知道為什麼。憂鬱的反面並非快樂,而是活力。當時我感到活力似乎逐漸離我遠去,所有該做的事似乎都麻煩透頂。回家後看見答錄機閃爍的紅燈,我並非因朋友來電而欣喜,而是想:「怎麼有那麼多電話得回。」或者我決定該吃午餐了,心裡卻想,我還得把食物拿出來,放進盤子裡,切它、嚼它、咽下它,感覺彷彿耶穌受難。

 

關於憂鬱的討論經常被忽略的一點是,你知道這一切荒謬透頂,你經歷這一切時即知道這相當荒謬,你知道大多數人都能聽留言、吃午餐,讓自己沖個澡、走出家門,這不是什麼大不了的事,你卻逃不出它的手掌心,無法找到任何解決辦法。於是我開始意識到,自己做得少、想得少、感覺得少,彷彿是個空殼。

 

然後焦慮接踵而至。如果你告訴我下個月我會處於憂鬱狀態,我會說,「只要知道它會在十一月結束,我可以承受。」但如果你告訴我,「下個月你會處於極度焦慮狀態。」我寧可割腕也不願經歷。那是一種如影隨形的感覺,就像你走在路上,突然滑倒或絆倒,地面衝向你的感覺。但這種感覺並非持續半秒,而是半年。那是一種時時刻刻處於恐懼中的感覺,但甚至不知道自己恐懼什麼。就在那時,我開始思考,活著太痛苦了,唯一沒走上自殺一途的原因是為了不想傷害其他人。

 

終於,某天我醒來時,感到自己或許中風了,因為我躺在床上,完全無法動彈。我盯著電話,心想,「情況不太對勁,我應該打電話求助。」但我無法伸手拿電話撥號。終於,我躺在床上盯著電話整整四小時後,電話響了。我設法拿起話筒,是父親打來的。我說,「我遇上大麻煩了,我們必須做點什麼。」

 

隔天我開始吃藥,接受治療,也開始思考這個可怕的問題:如果我不是那種堅強到能在集中營裡存活下來的人,那我是什麼樣的人?如果我需要吃藥,那麼藥物的作用是讓我變得更像自己,還是讓我更不像自己?如果它讓我變得不像自己,我如何意識到這一點?

 

在這場抗爭中,我有兩項優勢。首先是,我知道客觀來說我擁有不錯的生活,如果我能恢復健康,憂鬱的彼岸將有某些值得我為之而活的事物。另一項優勢是,我能獲得良好的治療。

 

儘管如此,我好轉後又復發、好轉後又復發、好轉後又復發,最後我意識到我得一輩子依賴藥物及治療,於是我想,「這到底是化學問題,還是心理問題?這需要化學療法、還是心理療法?」我無法找出答案。然後我意識到,事實上我們在兩個領域的進展都不足以完整解釋這個謎團。化學療法及心理療法都有其作用,我也意識到憂鬱是某種與我們緊密相繫的東西,無法將它與我們的性格及特質徹底分離。

 

我想說的是,目前治療憂鬱的方法太糟了,沒什麼效果、相當昂貴、且伴隨無數副作用,簡直就是災難。但我十分慶幸活在現今,而非50年前。當時幾乎沒有任何治療方法。我希望50年後,人們聽見我接受的療法,會震驚於竟有人必須忍受如此粗陋的科學。

 

憂鬱是愛的瑕疵,如果你跟某人結婚,然後想,「好吧,如果妻子過世,我會再找個新的。」這並非我們所認為的愛。沒有一種愛不包含對失去的預期,這種絕望的陰影將成為親密關係的動力。

 

人們很容易混淆三種情緒:憂鬱、悲傷、難過。悲傷是一種明確反應,如果你失去某樣東西、感到相當不快樂,六個月後你依然相當難過,但狀況稍微好些,這或許是悲傷,或許最後在某種程度上能夠自癒。如果你遭受慘痛損失,感覺相當糟,六個月後你依然無法正常生活,這或許是悲慘境遇引發的憂鬱。這些發展軌跡讓我們得知許多資訊。人們認為憂鬱只是難過而已,太多的難過、太多的悲傷,起因卻微不足道。

 

當我開始著手瞭解憂鬱,採訪擁有這種經歷的人,我發現有些人表面上看來似乎屬於較輕度的憂鬱,卻完全喪失正常生活能力。根據另一些人的描述,他們似乎經歷相當嚴重的憂鬱,卻在憂鬱發作的間隙過著不錯的生活,於是我開始探索使某些人更具適應性的原因。什麼機制使這些人得以倖免?於是我採訪一個又一個飽受憂鬱所苦的人。

 

我第一個採訪對象將憂鬱描述為一種緩慢的死亡方式。對我來說,罹病初期獲得這項資訊是件好事,因為這提醒我緩慢的死亡方式可導致真正的死亡,這是相當嚴重的事。這是全球主要的疾病之一,每天都有人因此死亡。

 

當我試著瞭解這一點時,其中一位採訪對象是我相識多年的摯友,她大一時曾罹患精神疾病,之後陷入嚴重憂鬱狀態。她罹患雙極性情緒障礙,或當時稱之為躁鬱症。多年來,她在鋰鹽治療下,病情控制得非常好,最後她停止服用鋰鹽,看看是否能脫離對藥物的依賴,結果舊疾復發,陷入我見過最嚴重的憂鬱狀態。她待在父母的公寓裡,不時出現緊張性精神症狀,幾乎足不出戶,日復一日。幾年後,當我採訪她當時的經歷時-她目前是詩人兼心理治療師,名叫Maggie Robbins-當我採訪她時,她說,「我一遍又一遍地唱著《花落何處》來佔據我的思緒,藉此屏除腦海裡不斷浮現的話語:『你一文不值,只是無名小卒,甚至不配活在世上。』那就是我真正開始浮現自殺念頭的時候。」

 

在憂鬱狀態中,你不認為自己戴著一層灰色面紗,正透過壞情緒的陰霾看待這個世界。你認為快樂的面紗已被摘掉,現在所見的才是事實。幫助精神分裂症患者較容易,他們認為體內存在某種異質,需要被驅除。但幫助憂鬱症患者十分困難,因為我們堅信自己看到的是事實。

 

但事實並非真相。我深受這句話吸引:「事實並非真相。」當我與憂鬱症患者交談時,發現他們擁有許多妄想念頭。當人們說,「沒人愛我。」你會說,「我愛你,你的妻子愛你,母親愛你。」你能夠迅速地這麼回答,至少大多數人都是如此。但憂鬱症患者還會說,「無論我們做什麼,終究不免一死。」或者他們會說,「兩個人之間不可能存在真正的親密關係,每個人都束縛在各自的身體中。」你得這麼回答,「確實如此,但我認為目前我們該在乎的是早餐吃什麼。」(笑聲)許多時候,他們所呈現的並非疾病,而是觀點差異。他們認為非比尋常的事,是大多數人知道、但不甚在意的存在性問題。有個我特別喜歡的研究是,要求一組憂鬱症患者及一組非憂鬱症患者分別打一小時電玩,一小時結束後,詢問他們認為自己殺了多少隻小怪獸。憂鬱組的準確度通常相差不到10%,非憂鬱組的人估計殺掉的小怪獸數量約為實際值的15至20倍。(笑聲)

 

當我決定寫下自己的憂鬱經歷時,許多人說,將這個秘密公諸於世肯定相當不容易。他們說,「人們會用不一樣的態度跟你說話嗎?」我說,「是的,人們會用不一樣的態度跟我說話。」其中差異在於,他們開始告訴我自身經歷,或他們姐妹的經歷,或他們朋友的經歷。不同之處在於,我現在明白憂鬱症是存在於每個家庭的秘密。

 

幾年前,我參加一場會議。三天會議中的星期五,其中一位與會者把我拉到一旁,她說,「我罹患憂鬱症,這讓我有點難為情,但-我一直服用某種藥物,我只是想問問你的看法?」因此我盡我所能地給了她一些建議。然後她說,「你知道,我丈夫永遠無法理解這種病,他是那種認為這是無稽之談的人,所以-呃-你知道,請幫我保密。」我說,「好,沒問題。」周日,在同一場會議中,她丈夫把我拉到一旁。他說,「如果我妻子知道這件事會認為我不像個男子漢,但-我一直與憂鬱抗爭,正在服用某種藥物,我想聽聽你的看法?」他們將同一種藥物藏在同一間臥室裡不同地方。於是我說,我認為婚姻中的溝通問題或許是這個病症的導火線之一。(笑聲)但我也震驚於這種共同秘密所造成的沉重負擔。憂鬱令人精疲力盡,佔據人們太多時間和精力,對此保持沉默只會讓憂鬱變本加厲。

 

我開始思考所有使憂鬱症患者好過一點的途徑。最初我對治療採取保守看法,我認為少數幾種療法確實有效,就那麼幾種-藥物治療、特定心理療法,也許還包括電療,其它方法都毫無意義。但後來我有所領悟。如果你罹患腦癌,你認為每天早晨倒立20分鐘會好過一些,這或許會讓你好過一些,但腦瘤依然存在,你依然可能因此而死。但如果你罹患憂鬱症,你認為每天倒立20分鐘會好過一些,那確實有效。因為憂鬱是你的感覺出了問題,如果你感覺好些,顯然就不再處於憂鬱狀態,因此我對世上各種另類療法變得寬容多了。

 

我收到數百封信,人們寫信與我分享對他們有效的療法。今天某個人在後台問我關於治療的事,我最喜愛的一封信來自一位女士。她說她試過心理療法、藥物治療,她幾乎試過所有療法,最後她發現一個有效方法,希望我告訴全世界,那就是用毛線做點小東西(笑聲)。她還送了我一些(笑聲),我現在沒穿在身上。我建議她也該查查《精神疾病診斷與統計手冊》中的強迫症症狀。

 

然而,當我試著瞭解另類療法時,也獲得對其他療法的認知。我在塞內加爾參與過一場部落驅魔儀式,其中使用了大量公羊血,我就不在這裡詳述了。但幾年後,我前往盧安達參與另一項計畫時,碰巧與某個人談到那場經歷。他說,「嗯,你知道,那是西非,這裡是東非,以某方面來說,我們的宗教儀式大不相同,但我們確實有某些宗教儀式與你描述的雷同。」我說,「喔。」他說,「是的。」然後說,「但我們與西方心理健康工作者有不少爭執,尤其是大屠殺事件後前來的那些。」我說,「什麼樣的爭執?」他說,「嗯,他們老做些古怪的事。他們不帶人們到戶外曬太陽,這會讓人好過一些。他們不用鼓聲或音樂振奮人們的精神,他們不讓整個社區參與其中,他們不讓憂鬱成為具體化的惡靈。相反地,他們所做的是將人們單獨帶進一個昏暗的小房間,花一個小時讓他們敘述所經歷的悲慘遭遇。」(笑聲)(掌聲)他說,「我們只好請他們離開這個國家。」(笑聲)

 

現在,關於另類療法的另一面,讓我以Frank Russakoff為例。Frank Russakoff的憂鬱症狀或許是我見過最嚴重的。他持續處於憂鬱狀態,當我遇見他時,他每個月都得接受電療。因此他第一周感覺有點混亂,第二周還算正常,第三周開始走下坡,然後接受另一次電療。當我遇見他時,他說,「這種生活令人難以承受,我無法再這麼下去。我知道如果不能好起來會有什麼結果,但是,」他對我說,「我聽說麻省總醫院正在進行一種腦部手術試驗,叫迴帶扣切開術,我想我會試試看。」我依然記得當時的震驚,想到某個人顯然擁有太多悲慘經歷、忍受過太多不同療法,內心深處依然擁有足夠的樂觀,不斷進行嘗試。他做了迴帶扣切開術,出乎意料地成功,現在他成了我的朋友,他有一個可愛的妻子和兩個漂亮的孩子。手術後那個聖誕節,他寫了一封信給我,他說,「父親今年送我兩件禮物,第一件是The Sharper Image電動CD架,我不是很需要,但我知道他是為了慶祝我能獨立生活,並擁有一份喜愛的工作。另一件禮物是祖母的相片,她自殺身亡。當我拆開包裝時,忍不住開始哭泣。我母親上前問道:『你是因為從未見過祖母而哭嗎?』我說,『她擁有和我相同的疾病。』寫到這裡,我又忍不住哭泣,不是因為太過悲傷,而是太過感動。因為我也可能走上自殺一途,但父母一路支持我,還有治療我的醫生。我有幸接受這個手術,我活著,心懷感恩。我們生活在對的時代,儘管並非總是美好。」

 

我對人們普遍將憂鬱症視為現代西方中產階級特有疾病十分感興趣,因此我開始探索它在各種環境中的影響。我最感興趣的是憂鬱症對貧困者的影響,因此試著探索貧困者如何因應憂鬱症。我發現罹患憂鬱症的貧困者多半不曾接受治療。憂鬱症源於基因缺陷,意味著它平均分佈於各個族群,環境的觸發對貧困者的影響似乎更加嚴重。事實上,如果你的生活一帆風順,卻總是感到不快樂,你會思考:「為何我有這種感覺?肯定是罹患憂鬱症了。」然後設法尋求醫療協助。但如果你的生活相當糟,你總是感到不快樂,你的感受與生活狀態成正比,你不會想到:「也許這是可以治療的。」因此在我國貧困族群中,憂鬱症彷彿流行病,卻不曾受到注意,不曾採取治療、不曾獲得解決,這是相當大的悲劇。因此我找到一位學者,當時她在華盛頓特區周遭的貧民窟進行相關研究。她邀請為了其他健康問題前來求診的女性進行憂鬱症診斷,並提出為期六個月的實驗計畫。其中一位名叫Lolly的女士前來求診,當時她說她是已婚婦女-順帶一提,她有7個孩子-她說,「我曾經有份工作,但不得不辭職,因為我無法離開家中。我與孩子無話可說,早晨時,我迫不及待地希望他們離開,然後爬上床,蒙頭大睡。下午三點,他們返家時,感覺時間似乎過得太快了。我持續服用大量Tylenol(止痛藥),任何能讓我多睡一會兒的東西。丈夫總是說我蠢、說我醜,我希望能結束這種痛苦。」

 

於是她參與這項實驗計畫。六個月後,當我採訪她時,她找到一份為美國海軍照顧孩子的工作。她離開了那位虐待狂丈夫,她對我說,「我的孩子現在快樂多了。」她說,「現在我的新家有一間男孩臥室、一間女孩臥室,但晚上時,他們都聚在我的床上。我們一起做功課,做所有的事。一個孩子想當牧師,一個孩子想當消防員,其中一個女兒說她想當律師。他們不像以前那麼愛哭、那麼愛爭執,只要有這些孩子我就心滿意足了。情況持續改觀,我的穿著、我的感覺、我的言行。我不再恐懼外出,不再擔心那些糟糕情緒會捲土重來。如果不是Miranda博士,現在我仍然在家裡蒙頭大睡。如果我能活到現在,我曾乞求上帝派一位天使幫助我,祂聽見我的禱告。」

 

我深這些經歷感動,我決定寫下這些故事。不僅是一本書,還有一篇報導。因此我接受《紐約時報雜誌》的委託,撰寫關於貧困者憂鬱症的情形。

 

當我交出這篇故事後,編輯打電話跟我說,「我們實在無法刊登這個故事。」

 

我說,「為什麼?」

 

她說,「內容太牽強了。這些人可說是生活在社會最底層,經過幾個月的治療,他們就有能力經營摩根士丹利(國際金融服務公司)?太離譜了。」她說,「我從未聽過像這樣的事。」

 

我說,「你從未聽過,正代表這是新聞。」(笑聲)(掌聲)「而你們是新聞雜誌。」

 

因此經過多次協商後,他們同意刊登,但我認為他們的說法與許多奇特的認知息息相關。即人們對治療的想法仍持負面態度,彷彿意味著如果我們大規模治療貧困族群,將是一種剝削,因為我們著手改造他們。這種錯誤的道德教條似乎存在於我們四周,即憂鬱症療法、藥物治療等等都是人為產物,並非自然結果。我認為這完全是謬誤的觀念。人掉牙齒是自然現象,但沒有人會反對使用牙膏,至少我周遭沒有。

 

人們或許會說,「好吧,但憂鬱不是人類該經歷的過程嗎?難道憂鬱不是演化的結果?難道它不是性格的一部分?」對此,我會說,情緒具適應性,能感受悲傷、恐懼、喜悅、快樂及所有其他人類擁有的情緒是相當珍貴的事。憂鬱的主因在於這個系統出了問題,不再具有適應性。

 

人們會對我說,「但我認為,如果能再撐一年,我認為我能克服憂鬱。」

 

我總是對他們說,「你或許能克服它,但再也無法回到37歲。人生苦短,你卻準備浪費一年時間?仔細思考一下。」

 

英語詞彙相當貧乏,大多數語言亦是如此。同樣「depression」這個字,我們用來描述孩子生日當天遇上下雨的心情,也用來描述某人自殺前一分鐘的感覺。

 

人們問我,「嗯,這是否是持續處於悲傷狀態?」我會說,以某種程度來說確實如此,其中存在一定關聯,但這種關聯就像屋外的鐵欄杆有一點銹斑,你需要用砂紙將它磨掉,重新上漆。如果你的房子100年沒人住,將銹蝕到只剩一堆橘銹。我們需要解決的問題就像銹斑逐漸變成橘銹的問題。

 

因此現在人們會問我,「服用這些快樂丸(指抗憂鬱藥)會讓你感到快樂嗎?」不,但我不會因為必須吃午餐而悲傷,不會因為電話答錄機而悲傷,不會因為洗澡而悲傷。事實上,我認為我的感受更加豐富。因為我能感受悲傷,但不會因此消沉。我因工作不如意而悲傷,因破碎的愛情而悲傷,因全球暖化而悲傷,這些是目前令我感到悲傷的事。我自問,好,結論是什麼?為何那些生活條件較佳者卻需要克服更嚴重的憂鬱?其中的復原機制為何?我不時遇見某些不願承認這段經歷的人,他們說,「憂鬱已是陳年往事,我不願再回想、分析那段經歷,我只想繼續往後的人生。」諷刺的是,正是這些人最容易被過往經歷束縛,逃避憂鬱只會讓它壯大。你越是隱藏,它越茁壯。表現較佳的人,是那些能正視自己曾處於這種狀態的人;最終能復原的人,是那些能正視憂鬱的人。

 

因此Frank Russakoff對我說,「如果一切重新來過,我想我不會採取這種方式。但奇怪的是,我很感激經歷過的一切。我很高興曾住院40次,這讓我更瞭解愛。我和父母、醫生的關係對我來說珍貴無比,永遠如此。」

 

Maggie Robbins說,「我曾在愛滋診所擔任志工,我只是不斷地和協助對象交談,但他們的反應並不積極,於是我想:『這對他們似乎不太有幫助。』後來我意識到,第一次見面時,他們只想進行幾分鐘簡短談話,實際情況不過是:我沒有愛滋病,我並未面臨死亡威脅,但我能接受他們罹病且面臨死亡的事實。人類的需求是最寶貴的資產,後來我學會設身處地幫助他人。」

 

正視憂鬱無法保證不再復發,但或許能使病患對復發有所準備,甚至使復發過程更容易承受。問題不在於尋找並賦予你的憂鬱深刻意義,而是當它捲土重來時,尋找並思考其中意義:「這就像身處地獄,但我將從中學習某些東西。」我從自己的憂鬱領悟到情緒的影響多麼巨大,甚至比事實更真切。我發現這段經歷使我得以更深刻、更專注地體會正面情緒。憂鬱的反面並非快樂,而是活力。這段期間,我的生命充滿活力,甚至當我處於悲傷狀態時。我腦海裡浮現一場葬禮,我身處世界盡頭,坐在羅德島巨像旁。我發現體內某些東西,稱之為靈魂的東西,直到20年前才成型。當地獄突然降臨,我想,儘管我痛恨處於憂鬱狀態,痛恨舊疾復發,我已找到喜愛憂鬱的方式。我愛它,因為它迫使我追尋並珍惜快樂;我愛它,因為我每天都下定決心,雖然有時充滿勇氣,有時不甚理性,依然堅守生存的理由。我想,這是相當值得高興的事。

 

謝謝。

 

(掌聲)

 

以下為系統擷取之英文原文

About this Speak

"The opposite of depression is not happiness, but vitality, and it was vitality that seemed to seep away from me in that moment." In a talk equal parts eloquent and devastating, writer Andrew Solomon takes you to the darkest corners of his mind during the years he battled depression. That led him to an eye-opening journey across the world to interview others with depression — only to discover that, to his surprise, the more he talked, the more people wanted to tell their own stories.

About he Author

Andrew Solomon is a writer on politics, culture and psychology. Full bio.

Transcript

We know depression through metaphors. Emily Dickinson was able to convey it in language, Goya in an image. Half the purpose of art is to describe such iconic states.

As for me, I had always thought myself tough, one of the people who could survive if I'd been sent to a concentration camp.

In 1991, I had a series of losses. My mother died, a relationship I'd been in ended, I moved back to the United States from some years abroad, and I got through all of those experiences intact.

But in 1994, three years later, I found myself losing interest in almost everything. I didn't want to do any of the things I had previously wanted to do, and I didn't know why. The opposite of depression is not happiness, but vitality, and it was vitality that seemed to seep away from me in that moment. Everything there was to do seemed like too much work. I would come home and I would see the red light flashing on my answering machine, and instead of being thrilled to hear from my friends, I would think, "What a lot of people that is to have to call back." Or I would decide I should have lunch, and then I would think, but I'd have to get the food out and put it on a plate and cut it up and chew it and swallow it, and it felt to me like the Stations of the Cross.

And one of the things that often gets lost in discussions of depression is that you know it's ridiculous. You know it's ridiculous while you're experiencing it. You know that most people manage to listen to their messages and eat lunch and organize themselves to take a shower and go out the front door and that it's not a big deal, and yet you are nonetheless in its grip and you are unable to figure out any way around it. And so I began to feel myself doing less and thinking less and feeling less. It was a kind of nullity.

And then the anxiety set in. If you told me that I'd have to be depressed for the next month, I would say, "As long I know it'll be over in November, I can do it." But if you said to me, "You have to have acute anxiety for the next month," I would rather slit my wrist than go through it. It was the feeling all the time like that feeling you have if you're walking and you slip or trip and the ground is rushing up at you, but instead of lasting half a second, the way that does, it lasted for six months. It's a sensation of being afraid all the time but not even knowing what it is that you're afraid of. And it was at that point that I began to think that it was just too painful to be alive, and that the only reason not to kill oneself was so as not to hurt other people.

And finally one day, I woke up and I thought perhaps I'd had a stroke, because I lay in bed completely frozen, looking at the telephone, thinking, "Something is wrong and I should call for help," and I couldn't reach out my arm and pick up the phone and dial. And finally, after four full hours of my lying and staring at it, the phone rang, and somehow I managed to pick it up, and it was my father, and I said, "I'm in serious trouble. We need to do something."

The next day I started with the medications and the therapy. And I also started reckoning with this terrible question: If I'm not the tough person who could have made it through a concentration camp, then who am I? And if I have to take medication, is that medication making me more fully myself, or is it making me someone else? And how do I feel about it if it's making me someone else?

I had two advantages as I went in to the fight. The first is that I knew that, objectively speaking, I had a nice life, and that if I could only get well, there was something at the other end that was worth living for. And the other was that I had access to good treatment.

But I nonetheless emerged and relapsed, and emerged and relapsed, and emerged and relapsed, and finally understood I would have to be on medication and in therapy forever. And I thought, "But is it a chemical problem or a psychological problem? And does it need a chemical cure or a philosophical cure?" And I couldn't figure out which it was. And then I understood that actually, we aren't advanced enough in either area for it to explain things fully. The chemical cure and the psychological cure both have a role to play, and I also figured out that depression was something that was braided so deep into us that there was no separating it from our character and personality.

I want to say that the treatments we have for depression are appalling. They're not very effective. They're extremely costly. They come with innumerable side effects. They're a disaster. But I am so grateful that I live now and not 50 years ago, when there would have been almost nothing to be done. I hope that 50 years hence, people will hear about my treatments and be appalled that anyone endured such primitive science.

Depression is the flaw in love. If you were married to someone and thought, "Well, if my wife dies, I'll find another one," it wouldn't be love as we know it. There's no such thing as love without the anticipation of loss, and that specter of despair can be the engine of intimacy.

There are three things people tend to confuse: depression, grief and sadness. Grief is explicitly reactive. If you have a loss and you feel incredibly unhappy, and then, six months later, you are still deeply sad, but you're functioning a little better, it's probably grief, and it will probably ultimately resolve itself in some measure. If you experience a catastrophic loss, and you feel terrible, and six months later you can barely function at all, then it's probably a depression that was triggered by the catastrophic circumstances. The trajectory tells us a great deal. People think of depression as being just sadness. It's much, much too much sadness, much too much grief at far too slight a cause.

As I set out to understand depression, and to interview people who had experienced it, I found that there were people who seemed on the surface to have what sounded like relatively mild depression who were nonetheless utterly disabled by it. And there were other people who had what sounded as they described it like terribly severe depression who nonetheless had good lives in the interstices between their depressive episodes. And I set out to find out what it is that causes some people to be more resilient than other people. What are the mechanisms that allow people to survive? And I went out and I interviewed person after person who was suffering with depression.

One of the first people I interviewed described depression as a slower way of being dead, and that was a good thing for me to hear early on because it reminded me that that slow way of being dead can lead to actual deadness, that this is a serious business. It's the leading disability worldwide, and people die of it every day.

One of the people I talked to when I was trying to understand this was a beloved friend who I had known for many years, and who had had a psychotic episode in her freshman year of college, and then plummeted into a horrific depression. She had bipolar illness, or manic depression, as it was then known. And then she did very well for many years on lithium, and then eventually, she was taken off her lithium to see how she would do without it, and she had another psychosis, and then plunged into the worst depression that I had ever seen in which she sat in her parents' apartment, more or less catatonic, essentially without moving, day after day after day. And when I interviewed her about that experience some years later -- she's a poet and psychotherapist named Maggie Robbins — when I interviewed her, she said, "I was singing 'Where Have All The Flowers Gone' over and over to occupy my mind. I was singing to blot out the things my mind was saying, which were, 'You are nothing. You are nobody. You don't even deserve to live.' And that was when I really started thinking about killing myself."

You don't think in depression that you've put on a gray veil and are seeing the world through the haze of a bad mood. You think that the veil has been taken away, the veil of happiness, and that now you're seeing truly. It's easier to help schizophrenics who perceive that there's something foreign inside of them that needs to be exorcised, but it's difficult with depressives, because we believe we are seeing the truth.

But the truth lies. I became obsessed with that sentence: "But the truth lies." And I discovered, as I talked to depressive people, that they have many delusional perceptions. People will say, "No one loves me." And you say, "I love you, your wife loves you, your mother loves you." You can answer that one pretty readily, at least for most people. But people who are depressed will also say, "No matter what we do, we're all just going to die in the end." Or they'll say, "There can be no true communion between two human beings. Each of us is trapped in his own body." To which you have to say, "That's true, but I think we should focus right now on what to have for breakfast." (Laughter) A lot of the time, what they are expressing is not illness, but insight, and one comes to think what's really extraordinary is that most of us know about those existential questions and they don't distract us very much. There was a study I particularly liked in which a group of depressed and a group of non-depressed people were asked to play a video game for an hour, and at the end of the hour, they were asked how many little monsters they thought they had killed. The depressive group was usually accurate to within about 10 percent, and the non-depressed people guessed between 15 and 20 times as many little monsters — (Laughter) — as they had actually killed.A lot of people said, when I chose to write about my depression, that it must be very difficult to be out of that closet, to have people know. They said, "Do people talk to you differently?" And I said, "Yes, people talk to me differently. They talk to me differently insofar as they start telling me about their experience, or their sister's experience, or their friend's experience. Things are different because now I know that depression is the family secret that everyone has.

I went a few years ago to a conference, and on Friday of the three-day conference, one of the participants took me aside, and she said, "I suffer from depression and I'm a little embarrassed about it, but I've been taking this medication, and I just wanted to ask you what you think?" And so I did my best to give her such advice as I could. And then she said, "You know, my husband would never understand this. He's really the kind of guy to whom this wouldn't make any sense, so I just, you know, it's just between us." And I said, "Yes, that's fine." On Sunday of the same conference, her husband took me aside, and he said, "My wife wouldn't think that I was really much of a guy if she knew this, but I've been dealing with this depression and I'm taking some medication, and I wondered what you think?" They were hiding the same medication in two different places in the same bedroom. And I said that I thought communication within the marriage might be triggering some of their problems. (Laughter) But I was also struck by the burdensome nature of such mutual secrecy. Depression is so exhausting. It takes up so much of your time and energy, and silence about it, it really does make the depression worse.

And then I began thinking about all the ways people make themselves better. I'd started off as a medical conservative. I thought there were a few kinds of therapy that worked, it was clear what they were -- there was medication, there were certain psychotherapies, there was possibly electroconvulsive treatment, and that everything else was nonsense. But then I discovered something. If you have brain cancer, and you say that standing on your head for 20 minutes every morning makes you feel better, it may make you feel better, but you still have brain cancer, and you'll still probably die from it. But if you say that you have depression, and standing on your head for 20 minutes every day makes you feel better, then it's worked, because depression is an illness of how you feel, and if you feel better, then you are effectively not depressed anymore. So I became much more tolerant of the vast world of alternative treatments.

And I get letters, I get hundreds of letters from people writing to tell me about what's worked for them. Someone was asking me backstage today about meditation. My favorite of the letters that I got was the one that came from a woman who wrote and said that she had tried therapy, she had tried medication, she had tried pretty much everything, and she had found a solution and hoped I would tell the world, and that was making little things from yarn. (Laughter) She sent me some of them. (Laughter) And I'm not wearing them right now. I suggested to her that she also should look up obsessive compulsive disorder in the DSM.

And yet, when I went to look at alternative treatments, I also gained perspective on other treatments. I went through a tribal exorcism in Senegal that involved a great deal of ram's blood and that I'm not going to detail right now, but a few years afterwards I was in Rwanda working on a different project, and I happened to describe my experience to someone, and he said, "Well, you know, that's West Africa, and we're in East Africa, and our rituals are in some ways very different, but we do have some rituals that have something in common with what you're describing." And I said, "Oh." And he said, "Yes," he said, "but we've had a lot of trouble with Western mental health workers, especially the ones who came right after the genocide." And I said, "What kind of trouble did you have?" And he said, "Well, they would do this bizarre thing. They didn't take people out in the sunshine where you begin to feel better. They didn't include drumming or music to get people's blood going. They didn't involve the whole community. They didn't externalize the depression as an invasive spirit. Instead what they did was they took people one at a time into dingy little rooms and had them talk for an hour about bad things that had happened to them." (Laughter) (Applause) He said, "We had to ask them to leave the country." (Laughter)

Now at the other end of alternative treatments, let me tell you about Frank Russakoff. Frank Russakoff had the worst depression perhaps that I've ever seen in a man. He was constantly depressed. He was, when I met him, at a point at which every month he would have electroshock treatment. Then he would feel sort of disoriented for a week. Then he would feel okay for a week. Then he would have a week of going downhill. And then he would have another electroshock treatment. And he said to me when I met him, "It's unbearable to go through my weeks this way. I can't go on this way, and I've figured out how I'm going to end it if I don't get better. But," he said to me, "I heard about a protocol at Mass General for a procedure called a cingulotomy, which is a brain surgery, and I think I'm going to give that a try." And I remember being amazed at that point to think that someone who clearly had so many bad experiences with so many different treatments still had buried in him somewhere enough optimism to reach out for one more. And he had the cingulotomy, and it was incredibly successful. He's now a friend of mine. He has a lovely wife and two beautiful children. He wrote me a letter the Christmas after the surgery, and he said, "My father sent me two presents this year, First, a motorized C.D. rack from The Sharper Image that I didn't really need, but I knew he was giving it to me to celebrate the fact that I'm living on my own and have a job I seem to love. And the other present was a photo of my grandmother, who committed suicide. As I unwrapped it, I began to cry, and my mother came over and said, 'Are you crying because of the relatives you never knew?' And I said, 'She had the same disease I have.' I'm crying now as I write to you. It's not that I'm so sad, but I get overwhelmed, I think, because I could have killed myself, but my parents kept me going, and so did the doctors, and I had the surgery. I'm alive and grateful. We live in the right time, even if it doesn't always feel like it."

I was struck by the fact that depression is broadly perceived to be a modern, Western, middle-class thing, and I went to look at how it operated in a variety of other contexts, and one of the things I was most interested in was depression among the indigent. And so I went out to try to look at what was being done for poor people with depression. And what I discovered is that poor people are mostly not being treated for depression. Depression is the result of a genetic vulnerability, which is presumably evenly distributed in the population, and triggering circumstances, which are likely to be more severe for people who are impoverished. And yet it turns out that if you have a really lovely life but feel miserable all the time, you think, "Why do I feel like this? I must have depression." And you set out to find treatment for it. But if you have a perfectly awful life, and you feel miserable all the time, the way you feel is commensurate with your life, and it doesn't occur to you to think, "Maybe this is treatable." And so we have an epidemic in this country of depression among impoverished people that's not being picked up and that's not being treated and that's not being addressed, and it's a tragedy of a grand order. And so I found an academic who was doing a research project in slums outside of D.C., where she picked up women who had come in for other health problems and diagnosed them with depression, and then provided six months of the experimental protocol. One of them, Lolly, came in, and this is what she said the day she came in. She said, and she was a woman, by the way, who had seven children. She said, "I used to have a job but I had to give it up because I couldn't go out of the house. I have nothing to say to my children. In the morning, I can't wait for them to leave, and then I climb in bed and pull the covers over my head, and three o'clock when they come home, it just comes so fast." She said, "I've been taking a lot of Tylenol, anything I can take so that I can sleep more. My husband has been telling me I'm stupid, I'm ugly. I wish I could stop the pain."

Well, she was brought into this experimental protocol, and when I interviewed her six months later, she had taken a job working in childcare for the U.S. Navy, she had left the abusive husband, and she said to me, "My kids are so much happier now." She said, "There's one room in my new place for the boys and one room for the girls, but at night, they're just all up on my bed, and we're doing homework all together and everything. One of them wants to be a preacher, one of them wants to be a firefighter, and one of the girls says she's going to be a lawyer. They don't cry like they used to, and they don't fight like they did. That's all I need now is my kids. Things keep on changing, the way I dress, the way I feel, the way I act. I can go outside not being afraid anymore, and I don't think those bad feelings are coming back, and if it weren't for Dr. Miranda and that, I would still be at home with the covers pulled over my head, if I were still alive at all. I asked the Lord to send me an angel, and he heard my prayers."

I was really moved by these experiences, and I decided that I wanted to write about them not only in a book I was working on, but also in an article, and so I got a commission from The New York Times Magazine to write about depression among the indigent.

And I turned in my story, and my editor called me and said, "We really can't publish this."

And I said, "Why not?"

And she said, "It just is too far-fetched. These people who are sort of at the very bottom rung of society and then they get a few months of treatment and they're virtually ready to run Morgan Stanley? It's just too implausible." She said, I've never even heard of anything like it."

And I said, "The fact that you've never heard of it is an indication that it is news." (Laughter) (Applause) "And you are a news magazine."

So after a certain amount of negotiation, they agreed to it. But I think a lot of what they said was connected in some strange way to this distaste that people still have for the idea of treatment, the notion that somehow if we went out and treated a lot of people in indigent communities, that would be an exploitative thing to do, because we would be changing them. There is this false moral imperative that seems to be all around us that treatment of depression, the medications and so on, are an artifice, and that it's not natural. And I think that's very misguided. It would be natural for people's teeth to fall out, but there is nobody militating against toothpaste, at least not in my circles.

And people then say, "Well, but isn't depression part of what people are supposed to experience? Didn't we evolve to have depression? Isn't it part of your personality?" To which I would say, mood is adaptive. Being able to have sadness and fear and joy and pleasure and all of the other moods that we have, that's incredibly valuable. And major depression is something that happens when that system gets broken. It's maladaptive.

People will come to me and say, "I think, though, if I just stick it out for another year, I think I can just get through this."

And I always say to them, "You may get through it, but you'll never be 37 again. Life is short, and that's a whole year you're talking about giving up. Think it through."

It's a strange poverty of the English language, and indeed of many other languages, that we use this same word, depression, to describe how a kid feels when it rains on his birthday, and to describe how somebody feels the minute before they commit suicide.

People say to me, "Well, is it continuous with normal sadness?" And I say, in a way it's continuous with normal sadness. There is a certain amount of continuity, but it's the same way there's continuity between having an iron fence outside your house that gets a little rust spot that you have to sand off and do a little repainting, and what happens if you leave the house for 100 years and it rusts through until it's only a pile of orange dust. And it's that orange dust spot, that orange dust problem, that's the one we're setting out to address.

So now people say, "You take these happy pills, and do you feel happy?" And I don't. But I don't feel sad about having to eat lunch, and I don't feel sad about my answering machine, and I don't feel sad about taking a shower. I feel more, in fact, I think, because I can feel sadness without nullity. I feel sad about professional disappointments, about damaged relationships, about global warming. Those are the things that I feel sad about now. And I said to myself, well, what is the conclusion? How did those people who have better lives even with bigger depression manage to get through? What is the mechanism of resilience? And what I came up with over time was that the people who deny their experience, the ones who say, "I was depressed a long time ago and I never want to think about it again and I'm not going to look at it and I'm just going to get on with my life," ironically, those are the people who are most enslaved by what they have. Shutting out the depression strengthens it. While you hide from it, it grows. And the people who do better are the ones who are able to tolerate the fact that they have this condition. Those who can tolerate their depression are the ones who achieve resilience.

So Frank Russakoff said to me, "If I had it again to do over, I suppose I wouldn't do it this way, but in a strange way, I'm grateful for what I've experienced. I'm glad to have been in the hospital 40 times. It taught me so much about love, and my relationship with my parents and my doctors has been so precious to me, and will be always."

And Maggie Robbins said, "I used to volunteer in an AIDS clinic, and I would just talk and talk and talk, and the people I was dealing with weren't very responsive, and I thought, 'That's not very friendly or helpful of them.' And then I realized, I realized that they weren't going to do more than make those first few minutes of small talk. It was simply going to be an occasion where I didn't have AIDS and I wasn't dying, but could tolerate the fact that they did and they were. Our needs are our greatest assets. It turns out I've learned to give all the things I need."

Valuing one's depression does not prevent a relapse, but it may make the prospect of relapse and even relapse itself easier to tolerate. The question is not so much of finding great meaning and deciding your depression has been very meaningful. It's of seeking that meaning and thinking, when it comes again, "This will be hellish, but I will learn something from it." I have learned in my own depression how big an emotion can be, how it can be more real than facts, and I have found that that experience has allowed me to experience positive emotion in a more intense and more focused way. The opposite of depression is not happiness, but vitality, and these days, my life is vital, even on the days when I'm sad. I felt that funeral in my brain, and I sat next to the colossus at the edge of the world, and I have discovered something inside of myself that I would have to call a soul that I had never formulated until that day 20 years ago when hell came to pay me a surprise visit. I think that while I hated being depressed and would hate to be depressed again, I've found a way to love my depression. I love it because it has forced me to find and cling to joy. I love it because each day I decide, sometimes gamely, and sometimes against the moment's reason, to cleave to the reasons for living. And that, I think, is a highly privileged rapture.

 


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