I used to describe chronic depression in terms of ocean waves: You’re walking down a dry street toward a favorite park on a sunny day when you hear the rumble behind you, the sound of a big wave coming up behind your back. When it crashes over you, all you can do is ride it out, avoid undertow, and look for a buoy.
An average big ocean wave is 410 tons of water.
When depression crashes over you, the dry street, warm sun, and favorite park haven’t disappeared. You can still see them, but you can’t get there.
If you do not have chronic depression, Friend, you might confuse it with sadness or grief. Malaise. Disappointment. Those often accompany depression, but they aren’t the substance of it. People with depression aren’t just sad all the time. Nor do we necessarily take to our beds and weep.
When I was in my twenties and early thirties, I experienced depression as high energy with just a soupçon of anxiety. To keep the darkness at bay I worked 60 hours or more a week, went to the gym or did ballet 3-4 hours a day, had the world’s tidiest apartment, and ironed my sheets. 4 hours of sleep was a good night. When Sunday rolled around, and the work was done, I felt like peeling the paint off my walls with my teeth: the internal shriek of pent-up energy with no place to go.
I was undiagnosed in my twenties and early thirties. And, I was extremely productive. We are rewarded for our productivity, so it never occurred to me anything was physically wrong with me.
To be very clear: chronic depression is a physical illness. Brains are physical things. What happens in your brain and mine is physical. What happens in our minds—our feelings, thoughts, desires, hopes—that’s something else.
Chronic depression is a physical condition that disproportionately affects mood, feeling, and mental imagery. In my case, medication and general good habits tend to keep my brain functioning as it should. There are very few waves, and I am an excellent swimmer.
Another way I have described depressive episodes is as “breakthrough bleeding,” like when a cut finger is bandaged but not enough to stanch the flow. That was not quite right. In a serious depressive episode, it’s more like internal bleeding.
Here’s the analogy:
Imagine that you have both very high blood pressure and thin blood vessel walls. You stay healthy by taking your medication, eating properly, avoiding stress, getting the right exercise.
One day, somewhere inside your body, a blood vessel bursts. The stuff that keeps life’s breath flowing has escaped its banks. But the burst blood vessel is deep enough, and hidden enough, that you don’t realize anything is wrong until you’re half dead.
You may talk with your doctor and other wise people to try and locate the problem, but unlike a cut through the skin, no amount of pressure and stitching can force the walls of the vessel to knit back together.
In most people, most of the time, a clot forms, the vein repairs itself, the spilt blood is reabsorbed by the body, and you go on as you were. You take the medication, eat properly, avoid stress, build support systems, get exercise.
All is well, until the next time you suddenly start bleeding again.
That’s the part that is most terrifying to a depressive, and most confusing to an outsider.
Here’s what happened, Friend. You know how sometimes (or often) you dislike yourself, or pick on your looks, or don’t feel your partner’s love, or remember your mother’s yelling at you for dropping the milk when you were five? Everyone does it: negative thoughts are part of thinking. You and I work to overcome them, carefully cultivating positivity by replacing the destructive thoughts with constructive ones, and talking back to the ancient voices of shame and guilt.
When your brain is operating as it should, you can choose to think of different things. If you have a terrible day at work, healthy brains allow your mind to focus on a funny cat video. You may choose to focus on the terrible day, but with effort you are able to pick and choose what to focus your mind upon. You may not even realize you’re doing it—it’s so automatic-this choosing your thoughts.
In the midst of a depressive episode, when the depression-vessel has burst and my brain is not operating as it should, all those awful thoughts are unleashed, roaring and flooding my mind. The carefully cultivated positive thoughts are slippery, overwhelmed by the negative ones. I try to grab onto the good thoughts as they pass by, but the negative ones are more vibrant, more active, and far more powerful. It’s as though the deep fears and rejections gather together into one gigantic mass of screaming, drowning out the softer whispers of love and security. Until the depression wanes — until the metaphorical burst vessel begins to clot — it’s just going to be like that.
That’s the scary part. It’s just going to be like that.
For most of us, most of the time, this isn’t hopeless, even at its worst. Horrible, but not hopeless. We can remind ourselves we’ve survived this before, that it will pass. As it wanes, we can accept tiny bits of care, or humor, or joy. The vessel heals, the wave subsides. Most of us, most of the time, know this will happen. There’s hope in that.
Even when it seems hopeless to you, Friend, and you are painfully aware of how little you can do to help.
Beloved friends and family of those afflicted with chronic depression, please hear this:
When you friends and family make the effort to cheer up your loved one in the midst of a depressive episode, it can be a very good thing: your love and kindness puts more good thoughts into the flow.
When you stay nearby, and listen, and remain present, you can be a buoy to hang onto.
But when you admonish a depressive to “just think positively! Think of all the good things! Be grateful!” it is exactly like telling someone with an aneurysm and internal bleeding, “Just stop bleeding, stupid!”
We would stop the blood from pouring out of our mental veins if we could, dumbass.
Positive thinking, meditation, prayer, therapy, yoga, support systems, and so forth do help before and after the episode. When you and I train ourselves to think more healthfully, recognize reality more clearly, know God more thoroughly, and accept love more deeply, we are training ourselves to have more readily accessible good thoughts. When we work with competent therapists to deal with those childhood wounds, they are less likely to open up uncontrollably. Then, when the next depression-vessel breaks, the negative thoughts aren’t quite so powerful, not quite so prevalent. There are more good thoughts in the flow, quieting the screaming bad and helping the burst depression-vessel heal.
Today I am walking down a dry street. The sun is peeking through clouds. My favorite park is just ahead.
I may actually make it there.
And yes: I am grateful.